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HomeMy WebLinkAboutEAGLE PARK BLK 3 LT 7 ~ MUNICIPALITY OF ANCHORAGE f 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 ,'¢; HOMEMADE: DISTANCE TO: DISTANCE TO: No. of liner Top of tile to finish Length Well Length Inside length Dwelling J F ou~nd/l~,l[~n Material beneath tile ~dth Depth Type of crib Crib diameter Well DISTANCE TO: Class Depth DISTANCE TO: Building foundation W dth OTHER PIPEMATERIAL,~ ~. ~, SOILTEBT.?? ) Material NO. OF BEDROOMS No~.~compartments Liquid depth PERMIT NO. Liquid capacity in gallons Crib depth Total effective absorption area Building foundation Nearest lot line Distance to lot line PERMIT NO. Septic tank Absorption area{s) · 7~VED DATE LEGAL PERMIT NO. APPLICANT LOCATION LEGAL MUhl I ¢ I F .-:IL IT¥ OF AI'-.ICH,.. RAGE ~)EPRRTMENT OF HERLTH AMD ENYIROt'JMENTAL PROTECTION 825 'L'" STREET, ANCHORAGE, AK. .~9501 264-4720 01'4--S ITE SEI,IER PERM SYDNEY R. HUFFNRGLE P.O. BOX 182, E.R. RAVEN ST. · E. R, L7 B~ EAGLE PARK S/D 694-9746 66000 SQUARE FEET LOT SIZE TYPE OF SOIL ABSORPTION SYSTEM IS: TREMCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING <SQ FT?BR)= 270 /J ~ THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ~ ~~1~°~ D~PTH= ~EIqGTH= RRt'EL DEPTH= ~r THE LENGTH DIMEHSIO~-I IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TREt'ICH OR PIT I~ THE DISTANCE BETWEEN THE SURFACE OF THE GROUND At'ID THE BOTTOM OF THE EXCRVRTIOt'I (IN FEET>. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE At'ID THE BOTTOM OF THE EXCRVRTIOt'I (IN FEET>. REQ~m I RED SEPT I C TRI'41< S I ~--"E.= :1250 GRLLOI'-.IS PERMIT 8PPLICRt'IT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTRLLRTIODI INSPECTIOt'IS OF AMY WELLS ADJACENT TO THIS PROPERTY 8ND THE NUMBER OF RESIDENCES THAT THE HELL WILL SERVE. Ti,-IO ( 2 ::, I I'-ILL:;PECT I ON--'L:; lIRE RE~..U I RED BACKFILLING OF AN'¢ SYSTEM WITHOUT FINAL INSPECTION AND RPPROV8L BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRt~CE BETHEEN A HELL AND AMY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR 8 PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC HELL MINIMUM DISTANCE FROM R PRIVATE HELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREmeNTS MRY APPLY. SPECIFICATIONS 8~D CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERP1 I T EXP I RES DEC:EPIBER .?-1.- I CERTIFY THRT 1: I RM FAMILIAR WITH THE REOUIREMENTS FOR ON-SITE SB.IERS At-JD HELLS RS SET FORTH BY THE MUNICIPRLITY OF ANCHORAGE. 2: I HILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTRND THAT THE ON-SITE SEHER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. /0~ /YZ/- ~ ~,~s '~ A~LICR~ SYDMEY~ HOFFNROLE ~B = It.~/~f O & E ENG,'~NEERING & DEVELO~'r'~MENT CO. Box 90, Davis St., Eagle River; Alaska 99577 694-2774 or 688-2280 Ru~ell Oyster 694-2774 SOIL LOG Performedfoc, Name' .~"~'~ ? ~:~A/~'r;~--4/C~'~"l~3/q' Tel. No. Earl EIIII 688-2280 q?,s-77 Depth (feet) 8oll Characlerllfl¢~ 0 lm m 7~ 8~ 9~ 12 .eTo PLOT PLAN PERC. TEST / /,~ ~fr/p~.~.. I?. Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: Performed by: O & E ENG,,,IEERING & DEVELO~.,/1ENTiCO. Ru.ell Oyster 694-2774 Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Performed for: Name: '--~ P~) H ~"P ~'~']u] '~]-L~/-' ~' Tel. NO Mailing Address' LegalDescription: /-07- ~7/ /~'/-oc/4 ~, ~'/~-~C.z~'- ,~/~.~--/~,~'~C//Z~Z). Earl 688-2280 Depth (feet) 0 1 2 3 Soft CherecteHttlcl 10 11__ 12__ 13 PLOT PLAN 14 15 16__ ~ ~-~O?'p'O,,'~ '~' ~/p- PERC. TEST No "If yes, what depth Drain Field Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: Performed by: .~ ITII-I~I I C I F~L I TY OF A~ICH~"~;~AGE . DEPARTMENT C HERLTH AND ENVIRONMENTAL ~ JTECTION .,~ -" 825 'L~ ~TREET, ANCHORAGE, AK. ~501 264-4720 I~ELL PEEH [ T PERMIT NO. ( 8~0220 ) APPLICRNT SYDtIEY R HUFFNRGLE LOCATION RRVEN ST. LEORL LT.? BLK. 3 EROLE PRRK S?D PO BX 102 ER LOT SIZE 694-9746 50000 SQURRE FEET MINIMUM DISTRNCE BETWEEN R WELL AND ANY ON-SITE SEWROE DISPOSRL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR i50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTR~tCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE HELL COMPLETION. OTHER REQUIREMENTS MRY APPLY. SPECIFICATIONS RND CONSTRUCTION DIRORRMS RRE AVRILRBLE TO INSURE PROPER INSTALLATION. PERr~ I T EXP I RES DECEMBER I CERTIFY THRT · ~: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLIT¥ OF RNCHORROE. 2: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES. .......... V4. 0 OF H~AL?H & ENVIRONMENTAL P~,OTECTION DOC CO. SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK. ALASKA 99567 · TELEPHONE 688-2759 MAY 1 5 1981 RECEIVED OWNER OF LAND '~-! ~ ~'-/~ F ;,'~,~ CC ~ DE~H OF WELL ~ ~ ADDR~S ~ c' ~ ~ ~ ~ o ~ ~ ~ STATIC LEVEL OF WATER LEGAL D~CRI~ION ~ ~ ~'4 ~< ~ ~ ~ ~P~'- DRAW ~WN ~. ~ OA~-s~.~ ~/'~-,/~/ ~.d~ ~-~-/~' ~A~.~.., /~ ~ PE~ITNUMBER ~1 ~ p~ KIND OF CASING ~ ~o KIND OF FORMATION: From /) Ft. to ~ From ') Ft. to '~' From , ~' Ft. to / C' Ft. From / ~ Ft. to ~ '~ Ft. From n.!.' Vt. to/.? Ft. From / - ~ Ft. to/- ~'' Ft. From Ft. to Fi, From__Ft. to Ft. From Ft. to~__.Ft, From Ft. to Ft. From Ft. to Ft._ From Ft. to__.Ft From Ft. to Ft. From Ft. to Ft From __ Ft. to__.Ft. From Ft. to Ft._ From Ft. to Ft. From--Ft. to--.Ft. From__Ft. to Ft. From Ft. to Ft. From__Fi. to Ft, From__Ft. to Ft. From__Ft. to Ft. From Ft. to__Ft. From Ft. to Ft. From Ft. to Ft. From__Ft. to Ft. From Ft. to___Ft. ~From Ft. to Ft. From Ft. to___Ft. From - Ft. to Ft. From Ft. to Ft. From Ft. to Ft.. From__Ft. to Ft__ MISCL. INFORMATION: DRILLER'S NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address C/O REUAX o~ EAGLE RIVER 20717 Raven Drive Ea~Le River, AK Day phone 16600 Ce~,terfle~.d Prlue Day phone- Eaqle R/uer~ AK 99571 Day phone e Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community ~vell Public water NOTE: XY, X 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 NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. Se 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, regulations in effect ~ ordinances, an 3n the dd_~te-o'r~is inspection. Name of Firm__ Phone Address 17034 Eagle Rl,~c-L~Road ~. 233 Eagle R~ Engineer's signature Date DHHS SIGNATURE ~ Approved for 4 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certifica.'es based only upon the representations given in paragraph 5 above by an independent professional engineer registe,ed 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~.,.c,~' q I~/--"~ ~-,~.,~.~-¢~-t..,C-~Lrcel I.D. A. Well Data Well lype Log present ~)N) Total depth Sanita~ seal ~/N) If A, B, or C, attach ADEC letter. ADEC water system number ,3"'-~'-- 8 ! Driller Cased to ? FROM WELL LOG Date of test Static water level ~ e, / Well flow ,,~o. o Pump level1 ~- SEPARATION DISTANCES FROM WELL TO: Date completed ~, / ~ Casing height pmpedy protected (~/N) Wires AT INSPECTION g.p.m. ; On adjacent lots I o ~ ; On adjacent lots I o o ~ + Public sewer manhole/cleanout .Petroleum tank ~' ~'~ Septic/holding tank on lot J bo ' Absorption field on lot ~ DC> ~ ¥ Public sewer main ~ I ~ Sewer service line ~ WATER SAMPLE RESULTS: Coliform C3 Nitrate Date of sample: ~,-/'f-~ //,'-' B -5' f B. SEPTIC/HOLDING TANK DATA Date installed '7.- ~.5'"-. ~ t Cleanouts ~N) ~f High water alan'n (Y~ Date of pumping .~. ~. Other bacteria 43 Collected by: .Tank size ~.'3.-~" D Compartments Foundation cleanout {~VN) ,~ Depression (Y~ /'/ Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /o ~ ~ On adjacent lots To property line /'~ / '/' Absorption field Surface water/drainage / ~'~ ~ ~' Foundation 5'"/ .Water main/service line ' ~z.o2e ra~' F,o~ CONTINUED ON BACK PAGE C. UFT STATION Date installed Size in gallons Vent (Y/N) 'Pump on' level at High water alarm level Meets MOA Well on lot · ' On adjacent 10ts, Manufacturer Manhole/Access (Y/N) .Surface water Total al:~orption area Date of ad~:luacy test D. ABSORPTION FIELD DATA "Date installed . : ' . ' Waler level in absorplion lleid before lest :, Peroxidetr ament (pa, st Soil rating (GPD/Ft2) '7---"~ T/~'~ Systemlype .3 ' .Gravel thicimess / D, 5" Total depth /5~. -~' Cleanout present ~'/N) ~ Depression over field (Y~ ,J Results (j~ai]) /~'f~:~ for ;~ Bedrooms '~-~" .Ntertest '~ /" ,,Jo ,,J.~_/zJ,~ J./~ yes, giVe date' ~/~. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot J~,~ '¥ On adjacent lots t mo ~'' Property line To building foundation ,~,~,, .b~ .To fxisting or abandoned system on lot On adjacent lots ~ ~ ~._~_.~cUtbank ~1~. Water main/service line Surface water ~ Driveway, parking/vehicle storage area ~"o~ Curtain drain E. ENGINEER'S CERTIFICATION I cerO'fy that I have checked, vedfied, or conforr~ed~ all MOA and HAA guidelines in e~t~o.n_ ~I~ this I.n.~on. '..~ OF , ': · /, / .. · 17034£ I,R ~ "· HM Fee $ f~(~ 43 -, c/Z) Waiver Fee $ ' Date of Payment ~'-"/'",~ ~ Date of Payment Nur r 0¢0¢,5 .umber, CT&E Ref.# Client Sample ID Ma~x Commercial Testing & Engineering Co. Environmental Laboratory Services ~~-l.~.a-~e-~:a-.a-~s-.~-.~-f.~.e-.~.~-.a-.~.~.a LABORATORY ANALYSIS REPORT 94.2832-3 L7 BLIO EAGLE PARK S/D WATER Client Name S & S ENGINEERING WORK Order 79243 Ordered By R..LS. Printed Dale 06/14/94 1~07:18 hrs. Project Name Collected Date 06/08/94 ~ 13:30 h~. Project# Received Dar e 06/09/94 1~ 12:00 hrs. PWSID UA Technical Director Rele~d By: .=.~-~'-~ STEPI IEN C. EDE Sample Remarks: ROUTINE SAMPLECOLLECIED BY: RAY. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Dale Date Init Nitrate-N 2.6 mg/L EPA 353.2/300.0 10 06/10/94 DJS * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Anaiyzed U = Undetected, Reported value is the practical quantification limit. LT = Less 'l~nn ~ D = Secondary diluHon. GT = Greater 'I~an 5633 B Street, Anchorage, AK 99518-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA. COLORADO. FLORIDA. ILLINOIS, MARYLAND, NEW JERSEY, OHIO. UTAH. WEST VIRGINIA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~ / GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, tinge) Location (address or directions) ' Telephone: Home ~'~'/--,'z-O ~'~ Business (b) Applicant Name ~ ~ :~ (c) Applicant is (check one): Lending Institution r-I; Owner/builder I-I; Buyer []; Other (explain); Lending Institution *'~'~'~.z--;;v-~'z-.-~'-,,'~/ ~ ~".',<'," Telephone Address /' (d) (e) Real Estate Company and Agent Address Telephone (fL_~'~HAA to the following address: ,T ,~..w. ,~:~r.~.. - - TYPE OF RESIDENCE Single-Family, S, Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well~ Community ri Public1-1 Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 o! 2 SEWAGE DISPOSAL Onsite'~ Public [] Community 1-1 Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION " "~.: ? ~. '. ' 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 shows that the on-site water supply and/or wast?water 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. Name of Firm '~ ~ ~.E~iI~F.~I~ Telephone , ,~ · '~ lg.r.~, - Address Date .......... Approved for ]~-~'"~ be '~'~P--"~.-~-'-'~C' g'~Date Approved ~. Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data bi, fore a certificate is issued. 'The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) .EALT. AUT.OR,TY A.PROVAL .AA, (13^1333 ! CHECKLIST- FEBRUARY 1984 ' * Legal De.~s~cription: ~ r~ ) ~lY)H ~0 *Zd3Q Well Classification ~'-;>, ~' If A, B, C. D.E.C. Approved (Y/N) Well Log Present~) Date Completed ~"-'~ ~' ~ ~ . Yield Total Depth (~ ~ ~-~" Cased to "~C)~J~ Depth of Grouting '"'-- Static Water Level 'z~c::~ ~ Casing Height Above Ground ~t Electrical Wiring in Conduit (~N) Separation Distances from Well: Pump Set At 0 [~/~. Sanitary Seal on Casing~'N) Depression Around Wellhead (Y~ To Septic/l~ Tank on Lot t ~::~ ~ ; On Adjoining Lots To Nearest Edge of Absorption Field o~ Lot lOOt'+' ; On Adjoining Lots *t, [~.~, I.~ ' ~/~ To Nearest Public Sewer TO Nearest Public Sewer Line fo / ~ 0~:) Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~ ~)K~!- Bm SEPTI~ANK DATA Date Installed Standpipes~N) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /,,3//,, Separation Distances from Septic/~t,,,ld,.~ Tank: To Water-Supply Well J To Property Line To Water ;,~',~;-.,'Service Line ~ [~. ~''~ Course Size ~ ~-~"~ No. of Compartments ~- Air-tight Capsl~N) Foundation Cleanout Date Last Pumped ~"~ ~'~/,A* ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field /~. r To Stream, Pond, Lake. or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '7 - ~' - Width of Field ~" '~-'~"'3 ~' /P~O_~- Typeof System Design Length of Field " Depth of Field Gravel ~ Thick~ St~ndpi~ Pre~nt · Square Feet of Absorption Area Depression over Field (Y.~ Results of Last Adequacy Test · Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation .,~ t .~.~ Lot To Water Nlmn'/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway. Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots J~,A.Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Acce~ (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request *" I certify that I have check~.w;Ly.~[[JJed, or conformed to all MOA and HAA guidelines in effect on the date of this inspecti n Signed ~n 1~ Date ~ ~ ~/~ ~ Company pH. ~8 MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 " APPLIC'"NT FILLS OUT UPPER HA"'%ONLY Realty~.&A~nt ~' ' ~' ' / .... ~e Address ~~ Zip Strut L~ati~ ~O. ~/~ ~ Other Water Supply mm~lty For wefts ~ill~ pilot Io thM date, give well depth (attach I~ If available). ~ Public Utility lndlvldl ~ Year Indlv~ual Install~: Public ~lllty When ~t~ to Public ~tll[ty~ ' ~ Holding Tank ' NOTE: THE INSPE~ION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~ESSING CAN BE INITIATED. Time Time Time Time '._.. Oate Date Date Inspector Inspector Inspector Inspector Field Notes: i'~APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received "7-~( W.l,,oTank Septic T,.k-~l.