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TUSTAMENA TERRACE #1 LT 12
Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191364 PID Number: 017-381-50 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name JANET REISER ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ound Site Address 5450 NAKNEK LANE *ANCHORAGE, AK 99516 El Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-317-1731 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot TUSTAMENA TERRACE #1; LOT 12 Fill added above original gr Ft. Gravel length Ft. Township Range Section - Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1250 Gal. Surface Water 100'+ Material Number of compartments Lot Line 5'+ NA HDPE 2 Foundation 10'+ LIFT STATION Manufacturer Capacity Remarks OLD TANK REMOVED FROM PROPERTY Gal. PER CONTRACTOR Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Installer JOHNS EXCAVATING Drainfield D3034/EXISTING CO/MT D3034 Inspector TIM ECKLUND AND DAVID GARNESS BENCH MARK (Assumed elevation) 101.95 ft Inspectiones: 1s` 9/5/2019 - Location and description nd 2 BOTTOM OF SIDING AT FCO 3'd _ 4w _ ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer s St p _op6OO Conditional Approval: Date o 0 * .T �.................... ... .. ... ..................� Septic System ,� oO J f ss: �p ApproveGI-- Date® CE —795r 0 0�44�e�p iZi�o�o Note: this approval does not include well permit requirements. #AEccsa4��0o00000� (Kev U5/UL/16) J 'PERMIT NUMBER: RECORD D RAW I N G PARCEL NUMBER: ii OSP191364 017-388 1-50 A I B PTC01 45.8 14.5 MH 44.9 15.4 ST1 44.6 18.1 DBL1 44.9 19.1 DBL2 44.6 19.7 TMT 42.9 12.5 CLEANOUT AND MONITORING TUBE INSTALLED FOR SEPTIC ADEQUACY TE EXISTING DRAINFIELD NEW 1250 GALLON HDPE GREER TANK 100' WELL 1&2 NPKNEK SANE EXISTING 4 BEDROOM HOUSE __ MEN IN TUSTAMENA TERRACE #1; LOT 16 SCALE: 1 � ,,,=40' GARNESS ENGINEERING GROUP, Ltd ----------------- --- ENGINEERING - SALES oCONSULTING -----__ ----- -- 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507 -PHONE (907) 337-6179 • FAX (907) 338-3246 -WEBSITE: v gamessengheenng. m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JANET RISER 907-317-1731 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: TUSTAMENA TERRACE #1; LOT 12 D.J.G. TYPE OF WORK: DATE: I,, SEPTIC TANK RECORD DRAWINGS 9/6/2019 TUSTAMENA TERRACE #1; LOT 13 VLlk �.�P'�E ...... iAV 4L , 4 * ••i 0...... .. ................, 0 �.� ...A..Gar.ess... W ?: LICENSE tRO ESSO**.�•• #AECC884 ,�lk`z"* / ERIMIT PNUMBER: RECORD DRAWING P017-381 50 ER: OSP OSP191364 FINAL GRADE = 100.19 FINAL GRADE = 99.59-99.98 MH ST1 2" INSULATION PER CONTRACTOR TOP OF TANK AT INTLET = 95.86 TOP OF TANK AT OUTLET = 95.94 NEW 1250 INVERT OF BUNG AT INLET = 95.28 GALLON H. D. P. E. INVERT OF BUNG AT OUTLET = 95.10 SEPTIC TANK GARNESS ENGINEERING GROUP, Ltd... °• *'11 .....::........ _ - = ENGINEERING, SALES=CONSULTING :---- -- -- - -__- - 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 - PHONE (907) 337-6179FAX (907) 338-3246 - WEBSITE: w gamessengineenng—m 0 „. ....... ,,,,, , / PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JANET RISER 907-317-1731 3 OF 3 0 G '• C -7 yarn •s •• _ LEGAL DESCRIPTION: DRAWN BY: # q �\� TUSTAMENA TERRACE #1; LOT 12 D.J.G. �j� FD'•••.J. ,Z,j ••�-���• TYPE OF WORK: DATE: LIC ENSE'1�I;:;;SSO\� • SEPTIC TANK PROFILE 9/23/2019 #AECC884 TY0, MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program 5�; PO Box 196650 4700 Elmore Road r. Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite + �• Department Sh"cw nu nGE On-Site Wastewater Disposal System Permit Permit Number: OSP191364 Effective Date: 8/20/2019 Work Type: SepticTank Upgrade Expiration Date: 8/19/2020 Tax Code Number: 01738150000 Site Legal Address: TUSTAMENA TERRACE #1 LT 12 G:2837 Site Mailing Address: 5450 NAKNEK LN, Anchorage Owner: REISER JANET L Lot Size in Sq Ft: 44831 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 2 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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: ,/ L �„ Date: ` Issued By: /./ 4j•.,--(14 / Date: i /� 18970 >> MUNICIPALITY OF_ ANCHOu�; -44- r `'� AUG1 4 2019 / .,ir� Community Development Department r" - n►.e: 907-343-7904 Development Services \r,-P4 S`iT 907- 34 -7,997 On-Site Water & Wastewater Program W.06 8 t 9 Mayor Dan Sullivan On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 017-381-50 Property owner(s) JANET REISER Day phone 317-1731 Mailing address 5450 NAKNEK LANE `ANCHORAGE,AK 99516 Site address 5450 NAKNEK LANE *ANCHORAGE.AK 99516 Legal description (Sub'd, Block & Lot) TUSTAMENA TERRACE#1; LOT 12 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial ❑ Single Family (SF) ZI Absorption Field ❑ (w/wo ADU) Septic Tank ® Upgrade Duplex (D) ❑ Renewal Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: a a5 Waiver Fees: Date of Payment: )IQ lid Date of Payment: Receipt Number: n0/3 /02(4 Receipt Number: Permit No. �SPf 1 13L,L/ Waiver No. (Rev.01;11) GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING August 14, 2019 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for Tustamena Terrace #1; Lot 12 To whom it may concern: The existing 4-bedroom house is served by private septic system and a private well. The existing steel septic tank is 34 years old, so it is reasonable to believe that it is at the end of its usfule life; therefore, we are proposing to decommission the existing 1,250-gallon steel septic tank per UPC and install a new 1,250-gallon HDPE Greer Tank rated for 10' burial. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your a sistance. ince ely, Jeffr_ ' Ga`7s.., a. ., M.S. Pres '�e 3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179'Fax: (907)338-3246*Website: www.garnessengineering.com • •100'WELL RADIUS O i CONTOUR I" 0 ACRES#4; BLOCK 2,LOT 8 100'WELL RADI TUSTA ENA TERRRRACE #1; TAMENA c.::\c , TUSTAMENA LOT 0 7-RACE #1; TERRACE #1; LOT 9 LOT 11 W Z J A ' o rum& SNE a 6 CONTOUR m ACRES#4; O \ BLOCK 2,LOT 9 ': 111111111161; i 10• �► RADI • 1 1" �c':� TUSTAMENA % 1- , TERRACE #1; LOT 13 • nDI 11101,: 44,1drvil I - 1 IIPIPI #41k Ilk ' TUSTAMENA TERRACE #1; . LOT 14A 100' • . / - i • • CONTOUR ACRES#4; 0 111 •aBLOCK 2, 100'WELL- lik LOT10 • TUSTAMENA TUSTAMENA TERRACE #1; TERRACE #1: LOT 16 LOT 15A *111111P SECLUDED HILLS;BLOCK 1, = N LOT 1 ----L S ALE: O 1"=100' r. rt 1 _ \./\ OF • GARNESS ENGINEERING GROUP, Ltd ; 9 \'* • • ENGINEERING.,SALES CONSULTING -- - -= - - • 3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK99507•PHONE(907)337-6179•FAX(907)338.3246•WEBSITE:VMW.gamessengineerirg.corn •• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 t^ S - • Games JANET REISER 317-1731 1 F 2 •o j. -79 c• m PROJECT/LEGAL DESCRIPTION: DRAWN BY: - •v. :&•... It 4�' 4. 4, TUSTAMENA TERRACE#1; LOT 12 PNB ♦ p'��U�1�•• • �, �• TYPE OF WORK: DATE: LICENSE•,1� E�` �• SITE PLAN 6/4/19 #AECC884 ������ • / GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN.BY PROCEEDING FORWARD WITH THIS INSTALLATION,THE ENGINEER,WELL DRILLER,CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. NAKNEK`ANE -4;.4:'''..•••: TUSTAMENA • :; TERRACE #1;LOT 13 :4• 4 ..• 1 •:. . •4 CLEANOUT AND MONITORING TUBE INSTALLED FOR SEPTIC ADEQUACY TEST ;�!.;. ,.: • 1... ...4. Lii Z EXISTING DRAINFIELD al — _- DECOMMISSION•, :••' --•*• 0 — • EXISTING TANn . QPER UPC •:•y,..• FCO PROPOSED 1250 HDPE GREER TANK WITH EXISTING 4 DOUBLE CLEANOUTS BEFORE AND AFTER TANK BEDROOM C HOUSE • `� 1Q V , 1 N TUSTAMENA TERRACE #1;LOT 16 3 100'W ' WELL RADIOS S ALE: 1"=40' .♦♦♦IMI i11 ♦ � QFA ./ GARNESS ENGINEERING GROUP, Ltd ; *I1 4' 'i ��* • • ENGINEERING.SALES CONSULTING _- • 3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE,AK 99507'PHONE(907)337-6179'FAX(907)336.3246'WEBSITE:www.gamessengineeong corn I/ • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 • = e -1.-7.1.414'jfi : JANET REISER 317-1731 2 OF 2 ���iJ,•••� V CE-795 PROJECT/LEGAL DESCRIPTION: DRAWN BY: �. .• 1 1Q••� • TUSTAMENA TERRACE#1; LOT 12 PNB 1�FQ••'''U •1•�• ,gyp`._ ♦♦• TYPE OF WORK: DATE: 444 ESS\��♦♦ DESIGN OF SEPTIC TANK UPGRADE 8/14/2019 #AECC884 1���sss♦ LANE NAKNEK . ,,.5REFIIRN8746'WSd?' ,---FROu COmPU7E0PoS'7,gV ---\ 4\ N78 70'j6' E 112.36 NB959'E4305 r • \\\\ L' \ .. \. I Z W • I3� i lE I • v O • i ` gFGY • , y ,i 11���NIE HDOSE cc 'x 5 f� a=_: o �NcaD' N4 \\ f L✓r1 "' ..N1 NOTE: THIS SUBDIVISION HAS NUMEROUS ERRORS AS-BUILT SURVEY 1" =30' REGARDING FOUND PROPERTY CORNERS AND E 255?a RECORD DATA FROM THE PLAT. THE SOUTH NO CORNERS SET f HIS DATE 69 00'20� AND WEST BOUNDARY OF THE SUB. WAS USED Qo000pp ter-,II N ASA RETRACEMENT TO COMPUTE THE BOUNDARY TY vv�� OF AtX/6)1(), S�4 O OF LOT 12,AND THE CORNERS SHOWN HEREON I HEREBY CERTIFY THAT DESCIBHAVE ED PROPERPERFORMED A SURVEY W+s� AS NOT IN CORRECT POSITION ARE A RESULT OCG 47,TH OOOD OF THOSE COMPUTATIONS _OT 72, TUSTAMENA TERRACE FIRST ADO'.. ° 49 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE S- ./41 /7/4 - VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN O l„ -O f;' THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS OD0. SHANE A.HOLT ,OO NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EXIST OTHER THAN NOTED. Q s LS-6914 - . j O EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN DATED AT ANCHORAGE,ALASKA THIS DAY OF �p�a HEREON ( UNLESS INDICATED) ._ : , 2019 Oprofesslonsl Vao NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE p"00000Q R..I NO5.4E&ARN875t1WSSO' PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAPD SURVEYING FROM/COMPUrfDPosfrpv ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5513 r~-"~ MUNICIPALITY OF ANCHORAGE ~ DE~ .,-ITMENT OF HEALTH AND HUMAN SER~. 2S ,.. ~," .' Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Terephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Nar.~DISTANCES ]Address ~ SEPTIC ABSORPTION ~ x / ~ 0 ~ ~ ~ ~.,c ~, ~/~ ~. ~ ~<- ~j TANK FIELD WELL Phonets)~y~ ~'~ PermR~_O~~NO NO. of~d~j ...... WELL LEGAC DESCRIPTION LOT LINE TownsUip, Range, Section ~ ~- ~ )~ / ~./~- ~ ~ AS-BUILT DIAGRAM (Show IocaUon ol well, septic system, property hnes, foundabon, driveway, water bo0ies, TANKS ~EPTIC ~ HOLDING Manulact .... Capacity in gallons ~ Me[erial NO ol CompaHments ~TRENCH ~ BED ~ W, DRAIN ~OTHER ~;,~ or,ginal grade ~' FT /'~ FI Gravel length >" GraveJ width ~ ~) .~_ z/~,,/,,~, Number ol /mmnes Soi)~_ratm9 SOFT Pmpe ~/mateua ~ ~ u~ WELLS ~ PRIVATE ~ OTHER (Identify) REMARKS: j~ p/ ~ ~.~ '~/~, 2 ~ ~ D'/~ - - m.? ~.~ p~,-~f~ ~"'/- 1'7''~' ~'/ ~""'~':~ ~: , e~ ~ / Scale: ~ '~G~ & 's SEAL ~ q'¢~['~ ' Inspections Pedormed by: :.,., ~'!:.~ ,,~ Municipal and State ~ui~eliaes in ell~ct on this date: ~ '- ~t/ .- ~ S'~ -- ~2-013 (3/85} PERMIT NO: DATE ISSUED: AF'PL ICANT: ADDRESS: CON]'ACT PI-JO,NE: DEF:ARTMENT E HEALTH AND ENVIROANE'~TAL i]I"ECTION 8~.,,,.; L. STREET. Al ff,HORAGE, AK 995Q1 85 '}36 ('} .}6/~.6/8o P~I.JL LE'I"HENSTROM BOX 110367 ANCHORAGE~ AK 99511 32$6-3799 F"EIr-iI~"i Ii T LESAL DESCRIP: SLJBDIVISION: ~UGTAMENA TERRACE LOT: 12 SECTION: 27 TOWNSHIP: 12N RANGE: 5W L. OT SIZE: 44831 (SQ.FT. OR ACRES) · MAX BEDROOMS: 4 BLOCK: 0 Listed below are the options, available to. you in ,designing your, septic system. Choose the option that best fits your S~te. ~'O"RE,ICH ' BET-} W . DRA I N BEPTH T'O PIPE BOTTOM (FT.) 4.0 · GRAVEL DEPTH (F'Y.) 8.0 TOTAL DEPTH (F'T.) 12.0 GRAVE[.. WIDTH (FT.) 2.5 GRAVEL LENGTH (Fl'.) 72.0 GRAVEL VOLUME (CU. YDS, ) 56. '7 TAN}( SIZE (GALS) 1,250.0 ~* SOIL RATING (SQ.F'[, /BR) 287 4.0 0.5 4.5 28.0 54.0 56.0 1,250.0 ** 25(} 4.0 3.5 7.5 5.0, 124.0 ** 91.9 1,250.0 ** 287 ** ~3RAVEL LENGTH > 75 PT.. REQUIRES MOLTIPLE RUNS (NOT EXCEEDINI~ 7,.~ FT. EACH) e* TANK MUST HAVE AT LEAS]" 'TWO COMPARTMENTS I certi£y that: ~1. I am familiar with ,'.,7. 3, 4. the requirements for on-site sewers and Wells as set £orth by the Municipality o£ Anchorage (MOA) and the State o£ Alaska. I will install the system in accordance with all MOA codes and regu. lations.~ arid in compliance with the design criteria of this Permit. I will adhere to all MGA and State of Alaska requirements fop the set back distances £rom aDy existing well, wastewater disposal system or public sewerage system on this or any adjacent or near, by lot,. I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit. IF A L. IFI' STATION IS iItSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN 'ELECTRICAL PERMIT~ND INSPECTIOI/ MUST' BE,OBTAINED; (2) AS-BUILTS WILI~ NOT BE APPROVED WI]"HOUT I~q E~..ECTRICAL INSPECTION REPORT~ AND (~) THE EI..EECTRI~ORi~ BE ~0~' A~LICEI,~SED EELECTRICIAN. ' APPLI~gNTa P~DI_ LE]"HENS'T'RO~ ' ' [] SOILS LOG PERFORMED FOR: ~'d¢' / LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~E]~ PERCOLATION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST 1 2 3- 4~- 5 6 ,7~ 8 10 11 12 14 15 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: SLOPE ,./ WAS GROUND WATER ENCOUNTERED? ,F'<ES, ATW.AT ,4//4 DEPTH? ~ SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop ~; ?5' 73'~ o 72-008 (6/79) .::"ETU"i 'i T t.40. TOM F F. I _.E LOT ±2 TU_-THHENI-I TERRH~.E :::,!'::H E,U.;', ~.75L ...... ]:45-±i7~ LOT =,I~E '_'2¢L~gL~'9'9 S, QURF.:E FEET I.I ,.~....!~ E:,ISTFINCE E, Ef'I-]EEI'4 FI !-,]EL.L FIN[:,,.,c:"."-.', O['4-SITE SE.[,.!FIGE E..I.._,FU_,HL :,-r.=,TEII I:, :J.E;E) .... F F-F.' Ft FF.._¢PI]E I.,.IELL "Pb." ':L.=_E~ TO 2:E)E~ FEET FROt'I Ft F'UE:LIC .NELL [:,EPENE:,ING J[.:'Cd-. fbiE T"r'F'E OF FUE, LIu L,.IELL. i"lii".i;!'.Si'i DZS'TFI?',ICE FF.:OH a ='F-:IVRTE .~4ELL TC R PR'.t',,,'FITE SE!-'.IER LINE IS 25 FEET F'fl",lb TO ~-:! ,.CCihii"]Uf',tIT'T' S,E!.4EF.'. LINE IS 7._'3', FEET. · ,-!ELL. ":": FIRE '~:EC!UIRE[:, Bf',l[:, I1LI.=T E,E F.:E'tLt~'E:NEB' TO THE [:,EF'FIRTHENT NITHIN ];0 [PIT=, OF ii"'i= i4ELL F:F&"IPLETION. UTr'.::~',:. N'Z'::L'~F.'EFiENTS MFI"r' FIF'F'L'¢. SF'EC:IFiC:F:ITiE&",tS Fli",l[:~ COi",ISTF.'LI]:TIZN [.'tFIt~F-.FItL, FIRE Ft',,,'F'~ZLiIc',L£ ECl INSUF.:E PE. JFEF-' INL=;TRLLFITZON. · ER T t THFIT · t: I RI-,1 FRI','I!LttaR FOF.:TH E:'¢ THE I"IUNICIF'FILIT"r 3F FtI'4C:HORRI.aE. 2 I NtLL INSTFtLL FHE S'¢STEH IN FIC:CCIF.:DFtHC:E ,t,.tlTH THE' CO[:,ES. Si GNED: ................ RF~~OPI F'F.: I C:E I-,.IITH THE ,-.[ .......... I,-.EflENT-, FOE.: ON-'~ITE ..,EHER_, FINE:, !.IELL .... ET V4. 0 Sheet / of / WATERWELL - TEST PUMP REPORT Owner /~U/ Lp~/~c.',~ ' Address ~ /~ ,~ /'/~ ~ ~ /~, Well Location ~/~ ~/F~'/~'~/E ~ Well Information: Ttl. Depth /~-~Depth of Casing / 2~-.~Screen From ~ To ~ Casing Size ~ U Screen Oiam ~ Screen Slot ~ Remarks t~L~ /~/~,~//~ ~ /~ /I/ ~- /~1 ~/~ ~/~ ~//~.~-- Pump Information: Intake Depth /2 / Pump Size / ~/-~ >.w~, Air Line Static Water Level ,/~ ~- ~ ~ ~. Discharge~; ~/ GPM, Max. Drawdown PI ( FLOW Ti~/ WA ER TU~ ~ REMARKS WATER ~,~E' REMARKS . L;~ PLO>, TIME LEVEL GPM /33 ~- /,:..~ 6 / ./h //V I 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: L 12v In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE System #1 Approved for t' bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the #AECC884 *��t�atcccccsrr(�r ON-sj-rE WA-rER ND ing �SCt�Tla AGZR a�O^ `�ROG�AM ,{� e ��117111`� Original Certificate Date:,3 " Z' 2dZ3 L4 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 Septic System Advisory Well Flow Advisory Nitrate Advisory' Arsenic Advisory' ' • ` ' Other '` • �" CSA Checklist Legal Description: Tustamena Terrace #1; Lot 12 Parcel ID: 017-381-50 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 0.18 gpm Date drilled '28"983 Water storage tank volume 500 gallons Total depth *120 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to *120 ft Coliform bacteria is Negative RE Sanitary seal is functioning correctly Nitrate (No mg/L ❑Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by GEG, LTD Date of flow test for COSA 8/8/19 Date of. Sample 2/25/20 if (ZZZt3 1q Static water level at beginning of test 116.5 ft Comments *PER GEG INSPECTION - MAXIMUM DRAWDOWN WAS 125.3 B. TANK DATA Age of tank(s) NEW years Tank type/material HDPE Measured operating fluid level in septic tank NIA ❑ Standpipes/foundation cleanout per record drawing Date of pumping _N/A D. ABSORPTION FIELD DATA Which system tested (date installed) 1985 Al ALL standpipes present per record drawing Total measured depth from grade 10.5 ft (max) Measured depth to pipe invert from grade 6.9 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. if not, state depth into effective 3.5 ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: 'SEE ATTACHED LETTER COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance Age of lift station Lift station mate Comme rs Adequacy test date 8/8/2019 Results QPass For 4 bedrooms * Fluid depth prior to test in * Water added gal New depth * in Elapsed time * min * Final fluid depth in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) NO If yes, enter date N/A E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' ✓v Yes if No ft ✓] Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25'✓Q Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' Q✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10'✓0 Animal Containment > 50' ❑✓ Yes if No ft ✓❑ Yes if No ft 0✓ Yes if No ft Water Service Line > 10' E✓ Yes if No Manure/Animal Excreta Storage > 100' —❑✓ If septic tank is under driveway Community Sewer Main > 75'✓71 Yes if No ft Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5'✓❑ Yes Yes if No ft Wells on Adjacent Lots: ✓❑ Absorption Field > 5'-;, if No Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10'✓0 ft Yes if No ft Community Wells > 200' 0✓ Yes if No ft Water Service Line > 10' E✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ✓l Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells > 100' Q✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200'✓Q Yes if No ft Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S 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. COSA Checklist yellow sheet CE -79 3 •mac #AECC884 GA1Rr11\.1_1q ESQ E+ NGffNIEIER fNG GROUP9 Ltd ENGINEERING SALES CONSULTING September 12, 2019 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Septic Adequacy Test for Tustamina Terrace #1; Lot 12 To whom it may concern: A septic adequacy test was performed at the subject lot on 8/8/2019. Prior to the start of the test, a new monitoring tub and cleanout was installed at the east end of the trench by A+ Home Services. The monitoring tube is approximately 4.5 feet short. It is our belief that the excavation during construction was sloughing heavily and therefore a functional monitoring tube could not be installed with the installation method chosen by the contractor (compared to driving the monitoring tube). Based upon this fact, our septic adequacy test results is based upon the following assumptions and calculations: 1. There is 8 feet of rock per the MOA inspection report 2. The monitoring tube extents 3.5 feet below the invert (4.5 feet above the bottom) 3. We are assuming the drainfield was dry prior to the start of the test, leaving the potential for 54 inches of "unobservable" rise (4.5 feet x 12 inches/foot). 4. 1273 gallons were introduced causing a rise of 9 inches in the monitoring tube, which equated to 63 inches of total rise (assumed based upon assumption #3) 5. 1273 gallons/63 inches equated to 20.2 gallons/inch 6. Over a 120 minutes period the liquid level in the drainfield dropped 4 inches 7. A 4 -inch drop at 20.2 gallons per inch equates to 80.4 gallons absorbed over 120 minutes 8. 80.4 gallons over 120 minutes equates to 0.67 gallons/minute. 9. There are 1440 minutes in a day which equates to an absorption rate greater than 600 gallons/day which is the municipal requirement for a 4 -bedroom system. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com Nitrate Advisory Certificate of On -Site Systems Approval # OSC201075 Subdivision: Tustamenia Terrace #1, Lot: 12 A water sample revealed a nitrate concentration of 9.65 milligrams per liter (mg/Q. 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. y '� Mailing Atldress P� O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org 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 Pesults 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. (� $ � ` ` Madmg Address P� (1 Box 196650 *anchorage, blaska`99519 6650 *"'www muni org Well Nater Advisory Certificate of On -Site Systems Approval # OSC201075 Subdivision: Tustamenia Terrace #1, Lot: 1 This well's productivity was determined to be .6 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 4 -bedroom residence is .41 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Ma�l�ng Address Pk O Boit 196650 *Anchorage, Alaska 995,1!',665 *www muni org Sonja Blewett From: Jeff Garness Sent: Sunday, February 09, 2020 8:16 PM To: Sonja Blewett Subject: Fwd: 5450 Naknek Lane Sent from my iPhone Jeffrey A Garmess, P.E., M.S. President Garness Engineering Group, Ltd. Begin forwarded message: From: David Harper <dlharper2@gmail.com> Date: February 9, 2020 at 6:58:28 PM AKST, To: Jeff Garness <Jeff@garnessengineering.com>, Michelle Nelson <michellenelsonak@gmail.com> Subject: 5450 Naknek Lane Jeff, Michelle, the well located at the above address has been looked at to a depth of 60+ feet with a downhole camera. There did not appear to be any damage to the pitless adapter nor to the casing. We saw no sign of water entering the well at any point in the survey. David Harper Aarow Pump & Well Service, LLC OF q �gsppo TH* ;o o N� SHANE A. HOLT .' G DO P LS -6914 p�aA... • 0\,Ofessional e Q L11 Q Q m N O O Z L� DWELL FI—VD. NO. 5 REBAR N8754' ['15.50' FROM COAIPU7ED FOOION N, N 89 59'E 43.05 0 N 78 20' S6„ E 1"12.36 o o SH_D FND. NO, -5 REM I? N 6746' '1542' /FROM COAdoUTED P05/TION v�E 00 FRP DECK OIJ CRAPE 1U. �1IUN EPSEMEN T E 255.2-4 TH15 SUBD114SION HAS NUMEROUS ERRORS 20 REGARDING FOUND PROPERD'CORNERSAND N 69 p0 RECORD DATA FROM THE PLAT THE SOUTH AND WEST BOUNDARY OF THE SUB. VIAS USED ASA RETRACEMENT TO COMPUTE THE BOUNDARY OF LOT 12; AND THE CORNERS SHOWN HEREON AS NOT IN CORRECT POSITION AREA RESULT OF THOSE COMPUTATIONS THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS-BU/LTSURVEY I" =30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 12, TUSTAMENA TERRACEFIRSTADD'N. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 12 TH DAY OF OCTOBER , 2019 i4257 FB i5-17-9 Tp -i3 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5513 c 3 A O A s a n^ � O O v�E 00 FRP DECK OIJ CRAPE 1U. �1IUN EPSEMEN T E 255.2-4 TH15 SUBD114SION HAS NUMEROUS ERRORS 20 REGARDING FOUND PROPERD'CORNERSAND N 69 p0 RECORD DATA FROM THE PLAT THE SOUTH AND WEST BOUNDARY OF THE SUB. VIAS USED ASA RETRACEMENT TO COMPUTE THE BOUNDARY OF LOT 12; AND THE CORNERS SHOWN HEREON AS NOT IN CORRECT POSITION AREA RESULT OF THOSE COMPUTATIONS THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS-BU/LTSURVEY I" =30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 12, TUSTAMENA TERRACEFIRSTADD'N. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 12 TH DAY OF OCTOBER , 2019 i4257 FB i5-17-9 Tp -i3 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5513 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 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (incrude lot, block, subdivision, section, township, range) '7'~--/-~,~,~,~ -/'e,-r~c~ Lo'/* /'2. ~'~'~ 2~' '7t~ t~t~cO~ Location (address or directions) (b) Applicant Name .S',.~.~ ,/,,..,t~ ~ r,~n Telephone: Home ~ NJ- ~ ? ~ Business Applicant Address ~o~ //o~ ~ ~/~ ~K ~ )~f / is (check ooe): Lending Institution ~; Owner/builder; Buyer ~; Other D (explain); (c) Applicant (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address .. Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms 4~ Other 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. SEWA~F~DISPOSAL Onsite~,~,, Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) . ENGINEERING' FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA~,-..~ND INFORMATION ~11~-*' 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 farther verify that based on the information obtained from the Municipality of Anchorage files and from ray 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 ,'~E'~'-~ Telephone 3'-6 / -5-~ '-/ O Address /2o0 qJ,' ~.2 A~¢/~ AK~'~'~,' -~ Date DHEP APPROVAL ~'"~:3~z~~~ Approved for ~;~__/~A~'~, bedrooms by . _ te Approved ,~ Disapproved Conditional Terms of ~onditional Approval 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 (,1/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: .5'~. 2.7- M~/CIP~J.I'/Y C~ ANCHORAGE DEPT. OF HEAL1H & ENVIRONMENTAL P~OTECTION NOV 0 8 R E C .,I D WELL DATA Well Classification ~o r,t¢ s4~'¢_ ifA, B, C, D.E.C. Approved (Y/N) Well Log Present ~.¢~) Date Completed 8- ~- -(~.~ Yield Total Depth J ;z. 2. ,~ Cased to I ~2_, ~ Depth of Grouting Static Water Level i°~r ''~' Pump Set At Casing Height Above Ground ~' ~,~ Sanitary Seal on Casing ~N) Electrical Wiring in Conduit~_0~N) Depression Around Wellhead (Y/~ Separation Distances from Well: To Septic/Holding Tank on Lot / ~' / ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot. / ~'~ ; On Adjoining Lots To Nearest Public Sewer Line ~ To Nearest Public Sewer Cleanout/Manhole -- To Nearest Sewer Service Line on Lot Water Sample Collected by ~ ~,~-~ ~' ; Date //- Water Sample Test Results ~ ~_.¢-,. ~"',~ ~_~f~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~-~--~- Standpipes(~N) Depression over Tank (Y/I~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well / ~'' ( To Property Line ~ ~- To Water Main/Service Line Course ~ ?- /OO Size /~ 5-© No. of Compartments Air-tight Caps (~N) Foundation Cleanout ~N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation /~ To Disposal Field ~, ~z. To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(H/84) C, ABSORPTION FIELD DATA Soils Rating in Absorpt on Strata ~ 8 7~ r~ ~,/.~. Type of System Design Date'lnstalled ~ - /~ - ~:' '~ Length of Field Width of Field '- ~ .~,',~.? 4 '~'¢-*' ~ Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Depression over Field (Y/~¢? Results of Last Adequacy Test Standpipes Present~'~'4) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / '~- B To Building Foundation ~ ~/~ Lot To Water Main/Service Line (~' ~- ! O To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line _ :~ O To Existing or Abandoned System on ; On Adjoining Lots ~'~F' ,30 To Cutbank (if present) ~T Date Installed %~.~ Size in Gallons ~--~- "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments~~'~ Dimensions Manhole/Access (Y/N) "Pump Off" Le~ePat '~-_ ~ Vent (Y/N) Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that~_~ __1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '~¢"~'~. ~ ' Date Company ',~cS MOA No. '~"~' Receipt No. ~ ~,O/~ (.~ Date of Payment Amount: $ (o,~-3~''B-~'~ Page 2 of 2 72 026 (11/84)