HomeMy WebLinkAboutWHALEY #4 TR 1DWhaley #4
Trlb
#051 - 111 - 17
Municipality of Anchorage
On-Site Water and Wastewater Program• (907)343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP161074 PID Number 5111117000
Dwelling: 0 Single Family(SF) [' Duplex(D) ❑ Multiple(SF and/or D) Project: 0 New ❑ Upgrade
Name:
Alex Arseneau ABSORPTION FIELD
Address
Bed ❑ Mound
24129 Temple Drive, Chugiak AK 99567 0 Deep Trench [' Shallow Trench 0
❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
907-351-4494 3 0.4 GPD/SF 3 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 2 Ft.1 Ft.
Whaley Subdivision, 4th Addition Tract/D Fill added above original grade Gravel length
Township Range Section 1 Ft.94 Ft.
15 North 1 West 10 Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 12 Ft. 2 6 Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line 1,128 Ft2 Ft.
Well 104 120 65 TANK a Septic 0 S.T.E.P. ❑Holding ❑Other
Manufacturer Capacity
Surface Water >100 >100 Greer 1,000 Gal.
Material Number of compartments
Lot Line 80 22 NA Steel 2
Foundation 50 61 LIFT STATION
Manufacturer Capacity
Curtain Drain >50 >50 Gal.
Pump on level at 'Pump off level at High water alarm at
Remarks Pipe material is PVC ASTM D3034
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tankTank to
PVC PVC
Installer drainfield
Alex Arseneau Drainfield PVC CO/MTPVC
Inspector Sam Carlson, P.E. BENCH MARK (Assumed elevation)474.2 ft
Inspection
iso 8/6/16 2„d 8/28/16 Location and description
3rd 4`” NE corner Tract 1D, NAVD88 (geoid 12b)
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
_`tet\\ S—ID—I"}
Conditional Approval: Date i�P�.•• .s,N 4
1:9 tOj
, Sam T,Carlson :
67 (1'•• CE 114176 .•�i`��
1 ,Approved JaCA Date L/30 7_. , �`6; ,7,; \.4v
Inspection Report_P-1-12.doc
LL
P :
- D _ LAND SURVEYING&
., , CIVIL ENGINEERING PHONE(907)479-4250 I°h%(907)746-4186
April 6, 2017
Municipality of Anchorage c/o
Alex Arseneau
P.O. Box 671055
Chugiak,AK 99567
Re: 0SP161074 permit closeout
Ms. Becca Carroll,
Please see the attached inspection report, as built&profile drawings,well log, percolation
test and photos for the well and septic installed at Tract 1D Whaley Subdivision, 4th
Addition also known as 24129 Temple Drive, Chugiak AK 99567.The well pump will be
installed after the ground thaws. The pump log and water sample will be submitted to you
by the owner immediately after he receives it.
The septic and well were installed according to plan with the exception of 2 additional
inches of insulation throughout the system and PVC (ASTM D3034) was used instead of
HDPE for all pipe.
Please contact me with any questions you may have regarding this permit.
Sam Carlson, P.E.
907-479-4250
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RECORD DATA PER PLAT: TRACT 1 C m o
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TRACT 1A Z PLAT #74-77 0 x_=o_
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SWING TIES:
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+NNW HSE COR.-SEP.'n O P 4(1/ / in z m a m o
TANK VENT=50' m /� =�/\O// LOT 1 ,�_,,ti i{„rrn A
;6�ONW HSE COR.-ABS.D4 z ��,/ �� ,l WHALEY SUBD. -0 ;518
—1FIELD C/0=65' .� ... / o w 5TH ADDITION m z<r 0
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LOT 10 (N 89'56' E 160.00') "'r
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MARIE ESTATES !ti TEMPLE CIRCLE(60' ROW PLAT #76-252) °<
PLAT #76-252 m 7
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AS-BUILT DRAWING OF: 0 25 50 SCALE: 1"=50 FEET
DATE: 5/9/2017
TRACT FILE: 15-83 ARSENEAU
WHALEY SUBDIVISION 4TH ADDN. PROPERTY
°Po ADDRESS: �"°�REEL TRACT ID, SU ou A , DR.,4 99567
ALL POINTS NORTH --- PO BOX 4207. PALMER, AK 99645 TEL: 907-746-4185
EXHIBIT E
4
TWO MONITORING TUBESi/-
TWO CLEANOUTS TWO MONITORING TUBES
TWO CLEANOUTS
(ONE PER PERF. PIPE)
MINIMUM 24" COVER
7 OVER INSULATION FINISH GRADE=504'
4" INSULATION
4" PVC PERF PIPE- 4.. MIN 2" GRAVEL ON TOP OF PERF PIPE INSTALL FILTER FABRIC BETWEEN
GRAVEL AND INSULATION
_ pr_ -
4" NON-_,---."" '‘'''.--PIPE INVERT EL=501'
PERF PIPE -
TOP FIELD BOTTOM FIELD '"`
EL=501.5' EL=500' _�� �v
12" SEWER ROCK
Any�� F •A� `i�
1/2"-2.5" FOR IABSORPT ON LAYER PERCOLATION 4+ /CATION OF �oj�P' 4.---..yt,,
PERCOLATION RATE TEST %*: 49/ .. . � ,1\ *
� /
20MIN/INCH
GWT Of
SIDE PROFILE ABSORPTION FIELD EL=496-'1*-2 — rl � , �
.•. Sam T.Carlson .
+,� Ao
No. 114176 .• <4,419,
N •
•
1. MON. TUBES AT ALL CORNERS OF FIELD, 4 TOTAL
�l�\PROFESSIONP\
2. TEST HOLE WAS EXCAVATED 4/3/16 TO 10.5 FEET DEEP, 490.5'. \AN����ilb.
3. GROUNDWATER WAS OBSERVED ON 5/1/16 AT 496'. 4 -1-77-2,a4 7
s_ i0 - 1-1-
EXHIBIT F
MON. TUBES
CLEANOUT
FINISH GRADE=504'
12.0'-
MINIMUM 24" COVER
— _ 2%_ OVER INSULATION ��\\\\,
4" INSULATION ��. A��S�)
INSTALL FILTER FABRIC BETWEEN I TOP FIELD r,�Q'. . .
GRAVEL AND INSULATION — +- EL=501.5' �Gj •• ��s
MIN 2" GRAVEL ON TOP OF PERF PIPE *'•49TH �� • *
BOTTOM FIELD
4" PVC PERF EL=500' ,Y �,.•
PIPE SPACED `
6' APART, IE=501' 12" SEWER ROCK 6` Sam T.Carlson '
1/2"-2.5" {� f(c No. 114176 .••."`tr
24" IN SITU SOIL LAYER Os �°‘4,-• .••��,.r
FOR ABSORPTION, 1 'pFD o • • • ' •s,',..\:<.. _AP'
PERCOLATION RATE 4+ �`, ROFESStO
20 MIN/INCH `0�\�1Z�
GWT 4/
p,EL=496' ST In -t
CROSS SECTION ABSORPTION FIELD
LOOKING NORTH
EXHIBIT G
J
J
W
0
U-
0
C/0 2' OFFSET
FROM HOUSE
PROPOSED 3 BEDROOM z_
SINGLE FAMILY RESIDENCE
FINISH GRADE
EL=510' FINISH GRADE=504.5'
FINISHED FLOOR
EL=510.7' 50 L.F.
ORIGINAL GRADE C/O C/0 C/0
BOTTOM FOOTER FLOW LINE EL=506'
EL=508.7' SLOPE=
2Z MAX. 10 L.F. 0 ABSORPTION BED
4" PVC NON PERF PIPE —FLOW LINE EL=501
WITH 2" INSULATION MOA APPROVED 2 PART
SEPTIC TANK, 1,000 GALLON I 4" PVC NON PERF PIPE
WHEN LESS THAN 4' CAPACITY WITH 4" INSULATION WITH 4" INSULATION
COVER
FLOW LINE EL=502.2' FLOW LINE EL=501.2'
GWT
EL=4 fi– -
SZ
SEPTIC TANK PROFILE OF
qS����
N.T.S. �* 49TH %\ •*�l
e
tl Sam T,Carlson
. No. 114176
F,PROFESSIONP�4
_Iv-
EXHIBIT H
4" PVC NON- TOP BED EL=5015
PEDGE OF ABSORPTION BEDMON. TUBE (TYP.)
OF FROM SEPTIC TANK BOTTOM BED EL7=500'
_ftr6 TE=501.
• 3.0'
t
4" PVC PERF PIPE OFFSET 3' FROM OUTER EDGE OF ABSORPTION 3.0'-----i PERFORATIONS PLACED DOWN AND ENDS OF 12
PIPE ARE CAPPED. t
3.0'1 _• -
3.0'
T C.O. (TYP.)
94'
**NOTE: ALL PIPE IN ABSORPTION FIELD LAID LEVEL
ABSORPTION BED PLAN *�• TH N.:, '`w*OA
N.T.S. 49— .
V---)-‘7-. V . �
T Sam T.Carlson /
�104 �F No.114176 ' ��
+!l`;pROFESSnws 4
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4/17/2017
. �Azu
Municipality of Anchorage �� I EERs -ti
Development Services Department *: 4 Q TH
•
Building Safety Division "
f r On-Site Water and Wastewater Program �� �
4700 Elmore Road / !r.L, , �„Cf�t!I4
_�; t— P.O Box 196650 Anchorage,AK 99507 ((`__
..w. ci anchorage ak us / , ', m T.Carlson .�
_ (907)343-7904 ';.,•. No. 114176 •00- k:'/
Soils Log - Percolation Test Ale
‘~!. ,,_,FEgS," ��-
For A I.-X /4 r 5-L h��-� Date Performed' gi-7t.- _qc"--
Performedb
Legal Description: Whg 14--(l `i 141 h-dell/)007 Tr. /Dtownship Range.Section: 71 SN 121 W $tC. ( 0
Slope Site Plan
d k-
..\ . ,
pp Y
Depth C\07_ 7 li
(Feet) u�
1-r///---+�Ps o;T � N
N.
fs
2- �,`• s P l —;,S �,� ��
3- 4 . �,�,.,,,Qly sw^� 1
1 C,7
5- \ '
7-
I, .k`
eliiii .8-
WAS GROUND WATER
9- ENCOUNTERED'
10- IF YES,AT WHAT DEPTH'S /r
Depth to Water After
11- — Monitoring? G
12- Dale
13-
14- Reading Date Gross Time Net Time Depth to Water Net Drop
15- 0 8/20/IL H130 t 0 0
16- l 0 LI AO t o t I
17- 20 y..CO 10 1.`�5 0.14
18- 3 O 5'.co t D 2.5 0.1-5
19- `i 5- : 10 to 3 v_5
20- cD J 5 •, 0
z° t 0 3.5 v.s
10 5 .$D 1 o y D.s
PERCOLATION RATE '2wr�1 iminuiesnnrn• PERC HOLE DIAMETER 6 !Ac h
TEST RUN BETWEEN 3.S FT AND • •. FT
COMMENTS 3 81drO-D11OM.2 Y ASO GPO r3-e' Syfte-"ir
PERFORMED BY: 544-,viT ` rlJ an I ,'•1 T. (-1 1YLCERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICI L GUIDELINES IN EFFECT ON THIS DATE DATE 8120/14,
Certified Drilling Log
DOC CO dba
IP
001161LL 8. COLE WELLS
4ULLIVAN WATER
aellil-- P.O. Box 670269, Chugiak,AK 99567 688-2759
OWNER OF LAND: Alex Arseneau Bore Hole Data
ADDRESS: 24129 Temple Dr. Chugiak,AK 99567 Depth
LEGAL DESCRIPTION Whaley#4 TR 1D From To
DATE: 1-28-17 0 2 Casing Stickup
PERMIT NUMBER: OSP161074 DATE OF ISSUE: 5-6-16
TAX IDENTIFICATION NUMBER 05111117000 2 4 Overburden
Is well located at approved permit location: Yes ElNo 4 50 Tight Silty Sand &Gravel
Method of Drilling: Flair rotary ❑cable tool 50 55 Silty Sand &Gravel w/Clay
Depth of Well: 245' 55 59 Boulder
Casing Type: Steel Wall thickness .250 inches 59 102 Hardpan &Cobbles
Diameter: 6 inches, depth 231 feet
102 115 Sand &Gravel
Liner type
Static Water Level: 189 feet 115 121 Boulder
Recovery Rate 15 N gpm n gph 121 179 Sand &Gravel Cobbles
Method of Testing 179 189 Silt&Sand
Well Intake Opening Type:N open end _open hole
n Screened Start feet Stopped
189 226 Tight Sand & Gravel w/ Boulders
C Perforations Start feet Stopped 226 238 Sand & Gravel Water
Grout Type: Bentonite Volume: 50 lbs 238 245 Hardpan &Cobbles
Depth:from 2 feet,to 42 feet
Well Disinfected Upon Completion: Flyes F no
Method of Disinfection: Chlorine 50 PPM
Comments:
WATER QUALITY TESTING
Cdlform uwrf Co11100m
Nitrates 2.5 1 m8lt-
Araenic Nm ug/L
Drillers Name: Cole Sullivan
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.
DOG GO dba
IP
iiLLWiN WATER WELLS
.... s*
P.O. Box 670269, Chugiak,AK 99567 688-2759
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number: SW OSP161074 Date of Issue 5-6-16
Parcel Identification Number: 05111117000
Legal Description Property Owner Name &Address
Whaley#4 TR 1D Alex Arseneau 24115 Temple Drive Chugiak,AK 99567
Pump Installation Date: 5-3-17
Pump Intake Depth Below Top of Well Casing: 210 feet
Pump manufacturer's Name: Goulds
Pump Model: 10SB10412CL
Pump Size: 1 hp
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Installer: Sullivan Water Wells
Disinfected Upon Completion? ® yes ❑ no
Method of Disinfection: Chlorine 50 PPM
Comments: Pitless Manufacturer: Martinson
Pump Installers Name: Sullivan Water Wells
Attention:The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Permit Number:
Tax Code Number:
Work Type:
Permit Effective Dates:
Design Engineer:
Subdivision:
Site Legal Address:
Owner/Address:
On-Site Water & Wastewater System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
OSP161074
05111117000
WelISeptic Initial
May 06, 2016 to May 06, 2017
Schillinger Max
WHALEY #4
WHALEY#4TR 1D G:1361
ARSENEAU ALEXANDER D
24129 TEMPLE DRIVE CHUGIAK AK 995670000
epartment
Site Mailing Address: 24115 TEMPLE DR, Chugiak
This permit is for the construction of:
Y Disposal Field Y SepticTank
N Holding Tank N Privy
Lot Size in Sq Ft: 6621
Total Bedrooms: 3
Y Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours pdor to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
~~RIOR TO CONSTRUCTION: A percolation test shall be completed at THp ~
(shown on Exhibit A) to verify the proposed drainfield application rate. An approved change order ~
shall be issued prior to construction if design revisions are required. Percolation test results shall ~:
be submitted with the inspection report. ~
Date:
Date:
Community Development Department
Development Services Division
On-Site Water & Wastewater Program
MUNICIPALITY OF ANCHORAGE
~ Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION~V~ ~,,¢'v''/W.~. ~/07-~,¢'-4'z/1¢¢'
Parcel I.D. 05\\
Property owner(s)
Mailing address,
Site address ~k~ 6~)~
Day phone cl
Legal description (Sub'd., Block & Lot) ~¼¢-~,4¢¢q ~L
Legal description (Township, Range & Section)
Lot Size I Sq. Ft. Number of Bedrooms
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
([~;~] all that apply)
Absorption Field ~ Initial [] Single Family (SF) []
Septic Tank [] Upgrade [] (w/wo ADU)
Holding Tank ' [] Renewal [] Duplex (D). []
Multiple Dwellings []
Privy [] (SF and/or D)
Private Well []
Water Storage []
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
(Signature of property owner or authorized agent)
Permit/Rush Fees: ~"3¢~ ¢. ~'15"" '~ q~¥ ~Waiver Fees:
Date of Payment: C~ Date'ofPayment:
Receipt Number: t¢1-¢~O q Receipt Number:
Permit No. (~:)~t¢l{o I D~ Waiver No.
Municipality of Anchorage c/o
Alex Arseneau
P.O. Box 671055
Chugiak, AK 99567
Re: Onsite wastewater disposal system design for the Arseneau proposed 3 Bedroom House
Background Information:
Legal Description: Tract 1 D Whaley Subdivision, 4th Addition
Property Address: 24129 Temple Drive, Chugiak
Owner: Alex Arseneau
Tax Id: 051-111-17-000
Type of Residence: New Single Family
Number of Bedrooms: 3
Existing Site Conditions:
The existing site conditions are shown on the site plan (see Exhibit A.) The existing ground is
mostly cleared and slopes generally to the Northwest. Lots on all sides are developed.
Therefore neighboring septic fields and wells were asbuilt such as to be able to verify setbacks.
Existing Soil Conditions:
Soil conditions on site varied from gravelly sands (SP) to silty gravels (GM) as classified with the
Unified Soil Classification system. A percolation test was taken on May 1, 2016 4 feet below
original ground. The test, attached on Exhibit J, showed a percolation rate of 20 minutes per inch.
A deep test hole was also dug. Bed rock was found 10.5 feet below original ground. Water
seepage was observed around 6.5 feet below original ground.
Design of Wastewater Disposal System:
The preliminary design of the system is as follows (with any references in parenthesis):
· Septic Tank 1,000 gallon (Exhibit B)
· Percolation rate 20 min./inch (Exhibit J)
· Absorption Field Criteria 1,125 square feet (Exhibit C)
Provided:
· 12 ft wide x 94 ft length = 1,128 square feet
See Exhibit E for a side profile.
See Exhibit F for a cross section.
See Exhibit G for a septic profile.
See Exhibit H for an absorption bed plan.
See Exhibit I for a materials list.
Please contact me should you have any questions about this system.
Max A. Schillinger, PE
OWNERS
PROPOSE[
(~)WELL
FF=510.7
PROPOSED
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/
AP ~: ~1-11-123 ~ ~ / '
5UEVEYOE/ENCINEEE
P.O, Box 4207,
~lmer, AK. 99645
LLINGER.
I
TRACT 1C WHALEY SUBD
EXHIBIT A
· x k 5chiilinger
LS-1203~
o5/07/2o16
TRACT 1D WHALEY SUBD 4TH ADDN.
Containing 1,52 Acres
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Materials List
1. Two Compartment Septic Tank
2. Aggregate
Size:
Sewer Rock
Size:
Quantity:
Sand Filter
Quantity:
3, Pipe Materials
4" Drainfield (leegth in feet)
Cast Iron
ASTM D3034 (PVC)
ASTM F789 (PVC)
ASTM D2662 (ABS)
ASTM D2751 (ABS)
ASTM F810 (HDPE)
4" Cleanout/Standpipe (length in tent)
Cast Iron
ASTM D3034 (PVC)
ASTM F789 (PVC)
ASTM D2662 (ABS)
4. Miscellaneous
Couplings Needed (Caulder, Femco, or equivalent)
1,000 gallon
MOA approved
1/2" - 2 1/2"
42 cy
n/a
see Exhibit G/H
EXHIBIT I
5. Other Materials
(List any sealants or other materials needed)
General Material Specifications
Couplings
Caulder, Fernco, or equivalent
Insulation
Dow Chemical Co. Styrofoam HI (Blue Board) or equivalent
Septic tanks
Must meet plumbing code requirements and be watertight
Wood septic tanks
NOT ACCEPTABLE
Filter Fabric
Typar 3401, Mirafi 140N, or equivalent
Sewer Rock: 1/2" - 2 1/2"
Backfill (screened rock)~3/4" [u 3~ screened rock with less
than 3% passing #200 sieve residual, unless prior waiver
issued due to remoteness, etc.
Sizing (requirements)~for deep trench and pits
3;4' [u i.5" ~or bed and shallow trench type systems
1/2" - 2 1/2"
Filter Fabric (enter amounts)
Typar 3401
see Exhibit H
Mirefi 140N
Insulation ([~ow Chemical, Styrofoam HI or equivalent)
amount see Exhibit E/F
Performed For:
Legal Description:
11-
14-
15-
16-
17-
18-
19-
20-
On-Site Water and Wastewa~r Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
wvAv. d.ancheraae.ek.us ~ I
Soils LOg - Percolation Test '7'/'/-~ ~ .........' ..xq
Slope
II
II
I,I
I%1~
I Id
II
II
II
WAS GROUND WATER
ENCOUNTERED?
I D ~ IF YES, AT WHAT DEPTH?
Depth to Water A~er
Monrmrlng?
Towr~hip, Range, Section: TISN RIJ Site Plan
Reading Cate Gross Time Net Time Depth to WaterNet Drop
¢.- '~5,~,~ ~,~ h 0
~ I~,~,,,, i~ ~,~' I, z5
PERCOLATION RATE '~..~) (mlnutes4n~) PERC HOLE DIAMETER
TEST RUN 8ET~NEEN ,'~ FT AND ~/ FT
COMMENTS ~ ~gOP, OOfV) I~.~F ,. ~0 ~P~;
~¢ ~ ~ yF~ ~,~ ~N~I 6ov~ Z'~,N
PERF..E. IN ACCORDANCE .TH ALL STATE AN::UNIOIP~ ~UIDELCES ,~FFECT ON THIS DATE. DATE:
MUNICIPALITY OF ANCHORAGE
Community Development Department ~,~ Phone: 907-343-7904
On-Site Water & Wastewater Program ~ Fax: 907-343-7997
Septic System Owner-installer A.qreement
A real estate property owner (Owner) may install their own septic system.
The department may issue an approval for a homeowner to perform work on a conventional
(not A I4,14/TS) on-site wastewater disposal system to serve that individual's owner-occupied,
single-family or duplex home if the homeowner satisfies and agrees to the following
requirements.
The property owner and excavation equipment operator may perform work on no more than
one owner installed project in a 12-month period.
As owner of (legal description) ~O~' \~.~ ~ ~,r~5¢~,~- ~ ~~ ~ '~-''
following items are true and accurate.
I agree the
1. My experience installing septic systems is as follows.
2. The name of the excavation equipment operator is. /Z~/~X:
3. There will not be compensation for installation services rendered.
4. I will be actively involved with the septic system installation at all times.
5. The nameofthe inspecting engineeris
6. I agree to discuss the following items with the inspecting engineer:
a. Permit design criteria and specifications.
b. Inspection requirements set forth in AMC 15.65.150.
c. 2-hour minimum advance notice given to the On-site Water & Wastewater
Program for all required municipal inspections.
7. I agree any changes make to the items listed above will require a new approval before
performing work.
8. I agree to have the project-specific On-site Wastewater Disposal System Permit available
at the construction site for the duration of all related work.
Owner's printed name: ~I~'X
Septic System Owner Installer Agreement_Feb2015.doc