HomeMy WebLinkAboutMARIE ESTATES LT 6Mari*e Estates
Lot 6
#051-111-32
Inspection Report_1-1-12.doc
Municipality of Anchorage
Community Development Department Page 1 of 2
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP171204
PID Number: 051-111-32 ❑ New ❑✓ Upgrade
Name:
CHARLES & KATHLEEN HAMMERLE
ABSORPTION FIELD
❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
20527 STEPHEN CIRCLE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
0.6GPD/SF
9.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4.0 Ft.
Gravel depth beneath pipe
5.0Ft.
Subdivision
Block Lot
MARIE ESTATES
6
Fill added above original grade
~0.5 Ft.
Gravel length
80.0 Ft.
Township Range Section
Gravel width
2.5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
LiftStation
Tank
Line
800 Ft2
1
Ft.
well
100+
100+
N/A
N/A
25+
TANK [ZI Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1 1000Gal.
Surface Water
100+
100+
N/A
N/A
Material
STEEL
Number of compartments
2
Lot Line
50.5
30.3
N/A
N/A
NA
Foundation
24.6
42.9
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
50+
50+
N/A
N/A
Pump on level at
Pump off level at
High water alarm at
Remarks
in.
in.
in.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank to
drainfield 3034
Installer
JR'S SEPTIC
Drainfield 3034 CO/MT 3034
Inspector Pannone Engineering Services
BENCH MARK (Assumed elevation) 96ft
Inspection M
1 09AUG17
10AUG17
Location and description
dates:
2�d
House Trim near foundation cleanout
3rd 11AUG17
4th
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
-mvConditional
el 0F AL'QSI��
Approval:
Date
•teveri .�. •I�annotae
�,• C 814Adw,
Approved
Date g 2Z ,2 17
1 Cu oNA`Aw
Inspection Report_1-1-12.doc
ABBREVIATIONS
UPGRADE SEPTIC SYSTEM
TH
TEST HOLE
NO. BEDROOM: 3 (450 gpd)
(P)
PROPOSED
TANK SIZE: 1,000g
(E)
EXISTING
PERC RATE: 16-30 MPI
W B
SOIL RATING: 0.6 GPD/SF
CO
CLEAN OUT N0.
AREA ROD: 750 SF
MT
MONITOR TUBE N0.
TYP
TYPICAL
� � I
SEPTIC AREA (E) I
SYS. TYPE: DEEP TRENCH: 5.0 ED
MIN LENGTH: 75 LF VELL (E) I
_ / I � LOT 5 TH-1995 -TRUE b TH SdALE :/Y 50'
USED: /PF/ (ANDERSON)
80LFx2.5'Wx5.0' E.D., 9.0' TD
TOTAL AREA: 800 SF
/I /l �h- �\TH 1983
/T 1
U
/
DRIVEWAY
Date
08/16/17
150.5
30.3, I / / WELL (E)
z
�/
W B
DRAWN JRL
PERMIT NO.
OSP171204
SITE PLAN
Sheet
2OF3
LLJ I
WELE�) E /
104.2
v
I- I
Tri
PGRADED DRAIN FIELD (N)
A
B
T6/
80LF x 2.5'W x 5'ED x 9.0'TD
INSTALLED MT AND CO AT EACH END
T1
27.0
50.40
\
--
_ - , /
_� / / // j /
T2
32.0
56.3
1 /
INSTALLED
1000G SEPTIC TANK(N)
C1
51.0
87.5 /^\
\ /
�p
W/ DCO
& DV AFTER ��
C2
91.1
98.6 \ \ — ��
-�
I \ /
0
0
p F-
QO
H H
O O
z
w
U >
z z
o w
E
z z
w w
w w
m
Z) wF-
w
m
w
FILTER FABRIC Co
U
EL:100.0
U U
0 o
p
z or
4" 0 DRAIN PIPE =p
DRAIN ROCK 6" Fo z
J 2
ABOVE PIPE INV o w
4.0
U
U
EL:96.2
i
95.4
1000 GAL
F:95.2
-2.0 "`
TANK (N)
J I II DRAIN ROCK II I SI
_ SP/GP
PROFILE 80.0 I
SCALE 1"=10'
_16.6
-pan 10AUG17
NOTES:
PANNONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510�G
PHONE (907) 272-8218 FAX (907) 272-8211
•••.
��'••• �•
* • •*
•• •••••••
••}'even "�aririwie'
••• CE 8149
Date
08/16/17
RECORD DRAWING
Scale
1 " = 50'
MARIE ESTATES L6051-111-32
CHARLES & KATHLEEN HAMMERLE
20527 STEPHEN CIRCLE
CHUGIAK, AK 99567
P.I.D. NO
DRAWN JRL
PERMIT NO.
OSP171204
SITE PLAN
Sheet
2OF3
SOILS LOG — PERCOLATION TEST
SLOPE
TEST
HOLE
WAS GROUND WA
ENCOUNTERED?
IF YES. AT WHAT
DEPTH? —
DEPTH TO WATER
MONITORING?
DATE: 16AUG� ,
READING DATE
TEST HOLE 1
NET TIME
WATER
LEVEL
READING
OR
TOPSOIL
1
1015
BROWN SILTS
2
ML
1025
10 MIN
5.950"
3
13.8
3
1026
4
4
1036
5
5.970"
0.74"
13.5
5
6
5.230"
7
1047
10 MIN
5.970"
0.74"
13.5
GRAY POORLY
8
GRADED
SP/GP
SANDS AND
9
GRAVELS
10
11
12
13
14
15
16
17
18
BOH
DATE
PERFORMED:
09AUG17
SOILS LOG — PERCOLATION TEST
SLOPE
TEST
HOLE
WAS GROUND WA
ENCOUNTERED?
IF YES. AT WHAT
DEPTH? —
DEPTH TO WATER
MONITORING?
DATE: 16AUG� ,
READING DATE
GTIMEK
NET TIME
WATER
LEVEL
READING
NET DROP
(MPI)
1 09AUG17
1015
5.230"
P.I.D. NO
__2_51-111-32
2
1025
10 MIN
5.950"
0.72"
13.8
3
1026
5.230"
4
1036
10 MIN
5.970"
0.74"
13.5
5
1037
5.230"
6
1047
10 MIN
5.970"
0.74"
13.5
COMMENTS: Test hole excavated by JRs SEPTIC.
SOIL TEST RESULTS/ANALYSIS
• PERCOLATION RATE 13.8 (min/inch)
(Hydrologic Soils Group: HSG A)
• PERC HOLE DIAMETER 6"
• TEST RUN BETWEEN 5 FT AND 6 FT.
• TEST RUN FOR OVER AN HOUR, LAST
THREE READINGS PROVIDED.
PERFORMED BY: STEVEN PANNONE. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES:
PANNONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
,�GG� o f ..
Q'�•••' •.
* •. *
.... ...' . .. ..
�� M..
��• °""O"°
CE 8149
Date 8/, 6/, 7
RECORD DRAWING
Scale
NTS
MARIE ESTATES L6051-111-32
CHARLES & KATHLEEN HAMMERLE
20527 STEPHEN CIRCLE
CHUGIAK, AK 99567
P.I.D. NO
__2_51-111-32
PERMIT NO.
OSP171204
DRAWN JRL
SOILS LOGS
Sheet
3 O 3
. —.�1,- 0! MUNICIPALITY OF ANCHORAGE caenr
7 ' On-Site Water&Wastewater Program
/ r PO Box 196650 4700 Elmore Road• f
11 Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax: (907)343-7997
'r httpa/www muni.org/onsite '
4',;-Not AV4
On-Site Wastewater Disposal System Permit
Permit Number: OSP171204 Effective Date: 8/7/2017
Work Type: Septic Upgrade Expiration Date: 8/7/2018
Tax Code Number: 05111132000 g/?/r-i 'r �
Site Legal Address: MARIE ESTATES LT 6 G:1361
Site Mailing Address: 20527 STEPHEN CIR, Chugiak
Owner: HAMMERLE CHARLES F & Lot Size in Sq Ft: 50020
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3
This permit is for the construction of:
El Disposal Field El Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1, The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: Ti dct )
Date:
Issued By: , `.-C-04, r/ Date: al/20 7
Municipality of Anchorage
I. I
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http:llwww.muni.orglOnsite
Development Services Division
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV171077 COSA#: Permit#: OSP171204
PID#: 051-111-32
Legal Description: Marie Estates Lot 6
Engineer: Pannone Engineering Services
Applicant: Charles & Kathleen Hammerle
Your request for a waiver of the requirement to provide a test hole within 30 feet of the proposed
drainfield, to demonstrate the required vertical separations to an impermeable layer and
groundwater, has been approved. Numerous test holes from adjacent properties and properties in
the area demonstrate adequate separation.
This waiver approval applies to the proposed drainfield only. Any future upgrade to the on-site
wastewater disposal system will require all code requirements be met or another approval from
this department.
n The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
'
Waiver is Granted: X Waiver is not Granted:
Date: V7/20 Approved by: 9t.�,�.t°.�,('P�, ral:LeV
Name of Reviewer
**** VARIANCE/WAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
,.
_, ,,_
Community Development Department n
Phon-• 7.• * = '11 ,
Development Services Division _�� F- ''=I - 4o
On-Site Water & Wastewater Program
JUL 2 5 2017 3
ON-SITE SEWER/WELL PERMIT APPLICATION �•
IA. � ti
w
Parcel I.D. 051-111-32 �� oil 6 s L �^
Property owner(s) Charles & Kathleen Hammerle Day phone
Mailing address 20527 Stephen Circle, Chugiak, AK 99567
Site address 20527 Stephen Circle
Legal description (Sub'd., Block & Lot) Marie Estates, Lot 6
Legal description (Township, Range & Section)
Lot Size 50,020 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(Z all that apply)
Absorption Field ❑X Initial ❑ Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade ❑X Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
LJ S 2 c aLsti s T 14 ---T—ck_ t 67..1::::4%. % A Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
quib
(Signature of property owner or authorized agent)
Permit/Rush Fees: c(0611 Waiver Fees: (S
Iff
Date of Payment: 112-(, i i Date of Payment: 1 !te i l
Receipt Number: 05%I G Receipt Number: 0r?1(0l G
Permit No. OPI1 12tti Waiver No. or3vn I 071
Permit App_.• • ::.,c
Pannone Engineering Services LLc
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
25 July 2017
Subject: Marie Estates, Lot 6
Septic System Install Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade septic system to be issued for this property.The proposed
system will serve an existing three-bedroom(3BR)house.Currently the lot is developed. This lot and the surrounding lots
are served by private wells. There are no wells within 100' of the septic system.
1. Soils: One test hole was performed to a depth of thirteen feet(13') on this lot in August of 1983,with a percolation
test, but no recorded 7 day ground water monitoring. The system was installed in 1983. The percolation rate was found
to be 23 minutes per inch. Using that rate,the size of the drain field was validated as the system has been functioning
properly for 30+years. The proposed system will be installed 50%in the existing test hole radius.
PES proposes using the existing size and successful use of the system and verification of lack of ground water and bedrock
from surrounding lot's soil investigations.The neighboring lots all have test holes to depths ranging from 15 to 18 feet.
Ground water was not observed in any test holes to a depth of 18' below the surface after the 7-day monitoring period.
Bedrock was not encountered in any of the test holes. The soil reports for those test holes on the surrounding lots are
included in this design package.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water:There is no surface water within 100 feet of the proposed septic tank and drain field.The proposed
drain field upgrade will maintain at least 100 feet from all surface water. .
4. Topography:The proposed system sits upon a hilltop to the east of the structure. The ground to the east and west
slopes away from the septic area. The slope to the east has a maximum slope of approximately 50%, but no slope exceeds
25%within 50'of the proposed drain field.
The proposed installation will not affect the future development of the surrounding or existing lots.There are no wells
within 100 feet of the proposed septic location.
If you have any questions or concerns, please contact me at 272-8218.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
1
3 SEPTIC AREA (E)-
\.., --1 ,--
WELL (E)7M WELL (E)7
� LOT 5 TH-1995 'z
i� �M \ I (ANDERSON) i 11
„..\_____-.-
5
/ / x \I i
L \ „ , / 4 0
I C u
z
ifx
/% 4
j N
/ A% TH-1983 --7 . - . -\N� .
III N.
/ (S&S) 16.2
• `L4` DR/V- W /`1� W im O WELL E)
� YY�* w________- ` /� or ` I
HOUSE 6 4, /__ ; ,
WELL'-E) (E) \ _ 55 51.4----....jr/ \,nk,___----M-----___A,
•
\ / N /
c,°) UPGRADE DRAIN FIELD (P)
,/-
�
/� �o (2EA) 4OLF x 2.5'W x 5'ED x 9.0'TD •
LO 1 6 / -INSTALL MT AND CO AT EACH END __
,{
• .44VERIFY CONDITION OF
W 1,000g SEPTIC TANK (E) /tet
I T f 'REPLACE IF FOUND TO BE LEAKING/
INSTALL DOUBLE CLEAN OUT, ,-,\Q)DIVERTER VALVE, AND
FLOW SPLITTER AFTER TANK
i
f I
!WELL (E) j' 7 �. � \ / %f ' / / / /
/ / / / /
/ i
�' t I ,„/ ; i
7 / / / /i
- / // //• / / ;
/ f(LGOATR7NTH-2003 i /yJ� ESS) 7 /r i � ,
DESIGN PARAMETERS
UPGRADE SEPTIC SYSTEM
NO. BEDROOM: 3 (450 gpd) LEGEND
TANK SIZE: 1,000g W WATER LINE/
PERC RATE: 16-30 MPI WELL RADIUS ABBREVIATIONS
SOIL RATING: 0.6 GPD/SF TH TEST HOLE
AREA ROD: 750 SF SS NEW SEPTIC
SYS. TYPE: DEEP TRENCH: 5.0'ED (P) PROPOSED
MIN LENGTH: 75 LF — - -GB- _ — GRADE BREAK (E) EXISTING
CO CLEAN OUT NO.
USE: MT MONITOR TUBE NO.
(2EA) 4OLFx2.5'Wx5.0' E.D., 9.0' TD 0 0 RETAINING WALL TYP TYPICAL
TOTAL AREA: 800 SF
NOTES: �..........-m„, Date
PANNONE ENG SVC, LLCoF.Ai t 8�3�2017
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 ."s. S k
PHONE (907) 272-8218 FAX (907) 272-8211 iea.. ��� '�y +01 Scale 50
DRAWN BY: ;it*: 4' TH 41�
DRM All • "`���" , P.I.D. NO
MARIE ESTATES, LOT 6 .S.I�'�� nn orae' / 051-111-32
CHARLES & KATHLEEN HAMMERLE / PERMIT NO.
4 ��•• CE 8149 .,�e�/� OSP171204
20527 STEPHEN CIRCLE +t cs . ••, i
PLAN CHUGIAK, AK 99567 b1��'Ejj' •p��w—� Sheet
l>t PROFESS1oN4.
�`\�"`- 1 OF 2
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55.
2. SCOPE OF WORK: VERIFY TANK AND REPLACE IF FOUND TO BE LEAKING. INSTALL NEW DRAIN FIELD.
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 13 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE
SOIL TEST HOLE, ON THIS LOT, OR TO 15 FEET — 18 FEET ON THE SURROUNDING LOTS. IF AN APPARENT WATER
TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 15 FEET BELOW EXISTING GRADE NOTIFY THE
ENGINEER IMMEDIATELY.
4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC
LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED
SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK.
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING
AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER.
8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE
ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND
TANK ELEVATIONS.
10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF
EXCAVATION, TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING.
11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE
PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE
ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN
DEFECTS BY THE CONTRACTOR.
12. THE CONTRACTOR SHALL SIGN THE FOLLOWING:
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED.
CONTRACTOR:
BY: . TITLE:
DATE: •
NOTES: ��� \ Dote
PANNONE ENG SVC, LLC OF A����
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 8/3/2017
?'� ' qS �
PHONE (907) 272-8218 FAX (907) 272-8211 Awo),P �1�''�77 T Scale
DRAWN BY: r*: 49 TH /\ •*y NTS
O
DRM MARIE ESTATES, LOT 6 :. .• .. P.I.D.
1-111-1-
32
CHARLES & KATHLEEN HAMMERLE n • ••onno• / PERMIT NO.
. CE 8149 • OSP171204
20527 STEPHEN CIRCLE 9064' � ,.
DESIGN DETAILS CHUGIAK, AK 99567 ll�F�/••.
•51•0• Sheet
,i\\\V��14 2 of 2
MUNICIPALITYOF ANCHORAGE
• 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
/"'2�-�
��•-ZZ
❑UPGRADE
MAILILXDDRESS
LEGAL DESCRIPTION
LOCATION
NO. OF BEDROOMS
DISTANCE TO:
Well /
t
Absorption area ;�
`� -f
Dwelling
js �L'
PERMIT NO .
9 4894a�
Uy
HZ
W�
Manufacturer
Material �L
No. of compartments Z
rn
c
Liq.pitti in�7allons
'�
IF HOMEMADE:
Inside length
,.�—
Width
1�
Liquid depth
y
DISTANCE TO:
Well Il /
Dwelling
PERMIT NO.
Jaz/
0 z F
Manufacturer
Material
Liquid capacity in gallons
�=
DISTANCE TO:
Well Z� /`
'FS
Foundation
Nearest lot line
PERMI
w
J w Z
No. of lines
Leg* of e h I' e
Total le th lides
Trench vq
Distance between li es /
F Z w
G-Z>
�j
r% inches
-�
f
Top tile to finish
Material beneath
Total
¢
of grade
tile//
60
eff ctive absorp on area
p
inches
S
Length
Width
Depth
PERMIT NO.
UJ
a
Q H
Type of crib
Crib diameterth
Total effective absorption area
as
w
y
DISTANCE TO:
Well
B it ing foundation
Nearest lot line
J
Class
De th
Driller
Distance to lot line
PERMIT NO.
J
_
wu
D TANCE T0:
ding fo in ation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
V(�
SOI L TEST RATI NG 10
1.e
INSTALLER
/n c A 4-,_/ v/9-
REMARKS
a
C�
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As9�1'
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DEa= aP Tli ENT OF HEEL. FH AND"Er ' I R��t��'f9�!t�+4 fr�L PROTECTION
82- 'L' 'TREET, ANCHORRGEr
RPPL I r f;NT HAPPY N YIER P. G. BOX 1599 CHUG I AK HK 983-98$
LOCATION
LFII L LOT 6NA LA EST. LOT Sly -9 999999 51RUME F0'
TYPE OF ;Ij IL ; 765ORr.PT I ON S'>*S TEt'l 1"27; TRENCH
U HTlti :mAXIi M NUH ER OF 'EIkrOPI �P
THE REI UIREn SI E*0F THE- '501L HSSORRTION SY5tef'i IS:
rHE LgNGTH DIMENSION 15 fHE •LENGTH (IN FF-eT) I-V THE,TRENCH i)R, 019AINFIELD.
THE DEPTH OF a rRENCH OR PIT I'_ THE 01STANCE BETWEEN THE GURFACIr 13 THE
CROW-!() AND THE Si1TTON +3F THE -6f -,C VtiTi0 CIN FEDI}.
THERE 15 NO ' E r t4 f & rH FOR TRENCHE'a, 1
THE i-3RAVEL DE; IS THE_ MrNICU ll C39PTH OF OR19 `EL, oerl-JEEN TkiE OUTFALL:SIDE .
RNO THE Us3Tism OF THE .EXCAVATION SIN FEET?.
P5RMf r RPPLICRNT HAS THE RESPONSIBILITY TO INFORM `THIS DEPARTMENT>DURt- 3 THEI
. fNST'ALL STION IN'at 4EQ-rf0?4'3 OF ;tijY NeLi S ADJACENT ENT To rNIS PROPERT`r ANO THE
ITLErS Ei? t RESIDENCES -THAT HE WELL WILL �5ERVE.
U-4 4-n ' ;y T l' I' € i t�tP= I # :''z# i I SG
-19aCKFILLINQ OF t=iNY SYSTEM WfTHOUT FINAL tNGPECTION AND APPROVAL BY -THIS
��2PARi ENT !-JILL SE Sl tBJECT . Tip PROSECUTION.
a Fit It IMI ii1 DISTANCE Oe rWEeP! A WELL AND Appy 04 -'SITE SEWAGE 01 SPOSAL SYSTEM I`5
i*oj FEer FOR €i PRIVATE WELL. CR 150 TO 200 FEET #sPOM A PUBLIC WELL. DrMPI=NDING'
lR80N THe T` P2 OF ` PUBLIC WEL tL .
F_idItlItUitt DL'u� FROM OM A -PRIVATE WELL TO H PRIVATE SEW R LFFIE It; � ��ET'�lC�=
TO RCOMMUNITY IEWER LINE IS 755 FEET.
a,; -L Lj-.V 5 l;PF_ ., R•Ei:!U I #IED AND MUST SE Pe rljPNED TO THE DEPHRTMENr -141 THIN 20 DAVS J
13F THE WELL COMPLETION.
17JTHEP REGUIREi9ENT5 MAY APPLY. SPECIFICATIONS ANO CONSTRUCTION DIRGRAMS #ARE
_;iIVAILA8L Ey Tys-�-{INSURE PRRQPk-FZ �aINSTALLATION.
��-.`�j"'•.:7 `! 1. 4 •�a'ii � �`s�G',.:..t �,•9 �ir.��`i l� �..LJ �_�x��� -
I CERTIFY THAT
t: I AN FHNIL CHR WITH THE REQUIREP}ENT5 FOR ON-SITE yEWER5 HNQ 1-40"L!9 AS SET
FORTH BY THE UN IC I PAL I T Y OF Atli ', lt3R
1'AGE.
:2: I WILL INSTALL THE n5Y$TCJI rN ACCORDANCE WITH THE 4Ct�I3.
I 'JHDFR5T,9NC> THAT THE 0114 -SITE SEWER 'SYS -M MAY REQUIRE ENL•HRQ'EMENT IF THE
P SIDENCE Ir= REitU FLED TO INCLUDE MORE THHN = SEDROO111S.
we
i r Lf; T RRY Nc'YER
j
TmilED',� _- ___DATE__ ___ `+�
IR
0-_9 %_j h Edi : E %M: I F-" 9=1 L__..�. —a °-s" %_% F= F:fi I!" -J a=_"%® alEi E"
DE_'F'ARTMENdT �' HEALTH AND' ENV IIT:OI'11"IEN•dTAL `)0TECT I ON
25 'L :=.TREETj ANCHORAGE: AK. _'_:;_-jl
-
264-4720 _
'°. l;.^.ai EE L_ L_ F:� P-4 E m %- % Y-4 -- TL —F E E-7 L-0 E= FR lF::' l::;" I_' lrl 1' -T_.
APPLICANT HARRY "MEE.�Y'ER f 0. EOIX 699 ��Hi GIAK All E.8 988
LOCRTI ON,I
!-_EGHL. L.O'r 611F!RIA EST.
LOT SIZE 999999 SQUARE FEET
T'Y'PE: (.IF SOIL ABSORPTION, S Y'E• T Ef'! IS: TRENCH
f'1A;X I NUI.cl NUMBER OF E:EDROONIE: i _OIL RATING 50 FTe-E,R) = 222.
THE REQUIRED SI=E'OF THE' ::OIL ABSORPTIOhl SYSTEM IS:
�. x _ ^ -__ k.:E. n %-,_@ FF::l °^""m F7 L_ E -e E- F'" —F
THE L...EN NTH DIMENSION IS THE LE hIGTH (IN FEET) OF THE TRENCH OR C:lRA I NF I ELD.
THE DEPTH OF' A TRENCH OR PIT is THE DISTANCE BETWEEN•d THE SURFACE OF THE
GROUND AND THE BOTTOf-1 CSF' THE EXCAVATION k'IN FEET).
'THERE I'.- N•,10 SE_T WIDTH FCR TRENCHES.
THE' GF.AVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL F'IF'E
AN,ID THE BOTTOM OF THE EXC:AVATIONd (IN FEET;.
PERMIT APPLICANT HA:. THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INN°_•TALLATION•d INSPECTIONS OF AN•d=r' WELLS AG _1'A=EN•dT TO i THI_• F'R PERT4' AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
E,ACk::FIL.LIN-,!G OF ANY SYSTEM WITHOUT FINAL INSPECTION) AND APPROVAL BY THI
DEF'ARTL'1ENIT WILL BE SI_B ECT TO PROSECUTION.
MINIMUM C:'ISTAN•dCE E:ETI.JEF_Nd A WELL AN E:1 ANY ON—SITE ;ITE SEWAGE DISPOSAL _•'r'_ TENT IS
:1_00 FEET FOR A PRIVATE WELL. OR ::1.50 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE T'Y'PE OF PUBLIC WELL.
MINIMUM DISTAN•dC:E. FIT:Of'i A PRI'••+.HTE WELL TO A PRIVATE SEWER LINE "is 25 FEET FIND
TO A CCiN•1N'IUNITY SEWER LINE IS 5 FEET.
iJELL. LOGS FIRE. REQUIRED AND MUST BE: RETURNED TO THE DEPARTMENT WITHIN•d -:ti=t DAYS
OF THE WELL CONPL...E:TION.
OTHER RE'QU I REMENdTE HAY APPLY. SPEC: I F I is AT I ON S AND CONSTRUCTION DIAGRAN' S ARE
FI%JAI!_.AE,LE TO INSURE PROPER INSTALLATION.
I CERTIFY THAT
1: I AM FAMILIAR WITH THE. REfDU I REFIENdTS FOR Ot+—SITE SEWERS AND WELL_ AS SET
FIRTH BY 'THE MUNICIPALITY OF ANCHORAGE.
-_: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
I I.INdDER_ TANdL THAT THE: Ohl—.—CUTE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RE_=:IDEN•dCE IS REMODELED TO INCLUDE MORE THAN _ BEDROOMS.
EIGNdEC..
APPLI;;FtNdT HARRY ME.','EG'
❑ SOILS LOG
t~
MUNICIPALITY OF ANCHORAGE
• �e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 _ 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: (d "y�i!9NYdC�1�. DATE PERFORMED:
LEGAL DESCRIPTION: `"��%� SCJ // �1C /11 It --'S-77
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Time
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Time
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PERCOLATION RATE yet.. �I (m)nutes/inch)
TEST RUN BETWEEN _J— FT-4,ND � FT
PERFORMED BY:. -c �,°,�'jr,- yfo,Lyt- CERTIFI
ALASKA %bl;t
PH. 604-907D
72-008 (6/79)
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•JC.-�-� Municipality of Anchorage '6�f • 6.
. . .
. ,.
On-Site Water and Wastewater Program AUG 1 4ILI�
(907) 343-7904 n s A 11 ,
I
6 : c„
Certificate of On-Site Systems Approval C. it £? s s I- c)c>
Parcel I.D. 051-111-32 Expiration Date: Nov t a d 0 11
1. GENERAL INFORMATION
Complete legal description Marie Estates Lot 6
Location (site address) 20527 Stephen Circle
Current Property owner(s) Charles & Kathleen Hammerle Day phone
Mailing address 20527 Stephen Circle Chugiak, AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
E Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Ei Individual t]
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by. a) .4,,,/t I / , Date: L*91// -7COSA to be released to the engineer,unless otherwise requ=-te• by the engineer.
COSA Fee $ g,(A
Waiver Fee $
Date of Payment g { ti (LI Date of Payment
Receipt Number O31 lob Receipt Number
COSA# nckn \34ol Waiver#
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, based on procedures outlined
in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at
the time of installation.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe 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 soil
condition,ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of irm Pannone one Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 8/16/2017
t
OF Ak•Qsi
4
16
*:49 TH 1\ %it 94
6. DSD SIGNATURE J '
System #1 Approved for 3 bedrooms Steven R. Pfannone
System #2 Approved for bedrooms �9 ¢�.
CE— . -•
•
Disapproved il .Cr
k . OFESS
Conditional approval for bedrooms, with the following stipulations:
J 1'x`' V r=h!
•
ON-SITE I-;:,
WATER AND cc,
WASTEWATER
PROGRAM
• � �
By: Original Certificate Date: $ a .2 0 i 7
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_f -
If more than 1 septic system is on the lot:
COSA Checklist# I of 1
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Maire Estates Lot 6 Parcel ID: 051-111-32
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 811/1983 Sanitary seal (YIN) Y Wires properly protected (YIN) Y
Total depth 80 ft. Cased to 80 ft. Casing height (above ground) 24 _ in
FROM WELL LOG AT INSPCTION
Date of test
8/1/1983 i- w/ t j
ciStatic water level 35 ft 41 . ft.
Well production 3 g.p.m. l•4 + g p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 8.79 mg/L
Arsenic ND ug/L Date of sample: 8/8/201 7 Collected by PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 8/10/2017
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A
Date of pumping NEW Pumper N/A
C. ABSORPTION FIELD DATA
Date installed 8/10/2017 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 GPD/SF System type Deep Trench
Length 80 ft. Width 2.5 ft. Gravel below pipe 5 ft
Total depth 9 ft. Eff. absorption area 800 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NEW Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo ) (YIN & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm& circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ 5-F line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION ���OF A�Q1(,
I certify that 1 have determined through field inspections and *- 76:0\
, .y'�
review of Municipal records that the above systems are in %*;' TI-I /\ . *,
conformance with MOA COSA guidelines in effect on this date. ` e-- c
Engineer's Printed Name Steven Pannone ";S}e,ren II..hringrie:•• p
Date 8/16/2017 0 -0,-. CE-8149 r�
COSA canary sheet_2-6-15.doc
Municipality of Anchorage
t'F .i.'i i .rUi
• '� Development Services Department
Building Safety Division _,
s..E
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC 171361
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Lot 6 of Marie
Estates subdivision. This inspection revealed a nitrate concentration of 8.79
milligrams per liter (mg/L) was reported for the property's well water
sample. The Environmental Protection Agency (EPA) has established a
maximum contaminant level (MCL) of 10.0 mg/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical"
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
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ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:
y QQMlc 1
FOLLOWING DESCRIBED/� PROPERTY: __�� O -4-. ..�' O
l/J,jQ/c'` 33 c- sr,,,e Gal-- r DATE- �.� A
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS �v/� . • `� t.
X--•
INDICATED. IT IS THE RESPONSIBILITY OF THE ���j a f• T! ` .¢'
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: r '" /7/..,.":4:
•�t v
EASEMENTS, COVENANTS, OR RESTRICTIONS /J/1. .- �.,- _ , Y--ne:Z ' ee-g l
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- ---- '" •
Icy • Dun Mark Sewar a`1
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FS' �^� 001 LS- sr►a .; •
ANY DATA HEREON BE USED FOR CONSTRUCTION /�- �.c,,,.„-.-87,7_,,,-:. ac.,• 4-
1
OF FENCE LINES, OR FOR ESTABLISHING BOUND- DR 3 ...AL r,. t:s °•''"
ARY LINES. DRAWN: hN � '=u'o.a
.e 27'
Municipality of Anchorage
I��-•1 Development Services Department
• Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519519
-6650 !/✓�
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. OSI- I11-32 COSA# 09 0179
1. GENERAL INFORMATION Expiration Date: -q- 1-7-09
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
MARIE ESTATES LOT 6
20527 STEPHEN CIRCLE • CHUGIAK, AK 995.67
JAMES REAVES Day phone 317-5292
20527 STEPHEN CIRCLE * CHUGIAK AK 99567
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
O
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
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 Ede (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 engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Wr' /0"i
Engineer's Comments:
In conducting this evaluation, GEG, LID. attempted to provide a thorough,
o0o���4p
OFA
conscientious engineering analysis of the system In accordance with ADEC and MOA
o gou4
DSD Guidelines & Regulations. The reported results described the performance of the
at the time of the test, and separation
Gv ` ,.•" s DO
- •'•
system under the conditions encountered
identifiable features. The life of all wells and
p
distances measured to readily operational
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.
0
These conditions are outside the control of the evaluator of the system. Satisfactory test
0.. • • :. • • • ...........
QO '. G rness:
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
Q o, E-7
�04'e
any warranty or future estimate of how long the system will continue to meet the
'' •( -it 0'9 oQoo�
operational requirements of the ADEC or MOA DSD. The content of this report Is for
0p°e Pro f s slo"
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
4p e
ft t tffff/
otherperson or party Is not authorized, nor will it conferany legal right whatsoever.
S. DSD SIGNATURE
V Approved for ,? bedrooms. ` J • ONSITE
WATER AND
Disapproved. ; WASTEWATER
Conditional approval for bedrooms, with the f hiving stipulations: � PROGRAM
.....
Attachments: /
COSA Checklist 1/ Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: /� �.o Original Certificate Date: L 7'0 9
r 7
(R. 11105)
Municipality of Anchorage ,
--1 Development Services Department
\ Building Safety Division
On -Site Water & Wastewater Program "
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: MARIE ESTATES, LOT 6 Parcel ID: Q-51 _ I r 1- 3 2�
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N A
Date completed 8/l/1983 Sanitary seal (Y/N) YES
Total depth 80 ft.
Date of test
Static water level
Cased to 80 ft.
FROM WELL LOG
8/1/1983
35 ft.
Well Log (YIN) YES
Wires properly protected (YIN) YES
Casing height (above ground) 24 in.
AT INSPECTION
5/26/2009
41 ft.
Well production 3 9.131 1.0 9•P•m•
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrates• 39mgJL. Other bacteria colonies/100 ml.
Arsenic: Maug.&. Date of sample: 5/28/2009 Collected by: GEG Ltd.
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 9/9/1983
Tank size 1000 gal. Number of Compartments 2 Cieanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A
Date of pumping 5/27/2009 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA SOUTHWEST TRENCH/NORTHEAST TRENCH
Date installed 9/9/1983 Soil rating (g.p.d./ft=o !bd 225 System type TRENCH
Length 22/45 ft. Width UKN ft. Gravel below pipe 5 ft.
"6.08/
Total depth 9.58 ft. Eff. absorption area 675 fe ' Monitoring tube YES Depression over field NO
Date of adequacy test "5/27/2009 Results (Pass/Fail) PASS For E bedrooms
Fluid depth in absorption field before test 27/DR Y In. Water added 500 gal. New depth 27 DRYin.
Elapsed Time: E min. Final fluid depth 27/DR In. 1 Absorption rate >= 450'+ g,p,d,
Any rejuvenation treatment (past 12 moa (YIN & type) NONE KNOWN If yes, give date -
*BELOW EXISTING GRADE, THE MT IN THE SOUTHWEST TRENCH .ONLY EXTENDS 15 INCHES
BELOW THE TANK OUTLET INVERT.
**THE NORTHEAST TRENCH WAS TESTED, THE SOUTHWEST TRENCH WAS SURCHARGED.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump offleve High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 1000+
Public sewer manhole/cleanout N/A
Holding tank N/A
Animal containment areas 500+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway. parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
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.
Engineers Printed Name JEFFREY A. CARNESS
Date bt11b)g
COSA Fee S 11 q a
Date of Payment G
Receipt Number O X S 5-1 2
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
OF A
p
..................
.....
.. ......... ...
••.J y Carnes
J
�tpG
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
NitrateAdvisory
Certificate of On -Site Systems Approval # 090179
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
6 of Marie Estates subdivision. This inspection revealed a nitrate
concentration of 5.38 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
N 89.59100' W 354.75'
os,sv
r I '
J r
f•• .' N O
O
00 5PLTr
LG2e — ,o
LemQ.v 0° %_ o
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NOUS. -
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y a
zo.o• J ,;
1 S 42GfNNOUSG r ��/ .S
r -
W .
ryS 89.59100• E ���/ 354.75'
,
W I ."eery LNG I
,
I _���iti,
IL +•.�E OF '4q -+I, ' I
CIO' o',tP•e'•• Ste'' 0 50 100 '
'••• I
.:'}'9.m'; ...7..:. • . /0 SCALE IN FEET
'
i0 � • IJ10HAAEL J. HEINZ ; Ar r
1 Z /`a
No LS 7837•.'& I I
�- • C�T ,
lAt •�i1lVU AS—BUILT
I hereby certify that I, or someone under my supervision, have
performed an As -Built survey of the property described as:
LOT 6 of MARIE ESTATES SUBDIVISION
Anchorage Recording District, Alaska
The Improvements situated thereon are within the property lines
and do not encroach or overlap onto adjacent properties nor do
any Improvements from adjacent properties encroach or overlap
onto this property except as Indicated hereon.
LEGEND
This As -Built Is Mly for IM use of lending institutions to shon ony conflicts
SEPTIC CLEAN OUT hot... esisling ei$ibl♦ structures and plotted lot lines ou •olesnts. It not
adequate tor, mer should It be used for pesitiMing additional Igrovoxnls or for
establishing boundary Or lent$ If"$. or$fl ing end reproduction my produce
A% WELL gfdphic inconsistencies; tbdrefore waling should MI be etlenpied to doter+in•
onehoen disensions. No cornsrs wo set this dale.
OS, SEPTIC VENT
LNlees $p•<Ilicelly "led otherwise only essernls /rs the NeardM subdivision
Plot $ro shell h•r•M. II is the responsibility of IM o.n,' to d•t•roins it ony
other •asM .ts. eo.enonls. or Itst'ictloo, Neill.
FIMD WORK DATE 11-1e-93 I3fEc3(ED BY: Bid aRtO: NW 1331 DWG NAME;* A893-194 PLOT SCALE 1'-50'
DRAWN DATE: 12-1-93 DRAWN BY: 1111 FIELD BOCK: 930.5 DISK NO: B93-oa98 JOB NO.. 93-194
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.enchorage.ek.us
(907) 343-7904
0
(Czal LJ3+
i�Z1j/ps ;
i
:e, [,r
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel l.D.bal' 111-39 HAA# Q9Qgg0
Expiration Date: I ;L — 2 7 - 0.5'
1. GENERAL INFORMATION
Complete legal description Lot 6: Marie Estates Subdivision
Location (site address or directions) 20527 Stephen Cir_
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
David Withrow
Day phone
PO Box 671710 Chugiak, AK 99567
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: I_
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
Day phone
Day phone
688-0573
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
J®
Individual Holding tank
❑
Community On-site
❑
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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm S 6 S Engineering Phone 694-2979
Address 17034 N. Eap.l VeF Loo te. 4104 Earle River, AK 99577
Engineer's Printed Name Date 7/G?�
- y
c4s1l
' •�p,,,�."`L_�/�p
5. DSD SIGNATURE rTr
j h
-'.`
" �� :
�� Approved for .3 bedrooms.i'�
9 v
Disapproved. t� . ; • s ��f
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Note: The well for this property meets existing State and Alunicipal Codes. There are nitrates
present. It is suggested that periodic testing be performed to insure the wells continued suitability.
Current nitrate concentration Is 6.05 mg/l. EPA maximum concentration is 10.0 mg/l. Nfore
Information on nitrates is available from the On -Site Services Program, at 343-7904.
Attachments:
HAA -Checklist -- X
Septic System Advisory
Well Flow Advisory
-Maintenance Agreements
Supplemental Engineer's Report
Other
By: t (% Original Certificate Date: Z7-
(Re, OLOI)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
i (907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: koT 6') MocV-1r, 5/b Parcel ID: O.S/ - /I I - 32-
A. WELL DATA
Well type � VW I� If A, B, or C provide PWSID #
Date completedJ 1 I g'� Sanitary seal (MN)
Total depth-Bo—ft. Cased to 86' ft.
FROM WELL LOG
Date of test
i
Static water level 56 ft.
Well production 0.6 t g.p.m.
WATER SAMPLE RESULTS:
Coliform _colonies/100 mi. Nitrate %-OSmg./I.
Arsenic: mg./I. Dale of sample: *06(05
B. SEPTIC/HOLDING TANK DATA %
Tank Type/Material ���/ -b— r --L,
Tank size 1050 gal. Number of Compartments Z
Well Log (5m) lee-
Wires
E4Wires properly protected [>��
Casing height (above ground) %1:'A- in.
AT INSPECTION
`1 105'
1 • g.p.m.
Other bacteria ^ colonies/100 ml.
Collected by: 54'-5 Lu(�rK71c21U!►
Date installed 6 g
Cleanouts QN) `IE'S
Foundation cleanout `i�S Depression over tank (Y/Bp �x) High water alarm (YAV K -'a
r
Date of pumping �`( LOS Pumper IZ S �ut� Pt�Ca
C. ABSORPTION FIELD DATA
d �•
Date installed Soil rating (g.p.d./ftZ r ft /bdrm 2ZS System type I rc r -&X -J -
I�
Length 4,� ft. Width 30n ft. Gravel below pipe b0to *4KXA4fs
I
Total depth _('D ft. Eff. absorption area 616 ftZ Monitoring tube1IF'S Depression over field A -a
Date of adequacy test I11110c, Results(as ail) +�S For 2L bedrooms
Fluid depth in absorption field before test" in. Water added gat. New depth
Elapsed Time: 6W) min. Final fluid depth al in. Absorption rate >= 0+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y(9 type) OJO If yes, give date
D. LIFT STATION
Date installed Size in gallons _
`Pump on" level at _ in. 'Pump off" level
Datum Cycles tested _
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot t oo
Absorption field on lot 100 I t
water alarm level at
Meets alarm & circuit requirements?
On adjacent lots I VC) 14-
On
+On adjacent lots 10014-
Public sewer main fJ W Public sewer manhole/cleanout 1J 14
Sewer /septic service line ?,r, t +- Holding tank ►J ✓t -
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation S I'- Property line 5 t t Absorption field 5 r+
Water main 1y W Water service line 10 I Surface water 100 I+
Wells on adjacent lots t 00 1+
in.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10 1"f' Building foundation 104- Water main #0 14
Water Service line 10 1+ Surface water 100 4- Driveway, parkingivehide storage to t+
1
Curtain drain NOUe 14AX e O Wells on adjacent lots 1 CSO 1+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
�' "� '• 9
I certify that I have determined through field inspections and (r X r .9 ti
review of Municipal records that above systems are in
conformance with MOA HAA uid sthi A. tri ......•
Engineer's Printed Name -
- r
/ Z
GGyy/
Date 1_/7/Z�t0 �t— : Altrs.4
HAA Fee $ y'n.a'
Date of PaymentVZ3la cns
Receipt Number 7y�4a �Am
(Rev. 12101)
Waiver Fee $
Date of Payment
Receipt Number
' I I
1 _ -....-9231 • _ Q!
GPAVC4
.. og"
I
� rorr
LLI
U
Of
U
S
LEGEND
N 89.59'010- w
~
102 O2• it H ow
ro S 9..�,�
SPLIT ° e
MAC
00LEM (ah, o°
fRAMG
)1z 01
House
L a
" b
S 89.59100' E
.•PSE OF A�S�
* :49111 * •
................
0. . .�
0 _ - -.MICHAEL J. HONZ ,F
••, No. LS 7877 .'
.......s... •
8°
SEPTIC
CLEAN OUT
4%
WELL
CSV
SEPTIC
VENT
FIELD WORK DAIS 11-16-93
CHECKED BY: BV
DRAWN DATE
12-1-93
DRAWN BY: MN
X54.75'
OW
354.75'
J
L-6
ro 10Cir r
eo7H n+ groesM or
P.eoaem Lae ,
y
,
0 50 100 ;
SCALE IN FEET
f._;F�: JIlijy
1 hereby certify that I, or someone under my supervision, have
performed an As -Built survey of the property described as:
LOT 6 of MARIE ESTATES SUBDIVISION
Anchorage Recording District, Alaska
The improvements situated thereon are within the property lines
and do not encroach or overlap onto adjacent properties nor do
any Improvements from adjacent properties encroach or overlap
onto this property except as indicated hereon.
This As-Buill Is only for the use of lending institutions to ohm any conflicts
betwea existing visible slrwteres u,d platted lot lines w easement.. It'Is net
odeyveto for. net should It be used for petitioning additional Iaprovowals or ret
est0bliahing boundary w fence lines. Drafting and reproductlM usr produce
graphic inseie,islensies; Uerefere oealins shwld MI be elle"lod to delue,iw
unsho.n dimensions. No cwwre etre set this date.
IMIms specifically noted otherwise only .memento free, the recorded subdivision
plot ere shown here". It Is the res".sibilily of the owwr to detemiw it any
ether wsemenls. covenants, or rwlricli"s exist.
tune, NW 1361 DWG NAME: A093-194 PLDT SCALE. I' -.W
FIELD BOCK: 9303 DISK NO: 893-0096 JCB Not 9.1-194
,
,
,
,
,
,
r•
,
,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY P
264-4720
Application Date 2 " l&' 8 %
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
G 6 l Y"1,6 4Es7';,&r 7E.1
Location (address or directions)
(b) Applicant Name Aall'G/ ir1G/L Telephone: Home y Business
Applicant Address 12 & ox Fi 7d 6 I V eK ',?55 _6 :7
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address �'�Gh /3� ��v IGUL /' 7 IE/5;4Z_'
Telephone
(f) Mail the HAA to the following address:
5 & S chit.-Mr-RIN
17034 Eagle River Loop Road No. 204
Eagle , Alaska 99577
2. TYPE OF RESIDENCE
Single -Family. Multi -Family ❑ Other
Number of Bedrooms
3. WATER SUPPLY
Individual Well, Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsitek Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 i2-025(11/84)
5. ENGINEERING FIRM PROVIDR INSPECTIONS, TESTS, FILE SEARCH, D. AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the 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 & 5 ENGINEERING Telephone �9
Address 17034 Eagle River Loop Road No. 204
Eagle River, Aluska 99577
Date
n 1n' r'
I`l
5' 3.1.H s. -LI
k ��%'�a'e+aa ace aaec�r,�'���•
FRO
6. DHEP APPROVAL
Approved for J bedrooms by . ZdZ/ Date 3 7
Approved Disapproved Conditional �—
Terms of Conditional Approval
Mare: 4hsoYo7iivkr Amelel arl�ry(crare tOv %6rK�. &te(s�r�s�IS1�yr1y.
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations 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 requirements. 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.
Page 2 of 2
72-025 (11/84)
\Adl' o-034UNICIPALITY OF ANCHORAGE (MOAJ
��Sos HEALTH AUTAPPROVAL HAA)
\Gyvl',�4CHECKLIST - FEBRUARY 4
IK04
264-4720
10\�o 4�Q�24� �O Legal Description: o /
C S J,
A. WELL DATA
I> Ar1
Well Classification If A, B, C, D.E.C. Approved (Y/N) /f
Well Log Present (()?�N) Date Completed 3.61103 Yield
Total Depth c�O Cased to Depth of Grouting
Static Water Level Pump Set At�
Casing Height Above Ground 1-y Sanitary Seal on Casing 4/N)
Depression Around Wellhead (Y&
Electrical Wiring in Conduit �I)
Separation Distances from Well:
To Septic/Holding Tank on Lot / 05 ; On Adjoining Lots /00/4
To Nearest Edge of Absorption Field on/Lot ZO ; On Adjoining Lots
To Nearest Public Sewer Line �r� To Nearest Public Sewer
Cleanout/Manhole _ To Nearest Sewer Service Line on/L,ot �' S
Water Sample Collected by C �����=mac ��' ;Date a_/����
Water Sample Test Results
Comments 71L:F (_
B. SEPTIC/HOLDING TANK DATA
C 7-'O,< 7`
Date Installed Size / rf- No. of Compartments Z
StandpipesCVN) Air -tight Caps (Y/N) Foundation Cleanout 67N)
Depression over Tank (Y/b Date Last Pumped Z 5 7G—
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) �AlTemporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 1 5
i
To Property Line �
/ �
To Water Main/Service Line o�
Course
Comments
Page 1 of 2
72-026(11/84)
To Building Foundation 3 S
To Disposal Field � ?
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
I/) 1--�
Soils Rating in Absorption Strata 2 -Z's, /i3Q Type of System Designer AJC /� v
Date Installed 9Z91163 Length of Field
if
Width of Field
Depth of Field
7A,
Gravel Bed Thickness S
Square Feet of Absorption Area 760 f Standpipes Present/N)
Depression over Field (Y Date of Last Adequacy Test ___?J//!� ;Z 4-1
n
Results of Last Adequacy Test Sf'AEi�:eW
I v2
Separation Distance from Absorption Field:
To Water -Supply Well Zo7
i
To Building Foundatii yob
Lot
i
To Water Main/Service Line /D 4
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking
3Area, or Vehicle Storage Area
( )
Comments ? c3 � d 75 o xy rr~
D. LIFT STATION
Date Installed
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
Cutbank (if present)
N,
C.Y. 0e Z. '1.97 dpi
Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at N "Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed S & S ENGINEERING Date 9' g
Company 17034 Eagle River Loop Road N�b?A04o
P Y Eagle ver, Alaska F.
Receipt No. /0a
Date of Payment
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