HomeMy WebLinkAboutBERNARD BLK 4 LT 6Bernard
Block 4
Lot 6
#060-321-07
$UUMITTM1
Municipality of Anchorage
Community Development Department Page
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: OSP131318 PID Number 060-321-07 ❑ New
1
1 of 2
Upgrade
Name:
Margaret Ingmanson
ABSORPTION FIELD
Address
19120 Elnora Lane
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
❑ Other
Phone
Number of Bedrooms
3
Soil Rating
GPD/SF
Total depth from original grade
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Gravel depth beneath pipe
Subdivision Block Lot
Ft.
Ft.
Bernard 4 6
Fill added above original grade
Gravel length
Township Range Section
Ft.
Ft.
Gravel width
Beds: Number of Lines
Distance between lines
SEPARATION DISTANCES
Ft.
Ft.
To
From
Septic
Tank
AbsorptionHolding
Field
Lift Station
Tank
Sewer
Line
Total absorption area
Ft'
Number of trenches
Dist. between trenches
Ft.
Well
110.2
123t(E)
N/A
N/A
102
TANK 17 Septic • S.T.E.P. 0 Holding • Other
Manufacturer
Capacity
Surface Water
100+
100+(E)
N/A
N/A
Anchorage Tank
1000Ga1,
NA
Material
Steel
Number of compartments
2
Lot Line
81.9
68±(E)
N/A
N/A
Foundation
14.9
22±(E)
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
N/A
N/A
N/A
N/A
Remarks Tank installation only.
Pump on level at
Pump off level at
High water alarm at
in.
in.
in.
Pump make and model
Electrical Inspections performed by
Installer
to
PIPE MATERIAL House to tank 3034 drainfld Taneid 3034
JRs Septic Pumping
Drainfield CO/MT 3034
Inspector Pannone Engineering Services
BENCH MARK (Assumed elevation) 100ft
Inspection Iso 9/30/2013 2m
Location and description
3rd 4"
Garage FF
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Conditional Approval: Date
Engineer's Stamp
�F At
e
Approved go / ,i `I Date / //144 Sl
Steven A•`•annarae
i4s._i lCifCy l
RtpFEIk S>> ' +
VOLI
Inspection Report_1-1-12.doc
F7
BERNARD DRIVE
DRIVEWAY
WELL (E)
W
W
SEPTIC AREA (E)
NOTES:
RECORD DRAWING
110.2
\1\1"--
SEPTIC
/SEPTIC AREA (E)
5A
LOT6
DCO1
T1 •,'_141 (E)
T2
DCO2
�Sg
DRAIN FIELD (E)
SEPTIC
COLLAPSED 1000g SEPTIC TANK
ABANDONED PER CODE
INSTALLED 1000g SEPTIC TANK
W/ DCO BEFORE AND AFTER
REA (E)
0I-
00
z
OV
102.8
0
Pc)
w0
mww
00
PANNONE ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
PROFILE
PLAN
BERNARD, BLOCK 4, LOT 6
MARGARET INGMANSON
19120 ELNORA LANE
EAGLE RIVER, AK 99577
95.3
NEW 1000g I95
SEPTIC TANK J
1-` 9 . A/1
.............
teven R. Panno149�n2efrof
-
I ��+i��>\ OFECE 851 rim
Date
10/16/13
Scale
1"=50'
P.I.D. NO
-07
PERMIT NO.
OSP131318
Shee
2 OF 2
A
B
DC01
20.5
23.3
T1
22.4
24.5
T2
26.4
29.5
DCO2
28.2
30.9
M (E)
36.2
85.7
SEPTIC
COLLAPSED 1000g SEPTIC TANK
ABANDONED PER CODE
INSTALLED 1000g SEPTIC TANK
W/ DCO BEFORE AND AFTER
REA (E)
0I-
00
z
OV
102.8
0
Pc)
w0
mww
00
PANNONE ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
PROFILE
PLAN
BERNARD, BLOCK 4, LOT 6
MARGARET INGMANSON
19120 ELNORA LANE
EAGLE RIVER, AK 99577
95.3
NEW 1000g I95
SEPTIC TANK J
1-` 9 . A/1
.............
teven R. Panno149�n2efrof
-
I ��+i��>\ OFECE 851 rim
Date
10/16/13
Scale
1"=50'
P.I.D. NO
-07
PERMIT NO.
OSP131318
Shee
2 OF 2
On -Site Wastewater Disposal 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: OSP131318
Tax Code Number: 06032107000
Work Type: Septic
Permit Effective Dates: September 10, 2013 to
September 10, 2014
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: BERNARD
Site Legal Address: BERNARD BLK 4 LT 6 G:0254
Owner/Address:
INGMANSON MARGARET C
PO BOX 773152 EAGLE RIVER AK 995773152
Site Mailing Address: 19120 ELNORA LN, Eagle River
Lot Size in Sq Ft: 53006
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 By:
Issued By:
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division ����;
On -Site Water & Wastewater Program
1 h /
BUS/01-RITE SEWER/WELL PERMIT APPLICATION
Phone: 907-343-7904
1 Fax: 907-343-7997
Parcel I.D. 060-321-07
Property owner(s) Margaret Ingmanson
Mailing address P.O. Box 773152, Eagle River, AK 99577
F'USH!
Day phone
Site address 19120 Elnora Lane
Legal description (Sub'd., Block & Lot) Bernard, Block 4, Lot 6
Legal description (Township, Range & Section)
Lot Size 53,006 Sq. Ft. Number of Bedrooms
APPLICATION IS FOR:
(I all that apply)
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
APPLICATION IS AN:
Initial
Upgrade
Renewal
3
TYPE OF DWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D)
Multiple Dwellings
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
❑X
I certify that the above information is correct. 1 further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
12040 .41
9 //o l/3
03 WA
Permit No. ASP/3/Sig
Permit App :•;L:c.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Pannone Engineering Services ac
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
September 6, 2013
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
Anchorage, Alaska 99519
Subject: Bemard, Block 4, Lot 6
Septic Tank Replacement Permit Request
Ladies and Gentlemen:
I am writing to request that a permit to install a new 1000 gallon septic tank be issued for this lot.
The proposed system will serve an existing three-bedroom house. Currently the lot is developed.
The existing septic system was designed and installed for three bedrooms. The existing 1000
gallon septic tank has collapsed. The existing 1000 gallon tank and lift station will be abandoned
per code. This lot is served by a private well that is over 100' from the septic system. The
surrounding lots are also served by private wells that are over 100' from this system..
1. Upgrade Tank Design.
a. See Sheet 1 of 1 of the plan set
2. Surface Water: There is no surface water within 100 feet of the proposed system. The
proposed systems will maintain at least 100 feet from all surface water and drainage ditches.
3. Topography: Lot 25 slopes from southwest to northeast at approximately 15% in the
area of the tank replacement. The proposed installation will be located in the central portion of
the lot next to the existing septic tank and absorption system. There are no steep slopes within
50 feet of this system.
Mailing: P.Q. Box 100217, Anchorage, AK 99510.0217
Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
Page 2 of 2
The proposed installation will not affect the future development of the surrounding or existing
lots. There are no wells within 100 feet of the proposed septic location. If you have any questions
or concerns, please contact me at 272-8218.
Sincerely,
5•
�'P�. ws ##i
•
•
VASteven R. Pannone (� a
er
a.
1*,,,lfl»ss
Steven R. Pannone, P.E.
Owner/Civil Engineer
Attachments:
Mailing: P -O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
BERNARD DRIVE
r �9
WELL (E)
W
W
SEPTIC AREA (E)
NOTES:
EMERGENCY TANK REPLACE
LOT 6
\S9
C— DRAIN FIELD (E)
�s3
SEPTIC AREA (E)
COLLAPSED 1000g SEPTIC TANK (E)
ABANDON PER CODE
INSTALL 1000g SEPTIC TANK (P)
W/
DCO
SEPTIC AREA (E)
5A
PANNONE ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
PLAN
BERNARD, BLOCK 4, LOT 6
MARGARET INGMANSON
19120 ELNORA LANE
EAGLE RIVER, AK 99577
M
OF 44•44lki
Steven R. Pannone fro
��. CE 8149
`0 .r
Date
M
9/6/13
Scale
P.I.D. NO
0-321-07
PERMIT NO.
OSPXXXXXX
Sheet
1 OF 1
Jul 29 08 07:18a
Sullivan Water Wells
907 688 2759
Qtertitteb Attain log
by
DOC CO. Cba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 •TELEPHONE 688-2759
OWNER OF LAND /TM
Ac41r7 1N6140.1JCniBORE HOLE DATA
DEPTH
ADDRESS'
LEGAL DESCRIPTION- 4 r1 && 4 4 •T6
Fqm
la
DATE: -74.2 *
PERMIT NUMBER* 070141 Date of Issue 7 -L
TAX IDENTIFICATION NUMBER: (7A O - /AL_ - Cs
Is well located at approved permit location? 1.3.-Yeg. 0 No
Method of Drilling: CI-att.-rotary rotary 7 cable tool
Depth of well* a 7
Casing Type Si cam. Wall Thickness ,9J
Diameter tit
inches, depth 4
Liner Type: a C C � C 1 " PVC
a
yr
ar
1/S- D5
inches
feet /Z 1C -N
1,25'210
Casing Stickup Above Ground*
Static Water Level. 3
Recover Rate' _1 gpm
Method of Testing' /4/4
Well Intake Opening Type: 0 open end 7 open hole
a
feet
feet
0 Screened; Start
0 Perforations Start
Grout Type. $F.o 7%04. rd.
Depth: from Q
feet Stopped feet
feet S Aped feet
volume
feet, to al a feet
Well Disinfected Upon Completion? 0 No
Method of Disinfection* rS.c C..,r& ztofien
Comments:
r
240
p.1
C.R-Si..!e. 51-7-r csc.
o .= t ¢. 4 a 44 &,.,!
SihTi 624JSc �isv�J..�✓E
a e4<s,C - 644-1
/true' L4. hie kb,
feel& wf0.v1/4-1Z 36n•
6 Edh c K 6 are
Driller's Name sj4 C
ATTENTION: It Is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation.
ARCTIC PUMP & WELL INC.
Jim Sullivan, CPI
PO Box 770197
Eagle River, AK 99577
(907) 688-2510
(907) 258-2510
(907) 745-2510
ppw' eci.net
Pump Installation Log
Well Drilling Permit Number: SW070149
Parcel Identification Number: 060-321-07
Date of Issue:7-10-08
Legal Description:Bemard
Lot:6
Block4:
Property Owner Name & Address:
Margaret Ingmanson
PO BX773152
Pool. R kion A V Q0G77
Pump Installation Date: 8-28-07
Pump Intake Depth Below Top of Well Casing:225 Feet
Pump Manufacturer's Name: Dempster
Pump Model:MBF3-75-S2
Pump Size:3/4
hp
Pitless Adapter Burial Depth:10 feet
Pitless Adapter Manufacturer's Name:Martinson
Pitless Adapter Installer: Arctic Pump & Well, Inc.
Well Disinfected Upon Completion? Yes
Method of Disinfection: Chlorine
Comments:
Pump Installer Name:
Arctic Pump & Well, Inc.
Arctic Pump & Well, Inc.
Page 1 of 1
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Permit Number: SW070149
Legal Description: BERNARD BLK 4 LT 6
Design Engineer: 0000 ZZ - NONE NEEDED
Owner Name: MARGARET C. INGMANSON
Owner Address: PO BOX 773152
EAGLE RIVER , AK 99577-3152
Date Issued: Jul 10, 2007
Expiration Date: Jul 09, 2008
Parcel ID: 060-321-07
Site Address: 019120 ELNORA LN
Lot Size: 53006 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit Is for the construction of:
❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well ❑ 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
-THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55.
PLEASE SEE THE ATTACHED SHEET "PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM".
Received By
Issued By
./
Date.
/d x
Date: 7/V77
4.
Parcel I.D.
Municipality of Anchorage
- Development:Serices Dopartment
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
04 d- 3a( -07 - 000
Property owner(s) "la (/ e '- C , I et n' iz t .Sel t1
Mailing address igrlX • 77 3 LSa- Ear %
Site address /9/ a2� g Lore(G- n �' /�
Legal description (Sub'd, Block & Lot) re. r-naA ri CCL/
111
Day phone l°t-.3R'/G?yl
K. Pr is Zip Code 'VS
Zip Code ! 7 5?4z
to" l /3CK
'Esti
Legal description (Township, Section & Range)
Lot Size - '3, Qd 4' Sq. Ft.
THIS APPLICATION IS FOR (gall that apply):
0
0
0
0
Absorption Field0
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
Number of Bedrooms 3
THIS APPLICATION IS AN:
Initial
Upgrade
Renewal
I certify that the above Information is correct. I further certify that this application is being made for a
Single Famii Dwelling and is in 9ecordance with applicable Municipal Codes.
(Signature of
/11( ---).-
rty owner or ize agent)
Permit/Rush Fees: /973- °' Waiver Fees:
Date of Payment: J2 07 /�7 Date of Payment:
Receipt Number. 076663
(Rev. 11/05)
Receipt Number:
F r. 01
G-2
%864 S.F.
Y
ALG.
SET 86:14Arrlen •
IST GN***** IIsrAbtsA-f MIN.
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ASBUILT-NO CORNERS SET•THIS DATE.
SEWARD
ci
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY* Lot 6,
Block 4, Bernard Subdivision•
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SCALE
1" = 30'
•
& ASSOCIATES LAND SURVEYING 688-4566
f.Pc .. Ads40
( 1A
i `* 49TH y* 4
ctC ( �l([Y"y/
Du,n. Mark Seward
LS.69i8 �g
-`1X14.1..e.x.9'
DATE'
7/21/92
GRID'
• SW254
FBr
30-36
DRAWN*
DPLS
• MUNICIPALITY OF ANCHORAGE
i/
f r DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
_ ► ( 1 ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE
D - b' L A 149i7-3(7,251
L�NEW
❑ UPGRADE
MAILING ADDRESS
Qfrt/ (23 (ii P/0.
LEGAL DESCRIPTION
(e 84 & en
LOCATION
E,1 Q v-o A Sl-.
NO. OF BEDROOMS
3
SEPTIC
TANK
DISTANCE TO:
ell,/._� �
fyvv wcc bU
Absorption area
/o /
Dwelling /
/ 5_
Material
�S � E.. L-,
PERMIT NO.
g,20a6,S
No. of compartments
-2
Manufacturer
G2€' F2
Liq. capacity in gallons
COQ
IF HOMEMADE:
Inside length
Width
—
Liquid depth
o Y
JC7Z
0 z <
2 I—
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Manufacturer
Material
Liquid capacity in gallons
TILE
DRAINFIELD
TRENCH
DISTANCE TO:
(Veil ,
. _ g �„
U c�
Foundation 33 i
Nearest lot line /
¢ �_
PERMIT NO.
82c)268
No. of lines (
Length of eacP
ling y
S/
Total length of est/
y
Trench widt�� inches
Distance between lines
Top of tile to finish grade/ i
^',�
Material beneath the
Total effective absorpn area
n hes
'x 6j
SEEPAGE
PIT
Length
Width
Depth
PERMIT NO.
Type of crib
Crib diameter
Crib depth
Total effective absorption area
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
-1
W
alass
/Y GtJ
Depth
Driller
Distance to lot line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
b 36341
N
up1.-
SOIL TEST RATING
INSTALLER
be4- —6LA
REMARKS
Op (.,..),41-2E.
o
'D
7-t,4,I — w vc,-Q-8 OA" 2(AC-*
1-4,4,4-
us
Q
o
APPROVED DATE LEGAL OV
. . /z
72-013 (Rev. 3/78)
rti P-4�^��������_�-�"�_ K�ON 11
r�����������K���
oErA�/n�m� H�A .�|.� AND EMv��Um11 E.:r1!FiL 'OTECT3 ON
825 STREET, HNCHORHGE, HK. 9- ]1."-Alik.AAvS
264-472G
PERMIT ( 820268 )
APPLICANT DEAN-DELUCIH
LOCATION B-ENORH ST
LEGAL L6B4 BERNARD
BOX 2]4 ER
�
�.
��4-]424
LOT SIZE 53000 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS - ] SOIL RATING (SQ FT/BR)= 140
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
IDEE:97,,"-VIFA= 1.._IED"A(31-0-41= 7?R:2-7.4 111311,4",./RELA._ DIFEF"-FIF4=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD,
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEEM
THERE IS NO SET WIDTH FOR TRENCHES
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
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
7440 <;2.:> IINSFAIEEC-FION 1-4,17.&11.AUIFREEAD.
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTIOR
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F�ri :lc �FE.� Eg .. Sti���
I CERTIFY THAT
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE
2: I NILL 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 ] BEDROOMS.
-----------
FPPLICHATDEHN-DELUCIH
SIGNED.
------------
------------
TE
[-CT
Y4.0
December 31, 1979
Robert Waters
7425 Pamela Place
Anchorage, Alaska
Permit #790365
99 504
HEFT
'i` G_. ALASKA 09501
Subject: Lot 6 Block 4 Bernard 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.
1r an engineer has inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our files.
If there are any further questions, please contact this
office at 264-4720.
Sincerely,
Les N.
Buchholz, R.S.
L-----
Senior Environmental Speci 5t
LNB/ljw
enc: Copy of Permit
MU! rNI I C2: I 1 -r• 'V LIF Fir4c-;.F4 9Rc3E
DEPARTMENT OF dEALTH AND ENVIRONMENTAL PkuTECTION
825 'L' STREET. ANCHORAGE, AK. 99501
264-4720
0f4—E5ITE: si;E:weIR
PERMIT NO. ( 790365 )
10i;0%13-5
APPLICANT ROBERT 101-T--T-G-lit 7425 PAMELA PLACE ERFILE-R-I-YER
LOCATION ELNORA & BERNARD
LEGAL L6 84 BERNARD S/D'
LOT SIZE 53000 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 140
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
r1 -i= dL:IL LEENGTH= CBEEIRTIFI=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIEM
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
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
RflEOUIR:EIDA TFiNK (3F4L_L_OW.7
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.
- (2> PIIREE iJIFEC
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND 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 WELL.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
FlEFZMIT lexF.xER
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED.
APP ICANT RT WAT'grg b0/9 -TO/
ISSUED BY__ DATE
•
Russell Oyster
694-2774
O & E ENLINEERING & DEVELG MVIENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
SOIL LOG
Earl EIIIs
688-2280
Performed for: Name• 5&6 Tel. No
Mailing Address. 75 2 S F/Ifri-Lf P4 cE / 4,vc,ceo/2_, E q s o�
Legal Description. Lo7" , /Se4, 81e/v'/9-.e0
Depth (feet) Soli Characteristics
0
1 AIL of SP M'i.cep tic r iq,vo s/1wb _�d���B,
Ta,
2
3
Com ESE 86-01/ fie.
5 P ,47/t/ /7.5-0/5,g,
6 Gr P C'o4xs4 S vvi- 6/tpr�•cc,
7 SP //.v4 s�.vo - — _ i 7S'��b,,2
8
9 'g v') �¢� ✓mac_
7 .4c of Sigr
10
- /3o f/,e.
11
/111-• agNs D /6..e.
12
13
c* -17 o Yk,2,
14
15 450✓rade
16
Ground Water Encountered: Yes
56,6 v.
PLOT PLAN
A4 gd-Ac ff-
PERC. TEST
No If yes, what depth
Proposed Installation: Seepage Pit_ Drain Field
Comments.
Performed by:
Development Services Department _' Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 060-321-07-000
Expiration Date:
Legal description BERNARD BLK 4 LT 6
Site address 19120 ELNORA LN Eagle River AK 99577
Current property owner(s) INGMANSON MARGARET C
12/11/2023
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 9/11/2023
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval June 2022
pp
Development Services Department ��= r� Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 06032107000
Complete legal description BERNARDBLK 4 LT 6
Location (site address) 19120 ELNORA LN
Current property owner(s) INGMANSON MARGARET C Day phone 907-227-1859
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 10 yrs _ See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑® Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $.5 430 Waiver Fee $
Date of Payment Date ����23 Date of Payment
COSA #�G2.3 132 Waiver #
COSA Application—June 2022
Legal Description: BERNARDBLK 4 LT 6
Parcel ID: 06032107000
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 7/12/07 Total depth 240 ft
Cased to 40+ ft
Al Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 8/7/23
Static water level at beginning of test 35 ft.
Comments
B. TANK DATA
Measured operating fluid level in septic tank 50
Date of pumping 8/15/23
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/2/82
❑ ALL standpipes present per record drawing
Total measured depth from grade 11 ft (max)
Measured depth to pipe invert from grade 4 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑ Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficiencies:
COSA Checklist June 2022
Well production at time of test 4+ gpm
Water storage tank volume0 gallons
Well disinfected for coliform test? ❑ Yes ❑ Nc
❑ Coliform bacteria is Negative
Nitrate 0.251 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by NRimEng
Date 8/4/23
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 8/7/23
Results F Pass
Fluid depth prior to test 0 in
Water added 450 gal
New fluid depth 5 in
Elapsed time 30 min
Final fluid depth 0 in
Absorption rate 450 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 84 in
Effective depth used 0 in
Effective depth remaining 84 in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less khan required a if community well on lot)
Septic TanklLift Station on Lot > 100'
■❑
Yes
Community Sewer ManholeiCleanout > 100'
WYes
if No
ft
❑■ Yes
if No ft
Neighboring Tank > 100' ❑■ Yes
if No
ft
Private ewers' eptic Line > 25' ■❑Yes
if No ft
Absorption Field Qn Lot > 100' E Yes
if No
ft
Holding Tank > 100' ■❑Yes
if No ft
Neighboring Absorption Fields > 100'
E Yes if No = ft
Water Main 10'
Animal Containment> 50' Yes
if No ft
❑■ Yes
if No
ft
■❑ Yes if No = ft
Water Service Line > 10:
❑■
Yes
if No
ManurelAnimal Excreta Storage > 100'
If tank or field is under driveway comment below
Community Sewer Main > 75' [EYes
if No
ft
rol Yes
if No ft
L1 IN 1A — Served by Community Well (not on lot) or Public Nater
From Septic1Hold ing Tank and Absorption Field{s} on Lot to: (Please enter distances if less khan required)
Building Foundations > 10'
■❑
Yes
if No
ft
Surface Water> 100'[]■
Yes if No ft
Tank to Property Lime> 5'
F
Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
Q
Yes
if No
_ ft
Private Wells > 100'
E Yes if No = ft
Water Main 10'
Fol
Yes
if No �
ft
Community Wells > 200'
■❑ Yes if No = ft
Water Service Line > 10:
❑■
Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
G. CERTIFICATION & 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, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on -sate water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Nance of Firm North Rim Engineering Phoac
En-inccr's Printed am Steve Eng Datc _
OOSA Checklist June 2022
694-7028
8{15!23
OF
'*
"49TH*""
.s �.. ; ... Steve Eng . . ` to
CE -6256 .00 •
s
DocuSign Envelope ID: 793BFF1E-F051-4879-86AC-80430AC0DC27
8/14/2023 | 8:17 PM AKDT
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # OloO ' - C)-1
HAA# ��1(-1,Q(
1. GENERAL INFORMATION
Complete legal description Lo- S K Li Berv+n.rc'
Location (site address or directions) el K are.
Property owner Iq i L.Ltau) S. Jk rs Day phone
Mailing address 13.e leu .t.- 'u/a
at
Lending agency 6A Day phone
Mailing address
Agent E. v 0. Lake H42�+titaX Day phone 6 / q "lux)
Zrrc
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
.3 �Y
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:
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 e21
5. 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.
Name of Firm
o bto eti ve tat k
Address Ao
Engineer's signature
Phone 2'7 4 -.Pt 14:,
Date 11W1 1°1
6. DHHS SIGNATURE
Y. Approved for 77`x'`" &bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By
Date
' CAUTION
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 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.
72-025 (Rev. 1/91) Back MOA #21
Legal Description:
A. WELL DATA
Well type
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
La -(.1[3k4, ?.ei- &rdQ
cbo— 7/—G,7
Parcel I D - —
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing height
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
Wires properly protected (Y/N) 0
1�
FROM WELL LOG AT INSPECTION
ac
c
3>
gpm g �p
aca
W
m
"Q
N)
ro
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ; On adjacent lots
Absorption field on lot ; On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer service line Petroleum tank
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample: Collected by.
B. SEPTIC/HOLDING TANK DATA
Date installed 6/2-$ V- Tank size itro n Compartments L
Cleanouts (Y/N) Foundation cleanout (Y/N) 14 Depression (Y/N) t4
High water alarm (Y/N)
Date of pumping
Ain 4 2 -
Alarm tested (Y/N) N/A
Pu
mper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot N/A
On adjacent lots 1•4/A►
Foundation (�
To property line > 10 Absorption field 10 Water main/service line >
Surface water/drainage
72-026 (Rev. 7/91) Front
"!o
CONTINUED ON BACK PAGE
C. LIFT STATION 1 \A.
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at "Pump off" level at
High water alarm level Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed
4/01g 14.
Length '5 'i Width 3
Total absorption area 41 L.
Soil rating 14t System type TRE SCA
Gravel thickness 7 Total depth 11
Depression over field (Y/N) N
Results (pass/fail)
Cleanouts present (Y/N)
Date of adequacy test 747 9 2 -
for
for bedrooms
Peroxide treatment (past 12 months) (Y/N) If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
On adjacent Tots
N/A
Property line ? .2O
To building foundation > £3 To existing or abandoned system on lot
N/A
On adjacent lots > l vo Cutbank Water main/service line 7 A
Surface water NlG Driveway, parking/vehicle storage area ) 50
Curtain drain �lv
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect op the a1 of this inspection.
"`` •
Ace
/� r� I! �R �* Parg• y,r .��;
As a 1.4*.�1 •t.,�1a
4" s
}1•� 111
T
_1 S
Signature D
Engineer's Name
Date
l tobe.&t S furk1a1taQ F
,A
• ty'tl , a .
HAA Fee $
Date of Payment
Receipt Number 9:1-1(2.) \ 0
72-026 (Rev. 3/91) Beck MOA 21
Waiver Fee' $
Date of Payment
Receipt Number
WALTER J. HICKEL, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
August 31, 1992
Eva Loken
Remax Realty
SUBJECT: Bernard Stewart Subdivision
Class "A" Public Water System, PWSID #212754
Dear Ms. Loken:
(907) 349-7755
I have completed a review of this office's files concerning the monitoring status of the
above -referenced Class "A" Public Water System and found the following:
1. The last satisfactory Total Coliform Bacteria Sample result was submitted to
this Department on August 10, 1992. This meets the provisions of 18 AAC
80.200(a) of the State Drinking Water Regulations.
2. The last inorganic Chemical Contaminants Sample results were submitted
to this Department on January 9, 1991. This meets the provisions of 18
AAC 80.200(a).
3. The last Radioactive Contaminants Sample results were submitted to the
Department in July 28, 1988. This does not meet the provisions of 18 AAC
80.200(a), State Drinking Water Regulations.
4. The last Organic Chemical Contaminants/Volatile Organic Chemicals were
submitted to this Department on June 12, 1992. This meets the provisions
of 18 AAC 80.200(a), State Drinking Water Regulations.
Issuance of this letter does not imply that the above -referenced Class "A" Public Water
System is in compliance with other provisions of the State Drinking Regulations.
If you have any questions on the above information, please do not hesitate to contact this
office at 349-7755.
Sincerely,
—6L?f)
Keven K. Kleweno
District Engineer
KKK/cf
INSPECTION APPOINTMENTS
DA -re RECEIVED
TIME
TIME
TIME
1 e L1.0 - k'''''- -9
DATE
DATE
DATE
CO -3-S-- 1 \Y3
INSPECTOR
INSPECTOR
INSPECTOR
V`( cc CY
El PUBLIC UTILITY i o `a -i
MUNICIPALITY OF ANCHORAGE MUNI / I ILD, OF ANCHORAGE
OF HEALTH & ENVIRONMENTAL PROTEC
OF HEALTH &
825 L Street - Anchorage, Alaska 89501 ENVIR_NMEN FAL PRO(ECTIC)
SANITATION DIVISION t�,�
Telephone 264-4720 2 1982
OF INDIVIDUAL WATER ANDRHI f A DIES
DEPARTMENT
/ e
/ • r r
1 ENVIRONMENTAL
REQUEST FOR APPROVAL
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days fo processing.
1. PROPERTY OWNER
e, - h (1 Le C -c' ..
Gac(-3Y2
MAI LIbDRESS C,) -4L . a -9------
02- eCLI r oev
PROPERTY RE (DENT (If differet from abo
PHONE
,Q fle �scC-O-fJ
MAI3IN7G�RESS�0 e� �eA P rAt_
,'�C,'
9e
3. LENDING INSTIITT/UTION
(
�^
%P�O�NE (,,
MAILING ADDRESS jj
C•, - Ie J i
.._
f 4dQr 3 �_,+--i-
4. RE LT• -/AGENT cPHONE
(%
d,cc , of ci/.(
A
e,
aC � 0
-
ce- -- s s
na D (
5. LEGAL DESC IPTION
G L cf of 61c o($ctkccp6( =5 c' ,.
STREET LOCATION 1r
6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS
st® One N Four • Other
SINGLE FAMILY
■ Two IIS Five
MULTIPLE FAMILY [( Three ❑ Six
7. WATER SUPPLY
MI INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
110 COMMUNITY since June 1975. For wells drilled prior to that date, give well
101 PUBLIC UTILITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM d
l INDIVIDUAL/ON-SITE** 12 xa. YEAR ON-SITE SYSTEM WAS INSTALLED.
El PUBLIC UTILITY i o `a -i
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
.-.4,—
1. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
• SINGLE FAMILY
• ONE • THREE • FIVE
• OTHER
• MULTIPLE FAMILY
• TWO • FOUR • SIX
2. WATER SUPPLY
PERMIT NUMBER
• INDIVIDUAL
DEPTH OF WELL
• COMMUNITY
DATE DRILLED
• PUBLIC UTILITY
Connection Verified
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
PERMIT NUMBER
DATE INSTALLED
IN PUBLIC UTILITY
Connection Verified
INSTALLER
• Septic Tank or • Holding Tank
Size: If Tank is homemade
SOILS RATING
give dimensions:
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
it." -"APPROVED FOR 3 BEDROOMS
certificate)
El CONDITIONAL APPROVAL
(letter must accompany
• DISAPPROVED
DATE
3 •-ci `2.--
BY
cr..._ 04-05"-
72-010 (Rev. 6/79)