HomeMy WebLinkAboutPARK HILLS #1 BLK 2 LT 1Onsite File
#017-142-14
Swale no longer required. 15.65 allows
AWWTS to be 50 ft from surface water.
Jun 24 22 10:07p Anchorage Well & Pump Ser
9072430742 p.1
MUNICIPALITY OF ANCHORAGE
Development Services DepartmentQ 1 Phone: 907-343-7904
On -Site Water & Wastewater Section t Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number:
Parcel Identification Number: 017 142 14
Date of Issue: - -
Legal Description Block Lot Property Owner Name & Address:
FRANCIONE JOHN M & PAMELA J
PARK HILLS#1 2 1 14621 PARK HILLS DRIVE
ANCHORAGE, AK 99516
Pump Installation Date: e6 - 16 - 2022
Pump Intake Depth Below Top or Well Casing: "
Pump Manufacturer's Name: AYMCDONALD
Pump Model: 6622-059/23050V3
Pump Size: '50 hp
Pitless Adapter Burial Depth: 10
I Pitless Adapter Manufacturer's Name:
I Pitless Adapter Installer:
feet
feet
MARTINSEN
Well Disinfected Upon Completion? I\Yes ❑ No
i Method of Disinfection: PELLETS
Comments:
Pump Installer Name: _
ANCHORAGE WELL & PUMP SERVICE
Company: 7640 KING STREET
ANCHORAGE, AK 99518
Mailing Address: 907-243-0740
City: State: Zip:
Municipality of Anchorage
Development Services Department
Building Safety Division
,.
On-Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page I of Z
www ci.anchorage.ak us (907) 3417904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SUO O 70 3 13 PID Number: Of 7- r Y 2- l y
Nam.
H F k lion C-h e i1L I,. i Wastewater System: ❑ New ® Upgrade
Agaetf
15162! park jfFfl� Or'la-C
ABSORPTION FIELD
P'o"• Nu M sowoomt,
3 Ir- 76S'2. g
D Deep Tglrll 19 S1ul1 Tr«m D aW O mo 13 Dpvr
LEGAL DESCRIPTION
Sod Rung
3.0
TOM Doi Mom mg." glee
.p
2 SW n,sm
Ll Par4 Hall 11t/
GPDIFtl
Depth to p" boaom can anger, pada
.!. y Ft.
Gran« dean beneath pp.
TowlWp Range Seam
2.7 FI.
TO added audr."" Pld•
0.7 Fi
Crar«L«pm
O FI.
38 Ft
Well: Ewrr ❑ New ❑ Upgrade
Z'a ""n0" s
Num aono a orrnw wt-een:net
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FL
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i 90 Fla
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A�'
�ZlJ �07
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Pure S« «
Catep M•grx Actor• Crocq
GPM
Ft.
Ft
TANK
SEPARATION DISTANCES
❑ Septic ❑ Holding ❑ S T.E.P. U6,C44 /-t>,c Ii7Other:
To Septic ADsorptlon Lit
From Tank Field Station
Holding ubuuPnvate
Tank Sewer Line
•T.. ap«aly
A-r1CA0r e %eA k ISOGG«
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tor'
Up,
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Engineer's Stamp
Inspections performed by: r,=(a/Llap -"rel, Sue Dates: 1" 12/Z l a7
2nd 12 /S/ �7
` ` ; • •A4 a„B�
Development Services Department Approval
Conditional Approval Date:
%;'49 11`:� .r O
N
...........
............ .
THEODOPE F. MOORE��
Reviewed and approved b : 7 �.� V'Oy
PP Y
CE-3587 •XL`r
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i/ Date: v
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PAGE 2OF2
SWING TIES
-TBM - FROM:
«„ «H.. TO:
"ADVANTEX" TO S.IR=M
TREATMENT
TANK
�i��
38 -FOOT LONG x 5 -FOOT WIDE
SOIL ABSORPTION DRAINFIELD
w. 0.7. GVL. 81.0' SAND UNDER PIPE
COR. "A• COR. "B'
---
FDN. C.O. "C"
3.5'
43'
a
S.T. C.O. "D"
12'
47.5'
o
CTR. POD "E"
15'
50.5'
m
TANK M.H. "F"
19'
53.5'
T
DRFLD C.O. "G"
27'
42'
a
DRFLD M.T. "H"
_42.5' ---39'—
N
OR -F D -c. "
62.5'
48'
���/1YPARAIIEI QP, �3r.eePLAN VIEW
��� PPROX�MATE w"G l'_t�' AtltCSCALE: 1" = 30'
........•Ni•..�
7.�........� .. c
FILTER POD "" 000RS F. IdOOR: j J7
C:-35EJ �1Y'
6'" dap
FINAL GRADE ELEV. 93.5'Fl
–�
,r/I/Ui1���• f/
:, r...
Z2.0. SOIL COVER /-2" RIGID INSULATION
f
PROFILE VIEW
NOT TO SCALE
--------------------------
I/ .'1A' FILTER SAND ELEV. 90 T : I
ELEV. 89.1'
4" DIA. D-3034
INV. 90.8'
THROUGHOUT
0.7' SEWER GRAVEL
BELOW DIST. PIPE
38 -FOOT LONG x 5 -FOOT WIDE
SOIL ABSORPTION DRAINFIELD
w. 0.7. GVL. 8 1.0' SAND UNDER
1500 -GALLON
"ADVANTEX"
M'
"
TREATMENT TANK
INLET PIPE
INV. 89.5'
BOTTOM T.H. #1 M.T.
ELEV. 79.1' - WATER
@ 83.8' 11/8/07
"
f
PROFILE VIEW
NOT TO SCALE
--------------------------
I/ .'1A' FILTER SAND ELEV. 90 T : I
ELEV. 89.1'
4" DIA. D-3034
INV. 90.8'
THROUGHOUT
0.7' SEWER GRAVEL
BELOW DIST. PIPE
38 -FOOT LONG x 5 -FOOT WIDE
SOIL ABSORPTION DRAINFIELD
w. 0.7. GVL. 8 1.0' SAND UNDER
wa t el: nl�. !M. b0/ U[ 4bw 12/10/07 10:33a P. 001
eYvq' `t' EMPF.C77ONREPORT
MUNICIPALITY OF ANCII0IL4GE -- BUILDING SAFETY DI VISION
4700 SOUTH NRAGAW STREXI'
/,NNPh.'l.T/O,V.V_Voice: (907) 343-8300 Fax: (907) Zd9-777J �wrn munior�+?fSDgiupcc6��ns.cfm
NAAIr: - .--.. _..
_ PERAr7T7Y::
C0.'NPAVY C:_- Z)-I� Jam' ['�—� CVSPCCrDAM - --- —
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_tnT. _ Ln.vc:Kr SUUDIiTS'(UN. GRID# -_
COMMEN'IN UP L)W.rrIO,vS:
I'YPE or IMP£CTIVV: _.
(OM.+lT N7s: (MR Ev.vpEc.'TvR V..CL• On))
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0
MUNICIPALITY OF ANCHOR4GE
Development Services Department
On -Silo Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW070313
Legal Description: PARK HILLS #1 BLK 2 LT 1
Design Engineer: 0019 FLATTOP TECHNICAL SERVICES
Owner Name: MIKE RONCHETTI
Owner Address: 14621 PARK HILLS DR
ANCHORAGEGE , AK 99516 -
Date Issued: Nov 26, 2007
Expiration Date: Nov 25, 2008
Parcel ID: 017-142-14
Site Address: 014621 PARK HILLS DR
Lot Size: 39932 SO. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of.
❑✓ Disposal Field Q 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: Date: ///3 v /o
Issued By: _[� GU(r/�ir/.�/rr,/ Date:O
Municipality of Anchorage
-�1 Development Services Department
Building Safety Division
On -Site Water and Wastewater Program 7t *ti
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D. 6jq_lL4a- /q
.ash
Property owner(s) Mr kL 8 P c,43�
Ff ; Day phone F^YL /
Mailing address lYt; 2l LtF-k- 8,lG DeltZ MAc�, Zip Code 9`75 -ll
Site address xe_ .e Zip Code
Legal description (Sub'd., Block & Lot) Lot 1. /y-i/lr C /A -Al
Legal description (Township, Range & Section)
Lot Size ��q "I 32- Sq. Ft.
THIS APPLICATION IS FOR (Z all that apply):
Absorption Field 19
Septic Tank 19
Holding Tank O
Privy El
Private Well
Water Storage
Number of Bedrooms 3
THIS APPLICATION IS AN:
Initial
Upgrade
Renewal
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: `1160 Waiver Fees: —I rS'D
Date of Payment: 11 /l3 /07 Date of Payment: 11 /13 /0 7
Receipt Number. /6141/4'q Receipt Number.
(Rev. 11/05)
o � Mimicipality of Anchorage
Y,3r 1'.(). nktx 19(NM • Anchnrn(;c, Alaslm ffiAi19.6GiO • 47(N)1;6uorc Poxul
01,.. / ()fli(v: (SNYI) 3()4.9101 • Pax: ((X)7) 343.8200 htgr.//aiwtnuml.org
Mayor Mark Begich I)cvclopment Sen3ces Depart);netiit
November 26, 2007
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, AK 99577
Subject: Waiver Request for Park Ilills #1, B2 Ll
Waiver Request WR#: 070063
Parcel ID # 017-142-14
SW070313
Dear Ted Moore, P.E.:
Nov
c
o�
A '
n
Departr
Your request for a waiver of the required 100 feet horizontal separation from the
absorption field and septic tank to the surface water has been approved. The approved
separation distance is 60.0 feet.
This waiver approval applies to the existing absorption field and septic tank to surface
water separation only. Any future upgrade to the on-site wastewater disposal system will
require all separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
N�
Deb Wockenfuss
Civil Engineer
On -Site Water R Wastewater Program
Conlmuniti/, Security, Prosperity
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.ci.anchoragc.ak.us
(907)343-7904
Waiver Review Worksheet
WR#:070063 PID#:017-142-14 HA/Permit# SW070313
Date Received: November 26, 2007
Legal Description: Park Hills #1, B2 Ll
Engineer:
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, AK 99577
Applicant: Mike Ronchetti
Waiver Requested: 60' from tank and disposal field to surface water
Criteria: Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Points:
Total:
..........................................................................
Waiver is Granted: X Waiver is not Granted:
List Conditions or Reasons for above: Cateoory III Nitrate Reducina with Remote T lemetiv
system will be used
Date: _11/26/07 By: Deb Wockenfuss
Name of Reviewer
..........................................................................
Rec#: 102149 Amount: $1]_ Q Date Paid: 11/26/2007
FLATTOP TECHNICAL SERVICES
CIVIL & ENVIRONMENTAL ENGINEERING ENERGY CONSERVATION & ANALYSIS
TED MOORE, P.E. 14530 ECHO CANYON ROAD
PHJFAX: (907)345-1355 ANCHORAGE, AK 99516
E -Mail: tgmoore@gcl.net November 14, 2007
M.O.A. DSD — Building Safety Division
On -Site Water and Wastewater Program: Attn: Deb Wockenfuss
4700 South Bragaw Street
P.O. Box 19-6650
Anchorage, AK 99519-6650
Dear Ms. Wockenfuss:
The following narrative with changes in bold type addresses the comments contained in
your 11/14/07 Comment Sheet. By means of this letter we are requesting issuance of a permit allowing
installation of an "Advantex" Advanced Treatment Wastewater Treatment System to replace the existing
septic system on Lot 1, Block 2, Park Hills S/D #1. The existing septic system is operating in a
surcharged condition. Documents pertaining to that system are found on your website under the
erroneous legal description of Lot 1, Block 2, Park hills S/D. A revised site plan illustrating the
proposed configuration and a plan and cross-section drawing and specifications are enclosed. These are
being sent by US Mail in order to accommodate your insistence upon original signed documents.
The plat for this subdivision designates a 100 -foot septic system setback from creek running
along the southern property lines. The present septic system is located within that setback and in March
of 1989 a MOA DHIIS employee determined that the designated creek was sufficiently intermittent to
reapprove the system without requiring a waiver to the 100 -foot separation. Ilow•ever, at this time the
creek flows relatively continuously and thus has to be categorized as surface water requiring a 100 -foot
setback. Due to the location of the existing well on the lot there is no site available to construction of a
septic system that meets the required setbacks; the maximum achievable separation from the creek is
approximately 60 feet. Thus, I am hereby applying for a "field waiver" allowing the proposed treatment
tank and residual disposal drainfield to be located as close as 60 feet from the closest edge of the creek.
As I discussed with Joe Goodall on November 9'h, in order to justify granting the requested
waiver we propose to install an advanced treatment wastewater tank which has been shown to produce
effluent meeting secondary treatment standards. As can be seen from the enclosed design and
specifications the system we are proposing to install is an "Oren co/Anchorage Tank" Advantex
System with an AX -20 Filter Pod with monitoring by remote telemetry. I understand that your
department has accepted this system as a Category ill System that also provides nitrate reduction.
Furthermore, we propose to create a drainage swale downstream to the tank and residual disposal
drainfield such that the surface flow path followed by any effluent daylighting from a failing treatment
tank or residual disposal drainfield will be greater than 100 lineal feet before the flow could encounter
surface water. These two factors acting in concert should provide an equivalent or higher level of
surface water protection that that achieved by a conventional septic system located just over 100 feet
away from the creek. Thus, the situation after construction will be an improvement over the present
situation.
The soils testing for a potential septic upgrade was conducted in May of 2003. The enclosed
logs show sandy loam and silty sand overlying a dense sandy silt that was encountered at a depth of 6
feet. Water seeps were encountered at a depth of 11 feet and subsequent groundwater monitoring during
spring breakup indicated a maximum groundwater elevation of 9'— 7" below ground level. Recent
monitoring conducted during the present wet fall season indicates a seasonal high groundwater level at
8'-4" below ground level. Due to the absence of groundwater at the interface we believe that the
AIL soil encountered below 6.0 feet is not impermeable and will pere at a rate of <120 minutes per
inch. Nevertheless, we have designed the proposed residual disposal trench such that the bottom
of the sewer gravel will be no deeper than 4.0 feet below ground level on the uphill side of the
drainfield. To enhance the longevity of the system we propose to over excavate the drainfield to a
depth of 5.0 feet and then place 1.0 feet of MOA filter sand under the sewer gravel.
The measured percolation rate of the native silty sand material underlying the proposed
drainfield is 9 minutes per inch, which according to the wastewater code can accept effluent from a
Category II Advanced treatment system at 3.0 gpd/sq. ft. This 3 -bedroom residence thus requires an
effective absorption area of (3 x 150)/3 = 150 square feet. The proposed 38 -foot long by 5 -foot wide
soil absorption drainfield is conservatively sized with a basal area of 190 square feet. We also propose
to place 12 inches of sewer gravel under the distribution pipe to allow for additional sidewall absorption
equivalent to an additional 38 square feet of area.
Because this is an advanced treatment system I am requesting the property owner to come in to
your office in order to execute the required maintenance agreement. Since I will be out of town for a
couple of weeks, please send me an e-mail if you have any questions on this submittal.
I trust this resubmittal will satisfactorily resolve any lingering concerns you may have with
regard to the suitability of the proposed design. If not, please send me another e-mail and I will
endeavor to accommodate your further concerns. I hope that your office recognizes that the
proposed residual drainfield design exceeds the minimum code requirements in a number of
respects, which has been done in order to enhance the longevity and performance of the system.
Sincerely,
99
Ted Moore, P.E.
cc: Mike Ronchetti; (ph: 350-2529)
SEPTIC
° SYSTEM
°
LOT 2, BLOCK i
, 1h
•
-w ---I
••.
%44
/-� _sVDE
ABANDON EXISTING / y
SEPTIC TANK AND
TRENCH PER CODE
LOT 6
BLOCK 1
SEPTIC
AREA '
LOT 1
BLOCK 2
R1
VWELL
HOUSE
SEPTIC
' AREA
LOT 2
BLOCK 1
�\ EXISTING WELL >200'FROM
\ PROPOSED UPGRADE SEPTIC
\ ,
100' OFFSET F_RO_M_ _ \
CREEK AS PLATTED \ LOT 1
35% T.H. BLK.1
INSTALL 1500 -GA LL ON 10%
STEEL"ADVANTEX" AVG
TREATMENT TANK _
INSTALL"ORENCO _
AX_ -20" FILTER POD"
_ ROX.9 01'. POP' 6N�PY�
CREEICFOL�O'NS PPP LOT 8, BLOCK 2
EXISTING WELL >200'FROM
PROPOSED UPGRADE SEPTIC
Gr A4
� .rrti�y. • • �: ^0
FY:'nr9Tr1C`� ter,
-.THEODORE F. MOORE
5509
r_ r_ _ .inti
,—A
§ \ \
CONSTRUCT 38 -FOOT LONG
. x 5 -FOOT WIDE SOIL ABS DRAIN D
w.1.0' SAND & 1.0' GRAVEL
BELOW DISTRIBUTION PIPE
------------------------
NO CUT BANK AT STREAM
CONSTRUCT DRAINAGE SWALE SUCH
THAT SHORTEST SURFACE FLOW PATH
FROM DRAINFIELD TO CREEK IS > 100'
PORTION SECTION 34, T12N, R3W
NO WELL AND SEPTIC RECORDS ON MUNI DATABASE
EXISTING WELL IS >200 FEET FROM PROP. SEPTIC UPGRADE
LOT 1, BLOCK 2, PARK HILLS SID #1
SEPTIC SYSTEM UPGRADE
SITE PLAN
FLATTOP TECI INICAL SERVICES I'1 INCH = 50 FEET
14530 ECI IO CANYON ROAD DRAWN BY TFM
ANCHORAGE, ALASKA 99516 1 REV. NOV. 2007
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
4• WASTE LINE
FROM EXISTING
FOUNDATION C.O.
14
INSTALL"ORENCO"
"AX -20" FILTER POD
1463
MONITOR
ORIGINAL
INSTALL 1500 -GALLON EPDXY-COATED
STEEL "ADVANTEX" TREATMENT TANK
3" PVC OR 4" D-3034
DISCHARGE LINE
FROM FLOW SPLITTER
38
PLAN VIEW
SCALE: 1" = 10'
10Y. AVERAGE SLOPE
FILTER FABRIC
4" DIA. F-810
1/2"- 2 1/2" SEWER GVL. _
(1.0' BELOW INV.)
1.0' MOA FILTER SAND -
BOTTOM OF EXCAVATION
-41..A.,
C.O.
OR TUBE
TION PIPE 5
CONSTRUCT 38 -FOOT LONG x 5' WIDE
RESIDUAL DISPOSAL DRAINFIELD w.
1.0' FILTER SAND 8 1.0' SEWER GRAVEL
BELOW DISTRIBUTION PIPE. TOP OF
SAND SHALL BE AT 4.0' BELOW GROUND
LEVEL ON UPHILL SIDE OF DRAINFIELD
3
CROSS-SECTION "A - All
•'
SCALE: 1" = 5'
A' 40 .- 4''••;.f' C
th
'�- •�' �
�•
LOT 1, BLOCK 2, PARK IIILLS S/D #1
SEPTIC SYSTEM UPGRADE
I.'
I . TRSCDC": F A•OCIOR�CRI
PLAN AND CROSS-SECTION
`; /�?T�!'
FLATTOP TECIIN[CAL SERVICES SCALE: AS SIIONN
�•
, ' .':;-..•. •r7, `;Q'
14530 ECI IO CANYON ROAD DRAWN BY: TFM
ANCIIORAGE, AK, 99516 i NOVEMBER, 2007
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
TEST HOLE # 1 I SOILS LOG — PERCOLATION TEST
LEGAL DESCRIPTION:__ Lotl. Block 2, Park Hills S/D _#
DATE PERFORMED: __ _May 9, 2003 (Updated Nov. 2007),_
Mike Ronchetti......
__.
GM (fill material)
Pt.
SM Reddish sandy loam
SM Gray silty sand
Dry, loose, fine
SLOPE _ /EX17STlN1,G
SITE PLAN
DVBDRM
i HOUSE 34
<%DECK—�1° #1 33
YSTEM %` l r
j 0%
ML Gray gravelly sandy silt o !
Dense, hard digging I 120/o
Sidewalls do not smear
Depth to Groundwater
Date
Water seeps-__ -
Seeps @ 11.0'
`_5/9/03
C Water9'-.7” 15/16/03 __-
f Water �Sa 9' - 9" SLOPE
520/03
'Water@8'-1'-
Time
(minutes)
l Reading
B.H. ----
i
L_519�_12"Presoak ----•------�_._
i
Date Reading
0%
Net Time
Percometer I
Net Drop
p
i
i
Date Reading
Clock
Net Time
Percometer I
Net Drop
p
Time
(minutes)
l Reading
(inches)
L_519�_12"Presoak ----•------�_._
1.12" resoak __—
_
._27.1)2_--
27 1/2
I Add water S start
12:17:20
23 3l8
} Add water. -
—1_ ----
_124720
-__12:47:45.:
I 30 ___�-195/8„-
_
_
L
_33/4
#2_,_____,__1;17:45,_
30
.233/8
_1911/16.,.
311/16
Add water
1;1815
j 239/16
.i
I
30
r - 1915/16 }
_3518 _..�
PERCOLATION RATE _ _g (minutestiinch) PERC HOLE DIAMETER
TEST RUN BETWEEN —5.5_.F'T AND --6.0 __Fr
COMMENTS: -.Advanced treatment soil absorption system should be sized at 3.0 gpd/sq. ft. (minimum). _-
PERFORMED BY FLATTOP TECHNICAL SERVICES. 1 _ 1Z� CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
; - - ---- --- ------
TEST HOLE # la
�4 =�•i t. Yl
FLATTOP TECHNICAL SERVICES
14530 ECHO ST. R' +; • .•' �.?�
ANCHORAGE, ALASKA 99516 Z. •r'',,.' Soy 0
SOILS LOG - PERCOLATION TEST •••................
•••••••tw•••••1
LEGAL DESCRIPTION:__ _Lot 1, Block 2, Park Hills SID _-M)____.___. _
DATE PERFORMED: _May 9, 2003 (Updated Nov., 2007) ..
PERFORMED FOR: ----..-.Mike Ronchettl
GM (fill material)
Pt.
SM Reddish sandy loam
SM Gray silty sand
Dry, loose, fine
SLOPE
•. THEOJO?: F. A:OORE � A
CE -3569 ' 4
e� 4
� �A "-• Ste.
SITE PLAN
/EX17STINIG
DRIVE-BDRM
HOUSE
34DECK -T.H`� / 33
SYSTEM ` IAF
I
ML Gray gravelly sandy silt / 20% i
Dense, hard digging i
Sidewalls do not smear
Depth to Groundwater Date '
Water seeps
�eps @ 11.0' -j
Se_519/03
Waterna 9'-7 5/16/03 _SLOPE
Water PPaaSs 9'-9” 5/20/03
f Water@8'_4"-_11/8/07
r- --.
B.H. - -- - --- - ------ i
0%
I
I
Date
Reading
Clock
Net Time
Percwmeter l
Net Drop
'
I
•. THEOJO?: F. A:OORE � A
CE -3569 ' 4
e� 4
� �A "-• Ste.
SITE PLAN
/EX17STINIG
DRIVE-BDRM
HOUSE
34DECK -T.H`� / 33
SYSTEM ` IAF
I
ML Gray gravelly sandy silt / 20% i
Dense, hard digging i
Sidewalls do not smear
Depth to Groundwater Date '
Water seeps
�eps @ 11.0' -j
Se_519/03
Waterna 9'-7 5/16/03 _SLOPE
Water PPaaSs 9'-9” 5/20/03
f Water@8'_4"-_11/8/07
r- --.
B.H. - -- - --- - ------ i
0%
I
I
Date
Reading
Clock
Net Time
Percwmeter l
Net Drop
Time
(minutes)
Reading I
(inches)
5/9=?
-12 .Presoak _
__
31 ._
1 !
12
31
I
( !
Add
Add water & start-
--112:0410_ _
27 -
-
-._..__#1__-
._ 121410-1-
10 _._.
__.211/4 I
—
. Add water___
..__12:15:45
- _ ._ _ - ;
27
..53/4
-
#2
-- 12:25:45 ,
10_21
3/8
Add water
_; --12:26:15 _ _
_.
(
_..-#3
123615 --_
10 ._.
_217116
-_59/16 _
r
h
PERCOLATION RATE 2 (minuteslinch) PERC HOLE DIAMETER-&'-
TEST
IAMETER&'TEST RUN BETWEEN__ 3.0 -„_ FTAND___3.5 .. , FT
COMMENTS:.- 2nd pert test conducted adjacent to same test hole to determine percolation rate of upper SM stratum... .
PERFORMED BY FLATTOP TECHNICAL SERVICES. I T�_ %'1�[G.c� - CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: I r / �,�_ / v 7 _ -
tEYattop ?echnicarservices
14530 Echo Street, Anchorage, AX 99516
(Phone (907) 345-13S5
Lot 1, Block 2, Park hills S/D #1
14621 Park Hills Drive
Wastewater disposal system upgrade
Specifications
1.0 General:
1.1 The scope of the project consists of installing an "Advantex" advanced treatment system
using a 1500 -gallon epoxy -coated steel Anchorage tank with a single AX -20 Advantex treatment pod.
The filtered effluent is discharged into a 38 -foot long by 5 -foot wide residual absorption drainfield with
12 inches of filter sand and 12 inches of server gravel below the distribution pipe.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform to Municipal and State
requirements. All separation distances shall be in conformance with Municipal requirements, unless
specifically waived. A waiver has been requested allowing the wastewater system components to be as
close as 60 feet from surface water in the creek along the south boundary of the lot.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work
around any buried utilities.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved ailer settlement and that there are no residual
depressions. insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading
after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the
construction.
2.0 "Advantex" AX -20 Advanced Treatment System:
2.1 The "Advantex" treatment unit major components include (1) a 1500 -gallon, 2 -compartment
epoxy -coated steel tank and (2) a single AX -20 filter pod. All components shall be Municipally
approved and shall be set level on undisturbed soil and backfilled in accordance with Municipal
requirements as well as Orenco's and the supplier's instructions.
2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings.
The waste line from the residence to the tank shall have a minimum slope of 1/4"' per foot, and the
waste line between the splitter valve and the drainfield shall have a minimum slope of 1/8" per foot.
2.3 The contractor shall be responsible to obtain the necessary Municipal electric permit and
inspection, and shall provide a copy of the electrical inspector's report to the engineer overseeing the
construction of the wastewater disposal system.
2.4 The second compartment of the tank shall be equipped with a watertight, insulated manhole
riser and cover extending a minimum of 6" above final grade with positive surface drainage away from
the manhole. The contractor shall be responsible for determining the necessary length of the manhole
riser, and for properly positioning the Recirculating Splitter Valve (RSV) in the riser.
2.5 The control and alarm floats shall be set at the elevations specified by the supplier, and their
proper operations shall be verified by the contractor.
2.6 The treatment unit shall be set up with a "VeriComm" remote monitoring system as supplied
by the distributor, and the control panel for the unit shall be mounted at an approved location.
3.0 Residual soil absorption system:
3.1 The soil absorption system shall be constructed by excavating a 38 -foot long drainfield to a
depth of no more than 5.0 feet below ground level. The long axis of the drainfield shall be parallel to a
natural contour of the ground and the downhill side of the drainfield shall be no closer than 60 feet
front the north side of the creek.
3.2 The bottom of the excavation shall be level. A total of 1.0 feet of M.O.A. filter sand (<4%
passing the #100 sieve) and 1.5 feet of sewer gravel shall be placed in the trench excavation with the
perforated distribution pipe laid level such that the pipe invert is 12 inches above the bottom of the
sewer gravel. Sewer gravel shall be 0.5" - 2.5" washed gravel. The distribution pipe shall be 4"
diameter f-810 perforated pipe.
3.3 The monitor tube shall be of 4" diameter and installed in the location shown on the design
drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated.
3.4 Approved filter fabric shall be placed over the entire top surface of the sewer gravel.
3.5 The top surface of the cover material shall be raised a minimum of 6 inches higher than the
surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1, and shall be extended out until they intersect natural ground.
3.6 The contractor shall create a shallow drainage srvale parallel to the creek on the down/ill!
side of the drainfield such that the shortest surface flow path bethveen the tank or drainfield and the
creek is greater than 100 feet it: length.
3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to
have the site finish graded after the backfill material has stabilized, and for placement of adequate
topsoil and seeding to promote rapid revegetation of all areas disturbed by the construction.
4.0 Inspections:
4.1 A minimum of 5 engineering inspections will be required during the course of the project:
(1) initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the
infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test
information, (3) after the sand filter material has been placed, (4) after the sewer gravel is in place and
the distribution pipe has been laid and connected up to the septic tank, but prior to placement of filter
fabric, and (5) after rough backfill and grading is complete. The "Advantex" treatment unit requires one
inspection after the tank is set level and the piping connected, but prior to backfill. This inspection may
be incorporated with any of the above inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far
in advance to ensure the availability of the engineer.
MUNICIPALITY OF ANCHORAGE
DEPARTNII~NT OF HEALTH & ENVIRONMENTAL PROTE~CTiON
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl INSPECTION RI:PORT
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
' · DROOMS
2z DISTANCE TO: Well IO~ ~ ~O~
~ Manufacturer
No, of compartments
~ ~ ~ Materi~ .~
~ Liq. capacity in gallons
~00~ IF HOMEMADE: Inside length Width Liquid dept~
~ ~ DISTANCE TO: Well Dwelling
~ PERMIT NO,
O ~ ~ Manufacturer
Material Liquid capacity in gaNons
~ Well Foundation Nearest lot line PERMIT NO,
No, of lines ~ Length ~ ~ch fine Total length of lines Trench Distance between Pines
Top of tile to finish grade~_I ~/ ~-~ Material beneath tile Total effective absorpt;on area
Length Width
~ Depth PERMIT NO.
~ N Type of crib Crib diameter
~ ~ Crib depth Total effective absorption area
~ Well
DISTANCE TO: Building foundation Nearest lot line
~ Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS ~ ~
SOIL TEST RATING
INSTALLER
REMARKS ~
/
/
APPROVED
DATE LEGAL
72-013 (Rev, 3/78)
BOX ~69, STAR I~OUT~ .~ -~(~ItORA(~E~ ALASKA
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF
DRILLED at the rATE OF :~9~, 00, PEr FOOT.
PROPERTY OWNEr
LOCATION OF WELL SITB
WELL LOG:
0 .... 22' S~.,. q~.~eZ.
777
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLF_'fION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING works for THE SUM Of '~9'~9~00
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART DRILLING WORKS
SERVICE CHARGE OF 1~,% PER MONTH WILL Be ASSESSED O~' b~
F'ERHI T N0.
FtF'F'L I CRN'F
LOCRT 1 ON
LEGAL
STEVE F'IZR
LIB.'-:' F'RRK HILLS
SRR 4 .... --", ANCHORAGE :~L4.5E~7 ~,~.~_ =-
LOT SIZE 999999 S6!URRE FEET
TVF'E OF SOIL RE=SORF'TION S'¢STEM IS: TRERC:FI
MRF-',"IMUN NUMBER OF BEE:,ROOM'-] = :: SOIL RATING (SL.] FT,. E,F..',= ±90
THE REL-]LIRED SIZE OF ]'FIE SOIL ABSORPTION SVSTEM IS:
THE LENGTH [.',IMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR [:'RRINFIEL[:,.
THE [:'EPTH OF R TRENCH CF.' PIT IS THE [:'ISTRNCE BETHEEN THE SURFACE OF THE
GF.'3JND AND THE BOTTOM OF THE EXRR\,'FJTIF~N (IN FEET).
THERE IS NO SET 1.4I[:,TH FOR TF. ENCHES.
THE GRR\,'EL DEPTH IS THE MINIMUM [:,EPTH OF GRA\,'EL BETWEEN THE OUTFRLL PIPE
RND THE BOTTAM OF THE E,.,bR,HTI_N (IN FEET).
PERMIT APPLICANT HAS THE RESPONSIE:ILiTV TO INFORM THIS DEPARTMENT DURING THE
INSTALLA'rION IN=,FE_.TIuNb OF FINV HELLS R[:,JACENT TO THIS PROF'ERTV AN[:, THE
NUME,'ER OF RESIDENCES THAT THE HELL [,.IILL SERVE.
TI.--tC~ ':: '---:---: ::' :[ i%~SF'EC:T :[ C~ [%1___'-: RF-:E E:E L--:.~L~ Z
BR~]:KFILLING OF RN'¢ SVS]'EM HITHOUT FINAL INSF'ECTIOH RN[:, ~F'P~'A',,~
........ ',, ,~- THIS
[:'EF'RRTMENT 1.4ILL BE SUBJECT TO PROSECUTION.
PIINIMUM [-"ISTRNCE BETHEEH R HELL RN[:, RHV ON-SITE SEHRGE [.',ISF'C,_=;RL S'¢STEM IS
±E~O FEET FCA R PRIVRTE HELL OF.: ±5F~ TO 200 FEET FROM R PUBLIC HELL [:'EPEN[:,ING
UPON THE TVF'E OF PUBLIC HELL
MINIMUH [:,ISTRNCE FRJM R F'RIVRTE [4ELL TO R PRIVATE SEWER LINE IS ':'=; FEET AHD
TO R COMMLINIT'¢ SE[4ER LINE IS 75 FEET. ' ....
1.4ELL LOGS RRE RE6!UIRE[:, RN[:, MUST BE RETLRNE[:, TO THE [:'EPRF.'.TMENT HITHIN _--.':A
OF THE [4ELL COMPLETIOH. -
OTHER RE-c,~UIREMENTS MRV RPPL'¢. SPECIFICATIONS RN[:, F:FIHC;TF.'UCTION [:'IAGF.:RMS ARE
RVRILRE:LE TO INSURE FR_FER IHSTALLRTION.
PEE:~'.'i I -f' E.--.F Z [;:-:ES [:'EC:EI"JBEF:.- _-----:dl _. -']
I CERTIFV THRT
±: i RH FAMILIAR [4ITH THE REEqUIF'.EI"JENTS FOR OH-SITE SEHERS RN[:, [4ELLS RS SET
FORTH B'¢ THE FIUNIF:IF'ALITV OF ANCHORAGE.
.2- I HILL INSTALL THE '--"~
-,~:,TEM IN RCCOF.'.[:'RNCE ~,.IITH THE CEE)ES.
3: I UN[:,ERSTRND THRT THE ON-SITE SE~4ER SVSTEM MR'¢ REE.!UIRE ENLARGEMENT IF THE
F.'.ESI[.',ENCE IS REMO[:,ELE[:, TO INCLUDE MORE THAN 2'. BE[:,F.!OOML-~.
\,'4. 0
Ar( Civil and. Geotechnical Engineering Consu' ts
A.W. Murfitt Compa__ny_
8010 King St. ~:~$<~(~)~i~ · Anchorage, Alaska 99502
Telephone 349-7531/7533
Iqarch 3, 1983
Arctic Resodrces Drilling, Inc.
6361Nielson Way, Suite 101
Anchorage, Alaska 99502
Attention: Ray Morris
Vice President
Re: Borehole location error regarding lots 1 and 2, Block 2,
Park Hills Subdivision,
~ncI~orage, aska.
Dear Ray,
On Hatch 31 1983, while walking Lot 1 of the above .,~=~ ~ ~
division, /.ir. ~ceve Pisa showed me two PVC standpipes installed in
a previously drilled test hole and percolation test hole at iJ]is ..}{e.
Sc=~e s concern was that the test hole was actually Test Hole 7A
on c~,_ plat to be located on Lot 2 of this subdivision and that he
might not need to re-drill the site and perform percolation tests.
After 1 ~ ''
o:ac;ng [he approximate lot lines for Lots 1,2, and 3, I walked
Lot 2 in an aa.,,:mpc to ocace any previously drilled borehole in the
vicinity of Test F;ole 7A as shown on the plat. I could not find any
borehole or ~:VC ~'~'~n~,i ~ =
drilled =~ ..... " ....p pe for this t~s, hole on Lot 2. As the previously
~.,:s~ ,o~es w:~re drilled prior to road c ~ '
on the la~,d, I ..... ~ onscruct]on and improvements
. ,~1 ~,,a~ an e~'~'or :T~a3., ?~ve ]~:en made in the original
location of =~'
L;]iS test ;o]e.
Upon locating thc
and 2, I feel that Test note FA is ~c~oally ocated on lot 1 of this
subm]N]s]on. The approximate location of Test Hole 7A is shown on the
attached Plate 1.
Test Hole 7A was drilled on 3-23-82 and a percolation test was performed
on 3-30-82 by "others" (per attached Municipality of Anchorage Soils
log and Percolation Test). I measured the depth of the perforated
4--inch diameter PVC casing -For the percolation test and found it to be
approximately 76-inches in depth with a 6 3/4 inch stick-up above
§round as indicated on the soils log. I, also, measured the depth of
the I 1/2 inch diameter PVC slotted casing installed in the test hole
and found the depth to be 14.5 feet, however, the probe indicated that
the PVC has "silted in" and that the actual installed depth cannot
A~ctic Resources Drilling, Inc.
March 3, 1983
be determined.
It is my opinion that the location of Test ltole 7A as indicated on the
plat is incorrect and should be as indicated on the attached Plate 1.
I, also, feel that the borehole soils log and percolation test results
performed in Test Hole 7A should satisify the requirements of the
Municipality of Anchorage, Department of Health and El~viror~mental
Protection For lot 1 of this site.
Should you have any questions regarding this matter, olease do not
esltabe to CO~ltact us.
Yours truly,
A. W. l,iLIRFIl-i' COMPANY
,Mffrey hi. Aires
S,_:nior Engineering Geologist
JMA/dt
0
£/
PERFORMED FOR:..
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
\'~MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 2644720
SOILS LOG-- PERCOLATION TEST
SLOPE
[] .~ SOILS LOG
[] PERCOLATION
TEST
_ DATE PERFORMED:__3 o ~. ~ ~.
SITE PLAN
11
12
13
14
15
16
17
18
19
20.--
OMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
.DEPTH?
Reading Date
I
PERCOLATION RATE~
Time
0
S
Net
Time
O
I:o&
Depth to
Water
(mlnutes/~nchJ
TEST RUN BETWEEN .~"'/4~- FT AND ,J~'"'~/4 FT
Net
Drop
ERFORMED BY:
.CERTIFIED BY:
DATE:__.
?-o0a (6/79j ~ ~
i4£' 84
• Municipality of Anchorage
!�.
On -Site Water and Wastewater Program 4
(907) 3`1'3-- 904 $ A E T Y -
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel i. D. , Of 7- 1Y 2- I y
Expiration Date:
1.
GENERAL INFORMATION
Complete legal description a t 1y
Q /ac
2 P""4, k lflllr #*i
Location (site address) + Y 6 2 f
Pcr r 4 l4
i ILr
,Current Property owner(s) M t' 1
Ran c ti f.t r Day phone 3 Z
Mailing address 146 2/
Pcirtc 1t111.r
D. ice¢ Ac!,: A- k- 9,?,!; -1,!r
Real Estate Agent (� r S M r ch a e e)
P eLt offn ii4 Day phone 76 Z - 58 3 2 .
230 - sr7 7
2.'
TYPE OF DWELLING:
Pl pcv[ cal it or 2 —.n ca, l Rea /fir
® Single Family (wltivo ADO)
bJ m Lo Gr l et r• kc+ , n of whin
El Duplex
❑ Multiple Dwellings (Single Family and/or Duplex) Cis p
3.
NUMBER OF BEDROOMS:
3
4,
TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank ❑
Community Class Well
❑
Community ❑
Public Water System
❑
Public Sewer ❑
Received by: aA, All f (,I(v W Date: l'
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSH Fee $ `t q ` Waiver Fee $
Date of Payment l `/3 Date of Payment
Receipt NumberQf`j �JrS� Receipt Number
COSA# ez3//s7/Waiver
S. 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,
~zbased :on procedures outiided 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 flies and from my investigation and inspection, the onsfte water
supply and/or wastewater disposal system ls(aro) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Fro 1= fcd �&w Tc cG, n i ca/ S e rvr� v Phone . 3 Ns- I � ss
Address- /119 -:rep Cr -4o 4e?,iA ., A- C6
Engineer's Printed Name /f r rc a Date
.. .. A `.. (:.
s DSD SIGNATURE ERIN,
System 01 Approved for bedrooms. �fc2 17
ham,
System #2 Approved for bedrooms. q E 1K y
Disapproved.
Conditional approval for bedrooms, with the following stipulations
Uk an, 16'_
By: l—' Original Certiffcate.Date:—
The' unid li o 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 dvii engineer registered in the State of Alaska. The
Municipality of Anchorage Is not responsible for errors or omissions In the professional eng'ineer's work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other
r=:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material _ %(yri et n f -e x / S %r e l Date installed 17- m0
Tank size "t . gal. Number of Compartments 2. Cleanouts (Y/N) Y
Foundation cleanout (YIN) Y Depression over tank (Y/N) . N High water alarm (Y/N) Y
Date of pumping 1nrp 6//►/t2 Pumper A{- /FKeha��. qnk
C. ABSORPTION FIELD DATA
Date installed I a/S/ G7 Soil rating (g.p.d./ft2 or fe bdrm)3� System type 4" urda
'�j• i
Length 340' ft. Width ft: Gravel below pipe 0.7 it
Total depth 3. Y ft. Eff. absorption area ► O fe .Monitoring tube Y Depression over field m
Date of adequacy test H /&/ 20,13 Results (Pass/Fail) Pods✓ For _ bedrooms
fluid depth in absorption field before test O in. Water added -7 _-27 gal. New depth__S in.
Elapsed Time: _SQ_ min. Final fluid depth _ 0 in. Absorption rate >= '/s G g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N R type) IJ If yes, give date N • A
If more than 1 septic system is on the lot:
COSA CheGdist # . of
Structure served by this system
Certificate of On -Site Systems
Approval Checklist
Legal Description: _Lo f l-, 0 /ac k 2 Pee e, 4 #) I If
#/ Parcel ID: O 17. — J y 2— I y
A. WELL DATA
Well type P If A. B, or C provide PWSID # —
Well Log (Y/N) Y
Date completed 3127 Ag Sanitary seal (Y/N) Y
Wires property protected (Y/N) `f .
Total depth J ► 7 ft. Casedao l�fL.
Casing height (above ground) 33 in.
FROM WELL LOG
AT INSPECTION
Date of test 3 / 2 > / 83
y / 8 / 20 r_3
Static water level 57 fl
15-3 ft
Well production `/ 9 -P.M.
1.,�
WATER SAMPLE RESULTS:
Coliform :., O oolonlesll00 mL Nitrate 4 0. ! mg/L
Arsenic 4 6- .ug/L Date of sample: Y W I.2-6 3
Colleded by f= let iii` AcY7 Tech -C-e
r=:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material _ %(yri et n f -e x / S %r e l Date installed 17- m0
Tank size "t . gal. Number of Compartments 2. Cleanouts (Y/N) Y
Foundation cleanout (YIN) Y Depression over tank (Y/N) . N High water alarm (Y/N) Y
Date of pumping 1nrp 6//►/t2 Pumper A{- /FKeha��. qnk
C. ABSORPTION FIELD DATA
Date installed I a/S/ G7 Soil rating (g.p.d./ft2 or fe bdrm)3� System type 4" urda
'�j• i
Length 340' ft. Width ft: Gravel below pipe 0.7 it
Total depth 3. Y ft. Eff. absorption area ► O fe .Monitoring tube Y Depression over field m
Date of adequacy test H /&/ 20,13 Results (Pass/Fail) Pods✓ For _ bedrooms
fluid depth in absorption field before test O in. Water added -7 _-27 gal. New depth__S in.
Elapsed Time: _SQ_ min. Final fluid depth _ 0 in. Absorption rate >= '/s G g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N R type) IJ If yes, give date N • A
D. LIFT STATION M. A.
Date installed
"Pump ore level at in.
Datum
Size in gallons 4AantiolelAcoess (Y/i q -__ _
'Pump ofr level at in. High water alarm level at in.
Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tankllift station on lot 105" On adjacent lots >
Absorption field on lot ! 16 On adjacent lots > 14V41=1
Public sewer main N. A. Public sewer manhole/cleanout N• A,
Sewer /septic service line > 2-S" Holding tank N • A,
;Animal Containment areas Manure/animal excrete storage areas A��a�> t `
SEPTICIHOLDING TANK ON LOT TO:
Building: foundation 16" ''Property line —e 0,p Absorption field !o't
Water main N. A. Water service tine 10 '. Surface water 6 S
Wells on adjacent lots> to0
ABSORPTIONFIELD.ONLOT TO: -
Property line SS Building foundation 20 Water main IV • A,
Water Service line 1O ' Surface water 60 r ' Ddveway, paridngivehide storage > 30 '
Curtain drain No Ae Sean_ Wells on adjacent lots>
F. COMMENTS
SK/ �Gae` G(/4M SWoteahon a 4.fk4nler -at O7Oa6�
ISSu�o� fl/26/2G07
G. ENGINEER'S CERTIFICATION
I Certify that i have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name E. Mae -
Date 'i/ / 245�' / 2.0 1 2
COSA brown sheeL10-10-12.doc
THECVORE F. AK?Oke .°
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—' 25' MAIN. & DRNG ESMT $
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UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE ONES.
THE SURVEYOR TAKES RESPONSIBWTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LOT SMEY SURVEY TYPE
SYMBOLS
FOUNDATION AS -&Air
• SET REBARDRAINAGE ASPHALT
❑ FAIAL STRUCTURE AS -BUILT
o FOUND REBAR 'a::..: CONCRETE
❑ PLOT PUN ... o CORNERS SET n T ... LOT s MER ... TON AS- UL
9--9 a WOOD FENCE
E3 ASSUMED ELEV. -K--ii—* METAL FENCE ® WOW DECK
PLOT PLANS & LOT SURVEYS
NOTE:
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLEWILL BE
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS. SIDEWALKS, DRIVEWAYS,
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO OETERMINE
ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURVEY CERTIFICATION
s "R�
Prepared by
Robert E. Johns, Jr. & Assoc.
PLOT PLAIT
Ines, x111 A`Wel+..-Npw,...,r
Ir enw rr r'r Irq a.1 uM I
.•�-'""' �j
Professional Land Surveyors
Ave Iun/ r rWrr r M M Y alar•
-`.•+*E
%m.
�'
♦
1700 Brink Drive.
ANCHORAGE, ALASKA 99504
r.r r ranita. na.a OIr
�w
�' Lot S.F.
Ree. Plat Flle No.
w
� • -- �,
1 - �
1" = 50'
FOUNDATION AS-BUA.T
�•••• •• '�
•• • '''
Date Surveyed: 04/21/13
Draws by RE J
Checked b�
MK
Aarl L AraA+. aa+r +Ih rn
Ave yrlrarl r, AriA1 ..»
ArtleYl w tlr A% N we A eve
• •••••• •••• ••• •••�•••
ewirn N Ylrwallr � erw Ira.'•
- r
Q E. S. JR. '
I' p ;+✓ o
Date Orara:
04/22/13
0"d:
3037
W.0
13-139
FINAL STRUCTURE AS -BUILT
�i ; f. �: ,a�'�
�. A'^ •-,
Legal Description:
L Aryl c AVM r. Arry ami, ur I
�r"�.. w' aw"'°rin.e• uv« «•
�,.� yea♦1
If eo p 4y• a
Lot 1 BLOCK 2
e.rera r wa.alalr s cave nine.,
`ac ♦a
� iota ion d
ion
PARK HILLS #1
Nunn ■ ■N■ on n■ ■ lWEER ■ r ■rrN r
•�: r iri rrrsonB0 Boom man rr robin ■ i
FAA.avanTeic® Fhdd Malnteeawn Beport
Annual Inspection 4nahorageTank &Welding, Inc.
907-272-3543
Michael Rant h tti Reba= Copeland Mike
unnearea.
Mike Blakeslee
14621 Park Hills drive Angio"
rage AK 99516
LN ise o e (9D7) 345,7852
Feeley lee roes RN Ma.e
AX -115057 a.. er u t m.wLiu
&5
SW070313 211073 RT 111916 06/78/2071
Retrieve O&M Info
Daly naw
Redno Nada
Tlmar ealtlrr( ,
Perform Fkdd Sampling/06servi lens
oaar m
7Yp� Musty ourthy ❑tlmdy
Nan-byplael ❑SuMWe ❑Cabbage ❑DOI
ally fmn In Pvu ❑ Vee No
Feta In tw* ❑ Yea Nc
Chock Central Panel
R01M AWW Dladrerge A npa
!�)l J,
Audible and Wmal alArrns oK
nisi eons (telemetry only) []NO
Inapeat/dean Pump Sysiem
Rlaar/Lld
f
Y� e ✓
oaar m
7Yp� Musty ourthy ❑tlmdy
Nan-byplael ❑SuMWe ❑Cabbage ❑DOI
ally fmn In Pvu ❑ Vee No
Feta In tw* ❑ Yea Nc
Chock Central Panel
R01M AWW Dladrerge A npa
!�)l J,
Audible and Wmal alArrns oK
nisi eons (telemetry only) []NO
Inapeat/dean Pump Sysiem
Rlaar/Lld
Inspect
.....................
Spice Box ....................
Float Cods ...................J
FbWs........................
Pump ........................
Bkdubea Firer .................
%Xuba Pump vault ............
Redmulagng Speller %tabs.......
Comments
Measure Sludge/scam
Conrpadmem
Baan
Prerlous Cunem Prevfoua
2nd ComparonartICurnprK ..Previarc Curram
InaPaet/Grran Advan%x Piker
Oder, c Normal ❑ P' n.nt
eforna4 RN'o�m�al ❑Emasom
CX
Bridahw%ndlna: K.yrrMG&I. ❑Excessin
l"SPeaNfYean Discharge Pump System
Inspect
Rlesrh.ld ❑
solice Box ❑
Flcae awds ❑
MAINZ t ehlon
rwaft ❑ ❑
Pump ❑ ❑
Inspect/Service ower System Camponente
Inspect Clean Inspect Clean
D110nfaa6an rMulpmant ❑ ❑ Dlspersai LBterelai'Otiaaes ❑ 0
Addluanaisarviess Rendered
❑ Cleaned WXft cheate7 ❑ Replaced W neme7
❑ ReplacedAJaed od. Rema?
Paha Used: W = Warrm* a . BlBable (✓ appropriate selseftn)
W B INet Number DeeeWeea.
FinaU8a/agr lnspentlon /✓f
Xm retrlstaied
oasaI reconnected; Rush wives ak.5d
Sumr�n'IMrOdcommsndstions
' Syelsm Performing; no furtlrer sedan heodea
l❑ Call rho service
Fax completed form to 1-8$6-584�7404
RrYI 4,r td i U,-
MWc boNed on /y
WoMml panel ncaatNatad
❑Tank needs pumpinp
❑ othet?
i
r
MAINZ t ehlon
rwaft ❑ ❑
Pump ❑ ❑
Inspect/Service ower System Camponente
Inspect Clean Inspect Clean
D110nfaa6an rMulpmant ❑ ❑ Dlspersai LBterelai'Otiaaes ❑ 0
Addluanaisarviess Rendered
❑ Cleaned WXft cheate7 ❑ Replaced W neme7
❑ ReplacedAJaed od. Rema?
Paha Used: W = Warrm* a . BlBable (✓ appropriate selseftn)
W B INet Number DeeeWeea.
FinaU8a/agr lnspentlon /✓f
Xm retrlstaied
oasaI reconnected; Rush wives ak.5d
Sumr�n'IMrOdcommsndstions
' Syelsm Performing; no furtlrer sedan heodea
l❑ Call rho service
Fax completed form to 1-8$6-584�7404
RrYI 4,r td i U,-
MWc boNed on /y
WoMml panel ncaatNatad
❑Tank needs pumpinp
❑ othet?
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN MUNICIPAJJTY OF CHORAGE
AND4LK & tikvF�.G� Piv r,dnn�
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
Ai Day of Mq�r of 20.3 by and between AAL6d1 d' Wf 11
r
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Wastewater
Treatment System (AWWTS), described as �/ fp X located
at Nod(, a- I pa', -u4; SlS �, Anchorage, Alaska.
2. Definitions.
A. Alteration. Any change to the design or function of an AW WTS that
Includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design. Prior to
performing any alterations to an AW WTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinafter, "AMC') 15.65.
B. Certificate of On -Site Systems Approval. An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
These approvals certify that the systems are adequate for the homes that
they support and meet the codes that were in place at the time of system
construction.
C. Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
D. Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AW WTS that were included in
the original design which would allow the AWWTS to continue to
perform as designed.
E. Permit (Construction) An On -Site Wastewater Disposal System
Construction Permit as defined by AMC 15.65.
F. Permit (Operating) An Advanced Wastewater Treatment System
Operating Permit. An annual permit, issued by the Municipality, that
allows the Owner to operate an AW WTS, upon meeting all the
requirements of this agreement, the conditions of Operating Permit, the
requirements of the On -Site Wastewater System Construction Permit and
all relevant provisions of AMC 1.5.65 /
3. Fee. Owner shall pay to Municipality an annual fee of 1/
($ � .00), payable on or before the issuance of the operating permit and annually
thereafter. The annual fee is due on or before the anniversary date of the approval by the
Municipality of installed system.
4. Term. The term of this Memorandum of Understanding shall be for the life of the
FAIL, I=
The term begins on the date of approval by the Municipality of the installed system and
shall continue while the AWWTS system is in use or operational or until the property is
sold or title is transferred by owner and a new certificate of On -Site approval is issued to
the new owner or transferee of the property.
5. Alterations. Installation and Removal of Additional Equipment. Owner agrees
not to make any alterations, removal of parts or additions to the AWWTS without a
Construction Permit from the Municipality.
6. Maintenance and Repairs
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AWWTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2)
maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
rules and orders for the AWWTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's AWWTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AWWTS
Operating Permit is:
C. Owner acknowledges that the fine schedule for failing to maintain and repair an
AWWTS are codified in AMC 14.60.
D. Owner agrees that only maintenance, repair personnel certified by the
Municipality will inspect and make any necessary maintenance, repairs or permitted
alterations to the system.
E. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
F. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
G. Owner agrees that the relevant provisions of the standard specification guidebook
for AWWTS is the governing professional guidelines for the construction,
maintenance and repair of the Owner's AWWTS.
7. Nonwaiver. The failure of either party at any time to enforce a provision of this
Memorandum of Understanding shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of Understanding or any part
hereof, or the right of such party thereafter to enforce each and every provision
hereof.
8. Amendment.
A. This Memorandum of Understanding shall only be amended, modified or changed
by a writing, executed by authorized representatives of the parties, with the same
formality of this Memorandum of Understanding was executed and such writing shall
be attached to this Memorandum of Understanding as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this contract, the only authorized representatives of the parties are:
Owner:
Anchorage: Purchasing Officer
H
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of
Understanding shall be brought in the Superior Court for the Third Judicial District of the
State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and
obligations of the parties under this Memorandum of Understanding.
10. Severability. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
O
Date:
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
MUNICIPALITY:
By:
Title:
Date:
) ss.
The forego'instrument was acknowledged before me this 2 day of
20 , by f C fr ®ate
r *F 5?14 5,q v
,IC POR ALASKA
expires: 6112$ • / q
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
/ Fo" 8/
(b) Property owner C/~'rf &-~7'~t,n
Telephone: (home)3'f'5'"~'Y¢~¢' Business
Mailing Address
(c) Lending Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent
Address :~30~ '~J" Z'f..~
Telephone 5""O"~- 7'd',~'_?
(e) Mail the HAA to the following address: (or check here F~, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family [] Number of bedrooms
3. WATER SUPPLY
Individual Well []
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site [] 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.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date showr~ below, I verify that my investigation of [his
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 regulations in effect on the date of this inspection.
Na.me of Firm F('~'/--~¢,/~ ~"¢c4,~¢crj' ~'e~,~ Telephone
Address
Date
6. DHHS APPROVAL
Approved for ~ bedrooms by
Approved ,,~ Disapproved
Terms of Conditional Approval
Conditional
Date_
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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.
72-025 (Rev. 7/88) Back Page 2 of 2
Tom Fink,
Mayor
unicipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
April 10, 1989
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject: Waiver Request for Lot 1 Block 2 Park Hills S/D
Waiver Request ~WR890012, HA890123, PID ~017-142-14
Dear Mr. Moore:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved.
waived distance is 2 feet.
The
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
DJR/ljw~7
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
Well Classification
Well Log Present (Y/N) 'r' Date Completed 3 / 8 ? ¢'~'.~
Total Depth 11'7' Cased to It"t ~ Depth of Grouting N,/J,.
If A, B, C. D.E.C. Approved (Y/N)
Yield
Static Water Level ~-0 '
Casing Height Above Ground ~'"
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot t 0
To Nearest Edge of Absorption Field on LOt
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by 7
Water Sample Test Results
Comments
Pump Set At It ~ /
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
N
; On Adjoining Lots
i a~,' ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date
B. SEPTIC/HOLDING TANK DATA
Datelnstalled.~'/I-~/~9--v Size IO00~,otl No. of Compartments ~-
Standpipes (Y/N) ~ Air-tight Caps (Y/N)
Depression over Tank (Y/N) N
Pumping/Maintenance Contact on File (Y/N) N,At.
Holding Tank High-Water Alarm (Y/N) l~l./'t.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well 149 ~ ~ To Building Foundation
To Property Line ~"O ~ To Disposal Field
To Water Main/Service Line ~ ~5'~
T' Foundation Cleanout (Y/N)
Date Last Pumped lO/Ef//',~'
; for
Temporary Holding Tank Permit (Y/N)
tO'
To Stream, Pond, Lake or Major Drainage Course 7'~ P~rt~ /.JttO' .C~b,:~/,u,..~,,,~ ,/~'~ ~/~/~
Comments ~ cree~ ~emenf ~(o~ ~ ~o~ /o/ /,~ ~wm ~Ae~ ~o ~e/ ~
Page 1 of 2 ~ .
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~-~"/I-~ /~'-~
Width of Field ,~ J
Square Feet of Absortion Area
Depression over Field (Y/N) hi
Results of Last Adequacy Test
~'/g~r~t-1 Type of System Design "'/-'r-¢,~¢~
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well 1¢8' To Property Lin~
To Building Foundation ~ j' To Existing or Abandoned System on
Lot ~0,4-. ; On Adjoining Lots
To Water Main/Service Line .~ ~',5"' To Cutback (if present) -~',~'~
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~.. /~ ~¢~,-~ ~.~/?'~¢..5' . ,/~.~. ~,~'/~,//'
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to a MOA and HAA gAd~ j.b'~!~):~.ffect on the date of t' s
inspection. ~/~"~;,
¢'; ...........................d En ineer'sSeal
Date /¢¢/¢?,/ .~ /)~¢.,) ~.~'/".~,~,,~,-,, ~' 2..-¢'Z¢-~ [J g '
MOA No. ~¢ ,- ~::2.~'~. ¢, , ,,
Receipt No. ~__ __/~'. ~ Receipt No.
Date of Payment ¢'~ ,-,~ ~' ~d~/~' Waiver Fee: $
Amount: $ /2ff~9 ~ ~) Date of Payment LI~
72-026 (Rev. 7/88) Back Page 2 of 2
!
NOTES:
I. I! ~IHAL, L. Im THIr REIPONSJ~II.I?y OF THE: IUil. OrR OR
IUILDINt LOP.,ATI~N IHO~IN M[ITI Al.l, IU~DPII~ION COYe'NANtl AND ZONINO
~..I¥ Ii THE ~I'IPONIIIIII. ITy OF' THE IUII, DJR TOV[RIFY AI,.c IH. Ir¥&?iONI V
........... JIIIPIAY fO Akl. -I,~lhl..T.I III
I
I, IT 8Hlh[ BE THE REIPONSII~ITY OF THE IUI~DIR OROWNER ~YERIFY.
IUI~DIN~ ~T~ I~ MEET8 A~ S~D~WlON COVENANTS AND ~lNG .: ~
]. THI= pLAT.REP~[~ THE PANEL OF PROP~TY DESCRIBED BZL~ TAKEN '
,R[CORDED PRIOR ~ O~AFTER THE FI~INIOF THE A[OOROEO.PgAT."-:
4. THE INF~T~ ON ~IS ~AT IS FOR TH[ US~ OF L[NDING WSTIT~IONS .
~ECIFICALLY TO 8~W~ CONFkI~$:BET~EN .EX~TINO ~R~TUR[$ A~ P~D
~T LINE~ ~ EAIEMEN~, THE ~AT I~ NOT ~ BE U~ED FOR P~ITIONIH~ . , .
: ~-['1o~,1' NO,; t: ::.
349.6537 6937 Old Semord Hiohwav
APpL|: NT FILLS OUT UPPER HA! ONLY
Property, Ot;me~ _~' 7]~_ \[ :4~ /L'b / (~/~,~/' "-.~-.
Phone
Address (.L ~;) /_ /.) C ~ ~_ / (] .4_.., /./<.. ~ ~. (_ /-~ ~.j ? /¢' ./I ~ Zip Code
Lending Institution
Address .~ -..
z./~/ ~ ~,: A ? ~/t:~ ((. ./~' /,'~ ('{~ /~ A: Zip Code
Realty Co. & Agent
Address / .~
Legal Description
Street Locati~
Type of Residence
[~Single Family
[] Multiple Family
[] Other
Phone
Phone
No. of Bedrooms
Water Supply
[]~( Individual
Community
[] Public Utility
ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach Icg if available).
Sewer Disposal
/~ Individual
Public Utility
[] Holding Tank
Year Individual Installed:
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
~ E.. C- ~ MUNICIPALITY OF
( C~ ~~ --_~__ _ __ ENVIRONMENTAL
(~ ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL~ ~ ~
) ~SA.PROWP
) CONDITIONAL APPROVAL*
Soils Rating Date ~wer Installed Well To Absorption Area I (~) '~ Well Log Received
,~:~ % Well to Tank / ~ C) Septic T~k Size