HomeMy WebLinkAboutTHE TABLELANDS #1 BLK 8 LT 21The Tablelands Block 8 Lot 21 #051-801-66 Municipality of Anchorage Development Services Department = `- Building Safety Division On -Site Water 8 Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.G.anchorage.ak.us(907)343-7904 Page 1 of 3 Onsite Wastewater Disposal System and/or Well Inspection Report Permit Number. SW050124 PID Number. 051-801-66 Name: WALLACE HOMES Wastewater System: ■ New ❑ Upgrade Iddnrew: 18306 PARKVIEW TERRACE LOOP ANCHORAGE, AK. 99577 ABSORPTION FIELD Phone: No. of Bednwm.: (907) 230-9199 4 ODeep Trench ■Shollow Trench OBed 0klound ODther LEGAL DESCRIPTION so eatlV 0.8 Told Depth Mem °10 MAX on/s, n 3 n Block: LOL• Subdivision: 8 21 ..TABLELANDS `' Depth to yeti hattm tram arep' a , , SEE n, .per e„ep D4* DWG. n 2+ a Township: — Range: _ .. Section: rN .edea .ewe eiMb Pee* orawl knout — SEE DWG. n 105 2 ® 52.5) n WELL: ❑New ❑ Upgrade arw'd wwft 5 leen... d 0.el.bee 2 edeeeo k. 10 n n Cla.ebov-(W.V*AB.0 . Coed Tame Told eteerptbm oma hoe metwlok 750+ so. n D 3034/ F-810 smee "'Aw L...e .elder: GREEN GENERAL ode '6728-29/2005 1±8�"\C "•• `'• • Dee. Do.* n rr� rw•P set ac c**q a+ae *C V orea.m E)2 UrJ' UI TANK LPer n SEPARATION DISTANCES ■septic 13Nokling 13 S.T.E.P. 13 Other To rrom Septi Torek Ib Bon FINd Uft station Nobdlrq Tank /prkvte s...r u. mw.#Q0b'en ANCHORAGE TANK ~ e+^S 1250 Well 100•+ 100•+ — — 25'+` STEEL d� 2 Surface Water 100•+ 1006+ — — — LIFT STATION Lot Line 5'+ •1• — — — sw In °pe"* YsfocOi Foundation S'+ 1 10'+ _ _ _ en' n 1" d: at ley, .tie. dam rt Curtain Droin NONE KNOW p ww •0w' Doubled kwe.°uae panne° pe Remarks: 'WE REQUEST YOUR DEPARTMENT AMEND BENCH MARK THE EXISTING 5 FOOT LOT UNE WAIVER TO 1 F00T. Leedom We DO.agewt TOP OF CMU FOUNDATION O FCO A.an.d Bweuat 102.90 n cralra:cas Inspections performed by: GEG, Ltd.Dates: 1st _.2/28/2005 sy 2nd 6/28/2005 3rd 6/29/2005 { . . Go mess.: .... ... �Q : Development ervices Department Approval E-7 p• Qa Reviewed and approved b Date: PP Y41 ,u .•�'��?� °4 P,ofesdan ot..,.12/00 - 0 PEMMrr SW0 0124 AS-BUILT DRAWING PARCEL ° NUMBER: SW050124 051-801-66 FCO 29.51 4.03 ST1 32.99 22.16 ST2 26.48 24.56 DBLI 24.89 25.63 DBL2 24.13 26.16 FS 25.06 33.56 C01 43.40 35.62 MT1 37.91 33.32 CO2 37.91 65.55 MT2 37.64 63.63 C01 62.26 52.47 MT1 59.58 53.48 CO2 47.40 66.94 M172 44.76 62.71 DEER PARK DRIVE NEW DRAINFIELDS NEW 1250 SEPDC LOT 20. BLOCK 6; TABLELANDS S/D NACW>) —ALTERNATE SITE WILL REQUIRE THE USE OF AN M.OA APPROVED RECIRCULATING TRICKLING FILTER (SUED FOR 4 BEDROOMS). GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS t GENERAL CONTRACTORS OM L 1110011 10111 On 1M ..Y01OM00. 011 110M . 0 Ig1iW1 j10 . IMt paro� PREPARED FOR: PHONE NUMBER: PACE NUMBER: WALLACE HOMES (907) 230-9199 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: TABLELANDS SUBIDIVISION; LOT 21, BLOCK B. R.A.L. WE of WORK: DATE' AS—BUILT FOR NEW SEPTIC SYSTEM 7/19/2( 0 1, II �i �� SW05o 2244 AS -BUILT DRAWING PARCEL01 801-66 FINAL GRADE - 99.43 ST2 TOP OF TANK AT INLET - 95.23- n U NEW 1250 GALLON INVERT OF BUNG SEPTIC TANK AT INLET - 95.08 TANK AT - 95.23 INVERT OF BUNG AT OUTLET - 94.87 'NOTE: TEST HOLES WERE EXCAVATED AT THE BOTTOM OF A GULLY. THE DESIGN SHOWED A 4 FEE DEEP MAXIMUM DEPTH WHICH WAS FOUND TO BE INCORRECT IN THE FIELD. THE TRENCHES WERE INSTALLED ONLY 3 FEET DEEP FROM THE GRADE AT THE TEST HOLE ELEVATIONS. FINAL GRADE - 98.88-9721 FABRIC F9LLL GRADE TH/1 9728-97.93 k TH/2 FABRK: FILTER IgNAL -E IST CO AL 1TA B B "' a' •::i. � ��.�;i:i:i:ia.. it% it?i3i?%i?i?i a- �Ga Ltl:�'1P?fes HOLE O 87.18 7H/2 I GARNESS ENGINEERING GROUP, Ltd. 0%k - 4 IHS CONSULTANTS 6 GENERAL CONTRACTORS Q• • • •. =1 L 11COR 00.481 101. M10Cro0G �[OMOI. •• •• •••••• •••••••••••• ACK (00!)A) -GIT . R111 hOn11-RM PREPARED FOR:- PHONE NUMBER: PAGE NUMBER: ............ WALLACE HOMES (907) 230-9199 3 OF 3 OQ P A. mess.: LEGAL DESCRIPTION: DRAWN BY: ODA. ' -7 3 . - kA, TABLELANDS SUBIDIVISION; LOT 21. BLOCK B. R.A.L . 'N' �f * TYPE OF WORK: DATE: 000 ,toe PROFILE AS—BUILT FOR NEW SEPTIC SYSTEM 7/19/2005 fRN. 01MI MUNICIPALITY OF ANCHORAGE 12 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 ) WATER SUPPLY PERMIT Initial Date Issued: May 17, 2005 Expiration Date: May 17, 2006 Permit Number: SWO50124 Parcel ID: 051.801-66 Legal Description: THE TABLELANDS #1 SUBDIVISION BLOCK 8 LOT 21 Design Engineer: 0855 Garness Engineering Group, LTD Owner Name: WALLACE HOMES Owner Address: 18306 PARKVIEW TERRACE LOOP EAGLE RIVER. AK 99577 - Site Address: 18306 PARKVIEW TERRACE LOOP Lot Size: 40663 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 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. 5. The following special provisions. a.) Maximum depth of absorption field shall not exceed 3 feet below original grade. Received By: Issued By. Date: S Municipality of Anchorage ' Development Services Department.`' 1C•; Building Safety Division 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 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051—'goI- (rtr Permit Number Property owner(s) - WALLAcir Homirs Day phone Mailing address (1) 18306 PARKVIEW TERRACE LOOP • EAGLE RNER, AK. Mailing address (2) Zip Code 99577 Legal description (Lot, Block & Sub'd.) LOT 21 BLOCK B• TABLELAND St IBDMSION H 1 Legal description (Section, Township & Range) N/A Lot Size 401 Gt' 3 Acre Sq.Ft. Number of Bedrooms 4 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 fora Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. Permit Fees: 4 / %Waiver Fees - Date of Payment: 1 G5 Date of Payment: _ oe7 /6_43 Receipt Number: lDgq_;3C Receipt Number: &?4-35- GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS d, GENERAL CONTRACTORS May 12, 2005 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Resubmital for Tableland Subdivision; Lot 21, Block 8, To whom it may concern: On 5/9/2005 we submitted a design to your department for a private septic system for the referenced property. A permit has not been issued. On 5/12/2005 the groundwater in test holes 1 & 2 was measured at 7' 2" below the ground surface. Due to these findings we have changed the design of the proposed drainfield. The design criteria is stated on the design drawing as a part of this package. We are unawareany adverse impacts this installation would have on adjacent wells or septic systems. If you have any �stions, please contact us at 337-6179. Thank you for your assistance. .E., M.S. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507 Ph: (907) 337-6179 0 Fax: (907) 338-3246 • Website: gamcssengineering.com LOT a. BLOCK 1: DEER PARK ADDITIONJ LOT 13. BLOCK 8; TABLELANDS S/D LOT 19. BLOCK 8; NACANh TABLELANDS S/D (VACANT) LOT 18. BLOCK 8; TABLELANDS S/D (VACANT) APPROXIMATE LOT 20. BLOCK a; LOCATIO TABLELANDS S/D (VAC" LOT 14, BLOCK 8; \ TABLELANDS S/D (VAST) TH12 LOT S. BL.COK 1; DEER PARK ADDLT10NJ1 oononern vr., ., —11--� \ 1 / APPROXIMATE , TNJ LOCATION 1 LOT 15. BLOCK a; PROPOSED --7 TABLELANDS S/D — _—._-- 4 BEDROOM I (VACANT) HOUSE LOT 17. BLOCK a; DEER PARK DRIVE / TABLELANDS S/D --'--- _ , LOT 18, BLOCK 8; Z TABLELANDS S/D z \ (VACANT) LOT 7, BLOCK 9; O TABLELANDS S/D I a NAS o ,N �J LOT 4, BLOCK 9; 0 TABLELANDS S/O GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 6 GENERAL CONTRACTORS ..... ... ..... .............. $V1 E roar Law a e01 • A.LHINGL W rem • P � -s+r • M w • some ... 0 PREPARED FOR: NE NUMBER: PACE NUMBER: .. • • •••••• ............•• PHO WALLACE HOMES (907) 230-9199 1 OF 3 Q p rey A. Comess.: LEGAL DESCRIPTION: ORAwN BY: QO°o, CE -7 5 TABLELANDS SUBDIVISION: LOT 21, BLOCK 8. R.A.L• 6/Jl TYPE OF WORK: DATE; Q40'p,olas 01% SITE PLAN FOR PROPOSED WELL AND SEPTIC SYSTEM 5/12/2005 �OOoo��o IMQV. V IMI NUMBER OF BEDROOMS: -4 GALLONS PER DAY (GPD): 600 PERCOLATION RATE/S:7.5-14.11 MIN./INCH PROPOSED APPLICATION RATE. 0.8 MINIMUM DRAJNFIELD SOXT.: 750 IM DEPTH:4 FEET 5 FEET 1:105 FEET (20 52.5') WE, 2 FEET noN FACTOR:0.70 . SOXT.: 750 TO OBTAIN A COPY OF THE LETTER CONTACT CEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND LOT 20. BLOCK a; TABLELANDS S/D (VACANT) LOT Jjjjr W, "T SED IELD uEsr KEY vv NX//1�47;'11,117ANniff PROPOSED Joe DOUBLE DEER PARK DRIVE -e GARNESS ENGINEERING GROUP,, Ltd. CONSULTANTS & GENERAL CONTRACTORS .. ... ...... ............. F&A am 101 - moamc m n (WrNm.esm - w fwr'mSao - e . . EPARED FOR: PHONE NUMBER: PAGE UMBER: WALLACE HOMES (907) 230-9199 2 OF 3 1 J Fre A. a,m**e*s**s*::*** DESCRIPTION: ORA" BY. CE 3 TABLELANDS SUBDIVISION; LOT 21. BLOCK 8, R.A.L. IE OF WORK: DATE: REVISED Opo, slo DESIGN FOR PROPOSED WELL AND SEPTIC SYSTEM 5/12/2005 1250 GALLON SEPTIC TANK ALTERNATE SITE WILL REOU:RE THE INSTALL FOUNDATION OF A MOA APPS ED THJI LEANour RECIRCULATING TRICKLE FILTER PROPOSED WATER LINE LOCATION DEER PARK DRIVE -e GARNESS ENGINEERING GROUP,, Ltd. CONSULTANTS & GENERAL CONTRACTORS .. ... ...... ............. F&A am 101 - moamc m n (WrNm.esm - w fwr'mSao - e . . EPARED FOR: PHONE NUMBER: PAGE UMBER: WALLACE HOMES (907) 230-9199 2 OF 3 1 J Fre A. a,m**e*s**s*::*** DESCRIPTION: ORA" BY. CE 3 TABLELANDS SUBDIVISION; LOT 21. BLOCK 8, R.A.L. IE OF WORK: DATE: REVISED Opo, slo DESIGN FOR PROPOSED WELL AND SEPTIC SYSTEM 5/12/2005 . Br r— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — I I Ow I I couI I OM I L— — — — — — — — — — — — — — — — — — L — — — — — — — — — — -� rr--87'- r -- —-------------- IOWT I L -------------- FINAL IN FROM TANK INSULATION )RIC FILTER FINAL GRADE ORIGINAL GRADE r 4' MAX. -----------� I OWT I GARNESS ENGINEERING GROUP, Ltd. p°;? CONSULTANTS & GENERAL CONTRACTORS Q• I L n V"A a ,a) • Mowat M a.em • Mort (001i3V am • W (0o>Kv na • ZPARED FOR: PHONE NUMBER: PACE NUMBER: •• WALLACE HOMES 1 (907) 230-9199 1 3 OF 3 TABLELANDS LOT 21, BLOCK 8, OF WORK: DESIGN FOR PROPOSED WELL AND SEPTIC SYSTEM (nar. Ulm) R% L INSULATION IRIC FILTER ORIGINAL GRADE MAX. %/ 1,;- dwra� TEST HOLE #171 y • . 4/19/2005 GARNESS ENGINEERING GROUP, Ltd. 4/27/2005 7' 2' 5/12/2005 CONSULTANTS & GENERAL CONTRACTORS # J 4 6:30 NI qV. 101 � NtlW(i. Mf. 00001 � ROIG b -.1]� � liUl: N � .OGIL pti�nyrYgmn ...... ... .. ... .............. SOIL LOG — PERCOLATION TEST - 6' - LEGAL DESCRIPTION: TABLELANDS SUBDMSION; LOT 21, BLOCK S. ,p •. f Y Om•S9� PERFORMED FOR: WALLACE HOMES DATE: 4 19 2005 a, '• CE -7953 TEST HOLE #171 DEPTH TO GROUNDWATER y • . 4/19/2005 10' 4/27/2005 7' 2' 5/12/2005 I111�111�11 - � 6:30 III*I 3 7/8- 2 1/8- 8'3 H/HN, 6:30 - 6' - 4 7:00 30 • Q 5 !�! - IIIIIiIII - 6 7:30 30 3 7/8- 2 1/8 - 8' IIIIIII A • DEPTH TO GROUNDWATER DATE DRY 4/19/2005 10' 4/27/2005 7' 2' 5/12/2005 6' - DATE READING PERCOLATION CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 4/20/2005 1 6:00 - 6' - 2 6:30 30 3 7/8- 2 1/8- 8'3 3 6:30 - 6' - 4 7:00 30 3 7/8- 2 1/8- 8'5 5 7:00 - 6' - 6 7:30 30 3 7/8- 2 1/8 - 8' PERCOLATION RATE 14.11 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4 FT. AND 4.5 FT. A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS COMMENTS: PERFORMED BY GEC, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WASP FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: PERFORMED FOR: WALLACE HOMES TEST HOLE 2 DEPTH TO GROUNDWATER I •- - III111111 4/27/2005 7. 2- 5/12/2005 6' /.% HHfH 6:30 • 2- IIIIIIIII 3 6:30 kRw %//% - Ilfilll 4.68, • 2- 4- DEPTH TO GROUNDWATER DATE DRY 4/19/2005 11' 4/27/2005 7. 2- 5/12/2005 6' - DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 4/20/2005 1 6:00 — 6' - 2 6:30 30 2- 4- 3 6:30 - 6- - 4 7:00 30 2- 4- 5 7:00 - 6' - 6 7:30 30 2- 4 - PERCOLATION RATE 7.5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4 FT. AND 4.5 FT. A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS COMMENTS: PERFORMED BY GEG, Ltd. I. JEFFREY A. GARNESS, CERTIFY THAT THIS WAS EORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS May 11, 2005 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Resubmital for Tableland Subdivision; Lot 2l, Block 8, To whom it may concern: We have recently submitted a design to your department for a private septic system for the referenced property on 5/9/2005. A permit has not been issued. Due to a change in the house location the septic system location has been revised. Criteria will remain the same as in the previous design package. We are unaware f any adverse impacts this installation would have on adjacent wells or septic systems. If you have any estions, please contact us at 337-6179. Thank you for your assistance. .E., M.S. 3701 E. Tudor Road, Suite 101 " Anchorage, AK 99507 Ph: (907) 337.6179 • Fax: (907) 338-3246 • Website: gamcssengincering.com LOT 8, BLCOK DEER PARK ADDr APPROXIMATE LOCATION LAT 5, BLCOK 1; DEER PARK ADDITION/' APPROXIMATE LOCATION --,-PEER PAS LAT 19, BLOCK B; I TABLELANDS S/D (VACANT) LAT 18, BLOCK 8: TABLELANDS S/D (VACANT) LOT 20, BLACK 8; TABLELANDS S/D (VACANT) PROPOSED SEPTIC SYSTEM LOT 13. BLOCK e; TABLELANDS S/D rACANT) LOT 14, BLOCK 8; TABLELANDS S/D CVACAN G' J TH j LOT 15, BLOCK 8; PROPOSED m TABLELANDS S/D (VACANT) 4 BEDROO I HOUSE LOT 17, BLOCK 8; TABLELANDS S/D / DRIVE LOT 18, BLOCK 8; TABLELANDSVVACANT) \ R LOT 7, BLOCK 9; TABLELANDS S/D R ` i LOT 4, BLOCKTABLELANDS S/DD (VACANT) A GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS ,AI L N10011 C.D. NRR 101 • ONCHOr DL Nf OM01 Nip( �1)\ fUf N NOlOfi .w PREPARED FOR: PHONE NUMBER: PACE NUMBER: WALLACE HOMES (907) 230-9199 1 OF 2 LEGAL DESCRIPnON: DRAWN BY: TABLELANDS SUBDIVISION; LOT 21. BLOCK 8, 1 R.A.L. OF WORK: SITE PLAN FOR PRO (rsn. Daus) 5/11/2005 ...... ......... A. OT094;� CE 753 :t NUMBER OF BEDROOMS. -4 GALLONS PER DAY (GPD): 600 PERCOLATION RATE/S:7.5-14.11 MIN./INCH PROPOSED APPLICATION RATE 0.6 MINIMUM ORNNFIELD SO.FT.:750 MAXIMUM DEPTH:5 FEET WIDTH: 5 FEET LENCTH:87 FEET M.OA APPROVED SAND FILTER:N/A EFFECTIVE.3 FEET REDUCLION FACTOR: N/A ACTUAL SO.FT.: 750 DEER / CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION. THE ENGINEER. WELL DRILLER. CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND 5• LOT UNE WAM7? M ALTERNATE SITE 111(((1 / WILL REQUIRE THE USE `;{ //� OF EO IRE TH EX \ - / TREATMENT SYSTEM </ / // 16' / v / TH/T PARK DRIVE LOT 20. BLOCK 8: TABLELANDS S/D (VACANT) KEY Z _ STALL µOUT ROPOSED 1250 GALLON SEPRC TANK INSTALL FOUNDATION .CLEANOUT , iwi .: T�.�•V::.. yn � Fy. PROPOSED DRAINFIELD PROPOSED WATER UNE LOCATION GARNESS ENGINEERING GROUP, Ltd. p°;'?•I :' CONSULTANTS i GENERAL CONTRACTORS Q'•• ......•••• amt L Woos sow � 101 • MCHWAC ss ssmr . Wart OorW-stns • ns (soroJ " • ss�r. w.s..r�nq..s 0 PREPARED FOR: PHONENUMBER: PACE NUMBER: ••••••••••••• WALLACE HOMES (9 07 230-9199 2OF 2 p ey A. Gamess: �Q�v CE -7753 :Q) LEGAL DESCRIPTION: DRAWN BY:j1OS • ,• :Q )LEGAL SUBDIVISION; LOT 21. BLOCK 8. R.A.L. Fo4v TYPE OF WORK: DAM REVISED ��0 p,o fas,0('6% DESIGN FOR PROPOSED WELL AND SEPTIC SYSTEM 5/11/2005 0�00� IKa. Ulm) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS April 27, 2005 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic System for Tablelands Subdivision; Lot 21, Block 8, To whom it may concern: The proposed 4 bedroom house will be served by public water and a private septic system. Two test holes were excavated on the property. We are proposing to install a new 1250 gallon septic tank and a 5 -wide trench type drainfield. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radii of test holes #1 and #2. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached design drawing the proposed drainfield will be installed at the base of a 10-15 percent slope running approximately southeast to northwest. In short there are no slope concerns. 5. WAIVER: We request a 5 foot lot line waiver from the north lot line to the proposed septic system. We are unaware of any adverse effects to the adjacent lots with the granting of this waiver. We are unawar5lof any adverse impacts this installation would have on adjacent wells or septic systems. If you have aniAstions, please contact us at 337-6179. Thank you for your assistance. .E., M.S. NOTE: Attached is a site plan drawing, a design drawing, a detail drawing, and Two soil logs, which are all part of the design packagefor this septic system. (Contact C.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road Suite 101 ' Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessengineering.com LOT 6, BLCCK DEER PARK ADDT APPROXIMATE LOCATION LAT S. BLCCK 1; DEER PARK ADDTTIOL DEER PA 7 0 Z g t7 LaJ 0- 0 J L.I D Z LOT 19, BLOCK 8; I TABLELANDS S/D (VACANT) LAT 18. BLOCK e; TABLELANDS S/D (VACANT) LOT 20, BLACK 8: TABLELANDS S/D (VACANT) PROPOSED 4 BEDROOM HOUSE N LOT 17, BLACK 8: / TABLELANDS S/D _)RIVE LOT 7. BLOCK 9; TABLELANDS S/D N rte» N �J LOT 4. BLACK 9; TABLELANDS S/D rAC" LOT 13, BLOCK 8; TABLELANDS S/D rACWm LOT 14, BLOCK 8; TABLELANDS S/D (VACANT) LOT 15, BLOCK 8: TABLELANDS S/D (VACANT) LOT 16. BLACK 8: TABLELANDS S/D GARNESS ENGINEERING GROUP, Ltd.��j�;'?. CONSULTANTS& GENERAL CONTRACTORS %%••••• •• •• ............. PREPARED FOR: PHONE NUMBER: PACE NUMBER: •• WALLACE HOMES (907) 230-9199 1 OF 3 Y OTeSS•' LEGAL DESCRIPTION: DRAWN BY: 000 CE -795!3 `�` TABLELANDS SUBDIVISION; LOT 21, BLOCK 8, R.A.L �Q,e �'f�oJ''�o4csP TYPE OF WORK: DATE:YD dPo/eesI od\ SITE PLAN FOR PROPOSED WELL AND SEPTIC SYSTEM 4/27/2005 �0�0 (R«.01005) NUMBER OF BEDROOMS.4 GALLONS PER DAY (CPD): 600 PERCOLATION RATE/S:7.S-14.11 MIN./INCH PROPOSED APPLICATION RATE:0.6 MINIMUM DRAINFIELD SO.FT.:750 f10AIMrICl n nC'CICIJ. MAXIMUM DEPTH:5 FEET WIDTH:5 FEET LENGTH:67 FEET W.O.A. APPROVED SAND FILTER: N/A EFFECTIVE 3 FEET REDUCTION FACTOR: N/A ACTUAL SO.R.: 750 TO OBTNN A COPY Oi THE LETTER CONTACT CEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND 5• LDT UNE WAIVER ALTERNATE SITE � PROPOSED I � — DEER PARK DRIVE 1250 GALLON SEPTIC TANK - PROPOSED DRAINFIELD , LOT 20, BLOCK B: TABLELANDS S/D (VACANT) PROPOSED WATER UNE LOCATION KEY J Q YJ UV 15(-) GARNESS ENGINEERING GROUP, Ltd. p*?' •:F' CONSULTANTS& GENERAL CONTRACTORS Q'••••••••••••• ••••••••••• Ml L T MWA s 101 • MOO VAL Mf s,mr . FOL[ @Krl)3 t IM • FAX (WF)l1 " • O w.�� PREPARED FOR: PHONE NUMBER: PAGE NUMBER: .. ••• •• •••• .••••••••••• WALLACE HOMES 907 230-9199 2 OF 3 Q m Y arness:' LEGAL DESCRIPTION: DRAWN BY. Oo Oi C� —79 3 `��•` TABLELANDS SUBDIVISION; LOT 21, BLOCK 8, R.A.L 0�4,�' �fl.?�pS'��oog TYPE OF WORK: DATE.' 400Q4Opss10,16 DESIGN FOR PROPOSED WELL AND SEPTIC SYSTEM 4/27/2005 C�� er ------------------------------- I OWT I I I I CMT - - - - - - - - - - ---- IN FROM TANK FINAL INSULATION S' FILTER GARNESS ENGINEERING GROUP, Ltd. p;� y' CONSULTANTS i GENERAL CONTRACTORS Q••••••• ••••• ••••••••• m, L Am RWA �uic 101 • ROOMS M war . no.c fwr)vr-sir . M CWA3 =U . siu .... ... PREPARED FOR: PHONE NUMBER:- WALLACE UMBER: PAGE HUMBER: •• ••••••• •••••••••• WALLACE HOMES (907) 230-9199 3 OF 3 D. c TABLELANDS SUBDIVISION: LOT 21. BLOCK 8. 1 R.A.L. : OF WORK: DESIGN FOR PROPOSED WELL AND SEPTIC SYSTEM Jn .o,ml GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS d GENERAL CONTRACTORS SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: TABLELANDS SUBUMSION; LOT 21, BLOCK N PERFORMED FOR: WALLACE HOMES TEST HOLE 1 lolwaln- l aZ�S • ' IIIIIIIII rA Hum • Q mom 0 O.W. 111111111 • %////. Ilfitll 4'.G� • DEPTH TO DATE GROUNDWATER DRY 4/19/2005 10' 4/27/2005 PqR ,DRIVE DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 4/20/2005 1 6:00 — 6- — 2 6:30 30 3 7/8- 2 1/8- 3 6:30 — 6- — 4 7:00 30 1 3 7/8* 2 1/8- 5 7:00 — 6- 6 7:30 30 3 7/8- 2 1/8 - PERCOLATION RATE 14.11 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4 FT. AND 4.5 FT. A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS ERF RMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: / Zt O GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS d GENERAL CONTRACTORS SOIL LOG - PERCOLATION TEST LECAL DESCRIPTION: PERFORMED FOR: WAUACE HOMES TEST HOLE #2 • •. i •. am 111111111 4/27/2005 11191 %//% 6' /.% HHH 6:30 • !�9! 111111111 3 6:30 ow 6' - 1111111 4'.48. • 2' 4- DEPTH TO GROUNDWATER DATE DRY 4/19/2005 11' 4/27/2005 6:00 - 6' - DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 4 20 2005 1 6:00 - 6' - 2 6:30 30 2' 4' 3 6:30 - 6' - 4 7:00 30 2' 4- 5 7:00 - 6' - 6 7:30 30 2' 4' PERCOLATION RATE 7.5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4 FT. AND 4.5 FT. A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS COMMENTS: PERFORMED BY GEG, Ltd. 1, JEFFREY A. GARNESS, CERTIFY THAT THISWAS PER ORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: - MuniciahiitT ofAnchorage RO. ha EXAM • Anchonigc, Alnslu) 99519-C))CM • Tckphonc (!X)7) 313-KA)l • Fns (!X)7)3A3-H2(X) 470011mgnx' Sian • Anchomgc, Alaska !X).507 x�m.munl.org Mayor A/ark llcgicil Ilttilding Salcty llIvision 8/16/2005 Gamess Engineering Group 3701 East Tudor Road, Suite 101 Anchorage, Alaska 99507 Subject: Waiver Request for The Tablelands Subdivision #1, Block 8, Lot 21 Waiver Request #WR050027 Parcel ID #051-801-66 Permit # SW050124 Dear Mr. Garness: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 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, Julie Makela, P.E. Civil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity Municipality ofAnchorage N). JWx IMCi) • Anchorage, Alaska 9J.51fMirkW) • Telephone (r.N)7) 3 -10)1 • rax 01) 343-8^,(N) � 47(X) 11rup r Strccl • Anchorage, Alaska 19[).507 NU a��w.munl.nrg Mayor Mark Bc#ich Building S1fety Division 5/17/2005 Gamess Engineering Group 3701 East Tudor Road, Suite 101 Anchorage, Alaska 99507 Subject: Waiver Request for The Tablelands #1, Block 8, Lot 21 Waiver Request #WR050027 Parcel ID #051-801-66 Permit # SW050124 Dear Mr. Gamcss: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. 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, Julie Makela, P.E. Civil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity Municipality of Anchorage Development Services Department • �..r Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)341-7904 Waiver Review Worksheet l.JCl5b% WR#: BVRtf301Zd PID#: 051-801.66 HAM Permit#: SW050124 Date Received: 519106 Legal Description: The Tablelands #1, block 8. Lot 21 Engineer. Garness Engineering Group rrj �LfSii • u : �Z7TSiLTiLinmr-r-177Z'rl'Ifri=nq Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: ............................................................................... Waiver is Granted: Waiver is not Granted. List Conditions or Reasons for above: Date: By:�.L-i A. - Name of Reviewer ............................................................................. Rec#: 0667435 Amount: $175.00 Date Paid:ANM5S ej 1469oD5 P,oear � W-z>x 0-x � �o v 90,se • • •� '� Municipality of Anchorage On-Site Water and Wastewater Program < (907) 343-7904 5. , ,Y Certificate of On-Site Systems Approval Parcel I.D. 051-801-66 Expiration Date: T-7- (2 1. GENERAL INFORMATION Complete legal description Lot 21 , Bk 8, The Tablelands Subdivision #1 Location (site address) 22400 Blacktail Circle, Chugiak, AK 99567 Current Property owner(s) Scott & Evelena Eastepp Day phone (907) 250-4577 Mailing address 22400 Blacktail Circle, Chugiak, AR 99567 Real Estate Agent None - FSBO Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual [� Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ® Public Sewer ❑ WaiverNariance request for: Distance: (r/ A/Received by: �i �' Date: 5/ / COSA to be released to tine engineer,unless otherwise requested by the engineer. COSA Fee $ IFcA • N Waiver Fee $ Date of Payment 1-(>2-0 ! /r' Date of Payment Receipt Number ;)--3K(7 Receipt Number COSA# OSC ��15 � Waiver# 0'�° L( ()3)- 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. Name of Firm Pinard Engineering Phone (907) 232-1347 Address PO Box 871347, Wasilla, Alaska 99687 Engineer's Printed Name Paul E. Pinard Date 4/18/18 rc0oZ�O®.G..1/4•441 � Itea . r /j 6. DSD SIGNATURE � •c,� ��� eoo.r System#1 Approved for 4 bedrooms s L..2:-:-,cgo ` .o.oeooe� „. ,.,.•eoasoeaf...ef A System#2 Approved for bedrooms ,t, Pau'E. Pinard o�"'d� t �� CE-4793 ®0 ���' • Disapproved `(t' l`•• n°©000�,10G',\,. ee-oa Conditional approval for bedrooms, with the following stimatiCt• ,,,•• OF AN-4., :„.0Qe G ' V 'S\� �` ENPN� P�M W R1E0 SM �, Q *-cP • ? c� y. —,,\____ ---0 , Original Certificate Date: op . I— le-1e The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. • 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Lot 21 , Bk 8, The Tablelands Subd #1 Parcel ID: 051-801-66 A. WELL DATA PUBLIC WATER Well type If A, B, or C provide PWSI D# Well Log (YIN) Date completed Sanitary seal (YIN) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test. Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: • B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 6/28 - 29/05 Tank size 1750 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N Date of pumping R/7/17 Pumper Sanitary _Pumpers C. ABSORPTION FIELD DATA Date installed 6/28 -29/86iI rating (g.p.d./ft2oKftenlIKX 0. 8 System type 5 Wide Length 2 ea @52.;$t.' Width 5 ft. Gravel below pipe 2+ ft. Total depth 6.1 ft. Ebsorption area 750+ft2 Monitoring tube Y Depression over field N Date of adequacy test 4/13/18 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 5 & an. Water added 600 gal. New depthl 0 & $n. Elapsed Time: 1 135 min. Final fluid depth 5 & 3 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date D. LIFT STATION NA Date installed Size in gallons Manhole/Access (Y/N) "Pump on"level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: PUBLIC WATER Septic tank/lift station on lot On adjacent lots Absorption field on lot _ On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10 + Property line 51+ 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 1 ' * Building foundation 10' + Water main 10' + Water Service line 10'+ Surface water 100;+ Driveway, parking/vehicle storage 1 0 + Curtain drain None Known Wells on adjacent lots100' + F. COMMENTS * Waiver previously issued by MOA for this separation. 44%,%ttNtt G. ENGINEER'S CERTIFICATION �‘ OF ALAN I certify that / have determined through field inspections and Poe*: • --.1i '.7Vr review of Municipal records that the above systems are in . TH /� ;* d* 49 - conformance with MOA COSA guidelines in effect on this date. ••••-iae. 4••••••••••0 �.. a► iit►�i. ••• Engineer's Printed Name Paul E. Pinard p Pally E. K] des: � Date 4/18/18 �1 s�, CE-4PI793 r � � •. . • 1 PROFESSION•�4,' COSA yellow sheet_2-6-15.doc °h Municipality of Anchorage . �.._, Development Services Department Building Safety Division ` On -Site Water ti Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL C FOR A SINGLE FAMILY DWELLING Parcell.D. 057-dnl-&6 HAA# 1. GENERAL INFORMATION Expiration Date: dti 1 �T Complete legal description ThE TABLELANDS S/D: LOT 21. BLOCK 8. Location (site address or directions) Alq BLACKTAIL CIRCLE *CHUGIAK. AK 99567 Current Property owner(s) WALLACE BOSSERMAN Day phone 230-9199 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 18306 PARKVIEW TERRACE LOOP * ANCHORAGE. AK. 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site K Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System E 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 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. 1 further verify that based on the information obtained from the Municipality of Anchorage riles 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted 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 at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family 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 other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for --4— bedrooms. Disapproved. Conditional approval for bedrooms, with the following Phone 337-6179 Date to 17/57 i�tYorrs:' • • , •:'rO E •• v,mTr-R AND Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: t y , 0 , 1 pp Original Certificate Date: 16 jc2n 01r) t�rn— (R" 0101) Municipality of Anchorage Development Services Department �J Building Safety Division OnSke water & wastewater Program 47W South Bragaw St. P.O. Box 196850 Anchorage, AK 99519 -WW www.d.anchorage.ak.us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: TABLELANDS S/D: LOT 21, BLOCK S. Parcel ID: #051-801-66 A. t1VELL DATA Well type Date completed _ Total depth�� Date of test Static water level Web production PUBLIC WATER If A, B. or C provide PWSID# Cased to ft. FROM WELL LOO WATER SAMPLE RESULTS: Collform colonieW100 ml. Nitrate B. SEPTIC/HOLDING TANK DATA R. g.p.m. Date of sample: Tank Type/Material STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (YIN) —YES Depression over tank (YM) NO Date of pumping NEW Pumper C. ABSORPTION FIELD DATA Wires properly protected (YM) Casing height (above ground) in. AT INSPECTION ft. — 9 -p.m - colonies/100 mi. Collected by: GEG. LtD. Date Installed 6/28-29/2005 Cleanouts (YM) YES High water alarm (YIN) N/A Date Installed 8/28-29/2005 Soil rating tt.p.d ftJbdrm) 0_8 System type SHALLOW TRENCH Length 20 52.5 R. Width 5 R. Gravel below pipe 2+ ft. 6.6 Total depth -5.ee R. Eff. absorption area 750+ fe Monitoring tubed Depression over field NO Date of adequacy test NEW Results (Pass/Fab) PASS For 4 bedrooms Fluid depth in absorption Reid before test = In. Water added =gal. Now depth =1n. Elapsed Tine: = min. Final fluid depth = In. Absorption rote » - g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date - * SEPTIC SYSTEM IS LESS THAN TWO YEARS OLD D. LIFT STATION Date Installed Size in gallons "Pump on" level at _in. E. SEPARATION DISTANCES High water storm level at in. Cycles tested Meets alarm 3 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAifi station on lot Absorption field on lot Public sewer main line PUBLIC WATER On adjacent Public sewer manholeideanout Holding tank SEPARATION DISTANCES FROM 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'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 01' Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway. parkinghrehide storage Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 0 WR j1050027 „ O. ENGINEER'S CERTIFICATION I serdfy that 1 have deterudned through Held lnspectfwu and review of Municipal records that the above systems are In conformance with MOA HAA gudelines in effed on this date. y ........ ..... ess:' ... Engineers Printed Name JEFFREY A. GARNESS ,' g 3 Date 10 1/13 s°pro/�aswed HAA Fee $ r 5O Waiver Fee S Date of Payment U' 1—j'US Date of Payment Receipt Number Receipt Number (Rev. 1201) .— Z00 — � Y '•; U .-<O": 0 _ i VI M NZt— N J ~ Q O W 31o�� �o 1b�J� 00' M.64�9Zt� .L0.00 N '.. �s�c•� — _ �ySi dioN '•; 14�' o 40�� 0 _ A, : : ■ .` ,• V/ • MI jo / � � 9� � Q7 a 'OP W fes' • • � '• � n 0 to I 1 I 1 � � � ia 1 ol N 4 n I 1 S 'o N .10'8LL A%169.L0.00 N w O II t� LLI B=ao aw Z ~ Z 3 _ 05 q. Z=1 N �a Id m��U L. cn ca fil �0UZE38Ao0 N Ir W W NIiZ P � R W jQ =Qp Gl W 06mIX U =WZ oZmx 2 mm ZZ W y � O g a Q 2 —auto °d=x L�W p h f U yj �Za in g m J O J> O Y C4 Q E�p q O D C3 ,Q 0 I >d�V� o D C4 m 0- a yrl ID �V� AV '•; 14�' o 40�� LL• , •p. : : : ■ .` ,• V/ • • •• QtyAir AV LLI B=ao aw Z ~ Z 3 _ 05 q. Z=1 N �a Id m��U L. cn ca fil �0UZE38Ao0 N Ir W W NIiZ P � R W jQ =Qp Gl W 06mIX U =WZ oZmx 2 mm ZZ W y � O g a Q 2 —auto °d=x L�W p h f U yj �Za in g m J O J> O Y C4 Q E�p q O D C3 ,Q 0 I >d�V� o D C4 m 0- a yrl ID �V�