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HomeMy WebLinkAboutROCKHILL BLK 2 LT 3Rock Hill Block 2 Lot 3 #015-362-08 Municipality of Anchorage 'c•., �•r'' Development Services Department Building Safety Division .. , '- On-Sde Water and Wastewater Program, 4700 Elmore St. 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: Stil090094 PID Number: 015 -162 -OS Na. T 3i Wastewater System: E] New rade y ❑ Upgrade Aodfna 9136 Arlon Scree "A3-• 994 ABSORPTION FIELD �ij f j Pnoro NurMoerM Beorooma O Deep TrertrJt O $hakow Trance O Bad ❑ MouM O Ouw LEGAL DESCRIPTION sod RON TOM DWt tram "nal grMoe GPDIFIa FI. Block Lr suodrvtrM' a 3 Rock Witt Depot to tape Daum haat ongmr ands Gray "Put Dream tape Ft Ft Tornrup Range secuon. FY added Moore Mprtal pada Craw Length Ft. Ft. Well: Q 1 ❑ New ❑ Upgrade C7:lsl Grawwdth Nnm"erml„.a Dnlanoaeelreenlaua l� FI. FI Claavkcaum (Pnral . A, B. C) ToW Depth Caned n TOM absorption ane Pipe Malenal FI. FI Ft' Dniur Dale Drled Sla4c Wafer Law Ittuawn Ck- `5 % lNoe & Dau In isd. 6 29 FL viul, OQ Y.MdPump Setr -sung Nepht Aoow Ground TANK GPM FI. FL SEPARATION DISTANCES PrSeptic ❑ Holding ❑ S.T.E.P. ❑ Other. To From Septic Tank Absorption Field Lift Station Holding Tank lubliellOvale Sewer Line 'punt` ArOl rA39_TAnk apaaro Gal t2$0 wen too' too f Mannal S rl Nu r Colnpanmenla sunKAwalerD4- LIFT STATION Lot Lne r 5+ .!e nu ,purer Gal FouMalgn S f + Pump on' law at Pump off few a Highrate rrm r In in In. Cunrn Drrn Vr(/. Pump Make a Moor ElecinrW klapason, pedonneo by R"mane ..Ih Al. MDA BENCH MARK Lobuuon aM Deamp1km. CU (t it 4 do Str77n SE G A E %rn tJ, wnNd EIOV84M JC)() FL I c^ 1 Inspections performed by: Lacs JINki0.4 Dates: 1N 6 zt o E�4Q�G\\S �;V = \� OF q (,qs t' 2nd } Development Services Department Approval Co. 49TH f^//``r A Conditional Approval Date: •� �y LA RS E�SFuRKI.A4D.:* j Il G s0U/•''vim %� Reviewed and approved by: r / C t ate: %' �0 Ill\uFE 5��" � SW/NC nrs \ / ® A B A \ C 313' 53.0' D 60.3' 56.3' \ r 61.0' 57.0' 3 \ F 610 57.3' Z PSTALLLD NEW 1230 GALLON SM SLP C(�� \ A TANK 100 FEET ROM LX157TAG KILS D \ AND 3t FUT FROM rDzmw IRE79N f ARMDONCD EX I NO \Fi SEPTIC TANK PER 1KN A \ CODE RrQUIRnArNTS op 1 NO PUBL.0 WAIrR SYSTEMS WI71RN 200• PRIVA7r WC115 TJ 100' SOUTH OF PROPOSED SEPTIC TANK SHALE CIRLCE NINSTALLED DYAIDLE CLEAAUITS NOT£.• THIS IS NOT A SURVEYED PUL WELL Q SEPTIC LOCA77ONS TAKEN FROM ON -SIT£ WATER AND W4S7r WATER DEPARTMENT DOCOM£NTAT,'ON ALL LOCATIONS SHOWN ARF APPROXIMATE. 5.7 FEET MM 91.1' COMECT£D m 1250 GALLLN SrPTIC TANG EXIST DRAIAFIELD 49th LARS Nli% n 0 n 30 75 1m 125 150 SCALE, P = 50 FT. t�Nal uAaK BOnoM SIDS Sr CORNER GARAGE ASSUMCD fLLI'A7KAv l0O FrrT SPURKLIND fNCINffR/NGFount OCK HILL BLOCK 2 LOT 3 SEPTIC SYSTEM ASBU/LT ?03 W 15TH. AVENUE ANCH. AK. 99501 JIM TOPOLSKI DATE. JUNE 30, 2009 907 179-3916 SHALE CIRCLE ANCHORAGE. AK 99516 SHEET. 1/1 GRID: 2438 X SW09094 PID 11 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO90094 Legal Description: ROCK HILL BLK 2 LT 3 Design Engineer: 0007 SPURKLAND ENGINEERING Owner Name: JIM TOPOLSKI Owner Address: 9138 ARION ST #A3-994 ANCHORAGE. A 99507 - 6 .2'7 - C 1 e r: 30 Date Issued: Jun 25, 2009 Expiration Date: Jun 25, 2010 Parcel ID: 015-362-08 Site Address: 6401 SHALE Lot Size: 43620 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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. Received By. Date: �' L Issued By: Pt'z- //ll f tP+ r tiff Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www.muni.org/onsite (907)343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Q) 5- 3b2- D g Property owner(s) T•„ To(wls tc1 Day phone Mailing address 1138 Aiticn Si'/eet *A3- 99y Zip Code 99501 Site address 6401 56%le. Zip Code 99516 Legal description (Sub'd., Block & Lot) 100[L Z LA 3 Legal description (Township, Range & Section) Lot Size LIS, 620 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank 3, Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 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 Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of iroperty owner or authorized agent) Permit/Rush Fees: Sib a Waiver Fees: Date of Payment: &/Zd" 9 Receipt Number: 06482.4 (Rev. 11/05) Date of Payment: Receipt Number. Environmental Consulting and Design May 14, 2009 Municipality of Anchorage Development Services Department Building Services Division On-site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Subject: SEPTIC TANK PERMIT APPLICATION Rock Hill Block 2 Lot 3 Ladies and Gentlemen: We are submitting an application to upgrade the septic tank for this lot. The existing septic tank serving the above referenced property is 27 years old and is collapsing. The submittal consists of one (1) drawing showing the present improvements on the lot and the proposed improvements of the lot, of which only the septic tank is subject to this permit application. There are no wells within one hundred feet of the proposed replacement site. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic tank location. The proposed septic tank will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or are in need of additional information please contact me at 279-3916. Sincerely, Lars Spurkland, P.E. 203 Nest 15i' Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng`aa gci.net a \ \ e�C 1NSTALt NEW 1250 GALLON STEa SEPTIC \ TANK 100+ frrT FROM EXISTING wars m \$ AND 5+ FEET FROM EXISTINrG iR£NCN AB.INDON EX577NC �'� 3CPTlC LANK PER MOA y e CODE RE IRCYCHTS 'o . o oPProX• loc°tton _ • :: 1 NO PUBLIC WATER SYSTEMS WTIHIN 200' PRIVATE WELLS N fOO' SOUTH Or PROPOSED SEPTIC TANK SHALE CIRLCE NJIf IVIS �S NCT A SURV rGJ GU'. w2L Q SCPII i LOCATIJVS TAKEV F4 .0 CN SIF 94 -ER AY,? B457 WAT;A ufoA MINT DOCUVENTAT:O A ' LO -AWNS S.90N'V kY AGGR9d Y47£. XUBL£ a£AAWTS CLiat£T TO EXIST APAIAFIELD 25 0 n 50 75 100 125 150 SCALE, I' = 50 FT. 4 FEET COVER JYUHICLaNU tNG7NttK/Nli ROCK HILL BLOCK 2 LOT 3 SEPTIC SYSTEM DESIGN 203 W 151H. AVENUE I I DA TE. JUNE 19, 2009 I I ANCH. AK. 99501 /907) 279-3916 JIM TOPOLSKI 6401 SHA/F C/RCIF ANCNORdrF dK 99516 SHEET 1 ! GR/D: 2438 PERMIT N SV090XX P1B k RockHWB2L3Dl.dwg "�-•; Environmental Consulting and Design Single Family On-site Wastewater Disposal System Construction and Material Specifications Subject Property: Rock Hill Block 2 Lot 4 Date: May 14, 2009 General: 1. The owner shall contract with a contractor to perform the work outlined In these specifications and plans in accordance with the attached MOA permit. There is not contractual arrangement between the contractor and the Engineer. The Engineer shall be the owner's representative and will inspect the work to document the contractors activities. Final acceptance of the contractors work rests with the owner and the MOA. 2. The scope of the work includes the installation of a new 1250 gallon septic tank. The location of the drain field Is shown on the attached site plan drawings. All components of the proposed septic system must be constructed a minimum of 100 feet from any surface water or water wells in the area. A minimum of 4 feet of earthen cover is required over the septic tank. If less than 4 feet of cover is available, 2 -inch thick, 40 psi, direct bury board foam shall be installed directly over the septic tank and all Installed piping. 3. Construction shall be in accordance with the approved site plan and design drawings and any special provisions noted on the Municipal well and/or septic permit. All materials, components, workmanship and construction practices shall comply with the Municipality of Anchorage's latest ordinances regarding wells and septic systems, as well as MOA, Development Services Department, On-site Water and Wastewater Program (DSD) policies. 4. The contractor is responsible for obtaining all underground utility locates, layout of the proposed system, and verifying and maintaining all required separation distances to lot lines, surface water, wells, steep slopes, etc. 5. The property owner shall be responsible for final grading any depressions formed from settlement of backfill material. The property owner is also responsible for vegetation of all areas disturbed by septic system installation activities. 6. Contractors Installing wastewater disposal systems must be certified to do so by the MOA DSD, On-site Water Wastewater Program. Property owners installing their own systems must receive advanced approval from MOA DSD prior to system Installation activities. 7. The contractor shall ensure that ALL materials being used are in compliance with the most current guidelines established by the Municipality of Anchorage. Refer to "Standards and Specifications for Component Parts and Materials Used In the Construction of On-site Wastewater Disposal Systems", Dated December 2000, as provided by MOA DSD, On-site Water and Wastewater Program. 203 Nest 15'h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, LspurklandCagci.net Environmental Consulting and Design ..� 9 9 Septic Tank Installation: 1. A new septic tank, of the size specified in the design drawings, shall be procured from a qualified manufacture/supplier if the existing septic tank is found to be defective. Construction shall Include two 4" diameter deanouts for pumping access. 2. The burial rating of the tank shall be adequate for the actual burial depth encountered. 3. The tank shall be level and sufficiently bedded to prevent settling of shifting of the tank. 4. All standpipes on the tank shall extend a minimum of 12inches above the final grade. S. Tanks installed with less than 4 feet of cover shall be insulated. 6. The sewer service line from the house to the tank shall have a minimum slope of 2% unless prior approval is obtained from the engineer. 7. The Inlet and outlet lines from the tank shall be bedded In drain rock or the soil shall be sufficiently compacted to prevent future settlement of the soil. 8. Septic tank Inlets, outlets and deanouts shall be fitted with water tight couplings. 9. A cleanout shall be Installed 1 to 4 feet from the foundation. 10. Post tank deanouts shall be installed per MOA requirements. Does not apply to pressurized lines. 11. In areas with high ground water, the septic tank shall be sufficiently anchored to resist buoyancy forces when there is not adequate soil cover to resist uplift force. The contractor shall refer to the engineer for direction regarding this matter. 12. The tank backfill shall be graded sufficiently to ensure positive drainage away from the tank. 13. All holding tank and lift stations shall have an audible and visible alarm Inside the residence being served. 14. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform Electrical Code. A municipal electrical permit and Inspections must be obtained where required by the MOA. 15. The contractor shall verify that the septic tank/lift station is a minimum of 100 feet from any residential water well, 150' from any class'C' well and 200 feet from any community water wells. Additional separation distances must also be maintained. 16. The contractor shall remove or abandon the existing tank in compliance with the Unform Plumbing Code. Inspections: 1. A minimum of one Inspection is required by the Municipality of Anchorage. These Inspections must be conducted under the supervision of a Professional Engineer licensed to practice in the State of Alaska. 2. The septic tank may be set in place, but may not be backfilled. 3. The contractor shall provide a legible copy of all field notes relating to system layout and construction to the engineer for the use in preparing the record drawings. 4. The contractor shall coordinate all inspections with the Engineer. A minimum of 24 hours notice Is required prior to the start of construction. If necessary, a preconstruction meeting will be held on-site. 203 Nest 15i4 Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland a?gci.nct MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL_ ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL_ SYSTEM AND/OR WELL INSPECTION REPORT NAME^.m..w._.�._._.e._.��.�.��.�.__�.�.._.�. VJTKCorsi f. PHONE SC�—/J8 _W ❑UPGRADE MAILING ADDRESS SQ - LEGAL DESCRIPTION /,3 6.2 ecc A. II qb LOCATION s�pIay{/ NO. OF BEDROOMS Uy DISTANCE TO: W,e I d Absorption area f Dwelling 2� PERMIT NO . a Q wl Manufacturer � Materia £L No. of compartments y Liq, capacity in gallons Z ..- IF HOMEMADE: Inside length e__.___. Width Liquid depth 6y J 0z DISTANCE TO: Well Dwelling PERMIT NO. O Z G S�F Manufacturer Material Liquid capacity in gallons O w 2 DISTANCE TO: Weh Foundation �� / Nearest lot line 1179?/ PERMIT NO J LL ZNo. F Z w of es Length 6f lie Total le gth of lines Trench wthid inches Distance between lines H p Top of tile to finish grade w !/2 Material beneath tile wm4es Total effectiv absorption area w Length Width Depth PERMIT NO. Q F as W Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line J _j J Cie QDOCSEC� Depth Driller Distancelot line PERMIT NO. ego aZ W DISTANCE T0: Building foundation Sewer line Septic tank Absorption area(s) OTHER N LEGAL ' V" PIPE MATERIALS o SOIL TEST RATING INSTALLER REMARKS Pn W R + f CW n, 3 3' ► APPROVED DATE r-1 q.—A PA 1 97'. 1 F::" Fl L— I r k1ro Cw P" r-4 �—Il Cff F=w VC3 ]I FE: DEPF'!f-?.TMEP--Fl" r-`\ HERLTH FINE, -'L S"TREET, W-JC.+-IORA(JE., M., PERMIT P-40, 82C1245 Q)L j F-'iPPL I CMI'T C:ONST SRA, BOX 344-083--, 1 C"j 0 Al T I 1C., N SHALE CIRCLE�' LEGFIL E-3 B2 ROCKHILL S/D L 0T I Z E :..J.',WARE F'EET 7 TYPE: OF- 'SCAIL. AB.E,'()PPTION TEIM :IS: 'TRENCI 1 MAXIMUM NUMBER OF* BF.,:*.DRO011-lS SOIL. RATING F`I",-,'BR.)------: 1.25, D- A-3 THE REQUIRE!) SIZE OF THE SOIL ABSOF!PTIONI l-'Yc'TE[l IS: !314 'THE' LENGTH IS 'THE LAWTH UN FE.*ET,',,i OF-. THE TRENCI-I THE DEPTH C.,F* A TF."VID-1 OR FAIT IS THE DISTANCE BETkIEPol THE :.=!. RF OF- THE GROUND AND THEE BOTTOM OF THE E,---,,'C:AVA'TIClN FEET:.",. THERE IS NO SET I-III)TH FO' TRP-,!C:I-lES, '!'[--IE GRFI-,!E!,,, DEA -PTH C5 TFIE 11U,11M1..iM DEPTH C17 GRAVEL BETWEEN 'THEE OU"I"FALL FIND THE BOTTOM OF. THE EXCAVATION CIN FEET), E.�-'.* iG-':p L-9 1: IRV. E.E: E.,-" 1, C VIF� PA l W; :9::< : Q It. (E -i C P-:1 L.- L. ICK It 4,00 PER'tell"r FIF'RACRAIT HFAS TFIE RESPONSIBILITY 'TO INFORM THIS DEPART11,10.4"T DURING THE INSPECTIONS OF' ANY WE ADJACENT TO THIS PRC'lPE,.-:lRTY AND THE OF" RESIDEMES THAT "!"HE ILIELL WILL. BACI,--*.'FILL.ING OF' FINY SY.,5JEN 1,41THOUT FOINAL P-,!.,-'-;PECTIO?-1 FIND APPRO%JAL Bl e T! --IIS DEPAP.MlEPAT WILL. E:E- SUBJEC.7' 'TO PRC.)S'ECUTION. MINIMUM DISTANCE BETHREEN A !,,TELL. AND FIT' SI ONAS,'ITEE. SEk!AQE DISPO,'.-,FlL IS 100, A PRIVATE WELA OR 1150 'TO 120,C) FE:F.,*.:-r' FROM A FUBLIC"., WIEJ L. Df,-.-,PEr-JUING' UPON THE T-r'PE (A7 PUBLIC 14EI L. MINIMUM FROM A Fl,'.'IVFlTE WELI. ..CO A isurvATE SEWER LIF4E IS 2�51 FEET TO A COMMUV-4IT%l SEWEP! LINE 75 FEET. WEL-1. LOGS ARE REG!UIRED FINE) MUST EJE: RETURNIED TO THE DEPARTMEITT P41THP-1 DAY.,.E", OF !.,!ELL- COrelf"LETION. OTHER REQUIREMEENTS PMY APPLA ANC� E:1IFl,3RfIMS ARE AVf--lILAE*-,'L.E TO PASURFE PIRC)PER INSTALLATION. -T- Q 14C W 1 FR 1"'1= I:-.-. E> EE. C. ir-1 FIE'. E.E., F, I : .1. 2L. <?- I CERTIP-r' 'THAIT 1: I. FiM F'AMILIAR. W.ITH 'THE: REQUIREMENT" 10OR ON—SITE FIND FTORTH BY 'THE: VILINICIPAL. ITY OF' j`IPICHORAGE. 12: "' WILL INSTALL THE: SYSTEM IN ACCORDANCE WITH 'THE (:',ODE,-'.'-.';. I UNDERSTAND TFIFIT THE OP+ -SITE SE14ER.: -%lS-lFEreI lleff--ill REQUIRE ETILARGEMENT IF' TWE RESIDENCE Icq REP.-IMELEP 'TO INCI - IlDi.' PlF."IF,11 'THAN E,,EDrROOMl-'--,. 14P i� IL SiCit-JECl: e I" 4---aA ZIPLI CAT CONI-H."T s , MUNICIPALITY OF ANCHORAGE ac DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: J AP, LEGAL DESCRIPTION: L DEPTH (FEET) �T 1 Net Time Depth to Water 2 3 yetir, 4 5 Ai j) 6 i Z 7 8 9 18 tf hilt= 10 SLOPE a Tx SOILS LOG ❑ PERCOLATION TEST DATE PERFORMED: SITE PLAN ` WAS GROUND WATER t)°© S 11 ENCOUNTERED? JV L 0 P 12 — E IF YES, AT WHAT DEPTH? 13- 14- 15- 16- 17 3 14151617 Date Gross Time Net Time Depth to Water Net Drop 99 m� 18 t o h ai (� J 19 &d �'Y t NflSS CCS t iii*H'li�d�'J OC �J J v 1 U iy J ` WAS GROUND WATER t)°© S 11 ENCOUNTERED? JV L 0 P 12 — E IF YES, AT WHAT DEPTH? 13- 14- 15- 16- 17 3 14151617 Date Gross Time Net Time Depth to Water Net Drop 99 m� 18 t o h ai (� 19 &d �'Y t NflSS CCS t iii*H'li�d�'J OC �J hdv7.1,J?r, Reading Date Gross Time Net Time Depth to Water Net Drop v 20 Gia June PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: ©O7'e`CERTIFIED BY: DATE: 4 ,Z Y-9 11 PI T�,71 4ql INVOICE NO X4.4-4435 3-405 SOLD TO lZCy' IT 1-0 j4 VV041TT 0 STREET&NO, sll�o J'14t- ------------- U2 STREETaNO. CITY I CITY 7H 736 1v i I F.O.G. T I ENVIR ,Nn, 4 "old C0kZ5\� \ Time APPLK NT FILLS OUT UPPER HAIL 31SILY n — _ Property Gwner Phone Time 0 Date Date Mailing Address j / Zip Code Date Buyer Inspector Address Zip Code Lending Institution ��yy;/,% , ,„ d - Phone Address Zip Code RECEIVED Realty Co. & Agent 'CONDITIONS OF APPROVAL Phone ( ) DISAPPROVED Address Zip Code Legal Description Street Location �} - / "'/f. L= Type of Residence Muie Family 11 ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply individual Well to Tank ATTACH WELL LOG. A well log is required for allwells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal individual Year Individual Installed: r3 ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. - "old C0kZ5\� \ Time Time Time Time 0 Date Date Date Date Inspector Inspector Inspector Inspector �J Field Notes: �� �j MUNICIPALITY OF ANCHORAGE ENVIR'Ji��btj ,: A-. [ ,.U, F(TION RECEIVED ( APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE -1-9 BY: Ads 2"e Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank