HomeMy WebLinkAboutILIAMNA ACRES TR 4AIliamna Acres
Tract 4A
#017-101-22
(Kev Ub/U2/16)
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 f, of 3
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP201330
PID Number: 017-101-22 "OZ,
Dwelling: 9 Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade
Name
Ted & Leslie Kramer
ABSORPTION FIELD
El Deep Trench XWide Trench El Bed ❑Mound
Site Address
5400 E. 142nd Avenue Anchorage, AK 99516
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
985-867-0665
1 5
1.0 GPD/SF
+2.25 / +0.95 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
+2.75 / +1.40 Ft.
Gravel depth beneath pipe
.5/.45 Ft.
Subdivision
Block Lot
Iliamna Acres
Tract 4A
Fill added above original grade
5.45/3.95 Ft.
Gravel length
75/75 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
750 Ft2
2
> 6 Ft.
Well
>100'
>100'
N/A
N/A
>25'
TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
Greer 1,500 Gal.
Surface Water
>1
>1 00'
N/A
N/A
Material
Number of compartments
Lot Line
>5'
>10'
N/A
N/A
NA
Plastic
2
Foundation
>10'
>10'
N/A
N/A
LIFT STATION
Manufacturer
N/A
Capacity
Gal.
Remarks 2" Insulation over absorption trenches.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank D3034Tank to D3034
drainfield
Installer
Denali Excavation
Drainfield D3034 CO/MT D3034
Inspector J. Millette / L. Tidwell
BENCH MARK (Assumed elevation) 100 ft
Inspection151 10/12/20
10/14/20
Location and description
3rd
4,h
Bottom of Siding at S.E. Corner.
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
®� ®OFq� ®�+e
Conditional Approval:
Date
®�®P.•••'""""••:qS �4.
Aw
• 49th
® ............. I..................................
E. ANDERSON• g= W
Septic System
�i
AW
®s No. CE-4381 ,' ��
��'F'°••..,
Approved
( Date 1/1 1 402
6/18/21 •.••°'C�=�®
♦e
Note: this approval does not include well permit requirements.
a�®��®®®S®®®�®®®®®
(Kev Ub/U2/16)
// // // ALTERNATE SITE: CATEGORY III
SYSTEM w/30' LONG x 5' WIDE x .5'
EFFECTIVE DEPTH ABSORPTION
TRENCH. APP. RATE 5 GPD/SF.
1"=50'
2-75' LONG x 5' WIDE x .5'
EFFECTIVE DEPTH
ABSORPTION TRENCHES
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
TH2
PERMIT # OSP201330 PID # 017-101-22
ILIAMNA ACRES SUB, TRACT 4A
A B
MH1 69.2
SV1 73.4
A B
2CO2 78.8
CO1 105.7
MT1 107.5
MT2 136.5
47.5
49.8
54.6
77.85
79.5
115.05
EAST 142 AVE
FEET
0 50 100
GARAGE
10' UTILITY EASEMENT
SHED
TH1
5
7
5
570
565
EXISTING WELL
THREE BEDROOM
HOME
TOE OF
FILL SLOPE
CO4
MT6
CO3
CO1
CO2
MT4
MT3
MT1
MT2TOE OF
FILL SLOPE
1,500 GALLON SEPTIC
TANK w/20" MANWAY.
2CO2
SV1 MH1
ALTERNATE SITE TOE OF SLOPE.
TOTAL HEIGHTS 2.5' ABOVE GRADE.
2' SEPARATION TO GROUNDWATER,
3' TO IMPERMEABLE LAYER.
FENCE.
NO WELL OR SEPTIC
CO2 141.9
MT3 143.3
CO3 130.1
MT4 128.1
MT5 153.2
C04 156.1
MT6 154.6
127.75
128.8
97.0
95.5
130.5
137.2
135.7
MT5
PLAN AS-BUILT
FS
PT3
2CO1
2CO1 28.939.0
ABANDONED TRENCH
6/18/21
PROFILE AS-BUILT
(NO SCALE)
82.55
76.9
83.1
89.4MH SV1500 GAL
SEPTIC TANK 2CO282.3
PERMIT # OSP201330 PID # 017-101-22
ILIAMNA ACRES SUB, TRACT 4A
7/8/212CO1
PROFILE AS-BUILT
(NO SCALE)
75'
81.85 FINISH GRADEMT1
TH#272.4 GROUNDWATER MONITORING
10/12/20
79.15 CO1CO270.4
78.65
76.4 ORIGINAL GRADE MT3MOA APPROVED SAND LINER
DRAINFIELD ROCK
75'
77.3 FINISH GRADEMT4
TH#269.35 GROUND WATER MONITORING
10/12/20
74.374.75 CO3CO467.35
74.3 74.75
73.35 ORIGINAL GRADE MT6MOA APPROVED SAND LINER
DRAINFIELD ROCK
71.5571.55
74.4
78.65 79.15
75.1
PERMIT # OSP201330 PID # 017-101-22
ILIAMNA ACRES SUB, TRACT 4A
8/10/21MT2MT578.65
74.3
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE 2
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME(minutes)NET TIME(minutes)
DEPTH ofWATER NET DROP
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
ILIAMNA ACRES SUB TR-4A
7/31/20
M. Jakubisin
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?-
1.1 6
3 4
017-101-22
TED KRAMER
12:38/12:43
8/3/20
1
2
3
6"/0
12:45/12:52
12:55/1:02
1' OB
Professional Engineers Stamp:
5:20
NO
4.5
8/10/20
GM
BOH HARD PAN
6"
6"/06:55 6"
6"/07:01 6"
Measurements taken to 1/16". Percolation test will be redone and verified prior to construction.
7/8/21
6.0
10/12/20
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
PERK TEST 3
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME(minutes)NET TIME(minutes)
DEPTH ofWATER NET DROP
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
ILIAMNA ACRES SUB TR-4A
5/14/21
J. MILLETTE
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?
3.0 6
2 3
017-101-22
TED KRAMER
12:45
5/14/21
1
2
3
6 0
16 / 9 8
16
12:56
1:08
Professional Engineers Stamp:
10 3 8
16
10
10
1:204
5
6
1:31
1:42
10
10
10
6 0
16 / 9 7
16 3 7
16
6 0
16 / 9 6
16 3 6
16
6 0
16 / 9 5
16 3 5
16
6 0
16 / 9 5
16 3 5
16
6 0
16 / 9 5
16 3 5
16
6/18/21
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201330
Work Type: Septic Upgrade
Tax Code Number: 01710122000
Site Legal Address: ILIAMNA ACRES TR 4A G:3037
Site Mailing Address: 5400 E 142ND AVE, Anchorage
Owner: KRAMER TED E & LESLIE J
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
I r
t�C'I)al'TI]INnT
8/26/2020
8/26/2021
99274
0 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: The Engineer is required to do an additional percolation test prior to construction of the
septic field. Percolation tests are to be performed according to the Wastewater code. Please submit stamped
and signed results with the As -built Inspection Report. If the results require a design change, construction of the
system will stop pending On -Site review and approval.
Received By:
Issued By:
Date:
Date:
5
MUNICIPALITY OF ANCHORAGO
Community Development Department = q Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 017-101-22
Property owner(s) Ted & Leslie Kramer
Mailing address 5400 E. 142nd Avenue Anchorage, AK 99516
Site address Same
Day phone 985-867-0665
Legal description (Sub'd., Block & Lot) Iliamna Acres, Tract 4A
Legal description (Township, Range & Section)
Lot Size 99274 Sq. Ft. Number of Bedrooms Five (5)
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑X
Initial ❑
Single Family (SF)
❑X
(w/wo ADU)
Septic Tank
7X
Upgrade ❑X
Duplex
❑
(D)
Holding Tank
❑
Renewal ❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES
A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees4 q`7 6- o 5 (Uv i D-1 �
Date of Payment: 2 0/.2- 02 v
Receipt Number: Q`16 3 -
Permit
Permit No. 0 5 A 20.1 3 3 0
Permit App_'- :- : ..:c
iver Fees:
Date of Payment:
Receipt Number:
Waiver No.
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
August 19, 2020
M.O.A. Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Subject: Iliamna Acres, Tract 4 – 5400 East 142nd Avenue
Septic System Design
Dear On-Site Services Engineer:
The existing septic system on the subject lot has failed and must be replaced to serve the three-
bedroom home on the property. The new septic system is designed to serve a five-bedroom home
at the request of the owner. We are submitting this permit application for the construction of a
new septic system. The attached site plan identifies the location of the home and the existing well
and the existing and proposed septic system. No conflicts exist between this proposed system and
any other well or septic system on this lot or adjacent lots.
The ground surface on the lot slopes to the west at grades approximating 15%. There are no slopes
greater than 25% within 50 feet downslope of the proposed site. Ground contours are shown on
the site plan indicating the grade and direction of flow. Stormwater drainage will not impact this
septic system. The new trenches will be constructed parallel to the slope as much as possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water and more than 5’ from the septic tank.
Please refer to the attached test hole log and plan and profile sheets for the septic design. If this
design is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Michael E. Anderson, PE
8/19/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201330, Deb Wockenfuss, 08/26/20
// // //ALTERNATE SITE: CATEGORY III
SYSTEM w/30' LONG x 5' WIDE x .5'
EFFECTIVE DEPTH ABSORPTION
TRENCH. APP. RATE 5 GPD/SF.
1"=50'
2-75' LONG x 5' WIDE x .5'
EFFECTIVE DEPTH
ABSORPTION TRENCHES
NOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
TH1
ILIAMNA ACRES, TRACT 4A
EAST 142 AVE
8/26/20 FEET
0 50 100
GARAGE
10' UTILITY EASEMENT
SHED
TH2
57
5
570
565
EXISTING WELL
THREE BEDROOM
HOME
TOE OF
FILL SLOPE
CO
MT
CO
CO
CO
MT
MT
MT MT
DECOMMISSION
EXISTING SEPTIC
TANKS PER U.B.C.
ABANDON EXISTING
ABSORPTION TRENCH.
TOE OF
FILL SLOPE
1,500 GALLON SEPTIC
TANK w/20" MANWAY.
2CO SV
MH
2CO
FS
ALTERNATE SITE TOE OF SLOPE.
TOTAL HEIGHTS 2.5' ABOVE GRADE.
2' SEPARATION TO GROUNDWATER,
3' TO IMPERMEABLE LAYER.
FENCE.
NO WELL OR SEPTIC
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201330, Deb Wockenfuss, 08/26/20
ILIAMNA ACRES, TRACT 4A
DESIGN FACTORS: SYSTEM REQUIREMENTS:
750 GPD PEAK FLOW
PERK RATE: 1-5 MIN/IN
APPLICATION RATE: 1.0 GPD/SF
5' WIDE TRENCH SYSTEM
1,500-GALLON SEPTIC TANK
TYPICAL TRENCH SECTION
(NO SCALE)
4" PERFORATED
PVC (HOLES DOWN)
DRAINFIELD ROCK
5'
6"
2'
6"
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
BOTTOM OF TRENCH: 1.5' ABOVE GRADE
FLOW LINE ELEVATION: 2.0' ABOVE GRADE
TOP OF TRENCH: 4.0' ABOVE GRADE
750 GPD / 1.0 GPD/SF /5' WIDE - 1.0 (RED. FACTOR) = 150 LF TRENCH REQUIRED (150 LF SPECIFIED)
8/19/20
2.5' MOA APPROVED SAND
2" INSULATION &
GEOTEXTILE FABRIC
1.5'
REMOVE ORGANIC MATERIAL TO UNDERLYING RECEIVING
SOIL (GM). REPLACE WITH MOA APPROVED SAND.
NOTE:
6" TOPSOIL &
REVEGETATE MOUND.
3
1
3
1
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201330, Deb Wockenfuss, 08/26/20
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE 2
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH of
WATER NET DROP
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
ILIAMNA ACRES TR-4A
7/31/20
M. Jakubisin
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH? -
3.2 6
3 4
017-101-22
TED KRAMER
11:50/12:00
8/3/20
1
2
3
4
6"/0
12:04/12:20
12:20/12:39
12:46/1:05
1' OB
Professional Engineers Stamp:
8/19/20
10:32
NO
7.0
8/10/20
GM
BOH HARD PAN
6"
6"/016:10 6"
6"/019:35 6"
6"/019:41 6"
Measurements taken to 1/16". Percolation test will be redone and verified prior to construction.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201330, Deb Wockenfuss, 08/26/20
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE 2
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH of
WATER NET DROP
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
ILIAMNA ACRES TR-4A
7/31/20
M. Jakubisin
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH? -
3.2 6
3 4
017-101-22
TED KRAMER
12:38/12:43
8/3/20
1
2
3
6"/0
12:45/12:52
12:55/1:02
1' OB
Professional Engineers Stamp:
8/19/20
5:20
NO
4.5
8/10/20
GM
BOH HARD PAN
6"
6"/06:55 6"
6"/07:01 6"
Measurements taken to 1/16". Percolation test will be redone and verified prior to construction.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201330, Deb Wockenfuss, 08/26/20
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Development Services Department
Building Safety Division
*A1
On-Site Water & Wastewater Program4700 Elmore RoadP.O. Box 196650 `Mark Begich Anchorage, AK 99507
Mayor www muni.om/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number:
Legal Description Property,Owner Name & Address:_
�La WL n a /_EStiE � %ED KRAmoe
�R Si(OaC, gzwA-4c i[o-zloaz
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: qd feyet�/fe��x�(y�
Pump. Manufacturer's Name:
Pump Model: '7V
Pump Size JV2, hp
Pitless Adapter Burial Depth: / V feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer: A))4 -
Well Disinfected Upon Completion? Wes ❑ No
Method of Disinfection: 4 ,o z
Comments:
Pump Installer Name: �T�/ 3 ANCHORAGE WELL & PUMP SERV.
0111112 330 EAST 76TH AVENUE ANCHORAGE, AK 99518
AWPS.COM
PHONE: 907-243-0740
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEAl_TH & ENVIRONMENTAL PROTECTION
ENVIRONMENI'AL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NA TPHONE.
LOCATION
· dSq q <J,g
Ma n u f act u rer ,~ r,,,~___. ~. ¢/~
gallons
IF HOMEMADE:
Well
DISTANCE TO:
Inside !e n gt h~_...~_=_.~
DISTANCE TO:
No. of lines [ Length of each
F°undati°n 7,~ 0 ~ Material
Tota engt~ of nes~y~ Tronch width~-~''
~J inches
NO, OF BEDROOMS
PE Dq9
No. of cl~.~tmeats
Liquid depth
PERMIT NO.
a of tile to finish grade
Material beneatl] tile
Length Width Depth
Type of crib ;rib depth
Well
DISTANCE TO:
Depth
foundation
Nearest Io:t~) ~.
DISTANCE TO:
Total effecl
lot line
Distance between lines
inches
· ption area
)tion area
Building founda
D riller.~..~_ Distance to
Sewer line
PERMITNO' 7¢
Absorption
OTHER
A 'PF~V E D .(~ DATE
72-013 (Rev. 3/78)
Glr "~.TER ANCHORAGE AREA BOROF '~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N? g33
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
°,STANCE FRO,,,, WELL / ZO"
LIQUID CAPACITY /~ '~9 ¢
NUMBER OF
INSIDE LENGTH INSIDE WIDTH
.GALLONS.
MAILING
ADDRESS IIZ
LIQUID
_DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
L,N,NGMATER,A, .
NEARESi' LOT LINE
! /
DISTANCE FROM WELL / ~ 0 l
__ , BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) '~ (~' SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DIS,~E-.F~R~.~ WELL ,-~-%, ,FOUNDATION ,NEAREST LOT LI~ ,O~ .
(/ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE~'~
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__
WELL: TYPE. L{¢;//~ DEPTH. ~Z j DISTANCE FROM "'~ ~ WATER
,BUILDING FOUNDATION, SAMPLE ., NEAREST
'.J__ NEAREST SEPTIC ' ~ ~
12~' SEEPAGE /~ OTHER
/
T
, SEWER LINE , TANK - , SYSTEM , CESSPOOL .... , SOURCES
LOT
LINE
DISTANCES:
,4,-C z: I ZOI
/
'A
,4//
DIAGRAM OF SYSTEM
C'
DATE
HEALTH AUIHORIIY
1"1'11~ t..l:::l'.,It..:iTH I:::,;[ I"'ll:if:l",l:!ii;): 01",! :!: '.:~:; "J't'll:1{ I...l:i~:l",l(':i-I"H ( '_1: Iq I':'l:!!:lii2F ::, OF:' 't'l..'h~:: 'I:'f;i:I::~:NE:I.I l:':ll:~: I';:,Fi:I:::I :i: i'.,ff::' :[ El .D.
l:'~l~i:: DEI::'TH CII::' I:::1 "I'I';i~E~NC:H Ell:ii'. I:::'1"1" ii7::i:; "1'1.1[~i D)::~i;TI'::II'.,IC[iil Ediii'l'l,.ll::i[~:l'.,l THE' :ii;l:.tl:~:l::;'F:l('i:l:il 01= 'Tl'ff~i
GF.'.'OI:..II'.,tt;} F'II'.,I[.:, 'l:'l:ll:iil E:CII'TCtP1 C'll:= 'T'HEi f!i'.',:.OZ:I::I',,,'FIT]it:.iIt'.~ ,:ill:lq
'-ii' Ir'"'l:t L: :.. "'~F' IF:~ lEE: Ii'"',,~ ~:Z::: ~"' '~ I..1.ql :1[' IE:::,~ '"IF' Ii'-'l~ 'ii' ."ii!~; ~ IF::::" IE:!i: I!!iiiii: -ii"
:ir: r'l , r:: t.. [::'l:~:l:::q-H :1: !i!: 'I"HE I:'I :~: i",l .[ I'"ll..li'"l I::'~::I:="I"H I:::tl::' GI:,i~I'::t',/~:I..
FIN(::' 'THI:{ [}i;i:::Fl:'T(:ll:,'l 01':: 'I"HE I:ii:::'::E:F:I',,,'F:I'I":I:I::)BI '::J:t",l [:'E-i!ET::,.
: :' l!!!: l:~i', i'"l :l: 'T I::'IF'F:'L.):I:::FfI",I'I" I'll:i:ii: 'I'HI'ii: [,.:L:!'.!:i;l:x'Ol",l:ii!;:(l~!:]:l..~:l:'t"-r' TO :l:BIl::'l:::ll:~::l"t l'l't:(:ii; [::'l':i:Pl':ll;i'.Ti'"l[i:l",l'l:' [::,I..IB:]:NI::!i TI'Il:ii:
:i:I",I:!!!:TI:::iI.I..I:::I-I:']:ON ):N::iiil::'EC:T:[EIf',l:ii; 01:= t:::!N"r' .t,.ll'i:L.L..!!il t:'l[::'..:rl:::lC:l:ii:Nl' '1"O TI"I):~!!; I:::'[;;:CIF'I::::Fi:'I"T' F:INI:::' THE:
Iql_.il"ll:i:liii:l:ill CIF:' Fi:l:ii:!:il]:[::'[!{i",lE:l:ii::i~i "['HFIT THE: I.,I:I:!!:L.I... I.,.I:I:L.I...
Fi',f:lC:k:f; :i: I..I .. :[ b,l(:Fi OF:' l:::lt",l~'r' '.i'];"r"_::;'FEl:'l H :i: TI'IOI...IT F:' .1:. I",ff::l[. :[ I",I:i:~;F'[CI:::T :i: ()N F:II",II::~ I:::II:':'F'I:;i:(')',,,~I:t:IL. [ii¢'r' TI'I :i: :B
[::'li!i:l:::'i:::ll:;i:TH[!!:t'q'l* I.,.l:[t..I.. [ii',[~: :E;I:.II:~L]'[!i:C:T TO
August 14, 1979
Don Bender
Box 68
Talkeetna, Alaska
Subject: Tract 4A Illiamna Acres
Overflowing Sewage Complaint ~791542
Dear Mr. Bender:
The on-site sewer system on your lot has failed and an upgrade
is required.
If the house is not in use, this department has no objection
to delaying the upgrade. However, prior to occupancy, an
upgrade is required.
You indicated that the present tenants will be vacating the
house by September 1, 1979. It is your responsibility to
keep the sewage off the ground even if it requires daily
pumping. It will be your responsibili~y to inform this
department when the house is vacated, and when occupancy is
resumed.
This department will make periodical checks during the period
of vacancy for overflow.
If there are any further questions, please contact this off,ce
at 264-4720.
Sincerely,
Lynn Lindquist
Senior Environmental Code Officer
LL/ljw
cc: Ken Norman
Legal Department
GAAB-I-I D-2
GREATER
327 Eagle St.
XNCHORAGE AREA I ')ROUGH CaseSo.//:
HEALTH DEPARTMENT
Anchorage, Alaska 99501 279-2511 /
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RES,.ENCE A.D.ESS .~o.~___- LOCAT,ON DF ,NSTALL^T.ONI~afSX'~-~ ~ ~ff,'?k~
LEGAL DESCRIPTION
SEEPAGE PIT ., DRAIN FIELD , OTHER
~ D p.r~ 'TT a ~ ~. ak
TO ,~E ,NSTAL.E..Y_ .
ANTICIPATED DATE OF COMPLETION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED T.R0UaN ~e. C ~
PERCOLATION TEST RESULTS
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
T.IS .S TO SE.YE AS ?Y~' /~
AS DESCRIBED BELOW.
. SEPTIC TANK SIZE
DISTANCES:
, PERMIT TO INSTALL A
SIZE OF UNIT T0 BE SERVED
TYPE (~Q/Tt&~/~-EPAGE AREA TYPE
HEALTH AUTHORITY
OR
LICENSED DESD~NER
I certify tha. t I am fa,nil!ar, with the 'requir.emen!s of Greater Anchorage A,~eaz B°r°tlgb9,, rd~ance Ngd~8-S~'and. that,__
above descnbe~ systen~ ,s in accordance with said code. ~.~ff~/f(.~.c/~,_L//
DATE ~ APPLICANTSSIGNATUR ~ ¢//~ ~
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 017-101-22
Legal description Illamna Acres Tract 4A
Site address 5400 E 142nd Ave, Anchorage
Current property owner(s) Kramer
Expiration Date: 1-18-2023
X The On-site system(s) is/are approved for 5 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
� JJ
By: Original Certificate Date:
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory x
Tank Age Advisory Arsenic Advisory
Other
COSA Approvdjune 2022
MUNICIPALITY OF ANCHORAGE
ii
Development Services DepartmentNa�)7 Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel 1. D. 017-101-22
Complete legal description Iliamna Acres, Tract 4A
Location (site address) 5400 E 142nd Avenue, Anchorage, AK 99516
Current property owners) Ted & Leslie Kramer
2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS
Day phone (907) 350-1221
3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑■ Plastic ❑ Concrete ❑ Fiberglass
Age <2 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ ai ?0
Date of Payment /U z7- f2�
COSA # 'a
UO�lS�D
Waiver Fee $
Date of Payment
Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: Iliamna Acres,Tract 4A Parcel ID: 017-101-22
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled -- Total depth 98* ft
Cased to 50+* ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 26 in.
Date of flow test for COSA 9/26/22
Static water level at beginning of test 22 ft.
Comments *Per inspection 8/2/12
B. TANK DATA
Measured operating fluid level in septic tank NEW
Date of pumping 10/7/22 Northland Pumping
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 10/12/22
❑ ALL standpipes present per record drawing
Total measured depth from grade 3.2/3.0 ft (max)
Measured depth to pipe invert from grade 2.7/2.55 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑ Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced N/A gallons N/A date
Any rejuvenation treatment (past 12 months) N/A
If yes, enter date
Comments/Deficiencies:
COSA Checklist June 2022
Well production at time of test 3.6 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 6.35 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date 9/26/22
C. LIFT STATION
fired maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date NEW
Results ❑ Pass
Nid depth prior to test in
Wat added gal
New flui depth in
Elapsed tim6\ min
Final fluid depth_ in
Absorption rate > gpd
FIELD STATUS — POS ECOVERY
Effective depth (per recor\aw,) in
Effective depth used
Effective depth remaining
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100'
Community Sewer Manhole/Cleanout > 100'
Fm]Yes
if No
ft
QQ Yes if No ft
Neighboring Tank > 100' g Yes
if No
ft
Private Sewer/Septic Line > 25' ❑® Yes if No ft
Absorption Field on Lot > 100' M Yes
if No
ft
Holding Tank > 100' Mm Yes if No ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' Yes if No ft
0 Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Yes
if No
ft
❑ Yes if No ft
❑ N/A — Served by Community
Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot
to: (Please enter distances if less than required)
Building Foundations > 10' Fm_1 Yes
if No
ft
Surface Water > 100' M Yes if No ft
Tank to Property Line > 5' 0 Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10' [E Yes
if No
ft
Private Wells > 100' 0 Yes if No ft
Water Main > 10' FE] Yes
if No
ft
Community Wells > 200' Fm] Yes if No ft
Water Service Line > 10' FEI Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Forge Engineering
Engineer's Printed Name Benjamin Schiller, P.E.
COSA Checklist—June 2022
Phone (907) 522-7773
Date 9/28/22
4� TM _
Benjarri S'chiller
CE 12592cv`4`�®
AW
���kFAF�pROFESSO��.�
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 221496
Subdivision: Iliamna Acres Tract 4A
A water sample revealed a nitrate concentration of 6.35 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
MaiUng Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
,n Ma�hrig Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
Municipality of Anchorage
84i
• .� Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904 AUG
AL
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Rm.8
FOR A SINGLE FAMILY DWELLING ((�^
Parcel 1,13. 017-101-22 COSA # O S � 12 i `?�5 K0
Expiration Date: Q —/2-
1.
-/21. GENERAL INFORMATION
Complete legal description ILIAMNA ACRES TRACT 4A
Location (site address) 5400 E. 142ND AVE., ANCHORAGE, AK 99516
Current Property owner(s) DON BENDER Day phone 345-6197
Mailing address ; " PMB 321, 1120 HUFFMAN, ANCHORAGE, AK 99515
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
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 (]
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 sample results. (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
Spurkland Enginneering
Address 203 W. 15th Ave., Ste 202, Anchorage, AK 99501
Engineers Printed Name Lars Spurkland
5. DSD SIGNATURE
_Z Approved for bedrooms.
Disapproved.
Conditional approval for
bedrooms,
Phone 279-3916
Date AUGUST 9, 2012
OF A<gS�ir'
00
' 49v
yi ....ls. .. .
PURKLAND;•�
11 00
with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: _ r G G—C Original Certificate Date:
(Rev. 11105)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On-Site Water & Wastewater Program `
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: ILIAMNA ACRES TRACT 4A Parcel ID: 017-101-22
A. WELL DATA
Well type PRI If A, B, or C provide PWSID # — Well Log (Y/N) NO
Date completed Sanitary seal (YIN) Y Wires properly protected (Y/N) Y
Total depth 98 ft. Cased to >40 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test UNKNOWN 7/17/2012
Static water level UNKNOWN ft 24 ft
Well production UNKNOWN 9-P.M. 5.3 g p m
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 4.76 // mg/L Collected by: SPURKLAND ENG.
Arsenic: ND ug/L date of sample: 8/11/ -2
B. SEPTICIHOLDING TANK DATA
Tank Type/Material CONCRETE & STEEL Date installed 0/14/70 & 9/13179
Tank size 1 000 gal. Number of Compartments 1/2 Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y
Date of pumping 7/27/12 Pumper ISAAC'S PUMPING SERVICE
C. ABSORPTION FIELD DATA
Date installed 9/13/79 Soil rating (g.p.d./ft2 or ftz/bdrm) 155 System type SHALLOW TRENCH
Length 85 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 4 ft. Eff. absorption area 465 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 7/17/12 Results (PassiFail) PASS For 3 bedrooms
Fluid depth in absorption field before test 33 in. Water added 450 gal. New depth50 in.
Elapsed Time: 30 min. Final fluid depth 50 in. Absorption rate >= 450 g p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date a
D. LIFT STATION
Date installed
"Pump on" level at —
Datum
Size in gallons
in. "Pump off' level at—in.
E. SEPARATION DISTANCES
Cycles tested ---
SEPARATION
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100,+
Public sewer main NA
Sewer /septic service line 25'+
Animal containment areas 50+
Manhole/Access (Y/N)-
High water alarm level at ---
Meets
Meets alarm & circuit requirements?
On adjacent lots 100,+
On adjacent lots 100 +
Public sewer manhole/cleanout NA
Holding tank NA
Manure/animal excrete storage areas 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption fiield5-+
Water main NA Water service line 10+ Surface water 1001+
Wells on adjacent lots 100,+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main NA
Water Service line 10,+ Surface water 100,+ Driveway, parking/vehicle storage 25—+
Curtain drain 50+ Wells on adjacent lots 100'+
F. COMMENTS
TRENCH MONITOR/ SUMP BLOCKED 30" ABOVE BOTTOM OF FIELD
G. ENGINEER'S CERTIFICATION / .P�E OF ,A�q`
1 certify that t have determined through field inspections and ; 4 H 9
review of Municipal records that the above systems are in :... ... .. .....%..
conformance with MOA COSA guidelines in effect on this date. 00
LARS SPURKLAND SPURK4AND
Engineer's Printed Name �� 1 U ,
Date 8/812012g��
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COSA Fee $ 00
Date of Payment 6 r3I ( a
Receipt Number. N L ��%
(Rev. 4/10)
Waiver Fee $
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AAROW PUMP Cit WEII SERVICE, LLC WOKE
P.O. Box 110496 NO. 9��
Anchorage, AK 99511
Office: (907) 346-9355 • Fax (907) 333-8976
Eagle River: (907) 622-9335 Y`
I CUSTOMER ! F JOB SITE.
/--%4 r 5
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INVOICE PATE
,WELLDEPTH
eWl_ n ^
-0HLORIN70
PUMP DEPTH/
SALESPERSON -
9U Iry
DESCRIPTION -
`. PRICE
-. AMOUNT
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1753- - ? i; I I:g /� .t tyi
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11
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LABOR
HOURS
RATE
AMOUNT
TOTAL MATERIAL
TOTAL LABOR
-
-
i
WORK ORDERED BY
DATE COMP.TOTAL
LABOR
PAY THIS AMOUNT
X
Thank You
SIGNATURE
(1 Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that it above work is not paid for in 90 days I agree to allow Aarow
Pump & Weil Service, LLC. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment.)
TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE.
SERVICE CHARGE AT RATE OF 1.6% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS.