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HomeMy WebLinkAboutCANYON VIEW ESTATES BLK 2 LT 1r*.oanyon iew Estates -t t Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231034 PID Number: 021-021-47 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑■ New ❑ Upgrade Name Hultquist Homes, Inc. ABSORPTION FIELD ❑ Deep Trench X Wide Trench ❑ Bed ❑ Mound Site Address 13728 Canyon Road ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 3 6.0 GPD/SF JTotal 1.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 0.5 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot Canyon View Est. Phase 1 2 1 Fill added above original grade +3 Ft. Gravel length 25 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines n/a Distance between lines n/a Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 125 Ft2 1 n/a Ft. Well 100'+ 100'+ NA NA 25'+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding 9 Other Manufacturer ORENCO Capacity 1500 Gal. Surface Water 100'+ 100'+ NA NA Material Number of compartments Lot Line 5'+ 10'+ NA NA NA HDPE 2 Foundation 10'+ 10'+ NA NA LIFT STATION Manufacturer Capacity Remarks ORENCO 250 Gal. Alarm location House Electrical installed by Solid Ground Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Brownson Bros, LLC. Drainfield 3034 CO/MT3034 Inspector PES BENCH MARK (Assumed elevation) 100.0 ft Inspectoo 1s` 10/10/23 10/11/23 Location and description 2nd Yd 10/12/23 41" 10/13/23 See Site Plan, Bottom of house trim ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date pp q�qs���� j * 49 TH ....... Steven R. Pannone l� �'F . CE 8149 Septic System •6 Approved c�.�l C /�(. Date Note: this approval does not include well permit requirements. k�Gv uu/uz/ 10) PROFILE PA N N O N E E N G S V C , L L C ( C . I . 1 0 8 8 ) N S EW Lot 1, Block 2, Canyon View Estates Subdivision Asbuilt Land Surveying Land Development Consultants Subdivision Specialists Construction Surveying AEC# 173042 S4 Group 124 E 7th Avenue Anchorage, Alaska 99501 (907) 306-8104 mail@S4AK.com 10/12/2023 Development Services Department Building Safety Division On -Site Water & Wastewater Program z a 4700 Elmore Road z z P.O. Box 196650 e, AK 99507 Anchorage, S E T Y Mario Begich g Mayor www.muni.org/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: _(,�f a I U 3 `( Date of Issue: Parcel Identification Number: Legal Description Property O ner Name & Address: C c,, V� v 1 e �, 5-E ► �j',3 by a. I � l -�-cLc� � -� �}�v`1 e S y hle(,V, 2 L-o4 �. Pump Installation Date: Pump Intake Depth Below Top of Well Casing: � 50 feet Pump Manufacturer's Name: V eU h Pump Model: l V 5 Q!✓ f `D 3�O Pump Size 1,5 hp Pitless Adapter Burial Depth: /0 feet Pitless Adapter Manufacturer's Name: Co wlIbe Pitless Adapter Installer: J)(4 y,, 1l 01V) Well Disinfected Upon Completion? I Yes ❑ No Method of Disinfection: ►ti i.V0. � kr 6S Comments: Pump Installer Name: Johnny Kay Hefty Drilling, Inc. Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE f �r 1 Development Services Department k phone: 907-343-7904 Can -Site Water & Wastewater Section Fax: 907-343-7997 J Permit Number: # 231034 Date of Issue: 4-4-23 Parcel Identification Number: (2 a(0a I 1 Date Started: 8-28-23 Date Completed: 8-31-23 Is well located at approved permit location? Yes ❑ No ❑ Legal Description: Canyon View Est. Block 2 Lot 1 G: 3042 Property Owner Name & Address Hultguist Homes, Inc. Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To casing stick up 0 2 sandy clay (brown) 2 10 sandy clay (brown) w/ gravel 10 60 silt & gravel 60 110 bedrock (soft) 110 180 bedrock (hard) 180 280 Lat: 61.096221 Lon:-149.709120 Water Sample Results: Arsenic: Nitrates: Total Coliform Bacteria: ug/L mg/L colonies/100mL Method of Drilling ❑ air rotary ❑ cable tool Casing type: steel Wall Thickness:.250 inches Diameter: 6 inches Depth: 110 feet Liner Type: PVC Diameter: 4.5 inches Depth: 235 feet Casing stickup above ground: 2 feet Static water level (froth ground level): 132 feet Pumping level: feet after hours pumping gpm Recovery Rate: 10 gpm Method of Testing: airlift Well Intake Opening Type: ❑ Open End ❑ Open lJole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite Volume: 2 bags Depth: 20' Start 0' feet Stopped 20' feet Well Disinfected Upon Completion? Yes No Method of Disinfection: tabs Comments: 0 ❑ Well Driller: Johnny Kay Company: Hefty Drilling, Inc. Mailing Address: po box 112130 Anch AK 995� Attention: The well driller shall provide a well log to the On -site Water and Wastewater Section within 30 days of completion. 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 Water & Wastewater System Permit Permit Number: OSP231034 Work Type: WellSeptic Initial Tax Code Number: 02102147000 Site Legal Address: CANYON VIEW ESTATES BLK 2 LT 1 G:3042 Site Mailing Address: 13728 CANYON RD, Anchorage Owner: HULTQUIST HOMES INC Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date trent S O Department Lot Size in Sq Ft: Total Bedrooms: 4/4/2023 4/3/2024 67689 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage 3 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: 1. Pipe must enter the middle of the distribution pipe in order to qualify for the reduced vertical separation. Fj 2. A test hole is required prior to construction of the absorption field, in the location shown on the site plan, to P'onfirm minimum separation to impermeable soil and seasonal high groundwater, as well as percolation rale. Construction may proceed at your own risk prior to 7 -day groundwater monitoring. If results require a design change, construction shall stop pending approval of a change order. Please submit results with the inspection report (or change order, if required). ;&Mql 00 � �es,gvt C� la e, . -ReGeivet=By: . 55ued -�v A�5 Date: Issued By: Gl% Date: Z MUNICIPALITY OF ANCHORAGE Community Development Department 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. 021-021-47 Property owner(s) Hultquist Homes, Inc. Mailing address Site address WIN Canyon Road Day phone Legal description (Sub'd., Block & Lot) Canyon View Estates Phase 1 Block 2 Lot 1 Legal description (Township, Range & Section) Lot Size 67,689 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field X❑ Initial 0 Single Family (SF) X❑ (w/wo ADU) Septic Tank ❑X Upgrade ElDuplex ElHolding (D) Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well 0 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: M Date of Payment: 31131 e23 Receipt Number: 6 2 66-gA Permit No. 03 2,3103 `1 Permit App_.:- ::—..:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveCcDpanenaak.com 2 October 2023 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99519 Subject: Canyon View Estates Block 2 Lot 1 Well & Septic System Permit Request Septic System Design Narrative This is a design narrative for a permit to install an initial well and septic system on the subject property. The proposed system will serve a proposed three-bedroom (3) house. Currently the lot is undeveloped. This lot and surrounding lots are served by private wells. Currently there are no wells within 100 feet of the proposed system. 1. Soils: A test hole was performed on this lot by Pannone Engineering Services, LLC in March of 2023. Groundwater was not observed during the excavation of the test hole, and bedrock was not encountered. Groundwater was observed in the test hole monitor tube after 7 -days at a level of (4.0') below grade on (9/25/2023). Based on the results of the percolation tests, overall soils appearance and the selection of the proposed drain field; an application rate of 6.0 gallons/day/square foot was used for a CAT III wastewater system in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There are several mapped drainage ways on the subject property. Please the attached site plan for locations. 4. Topography: See attached site plan for area topography. 5. Drawing Markings: The Drawings are marked "For MOA Review Only". When written notification that the review is complete and no further comments are received from MoA On -Site Department, the note will be removed and "For Construction" drawings will be issued. Mailing: P.O.Box 1807, Palmer, AK 99645 Telephone: (907) 745-8200 FAX: (907) 745-8201 Page 2 of 2 GO � 1 The proposed installation will not affect the future development of this or the surrounding lots. If you have any questions or concerns, please contact me at (907) 745-8200. Sincerely, S T�—>T Steven R. Pannone, P.E. F. ASCE Owner/Civil Engineer Mailing: P.O.Box 1807, Palmer, AK 99645 Telephone: (907) 745-8200 FAX: (907) 745-8201 co f mco ;5;ocm�0Ln ���zz�r_0-D r 0 (n Z p 2- N f �-0-r00 m O p r o cIz� `'1Z mmZ (n o z Z m A r D O Z r m O cn D r p Z Nm / -'I2 (n O C) - m> mI M o r az��mz -0 pZ > 0 (Jt m '1 O 0 20 D -Ox ;;a70� DOO m z O O < D Z V) m V) m70 v -`1 0 � D ;o D K: m= O r r -D z O _D 0 N Z o � � D o z D N vAO� 2m � � k ?a G� ,y Z U 2 I \ Pa �r c � 00 p � O c / c / � r T� �C / i / / r i / � Z o Ode / ti / -'I2 (n O C) - m> mI M o r az��mz -0 pZ > 0 (Jt m '1 O 0 20 D -Ox ;;a70� DOO m z O O < D Z V) m V) m70 v -`1 0 � D ;o D K: m= O r r -D z O _D 0 N Z o � � D o z D N nj N 2 o 2A�CCc) \ r'1 h1 m k oiaAm v ZZZnso vAO� 2m � � k ?a G� ,y Z U 2 I \ Pa �r c 0 0 c p � O c / c / � r T� / i / r i O r—f-- ti 0 nj N 2 o 2A�CCc) \ r'1 h1 m k oiaAm v ZZZnso vAO� 2m � � k ?a G� ,y Z o moo \ Pa �r c 0 0 c nj N 2 o 2A�CCc) \ r'1 h1 m k oiaAm v ZZZnso \ a Io �s \ � G� ,y Z \ Pa �r c c p � O c / c / � r T� / / i O r—f-- nj N 2 o 2A�CCc) \ r'1 h1 m k oiaAm v ZZZnso NOTES: PANNONE ENG SVC LLC (C.1. 1088) CHANGE ORDER P.PHONE O. BOX 74808200 PALMER, (907)9645 745-8201 FOR CONSTRUCTION DRAWN LJC/DRM CANYON VIEW EST. PH1 B2 L1 CHECKED ACP HULTQUIST HOMES, INC. SITE: NHN CANYON ROAD SITE PLAN ANCHORAGE, AK 99516 REVISIONS UAIL 10/02/2023 1"= 50' J.D. NO 021-021-47 ERM IT NO. OSP231034 1 OF 2 moo rr, r � G� c�) �n �!'� q� ��o Z INO�' p � O T� y NOTES: PANNONE ENG SVC LLC (C.1. 1088) CHANGE ORDER P.PHONE O. BOX 74808200 PALMER, (907)9645 745-8201 FOR CONSTRUCTION DRAWN LJC/DRM CANYON VIEW EST. PH1 B2 L1 CHECKED ACP HULTQUIST HOMES, INC. SITE: NHN CANYON ROAD SITE PLAN ANCHORAGE, AK 99516 REVISIONS UAIL 10/02/2023 1"= 50' J.D. NO 021-021-47 ERM IT NO. 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A- J y Qj Z, O y v ov^ zo 1 omc m H (n mai z vD �pv Q v, O mO y m D Z1 ~ y Zz ou Cy Z z T 3 m D I Mm mLn r Z;u mvD s ,P m Zm CC)m Ln m Q z o m < z� G) z m Z n o o m n yom Z vDG) m - D z _ a y - y r) a m m D Om m m Z y y z A O m m x _ W n >_ m r m N i x v u z O o i { z m m >= O v a A C = H ° z- n 9 v�D m NOTES: PANNONE ENG SVC LLC (CJ. 1088) REVISIONS DATE CHANGE ORDER P.O. BOX 102954 ANCHORAGE, AK 99510 ,SOF 10/02/2023 PHONE 907 272-8218 FAX 907 272-8211 �P• '' SCALE FOR CONSTRUCTION NTS DRAWN LJC DRM *'•. •.. CANYON VIEW EST. PHI B2 L1 P.I.D. NO CHECKED ACP HULTQUIST HOMES, INC. "fiieven ar;riaAa 021-021-47 SITE: NHN CANYON ROAD 1oji29 PEOSP2MIT 31034 SOIL LOG ANCHORAGE, AK 99516 SHEET 2 OF 2 :O D rn UI i• W N p Z 07 o N m D W 1 D D .'Lm] 1 C) r) D D mO � � CO � C N A O D co m v r � Omm D O O Z 1 O .11 O 040.002 Client: Pannone Engineering Services Project: Canyon View Block 2 Lot 1 Date: April 14, 2023 C-0 -?P::l Crowther Associates Particle Size Distribution Table (percent passing subject sieve size) Sample Source -- Moisture Content 7.1% Sieve Size Percent Finer Percent Finer Percent Finer Percent Finer 3 inch 100 1-1/2 inch 100 % inch 94 #4 63 #10 45 #40 16 #100 7 #200 6 0.02 mm xx Classification Gravelly Sand with Silt (SP -SM) Invoice 187 1632 Bellevue Circle /Anchorage, Alaska 99515 Telephone (907) 349-2198 / E mail: crowthei-@alasko.net 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 TH24 OR TOPSOIL GM/SM 111OCT19 SAND & GRAVEL SM/MLI SAND & GRAVEL BOH DATE PERFORMED: 03OCT19 SOILS LOG - PERCOLATION TEST SLOPE TEST HOLE Municipality of Anchorage 99202. - .. SITE PLAN OSP231 L1(e SUE 016-01 \ i Vaca d this OTH24ot 2% ` 55,633 sf SLOPE TH 1 WAS GROUND WATER ENCOUNTERED? Y IF YES, AT WHAT DEPTH? -6.0'- DEPTH TO WATER AFTER MONITORING? 3.5' DATE: 11 OCT19 COMMENTS: Test hole excavated by WHITE RAVEN PERFORMED BY: AARON PARADIS. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. SOIL TEST RESULTS/ANALYSIS • PERCOLATION RATE 38.9 mpi(min/inch) (Hydrologic Soils Group: HSG A) • PERC HOLE DIAMETER 6" • TEST RUN BETWEEN 2 FT AND 3 FT. • TEST RUN FOR OVER AN HOUR, LAST THREE READINGS PROVIDED. READING DATE NET TIME WATER LEVEL READING NET DROP RATE (MPI) 1 030CT19 5.900" 2 30 MIN 7.002" 1.10" 27.2 3 5.900" 4 30 MIN 6.730" 0.84" 35.7 5 5.900" 6 30 MIN 6.670" 0.77" 38.9 NOTES: r ®RTC EN CVC, LLC C SOILS REPORT 1 P.O. BOX18071PAALLMMER,, AK99645 PHONE (907) 745-8200 FAX (907) 745-8201 CANYON VIEW EST PHI 131 L27 DRAWN JRL SITE: CANYON ROAD SOILS BOGS ANCHORAGE, AK m Date 12/17/2019 Scale NTS P.I.D. NO 021-021-47 PERMIT NO. OSPxxxxxx Sheet 20 OF 27 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into asofthis M44k� Day of ®(J`(XA ✓ of 20 15, by and between -� Ylwu (}txc(jbherein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advantex located at (legal description) Canyon View B2 L1 2. Maintenance Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. 101 It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). 4 Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. i Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 ❑91D Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. (1 Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. hp Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing j guidelines for the construction, maintenance and repair of the Owner's AWWTS. r Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By: signature). Date: 1011112 (jL 62Aa::�, �5-(print name) STATE OF ALASKA THIRD JUDICIAL DISTRICT The foregoing instrument was z 201_3�, by AlIELV-L 6 A!RC:Q... )ss. edged before me this )q"day of Wdo-p. rk"T Ic 0 NOTARY PU B IC OR ALA A r1m ssio S. . n My Commission ssion ' res: Asshlec LaVigna, :�7�P L- -- MUNICIPALITY: By: (signature) (print name) Date: l 3 012-,, 13 Title: Gl VjL ti Ci rz- (rev. 05/18/2018) Page 3 of 3 MUNICIPALITY OF ANCHORAGE Development Services Department t Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 021-021-47 Certificate of On -Site Systems Approval Expiration Date: .� Legal description CANYON VIEW ESTATES BLK 2 LT 1 Site address 13728 CANYON RD Anchorage AK Current property owner(s) HULTQUIST HOMES X The On -site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 10/30/2023 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 Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approvdjune 2022 MUNICIPALITY OF ANCHORAGERU5)i Development Services Department tl 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. 02102147 Complete legal description Canyon View Estates 132 L1 Location (site address) 13728 Canyon Rd Current property owner(s) Hultquist Homes 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY:❑ 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: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel X Plastic ❑ Concrete ❑ Fiberglass Age 0 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: X AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested:❑ 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 $ 1 Z C> Waiver Fee $ Date of Payment U �OP Date of Payment COSA # OS C 2 31 LI 1 2 -. Waiver # COSA Application —June 2022 * * * steel cased to 110', pvc lined the remaining depth to 235'