HomeMy WebLinkAboutPARKS LT 2Onsite File
Parks
Lot 2
PID# 051-104-82
Formerly T15N R1W Sec 9 Lt 93.
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231331 PID Number: 051-104-K
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family
MEA - C/O AMY NICKERSON
Site Address
20431 WHITE BIRCH ROAD, CHUGIAK, AK 99567
Phone Number of Bedrooms
1-541-817-4560 3
LEGAL DESCRIPTION
:)uumvision Block Lot
PARKS - 2
Fownship Range Section
iEPARATION
DISTANCES
To
'rom
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Well
EXIST.
*50'+
EXIST.
-
Surface Water
EXIST.
*501+
EXIST.
-
Lot Line
EXIST.
*5'+
EXIST.
-
Foundation
EXIST.
1 0'+
EXIST.
-
Page 1 of 3
Project: ❑ New 0 Upgrade
3SORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed 0 Mound
❑ Other
I Rating Total depth from original grade
*2.0 GPD/SFJ SEE DWG. F
)th to pipe invert from original grade Gravel depth beneath pipe
SEE DWG. Ft. 0.52 F
added above original grade Gravel length
SEE DWG. Ft. 20 F
Gravel width Beds: Number of Lines Distance between lines
15 Ft. 3 5 F
Sewer Total absorption area Number of trenches Dist. between trenches
Line 300 Ftz - - F
25'+ TA Septic ❑ S.T.E.P. ❑ Holding ❑ Other
NA
TION
Remarks *THIS IS A AWWTS. THIS IS A REBUILD OF
THE EXISTING BED TO A HIGHER ELEVATION. Alarm location
Installer
JR'S EXCAVATION
Inspector GEG CONSULTANT, JODY MAUS
Gal.
Gal.
by
PIPE MATERIAL House to tank EXIST. Tank to D3034
drainfield
Drainfield D3034 CO/MT D3034
BENCHMARK (Assumed elevation) 100.00 It
Inspection ill 10/23/23 2�d 10/24123 Location and description
3'd 10/24/23 4w - BOTTOM OF SIDING NEAR POINT "A"
ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp
Conditional Approval:
oo�o0 44
Date
4T' •.5�4��0
.
Septic Syste� 0� � e fAGd Hess:
ApprovedDate l �j CE_
Q�rP ro Z�3 :o
Not : is approval does not include well permit requirements. / P'Of ess=ooa�.
#AECC884 O�OQO
(Rev 05/02118) /
PERMrr NUMBER: PARCEL ID NUMBER:
OSP231331 RECORD DRAWING 051-104-82
r �
r 100' WELL RADIUS
� r �
� I i
_
EXISTING 15' WIDE BY 20' LONG
BED TYPE DRAINFIELD REBUILT
TO A HIGHER ELEVATION.—n
�♦ EXISTING
�\ DOUBLE
\\ CLEANOUT
EXISTING ADVANTEX
TREATMENT SYSTEM
ENGINEERING * SALES e- CONSULTING
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE. ALASKA. PHONE (907) 337-6179' WEBSITE: N
PREPARED FOR: PHONE NUMBER:
MEA - C/O AMY NICKERSON 1-541-817-4560
PROJECT/LEGAL DESCRIPTION:
PARKS S/D; LOT 2
TYPE OF WORK:
RECORD DRAWING OF DRAINFIELD REBUILD
A B
MT1 49.6 39.3
C01 51.0 41.0
CO2 54.9 45.9
CO3 59.2 50.8
MT2 61.8 53.8
MT3 61.4 44.5
Cl 62.4 46.0
C05 65.6 50.3
CO6 69.3 55.0
MT4 71.5 57.7
NOTE: PIPE LOCATIONS ARE
SHOWN PER GEG SHOTS
TAKEN WITH LEICA DISTO
S910 LASER DISTANCE
METER. SWING -TIES TO
HOUSE CORNERS WERE
GENERATED IN AUTOCAD.
1/J
CANA
PAGE NUMBER: I Cn '; J rey A. Garness W
DRAWN 3 ••♦�1 �• YE -79532 i
J.L.M. 1� Fp 'p���••l,J.,.....1 •••'•P�,
DATE: LICENSE,,P-r
OF
10/25/2023 #AECC884
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231331
Work Type: Septic Upgrade
Tax Code Number: 05110482000
Site Legal Address: PARKS LT 2 G:1358
Site Mailing Address: 20431 WHITE BIRCH RD, Chugiak
Owner: MATANUSKA ELECTRIC ASSOCIATION
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
�lt�cnr S
Department
9/27/2023
9/26/2024
82693
Q Disposal Field ❑ Septic Tank ❑ 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
Special Provisions:
• The October groundwater elevation Is not to be higher than 91.32 (BM is 100' at bottom of siding at NE
corner of house). If higher, a change order may be required. Submit groundwater reading with the IR.
: _ C55c t e- cel -ta GiE:�z
Issued By:i�0 �e�
Z . __
Date:
Date: 2107 Z
3
MM -1-a AUTY OSA ANCHORAGE
Development Services DepartmentPhone 907-343-7904
On -Site Water & Wastewater Section � Fax: 907-343-1997
ON-SITE SEPTIC/WELL PERMIT APPLICATION eN Wr
Parcel I.D. 051-104-82
Property owner(s) MATANUSKA ELECTRIC ASSOCIATION Day phone 907-317-0898
Mailing address PO BOX 2929, PALMER, AK 99645
Site address 20431 WHITE BIRCH ROAD, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) PARKS; LOT 2
Legal description (Township, Range & Section)
Lot Size
Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) 0
(w/wo ADU)
Septic Tank
❑
Upgrade D
(D) El
Holding Tank
❑
RenewalDuplex
❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 9 � Z Waiver Fees:
Date of Payment: 812.7 j ?
Receipt Number: _ Q R G-7
Permit No. 05,0-z-3/-3 j
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and WastewaterTormsUient Forms\Pennit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231331, Deb Wockenfuss, 09/27/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231331, Deb Wockenfuss, 09/27/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231331, Deb Wockenfuss, 09/27/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231331, Deb Wockenfuss, 09/27/23
.N89°54'16"E 680.76' (C) N89°5630".660.56 (BLM)
.. ... .... .. 75.46' ...... ..E
'B DING SETBACK
G..E
ELECTRIC ESM TB. S C0
(DTM)
H�0m
WATER WELL O,
SEE DETAIL
LOT 2
82,693 SQ. FT.
1.898 ACRES
50'ROADBUTILITIES
RESERVATION
PERG'234, PG. 65 SEE NOTE 4
I_O
M
ZMA
TOWNSHIP 15N,
RANGE 1W, S.M., AK.
<`
OF 44
��gsll
T••
�j AVID C. HALE
1 �
9 LS 10395
�1��••, 10/25/23 •,• �Awl
`\A•••. .•' OC'
`lrOfessiona\ \1 141111�
-4b-
..... J4U.4 /'.............. ...........
G25' BUILDING SETBA! J X=
PROPOSED ACCESS DRIVE r =
o o L
° r°
0
o o
PR01'O�h I� SIIRSTe.T OV
LOT 1A
0 0 ° ° 99,167 SQ. FT. L =
2.277 ACRES °
° o
U G X - X
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PROPOSED FENCE Y Ix
�0 ROAD 8 UTILITIES
R SERVATION Ydl'C' 10'TELEPHONEB
K. 234' PG. ELECTRIC ESMT. (DTM)
S E $TING LOT L E®
TO BE VACATED
McKINLEY VIEW AVE.
— X— —X L
I` IL
-� 0' ROAD 8 UTILITIES
ESERVATION i
ER BK. 234, PI . 65
SEE NOTE 4
I
I�I
GDRY
I�
OA
a
O M4
M
SEWER VENT (TYP.)
J 12.7'
10.61 ... �........
�G J ..... ............ /
2-5" 6U LDIf4G�SETBACKA
S` G
` "S`
SEWER� MANHOLE (TYP.) ® sa
2
LOT
82,693 SQ. FT. ,
1.898 ACRES SEWER VAULT
G 0 Y
SEWER CLEANOUT (TYP.) m
— — www
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DETAIL 1"=40'
U) i
W
IL
LL
AS -BUILT DRAWING
LOT 2, PARKS SUBDIVISION SEPTIC SYSTEM
SCALE: 1"=100' DATE: 10/25/23
GRID: NW 1358 PAGE: 1 OF 1
9101 Vanguard Drive Anchorage, Alaska, 99507
PH (907) 522-1707 FAX (907) 522-3403
RQ*% www.rmeonsult.com
- AECC 111
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201466 PID Number: 051-104-41
Dwelling: ❑t Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade
Name
Kevin & Marilyn McNamara
ABSORPTION FIELD
❑ Deep Trench El Wide Trench ■❑ Bed El Mound
Site Address
Matanuska Electric Assn., Inc.
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
761-9559
3
2.0 GPD/SF
2.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.5 Ft.
Gravel depth beneath pipe
0.5 Ft.
Subdivision Block Lot
93
Fill added above original grade
2.9 Ft.
Gravel length
20 Ft.
Township Range Section
15N 1W 9
Gravel width
15 Ft.
Beds: Number of Lines
3
Distance between lines
5 Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
300 - W
Ft.
Well
>100'
>1 00'
N/A
N/A
>25
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding F!] Other
Manufacturer
Greer / Advantex
Capacity
1,500 Gal.
Surface Water
>1
>1 00'
N/A
N/A
Material
Plastic
Number of compartments
2
Lot Line
>5'
*>5'
N/A
N/A
NA
Foundation
>1 0'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Remarks Organics not removed from under perimeter of mound.
Gal.
No impacts to this system are expected due to this deviation.
Alarm location
Electrical installed by
*Meets MOA requirements for CAT III systems
PIPE MATERIAL House to tank D3034 drainfield Tank to
D3034
Installer
Pomraning Excavation
Drainfield D3034 CO/MTD3034
Inspector J. Millette
BENCH MARK (Assumed elevation) 100 ft
Inspeection
15' 6/12/21 n 6/18/21
Location and description
ction 2
Bottom of siding @ point B
3'd 4`h
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
)F
Conditional Approval: Date
,��P,.•••" •.,S
6 •: °®
Air ,
Air
:' •:
49th
........... .... .
H I �r 1�
s -� v
go ............................................. ... 0
MICHAEL E. ANDERSON
Septic Syste
0.��;• No. CE -4381 �=
•'••..
Approved Date Z I Z I
®F 9/9/21 ..••°F�`'t
�0 4'FD ••.............
Note: this approva oes not include well permit requirements.
o.
®1�It%I, s=a`.�
(Kev Ub/02/16)
// // // //
// // // // // // // xxxxxxxxxx
// // // EXISTING WELL
1"=50'3-BDRM HOME1500-GAL GREER
TANK w/ ADVANTEX
AX20 FILTER POD
BUOYANCY NOT
NEEDED
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
PV - PUMP VAULT
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND240PERMIT # OSP201466 PID # 051-104-41
T15N R1W SECTION 9 LOT 93
A B
WHITE BIRCH ROAD9/9/21
FEET
0 50 100
McKINLEY VIEW AVENUE
25' BUILDING SETBACK
25' BUILDING SETBACK
GARAGE
GARAGE
10' T&E EASEMENT
50' ROAD & UTILITIES EASEMENT
PER BK. 234 PG 29
25' BUILDING SETBACK
PROPOSED LOT LINE
(SHIFTED 30' WEST)
EXISTING LOT LINE
TO BE VACATED
MT4 MT1
MT3 MT2
EXISTING
ABSORPTION
BED & TANK
ABANDONED IN
PLACE
20' LONG x 15' WIDE
ABSORPTION BED
100' WELL RADIUS
245
235
FCO
WELL ON THIS LOT IS >100'
FROM PROPERTY LINE.
NOTE:
MH2
MH1
VACANT LOT
NO WELL
2CO
TH-1
A B
MH1 28.5
MH2 31.7
2CO 37.4
MT1 51.3
CO1 52.1
CO2 57.7
CO3 63.0
36.2
36.4
39.0
42.2
43.2
49.4
55.2
MT2 64.3
MT3 72.6
CO4 72.4
CO5 67.8
CO6 63.9
MT4 63.4
56.3
58.4
58.1
52.8
47.6
47.1
PLAN AS-BUILT
CO1
CO2
CO3
CO6
CO5
CO4
PROFILE AS-BUILT
(NO SCALE)
94.5
88.9
95.1
99.1FCOMH MH8/23/21
1500 GAL
GREER TANK 2COPERMIT # OSP201466 PID # 051-104-41
T15N R1W SECTION 9 LOT 93
AX-20 POD
DRAINFIELD ROCK
MOA APPROVED FILTER SAND
TYPE II ERS MTCOMTCO95.1 FINISH GRADE
20'86.388.2
86.3
88.2
92.2 ORIGINAL GRADE
TH#1GROUNDWATER @ 87.2 ON 10/15/20
78.2
90.2
90.7 90.2
90.7
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NW54'16'E 660.76'(C) N89 -5830-E 660.56' (BLM). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I
0!=1w MA,
1T1'ELECTRICESW.(DTM)
Io
z
r0
WATER WELL
SEE DETAIL a_� 2147"
0,O
PROPOSEDLOT
S
82,693 SQ. FT. m
50'ROAD B UTILITIES ESMT. 1.898 ACRES
PER BK. 234, PG. 29
C
►?��
I
TOWNSHIP 15N,
RANGE 1W, S.M., AK.
OF A4
*. T .....'*.��
..
..o
II• AVID. C. HALE
'••
LS 10395
��'•• 09/09/21 •'•�AV'
\`rofessiona\ r
99,167 SQ. FT N LL
2.277 ACRES W
-10' TELEPHONE &
pELECTRIC ESMT. (DTM)
W" r 150' ROAD 8 UTILITIES ESMT.
McKINLEY VIEW AVE.
M
v
SEWER VENT (TYP.)
..
F
�1"ek-49`
10.3'
25� 9U LDIRG SETBACK sv
\
v e"c 50 ROAD $
11TIL� IES ESMT\
Cs
> 234
PG 65 } G
1"
�s
®sem
OPOSED LOT 1A
MW
99,167 SQ. FT N LL
2.277 ACRES W
-10' TELEPHONE &
pELECTRIC ESMT. (DTM)
W" r 150' ROAD 8 UTILITIES ESMT.
McKINLEY VIEW AVE.
M
v
SEWER VENT (TYP.)
10.3'
25� 9U LDIRG SETBACK sv
10.3'
Cs
SEi1 t R MANHOLE (TYP.)
�s
®sem
-Zsss
45.9'
SEWER VAULT
'
- ----{ ---
_
U
SEWER CLEANOUT (TYP.)
m
-- _
w
z
�^
o I
o
N
DETAIL 1"=40'
PARKS SUBDIVISION SEPTIC SYSTEM AS -BUILT
SCALE: 1"=100' DATE: 09/09/21
GRID: NW 1358 PAGE: 1 OF 1
9101 Vanguard Drive Anchorage, Alaska, 99507
PH (907) 522-1707 FAX (907) 522-3403
R96& www.rmconsult.com
-AECC 111
S12551
t� ""MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
j http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201466
Work Type: Septic Upgrade
Tax Code Number: 05110441000
Site Legal Address: T15N R1 W SEC 9 LT 93 G:1358
Site Mailing Address: 20431 WHITE BIRCH RD, Chugiak
Owner: MATANUSKA ELECTRIC ASSOCIATION
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date:
�1„cnr
o�
r
n �
Department
Lot Size in Sq Ft:
Total Bedrooms:
11/10/2020
11/10/2021
108900
❑ 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:
Issued By:
Date:
Date: it i
3
MUNICIPALITY OF ANCHORAGE
MY��
Community Development Department rF Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-104-41-000
Property owner(s) Kevin & Marilyn McNamara
Mailing address PO Box 670190 Chugiak, AK 99567
Site address 20431 White Birch Road Chugiak, AK
Day phone 761-9559
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section) T1 5N R1 W Section 9 Lot 93
Lot Size 108,900 Sq. Ft. Number of Bedrooms Three (3)
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑X Initial ❑
Single Family (SF) ❑X
(w/wo AD U)
Septic Tank 1Z Upgrade ❑X
Duplex (D) El
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 4446-2S Cf V►17 Waiver Fees:
Date of Payment: 10301 a 02 O Date of Payment:
Receipt Number: d q O 3 Receipt Number:
Permit No. OS p20I qGC--) Waiver No.
Permit App__- : c
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
November 3, 2020
M.O.A. Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Subject: T15N R1W Section 9 Lot 93 – 20431 White Birch Road
Septic System Design
Dear On-Site Services Engineer:
The subject property is currently being replatted and the existing absorption bed is too close to the
proposed lot line. The system was originally permitted and constructed in December of 1985 and
has remained in service since that time. We are submitting this design and permit application for
the replacement of the existing system. The attached site plan identifies the location of the home
and the existing well and septic system. The proposed septic location is also shown. No conflicts
exist between this proposed system and any other well or septic system on this lot or adjacent lots.
The ground surface on the lot is virtually flat in the area of the proposed absorption bed. The
existing bed will be abandoned in place and all piping will be removed. There are no slopes greater
than 25% within 50 feet downslope of the absorption bed. Drainage arrows are shown on the
Site Plan indicating the grade and direction of flow.
The absorption bed will be constructed with the use of Engineered Receiving Soils. Existing
material will be excavated to a depth of 6’ below the surface. Approximately 2’ of select backfill
meeting the gradation of Municipal Type IIA backfill will then be placed. A 2’ layer of Municipal
Approved Sand will be placed atop the backfill layer. The bed will then be constructed atop the
sand. All organic material under the perimeter of the new bed will be removed and replaced with
in situ silty gravel to provide structural support for the mound.
Wells on this and adjacent lots are shown. The lot to the East contains the Matanuska Electric
substation. Grounding wells are located on this lot. These wells are clearly marked and do not
include a bottom hole pump. They are not intended to be used for providing drinking water. The
closest well is more than 100’ from the proposed absorption system and more than 70’ from the
proposed septic tank location. The attached base map shows the location of the nearest grounding
well. The new system will be a minimum of 50’ from all wells and surface water and more than
5’ from the septic tank.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201466, Deb Wockenfuss, 11/10/20
Please refer to the attached test hole logs and plan and profile sheets for the septic design. If this
design is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Michael E. Anderson, PE
11/3/20
// // // //
// // // // // // //x x x xxx x xxx
// // //EXISTING WELL
1"=50'3-B D R M HOME1500-GAL ADVANTEX
TANK W/ AX20 POD.
TANK & POD MUST BE
ANCHORED FOR
BOUYANCY. SEE
MANUFACTURERS
RECOMMENDATIONS.
NOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
PV - PUMP VAULT
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND240T15N R1W SECTION 9 LOT 93
WHITE BIRCH ROAD11/6/20 FEET
0 50 100
McKINLEY VIEW AVENUE
25' BUILDING SETBACK
25' BUILDING SETBACK
GARAGE
GARAGE
10' T&E EASEMENT
50' ROAD & UTILITIES EASEMENT
PER BK. 234 PG 29
25' BUILDING SETBACK
PROPOSED LOT LINE
(SHIFTED 30' WEST)
EXISTING LOT LINE
TO BE VACATED
MT
MT
MT
MT
EXISTING ABSORPTION BED. REMOVE
PIPE & ABANDON IN PLACE20' LONG x 15' WIDE
ABSORPTION BED
PUMP VAULT MUST BE
ANCHORED FOR
BOUYANCY. SEE
MANUFACTURER'S
RECOMMENDATIONS.
100' WELL RADIUS
245
235
FCO
TOE OF SLOPE
WELL ON THIS LOT IS >100'
FROM PROPERTY LINE.
NOTE:
PV
MH
MH
VACANT LOT
NO WELL
12'
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201466, Deb Wockenfuss, 11/10/20
T15N R1W SECTION 9 LOT 93
DESIGN FACTORS: SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW
PERK RATE: 40 MIN/IN
APPLICATION RATE: 2.0 GPD/SF
TYPICAL BED SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER BED TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER BED AND 4' OVER SEPTIC TANK, OR 2' WITH 2"
OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
BOTTOM OF BED: 2.0' BELOW GRADE
FLOW LINE ELEVATION:1.5' BELOW GRADE
TOP OF BED: 2.0' ABOVE GRADE
450 GPD / 2.0 GPD/SF /15' WIDE = 15 LF BED REQUIRED (20 LF SPECIFIED)
11/6/20
5'
2'
OG
3
1 1
3
2'
DRAINFIELD ROCK
2" INSULATION AND
GEOTEXTILE FABRIC
1" PVC LATERALS (3 EACH)
6" TOPSOIL &
REVEGETATE
OG
MOA APPROVED SAND
SHALLOW ABSORPTION BED
1,500-GAL FAP ADVANTEX TREATMENT SYSTEM
w/AX-20 FILTER POD & PUMP VAULT
6"
6"
2.5' 5' 2.5'
10 - 3
16 " DIAMETER HOLES PER
LATERAL @ 1.5' SPACING O.C.
TYPE 2A SELECT BACKFILL
2'
6"
6"
REMOVE ORGANIC
MATERIAL & REPLACE
w/IN SITU SILTY GRAVEL
REMOVE ORGANIC
MATERIAL & REPLACE
w/IN SITU SILTY GRAVEL
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201466, Deb Wockenfuss, 11/10/20
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE 1
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
T15N R1W SECTION 9 LOT 93
10/8/20
J. MILLETTE
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH? 5'
40 6
6 7
051-104-41
MEA
10:21
10/8/20
1
2
3
4
5
6
3 4
1610:51
10:52
11:22
11:23
11:53
.5' OB
Professional Engineers Stamp:
11/3/20
30
Yes
5'
10/15/20
ML/GM
COBBLES w/ORGANICS
GP
GM
BOH
30
30
3 4
16
3 4
16
4 0
16
4 0
16
4 0
16
12
16
12
16
12
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201466, Deb Wockenfuss, 11/10/20
v Q V V
/� Knik Arm
I /\ /♦ 1 / -1- 1 /. -1- /\ !\ �� r- /. /♦ -1-.4 r- A 1 r\ /r 1 I / �O /. /. 1 / -/- / /\ -1- e% r7 �� r- /♦ /� -1- /1 r' A 1 r\ Ir 1 /� (/ / , I U I � A_
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..............
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McKINLEY VIEW A
....................... .
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ry
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•....................... .
z
• ;::::::::::.:::: —�//IIIA
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SYMBOL LEGEND
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O
BOLLARD / POST / GATEPOST
GAS METER
-0-
UTILITY POLE
DRY
STORM DRAIN DRYWELL
o
UTILITY POLE RISER
CW-)
WATER WELL
GUY WIRE
69;
MONITOR WELL
O -OEM
ELECTRIC METER
;i;
TREE: CONIFER / DECIDUOUS
TELEPHONE PEDESTAL
e
BOULDER (ROUGHLY AT SCALE)
A�
CABLE TV PEDESTAL
123.4 2
SPOT ELEVATION
Is;
LEACH -FIELD VENT
LINE LEGEND
0
M
UT
E T OE C
T U T -
1o50' ROADS &
UTILITIES ESMT.
U.S. PATENT
1224486
T
o 0
M
,VE.
275 0
a �
2 5�a 0 2�fl J
50' ROADS &
r'
a 271 6' UTILITIES ESMT.
+ o BK. 260, PG. 330
Y•I
\ fl10 •• ° o
• • • • • • • • • • • •
• • • • ? • • • • • • • •-y y
/\ IN 1 /-I- I /\ -1- Ae%r7 �� r-�♦ �♦ -1-.4 r -A 1 r\.41 A /
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_ I
-ii is t: " "1 I'll
x x XX— CHAINLINK FENCE
WOODEN FENCE
• ••••••••••• SURVEY LIMITS
of OVERHEAD ELECTRIC
of/oT OVERHEAD ELEC. & TELE.
uT U.G. TELEPHONE
uG/C U.G. CABLE TV
W U.G. WATERLINE
UE U.G. ELECTRIC
G U.G. GAS
STREET CENTERLINE
PROPERTY BOUNDARY
------------ EASEMENT
123 MAJOR CONTOUR
HATCH PATTERN LEGEND
o F A 4
iqsl�
co
.:...IS G
Randal H. Brinker 0 /
,p LS LS 8852 �_\
;^� •. ir
9/19/19 .•°•aC'i
iiA ••. .•• °�.►
irOfession°� oft,
12 7 8
Beach pQ BlrChw00 eft
Lake p �\
v
eK a
Cie gyp°
13
to Mlnk
Lake
33
4 1 3 ua
THIS
lew
-PROJECT
NA Peters
g Creek
10
%17 Nay 16
G\e� Chugiak
pkel
VICINITY MAP
Scale: 1" = 1 Mile
Edmonds
Lake
T16N
T15N
-WIT'ror
Lake
2
11
15 1 14
GRAPHIC SCALE
30 0 15 30 60
Rgi&
( IN FEET ) -
1 inch = 30 ft.
NOTES
1. INFORMATION PROVIDED HERE IS BASED ON FIELD
SURVEYS PERFORMED BY R&M CONSULTANTS, INC. JULY
- SEPTEMBER, 2019.
2. CONTOUR INTERVAL SHOWN IS ONE FOOT.
3. UNDERGROUND UTILITIES SHOWN HERE ARE BASED ON
TIES TO ABOVE GROUND UTILITY STRUCTURES AND
MARKINGS PAINTED ON THE GROUND BY UTILITY
PERSONNEL. THE SURVEYOR MAKES NO GUARANTEES
THAT THE UNDERGROUND UTILITIES SHOWN COMPRISE ALL
SUCH UTILITIES IN THE AREA. THE SURVEYOR FURTHER
DOES NOT WARRANT THAT THE UNDERGROUND UTILITIES
SHOWN ARE IN THE EXACT LOCATION INDICATED. THE
SURVEYOR DOES CERTIFY THAT UNDERGROUND UTILITIES
ARE LOCATED AS ACCURATELY AS POSSIBLE FROM THE
INFORMATION AVAILABLE. CONTACT ALASKA DIG LINE
(DIAL 811) BEFORE DIGGING.
ADDENDUM: UTILITY PERSONNEL NEGLECTED TO LOCATE
U.G. ELEC. & COMM. ALONG WHITE BIRCH ROAD AND
MCKINLEY VIEW AVENUE. R&M LOCATED THESE UTILITIES
WITHOUT THE AID OF SCHEMATICS. R&M MAKES NO
GUARANTEE THAT THESE LOCATIONS ARE ACCURATE OR
COMPLETE.
4. WHETHER LISTED OR NOT, ALL MONUMENTS OR
PROPERTY MARKERS, CORNERS, OR ACCESSORIES WHICH
WILL BE DISTURBED OR BURIED, SHALL BE REFERENCED
OR RE-ESTABLISHED IN THEIR ORIGINAL POSITION (A.S.
19.10.260) AND RECORDED (A.S. 34.65.040)
5. EASEMENT DESCRIPTIONS ARE LISTED HERE AS THEY ARE
SHOWN ON PLATS AND PATENTED DEEDS OF RECORD.
6. REFERENCE PROJECT SURVEY -CONTROL -SHEET FOR
PROJECT CONTROL, MONUMENT TIES AND COORDINATE
TABLES.
TOPOGRAPHIC MAPPING
MEA PARKS SUBSTATION
LOT 1, PARKS SUBSTATION SUBDIVISION
PLAT NO. 2013-40
Located within the NW1 /4, Section 9, T.15N., RAW., S.M.,
Anchorage Recording District
® 9101 Vanguard Drive, Anchorage, Alaska, 99507
PH (907) 522-1707 FAX (907) 522-3403
www.rmconsult.com
DRAWN: RHB SCALE: 1"=30' PROJECT: 2762.01 GRID: NW 1358
CHECKED: RHB FIELD BK: 2762.01 DATE: 9/17/2019 SHEET: 1 OF 1
-YH,'N1C.'PALVYY OFANCH"OR-AGE
I I, I
D
I 1F'NASTEVVATQR
"VA -.D�
(
.`vl A I A N1 C 1E A N D R 1,�: P A 1 R AC.R E, E M E rTF
THI�,N'IAPNA ENAN{._IE WID nnade and
emend imonsofdjs,2QYL,jayof CNAWar
of AQ0 , by and between
herein th-t -0WNF,.'.P-7'and the IN,lunicipality, of
ih-1,11, NIC1113ALM7 in accordance with Z\ ncho rage Municipal (:ode
(AN,lC) lf,,.65,}65. In consideration of the rnuwal covenants contained hnnin, Be pales W this
Agrew-nem agne as Blows:
1. AWV.. I YVI.-te)vate- TreatrnenjjIstenis. The k1unicipality grants permission to, the
(Aner to WIN and operate an Advwxed. f/astewan Treatment Sysurn (ANVVVTS).
desez
c ibedas Advantex Waste Water Treatment Svs [ern
located at (lega! description)
T! 5N RI W SEC 9 Lot 93
I MAP -t- - .-ce, ReTniirs and Alterations.
(()b ner is requked to Qod,'Under.Stand and initial each section)
1'i1fOU'LJ-1QW the ISM of this .Ag reen,.ern.. the 0wner AN! enter into a suvwe agreement
%vith an A�A'\\'TS sNice and amaintenanco provider appnoved by the %Municipality or the
i Flo 111-1 1"icturtl' s rtprtsz:,ntative. The NVVV/TS shall be maintained in a satisfactory
condi,,4.ion capable of perRxrnQ:). as designed and producing treated septic effluent in
accordarice with the- ecluipment's approval for operation in the Municipality.
1" s1hall be the responsililly of the Owner du6ng the re nn of this Agreement to pay bot all
replace inert cow and Mpecdon comy This
awlaks on aimival maintenance fie Qpiudt, $400 to $600).
ov"ner ag
'rees that C"Q maintenance and repair perammel approved by the Munkipality
or the 11,anufacturer's representa6ve Avill inspect and rnake any necessary maintenancc.
repairs or pennitted ahcrations to the systein.
n-Faintenance of an A'W'W-FIS reduces the potential
AN; (Knor ackno"dedges that regulou
01mc of the systern. AM could include sewage backup and costly repArs OF dr2i n0eld
nplacement.
crev. 0518/2018) Page I of 3
-ds of maintenance and
Mller 'Itcknow1adues dot Me QmQahty nm�, reclucs, rocoi
repaid from tilt manulbourer's representative or maintenance provider.
ownr acknov,,Jedges that the One A Hing to mainwhi atict repatir an AN7\VTS may be
1. G,sScssccl in accordance with AINVIC 14.60.030.
O%k ncr agrces to grant the NAAcipality reasonable access to test Lind inspect We
The 'Nfunicipalit� will glee at Rag 3=t -hour notice.
0%vner cigree's diat any sale or warisk of title of the prof aql will not occur without a
A.) cert0cso of (.)n-Sitc Systems Approval.
a',grces th,t 'shc ANV\,V-I-S inxtaHahwi and maintenance reqLhrernentS al PrOVided
It thc and a"rmTd by the 10unkipAity are the governing
gAdelines for die conoruction, nia.imenance and repair of the Owner's AWWTS.
to maintain re -mote nwn±Hlg of the ANVWT as,-eqLIi'CtLl by the
K, AW A I S approval.
3. Arn The Ono of dds Agreement shall begin on the cla-ie of approval by the
WAINiq to operme the installed sygern, or upon -:ransfcr of title, and shall cointimic
HE WANANT113 is operaion al or until title is transferred.
T. -� -01alvaive".r. The ol"thic, N-Junicipalit%; at ai-,y uinie to en%ce a IrovAion of this
Agmument shall in no way constitute a wativer of the provisions. nor in ant wa), affect
"",ahchu� of the or any pan hereof, or the right of the hAtinicipa-lity
Wereafter to entbree every provision hereof.
5, Amendment This Agreement shall only be amem5d by authorized representatives of
the (Aver and 01unicipality. Any attempt to amend this agreement by either an
unaudioriz,,-d representative or unauthorized means shall be void.
6, Jui-isdiction: Choice of Law. Any civil action arising From this Agreement shall be
bmuWg in the Superior Am or the ThId Ju dat WaY of the State c0klaska at
Anchorage. The laws of the State of,kWska shall govern the rights Lind obligations of the
pairties under this Agneenient,
7. SeveratAlity. Any PrIDvisions of this Agrccmcnt decreed invalid tj� a court ofcompetent
j1dKon W11 inw i!�.,validatc the uti-fraining,pi-uvisions of,'.1-re Agreement.
(rev. 05A 020111) Page 2 of 3
OWNE',:
By: —(signature.) Date: October 26, 2020
Manny' o 'pe z, S
MEA Land Seirvl( �s Madeger, (print name)
STATE OF ALASKA
ss.
THIRDJUDICIAL DISTRICT
The forecloin strumentwas acluiowledcjed before me this, day of
-O_OTD by Ml,,KAA
A v A ZI/ I I
\ % �tL;J'�N `A� "
NOM—tkPTLIC FOR
N,,iv Conu-nission expires:
MITNICTPALl"Y:
ZI cac
Is Mil
pu'llu, Sea;
16s jui a 26, Lr2
BY (signature)
(print name)
Date: OMI00
I
Title:
�14
C)
Date: OMI00
I
Title:
MUNICIPALITY OF ANCHORAGE
- ITMENT OF HEALTH AND HUMAN SERI -"S
Environmental Health Division
o25 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
DISTANCES
.... ~ TANK FIELD WELL
~ ~C ~ ~ I ~ ~ ~ ~ AS-BUILT DIAGRAM (Show location oI well, septic system property hnes, Ioundat,on,
TANKS N
~ SEPTIC ~ HOLDING
TYPE OF SYSTEM
~ SED ~ w. ORA~N
TRENCH
Installer ,~ j )ate InstalLed
WELLS
~ ~ ~,r J, ....
~ PRIVATE ~ OTHER (Idenlifv)
~OT~
......... H
FT ~'~ ~ 0 ~ h
REMARKS:
~¢~ % [~ [* I nspeogon; Pedormed by:
Municipal a~¢ S a e ~uiCeli~es in effect ~ Ibis ~ate:
Hea h Depadmeflt Appr¢¢l: , , Date:
72 013 (3/85)
DIEPARTIvlIEN'T' [:IF:' NEAL. I"H AND ENVIRONMENTAL PROTECTION
'825 L EFFREIET, ANCNORAGE..], AK 99501
264-4720
PERMIT NO
DAI'E ISSUED:
850458 ENGINEERED DESIGN
07/23/85
APPI. I CANT
ADDRESS =
CGNTACT PHSNE:
JONN MOORE
BOX, 4-604
ANCHORAGE, Al<
688-4555
99509
L. EGAL DESCRIP:
LOT SIZE::
SUBDIVISION,~ NA LOT: 95
SECTION: 9 TOWNSHIP: 15N RANGE: 1W
2,,5A (E~Q.F:'T. OR ACRES)
BL. FICK: NA
certify that:
1. I alrl familiar wit, h the reqt.~irements
¢of on-.,,site sewers and we:Lls as set
fl~r't,l'] by the Municipality o£ Anchor'age (MOA) arid the Stat, e ef Alaska.
I will install the system in accen(Jance wi'Lb all MOA cr~des and negulatiens~
and in compliance wi{h t. he design criteria of this permit,,
I will adhere 'Lo all MOA and State of Alaska requirements lap the set back
dist, ances £rom any exist.:~ng well, wastew~ter disposal system or public
sewel*age eystem on thi,.-] or any adjacent or nearby let.
Il:: A I....IFT STATION IS INSTALLED IN AN AREA COVERED BY MOA EUILDINb~ * CODI'}:,c.;,~.
TNEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE C]BTAINED; (2) AS-BUIL. TS
WIL. L NOT BE APPROVED WITNOUT AN ELECTRICAL INSPECTION REPORT; AND (~) THE;
IE:LIE:CTI~ICAL WORK MUST BE DONE BY A I....ICENSED ELECTRICIAN.
APPL I CANT': ~ OHN MOORE
ALASKA e, iUIROFIITI iqTAL COFITROL SE!RUICE!$, IllC.
SPECIFICATIONS FOR ELEVATED BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM
BLM LOT 93 SECTION 9 T15N R1W S.M.
1.0 GENERAL
1.1 THE DRAWINGS, SHEETS 1 THRU 3, SHALL BE PART OF THIS
SPECIFICATION.
1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE
REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND
HUMAN SERVICES.
1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE
VERIFIED IN THE FIELD BY THE CONTRACTOR.
2.0 THE LIFT STATION (NOT USED)
3.0 SEEPAGE BED
3.1 THE GRAVEL FOR THE BED SHALL BE SCREENED TO THE SIZES
INDICATED; 0.5 TO 2.5 INCHES.
3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE
BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN
COMPACTED DURING EXCAVATION.
3.3 TWO OBSERVATION PIPES SHALL BE PLACED AS SHOWN IN THE
DRAWINGS. THEY SHALL BE RIGID PVC, ASTM 3003 D-3034.
THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5"
HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE
OR A SECTION OF REGULAR PERFORATED SEWER PIPE MAY BE
CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR
SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL)
SHALL BE PLACED ON THE TOP OF THE PIPE.
3.4 INSULATION,IF ANY SHALL BE DOW EXTRUDED BLUE STYROFOAM
BOARD OR EQUIVALENT.
3.5 THE TOP AND SIDES OF THE BED SHALL BE PLANTED WITH A
WHITE CLOVER AND RED FESCUE MIX OR BLUE GRASS.
3.6 THE SEPTIC TANK OF BED MUST NOT BE CLOSER THAN 100 FT.
TO ANY EXISTING PRIVATE WELL OR BODY OF WATER AND SHALL
BE NOT CLOSER THAN 150 FEET FROM EXISTING CLASS C WELLS
OR 200 FT FROM ANY CLASS A OR B WELL.
3.7 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR
POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL.
3.9 THE SAND SHALL HAVE AN EFFECTIVE SIZE OF 0.4 TO 0.6
MM AND A UNIFORMITY COEFFICIENT OR NOT MORE THAN 4.
3.10 THE BERM AROUND THE SEEPAGE BED SHALL BE CONSTRUCTED OF
IMPERMEABLE MATERIAL, AND ON A SLOPE OF 1 FOOT VERTICAL
TO 3.0 FEET HORIZONAL.
4.0 INSPECTIONS
4.1 THREE INSPECTIONS WILL BE REQUIRED 1 OF THE EXCAVATION,
1 OF THE SAND IN PLACE, AND A FINAL OF THE SEWER ROCKS/
PIPES/INSULATION AND TANK IN PLACE. IF AECS DOES NOT
PERFORM THE INSPECTIONS AECS WILL NOT BE RESPONSIBLE
FOR THE BED.
5.0 SEPTIC SYSTEM
5.1 THE SEPTIC TANK SHALL BE A UPC APPROVED TWO
COMPARTMENT TANK, SET LEVEL, AND INSULATED WITH AN
OVERLYING LAYER OF 2 INCH BURIAL TYPE POLYSTYRENT.
THE SEPTIC TANK SHALL REST ON UNDISTURBED SOIL.
5.2 INLET AND OUTLET PIPING SHALL BE FITTED WITH WATER-
1200 ~e$l 33r~ ~Ucnu¢, Suile ~,~nchorQ§e, ~las~d 99503,(907} 561-5040
5.3
5.4
TIGHT CALDER COUPLINGS. PIPING SHALL BE 4 INCH
SOLID PVC, SLOPED A MINIMUM OF 1/4 INCH PER FOOT,
WITH A MINIMUM OF 4 FEET FO COVER. IF LESS THAN
4 FEET, USE 1 INCH OF DOW EXTRUDED BLUE POLYSTYRENE
FOR EACH FOOT OF COVER LESS THAN 4 FEET (INCLUDED
IN .5).
CLEANOUTS SHALL BE INSTALLED WITH CALDER COUPLINGS,
CAPPED WITH AIR-TIGHT JIM CAPS (OR EQUIVALENT), AND
EXTEND A MINIMUM OF 1 FOOT ABOVE GROUND LEVEL.
THE SEPTIC TANK SHALL BE A MINIMUM OF 5 FEET FROM
THE HOUSE FOUNDATION, AND A MINIMUM OF 5 FEET FROM
THE DRAINFIELD.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND £NVlRONMI:NTAL PROTECTION
S2E L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~.. SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED: ~ Z~ - ~:~,~
LEGAL DESCRIPTION: BLI"~ Le~'~,5
SLOPE
SITE PLAN
/
old ~r, ~, 30
/
10
11
12
13
14
15
16
17
18
19
20-
WAS GROUND WATER S
ENCOUNTERED? ..~ .c$ oL
P
IFYES, ATWHAT ,~ o~, ~~2q E
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
COMMENTS
TEST RUN BETWEEN
, FT AND -- FT
"'~'~/7 4° !oo '/ ,
,/-'hi /~
CERTIFIED BY: ~
PERFORMED BY: '~ ~ ¢c'~
72-008 (6/79)
, ALASKA ENVIRON .,ENTAL
CONTROL SERVICES, INC.
].200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO. OF
CALCULATED BY ~)~/ DATE
CHECKED BY DATE
,ALASKA* ENVIRONMENTAL
'-CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE ALASKA 99503
(907) 56].-5040
OF
DATE
DATE
.AI. ASKA ENVIRONMENTAL
'*CONT~ROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE. ALASKA 99503
(907) 561.5040
SHEET NO '~ OF
CHECKED BY. DATE
SCALE
MUNICIPALITY OF ANCHORAGE
· DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONIVlENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE [] NEW
~AILING ADDRE~i(~ ~ J
LEGAL DESCRIPTION ~
Manu facturor ~ ~ Material ~o. of~mpartm~nts
Liq. capacity in gallons IF HOME.DE: Inside len~ Width Liquid depth
~OZ~ ~ DISTANCE TO: Well ~l Dwelling ~1 PERMITNO.
,~ Manufacturer GC~C Ma~ ~ Liq u id c apacgi~a~n~
Q Well Foundation Nearest lot line ~ PERMIT ~
~= DISTANCE TO: ~
~=U~ ~ No, of li~es ~ Length of each li~e Total length of lines Trench width ~ Distance be~.ines
~ ~ inches
-- ~ ~ Top of tile to finish grade ~ Material beneath tile Total effective absorption area
Q ~ ~ inches
Length Width Depth PERMIT NO.
~ Type of crib Crib diameter Crib depth ~ Total effective abso~ area
m Well Bu Id ng foundat on Nearest lot line~
~ DISTANCE TO: ~
~ Class Depth ~ Driller ~ Distance to Io~e PERVO.
~ DISTANCE TO: ~-
~, OTHER
SOIL TEST RATING
iNSTALLER /
. ,[
FI F::q:::'L. ]:
L ['" '" F:l'f' I IN
LJEEiF::IL
:,....[ L HI., :, I:..[:, I 1 ... i',l ................ '
. .:, ] I .['1 I :,. I:::'F;[:I:::1:1: f',lF::' I EL. [:'
THE L. ENGTH DIMIEN:".5I[)i"~ IS THE LENGTH (IN F'EET) Cfi:' THE "I"I;'.IENC:H
THE E:'E;F::'TH CIF::' I:::1 TI:;?.ENCH O1:;?. F'IT IS THE [)ISTFINC:E:; EdETHEEI",I THE SUF?.F:FIC:IE OF:' TI'"tI!!:
GF;~:OUND FIN[) THE Ei~OTTOM ElF 'T'HIE E',='0:;:FI","FITIEIN (II",l F:'IEE"[).
.... il'"' IFql lEE: ""Ir'" IF;;iL'; E: I~'....II C::: IF...[~ [L,,..II Z il::::::,, T' II.q :E: .".liE;; ~r:E:.~ ~ ~ ~;;E~ fi;E!, Il:::::' IE E!E "'1~
THE: GRFI',,,'EL. DEF:'TH :[':'5 THE MZI'.,IZMLIM [:,EF::'TH 01'::' diI:;?.FI',/E:L BETH[.::E::i'.,I THE OU"I'FRL. L F:'IF'E
I:::[l",lO 'TIqE: [~,OTT[')M OF THE: EXCF:I","Ft"f'ICff',I (IN F:'IEEi:T).
M]:I",I:I:MI..IM [::'I:::STANCE; BE'T'P.IEE!:I"4 f:~ .t,.IE:L..L.. F:IN[) F:llq"r' Of',I'""',.:!~ITE SEHF::IGE [:, :[ SI:::'I:)SI:::[L S"r'S"FE]"I :[fi:;
::t. Y3e.~ F'EE'T F'OF?. I::1 PRI',/F:fT'E I,.IE~I...I...~
:LS[~I '['1:) 2EII;:!I FEET F::F;'.OM FI F::'UEC..IC t.4EL. I.., DEF:'EN[:'II"~[;:i UF'CII",I "I"HIE: 'Th"PE or::' F:'UEi~LIC I,.IEI.! ....
OTHER Fi:E[;g. JIF;;:Ei','IE]q'T':E; I~dF:l'.r'F:IF::'F'I..'TL ~ii;F:'ECIFIC:f::ITI(:)RI:]i; FIN[:, C:I[)I",IE!;T[:;:I..ICTICIIq [:,II:::l(iiF;;:i:::lP!:!!;
I:::I",,'I:;:Itl...FI[~I[.E TO IN:~;URE F:'F?,(:IF'E[;?. ii",ISTI:::IL.[,.I::ITIOi",I.
I 6EF;:T]:I:::'"r' 'T'HI:qT
::L: I F:IM F::'I::IMILIF::IF[: I'.IITH THE IRliE):i]UIR[CME:IqTS F'OF:'. ON'"'SITE SEI.'.IEF;:S F:IIqD I.,IEL.I_:!!ii
F'Cff';rTH E:"r' THE ['"ILII"~IC:IF'f:ILITk' OF:' FIi",ICHOF;;:F:IGEL
2: I 1.41 I...L. I iqSTF:II..L THI:E 'J!!;"r'STE;M I N FICCO[:?.DI::II",IE:IE I.'.11 TH THE CODES.
:J;: I I.)N[:'EF;'.':'~;TF:II' TI'"IFI'I" "1"1'~I1::~ ()i"4-:iil;ITE: SE].'.IE:F;: :E;'T'S'T'E]"I MFI"r' Fi:E[;:!I...IIRIE ENI..F:'iF;?6iE]¥1E],.,Fr' IF::' THE
I:;?.ESII)Ei'.,IC:E :IS ..[ED TD INC[..UDE MO[;i:E' THI:::IN :!i: li~IE])f;?.CIOl"lS.
_, 1 ...
O El' E GEC .:CHNICAL ~' DEVEL ,?MENT CO.
Russell Oyster
694-2774
Soils ~t Foundations
Performed for:
Legal Description:
Depth (feet)
0
2
3 ,
6
?
9
10 ,
12,
~.,
Box go, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Name: /~.r~
Mailing Address:
Ground Water Encountered:
Proposed Installation:
Comments:
SOIL LOG
Performed by:
Ear/Ellis
688-2280
Land Development
Tel. No.
Sotl Characteristics
Yes
Seepage Pit
No /"//If yes, what depth
Drain Field
WATERWELL - T~ST PU~P REPORT
Casing Size ~ //_Screen Dlam ~ ....... Screen Slot __ -'~-- _. _
Pump Information: Intake Depth~Pump Size
Static Water Level ~_~ ....... Ay. Dlscharge~¢~GPM,
Pump 0.: Time ~ Date ~_Pump
REMARKS REMARKS
DRILLING
0000
~0
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-104-82-000
Expiration Date: 1/27/2024
Legal description PARKS LT 2
Site address 20431 WHITE BIRCH RD Chugiak AK 99567
Current property owner(s) MATANUSKA ELECTRIC ASSOCIATIONINC
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories: New owner will be required to sign a new AWWTS agreement
and initiate remote monitoring of the system.
Original Certificate Date: 10/27/2023
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory X
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory . Arsenic Advisory
Other
COSA Approval_June 2022
lh�)_C_11 02� H
sem:
Development Services Department --� Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-104-82
Complete legal description PARKS; LOT 2
Location (site address) 20431 WHITE BIRCH ROAD, CHUGIAK, AK 99567
Current property owner(s) MEA - C/O AMY NICKERSON Day phone 1-541-817-4560
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: Q Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑8 Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel n Plastic ❑ Concrete ❑ Fiberglass
Age 2 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: 0 AWWTS 0 Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: Q
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ y S Waiver Fee $
Date of Payment _ �� A C' /7 �� Date of Payment
COSA # DSC 2� Z 1 Waiver #
COSA Applicflon_June 2022
COSA Checklist
Legal Description: PARKS; LOT 2
Parcel ID: 051-104-82
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled *UNK Total depth *171 ft
Cased to *51 ft
0 Sanitary seal is functioning correctly
0 Wires are properly protected
Well production at time of test 0.9+ gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes 0 No
0 Coliform bacteria is Negative
Nitrate mg/L 0 Nitrate less than MRL (ND)
Casing height (above ground) 12+ in. Arsenic ug/L 0 Arsenic less than MRL (ND)
Date of flow test for COSA 9/11/2023 Collected by GEG, LTD.
Static water level at beginning of test 5.5 ft. Date 9/11/2023
Comments *PER KEN COMPANY - 9/25/1985 TEST PUMP REPORT, WELL EXISTED 1985.
B. TANK DATA
Measured operating fluid level in septic tank *NIA
Date of pumping *N/A
0 Required maintenance completed, if AWWTS
Comments: *AWWTS HAS NOT BEEN USED SINCE INSTALLED
D. ABSORPTION FIELD DATA
Which system tested (date installed) 10/23-24/23
0 ALL standpipes present per record drawing
Total measured depth from grade 3.3 ft (max)
Measured depth to pipe invert from grade 2.7 ft (min)
❑ N/A — pressurized field.
0 Per record drawings, field is insulated.
0 Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced _gallons date
Any rejuvenation treatment (past 12 months) N/A
If yes, enter date
C. LIFT STATION
0 Required maintenance completed
Age of lift station 2 years
Lift station material PLASTIC
Comments: AWWTS HAS NOT BEEN USED SINCE INSTALLED
Adequacy test date NEW
Results Q Pass
Fluid depth prior to test NEW in
Water added NEW gal
New fluid depth NEW in
Elapsed time NEW min
Final fluid depth NEW in
Absorption rate 450+ gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 6 in
Effective depth used 0 in
Effective depth remaining 6 in
Comments/Deficiencies: PER MEA, THE HOUSE HAS BEEN VACANT SINCE 2021. THE AWWTS HAS NOT
BEEN USED SINCE THE INSTALLATION IN 2021
COSA Checklist June 2022
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100'Community
*50'+
Sewer Manhole/Cleanout > 100'
[:]Yes
if No
ft
Q■ Yes
if No
ft
Neighboring Tank > 100' ❑i Yes
if No
ft
Private Sewer/Septic Line > 25' QYes
if No
ft
Absorption Field on Lot > 100' ❑ Yes
if No
*50'+ ft
Holding Tank > 100' QYes
if No
ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' [_N� Yes
if No
ft
❑i Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes
if No
ft
Q Yes
if No
ft
❑ N/A — Served by
Community
Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10' g Yes
if No
ft
Surface Water > 100' [:]Yes
if No
*50'+ ft
Tank to Property Line > 5' [E Yes if No ft
Field to Property Line > 10' ❑ Yes if No *51+ ft
Water Main > 10' Yes if No ft
Water Service Line > 10' Yes if No ft
F. ENGINEER'S COMMENTS
*THIS IS AN AWWTS.
Wells on Adjacent Lots:
Private Wells > 100'
Community Wells > 200'
❑ Yes if No *50'+ ft
❑ Yes if No ft
If tank or field is under driveway comment below
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Gamess Engineering Group, LTD. (GEG) Phone
Engineer's Printed Name Jeffrey A. Gayness Date _
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.
COSA Checklist June 2022
907-337-6179
WZGc a
To:
Page: 08 of 10 2023-05-18 23:39:01 GMT 19073086608 From: Wes Anderson
.......... . . ..... .. ..........
457441
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Anniml Iner-iimr.-finn 907-272-3543
ReftfQVe - 6&M Info
Radio MUD
Timer settings:
Perform Field SamplinvI-Observations
[NTUt1fi*-NT,U-)
PH (6-9)
DO (2-0)
Plop" owmffftc" f
Matanuska Electric Association
Racine Amps
A+ Home Services Tech
current -
Audible and Visual Alarm
Q
Sit* Address
20431 White Birch Road'. Chuglak AK 907-565-5555
&OK
(.907) 556-5555
AXase D's
coway 10 #
Pod I
RTU alUL N
Date of Last InspW40
AX -153358
OSP201466
435905
RTU144945
1011.2/2022
ReftfQVe - 6&M Info
Radio MUD
Timer settings:
Perform Field SamplinvI-Observations
[NTUt1fi*-NT,U-)
PH (6-9)
DO (2-0)
Cura"'
Racine Amps
Dischaw-Amps
'prior of sample
wwal M Musty E) Earthy 0 Moldy
Non-tyvioal ElSuffide MC-abbage 000MY
M turn In PVU Oyes N No
Vow In tank � Cyas No
Check COMM[ Panel
Curl",
NW1003,
Cura"'
Racine Amps
Dischaw-Amps
current -
Audible and Visual Alarm
Q
Previous
&OK
Dal tone (talemetryorm
0 Yes
n No
InspectMean PUMP System'
Inspect
CIM
Raw" ..... ............
El
Clear;
Splice Boot ...................
f7i
Ploat Collis .................
Pump
floe. AS .... ............
..............
Impact Clean
wmpoa
CUM
Distilfaction Equipment Dispamai Lateraworifim 171
Skftft-PuMVault ... ,-........
Observations
flocirculating
comments
Measure Sludqb/Scum
Sawn
I st compadm'�"t-
Curl",
NW1003,
Cura"'
Predtotss
2nd Compartment
current -
jP7revious]GUr"t
Q
Previous
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Odor. 19NOnnal DFUCIVOt
Latuals/Oftcas E)
Q
Bionla IN Normal aj ❑ Excessive
Plod S*ttM
NNonaMnor n EX0888W
Intake Vent
InegeotlClean Discharge Pump System
Inspect
Inspect
Clear;
PJserAJd
Floaft
splice Box
Pump
Float cords
InspeWfIerVice Other SySUM COrnpOrlOnft
Impact Clean
wmpoa
CUM
Distilfaction Equipment Dispamai Lateraworifim 171
El
Observations
Additional SerVlc*s Rendered
D cleared textile sheets?.
n Rephwed UV dam!
n f4opfaceWUsed other ileftl$?
Parts Usech W =Warranty. B - Billable (-/ APPWOMU 96lectIM)
W a Italn Number Description
Ftnal/SafeJy, Inspection
MRSV mInstaked
9) lids bolted on
N Mam fold reconnpatod; flush .1, es,, fosed
oonnbal pal reactivated
Summary/Recommendatims
E]System pertwmW, t Apther action neWed❑
Tank tuleds puelpsq;
Cd-fo, wAqe
Date.
Fax completed form to 1-.866-384-7404
www.muni.org/onsite
Well Nater Advisory
Certificate of On -Site Systems Approval # OSC231421
Subdivision: Parks, Block: , Lot: 2
This well's productivity was determined to be .9 gallons per minute. The minimum
well productivity required under (AMC 15.55) for a 3 -bedroom residence is .31
gallons per minute or 150 gallons per day per bedroom. Although the subject well
currently exceeds this minimum requirement, the production capacity can
fluctuate and may be insufficient to meet your needs.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
MaiUng Address P O Box 196650 * Anchorage,tAlaska 99519 6650 *www muni org
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
{~),~ / ~ ~Lr~C/- 'L-/ \ HAA # ~1 ['~ ,~0~ I~0~:~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 93, Section 9; T15N; R1W; S.M.
Location (address or directions)
White Birch
(b) Property owner Ak. USA FCU
Mailing Address P.O. Box 196613, Anchorage,
(C) Lending Institution
Mailing Address
Telephone: (home)
AK. gg~19-66]
Telephone
Business
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here~, if hold for pick up.)
List contact person and day phone number below:
ordered by Finis Sheldon
$ & $ ENGINEERING 786-2503
17034 Eagle RLver Loop Road No. 204
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms 3
3. WATER SUPPLY
Individual Well E~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
'Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site E~ 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.
72-025 (Rev. 7/88) / Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the 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
Telephone
S & S ENGINEERING
Address ~ ;'C34 r-a~'.~, .':-';'~; L~p R~,,d r, io. ~04
Eagle River, Alaska 99577 ~-./2../? ~'
Date --,--/-
6. DHHS APPROVAL f/~/~,/~,-
Approved for ,~' bedrooms by ~' Date
Approved v~-~._ Disapproved Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federaJ and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Mu nicipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88)Back Page 2 of 2
~ MUNICIPALITY OF ANCHORAGE (MOA)
,,..~., ~.i1~,~,'~'~I I':~ :'/~ealth Authority Approval (HAA)
, ;,~,, ~, ,,,~'i~ I~ ~)IvI:,~ECKLiST . FEBRUARY 1984
~ ' 343-4744
Legal Description: ~ ~'~
A. WELL DATA
Well Classification t ~ ~ I CPO
Well Log Pr0sent (Y/4~ Date Completed
Total Cased to ept, o, Grouting
If A, B, C, D.E.C. Approved (Y/N)
Yield '~ ~ ¢M
Static Water Level \~--"
Casing Height Above Ground ~--~
Electrical Wiring in Conduit ~t~/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field qnLot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Pump Set At
Sanitary Seal on Casing~.'.'.'.'.'.'.'.'.~N)
Depression Around Wellhead (Y/~;I~
; On Adjoining Lots
~ z:Y't::~'A~ ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TA~.I~K DATA
Date Installed '~'\~'~ Size I ~ No. of Compartments ~
Standpipes~) "-~' Air-tight CapsdCC~N) '~' Foundation Cleanout<~:~i~;~) ',/
To Water-Supply Well
To Property Line ~,~> '~
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments '~[?---~ ~----"~:~--'-~-~ ~0,'"'~t2\~
Depression over Tank (Y/<:[~P F
Pumping/Maintenance Contact on File (Y/N~//
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
\/---"~'Z---'I To Building Foundation
To Disposal Field
Date Last Pumped
i"--~ [~, ;for
Temporary Holding Tank Permit (Y/N)
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~ ~ ~J~¥~---~ Type of System Design
Date Installed ~ ~'-,,~(~" Length of Field
Width of Field
Depth of Field "~ '~
Gravel Bed Thickness C),~
Square Feet of Absortion Area L¢~"~'''f'' Statndpipes Present CNN)
Depression over Field (Y~ 1~ Date of Last Adequacy Test
Results of Last Adequacy Test ~---~~~ ~ ~
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well \,¢¢c~ ~--~ To Property Line / '~
7"~' '37 To Existing or Abandoned System on
To Building Foundation .... .
Lot ~'~ ~f~ ~"r~-~'~Onf~.djoiningLOts
To Water Main/Service Line \. ~ \.~ To Cutback (if present) r~/~'
To Stream, Pond, Lake, or Major Drainage Course \
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION ~ /~.
Date In~.~ed_
,ze,n
Pump On' Level at~'"'"~-~
High Water Alarm Level at
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Pumping Cycles during Adequacy Test.
**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
Company
Date
MOA No.
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2