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HomeMy WebLinkAboutSECLUDED HILLS BLK 1 LT 3Secluded Hills Block 1 Lot 3 #017-343-03 AN NESAMI7oTa ■ Municipality of Anchorage Community Development Department Page 1 of On -Site Water and Wastewater Program DEC 3 0 2095 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http:llwww.muni.org/onsite • (907) 343-7904 ..,AIV -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP151009 RID Number: 017-343-03 ❑ New ❑✓ Upgrade Name: David & Heather Carter ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 5201 Secluded Cir. Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating - Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe - Ft. Subdivision Block Lot Secluded Hills 1 3 Fill added above original grade Ft. Gravel length - Ft. Township _ Range Section. Gravel width Ft. Beds: Number of Lines Distance between lines I Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area. Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ftp Ft. Well 113.7 N/A NIA N/A NIA TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity I 1,000Gal. Surface Water 100+ 100+ NIA N/A Material Steel Number of compartments 2 Lot Line 34.2 N/A NIA N/A NA Foundation 33.5 N/A N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain 50+ NIA N/A N/A -- Pump on level at Pump off level at High water alarm at Remarks in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL Housetotank 3034 drainfeld Tankto InsInstaller3034 Isaacs Excavating Services Drainfeld 3034 CO/MT 3034 Inspector Pannone Engineering Services LLC. BENCH MARK (Assumed elevation) 100ft Inspection1� 6124(2015 Location and description dates: 2 Top of Deck 3" 4'h COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date*�Q ......... "$1even " anriotae CE 8149 Approved twl ��?� Datez-8�� zzUr. ..'•r .. Inspection Report_1-1-12.doc SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE. STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED. IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS. - 2. SCOPE OF WORK: INSTALLED NEW 1,000 GALLON STEEL TANK. 3. BASED ON PERIODIC FIELD OBSERVATIONS AS REQUIRED BY AMC15.65 THIS RECORD DRAWING REPRESENTS THE PROJECT AS CONSTRUCTED, BUT DOES NOT GUARANTEE THERE ARE NO HIDDEN DEFECTS BY THE CONTR Iz .z w� w � �a 0I / w Q g J z QI0 jN - WELL (E) 10008 SEPTIC TANK Og ABANDONED PER CODE INSTALLED NEW 10009 SEPTIC TANK WITH DCO FC (E) HOUSE (E) `� DRAIN FIELD (E) \ 3BR� �j U C I _ 9 9 ABBREVIATIONS FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT N0. DCO DOUBLE CLEAN OUT BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL & VEGETATE DRIVEWAY W— MSM= 1p. DRA _ =AGG- SEME _ SEPTIC AREA (E) A B T1 42.20 45.30 T2 48.10 52.60 DC 50.20 55.20- 2 SECLUDED CIRCLE z o,. z 101e 12/24/2015 USED: 2 wa NEW 1,000 GAL STEEL TANK o< SECLUDED CIRCLE NOTES: z o,. z 101e 12/24/2015 USED: scale P.LD. NO 017-343-03 PERMIT NO. OSP151ooe wa NEW 1,000 GAL STEEL TANK o< w o< PLAN 10U U OU LEGEND EL 9z.7 W - WATER LINE/ - PL EL. azo WELL RADIUS NEW 1,000 GAL SS �— NEW SEPTIC SEPTIC TANK EL. 56-9 NOTES: PANNONE ENG SVC, LLC\1 P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 J'�� OF,.. qS (, ig�P �9f1 %*: 49 •.w ......... .. .. ... / Steven R. onnone �jPs CE 8149�^�� ES.... ++11 iD,....qo ft 101e 12/24/2015 RECORD DRAWING scale P.LD. NO 017-343-03 PERMIT NO. OSP151ooe -DRAWN BY: SECLUDED HILLS, BLOCK 1, LOT3 DAVID & HEATHER CARTER 5201 SECLUDED CIR. ANCHORAGE, AK 99516 NJC PLAN Sheet 2 OF 2 .r w / z WELL (E) COLLAPSING 10008 SEPTIC TANK (E) ABANDON PER CODE INSTALL 1000g SEPTIC TANK (P) /\ WITH DOUBLE CLEAN OUT 3 BR HOUSE (E) / 1 I DRAIN FIELD (E) ITANK REPLACE I PLAN W— DRIVEWAY 70' nRAR AGG=EAA t� SECLUDED CIRCLE SEPTIC AREA (E) I I I 4 \ PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SECLUDED HILLS, BLOCK 1, LOT DAVID & HEATHER CARTER 5201 SECLUDED CIRCLE ANCHORAGE, AK 99516 WELL (E) Dote 1/13/2015 TH ..... .. .. �. .. P.I.D. NO 017-343-03 Steven R� annone pERMJI NO 1 P CE 8149 .,� 1 OF 1 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151009 Tax Code Number: 01734303000 Work Type: Septic Upgrade Permit Effective Dates: January 16, 2015 to January 16, 2016 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: SECLUDED HILLS Site Legal Address: SECLUDED HILLS BLK 1 LT 3 G:2937 Owner/Address: CARTER DAVID M & HEATHER M 5201 SECLUDED CIR ANCHORAGE AK 995163038 Site Mailing Address: 5201 SECLUDED CIR, Anchorage This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 65905 Total Bedrooms: 3 N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and.Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The permit drawing has property line scaling issues that are not anticipated to affect construction. The engineer's asbuilt drawing shall scale correctly. Received I Issued By: MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water &Wastewater Program e® t13■.I-TTA ON-SITE SEWERIWELL PERMIT APPLICATION JAN 14 2015 Cratchen Stuller Parcel I.D. 017-343-03 Property owner(s) David & Heather Carter Day phone Mailing address 5201 Secluded Circle, Anchorage, AK 99516 Site address 5201 Secluded Circle Legal description (Sub'd., Block & Lot) Secluded Hills, Block 1, Lot 3 Legal description (Township, Range & Section) Lot Size 65,905 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade ❑X (w/wo ADU) Duplex (D) ElHolding Tank ❑ Renewal F-1Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. property owner or authorized agent) Permit/Rush Fees: 4.21.5 Date of Payment: (//U116 Receipt Number:�j �u$(�] Permit No. 6505-10( 9 Permit App_.;- : Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve(@Panenaak.com January 13, 2015 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Secluded Hills, Block 1, Lot 3 Septic Tank Upgrade Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1000 gallon Septic tank be issued for this lot. The proposed system will serve an existing 3 bedroom house. Currently the lot is developed. The existing septic system was designed and installed for three bedrooms. The existing tank is collapsing and is in need of replacement. This lot is served by a private well that is over 100' from the septic system. The surrounding lots are also served by private wells that are over 100' from this system. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: This lot slopes from southeast to northwest in the area of the tank replacement. The proposed installation will be located in the southern portion of the lot, next to the existing system. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells 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: Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Zw ,wlal / ell- WELL (E)` a o • � o \ i COLLAPSING 7 DOOg SEPTIC TANK (E) ABANDON PER CODE INSTALL 1000g SEPTIC TANK (P) WITH DOUBLE CLEAN OUT 3 BR I� I \ \ n, 'i, (Fl DRAIN FIELD (E) L U—, --2 NOTES: TANK REPLACE PLAN W_ DRIVEWAY \ � M �M M 10 ORAh _NAGE EAS t� � �EAAEni _ SECLUDED CIRCLE SEPTIC AREA I 4 � PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-82' SECLUDED HILLS, BLOCK 1, LOT DAVID & HEATHER CARTER 5201 SECLUDED CIRCLE ANCHORAGE, AK 99516 (E) ELL (E) Steven •R� 'mar CE 8149 Date 11 1/13/2015 /�+I Scale *'I 1 ..=50' )" P.LD. NO 017-343-03 7 OF 1 MUNICIPALITY OF ANCHORAGE ep DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME us i (3 , (�t�r+ PHONE Z�,�ibi�i2 EW UPGRADE MAILING ADDRESS «<� a Alas I(" LEGAL DESCRIPTION LOCATION 66La NO. OF BEDROOMS _3 cf Y DISTANCE TO: Well h ty� l ry Absorption area d Dwelling h p1"- i t PERMIT NO. ys y F- 2 Uj Manufacturern Material No. of compartments rn Liq. capacity inallons 1013 IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. 9 Q T'H Manufacturer Material Liquid capacity in gallons [] LU a DISTANCE TO: Well nc;y �'� Foundation !1 iat i �0 Nearest lot lines Z" PER NO. jn _j u. Z F7 No. of lines Length of each line Total length of lines ` 2 Trench width 31 -f inrl^ac Distance between lines Ae �' < P D Top of tile to finish grade � Material beneath tile / / .7— C) inches Total effective absorption area 6r `-%CJ Q - to C7 Length Width Depth - PERMIT NO. .� <1t' o — ui Type of crib Crib diameter Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER �- PIPE MATERIALS ti 30 i `l c f 40 45c SOIL TEST RATING INSTALLER C&' - C S C_`F. s REMARKS ,-/- ec L o Nn A /VILA_. j rCrlci vc q J'v l ( ' — — � C a APPROVED DATE LEGAL 72-013 (Rev. 3/78) Wk M U IM X C ": 1 Rr ���­V '-IV" C�) P_ � ". 11 0 -- 0 h it 4_.�h D-.'- -.. , DEPARTMENT OF HEALTH AND � PROTECTION (��r> 825 L STREET, ANCHORAGE, AK 99501 APPLICANT: 264-4720 L�^, v CUM M X -V FEE 30 FEE SO FEE UR Sc W FEE 0. R �9: .. ZO-11 1� 1� 99503 PERMIT NQ: 850454 DOTE ISSUED: 07/29/85 APPLICANT: JOSEPH B" AUSTIN ADDRESS: 3401 WISCC)NSIN ST" ANCI­ORAGE, AK 99503 CONTACT PHONE: 264-6492 ' LEGAL DESCRIP: SUBDIVISION: SECLUDED HILLS LOT: 3 BLOCK: 1 SECTIQN: 22 TOWNSHIP: 12B RANGE: 3W LOT SIZE: 1"5A (SQ"FT" OR ACRES) MAX BEDROOMS: 3 Listcn?d b«*lcm are the options available to you in designing your septic system" Choose �..... ... ..... the optinn that best f,its your .... ... �� sit�` ..... ..... ��� 0- 1P4. P4 IF 0 .13: Ei:: 1) LN5= 1::11 F::�! W�4"IF �11 DEPTH T8 PIPE BOTTOM (FT,>, 4"0 4"0 4^0 GROVEL DEPTT-1 (FT,> 10"0 0"5 7s. IV; TOTAL DEPTH -WT.) 14"0 ' 4.5 7"5 GRAVEL WIDTH ("T"> 2"5 21.0 5"0 GRAVEL LENGTH (FT"> 30"0 42"0 63.0 GRAVEL VOLUME (CU. YDS. 29.2 32"7 46"7 TANK SIZE (GALS> 1,000^0 ** 1v000.0 ** 1,000"0 ** SOIL RATING (SQ^FT./BR) 194 193 194 �* TANK PIUST 1-4AV2 AT LEAST TWO COMPART�1ENTS � [ certify that: 1. I am familRu, with 1 -he requirements 1'oP on~s1t,e and wel1s a�i� set fc.)rth by the of' Anchorage (MOA) and the State of Alaska. 2" I will install th-0 system iD accordance with all MOA c-.odc.,?s and pegulations, �nd in compliance with the design criteria of i�his 9erNit" � 3. I Will a6here to all MOA and State oJ Alaska requirements for the set back distances from any existing well, wastewater diSposal system or public sewerage system on this or any adjacent or neapby lot" 4. I understand thatthis pormit is valid for a maximum of 3 bedroomo and any Will an additional permit" . IF A LIFT �TATION IS INE) IN AN AREA COVERED BY MOA 8UILDING CODES� THEN (1) AN ELECTRICAL PERMIT AND INSPE[TION MUST BE,: OBTAINED; (2) 0S-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT" AND (3) THE � ELECTRICAL M T CTRICIAN" SIGNED DATE: APPLICANT: J0 F, H1 AUSTIN ISSUED BY DATE: ~~�.,;m_~�������.~' LL�� Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST (ENGIN ER'S $EAL) PERFORMED FOR: ��-Y��� !-'Z`Ctt.\/'-��r �cF �lE�,-� DATE PERFORMED:_ _ LEGAL DESCRIPTION: OC'-t=4c1",•L!X 61''•-,:, Township, Range, Section: _� 7?- PFPITIN SLOPE SITE PLAN 1 L� G> ri A-rt,r'-c S-10 2 3 4 5 6 7 8 9' 10- 11 12- 13 L 14 15- 16 17 18 19- c?OAi <rI.-7 -j S4". -LQ Zr rr\e '-'-jCR . WAS GROUND WATER ENCOUNTERED?.%Ll IF YES, AT WHAT DEPTH? Depth to Water Aller Monitoring? Date: 5 O/d S L O P E Reading Date Gross Time Net Time Depth to Water Net Drop GUIDELINES IN EFFECT ON THIS DATE. 1 110 To ■■ ■■■ - ■■ ■■■ ■■■!Nom mom ■■ 3•b ) - $ ■ ■■■ ■� ,■`■■ �■■ II AE ■I ■ 5 O/d S L O P E Reading Date Gross Time Net Time Depth to Water Net Drop GUIDELINES IN EFFECT ON THIS DATE. DATE: 2 To - 1 r)t' 3•b ) - $ 20 -� ✓ `, ~` PERCOLATION RATE --LL /(minutes/inch) PERC HOLE DIAMETER + TEST RUN BETWEEN /j � ��FTAND 5—FT COMMENTS c5'0 + "4 fn 0 .70 ✓ & N 6 u' c� (-/ tf--, 17 ✓� PERFORMED BY: ` `� t��iz{ fRO/C� y �'f��r+= "CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 2 72-008 (Rev. 4/85) LOCATION OF WELL (Please complete either lo, Ib or Ic.) 'I e WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. A.D.L. No. lo.1 Borough Subdivis,,''4 eolow Lo[ Block I/4 gtrs-• F Section No. Township N Q Range E Q Meridian Sec Ari :Zt .Y or_or_of— sQ w❑ IC. DISTANCE Apo DIRECTION. FR M ROAD INTERSECTIONS I e 3. OWNER OF WELIw [:I. (��d�,, ,t �? �(J..L.�L.-16� 1-t C. sad re sac: Street Address and Area of Well Location Feet Below 2. WELL: LOG - Surface - 4. WELL DEPTH: (}Tool) / ft.� 5. GATE OF CO�M-PLETION,,., - LJ -•:? Material Type Top Bottom - _ - - _� 6. Q Cable tool M Rotary Q. Driven-. 0 Dug Q Auger [] Jetted Q Bored Q Other ?.USE: ® Domestic Q Public Supply Q Industry Q Irrigation Q Recharge Q commerical - QTest Well QOthsr: - - S. CASING: Q Threaded 'E3 Welded diem.-�in. toff. Depth WeightIbe:/ft. diam. In, to ft. Depth - Stickup i--- ft, - - /- 140 9. FINISH �sOF�. ,,,,WE/ELL: - ,f TYDe: f l�,% Diameter: 4 /s Slot Mesh `'Site; Length; Set between ft, and ft. -- _�f ,et+�_a., '`T-. `=.P.drrt:f'E�•u�_�4ixc*.: '.i y-. Bockf Ming _ Gravel pack / -- 10. STATIC WATER LEVEL! /Ia�s }t.]. - - lei I/ Above or Below land surface Date .� F F Egulpmentused: II I. PUMPING LEVEL below land surface and YIELD rL ofter .._hra• Pumping - 9 -P.M. ft. offer hre, pumping g. p, m. DEPT. OF EALTF1 & LNVIRUNMENTY LL PROTECTliN. - - 12.GROUTING Well Grouted: Q Yes ©No Material: Q Neot Cement ❑ Other: _ - - -- - 13, PUMP: ( if available) HP . Length of Drop Pipe ft. capacity g.p.m. -- -- Q _1ubm, Q Jet 0 Centrificol E] Other -14.REMAR.KS: 16. -WATER WELL CONTRACTO'R'S CERTIFICATION: ' -15. Wafer T a mperaiure _ Q F Q C This well was-drilledder y )u�rlsdictlon anL this report is true _ to the but CJgf my/ knowledge and belief; X V/) -t�y. Registered Business NoA � � .Contract License Number Signed t---s/`rs r"°�il.. �s,yir. Date: Authorlzof Representative i_ - Fo14tO'2-WWR (11/81) Copy Distribution: WHITE -State DGOS, PINK -Driller, CANARY- Customer Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CL V1 C- L CERTIFICATE OF ON-SITE SYSTEMS APPROVAL" FOR A SINGLE FAMILY DWELLING Parcell.D. 017-343-03 COSA# 1311 aS? 1. GENERAL INFORMATION Expiration Date: — o 3 Complete legal description SECLUDED HILLS S/D; BLOCK 1, LOT 3 Location (site address) 5201 SECLUDED HILLS CIRCLE * ANCHORAGE, AK * 99516 Current Property owner(s) JOSEPH & KAYE AUSTIN Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing address 345-3806 5201 SECLUDED HILLS CIRCLE * ANCHORAGE, AK * 99516 Day phone KATHI JOHNSON W/ PRUDENTIAL Day phone 762-3123 3801 CENTERPOINT DR, #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: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site m 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 On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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. 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. 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. Engineers Comments: In conducting this evaluation, GEG. LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSO Guidelines 6 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 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 them 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 atherperson or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE /System #1 Approved for �27 bedrooms. 0 Phone 337-6179 9)/g/3 Date System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: �tlllll(((t((((fff OF Aij6' ON-SITE WATER AND WASTEWATER o^ _12 RA ��r�ylbwl Original Certificate Date: Si - Q, ' TheWKnicip y q A `ncho Develop,emt Services Division (DSD) issues Certificates of on -Site Systems Approval (COSA) based only upon the r resenatations 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. ATTCHMENTS: / COSA Checklist L/ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 11105) CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SECLUDED HILLS S/D; BLOCK 1, LOT 3 Parcel ID: 017-343-03 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 8/15/1985 Sanitary seal (Y/N) YES Total depth 182 ft. Cased to 182 ft. FROM WELL LOG Date of test 8/15/1985 Static water level 133 Well production 2 WATER SAMPLE RESULTS: Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 7/2/2012 Coliform (0 colonies/100 ml. Nitrate• y� mg./L. Arsenic: N13 ug./L. Date of sample: y/ -)J13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL 134 0.5 9.p -m. Collected by: GEG, Ltd. Date installed 7/31/1985 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6/12/2013 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA Date installed 7/31/1985 Soil rating (g.p.d./ftor /bdr)194 System type TRENCH Length 32 ft. Width 3+ ft. Gravel below pipe 10 ft. Total depth *14.9 ft. Eff. absorption area 640 ft' Monitoring tube YES Depression over field NO Date of adequacy test 7/4/2012 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 92 in. Water added 530 gal. New depth **121 in. Elapsed Time: 120 min. Final fluid depth 11177 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — NOTE: MT EXTENDS PAST EFFECTIVE DEPTH. TOTAL DEPTH AND LIQUID LEVELS ARE CALCULATED FROM THE LATERAL LINE INVERT. **1" OF WATER ABOVE INVERT. D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump off' level High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal 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 Building foundation t0'+ Water main N/A Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION i certify that / 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 JEFFREY A. GARNESS Date 916b COSA Fee Date of Payment Receipt Number (Rev. 11/05) Driveway, parking/vehicle storage 10'+ Waiver Fee Date of Payment Receipt Number Municipality of Anchorage ' Development Services Department Building Safety Division A s ,;, On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ei.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 131188 During a recent COSA on-site inspection and test of the potable water supply well on Block 1, Lot 3 of Secluded Hills subdivision, the well's productivity was determined to be 0.5 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.3 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 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 f www.muni.org/onsite •" (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING p Parcel I.D. 017-343-03 COSA#g 1. GENERAL INFORMATION Expiration Date: 9-17-13 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SECLUDED HILLS S/D• BLOCK 1 LOT 3 5201 SECLUDED HILLS CIRCLE * ANCHORAGE, AK * 99516 JOSEPH & KAYE AUSTIN Day phone 345-3806 5201 SECLUDED HILLS CIRCLE * ANCHORAGE, AK * 99516 Day phone KATHI JOHNSON W/ PRUDENTIAL Day phone 762-3123 3801 CENTERPOINT DR #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 Individual Water Storage Community Class Well Public Water System 61, Lily 3 cam- 0!1:1-- (�i vv) The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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. 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 On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my 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. 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 rr /3 Engineer's Comments In conducting this evaluation, GEG, LtD. attempted to provide a thorough, oo�DOp�4 conscientious engineering analysis of the system in accordance with ADEC and MOA o OF q DSD Guidelines & Regulations. The reported results described the performance of the K. ��! • . ""' `'9s�oo 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 Q�H.'�*� septic systems depend on the local soils condition, groundwater levels that may ....... Q ..... �....:,...Y... ..... 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 !.....'r... :.,.�.V� results do not guarantee future performance of the system, nor do They guaranteethat QO�Jeffrey A: '6orness: there are no hidden defects or encroachments. GEG, LTD. can therefore not provide CE -7953 mo G any warranty or future estimate of how long the system will continue to meet the OQ sre • �%:.t(, !,� • . o; �� 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 X00 ro f essl000 40000 other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIG/NATURE®�YfOF V4 Approved for bedrooms. _ j� ON-SITE --.-- Disapproved - -- ------ - ——MATER i��+ ,AIAC_rr-VVATE Conditional for beuiuuiTis, with the fuiiowing stipulations: � m vvnv: �-•- PROGRAM Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory Other By: (Rev. 11105) Original Certificate Date: �r —17-1_3 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 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SECLUDED HILLS S/D; BLOCK 1, LOT 3 Parcel ID: 017-343-03 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 8/15/1985 Sanitary seal (Y/N) YES Total depth 182 ft. Date of test Static water level Well production Cased to 182 ft. FROM WELL LOG 8/15/1985 WATER SAMPLE RESULTS: 133 ft. 2 Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 7/2/2012 134 ft. g.p.m. 0.5 g.p.m. Coliform _0-1, colonies/100 ml. Nitrate 3. 41 mg./L. Collected by: GEG, Ltd. Arsenic: N 0-ug./L. Date of sample: 4 Z f3 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 7/31/1985 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 6/19/2012 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA Date installed 7/31/1985 Soil rating (g.p.d./ft or �194 System type TRENCH Length 32 ft. Width 3+ ft. Gravel below pipe 10 ft. Total depth *14.9 ft. Eff. absorption area 640 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 7/4/2012 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 92 in. Water added 530 gal. New depth ** 121 in. Elapsed Time: 1120 min. Final fluid depth 117 in. Absorption rate >= 450+ g.p.d Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date – NOTE: MT EXTENDS PAST EFFECTIVE DEPTH. TOTAL DEPTH AND LIQUID LEVELS ARE CALCULATED FROM THE LATERAL LINE INVERT. **1" OF WATER ABOVE INVERT. C1?, a LtQv(4 pu `"2-G44 o.)J 4/Z,/!3 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level �i High water alarm level Cycles tested Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main 5'+ Wells on adjacent lots 100'+ Property line 5'+ Absorption field 5'+ Water service line 10'+ Surface 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /a -t- Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION d , QF I certify that I have determined through field inspections and * �J i Y* uo review of Municipal records that the above systems are in """"'� conformance with MOA COSA guidelines in effect on this date. r A. Garne s, Engineer's Printed N me JEFFREY A. GARNE55 OQQO� E-7 3� omp� s Date Y/11 / /3 4 m e�ji3 \ dodo 4 pr0fess10�`Oo ��000000�� COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division a s On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 131188 During a recent COSA on-site inspection and test of the potable water supply well on Block 1, Lot 3 of Secluded Hills subdivision, the well's productivity was determined to be 0.5 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.3 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Tract A-1 Lot 10 Detail "A" S89'56'09"W 126.55' 'oma No Scale k 10' Utility Easement 1�. `SO• / 10'X30' Anchor - Easement d' Lot 2 v 0 R rr 3� m p h �p't �0F� a Existing 5 `� Ih�`. House F Ob 2 ✓ / aCP. Jit 6 Werr. o I s,� Lot 2 A '4 �o(�OF 414 -Tvl• C5o��� oo�P••. �� C4 _ "� M a Lot 3 p �: 49?H dp ......................... ° p °—yry/ Well .......,, \��` rr' I O Q m Janice M. Zilko o I L ® �(J� '•. 00 ° y r LS-8629 p�N M -Q04�oo�0 See Brick Lot 3 I I Detail A" 6� k Existing House F.'6Ve�# 1lYtY� H 27 4M 10 * •6 Droi no 9e Esa en'ent --"_ Shed S78-31'35-E 271.55, NOTE: Lot 4 Secluded THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT t y Circle PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH, Legal Description: AS' B U I LT Ordered By Kath! Johnson/Prudential Legend: Lot 3, Block 1, Septic Standpipe®wet« wdl ®Secluded am Hills Subdivision Fence--x—x— has conducted a Physical survey of the SURVEY CEereon LXWW1t2=1 ore withiLANn property as shown on this drawing and certifies that the Improvements the thereon ora within the property linea and no encroachments exist of exist other than noted. LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS EXCLUSIONARY NOTE: It Is the owners' responalbility to determine the existence of any easements, covenants, restrictions or right–of–way 440 West Benson Boulevard, Suite 200 Phone: 562-5291 takings which do not appear on the recorded subdNislon plat under no cUc°matances should any data hereon be used far construction, far Anchorage, bAlaska 99503 Fax: 561-6626 establishing property linea, or far plot–plan purposes Plat: 81-1 cdd: 2937 Date: July 3, 2012 Drawn By. PL Work order. 2012—L-122 Fb/Pg: 784/19-20 Scde: 1"=50' lChecked By. JMZ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivisionsection, township, range) L. 3 Q l & //S '5+4 c/ n %/Z N e. -WO $ "1 ,$.=2L/ Z L Location (address or directions) (b) Applicant Name J'9 7,7'- Telephone: Home Businessr;4A Applicant Addre ss It 9910 (c) Applicant is (check ohe); L•endin Institution El; Owner/builder,; Buyer El; Other ❑ (explain); _1 (d) Lending Institution 3Ga L— Telephone Address (e) Real Estate Company and Agent Address Telephone 2. TYPE OF RESIDENCE Single-FamilyZ Multi-Famil ❑ Other Number of Bedrooms —Y 3. WATER SUPPLY Individual WeII4 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 Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11/84) 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 regulations in effect on the date of this inspection. �I Name of Firm �/ I- C..5 e- Telephone �S ) r- C) Address /Z v n P 33 -Fd 4� a Date oc Z13 `'C.••vv�oo•vorn4ne4ti/ f'�U ) , Qj ysr Id, Jr.�^+� a. 1E �.• c�, , •r �C\ pROFE9S���P� 6. DHEP APPROVAL Approved for - c bedrooms by C.�i�z eCC/L ate c �'— Approved �� Disapproved Conditional Terms of Conditional Approval The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. 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 omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) I- E:. (3 2 11986 CHECKLIST - FEBRUARY 1984 264-4720 R Legal Description: S �� / z- N 3 LJ :Siti 5' ZZ. A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) — It ',V Well Log Present/N) _ Date Completed—I„ 7/ir Yield Z. . Total Depth �?Z — Cased to Q z- Depth of Grouting A) //J Static Water Level ?? 3 Pump Set At U k, (c„ v ' / Casing Height Above Ground Z Sanitary Seal on CasingtN) Electrical Wiring in Conduit A) Depression Around Wellhead (YR Separation Distances from Well: To Septic/Holding 'Tank on Lot /� 3 / On Adjoining Lots /00 To Nearest Edge of Absorption Field on Lot �ZD ; On Adjoining Lots — /en d ' To Nearest Public Sewer Line N//9L To Nearest Public Sewer Cleanout/Manhole _ /V/)4 To Nearest Sewer Service Line on Lot w/n` Water Sample Collected by 1 , 2 _, 1 r �_ /i a/ci Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 713185 Size / 0 UU No. of Compartments Z - Standpipes6?N) Air -tight Caps 69N) Foundation Cleanout Y N) Depression over Tank (Y& Date Last Pumped N/A Pumping/Maintenance Contract on File (Y/N) _ ; for — Holding Tank High -Water Alarm (Y/N) /4114 Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 1 3 To Building Foundation21 �y To Property Line _ 2 Sri To Disposal Field _ P To Water Main/Service Line S r To Stream, Pond, Lake, or Major Drainage Course - Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 6 %a12 Type of System Design %fin Date Installed !4.f S Length of Field 32 Width of Field 3 Depth of Field Gravel Bed Thickness Square Feet of Absorption Area `�� Standpipes Present &7N) Depression over Field (Y/6) Date of Last Adequacy Test 411A Results of Last Adequacy Test /-f/n Separation Distance from Absorption Field: To Water -Supply Well /Z To Building Foundation ,S Lot NN/i9 To Water Main/Service Line ��rt To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments To Property Line 16 To Existing or Abandoned System on On Adjoining Lots 7 To Cutbank (if present) N/xJ Dimensions Manhole/Access (Y/ — "Pum Level at Rl — Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request " I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the "pection. Signed `�� Date V/J/F6 �OF A� Company -5 %C MOA No. F&—c-2 p�fi�,.•°� • °•P^j✓'�Q ® Receipt No. 3% (o % 4 o0o u• 9 g °. •• ...• Date of Payment y �• 1 ...• 1 •w•V*.n..• ••NH Amount: $ l� 5 �, ;� Iro 'riaeR��et91: $`!►�°pROFESS\�� 4P Page 2 of 2 72-026 (11/84) PMC1 ml 4'�V-cer3 'rc L-dv: Mess 01471 JOB ALASKA ENVIRONA47NTAL CONTROL SERVIC. ;, INC. SHEET NO. OF 1200 West 33rd Avenue, Suite B CALCULATED BYDATE ANCHORAGE, ALASKA 99503 (907) 561.5040 _ CHECKED By DATE SCALE_ Z1. PMC1 ml 4'�V-cer3 'rc L-dv: Mess 01471