HomeMy WebLinkAboutGLACIER VIEW HEIGHTS #4 BLK 1 LT 7Glcici
r View
Heights
Block I
Lo1- 7
#050-501-49
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 $. Bragaw SL
P.O. Box 196650 Anchorage. AK 99519-6650
www. cl.a nchorage.ak.us (907) 343-7904
Page J of :~
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PID Number. O,~O --~->OI -- /.-/q
WastewaterSystem: ~ New D Upgrade
LEGAL DESCRIPTION
Well: ~i';~/o~'[, [~New D Upgrade
SEPARATION DISTANCES
ABSORPTION FIELD
+O. 5
:.:::
"+-~
TANK
F1 Septic [] Holding I'-I S.T.E.P. IRI Other:
Septic Absotptior LI~ ~.,,,.4 ~.~u,~ c.~*:v
Tank Field Station ~tOC"/¢L~ Iht,' e ~., ~
H J ~ -- LIFT STATION
BENCH MARK
Inspections performed by: ~,. C I./~_~./~ D~tes: 1" ~*
Development Se~ices Depa~ment Approval
~:.xie~eO and approved by:~_h6t .~~ Date: ~
~TAL DEPTH I FT
170~R SIND 21'7'
TOTAL SEWER ROCK I0
1#5{ILAIT~V
COVER
Jl'OBSEN SPURKLANO P.E.
207 V/ ISTN. AVENUE
ANCN. AK. 99501
p££ylT # $vO$OIge
I, IINOR RESIOENCE DATE: AU~ P, PO04
¢OLUAIBIA CL4¢IER LOOP SHEET: 2/$ 6Riff, $V159
Plo # fl50-501-49
fiVHOIOTP. DVG
.,iS BUILT
roae£N SPURKLAND P.E.
PE£~IT # SV030I~8
II
LOT ? BLOCK 1 GLACIER
COLUI~BIA GI..4CIER LOOP
JtARK
SEPTIC SYSTEN SHENATIC
DATE: AUG. 2, 2004
SHELf: 3/:7 GRID: NWI$~.
PIB # 050-501-49
~073~VG
M-W Drilling, ]:nc.
· P.O. Box 110378e Ancheeage, AK 995H*
egoT-34~R)CX) · 907-34~-3287 Fax·
lob No.: 04-1(}] Parcel No.: ,0~0-~)149 , Period No. 5W03019~
~roundwater Wel( As-Bulit & ~
· ~e~ O~n~: Mi~, Ma~ & J~i~ · ~s~ e/~1: Dom~t~
eL~etD~c~II~: Glacier V~w Height~ Bl~k I~ ~t 7
224~ Columb~ Oilier ~ ~ River. Alaska
· HoleD·pti*: 121' eCtulng$1~e: 6" ~,CatedTo: 120.$6' eM~rlal:
DrilIM~: Air Ro~
~ll Co~l~lon. O~ end X ~ ~or~ ~eth~:
· Grout~et~: (1)
A 53 Steel
· Well Deveio~nettt: Method: Air surge A'~e~:
· S, tuti¢ muter I~t 1S~) 16' (~) (~ow) ~ ofcm~g ~'~.
· WellyleM t~ ~1 I ~ $~1~ ~r m~ (GPM~~~} for ~
· MeekS: Air lift
I Hvuffs)
· Dote ofcvmpletlon:
~ Depth In feet from
· topofcaslng.
0 TO
..... -=--YO.
....
38 TO
48 TO 62
62 TO 80
80 TO ' ' 82
82 TO 98
98 TO 105
105 TO 121
TO
TO
TO
TO
TO
9 January 2004 · Primp .~nsto/l: __
Well Log
Details of formations i~netrated~ ilzt of materialt cobr and hardness.
CasinB atickup
~_ra_vz ll_y~il t: ~.a.y _
_.G.ravelly s,ilt: brown
_Silt~ gravel: wet
Sihv sand: wet
Silt: gray, gravelly
As above: damp
As above: dry
As above: wet
_Water..g_rav.cl.: 10-15 gpm
NWWA Certified Ccntractor
SEPTIC SYSTEM DESIGN
LOT 7 BLOCK 1 GLACIER VIEW HEIGHTS
Municipality of Anchorage
Development Services Department
On Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, Alaska 99519
November 30, 2005
SUBJECT: Asbuilt Inspection Lot 7 Block 1 Glacier View tleights
JulieMakela,
On November 23, 2005 1 verified that the following had been completed at the above referenced
property.
The upper six inches of the mound system consists of top soil.
The mound is vegetated sufficiently to prevent erosion.
A foundation cleanout is located inside the crawl space. It provides access to the
sewer line between the house and the septic tank.
Ifyou have any questions, please contact me at 279-3916.
Sincerely,
Lars Spurkland
203 West 15a Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (907) 276-6013, SpurklandEng~gci.net
12-1-05
Art. n: Ma~ Pete's fax 6~4-3279
To who Jt may concern:
El~trical ,~ng for lhe Bio-Cycle septic system ~t acktress below has b~n in~r ,,~,t ,,~-
uurrent ~at~onaJ ele~'tn~al r,~xle,
Job:
~,~1~ ~ir, or
22486 Columbia Glacier Loop
Lot 7 Block l
· Gekwe~ Glacier View #4
SJ~r~ly,
William Briekwell- l:'resideuT
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
ON-SITE SEWEPJVVELL SUBMITTAL COMMENT SHEET
To: Tobben Spurkland
Legal description: 6lacier View Heicjhts, block 1, Lot 7
The attached paperwork has been reviewed and is belng returned for the following reasons:
[] Original signature or stamp missing on
[] Calculation error in design.
[] Additional soils information needed.
[] Water monitorin, g results inadequate.
[] Discrepancy in ,nformation submitted.
[] Topographic information missin.g .or in.adequate. .
[] Incomplete; missing Well class~f~catmn and soil rat~nq,
[] Incomplete; missing
[] Additional adequacy test information needed.
[] Water sample unacceptable. . . .
[] Measured/proposed distances/dimensions missing.
[] Locations of all soils, percolation an.d water monitoring tests not shown.
[] Proposed system too deep for soils information submitted.
[] Well Icg required.
[] Omission in narrative.
[] Insufficient fill over tank or. field. .
[] Other. l,) The upper s~x inch.es of a mound system .must consist of top soil; 2,) The
mound must be veqetated sufficmntly to prevent erosmn; 3,) Please provide electrical
inspection letter; 4,) On-site wastewater disposal system must be installed by an approved
installer; 5,) An exterior cleanout one to four feet from the foundation wall is required,
Name of reviewer: 3'ulie Makela, P,E, Date: 12/I/2004.
Please supply the necessary information and re-submit your request.
LEA VE THIS FORM ATTACHED TO THE PAPERWORK
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7P04
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Renewal
Date Issued: Jun 22, 2004
Expiration Date: Jun 22, 2005
Permit Number: SW040217
Legal Description: Glacier View Heights Block 1 Lot 7
Design Engineer: 0007 Tobben Spurkland, PE
Owner Name: Mark Minor
Owner Address: PO Box 770462
Eagle River, AK 99577-
Parcel ID: 050-501-49
Site Address: 22486 Columbia Glacier Loop
Lot Size: 51911 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] DisposalField [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be In accordance with:
1. The attached approved design.
2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Aiaska
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
mus[ be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. ~,~%~O --%~(~ I ~L.~ q
Permit Number SW
Property owner(s)
Mailing address (1)
Day phone' ~,-~'--'~'"~'~'"~"~"~:~
Mailing address (2) .Zip Code
Legal description (Lot, Block & Sub'd.) 0,01
Legal descript,on (Section. Township&Range)
LotSize ~--~ (~ Acres~ Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
Well Only []
Water Storage []
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
[] Jacuzzi []
[] Water Softening Unit []
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.
(Signature of property owner or authorized agent)
Permit Fees: -~1 I% Waiver Fees:
Date of Payment: t_O[ 1%'3-'''-} Ot Dato of Payment:
Receipt Number: ~---'-"~'")q I ~ "~ Receipt Number:
(Rev. 12/00)
Anchoragc, ~'daska 99519-6(350 · (907) ~.$-8301o Fax (907) 3~,3-$200
h t/p://w~'w.mu nl.org
June 1,2004
Mark Minor
P.O. Box 770462
Eagle River, AK 99577
Subject:
On-Site Water and/or Wastewater Permit.
Permit Number: SW030195
Legal Description~7~l~f&--Vf~'~'He~hts-Bl6elCl'~Lot 7.1
Dear Mr. Minor:
An On-Site Water/Wastewater Permit, number SW030198, issued by this office for a single-family
system, v,511 expire on June 17, 2004 This permit ~vas 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 waste~vater 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.
If no 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 Roth
Program Manager
On-Site Water and Wastewater Program
Enc: Copy ofpermit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Waslewater Program
4700 South Bregaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Jun 18, 2003
Expiration Date: Jun 17, 2004
Permit Number: SW030198
Legal Description:~Glacier View Heights Bl(~ck'l L~t 7
Design Engineer. 0007 Tobben Spurkland, PE ·
Owner Name: Mark Minor
OwnerAddress: PO Box 770462
Eagle River, AK 99577-
Pamel ID: 050-501-49
Site Address: 22486 Columbia Glacier Loop
Lot Size: 51911 SQ. 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 subsurface disposal field may not be located: Where the water table during any season of the year will be within
four feet of the bottom of the absorption area
Received BI
Issued By~
Date:
Date:
Municipality of Anchorage
Development Services Department
Building Safety Dlvlslon
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.a k.us
(907) 343-7904
ON-SITE SEWEPJVVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Permit Number SW
Property owner(s) '~/~--'~-. ~{. I '~"-J 0 l'7,.. Day phone
Mailing address (1) pA ~ ~ '"')'"~ {~L~ ~ Z-..
Legaldescription(Lot, Block&Sub'd.) LOT '7. ~F---!
.I
Legal description (Section, Township & Range)
LotSize 5/iq ~1 Acres/Sq. Ft. Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
[] Well Only. []
[~ Water Storage []
[]
Jacuzzi
Water Softening Unit
[]
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 MunicilSal Codes.
(Signature of property owner, or a~thorized~agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12100)
Waiver Fees:
Date of Payment:
Receipt Number:
Parcel I.D.
Municipality of Anchorage
Development Sen/ices Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage .ak.us
(907) 343-7904
.-ON-SITE SEWEP-fiNELL P, ERMJ'r. APPL ~AT~ON --., _
FOR A SINGLE FAMILY DWELLING
Permit Number SW
Property owner(s) ~/[~t/
Mailing address (1)
Mailing address (2)
Legal description (Lot, Block & Sub'd.)
Day phone '~-'~-- ~"~"~.--"7 '~.'7_."~
Zip Code
~t.,4~t/~e.- wF--~ ~,'~¢/¢--~'?'~' ~'~
Number of Bedrooms
Well Only []
Water Storage []
Legal description (Section, Township & Range)
Lot Size ~' ~ ~ C~ \ ~ Acres/Sq. Ft.
THIS APPLICATION IS FOR:
Sewer Only []
Sewer and Well []
Sewer Upgrade []
THIS PROPERTY CONTAINS:
Hot Tub []
Swimming Pool []
Therapy Pool []
Jacuzzi []
Water Softening Unit []
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.
(Signature of property owner or authorized agent)
Waiver Fees:
Date of Payment:
Receipt Number:
203 W 15th. Avenue, Suite 203
ANCIIORAGE, ALASKA 99501
{907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 7 BLOCK I GLACIER VIEW HEIGHTS
Municipality of Anchorage
Development Services Department
On Site Water and Wastewater Program
4700 South Bmgaw Street
Anchorage, Alaska 99519
June 12, 2003
We are submitting an application for the installation of a well and septic system for this IoL The
submittal consists of three (3) drawings showing the present improvements on the lot and the
adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the well and
septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system,
(sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic
system design is based on the following:
Groundwater at 5 Ft Oct 21, 1992
Use Standard Bed with BioCyele
Soll Rating. From Te~thole 10/16/92
20 tala/in "-2 gal per sq.tt/day
No. of Bedrooms 4
Required Area per Bedroom: 150/2 ~-75 sq.tL
Total area required: 75 x 4 = 300 sqfl
Bottom Rock At Ifeet
Rock Depth 0.5 feet
Total Bed Length 300 /I 0 = 30
SYSTEM CONFIGURATION
BIOCYCLE
STANDARD BED
TOTAL LENGTiI 30 FT
TOTAL WIDTil l0 FT
TOTAL DEPTtl I FT
F1LTER SAND/LEVELING COURSE I FOOT
ROCK DEPTH 0.5 FT
COVER 3 FT
The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent
lots.
There are no developed or natural surface I sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Pending and/or concentration of surface
nmoffwill not result from this i~tallation.
N
5 \
205 ~/ ISTX. AVENUE
ANCX. AK.
8 BI, O{~ I r. LIc~x
WNOR RESIDENCE
COLUMBIA CLACIER LOOP
IISEPTIC SYSTEI, I DESIGN
DATE: JUNE 9, 2005
SHEET: I/3 GRID: $1fI$
PERMI[ # SVOSOXXX PID Il XX GVHOIOTI. gVG
IO X 3~ FT
TOTAl. DEPDI I t7
t'~'E~.S4ND ItT
TOTAl. ~ ROCK lOt#~tlE~
IN~UL4T10N
COVER 2 f'i*
///
I !
~ ? · 8 Bzoc% 1 G~oz~ ~ SEPTIC SYSTE~I DESIGH
~tlNOR RESIDENCE DATE: JUNE 12, 2003
CO£UWBIA CL4CIER LOOP SHEET.. 2/3 GRIB, $V159
PERMIT #$VO3OXXX
PIB # XX
GVHOIO72.DVG
....~INfl/GRAVEL g4CKF?LL
o%
TOBBEN SPURKLANO P.E.
205 V/ 15171. AVENUE
ANCX. AK. 99501
(907) 279-3916
i PERHII' # $1/030XX
£Or 7 BLOCK 1 GIdCl~R V~W ttT. IGHTS 2-03
COLUI, IBI,,I CL4¢IER LOOP
t, t4RI'IN PETERS SHEET.. 3/3 GRID:
Plfl # XX
04/'25,'2~3 le:20 ~{~73732602 EFDE TNC PA~ 03
DEPARTMENT OF HEALTH & HUMAN SERVICES ~ -~_~.[.~~ I
S O'~ LOG P ERCO~T,O. TEST
LEGAL DESCRIPTION:
4 '
Township. Range, SECtiOn:
II!I
ifil
111
III
10 WAS GROUNC WATER
ENC~NTERED?
11
DEPTH?IF YES, AT
iii
~.. 2:4o, ~ ,. ,-', ,-',. ~-' '/~.'
"~ t..; ~; ~, -.. ~--."
..... ,j.r:, ,,'~ % ~..~ ,~ '
I
I
1~034 Eagle Rl~r Loop Ila~d bio. 204
04/25/';'0~3 2P: 189873732S82 EPDE
".'. .'. . ~.),,,.. ,~/, ~,
~ ~ DEPA~ENT OF HEALTH & HUMAN SERVICES
825 L Str~[ Anch0rage. Alaska
~ SOILS LOG -- PERCO~TION TEST
~ [.,)~.~.,~ ~-(/,.. T.ownsh~p. R,lnge. Sect*on:
t
3
6
?
WASGROUNDWATER
ENCOUNTERED?
'/
IF YES, AT WHAT
III
Pt~L~i,O~M~t .~1 (m,r~t,H,/,nchj pERCP,O~lr ~AjV, ETER ~
TEST RUfd aETWEEN ~ Ft' AND ~) FT
ENGINEERING
ACCOROANCE WIT~ ~E, ~ ~ OUICELI~S tN EFFECT ON T~:5 DATE.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
, www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel
GENERAL.,1NFORMA¥1ON
.Complete legal description
[~cation (site addresS) -'7_Z ~i ~-
Expiration Date:
Curr~ntPr~perty. owner(s) Co~,,,~-~, '~,(~-c Day phone
Mailing address
Lending agency
Day phone
Mailing address
Real Esta~te Agent
~fi.i!ing/~ddre~Ss
unless othe~/i$~'i~e:g. Feste, '~i: COSA will be held by DSD for pickup.
!, ~' ; i~ ~ -.
NuMBER'O'F :BiEDROOMs:
TYPE OF.WATER sUPPLY:
Individual Well'
Individual Water Storage []
Community Class, Well []
Public Water System []
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ,,~-~
Individual Holding Tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska: Certificates of On-Site Systems 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 COSAs upon request to homeowners, certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 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 Mun cipality 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.
Address
Engineer's Printed Name L,~_s ~p~,-/'~/¢,¢,~:~, Date
DSD SIGNATURE
~/Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
By:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev, 11/05)
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building SafetyDivision
On-Site Water&Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343'-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST'
Legal Description:
A. WELL DATA
we, ~/pe
Date completed t
Total depth [7-1 ft.
Date of test
Static water level
Well.production 10 4.
WATER SAMPLE RESULTS:
Coliform /~/~ colonies/100 mL
IfA, B, or C provide PWSID # __
Sanitary seal (Y/N) "/
Cased to 1~0,5 ft.
FROM WELL LOG
t(o ft.
g.p.m.
Nitrate /VD mg/L
Parcel ID: 0 ~ 0 --,~ O I ' ~ q
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above gmu~l)
AT INSPECTION
ft.
g.p.m.
Collected by: L~I~ .~p,,zJ~/~.~c~
in.
.... Arsenic: /VD ug/L date of sample:
B. SEPTIC/HOLDING TAHK DATA
'~ Tank Type/Material. J~ lOC-)/c/~. /
Tank size [boo g~l.- _.: Number of Compartments z~
Foundat~oa~eleanout (Y/N).."/ Depression over tank (Y/N). N"
Date of pumping' ~ho6~,.~.;:~A~.~T~=n4~.Pumper ~,
C, ABS;ORP~ION E. IELD 13ATA
Date ,l~stalle~i'' "~lGJo~ "' Soj['raflng ~orff~lbdrm)
Length ', ~ . .~ ff. Width [ 0 ff.
Total depth ;~.~" .'~ "' /~Eff. absorption area ~ O0 .ftt Monitoring tube .
Date of adequacy test ~.j--z.,[ 'z.Oll Results(Pass/Fail)
Fluid depth in absorption field before test J~ in.
Elapsed Time: (~ min. Final fluid depth .. ~.
Any .rejuvenation treatment ('past 12 mo.) (Y/N~ ~'{ype)
Date installed "7-/6/"zoo~
Cleanouts (Y/N)
High water alarm. (Y/N)
Aksk ~,
... in. Absorption rate >=
System type [~c)
Glravel below pipe O,~ ft.
Depression over field /V'
For Z~ bedrooms
New depth (~ in.
~O0 g.p.d.
If yes, give date '
LIFT STATION
Date installed.
"Pump on" level at -2_7_ in.
Datum
Size in gallons l {o00
"Pump off" level at IS
Cycles tested -~ +
in,
Manhole/Access (Y/N) ~//
High water alarm level at
Meets alarm & Circuit requirements? ~/'
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ( o0 +
Absorption field on lot IOot+
Public sewer main /viA.
Sewer/septic service line
Animal containment areas
5.01+
On adjacent lots [ O0 +
On adjacent lots .
Public sewer manhole/deanout,
Holding, tank /V//~
Manure/animal exCrete storage are. as
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: '
Building foundation 5 +
Water main /V'/A~ l0 t+
Wells on adjacent lots I00I+
Property line S 4-
Water service line
Absorption field
Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line l0
Water Service line
Curtain drain
Building foundation I
Surface water
Wells on adjacent lots
Water main /~/'~/~
Driveway, parking/vehicle storage,
~F; COMMENTS
in.
G. ENGINEER'S CERTIFICATION ~., ~...~ E:..~. ~ t I,
,certify that, have determinedthrough field inspections and ~,,~.,~.??.-r ~w. ..~..~l~.~ , ~,
review of Municipal ~s that the a~ve systems are in ~ ~9 ~ J /'~
~nf~mance with MOA COSA guidelines in effe~ On this date. ~" ~ ~~ ~'~
Engineers Pr, nted Name ~ ~ ~q~ ~'~~~~
Date ~/~1]~0[[ - t~7;~'~~
Date of Payment ~ ~ ~ ~ ~ ~ ~ Date of Payment
Re~ipt Number O ~ ~ ~ ~ ~ Receipt Number
(Rev. 4/10)
ii II
LOT 6
)" W
5.60'
,EXIST NG
HOUSE
25'
LOT 7
LOT 8
TRACT B-1
ORDERED
NOTE 1: THIS DRAWING IS NOT TO BE MODIFIED FOR USE AS A PLOT PLAN.
NOTE 2: SNOW AND ICE MAY CONCEAL MINOR SURFACE FEATURES.
EXCLUSION NOTES: It is the owners' responsibility to determine
the existence of any easements, covenants, or restrictions
which do not appear on the recorded subdivision plat. NOTE:
Under no,. circum?ance, s ~hould {:my data hereon be used for
cons[ruc~on or for establishing property lines.
SURVEY CERTIFICA~ON: LANTECH has conducted a
phy~ic(~l survey of this property es shown on this
drawing and that the Improvements situated there-
on are within the property lines and no encroach-
ments exist other than noted.
A S -- E~ U I L T O F-: LEGAL DESCRIPTION:
LEGEND: SET FND
5/8"R8 W/CAP(~) 5/8" RB
3.25" AL.MON. ~ MONUMENT
HUB & TACK
FENCe- ~x X --
OVERHANG- ~
WOOD DECKS- ii.I ~
CONCRETE- I[", :'.,.. - ';; ":1
ASPHALT- ~
SEPTIC STANDPIPES- (~
WATER WELL- ~
ELEV.(NO DATUM)- ~
440 WEST BENSON BLVD. ¢ 200 (fax) 561-6626
^NC.O AG£. A'^S A 562- 2 LOT 7, BLOCK 1
Nuv. zg, 2005 1"=40'85-185
W
Lr-j
W
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