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Home My WebLink AboutSIEFKER TR 9$i fkcr Tract #015-281-08 Municipality of Anchorage Page I of Department of Health and Human Services Division of Environmental Services On-Sita Services Section 825 'L' Street Room 502 P.O, Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907) 343-4744 ON-SITE WASTE-WATER DISPOSAL SYSTEM AND/OR WELL. INSPECTION REPORT Permit Number: SW010166 PID Number: 015-281-08 , .~.,: Nastewater System: Upgrade Larry & Lynette Motz *~,-: ABSORPTION FIELD 12000 Avion Street Anchorage, AK 99516 n~.: ......,~ s.~ ....Deep Trench Three LEGAL DESCRIPTION .45 c~e 10.5 Tract 9 Siefker 2.5 n. 8 1.5 .. 64 Well: Existing :~ n. 1I - n. ~,. ~,.1,024 Fe ASTM D3034 PVC ~,. Acreal~e Systems 7/19/01 ¥,,,.. ~ i,~,.s~.,.~,, ic.~, ,,.~,,,~.,,.o.,~.~, TANK SEPARATION DISTANCES Septic Septic Absorption Lift Holding ,ubl~l~nvate .......... Tank Field Station Tank Sewer Li~e Anchorage Tank 1,000 w,, >100' >100' N/A N/A >25' Steel Two (2) ~,.w,,.>100' >100' N/A N/A ~ / LIFT STATION - NONE ON LOT ~u. >5' >10' N/A N/A F .... >5' >10' N/A N/A ~ ~1 c.~,. None Noted ,~,,,~: BENCH MARK Existing Septic Tank Was Pumped. Crushed. Backfilled and Abandoned On Site. Existing Absorption Bed Was Abandoned In Place. Rear Deck Slab. Southwest Corner of House. 100.0 F~ ..-; O~..4/. .~. ~..... -.....~ Inspections performed by: Mike Anderson Dates: 1". 7/19/01 ,,,-.T.'.~., .... 2''~ 7/19/01 ~ ~:~,~*~t.. Department of Health a0d_ HumAn Services approval ~.G'.~ .. ~,-=. ..~.~ Reviewed and approved by: Date: ~ D'Z. '41 ......... ~, '~£0 r [ SS~,'~,'x '~, Permit Number SW010166 Page 2 of 3 PID No. 015-281-08 VACANT .Three droom Ezistin9 Well ~fstfn9 Well A B S1 106.2 116.8 S2 112.3 123.0 C5 117.7 128.5 M1 179.5 191.5 C6 179.7 191.9 S2 C4 C5 PLAN AS-BUILT SCALE 1" = 30' 10' utili{y Easement Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On-Site Wastewater Disposal System or Well Inspection Report Permit Number. SW010166 Page 3 of 3 2 Insular 000Galton I\ PID NO. 015-281-08 51.0' 96.8 .__G e O~.t e x t it · ._~F a Io ~'~ic .... ?' Insulation _-- ~sI ~ Dr'ainf'ietd Rock 84.7j 64' ' I PROFILE AS-BUILT Scale: 1= - 10' ~/-'--77.8 ANDERSON ENGINEERING [ P.O. BOX 240773 ANCHORAGE, AK 99524 522.7773 522-6779 (FAX) MEMORANDUM DATE: April 28, 2002 TO: FROM: Dan Roth Mike Anderson, P.E.~/~'''''' SUBJECT: Tract 9, Siefker Subdivision Septic System Construction As.Built I have modified the septic system as-built for the subject lot to include the distance between the septic tank and the absorption trench. That distance is shown as 5' on the attached drawings. Please let me know if you have further questions. MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 06, 2001 Expiration Date: Jun 06, 2002 Permit Number: SW010166 Legal Description: SIEFKER TR 9 Design Engineer: 0014 Anderson Engineering Owner Name: LARRY L. & LYNETTE MOTZ Owner Address: 12000 AVION STREET ANCHORAGE , AK 99516-2161 Parcel ID: 015-281-08 Site Address: 012000 AVION ST Lot Size: 40500 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank !-_-j Holding Tank [.~ Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~~--~" ~ Issued By: ~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWEPJWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-2814)8 Permit N um be r SW O/__.W.~_~O_~_ Property owner(s) Lan"/and Lynette Motz Mailing address (1) t2000 Avlon Street Anchorage, AK 99516.2t61 Mailing address (2) Legal description (Lot, Block & Sub'd.) Tract 9, Siefl(er Subdivision Legal description (Section. Township & Range) LotSize 40,500 Day phone 522.7773 Zip Code Acre~ Number of Bedrooms 'rhree (3) THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Well Only Water Storage Jacuzzi Water Softening Unit I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: May 24, 2001 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Tract 9. Siefker Subdivision Septic System Design and .P. ermit Application Impacts to Adjacent Properties Dear Onsite Services Engineer:. The exist n~ absorption bed on Tract 9, Siefker Subdivision has failed, and ~.ep. tic effluent has-been noted on the ground surface n the area. We are theremre app y ng for a permit to construct a new septic system on the lot to serve the existing three- bedroom home. The attached Site Plan and backup documentation Identify the location and configuration of the new septic system and the para.meters used in the design. It also shows the location of the existing septic system which was constructed in 1969. The existing septic tank is inside the 100~.pr.otecti.v.e r. adiu..s and...will, be. properly abandoned in its current location. Also idemiT~eo are tne location o; tne ~es~ hole and the neighboring well. Existing drainage patterns are shown and will not be altered by the development of the lot. We have surveyed the area and the new system will not conflict with wells already In existence in the area. A test hole was recently placed on the lot to determine subsurface conditions. Soils were found to 'be poorly graded fine sands with minor amounts of silt in the upper 4'. This material was underlain by siltier sands. Pemolation tests in the matedal Indicated rates approximating 43 minutes per inch. The upper layer percolated much faster, but the system is designed to accommodate the slower rate. Groundwater was found dudng the excavation at the 16' level and maintained that level during the monitoring period. We are therefore proposing to place an absorption trench 63' long by 3' wide with an 8' effective depth to treat the septic effluent. The distribution pipe will be placed at 2' below the existing ground surface to utilize the sandier lense and the total de. pth. of the system will be 10'. Mounding may be required over the trench to proviee me necessary 3' of protective cover. The ground surface on the lot slopes as shown on the attached Site Plan with slight grades from east to west. The new absorption trench will be constructed parallel to the cont.ours of the surface .as much as. possible in conformance with Municipal requirements. Grad ng.w~ll be accomplished to assure surfa..c.e drainage Is away fm.m the new trench. The existing drainage pattern on the lot wi not be affected dunng development. Tract 9, Siefker Subdivision May 24, 2001 Page Two if the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, If constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located In the area. 4, The system, if constructed as designed, will have no adverse impact on drainage patterns in the area, The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments AVION STREET VACANT Existing Well Existing Well NOTE: No with Wells in the Existing Septic Tank SCOPE OF WORK: 1. Verify 2. Remove and Dis 3. ADEC Requirements. 4. Place New 1,000 Gall~ 5. Place 2 Post Tank Ch 6. Construct 6. Regrade Ail 7. Revegetste Area As I in Accordance With ( 3' Wide X 8' Effective Areas. .sting Be, SITE PLAN· SCALE 1" = 30' 1,000 Gallon. Septic Tank 63' x 8' TH 3' Wide tire Depth Trench CE - 4381 10' Utility Easement TRACT 9, SIEFKER SUBDIVISION DESIGN FACTORS: Three Bedroom Home Perc. Rate: 30 -60 Min~lnch Application Rate: .45 GPDISF SYSTEM REQUIREMENTS: Deep Trench System 1,000 Gallon Septic Tank 8' Drain Field Rock 3 Bedrooms X 150 GPD 1.45 GPDISF = 1,000 SF of Absorption Area 1,000 SFI16SF/LF = 62.5 LF Trench Length Therefore: Construct an Absorption Trench 63' .in Length by 3' Wide Wit,h, 8' .of D_rai.n~eld Rock Beneath the Distribution Lateral. Distribut;on Lateral to Be Placed 2 Below ~.xlsting Ground. Total Depth of Trench to Be 10' from Existing Surface. Mound Over Trench if Necessaw to Provide Minimum Cover of 3'. NOTE: TYPICAL DEEP TRENCH SECTION (NO SCALE) Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 10' Separation From Lot Line. Minimum 4' Separation From Groundwater. · Minimum 100' Separation From Wells in Area. Maintain 50' Separation From Slope >25%. Performed For: [any Motz Legal Description: Trac! 9. Siefl(er Subdivision 3 4 9 10 11 12 13 14 17 18 21 OGIOL SP SM 40% Silt Depa~ent of Health & Human Se~i~ 825 L S~t, ~omge. ~ 99502~650 SOILS LOG - PERCO~ON TEST Date Bottom of- Hole Was Groundwater Encountered? If Yes, What Depth? Depth to Water After Monitoring Date: SLOPE SITE PLAN North South Yes 16' See Site Plan 16' 6~5/01 S L O 1% -2% Reading Date Gross Net Depth To Net Time Time Water Drop I 5/22/01 6:25 1.125" 2 6:55 30 1.875' .75" 3 6:56 1 ' 4 7'26 30 1.69" .69" 5 7:56 30 2.38" .69" 6 Perc. Rate: 44 MinJlnch Perc. Hole Diameter:. 8" Test Run Between 5 Ft. and 6 FL Comments: Testhole Presoaked Prior to Percolation Test. SP Layer Percolates <30 Min. per Inch. Design System for Lower Layer or 30 to 60 Min, per Inch. Performed By: Mike Anderson. I, Michael E Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 5/24/01 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: TRACT 9, SIEFKERSUBDIVISION GENERAL: 1. The scope of this project includes the pumping,, crushing and abandoning in place of the existing 1,000 gallon sepbc tank and the abandonment in accordance with City and State requirements of the existing absorption bed. In addition it includes the procurement and placement of a new 1,000. gallon septic tank at the location shown on the site plan. Work also ~ncludes the construction of a new 63' long X 3' wide X 8' effective depth absorption trench at the location shown. The distribution line in the trench will be placed at 2' below the existing ground surface. Total depth of the trench will be 10' below the existing ground surface. All components of the septic system must be placed a minimum of 100' from all wells in the area. 2. Con. structon sha be in. accordance with the approved s. ite plan, des gn draw ngs Municipal Permit with any spec al provisions or conditions, and all applicabe State and Munclpal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,000 gallon septic tank must be be procured from an approved source and installed at the location shown. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. Tract 9, Siefker Subdivision May 24, 2001 Page 2 of 3 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfleld shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall vedfy the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe mate. rials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). Tract 9, Siefker Subdivision May 24, 2001 Page 3 of 3 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. · 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. GR~TER ANCHORAGE AREA BOROP~H HEALTH DEP.,RTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION ADDRESS LEGAL DESCRIPTION PHONE__ SEPTIC TANK: DISTANCE FROM WELL ~,5-- L,OU~D CAPACITY /~900 GALLONS. MATERIAL ~ ~¢~. ~::~/¢~/ '~- NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH ___ SEEPAGE SYSTEM: NUMBER OF PITS LINING MAIERIAL__ NEAREST LOT LINE SEEPAGE PIT: OUTSIDE DIAMETER OR WIDTH · DISTANCE FROM WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA} ·LENGTH , DEPTH BUILDING FOUNDATION SQ. FT. DISTANCE FROM WELt NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE lO FINISH GRADE /WO~- / ,FOUNDAT,ON ~:g-~ '70' , NEAREST LOT LINE DISTANCE BETWEEN LINES TRENCH WIDTH 0 SO. ET. ,ENGTHOEEACHL,NE / g It DEPTH OF FILTER MATERIAL BENEATH TILg_ g ,I TOTAL LENGTH OF LINES /~ "7 O ! IN. TOTAL EFFECTIVE IN. ABOVE TILE J '~ DISTANCE FROM 4 ! WATER WELL: TYPE '''~ ir' t [J~ ~ DEPTH ' , BUILDING FOUNDATION _SAMPLE NEAREST ' ' LOT LINE , SEWER LINE ,~',-5~ SEPTIC SEEPAGE ~ , TANK , SYSTEM , CESSPOOL NEAREST OTHER SOURCES DIAGRAM OF SYSTEM DISTANCES: ¥ ->d- log' DATE APPROVED GREATEK ANCHORAGE AREA HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 ~ )ROUGH;;~,~ ca~ No. ~ ~& 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT RESIDENCE ADDRESS LEGAL DESCRIPTION. APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ~TEST RESULTS MAILING ADDRESS. lgq$ cH, , PHONE NO, TO BE INSTALl_ED BY. ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS qw~-.~, [(.OR.~, ,PERMITTO INSTALLA AS DF. SCRIBED BELOW. SIZE OF UNIT TO BE SERVED ,SEPTIC TANK SIZE ! 0 C~) TYPE SEEPA DIA' OF SYSTEM DISTANCES: --:TO BE. Loca~-c._ o ~o0~ I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 2~68 and that the above described system is in accordance with said code. DATE APPLICANTS SIGNATURE 6REATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE STREET ANCHORAGE~ ALASKA99501 CASE Perfo~'med For, '/~/,.~ ,/~/~,/~/~c ..... ~ate Pem~o~med~~ /~.... . This Form Reports a: Soils Log~j]~.~,.._--Pe~a=on Test~ Depth Feet So~1 Chapacteristics Was Ground Watem Encountered?__~ If Yes~ At ,,,'at Depth · Proposed Installation: Seepage Pit G~oss Time Net Time Location Sketch Depth To H20 Drain Field Net Dz~op Depth Of Inlet..~,,..__~__,__._...,,_Depth T-----~Bot'"~--tom Of:~it Om 'J!'lJench COMe, ON'rS: Test Performed By: Data Certified By: Date: REQUEST FOR APPROVAL OF V ' I INDIVIDUAL SEWAGE AND WATER FACILITIES --, (Fill ou~ in Trip.licate) a. Bactemia~, ....... b. Detergent data: a. Type -)(f , . ~ _~ , c. Casing Size . Distance from well to clOsest existing or proposed: 1, Sewer line ,,-~),CJ~ 2, Septic tank [~.:{ . 4, Cesspool~ ....... , 5. Property Line ,9~ /. 6. Other sources of possible contamination, i,e., creeks, lakes, houses, barn~ drainage ditcl~, etc, . :. . Sewage disposal system, a. Age of system_ : I ~ ~' 2 · b, Septic tank capacity ~n gallons ~d~'~'/--~:) , . c, Name of septic tank manufactu~e~ ~t::%' (/~~(' ' 1. If "home made" show diagram on reverse side of this fomm, dj' Disposal field or seepage pit size and 1, Distance to property., line to house foundation e. PePcolatio~ Te~th~esults ,.~ ~ufi~ Percolation Test performed by ....................... ........... . the reverse.side of this fo~'m to show diagram. Diagram should fn¢lude following info~matlonl p~ope~ty lines;.w~ll location, house locatlon~ 'l~.p~ic tank location, disposal aroa loeation~ location of percolation tost~ a~ di~ection of ground slope, The }~f~or~ation on this form is ~ue and cop~ect to the best of my knowledge. ~O,, BE FILLED ,OUT. , B,Y, H, EA,LTH. . ,DE,PART('!ENT, ,. ,,, ,PErSONiFy.L, .. _ ~'he above described sanltamy facilities ama hereby epproved~ subject to the Conditions: /~2~i The above described sanitary facilities are dis~3pp~oved rom the following Peaso~]s: "~ .Appmoval i~/val~d fom one year followin~ the date of approval. ~' CPJ:cw METROPOLIT -fl N 533 W. 8TH AVENUE ANCHORAGE, ALASKA 99501 279-7200 Health Center Division of Public Health State of Alaska 327 Eagle St Anchorage~ Alaska June 3, 1970 HOMES ACREAGE INCOME PRO Y.E. CTI O N FINANCING Attention: Mrs. Nelson Dear Mrs. N~lson: Attached is a key to property we are selling and upon which we understand you have previously issued an approval of sanitary services. As ~Te understand you will need to take a new water ssmple, we are enclosing the key together with a copy of an asbuilt survey of the subject property. We would appreciate receiving an approval of the w~ter and the sewage system at this address; if necessary you may forward the approval directly to the Veterans Administration with the notation that this is in reference to the Larry Motz loan application. DT/hta '/7,truly~ffTrs ' """' .~ / % ~:,//,-F~,'~'~4"'~'~ ./// ']~"I'7 REQUES? FOR AP?ROVAL OF ~ .d~j!/f~/([~.~L,;~/~-,~..~ a"7' .... _ -- c. Casin~ Siz~: ~ll d. Distance from well to closest exlstin~ oP pPopose~: ,. 3, $eepa[~e Area / . 4. Cesspool' , 5. Property Line 6. Other sources of possible contamination, i,e., creeks, lakes, houses, baPn~ drainage ditch, etc.. ........................... 7. Sewage disposal syste~l. l, If "home made" ~how dia~r.~m on reverse ~ide of ~his fo~m, ~; Disposal field or seepage pi~ size and ~yp~C.~_a ~ l, Dim~ance ~o p~op~r~y .lim~ ~o house Percolation Test Tesults f. Percolation Test performed by ~'"~. Use the reverse .side of this form to show diagram. Diagram should include .-[i-the following Jnformatior,: pFoperty lines~ .well location, house location, ,~e~ptlc tank location, disposal, area location, location of percolation test, aad, direction of g'oound slope. 9. The 5~,-~,-~at~or~ on this form is true anal correct to the best of my knowledge. Date Signed TO B._~E_FILLED OU'? BY HEALTH DEPART~.!ENT PERSONNEL ~-~T~e~... above, described sanitary facilities are hereby approved, ~ubjec~ to the follow,.n? cor~d~'fons: - - Conditior~s: The above described sanitary facilities are disapproved for the followin~ reaso~ Approval is valid for one year following the date of approval. CPJ:cw