HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 4 LT 1Mountain Park
Estates
Lot 1
Block 4
#017-061-30
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ,,.~k)../~)~)O ~L"b;;~. PIDNumber:
Name: '/~¢c~'~' ~ ~ ~'~ Wastewater System: D New ~ Upgrade
~ Deep Trench ~ Shallow Trench ~ Bed D Mound ~ Other
Total Depth from original grade:
LEGAL DESCRIPTION ~S°ilRating: ],~ GPD/Sq. Ft.
Township: ~ Range: ~ Section: Fill added above original grade: Gravel length:
Ft. ~ ~ Ft.
WELL: D New ~ Upgrade Grave~width: ~ Ft. [ Ft.
Total Depth: Cased To: Total absorption area: Pipe material:
~ Ft.
' GPM ~ Ft. Ft.
SEPARATION DISTANCES ~s~ptic ~ uo~i~ ~ s.~.....
TO Septic Absorption Lift Holding Public/Private Manufacturer: . Capacityln gallons:
su~C~wat.~ N[o ~ ~o LIFT STATION
Lot Size in gallons: ~ Manufacturer:
~ "Pump on" level at: I "Pump o~' level at: I High water alarm at:
Foundation ~ ~ ~
Cu~ainDrain ~ ~)~ PumpMake&Model IElectri~llnspectionspedormedby:
Remarks: BENCH MARK
~ ~/~ ~ ~ Location and Descripfion:
Inspections pedormed by: ~ ~ Dates: 1st
Depadment of Health and Human Se~ices approval
Reviewed and approved by: ~ ~, Date: ~ ~ ~ -0 o
72-013 (Rev. 9/91) MOA 25
~5 [ ~ 1£5
I $£AL~
= 50 FL
S YS TEM
6AL SEPTIC TANK
ITAL 40 FT
TAL DEP lO FT
TOBBEN SPURKLAND P.E. J
205 W 15TH. AVENUE
I
ANCH. AK. 99501
(907) 279-$916
MOUNTAIN PARK ESTATE
LOT I BLOCK 4
5921 DEARMOUN ROAD
SEP?/C SYSTE/d AS BUILT
DATE: AUG. 1, 2000
SHEET: 2/5 GRID: 2958
PEP, MIT # SV00£3£
PI~ #' 017-061-30
NPEO40i£.Db/G
P£1MA£Y T£ENCH
2~dnddrd Zrench;
40' Lon~
10' ~eep
6' Sewer rock
4' Cover
NO SCALE
/~onltom
Cleonout~
4' Cover
97.~
90.6
84. 6
6 Pt o£ ~eptic /?ocr
Effective
ND SCALE
]000 901 Septic tank
90.6 ~ 9~75
84. 6
1000 9aL sepb'c ~onk
TBBBEN SPURKLAND P.E.
203 \415th Ave
Anchoroge Ak 99501
MOUNTAIN PARK ESTATE LOT I BI( 4
MARIETTE MARTIN
$592! DE A£k;OUN ?OAD
SEPTIC SYSTEM SCHEMATIC
DATE: AUG. I, 2000
SHEET: GRID: 2938
PERMIT ff SW000252
PARCEL ID ff 017-06l 30
MPEO4013. DWC
MUNICIPALITY OF ANCHORA GE
Department of Health and Human Services
OmSite Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 995'19-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jul 13, 2000
Expiration Date: Jul 13, 2001
Permit Number: SW000232
Legal Description: MOUNTAIN PARK ESTATES BLK 4 LT 1
Design Engineer: 0007 Tobben Spurkland, PE
Owner Name: Mariette Martin
Owner Address: 5921 Dearmoun Rd.
Anchorage, AK 99516-3153
ParcellD: 017-06t-30
Site Address: 005921 DE ARMOUN RD
Lot Size: 35000 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 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.
S P I {LANrD
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM UPGRADE DESIGN
LOT 1 BLOCK 4 MOUNTAIN PARK ESTATE
MARIETTE MARTIN
Municipality of Anchorage
Department of Health and Social Services
825 L Street
Anchorage, Alaska 99501
June 28,2000
We are submitting an application for the upgrade of the septic system for this lot. The submittal
consists of three (3) drawings showing the present improvements on the lot and the adjoining
properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is
subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil
logs and percolation tests of applicable testholes are also enclosed. The septic system design is
based on the following:
No Ground Water or Impervious Layer to 16
Use Standard Trench
Soil Rating. From Testhole June 22, 2000
<5 rain/in = 1.2 gal per sq. Pdday
No. of Bedrooms 3
Required Area per Bedroom: 150/1.2 - 125 sq.ff.
Total area required: 125 x 3 - 375 sqff
Testhole depth 16 feet
Bottom Rock At 10 feet
Top Rock At 4 feet
Rock Depth 6 feet
Total Trench Length 375/12 - 32
USE 40 LF
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH 40 FT
TOTAL WIDTH 2 FT
TOTAL DEPTH 10 FT
ROCK DEPTH 6 FT
COVER 4 FT
SEPTIC TANK 1000 GAL
The installation of this septic system will not prevent development of adjacent lots.
There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will not result from this installation.
5O 0
TOBBEN SPURKLAND P.E.
203 W 15TH. AVENUE
ARCH. AK. 99501
279-3916
MOUNTAIN PARK ESTATE
LOT I BLOC/( 4
5921 DEARWOUN ROAD
SEPTIC SYSTEk,f DESIGN
DATE: JUNE 30, 2OOO
SHEET: 1/3 GRID: 2938
PERMIT # SWOOXXX
PIP # 017-0~1-30
HPEO4Oll,DI/6
SCALE
N
S TANDA£D ~
£EPLACE 1~
DEEP T£ENt
TOTAL LENO
TOTAL DEPl
EFFEC TII/t
~PTIC SYSTEM
5AL SEPTIC fAN/(
? 40 Ff
10 FT
~)DCK DEPTH 6 FT
4 ??
TOBBEN SPURI<LAND P.E.
205 W 15TH. AVENUE
ANCH. AK. 99501
~907) 279-5916
MOUNTAIN £ARK ESTATE
LOT 1 BLO£K 4
5921 DEARMOUN ROAD
SEPflO SYSTEM DES/ON
DATE: JUNE 3~ 2000
SHEEL' 2/5 OR~: 2958
PERMIT # SWOOXXX
PIP # 0I_7-061_-30
MPEO4OJ£,D W5
PRI~A£Y T£ENCH
S$ondord Trench;
£' FI/de
40' Lon9
lO' Deep
6' Se~/er foci<
4' Covem
NZ7 SCALE
/doni4~ot~
Cleonou~s
4' Cover
C~O
1000 9ol Septic tonk
Si! ~
6 £~ 03' Septic RocA:
Effective
ND SCALE
lO00 OoL ~ep~ic Mnl~
TBBBEN SPURKLAN]] P.E.
~03 W15th Ave
anc¼o~ege Ak 99501
pZ?-391F
MOUNTAIN PARK ESTATE LOT 1 BI( 4
MARIETTE MARTIN
55921 DE ARMOUN £OAD
PERMIT// SWOOOOXX
PARCEL ID ff 017-061-30
MPE04015, DWG
PERFORMED FOR:
Municil~,ality of Anchorage
DEPARTMENT OF '~EALTH & HUMAN SERVICES
825 "L" Street, Am:horage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
DATE PERFORMED: '~ ~-~---- ~
LEG^L DESORIPT,ON: k O T I i/.
1
2 --
6
7
8
9
10
11
12
13
14
15
16 --
17
18
19
20-
H o LE
DISCLAIMFR: Grnundwat~r
Past and future presence
from these observations.
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED? ~,~ O
SITE PLAN
IF '/ES, AT WHAT O
DEPTH? p
E
Monitor/fiD? ~ Date:
Peading Date Gross Net Depth to Net
~/~./,.. ¢_~_~,~j Time Time Water Drop
/
PERCOLATION RATE ~ ~ (minutes/inch) PERC HOLE DIAMETER ~ ~
TEST RUN BETWEEN ~ FT AND ~ YZ FT
tend/t/oDs indicated are for the dates shown only.
and/or depth of groundwater can not be predicted
PERFORMED BY: '7' ~ __. I I"~ 'E~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUll EUNES IN EFFECT ON THIS DATE. DATE: ~/~/~'~
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
Hea and Environmental Prote~ on
I,'ourth F].oor We,t;L
825 L Street.
Anchorage, Alaska 99501
279-25tl, X 224, 225
.......................... i~,]'~'~"EcTION REPORT ON-SITE STOWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE ~'~ I
NUIMBE R OF
COMPAf~I M [:N f'S
INSIDE LELNGTH ............ tNSIL)t:: WI!)II~ _ I ICgt~H) (WPltl .. l i()LJl[) CAP/\C 1Y J.~GALLONS.
TILE DRAIN FIELD:
DIS'IFNCE t ROM W _L'
Al%S() RPT ION At:~ Ii A ............
i)EPltt: lOP OF Iii. t! lO t-INI~tl (~!{A[)[. _ . kIA]l lil~t, iii r~I[ Alii 'flt_[ ~O ................. N A[~I)V[: [1[ [ ~ It, J,
SEEPAGE PIT:
DI/xMEI ER ..... 01( WI[)]H ...... LI~NG]II ...... DI:PTI~
Log Crib __Rings ....... Crib Sizo: t~l/\ivltl~ it . _DEPI I~1 ..... DISTt\NC[: FROM.
lO'IAI. Et'I t'CI'IV[
BUILDING ['(.)LJN[iA]ION ...... IlEA[tLS] I.O1 i IN[ ....... t'q4bOl?P'llON AREA (WALL
Well 9e~~
Class: '~. Depth:
Well Distance To: Lot Line J
Bldg: Sewer Line: --- [ -~
Pipe Materials: ~ ~ ---
% of Bedrooms: _~
Installer: _
Remarks: _~ %%~ ~'
t I
'1"'CF'E: [)F E;O]:I... HE ......... ~.E,I].ON ...-.~.:,lEi'l IS: lf~EN..H
i',IFt::.::]:I','IUI',t tq ti'IBEI~. OF BEDF,'O[]f'I~5 = ]:
SOIL Rla"I"ING ,::SI:;:! F']",."'BF.'.::'= ]u,~.,
'T'HE REIJ:!LI:[REI) E; ]: :.i;.iE: I:)F THE SOIL FI~SORPTION ..:..,~-.-~1'E. 1'1 IS:
THE' I...ENGTH D:[MENSION I'.:; THE LENG'T'H (IN FEET'.':, OF 'T'HE TRENCH OR [::,RFiINFZE:LB,.
'I"HE: DEF'TH OF la TRENCH OR PIT IS THE DIS'I"FINC;E BETWEEN THE SURF'laCE OF ]"HE.:.
GF.'.OUNB, laNE:'., ']"HE BOTTOM OF THE E',:-=:CFIVlaTION ,.':IN FEET::'.
THERE ]:SE; NO SET' 14IDTH FOF.'. TF~'.ENCHES.
"f'HE GF:'.RVEL [)E:P'I"H IS I"HE r'IlNIfNUf'I [.':,EPTH OF GRAVEL. BETWEEN THE OUI"FRI.J... PIPE:
ANt) THE BOTTOP1 OF THE EXC:RVRTION ,::IN FEE:I").
P la I:l:: IK ia i'.~ E:: F" I._ I-I r-.t ql'"' ~:::) F" '1'" :.[ i:::) f.I
FI PFICKFIGE F'L. FINT' MFI'¢ BE ZNSTFIL..!...EE:, FIT THE F:'EE:fi',I ]: "rTEE '" '-'.:., OPTION SUB..TECT TO 'THE:
F'[:]I...I...[)I.,.I .'[ NC'i COWl) 11" I ONE;:
:'.1.. EITHER'. A CLRSS I OR II NSF' APPROVED PLANT tNR'Y' BE INE;TRLLED.
la C:ONTINI..If.)I..IS FIFIINTENFINCE laGF.'.'EEi"IENT I$ REI;~.IJIF.'.E[:,. IF' FI HRINTENRNCE
FIGF..'EEHENT :ES NO']" KEPT CU,q:F..'ENT YOU i"lFi'¢ BE F..'E[;).UIF.:ED '1'0 EN!...FIE:.'GE THE SOIl ....
FIBSORP"I" ]: ON S'¢S'f'Er,1 FIND,-."OR '.r'OI...I f'lR"r' BE SL.tB.TE[::T TO Pt~IO'.E;Ef%JT~ON.
.... ' ........ " .....I1"'-" - ~ '"::" """~ ........
"1"" L-JI Ci .:' ;-:' ':. :1[: I".-.I _"::... F E ....... -1 II". tTI 1"-41 ."~;
E,H .k.F.I.I..LINEi OF RN'¢ ::,k...,IEH W;[THOI..J'I" FINAL ]:N.~FE .f]LN FINE::, n~'~...~mL. E,'r 1HI.:,
[::,EF'FtI~:t"I"r,IENI' !.4 1 LL BE SUB.]ECT 'T'O F'F. ff~"rSEE L.tT ]: fiN.
HtN:[MIJH DISTFINC:E 8E'TWEEN FI WE[_[_ AN[) ANY ON-SI'T'E SEWFIGE DISPOSAL S"r'S'T'EH
:l. OO FEE:T FOIR R PF.'.I'¢RTE WELL OR 2E.~O FEET FOF.'. FI PL.IBL..IC I.,.IEL. L.
WEL. L. LOGS FIRE RE(;:!UIRED FIN[) MUS'T BE RETURNE[;~ 'TO ]"HE: I)EPFIRTHENT' I.,.IITHIN ]~:O DR'T'S
ELF:' "rile NEIJ_ COHPLE'I"ION
CrT'HE:R RE('::!.t..IIREMENT".E; MR"r' APPI...~". SPEC:IFICR'T'IONS AND CONSTRUiBTION [:,IFIC:iRAi'"IS i::IF~'.E
AVAZL...ABL. E "1"O INSt..IF. rE PROPER :[NSTALL. ATION.
I [:~;E]4.'.']".'[ F'Y ]"HFI"I'
::L: :[ AP1 FFIHILJ:FIR WITH 'THE REE!UI'REPtENTS F'OF.'! ON-SITE SEWERS FINE:, NEI._L.S las E;E'f'
FOR"f H B"r' THE HUN:I:C:I PlaL. I]'"r' OF RNCHORFIGE.
2: :[ NIL. L INSl"lal...I... THE S"r'S"I"Ei"I :[1"~ FICC:ORDFINC'E 14T'TH T'HE C;CIE:'ES.
:;: Z UNI::,EI~.'S'f'laNE:' 'T'Hlal" THE ON-SITE SEWEt4..' S¥STEr,1 r,lFl'.r' REDtJ:[RE ENLFIF.!EiEPtENf'
~.'ES.[DENCE .IS REr,IO(:.',E:LEL::, ILl ]:NC:LUE:,E P1ORE 'T'HFIN :~:
111F' '1'HE
Performed for .....
Legal Description:
This form reports:
u~i)ai'bill~J[It oi LIl¥1Foilmellb~li ¼
3330 "C" Street
Anchorage, Alaska 99503
,.OILS LOG - IEROI,AiION iLS1
Soils log ~. Percolation test
Depth
Feet
2-
5-
6---
g,Lt-
t L'f A, l t..- cX rm
10 - ,~ ?o~o
ll -
12-
13-
Was ground water encountered? _ L~._I~ .....
If yes, at what depth?
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
,Proposed ' ' llatlo--~--n¥'-¥e~'~a--g~ P~te Drain Field
---/-~"'_--I -
~q o40 r~/74)
A unicipality
July 22, 1
Patrick D.~
Star Rout6
Anchorage,
Subject:
Approval ~
cannot be
completed
~~1) Awe]
. review.
(3)
ANCHORAGE, ALASKA 99501
The top of the well casing sealed with a sanitary
seal so that it is water tight.
The water analysis report be delivered to this
department from Chem Lab, 5633 B Street, for
our review.
(~/~ The septic tank pumped with a receipt submitted to
~C~3U Jthis department.
Please notify this department for a reinspection when the
noted descrepancy has been corrected. If there are any
further questions, please call this department at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: National Bank of Alaska
Pouch 7-025 99510
Jim Baxter
% Poe Realty, Inc
807 Barrow 99501
MUNICIPALITY OF ANCHORAGE ~ DI~PT OF HEALTH &
'~ t~//(([~ ~ ENVI, RoNMENTAL ENGINEERING O V SION SEP 2 1978
~ Telephone ~64-4~2~ __
MAtLINGADDRESS ~ ~ -- . ~
PROPERTY RE~ferent from above) . PHONE
MAILING ADDRESS ' r i
3, LsN~ N ~
a I G ..... 3 , ' m
4. ~EALT~/AGENT ~ ~ I PHONE
MAI LING ADDRESS
[~ SINGLE FAM LY '~i" --~ One F"I Four [] Other
[] MULTIPLE FAMILY '"~' ~'' [] Two [] Five
~ Three [] Six
7. WATER SUPPLY
~ INDIVIDUAL* * ATTACH WELL LOG Awe og srequredfora we sdr ed
[] COMMUNITY ~inceJune 1975 Forwe sdr ed pr or to that date gvewe
[] PUBLIC UT L TY depth (attach og if ava ab e.
8. SEWAGE DISposAL'SYSTEM ' '" ' ' ' - __
[~ I NDIVIDUAL/O-N SITE* f Irld v dual/on-site, g ve nsta at on date~--~ ~.. .
f system s over two (2) years o d an adequacy test s requ red
I F~ PUBL C UT LTY b th s De artment
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQuEsT BEFORE PRocESSING CAN BE INITIATED.
8)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FiVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] iNDIViDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ~'~q
Connection Verified INSTALLER
[]Septic Tanker I--I Holding Tank
Size: /Od~)~ If Tank is homemade SOILS RATING
give dimensions: I ( ~"
TYPE OF TANK MANUFACTURER ~,~ ~j~
TOTAL ABSORPTION AREA MATERIAL
Absorption Ar~a to nearest Lot Line
5. COMMENTS
[2~APPROV ED
FOR .~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
"TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOF~
~UNICIPALITY OF ANCHOrAgE DEPT. OF H~ALTH &
D~PARTM~NT O~ H~ALTH & ~NVIBONM~NTAL P~OT~aTI~VIRONMENTAL PKOTECTJON
825 L Street - Anchorage, Alaska 99501
J
7
1980
ENVIRONMENTAL SANITATION DIVISION UL
Telephone 264-4720 R E C E ! V E D
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page I. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1.-',,PER~Y OWNER ,~b~N E ~
PROPERTY RESIbENT (If different from above~ ~,. PHONE
2, BUYER PHONE
MAILING ADDRESS
3, LENDING INSTITUTION
MAILING ADDRESS --
4. REALTO~GENT PHONE
5, LEGAL DESCRIPTION
STREET LOCATION
6, TYPE OF RESIDENCE
~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF,BEDROOMS
[] One [] Four
[] Two [] Five
~ Three [] Six
[] Other
7. WAT R~UPPLY
[2~3 INDIVIDUAL*
r- COMMUNITY
I--- PUBLIC UTIL TY
* ATTACH WELL LOG. A well log is required for all wells dril ed
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE**
E PUBLIC UTIL TY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 3/78)
THiS SIDE FOR OFFICIAL USE ONLY
' DATE RECEIVED "
INSPECTION APPOINTMENTS
'd'ATE ' DATE 'r bATE · '
"INSPECTOR . ~ r
· . , INSPECTOR INSPECTOR
-DIRECTIONS: ....
1, TYPE OF RESIDENCE NL~MBER OF BEDROOMS '
[] SINGLE FAMILY [] ONE [] THREE' [] ~FIVE i [] ' OTHER;'
Fl MULTIPLE FAMILY [] TWO r-1 FOUR [] SIX
2, WATER SUPPLY PERMIT NUMBER ' ' ' ' '
[] INDIVIDUAL DEPTH OFWELL
[] COMMUNITY - D ' '
ATE DRILLED
[] PUBLIC UTI LITY
C~nnection Verified ., , LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ·
[]INDIVIDUAL/ON-SITE DATE NSTALLED '
Connection Verified INSTALLER --
[]PUBLIC UTILITY ~ ~
[]Septic Tank or [] Holding Tank ~_/.iC~.3.~L~4,/o(~/(.
Size: ! C)O¢:) IfTa'nk is homemade 'SOILS RATING ~ 'Y' '~
give dimensions: ' // ,
TYPE OF TANK MANUFACTURER ~ '
'TOTALABSORPT ON AREA MATER AL ~
4, DISTANCES ept c/Holding Tank Absorption ~,r~ ' Sewer L ne Nearest Lot L ne
WELL TO: I I
'Absorption Area to nearest Lot Line
6, COMMENTS
[~;;~'/' APPROVED FOR _.~ BEDROOMs -
[] CONDITIONAL APPROVAL (letter must accomp~3Y~lertificate)
[] DISAPPROVED '/7