HomeMy WebLinkAboutSUNNY VALLEY LT 19unny Valley
#050 -354 -SO
Municipality of Anchorage Page _..Lot
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: _. S71yo'/O/co PID Number: G5'0 - 4Sf — y_
Name: �
iGK OLEj�//Cz/A->�
Wastewater S ystem: '&'New ❑Upgrade
Address:
17v 7�KLAA/1eA Dp.
ABSORPTION FIELD
Phone:
( 9& - 17G,
No. of Bedrooms:
❑ Deep Trench ❑ Shallow Trench Bed ❑ Mound O:Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from ori1pinal grade:
Lot: / Block: �+ Subdivision: _
� vf} LLE r
�- GPD/So. . Ft.
Depth to pipe bottom from original grade:.
j
Gravel depth beneath pipe
J
-2. 5 Ft.
o, 5 Ft.
Township: '� ' r Range ' w Section: /b
N
Fill added above original grade:
Gravel length:
0• 6, FL
817 Ft.
WELL: New ❑ Upgrade
Gravel width: /5 /
Numberoflines: Distance between lines:
Classification (Private, A,B,C): Total Depth: Casetl To:
�/Q/Vfi
Ft.
Total absorption area:
3 Si Ft.
Pipe material:
TE /So2 FL /5a FL
/,,200 S Ft.
"IjvG .
Driller: Date Drilled: Static Water Level:
3NLt-1 ✓a rl (ell 5 2009 141 Ft.
.
Installer:
GC+A.eAA/T,t ED SVS.
Date installed:
g pa 0,7 y
Yield:
a5
Pump Set at:
S146
Casing Height Above Ground:
TANK
GPM
Ft.
oZ Ft.
SEPARATION
DISTANCES
❑ Septic ❑ Holding ,<S.T.E.P.
To
From
Septic
Absorption
Lift
Holding
ublic/Private
Manufacturer:
Capacity In gallons:
Tank
Field
Station
Tank
SewerLinea
GHc/2AGE TANk-
) 5G0
Well
13,5'
1(0(0 r
r
Material:
STEEL•
Number of Compartments:
g
Surface
Water
t/Do'
f/00'
4.100'
1100
LIFT STATION
Lot�,
Line
f
I! f
r
31
I
t 1
Size in gallons:
/500
Manufacturer:
4A1&109r4&i5 74n/k
Foundation
I —/ %
7 r
i
"Pump on" level at:"
Pump off' level at:
High water alarm at:
H 4
O
,r
Curtain *
-Y SO'
tSb r
F�j O A
fst7 f
Pump Make 8 Model
Electrical Inspections pertormed by: :.
-OSaO N
CrALA-XY LK7Azfc xNG',
Remarks: 4ohlE KNotA)d
BENCH MARK
Location and Description:
,IL Itj E14 FAje 4 TANK
Assumed Elevation:
IT
E
4.F...q�R'F
Inspections performed by: C#PisroPWE,? K. tyroD Dates: 1st Q/al b4
2nd Flit i 04
T oPHERILW00D
Department of Health and Human Services approval
Reviewed and approved by: W. Date: ( —
ssioJ031�
M-n1A 1P.v Cron Line vc
r
Permit No. SWO40100 Page 2 of 2
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 InspectionReport
Legal Description: SUNNY VALLEY LOT 19 PID No.:: 050-354-10
2'
W
q04
N
2
4
y
7C
!( REST LAKE DRIVE
I #~ wuw w I
BR HOUSE
LOT 19
ELEVATIONS
REAR DECK OF HOUSE
(NOT TO SCALE)QF ASSUMED ELEV . 1oo.ow
-0ML
SCALE V = 80'
LOT 20
SWING TIES
C
D 27.4' 19.3' -
$ I -- 1 43.8' 62.2'
LEGEND
® - TEST HOLE
• - MONITOR TUBE
R - SEWER CLEAN OUT
4 - WELL
- EASEMENT
'� - LEACH FIELD
DRIVEWAY
9/25/04
ENGINEER'S SEAL
OF 00000pp�4
e, O�j�HRISTCPHER Wf
�oo��.. CE -10387
....
December 1, 2004
Galaxy Electric Inc.
7347 Potter Rd.
Bear lake Mi 49614
(231) 864-5010
To Whom It May Concern:
This letter is in regards to the lift station at the Rick and Aimee Oleniczak residence.
During my time in Alaska I (Joel Fink) gave the Oleniczak's a hand installing the
electrical and the lift station at there residence. I have checked the MUNI web sight for
any changes to the 2002 NEC and found time not to be any alterations. After checking
this information we proceeded to in stall the unit per the 2002 NEC and the manufactures
installation specs. All the wire installed is # 12 AWG and in conduit at 24 inches in depth
or deeper.
Any further questions please call.
Joel Fink
Master Lie. #6212795
Contractor be. #6110290
(231) 864-5010
Z/Z sOed `.ndSV:9 VO -1-090 !Om V99 ma `.ONI DIU10313 AXV1V0 :A9 jus
Certitieb �Drftttng In
by
WC�.�
SULLIVAN WATER WELLS
PA. BOX 670272, CMUGWK, ALASKA 9958%
�IGt nLE,.flt-z1Ak -
)MINER OF l AND- '_�`
>oDRESS:
XGAL DESCRPnOm4S; •J � d "j -Z 1(. 4oT /9
Cr4, "'M Srfc,c.Jr*
TLA.
CAN 43
f4,4Ja'�-
ITtFJJT1ON: R Is the responsibMty of the property owner to subml a copy of the well lop to tia proper authority. ML dPaRlY
0 Anchorage: Department of Health & Human Services and/or Department of Enviromental Consmation. MatSu Borough
)apartment of Env(ronmental Conservation.
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water & Wastewater Program
4700 South Bregaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
W--400cf /)-6�
o/Z/a (./ 3:
ONSITE WASTEWATER DISPOSAL SYSTEM f WATER SUPPLY PERMIT
Initial
Date issued: May 04, 2004
Expiration Date: May 04, 2005
Permit Number: SW040100 Parcel ID: 050-35410
Legal Description: a Lat 19
Design Engineer: 0848 Eagle River Engineering Services Site Address: 9544 West Lake Drive
Owner Name: Rick Olenicziak Lot Size: 90605 SQ. FT.
Owner Address: 17824 Teklanika Drive Total Bedrooms: 5 Permit Bedrooms: 5
Eagle River , A 99577 -
This permit is for the construction of:
❑✓ Disposal Field ❑✓ 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:
Date: LL y D3;/
Issued By: Date: S 440-f
Oct -14-03 12:57P Permit Counter 907 343 8250 P.01
Municipality of Anchorage
Development Services Department .•°` '.,
Building Safety Division ".
On -Site Water and Wastewater Program
4700 South Bragew St.
P.O. Box 196650 Anchorage, AK 99519-ee5o
www.ci.anchorege.ak.us
(907)343-7904
ON-SITE SEWEPIWEI.1 PERIVIT APPLICATION)
FOR A SINGLE FAMILY DWELLING
Parcel I.D. '9 5 O — 3 Sy — /0 Permit Number SW
Property owner(s)
[ZT Uc
Day phone 419�4 -176 3
Mailing address (1)
/ 71 L
TE tc j_,4 rypk 4 fl t2 -
Mailing address (2)
6A-GLL_
u2i JCP— 4K
Zip Code `/ .S 7 7
Legal description (Lot, Block & Sub'd.) S uNu / V4U_e� LD i- f 9
Legal description (Section, Township & Range) T-041 n) 51:c
Lot Size 7.0 A.FL Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
Well Only
Sewer and Well
Water Storage
❑
Sewer Upgrade
❑
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
❑
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 FagAy D)rrelling ano is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
TO, w
Waiver Fees:
Date of Payment:
Receipt Number: 5137Receipt Number:
(Rev. 12!00) L#1
Eagle River Engineering Services
Clrretopber R. Wood, P.1G.
10421 VFW RD, SUITE 201 (902) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
November 5, 2003
Jim Cross, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Sunny Valley Lot 19
Well and Septic Narrative & Permit Application
Dear Mr. Cross:
The proposed well and septic system 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 septic systems are all +30' distance.
3. Reserve space is adequate, and underlying soils are adequate for a future
replacement drainfield, if necessary.
4. Drainage will not be affected and is not a major consideration in our design.
This well and septic system will have little impact on adjacent lots, due to the large lot sizes.
Neighboring wells and septic systems have been located and identified. Impact to future wells
and reserved spaces will be minimal, or none. Drainage will not be affected by this design.
Test Hole #1 and Test Hole #2 have adequate percolation rates, and soils of sufficient depth to
support an on-site septic system, and have sufficient separation to groundwater. Farther south on
the lot, several test holes were begun but abandoned due to the discovery of a high water table
and clay. Because of this, we have the leachfield located on the highest ground on the lot, on the
north property line, where adequate soils were found. The system will need to be pressurized
with a lift station. The primary system will be finish graded, while the replacement system will
have to be mounded. If you have any questions please call our office at 694-5195.
Sinc/
top R. ood, P.E.
Principal
\1997\03-038 NAe.Doc
Y't
ti
4
WELL }2W _-- -
SEM +30' It WEST LAKE DRIVE ``�
1 w'
NOTES
1. SURFACE WATER +100'
WELL SEPTIC
LEGAL:LOT 19. SUNNY VALL
SITE
SUBDIVI'
R-364.71'
L-126.88'
LOT 20
LEGEND
® —
TEST HOLE
• —
MONITOR TUBE
o —
SEWER CLEAN OUT
¢ —
WELL
— — —
EASEMENT
— — —
PROPOSED LEACH FIELD
—
DRIVEWAY
PLAN
NTRACTOR: N/A
3# 03-038WS DATE: 11 /03/031 SCALE 1 " = 50'
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297
OF gC,9s671
r
A• .1m OPFiER R. WOOD
C CE -10387
'I " ...
Eagle River Engineering ,Services
Christopher R. Wood, RE
10421 VFW Rd. Suite 201
Eagle River, AK 995773294
(907) 694-5195 tel
(907) 694-3297 fax
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: Sunny Valley Lot 19
November 6, 2003
A. GENERAL
1. The well & septic plan is for a 4 bedroom 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 are to be verified or modified 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.
9. Any remaining open test hole excavations shall be filled.
B. SEPTIC TANK WITH LIFT STATION
1. The septic tank shall be an Anchorage Tank 1500 gallon septic tank with integral OSI lift station pump
model OSI -05 -20 -BHF.
2. A receipt from a licensed electrician shall be provided to the engineer verifying lift station wiring to all
applicable codes.
C. BED
1. The bed is to follow the natural land contour to maintain uniform total depth of the bed bottom.
2. The bottom of the bed shall be level, plus or minus 1.5".
3. The depth below grade of the gravel layer is not to exceed 3' at any point.
4. The effluent lines (3) are to be 1" PVC lines with 1/8" holes drilled 42" OC within the leachfield,
placed face down, or up with orifice shields placed over holes. Line from tank to field is to be 1-1/4"
HDPE.
5. The bed 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 bed. Mounded side slopes not to exceed 3:1.
7. 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 LEACHFIELD DIMENSIONS:
BENCHMARK = 100.00 ASSUMED DATUM Top of Monitor Tube
BOTTOM OF GRAVEL LAYER = 3' Below Grade
GRAVEL THICKNESS = 6" under pipe, 2" over pipe
BED LENGTH = 80' BED WIDTH= 15'
SOIL RATING - 0.5 GPD/ft5 BEDROOM CAPACITY = 4
SEPTIC TANK = 1500 with lift station
EFFLUENT PIPE =1" PVC with 1/8" holes oriented down, or up with orifice shields spaced at 42" OC.
Twenty-four (24) hours notice required for all inspections.
\1997\03-038Bed-sys & lift spec.doc ..
`.
4
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 6945195
ERES Project No.:
Calculated By:
Date:
Legal:
03-038
CW
11/06/2003
Sunny Valley L19
Single Family 4 Bedroom Dwelling
Primary System
Bed Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom =
Percolation rate =
Wastewater application rate =
Required absorption area =
Bed width (VII) =
Gravel depth (D) =
TEST HOLE 1
600 gallons
9 minutes per inch
0.5 gallons per day per square foot
1200 square feet
15 feet
0.5 feet
Required length a Required absorption area / Bed width
Required length - 1200 / 15
Required length = 80 feet
Total Excavation Depth = 3.0 feet
CHRISTOPHER R.
CE:�j
03-038 Calc.xis 4:19 PM11/06/2003
A
03-038 Calc.xis 4:19 PM11/06/2003
EAGLE RIVER
a1NEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 6945195
ERES Project No.: 03-038
Calculated By: CW
Date: 11/08/2003
Legal: Sunny Valley L19
Single Family 4 Bedroom Dwelling
Replacement System
Bed Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom =
Percolation rate =
Wastewater application rate =
Required absorption area =
Bed width (W) =
Gravel depth (D) =
TEST HOLE 2
800 gallons
30 minutes per Inch
0.45 gallons per day per square foot
1333 square feet
15 feet
0.5 feet
Required length = Required absorption area / Bed width
Required length = 1333 / 15
Required length = 89 feet
Total Excavation Depth = 2.0 feet
03-038 RepiacementCalc.xls 4:34 PM 11/05/2003
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: RICK- 0LP-"3XZ4K DATE PERFORMED:
LEGAL DESCRIPTION: NMy VAUEY L07 /Q TOWnship, Rance, Section:TuA l 2n
1
2
3
4
5
6
7
8
9
10
11
12
13
14
1s
16
17
18
19
20
COMMENTS
bQ fnhnr'LS�'R�PSOT L
( If l 1 6kw
�'t ►� I $1 LTi x'12 f (�' ��/
SLOPE
WAS GROUND WATER
bovmp ENCOUNTERED? AAO
S
I3 oTrOrn OF TL�5-1 ROLt+ IF YES, DEPTH?AT WHAT 1%ONE L'✓Dt L
E
Depth is Water Aller
7
Monitoring?? .9 Dalt IU
&RISTOPNER R. WOOD
1. CE..10381
PLAN
S c.G J
Reeding Date Grou
Time
Not
Time
Depth to
Water
Net
Drop
: o ern
o
It
Z
30
3-7
3
p
3
3 - 7
7
0
•N
Geo
O
• 7'
3
PERCOLATION RATE 912 (minutea/inch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN _3 FT AND LFT
PERFORMED BY: if -AP -T.5 I'hn! {Ii ) 4f�/y !! CERTIFYYTHAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: T//�/�
72-M (Rev. 4/85) - '
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0850
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:_It1(-K (7 F A) G7A1C DATE
LEGAL DESCRIPTION: SU.rJ�(,F;`/ / OT //Township, Range, Section:
(PEET) 6R(ngNiCS /T�PSdrL
1
2 b I STTLTT61? NEAR go ROM
3
St R A /
_
4- Ml, [_II
5
C
6-
7
8-
10-
11 1011
12-
13-
14-
is-
16
213141fi18
17-
is-
19 -
20 -4
7181920
COMMENTS
Q0 from Of Jz�-51- qoc
CHRISTOPHER R. Yd000
CE. 3
SITE
WAS GROUND WATER
ENCOUNTERED?_
. S _
IF YES, AT WHAT / P
L
DEPTH? 6O O
E
Depth 10 Water Mer /D(.S
Monitoring? 5.5 Dale: /0/03
3
PERCOLATION RATE (minuteVinch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND —3 FT
r I _
PERFORMED BY: K/Od-' I l��'� C14/
CERTIF�YyT/HAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE
72.008 (Rev. 4/85) '
f/1
wal `(H41) POGH aiweuAa imi
Pte, •.
s
tea• � :
9
R K
n
�
10
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.ci.anchorage.ek.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING:,
Parcel I.D. oSo- esy-w HAA# 0 *0 6 S2
Expiration Date: -
1. GENERAL` INFORMATION
Cornplete legal description z5a vdv j&dui sv �,sr ig
x_
Location (site address or directions) 9Sy41 A4,tir
Current Property owner(s), _z-*.ez- Day phone /o9L - 3
Mailing address /_W' ; x,r�.A.o..r.c XPAr- ledaZX Ar ME X
Lending agency Day phone
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. 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
❑
Pubfic 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 seal affixed hereto and as of the validation date shown below, l 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 Eagle River Engineering Servi= Phone 69iy-s- 9 S
10421 VP#V Rd;, Wb OM
Address Eagle River AK 99577
Engineer's Printed Name Date 1216 7AQ v
L
5. DSD SIGNATURE 1 owimI iotR
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipula) s:
By:
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
Original Certificate Date: I ;L - 10 - l7
Municipality of Anchoragee�,
• "-` Development Services Department
Building Safety Division i
On -Site Water & Wastewater Program <`..
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: c i Lof Parcel ID: DSO- 3S9 — ! 0
A. WELL DATA
Well type�orl�G If A. B, or C provide PWSID # _ Well Log ®/N)
Date completed �l0 q- Sanitary seal ®/N) (hd� Wires properly protectedON)
Total depth /$a. ft. Cased to J5a ft. Casing height (above ground) _ ./h in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level G / ft. ft.
Well production ,25 g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform .� colonies/100 mi. Nitrate LO• 10 mg./I. Other bacteria ) colonies/100 ml.
Arsenic: mg./I. Date of sample: 111217-/0 #f- Collected by:
B. SEPTICg40t@fN8 TANK DATA
Tank Type/Material -111" L. Date installed
Tank size 000 gal. Number of Compartments CleanoutsOY N) f L.J..
Foundation cleanout ON) Gam. Depression over tank (YQ � High water alarm (6)
High
of pumping nal- as d Pumper
r C. ABSORPTION FIELD DATA
Date installed'/O�fT/0Y Soil rating (g.p.d./ft2 or ft2/bdrm) _a-. System 4ype.
Length SO ft. Width l ft. Gravel below pipe 0-5 ft.
Total depth �_ ft. Eff. absorption area /,200 ftZ Monitoring tube A� Depression over field �g
rr,orr.c rta rd, 0
Date of adequacy test eu S[q$•fe�n Results �IFaiq �_ For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth= in.
Elapsed Time: ^ min. Final fluid depth = in. Absorption rate >= g.p.d.
,j Any rejuvenation treatment (past 12 mo.) (Y/N & type) r If yes, give date
n
Date installed S - 0 2 ^ PFJ Size in gallons 4 $00 Manhole/Access ON) L1�iy
"Pump on" level at q'f in. "Pump off" level at *0 in. High water alarm level at 45 in.
DatumNt Cycles tested Meets alarm 8 circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /57
Absorption field on lot 136 /
Public sewer main t 75
Sewer /septic service line t�5
/
On adjacent lots +/001
On adjacent lots ^f'100
Public sewer manhole/cleanout q-)00
Holding tank t lav,
SEPARATION DISTANCES FROM SEPTICS TANK ON LOT TO:
Building foundation 1"7 t Property liner Absorption field
Water main -�- /0 r Water service line J-/0 Surface water t /00
Wells on adjacent lots -f 100 /
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line // r Building foundation 3io Water main *10 /
Water Service line +/O Surface water 4.100 Driveway, parking/vehicle storage /0
Curtain drain +SO
—nnnc norvn
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Wells on adjacent lots 1100
1 certify that 1 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.
Engineer's Printed Name 6 S-AA&Z A - AlMd
Date /,X.J7 1104
HAA Fee $ S- / • S42
Date of Payment
Receipt Number d
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
CE1 7
DEC-10-2004(FRI) 13:11 EAGLE RIVER ENGINEERING (FAX)907 894 3297 P.001/001
,{
esiarlsy- '� a. .
Z. -
ell, .�
9q
;,.. If
- s
R'
`'" `'. I5 -1910. •'Sry
� � n ryr,:inul t'�'•'
I HEREBY CERTIFY THAT i HAVE SURVEYED THE
SCALE'
FOLLOWING DESCRIBED PRR.DPERTY,
/ of O
ANDTHAT NP ENCRpeCHENTS EXIST EXCEPT
AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
1��y
OWNER TO DETERMINE THE EXISTENCE OF ANY
BRIDt
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
S.r.fB
VISION PIATT, UNDER NO CIRCUMSTANCES SHOULD
FB
ANY DATA HEREON BE USED FOR CONSTRUCTIOOF N
FENCE OR FOR ESTABLISHING BOUND-
DRAWN'
RY ES INES,
`'" `'. I5 -1910. •'Sry
� � n ryr,:inul t'�'•'