HomeMy WebLinkAboutTURNAGAIN BLK 3 LT 12
/~'T~ 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
NA~ PHONE [] NEW
U A I L~O AD6RESS
LOCATION ~ NO. OF BEDROOMS
] Well I Absorption area Dwelling PERMIT NO,
DISTANCE
TO:
I
I
~ ~ Manufacturer Material No, o~ compartments
~ Liq, capacity in gallons Inside length Width Liquid depth
IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ~ Manufacturer Material Liquid capacity in gallons
O Well Foundation Nearest lot lin~
Length of e ch ]'ne
-- No. of lines /7¢~ Trench w~ inches Distance bet~z~es
~ Topo, tHetofln,sh.ra~, ~ ~ To.allenoth~fFnes Total.f ti oaBsorotionarea
Length Width Depth PERMIT NO,
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS ~ ~
REMARKS
..... '=
APPRO~D ~ DATE .EGA L
72-013' ~v. 3/78)
PERMIT NO. ( ~O0010 )
APPLICANT GLORIA SEPT
LOCATION SEWARD HWY
LEGAL LT. 12 BLK.B TURNAGAIN S/D
DEPARTMENT L ;JHEALTH AND ENVIRONMENTAL . 3TECTION ~ ~~
" 825 ,L, STREET, ANCHORAGE, AK. 99S01 ~5,
264-4720
LOT SIZE 1~000 SGUARE FEET
Type of soil absorption sXst~m is." TRENCH
Maximum number of bedrooms = 3 Soil rating (S(t FT/BR)= ~S-~
The requJ, re/~,,~'.ze., of the soil a~sorption system is-'
The ].eng~h d~mens~on ~s ~he length (~n Ceeb) o~ the ~rench or dra~nCJ, e].d,
The depth of a ~rench on p{~ ~s the d~s~ance between ~he surface o~ ~he
ground and the bo~om o¢ ~he excavation (in .F. ee~).
There is no se~ width ~or trenches.
The gravel depth is the minimum depth o¢ gravel between the ou~fall pipe
mod the bottom of the excavation (in feet).
Per'mi~ applicant hms the responsibility ~o inform ~his department during ~he
installation inspections of any wells adjacent to ~his property and ~he
number of residences that ~he well will serve.
...... -FW[] ( 8 ) I ~'~SPECI'" ~i ONS ARE RE(~IJ I t:~E[)
BackfilIing of any system without final inspection and approval by this
department will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is
100 feet for a private well or 1S0 to 200 feet .~rom a public well depending
upon the type of public well.
Other requir, ements may apply. Specifications and construction diagrams are
mvailable to insure proper installation.
I certify ±hat
1." I am familiar' with the requirements for on-site sewer's and wells as set
forth by the Municipality of Anchorage.
2". I will install the system in accordance with the codes.
B." I understand that the on-site sewer system may require enlargement if the
residence is remodeled to include more than 3 bedrooms.
APPLICANT GLORIA SEPT
V4.0
GRE, ,ER ANCHORAGE AREA BOP UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ADDRESS ~<~'00 ~'~)~).~'~.)20 ~J~ PHONE
SEPTIC TANK:
FROM WELL /00 / MANUFACTURER
iNSIDE LENGTH
INSIDE WIDTH
MATE RIAL ..,,~
NUMBER OF
COMPARTMENTS
LIQUID DEPTH
.LIQUID CAPACITY !~O GALLONS.
SEEPAGE PIT:
NUMBER OF PITS
DIAMETER
OR WIDTH LENGTH DEPTH
LINING MATERIAL~)./-~,.~/~ CRIB SIZE: DIAMETER__DEPTH DISTANCE FROM: WELL [,~) .
~1 TOTAL EFFECTIVE
BUILDING FOUNDATION~:~, NEAREST LOT LINE'~.~,~-O ABSORPTION AREA (WALL AREA)~.~ ,~(~ SQ. FT.
ADDITIONAL ABSORPTION
WELL:
BUILDING
FOUNDATION __
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
NEAREST
SEWER LINE
REMARKS
DEPTH DISTANCE FROM:
SEPTIC - r SEEPAGE
TANK ,/'OO , SYSTEM /~ t'
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY: ~,'~'~,'~
PIPe MATERIAL:
LOT SLOPE: ~'
Form NO. EQ-O31
DATE ~-~f'- ~"~'~ APPROVED
G.A.A.B,
GREATER ANCHORAGE AREA E~OROUGH
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
DRAIN FIELD OTHER
SOIL TEST RESULTS N® ~-'~4 [~-- NOTE: THIS PERMIT is NOT VALID WITHOUT ~IL ~ST
COMPLETION DATE ANTICIPATED pFRMTT Vfll TB flNF YFAR :
FINAL INSPECTION~ 24 HOUR NOTI~ REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY TM~
HEA~TH DEPARTMENT AUTHORI~ WILL BE ~UBJE~T TO PROSECUTION.
DIAGRAM OF SYB'r~M
5 ft,
FOUNDATION TO SEEPAGE PIT 20 ~:te DRAIN FIELD
SEPTIC TANK, ~:~Ge SEEPAGE PIT ].00 ~te' DRAIN FIELD
· .'" '' '--' REATER ANCHORAGE AREA BOROUGH
· ?-'~. i/E~glCg~EPAR~,.NT OF ENVIRDNblENTAL QUALT~'xy
· *., ,. 3500 IUDOR RO^D
'-' ,. A[~iq - ~[3 ~ ANCltORAGE, ALASKA 99502
Performed For KarlBohli~
..... Legal-Description: - Lot.l~_Block 3
This Form Reports Soils Log
CASE #
LAB # 8576
Date Performed Aprill2~ 1973
S u b d i v i s i o n Turnagain
Percolation Test
Depth
Feet
Soil Characteristics
Da~k Gray Silt (CL)
Tan Silty Gravel (GM)
Gray Sandy Gravel (GW)
'2
4,
6
8__
".10.,
12
14
16----
Gray Fine to Medium Sand
(sw)..
Was Ground Water Encountered?
If Yes, At What Depth? ....
No
Reading
["
Date Gross
'Percolation Rate
Proposed Installation:
Depth Of Inlet
COMMENTS:
Time Net Time
Minute
Seepage Pit XX
Depth to H20 Net Dro
Drain Field
,Depth TO Bottom Of Pit Or Trench.___,
105so. ~, ofdraina~eareais required per bedroom.
)'est Performed By
Carlisle D a t a
Alaska Mineral & Materials' Lab
C e r t i lye d By: ~t~X~ff~tft~g~X
Date: 4-13-73
- -'
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include I(~t, block, subdivision, section, township, range)
Locahon (addreSs or d~reciidns)
(b) Property 0whet ',
Mailing Address' ' ' ' '
(c) Lending I~titution
Mailing Address
(d) Real Estate Company and Agent
Telephone: Home
~,. ~. Telephone
Business
Address
(e)
Telephone .~/'~/' ~:~"~
Mail the HAA to the followina address: or: Check here [~, if hold for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-Family~
Number of Bedrooms
WATER SUPPLY
Individual Well~[ Community [] Public []
Note: If comm unity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~l~r. Public [] Community [] Holding Tank []
Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation
attesting tO the legality and status.
Page 1 of 2 72-025 IRev 8/86~ Front
abed
NOIJ. n¥o
'9
WELL DATA
LITY Of o,~AG£
.,~.,~C.~If~TY OF ANCHORAGE (MOA)
NTAL SE~
~Nv~ON~ ~[TH AUTHORITY APPROVAL (HAA)
[9~TCHECKLIST - FEBRUARY 1984
NOV 0 s4- 44
'~,~/t,/~--~" If A, B, C, D.E.C. Approved (Y/N)
~.~te Completed ~E- / ~'?~' Yield
Cased to ~ ~'~' Depth of Grouting
Pump Set At
/
~- ~' Sanitary Seal on Casing ON)
Depression Around Wellhead (Y,~
Well Classification
Well Log Present (Y~
Total Depth ~
Static Water Level '~ ~-'-'~ ~
Casing Height Above Ground
Electrical Wiring in Conduit(~N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot /,cz) ~/-
To Nearest Public Sewer Line ,~J/~
Cleanout/Manhole A)//,~
Water Sample Collected by ~ ~'
Water Sample Test Results ~/"¢-- '7- ~
Comments ~ z///¢~ ~'Z¢. /~,¢/~)
/~r~ '-,¢~ , On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date //- ~
B. SEPTIC/HOLDING TANK DATA
Size
Date Installed
Standpipes~)N) Air-tight CapsON)
Depression over Tank (Y(~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To WaterTSupply Well /'¢~'
No. of Compartments
Foundation Cleano u.~Y~
Date Last Pumped //'~',~
,~J/~ ; for
Temporary Holding Tank Permit (Y/N) ,'~)/"~
To Building Foundation
T~ Rrop?rty Line . /d ~"~
To Water. Main/Se~;i(~e Line /~ ~'~
Course /~-r) ~
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-028 fRev 8/86/ Fronl
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ¢~/~
Width of Field ¢~/,~ 242
Square Feet of Absorption Area
Depression over Field (Y(~
Results of Last Adequacy Test
Type of System Design
Length
of
Field
~"~/'/ -,~" Depth of Field ~.~/~ ·
Gravel Bed Thickness ~,~1/~ ~
Standpipes Present ~N)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /,¢o
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
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots /~'
To Cutbank (if present)
Comments
D. LIFT STATION
"Pump On" Level at "'"-~ ~..
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
d~urin9 Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have cJ~ck¢¢, verif'~ed, or conformed to all M CA and HAA guidelines in effect on the date of this inspection.
Signed ~L/'/ '//t'///'"~ Date
Company ,,'~'~'~ ~ MOA No.
Receipt No. '~--O O /--OOO ~
Date of Payment _~/~ 0 ~7
Amount: $ ,'/~ ('~ ~'~
Page 2 of 2
72-026 fRev 8/861 8ack
P.O. B0'~96650
ANCHORAGE, ALASKA 99519-6650
(907) 343-4200
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
December 1, 1987
Alan C. Wien
Engineering Technician
Alaska Environmental Control Services,
1200 West 33rd Avenue, Suite B
Anchorage, Alaska 99503
Inc.
Subject: Waiver of Performing an Adequacy Test on an On-Site
Wastewater System for Lot 12 Block 3 Turnagain Subd.
Waiver Request Number WR87-073
Dear Mr Wien:
Your request to waive the requirement of an adequacy test on
the wastewater system for the subject lot to obtain a Health
Authority Approval has been granted.
A condition of this approval is the structure occupying this
lot will be connected to public sewer no later than October 31,
1988. If this is not accomplished by the date specified then
an adequacy test will have to be performed immediately.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Services
cc: Gus Andress, P.E.
Manager, On-Site Services/Water Quality Programs
ALASKA
E 'I1UIROIlmEnTAL CONTROL
~NVIRON~NTAL PROT~iON
RECEIVED
~o~e~ber ~E, ~8~
Municipality of Anchorage
Department of Health & Human Services
825 L Street
Anchorage, AK. 99501
Re: Lot 12, Block 8, Turnagain Subdivision
We are requesting Health Authority Approval with a waiver of the adequacy test
requirement on the absorption field. Per AWWU, the Old Seward LID #159 is in
the final stage of design and will be up for bid in early 1988 with construction
scheduled for summer of 1988. This public sewer will be available to the
subject lot. In early October of this year, I spoke with Steve Morris and he
gave me verbal approval to forgo the adequacy test due to the short amount of
time before the hook up to public sewer. At present, the absorption field is
completely dry and the house is vacant. The system was tested on 10/08/83 and
had an absorption rate in excess of 1,000 gallons per day. With the system
completely empty now, it should easily last until it must be abandoned when the
public sewer is installed.
We request that you grant Health Authority Approval with the condition to hook
up to the public sewer when available.
Sincerely,
Alan C. Wien
Engineering Technician
Approved by:
1200 LUcsi 33rJ A~¢nu¢, SuJl¢ B o Ancbroq~, Absb 99503.[907) 551-5040
§A
I \
7
KLATT Rd
TR A
TR B
OLD SEWARD, Ll.D. '" 159
L.I.D. BOUNDARY
EXISTING SEWER
PROPOSED SEWER
ALASKA NOW-WELL
VERN'S DRILLING & ENTERPRISES
12241 Avion St.
ANCHORAGE, ALASKA 99516
(907) 345-4417
NAME
OTY, DESCRIPTION PRICE AMOUNT
~ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
/o.'~;,,.~-- 5-~'~'-~TB---~ ANCHORAGE, ALASKA 99518 TELEPHONE (907) 502-2343
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
~,~~.~ FEDERAL TAX ID # 9,2-0040440
.,~ ~' APPLICT'~'IT FILLS OUT UPPER HAL"""3NLY
Phone
Prope. tyOwner !~.! \[ i?; /_~ , ) ' J
Mailing Address ! ~ ~ X ~ /{,~¢ i~ ~ ~, ,'/~ .J' ZipCode ,//:f~,~_~ · -- .~._~-~ /
Buyer /~ ~ ~: ), .:
Address Zip Code
Phone
Lending Institution ~ ].. ', .,~ ~ ;? /. ~ ( : .A ~:_ ~ /:~ _ ~ , ( ~ ~:: ,
~ - ' ' ' /~¥'} , >~_ ~ Zip Code
RealtyCo.&Acnt '~ ' (?,~ [% L_'(?
' ~ ~(_, t~,~ ~; zi~ Cod. ., ~ /
Street Locati~ ~ ~/~ J: /" i ~ : ~' ~/~ ~ ~'
Well to Tank ¢--, ~ Septic T~k Size
72 023
September 27, 19%i3
2330
Anchorage ~ ~K 99507
be 9ranted until tl~e ~ollo~ing item~
Of the ~L~nJ.~ipa~LJ.~y
in conduit.
An adequacy t~st needs to be perfor~.qed o~ the e~istin<3
le~ch~.ng area. J?his test :~viit de~ier~?,~ne i~ the sys~:e~ is
adequate accordin9 to ~ational Standards. A listing of
private iirms per~orm~%~3 th~s test is enclosed. 'i'his report
n~c2c{s %0 b~ submitted to this office for our review.
Locate and expose the cieanoo, h to the set, page ~lt and/or
loac~in9 ~re~ for our inspection. 'fhis is to insure thc~
~,~in~mura distance roq~ire~ents are ~aet b~tween the well and
ALASKA
ei'FuII OFlmeF/TAL COFITI OL SeI uICe$, InC.
OTOBER 3 i983
LYNN BURNS
SRA BOX 2330
ANCHORAGE AK 99507
SELLER - LYN BURNS BUYER -
SUBDIVISION - TURNAGAIN BLOCK - 3 LOT - 12
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 390 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 675 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON 3/18/83
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
ADDITIONAL COMMENTS :
SEPTIC TANK AND TRENCH ARE LOCATED OVER 1'00 FEET FROM THE WELL.
BOTH CLEANOUTS ARE ABOVE GROUND AND CAPPED.
.....
1200 ~Jcsl 33rd Ausnu¢, $uii¢ I~. Anchoro§¢, Alos[o 99503 ,, (907) 276-1361
Spurldand
8155 Cranberry St.
Anchorage, Alaska 99502
Phone(907) 243-5302
SEWER ADEQUACY TEST
LOT 12, BLOCK 3, TURNAGAIN S/D
Gloria Sept
Hanson- Century 21 Realty
401E 36th
Anchorage, Alaska 99503
Residence:
Water System
Sewer System
Date of Test
Test Procedure
3 Bedroom single family
On Site Well
From Municipal Records:
1000 gal Steel Tank Greer
Concrete Ring Sepage Pit 6 feet deep
Absorption Area 390 sq. ft.
JanuarF 30, 1980
On inspection pit was found surcharged. Fluid depth 7-11
Septic tank was pumped ~n Jan. 29,1980
Flaid depths on Jan. 30, 1980
Septic Tank 25 inches
Pit 71 inches ( 5-11 )
500 gal was removed from pit
Fluid depth in pit 45 inches
Pit filled to owerflow
Water levels
Tank 25.5 inches
Pit 71 inches
Amount of water used
500 gal +
Water levels on Jan. 31, 1980
Pit 67 inches
Tank 34 inches
Total absorption 4
2~x---~ = 7o.5 gal/24 ~r.
~.. ~,
~..~.....~ ~',',~ ~
DAVID A. SLENKAMP
ROBERT A. SHAFER
Mr. Ken Triplett
SBA Box 1376
Anchorage, Alaska
MECHANICAL ENGINEER
694-9055
February 8,. 1980
99502
CIVIL ENGINEER
NTAL ?fiOTECTioN
FEB ~ :~ 1980
Dear Mr. Triplett,
Reference: Lot 12; Block 3; Turnagain Subdivision
& sewer system adequacy test was performed on the referenced property
as requested by Century 21, Hansen. The septic tank was pumped
and verified to have a capacity of 1000 gallons.
The seepage pit was full of w~ter. Approximately 1500 gallons
was removed and the the pit recharged with approximately 1000
gallons of water. Measurements t~ken after a 24 hour period in-
dicated a loss through percolation of appro×imately 50 gallons.
From the above survey and test it can be concluded that the septic
tank is adequate for a three bedroom residence, however, I regret to
inform you that the seepage nit has essentially failed to percolate
as designed.
It ~ll be necessary that you obtain a permit for the ungrading
of this system from the Municipality of Anchorage, Department of
Health and Enviornmental Protection~ 825 L. Street, Anchorage, Alaska.
Due to the adverse weather and cost associated with construction
work at this time, I recommend that the upgrading be done after
break-up this Spring.
If we may be of further assistance, please do not hesitate to call.
cc: Municip~ity of Anchorage al
Departmentment of Health and Enviornment Protection
Century 21, Hansen
ATTENTION: Gloria Sept
Alaska Pacific Bank
SRB lg6X EAGLE RIVER, ALASKA
.~ / DATE RECEIVED
'TIME TIME TIME
DATE ' ' DATE
~UNICIPALI~ OF ANCHO~GE
MUNICIPALITY OF ANCHORAGE DEPT. OF ~;~ALTH &
DEPARTMENT OF HEALTH · ENVIRONMENTAL pROTEOTI~IRONMENTAL P,.OTECTION
82D L Street - Anchorage. Alaska ggs01
( ENVIRONmENTAL SANITATION DIVISION JAN 1 1980
Telephone 264-4720 RECfiiVED
REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete ali parts on page 3. Incomplete reques~ will not be proCe~ed. Please allow ten (1 O) days for processing.
4..EALtO~Aa~NT PHONE
~/o
5. LEGAL DESCRIPTION
STREET LOCA~I N
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four
[~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
[] Other
7. WATER SUPPLY
~,. INDIVIDUAL* ATTACH WELL LOG. A well log is required
for
all
weJJs
drilled
[] COMMUNITY since June lg75. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8, SEWAGE DISPOSAL SYSTEM
--~ INDIVIDUAL/ON-SITE** //~h'-~ YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
I
THIS SIDE FOR OFFICIAL USE ONLY .
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS !,
I~ 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 DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -BITE DATE INSTALLED
[]PUBLIC UTILITY ~,~
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank ~(~
Size: ¢ ¢(~? O if Tank is homemade SOILS RATING
give dimensions: 1 0 ~
TOTAL ABSORPTION AREA MATERIAL ¢ ,--
4, DISTANCES Septic/Holding Tank Absorption Area' ~l~ewer Line Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
I~'~0NDITIONAL APPROVAL (letter must accompany certificate)
E~3 DISAPPROVED
72-OLO (Rev. 6/79)