HomeMy WebLinkAboutSOUTHPARK #1 BLK 3 LT 10 DI:PARTMENT OF HEALTH & ENVIRONMENTAL PROTEOTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE E~NEW
~ L [] UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF B~DROOMS
PERMIT O.
ell , Absorption area Dwelling
~ ~ Manufacture ~ Material ~ No. of compartments
Liq. capacity in gallons I~HOME~DE: Inside length Width Liquid ~th
, ~ Well Dwelling PERMIT NO.
~ O z DISTANCE TO:
O Z ~ Manufacturer ~ Material Liquid capacity in gallons
~ ~ell , . . Foundation Nearest lot line PERMIT NO.
~__ ~ Z~ NO. of linesl Length o~li n e Total length of~lin s Trench width~ ~ inches Distance~between lines
~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area
Length Width Oepth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
m Well 8ugding foundation Nearest lot line
~ DISTANCE TO:
CI s ~ De th Driller ~ Distance to lot line PERMITNO.
m Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
REMARKS
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
PERMIT NO~
DEPFIRTMENT L
RPPLIC:RNT
LOCBTiON
LEGRL
825 eL¢ STREET~
C~-4--SXTE
RUSSELL E MINKEMRNN
LlO B~ $OUTHPRRK ¢~
LOT SIZE 999999 SQURRE FEET
T'¢F'E OF SOIL RBSORF'TION SYSTEM IS: TRENCH
MRXIMUM NUMBER OF BEDROOMS = 4
SOIL RRTING (SQ FT/BR)= ±25
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
£:'EPTH--- 8 L El'-~ ,3 T H = ~_]_~=: GRR%-'EL [-'. E F' T Ii-t = 4
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF ~ TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE EXC8VRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
PERMIT RPPLICRNT HM_, THE RESPONSIBILITY TO iNFORM THIS DEF'RRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RN'¢ HELLS RDJRCENT TO THIS PROPERT'¢ RND THE
NUMBER OF RESIDENCES THRT THE WELL HILL SER',/E.
Ti..-~ £~ ,:: 2 ':. X P-,~SPE£:T X ~]l'-,IS RF-:E RE~':!LI 'r
BRCKFILLING OF RNY SYSTEM HITHOUT FINRL INSPECTION RN[:, RPPROVRL BY THIS
[:'EPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUId DISTRNCE BETWEEN R WELL RND RN'¢ ON-SITE SEWRGE DISPOSRL S'¢STEM IS
±00 FEET FOR R PRIVRTE WELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE T'¢PE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRI',,,'RTE WELL 'TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNIT'¢ SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MR'¢ RPPL'¢. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
F"EF-:~.I X T E ::---':. F" X F.:E~; [)E£:E[r-IBEF: 2-:1.. 1L.:~- E:"'a:
I CERTIF'¢ THRT
±: IRM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLIT'¢ OF RNCHORRGE.
2: I HILL INSTBLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
3:: I UNDERSTFtND THRT THE ON-SITE SEHER S'¢STEM MR'¢ REQUIRE ENLRRGEMENT IF THE
RESIDENCE I~ REMODELED TO INCLUDE MORE THRN 4 BEDROOMS.
bluNED
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~est Hole ~7
Depth in Feet
From To
0.0' - 1.0'
1.0' - 12.0.'
Table A
WO ~A18753
Logged
Date:
Soil Description
By: Client
10-28-78
Organic Topsoil.
~ Gravels, GP, NFS, d~mp, cobbles
12 inch--, ~-~-70% plus #4 agg.
to
Bottom of T~st Hole:
Frost Line:
Free Water Level:
Remarks:
12.0'
None Observed
None Observed
Test Hole Logged By Client
Verified by Alask~ Testlab
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COSA Checklist.docx
COSA Checklist
Legal Description: SOUTHPARK #1 BLOCK 3 LOT 10 Parcel ID: 020-491-36
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA - PUBLIC &/OR CLASS “A” WATER
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank 50”
Date of pumping 8/1/24
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/25/83
ALL standpipes present per record drawing
Total measured depth from grade 9.6 ft (max)
Measured depth to pipe invert from grade 7.54 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective (ED).
If not, state depth into effective 2.5 ft
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 8/1/2024
Results Pass
Fluid depth prior to test 4 in
Water added 1150 gal
New fluid depth 9 in
Elapsed time 1440 min
Final fluid depth 3 in (& 18” ED missing)
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 48 in (MOA 4’ ED)
Effective depth used 21 in (Missing ED + Final Fluid Depth)
Effective depth remaining 27 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots &
appears approximately 1.5’ or 18” ED is missing.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 8/15/2024
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
8/15/2024
08 /15 /2 4
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & 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
ParcelI.D. 020-051-60 HAA#
GENERAL INFORMATION Expiration Date:
Complete legal description SOUTH PARK SUBDIVISION #1; LOT 10, BLOCK 3,
Location (site address ordiroctions) 4.400 SOUTHPARK BLUFF DRIVE * ANCHORAGE, AK 99516
Current Property owner(s)
Mailing address
Lending agency
GENE SWEAT Dayphone 34-8-8694
4400 SOUTHPARK BLUFF DRIVE * ANCHORAGEr AK 99516
Day phone
Mailing address
Real Estate Agent
Mailing address
JACK BLAIR w/ REMAX PROPERTIES Day phone
2600 CORDOVA STREET * ANCHORAGE, AK 99503
276-2761
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class "A" Well ·
Public Water System []
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 title (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 pedod of
up to one year with valid water samples.) Certificates ars 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 OFINSPECTION BY ENGINEER
As cerUfied by my seal affixed hereto and as of the validation date shown be/ow, I verify that my
invesb'gation, based on procedures outlined in the Health Authori~y Approval Guidelines for this application,
shows that the on-site water supp¥ and/or wastawater disposal system is(are) safe, functional and adequate
for the number of bedrooms and ~ of structure indicated herein. I further verify that based on the
information obtained from the MunicipalEy of Anchorage files and from my invesb'gafion and inspection, the
on-sita 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504.
Phone 337-6179
Engineer's Printed Name JEFFREY A. CARNESS, P.E. Date
Engineer's Comments:
In conducting this evaluation, AWVV~, Inc. attempted to prot4de a thorough,
conscientious engineadng ana~sis of the system in accordance v~th ADEC and MOA
DSD Guidelines & Regulations. The reported reauits deacdb~d the performance of the
system under ~he conditions encountered at the time of the test, and separation
distances measured to readi¥ idenEfiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate dufing the year, and the water ueage of the family being sen/ed by the system.
These conditions are outside the conkol of the evaluator of the syslam. Satisfactory test
results do not guarantea future pon'ormanco of the system, nor do they guarantea that
there are no hidden defects or encroachments. AWWC, Inc. can U~retore not provide
any warranty or fuJure eaUmata of how long the system v, fll continue to meat the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listad above. Any reliance upon or use of this report by any
other person or party is not authorized, nor v/fll it confer any legal fight whatsoever.
5. DSD SIGNATURE
Approved for L'Jr'
Disapproved.
Conditional approval for __
bedrooms, wi~ the fllowing stipulafions~ ~ :: WASTEWATERWATER AND
PROG~M
....
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
By..
(Rev. 12J00)
Original Certificate Date:
Municipality of Anchorage
Development Services Department
8uM~g ~;~ty Dlv~m
Or~t~ W~r & W~stwn~r Program
P.O. Box 1~6650 Andmm~e. AK 99519-6650
Leg~Desatpt~n:
A. WELLDATA
HEALTH AUTHORITY APPROVAL CHECKLIST
SOUTH PARK S,/D ~1; LOT 10t BLOCK 3t Pal~ellD: 020-051-60
Welltype 'A' IfA, B, orCpmvlcl.e__PWSlD~7~~ ~
Date completed. ~ properly IXO;~cted (Y/N) --
1~ Cased to ft. Casing height (al:xw~ gmuna') In.
FROM WELL LOG AT INSPECTION
8talio water level ~ ft. Jif.
~ g.p.m. ~J g.p.m.
WATER SAMPLE RESULTS:
B. 8EPTIC/HOLDDJO TANK DATA
Tml~ T~r~l
Tm~kMz9 1250 ~. N~r~~ 2
~ d ~pl~ 9/50/20~ ~r
C. ~O~N R~ DATA
~ 66
T~ de~
~ad~ 6/29/2~1 ~~ P~
Date Installed 7/83
cmmouts (Y/N) YES
Hlgh water elam1 (YAWl)
A+ HOME SERVICES
7/&1 ~ raUno (g.p.d~ 125 System type TRENCH
It. Width 4. ,It. Gravel below pipe 4. ft.
It. Eff. al~ama 528 tts Moflltodngtube YES Depm~slofloverfleld, NO
For 4 bedrooms
New deplh 28 In.
600+ g.p.d.
NONE KNOWN ff y~l, glv8 dato -
D. UFT STATION
'Pump on level at in. 'Pump n. High water alarm level at In.
~ Cycles tested Meets alarm & olrcult requirements?
E. SEPARATION DISTANCES
COMMUNITY WATER
SEPARATION DISTANCES FROM WELL ON LOT TO:
On adjacent lots
SeplJc lank/tiff statlon on lot
Absorption field on lot.
Publ~ esw~r meln
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Properly fine ~ 0%
Water sewf~e ane 10'+
Curteln drain NONE KNOWN
F. COMMENT8
Building foundation 5'+ Properly line 5'+
Water meln lO'+ Water esn~ce line lO'+
Wells on adjacent Iote 200'+
SEPARATION DISTANCE FROM ABSORPTION RFI n ON LOT TO:
Building foundation 10%
Surface water 100'+
Wells on adjacent lots 200'+
Water n~n 10%
5'+
100'+
Driveway, parldng/vehlde ~torage 25'+
G. ENGINEER'8 CERTIFICATION
I cerUfy that I have determined ~hrou~h field in~cecUon~ and
review of Municipal records ~hat ~he above systems are In
conformance wlJh MOA HAA guidelines In effect on ~hls date.
Englnes~ Prlnte¢. Nar~e ..~Er~EY A. OARNESS
Date of Payment <:~'//,~-/d/
~Ke~pt Number ~/~' '-~ '7
O~v. ~2/0o)
Waiver Fee $
Date of Payment
Receipt Number
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental ServJces
On-Site Services Section
P.O. Box 196650 Anchorage, Ai~aska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description ~ ~--
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address /'U'//~
Agent ~'~',k-' ~c//4/'2--~/("~-'T/-/ /'c/~F'/-//b/,~'/~ Day phone 7~,=~ '.~//1
/
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY: -"~/'-~
Individua well ./~"~/~
Community well ./'~ ,.~' '?~ ~ / '~.,~
Public water
NOTE: If community well system, provide written confirmation from State ADEC aitest-
lng 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) =ront MOA#21
=
STATEMENT OF INSPECTION BY,ENGINEER
As certified by my seal affixed hereto and aS of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this ins~p~
Name
of
Firm
Alaska Water & .¢'//
Address
EngineeCs signature TF/ <
DHHS SIGNATURE
'(~ Approved for
Disapproved.
Conditional approval for
bedrooms.
,'tion.
Phone
bedrooms, with the following stipulations:
Additional Comments
By:
Date
,Munic!pality oi Anchorage Department of Health and Human Services [DHHS) issues Health Authority
Apprbval Certificates based only upon the representations given in paragraph 5 above by an independent
profe~i~nal engineer registered in tbe State of Alaska, Th~ D H HS 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 s issued, The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-O25(Rev. 1/91) Bsck MOAf~21
MUNICIPALIT? OF A~NCHORAGE
FNVIRONIVIENTAL 8F. RVICE.S DIVISION
Municipality of Anchorage MAR 17
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744
Health Authority Approval Checklist
Legal Description: Lo'(" IO,~ ~ ~ ~'~-~ ~z~¢; .~e I Parcel I.D.:
A. WELL DATA
Well type
f~, or C, attach ADEC letter. ADEC water system number
Log~nt (Y/N) Date completed
Total depth ~, Cased to
Sanitary seal (Y/~)~
Date of test ~ELL
LOG
Static water level ~,~
Well production
WATER SAMPLE RESULTS:
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
Coliform Nitrate Other bacteria
Date of sample: . _ _ ~ iCollected by:
B. SEPTIC/H~LDINGTANK DATA s~Y/N
Date installed '~/~-~ Tank size /~.~'O _ Number of compartment
Foundation cleanout (Y/N) "/'~-~ Depression (Y/N) ~ High water alarm (Y/N)
Date of Pumping ~/,..2//~ Pumper
C. ABSORPTION FIELD DATA
Date installed '7/~ 3
Length ~ / Width
Effective absorption area
Soil rating (g.p.d./fF or fF/bdrm) ! 25- System type
· ~' Gravel thickness below pipe Total depth
Monitoring Tube present (Y/N) '¥~'"CDepression o~er field (Y/N)
Date of adequacy test ~ J I~"/~"~ Results (Pass/Fail) [:::::'/:~'~'S For
Fluid depth in absorp.tion field before test (in.); ~ Immediately after ~O~gal. water added (in,):
Fluid depth __.~ (ins) Minutes later: /(~ Absorption rate = ~, ~O.(~ g.p.d,
Peroxide treatment (past 12 months) (Y/N) /.~ i~..~o,w~/ If yes, give date
bedrooms
72-026 (Rev. 3/96)* ,
B~IFT STATION
Manhole/Access (Y/N) _-~p~on" level at* "Pump off" level at*
High water alarm leY~'~
E. SEPARATION DISTANCES
S FROM WELL ON LOT TO:
Public sewer main
~ine Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation I~- /
. Property line ~'Or~' Absorption field
Water main/service line'~'>10'' Surfacewateddrainage ~.lO~' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line I ~_. ~
Building foundation '~¢ ~.~-~,. ~_p~,r'-'
Water main/service line
Sudace water ~. I 'DO I Driveway, parking/vehicle storage area
Curtain drain /"J/'~- ( ~-a~J "~ Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
I certify that I have
in conformance
Signature
Eng
Date '"~ / ' ~-/'¢~' ~
HAA Fee $ ~--"~ D'g~ t z~
Date of Payment
Receipt Number o~,¢ ~;-~) L-'/~'~-~ )
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
~ ' ~i= 'OUT UPPER HAt'~'-iONLY
~ APPLI(,, "'~IT FILES
,* ?'~ Phone
Property O;~ner 'J-~
Mailing Addre~ -~
~',
Address
Address
Street Locati~ ~, ~, ~ ?~,~,~' ~- ~ .
~Slngle Family
Time
Date Date Date ,/,,//~ ~.~._/~ ,~-- --
Inspector Inspector Inspector Inspector
Field Notes:
L.j~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL
(
( ' ) DISAPPROVED
{ ) CONDITIONAL APP~ROVAL'
Boils Bating Date Sewer Installed Well To Absorption Area / .4 Well Log Received
72-023