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HomeMy WebLinkAboutT12N R3W SEC 22 LT 8 S180'TI R3W Section 22 Lot 8 S180 #015-521-03 Municipality of Anchorage .-':;," Development Services Department -' '~' ~'. Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw SL P.O. Box 196650 Anchorage. AK 99519-6650 Page of www.ci, anchorage.ak, us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. ,,~,~"01071~.~c:) PlONumber. N~, T~[~ ~-..~. ~.) T ~-~ Wastewater System: DNew ~.Upgrade IOq~ 1 t~:)Ol~_ }~/~..~ ABSORPTION FIELD LEGAL DESCRIPTION --~ Well: [] New [] Upgrade ~. ~ .~ c...~..~,,,~,, c,~,,~ TANK SEPARATION DISTANCES [3 septic r-I Holding [] S.T.E.P. ~Other: Tank FietdStation TankSever Line ~//~)~ ,~. /~os- /~ /~,~-'~ ~/~ Flhtc ~1~ s"'"w"'l ~//o NI,~ .lo 5~/// ' LIFTSTATION "*~' BENCH MARK O /e/ 4-.,,t i:. I/-eJ ~' ,l,4 D~T-CO~ E Bginee~..s~mp ~.; " Reviewed and approved by Date -~ ffrell TRENCH r'-~FI' Oir ROCK OLD $~ TANK FlU. CD IfiTII U2AN CONCREI~ A AB 261:T AC, AD BD B~NCH %6IRK AT B BOTI'O~ SIDING I00.00 N 25 75 108 1£5 158 l' = 58 FT. TOBBEN 5PURKLAND P.E. 203 1~ 15TN. AVENUE ANCI'I. AK. 99501 (907) 279-3916 $180 LOT 8 SEC 22 TI2N R3~/ 10951 OUR ROAD SEPTIC SYSTEM AS BUILT DATE: AUG. 28, 2001 SHEET: 2/3 GRID: 2637 PERMIT # $V010526 PID # 015-141-57 123225B~.BVG AST/,t 3034 ~ ,-- GRABE TO BRA~N BACK FILL 3' SEVER RgCK ~l ~ STANDA£D TRENCH NT$ FDUNBBATION CLEAN ~JT ~ INSTAL L A TIgN I. EXCAVATE A I0' x 10' x 10' DEEP H~LE FOR DI~CYCLE SYSTE/~ ~ ~ACE A M~ ~ ~' ~ ~ ~A~ FOR LEVELI~ ~ IN ~ BDTT~ ~ T~ EX~VATI~ ~ ~ 4 ~TS ~ ~ x ~ x ~ ~CT ~I~ ~IGID IN~AT~ ~ T~ ~ ~D LEV~I~ C~ TO ~CT ~T~ ~ FI~ASS fA~ T~E EXTRA C~ Tg ASS~ T~T I~AT~ C~ IS LEaL IN ALL DI~C~S, 4. ~ILL ~D TA~ ~ TD INVER~ ~ 4' ~L~NT ~ 1-I/4' ~NT LI~S ~I~ ~E-FLDVI~ ~F MA~I~ ~ ~ L~ ST~2 ~ ~ CAP END 1-1/4' SCHEB]LE 4B PVC V/1/8' HOLES 8 30" SANB/GRA VEL BACKFILL ]0 MONITOR TU~E MINUS $£VLrR R~CK 49th 20:7 HI 15171. AVENUE ANC/'/. AK. 99501 $180 LOT 8 SEC 22 TI2N R:THI 10951 OUR ROAD SEPTIC SCHEIWATIC DATE: AUG. 28, 2001 SHEET: $/:7 GRID: 26:77 PERMIT # 2V010326 Piti # 015-i41-57 12322S83,flVG ~u~ a80l lOi37a · .Ha;il~ Elsenbast ~463559 p.1 P: TYPE OF IN.~PECTION; [~NCO0 NONCOMPLIANCE OBSERVF..D · ,[ ] ~ ~-~1< AT N~ L~ION [ ~ DO NOT,CONC~L U~ COM~E~S;.(FOR I~P~OR USE ONL~ INSFECT(~R ~ CORRE. C'TIONt~ ARE MADE pLEASE CALl. FOR RF-INS PECTJON DO NOT REMOVE THIS ~OTI~E 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 WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 17, 2001 Expiration Date: Aug 17, 2002 Permit Number: SW010326 Legal Description: T12N R3W SEC 22 LT 8 S180' Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Ted Kruth Owner Address: 10951 Our Rd Anchorage, AK 99516-1637 Pamel ID: 015-521-03 Site Address: Lot Size: 59400 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Aiaska 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. Date:f Date: E -17- I Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorag e,ak.us (907) 343-7904 Parcel I.D. ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING <-- ,~',~-I -~ ~:~i -'~ ],] ~, - ~ Permit Number~ Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size ~/-'~/~)0 Acres/G Day phone Zip Code I/3O 7 Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Well Only Water Storage Jacuzzi Water Softening Unit I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signatu~'e of property owner o/authorized agent) ~- Permit Fees: Date of Payment: Receipt Number: (Rev, 12/00) Waiver Fees: Date of Payment: Receipt Number: T. ?UF KLAND ?.E. 203 W 15th. Avenue, Suite 203 ANCIIORAGE, ALASKA 9950 I (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN S180 LOT 8 SEC. 22 TI2N R3W 10951 OUR ROAD Municipality of Anchomge Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Aug. 7,2001 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and thc adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to Ihis permit application, (sheet 2/3), and a schematic ofthe septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: No Groundwater or Impervious Soil to 14 Ft. Use Standard with BioCyele Soil Rating. From Testhole 08/01/01. 7 rain/in = 3 gal per sq.lt/day No. of Bedrooms 4 Required Area per Bedroom: 150/3 = 50 sq.ft. Total area required: 50 x 4 = 200 sqfl Bottom Rock At 8 feet Top Rock At 3 feet Rock Depth 5 feet Total Trench Length 200 /I 0 -- 20 USE 40 let SYSTEM CONFIGURATION BIOCYCLE STANDARD TRENCI! TOTAL LENGTII 40 let TOTAL WIDTH 2 FT TOTAL DEPTtl 8 FT ROCK DEPTII 5 let COVER 3 FT The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the genera!slope of the area. Ponding and/or concentration of surface runoffwillnotresultfromthlsinsta aton. ~t~.~,c..~'ys'~.~,'~ o'q~(J~"~ 4a'~. ~ ~q" Performed For: Legal Description: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw SL P.O. Sox 196650 Anchorage, AK 99519-6650 www d.anchoraee.ak.us (907) 343-7904 Soils Log - Percolation Test g~T ~¢~ Township. Range. Section: Slope Site Plan 1~-- 2- 3- 4. 5- 6- 7- 8- 9- 11. 12- 13. 14. 15- 16- 17- 18- 19- 20- COMMENTS Hr-. WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE 7 (ntn~e'~nchl PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT ANt:) ~ FT PERFORMED BY: T, -~' I I r CERTIFY THAT THIS TEST, W~.S PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/I/~) I ll'M~LL£¥ £DAB I I I 7 N ~ gell 100 FT. TOBBEM SPURKL4MD P.E. 203 W 15TH. AVENUE ~MCM. ,~. ~gsol (907) 2n-~9~ PERMIT # SVOIOXXX PIB # $180 LOT SEC 22 1'12M R3W 10951 OUR ROAD 015-141-57 SEPTIC SYSTD, I fiESlaM DATE: AUG. 7, 2001 SHEET.. I/3 aR/fi: 2G37 No. CE-a;~L~ [TOBBEN SPURKLAND P.E. 203 I~ 15TH. AVENUE ANCM. AK. 99501 (907) 279-3915 PERMIT # SVOIOXXX $180 LOT, 8 SEC 22 TI2N RJP/ 10951 OUR ROAD P1B # 015-141-57 IISEPTIC SrSTE~ DESmN DATE: AUG. X, 2001 · SHEEr: 2/3 GRID: 2637 ~...,. 1232£282.BVG IZ7UND~TIZ~V~E~OUT--~ ~-1/4' $C7~L~.£ 40 PVC VI 1/8' I~L£2 ~e ~ 0 o. ~ S180 LOT 203 IF ISIX. AVENUE II SEC 22 TISN 279-3916 ~u~ PERXIT ~ ~o~ PIB ~ DESIGN DM'E: AUG. 7, 2001 SXEEI'.. $/3 CRIO: 2637 NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 254-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE (~NEW ~.~'~ ~.,O~ O [] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION Liq. capacity in g lions I ')---5 ~ F HOMEMADE DIBTANCE TO: Manufacturer DISTANCE TO: Well],~ o ~- Length Width Type of crib Crib diameter DISTANCE TO: Wail I Absorptigarea Dwelling Material Width Inside length Dwelling IMaterial F oundation~_ f¢3 Nea reit I o~ line Totall ~len~:~th of lines Trench[~v~'~h inches Material beneath tile inches Depth Crib depth Total effective absorption area Building foundation i Nearest lot line Driller Distance to lot line Sewer line Septic tank NO. OFBEDROOMS PERMIT NO. No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons Distance between lines ~:~ ~ Total effectivel~o~tion area IPERMITNO. OTHER PIPE MATERIALS ?-¢~ SOl L TEST RATING INSTALLER REMARKS APPROVE D DATE LEGAL 72-013 (Rev. 3/78) PERMIT NO. H~L:F, ~RRuE ~ILI~ I CI:~FtLIT'~" OF -- ~ :~ ~ DEPARTMENT .. HEALTH AND ENVIRONMENTAL ,.ROTECTION 825 'L' STREET~ ANCHORAGE, AK. 93501 264-4728 ~4ELL R[4['a mii~4--SlTE ~.EL4ER PERF4 IT RPPLICANT LOCATION LEGAL THEODORE R KRUTH SRR BOX 16~O-T 99507 51 ol Ti2NR~W S22 L8 ( - ) LOT SIZE 276-2010 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRRINFIELD MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT?BR)= 270 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [)EF"TH= 6 LE~-tGTH= ::L E:2 GRAVEL [-~EPTH= 2 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE TRE~4CH W ICCTH IS 5. 888 FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE 80TTOM OF THE EXCAVATION (IN FEET). REm=~.U I F-:EB, SEF'T I C TRI'4F-':. $ I ZE= -! 25~-] GRLLOI'-iS 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 THRT THE WELL WILL SERVE. T~O (2) I[4SPE£:TIOF~$ RRE REG--HJIRED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND RNY ON-SITE SEWAGE DISPOSAL SYSTEM IS ±00 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMLIM DISTANCE FROM R PRIVRTE wELL TO R PRIVATEC_,EHER. ' LINE IS o=~._, FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGR8MS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F"EI~:M I T E::-.'P I RES [)ECEI'IRER ~-1. -1 £--~E: -3 I CERTIFY THAT ±: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I 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 4 BEDROOMS. S I GNED. __~__~_~____/~___~ ............ RF'PLIC:ANT THEODORE R KRUTH ~ TM j ISSUED B~'~~--~-I:~ ................. DRTE_d~J:_-~~-- V4.0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST 1 2 3- 4- 5- SITE PLAN 10- 11 13 14 15 16 17 18 19 2O COMMENTS WAS GROUND WATER ~ ENCOUNTERED? ~'~O ~ E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time ~ Water Drop ~'z:O~ :30 I0 ,5"? * 07 PERCOLATION RATE CERTIFIED BY: ~9 (minutes/inch) )~'~ FT AND ~ FT ' 72-008 (6/79) SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 350 Fee. L° DRILLED AT THE RATE OF .79~. 0~ _ PE~ FOOT. F~. T~. 7~z 27~-2070 354-5085 PROPERTY OWNER WELL LOG: ~? .....g5' C,~za,~oL ~aFo% 40¢ c,lz,~, 2J~de&. MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ~NVI RONM.':- NTAL PROJECTION APR 5 1983 RECEIVED COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ¢(~0,50o O0 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS SERVICE CHARGEOF 1Fz% PER MONTH WILL A ~ DATE o ...._ i, ~ MUNICIPALITY OF ANCHORA(~ ~-~( /~, . Department of Health and Environmentai Pro~eq%~.~n, -~~[ 825 L Street, Anchorage, Alaska ~[.~[,~ ~:~  / 264-4720 ' ~Hequest for Approval of Individual Sewer and W a' 1. PropertY Owner: ~_ ~ ~ Mailing Address:~~.~ ~ /~/ Phone: 2. Name of Buyer: Mailing Address: Phone Lending Institution: Realtor/Agent: Mailing Address Phone: Single Family Residence: ~'~ Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: * Individual Well ~ Public/Coi]ununity System If Individual Well, well depth_/~'~__ If Conm]unity System, name of system ( ) 8· Sewage Disposal Sys'tem: *~Dn-site System (/'~Public System ( ) If On-site System~ date of installation: ~b/~2/~ *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over Ewo(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 Page Two Department of Health and Eavironmenhal Protection Request for Approval of Individual Sewer and Water Facil-[~ies Legal Description: T12N R3W Section 22 Lot 8 Comments: Affadavit Attached: Approved:~_'~ Disapproved: Letter Attached: ) Date: Department Worksheet: Maintenance Agreement Instructions: The Maintenance agreement must be signed and notarized by the buyers. Below are instructions for the Blanks that must be filled in that are not readily obvious. Call me at 279-3916 if you have any questions. 1. Advanced Wastewater Treatmem Systems. (AWWTS), described as BioCycle located at10951 Our Road, Anchorage, AK 3. Fee. Owner shall pay to the Municipality an annual fee of .....ZERO, ($.0.....00), payable on or ..... 6. Maintenance and Repairs. B. Operating permit is: ANNUALLY Municipality of Anchorage Development serVices Department Building Satiety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Expiration Date: GENERAL INFORMATION T12N R3W SEC 22 LOT .~r's t 80' complete legal description Location (site address) 10951 OUR RD., ANCHORAGE, AK 99516 Current Property owner(s) KONI ARNOLD Mailing address 'Day phone Len ding agency -Day phone Mailing address Real Estate'Agent Mailing AddreSs MARY STEPHENS Day phone 748-5579 Unless otherwise.requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well [] [] [] [] TYPE OF WASTEWATER D, IS~OSAL: . / . ..,~ b "; ?!" Individual On-site [] Individual Holding Tank [] Community On-site [] 'Public Sewer · [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and maY be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells Or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Spurkland Enginneering Phone 279-3916 Address 203 W. 15th Ave., Ste 202, Anchorage, AK 99501 Engineer's Printed Name Lars Spurkland DSD SIGNATURE ~Approved for Disapproved. Conditional approval for ' Date 8/15/2011 bodrooms, with tho followin~ stipulations: By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~'~' ~'~ (-~" / / (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHEC Legal Description: 'T'l~,¥ ~.5~' SC-C. 2_7. LoT ~ $ igO . Parcel A. WELL DATA Well type r~., If A, B, or C provide PWSID # - Well Log (Y/N) Date completed 5 / ~-]~, 7_ Sanitary seal (Y/N) ¥ Wires properly protected (Y/N) Total depth :~SP~ ft. Cased to _3'.~.~ ft. Casing height (above ground) t-/8 in. FROM WELL LOG AT INSPECTION Date of test 5/'~z/%~- ~/tb/, I ' Static water level ~0 ff. 7_~1 ff. Well production {L~ g.p.m. ~,._~ g.p.m. WATER SAMPLE RESULTS: Coliform /'J~, colonies/100 mL Arsenic: /q~ ug/L date of sample: . . B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~)ic Cyc\-c/~"; D~,.7__~ I~5 Tank size IL~UO gal. Nitrate . N ~ . mg!L Number of Compartments L~ Date installed Cleanouts (Y/N) Foundation cleanout (Y/N) ~ '~/ Depression over tank (Y/N) fY' High water alarm (Y/N) '?' Date of pumping Pumper C. ABSORPTIoI~'I~IELD DATA' Date installed ~/~'~]Oi Soilrating (g.p.d./ft2er.~-.!b~..d~. ".~ Length H© ft. Width Total depth ~;~ ft. Date of adequacy test ft. Eft. absorption area ~/C0 ft2 Monitoring tube "'/ ~)i~/, t Results(Pass/Fail) ~'~5 __ in. Water added 5~X~ gal. System type Gravel below pipe Fluid depth in absorption field before test Final fluid depth ~ ~ in. Depression over field A/' Elapsed Time: i~Z min. Absorption rate >= For ~ bedrooms New depth G 2_ in. (~r.,C g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) A/c If yes, give date LIFT STATION Date installed ~/7-¢ lo I Size in gallons i o0 "Pump on" level at ?_.5 in. "Pump off" level at ~/~/lz in. Datum [~J¢~- Cycles tested v/' E. SEPARATION DISTANCES Manhole/Access (Y/N) "/ High water alarm level at ~_Z ~/? in. Meets alarm & circuit requirements? Y'c.~, SEPARATtON DISTANCES FROM WELL ON LOT TO: t Septic tank/lift station on lot IO0 '+ On adjacent lots Absorption field on lot lO0 ~- On adjacent lots JOG + Public sewer main A//~, Public sewer manhole/cleanout Sewer/septic service line Z5 i~. Holding tank A//A Animal containment areas 50 ~- Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~_5 Property line _r~ ~_ Water main ~//.A Water service line Wells on adjacent lots 10¢ ~+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line lot,- Building foundation Water Service line iO'~- sUrface water leo' Curtain drain .5c, + (/A/, ~ "/ Wells on adjacent lots tOO, Absorption .field Surface water Water main l'//-~ Driveway, parking/vehicle storage F. COMMENTS I certify that I have determined through field inspections and review of Municipal records that the above systems are in r °2."~O TN~''' conformance with MOA COSA guidelines in effect on this date. "'~2' ...~.~T~, Engineer's Printed Name LA¢,5 ~'i3uP. kl(~c/ ..~_...~,.~_~ .k% ~.ii' · ' ' · Waiver Fee $ Date of Payment ] ' Date of Payment Receipt Number O?- "~ ¥?' L~ .~ Receipt Number (Rev. 4/10) Q LOT LOT <~ $~.pT/O ~ b WAY 7~IOCYCI..E [] .,?EPTI C TANK L£SAL DE$CRIPTIO'V A PARCEL OF LAND IN LOT ~ OF: THE ",z:t~TTSR LINIT _5'~0. ~2, ~I2,,V., ,q. $ W:., S.A,~., A/_AS~A.; ~GINNIH~ AT TEE .gDL/FHYv'E37' CO~.tVEt~ OF ~v'O LOT ~; TH~ EAST OAI THE b"OUYtd U~/E OF SAID LOT ~ 7'0 Tt-t~ EAST LINE _~AID LOT; THENCE NORTH ON SAID EAST UNE I~OFT. TO A FOINT; THENCE WEST~ PAj~ALLEL TO ,SAID b-t~UTH Tt!~ VY~$T LINE O~. ~A/D LOT~ T/-YENCE .6~.T/-/ OF SAlX:2 t{VE57" Z.//VE TO T/-/£ ,,°OIA/T OF ~EG/,,V,~t/M~.~ Lot , Block Anchorege Recording Distric--~, Aiasko LOT SURVEY CERTIFICATION I hereby certify that I hove surveyed the property eho~n and described hereon, and that tile Improvements situated thereon are within the prop- erty lines and 40 not overlol~ or encroach on adjacent property an~l that no improverne~t~ on adjacent property overlap or encroach on the premises t~ question and that there are ~o roadways, utility lin#, or other visible easements o~ enid property except ae in,looted hereon. Easemonts of record other than those ehown the plat of record ore not shown hereon otherwise noted. LEGEND Brass or Aluminum c~pped monument recovered 0 Iron pipe end/or reber recovered. [] 2 x ~ hub & tack recovered 5/8" x :50" rebcr set this survey Scale /#o Ret Date © F.B. No. 0/-0 5 Prepared by: (,9072279-6~00 ~ L. BUTTON .Registered £ond Surveyor 519 W. Eighth Ave. Anchorage Al~k~ 99501 Proper,;, o,: ~)06~/r7~ AmO/U BioCycle Alaska 4971 Thompson Drive Homer. AK 960o 226-2476 office o :))-0.~31 cell Email: biocyc!ealaska~gci.net Customer Dr. Robert and Konstance Arnold 10951 Our Road Anchorage, AK 99516 345-7460 1st Qtr Maintenance 2011 BioCycle Location O'Malley Install Date: August-01 Tank Ct: ¢t¢ MAINTENANCE DESCRIPTION PRIMARY CHAMBER SC[IM I.t';V]2, /OKi; FflGit AERATION CHAMBER & AERATION SYSTEM IBLOWER SIZK Ai_{I~'\TION PRI NOISE LNVEI, G I,;NE]~I., CONI )]'I'I()N SYSTEM: AH~ LEAKS AIR DWI;'[JSNIUAIII SIJPPI,Y MIXED LIQUOR CONi)tTION O1)OR 60 S( 120 IJMiN . oK i-E[GI:t LOW ()K, PO()R 'OK '7 I.EAKS :,~o ', yr!s CLARIFICATION CHAMBER SI.UDGE ACCUM IN CI,ARITY OF I 1: ' IJI~NT DISCHARGE CHAMBER DISCIIAR£}I'i PUM]) OI>F.I>~&TING N () ALARMS CHECKED AND OPERATING ,. ..... , AJIU'POW}'; R ,,Yi i S ", IIIGH WA']'Etl [YES .: NO NO COMMENTS 1st Qtr 2011 .Maintenancc was pcrtbrmed today BY:__ LARRY BETTS DATE: BioCycle Alaska 4971 Thompson Drive Homer, AK 99603 226-2476 o£fice 399-0331 cell Email: biocyclcalaska~gci.net Customer Dr. Robert and Konstance Arnold 10951 Our Road Anchorage, AK 99516 345-7460 2nd Qtr Maintenance 20t t BioCycle Location O'Malley Install Date: August-01 Tank #: gg MAINTENANCE DESCRIPTION PRIMARY CHAMBER SCIJM LEVEl, ,;'"OK ) HIGII AERATION CHAMBER & AERATION SYSTEM ... ,~ BLOWER SIZE . 60, (84Y 120 L/MIN AERATION PRESSURE ,OKi' HIGH LOW NOISE LEVEL OK,; IIIGH GENERAI, CONDITION OK" POOR SYSTEM: AIR LEAKS OK.! LEAKS AIR DIFFUSERJAIR SUPPI,Y '~:()K.: POOR MIXED LIQUOR CONDITION ODOR ~.NO .,~ YES CLARIFICATION CHAMBER SI,UI)GE ACCUM IN HOPPER CLARITY OF EFFLUENT LOW ", I.[IGH CLEAR,, FAIR CLOUDY DISCHARGE CHAMBER DISCHARGE PUMP OPERATING NO ALARMS CHECKED AND OPERATING ' AIR/POWER ~ YES '~i NO COMMENTS 2nd Qtr 2011 Maintenance was performed today BY: LARRY BETTS DATE: ({ BioCycle Alaska 4971 Thompson Drive Homer. AK 99603 226-2476 office 399-0331 cell Email: biocyclealaskaO~gci.net Customer Dr. Robert and Konstance Arnold 10951 Our Road Anchorage, AK 99516 345-7460 3rd Qtr Maintenance 2011 BioCycle Location O'Mailey Install Date: August-01 Tank #: #¢ MAINTENANCE DESCRIPTION PRIMARY CHAMBER SCUM LEVEL AERATION CHAMBER & AERATION SYSTEM BLOWER SIZE AERATION PRESSU RE NOISE I.EVEL GENERAL CONDITION SYSTEM: AIR LEAKS AIR DIFFUSER/AIR SUPPLY MIXED LIQUOR CONDFI'ION ODOR HIGH 60 i'~'~) 120 L/MIN HIGH LOW '~ POOR LEAKS POOR YES CLARIFICATION CHAMBER SLUDGE ACCUM IN IlOPPER CLARITY OF EFFLUF. NT CB~',,k HiGH \ / / "YES i NO DISCHARGE CHAMBER DISCIIARGE PUMP OPERATING ALARMS CHECKED AND OPERATING/~.. AIR/POWER [ Yli~\ ttlGH WATER { yESt} NO NO COMMENTS 3rd Qtr 2011 Maintenance was perfbrmed today' BY: LARRY BETTS DATE: BioCycle Alaska 4971 Thompson Drive 9 ~ Homer. AK _ 9600 226-2476 office 39%0331 cell Email: biocyctealaska~gci.net Customer Dr. Robert Arnold 10951 Our Road Anchorage, Ak 99516 345-7460 4th Qtr Maintenance 2010 BioCycle Location O'Malley Install Date: August-01j Tank #: # 114 MAINTENANCE DESCRIPTION PRIMARY CHAMBER SCUM LEVEL f)K ", ItlGH AERATION CHAMBER & AERAT1ON SYSTEM BLOWER SIZE 60 80 1120 L/iMiN AER.,,VI'ION PRESSURE OK 5. I. tlGll LOW NOISE LEVEL OK .., HIGI:t (iENEI, b'kL CONDITION O1.:. ."POOR SYSTEM: AIR LF, AKS OK ..LEAKS AIR DIFFUSER/AlP, SUPPI.Y QK POOR IMIXED MQUOR CONDITION OI3OR NO ;YES CLARIFICATION CHAMBER SLUDGE ACCUM IN 140PPER CI.ARITY OF EFFLLrENT LOW "HIGH '..CLEAR ~'AIR CI,OUDY DISCHARGE CHAMBER DISCIIARGE PLIMP OPERATING YES NO ALARMS CHECKED AND OPERATING - AIR/POWI]R YF.S HIGH WATER NO NO COMMENTS 4th Qtr 2010 Maintenance was performed today BY: LARRY BETTS DATE: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. GENERAL INFORMATION Complete legal description ~:~ J Location (site address or directions) Current Property owner(s) Mailing address HAA# ~/.,/2~ Expiration Date: Lending agency T[~ED '~-~.0 T-t-i- Day phone Day phone Mailing address Real Estate Agent Mailing Address Day phone ¢-7b / Un/ess otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: t.~ TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of flue (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new Water sample results less than 30 days old. (Certificates may be reissued for a Period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm Address ~ ~J~ Engineer's Printed Name ~~ DSD SIGNATURE ~ Approved for L'IL Disapproved. Conditional approval for Phone ~-'Tq-s~ I J~ Date bedrooms. bedrooms, with the following stipulations: Additional Comments ~.~: WATER AND '--- WAST:vw, ~-, ~ : PROGRAM '... Attachments: HAA Checklist Septic System Advisory We[] Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 12/0o) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bregaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type .~ II , Date completed .~,~.~_ Total depth ~"O ft. IfA, B, or C provide PWSID # H~. Sanitary seal (y/N) 7 FROM WELL LOG Data of test ! ~/~-7,//~ ~ Static water level ~ ~ C) ft. Well production I ~ g.p.m. Well Leg (Y/N) '/ Wires pmpedy protected (Y/N) Casing height (above ground) AT INSPECTION ft. /7/, ~" g.p.m. Y WATER SAMPLE RESULTS: Cotiform _~colonies/100 mi. Nitrate N ~) mg./l. Date of sample: ~ Collected by: B. SEPTIC/HOLDING TANK DATA 'Tank Typ~/Matarial ~ IOC'/£ I.- Tank size /_~O gal. Number of Compartments Foundation cleanout (Y/N) _.~ Depression over tank (Y/N) Date of pumping )"tl//~ Pumper Other becter~a ] colonias/lO0 mi. Data installed ~'/,~L'7/~ I Cleanouts (Y/N) ~ High water alarm (Y/N) y C. ABSORPTION FIELD DATA 'Datainstelled ~/~//D/ Soilrating (g.p.dJ~-..'?-.~d..."m,~_."~ Systemtype Length q O ff. Width ~ ff. Gravel below pipe . ~-7 ft. Date of adequacy test 1~//'3~- Results (Pass/Fail) Fluid depth in absorption field before test [/'/'~. Water added Elapsed Time: b~min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) Depression over field For ZT/ bedrooms New depth ~ Absorption rate >= ~ g.,~d. If yes, give date D. LIFT STATION Date installed ~ Size in gallons ~ 'Pump on" level at ~ in. 'Pump orr level at ?~r.,in. Datum I~,f~,~'- Cycles tested ~ Manhole/Access (Y/N) %'/ High water alan'n level at ~ in. Meets alam~ & dmult requirements? y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Sepuc tenkailt station on lot ~0¢)~ ~ Absorption field on lot I f~ Public sewer main ~"~/,~' Sewer/sepuc se~ice line ,~ I ~ Building foundation Water main Wells on adjacent lots On adjacent lots On adjacent lots Public sewer manhole/deanout I"~/~_ SEPARATION DISTANCES FROM SEPTIC/NOLDING TANK ON LOT TO: Properb/line. ~) Absoq:)tion field ~ ~ Water senace line ~' ~-~ , Sun'ace water t'~ I C7 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~:) C~ Building foundation :~ -~ Water main WaterServiceline ~')~,~Surface water ~"~t (~ Dfiveway. palY, ine/vehictsstorage ~) Curtain drain /'~ [ 0 Wells on adjacent lots ~/~ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have deten'nlned through field inspectJona and rev/ew of Municipal records that the above systems ere/n conformance with MOA HAA guidelines in effect on this date. Engineer's printed Name '~J~J~¥'/~ ~1i~' V.~,41- HAA Fee $ ~(~:~ Date of Peyment Receipt Number (Rev. 12/00) Receipt Number 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 I ~-~ ~ - .~,-] HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) / Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: z~ TYPE OF WATER SUPPLY: Individual well )4 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 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that :ny 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 Phone Address Engineer's signature Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 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/gl) Back MOA #21 Municipality of Anchorage ~ Department of Health & Human Services r HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type'~t'JA'~-~ Log present (Y/N). Total depth "~ Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed /~oV¢ J~f~?~ Driller Casedto ~,S'o Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION ~::~.-.~,--q ~.. MUNICiPALITY gF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION OCT 0 5 1992 g.p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /Oo Absorption field on lot Public sewer main Sewer service line ; On adjacent lots. ; On adjacent lots /OC) 'f- Public sewer manho e/cleanout P,etro eum tank WATER SAMPLE RESULTS: Coliform - 0-' ' Date of sample: q'- Z~-O~ Nitrate Collected by: Other bacteria SEPTIC/HOLDING TANK OATA Date installed ~/~'7-- Tank size I'Z,.~' ~ Compartments Cleanouts (Y/N) [ Foundation cleanout (Y/N) { Depression (Y/N) High water alarm (Y/N) ~-LO Alarm tested (Y/N) Date of pumping ~ ~'l~" °J 2-- Pumper SEPARATION DISTANCES,F~OM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage Absorption field '-~- ~t~c Cc Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ~ //~ Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) ' "Pump'off" levbl 'at 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 ~' Length /~¢ 40~ Width Total absorption area / ~'~"~ Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) NC O SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ¢c~ 'f' On adjacent lots ,,'¢o 'fl To building foundation /"/C~-~ -~ Cutbank On adjacent lots Surface water Curtain drair~ Soil rating '7-':~O $1~/'BKL System type '"~fze.,,¢ c1¢ ~,k Gravel thickness '~ ~ Total depth ~z ~..~, Cleanouts present (Y/N) "¢¢-'¢ Date of adequacy test ?-.~--~ ~- for /1/ bedrooms If yes, give date '~'~/~ Property line /! '~' Driveway, parking/vehicle storage area ~,r~:o~-~. To existing or abandoned ~ystem on lot /x~ {A Water main/service line E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelihes in ~ffect on the date of this inspection. Engineer's Name Date l ~--,~'-~-- ~. HAA Fee $ / ~'¢-') Date of Payment Receipt Number 72-026 (Rev. $/91) Back MOA 21 Waiver Fee:$ Date of Payment Receipt Number Architecture · Engineering * Land Surveying Anchorage · Planning Fairbanks S:t o ~z~ Wq Project Title I (~.'h-~ K~~-~ ~.5 I~-0~,,~ ~ Page Title -~,4-'7=~ E-t*4~ -'~_E~' ,, W.O. # Date ~ ~"--~ ~- By ~ Page LOT 0 0 Ee.4' 1 8,0.0' _11 Box 1369, STAR ROIJ~E A ANCHORAGE, ALASKA 99502 8~-~14 {~ SIX INCH WATER WELL DRILLED AND CASED OUT TO THE D~PTH OF ~0 ~e.~. DRILLED AT THE RATE Of .5~9~, 00 PROPERTY OWNER PER FOOT. 27~-2010 354-5085 LOCATION OF WELL SIT~ DRILLER WELL LOG: 0 ..... 23 ' 23 .... 65 ' J---11, 115--172' 172--26.5 ' Z5--.345' 7a.'.n.~ .oZ2~l~. n~.cweZ. 207/, ~o~cb. Cot~oo tve~. ~,. q~.v~t. I 1/2 ~.2~2 ~o 25?fil {f~ o~ ~'~. wt 172 Co~ o~;~ ~2d..U~b'~9: ,.~23.00 ~e~z ~ooi X 350 7e.~: ,~8050o00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PaYabLE TO RAMPART DRILLING WORKS FOR THE SUM OF ~80g, Oo O0 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS SERVICE CHARGE O F 1~% PER MONTH WILL A ~. DATE APPLIC-'NT FILLS OUT UPPER HAI.~ONLY Address Phone Lending Institution Address Zip Code Really Co. & A~nt Phone Address ~ Zip Gode ~ Multiple Family Water Supply ¢/~ ¢ ~ Individual Year IndivMual Installed: ~f),/; i ~ ~2 ~ Time Time Time , Tim& ~C4 d~ Inspec or Inspector Inspector Inspector Field Notes: ~ ~ MUNICIPALI~ OF ANCHORAGE DEPT, OF H~ALTH ~ ~. ENW~QNM~NTAL PROTeCTioN APR 5 R[CEIV[D (~ APPROVED BEDROOMS 'CONDITIONS OF APPROVAL Soils Raling Date ~wer Installed Well To Absorption Area ~/~ / Well Log Received 72-023(31~2)