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HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 8 LT 3River View Estates Lot 3 Block 8 #050-792-33 Municipality of Anchorage Page _J_ of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: _SW GIC1 O oZ L1 q PID Number: (ASO —%iia —33 Name: 4 1 sastewater d e� �OriS /NG7 /O!�` WY Upgrade System: ld New ❑ Ad ess:ABSORPTION Box 776 E le tom/ 9 S FIELD No. of Bedrooms: Phone: / —-7 1 D ❑Deep Trench QQ Shallow Trench ❑Bed E3 Mound ❑Other LEGAL DESCRIPTION soil Rating: Total Depth from original grade: s ,OGPDrS Ft S.0 Lot: Block: S bdivisic, { Depth to pipe bottom from original rade: Gravel depth beneath pipe 1 !✓ / . Ft 3 FI. Township: Range: Section: Fill added above original gradQ•e:5 , Gravel length: ZK t FI . Ft. WELL: ❑ New ❑ Upgrade Gravel width' s Numberoflines: Dislancebelweenarair Classilication (Private. A,B,C): Total Depin: Cased To: t FL ' O FL �{1 Ft. Total absorption area: � Ft. Pipe material - SO. Ft. H M 6?03 810 Differ Driller. Date Drilled: !!�� Static water Level: r W0.7!/ h/�� /' q q Ff Installer. / r TwCI ER eA ✓q Date installed: Veld: S GPM Pump Set at: Casing Height Above round r TANK Ft. oc SEPARATION DISTANCES 9Septic ❑Holding ❑S.T.E.P. To From Septic Tank Absorption Field Lin Station Moelnp Tank ubilamdvale Sewer UnM ManWacturer. II'1 ���/a s'�r Cs Capacity In gallons: /d00 Well IODt.'.- Ica* ttr �r �• Material: P Number of Compartments: vv e Surface _ 100'+ 100`+ LIFT STATION Lot Line Sa % C s 7 Size in gallons: Manu er. Foundation 39 ` I yX I� 'Pump on' level at: 'P •lave Hign water alarm at: Curtain Drain // /t/0 ✓/D h Pump Mak Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: �- 10j2 o-� We p Assumed Elevation: I IJ A U. ENGINEER'S S ;{ '' • ' • ti , �L 17034 Eagle River Loop ROAN4l®, Inspections performed by: ragle River Alasks "In DateS:1St "31�`Ig �=�kw•Y, 2nd 8'3r" 9q f Department of Health and Human Services approval u> Q" •ryAt Reviewed and approved by: AOX / Date:° IL PERMIT No. SW990249 PACE 2 OF 3 DEPARTMENT OF ANDhHUM9AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Te�l�ep hone: 343-4744 W ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 3, BLOCK 8, RIVERVIEW ESTATES P.I.O. NO. 050-792-33 LOT 2 r � r 6pl m N �' < Tp op THMI 1000 GALLON LOT 9 \ c1� EXISTING FOUNDATION LOT 4 l�Y \ SCAM I" . 60' �ENCI4EER. NP \ .YN�a.saY�nli \ {{{...(/ %' �� \ ``�'� �. • i� {4'x.1 l �, PERMIT No. SW990249 PAGE 3 OF 3 Municipalit of Anchorage DEPARTMENT OF HEAUH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 3, BLOCK 8, RIVERVIEW ESTATES P.I.D. NO. 050-792-33 98 1 , FINAL GRADE INSULATION 94.7' NEW1000 GAL. POLY. TANK 94.5' A B FCO 23.5 32.5 STI 61.0 69.5 ST2 64.5 72.5 DBL1 70.5 77.5 DBL2 71.5 78.0 Col C01 70.0 60.5 CO2 MT1 69.0 60.0 MTI MT2 JCOI = 96.3' CO2 102.5 116.5 CO2 = 96.1' IMT2 1 103.0 II7.o FINAL GRADE 2" INSULATION COI = 93.8' SR CO2 = 93.7' N. T. S. ENGINEER STA MTI = 90.81—/MT2 = 90.7' WATER FOUND © 86.7' a!aw I er 82.7 B.O.H. by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND DI S cT 6A. Co u3 ADDRESS Qc7 40 X '7_7 O d10 LEGAL DESCRIPTION /3LK LcT 3 Qloc,x J/EtJ PERMIT NUMBER 4 Date of Issue TAX INDENTIFICATION NUMBER OSa - 7gy7 - 33 Is well located at approved permit location? es Q No Method of Drilling:rotary Q cable tool Depth of well: /W Casing Type I /_ Wall Thickness inches Diameter // inches, depth 41 feet Liner Type: e "'o /TO Casing Stickup Above Ground: 1 / feet Static Water Level (from ground level): .S feet Pumping level:—feet after hrs. pumping _gpm Recover Rate: 10 T pm Method of Testing: A/k Well Intake Opening Type: ❑ Open End Jpen Hole Q Screened; Startfeet Stopped feet D41e'rforations Stag �i _ te�� Stopped /;? 0- feet Grout Type: AFn+To� �T— c F1/Volume 15% 1-13J- Depth: 13J-Depth: from feet, to feet Pump Intake Depth: Pump Size hp Brand Name Well Disinfected Upon Completion? es Q No Method of Disinfection: 6140d sod 5.0 MeA' DEPTH O 1 ,l e_*f,�J6 ST/CXJP OJa'< BalGbo-i S/<<7 i 6WAVeL 14 a g'#Xo PA -j 3a jP &WRace //AHr ,0A,4^l /4 Qe.dl cck A 64A7 S /Tr '3c0,cjcr Oily SS a dED,eitk. 6441 Comments: of idget Drillers Name oCS.-�-� ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. • Vo ' (`1�Cn M MUNICIPALITY OF ANCHORAGE Department of Health and Human Services d n M On -Site Services Program 825 L Street, Room 502 i ►� '3 �' 1, P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM /WATER SUPPLY PERMIT Initial Permit Number. SW990249 Legal Description: RIVER VIEW ESTATES BLK 8 LT 3 Date Issued: Aug 04, 1999 Expiration Date: Aug 03, 2000 Parcel ID: 050-792-33 Design Engineer. 0003 S & S Engineering Site Address: Owner Name: Distoll Construction Lot Size: 42075 SQ. FT. Owner Address: PO Box 770210 Total Bedrooms: 3 Permit Bedrooms: 3 Eagle River. AK 99577-0000 This permit Is for the construction of: ❑✓ Disposal Field ✓❑ Septic Tank ❑ Holding Tank ❑ Privy Q 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 (1 BAAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-4744 (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: / Date: k99 7 S& HEALTHARHMTY APPACNALS SEINER& WATER IANND(TENSIONS SEWER& WATER INSPECTION ENGINEERNGSTNDIES ANDREPORTS WELLNSPECTION A FLOW TEST SITE PLANS I: �T`.Ii.A±kGA SOIL TEST PERCOLATION TEST STM&WOL& WCOMICNL INSPECTWNS ON SITE WASTEWATER DISPOSALSYSTEIA DESIGN July 29, 1999 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 3, Block 8, Riverview Estates S/D ROBERTC. COWAN, P.E. ROBERTA. SHAFER P.E. CML ENGINEERS (907) 6942979 FAX(907)694-1211 Request you issue a permit to install a well and septic system to serve the proposed three bedroom dwelling on the referenced property. Two test holes were excavated and percolation tests performed. The approximate locations of the test holes are located on the attached site plan. At the time of excavation, 7-7-99, water was found at i I feet. After seven days of ground water monitoring, water was found at 9.5 feet. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require A. Shafer, P.E. Enclosure information, please contact us. 17034 NORTH EAGLE RNER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577 1 " = 60' DESIGN e� SITE -PLAN AI CrJ 02MFO g \ io / II z ` O Zv+l nnHs Ln O A SONO rn N U ►� �U p O 6 N p 0 / O N / O HIP A6g' F— 0 a e� CrJ 02MFO g II z ` `3 II O Ln O A SONO N U ►� NDO ►+ OOO l� 4 O 1 1 M O n C:7 n , O C C J I � t r3 a *Von Aim= JC A = A hTl z s OCy j l�J C/) V ^/ ti s --1p r ,^ Vf DKV X O m on 0 s � A N 0 ;I e r Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: DATE I 'X \LEGAL DESCRIPTION:y3 3 $ P kjkj"-VIh.r,.J r<i, Township, Range, Section: rro 1 SLOPE SITE PLAN (-7 t,, -V '-41411Ivv WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? DepN to Water Alter 1.14 AS 111witaring? Cl •'S Date: I. AS%I Reading Date Groat Net Time Time Depth to Water Net Drop R a 2 fuL toD 1 3" REFI o� 4 3aµ+ S' J S` PERCOLATION RATE (mmutevinch) PERC HOLE DIAMETER EST RUN BETWEEN 3 FT AND y FT Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ISI S o'Q�e.4L, l..O.J Si. DATE 4fv/LEGAL DESCRIPTION: LiJ U$ESeTownship, Range, Section: DEFT SLOPE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 OL— CA" LSM (,4/5, 5�7z. / I I I WAS GROUND WATER g J.,A Mf [+(i (j1f:5 ENCOUNTERED? b S r� L I, -- P P E � • k1.sS IF YES, AT WHAT DEPTH?_ oe(uA In Water, Alter��• PA y1 Monitoring? I wit SITE PERCOLATION RATE ..L� (minute inch) PERC HOLE DIAMETER /0 TEST RUN BETWEEN c7''S FTAND 315� FT COMMENTS PERFORMEDBY: I CERTIFY THAT THIS TEPT WAS PERFORMED IN ACCORDANCE W HA D STATE /1 MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 2 72-008 (Rev. Alias) 7 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS Lot 3, Block 8, Riverview Estates July 29, 1999 DtDlem t7\in The scope of this project includes the installation of a 1000 gallon polyethylene Premier septic tank and leachfield trench for the proposed three bedroom house located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page 2 Lot 3, Block 8, Riverview Estates July 29, 1999 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 3, Block 8, Riverview Estates July 29, 1999 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirall 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot 3, Block 8, Riverview Estates July 29, 1999 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owners representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOMNSTALLER MUh.I I C I PAL I TY 4F At�ICHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL P�TECTION 825 'L�iTREET, ANCHORAGE, AK. 99- '. 264-4720 OtJ—SITE SEWER PER17 I T PERMIT NO. C 830007 ) APPLICANT JOHN GROSS PO BOX 1161 99577 694 9138 LOCATION RENEWAL PERMIT ##820032 LEGAL L3B8 RIVERVIEW ESTATES LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER. OF BEDROOMS = T a 7 SOIL RATING CSO FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 11 LEtJC,TH= GRAVEL DEPTH= S THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DP,AINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN 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 (IF# FEET). 3, So o REH: C�U I RED SEPT I C TAr-4K S I ZE=9RUESS500 GALLOt-IS PERMIT APPLICANT HAS THE RE6PONSIBILITY 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. --- TWQ C 2 ] I tJSPECT I Ot+IS ARE REGtU I REC7 --- BACKFILLING OF ANY SYSTEM 14ITHOUT 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 14ELL TO A PRIVATE SEWER, LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T EXP I RES L?ECEME3ER 31r :3_i+22: I CERTIFY THAT 1: I AM FAMILIAR 14ITH 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 THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN Z BEDROOMS. / ;L/ SIGNED ICANT JOHN GROSS ISSUED BY _ q -B3 W O i Y-eK-G(�e5 O `{inLS �-17� Ctwe_� 1veTo h -e 1 ✓lS4-u_(i ed. V4. 0 MUNICIPALITY OF ANCHORAGE i'1 ction Department Health and Environmental rote 825 L Street, Anchorage, AK. 99501 264-4720 Permit # 9anoSn * * * HANDWRITTEN PERMIT kXttx *R ON-SITE SEWER PERMIT Applicant: John Gross Mailing Address: Po Box 1161 99577 Location: Eagle River Phone Number: 694-9138 Legal Description: Lot 3 Block 8 River View EstatesLot Size: 47,075 Type of Soil Absorption System Is: Trench: xx Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: 24 Soil Rating(sq.ft/br) 125 The Required Size of the Soil Absorption System Is: DEPTH 11 LENGTH 115' . GRAVEL DEPTH 8' WIDTH !C C 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(*=-}� TANK SIZE = 3,500 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 departmen will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee 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 3 2 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�rress'dence is remodeled to include more that 3 bedrooms. Signe3: I ,�y,. ,� Issued by: ,applicant V Date: Feb 16, 1982 Two trenches of this size are required to be instal e . SWP/024(1/81) n r; January 4, 1982 John Gross P.O. Box 1161 Eagle River, AK 99577 Permit # 811138 Subject: L3 Blk8 Riverview Est. Subd. L"SIkFET ("0/1 ?G *I 4111 I A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, A6- Les N. Buchholz R. . Program Manager Sewer and Water Program Enclosure: Copy of Permit gUNICIPALITY OF ANCHORAGE,j1 Department Health and Environmenta: rotection ,• 825 'L Street, Anchorage, AIC. 99501 264-4720 HANDWRITTEN PERMIT _WM:Um� ON-SITE SEWER PERMIT Applicant: D►IN ls�NmS `3 Mailing Address:/ Location: Phone Number: Legal Description: Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating (sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH LENGTH GRAVEL DEPTH BJ 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 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 W INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this departmen- will be subject to prosecution. c� Minimum distance between a well and any on-site sewage disposal system is 100 fee - 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 3 1 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 is remodeled to include more that 3 bedrooms. Signed: Issued by: Applicant Date : �. SWP/024 (1/81) /4f/e //e,(oi f.S Dr,` OJf [� SOILS LOG MUNICIPALITY OF ANCHORAGE \ ❑ PERCOLATION � DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 7Es7 \ 825 L. Street. Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �`-' CZ©`+ S DATE PERFORMED: O O LEGAL (FEET) 1 2- 3- 4 34 5- 6- 7 6 bLL) 8- 91011 9- 10- 11 12- 13 14- 15- 16- 17- 18- " 4151617181s 20 PERFORMED 72-008 (6/79) 5/�N17� Gc..avcL ��S �rtZ�81sR�y Reading Zoo j C,eaDED<<o N O=< TER �Anl DS — TCO E a a z o. W O CD W Z'C � YES, WP9t �• 1SU 7�C�/AWGe AT !( Q�PTH7 Reading Date Time Time De W-All4`Nt _ �.�(!)et ,gyp•,.. ' • ,q ,� � ' TH •ng'1.: PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT . FIEDBY:,r d/�QL77/ till L v B L •; Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. Q5>.. Lq�L',%" GENERAL INFORMATION Expiration Date: i _3 i _1 7 Complete legal description! CJ�'pU%GI✓✓ Lri (� tt� P J `dL`r�K Location (.site address _� 6/k60 (-j - ` 'DYf , / P Current Property owner(4Da) 1> r N;�.L'L Day phone 5W f-;'r�)� Mailing address f " J `-EGy i E A I F -r- Real Estate Agent, - r� �(7�% �N i ©� Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) L016 ( s F-1Duplex 5 OCT 2 ❑ Multiple Dwellings (Single Family and/or Duplex) VZ\^-� 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System WaiverNariance request for: Received TYPE OF WASTEWATER DISPOSAL: l� Individual X ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ h 00 Date of Payment l D – ZS-- lJo Receipt Number COSA # ��l fP ISa Date: 1194!�Zlv�FOl,b 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. , 07 Name of Firm r� f t/✓q T/U&;i:Z/ffiEfz V z/ Phone 2���„' Address 3E�Oj7}r��(fF t5AIr Ava Engineer's Printed Name(/�W-F 5 i��k,1VT 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Date } bedrooms, with the following stipulations: BY�C �����— /� Original Certificate Date: ^3 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 of omissions in the professional engineer's work. 7. ATTACHMENTS COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet! .: c If more than 1 septic system is on the lot: COSA Checklist# 1. of Structure served by this system 1 Certificate of On Site Systems Approval Checklist Legal Description: Riverview Estates tot 3 Block 8 Parcel ID: 050-792-33 A. WELL DATA Well type private If A. B, or C provide PWSID # Well Log (Y/N) yes Date completed 8/11/1999 Sanitary seal (Y/N) Wires properly protected (Y/N)Yes . Total depth 160 .ft. Cased to 41 ft. Casing height (above ground) 20+., in. FROM WELL LOG AT INSPECTION Date of test 8/11/1999 10/18/2016 Static water level 5 ft. ' 18 ft. Well production • 1.5 g.p.m. +1.0 g.p.m. WATER SAMPLE RESULTS: Coliform A/F-(' colonies/100 mL Nitrated�mg/L Arsenic AJ ug/L Date of sample: 10/19/2016 Collected by: C&M Engineering - B. SEPTIC/HOLDING TANK DATA Tank Type/Material- septic/polyethylene Date installed 8/31/99 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) yes Foundation cleanout (Y/N) yes Depression over tank (Y/N) no High water alarm (Y/N) no Date of pumping S/gP0/e-A0lb Pumper. C. ABSORPTION FIELD DATA Date installed 8/31/1 Soil rating (g.p.d.Ift2 or ft2/bdrm) 0.8 System type shallow r Lk•1Bi/yN; Length 66 r 'ftp Width 5 ft. Gravel below pipe 3 ft. Liv 37. Total;deptt;.7.• ft., t Efti. absorption area 569 ftZ Monitoring tube yes Depression over field no kDate'of adequacy test'1'0%i &016 Results (Pass/Fail)ap ss For 3_ bedrooms depth in absorption feltbefore test 0 in. Water added ,Fluid d + +1000 gal New depth 0 in. SLL '.Pi .q ii(iPt•ID•" ~U' h Elapsed Time �O'-- .'min. Final fluid depth 0 in. Absorption rate >= 450 g. p. d. Any �ejuwenation:treatment (past 12 mo.) (Y/N & type) none known - If yes, give date n/a D. LIFT STATION Date installed no lift Size in gallons _ "Pump on" level at in. "Pump off' level at Datum E. SEPARATION DISTANCES Cycles tested WELL ON LOT TO: Septic tank/lift station on lot +100' Absorption field on lot 100' Public sewer main +100' Sewer /septic service line +100' Bi Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots +100' On adjacent lots +100' Public sewer manhole/cleanout +100' Holding tank +100' Animal containment areas +100' Manure/animal excrete storage areas +100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation +5' Property line +5' Absorption field +5' Water main +10' Water service line +10' Surface water +100' Wells on adjacent lots +100' ABSORPTION FIELD ON LOT TO: Property line +10' Building foundation +10' Water main +10' Water Service line +10' Surface water +100' Driveway, parking/vehicle storage 5' Curtain drain +50' Wells on adjacent lots +100' F. COMMENTS well cap repaired parking pad over leachfield abandoned and blocked Artesian well may cause future damage to well cap G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name charles balzarinl Date 10/25/2016 COSA canary sheet_2-6-15.doc in. MUn,iafpalify df Ancfib�age Development SeirVices'Departmerit Building Safety Division . Onsite Water 6 Wastewater Prodiirn 4700 South Bragaw SL . P.O. Box 196650 Anchorage, AK 995196650 www.d.enchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description RNER VIEW ESTATES: LOT 3: BLOCK 8. Community Class Weil ❑ Public Water System Location (site address or directions) 21400 WHiTE WATER DRNE • EAGLE RrVER, AK. 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CHAD STOLP Day phone (907) 227-2682 21400 WHiTE WATER DRIVE • EAGLE RIVER, AK. 99577 Day phone JED WDNGARTEN w/ DYNAMIC PROPERTIES Day phone 3111 'C* STREET • ANCHORAGE, AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 727-5333 --- - =3.='TYPE OF WATERSUPPLY: — TYPE OF WASTEWATER DISPOSAL —_-.— —. Individual Well 0 Individual Water Storage ❑ Community Class Weil ❑ Public Water System ❑ Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the onsite 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 ofAnchorege files and from my Investigation and inspection, the onsite 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 Engineer's Printed Name JEFFREY A GARNESS, P.E. Engineers Comments: In conducting this evaluation, GEG, Ltdattempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered of Me time of the test, and separation distances measured to readily identifiable features. The operational rife of all wells and septic systems depend on the local softs condition, groundwater levels that may fluctuate during the year, and the water usage of the famr7y being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any otherperson or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for -'1%_ bedrooms. Disapproved. Conditional Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Phone 337-6179 Date 2/loloS If for bedrooms, with the following stipulatiP,•' '•. - ON -S .�2 • ..�� =- pR 111111 _ Maintenance Agreements Supplemental Engineer's Report Other rn«. h2MV Original Certificate Date: tn• Municipality of Anchorage ' Development Services Department Building Safety Division On.4Poe Water & Wastewater Program 470D South Bragaw SL P.O. Box 198850 Anchorage, AK 99519 -SM www.ci.anchorage.ek.us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: RIVER VIEW ESTATES: BLOCKS LOT 3, Parcel ID: 0`- A. `- A. WELL DATA Well" PRWE If A. B, or C provide PWSID# N/A Date completed 8/11/1999 Sanitary seal (YIN) YES Total depth 160 ft. Cased to 41 ft. FROM WELL LOG Date of test 8/11/1999 Static water level 5 ft. Well production 1.5 g.p,m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.185 mg./L, Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 18 in. AT INSPECTION 2/1-2/2005 12 ft. 1.20 g.p.m. Other bacteria 0 oolonies/100 mi. Arsenic: N/A mg./L. Date of sample: 2/l/2005 Collected by: GEG, LtD. B. SEPTIC/HOLDING TANK DATA Tank Type/Material PREMIER/HDPE Date installed 8/31/1999 Tank size 1000 gal. . Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over lank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 5/26/2004 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 8/31/1999 Soil rating 15a>r ft'/bdrm) 0_8 System type TRENCH Length 66 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 06.75 ft. Eft. absorption area 569 ft' Monitoring tube YES Depression over field NO Date of adequacy test 2/1-2/2005 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before test 1 in. Water added"852 gal. New depth 1 in. Elapsed Time: 0 min. Final fluid depth 1 in. Absorption rate >= 450+ g,p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **LAST 777 GALLONS INTRODUCED CAUSED NO RISE IN DRAINFIELD. D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot 100'+ Absorption field on lot • 100.24' Public sewer main N/A Sewer /septic service line 25'+ High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Buildingfoundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS "SHOT WITH TOPCON TOTAL STATION FROM EDGE OF WELL ON LOT TO EDGE OF NEAREST CLEANOUT G. ENGINEER'S CERTIFICATION 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 JEFFREY A. GARNESS Date :1110 /, HAA Fee $ � f � / XJ4" Date of Payment hl lvi Receipt Number (YA' ,qf jQZ (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number JAN -31-2005 MON 05:00 PM DYNAMIC PROPERTIES FAX NO. 9072617446 1 P. 02/02 '•l. } ;x L.'�lrla,w>>,•hi:%'�{jj,L`: ti':1713'AVi.'IjY.i:,MI �� �'i'1T.1 YK•'��1L �.: 'Kf: {' .�'a .. :.s IV i A .- ?.t �^{ t.I •. •f,, ..E a .t ^lr .`'ice •'r l:: ., ;'+, n' ,` •� • f /Hktfat, 4do+/a ' �'tk 4r'%..r sy: . h AS -BULL I e • . 1 rerebycertify 'that (have. su ey;d(the followin$ described'' • Lvr Gfo�..8.1 PrP<y� —T,1U T.r��..t, zo, T►4-Nt•R l rail SM.: � •• :. :�; M..,-�'r'�°•"+aZ- A�+chorage Recording Precinct; Alaska;-er4-that the Improve-` '. O� A �• at r n nts situated thereon are within the toe lines d do note,- %�' � .r•�i'�'• �, �.i .",� +, oy rlap'or encroach on the property lysing adrjac"dent thereto; that, �i �`• ' ' „ •- np improvements on property, lying adfacent thereto enczaadl ,,.- ar 'fd+. on the premises in question and 1*t [fiere-are no roadways., r r ' triim Rsion lines or other visible easemFnts on said property ";h mept as indicated hereon.. :y '; D ted at Eagle River, Alaska ��of : 2-10-05: 4:41PM: I 'GS Ref.4 1050597002 :hent Name Gartxss Engineering Group, Ltd. Project Namem -Various Hent Sample ID River View Est B8 L3 dams Drinking Water ..WSID 0 :907 6615301 0 3/ 5 All D■tesrnmes are Alaska Standard Time Printed Date/Time 02/102005 1537 Collected Daterrime 02/032005 9:40 Reeelved Datdrtme 02/031 15:11 Technical Director tep . Ede Released laramaer Results PQL Units Method Container ID Atbwble Prep Limits Date Amlysis " Date left raters Department Nitrate -N 0.185. 0.100 mg/L EPA300.0 B (<-10) 02/03/05 CAM Iicrobiology Laboratory Total Coliform 0 col/100m]. SM2092229 A (<=I) 02/03/05 DKC Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. 050-792-33 HAA# 0ijCQ(A 5 i' Expiration Date: C�I�►I�L•j�P►r�d: il�ii_��L�P►� Complete legal description Lot 3, Block 8, Riverview Estates Location (site address or directions) NHN Whitewater Circle Current Propertyowner(s) Disotell Construction Dayphone 694-5797 Mailing address PO Box 770210, Eagle River, AK 99577 Lending agency Mailing address Day phone Real Estate Agent Day phone Mailing Address Unless otherwise requested. HAA will be held by DHHS for pickup. HAA picked up by: . 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: ® Individual On-site El ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 less than 30 days old. 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. C25 rev. 01 001* 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verity that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. 5 8 S ENGINEERING 17034 Eagle River Loop Road No. 204 Name of Firm r'.feJUver, Alasa kaS9577 Phone `i - '79 Address Engineer's Printed Name )e t /3 i A r C. Cc wt -,/ Date 6. DHHS SIGNATURE f/ Approved for �_ bedrooms. Disapproved. Conditional approval for Additional Comments ovhq bedrooms, with the following stipulations. Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other BY: �� Original Certificate Date: - Z41-0 U Expiration Date: 7 -:2 S' - O o Reissue Date: 75025 1Rey 01001' RECEIVED "'Municipality of Anchorage APR 20 2W • Department of Health and Human Services Division of Environmental Services MMCIPAutY On -Site Services Section 825 V Street Room 502 ,nor geKvi�r P.O. Box 198850 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1-o T 3 (? L o Q K $" R ry t.4 V j t w ,r r,4 rE J Parcel I.D.: A. WELL DATA Well type P'elg4 M If A. B, or C provide PWSID # Well Log YEl Date completed K),(/gf) Sanitaryseal YE s Total depth / 6 o It Cased to 41 it FROM WELL LOG Date of test 8 it /01 el Static water level S ft Well production ) . S- g.p.m WATER SAMPLE RESULTS: Wires properly protected Y E S Casing height (above ground) 2 in. AT INSPECTION Coliform 0 colonies/100 mi Nitrate a o mg/I Other bacteria O colonies/100 ml Date of sample: N/ )-7/00 Collected by: s & S ENGINEEttING B. SEFnWHOLDING TANK DATA 17034 Eapla River Loop Road No. 204 Eagle River, Alaska 99377 Tank Type/Material SCP r ( /P AL -y c I SPI LENE Date installed � / 3) / 19 Tank size )060 gal Number of Compartments % Cleanouts -Y*-S Foundation cleanout y E S Depression over tank 14 High water alarm No Date of pumping V14 — N *, w/ Pumper — C. ABSORPTION FIELD DATA k% ! Date installed ? I �q°) Soil rating . j2 or ff2lbdrm) 0• g System type $r#eAL�ac cl�.•N Length 64 it Width S It Gravel below pipe --2—ft Total depth S L/*- ft Effective absorption areal -61 ft2 Monitoring tube WS Depression over field A19 Date of adequacy test )'J1A -N tv Results (Pass/Fail) For 3 bedrooms Fluid depth in absorption field before test Water added gal. New depth in. Elapsed Time: m' Final fluid depth in Absorption rate >= g.p.d. Any 72-026 (Rev. 01100)• (past 12 mo.) (YIN & yes, give date D. LIFT STATION Date installed "Pump on" level at Size in gallons in "Pump oxjwel•n E. SEPARATION DISTANCES in High water alarm level at in Cycles tested Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ) D 0 1- On adjacent lots Absorption field on lot /00 + On adjacent lots 100 '00 4 Public sewer main N /4 Public sewer manhole/cleanout NIA Sewer /septic service line a S rf Holding tank N14 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 39 Property line S d. Absorption field S f Water main N t* Drainage 10,0 + Water service line 10 1*f Wells on adjacent lots /00 f Surface water /00 > SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3 S Building foundation `I a � Water main P 1.4 Water Service line 1 e 1 Surface water 3 0 0 � Driveway, parking/vehicle storage S 4 - Curtain Curtain drain Naiwk k e0W✓ Wells on adjacent lots 100 4 F. COMMENTS G. ENGINEER'S CERTIFICATION 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. Engineer's Printed Name/ 0134A r C. COW-4,J Date K / r q/60 HAA Fee $ 6-3,!53 ' Date of Payment Receipt Number :5 C -f 57t 72.026 (Rev. 01100)• Waiver Fee $ Date of Payment Receipt Number moi" 0 ROBE:? C. COWAN- I • cE -esoti JAL. CTBE_Envir_onm_ental Services Inc. •III I I CT&E Ref.# 1001622001 Client PO# Client Name S & S Engineering Printed Date/time Project Name/# Lot 3 Block 8 Riverview Collected Date/time Client Sample ID Lot 3 Block 8 Riverview Received Date/time Matrix Drinking Water Technical Director Ordered By Released By J� / PWSID 0 /r Sample Remarks 0411912000 17:09 04/17/2000 14:00 04/17/2000 16:55 Stephen C. Ede Allowabte Prep Anatysis Parameter Results PDL Units Method Limits Date Date snit WATERS DEPT Nitrate -N 0.603 0.500 ma/L EPA 300.0 (<to) 04/17/00 SCL MICRO LAB Totat Coliform J0 0 Col/100mL SM18 92228 04/17/00 KAP