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HomeMy WebLinkAboutHAMANN LT 1AHamann Lot 1 A #050-611-35 Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: OSP IRII 3'i PID Number: b o- (a - Name:grUgF CP— _ManWastewater System: El New ®Upgrade Address: a4005 At 5 en ow pc, ABSORPTION FIELD Phone: Number of Bedrooms: ❑Deep Trench AShalbw Trench ❑ Bed ❑ Mound ❑Other: LEGAL DESCRIPTION Soil Rating: 4 Total Depth from original grade: 3.1 GPD/Fe Ft. Block: Lot: Subrlmsion: Depth to pipe bottom from original grade: Gravel depth beneath pipe: �n -/ [A AMN1V 2.!3 Ft. 1.1 R. Township: Range: section: Fill added above original grade: Gravel Length: 0-1 Ft. 3Z Ft. Well: Ei(15f1n ❑ New ❑ Upgrade Gravely Idth: S Numberoflines: I Distance between lines: FL Ft. Classification (Private, B, C): Total Depth: Cased to: Total absorption area: (Q Pipe p Fl. Ft. v F� dG1Material: 1D h l r V Driller. Date Drilled: static Water Level: Installer: a �EAIn C Data lnstalletl' � 28 �t Ft. ong�. Yield: Pump Set at: Casing Height Abe"Ground: TANK GPM FL Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. Other: To Septic Absorption Lift Holding uble/Pdvate Manufacture/1r: 6toC Capacity: I Ib00 From Tank Field Station Tank sewer Line C`ie Gal. Well (00+ 1001+ 1001' N1A 1 25t Material: Fiber 155 Number of Compartments: 1 41 Surface Water lot tool+ qo'} p/ A Z LIFT STATION Lot Line tot+ rize: 10 + to 1 It. NIA /y� 1600 -.. Gal. Manufacurtrrer: /� 1310 Cycle Foundation 5'+ I 1 D + s'+ N h 'Pump on, level at: ZS 'Pump ofP level at / qq II High water alarm ab Z�, t/Z, in. Z in. in. Curtain Dram so I k so'* 5a + NIA Pump Make & Model B.ddcel Inspectlons performed by: �tam�len en on Remarks: J ,/tI fX451in Ta„k 4b,n pa AOA BENCH MARK on LOMIthm and Description: Salon Silly, F.C.0, repi'm wlen s. Assumed Bevaum ILO Ft Inspections performed by: L/A$ SPQF_kla.� Dates: tat Z`b li En Tj `�OFq��p\� 111 rid 2 PSE..... • , �qs f� It Development Services Department Approval 49TH 9 :. Conditional Approval — — - -- Date: !- j % Ra H SPURKAND., ;or / 81 00 �/ rl, IV / a Date:1-93-14' Reviewed and approved by: �.\ gnrod) `\F�PROF S110�P� . \ (Rev. INSTALLED 4-BEDROOM S£P77C SYSTEM/ B10CYCLE AWTS W/ SHALLOW TRENCH LENGTH 32 FEET I WIDTH 5.0 FEET ' I 1 W DEPTH 3.9 FEET ROCK DEPTH 1.1 FEET INSULATION 2 INCHES COVER 3 FEET LUT 3B� t' / W \ TH D f LUT 14 ABAIIINDONED EXISTING SEPTIC / 2I C YSTEM PER UPC REQUIREMENTS EXISTING F.C.O A •eall I SWING TIES wI FAT B \ter Well RT \ LUT 5 -¢- well ♦♦♦'(E NOTE: THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC i LOCATIO,VS TAKEN FROM ON-SITE WATER AND WASTE WATER itf DEPARTMENT DOCUMENTATIOM ALL LOCA77ONS SHOWN ARE f 49th APPROXIMATE. I •••"" %...oa ••..... SI 25 0 25 50 75 100 125 150 I�f���, ,,No. �t SCALE., 1' = 50 FT, ��:.' •. bJ. LUT 1B 0 SPURKLAND ENGINEERING I I f1AMANN LOT IA ENGINEERING LOT IA I�SEPTIC SYSTEM ASBUXrSYSTEM ASBUXT 203 W 15TH. AVENUE BRUCE HERMAN DATE. AUGUST 9, 2011 qgo A . 99501 24001 ALP£NGLOW DR., EAGLE R/V£R, AK 99177 SH€€T.• 1 3 MID: 2322 LNC 2 9-3916 % PERMIT #DSP111134 PID # 050-611-35 HAMANNLIADLDVG 4' AfiW7 R ASTM 3034 T.H. •(3bTEXT/L£ ELEK-- 103.9' ' 24' MAX EG. £LEV.= 10.3.5' BACK F2 /i -I/ PVC DISCNWGE 3 SEVER RDC G� ELEV.= 100.8' 2-1/2' NIIAIS ° Nq I o m � `o � ELEV.=99.699.6 ' STANDARD TRENCH NTS ELEV.= 89.5' INSTALLATION F0Nm muv aEAN wT SLOPE FINISIEB GRADE AVAY F TOP IN ALL BRECTIOK4 M PVC INVENT ® PFWP WY CHAMBER 0 AIMTBM CM4M&R mCLARIFIER ®DISCHARGE CHAMBER MTTDN OF TANG 1. EXCAVATE A 10' x 10' x 10' DEEP HOLE FOR BIOCYCLE SYSTEM 2. PLACE A MINIMUM OF 4' SAND OR GRAVEL FOR LEVELING COURSE IN THE BOTTOM DF THE EXCAVATION COMPACT AS REOUIREA. 3 PLACE 4 SHEETS OF 2' x 8' x 2' DIRECT BURIAL RIGID INSULATION ON TOP OF COMPACTED LEVELING CDUQSE TO PROTECT BOTTOM OF FIBERGLASS TANK. TAKE EXTRA CARE TO ASSURE THAT INSMATIDN CDURSE IS LEVEL IN ALL DIRECTIONS 4. BACKFILL AROUND TANK UP TO INVERT DF 4' INFLUENT AND 1-1/4' EFFLUENT LINES VlrH FREE-FLOWING NSF MATERIAL FREE OF LARGE STONES DR BDULDERS MONITOR TUBE CAP END O 1-1/4' SCHEDULE 40 PUC V/ 1/8' 2-1/2' MINUS SEVER ROCK C BENCH MARK BOTTOM SIDING 0 F.C.O. ASSUMED £L£VA77ON IS 100' I SPURKLAND ENGINEERINGI I HAMANN LOT IA I I SEPTIC SYSTEM ASSUILT I 203 W 15TH. AVENUE BRUCE HERMAN DATE.' AUGUST 9, 2011 WA AAR, 24005 ALP£NOLOW DIE £AOL£ RIVER, AK 55577 SHf9Ti /r3 ORID: SJ22 ' PERMIT # IISPIII134 PID # 050-611-35 - HAMAAM21A.ft ' Wockenfuss, Deborah M. From: Lars Spurkland [Lspurkland@gci.net] Sent: Wednesday, July 11, 2012 7:31 AM To: Wockenfuss, Deborah M. Subject: Expired Permits List Haman Lot 1A Debbie, Here is the letter (email) I finally got from the electrician. Lars -----Original Message ----- From: Aaron Sent: Monday, July 09, 2012 2:46 PM To: lbetts@gci.net Subject: 24005 Alpenglow dr. Bio Cycle - Power Lighting and Control, Aaron Chambers 242-5211 The project consisted of a new nema 3 panel next to service on the right back corner of building.From panel power was run in emt using water tight fittings until it transitioned to under ground via ltfmc To the best of my knowledge everything was installed to code.If there are concerns or questions please contact the number provided and I will do my best to answer them. Thank you Aaron Chambers tis X36389 1 On -Site Wastewater Disposal 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 Permit Number: OSP111134 Tax Code Number: 05061135000 Work Type: Septic Upgrade Permit Effective Dates: July 21, 2011 to July 20, 2012 Design Engineer: SPURKLAND ENGINEERING Subdivision: HAMANN Site Legal Address: HAMANN LT 1A G:0161 Owner/Address: PEAKE DEVON J PO BOX 202044 ANCHORAGE AK 995202044 Site Mailing Address: 24005 ALPENGLOW DR, Eagle River Lot Size in Sq Ft: 59573 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage c' 51:3 3 (0 / v 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 prior 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. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: 7122-1 11 t? -1) 1 Municipality of Anchorage Development Services Department Onsite Water and Wastewater Program mcnt S, '0 �. V Department **** VARIANCE/WAIVER REVIEW **** Waiver#: SP111327 COSA#: PID#: 050-611-35 Legal Description: Hamann Lot 1A Engineer: Spurkland Engineerinq Applicant: Bruce Herman Permit#: OSP111134 Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the surface water has been approved. The approved separation distance is 90.0 feet. This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. .................................................... a....... 0.................. Waiver is Granted: X Waiver is not Granted: Date: V 7 // Approved by: Name of Reviewer .................................. a........... a..... a ...... ... i..............• Rec#: NA Amount: Date Paid: **** VARIANCEMAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 050 -(oh -3-5 Property owner(s) Etira pelzmearl Day phone 2 S0- 218-F Mailing address PO t&x -7-10 5v5 EAy/�; ./AK 99 6"74 Site address 2 Y005 Alaen sc16 � (give Legal description (Sub'd., Block & Lot) Namznn 41 /A Legal description (Township, Range & Section) Lot Size _59, 57 3 Sq. Ft. Number of Bedrooms 41 THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (M all that apply) Initial ❑ Absorption Field Septic Tank Upgrade Q Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 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. (Signatude of property owner or authorized agent) Fees: of Payment: Receipt Number: d � C) �)(o-1 Permit No. 05P I M 31 Waiver Fees: Date of Payment: Receipt Number: Waiver No. d S P 1113 Z7 Ab%�Jcr G:\Building\On Site\Forms\Client FormsTermit App_01 041 1.doc (Rev. 1 /11) �� } Saar M and C�ngoines ong '� Environmental Consulting and Design SEPTIC SYSTEM DESIGN HAMANN LOT 1A Municipality of Anchorage June 16, 2011 Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 Subject: Septic System Installation Permit 24005 Alpenglow Dr. Ladies and Gentlemen: I am writing to request a permit to upgrade the septic system for the above referenced property. The proposed system will serve a 3 -bedroom single-family residence. The existing system was flooded during breakup, possibly due to the installation of drainage features along Eagle River Road last summer. Soil logs, design calculations, a site plan, design drawings and construction specifications are enclosed for your review. Design Calcs: No Groundwater observed to a depth of 14 feet below ground surface (5/10/2011) Soil Rating. From Testhole 5/18/2011 3.6 min/in = 4 gal per sq.ft/day No. of Bedrooms 4 Required Area per Bedroom: 150/ 4 =37.5 sq.ft. Total area required: 37.5x 4 = 150 sgft System: We are proposing a BioCycle AW WTS, and a shallow trench absorption field. The absorption field will be 30 feet long and 5 feet wide and contain 1 foot (172 sq.ft. effective) of sewer rock. Sails: A test holes was excavated on May 10'x', 2011. See the attached soil logs. Ground water was monitored for through May 18`h, 2011. Ground water was not observed. Surface Water: A drainage ditch was constructed by the MOA last summer. Run off from Eagle River Road is channeled into a infiltration basin off the north west corner of the property. An overflow storm drain captures the excess storm water and transports it along the west property line. The out fall of the storm drain is +/- 100 feet from the proposed BioCycle location. Topography: The lot slopes to the south at approximately 20% Waivers: Septic Tank to surface water. 203 West 15`x' Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net SPLIT and ERgoIMBOToimg Environmental Consulting and Design go I The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or concerns, please contact me at 279-3916. Sincerely, Lars Spurand, P.E. Civil Engineer 203 West 15`h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net ARM" SPUME Nd ENU�W@Mmu Environmental Consulting and Design June 22, 2011 Municipality of Anchorage Development Services Department On Site Water and Wastewater Program 4700 South Braeaw St. Anchorage; Alaska 99516 Subject: WAVIER REQUEST HAMANN LOT I Ladies and Gentlemen: We are applying for a waiver of the separation distances required between a proposed septic system upgrade and a storm drain outfall paralleling the west edge of this lot. A new 1600 gallon BioCycle tank is proposed for installation at the above referenced property. The BioCycle system is an advanced treatment unit consisting of an insulated fiberglass tank that processes household waste- in four separate compartments producing a clarified effluent. High water alarms and a maintenance agreement with Biocycle insures operational problems are quickly identified and corrected. The maintenance and monitoring program virtually insures that septic system overflow will be immediately recognized and properly dealt with. If the septic tank were to overflow, sewage would drain in a south east direction and would have to travel overland through a high use area for over 100 feet before it could contaminate any surface waters.This effluent is disposed of in a shallow trench absorption field located over 100 feet from the storm drain outfall to the south west. The proposed BioCycle AWWTS Tank does not pose a hieh contamination risk to the surface water. A drainage ditch was constructed by the MOA last summer. Run off from Eagle River Road is channeled into an infiltration basin off the north west corner of the property. An overflow storm drain captures the excess storm water and transports it along the west property line. The out fall of the storm drain is +/- 95 feet from the proposed BioCycle location. Due to the depth of the existing sewer line and the slope behind the house the location of the BioCycle tank is confined to the area proposed. Waiver Request: 90 feet from BioCycle Tank to Storm drain outfall At this time we are applying for an On Site System Approval, and request that a formal waiver be granted. The home owners feel they should not be responsible for the payment of the Onsite 203 Rest 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurkiandEng a-gei.net Environmental Consulting and Design programs waiver fee because it was the MOA that created the set back problem with the construction of the storm drain out fall in its present location. If you have any questions or are in need of additional information please contact me at 279-3916. S jaLars Spu klan, P.E. Spurkland Engineering 203 West 15`h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gci.net PARK SUNNY GLEN DRI �eptic—y rea p I Iti LET 5 IW �P I / LN - LET IA OEE� �Sgtic!} Fr a wn I LOT IB I \ � I \ I LET 5C VACENT \ �\ NOTE. THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC AN LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER E A APPROXI .... . Nr DOCUMENTATION. ALL LOCATIONS SHOWN ARE.... 50 0 50 100 150 200 250 300 SCALE: 1' = 100 FT. R$ SPURKLAN➢ No. CE -11500 SPURKLAND ENGINEERINGI I HAMANN LUT IA I I SEPTIC SYSTEM DESIGN 203 W K. 99501 TH. AVENUE ANCH. AK. BRUCE HERMAN DATE: JUNE 2, 2011 (907) 279-3916 24005 ALPENGLOW DR., EAGLE RIVER, AK 99577 SHEET.• 1/3 GRID: 2322 PERMIT #ESP1110XX PID # 050-611-35 HAMANNLIADI,DWG I �I WI W L T 3B of e tl J jl ea . ^I oG I I Iti LET 5 IW �P I / LN - LET IA OEE� �Sgtic!} Fr a wn I LOT IB I \ � I \ I LET 5C VACENT \ �\ NOTE. THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC AN LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER E A APPROXI .... . Nr DOCUMENTATION. ALL LOCATIONS SHOWN ARE.... 50 0 50 100 150 200 250 300 SCALE: 1' = 100 FT. R$ SPURKLAN➢ No. CE -11500 SPURKLAND ENGINEERINGI I HAMANN LUT IA I I SEPTIC SYSTEM DESIGN 203 W K. 99501 TH. AVENUE ANCH. AK. BRUCE HERMAN DATE: JUNE 2, 2011 (907) 279-3916 24005 ALPENGLOW DR., EAGLE RIVER, AK 99577 SHEET.• 1/3 GRID: 2322 PERMIT #ESP1110XX PID # 050-611-35 HAMANNLIADI,DWG c LOT 3B h C / L2 N Q \ Se tic EXISTIJJF.C.O� Area OI a /0, � F \ INSTALL 3-80ROOM SEPTIC SYSTEM BIOCYCLE AWTS W/ SHALLOW TRENCH LENGTH 30 FEET WIDTH 5.0 FEET MAX DEPTH 3 FEET ROCK DEPTH 1 FEET INSULATION 2 INCHES COVER 2.0 FEET N\ l� \ LOT 5 Y Well NOTE. THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON—SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. 25 0 25 50 75 100 125 150 SCALE. I' = 50 FT Well LOT IB SPURKLAND [1 SPURKLAND ENGINEERING I I HAMANN LOT IAI I SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE BRUCE HERMAN DATE: JUNE 2, 2011 ANCH. AK.(907) 279 39161 24003 ALPENGLOW DR., EAGLE RIVER, AK 99377 SHEET.• 1/3 GRID: 2322 PERMIT #OSPIIIOXX PIE If 050-611-35 HAMANNLIADLDWG FOU0,0411 N CLEAN WT 4' MONITOR ASTM 3034 GRADE TO DRAIN SLOPE FINISHEDGRADE AWAY T.M. 2 -IN /NSULATDdN 6' MIN �FRUR TOP INNAL ALL DIR£CT76NS GEOT£XTRE ]ELEV.= 100+/ 24' NAX NITE.G. ELEV.= 4 0 BACK FILL R, -1/ PVC DISCHARGE 1V7 SEVER ROCK ,y� ELl:Y- 4- PVC INFLUENT ° a-1/2' MINUS �T,j''X'Yi q + o ® m PPRIMARY CHAMBER o I`/Sy'YI) / h ® AERATILN CHAMBER o ti •� 1' ® iL (3)CLARIFIER OBISCHARQ CHAMBER f-BGTTrnr LF TANK 30' — ............... .......... BLUEBOAR➢ INSL4ATIIIN STANDARD TRENCH Ha' -a' 4' SAND/GRAVEL NTS LEVELAG COURSE, COWACT£D B.O.I. ELEV.= INSTALLATIDN L EXCAVATE A 10' x 10' x 10' DEEP HOLE FUR BIOCYCLE SYSTEM, 2. PLACE A MINIMUM OF 4' SAND UR GRAVEL FUR LEVELING COURSE IN THE BOTTOM OF THE EXCAVATIDN. COMPACT AS REQUIRED. 3, PLACE 4 SHEETS OF 2' x 8' x 2' DIRECT BURIAL RIGIB INSULATION ON TOP DF CUMPACTED LEVELING COURSE TU PROTECT BOTTOM DF FIBERGLASS TANK. TAKE EXTRA CARE TO ASSURE THAT INSULATIDN COURSE IS LEVEL IN ALL DIRECTIONS 4, BACKFILL AROUND TANK UP TO INVERT OF 4' INFLUENT AND 1-1/4' EFFLUENT LINES WITH FREE-FLOWING NSF MATERIAL FREE OF LARGE STONES OR BOULDERS SANB/GRAVEL BACKFILL MONITOR TUBE' CAP END O 1-1/4' SCHEDULE 40 PVC W/ 1/8' HDLES @ 30' O 2-112' MINUS SEWER ROCK MUNITUR TUBE SPURKLAND ENGINEERING HAMANN LOT IA (� SEPTIC SYSTEM SCHEMATIC (907f 279-3916 203 W 15TH. AVENUE BRUCE HERMAN DATE.- JUNE 16, 2011 ANCH AK. 99501 24005 ALPENGLOW OR. EAGLE RIPER, AK 99577 9N€€T: 1/3 GRID: 2322 PERMIT # DSPXXXX PID # 050-611-35 HANANNLIA.dwg Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ci.a nchoraoe.ak.us (907) 343-7904 Soils Log - Percolation Test Performed For: 9'CiLP P(Tnt y) Date Park Legal Description: d4N9Grin Lef / A Township, Range, Section: Depth (Feet, 2- 3- is 4- 5- 6- 7- r 8- , 9- 10- 11-, 12- 13- 14L it, Lo,irn; &q0,, "+ 13,o,N, WAS GROUND WATER Date Gross Time ENCOUNTERED? O Net Drop j Sio i! s IF YES, AT WHAT DEPTH? 1158"e L Depth to Water After t+ O P Monitoring? '— E Date: 31$ 2'. 0 3 O VEER ,:yL 11 .49TH RP UIiKLA ND •. 11500 QCs a>; Site Plan Reading Date Gross Time Net Time Depth to Water Net Drop j Sio i! I:ti$,n, 0 ern 1158"e dt ¢l� t+ 1158 - 10 Min II ' r, 3 t��n `f 1t. �� " 2'. 0 3 i. 11 5/8 3 r/M n ,nT yA'.l it -,/v" 3" 2!_ 5 r>7 �� IN'n 11 319 �� r, 28 ` 2 ; 3$ M fj(7 ; n 11 31y 1 2 3/y n a t Z: y m Nh H li 2 31q PERFORMED BY: Lao cl PO'kil U 4 I &,) —avj CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANC WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ,5 / ZD i I PERCOLATION RATE 3,0 (Mnuteslinah) PERC HOLE DIAMETER Pre SOa j TEST RUN BETWEEN Z FT AND 3 FT COMMENTS dt ¢l� PERFORMED BY: Lao cl PO'kil U 4 I &,) —avj CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANC WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ,5 / ZD i I ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNICIPALITY OF ANCHORAGE AND Jm �ieLE%e THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this / eDay of �, F of 201L, by and between _[Nvc v,)-, h 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 Treatment System (AWWTS), described as i y _ located at Atteher-age, Alaska. 0(m norl L1 2. Definitions. A. Alteration. Any change to the design or function of an AWWTS 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 AWWTS 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. 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: (I) 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. B. 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: A n C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. Owner: e voy\ T p,,, , L e. 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. OWNER: }} } By:V6Jv�;�J Date: STATE OF ALASKA THIRD JUDICIAL DISTRICT MUNICIPALITY: By: Title: Date: ss. The foregoing instrument was acknowledged before me this day of i> 201 , by NOTARY PUNLW FO ALASKA My Commission expires:}elks P'l _f MUNICIPALITY OF ANCHORAGE `— p DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION j� ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet -Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEj PHONE NEW �.'/te ❑ UPGRADE MAILING RES y� LEGAL ESCRIPTION4��ry{ IV LOCATION le i NO. OF BEDROOMS Z/Z DISTANCE TO: Well ��(��" ¢�'� Absorptionea J Dwelling % PERYO _ Uy w2 Manufacturer M��ex' No. of comp rtments ti Liq. capacity iingallons IF HOMEMADE: Inside length Width Liquid depth Y DISTANCE T0: Well D elling PERMIT NO, JUZ 02 F Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well . �Q� - Found o j Nearest I t line �` V • L PE IT O ` = _ Ul Z No. of lines Length of e h lined Total length of lines Trench vy4dth /y Distance 6 t Ines F- w �% J inches h Top of tile to finish grade Material beneath ,tile / B jJ o Total a fect bsor ar (U ,5 / © inches Ci ° Length Width Depth MUNI -_WA, �,P•AN HOP.AGE w Q F as W Type of crib Crib diameter j) �l6 ri pth Total effective absorr Tffij.CeikMt @ `� NTf:�..L . ICTECTION LU w Well Building foundation Nearest lot line DISTANCE TO: .fin— J CI ss Depth Driller Distance to lot line PE- I NO.'" J ° LUBuilding foundation DISTANCE TO: Sewer line Septic tank s pyo rary'$ OTHER PIPE MATERIALS SOIL TEST RA G t , ° INSTALLER REMARKS �•os ta "�I ` o• - S zo Poo S M`r.r< A. Shafer �V �• w FpA •••NM.•�•r���_A I ._ �.;}L 9�.' Y'iYti191V�GT7t4U6Y APPROVED� ➢ 1�f,¢1�s�a;? �w~{`y�" DATE GAL 10 niQ lo.... Q/v41 / i - I 01/16/2008 14:36 6882259 SULLIVAN PAGE 01/01 Trrtifird Brilting a'vg by DOC Co. am SULLIVAN WATER WELLS P.O. BOX 272. CHUGIAK, ALASKA 99667 . TELEPHONE688.2769 OWNER OF LAND �9 fT Z Y Co .auS %r ADDRESS PD 18CfC 16 Cil E 2 LEGAL DESCRIPTION Z-07, / A No'?'w ,4r7/✓ DATE -Started `i Ended jo4!Y PER.IIIT NUMBER KIND OF FORILITION: DEPTH OF WELL 011 4D / STATIC LEVEL OF WATER FT. (Ori DRAW DOWN FT. GALS. PER IIR /-So KIND OF CASING G +,b A From 1_Ft. to a Ft.��t <dURO6� From Ft. to Ft. From-4>1—Ft. to�Ft. %ARA/y..t From Ft. to Ft. From /F Ft. to.,rl-Ft. Le A J' F 6 XA From Ft. to Ft. From,4L4L_Ft. tot �S-'Ft. From Ft. to Ft Fromi tr Ft. to-JeJ-Ft. 4 i-ElO K0G� 6 �a kC^j From Ft. to Ft From Ft.to Ft. XZ 94"F'rZ. 1 C ff" From Ft. to FL From t93 Ft_to-221'_Ft. bFyoeccirc From Ft. to Ft. From, -)Al Ft. to Ft. From Ft. to Ft. j C From Ft. to Ft. �Z From 225- L to .24 0Ft. AiCOteG rG From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From FL to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft ItUSCL. INFORMATION: t it Tp 7 A? A, aisJoly 4G &,�L ` DRILLER'S NAME ���✓ �� �`-f M U PA I C-, :1 F="af-% L.- I --11r "ir UJ P- �f.L-,j 01 IFZ Ir -11, IFE ° DEPARTMENT OF HEALTH AND ENVIRONMENTALPROTECTION �r � 825 L STREET, ANCHORAGE, AK 99501 . 264-472O � ' ��IE.": JE- 11-0,11 UE F . VJ1 IE - L_ F������� PERMIT NO: DATE ISSUED: APPLICANT: AD DRE 840731 08/28/84 C/O S & S ENG'G SRP 196X EAGLE RIVER, Al,", 694-2979 CHUCK BARR 99577 LEGAL D1 ----SCRIP: SUBDIVISION: HAMANN LOT: 1A BLOCK: NA � SECTION: 15* TOWN! HIP: 15N RANGE: 1W LOT SIZE: 59573 (SQ. 1"T. OR ACRES) MAX BEDROOMS: 4 Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. '7 V< FE Ph, 0 0-1 E-1: 1E- 1.3 L --.q= �F-Z. -1 111,,,H DEPTH TO PIPE BOTTOM (FT.) 6.0 4"0 4. 0 GRAVEL QEPTH (FT.) 9o0 0.5 3.5 TOTAL DEPTH (FT.) 15.Q 4.5 7.5 GRAVEL WIDTH (FT. > 2.5 27.0 5.0 GRAVEL LENGTH (FT.) 60^0 54"0 116^0 ** GRAVEL VOLUME <CU.YDS.) 52.8 54.0 86.0 TANK SIZE (GALS) 1,250.0 ** 1,250.0 ** 1,25O.0 ** SOIL RATING (SQ.FT./BR) 268 239 ` 268 ** GRAVELLENGTH > 75 FT" REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT- EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ... ..... --- _�~~��~_���^� ' ` I certify that: 1^ I am familiar with the requirements{or on-site sewersand we/1s as set forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2, I will install the system in accordance with all MOAcodes and regulationsr and in compliance with the design criteria oJ this permit. 3. Iwill adhere toall MOA and State of Alaska requirements for the set back distances from any existing well� wastewater di'sposal system or public sewerage system on this or any adjacent or nearby lot" 4" I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will requirean additional permit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUSTBE OBTAINED; (2) WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND ELECTRICAL WORK ML�� BE DONE BY LIC����D��LECTRICIAN. SIGNED APPLICANT: ISSUED BY �~.... ... .......... DATE: DATE: � CODES, AS-BUILTS (3) THE r { I J ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE ! S Y 67_-J/ e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION X PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: LL -(i' /� J��� _ DATE PERFORMED: 12,3 Z1 LEGAL DESCRIPTION: Z— / A Ala "7,ii /7 `J `S SLOPE SITE PLAN DEPTH �i (FEET) 1 2 C3 3 _ 4- 6 6 71 All, 8 V 9 10 G 11 C l12 13 14' 15 16 17 1 s jl G 19 C� cy-N- 26 4f �t WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT ® DEPTH? i1 r, Rebart A. Sheller ; •� No. 1437-E *• _�� •s pkoi=essloNP,. 0 /—/ .Reading Date Gross Time Net Time Depth to Water Net Drop tj v 3o 141/-1 3 7z l/ % e Al rr 134 / rt e. 20 � v PERCOLATION RATE • - ! (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS r 40 PERFORMED BY[:.:',. SRO 198X CERTIFIED B DATE: I y� i 19 72-008 (6/79) �_� MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES i� j d 10t Division of Environmental Services On -Site Services Section e Dow 4-A't P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 5d ^ (a l ! '-' 3-i' � HAA # VZ (!�) 15Z 1. GENERAL INFORMATION / Complete legal description � O _L r a �a 0.M� g ll Location (site address or directions) S'�-y+ X— 44f 4r"< Property owner 1-4,4,OLDay phone Mailing address Lending agency N 0 ✓&AAA VA Day phone Mailing address Agent �� �TgddA F2+M92 )! Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site — Holding tank Community on-site Public sewer NOTE: 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 and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 I © ti UY-V-La Kcv,� L Phone Address Engineer's signature 6. DHIJS SIGNATURE Approved for zw0 bedrooms. Disapproved. Conditional approval for 0 Additional Comments auTIr Date "I `l Z bedrooms, with the following stipulations: Date � ./ 7__%D__� 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 421 .Q Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: I-ok- l A \+A LkikNIN s /D Parcel I.D. b50- G11- .315' A. WELL DATA Well type 9 If A, B, or C, attach ADEC letter. ADEC water system number PI//AA Log present (Y/N) Date completed Sz121-L 1,18Y Driller S O I I,L�14 Total depth "ZLlD Cased to L'?_ , Casing height I ; t I Sanitary seal (Y/N) Date of test Static water level FROM WELL LOG apt IC1(9 I a.� Wires properly protected (Y/N) Well flow a g.p.m. Pump level 3�^" SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 10-5 AT INSPECTION MUNICIPALITY OF ANCHORAGE Z ENVIRONMENTAL SERVICES DIVISION /,;2 JUP1 •- 5 1992 40 g-PRECEIVED ; On adjacent lots )'/0-0 Absorption field on lot I g ; On adjacent lots Public sewer main IY/A Public sewer manhole/cleanout Sewer service line q0 f Petroleum tank r-4 I'D WATER SAMPLE RESULTS: Coliform Nitrate N b Other bacteria Date of sample: ' q 2� Collected by: S B. SEPTIC/HOLDING TANK DATA Date installed q/'q 9�8 y Tank size �a 7 o Compartments11 Cleanouts (Y/N) AL Foundation cleanout (Y/N) / Depression (Y/N) N High water alarm (Y/N) ��` Alarm tested (Y/N) NIA Date of pumping b Z Pumper �5 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: I / Well(s) on lot /0-61 On adjacent lots ' a � Foundation 1A To property line 5 Absorption field Water main/service line > 5b Surface water/drainage t / 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level — 'Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA /2-9/6 Date installed Length (00 Width "Pump off" level at Cycles tested On adjacent lots Surface water Soil rating 12-& g System type Gravel thickness q Total depth I �✓ ! Z - Total absorption area __ l o ogo Cleanouts present (Y/N) Depression over field (Y/N) ' 7 Date of adequacy test �!! ` Z Results (pass/fail) 7 CtJ� for � bedrooms Peroxide treatment (Past 12 months) (Y/N) N O If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 116 On adjacent lots i 10-0 Property line lqt To building foundation 7 To existing or abandoned system on lot Nl,,, On adjacent lots 7 0 Cutbank Water main/service line- Surface ine Surface water Curtain drain E. ENGINEER'S CER'T'IFICATION Driveway, parking/vehicle storage area i 3a I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the,date of this inspection. Signature v - II Engineer's Name el -i �7� ti r k LAA_ pp � Date 1��� G Z HAA Fee $ � > Waiver Fee: $ Date of Payment (0 Receipt Number 23 C 72-026 (Rev. 3/91) Back MOA 21 Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. LAB.. ATO 565633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 54346 Chemlab Ref.# 92.2476 Sample # 1 Matrix: WATER Client Sample ID L1A HAMANN Client Name :TOBBEN SPURRLAND, P.E. PWSID UA Client Acct :TOBBENS Collected JUN 1 92 @ 06:30 his. BPO# PO# :HONE RECEIVED Received JUN 2 92 @ 11:15 hrs. Req# Preserved with AS REQUIRED Ordered By :TOBBEN Analysis Completed JUN 3 92 Send Reports to: SupervisorHEN_C. EDE 1)T08BEN SPURRLAND, P.E. Releasedeleased By G�l/�,—" 2) _====aa'Parametera==== Results Units Method Allowable Limits ------------------------------------------------------------------------------------------------------------------------------------ NITRATE-N ND(0.10) mg/l EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: T.S. NO TAG FOR THIS SAMPLE. Remarks: ====a======3C2LOCII 1Tests Performed See Special Instructions Above UA -Unavailable ND= None Detected See Sample Remarks Above NA- Not Analyzed LT=Less Than, GT -Greater Than 11610NIS 3S Member of the SGS Group (Socidte Generale de Surveillance) MUNICIPALITY OF ANCHORAGE ' DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date / 6 r 8� (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name �Ojl S Telephone ® Home Business scV,3ifli�Sl�I�a Applicants Address (c) Applicant is (check one) Lending-Inatitution ; rev/builder ; Buyer f ; Other (explain); (d) Lending Institution /u co �-JE Telephone Address (e) Real Estate Co. & Agent Address !V 0 Telephone /4D /..0 (f) &a-Jz3. the HAA to the following address: 2. Type of Residence Single -Family Multi -Family Other (describe) Number of Bedrooms 17-1 3. Water Supply Individual Well Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information 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 shows 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 arr-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Telephone Address Date 6. DHEP Approval Approved Approved Terms of Conditional Disapproved Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 i MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: 1,e, AA. WELL 11ATA A -Ail-/ rr' � Well ClassificationY. If A, B. or C. D.E.C. Approved(Y/N) Well Log Present (Y Date Completed YieldC r Total Depth '�[' Cased to Depth of Grouting Static Water Level %�{'� Pump Set At it Casing Height Above Ground 3 g Sanitary Seal on Casing Electrical Wiring in Ccnduit (Y i Depression Around Wellhead (Y. 1 Separation Distances from Nbll: 1 To Septic/H91-41-4 Tank on Lot lep On Adjoining Lots /vu To Nearest Edge of Absorption Field on/ Lot /,00 ; On Adjoining Lots /00 --/-! To Nearest Public Sewer Line /J A To Nearest Public Sewer f Cleanout/Manhole To Nearest Sewer Service Line on Lot 25 -V-- Water Sample Collected By 46 bi2kee,114Z; Date - Water Sample Test Results Catments B. SEPTICA&� TANK DATA Date Installed B¢ Size IZ5�C) No. of Ccmpartments Z Standpipes e/N) Air -tight Caps 01N) Foundation Cleanout(ON) Depression over Tank (y& Date Last P d Pumping/Maintenance Contract on File (Y/N) ; for>-- Holding Tank High -Water Alarm (YIN) 'A' /4 Temporary Holding Tank Permit (Y/N) ti Separation Distances from Septic g Tank: To Water -Supply Well 4be i To Building Foundation Z To Property Line lb z To Disposal Field -y r To Water Main/Service Line '`�� To Stream, Pond, Lake, or Major Drainage Course Comments Receipt # Date Paid: r.-!'-I-2��� Amount: 4 (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ;z �laxt Type of System Design Date Installed 1..-Z.g -g Z/ Length of Field (U� Width of Field 30 `r Depth of Field /,5, Gravel Bed Thickness los P Square Feet of Absorption Area X09096 Standpipes Present /N) Depression over Field (Y Date of Last Adequacy Test Results of Last Adequacy Test 114 { Separation Distance from Absorption Field: To Water -Supply Well /D o �f' To Property Line To Building Fo/undation 7-7 / To Existing or Abandoned System on Lot AJ/a On Adjoining Lots 3_0F To Water Maim/Service Line /b F- To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course --VIA To Driveway, Parking Area, or Vehicle Storage Area Conrtrents D. LIFT STATION Date Installed Dimensions Size in Gallons I Manhole/Access (YIN) "Pump On" Level at IAI "Pump Off" Level at _ u High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. V Signed -0-a i C4lGIAI� pllVt Date /- (2.>� � Q or A I %�J gne 4 0 Company' , I'xPli sm4„?AU A X5577 MOA No. �.� ::na e;vs% a xW ee.j... �o KB1/d5/s (Page 2 of 21 ��L'i:e eneeo..aga �. Rehor1 A. Shafer `fit No. 1457-E- 2-15-84