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Home My WebLink AboutHAMANN LT 1BHamann Lot 1 B #050-611-36 Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 Page 1 of 2 www.cl.anchorage.ek.us (907) 343-7904 ON—SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO50172 PID Number: 051.611-36 7 Wastewater System: ❑ New ® Upgrade Ad",PENGLOW DRIVE ABSORPTION FIELD Ph" Nu of eeapppu O Deep Tnrch ® Shallot Tnrah O SW O Mond O otJW LEGAL DESCRIPTION soot Am" Taet oepm"M aarrl orad. 0.8 GPOff? 7.3 Ft. al c La Sul .ori: Depen a ppe lxaom from araaal paM GrM depth heneeth ppr 18 HMANN 2.2 Ft. 5.1 FI Tmrww R«pe swan: FdW same olprul Vecle GlM LftVh 14N 1W 15 0.5 Ft. 56 Ft. Well: ❑New rade ❑ Upgrade G M want 5 Nunn« a It ea 1 otNanpe eNreM h ea 0 FI. FI. Claa� (P *. A 9. C) Tar Dean:Ceded b' TOW eow txxxi "a P" wtanr EXISTING PRIVATE FI. FL 563F0 ASTM 3034 DM« Doe DNNd StNa wN«LM "&W'. Data YWaeW. FL CCC CONSTRUCTION 9/2912005 mea Pump sow C.eaa H.yn Aoo.. Grand TANK GPM FL FL SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding ubllWrivate 'w`« ly From Tank Field Station Tank Sewer Una ANCHORAGE TANK 1500 Gr. V014 +100' +100' — — +25' MH«ul STEEL Nvmp« a Go ve tmwna 2 s,ar«ewn« +100' +100' — — LIFT STATION La L" +5' +10' — — �e NO LIFT Gr w,.« +5' +10' — — 'Pump Orl' IMM 'Pure pit I at Hrph ". al. N. FOundMgn H N k +50' +JV' — — Pump Make a Moat Elwnul oewpeam P«romW by Dutein C. 3 BENCH MARK U 4. Lmm« «a 09scroal. TOP OF HOUSE FOUNDATION Santa Nv84 ',. 100 FL P'), E ' Inspections performed by: E.R.E.S Dates: 1N 9/2012005 QFwq 2"d 912912005 . Development Services Department Approval Conditional Approval Date: CHRIS MRS. N„d'1°• Reviewed and approved by: r rN• Date: � O (Rev 0406) Permit No. SW050172 Page 2 of 2 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT ON—SITE WATER & WASTEWATER PROGRAM 4700 SOUTH BRAGAW STREET P.O. BOX 196650, ANCHORAGE, AK 99519-6650 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: HAMANN LOT IS 050-611-36 CAT III. RESERVE 2 VEW 1500 GAL. SEP/TIC TANK 1NEW 5'X56' „�c-, LEACHFIELD T® 1 G FIELD �- O - CLEANOUT ELEVATIONS + - WELL (NOT TO SCALE)P F N A N _ MONITOR TUBE ASSUMED ELEVATION • tOO' 6/20/ ORIGINAL GROUND ENGINEER'S SEAL LEVEL AT, 98.7 0000Opp� / \ o OF A� 0.5' FILL MT -2 J 1. TH-1 ' 'C` ........ .....'9 ISULN91, 962M1.91SULATIOYPA-96.5 o ° o • �•86.4 o 5L• e96.0e 9 o ° o. 91.4 84.7 91 BOTTOM OF T.H. 91.4 A'•. CHRISTOPHER R. WOOD.-' cf'• CE -10387 044 "D0000�� MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 14, 2005 Expiration Date: Jun 14, 2006 Permit Number: SWO50172 Parcel ID: 050-611-36 Legal Description: HAMANN LT 1 B Design Engineer: 0848 Eagle River Engineering Services Site Address: 024023 ALPENGLOW DR Owner Name: J. ALAN GOODWIN Lot Size: 53061 SO. FT. Owner Address: 24023 ALPENGLOW DRIVE Total Bedrooms: 5 Permit Bedrooms: 5 EAGLE RIVER. AK 99577-2008 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. a.) At the time of construction, additional lest hole(s), percolation test(s) and 7 -day groundwater monitoring will be completed for the 5 -bedroom reserve absorption field. Received By: Issued By. Date: 6/105 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us. (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Number SW Property owner(s) % rey�Day phone Mailing address (1) -2 10A Mailing address (2) 6ce .ir zA A Zip Code 917S77- 17&M Legal description (Lot, Block & Sub'd.) f{GtmGt nr) s'1.B Legal description (Section, Township & Range) 5r_ . /5 Ti yA1 e -/G✓ Lot Size 63, 06/ Acres Number of Bedrooms 15- THIS 5 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application Is being made for a Single Fam}Fy Dwellin"nd is iP accordpce with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Dale of Payment: & Receipt Number: b tY153 (Rev. 12100) P"1�{-- Waiver Fees: Date of Payment: Receipt Number: Eagle River Engineering Services Christopher P. Wood, P.E. 10421 VFW RD. Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax June 7, 2005 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Hamann Lot 1B Narrative & Permit Application Dear Mr. Roth: Eagle River Engineering Services (ERES) was contracted to design a septic system upgrade at the above referenced property. The homeowner wishes to upgrade from 2 bedrooms, to 5 bedrooms. The septic tank will be upgraded from 1,000 gallon to 1,500 gallon. The existing leachfield is dry, and in GM material. A test hole and soils percolation test has yielded a percolation rate of 9 minutes per inch, and a water table depth of 12.3' after 7 days of monitoring. The soil type appears adequate to support a new 3 bedroom leachfield. Additionally, a Health Authority Approval Certificate was issued in 2004 for this property. The proposed 5 bedroom septic system upgrade will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, so there is room for wells, septic systems and alternate sites. 2. Immediate neighboring septic systems are all +20' distance, and no private (or community) wells within 100' of the proposed septic system. 4. Drainage will not be affected and is not a major consideration in our design. Installation of this 3 bedroom upgrade, from 2 to 5 bedrooms total, will not adversely affect the wells or septic systems or reserve areas on adjacent lots. If you have any questions please call our office at 694-5195. Sincerely, EAGLE RJY6R E G GS RVIC Christopher �RlWeood, P.E. Principal \2003\05.04 BSEMCNARRATI V E + 30' TO SEPTIC LOT to + 2DO' TO WELL 0 I + 200' TO WELL / CONDUCT PERC TEST IN VICINITY OF NEW IEACHFlELD DURING SEPTIC UPGRADE m w � � n \ ` TWO 3'x38' RESERVE SITES qL / EXISTING/ / TANK \ \ 90• \ \ \ CpF'1'ClOy, \ \ \ \ WELL/SEPTIC LEGAL: LOT 1B, HAMANN SUED. OWNER: J. ALAN GOODWIN CONTRACTOR: UNKNOWN JOBA 05-048 1 DATE: 06/1 EXISTING FIELD TO REMAIN I INSTALL NEW 3X36 — — LEACHFIELD. LOT 2 � a'brs I WELL 3 0 EASEMENT "QI\ — — — — PROPOSED LEACH FIELD \ �• — EXISTING LEACH FIELD DRIVEWAY • — MONITOR TUBE o — SEWER CLEAN OUT — WELL ® — TEST HOLE 1. NO KNOWN CURTAIN DRAINS SITE PLAN `.��.OF�q 51 SCALE 1"= 60 EAGLE RIVER ENGINEERING P.O. box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) �.:..-.I....... r......... An %CHRISTOPHER R. WOOD SERVICES ♦� •, CE -10387 \; 694-329 Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW Rd. Suite 201 Eagle River, AK 99577 (907) 694-5195 tel (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Ilamann Lot III Aiay 2, 2005 A. GENERAL 1. The well and septic plan is for a 3 bedroom upgrade to a 5 bedroom total single family residence only. 2. The drawing and or site plan shall be apart of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remaining open test hole excavations shall be filled and monitor tube removed. B. SEPTIC TANK 1. The sewer piping from the house shall be 4" PVC 3034 laid at 2% grade maximum — 1% minimum and insulated with 2" of burial foam if shallower than 3 ft., with 2 R. minimum. 2. Septic Tank shall be a minimum of 1,500 gallon tank of MOA approved construction, insulated, or place with 4' of soil cover, min. C. DRAWFIELD 1. The drainfield is to be placed as shown on the site plan. Contractor shall take extreme care ensure that 10'scpartation distance is maintained between trenches, from the lot line, and from the house foundation. It is recommended that a licensed surveyor be utilized to locate all immediately adjacent lot lines and easements. 2. The bottom of the drainfield excavation shall be level, plus or minus 1.5", prior to placing gravel. 3. The total depth of the drainfield excavation shall not exceed $ ft. at any point in relation to natural ground surface. 4. The drainfield gravel shall be covered with typar fabric material. 5. Soil or a combination of soil and extruded board insulation to at depth of 3' or equivalent is to be placed over the leachficld. 6. The area over the drainfield is to be finish graded or mounded to prevent ponding of surface water runoff. 7. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. \\Eres\docs\W PDOCS\2005\05-048.3brdminficid- spmdoc Eagle River Engineering Services Christopher R. Wood, P.E. RECOMMENDED LEACIIFIELD DIMENSIONS: TOTAL DEPT I I = 4' GRAVEL DEPTII = 4' under pipe, 2" over pipe (4.5' total) DRAINFIELD LENGTII = 56 DRAINFIELD WIDTII - 5' SOIL RATING= 0.8 GPD/112 BEDROOM CAPACITY= 3 total SEPTIC TANK = 1500 gallons min. Twenty-four (24) hours notice required for all inspections. \\Em\dacs\W PDOCS\2005\05-048-3brdminfield- spec.doc EAGLE RIVER ENGINEERING SERVICES 10421 VFW RD Suite 201 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 05-048 Calculated By: CW Date: e/7/2005 Legal: Hamann Lot 1B Single Family 3 Bedroom Dwelling TEST HOLE 1 Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom - Percolation rate = Wastewater application rate = Required absorption area = Trench width (W) = Gravel depth (D) = 450 gallons 9 minutes per inch 0.8 gallons per day per square fool 583 square feet 5 feet 4 feet Required length - Shallow trench factor • Required absorption area / W Shallow trench factor = (W + 2) / (W + 1 +2 D) Shallow trench factor - 0.50 Q7.0 Total Excavation Depth = 13-5,188t Required length = 5e feet 05-048 2brdrainfieldCalc 12:50 PMe/7/2005 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519E6SO www.cf.anchoraqe.8k.us (907) 343.7904 Soils Log - Percolation Test Performed For. ALAAJ G c;obt,J1 Al Date Perfa Legal Description: 9.-m4A/A/ La % 113 Township, Range, Section: r I LIAJ 21 W Stl 5 Depth Iv`�I FTLL 0 r. v V a• �M - TAA/ 5 SAA)b+ CLRdvFL 10- 11- 12- 13-_, 1 12- 13 _ 'o 14- 15- 1s (,LAYER . '° 6OITOW1 17- rlan WAS GROUND WATER ENCOUNTERED? ? / a IF YES. AT WHAT DEPTH? L Depth to WetarAner / O Monitodng? IZ•3 E Date: 511310 Reading Date Gross Time Net Time Depth to Water Net Drop Z 9:00 30 6r- io %t " 3 1-.o ► 6= 6" q °l.' 31 30 = e/i6 114 ,r 6 Io: DZ -30 6 -Cl PRFs LI -H25 PERCOLATION RATE I (MI M -Ifth) PERO HOLE DIAMETER 61, TEST RUN BETWEEN J�,_FT AND FT COMMENTS ' 1 PERFORMED BY: ('�21 S WC C) 1-> ( ERTIFY THAT THIS TES WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL INES IN EFFECT O THIS DATE. GATE: 510y/dr MUNICIPALITY OF ANCHORAGE j DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME) PHONE .<NEW % k- I T/9 L/ i /�( ❑UPGRADE MAILING A ESS- s�6 l 6 `r E, X ^�� x y� LEGAL D SCRIPTION - L l /�f9r� �I air .ti Ij LOCATION NO. OF B O S Well -L., - Absorgt,lor�aree Dwelling L PE�jy11T�120.� Y� Uy DISTANCE TO: L. C) a. z Manufactu r j} /� M i No. of compartm IT IS rn Liq. pa�itY,i ngallons (`0 (� IF HOMEMADE: Inside length .,-. Width Liquid depth Well Dwelling PERMIT NO. DISTANCE TO: z G Manufacturer Material Liquid capacity in gallons 2 H p Well/ --,ry j Found�� -4- Nearest et line PE9IT,,NO �-� DISTANCE TO: C.� LJ w J LL No. of lines / Length a Ilne Total th of Ines Trench wi 8+" Distance be Me'nem A inches - - - F- Q/ < Top of tile to fini g�de erigl en� h �Ie `-" j Lrt _ ... ct ; _ O v Z - inches (,� J, Length Width Depth PERMI NU. \, r Lu Q I- Type of crib Crib diameter C i depth -Total absorption area .3 W N Well Eluilding foundation Nearest lot line DISTANCE TO: Class Depth Driller Distang 16tIine I PE Ty J J LLI � Building foundation Sew / Septic aRC/k® Absorption�arg�lsZ„ DISTANCE TO: Clue OTHER VAII C '� PIPE MATERIALS J v" SOIL TEST RATIN] 10�` INSLAJ-"R J' cpl t ,j REMARKS O le• el m.�c" •!�, 'l� _ i� 01 ✓%Jl { p ` h el b tai b r. Jj ILC f APPROVED ' ","" `",-, ,- :r:i«a":° Df#fiE !-013 (Rev. 3/78) V /T // / LI I r N r x Ln a ul i ® Q Y Y a ® H. Cr J a � J a Q D d w w J L) s z ¢ U �-c w N wX r� ® N m 69 W 4? 4-t S i 0 roi P i4 ~ O1 0 a I P4 0) 4-) ro �a ro 3 0 I~ O z ro S4 S4 ro 3 0 r r x Ln ul I -I. H. Cr U. U. O.f 6� . w w ro rf L w L4 : y: �-c W -,I: M : r� H 4? 4-t S i ro ; roi Q i4 (d: O1 W rI x; P+ : O: i d' i •H: O �: q i c W: Ln:: CO: F w W 0: 4- LA ,c: U. N :C403 W o; 4-1: Ul: S~ i 0)i - O: o �,Q: x : 3 r+i Lo Ln : Ln " as F w O W F E-+ w Z Q C4 a v z A A ai A U x P4 0) 4-) ro �a ro 3 0 I~ O z ro S4 S4 ro 3 0 r r x Ln I -I. H. Cr U. U. U O 6� . w w ro vi L w L4 : y: w W -,I: M : r� H �4i S i ro ; roi i4 (d: O1 W x; P+ : Ri i d' i •H: O �: q i c ,j:a) F Cn i CO ro: is F F 1 r+; 4-1: U) : S~ i 0)i - �4: x : o : W : w Ln : Ln w w w w w w w �5i ro: Lz: x x xi O O O O O (a; 0) O O O x x x x x cx x x x x x w w U) a w z w w w w w w �+ : u: sA (1): I~ : as: W prii ' � vFi rt wuj i yi ro : ri: O) : }4: 0) : ?a: 3 A w O Q 3 A A P4 0) 4-) ro �a ro 3 0 I~ O z ro S4 S4 ro 3 0 lz x I -I. H. U. U. U O 6� . w w w w L w 114 U. (-CL" w �4i S i ro ; roi a w p O O O O O O O O O O F F F F F F F F F F F F �4: x : w w w w w w w w w w w w �5i L,5: Lz: u: �5 u: O O O O O O O O O O O O x x x x x cx x x x x x w w L.. w w (.T, w w w w w w P4 0) 4-) ro �a ro 3 0 I~ O z ro S4 S4 ro 3 0 x x I -I. H. U. U. �4i S i ro ; roi �4: x : �(: x : >J: x �5i L,5: Lz: u: �5 u: L2: O: •N: O: +(: Q �,: rO i �i u: �+ : u: sA (1): I~ : as: rcl : ro: ' ro: yi ro : ri: O) : }4: 0) : ?a: 03 Oi (1): U: m : Wi M (14: fG F F F F F F F F F F F F w w w w w w w w w w w w N : Ln: r i r -f: Lf$ r mp m : w: L0: r: 0� N; (y): "0: .-4 N ; N: N O O O O O O O O O O O O F F F F F F F F F F F F w w w w w w w w w w w w oN: In : ri r+ F r OJ i 00:O ; �0: r: M: Lfl ; 1-1: 1 N; (q a a °� a °a W 000 o C4 a a w w w w w w w w w w w w A z P4 0) 4-) ro �a ro 3 0 I~ O z ro S4 S4 ro 3 0 �Y, CD, F---' 9 IC-`- H -i fc) F--' H=1 53� DEPHRTMENT OF HEHLTH HND EPTVIRO�MENTHL 1 CTuN B25 L STREET, RNCHORHGE, HK 99501 ' 264-4720 Q phi --- ��-1- E�i�: PERMIT NO: 84008] DHTE ISSUED� 0]/28/84 .HPPLICHNTMHRK WOJTHLIK HDDRESS: C/O S & S ENG'GSRB 196X EHGLE RIVER/ HK 99577 CONTHCT PHONE694�2979 LEGHL DESCRIF" LOT: 1B BLOCK: NH SECTION: 15 TOWNSHIP: 15N R8NGE1W LOT SIZE� 0 (SQ�FT� OR HCRES) MHX BEDROOMS� +�� / ` LISTED BELOW ARE THE., OPTIONS HVHILHBLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEMCHOOSE THE OPTION THHT BEST FIT� YOUR SITE .... �... ..... .... ... ..... ��^�� ^ ��9� DEPTH TO PIPE BOTTOM (FY ) ].0 ** 4.0 40 GRHVEL DEPTH 6.0 0.5 ]5 TOM. DEPTH (FT. 4.5 7.5 GRHYEL WIDTH (FR ) 2.5 25.0 5.0 GRHVEL LENGTH 0 ** 48. 0r��-�* GRHVEL VOLUME (CU- 9 44.4 74. 8 THNK SIZE MALS) 000. 0 ** 1'000. 0 ** SOIL RHTING (SQ�FT�/BR) ]12 264 ]12 ** DEPTH TO FT. REQUIRES INSULHTION ** DEPTH TO PIPE BOTTOM { 4.0 FT. MHY REQUIRE H LIFT STATION ** GRAVEL LENGTH } 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EHCH) ** T MUST HHVE HT LEHST TWO COMMITMENTS ^ I CETHFT: 1- I RM FHMILIHR WITH THE REQUIREMENTS FOR ON�SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITYOF ANCHORAGE (MOH) HND THE STATE OF HLHSKH it. I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH FILL MOH CODES AND REGULATIONS;, `HND IN COMPLIHNCE WITH THE DESIGN CRITERIA OF' THIS PERMIT. �I WILL HDHERE TO R.A.MOH HND STATE OF HLHSKH RDQUIREMENTS FOR THE SET BACK DISTANCES FROM HNY EXISTING WELL/ WHSTEWHTER DISPOSAL SYSTEll OR PUBLIC SEWERHGE SYSTEM ON THIS OR HNY ADJACENT OR NEHRBY LOT. A I UNDERSTHND THAT THIS PERMIT IS VALID FOR H MAXIMUM OF ] BEDROOMS AND MY ENLARGEMENT WILL REQUIRE HN ADDITIONAL PERMIT. 1F H LIFT STATION IS INSTHLLED IN HN fl --,.'EB COVERED BY MOH GUILDING CODES/ THEN (1) AN ELECTRICHL PERMIT HND INSP�CTION MUST BE OBTAINED/ (2) HS�BUILTS WILL NOT^BE APPROVED WITHOUT HN ELECTRICHL INSPECTION REPORT/ HND (]) THE ELECTRIC -HL WORK H LICENSED ELECTRICIAN. SIGNED DHTE: HPPLICHNTRKW�iJTHL�k ISSUED BY 8/A'/ a ❑ SOILS LOG i' MUNICIPALITY OF ANCHORAGE ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 /SOILS e�LOG — PERCOLATION TEST /j At/ PERFORMED FOR: V v 7- 14 LDATE PERFORMED:7`�"-v LEGAL DESCRIPTION: PEPTH SET) .r 2 3 � 4 4 5 6-j 7- / 8. r �� 10 11 12 13 14 15 16 17 18 19 20 COMM L L'J✓//l�K 3 2 XIX�r f WAS GROUND WATER 7J J� S ENCOUNTERED? L O P E IF YES, AT WHAT DEPTH? Reading ,PERCOLATION Date Gross Time Net Time Depth to Water Net Drop le /Bj 02 -719 ry h c OS - , ,PERCOLATION RATE TEST RUN BETWEEN F inutes/inch) _ FT AN4 V, E-:1GI r:5Rpjft PERFORMED BY: r _;�`� ej s u0m - CERTIFIED DATEOU 72-008 (6/79) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program ` 4700 South J B 9951 St. s ^ E P.O. Box 196650 Anchorage, AK 99519-6650 _ www.ci.enchorage'ak.us 343-79 .ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O SD/aiHAA 11 a 3R 1. GENERAL INFORMATION Expiration Date: Complete legal description 4AAIw ,e4V;l Location (site address or directions) �n Current Property owners).teoA,y !& EakiDay phone l�9_ y x^i Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone p RAE o �nF� Day phone /e2-og- i80 /6 le 2rd— Ir" riez .imp Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: le 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (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. STATEMENT OF INSPECTION BY ENGINEER seal affixed hereto and as of the validation date shown below, I verify t my investigation, As certified by my Approval Guidelines for this applicati e numbehat the r based on procedurre, outlined in the Health Authority App d from the site water supply= or wastewater disposal system is(are) safe, functional and adequat bedrooms �{tid tip tructure indicated herein. I further verify that based on the information and/or Mu ipalfty anchorage files and from my investigation and inspection, the on water . PP nces, n Compliance with all applicable Municipal and State codes, 4 . titer' disposal system is(are) 'r an ;~regulations in effect at the time of installation. �Sv`?hone Name of Firm f��„—rte vS — Address 0619 Engineer's Printed Date '17131 10q 5. DSD SIGNATURE i/ Approved for bedrooms. Disapproved. bedrooms, with the following stipulations: Conditional approval for Additional Comments WASTEWATER Attachments: Maintenance Agreements _— — HAA Checklist X Supplemental Engineer's Report Septic System Advisory other Well Flow Advisory By: ��ZZA (Rev. 01/02) f original Certificate Date: —� "_ -HEALTH AUTHO'PTtY%APP}-R"C�A� CHECKLIST M I y + kj r w S 4. 7d47-4= If A B or C prove e� MIR11101-y1lity of Anchorage DevelopmeT'i Services Department, Building Safety Division =P`' On Sde Water &Wastewater A ", t # 4700""South ragaty St. e , P Casing height (above d )in. Ff�IiV LL rage ak AT INSPE�TC)N " w N` "_ -HEALTH AUTHO'PTtY%APP}-R"C�A� CHECKLIST M I y Parcel ID e --j" 4. 7d47-4= If A B or C prove e� Welll Log yam, g d �!� B'Y Semtary seal)S W u res properly protecte W. �)- �.Z_ Cased tom ft Casing height (above d )in. Ff�IiV LL r 1 0 AT INSPE�TC)N " w N` t � . y?I ft. g.p.m. _colonies/100 mI Nitrated Img�I Other baeYer(a _ colon[es/100 rid. Date of saml7le S` id/e y Collected by: fir_ ,.,,� �' s '�`+• pk^°�'iMa"Y' A N �i JM4`W "+"v^3 N N.- '.'.t MrF . M N'+S ..5 '.?c � p.--_ gal Number of Compartments Z� i Cleanouts N Depressionovefitank _ High water alarm a utm ianng (g p a m or ft`/bdrm) 312 System type eII s . ,= t. . - t Width cT ft Gravel below pipe '3,S ft 601q Eff absorption area ft2 Monitoring tube x Depression over field &",p 5L3t log Results Pas Fail) 45.5 For bedrooms , fieldb f roe a test in �Dgal. z Water added New depth�in. Final fluid depth" in. Absorption rate >= pp ---- 9. p. d. nt (past 12 mo) (Y(1Q & type)' If ves nivA rint. i`. Ztea .. D. LIFT STATION ze in gallonso e/Access (Y/N) Si Date installed w ,.,. a in. Pump on" level at in. u evel at _ in. High water alarm level at Cycles tested Meets alarm & circuit requirements? Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO:o ' Septic tank/lift station on lot /2g On adjacent lots Se On adjacent lots Absorption field on lot /D m Public sewer main 't-100 ` cleanout Public sewer manhole/fi/� Holding tank 71 i nn j; Sewer /septic service line y— SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO. 4- ,p �' Property line �' Absorption field t/!9 Building foundation, /4 t /to ' water service line Surface water t 4 i Water main Wells on adjacent lots tl00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i 3 Water ma Building foundation t/main/4 Property line--- Water Service line i'/d ' Surface watert /_ 4�_ Driveway, parking/vehicle storage ---- Wells on adjacent lots f/Oo Curtain drain 7 3� F. COMMENTS 0R T6✓�v tLhcHr^iELD G•S'DEeP uN�bR bpX,) M 1 LL "�/S?FJti'I RE"'i�A1e. t.JC) D0 -Al -00Y 10 Y-lK flAwi/}G� Fi2dvY1 Gh/uDSc PIS ION ybKNvbRlrrtlA� t2owt v(4cwnliL see s P��r�...4F....A,<A G. ENGINEER'S CERTIFICAT I certify that i have determined through field inspections and review of Municipal records that the above systems are in s conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name �isirll'h1/L '� A. CHRISTOPHE R WOOD m: ' CE:10�1 Date �d HAA Fee $ mer Fee $ ®® J Date of Payment ° Ti 0 Date of Payment Receipt Number 'Receipt Number (Rev. 12101) Eagle River Engineering Services 10421 VFW Rd. Snit, 201 Christopher R. Wood, P.E. Eagle River, AK 99577-3294 (907) 694-5195 tel (907) 694-3297 6 September 2, 2004 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Hamann Lot 1B Septic System to Lot line Separation Distance Waiver Request. Dear Mr. Roth: This letter is to request a separation distance waiver from the referenced property's on-site septic System to Lot Line. All adjacent lots are large, allowing room for on-site septic systems and replacement sites. We are requesting a waiver to allow a separation distance of 3' from the on-site leachfield to lot line. This system was installed in 1984. A recent as -built survey and repair work has revealed that the end of the leachfield is only 3 feet from the lot line. ERES believes that granting of this waiver will not affect or encroach on the neighboring lot's septic system, on-site well, or replacement leachfield sites. Thank you for your consideration of this matter. Please call if you have any questions regarding this waiver request. I can be reached at 694-5195 Sincerely, EAGLE RIVER ENGINEERING SERVICES Christopher R. Wood, P.E. Principal \2003\04-067 WAivaRREQuesT.noc 4 08:07AM FROM -CUE ESL- SCS ENV SERVICES SGS SGS Reu Client Name Project Namd# Client Sample ID Matrix 1044912001 Eagle River Engineering Hamann Lot 1B Hamann Lot IB Drinking Water 9075615301 i-653 P.02/03 F-066 All Dates/Times are Alaska Standard Time Printed Date/Time 08/17/2004 Collected Date/Time 08/10/2004 16:00 Received Date/Time 08/10/2004 17:05 Technical Director S top Ede Released �++TV Sample Remarks: EP 300.0 -Sample was rem past bold time for nitrate to cottfutn will be repotted, the original result of 0.188 mg/L„ Original result has been posted and Parameter Results PQL Units nM.k. Waters Department Nitrate.N 0.188 Microbiology Laboratory Total Coufonn 0 0.100 mg/L EPA 300.0 coU1001111- SM20 92228 Contained) Allowable 13 (<=10) A (<=1) Init 08/10/04 LIB 08/10/04 DKC SEP-01-2004(WED) 15:43 EAGLE RIVER ENGINEERING (FAX)907 694 3297 09/01/04 WED 11:34 FAX 6890499 VISTA REAL ESTATE ER I I. - P. 001/001 Booz V_ 1h 6 ?- 3 s " A L. P 5?4 i5m.j0 DR 1 hereby. AS -BUILT I that.1 have gmveye.d ;hejoWw- 7"' 1 R , MS dimicribed and that the •'.', - - .. � mo:7 -1., : F ;7`,!-PM,6rm merelan aw Within the , h a PfOpafy mm and not I 91m "Mawl an the property lyjn$ srht ...,7 4, A. no _Edy that 1mProvaWARts On FPXD I I 0% the -in Vent themi6 ena.oacK t, MIM 1109 Ilk 14 i4 w..3, tra a" no ."ImI34M lines Or visible qamities",on P9 fteept af, WraW hereon. Datid at Ee9k Riva. -Alaaka of 'SCALE: Registered Land Surv" Wir 77-04%,'Faglit River, Alaska 995577 _AqC 2-60 SEP -01-2004 07.00 AR P.01 Au roving l'O am "V7341 S 8$91$RivEE, AX 99Sf7 (9W) 04-US4. s.rwa. Avrwm•nr 0,w,s West Oft Mk4wl.M �n.i.l.»,.;q„;;;eiy" ....... ...... R.iwlM oprr ,,.Aw.•i001 wCo.m 7000i, v►W 4 00 y01 ... ' bases"" 1$000 r,$ wa" raw A imine, M.O. O. 'do. OW) RAK AM 01617 r01w1p: N« ip M►8"163 •WMnnr Nyy MrrMwr Job Ty ;Np. cm, GMs herr w MRp amr in.. WSW qkv, Raid 70419 Aln^Orw CNa. Job Comm/e,y; $pN R1Nr, AR ROM 010r1i$6lfti fffwftrf'M ON asp'* sem" wumo 01 1 A$Altip es LMNM CgwwnOoq; 'wp 4n Nosot deg 11-:60 i 10rr. RtlOp mppl rpw $pNNlm: 0 1 polef" view 7y 8170.40 No No nuwpm: „A.00 ....--•— -..�.. _,.`. ...'4610M OINAM9: 1000 081111111 Amw ! —iAd1 VIA YrA clac�l� oKt �•�wk� - l' ti h COtAPL< k.CtS �Nlwplp6 ONd$M: •--•••�+ $17aoo Kolbrew to 10'00 01,07 » �ane�rpw.r awhw RwrrAr$luw0 �� a � � p«,a;,«Mw aonmulw,p, 0111 1w4"M Aw.A,pn AM AMI.104pw ,671 aR0'Ow ya $�M4v�YMMwW NIµµ-Cwp VOYrym�n:e u�avlM OMYN. w'Pp "Note W`L It GEW6Rr 019.00 Per NOP CNM, Remorse MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 L� y/q cl: 343-4744 l CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ft r r —c - 1 \ HAA # `r � OCL 1 ) `,' 1. GENERAL INFORMATION Complete legal description Lot 1B, Hamann S/D - Location (site address or directions) 24023 Alpenglow Drive Property owner Estate of Mark Mailing address Lending agency Mailing address Agent Target Realty/Dick Brown Address PO Box 774627, ik le River, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone Day phone 694-2388 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 XXX _ 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. 1/81) 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 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEr7R?VG Phone 17034 Eagle i': :. !and No. 204 Address Eagle Rive r,Ala%ii:a ;77 Engineer's signature 6. DSIGNATURE Approved for Disapproved. By: Conditional approval for Additional Comments bedrooms. Date � Z a / e7 i bedrooms, with the following stipulations: M %tITlrl 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 orderto 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. 1/81) Back MOA #21 .:�F�;� •'" 1 ttQ� AR ROBERT C. COYNN f• CE -8801 ra I bedrooms, with the following stipulations: M %tITlrl 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 orderto 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. 1/81) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 a.;' Lj Health Authority Approval Checklist APR 0 b 1999 Legal Description: L -a 1 B 1-14 M A. WELL DATA Parcel I.D.: MUNICIPALITY OF ANCHORAGE NVIRONMENTAL SERVICES DIVISION Well type P A 1,4 >4 T 'z If A, B, or C, attach ADEC letter. ADEC water system number Log present (V)N) `y r` 5 Date completed S-/ /f/ `y % Total depth -. `�- S r Cased to 73 / Sanitary seal (VN) Y#_ S Date of test Static water level Well production FROM WELL LOG S //,/�5y WATER SAMPLE RESULTS: Coliform I ")- s /0 g.p.m. 0 Nitrate Casing height (above ground) Wires properly protected &N) _ y'- S 0,6 -7 ) AT INSPECTION Other bacteria O g.p.m. 3 /) 6 / c� o S ENCINELIZING Date of sample: / Collected by: 3 .age ffiver Loop Road o. 204 B. SEPTIC/HOLDING TANK DATA a Fiver, /Alaska 99577 Date installed / 1 I 5 V Tank size o o Number of Compartments 2-- Cleanoutso/N) Y�J` Foundation cleanout &)N) Yi- J Depression (YLA) �" 0 High water alarm (Y/� D Date of Pumping Pumper J_A s C. ABSORPTION FIELD DATA Date installed S l s-1 'dJ Length s` Width Soil rating (g.p.d./ft2 or ft2/bdrm 2 System type i S Gravel thickness below pipe 3 �� ' _ Total depth Effective absorption area `I 3 6 i %Z Monitoring Tube present V/N) Yl�J Depression over field (Y& N o Date of adequacy test 2'1 / 04 611 Results (Past ail) Pd 91 For _ 3 bedrooms Fluid depth in absorption field before test (in.); M4,Y Immediately afteM 11 gal. water added (in.): t� Fluid depth W (ins) Minutes later: 3 <l Absorption rate = z/ S'U -) g.p.d. Peroxide treatment (past 12 months) (Y/N) """rO AG Ij0 &V IV 72-026 (Rev. 3/96)" If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES "Pump on" *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Jac Absorption field on lot Public sewer main Size in gallons On adjacent lots On adjacent lots "Pump off" level at* N / q Public sewer manhole/cleanout Sewer /septic service line a S f Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation / U f Property line /b -,�- Absorption Water main/service line I o 'L Surface water/drainage J c f Wells on adjacent lots _ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / Property line 10 Building foundation )o 4- Water main/service line Surface water /00 I t Curtain drain N G /' At- "N o V w F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area Wells on adjacent lots Io � >o -f I certify that I have determined thru field inspections and review of Municipal records .thattl in conformance with�is�/ � guidelines in effect on this date: Signature Engineer's Name xoa Tf Date ci4t HAA Fee$ �'D Waiver Fee $ Date of Payment Date of Payment Receipt Number 4-7S__9 (2Z -Y,) Receipt Number 72-026 (Rev. 3/96)* are WAR q L CT&E Environmental Services Inc CT&E Ref -9 990985001 Client PON Client Nasse S & S Engineering Printed Date/Time 03/23/99 11:46 Praject Name/0 Lot 1B Hamann Collected Date/Time 03/16/99 17.15 Client Sample ID I.ot lB Hamann Received Date/Time 03/17/99 09:30 Matrix Drinking Water Technical Director: Stephen C. Ede Ordered By PWSID 0 Released sy 9AJ Sample Remarks: Allocable Prep Analysis ParAmeter Results POL units Method Limits Date Date [nit Total Coliform 0 c0l/10DmL SM7$ 92228 03/17/99 KAP waters Department Analyses Mirrate-N 0.072 0.100 m9rL EPA 300.0 03/17/99 03/17/99 SCL RECEIVED APR 5 1999 n/U1 1C. UQ,ot. Mea th Humans, e MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENt OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ht' (a) Legal Description (inc ude lot, block�Q division, section, township, range) LST / 13 HA�i-i,4A1�1/ --- - - Location (address or directions) �Aet I.✓ &�� y� y/ (b) Applicants Name U T'�i4Ll/� Telephone - H me _Business Applicants Address (c) Applicant is (check one) Lending Institution ; owner/builder; Buyer F::] ; Other F�__j (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Number of Bedrooms 3. Water Supply" Individual Well Multi NMI Other (describe) Public El 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 E Community [=I 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 21 v 5. Engineering Firm Providing _Inspections, Tests, File Search, Data and Information N-1 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 on-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 Address E"GIWteS '1140 1RIVEH, ALASKAtrS37:7 Date PH. 19 t.,i"70 c Icy (ENGINEER DHEP Approval 5 �i �i' Approved for bedrooms By Approved Disapproved �"`� Terms of C3pditional Approval 17• CAUTION Telephone Ac: .n R. Sbakf Or ®ii'ee• - �o. 1857-E «o'er Date CJ %c c7 l Conditional THE 14UNICIPALITY 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 MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION, CHECKLIST - FEBRUARY 1984 %A U G R 1Q 4 A. WELL DATA 4-, 1,13 ! f\ItIt Well Classification 51 If A, B. or C, D.E.C. proved(Y/N) Well Log Present (. /N) Date Completed Yield2- Total Depth 2-eS71 Cased to % Depth of Grouting / Static Water Level //Z Pump Set At 6141 Casing Height Above Ground 3611 Sanitary Seal on Casing ) Electrical Wiring in Conduits_%/N) Depression Around Wellhead (yg!__ Separation Distances from Well: To Septic/H�i�ig Tank on Lot 142,2 - ; On Adjoining Lots 2G70 r To Nearest Edge of Absorption Field on Lot 1& ; On Adjoining Lots 1/9-o To Nearest Public Se%sr Line y A To Nearest Public Sewer Cleanout/Manhole / To Nearest Sewer Service Line on Lot Z12—z-? Water Sample Collected By ; Date Water Sample/I Test Results Comments sy t,✓�Z� T�t�v 7�5i 5{l�i,�e ��z ��z� B. SEPrIC/H9G TANK DATA Date Installed S S Size 119ergeV No. of Compartments StandpipesC YY�/N) Air -tight Caps ( /N) Foundation Cleanout (I' N) Depression over Tank (� Date Last Punped 2/ Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) /a Temporary Holding Tank Permit (YIN) Separation Distances from Septic/4444i-;gg Tanks i To Water -Supply Wb11 To Building Foundation (Q To Property Line �� To Disposal Field 2-01 To Water Main/Service Line � To Stream, Pond, Lake, cr Major Drainage Course �/A - Comments rf'�S. Pie C, [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 322 4/a- Type of System Design Date Installed !5;�� Length of Field 7S Width of Field lLo q Depth of Field 7 / Gravel Bed Thickness /V�2 Square Feet of Absorption Area 23 10 Standpipes Present 0/N) Depression over Field (Y[ - Pate of Last Adequacy Test �J Results of Last Adequacy 'lest Separation Distance from Absorption Field: To Water -Supply Well /Q O To Property Line /e ` i To Building Foundation 25 To Existing or Abandoned System on Lot On Adjoining Lots So U To Water Main/Service Line 'u/ To Cutbank(if resent) � /J To Stream/Pond/Lake/or Major Drainage Course 'AJIA To Driveway, Parking Area, or Vehicle Storage Area %�i- /. f. .• w�ii" '��#L.'� D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(YM) Con¢nents Pumping Dimensions le Access (Y/10 Off" Level at Vent (YM) s during Adequacy Test. Meets MOA ** 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. 45 4(1 v'L ;J IIt+E L'. Signed S : B�Nt Date Ahz'z + ,, Ei1, Al�(l2 '7�d/� MOA No. Compan �'�i. ��n.. KB1/d5/s (Page 2 of 21 2-15-84 e.ey. P�.e •S h 01 •4 • ♦• ap •1• a...... ..•. 9 I• +�•, 1l.brrl A. Slick" + 1457-E •, a A P" ` 40 0 SIONA 2-15-84