HomeMy WebLinkAboutT15N R1W SEC 18 LT 7T15N RIW
Sec 18
Lot 7
#051-171-11
Municipality of Anchorage '
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program. 4700 S. Bragaw St.
P.O. Boz 196650 Anchorage. AK 99519-6650 Page of
www.d.anchorage.ak.us (907) 3437904
ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. W U PID Number. Q0 —/7! 11
�r
Wastewater System: ❑ New ❑ Upgrade
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ABSORPTION FIELD
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PMM sw O-�O'3 .3 RECORD DRAWINGS \ NUMBER -i7bil
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�..�.1.. T15N, RIIV, SECTION 18, LOT 7
-
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�..�.1.. T15N, RIIV, SECTION 18, LOT 7
r; ,t
P.O. BOX 1315
Charles A. Leet :
I.. r; d
PALMER, ALASKA 99645
C. A. LEET, P.E. PHONE: (907)745-8371
1041j0
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FAX: (907)745-8371
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DETAIL
oD.A4�% Conventional Single Family Residential
" A� .'ft SEPTIC SYSTEM RECORD DRAWINGS
v S 49TH vtrpp� n�°trytw. T15N, R1�V, SECTION 1£3, LOT 7
O P.O. BOX 1315
PALME, ALASKA 9645
1 -?,-..Charles A. Leet .:o° C. A. LEET, P.E. PHONE: (907)74598371
��fo CE 10480`�o FAX: (907)745-8371
(ld PROFESS1
ab�00�o�0 C. A. LEET, P.E. pada 8 0 Cy1aW!! ET 2 OF 2
MUNICIPALITY OF ANCHORAGE
Building Safety Division
DATE: December 2, 2003
MEMORANDUM
TO: The File For T15N R1 W Section 18 Lot 6
FROM: Dan Roth
Engineer II, On -Site Water Wastewater Program
SUBJ: Clarification of Septic Construction Parameters To Be Placed in the Subject
Lots Hard File
To clarify and assure that the construction of the absorption field on
the adajacent Lot 7 has not impacted the subject Lot 6, the following
statements can be made:
1. An absorption system maybe constructed on Lot 6 as close as 10
feet from the property line in the location of the newly constructed trench on
Lot 7. This trench runs parallel approximately 2 feet from to the property
line between Lot 7 and Lot 6.
2. The soils test for the absorption trench on Lot 7 was dug close to
the property line in the vacinity of a potential future septic site for Lot 6. If
the owner of Lot 6 chooses to construct a potential upgrade wastewater
absorption field in this location then this soils test may either in part or in
total be used providing requirements of AMC 15.65 are satisfied.
Roth, Dan J.
From: Cross, Jim E. (Dev Svs)
Sent: Wednesday, November 05, 2003 5:21 PM
To: Moyer, Greg M.
Cc: Roth, Dan J.; Thompson, Ron J.
Subject: RE: DIAL'S
Greg,
just had a long conversation with the Dial's concerning their neighbor's septic system and came up with a list of items to
address their concerns. Dan Roth will accomplish these while I am on leave. The items are:
1. A letter will be placed in the Dial's file stating that they can construct a septic system to within 10 feet of their
property line. This is in agreement with the code. Their neighbor was granted a lot line waiver to 1 ft. from the
property line, and he obtained the waiver because he applied first.
2. A second letter will be placed in their file stating that they can use the test -hole information from their neighbor's
permit application. A copy of this soils log will be added to their file.
3. The engineer who designed and inspected the neighbor's system will verify with a scaled inspection report that the
system is entirely on the neighbors property and meets the permit requirements. A copy of this inspection report
will be sent to the Dials.
4. A copy of the neighbor's request to do an'owner install" of his septic system will be sent to the Dial's.
There are two items that we cannot address:
1. The engineer who designed and inspected the system used letterhead from an engineering firm he works for in
the valley, but was moonlighting on this project. Our requirements are that he use his professional engineer's
stamp and has his original signature on the permit documents. The letterhead and any involvement or non-
involvement of the firm is not our concern.
2. The Dials claim that some trees on their property were cut during construction of this septic system. I Informed
them that if any trespass occurred, that it was a civil matter and I had no authority to be involved.
Dan will send you a follow up e-mail when this has been accomplished.
Jim
—Original Message—
From: Moyer, Greg M.
Sent: Wednesday, November 05, 2003 3:02 PM
To: Cross, Jim E. (Dev Svs)
Subject: DIAL'S
Jim —
As Ombudsman, I would greatly appreciate it if you would call the Dial's on some outstanding concerns.
They are at 688-2640.
Let me know the outcome. Thanksl
Greg Moyer
Ombudsman
343-4755
S!
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 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: SW030343
Legal Description: T15N R1 W SEC 18 LT 7
Date Issued: Aug 28, 2003
Expiration Date: Aug 27, 2004
Parcel ID: 051-171-11
Design Engineer: 0032 Alaska Rim Engineering Site Address: 019517 INLET VIEW DR
Owner Name: TED CLIFFORD Lot Size: 64469 SQ. FT.
Owner Address: 19517 INLET VIEW DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
CHUGIAK , AK 99567.6628
This permit is for the construction of:
Q Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked 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, seated, and heated to prevent freezing.
Received By:
Issued By.
Date: t CN
/ �� Date: 2111103
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 28, 2003
Expiration Date: Aug 27, 2004
Permit Number: SW030343 Parcel ID: 051-171-11
Legal Description,"T15N R1 W SEC 18 LT 7
Design Engineer: 0032 Alaska Rim Engineering Site Address: 019517 INLET VIEW DR
Owner Name: TED CLIFFORD Lot Size: 64469 SO. FT.
Owner Address: 19517 INLET VIEW DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
CHUGIAK . AK 99567-6628
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: " •�28,03
Date: B 28 0
\ Municipality of Anchorage
1 Development Services Department
Building Safety Division
Onsite Water and Wastewater Program `
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 995196650
www.ci.anchorage.akus
(907) 343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. t') 5't — I-? 1-11 Permit Number SW030310
Property owners) 1 ?1A Day phone _099 —fl- CIA
Mailing address (1) /q17/7 /NG iiE[cJ 11rq�2. e --;t—
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'J.)
Legal description (Section, Township & Range) (Ii)
4 In n
Lot Size__�i `/`/, G-� Acres/4 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 ❑
certify that the above information is correct I further certify that this application is being made for a
Ingle Family Dwo'n-0
ellin/g�and is' ccordance with applicable Municipal Codes.
1 F Pte.
(Sig a, re of property owner or authorized agent) Crl rh. .
Permit Fees: 4X Waiver Fees: �" I '-�D
Date of Payment: 8 ZB O Date of Payment q In 03
Receipt Number:
Receipt Number. l U U
(Rev. 12100)
P.O Boz 1315
Palmer, AK 99645
Charles A. Leet, P.E.
September 8, 2003
Mr. Dan Roth
Municipality of Anchorage
Development Service Department
Anchorage, AK 99519
RE: T15N, R1 W, SECT 18, LOT 7.
Subject: Amended Permit Request— Design Narrative
Dear Mr. Roth:
The owner of the above referenced lot recently (8/30/03) requested a permit to replace the onsite
septic tank; he would now like to replace the septic line as well. I am request to amend my previous
submittal to accommodate my clients' wishes. is proposing a three-bedroom singly family residence.
We are requesting a continuance of our plan review and a permit to install the replacement septic
tank.
Soils
A test hole was excavated and a percolation test performed by on August 30"' and 31`., 2003. The
approximate location of the test hole is located on the attached site plan. The soils were visually rate
GW -GM and GM. The percolation test indicates the use of an application rate of 0.6gal/day/sft. On
September 6, 2003, the monitoring tube was checked, no groundwater was observed in the
monitoring tube.
Trench Design
The dwelling proposed is a three-bedroom, with an estimated daily wastewater flow rate of 450
gallons per day. The wastewater application rate from the perk test is 0.6 gal/day/sft. The required
absorption area is 750 square feet. Proposed is a deep trench 9' deep by 42 -foot in length. Enclosed
are drawings of the proposed system. We proposed to maintain a minimum of 4 -feet of cover by
using the spoil from the trench excavation to bury the septic field deeper.
............................
T15N, RIW, SECT 18, LOT 7 9/y3/2003
Amended Permit Request — Design Narrative Page 2 of 2
Surface Waters
There is no surface water within 100 feet of the proposed upgrades.
Side Lot Setback Waiver
The owner wishes to request a waiver to the side lot setback. As he wishes to install the deep trench
between the lot line and his existing trench. We do not anticipate any adverse effects by granting us
this waiver to the neighboring well, septic systems, as these improvements have already been
constructed. Lot 6 currently has a well and skeptic in place.
Oed,'--O
Charles A. Leet, P.E.
End Permit Application
Waiver fees
Soil Log — Percolation Test
Site Plan (2)
Cc: Client
r,.s.v—
ONatxs k Leet
10' SEPARATION
DISTANCE
BETWEEN OLD
AND NEW
DISPOSAL FIELD
SCALE 1"= 60'
PROPOSED
42' X 9' E.D.
DEEP TRENCH
EXISTING
1500 GALLN
STEEL SEP IC TANK
NEW 8/30 3
DEEP TRENCH
ABANDON IN PLACE
ii Nc1u114-rc(r.•G
_10' BLDG.
SETBACK LINE
—10 ---P---
SEPTIC SYSTEM PLOT PLAN
6.40'
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0
c1
eou
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p SEPTIC SYSTEM PROFILE
OF q4 Conventional Single Family Residential
<�UD9s9Q00 PROPOSED SEPTIC SYSTEM DESIGN
* '49rH SOD ye�o,pto T15N, R1W, SECTION 18, LOT 7
D
•��'����.� P.O. BOX 1315
,oiCharles A. Leet i D PALMER, ALASKA 99645
�. o C. A. LEFT, P.E. PHONE: (907)745-8371
IQ f� CE 10480 'gid FAX: (907)745-8371
0
l;a51
perforated 4' PPC
son Note 1
e/4' to 3-
.. rook
m.t.D mooltor tuka
at and of troock
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X =,
solid 4• AM DIP.
or PTC Sb. 40 42' t
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(netkln 0.01 Iwt of same Nanuon)
wtextlls
4 PTC drain pipe. u/ kola loon
smr rock
TRENCH DETAIL
DEEP TRENCH
PLAN VIEW
ELEV. 100.0'
.road e Q u unad = _
Note is Plano • —Wotum of 4-fsat of earth onoor
(a equlaelaot) era, skaotpU. Iranek. 0"
look W .Marro TonWlonm 0' (a p.) ttuf
b oukaUtute4 for on* foot of saM OOaar
up to a mantmum of loo lock, of WuteU
Note e: 9po0 from trash e.noraUon to M uasd to oaaa.
Note 4: The matlmum oaca.a0on daptk from original
2' t
parforaw tNC
kde orlmtaUon
(hot" Goon)
SECTION X -X
remonodda
sap
J7
xx-�'
pada aka w 10 foot. TRENCH SECTION MONITOR TUBE
DETAIL
gt �V OF A4 Conventional Single Family Residential
?�gcgs�ao0 PROPOSED SEPTIC SYSTEM DESIGN
q ten
' grH ps,no.;,ptio.n T15N, 8111, SECTION 18, LOT 7
P.O. BOX 1315
rp Charles'A. Leet '-� C. A. LEET, P.E. PALMER, ALASKA 99645
•. CE 10480 d PHONE: (907)745-8371
?Q��o. •._ ��� FAX: (907)745-8371
tad
C. A. LEET, P.E. ate ®°ate atrcET 2 OF 2
91
,. nam rock
.Matt,a daptk
ELEV. Be.O'
mdlnlurbd
Y
eeneonal klek
grottiulwator
tin sakte I,
ELEV. B4.0
BOTTOM OF TH
2' t
parforaw tNC
kde orlmtaUon
(hot" Goon)
SECTION X -X
remonodda
sap
J7
xx-�'
pada aka w 10 foot. TRENCH SECTION MONITOR TUBE
DETAIL
gt �V OF A4 Conventional Single Family Residential
?�gcgs�ao0 PROPOSED SEPTIC SYSTEM DESIGN
q ten
' grH ps,no.;,ptio.n T15N, 8111, SECTION 18, LOT 7
P.O. BOX 1315
rp Charles'A. Leet '-� C. A. LEET, P.E. PALMER, ALASKA 99645
•. CE 10480 d PHONE: (907)745-8371
?Q��o. •._ ��� FAX: (907)745-8371
tad
C. A. LEET, P.E. ate ®°ate atrcET 2 OF 2
Municipality of Anchorage
Development Services Department
Building Safety Division
• Y! Onsite Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www cl.on`horaoe elix
(907)343.7904
Soils Lo - Percolation Test
Performed For. _ T C�prd. Date
Legal Description: —FIS N, pc l T% Township, Range, Section:
MGANICS, VCCT
%76ww
arnoclw1s l
M.'Dehs e-, TAa
A>zA WW-GMl
WTtc"cP'r t+ -
rian
WAS GROUND WATER
Date
ENCOUNTERED?
N
IF YES, ATNHAT DEPTH?
Net Drop
Depth to Water After
Monitoring?
3o„Ai
Date:
r•-lD
Reading
Date
Gross Time
Net Tena
Depth to Water
Net Drop
3o„Ai
q
h
`J 3�4
q 3r, 6
i Vl
15 7
�rxi tL
PERCOLATION RATE (m"A vi h) PERC HOLE DIAMETER
epS� TESTRUNSETWEEN `S`• FT AND '52, Fr
COMMENTS Fk : E" -Z) N
PERFORMED BY: 0., L,, -, J— I CERTIFY THAT THIS TEST W S
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE:
P.O Box 1315
Palmer, AK 99645
Charles A. Leet, P.E.
August 27, 2003
Mr. Dan Roth
Municipality of Anchorage
Development Service Department
Anchorage, AK 99519
RE: T15N, R1 W, Sec. 18, Lot 7
Subject: Permit Request— Design Narrative
Dear Mr. Roth:
The owner of the above referenced lot was in the process of replacing his septic tank when MOA onsite
personnel informed the owner he was in violation of Municipal Code requiring a permit to install or modify a
septic system. Currently the tank has been destroyed and the new tank is ready for installation pending a
permit. We are requesting a plan review and a permit to install a 1500 gallon septic to serve the existing three
bedroom residence.
Existing Wells 8 Septic
The subject lot's well is located behind the house over a hundred feet from the well. Lot 6 septic system is in
the front of the house with the well behind the house. Lot 1, 2, and 3 well to the North is located behind the
house. The lots to the south are over a hundred feet away with the help of Garnet Court 30 right of way.
Surface Waters
There is no surface water within 100 feet of the proposed upgrades.
The Plan
The plan is to install the 1500 gallon steel septic tank in the same location as the old septic tank.
We do not anticipate any adverse effects on the neighboring, septic systems, reserve areas or drainage patterns
by the installation of the proposed septic system. This subdivision is server by a community water system.
Sincerely,
(3)
Charles A. Leet, P.E.
Project Engineer
Encl: Permit Application
Permit fees (to be provided by owner)
Cc: Client
............................
lI
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I o � i�►� 5�q �' /'�'1
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iS �V 1 w Sec�'0 l8 Lot 7
FROM CLIFFORD REMODELING
PHONE 140. : 9(77 688 0348 Aug. 27 2003 12:24AM P2
R;
PA
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10/9/2003
Municipality of .Anchorage
Mark Begick, Mayor
Building Safety Division
P.O. Dox 19(iCZ0 • 4700 I1nigaw Street
Anchorage, Alaska 99519-W50 • (9()7) 343.0:101 • Pim (907) 343.8'2(x)
fit 1,1/mm.mun Lorg
Charles A. Leet, P.E.
Alaska Rim Engineering
P.O. Box 1315
Palmer, AK 99645
Subject: Waiver Request for T15N R1 W Sec 18 Lot 7
Waiver Request 4WR030093
Parcel ID 4051-171-11
Dear Mr. Leet:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
1.0 foot.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely, %
WP-
Daniel J. Roth
Civil Engineer
On -Site Water & Wastewater Program
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchoragc.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: 030093 PID#: 051-171-11 HAM Permit#: SW030343
Date Received: 1019103
Legal Description: T15N R1W See 18 Lot 7
Engineer. Alaska Rim Enaineerina
P.O. Box 1315
Applicant: Ted Clifford
Waiver Requested: 1 foot Lot Line Waiver from the Absorption Field to the Property Line
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
mass ... one ..... son ...
.........................................................�
Waiver is Granted: >( Waiver is not Granted:
List Conditions or Reasons for above: SE -0 rti4 /PEr)Q tS t
L��STl F/CNT/GYL 0,6 %�—O $ VE-tO% 8 03 A74CZ&=
Date: B)16
1
y: 17 N
Name of Reviewer
.................................................. so.... as.... so .... ..........�
Rec#: 41441 Amount: $150.00 Date Paid: 10f912003
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES /y
Environmental Health Division / / �/
825 "L" Street, Anchorage, Alaska 99502, Telephone 264.4720 V
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
DISTANCES
TO
fflOM
SEPTIC
TANK
ABSORPTION
FIELD
WELL
�aa1.s. /
a � x%
F07 CAIW40',+A /Jk �r1ju,
WELL
127
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ptwrelel
bq -uw/O
PnmO No.
No. of eeorooma
-3
LOT LINE
uc11t. norr
o[acet.
Lot
ato(:a
Subdnpon
FOUNDATION
8¢
g9
Township. Range, Sedan
e AJ / [i %
C� w
AS -BUILT DIAGRAM (Sh" button of wall, septic system, properly lines, toumauOn.
Omeway. water bodes. etc 1
TANKS
SEPTIC ❑ HOLDING
U
1
ce
L4,
e
ManufacturerAA�
e7�`�
capacity a gauche
/C00
Malens'
5716Et-
No. of Compenmenq
I'
TYPE OF SYSTEM
TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER
Depth to pope bohom from
on9inal 911109 G-• FT
Total oeptn nom orpmal 911100
Pi FT
�)
�
a
flV
W
°r
Fill 11aba° abo.e orpmal 91stle
FT
4 111" depth beneath pipe
F FT
GI" length
3 FT
Gnwn width
Z l FT
Total absorption ansa
i., `4• SO FT
Distance between lines
— FT
Number of •nee
I
Soil rating
I L't-o SO FT
Pipe mtenal
A-STm 3ob4-
mawlaDale
�
Installed
(O 24
WELLS
PRIVATE ❑ OTHER (IdentIN)
classification (AB.C)
Total Depth
Z07 FT
casco to
1 &0 FT
Inafaner
IL..uAMS /LILLlA74
ate Inslallad.
I %ai `d
REMARKS:
f�
/F
Scale:
Inspections peAormed DY:
�. P.�•yroJ
��,; �mf. (:
-% G AC
p91"A•Y'
.� �.;
•• •«�a••«•ie«•••••« �•� ,�
2205E
f,�9F ROFESStO��'►"`~
Dole,
D des
1 � 9v� " • " c �� tastily BW Nis Inspedlon was periamed [aordinp m [II �
MunidDsl and State guidelines N [Bed
e ' / Zz _77
Health oewrDn.nt Approvab oa(
M U N I C I P A L I T Y O F A N C H O R A G E
Department of Health & Human Services
025 L Street, Anchorage, Alaska 99501 343-4720
O N- S I T E
Permit Number: 900015 Upgrade
Date Issued: 01/18/90
Owner Name: NORMAN DIAL
Owner Address: HC78, BOX 2407
CHUG I A:, AK 99567
W E L L P E R M I T
ti W
Parcel Id: 051-171-01
Lot Legal: Subdivision: NA Lot: 7 Block: NA
Section: 18 Township: 15N Range: 1W
Lot Size 99000 (sq.ft. or acres)
Max Bedrooms: This Permit: 3 Total Capacity: 3
Day Phone:
688-2640
WELL: Log must be submitted to Municipality of Anchorage Department of Health
and Human Servicers within 30 days of well completion.
PERMIT EXPIRES DECEMBER 31, 1990.
WELL LOG REQUIRED WITHIN air DAYS FOLLOWING DRILLING.
ORIGINAL WELL MAY BE RETAINED PROVIDED THAT EITHER A SANITARY
SEAL IS KEPT IN PLACE, OR A TEMPORARY STEEL PLATE IS WELDED ON
TOP OF WELL CASING. FOR FHS PURPOSES, ORIGINAL WELL MUST BE
DISCONNECTED FROM DWELLING.
I CERTIFY THAT:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. 1 will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back:
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. 1 understand that this permit is valid for a maximum of 3 bedrooms. I
also underst that the caracity !Ztional
the total system is 3 bedrooms and
any enlar_.:men will r ire an .� permit.
Signed: DATE:
(Owner) NOFMAN DIAL
Issued By: DATE: Z/g-9O
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December 5, 1989
DAVID R. DAYTON, P.E.
SR 1 [)ox 1026
Chuglok, Alaska 99567
(907) 688-2417
ADEQUACY TEST
Legal Edscription: Lot 7, Sec. 18, T15N, R1W, S.M., Alaska
Date Performed: December 4, 1989
House Size: 3 Bedroom
Septic Tank Size: 1000 gallon, 2 compartment, steel tank. (DHHS Records)
Absorbtion System: 4'effective depth x 83' deep trench, 664s.f. (DHHS Rec.)
Soils Rating: 220 sf/br (DHHS Rec.)
Daily sewage flow: 3Br x 150 gal/Br - 450 gal/day
Average flow: 450 gal/1440 min.- 0.313 gal/min.
Peak flow: 0.313 x 1.5 - .469 gal/min.
Test:
As the house has been vacant for several months, the system was
presoaked with 2000 gal. of water on Dec. 2, 1989.
On Dec 4, 1989, water was introduced into the absorbtion system
at 5 gal/min. for 60 minutes. (5 gal/min is approximately 10 times
the peak flow)
Results:
The system accepted the 5 gal/min flow for 1 hour with no evidence
of backup in to the septic tank or surcharge on the absorbtion
system.
Conclusion:
Septic system is currently functioning adequately.
GF 4
•NNNN••..• .. W•
CQVW R. Dcyt"
�•, HO. 22051
d�. pROFESS�O�'a:
C,.:ent Sale ID:L7 SIS T15N R1W SN
PEND :IIA
Co:lected JV 25 90 t 10:30 hrs.
2eeeiced J35 25 90 B 13:00 hrs.
Preserved with :AS REQOIRED
C`emLab Ref- C :9323
Aalysis Coyleted :
<• ervisor :STEPHEN C. EDE
LAB 11:STRUC11113 forDate Report Pointed JANk29 90re 12`
V
:,.Sent Nar_e -.DIAL. IMIM2;N
:,.lent Aect *.DIALNC
?.0.. 1.O11E RECEIVED
?.eq t
:tasted By : DAVID DAIi04
Send Reports to:
1)DIAL. 1:011'.AN
2)
Laborata:7 -*Jp.......
Raleesed 37 ° •••••••••••••••••••••••••••••
•Special
Instruct:
Pateseter Method
Units Result
Client To 'lest
..
Cherlab •••••••••••••••••••sol/100n1
tion Matrix ..........
Sarple = Sysnle .....Desexp ------
..........................
............
.........-_18. 1 20005-10TAL COLIFORM
2 L7 SSB T15N RSW SM
Client Sar_ple ID:L7 SIB 71511 R1W SH
FUSID :UA
Collected JLN 25 90 E 10:30 hrs.
Received JAN 2S 90 E 13:00 hrs.
Preserved with ;AS REQUIRED
Cherlab Ref. t :9323
LAB INSTRUCIIONS fox Work Order i 19523
Date Report Printed: JAN 29 90 E 12:09
Client Name DIAL. NO?.!'.AN
Client Acct DIALNC
P.0.1 NONE RECEIVED
Req i
Ordered By : DAVID DAYTON
Analysis Completed : /—A2_70 Send Reports to:
Laboratory Supervisor :STEPHEN C. EDE 1)DIAL. MUM
Released By 'Pil (1 2)
..................................................................................................................
Spocial
Instruct:
]herlab
Client
Parameter
;ample i
Sample Description
Iatriz To Teat
Nethod Units
Result
......................................................................................................................
L L7
SIB TiSN R1W SN
1 20153-NIIRATE-N
EPA 353.2 mg/1
�•IO
Municipality of Anchorage j
Department of Health and Human Services
825 "V Street
romP.O. Box 196650 Anchorage, Alaska 99519-6650
Mayoror
January 8, 1990
Norman Dial
HC 78 Box 2407
Chugiak, Alaska 99567
1 �h-
Subject: T15N R1W Section Lot 7
Permit #890269, PIU #051-171-01
The subject permit, issued by.thi.s office.for a single.family
well and/or on-site wastewater system has expired'as of December
31, 1989.
Permits are issued on a calendar year basis by authority of the
Municipal Code of Regulations. A new permit must be obtained
from this office for an well and/or on-site wastewater system
not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this office for documentation of the installation and to close
the permit.
If a private engineer inspected the installation of the on-site
wastewater system, the original as -built inspection report
(three-part form) must be sent to this office for'review,
approval and documentation.
When applying for a new permit, the fees are:'$90.00 for an
on-site wastewater permit; $50.00 for a well permit; $140.00 for
a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Sincerely,
John Smith, P.E.
Program Manager
On-site Services
JW/ 1jm:200
enc: Copy of Permit
"Kids Are Our Future"
M U N I C I P A L I T Y O F A N C H O R A G E
Department of Health & Human Services
025 L Street, Anchorage, Alaska 99501 343-4720
O N- S I T E
Permit Number: 890269 Upgrade
Date Issued: 12/06/89
Owner Name: NORMAN DIAL
Owner, Address: FIC 78 BOX 2407
CHUGIAK, AK 99567
W E L L F E R M I T
Parcel Id: 051-171-01
Lot Legal: Subdivision: NA Lot: 7 Block: NA
Section: 18 Township: 15N Range: 1W
Lot Size 99000 (sq.ft. or acres)
Max Bedrooms: This Permit: 3 Total Capacity: 3
Day Phone:
688-2640
WELL: Log must be submitted to Municipality of Anchorage Department of Health
and Fluman Services within 30 days of well completion.
PERMIT EXPIRES DECEMBER 31, 1989.
ORIGINAL WELL MAY BE RETAINED PROVIDED THAT EITHER A SANITARY
SEAL IS KEPT IN PLACE, OR A TEMPORARY STEEL PLATE IS WELDED ON
TOP OF WELL CASING. FOR FHA PURPOSES, ORIGINAL WELL MUST BE
DISCONNECTED FROM DWELLING.
SUBMIT WELL LOG WITHIN 30 DAYS OF WELL COMPLETION.
I CERTIFY THAT:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
I will adhere to all MOA and State of Alaska requirements for the set back:
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms. I
also understand that the capacity of the total system is 3 bedrooms and
any enlar .r::me t will rsire an additional permit.
Signed: - ----- DATE:
(Owner) NORMAN DIAL
Issued Dy:�------- DATE:
C4�
R,
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
sENVIRONMENTAL ENGINEERING DIVISION
1 825 L Street • Anchorage. Alaska 99501 Telephone 264-4720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
E�
PHONE
68 -Zl
ONEW
OUPGRADE
MAILING ADDRESS
'1
f.
LEGAL DESCRIPTION
LOCATION
AMLET V\Ew mFg
t� ` cl
p�RcHWooD Looe J
NO. OF BEDROOMS
3
U Y
DISTANCE TO:
Well
Q�
Absorption rea
Dwelling
PERMIT NO. 8\0\4-
_
�Z
y �
Manufacturer
Get -F.
Material
c .. L
No. of compartments
1
Liq.caQ cOityOIn gallons
IF HOMEMADE:
Inside length,`
`V
Width
Liquid depth
d Y
J2Z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
_? H
Manufacturer
Material
Liquid capacity in gallons
WS
DISTANCE TO:
Well
`0S
Foundation QQ
.6 -.
Nearest lot line
fJ
PERMIT NO. p
O10 k�
W Z V
F Z w
No. of lines
%
Len th of each line
g
3
Total length of lines
g 3
Trench wi th
inches
Distance between lines
1
1¢.
o
Top of tile to finish grade ` tt
O
Materiel beneath lila
t
4 O Inches
Total effective absorption area
W
Length
Width
Depth
PERMIT NO.
F
a
W
Type of c (�
�1
Crib diameter
Crib depth
Total effective absorption area
N
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
lass
�V
Depth
Driller
Distance to lot line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area
OTHER
PIPE MATERIALS
Asim '3os�- \aoa
SOIL TEST RATING lko
INSTALLER
3
V
R
S
REMARKS
—�
n�
t0
14
4
S
44
\C
IC
to
I
q
.SO3
1
L
ROVED
DATE LEGAL
72-013 (Rev. 3178)
I.,
�.� � MUM I C I f �L I TY OF FINCH ZFiGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PvOTECTION
• 825 'L' STREET. ANCHORAGE, AK. 99501
264-4720
01 —S I TE EWEE: FZ F}EFZ tj I T
PERMIT NO. t 781014 ) aA -*)913'Pd.
��c�tclLA
U
"Du U
,Ql_Lcn s
APPLICANT STEPHEN BULLOCK BOX 773 EAGLE RIVER 688 2737
LOCATION BIRCHWOOD LOOP
LEGAL L7 S18 T15N R1W SM LOT SIZE 43000 SQUARE FEET
TYPE OF SOIL ABSORSTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (50 FT/BR)= 220
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
1/D 3
DEF -17"= S L.EMGTH= O3 C3FZFI• E:L- F>EF-r"= 4
THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF R 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 CIN FEET).
FZECPU I FZEE: F> SEPT I C TFIMK S 12E= 1E060O Gf=l ILLON5
,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 C 2 ] I fJSP ECT I OM1 F/FZE FRa G2U I FZEF> ---
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.
OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AFJD CONSTRUCTION DIAGRAMS ARE
.AVAILABLE TO INSURE PROPER INSTALLATION.
F='EFZM I T EXP I FZE.E; OECEMBEFZ 31r 1E31 r S
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 THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDE14CE IS ,F OODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED
3SUED BY
BULLOCK.
V3. 2
0 £f E GEL 'ECHNI CAL & DEVE JPMENT CO.
Box.
Box 90, Davis St., Eagle River, Alaska 99577
694.2774 or 6882280
Russell Oyster Ead Ellis
6942774 SOIL LOG O
Sons & Foundations - - Land Development
- Perfo'med for: Name: I&P,41A,v r3. D/AL el. No. L•��'?� �n
Mailing Address:fTS67
Legal Description: Lor 7, �t<c-t/B, 7-1546 ,P/W, Z5
Depth (feet) 11.!'s $oil CheractcHstics w, ,
o `
3 GO �>`=lA/ CL.e.9n/ SANDY �CAiEL
4 ¢ sc.�HrrY �.zrty Syvof'
. '� Gaq✓E�-.�/moo. DEiv�irY
7
+r 8
10 ' SP SkiiY'A� F L f.�'AdEtt.•Y/
11
_ 12
X13
,B�Tr•��'{,�F f ,T
..0 r
i
r..
Ground Water Encountered: Yes No v _If,yesj what depth
Proposed;Installation: Seepage pit Drain Field__!::_
w✓
Comments
Performed b . Date:
y:
..
J
fes_,
APPLI�"ANT FILLS
OUT UPPER HAI` ONLY
Property OwnerOPMcan
t3•JIct\1
P"°"°
Mailing Addra r 1 (
�
C u I Zip Code
Buyer
.. 'e -
n0nee
/
...
-
Address
Address
•
Zip Code
Lending Institution
�
Bonk /
A lcl 5kci. Bonk 0 'F (� /)1 I>1 Cu YC'G•
Phone
Address M f ��
/ �(/ I , / ) wd 1
�. _
' Code _ i
„ 1 ,?D 9 l
Realty Co. & Agent
�/
Phone
Address
Zip Code
Legal Description
t / J !J , 1 1 /) Sea 17
'CONDITIONS OF APPROVAL
Street Location
le
tno
Type of Residence
DATE Z
)Z Single Family
Soils Rating
❑ Multiple Family
No. of Bedrooms i
, t �. i .
❑ Other'
c
I t Q— 2 -If `70
.
Water Supply
Septic Tank Size /0— p
[Z Individual
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
❑ Community
For wells trilled prior to that date, give well depth (attach tog It available).
❑ Public Utility
Sewer Disposal
n n
§' Individual
Year Individual Installed:
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Cl '
Time
:2—
r.
.� 4s
Date
Date
Date
Date
o�,;LL(_
Date X77 %
Inspector
Inspector
InsDectJ>r
inspector
Field Notes:
N z 66
( ) APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ( DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE Z
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area / os
Well Log Received
Z Za
c
I t Q— 2 -If `70
Well to Tank
/ (.p
Septic Tank Size /0— p
rtm3 irm
February 9, 1979
Alaska Pacific Assurance
4041 B Street
Anchorage, Alaska 99503
Attention: Bob Polley
Subject: T15H R1W Section 18 Lot 7(R. Taylor Property)
Septic Tank Claim Settlement
This depart^nnt, in an effort to resolve the question of
a septic tank verification, has field inspected the property
on February 8, 1979 with a metal detector. The results
were negative.
Two(2) possibilities exist, namely:
(1) There is a tank, which is constructed of concrete,
and would not register on the detector.
(2) No tank exists and Mr. Blair errored in assuming a _
tank was present through verbal statements, or sewer
line cleanouts wore mistaken as tank cleanouts.
The Eagle River office was experiencing an overload
during this period and a subordinate may have errored
in reporting to Mr. Mair.
Alaska Pacific Assurance
February 9, 1979
Page Two
The possibility still exists that a concrete tank is present,
however, the matter of weighing exploration costs versus
settlement of the claim remains in your expertise.
If there are any further questions, please contact this
office at 264-4720.
Sincerely,
Los N. Buchholz, R.S.
Senior Environmental Specialist
VII/1 jer
cc: Elizabeth
Risk Management
425 1 Street 99501
Joseph S. Blair, R.✓.
Star Route Box 1460 99567
Ajun^ip&W of Anchor, -"se RECEIVED
MEMORANDUM I40V 7 1978
DATE: November 3, 1978 11UNICIPAL ATT0PU E1•
TO: Ken Norman, Municipal �Attorrney
FROM: Joseph S. Blair, R.S. 2.ne
SUBJECT: On-site Sewer Lot 7 Section 18 T 15 N R 1 W. Mrs. Dial
Telephone No. 688-2640 or 277-1488
A Mrs. Dial, present owner of the above described lot called me on
October 27, 1978 and'stated she was very very irate because she had
bought the property because it had an approved sewer and well. She
stated she was in possession of a loan approval request dated November
7, 1972 and signed by me that indicated the on-site sewer and weTT--
were adequate and approved. However, she stated excavation revealed
no septic tank.
A search of all records on file here failed to reflect any record
of the above but did indicate that a soils test was performed on the
property by Earl Ellis on October 190 1978 and that on October 23 1978
excavator Stephen Bullock requeste an obtained a permit to �nsta
a sewer system on this lot.
The 1st inspection of the system installed by Bullock was conducted
by John Kennedy at 9:30 a.m. October 24 1978, and the second inspection
conducted by Hank Allers at 2: p.m. cto cr :••".,1^73.
On October 30, 1978 I obtained a copy of the loan approval referred to
from Peoples Bank and Trust. (Copy Attached)
On October 31, 1978 Hank Allers and I went to the property in an attempt
to correlate all the known facts. I do not recall ever visiting this
particular property at any previous time.
An ink sketch with notes accompanice this memo. Of significance is the
proximity of the old seepage pit to the foundation and the note on the
1972 loan approval that locates the seepage pit 113 from the foundation .
and a septic tank 63' from the foundation; 100 from the well to the
septic tank and 150' from the well to the seepage pit.
I am continuing to attempt to locate somebody that knows something of
Arctic Excavators, the firm that supposedly installed the original system.
I am of the opinion that a spectic tank does in fact exist or did exist
but in an area other than that excavated during the current installation.
Mrs. Dial intends to file a claim against us for the total cost of the
on-site system.
91-0101Na)
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r GREATER ANCHORAGE AREA;BO
s Department of Environmental, y
3500 Tudor Road, .Anchorage, Alaska ..90- X74=8695
Date Rec lictnb@r 25: 1472
Time of T�ction
Date of Inspections ob r- 7 1472
REQUEST FOR APPROVAL OF
INT) VIDUAL SEINER'& WATERF ACILfTIES-
FOR
1 Conventional
f Approval Requested eys Mr. Ltax Bevans -
f Address:Devie; Associates, 4205 Minnesota Driwe 95311 Phone:279-2491
i%one 688-2410
2.' Property, Owner R.ITaylor � ''
Legal`Description3 LOt 7 •,Section 18 T1SN`.R1W
..
4.:, Location: Inlet'View Drive
i,' S:• Typ�'of Facility to be Inspected. ',Single-Famil
Number of'Sedrooms: . Three.(3)
4 6. Well Data:,,
i
A. ,Type .Drilled B •Depth
C. Construction 6" Steel' D. Bacterial i Alis Satisfactory
F„
7.- Sewage Disoosal System:
A. "Installed' 8. Installer ating
Septic Tank. 1. Size 1,200 2. ManufeeIL
D., Seepage'Pit: 1: .Size 2. Materij
E.' -Disposal Field: Total Lergth`of Lines
8. Distances:
A. Well To: ,Septic Tank 100' Absorption Area '.150 Sewer Lines
,.Nearest Lot Line 25' Other Contamination
B. Foundation -to.Septic Tank 63' r Absorption Area 113'!
C. Absorption Area to Nearest Lot Line 30':
i -
y
GREATER -ANCHORAGE AREA BOROUGH_
"`r -3500 TUDOR ROAD:
J !. :ANCHORAGE.ALASKA 99507.
Y
,.:f� DEPARTMENT OF ENVIRONMENTAL DUALITY
4
Wn � �
Re: Lot 7, Section 18, T15N, RIW, SM., R. Taylor.
November 7, 1972
To whom it may concern:
� The above subject property has been inspected by the Greater Anchorage Area
E Borough,_Uepa_rtment of Environmental Quality for approval of the water
N supply and sewage disposal"systems:�_ "
A The water supply system consists of a drilled well one -hundred and sixty
(160) feet deep, with six (6) inch steel casing to full depth and a
R submersible pump. Bacteriological examination of water collected on
October 30, 1972 was satisfactory.
c The sewage disposal system consists of a one -thousand, two -hundred gallon
L steel septic tank and a seepage pit.
C
The above systems meet all minimum requirments and if properly maintained
should function satisfactorily.
r_
I, oseph S. Blair R.S.
anitarian II
dd
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH S HUMAN SERVICES (J
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL +-I A 90��
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date0� y40
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
71 SIB, ,-Ismr 21 W,
Location (address or directions) (�
/tirLCT )/te,,j 1>Q OFF S. CC -" coo 30 LSP
(b) Property Owner t4oR^'" Q,AL Telephone: Home 6gf Z6 do Business �.V�ozd
Mailing Address X78 you 2107 Q/Ju�//9,e %�C �i95Coi
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
Telephone
(e) Mail the HAA to List contact persohn anllowina address: or: d clay phone number belovhere Ly if hold for pick up.
Gts/u�.A� �¢�.9tc.a 955% �ocaL•'-ZG4-y
2. TYPE OF RESIDENCE
Single-FamilyX
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 �R'v O�B61 From
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NOIIVWHOdNI ONV V1Va'HOHV3S 3ljd'S1S31'SNO11O3dSNI ONIOIAOHd WHid DNIH33NIJN3 'S
MUNICIPALITY OF ANCHMUNfCIPALITY OF ANCHORAGE (MOA)
ENVIRONMENTAL SERVICESpgAXtH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
FE37 1 1930 2644744 Q
Legal Description: �4
T/SN i Q /
RECEIVED
A. WELL DATA
vv 0g-7� If A. B, C, D.E C. Approved (Y/N)
Well Classification Rai
Well Log Present (Y/N) -[— Date Completed 19190 Yield S
Total Depth Z0_ Cased to 4940 Depth of Grouting - —w ✓O —
i/a S
Static Water Level �Z S Pump Set At
Casing Height Above Ground 9_ Sanitary Seal on Casing (Y/N) y
Electrical Wiring in'Conduit (Y/N) / Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot �ZS ; On Adjoining Lots /040./.
i
To Nearest Edge of Absorption Field on Lot jKjQ On Adjoining Lots foo "t
To Nearest Public Sewer Line 4/6 *J To Nearest Public Sewer
Cleanout/Manhole A/4 NlkTo Nearest Sewer Service Line on Lot
Water Sample Collected by �; Date
Water Sample Test Results ��tAL0G�7 l �-� ltlm '/ - /o `
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed Size / 0#0 No. of Compartments 7—
Standpipes
Standpipes (Y/N) Y Air -tight Caps (Y/N) %/ Foundation Cleanout (Y�/N) "'V
Depression over Tank (Y/N) Al Date Last Pumped z�r e9
Pumping/Maintenance Contract on File (Y/N) /✓ ; for
Holding Tank High -Water Alarm (Y/N) cY Temporary Holding Tank Permit (Y/N) A✓
Separation Distances from Septic/Holding Tank:
To Water -Supply Well !Zs
To Property Line
To Water Main/Service Line
Course
Comments' • Z&
Page 1 of 2''
72-M (Fl" 9'861 Front
To Building Foundation J9 ¢
To Disposal Field �7
To Stream, Pond, Lake, or Major Drainage
c.
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 2 ZO
Type of System Design Qfi✓�if/
Date Installed/2 y 78
70,.- } Length of Field 83
Width of Field ~ Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area to 6¢ Standpipes Present (Y/N) Y
Depression over Field (Y/N) Date of Last Adequacy Test.- /IL4ZB 9
Results of Last Adequacy Test �El:�urS
Separation Distance from Absorption Field:
To Water -Supply Well / 40 To Property Line
To Building Foundation 9 99 To Existing or Abandoned System on
Lot _el wX- f�u..��J ; On Adjoining Lots '- IVQwe �V 06,JAJ
To Water Main/Service Line W ^ r To Cutbank (if present) 44 w L.
To Stream/Pond/Lake/or Major Drainage Course /00 -,r-
To
To Driveway, Parking Area, or Vehicle Storage Area _ �c
Comments . F -le"" Pi/iSt 6-co2es C,yir 7�/O fG
1i2f1/nfFiL=iD �,� oattr0 pR.to2 ro A-fl�Ru i4e.s! �sT
D. LIFT STATION
Date Installed ' ,� �' V A/�
Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
Check Permitted Bedroo Rating Against HAA Request •' '
Icertifythat a d, erifie,orconformedtoall MOA and HAA guidelines ineffect onthe date ofthis inspection.
Signed Date�� �1Z9b
Company A J 16e MOA No. 90 00/(P
Receipt No. 70 OF q(q
Date of Payment. 9 9�
Amount: $ �7D. D * I ZXM n Ineerml
Page 2 of 2
72.026 (Rev 8'861 Exch
Da*J R. Dcybn
NO. 2201E