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Home My WebLink AboutROCKHILL BLK 1 LT 8 ... Municipality of Anchorage Page l of .-~ " DEPARTMENT OF HEALTH AND HUMAN SERVICES -' ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 * 'Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Dispo. sal System. and/or Well Inspection Report Name: Wastewater System: [] New I~Upgrade AddreSs:Phone: b-~ I '~:~A]P--;]P--.-~'~) ~X,,'/~'e/.~No. of B cms: ABSORPTION FIELD [] Deep Trench [] Shallow Trench [] Bed [] Mound'01~_Other LEGAL DESCRIPTION !Sol, Rating: Total Depth from original grade: GPD/Sq. Ft. Lot:~ .~ BIock:~ I ~- ~) ~Subdivksi°n:~,~.- ~ 1 ~ ~,~ Depth to pipe bottom from original grade: Ft. Gravel depth beneath pipe Ft. nj~i~.', J R ge: Se ion: Fill added above original grade: Gravel length: Upg rede Grave~ width: Number of lines: Distance between lines: WELL: New Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. SQ. Ft. Driller: Date Drilled: Static Water Level: Installer: Date inst~lled: Yield: Pump Set at: Casing Height Above Ground: GPM Ft. Ft. TANK SEPARATION DISTANCES ,~Septic [] Holding [] S:T.E.P. To Septic Absorption Lift Holding 3ublic/Private Manufacturer: ! Capacity in gallons: Wel¥ ~j~., Material: ~.~.~ ~t Number of Co.~artments: Surface Water ~,~4~ LIFT STATION Lot.~^ i size in gallons: I Manufacturer: Line Foundation j~'l "Pump on" level at: "Pump off" level at: I High water alarm at: CurtainDrain N~Vl ~ Pump Make & Model I Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: I Assumed Elevation: Inspections performed by: /~'~ Dates: 1st ~ & Department of Hea ih and } ices approval ,-~- Reviewed and approved by:~ [~q~ Date: '~['~/% ALTERNATE DISPOSAL TRENCH TOTAL LENGTH: 50 FT TOTAL DEPTH 10 FT EFFECDVENOCKDEPTH 5 FT G£. 92Y_ PERC G 10 0 I 0 20 50 SCALE: I": 20 FL 4O 5O 6O 1250 GAL GREER TANK SWING TIES: AC 12 FT £C 8.4' AD 18.5 BD 15 AE 21 AF 44 BF 41 AG 99 BG 97 BENCH MARK 1250 GAL. SEPTIC TANK ~. No, CE-2225 ¢ ~ ~'" ............... TOBBEN SPURKLAND P.E. II II 203 W 15TH. AVENUE ANOH. AK. 99501 (907~ 279-3916 LOT 8 BLOCK 1 ROCKHILL S/D OAILE STOVER 622/ BARRY AVENUE 91.11 INKELEV. 90.47 BENCH MARK: '~ :J~ "' BOTTOtd SIDING 6. :: ASSUMED: ELEV. I O~:O0. :FT - - P.z -'L SHEET: 2~Z GRID: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~EOA-DE~CRIPT,ON: 1 2 ¸11 - 14 15 16 17, ~,L) 18- 19- 20 COMMENTS DATE 'PERFO J~e) ,~ j~ownshiPl Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? :1 N S L IF YES, AT WHAT O DEPTH? p E Depth to Water After/ J ~'/0/~__~ Monitoring? ~1¢ ~.~ Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE J~) (minutes/inch) PERC HOLE DIAMETI~R__" ~:~ I! TEST RUN BETWEEN ~- FTAND -~Y~-- FT P~RFORMED BY: "~__ ,~ AOCOROANCE W,TH ALL STATE AND M~N,C,PAL ~,DEL,N~S,N E~EOT OH TH,S DATE. OATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~To V ~___'~ ,. ~,~ t/~ I L. LEGAL DESCRIPTION: LoT ~ '~V.. t. ~-ocl/- t41LL {~IJ~[~WAS GROUND WATER ENCOUNTERED? 1 2 3- 4- 5- 6- 7 8 9 10 11 12 13 14 15 16 17- 18- 19- 20- DATE PERFOF Township, Range, Section: COMMENTS ~oTToot~ o ~ S IF YES, AT WHAT ~) DEPTH? p E Deplh to Water Alter bl0nil0ring? Dale: SLOPE SITE PLAN A Reading Date Gross Net Depth to Net Time Time Water Drop PERCOL~TIO~ ~TE ~ (minutes/tach) PERC HOLE DI~UETER TEST RUN BETWEEN FT AND FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN PERMIT NUMBER:SW960011 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:STOVER GAIL F OWNER ADDRESS:6221 BARRY AVE ANCHORAGE, ALASKA 99516 PARCEL ID:0!536216 LEGAL DESCRIPTION: ROCKHILL BLK 1 LT PAGE ~ OF ~ OF ANCHORAGE 0,4~66~.6~/, \~z~ ~ MUNICIPALITY DEPARTMENT OF HEALTH AND HUMAN SERVICES C_~.~'~-__ P.O. BOX 196650, 825 "L" STREET, ROOM 502 ~ ~- ANCHORAGE, ALASKA 99519-6650 Q~_. /~ ~O~ t~/~? ~7~, ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT~-~O'k~'~ £~'~t~ 76~ DATE ISSUED: 1/23/96 2/1'1~( EXPIRATION DATE: 1/23/97 LOT SIZE: 49031 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE iN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. 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) . THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: PRIOR TO RECEIVING FOUR (4) BEDROOM APPROVAL FROM THIS DEPARTMENT, THE FOLLOWING PROVISIONS MUST BE MET. 1. PERFORM ADDITIONAL SOILS/PERCOLATION TESTS AC- CORDING TO AMC 15.65.060.B FOR THE EXISTING TRENCH (NEAR S.W. END) AND FOR A FOUR BEDROOM ALTERNATE DISPOSAL SYSTEM. 2. DESIGN A REPLACEMENT SYSTEM AND SHOW THE DESIGNATED REPLACEMENT SITE ON THE ASBUILT DRAWINGS. 3. INSTALL THE REQUIRED CLEANOUTS TO THE EXISTING SYSTEM AS DESCRIBED BY AMC 15.65.050.C AND DATE: DATE: T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 RECEIVED Municipality ol Anchorage Dept. Health & Human Services Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Decernber7,1995 Subject: Septic System Approval Lot 8, Block 1 Rockhill S/D Gentlemen; A septic system was installed on this lot in 1981 under permit # 810135. This is a 3 bedroom system. The house is a 4 bedroom residence and the system needs to be upgraded. The As Built shows the drainfield to be 340 square feet. However, the dimensions of the trench leads one to believe that the total absorption area is 560 sq. ft. 4 feet o£rock for 35 feet and 7 feet for 20 feet. The monitor at the end of the trench is 12 feet deep with the lateral at 4 feet below ground level. The soil rating from 1981 is 85 and 125. A testhole and perc test performed on Dec. 1, 1995 indicates that the perc rate is 10 min/inch. This rate will require 750 sq.ft, of absorption area per todays requirements. However, based on the rating of 125 that could have been used in 1981, 500 sq. Ft. would be required. The present trench seems to meet this requirement, and no modification to the trench is required. There was no water observed in the monitor on Dec. 1. An adequacy test has not been performed, but will be in the near future. Please review your file and inform me what modifications will be required to upgrade this system to a 4-bedroom system. Yo~s Tobben Sp2~rkland P.E. MI NIC. H'~Li~ y OI- DEPARTM£NTOF HE-~LTH& [NUlRONK~ENTAL PHOT[~ION EtCVIRONMEN1AL ENGINEERING ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 January 4, 1996 Subject: Gentlemen; Lot 8, Block 1 Rochhill S/D PID 015-362-16 HAA The owner of this property is applying for a HAA. The septic system was installed in 1981 as a three bedroom system. The residence has 4 bedrooms and the owner intends to upgrade the system by replacing the existing tank. A permit application is attached. The monitor at the end of the trench is 12 feet deep. The lateral pipe can be seen 4 feet below the ground level. This observation indicates that the system is installed with 4 feet of cover or from 4 feet to 9 feet for 35 feet, and from 4 to 11 feet for 20 feet. The soiltest performed in 1981 shows sandy grave between 2 and five feet, silty gravel fi'om 5 to 7 feet and clean gravel from 7 to 15 feet. The soil strata were visually rated. No perc test was performed. On 12/1/95 I witnessed the excavation of a testhole adjacent to the trench. The conditions found are shown on the attached soil log. My observations agree with the soil log from 1981. A perctest performed in the silty gravel indicated a percolation rate of 10 minutes per inch, equivalent to a soil rating of 0.8 gallons per square foot or 188 sq. ft per bedroom. The clean gravel used to be rated as 85 sq.fi per bedroom. To day a rating of 125, or 1.2 gal per sq.ft is used. Based on my investigation the trench has 330 sq.ft of absorption area rated at .8 gal. equal to 264 gallons, and 320 sq.fi at 1.2 gal = 384 gallons for a total of 648 gallons per day. This is sufficient for a 4-bedroom house. On Dec. 1 no water was observed in the monitor, and the trench passed the adequacy test based on a 4-bedroom house. To expedite the review of this property I am submitting both a HAA application and a application to replace the tank. The owner intends to replace the tank immediately, and I request that the HAA application be on hold until the tank is replaced, at which time a revised HAA checklist will be submitted. Yours o en Spurkland P E N 5O lot) / SCALE/' / / / ® 9 / iSO £00 = 100 FT, VACANT 300 / REPLACE lOOO GAL TANK WITH TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE ANCH. AK. 99501 LOT 8 BLOCK 1 ROCKHILL $/D OAILE SLOVEN 6221 BARRY A VENUE SEPTIC SYSTEM DESIGN DATE: DEC. 1, 1995 SHEET: 1/$ GRID: 2455 PERFORMED FOR: LEGAL DESCRIPTION: 1 2, 4 5 6 7 8 9 10 11 12 13- 14- 15- 16- 17 18 19 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: ': /~ / ~j~'~-- WAS GROUND WATER ENCOUNTERED?~'~, L IF YES, AT WHAT O DEPTH? p E Depth to Water Alte~ Monitoring? .~L~.__Dato: I~°/'~~ SLOPE SITE PLAN Reading Date Gross Net Depth to Net ~'~/~ /.1. Time Time Water Drop _60~ ~/~/~ ~_; ~ - ,&o ~ '~'~ ~t ~ ~0~ ~, ~o ~i - Ho O, t PERCOLATION RATE TEST RUN BETWEEN -- (minutes/inch) PERC HOLE DIAMETER __ .~_//_~ / __ FT AND ~ FT pi=RFORMED BY: ~ ~ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: 72-008 (Rev. 4/85) ~UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services Qn-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 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: 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 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. Engineer's signature Phone Date 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments /VlolglZ~£ bedrooms, with the following stipulations: Date The Mur~i¢ipality 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 T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Jim Williams Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 February20,1996 Subject: HAA Lot 8, Block 1 Rockhill SD SW960011 Gentlemen; A permit for a septic tank replacement was issued for this property on Jan. 23, 1996. An attempt to install the tank was done on Feb. 15., The attempt was aborted due to deep frost. The excavator was concerned that the existing tank would be damaged and that backfilling with frozen soil would not be acceptable. The excavator has provided the owner with a contract to install the tank after break up. This will be substantially cheaper than installing the tank at this time. In order to complete the sale of the home, a conditional HAA is requested. The permit to install the tank had several conditions associated with a 4-bedroom HAA. All of the conditions were concerned with the possibility of replacing the existing trench. A total of 18,000 sq. ft are available for septic system replacement. Two testholes, one dug in 1981 and one in 1995. Both testholes shows silty gravel to 7 feet and clean gravel to 17 feet. No groundwater has been observed. The lot is level with slopes less than 5%. There is no question that a standard septic system can not be installed on this lot. If the gravel material is to permeable for a trench, a bed with a two foot filter layer, or a 5-wide with a filter layer can be installed. The conditions of the permit can easily be met after breakup. Yours Legal Description: A. VOgLL DATA Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Health Authority Approval Checklist ~t j3V& I .~_OC~ ~4 lkt~ Parcel I.D.: Y If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~'~, 28~ ~ i Cased to ~O ~ ~ Casing height (above ground) FROM WELL LOG Date of test ~'~ '2oF 8 ~ Static water level ~ y I Well production ] ~ g.p.m. Wires properly protected (Y/N) y AT INSPECTION C. ABSORPTION FIELD DATA Length ,t~ ~ Width Effective absorption area WATER SAMPLE RESULTS: Coliform ~{~ Nitrate c,~ ~/a~ FI4~': Other bacteria Date of sample: /,fi-'/q. q~ Collected by: Date installed Cj*/~ [ Ta~ size /~ Number of Compa*ments ¢ Cle~outs Date of Pumping ~ ¢~0 Pumper I - Soil rating (g.p.d./fi2 or fi2~dm)O°~/~-System ~pe Gravel t~ck~ess below pipe To~ dept~ ~ ¢// Mo~itori~8 Tube gmsem(~ Depression over ~eld (~ Date of adequacy test ' ~/~ ~ Results ~ass~ail) '~' For ~ be~ooms Fluid depth in abso~tion field&~bef°re~test (in.); ~ I~ediately ~erT~Ogfl. water added (in.): ~ 0 Fluid depth ~r~ (ins.) ~ later: AbsoCtion rate = ~ ~ g.p.d. Peroxide treatment (past 12 months) (Y~) ~ If yes, give date D. LIFT STATION N/n Date installed Size in gallons Manhole/Access (Y/N) High water alarm level at* "Pump on" level at* *Datum "Pump off" level at* Cycles tested E. SEPARATION DISTANCES Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tmzk on lot / [ ~ 4' ! Ii~-bI : On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ I Property line ~-70 t' Absorption field Water main/service line ~ 19 I Surface water/drainage P"l/o Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ O t Water main/service line Surface water ~ I 0 Curtain drain I'q [ O I Driveway. parking/vehicle storage area _ ] 0-~ Wells on adjacent lots "~ / ~0 Proper~y line F. ENGINEER'S CERTIFICATION I certifv that I have determined ,hrufield mspecttons and rqview of Municipal in conJbrmance with MOA H~ guidelines in effect on this'date ............................................................................................. HAA Fee $ Date of Payment / Receipt Number ~;~/~'"'73 (~/~ Rev. 8/95 DSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc. L a b o r a ~ o ry D iv is i o n r...~.~-~_,~,~-.~-,~-~.~,'.~'.~.,~'.~'.~,~'.,~.~'.~'.,~'.~',~-~ Drinkin_~ Water Analys~ Report for Total Coliform Bacteria 2oD w, ?o=a: o,~va ~ Anchorage, AK 99518-1505 R~.qD LVSTRUCT,[O.YS O.V REVER~E SIDE BEFOR~E COLLECTL','G S.4)[P£E Tel: (907) 552-23-z3 Fax: (907) 551-5301 .~rL:"$T BE CO>LDLET£D BY WATE?-. SL'PPLLE~ PR-D/ATE VVATER SYSTEM Send Results ~ Send lnvoic~ Send ResMcs ~ Send invoice DATE: Month · Year SAMPLE TYPE: Routine _ Repeat Sampe (for tontine sample with lab ref. no. ) ~q Special Purpose SA3'[PL E LOCATION Time Collected Treated Water Untreated %Vater Collected By t¥: zO TO BE CO),[PLETED BY LASOR_a. TORY Analysis shows [his Wa,.'er S.<MPLE to be: ~ Sampte over 30 hours oid. resuks may be unreliable Sample ~oo long ia ~r~nsk: sampi~ no~ be over 48 hours old ~o indicate reliable resuks. Please send new s=mpte via spe:iz{ detiveo' m~iI. Date Rece'ved Time Received I q Analysis Began / Analytical Method: .~--'. [.ma ..... et[,., ~. MMO-MUG * Number oFcolonies,"100 mi. Lab Ret'. *'o. Result* Sent to A.D.£.C. ~ gbk~ ,Jun Client notified of unsafisfactor?' results: Phoned Spoke ~i~h Da~e: . Time: Analyst BACTERIOLOGICAL VCATER .4xN'.ALYSIS RECORD Faxed Faxed M.MO-.%t-UG Result: Total Coliform Membrane Filter: Direc~ Count E. Coli Verification: LTB O Colonies/I00 mi Fecal Coliform Confirmation BGB COLIFIRM Final Membrane Fiker Results Reported CT&E Environmental Services Inc. CT&E Ref.~ Matrix Client Sample ID 95.5458-3 WATER POTABLE LOT 8 BK1, ROCK HILL Client Name TOBBEN SPURKLAND, P.E. WORK Order 20213 Ordered By TOBBEN SPURKLJLND Printed Date 12/27/95 @ 17:25 hrs. Project Name Collected Date 12/14/95 @ 14:20 hrs. Project~ Received Date 12/14/95 @ 14:30 hrs. PWSID UA Technical Director STEPHEN C. EDE Sample Remarks: SAMPLE COLLECTED BY: T.S. Qc Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 2.12 m~/L EPA 300.0 ION 10 12/20/95 12/20/95 ~ * See Special Instructions ~ubove UA = Unavailable ~'** See Sample Remarks Above NA = Not Analyzed ~U = Undetected, Reported value is the practical quantification limit. LT = Less Than i-D = Secondary dilution. GT = Greater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE NAME MAI LING A D DF~'1JSS LEGAL DESCRIPTION ~/~ J ~.,.. I DISTANCE TO: , ~"/0 -~/'~ I ~>~ ~ ~ I Manufactur~~-~'' ~ ILiq' c?(~i~' ~gallOns ]F HOMEMADE: ,.sMe length DISTANCE T ' Well I Dwelling Well F ou ndat io%~.~ ~) DISTANCE TO: 1~/ ~0 No. of lines~, ag~ eac~/l~ Total lengt~;~es,. Top of tile to finish fade ~ ¢ Material beneath tile Length Width Depth Type of crib __ neter Dwelling IWidth tINearest lot Jine~.._;/.~_~ ~ /Trenchwidth . ~¢ ! ~.~3 inches Total effective Building foundation Nearest lot line NO.~BEDROOMS PE.M,T NO. -5 No. compartments Liq, uid depth PERMIT NO. Liqu~;;;.~;,y h. gauons Total ~ffect~. absor~tion~(~ area PERMIT NO. Depth Driller DISTANCE TO: Building foundation Sewer line ante to lot line Septic tank IPERMITNO, Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING / INSTALLER R EMAR KS Well Log ~,ooat~o~ ..... ~.~..'. .... ~....:: ..... ~5 ..... /..--.....,:..:.~..:~ .... ..U...:.,.:.~. ..... : f.,..~..: Date completed ..... ~-- 2 ~ -. ~; 1 Depth of well ............ ~.'~ / Szze of casm ~'~ Distance to water ..... .................. '~'~ ...~ ......................................................................... Distance to water while pumping ................ '....~...~ ............ at rate of .............. '7 ~ O ........... gallons per hour. Formation from to 0 ~_o. iviUNiCiPALI3 DEPT. AtJ~ OF ........... ,.cE )F HEALTH & ~ 3 't 1981 REdEIVED Lv"¢ Driller DELTA DRILLING COMPANY SRA BOX 394 B ANChOrAGE. ALASKA 99507 ~,,,, DEPRRTMENT '~-" HERLTH RND EN,,IRLNMEN]HL ,~..UTEL:TION HFFLI...~N F LOCRT I ON r*- LOT SZZE 4~7~¢¢~ SQIJ~E FEET [_E~HI_ L8 B~ ROCKHILL -- - TYPE OF SOIL FIBSORPTION SYSTEM IS: TRENCH ~. ~~ MM,:sIHUM NUME, ER OF 6EDROOM=, - II ' THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR ORRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETREEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRR',/EL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFFILL PIPE RND THE BOTTOM OF THE EXCR'¢RTION (IN FEET). 825 "L~ STREET, RNCHORRGE, PK. D~50t 264-4720 ( 8101~5 ) GOENTZEL BUILDERS INC PO BOX £02~8 SO STN 8RRRY STREET F~:EI;~UIRE[:~ SEF'TIC: TRN~ S IZE~= l~l~E~i~ GRLLiD~4S PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE iNSTRLLRTION INSPECTIONS OF RNY REt_LS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE RELL RILL SERVE. ........ T'i4C, (;~) I ~-~S;F'EC:!'ICJ~S; PRE ~:E¢;!!J IRE[:. BRCKFILLING OF RNY SYSTEM RITHOUT F!NRL INSPECTION RND RPPROVRL BY THIS DEPRRTMENT RILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS t00 FEET FOR ~ PRIVATE WELL OR ±50 TO 200 FEET FROM ~ PUBLIC RELL DEPENDING UPON THE TYPE OF PUBLIC WELL.. MINIMUM DISTANCE FROM ~ PRIVATE WELL 'TO ~ PRIVATE SEWER LINE IS 25 FEET TO ~ COMMUNITY SERER LINE IS 75 FEET, WE[..[. LOGS ~RE REQUIRED ~ND MUST BE RETURNED TO THE DEP~RTMENT WITHIN 30 OF THE WELL COMPLETION. OTHER REQUIREMENTS M~Y 8PPLY. SPECIFICATIONS ~ND CONSTRUCTION DIaGRaMS ~RE ~V~IL~BLE TO INSURE PROPER INST~LL~TION. PER:r-1 I T E::-::P I RES; [:.EC:EMBER I CERTIFY THRT t! IRM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I RILL INSTRLL THE SYSTEM IN RCCORDRNCE PITH THE CODES. 3:: I UNDERSTRND THRT THE ON-SITE SERER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 3 BEDROOMS. ISSLED B'~ -- ',,,'4. 0 -'-- .............. ........... z ...... PERFORMED FOR', LEGAL DESCRIPTION: 1 2 3- 4 7 10 12- 13- 14- 15 16- 17 18 19 20 COMMENTS PERFORMED BY: MUNICIPALITY OF,, DEPARTMENTOF HEALTH AND ENVIRONMENTAl. PROTECTION 825 L. Street. Anchorage. Alaska 99501 2~.-~.720 SOILS LOG - PERCOLATION TEST 7- /5- WASGROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? SLOPE T ~LATION rEST Reading Date Gross Time Net Time NO. 1732-E June 22, 1968 PERCOLATION RATE TEST RUN BETWEEN FT AND (minute~/inch) r 72~008 [6/7cji 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. # OI~"--- 3b~.-Ib HAA# ~..,~.~., C~[~ 1. GENERAL INFORMATION Complete legal description 'Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address 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 o 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 fur[her verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water suppty 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. Phone Name of Firm Address Engineer's signature bedrooms. DHHS SIGNATURE Approved for Disapproved. Date Conditional approval for 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 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 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVI[~I~ E IV E D Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 JUN ?_. 5 1996 Legal Description: Municipality of ~,ncl~orage Health Authority Approval Checklist Dept. Health & Human Services A. WELL DATA Well type ~-. Log present (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number 7 Date completed Total depth Cased to ~P ~ j Casing height (above gronnd) ~ / ~ // Sanitary seal (Y/N) Wires properly protected (Y/N) Date of test Static water level FROM WELL LOG AT INSPECTION Well production ! ~ g.p.m. ~ g.p.m. WATER SAMPLE RESULTS: Coliform ~9/ Date of sample: Nitrate c.~,/~2 v~4~/ Other bacteria ~ Collected by: ~ --~ B. SEPTIC/HOLDING TANK DATA Date installed ~/~/~/~ g, Foundation cleanout (Y/N) Date of Pumping /%/t~3x Tank size t~Z~' O Number of Compartments ~,~ Cleanouts (Y/N) Depression (Y/N) Pumper Co ABSORPTION FIELD DATA Date installed (°/~/a9 / Length. O~- ~ Width Soil rating (g.p.d./ft2 or ft2/bdrm) ~'3 System type Gravel thickness below pipe ~]9t~ ~'~ Torsi depth Effective absorption area ~ _~ffL) Monitoring Tube present(V/N) ~"/ Depression over field (V/N)_ ]x~/ Date of adequacy test /~'~-?/~,i~ Results(Pass/Fail)? For // bedrooms Fluid depth in absorption field before test (in.); Fluid depth ~_~_~(ins.) Minutes later: Peroxide treatment/-"/(past 12 months) (Y/N) Immediately after 7'd:;~Dgal. water added (in.): Absorption rate = ,~/o0~ g.p.d. If yes, give date Do LIFI' STATION Date iustalled Size in gallous Manhole/Acccss (Y/N) "Pump on" level at* '~Pump off' level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot / Public sewer main Sewer/septic service liue ; On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ,,a d'T3 So t Building foundation __ Property line Absorption field Water main/service line ,)'~ Surface water/drainage /x/. ~4'(. Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation q q / Water main/service line I O-a~ / Surface water Curtain drain F. ENGINEER S CERTIFICATION · I certii/i~ that 1 have determined thru fteld inst)ections and review of Municipal reco~z?~e able m conformance wtth MOA H~ gmdehnes tn effect on thts date, Signature Engineer's Name ' To~ bff ~ HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number Rev. 8/95 OSS: haa.wk.doc T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 James Williams Municipality of Anchorage Department o£Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: HAA Lot 8 Block 1 Rockhill S/D PID # 015-362-16 June 23, 1996 Gentlemen; A conditional HAA was requested for this property on Feb. 20, 1996. The septic tank needed to be replaced, but due to deep frost the work could not be performed at that time. The conditional HAA was issued, and a permit for the installation of new tank was also issued. The work has now been completed, an As Built showing the location of the new tank, as well as the additional information demanded in the permit. As a result of the demand for additional soil test the whole back yard of this property was disturbed, making a complete replacement of the lawn necessary. A simple tank replacement that was supposed to cost $ 3,000 turned into a $ 6,000 project. Please issue an unconditional HAA. Yours MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Address /¢) ~c ~'~ Telephone: Home .~-~,- )~,..~ .2. Business (c) Applicant is (check one): Lending Institution []; Owner/builder/J~; Buyer []; Other [] (explain); (d) Lending Institution '~//'~/ Address ~t-,) O ~-T~4¢~) (e) Real Estate Company and Agent Address Telephone Telephone (f) Mail the HAA to the following address: Cr~ i~ $4-~,- ~,92 TYPE OF RESIDENCE Single-Family~l~ Multi-Family [] Number of Bedrooms -7 Other WATER SUPPLY Individual Well,~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ,, ~ i ( ~ Page I of 2 SEWAGE DISPOSAL ~ ¢ , Onsite ~' Public [] Community [] Holding Tank I~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, 72-025 (11/84} ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 Address ~ / ~ ~ Date ~//,~'~ Telephone WATER WELL NOTE: This Health Authority Approval inspection merely certifies that the subject water well produced 150 gallons per bedroom per day and that certified laboratory tests showed no presence of coliform bacteria in a sample of that water, No warantee or certification is expressed or implied concerning the long term adequacy or safety of the water supply. ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval inspection merely certifies that the subject on-site sewage disposal system accepted at least 150 gallons of water per bedroom per day as determined by methods approved by the Municipality of Anchorage Department of Health and Human Services, No warantee or certification is expressed or implied concerning the long term adequacy of the on-site sewage disposal system. Construction data reported on buried system components is from MOA files and was not verified during this inspection. DHEP APPROV-AL~7~--/~ ~'~ ~ ~~. i~.~Aate Approved for bedroomsby Approved . disapprove? Oondit'onal Terms of Conditional Approval ·, CAUTION ' The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations'given in paragraph ,5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. MUNICIPALITY OF ANCHORAGE (MOA) "t :/OHEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: S~V~ WELL DATA Well Classification /~z/,,/,z~'r~'. If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Y',,~ Date Completed ~"'~' ~*_~'/ Yield Total Depth ~ / Cased to )' d/'~/ v~J~/ Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line CleanouVManhole Water Sample Collected by Water Sample Test Results ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date ~'~ ,.-.~ ,--~r~_..~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~"~:~-~/' Size /~ ~',4~/-~No. of Compartments Standpipes (Y/N) Y~$ Air-tight Caps (Y/N) Y'~'-~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) /(/Z') Date Last Pumped /~ '~' Pumping/Maintenance Contract on File (Y/N) /~//~ ; for ~/,~ Holding Tank High-Water Alarm {Y/N) ,~ Temporary Holding Tank Permit (Y/N) / Separation Distances from Septic/Holding Tank: To Water-Supply Well Z'~,/~ /' To Building Foundation ? ! To Property Line -~/~" ¢' To Disposal Field _,.~z/' ~ To Water Main/Service Line ':~(~) / '/' To Stream, Pond, Lake, or Major Drainage Course comments Page 1 of 2 ~ C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field -"~// ~Type of System Design Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Test Date of Last Adeqv.acy To Property Line ,,/~"~ To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify tha~e/Chee~k~/d, ver~fij~d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ,, Dateof Payment ~ /~ ~ [~ ~ ' ~Z '~ ~-~ Amount' .$ . .~ · , Page 2 of 2 72-026 (11/84) SEWARD HIGHWAY , ~LASKA 99518 *(907) 344-8551 LAmlMT~YI.D.f mACTERIOLOGICAL MAiER AIMLYSIS l.O. HO. (PU~BLIC'SYSTEMS) I I I I I I NAME OF SYSTEH TO BE COI~LETED BY M~TER SUPPLIER DATE COLLECTED TZHE COLLECTED~4~ TYPE OF SYSTEM /,,.~., .</,~-'"'(~-~ I'"1 PUBLIC ~NDIVIDUAL CIRCLE CLASS I A B C Residential TELEPHONE NUMBER SYSTEF~ ADDRESS LOCATION WNEII~E SAMPLE WAS COLLECTED ,~z,,,'/Ss/~_.. · COL LEC~..~. ~B.~yo~,qC~,Z GNATL) RE ) TYPE OF SAMP)UE/ (CHECK ONLY ~E THIS COLUMN) [~'DRINKING )lATER /CHFJCK TREATMENT ZIP CODE I-]CHLORINATED I'IFILTERED ~I~REATED OR OTHER ~t~AW SOU)~CE WATER r') NEw CO)~TRUCTION OR REPAIRS I-1 OTHER(Specify) 'IS THIS SAMP~£ A CHECK SAMPLE TO A PREVIOUS NON-CONFORMING 'SAMPLE? [:]YES E~ PREVIOUS COLLECTION DATE ANALYSIS REQI~ESTED (IF OTHER THAN TOTAL COLIFORM) SEND REPORT TO~PRINTFU~ NAME,ADDRESS AND ZIP CODE NAME ADDRESS I'1 RESUBMIT SAMPLE Sample rejected because: CHECK ONE OR MORE C~ Sample too long in transit. Sample should not be over 30 hours. r-] sample received too late in week I'~Not tn proper container rlLeaked out ri Insufficient information provided. Please read instructions on form. [] Other (Specify) RECEIVED ~Y . ~_.~)/-YJd DATE ~'~'/~ TIME ~.TATION TUBE Date A Ti~ Started ~'~'~ -~:/~ Date & Time Completed ~*~ ~.'~P~ LABORATSJ)RY RESUJ.).!y__ [-I Other Bacteria ~) Test unsuitable because: [] Confluent Growth [] TNTC SATISFACTORY ~/ URSATISFACTORY BACTERIOLOGICAL ~TER ANALYSIS RECORD FOR LAB USE ONLY ~/ TOTAL COLIFORMS '-'] ~ECAL COLIFORNS [-~ ~OTHER Membrane Filter: Direct Count Verification: LTB BGB Final Membrane Filter Results Reported By Date Time Coliform/lOOml Coliform/lOOml A.M. READ SAMPLE COLLECTION INSTRUCTIONS ON BACK OF FORM r., DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR I NSPECTOR~ INSPECTOR MUNICIPALITY OF ANCHORAGE ~UNIClPAUTY OF ANC,ORAgE DEPARTMENT OF HEALTH ~ ENVIRONMENTAL PROTECTIO~E~T. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL pROJECTION ENVIRONMENTAL SANITATION DIVISION AU8 ?J ~ ~981 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be processed. Please allow ten (10)'days for processing, 1. PROPERTY OWNER j PHONE MAILING ADDRESS PROPERTY RESI DENT (If different from above) PHONE 2. BUYER PHONE ~AILING ADD~ES~ 3. L~DI~INSTITUTION J PHONE I ~AILING ADDBESS 4. ~EALTO~/A~NT J PHONE I MAILING ADDRESS 5. LEGAL DESCRIPTION 6, TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [~"~SiNG LE FAMILY [] ~T~wo [] Five [] MULTIPLE FAMILY E~~/Three [] Six [] Other 7. WATER SUPPLY ~NDiVIDUAL* 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 UTI LITY depth (attach log if available.) 8. SEWAGE DISIN~SAL SYSTEM [~INDIVIDUAL/ON-SITE** J? (~ / YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Rev. 6/79) ' ( 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 DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE plSPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED I--~ 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. DISTANCESwELL TO: Septic/H°lding Tank IAbs°rpti°n Area ISewer Line INearest L°t Line Absorption Area to nearest Lot Line 5. COMMENTS .[;;;~,ppRovED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED