HomeMy WebLinkAboutTANAINA HILLS LT 6Tanaina Hill
Lot 6
#011-051-07
) Municipality of Anchorage
Development Services Department ."-"'-~
~,-'- = ..-' .o
Building SafetY Division ~=~- ' --
On-Site Water & Wastewater Program, 4700 South Bragaw St. =~
P.O. Box 196650 Anchorage, AK 99519-6650 ~
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number:. SW050005 PID Number:. 011-051-07
Name:
KENNETH & GRACE JOHNSON Wastewater System: [] New [] Upgrade
Address:
6154 TANAINA DRIVE ANCH. AK, 99502 ABSORPTION FIELD
No. of Bedrooms: Trench O Shallow Trench 0 0
Ph°ne:(,907)' ' 245-5587 5 ODeep Sad Mound./ he~
LEGAL DESCRIPTION ~ .~, .04, ~..~.j~o,
- 6 TANAINA HILLS n.~ n.
Township: Range: Section: rill eddad abo~e o~19~n~l grade: ~\~,,,,~' ~,mvel Imgth:
WELL: [] New [] Upgrade
n. DENALI
~. ,~ ~ TANK
SEPARATION DISTANCES ,s.ptia .Holding rlS.T.E.P., r'lOther
TFmm~"~ Septic Abs~er~d~on Uft Holding Pubnc/Pn've~. I~euf.atumn C~peclt~ in g~uon~:
Tank Stc3tlon Tank S.-., U~ ANCHORAGE TANK 1000
Well 100'+ *97.3 - - 25'+ STEEL 2
Surfak. Water' ~00'+ ~00'+ - - - LIFT STATION
Lot Line 5'+ 10'+ -- -- -- $I*'~:Ir~umP ~''~r
Foundation .5'+ 10'+ - - -
Curtain Drain NONE KNOWN I'.m~_~.~..~,~,: I[~'u',~, I~p,cuo~ I~,,ornn~ ~
I
~e~o~: BENCH MARK
*ID(IST1NG DRAINFIELD INSTALLED TOO CLOSECORNER OF DECK @ NW CORNER OF HOUSE
3'0 WELL BY KEN JOHNSON IN 8/24/77. WE
REQUEST 97' WAIVER TO WELL FROM DRNNF1ELDIA''"''~ ~'~ 100~00
..ou sE, c U O.
....... ,,.......... .... .... .,
Development ~~p.a.r~ent. ApproYal . . /O~,.~"..t, E-~?~S3 ....Y.~o?.~
R(Jviewed and approved by: Dote: ¢7 ~,~.o~s~_~o~<~.~<~,=
SW030005 O11-051-07
FCO 17.8 10.8
~1 60.97 72.73
__ 812 67.0 78.97 ................... M ~ -
DBL1 68.9 81.42
DB~ 68.79 81.9
..... Mi1 46.86 63.73 --
~12 102.88 118.52
DA~: ·
......................... D~WN
~S~ ~TER & 5~STE~TER ~: zJ.o.
KENNETH & GRACE JOHNSON (907) 243-5587 2 OF 3 j ;~i'"
AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
PERMIT NUMBER: AS BUILT D RAWIN G PARCEL ID NUMBER:
SW050005 ~ 011-051-07
--FINAL GRADE m 93.0_.,5+
TOP Otc. TANK AT INLL"T~ '--' / w ~~'"-TOP OF TANK AT OUTLET ,- 89.0'~
E
INVERT OF BUNG AT INLET - 88.4,B-~ ~,,-----INVERT OF' BUNG AT OUT!,.L-r ,- 88.34
ALASI~ WATER & WASTEWATER ~.s.G. ~ .'" ~
KENNETH &: GRACE JOHNSON (907) 243-5587 3 OF' 3 v{)/), ~....,~/ ,f; 'Y ,'. ~'..." ~,~
PROFILE DRAWING OF SEPTIC SYSTEM UPGRADE
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: Jan 07, 2003
Expiration Date: Jan 07, 2004
Permit Number: SW030005
[l~egaI.DeScript~0n: .TANAINA. HILLS LTi6
Design Engineer: 0041 AK Water & Wastewater Consultan'
Owner Name: Kenneth & Grace Johnson
Owner Address: 6134 TANAINA DRIVE
ANCHORAGE, AK 99502-1833
Parcel ID: 011-051-07
Site Address:
Lot Size: 48556 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
~ Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail 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:
Date:
Municipality of Anchorage
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.ak.us
(907) 343-7904
Parcel I.D.
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
011-051-07
Permit Number
Property owner(s)
Mailing address (1)
Mailing address (2)
KENNETH & GRACE JOHNSON
§134 TAINAINA DR,
Day phone 245-5587
Zip Code 99502
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size ..L,,.1--~ ~'~<',~'-5'(,~, Acres
TANAINA HILLS S/ID; LOT 6;
N/^
Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only [] Well Only []
Sewer and Well [] Water Storage []
Sewer Upgrade ·
THIS PROPERTY CONTAINS:
Hot Tub [] Jacuzzi []
Swimming Pool [] Water Softening Unit []
Therapy Pool []
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.
ALASKA WATER & WASTEWATER CONSULTANTSr INC.
Permit Fees: ' Waiver Fees;
Date of Payment: O I- 0~/~-0.~ Date of Payment:
Receipt Number':~ Receipt Number:
ALASIO WATER & WASTEWATER
CONSULTANTS, INC.
&
Janum7~ 200:3
Municipality of Anchorage
Development Service Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragraw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
Reft Septic Tank Upgrade for Lot 6, Tanaina llills S/D;
To whom it may concern:
The existing 3 bedroom house is currently served by an on-site septic system that consists ora septic tank
and a trench type drainfield. The septic tank has collapsed and needs to be upgraded as soon as possible
The inspection report retrieved from the city's archives doesn't contain information regarding the
collapsed septic tanks capacity. Based Ijpon the as-built received from Shane Holt Surveying it appears
that the drainfield may encroach upon the 100 well radius setback. Rather than delaying installation of the
new septic tank while awaiting a waiver for the well to the absorption field we are requesting a permit be
issued to install a new septic tank, without issuing a waiver requirement for the drainfield. We intend to
assess the distance of separation while performing inspections on the new septic tank. We will use a Total
Station to take an accurate measurement from the cleanout to the well, and if needed at that point we will
apply for a waiver.
We propose to excavate, pump, crush, and abandon the existing septic tank by burying it on-site, and
replacing it with a new 1000-gallon septic tank. A foundation cleanout and a line cleanout must be
installed along the line before the tank. Double cleanouts will be installed after the new tank. We request
that you issue an expedited permit due to the health hazard.
ra~eskV.E.,~.S.
Prefk ~
NOTE: Attached is a site plan drmving, a design drmving,, and a 5 page construction
specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
TANNNA HILLS S/D; ~ i LOT 25 /J /'
LOT 4 . J.~'/'//' '\.~'\.
' ,-- ,- -'~-~//
\\ '
~' \ ,~,~.A .IL,S s,o:"'~'.'
\ LOT ~ -'
\ \
i TANA~NA_ _HLLLS S/D; ~ \\~\',
!
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, ,' . ~ ,. _~ ,
\~' // \~ I ~ ~ ~ II
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/ ',. %'.:.~ ,",..
// T~ HIL~ S/D;
~ ~ LOT 7
UPG~E (SEE PAGE 2 0F 3) ~ ----~ .
LOT 6
DATE:
~ ~/~/o~ ~ OF
O~WN ~: ~'~X ..-
~S~ ~TER & ~STEWATER ..s.o. z3~
.... ~ONSULTANT$. IN~. ~ ~ ~ ..~ .............
KENNETH · GRACE JOHNSON (907) 245-5587 1 OF 5 '~ '.J~r(
TANAINA HILLS S/D; LOT 6;
100' SCALE SITE P~N
INST~ FOUNDATION ' / /
~ .~...., ~F~ ~
~SI~ ~VATER & ~VASTE~VATER ,~,,:
KENNETH A GRACE JOHNSON (907) 243-5587 2 OF 3 ~ ~ ef re~ A~s~.: ~
.[~ D[SCRIPBON:
40' SCALE SITE P~N '~%%~
Municipality !f Anchorage
Development Services Department
, Buildi~gSltyDivisi0n
On.Site W~er~d,., ~wat,,~ Program
P.O. Box 1966S0 Anchorage, AK
www.¢i.an~horage.ak, us
(907) ~3-7904
Waiver Review Worksheet
WR#: WR03000'/ PLO#: 0tt-05t-07
Date Received: 1(31103
Legal Description: T~naina Hills Lot 6
Engineer. ~leffre¥ A. Gar~os$. PE
HA~.
Alaska Water & Wastewater Consultants. Inc.
Applicant: Kenneth & Grace John$o~1
Waiver Requested: 95 feet from W~ll t~o drainfleld
Criteria: Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Permit~: $W030005
Points:
Waiver is Granted: ~' Waiver is not Granted:
List Conditions or Reasons for above:
Name of Reviewer
Cc°rOe r. u;,era,,Building S,-ffe~' Dn~is,on
Mayor 2002
2/12/2003
Jeffrey A. Gamess, PE
Alaska water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B
Anchorage, Alaska 99504.
Subject:
Waiver Request for Tanainal Hills Subdivision Lot 6
Waiver Request #WR030007
Parcel ID #011-051-07
Construction Permit Number SW030005
Dear Mr. Garness:
Your request for a waiver of the required 100 feet horizontal separation from the
absorption field to private well has been approved. The approved separation distance is
95.0 feet.
This waiver approval applies to the existing absorption field'to private well separation
only. Any future upgrade to the on-site waste~Vater disposal system will require all
separation distances be met or another approval from this department.
If'there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
G"',,
Daniel J. Roth
Civil Engineer
On-Site Water & Wastewater Program
P.O. Box 196650 · Ancho,'agc, Alaska 99519-6650 ·Tclcphonc: (907) 3~,3-8301 * F~x: (907) 343-8200
4700 South lh'agaw Street * Anchorage, Alaska 99507
hltl)://xxax~v.ci.nnchoragc.nlc.us
~ ut3p. I. ~r 6
~OIL- $OR~TION
~. ~. 6'o~ $. C.. le. o.
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I~ l~l~O III'filL
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"'"' ""'~~"""" CONSULTANTS, INC. ~'~"~""~"~"~"'~'~'~'~'"~"'~"~J'~'~
January 24, 2003
Municipality of Anchorage
Development Service Department
Building Safety Division
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Waiver Request for Tanaina Hills Subdivision; Lot 6
The existing 3 bedroom house is served by a private well and septic system. We identified the
deficiency during our site evaluation on the subject property:
Well to drainfield is 97.3 feet.
We request your department grant the following waiver:
· Well to drainfield: 95 feet.
The well that serves the subject property was drilled on November 2, 1965, and the septic system
was installed on August 24, 1977
Justification for the waivers:
· The lot is sloping down from the well to the septic. The existing house is in between the well
and the septic system. If the septic system were to overflow, the effluent would not travel
towards the well head. In short, the only path of contamination would be subsurface
migration of the effluent.
· Attached are copies of well logs from surrounding properties: The aquifer is over 200 feet
deep and confined beneath various strata/mixtures of silt, sand, & clay.
· Recent water samples from the encroached well indicate Nitrate levels of 0.2 mg/L and 1 OB.
In short, it appears that there has been no significant impact on the aquifer because of this
encroachment.
· The encroachments have existed for over 25 years with no adverse impact.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
Based upon the aforementioned facts, it appears that there is minimal risk associated with
granting the reque~;t~ waiver. If you have any questions, please contact us at 337-6179. Thank
you for your . . t .
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akxvwc.com
Certified Well
_
Size
· o! Format,on ,,. ,.~. ,.... ,..' from . to
Description ' "'" '" : ' '.
Tan-brown 'silt}'. sand[ -., ,.',-..-,., ...' '.:' O 76
'." " san/l,y, sS,It .' .......... ', " 78 · · 87
Gravelly rill
Brown ~ilti 'san
Ora¥oll,y till ~-.-'-'- '""...'; "..".- .... -. ' 136 169
;.le't ~llt,~' nan~ '" '* "
.' ,,. :..';:':~'r'..;'. 169 1~o
l~in~ ~ heavinR cla~-k;, l~rowri?~'-6~hcl.' ..... 190 ~0~.~',
',, '. ,,. '.,,' '".:,,
: ." ~' ".". "'"'~ :- ' I
.:.. ,'- ' I certify th~ above true ahd correct. ·
· ...'
", r'7'7'."':':'".- : .......... B'~iY/~'FT" ............................
..'".i..... ,.DOTTEN DRILLING CO.
]ohn's Road · '
SPENARD. ALASKA
We advise you to attach rids certificate to ~,our deed.
a~t~--- CT&E Environmental Se~lces Inc,
CT&E Ret#
Client Name
Project Name/It
Client Sample ID
Matrix
1030275001
AK Water & Wastcwatcr Consultants Inc.
Tanaina Hills
Tanaina Hills
D ri.-.ldn§ Water
Sample Remarks:
All Dates/Times are Alaska Standard Time
Printed DateffTime 01116/2003 10:51
Collected Daterfime 01113/2003 14:40
Received Daterrlme 01/13/2003 15:00
Technical Director ~. Stephen C.~ ][de
Allowable Prep Analysis
parameter Result~ PQL Unlu Method Limits Date Date Init
Wa~ers Department
Ni~ratc-N
M:l. crob4 ology Laborat;ory
Total Coliform
0.200 U 0.200 ms, q., EPA 300.0 (<=I0) 01113103
I OD, NoColi col/100mL SMIg9222B (<al'} 01113/03
JS
KAP
MUNICIPALITY OF ANCIIORAGE
}lea ~ and Environmental Proter on
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
,5 E P'I- I C TANK:
FROM WELl. ~'~ MArqUi AC: [tm[ ~
DISFAN(:[ [ ROM WELL /~O /..FOUN[)AIION ~E2 / y''Nt A[q %/ I01 tIN{ ~ [ .oFIOI'AI-.IFELErqGI'[I~/
SEEPAGE PiT:
Well
Class: ........... Depth: ...........
Well Distance To: Lot Line
Bldg: Sewer Line:
~ of Bedrooms:
Installer:
Log Crib Rings (;rib Size: DIAMi_.'rLf] .. [)1PIH ....... DISTANCE FROM: WELL
lOT,at_ FFI FCTIVE
BUll {DING FOLJNDA-I'ION NEAREST LOT N~'
I...I]l.::Fl'7' :[ ON
I J~EGFIL
DEF'RI~::TMENT ~' HISFIL. TH FIND ISI',IV I ROI'.~I'dENTRL ':]TEC]' I ON
82.5 '", ::7'I"REET., I:~NCHOR~I.:~IS, RK. 9S x:l..
I< E N ...r .. I -IN --: L t a
TFINR I NFl
I./F. e, TRN~INR HILl_z, ._,,~D
61Z~4 "I'Ri'.~R I t.,IFI I)F~'..
MFI>':::[MI..tM NI,3i'IL, EF:. I::lF' E, EDf,.u...hl:, =
SC:H. ,q'l:::lTIl"J:i "':: F], E.F ..... 2?Pi
'[HE REI]:!UIF. fE:[) ..].,:':E I::IF :"HE: ::,t [I HE, z,-RF I I .N ..,r'_,]EII ''-:
THE L..ENEiTH DIMENSION 7:'.5 THE L.ENGTH <IN FEET) OF 'THE TRENCH OR DRR:[NF:[I.B..[:,.
THE DEPTFI OF 8 TRENCH OR P]:T IS; TNE DISTBNC:IS 8ETI.qEEN TNE SI.JRFFICE OF TFIE
GRI.]UNI} FIND THIS B[]fTTOH OF THIS E)-,',C~',/FITION (iN F'EET).
]'HERE IS; NO SET W:[[:,TH FOR TRENCHE:5.
'I'HE I.]RFI'~,'EL [:'EPTN :[:5 TNE MINIMLIH [:'E:PTI4 OF i3RRVEL. BETWEEN ]"I-IE CIU'TF:FII_I... F':[PE
FiND 'I"HE [F}[:ll"t"Ol'"t OF TFIE E~:',CRVRI'FION (:IN FEE]').
........................... F" FII ~::: ~-( Ffl K:-~ F:: F' L, IFil I'-,I T'
FI PFII:::I,:::FII:i[: PI.,Fli',([ MFIV ~E ]:NSTFILI.E[:, FYI' '['HE: F'ERH:[T]'I~:E'":; OI::'TION SI,.IE:JIEI.i:T TO THE
F'O Ll..l.::mb.I :[ NCi I,::OND I "1" :[ CINS:
:t.. EE:I:I"HER FI CLFIS~:; I OR II NSF FIPPROVEI,) PL. FINT MFI'T' BE: IN:STFE.I...EI).
P':. FI CONT:[NUOI..I!5 HFIIi'.,ITENFINC:E FlqiREEMENT :[S, REQI. 7:[I:;!ED. ]:F: Fi I',iFIINTIF]'.aFINCI~':
FtGREEMEi'.,IT :[:~; NI,]T KEPT CIJRREi'.,IT '~'OIJ Ml,:l"r' BE F?.Eg!I...I:[RED TO Ei",IL. FIR(31S THE ~SO:[I...
FISSOI~IF'T :[ ON S'~'S'TEH FIND/OR VOU I'"lFl"r' 8E SI...18JECT ]'O
6H..I.,F [IJ [Nbl I.]F FIN'?' .:,W.:'[EII P.I:[q'HOI..r'I" FINRL INSF'EC:TICIN Fti'.,II::, HI, FF._. ~ -IL.. THIS
DEPFII,TI,'MEI',I]' P.IIL.L BE .:,I.J:[S'..rE_. I TCi [ ~.C....E...L.I[ I ..N.
MINIMUN [)It~TRNE:E BETI.qEEN R HEI_.I.. RND RNV ON-SII'E :SEi].,.IRI,!iIS: DISPOSRL :5'?.'S"I'EH
FEET F'ORR F'RI"/FITE HELL OR ;;3Cll;~ll FEI+'71.' FOR R PUBI_IC I,.IEI..I ....
I,)TFIER RE[;:!I..I:[,q~EHI~:NTS MFIV FIPF'I_%". SPEC :[ F I CFI]' :[ ONS FIND CON:E;]"I:'.IJC:TION DIFIGRFIME!; FIRE
FIVFI:[LFIBLE ]'O :[NSI.JRE: F'F..'OPEI,;'. :[N:~';]'FII..,LFIT:[ON.
:[ I:::EI:.~:TIF:'V THFIT
t: :[ RM FRHIL:[I::IR I.qlTH THE REC:.!LIIREMENTS FOR OIq-SI'I'E :SIF.:I*IERS Ri'.Jb !,.IEL.I_.$ RE; SET
FI]R"H-t 8~.' THE MUi'.~ICIPFII_ITV OF FII'.,ICHOI,;!FIGE.
2.: I HII..L. :[NS]"RI,..L THE ..'E.".','~'S';TEi','I :Ii'.,! I::ICI,::ORDRNCE I,.I~]"FI THIE: I.::ODES.
~:: I IJNDERSTFIN[:, THFIT THIS: ON-S;ITE SEI.,.IER !S'~'.S;TE:M r,IFIV REQUIRE Ei'.,ILf.aF,'I,3EMENT IF THE
F:'.I!::i~;:[I::,E:t'.,ICE :[5; F..'EMOI,)EI..ED TI,:) INCI..UDE MI]RE ]"FIFIN 2';
Performed
Leoal
This
"0.~ te~ t~ worth a ~housand npi.ion~"
2204 Cleveland Anchorage, Alaska 99503
For }fen Johnson Date Perf0rmed__7~f77
qescriotion: Lot 6 Block Subdivision Tanaina Hills
form Renorts Soils Loc~ yes Percolation Test_~?s
nel~th
Feet Soil Characteristics
2 --
Brown Silty.Sand/Sandy Silt
Perc 8---
zone
12--
BoLtom of Test Hole
16--
18--
20----
!i
Was Ground
I~ Yes, At
Water Encountered? No ~?o^
what Denth?
Date Gross Time Net Time Depth to H20 Net Dro~
J nches J nches
_TJ~!3J 77 ...... _9_..'_3_Q _ ] .......................................
· 9: 50 10 min. 3-~.4
z o: 2 o .... !~_m_ iR~ ......... 4~ ............~.4 ....
Percolation Rate
Prnposed Instal ation: SeeDame Pit Drain Field
Den. th of Inlet Depth To Bottom Of Pit Or Trench
CnU~ENTS: 275 :_S_q__F~t d:rainaqe r__e_quired ]2el_b~e~d3zo_9_m__from
Test P er for in ed By ~_~_.,~i{-_-~]---T~i..- ' Data Certified ~CONSTRUCTION TEST LA]
-- 'U~U-Y~J~h-1 ................ Date: 7/13/77
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(FilI out in Tr%p.l_icate,)
1. Name of person rsquestzng app
O L
~ ~u~be~ o¢ beapooas
Watem Analysis:
a. Bacterzal ~//, ~
· ,
~e~ da~a~
a. Type~ ~ ..... ·
b. Depth__ ~~.
c. Casing Size (
d. Distance f~om well to closest existing o~ p~oposed:
1. SeweP line~~
Septic tank
3, Seepage A~ea
5. P~ope~ty Line
6. Othem soupces of posszbl? contam2nat~on~ ~.e.~ cmeek ~ ].akes~
houses, ba~n, d~ainage dztch, etc.
Sewage disposal system.
a. Age of system ~/C b~ .
c ,, ,~ ~ -iJ 5~'~-~'1 ./
c. Name of septic tank manufactu~.~~~
1. If "home made" show diagram on reverse side of this fopm.
,
d. Disposal field o~ seepage pit size and
1. Distance to ppopa~ty line o house foundat o
e, Percolation Test ~esults
n. s form ro snow dlagmam, D.].agram should include
the following JnfoPmatlon: p~opeYty llnes'~.well looatlon, house locat~on~
septic tan]< location~ disposal area location
and dlrectiou of ground slope.
9. The infommation on x~s~orm ~ ~d ~mrect to the best of my knowledge.
vo~gn~ or l%pplzcant 6~ned
TO BE FI.~i~ED OUT BY HEALTH DF3ARTqENT PERSONNEl,
ho above lesc~3.bed sanzta~y facilities amc hereby approved~ ub]ect to the
..
The above escrn.bed anztaPy aczl~tles are disapproved for the following
d ' s ' f' · '
reasons |
Date .'::" . !."~' r.~ ,~i .....
pp 1 .ls valid fop one year following the date of appmoval.
CPJ: ow