HomeMy WebLinkAboutKYLE AND ERICA LT 1Kyle &Erica
Lot 1
#050-321-69
Municipality of Anchorage
ODevelopment Services Department
Building Safety Division .• .,
On-Site Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
www.cLanchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW070098 PID Number. 050-321-69
Name:
William and sheen Gould
Wastewater System: ❑ New ❑Upgrade
Adtlress:
18700 Upper Skyline Drive Eagle River, AK 99577
ABSORPTION FIELD
Phone: 694-9684 Number at Bedrooms:
6
[3 Deep Trench lid Shallow Trench D Bed ❑ Mound ❑Other
LEGAL DESCRIPTION
Sall Rating:
Total Depth from anginal grade:
4 GpD t?
r-t5' Ft.
Block: Lot: 1 Subdivsion:.
Depth to pipe bottom from original grads:
Gravel depth beneath pipe:
Kyle and Erica
+4'-+4.5' Ft
5 Ft
Township: Range: Section:
Fill added above original grade:
Gravel Lerglh:
T"8- Fl.
40 Ft.
Well: ZNew ElUpgrade
Gravel width:
Number of linea:
Distance between lines:
5 Ft.
1
Ft.
Classification (Private, A, B, C):
Total Depth:
Cased to:
Total absorption area:
Pipe Matetlal:
Private
400 Fl
43 Ft.
200 Fe
ASTM D3034 PVC
Ddiler.
Date Drilled:
Static Water Level:
Insteller.
Data Installed
Sullivan Water Wells
6/8107
14 Ft
Sanders & Sanders
7/13-1412007
Yield:
Pump Set at:
Casing Height Abave Ground:
TANK
1 GPM
- 382 Fl.
2 Ft.
SEPARATION DISTANCES
❑ Septic ❑ Holding ❑ S.T.E.P, m Other:
To
Septic
Absorption
Lift
Holding
DubliclPrivate
Manufacturer:Capacity:
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank/Orenco
2,500 Gal.
Material:
Number of Compartments:
Well
>100'
>100'
>100'
N/A
>25'
Steel
Three (3)
Surface Water
>too'
>100'
>100'
N/A
LIFT STATION
Re:
Manufacturer
Lot Une
>5'
>10'
>5'
N/A
Gal.
"Pump on°level at
'Pump ofr level at:
High water alarm at:
Foundation
>5'
>10'
>5'
N/A
in.
curtain Drain
None
Noted
Pump Make & Model
Eleeldcal Inspections performed by:
Copper Electrical
Remarks:
Topsoil and Seed to be Applied to Mound in the Spring of
BENCH MARK
Location and Desorption:
2009. Additional Fill Required to Flatten Fill Slopes.
Lower Level Crawl Space Access Door Stoop.
Assumed Elevation:
S4 Coarse Sand Placed to Raise Trench to Minimum 6'
100.0 Ft.
Above Bedrock.
Inspections performed by: S. Gilbert Dates: 1" 7/13/2007
O �A4 4t
2nd 7/14/2007
a'e
•^�'
Develo merit Services Departmen prove!�
* � 49TH � �
Conditional Approval Date:
_op
c�j06
.. ...........5++:.............�
10
D C 0- J- e 01o7rrc e 5
:AU04AEL a ANDERSON:
l
Reviewed and approved by: Date: of - i
FfSS9
(Rev.. 04ro6)
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Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report Page 3 of 3
Permit Number: SW070098
/513,8
U N M � UU
050-321-69
M
Bedrock
PROFILE AS -BUILT
Scale: NONE
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
MEMORANDUM
DATE: November 4, 2012
TO: Jeff Poet
FROM: Mike Anderson, P.E.
SUBJECT: Kyle and Erica Subdivision, Lot 1
Septic System Permit No. SW070098
Topsoil and seeding has taken place on the septic system area serving Lot 1, Kyle and
Erica Subdivision. Revegetation is complete and there is no danger of erosion to the
slopes of the completed mound. The conditional status of the inspection report should
be removed.
�ertifie� Orft ing log
by
DOC CO. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 -TELEPHONE 688-2759
OWNER OF LAND:
ADDRESS:
LEGAL DESCRIPTION: X_-)�4a 4- C _,4 4c 1
DATE: L-11 Vo 4
PERMIT NUMBER: 0700 4(F Date of Issue—6 -�
TAX IDENTIFICATION NUM BER: le)"10- �_ -—
Is well located at approved permit location? Q -;es ❑ No
Method of Drilling: &.aifrotary ❑ cable tool
Depth of well: 40 0
Casing Type Wall Thickness .25� inches
Diameter :7L inches, depth 43 feet
Liner Type: 10 O'A'F_
Casing Stickup Above tGrround: A - feet
Static Water Level: 1T feet
Recover. Rate: T gpm
MethodofTesting:*4.) Tse` -P7 c -
Well Intake Opening Type: ❑ open end 9,6 -pen hole
O Screened; Start feet Stopped feet
:1 Perforations Start—feet
Supped
Grout Type: i3dNT s r i Volume
Depth: from
I
feet
feet, to 40 feet
Well Disinfected Upon Completion? &-f1fes U No
Method of Disinfection: d44.. A 'Wi4i S"b pPsrf-
Comments:
E HOLE
DEPTH
C'gr1 ar<, CTicKJ1-9
D�E�2 i�.3RG1��
jjZ0A70GA:� 4/6cve7- KIZ41'
Driller'sName Ca4e Fc![tQ4,J
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough:
Department of Environmental Conservation.
Z'd 69LZ 989 Z06
s119M aafeM ueAIIInS
d8£:60 80 96 deS
ARCTIC PUMP & WELL INC.
_
Jim Sullivan, CPI
PO Box 770197
-
Eagle River, AK 99577
sua s sear[ -
(907) 688-2510
(907) 258-2510
(907)745-2510
aweci.net
Pump Installation Log
Well Drilling Permit Number: SW070098
Parcel Identification Number: 050-321-69
Legal Description: Kyle and Erica
Lot:I
Block:
Date of Issue: 6-8-08
Property Owner Name & Address:
Bill Gould
18244 Driftwood bay
FARIP River AK O(477
Pump Installation Date: 1-8-08
Pump Intake Depth Below Top of Well Casing:382 Feet
Pump Manufacturer's Name: Dempster
Pump Model:LBF2-100-S2
Pump Size:I hp
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Manufacturer's Name:Martinson
Pitless Adapter Installer: Sanders&Sanders
Well Disinfected Upon Completion? Yes
Method of Disinfection: Chlorine
Comments:
Pump Installer Name:
Arctic Pump & Well, Inc.
Arctic Pump & Well, Inc.
Page I of I
Sanders & Sanders
Excavation, Inc. p�
�D Z z lelf
--V 6j14"'V"-T
f I
lCrk /I r S S
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1�'0
tie
P.O. Box 231541 Anchorage, Ah. 99523
(907) 522-1997 FAX 522-2487
LBtiZZZS
M
dL0:21 80 82 R00
Oct 31 08 12:26p
Oct 27 08 08:67p Ryan
Jason Hoesl
4564 S. Sallors Loop
Wasll la, AK 99654
Phone (907) 376-8931
Fax (907) 376-8932
9076945252
907-376-8932
To Whom It May Concern:
This letter is to inform you that the lift station at lot 1 Kyle and Erika Subdivision was
wired by a licensed electrician and the work was done in accord with both NEC and
Anchorage municipality codes.
Ryan Frisbie
Copper Electrical
P.1
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 / WATER SUPPLY PERMIT
Initial
Permit Number: SW070098
Legal Description: KYLE AND ERICA LT 1
Design Engineer: 0014 ANDERSON ENGINEERING
Owner Name: WILLIAM AND SHERRI GOULD
Owner Address: 18244 DRIFTWOOD BAY
EAGLE RIVER, AK 99577-
Iq w
Date Issued: Jun 08, 2007
Expiration Date: Jun 07, 2008
ParcelID: 050-321-69
Site Address:
Lot Size: 76800 SQ. FT.
Total Bedrooms: 6 Permit Bedrooms: 6
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. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
PRIOR TO CONSTRUCTION, AN ADDITIONAL TESTHOLE NEEDS TO BE DUG TO VERIFY BEDROCK DEPTH.
THIS TESTHOLE IS TO BE LOCATED DOWNGRADIENT OF THE RESERVE SEPTIC FIELD. PLEASE SUBMIT
STAMPED AND SIGNED RESULTS WITH THE AS -BUILT INSPECTION REPORT. IF THE RESULTS REQUIRE A
DESIGN CHANGE, CONSTRUCTION OF THE SYSTEM WILL STOP PENDING ON-SITE REVIEW AND
APPROVAL.
Received
Date: ri —7
Issued By: �if /iiCi4D �ry� Date: 7
Parcel I.D. 050-321-69
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Property owner(s) William R. and Sherri L. Gould Day phone 694-9654
Mailing address 15244 Driftwood Bay Drive Eagle River, AK Zip Code 99577
Site address�jt1N Upper Skyline Drive Zip Code
Legal description (Sub'd., Block & Lot) Lot 1, Kyle and Erica Subdivision
Legal description (Township, Range & Section)
Lot Size 76,800 Sq. Ft.
THIS APPLICATION IS FOR (® all that apply)
Absorption Field
Q
Septic Tank
❑
Holding Tank
❑
Privy
❑
Private Well 0
Water Storage ❑
Number of Bedrooms Foyiv(4� ✓! X-- -- - -- -- -- -- -
1—'
THIS APPLICATION IS AN:
Initial
Q
Upgrade
❑
Renewal
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush
Waiver Fees:
Date of Payment: 61-5167 Date of Payment:
Receipt Number: -f.5—GO 9 60/w Receipt Number.
(Rev. 11105)
MEMORANDUM
DATE: July 2, 2007
TO: Deb Wockenfuss
FROM: Mike Anderson, P.E.
SUBJECT: Lot 1, Kyle and Erica Subdivision
Permit No. SW070098
The owner of the subject property has decided to construct a six bedroom septic
system. We have therefore revised the design for the Advantex System to include a
2,500 gallon tank with 2 AX 20 Pods. The absorption trench has been extended to 38'
to accommodate six bedrooms.
A site visit was made on July 1 to view additional test holes in the area of the new
absorption trenches. All holes were identical in that the depth was 4' to bedrock and
soils encountered included 1' of organics underlain by poorly graded sand (SP). Each
hole including Test Hole Nos. 1 and 2 were accurately located in relation to the new
home site. The location for Test Hole Nos. 1 and 2 are slightly different than our
previous submittal. We have therefore redesigned the absorption trench to be a total
of 3' above ground level. Coarse sand will be imported to raise the trench to provide a
minimum of 6' above bedrock.
The location of the trench is in a lower area and conducive to the placement of backfill.
A minimum of Twill be placed over the trench with the top 6" vegetated with topsoil and
seed. We hereby request the permit be modified to allow the 6 bedroom system.
Please review this data and advise if further information is required.
LOT 1, KYLE AND ERICA SUBDIVISION
DESIGN FACTORS:
Six Bedroom Home
Perc. Rate: 1 to 5 Min./Inch
Application Rate: 4 GPD/SF
SYSTEM REQUIREMENTS:
5' Wide Trench System
6 Bedroom Advantex Treatment System
No Effective Depth
2,500 Gallon Tank
2 - AX20 Pods
6 Bedrooms X 150 GPD/4 GPD/SF (Application Rate) =187.5 SF Absorption Area
187.5 SF/5 SF/LF = 37.5 LF Trench Length
THEREFORE: Construct a Trench 38' Long x 5' Wide with no Effective Depth.
Flow Line Elevation in Trench to be 2.5' Above Original Ground Surface. Total Depth to be
1' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trench. Remove Organic Material to 1' Below Surface and Replace with Filter Sand.
3 Natural Topsoil & Seed
1 Backfill Upper 6"
Plywood w/Bracing 2" Insulation &
to Contain Sand Geotextile Fabric
O 4" Perforated
6"T PVC (Holes Down)
2'0" 1 II �— Drainfield Rock
1'0" 1 I Filter Sand
Contain Sand with Plywood and Bracing at Edges of Trench.
TYPICAL 5' WIDE TRENCH SECTION6M°F,
.•�
(NO SCALE)
i fir. 49th
NOTE: Grade Area Over Trench to Drain Away. i•ry••_..A�•-•••••r -•••
Minimum 6' Separation From Bedrock. ...... "'""""""""'.
Minimum 4' Separation From Groundwater. • �c woem
Minimum 200' Separation From Wells in the Area. �i� s�• No. cele,
Minimum 100' Separation From Surface Water or Streams. �� '�»!�,- 0.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT I, KYLE & ERICA S/D
PERFORMED FOR: GOULD
DATE: 5/22/2007 PROJECT No.:
PARCEL ID#: TECIINICIAN: T. L. KIMBROUGH
Dorm TEST HOLE 1
(fa)
1 OB/OG
4.
2
3 POORLY GRADED SAND
SP
4
•I SILT LENSES
5 ..:.
6 BEDROCK @ 6'
7
8
9
10
11
12
13
14
15
16
17
18
19
SLOPE
WAS GROUNDWATER ENCOUNTERED? NO
IF YES GA WIIATDEPnI'
DEPII OF WATER AFTER MONITORING: Na[ VARIES
DATE OF MONITORING: Si30�o6
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
5/22/07
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
1019
9.5
CHARGE
2
1049
30
3.625
5.875
3
1049
10.125
CHARGE
4
1119
30
4.375
5.75
5
1119
11,0
CHARGE
6
1149
30
5.125
5.875
PERCOLATION RATE: 5.1 (MIN/INCI I) FERC. HOLE DIA. 6 (INCI IES)
TEST RUN BETWEEN: 3_5 FT, and 4_5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE; ; 5/31/2007
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT I, KYLE & ERICA S/D
PERFORMED FOR: GOULD
DATE: 5/22/2007 PROJECT No.:
PARCELID#: TECHNICIAN: T. L. KIMBROUGH
DITTII TEST HOLE 2
Ir1-q
1JEW OB/OG
2 POORLY GRADED SAND
SP
3 e SILT LENSES
4j•BEDROCK @ 4'
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
WAS GROUND WATER ENCOUNTERFD7 No
IF YES ® WI IAT D[P II+
DEFTII OF WATER AFTER MONITORING: NONE VARIES
DATE OF MONITORING: b130/06
DATE
IIIEADIN61GROSS
TIME
(MINUTES)
NET TIME
(MINUTES)
WA ER O
(INCHES)
NET DROP
I (INCHES)
5/22/071
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
1 1025
7.875
CHARGE
2
1055
30
1.75
6.125
3
1055
9.625
CHARGE
4
1125
30
3.625
6.0
5
1125
10,25
CHARGE
6
1155
30
4.25
6.0
PERCOLATION RATE: 5.0 (MIN/INCII) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 1.5 FT. and 2_5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 5/31/2007
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT I, KYLE & ERICA S/D
PERFORMED FOR: BILLY GOULD
DATE: 5/22/2007 PROJECT No.:
PARCEL ID#: TECHMCIAN: M. ANDERSON
DEMI TEST HOLE 3
(rad)
10 WAS GROUND WATER ENCOUNTERED? NO
IF YES @ WIIATOEPn'
DEFTII OF WATER AFTER MOMTORING: VARIES
I I DATE OF MONITORING:
11
1
1
I
1
I
GROSS TIME NET TIME DEPTH TO INET DROP
DATE READING (MINUTES) (MINUTES) WATER(INCHES)
(INCHES)
PERCOLATION RATE;_(MIN/INCII) PERC. HOLE DIA,_(INCHES)
TEST RUN BETWEEN:—FT. and_FT.
COMMENTS: IDENTICAL MATERIAL TO TEST HOLE NOS. I AND 2.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPLE GUIDELINES IN EFFECT ON TFIIS
DATE. 7/2/2007
OB/OG
1
Z
POORLY GRADED SAND
Sp
3
•a "• ;
SILT LENSES
4
BEDROCK @ 4'
5
6
7
8
9
10 WAS GROUND WATER ENCOUNTERED? NO
IF YES @ WIIATOEPn'
DEFTII OF WATER AFTER MOMTORING: VARIES
I I DATE OF MONITORING:
11
1
1
I
1
I
GROSS TIME NET TIME DEPTH TO INET DROP
DATE READING (MINUTES) (MINUTES) WATER(INCHES)
(INCHES)
PERCOLATION RATE;_(MIN/INCII) PERC. HOLE DIA,_(INCHES)
TEST RUN BETWEEN:—FT. and_FT.
COMMENTS: IDENTICAL MATERIAL TO TEST HOLE NOS. I AND 2.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPLE GUIDELINES IN EFFECT ON TFIIS
DATE. 7/2/2007
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT I, KYLE 8 ERICA S/D
PERFORMED FOR: BILLY GOULD
DATE: 5/22/2007 PROJECT NO.:
PARCEL ID#: TECHMCIAN: M. ANDERSON
DErm TEST HOLE 4
O&TO
1 OB/OG
2 POORLY GRADED SAND
SP
3 "• ; SILT LENSES
4 a BEDROCK @ 4'
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
WAS GROUND WATER ENCOUNTERED? Nn
IF YES @ WIIAT DEFD r
DEFnI OF WATER AFTER MONITORING: VARIES
DATE OF MONITORING:
W
GROSS TIME NET TIME DEPTH To NET DROP
DATE READING (MINUTES) (MINUTES) ATER (INCHES)
(INCHES)
PERCOLATION RATE;--(MIN/INCII) PERC. HOLE DIA`INCHES)
TEST RUN BETWEEN:—FT. and—FT.
COMMENTS: IDENTICAL MATERIAL TO TEST HOLE NOS. I AND 2.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 7/2/2007
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT I, KYLE & ERICA S/D
PERFORMED FOR: BILLY GOULD
DATE: 5/22/2007 PROJECT No.:
PARCEL ID#: TECHMCIAN: M. ANDERSON
DEPTH TEST HOLE 5
(fmt)
1 OB/OG
2 POORLY GRADED SAND
SP
3 .a "• SILT LENSES
4 'j BEDROCK @ 4'
5
6
7
8
9
10
11
12
13
14
1
1
1
1
WAS GROUND WATER ENCOUNTERED? No
IF YES FA WI IAT DFPn 11
DEFnI OF WATER AFTER MONrtORING: VARIES
DATE OF MONITORING:
DATE GROSS
NET IDINET
OPIITSI (MINUTES) (INCHES) (INC,
PERCOLATION RATE;__(MIN/INCII) PERC. IIOLE DIA_(ONCHES)
TEST RUN BETWEEN:_FT. and—FT.
COMMENTS: IDENTICAL MATERIAL TO TEST HOLE NOS. I AND 2.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 7/2/2007
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN MUNICIPALITY OF ANCHORAGE
AND
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
Day of
of 20___, by and between ,
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Wastewater
Ab q A..J TE+, " rj oL C.ATMs..!'T—
Treatment System (AWWTS), described as Sy s rL-rA located
at Lor I t I Cy u= -t- G /ta e,II Anchorage, Alaska.
2. Definitions.
A. Alteration. Any change to the design or function of an AW WTS that
Includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design. Prior to
performing any alterations to an AW WTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65.
B. Certificate of On -Site Systems Approval. An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
These approvals certify that the systems are adequate for the homes that
they support and meet the codes that were in place at the time of system
construction.
C. Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
D. Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included in
the original design which would allow the AW WTS to continue to
perform as designed.
E. Permit (Construction) An On -Site Wastewater Disposal System
Construction Permit as defined by AMC 15.65.
F. Permit (Operating) An Advanced Wastewater Treatment System
Operating Permit. An annual permit, issued by the Municipality, that
allows the Owner to operate an AW WTS, upon meeting all the
requirements of this agreement, the conditions of Operating Permit, the
requirements of the On -Site Wastewater System Construction Permit and
all relevant provisions of AMC 15.65 AJ
3. Fee. Owner shall pay to Municipality an annual fee of A O rJ
($ 0 .00), payable on or before the issuance of the operating permit and annually
thereafter. The annual fee is due on or before the anniversary date of the approval by the
Municipality of installed system.
4. Term. The term of this Memorandum of Understanding shall be for the life of the
AW WTS.
The term begins on the date of approval by the Municipality of the installed system and
shall continue while the AWWTS system is in use or operational or until the property is
sold or title is transferred by owner and a new certificate of On -Site approval is issued to
the new owner or transferee of the property.
5. Alterations, installation and Removal of Additional Equipment. Owner agrees
not to make any alterations, removal of parts or additions to the AWWTS without a
Construction Permit from the Municipality.
6. Maintenance and Repairs.
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AWWTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2)
maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
rules and orders for the AWWTS.
Q. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's AWWTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AWWTS
Operating Permit is:
C. Owner acknowledges that the fine schedule for failing to maintain and repair an
AWWTS are codified in AMC 14.60.
D. Owner agrees that only maintenance, repair personnel certified by the
Municipality will inspect and make any necessary maintenance, repairs or permitted
alterations to the system.
E. Owner agrees to grant the Municipality reasonable access to test and inspect the
AW WTS upon 24 hours written notice.
F. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
G. Owner agrees that the relevant provisions of the standard specification guidebook
for AW WTS is the governing professional guidelines for the construction,
maintenance and repair of the Owner's AW WTS.
7. Nonwaiver. The failure of either party at any time to enforce a provision of this
Memorandum of Understanding shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of Understanding or any part
hereof, or the right of such parry thereafter to enforce each and every provision
hereof.
8. Amendment.
A. This Memorandum of Understanding shall only be amended, modified or changed
by a writing, executed by authorized representatives of the parties, with the same
formality of this Memorandum of Understanding was executed and such writing shall
be attached to this Memorandum of Understanding as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this contract, the only authorized representatives of the parties are:
Owner:
Anchorage: Purchasing Officer
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of
Understanding shall be brought in the Superior Court for the Third Judicial District of the
State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and
obligations of the parties under this Memorandum of Understanding.
10. Severability. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
OWNF,R:�_%���G��j�
By:�_/ Pt u[�
Date: Sure, 7
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
MUNICIPALITY:
By:
Title:
Date:
) ss.
The foregoing instrument was acknowledged before me this 'J0-- day of,kk&,L-
29n by 5ttt4x-% 6 cu�D
STATE OF ALASKA
NOTAR PUBLIC FOR ALASKA NOTARY PUBLIC y
a
My Commission expires. ?44-k—(, lozz Tanya Carrier
MV Commission Expires Sept 6.2008
Municipality of Anchorage
Department of Health and Human Services 16
825 "U" Street
Rick Mystrom. P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor
http://www.ci.anchorage.ak.us
June 7, 2000
Leon Hakala
PO Box 672387
Chugiak, AK 99567
Subject: Kyle and Erica, Lot 1
Permit # SW990193 PID # 050-321-69
The subject permit #SW990193 issued by this office for a single family well and/or on-
site wastewater system, is due to expire 365 days after it's issuance on July 14, 1999.
If this is a well permit and you have drilled the well, a well log must be sent to this office
for documentation of the installation and to close the permit.
If this is an on-site wastewater system and a licensed Professional Engineer has inspected
the installation, the original as -built inspection report must be sent to this office for
review, approval and documentation. All inspection reports must be submitted within 30
days of construction completion.
A new permit must be obtained from this office for a well and/or on-site wastewater
system NOT installed by the expiration date. However a new permit can be issued free of
charge for a second year if the application for the renewal is received on or before the
date of expiration of the original permit for which a fee was paid.
When applying for a new permit after the original permit has expired or for more than a
second year, the fees are: $320.00 for an on-site wastewater permit and $120.00 for a well
permit.
If you have any questions, please call this office at 343-4744.
Jahics Cross, PE
Program Manager
On-site Services
enc: Copy of Permit
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number: SW990193
Legal Description: KYLE AND ERICA LT 1
Design Engineer: 0003 S & S Engineering
Owner Name: Leona Hakala
Owner Addre
6DQ CQ-7a3M-
This permit is f,
Disposal Fi
All construction must De in accordance with:
1. The attached approved design.
Date Issued: Jul 14, 1999
Expiration Date: Jul 13, 2000
Parcel ID: 050-321-69
Site Address:
Lot Size: 76800 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
3455
ling Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
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
(907) 343-4744 (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: 7" l y— 9 l
Date: _7—/+1—/ 7
HEALTHAUTHORITY
APPROVALS
SEWER&WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERINGSTUDIES
ANDREPORTS
WELLINSPECTION
& F.LOW TEST
SITE PLANS
ROADDESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
ROBERT C. COWAN, P.E.
CIVIL ENGINEERS
(907)694-2979
FAX(907)694-1211
June 7, 1999
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 1, Kyle & Erica Subdivision
Request you issue a permit to drill a well and install a septic system to serve the
proposed three bedroom dwelling on the referenced property.
One test hole was excavated and percolation tests performed. The approximate location
of the test hole and percolation tests is located on the attached site plan.
At the time of excavation, 10-9-87 water was not found. After seven days of ground
water monitoring the monitoring tube was dry.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the
adjacent properties.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/bjj
Enclosure
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577
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e Municipality of Anchorage .
DEPARTMENT OF HEALTH R HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: L. Co r A- Ff 44t 4 —.4 DATE
4
LEGAL DESCRIPTION:" � 1 k YI-4— 4- rtRWA Township, Range, Section:
SLOPE SITE PLAN
2 sMl
n t P tAi,
3
BNI_y
4-
5
6
7
8
9
10
Date
WAS GROUND WATER
Net Depth to
Time Water
Net
Drop
ENCOUNTERED? _
11
IF YES, AT WHAT
DEPTH?
12
_
:2
Depth to Water After
13
a -O
Menilorin07 Date:
14
15
16
17
18
19
20
COMMENTS
S
L
0
P
E
Reading
Date
Gross
Time
Net Depth to
Time Water
Net
Drop
S D A'vr
1087/4
:2
a -O
1 B '/s-
A ya„
Atf.w
ro 4G r
d-0
1
-a .4
R%F,v
ro 6 V/1,6
n
PERCOLATION RATE • `t (minuteslinch) PERC HOLE DIAMETER 6 -
TEST RUN BETWEEN '� / FT AND i FT
S & S ENGINEERING rlZ(.n�-
PERFORMED BY: r LOOP Oa O. 264 6 CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITS tleftIP&A 4 11 5 111 91 19 0 711- GUIDELINES IN EFFECT ON THIS DATE. DATE: '� /V1 ( 61
72-008 (Rev. 4/85)
e Municipality of Anchorage .
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: I- 0-o N M- 14,114 4 L. A
LEGAL DESCRIPTION: LD / K'rl—OL $' �2i Gp
DEPTH
(FEET) 646.
1
2 S L
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
oNLy
SLOPE
DATE PERFORMED:
Section:
WAS GROUND WATER i✓ O
ENCOUNTERED?
S
IF YES, AT WHAT L
DEPTH? O
P
E
Depth to Water After _
Monitoring? Date:
SITE
Reading
Date
Gross
Time
Net Depth to
Time Water
Net
Drop
pRs
QAK
Rn.r),.i
Yo it 2"
36
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Rh
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YO
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S-0
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PERCOLATION RATE s' % (minutes/inch) PERC HOLE DIAMETER 6 /
TEST RUN BETWEEN 1 /a FT AND a' FT
S & S ENGINEERING
PERFORMED BY: 17034 EdgleKoail No. I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE W191algilth"MEMARIgI19IMPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Ay /q
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L•• Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:�G3-�1�i i v\ Tom—'/moi-1 DATE
LEGAL,DESCRIPTION:LL 6AZ4,c .Township, Range, Section: .
TEPyµ T SLOPE
2
3 �.
5 r
7-
s
9-
1011 to -
11
12-
13-
14-
15-
16-
17
21314151617
18
19
20
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
11
IF YES, AT WHAT
DEPTH?
Depth to Water Alter
Monitoring? Qa=4— Date; 1./n,44
SITE
•
%b«1A.9£helIer
Na 1457.6
PERCOLATION RATE
TEST RUN BETWEEN
PERFORMED BY 117M Eftle RIVK Loop Road N0.
KIVU, 7968kiii
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUI
72-008 (Rev. 4/85)
N
(minutes/inch) PERC HOLE DIAMETER
FT AND 1 �`FT
r — CERTIFY THAT THI TEST WAS PERFORMED IN
ON THIS DATE. DATE:
0���>■l���li0iltY�
PERCOLATION RATE
TEST RUN BETWEEN
PERFORMED BY 117M Eftle RIVK Loop Road N0.
KIVU, 7968kiii
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUI
72-008 (Rev. 4/85)
N
(minutes/inch) PERC HOLE DIAMETER
FT AND 1 �`FT
r — CERTIFY THAT THI TEST WAS PERFORMED IN
ON THIS DATE. DATE:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-321-69
1. GENERAL INFORMATION
cosA # `� 3
Expiration Date:
Complete legal description Lot 1, Kyle and Erica Subdivision
Location (site address) 18700 Upper Skyline Drive Eagle River, AK 99577
Current Property owner(s) William and Sherri Gould Day phone 96-5424
Mailing address 18700 Upper Skyline Drive Eagle River, AK 99577
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup
2. NUMBER OF BEDROOMS: Six (6)
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
✓❑
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 sample results. (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 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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
Phone 522-7773
•� t 1� ►
• Q. ,
�MIOL49L E ANDERSON
CE -4381
5. DSD SIGNATUREp�•. 72: Li—r� ✓w
Approved for 62 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
UA ii:Tl. i Iii -W,
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: — Z
�eaiiron
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
MEMORANDUM
DATE: November 4, 2012
TO: Jeff Poet
FROM: Mike Anderson, P.E.
SUBJECT: Kyle and Erica Subdivision, Lot 1
Septic System Permit No. SW070098
Topsoil and seeding has taken place on the septic system area serving Lot 1, Kyle and
Erica Subdivision. Revegetation is complete and there is no danger of erosion to the
slopes of the completed mound. The conditional status of the inspection report should
be removed.
Municipality of Anchorage
Development Services Department °
Building Safety Division '•:
Onsite Waterand Wastewater Program AILRAI11111191111.
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050321.69
1. GENERAL INFORMATION
Complete legal description lot 1. Kyle and Erica subdivision
COSA #- ()AD3�?C
Expiration Date:
Location (site address) 18700 Upper Skyline Drive Eagle River, AK 99577
Current Prdperty owner(s) Wiliam and Sherri Gould Day phone 696-5424
Mailing address 18700 Upper Skyline Drive Eagle River, AK assn
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD /or pickup.
2. NUMBER OF BEDROOMS: Six (6)
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Q Individual On-site 0
Individual Water Storage ❑ Individual Holding Tank ❑
---Community Class- Well-----❑...--------_--Communi On-site--------- -
Public Water System ❑ Public Sewer ❑
The'Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite 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 Onsite 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 Onsite 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- sample -resufts.—(Certificates maybe -reissued fora period of -up to one-yearwithvalid 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 seat affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined In the Certificate of Onsite 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 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 Finn
Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
V/Conditional approval for lD bedrooms, with the
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rw..,,MS)
Arsenic Advisory
Date 1115a008
ig stipulations: --{-
ji e, C 0t77� I e.l eic�
Maintenance Agreements
Supplemental Engineer's Report
Other
"��'-'7'--Originat Certificate Date:
Municipality of Anchorage
De
velopment Services Department
Building Safety Division
On -Site Water 8 Wastewater Program • +
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsfte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 1. Kyle and Erica Subdivision Parcel ID: 050-321.69
A. WELL DATA
Well type Pula If A, 8, or C provide PWS ID #_ Well Log (Y/N) Y
Date completed 6/8/07 Sanitary seal (YM) Y Wires property protected (YM) v
Total depth 400 ft. Cased to 43 ft. Casing height (above ground) >24 in.
FROM WELL LOG AT INSPECTION
Date of test 6/8/07
Static water level 14 ft ft.
Well production t g.p.m.
g.p.m.
WATER SAMPLE RESULTS:
COlifOrm —L--colonies/100 mL Nitrate 4.5 mg/L Other bacteria 0
colonies/100 mL
Arsenic:N/ mg/I Date of sample: 1o2W06 Collected by: S. Gilbert
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Advantax/Steai
Date installed 7l13n007
Tank size 21500 gal. Number of Compartments Three Cleanouts (YM) Y
Foundation cleanout (Y/N) Y Depression over tank (YM) N High water alarm (Y/N) Y
Date of pumping New construction Pumper
--_-C._ABSORP710NFIELDDATA------__.—...---.--_-._--.--_-_____-._.__
Date installed 7/141=7 Soil rating (g.p.dJft=orft2/bdnn)4 GPD1SF- - - -
System type .7 Wide Trench
Length 40 ft. Width 5 ft. Gravel below pipe s ft.
Total depth 6-B fL Eff. absorption area Zoo ftz Monitoring tube Y Depression over field N
Date of adequacy test New Const Results (Pass/Fail) For_ bedrooms
Fluid depth In absorption field before test in. Water added
_gal. New depth In.
- -------Elapsed Time: min.—Final fluid depth------in.----Absorpfion rate >_ — ---
Any rejuvenation treatment (past 12 mo.) (Y/N 6 type) If yes, give date
D. LIFT STATION
Clete installed Size in gallons
Manhole/Access (YIN)
'Pump on' level at_ in. 'Pump off level at_
in. High water alarm level at in.
Datum Cycles tested
Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot >100'
On adjacent lots >100'
Absorption field on lot >100'
On adjacent lots >100•
Public sewer main N/A
Public sewer manhole/cleanout NIA
Sewer /septic service line >25'
Holding tank N/A
Animal containment areas None
Manurelanimal excrete storage areas None
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation >5' Property line>5_
Absorption field >T
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 170' Building foundation
>10' Water main >1a
Water Service line >10' Surface water >100' Driveway, parkingtvehicie storage >26
Curtain drain None Noted Wells on adjacent lots
>100'
F. COMMENTS' Gravity Flow From Filter Pod to Absorptlon Trench.
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and
.—.review -of.-Municipal -records-that the -above .systems .are in . --
conformance with MOA COSA guidelines in effect on this date.
Engineers Printed Name Michael E. Anderson. P.E.
Date 11/5/2008
COSA Fee $_ "F' J v Waiver Fee $ _
1 l II Date Date of Payment
Date of Payment
' — Receipt Number —Receipt Number,
(Rev. 11105)
MldlAft G-ANbUSON AW
Jf ROFESSta�a o�
ASBUILT
14/OG'JT
I HEREBY CERTIFY •THAT'I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY=
AND THAT NO ENCROACHMEWtS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE TH7 rXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI—
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
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