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Home My WebLink AboutSHENANDOAH HILLS LT 5Onsite File Shenandoah Hills Lot 5 #015-212-42 Prior to approval of a COSA, the 1996 field shall be documented and an as-built survey shall be submitted that shows all septic system standpipes. Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201263 PID Number: 015-212-42 Dwelling: ❑® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name PERRY EATON ABSORPTION FIELD ❑ Deep Trench ❑Wide Trench ❑Bed [1 Mound Site Address 12000 SHENANDOAH RD, ANCHORAGE AK 99516 ❑ Other Phone Number of Bedroorns Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SHENANDOAH HILLS 5 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width 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 I Field Tank Line Ftl Ft. Well I100'+ I n/a n/a n/a 74.0 TANK R Septic [IS.T.E.P. 171 Holding El Other Manufacturer Greer Capacity 1250 Gal, Surface water 100'+ n/a n/a n/a Material Number of compartments Lot Line 10'+ n/a n/a n/a NA Septic/Plastic 2 Foundation 10'+ n/a n/a n/a LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainrield Installer BTH CONSTRUCTION Drainrield CO/MT 3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 476 ft Inspeection v 20201009 20201012 Location and description 2,d ction 3`d 4"' HOUSE TRIM ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date , ; �� OF• ACq& 4 co 9 n �.' TH .....�� 5i8✓er -'.. Fonn6ne Septic System Approved2 3 Date a�4�Al%�G14 Note: this approval does not include well permit requirements. (Kev ubwz/18) X CPp'D vJ CkfoR 1 9 tp iso rr� fl J,Cj� �9 U4 do et /? r e.7 _k c/. A0ov�=D CD -iz oC7 O�f7l CDz 0 co >C/) m m m(n Oc v Z O m� O(A N� N> _ v_+o mo— �-0 �� c�oc om0 Z cn > _ m m n z U)O I' O�DO Z Z m mD r m (p -i O cm u x D m m - o z n, fTl cm I N � i D I z / 3 71 m ' Z/ / 10 pr m a FCO(E) / — W m J ;of II J cl /moo"-- D _ IN _-"!_ MH ._ O. / N.// 00 � Z �. y J \ _ ( T2 0 Cn CO—F DCO �(�'� V / F��l 1 DV/ - o Z 41 1 ` . _ OOm J o N = 00 oy n i 'r -� Z. / N ugq \G Z O y (D CD (n -j W W Cr+ CA ,I 00 p p CD NOTES: PANNONE ENG SVC LLC {C.I. 1085) P.O. BOX 1807 PA, AK 99645 LER PHONE 907) 745-8200 FAX (907) 745-8201 � �( '' . REVISIONS DATE 0201104 RECORD DRAWING REV: 20201124 SCALE SHENANDOAH HILLS L5 PERRY EATON 12000 SHENANDOAH RD *:49 I!i :ir "" " """' "S�ewon on" a CE 8149 1 " = 50' P.I.D. NO 015-212-42 DRAWN JRL PERMIT NO. OSP201263 SITE PLAN ANCHORAGE, AK 99516 EEtLL] Engineer: Legal Description Parcel ID: Permit: Report Type: Municipality Of Anchorage On -Site Water and Wastewater Program P.O. Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Review Comments PANNONE ENGINEERING SERVICES EPLANS SHENANDOAH HILLS LT 5 01521242000 OSP201263 SepticTank As Built Review s L)C'.�7�11't'17lt�TlC 11/17/2020 Completed By: R.Carroll The application has been reviewed and the following comments have been generated. These are to be satisfactorily addressed prior to MOA approval: Please provide swing tie distances. -A 2. The as -built survey is missing all the absorption field standpipes. Please address. LOT 6 Shenandoah Place LOT 5 J ,;Rq'.97,4.S"F 1AQ RQ' N101 Traverse Way 10S. 48 Existing Sam U-) O 0 4 0 0 V) MY x 16.2' Sauna Septic Detail Scale : 1"=20' 4" Dia. Vents Manhole Scale : 1"=20' Legal Description: As -built Shenandoah Hills Subdivision Lot 5 Set Rebar with Cap @ AL. Monument <� Found Rebar 0 Iron Pipe Well Septic G "ovement *verhangsai Wood Deck Concrete Fence Onsite File Shenandoah Hills Lot 5 #015-212-42 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program pOBox 188snO ^rOOElmore Road Anchorage, Alaska g851S'O85O Ph 904 Fax: (9O7)34S79S7 .0"in-Site Wastewater Disposal System Permit Permit Number: {}SP201263 Work Type: SepticTank Upgrade Tax Code Number: 01521242000 Site Legal Address: SHENANDOAH HILLS LT 5 G:2736 Site Mailing Address: 12000 SHENANDOAH RD, Anchorage Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: 7/202020 7128/2021 17-1 Disposal Field 0 Septic Tank EJ Holding Tank 0 Privy M Private Well 0 Water Storage All construction shall bminaccordance with: 1- The attached approved design. 2. All requirements specified inAnchorage Municipal codChapters 1565 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) — The wastewater code requires "inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65.Provide notification ' �naUing0' (907) 343-7904 4� FvonnOctober 15boAoh|15,osubsur�cosoil Gboo�tionsystemun`er constructionduring freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated 0oprevent freezing CSpecial Provisions: Septic tank shall have aminimum 2Oinch nnonwayriser tothe first compartment. Received / By: Date: / Issued By: S Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201263, Rebecca Carroll, 07/28/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201263, Rebecca Carroll, 07/28/20 BRENT P. EATON, P.E. CIVIL ENGINEER 11,~55,..., ~fipyqlassj Circle * Anchorage, Alaska 99515 * Phone 229-,5777 October 16, 1997 Municipality of Anchorage On-Site Services Attn: Jim Cross, P.E., Manager P, O. Box 196650 Anchorage, AK 99519 Subject: Lot 5, Shenandoah Hills Dear Mr. Cross: This letter is in response to your letter dated July 9, 1997, addressed to Perry R. & Ardene J. Eaton. That letter references permit number SW960177. The permit was used, and the new system was installed prior to the permit's expiration date. The installer was Carl's Excavating. I was on site for many inspections, as well as an additional percolation test (as instructed by your office) during construction. I apologize for the lack of as-built documentation at this point. Field information has been gathered, however my computer generated plot plan as-built shows a (hopefully) erroneous separation distance between the old and new systems. As soon as I solve this problem, I will complete the required documents and forward them to your office. Thank you for your patience on this matter, and once again I apologize for any inconvenience this may have caused you or your staff. If you have any questions please call me at 229-3777. R ectfully, Brent P. Eaon, . . C:\BPE~ DOCUMENT~PERRY~LATEASBUILT DOC Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 9, 1997 Perry $ & Ardene J Eaton 12000 Shenandoah Place Anchorage, Alaska 99516 2201 Subject: Lot 5 Shenandoah Hills Subdivision Permit #SW960177, PID #015-212-42 The subject permit, issued July 9, 1996 by this office for a single family well and/or on-site wastewater system, has expired as of July 9, 1997. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Single,y, ~j am e~s Cro~s~, ~p !E.~/~ Program Manager On-site Services enc: Copy of Permit cc: Brent Eaton, P.E. PAGE 1 OF i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960177 DESIGN ENGINEER:BRENT EATON, P.E. OWNER NAME:EATON PERRY R & ARDENE J OWNER ADDRESS:12000 SHENANDOAH RD ANCHORAGE, AK 99516 DATE ISSUED: 7/09/96 EXPIRATION DATE: 7/09/97 PARCEL ID:01521242 LEGAL DESCRIPTION: SHENANDOAH HILLS LT LOT SIZE: 62975 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 (iSAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. THE NEW TRENCH MUST BE NOT LESS THAN TWENTY FEET FROM THE EXISTING TRENCH. 2. DURING EXCAVATION OF THE TRENCH, A PERC TEST MUST BE TAKEN IN TH~C~ SOIL STRATUM AT A DEPTH oF AP DATE BRENT P. EATON, P.E. CIVIL ENGINE~ZR 3801 A Wilson Sired '* Anchorage, A/asl<o 99503 * Phone 229 3777 September 10, 1995 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Subject: Lot 5, Shenandoah Hills Dear Mr. Cross: The proposed septic system will have very limited impact on adjacent properties for the following reasons: The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +75' distance. 3. The design is an upgrade to an existing, adequate system. Drainage will not be affected and is not a major consideration in my design. The separation distance between the existing system and the neighboring well on Lot 6 was addressed in a letter to your office on February 24, 199~4, from Mark Pearson, Mountain Engineering. The septic system on Lot 5 was installed prior to the drilling of the well on Lot 6. Other neighboring wells are greater than 100' from any existing or proposed septic improvements. I will be on site continuously, throughout construction of the proposed improvements should there be any change in below ground conditions that would require a design modification. If you have any questions please call me at 229-3777. Brent P. Eaton, P.E. C:~BPE~TUFF~DOCUMENT~PERRy~PRENARR.DOC BRENT P. EATON, P.E, CIVIL ENGINEER 5801-A Wilson S[ree[ * Anchorage, Alaska 99505 · Phone 229-,~777 BPE Project No.: 95-01 Calculated By: MP Date: Sep. 10, 1995 Legal: Lot 5, Shenandoah Hills Test Hole No. 1 Single Family, 4 Bedroom Dwelling Deep Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 600 gallons Percolation Rate = 5Q minutes per inch Wastewater application rate =,~llons per day per square foot Required absorption area = 1,333 square feet Gravel depth = 11 feet Required length = 61 feet Total Excavation Depth = 13 feet C:~ PE~STU FF~OC UME NT'~.P E RRY~ REC^LC.DO C .--' .~. '~... OEN'f?J~ LiNE 'fRAVF_~$£ WAY .-~' .... ~ S 89 57~45' E 189.89' REC. ~, . 4 X LEGEND ~SH~NANDOAH P~CE + WELL = ~ST HOLE ~ LUMINAIRE ~ EXIS~NG STAND PIPE ~EX. ~ENCH DRAINFIELD NO~S: ~ ~IN~ T~NcN ~ ~ ~ NEW CLEANOUT * NEW MONITORING ~BE NO SURFACE WATER +100' l~ [~ m~ m~lL ~NEW ~ENCH DRAINFIELD NO KNO~ CURTAIN DRAINS ~¢ ~(~ ~ ~, S E P TI C SI TE P LA N LEGAL: LOT 5 SHENANDOAH HILLS ~.. ..... OWNER/INSTALLER: PERRY EATON DATE: 08/08/95 SCALE: 1 = 50' , ~....... .~.~ 3801-A WILSON STREET ANCHORAGE, AK 99503 PH. 229-3777 ,~~ Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-06,50 SOILS LOG -- PERCOLATION TEST 3 4 5 6 7 8 9 11 12 14 15- 16- 17 18 19- 20- I DATE PERFORMED: Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT N~/~ DEPTH? E Depthto Water Alter /. Moniloring? ~['~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop ~. ~ 9' :~"7 ~.4 "' o..., ~.~,~ 0:5" ~ ~: ~?,..- ,.:, ,.., ?-.., O" ,,-, ,L,,, ¢, / 9: (-Z- ,-~, ¢,4. ;~ 9: .~ Z.7~" 0,2~ PERCOLATION RATE ¢~ tminutes/mch) PERC HOLE DIAMETER ~;~,,.I, TEST RUN BETWEEN ~ FT AND ~ F'T COMMENTS '[~F___.,. F~C , '~ [~tlj'~ '~;;~ t..~ ~-~1~. ~, 1 ~ '~'~',~'~ '"g~ / 72-008 (Rev. 4/85) BRENT P. EATON, P.E. CIVIL ENGINEER 5801 A Wilson Sired * Anchorage, Absko 99 0, * Phone 229 5777 BPE Project No.: 95-01 Calculated By: BPE Date: Sep. 10, 199,5 Legal: Lot 5, Shenandoah Hills SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM A. GENERAL The well and septic plan are for a single family residence only, The drawing and or site plan shall be a part of this specification, All materials and workmanship shall meet the Municipality of Anchorage Department of Health & Human Services requirements. All soil tests are advisory to the design and are to be verified in the field by the Engineer. All excavations and depths are advisory and are to be verified in the field by the Installer to meet Municipality of Anchorage requirements. It is the responsibility of the owner to obtain all necessary permits or easements and to locate all adjacent multi-family wells. The excavation is to be exacty~in the area shown on the site plan, any deviation requires Engineer approval. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. DEEP TRENCH 2. 3. 4. 5. The bottom of the trench shall be level, plus or minus 0.1 feet. The total depth of the trench excavation shall not exceed 13 feet, The sewer line shall be level, plus or minus 0.03 feet. The trench gravel is to be covered with geo-textile material. Insulation board (2" Thick) shall be placed over the drain tile, over which a minimum of 2 feet of soil shall be placed. The area over the trench is to be finish graded to prevent ponding of surface water runoff. The septic tank and leachfield must not be closer than 100 feet to any exising private well, 150 feet to any Class "C" well, or 200 feet to any community welt, Note: Twenty-four (24) hours notice required for all inspections. C:~B pEVSTU FF~DOCUM ENT~PE RRY~ RESPEC.DOC Rick Mystrom, Mayor Mmdc p of : chorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 December 10, 1996 Brent P. Eaton, P.E. 11835 Sypgtass Circle Anchorage, Alaska 99515 2707 Subject: Waiver Request for Lot 5 Shenandoah Hills Subdivision Waiver Request #WR960067, PID #015-212-42, SW960177 Dear Mr. Eaton: Your request for waiver of the required 100 foot horizontal separation of an on-site wastewater disposal system to a private well has been approved. The approved separation distance is the private well on Lot 6 to the leachfield on Lot 5 of 87 feet. This waiver approval applies to the existing on-site wastewater disposal system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. If there are any further questions or concerns regarding this waiver, please call om' office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-site Services DJR/ljm:Eaton Rick Mystrom. Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 December 10, 1996 Jay E. & Tammy L. Kassner Property Owner's of Lot 6 Shenandoah Hills Subd. 12020 Shenandoah Place Anchorage, Alaska 99516-2201 Re: Separation Encroachment, Lot 6 Shenandoah Hills Subdivision, P.I.D. 015-212-43, WR960067 Dear Mr. & Mrs. Kassner: As a result of the recent upgrade to the wastewater system on Lot 5 Shenandoah Hills Subdivision, the engineer who designed and inspected this wastewater system discovered that the existing wastewater system serving this property is being encroached upon by the well on lot 6. The separation distance is approximately 87 feet. The required separation distance is 100 feet for a private well to a wastewater system, The existing wastewater system on lot 5 was constructed in July of 1978 and the well on lot 6 was constructed in June of 1983. Because the wastewater system on lot 5 was in place at the time the well on lot 6 was constructed, makes the responsibility of resolving this encroachment matter the property owner of lot 6. Be advised that Lot 6 Shenandoah Hills will not be eligible for Health Authority Approval from this office to obtain conventional financing for purposes of selling or refinancing the property until the separation encroachment matter is resolved. If you have questions of the above, feel free to contact me at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-Site/Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR960067 PID~ 015-212-42 HA# Permit ~ SW960177 Date Received: ~zJuly 2, 1996 Legal Description: Lot 5 Shenandoah Hills Subdivision Engineer: Brent P. Eaton, P.E., Applicant: 118351 Spyglass Circle, Anchorage, Alaska 99515 2707 Pe~rv R & Ardene J Eaton Waiver Requested: of ~' feet. Lot 6 private well to the leachfield on Lot 5 Shenandoah Hills 1i. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Conditions: Criteria: 2. Special 3. Other: Waiver is Granted: ~ List Conditions or Reasons Waiver is NOT Granted: for above: Name of Reviewer Note: fee waived the drainfield was installed prior to the well on Lot 6 therefore Rec ~: Amount: $ Date Paid: lot 6 must pay for the waiver fee. ~OIL ~otf~TlOl~ 2.0 /7. Z co ~ 2>.. ~ /11735 ~.11745~./ //11756o,~ 'X. ~ kllgso[llgSSil194~ 42~ 4210 ,, ? ~ ~L ~' ' ~ ~ ~ ~0 4410 12200 1222( 122~0 12302 12324 ,$ 1 2200 12201 12221 ; 12220 12231 12230 4 9 /2~ - 12302 /(9 /4 12116 12126 /,7 12201 8 ? 12324 12325 12316 2 2325 /I 2 // 12326 I 12 i 43Ql i 4335 4421 /.8 12105 9 ,5' ? 12125 12205 12215 12225 4 ,12305 3 ! 12315 2 12325 / 4 I'ATHERTON 2 HUFFMAN ROI; tHELBO BRENT P. EATON, P.E. CiVil ENOINEIZR btree~. * Mchorogc, /\los!<o 99503 * Phone 229 ,577/ 580I A Wilson ~'~ May 30, 1996 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 RECEIVED JUL 2 1996 Municipality of Anchorage Dept. Health & Human Services Subject: Lot 5, Shenandoah Hills Dear Mr. Cross: This letter is to request a that a separation distance waiver be issued for the subject property. The distance from the well on lot 6 to the end of the existing trench on lot 5 is less than the required 100 feet (see drawing attached to permit application dated August 8, 1995). A Health Authority Approval was previously issued for this property in March, 1994. At this time a letter was submitted to your office explaining the separation distance situation and no waiver was issued. The well and septic system was tested on February 8, 1994, and found adequate for four (4) bedrooms. At this time a sample of water from the subject well was analyzed for coliform and nitrates by CT&E Environmental Services inc. The result of this analysis was 0 colonies/100mi, and 0.22 mg/I Nitrate. The above results indicate no apparent health hazard associated with the current physical location of the neighboring well and existing trench system. The existing system on the subject property will not be used after installation of the new system, but will be kept as a back up and possibly used periodically in future years. Attached please find well logs from several neighboring properties. If you have any questions please contact me by phone at the number given above. Brent P. Eaton, P.E. C:\BPE\DOCUMENT~PERR~WAIVER,DOC MOUNTAIN ENGINEERING 3868 Shannon Circle Anchorage, Alaska 99508 (907} 562-1500 February 24, 1994 Mr. John Smith On-Site Services Section Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Regarding: Lot 5, Shenandoah Hills; Insufficient Separation Distance Dear John: Recently, Mountain Engineering performed tests and collected the field data required for a Health Authority Approval at the' subject residence. At this time it was discovered that the well on Lot 6 (the neighboring 1o0 was drilled at a horizontal distance less than 100 feet from the monitoring tube for the drain field on Lot 5. The actual distance was measured at 91 feet. According to records obtained from your offices, the septic system on Lot 5 was installed in 1978, the well on Lot 6 was drilled in 1983. A Health Authority Approval for Lot 6 was issued in 1989, on which this separation distance was said to be sufficient. Because the separation problem was caused by Lot 6, it is our understanding that they will be responsible for obtaining a waiver. ~ Please contact me at 562-1500 if you will need any additional information. Sincerely, MOUNTAIN ENGINEERING Mark Pearson, P.E. ~ ~ ~ ~---~ CENI'r.~ LINE TRA'vF_~SE WAY ~ S 89 57~5' E 169.89' REC. N /'~ ..... ~.... ~ / 10' UTIUTY & WALKWAY EASEMENT ~ ~. /__. -/ ................... --'-,........~\ ~ LUMINAIRE ¢ EXISTING STAND PiPE ~','"',~EX. TRENCH DRAINFIELD o NEW CLEANOUT ~ ,~-'~"r,>4~ Te-~4c~ ,,,,/tLI- ~ · NEW MONITOR NG TUBE -".-NEW TRENCH BRAINF ELD NOTES: ~'¢¢~..,",fl~1::, (.~ ~.-w) NO SURFACE WATER +100' ~,~m-te.,~ *,4¢r'L¢-.~ -I~ NO KNOWN CURTAIN DRAINS DESIGN ONLY SEPTIC SITE PLAN ~"~OF ~'X.- .......... ."/ ~ ~:,q..... ~.. OWNER~iNSTALLER: PERRY EATON ~ DATE: 08~95 SCALE: 1"- 50' , ~ ~..'F__..~..../.~.. - ~.,,~_. ,,~,. ~TO, ...,- B R E N T P E A TON P. E ~F~z.... ' ' ' 3801-A WILSON STREET ANCHORAGE, AK 9950.3 PH. 229-5777 ~ ~~~ .'. MUNICIPALITY, OF ANCHORAGE · DEPARTMENT OF HEALTH & ENVIRONMENTAL PRoTEcTION ENVIRONMENTAL ENGINEERING DIVISION ' 825 LStreet- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL sySTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION LOOATION NO. OF BEDrOOmS ~ DISTANCE TO: ~OO' kOS' ~ ~ Ua~ufact urer ~ ~i[~ Material Liq. capacity in gallons Inside length Width Liquid depth ~ DISTANCE TO: Well ~ Dwelling PERMITNO. ~ Well Foundation Nearest lot line PERMIT NO. ~Z~m No. of lines ~ Length of eaChr lin~ Total length~ll~s Trench width~ inches Distance bet~en lines ~ ~ ~ Top of tile to fi.ich grade ;~ Material beneath tile Total effecti~a~ion area Length Width Depth PERMIT NO. ~ ~ Type of crib diameter Crib depth Total effective absorption area ~ " ~ ~11 Building foundation Nearest lot line m DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO, ~ m Building foundation Sewer line~ DISTANCE TO: ' ~ ~ O ta ~ Septic Absorption area{s) ~:' J SOIL TEST RATINB INSTAULER R EMAR KS '" ~DATE LEGAL 72~313 I SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED at ThE rate Of ~°78.0,'~ PEr FOOT. 700 Tee,t.. ProPErTY OWNEr LocaTION Of Well 'WELL LOG: "0 ....2~' San~, q~weA ~ 4~ c~, COST INCLUDES ALL LABOR AND MATERIAL FOR COMPL~--~iON OF SAID DRILLING. WRITE CHECK PaYaBLE TO raMPaRT DRILLINg WORKS FOR THE SUM Of ~7800.00 THANK YOU VERY MUCH. DATF BERNIE CLAUS OF RAMPART DRILLING WORKS SERVICE CHARGEOF I~% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. · , . 825 'L' STREET, ANCHORAGE, AK. 99501 ~? '~ · - WELL LIND O~--~ITE SEWER PERrdlT _"~% PER~4IT NO. ( 780432 > : ~/~~ -- ~;~., LOCATION SHENANDOAH PLACE LEGAL L 5 SHENANDOAH HILLS S?D LOT SIZE 62975 SQUARE FEET TYPE OF SOIL 8BSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR>= 225 THE REQUIRED SIZE Of THE SOIL ABSORPTION SYSTEM IS: DEPTH= :1_-1 LENGTH= 7~ GRR%-~EL ['-~EPTh= ~ THE LENGTH DIMENSION IS THE LENGTH ~IN FEET> Of THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE 'DISTANCE BETNEEN"THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FE~T). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION <IN FEET>. REIL-~U I RED SEPT I C TANK S I ::~E= -1::)50 GIILLONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER'OF RESIDENCES.THAT THE NELL WILL SERVE. TWO ~ 2 > INSPECT I Or-,IS i IRE REli~U I RED BACKFILLING Of ANY SYSTEM WITHOUT FINAL INSPECTION AND RPPROVRL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A NELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A'PRIVATE WELL~ OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC NELL. HELL LOGS ARE REQUIRED AND MUST BE.RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAHS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I t E,~P I RES DECEMBER ~-1.- -1978 I CERTIFY THAT' l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEI4ERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THRT'THE ON-SITE SEHER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. V~. 2 4040 °'B" STREET ANCHORAGE, ALASKA 99503 (907) 278-1551 May 11, 1978 W.O. %A18435 Grid %2736 Perry Eaton 3501 Hooper Way Anchorage, Alaska 99502 Subject: Subsurface Investigation for Suitability of On-Site Sewer, Lot 5, Shenandoah Hills Subdivision Dear Mrs. Eaton: Transmitted herein in accordance with your instructions are the results of the above referenced investigation as performed by us on May 9, 1978. The scope of this project is the investigation for suitability of an on-site sewerage system. Included in this transmittal are: Test Hole Location Sketch Test Hole Log Explanatory Information Figure 1 Table A Sheets 1-3 The explOration was conducted using a continuous flight solid stem auger. The rig is owned and operated by Denali Drilling, Inc. Drilling was supervised, the test hole logged and percolation test performed by Mr. O. M. Hatch, geologist for Alaska Testlab. The log of the test hole is included as Table A of this report. In interpreting the log, it would be helpful to utilize the explanatory information contained in Sheets 1-3 of the report. When drilling was completed a 3/4" slotted PVC pipe was inserted in the hole to aid in determining the free water level. For the percolation test, the test hole was filled with water and left overnight to saturate. On returning the next day, the hole was refilled with water and the drop in the water level carefully monitored over the next-60 minutes. This procedure is not a standardized percolation test, howver, we understand that the Municipality of Anchorage, Department of Public Health and Environmental Protection prefers tests performed in this manner to evaluate a site for a proposed on-site sewerage system. Mrs. Perry Eaton May 11, 1978 Page 2 Using the above test, the observed minimum percolation rate for test hole 1 was 20 minutes/inch, c-~~~/~ The percolation rate obtained is lower than would .normally be expected for the soil types encountered. 'Soils in the area are highly varible. If soil conditions appear to im- prove during construction, a visual inspection of those soils may allow reduction of the trench length. No water table was observed during drilling. It should be noted though, that the free water level normally fluctuates seasonally and with precipitation. We hope this report meets your present needs. If we can be of further service, please feel free to contact us. Very sincerely, ALASKA TESTLAB Robert C. Stinnett RCS:bjc enclosures APPROVED Melvin R. Nichols, P.E. Laboratory Manager 't': '., ,~ ..' .. ~.: ~, .~' ,,~ ,,.,,,~ & .~ ~ ~:~',:L''~. .~ '-) ~t .:. ,' -r~: ,'.. . ' ..... . ..;..,-..-; :~':t t' Anchorage ,' :Ala'ska 9'9'5i:6.:,'.'~'..' ..... ; .~ ..... -,, . ' . . , - .. ,, ;... ?"' t,~f .',' . : . : . , ,', , ' .',' ' . - ', , ' ''' "' " ,' ' '.' ' .'*'t,t,~,~'.' ' ' .'.,' . '~t _ ' ., ,', .:~,:'..' , .: Prope~y owner .: p~r~v..~' Zra~n~ '.~nn:' May. phone 224'-~4~0,' .', ; '~;,,$ - , ,'. . :.' ,, , ,..., .~ g .., .., .-, ..... ~,:',~- ~--',....:., ~,..~ . ;' : .... ::".(/.~{?'.:'s',' .,,'":. :,.':,,'-' ,.".': :'-. ',. ~,, :'-.'- :.", ,,.-~[~:t;:,:."? '.hiC-.":-'' . '' '- - . t,;,~i:/)?~.,~.;.:..~,L: Mailingaddre~S,...~OOO:Sh~nandoah,:,.Place,:~hnchora~e, ~ 90516' .'- .".~ . .... .... ....,.., :.. ,,.,.,. ..... -:'~'*4~t}::.',:~."..'~' }~ 'Lending agenoY ' .~agiona~ ',-Bank-~:O'f-,':~hlaska::, ." Day phone ... :... :. , ~,; , ., ,...,. ,',~ :.z. . ~ - ,L-~ ~....~'-',.": :~,'-'-' ;,,.. · ,', ' . · '" '"'.",'~:".J% ,':'?;,."' ',"-'.'" ...... ' ' ' ' ." ' ~: .:-;",.'""::"".1~:i,':;''',','';:t/:.,'t?.;?'l' ~':',:"" : '~':" "" t, ' ~n3 ,.'. '., ' . .... :' .":',t:,.'~: :~;"" ...... ,,'.".','"'.' .............. ,'~ :'"·' ' ~500' ~',;,Be~son::9,L~8 ~..A~o~o~aqe,,'.'A~ 995 . '. ',".':-' '.,"~-.-~., .,,,..,,,,:,;..; :~ ...,. ~,?.~;.:.,~,~.:, ....:,,,....:.:~,,.,,, ,, Madras address, , , , ........ , .... .,..: ;~,~.,q..?,~,.::.-~ ,...: .......... ., .,,..,..,-,,::.,~. ,~;,.:;,.,,, ::,::~]:' i/:',,,~. '- . ' . ' . .. .',".t ~ ":-,:'...::"~'t~;.:",,?-.,,t"t..',,i~,: .... .,"~.':,'~ ,'.',',' ' .: ?~;~',?'::.-::,t.,:':~ .~ :Agent .... ' ...... ~ ....... ·., .................................. Day phone ..... , , . ~- ,'., ' ,: ;;~-., ,'; ' - ,, ':. ~,:' ; "t'1~-, . , '~ ' ' ~ .',,' ::-,:~".: '" ' 'Address " , ~ ......... , ....... , ..... ~:,:, :, :,,'L'.- :-- .. , .... . ';'; ; ' , '.;V .~ ~:: '~' ') , ::. ;"~," ' · ................. : ........ ', ":-,, .t ,.~, ,':,'~-,' ~,; ;t.:,~' .-J 2~'.:-'.NUMBER OF. BEDROOMS...~ ,' , ' ",, :.~;.T,~:,,';~':,,:.,:,~'t,".' '.', ..... ..-,~' .L.... ' .., ' . '..,.'...:.q.'.~'~. . ~,': ..... , , ?. , .. . , ,' , .. . ,... .... ..j,: . .:.; ./ ,.: .,'~:, ,:~ ..... :',,,.:..,~I:,.,.,.~; ,~... . ~.,. ,TYPE OF WATER SUPPLY. .' ....... ";:.,,,~ ,.:'.,,, ..-.: ..... :: ....................... . ....... ~.~ ','..:~- .'. ' k ' '. ' -~.[,~ '~" ,' %;.' . ..', ~ . ' ' ' . .,. ,. , . . ..; . .:., ... ..... . ......... ~-, ~',' · · ' ' · ' ". ' ' '. :~ · ~, '..~ "; ........ r '. ..... "i'- ~ ..... · . · - t Indlwdualwell. ,... ,. ,.,~,:. ,.~ .~. .... . .... ':' ~'""~;",' "' ", ' ~' ................. :'.' - ,' ':"' ~7: ";,'t?'?' "~:' '7' t ,, :"t , . ,. .. L --'t' "'~ ~' :~-:',' "' ', ' ' , ' ~ r; ,-'"J"~'':;''- ~ .' ; ~;.~:;,' .~ ~ '' ' :'',,% ..,~ ...., . Commumtywell . . ..... ... ......~ ..:.~ .... ,.~.,, . ...... i'~.j';'-'-~:.':'. '.- · ' Publicwater,. ;.' . L~.,,,,.,~ ...... '-': ..... ~, '.-,:,..~:~;,~ ' .... :. ... ;~,..'.... i -,..'.,'~:~?~ ,".:-'~-~.': :.,.f'," ':.'..: , ', '.NOTE: .1~ communil~ well system,'.:proWde wnlten;confi~mat~on,from State AD~ altest-. ~:~. ; *~'!, ']',::*".' ' .' ' · .. ' . - * ,*' , . ,,'..'.'-,. , ~' ~',"::;', . ,~;'::'.~, ":."".q' ', ' . . . ' ' .',::,i ?.,.~.::;.-.' .:4.' .. TYPE OF WASTEWATER DISPOSAL. :. ;...,~, '..... '. '. · '. ?.." · · '.*;ii'"',,,,,,' *~* . -., . . ,' ,- ,;".' ,' ..... "* .-:'~ "~, . ' ".- .' , . ' , ,'.' - ., .] .... . . .; - . . r 7 ' ' ' ~ ....... '..'~,"'.. -:~ ' ' Holdlngtank.:..~, ;.~ ' ........ "-~"-': .... ;,' . ' ,.:?,:'-.L~'"',', . ',"..~': ,t . .' '' .... ~"" '~ ""," '.: , :;'~ t;:.',::~;)~','~" ~'~...," ',.." .." ',,'. , ~.' , ~ '~ . ~",, .~ ,-',,~;-".' .'-.'-. '~':' ~'~ .. -~"~,,,,-,. .-: - ,' .~ · ;-% ,., .,,~, .,~. ~..,.,-, ~,~.,~.,,%,,-~:~-, ~ ,~ .~¥~,,~i l- ,' -','-,: ~ .... ~' ~.-r :~, ~.,; , , P~bllO sewer :. ~ .... . . ,, ~ .... .. ~ , · ..... ~ '~', ~ '-'~ t ',' ~' . ' .... ~ ...... ,~,,~.'~.~,~[-J~,~.,~,~,~,,~%~",,,:~.~ ~.;t,, 1.' ...... ~.,-,, ,.,,~ ...... ~...~,,.~,,.:~L~ · . ~, It~ . . i , . i,.,, . ',' ~ .T~.',' '. - '. ~ , , ' , . . ,.J',' . t''~ -.' ," ,, ~ ~. - , , ,.h ,.~ ~,~ .i'~''' i ~h:, ..,~ ~-':'~s,'~-,~.. ,'':,,.' ~,~'~ '- "" .' ' ' ' .... ~ ~' '. ~'~ '~i-" ~-,~ ".": ;:' ~:":;': "~:',~'" :'.~:~':'N OTE' ~"'/f bom'mUnitv'~stewate~system,~prowde written confirmat~on'from'~,tate.A~EO :,:~,:.,.¥.~.:~.: ~.~ -. ~ ' ' '~'. " ,?' " ~, ~ ~ , ~ .. ~. ,~,, ,~ ~ ~ ;- ,~ 'I ' ~. - ~ ,' "- ,' -'-"'~' ' ' , ,':.~ , .~1 ,,,; "-"~'.~ ' . , ' ',t ,,~' .'T~ ~' ,t.-,-.l~".-. ~r~ ~i, ~,~. ..... ~.~,' ,~ ~,-...? ' . ,'~ ,~ '...'.- ,.,.'. ' [' t"' ,,' ,.r, 1"'~ "-~ ":.";~., ~.~..:~:?,~ :'? ,.-~.:' '.h; ~.'attes't~ng to the legaht~'an~tatus'o(:'system. :. ,' ,. ' - ' ' . '..~,,','~.','t.. ~' ,' · '. " ' ,' -~4~' '"~ .,"' "-''. ' .... ' -', ..?.::.. ". :. supply and/or wastewat~[::d!s~sa[~syste~,' ~s.~ni~phance~w~th.ali. MunicipaI and state C6d~s;~--;: ., ,-,,,.,,.o.,,,o, regulat~onsm effect.on of th~s ~nspection.. . , .'.:::.,...~:.t '.. Municipality of Anch?age Department of Health and HUman Services · HEALTH :AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 5, $1iPnan~oah Hills Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed 8/1/78 Driller ' Bernie Cased to 100 ' Casing height 1,5 ' Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Yes FROM WELL LOG AT INSPECTION Date of test 8/1/78 2/8/94 Static water level 60 ' 38 ' Well flow _ 6 g.p.m. 7.0 Pump level1 A. Well Data Well type Res. 1 Faro. Log present (Y/N) Yes Total depth 100 ' SEPARATION DISTANCES FROM WELL TO: 100'+ ; On adjacent lots 144 ' ;'On adjacent lots 1 50 ' Public sewe~ manh01e/cleanout Petroleum tank Septic/holding tank on lot Absorption field on lot 10 [~ ° Public sewer main ~ r~/~. Sewer service line n/a g.p.m. ,~ Claus n/a WATER SAMPLE RESULTS: Coliform None Detected Date of sample: 2//9//94 B. SEPTIC/HOLDING TANK DATA Date installed 7/8/78 Cleanouts (Y/N) Yes High water alarm (Y/N) No Date of pumping Nitrate Tank size Foundation cleanout (Y/N) 2/10/94 .22 m9/1 Collected by: Other bacteria None Brent Eaton Detected 1,250 qal. Compartments 2 Yes Depression (Y/N) No Alarm tested (Y/N) n/a Pumper Denali Sewer & Drain Service SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 100 ' To property line 50 ' Surface water/drainage .On. a.djacent lots 10 O' + Absorption field ;,.. .~ 72-026 (3/93)' Front Foundation 33 ' Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION ~' Date installed i Size in gallons Vent (Y/N) High water alarm level "Pump. 0.n, level at Manufacturer Manhole/Access (Y/N) "pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: - Well on lot ~ · ' ': ~ On adjacent IdtS ~ i . D. ABSORPTION FIELD DATA' Surface water Date installed 7/78 Soil rating (GPD/FF) 2'25" sc[ ft/br Length '79 '~ Width 32" Gravel thicknes~s ..Total absorptiOn area ' 864"sc[ £tCleanout present (Y/N) Yes Date o! adequacy test 2/8/'94 'Results (pass/fail) pass Water levelin absorption field before test '3.4, below grourid Peroxide treatment (past 12 months) (Y/N) NO SEPARATION DISTANCE FROM ABSORPTION FIELD TO: .... Systemtype :trench ~- DePreSsion over field (Y/N) No for ~ Bedrooms -Aftertest 3.4, bP_low 'lf'~/es, give-'d'ate Well on lot ! 0,5 ' To building foundation 46.5 ' On adjacent lots 1 O0, + Surface water n/a Curtain ~lrai~ n./ E. ENGINEER'S CERTIFICATION. On adja,cent lots 91 ' ( s e e a t t ) Property line To existing or abandoned system on lot Cutbank n/'a Water main/service line Driveway, parking/vehicle storage area 5 ' 50' n/a I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe~c.t ?n~ tbe~d~(eofJhis inspection. ,, ~:, ,' . .~ ", ;.-...-~,,r:,~.'. . . , . . :, ~ . ~. : i~I~ 'Signature Engineer's Name Date ., ........ HAA Fee $ Date of Payment ReCeipt Number 72-026 (3/93)* Back :Waiver Fee $ i' Date of Payment Receipt Number : .... ~ : ":" ~' " . ~: ''"! ':! ~ .... ~ ,'? ' ~ DEPT OF HEA"fH & i.:' , ' i i :, , :~.;. MUNICIPALITYOF'ANCHORAGE .,, ':" ' i.-- ' '~ .:',' ~" i', DEP~RTMENT;OF HEALTH &tENVIRONMENTAL PROTEcTII~'IRONMENTAL PROTECTION ', /'~ I ~ ~', , ' ,I '~ ' 8'25 LSi~et-!An'chorage~Alaska9950.1 i ..... ' · .. , . . . :.? ,. ,~,. ,r,~ ~, , , . ',, ' ' ' ~:' 1979 ':((~4l~ ~7'./))'" ' -~ ..... : I .... ,,~, 4, ,,- ..~ ,,~:,~ JAN ~ ' . ' , !~,ENViRONME, NTAL'ENGINEERINGDIVISION , : ?' ' ~ I? t '.' ':i . - ; ...... ', ' . P i%L%.,LIyL-I~ ,,. ., i REQUEST FOR APPR,0VAL' INDIVIDUAl WATER AND $EWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests Will'not be'Processed. Please allow ten ~(10) days for processing. PROPERTY OWNER ! ' ] : =~ i i: 'ri ]; " ;' , PHONE .... :;,/..: ' !i ': :I:' :344~0607'~ " ' P.O-' :Box 10-1592, Ancttgrage; AK ~99511i 1'.:1~'~ ,, .' ~ ' . . PHONE PROPERTY RES DENT (If different from above) I'l I '.; r,i! ' 2 . ; ~. BUYER ~l,i , . ,. , ' , ',1 ~) , ,;,.,I .... :,[ ' .PHONE MAILING ADDRESS ..... ~ .... "; ' ' ;: ; ' '! i Ir : ' ""- ~,-P.O; Box i -1592, Anch r ge~' AK 9951 MAILING ADDRESS ~ :! - J;: ;r: .... l!:l'It !. [.:,t{il! '~ : ,:.:i].i;[.,. ,il',.! , . ~- 645' "G" St~eet'~- Anchorage, 'AK' :99501 :: 'I: ' ' ,!I . . !, !: ' None .; i) -"-.-- ; -* ' ,.. i;; i, ,' :. i, " ~:., ii . ':.il [!1: I PHONE MAILINGADDRES8 ' : : ~:,: r', .~ :r ;. ii I : i.,!:i i " "' "" '.' ";''." : : i lilf"' "" ' ~'% '''! ~r'r '" 5. LEGAL DESCRI~ION : : .':...I.,. ,: ! i ,: ! ~o~ 5, sb~&anJoa~' ;~ ts" Suba~L~'~S~on ,. ~ STREET LOCATION 11230 Sheri~nd0ah Place, 6. TYPE OF RESIDENCE ~x mN~LE FAM;LY [] MULTIPLE FAMILY 7. WATER SUPPLY : ........... 5~ INDIVIDUAL' [] COMMUNITY [] POBLIC"UTI EITY · , NUMBER OF BEDROOMS "F..~ :i !. ~ Th ee J . ATTACH WELL LOG.'A well log i~ ~e~u'ired f~r ~11' , i sincegun~ 1975. For .wells dnlled prior to that date, g,vewell . ~ .~ deptH(attach log f.avadable.~ 8. SEWAGE DISPO,,SAL SYSTEM , , ~ INDIVIDUAL/ON-SITE**: [] PUBLIC UTILITY i:i~ 1978 "If ind viddal/on-site, [live instal ation date . " ~ ~; ........ '; adeqb~c~ required If s~/stem Is over two (2) years old a~ test is bythm Department.. ~ ; "~ , NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCE~SiI~G-CAN BE INITIATED. ~= 72-010(: ' ' OFFICIAL i, ISE ' ,~' , THIS SIDE FOR ONLY · ' ':; ~' '" ': i DATE RECEIVED NSPECTION APPOINTMENTS TIME;' . ~' , :~ ... TIME TIME DATE " ~ DATE DATE INSPECTOR:~" .~. '*, ' ' /' INSPECTOR INSPECTOR DIRECTIONS: 1. T~'~EoF'R'ESI'DENCE : ' : '" NUMBEROFBEDRO~Msi' '~!' I~1~ SINGLE FAMILY ' ' [] = ONE THREE I--I FiVE~! ~ MULTIPLE FAMILY [] iTWO !; , , ~ ' ir--I FOUR [] SI ,'l, '~ ' ' PERMIT NUMBER ' - , 2~. WATER SUPPLY. ii= ~: ' ' ' i~ ' .':f,, .: ;I l_Li, i i I-q ' INI~I coMMUNITY IDUAL .i.. DEPTH OF:WELL: ~ ;. ~ ,;,~ !i .... E~]I DATE DRILLED .,:. i~,;: :~' ] ' 'pUBLI'C'UTI LITY ' :. ~ ' i il" Connection Verified' LOG RECEIVED ,;i .~' 3' :sEWAGE DISPOSAL sYSTEM PERM T NUMBER .~ ~, " F-I'" ~ ' : ' . .. i ~ ,, INDIVIDUAL/ON -SITE 0 DATE INSTALLED .... , []puBLIC. TILITY , .~;, I,. ~:i!', , Connection Verified · ' ' ' INSTALLER i ~ , ~Sept~c Tank or ~ Holding Tank ...... Size:'; ' '~ If Tank is hOmemade "! ' give" ' .... '~' ~ -:" .- Area to nearest Lot Line ~ ,, '" ,~1 5J COMMENTS ' '~ : ;,, ~,, /~,,;,. ;~. i.. , . · . ' '' , ~-APPROVEDFOR, ~ :BEDROOMS ~ .... ...... '' , D CONDITIONAL, APPROVAL (letter must pah~ ~ertif c~te)' ~ ~ISAPPROVED , ,,~ ',~' ~'~ ' ' ' I '; ~' , ,' I. , ' ' . . '. , i: ,]~ LEGAL'DESCRIPTION , ~ , [~ .... i