HomeMy WebLinkAboutGRANITE VIEW BLK 11 LT 12Granite View
Block I I
Lot 12
#014-302-27
Municipality of Anchorage Page ___Lot Z
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 26 �!?JO�L%� PID Number: 6I�OZ?a
Name:
G
Wastewater System: ❑New Upgrade
Adore a: �D t �� cls%
ABSORPTION FIELD
Phone:
No. of Bedrooms:
eep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
oil Rating: p,(/GPO/Sq
Total Depth from original grad
Ft
Ia
Lot. Block: I I �Subdivi�sionn:
e-!` (r \/I �
Depth to pipe bottom from original grade/
Gravel depth beneath pipe /
i-• G
Ft
Ll Ft
Township:
Range:
Section:
Fill added above Original grade: /
Gravel length:
+*
Ft
Ft
WELL: ❑ New ❑ Upgrade
Gravel width:
Number of lines:
potence ,wenrines:
FI
Irk A• Ft
C'ya y�p/Latwfn� (PrJivate. A 8
/C):
Total Depth:
Cased To:
Total absorption area-
Pipe material
Ft.
FI.
. G FI
4---r"
Driller.
Dale Drilled:
Static Water Level.
Instiller
Date inslallee q
I
FI.
I�� G
1 1
Yield.
Pump Set at:
Casing Height Move Ground.
TANK
GPM
Ft
FI.
SEPARATION
DISTANCES
Y.SepticC7tl6'f- ❑Holding ❑S.T.E.P.
To
Sepuc
AbsorDuon
Ldl
Holding
Public/Presale
Manufacturer
Capacity in gallons:
From
brit
Freie
Suwon
Tank
Sewer LinLinesn
Well
ID1Z_
I n�
-_
`
Material:
Number of Compartments:
Surface
ItTD`
li§v4-
--
—
LIFT STATION
Lot
/
f
Size in gallons:
Manufacturer:
Line
Foundation
9
I
3� /
�A'
'Pump on" level st:
Doll" level at:
High water alarm at:
Curtain
,
C7 F-5
lump et
Make
Electrical Inspections performed by:
Drain
G
Remarks:
BENCH MARK
L«ah�gdDeacnD� or
Assumed Elevation: ( p
1172�— Ft
ENGINEER'S SEAL^'
S 3 S ENGINEERING
Inspections by: 1s�
.r.,.. .....»....:..(a..
performed 17auEp6slau.LaopJtaad.tlQaW:
- Epi. IYK,Alaska 9 2nd f
•• . •.•• • ••
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AoI.aA Vla{dl' /
Department of Healt rid Hum n Se rvi es appro al
` '• "° ""� %`
Reviewed and approved by: Date: Z
l op hr
ae�
72-017 (Rev. 9191) MOA 25
Permit No. Page 2 of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Descriptior>6RANITE VIEW SUBDIVISION. BLOCK 11 LOT 12 PID No.: 01430227
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PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE 9 nni
DEPARTMENT OF HEALTH AND HUMAN SERVICES 9-613
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930333
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:CRABB DAVID B K &
OWNER ADDRESS:9050 GRANITE PL
ANCHORAGE, AK 99516
PARCEL ID:01430227
LEGAL DESCRIPTION: GRANITE VIEW BLK 11 LT 12
LOT SIZE: 9995 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED: 8/30/93
EXPIRATION DATE: 8/30/94
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 DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
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:
WAIVER WR930054 APPROVED ON 8/30/93 FOR LOT LINE WAIVER.
RECEIVED BY: '5tW
ISSUED BY
DATE:
DATE)-a�
MunicrPality of Anchorage
Department of Health and Human Services
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
August 30, 1993
Robert Shafer, P.E.
S & S Enginering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 12 Block 11 Granite View S/D
Waiver Request #WR930054, PID #014-302-27, SW930333
Dear Mr. Shafer:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 1 foot from the north property'line.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sin rely,
Robert W. Robinson
Civil Engineer
On-site Services
'MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR#lig G2,M,,�t1 PID# 014-302-27 HA# Permit #�
Date Received: August 20, 1993
Legal Description: Lot 12 Block 11 Granite View Subdivision
Engineer: Robert Shafer, P.E., S & S Engineering
17034 Eagle River Loop Road, Suite 204, Eagle River 99577
Applicant: Anna Mae & David Crabb
Waiver Requested: Lot line - 1 foot to the north property line
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Waiver is Granted: / \ Waiver is NOT Granted:
List Conditions or Reasons for abe: % �"Ii gt.4" c+� ��17�[
Rec #: 25067 . 9662
Amount: $ 115.00 Date Paid: 8-20-93
A.101f -A
August 18, 1993
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
Municipality of Anchorage
HEALTH AUTHORITY
APPROVALS DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, Alaska 99501
SEWER&WATER
MAIN EXTENSIONS REFERENCE: Granite View Subdivision, Block 11, Lot 12
SEWER 8WATER
INSPECTION Request you issue a permit to upgrade the septic system
serving the three bedroom house on the referenced property
and grant a 1 foot property line waiver.
ENGINEERING STUDIES An adequacy test performed on the existing system on July 26,
AND REPORTS 1993, for Health kuthority n'Approval'.. purposes found the
existing system in a state of failure.
A 1 foot property line waiver is necessary to prevent the
WELLINSPECTION proposed septic system from encroaching the well radii from
&FLOW TEST adiacent lots.
A test hole was excavated and percolation test performed in
the area of the proposed upgrade. Attached is the proposed
SITE PLANS upgrade design.
We do not anticipate any adverse effects on neighboring
properties by the installation of the proposed septic
ROAD DESIGN upgrade.
If you have any questions or require additional information
for your review, please contact us.
SOIL TEST
7erc,
PERCOLATION )
TEST L
A. Shafer, P.E.
STRUCTURAL& I�'•�/LSU/lsu
MECHANICAL
INSPECTIONS
ONSITE
WASTE WATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
1" = 30' I UPGRADE
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ON-SITE WASTEWATER
CONSTRUCTION
and
MATERIAL SPEC'.
DISPOSAL SYSTEM
PRACTICES
. Granite View Subdivision, Block 11, Lot 12
1. The scope of this project includes the installation of a
leachfield trench to serve the three bedroom residence
located on the referenced property and excavation of the
existing 1000 gal septic tank to verify its integrity.
If its integrity is adequate the septic tank is to be
relocated outside the well radius, or if of poor
integrity the existing septic tank is to be excavated,
pumped, crushed, and abandoned in place and a new 1000
gal septic tank installed outside the well radius. Also,
the existing trench shall be abandoned such that it may
be used in the future (diverter valve).
2. Construction shall be in accordance with the approved
site plan and design drawings; Municipal permit with any
special provisions or conditions; and all applicable
State and Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any
necessary underground utility locates.
4. Unless specifically agreed otherwise, the property owner
shall be responsible for final grading areas subsequently
depressed from soil settling.
5. Contractors installing wastewater disposal systems must
be certified by the Municipal Health Department for
system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic
tank manufacturer. Construction shall include two 4•
cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum
of 12 inches above final grade.
Page Two
Granite View Subdivision, Block 11, Lot 12
August 18, 1993
4. Septic tanks installed with less than 4 ft. of cover
shall be insulated.
5. A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the
tank and the leachfield there shall be two adjacent
cleanouts (unless an effluent pumping system exists
within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the
tank. The first cleanout, in line, shall be to clean
toward the leachfield. The second cleanout shall be to
clean toward the septic tank.
6. Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on
the design. The bottom of the excavation shall be within
2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched (ruffed -
up) before gravel (sewer rock) placement.
2. Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
4. Monitor tubes shall be of four (4) inch diameter and
installed approximately in the locations shown on the
design. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This
is equivalent to the effective depth of the gravel as
noted on the design.
Page Three
Granite View Subdivision, Block 11, Lot 12
August 18, 1993
5. Backfill over the final gravel layer must not be less
than twenty-four (24) inches. Insulation must be
installed when the backfill depth is less than thirty-six
(36) inches. The finish grade over the trench must be
mounded to prevent the formation of a depression after
settling.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in
septic system installations in the Municipality of
Anchorage:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
3. Insulation shall be at least 20 thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi
140N, or equal) must be installed between the final
leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.50-2.50
screened gravel with less than 38 passing the #200 sieve.
7. When sand is being used as a filter material, it's
gradation specifications must conform to current M.O.A.
or D.E.C. requirements.
Page Four
Granite View Subdivision, Block 11, Lot 12
August 18, 1993
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
1. The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and before
the installation of any gravel. A septic tank may be set
in place, but may not be backfilled before this
inspection.
2. The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
3. The final inspection is to occur upon final grading
of the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre -
construction meeting will take place on-site.
e .r Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG— PERCOLATION TEST
PERFORMED FOR: PONr.hF Fz F II [^/' L4 r. 1i DATE PE
LEGAL DESCRIPTION: EI K I l r Lo7124 (Tj2AN17i= Township, Range, Section:
, m7P UI �Y 1 S' SLOPE
�fTf-1 r--ru nom
1
sfw - slc ty C4 -o
z
_3 GM
StLcy S"y G ur-
a
5
8
9
.10
it
12
13
14
15
16
17
18
19
20
COMMENTS
S & S ENGINEERING
WAS GROUND WATER
ENCOUNTERED?
S
T WHAT L
O
P
E
r AilElm I
et�
No
(ENNQ1WEEW5 SEAL)
OF.
;.. ...i •
1'
IF YES, A
DEPTH?
cepth to W>te
Monilorinp?
PERCOLATION RATE PU
TEST RUN BETWEEN
n
smch) FERC HOLE DIAMETER .4_
�FT
.• vas c.na'e wlv LOOP KWO NO. "LV¢
PERFORMED G"lf River, AI,mp, CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUID EFFECT ON THIS DATE. DATE:
72-008 (A". 4,951
//� • MUNICIPALITY OF ANCHORAGE
(/ • .r`� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
II ENVIRONMENTAL ENGINEERING DIVISION
825 L Street • Anchorage, Alaska 99501 Telephone 2644720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME�(�
&�..+ �C�V"lJ'
PHONE
3-S,3oi (�
sy
UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
NO. OF BEDROOM
DISTANCE TO: Well
Absorption area
1100 r
Dwelling
5
PERMIT N 1 0%aVg
�
;:z�,
0 2
W c
N~
Manulac �r
Materia
Widtt_�
No. of compyrtments
..L.
Liquid depth
ap dty n gpllons
Liq. `76Y,66
Cl v IF HOMEMADE:
Inside length
6
DISTANCE TO: Well
Dwelling
PERMIT NO.
Z?f
Manuh r .a
squid mgallons
D
m=
DISTANCE TO:
Well e
FoundatioC Nearest lot fine
Y •
PERMIT NO.
6
�1LL Z
H ��
f
No. of lines Length of each Ione
Top of tile to finish grade
Total length lines Trench wi
inches
Material beneath hie Ci
Distance bet en lines
Total elle tive ab. p)i2n area
w
U
LengthWidth
Depth
PERMIT NO.
a F
w�
Type of crib
Crib d' Hetet
Crib
Total elfectiw a tea
(STANCE TO:
We
Building fo
Nearest lot line
s
Depth
Droller
Distance to lot hne
PEHMIT NO.
3
DISTANCE TO:
Building foundation
Sewer line
Septic lank/ r
GLV
Absorption area(s)
OTHER
PIPE MATERIALS
I.iWCLJ' �C�t_.Orl.
SOIL TEST R�AAT`ING
`/
INSTALLER C _ _L .
REMARKS
66
7s Z
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A
APPROVED DATE LEGAL
4VIa 1"ev.J//01 v
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM IJUV18ER OF BEDROOMS = 3 SOIL RATING (SO FT/BR>= 234
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
C•EF='TH= S4 t-ar4O-r"= !25S4 C3F?nVEL- OEF=TH= oS
THE LENGTH DIMENSION IS THE LENGTH (IPJ 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 (IN FEET).
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).
F?EvDU I AEC• SEPTIC TF:1tyFK '3 I ME= 1 C3F1t-t-1Dt45
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 WELL WILL.SERVE.
f
--- TL40 C 2 ] I t4SPECT I Ct-dS F=iF?E PE: at u I AEC• ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPAP,TME14T WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE 14ELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SE14ER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS'AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PEF?M I T EXP I F� ES C>ECEMFIFEE F?
I CERTIFY THAT
1: I AM FAMILIAR. WITH THE REOUIP.EMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER, SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MOPE THAN 3 BEDROOMS.
SIGNED: ------------
APPLICANT ANN MAE CRABS
------ / 8 I __ :., V4. 0
ISSUED BY ------ Cr DATE ---- � _
t'1ur-4I C I r Fit- I -r --e OF Fit FCHCF= nc3iz
'Qu., -j a SSI
•
DEPARTMENT
OF HEALTH
AND ENVIRONMENTAL PROTECTION
u
825
'L' STREET,
ANCHORAGE, Aft. 99501
—
2E4-4720
or-J—S
I TE
'SEWEF= F'EFRM I T
Z;u.
PERMIT
NO. ( 810725 )
0A J jr. f h benzwh a-�•
RL 1-Y]OLV 1
APPLICANT
ANNA MAE CRABB
8051 CRANBERRY ST
243-5328
LOCATION
GRANITE PL
LEGAL
L12 611 GRANITE
VIEW
LOT SIZE 23000
SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM IJUV18ER OF BEDROOMS = 3 SOIL RATING (SO FT/BR>= 234
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
C•EF='TH= S4 t-ar4O-r"= !25S4 C3F?nVEL- OEF=TH= oS
THE LENGTH DIMENSION IS THE LENGTH (IPJ 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 (IN FEET).
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).
F?EvDU I AEC• SEPTIC TF:1tyFK '3 I ME= 1 C3F1t-t-1Dt45
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 WELL WILL.SERVE.
f
--- TL40 C 2 ] I t4SPECT I Ct-dS F=iF?E PE: at u I AEC• ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPAP,TME14T WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE 14ELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SE14ER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS'AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PEF?M I T EXP I F� ES C>ECEMFIFEE F?
I CERTIFY THAT
1: I AM FAMILIAR. WITH THE REOUIP.EMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER, SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MOPE THAN 3 BEDROOMS.
SIGNED: ------------
APPLICANT ANN MAE CRABS
------ / 8 I __ :., V4. 0
ISSUED BY ------ Cr DATE ---- � _
L
MUNICIPALITY OF ANCHORAGE
a+\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
`I 825 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG — PERCOLATION TEST
PERFORMED
LEGAL DESCRIPTION: ` • 2" i
(FEET)
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i DATE PERFORMED:
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12 ,
• IF YES, AT WHAT
13
14
15
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Time
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Time
Depth to
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Drop
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COMMENTS G7
PERFORMED BV: S & S '
74.008 (6/79)
PERCOLATION
TEST
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Drop
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'96PERCOLATION RATE (minutes/inch)
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Muhl I C I F nL- I -ry oF= nrgrCF-FC?F;znQa:
DEPARTMENT !� HEALTH AND ENVIRONMENTAL j-�OTECTION
825 STREET, ANCHORAGE, AK. 95 ,l
264-4720
WELL F=`EFzM I T
PERMIT NO. C S1O360 )
APPLICANT DAVE CRABS 8051 CRANBERRY STREET 99502 243-5328
LOCATION GRANITE PLACE
LEGAL L :'2 B 11 GRANITE VIEW S/D LOT SIZE 10000 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL 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 WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER, LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER, INSTALLATION.
F`EFt M I T EXF• I FRES I7ECEt1F3EFZ 31r 1SR51
I CERTIFY THAT
1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
SIGNED
APPLICANT DAVE CRABS
ISSUED BY ------------------------------ DATEAL_L9 = U ---- V4.0
r"4�JNICIPALITY OF ANCHORAGE r`,
Department o. Health and Environmental _totection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT
WEELLL+/�/� PERMIT
Applicant: 1��` (��/7C!�"QIP Mailing Address: Yan 4
Location: (2;Yy-A 114r f �ta/ �° Phone umber: y�s3C=Z
IZ. ALLK �l Lzedna of �SizeYD IO.OdD
Legal Description: —�
Type of Soil Absorption System Is:
Trench: Drainfield: __ Seepage Bed: Holding Tank:
Maximum Number of Bedrooms:
Soil Rating(sq.ft/br) _
The Required Size of the Soil Absorption System Is:
DEPTH J^ LENGTH GRAVEL DEPTF(" WIDTH
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(in feet). 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).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = NS
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 well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection and approval by this departmen
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
for a private well or 150 to 200 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. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 1
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may.require enlargement if
theresidenceis remodeled
,,, to include more that 3 bedrooms.
Signed: �A -,M;) e V "� "' Issued by: el e 4V�ry-[
Applicant Date: _ 15 — f+
SWP/024(1/81)
Klvi yr Wr;,�
Municipality of Anchorage
Development Services Department -:
Building Safety Division
On -Site Water S Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519.6650
www.cl.anchorage.ek.us
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING //���
Parcell.D. 014-302-27 COSA#yLrO042,
1. GENERAL INFORMATION Expiration Date: -5- - I Jr- CIL
Complete legal description GRANITE VIEW SUBDIVISION: LOT 12, BLOCK 11
Location (site address or directions) - 9050 GRANITE PLACE * ANCHORAGE. AK 99507
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
ANDREW BENNISON Dayphone 240-6321
9050 GRANITE PLACE • ANCHORAGE. AK 99507
RON SMITH w/INVESTMENT GROUP
Day phone
Day phone 440-7775
3201 "C" STREET • ANCHORAGE. AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
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 riles 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 Finn GARNESS ENGINEERING GROUP, Ltd. I Phone
Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 6 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwaterlevels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory lost
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will If confer any legal right whatsoever.
5. DSD SIGNATURE
_),tff' Approved for -3 bedrooms.
Disapproved.
337-6179
Date a L7 Ob
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
t� Arsenic Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
Yt0Ffrr�i�
�Q 0/;",�
• ON-SITE
WATER AND
t WASTFWAT R
PROGRAM ;
By://�/ /i� / Original Certificate Date: — 1S— 0
(11".12101)
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water 6 Wastewater Program
47W Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6850
www.muni,oryionsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: GRANITE VIEW SUBDIVISION; LOT 12, BLOCK 11 Parcel ID: 014-302-27
A. WELL DATA
Well type PlaVATE_ If A. B, or C provide PWSID# N/A
Date completed 5/20/1981 Sanitary seal (YM) YES
Total depth 208 ft. Cased to 40 ft.
FROM WELL LOG
Date of test 5/20/1981
Static water level UNKNOWN R.
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
1/27/2006
76 R.
Well production 12 g.p.m. 4.0 g.p.m.
WATER SAMPLE RESULTS:
Collfonn 0 oolonies/100 m1. Nitrate 0.1 mg,/L, Other bacteria colonies/1GO ml.
1/27/2006
Arsenic: <5.0 ug./L. Date of sample: 2/6/2006 Collected by: GEG. LtD.
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 7/24/1981
Tank size 1000 gal. Number of Compartments 3 Cleanouts (YM) YES
Foundation cleanout (Y/N) YES Depression over tank (YM) NO High water alarm (Y/N) N/A
Date of pumping 2/7/2006 Pumper MCDONALDS PUMPING
C. ABSORPTION FIELD DATA
Data installed 9/15/1993 Soil rating(o.p.d. ft%drm) 0_6 System type DEEP TRENCH
Length 47 ft. Width 3.0 ft. Gravel below pipe 8.0 ft.
Total depth 10.5 ft. Eff. absorption area 752 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 1/27/2006 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth In absorption field before test DRY in. Water added 630 gal. New depth 5 in.
Elapsed Time: 200 min. Final fluid depth DRY kr. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N 3 type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed Size in gallons
"Pump on' level at _in.
E. SEPARATION DISTANCES
High water alarm level at
Cycles tested Meets alar & circuit requirements?.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanknift station on lot 100'+
Absorption field on lot 100,+
Public sewer main N/A
On adjacent lots '83'
On adjacent lots 100'+
Public sewer manhole/deanout N/A
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main
N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line "'1' Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
••WR
G. ENGINEER'S CERTIFICATION
I cer* that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSH guidelines in effect on this
date. P
Engineer's Printed Name JEFFREY A. GARNESS •g.
Date A
COSA Fee &
4& -I'2
Date of Payment -//•3/�G
Receipt Number
(Rev. 1201)
Waiver Fee $
Date of Payment
Receipt Number
...... .......
,Jan 26 06 10:46a
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•
I N89 's3'E
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/40.00
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Sculc: II %3O, AS -BUILT NO CORNERS SET THIS DATE
�wvtS�}t-
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. FBg/-3 PZ/
I hereby certify that I have performed a Mortagee's in.
spection of the following described property _L a 7F /2,,_
lock /,, Gr�nite View SNbd.
Anchorage Iterording Precinct. Alaska• and that the improve-
ments situated thereon are within the property Imes and do
not overlap or encroach on the property lying adjaeeat there-
to. that no Improvements on property lying adjacent thereto
encroach an the premises in question and that there an no
roadways, transmission lines or other visible easements on
said properexcept as indicated hereon.
Datety d at Anchorage. Alaska
this ♦ti
/O aay ot_S�P an•, (ie/ 19�
I•'RED WALATICA S. ASSOCIATES
Engineers and Surveyors
SCS WE#
1060496001
Client lame
Garncss Engineering Group, Ltd.
Project Name/N
Granite View Lot 12 Block 11
Client Sample ID
Granite View Lot 12 Block I1
Matrix
Drinking Water
PWSID
0
Sample Remarks:
All Dates/Times are Alaska Standard Time
Printed Dale/Time 02/02/2006 15:05
Collected Dateffime 0127/2006 14:50
Received Date/Time 01272006 15:40
Technical Director Stephen C. Ede
Parameter Results
PQL
Units
Method
Container ID
Allowable
Limits
Prep
Date
Analysis
Date
Init
Nitrate -N 0.100 U
0.100
mg/L
EPA 353.2
B
(<=10)
0127/06
JC
Metals by ICP/MS
Arsenic 5.00 U
Microbiology Laboratory
Total Coliform 45 OB, No Coli
5.00 ug/L EP200.8 C
coUl00mL SN1209222B A (<-1)
01/31/06 02/02/06 TK
0127/06 TLF
SGS/CT&E ENVIRONMENTAL SERVICES
Drinking Water Analysis Report for Total Coliform Bacteria
READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE
MUST BE COMPLETED BY WATER SUPPLIER -•- - - .. _ . -:
p LIC WATER SYSTEM De
--
—_ — —
B
PRAVATEi"RaValEM
�Rotrtina 13 Treated Water
—
—
L3 Send Re"s
❑ .
Send Mdce
(3 Send Reaub
20o W. POTTER DRIVE
ANCHORAGE, ALASKA 99515
Tel: 907-562-2343,
Fax 907.561-5301
tae Ref No.
1060496-*
Send lrnoiu INS$
-.._
SAMPLE COLLECTION:
t
SAMPLE TYPE:
r..+.w.ra err.e.ir rnrr r.r�.rrr..
�j
B
Date: LZil g��
t�Q.J�
�Rotrtina 13 Treated Water
Dw,
❑ Unsatisfactory
Vow E)� w
r»I E Repeat Sample ❑ Untreated Water
Location:
(refer to lab no. 1
Cooectw: rare
❑ Special Purpose
Transported
to Lab Or. Same a5
collector Other:
TO BE COMPLETED BY LABORATORY
_Sample Receiving,
Date:
DSampk,o 30homwd. - ❑. RUSH
Time: O
.. SAMPLE
Reeutm may be umelable
Temp:
48 Hour We%w Phone P.
Delivery Method: Gl
FarRemote LoWom Fax IP:
Comments:
••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••sant10ADEC: •••.....
•••••••••••••••
Bacteriological Water Analysis Record
MMO-MUG (PIA) RESULTS: MD FBK JUN
Matysle Began: /�L>�b6 /.yEXS Totai Cosbrm Dat&Twpe:
Anacyst: _ 'i�_ E cos:
Sent b Client
Analyecal Mallod:
�– Membrane Flher
El MMO-MUG (P/A)
MEMBRANE FILTER RESULTS: Phoned Q Faxed
Direct Carat YS'Cj4 Colorles/toomL Dewrlrne;
VvIlicadon: rv. ev spoke wAa:
._[ LTB: r
B
Satisfactory
,...
rre{ E
❑ Unsatisfactory
Reported By.
sxwase
/
Date/Tirne•Y/T�e //:
-
est 1Ni6iTNru ftcr
ea .o� 9.
%Nuwslnas0lVWltGmupDat,XPublcl =MENTIFORMSlapprovodtCdl Form 121703.tds Forma FW -0057 12/17103
01
SCS ReLN
1060595001
All Dates(firnes are Alaska Standard Time
Client Name
Garness Engineering Group, Ltd.
Printed Date/rime
02/1012006 14:21
Project Name/N
Granite View SD L12 BI I
Collected Date/Time
02/0612006 14:40
Client Sample ID
Granite View SD L12 DI1
Received Date/Time
02/0612006 14:55
Matrix
Drinking Water
Technical Director
Stephen C. Ede
PN'SID
0
Sample Remarks:
Allowable prep Analysis
parameter
Results PQL
Units Method Container ID
Limits Date Date lnit
Microbiology
Laboratory
Total Coliform
306. No Coli
colIl00mL SM209222B A
(�I) 02/06/06 DPT
200 W. POTTER DRIVE
ANCHORAGE, ALASKA 99518
SGS/CT&E ENVIRONMENTAL SERVICES Tet: 907-562.2343
sroog Fax 907-561-5301
Lab Ref No.
Drinking Water Analysis Report for Total Coliform Bacteria
1060595,&l A
READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE r
MUST BE COMPLETED BY WATER SUPPLIER liii itl� iiiiiii
PUBLIC WATER SYSTEM IDet
01PRNATEE,SYBTEM
SenO Y= SarM Invoke ❑ Send Rewhs [3 Send Yrvolce
r-S.
SAMPLE COLLECTION:
[r....LOJ L.17J •�,r,,,��
Date: VIAD
Tm .P .a
to tae By: E( Same as collector Other.
SAMPLE TYPE:
VRoutlne ❑ Treated Water
❑ Repeat Sample ❑ Untreated Water
(refer to lab no. 1
❑ Special Purpose
TO BE COMPLETED BY LABORATORY
Sample Receiving:
Date: ;)wml ❑Samdeo.ar30boundd: ❑ RUSH SAMPLE
_1, Rewlla may be unreliable .
Temp: FJ*AAb 0n&T— ❑ 43 Hour Waiver _ Phone N
Delivery Method: py�t�7 __ForR°mol° aero Fax#.
Received By. h7R� 1 HkA
Comments:
..............................................................................................................................................
Bacterfoloaical Water Analysis Record:
SerdbADEC:
MMO-MUGfP1A)RESULT3:
ANC FBK .NN
LL
Analyala Beean: Z/!C6 %��
Total Cdlform:
Oatemme:
Analyst:
I— Coli:
Sem b pant
l Analytical Method:
MEMBRANE FILTER RESULTS: -
Phoned Q Faxed
Olrect Count :3 &N' .//Col.A.ADDmL
Dat./Tim-
0--membrane Filter
Vert ``
r"don: I'M G
SooaewXn:
MMO-MUG (P/A)
wear. LTB:
BGS :-25—Satisfactory
❑ Unsatisfactory
ngC•Tserrrwtwr
Reported By: 1�....—�
Date/I % Imo+ a. •oe+..�rr
n..
Form N FW -0053 12/17/03
%%usesinasOlVWK GroupData%PubkM)=MENTfORMStapproved%COD Form 121703xk
Municipality of Anchorage CA •.,
• Development Services Department
Building Safety Division ,.
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel l.D. 014-302-27 HAA# C�Y._nA 1
1. GENERAL INFORMATION Expira{ion Date: -7--7— d
Complete legal description ORANfTE VIEW SUBOMSION, LOT 12. 'BLOCK 11
Location (site address or directions) 9050 GRANITE PLACE • ANCHORAGE. AK 99507
Current Property bVi6ii(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
JOEL 6ENNISON Day phone 301-6716
9050 GRANITE PLACE • ANCHORAGE. AK 99507
Day phone
CYNDIE PARTCH w/ PRUDENTIAL J.W. Day phone 440-7775
3201 'C' STREET + ANCHORAGE, AK 99503
Unless otherwise iequeVeid, HAA will be held by DSD for plckdi .
2. 'NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
—Individual Water Storage
Community Class Well
Public Water System
3
The Municipality of Anchorage Deveiopinent Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's
work.
TYPE OF WASTEWATER bl§POSAL:
Individual On-site
❑
Individual Holding'tank
❑
❑
Community On-site
❑
❑
Public Sewer
❑
The Municipality of Anchorage Deveiopinent Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
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 Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate
for the number of bedrooms and typo of structure indicated herein. I further verify that based on the
Information obtained from the Municipality ofAnchorage riles and from my investigation and inspection, the
onsite 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SURE 101 * ANCHORAGE, AK 99507
Engineers Printed Name JEFFREY A. CARNESS. P.E.
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identsable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal tight whatsoever.
5. DSD SIGNATURE
--1! Approved for :3 bedrooms.
Disapproved.
Date
Conditional approval for bedrooms, with the flowing stipulations:
Ci
WATERAND
PROGRAM
41
Attachments:
HAA Checklist _� Manitenance Agreements
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory Other
By: Original Certificate Date:
caw. t7Mq
Municipality of Anchorage e .
Development Services Department
Building Safety Division :.
On -Site water d wastewater Program
4700 South Sragaw St.
P.O. Box 196850 Anchorage, AK 09519.8650
www.cl.anchorageAk.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: GRANITE VIEW SUBDIVISION: LOT 12, BLOCK 11 Parcel ID: 014-302-27
A. WELL DATA
*TEST DATA PER S&S ENGINEERING.
Wall" em A3 If A, B. or C provide PWSID# N/A
Date completed 5/20/1981 Sanitary seal (YM) YES
Total depth 208 ft. Cased to 40 ft.
FROM WELL LOG
Data of test 5/20/1981
Static water level UNKNOWN ft,
Well production 12 —9 -13 -m -
WATER SAMPLE RESULTS:
Well Log (YIN) YES
Wires property protected (YIN) YES
Casing height (above ground) 12+ in.
AT INSPECTION
*4/7/2002
78 ft.
5.0 g.p.m.
Coliform 0
colonies/100 ml.
Nitrate 0.1 mg./L.
Other bacteria
0 colonies/100 ml.
Arsenic: N/A
mg./L.
Date of sample: 3/29/2004
Collected by:
GEG. LtD.
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Date installed 7/24/1981
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A
Date of pumping 11/03/2003 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA I -BELOW nsnNo cR B
Date Installed 9/15/1993 Soil rating .p.d. ft%bdnn) 0_6
Length 47 ft. Width 3.0 ft.
System type DEEP TRENCH
Gravel below pipe 8.0 ft.
Total depth 10.5 ft. Eff. absorption area 752 ft' Monitoring tube YES Depression over field NO
Date of adequacy test "4/7/2002 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 33 In. Water added 478 gal. New depth 48.5 in.
Elapsed Time: 60 min. Final fluid depth 46.5 In. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date –
**TEST DATA PER S&S ENGINEERING. DRAINFIELD DRY ON 3/29/2004
D. UFT STATION
Date installed
"Pump on* level at _in.
E. SEPARATION DISTANCES
Stze in.gallons
High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service One 25'+
On adjacent lots '83'
On adjacent lots 1 ow+
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 50+ Absorption field 5'
Water main 10'+ Water service line 10'+ Surface water 100'+
Wens on adjacent lots too'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line "1' Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 1001+ Driveway, parkingtvehicle storage 50'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
OWR #920057 •*WR
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspecilons and
review of Municipal records that the above systems are in "' •' •'
conformance with MOA HAA guidelines in effect on this date.
................
Engineer's Printed Name JEFFREY A GARNESS 79S'
Date 412/9A s^°OPres...wod
HAA Fee $ v Waiver Fee $
Data of Payment' Date of Payment
Receipt Number. , Receipt Number
(Ftw. 12101)
Municipality of Anchorage
•� -= Development Services bepdrtment
Building Safety Division
i Onsite Water and Wastewater Program '
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.d.anchorage.ak.Us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 014-302-27-000-94 HAA# Hfi 0Z01910
Expiration Dale: 8 l3 O Z
1. GENERAL INFORMATION
Complete legal description Lot 12; Block 11; Granite View Subdivision
Location (site address or directions) 9050 Granite Place Anchorage, AK 99507
Current Propertyowner(s) Susan Murray Dayphone 344-5735
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
Day phone
Unless otherwise requested, HAA will be held by DSD for pickup. %wZ / I�/i 7ld G
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
E
Individual On-site
❑
Individual Holding lank
❑
❑
Community On-site
❑
❑
Public Sewer
❑
The Municipality or Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
venter syslem. The Municipality of Anchorage Is not responsible for errors or omissions in the professional
engineer's work.
4. 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 Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of
bedrooms and type 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 c S S Eneinees#np Phone694-2979
Address 17034 N. Eagle River Loop Rd. Eagle River, AK 99577
Engineer's Printed Name Robert C. Cowan
Dale
`"••-�ENGINEEFj'S. p'1'r
S iNATURE Y ,� R. CE c COWANl
5. DSD i
I/ V. ��r '.� CE -8801
Approved for bedrooms. Atli �jF;:__
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments WATER AND j m7
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: ,Original Certificate Date:
�l
(Pw 12=1
Municipality of Anchorage •.
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 1116650 Anchorage, AK 99519-6650
www.ciAnchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 1-07- r A. /3 L-A c,< // &R Ali, r t %/it w Parcel ID: O 1 Y- 3 o]- a 7
A. WELL DATA
Well type M IV art if A, B, or C provide PWSID #
Date completed S -LVO/ Y/ Sanitary seal 6iN) Yt f
Total depth 2' 0 9ft. Cased to Y 0 ft.
FROM WELL LOG
Date of test s10 / v /
Static water level
Well production
WATER SAMPLE RESULTS:
u 1K ft
I 1
Well Log a) Yi J
Who properly protected ®/N) YE J
Casing height (above ground) I a''} In.
AT INSPECTION
y/7 /0 X
7'?
ft.
g.p.m. 5-•0 9—
p.m-
Coliform _Q_colonies/100 mi. Nitrate 0.;X mg.A. Other bacteria 0 coloniesl100 ml.
Date of sample: S / 0 2 Collected by: : t r ENGINFERING
B. SEPTIC/HOLDING TANK DATA 17034 River Loop RoW No.:891* River,
Alnita 99377
Tank Type/Material S L, r, r-/ S T G d u Date installed 7/ a Y T
Tank size 1000 gal. Number of Compartments 1
Foundation cleanout Q( J)YES Depression over tank (YA@ NO
Date of pumping '7/1-3/o/ Pum A -t po'" E
C. ABSORPTION FIELD DATA
Date installed 9 /1 )` / 4l Soil rating p.d. or ft /bdrm)0, (p
Length 10 ft. Width 3 1 ft.
Cleanouts&N) V f S
High water alarm (YO r 0
.f,6.1 v, I- f
System type -f'A t", H
Gravel below pipe T ft.
Total depth /0 #/)L ft. Eff. absorption area /TX IF Monitoring tube YLS Depression over field N o
Date of adequacy test 1 /0 a-- Results as Fail) PASS For 3 bedrooms
Fluid depth in absorption field before testa '9 `in. Water added){)$ gal. New depthb i `in.
Elapsed Time: Go min. Final fluid depth 3 ��i.Iin. Absorption rate >=
N 510 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N a N 4- K a p W,i If yes, give date —
D. LIFT STATION
Date installed
'Pump on" level at _ in.
E. SEPARATION DISTANCES
Size in gallons
'Pump off" level at _ in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot /00 +
Absorption field on lot 100 r+
Public sewer main N 1A
Sewer /septic service line Z S I+
Manhole/Access
level at
Meets alarm 6 circuit requirements?
f. 11
On adjacent lots 0 ,1wR
On adjacent lots /00 1.t
Public sewer manhole/cleanout ^r
Holding tank N / 4
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line _ Absorption field
S
Water main r'Q / + Water service line ) 0 t Surface water _)-Do
f
Wells on adjacent lots�-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
PropertS y line r (w R 93 00 )Bunding foundation 37 , Water main
Water Service line ) 0 t Surface water 100 ' Driveway, peddngivehicie storage SO t
nl 1A
Curtain drain Mr,N, K ra w,r Wells on adjacent lots / 0 0
F. COMMENTS
G. ENGINEER'S CERTIFICATION i';;•• """" ••. `;
I certify that I have determined through field Inspections and
review of Municipal records that the above systems are in , ..•~iGR7�
conformance with MOA HAA guldelines in effect on this date. �; E
!+ "MF COWAN .•%.
Engineer's Printed Name
41,64A7- - CJ ✓4�J ��
Date S� S �,:'
HAA Fee $ 3 IS. ' Waiver Fee $
Date of Payment S 0 Z Date of Payment
Receipt Number D 1 9 g a 3 Receipt Number
(Rev. 12/00)
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• - MUNICIPALITY OF ANCHORAGE
yJ DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # n ILI - �l] J -�-1 -!Y V♦ -�L�
1. GENERAL INFORMATION
HAA# VAA01SNnQ1
Complete legal description Lot 12; Stock 11; Granite View Subdivision
Location (site address or directions)
9050 G4anitell?tace
Anchohage, AK 99507
Property owner Anna Mae and David Crabb Day phone 344-4980
Mailing address 9050 Grtan.ite P.face Anchorage. AK 99507
Lending agency
Mailing address
Day phone
Agent Ronnie Lee/ POLAR REALTY Day phone 349-7681
Address - 1101 E. 76th Ave. Suite "BI101 E. Ave. "B" Ancho4age. AK 99518AK 99518
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
VM
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
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.
72-02SM".V91) Rwt MOA/21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat 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 nnfe, 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 invest!gation 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
Address »oaa rags, Wyse 1
Eagle River, Alaska
Engineers signature
6. DHHS SIGNATURE
_tz Approved for ZL bedrooms.
Disapproved.
Conditional approval for
a
Additional Comments
Phone
Date
bedrooms, with the following stipulations:
r
a
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lendi ng 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 professiona� engineers work.
n425Biw'.1A1) Beck MOA921
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: C` -CCS L�Or Iy Parcel I.D.
A. Well Data
Well type/✓P r� If A, B, or C, attach ADEC letter. ADEC water system number I
.
Log present (Y/N)
Date completed Driller aA1✓2//mac
Total depth zoo
�S,E�
� Cased to ZO�J r Casing height /Z"'�—
Sanitary sealV/J�N)
Wires property protected)
FROM WELL LOG AT INSPECTION
rn
A
Date of test
✓r�?O�R �Z�l�l3
n
rn
Static water level
/
u�L �CO
rn
N
v
t°
m
Well flow
72 m. �. 3
9.p. g.p.m.
1"r I
w
w
Pump levell
U lel—
LSEPARATION
SEPARATIONDISTANCES FROM WELL TO:
Z
Septic/holding tank on lot 1 OZ� ; On adjacent lots �3 /
Absorption field on lot
�!�O / ; On adjacent lots
Public sewer main
OC711 Public sewer manhole/cleanout ti1&IAr
Sewer service line
r
'L6 -(— Petroleum tank IJ V.
WATER SAMPLE RESULTS:
Coliform Nitrate /_ . Other bacteria d
Date of sample: g/�� �� Collected by:
B. SEPTIC/HOLDING TANK DATA
Date Installed �/7�g Tank size 11700 Compartments Z
Cleanout (ON) Foundation cleanout 19N) Depression (ye
High water alarm (Y /'I Alarm tested (YA). /'J
Date of pumping Pumper 444 /%% 91 ;J c
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Weil(s) on lot 1 OZ� On adjacent lots 1 O�I Foundation /
r +
To property line Absorption field 7i0 Water main/service line 10 /
Surface water/drainage 16V 14-
72-026 tysai• Fw, CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size in gallons
Vent (YM)
High water alar level
Meets MOA electrical i
SEPARATION DW Al
'Pump on' level at
FROM LIFT STATION TO:
D. ABSORPTION FIELD DATA
:ss (YM)
'Pump of * Level at
tested
On adjacent lots Surface water
Date Installed q 1151'I� Soil rating (GPD/Ft2) 0• & System type
Length 4q 1 Wiidth� , __�?) Gravel thickness 8 1 Total depth
Total absorption area Cleanout presen& Depression over field (Ye J
Date of adequacy test IJ, Results (pass/fail) for � Bedrooms
Water level in absorption field before test After test )J
Peroxide treatment (past 12 months)(Y& ti If yes, give date fJ
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
/ r
Well on lot 1 Zb1 On adjacent lots 1Zo Property line S
To building foundation _771— To existing or abandoned system on lot 16'4 -
On
b-I'On adjacent lots r" Cutbank 0 D til k ---Water main/service line 16'4-
Surface water I /7 n '4- Driveway, parking/vehicle storage area 0101
Curtain drain oil/ --
E.
(L
E. ENGINEER'S CERTIFICATION
I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date ofthis inspection.
t.
P fir. .• �+� IE.
Signature s .........
�'o-.. • ................. r4 S
Engineer's Name SECRL
1 034 E gle River Loop Road No. 2 Z q�3 �q �' No. l u7k • ; � o
Date c, re os u� / f .,
HAA Fee $ t%L , "co
Date of Payment J-27 g3
Receipt Number % cy �-X
72-026 (3W)' Back
Waiver Fee $
Date of Payment
Receipt Number,
f
S. LEGAL DESCRIPTION
G.n..E, RECEIVED
INSPECTION APPOINTMENTS
/6,w4 V1,r
TIME
TIME t.r
V
TIME
DATE
DATE
DATE
INSPECTOR
INSPECT
INSPECTO
MUNICIPALITY OF ANCHORAGE DEFT. OF HE,111i1 Z
OE►ARTMENT OF HEALTN A ENVIRONMENTAL PROTECT 12CNMENTAE FI.OTECTION
L S~• AnrhaIW�yF. Au E9601
,326
SEP 1 it:1981
(*Dl
ENVIRONMENTAL SANITATION DIVISION
Telephone264.4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Inaampleb reppwb will not be proeewa L Plewa allow ten (10) days for processing.
1. PROPERTY OWNER
f>a III J nnk Ake C t3
PHONE
I 2 y9 -.532S
MAILING ADDRESS
SPS7 a ewLY�- r %%542
PROPERTY RESIDENT fit different from above) /
905 -dr P/. Qi7c/! al.
PHONE
�J 7�e
❑ PUBLIC UTILITY
2. BUYER
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
MAILING ADDRESS
3. LENDING 114TITUTION / S>`
J� C1AM
PHONE
MAILING ADDRESS
d. REALTOR/AGENT
MAILING ADDRESS
S. LEGAL DESCRIPTION
Lt 1
/6,w4 V1,r
STREETLOCATION
S. TYPE OFF RESIDENCE
NUMBER F SFDROOW
❑ One ❑ Four ❑ Other
VRESINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
Three ❑ Six
7. WATER SUPPLY
INDIVIDUAL'
'ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
S. SEWAGE DISPOSAL SYSTEM
lilt INDIVIDUAL/ON-SITE"
Al YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72010 (Ray. 6/79)
��10 ✓
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
C ✓SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE &--THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
U INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
d496IVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
8eepticTank or E-3 Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER C,
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELLTO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
0 APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE yy, /A
—�O �v 1
rom
72010 (ReY. 6/79)