HomeMy WebLinkAboutSKY RANCH ESTATES #1 BLK 5 LT 19Onsite File
,Sky Ranch Estates #1
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1-7
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS -__- 1
October 6, 2017
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Rd. P.O. Box 196650,
Anchorage, AK 99519-6650
(907) 343-7904
Attn: Deb Wockenfuss
Ina"Ic's"
Advanced T'ratntent System
Cl-ry u
D -
Ref: Sky Ranch Estates S/D; Block 5, Lot 19 - Memo concerning converting CAT III
AWWTS to CAT II AWWTS septic system
Ms. Wockenfuss;
The permitted septic system was installed on the referenced property in 2011 and started up
on May of 2011. During the last few site visits by GEG Consultant, Jody Maus, he have
observed that the liquid level in the drainfield was operating well below the invert of the
distribution line (4'+ below invert). In order to simplify the operation and maintenance of the
system, we are proposing that this unit be permanently configured as a CAT I I system. Our
justifications are as follows:
• The receiving soil perked at less than 10 minute per inch and so the CAT I I soil
application rate is 3.0 gpd/sq.ft.
The home has 4 bedrooms, so 200 sq./ft. of absorption area is required for a CAT II system
(600 gpd / 3.0). The existing 2011 drainfield has 318 sq./ft. of absorption area.
The following information should supersede the application rates outlined in GEG's original
design dated 8/18/2010:
-Allowable application rate: 5.0 gpd/sq.ft.
-Proposed application: 3.0 gpd/sq.ft.
At this time, we request that your department approve a CAT II configuration to be used at
the referenced property. Upon your concurrence, we will insure the jandy valve is e i t h e r
I eft i n t a opep position or completely remove, and we will place a CAT II sticker on the
control panel. /I
ly
, P. E., M.S.
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
Municipality of Anchorage
Community Development Department Page ! of 3
On-Site Water and Wastewater Program
4700 Elmore St. · P.O. Box 196650 Anchorage, AK 99519-6650 · http://www.muni.org/onsite · (907) 343-7904
ON-SITE WATER AND WASTEWATER INSPECTION REPORT
Permit Number: OSP 101165 PID Number: 015-301-09
Name: WASTEWATER SYSTEM [] New [] Upgrade
Craig Stowers ABSORPTION FIELD
Address [] Deep Trench [] Shallow Trench [] Bed [] Mound
11931 Whispering Spruce Drive [] Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
907-345-14274 5.0 (Advanced) GPD/SF 10 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 4 Ft. 6 Ft.
Sky Ranch Estates # 1 5 19 Fill added above original grade Gravel length
Township Range Section See dwg. Ft. 26.5 Ft.
- - Gravel width Beds: Number of Lines Distance between lines
WELL (from logs/tests) [] New [] Upgrade 3 Ft. - Ft.
ExistingClassificati°n (Private, A, B, C) Total_ Depth Ft. Cased_ toFt.Total absorption3areal 8 Ft2;Number of trenches 1 Dist. between trenches_ Ft.
Driller Date Drilled Static Water Level TANK [] Septic [] S.T.E.P. [] Holding [] Other
- - Ft.Manufacturer Capacity
Yield Pump set at Casing height above ground Oreer Tank 1500 Gal.
- GPM - Ft. Ft. Material Number of compartments
Water quality testing Coliform - Col/100mL Steel 2
LIFT STATION
Arsenic - ug/L Nitrates - mg/L Manufacturer Capacity
SEPARATION DISTANCES Greer/Quanics 1500 Gal.
To Septic Absorption Lift Station Holding Sewer Pump on level at Pump off level at High water alarm at
From Tank Field Tank Line
Well tOO'+ 100'+ 100'+ 10'+ Timer in. Timer in. 46 in.
Surface Water 100'+ 100'+ 100'+ Pump make and model Electrical Inspections performed by
Lot Line 10'+ 10'+ 10'+ NA P-SE-41T M.O.A.
Foundation 10'+ 10'+ 10'+ PIPE MATERIAL D3034/F810 Sch 40
Curtain Drain N/A N/A N/A BENCH MARK Assumed elevation 92.22
Remarks: Location and description
Bottom of trim on SE comer of house
This is a Quanics Aerocell system.
Note: At least 22' of old drainfield (measured by GEG)
connected as reserve site. 178+ square feet in reserve.
Installer Wilco Contractors Inspection 1" 5/10/2011 Enc. ~'~ ~ .. ~p
dates:
Inspector .GEG, Ltd. 2nd 5/12/2011 ~ /~ .~
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL "~¢?'°' ~r! ..... ~?'~
Conditional Approval: Date
'~.,, fir
· , C,E-7953 ..~
Approved~,//&'"/////'A'"~/~' ~f,/~'~////_ .,/' '/~,X.-~ Date ,~'~-.~. 7 '-// ~"~'4~ ~~].~..3./..~.~i~ ~;~*
AS BUILT DRAWING
OSPIO11 65 - 015-,501-19
x / ~ ~ /
~ I ~oo' w[cc ~,~us ~ /
x / /
/ //
N / /
/
/ N /
/
N PORTION OF 1982 D~INFIELD
N UNKNOWN. B~ED UPON F~ELD
~ // N ~YOUT AND ~NSPECT~ON,
~ D~INFIELD APP~RED TO HAVE
WAS ONSII[ FOR
FCO ~ TH~I
~ ~ / N~ 1500 GALLON
~ ~ ~ ~ ~ S.T.E.P. TANK
NEW DRAINFIELD
A B C
PTCO 56.48 36.16 69.94
ST1 57.57 36.61 69.89
MH 64.44 40.37 70.25
SUMP 63.83 48.70 8,.3.98
DV 74.15 56.88 90.91
ACL1 76.02 57.74 91.17
ACL2 77.52 58.57 91.43
C01 77.23 60.53 94.72
MT1 78.14 60.51 94.22
C02 99.25 76.92 05.63
MT2 96.85 75.21 04.88
NOTE: aerOCEll SERVICE
AND RECIRCULATION LINES]
WERE INSULATED WITH 4"
BLUEBOARD NSULAT ON.
NOTE: OLD TANK WAS
PUMPED, FILLED WITH
DRAINROCK AND
ABANDONED IN PLACE
SCALE:
I I
1' = 40'
CRAIG STOWERS I 907-545-1427 I 2 OF 5, ess..'
SKY RANCH ESTATES #1; BLOCK 5, LOT 19 IA.J.G.
~ ~ I D^'rE: ~%~ o f e ~ ~,o~/
~s-~u~ ~.~w~.~ o~ .[w sE.~c svs~Eu I s/~,/2o~
(Rev. 01/05)
OSPIO11 65 - 015-,501-19
FINAL G~DE=
~ 93.72-94.38--~ ~ MANHOLE~ ~ ·
4' INSU~TION
TOP OF TANK
INLY= 85.61-
~_ ~~ _ - ~ ~ FROM AEROCELL UNIT
' I ~ TOP OF TANK
1500 GALLON 10 GAUGE
OUIL~=
85.78
INVERT OF BUNG SIEEL DEEP BURIAL lANK -- ~ ' . II
= 84.95
FINAL G~DE = MT CO
97.99-98.33 I ~~0
~ ORIGI~L GRADE = 97.79
TH~I
-- ~ INSU~TION
~:: ~ = 93.79
RE~T
BOSOM OF TE~HOLE =
~ 79.79 (DRY 5/5/2011)
OAaNESS ENG[NEER[N'G GaOUP, Ltd.
5701 E. ~R ~. SU~ 101 * ~CHO~ ~ 99~7 * PNONE (907)]57-6179 * F~ (907)~-52~6 * ~ ~.ge~engln~dng.com
P~aPA~aD [0~: [PHONE NUM5[R: PA~[ NUU~[R: ~~~ ~~ .....
CRAIG SIOWEES 907-545-1427 3 OF 3 s."
LEGAL DESCRIPTION: DRAWN BY:
SKY RANCH [SIAI[S ~1; BLOCK 5, LOI 19 A.J.G.
~PE OF WORK: DATE: ~rofess~O
PROFILE AS-BUILI OF NEW SEPIIC SYSIEM 5/19/11
(Rev. 01/05)
1 04:08P FROM:ED'S ELECTRIC INC 2T2 4590 T0:5385246
Municipality of Anchorage
Community Development Department - Development Services Division
P.O, Box 196650 - Anchorage, Alaska 99519-6650 - 4700 E. Imoro Roact
Info and Help; (907) 343-82'~ 1
INSPECTION; Voice: (907) 343-8300 Fax ('907) 249-7777
Inspection Report- Electrical
APPLICATION NO. RETROE111131
Master/St~ndelone Permi[ Permit Type: Electrical
,
Notes: home oWne~ requests'inStl~%ction some time t~etween 10.12 am. call;when complete, if
possible, thank you Kenny, 227-18'12.. Requested by: Kenny ;227-1812
eei1954@gmail,com
ABai;ese of ProJeot: ' 1~-931 WHISPERING SPRUCE
Contacts
Owner STOWERS CRAIG F
Contractor (007)272-4591 ED'S EbECTR~C INC P,O. BOX 2107(37
Inspector Comments:
Res
Schedule Oat-e:05/:[6/20 iT--
Preference:AM
Inspection #: 127730
P-a~;cel~ 0153011900'0
Oate: ,.~-' lb
Permit Number: OSP101165
Tax Code Number: 01530119000
Work Type: Septic
Permit Effective Dates: May 02, 2011
On-Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
to May 01, 2012
Design Engineer: GARNESS ENGINEERING GROUP LTD
Subdivision: SKY RANCH ESTATES #1
Site Legal Address: SKY RANCH ESTATES #1 BLK 5 LT 19 G:2737
Owner/Address: STOWERS CRAIG F
PO BOX 112210 ANCHORAGE AK 995112210
Site Mailing Address: 11931 WHISPERING SPRUCE CIR, Anchorage
Lot Size in Sq Ft: 34296
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a ~surface soil absorption system under construction during freezing weather must either:
A. Open a.r~! ~'"o~ the'~'m~ day
B. Cover'S'd, sealed, and heated to prevent free7Jr~j. ..
.:.~E,e. cial Provisions:
i~HE ALTERNATE DISPOSAL FIELD IS NOT WITHIN A 30 FOOT RADIUS OF A SOILS
:~i,. INVESTIGATION. THE ENGINEER NEEDS TO DO A COMPLETE SOILS INVESTIGATION
~i,~PRIOR TO THE CONSTRUCT ON OF THE SEPTIC FIELD. THIS MAY INVOLVE 2
:i~' PERCOLATION TESTS, ONE FOR EACH STRATA. CONSTRUCTION MAY PROCEED AT
YOUR OWN RISK BEFORE THE 7 DAY WATER MONITORING IS COMPLETE. PLEASE
SUBMIT STAMPED AND SIGNED RESULTS WITH THE AS-BUILT INSPECTION REPORT. IF
THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE SYSTEM WILL STOP
PENDING ON-SITE REVIEW AND APPROVAL.
Date: 5/~//'~'
/
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw St.
P.O. Box 196650
Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Parcel I.D.
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
015-301-19
Property owner(s) CRAIG STOWERS Day phone ,545-1427
Mailing address P.O. BOX 112210 * ANCHORAGE, AK * 99516
Site address 119.51 WHISPERING SPRUCE CIRCLE * ANCHORAGE, AK Zip Code 99516
Legal description (Sub'd, Block& Lot) SKY RANCH ESTATES #1; BLOCK 5, LOT 19
Legal description (Township, Section & Range)
Lot Size ~ ~ '2~¢[~ Sq. Ft.
N/A
Number of Bedrooms
4
THIS APPLICATION IS FOR ( [] all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
Permit/Rush Fees:
Date of Payment:
Receipt Number:
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENEPJ~.L CONTRACTORS
May 6, 2011
PERMIT # OSP101165
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907) 343-7904
Ref: DESIGN REVISION Septic System Upgrade Re-Design for Sky Ranch Estates #1; Block 5,
Lot 19,
To whom it may concern:
Prior to installing the MOA approved septic system for the referenced property the testhole was checked
for groundwater on May 5,2011 and was found to be dry to 18 feet. We believe the June of 2004 readings
are incorrect and what we initially believed to be groundwater was actually the existing drainfield
leaching into the tesThole because of their proximity to each other° With the new data we are proposing to
modify the drainfield design from a 5-wide trench to a deep trench drainfield. We are still proposing to
install a new 1500 gallon SaT.E.P~ tank with Quanics controls/floats. The drainfield will be designed
around the 30 foot radius of the test hole. Comments regarding the design are summarized as follows:
1. SOILS: See the attached togs which shows the soil classifications, groundwater monitoring, and the
percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If you have any quei~ons, please contact us at 337-6179. Thank you for your assistance.
Sincerely,
(ess, P.E.,i'M.S.
NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for
this septic system. (Contact G.E.G. Ltd for 7 page construction specification letter.)
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
GARNESS EN-GINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
August 18, 2010
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907) 343-7904
Ref: Proposed Septic Upgrade for Sky Ranch Estates #1; Block 5, Lot 19,
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. The septic system is in a state
of failure and needs to be upgraded. Per the owner's request, we are sizing the upgrade for 4 bedrooms.
We are proposing to install a new 1500 gallon S.T.E.P. tank with Quanics controls/floats and a 5-wide
trench type drainfield. One test hole was excavated on the property. The drainfield will be designed
around the 30 foot radius of this test hole. 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 average topography below the
drainfield is a 10-25 percent slope running approximately northeast to southwest.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If you have any questions, please contact us at 337-6179. Thank you for your assistance.
Pr~i~ent :
NOTE: Attached is a siw plan drawing, a design drawin& one soil log, which are aH part of the design package for
this septic system. (Contact G.E.G. Ltd. for 7page construction spec~cation letterO
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com
~ \ ~ ~N~LHU~F_~:;T~ '\ ~ \ '";~ SKY I~NCH EST.
\ \ \ ................ '\\x ~____.
LOT 25, BLOCK 5 ~ ', ~ ', ~ ~ ~ ~
GARNESS ENGINEERING GROUP, Ltd "~¢
,,o,, ....o...~ ,o,. ~c.o~.,, ~ ,.o....o., ,,o....-,,.,. ~ ,,o,,.,-,,.. w,.~ ..., ...... ,..,.,._ I~ ~
, q~
CRAIG STOWERS I 907-545-1427 ] 1 OF 5 [ ~
s,Y ,,,c, EST*TES ~; ~LOCK ~. LOT ~9 *.J.~. X~ ~'"' ........... "~.~'/
DATE ~
SITE PLAN 8/18/2010
(Rev. 01/05)
DESIGN CRITERIA: GEG, Ltd. HAS A 7 PAGE SPECIFICATION
N M F LETTER THAT PERTAINS TO THIS DESIGN. , NOTE: CONTRACTOR SHALL HAVE
U DER 0 BEDROOMS: 4 TO OBTAIN A COPY OF THE LETTER \ THE WELL RADIUS, LOT LINES
GALLONS PER DAY (GPD): 600 CONTACT GEG. BY PROCEEDING FORWARD \ AND UTILITY EASEMENT FLAGGED
PERCOLATION RATE/S: 10 MIN/IN WITH THIS INSTALLATION THE ENGINEER, \ BY A REGISTERED LAND
ALLOWABLE APPLICATION RATE: '5.0 WELL DRILLER, CONTRACTOR AND \ SURVEYOR PRIOR TO
PROPOSED APPLICATION RATE: *4.0 PROPERTY OWNER AGREE THAT THEY ~ CONSTRUCTION. /'
MINIMUM DRAINFIELD SQ FTo 150 .-- HAVE READ THESE SPECIFICATIONS AND \ ~
*An .................. ~v~r~. ~'~ i AGREE TO ACCEPT THE TERMS AND ~ / '
DRANFIELD DESIGN: : \ ---- -~ / /
MAXIMUM DEPTH:~O' X o '~'X~ REVISED (OSP 101165)
WIDTH: 2.5' % \ ~' \ / I /
LENGTH: 25' ~ ~ '~ ~ ,
M.O.A. APPROVED SAND FILTER: N/A ' ' \ ~ /
EFFECTIVE: 6' --- % ~ ~~ X ///
REDUCTION FACTOR: N/A \ \ X ~ !
.IACTUAL.SQ-FT': 500 SQ. FT \\ ~ kk ~ ~ ~ ///I/
. .. ::..... ,~,~ ~ .-_ __._~'~k__\ ~_\ \ --~ /
~~~""..i.."..,... ',.. ~~ -X-- ~X //
X / ~':y~ %~ ALTERNATE SITE WILL REQUIRE , ,,
I '..'.'.:'.',. %
x X / ~ ~'X EXISTING D~INFIELD TO / XX ~ rR~ER
N' x , x.~.."-.x RESERVE SITE. ~ / ~
INSTALL PROPOSED 1500
W/ INTERNAL dANDY VALVE ~ ~ /
..o.os~ ~,..,~.~ ~
SCALE:
I I
1"= 40'
GAR'NESS ENGIN:EERING GROUP, :Ltd. H
PREPARED FOR: IPHONE NUMBER: I PAGE NUMBER: "~..~-'.- '=~
...,;,~. · ,,~ ',:,;, ',? · ,{. ....... ?.
c~ a STOWE~S 90~-S4S- 1427 ~ 2 OF S ~ ~ -,g¢~t~ A, C:::~S:
LEGAL DESCRIPTION: DRAWN BY:
[STAT[S ~; BLOC, S, LOT ~9 A.O.~.
(Rev. 01/05)
GAiR'N iESS EN G I'NE E'R I'NG GiRO'U'P, iL'rd.
CONSULTANTS &GEN ER:AL CONT~CTORS
5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE. AK. 99507 * PHONE: (907)357-6179 * FAX: (907)538-5246 * WEBSITE: gom~ssenglneering.com
[SOIL LOG - PERCOLATION TESTI
LEGAL DESCRIPTION: SKY RANCH ESTATES #1; LOT 19, BLOCK 5
PERFORMED FOR: CRAIG STOWERS DATE: 6/5/2004
TEST HOLE #1
ORGANICS
AND LOAM
SOIL CLASSIFICATIONS
GP/SP
SM/ML
SP/SM
SM/ML
SOILS LOGGED BY:
OW
GP
GM
GC
SW
SP
SM
SC
ORG
ML
CL
OL
NH
CH
OH
DEPTH TO
GROUNDWATER DATE
SEEP @ 10' 6/5/2004
11.6' 6/14/2004
DRY 5/5/11
TH#1
SITE PLAN
1 "= 100'
DATE READING CLOCK NET TIME WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
6/7/2004 1 4:05 - 6,, _
2 4:35 30 2.5" 3.5"
3 4:35 - 6- _
4 5:05 30 3" 3"
5 5:05 - 6,, _
6 5:35 30 3" 3"
PERCOLATION RATE 10 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES
TEST RUN BETWEEN 6.0 FT. AND 6.5 FT.
A FOUR HOUR PRESOAK WAS PERFORMED: 1YES F-INO
JODY MAUS PERCOLATION TEST PERFORMED BY: ROB CAMPBELL
COMMENTS:
PERFORMED BY GEG, Ltd. l, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PEF~FOI~MED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: ¢'-,/~ ,?'~
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DRAWN BY:
OATE:8/1-- 8/2010 A.J.G.
LEGAL DESCRIPTION:
SKY RANCH ESTATES #1; BLOCK 5, LOT 19
TYPE OF WORK:
DESIGN OF QUANICS AEROCELL SYSTEM
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PREPARED FOR: PHONE NUMBER: IPAGE:
CRAIG STOWERS 907-,345-1427
OF
3
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ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN MUFI~i, ICIPA~ LITe[ ANCHORAGE
AND
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
~ Day of J~ ~v~[ of 20Il,by and between
-
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Wastewater
Treatment System (AWWTS), described asC, Q,)O~I.~.k .]~,Q~Of'P_ [1 located
at ~.<_~rO. LaCk ~.~.4, :~[ ~ ~'- /,.,. [ C~. , Anchorage, Alaska.
2. Definitions.
A. Alteration. Any change to the design or function of an AWWTS that
Includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design. Prior to
performing any alterations to an AWWTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65.
B. Certificate of On-Site Systems Approval. An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
These approvals certify that the systems are adequate for the homes that
they support and meet the codes that were in place at the time of system
construction.
C. Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
D. Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included in
the original design which would allow the AWWTS to continue to
perform as designed.
E. Permit (Construction) An On-Site Wastewater Disposal System
Construction Permit as defined by AMC 15.65.
F. Permit (Operating) An Advanced Wastewater Treatment System
Operating Permit. An annual permit, issued by the Municipality, that
allows the Owner to operate an AWWTS, upon meeting all the
requirements of this agreement, the conditions of Operating Permit, the
requirements of the On-Site Wastewater System Construction Permit and
all relevant provisions of AMC 15.65
3. Fee. Owner shall pay to Municipality an annual fee of /rD
($__~_.00), payable on or before the issuance of the operating permit and
annually
thereafter. The annual fee is due on or before the anniversary date of the approval by the
Municipality of installed system.
4. Term. The term of this Memorandum of Understanding shall be for the life of the
AWWTS.
The tem~ begins on the date of approval by the Municipality of the installed system and
shall continue while the AWWTS system is in use or operational or until the property is
sold or title is transferred by owner and a new certificate of On-Site approval is issued to
the new owner or transferee of the property.
5. Alterations~ Installation and Removal of Additional Equipment. Owner agrees
not to make any alterations, removal of parts or additions to the AWWTS without a
Construction Permit from the Municipality.
6. Maintenance and Repairs.
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AWWTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2)
maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
rules and orders for the AWWTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's AWWTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AWWTS
Operating Permit is: 'Tt,~'¢~ ~k t4 ttl v~
c. Owner acknowledges that the fine schedule for failing to maintain and repair an
AWWTS are codified in AMC 14.60.
D. Owner agrees that only maintenance, repair persom~el certified by the
Municipality will inspect and make any necessary maintenance, repairs or permitted
alterations to the system.
E. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
F. Owner agrees that any sale or transfer of title oftl~e property will not occur
without a new Certificate of On-Site Systems Approval.
G. Owner agrees that the relevant provisions of the standard specification guidebook
for AWWTS is the governing professional guidelines for the construction,
maintenance and repair of the Owner's AWWTS.
7. Nonwaiver. The failure of either party at any time to enforce a provision of this
Memorandum of Understanding shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of Understanding or any part
hereof, or the right of such party thereafter to enforce each and every provision
hereof.
8. Amendment.
A. This Memorandum of Understanding shall only be amended, modified or changed
by a writing, executed by authorized representatives of the parties, with the same
formality of this Memorandum of Understanding was executed and such writing shall
be attached to this Memorandum of Understanding as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this contract, the only authorized representatives of the parties are:
Owner: V Cx~ a
Anchorage: Purchasina O~r~erI
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of
Understanding shall be brought in the Superior Court for the Third Judicial District of the
State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and
obligations of the parties under this Memorandum of Understanding.
10. Severabilitw. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
OWNER: - ~ MUNICIPALITY:
Title:
Date: ~ ~ [ Date:
STATE OF ALASKA )
) SS.
THIRD JUDICIAL DISTRICT )
The foregoi~ instrument was ac~owledged before me this~: day o~~ ,
(
NOTARY PUBLIC FOR AL~KA/ -- ~ " .... "~' "
'~ : -..
Commi..io' expires:
May 17, 2005
Craig Stowers
P.O. Box 112210
Anchorage. AK 99516-2320
Subject:
On-Site Water andtor Wastewater Permit.
Permit Number: SW040229
Legal Description: Sky Ranch Estates #1 Block 5 Lot 19
Dear Mr. Stowers:
An On-Site Water/Wastewater Permit, number SW040229, issued by this office for a single-family
system, will expire on June 28.2005. The permit is valid for 365 calendar days.
If this was a well permit and the well has been drilled, a well log must be sent to this office for
documentation of the installation and to close the permit.
If this permit was for a wastewater disposal system, an original as-built inspection report must be sent to
this office for review, approval and documentation. This as-built inspection report must be signed by
the licensed Professional Engineer who inspected the installation of the system. As-built inspection
reports are required to be submitted within 30 days of the completion of the system.
lfno system was installed under this permit, and you are still planning to install a well or wastewater
disposal system, a new permit must be obtained from this office. A new permit for a second year may
be issued for a fee orS115.00 if the renewal application is received on or before the expiration date of
the original permit.
When applying for a new permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well
permit.
If you have any questions, please call this office at 343-7904.
Sincerely,
Daniel J. Roth
Program Manager
On-Site Water and Wastewater Program
Enc: Copy of permit
Community, Security, Prosperity
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jun 28, 2004
Expiration Date: Jun 28, 2005
Permit Number:. SW040229
Legal Description: ~ RANCH ESTATES'~ BLK'--5 LT ;19'
Design Engineer: 0855 Garness Engineering Group, LTD
Owner Name: Craig Stowers
Owner Address: P.O. Box 112210
Anchorage, AK 99516-2320
Parcel ID: 015-301-19
Site Address: 011931 WHISPERING SPRUCE CIR
Lot Size: 34296 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
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.
Issued
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci,anchorage.ak.us
(907) 343-7904
Parcel I.D.
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Permit Number
Property owner(s) CRAIG STOWERS
Day phone 345-1427
Mailing address (1) P.O. BOX 112210 * ANCHORAGE. AK,
Mailing address (2).
Zip Code 9~516
Legal description (Lot, Block&Sub'd.) SKY RANCH ESTATES SUBDMSION ~1: LOT 19. BLOCK 5.
Legal description (Section, Township & Range) ~ ~1(~ I '~t I~-i~_,1"'1
Lot Size 3 q., "~q ~.~ Acres~ Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only ~r~ Well Only
Sewer and Well Water Storage
Sewer Upgrade []
THIS PROPERTY CONTAINS:
HotTub ~ Jacuzzi [~
Swimming Pool Water Softening Unit
Therapy Pool []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
GARNESS ENGINEERING GROUP~ Ltd.
Permit Fees:
Date of Payment:
Receipt Number:.
Waiver Fees;
Date of Payment:
Receipt Number,
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
June 17, 2004
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 South Bmgaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907) 343-7904
Ref: Proposed Septic Upgrade for Sky Ranch Estates; Lot 19, Block 5,
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. The septic system is
in a state of failure and needs to be replaced. We are proposing to install a new 1250 gallon
S.T.E.P. tank and 5-wide trench type dminfield. One test hole was excavated on the property.
The drainfield will be designed around the 30 foot radius of this test hole. 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. It is our opinion that an application rate of 0.8 gallons/day/ti'
should be used.
2. TRENCH DESIGN:
a. Percolation Rate: 10 minutes/inch
b. Proposed Application Rate: 0.8 gallons/day/ft2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day 2
e. Minimum Absorption Area: 563 Ii
f. Total Depth: 6 feet (maximum)
g. Effective Depth: 3 feet (minimum)
h. Width: 5 feet
i. Reduction Factor: .58
j. Minimum Length: 66 feet long
k. Effective absorption area = 568 II~
Note: The distribution line is to be 1.25" schedule 40 pvc with W' diameter holes {~ 3'
on center.
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: gamessengineefing.com
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
system.
4. TOPOGRAPHY: The trench will be installed at the base ora 25%+ slope. However, the
slope below the drainfield is 10-15% running northeast to southwest In short, there are no slope
concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
mess, P.E., M.S.
NOTE: A site plan drawing, a design drawing, one soil log, and a 7 page construction
specification letter which are all part of the design package for this septic system.
3701 E. Tudor Road, Suite 101 * Anchorage. AK 99507
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: gamessengineering.com
I . / ~ I ~ . ~ I
'~ i~& X / ~ -~---
~ /~~ '~ X X / LOT 1I. B~K 5 I
3 BEDR~U / EXt~NO S[~C ~
/~ ~/~/2oo~ ~:~ 0
D~WN BY:
GARNESS ENGINEERING GROUP, Ltd. ~:
,--,oo' ?.. [t.r.:...
PREPPED FOR PHONE NUMBER: P~[
CRAIG STOWERS 545-1427 1 OF 2
*',:~.
~ O[SCRIPBON:
SKY RANCH ESTATES SUBDIVISION ~1; LOT 1~, BLOCK 5
~[ OF WORK:
~1~[ P~N FOR ~[PTIC $YSTE~ UPGRADE
~ w~-
~.~,~,
...... ,,.,,,,..,,,,,.,,,,.,.., ,..,,,~-',~, .,
SKY RANCH [STATES SUBDIVISION ~1; LOT
~E OF WORK:
DESIGN FOR SEPTIC SYSTEM UPGRADE
OARNESS ENGINEERING GROUP, Ltd. i.,.~.,.¥ .4. !!
CONSULTANTS & GENERAL CONTRACTORS , · .
ISOlL LOG - PERCOLATION TESll .~-~¢...,~. ..~.. .....
~ DESCRIP~ON: S~ ~CH E~A~S fl; LOT 19, BLOCK 5 vO~v~.. CE37~
PERPORMED FOR: C~ ;OWENS DA;: 6/S/2004 ~-~.."1 .., ~... ..... "¢~ff
~'~[ ~-~ ITEST HOLE
~ OR~ICS
D LO~ I I , I
'"'
<.*~ GM ~ CL
<..~ SW MR
; · ' SP CH
SM/ML G ROUNDWAT ER
11.6' 6/14/2004 m~l
SITE P~
~o ~sP/su ~'-~oo J
11,~JjJJ~ DATE READING CLOCK NET TIME WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
12 6~/2004 1 4:05 - 6- -
2 4:~5 ~0 2.5'
13 ~ 4:~5 - 6- -
4 5:05 ~0 ~'
14 ;~lJlJlSU/~L 5 5:05 - 6, _
6 5:~5 ~0 ~-
15
16
17
1 ;~}Li PERCO~TION RATE 10 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST R~ BETWEEN 6.0 FT. ~D 6.5 FT.
20-- A FO~ HO~ PRESOAK WAS PERFORMED: ~ YES ~ NO
SOILS LOGGED BY: JODY UAUS PERCOLATION TEST PERFORMED BY: ROB ~UPBELL
COHHENTS:
PERFORMED BY GEG, Ltd. I, JE~R~ ~ G~NESS. CE~ ~T ~IS W~ER~RUED IN ACCORD~CE
W~ ~ ~A~ ~D UUNICIP~ GUIDEUNES IN [~ ON ~lS DA~: ~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF FIEAI.TH & ENVIRONMENTAl.. PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchora§e, A~aska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WEI.L INSPECTION REPORT
DISTANCE TO~ Iwell I oI
ILiq. capacity in gallons I ,-
~Manufacturer --~
No. of Hnes Length of e ch line
DISTANCE ~ ~----~
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
Insidelength
Foundation
Material beneath die
Depth
: PHONE
],21~,- T--~NEW
Material
Nearest lot line
Trench width
"~o inches
NO. OF BEDROOMS
PERMIT NO.
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT
Distance between lines
Total effective absorption area
PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Sewer line
Distance to lot line
S0ptic tank
%i2ea(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
~.o~ - N
REMARKS
APPROVED DATE
72-013 (Rev. 3/78) ~
LEGAL
F!F:'F'L I C:FII",IT
t,.Or':F!'f' ;' ;' I',I
L [El:!il=l!_
'T,LIE~ L.IZI'.,I(:iTH J) I l'"lE:i',l'_'~;I OBI Z :E; TH[E !..E:hI(3TH ( ;[ h! FEE'[') OF I'I-I[E Tt:,~:ENCH (:)F! Df;i:F:l
'TI..IF~ !::,[E:P]'H OF FI "['I;:i~:F,IC:H (]1:~: F?T' Z:E; THE: [:,:[E;'I'I=IFICI}: I~EE"I'I, IE:E:I'-.! -I'HIE t/:;I..l~;;:Ft::l(:;I.~ OF 't']..I!E:
Gl:;;:OtJl'.,l[) I=If.,ID '1'1-1[~: [~',OTTOM CIF:' THE: [~]:;.;',CFI~,,,~F:IT]:Oh,I (ZN
T'I'I[;F?.[E liE; f',tO 'E;[E]' I,.!il]:,TH F'O[;:
'I'IdrE: GF;:F!',,,'[EL [:,IEF'TH Z:~; THE: I"IlI'.~II'ql...IM [)E:PI'H OF G[;;:FIV[EL. [~I[/-I"I.,.I[EE(f.~ THE OUTt::'[:I!_L
F:It'.,ID THE EK3'T'TOM OF THEE [?,:':',IJ::f:IVf:I"I':[Of..J (:[f'.l FEE:T::,.
~ C:Ei:F~:!'IF'-r' ]"HFIT'
:1..: ): 1=11"'1 F:'Ir=Ii'~ZL.:[FIF~: .h.lI-i"H 'f'HF: F~:EC.:!IJZ[;~[£MEI'.,IT'=:;
FOI:RT'H [ii',"," T'H[E i'llJI",IIC:J:F:'FIL. IT"r' OF
~:: Z !'.IZL. L ]:I',ISi;TI:::II...I.._ ]'HIE !~:;"~":~i;"t'[::t"1
]!i:: I I...II'-.t[)E!:[;:::'!;TI::~I.,II::, THI:::IT "FId!iZ ON-':~;ITEi] :!i~['-'-.!.,.IE]l';~ '-"!!;'¢ST[-ZM MFI"¢ I~[E]~:]L.IZF~:!!': Ei]",![..F!I:;~:(3E~I'"I[::!"~IT ZI'::' THE:
F~?.!i!::i:;IC'!Etx!C:[~ ZS; F?.E!'IOL')E:L.[E[:, ]"O ZI",ICL. LII]:'F'_'
PERFORMED FOR:
LEGAL DESCRIPTION:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~' SOILS LOG
PERCOLATION
TEST
1
2
3
4
5
6
7
8
9-
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
PERFORMED BY:
IF YES, AT WHAT
DEPTH?
SLOPE SITE PLAN
,1¸
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE r~ Iminutes/inch}
TEST RUN BETWEEN __ ~ FT AND ,.~,,~'~ FT
/.:o q / / ,¢
72-008
MUNICIPALITY OF ANCHORAGE
DEPARTM[*:NT OF HEALTH AND ENVIRONMENTAL Ph',.,I'ECTION
DIVISION OF ENVlRONMEN'FAL HEALTH
CERTIFiCA'I E OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name .~. /4///d~ Business
Applicant Address
Telephone: Home
(c) Applicant is (check one): Lending Institution []; Owner/builder..J~ Buyer []; Other [] (explain);
(d) Lending Institution
Address ,,'¢ ~<
(e) Real Estate Companyand Agent
(f)
Address
Telephone
Telephone
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-FamilyCE-J/ Multi~Family []
of Bedrooms .~
Number
Other
WATER SUPPLY
/
Individual We[l~ Comraunity [] Public []
Note: If community well system, must have written confimmtion from the State Department ot Environmental Conservation
attesting to the legality and slatus.
4. SEWAGE DISPOSAL
Onsite~, Public r~ Community [] Holding l'ank Lq
, , '.i, Note:ll~ornmunitywellsystem musthavewrittenconfirmationfromtheStateDepadmentofEnvironmenta Consevaton
,, attest ng,to the ega tyaqd status
5. ENGINEERING FIRM PROVID..G INSPECTIONS, TESTS, FILE SEARCH, L,~.i'A AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation ~f this H,ealth
Authority Approval shows 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 Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm A ,~.~.,,-,~-~ /~. v~-F Telephone ,~-~-7/I
Address ~ (~ ~) ~ /-(~/
Date ,~ ) ~ I ~ ~
DHEP APPROVAL
Approved for.,/-'~'~'"'~-g~"~)edr°°ms by/'~'¢-~''~ /~' /~t~-~w~
Approved ¢'~ Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOLl
HEALTH AUTHORITY APPROVAL (HAA)
MUNICIPALITY OF ANCHORAGE CHECKLIST - FEBRUARY 1984
DFPT, OF HEALTH & 264-4720
ENVIRONMENTAL PROTECTION
MAY 2 lg86
WEL'DATARECEIVED
Legal Description:
If A, B, C, D.E.C. Approved (Y/N) /"~//~¢¢
Well Log Present (Y/N) ~'~ Date Completed 1,~'~2r ? Yield ~'
Total Depth ~ased to ~ ,'~/t"~" Depth of Grouting
Static Water Level ~,,'¢,//~'~¢g¢~¢'¢ Pump Set At /¢
Casing Height Above Ground ,4',,.~" · Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) V¢.~ Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot /,/"J
To Nearest Public Sewer Line
Cleanout/Manhole ,,/¢///¢
Water Samp e Co lected by
Water Sample Test Results
Comments Mo ,~.~¢ I J ,~¢,,'w~'~ 7
; On Adjoining Lots ,/~::¢¢~
; On Adjoining Lots ,/4¢2~'''~'
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot .~¢
; Date ,~'~'~/
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /~)~2 r
To Property Line /~ /
To Water Main/Service Line '~
Course
Size ~ No. of Compartments
Air-tight Caps (Y/N) .-{/('¢'~ Foundation Cleanout (Y/N)
/l/4¢~ Date Last Pumped ~"~-~'~./'
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~-.~ '
To Disposal Field ,/~;)"
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026{11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~-./~'-~' ~.
Width of Field ,~ //
Square Feet of Absorption Area
Type of System Design
/
Length of Field
Depth of Field /--~
Gravel Bed Thickness
Standpipes Present (Y/N)
Depression over Field (Y/N) /~
Results of Last Adequacy Test
/
Separation Distance from Absorption Field:
To Water-Supply Well /O
TO Building Foundation ,~
Lot
To Water Main/Service Line ¢.~ ! ¢''
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Date of Last Adequacy Test
To Property Line /~;) '~ ~
To Existing or Abandoned System on
; On Adjoining Lots /62::~ ~ ~
To Cutbank (if present) ,,,'42//,~
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump OfF Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that Ijh~._e_~ch~7~e_d, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~~ Date .¢3'-~/.:2- .;t //Z¢~
Company ~/TZ~t vjT~l,o¢,, ¢ __~C:;.~ MOA NO.
Receipt No,
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
APPL~ ~.NT FILLS OUT UPPER HAL ONLY
Address ~ 0/I ~--- Zip Code
Type Resl~noe
~ Other
Sew r Disposal
~ Individual Year Individual Installed: ~
~ Public Ulllity When Connected to Public Utility:
~ Holding Tank
Time Time Time
Oate~
Da Date Date
(~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDmONAL APPROVAL*
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
'7 -- ~'~ Well to Tank Septic T~N Size
72.023{3/~2)