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HomeMy WebLinkAboutILIAMNA ACRES LT 7B:1:1 iamna Act Lot 7 017-101 -35 I , Municipality of Anchorage Poge 1 of. DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW9901 O0 PID Number: 017--010--55 Nome: CHRISTINA SIEGMANN WastewaterSystem: · New [] Upgrade Address: 4201 DE ARMOUN RD ANCH. AK, 99516 ABSORPTION FIELD* I No. of Bedrooms: Ph°ne:~907/(' ~ 345--2413/265-1551 4 i-i Deep Trench [] Shallow Trench · Bed [] Mound · Other* LEGAL DESCRIPTION ,a,, Rating, * Total Depth from original grads, 2 GPD/Sq. Ft. 0 -- 1.1 (TOP OF SAND) Ft. Lot: Block: Subdivision: Depth to pipe bottom from origlr~l grads: Gravel depth beneath pipe: 7B - ILIAMNA ACRES 0 - 0.8 Ft. 0.27 Ft Township: Range: Section: RII added above original grade: Gravel length: - - - 1.4 TO 2.5 Ft. 50+ F~ d ~-~-~ Gravel width: Number of lines: Distance between Ilne~: WELL: [] New [] Upgra 12+ Ft. 5 2.5' F~ Clauification (Private, A,B,C): ~ Ca.ed To: Total absorption area: Pipe material: F~F~ 360+ SO. Ft. ASTM D-3054/SCH 40 DateDrilled: Static Water Level: Ins~allen Date In~talled: Ft. A+ HOME SERVICES 9/7/99 - 9/8/99 Ft. Casing Height Above Ground:Ft. TANK SEPARATION DISTANCES [] Septio [] .oldi.g · To Septic Absorption Lift Holding Public/Private Manufacturer:. Capacity In gallons: From Tank Field Station Tank Sewer Unoe ANCHORAGE TANK 1500 Material: Number of compartments: Well 100'+ 100'+ 100'+ - 25'+ STEEL 2 Su~oCewotertOO'+ 100'+ 100'+ -- - LIFT STATION Lot ~zo In gallons: I Manufacturer:. Line 5'+ **4.5' 5'+ -- - 1 500 ANCHORAGE TANK I Foundation Cu~ain Pump Make & Model: Electrical Inapeatlons performed by: Drain -- NONEi KNOWNi ' 20 OS 05 HHF M.O.A. Remarks:* THIS IS A BO'FrOMLESS INTERMITENT SAND FILTER. BENCH MARK Location and Description: · * REQUEST THAT THE 5' LOT LINE WAIVER (PERMIT # TOP OF PORCH STEP. WR990025) BE AMENDED TO 4.5 FEET. Assumed Elevation: 100.00 ENGINEER'S SEAL Inspections performed by:. AWWC, INC. Dates: 1st 9/7/99 ~?~...':i..~.. '~~ 2nd 9/8/99 ~" 3rd 9/13/99 ~ .............. , &'t/J, 'rO;~; '.. (!E-7953 ." Department of Health and Human Services approval ~i~. "..,, .." Reviewed and approved by: /~,.~,,.-u.-,// /~'./°~ Date: / O- I ? -~/~/ 7~-o~ (,,v. ~/~) ~o~ ~.~ ~" /~' '/' PERMIT NUMBER: ~,,,~o~oo AS- BUILT DRAW NG ~^~°~' '~o~-~o~"~""":-~ ST~ 6~.6 17.~ c~ ~ ST2 70.4 25.5 ~ ~7%., ~T1 95.1 64.5 I ~.,' "::'~ ~ / ~ MT~ 85.1 81.5 ~ ~ ~ -~ ~..,/' ,~,?,,,~,.';, NEW FOUR FLUSHING %~ ,,' ...... ..-~. HOUSE ~ NEW BO~OMLESS~ MT4~¢~[P]MT5 I I~ALTERNATE ~h ....... INTERMI~ANT SANE % . I I ~ SITE FILTER DRAINFIEL~- %~ ~TH¢4 I I I J I L ~ %~ ~ TH~5. .. ~;_/I - - ~, ~co ¢ I ~NEW 1500 GALLON S.T.E.P. TANK / PHONE: (907) ~7-6179/F~: (907) ~8-~246 ." LEaL BESORIPTION: ILIA~NA ACRES SUBDIVISION; LOT 7B ~,~.:,..~, 4,- ~~ -- AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE PREPPED FOR: PHONE NUMBER: ., SIEGMANN CHRISTINA (907) ~45-2415/265-1551 ~.".. C~:~7955 ... I I I .......... 10/1/99 K.D.W. 1 = 30' 2 OF 5 PERMIT NUMBER: PaROeL ID NUMBER: ~o~oo A S- B U IL T D R A W N G o~7-~o~-~5 YOP OP 5~P - 9~,2 ~ ;;i~;~ / ~,~- ~,~ P~OFILE VIEW ~ De~RR ROAD. sure ~B. aN~HO~e. ~. ,.~.,~ ~ ~,,,,~,~,~: ~ ~, ~..,.:....~. ..... ~....~ ~Pe Of WORK: PREPARED FOR: PHONE NUMBER: SmEG~ANN . Uh~_-.~._ CHRISTINA (907) 345-241 K.D.W. 1 = 30' 3 Of 3 -~~ COMMENTN 17fPE OF INSPECTION: FROM : FLEMING SURUEYING SUC. PHONE NO. : 907 243 4890 Sep. 29 1999 02:10PM P01 PROPERTY OWNER AGREEM~.NT FOR THE MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM Anchorage Department of'Health and Human Servic6s (DHHS) and the property -'. of: Thi.~ a~reeme~ is made for the purpose of maintaining an on-site wastewater disposal system on ~he subject property. The property owners agree to ~e following: Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation sutement from a registered professional engineer. Th~ i--~pection and . operation statement shall verify that the engineer.has inspected all effluent and air pumps, timers, and alarms, and that any deficiencies have been repaired and that the system is fun~oning as designed. (S~smmr;t' - ~<'~-' (Sis~tre) (Printed Name) (Priated Name) Notarize Here - --- personaXXy appeared before me, who'ks personally known to me ?....- , ~ whose identity I proved on the basis of ~/~ ,~'t~ ~t"~;~;-C'o x%X~,'~?.¥ ~.__. whose identity I proved on the bath/affi~tion of ~ - ~,.~ ............ ~ ......... ~ ~/- % ~ - -- . a credible witness ~{ ~%~er of the abo~ document, and he/she acknowledged tha~ he/she si~ed MUN/CIPALITY OF ANCHORAGE Department of Hea/th and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: May 18, 1999 Expiration Date: May 17, 2000 Permit Number: SW990100 Legal Description: ILIAMNA ACRES LT 7B Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Cristina Siegmann Owner Address: 4201 DE ARMOUN ROAD ANCHORAGE , AK 99516-3619 Parcel ID: 017-101-35 Site Address: 005120 142ND AVE E Lot Size: 495051 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. blDSF - this permit is for a bottomless intermittant dosing sand filter. A property owner maintenance agreement shall be part of the As-Built package. Received By: ~~~. ~ Date: Issued By: ~--~,~Z/?~.~/ ~ /L,~~ Date: Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services @25 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us AK Water & Wastewater Consultants, Inc. ATTN: Jeffrey Garness, PE 6901 De Barr Road, Suite 2B Anchorage, AK 99504-0000 May 18, 1999 Subject: Waiver Request for ILIAMNA ACRES LT 7B Waiver # WR990025 Lot Line Request for Parcel ID 017-101-35 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the lot line has been approved. The approved separation distance is 5 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Civil Engineer I On-Site Water Quality Program WR$ WR990025 PID% 017-101-35 HA# Date Received: April 30, 1999 Legal Description: Lot 7B Iliamna Acres MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet Permit Engineer: Jeff Garness, PE, Alaska Water & Wastewater Consultants, Inc. 6901 De Barr road, Suite 2B, Anchorage~ Alaska 99504 Applicant: Cristina Sie~mann Waiver Requested: west property line Lot line waiver of 5 feet fromt he proposed ISF system to the Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: e 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: Rec ~: #04815/3351 Amount: $ 115.00 Date Paid: 4-30-99 Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B - Anchorage - Alaska 99504 (907) 337-6179 - Fax (907) 338-3246 Consulting Engineers April 28, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Proposed Septic System (Bottomless ISF) and Lot Line Waiver Request for Lot 7B, Iliamna Acres Subdivision To whom it may concern: The proposed 4 bedroom house will be served by an onsite septic system and a existing private well. A well and septic permit was issued in 1984 and the well was drilled on 6/2/84. A septic system was installed on the property in the approximate location shown on the site plan and design. It is believed that a 25 foot by 50 foot bed was installed in 1984 and has never been used. It is also believed that no inspections were performed by a engineer. We are proposing to abandoned all portions of this existing septic system and install a new system in the same area. Comments regarding the proposed upgrade are summarized as follows: 1. GENERAL: There are a number of site restrictions which limit the available area to put a new drainfield. These restrictions are summarized as follows: The location of the creek. · The location of the 100 foot well radii. The presence of poor soils and groundwater. · The proposed location of the house. As can be seen on the attached site plan and design, there is limited available area to install a septic system. Consequently, we are proposing to install a bottomless Intermittent Sand Filter (I.S.F.) system. 2. LOT LINE WAIVER REQUEST: We request that your department issue a 5' lot line waiver from the proposed I.S.F. system to the west property line. We are unaware of any adverse effects with the granting of this waiver. 3. SOILS: On April 6, 1999, four test holes were excavated and six percolation tests were performed at several locations on the property. A copy of the logs are attached. As can be seen from the soil logs, TH#1 and TH#2 had percolation rates ranged from 7.1 to 60 minutes/inch. The :soils. in TH#3 were found to be impermeable at 4 feet. TH~4 was excavated in the middle of the existing undocumented bed to confirm soils conditions. Given the fact that the percolation rates in TH#1 were the most favorable, we propose placing the bottomless ISF in the 30 foot radii of TH#1 and TH~4. 4. SYSTEM DESIGN: Bottomless Intermittent Sand Filter (I.S.F.) a. Percolation Rate: 7.1, 24, 48, & 60 minutes/inch (for TH#1 & TH#2) b. Allowable Application Rate for ISF: 2 gallons/day/fl2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 300 tt2 f. Effective Depth below pressure pipes: 3+ inches g. Width: 10 feet h. Length: 36 feet. i. Effective absorption area = 360 112 (>225 112 OK) j. Ak Supply: Thomas Industries, Model 5070, "Anchorage Tank". k. Air Supply Line: "Wasteflow" emltterline, 1/2 inch I.D, "Anchorage Tank". 1. Sand Materia41: Per Latest Guidance by Municipality of Anchorage m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and less than 1% passing the #8 sieve. We are proposing to excavate down to a depth of 3.0 feet (maximum), place a minimum of 6 inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On top of the sand, we will place 3 inches of 3/8 inch pea gravel above and below the pressure laterals. We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can be intermittently dosed to the ISF. 5. TOPOGRAPHY: grade of 5% to 10% concerns. As you can see from the attached topography site plan, the lot slopes at a running from approximately east to west, in short, there are no slope 6. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation & Maintenance Manual". The contractor should read this documem prior to construction. Copies are available at the Municipal Onsite Services office (5th floor, 9th & L St.). 7. CLOSING: I am open to any suggestions from your department, which would be an improvement to the proposed design. I am unaware of any adverse impacts this installation would have on adjacent we~lls or septic systems. If you have any questions, please contact me at 337-6179, or 244-9~2. Thank you for your assistance. S' !i ~ TRACT lOB, ILIAMNA ACRES bJ Z ' ! ~ ~ TRACT 10C, ILIAMNA ACRES ~ i. ~ TRACT 11, ILIAMNA ACRES i TIC AR.~ i .......................... -{ F ~-'-'~' ~ "'"~L ! / EAST 142nd AVENUE / \ ~TH~ ~ ~ UNDOCUME~ED ~ } 4 BEDROOM ~ ~ ~ S~IC ~M ~ ~ HOUSE ~ ~ ~ ~ ~ 6, I~ ~RES z ~ L ................ ~ ..................................... / ~ { T~CT 7D. IUAM~ ACRES ;~ ~ 7C. IU~NA ~R~ co sm s, PHONE: (907) 337-6179/F~: (907) ~8-3246 ' .E~ D~CRI~ON: SITE P~N FOR SEPTIC DESIGN CRISTINA SIEGMANN 545-2415/265-1511 ... ~ e~ .. .......... '~ J.L.M. 1 = 100' 1 OF 5 ~o~ess~o THE m~ZBU~ON UNE. ~ ~C~ / ~ / ~H~ / - _ /~/ ~S ~..~!~a~ ' D ~E 1~ F~T S~ ~ ~ PRIOR ~ ~ C~U~ON. I '  BEU~D TO BE A 25' ~ ~D' BED THAT ~ N~ER BEN USED. THE PROPPED P~ A O-lO ~1 ~SURE ~gE AT A ~ON WHICH IS R~ILY ~1~ ~M ~IN ~E HOUSE, /- ~ IS TO BE IN~A~D IN A POTION / AND AT A LOWER E~A~ON TH~ THE (A 30 ~1 ~E ~ N~ ~.) / EXI~NG BO, ~ ~I~ING PIPING, FILTER COMPL~ELY AN) REP~CED WffH N~ MATERIAl. UNE S~ ~ 1/2' D~R HOPE (1 PIE~, INSUreD W~ 1/2 INCH F~ PIPE W~ (~ V~ INSI~ A 2 NCH ~H.~ ~ ~K~. ~E UNE S~ BE BURIED A MINIMUM DE~ OF 5 ~. ~ ~7 4) ~E ~L p~ ~R ~E ~P T~K S~ BE ] 10' UTiL~ ~E~ENT · ! /~PI~,O~, :2 t~1', OI~NCO (HOUL~ ~l~l.i~ ~ ~ ....... ' /~ ~ ,, , ,~, , , , , , / ~ ~' ' ,,,, / ~ ~ , ,,, , ,, , , , , , , __- /,,,~,,~,~~ ~"~,~'~~*~-~ --r~~~ I~, (~bb I/~ I~ ~ ~) P~N VIEW ~AYlN~ , :~' '::~ ' ' , ~I ~ 4' MIN, 2 P~f MIN, ~ ~L~R ~~j- / I0' =J fO ~A~R ~~ PROFILE VIEW ~I.AS~ WA~ A~ WAS~WA~ CONS~TA~S, ~C. ~um~ ~c~[s su~mws~o~; Lo~ ~, ?m: .... ~..:.~: .... "t'" BOTTOMLESS INTERMI~ENT SAND FILTER (ISF) DETAIL PREPare FOR: PHONE NUMBER: V~ C,~ST~NA S~E~VANN ~4S-~13/~SS-1S~ 'q[~y, '"-. ..'"Z~'~ DATE:4/28/99 D~ ~: S~E: PAGE: AT.&SK& WATP. R. & WASTEWATEI~ CONSULTA.NTS, INC. DESCRIPTION: ~ERFORMED FOR: CRISTINA SIEGMANN ,,, DATE PERFORMED: 4/6/99 ' DEPTH ~ ~¢~o%~a~,~ SOIL C~SSIFICATIONS [SITE PLAN[ . / , I , 1 ;;~ ~ ~ I ~M ¢ BEDROOM~ 7--,o~o ~ DEPTH TO DATE uous~ . .... [ GROUNDWATER UNDOCUMEN~D ,?~ i ~ CLOCK NET TIME WATER LEVEL NET DROP 11 ~;%o ~, ~ DATE READING ,,~ ~, ~, ~ ~ ~ ~ TIME (MINUTES) READING (INCHES) h,?o~' ~ 4/7/99 I 5:18 16 _ 5.~v o N J [ LOWER 2 5:~9 30 MIN. 1 B.O.H. --BENCH 3 5:49 6" ~ 5 6:19 6" 19-- PERCO~TION ~TE 24/7.1 (HIN./INCH) PERC. HO~ DIA. 6" (INCHES) (UPPER) AN~-OWER) 20 TEST RUN BETWEEN 3.0'-4.0~ FT. .5'-6.5' FT. BOTH PERC CA~TIES WERE PRESOAKED FOR~ H~RS~IOR TO TEST. COMMENTS: / I I! / DEPTH TO DATE GROUNDWATER 10' 4/21/99 ^I.&Sl{& WATER, & WASTEWATER CONSLTLTANTS, INC. ~-~ ©? PHONE (907) 557-6179 * FAX (907) 338-324.6 I SO,L LOG - P ' COLA'r,o, TrS-rl ,/-'"'.: ^=s ,,. LEGAL DESCRIPTION: ILIAMNA PERFORMED DATE PERFORMED: 4/6/.9 "Og~. '-. ~.5~ ...-'../~ I 1 '<"~ '"' .... '" ~ DEPTH (fe.t) !::i!.~i;i~ TEST HOLE #2 ~,~...,~..' ........ 1 --:~ 2!2L~ ~ ORGANICS 2 ~ GW/GP LAYER SOIL CLASSIFICATIONS I E PLAN ,I ~ ' --~ ..........{-I~=100 ~i ~ I ~ J. ~- ?Pr!4!'sw LENSE~ s--~ ~?~','~ ~'SP CH ~ ~Fq ~ / ~' ~' [~, ~' ~ PROPOSED~ ~PROPO~ED ~ SE~IC ~_ ~ ~, DEPTH TO DATE ~" ~ BEDROO~ ~HOUSE ~ ~ GROUNDWATER~ B--~ ~ (~.~¢~M/w T~ 11.5' 4/6/99 ~K --~I~IN6 , UNDOCUMEN~D i ~4e~ / SE~C ~EM ;~ ~p~ ~ SOME SW 10' 4/12/99 , 9--~I~ LENSES ~ ~ ~' , CLOCK NET TIME WATER LEVEL NET DROP ~ ~", ~, DATE READING · ' --~ ~?~ ~ TIME (MINUTES) READING (INCHES) ~2--~¢'-~ ~ ~ ~ ~/7/9~ J__ 5:15 , ~ , ~ UPPER 2 5:45 50 MIN. 5 3/8" 5/8" ~ ~, ~ -BENCH"'- 6" 15 ~ ~ ,, ~ 5 5:45 ~',~, j~ ¢ 6:15 30 MIN. 5 3/8" 5/8" B.O.H. - 6 6:45 30 MIN. 5 3/8" 5/8" 15-- 4/7/9~ ...... 1 5:15 6" -Low~E~ ~- .... 5:4~ ~o ~lN. 5 ~/2" ~/2" 16 ~ ' -BENCH ....... ~ 5:45 6" 17~ 4 6:13 50 MIN. 5 1/2" 1/2' ..............5 6:15 6" 18 ~i .............. 6 ..... 6:45 50 MIN. 5 1/2" 1/2" 19-- ; PERCO~TION ~TE 48/60 (HIN./INCH) '=ERC. HO~ DIA. 6" (INCHES) (UPPER) ~ ~ER) 20 TEST RUN BETWEEN 2.0'-~.0' ~. AND -6.0' ~. COMMENTS: BOTH PERC CAVITIES WERE PRESO~ED FOR~ H O ~ST. / PERFORMED BY A~SKA WATER A WAST~ATER I, ~ A ~/~ , CERTI~ THAT T.~S WAS ~.~O~¢~ ¢ ACCO.OA. CS W~T. *.. STAT~ ¢~ ~~~O~U.~S ~. ~CT O. DEPTH TO DATE GROUNDWATER 11.5' 4/6/g9 10' 4/12/99 AI.~SK/k WATER, I~ WASTEWATF.~ CONSULTANTS~ ~C, ~ ~ ~ ~A 6901 DE~RR R~D, SUrE 2B 'IANCHO~E, ~. ~950~ ~. ' LEGAL DESCRIPTION: ILIAMNA ACRES SUBDIVISION; LOT 7B,~'""~~~~ .... . ............. PERFORMED FOR: CRISTINA SIEGMANN ~;~;~~~'~ DATE PERFORMED: 4/6/99 vOh3~'.~ ~-7953 .-' DEPTH I I (feet) ~ TEST HOLE ~3 ~'* "............. '~ ;:; ::; ::: ';:: ~ ORG/FILL ,~ ~? .... ' ~ , , o__~o ~'~ 18 -Z~ OF SW SOIL C~SSIFICATIONS SITE P~NJ · /~ ~ ~ , l ' ~ ......... J I"= I00' J I~ ~ ~ ~ :~ 1 ~ ]~: VERY DENSE sEmlc / ~[~ ~ DEPTH TO DATE HOUSE ~ ~ GROUNDWATER~ ~ 8-- I ~ ~ 11.5' 4/6/99~~ ~ UNDOCUMEN~D ~ 5.5' 4/12/99 ': ~+~ CLOCK NET TIME WATER LEVEL NET DROP 11 --[~ DATE READING ~ ~ ~;, TIME (MINUTES) READING (INCHES) 12~T~ 4/7/99 - PERC CAVI~ ABSORBED WATER AS FA~ ~ IT WAS ADDED. % " ' t ~ ~ '-BENCH- , ,.~,-.' 11" ~%~t~ ~/7/99 ~ 5=~0 ............................. · ~ ,~;?~?~ LOWER 2 5:~ 30 MIN. 10 3/~" 1/4" t~',~} '--BENCH-'- ~t~,~T~ ............................. B.O.H. - .................... ! .................................................................. 18~ 19~ PERCO~TION ~TE ~/120 (HIN./INCH) ~ERC. HO~ DIA. 6" (INCHES) (UPPER) .u. COMMENTS: BO~ PERC CAVITIES WERE PRESOAKED FOR~ H TEST. PERFOEUED BY A~S~ ,WATER ~ WASTEWATER ', [ j~ ~k.~~ ~ , CERTI~ THAT DEPTH TO DATE SROUNDWATER ........ ~.~:~ ................ ~/6/~ ...... ....... 5.F ~/!.2/~? ._ I SOlL LOG - PERCO~TION TEST I LEGAL DESCRIPTION: ILIA~NA ACRES SUBDIVISION; LOT 7B, ~'"'~'j ~~.~.....j, DATE PERFORMED: 4/6/99 V~J"'] NE-7955 ." ,~,'-...- ...- (feet) ~ EXISTING 1 ~ ~ m , UNDOCUNENTED g ~ SEPTIC SYSTEH ~o SOIL C~SSIFICATIONS SITE PLANJ- /~ ~ 2--~~ I"= IO0'..J I~ I ~ ', [ 7--+;~ ~, ~ DEPTH TO DATE HOUS~ ~ GROUNDWATER ~ B. O. H. 8 ~ i DRY 4/6/99 ~~K UNDOCUME~D ...................... 10~ NET DROP 11 -- DATE ~EADING TIHE (HINUTES) READING (INCHES) 12~ - ................. - 15~ - NO PERCO~TION TEST PERFORMED 16~ 17~ 18-- 19 ~ PERCO~TION ~TE ~ .(NIN./INCH) PERC. HO~ DIA. 6~ (INCHES) 20-- TEST RUN BETWEEN - ~T. ~D~FT. PERFORMED BY A~SKA WATER & WASTEWATER I , CERTI~ THAT THIS WAS PERFORMED ~ ACCORDANCE WITH ALL STAgy ~ M~C~L GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/~/~ ~ --// DEPTH TO DATE GROUNDWATER .......... 97 ............. 4/_..6_/~ ........ 6' 4/21/99 Municipality of Anchorage Page / of ~-- DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report ~',,~./¢¢c?,,c// ,/~, ~z ~--~,~,4_~u'jt.,) Wastewater System: [] New [] Upgrade Address; Phone: No. of Bedrooms: -' ¢' '-"~LZ'~;---,~'-~-T--~4Z'~.r~' [] Deep Trench [] Shallow Trench [] Bed [] Mound [] Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: GPD/Sq. Ft. Lot: .,._ ~ Block: Subdivision: Depth to pipe boltom from original grads: Gravel depth beneath pipe Towvo~shi p: Range:/ T t~.-- Section: */~"~/(~L ~_/.' , Fill added above original grade: Gravel length: ~ Ft, Ft. .-¢P-1~'~ ~ H ~,,~ ra,4e Grave~ width: Number of lines: Distance between lines: WELL: [] New Ft. FI. Classi~cation (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Yield: Put/rip Set at:, Casing Height Above Ground: SEPARATION DISTANCES [] Se¢io [] Holdi,g [] s.'r.~.P. To Septic Absorption Lift Holding ~ubtic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines We,I- //~'L//,/ f/OO /~ Material: Number of Compartmenta: Surface Water LIFT STAT I O N Lot Size in gallons: Manufacturer: Line Foundation "Pump on" level at: "Pump off" level at: High water alarm at: Curtain Pump Make & Model Electrical Inspections perCormed by: Drain Remarks: BENCH MARK Location and Description: Assumed Elevation: ENGINEER'S SEAL Inspections performed by: Dates: 1st 2nd. Department of Health and Human Services approval Reviewed and approved by: ~/~**¢,~-~-- / Date: 72-013 (Rev. 9/91) MOA 25 Permit No, ~,~,1 ~/~C~')~ c) Page, '~ of /~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposa~S~y~stem and/or Well Inspection Report LegalDescription: L~'~- ~ --~-~//dr-/~//}A[- /~(~/~' PIDNo.: 72-013 A (Rev. 9/91) MOA 25 (N) RETURN fO: Division of Geological and Ge( leal Surveys (DGGS~ 3OO1 Porcupine Drive (Teleph~,.,: 277-6615) Anchorage. Alaska 99501 WATER WELL RECORD ~ ~. ,,(.~ i '~-:~ U.S.G.S. Local ~ ~ DrtllJng Permit No. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES .OCATION OF WELL ] Please complete either la, lb, or lc. A.U.L. NO. la. Borough Subdivision Lot I Block lb. Fraction Section No. Township Range Meridian ,,~ . 'l- ~ · ,, ,-~, ~J / / / lc. Distance and Direction from Road Intersections 3. OWNER OF WELL: I Address: Street Address and Area of Well Location 2. WELL LOG Feet Bel~ 4. WELL DEPTH: (completed) Surface Elevation Date of Com~l et ion Material Type Top Bottom ':' - ~ '"~ ' .~ / ~' ~ ~ Other: ~ ~,Y] d*. , ~,- ..... ~!, ,' ',"' - 8. FINISH OF WELL: Type: ~, ';',_ m ~... Dia~ter: ,~ " t j Slot/Mesh Size: Length: J - Set batten ft. and ft.  Fittings: 9. STATIC WATE~ LEVEL: ~A~ve ~Below land surface ~. y ~ i i'~ ~" ~/[~ ~, ,~ ~ ~ ' " ~ ;~"' /'~'~ + ..... ~'""~ ~" Type of Measur~nt: /' ..,,, - /,~ ~ I 10. PUHPING LEVEL belo~ land surface J J ~ ft. after hrs. pumping ~ g.p.m. ft. after hrs. pumping g.p.m. g~R~, 0 n~T~O~ ~Pl:]ess Adapter inches above grade ~ · · I ~ ~ 13. PUMP: (lf available) HP Type: ~ Sub~rsible ) )~. R~HARKS: 5. WATER WELL CONTRACTOR'S CERTIFICATION: This wall was drilled under my jurisdiction and this report is true to the best of my knowledge and bellef: a~ ,>~,~,~..'~ ,, :/~ .' ~ - ~ - Registered Bus'ness Name Contract LicenSe Number . , ., ., - Authorized ReDresentat {Ye ,~ 6 650 ANQI~ORAGE. Al l',~l<lx 09502--0650 264 4111 DEPARTMENT OF HEALTtt AND ENVIRONMENTAL PROTECTION Permit ~: 840069 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 7 B Illisr~na Acres Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, ].98~, Permits are issued on a calendar year basis by authority of Municipal Ordinance° A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date° If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as-built inspection report and the yellow copy must be sent to 'this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, rKeith E. Bandt, Supe~viso Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/0 5 7 i'~:, I:::1T Eil ]] E~ '.!!;i..I E E) CE:F:T :t~ f"r' 'r['HI:::IT: ::L. ]: !:r;IH I:::'I:::li"i:I:I...:[FIi:;;: !.,.!:["FH "i-HE!: F:Ei:I:i:flJi[f:;:E;i'"fE:i",IT'.E; I::;'OF;: Oi',H-'J~:;:t:'T'li{ ~-~;EIr,.E:~iiE: FINE:, r,.IE!:I....I....:E; I;:iL":i; E;Ei:T F'O[h. TH Dh" THFE: r,H..IN :!: C: :[ I::;'F::Ii. ]: TV OF' F::!i'.,iCi-.lOFE:Ft(!iiE ,:'.hlCiF:l) i::ii'.,IB, TI.IE: E;'i"F:I-f'E ElF F:!L..I::I'.~;I.:::I::I. 2.. :[ l.,.t:f].}. ]:N:BTF;IL.L. '['k'ilE~'. '.SY'?5"FEi,i :i:I'-,! F~CC:OFU::,F:fi4C:E; !,.l;E'['l.-I f;~t..L. H(:)Fi COE:,E:B FIND i;REGUL. FFt":[ON'.5, FINr.::, ~ I'.,] C:OhlPL.. ~ Fli'.,ICE: t,.! ~ TH T'HE; E:,E::E; :[ !::~i".~ i::::F~'. :[ 'FE:F'. ]: I~I OF' i'l'l ]; E; i:::'EEF':'.I"I ): 'T'. ]: N'.[L.L. FtE:,I--.IE:I:RE: Tr.::l Flt...l.. HOF:I FiND '.~;'i':1:::i~i'1~: OF;' FiLJ;::i:fi;!'CF:I' iE:I~:i:;:!L.i~[FRE~HE-:I'.,IT'E; F:OF~'. THE: '.~;E:T E:.i:::ICI'::: E:, :!'. 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F:IFIF'L.. ~ I::FIi",IT: I"'!FIF:E:~ E:]. E:'F:IN :i: I~E!... .... MUNICIPALITY OF ANCHORAGE ~rotection ~~g3' ~mL'~',~'F Department ~ Health and Environmenta~ ..~ 825 ~ Street, Anchorage, AK. ~9501 ' ,~' 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~ WELL AND/OR ON-SITE SEWER PERMIT Location: /D/.O/_~ X~, ~9.~£ /~'~ Phone Number: ,5 ~/--~ Legal Description: Z~',74~ ~~~ LOt Size: Type of Soil Absorption System Is: ~/ Trench: Drainfield: Seepage Bed: /~ . Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br)~ ,, ....~ The Required Size of the Soil Absorption System Is: DEPTH//~-A,-> LENGTH ,5'~ GRAVEL DEPTH ~ WIDTH cQ_q The length dimension is -the len~'h~-i~a~e~ of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). REQUIRED SEPTIC(HOLDING) TANK SIZE = /~'O GALLONS * * * * Permit applicant has the responsibility to inform this departmen~ during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any. system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion, Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence~s_~ remo~t~jLed.(~ J to include more that 3 bedrooms. A~l~ic an~ ,- . SWP/024(1/81) PERFORMED FOR: L E G A L~j~ ESC~iCTI C~N: 3 4/, 6 7 14 20 MIINLC PAt ltv OF ," N(:HORAGE MUNIClPAL~T'PO DEPARTMENT OF HEALTH 825 L. Street, Anchorage, Alaska 99501 ,~64-4720 SOILS LOG - ~"1~ '~% DATE PERFORMED: SOl LS LOG [~PERCO LATION TEST SLOPE SITE PLAN I COMM ENTS__~E ~ ~ ~,'~1~,~ fJ $:) PERFORMED BY: ~¢1~¢~ ]~"~.~.~ 'l ENCOUNTER ED7 ~}'~,_~ I~ WAS GROUND WATER DEPTH? 6" do .e. Gross Net Depth to Net Reading Date Time Time Water Drop ~ rT'~ .~o PERCOLATION RATE I~.~¢~' 1, ; ~'~ [0 (minutes/inch) TEST RUN BETWEEN ' J_L.~ FT AND ~ '~' FT CERTIFIED BY: DATE: J O B '~w-L,I~ LEGAL ALASKA eF, ,F OFlmeFITAL COFITROL ~nqin~¢rin(j $ ~nuironm~nl~l SUPPLEMENTAL SOILS LOGS TEST HOLE NO. ~ TEST HOLE NO. (~ DJ Z ~ I 1 1 1 ,1 '1. 2. 3. o- 6- 7' 8- .8- 9- 1 11- 1 13- 14- 1 16- 17- 18- 19 20, MUi',i[C[PALITY OF ANCkiOP, AGE :!'~'r OF ltEALI'H & [~iq\/!;~:{.;: .',:{!'-,i/:',l [,,,~r .CF[ON 1200 LUcsl $3r~I ~ucnu¢, Suile B · A,~hor(]q¢, AIo~l<a 99~03 · (907) 276-1361 $ H E E T/Z, O F ';2' · : RE1URN TO: Division of Geological and Ge~ Ical Surveys (DGGS) ]OOI Porcupine Drive (Teleph~...: 277-6615) Anchorage, Alaska 99501 WATER WELL ~ECORD · J~ ~'~ U.S.G.S. Local No. grilling Company Nane ,'~ '!,~,.!' "~'~; ~'~' ~ ~' " ' -~ ' ' Drilling Permit No. STATE OF ALASKA DEPARTMENT OF NATgBAL RESOURCES OCATION OF WELL Please complete either la, lb, or I.c.~ /~,g.L. la. Borough Subdivision Lot NIock lb. Fraction Section No. Township Range Meridian Address: Street Address and Area of Well Location 2. WELL LOG Feet Below 4. WELL DEPTH: (completed) Surface Elevation Date of Surface Completion Material Type Top Bottom ft, ~,,: ,, 6. USE: [~lOorr~st~C E~Public Supply ,~ ~Test Well ~ Other: :, 7. CASING: ~ Threaded ~Welded 9. STATIC WATER LEVEL: ft. ~A~ve []Below land surface .... A,t~ O~ ~[;~o~_ m 11, WELL H~D COMPLETION: ~ In Approved Pit ~I%~ ~ ~Lt ~TF~O~ ~ PI cless Adapter inches above grade 12, GROUTING: Well Grouted: ~ Yes j ~ ~ I~. PUMP; (if available) HP Type: ~ Submersible ~Rec iprocat ing ~Jet ~Other: TO ALASKA ENVIRONMENTAL C"'ITROL SERVICES, INC. 1200 W. 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 WE ARE SENDING YOU [] Attached [] Under separate cover via [] Shop drawings [] Prints [] Plans [] Copy of letter [] Change order []_ DATE NO. OESCRIPTION Ami DEPT' ' OF'~6~ 'rems: MAR Specifications1984 THESE ARE TRANSMITTED as checked below: [] For approval [] For your use (~As requested [] For review and comment [] FOR BIDS DUE M Approved as submitted [] Approved ss noted [] Returned for corrections 19 E~ Resubmit [] Submit_ [] Return__ ._copies for approval copies for distribution _corrected prints [] PRINTS RETURNED AF'FER LOAN TO US t REMARKS SIGNED ¢ . If enclosures are not as noted, kindly notify us at oncei~'f ~ ~z~"~/ ALASKA ENVIRONMENTAL CONTROL SERVICE' INC. 1200 West 33rd Avenue Suite B /~NCHORAGE, ALASKA 99503 Phone 276.1361 SHEET NO OF CHECKED BY DATE SCALE JOB ALASKA ENVIRONMENTAL CONTROL SERVICF ]NC. 1200 West 33rd Avenue Suite.B ANCHORAGE, ALASKA 99503 Phone 276-1361 SHEET NO. CALCULATED CHECKED BY SCALE OF DATE DATE ! JOB ALASKA ENVIRONMENTAL CONTROL SERVIC£ INC. 12OO West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 SHEET NO CALCULATED BY CHECKED BY SCALE \ II DATE DATE t I JOB ALASKA ENVIRONMFNTAL CONTROL SERVIC[ INC. 1200 WeFt 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276.1361 SHEET NO. CALCULATED BY CHECKED BY SCALE OF DATE DATE ' , ~NT~L SERV~ NC. ~EET · , ' 12~ West 33rd Aven~ ~uiteB ~CHORAGE, ~SKA 99503 C~CU~T~O ~ 27~1~1 C.~CKEO BY. DATE ALASKA eF uiROI]ITI FITAL COFITROL S RU,USS, IFIL ~nq,necrin§ $ ~nuironmcnlal Studies April 3, 1987 Municipality of Anchorage 825 L Street Anchorage, Alaska 99501 Legal Description: ILLIAMNA ACRES SUBDIVISION LOT 7B Alaska Environmental Control Services, Inc. ~nspected the ~nstallat~on of the sewer system installed on the above mentioned property. The or{g{nal as-built has not been filed due to non-payment o~ ~nspection fees. Please contact ALaska Environmental Control Services Inc. at 561-5040. Thank you. 1200 LUcsl 33rd Ausnu¢. Suil¢ ~, Ancheraq¢. AJasko 99503 ,(907) 561-50/40 ALASKA I I1UIROFImeFITAL COFITROL SeRUICI $, IFIL ~n§incerin~ 8 J~nuiro,mcntaJ $1udies SPECIFICATIONS FOR ELEVATED BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM-- LOT 7B, ILLIAMNA ACRES SUBDIVISION 1.0 GENERAL 1.1 THE DRAWINGS, SHEETS 1 THRU 5, SHALL BE A PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERMIT AND REGULATIONS. 2.0 THE LIFT STATION 2.1 THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER GALVANIZED STEEL (ASTM A-4444-76), OR ALUMINUM CULVERT, CAPABLE OF BURIAL TO 10 FT. 2.2 THE 36" PIPE FOR THE LIFT STATION SHALL HAVE A WELDED WATER TIGHT BOTTOM OF THE SAME THICKNESS AND COMPOSITION AS THE CULVERT. 2.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED AND WATER TIGHT. ALL WELDS SHALL BE CLEANED OF SLAG. WELDS ON GALVANIZED STEEL WILL BE SPRAYED WITH ZINC RICH PAINT OR COATED WITH BITUMASTIC. 2.4 THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED WITH SCREWS. A TWO INCH LAYER OF POLYURETNANE FOAM SHALL BE GLUED TO TIlE INSIDE OF THE TOP CAP. 2.5 ALL ELECTRICAL FITTINGS AND CONNECTIONS IN THE LIFT STATION SHALL MEET THE REQUIREMENTS FOR A WATER TIGHT SERVICE. 2.6 THERE SHALL BE A HIGH LEVEL ALARM, PEABODY BARNES 6147 OR EQUAL SET AT THE LEVEL OF THE SOLID PIPE FROM THE SEPTIC TANK. THE BUZZER SHALL BE LOCATED NEAR THE ELECTRICAL CONTROL PANEL OR IN A LOCATION DESIGNATED BY THE HOMEOWNER. 2.7 THE SUMP PUMP SHALL BE CAPABLE OF DELIVERING 10 GPM AT A HEAD OF 20 FEET. 2.8 PROVIDE A CALDER COUPLING AT THE CONNECTION OF THE 4"2 SOLID PVC INFLUENT PIPE AND 4"2 STEEL NIPPLE. 2.9 THE PUMP SHALL BE CONTROLLED BY A DIFFERENTIAL MERCURY FLOAT SWITCH, ADJUSTED TO ALLOW A TWO FOOT SPAN BETWEEN 'ON' AND 'OFF', AS SHOWN IN THE DRAWING. ALL RELAYS AND ELECTRICAL CONTACTS SHOULD BE LOCATED OUTSIDE THE CHAMBER TO PROTECT THEM FROM COROSION, PREFERRABLY IN A DRY LOCATION WITHIN THE HOME. 2.10 COAT THE INTERIOR OF THE CHAMBER WITH BITUMASTIC PAINT OR TAR TO APPROXIMATELY 3.5 FEET ABOVE THE BOTTOM. 2.11 MOA BUILDING CODES: WHEN LIFT STATIONS ARE INSTALLED WITHIN THE MUNICIPALITY, AN ELECTRICAL PERMIT AND INSPECTION ARE REQUIRED. IN AREAS NOT COVERED BY MOA BUILDING CODES, ~{E SYSTEM SHALL BE INSPECTED BY A LICENSED ELECTRICIAN TO INSURE THAT THE ELECTRICAL INSTALLATION IS IN ACCORDANCE WITH APPLICABLE CODES AND REGULATIONS. 1200 UJesl 33rd Auenu¢. SuJl¢ [3,Anchoreqe. Alaska 99503,(907) 561-5040 ALASKA E IIUIROFlmI F1TAL COFITROL $1 RUICIZ$, IF1C. ~n,:lin¢~rin§ $ ~nui?onm~,lol $1uJics 3.0 SEEPAGE BED 3.1 THE GRAVEL FOR THE BED SHALL BE SCREENED TO 0.5 TO 2.5 INCHES PER CODE. 3.2 THE SAND SHALL HAVE AN EFFECTIVE SIZE OF 0.4 TO 0.6 MM AND A UNIFORMITY COEFFICIENT OF NOT MORE THAN 4. 3.3 THE BERM AROUND THE SEEPAGE BED SI{ALL BE CONSTRUCTED OF IMPERMEABLE MATERIAL, AND ON A SLOPE OF 1 FOOT VERTICAL PER 3.0 FOOT HORIZONTAL. 3.4 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL BE PLUS OR MINUS 2". 3.5 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL BE RIGID PVC, ASTM 3033 D-3034. THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5" HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A REGULAR SECTION OF REGULAR PERFORATED SEWER MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP OF THE PIPE. 3.6 IF INSULATION IS REQUIRED THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM BOARD OR WESTERN INSULFOAM OF THE THICKNESS SHOWN ON THE DRAWINGS. 3.7 THE TOP AND SIDES OF THE BED SHALL BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX OR BLUEGRASS. 4.0 PRESSURE SEWER 4.1 THE PRESSURE SEWER SHALL BE 2 INCH POLYETHYLENE OR PVC PIPE BURIED TO THE DEPTH OF 4 FEET FROM THE LIFT STATION TO THE CENTER OF THE BED. 1200 LUesl 33r(I Avenue, $ui1¢ [~,A,chor~]q¢, Alaska 99503 ,(907) 561-5040 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 E!more Road P.O. Box 196650 Anchorage, AK 99519-6650 vcvrw.m uni.org/0nsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAHILY DWELLING O Parcel I.D. 017-101-,35 1. GENERAL INFORMATION COSA# Expiration Date: Complete legal description ILiAMNA ACRES S/D; LOT 7B Location (site address) 5120 E. 142ND AVENUE * ANCHORAGE, AK * 99516 Current Property owner(s) KRISTINA SIEGMANN Day phone 550-6249 Mailing address 5120 E. 142ND AVENUE * ANCHORAGE, AK * 99516 Lending agency Day phone Mailing address REED MOORE W/ KELLER WILLIAMS Day phone 865-654,3 Real Estate Agent ,."'.. Mailing aSdress 101 W. BENSON BLVD, #503 * Unless otherwise ~;~qUested, COSA will be held by DSD for pickup. NUMBER oF'BEDROOMS: 4 ANCHORAGE, AK * 99505 TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site · · Individual Water Storage [] Individual Holding tank [] Community Class__Well [] Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF !NSPECT~ON BY ENG!NEER As certified by my seal affixed hereto and as of the vafidafion date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site ;'~ter supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein, t further verify t,~at based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, t,~e on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm GARNESS ENGINEERING GROUP, Ltd. Phone 537-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempte, d to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE V'~ Approved for Disapproved° bedrooms. Conditional approval for bedrooms, with the following stipulations: ~,,../~.~,°o. o, .' ~.,~,.,,~ Checklist Septic System Advisory Well Flow Advisory (Rew ~t05) Arsenic Adviso.w Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~"~- ~ ~-- // CERTIFICATE Legal Description: A. WELL DATA Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 OF ON-SITE SYSTEHS APPROVAL CHECKLIST ILIAMNA ACRES S/D; LOT 7B Parcel ID: 017-010-55 Well type PRIVATE Date completed 5/31/1984 Total depth 137 ft. If A, B, or C provide PWSlD# N/A Sanitary seal (Y/N)YES Cased to 137 .ft. FROM WELL LOG Date of test 5/51/1984 Static water level 34 ft. Well production 30-40 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Nitrate 0.80 mg./L. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 6/30/2011 44 ff. 5.9 g.p.m. Yes Arsenic: ND ug./L. SEPTIC/HOLDING TANK DATA Tank Type/Material S.T.E.P./STEEL Tank size 1500 gal. Number of Compartments Foundation cleanout (Y/N) YES Date of pumping 1 1/6/2010 ABSORPTION FIELD DATA Date installed 9/7-15/1999 Length 12+ ft. Date of sample: 6/30/201 1 2 Depression over tank (Y/N) NO Pumper I'BELOW EXISTING GRADEI Soil rating ~r ft2/bdrm)2.0 Width 3O ft. Collected by: GEG, Ltd. Date installed 9/7-13/1999 Cleanouts (Y/N) YES High water alarm (Y/N) YES ISAACS PUMPING INTERMrFrENT SAND FILTER * 4 Total depth .2.4-2.5 ft. Date of adequacy test Eft. absorption area560+ ft2 Monitoring tube YES 6/50/2011 Results (Pass/Fail) PASS System type YES 12+ .in. Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 0 in. Elapsed Time: - min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - NOTE: ISF IS INSULATED. 24" SOIL COVER ACHIEVED. Gravel below pipe 0.27 ft. Depression over field NO For 4 bedrooms LIFT STATION *SEE ATTACHED A+ HOME SERVICES INSPECTION REPORT. Date installed 9/7-13/99 Size in gallons 1500 Manhole/Access (Y/N) YES "Pump on" level at TIMER in. "Pump off" level atTIMER in. High water alarm level at 46 Datum BOTTOM OF TANK Cycles tested. * Meets alarm & circuit requirements? YES ,in. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas. 50'-I- 100'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ Absorption field 5'+ Surface water. 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *4.5' Building foundation. 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots. 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ F. COMMENTS *PER EXISTING WAIVER #WR990025. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A, GARNESS Date COSA Fee $ /-~ ,::,a,e o,,:'.¥ment '"'] Receipt Number (~'~-- (Rev. 11/05) Waiver Fee $ Date of Payment, Receipt Number, 'SGS SGS ReL# 1112838001 Client Name Garness Engineering Group, Ltd Printed Date/Time 07/11/2011 14:50 Project Name/# lliamna Acres Lot 7 B Collected Date/Time 06/30/2011 12:05 Client Sample ID lliamna Acres Lot 7B Received Date/Time 06/30/2011 13:30 Matrix Drinking Water Technical Director Steohen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Hardness as CaCO3 114 5.00 mg/L SM20 2340B C 07/01/11 07/08/11 NRB Waters Department TotalNitrate/Nitrite-N 0.800 0.100 mg/L SM20 4500NO3-F B 07/01/I1 AYC Microbiology Laboratory E. Coil Ne~.ative 1 100mL SM20 9223B A 06/30/11 SDP Total Coliform Negative 1 100mL SM20 9223B A 06/30/11 SDP Private Individual Analysis Alkalinity' 105 10.0 mg/L SM20 2320B D 06/30/11 SDP Aluminum ND 20.0 ug/L EP200.8 C 07/01/1 I 07/08/11 NRB Antimony ND 1.00 ug/L EP200.8 C (<6) 07/01/1 I 07/08/11 NRB Arsenic ND 5.00 ug/L EP200.8 C (<10) 07/01/11 07/08/I1 NRB Barium 6.15 3.00 ug/L EP200.8 C (<2000) 07/01/11 07/08/11 NRB Cadmium ND 0.500 ug/L EP200.8 C (<5) 07/01/11 07/08/11 NRB Calcium 31800 500 ug/L EP200.8 C 07/01/11 07/08/11 NRB Chloride 4.20 0.100 mg/L EPA 300.0 D (<250) 07/05/11 07/05/11 SDP Chromium ND 2.00 ug/L EP200.8 C (<100) 07/01/11 07/08/11 NRB CO3 Alkalinity ND 10.0 mg/L SM20 2320B D 06/30/11 SDP Conductivity 244 1.00 umhos/cm SM20 2510B D 06/30/11 SDP Copper 12.3 1.00 ug/L EP200.8 C (<1300) 07/01/11 07/08/11 NRB Fluoride 0. I 17 0.100 mg/L EPA 300.0 D (<2) 07/05/11 07/05/11 SDP HCO3 Alkalinity 105 10.0 mg/L SM20 2320B D 06/30/1 I SDP Iron ND 250 ug/L EP200.8 C (<300) 07/01/11 07/08/11 NRB PAGE A+ Ho-,e Services I nc III ' ~ · Inspections Tan k ]".',"i0c: ............... ~_.,%...F.- .................................. Phone Numbcr:__ ~- ..~c,,O::... Inspect/on/-/ Timer Setting.. Elapsed Time .... ,57_"_~..0_ ,~.~; gvcnt Counter Date & Time ....... ~ ,-.._~ ,_ Problem: ADVANCED WAS'I'EWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNICIPALITY OF ANCHORAGE 'ITHIS MEMORANDUM OF LNDERSTANDING made and entered into as o£this herein the "OkkTERf' and the Municipality of Anchorage. herein the "MUNICIPAI.ITY." In consideration of the mutual covenants contained herein, the panics to this Memorandum of Understanding agree as ~bllows: ~. ADVANCED WASTEWATER TREATMEN'[ SYSTEMS. Municipality grants permission to Owner to utilize ~d operate an Advanced Wastewater Treatment System (AWWIS), described as T 5 ~ ....................... located 2. Definitions. A. Alteration. Anv~ change to the design or ~nction ~,3r an AWWTS that Includes the installation or removal of any pans, components or pieces not included in thc original construction permit: and design. Prior to perfbrmhag any alterations to an AWWTS the owner must obtain a Wastewatcr Disposal System Construction Pc~it lkom the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") i 5.65. 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. '[hcsc approxals certii:~ that the systems are adequate ~'or thc homes thai they support and meet the codes that were in place at the time o~~ system construction. C. Damage. An> man-made or natural change in a system thai would inhibit the system from pertbrming as designed. D. Maintenance and Repair. The scheduled and as needed replacement ot~ existing pm~s. components and pieces of an AWWTS that were included in the original design which would allow the A ,'% FS to continue to perlbrm as designed. E. Permit (Construction) An ()n-Site ~'astewatcr l)isposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater'I'rcatmcnt System Operating Permit. An annual pe~it, issued by the Municipality. that allox~.s the Ox~.ner to operate an AWWTS, upon meeting all the t'equh'ements -~'"-:- t et'mm the t,~ tins agreement, the conditions of'Operating ~) ' requirements of the On-Site Wastewater S> stem Construction Permit and all rolex ant provisions oF AMC 15.65 3. Fee. Owner shall pay to Municipality ~ annual fee of O (.S O .00), payable on c)r betbre the issuance of the operating permit and annuallx thereafter, 'fhe ammai fee is due on or belbre the a~iversau' date of the approval by thc Municipality o~' installed system. 4. Term. The term of this Memorandum of Underst~ding shall be l~r the !lib of the AWWTS. The term begins on thc date of approval by the MunicipaliD of the installed system and shall continue while the AWWTS s},stem is in use or operational or until tile propert? is sold or title is transferred by owner and a new certificate of On-Site approval is issued thc nc~ ox~ner or transfbree 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 thc term o{'this Memorandum of Understanding. the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Oxvner during thc term of this Memorandum of Understanding. and any extensions or renewals thereof: at the owner's sole expense, to pay for ma) and all: (1) repair(s), (2') maintenance, (3) a4 ustment(s), (4) replacement costs, and (5) inspection costs. Further. Owner agrees to comply will all applicable ordinance, laws, regulations. rules and orders l'or tile AWWTS. B. Owner agrees to providc the Municipality a written schedule of routine maintenance and repairs which have been perfbnned on the system pursuant to the terms and conditions contained in the Ow'ner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. Thc schedule or'maintenance and repair contained in the Owner's A\VWTS Operating Permit is: C. C)x~ner ackno~vledges that the fine schedule for thiling to maintain and repair an AWWTS are codified in AMC 14.60. D. ()xvner agrees that only maintenance, repair personnel certified bx the Municipality x~:ilI inspect and make any necessa~' maintenance, repairs or permilied allerations to the svstem. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours wriuen notice. F. Owner agrees that any sale or transfer of title of thc property wilt not occur without a new Ce~ificate of On-Site Systems Approval. G. O~vner agrees tha~ the retevanl provisions of the standard specification guidebook tbr AWWTS is ~he governing prot~ssional guidelines fbr the construction. maintcnancc and repair of the Owner's AWWTS. 7. Nonwaiver. The Failure of either pa~y at any time to enfbrce a provision o f this Memorandum oF Understanding shall in no way constitute a waiver o~' thc provisions. nor in any wax eflbct the x alidity of the Memorandum of Understanding or any part hereoI~ or the right of such part> thereafter to enforce each and every prox ision hereof. 8. Amendment. A. This Memorandum ol'iJnderstanding shall only be amended, modi fled or changed by a writing, executed by authorized representatives of the parties, witln the same formalin: of this Memorandum of Understanding was executed and such writing shall be a~ached to this Memorandum of Understanding as an amendment. B. For the pt~rposes of an). aanendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Anchorage: Purchasing Officer C. An? attempt to amend, modify, or change this contract by either an un.authorized representative or unauthorized meals shall be void. 9. ,turisdiction: Choice of Law. Any cMl action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Third Judicial Distric~ of ~he State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of thc parties under this Memorandum of Understanding. 10. Severabilitv. Any provisions of this Memorandum of Understanding decreed invalid by a court ofcompctent.}urisdicdon shall not invalidate the remaining provisions o¢ th~ Memorandum of Understandina. STATE Oi: ALASKA MUNICIPALITY: By': Title: Date: ) T H l R I ).I t; D I C I ,!x, I. 17) ] S T RI C' T Thc t~brcgoin~_instrument_was acknowledged beCr. e me this gsa:" [ INVOICE .entral 212 E. Int'l Airport Rd, Anchorage AK 99518-1214 TEL: (907) 562-2511 FAX: (907) 562-2578 INVOICE NUMBER: 0375452-IN INVOICE DATE: 7/5/2011 ORDER NUMBER: ORDER DATE: SALESPERSON: Pili. William CUSTOMER NO: 00000! 0 CASH COUNTER SALES HAROLD SIEGMANN ANCHORAGE, AK 0~0 ANCHORAGE, AK 0-0 SIEGMANN CASH SALE 12910110 CAST SANITARY WELL CAP*CODE* EA 1.00 1.00 0.00 44.03 44.03 "Over 50 Years of Service to Alaska. Since 1959" *NO RETURNS O'N CHEMICALS, ELECTRICAL ITEMS OR ANY SPECIAL ORDERS * NO RETURNS AFTER 90 DAYS ** ANY ACCEPTED RETURNS WILL BE SUBJECT TO :~ESTOCKING FEE Net Invoice: Less Discotml: III IIIII III I [lllllll t:'~rei~hl: Sales Tax; Invoice Torah 44.03 0.00 0.00 0,00 4&03 1,5% Service Charge on all accounts30 daYs past due R.EF: 0003 1012 Less PaymenI: Paymem Type: CC Invoice B~lance: 44.03 0.00 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 01 7-1 01 -35 HAA # 1. GENERAL INFORMATION Complete legal description Lot 7B; Iliamna Acres Location (site address or directions) Property owner Mailing address Lending agency Mailing address NHN E. 142nd Avenue Anchoraqe, AK Shawn & Christina 4201 D~Armoun Rd. Sieqmann Day phone 345-2413 Anchorage~ AK 99518 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XX 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 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 com ordinances, and regulations in Name of Firm Wastewater Address Engineer's signature ~ Wastewater Consultant~ lnc, Shall be PAID $ ~:)--' , I~, or prior to, closing for the Engineering Services Provided, DHHS SIGNATURE Approved for /~-'~:~) C//~ bedrooms. Disapproved. 31iance with all Municipal and State codes, ,inspection. ;, I~C, Phone .~ 7--~/7~' ~ Date /°l'z///~ ~ Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of 'Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev. 1/91) Back MOAICZ1 RECEIVEb OCT 15 Municipality of Anchorage '~ DEPARTMENT OF HEALTH & HUM,~N'SERVICE~uN~c~PAu~Y oF ^NCH~ Environmental Services Division ~NVI~ON~AL SERVICES 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Legal Description: A. WELL DATA Well type PRIVATE Log present (Y/NJ Total depth 137' Sanitary seal (Y/N) Health Authority Approval Checklist ILIAMNA ACRES; LOT 7B Parcel I.D.: 017-101-35 If A, B, or C, attach ADEC letter. ADEC water system number YES Date of test Static water level Well prOduction WATER SAMPLE RESULTS: Coliform o Date of sample: 10/8/99 B. SEPTIC/NOLDING TANK DATA Date installed g/7/eg-s/s/9~ Foundation cleanout (Y/N) Date of 'Pumping NEW C. ABSORPTION FIELD DATA Date installed Length, 30' Effective absorption area Date of adequacy test NEW Date completed Cased to 137' YES N/A .s/2/84 Casing height (above ground) 2°+ Wires properly protected (Y/N) YES FROM WELL LOG AT INSPECTION 6/2/84 10/7/99 39' 47' 30 - 40 g.p.m. 8.5 g.p.m. Nitrate 0.899 m§/L Collected by: - Other bacteria A.W.W.C., INC. Tank size 1500 Number of Compartments 2 YES Depression (Y/N) NO High water alarm (Y/N) Pumper - I*INTERMITTENT BO'I'I'OMLESS SAND FILTER Soil rating (g.p.d./fF or ft=/bdrm) 2 System type 12% Cleanouts (y/N).YES NO *BED Gravel thickness below pipe Monitoring Tube present (Y/N)YES Results (Pass/Fail) 0.27 Total depth~ Depression over field (Y/N) NO For ~.-'"~"'~oms Fluid depth in absorption field before test(in.); t_.._h33medtatei[~ gal. water added (in.): Fluid depth ~.~~_J[13s,LM~a~'~ater: Absorption rate = q.p.d. ~ment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. UFT STATION Date installed_ Manhole/Access (Y/N) "?~er~F. evel at* "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer rna~n N/A Public sewer manhole/cleanout N/A Sewer/septic service line 25'+ Lift station 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line ,5'+ Absorption field. 5'+ Water main/service line 10'+ .Surface water/drainage 100'+ Wells on adjacent lots. 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line *4.5 Building foundation 10' Water main/service line 10'+ Surface water 1 i~3,4- Driveway, parking/vehicle storage area 10'-t- Curtain~drain 50'+ Wells on adjacent lots 100'+ EN~.k..~,,.~,,, ,,.,.,,.,...,..,,,,,.,.,.,.,./ '1 *AMENDMENT TO 5' LOT UNE WNVER (#WR990025) F. / Icertffy. thatl~ ~l/~.~,'m~Ffl ~fieidinspectionsandreviewofMunicipalre~ ~_ i~ems inconforma/ce, V. Date HAA Fee $ Date of 'Payment Receipt Number 72-026 (Rev. 3~6)* Waiver Fee'S Date of Payment Receipt Number