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HomeMy WebLinkAboutT15N R1W SEC 9 LT 39AT15N RIW
SEC 9
Lot 39A
#051-103-08
Municipality of Anchorage
Development Services Department �_•�
�;'�=_ _
Building Safety Division
On -Site Water 8 Wastewater Program, 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519650
www.cl.anchorage.sk.us (907) 343-7904 Page 1 of 3
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. SW050003 PID Number. 051-103-08
Nam: THOMAS AND LYNETTE MCKINNON
Wastewater System: ❑ New ■ Upgrade
Addreee:
20994 OBERG ROAD * CHUGIAK, AK. 99567
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 230-0642 3
0 Deep Trench ■ shallow Trench 0 Bed 0 Wund ■ Other
LEGAL DESCRIPTION
=a ' 3.0
lad o,t& nem a SE DWG.
WD/sq. rt
m
Block: Lot. SubdivWon:
OWh fa pipe lb a can 010 ileac
arae) erph e.nelh pile
— 39A —
SEE DWG. n
0.5+
Township: 15N Range: 1 W Section: 9
r• .sews eb w a -1 peas
area Nnpn
SEE DWG. n
40 R
WELL: [3 New [I Upgrade
gnwd amn:
5
Nunes of ens
1
pbl.ce ea.«n ewes
—
R
n
cw"d" n "C),. Tad
Ceres 7e
Tad eee.paan ens:
200+ $a n
Poe maeri k
D 3034/ F-810/ SCH 40 PVC
5�\tJG n
aw.. Data D1
n
s ab wawGREEN
oae
GENERAL
�14-16/2005
n
TrNk
so Ac
I
c w" wipe asp.. uant
� U S T}
W,Aenp
n
FLTANK
SEPARATION
DISTANCES
aseptic 0HolCing ■s.T.E.P. ■Other*
To
From
Septic
Tank
Abs&rrppHon
Fleld
Uft
station
Holding
Tank
/Prhwb
s..a lkne
ManWuct~.
GREER TANK
C -P -W4' in V°
1500
Well
1000+
100'+
100'+
—
25'+
uol.bk
3/16- STEEL DOUBLE COATED
N.niOer a ewnp�
1 2
Surface water
100'+
1000+
100'+
—
—
LIFT STATION
Lot Une
5'+
10'+
5'+
—
1500
GREER TANK ZABEL TECHNOLOGIES
Foundation
50+
10'+
5'+
—
—
.n lasa:
TIMER
a:
TIMER
NO .ear a:
' 1 46n
Curtain Drain
NONE KNOW
rwnp wee • uea.k
#P -SE -13T
aecumd k.p... P. h. Ir
WALKER ELECTRIC
Remarks:
BENCH MARK:,*"'
t.oabn ar D..Ipum
*THIS IS A ZABEL SCAT BIOFILTER SYSTEM.
TOP OF CONCRETE SLAB AT CORNER OF
THE OLD SEPTIC TANK AND CRIB WERE COMPLETELY
HOUSE BY GARAGE
ABANDONED PER UPC.
n.4V.,90.100.00 R
^. t[MOINEE e[Al
O
ACgp��
Inspections performed by: GEG, Ltd. Dates: 1st 5/14/2005
2nd 5/14/2005
* '
3rd 5/16/2005
....A.
Q
f omens,:
�QQ��'
Development rvices Department Approval
. CE— 53
4 8 z AS•''' �o
dpp4o4
Re�ev�ewled and approved by: Date:
feeei0
O�oo
PERMIT NUMBER.
AS-BUILT DRAWING PARCEL 051-103-08
DBLI
30.34
19.57
DBL2
29.54
20.83
STI
25.65
26.67
ST2
27.23
32.93
NH
28.03
35.05
POD1
33.23
38.62
PGD2
35.11
40.36
COI
68.12
66.40
AfTI
63.77
63.58
CO2
41.56
67.48
MT2
45.12
68.66
EXISTING
DabNG
4 BEDROOM
TOE OF SLOPE C� ANEW ,600 GALLON
� � S.T.E.P. TANK /
ALTERNATE StTENEW DRNNFIELD
//
GARNESS ENGINEERING GROUP, Ltd. ff- 4
CONSULTANTS 6 GENERAL CONTRACTORS
• • •... . •
: L ww. NVA WM rw • MR MM. M was .nae Lp?>n-ern . nuc 00r,av nw ....,..ry..�.�..
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: r�
TOM do LYNETTE MCKINNON (907) 830-0642 2 OF 3
1T15N. R1W. SECTION
FOR SEPTIC SYSTEM UPGRADE
(N".01M)
R.A.L.
/
I SW05000 ` AS -BUILT DRAWING PARCEL 1 "��
051 -103 -OS
TOP OF TANK
AT INLET . 94.23
INERT OF BUNG
AT INLET - 93.74
ST
NEW 1500 GALLON
S.T.E.P. TANK
OF MANHOLE
- 99.17
f- TOP OF TANK
AT OUTLET - 94.27
ZABEL SCAT
BIOFILTER
-FINAL GRADE
89.65 (AVG.)
FABRIC
DRIGINAL GRADE
- 85.17 O
HIGHEST POINT
ERT OF
APPROVED
INV
r•; ': i :.'. x x t
"'-`'¢MID FILTER (;t '-!•:i: PIPE
TOP OF SAND FILTER ' -f' • .:-.r. t•>',:; 83.78(AVC.)
83.21 (AVG.)
NATER IN TEST HOLE O 77.17
ELEVATION OF
OF TEST HOLE O 69.17
M OF
61.17
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS& GENERAL CONTRACTORS •
MI L TOM IOM, VJM 101 • MOWGC M MW7 • ROK (PWy177 M • FM (WA " • 11Di1O w..�.wpwYy�w
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
TOM & LYNETTE MCKINNON (907) 830-0642 3 OF 3 OQ p
LEGAL DESCRIPTION: DRAWN BY: O4 di •.
T15N, RAW, SECTION 9; LOT 39A, R.A.L �Q
s,
TYPE OF WORK:-
DATE: O
PROFILE AS -BUILT FOR SEPTIC SYSTEM UPGRADE 8/1/2005 O
(Rw. 9Los)
08/04/2005 13:40 9076961815 GREEN GENERAL INC PAGE 03/03
CUNT WAM
10319 Colville U
EAGLE RIVER A6, 99377
Lj e a 1310
pba 696.8964 Cel N 223-6304
Fmul C1inL1Lnga01.wm
To: Green General Contracting
PO Box 672125
Chugiak AK 99567
Date :6-1-05
Ref :T15N, Rlw Sec. 9 Lot 39A
Permit:
This is to certify that on site sewer lift station at above mentioned
property has been wired in accordance with the standards of the National
Electrical Code and manufactures specification.
Systems were checked and performed as specified in the systems
manual.
Clint Walker
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN I%TUNICIPALITY OF ANCIIORAGE
AND �M �C1C�i�Clc�f—+�
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
day of�L,S� of 2005 by and between\
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
I. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Wastewater
Treatment System (AWWTS), described as zcz�L �� Fi"r located
at filnchorage, Alaska.
2. Definitions.
A. Alteration. Any change to the design or function of an A\VWTS that
includes the installation or removal of any parts, components or pieces
not included in the original construction permit and design. Prior to
performing any alterations to an AWWTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65.
B. Certificate of On -Site Systems Approval. An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
These approvals certify that the systems are adequate for the homes that
they support and meet the codes that were in place at the time of system
construction. '
C. Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
D. Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included in
the original design which would allow the AWNVTS to continue to
perform as designed.
E. Permit (Construction) An On -Site Wastewater Disposal System
Construction Permit as defined by AMC 15.65.
F. Permit (Operating) An Advanced Wastewater Treatment System
Operating Permit. An annual permit, issued by the Municipality, that
allows the Owner to operate an AWWTS, upon meeting all the
requirements of this agreement, the conditions of Operating Permit, the
requirements of the On -Site Wastewater System Construction Permit and
all relevant provisions of AMC 15.65
3. Fee. Owner shall pay to Municipality an annual fee of ZC i
($4.00), payable on or before the issuance of the operating permit and annually
thereafter. The annual fee is due on or before the anniversary date of the approval by the
Municipality of installed system.
4. Term. The term of this Memorandum of Understanding shall be for the life of the
The term begins on the date of approval by the Municipality of the installed system and
shall continue while the AWWTS system is in use or operational or until the property is
sold or title is transferred by owner and a new certificate of On -Site approval is issued to
the new owner or transferee of the property.
5. Alterations, installation and Removal of Additional Equipment. Owner agrees
not to make any alterations, removal of parts or additions to the AW WTS without a
Construction Permit from the Municipality.
6. Maintenance and Repairs.
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AWWTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2)
maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
rules and orders for the AWWTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's ANVAN TS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AWWTS
Operating Permit is:
C. Owner acknowledges that the fine schedule for failing to maintain and repair an
AWNVTS are codified in AMC 14.60.
D. Owner agrees that only maintenance, repair personnel certified by the
Municipality will inspect and make any necessary maintenance, repairs or permitted
alterations to the system.
E. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
F. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
G. Owner agrees that the relevant provisions of the standard specification guidebook
for AWWTS is the governing professional guidelines for the construction,
maintenance and repair of the Owner's AWWTS.
7. Nonwaiver. The failure of either party at any time to enforce a provision of this
Memorandum of Understanding shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of Understanding or any part
hereof, or the right of such party thereafter to enforce each and every provision
hereof.
S. Amendment.
A. This Memorandum of Understanding shall only be amended, modified or changed
by a writing, executed by authorized representatives of the parties, with the same
formality of this Memorandum of Understanding was executed and such writing shall
be attached to this Memorandum of Understanding as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this contract, the only authorized representatives of the parties are:
Anchorage: Purchasing Officer
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of
Understanding shall be brought in the Superior Court for the Third Judicial District of the
State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and
obligations of the parties under this Memorandum of Understanding.
10. Severability. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
O\YNER:
Date: )Iy c . 19 Son S
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
MUNICIPALITY:
By:
Title:
Date:
) ss.
The foregoina instrument was acknowledged before me this jq day of 4 usr ,
20b5 by mashlClGcnnUr, ,the #)wntAv of
on behalf of the Municipality of Anchorage.
17ARY PUBLIC FO ALAS '
•
Commission expires:
S�o1J�bvl� ^� `:
Municipality of Anchorage
Development Services Department
• +.e Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: harness Engineering Group
Legal description: T15N. PIW, Section 9. Lot 39A
The attached paperwork has been reviewed and Is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design. _
❑ Additional soils information needed.
❑ Water monitoring results inadequate. _
❑ Discrepancy in information submitted. _
❑ Topographic information missing or inadequate.
® Incomplete; missing maintenance agreement
❑ Incomplete; missing _
❑ Additional adequacy lest information needed. _
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing.
❑ Locations of all soils, percolation and water monitoring tests not shown.
❑ Proposed system too deep for soils information submitted.
❑ Well log required. _
❑ Omission in narrative.
❑ Insufficient fill over tank or field._
❑ Other.
Name of reviewer. Julie Makela. P. E.
Date: 8/15/2005
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
Mt1N/C/PALt7Y 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
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Permit Number: SWO50003
Legal Description: T1 5N R1 W SEC 9 LT 39A
Design Engineer: 0855 Gamess Engineering Group, LTD
Owner Name: THOMAS & LYNETTE MCKINNON
Owner Address: 20994 OBERG ROAD
CHUGIAK , AK 99567-6141
Date Issued: Jan 06, 2005
Expiration Date: Jan 06, 2006
Parcel ID: 051-103-08
Site Address:
Lot Size:
Total Bedrooms:
This permit is for the construction of.,
Disposal Field ❑,/ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
108900 SO. FT.
lg4"fn Permit Bedrooms:615105
❑ Private Well ❑ Water Storage
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
FINAL GRADING MUST INCLUDE THE UPPER SIX INCHES TO CONSIST OF TOP SOIL AND BE VEGETATED
SUFFICIENTLY TO PREVENT EROSION
Received By.
Date: a/nS
Issued By V 11 1 Date: /A�D.S-
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.ek.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR ASINGLE FAMILY DWELLING
Parcel I.D. 5� 1 _ )n -m Permit Number
Property owner(s) TOM & LYNETTE MCKINNON Day phone 688-4607
MM3+7dig address (1) 20994 OBERG ROAD • CHUGIAK. AK
Mailing address (2)
Legal description (Lot, Block & Sub'd.) LOT 39A.
Zip Code 99567
Legal description (Section, Township & Range) SECTION 9. T15N. R1 w. LoT 3R A
Lot Size � Acre q.Ft Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade 0
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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.
GARNESS ENGINEERING GROUP, Ltd.
Permit Fees: 40 -Gz
Date of Payment: 3 Ct n DS
Receipt Number: lOe?a
Waiver Fees,
Date of Payment:
Receipt Number.
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
December 20, 2004
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Proposed Septic Upgrade for T15N, R1W, Section 9; Lot 39A,
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. The septic system is
currently in the state of failure and needs to be upgraded. We are proposing to install a new 1500
gallon Advantex Treatment System and a 5 -wide trench type drainfield. One test hole was
excavated on the property. The drainfield will be designed around the 30 foot radius of this test
hole. Per the homeowners request we are sizing the septic system for 4 bedrooms. Comments
regarding the design are summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring,
and the percolation test results.
2. TRENCH DESIGN:
a. Percolation Rate: 12 minutes/inch
b. Allowable Application Rate: 5.0 gallons/day/ft'
c. Proposed Application Rate: 3.0 gallons/day/ft=
d. Number of Bedrooms: 4
e. Design Flow: 600 gallons per day
f. Minimum Absorption Area: 200 fl=
g. Total Depth: 4 feet (maximum)
h. Sand Filter: 2+ feet
i. Effective Depth: 0.5 feet (minimum)
j. Width: 5 feet
k. Reduction Factor: N/A
1. Minimum Length: 40 feet long
m. Effective absorption area = 200 R'
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507
Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessengineering.com
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
system.
4. TOPOGRAPHY: The proposed drainfield is to be installed on the toe of a 25+ percent
slope. Directelly below the drainfields is a 10-15 percent slope. Approximately 20 feet downhill
from the drainfields is a slope greater than 25 percent. The area below the drainfield will be
graded so there is no slope greater than a 25 percent slope 50 feet downhill from the primary
drainfield. We request that you grant a 35 foot waiver to a slope greater than 25 percent for the
alternate site.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
NOTE. A site plan drawing, a design drawing, tank derail, trench detail, slope detail, one soil log, and a 7 page
construction specification letter which are all part ofthe design package for this septic system.
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507
Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessengineering.com
T15N, R1 ,EC 9. LOT 37, I T15N, R1 W/SEECC ;, LOT 38,
•C /
—___—_— _—___—_— _-___
A/
PROPOSED SEPTIC UPGRADE
(SEE DESIGN PACE 2 OF 2)
ALTERNATE SITE
T15N. RIW, SEC 9, LOT 40,
(VACANT)
T15N. RIW, SEC 9. LOT 33,
(NO CONCERN)
EIOSTNG
3 BEDROC
TH/1
/ISO' WELL RADIUS I
/ THAT SERVES BOTH I
I LOTS 54A AND 54B I
I
LOT 54A; LOT 54B'. \\I
/ /' EAC BERNIE S/D BERNIE S/D �\
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS d GENERAL CONTRACTORS
om C nfllla annn a, YTC Inl • eurunoArc eR a R, • eunue !Oa)1ltl J.no • iev taOm y. Vice
PARED FOR PHONE NUMBEI
TOM AND LYNETTE MCKINNON 830-0642
T15N, R1W, SEC. 9; LOT 39A,
SITE PLAN FOR SEPTIC SYSTEM UPGRADE
FZ
N
LAAIPERT ESTATES
/ PARK TRACT TRI
(VACANT)
TRACT B1—A;
LAMPERT ESTATES
WELL AND SEPTIC
ON EAST SIDE OF
LOT.(NO CONCERN)
12/20/2004 - pF
kwN BY:
R.A.L./C.J.G.: 4 V Qe
1" = 100' S: ..... .... .. . ...............
iE NUMBER: Vii.... ..... .... ...
1 OF 5 r A. ar ess;•
ti4 —7953
NOTE: THE CONTRACTOR SHALL
FAVE THE 10' LINE EASMENT
LLAGGED BY A REGISTERED LAND
SURVEYOR PRIOR TO CONSTRUCTION.
/ EWEELNGLLf y�• / / � /
I /
INSTALL DOUBLECLEANOUTS
i'
PROPOSED 1500 / :'�'• / / / '
GALLON ADVANTEX
TREATMENT SYSTEM 1� / �.'••_ / / /
INSTALL DOUBLE EXISTING
CLEANOUTS 4 OM
BEDRO/ � • \ // / / /
INSTALL FLOW
DNERTER
re
TOE OF SLOPE ` // EXISTING SEPTIC TANK
TO BE COMPLETELY /
C� T ABANDONED
ALTERNATE SITE EXISTING DRNNFIELD TO BE
PROPOSED DRAINFIELDS. EXCAVATE / / yC,� / USED AS A RESER SITE
A TRENCH THAT IS 4 FEET DEEP 4T
MAXIMUM BY 5 FEET WIDE BY 40 //J,tr„
FEET LONG. ADD 2+ FEET OF
M.OA ED SAND
AND TH NP0.5 FEET OF CLLEAN.
WASHED SEWER DRAXNROCK.
DATE:
12/20/2004 o 4
0
DRAWN pP'`�C%• OF
.gs14o
BY:
C.J.G. �. 9 F -DO
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS 8 GENERAL CONTRACTORS SCALE' J•
I"
....:. .. .... ............
PM F TIOOo 9n4A SInTF 101ANfwtlOpfe AR 0050) • FNfWF /00)1S•) -0i10 • FAX loon•}F-})4A 1 — — SD•
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:Q
TOM & LYNETTE MCKINNON (907) 830-0642 1 2 OF 5 Q ...
• Ga es..
LEGAL DESCRIP71ON: QO w — ; • e�Qv
T15N, RiW, SECTION 9; LOT 39A,
TYPE OF WORK: 444O
DESIGN FOR PROPOSED SEPTIC SYSTEM UPGRADE �Dopoo�cdP!O (elsio�pa
AdvanTex Treatment System _
AX Series - Mode 1 a
One (1) 40x96 Pod
`_J
6' JIM CAP
(TYP.2) -
FINAL GRADE
6' PVC PUMP -OUT
(TYP.2) 1
1500 GALLON
STEEL ADVANTEX
TANK
AX20 POD
SAND
NOTE: THE BOARD INSULATION TO BE
INSTALLED OVER THE SEPTIC TANK & V
BEYOND ON ALL SIDES EXCEPT UNDER
THE ADVANTEX FILTER. THIS WILL ALLOW
FOR HEAT TO ESCAPE FROM TANK &
RISE TO THE FILTER ABOVE IT.
12/20/2C
DRAWN BY:
GARNESS ENGINEERING GROUP, Ltd. c.�.c.
CONSULTANTS d GENERAL CONTRACTORS SCALE'
3701 E. TUDOR ROAD. SUITE 101 , ANCHORAGE. AK 90507 , PHONE (907)537-0179' FAX (007)538-3216 N.T.S.
PREPARED FOR: PHONE NUMBER: PACE NUMBER:
TOM do LYNETTE MCKINNON (907) 688-4607 3 OF 5
LEGAL DESCRIPTION:
T15N, R1W, SECTION 9; LOT 39A,
TYPE OF WORK:
PROFILE DRAWING OF ADVANTEX TREATMENT SYSTEM
FROM TANK
DISCHARGE
FILTRATE
11
30 INCH
INSULATED
RISER -
-ORENCO
BIOTUBE
SCREENED
VAULT
•ORENCO
EFFLUENT
PUMP
*�4
......... ..................�
e A. arness10
00
533 v 0
• FROM ADVANTEX
TREATMENT SYSTEM
'f r-------------------------------w-T0-i
� I o
I OWT
Cq
L— ---------------------------------i
�- 40' LONG
lil!7iffq:710
FILTER
0.5' OF EFFECTIVE
2'+ OF M.OA
~, .APPROVED SAND FILTER
�--a' WIDE-�
GRADE
/+
12/20/2004
DRAWN BY: p
GARNESS ENGINEERING GROUP, Ltd. c J.c.
SCALE'
CONSULTANTS It GENERAL CONTRACTORS y
3701 F TMOR ROAD S10TF 101 • ANTHORAGF AK Oa30) • PHONF (00))33)-6170 • FAX (007MR-NM N.T.S. • •'
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
TOM & LYNETTE MCKINNON (907) 688-4607 4 OF 5 Q
LEGAL DESCRIPTION: Qoo
T15N, RiW, SECTION 9; LOT 39A, p�4444
DETAIL DRAWING OF PROPOSED DRAINFIELD
• -'•. 1. ll quo
Fi �dl
GARNESS ENGINEER & GENERALING�GROUP, Ltd.
CONSULTAONCTORS
5701 F TITOR POM) SIUTF 101 • ANr"MArF AR 00507 • PNIWF f9n7)117-61706 FAR (001Ogdi64
PREPARED FOR: PHONE NUMBER:
TOM & LYNETTE MCKINNON (907) 688-4607
T15N, R1W, SECTION 9; LOT 39A,
OF WORK:
DETAIL DRAWING OF PROPOSED DRAINFIELD
12/20/2004
0� Q
\WN BY:
C.J.G.
po
N.T.S.
:E NUMBER:
5 OF 5
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GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
7101 L 11A011 ROAD. WE 101 • AWAOR" A 9 l • MQW- (W]illy • EAL W7 N • W2L ymrwpirwYq.00m
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: T15N, R1W, SECTION 9; LOT 39A,
PERFORMED FOR: TOM & LYNETTE McKINNON DATE: 12/7/2004
DEPTH
(feet) ORGANICS TEST HOLE 1
2
3
4
5
1 11
8
9
10
11
12
13 GM/ML W/
14 POCKETS OF
GC MIXED
15 THROGHOUT
16
17
18
DEPTH TO
GROUNDWATER
DATE
DRY
12/7/2004
8'
2/13/200
8'
2/14/200
6-
—
2
2:02
30
lei
2 1/2-
2'3
3
2:02
—
6-
—
4
UNN
•
m
2 1/2"
5
1111"111
—
Mm
•
6
„/%
30
1111!1!
2 1/2-
2'
VM
•map
DEPTH TO
GROUNDWATER
DATE
DRY
12/7/2004
8'
2/13/200
8'
2/14/200
6-
—
EXISTNG
3 BEDROOM
HOUSE
TH/1
SITE PLAN
1'=100'
DATE READING
19
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
12/8/2004 1
1:32
—
6-
—
2
2:02
30
3 1/2-
2 1/2-
2'3
3
2:02
—
6-
—
4
2:32
30
1 3 1/2-
2 1/2"
5
2:32
—
6'
—
6
3:02
30
3 1/2-
2 1/2-
2'
19PERCOLATION RATE 12 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 5.0 FT. AND 6.0 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: ROB CAMPBELL
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS. CERTIFY THAT THIS WAS P RF RMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Zo o�F
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS 3 GENERAL CONTRACTORS
May 2, 2005
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Revisions to Septic Upgrade Design for T15N, R1 W, Section 9; Lot 39A,
To whom it may concern:
A permit (#SW050003) was issued by your department on January 6, 2005, for a proposed septic
upgrade for the reference property. The septic design was for a Advantex Treatment System. We
are proposing to use this property as the first site for the SCATTMt Biofilter System. We request
the existing sewer permit be revised to reflect this change. Attached is a revised design package
which shows the changes made to original design package. This request is also being submitted
simontaneously with Alaska SCATrm Biofilter System installation and design package. The
original design criteria for the drainfield will still apply. We are anticipating a early to mid May
installation. If you require any additional information or have any questions, please feel free to
call me or Mr. Alv Maus at 337-6179.
P.E., M.S.
NOTE: A site plan drawing, a design drawing, three detail drawings, one soil log, and a 7 page construction
specification letter which are all part of the design package for this septic system.
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507
Ph: (907) 337-6179 • Fax: (907) 338-3246' Website: garnessengineering.com
T15N. RIW. SEC 9. LOT 37. T15N. RIW. SEC 9. LOT 38.
(VACANT) I (VACANT)
PROPOSED SEPTIC UPM
(SEE DESIGN. PACE 2 OF
ALTERNATE SITE
TI5N. RIW, SEC 9, LOT 40,
(VACANT)
T15N. RIW, SEC 9. LOT 53.
(NO CONCERN)
1
EXISTNG
4 BEDROOM
TMJ1 /
/r150' WELL RADIUS
//THAT SERVES BOTH
1 `J LOTS 54A AND 548
LOT 54A,
BERNIE 5/D
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1
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/ (VACANT)
SEPTIC SYSTEM
TRACT 61-A:
LAMPERT ESTATES
WELL AND SEPTIC
ON EAST SIDE OF
LOT.(NO CONCERN)
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>REPARED FOR PHONE NUMBER:
PAGL NUMBLR:
TOM AND LYNETTE MCKINNON 830-0642
1 OF 5
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:.ECRL DESCRIPTION:
T15N, RIW, SEC. 9; LOT 39A,
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TYPE OF WORK:
p/O/e9
SITE PLAN FOR SEPTIC SYSTEM UPGRADE
NOTE: THE CONTRACTOR SHALL
HAVE THE 10' GAS LINE EASMENT
FLAGGED BY A REGISTERED LAND
SURVEYOR PRIOR TO CONSTRUCTION.
CLEANOUTS-\
PROPOSED 1500
GALLON S.T.E.P. TANK
(SEE DETAIL DRAWING
ON PACE 3 OF 5) -
PROPOSED ZABEL SCAT DIOFILTERrM
(SEE DETAILS. PACE 3 & 4 OF 5)
INSTALL FLOW
DIVERTER
TOE OF SLOPE
C�
/
/ EXISTING
WELL -
I
EXISTING
4 BEDROOM
HOUSE
FA
EXISTING SEPTIC TANK /
TO BE COMPLETELY
ABANDONED
ALTERNATE SITE �`
21 EXISTING GRAINFIELD TO BE
/444' USED AS A RESERVE SITE
PROPOSED DRAINFIELD. EXCAVATE / / //4Ty
MAXIMUM BY 5A TRENCH TIS FEET4 WIDE BYEP
40
FEET LONG. ADD 2♦ FEET OF
M O.A. APPROVED SAND FILTER ?~ / / /yo
AND THEN 0.5 FEET OF CLEAN. /�? /
WASHED SEWER DRAINROCK. (SEE 17
DETAIL DRAWING. PACE 5 OF 5) ��/ / d,
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CONSULTANTS& GENERAL CONTRACTORS 'CALL:
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,'REPARED FOR: PHONE NUMBER: ''ACL NUMBLR:
TOM & LYNETTE MCKINNON (907) 830-0642 2 OF 5
T15N, R1W, SECTION 9; LOT 39A,
(YPE OF WORK:
DESIGN FOR PROPOSED SEPTIC SYSTEM UPGRADE
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�— 40' LONG
INSTALL BRACING AND
STAKING AS NEEDED
FINAL GRADE
INSULATION —
FILTER FABRIC -
0.5' OF EFFECTIVE
rl
+".APPRQVED SAND FILTER'." —
S' WIDE
2/2005
by:
GARNESS ENGINEERING GROUP, Ltd. J.L.M.
CONSULTANTS III GENERAL CONTRACTORS SCALL.
Jlnl F TIAAQ PAAO SInTF IM . ANCNC AC.F AR 9Q[nl • P~ 44A71]}l'A179 • FAv lPO713%A-3)4A N.T.S.
PREPARED FOR: PHONE NUMBER: PAGL NUMBLH:
TOM do LYNETTE MCKINNON (907) 688-4607 5 OF 5
LEGAL DESCRIPTION:
T15N, R1W, SECTION 9; LOT 39A,
TYPE OF WORK:
DETAIL DRAWING OF PROPOSED DRAINFIELD
ORIGINAL GRADE
'®jN�
eC mess:
CE -79,53 .•i
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS S GENERAL CONTRACTORS ........
1 eoa 101 AMtl101MCL AK eY50] IIO[: b] ]il]Y AIL YO] N 110LIE: p.wwq,rxpsv.
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: T15N, R1W, SECTION 9; LOT 39A, a mess:
Q e CE-795jjj `
PERFORMED FOR:
TOM 6c LYNEITE McKINNON DATE: 12/7/2004 „ /� JD ��FpG
DEPTH 400edProfjesslore°\oo
(feet) =y== ORGANICS TEST HOLE 1 ��00000�d
1
2
M
allillilm
7
8
9
10
11
12
13 GM/ML w/
14 POCKETS OF
GC MIXED
15 THROGHOUT
16
1
Yellwl i ts--j
l ay[yL�r.LlNyL.`
I.
12/7/2004
8'
2/13/200
8'
2/14/200
\
—
v
111111111
/
111141
2 1/2-
3
vzzzi
—
0o
—
4
HHH
•
3 1/2-
2 1/2.
5
111111111
4i t
6
%//%
30
X111111
2 1/2 -
2 -
17'.68,
•
DEPTH TO
GROUNDWATER
DATE
DRY
12/7/2004
8'
2/13/200
8'
2/14/200
\
—
DATE READING
PERCOLATION
CLOCK
TIME
EXIMG
WATER LEVEL
READING
3 BEDROOM
1 /
12/8/2004 1
HOUSE
—
\
—
v
2:02
/
3 1/2-
2 1/2-
3
2:02
—
6-
—
4
2:32
t
SITE PLAN
3 1/2-
DATE READING
PERCOLATION
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
12/8/2004 1
1:32
—
6.
—
2
2:02
30
3 1/2-
2 1/2-
3
2:02
—
6-
—
4
2:32
30
3 1/2-
2 1/2.
5
2:32
6-
6
3:02
30
3 1/2-
2 1/2 -
2 -
PERCOLATION RATE 12 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
—jl�—J'� TEST RUN BETWEEN 5.0 FT. AND 6.0 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: ROB CAMPBELL
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS P RF RMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Z",/04
et)
Time
APPLI INT FILLS
OUT UPPER HA ONLY
Property Owner ^�'-''/g'U/JC
�-
one
Mallin Address
g"C��f
�/ /fl rnf.'
P ,a
fG ZI CodeTT-
Inspector
Buyer ,! rr�:.
P/� i''./jr �:r, /rs�i %ur
/P9 A:
Inspector
Address 4/r?OeV
Zip Code
4420
Lending Institution
h �%ry // C) /
Phone
��e2�o'zv/j/P•gc.
Address !� (2"rj �f JC:,ay U ud' '� Zip Code �' •.��'
�'� !�3�
Realty Cod.&Agent
r'){, / x f!'' �j� /r;;/
I/ j'rt
Phone
Address
Zip Code
Legal Description
` 1
Soils Rating
Date Sewer Installed
Street Location
Well Log Received
Septic Tank Size
Well to Tank
Type of Residence
9 -tingle Family
f
❑ Multiple Family
No. of Bedrooms
❑ Other
Water SSqpply
Z--fndividual
ATTACH WELL LOG. A well log Is required for all wells drilled
since June 1975.
❑ Community
For wells drilled prior to that date, give well depth (attach logit
available).
❑ Public Utility
G
Sewer Disposal c..:
f-9ndividual
�"�. (,! :�[" r^�/°�- "i �5 i
Year Individual Installed:
El Public Utility-
,/ F'.! •_,
When Connected to Public Utility:
Cl Holding Tank
'
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes: C^
4420
W
,jet r
( APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROV L
DATE
BY: e
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size
Well to Tank
72-023131981
,j
,A
EXCAVATION
WORK
March 28, 1982
Dynamic Realty
ATTENTION: Beth Allard
501 West Northern Lights Boulevard
Anchorage, Alaska 99503
Dear Ms. Allard,
Reference: Lot 39A; Section 9; T15N7 R1W
ROBERT A. SHAFER
CIVIL ENGINEER
694-2979
A sewer system adequacy test was performed on the system
located on the referenced property as you requested.
The package treatment plant was pumped and found to have
a capacity of approximately 1000 gallons. There were
very little solids in the tank indicating that the system
was working properly. The absorption trench was tested
by a continuous flow of water over a period of 48 hours.
During the first 24 hours, 612 gallons were added to the
system and with this flow water backed up into the package
treatment plant. During the second 24 hours, 490 gallons
were added to the system without any adverse effect.
This system was originally designed and installed for
a three bedroom residence and it does appear that the
system is functioning adequately for three bedrooms at
this time. However, it cannot be certified for the four
bedrooms as you had requested and the system cannot be
guaranteed against subsequent failures.
If we may be of further assistance, please do not hesitate
to call.
Since, y,
ROERT A.
RAS/ss
6 cc:
P. E.
Municipality of Anchorage
Department of Health and Environmental
SRB 196X EAGLE RIVER. ALASKA
MUNICIPALITY OF ANCHORAGE
Protection DEPT. OF HEALTH &
ENVIRONMEN"IAL PROI'ECIION
RECEIVED
GREA
,~ ANCHORAGE AREA BOR~ JH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MA,L,NG ADDRESS ?/7 PHON
SEPTIC TANK:
DISTANCE
FROM WEE' /d~d
MANUFACTURE MATERIAl
NUMBER OF
COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH
LIQUID CAPACITY__ GALLONS.
t''/ _~'~t'~ / .'"'} ."~ TOTAL LENGT/H~' ~'
DISTANCE FROM WELL/~'/~ FOUNDATION ~ _NEAREST LOT LINE~[ OF LINES ~'
NUMBER OF LINES ~ DISTANCE BETWEEN LINES TRENCH WlDT IN. TOTAL EFFECTIVE
/~/
ABSORPTION AREA~ 5Q, FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE. ~ { DEPTH OF FILTER~ff~* ~ F
MATERIAL BENEATH TILE~ ~. ABOVE TILE IN,
WELL:,
BUILDING
FOUNDATION
CESSPOOL
APPROVED
__CONSTRUCTION ~'
NEAREST NEAREST SEPTIC...,..,
LOT LINE SEWER LINE TANK~'~''~'''~
OTHER SOURCES
DISAPPROVED REMARKS
DEPTH __
DISTANCE FROM:
SEEPAGE
SYST E M__~?,~) ~--~ ~':'-'/'"--
DISTANCES:
,NSTALLEO
SEWER LINE DEPTH:
PIPE MATERIAL: ~---~'.~
~OT SLOPE: ~'~
REMARKS: ~-~ ?~-
DIAGRAM OF SYSTEM
t:::i!:::' :::' i [ ::: I:::It"IT
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t'HE: Dlliff::"lq-"l OF::' I:::t T'I:;;'.I:ii:h,IC::FI E)I:;?. I:::' :J: "l"
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'IHE:F?.f!i: :[:!i!; F,tO ~;E:I' Ft:I:E)TH F:'C:~I:;i: "l"l'~tl~i:l",~l:::l'"ll!ii::!:i;.
THE: I::iiI:;::FI',/E:L. E:'E:F'TH :l::iil; THE: H]:F,I]:HUH E)Ei:I:::'TH
t:::1I",t[::' THE: I:~u::YI"TOH 01::: 'I"I'"IE: Iiii:::'::I::::F:I'v~F:I'I']:I::IN '::]:N F::IZI~:T::,.
I"t:[H]:HI..IH I)]::iii;TI:::It",ICEi: Iii!:lZTklli~:liii:N t::1 I.'JEf:J....L. t:::ll",l[::' Fl?',l"r' CII",I'"":iii;:['TE~ :i~;lii::l'.lFICiiEi: D]::ili;t:::'(:)Eii;Ffl.... :?'r".ii:;'TEi:H
::l..Fil~i!~ F=iZE/t" F:'Cd:;i: I:~:1 I:::'F;i::['v'F:ITli::: I.,II!i':L.I.. 01:';: ;:?~i:JEii~ I::'lili:E!:T' I::'Ot:;?. t:::1 F:'LIt?,LZC t,.ltii::t..[
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01::: 'IHEi: HE:L.L.
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t:;~:iii:~!i;:l:t~)lli!:t",t(:::llii: ]:El; I:~i:liilJ"lCd:)llii:Ll!!i:l:::, '10 ]:I",ICL. I..II)IZ I'"li:)l:;itli~: THI=II",I ::?::
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O ~ E GEO', ._CHNICAL ~' DEVEL~,,'MENT CO.
Box 90, Davis St,, Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694 2774 SOIL LOG 688-2280
Soils Er Foundations Land Development
Perfomed for:
Legal Description= '~ '~
Depth (feet)
Sotl Characteristics
0
1
2
4
5
6__
8
10,,~
11__
12~
13
16
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
Col~:i~e~s: ~ ~ ~-~-~
No If yes, what depth
Drain Field /
A & L DRILLING COMPANY
BOX 97, EAGLE RIV'ER, ALASKA 99577 · TELEPHONE 694-258B
OWNER OF LAND.
ADDRESS
LEGAL DESCR1PTIO~_
DATE- Started I d/q/7 6 Ended
_ /
PERMIT NUMBER
DEPTH OF WELL /(~.~. ! (; 'r'
(~.~ ~ / L~ ~XCOI STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR _
KIND OF CASING
/q Y _
KIND OF FORMATION:
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MISCL INFORMATION:
,/ d l~),:': ~.',:;'(
DRILLER'S NAME
I-q One [] Four
SINGLE FAMILY
-~ Two [] Five
~ Three []
I NDIVIDUAL~ * ATTACH WELL LOG. A well log iS required for all wells drill
[] COMMUNITY ~inceJune 197B. Fo~wells drilled prior to thatdate, give Well
.~' iNDiViDUAL/ON.SlTE.. *~lf individual/on-site, give installation date~
If svstem is oyer two (2) years old an edequacy test is required
~. PUBL C UT LTY . b~ th s-Department. , ..... .. I
REALTORS®
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection: CMRO VA
2. Property Owner: Einar A. La'rs on
FHA CONV
Mailing Address:
Name of Buyer:
Mailing Address:
P.O. Box A-13
~hugiak, Ak 99567
Book~ Dahiel L.
4703 Ken~i St., Apt A,
Ancho~ag'9~ Ak 99504
(gq~ --~$~
Day Phone r~aS-~'
Day Phone
Name of Lending Institution: Alaska National
Pouch 7010
Mailing Address: Anchorage, Ak 99510
Bank of the North
Phone 278-4581
Realtors
Name of Realtor or Agent: AREA, Inc.
P.O. Box 1970
Mailing Address: ~Vasill~; Ak 99687
Phone
576-2253 _
Legal Description: T1SN R1W Sec 9 l,ot 59
Location: Peters C~r~ek; Alaska - o£f Oberg Road
7. Type of Facility to be inspected: ~es}dence
8. Water Supply
Type of Supply: Public Utility __ Individual
If Individual, number of dwellings presently served
If Individual, depth of well .$~7,
9. Sewage Disposal System
Type of System: Public Utility __
If Individual, date of installation:
No. Bdrms. 3
One ~
Individual (on-site) X
1976 - This is a commercial
aerobic system installed for
a three bedroom'residence,
REALTOP'~
AREA, INC. REALTORS
Anchorage
"C" St. Office
3300 C Street
(907) 278-2525
[] East Anchorage [~ Eagle River
Eastgate Office -- Parkgate Office
5437E. Northern Lights P.O. Box 249
{907) 278-2525 (907) 694-9555
* · ~THI8 SIDE FOR OFFICIAL USE ONL.
DATE RECEIVED ~'
INSPECTION APPOINTMENTS-
6ATE ' r DA'EE ' DATE '
I'NS~EdTOR " - INSPECTO~ INSPECTOR '
DIRECT]ONS:
I. TYPEOF RESIDENCE NU, MBER OF BEDROOM8 '
' F~I 'SINGLE FAMILY [] ONE [];;/THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY F-1 TWO [] FOUR [] SIX
:~, 'WA;tLR SUP~¥ PERMIT NUMBER
' [] INDIVIDUAL
DEPTH OF WELL
~ COMMUNITY ,-
DATE DR I LLE D
~ PUBLIC UTI EITY .
Connection Verified , , LOG RECEIVED
3~ SEWAGE D SPOSALSYSTEM PER~IT NUMBER '
~ IN DIV, I DUAL/ON -SITE
DATE INSTALLED
~PUBLIC UT LITY ~
Connection Verified ;, , INSTALLER
:~;pt~c Tank ~r ~ Holding Tank SOl LS RATING
~,ize: , If Tank is homemade
give dimensions', ~
TYPE OF TANK MANUFACTURER ~ ~ .
r
:4. DISTANCES ~ ~ ~ ~ Beptlo/Holdlng Tank Absorption Area Sewer Line Nearest Lot Line
-' WELL TO: ~
-'~ofption Area to nearest Lot Line ' ~ ' '
~.' COMMENTS
ROVED FOR ~ OM
~APP BEDRO S
~ CONDITIONAL APPROVAL (letter must accompany certificate)
' ~ DISAPPROVED
DATE ' BY (Ti I
~L~G~L DESCRIPTION" ~ ~ ' ....
(Rev. 3/78)