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Home My WebLink AboutT12N R3W SEC 15 LT 64AT12N R3W Sec 15 Lot 64A #015-052-44 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221083 PID Number: 015-052-44 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name BRET & NANCY BURROUGHS ABSORPTION FIELD ® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 9541 ELMORE ROAD, ANCHORAGE, AK ❑ Other Phone Number o f Bedrooms Soil Rating Total depth from original grade 3 0.8 GPD/SF 13 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade EAST END 7 Ft. Gravel depth beneath pipe 6 Ft. Subdivision Block Lot 64A Fill added above original grade VARIES SEE DWG Ft. Gravel length 50 Ft. Township Range Section T12 R3W SEC 15 Gravel width 2 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 600 Ft2 1 -- Ft. Well -- 100'+ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer EXISTING Capacity Gal. Surface water -- 100'+ Material Number of compartments Lot Line -- *rj'+ NA Foundation -- 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks*2022 MOA WAIVER. TIM ECKLUND MOA TOTAL DEPTH 13' MAX AT EAST END. Alarm location Electrical installed by Installer MIKE N ANDERSON, PE PIPE MATERIAL House to tank 3034 d a n Tank to 3034 Drainfield 3034 CO/MT 3034 Inspector FWC / MNA BENCH MARK (Assumed elevation) 100 ft Inspdection lst 4/23/22 2M 4/23/22 Location and description 3rd 4/24/22 4`h 4/27/22 GARAGE SLAB ON-SITE WATER AND WASTEWATER SECTION APPROVAL .roF A. Conditional Approval: Date i TH •• •••• ••••.....• SepticSyste A� '. Curtis Huffman Date"� �� 'FG, •. CE 128991 �� 'lF�•. 4/28/2022.- 0 liSSIDN�4 Note: this approval does not include well permit requirements. kov I PID: 015-052-44 PERMIT: OSP221083 A—C=46,8' B—C=24.7' A—D=44,4' B—D=58.5' A—E=47.2' B—E=55,2' A—F=70.1' B—F=44,1' EXISTING FIELD TH22-1 CO VERIFIED & ATINSTALED---,S.T.BARRIERS AT S. & FIELD DFCO W/ STEEL CAPS., A BM: GARAGE SLAB EXISTING 38R HOUSE //FCO W/ STEEL �u�u CO MT RISERS & CO z BARRIERS--C-0-- p ARRIERS0 103.1 INSUL 1.250—GALLON 98 I STEEL TANK 2003 INSTALL 92.9 BM: GARAGE SLAB CO F LOCATED WELLS & PL — -- _ —INSULATION PRIOR R TO CONST. INSTALLED _ �— DIVERTER GRAVEL C DRIVE DCO Co EXISTING S.T. & COS BI VERIFIED 100' TO WELL PRIOR TO CONST. f FINAL GRADE FILTER FABRIC SEWER ROCK SEPTIC SECTION — NTS MNA INSTALL Go GRADE 98.9/ SM/gm — soft MNA — RAKED SIDEWALLS 92.9 TD -12.6' DRY -4/15/22 LESS THAN TH22-1 13' MAX 19' 86.5 BOH 2N R3W SEC 15 LOT 64A SUPPORT SERVICES: AZ,PREPARED FOR: �� OF �� BRET & NANCY BURROUGHS 9541 ELMORE ROAD C *�9TH ANCHORAGE, AK 99507 FIRST WATER CONSULTING DATE: 4/28/22 tis Huffman SURVEY: HOLT t 128991 13030 SUES WAY DRAWN: FWCS ANCHORAGE, AK 99516 SCALE: 1" = 30' 4/28/22 907-350-9566 firstwaterAK©gmail. com PAGE: 1 of 1 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PQ Bux TD W.50 47LID Elmore Rmxf Ar-dicirage, Alaska SS51!R-6050 Phone: (907) ;i43-79ail Fax: (90 7) 343-7997 hitptf'A%-,m,,v,mtini.arg?cnsO,e Porynit Number. OSP221083 Work Type. Septic Upgrade Tax Coriet4umber, 01505244000 Site Legal Address: T1 2N R3W SEC 15 LT 64A 0:2435 F-Imore Site Mailing Address: 95541 L�RD, Anchorage Owner BURROLJOKS BRET M & NANCY A Design Engineer FIRST VIATER CONSULTING Effective Date. Expiration Date-, Lot Size in Sq Ft, Total Sedroorns; 411 ('2022 411812023 5448G This permit is for the construction of-, Disposal rield El Septic Tank 0 Holding Tank 0 Privy L7 Private '.'Vell FJ ItVater Stauage All Construction sh.911 be in accordance with: 1. Theattai;hed approved design. 2. Alt, requirements specified iri An c.horage Municipal code Choptar515,55 and 15.e5 and the State of Alaska Wastewater Di�sposal Regulations (18.AAC72) and Drinking Water Regulations (18AAC'80) 3. The %vastowater rinde rpqiiirr..,z ingpi�O.lon� Haring the irstzllatjQn. ThQ origittPror sihall riotify the Dayelopment Services Department per AMC f5.65, Provide notiricatlon by caldinei 0077) 34-3-79U4 (24!7). 4, From October 15 to subsurface April 15� a soil absorption 8-ystern �;ndeT construction during freezing Ymather shall be either: a- Opp -tied and Closed on the same day, or b. Covered, sealed, and Iroated to prevent freezing RecO.eed By: Issued By.pry 4/18/2022 Date; Date� I Municipali P.O. Box 196650 ® 4700 Elmore Road Anchorage. Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section vARIANCV'-J/WAI"V'r'-jlx'3%.Rr-jV Vi Waiver#: OSV221023 COSA#: Permit#:OSP221083 PID#: 015-052-44 Legal Description: T12N RM Section 15 Lot 64A Engineer: First Water Consulting Applicant: Bret & Nancy Burroughs n�cnt i I)c:paruneor Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. In addition, your request to install the absorption field perpendicular to slope contours has been approved. See engineer's waiver request for justifications. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ■ a a a m m a a a i C a a a a a i a a a a a i a a a a a a a i a i a m i a a a a a a a a a a a a a a m a a a a a a m a a a a a a a a a a a m a a a a m m a a 1 Waiver is Granted: X Waiver is not Granted: Date: g�o2CJ� Approved by: a6x�_ 6_�& Name of Reviewer ■■aaaaamaaemamaammamaaaasaaaeaaaaaammaaammmaaaaaaaaaaaeaaaaaamamaaaaaammaaamma. ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-052-44 Property owner(s) BRET & NANCY BURROUGHS Day phone Mailing address 9541 ELMORE ROAD, ANCHORAGE, AK 99507 Site address 9541 ELMORE ROAD, ANCHORAGE, AK 99507 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T12N R3W SEC 15 LOT 64A Lot Size 54,480 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: (® all that apply) .Upgrade Absorption Field Renewal Septic Tank ❑ ... Holding Tank " Privy Private Well ❑ Water Storage ❑ APPLICATION IS AN Initial ❑ .Upgrade ❑ Renewal ❑.. THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) ❑ (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) FIELD -- PERP TO SLOPE & WITHIN 10' OF N PROP. LINE Distance: TBD 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: Date of Payment: �i �� 5 % o� 0 9 Receipt Number: a 1 51 b q Permit No. Q S r,�� 1 0? 3 Waiver Fees: $ a 0 FJ Date of Payment: _ Receipt Number: Waiver No. D�S V �Q 1 ?j GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com April 15, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT WITH WAIVERS LEGAL: T12N R3W SEC 15 L64A 9541 ELMORE ROAD The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one deep trench to serve the existing 3-bedroom residence. The design is based on the recent test hole conducted on April 8, 2022. No groundwater was observed at test hole excavation or monitoring or in the surrounding soils data. The slopes are moderate at 5% at the proposed upgrade location. The trench will be perpendicular to slope and within 5 of the north property line and we request waivers as shown on the design. We took elevation shots of the area and also propose to verify existing septic tank barriers and protections of the existing system at construction. We proposed to keep both the existing and proposed fields via the proposed diverter. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221083, Rebecca Carroll, 04/18/22 Project Name: OSP221083 Project Description: T12N R3W SEC 15 LT 64A Review Comments List Date: 4/18/2022 Changemark note #01, DESIGN PG2.pdf Please address the change in elevation over the length of the field and how to ensure that the entire effective depth is in the perked SM/GM layer. Responded by: BRENT WESTERN - 4/18/22 2:38 PM We took elevation shots of the proposed field area (5% slope) and the DCO. The existing DCO is 4' from grade so 4.5' at the proposed field lateral mid point of the 501 trench. Using the elevations and proposed field run of 50' there is about 3' of elevation difference and the testhole /groundwater is ok. we can always do a confirming TH too if need be. The western lower proposed trench end is 3' from grade, the middle at 4.5' and the upper slope at 6' with a total of 6' ED that is -12' TD or 1' of fudge room. it was designed conservatively speaking. You can always place a permit note if need be. Thanks! Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221083, Rebecca Carroll, 04/18/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221083, Rebecca Carroll, 04/18/22 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: T12N R3W SEC 15 LOT 64A PERFORMED BY: FWCS / FWC & MIKE N ANDERSON, PE - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 4/15/2022 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 5 6 7 8 SM/gm - soft 9 10 11 12 13 14 15 16 17 18 19 20 BOH Reading Date Gross Time Net Time Depth to Water Net Drop 4/14/22 30 min 6 3 30 min 6 3 1/16 30 min 6 3 PERCOLATION RATE 10 (MIN / INCH) TEST RUN BEWTWEEN 5 & 6 FT PERC HOLE DIAMETER 6 PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 4/15/2020 TESTHOLE # 22-1 DATE PERFORMED: 4/8/2022 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT & WELL & PL AT TIME OF CONSTRUCTION PERFORMED FOR: BRET & NANCY BURROUGHS 4/15/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221083, Rebecca Carroll, 04/18/22 Municipality of Anchorage ,•'"' '';•, .� Development Services Department i Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page I of 3 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW030452 PID Number: 015-052-44 Name: Gary & Judy Skaggs Wastewater System: ❑ New El Upgrade Address. 9541 Abbott Loop Rd., Anchorage, 99507 ABSORPTION FIELD Phone. 346-3335 Number ofBadrooms: 3 1 Trench O Shallow Trench❑Bed ❑Mound ❑other. LEGAL DESCRIPTION Sol Rating Total Depth from original grade: GPO/F!' Ft. sion: Block: Lot: c 4 A Subdivision: Depth to pipe bottom from an grade: Grevel depth beneath pipe: V•� FI. Ft. Township: 12N Range. 3v1/ ion: 15 Fill added above original grade: Gravel Length: Ft. Ft. We ❑ New ❑ Upgrade Gravel width: Numbs doer. Distance between Ines: . FI. Ft. Classification (Prate, A, Trial Depth: Cased to: Total absorption was: Pipe Material: Existing Ft. I FL Ft' Driller: Da led: Static Water Level: Installer. 1{ Date installedQ / �I ' � � llll •� FL YmNd:Pump Set at Casm^B Hem Grou^d' TANK GPM FI. SEPARATION DISTANCES ElSeptic El Holding ❑S.T.E.P. ❑Other: To From septic Tank Absorption Field Lift Station Holding Tank lublictPrivate Sewer Line Manufacturer; Anchorage Tank Pauly: 1250 Gal. Material: Number of Compartments: wen 130 145 NA NA NA steel 2 Surface Water 100+ 100+ NA NA LIFT STATION mze: en adurer. Lot Lim 30+ 15+ NA NA V NA Gal. 9 'Pump on' level at: 'Pump olr level at: Wgh watt/ alarm at Foundation 5+ 15+ NA NA �,, a,. In. NA NA NA NA Pump Make d Model Elecperformed trical Inepecbons perfoed by: carlein Drain Remarks: Tank changeout. Old tank was removed and a BENCH MARK new tank put in its place. Two double cleanouts Locabon and Description: garage slab mad bvalwn: installed. Barriers installed around the tank FL 100.0 to prevent driving over it; it is partially in the driveway. En *' 4_9TH' Cindy W. Ellis, P.E. at 10/25/03 Inspections performed by: y Dates: 1 •:>♦• +F• ••/y�� " NA L'• ria j J Y �� 2nd Cin Development Services Department Approval 0%... W. Ellis; . CE by: Date: b =� ��.• -10577 Reviewed and approved (Rev. IZ'eb) r°4pFfS$IONAt-G/�i��c A9 S 89°59'21 "W 3313.18' Exis ingttrainfield----.__ Existing 1250 gal septic tank removed. i C3— New 12b0 gal-steetseptic tank installed._ _DC 3- 1e s around tank (5) 4x4 post Barriers °RA%'eL r +' ,SBM DC01 2 TST1 C j B \' I, A 1ALT Existing 3 BR house I ' J j Existing well 100 ft r iuk '� Property Line _U A B DC01 40.0 10.8 DCO2 40.0 it5 55.3 ST1 40.3 12.3 55.3 43.7 19.7 56.0 DC03 44 21.8 56.8 DC04 44.7 22.8 57.2 Well serving lot 64A ASBUILT 100 ft well radius Lot 64A Lot 65B Septic Upgrade for Gary & Judy Skaggs T12N RM, Sec 15, Lot 64A �' _*��49LH Watkins Engineering, Inc DATE: 11/01/03�"`''`'" CindyW. Ellis, RE . CiriPY W. Ellis PID No. 015-052-44 P.O. Box 110443 Scale: 1° = 30 ft •. ce-+0577 Anchorage, AK 99511 "'c0-'1 �^' Phone (907) 349-1851; Fax 349-1934 Permit No. SW030452 Final Grade: 101.52 ST1 ST2 98.46 2" rigid insulation 97.98 / 1250 gallon steel septic tank 97.67 Tank Profile ASBUILT No Scale OF.. A p� "'�'�.sVup T12N, R3W, Sec 15, Lot 64A Parcel ID 015-052-44 ��`� ' Septic System Upgrade permit # SW030452 0��' 49 rH % p, Gary &Judy Skaggs .:.....:......• ...,_::....� 1,14d4 D�� :, GC.y"' ' CWD 0 0� Watkins Engineering, Inc. 10577 •` C�4•�^ Cindy W. Ellis, P.E. v •� *8Dio , �G� November 4, 2003 Ir O'Z IO3-3rryi MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030452 Legal Description: T12N R3W SEC 15 LT 64A Design Engineer: 0844 Watkins Engineering, Inc Owner Name: GARY & JUDY SKAGGS Owner Address: 9541 ABBOTT LOOP RD ANCHORAGE. AK 99507-4223 Date Issued: Oct 22, 2003 Expiration Date: Oct 21, 2004 Parcel ID: 015-052-44 Site Address: 009541 ABBOTT LOOP RD Lot Size: 54480 SO. Ff. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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. 1 5:'The" following'speciai provisions" - tA PERMANENT BARRIER SHALL BE INSTALLED BETWEEN THE PROPOSED SEPTIC TANK AND THE .DRIVEWAY TO PREVENT VEHICLES FROM DRIVING ON THE SEPTIC TANK., Received By. Issued By: Date: Date:/Q/2 2103 Municipality of Anchorage t" Development Services Department 4 Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-052-44 it Permit Number SW 03043-2 Property owners) Gary & Judy Skaggs Day phone 346-3338 Mailing address (1) 9541 Abbott Loop Rd Mailing address (2) Anchorage, AK Zip Code 99507 Legal description (Lot, Block & Sub'd.) T12N R3W, Sec 15, Lot 64A Legal description (Section, Township & Range) Lot Size 54,480 Acres Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: SWell Only Elewer Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade a- iik 6o ❑ THIS PROPERTY CONTAINS: 13 Jacuzzi Hot Tub ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I 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. PE, (Signature of property owner o&thorized agent) Permit Fees: L1h7 I, Waiver Fees: Date of Payment: �'� 170 NT Date of Payment: Receipt Number: Receipt Number: (Rev. 12100) Watkins Engineering, Inc. P.O Box 110443, Anchorage, AK 99511 (907)349-1851 cwellis®gci.net October 20, 2003 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: T12N R3W, Sec 15, Lot 64A Septic Tank Replacement To Whom It May Concern: Attached please find an application to install a new 1250 gallon steel septic tank at the referenced 3 bedroom house in Anchorage. The existing steel septic tank was installed in 1983, and a hole was found in the tank during a repair. It will be removed and the new tank set in the same place. A foundation cleanout will also be installed. The drainfield has been tested and no work is proposed for it. There are no surface water concerns, and the new tank will be placed more than 100 ft away from any private wells. I am not aware of any adverse effect that this upgrade would have on any adjacent properties' water and wastewater treatment needs. Thank you for consideration of this permit application. If you have any questions or need further information, please call me at 349-1851 or 360-3389 (cell). Yours truly, Cindy Illis, P.E. President v M G: Class C well CL Lot 57 O J Vacant Lot 58 0 .n .n B B9'59'21W 330.18' � 200 ft well radi s 0 o Lot 63to CO 0 b „ j Lot 64A �w o b B ---- — — Hrn ----------- East 96th Ave. 100 ft well radius LL SERVIN LOT 64A� Vacant ,\100 ftwell radius Appro imate well location 0 Lot 65B Little Tiny SID Lot 1 11�J Lot 72 Septic Upgrade for Gary & Judy Skaggs '�`'" A'� T12N, RM, Sec 15, Lot 64A 49- TH� r Watkins Engineering, Inc. DATE: 10/17/03�"� -" Cindy W. Ellis, P.E. PID No. 015-052-44`• Ci dy W. EIIIS ; Scale: 1"= 100 ft CE-10577 ; P.O. Box 110443 Taken from Shane Holt Survey, LS-6914 Anchorage, AK 99511 October 15, 2003 ssiow� Phone: (907) 349-1851: Fax: 349-1934 S B905912 1 "W 330.1 8' ----:__-Existing drainfield. No I worcT—prbposed-----__.__ -- DCO ------------------------ .�- Existing 1250 gal septic tank.oR, ----------- -anEN,Av \ �-To be removed d a new �2�� g Install FCO steel septic tank install \ Tank to house 5 ft �I i ASP SALT Existing 3 BR house i ' J j Existing well 100 ft r iuk Property Line Well serving lot 64A 100 ft well radius for Lot 65B well Lot 65B 100 ft well radius Septic Upgrade for Gary & Judy Skaggs T12N RM, Sec 15, Lot 64A Watkins Engineering, Inc Cindy W. Ellis, P.E. P.O. Box 110443 Anchorage, AK 99511 Phone (907) 349-1851; Fax 349-1934 DATE: 10/20/03 PID No. 015-052-44 Scale: 1" = 100 ft Lot 64A 1 _ 5 • ET Clgdy W. Ellis M iom H SAFE f F.ASI'M�'Pr'" ^"7,i,VALL� CQN11IDEP/TION, JADES W. CO'JP,LEY and 11AF• E. i...... an! Wrifc, hereinafter referred to n- OFANT')V20 and r;ONVEY reasonable right: of inarc:: and lc._at^d on the followlnr, descrlbcd reel i,rnoert:r: Lot G5, Section 15, Township .12 North, P 3 West, Seward,Mcridlan; in the Inchova;�e Recording, District;.,^rird :7l.:trIet, State of Alaska.'::•' :c o;;%p LL EVER : i WELLS and MARINE IIAP•IE WELLS, husband !:erclnaftcr referred ts','as,GRA`ITEES, their heiro, ur•c:: �r.: and a -::inns and shall'not run with the land. Said •. '.nll !.� u. --ed ',nly by the GRANTEES, thetlr heir-, :c.. a::i a:..:l r..• and --hall not be used by the nubl'_'.. Tha GiiA;1;'=", their heir--, cuccezzorz and a:.ziirns, here- �'';rec :•rlth the GRAt. FS, their heirs,succeaoors and a::--lgns, if tno :•cell located on the above-described real prop^rty is jj1,ar.dorv:d,lf read In built, or abandoned for an9.other rea--on, the :aA;:':EE•;, their heirs, succesnors.and assigns, shall fill the well lt!. acccptatle fill material,at the .GFAIITEES, their heirs, :u^c1:.7• :r:! and expense. ,J� D LD this, �,�C clay of , / �l+C6T 1474. i .-ALL °Srii!:E'i": 'r;CLL3, G1'aC1LCN �' J tdES '' , GUUHLEY, Grantor 'I , . ' / iG/ L. `t' �, , •�.. Vic/ ;;AA I iE i,IARIE WELLS, Grantee 11:, A a GOU RL: ,vGrantor,: j 'i urS IS i0 C!i!:PI:'Y that an thS: T?/ da" of Xi1,/ :11tnte cf Alasku,'10�perronallyyappeared OP.RALLuEVhe under.. a No ERETT and ."o I•IAR1E WELLS, known to ,ne and Y•nonn to be the individuals q.nmrcd in and ::he executed the foregoing'instrunent and they acknow- I�cd,-ed to ne that they sirned the Dame freely and voluntarily for ;I Lc u-nz and purpose:: therein stated.:' A 1T.1wSa n:i hand and official seal the day and year last 9:::0:•-• .rltten. DAER, BARKER e.' & NANGLE AT,ORNE" AT LAW 7Q1 --It 3tRCCT. EUITC ! ANLNtMAGC. AL^!. A D1,M, • . .'(. ,,:,•, notary ,Public in and I'er, Agaaka • •r. ;Commission exDirCy -1- I O CFfP.".'TFY that, cn thic da, of ��<•I .� the ur:era/Encd, a Notary.Putlie in and Tor thr-• r,f ; appeared"JAM25 W.'I GOUnLEY, and 14.1E E. ::is f^raon111;; 'rna:Ir. to �I! and knewn ;to be 'the individuals named in and �•r.;.,,.;Ir1 :ia; forerolnr instrument and they acknowledced to ne ••:. • tt:^? .::rn^d t�,^ name freely ,and voluntarily for the uzcs and t. 'r:^•Jif, tili•CII. I, Zt my hand and official deal the day and year la" otary ubl c n an or Ala ka i14y:Co+nnission'expires /7 i; h I �1 C ? "r� it • _ i 74.. I ea , II r �I N ,I • BAER, BARKER 6 NANGLE i AII(IRNE" At LAW INN •'If' SIR[ L I. SUI IE I ANCIK AGE. ALAV_ A :n IN. I ,1 i� 'NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT QF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE [)ISPOSAL SYSTEM AND/OR WELL INSPE!CTION REPORT PHONE []NEW ~I3~PGRADE MAILING ADDRESS EGAL DESCRIPTIQN LOCATION O,STANCE TO: I ILq. c pacity ngalons] Manufacturer DISTANCE TO:I ~P I T°P °t tile t° finish grade ¢/ %; Length Width ~ ~ Type of crib Crib diameter Foundation Total length of lines NO. OF BEDROOMS PERMIT NO. No. of compartments Liquid depth Dwelling PERMIT NO. LiquM capacity in gallons Material beneath tile OTHER PIPE MATERIALS ~OI L TEST FCATI NG INSTALLER REMARKS Depth Crib depth Material Nearest lot lin~,~ ~¢_ ,/ Trench w'dth PERMIT NO. Distance between lines Total effective absorotion area PERMIT NO. DATE tO- APPROVED Total effective absorption area BuiMing foundation Nearest lot line Driller Distance to lot line PERMIT NO, Sewer line Septic tank Absorption a~ea(s) LEGAL 72-013 (Rev. 3/78) oGRE ':R ANCHORAGE AREA BOR"'IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /~o~£7~T- ~L2/~/- ~, MAILING ADDRESS ¢?: ~// ,~)D'/yd?-2 /.r.o~ ~°!) PHONE }J~/~/~/~C' LOCATION ¢4¢¢// SEPTIC TANK: DISTANCE FROM WELL ~0 ~ __MANUFACTURER INSIDE LENGTH INSIDE WIDTH MATERIAL NUMBER OF _ COMPARTMENTS. LIQUID DEPTH _____LIQUID CAPACITY//~g~O GALLONS. SEEPAGE PIT: NUMBER OF PITS ~ --. DIAMETER OR WIDTH/?'/'~[ L. ENG'[H/~-_/,/ DEPTH ~ / ~ LINING MATERIAL(%No~-*Z:T/ ~]¢~RIB SIZE:/C~uDIAMETER__DEPTH _ DISTANCE FROM: TOTAL EFFECTIVE BUILDING FOUNDATION(~¢'/ , NFAREST LOT LINE~2¢~ . ABSORPTION AREA (WALl_ AREA) WELL / .SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE (~" / ] ~' L~ /~'~ BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES__ _ DISAPPROVED__ NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: INSTALLED BY: PiPE MATERIAL: (~/],~,~/ -,/~ LOT SLOPE: ]V ~ /~ L~. REMARKS: Form NO, EQ-O31 DIAGRAM OF SYSTEM DATE APPROVED ~ ~'-L~/- C~.~ ~ G.A.A.B. Permit ~ Applicant: ~./~ ~/.~ Location: Type of Soil Absorption System Is: Trench: _~/. Drainfield: Maximum Number of Bedrooms: ~ Department [ Health and Environmenta 7rotection 825 ~ Street, Anchorage, AK. ~9501 /~ 264-4720 ~ * * * HANDWRITTEN PERMIT * * * - WELL AND/OR ON-SITE SEWER PERMIT Phone Number :'~Z//Z/-- Z~~69 S ~ ~/~"T Lot Size: Seepage Bed: __Holding Tank: Soil Rating(sq.ft/br) /~ The Required Size of the Soil Absorption System Is: DEPTH /~I ~-' LENGTH ~-' GRAVEL DEPTH ~/'~- WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~E;<~ GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will. be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that:' (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence remodeled to is include more that/~m~edrooms. Applica Da he: /r~ SWP/024(1/81) ' i {- ivy.(. (_~c I o [ ~ NAME Of APPLICANT GREATER ANCHORAGE AREA E'~OROUGH PERMIT NO,~ SEWAGE DISPOSAL SYSTEM -- APPLICATION ANi) PERMIT COMPLETION DArE ANTICIPATED , OTHER TO BE INSTALLED BY ---~'-~"~ / e ~ ~.~,tZ~__. NOTE: THIS PEI{MIT IS NOT VALID WITHOUT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTFI AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~'"~i LS LOG PERCOLATION TEST 1 2 3 4 5- 6 7 9 10 11 12 13 14 15 16 17 18 19 2o SLOPE SITE PLAN WAS GROUND WATER S ENCOUNTERED? ~J ~, L O P E DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) COMMENTS TEST RUN BETWEEN FT AND FT PERFORMED CERTIFIED BY:. DATE-: Performed For ~ Legal Description: This Form Reports Soils L, og Soil Test Must Be Logged To 4~ Depth Feet Soil Characteristics 10-- 11-- 12-- 13-- 14-- GREATER ANCHORAGE AREA BOROUGtl DEPARlMENT OF ENVIRONMENTAl. QUAi. ITY 3330 "C" Street ANCliORAGE, ALASKA 99503 Case # Dated Performed ~-~-T& Subdivision ~ ?~ 72z~/' ~u) Percolation Test Below Proposed Seepage System Was GroLind Water Encountered? If Yes, At What Depth? Reading Date Gross Time Net Time Depth to H20 Net Dro Percolation Rate Proposed Depth of Inlet COMMENI'S: Minute Installation: Seepage Pit Depth Drain to Bottom of Pit or F i e I d Trench- Test Performed BY Date Certified BY: ~-~. /~A~.~_ Date -~- M~ : ~= ...... ::_ ....... GREATER ANCltORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed FO r__J~L.~ ~t~ Legal Description: Lot This Form Reports Soils Soil Test Must Be Logged To Depth Feet Soil Characteristics 7-~ ll-- Encountered?~_O _ Was Ground Water If Yes, At What Depth? Case # Dated Performed ~Z~____ I$~ Subdivision '~-I~ ~q~-~.~ Percolation Test 4' Below Proposed Seepage System Reading Date Percolation Rate Proposed Installation: Depth of Inlet COMMENTS: /so Gross Time Net Time Depth to N20 Net Dropl M i n u [ e Seepage Pit Depth to Bottom Drain Field of Pit or Trench Test Performed 13Y_z~.~ ~~ Date Certified BY: Date: MUNICIPALITY OF ANCHORAGE 10 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-052-44 1. GENERAL INFORMATION Complete legal description T12N R3W SEC 15 LOT 64A Expiration Date: 9 -21 r Z -©ZZ Location (site address) 9541 ELMORE ROAD, ANCHORAGE, AK 99507 Current property owner(s) BRET & NANCY BURROUGHS Day phone Mailing address Real estate agent 9541 ELMORE ROAD, ANCHORAGE AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ ',-"go Date of Payment y�r' h-2 Receipt Number 7 ( G 2.5L� COSA 2-116 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 4/26/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to �.. or— e / �� these various and dynamic characteristics and are outside the control of the evaluator of the "�•�Q well and septic system. Therefore, any estimate of how long a system will function satisfactory rg�Q: •' • . • !fes for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & TH • '. Stars77, 6. DSD SIGNATURE "" "'v'�' Curtis Huffman System #1 Approved for bedrooms ��F9�s•, CE 128991�� System #2 Approved for bedrooms l\��PROF S5Q0 r Disapproved Conditional approval for bedrooms, with the following stipulwRl �Iw:((t w( OF Q7 VVATER AN P TER BY Original Certificate Date: S� Z^ Z©zZ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: T12N R3W SEC 15 LOT 64A Parcel ID: 015-052-44 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled CIRCA 1973 Total depth 178+ ft (ASSUMED - MOA DOCS) Cased to 40+ ft (ASSUMED - MOA DOCS) ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/20/22 Static water level at beginning of test 151 ft. Comments B. TANK DATA Age of tank(s) 19 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 50" ® Standpipes/foundation cleanout per record drawing Date of pumping 3/4/2022 D. ABSORPTION FIELD DATA Which system tested (date installed) NEW SYSTEM ® ALL standpipes present per record drawing Total measured depth from grade 10.2 ft (max) Measured depth to pipe invert from grade 4.2 ft (min) ❑ NIA — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Structure served by this system _ Well production at time of test 4+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 4.38 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by° Date of Sample 3/7/2022 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date NEW SYSTEM Results M Pass For 3 bedrooms Fluid depth prior to test _ in Water added gal New depth in Elapsed time min ®Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons F�� Comments/Deficiencies:WEST CO & MT AT GRADE. F E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes — if No ft ®Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells >' 100 _ ®Yes if No Water Main > 10' Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *5 ft . Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells >' 100 _ ®Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *2022 MOA WAIVER # OSV221023 G. ENGINEER'S CERTIFICATION l certify that l 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. .lw��.�.a�,�01 Age .. .... • ....�..�... . Curtis Huffman 1� CE 128991 � OFESSOV��o� ft ft ft ft ft ft ft ft mloozolm &» #gL M�zt§O.O N G VOS 3SO11V /3 E®§ z \ i §)_ 9 D0 - \ Municipality of Anchorage Development Services Department -Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-052-44 HAA #�1 Expiration Date: 2 ' Co — Qq - 1. q- 1. GENERAL INFORMATION Complete legal description T12N R3W Sec 15 Lot 64A Location (site address or directions) 9541 Abbott Loop Rd, Anchorage, AK 99507 Current Property owner(s) Gary & Judy Skaggs Day phone 346-3338 Mailing address 651 E. 100th Ave., Anchorage, AK 99515 Lending agency First American Title Co. ! Estelle Day phone 786-9531 Mailing address Real Estate Agent Day phone Mailing Address .Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 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 Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 seat affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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 Watkins Engineeing, Inc. Phone 349-1851 Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis Date /t -4-e"> 5. DSD SIGNATURE Approved for -3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following 49Ri* toy W. Ellis CE -10577 INARiEWATFR �- nn nnn All • _ Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: f — r ^ 0 3 (Rev. 01,02) Municipality of Anchorage • Development Services Department Building Safety Division ` On -Site Water & Wastewater Program ' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Ti 2N R3W Sec 15 Lot 64A Parcel ID: 015-05244 A. WELL DATA Well type PH Date completed 1973 Total depth 178+ ft. Date of test Static water level If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 40+ ft. FROM WELL LOG unknown Well production — WATER SAMPLE RESULTS: ft. Well Log (YIN) No Wires properly protected (YIN) Y Casing height (above ground) 15 in. AT INSPECTION 10-11-03 148 ft. g.p.m. 5.65 g.p.m. Coliform U colonies/100 ml. Nitrate 1.96 mg./l. 10-14-03 Arsenic: NA mg./l. Date of sample: 10-1'-0' B. SEPTICIHOLDING TANK DATA Tank Type/Material steel Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) DCO Depression over tank (Y/N) n Other bacteria 0 colonies/100 ml. Collected by: Watkins Engr Date installed 10/25/03 Cleanouts (Y/N) Y High water alarm (YIN) NA Date of pumping NA - new Pumper NA C. ABSORPTION FIELD DATA Date installed 10/31/83 Soil rating (g.p.d.e or ttz/bdrm) 150 System type deep trench Length 50 ft. Width 3 ft. Gravel below pipe �5� 5 ft. Total depth 11.1 ft. Eff. absorption area 650 ftZ Monitoring tube Y Depression over field N Date of adequacy test 10-11-03 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test28.5 in. Water added800 gal. New depth 66.5 in. Elapsed Time: 36 min. Final fluid depth 52_5 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date - D. LIFT STATION 'Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons "Pump Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 130 Absorption field on lot 145 Public sewer main NA Sewer/ septic service line 25+ Manhole/Access (Y/N) _ Hiqh water alarm level at Meets alarm & circuit On adjacent lots 130 On adjacent lots 130 Public sewer manhole/cleanout NA Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 30+ Absorption field 5+ Water main NA Water service line 25+ Surface water 100+ Welts on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 15+ Building foundation 15+ Water main NA in. Water Service line 25+ Surface water 100+ Driveway, parking/vehicle storage 0 Curtain drain None known Wells on adjacent lots 100+ F. COMMENTS Tank IiS PRl fiQliy u011ar driveway. J541-riea irula&d fD P1e✓ekd drivirtja,w, Well is 10 ft off lot, with ingress/egress agreement (attached). Drainfield is under driveway. G. ENGINEER'S CERTIFICATION .i! c 744%4' 114.0 I certify that I have determined through field Inspections and review of Municipal records that the above systems are in �` conformance with MOA HAA guidelines in effect on this date. * 4 9 TN - Engineer's Printed Name Cindy W. Ellis Date I-4-63 ': CindN Ellis VCE.1os» HAA Fee $ Waiver Fee $ _ Date of Payment v� Date of Payment s Receipt Number Receipt Number. (Rev. 12/01) az 0 3 WO Oo ,SG'b9l M„Ztb,SOoO N LLQLL N W aF M 10'TELE.6 CLEC. EBM7. I >t' _ — x N I -O =Vy1j I•!�y�F LL`d O g � I y ¢ W W yN UUO N I maw a W W V Q v mq� .0w1- =io I I I \ i o \ e / \ I W N e O I I I I WFI < I m I °� I a w 1'1O rl 0 I I N M I I o,NB I m 3 I a l I m NLn I > I Z o+ I I I 3 m I En I I I \ I � I WWI aw I I I y Jc I 'w'O J I I .•BE lOEOV` ° I "O, I I � I I I --1= ----------I--- _ , �4 JI I < SO' B.L.M. 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