HomeMy WebLinkAboutELMORE #1 BLK 6 LT 6Elmore #1
Block 6
Lot 6
#018-172-12
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ONSITE WASTEWATER INSPECTION REPORT
Permit Number: OSP141137 PID Number: 018-172-12
Dwelling: R Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Upgrade
Name:
STEVE COUTURE
ABSORPTION FIELD
❑ Deep Trench N Shallow Trench ❑ Bed ❑ Mound
Address
4900 NATRONA AVE ANCHORAGE AK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
1.0 GPD/SF
1.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
0.5 Ft.
Gravel depth beneath pipe
0.5 Ft.
Subdivision Block Lot
ELMORE #1 6 6
Fill added above original grade
-2,5 Ft.
Gravel length
2X45 = 90 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
450 Ft=
2
10 Ft.
Well
>100'
>100'
>100'NA
>25'
TANK ❑ Septic ■ S.T.E.P. [I Holding E] Other
Manufacturer
ANCHORAGE TANK
Capacity
1250 Gal.
Surface Water
>100'
>100'
>100,
NA
Material
Number of compartments
Lot Line
>6
>10'
>5'
NA
STEEL
2
NA
Foundation
>5'
>10'
>5'
NA
LIFT STATION
Manufacturer
Capacity
Curtain Drain
>50,
>50'
>50,
NA
ANCHORAGE TANK
1250 Gal.
Remarks EXISTING TANK ABANDONED PER UPC
Pump on level at
25
Pump off level at
44
High water alarm at
22.5
REQUIREMENTS. 4+ FEET OF ERS TYPE ii FILL &
in
in
in
2.0 FEET OF MOA FILTER SAND BELOW ROCK
Pump make and model
ORENCO
Electrical Inspections performed by
MOA
Installer
PIPE MATERIAL Housetotank 3034 Tankto
drainfieltl SCH40
ISAACS EXCAVATING
Drainfield SCH40 CO/MT 3034
inspector LARS SPURKLAND
BENCHMARK (Assumed elevation)100 ft
Inspeection
1" 6/18/14 6/20/14
Location and description
ction 2m
3'd6/20/14 0
BOTTOM SIDING NW HOUSE CORNER
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
E„jL
i
Q_ A
lit
Conditional Approval: Date
49 H
i.. r
....
Approved Date
Inspection Report_9-1-12.doc
7
NATRONA VE
TV
A B C F
0 21.5 7.5
E 20.5 13.5
F 220 21.0
C 7
G 38.0 47.5 INSTALLED 3-80ROOM SEPTIC SYSTEM
H 61.0 30.0 I 1150 STEP TANX W/ SHALLOW TRENCH
G TRENCH LENGTH 2 X 45 FEET
1 73.5 46.0 ' TRENCH W/DTH 5 FEET
J 5.0 197.0 ® TRENCH DEPTH 6 FEET
REMOVE ORGANICS/SILT
J I MOA TYPE IIA ENGINEERED FILL 4+ FEET
COARSE FILTER SAND 2 FEET
® SEWER ROCK 0.5 FEET
Se tics 2" RIGID /NS!/UTION
Area COVER 2 FEET MIN.
— — — — f — — �a' ura EASE — — — — — —
i i -
-- -- #, Sip
p - - - - --
RAE
LM
E BLOCK 6
cArPCE. ��i�r•�i�
NOTE. THIS IS NOT A SURVEYED PUT. WELL & S£P77C A, 49 j
...............:.
LOCATIONS TAKEN FROM ON -SNE WATER AND WASTE WATER ""''"' '...
r
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE M :,,
APPROXIMATE. L URKLAND
No. CE -11500
my
25 0 25 50 75 100 125 150 ''�'� P� ♦♦♦ SCALE 1' 1' = 50 FT 4Ai�w•�
SPURKLAND ENGINEERINGELMORE # 1 BLK 6 LOT 6 SEPTIC SYSTEM ASBUILT
203 W 15TH. AVENUE
ANCH AK. 99501 STEVE COUTURE DATE' JULY 8 2014
(907) 279-3916 4900 NATRONA RD., ANCHORAGE, AK 99516 SHEET., 2/3 GRID, 3036
PERMIT # 17SP141137 PID # 018-172-12 ELNORE#1B6L6SC50-ASB.DWG
TH
E.G EUV. -97.3'
TOP PIPE ELEY=!
IOP SAND aElF
IOP ERS £LEY= 94
H2O ECFV.=90.3'
ON ECFV= A
BOTH ELEY.--N.3'
SHALLOW WIDE Trench,
5' Wide
2 X 45' Long
Remove Organics & Fill
4'+ Engineered Redeving Slot
0,5' Sewer Rock
2' Insulation
2' Cover
TYP IIA) Installed 1250 STEP Tank
a5 ft of Septic Rock
2,0 ft of MOA Fliter Sond
4 ft of MOA Typ IIA
NOTE: ERS SHALL BE PLACED IN 11 -INCH MAXIMUM LIFTS.
EACH UFT SHALL BE COMPACTED TO CREATE A STABLE BASE
FOR THE ABSOPR770M SYSTEM.
BENCH MARK BOTTO,V SIDING NW CORNER
ASSUMED ELEVANON 100 FEET
ISPURKLAND ENGINEERINGI I ELMORE /I BLK 6 LOT 6 (I SEPTIC SYSTEM ASSUILT
203. AK. K. 99501 TH. AVENUE
ANCH. STEVE COUTURE BATE, JULY 8 2014
(907) 279-3916 4900 NATRONABR, ANCHORAGE AK 99516 SHEEP 3/3 GRID, 3036
PERMIT If 17SP141137 PID # 018-172-12 ELNORE#1B6L6D3-ASB.DWG I
Spurkland Engineering .•�P� °F'
203 W.15thAve. Ste. 202A .... ....'::'�'
Anchorage, AK99501
;• LA SPURKLAND .
�� r •• NO. 1E-11500
TEST —5- SOIL LOG AND PERCOLATION TEST '��••.1,sEP SOIL DESCRIPTIONAQ,��...�.
ORGANICS Yes
1 WAS GROUNDWATER OBSERVED:
Sandy Sot (RII) IF YES, AT WHAT DEPTH: 7.0
2 NO DATE OBSERVED:
3 PERCOLATION TEST.•
4
Organics/stR (bury pit)
(01K)
5�j
ox6Bzed Sill
NO
NO
6
j/
7
Sand R Grove! (Sat. H20)
(SW,GW)
B
B.O.N.
9 PERCOLATION RATE.•
10 PERC HOLE DIAMETER:
TEST RUN BETWEEN FT AND FT
if SITE PLAN:
12
N
13
14
15
16
17
18
19 NOTES TEST HOLE TO CONFIRM SOIL TYPES FOR ERS TYPE If E14L U
20 —
PERFORMED BY: Lars Spurkland, P.E. 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL
STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
SPURKLAND ENGINEERING
1907) 279-33916916 I I ELMORE /1 BLK 6 LOT 6 I I SOIL LOG PERCOLATION TEST I
203 V 15TH AVENUE STEVE COUTURE BATE.- JUNE 26 2014
(NCH. AK. 4900 NATRDNA AVE, ANCHORAGE, AK 99516 GRID #,'3036
PERMIT # PID # 018-172-12
Spurkland Engineering
203 W. IM Ave, Ste. 202A
Anchorage, AK99501
TEST HOLE f _¢_ SOIL LOG AND PERCOLATION TEST
DEPTH SOIL DESCRIPTION DATE._ 4Z2W 4
ORGANICS Yes
1 WAS GROUNDWATER OBSERVED:
Sandy SIH (RII) IF YES, AT WHAT DEPTH: 6.5
2 NO DATE OBSERVED:
3 PERCOLATION TEST.•
Organics) (bury pit)
4
(o,An)
5
oxidized SI#
//
(AIC)
6
Sand R Gravel (Sat H20)
(SW,GW)
7
B.O.H.
8
9 PERCOLATION RATE:
10 PERC HOLE DIAMETER:
TEST RUN BETWEEN FT AND FT
11 SITE PIAN.-
12
LAN.12
13
14
15
16
17
18
19 NOTES. TEST HOLE TO CONf/RM SO�TYPE FOR CK TYPE 11 FILL USE _
20 ----
PERFORMED BY.• Lars Spurkland, P.E. i CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL
STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
SPURKLAND ENGINEERING(I ELMORE 11 BLK 6 LOT 6 I I SOIL LOG PERCOLATION TEST
M. 203 V 15AVENUE STEVE COUTURE DATE, JUNE 20 2014
(NCH. AK. 4900 NATRONA AVE., ANCHORAGE, AK 99516 GRID #, 3036
(907) 279-39763916
PERMIT # PID # 018-172-12
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP141137
Tax Code Number: 01817212000
Work Type: Septic Upgrade
Permit Effective Dates: June 16, 2014 to June 16, 2015
Subdivision: ELMORE #1
Site Legal Address: ELMORE #1 BLK 6 LT 6 G:3036
Owner/Address: COUTURE ROSELLA
1544 OLD NACHES HWY NACHES WA 989378743
Site Mailing Address: 4900 NATRONA AVE, Anchorage Lot Size in Sq Ft:
Total Bedrooms:
This permit is forthe construction of:
6-/q-ly /:oa
-2J- 1i' °'D
Design Engineer: SPURKLAND ENGINEERING0 00
23590
3
N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: f required prior to
construction. If the testholes do not confirm acceptable soil, an approved change order shall be
aquired prior to construction. Submit results with the final inspection report.
Receiv
Issued
MUNICIPALITY OF
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I. D. 018-172-12
Property owner(s) STEVE COUTURE
Mailing address 4900 NATRONA DR., ANCHORAGE, AK 99516
Site address SAME
Legal description (Sub'd., Block & Lot) ELMORE 41 BLOCK 6 LOT 6
Day phone 440-0342
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Single Family (SF)
rp Field Initial ❑ QJ (w/wo ADU)
Septic Tank Q Upgrade 0 Duplex (D) ❑
Holding Tank ElRenewal ElMultiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑ El�l�13MIT I A�
Water Storage
MAY 2 7 2014
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
ERS Distance: NA
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
1
L�
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5(�9' Waiver Fees: Z -/S
Date of Payment: 4517ll `i G� Date of Payment: 5 ZS? ° )0" G�
Receipt Number: 62-04 1G Receipt Number: b I9aEra
Permit No. 0') el Lf 11 3 % Waiver No. 0 V I Lt /I 3$0
Permit App_**-12.doc
SpaftJ aimd Engonee ong
Environmental Consulting and Design
SEPTIC SYSTEM DESIGN
Municipality of Anchorage November 6, 2013
Development Services Department
On Site Water and Wastewater Program
4700 Elmore Rd.
Anchorage, Alaska 99519
Subject: Septic System Installation Permit
ELMORE #1 Block 6 Lot 6
Ladies and Gentlemen:
I am writing to request a septic system upgrade permit for the above referenced property. The
proposed system will serve a 3 -bedroom single-family residence. Soil logs, design calculations,
a site plan, design drawings and construction specifications are enclosed for your review.
Design Cates: Groundwater observed at a depth of 6 feet below ground surface
(7/15/13).
Soil Rating
Gravelly Sand w/ trace silt = 1.2 gpd/s.ft.
ERS (1-5 min/in) =1.0 gal per sq.ft/day
No. of Bedrooms 3
Required Area per Bedroom: 15011.0 = 150 sq.ft.
Total area required: 150 x 3 = 450 sq.ft.
System: We are proposing a shallow trench absorption with anew 1250 gallon STEP tank.
The absorption field will consist of 2 trenches 45 feet long and 5 feet wide and consist of 4+ feet
of MOA Type IIA Engineering Receiving Soil, 2 feet of course filter sand, and 0.5 feet (450
sq.ft. effective) of sewer rock.
Soils: Test holes were excavated on July 3`d, 2013. See the attached soil logs. Ground water
monitoring will continue through construction of the septic system. Groundwater was observed
at a depth of 6 feet below ground surface on July 15'h, 2013.
Surface Water: There are no surface waters within one hundred feet of the proposed septic
system upgrade.
Topography: The ground level is level throughout the property.
203 West 15 Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
SparrMaimd C imudim enimp
Environmental Consulting and Design
Waivers: We are requesting a waiver to the 1992 Code to use the proposed Code Update
section of Engineering Receiving Soils (ERS). Below is our justification for the use of ERS.
1. The existing soils, as seen in the attached soil logs are organics and silt fill up to a
depth of 6 feet. These soils are not suitable for an onsite septic system.
2. With the proposed 5' wide trench, the septic system effluent percolates downward
through the filter sand and ERS into the sand and gravel layer starting at around 6 feet
below the ground surface.
3. Pressurized shallow trenches allow for better aeration of the absorption surface,
because the absorption surface is dosed intermittently. Pressurized distribution will
also ensure that effluent is distributed over the entire bed surface, preventing
localized overloading and maintaining aerobic conditions in the absorption field.
4. A minimum of 2 foot of filter sand will be placed beneath the sewer rock, this will
provided a degree of filtration treatment before effluent percolates into the
Engineered Receiving Soils. Filter sand has high permeability, increasing the likely
hood of maintaining aerobic conditions at the sewer rock filter sand interface.
5. Standard septic systems are routinely installed in coarse sands & gravels with
percolation rates of less than 1 minute per inch, as long as a 2 foot layer of filter sand
is installed. This system replicates an existing practice will a high degree of control
of the material below the filter sand.
The installation of this septic system will not prevent wells and septic systems from being
installed on 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.
If you have any questions or concerns, please contact me at 279-3916.
Sincerely,
Larskland, P.E.
Civil Engineer
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
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....�
NOTE., THIS 15 NOT A SURVEYED PLAT WELL & SEPTIC
V
..... :....... ....... ......... ........
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATKIA! ALL LOCATIONS SHOWN ARE
•• •••• ••••••• •00
APPROXIMATE.
S SPURKLAN➢
���✓j, '
i No. E 150 AV
Ar
50 D sD SCALE 1' = 100 FT 200 2so 300
••/���aaaa��••.
SPURKLAND ENGINEERING
ELMORE #1 Bm 6 LT 6
SEPTIC SYSTEM DESIGN
203 V TH. AVENUE
ANCH. AK.K. 99501
STEVE COUTURE
BATE.- NOV. 6, 2013
(907) 279-3916
4861 RIVERTON BR, ANCHORAGE AK 99516
SHEET; 1/3 GRID 3036
PERMIT # DSPI110XX PIB # 018 -172 --Ml,
ELMOREIB60O..SCIOO.BVG
NA TRONA W VE
❑s
7
1250 STEP TANK W/ SHALLOW TRENCH
TRENCH LENGTH 2 X 45 FEET
TRENCH WIDTH 5 FEET
TRENCH DEPTH 6 FEET
REMOVE ORGANICS/SILT
MOA TYPE IIA ENGINEERED FILL 4+ FEET
COARSE FILTER SAND 2 FEET
�ixwcx NWK U.1)rtu
Se tic 2" RIGID INSULATION
Area COVER 2 FEET MIN.
4.
UIX S£
- - - - # 1 S / p - - - - -
0RE
L M I 9
E BLOCK 6 �.•e•`•����
iC'J,.•''
NOTE: THIS IS NOT A SURVEYED PUT. WELL A• SEPTIC
4 h `�•%
....................::.....
LOCATONS TAKEN FROM ON-SITE WATER AND WASTE WATER �'.'•• •'" •• 0
DEPARTMENT DOCUM£NTATKIM. ALL LOCATIONS SHOWN ARE , , ,,,,, i
APPROXIMATE. � ° S SPURKLANO....°�S
* f
4A.S :, NO. CE 11500
25 0 25 75 100 125 Iso
SCALE, 1' = 50 FT. ,,,"";.���
SPURKLAND ENGINEERINGELMORE 1 BLK 6 LOT 6 SEPTIC SYSTEM DESIGN
203 V 15TH. AVENUE
ANCH. AK. 99501 STEVE COUTURE B4 TE, JULY 18, 2013
(907) 279-3916 11 4900 NATRONA RB., ANCHURAGE, AK 99516 SHEET, 2/3 CRIB, 3036
PERMIT If 0SPIPIOXX PID # 018-172-12 ELMW#IB6L6SC50DV6
SHALLOW WIDE Trench; _O O
5' Wide
2 X 45' Long
Renove Organics & Fill
4'+ Engineered Recieving Slot (MOA TYP IIA) Install 1250 STEP Tank
0.5' Sewer Rock /
2' Insulation
2' Cover
NO SCALE
Trench Elevation (TyP)
� Mon1-Gor
/ Silt Borrj
2' Insula tion
2' Cover
♦. 4 F 4} 4 F+ + 4 4 4! 4
4 F+ +F+ rF+4++ f
r 4 4 ! e f e e e + h h++
+
4! f 4 4 h♦ 4♦+ h F 4 1+4h4+4+}+4!}+h # t } h # f
h + ! 4 + ♦h+4lf hlh 4F 444
♦ h4♦4h 4h+Rf}+44h.f } !4} h + + 4 !
} + t + ♦ h4♦ h h F+♦4
+F4f h41+4 hF+14}+h 44 f } h h f
} 4 4 ♦ 4 4 h ♦4h.h 4F4♦4
+h 4t h♦+F 41+144 t44+h 4 4 4 4
4# 4 ! 4 4 h +4+ F+I.F4t4
1 F.Y+h4♦ h41+14} tf hh4 4} 4 4 4# h+
4# 4 4 4+ h+ f+ h h 4 4!+ t+♦ 4 44
a5 Ft of Septic Rock
2,0 Ft of MOA Filter Sand
4 Ft of MOA Typ IIA
NOTE. ERS SHALL BE PLACED IN 12 -INCH MAXIMUM LIFTS
EACH UFT SHALL BE COMPACTED TO CREATE A STABLE BASE
FOR THE ASSOPRTKIN SYSTEM.
To Septic Tarok
ISPURKLAND ENGINEERING (I ELMORE #1 BLK 6 LOT 6 I I SEPTIC SYSTEM SCHEMATIC I
203 W 15THAVENUE STEVE COUTURE BATE.- NOV. 6, 2013
ANCH. AK. 99501
(907) 279-3916 4900 NATRONABR, ANCH17RAGE AK 99516 SHEEP 3/3 GRID: 3036
PERMIT # OSP131XXX PID # 018-172-12 ELMORE#1B6L6D3.BVG
Spurkland &glneenf ig
203 W. 15th Ave. Ste. 202A
Anchorage, AK99501
TEST HOLE I SOIL LOG AND PERCOLATION TEST
DEPTH SOIL DESCRIPTION DA TE.- 7/4./13
ORGANICS/UNDSCAPE ROCK Yes
1 WAS GROUNDWATER OBSERVED:
Sandy Silt (Fill) IF YES, AT WHAT DEPTH: 7 �r----
2 NO DATE OBSERVED: _ 7/15/13
3 PERCOLATION TEST.•
4
�\\\�
anles 0
r9 �sIlt (bury Plt)
5
(a ML)
6
7
Sand k Gravel (Sat. H20)
(SW,GW)
8
B.O.H.
9 PERCOLATION RATE:
10 PERC HOLE DIAMETER.
TEST RUN BETWEEN FT AND FT
11 SITE PLAN:
12
rv.
13
14 t0T y
I tors I I
15 I ® I I
16
0
17 10' OHL EASE
18 - - - - - — - - - - - - -
19 NOTES.•
20
PERFORMED BY. Lars Spurkland, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL
STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
SPURKLAND ENGINEERING I I ELVORE /I BM 6 LOT 6 I I SOIL LOG PERCOLATION TEST
203 V15TH.9 AVENUE STEVE COUTURE DATE.• JULY 18, 2013
�(yC
AIR 4YUU AWKUAW AVt, AWHWbt, AK- YYW& bKtD #13U36
PERMIT # n PID # 018-172-12
Spurkland Engineering
203 W. 156 Ave. Ste. 202A
Anchorage, AK99501
TEST HOLE - 2 SOIL LOG AND PERCOLATION TEST
DEPTH SOIL DESCRIPTION DATE:_ 7/J/13
ORGANICS Yes
1 WAS GROUNDWATER OBSERVED:
Sandy Silt w/ some Gravel (17R) IF YES, AT WHAT DEPTH: 6r_--
2 NO DATE OBSERVED: 7/15/13
3 Organics PERCOLATION TEST:
4
(0)
�\
Oxldfzed si#
(ML)
6
Sand R Grovel (Sat. HN))
7
(SW,GW)
B.O.H.
8
9 PERCOLATION RA 7f.
10 PERC HOLE DIAMETER:
TEST RUN BETWEEN FT AND FT
11 SITE PLAN:
12--
..4
AWS A
13
o.
14 Lor 7
� LOT 6 � �
15
16
e
17 10' UTIL EASE
18 — — — — — — — — — — — — —
19 NOTES.•
20
PERFORMED BY.- Lars Spurkland, P.E. i CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL
STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
SPURKLAND ENGINEERING
1907) 279-33916916 I ( ELMORE #1 BLK 6 LOT 6 (I SOIL LOG PERCOLATION TEST
203 V 15TH. AVENUE STEVE COUTURE BA 7E., JULY 18, 2013
(NCM (K. 4900 NATRONA AVE., ANCHORAGE, AK 99516 GRID #) 3036
PERMIT # PID # 018-172-12
Spurkland Engin eeing
203 W. ISthAve. Ste. 202A
Anchorage, AK99501
TEST HOLE 1 3
DEPTH
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
SOIL LOG AND PERCOLATION TEST
SOIL DESCRIPTION DATE.• 7/3/13
ORGANICS
WAS GROUNDWATER OBSERVED: Yes
Sandy Silt w/ some Grovel (Fill) IF YES, AT WHAT DEPTH.' 7.7 ---
(K) DATE OBSERVED: 7/15/13
PERCOLATION TEST.•
Oxidized sill
(ML)
B.O.N.
NOTES.•
FILL I DATE I GROSS TIME I NET TIME I DISTANCE I DROP
PERCOLATION RA TE.
PERC HOLE DIAMETER:
TEST RUN BETWEEN FT AND FT
SITE PLAN.•
e_
LOT 7
I tors I I
I ® I I
e
e
rhea
____ roumusE—_
PERFORMED BY.- Lars Spurkland, P.E. i CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL
STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
SPURKLAND ENGINEERINGI I ELMORE /I BU 6 LOT 6 I I SOIL LOG PERCOLATION TEST
203��{V 15TH. AVENUE STEVE COUTURE BA lb- JULY 18, 2013
Rm ps 9 ff 4YW NAM WA AVE-, AftHWAbt, AK- YYWC, 6Ktd #+ 3636
PERMIT # PIB # 018-172-12
Spurhland Engineering
Environmental Consulting and Design
Municipality of Anchorage June 10, 2014
Development Services Department
On Site Water and Wastewater Program
4700 Elmore Road
Anchorage, Alaska 99519
Subject: Septic System Installation Permit OSP 141137
Elmore #1 Block 6 Lot 6
Nitrate Analysis
Ladies and Gentlemen:
This nitrate analysis follows the procedure outlined by Steve Willingham 1989.
Nitrate Mass Balance Equation:
Where
Ca =
Qb*Cb+Qs*Cs+Qi*Ci
Qb+Qs+Qi
_ (279000 * 0.7) + (450 * 70) + (87 * 0)
(279000 + 450 + 87)
226800 mgll * gallday
Ca gal = 0.81 mg/l
279537 Iday
Ca = nitrate concentration
Qb = background subsurface flow
Cb = background nitrate concentration
Q, = wastewater flow
C, = nitrate concentration of wastewater
* = infiltration from precipitation
C, = nitrate concentration of precipitation
0.81 mg/1
279000 gal/day
0.7 mg/l
450 gal/day
70 mg/1
87 gal/day
0 mg/1
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
S-purkland Engineering
Environmental Consulting and Design
Qb—Background subsurface flow
Qb = KiA = 279,000 gallons per day
Where
K = Hydraulic conductivity = 2000 gallons/day sq. ft
i = Hydraulic Gradient = 0.04 ft/ft
A = Cross Sectional Area = 3487.5 sq ft
K is determined from Table 2 in Willingham's paper and the soils identified in test holes and
well longs. Most properties in the area are missing well logs, but from the few available and test
hole information for the surrounding area, the subsurface soils consist of mostly gravel with
some silt. Some lenses of silt and clay exist in the area but the predominant soil type is gravel
with some fines. Based on this, we assumed a value of 2000 gallons/day sq. f1. to account for
both the gravel and fines.
i was determined by assuming that the hydraulic gradient mirrored the ground surface slope and
confirmed by computing the gradient between the static water levels of several wells in the area.
Based on contours in the area the ground slope has a gradient of 0.04. The well on lot 7 has a
static water level of 61' below the top of the casing and the well on lot 4 has a static water level
of 62' below the top of the casing. There is a 15' vertical drop between the elevations of the two
wells and a 450' horizontal separation. This results in a gradient of 0.033, which confirms the
surface gradient.
A is computing by using 1.5 times the projected width of the drain field on the subsurface flow
and the vertical distance from the top of the ground water and the inlet of the shallowest well in
the area. Assuming the subsurface flow generally mirrors the ground surface, the projected width
of the drain field, which runs parallel to the slop contours, would be 75'. The shallowest
recorded well casing in the area is 91 feet deep and the static water level is approximately 60 feet
below the ground surface. This results in an area of 3487.5 sq ft (75' * 1.5 * [91-601)
Qb = KiA = 279,000 gallons per day (2000 * 0.04 * 3487.5)
Cb—Background Nitrate Concentration
203 West 15r" Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
Alk A-k
Spurkl and Engineering
Environmental Consulting and Design
A file search of water quality reports from the surrounding area revealed nitrate levels ranging
from 0.2 to 0.9 mg/l. The most recent values taken are between 0,9 and 0.6 mg/1. For the
purposes of this analysis we are assuming a background nitrate concentration of 0.7 mg/l for the
area.
Qs— Wastewater Flow
Q, = 450 gallons per day
Cs—Nitrate Concentration of Wastewater Flow
The EPA "Onsite Wastewater Treatment and Disposal Systems" Design Manual shows in Table
4-3 that residential wastewater can be expected to have a total nitrogen concentration of 35-100
mg/1. For this analysis, we are assuming a midpoint estimate of 70 mg/1 concentration.
Q;— Infiltration from Precipitation
Rainfall data from the area record an average rainfall of around 15 inches which equates to
approximately 9.4 gallons per sq. ft. per year. We can expect that 50% of this amount will run off
as overland flow and 50% will infiltrate into the subsurface and combine with groundwater. The
area subject to rainfall infiltration is the projected width of the drain field times the average
distance to property line. A = 75' * 1.5 * 60' = 6750 sq. ft.
Total infiltration is 6750 * 4.7 / 365 = 87 gallons per day
C; — Nitrate Concentration of Precipitation
We are assuming that rainfall and snow contains no nitrates
Conclusion:
This analysis shows that the anticipated additional nitrate concentration of the ground water
caused by this installation would be 0.11 mg/1. With an existing background nitrate concentration
of 0.5-0.9 mg/l, we anticipate the new nitrate concentration range of 0.6 to 1.1 mg/l, which is
well below the action level of 5.0 mg/l.
Since this installation replaces a failed existing system that is likely surcharged by ground water
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
i A, -3 & Spurktand Engineering
Environmental Consulting and Design
(i.e. the nitrate load is not being increased over current levels) or may reduce them slightly by
improved treatment (the addition of filter sand) and increased vertical separation between the
bottom of the drain field and seasonal high ground water.
If you have any questions or concerns, please contact me at 279-3916.
LO1494
incerely,
Lars Spurkland, P.E.
Civil Engineer
203 West 1501 Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
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
NAME- �A
Jo/ /v(e �La Yin
PHONDE
�-ni o
Yl
NEW
❑ UPGRADE
MAILING ADDRESS
5'/2 /9 1,704 A„c �, e Alt 4 9Sa
LEGAL DESCRIPTION
/. 4 Q C/rt gre Sbio/ t
LOCATION
Lilz�v»ta Drier
NO. OF BEDROOMS
-91.
U
DISTANCE TO:
Well
,Up f. T.,
Absorption area
Dwelling
.PERMIT NO.
_Y
i Z
Manufacturer
Material
No, of compartments
Liq. apacity in gallons
0
IF HOMEMADE:
Inside length
Width
Liquid depth
0 Y
JUz
DISTANCE TO:
Well
Dwelling
PERMIT NO.
02 F
Manufacturer
Material
Liquid capacity in gallons
O
w=
DISTANCE TO:
Well
Foundation
Nearest lot line
PERMIT NO.
j M Zr
F ? to
No. of lines
Length of each line
Total length of lines
Trench width
G o inches
Distance between lines
HTop
of the to finish grade _ /
Material beneath rile
2 inches
Total effective absorption area
-)S"L17
w
(7
Length
Width
Depth
PERMIT NO.
c F-
LU
Type of crib
Crib diameter
Crib depth
Total effective absorption area
LU
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth -
Driller
Distance to lot line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
-
Septic tank
Absorption area(s)
OTHER
O
2
W
IS
PIPE MATERIALS
Ph 5, �
+
I
SOIL TEST RATING
/DOOM/62
INSTALLER
b�PytetlrcT �,-�s71�vc.7ic..
REMARKS / ,
Oki
I
y- trl ld i✓ZS "."'d 'ice
NQ-/ /4a -s< 6�ff, if a, cct
APPROVED - DATE LEGAL
72-013 (Rev. 3/78)
WELL LOG
irate Drilled= // // -l3 - P/
Static Water Level_? feet
Draw Down /C--::> feet
Tuve Material Drilled:
0 feet to
to
b0-� to 9(
to
to
to
Hefty Drilling
S.R.A. Box 1553 H
Anahorage,Alaska
99507
L4 `sem
E� wo"
0
Gallons Per Minute — �Q
Total Feet of Lasing / 4�O
DEPARTMENT11V HEALTH AND ENVIRONMENTA11PROTECTION
25 KL STREET, ANCHORAGE, AK '9501
264-; 720
t4 Ev l__ I_ fA r -a E> CD r4 — _- 17 07 =u E 01 K FA: F=00000117'
PERMIT NO. f 81110
APPLICANT J. MC:LAUGHLIN BOX 1306 SRA 99502 49-3700
LOCATION NATRONA AVE
LEGAL LOT SIZE 25589
SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD
MAXIMUM NUMBER: OF BEDROOMS _ z SOIL RATING iSQ FT/BR)= 100
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
FTwfo!Fo-T --1= on- to !—Erb TF 6= vv_' C3FRFA" E_!_ C•E=F` t i— I
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION ON FEET?.
THE GRAVEL DEPTH I'= THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
FT En CA LJ I FT K E • "n F=, -r- I TV -r 6=4 VA K IT I _ Eo CA CA CA C3 Fl L_ I_ CD PA
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELL:_ ADJACENT TO THIS PROPERTY AND THE
NUMBER: OF RESIDENCES THAT THE WELL WILL SERVE.
-- — -r hi co a_ :2 > I rA F• E= ®_ -r- I ®A r-4 - FAFR EO FZ t= C LJ I FR E•= c, ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPEi_TION AND APPROVAL BY THIS
DEPARTMENT tJILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR: A PRIVATE WELL OR 150 TO :=00 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
14ELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 0 DH's":
OF THE WELL COMPLETION.
ON.
OTHER REQUIREMENTS. MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER IN'=TALLATION.
I CERTIFY THAT
1: I AN FAMILIAR WITH THE REQUIREMENTS FOR: ON-SITE SEWERS
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES -
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN v BEDROOMS
y~TE3n1L
AND WELL= AS SET
ENLARGEMENT IF THE
`�tEZ17 ct5 —
SIGNED:-- - - ------------------------
AF' DANT -J- CLAUGHLIN c
1
pp
0I
ISSUED BY! ----------- --------- DATE_JV1Y_§ _S?
SOILS LOG R
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:/�'i NC La., ;g? ✓t DATE PERFORMED:, ja
1. —��
LEGAL DESCRIPTION: 4 O C� OIC
DEPTH SLOPE SITE PLAN
(FEET)
1 I
l�a2ih _
2-
3-
4-
5 345
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
(6P)
/no 4'/a4.
WAS GROUND WATER
Date
ENCOUNTERED?
tS
Depth to
Water
IF YES, AT WHAT
Com'
J
DEPTH?
Reading
Date
Grass
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
FT AND
(minutes/inch)
FT
PERFORMED BY: L�Y&a fl CERTIFIED BY: UA I L: /" - I J -- w r
72-008 (6/79)
Parcel I.D. 018-172-12
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description ELMORE #1 BLOCK 6 LOT 6
Expiration Date: l ® -5-- z
Location (site address) 4900 NATRONA AVE., ANCHORAGE, AK 99516
Current Property owners) STEVE COUTURE
Mailing address
Real Estate Agent JANET DALEY
2. TYPE OF DWELLING:
Q Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Individual Well IN
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
WaiverNariance request
Received by:
COSA to be relea.
NONE
Day phone 440-0348
Day phone 727-5677
L
JUL 2 1 2014
TYPE OF WASTEWATER DISPOSAL
Individual
(]
Holding Tank
❑
Community
❑
Public Sewer
❑
unless otherwise requested by the engineer.
"
Date: aF _ t ? �-'-
COSA Fee $ 9'6o �4.0 Waiver Fee $
Date of Payment -2—t 1 N ( Date of Payment
Receipt Number dna y G Receipt Number
COSA # 015C.ILA VN g Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines 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 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(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm SPURKLAND ENGINEERING
Address 203 W. 15TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
Phone 279-3916
Da��17/14 v � e p
s- a
%..:4� H .:..
-^0 c:
ESSOt`%
with the following stipulations:
By: Original Certificate Date: 7' 02 5-- /�e
The n li chorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 7 ! -
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: ELMORE #1 BLK 6 LT 6
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID #
Date completed 11/1981 Sanitary seal (Y/N) Y
Total depth 96 ft. Cased to 96 ft.
FROM WELL LOG
Date of test 11/81
Static water level 70 ft.
Well production 7-10 9 -P.M.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate '864 mg/L
Arsenic ND ug/L Date of sample: 6/5/14
Parcel ID: 018-172-12
Well Log (Y/N) Y
Wires properly protected (YIN) Y
Casing height (above ground) 18+ in.
AT INSPECTION
7/8/14
68 ft.
4.8
9 -
p.m -
Collected by: ANSON MOXNESS
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/STEEL Date installed 6/18/14
Tank size 1250 gal. Number of Compartments Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) Y
Date of pumping NEW Pumper
C. ABSORPTION FIELD DATA
Date installed 6120/14 Soil rating (g.p.d.W or ft2/bdrm) 1.0 System type 5 -WIDE
Length 90 ft. Width 5 ft. Gravel below pipe 0.5 ft.
Total depth 2.8 ft. Eff. absorption area 450 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NEW Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth _ in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed 6/20/14
"Pump on" level at 25 in.
Datum TOP PUMP VAULT
E. SEPARATION DISTANCES
WELL ON LOT TO:
Size in gallons 1250
"Pump off' level at 44 in.
Cycles tested NEW
Septic tank/lift station on lot 100'+
Absorption field on lot 1001+
Public sewer main NA
Sewer /septic service line 25'+
Animal containment areas 50'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 51+
Manhole/Access (Y/N) Y
High water alarm level at 22.5
Meets alarm & circuit requirements? YES
On adjacent lots 1001+
On adjacent lots100 +
Public sewer manhole/cleanout NA
Holding tank NA
Manure/animal excrete storage areas 100'+
Water main NA Water service line 10+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+
Water Service line 10+
Curtain drain 501+ (N.O.)
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Surface water 100'+(N.O.)
Wells on adjacent lots100 +
I certify that l have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name LARS SPURKLAND
Date 7/10114
COSA brown sheet -10 -10 -12 -doe
Absorption field 5'+
Surface water 1001+
Water main NA
Driveway, parking/vehicle storage 10'+
in.
I
NATRONA AVENUE
�__ ���. .��'.•.°NI871e'Ifl'E 932DIj°/ '�.. Jf
GRAYEc !
SE" M C:.EN;OUTS WALKW IY .
r1i
12. 27.6'
iREATMENr 'm g,8 3 ac 42.0• .,
1 STORY
MANHOLE �• RESIDENCE
29,9' 46.8 0.9'xA,2' CPM g
DECK
y 30.6° 2&2°
ji�t �J wODDEN PATIO
LOT 5 `40.3'x®z' SHED x7.2' SHED—/
17.2'x16.3' SHED
SEPTIC CLEANOUTS
LOT 6 N
2,3590 s.f.
12.1'x10' SHED -i
8'x12' SHED
�
WOODEN FENCE —
897+930 132.00
I LOT 9
i
:PALL
LAT 7� /
GENERAL UTILITY
EASEWEMT
PLOT PIAN _ AS BUILT X SCALE V = 40' GRID SW 3036 Project No. 14-120
Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska 99616-3049
(907) 522-6476 Phone
Registered Land Surveyors (907) 522-4625 Fax �^
kenOlongsurvey.ccm / jonafhonOlangsurvey.com p�/`C!•ql
'° gs�40
I hereby certify that i have surveyed the following described property: 'f
LAT 6. BLOCK 6, ELMORE SUBDIVISIONPLAT P -635A) * t� gj�j ye
Anchorage Recording District. Alaska, and (that the Improvements situated thereon are .. ,.....
within the property lines and do not encroach onto the property adjacent thereto, that
no Improvements on the property lying adjacent thereto encroach on the surveyedN Y
promises and that there orb no roadways, transmission lines or other Y'sible KEN
easements on said property, except as Indicated hereon. �jm bflt
Dated this the {Q�' Day of Sid,4 ,'2,11, of Anchorage, Alaska `%c��°"520�.•`a��®
B is the re+ponsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
SGS Ref.#
1142280001
Client Name
Spurkland Engineering
Project Name/#
Elmore #1 B61,6
Client Sample ID
Elmore #1 B61,6
Matrix
Drinking Water
Printed Dateffime 06/10/2014 8:48
Collected Date/Time 06/05/2014 9:15
Received Date/Time 06/05/2014 10:03
Technical Director Stephen C. Ede
Sample Remarks:
Allowable
Prep Analysis
Parameter
Results
LOQ
Units
Method Container ID
Limits
Date Date
Init
Metals by ICP/MS
Arsenic
ND
5.00
ug/L
EP200.8
C
(<10)
06/06/14 06/09/14
EAB
Waters Department
Total Nitrate/Nitnte-N
0.864
0.100
mg/L
SM21 450ONO3-F
B
(<10)
06/06/14
CDE
Microbiology Laboratory
E. Coli
Negative
1
100mL
SM21 9223B
A
06/05/14
SDP
Total Coliform
Negative
1
100mL
SM21 9223B
A
06/05/14
SDP
Time
PPI
,ELLS OUT UPPER HA4WNLY
Property Owner ''-�0*mLo
c � aa-
Phone -
4 �
Mailing Address
(�
Code
(��
`(1Q
Inspectors
Zip S"'� ,.
4'
Buyer 2.0 ft
-
Field Notes:
-
Address
3 V
-.Zip,Code
Lending Institution
-
rf
Phone.
Address
'CONDITIONS OF APPROVAL
Zip Code
Really Co. & Agent
.....
a ` tom _ � AOUYA� - -
Phone
�`
c/�7�% f
g)
2
2�6 1SJ
Address
K.t�l� - \
Zip Code I tet'.
Solis Rating
Legal Description
-
Area
Street Location
1499
/� -%S—� I
Tyj�e�of Residence
/C9 Single Family-
3
Septic Tank Size a n O
❑ Multiple Family
No. of Bedrooms
❑ Other
-
Wat a upplK
- -.
IndividualJF�L
CH WEL LOG. A well log. is required for all wells drilled since June 1975.
-� Community
ells drilled prior to that date, give well dep[f! (attach log if
available)..
❑ Public Utility
-
- - -
Sewer isposal
-
2i_
-
Individual
Year Individual Installed:
❑'Public. Utility
When Connected toPublicUtility:-
❑ Holding Tank
-
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
- Time
-
Time ,yt -
Time _
Date
Date
Date
Inspectors
Inspector
Inspector - -
Inspector
Field Notes:
IN -
a7
-
APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
(- ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE:
-.
BY: -
-
Solis Rating
Date Sewer Installed
Well To Absorption
Area
Well Log Received -
1499
/� -%S—� I
Well to Tank
Septic Tank Size a n O
72023 (31
0
