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HomeMy WebLinkAboutPROSPECT HEIGHTS #1 BLK 5 LT 16Prospect 0 hts Heig Block 5 Lot 16 #015�091�36 y�l Inspection Report_1-1-12.doc Municipality of Anchorage `'' r- s, `" Page Community Development Department '�' 1 of 2 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 WASTEWATER INSPECTION REPORT Permit Number: OSP151164 PID Number: 015-091-36 ❑ New ❑✓ Upgrade Name: Paul & Cynthia Vanderweide ABSORPTION FIELD ❑ Deep Trench El Shallow Trench El Bed ❑Mound Address 9910 Schuss Dr ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Prospect Heights #1 5 16 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line FtZ Ft. Well 100+ N/A N/A N/A N/A TANK p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Acnhorage Tank Capacity 1,250Ga1. Surface Water 100+ N/A N/A N/A Material Steel Number of compartments 2 Lot Line 10+ N/A N/A N/A NA Foundation 5+ N/A N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain 50+ N/A N/A N/A RemarksNew Tank Only Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer Drainfield CO/MT 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 100ft Inspection 1s, i Location and description dates: �!/(� S/�S 2"d Top of trim at point A 3rd 4'h COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date • • ��G. '9s ,� /_N4: • : f,9,�� • TH Steven • •f�annorae• j ��,• CE 8149 Approved { � Date t 1 0 C ] 7 Inspection Report_1-1-12.doc (E) J w- w / DRAIN FIELD (E)- 45 3�u O b I1 ISEPTIC AREA (E) � l DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM TANK SIZE: 1,250g TANK USED: 1,250g NEW SEPTIC TANK LOT ABBREVIATIONS M# TH TEST HOLE R. 1. FC FOUNDATION CLEAN OUT DCO T# TANK CLEAN OUT NO. OG C# CLEAN OUT NO. FG REMOVED & REPLACED 1250g SEPTIC TANK WITH DOUBLE CLEAN OUT AFTER TANK X, \ FC (E) .Vl\�41 u' LEGEND W WATERLINE/ WELL RADIUS SS NEW SEPTIC MONITOR TUBE NO. RIGID INSULATION DOUBLE CLEAN OUT ORIGINAL GRADE FINISH GRADE A B T1 10.0 27.3 T2 12.5 34.6 z o� PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510'�� PHONE (907) 272-8218 FAX (907) 272-8211 of a L'gsl j .49 TH+� .... — /� "' .... .,,,,.yt Steven R. 'Pannone (✓ �Fc/, CE 8149 j (�,�� ll�k.�\\` `am Q0 0 0 ,0 �Z za Z Z a a -Z ma Li P.I.D. NO 015-091-36 PERMIT N0. OSP151164 UJ 0 0 0 OG FG 0 0 EL. 99.30 t: 4i2'• R.I. 3I2 EL. 95> 3 1,250g SEPTIC EL.95.1 TANK NEW PROFILE NOTES: PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510'�� PHONE (907) 272-8218 FAX (907) 272-8211 of a L'gsl j .49 TH+� .... — /� "' .... .,,,,.yt Steven R. 'Pannone (✓ �Fc/, CE 8149 j (�,�� ll�k.�\\` `am Date Date 9/13/2017 RECORD DRAING Scale 1"=50' DRAWN BY: PROSPECT HEIGHTS #1, BLOCK 5, LOT 16 PAUL & CYNTHIA VANDERWEIDE 9910 SCHUSS DRIVEs����Ul ANCHORAGE, AK 99507 NJC P.I.D. NO 015-091-36 PERMIT N0. OSP151164 PLAN Sheet 2 On -Site Water and/or Wastewater 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 Permit Number: OSPI51164 Tax Code Number: 01509136000 Work Type: SepticTank Upgrade Permit Effective Dates: June 12, 2015 to Junell,2016 Design Engineer: Subdivision: PROSPECT HEIGHTS #1 Site Legal Address: PROSPECT HEIGHTS #1 BILK 5 LT 16 G:2440 Owner/Address: VANDERWEIDE PAUL N & CYNTHIA K 9910 SCHUSS DR ANCHORAGE AK 995161066 Site Mailing Address: 9920 SCHUSS DR, Anchorage This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy All construction must be in accordance with: Lot Size in Sq Ft: 87556 Total Bedrooms: 4 N Private Well N Water Storage 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 subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing - Received Issued By MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. 015-091-36 Property owner(s) Paul & Cynthia Vanderwelde - Day phone Mailing address 9910 Schuss Drive, Anchorage, AK 99507 Site address 9910 Sch uss Drive Legal description (Sub'd., Block & Lot) Prospect Heights #11, Block 5, Lot 16 Legal description (Township, Range & Section) Lot Size 87,556 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (0 all that apply) Absorption Field F-1 Initial Single Family (SF) Septic Tank [9 Upgrade FX1 (w/wo ADU) Holding Tank El - Renewal Duplex (D) Multiple Dwellings Privy F� (SF and/or D) Private Well Water Storage THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: (a 157116- d:;l� Date of Payment: Receipt Number: 0510,11,4 Receipt Number: Permit No. 0-5e[6i I L.*4 Waiver No. Permit App_-'- :- � L.a z Pannone Engineering ServiceS LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveApanengak.-com June 3, 2015 Subject: Prospect Heights #1, Block 5, Lot 16 Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install a new 1250g septic tank to be issued for this property. The proposed systems will serve an existing four (4) bedroom house. Currently the lot is developed. The surrounding developed lots are served by private wells. There are no wells on surrounding lots within 100 feet of this system and there are no septic systems installed on the surrounding lots within 100 feet of the proposed well. 1. Tank Design. a. See Sheet 2 of the design package. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank. The proposed septic tank will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The existing topography slopes from the southeast to the northwest at approximately 10% in the area of the tank replacement. 4. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells within 100 feet of the proposed septic location or septics within 100 feet of the proposed well location. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 I (E) W—� DRAIN FIELD (E) I LOT 16 7 S EPTIC AREA (E) v 1250g SEPTIC TANK (E) DECOMMISSION PER CODE AND INSTALL 1250g WTIC TANK (P) WITH DOUBLE C L N OUT w 41 NOTES PAMONE ENG SVC, LLC Dote TANK REPLACE 6/3/2015 P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 Scole 1 -50 41 TH ....... ... PJ,D. NO PROSPECT HEIGHTS #1, BLOCK 5, LOT 16 �,ver� R: 6n -015-091-36 PAUL & CYNTHIA VANDERWEIDE '6.n PERMIT NO. CE 8149 Ospxxxxxx 9910 SCHUSS DRIVE PLAN ANCHORAGE, AK 99507 S'eet 1 OF 1 bwoml 1 1 #%L OCT IS 2013 Inspection Report 1-1-12.doc Municipality of Anchorage Community Development Department Page I 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 WASTEWATER INSPECTION REPORT Permit Number: OSP121209 PID Number: 015-091-36 El New V1 Upgrade Name: ABSORPTION FIELD Paul and Cynthia Vanderwelde El Deep Trench [Z] Shallow Trench [:] Bed Ej Mound Address 9910 Schuss Drive Anchorage, AK 99516 El Other Phone Number of Bedrooms Soil Rating depth from original grade 1 3 1.2GPD/SF ITotal 10 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6 Ft. Gravel depth beneath pipe 4-OFt. Subdivision Block Lot Prospect Heights No. 1 5 16 Fill added above original grade 1-2 Ft. Gravel length 50 Ft. Township Range Section Gravel width 5FTT ads: Number of Lines I Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field LiftStardion Tank Line 500 W1 One I Ft. well >100' >100' N/A N/A >25' IANK [71 Septic 0 ST.E.P. [I Holding 0 Other Manufacturer Anchorage Tank Capacity I I 000G31. Surface Water >100' >1 00' Material Steel Number of compartments Two Lot Line >5' >10' NA Foundation >51 >10' LIFT STATION Manufacturer Capacity I Gal. Curtain Drain None _Noted Pump on level at Pump off level at High water alarm at Remarks in. in. in. Fump -make and model Electrical Inspections performed by PIPEMATERIAL Housetotank D3034 Tankto drainfield D3034 Installer Red Dog Excavation Drainfield HDPE CO/MT D3034 Inspector MEA BENCH MARK (Assumed elevation) 100.0ft Inspeciion 8127/12 8/27/12 Location and description dates: - 2 Back Deck Door. Sd 8/28/12 4th COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL E A 111to Conditional Approval: Date 9TH .. ........... HM F ANDERSON -4381 Approved i Date/0 "ROFES Inspection Report 1-1-12.doc Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT Page 2 of 3 4700 Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 PID No. 015-091-36 Permit No.: OSP121209 On -Site Wastewater Dispos System or Well Inspection Report PROSPECT HEIGHTS SUBDIVISION NO. 1 LOT 16, BLOCK 5 Aj .6_� 17 87,556 Square Feet Existin 250 WIon9Scp.rc Tonk E.isting 52.V' Lee, 6' Ella?��. =Pg, Absorption Trench., A, 0, EXISTING HOUSE Existing Well 17,5' '�3. 1— ParkinV(Driveway S2 27.5' �0.0' C4 21.8! 132 C5 74.5' 64.2' MI 23.5' 15.5' M2 30.7' 32.0' 3 Bedroom HOUSO C6 B C) co C5 SI Lij M2 S2 A Nr6 ao 'Z 6) TH 11 0 C F it . ................. M 1 C4 7" 49th 30; * I ..... 0 ........ ........... ...... I ... ....... 0 e_ 0 ............... I ................. .......... Oo, MICHAEL E. ANDERSON No CE4381 ...... .... LEGEND FESS\ Isk MI — Monitor be hd.ju FCO — Fou 0. CIc.n out TH — Test Hole PLAN AS BUILT C4 — Clean Out Sl — Septic Vent SCALE 1 50' Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP121209 PID No. 015-091-36 50' (Trench Length) PROFILE AS -BUILT No Scale 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 Permit Number: OSP121209 Tax Code Number: 01509136000 Work Type: Septic Initial Permit Effective Dates: July 27. 2012 to July27,2013 Design Engineer: ANDERSON ENGINEERING Subdivision: PROSPECT HEIGHTS #1 Site Legal Address: PROSPECT HEIGHTS #11 BLK 5 LT 16 G:2440 Owner/Address: VANDERWEIDE PAUL N & CYNTHIA K 9910 SCHUSS DR ANCHORAGE AK 995161066 Site Mailing Address: 9920 SCHUSS DR, Anchorage Lot Size in Sq Ft: 87556 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N PrivateWell N WaterStorage 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) 343-79G4 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By MUNICIPALITY OF Community Development Department Development Services Division C*w On -Site Water & Wastewater Program ANCHORAGE Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D.: 01"91-36 Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s): Paul & Cynthia Vanderwelde Day phone: Mailing address: 9910 Schuss Drive Anchorage, AK 99516 Site address: Same Legal description (Sub'd., Block & Lot): Prospect Heights No. 1, Block 5, Lot 16 Legal description (Township, Range & Section) Lot Size: 87,556 Sq. Ft. Number of Bedrooms: Three (3) THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (E] all that apply) Initial X Absorption Field X Upgrade Septic Tank X Renewal Holding Tank F Privy Private Well Water Storage THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 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. -X4� E ct'j" (Signature of property owner or authorized agent) Permit/Rush Fees: 4 5 3.0 -1& Waiver Fees: — Date of Payment: V91311'a Date of Payment: inn q2 1 /9 Receipt Number: - Lg_(;;I__ Receipt Number: Permit No. 6SPIRI P,69 Waiver No. C:kUsers�AndEng\Desktop\Mike\Sleepy HollowlPermit Application Lot 8.docC:�Users\AndEng\Desktop\Mike\Sleepy Hollow\Permit Application Lot 8.doc ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) July 23, 2012 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 16, Block 5, Prospect Heights Subdivision No. I Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer The owner of Lot 16, Block 5, Prospect Heights Subdivision No. 1 intends to construct a second home on the lot. We are therefore requesting a permit be issued for the construction of the septic system to accommodate the three-bedroom home. The existing well on the lot will be used to service both houses and will become a Class C Well. The attached Site Plan and backup documentation identify the location and configuration of the proposed septic system and the existing septic system on the lot. Also identified on the plans are the locations of the existing well on this and adjacent lots. No conflicts exist between the proposed septic system and the wells on this or in the area. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test hole placed on the lot at the location of the new absorption trench indicated sandy gravel with some silt (GM). The percolation rate was determined to be less than 5 minutes per inch. Previous test holes completed in the past are similar to our results. We are proposing to construct a 1,000 gallon septic tank and a 38' long by 5' wide absorption trench with 4' of gravel beneath the distribution pipe. The distribution pipe in the trenches will be placed at 4' below the surface with the total depth at 8'. No groundwater was encountered during placement of the test hole and none has developed over the past several weeks since the test hole was placed. The ground surface on the lot slopes slightly to the southwest in the area of the absorption trench. The trench will be placed parallel to the contours of the ground as much as possible and in conformance with design criteria. A minimum of 150' will be maintained between all components of the septic system and the existing well and 100' Lot 16, Block 5, Prospect Heights No. I July 23, 2012 Page Two from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments 49th MICHAEL E. ANDERSON I.. Nom CE�4381 J PROSPECT HEIGHTS Cb 05 SUBDIVISION NO. 1 04� LOT 16, BLOCK 5 87,556 Square Feet "e"09 sc An"o 1 LEGEND / MT — Monitor Tube MH — Man Hole FCO Foundation Clean Out SITE PLAN 0 1 41�i -17, 1 UWN 52.5' �g x 6' Effecive Daptfi Absorption Twat. 4!� A, EXISTING HOUSE Exeing W.11 c. 0 A z 30, 3 Bedroom House NO, Go wJJ 2 1,!IV lgws� OF . ............. x 5 Vele 49th *#0 Amarption Trench. NOTE: lie ..... I ....... ....... ^ No Area, of Excessive Slope or Surface ........ . ........ �.. Water are Within 100' of Any Part of the j4. MICHAEL E. ANOERSON New Septic System. No Wells or Waste oter Systems on Adjacent Lots Conflict withwthe NO CE4381 M Proposed Septic System. LEGEND MT — Monitor Tube MH — Man Hole FCO Foundation Clean Out SITE PLAN TH Test Hole CO Clean Out SCALE 1" = 50' LOT 16, BLOCK 5, PROSPECT HEIGHTS SUB. NO. I DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom Home 5'Wide Trench System Perc. Rate: 1-5 Min./Inch 1,000 Gallon Septic Tank Application Rate: 1.2 GPD/SF 4'Drainfield Rock 3 Bedrooms * 150 GPD/Bedroom = 450 SF Absorption Area 450 SF11.2 GPD/SF/5 SF (Width) *.5 (Red. Factor)= 37.5 LF Trench Length THEREFORE: Construct a 38' Long x 5'Wide x 4' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 4'Below Original Ground Surface. Total Depth to be 8' Below Existing Ground. Provide 3' Cover Over Absorption Trench and 4' Cover Over Septic Tank. lin 91 EN 5' Fabric 4" Perforated PVC (Holes Down) Drainfield Rock Coarse Sand (See Specification) TYPICAL 5'WIDE TRENCH SECTION (NO SCALE) A NOTE: Grade Area Over Trench to Drain Away. 0�4 Minimum 6'Separation From Bedrock. Minimum 4'Separation From Groundwater. ..... Minimum 100'Separation From Private Wells in the Area . Minimum 100'Separation From Surface Water or StrearnsAt #� 'e MI -E!"11, MIC�L E. ANDERWN 1 No. CE4381 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICEs DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 DEPTI I 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: PROSPECT HEIGHTs, BLOCK 5, LOT 16 PERFORMED FOR: JoHN's ExcAvATiNG DATE: 7/13/2012 PROJECT No.: PARCELID#: TECHNICIAN: J- BERKRAM I TEST HOLE I ME OB/OG SILTY GRAVEL WITH SAND 4 GM A 4 4 BOH @ 18' (7) 49th MICHAEL E, ANDERSON No, CE -4381 S I I I- Fjl-AN SEE SITE PLAN sa WAS GROUND WATER ENCOUNTERED? !No IF YES @ WHAT DEPTH? DEPTH OF WATER AFTER MONITORING: HOME DATE OF MONITORING:4—�3'62' SEE SITE PLAN llejlzu!6 DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH To WATER (INCHES) INET DROP I (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 7/16 1 3:20 5.0011 2 3:50 30 12.501, 7.50" 3 3:51 4.751t 4 4:21 30 12.00FI 7.25" 5 4:22 5.0011 6 4:52 30 12.2511 7.25" PERCOLATION RATE: 4.1 (MINANCH) PERC. HOLE DIA.�(INCHFS) TEST RUN BETWEEN: 3 .0 FT. and 4.0 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR To TEST. TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 7/23/2012 bevelorment] Services Departl ment CBuilding 5cfety Division on-site Water& was+�Wc er prograrn 470(D Bragaw STreet P.O. Sax 196650 Mark Begich Arir�ioraqc, AK 90519-6650 Mayor lv�wjnjr. orqIoni �e (9n7; 343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: Legal Description Fr- 8 Property Oii ner )ame & Address: i�u v Pq AJ -D r5r� to ZZ I V ff Pump Installation Date: r7— Pump I ntake Depth Below Top of Well Casing: 2SVfeet pump Manufacturer's Name: ej--Z� —D,�dc-e-A- Pump Model: Pump Size 3Vq hp Pitless Adapter Burial Depth: feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: AJ VA - Well Disinfected Upon Cornpletion?fw:� Yes F No Method of Disinfection: Comments: Anchorage Pump & Well Service Pump Installer Name: 330 East 76th Avenue Anchorage, Alaska 99518 Phone: 907-243-0740 Fax: 907-243-0742 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. I V11 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH& ENVIRONMFNTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION $25 L Street- Anchorage, Afaska 99501 Tefephonsi ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE LKINEW 6 ROC E T A E)qsn IZ74—eifiI.90 I EDUPGRADE MAILING ADDRESS 324 I-IANOr A Mc C? 9--c-0 I LEGAL DESCRIPTION L.nT /6 in iv r PROSPCC-r TIZ-'U /?3.LJ SZC-. 13 LOCATION NO. OF HEIVOMS -'� C -Jq AI A r T- b R, ell Absorption arpa Dwelling F PERMIT NO. oy DISTANCE TO.77190 21 9 P46 8946 ;:z Manufacturer Material No. of cor%Zrtments Lig. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth 6 le DISTANCE TO: Well I Dwelling I PERMIT NO. -10Z Manufacturer Mate ial Liquid capacity in gallons DISTANCE TO: Well 1'7) Foundation Nearest lot his of OS3 P'9�8`8e,-6 Total len h I lia" %`i Trench wc! Is 4 Distance I enlines P: Z . b MZY-1 4P Top finish Material beneath Toutleffectl of tile to grade 41 tile ah,orp1blarea Length ffidth Depth PERMIT NO. V 1- Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class PX'iVATi5 Depth Driller Distance to lot line :7T MIT NO. DISTANCE TO. . Building foundation I Sewer line Septic lank I Absorption areas) /-), .0 OTHER PIPE MATERIALS I ILI CA S7 if& A) -ec jp 3o34 SOIL TEST RATING t INSTALLER G 0A5rAHC- r-AALf- 139 - 2.0 It 40 A:w REMARKS ivsLILAr' 13Q;LniA/e� T t ,5�fcic< -t&s A Y Z 0 14AJ 6ATC!�' -jL�U-1- (.7" ;ycenovelli Our to I'Less, Gorislyril. DATE LEGAL 171 'T WC, PC,—'r 14 T ICA31g it L 16 SS' P,,�os I? 1? 3 40 S-rc- 1-3 I 72-013 (Rev. 3/78) MU" I C-- I F�AL_ I -rN' C3 F= N1 Q F,: i=� C3 F_-_ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, At- 99501 264-4720 C3 E; I -r E=- IIS I-- W I-- F�% F� I —_- FZ4 M I -r PERMIT NO: 840896 DATE ISSUED: 10/22/84 APPLICANT: BRUCE.T. ANDERSON ADDRESS: 324 E. MANOR ANCHORAGE9.AK 99501 CONTACT PHONE: 274-6490 LEGAL DESCRIP: SUBDIVISION: PROSPECT HTS. #1 LOT: 16 BLOCK: 5 SECTION: 13 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 2.01A (SQ.FT. OR ACRES) MAX BEDROOMS: 4 Listed below are the options available to you in designing your septic system. Choose the option that best fits your,site. - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - _r F -,:z I=- t\J (__ 1-1 n I—_- 3:3 LAJ ID r -;Z ink I DEPTH TO PIPE BOTTOM (FT.). ��.o 4.0 4.0 GRAVEL DEPTH (FT.) -7.0 0.5 3.5 TOTAL DEPTH (FT.) 10.0 .4.5 7.5 GRAVEL WIDTH (FT.) 2 5 5.0 GRAVEL LENGTH (FT.) :43�:o 41.0 65.0 GRAVEL VOLUME (CU.YDS.) 29.9 33.5 48.2 TANK SIZE (GALS) 1,250.0 lo250.0 10250.0 SOIL RATING (SQ.FT./BR) 150 150 150 DEPTH TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULATION DEP TH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION TANI' MUST HAVE AT LEAST - - - - - - - - - - - - - - TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - I certif-y that: 1. 1 am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. 1 will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of.this permit. 3. 1 will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal -system or public sewerage system on this or any adjacent or nearby lot. 4. 1 understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BED N BY A LICENSED ELECTRICIAN. SIGNED DATE: APPLICANT: BRUCF'�r,�. ANDERSON' IS�UED BY DATE: RZY I- — V7 g.. I MU" I (-- I F='03bIL_ I -r%l Ml= ic� C:) FZ tcb (!; f -E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREETp ANCHORAGE9 AK 99501 264-4720 C3P,J—!3X-r1-= E3FZW1-=FZ PERMIT NO: 840513 DATE ISSUED: 06/27/134 APPLICANT: BRADISON REMODELING P4 P-6 ADDRESS: 4601 VAN BUREN ANCHORAGEt At" 99503 CONTACT PHONE: 561-1813 -r-'ec o`�Ac LEGAL DESCRIP: SUBDIVISION: PROSPECTS HTS. -LOT: 16 Plmrw: 5 SECTION:.13 TOWNSHIP: 12N_ RAtJGE:,3W LOT SIZE: 2.01A (SO.FT. OR ACRES),,4a, 6��. �� &��"Je MAX BEDROOMS: 3 :E zz.� Listed below are the options available to you in designing your sep�t=�p system. Choose the option that best fits your site. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F- FZ E: " (-_ " EDI I -E 13 W - ID Fz hl!:�h 1 P4 DEPTH TO PIPE.BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL DEPTH (FT.) 5.0 0.5 2.0 TOTAL DEPTH (FT.) 9.0 6.0 GRAVEL WIDTH (FT.) 2.5 14.0 5.0 GRAVEL LENGTH (FT.) 34.0 28.0 36.0 GRAVEL VOLUME (CU.YDS.) 17.3 14.5 2.1.9 TANI" SIZE (GALS) IP000.0 1,000.0 1,000.0 SOIL RATING (SQ.FT./BR) ill 85 85 ** TANI" MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - --- - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - 1. 1 am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. 1 will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. 1 will adhere to all MOA and State of Alaska requirements for -the set -back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. 1 understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED DATE: ----------- — APPLICANT: BRADIS REMODELING ISSUED BY DATE - -- ---- --- �A_ MUMXr_-1F=*jPk.L_1-r%e MF= if4M(—_"C3F7Z6AC31=_ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION �825 L STREETt ANCHORAGE, AK 99501 264-4720 C3 P-1 — f�3 X -T- FE: E; [-= W 1-= F;Z 9� W FEE L_ L_ PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: 840034 06/26/84 BRADISON REMODELING 4601 VAN BUREN ANCHORAGE, AK 99SO3 561-1813 F� I-= FZ M X -r LEGAL DESCRIP: SUBDIVISION: PROSPECT HTS. LOT: 16 BLOCK: 5 SECTION: 13 TOWNSHIP: 12N RANGE: ZW LOT SIZE: 2.01A (SQ.FT. OR ACRES) MAX BEDROOMS: 3 Listed below are the options available to you in designing your septic system. Choose the option that best (its your site. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -r F;Z 1= P4 4-- L%J - ID FzZ d!214 7: P4 DEPTH TO PIPE BOTTOM%(FT.) 4.0 4.0 0 GRAVEL DEPTH (FT.) 5.0 0.5 2.0 TOTAL DEPTH (FT.) 9.0 4.5 6.0 GRAVEL WIDTH (FT.) 5 14.0 5.0 GRAVEL LENGTH .(FT.) :0 28.0 Z6.0 GRAVEL VOLUME (CU.YDS.) :�7 0> 14.5 21.9 TANK SIZE (GALS) 10 1,000.0 1,000:0 SOIL RATING (SQ.FT./BR) 135 TANK MUST HAVE AT LEAST,TWPZOM77 - - - - - - - - - - - - -I ce-rt-if-y th-at: - - - - - - - - r 1. 1 am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of -Anchorage (MOA) and the State of Alaska. 2. 1 will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria,of this permit. - 3. 1 will adhere to all MOA and State of Alaska requirements for the set back distances from any existing welly wastewater disposal system or public sewerage system an this or any adjacent or nearby lot. 4. 1 understand that this permit is valid (or a maximum or 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, . THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED,WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED APPLICANT: ISSUED BY DA TE: R D REMODELING DATE: rffi�) S;ILS !.Oj� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L Street, Anchors". Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST ipt I PERFORMED FOR: 4L&e�y c -NO DATE PERFORMED: Oct 70 I LEGAL DESCRIPTION: Lot 16 MOCIZ 5- 74) SLOPE SITE PLAN MW rZOIN r-T—r—T--1 I I I i I I I I 1 7-1 2- 3- 4- 5- 6- 7- 4 10 - 12 - 13 -IR 14- 15- 16- 17- 18- 19- 201 M(nw- ScIl lale- WASGROUNDWATER C-1 ri Sf ENCOUNTERED? -AD IF YES, AT WHAT DEPTH7 %,j cld�� 5 cf-'e I IGL�y T 3 L Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN 40M -fu I I "I PERFORMED BY'04=y INOA T7--tYO'ZV CERTIFIED BY: I 72-008 (6/79) FT AND - FT e d nc- f S: -t-3 T7 DATE: /0/2 r -'N 50ILS LOU MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION 1 40j-:� 825 L. Street, Anchorage, Alaska 99501 264-4720 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: c GINNIS DATE PERFORMED: (0/2 - LEGAL DESCRIPTION: L07 1(,.I�K 5 ?(Z.0,cPEC-T HEI�HTS SEC -13,112o' 3L MEMO MMENERNOME M 0 MMEN OMMMENOMMIN No 0091000 ryl =I 'As No OFAME 11113 mono NNOMN3MOMM is ERME REMMONSMNE MMOO 7 - 8- Poo e L �1 A C t -e c.J-0 9 C AN 10 - WAS GROUND WATER ENCOUNTERED? 12- 13 -TT -1 --[- P 14- Date Gross Time 15- Depth to Watar Net Drop 16- ii000.1., 0 17 - 18 - Nil 19- 20 - COMMENTS PERFORMED BY: 4 72-005 16/79) IF YES, AT WHAT Li —AULF`LqTH7 y6T V 3Nnr 3-9ZZZ ON ........ 0.00". ST (gy—o" ONO UNIONME NEREENNEEN Readtnq Date Gross Time Net Time Depth to Watar Net Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) FT AND — FT � C' CERTIFIED BY: I . — DATE Type Material Drilleds 0 feet 18 Cravel 18 feet to .25 Sand �25 feet to 37 Sandv Of HaLni V.ONMENIA V?,OTE I CTOA 37 feet to 40 Cravel/water EWI ID ZQ� 40 fek to 70 Clav, vravel 70 feet to 82 gravel, damn sand R2 feet to 83 Water, at I Rpm. 83 feet to 90 rravel, clay 90 feet to 95 Sand, gravel Hefty Drilling 95 feet to clax, gravel S.R.A. Box 1553 R 99 feet to 309 Bedrock AnchoragepAlwgm Perforated casinp at 82 and 83 feet. 99507 • q-• Municipality of Anchorage s ,o F �p ,•�l�r—. � On-Site Water and Wastewater Program ^ �� l tri . r, (907) 343-7904 ._ e. ��2 018 Certificate of On-Site Systems Approval �J 015-091-36 --ZF-er`=' Parcel I.D. Expiration Dat:. �' r;� 6 : • S IL(— 1 s. 1. GENERAL INFORMATION Complete legal description Prospect Heights #1 Block 5 Lot 16 Location (site address) 9910 Schuss Drive Current Property owner(s) Paul & Cynthia Vanderweide Day phone Mailing address 9910 Schuss Drive Anchorage, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex 0 Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4/3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by. c /AL I All -.I t , Date: 2/14418 COSA to be released to the engineer,unless otherwise requested by the engine-r. { COSA Fee $ Waiver Fee $ Date of Payment a/Gii� Date of Payment Receipt Number a110146 Receipt Number COSA# Q&A/G.3 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe 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 soil condition,ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 2/2/2018 .�`~OF 4(� kk r • A *• 49 .* 6. DSD SIGNATURE ... / K‘ � 2f____......-- System #1 Approved for f7 r.bedrooms r�' Steven iR.•f�annorie: System #2 Approved for bedrooms •1�� 9�, CE-8149 •\,,��� Disapproved ��kU,.PROFESSIONA\- � Conditional approval for bedrooms, with the following stipulations: .,` pF ANrh`O Q, /P-9,-.. EN'S\Ce Nr SN' =.o�� PC�OG\�P� e7 By: C "`-�- 1' Original Certificate Date: 2--I 14, ^(S? 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_f .. c If more than 1 septic system is on the lot: COSA Checklist# 1 of 2 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Prospect Heights #1 Block 5 Lot 16 Parcel ID:015-091-36 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 9/25/1984 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 309 ft. Cased to 100 ft Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/25/1984 1/26/2018 Static water level 35 ft. 100.9 ft Well production 2.5 g.p.m. 3.5 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 1.53 mg/L Arsenic ND D ug/L Date of sample: 1/26/2018 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 6/15/2015 Tank size 1250 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/A Date of pumping 1/29/2018 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 10/23/1984 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 SF/BORN System type Deep Trench Length 52.5 t. Width 3 ft. Gravel below pipe 6 ft. Tottaal�de • ft. Eff. absorption area 630 ft' Monitoring tube Y Depression over field N Date of adequacy test 1/26/2018 Results(Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 6 in. Water added 600 gal. New depth 33 in. Elapsed Time: 240 min. Final fluid depth 6 in. Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION 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: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 1 00+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on file. G. ENGINEER'S CERTIFICATION ���'�"`xx O F A I certify that I have determined through field inspections and r�''p>' - j ..y+�0 review of Municipal records that the above systems are in ;7*; ,4. i. /\ •* i conformance with MOA COSA guidelines in effect on this date. ....4*..k.ji — —. ' Engineer's Printed Name Steven Pannone —i�'••'Slaver;1R, Pannone : ilert Date 2/2/2018 1t4. CE-8149 . il�j`�`��o�s9c* COSA canary sheet_2-6-15.doc If more than 1 septic system is on the lot: COSA Checklist# 2 of 2 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Prospect Heights #1 Block 5 Lot 16 Parcel ID:015-091-36 A. WELL DATA Well type If A, B, or C provide PWSID# Well Log (Y/N) Date completed Sanitary seal (Y/N) 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 8/27/2012 Tank size 1000gal. 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/A Date of pumping 1/30/2018 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 8/27/2012 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type Shallow Trench Length 50 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 10 ft. Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N Date of adequacy test 1/30/2018 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in. Elapsed Time: 60 _min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION 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: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 00+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ • F. COMMENTS Survey on file. G. ENGINEER'S CERTIFICATION +~ OF 4,Q �P)• sly I certify that l have determined through field inspections and j o'�.• `4` y,�� review of Municipal records that the above systems are in 0*: -I\ •. conformance with MOA COSA guidelines in effect on this date. •••• 0`0 • ••• 0 Steven Pannone -I Engineer's Printed Name 1 •eleven . Pannone Date 2/2/2018 ' CE-8149 , 'i COSA canary sheet_2-6-15.doc PROPOSED MSNED FLOOR ELEV.(ASSUMED) / PROPOSED BONDING CORNER / 'REV.(ASSUMED) /• / ZONING ORIRCT FRONT BINDING 4IBACX % • sloe emetic SETBAa( /..S\ REAR RUI DING SE1BACx /�* / h /r.,4? / C- . ', 1, /O i /, a o / I :" / > I /'/ /' / I / 7 I A' o� / % �.�6� /' % 30 . % G�JSS./ I Si 7 I •"74. /./ /, r /' % /- 1 :/. UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSHING BOUNDARY OR FENCE UNES. THE SURVEYOR TAKES RESPONSIBIUTY FOR THE INITIAL TRANSACTION ONLY APD ASSUMES FINANCIAL UABILITY ONLY FOR THE COST OF THE SURVEY. USTED DISTANCES PREVAIL OVER SCAUNG. REPRODLCTION MAY CAUSE ERRORS IN SCALE. ❑ or SURVEY SURVEY TYPE SYMBOLS 0 FOUNDATION AS-BUILTa PeMvO® 0 FINAL STRUCTURE AS-BUILT SET REBAR 6.11110. DRAINAGE k`'"'"""1 ASPHALT C FOUND REBAR °R-9—e: WOOD FENCE t. ..°..41 CONCRETE ❑ PLOT PLAN. . . AS-BUILT. . . LOT SURVEY. . . TOPOGRAPHY �l� ASSUMED ELEV. X X X METAL FENCE WWI WOOD DECK ® AS-BUILT. . . NO CORNERS SET 0 RECERTIFICATION AS-BUILT . . . NO CORNERS SET PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS. TO FINISHED GRADE AND UTIUTY CONNECTIONS AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS M<.Y PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. AL L DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION .',.,.0int�4,, Prepared by PLOT PLAN �P-\E ,r te Robert E. Johns, Jr. & Assoc. Ibusby orwyealNm.py.mey-�• 4,� •�`{'�je Professional Land Surveyors the lot droen and deserted herote.old that I �^ (y how'coed or esed.lIN.ed dl of the Rot comers ir vl o° . 1700 Brink Drive. m wen o,the pen end to deotbest of my � ' . ANCHORAGE, ALASKA 99504 Imoofedge and abeam dl etnendms haw bees. t M •. K . meso red tale and:meetY Y N • .•e 7 Scele: n t Rec. Lot S.F. Rec. Plot File No. (FOUNDATION AS-BUILT �• '� Qi'•"°'•� 1 1 _ 100 I.Rabert E Jannm Jr..hereby oertfry that I t / 0 Surveyed: Drown b Checked J A K have porn: ad m -Butt envoy of B.. a �` 10/03/13 Y REJ J'VI tonelotlan o,MY lot and that at the dm.m.00.o and Intomoton os thank aro• RO: RT..JON ,JR. we boo and no eneraodonmte hoer.+aloe d •- Dote Drown: Grid: W.O. -�•.aeeel- 1�. '• 41 _� `',„ 10/04/13 2440 13-517 FINAL STRUCTURE AS-BUILT .A.,4* •• Ap I.Robert E Jahnm Jr..hereby certify that I ., ® ., , Lego; Description: h;:ee pc/w-+Nd m Am-Bolt coney of IM el the a Or. • ...........••� dye LOT 16 BLOCK 5 I a.mds.duro Gad thieflot os dMoon heroes. i ♦"a. pores aiona`0��� �cm het seoereade.t.e.N.tad«a �ornilauwei.�V"'s I PROSPECT HEIGHTS ,yw:m otherwise. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Brag3W Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEms APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. COSA# citlowol 1. GENERAL INFORMATION Expiration Date: / 01- -.9-19 0 6 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address PROSPECT HEIGHTS SUBDIVISION #11: LOT 16, BLOCK 5 9910 SCHUSS DRIVE 0 ANCHORAGE, AK 99516 MICHAEL & JANICE MARSH — Day phone 346-1158 9910 SCHUSS ORWE * ANCHORAGE, AK 99516 Day phone Real Estate Agent CAROL BUTLER w/ RFMAX PROPERTIES Day phone 257-0116 Mailing address 110 W. 38th SUITE 100 * ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD forpickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage El Community Class—Well El Public Water System 13 TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank 13 Community On-site 1:1 Public Sewer 11 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 AJaska. 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 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 seat 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 andlor 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 riles and from my investigation and inspection, the on-site water supply andlor 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 CARNESS ENGINEERING GROUP, Ltd. Phone Address 370 1 E. TUDOR ROAD. SUITE 101 * ANCHORAGE. AK 99507 Engineers 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 DSO Guidelines & 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 fife 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 ofthe system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate othow long the system will continue to meet the operational requirements ofthe ADEC or MOA DSD. The content of this report is for the sole benefil ofthe 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 bedrooms. Disapproved. 337-6179 Date 9 /Z (WOL, Conditional approval for — bedrooms, with the filowing stipulations: WATER AND PROGRAM Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other — By: zm/ �P�4- Original Certificate Date: Municipality of Anchorage Development ServIces Department Building Safety Division O"Ite Water & Wastewater Program 47W Bragaw Street P.O. BOX 196M Andxnge, AK 9951 9 -WW www.muni.orgionsits (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEms APPROVAL CHECKLIST Z Legal Description: PROSPECT HEIGHTS SUBDIVISIo ;'Lar 16, BLOCK 5 Parcel ID: Q Jf- () 01/- 3 6 A. WELL DATA Well type PWATE If A, B, or C provide PW`SID# NIA Date completed 9/25/1984 Sanitary, goal (yjN) YES Total depth 309 ft. Casedto 100 ft. FROM WELL LOG Date of test 9/25/1984 Static water level 35 ft. Well production 2.5 O.P.M. WATER SAMPLE RESULTS: Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 9/8/2006 100 6.62 g.p.m. Collform 0 coloniWI00 rnI. Nitrate _2&�j_mQA. Other bacteria 0 colmiesiloo rrd. Arsenic: -AM_ugjL. Date of sample: 9/8/2005 Collected by: GEG, Ltd. B. SEFTICIHOLDING TANK DATA Tank TypelfMaterial SEP7IC/STEEL Date Installed 10/23/1984 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout (Y/N) YES Depression over tank (Y/N) NO Ngh water alarm (YIN) NIA Date of pumping 9/8/2006 Pumper ROTO ROOTER C. A13SORPTION FIELD DATA RINDWISMOR1�1 Date Installed 10/23/1984 Soil rating (g.p.dAbr((� 150 system type TRENCH Length 515 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth Eff. absorption area 630 fe Monitoring tube YES Depression over field NO Date of adequacy test 9/812006 Results (Pass/Fall) kSS For 4 bedrooms Fluid depth In absorption field before test DRY In. Water added 838 gal. Now depth 17 In. Elapsed Tom: 38 min. Final fluld depth 3 In. Absorption rate >z 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN — If yes. give date D. LIFT STATION Date installed "Pump ono level at _in. E. SEPARATION DISTANCES Size In gallons High water alarm level at Cycles tested— Meats alarm & circuit requirements?— SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfitft station on lot 100!+ On adjacent lots 1001+ Absorption field on lot 10V+ On adjacent lots 100,+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer rrianhole/deenout N/A Holding tank N/A Manure/anunal excrete storage areas 10V+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property Une 5'+ Absorption fleld 5'+ Water main I N/A — Water service One 10'+ Surface water----J22:+— Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main NIA Water service line 106+ Surface water 100'+ Driveway, parkingMshicle storage 10'+ Curtain drain NONE KNOWN Wells an adjacent lots 100'+ F. COMMENTS 0. ENGINEER1 CERTIFICATION I cer* that I have determined ftough #old inspections and review of Muniopat records that Me above systems are in conformance with MCA COSA guidefines in effed on this date. Engineses Printed Name JEFFREY A. GARNESS Date , /,z (0 )a /0 COSA Fee 9 '13 6. <30 Date of Payment Z,2�/C4 Receipt Number (Rev. I V05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 060467 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 5, Lot 16 of Prospect Heights-'�/subdivision. This inspection revealed a nitrate concentration of 7.27 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 02 4v, t% 4� // r2 Of < �N .Es;— [3F A "V�� -7 I -q r,< . ............ 47. 49MH ............... * .......... SHANE A. HOLT.- LS-6914 ...... .... 0 It A q.., COP DCALK 1' 50' AS -BUILT SURVEY NO CORNERS SET THIS DATE I WREW CERTWY �T I MVE KRFORWD A NOTE: LOT 10. IULOCK 5. PRO�Cl W�S W. I NO eASE.ENTS APPEAR 0 THI LOT ON THE RECORD PLAT. 7TE "OfflWbk� WREO� M FOR � L*E OF LE� VVTTLFT� IIPSCF�y TO EMSTWO STRL0CTINES MD ��O LOT LAES OR �EKTS MO W WT TO IX 8TRLCTLPESORFEW0.WfS EMEME� OF RECORD. O�R � �SE � O� TVIE RECORMO RAT. ME WT � WREOfk NOTE ��E�S�MEL�MD��MLY�MEWTTOMMOTO�RM��W�3 OR L�TE STRMTLRES O�R T� WTED WED AT ��F � MS _19TH_ MYOF WPTEMWR HOLTLN��Y*47-161"!TFTY�W — TELU&6513 PAV IF 9 es] SGS ReEN 1065388001 Client Name Gamcss Engineering Group, Ltd. Project Name/11 Lot 16 Blk 5 Prospect I Its #I Client Sample ID Lot 16 Blk 5 Prospect I Its N I Matrix Drinking Water All Dateiffirnes; are Alaska Standard Time Printed Datdrime 09/20/2006 8:27 Collected Date/Time 09/11/2006 8:33 Received DAtelTime 091IM006 14:10 Technical Director Stephen C. Ede Saniple Remarks: Allo"ble Prep Analysis Parunctcr Results PQL Units Method Containff ID Limits Date Date ]nit Metals by XCP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 09/12/06 09114/06 Mll Waters Department Nitratc-N 7.27 0.100 mg/L EPA 353.2 B (<10) 09/11/06 ALR Microbiology Laboratory Total Colilarm 0 col/100ml- SM209222B A (<I) 09/11/06 TLF MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date _ (a) Legal Description (include lot, block, subdivision, section township, range) i-711POA95- , PWC5j2C-C+ ATS4.1 'T I z K) rL 3 Lk -1 S ft ]I Location (address or directions) -!Cf-Cej4-TT -D(L Address (a) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of -Residence Single -Family t�R Multi -Family Number of Bedrooms 3. Water Supply Individual Well cs� Community = Other (describe) Public M Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite 4?1z r_ .2S�r Public Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 472-bg&V (b) Applicants Name �nL4CF AV1t>CrV50-j Telephone Home Business Applicants Address zoo W-30�1 V931' Ave 4)t qqe:,<)? (c) Applicant is (check one) Lending Institution OwnerAbuilder -::l Buyer [-::[ ; Other E (explain); (d) Lending Institution Telephone Address (a) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of -Residence Single -Family t�R Multi -Family Number of Bedrooms 3. Water Supply Individual Well cs� Community = Other (describe) Public M Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite 4?1z r_ .2S�r Public Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] t'r j('0 �fcr 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health 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 otr-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and.regula- tions in effect on the date of this inspection. Name of Firm AFC!5 Telephone 5(01-50440 Address Date— 16 -1 c-� R 5� 6. DEEP Approval Approved for Approved t— Terms of Co itional (ENGINEER EFAL) bedrooms By �Datj Disapproved Conditional Approval A F-1- 61#CIR C. Rald, Jr. . 2251-E .., THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASXA- THE MEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. E!4FLOYEES OF VUEP 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. (DUEP SEAL) RR4/ej/Dl8 [Page 2 of 21 7-19-84 ki 1. ­ eol� ALASKA CIIJIMUTAL COnTROL S66US, InC. Enqinterinq 6 Enuironmental Studies July 12, 1983 MUNICIPAUTY OF ANCHOPAGE DEPT Of H-ALTH & Department of Health and Environmental Protection ENV1RO,',:,4-ZNTAL PROTECTION 825 L. Street JUL 14 1900 Anchorage, Alaska 99503 Attn: John Lynn RECEIVED Dear John: As per Municipal Regulations we have taken water level readings in the water monitors installed in the testholes at Prospect Heights Subdivision # The results are presented in Table 1. AY Although the water levels have fluctuated since the testholes have been drilled, suitability of the lots for on—site systems has not been affected. Structural Engineer Approved by: eeroy C Reid Ph P resident 1200 West 33rd Avenue, Suite B * Anchoraqe, Alaska 99503 e (907) 276-1361 Table 1. Water Monitoring at Prospect Heights Subdivision #4 Date T.H.NO. Block 1!90 Depth LOt 6/22/83 9 1 1 5. 0' 6/22/83 7 2 1 5.01 6/22/83 8 3 1 10.01 6/22/83 20 4 1 15.01 6/22/83 19 5 1 11.5' 6/22/83 18 6 1 8.5' 6/9/83 10-B 7 1 8.51 6/22/83 17-C 1 2 11.01 6/22/83 16-B 2 2 11.01 6/22183 6 3 2 7.5' 6/22/83 5 4 2 8.01 6/22/83 4 5 2 7.0' 6/22/83 3 7 2 None 6/22/83 I -B 8 2 9.01 6/22/83 2B(IO) 9 2 8.0' 6/9/83 11 2 None 6/22/82 14 12 2 10.01 6/22/83 13 13 2 9.5' 6/22/83 12 14 2 5.01 6/22/83 11-B 15 2 None A. WML DM M',;.N!-V PALIT Y OF / DEPT. OF HE,! MUNICIPALITY OF ANCHORAGE INTAL F HEMM AUTHDPM APPF40M (HAA') J Ali 16 CHECKLIST - FEBRUARY 1984 . RECEI\ Legal Description:. /-,07 V** I V well classification J)ri 62;4 If A, B, cr C. D.E.C. Approved(YM) Won Log Present ry*) Date ompleted Yield Total Depth —aaaZ— Cased to_ Depth 'of drouti Static Water Level 555' � P=p Sat At &/h�00-v� Casing Height Above Ground ',X/ Sanitary Seal on Casing 6N) Electrical wiring in Conduit (,ON) Depression Around wellhead (YA) So paration Distances from wells To septic/Holding Tank on L*t i 4ro - _.r On Adjoining Lots ALLgo To Nearest Edge of Absorption Field on Lot 21' ; On Adjoining Lots 6TXO To Nearest Pk2blic Sewer Line 1-i To Newest Public Sewer Cleanout/Manhole #JA Th Nearest Sewer Service Line on Lot V+ Date I Water Sample Collected By I Water Sample Test Results '--�)An5rwme�� A B. SEPTIC/93LDING UNK =h Date Installed /0 iU 174 __ Size 1 -1 *f 0 No. of Caqpewtmanta — �L — Standpipes &i)- Air -tight Caps "Y) Foundaticn Cleancut Depression over Tank Date East Pumped k4c-10 Pumping/Mainteranca Contract cn File for d4E---- Holding Tank High-Mter Alarm (Y/N) Al porary Holding Tank Permit (IN),44— i) fty) �-mnlx Separaticn Distances fran Septic/Holding Tanks f To Water -Supply Well I TO To Building F0undaticn1_Ak_q_ Th Prcperty Line &Yat -- To Disposal Field V- 'z I I To water mairV%ervice Line PiA. To Stream, Pando Laker or Major Drainage course rx:fod%( Cclmma Receipt # lt� a Date Paid: i - Amount: r1 of 21 2-15-84 4or 14o (a "04 ODIJI In 47d Soils Rating in Abscrpticn Strata *-I Q al -j A x - Type of System Design C h Date Insta 11 d 4- 41� Iz -4 1 R q Length of Field )1� �J,S- / Width of Field 4:- Depth of Field J;--JbO Gravel Bed Thickness (0 ( Square Feet ct Abscrpticn Area 4- 1,30117-- — standpipes Presentlev- Depression cver Field (Y& Date of Last Adequacy Test Results of Last Adequacy Test 7-11 Separation Distance fran Abscrpticn Field: TO water -supply Well "L I-),, To Property Line 4- ToBuildingFwidation I- pit To Existing cr Abandcred System cn Lot .. &IAI.�y On Adjoining Lots #. 6-T(po' To Water MairAlService Line N 4 To Cutbank To Strew/Pmd/Lake/cr Major Drainage Ccwsa_ ,p./Vb To Driveway, Parking Area, cr Vehicle Stcraga Area cc=ents-b( Aft'f.-- AFR'-C� AS -R%.14 -- D. LIFT' STRITON Date Install d Size in Gallans opump Ono Level at High Water Alarm Level at Tested for Electrical Level at ell� Vent (YAN) Cycles dwing Adequacy Test. Meets MOA Check Permitted Bedrocm Rating Against HAA RqqMSt I certify that I have chackedl verified, cr cenfcrmed to all mM HAA Widalinss in effect on the date of this irmnacticn. Signed, C6U,%-, Date Cmpany I JP -C-5- MOR No. ry- 0 7- V KBl/d5/s [Page 2 of 21 . . . . . . . . . . . . . . . . . . . . L" C. &W J, NM 225 1 -E 2-15-84