HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 4 LT 6
-' ~., ' Municipality of Anchorage
DEPA~TIVIENT OF HEALTH & ENVIRONMENTAL PROTECTION POUCH 6-650 ANCHORAGE, ALASKA 99501
INSPECTION REPORT ON ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL
NAME--'~-----~ {J"~ ~"~.~('~¥ LOCATION ~'-~'~' ~ ~7 0~ /
ADDRESS ~ ~i~-~ LEGAL DESCRIPTION L~ ~ ~&'~ PERMIT NUMBER
PHONE{S) ~'~t ~ ~OF BEDROOMS
SEPTIC TANK
MANUFACTURER "~ ~¢
MATERIAL
INSIDE DIMENSIONI
LENGTH -- ]WIDTH
CAPAC TY IN GALS.
#OF CO'MP~'ARTMENTS
DEPTH
SEEPAGE SYSTEM
[] TiLE DRAINFIELD
NUMBER OF LINES LENGTH ~ACH
DISTANCE BETWEEN LINES
t ;)-Lc
TOTAL LENGTH
TRENCH. WIDTH
DEPTHS: i I t~
TILE TO BRABE FILL BELOW TILE FILL ABOVE TILE
~j~SEEPAGETRENCH OR E]PIT
WIDTH LENGTH DEPTH
[] LOG CRIB
[] RINGS- DIA,
FILL MATERIAL DEPTH
TOTAL EFFECTIVE ABSORPTION AREA; ~"~ '~ SQ. FT.
~"~ ["Z~ ~ ' WELL
CLASSIFICATION . DEPTH I PIPE MATERIAL
INSTALLER
DATE ~'~//~?'~f"~"~ APPROV~:D BY ~
72-012 (9/77)"
DISTANCES
SEPTIC SEEPAGE SEWER
TANK SYSTEM LINE CESSPOOL WELL
WELL
LOT
LINE
-~ ,OoUNN D A'
SYSTEM DIAGRAM
',,/
z::' L.¢-3 ,
TF'ii"~: L. Ei'4G"H"I i:;' ~' P1Eiq:E; t ON I :F!; "['FIE LE:NGTH ':; i N i::'EET ::' OF' "FHE 'I"F..'ENCH OF.:: I:~:'i:;;:t:::l i ~",tF I EL.D.
THE:: i::'EF'TH OF' Fi TF.:Ei",ICH Oi;~: F'IT I:E; THE t::'L'Ef'RNCE: BETNEEN THE '."2;URF'F'ICE CIF'" 'T'f"i[E;
EiF;:OLii'40 Fl tq i) "i" H [E E:OTTOH OF' TI"'I[.:.' EE;:"-;CFIVRTZEIN ':: IN
THEi:;?.iE I fi; i"40 '-:"i;E"f' i.,.I I [::"TI"I F'OR
THEE G F;: ,q "t E1.. t:-"EF'TH ;IL;.:, THE l"l;t:i",i;[t"iUt'"t DEPTH
FiND THE E~EI"f"f'OH (;If:' THE iEXCFI",,'R'I".'[ON ':.'IN F'"EE'2'F.':'.
D1Ft"/ E~E i i"4:Jk;'i'RL.i,,,E:[;:' I::1"1' THE F'E~:J:f'iITTE:;E'"Ei; CIi'::"i"'J:OF4 :E;UEL)'EC:T 'TEl TI"IIE
'1']. CIN:5:
C:L. FI:i~;:F.; ]; Oi:::: .'!::[ NSF' FIPF:'[~:O',,,'ED F'L. RNT HFI"r' BE INSTFIL.L_ED.
(.';:CI~',I"I"]~NUIiIU% i"'iF:tZN'f'E:NF,'hiE:iE I::IGREEHIi~i'qT
F~GF::IEEI"'IE~'NT Z::.; NOT I':::EF'T C':UF[:RE!:NT
R ~3 :i~;',.'::li::;: F' T ~ O i~ ii::;"r"."~; T EX'I
i"l;i:i'.,J_~:i','li...ti','t C,Z'....:;TFtNCt.C E',[.¢.Ti.,t[EI:i:N R NE:L.i.. I::ti'.,![.':, F:it',l"r' Oi',i'-'2;iTE '."!;ENFIGIE
:J.¢3~:~ F:'iE[}:T t'::'[3F.: R F'Fi:IVi::f'TE NELL. Oi';~: ;E:.(~I.3 FEET Ix'OR FI F'U[~d...i'C I.,.IELL.
1.4EL. L LOG'.";.; Ri:'::E i;;:Et'.:.!LllFi!ED FfNC' PIt...i:~;T BE: RETURNED TO THE [;'El:::'l::ll;."."f't"1E:l",l'i" 1.4:[THZi",i
Oi::: Tt-"I[~: Ni. iH...[.. C:EII"tF:'L[i~TZ ON.
O'['F'i[i~[;: f;;'.I_E(;!U :[ [~![~?'t['!i%!T~:; i"lFtk' F:!I:::'F:'L."r'. :':T,t:::'[~;C Z F:' I tl.'f::tT :t: t:)N:i~; Fi[qb CON:E;TF?.UC':T
R',,.'R :t: L. FtEC..IE TCI :i: i".l:~,Ui::~:tZ PIROi":'E:I:~: ]: i',I:~i;TF:IL.L.F:I"t- .'[
I C:Ei;~:TZF'V THRT
:1_: :i: I:~i"I i:::'f:li'"fZl..:[f:i[:~: i.,.IiTH TI"i[~: I::~:IE~;:!UtF::E:HENT':_:; F-OI::~: ON-'":F.';ITIE :F.;EI.,.t[ER:::~; t:::li",l[:." i.,.IEL[.2[.:, Fi:iii; :ii;ET
i:::'Of:~:TH E¢'r' THE HUN .T. C :1~ F:'FIL :[ 'i"'¢ OF
;.2:: :[ [,.! Z i..L. :[ N:~E;T.,'::IL.L. 'THE ~iil;"~"E;'T~i'"l Z i"4 FfE:COF.:DI:::INC[L' [,.t Z," TH THE
X:: i Ui"4i:::,EE~:::~;"i'FiND 'THFtT THE; CIN"-':5:[TE: :':':;I~iNE:~: :Ei;'~':~;'f'iEf"i P'iF:iV F::ii~%:!Li].'RE~ E:NL. FII:;.:GE:HEiqT ].'F' THE:
i:~:Ei::i~', :[ [::'[ii:i",lE:E~ :[ :~i; I;;:E:i"tCIDELED TO .'[ NE:[...LIt, I:2: f"iOi:;UE "i'HF~IN 4
,,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-2225
SOILS LOG -- PERCOLATION TEST
.ERFORMED FOR:
LEGAL DESCRIPTION:
DATE PERFORMED:
[~SOI LS LOG
[] PERCOLATION
TEST
1
2
3
4
5
6
7
8
9-
10-
11
SLOPE
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
12
13
14
15
16
17
18
19
2O
COMMENTS
PERFORMED BY:
72-008 (7/76)
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND ~ FT
Post-It"' brand fax transmittal memo 7671 # of pages
co. ~vo~C,, \¢~¢... co.
Faxfl 5~~ ~ Fax~
~2~ -.' Well~og
Lot 6 ou~ ~ln Park Estates .
~ep}}i~tion:6,iw ....
' ~ ~ ~± cased to 160 ft. approx. 5I ft[' east of house
-II gravel
~ I8 sand
2e 2e boulders
25 8~ sand
8e I25 brown clay
126 I55 brown clayesand
I56 Iqg gravel(water bearing)
Yield: ~gpm
Static water level:.
· Drilled by:Thomas Drillers
P.O. box I0-SI6
Anchorage,Alaska
99511
License # WD 78020
~'Completed June I2,I978
Parcel I.D. #
1,
017-023-06¼
GENERALINFORMATION
Complete'legaldescription
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744 :
cERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Lot 6; Block 4; Mountain Park Estates #2
Location (site address or directions)
12940 Foster Rd.
Anchorage, AK
Propsrtyowner Greg & Jeanette Wakefield Day phone 345-4566
Mailing address 14030 Venus Way Anchorage, AK 99515
'Lending agency
'>Mailing address,
Day phone
Agent BeCky Br°cies/ Dynamic Real Estate
Add~ess
Day phone 261-76~
Unless otherwise requested, HAA ~vill be held for pickup.
NUMBER OF BEDROOMS: ~,~-~ 3
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
xx
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site XX
Holding tank =-
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and statUs of system. ' '
72-025 (Rev. 1/91) Front MOA #21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
regulatio, n. sjD_effect on the date q, tathis inspection.
ordinances, and ,",L,~SF~ WATER & [~. AT~R Phone 3 3 7- 61 ? 9
Name of Firm ~'~B /~///~
Address '
Engineer's signature ' Date_~/ ' '~'
Alaska Water & Wa~tewater Consultants, Inc.
shall be paid ~5 at, or prior to closing
for the engineering services provided.
DHHS SIGNATURE
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
By:
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaskal The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work, . .
72-0~5 (Rev. 1/91) Back MOA #21
RECEIVED
Municipality of Anchorage JAN 2. 6 1999
DEPARTMENT OF HEALTH & HUMAN SERVICES
· . /'~UNICIPALIT¥ OF A,NCHOP~(~,JJ~'~'--~
Environmental Services Diws~on .... ~w~T~, ~,, "-" ...." '--~'
/
. ......... .
825 LStreet, Room 502 Anchorage, ~asKa ~bu~ [~u/]
Legal Description:
A. WELL DATA
Health Authority Approval Checklist
Parcel I.D.:
ol-/--o 7-3
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC wa~er system number
"~ ~--~ Date completed 2.,. j~
J -7~' Cased to J (o 0 Casing height (above ground)
'~_-~ Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION
Date of test
Static water level
Well production
g.p.m.
g.p.m.
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
B. SEPTIC/HOLDING TANK DATA
Date installed tO/"'/-/ Tank size
Foundation cleanout (Y/N)
Date of Pumping /O/Z-'/~i'~
~:~, 4' l /~,~ ./J~ Other bacteria
Collected by: ~,~JVJ ¢-~ ~'rJ C.~
Number of Compartments ~- Cleanouts (Y/N) Y
Depression (Y/N)
Pumper
Fluid depth I~. ~" (ins) Minutes ater: /4J-'z~rO
Peroxide treatment (past 12 months) (Y/N) %J~J~
C. ABSORPTION FIELD DATA
Date installed t [o/'7'7 : S~ting (g'p'd'/fF °r ff2/bdrm) I ~'~''-,4_ System type .-~r~ ~--~.,~T.-P~l
Length I~ Width ~ Gravelthickness below pipe ~TIf
~ Total depth ~' ~ ~
Effective absOrption area ~ Monitoring Tube present (WN) ~ Depression over field (WN) NO o~
Date of adequacy test /'~/~/~ ~ Results(Pass/Fail) ~' For ~ bedrooms
Fluid depth in absorption field before test (in.); /~- ~ Immediately after/~al, water added (in.): ~Z, ~
Absorption rate = ~ ~ .g.p.d.
If yes, give date ~'~~ ~
72-026 (Rev. 3/96)*
D. LI~
Date installed ~~
~, ~ "Pump off" level at*
-~Cycles tested ~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot [ CO/.~.
Absorption field on ~ot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots /~)C~ ~'~'
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~ Property line ~' [¥' Absorption field
/
Water main/service line 10 4- Surface water/drainage /(20/4- Wells on adjacent lots
/oo &
Property line Water main/service line
Surface water Driveway, parking/vehicle storage area
Curtain drain )V~,,,/¢~.. 1~-.~9 ~,¢'¢"/' Wells on adjacent lots /~)~ t'4L'
ENGINEER'S CERTIFICATION U ,~._"~'~"~ "~ ,'A..~.J /
/certify that/hau~"R~Jn./ned~/fie/e ,,pections and review of Municipal re,¢~
Signature Nam/¢.~. ~~ ~ ~
Engineer's , ~ A~ ~¢~ '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
O.~=,_?or~Building foundation [ 0
/o3
HAA Fee $. ~
Date of Payment
Receipt Number
, Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Rick Mystrom,
Mayor
Mtmicipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
http://www.cL anchorage.ak.us
AK Water & Wastewater Consultants, Inc.
ATTN: Jeffrey Garness, PE
6901 De Barr Road, Suite 2B
Anchorage, AK 99504-0000
February 10, 1999
Subject: Waiver Request for MOUNTAIN PARK ESTATES #2 BLK 4 LT
Waiver # WR990010 Lot Line Request for Parcel ID 017-023-06
Dear Engineer:
Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater
disposal system to the lot line has been approved. The approved separation distance is 6 feet.
This waiver approval applies to the current on-site wastewater disposal system and lot line
separation only. Any future upgrade to the on-site wastewater disposal system and lot line will
require all separation distances to be met or another waiver approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office at
343-4744.
Sincerely,
Civil Engineer I
On-Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR~ qq~OIO PID# 017-~)~-(~~ HA# 9~~ Permit #
Date Received: 2'
Legal DescriPtion:
Engineer: ~ ~~
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special Conditions:
3. Other:
Waiver is Granted: ~ Waiver is NOT Granted:
List Conditions or Reasons for above:
Date:
Nam% of Reviewer
Rec #: C~-0~48~.,~ Amount: $ [1~ Date Paid:
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2-B ~ Anchorage ~ Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
February 9, 1999
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
FEB 10 1999
Municipality ot Anchorage
DepL Health & Human ~ervtce,
Subject: Lot Line Waiver for Lot 6, Bk 4, Mountain Park Estates #2.
To whom it may concern:
When the septic system for this lot was installed on 10/27/77, it was noted that the trench was 6
feet fi:om the north lot line, which puts it 4 feet into the utility easement. Attached is letters of
non-objection fi:om ATU, Chugach Electric, GCI, and Enstar. The septic system on the lot to the
north (Lot 5, Bk 4) is supposedly 6 feet fi:om its south lot line, which places it about 12 feet away
from the subject drainfield. Both drainfields only have an effective depth of 24 inches. In short,
there does not appear to be any adverse impacts associated with the subject encroachment;
therefore, we are requesting that you waive the required separation distance between the trench
and the lot line to 6 feet./fyou have any questions, please contact me at 337-6179.
/I
Jeffrp ~. ~: xtess, l%F_~. JVi. S.
President kJ
' ; ' :. .. --...: *'. . . ~ · ~ ' .
.. .
I ~ ', lI I ~ ~ ~ i '
il l,.,, , ~j-' ~.' o~ ,' ~ /~
" j THE INFORMATION HEREON IS FOR THE USE OF
- LENDING INSTITUTIONS SPECIFICALLY TO SHOW
ANY CONFLICTS BE~EEN EXISTING STRUCTURES
EASEMENTS OF ~ECORD, OTHER THAN ~ AND P~ED LOT LINE8 OR EASEMENTS AND IS
THOSE SHOWN ON THE RECORDEDL'E~ /,.~. NOT TO BE USED FOR POSITIONING ADDITIONAL
P~T, ARE NOT SHOWN HEREON, ~A STRUCTURE8 OR FENOELINES.
"A8BUILT" No corners set Book pg ~/z~
-- OFA~
I hereby ce~i~ that I have su~eyed the (ollowing described prope~, Lot ~ Block ~
~/~/~ ~ E~T~An ho r ~ r I s d ha~ the
~ c rage reco~ing dstict Aa ka, an ~
improvements situated thereon are within the ro · lines and do not oveda or en~oach on
t p p ~ ying a jacent ther~o ~at no Improvements on prope~y lying adjacent thereto
encroach on the premises in question and that there are no roadways transmission hnes or other
. ~, ~ ,,, ,,, ~s+ ~
~ / ......... ~ O~5Sl~V ~ ~ ..........
'Andhdrage, A~ska .... /~ ~ ~' /~"~ .......
JAN-25-1999 09:45 CT~E ESI ANCHORAGE
~.~ CT&IE Enviro~lment. I
Services
Inc.
CT&E Ref.#
Client Name
project Name/#
Client Sample ID
Matrix
Ordered By
PW$ID
~am~le Remake:
Nitratc-N
990297001
AK Water & W~tewatei' Consultants Inc,
12940 Foster Road
1~940 Foster Raad
Drinking Water
0
? oB/ID0 ML, NO COLI
6.41
Client PO#
Printed Date/Time 01/22/99 10:26
Collecte~l Date/Time 0t/19/99 lS:aJ
Reeelvod Date/Time 01/19!99 16:10
Technical Director: ~tephen C. gdo
Me[hod
0,100 mg/k
Allowable Prep Analysis
~imit~ Dat?..~.~ Oare Init
max
01/!9/99
01/q9/99 0i/19/99
RECEIVED
JAil 26 lgS9
Municipalib/o ....
Oept. Health & H~'; ~,~' ~rvices
Alaska Water & WasteWater Consultants, Inc.
6901 Debarr Road, Suite 2-B ~ Anchorage ~ Alaska 99504
Phone (907) 33%6179 ~ Fax (907) 338-3246
Consulting Engineers
RECEIVED
December 21, 1998
26 1999
Municipality ot Ancnora~o
Oept. Health & Human Services
Jeanette Wakefield
12940 Foster Road
Anchorage, Alaska 99516
Subject: Testing of Septic System. Mountain Park Estates #2., Lot 6, Bk 4.
Dear Ms. Wakefield:
Per your request, we retested the subject septic system 30 days after it was chemically treated.
The results of the adequacy test are summarized as follows:
SEPTIC SYSTEM ADEQUACY TEST:
The septic system was initially tested on 10/21/98 through 10/22/98 and determined to have
an absorption capacity of approximately 250 gallons per day.
The septic system was chemically treated (SeptiClear) on 10/30/98 by Old McDonald's
Pumping Service.
On 12/4/98 the liquid depth in the steel monitoring tube was roughly 18.5 inches deep. Based
upon our field measurements, the bottom of the monitoring tube extends 2.1 feet below the
drainpipe invert. Over a period of about 1.5 hours, 1600 gallons was introduced into the
drainfield via a pump truck, causing the liquid level in the monitoring tube to rise 4 inches.
Twenty-four hours later the liquid level had dropped 5 inches, indicating that all of the water
had been absorbed. The validity of this data is based upon the assumption that the existing
steel monitoring tube accurately reflects the liquid depth in the trench system. This is a
reasonable assumption.
· Based upon this data, it was determined that the absorption rate of the trench exceeds 450
gallons per day, as required for a 3 bedroom house.
NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not
limited to, seasonal surface water infiltration, groundwater variations, septic system
maintenance (frequency of septic tank pumping, usage of biological additives), condition of
drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age),
type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects),
and the amount of water being introduced on a continual basis. Consequently, the results of this
adequacy test are only yah'd for the specific day of the test. Furthermore, because of the limited
nature of this investigation, it is possible that there are hidden defects which may not have been
detected. No warrantee is made regarding the future performance of this septic system.
SEPTIC TANK: According to the MOA records, the septic tank was installed in October of
1977, it is made of steel, has two compartments, and a capacity of 1250 gallons. Steel septic
tanks typically have a structural life of 20-25 years. No warrantee is made or implied regarding
the structural integrity of the septic tank.
If you have any questions,.~/~ase contact me at 337-6179.
Sincerely, ~ /~/'[
Jeffxq~ 5/. ~ tess, P.E., M.S.
President
Alaska Water & Wastewater Consultants, Inc.
7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
October 26, 1998
Jeanette Wakefield
12940 Foster Rd.
Anchorage, AK 99516
REFERENCE: Lot 6; Block 4; Mountain Park Estates #2
Dear Ms. Wakefield,
Per your request a septic adequacy test and a well flow test was performed on the
referenced property. Our findings are as follows:
A. WELL: On the day of our test (10/20/98) the static water level in the well was 137
feet below the top of the casing (BTC). A meter was connected to the outside hose bib
and the flow turned on full until the well was depleted (level dropped 35 feet in the
casing). This took approximtely 27 minutes, and a total of 147 gallons was pumped. The
well was allowed to recover for 30 minutes and the water turned on full again, resulting in
a flow of 60 gallons. The elapsed time fi.om the flow off (initial pumping cycle) to flow
off (second pumping cycle) was 41 minutes, during which time 60 gallons was pumped.
This corresponds to a recovery of approximately 1.46 gallons per minute.
Over the next 113 minutes this procedure was repeated through 3 more cycles. The
recovery rates were 1.34 gpm, 1.28 gpm, and 1.3 gpm. In short, the recovery rate
stabilized at about 1.3 gallons per minutes. Based upon this data, it was was concluded
that the well production meets the Municipality of Anchorage (MOA) minimum flow
requirements for a three bedroom dwelling, which is .31 gallons per minute. It should be
noted that seasonal fluctuations in the well production can occur, and that future
performance is not guaranteed.
B. SEPTIC: Per Municipal records the on-site wastewater disposal system was installed
in October, 1977 and consists ora 1250 gallon septic tank followed by a 126 foot trench
that is 4.5 ft. deep, and has an effective depth of 24 inches. On the day of our inspection,
we found the monitoring tube in the leach_field to have 18.5" of liquid in it prior to the test.
Over a period of 40 minutes, 1000 gallons was introduced into the trench via a pump
truck, causing the liquid level to rise 6.75 inches (148 gallons per inch). The recovery was
monitored 23 hours later and the level had dropped 1.75 inches, indicating an absorption
of 259 gallons. This correponds to an absorption of approximately 270 gallons per day.
Page Two
Lot 6; Block 4; Mountain Park Estates #2
October 26, 1998
This is less than the MOA absorption requirement, for a 3 bedroom house, of 450 gallons
per day. Based on our findings, it was detemfined the septic system is in a state of
failure. It is our understanding you may have your septic system chemically treated, with
a adequacy retest 30 days later. The cost for the retest will be $400.00* plus a water
haul. If the chemical treatment is unsuccessful, the following is a summarization of the
engineering costs associated with an upgrade:
C. UPGRADE COSTS:
· Engineering services to perform the soils evaluation & percolation for two test holes:
$400.00* for the first perk test and $200.00* for each additional hole.
· Excavator to dig two test holes: $600.00 (approximately) We can provide you a list
of recommended contractors. You should call them for costs and contract with them
directly.
· Engineering services to design the septic system: $500.00~. This is based upon a
conventional gravity flow septic system with no waivers to surface water, or nearby
wells.
· M.O.A. sewer permit: $320.00~. Payable to the M.O.A.
· Engineering services to inspect the installation of the septic system and prepare asbuilt
drawings. Assuming a conventional gravity flow septic system with a single trench:
$450.00
· If an innovative septic system is required, add $950.00 to the design and the inspection
costs. We will know whether an innovative system is necessapy after test holes are
completed.
The items marked with an asterisk must be paid prior to submitting the design
package to the M.O.A.
The cost for the excavator to perform the installation is unknown at this time. After the
soils testing and design is completed you should obtain bids from several reputable
contractors. We can provide you a list of recommended contractors.
Page Three
Lot 6: Block 4; Mountain Park Estates #2
October 26, 1998
Prior to obtaining a M.O.A. Health Certificate, water samples will need to be taken and
tested for coliform bacteria and nitrates. The costs for these services are summarized as
follows:
· Water sampling/analysis: $100.00
· MOA HAA processing fee: $300.00
If you have any questions, please contact us at 337-6179. We look forward to assisting
you with your engineering needs.
Sincerely
President
~~--
]arness, P.E., M.S.
JAG/gk
FEB-04-99 THU 01:54 PM Dynamic Properties
?, 02
RECEIVED
February 4,1999
Becky Broeies
Listing Agent
12940 Foster Road
Anchorage, Alaska 99516
FEB .4 1999
D Municipality of Anchorage
ept. Health & Human Services
Dear Ms. Brocles,
Subject to your agreement to indemnify tho company as set forth below, GCI Cable Inc.
of Alaska has no objection to the septic system drain field encroaching into the utility
easement on the north property line of l,ot 6, Block 4 Mountain Park Estates #2.
Known as 12940 Foster Road, city grid 2839.
Tiffs letter of non-objection in no ww precludes GCI Cable ¢rom full use and enjoyment
o1' any rights it may have within any portion of the utility easement mad or the right-of-
way, including unlimited access for servicing its facilities. Also may additional and
extraordinary costs incurred during any future required construction, repair or
reconstruction of GC['s facilities to accommodate any or all ot'fl~e encroachments shall
be paid by the property owner,
By signing below, you agree to indemnit'y and hold OCI Cable harmless, now and
forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities
and injury to any person or property occurring as a result of the encroachment,
Please indicate your acceptm~ce by signing and returning this letter to myself at thc
address below.
Sincerely,
nc, _
~coecca ~olton
OSP Design Engineer
Acceptance
5151 Fairbanks Street · Anchorage, Alaska 99503 · 907 / 786-9260
Cable services provided by GCI Cable, Inc,
02/04/199B 15:87
90?5620053
PAGE 0i/03
A 01VI$[0N OF SEAGUI,[, ~NERG¥ CORPO~T[ON
401 E. I~emefio~al Ai~o~ R~ed
P. O. Box ~ 90288
A~cho~go, ~a~ka ggB~ g-02~8
[~7) 26~3740
F~ (907) 56~085
02/04/99
Aaron Gray
609! Debarr Rcl
A~chomge, AK 99504
To whom it may e, oncem:
ENSTAR Natural Gas Company has no objection to the enexoaebxaent sewer drainfield in the
10' utility easemeat cia the ~ao~h side of Lot 6, Block 4, Momatain Park Estates #2. See
attached as-built survey dated 1119/99.
Acceptance and use of this letter of non-objection by yours, elf, your heirs, your assigns, or
your sueeessoxs, w~ll eo~asfitute ag~eeme~at to ~e following stipulations:
ENSTAR will be held h~emless, now and £ozever for any damages OX injury to any
person or p~opexty as a ~esult oftlffs encroachment.
Auy ENSTAR faci~.ity damaged or destroyed, as a ~esult of this encroachment will be
repaired at no cost to ENSTAR.
Any costs iactuxeet by ENSTAR for special construction necessitated by this
encroacltment will be borne by the property owner.
All applies, bio safety eofle regulations will be observed and maintained.
This letter of non-objection will in no way preclude ENSTAR from gull use and
enjoyment of its fights within any poxtio~ of its fight-of-way.
Sincerely,
ENSTAR Nat~al Gas Company
Drew Smith
Senior Engineer
cc: File
600 Telephone Avenue · Anchorage, Alaska ° 99503-6091 · 907 564-1000
February 5, 1999
Alaska Water & Wastewater Consultants, Inc.
6901 DeBarr Road, Suite 2B
Anchorage, Alaska 99504
ATU Telecommunications has no objection to the encroachment of the
existing septic system into a platted easement located on Lot 6,
Block 4, Mountain Park Estates # 2, as depicted on the as-built
drawing submitted.
Acceptance and use of this letter of non-objection by yourself, your
heirs, your assigns, or your successors, will constitute agreement to
the following stipulations:
ATU will be held harmless, now and forever, for any
damages or injury to any person or property as a result of
this encroachment.
4 o
Any ATU facility damaged or destroyed as a result of this
encroachment will be repaired at no cost to ATU.
Any costs incurred by ATU for special construction
necessitated by this encroachment will be borne by the
property owner.
Ail applicable safety code regulations will be observed
and maintained.
from full use and enjoyment
portion of its right-of-way.
This letter of non-objection will in no way preclude ATU
of its rights within any
Sincerely,
Outsid~ p~ad~tF~nr~Tnaenering
GS\mi \g: mswd\ cor\ nonob\mt n_pk. doc
ENCROACHMENT PERMIT -
1203-26A
G-2839
EN99001
This permit is between Chugach Electric Association, Inc., an Alaska non-profit
electric cooperative, (herein "Chugach"), whose address is P. O. Box 196300,
Anchorage, Alaska 99519-6300 and Gregory A. and Jeanette Wakefield of Anchorage
(herein "Permittee"), whose address is 12940 Foster Road, Anchorage, Alaska 99516.
1. Easement. Chugach is the grantee or user of an easement for the
construction and maintenance of electrical facilities as follows:
Described in that certain written instrument recorded on the 20th day of
January, 1953, in Book 84, Page 298, on file in the office of the District
Recorder, Anchorage Recording District, Seward Meridian, State of
Alaska,
Dedicated by the plat of the subdivision known as Mountain Park Estates
Subdivision No. 2, according to Plat Number P-561, recorded on the 31st
day of October, 1960, on file in the office of the District Recorder, Anchorage
Recording District, Seward Meridian, Alaska,
(herein "Easement") which pertains to the following described real property:
The North Ten Feet (lq I0') of Lot Six (6), Block Four (4), Mountain Park
Estates Subdivision No. 2, according to Plat Number P-561, on file in the
office of the District Recorder, Anchorage Recording District, Seward
Meridian, Alaska.
Permittee acknowledges the validity of the Easement. Permittee warrants and represents
that Permittee is the owner of the fee simple interest in the land subject to the Easement and
the following described real property to which the Easement is adjacent:
Lot Six (6), Block Four (4), Mountain Park Estates Subdivision No. 2,
according to Plat Number P-561, on file in the office of the District
Recorder, Anchorage Recording District, Seward Meridian, Alaska,
(herein "Parcel").
Encroachment Permit - Page I of 4
2. Encroachment. Permittee has constructed the following improvements
on or within the real property subject to the Easement:
A septic system that encroaches approximately Four Feet (4') into the
Easement for a distance of approximately Five Feet (5'),
(herein "Encroachment").
3. Permit. Chugach hereby authorizes Permittee to continue the existence
of the Encroaclunent in its current location subject to the covenants set forth in this
pemfit.
4. Indemnification. Permittee shall indemnify and hold Chugach harmless
from any claims for personal injury, property damage or other loss arising in any way
from the construction or continuation of the Encroachment.
5.. No Expansion or Increase. Permittee shall not in any way expand or
increase the extent to which the Encroachment occupies any of the real property
encumbered by the Easement without the prior written consent of Chugach. Chugach
has no obligation to provide such consent.
6. No Interest in Real Estate Acquired. Permittee hereby acknowledges that
the Encroachment and any additions thereto, even if in violation of this permit, has not
and shall not in the future give rise to any interest or estate in the real property subject to
the Easement or any other real property. Without in any way limiting the foregoing,
Permittee acknowledges that the Encroachment is not adverse to any interest of
Chugach and its continuation is entirely with the permission of Chugach for purposes of
the common law doctrine of adverse possession. This permit creates no interest in the
real property subject to the easement.
7. Modification of Utility Facilities. If the electric utility facilities located
within the Easement are upgraded, added to, replaced or reconstructed, Permittee shall
pay that portion of Chugach's total costs for such modification which is reasonably
attributable to accommodating or preserving the Encroachment. If such payment is not
made within thirty (30) days of written demand for same, Chugach may terminate this
permit in accordance with paragraph 9, below.
8. Covenants Running with the Land. The obligations of the Permittee
arising from this permit shall be covenants running with the land which shall burden the
Parcel and the Permittee's interest in the land subject to the Easement and shall benefit
the Easement.
9. Termination. Chugach may terminate this permit after the giving of
thirty (30) days written notice of such termination iff
Encroachment Permit - Page 2 of 4
a. The Encroachment is enlarged, increased or extended
within the real property affected by the Easement.
b. The Encroachment is damaged by any means to an extent
of more than thirty percent (30%) of its replacement cost at the time of
destruction.
c. Permittee fails to make the payment described in
paragraph 7, above.
10. T.erm. This permit shall, if not sooner terminated by Chugach, expire
forty (40) years from the date hereof.
11. Entire Agreement. This written permit constitutes the entire agreement
between the parties with respect to the subject matter hereof and supersedes all other
prior or contemporaneous agreements, oral or written, between the parties. No
modifications, amendments, deletions, additions or alterations of the permit shall be
effective unless in writing and signed by all of the parties hereto.
CHUGACH ELECTRIC PERMITTEE
ASSOCIATION, INC. Greeo.cv-A.. and Jeanette Wakefield
~*$0~;,t, ~.. Title: E(ugon~ N.B.~L~ad Jeanette~akefield, Attc~rney-I~ZFact for
"""*~-... ~,,,~"h~""~'~'"Z-~,~"; · o""t General Manager /Gregory A. Wakefield
'-,,e.~:~::.,,i~ Date: ~~ k ~ ~ ~
eanette ~kefi~d
Date: ~.~
STATE OF ALASKA )
) SS:
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this ~ay of
C socia}i c
~ /~~ ' ~" ~ ~:~ .~ 0;. '"~(~,7.~-:,
0~a~ Pubhc In and for the State of Alaska
My commissmn expires ~ ~~.
s of 4 '%.? ·
STATE OF ALASKA )
) SS:
THIRD JUDICIAL DISTRICT )
The t~
~ , foregoing instrument was acknowledged before me this da.y
of [- ~b ~,A~,7 ,1999, by ~],~4j,'jY 2t'/~
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
Notary Public in and for the ~a2e of Alaska
My commission expires ,e~,-~..~ ~9 0 0
)
) SS:
)
of
The foregoing instrument was acknowledged befOre me this
., 1999, by
day
Notary Public in and for the State of Alaska
My commission expires
AFTER RECORDING RETURN TO:
Chugach Electric Association, Inc.
Land Services Department
P.O. Box 196300
Anchorage, Alaska 99519-6300
009350
Ah'CHORAGE
RECORDlt,IG DISTRICT
199MFE -9 PM 3:09
REOUESTED BYC ¢~
Encroachment Permit - Page 4 of 4
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O, Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D.#
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
O,:;L~ -- ~ (,~, HAA# ~ I~ c~-,-'n')('~'""),~)'.0) ''''~
GENERAL INFORMATION
cOmplete legal description
Location (site address or directions) /~ c~ ~L) ,....~os ~--¢~- ~,'~o0
Property owner
Mailing address
Lending agency
Mailing address
Agent
Add ress
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm '/ (~/d/J~.~ ~'~,,-.~%~ ~ ~ Phone
Address ¢¢,~O '~,
Engineer's signature
Date
DHHS SIGNATURE
~X~ Approved for ¢
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does th is as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS do not
conduct inspections or analyze data before a certificate is issued. The Munioipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
724)25 (Rev, 1/91) Back MOAif21
(~ Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type ~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
ADEC water system number
If A, B, or C, attach ADEC letter.
% Date completed e'/l~/? ~ Driller /-~'~,'~,~-
17 ~ Cased to I '~ ~' Casing height '~' ~/'
~'/ Wires properly protected (Y/N) y
FROM WELL LOG
Date of test (~/~Z-/~ 0
Static water level
Well flow
Pump level ~ ~/"~'"'~
SEPARATION DISTANCES FROM WELL TO:
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Septic/holding tank on lot fO 7
Absorption field on lot I ,3_0 ~
Public sewer main I"I/A
WATER SAMPLE RESULTS:
Coliform ¢
Date of sample: 1/~, [ ~i,
Nitrate ~'. ~9 Other bacteria
Collected by: --~-r/u--~,'' 'IL
B. SEPTIC/HOLDING TANK DATA
Date installed ~°/;z7/7 '~ Tank size ,/,;~- ~ Compartments
Cleanouts (Y/N) "/ Foundation cleanout'(Y/N) y DepressiOn (Y/N)
High water alarm (Y/N) ~4///--~, Alarm tested (Y/N)
Date of pumping 1/! .~l gl ~ Pumper
To property line ~/~
Surface water/drainage
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I0 '7 On adjacent lots
Absorption field / ~' ¢
Foundation
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION 1'¥X
//--¥
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
"Pump off" lev'el at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed IO/~?/? ~
/
Length 1~{~ Width '~
Total absorption area ~'~ ~
Depression over field (Y/N) i,q
Results (pass/fail) ~/'"~'
Peroxide treatment (past 12 months) (Y/N)
Soil rating
Gravel thickness
Cleanouts present (Y/N)
Date of adequacy test
for
If yes, give date
System type
Total depth
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~'
To building foundation
On adjacent lots
Surface water ~ /0
Curtain drain
On adjacent lots > /~-- ~"- Property line
To existing or abandoned system on lot
Cutbank ~.~ ~f ~- Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the .dateof this inspection.
Signature
Date
Engineer's Name
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA
Waiver Fee: $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE ~. : '
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION .
825 L Street - Anchorage. Alaska 99501 .......
(~) ENVIRONMENTAL ENGINEERING DIVlSlONTelephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed. Please allow ten (10) days for processing.
B~ILI~ A~OR[8~
P~OPERTM ~ESI~ENT (If different from above) ~ PHONE
2. B~R ' PHONE
~ILI~ A~BRE~
3, LENDING INSTITUTIO~ ~ / PHONE
4. R~ALIOR/A~ENT PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCAT'I ON'
6. TYPE OF RESIDENCE ~/~ BER OF BEDROOMS
[] One [] Four
~ SINGLE FAMILY
[] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
7. WATER S__U~I:~LY
~ I NDIVI DUAL* * 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. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date ~_~./~?~.
If system is over two (2) years old an adequacy test is required
[] PUBLIC UTI LITY by this Department.
NOTE: THE INSPECTION FEE NlUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
I NSP ECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[--IPUBLIC UTILITY / C.3 ""~ "7
Connection Verified INSTALLER
[]Septic Tank or []Holding Tank
Size: I~.~'0 If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTU~.R....
TOTAL ABSORPTION AREA MATERIAL .'~,~_ J
4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
~ APPROVED FOR ~) BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[~] DISAPPROVED
DATE /B~~
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
~ , DAT~E~'R ECEiVED ........
~. ~ INSPECTION APPOINTMENTS
TIME TIME , '~ (,,~ TIME
DATE, / DAT.E ~ ?/;~./' / / DATE
MUNICIPALITY OF ANCHORAGE DEPT. OF I~;A. LT.I &
DEPARTMENT OF HEALTH ~ ENVIRONMENTAL PROTECTIO~NV RONMENT~xL ; , ,..>TECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISIONJAN 2 ? I981
DI RE~ION~: Complete all parts on page 1, I~omplet~ ~qu~t~ will not b~ p~e~e~.~Plea~e allow ten (10) days for processing.
1. PROPERTY OWNER~ - PHONE
PROPERTY RESIDENT (If different from above) PHONE
MAI~JNG ADDRESS
4. REALTOR/AGENT I PHONE
I
MAIEING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION' ~
6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS
~ One [] Four
[~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
*ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[~ INDIVI DUAL/ON-SITE~
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL ~)EPTH OF WELL
[] COMMUNITY -DATE DRILLED
[] PUBLIC UTILITY
Connection Verified ~.OG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] IN D IVI DUAL/ON -SITE [)ATE INSTALLED
C] PUBLIC UTILITY 1 q'''~ ~' ~''~ ~'~
Connection Verified -~NSTALLER
FHSeptic Tank or E~]Holding Tank
Size: [ '.b.~--6~) If Tank is homemade -SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Ta~k IAbsorption Area Sewer Line Nearest Lot Line
I
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
OVED FOB / BEDROOMS
[~ CONDITIONAL APPROVAL (better m,,dst~ccompany certificate)
[] DISAPPROVED~-~ (._~ ),/~
,. C_'~ Y,~
BY
DATE ~.~2~ [0-/'3 (
72-010 (Rev, 6/79)