HomeMy WebLinkAboutSTOLLE BLK 4 LT 2Stolle
Block 4
Lot 2
#020-021-26
Municipality of Anchorage
Development Services Department •'=_ �"
Building Safety Division
-i
On -Site Water 8 Wastewater Program, 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. SW040395 PID Number. 020-021-26
Nom°
GERALDINE MERCHANT c/o AGENT JOHN CARTY
Wastewater System: O New ■ Upgrade
Y
Address:
16210 SNOW BEAR DRIVE ° ANCHORAGE, AK 99516
ABSORPTION FIELD
Phone: No. or Bedrooms:
265-9174 (AGENT) 3
0Deep Trench 0Shallow Trench IN Bad 0Mound 0Other
LEGAL DESCRIPTION
W Roting:
0.5
Tad Depth 1. e,10n groes:
e
CPO/Sq. rL
n
Block: Lot: Subdivision:
Depth to p" betlom I wn arginot rode:
Ganef depth bweelh pqe:
4 2 STOLLE
SEE DWG. rL
0.5+ r<
Township: Range: Section:
N sealed afro.• eriglnol groes:
G.1 wg :
- - -
SEE DWG. FL
47 rL
WELL: O New O Upgrade
GnmO .mh:
24
Name.. of w..:
4
tM.tenee W~ Weds:
6
n
rl
clae,iticoli,n PMele, ADS): Totd DepM Cooed Ts:
Tola1 oboorpDen ores:
Pp nW~
D 3034/ F-810
r<
1128 so. n
DN . Wed: sta wal•r L":
Ywlopw:
GEG, Ltd.
weM
9%22-25/2004
n
rield:
Pump set At:
Cosine N ghl More Ground:
TANK
CPN
n
rL
SEPARATION
DISTANCES
■septic Cl Holding 0S.T.E.P. OOther
io
Septic
Absorption
Lift
Holding
ubrw/prtvat•
N'"d«t..
ANCHORAGE TANK
copocily N gabns:
1000
From
Tank
Field
Station
Tank
se.e t n..
Well
100'+
100'+
—
—
25'+
STEEL
a •anwadmM.. 2
Surface Water
100'+
100'+
—
—
—
LIFT STATION
Lot Line
5'+
10'+
_
—
—
$1° In °OYOn°'
Uenutoctwer
Foundation
5'+
10'+
_
_
_
'""p •n `.d a: P.mp a1 Neel el:
a er abrin al
Curtain Drain
NONE KNOWN
Pump tbee t
viral kwpectione penomwd br:
Remarks: 'EXCAVATION WAS LIMITED TO THE
BENCH MARK
LoeeDen .red Description:
REMOVAL OF THE CONTAMINATED MATERIAL.
BOTTOM OF SIDING BY REAR PORCH
THE BED WAS REBUILT TO THE SAME OR HIGHER
rw.ned E�bon:
191.86
ELEVATION AS ORIGINALLY INSTALLED.
sl
ENGINEER'S eEAyl
OLD SEPTIC TANK WAS FILLED WITH CONCRETE
4040 Q
OF
oP �. • • •'�S�DO
GEG, Ltd. Dates: 1st 9/22/2004
(1);
Inspections performed by:
2nd /23/2004
• • • • • • • • Q
3rd 9/24/2004
4th 9/25/2004
QQ.A . y� . G nese:
Development Services Department Approval
Opp• •. E-7 3 .o
Reviewed and approved by: Date:�-3 01-3 0-1 4
40°d Professto^oao
(Red. 17/01) 470400�0�p6
PERMrTNUMBER: AS -BUILT D RAS Z I N G P 020 ID NUMBER:
SW0
SW040395 020-021-26
ST1
22.1
22.5
ST2
25.9
24.9
DBL1
27.8
26.4
DBL2
29.2
27.4
MT1
37.4
33.0
C01
39.1
34.2
CO2
43.6
39.2
CO3
48.3
44.4
C04
54.4
50.4
MT2
55.7
53.2
MT3
55.8
79.0
C05
55.5
79.7
C06
50.9
77.1
C07
46.0
74.3
MC08
41.0
71.0
MT4
38.6
68.9
DRAINFIELD /
47"/
�7s
JHOUS A4
\ `DBL1
`NEW 1000 GALLON
SEPTIC TANK
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS 6 GENERAL CONTRACTORS
5701 F TMOR ROAn. 5111TF 101 • ANh10RA0F. AA 00507 • FR(1NF (007P57. 179 • FAX (007)AA-57&6
GERALDINE MERCHANT 265-9174
1L DESCRIPTION:
STOLLE SUBDIVISION; LOT 2, BLOCK 4,
AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
9/28/2004
WN BY:
C.J.G. fl �0(
1: 4Dr I
.....E NUMBER;
2 OF 3 D6 ess
PERMITNUMBER: AS -BUILT DRAWING PNUMBER:
SW0 020
SWO4O395 020-021-26
FINAL GRADE .. 99.94+
TOP OF '
INLET XX
n
U
NEW 1000 GALLON
INVERT OF BUNG SEPTIC TANK
AT INLET XX 97.38
TESTHOLE DUG APPROXIMATELY 9
FEET BELOW BOTTOM OF BED. NO
GROUNDWATER O(L BEDROCK FOUND.
INVERT OF DISTR18LMON
UNE 95.54 (AVC.)
C4' WIDE—
TOP OF SAND ..
95.03 (AVO.)
BOTTOM OF ORIGINAL
BED - 95.03 AVG.
GRADE - 97.87+
TOP OF TANK AT
OUTLET - 97.94
VERT OF BUNG AT
OUTLET AX 97.15
FABRIC
—BOTTOM OF BED - 92.08-94.83
(IXCAOFnCONTAMION NATED MATERIAL REMOVAL TO THE
,. 9/28/200
DRAWN BY:
GARNESS ENGINEERING GROUP, Ltd. C.J.G.
CONSULTANTS 8 GENERAL CONTRACTORS XX SCALE-'
3701 F TUM`.R ROAD. tWIF 101 • ANCHMAOF. AK 99507 • P F (90713}71179 • FAX ("7)VNR-3766 1 40'
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
GERALDINE MERCHANT 265-9174 (AGENT) 3 OF 3
LEGAL DESCRIPTION:
STOLLE SUBDIVISION; LOT 2, BLOCK 4,
TTPE OF WORK:
PROFILE AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
r...T.:f.9lif.IP-n
Garness'
7953 `KF p
.... ' ...Awl
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water d Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
V
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Sep 21, 2004
Expiration Date: Sep 21, 2005
Permit Number: SW040395 Parcel ID: 020-021-26
Legal Description: STOLLE BLK 4 LT 2
Design Engineer: 0855 Garness Engineering Group, LTD Site Address:
Owner Name: GERALDINE MERCHANT Lot Size: 57590 SO. FT.
Owner Address: 16210 SNOW BEAR DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE. AK 99516 -
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.
Received By.
Issued By.
Date: Q G
�- •
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
'i ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. A96-1�d/—P6
Property owner(s) GERALDINE MERCHANT
Mailing address (1)
Permit Number
Dayphone 265-9174 (AGENT)
Mailing address (2) Zip Code 99516
Legal description (Lot, Block & Sub'd.) LOT 2. BLOCK 4: STOLLE SUBDIVISION
Legal description (Section, Township & Range) N/A
Lot Size '5 ?, `S9(J Acres/Sq.Ft. Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade E
THIS PROPERTY CONTAINS:
Hot Tub ❑ 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: 4� a /%,�eC Waiver
Date of Payment: 91allol1
Receipt Number. 0 975. r
Date of Payment:
Receipt Number:
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
September 17, 2004
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Design for septic system upgrade. Stolle Subdivision; Lot 2, Block 4,
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. The old septic
system is in state of failure and needs to be upgraded. Given the slopes to the west of the existing
drainfield and limited space to the north we are proposing to rebuild the existing bed to the same
or higher elevation. We are also proposing that the septic tank be replaced with a new 1000
gallon septic tank. 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 0.5 gallons/day/R'should be used.
2. TRENCH DESIGN:
a. Percolation Rate: 10.9 minutes/inch
b. Application Rate: 0.5 gpd/ftz
c. Design Flow: 450 gallons per day
d. Minimum Absorption Area: 900 fl'
e. Total Depth: To be limited to the removal of the contaminated material
f. Sand Filter: 1+ feet
g. Effective Depth: 0.5 R
It. Width: 24 feet
i. Minimum Length: 47 feet long
j. Effective absorption area =1128 ft'
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507
Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: gamessengineering.com
5. TOPOGRAPHY: As can be seen on the attached topography site plan the old drainfield was
installed on a 15-20 percent slope running approximately east to west. The area was then graded
to a 5-10 percent slope running approximately east to west. The drainfield has been in use for
approximately 20 years and to our knowledge has functioned normally.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If yo,µ have any questions, please contact us at 337-6179. Thank you for your
assistance. /I
.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, soil logs, and
a 7 page constriction specification letter which are all part of the design package for this septic
systent.
3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507
Ph: (907) 337-6179' Fax: (907) 338-3246 * Website: gamessengineering.com
I
STOLLE S/D;
LOT 12. BLOCK 3. \\ \\
LOT 11, STOLLE
0OCK 3,
I
\
I I STOLLE S/D;
LOT 1. BLOCK 4•
I 61 /
EXISTING SEPTIC I j STOLLE S/D
SYSTEM1 PROPOSED SEPTIC UPGRADE \� LOT 10, BLOCK 3,
(SEE DESIGN PACE 2 OF 2) --' —`` \ \
UNSUBDIVIDED \
EXISTING
3 BEDROOM
HOUSE
---------------- NoN�
------------�/
II
I I STOLLE S/D;
1 1 LOT 2, BLOCK 1,
I I STOLLE S/D;
I I LOT 3. BLOCK 1, CP
i
II
I 1 DATE:
16/2004
DRAWN BY:
C.J.G. •s'f'y',
GARNESS ENGINEERING GROUP, Ltd.
SCALE: i �: 4
CONSULTANTS' GENERAL CONTRACTORS I
1" — 100' ,,,,+q
vMF TPnv vnM foie lN• c — ••••••��•••• "
nN^unvnf,_ AK OO.n)' OwnNe fOnTttl.pg0' FAX f0nita.q_}pGn i
PREPARED FOR PHONE NUMBER: PACE NUMBER: n
GERALDINE MERCHANT 265-9174 (AGENT) 1 OF 3 •.
� of A. Orn Is;
LEGAL DESCRIPTION: y i s C —79
STOLLE SUBDIVISION; LOT 2, BLOCK 4,
TYPE OF WORK: 4+`+�d p/O/
SITE PLAN FOR SEPTIC SYSTEM UPGRADE `• . °.•-- =
EXISTING BED TO BE REBUILT. EXCAVATION IS
TO BE LIMITED TO THE REMOVAL OF ALL
CONTAMINATED MATERIAL. ADD 1+ FOOT OF
M.OA APPROVED SAND FILTER AND THEN 0.5
FEET OF CLEAN. WASHED SEWER DRAINROCK.
THE BED (TOP OF SAND) IS TO BE REBUILT
TO THE EXISTING OR HIGHER ELEVATION,
I
I
I v
I
I
I
I
EXISTING SEPTIC TANK TO BE
COMPLETELY ABANDONED
I
I
I
I
W7 /
'W EXISTING
S' OF BED TO i WELL—
BE ABANDONED
0 INSTALL DOUBLE
CLFANOUTS
EX
J '
BROOM
HOUSE
LL FOUNDATION
CLEANOUT
NOTE. THE CONTRACTOR SHALL
HAVE THE NORTH LOT LINE AND
THE WELL ON RADIUS FLAGGED
PRIOR TO CONSTRUCTION.
� NON
I /
9/16/2004
GARNESS ENGINEERING GROUP,
1)P� F TI nOV 90A0. CONSULTANTS i LtdSCALE: C.J.G.
1-40,GENERAL CONTRACTORS ...: 4 ....y...
SNITF 101 • AWHO9AGF AK 99Sp1 . ONF 07)11){1'. FAX f90n%5A-1)4A pOo
PREPARED FOR: PHONE NUMBER: PAGE NVMBLR: y V
GERALDINE MERCHANT 265-9174 (AGENT) 2 OF 3 ••
A _ e r A. ness-
STOLLE SUBDIVISION; LOT 2, BLOCK
DESIGN OF PROPOSED SEPTIC SYSTEM UPGRADE
PFo
52' LONG
OF BED TO
ABONDONED
FINAL GRADE
ORIGINAL GRADE FILTER FABRIC
ML CO CO CO MT
TT
y0.
S
n
OS OF EFFECTIVE _
�— 24' WIDE
EXCAVATION TO BE LIMITED
TO THE REMOVAL OF ALL ,+' OF M.OA
CONTAMINATED MATERIAL APPROVED SAND FlLTER THE BED ITOP OF SAND) IS TO
BE REBUILT TO THE EXISTING
OR HIGHER ELEVATION.
DATE: oop600p 0
9/17/2004 0!
DRAWN BY:O� �s4o
GARNESS ENGINEERING GROUP, Ltd. SCALE C.J.G. oo� 9 V y0�p
CONSULTANTS & GENERAL CONTRACTORS T.S.O ¢
X'Al F TUDOR ROAD. SIOTF 101 • ANOMORAOF AK 90501 • FNONF (901)5A-0179 • PAX (00,155NA?LA N•SO • • . • • • • • • • • • • • • •
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: O
GERALDINE MERCHANT 265-9174 AGENT 3 OF 3
.......
f ey A. Corness.� •••.
LEGAL DESCRIPTION: Q , ' C 79 3 e`p
STOLLE SUBDIVISION; LOT 2, BLOCK 4, 0�, ' 41��.�
TYPE OF WORK: 'Prolessi0D0\
DETAIL DRAWING OF PROPOSED BED REBUILD 4pp000po
SOF
L �4d
tcl�-
GARNI✓SSCONSULTANTS aENGINER NERAL�NG4CGROUP, TORS Ltd. 9 y
])01 G TlDon ROID. ENIC 101 • M,('i,o0.Y.E. K .]]ll) • .IIOMG i0) )-.IT • iNl ]0) -]3N • VCHS.L ,m„�wp,wY„e•m
*0
SOIL LOG — PERCOLATION TEST ... ...........
LEGAL DESCRIPTION: STOLLE SUBDIVISION: LOT 2, BLOCK 4, Q u '•.J fr rn ss: Q
PERFORMED FOR: GERALDINE MERCHANT DATE: 9/11/2004 QQO �� E 795 �cp0�
c
uo' 41k�
DEPTH �_-- d rofesato�o\o
(feet) E_E_ ORGANICS TEST HOLE Tfl��O0000�a6
t = _
SOIL CLASSIFICATIONS
2 1
3 >,. s GP I MIL
GM CL
4 GC OL /
SW
5 L•. •. SP CH ' ` p THH/1
1 SM OH
6
SC
7 DEPTH TO DATE " \
GROUNDWATER
8 SM DRY 9/11/2004
DRY
20 /'
�`—
,/- SITE PLAN
10-
11-
0 tt
12
13
14
15 B.O.11.
16
17
18
19 PERCOLATION RATE 10.9 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 6.0 FT. AND 6.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: E YES []NO
SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: RICK LYON
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERF RMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: o
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
9/13 2004
1
3:10
—
6�
—
2
3:40
30
3 1/4'
2 3/4'
3
3:40
—
6'
—
4
4:10
30
3 1 4'
2 3 4'
5
4:10
—
6�
—
6
4:40
30
3 1 4'
2 3/4'
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
OVr s*vc 111 CO
PHONEZ
Z%I'�',iZO
NEW
❑UPGRADE
MAILING ADDRESS
33/9 4,.-Ea AZ S- ea f
LEGAL DESCRIPTION
S>-o//e Ss76div7Jioh 6r.AJVC.J Cot R
8114-
LOCATION
-
NO. OF BEDROOMS
DY
DISTANCE TC(
Well
//3
Absorption area
Dwelling
/0
PERMIT IN
Y1 Otf -7-
E <
Manufacturer Grier
Material
5,1�ee / .
No. of compartm is
H~
Liq. capacity in gallons
/000
IF HOMEMADE:
Inside length
Width -
I
Liquid depth
f3 se
JUZ
DISTANCE TO:
Well
Dwelling
PERMIT NO.
O? <
2 r
Manufacturer
ater
Material
Liquid capacity in gallons
q
0
uJ,=
Well
DISTANCE TO: /Oo
Foundation
��'
Nearest lot line
. /Q -f-
PERMITN
'I(c) �
j LL Z
No. of 1' e� ngth of e�`line
Total length of lines
Trench witlt
Inches
Distance between lines,
mi-
0
To of tile to finish grade
.2-5
Material beneath til;
-
6 inches
Total effective a4sorpti n rea 7
�/ Xir t7
W
Length
Width
Depth
PERMIT NO.
d P-
W fL
Type of crib
Crib diameter
Crib depth
Total effective absorption area
H
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth
Driller -
Distance to lot line
PERMIT NO.
3
DISTANCE T0:
Building foundation
Sewer line
Septic tank
Absorption area (s)
OTHER
1 5
PIPE MATERIALS
PVC
SOIL TEST RATING H /
� V f/SFJ
INSTALLER
9bo1 4"PA5 % t 069
I
o
REMARKS
�74-ta//tol xzS• Modr'f+•
,Tpa,'A /a?ecF-
. , r�/[. ri c� ✓! GIC � a� r%f 3`p
T/ie« .Y cit /t-' - Cf 4 o✓e— bed.
"^
O
r
JST-
x/75 Ct� L/.arc
MOF 02
of
APPHOV EO DATE LEGAL t// / O ,,
T e 2z ,6 z lJ / 20 Ile sb c/.? . / 7
72-013 (Rev. 31781 7 /
MUNICIPALITY OF ANC ^RAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STP.EET, ANCHORRGE, AK 99501
264-4720
C3 E; I TE SE=WEFZ PERtl I T
PERMIT NO: 840476
DATE ISSUED: 06118184 _
APPLICANT: FOUR, CONSTRUCTION '
ADDRESS: 3319 FAIRBANK STREET
ANCHHORAGE, AK 99503
•CONTACT' PHONE: 277-5207
G,Qjin z vi. -k) S/o
.LEGAL DESCRIP: SUBDIVISION: STOLLE LOT: 2
SECTION: 6 TOWNSHIP: 11N RANGE: 214
LOT SIZE: 57590 (SQ.FT. OR ACRES)
MAX BEDROOMS: 3
LISTED BELOW ARE THE OPTIONS AVAILABLE TO
YOU IN DESIGNING
SYSTEM. CHOOSE THE OPTION
- - - - - - - - - - - -
THAT BEST FITS
YOUR SITE.
-
- - - - - - - -
TREhJCH
- - - - - - - - -
BEIa
DEPTH TO PIPE BOTTOM (FT.)
5.0
6.0
GRAVEL DEPTH (FT. )
4.0
0. 5
TOTAL 'DEPTH (FT.)
9.0
6.5 DY�ff`
GRAVEL WIDTH (FT.) -
2.5
25. 0 y1�sY
GRAVEL LENGTH (FT.)
122.0 **
49.0
GRAVEL VOLUME (CU. YDS. )
50.8
45.3
TANK. SIZE (GALS)
11000.0 **
1'000.0 **
SOIL RATING (SQ. FT. /BR)
1 324
270
BLOCK: 4
YOUR SEPTIC
FR F=1 I N - -
W. E> 5.0
3.0
8. 0
5.0
114. 0 **
73.8
324
** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
* TANK MUST HAVE AT LEAST TWO C011PARTMENTS
I CERTIFY THAT:,
1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA.
2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOR CODES AND REGULATIONS,
AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
3. I WILL ADHERE TO ALL MOR AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK,
DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A -MAXIMUM OF 3 BEDROOMS 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 -GUILTS
14ILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED DATE:
-----
APPLICANT: FOUR CONS RUCTION
ISSUED all,
_ [)------__ DATE: 5v
Department�fUHealthLand Environmenta�'Protection
825 Street, Anchorage, AK. '.9501
264-4720
Permit # 83c7��� * * * HANDWRITTEN PERMIT
WELL AND/OR ON-SITE SEWER PERMIT
Applicant: rnr.,o C„ Mailing Address: 312 PiLe H.a.fa ST
Location: TIIIU R, -)w Sce.4, Phone Number: 0774'-SP07
Legal Description: Col'. 8(K t/ $Tol(f 56 Lot Size: 77,5`70
Type of Soil Absorption System Is:
Trench: _V Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: 3 Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is: '
,
DEPTH `t,
LENGTH /.2-1f .GRAVEL DEPTH _1/ WIDTH `20 it
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel.depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE _ /00 n GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* *.* TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection.and approval by this departmen-
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper.installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
Signed: 4!�3zC/C.+�+ / i�CLn(�,i Issued by:
Applicafit
Date: 30�k,?
SWP/024 (1/81) S�= W dE�- ACAJe l.. A)2 S-
3��1��`G.2A`x� tk i3,d o ,'a..J
4
P L119 i - Ls ( (�
/Os' = L S4-kp
s = at
PERFORMED
LEGAL DESC
DEP
(FEI
1
2-
3--
4--
5-
6-
7-
8-
9-
10-
12-
13--
14-
15-
16-
17-
18-
19-
20-4 345678 9 10 12 1314151617181920
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTI R
825 L. Street, Anchorage, Alaska 99501 264-4720 1
It
SOILS LOG — PERCOLATION TEST
1
%R COnISTQ UGTInI.I INC-.r1DATE PERFOR
STO.eAt 4r S
A
SLOPE
LOAMY FILL
ORIGIRAL C ROUMD
S V P,rAC.F.
S' ILTY LOAM
GLACIAL-
GRAYE.LLY SILTY
SAND -SM
COME COSL9 ES
Ko WATEQ
NO VvIOTT Lint (r
LIGHT SPUN TO
MAY
WASGROUND WATER
ENCOUNTERED? nI Q
n� IF YES, AT WHAT f
L7v11OM OF HOLE DEPTH?
Yonosfiek pp
I
�j143 w
PLAN
Reading
Date
Gross
Time(kr)
Net
Time (MIA,
Depth to
Water
Net
Drop
3
It
Is to
LiS—"
N
�
PERCOLATION RATE
TEST RUN BETWEEN
PERFORMED BY: r&n .46wL E CERTI
72-008 (6/79)
TE:_ 81q—k3
Box 1300, STAR Hou E A ANcuoRAGEg Az.AsIKA 00502
344-7714
SIX INCH WATER WELL DRILLED TO THE DEPTH OF 195 TC44
DRILLED AT THE RATE OF !23.00 PER FOOT.
PROPERTY OWNER 3i9 UttbaAka�: M03
LOCATION OF WELL SITE rt.9 WS L Sub. Stotts aundule,rl
.-
WELL •
JqLwrr
,. ..
•T Ad?,
be 4AO_a.LLed 10 to 75 A W bottom..
Bedtock 4ta4ted at 19 .tt JUL a 4oA eoLzj. mrAaU mat ttal.. Cac-Ly ma.e d,Wen to
56 .fit in.the -&,token {.Leeu&ed Mock un.W .tt man 4eate.d to deme & ueW hard bedrock.
(At.Wen to "at at 56 {t%
MUNICIPALITY OF ANVORAC'E
DEPTHEALTH 91
EWIPO . EM
AL PROTECTION
TECTIONM
Cost o� 1441ldn¢r '123.00 p`1. A. X 195 4: 14485.00 'JAN 16 95A RECEIVED
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF 1"IS-00
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART DRILLING WORKS
DATE • 166th. 1983 ��,� .
SERVICE CHARGE OF IY,% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS.
Municipality of Anchorage .
Development Services Department
• Building Safety Division ,., ...
On -Site Water & Wastewater Program
4700 Bragaw, Street
P.O. Box 196650
Anchorage, AK 99519 6650 ! r1(n/rIRJY t�
t� www.muni.orglonsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 6,2-Q - t72 / - Zla COSA#
1. GENERAL INFORMATION Expiration Date: 3/C31,07
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
STOLLE S/D• LOT 2 BLOCK 4
16210 SNOW BEAR DRIVE • ANCHORAGE. AK 99516
ADAM & HEIDI BOWMEN Day phone c/o AGENT
16210 SNOW BEAR DRNE " ANCHORAGE, AK 99516
Day phone
MARY STEPHENS w/PRUDENTIAL Day phone 273-7706
3801 CENTERPOINT DRIVE #200 + ANCHORAGE, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
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 Onsite 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 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 riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 1 '7
Engineer's Comments:
In conducting this evaluation, GEG, LID. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines B Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
Puctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
S. DSD SIGNATURE
X Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the flowing stipulate4>ftl t l t (110
Y OF
t'1N-SITE
WATER AND •` m=
PROGRAM
Attachments: COSH Checklist X l))lj`jj)�,h
Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Reort —
Nitrate Advisory Other
By: W I -e!I= Original Certificate Date: �Z�Sf06
(Ra. 1105)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Ske Water b Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Andxxage, AK 995198650
www.muni.org/onske
(907) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: STOLLE S/D: LOT 2. BLOCK 4
Parcel ID: i7G0^0Z FZ6
A. WELL DATA
Well type PRIVATE If A, B. or C provide PWSID# N/A
Well Log (YM) YES
Date completed 10/16/1983 Sanitary seal (Y/N) YES
Wires property protected (YM) YES
Total depth 195 ft. Cased to 56 ft.
Casing height (above ground) 12+ in.
FROM WELL LOG
AT INSPECTION
Data of test 10/16/1983
11/27/2006
Static water level 12 ft.
35 ft.
Well production 5-6 g.p.m.
5.5 g.p.m.
WATER SAMPLE RESULTS:
Co fform O colonies/100 ml. Nitrate 41mg./L.
Other bacteria _colonies/100 ml.
Arsenic:-0--ugJL. Date of sample: 11/27/2006 Collected by: GEG Ltd.
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Data installed 9/25/2004
Tank size 1000 gal. Number of Compartments E
Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression over tank (YM) NO
High water alarm (Y/N) N/A
Date of pumpingi1;29 /Qlg- Pumper
A+ HOME SERIVCES
C. ABSORPTION FIELD DATA
Date installed '9/25/2004 Soll rating .p.d ftijWrm) 0_5
System type BED
Length 47 ft. Width 24 ft.
Gravel below pipe O.5 ft.
Total depth 05.5 ft. Eft. absorption area 1128 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 11 /27/2006 Results (Pass/Fail)
PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 535 gal. New depth Din.
Elapsed Time: 0 min. Final fluid depth 0 in.
Absorption rate >= 450+ g.p,d,
Any rejuvenation treatment (past 12 mo.) (YM 8 type) NONE
KNOWN If yes, give date - 0
D. LIFT STATION
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (Y/NI
"Pump off" High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankllift station on lot 100'+ On adjacent kis 100'+
Absorption field on ki too '+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent kis 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Animal containment areas 50'+ Manurelanimal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line
10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION 1;9!,_ `'.'•••
I certify that I have determined through field inspections and
a
review of Municipal records that the above systems are in """"' " ' "'
conformance with MOA COSA guidelines in effect on this
........ ..... ................
date. f ey Go esa.:
Engineer's Printed Name JEFFREY A. GARNESS CE- \�0
Date 2L7�nb
e°prei_..w�d
COSA Fee S l -/ZD i 75 9u Sh Waiver Fee $
Date of Payment 1.1 7I O Date of Payment
Receipt Number / 5 c� Receipt Number
(Rev. 11/05)
SCS ReLM
1066907001
Client Name
Gemess Engineering Group, Ltd.
Project Name/#
Stolle SD Lot 2 Block 4
Client Sample ID
Stolle SD Lot 2 Block 4
hlatrix
Drinking Water
Sample Remarks:
All Dates/fimes are Alaska Standard Time
Printed Date/time 12/06/2006 8:31
Collected Date/time 11/27/2006 15:15
Received Date/time 11/272006 16:00
Technical Director Stephen C. Ede
Allowable Prep Analysis
Parameter Results PQL Units h(cthod Containtt ID . Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 11/29/06 12/01/06 TK
Waters Department
Nitrate -N ND 0.100
Microbiology Laboratory
Total Coliform 0
mg/L EPA 300.0 D (<10) 11/17/06 11/27/06 ALR
col/100mL SM209222B A (<I) 11/27/06 DPT
a0000vpp4
W 00
Qp p
. 0 K
/� O• �••'': (V�� a��o �� fin }}{{
J \
a;
\
S
Y •W
i0 Z
iu
00
C3 *b•� O
N
W n•«ani•Y \
N
C
C3 \
\
N
-----------------
________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
p
,SO.6EZ 3„S17,OZ°O S
irw
grN
F1i
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water 8 Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.anchorage.ak.us
(907) 343-7904
RUSH
ERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING �G
Parcel I.D. 020-021-26 HAA# Dq C61LA
1. GENERAL INFORMATION Expiration Date: I a — 3 0 — 0
Complete legal description STOLLE SUBDIVISION; LOT 2. BLOCK 4.
Location (site address or directions) 16210 SNOW BEAR DRIVE • ANCHORAGE. AK 99516
Current Property owner(s)
GERALDINE
MERCHANT
Day phone 265-9174 (AGENT)
0
Individual On-site
Mailing address
c/o JOHN
CARTY w/
COLDWELL BANKER
Lending agency
Mailing address
Real Estate Agent
Mailing address
Day phone
JOHN CARTY w/ COLDWELL BANKER Day phone
2525 "C" STREET • ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
265-9174
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
Rednooms
procedures outlined in the Health Authority Approval Guidelines for this application,
VorlMhonumbelrof
water supply and/or wastewater disposal system is(are) safe, functional and adequate
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 inspoction, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines S Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwaterlevels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will It confer any legal right whatsoever.
5. DSD SIGNATURE
__Z Approved for 3 bedrooms.
Disapproved.
Phone 337-6179
Date
Conditional approval for bedrooms, with the fllowing stipulations:
`oQ0.'��•.. •.�''r0�
ZS : ON -SIT
�s �Aja rR AND
ASTEWATEK
1 PROGRAM
Attachments:FZ'S
HAA Checklist �� Manitenance Agreements �i ra • • • • �`
Septic System Advisory Supplemental Engineer's Reort
/Illl l l f )
Well Flow Advisory Other
gyA` ,�� IX/. /cif C// Original Certificate Date: 9— 210— O 7
(Rw.1=1)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragew St.
P.O. Bar 196650 Anchorage, AK 99519-6650
www.d.anchorage.ak.us
(907) 9437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: STOLLE SUBDIVISION: LOT 2. BLOCK 4. Parcel ID: 020-021-26
A. WELL DATA
Web type PRIVATE If A. B, or C provide PWSID# N/A
Date completed 10/16/1983 Sanitary seal (Y/N) YES
Total depth 195 ft. Cased to 56 ft.
FROM WELL LOG
Date of test 10/16/1983
Static water level 12 ft.
Well production 5-6 —g.p.m.
WATER SAMPLE RESULTS:
Well Log (YM) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
8/28/2004
31 ft,
6.6 g.p.m.
Collfonn 0 oolonies/100 mi. Nitrate 0.1 mgJL. Other bacteria 0 colonies/100 ml.
Arsenic: N/A mgA. Date of sample: 8/27/2004 Collected by: GEG. Lt0.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Tank size 1000 gal. Number of Compartments E
Foundation cleanout (YM) YES Depression over tank (YIN) NO
Date of pumping NEW Pumper
Date installed 9/22-25/2004
Cleanouts (Y/N) YES
High water alarm (YIN) N/A
C. ABSORPTION FIELD DATA
Date Installed 9/22-25/2004 Soil rating .p.d. ftt)dnn) 0_5 System type BED
Length 47 ft. Width 24 ft. Gravel below pipe 0.5 ft.
Total depth 04.0+ ft. Eft. absorption area 1128 fe Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fail) – For E bedrooms
Fluid depth in absorption field before test = In. Water added =gal. New depth =In.
Elapsed Time: = min. Final fluid depth = In. Absorption rate >_ – g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
If yes, give date –
D. LIFT STATION
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAlft station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION! `.
I certlly that I have determined through field inspections and ::' I4 T FN y*
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines In effect on this date.
Engineer's Printed Name JEFFREY A. GARNESS If 7157
Date 9'�rcl off! V
HAA Fee $ 412 ' 6 ~)e (A6h t� Waiver Fee $
Date of Payment Oy Date of Payment
Receipt Number 5 Receipt Number
(Rev. IPJ01)
09-08-04 08:15AM FROM-CTEE ESI, SGS ENV SERVICES
Lsfi$—
SCS Refq
1045518001
Client Name
Gamess Engineering Group, Ltd.
Project Name/#
16210 Snowbear
Client Sample ID
Lot 2, Block 4, Stolle SID
hlatris
Drinking Water
Sample Remarks:
9075615301 T-028 P.02/03 F-603
All Dates/Times are Alaska Standard Time
Printed Datelrime 09/412004 11:05
Collected Dute/rime 08272004 12:02
Received Date/flme 0827214:00
Technical Director _ _ stephoelEde
Parameter Results Allowable Pp Andysis
PQL UuOs Method Container ID Limns Date Due lnit
Waters Department
Nitrate -N 0.100 U 0.100
Microbiology Laboratory
Total Coliform 0
mg/L EPA300.0 D (r--10) 0827/04 33p
col/100mL SMI -09222D A (r--1) 0827/04 DKC
r S 0?20»2I 2392E
„m ,m=om
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH d HUMAN SERVICES
Division of Environmental Services IMEW
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 020— 021— Z 6v
1. GENERAL INFORMATION
Complete legal description /,bT- Z $CacK 4( STocCia S/b
Location (site address or directions) 16-0/0 Ln./
Property owner Day phone
Mailing address
Lending agency
Mailing
Day phone
Agent - MP. LAv" cook Day
� - /.5 152SDay phone 274� - 3
Address 3coo IAS Sine -m7, gTR F ANcFl A fc •So,ca-t
Unless otherwise requested. HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
7-MOk-.7111) Fpn MOAnt
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 of this Health Authority Approval application 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—FlAw vew0l a"G. S\/c- Phone "272-5:Z718
Address 1o2'?X% 11Nrk AIL 4f0)_Va
Engineer's sig nature Date M/I/Rf'
S ra-¢ Az--r-A 4 em az +r-'ta7
6. D, ^7-
HH66 SIGNATURE u c
.lZ Approved for —LELE-,-
bedrooms.
By:
Disapproved.
Conditional approval for
Additional Comments
bedrooms, with the following stipulations:
��' - . G,! P4�e-<� Date '9 - & - q!J
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS 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.
72@5 MW. IN1) 8. k ►40A C1
Municipality of Anchorage RECEIVE D
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division AUG 3 1999
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Municipatlry of Anchorage
Health Authority Approval Checklist Dept. Health & Human Services
LegalDescripbon:_L_Z_iBy 57-oltti Parcell.D.: o20 -071-Z&
A. WELL DATA
Well type`s RWA-rtA It A, B, or C, attach ADEC letter. ADEC water system number
Log present (YM) Y Date completed /O 14 1 P3.3
Total depth / 4 St Cased to S6' Casing height (above ground) / 6 k
Sanitary seal (YM) t Wires properly protected (Y/N) Y
FROM WELL LOG AT INSPECTION
Date of test
Static water level ! 2 ! q
Well production S - 6. g,p,m.9•P•
S -3 m.
WATER SAMPLE RESULTS:
Coltior —C-07—
Nitrate _ Q . G oZ
Other bacteria
Date of sample:
ts3 /r
122
Collected by:S
-2n} aA'Vx'CW tt
S. SEPTICIHOLDING TANK DATA
Date installed ? 11?•/ l5 4 Tank size ! doo Number of Compartments Z Cleanouts (Y/N) Y
Foundation deanout (YM) Y Depression (YM) _ ,J High water alar (YM)
Date of Pumping 4 98 Pumper -Z=sSACS.
C. ABSORPTION FIELD DATA
Date Installed „ /r? r'1$ 4 Soil rating (g.p.dAt' o ft2/bd Z70 System type @ 60
Length S'L Width 25' Gravel thickness below pipe O S Total depth 4V �
Effective absorption area /2 N S Monitoring Tube present (Y/N) Y Depression over field (YM) Al
Date of adequacy test 9 tl I ! -7 4 Results (PasstFail) WA s.5 For 3 bedrooms
Fluid depth in absorption field before test (in.); -'b QY Immediately after Hao gal. water added (in.): 3 "
Fluid depth -b R t- (ins) Minutes later. 3 o Absorption rate = < Q Tb a.p.d.
Peroxide treatment (past 12 months) (YM) -,//A If yes, give date
72.026 (Rev. 3I90)•
D. UFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm
E. SEPARATION DISTANCES
size
level at'
'Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot / / SI On adjacent lots
"Pump otr level at'
/ 00 "f
Absorption field on lot /CW On adjacent lots /Cwt -
Public
oortPublic sewer main A-'194 Public sewer manhole/cleanout
Sewer /Septic service line
/ot7T
Lift station /00,-r
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation / D r Property line C/O Absorption field /a r
Water maintservice line Z t: Surface water/drainage fav - Wells on adjacent lots /ct' T'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line /Ot Building foundation 30r Water main/service line ZS -r
Surface water /0'v -r- Driveway. parking/vehicle storage area r
Curtain drain /CivY Wells on adjacent lots /OtpT
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review, of Municipal
in conformance with MOA HAA guidelines in effect on this date.
Signatu
Engineer's Name S-r-OfeN 1�An�.�oe.�rs,O rs• '�
Data V/1 l 4 q•
HAA Fee $ i`n. CY 1 Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)'
Date of Payment
Receipt Number
Steven R. Pannone, P.E.
P.O. Box 102954
Consulting Engineer Anchorage, Alaska 99510
(907)272-8218
SEPTIC SYSTEM ADEQUACY TEST
Legal: Lot 2, Block 4 Stolle S/D
Owner: Mr.
Residence: 16210 Honey Bear Ln, Anchorage AK 99516
Septic System: Tank Size: 1000 Absorption System Type: Bed
(from records) Absorption System Size: 24'x52'x0.5' Absorption Area: 1248 s.f.
Installation Date: 7/17/84 Soil Rating: 270 sf/br
Date of Pumping: 9-98 By: Issacs
Date of Test: 8-1-99
Test Procedure: System was inspected visually and measured. The drain field was found to have 38"
of cover and a total depth of 44". There were zero inches of water measured in the field's monitor tube.
Water was added from the well serving this property at a rate of 5.3 gallons per minute. Water levels in the
tank and drain -field monitor tubes were monitored. A total of 489 gallons of water was added. During the
test, the liquid level rose 3 inches in the drain field. There was no rise in the septic tank. The infiltration
rate was monitored for 30 minutes. During this period, a total of 489 gallons were absorbed. By the
observations made, this system has an absorption rate greater than 450 gallons per day at the time of the
test.
The well was tested at the same time as the septic system. The well had a static water level of 19 feet below
the top of the casing. The static water level was drawn down to 52 feet while the well was producing water
at a rate of 5.3 gallons per minute. The casing stuck-up 16 inches above the ground. Water was tested for
bacteria and Nitrates. The results are not available at the time of this writing
TESTS RESULTS: This system meets the code and operational requirements of the Municipality of
Anchorage, Department of Health and Human Services.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the
system. 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. We can therefore not give any estimate of how long thesystem.will-continue to meet the
operational requirements of the Municipality and State. "
AUXS-29 14:0! FRMK-,E EMKIIANTAL 9615301
�- CT&E Errrlronmentit Servlcw Inc.
T-520 P.C2/03 F-360
CUE RetJ
993868001
clkm POM
CUent Name
Panoone Ens. Srv.
Prhued Due/lime 08/05/99 08.14
Project Name/N
L 2 3 4 SWUI
CoUelud DatelTlme 0MI/99 134A
Mat Sample ID
Back Hose Bib
Received DateMme 06x,02/99 12:45
MRtrfr
DrUddnS Water
To"ad Director. Supbm C. Ede
Ordered BY
PWSID
0
Released By A
SUVIC Remarku
Allowable Prop analysis
PareMrer Results P44 units method Limits Date Date Init
Tont Cdtttarw
0
col/IDORL
IRIS 9222/
08/02/99 RAP
Rltrate-R
0.652
0.500 q/L
!PA 3CO.0
10 MA 08/02/99 05/02/99 SCL
MUNICIPALANCHORAGE
• '� DEPARTMENT OF HEALTH
i# HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l.D. # —n1-1( -QQ 1 -Q to HAA #
1. GENERAL INFORMATION
Complete legal description Lot 2 Block 4, Stolle Subdivision
Location (site address or directions)16210 South Snow Bear Road
1 Anchorage, Alaska
Property owner
Geraldine Merchant
Day phone
255-8470
Mailing address
P.O.
Box 230424 Anchorage, Alaska
99523-0424
Lending agency
1st
National Bank
Day phone 765-3061
Malting add
Agent —
Address _
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3 \,
X
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4.' TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-023111,x.1/911 Fr l MOA,21
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify tha; my
Investigation of this Health Authority Approval application 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 verity 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
Address
Engineer's signature
6. DHHS SIGNATURE
22
HAYES, INC.
Phone 279-0543
AVENUE ANCHORAGE, ALASKA 99501
Approved for Z7�1�0 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
auric
Date 1- ` O _ YL-
':�G OFAt.4�`It
r�
bedrooms, with the following stipulations:
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority
Approval Certificates based only upon the representations given In paragraph 5 above by an Independent
professional engineer registered In the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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.
non (R«.1191) B� MOA 911
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST MLAHA13AN
Legal Description: Lot 2. Bl ock 4. Stol l e SIIbd. Parcel I.D. 021J -1991-41,A. WELL DATA NOiSIAla s30IAM Tr1N3WNOSIAN3
Private 30WOHONV dO A11Vd01NnW
Weli type If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Yes Date completed 10-16-83 Driller Rampart
Total depth 195' Cased to 56' Casing height 14"
Sanitary seal (Y/N) Yes ,_ Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
10-16-83
12'
Unknown
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 112'
Absorption field on lot
100'
AT INSPECTION
01-21-92
14'
1. ✓
Unknown
Yes
g.p.m.
; On adjacent lots 1001+
; On adjacent lots 1001+
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer service line N/Avs` Petroleum tank N/A
WATER SAMPLE RESULTS:
Coliform
Date of sample: 01-21-92
B. SEPTIC/HOLDING TANK DATA
Nitrate <0.1 Other bacteria _
Collected by: Shaven Snisarenko
9
Date Installed 06-22-84 Tank size lnnn gallnnc Compartments 2 i-
Cieanouts (Y/N) Yes ✓ Foundation cleanout (Y/N) Yes ✓ Depression (Y/N) No
High water alarm (Y/N) N/A Alarm tested (Y/N) N/A
Date of pumping 01-27-92'x' Pumper A+ Home Services
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well (s)onlot 112' Onadjacentlots 1001+ Foundation 10'
Topropertyline 7 Absorption field - 71, 1 Water main/service line
N/A
Surface water/drainage
None In Area
72-026 (R". 7M) Front CONTINUED ON BACK PAGE
C. LIFT STATION N/A
Date Installed _
'Size in gallons
Vent(Y/N)
Manufacturer
Manhole/Access (Y/N)
"Pump on" levet at "Pump off" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
Cycles tested
Surface water —
Date Installed 06-22-84
Soil rating 270 sq. ft./Bed System type BED
Length 521 Width
24' 'r Gravel thickness 1.0 Total depth 5.5'
Total absorption area 1248
cn ft _ ✓ Cleanouts present (Y/N) Yes i
Depression over field (Y/N)
No Date of adequacy test 01-21-92
Results (pass/fail) Pass ✓ for 3 `� bedrooms
Peroxide treatment (past 12 months) (Y/N) No If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1n0'
Onadjacentlots 100'+ Propertyline 14'
To building foundation 17 '
To existing or abandoned system on lot N/A
On adjacent lots N/A
Cutbank N/A Water main/service line N/A )2.r'
Surface water N/A
Driveway, parking/vehicle storage area 61'
Curtain drain --
N/A
E. ENGINEER'S CERTIFICATION
I certify th I h ve4e.fied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
FASignatureEngineer'sN e 0 �N .ry7y ��`{ '. . {` �
Date "d-�—�t- a� �•• . 1-E ��
ii .' '<
10..1-E
HAA Fee $ cJo
Date of Payment Z� Z
Receipt Number
72-M (Rev. 3/91) Back MOA 21
Waiver Fee: $ _
Date of Payment
Receipt Number
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS. ALASKA 99701 (907) 4563116 . FAX 4563125
2505 FAIRBANKS STREET ANCHORAGE. ALASKA 99503 (907) 27783M • FAX 2749645
Tryck, Nyman 6 Hayes Report Date: 01/24/92
911 West 8th Avenue
Anchorage AK 99501 Date Arrived: 01/22/92
Date Sampled: 01/21/92
Time Sampled: 1600
Attn: - Collected By: SS
Our Lab f: A116054
Location/Project: -
Your Sample ID: Lot 2 Blk 4 Stolle Sub
Sample Matrix: Water
Comments:
Method Parameter
EPA 353.3 Nitrate -N
aAA- l�
Reported By: Susan C.Orifental
Microbiology Supervisor
MDL - Method Detection
Limit
Flag Definitions
B - Below Regulatory Min.
H - Above Regulatory Max.
E - Below Detection Limit
Estimated Value
Units Result Flag
'---------------------------'
mg/l <MDL
Date
MDL Analyzed
0.1 01/22/92
A � �
MUNICIPALITY OF ANCHORAGE
DIVISION OF HNVIROMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date 111t15,5—
(a)
1a1s:5—
(a) Legal Description (include lot block, subjlivision, section township, range)
i 1 n AI_ L i/ —1l /I_ G_ 1.lI 11 % r l
Location
(b) Applicants Name Ra -"n f4 q+,(,s4 Telephone — Home Business
Applicants Address
(c) Applicant is (check one) Lending Institution Owner/builder
Buyer r�] ; Other Q (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co. S Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. Type of Residence
Single—Family rZI
Number of Bedrooms
3. Water Supply
Multi—Family
3
Other (describe)
Individual Well [M Community = Public =
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
M
Onsite 0�1 Public F—M 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.
V
[Page 1 of 21
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 on-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
W, 3o
Date
6. DEEP Approval
(ENGINEER SEAL)
Telephone Slot'- 5054
;,7
n
Y C. ReidJr
No. 22,51-i
n R^er•�• ,
Approved for bedrooms By D -e�ate-�-•�-'f
Approved 4- Disapproved Conditional
Terms of `Conditional Approval
CAUTION
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 REGISTERE
IN THE STATE OF ALASKA- THE DEEP DOES THIS AS A COURTESY TO PURCHASERS OF HMMS AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS- 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 alISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 21
7-19-84
A. Wr" Id. DATA
j1 MUNICIPAUTY OF ANCHORAGE
_ DEPT. OF HEALTH &
MDNICIPALITY OF AJK3fJRAGE (MOA) ENVIRONMENTAL PROTECTION
HEALTH AUnMRITY ``PPROM (HAA) 'JAN 161985
if13. 1 " : 9 • 'i
Well Classification If A, B, or C, D.E.C. Approved(o
Well Log Present (Y ;) Date Ca:pleted /0 -/(v -S 7 Yield:A�L
Total Depth Iq 5 Cased to SG Depth of Grouting 6444-e
Static Water Level ("II Pump Set At 1,4a1 --w •w
Casing Height Above Ground /.oSanitary Seal on Casing
Electrical Wiring in Conduit YN) Depression Around Wallhead (Y
Separation Distances from Well:
To Septic/Holding Tank on Lot US (9 ; On Adjoining Lots /00-
To
GpTo Nearest Edge of Absorption Field on Lot /Cbz 0 On Adjoining Lots
To Nearest Public Serer Line QUA To Nearest Public Sewer
Cleancut/Manhole AJA To Nearest Sewer Service Line on Lot
Water Sample Collected By A #.< ; Date /-S-RT
Water Sanple Test Results
B. SEPTICAMDING TANK DATA
Date Installed 4,2.2-5n/ Size /000��«./ No. of Catpartments
Y
Standpipes N) Air -tight Caps Y) Foundation Cleanout /N)
Depression over Tank (Y446)) Date Last Pumped
Puiping/Maintenance Contract on File (Y/N) Ahk for /4//¢
Holding Tank Bioh-Water Alarm (Y/N) 4,Ar TaMorary Bolding Tank Permit (YM)
Separation Distances frau Septic/Holding Tanks
To Water -Supply Wall 113 Gi To Building Foundation /D 0
To Property Line IDS+ To Disposal Field 71 V
To Water MakNService Line _ To Stream, Pond, Lake, or Major Drainage
(Page 1 of 21
Receipt # 3a;? �
Date Paid: -
Amount: J
2-15-84
^l Lvr G7icK y S -Al/ 5r.6
C. ABSORPTICN FIELD DATA
Soils Rating in Abscspticn Strata Type of System Design _
Date .Installed l®- 72;z - 9q Length of Field So? n
Width of Field 24 ` D Depth of Field N.T - 575 -
Gravel Bed Thickness /,o `
Square Feet of Abscrption Area I91(dg 4 *' Standpipes Present )
Depression over Field (Y& Date of Last Adequacy Test �A
Results of Last Adequacy T st AIA
Separation Distance frau Abscrpticn Field:
To Water -Supply Wall /00 ` L To Property Line
To Building Foundation /7 D To Existing cc Abandoned System a:
Lot t On Adjoining Lots
To Water Main/'Service Line VA To Cutbank(if present)
To Stream/Pcr Lake/cr Major Drainage Cawse AAA
To Driveway, Parking Area, cr vehicle Storage Area
D. LIFT 90MCN
Date Installed Dimensions
Sias in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y
��c6ees (Yat)
Off" Level at
vent (YM)
Cycles dosing Adequacy Test. Meets MOA
Comments
" Check Permitted Bedroom Rating Against BAA Request "
I certify that I have checked, verified, cr cmfcrmed to all MOA HAA Guidelines in effect
on the date of this inspection. ;5 OF OF qt,��
Signed ...-- A�• �G k Date i-11 RS �. �'.... N4i%4- 11
Cavany E MOA No. _ S. - *11i,
KBl/d5/e � ""-`.
II a_ w. nst� c, �
/ �
(page 2 of 21
2-15-84