HomeMy WebLinkAboutRABBIT CREEK VIEW & HEIGHTS BLK 2H LT 11ARabbit k View & H ight Block 2H Lot #020- 551 - 10 MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On-Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-551-10 Property owner(s) Mark & Ramona Schimscheimer Mailing address 3161 Austria Drive, Anchorage, AK 99516 Day phone Site address Marino Drive Legal description (Sub'd., Block & Lot) Rabbit Creek View ~rl~ Heights, Block 2H, Lot 1 lA Legal description (Township, Range & Section) Lot Size 20,972 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: ([~ all that apply} Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] APPLICATION IS AN: Initial [] Upgrade [] Renewal [] TYPE OF DWELLING: Single Family (SF) [] (w/wo ADU) Duplex (D) [] Multiple Dwellings [] (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ('Si'gnature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: Permit No. Waiver Fees: Date of Payment: Receipt Number: Waiver No. Permit App__- .- ,_.~.c. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-maih steve(~panenRak.com March 6, 20:13 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 S. Bra§aw Street P. O. Box :196650 Anchorage, Alaska 995:19 Subject: Rabbit Creek View and Heights, Block 2H, Lot 11A Septic System Permit Upgrade Request Ladies and Gentlemen: I am writing to request a permit to install a well and septic system be issued for this property. The proposed systems will serve a proposed three (3) bedroom house. Currently the lot is undeveloped. A new 1500g S.T,E.P. tank with AX20 Pod and Auxiliary pump vault will be installed. A new well will be installed. The surrounding developed lots are also served by private wells. There are no wells within :100 feet of this system. Soils. A single test hole was excavated by Pannone Engineering Services in October of 20:12, and the ground water monitored for seven days. Water was monitored to a depth of 7.0 feet in the test hole after the seven day monitoring period. Bedrock was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 2 gallons/day/square feet should be used for a CAT III wastewater system. Soil Absorption System Design. a. See Sheet 2 of the design package. 3. Surface Water: There is no surface water within :100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography slopes from south to north at approximately 5%-7% in the area of the proposed drain field. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On-Site Department, the note will be removed and "Issued for Construction" drawings will be issued. Mailing: PO. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 9950Z Telephone: (907) 272-8218 FAX: (907) 272-82:[1 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments -Soils Log -Septic System Design N~ailing: P,O, Box 100217, Anchorage, AK 995i0-0217 Physical: 332 East Nlanor Ave, Anchorage, AK 99501 Telephone: (907) 272-821g FAX: (907) 272-8211 ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNICIPALITY OF ANCHORAGE THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this ,.]o/ Dayof /~t~'~ ~ of 20 / ~, by and between , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration 0fthe mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Osvner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), deseribed as /Z} ~5> ~/~-[/Q 7-'E3Z located 2. Definitions. f'~ - 2/~ ]- - / I ./4 A. Alteration. Any change to the design or function of an AWWTS that Includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AWWTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65. B. Certificate of On-Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systems given at . the time of property sale and title transfer in accordance with AMC 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance ~md Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On-Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On-Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Mtmicipality an annual fee of ~ E ~ O ($ C) .00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the AWWTS. The 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~ Iustallation 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 ofthis 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, roles 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: ~ //t Ft t2~ f 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 oftbe 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 thereaRer 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 patties, 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 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 M~morandum of Understanding shall be brought in the Superior Coua 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. SeverabilRy. Any provisions ofthis Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memom.~..~ Understanding. By~/~.~.~ -- By: ~sTATE OF ALASKA ) THIRD JUDICIAL DISTRICT ) MIINICIPALITY: Iq&day The foregoing ipstrument was acknowledged before me this of OT XCI [ ¢ FOr. My Commission expire'g~l~j~ MUNICRAUT OF ANCHO, RAGE C3 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 02055110 9. GENERAL INFORMATION Expiration Date: � Q Complete legal description Rabbit Creek View and Heights 132H L11A Location (site address) 8121 Marino Dr. Current property owner(s) Mailing address Day phone Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic F1 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment 1112-31121 Receipt Number c2m, 7 _3 COSA # D.�GZI 1 t 9 5 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name 6. DSD SIGNATURE Steven R. Pannone P.E. Date -2fO4F0-1 System #1 Approved for 3 bedrooms ��;5 annon9. e o14g ..cQ� System #2 Approved for bedrooms s Disapproved Conditional approval for bedrooms, with the following stipulations: WAST" VATER l PROGKAM JJJ� J� By: ��� i1%fi 9. uUvX Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Checklist ascription: Rabbit Creek View and Heights 132H L11A than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6/3/13 Total depth 72 ft Cased to 72 ft WE Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 4/20/21 Static water level at beginning of test 33 ft. Comments B. TANK DATA Age of tank(s) 20131$ years Tank type/material `se Gjs�-j Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 7/20/20 D. ABSORPTION FIELD DATA shallow trench Which system tested (date installed) 4/17/13 ❑ ALL standpipes present per record drawing Total measured depth from grade 3 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: +/-2" rigid insulation over field COSA Checklist yellow sheet Parcel ID: 02055110 Structure served by this system 1 Well production at time of test 4...._ gp Water storage tank volume na gallons Well disinfected for coliform test? ❑ Yes No (Coliform bacteria is Negative Nitrate mg/L [�J Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by PES Date of Sample 4/20/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station 8 years Lift station material Poly Comments: Adequacy test date 4/20/21 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 477 gal New depth 0 in Elapsed time 120 min Final fluid depth 0 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date DISTANCES ivate well on Lot to: (Please enter distances if less than required or if community we From Absorption Field on Lot to: (Please enter distances if less than required) Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' MV Yes if No ft Private Sewer/Septic Line > 25' ED Yes if No ft Absorption Field on Lot > 100' MV Yes if Na ft Holding Tank > 100' �✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' El Yes if No ft [✓� Yes if No ft Community Sewer Main > 75' M,/Yes if No ft Manure/Animal Excreta Storage > 100' []✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 171 Yes if No 5' ft Surface Water > 100' �✓ Yes if No ft Propert Building Foundation > 10' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' []✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' [✓I Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' [✓ Yes if No ft Surface Water > 100' 0 Yes if No ft y Line > 5' [✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' [✓ Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10' ❑✓ Yes if No ft Community Wells > 200' F-1 Yes if No ft Water Service Line ? 10' []✓ Yes if No ft If septic tank is under driveway comment below Building Foundation > 10' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' []✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' [✓I Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' [✓ Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS Tank to building of 5' was allowed at time of construction. G. ENGINEER'S CERTIFICATION I certify that t 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. ,:?10 4 Zz- COSA Checklist yellow sheet 9F -1k co' 49 TH 9 even RPannone CE 8149 \�_�'OFESSiOyF .� MUNICIPALITY OF ANCHORAGE ; 'i gaiw. 16 11,64 l i t N 51kyl I RZY THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this 36-V- Day of _ �,r � of 20")-� , by and between Ja�fc�H k-43AA- C" S , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AU ate, Q.x located at (legal description) 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in _ accordance with the equipment's approval for operation in the Municipality. �S It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). 7 Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 c^ Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. J Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. c� Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. c^' t� Owner agrees that any sale or transfer of title of the property will not occur without a new _ Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 3SOwner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement 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 Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By:--�� (signature) Date: 2 i �w�% Swe_n•,s S (print name) STATE OF ALASKA ) THIRD JUDICIAL DISTRICT ss. ) The foregoing instrument was ackno ledged before me this L day of b 1 2W , by_. I Q�4 yy�h Swam► �_ NOTARY PLIC FOR ALASKA STATE OF ALASKA My Commission expires: _ — ZOZ SJ NOTARY PUBLIC �. Liz Kowat My Commission Expires January 6, 2025 MUNICIPALITY: By: Q�,fi (signature) /fe 6e rca &t -r -a / (print name) (rev. 05/18/2018) Date: 5Z 0 1 31 Title: Page 3 of 3 07/06/2020 15:04 8686770 APLUS 366 447 m Nil■ n NN R slump R NNN■N■EN on � MORE R WE RRR R R R RR I N l SWIM MEN sin RI IRR on a NINE d�rar�T � r Field Maintenance Report Annual lnspE Iction Pmperry Gwr�rlrncuir>g ■ Mark Schimschelm ,r Site Add rem 8121 Marino Drive, Anchorage AK 99516 Ax $ile Ip A cauft Y m rt AX -131383 OSP131031 Retrieve O&M Into Daily flow Recirc ratio Time—,ernng;: Perform Field Samp. ng/Observations NTU (15 T NTUS) �pr 1 (B•9) DO (2-6) Odor of 3amplc Typical Mutat ❑ E&dhy 7_ Moldy Nan-typlaai Sulfa g ❑ Cabbage ❑ Deeay Oily film to PVU Yes �c Foam In tank Yes o Check Control Pane Recirc Amps Discharge Amps AudNo and visual ala ns RTOK Dial tone (tslometry crr y)as No Insp-11Clfaan Pump System Inspect Clean Rlsor/Lld .......... ......... Splice Box ......... ......... LM Float Conic . . . . . . .. ......... . Floats ............. ......... . Pump.. ........... ......... Biotube!" Flitar . . . ... .... . ... . Biotube Pump Vault . .......... ReelrCUlating SpI tterl 1lve....... _ comments Signature_ E n N N rrm R R R R R >trin operator Larry Betts P'4" WU NAR. N 415780 RTU128421 Measure Sludge/Scum Sludge PAGE 17 AnchorageTank 907-272-3543 Co Ua Phnnn (947)555-5555 Rota of La t Impm-bn 05/4512019 Scum 1 St Compartment Curre�ta Pmvlaue Current Previous 2nd Commmmnt Current Previous Current prevroua Inspect/Clean AdvanTex Fllter Odor, AYNormaf ❑ Pungent Biamat. Normal ❑ Excessive Bridging/Ponding: _ None/Minor [ Exaes%Ivo inspeattCiean discharge Pump System Inspect Rissr/Lid Splice Box Float cords InspectlservtCe Other Systema Components inspect Clean Disinfection ]Equipment � . , &. ala Observations Inspect Clean Literals/orirrcas Pod Bartram Intake vent _ r Inspect Clean Floats � +� Pump Inspect Clean Diapers Laterawordllcos .R Apir Additional SOrvioes Rendered ❑ Cleaned textile sheets? ❑ Replaced UV items? ❑ ReDlaced/Used other items? Parts Used: W . Warranty, 6 e Billable (t% appropriate soloed on) w H seem Number Descrlptwn Final/Safety Inspection q RSV reinstalled e�Lkls bolted on RManlfcld roconnected: flush valvas closed J' Cantrol pane! reactivated Summary/Recommendations ystem performing, no further action needed ❑ r-111 for Service Date Fax completed form to 1,866-384-7404 ❑Tank noods pumping ❑ Ot1,ee?