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HomeMy WebLinkAboutSECLUDED HILLS BLK 2 LT 1Secluded Hills Block 2 Lot 1 #017-343-09 Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: >w 9,­+02_�gg PID Number:. `iL — _�Y3-- 0 Name:Orr E4 Liu A llkm 1CK Wastewater System: ❑ New (Upgrade Address: 1320 1 ,1�,fto&r� Lt� ABSORPTION FIELD Phone: ^ 4— a l O No. of Bedroom : ❑ Deep Trench 9shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 0100 Total Depth from original grade: Si S +C, 6,5 GPD/S . Ft. Lot: Block:. S Subdivision:: // S 1 /1 _ Depth to pipe bottom from original grade: Gravel depth beneath pipe r "�CCuOIrD ALCd oZr3r ANO rSr Ft. 15 4 aro Ft. Township: Range: Section: Fill added above original grade: Gravel length: Ft. o` CAB Ft. WELL: nn New ❑ Upgrade Ext Gravel width: , S Number of lines: d- Distance between lines: /S 6 Ft. Ft. —77 Classification (P 'v' te, A,B,C): ('-ltlVPrZn_ Total Depth: Ft. Cased To: Ft. Total absorption area: ^ 3 O t x%31 = CSI SQ. Ft. _ Pipe material: FOND -a S%�4 1)743 SUC.IQ Driller: Dale Drilled: Static Water Level: Installer: /I n A'�' Dat installed: /93 Ft. •yte. ,�A'ZVitFJ Iz 4 rr 13 Yield: Pump Set at: Casing Height Above Ground: _ISS TANK GPM Ft. Ft. SEPARATION DISTANCES (septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: -��n Capacity in gallons: � From Tank Field Station Tank Sewer Lines A,NGN - v f-�V K_ I 0 D O 1000 WelhMaterial: /06'4- 106 > NjA NSA P-5 7 cEL - Number of Compa ments: I Watere 100'4- 100 ` dU �; LIFT STATION Lot Line t to f 10 1 r Size in gallons: Man urer: Foundation .Pump on" level at: "P off' leve High water alarm at: Curtain�rr Nokia }}-' �_ Pump Make del Electrical Inspections performed by: Drain )"W" Remarks: I&Lt, 2t,N xvr Z vkwao l T(" BENCH MARK EXLocation lS7lN6 ST N+1- N✓1 Ovcw Sys YS. and Description: 6v+g MEM& 7tFo caw S 106E Of= rS%r Assumed Elevation: w Ft ENGINEER'S SEAL +EF A dw . • of it r+�1 1,� t l.�V� a :; •.e 1 e w' Inspections performed b : Dates: 1st :.... %_4,P,.,ESS 2nd /11 /3/94- 1 1 f3 o t. .......... v r carft Depart lent of Healt and Human Services approval J# foe C 953 ,•' Reviewed and approved by: Date: /' © ,4`"`'e'�.�.'� 72-013 (Rev. 9/91) MOA 25 yrs NEW TRENCHES ARE 50' LONG EACH, TEST HOLE MT MT2A NORTH PROPERTY LINE 04 03 10' UTILITY EASEMENT FS' FLOW SPLITTER i MT3 COI BR' BULL RUN VALVE 02 w J NEW 1000 GALLON SINGLE COMPARTMENT w C• SEPTIC TANK a EX STING MP 'SP' UBLE C/ON ----------------- EXISITING DOUBLE I S' NEW 1000 GALLON DUAL COMPARTMENT SS i SEPTIC TANK C/(.1 COULD NOT INSTALLED, S DEWALLS TOO NSTABLE T WORK IN TRE CH SAFELY, F,CA TO A = 8,5 B TO COI = 40.5 FOUNDATION TO F,C,O = 4,0 C TO C01 = 41,0 A TO PRETANK CO = 13,5 B TO MTS = 48,7 B TO PRETANK CO = 36,5 C TO MT1 = 62 A TO SI = 12,5 MTI TO CO2 = '255 B TO S1 = 31,7 C TO CO2 = 87,0 ATOS2=135 BT00O3=563 TANK B TO S2 = 26.5 C TO CO3 = 52,3 EXISTING 1500 GAL ST A TO BULL RUN = 385 B TO MT2 = 640 A TO S3 = 153 FILLED WITH SOIL, EXISTING WELL 0 e re A. Gar s;• o C 7953 e`�D B TO BULL RUN - 12,5 C TO MT2 = 72.7 B TO S3 = 22,5 B TO F.S. = 40,0 B TO C04 = 79,0 A TO S4 = 18,3 C TO F.S. = 39,5 C TO C04 = 93.5 B TO S4 - 17,3 AS -BUILT D W G i SW970388 PID# 017-343-09 AS -BUILT OF SEPTIC UPGRADES LOT 1, BK 2, SECLUDED HILLS PREPARED FOR, MATT DIMMICK PREPARED BY, ALASKA WATER & WASTEWATER SERVICES DATEi 1/18/98 DRAWN, GARNESS SCALES 1' = 30' EXISTING WELL 0 e re A. Gar s;• o C 7953 e`�D SW970380 AS -BUILT DRAWING GROUND OVER TANK = 98,0 COVER = 6,4 FEET NOTEi DOUBLE C/O BETWEEN TANKS NOT SHOWN FOR CLARITY NEW 1000 GALLON SEPTIC TANK, INLET INVERT = 91,07, OUTLET INVERT = 90,90. TANK SET LEVEL WITIN .04 FEET, 4 INCH DIA, PVC LINE FROM HOUSE, .53 FOOT DROP FROM FOUNDTAION C/O TO THE SEPTIC TANK, SLOPE = I.7X APPROX. 2 COMPARTMENT TANK GROUND ELEVATION OVER SOUTH TRENCH = 93.4+, MINIMUM COVER = 4.4 FEET, GROUND ELEVATION OVER NORTH TRENCH - 92.5, MINIMUM COVER = 3.4 FEET, PIDNl 017-343-09 GROUND OVER TANK = 982+' COVER = 7,1 FEET NEW 1000 GALLON SEPTIC TANK, INLET INVERT = 90,41, OUTLET INVERT = TO 'BULL RUN' 90.33, TANK SET LEVEL WITIN ,03 FEET. -FOR LOCATION OF M,T's SEE PLAN DRAWING 4 INCH F810 DRAINPIPE, FILTER FABRIC OVER DRAINROCK SINGLE COMPARTMENT TANK A. BOTTOM OF TRENCH = 85.57 SOUTH TRENCH 6 86.2 NORTH TRENCH B, INVERT OF DRAINPIPE = 88,57 SOUTH TRENCH 6 88,7 NORTH TRENCH ., C. TRENCH LENGTH = 50' SOUTH L 50' NORTI4 = 100' TOTAL D. TOTAL ABSORPTION AREA = 821 + SO, FT, L,:•;• f•��•. E. NO BEDROCK WITHIN 6 FEET DF TRENCH BOTTOMS, +-••`•y F. NO GROUNDWATER WITHIN 4 FEET OF TRENCH BOTTOMS EFFECTIVE DEPTH IN SOUTH TRENCH = 3.0 EFFECTIVE DEPTH IN NORTH TRENCH = 2,5 5,0 MIN, SEPTIC AS -BUILT, LUT 1, BK 2, SECLUDED HILLS S/D PREPARED FOR, MATT DIMMICK (ALASKA WATER & WASTEWATER I DATE, 1/18/98 I DWNi GARNESS I SCALEi NTS e re A. Garn ss;' e 7953 44�p�pf'o/essWl_d w Ill oA r U /' �' _ pc�'��' _. i\ `TS q ._l Ivy, �0cy-\ PAGE 1 OF 1 \ MUNICIPALITY OF ANCHORAGEn1Y DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970388 DATE ISSUED:10/31/97 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES EXPIRATION DATE:10/31/98 OWNER NAME:DIMMICK MATT E & LORI A OWNER ADDRESS:13201 BADGER LN ANCHORAGE, ALASKA 99516 PARCEL ID:01734309 LEGAL DESCRIPTION: SECLUDED HILLS BLK 2 LT 1 LOT SIZE: 45559 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ✓/ '��LF �L� cam✓ DATE:_//^.� / ISSUED BY: Q� Q� L� `�� DATE: /0 "31 ' Alaska Water & Wastewater 8471 Brookridge Drive — Anchorage — Alaska 99504 (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers October 19, 1997 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Sewer Upgrade for Lot 1, Bk 2, Secluded Hills S/D. To whom it may concern: The existing 3 bedroom house is served by private well and septic system. The drainfield will not pass an adequacy test at this time, and must be upgraded prior to the sale of the house. Comments regarding the proposed upgrade are summarized as follows: ' 1. SOILS: Attached is a log which shows the soil profile, and the percolation test results. At a depth of 6.25' to 6.75', the percolation rates was 8.4 minuteshnch design range. Visually the soil appeared to be tighter, so a .6 gpd/ft2 application rate will be used. The soils appeared to get better above the profile tested. 2. TRENCH DESIGN: a. Percolation Rate: 8.4 minutes/inch. b. Allowable Application Rate: .8 gallons/day/ft2, but will use .6 gpd/ft2 c. Number of Bedrooms: 3 MUNIUMLITY OF ANL11Uwi�c f z e. Minimum Absorption Area: 750 ft2 OCT 2 3 1997 f. Effective Depth: 3.0 feet g. Reduction Factor =.58 RECEIVED h. Width: 5 feet minimum i Minimum Length: 87 feet. Will make trenches 50 feet long ea. j Effective absorption area = 862 ft2 (>750 ft2 OK) •` cc, r a. The existing 3 bedroom house is served by private well and septic system. The drainfield will not pass an adequacy test at this time, and must be upgraded prior to the sale of the house. Comments regarding the proposed upgrade are summarized as follows: ' 1. SOILS: Attached is a log which shows the soil profile, and the percolation test results. At a depth of 6.25' to 6.75', the percolation rates was 8.4 minuteshnch design range. Visually the soil appeared to be tighter, so a .6 gpd/ft2 application rate will be used. The soils appeared to get better above the profile tested. 2. TRENCH DESIGN: a. Percolation Rate: 8.4 minutes/inch. b. Allowable Application Rate: .8 gallons/day/ft2, but will use .6 gpd/ft2 c. Number of Bedrooms: 3 MUNIUMLITY OF ANL11Uwi�c d. Design Flow: 450 gallons per day ENVIRONMENTAL SERVICES DIVISION e. Minimum Absorption Area: 750 ft2 OCT 2 3 1997 f. Effective Depth: 3.0 feet g. Reduction Factor =.58 RECEIVED h. Width: 5 feet minimum i Minimum Length: 87 feet. Will make trenches 50 feet long ea. j Effective absorption area = 862 ft2 (>750 ft2 OK) We are proposing to install a diverter valve so that flow can be periodically alternated between the old and the new trenches. 4. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic upgrade. 5. TOPOGRAPHY: The new trench site is located on a flat, low area, where the slopes intersect from three sides. The nearby slopes vary from 3% to 10%. In short, there are no slope concerns associated with this installation. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Sincerely, Matt Dimmick Design Package.wps LOT 10, CONTOUR ACRES S/D. PRIVATE WELL AND SEPTIC SYSTEM. THE WELL IS 200+ FEET AWAY FROM THE EAST PROPERTY LINE PER THE AS - BUILT SURVEY ON FILE AT DHHS. SEPTIC AREA LUT 1, BK 1, SECLUDED HILLS S/D. PRIVATE WELL AND SEPTIC SYSTEM. G JQF4 ,i r � i O P 0 LOT 7, BK 1 SECLUDED HILLS S/D, PVT, WELL AND SEPTIC 0 LOT 16, TU TUMENA TERRACE S/D. PROP TY PS UNDEVELOPED, EXCEPT SEPTIC SYSTEM UPGRADE1 L❑T 1, BK 2, SECLUDED HILLS PREPARED F❑Ri MATT DIMMICK PREPARED BY, ALASKA WATER & WASTEWATER DATES 10/19/97 T7RAWNi CARNESS SCALE; 1" = 100' TRENCHES, 50' LONG EA. LANE SEPTIC' AREA 2, BK 2, UDED HILLS. WELL & IC SYSTEM a a���•OF•A 5��0 a e y A. ss, Q. '•, 7953 cp0�� aAroiesa onoQcr I TEST HOLE MT J�ZABEL' FLOW PLITT C/O MT L�. O o MT 'BULL Rl VAL THE CONTRACTOR SHALL HAVE E UTILITY EASEMENT FLAGGED BY A REGISTERED LAND SURVEYOR NEW TRENCHES ARE 50' LONG EACH. NORTH PROPERTY LINE C/O 10' UTILITY EASEMENT NOTE, THERE IS A ELECTRIC SERVICE LINE THAT RUNS FROM THE N.W. CORNER OF THE LOT, C/O TO THE HOUSE, THROUGH THE PROPOSED TRENCH SITE. THE CONTRACTOR SHALL HAVE THE LINE REROUTED IF NECESSARY. ABANDONED POWER POLE FOR PREVIOUS OVERHEAD SERVICE. POLE CAN BE REMOVED IF NECESSARY. W i ¢ i J - XISTING SUMP i9 ¢ pq THIS AREA F THE LOT HAS A PROX. j 7' TO 9' O FILL EXISITING 3 IN IT. STUM S & BEDROO USE DEBRIS. EW FOUNDATION C/O 1 DOUBLE. C/ A.SUMED LOCATION OF SERVICE LINE \-F M HOUSE TO EX STING SEPTIC NEW 10 0 GALLON SEPTIC TANK THE TA K BURIAL RATING SHALL BE COMP TIBLE WITH THE ACTUAL BURIAL PTH. INSTALL A C/O AT THE SOUTH END OF THE OLD TRENCH. THE EXISTING SEPTIC TANK IS BURIED RELATIVELY DEEP. IT IS APPROXIMATELY 7 FEET FROM THE GROUND ELEVATION TO THE TOP OF THE TANK. IT IS RECOMMENDED THAT THE CONTRACTOR 'PICK—UP' AS MUCH ELEVATION AS POSSIBLE STARTING BACK AT THE FOUNDATION. SEPTIC UPGRADE: LOT 1, BK Z, SECLUDED HILLS EXISTING WELL STING 1500 GAL ST a BE FILLED WITH SOIL. PREPARED FOR: MATT DIMMICK PREPARED BY ALASKA WATER & WASTEWATER SERVICES DATE; 10/19/97 DRAWN: GARNESS SCALEi V = 30' 1. e 0 Q,� '•, 7953 �4p�o fessio(la THE TRENCH SHALL HAVE A MINIMUM LENGTH OF 50 FEET. BACKFILL WITH NATIVE SOIL AND MOUND. TOPSOIL & RESEEDING SHALL BE RESPONSIBILITY OF HOMEOWNER. MONITORING TUBE (TYP.) — PERFORATED IN DRAINROCK. PROVIDE 2 INCHES OF BOARD INSULATION IF SOIL COVER IS LESS THAN 3 FEET. INSULATION SHALL COVER THE ENTIRE WIDTH OF THE TRENCH. FILTER FABRIC SILT BARRIER DRAINROCK SHALL BE SCREENED PER M.O.A SPECIFICATIONS. • e e \ e TOTAL DEPTH OF w e DRAINRQCK e TRENCH SHALL LL • �� NOT EXCEED 6.5 0 o o e FEET. 5 FEET WIDE NOTE: 1. TRENCH SHALL RUN PARALLEL TO THE SLOPE CONTOURS. 2. FOR LOCATION OF CLEAN -OUTS AND MONITORING TUBE SEE THE SITE PLAN. 3. CONSTUCTION PRACTICES, AND MATERIAL SPECIFICATIONS SHALL COMPLY WITH ANCHORAGE MUNICIPAL CODE 15.65, "WASTEWATER DISPOSAL REGULATIONS". 4. INSTALLATION SHALL COMPLY WITH SPECIAL PROVISIONS NOTED ON THE SEWER PERMIT. 5. SMEARED BOTTOM AND SIDEWALLS SHALL BE RAKED. 6. BOTTOM OF TRENCH SHALL BE LEVEL. 2 INCH MAXIMUM VARIATION BETWEEN HIGH AND LOW SPOTS. DETAIL FOR 5 FOOT WIDE SHALLOW TRENCH: PREPARED FOR: MATT DIMMICK ALASKA WATER & WASTEWATER DATE: 10/19/97 1 DWN: GARNESS I SCALE: NTS 4 INCH DIA., ASTM F810 PERFORATED PIPE. HOLES DOWN, PLACE 2 INCHES OF DRAINROCK OVER TOP OF PIPE, AND ACROSS ENTIRE WIDTH OF TRENCH. PIPE SHALL BE INSTALLED LEVEL (WITHIN .01 FEET). A. G, Nmwj5 QI F fA Municipality of Anchorage DEPARTMENT" OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Ni ter= D (MM 1qz— DATE PER LEGAL DESCRIPTION: LP�'�K 2 Township, Range, Section: Sisc�Vt��n F�tl�l s SLOPE SITE PLAN (FEET).-t.l 1 r-1 VL I 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 T7+rr+ 02 6p111r5 gftow�J o2�a4JIG slums ('s w -r) sw-sM j SM ao/ IE M L ao,+DE��`T'1(oF+ tom' 51 L;r 0R, GM B.o-4 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depthtri Water After Monit DR y Monitorinft? (— Date: Reading Date Gross Net Time Time 11110 hto Net a W Drop so A1C. - ir o U (24 + ,. /o ,o '40 30 3 qr„- Z.- 66 e) q a 3. 39 „+ 20 IL____JI PERCOLATION RATE� ' � (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 61/25' FT AND 6 -IF FT COMMENTS V1SIlAt( I�Ui �� L�-ll� 0 b GPDIF'r7- PERFORMED BY: V_eaip� ” `" F"S� I�ss CERTIFY THAT THIS TEST AS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: �/� _ 72-008 (Rev. 4/85) /ci 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION i ENVIRONMENTAL ENGINEERING DIVISION \ 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 \ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE W "�,4AI Awr % l_ ❑ UPGRADE MAILING ADDRESS /7 ] 6a LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well Absorption area Dwelling PERMIT NO. DISTANCE TO: ✓, r c� Manufacturer�p Mater No, of compartments Nh Liq. capacity in gallons �� IF HOMEMADE:Fi Inside length Width Liquid depIll DISTANCE TO: Well Dwelling PERMIY NO. Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well Foundation Nearest lot line - PERMIT NO. Lu S J LL z No. of lines Length of each line Total length of lines _j Trench width Distance between lines F z Lu '�'� ,�'i inches N Top tile to finish Material beneath the cc of grade ,, Total effective absorption area __ o �.& 7R inches IIS Length v� Width Depth PER M WIT NO. w aF— Type of crib Crib diameter rib depth Total effective absorption area wa Lw DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. W x/ 7-1,0 Ile DISTANCE T0: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 4e .�' r«n:,�, P 1,0291 'D//� SOIL TEST RATING INSTALLER ; +. REMARKS J L Il% .l id 9 . N T7 431- �4 A — r Robe D. Fcitllllrea a--141i fF r APPROVED LEGAL L 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMEN'T'AL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ^� PHO/NE ❑-NEW ❑ UPGRADE MAILINGADDRESS LEGAL DESCRIPTION h4) 4_L) LOCATION NO. OF BEDROOMS )2. N IOW sr. '. %.M• Well / Absorption area Dwelling / PERMIT N U Y DISTANCE TO: 1!_ ` Cn�- �,' &J12 s _ I— z Manufacturer -- > _ Material No. of compartments W F w Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth - L F'Z_� D/f D DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons O Well Foundation Nearest lot line PERMIT NO. DISTANCE TO: #41C No. of lines Length of each line Total length of lines Trench width Distance between lines inches cc Top of tile to finish grade Material beneath tile Total effective absorption area O inches Length Width Depth - PERMIT NO. 4 Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class iNDI Depth Driller a Distance to lot line PERMIT NO. I/ W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOI L TEST RATING Z32 L s INSTALLER r IV4 C c)n/Si: REMARKS _ � I I A HL 'h" I ANCHCRAG r MUNICIP -- LI Y O ENVIRON NTA PR TEC IO APPROVED DATE LEGAL® RECEIVED 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE Departmen, if Health and Environmenta. Protection � n 825 L Street, Anchorage, AK. 99501. Wd 264-4720 HANDWRITTEN PERMIT Permit #� WELL AND/OR ON-SITE SEWER PERMIT Applicant: e ' �fs��__ Mailing Address: Location: l L?��7 S�_c. �_7 Phone Number: _ SLn•� `f�?� Legal Description: _hof/ C �F�_&J_/-� /16 Lot Size: ^yS-SS1^,'r Type of Soil Absorption System Is: Trench: i Drainfield: _ Seepage Bed: Holding Tank: ^ Maximum Number of Bedrooms: _-3 Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH __ /�(.__ LENGTH .__> SGRAVEL DEPTH _ Co,S WIDTH The length dimension is the length(in feet) of the trench or drai.nfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). ae aE REQUIRED SEPTIC(HOLDING) TANK SIZE = 1Df> Co GALLONS .h. Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number Df residences that the well will serve. * * * TWO(%) INSPECTIONS ARE REQUIRED aF ao- at 3ackfilling of any system without final inspection and approval by this department will be subject to prosecution. ninimum distance between a well and any on-site sewage disposal system is 100 feet Lor a private well or 150 to 2.00 feet from a public well depending upon the type Df public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. :)cher requirements may apply. Specifications and construction diagrams are available to insure proper installation. rr * * PERMIT EXPIRES DECEMBER 31, 1 �) 3 3 aE # I certify that: (1) I am familiar with the requirements for on --site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. Signed: v!L Issued b Applicant Date: SWP/024(1/81) _/d/SugL fa" SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION • TEST 025 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: F/62 /V% DATE PERFORMED: a zl _ / LEGAL DESCRIPTION: NLUII !��T I �M 2 - SLOPE SITE PLAN DEPTH (FEET) 1 2 3 4 5 6 7 8 9 10 17_ 13 —14 15 16 17 18 19 okq qA Ls � f C s�q [ p¢ L 4S. 14 y1 �••.O.A �1�. 8PRc)WN��F.1 C� 1 O•° aov '3895- � ��' WAS GROUND WATER NO (4 ENCOUNTERED? _ IC IF YES, AT WHAT DEPTH? 9 L E Reading Date Gross Time MIN. Net Time �. Depth to �r Water Net Drop 2- 2912 „ 3 :3 �10 1'1 e y; 00 b n 20 4�'jC14V.�® PERCOLATION RATE 2,2 (minutes/inch) TEST RUN BETWEEN FT AND *y�_. FT COMMENTS �7l w1UNf�ID��lTy 0a gNCh!©) qG �iVVIR 7F rfF.q�r� & s �iVirit.iV(r�l, NK�IECT10 N 'JUN 01985 -RECEIVED, LOCATION OF WELL (Please complete either la, Ib or Ic.) I - BoroughU11.9I ub ivi ion Lot Block Ib. I/.q1 n. c�uded Anch1 2 1c DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Street Address and Area of Well Location 2. WELL LOG Mot.?iol Type Eflluvium: broe,n color,medium hardness. Les' .11 a.f know ledge Till: grey and hard. Alluvium: brown color, medium hardness. Till: grey and hard. Alluvium: lii-ht brown color, medium hardness. saturated. Alluvium: br,_nvn color and soft. `Pill: grey and hard. F,lluvium: light brown color and soft. £and & Gravel: grey, with water 1 gpm. `rill: gree and hard. Alluvium: br,) n color, medium _ hardness. Sand & Gravel: grey, with water 2 gpm. Alluvium: brown color, medium hardness. WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol B Geophysical Surveys Drilling Permit No. _ A.D L. No. Section No. Township N E) Ronge ED Meridian s� W❑ _ 3. OWNER OF WELL: Terry Fielder P.O. Box 3-650 ECB Address Anch. , Ak. 99501 Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLETIDN Surface 3 'TOT-7— Bot lam 32> if_ 11 — 0 46 8, 10L 122' 138 141 168 184 186 205 230 232 water: 1 288 !tllluvium: brown, med. hardness. 2;;9 Sand: urwrr;, ., th ,,,:ter; 10 gnm. 322 46 6. {Cable tool Rotary 0 Driven 0 Dug 15_Waler Tom Pe,olure _ 11 Auger O Jelfed ❑ Bored O Olha,: Les' .11 a.f know ledge ]rig; belicf� 7.USE: U Domestic 0 Public Supply 0 Industry 87 1] Irrigation El Recharge 0 Commerical Regisiefed Gusiness Name 11 Test Well [D Other: 1 OL B. CASING Threaded ® Welded i—p`\-_.. Do? 12(' diom. O in to 327, fl. Depth Weight 17IDs./ff. iee._�r.� 4utno, l He press ntoliva diam. in. to ft. Depth Stickup ff. 1728_ 9. FINISH OF WELL: ot)en end. Type: Dlometerl 141 Slot/Mesh Slee:_ Length: 168 Set between ft. and ft. 184 _ Backfilling pock rGravel 10. STATIC WATER LEVEL: 273 J 11. 1�7 3 186 Date Above or 9 Below land surface Equipment used: sand line 205 2317 II . PUMPING LEVEL below land surface and Yl E'LD \ 0 7,13 11. offer 2 hrt. gum pin Uq. P. m.7, 232 ft, after hrs. pumping g. p. m. 12.GROUTING Well Grouted: ® Yea E] No 288 Maleriol: u Neal Cement 0 other: natural 13. PUMPS (it available) HP rn Length of Drop Pipe ft. capacity g. P.m. m 289 I $ubm JetE] Cenlrifical E] Other r n a 3(2 14. REMARKS' 2 0 23 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15_Waler Tom Pe,olure -------- ° F _�) C_ This well Was or, !led under my jurisdiction and this report 15 true 10 the Les' .11 a.f know ledge ]rig; belicf� Regisiefed Gusiness Name Con!iecl L,Ca, -se kumeer ' Add,ess. S11- ' 'n{ 'J5c;0 Ghu,"ia;;'::.995'' Signe.: -. /.,.� �- i—p`\-_.. Do? ------ -- iee._�r.� 4utno, l He press ntoliva Copy WHITE - Slel• S_.=° . CA -4:,h c' • --c Municipality ofAnchorage I _-NA,.; On -Site Water and Wastewater Program < (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-343-09 1. GENERAL INFORMATION Complete legal description SECLUDED HILLS BLOCK 2, LOT 1 Expiration Date: /- �;) - ( 7 Location (site address) 13201 BADGER LANE, ANCHORAGE AK 99516 Current Property owner(s) BROOKFIELD GLOBAL RELOCATION Day phone Mailing address Real Estate Agent 455 TAFT AVE GLEN ELLYN IL 60137 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 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 ElCommunity ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by:'>� d46/ Date: �C 7 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Z G2 Waiver Fee $ Date of Payment S / !�6O Date of Payment Receipt Number C2 t 5 �_ r:) Receipt Number COSA # 0 S( 1 (0 I (j 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. Name of Firm _ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 4/08/16 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen OFA \ encroachments, deficiencies or discrepancies exist. Ar �� Z 4TH`, 6. DSD SIGNATURE System #1 Approved for bedrooms. 4n KEN ,;, UT �F r System #2 Approved for bedrooms. ��tE55loNA�' i Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: 5 - The 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 engineers work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA bWe sheel_1a1a12Ax If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system ; Certificate of On -Site Systems Approval Checklist Legal Description: SECLUDED HILLS BLOCK 2 LOT 1 Parcel ID: 017.343-09 A. WELL DATA Well type PRVT Date completed 111711983 Total depth 323 ft. If A, B, or C provide PWSID # Well Log (Y/N) Sanitary seal (Y/N) Y Cased to 323 ft. FROM WELL LOG Date of test 11.7.1983 Static water level 273 ft. Well production 10 g.p.m. Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 3118122016 ft. g.p:m. WATER SAMPLE RESULTS: Coliform G colonies/100 mL Nitrate %V 9 mg/L Arsenic: A10 ug/L Date of sample: Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Tanksize 100081000 gal. Number of Compartments 281 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 311 812 01 6 Pumper A+ C. ABSORPTION FIELD DATA Date installed 8.23.1983 Soil rating (g.p.d.W or ftz/bdrm) 237 Length 55 ft. Width 2.5 ft. Date installed 11119978111311998 Cleanouts(Y/N) High water alarm (Y/N) N System type DEEP TRENCH Gravel below pipe 6.5 ft. Total depth 10.7 ft. (Measured 3/25116) Eff. absorption area 715 112 Monitoring tube Y Depression over field N Date of adequacy test 312512016 Results (Pass/Fail) PASS For 3 bedrooms ,. Fluid depth in absorption field before test 0 in. Water added 650 gal. New depth 14 in. Elapsed Time:1180 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 1001+ Public sewer main 75'+ Sewer /septic service line 251+ Animal containment areas 501+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access(Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 1004 On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank 100'+ Manure/animal excrete storage areas 100'+ Building foundation 5'+ Property line 51+ Absorption field 5'+ Water main 101+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main 104 Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 501+ (NONE KNOWN) Wells on adjacent lots 1001+ F. COMMENTS 1998 trenches were saturated Presoaked 1983 trench per code and tested G. ENGINEER'S CERTIFICATION / certify that 1 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. ir4q OF 1 Engineer's Printed Name KENNETH M. DUFFUS / Date 41812016 �.I /� 9 COSA canary sheet_2b-15.doc KEN Du r in. • Municipality of Anchorage On -Site Water and Wastewater Program u- (907)343-7904 1 gg rV ti CERTIFICATE OF ON-SITE SYSTEMS A F ROV49 2016 �\ z Parcel I.D. 017-343-09 Expiration Dat o� 1. GENERAL INFORMATION Complete legal description SECLUDED HILLS BLOCK 2, LOT 1 Location (site address) 13201 BADGER LANE ANCHORAGE AK 99516 Current Property owner(s) JAMES A. BURD Day phone Mailing address Real Estate Agent 13201 BADGER LANE, ANCHORAGE AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 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 ❑ WaiverNariance request for: Distance: Received_by: ..g y — Datez_�:_tU COSA to be released to the engineer, unless o herwise requested by the engineer. COSA Fee $4� Date of Payment Std l Receipt Number CU�34pi, jJ � COSA# (DSC411-115-rl 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%ofl. astewater 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 4(08116 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. / �� L�l� [( TH f 6. DSD SIGNATURE �. System #1 Approved for � bedrooms. KE N+ oue 1 ,na res System #2 Approved for bedrooms. Disapproved. ,\sslca, e r Conditional approval for bedrooms, with the following stipulations: PROGRAM � N'�FyrS V�G�cJv - ByT.vm--- — -- — _. _ ...Original -Certificate -Date:-- :1 �,-- 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10.10-12.dw If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system _ Certificate of On. -Site Systems Approval Checklist Legal Description: SECLUDED HILLS BLOCK 2, LOT 1 Parcel ID: 017.343.09 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # _ Date completed 11/1/1983 Sanitary seal (Y/N) Y Total depth 323 ft. Cased to 323 ft. FROM WELL LOG Date of test 11.7.1983 Static water level 273 ft. Well production 10 9 - p.m - WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 0.669 mg/L Arsenic: ND ug/L Date of sample: 311812016 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Tank size 1000&1000 gal. Number of Compartments 2 & 1 Foundation cleanout (Y/N) Y Depression over tank (YIN) N Date of pumping 318/2016 Pumper A+ C. ABSORPTION FIELD DATA Date installed 8.23.1983 Soil rating (g.p.d./ft2 or ft2/bdrm) 237 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 3/18/22016 276 ft. 3+ g.p.m. Collected by: ARCTERRA Date installed 1111997&111311998 Cleanouts(Y/N) High water alarm (Y/N) N System type DEEP TRENCH Length .55 ft. Width 2.5 ft. Gravel below pipe 6.5 ft. Total depth 10.7 ft. (Measured 3/25/16) Eff. absorption area 715 If Monitoring tube Y Depression over field N Date of adequacy test 3/25/2016 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 650 gal. New depth 14 in. Elapsed Time: 180 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump an" level at _ in. Datum Size in gallons "Pump off" level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout 100'+ Holding tank Manure/animal excrete storage areas 100'+ Building foundation 5'+ Property line 51+ Absorption field 51+ Water main 10'+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main 10'+ Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 1001+ F. COMMENTS 1998 trenches were saturated. Presoaked 1983 trench per code and tested. G. ENGINEER'S CERTIFICATION l 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 KENNETH M.DUFFUS Date 41812010 COSAcanary sheet 2.6-15.doc i f1Fti A r\ KINK of g ��\ e W / stogy flaw 30' 25' K C C C C C U BADGER �y LOT 7 `�- BLOCK 1 ANCHORAGE RECORDING DISTRICT, ALASKA AS BUILT OF: SECLUDED HILLS SUBDIVISION LOT 1 BLOCK 2 PLAT 81-1 SURVEY CERTIFICATION: I, John L. Schuller, have conducted a physical survey of this property as shown on this drawing and that the improvements situated thereon are within the property lines and no enchroachments exist other that noted. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. 16-024 Y 3. 2016 JLS -1"=30' Z NUMBER: BOOK 2937 160126 O = FND REBAR .� OF A" N *.4. s "J L. SCHULLER: o 'ter F: LS -10408 gym% 9 zo N N 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax Parcel I.D. # MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & HUMAN SERVICES3 Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY --/ APPROVAL FOR A SINGLE FAMILY DWELLING /� q -]n 2 / © i /— 3+3 o 9 HAA # �11_lJ��", i y _ 1. GENERAL INFORMATION 1 Complete legal description LLQ f 1 J, Rk Z, Sir�-Lu/Oi5P 14ttL�S Location (site address or directions) ! Property owner P'It'I�K.- Day phone X44----(3 Ib Mailing address F -".t 64e_E -- Lending agency ���� ' � 1'"In(L-CASE Day phone Ai -76 Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone -' NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) From MOA%21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 7320 Address Engineer's signature v `� S' NJ g!-1'_J_V 6. DHHS SIGNATURE Approved for 1_0U2, bedrooms. By: Disapproved. Conditional approval for Phone— Date hone ff; Date Z11-7 l56 taaJ'.� M i•••Nii'�•..• of r A. Garnets W o •7953 V��� y o • � bedrooms, with the following stipulations: Additional Comments IS !S Q DUO�Ica 1 -e CeO t(CcL P r�iia 2 Z 111Tlrlr, Date 2 / g 93 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M (Rev. 1/91) Back MOA #21 m t MUNICIPALITY OF ANCHORAGE ° DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # d (� _ 3,1-3 — C9 HAA # �� Li"1-1Q_��r 1. GENERAL INFORMATION Complete legal description IN �� Z 5'ECLUO� •I{ICCS Location (site address or directions) �D �a OLS (r4'� Property owner MA- , i LO P t Day phone 2-44-- 101 Mailing addressLtNL- Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be heldzor pickup. 2. NUMBER OF BEDROOMS: —>� ; 3. TYPE OF WATER SUPPLY: Individual well �- Community well evaL Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA N21 5, STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Alaska Water & Wastewater Address Engineer's signature II jco- v 3 M rr'[&0i i!.�1.1 i% 7 744` 1S7'/�l l4 i D(^'1�-ltCf !i/zo/y7 6. DHHS SIGNATURE Approved bedrooms. for Disapproved. Conditional approval for Additional Comments By: r/ Phone 337-617/ — Date i?Ev15 bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA k21 •r'vi%'�"HLIIi VI' HI4L1iii.. s>. NVIRQNMENTAL SERVICES DIVISIUI NOV ? 0 1997 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES RIECEIVE Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist H /t'C,S Legal Description: L� ►i , z, SCG( Ut7� Parcel I.D.:_ D 1 %^ A. WELL DATA Well type Fy7' If A, B, or C, attach ADEC letter. ADEC wa rAAsystem number / Log present (Y/N) 1 F� Date completed 6/ T Total depth a 3 Cased to �2 3 Casing height (above ground) 2 Sanitary seal (Y/N) _ y I--- S Wires properly protected (Y/N) FROM/T8)'4- LOG Date of test g!3 Static water level _a -7 .3 Well production _ /0 g.p.m. AT INSPECTION 3,3 -1- g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate 6' ` Other bacteria Date of sample: I'l �I �1` Collected by: LAtl_S IV �,L,.� B. SEPTIC/HOLDING TANK DATA i000 6nous.J TWo evr-iP411�46� Focuow 'Number Date installed 1 Tank size /O f70 Number of Compartments_ Cleanouts (Y/N) y Foundation cleanout (Y/N) _ Depression (Y/N) Date of Pumping N Ijfs Pumper Jp�j1A tj High water alarm (Y/N) /J It4 C. ABSORPTION FIELD DATA N Date installed �/ `� 7� Soil rating (g.p.d./ft2 oto) 19 _ System type _ Length /00 Width ✓� Gravel thickness below pipe '' 3 _Total depth •rO A -L Effective absorption area O Z / + Date Monitoring Tube present (Y/N) Y Depression over field (Y/N) N 0 Ft � b Psv7EA Fluid depth in absorption field before test Fluid depth 72-026 (Rev. 3/96)* (ins) Mi (past 12 months) (Y/N) Results (Pass/Fail) For i1' ��Immedia�eJ atterga water added (in.): Absorptio-ra a ='-��_ g.p.d, /Vi If yes, give date D. 0f<T STATIO N Date installed Size in gallons Manhole/Access (Y/N) mp on" le "Pump off" level at* High water alarm level at* *Datum Cycles E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot t 10 /+ On adjacent lots 1570 + Absorption field on lot too On adjacent lots 102 `} Public sewer main N Ilk Public sewer manhole/cleanout AJ 14 Sewer /septic service line !f - Lift station N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation )0 Property line Absorption field 4 - Water main/service line l�l� Surface water/drainage 100 + Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: f Property line �� /'� Building foundation %d 4- Water main/service line Surface water / 00 iL Driveway, parking/vehicle storage area Curtain drain N 0 ci!r kri0 LAJn/ F. ENGINEER'S CERTIFICATION Wells on adjacent lots /Do 1 certify that t hay"et)��iine u %d inspections and review of Municipal in conforman witd �q A uide ines in effect on this date. Signature V1V03u�O Odb OUEi Y0�69 Engineer's Namediffyaur g !+ �S al,C ainess ; ,�� 1, CE -79.5 Date / / S �y:� 21;vo E HAA Fee $ 2" ' 0-6 Waiver Fee $ Date of Payment J// 7-0 /9 % Date of Payment Receipt Number -�7410� �7��� Receipt Number 72-026 (Rev, 3/96)* Alaska Wateir & Wastewater 8471 Brookridge Drive — Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers June 13, 1997 Prudential Vista Real Estate 4241 B Street Anchorage, Alaska 99503 —'in- Attn: Matt Dimmick Hy A. Garness < ��.N CE -7953 Subject: Inspection of Private Well & Septic System. Lot 1, Bk 2, Secluded Hills S/D. Dear Matt: Per your request, I performed an inspection of the subject well and septic system. The results of the field investigation and adequacy tests are summar}zed as follows: r G/1 }q -r A. WELL: On the day of my inspection the static level was 284 feet below the top of the casing. Water was pumped from the well at a rate of 6.6 gpm for 30 minutes (198 gallons). This caused the level to drop down to pump, at 323 feet! The flow was reduced to 3.3 gallons per minute for the next 105 minutes (347 gallons), during which time level quickly stabilized in the 300-305 feet range, and remained there throughout the rest of the test. In short, it will continuously produce 3.3 gpm. The well recovered completely in less than 30 minutes. Based upon this data it was determined that the capacity of the well exceeds the Municipal requirements for a 3 bedroom house (450 gallons per day). The well will produce greater than 720 gallons in four hours, as required for FHA financing. B: WATER QUALITY: Water samples were taken on 5/30/97 and analyzed for nitrates and bacteria. The nitrate levels were undetectable (10 mg/I max. allowable), and no bacteria was detected. In short, the water quality is good in regards to these parameters. C: C SYSTEM ADEQUACY TEST: It is my understanding that the house was vacant for the past sev wonths; therefore, the septic system had to be presoak before an adequacy test could be performed. 74w drainfield clean-out was dry prior to the presoak and had about 3 feet of thick, black, pasty solids i_n__t1Te4xittom of it. I had the pumper vacuum the solids out of the pipe prior to filling it with 1500 gallons of w -e�on 6/10/97). On 6/11/97, the liquid level in the field was 101.5 inches below th`e'tup_ctf the pipe. The invert of the drainpipe is 72,5 inches below the top of the pipe. In short, the liqu_RTIeve was 29 inches below the drainpipe invert. Water was added to the clean-out at an average rate of 2.9 for 2 minutes (840 gallons). The liquid level rose 16 inches (85.5 inches below the top of the pipe),-Whic.,h corresponds to 52.5 gallons per inch. Fourteen and one-half hours later the level had dropped at to`taLof 1.75 inches, indicating a recovery of 6.3 gallons per hour (152 gallons/day). Based upon this da , it was clear that the system would have to be filled completely if it was going to have a chance o sing an adequacy test. On 6/12/97 the water level in the syst�errn as 87.25 inches below the top of the pipe. Water was added to the system at a rate of 3.42 gpm for a al of 185 minutes (633 gallons) the liquid level rose 11.75 inches (75.5 inches below the top of the p' e), which is 3 inches below the drainpipe invert. In short, the system was filled to 96% capacity. Thereco�very was monitored 4.5 hours later and the level had dropped 1.25 inches, indicating an absorption'of-IS,gallons per hour, or 360 gallons per day. The municipality requires that a septic system serving a 3 bg room house have an absorption capacity of 450 gallons/day. Based upon this data, the septic system does not meet the M.O.A requirement of 450 gallons per day (3 bedroom house). The options at this time are to install a new septic system, or attempt to rejuvenate the existing one. If you have any questions, please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Sincerely, e G Jeffrey arness, I., M.S. Prinei al 1,4171.1-20-1997 09:12 CTE ESI FIHCHOPHGE C%T&E Environmental Serviove Inc. .,rauarav CT&E.Re?.# 977060001 Client Name AK water & Wastewater Services Project Name/# �5-Ecluded Hills S/t) Lot 1.Blk 2 Client Sample lD ,58cluded Hills U) Lot 1,131k2 Matrix Drinking Water Ordered By PWSH) 0 Parameter Res_ tte POL Units Nitrate•N 0,323 0,100 ms/L 907561530 P.02/03 Client PO# Printed Date/Time 11;20.'97 09:02 Collected Date/Time 11;14/97 12:15 Received DatelTime 11/14'97 14:10 Technical Director.! gtepgrn C. Ede Released By Ad//a " � i1P Allowable Prep Analysis Method LIInItS WIN Cote !nit 9PA 300,0 10 Flax 11/14/97 TM.W Waters DePertment Analyses Total coliform 0.00 collIOML BM16 92228 11/14/97 TMW MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date '7 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Hlu.G Loi i 3tWCL. Z 7-r2ri 2 36' 5 2-7 Location (address or directions) 13Z't r3Aoga(� L/aN� ANC�LU�FELII ��� (b) Property Owner r71L Telephone: Home Business Mailing Address (c) Lending Institution U13 Mailing Address 440 GF. 36TH AV6 (d) Real Estate Company and Agent Address Telephone Telephone _ l!�'lo' — �35 ( (e) Mail the HAA to the following address: or: Check here ❑, if hold for pick up. List contact person and day phone number below. CAO, ,5J AfN - Z5+q - &45 ) 2. TYPE OF RESIDENCE Single -Family 0 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 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 fRev 8/881 Front Vea (98 ,9 Aad) szo-z4 Z to Z abed >IAOM s,aaaulbua leuolssaload aql ui suoissiwo ao sioaaa Aol alglsuodsw lou si abejoyouy to j!Iedioiunw aql panssi si aleoilplaao e aaolaq elep azAleue ao suoiloadsui pnpuoo lou op SHHO to saa (oldw3 'sluewwinbaa @leis pue Ieaapal uiepao Alsges of aapao ui suoilnpisui 6ulpual Alagl pue sawoy to saasegoind of (solinoo e se sigl saop SHHO aql e�sely to alelS all u1 paaals169a Aaouibua leuolssaloid luapuadapui ue Aq anoge 9 gdea6eaed u1 uaA16 suogeluasaadw aql uodn Aluo paseq saleollllaao !enoaddy /l(aoylny glleaH sanss! (SHHO) saolna@S uewnH pue gl!e@H to luawueda( @beaogouy;o AlqudiownW ayl NOLLf1V0 Ienoaddy IeuoilipuoO to swial leuolllpu00 panoaddesl(3 panoaddy ale( r Aq swooapaq aol panoaddy 1VAOaddV SHH(3 '9 B Epea (aye c m:)00 ,byb�d • �Beo Heee ee••0LL70,,9VB�ef�s�+00 90 se i� ®Q �� goo, of ,e o e v -aO ale( SSE)Appv l ' v auoldalal 3 ci ; -x— Wald to aweN voiloadsui sigl to alep eql uo loage ui suollelnft pue 'saoueu!pao 'sepoo alelS pue ledlolunVI Ile ql!m aoue1ldwoo ui si welsAs lesods!p aaleMalseM ao/pue /Iddns AaleM alis-uo eql 'uo!loadsui pue uolle6llseAul Aw woil pue sa!ll a6eaogouy to AllledlolunW aql wojl paulelgo uollewaolul all uo paseq legl AlpaaA AegiAnl 1 -ulaaaq paleoilow aanlonais to adAj pue swooapaq to aagwnu aql Aol aienbape pue leuo11ounl'aps sl walsAs !esods!p AeleMalsem ao/pue (lddns aaleM alts-uo ayl legl sMogs lenoaddy Aj!joglny glleaH sill to uo11e61js9nul Aw lell Aj!AOA I 'Molaq umogs alep uo1lep1leA aql to se pue olaaaq paxllle leas Aw Aq pallllaao sy NOIIVVYUOjNI (INVviva `HOHV3S 3113 `S1S31 `SN01103dSNi `JNIOIAOad Wald ON1833NION3 -9 MUNICIPALITY OI' ANCh_xAGE ENVIRONMENTAL SERVICES DIVISION MUNICIPALITY OF ANCHORAGE (MOA) APR 3 19$7 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1964 264-4744 E(EICEIVED A. WELL DATA Well Classification Legal Description: L -GT I e),LOCAC. If A, B, C, D.E.C. Approved (Y/N) _ r tot t Li 6• , I V ft ('t51 Well Log Present (Y/N) � `�— Date Completed !( �" Y Id TMI`� i1: iti �i I ( rjP� r-- Total Depth �� Cased to 3 % — Depth of Grouting nr.A I Static Water Level Casing Height Above Ground l.2,` Pump Set At Sanitary Seal on Casing (Y/N) G Electrical Wiring in Conduit (Y/N) yL Depression Around Wellhead (Y/N) No Separation Distances from Well: / To Septic/Holding Tank on Lot I Oq — ; On Adjoining Lots It 100 To Nearest Edge of Absorption Field on Lot -I- 100 I ; On Adjoining Lots -t` To Nearest Public Sewer Line -1''7's r To Nearest Public Sewer / Cleanout/Manhole -t I ood To Nearest Sewer Service Line on Lot Water Sample Collected by 015 to `LAU 0 D(5P 5 ; Date A 1 -7- W, Water Sample Test Results Comments 13. SEPTIC/HOLDING TANK DATA S s Date Installed' Size No. of Compartments Standpipes (Y/N)Air-tight Caps (Y/N) Foundation Cleanout (Y/N)`� Depression over Tank (Y/N) NO Date Last Pumped 1—I Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) ;for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: i i To Water -Supply Well joq To Building Foundation ) 5 l To Disposal Field 5To Property Line p _ To Water Main/Service Line r Lir To Stream, Pond, Lake, or Major Drainage Course ? (LSU Comments =� (:fJsi7L I N'�Ffi-i�i'�1 a'U}1y1� �t1fC1P)IUl`1'�I Page 1 of 2 72-026 (P2v W861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ���� f � f3iyol Type of System Design Date Installed Length of Field 5E� Width of Field f Depth of Field 141 Gravel Bed Thickness �%• Square Feet of Absorption Area Standpipes Present (Y/N) Depression over Field (Y/N) ICU Date of Last Adequacy Test Results of Last Adequacy Test `• 5 R-TI�PA= IZC 3 3D�,M Separation Distance from Absorption Field: To Water -Supply Well To Property Line To Building Foundation Lot `r I(D To Water Main/Service Line 4 26, To Stream/Pond/Lake/or Major Drainage Course On Adjoining Lots To Existing or Abandoned System on -F- ( C1) ° To Cutbank (if present) NdT V12–us�� f 7 L) To Driveway, Parking Area, or Vehicle Storage Area * (� Comments ��tFAUNHU 1IJ`3NQW1J P–I OP • D. LIFT STATION �,;/A Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments " 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 date of this inspection. Signed Zi nnt �",VN Date l ' n '^ Company( `c j2 i G' y MOA No. Receipt No. D O �— U D `el f; Date of Payment % ; 3 �(� ��O oo,. c acapaon000 000aanou�•^ i� n Amount: $ lG � f<' R` o Care S. Meys ; v G a Page ` �`� pad°a eo na ao0o'�yJ e 2 of 2 � q© �� S�D�P ��;• 72-026 fRev 8186) Back r2�-P ){� ��tlt7 o r EaeoQ r, aonsoa ,ao '+oosco°000-^ €� •nn o e®R a Car y S. Me y r 4 0# 353 ° r � foo Location: BESSE, EPPS & Parrs 2220 EAST 88 AVENUE ANa103AGE, Ax 99507 (907) 349-6451 WATER WELL TEST Date: -4,/ Subdivision: �i Cl-. N - D H ILLI ) Lot: I Block: — Client's Name: /` o I Cr Address: 1 2-o 1 bApC&P t -ANC> Mcbffl�LA4GF 1, AL Tester: Grp V11c�(C[z Initial Reading on Meter: I O 0 TIME GPM GALLONS A VOLUME GALLONS TOTAL VOLUME 14-: 1 C, c 1A zb 2-0 NOTES: / u t�IGki�7� i� cf��1i { A c�r��I'r �r�'f VVGII-m Production Rate: 6, 17 GPM 24 --Hour Caoacity7./K?) Gallons MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Descriytion (include lot, Application Date L" ,-lo rs' ck, subdivision, section, township, range) Location (address or directions) (b) Applicants Name 7'9e&4'1 Telephone - Home Business3y "//33 Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer E:I ; Other L-7 (explain); (d) Lending Institution _ Telephone_ Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: r� 2. Type of Residence Single -Family Multi -Family Other (describe) Number of Bedrooms 3. Water Suppl Individual Well 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 E:j Community [-_I 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] ° 5. Engineering Firm Providing Inspections, Tests File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval. shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. / Name of Firm/M/0 1�f��� �}7i�L Ci,1r1AL 5C4'. MR _ Telephone Address -L G� _3 f4 ,f6tl �' Z) AWY1 Date �/Dr7TaaloQ� t�ECol4r'Jt /ADL/77ia�)it PALL fJz�z+Nr� JJL-'Lt/{IS-* deo°. (ENGINEER SEAL) 90 oe000gel 6. DHEP A22roval Approved f-org,9'_j bedrooms Approved Disapproved :q Len By a ce, Date' Conditional .60.°pQ Cif 20000'' 04000°..' , 901 C. Reid, 2251 (2 CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER 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 REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL RR4/ej/D18 [Page 2 of 2] �_�:_ _z-(., t/ (cfe.,. ,z_.,. 7-19--84 � rpt�eFALt I OF ANCHORAG2 DF.RF,_ OF HEALIFI & NZ PP, FOAL PROfECTIOt1 MUNICIPALITY OF ANCHORAGE (MOA) ,1 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 VR 264-4720 L� Legal Description: Z -0 r _:5ec_6.4a /{ELLS A. WELL DATA '%i?–Ai C314! 56.x, 2: j Well Classification *VeTa' If A, B, C, D.E.C. Approved (Y/N) — 4x Well Log Present (Y ) _ Date Completed - ��' ,'"�j Yield X14" Total Depth — Cased to Depth of Grouting Static Water Level 73 Pump Set At — j/3 Casing Height Above Ground % Sanitary Seal on Casin(Y N) Electrical Wiring in Conduit &) - Depression Around Wellhea (Y ) Separation Distances from Well: To Septic/Holding Tank on Lot — ; On Adjoining Lots /00 . f To Nearest Edge of Absorption Field on Lot %/O On Adjoining Lots I&I + To Nearest Public Sewer Line To Nearest Public &ewer Cleanout/Manhole AJ 14 �j )To Nearest Sewer Service Line on Lot Water Sample Collected by Agee /�' 4J/ 0 ; Date Water Sample Test Results 511­7_1310"&/d'e� Comme f504-1 5-rw)Ape. B. SEPTIC/HOLDING TANK DATA C*( ,,f 4WI971 J1k Date Installed X -70-P Size 1-ZV (719 No. of Compartments _ L' Standpipe (Y N) //1�� Air -tight Caps (Y N) Foundation Cleanout (Y/ ) Depression over Tank (YON) Date Last Pumped ,4 Pumping/Maintenance Contract on File (Y N)A_ ; for _ /,/A Holding Tank High -Water Alarm (Y/N) /W %) Temporary Holding Tank Permit (Y/N) -- Separation Distances from Septic/Flolding Tank: To Water -Supply Well lQ/ To Building Foundation _/�� / To Property Line _ w i To Water Main/Service Line _ Course Comments �/E%t3i4�lFfiE!?3l11 sT�PiP�3 //c� Page 1 of 2 72-026(11/84) To Disposal Field To Stream, Pond, Lake, or Major Drainage La7-1 /34C z- 16&& eb fflcL5 7T/L�J e3e-J 3e -t_ zi C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �� d Type of System Design Date Installed �T- 7-3. 9--3 Length of Field s� Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 7/50 Standpipes Present(Y N) Depression over Field (r%N1 A Date of Last Adequacy Test Results of Last Adequacy Test All /Y Separation Distance from Absorption Field: r To Water -Supply Well //0 To Property Line i To Building Foundation -33 To Existing or Abandoned System on Lot A11 On Adjoining Lots /4y 'i" To Water Main/Service Line �/%9 To Cutbank (if present) W_A_ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area / Comments "UPOIN175 S7NOI 3�- D. LIFT STATION Date Installed Dimensions Size in Gallons anle/Access (Y/N) "Pump On" Level at "P p Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pum Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request I certify that I hhav the ked, _rified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Sig! �t `"� Date Company MOA No. Receipt No. ��1 04109.990'. Date of Payment for• q'Y 4� al 06 Amount: $ tao •eo •°° ��NNNN 0° a®••ey® 14 az G' Leroy Reid, Jr. 417 9 Page 2 of 2 A T� ° 0 2257•E oe a\ Q Pic" 72-026 (11/64