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HomeMy WebLinkAboutMEADOW RIDGE ESTATES BLK 2 LT 1Meadow I idge Est. Block 2 Loi' 1 #0§1-461-21 Hei. ~UNICIPALITY OF ANCHORAGF and Environmental Protc Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 )n ................ ~i'-~I'."iP-ECTION it}!POR¥ ON-fill'F. ?.;[iWAGE DISPOSAL LOC.,',T,ON NUMBER OF ~7 COMPARTMENTS IF-ISIt]E LENGIlt .......... INSI©E WlOl'tt .... LIQUID DEPTH .. LIQUID CAPACITY-~d GALLONS. TILE DRAIN FILL[_): TOTAL LENGTH ,~.. ~ DIS'I/:,NCE FROM WELL~__FOU;IDATION ........ NEAREST LQI' LINE ........ OF LINE ~ of Lines .......... I)IflIANCE BEq WEEN LINES ....... fRENOt WIDTH IN. TOTAL EFFECTIVE /,,bSORI:'IiS:i AitEA ......... SQ. PT. lENGTH OF LACIt LINE DEPTII OF FILTER ~ ¢ ~ ~¢ DEP~i!: ~OF OF llL! ~O t !NISII GRA[)E ....... MA-IE RiAL t~EfqEATIt 'rite . IN. ABOVE TILE IN. SEEPAGE PIT: DI,,:,M ET ER .... OR WIDTH .... LENG 13 t___, DEPTH Log Crib __Rings Crib Size: Oh'kk,',E~ ER __DEPI-tt ...... DISTANCE FROM: WEI.L TOTAL EFFECTIVE ABSONPTION AREA (WAI. L AREA) SG. FT. BUILDIN,3 FOLJi~DA!'IOr',! .... NEAREST LOF LINE ..... Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: _~t~-- {I of ~edrooms: 3 Installer: Remarks: ID' m'"] ,~ 7- ~? ,"- ?'? O 8- E GEOCHNICAL 8- DEVEL~MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 S0)'L LOG 68~-2280 Soils ~ Foundations Land Development Performed for: Name: Mailing Address: Legal Description: Dept~ (feet) 0 $oll Characteristic~ 4 5~ 6 7~ 8 . , 12~ 14 Z5 Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No ~::' If yes, what depth Drain Field Performed by. x Date:_ / Municipality of Anchorage Development Services Department Budding Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 · Parcel I.D. 051-461-21 GENERAL INFORMATION Complete legal description Lot 1, CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY",D~J~I" I~j~G ". HAA# ~/~:~ OlO IClff Expiration Date: ~-'- / q - (5:) ~._ Block 2, Meadow Ridge Estates S/D Location(site address or directions)21140 Country View Drive CurrentPropertyowner(s)Kathleen & David Bohna Day phone 264-0458 Mailing address Lendin~ agency 21140 Country View Dr.. Chu~iak. ~K 99567 Day phone Mailing address Real Estate Agent Remax/Sharon Minsch Day phone 694-4200 Mailing Address 16601 Centerfield Dr.. Ste 201. Ea~,le l~iv~,r. Al( 99577 Unlessotherwiserequested. HAAwillbeheldbyDSDforpickup. ~I~Z ~ 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ^ Public Water System Well [] [] [] [] 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. Certilicates 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 period of up to one year with valid water samples.) Certificates are valid for one year for propedies 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 OF INSPECTION BY ENGINEER .5. As cedified by my seal affixed hereto and as of the vaIidation date shown below, I redly that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are} safe, functional and adequate for the number of bedrooms and type o[ 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(are) in compliance with all epplicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. $ & $ ENGINEERING Name of Firm Address Ea[lle RiYer, Alaska 99577 Engineer's Printed Name ~.obe=r C. Co~art, ?.£. DSD SIGNATURE L/'/' Approved for ~ bedrooms. Disapproved. Conditk~nal approval for Phone · Date bedrooms, with the following stipulations: Additional Comments WAsI -WArER :" PROGRAM . ~ ...... Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 625 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescfiption: L.- | '~7.. f,A~.~,-Oo.u~5;tr~, .~k_. ~',~ ParcelI.D.: O~1" ~61- 2( A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production LTS: Date of sample: Date completed Cased to FROM WELL LOG Wlres~ (Y/N) INSPECTION g.p.m, g.p.m. Nitrate Collected by: Other bacteria 8. SEPTIC/HOLDING TANK DATA Date installed ~,'~'1'~ Tanksize ~.o,,e Number of Compartments ~ Cleanouts~N)~ Foundation cleanout~l) ~ ~* dt. Depression (Y~) I~ High water alarm (Y/N) ~14~ Date of Pumping ~'.- 1,- o~ Pumper C. ABSORPTION RELD DATA Date installed I~ '~ '? Length '~'7 I Width ~ Effective al~orption area Date of adequacy test ~'''~ Z.. -' a I Fluid depth in absorption field before test (in.); Flulddepth /~-'g'~ (ins)Minutes later: Peroxide treatment (past 12 months) Gravel thickness below pipe Monitoring Tube present (~N)'~ Rasults,~ail) Soil rating (g.p.dJfF or ~/Ixtrm) V¥'~'~/~- System type Ea~ Total depth 1,0 . Depression ever field For /J ~ Immediately after~''// gal. water added (in.): [Z.- Absorption rate ~ P* = g.p.d. if yes, give date bedrooms 72-026 (Rev. 3/96)' D. UFT STATION Date installed M~nhole/Access (Y/N) High water alarm level at' Size in gallons 'Pump on" level at*~ at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main ,~c service line On adjacent lots Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 5'''~ '~ Property line /0 /''c Absorption field /./, / Water main/service line /~ ~ ~' Surface water/drainage /~# / ~"'Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation 10 ~.1~' Water main/service line IQ/'/'' Driveway. parking/vehicle storage area v~- ~ ~ Wells on adjacent lots ~ o R ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal record~4~l~t~ove systems are in conformance with MO.~ I-I.a~uidelin~s in effect on this date / ' Engineer s Name /<.~ E, ¢ .e ~ <._. L_ ~ ,~,¢~ ,~?.,._.:~V'~:~'.~I-,~¢~ ...... ~.,.,..~. -- .C"/- / ;'...~:t.;~ ...,C.-~. ~ ...*~.. ,-~....T...~ ~ 1',. .... _-:.-' _-.,,,. HAA Fee $ Waiver Fee $ Date of Payment ~'/~'/O I Date of Payment Receipt Number O ~ ~/0,3 7 Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL. INFORMATION Complete legal description Lot l; HAA# H4 q~ ~On ~ Block 2; Meadow Ridge Subdivision Location (site address or directions) 21140 Country View Drive CBugiak, AK Property owner Sheree Nipper Maili. rig address c/o vista Rea]. P, state ..Lending agency ' .... Mailing address '; ':' First National Bank Day phone 4241 "B" Street Anchoraqe, Day phone AK 99503 Agent Day phone Ad dress Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water xxx NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer xxx NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front 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 inspection. S & S ENGINEERING ~'~ Name of Firm Phone 1zu;J4 Eagle River Loop ~,oad No. 204 Address Eagle RiYer, Alask~a 99577 ~, Engineer's signature '~'/JJ~ ~---~"--'< Date REQUEST YOUISSUE A FULL HEALTH AUTHORITY APPROVAL AT THIS TIME. ON THE CONDITIONAL H.A.A. HAS BEEN COMPLETED: 1. first cleanout to septic trench was found and extended 2. depression has been filled in ALL WORK REQUIRED a barrier has been D~...S SIGNATURE · Approved for Disapproved, Conditional approval for installed to prevent parking/driuing ~<~'~bedrooms. ; . bedrooms, with the follc~~Jons: Additional Comments By: ~,~ . ,~ ~'~ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS 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 is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Ba~. 1/91) Back MOA~'I ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN E~TENSiONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL iNSPECTIONS ONSITE W,~STEWATER DISPOSAL SYSTEM DESIGN June 23, 1997 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, REFERENCE: CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Request you issue a full Health Authority Approval (HAA) for the referenced property. A Conditional Health Authority Approval (HAA) was issued on 4/3/97 for the referenced property. All work required for the Conditional HAA has been completed as follows: 1) the first cleanout to septic trench was found and extended as shown on original inspection report 2) depression has been filled in 3) a barrier has been installed to prevent parking/driving over septic system. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577 O~ A~cr~orage Mun~clpaht~, J,,~r, af~ Servioes o~t' Hea~tb ~ r~,,, AK 99519 Lot 1; Block 2; Meadow Ridge' Subdivision 'e MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES ' Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete le'gal description hot 1; Block 2; Headow Ridge Bstates Location (site address or directions) 21140 Country View Drive Chugiak, AK Property owner Sheuee Nipper Day phone Mailing address c/o vista Real Estate 4241 "B" Street Anchorage, AK 99503 First National Bank Lending agency Mailing address Agent Cathy BFown-Bake~-/ Vista Real Esha~ Day phone Day phone 562-6464 Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well x×x Public water NOTE: If community well system, provide written confirmation from Stafe ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: xxx If community wastewater system, provide written confirmation from State AD£C attesfing to the legality and status of system. 72-025 (Rev. 1/91) Front 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 inspection. 5 & $ ENGINEERING Name of Firm 17024 ....'~ ~: .... , hop,~a ~.~.04 Phone ¢°~i ~/ - p'~'} 7 ~) Address Eagle River, Alaska 99577 Engineer's signature -'}~_~; 7' F/ .Z~¢ ..... .--- Date '¢ / >-c/q 7 6. DH~';~ $1GNATURhl Approved for bedrooms. Disapproved. x×xxx Conditional approval for three(3) bedrooms, with the following stipulations: Escrow monies to perform all work necessary to: (1) Recover or replace fi~t c!esnout t~p4;ic trenct~;-(?) f~ ~LJ~ig~Jepr¢~_ion mmr s¢¢c ~nk; (3) Install barrier(s) to prevent parking/driving over septic system. in escrow until final approval is granted from this department Xupply Additional Comments Note: The water wellJffor this property_meets existing State and Municipal Codes. There are nitrates present. It is  uggested that ~periodi~ testing be p~rformed to insure the water Supply ontinue8 suiCab'~lity. Nit~ate concentration is 5.48 mg/1. EPA ~a~ ..... ~e~rat~on +s /~0/:0. mg/l_ By: ,~;, }fi%~'t.. ~ ~,(_,, ~/~L(~,~ Date The Municipali~ of Anchorage Depa~ment of Health and Human Se~ices (DHHS) issues Health AuthoriW Approval Ce~ificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a cou~esyto purchasers of homes and their lending institutions in order to satis~ ce~ain federal and state Cequirements. Employees of DHHS do not conduct inspections or analyze data before a ceAificate is issued. The Municipali~ of Anchorage is not responsible for errors or omissions in the professional engineets work. 72~25 (Rev, 1/91) 8ack MOA#21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 4~.~ ~ V 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3 Legal Description: A. WELL DATA Well type /~ Log present (Y/N) Total depth Health Authority Approval Checklist L~z,/z, __2 /4'¢,¢,A'C~3~J /~/P4£ Parcell. D.: ~"-J L'/L~I ¢---( If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to Casing height (above groun~~'-- Sanitary seal (Y/N) Wire~/N) FROM WELL LOG~,~,~'~ AT INSPECTION Date of test Static Wate; level ~ Wel~__ g.p.m, g.p.m. ~7'~:I"ER sAMpLE RESULTS: Coliform O Nitrate Date of sample: 3 - 1 7-- ? 7 B. SEPTIC/HOLDING TANK DATA Date installed /cl ~ '~ Tank size Foundation cleanout (Y/~.~_ r~ Date of Pumping % ,~ ~ '~ ~'-/ c. ABSORPTION FIELD DATA Date installed ~,~ ~ Length '5"7 ~ Width Effective absorption area ~t/'-//¢/ Date of adequacy test %- \'~ ~'~ -5% ¢~ Other bacteria Collected by: '~'/¢ ~' '~,'*~)4~', Number of Compartments ~- Cleanouts Depression (Y/~ ~-~ High water alarm (Y/N) Pumper --~¢-'-. ¢O'Hkf'l~ Lq _ Soil rating (g.p.d./ft2 or ft~/bdrm) .~ / Gravel thickness below pipe Monitoring Tube present.C~N) ~¢ Result~i~Fail) Fluid depth in absorption field before test (in.); Fluid depth I¢- ~ (ins) Minutes later: Peroxide treatment (past 12 months) ('~ ~ ~ ~/6~. System type ~ ~ Total depth /O . Depression over field For Immediately after ~'P gal. water added (in.): Absorption rate /-'//-¢~ ¢' = .g.p.d. ~'/¢~ yes, give date bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) ~ High wate~ *Datum C_.~sted "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main ~line On adjacent lots On adjacent lots sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~' ~ Property line \~ ~ '~- Absorption field Water main/service line Ia Surface wateddrainage /¢'~) J ~ Wells on adjacent lots ~-k SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line / o I ¢' Building foundation / o I 4-- Water main/service line Surface water / ~ e t ~ Driveway, parking/vehicle storage area O~ Curtain drain /03,,) ~ /<~,,,.) ,¢ ~ ,0 Wells on adjacent lots Zoo / ~- F, ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal record,, in conformance with~ M//O/~/¢/uide/~fs in effect on this date. Signature '- ~ ~-~, ~'?~-/¢"'"'~ :¢~"~ Engineer's Name ~/~¢,¢z- ¢ ~,.,//,~ HAA Fee $ ~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ~[[t[r~ CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 971293001 S & S Engineering L1 B2 Meadow Ridge LI B2 Meadow Ridge Drinking Water 211431 Sample Remarks: Sample collected by: Ray. Client PO// Printed Date/Time 03/21/97 00:28 Collected Date/Time 03/17/97 03:00 Received Date/Time 03/18/97 10:45 Technical Director: Stephen C. Erie ~itrate-N Total Coliform Results PQL Units 5.48 0 0.400 mg/L col/lOOmL Method Allowable Prep Analysis Limits Date Date Init 8M18 4500-NO3F 10 max SM18 9222B 03/19/97 JBL 03/18/97 RAM INSPECTION APPOINT~ME~"~ 0~. ~ ','7~CEI'VED (/ ~ATE DATE I N S p ECTOR ~d_h~.X~ ..... INSPECTOR (_ ~ MUNICIPALITY OF ANCHORAGE MUNicIPALITY OF ANCHORAGE (~- DEPARTMENT OFHEALTH& ENVIRONMENTAL PROTECTION DEPT, OF HEALTH &  825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENVIRONMENTAL SANITATION DIVISION ~J~ 5 Telephone 264-4720 DIRECTIONS: Complete all parts on paga 1. Incomplete requests will not be processed. Please allow ten {10) days for processing. 1. PROPERTY OWNER PROPERTY RESIDENT (~ different from above) PHONE % BUYER - , ........ PHONE M~LINGADDRESS ~ ~'~ ~ 3. k~DI~GI~S.TITHTIO~ ~ a ~HO~fi 4. REALTOR/AGEN~ ~ ~ PHONE 5. LEGAL DESCRIPTIO. J~ STREET EOCATION - . -/ , . ,¢_, ~, TYPE OF RESlDEN'CE NUMBER OF BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six 7. WATER SUPPLY ' [] INDIVIDUAL* '~ COMMUNITY [] PUBLIC UTILITY [] Other * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) SEWAGE DISPOSAL SYSTEIVI '~ INDIVIDUAL/ON-SITE*' [] PUBLIC UTILITY ON-SITE SYSTEM WAS INSTAl~LED. NOTE: THE INSpEcTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATE[). 72-010 (Rev, 6/79) -/~.~¢'-k /~.:~ /'~ ~(f~ __~ ~-,~ [L"~ 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 [] 1N D IVI DUAL/ON -SIT E DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: /~) (~) If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED