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HomeMy WebLinkAboutLAKE RIDGE TERRACE BLK 11 LT 7I �,k�2�dge lerra.ce *� 0 s 13 Z3 3p Inspection Keport_1-1-12.tloc Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: 171168 PID Number: 051-323-30 ❑ New ❑✓ Upgrade Name: THOMAS NORVIG ABSORPTION FIELD ❑ Deep Trench ❑✓ Shallow Trench El Bed El Mound Address 14428 DON CIRCLE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 6 1.2 GPD/SF 3.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.5 Ft. Gravel depth beneath pipe 1.0 Ft. Subdivision Block Lot LAKE RIDGE TERRACE 11 7 Fill added above original grade —1.0 Ft. Gravel length 100/50 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 500/250 z Ft 3 10 Ft. well 129.7 134.5 N/A N/A 25+ TANK EI Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1 1000Gal. Surface Water 100+ 100+ N/A N/A Material Number of compartments Lot Line 87.8 63.8 N/A N/A STEEL 2 NA Foundation 5.5 6.0 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ 50+ N/A N/A Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034Tank to 3034 drainfield JR'S SEPTIC Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 95ft Inspection M dates: 07/13/17 2 07/17/17 Location and description 3`' 07/18/17 th 4� SW ADU TRIM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp \"!N OF AL 111 Conditional Approval: Date �G • T4s Alt'. • iteven .�. flannorae­ 8149 Approved M,0,r�_ azltey Date Inspection Keport_1-1-12.tloc inspection Keport_1-1-12.00c Municipality of Anchorage Community Development Department Page 2 of 3 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: 161191 PID Number: 051-323-30 ❑ New ❑✓ Upgrade Name: THOMAS NORVIG ABSORPTION FIELD ❑ Deep Trench El Shallow Trench El Bed E] Mound Address 14428 DON CIRCLE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 6 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot LAKE RIDGE TERRACE 11 7 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft' Ft. well 110.8 N/A N/A N/A 25+ TANK ❑p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 2000Gal. Surface Water 100+ N/A N/A N/A Material Number of compartments Lot Line 72.2 N/A N/A N/A STEEL 2 NA Foundation 12.5 N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ N/A N/A N/A Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034Tank to 3034 drainfield JR'S SEPTIC Drainfield CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 102ft Inspection 1't07/27/16 nd Location and description 2 3rd 4'h SW TRIM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp \ " OF AL X11 Conditional Approval: Date r fiG. • T4s �! . • Steven f�. f�annoRe� CE 8149 Approved �Qnn Date ( F 1 g V_ AW .W ��t; �o�.� inspection Keport_1-1-12.00c DESIGN PARAMETERS Sor PRIMARY SEPTIC SYSTEM (MAIN/ADU) I NO. BEDROOM: 4(600 gpd)/2(300 gpd) TANK SIZE: 2000G(E) / 10006 PERC RATE: 2.6 MPI / 2.61 MPI SOIL RATING: 1.2 GPD/SF / 1.2 GPD/SF AREA RQD: 500 SF / 250 SF SYS. TYPE: WIDE TRENCH 1.0'ED / 1.0'ED REDUCTION FACTOR: 0.87 / 0.87 'EA (E) \ I TRUE NORTH SCALE : 1"= 60' ADJ AREA REQD: 435SF / 217.5SF MIN LENGTH: 87 LF / 44.0 USED: RESERVE DRAIN FIELD(NIC) MAIN HOUSE: 50LF x 5.0'W x 3.5'ED x 6.0'TD (2EA) 50LFx5.0'Wx1.0'E.D., 35T.D. TOTAL AREA: 500SF 2000g TANK (E) ADU: 50LFx5.0'Wx1.0'E.D.,3.5'T.D. \ DRAIN FIELD (E) TOTAL AREA: 250SF \ ABANDON PER CODE - T � TII FLOW SPLITTER (N) t , LOT/ Z HOUSE \ I UPGRADED PRIMARY RESIDENCE // (E) \ I I DRAIN FIELD (N) (2EA) 50LF x 5'W x 1.0'ED x 3.5'TD I O I INSTALLED MT AND CO AT EACH END / 2BR C ADU DRIVEWAY TQC 129.7 CF \\ A134.5 15014 /I TH-1 \\ \ ADU DRAIN FIELD (N) I \ m \I0. 50LF x 5'W x 1.0'ED x 3.5'TD 1 63.8 I 1 WELL (E) n m I INSTALLED MT AND CO AT EACH END T R A Cpi E � • I I 1000TANK N T1 �z 0 7.7 I o 0 I I / / INSTALLED FCO AND DCO 10 c \ C 1 z 14.4 _ C3 38.3 29.6 /co TRENCH 3 85.0 i -:g EL. 95.5 NEW 2,000 g EL. 95.3 I I o u - - l CD ,U NO WELLS ON LOT \ TANK (N) I I \ I PROFILE TANK 1 / \ WITHIN 200' 50.0 T2: 87.5 T3: 82.5 cM/ 6/28/17 GW _ _8.5 SCALE 1"=10' T1: 89.5 T2: 86.5 T3: 81.5 1 1 _12.5 I 1 I •. *� �H ...... .1.. �.. .. Date 12/13/2017 RECORD DRAWING I 11 1 f I � Jl P.I.D. NO LAKE RIDGE TERRACE 1311 L7 1-323-30 I \ \ / I I / / / 'VVI an o o � A B C T1 oZ o o ABOVE PIPE INV p o zQ z z mz a4" m RAIN PIP 0 a =o ,g, "R I „gJ 0¢ J o F.G.EL. 7.7 29.5 T1 (E) T R FABRI v 48.3 42.4 C 1 31.6 14.4 _ C3 38.3 29.6 I \ \ / I I / / / 'VVI an o o � w Z m o� D I r- > > D I RAIN RO oL m m K Z Z z o mQ Q ¢ Lu wmz O J J w oZ o o ABOVE PIPE INV p o zQ z z mz a4" m RAIN PIP 0 a =o ,g, "R I „gJ 0¢ J o F.G.EL. TRENCH 1 94.0 o c� U U oo e oo FI T R FABRI v TRENCH 2 91.0 EL. 100.5 TRENCH 3 86.0 _ JJL3.0 O.G.EL. TRENCH 1 93.0 TRENCH 2 90.0 u OB TRENCH 3 85.0 i -:g EL. 95.5 NEW 2,000 g EL. 95.3 91'4 1000 g SEPTIC 91.2 SEPTIC TANK TANK (N) I 1.0i T7: 90.5 PROFILE TANK 1 PROFILE TANK 2 50.0 T2: 87.5 T3: 82.5 cM/ 6/28/17 GW _ _8.5 SCALE 1"=10' T1: 89.5 T2: 86.5 T3: 81.5 1 1 _12.5 NOTES: PANNONE ENG SVC LLC P.O. BOX 102954 ANCHORAGE, AK 99510�G PHONE (907) 272-8218 FAX (907) 272-8211�'�•• •. *� �H ...... .1.. �.. .. Date 12/13/2017 RECORD DRAWING Scale 1 " = 60' P.I.D. NO LAKE RIDGE TERRACE 1311 L7 1-323-30 THOMAS NORVIG •� };;VW A:'�bnrio�e' PERMIT NO. DRAWN JRL 14428 DON CIRCLE CE 8149 REV:01/03/1 OSP171168 OSP161191 Sheet SITE PLAN EAGLE RIVER, AK 99577 '• """"- 3 OF 3 ® 6 ' i t3 �ty of Anchorage P.O. Box 196650 d 4700 Elmore Road Anchorage, Alaska 99519-6650 e (907) 343-7904 e Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program IWAIVER REVIEW 'x�C° Waiver#: OSC171154 COSA#: Permit#:OSP171168 PID#: 051-323-30 Legal Description: Lake Ridge Terrace 1311 L7 00 Engineer: Pannone Engineering Services Applicant: Thomas Norviq Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the foundation has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owners) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. . 0. 9 0 0 0. 0 ..... 0. 0 0 0 0 0 0.■■ 0.■0 0 0 0 .. 0 0 0 .. 0 0 0. 0■. 0. 0 U 0■. 0 a 0 0 0. 0 .. ■.■ 0 0. 9 0 0■. 0 0 0 1 Waiver is Granted: X Waiver is not Granted: Date: /2 -7 Approved by: Name of Reviewe Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com 13 December 2017 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. 0. Box 196650 Anchorage, Alaska 99519 Subject: LAKE RIDGE TERRACE B11 L7 ABSORPTION FIELD TO FOUNDATION SEPARATION DISTANCE Waiver Request Ladies and Gentlemen: We request a waiver to five feet (5') to the foundation for the single-family dwelling from the drain field. The fields were installed prior to the construction of the 2 BR ADU on the site. It appears the foundation had been installed closer to the fields than planned. Due to the nature of the soils surrounding the absorption field the drainage prism is such that the effluent will not migrate towards the footings and foundations but will drain at a steeper infiltration grade and dissipate well prior to the structures. Granting this waiver is not likely to cause damage to the structures now or in the future. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 O CQ p �� \\-\ / I N J% 2i M c-- ui w I F Z I U N 1-O I �� Wuj rj W tD d q O 1. W �l <o I 5` I O O W a. 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Y- a Q w w z 2 t� O O Q = tJ=wUQ w m pNa E- pi-�o< a� t-rz LL wZL>u w~awZO �> v w Q > > }�app �Z mQ N�iw w w w w o8UmccO oQm Q- Sg 00>ZO °"''i wwwM r �0, S c J N �ZO E Q 0 vQ _ w y O Z V LL ut Q�Oz'0" �a moo r-I w z z ro o r cO V m �'` 2 'n Q w � Q r�om= 0OF= Op0 V) Q� zjw o ED 2" p J �> t- O rn �J o W 2: H 2w�w c U H w 0 aoa =-4� MI Ii U La I— 0 0 L6 N_ W 0 0 F- 0 0 0 0 o �7z 0 N W 0 O 0 0 0 0 8296 KL I Lot 9 N89049'00"W 211.97 30 well ---------------------"�' o `�_3 LOT 8 I Gravel Driveway 2_00H \ ss.s Nts► N89049'00"W 251.84 SCALE: 1"= 40' 03 2 story Frame House o deck I~1O.V co of A m shed r f? Proposed Easement 66.8A LOT 7 N89049'00"W 318.81 Unsubdivided EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. Fb06-1, pg 5455 S 2wacrd f J, h n 5 .�mew T o,1�. 3-6 —06 BE o_ —80.T O O �M� O pn. � 30 shed \ N Gravel Driveway 4.0 ---7 // 11 loe mIg co o� / N 20.0 'L� i ' �R�6Q lea. 600 0 weu 0 w Cn i''UBWT-_- _QJN 0 1- 2017 .a 121-Icno � MELISSA DAVIDSON AS -BUILT & Proposed Easement NO CORNERS SET THIS DATE MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://w .muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP171168 Work Type: Septic Upgrade Tax Code Number: 05132330000 Site Legal Address: LAKE RIDGE TERRACE BLK 11 LT 7 G:0553 Site Mailing Address: 14428 DON CIR, Eagle River Owner: NORVIG THOMAS D Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date Ment d epartment Lot Size in Sq Ft: Total Bedrooms: 6/30/2018 56638 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. Any portion of the existing drainfield (that is to be abandoned) located under the foundation of the ADU shall be excavated out, backfilled and compacted. 2. The inspection report/record drawings to close out this permit shall include the 2,000 gallon tank installed under permit OSP161191. Received Issued By B Date: I�C 1° Date: -2017 MUNICIPALITY OF ANCHORAGE Community Development Department Pho Fie_7 A Development Services Division u 2 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-323-30 Property owner(s) Thomas Norvig Mailing address 14428 Don Circle, Eagle River, AK 99577 Site address 14428 Don Circle Day phone JUN `L 9 2017 �3 C Legal description (Sub'd., Block & Lot) Lake Ridge Terrace, Block 11, Lot 7 Legal description (Township, Range & Section) Lot Size 56,638 Sq. Ft. Number of Bedrooms 4+2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑x Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑x Duplex ❑ (D) Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. property owner or authorized agent) Permit/Rush Fees: 5(061 Date of Payment: (o 1;3D 1 i Receipt Number: O (ohOiT Permit No. 05P 17NOF Permit App_ c Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve(ftanen¢ak.com July 6, 2017 Subject: Lake Ridge Terrace, Block 11, Lot 7 Septic System Permit Request Design Narrative This is a design narrative for a permit to install a septic system to be issued for the primary residence and ADU on this property. The proposed system will serve a 2 bedroom ADU and a 4 bedroom primary residence. Currently the lot is developed, and the existing septic system is connected to the primary residence. The reserve system will be based on CAT III. The proposed system will utilize a new 1000g septic tank and conventional drain field on the ADU and an existing 2000g septic tank with a conventional field for the primary residence. This lot and the surrounding developed lots are served by private wells. There are no surrounding wells within 100' of the proposed septic system. 1. Soils. One test hole was performed in the vicinity of this system by PES in June 2017, and groundwater was monitored for at least seven days. Ground water was observed at a depth of 8.5' below the surface in the test hole monitor tube in June of 2017. Bedrock was not encountered in the test hole to 12.5'. Based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square foot was used for a conventional wastewater system, in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches, including Fire Creek on the next lot to the west. 4. Topography: The existing topography on the lot generally slopes from east to west, with a slope of approximately 20% in the area of the drain field. There are no steep slopes within 50' of the proposec drain field. The proposed drain field will maintain 50' separation all steep slopes. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding lots. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 i r + + I SEPTIC AREA (E) � I �II W W RESERVE DRAIN FIELD GA 50LF x 5.0'W x 3.5ED x 6.0'TD / r 2000g TANK (E)- _ \\ DRAIN FIELD (E) / ABANDON PER CODE - \ FLOW SPLITTER (P) LOT 7 s HOUSE UPGRADE PRIMARY RESIDENCE ss (E) DRAIN FIELD (P) 10.0 (2EA) 50LF x 5'W x 1.0'ED x 3.5'TD INSTALL MT AND CO AT EACH END 137.2��� 10.0 TH-1 1 ADU DRAIN FIELD (P) z o' I 50LF x 5'W x 1.0'ED x 3.5'TD INSTALL MT AND CO AT EACH END z Ni 10009 TANK (P) 0 o I INSTALL FCO AND DCO r o J 7 O 0 ADU \DRIVEWAY 4' (p) F ( 110.8 !F WELL (E) I \ 0 o u @ NO WELLS ON LOT J cP WITHIN 200' I - IP -1 ABBREVIATIONS TH TEST HOLE DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 2,000g (E) PERC RATE: 2.6 MPI SOIL RATING: 1.2 GPD/SF AREA ROD: 500 SF SYS. TYPE: WIDE TRENCH- 1.0'ED RF: 0.87 MIN LENGTH: 87 LF USE: (2EA) 50LFx5'Wxl.O' E.D., 3.5' TO TOTAL AREA: 575 SF NOTES: FOR CONSTRUCTION DRAWN BY: DRM PLAN DESIGN PARAMETERS (P) PROPOSED ADU SEPTIC SYSTEM (E) EXISTING NO. BEDROOM: 2 (300 gpd) CO CLEAN OUT NO. TANK SIZE: 1,000g MT MONITOR TUBE NO. PERC RATE: 2.6 MPI TYP TYPICAL SOIL RATING: 1.2 GPD/SF AREA ROD: 250 SF SYS. TYPE: WIDE TRENCH- 1.0'ED RF: 0.87 MIN LENGTH: 43.5 LF USE: 50 LFx5'Wx1.O' E.D., 3.5' TD TOTAL AREA: 287 SF PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 LAKE RIDGE TERRACE, BLOCK 11, LOT 7 THOMAS NORVIG 14428 DON CIRCLE EAGLE RIVER, AK 99577 LEGEND W WATER LINE/ WELL RADIUS — SS — NEW SEPTIC 17/6/2017 *� 49 1.=50' • • • •(^� • "' G P.I.D. NO PERMIT NO. CE 8IOSP171168 1 OF 3 TEST HOLE 1 1 FILL GRAVELLY FILL 2 OR ORGANICS 3 4 5 s GM/ SILTY GRAVEL 7 GW TO GRAVEL 8 y �&n 10 11 'K7 6/1&17 12 13 BOH 14 15 16 17 18 19 20 DATE PERFORMED 6116M7 SOILS LOG - PERCOLATION TEST SLOPE x TH WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -11.0' DEPTH TO WATER AFTER MONITORING? -8.5' DATE: 6/18/17 48R LOT 7 HO(EU)SE � ADU� DRIVEWAY (P) WELL (E) TH-1 SLOPE TH X READING GATE CLOCK NET TIME WATERTIME LEVEL READING NET DROP 1 6/16/17 1:00 — 4.95 -- 2 1:10 10 MIN 10.32 5.37 3 1:10 — 4.95 -- 4 1:20 10 MIN 9.49 4.54 5 1:20 — 4.95 — 6 1:30 10 MIN 9.08 4.13 7 1:30 — 4.95 — 8 1:40 10 MIN 8.88 3.93 9 1:40 - 4.95 10 1:50 10 MIN 8.79 3.84 11 1:50 ... 4.95 -- 12 2:00 10 MIN 8.75 3.80 PEROLATION RATE 2.6 (min/inch) PERC HOLE DIAMETER 6 inches COMMENTS: Test hole excavated by JR's SEPTIC TEST RUN BETWEEN 4 FT AND 5 FT PERFORMED BY: Dan Moran. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES:FOR PP•pNgp Ol ON2854 E ANCHORAGE, SVC, 99I9W PHONE (907) 272-8218 FAX (907) 272-8211 r '(� OF A�gS1�� i�g�P �y�� % *:.49 •*,� Steven . Gnnoae �,•, CE 8149 j �., t�\ ib---�--- ate D /6/2017 CONSTRUCTION Scaie P.I.D.NTS PERMIT N0. OSPt7t768 DRAWN BY: LAKE RIDGE TERRACE, BLOCK 11, LOT 7051-323-30 THOMAS NORVIG 14428 DON CIRCLE EAGLE RIVER, AK 99577 DRM SOILS LOG Sheet eOF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55. 2. SCOPE OF WORK: INSTALL NEW TANK AND DRAIN FIELD. 3. GROUNDWATER WAS ENCOUNTERED AT A DEPTH OF 8.5 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 8.5 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. 5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. 6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. 7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER. 8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN. 9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING. 11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE CONTRACTOR. 12. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. CONTRACTOR: BY: TITLE: NOTES PANNONE ENG SVC, LLC FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 DRAWN BY: DRM LAKE RIDGE TERRACE, BLOCK 11, LOT 7 THOMAS NORVIG 14428 DON CIRCLE DESIGN DETAILS EAGLE RIVER, AK 99577 DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 6 (900 gpd) TANK SIZE: 3,000g ADVANTEX W/ (2EA) AX20 PODS PERC RATE: 37 MPI SOIL RATING: 2 GPD/SF AREA ROD: 450 SF SYS. TYPE: WIDE TRENCH— 3.5'ED RF: 0.54 MIN LENGTH: 48.6 LF USE: 50LFx5'Wx3.5' E.D., 6.0' TD TOTAL AREA: 463 SF Dote cgs,�too s ale zo17 NTS �..... .. .. ... P.I.D. NO • • Steven •f��'ai CE 8149 PERMIT NO. OSP171168 3 OF On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161191 Tax Code Number: 05132330000 Work Type: SepticTank Upgrade Permit Effective Dates: July 19, 2016 to July 19, 2017 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: LAKE RIDGE TERRACE Site Legal Address: LAKE RIDGE TERRACE BILK 11 LT 7 G:0553 Owner/Address: NORVIG THOMAS D 14428 DON CIRCLE EAGLE RIVER AK 995779205 Site Mailing Address: 14428 DON CIR, Eagle River Lot Size in Sq Ft: 56638 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By: By:Date: Date: �� MUNICIPALITY OF ANCHORAGE Community Development Department Phone: Development Services Division Fax: On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I .D. 051-323-30 Property owner(s) Thomas Norvig Day phone Mailing address 14428 Don Circle, Eagle River, AK 99577 Site address 14428 Don Circle, Eagle River, AK 99577 Legal description (Sub'd., Block & Lot) LAKE RIDGE TERRACE B11 L7 Legal description (Township, Range & Section) Lot Size 56,638 Sq. Ft. Number of Bedrooms 3 U JUL 0 6 2016 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank RUpgrade ❑X Duplex ❑ (D) Holding Tank ❑ Renewal F] Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Permit/Rush Fees: t 21,. 00 Waiver Fees: Date of Payment: 7-1 ` /6 Date of Payment: Receipt Number: do22`J 6i Receipt Number: Permit No. 0•s�A01"t T/ Waiver No. Permit App_-'-:- :L -c: Pannone Engineering Services «c Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com July 6, 2016 Subject: LAKE RIDGE TERRACE B11 L7 Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 2000g Septic Tank to be issued for this property. The existing 10008 tank is collapsing placing the outlet out of service. It will be decommissioned per code and replaced. Currently the lot is developed. The proposed system will utilize a replacement 20008 septic tank that will be connected to the existing drain field. This lot and the surrounding lots are served by private wells. There are no wells within 100 feet of this system. 1. Upgrade Tank Design. a. See Sheet 1 of the design package. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank. The proposed septic tank upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The existing topography slopes from the northeast to the southwest at an approximately 10%-15% slope. There are no steep slopes within 50' of the system and the replacement of the tank will not change the slopes in the area surrounding the system. The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells within 100 feet of the proposed septic location. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 -- \ WELW LL E \ L E \ \N \\ \ I UE NORTH SCALE :/'-- 5y N _ TILING POND W/ \ / :FACE WATER \ / PROX LOCATION) 78.3 INO COMMUNITY WELLS \ W/I 200' OF SYSTEM 86.8 3BR SFD M 7 M 41 0 w U iITA (P) 1 DCO �S 133.9 \ TANK (P) W/ DCO gyp% BEFORE AND AFTER PROFILE WELL E. _— v / w w NOTES: PAMONE ENG SVC,. LLC PHONE (907)127258218NOFAXA(907) 2728211 - * .* ..... ... .. .. ••�;8 A' annpme 814.9 j Date FOR coNsrRucnoN Scale 1" = 50' LAKE RIDGE TERRACE B11 L7051-323-30 THOMAS NORVIG 14428 DON CIR EAGLE RIVER, AK 99577 P.I.D. NO DRAWN JRL PERMIT N0, osPxxxxxx SITE PLAN Sheet 1 OF 2 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55. 2. SCOPE OF WORK: INSTALL NEW 2000g SEPTIC TANK. 3. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. - 4. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. 5. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. . 6. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER. 7. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN. 8. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. - - - - - 9. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING. 10. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE CONTRACTOR. 11. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY -AND ALL CHANGE ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. CONTRACTOR: BY: TITLE: DATE:— _w ATE:—w w WATER LINE/ WELL RADIUS USE: _SS -m - NEW SEPTIC 20009 SEPTIC TANK NOTES: PANNONE ENG SVC, LLC ICTION. P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 LAKE RIDGE TERRACE B11 L7 DRAWN JRL THOMAS NORVIG 14428 DON CIR SITE PLAN EAGLE RIVER, AK 99577 ABBREVIATIONS TH TEST HOLE (P) PROPOSED (E) EXISTING CO CLEAN OUT NO. MT MONITOR TUBE NO. TYP TYPICAL CE 8149 07/13/2016 Scale NTS P.I.D. NO X051-323-30. PERMIT NO. OSPXXXXXX Sheet 2 OF MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE Eyy ❑UPGRADE MAILINGAD SS LEGAL DESCRIPTION / l 'Y J' LOCATION NO. OF BEDROOMS U Y DISTANCE T0: Well -� Absorption area/ Dwelling /� PERMIT NO. w ZQ � Manufacturer Maieri No. of compartmen oCJ N Liq. ca 6t iballons (� IF HOMEMADE: Inside le idt Liqui h J0Z DISTANCE TO: ell Dwellin PERMIT NO. O Z < Manufactur Ma Liquid c it in gal O w = DISTANCE TO: Well t (o C)S Foundation i Nearest lot line -a 'S©a PERMIT N0. - J LL z F Z w No. of I' es �� Length of each li Total length of li Trench width Qinches Distance between lineg a� /U ¢ F p Top of tile to finish grade Material beneath tile , inches Total effective sprpi-on area W Length Width Depth PERMIT NO. Q F wa ype of c b C ' diameter Cri pth Total option area WWell DISTANC O: Building foundati earest lot line J J Depth 7 Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building fou t' n Sewer line Septic tank SOU avU Absorption area(s) f OTHER �L PIPE MATERIALS nn L •�, ••'••• 1 SOIL TEST RATING INSTALLER REMARKS � O I � 3 m� If ` APPROVED "A t DATE LEGAL /7;;;' / '7 �Z!1 J b der- {I -11 -IS u'lEf-tARTMENT OF HEALTH FIND ENVIRONMENTAL PROTECT'-- R25 -'L' STREET, ANCHORAGE, fill. 99501 264-4720 C-3 1r4 --- o -E". .1 -F E= EF_ Ll FE F-;;* F=:' E= F-.* P-1 . -F PERMIT NO. 781028 AI APPLICANT ROGER LEE HAMMOND 1.33_34 EAGLE RIVER\ LOCATION DON CIRCLE LEGAL L 7 8 11 LAKE RIDGE TERRACE E. LOT SIZE TYPE OF SOIL FIBSORBTION SYSTEM IS: TRENCH NA"'-4INUN NUMBER OF BEDROOMS = --,: SOIL RATING (SO FT/BR)= 275 'I"HE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET.*, OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE' BOTTOM OF' THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE FIND THE BOTTOM OF THE EXCAVATION (IN FEET). !:E7F=F:­1-1C_" :I_1FZ01F_1a=u PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ­. — __ "r L-1 t_-# < ;2 > I I I -- -.- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL FIND ANY ON-SITE SEWAGE DISPOSAL SYSTEM Is 100 FEET FOR A PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC NE-L.L. OTHER RECDUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION E."IFIGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. 1F ­"E -_'Fr: §-e1 :E -T- Y= F7° T, Fc C_- F= F_- 1-1 E-3 V-71 --_a -.1 0-=A 7%7H. I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF' ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN _7 BEDROOMS. S I APPLIL' SS E.,.e .SUE ..... ______DATw V3. 2 0 Et E GEC `'ECHNI CAL & DEVEWRMENT CO. K Box 90, Davis St., Eagle River, Alaska 99577 ,. 694-2774 or 688-2280 Russell Oyster 'Earl Ellis 694-2774 SOIL LOG 688-2280 Soils 9 Foundations Land Development Performed for: Name: L 4�51 ,/9Aq/ly o/yP Tel. No. 6 94- 3-6G Mailing Address: 15ox / 3 ����.� 2l✓Eic. /�i<. 9�iJ" �7 Legal Description: Ldr 71 Depth (feet) N 1 NjL Soil Characteristics 2 P—J'�% S11-;ry G%LA✓ECLY S/"C' 3 Z!5 A-7 C;,eV l✓-�4 Y =/C.7-jl 6 5i7 sgi✓v � vv/fns, ,,u/�vG�7i.✓ � % 9 G&.f cot3�3cEs zz cde�c�s /v 10" / , 725 /9 "Q, Loos 11 aVT ALAN 1-� 12 2 . / �X 13 14 15 16 I Ground Water Encountered: Vest/ No If yess what depth /o Proposed Installation: Seepage Pit Drain Field Comments: Performed by:Date: \ I' December 29, 1978 #780276 Roger Lee Hammond Dox 1334 Eagle River, Alaska 99577 Subject: Lot 7 Block 11 Lake Ridge Terrace Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further (paestions, please contact this office at 264®4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Specialist LI,TB/l j w encs copy of permit ~'^ � �� ...... .... ��� " DEPHRTMENT L HEHLTH HND ENVlRONMENTRL '.OTECTION � ~ 825 STREET/ HNCHORHGE/ HK99501 "^ 264~4720 PERMIT NO ( 780276 ) �PPLICHNTO R EE BOX 1]]4 EHGLE RVR 688 26]8 LOCHTION L7 B11 LK RIDGE TERRHCE S/D LEGHL L7 B11 LK RIDGE TERRHCE S/D LQT SIZE 52000 SQUHRE FEET F:> I������ �������� ���������� ���. I CERTIFY THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON�SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE NITH THE CODES ..~.~................. R��ER LEE HHMMOND /tA n/ . i\ '!i`1 r r �a{i� -✓Yl 0 I ai{f D a � /ri. f 5. LEGAL DESCRIPTION _�- DATE RECEIVED ' INSPECTION APPOINTMENTS TIME' NUMBER OF,BEDROOMS TIME TIME SINGLE FAMILY ❑ o ❑ Five uu � i n>✓P Three ❑ Six DATE /� ( I2 DATE z In -6c)- C " DATE INSPECTOFl since June 1975. For wells drilled prior to that date, give well INSPEC R INSPECTOR J/, . INDIVIDUAL/ON-SITE** Ll 17 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & E{�V 8RNONMENTAL PROTECTION NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. DEPARTMENT OF HEALTH &ENVIRONMENTAL PROTEC I 825 L Street - Anchorage, Alaska 99501 • OCT 221979 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DI RECTIONS: Complete al I parts on page 1. Incomplete requests will not be processed. Please allow ten It 0) days for processing. 1. PROPERTYOWNER PHONE Oe MAILING ADDRESS 5K 36 �F A _ -�.- L�44Lh�- flV1 o /C/A �7 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION k9 PHONE 26 6-'L- ez MAILING ADDRESS ,r ) 4,-,11 A/6�'�� L 4. REALTOR/AGENT PHONE MAI LING ADDRESS 5. LEGAL DESCRIPTION _�- .4.7 1524"g STREET LOCA/T�ION 6. TYPE OF RESID NCE NUMBER OF,BEDROOMS ED One El Four E] Other SINGLE FAMILY ❑ o ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUP INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGEDISP LSYSTEM INDIVIDUAL/ON-SITE** Ll 17 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/78) r� � THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic�ank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING s TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS t --'APPROVED FOR � _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE b ._� f -- BY C