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HomeMy WebLinkAboutPTARMIGAN VIEW ESTATES LT 6Ptarmigan View Estates Lot 6 015-271-44 Not eligible for Certificate of Health Authority Approval because of need to apply for a waiver. Municipality ofAYlehorage d 1'.q. MX lfx;ra) Awhom , Ahlsku fMa�IfF6(Gi0 • � 1•reTelephone (J07) 34.9fCN)1 • 1'ac (fM)7) 37$.KNNi 47M limgaw Slreel z AMlomge, Alaska fM6507 s • <. Mayor DJark I]egicl, wIMMIml.org I1 illding Safety DIt9sion April 21, 2005 Cindy Ellis Watkins Engineering P.O. Box 110443 Anchorage, Alaska 99511 Subject: Waivcr Request for Ptarmigan View Estates Lot 8 Waiver Request #WR 050020 Parcel ID # 015-271-44 IIAA 050148 Dear Cindy Ellis: 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 90.0 feet. This waiver of 90.0 feet is for the horizontal separation from well on lot 6 to the absorbtion field on lot 8 This waiver approval applies to the existing absorption field to private well separation only. Any future upgrade to the on-site wastewater 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, Or Goodall Civil Engineer On -Site Water & Wastewater Program Comnltill ity, Security, Prosperity Municipality of Anchorage Development Services Department •• Building Safety Division On -Site Water and Wastewater Program ` 4700 Bragaw Street 5.1 1 r P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#: 050020 PID#: 015-271-44 HA/Permit# 11AA 050148 Date Received: April 21, 2005 Legal Description: Ptarmigan View Estates Lot 8 Engineer. Cindy Ellis Watkins Engineering P.O. Box 110443 Anchorage, Alaska 99511 Applicant: Charles Zimmerman Waiver Requested: 90.0 feet horizontal separation from well on lot 8 to the absorbtion field on lot 8 Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability fmo ?.*p D. Water Table Gradient y SSD E. Horizontal Separation Z. Total: 20.5 3 ........................................................................ Waiver Is Granted: Waiver Is not Granted: List Conditions or Reasons for above: Date:�By: ............ Name of Reviewer ............................................................. Rec#: Amount: $ Date Paid:9 No 77 ; P77A(7 M 116014 V"F'j E$lnt<£s L-oT 6 NfE�5) TO PA -7 >`oi 74403 WAIVES Dur— TO L -or(" wEtr` o^/S7rtVe-7ED AFTER LOT 8 iftoaeraA/F/FvO. State of Alaska: Separation Distance Waiver Guidelines for S.C.R.O. (State of Alaska Memorandum to District Office Engineers dated January 3, 1985) Waiver Request for. Ptarmigan View Estates Lot 8 Parcel I D#: 015-27144 Waiver Request Number. 050020 Waiver Requested: 90.0 feet horizontal separation from well on lot 6 to the absorbtion field on lot 8 IIAA 050148 Septic Field Data The absorbtion field on lot 8 was installed before the installtion of the well on lot 6. Because of this the waiver fee will be applied toward lot 6. The depth of the leach field is approximately to feet. The tank and the absorbtion field were installed May 27°, 1981. The well on lot 8 also encroaches this septic system on lot 8. this encroachment has been in existence since 1981 ans has a waiver for this encroachment. The well on lot 8 is alos down gradient to from the septic system. Lot 8 well was tested on a previous IIAA and had low nitrates. Well Data Lot 6 well: Well data in the area show low nitrates and the well on lot 6 showed low nitrates on a previous IIAA. Cindy Ellis determined that either the sample was bad or the nitrates came from animals on lot 6. Cindy Ellis determined that the nitrates are not from th septic system on Lot 8 State of Alaska: Separation Distance Waiver Guidelines for S.C.R.O. (State of Alaska Memorandum to District Office Engineers dated January 5,1985) Waiver Request for. Ptarmigan View Estates Lot 8 _ Parcel ID#: 015-27144 Waiver Request Number. 050020 �— q Waiver Requested: 90.0 feet horizontal separation from well on lot 6 to the absorbtion field on lot 8 11AA 050148 Water Table Depth of well: 203 Depth of septic system: 10 193 Distance from the bottomPoint Point Value Clean Gravel of the system to the highest Value 1 water table in feet 1.5 Sand w/ Small Amt of Clay 0 0 8 1 17 2 24 3 30 4 40 5 85 6 100 7 290 8 1000 9 10 ' Straight line Interpolation Is permitted between any two values Soil Sorbtion Soil Type I Point Value Clean Gravel 0 Fractured Rock 1 Course Clean Sand 1.5 Sand w/ Small Amt of Clay 2.5 Silt 3.5 Clay and Sand Equal 4.5 Clay 6 Points no 7.49 Points 3.94 (193,1 +(193,1.5 + r 93 6 +C 12 1 34.5 + l 93)3.5 +I 193) 0 + f 193) + C193) 0 + 0.4 + 2.8 + 0.3 0.4 + 0 + 0 + 0 'Use the predominant soil type but values can be averaged for a mixture Permeability 0.3 Separation -20% 0.7 slopes toward well -10% 1.2 25 -5% Points 1 0% 2.9 } flat 5% 2.00 5 Soil T e Point Value f 7 .9 + 55 .4 +( 90 3 +r 12 3 Clay(will channel) 0 l 193) 193, F1-9 3) L. 193, Silt and Sandy Clay 2 Clayey + 22 1 2 +( 1 + 1 + 1 Fine Sand 15 ( 93 J 193, 193, f 10 Sandy Gravel 1 Fractured Rock 0.9 0.03 + 0.11 + 1.40 + 0.19 Course Sand (30 grit) 0.4 0.23 + 0.04 + 0.00 + 0.00 Clean Gravel 0 'Use the predominant soil type but values can be averaged for a mixture Gradient Points p„ 4.5 4.50 % Slope I Points Value -30% 0.3 Separation -20% 0.7 slopes toward well -10% 1.2 25 -5% 2 1 0% 2.9 } flat 5% 4.5 5 10% 6 slopes away from well 60% 7 'If the gradient is unknown, assume the worst case Horizontal Points 90 2.6 Horizontal Point Separation Value in Feet 0 0 25 0.7 50 1 75 2 100 3 150 5 200 6 300 7 •Linear interpolation between two point value is acceptable. Horizontally means straight line distance to the well not the contaminate travel distance to water table which may be greater. Conclusion: Grant Waiver Total Points: 20.530; IR x tli y ♦ t �7.144� �Lp/.'� 141 {�� �`J'fOP•y.F�T7 II���.�. `aL ..� Sit_ f 14. ••(:�L.. - '"•yti Neu J.J '^ JF lytiV Y .Y{n lrL Lam.,. YI Yy 4.� rQ f "<sa �'�1t •S'M�rr�i ♦A }_ w.lj/y �x w ..T. �.. _ ^� +♦'��v __I•' 'h g/�. i / a-PAr"�'1 - L"'IVA i .. ' trn1�. 1 a. r ti rt y�Jx `'�`r'�/ �j,�t3/',� lI ren•. {i jr .. _- Y•L'L"WW/� 1, �, � , J~r,v.(r _»1.l. �l .-� 7 w •'A-y�,.��(.�..rwr .. Z � ��a 'f' 1��y�''S rJ" f ,t� L `,1. )•y�J �'�A ..,�M� , al.�. �r� i.lj �P '{ 11 ' � r 'rs r ,f r �� y 'F'i ♦I �� r.G. ^t . f �r ✓'+ _ J.' r , r}� l_IJ 1��✓Ift/ �1e �b�. ..i��% '�..r .nt rt. LCA 'r'.� C 7 ter •J, i �;:t-L91F.r J ;-., .\ . .. ��''k�`� �i �. L�� �I ,..fr tib. Watkins Engineering, Inc. P.0 Box 110443, Anchorage, AK 99511 (907)349-1851 fax 349-1934 April 22, 2005 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Attention: Joe Goodall RE: Ptarmigan View Estates, Lot 8 Waiver Request— Nitrates Information Dear Joe, I requested a waiver for the distance from the subject lot's septic drainfield to the well on Ptarmigan View Estates Lot 6, to a distance of 90 ft. In conjunction with that waiver request, I sampled the water from Lot 6 and had it ana!yzed for bacteria and nitrates. The analysis yielded 1 colony oother bacteria' and 7.65 mg/l nitrates on April 6, 2005. Although the nitrates are less than the allowable limit of 10 mgn, the level is higher than other wells in the area. Therefore, you asked for further information regarding a potential source of the nitrates. I surveyed the area on April 21, 2005, and found that the distance between the septic tank cleanout on Lot 6 and the center of the well on Lot 6 is 75.67 ft, when measured with a total station. This could potentially be the source of the nitrates in the well. do not believe that the source of the nitrates in the well are from the drainfield on Lot 8, due to the fact that the drainfield is 13 ft downhill from the well, and the well is 203 ft deep with impermeable layers between the aquifer and the surface. The house on Lot 8 has been sold, and an application has been made for a Health Authority Approval. The well on Lot 6 was drilled after the septic system was installed on Lot 8, and I do not believe that the sale of the property should be delayed due to the encroachment. If you need further information, please call me Yours truly, G MI'el va`�y Cindy Vt. Ellis, P.E. President Watkins Engineering, Inc. P.0 Box 110443, Anchorage, AK 99511 (907)349-1851 cwellis@gcl.net April 18, 2005 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: Ptarmigan View Estates, Lot 8 Waiver Request for Absorption System to Lot 6 Well To Whom It May Concern: We respectfully request a waiver for the distance from the soil absorption system on the subject lot to the private well on the adjacent Ptarmigan View Estates, Lot 6, to 90 ft. The soil absorption system for Lot 8 was installed and approved on May 27, 1981. The well for Lot 6 was drilled and completed on September 19, 1981. Therefore, the owner of Lot 8 is not responsible for the waiver fee. I believe that the reduced distance from the well to the soil absorption system will not lead to contamination of the well or the aquifer for the following reasons: 1) Satisfactory water analysis from the subject well, 2) Well depth of 203 ft provides substantial vertical separation, 3) Soil strata between the aquifer and the surface provide an adequate barrier, and 4) Difference in elevation, with the well 13 ft or more higher than the ground level at the trench. _ The water analysis on the Lot 6 well from a sample on 4/7/05 reported 7.65 mg/l nitrate, 0 coliform, and 1 colony/100 ml other bacteria. The lab report is attached. The Lot 6 well log is attached, showing clay and silt from 72 ft to 196 ft which provides a barrier to vertical migration of septic effluent. The well has a total depth of 203 ft. When drilled, the static water level was 68 ft in the bottom of the well, or 135 ft from the top of the casing. The current static water level on Lot 8 is 120 ft. Watkins Engineering, Inc., April f8, 2005 Ptarmigan Yew Est Lot 8 Waiver Request, page 2 of 2 The topography of the area prevents migration of fluids from the soil absorption system toward the well. Relative elevations are shown on the attached site plan. There is a difference of 13 ft or more between ground level at Lot 6 well and Lot 8 soil absorption system. Based upon these facts, I believe that the potential for contamination of the subject well and the aquifer is minimal. Therefore, I request that the required distance from the well to the soil absorption system be waived to the existing 90 ft. Thank you for consideration of this request. If you need any further information, please call me at 349-1851. Sincerely, �4 Cindy W?nis,P.E. President 04-11-05 03:11Pi1 FPOLKTdE ESI, SCS ENV SERVICES —Sill lam' V SCS ReLd 1051735001 ClicatName Watkins Engineering project Name/N Ptarrnkmn View Fat Lot 8 Ccent Sample 10 Plannlgan View Est Lot 8 Matris Drinking Water Sampte Remarks: 9075615301 T-407 P.02/04 F-322 All Date✓limes are Alatka Standard Time printed Datc/Fime 04/08/2005 14:07 Collected DatelPime 04/114/2005 14:45 Received Datc/I'imt 04/04.2005 17:06 Technical Director Stephen C. Ede Allowable Prep Analysis Prumncwr Results PQL Units M thud Container ID Limits Date Date Init Watera Department Nitrate -N 0.1000 0.100 mg/L. EPA300.O 0 04A)4/05 CAM Microbiolocry 3aboratory Twat Coliform U col/IO(hnL SM2092220 A (<-1) 04/04A)S TI.F ,99'ZS 3„60,01°0 S Z n 4 ,99'ZI3 / HANE STREET Id W IUTY EASEMEM�./ €� �l 4 I I I I I 1 I I 1 1 I I O+, I I I I 1 • I _ a75I Y I P ■' go �aV"Z I U I N of • I 3 I � 3 I � ' ,j N I m I a°pV �]� I Ln PO F^1 GOCEi W ; o 10 ID ' 1 �♦ � WjW I IoS °o Z n 4 ,99'ZI3 / HANE STREET €� I f(N P go �aV"Z Six U g° W �u ur 3 ,j N Oa jW a°pV �]� O O Q�jj>I0 Im PO F^1 GOCEi W ; 0) ZN zoM C) 1n co ET) I .9979 3..1£.01.0 _HA- NE_STREET- . w? J �L. N T6 G/ is :3 per: w 8O O amo W== m �LU E�m L N " E ED 8= O. f0 J N X j y o C C N C: 0co vii o d EN W C6 A �¢ d Q •�C 3 - LL: P4 . 0 C- v M Qi t V N � M C) M OOi V• Qi P I LL. tn CN Lm .� 01 W Y W v to M to Q r1 C) cm Y X'`°` C O ci 2� 0 C G Q 0- A 00 J d E"T WN . 4 C O Rn + C N Q .' uI O d v d� w� ;Ln n Y O r N A> MCD N C alp N— >LM E>� ) a~or ro � ��ua v •c '- u¢v�T 4-15-05: e:24AM: SGS/0T6E ENVIRONMENTAL'SERVICES, Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM IDI )4PRNATE WATER SYSTEM g Send Resulla IR Se d ln,4 W l—S M.« f vts nc. -Fa-4 —0, N. [,'. E11i5 v� 3411- 1551.1934 D 90 110443 `"/kne-hora e �K 4s11 SAMPLE COLLECTION: ❑ Sand Rawdls :307 5615301 0 1/ 1 200 W. POTTER DRIVE ANCHORAGE. ALASKA 99518 Tel: 907-562-2343 Fa1c 907-561-5301 V D Rsf No. 1051795—I& OSand I ndow SAMPLE TYPE: /dRoudm -❑ TremadWRbr ❑ Repeat Sample E3 Untreated Water (refer to lab no. t ❑ Special Purpose Transported v . to Lab By: XSame as collector Other. , BE COMPLETED BY LABORATORY Sample Renetvina*, . Date: 0SarVW~30bounOK ❑ RUSH SAMPLE Trne• rs9YL ReMxla nlay be laaa{aeb Temp: ❑ 4a N011rwaNer Phone 0: . DeVvery Method: G j Fax 0: Received BY. -30�r Co ts: .......................................................................................................................................... Bacteriological WaW.Ansaysts Rocord: S"bADEC: MAMO•MUG IPW RESULTS: AMC FBK JUN IDaternaw- A"Iysls Beean: c%/7/� �yi� Tonal Cobmr. Amly&L E. Cont Said b caent Analytical M othod: MEMBRANE MTER RESULTS: Phoned ❑ Faxed ❑ O'vea Count. Cobn1aW00mi. DaWnnw: Membrane Fitter v.nnouoresoaii an: MMO•MUG (PIA) � LTR, { )Satisfactory ory .-.a... ( Ec: ❑ Unsatisfactory ported By: DatelTime: y_// -•.S— /1;.. &awe 1Wsesinas011ANK_GrowDautPubgeoocUMENT%FORMSIapproredlCoq Form 121703ids Form 0 FW- 0053 12/17/03 4 -1e -O5: 2:+erN: _SGS Nitrate analysis for sample collected at: Ptamvgan View Estates Lot 6 :907 SBI?301 0 2/ 2 Collected on 4/06/05 and received at SGS on 4/07/05 and assigned sample number 1051795-001. The nitrate result is 7.65 rng/L, below the regulatory limit of 10 mg/L, A written report of this result will be mailed later this week. If you lave any questions, feel free to contact to at 907-562-2343. Sincerely, -� 11141oS ryan J. Aroold Project Manager MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION \\ / 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EW ❑UPGRADE MAILING ADDRES -3 - �C S LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS (UAA_{�,p v U Y DISTANCE TO: Well Absorption area — Dwelling l PERMIT NO. `Qy 7 �_ F Z Manufacturer ,,- ,}� Material No, of compartments a Q w� (.�(i(iC-6 y Liu. cap c i�ons IF HOMEMADE: idInso-Eength Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. JAZ z Q 2 F Manufacture real capacity in g DISTANCE TO: Well l Foundatjon r '%� Nearest lot Ijne l o PERMIT NO. / LU = —1 -{� �— J LL Z Z w No. of li es Length of each1ine Total length of lines �� Tre h h 'nches Distance betty en fines A/ . F- - - - o _ Material beneath tile Total effective r i soarea FTop of tile to finish grade pinches Length Width Depth PERMIT NO. U.1 C7 Q H — Type of crib n diameter Crib depth Total effective absor area CL LU Buil oundation _ fine wWell y DIS ANCE TO: J j Depth Driller Distance to Igt Ii�eU 4! PERMIT NO. Q J l w Building foundi n DISTANCE TO: �j Sewer line �- Septic tank Absorption area(s) OTHER k PIPE MAT!�51LS ,— ', SOIL TEST RATING INSTALLER REMARKS c 1 - b APPROVED DATE LEGAL 72-013 (Rev. 3/78) IV /� —Ir 0 0 0 0 0 0 0 0 0 0 0 0 2 § � � ¥ � 4 p - .. § /,§ o § § § \ \ k k k k k k�0 % x § LE \ / § / § ) ( Cl o § § ) ) § ) \ \ § § \ 0 0 0 0 0 0 0 4 p - .. § /,§ o § > [ ) § § \ 4 p - .. § /,§ o § > [ ! k k k k�0 % x § LE \ / § / § ) ( Cl o § § ) ) § 0 0 0 0 0 / / \ § m & \ § § ) ) \ k § 0§§§( k k k•k o;o o» o o» 0 0 o f|f VFOT 01 , ! IA. 2 4 ,|,| ' | • • | . . . . MEN « �a rol § k § /,§ o § > [ ! c § % x § LE ( / § § !9 \ � � o § > [ ! c § % x ( / § § § ) ( Cl o \ \ § m & � � x v.7 t v, to t_ i, 8 ����t J__u t_-_ � DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION /- 825 'L STREET ANCHORAGE, HK 99" � ' ' � ` 264-4720 >� ��l L f-1 54 E, CA r4 I -1F F�-- E:-:- t .4 IF:- F-.". ���ir-1 I -T- k«oxmx^c� PERMIT NO. ( 810472 ) (_ n" APPLICANT GLENN E. PHILLPS 1317 W. NORTHERN LIGHTS BLYD' 276 -22 -1 -4 - LOCATION CHRIS CIRCLE LEGAL LOT 6 PTHRMHGHIN VIEW ESTATES LOT SIZE 21249 SQUARE TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH y MHXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 105 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: F.7�������= �A �K rJ���= :2 C-4 ���fA %�K� ��F"��= E—::, THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H 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" E-�:: F T I �" r-4 I-_ �1 = EE= IL CA C7_1 13 F:! L_ t— CA�� 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. _T_ b I Cl :2 > T V4cwFF-*EF_C7_lF I 1--ft4fil: FAFREE: I F..*E�E-- BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H 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--EFF-_'lr-1 1. -T" 1 f--:�FE"m �*-: E; 1 1 L I CERTIFY THAT 1: I HM 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. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED APPLIC- PHILLPS ' ISSUED BY 3009'_ ___DHTE ______ Y4.0 • x SOILS LOG j MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFOIiMFD FOR: G •QHU\ f ! ' t ` t '6 S LFGAL DESCRIPTION: 2 3 � stamp —is_ 5 �L $ctv�•r.. J , 1 G ' 7 g 1 ZS Sti"/QUUv.,� 9 , 10 '4 11 ,A A% DATE PERFORMED:_ �LtAaylr V SLOPE SITE PLAN WAS GROUND WATER S ENCOUNTERED? N b L O P 12 _ IF YES, AT WHAT E 13 , DEPTH? 14 Date �Alf U., 15 Depth to Water Net Drop 1G A ,4�r0,r,��ve: i 49J—H 18 _I I 13 ••.••• • • •..... ••e Raiph•B. Jokela • 0 s, •.• NO. 1993-E � a44FOP........•��P,F:. 20 COMMENTS �• r c 56 CHRIS O CIRCLE �� 21, 801 Iv Reading Date Gross Time Net Time Depth to Water Net Drop i I® I ROFESSIO PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT P[RFORMED BY: A�\.,P (-4 �`(� `� �y�� CERTIFIED BY; .� DATE: 7- / 0 S�►w� � � � o J k o T +P,#," a.,,d ref lace, w %44, OX 4,z iocca.R►1 ow -Ne-^.-. C7-' s 3 0 S�►w� � � � o J k o T +P,#," a.,,d ref lace, w %44, OX 4,z iocca.R►1 ow -Ne-^.-. Time ,.a,, APPLI NT FILLS OUT UPPER HA ONLY F'toperty Owner Phone/ O -2 1 y �� ql �S�J 7Y ' &S-/(/ Mailing Address Zip Cod6 Date Buyer Inspector — Address Zip Code Inspector Lending Institution Phone Address // C� K� (o y� 5� Zip Code /950 / Realty Co. 3 Agent Phone Address Zip Code Legal Description Street Location P 16y40,) U Type of Residence Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply ( ) CON ITIONAL APPROVAL' dividual DATE 1�2BY: ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility 21 Sewer Disposal �C Soils Rating ,,dividual Year Individual Installed: / 0 ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank Well to Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time ,.a,, Time Time Time O Date Date Date Inspector Inspector Inspect Inspector / Field Notes: ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CON ITIONAL APPROVAL' DATE 1�2BY: 21 Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Q 1 � — Well to Tank Septic Tank Size % fjC1 72-023 (3182)