HomeMy WebLinkAboutSANDHILL LT 8andhill
Lot 8
#050-522-10
Municipality of Anchorage Page I of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: S'vWC1501640 PID Number: 05051PI.to
Name: PAV L 4 ?A"0T _5fV2TEL
Wastewater System: XNew El Upgrade
Address: CAC-2L-' 4ZlVeQ�AY{
L�.
ABSORPTION FIELD
l �l (� O I �. Mo �tTAL�vE q s 7
Phone:
No. of Bedrooms:
O Deep Trench K Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
0-S
Total Depth fro�sgi'algrade:
GPD/S .Ft.
Lot:Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
8 -SANDHI(^L
0.5" Ft.
Lf i Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
O . G f - 3 t Ft.
qc)I
Ft.
WELL: 1�New El Upgrade
Gravel width:
Number of lines:
I
Distance between lines:
5 Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material: AST vA
pe-I VATS
500' Ft.
,too f Ft.
ip SO. Ft.
111-910/D 303
Driller:
S.JL_ IVANWA*�- Wk-L'--5
Date Drilled:
Static WaterLevel:
19q' Ft.
Installer:
T?R.S EXE.
LjHE
Date installed: _
10'1`1-9'0
Yield:
Pump Set at:Casing
Height Above Ground:
TANK
I GPM
VJA Ft.
I i t- Ft.
SEPARATION
DISTANCES
XSeptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
A�,,<yoeA-_rANk
Capacity in gallons:
19 15D
From
Tank
Field
Station
Tank
Sewer Lines
weu
---
2S
Material:
�TsEL
Number of Compartments: a
I75t
/6110'—
+
Surface—
LIFT STATION
Water
ids t
100t
Lot(o
Size in gallons:
Manufacturer:
Line
o,
l
l
f
._
"Pump on" level at:
"Pump off" lev
High water alarm at:
FoundationIq
IQ
_
Curtain
iiN
W�
Pump Make&
lectrical Inspections performed by:
Drain
BENCH MARK
Remarks:
_
Location and Description: /- �a 0
—'uP &PV��JSC�✓E Sr..AB �✓
t=RD"7 OG SLAB .
Assumed Elevation:
1(DO.o
ENGINEM SEAL
a rig
-P J.
r
5 & S ENGINEERING
t5
Inspections performed 0)o34EagIeatverl=aopRoad.No.2C�ates:lst 1�-13'45""'"°""""
"...;'•...
°c"
Eagle River, Alaska 99577 2nd t ° _ 11- 9
"'•" ..
C. AN
Department of Heal and Human Services approval
`rtosERT
CE 8801
12 -5 - �S
Reviewed and approved by: Zh&4 Date:
72-013 (Rev. 9/91) MOA 25
Permi! No.
SW950340
Page 2
of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:
LOT 8, SANDHILL SUBD.
PID No.:
05052210
72-013 A (Rev. 9/91) MC 25
STI 92.4' ST
FINAL GRAD
9T—Iand
2 91.6'
NEW
88.62
125GAL
88.4'
SEPTIC TANI{
86.61A
SR
WELL
6z.s'
t
00_
♦ 78.6' NO
WATER FOUND
9-2
—95
FC
ST
433'40'
C01CO2CO3
83
96
MT1
80'
91'
C
4 25'
11'
�9L
W21
17'
NEW 12M
L
F
SEPTIC
TANK
O,f,��
F
coa
rrrie
\\\\\
o1 Fco
d k °•"��
cc
\
°
Z
NEW 4 1311RM
HOUSE'Ai
�'110.
;n••RO[ERT C. COWANt1ri
�G1•
CO3
MT1
• C�-�EB�'t''
NEW TRENCH—/
SCALI
1" 40'
fk
72-013 A (Rev. 9/91) MC 25
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE L
DEPARTMENT OF HEALTH AND HUMAN SERVICES \c) ' u
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW950340 DATE ISSUED:10/13/95
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE:10/13/96
OWNER NAME:BARTEL PAUL A & JANET E
OWNER ADDRESS:19601 S_ MONTAGUE LOOP
EAGLE RIVER, ALASKA 99577
PARCEL ID:05052210
LEGAL DESCRIPTION:
SANDHILL LT 8
LOT SIZE: 85828 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED P
ISSUED BY:
'S'_
DATE • /U"-/ -l� /
DATE: �V/�- 7-
Mixnieipality of Anchorage
Department of Health and Human Servicesi
Rick Mystrom, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
October 2, 1995
Paul A & Janet E Bartel
19601 S Montague Loop
Eagle River, Alaska 995778703
Subject: Lot 8 Sandhill Subdivision
Permit #SW940378, PID #050-522-10
The subject permit, issued September 30, 1994 by this office for a
single family well and/or on-site wastewater system, has
expired as of September 30, 1995.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
Close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as -built inspection report must be sent to this office for
review, approval and documentation. All inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744
S' erely,
J mes Cross, P.E.
Program Manager
On-site Services
enc: Copy of Permit
cc: Eagle River Engineering Serivices
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW940378 DATE ISSUED: 9/30/94
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 9/30/95
OWNER NAME:BEST KEN
OWNER ADDRESS:P.O. BOX 671282
CHUGIAK, ALASKA 99567
PARCEL ID:05052210
LEGAL DESCRIPTION: SANDHILL LT 8
LOT SIZE: 85828 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS) .
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED B
ISSUED BY:
DATE: 9` 36 ->
DATE:
Louis Butera, P.E.
Registered Civil Engineer
September 21, 1994
Jim Cross, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Sand Hill Estates Lot 8
Narrative & Permit Application
Dear Mr. Cross:
The proposed well and septic installation will have very limited impact on adjacent properties for
the following reasons:
1. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring lots are vacant.
3. Reserve space is adequate, due to absorption capacity.
4. Surface drainage will not be affected and is not a major consideration in our
design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\C:\WPWIN60\WPDOCS\1994\94-061A.NAR
P.O. Box 773294 • Eagle Rive-, Alaska 99577 • Telephone (907) 694-5195 • Fax (907) 694-3297
I
HAMANN
ROAD
SI
- TEST HOLE
•
- MONITOR TUBE
4
PROPOSED
0
- SEWER CLEANOUT
F
WELL
- WELL
1p0
T - PROPOSED LEACHFIELD
L ❑ T 7 - —
- —
- - EASEMENT
VACANT
KNOWN CURTAIN DRAINS
��\
NO
SURFACE WATER
��r
N s8 066
9y
A
tA
t/
��.
„2
2
o
`
NEW 1000
Turf GAL TANK
L ❑ T
9
s- T�FN� r�✓
}8f y
J
VACANT
R
FA °
PROPOSED
HOUSE
o
Lo'2�
LOT 8
1�0'
'110
F<OpMFNT
0
�J
.t' _
SI
- TEST HOLE
•
- MONITOR TUBE
4
0
- SEWER CLEANOUT
F
¢
- WELL
T - PROPOSED LEACHFIELD
- —
- - EASEMENT
NO
KNOWN CURTAIN DRAINS
NO
SURFACE WATER
SEPTI C SD ITE PLAN +..���%
LEGAL: LOT 8 SANDHILL ESTATES i �F
OWNER: BARTEL � � y I�
CONTRACTOR: N/A * i49TH
JOB # 94-061 DATE: 09/20/94 SCALE 1" = 60' T`:�� J0
EAGLE RIVER ENGINEERING SERVICES LOUIS A. BUTERA
�s CE -6736
P.O. Box 773294 'F e�
EAGLEAw
Aw
07 694 RIVER,5195 FAX.•57907) 694-3297 `,,��P��0:+���
� )(
I
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: Lot 8, Sand Hill Estates
A. GENERAL.
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
requirements.
4. All soil tests are advisory to the design and subject to verification or modification
in the field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi -family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
B. D ARD AR INFTELD
1. The drainfield is to follow the natural land contour to maintain uniform total depth
of the drainfield bottom.
2. The bottom of the drainfield excavation shall be level, plus or minus 1.5".
3. The total depth of the drainfield excavation is not to exceed 6' at any point.
4. The leach line is to be laid level.
5. The drainfield gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachfield.
7. The area over the drainfield is to be finish graded to prevent ponding of surface
water runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED TEACT4FTELD DIMENSIONS:
TOTAL DEPTH = 6' SEPTIC TANK = 1,250 gallons
DRAINFIELD LENGTH = 81' DRAINFIELD WIDTH = 5'
SOIL RATING = 0.8 GPD/ft2 BEDROOM CAPACITY = 4
GRAVEL DEPTH = 3.5' under pipe, 2" over pipe, 4.0' total
Twenty-four (24) hours notice required for all inspections.
C:\WPWIN60\WPDOCS\1994\94-061A.SPC
JOB
EAGLE RIVER
ENGINEERING SERVICES SHEETNO. OF
P.O. Box 773294 C« 09//!0 9y
EAGLE RIVER, AK 99577 CALCULATED BY / DATE
(907) 694-5195 CHECKED BY ✓ /�} J DATE
4
I
B
r
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: STI—IVL -
LEGAL DESCRIPTION: S,�kIJDI��I-{-TOTES iwi'lJ
1
DEPTH
PEAT LOADI
Sl' -.SILT, LOAM, GAVEL VARIES To
a
GM At z.s'
2
�=
0•",°-
3
Q_
6H UvwN, Pe4e- 'P 'd
4
MED -DENSE SMEA&SI 13ANDs or
SAMDIEZ e- SI6t1SrL MATeEUaL
5—
_
off- Shhll PAtc11�S of=s.Tucar-_D,
6
GaIdFSIVFy Sc,IL- !3e Lew Ip'
—
14 wATrp— Kk SEES
7
_
c--
8
9
—Q ,
F
y'la otK caJwv '. c:eac esa aY.rrvfsvi+- ^
DATE PERFORMED:
Township, Range, Section:
SLOPE
10 O. WAS GROUND WATER
ENCOUNTERED? NO
11 0 o S
G a IF YES, AT WHAT L
n _° .o DEPTH? N// A O
12 _ ._ E
13 uef-Y
LAE/of, (3oUt DF(Lj
14
15
16
17
18
19
Depth to Water Atter
Monitoring? 122 Date: 9-11L
SITE PLAN
20 I /t( —
IL_JI PERCOLATION RATE 10 (minutes/inch) PERC HOLE DIAMETER o
TEST RUN BETWEENH5 FT AND �'� FT
COMMENTS - tjSTAL-Lf0 NC. 70 t
7'H Al
PERFORMED BY: N/ei"iS ( CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72 -GOB (Ray. 41851
JH a-
1
' Ie
2
Net
Drop
SoN°K
�1-16-q'•t
tENGINEERS SEFaL1+ ' 6,I
3
l
Municipality of Anchorage
°ace ell
e �
DEPARTMENT OF HEALTH & HUMAN SERVICES
"" ° °`°°`°°""°"'•"°'
825 "L" Street, Anchorage, Alaska 99502-0650
<•,
SOILS LOG —PERCOLATION TEST
,, ,° �,
5
6
� j�! j
PERFORMED FOR: `�' ho'
gti3•n -
DATE PERFORMED 1• I { •J'
2
II 11.SL:33 n
LEGAI n=c�010--- Ldrg S4NDHIU. ESTATES Township Range Section:
JH a-
1
' Ie
2
Net
Drop
SoN°K
�1-16-q'•t
3
=�
aa.
4
t
0 �:
5
6
6
a_ ^
7 c
C
8
9 -7
10
o=
11 -0 -o
12 "
------
13-
14-
15-
16-
17-
1"
31415161718
19
SLOPE SITE PLAN
(29, PEAT, Roof MAT
TOPSOIL Q&e-K_.r or -
(GN), W -Owl -J, PA'214ES S*D(EL
IynT=@'�rij FE42actL+'1"
o tV li_ t':w-am 1-30" e 9t, HotSf
!aN€SNE. UE2`{Mots'rS�W11.ti
N� SEEPS. NEa.DENSITY
WAS GROUND WATER 1-16ENCOUNTERED?
S
L
N/A
E
Depthto Water Afterto "'r r
Montt 9 -A3 2,Y
Monitoring? 0[ y date:
IF YES, AT WHAT
DEPTH?
Reading
Date Gross Net
Time Time
Depth to
Water
Net
Drop
SoN°K
�1-16-q'•t
t
II l7"-Il:0o t6A HiN.
5"
6
2
II 11.SL:33 n
S3(6°
1° 6'
20 I _
PERCOLATION RATE 10 (minutes/inch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN FT AND 5 FT
COMMENTS I NYALL {.ZS PUC SLOMD Hr 'To n,
THva
PERFORMED BY: LZM 7 F -I'S 1�� CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
Cn�exttr�► 1r
by
DOC Co. dba -
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759
OWNER OF LAND �1�1 `-. t_
ADDRESS
LEGAL DESCRIPTION
DATE . Started Ended
DEPTH OF WELL < a` J
STATIC LEVEL OF WATER FT. �1
DRAW DOWN FT
GALS. PER HR
PERMIT NUMBER KIND OF CASING< -
KIND OF FORMATION:
From
Ft. to r Ft.
From
Ft. to
Ft.
From
Ft. to 'T1 _Ft
! L`- - - r3 r= `-%
From
Ft. to
Ft.
From
:q r=
Fr.
Ft.
Ft. to Ft
From
to
From ' ! J
FL to / i Ft.
From
Ft. to
Ft
From � -�
Ft. to > ' Ft
r
= 121;4° "
From.
Ft. to
Ft
From / I )
Ft. to Ft
) , («i,l
From
_Ft. to
Ft.
From
Ft. to Ft
_ 5 ; J,� c. i,�- .+-:,
From
Ft. to
Ft.
From
Ft. to Ft.
; W :, id 'r " '> ` -
From
Ft. to
Ft.
From
,Ft. to --,-3 -�Ft
'`- %W , c << ;, C
From
Ft. to
Ft.
From `$:a
Ft. to 1 Ft
s
C` !,`l .- r?
From
Ft. to -
Ft. _
From`
Ft. to 11Ft.
From
Ft. to
Ft.
From
Ft. to -'; I Ft.
'•
From
Ft. to
Ft.
From
Ft. to Ft.
From
Ft. to
Ft.
From i -'
Ft. to % Ft.
From
Ft. to
Ft.
From
Ft. to Ft.r,
From
Ft. toI_pt 1�
From i .-
Ft. to` 0.' Ft.
From
Ft. to -Ft.
5 1995
From
Ft. to Ft.
From
Ft. to
STT
ailly 01 Allunuragg
MISCL. INFORMATION:
Dept. Health & Human Services
a
DRILLER'S NAME t
1�- d 51""
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program ., ,..
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLINGII A ^ �y
Parcel I.D. 050-522-10 COSA # jilt ()�i D 10` J
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lot 8, Sandhill Subdivision
Location (site address) 24930 Hamann Road Eagle River, AK 99577
Current Property owner(s) Howard a Chrl"nn west Day phone 230-6628
Mailing address 24930 Hamann Road Eagle River, AK 99577
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four (4)
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER
DISPOSAL:
Individual Well El Individual On-site
R1
Individual Water Storage ❑ Individual Holding Tank
❑
Community Class Well ❑ Community On-site
❑
Public Water System ❑ Public Sewer
❑
The Municipality of Anchorage Development Services Department (OSD) Issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined in the 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 Anderson Engineering
Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 51IM2009
S. DSD SIGNATURE
Approved for
Disapproved.
Conditional approval for
K OF A4144
it
...............
0 ,•'-. ;MdQdAEt 4 ANDERSf7N : Q V
1 ✓ CE - 4381
bedrooms. �I '�q•.,5� jo•i�^f,� ��`��
1 f49
111
bedrooms, with the following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: 0,,4--^/ &J, Original Certificate Date:
(Rw 1 x15)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON—SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot e, SandhiR Subdlvlsion Parcel 10: 060.522-10
A. WELL DATA .
Well type E2ale
Date completed 10"94
Total depth s0o ft.
Date of test
Static water level
Well production
If A. B. or C provide PWSID # _
Sanitary seal (YIN) Y
Cased to 200 IL
FROM WELL LOG
10/04
199 ft.
Well Log [Y/N) Y
Wires property protected (YIN) Y
Casing height (above ground) >16 in.
AT INSPECTION
5/04109
261.6 ft.
g.p.m. 1.3 9 -
p.m -
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate N O mg/L
Arsenic: NID ugA Date of sample: 5/01/09
B. SEPTICIHOLDING TANK DATA
Tank Type/Matedal Sepfictsteel
Tank size 1.250 gal. Number of Compartments 2
Foundation cleanout (YIN) Y Depression over tank (YIN) N
Date of pumping 5/09109 Pumper sanitaryPumpers
Other bacteria 0 colonies/100 mL
Collected by: s. Gilbert
Date installed 10114194
Cleanouts (YM) Y
High water alarm (Y/N) N
C. ABSORPTION FIELD DATA
Date installed 10/14194 Soll rating (g.p.d./ t2 or ft2/bdrm) 'A SF/BORM System type 5' Wide Trench
Length
so ft. Width 5 ft. Gravel below pipe 4" ft.
Total depth L•5 fL Eff. absorption area 900"' ft Monitoring tube Y Depression over field N
Date of adequacy test 5111/09 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 37.5 in. Water added L gal. New depth 44.5 in.
Elapsed Time: 1.440 min. Final fluid depth 37.5 in. Absorption rate >= 600 g_p,d,
Any rejuvenation treatment (past 12 me.) (YtN & type) N If yes, give date
D. UFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
'Pump on' level at _ in. 'Pump off" level at_ In. High water alarm level at In.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100•
Meets alar & circuit requirements?
On adjacent lots >100,
Absorption field on lot >100• On adjacent lots >100•
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer/septic service line >25' Holding tank N/A
Animal containment areas None Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5'
Water main WA
Property line >5' Absorption field >T
Water service line >10, Surface water >100'
Wells on adjacent lots >100 -
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main WA
Water Service line >10' Surface water >100' Driveway, parkingrvehicle storage >6
Curtain drain None Noted' Wells on adjacent lots >100•
F. COMMENTS: ••• Design Required 3.5 Effective Depth. As Built Shows 4.0' Effective Depth. Could Not Verify Either.
•••• Subdrain Outlet 30' From West End of Trench. See Waiver.
G. ENGINEER'S CERTIFICATION
.;'tP;.•'••••�•t• ysdd
I certify that / have determined through field inspections and
49111 7� *O
I
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on Phis date.
Of ....• ......... ..
;'r+� ::Y. ;^s?
Engineer's Printed Name Michael E. Anderson, P.E.
404c;M1ChAEG E.•: h r
.•�: `C-- ', -MDDFit50N
Date 5/15=09
S' ?
#d PFB ••, g •;; •• ���
ddlp'EafESS10Ha��.�
—
COSA Fee $ OqO Waiver Fee $
Date of Payment �n� q Date of Payment
Receipt Number d r / ��� Receipt Number
(Rev. 11105)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
May 12, 2009
Howard West
24930 Hamann Road
Eagle River, AK 99577
Subject: Lot 8, Sandhill Subdivision
Well and Septic System Inspection, Testing and Certification
Certificate of On Site System Approval (COSA)
Dear Howard:
The septic system on Lot 8, Sandhill Subdivision was originally designed and permitted
for construction in September of 1994. The original design required an absorption
trench which was 81' long by 5' wide with an effective depth of 3.5'. The system was
constructed in October of 1995 and records indicate the trench was 90' long by 5' wide
with an effective depth of 4.0'. According to the as built records the trench was
constructed with an effective depth greater than the design required.
Our initial inspection of the absorption trench indicated 37.5" of standing water. This
compares with 34" found in the trench in May of 2006 when the last adequacy test was
completed on the absorption system. We then injected 600 gallons of water into the
trench and the level rose to 44.5". At this point standing water was noted in both
cleanouts in the absorption trench. If the effective depth of the absorption trench was
4.0' as indicated in the as built records no water should have risen into the cleanouts.
We therefore conclude the effective depth is probably 3.5' as originally designed and
permitted for the system.
The water level in the trench receded to the original level 24 hours after the initial
injection indicating the system absorbed 600 gallons of water and is eligible for
certification. It must be noted however that the system has now been in service more
than 14 years and is approaching the average useful life for a shallow wide trench
system. The absorption trench has deteriorated approximately 3.5" in the past 3 years.
It appears the trench has at least 4.5" and possibly 10.5" of freeboard remaining. The
remaining life of the trench will depend on the type of use and maintenance of the
system. At this time the absorption trench is capable of absorbing a minimum of 600
gallons of water per day and meets the requirements for certification.
A subsurface drain outlet is located approximately 30' northwest of the absorption
trench. The Municipal ordinance governing septic systems requires that any outlet for a
subdrain be a minimum of 100' from any element of a septic system. The drain appears
Lot 8, Sandhill
May 12, 2009
Page 2 of 2
to be a footing drain for the retaining wall on the north side of the driveway. It is
currently dry. A waiver will be required to allow the drain to stay in its current location.
A flow test was performed on the well and water system on Lot 8, Sandhill Subdivision
on May 4, 2009. The static water level in the well was found to be 261.6' below the top
of the casing prior to beginning of the test. The water was then allowed to flow freely
for a period of 4 hours and the well production measured on a regular basis during that
period. The average flow monitored during the test period was slightly more than 1.3
gallons per minute. The well and water system is in compliance with Municipal and
State of Alaska Department of Environmental Conservation (ADEC) regulations and
meets all requirements for a four bedroom home.
Water samples were taken from the system and tested for coliform, bacteria, arsenic
and nitrate content. Results have not been received yet, but are expected to be below
the maximum allowable limits.
Sincerely,
Michael E. Anderson, P.E.
Attachments
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
May 17, 2009
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 8, Sandhill Subdivision
Absorption Trench to Subdrain Outlet
Dear Onsite Services Engineer:
A 4" PVC subdrain outlet is currently located approximately 30' northwest of the end of
the existing absorption trench on the lot. The subdrain was constructed to provide
control of surface runoff behind a small retaining wall on the north side of the driveway.
The location of the outfall was apparently overlooked during past inspections for well
and septic system certifications.
The outfall and the subdrain are currently dry and no evidence of any water can be
found in the vegetation near the outfall during this the wettest runoff period of the year.
It is possible however that during periods of heavy runoff water could build behind the
retaining wall and flow through the subdrain. The flow would be shortlived as the water
buildup would be minimal. Further, there is no chance of water pooling at the outfall
due to the steep slope of the terrain to the south. We therefore recommend a waiver
be issued allowing the subdrain outfall to remain in its current location.
Sincerely, Q
Michael E. Anderson, P.E.
V C'A; . A%J!, RS-%
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
Ment
c o .S
Department
**** VARIANCE/WAIVER REVIEW ****
WR#: 090027 HA#:090128 Permit#:
PID#:050.522-10
Legal Description: Sandhill Lot 8
Engineer. Anderson Engineering
Applicant: Howard & Christvann West
Your request for a waiver of the required 100 feet horizontal separation distance from the
absorption field to the curtain drain outfall has been approved. The approved separation distance
is 30 feet.
This waiver approval applies to the absorption field to separation only. Any future upgrade to
the on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
...............................................................................
Waiver Is Granted: X Waiver Is not Granted:
Date: 611012009 Approved by:
ar� , Reviewer
.............................................. ... . ..........................
Rec#: 006446 Amount: $200.00 Date Paid: 5111109
**** VARIANCE/WAIVER REVIEW ****
A Cnl oil T
1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALL' '
FOLLOWING DESCRIBED PROPERTY= i�rso t �QF A(��
' DATES
AND THAT NO ENCROACHMEI'JTS EXIST EXCEPT AS�Q.
INDICATED. IT IS THE RESPONSIBILITY OF THE y �� q Trig'• . ;9
OWNER DETERMINE THE EXISTENCE OF ANY GRID: %`hG
CASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUSDI- p,,.,,. M„k y
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' o_yr 1�;•, IS -6918
ANY DATA HEREON DE USED FOR CONSTRUCTION 7 �t�?y•.,,,,,,.
OF FENCE LINES, OR FOR ESTABLISHING BOUND- t ”
ARY LINES.• DRAB .r' V, N% o"
SGS ReEN
1091695001
Client Name
Anderson Engineering
Project Name/N
Sandhill L3
Client Sample 1D
24930 Jlannann Rd.
Matrix
Drinking Water
Sample Remarks:
Printed Datefrime
Collected DateMme
Received Datelrime
Technical Director
05/132009 12:04
05/012009 8:00
05/012009 10:25
Stephen C. Ede
Parameter
Results PQL Units
Method Container ID
Allowable
Limits
Prep Analysts
Date Date Init
Metals by ICP/MS
Arsenic
ND 5.00 ug/L
EP200.8 C
(<10)
05/06/09 05/12/09 NRB
Waters Department
Total Nitrate/Nitritc-N
ND 0.100 mglL
SM204500NO3-F B
(<10)
05/08/09 JDZ
Microbiology Laboratory
Colony Count 0
Total Coliform 0
Fecal Coliform 0
col/100mL SNU09222B
col/100mL S%1209222B
col/100mL SM20 92228
A (<200)
A (<I)
A (<0
05/01/09 DLC
05/01/09 DLC
05/01/09 DLC
Municipality of Anchorage
P.O. Box 196650 •4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http:/twww.muni.orn/Onsite
Development Services Department
On -Site Water and Wastewater Program
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Mike Anderson
Legal description: Sandhill Lot 8
❑Permit ®C.O.S.A. ®Inspection Report
t^`nr .S
Metplitnilt
s
i
o
The attached paperwork has been reviewed and is being returned for the following reasons:
1. Can subsurface drain be extended to meet code?
2. $200 fee for waiver If subsurface drain cannot be extended.
Name of reviewer: Jeff
Date: 5-20-09
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
Municipality of Anchorage
Development Services Department ° <
1 Building Safety Division
= /
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D._0r.JD'599-10 COSA# Viop-*�rD
Expiration Date: 9 - I Ll - M-&
1. GENERAL INFORMATION
Complete legal description ' �n MN II Lcri- 2
Location (site address) e74`I3o 146rviantn 12e1, E _' tr, A-V. c1g517l 9(n2.,5
Current Property owner(s) Pni A l = J art -1 Re%rl--r I Day phone _
Mailing address ac(m-i-- 1.4eiA �"1�.O.gqI , Hot+csfrv,, -r.)c `-ialo
Es' -row of{;cer— r a-(%tA Goode_ Day phone A I - a a -.a.3
Mailing address 131ci-f c- t\Iov-KA 10,1&4- -fes .2,201 G.'s 4tz I IO
Real Estate Agent 17,5-B O Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
q_
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
[l
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined In the Certificate of Onsite 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 Eagle River En ginssring S911AM
1042 1 VFW Rd., Suits 201
Address Fsalp River. AK 99577
Engineer's Printed Name C.Anri<-hf2ba r- KZ. Wmc4—
5. DSD SIGNATURE
Approved for f' bedrooms.
Disapproved.
Conditional approval for
Phone 0 q - S 1 C15
Date
bedrooms, with the following
JUN 0 1 2661_
CHRISTOPHER R. WOOD
cuQ381
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Report
Other
By /tel Original Certificate Date: t'O
(Rw. 1 M)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonske
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Sek,-v_l k I I L4- 2 Parcel ID: 0.5-0- 92-X-/0
A. WELL DATA
Well type XYiV6t4t_ If A, B, or C provide PWSID #
Date compieted i4cl 4 Sanitary seal (WN)
Total depth E00 ft. Cased to _Z OO ft.
FROM WELL LOG
Date of test 10 1 R L4
Static water level 19 9 ft.
Well production I g.p.m.
WATER SAMPLE RESULTS:
Coliform � colonies/100 mL Nitrate Al b mg/L
Arsenic: _6LJ> mg/l Date of sample:.? `//06
B. SEPTIC1HOLDING TANK DATA
Well Log (YIN) (� A_
Wires properly protected (®N) ( <
Casing height (above ground) (.Sn_in.
AT INSPECTION
s las loh
a5 I n.
a- g.p.m.
Other bacteria -,Z—colonies/100 mL
Collected by: Ma itsRol-WYivll
Tank Type/Material --.t 6;Ji r. I s( c -Q Date installed i n{ 1 4 1110
Tank size J 50 gal. Number of Compartments P- Cleanouts ON)
Foundation cleanout (9)/N) Ji . Depression over tank (YAW tj2_Q High water alarm (YQ �-n n
Date of pumping �- a -10 G Pumper _ _ 'T4V
C. ABSORPTION FIELD DATA
Date installed _1011 q 1 4 Soil rating q or ft2/bdrm) n. !�' System type kn1 Icw -f-" nck
Length CIO ft. Width S ft. Gravel below pipe 4- ft.
Total depth (�.S ft. Eft. absorption area QW 112 Monitoring tube_L5 Depression over field
Date of adequacy test 5/AS/o(, Results F 8S Fail) -V:ASS For 14 bedrooms
Fluid depth in absorption field before test 3' in. Water added gal. New depth 3� in.
Elapsed Time:ll'(Qmin. Final fluid depth 34 in. Absorption rate >= (mer) g.p.d.
Any rejuvenation treatment (past 12 mo.) (YO& type) vi ont_ Iz ioLvyn If yes, give date n I n
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
'Pump on' le�at in. CyclWes
I at fX in.W- High water alarm level at in.
Datu ed Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot rto0,
Absorption field on lot -f too
Public sewer main -I I coo'
Sewer /septic service line + a's '
Animal containment areas -I 100'
On adjacent lots .4 1 rx-)
On adjacent lots + 1 c)o'
Public sewer manhole/clearwul_-
Holding tank + "1 S '
Manure/animal excrete storage areas + 1 O(7)'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 'I- 5 ' Property line t'S Absorption field
Water main + 1 n' Water service line -r 10' Surface water + 100 '
Wells on adjacent lots -I ic'1O
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line t 10' Building foundation +I O' Water main + I O'
Water Service line + I C)' Surface water t 1(1)0' Driveway, parkingivehicle storage aO '
Curtain drain + 5n ' Wells on adjacent lots r 100
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name C. V,r i 5 Jrrolne r txlcd
Date l cot O (c
COSA Fee $ (430 .tom
Date of Payment &r II1o%
Receipt Number SI/ y(6
(Rev. I IMS)
Waiver Fee $
Date of Payment
Receipt Number
Eagle River Engineering
Attn: Christopher Wood
10421 VFW Rd. Ste. 201
Eagle River, AK 99577
907-694-5195
Fax:
Client Sample ID:
Sandhlll Lot 8
Client Project:
Miscellaneous DW Testing
Location:
5/24/2006
Sample Matrix:
Aqueous
COC #:
AX 1803
PWS#:
Residual Chlorine:
Comments:
Set -Up Date/time: 525106 1:30 PM
Lab#: A0605265-OIA
r-,
Analytica International, Inc.
5761 Silverado Way, Unit
Anchorage, AK 99518
Phone: 907-258-2155
Fax: 907-258-6634
Report Date:
6/2/2006
Receipt Date:
5/24/2006
Sample Date:
5/24/2006
Sample Time:
11:15:OOAM
Collected By:
CB
Flag Definitions:
MRL — Method Reporting Limit
MCL - Maximum Contaminant Limit
B - Present also in Method Blank
H - Exceeds Regulatory Limit
M Matrix Interference
1 - Estimated Value
D Lost to Dilution
•• = RL higher than MCL; target not detected
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL Method Date Date Analyst
Bacteria, Other
Fecal Coliform Bacteria
Total Colifomr
Reported by: Kari Hagen,
Laboratory Project Manager
MF
<MRL CFU/100mL
<MRL CFU/100mL
<MRL CFU/I00mL
1.0
1.0
1.0
Page 1 of 1
Test was
5252006 5262006 DC
5252006 5262006 DC
Fie�itl tt. �U�U�t2.7 sZa]
Analytica International, Inc.
5761 Silverado Way, Unit N
Anchorage, AK 99518
Phone: 907-258-2155
Fax: 907-258-6634
ANAI.Y11CA
GRUCI'
Eagle River Engineering
Report Date: 6/8/2006
Attn: Christopher Wood
Receipt Date: 5/2412006
10421 VFW Rd. Ste. 201
Sample Date: 5/2412006
Eagle River, AK 99577
Sample Time: 11:15:OOAM
907.694-5195
Collected By: CB
Fax:
Flag Definitions:
MRL - Method Reporting Limit
Client Sample ID: Sandhlll Lot il
MCL — Maximum Contaminant Limit
Client Project: Miscellaneous DW Testing
B - Present also in Method Blank
Location:
11- Exceeds Regulatory Limit
Sample Matrix: Aqueous
M - Matrix Interference
COC #;
J- Estimated Value
PWSN:
D - Lost to Dilution
Residual Chlorine:
•• - RL higher than MCL; target not detected
Comments:
Lab#: A0605266 -01A
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL NICL Method Date Date Analyst
was
Nitrate as N <MRL mg/L 0.10 10 6/3/2006 613/2006 A)
Lab#: A0605266-OIB
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
200.8/200.8 (Aqueous) - Arsenic Test was conducted by: Analytica - Thornton
Arsenic <MRL ug/L 0.15 10 200.8 6/112006 6/1/2006 MCG
Reported by: Kari Ilagen,
Laboratory Project Manager
Page 1 of I
14-1B9 S7;�r'/t/ /7/./.?
aRRIIII T
1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE= �
FOLLOWING DESCRIBED PROPERTY
sr vO///!! sUp. for DATE,
AND THAT NO ENCROACHMEfJ S EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE ' rH y •
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID+ �....J ..
EASEMENTS, COVENANTS OR RESTRICTIONS SW ZdZ
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: Duan. Mark Snwe(d jr
7O_�t wQr •. 1S-6918
ANY DATA HEREON BE USED FOR CONSTRUCTION �A.� • Zr
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES. DRAWNt
• .O�f Q0.* .,►
06/06/2806 16:15
JW Pumping
PO Boa 773415
Eagle River, AJC 99577
(907) 694.6434
9073449021
1BIllina Information
Eagle River Engineering
10421 VFW Rd Ste 11201
Eagle River, AK 99577
(907)094-5195
Job Site Inforrnatlon�
Charles
24930 Hamann Road
Eagle River, AK 99577
(907)694-5195
i
JRS SEPTIC
Joh Desvlphon:
1 Doog
P.O. Number:
Order Date:
Tams:
Net 30
swearep:
Karlia
Map Bock:
60.00
Cross streets:
Eagle River Road
Job Comments:
PAGE 01
Service Agreement
Number:
020029
Order Date:
01 -Jun -2006
ServiceDate:
02 -Jun -2006 12:00
Technician:
Dave
Ta %: 0
Job Type: Repeat
Mp Grid 131- -
New
alk pump Tank - Heavy solids
3x's - REC : Repump
Additional Location Comments piyram: 3:10haremal2004g eme
Septic ® right home when facing
house
M -*e DW
Service Type Qty Price Each
Septic Service 15K 1 $150.00
Tax?
No
Gallons Planned: 1250
Gal. Actual:
Hose Length:
Double Tank: 0
Pump System:
Baffles Inlet:
Barnes Outlet: ❑
Extension Actual
S150.00
Actual Charges!
Customer agrees to the tams and cond.sons shown. THIS le A BINDING AGREEMENT.
signature arta Tlde of Customer Repreeentathre Date
Accepted by JRa Pumping Dia Accepted
For your added convenience we swipe Amerlcon Express. Deaver. Visa and Mrter Card payments over the phone.
After 30 Days aecamle wM he turned over to collections. $25.00 For NSF Checks ReWrned.
NonTexble Toil
Taxable Total
Tax Tote]
Grand Tote]
ErAmated Charges: $150.00
60.00
$0.00
$150.00
Actual Charges!
Customer agrees to the tams and cond.sons shown. THIS le A BINDING AGREEMENT.
signature arta Tlde of Customer Repreeentathre Date
Accepted by JRa Pumping Dia Accepted
For your added convenience we swipe Amerlcon Express. Deaver. Visa and Mrter Card payments over the phone.
After 30 Days aecamle wM he turned over to collections. $25.00 For NSF Checks ReWrned.