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HomeMy WebLinkAboutSAMPSON ESTATES BLK 4 LT 14Sampson Estates Block 4 Lot 14 #051-811-19 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program, 4700 Bragaw St. $' -- P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SWO80251 PID Number. 051-811-19 Name: CLIFF WILSON Wastewater System: O New ■ Upgrade Address: PO BOX 672126 " CHUGIAK, AK 99567 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 688-3600 3 l7 Deep Trench *Shallow Trench o Bed ❑ Mound El Other LEGAL DESCRIPTION Sall Ratcq Totalpepu+ from original 3•a ,� on/Sq. r< 3 TO TOP OF SAND FL Block: Lot: Subdivision: 4 14 SAMPSON ESTATES Depth to pipe trottom from originol grade: 2.48 MAX Gravel depth beneath pipe: 0.52 Ft. FL Township: Range: — Section: AN added above originoi grade: Gravel length: — SEE DWG. FL 42 Ft. WELL: p New p Upgrade Gravel ULM: 5 Number of Ones: 1 Drlome between Ones: Fl. In. Cloewfiaatnn Private. ".C): Told pep Cased T0:(sEDIIOCK) Told abeaption ams: Pipe materfok 210 ser. Fl D 3034/F-810/SCH 40 We Willed: Static Water Level: M10114C. GEG Ltd. Date Insta"d: 12/6/08 rL y4w. Pump set At:Gating Ne ht Above aroi.,d: TANK GPU FL FL SEPARATION DISTANCES El Septic 0Holding ■S.T.E.P. 19Other* To From Septic Tank Absorption Field Lift Station Holding Tank DGc/Prlvote s..er tJn.e Monulocturer: GREER capacity in galbne: 1500 Well 100'+ 100'+ 100'+ — 25'+ 4otenal: STEEL Number of comportments. 2 Surface water 100'+ 100'+ 100'+ — — LIFT STATION Lot Line 5'+ 10'+ 5'+ — — Sire In gollons: 1500 manufacturer 1 GREER Q NICS Foundation 5'+ 10'+ 5'+ _ _ 'Pump on Ie"eI a4 Pump alt level at: llgh rater clam, at: TIMER TIMER 44" Curtain Drain NONE KNOWN Pump Make & Model: Electrical b+epecbone pertomved br. I I _1P—TE-30—PLUS RISING SON Remarks: OLD TANK AND DRAINFIELD WAS ABANDONED BENCH MARK PER UPC. 'THIS IS A QUANICS AEROCELL �ITi Location and pescrlptwn: THRESHOLD (rp. Assumed Elevation: 100.00 �. •`'1 � ENGINEER'S SEAL Inspections performed by: GEG, Ltd. Dates: 1st _ 12/6/08 000 •,2nd 12 6/08 �6� OF !� ��044 IN000:0 itl;i: : ;i II..r •, f 17y6ZOS Development Services Department Approval 4 �Q40 .... ........ Conditional approval: Date: • • .. • ... ... p QO f� y ness.: CE-7953 e`Q Reviewed and approved by: AA ate; ' �~ 0 ��0°alpra Q9Siana, (Rev. 4/0e) 4OO��o�OOcs n V cr j C),-\ �_,c rn c` C_� I $ 4-o c\- C� 1 1� cw i-0 ,� e 8 u h c) i 8 : �6Ca, 60,_;—uL _i% GARNESS ENGINEERING GROUP, Ltd ENGINEERING o SALES o CONSULTING -- ----- - November 2, 2018 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 e Advanced Treatment System D - - Ref: Sampson Estates S/D; Block 4, Lot 14 (22430 Pharaoh Circle, Chugiak, AK) Memo concerning converting CAT III AWWTS to CAT II AWWTS septic system To whom it may concern: The permitted septic system was installed on the referenced property and started up in 2008. GEG Consultant, Jody Maus, has recently checked the monitoring tubes in the drainfield and found them to be dry. In order to simplify the operation and maintenance of the system, we are proposing that this unit be permanently configured as a CAT I I system. Our justifications are as follows: • The receiving soil had percolation rate of 15 minutes per inch. Given this percolation rate, a 3.0 gpd/sq.ft. application rate is required for a Cat II system. The home has 3 bedrooms, so 150 sq./ft. of absorption area is required for a CAT II system (450 gpd / 3.0). The existing 2008 drainfield has 210 sq./ft. of absorption area. The following information should supersede the application rates outlined in GEG's original design dated 11/10/2008 and the approved On-site Wastewater Inspection Report dated 1/5/2009: - Allowable application rate (for Cat 11 system): 3.0 gpd/sq.ft. At this time, we request that your department approve a CAT II configuration to be used at the referenced property. Upon your concurrence, we will have ARM Septic Service, LLC., go to the property rel el the Jandy valve basin, remove the actuator from the ball valve, leave the valve in the opep PO ition, and have them place a CAT II sticker on the control panel. PIE., M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com PERMITNUMBER: - AS -BUILT DRAWING PARCEL ID NUMBER: SWO SW0802510251 - 051-811-19 R * TH/ 1 COI `iv MT1 oo POD �� MT2 NEW DRAINFIELD CO2 EXISTING 3 BEDROOM HOUSE tDBL 1k2 1500 GALLON / T.E.P TANK / / / I I I 1 1 1 1 1 9�JF' \ ,y \ / / / / IF / 3 N S E: 1 1*40' I 1 1 000� DO GARNLSS ENC51NEERING GROUP, Ltd. p�\ - - CONSULTANTS 6 GENERAL CONTRACTORS ...... 0101 L TIOCN NDIA OMC 101 • M1p101UGL M M l (110TW7-01A . FAIL (OO1jU0-0,M . 1RVIL w.,s.rrpF.rYgmn PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CLIFF WILSON 907-688-3600 2 OF 3 OD.9 LEGAL DESCRIPTION: SAMPSON ESTATE TYPE OF WORK: ASBUILT DRAWING BLOCK 4. LOT 14 Fam. 12/18/08 •{21.te. A B ST1 52.13 60.62 MH 61.91 69.72 DBL1 29.11 43.89 DBL2 30.10 44.36 JV 72.65 86.35 POD 69.30 85.11 C01 93.18 99.38 MT1 94.50 101.29 CO2 66.44 88.30 MT? 64.53 87.15 * TH/ 1 COI `iv MT1 oo POD �� MT2 NEW DRAINFIELD CO2 EXISTING 3 BEDROOM HOUSE tDBL 1k2 1500 GALLON / T.E.P TANK / / / I I I 1 1 1 1 1 9�JF' \ ,y \ / / / / IF / 3 N S E: 1 1*40' I 1 1 000� DO GARNLSS ENC51NEERING GROUP, Ltd. p�\ - - CONSULTANTS 6 GENERAL CONTRACTORS ...... 0101 L TIOCN NDIA OMC 101 • M1p101UGL M M l (110TW7-01A . FAIL (OO1jU0-0,M . 1RVIL w.,s.rrpF.rYgmn PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CLIFF WILSON 907-688-3600 2 OF 3 OD.9 LEGAL DESCRIPTION: SAMPSON ESTATE TYPE OF WORK: ASBUILT DRAWING BLOCK 4. LOT 14 Fam. 12/18/08 •{21.te. PERMrTNUMBER: AS DRAWING PARCEL ID NUMBER: SWO SW080251 051-811-19 FINAL GRADE = TOP OF MAN JANDY VALVE 650 QUANICS 99.15 \H6LE = 99.09 AEROCELL UNIT n.n . . . 11 J"mmommool—r ITOP OF TANK - INLET = 93.70 INVERT OF - BUNG INLET = 93.64 1500 GALLON S.T.E.P TANK �-- 10 GA. RATED FOR 10' BURIAL DEPTH FINAL GRADE = 104.99-105.64 FILTER FABRIC TOP OF TANK OUTLET = 93.71 RIGINAL GRADE = 103.93 IP OF SAND = 100.93 INVERT OF PIPE = 101.45 BOTTOM OF TRENCH = 98.93 RELATIVE ELEVATION OF BOTTOM OF TESTHOLE = 88.93(H20 0 95.93) i TO GARNL•'SS ENGINEERING GROUP Ltd. . _ : _.: _. ,__ .-..,._ CONSULTANTS 3 GENERAL CONTRACTORS •---- - - � ...... • ...... • MI L n.0af fan. fort io, • M,°IORCL NI Nw> . wn[ (w>lu>-sm • ru (007p -uw • wsm ....o..�y�y�, y 0....... • . PREPARED FOR: PHONE NUMBER: PAGE NUMBER: •• • .•....... ........ CLIFF WILSON 688-3600 3 OF 3 If ey Gar ss.: LEGAL DESCRIPTION: DRAWN BY: QO° . GE- eG SAMPSON EESTATES; BLOCK 4. LOT 14 PNB �Q�°. aZi!B 4•ti� po`oG TYPE OF WORK: DATE: 04ay Prof°ssio��a� PROFILE DRAWING 12/18/08 MUNICIPALITY OFANCHOR4GE Development Services Department On -Site Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade ,'�_J5jo% two 1i330 Date Issued: Dec 04, 2008 Expiration Date: Dec 04, 2009 Permit Number: SW080251 Parcel ID: 051-811-19 Legal Description: SAMPSON ESTATES BLK 4 LT 14 Design Engineer: 0855 GARNESS ENGINEERING GROUP Site Address: 022430 PHARAOH CIR Owner Name: CLIFF WILSON Lot Size: 58396 SO. FT. Owner Address: PO BOX 672126 Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK , AK 99567 - This permit is for the construction of: Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Issued By: Date: .2 D Date: 124 !/� � Municipality of Anchorage e, �.. •I Development Services Department Building Safety Division On -Site Water BWastewater Program 4700 Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.sk.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. n� l - 3 i -1q UM -9 owner(s) CLIFF WILSON Day phone 907-688-3600 Nt,�a�i+�i-9 aadddress 22430 PHARAOH CIRCLE • CHUGIAK. AK * 99567 MMU ddr�ss Zip Code 99567 Legal description (Sub'd, Block & Lot) . SAMPSON ESTATES SUBDIVISION: BLOCK 4. LOT 14 Legal description (Township, Section & Range) N/A Lot Size 5�)f Sq.Ft. THIS APPLICATION IS FOR ( ®all that apply): Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 3 THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. 1� PermiURush Fees: p� Waiver Fees:_ Date of Payment: a L Q Date of Payment: Receipt Number: b Receipt Number:, (Rev. 11/05) GARNESS ENGINEERING GROUP, Ltd. - CONSULTANTS & GENERAL CONTRACTORS t=R-szsT•^awrrs� November 10, 2008 Municipality of Anchorage Development Service Department On -Site Water R Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic Upgrade for Sampson Subdivision; Lot 14, Block 4, To whom it may concern: The existing 3 bedroom house is served by private well and septic system. The septic system is in a state of failure and needs to be upgraded. Due TO the poor soil conditions in the area and the shallow groundwater table, we are proposing that a 1500 gallon S.T.E.P. tank with Quanics controwfloats, a Quanics 650 Aerocell system, and a 5 -wide type drainfield be installed. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of the test hole. Comments regarding the design are summarized as follows: . 1. SOILS: See the attached logs which show the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE NVATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography in the area of drainfield is approximately 10-15% running south to north. The area below the drainfield is generally flat. In short, there are no slope concerns with this installation. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any/kuestions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. NOTE: Atl6ched is a sire plan drawing, a design drawing, two detail drawings, and one soil log, which are all part of the design package for this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246 4 Website: www.gamessengincering.com / / / SAMPSON EST: / / / BLOCK 4. LOT 12A / / / / /I / SAMPSON EST: / /moi / 1 BLOCK S. LOT 8 / /'•+ / WATER i � / � SAMPSONWCES LOT 13A // \ 54APSON EST: t/ if \ OLOCK 3. LOT 9 I 1DO' WELL RADIUSif if I — if 3 EXISTING BEDROOM Po HOUSE \\\ /// It �-- / / 1 c ..•.1 �• ,.: jor if I /PUBLIC if WATER TM -IO--• \\ �� \ YI / SAMPSON EST: BLOCK 4, LOT 19 \ PROPOSED \ SEPTIC ` SIO. SYSTEM SAaCK 4. \ 0 18 I PUBLIC I WATER SAMPSON EST; BLOCK 4. LOT 17 BLOCK 4, LOT 15 I sIo• ��''' N �1• �E110�f{' BLOCCK04, LOOT 16 I GLS S 1• E: 1100' I aoo�op p4 GARNESS ENGINEERING GROUP, Ltd. p;'�- 4 T ..7 CONSULTANTS 6 GENERAL CONTRACTORS ��.•••.•• • • .•• ••••.••• n MSM I", E . w to, • M4,tl4R. m 1Y]Ol . wc�[ (M7)] IlIT • ru (MMM -]}N IR�11[• w�. .mn PREPARED FOR: PHONE NUMBER: PAGE NUMBER: �Oy . . •••••• ......•• CLIFF WILSON 907-68B-3600 1 OF 4l f r G I ess.: LEGAL DESCRIPTION: DRAWN BY: OQO r E-7953 •'tiFG SAMPSON ESTATES; BLOCK 4. LOT 14 J.L.M. 0� e, lll:1PIL ogo� TYPE OF WORK: DATE. 4QOp4Op�OOOao SITE PLAN DESIGN 11/10/2008 (Rtiv. 61M5) NUMBER OF BEDROOMS: 3 GALLONS PER DAY (CPD): 450 PERCOLATION RATE/S: 15 MIN./INCH ALLOWABLE APPLICATION RATE: 4.0 MINIMUM DRAINFlELD SO.FT.: 113 IM DEPTH: S FEET S FEET I: 40 FEET APPROVED SAND FILTER: 2 FEET NE: 0.5 FOOT RON FACTOR: N/A . SO.FT.: 2D0 TO BE 1 TO BE RECDCATED BY CONTRACTOR / QF NEEDED) �� fJ SHED M � C TH/1� x c -- n c PROPOSED DRAINFlELD PROPOSED OUANICS m 650 AEROCELL UNIT �I LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEC. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, / WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY / HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND / CONDITIONS OUTLINED. / E%ISTINC TANK TO BE PUMP, CRUSHED. ANDS — — � ABANDONED IN PLACE PER UPC CODE x� n 0 EXISTING 3 BEDROOM HOUSE C2 / )SED 1500 GALLON S.T.E.P. WITH QUANICS CONTROLS POSED RECIRCULATION/' JANDY VALVE BASIN I GARNESS ENGINEERING GROUP, Ltd. CONSUCjANT3 d GENERAL CONTRACTORS I L TC0111010. ll 1 101 • W1010MGI WI MOOT • /ICK (M1).U1-IIT • IA+ (WY}1 w" • K - .. cen PREPARED FOR:PHONE NUMBER: CLIFF WILSON 907-688-3600 LEGAL DESCRIPTION: SAMPSON ESTATES; BLOCK 4, LOT 14 TYPE OF WORK: DESIGN OF NEW SEPTIC SYSTEM ;E NUMBER: 2OF4 DRAWN BY: J.L.M. o�c ••.......,ys 4 y�l .../. ... ... . ... ........... J �9J CE -7953 •, ,FG ��,pr ''1LIIDID�d• c4� �40nd Pro FesslonoV u 11/10/2008 2' OF FILTER FINAL CRADE PROPOSED OUANICS 650 AEROCELL UNIT 1NE, 6�����i�������������0.5' OF EFFECTIVE� • 5 FEET 1 - f-- GARNESS ENGINEERING GROUP, Ltd. ;? ` 4 a CONSUtfANTS d GENERAL CONTRACTORS ... .... .. ........ Jlpl C TA1011 IIYO. WIC 101 • M9gMCL M! M 7 NdL (N1)ST)-SIT F" 007)=-.T14 • R ' .w.,s�wp�M1p<eiw PREPARED FOR: PHONE NUMBER: PAGE NUMBER: Q (� Cdr E... CLIFF WILSON 907-688-3600 4 OF 4 0 r '. LEGAL DESCRIPTION: DRAWN BY: OQ°14 SAMPSON ESTATES: BLOCK 4, LOT 14 J.L.M. QQ T�,J.o �T7 c4P TME OF WORK: DATE: �-Q-O40O�Q00000 DESIGN OF NEW SEPTIC SYSTEM 11/10/2008 I '^L: DRAWN BY: 1 1 /7/2008 A.J.G. LEGAL DESCRIPTION: Y SAMPSON ESTATES; BLOCK a, LOT 14 GARI�ESS ENGINEERING GROUP Ltd. TYPE OF WORK: CCNSULTAN73&GENERAL CONTFACTOFS DESIGN OF QUANICS AEROCELL SYSTEM IN.t1m dO.wwN rom.. NlTwa: ron mti.wme ton sN ar•o.w ... PREPARED FOR: PHONE NUMBER: PAGE: CLIFF WILSON 688-3600 3 OF 4 ' g ••...y* 00 1! GARNESS ENGI1`EERING GROUP, Ltd. - . I ,..".1 ,. +-- CONSULTANTS 3 GENERAL CONTRACTORS - •+-����--�+ SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: SAMPSON ESTATES; BLOCK 4. LOT 14 PERFORMED FOR: CLIFF WILSON D, DEPTH (feet) TEST HOLE 1 ORGANICS 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 GM OR ML DEPTH TO GROUNDWATER DATE SEEPS 0 7' 10/20/08 8' 10/27/08 2:30 - 6- - 2 3:00 30 4- 2' ZA 3:00 Hum • - 4 3:30 30 - 2- 5 3:30 ( n,$ 6- �ilyB • 4:00 30 DEPTH TO GROUNDWATER DATE SEEPS 0 7' 10/20/08 8' 10/27/08 2:30 - 6- - 1 Q A SEE SITE PLAN DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 10/21/08 1 2:30 - 6- - 2 3:00 30 4- 2' 3 3:00 - 6" - 4 3:30 30 1 4- 2- 5 3:30 - 6- - 6 4:00 30 4" 2- 9 PERCOLATION RATE 15 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4 FT. AND 5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: KYLE MAUS PERCOLATION TEST PERFORMED BY: KYLE MAUS COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS. CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 111510-a ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN AJUNICIPALITY OF ANCIIORAGE AND CUFF 1A)IIS60 THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this 4 Day of of 20t&, by and between ` herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AW WTS), described as1 I '1 f ocated at t h 11Y _� 4 Ll `i' Anchorage, Alaska. 2. Definitions. A. Alteration. Any change to the design or function of an AW WTS that Includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AW WTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65. B. Certificate of On -Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On -Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On -Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Municipality an annual fee of q-epo ($4.00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the AWWTS. The term begins on the date of approval by the Municipality of the installed system and shall continue while the AWWTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On -Site approval is issued to the new owner or transferee of the property. 5. Alterations installation and Removal of Additional Equipment. Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Construction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws, regulations, rules and orders for the AWWTS. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and' repair contained in the Owmer's AWWTS Operating Permit is: �9 - PfAYA 0 -Ga C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. F. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AW WTS is the governing professional guidelines for the construction, maintenance and repair of the Owner's AW WTS. 7. Nonwaiver. The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Owner: Anchorage: C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding 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 Memorandum of Understanding. 10. Severability. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. r STATE OF ALASKA THIRD JUDICIAL DISTRICT MUNICIPALITY: By: Title: Date: ) ss. The foregoi Instrumentl as acknowledged before me this � day o e 20a, by !1 S UYl , the 1} " MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHJONE EW I .5l£j3_j2;?J-�, El UPGRADE MAI LING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Wel Absorption area r Dwelling f PE MIT NO. ` V Y DISTANCE TO: h--� 9 &5 F Z Manufacturer Material No, of compartments y Lit capacity in gallons - IF HOMEMADE: Inside length �- Width Liquid depth ®Y DISTANCE TO: Well welling PE �,NO. oz z O z Q 2 f - Manufacturer - Material Liquid capacity in gallons Well Foundation I Nearest lot lined PERMIT NO. = DISTANCE TO: U (> to Z No. of lines Length of eachfqTotal len of 'nes I - Trench wi Distance between lines 1- w 1310 inches F Top of tile to finish grade I Material beneath tile _inches Total effective absor onarea 8 4 C 1 Length Width Depth PERMIT NO. LU 0 Q F Type of crib Crib diameter Crib depth Total effective absorption area as W N Well Building foundation Nearest lot line DISTANCE TO: J Class ! IBJ Dept r'}ler Distance to lot line PERMIT NO. w � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST �RATING n T 1 V INSTALLER 1 REMARKS � p ' OF AC g &5 & Cn 7� 4Oi` uYUa O y .-. 7 e gehp i A. 5%, ai"3Y otl No. 1.07-E [ Pilo rF< �! APPROVED ;g1t}NKA- ��� l DATE�j LEG - s- �t�� a�� r:i�� "( h/ EJ ✓ 70n1Q IQ— Q/v41 WA R.P 1AT 3: C; 1: F" P; R.. 3: -F Y" 1:11 F:�� h: -41! T':::.1l il AP �i� D�PAFIC TMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE� AK 99501 264~4720 ^ ` ` �PIP4 F EE W K: 10 IRE F? Tic WX W U R To, E170 Two :11 7' PERMIT NO: 850257 DATE ISSUED: 06/05/85 � APPLICANT: % S to I: CONST, ADDRESS: SRB 1960 EAGLE RIVER!j� AK 99577 CONTACT PHONE: 694�2979 LEGAL DESCRIP: BLOCK: 4 SUBDIVISION: SAMPSON ESTATES LOT: M. SECT309: 3 TOWNSHIP: 15N RANGE: 1W LOT SIZE: 58396 (SQ.FT. OR ACRES) LOT LQCATION: ' PHARAOH CIRCLE MAX BEDROOMS: 3 Listed below are the options availabW to you in designing your septic system. Choose the option that best fits your site. � � � � .... � ` � � � . ' DEPTH TO PIPE BOTTOM (FT,) 4.O 74 GRAVEL DEPTH (FT.) 0,5 3.5 TOTAL DEPTH <FT.) 4"5 7.5 GRAVEL WIDTH (FT.) 26,0 5,O SRAVEL LENGTH (F:'] 715. 0 50.0 113.0 ** GRAVEL VOLUME(D L. 15 1 1 1 418.2 83.8 TANK SIZE c:) (j" ** 1�000.0 v; -w SOIL RATING (SQ,FT,/BR) 284 349 � ** GRAVEL LENGTH > 75 FT, REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANKMUST HAVE AT LEAST°TWO COMPARTMENTS _ � � I l. J. that: 1. I am { sun ilimp with the requiroments for on-site sewers and wells as set �or th by the Municipality o[ Anchorage (IMA) and the State o[ Alaska, 2. I installthe inMOA will system accordance with all codes and/rugulations,, and in compliance 000 the design criteria o[ this permit, 3, I to MOA State Alaska 4 o the back will adhere all and o{ requirements set distances TrOm any existing well� wastewater disposal systnm or public sewerage system on this or any adjacent or nea?bylot. � 4. I that this1 is i understand permit valid and any enlargement will requirean additional permit. . IF A LIFT STATION IS INSTALLED IN AN AREA BY MOA CODE3� COVERED BUILDING THEN (1) AN ELAM TRICALPERMITAND INSPECTIONMUST BE OBTAINED; (2) Ash B11111353 WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. ~ 1-11 ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: (��-J_ 1 `"'f �7�-•'��' "� �A`M�� RSLOPE SITE PLAN � Cji'i �?4V1 Ci r 2 3 v c� 4 P/ 6 a ? 0, ( '--2 —7 c�J✓ I13rL. Ste• 8 y� 4C1 10- �'�P� Y��•P11�B� v'- �y•ia lv'i VyOye V4Qi 14 18c �awS(l' 15 16- 17 18- 19- Reading 819 Reading Date � nR t� iaPy. Net Time Depth to Water Net Drop AS GROUND WATER S 1 4 y �E}NCOUNTERED? �� L 1`.3o ✓�_� � _ .woe •nr a nae ae ° ry x cCq zy y P 12 ' E j ii U r <e n 7m�n�oaa«.o+•ay�;Y Robert R• Shaffer YES, AT WHAT EPTH? t; '2��©P 13 C `IZ No 1437-F v'- �y•ia lv'i VyOye V4Qi 14 18c �awS(l' 15 16- 17 18- 19- Reading 819 Reading Date Gross Time Net Time Depth to Water Net Drop 1 4 y 16 -F -I -0 1`.3o u (0Iq- j ii 3 '2��©P ►� C `IZ S ?Jl`i 1 VC) tl U N Y4- 20 PERCOLATION RATE C> (minutes/inch) TEST RUN BETWEEN a FT -ND �1 FT COMMENTS PERFORMED BY: -_.>,; 72-008 (6/79) CERTIFI DA Lr a 3 Y� to N ® J m ® Q Y Q) Q ZLLIQ Q W z _ Z WjX to w LLI -j r _ Qrc N M X IA O P: or W Wo W u J 02 } 2 U) Y p Ir U) Q 0) a �0) 0 LD LU J 2 Public sewer E- LT. ter. w w w w w kF„ w MUNICIPA�I7Y OF AMCHOitAGE E DEPT•. OF'HEA O E- 'FQ'EN p�� 0 O F 1- E"-�J�(� -.4 FW W F F W t VU r7 W W w w w x w :"EP: vi : 1 El r8 0 bi x PC) 3 Lq i J 3 > 3 q d O a O rx w d W z d q F Public sewer E- LT. ter. w w w w w kF„ w MUNICIPA�I7Y OF AMCHOitAGE E DEPT•. OF'HEA O E- 'FQ'EN p�� 0 O F 1- E"-�J�(� -.4 FW W F F W t VU r7 W W w w w x w : 1 El r8 0 bi PC) CY): i J q ' • � W w d q F W VD vFi N .• VD M: rr-C r L W I I I A O F .Wl HF O [- O F O F O F O F O F 3 a A Public sewer E- LT. ter. w w w w w kF„ w MUNICIPA�I7Y OF AMCHOitAGE E DEPT•. OF'HEA O E- 'FQ'EN p�� 0 O F 1- E"-�J�(� -.4 FW W F F W t VU r7 W W w w w x w SRI NOTE: If community wastewater system, provide written confirmation from State'ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 : El r8 bi � N .• N : M: rr-C r L O F O F O F O [- O F O F O F O F O F O F O F O F w w w w W F w F w F w IH w F w F w F w 0 F" Oji N N w O Q O a W O x w O c4 w O cG w O x w O x w O a w O cG w O x w O oC w O W w O rx w z U SRI NOTE: If community wastewater system, provide written confirmation from State'ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 I S. 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 of this Health Authority Approval application 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. l 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 17034 Eagle Address Engineer's signature 6. DHHS SIGNATURE /� Approved for T� `� bedrooms. Disapproved. Conditional approval for Additional Comments No.204 Phone — Date d W of .y ��• jt�o ¢�� bedrooms, with the following stipulations: By. d ,��� (0'4_�� Date q-- / 3 ` �73 ,l1TIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates 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 federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. - .,?_�_ 72-025 Rev. 1/91) Back MOA p21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: "T \ A dA SccmPsmA Parcel I.D. 0�s- / - r"(- rI A. Well Data P�k�t e�� If A, B, or C, attach ADEC letter. ADEC water system number Well type \� S / Log present O/N) �! Date completed C& 3 g Driller CV! 1 C-- bA-9-OtJS Kr Total depth \le L' Cased to \Lok Casing height I -L - Sanitary seal &N) Wires properly protected 6%) I— FROM WELL LOG AT INSPECTION < C o n Date of test �`as fY1 -�3 -a m y 7- Static water level 4?i \23 M < < p Well flow 10. C) co g.p.m. `�� g.p.m. m C) z t Pump levell r -n 6rd N C ti c SEPARATION DISTANCES FROM WELL TO: z Septic/holding tank on lot \ 0 o � ; On adjacent lots Absorption field on lot \ tom' ; On adjacent lots `,\nom Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform b Nitrate b•`\� Other bacteria tp Date of sample: 3 l q 3 Collected by: S& S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 94577 Date installed Tank size Compartments Cleanouts&N) Foundation cleanout N) \l Depression (Y�Q High water alarm( r 1` Alarm tested (Y/N1 Date of pumping \�� io -�l?� Pumpert, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots \ d , Foundation To property line Absorption field t Water main/service line Surface water/drainage "Op 72-026 (3/93)• Front CONTINUED ON BACK PAGE Client s Ple :93.°452-3 ID 4Lig Rq 'PDRT, SIB af.ANALX" - -- fiAMPS©N :WATER - _... _ Client Name Ordered ' Ry INKING - 5633 B S7REE7 ANCHCRAGE,AK 995, TEL: (507) 552.2343 Project : R. SHAM -WORK Order FAX: (907) 601 sao .530, , ' PWSID . :UA , Report :Com :70386 Dallected Pleted ,09/07/93 _ Sample Remarks: ROUTrNE fiAtsPLE Received '08/31/93 @ 15• = Technical :.09/01/93 :g5 hrs Difiector:STEPH @ 12 g0:h Ts. Released By C. COLL�'CT'R� BY:RAX.' EOE - Parsmetei ---�-- Nitrate -N-- ----------------Results - _ _ QC -- -- Qua, Units ---------------------Limits.,Mhod et Allowable 0.99 Ext . -. .Date --------4 g/L EPA 353.2 /300 -"-----------�--- _09/03 Anal Date Init- .0 10 LLH `'' '"•" • ,n •• •" TELEPHONE (907) 562-2343 A0 5633 B St t -- rea . Anchorage, Alsskg 99818. Drinking Water Analysis Report for Total Coliform Bacteria f TO BE COMPLETED BY WATER SUPPLIER I] PUBLIC WATER SYSTEM J.D. # ORr PRIVATE WATER SYSTEM 41-0hg A -0"—u car s+me zo code SAMPLE DATE: C ' = vo, Day Year SAMPLE TYPE: W-Routlne © Cheek Sample (for routine sample With lab ref. no._ ) 0 Treated Water 0 Special Purpose O Untreated Water TO BE COMPL&D.BY_LABORATORY t Analysis shows this' ater SAMPLE to be: Satisfactory Q Unsatisfactory Q Sample too long in transit; sample should not be over So ;hours old at examination to indicate reliable results, Please send new sample via special delivery mail. bete Received 9 Time Received 2 9f4 Analytical Method: Mernbrane Fitter " No, of ooloniesHoo mi. Analyst � Y wwormriwmi Rspert.d 13y TNTC -Too N 1 UJITI r UM 0 Caunt' x > , 4 OB - Othet"B81CtOt15�" .�i`St.';�_ x, ,•->�. _r. .r.�;r.'? ,6..,xz:'.v "�,. ... ,_n-.�,.,,,.. ,. dry ',ems a.,w-r:3E��. _..__u__� �.�.4,xi.u' ..-.,._.>. ..,..yst�. t 0 , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION " DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 0 1 In s t399- 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 0- r;5t�K, A- Location (address or directions) t:=,� '!§, 1'14 PKK 2�P� C-9, (b) Applicant Name Telephone: Home Business Applicant Address (c) Applicant is (check one): Lending Institution E7 ; Owner/builder Buyer E7 ;Other ® (explain); on (e) Lending Institution Address Real Estate Company and Agent Address Telephone (f) fait the HAA to the following address: 2. TYNE OF RESIDENCE Single -Family D�- Multi -Family ® Other Number of Bedrooms Telephone 3. WATER SUPPLY Individual Well Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 0- Public E] Community 11 Holding Tank El Note: If community well systern, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (> 1184) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by rnyseal 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 1, t•J SJIi'i Address Date W 6. DHEP APPROVAL„ t� r 1 "� Approved for '� bedrooms by - ' �� f _ Approved ----�� --_ Disapprove'Conditiona Turns of Conditional Approval CAUTION ,r Data Anchorage Department of Health and Environmental Protection (DHEP)issue- Heal?h Ar,tti sty r'd�+ solely upon the representations given in paragraph 5 above by an indepen""ni late Of Alaska. The DHEP does this as a courtesy to purchasers of honleS jnd ! r F �� ;' certain federal and State requirements. Employees of DHEP do not a3t g Ifo" a rficate is issued. The Municipality of Anchorage is not re, pan, e f r u , xt t p Y 9 S :. ! $ �w. �i�k��t�aS�Ff?rj WIN t1, 'V.I MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) n�ppC� CHECKLIST- FEBRUARY 1984 AUG 13 985 264-4720 Legal Description: - r ) c3Rfii EtV F A. WELL DATA Well Classification S If A, B, C. D.E.C. Approved fY/N) Well Log Present ON) Date Completed (z' " 22' ��_ 157 Yield Total Depth (fit Cased to It ll ( Depth of Grouting +� Static Water Level �1i' Pump Set At Casing Height Above Ground Sanitary Seal on Casing CON) Electrical Wiring in Conduitd N) Depression Around Wellhead (Y4Q Separation Distances from Well: To Septic/Hekkrrg•Tank on Lot 1 J:�' ; On Adjoining Lots ec '- To Nearest Edge of Absorption Field on Lot , t-475 ; On Adjoining Lots J To Nearest Public Sewer Line fa To Nearest Public Sewer Cleanout/Manhole lA To Nearest Sewer Service Line on Lot t �' Water Sample Collected by `� �' � �"� �^ � 2 j ^ �G= Date `3— V? — '�_55 Water Sample Test Results Comments B. SEPTICFM8619ING TANK DATA Date Installed Le' I _ `ear Size L No. of Compartments �- Stand pipec/N) Air -tight Caps ON) Foundation Cleanout (9N) Depression over Tank (Yjq Date Last Pumped Nsk�) Pumping/Maintenance Contract on File (Y/N) / ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) NIA Separation Distances from Septic6J6ng Tank: To Water -Supply Well To Building Foundation To Property Line I To Disposal Field r To Water Main/Service Line t t To Stream, Pond, Lake, or Major Drainage Course >✓ /A -- Comments _ Page 1 of 2 72-026(11/84) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC* or TELEPHONE (90f) 562-2343 ANCHORA 5633 B INDUS CENTER t..o..rswr.. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: SSS Water System Name Phone No. (•) See h on back - Z-' Mailing Address %S— 77 �, J ice'; State ZIP code city SAMPLE DATE: ® 'L+'—'_—' RO Mo. Day Yea SAMPLE TYPE: - .- g!¢ Routine [3 Check Sample (for routine sample 1 ❑ Treated Water with lab ref. no. b3� Untreated Water ❑ Special Purpose SAMPLE Time Collected NO. LOCATION Collected L/ 2�l'sc�.�J �5i II 3 4 5 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: 6S atisf actory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: -moi^g5� /moa — ❑ Fermentation Tube IOiMembrane Filter Lab Ref. No. Result' Analyst E M e ✓. /; /- �_J m *No, of colonies/ 100 ml or No. of Posit" Portions 09.1220 Ib1 BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1983 col Iforrn1100ml READ INSTRUCTIONS Membrane Filter. Direct Count BGB verification: LTB Coiltorm1100m1 Final Membrane Filter Results. BEFORE - _Date—� Reported By / Time: a.m. p.m. COLLECTING SAMPLE TNTC = Too Numerous To COU!It C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes "Pump on" level at SEPARATIONDJST-A-NCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) Level at Cycles tested On adjacent lots Surface water Date installed (o ,1 --C?� S Soil rating (GPD/Ft2) 3 k g System type Length -1S Width -15a Gravel thickness -7% Total depth i. ) Total absorption area i o'5�� Cleanout present ((y N) T_Depression over field (Y49 x-( Date of adequacy test C� '-i X93 Results /fail) Foy 5; for 3 Bedrooms Water level in absorption field before test y 14 After test 4'7 M Peroxide treatment (past 12 months) (YA&) "�yt� 6- l" VJ�s If yes, give date 'L'� Ar SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot_ \ \'�% On adjacent lots \ O ,�, ` k Property line 110, -- To building foundation lit> k To existing or abandoned system on lot �� `A -- On adjacent lots Cutbank_ r1 Water main/service line Surface water oDriveway, parking/vehicle storage area j Curtain drain r' ti E. ENGINEER'S CERTIFICATION l certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERI Signature ��nse , Engineer's Name Eagle River aska 99577 Date HAA Fee $ v Date of Payment Receipt Number i 72-026 (3/93)' Back Waiver Fee Date of Payment Receipt Number bed A. Nva 1457-G Waiver Fee Date of Payment Receipt Number C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design "r0 =� L V1 Date Installed Lr - Length of Field _ Width of Field < Depth of Field Gravel Bed Thickness o I M Square Feet of Absorption Area L C5--� Standpipes Present ON) Depression over Field (Y40 Date of Last Adequacy Test 's Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation t Lot P tT To Water Main/Service Line VC7) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed fi To Property Line To Existing or Abandoned System on I On Adjoining Lots "moo ,` / To%utbank (if present) � tJ � d 1. Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Eq Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S " F°dC(hiEi iiii'•fG Date '3iiJ fbV b,i t;ttt f ,^:LLtS"', a`fl - MOA Company"' No Receipt No. Date of Payment s , e Amount: $ a Raberl�3hafrr o• •�'` , G. v No. 1457•E XN Page 2 of 2 �!sF�Pb••.,vn,-�`*� .,r 72-026 (11/84)