HomeMy WebLinkAboutPTARMIGAN VIEW ESTATES LT 1Ptarmigan View
Estates
Lot 1
#015-271-51
'39 PH F ROOFING FAX NO, 907 349 0931 P, 01
02,
,' ....... · ·..: , . ........ ·.. ".' '::.: :...,.~ .' r:'r:"..::.,~;' .'.i'f~:F;~d.;:. :~.?;.:'.f':::,, ,... :/,> :-'~':,; ~"., i ..... .,_~.~,~_~,,-~.',.~, ~,,,,~e,~'; .~::.' ......
RAINPRO0_.:... i ,.':.: ...'. '".;:
..: ..STATE OFa.' ASKA ·: .' ': '"'. "~0 ,
Bu~r's Address:
Seller's Addr~s:
ON~IT~ DItlIOO~G WA~R SYSTEM:
Note:
ON-Srrg
· PrOl~m~ i~ ~ b~ a PUblic Water Syst~n, appmv~l by ~ Deimlment nnd cm-mnfly in mo~m~g ~mp~
A ~t ~g ~ ~plc ~ t~ at ~ ~EC ~ I~W~ ~ ~ found to m~ D~nt of
~n~ro~ ~fi~ ~ ~at~ ~ for to~ ~I~ b~
~ ~ l~t ~s On*Si~ d~g ~tcr ~em m~ ~mum ~on
~e i~on offs ~er ~ ~ ~t~ by a Prof~io~ En~n~
r~en~ ~ 18 ~C 72.
~s ~ ~ ~ ~1~ ~ a ~ i~ who ~ ~e ~em m~ ~ ~en~ ~ 1~ ~C ~2.
~s. ~ng ~ ~cm ~ ~ ~d t~ by a Prof~o~
~fi~ ~d ~t ~ ~ m~ ~e ~~~ ~ 1~ ~C 72,
.Z L U ......... auT omn ..................
Bassi on ~ ~~~ pr~ ~ ~ ~io~ Enter ~ ~ ln~ler ~d a ~ ~r app~m~ou for ~ ~d
~ ~ ~, ~ S~ of~ D~t ~En~o~ ~fi~ fin~ ~t ~e on-~ ~ ~er ~
~ ~nt ~ ~ ~ ~d~ ~ m~t ~n~ ~ ~ D~ent ~d i~ ~s ~b~c ~1~
Appmv~ m ~ ~ ~.
~ ~ iS ~d for a ~ s~e ~y m~-~ily r~ ~ zt to~ of ~ ~.
~e Depa~m~t of ~n~nmen~ Con~iou d~ n~ ~a~n~ the ~ntinued sa~ff~o~ pe~om~ of the d~n~ng
Si~ ;?~' Tifl~
Date: -: ~ ....... 19 :'t~
~ ~.~06B (o~) W'~t~ - Iamdm-, Canary - Appli~nv. Pink. Fiscal; Gol&mrod - File
Municipality of Anchorage Page I of
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
Permit Number: .~H./ ~¢0 ?..,~ PID Number: (215 ~ 71~/
Name:Wastewater System: ~ New ~ Upgrade
Address: 3oz'l E /1~ ~ ~ 4-c~ ~/~ ABSORPTION FIELD
Phone: ~-- ~O~ ~DoepTronch U Shallow Trench ~ BoO ~Mound UOther
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION ~,¢ ~,o/s,. ~. ~¢.~'
Lot: Block: Subdiv~ion: ~O Depth to pipe bottom from original grade: Gravel depth beneath pipe
Township: ~ Range: [ ~ction: Fill added above original grade: Gravel length:
WELL: ~ r u New B Upgrade Gravel width: Number of lines: Distance between lines:
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Ft. Ft. ~3 SQ. Ft. O-~
Driller: Date Drilled: Static Water Level:Installer: , Date installed:
~t. ~t~ ~¢~i? 2/ZZ/~--
Yield: GPM ~ Pump Set at: Ft. I~ Casing Height Above. Ground:Ft. TAN K
SEPARATION DISTANCES ~ Septic D Holding ~ S.T.E.P.
To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank SewerLines ~O~ ~ ~
Material: Number of C~mpartments:
Surfac, LIFT STATION ~. a.)
Water ~ {~' ~(~ -- -
Lot - ,
Line J J ~ j ~ i ~ Size in gallons: Manufacturer:
Foundation ,,~, i1~, -- - -- ,,Pump on,, level at: ] ,,Pump off,, level at: i High water alarm at:I I
Cu~ainDrain ..... Pump Make & Model ~ Electrical Inspections performed by:
BENCH MARK
Remarks: ~,~1 ~A~ ~.~ ~~ p;~
~ ~~ ~ ~'~ ~, ~'~t~ Location and Description:
' / / ENGINEER'S SEAL
Inspections performed by: I~1~ ~e~ ~ Dates: 1st ~/[3/~5- ~'*: ~--
2nd ~/z3/)~ :,~~~..
Department of Heal,and ~uman Services approval ~.,~'... c~.
Reviewed and approved by: ~ Date: //-/7-~ -~.~~.._~~.,- ' -
72-013 (Rev. 9/91) MOA 25
PERMIT NO:SW950~84.
PID NO:01527151
SWING TIES
FROM: "A .... B .... X .... Y .... Z"
TO:
C.O."D" 65' 60' 13'
C.O."E" 115' 111' 44' 32'
C.O."F" 120' 117' 49' 35'
C.O."G" 124'120' 52' 35'
M.T."H" 133' 128' 31' 47'
C.O."l" 142' 136' 40' 49'
PLAN VIEW
SCALE: 1" = 30'- 0"
PAGE 2 OF 2
T.H. #2
T.H. (~ "G""
I~EW 39' LO ..... 'NG~ 1 .... ''--
SOIL ABS. TRENCH J ' '
W. 6,2' SEWER GVL.
GAR.
LOT 1
150' RADIUS
FROM CLASS "C"
WELL ON LOT 5
NEW 1000 GAL.
SEPTIC TANK
150' RADIUS ,~,~',
FROM CLASS "C'
WELL ON LOT 1
1000 GAL. ~
SEPTICI'~__INV.
TANK j 88.9'
PROFILE VIEW
NOT TO SCALE
LOT 1, PTARMIGAN VIEW EST.
SEPTIC SYSTEM UPGRADE
AS-BUILT INSPECTION REPORT
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, ALASKA 99516
SCALE:
AS-SHOWN
DRAWN BY TFM
SEPTEMBER, 1995
LABORATORY TEST REPORT
R&M CONSULTANTS, INC,
9101 VANGUARD DR. ANCHORAGE. ALASKA 99507 PH 907-522-1707
C LIE U T/P R O J E C T: ..F.I=~T...T..0...p...~[~.~.H.NJ.(; A.L...S~.ER..~!.(~.~.~ ..........................................................................................................................
TEST ON: ................................................................................................................................................................................................
SOURCE: ....p.~t.a[_m..!~..a.~....~..g_b_~ ......................................................... SUBMITTED BY: T, Moore
SAMPLED FROM: n/a DATE SAMPLED: n/a
LOCATION: n/a DEPTH: n/a
R&M PROJECT: 551003
LAB NO,: 5180
FIELD NO,: n/a
DATE REPORTED: 9/20/95
DATE RECEIVED:
GRAIN SIZE DISTRIBUTION
SIEVE
5"
4"
3"
2"
1 1/2"
1"
3/4"
1/2"
3/8"
#4
#8
#10
#16
#20
#30
#40
#50
#60
#80
........... ,~..2..0..0.
....... ~..0_.2._.M_.M.. ......
,O05MM
.O02MM
CLASSIFICATION
UNIFIED AASHO FAA
%+10
+3
% GRAVEL
SAND
% SILT
% CLAY
FSV
LL
PL
PI
CLASS
73.9
26.1
COMPACTION
OPTIMUM MOISTURE:
MIN, DRY DENSITY.
MAX. DRY DENSITY:
CORR. MAX. DRY DENSITY:
% FRACTURE:
METHOD:
NATURAL DENSITY:
NATURAL MOISTURE:
WEIGHT LOOSE:
RODDED:
GRAIN SIZE DISTRIBUTION CHART
j,,o,oM,~, I
100 10
1 O.1 O.O1 0.O01
GRAIN SIZE (mm)
TOTAL WT, TESTED: 230 GMS.
COARSE SPEC FINE SPEC
DELETERIOUS MAT.
MINUS ~'200 MESH
SOFT FRAGMENTS
COAT & LIG. OR L,T,WT,PT.
CLAY LUMPS
STICKS & ROOTS
FRIABLE PARTICLES
THIN-ELONGATED
ORGANIC COLOR
FINENESS MODULUS
SULFATE SOUNDNESS
DEGRADATION VALUE
ABSORPTION
SPG.-BULK
SPG.-BULK S.S.D.
SPG,-APPARENT
ORGANIC CONTENT %:
L.A. ABRASION LOSS:
REMARKS:
I ~o.8
DJ "' 0.7
El
~ O§ I
N .:. . i
J~J [o.:~ !
iTl o.'~ ! I
jyj o.oi..:..: :~: ~ ~, =, i,,:.. :..:: o
II ,,.o% lO,,.o% ,,o,,.o%
/ FI MmSTUR~ 7~
Tested By: AJS Checked By: SAM
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW950284
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:JACKSON WARREN & DOREEN
OWNER ADDRESS:3051 E ll2TH AVE
ANCHORAGE ALASKA 99516
PARCEL ID:01527151
LEGAL DESCRIPTION:
PTARMIGAN VIEW ESTATES LT
DATE ISSUED: 9/20/95
EXPIRATION DATE: 9/20/96
LOT SIZE: 22000 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT:
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 MOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
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
RECEIVED BY- ~ ~
ISSUED BY: ' ~~ ~
DATE:
DATE:
CIVIL & ENVIRONMENTAl. ENGINEERING * ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 September 1, 1995
ANCHORAGE, ALASKA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application for a
permit to upgrade the wastewater disposal facilities on Lot 1, Ptarmigan View Estates, located at 3051 East
112th Avenue. The present seepage pit which was installed in 1971 is no longer able to accept the
wastewater load emanating from the house. Soils logs, perc test results, a site plan, design drawings and
specifications are enclosed for your review.
The proposed system will be constructed in the vicinity of test hole #1. As can be seen from the soil
log, the native material between 3' and 17' below ground level is a somewhat silty fine sand with a
measured perc rate of less than one minute per inch. Despite the high measured perc rate for this sand we
have chosen a slightly conservative soil application rate of 1.0 gpd/sq, ft. Thus, this 3 bedroom residence
requires a total absorption area of (3 x 150)/1.0 = 450 square feet. The proposed 38' long trench design
with 6 feet of sewer gravel beneath the horizontal distribution pipe has a total absorption area of 456
square feet.
The topography of the lot in the area of the proposed construction is generally level.
The proposed project will have no significant impact on present or future water supply and wastewater
disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-
surface and subsurface, or on drainage.
Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
/ ',', LOT 4
PW. ,': ~ I
WELLS ," ," I .... I I ~~ .... ~_ _
,, ,,' o o I I
' LOT 3
LOT 1
LOT 2
,,' SEPTIC
SYSTEM °
HOUSE SERVED
BY CLASS "C"
WELL ON LOT 1
WELL
EAST 112th AVENUE ',,
LOT 1
HOMAN ACRES ,
INSTALL NEW 38'
TRENCH W. 6' GVL.
INSTALL NEW 1000
GAL. SEPTIC TANK
yEpTIC
STEM
, ABANDON EXISTING
', SEPTIC TANK AND
, SEEPAGE PIT
HOUS '
LOT 1, PTARMIGAN VIEW ESTATES
WELL AND SEPTIC SYSTEM
SITE PLAN
FLAT?OP TECHNICAL SERVICES 1 INCH = 50 FEET
14530 ECHO STREET DRAWN BY TFM
ANCHORAGE, ALASKA 99516 AUG UST, 1995
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
38' LONG SOIL ABSORPTION TRENCH
WITH 6' SEWER GRAVEL BELOW PIPE
PLAN VIEW
SCALE: 1" = 10' - 0"
D-3034 PIPE
DOUBLE C.O.
1000 GALLON
SEPTIC TANK
FROM
EXISTING
HOUSE
-- CLEANOUT
TUBE
3
1I
BACKFILL 12"
GROUND
FABRIC
DIA F-810 PERF PIPE
-- I/2" - 2 1/2" SEWER GVL.
BOTTOM OF TRENCH
SECTION "A - A"
SCALE' 1" = 5'- 0"
LOT 1, PTARMIGAN VIEW ESTATES
SEPTIC SYSTEM UPGRADE
PLAN AND CROSS-SECTION
FLATTOP TECHNICAL SERVICES SCALE: AS SHOWN
14530 ECHO STREET DRAWN BY: TFM
ANCHORAGE, AK, 99516 AUGUST, 1995
Flattop Techn~al Servkes
14530 Echo Street, Anchorage, AK 99516
Phone (907) 345-1355
Lot 1, Ptarmigan View Estates
3051 East ll2th Avenue
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of abandonment of an existing septic tank and seepage pit and
installation of a new 1000 gallon septic tank followed by 38 lineal feet of soil absorption trench with 6 feet
of sewer gravel below the horizontal distribution pipe.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform with Municipal and State
requirements. All separation distances shall be in conformance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any
buried utilities.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depress,ions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after
the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction.
2.0 Septic Tank:
2.1 The existing septic tank and seepage pits must be properly abandoned by thoroughly pumping,
removing their tops and backfilling with soil.
2.2 The new 1000 gallon, 2 compartment septic tank shall be Municipally approved and shall be set
level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4"
cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type,
rigid insulation.
2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste
line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A
cleanout shall be installed at the point of connection into the existing waste line, and another one 75'
downstream towards the new septic tank. A double cleanout shall be installed within 5 feet downstream of
the septic tank.
3.0 Soil absorption system:
3.1 The soil absorption system shall be constructed by excavating a 38 foot long trench to a total depth
of 11 feet below ground level in the vicinity of test hole #1.
3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to
allow proper infiltration.
3.3 A total of 6.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with
the perforated distribution pipes laid level such that the pipe inverts are no less than 6.0 feet above the
bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing
the #200 sieve.
3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on
the design drawings. The portion of the monitor tube extending through the sewer gravel shall be
perforated.
3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum
of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet,
two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in
addition to the filter fabric.
3.6 The top surface of the cover material shall be raised a ininimum of 12 inches higher than the
surrounding ten'ain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the
site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed
to promote rapid revegetation of all areas disturbed by the construction.
4.0 Inspections:
4.1 A minimum of 4 engineering inspections will be required during the course of the project: (1)
initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the
inf'dtrative surface to ensure that it is level and at the right elevation, and conforms with the soil test
information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected
up to the septic tank, but prior to placement of filter fabric, and (4) after rough backfill and grading is
complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to
backfill. This inspection may be incorporated with any of the above inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
TEST HOLE
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
DEPTH
(feet)
1
11
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
Lot 1, Ptarmigan View Estates
August 22, 1995
Warren Jackson
Pt.
SM Reddish sandy loam
SP Coarse to medium sand
Densly compacted
SP/SM Tan, fine, somewhat silty sand
Dry, does not smear
Sidewalls sloughed
SLOPE
·
Depth to Groundwater Date
No groundwater 8/22/95
Monitor tube dry 9/1/95 _
SITE P~N
#1 "'
: ! : ! ! : : :
COMMENTS:
Clock Net Time Percometer Net Drop
Date Reading Time (minutes) Reading (inches)
8/22 12" Presoak 11:22:50 27 1/2
11:23:50 1 20 1/2 7
Add water 11:24:25 27 1/2
11:25:25 1 21 1/4 6 1/4
Add water 11:25:55 2T172
11:26:55 1 21 1/2 6
Add water i 1:27:2b 27 1/2
11:28:25 1 22 5 1/2
Add water 11:29 28
11 ;30 1 23 5
11:31 1 19 1/2 3 1/2
11:32 1 17 3/8 2 1/8
SM Tan silty sand
Dense, some gravel
B.H.
PERCOLATION RATE <<1 (minutes/inch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN 7.5 FT AND 8.0 FT
Recommend design of trench be based on soil application rate of 1.0 gpd/sq, rt.
PERFORMED BY FLATTOP TECHNICAL SERVICES. I ¢r~-.~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~)// / ! ~-
TEST HOLE # 2,
FLA'I-FOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
Lot 1, Ptarmigm~ View Estates
August 22, 1995
Warren Jackson
DEPTH
(feet)
Pt
SM Reddish sturdy loalil
SP Coarse somewhat silty sand
Consolidated
SP/SM Tan somewhat silty sand
Similar to test hole #1
Does not smear
SLOPE
Depth to Groundwater Date
No grouudwater 8/22/95
1" water in bot. of m.t. 9/1/95
q
SM Tm~ silty sand
damp, dense
B.H.
Clock Net Time Percometer Net Drop
Date Reading Time (minutes) Reading (inches)
I
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch) PERC HOLE DIAMETER
FT AND FT
COMMENTS:
PERFORMED BY FLATTOP TECHNICAL SERVICES. I '~,..4.~ ~ CERTIFY THAT THIS TEST WAS PERFORMED
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /q / / / 4).5-
Gl' TER ANCHORAGE AREA BOROr
Di:I~AFITMENT OF ENVIFIONMENTAL I1UALI1
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
NAME~ /it~.'J':''~'",- (X. ~iV,U(~, ADDRESS
LOCATION (-///~' 3/~L', , / __LEOAL DESCRIPTION
SEPTIC TANK:
· NUMBER OF .~,
DISTANCE FROM WELL ~ / MATERIAl ~")~-~L t.-I COMPARTMENTS ~
-~"'~ ~'V' ~ ' ] '1, i I LIQUID
LIQUID CAPACIJ'Y___ ~[)( (' GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH__
SEEPAGE SYSTEM: SEEPAGE PIT.
NUMBER OF PITS / OLJ'[SIDE DIAMEI'ER - OR WIDTH _ / ~
! /
LINING MATERIAL X, X DISTANCE FROM WELL // ~
NEAREST LO1 LINE .~"~(-: ' //o //.,,,,) TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
/
LENGTH / 2 , DEPTH
BU,LD,NG FOUNDAT,ON~"~' ;',' ?
%' 7.," SQ. Fr.
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION~ NEAREST LO[ LINE
~..~.
NUMBER OF LINES __DISTANCE BETWEEN LINES '""'"~x.~ IRENCH WIDTH
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
'~ __ DISTANCE FROM _ WATER t i .,,91,
WELL: TYPE ~.)t'_', J/~, '~-~ DEPi'H BUILDING FOUNDATION. SAMPLE "
NEAREST SEPTIC ,,,~, ' / SEEPAG~ x _
LOT LINE ~:~'(-"/'I', / SEWER LINE ,TANK SYSTEM //-~ CESSPOOL
DIAGRAM OF SYSIEM
, NEAREST
OTHER
, SOURCES__
DISTANCES:
( '~/~,1~, '.,
t'_
DATE
G.A.A.B.
213148
~.~.,.,~,,~: ;.,~, Certified Well ~ E [EI V E D
;, .:: .~_ ' .............................................................
L.,~. ~_ ":':;~: ::>"'.~p Location~.~ ....... ~[ }}}~.~.~.I.~.~.....~I~....~.~.T~....~.O2.~Z~./OM~~, ~ ~ ~.
' ' Date co leted .......................... ~. .................
.... ~Z.T !"
,:g~ g~,;-"' :.,.~ ..,~ :t'..~ Depth o[ well ......... ~..~ ....................................................................................
!'~''~ ~:~;"' ~,' casing ......... ~ '~
' 'V~' .~:'. i:~. , Size o[ ......................................................................
pumping ..... ' ~ ~ '' at
~:~:;~'~"~'::"~ ");~'m: ' Distance to water while .......................................................... rate
,./:~ ~::j.- . ~ ~.:.~. ;~
,.'z:,~,:' L-, '''~ ,~4. of ........... ~..~_~. ...................... ~llons per hour.
"d', ~': :..;~: "'
,., ~:?~) .",.
.~( ~..~ .:'.'?~ ,..,
Description of Formation "'.'.-- ,-, .... . from ., -. to
~;~ ~ ~ -.'""~ I '~
~,,~ ., :.. ,...' ,'~ I ~' i~
~-'zf ' .' .-- /y~ [ 2o0
~~ ~~t -" '- ~oI ~.~
· z"
,:,..~, -:.:~: ,/ · .._,,
.. ;;;: .,~i: ':.,,.
,,.:~ ~.. (t .'
,~':y.. .:~ ~ ~::,
,.,~.: :"' . . "/ l.,..l
'V.-..,~,~, ~
b:~~: .... ::. ?". '.~
~- :',- ?_- I certify the above true and correct.
?.;. :.. . ................... : ................................................
' ' .~,, · Driller
' :'"'~ DOTTEN DRILLING CO.
~I~A~-- ' ?~"' '"'"':"'
-.' John's Road - ( 7', ?.; ::';""
.... ~'::' SPENARD, ALASKA ,,,.;~'"":
%~e advise you lo attach this certificate to your
-.. ' ~t::-? ::3 .
............... ,ix ,, 7' -
.......... ' ....... ..,:'.~ '-.. "~ . ...... ? .':"::,:,?__., ..... ..,..::..:: ~'-~ v ...... .': ?": :"~',.,.,,.,.~. _ , ,,:~,, -' , ,' .
' ..~,.? :~ --.~ .
~. '~':-' ~-.. . ..... ~ -.~', · .~ -.. s.~o
.,; .~ - ~ ,,.: '7~ .-':~-... ~'.:''.,:.'''
- .. .. .... ,..... . .... - . ......,.,.. :..:. ,.....:....:..:'."
_ ~. .... -.: :L.'" -' -'_~ 2' ' -' ~)2-.- "~/ ":~-'" ".::~'~? "
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-4744
Parcel I.D.
1.
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
O t5'~ 7t5-!
GENERAL INFORMATION
Complete legal description ,Lo-/'
Location (site address or directions)
HAA# ./(.//~. ('~('_:("-~)/._,Z ~/
Expiration Date:
Current Property owner(s) J'--~.'~'/' C[c'''-¢ ~
Mailing address '~,:::'.q'! E 1/~- '~ ,,+~.'~,~-~ .,
Lending agency ~,ro-¢- .W,~ f '/ ,¢er4/.r, ¢ ~- ./¢-,-c.50,-~?--~ Day phone
Mailing address p.o. ,.%;, loP-, 'Tzo,, ..~.,~.q ~ ,.-~e. /¢'~< ~e.~.¢
Real Estate Agent .t)yn,cr/'n'~r_ p~'¢p.~rF,¢u' - /~/-t4,~ ~/ Day phone
Mailing Address ~'/z¢ "¢" £~.., ~'~,/-~ loc-,., ,.~,.,~^,,r-¢,~, ,4.-~:
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class "¢ '
Public Water System
Well
3
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
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
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.
5. 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 the Health Authority Approval
application show that the on-site water supply and /or wastewater disposal
system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I
further verify that based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with
all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm_ FI,,~/-/~.? ¢',~c4,~;¢,~,' Z'~"~'D,r¢./ Phone
Engineer's Printed Name ~4zo~o~, ~ ~oo¢c Date
DHHS SIGNATURE
Approved for ~ bedrooms.
Disapproved.
Conditional approval for __
ENGINEER'S
bedrooms, with the following stipulations.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date:
Original Certificate Date:
Reissue Date:
72 025*Rev 01 001'
Legal Description: ~-,~ ~'
A. WELL DATA
Well type ~{~s.r '~. '~
Date completed .__
Total depth
Municipality of Anchorage R E C E J V E
Department of Health and Human Services
Division of Environmental Services SEP ]. 3 Z000
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us MUNICIPALITY OF ANCHORAGE
(907) 343-4744 ENVIRONMENTAL SERVICES DIVISION
HEALTH AUTHORITY APPROVAL CHECKLIST
If A, B, or C provide PWSID # /.~-~-- Well Log ~
Sanitary seal __ Wires properly protected
ft Cased to ff Casing height (above ground)
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft
Well production g.p.m
WATER SAMPLE RESULTS:
Coliform ~P colonies/100 mi
Date of sample: 9/~'/
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Z' ~ ~ /
Date installed 9/z.= /~"
Cleanouts y' Foundation cleanout
Date of pumping
C. ABSORPTION FIELD DATA
Nitrate /.~'.5~ mg/I Other bacteria
Collected by: F~'~b,~.~, 7~c4
in.
ft
g.p.m
colonies/100 mi
Tank size ! ~,o,P gal Number of Compartments
~' Depression over tank ~,/ High water alarm __
Pumper ~ /~c,,-,~ ~
Date installed 9 / ~.3 / ¢¢~' Soil rating (g.p.d./ft2 or ft2/bdrm) ~System type
Length ~ :) ft Width ~. 5' ft Gravel below pipe ~', ~ ft
Total depth I¢. 8 ft Effective absorption area q,¢.~ f¢ Monitoring tube 'r' Depression over field ,V
Date of adequacy test ¢)/,¢'/~ooo Results (Pass/Fail) ?o.r.r For '~ bedrooms
Fluid depth in absorption field before test q~' in Water added '7 ?.'./ gal. New depth 6"5' '¢/~5 in.
Elapsed Time: ~'c/ rain Final fluid depth 5'~' 7/6 in Absorption rate >= 'f¢'o g.p.d.
Any rejuvenation treatment (past 12 me.) (Y/N & type) /',/~,~ ¢ ~,~.~., ,, If yes, give date
72-026 (Rev. 01/00)*
D=
LIFT STATION
Date installed
"Pump on" level at in
Datum
E. SEPARATION DISTANCES
Size in gallons __
"Pump off" level at __
Cycles tested
in
Manhole/Access
High water alarm level at __ in
Meets alarm & circuit requirements
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot I
Abserption field on lot 1 ¢' ,¢' /~, '~'
Public sewer main /d.
Sewer/septic service line ~ fi'C,'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
On adjacent lots II¢' ¢¢,
On adjacent lots
Public sewer manhole/cleanout
Holding tank M, ,4-,
Property line It '
Water service line '~. zo,~ '
Wells on adjacent lots _ ~ ~ o-¢, '
Building foundation
Water main ~ z
Drainage ';> ~¢-,¢,
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation I ~ g' Water main
Surface water '>. ~o¢,, Driveway,
Wells on adjacent lots ~> /,',7¢ '
Absorption field 5' '
Surface water -> ~o ,
Property line
Water Service line
Curtain drain
COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections 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
parking/vehicle storage ~ ¢o,
HAA Fee $
Date of Payment ~//~//
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev, 01/00)*
09-08-00 09:35 FROM-CTE ENVIRONMENTAL 5615301 T-851 P.02/02 F-1§9
CT& E Ref.~
Client Name
Projec! Name/#
Client Sample ID
.Matrix
Ordere~ By
PWSID
CT&E Environmental Services Inc.
Laboratory Division ~
Laboratory Analysis Report
1005286001
Flattop ql echnical Srv.
Lol I Ptarmaaan View Eslates
Lot 1 Ptarmigan View Estates
Drinking Water
000000
Client PO# Pre-Paid Colts/NO3
Printed Daterrlme 09/07/2000 15:39
Collected Date/Time 09/05/2000 13:25
Received Date/Time 09/05/2000 14:20
Technical Director Stephen C. Ede
Released ~ ~
Sample Remarks:
Alluwable P~ep Analysis
Results PQL Units Melho~ Limits Date Bate Init
0.500 U 0.500 mgJL EPA 3OO.U
09/05/00 SCL
Microbiolog~r L~boratory
'['olal Co}i£oma
col/100mL SMI8 9222B
O9105100 KAP
200 W. Potter Drive, Anchorage, AK 99518-1605 -Tel: (907) ,562-2343 Fax: (907) 561-5301
3180 Peger Road, Fairbanks, AK 9970~J-5471 -Tel: {907} 474-8656 Fax; ~907) 474-9685
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
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
HAA #
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
=
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional an'd adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address I I
Encjineer's signature ~-d~ uccc'__'!/--'~---~,,,~'(/-~-, _
SIGNATURE
Approved for ~
Disapproved.
Conditional approval for
DHHS
¥
bedrooms.
bedrooms, with the following stipUlations:
Additional Comments
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 lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025(Rev. 1/91) Back MOA~21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502. Anchorage, Alaska 99501. (907)
~c.~$ ~-
. .
Health Author;ty Approval Checkhst
Legal Description: ~ ?~j~ ~/'~ ~ Parcel I.D.:
Well type ~ If A, B, or C, attach ADEC le~er. ADEC water system number
Log present (Y/N) ~ ~ Date completed ~- q I
Total depth ~ r Oased to Casing height (above ground)
Sanitary seal (Y/N) ~ ~ Wires properly protected (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0
FROM WELL LOG
AT INSPECTION
!
lO g.p.m, g.p.m.
Nitrate
Collected by:
Date of sample: 7 -- '~ ~-'''j
Other bacteria
SEPTIC/HOLDING TANK DATA
Date installed 4' ~"~ -~ Tank size
Foundation cleanout (Y/N)
Date of Pumping
JC)cl~) Number of Compartments ~ Cleanouts (Y/N)
Depression (Y/N) 1~O High water alarm (Y/N)
Pumper ~ L,,-D
CJ
ABSORPTION FIELD DATA
Date installed ~ -~-'~ -~J ~ Soil .rating~r ft2/bdrm) -'J--
Length ~'~J Width ~, ~ ~ Gravel thickness below pipe
Effective absorption area/-J'~ c~, i:::, Monitoring Tube present (Y/N) '"J/
Date of adequacy test "7- ~-7--~ Results (Pass/Fail) ~)~-~ For
Fluid depth in absorption field before test (in.); i/'J?1 Immediately afte~gal, water added (in.):
Fluid depth J~, ~2~* (ins) Minutes later: J(4:~ I:t-1~ Absorption rate = ~z.{_~:::) .g.p.d.
Peroxide treatment (past 12 months) (Y/N) /~J I~ If yes, give date ~/A'
System type
/
~:)o '~)- Total depth
. Depression over field (Y/N)
bedrooms
72-026 (Rev. 3/96)*
LIFT STATION
Date installed
Size in gallons
Manhole/Access (Y/N)
"Pump on" level at*
"Pump off" level at*
High water alarm level at*
*Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
!
Absorption field on lot
On adjacent lots
On adjacent lots
Public sewer main ~J. _//~- Public sewer manhole/cleanout
Sewer/septic service line ,~;> !
Lift station ~/~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
/ ~
Foundation I ~ ~ Proper~ line ~ ~ Absorption field
Water main/service line ~ ~ f Sudace water/drainage ~/~
Wells on adjacent lots
F.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
/
Property line r,.-- z~ Building foundation I ~C) Water main/service line
Surface water ~//~
Curtain drain
ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area
/
Wells on adjacent lots >' I ~o
I certify that I haye,,determined thrj~,field inspections and r
in conformanc~wi~M~nesineffect on this date.
Signature V',,.J ~'~
Engineer's Name
Date
Waiver Fee $
Date of Payment
HAA Fee $
Date of Payment
Receipt Number
Receipt Number
72-026 (Rev. 3/96)*
JUL-31-199? 16:~6 CT&E ESI ANCHORAGE 907S615~01 P.O2/OG
CT&E Environmental fiervices Inc.
CT&E Ref,#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSH)
974102001
Eaton~ Brctxt
L1 Ptarmigan View
LI Ptarmigan View Well Water
Drinking Wate~
Client PO#
Printed Date/Time 07131/97 14:22
Collected Date/Time 07128/97 12:30
Received Date/Time 07/28/97 13:30
Technical Director: Stephen C. Ede
rks:
parameter
Nitrate-N
Total Cotiform
ResuLts
0.100 u
o
PaL
0.100
un1=s
me/L
cot/lOO~L
AtLmaable Prep Anaty$~5
Method Limits pate Date In~t
Sill8 &5OO-NO3F 10 max 0?/29/97 JRJ
SN18 92~2B 07/28/97 RAH
SE?-12-97 FRI 09:53
RAINPROOF ROOFING
349 093]. P, Ol
TONY KNOWLES, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN PUBLIC SERVICE AREA OFFICE
555 CORDOVA STREET
ANCHORAGE, ALASKA 99501
(907) 269-7505
September 8, 1997
Mr. Brent P. Eaton, P.E,
11835 Spyglass Circle
Anchorage, AK 99515
SUBJECT:
Lot 1 & 2, Ptarmigan View Estates Subdivision - 3051 E. 112th Avenue;
C lass "C" Public Water. System_Letter of Compliance, AWPSA Project No.
9836-0201-WJ-001:2.
Dear Mr. Eaton:
This letter is in response to the information received in this office September 3, 1997,
requesting a letter of compliance for the above Class "C" Public Water ,System serving a
single family residential dwelling, The Department has completed a review of the
monitoring status of this water system and found it to be in compliance for both coliform
bacteria and nitrate. .... ~
Since this drinking water system has been previously approved, and because it serves less
than 13 bedrooms or 25 residents, this water system is viewed as a Class "C" Public Water
System. Verification that the water supply has been recently tested will be required to
maintain compliance with State Drinking Water Regulations. Recently collected water
sample analysis (7~28/97) were satisfactory for' both total coliform bacteria and nitrate and
satisfy this concern, Therefore, for the concerns of this Department, this system is in
compliance with State of Alaska Drinking Water Regulations (18 AAC 80). Attached is a
"Public Health Authority Approval for On.site Drinking Water and Sewer Systems"
certificate verifying this system's status as an approved water system that is in compliance
with 18 AAC 80..Any future modifications to this system will require prior review and
approval by this offi-ce.'' Please n0te thai'this"letter does n[}t imply any certification or status'
of the existing on-site wastewater disposal system serving this property.
Thank you for your cooperation with this Department, if there are any questions regarding
the above, please do not hesitate to call.
MLU/cf . ...
Affachments
cc: Jim Cross, MOA/DHHS.
Sincerely,
Michael Lu
Environmental Engineer
~ . GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
." 3330 "¢" SEreet, Anchorage, Alaska 99503 274-4561
Date Received /___~ & -' ~'~
/ Time of ~nspection ~' ~o ~,~'
: Date of Inspection /-/~-~
~' ~/ REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
~ . FOR
1 Approval requested by: i, ~,. ~ ~)"/' '~1
Mailing Address: ~xo ~. ~~'~ x~ /~
2. Property Owner: ~')'~'~ ~.~ ,~ x,~/~'~ ,.'~..':~-~ Phone: ~ ~ m- /~ 7-~.
Mailing Address: ~' ~. /~, /~ /Z~ ~
3. Legal Description: . / ~-'~,/~ ~ ~~, ,,~,.~ ~~'
' ' ' " '"'"
· L.:. ,,.'/~ z
5. Type of facility to be inspected ,],' ..-~ ,~,, No. of bedrooms
e
C. Construction
Sewage Disposal System:Jnr~'.~
A. Installed ¢ -~¢-7/
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
D. Bacterial Analysis
B. Installer
1. Size?~-~.,~. 2. Manufacturer ~ ~
]. Absorption Area/~L~(~'. 2. Material/
Total length of lines
Distances-
A. Well to: Septic tank ~7/ , Absorption area
Nearest lot line ~o~ E, Other contamination
!
//~ , Sewer Lines
B. Foundation to septic tank ~
C. Absorption area to nearest lot line
, Absorption area
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Re st for Approval of Individual er & Water Facilities
Legal Description
Approved~m~ ~. ~?~'t~ ,~Disapproved
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)
3330
GREATER ANCHORAGE AR~/~ BOROUGH
Department of Environmental Quality
"C" St., Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection: CMRO
2. Property Owner:
Mailing Address:
3. Name of Buyer:
Mailing Address: ~_~_~
4. Name of Lending Institution:
Mailing Address:
Name of Realtor or Agent: ~.]c~
Mailing Address:
FHA CONV V//
Da~ Phone ~wm-~8~
Da j/ Phone ~-7 J - r,--/~ 7
Phone ~-7~q -7~ -7
Phone
Legal Description:
Location: ~/-~
Type of Facility to be inspected: ~i~cl/~ ~ou~,~¢ No. Bdrms.
Water Supply
Type of Supply: Public Utility Individual
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal'System
Type of S~stem: Public Utility
If Individual, date of installation
Individual (on-site)
O'~MALL E% ~
NOTE
IN THIS SUBDiVISiON MAY NOT BE DEVELOPED
WITH ON-SITE WATER SUPPLY AND SEWAGE
STREET
SURVEYOR'S CERTIFICATE:
LEGEND:
~ GLO or BLM BC Monumeet Existing
~ D/O BC Monument set this survey
VICINITY MAP I" = I MiLE
CERTIFICATE OF OWNERSHIP 5 DEDICAT1ON~ :
NOTARY'S ACKNOWLEDGEMENT,
, i97t,
PLAT APPROVAL ~
P~a~, approved Dy m( Borough Pledging Commiss~o~
PTARMAGAIN VIEW ESTATES