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HomeMy WebLinkAboutT14N R2W SEC 11 LT 66 REMT14N R2W Sec 11 Lot 66 REM #050 - 261 - SO Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT t8 Permit Number: OSP 161150 PID Number: 05026110 Dwelling: • Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New • Upgrade Name: CORY DAVIS ABSORPTION FIELD ❑Deep Trench ❑Shallow Trench El ❑ Other Bed ❑Mound Address 10103 VFW ROAD Phone 280-9834 Number of Bedrooms 2 Soil Rating C'$ ay1 6,o GPD/SF Total depththfrory jginal grade t 1. ! CJS Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1.3 Ft Gravel depth beneath pipe 0,6 Ft. Subdivision Block Lot 66 REM Fill added above original grade +/- 1 Ft. Gravel length 10 Ft. Township Range Section T14N 2W 11 Gravel width 6 Ft. Beds: Number of Lines 1 Distance between lines - Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area 60 Ft2 Number of trenches 1 Dist. between trenches - Ft. Well 81 95 - - +50 TANK ■ Septic ■ S.T.E.P. 0 Holding 0 Other Manufacturer ORENCO (ADVANTEX) Capacity 1500 Gal. Surface water 80 85 - Material FIBERGLASS Number of compartments 2 Lot Line +5 10 -NA Foundation 5 10 LIFT STATION Manufacturer NO LIFT Capacity Gal. Curtain Drain +50 +50 Remarks SEE C/O REQUEST. OLD TANK Pump on level at in. Pump off level at in. High water alarm at In. ABANDONED PER CODE Pump make and model Electrical Inspections performed by RISIN9ON C" Installer GUARANTEED SERVICES 6 PIPE MATERIAL House to tank 2#61 Tank to 2 61 drainfield Drainfield 3034 Co/MT3034 Inspector CHARLES BALZARINI BENCH MARK (Assumedelevation)100 ft Inspection dates: 1' 7/8/16 2nd 7/11/16 Location and description SIDEWALK BY STEP 3`d 4d, COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Conditional Approval: Date :r�itetR9l np �ty�� of ,( 'Ilk -.."\C:. * s :....... , 0. ... •0 .' / ...a .14t. Balzarini.ti: s• CE -13854 : ct® •,,,jiF��OFESS10ar�� — sirs.♦ a��. i ,,, / _ Appro ; .111f / a. A I/ Date /ry/%� f///�/ v / Y nspecti4n R5pbrt_9-1-12.doc CDL C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Septic System for T14N R2W Sec 11 Lot 66 REM Dear Reviewer, The above referenced property has recently had a new Advantex system installed to replace a failed crib. As you are aware, a permit was issued for another engineer's design which was contingent on additional soils exploration during construction. C&M Engineering was hired by the owner to inspect the construction of the system. On 7/8/2016, a test hole was excavated revealing the effluent accepting soils to be a SW material with some gravel. Percolation test results put the soils into a 1.2 gpd/sgft category. Groundwater was encountered at approximately 8' below grade. A clayey sandy material was encountered between 8 and 9 feet of depth. On 7/11/16, the Municipality commissioned an additional test hole to a depth of approximately 7 feet deep, to observe the soil materials, groundwater was not encountered. The design was modified to remove the sand liner which was required due to the unknown soil conditions, and the leach field was raised in the soil strata to ensure 6' separation between the bottom of the excavation and the groundwater table. We are requesting a change order to approve the removal of the sand liner, change the leach field elevation, and to accept the as -built separation distances which vary somewhat from the waiver request. Requested: As- Built Waiver Separation Distances 1. 57 feet: Abandoned well on David Lee Lot 1 to Advantex Tank and Pod 2. 65 feet: Abandoned well on David Lee Lot 1 to absorption field. 3. 81 feet: Well on Subject lot to Advantex tank and pod 4. 95 feet: Well on subject lot to absorption field 5. 40 feet: Well on subject lot to sewer main 6. 80 feet: Surface water to Advantex Tank and Pod 7. 85 feet: Surface Water to absorption field 8. 5 feet Advantex Tank and Pod to foundation. 9. 4 feet Advantex Tank to Absorption Field 10. 4.5 feet Absorption field to crib. 11. 5.5 feet foundation to foundation cleanout. Waiver request items 1 through 8 are principally the same as approved, with the exception that items 6 and 7 appear to be switched on the original waiver request. Note that the system is installed slightly differently than the original design. Waiver request 9. 4 feet tank to absorption field. The tank and absorption field are separated by only 4 feet from the end of the field to the tank. We do not believe this will have an adverse impact on the drainage of the field as the soils are free draining, and the leach field design relies on only bottom area. The tank will not be impacted by the field, as the field is effectively above the tank. The original design showed an encroachment between the absorption field and crib of 6.5 feet, but no waiver was requested. We believe the reduced separation distance should be approved due to the free draining nature of the soils, and since the crib is abandoned, any bio -matted soils that may effect the absorption system, will eventually heal. It is also important to note that the absorption field design relies on solely the bottom area of the field, and disposed effluent would tend to flow straight down through the soils. Included with this letter is an inspection report, drawing, and soil log. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini(c�gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE itLEGEND o CLEANOUT • MONITOR TUBE ® TEST HOLE SWING S A B� C:7.51 14.3 : 30.1 22.9 WELL gip. i • ARLES G:BA%%�__LZARIN! 0 +0�I,FO ROFESS kt•.hr/ SIDE WALK \ (B. M.) 0 CREEK 65' 1500 GAL IVANTEX WITH AX -20 FILTER POD 85'TO C cY A'.7Q' PO N oos/v Nq Ve\Ri I , of AKIV` — +100.0 DECK CORNER 20' 6' x 10' ABSORPTION FIELD FENCE 4" BLUE BOARD INSULATIO FILTER FABRIC 97.7 4"0 DISTRIBUTION PIPE 0.5' EFFECTIVE SEWER ROCK SCHEMATIC ELEVATION — SCALE: NTS ONITOR TUBE INISHED GRADE TFSTHOIF 97.3 INVER 96.68 T 98.6'0RIG. GRADE GROUNDWATER 90.69 B.O.H 89.7 C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: T14N R2W SEC 11 LOT 66 REM OWNER: CORY DAVIS DATE:7/18/16 REV: 1 DRAWN: CB REF: SEPTIC RECORD DRAWING Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ci.anchoracte.ak.us (907) 343-7904 Soils Log - Percolation Test Performed For: CORY DAVIS Date Performed: 7/8/16 Legal Description: T14N R2W SEC 11 LOT 66 REM Township, Range, Section: Est Hof # 0 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - Depth Feet' Er To? c? 5 c tY Fru - --ter C7 YEY ctt Slope WAS GROUND WATER ENCOUNTERED? YES s IF YES, AT WHAT DEPTH? 8' t Depth to Water After O l 0 Monitoring? E Date: //t 54 Site Plan 5E Cirr N Reading Date Gross Time Net Time Depth to Water Net Drop [ 7/6/G 7,' 5 6 : o o ' C9 ' 3 el/ :U or of h. s �j,06- 0 p' 0. 6 c<;Il 5 PERCOLATION RATE <1 TEST RUN BETWEEN 2 COMMENTS MATERIAL SAMPLE OBTAINED BY MOA. (minutes/inch) FT AND3 PERC HOLE DIAMETER 6 FT PERFORMED BY: CHARLES BALZARINI I CHARLES BALZARINI CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/13/16 ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND lore mS. Ile- t 72MQ L p. {fp- THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this "Dayof «utj of20Jio,byand between fe'CnLIA jS•ItI+ a14 1?ut t p. tat herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as ADVANTEX located at (legal description). T14N R2W SEC 11 LOT 66 REM 2. Definitions. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On -Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AW WTS to continue to perform as designed. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations, Installation and Removal of Additional Equipment. Prior to performing any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AWWTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS You created this PDF from an application that is not licensed to print to novaPDF printer (http://www.novapdf.com) service and maintenance provider avvroved by the municipality and the manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AWWTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. You created this PDF from an application that is not licensed to print to novaPDF printer (http://www.novapdf.com) H. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. I. Owner agrees to provide and maintain a telephone connection to the AWWTS as required by the AWWTS approval. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: je/ret11 I(61& cuAdTatra): P. b. Municipality: Director, Community Development or designated authority You created this PDF from an application that is not licensed to print to novaPDF printer (http://www.novapdf.com) C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: 9M8q" eW— efem y I -d FF Jiva i(01-1-- (print name) By:1 (signature) Date: 07/13/1,6 STATE OF ALASKA THIRD JUDICIAL DISTRICT The foregoin instrument was acknowle 20J, by ) ss. ,g -• Si,�`_ before me this j day o P5 ?Rge4/ "()TARf % 3 OTARY ' : IC FOR AL My Commission expires: MUNICIPALITY: By: (signature) (print name) %UBLc Q. cv i .'NT cr �3.yOrr. ,' ys . . • .. Q'Q i,,h�n Date: Title: You created this PDF from an application that is not licensed to print to novaPDF printer (http://www.novapdf.com) On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161150 Tax Code Number: 05026110000 Work Type: Septic Upgrade Permit Effective Dates: June 29, 2016 to June 29, 2017 Design Engineer: ALASKA RIM ENGINEERING Subdivision: T14N R2W SEC 11 Site Legal Address: T14N R2W SEC 11 LT 66 REM G:0051 Owner/Address: DAVIS CORY M & AUBRY 10103 VFW ROAD EAGLE RIVER AK 995770000 Site Mailing Address: 10103 VFW RD, Eagle River Lot Size in Sq Ft: 5410 Total Bedrooms: 2 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: PRIOR TO OPERATIONAL APPROVAL: The AWWTS Maintenance Agreement shall be submitted prior to approval of the inspection report. Special Provisions: PRIOR TO CONSTRUCTION: Soils testing shall be completed confirming the drainfield design is code compliant. If design revisions arerequired, an approved change order shall be obtained prior to construction. The soils test results shall be submitted with the inspection report. Municipality of Anchorage P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Division On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV161064 COSA#: Permit#: OSP161150 PID#: 050-261-10 Legal Description: T14N R2W Sec 11 Lot 66 REM Engineer: C&M Engineering Services (inspection) (design) Applicant: Cory & Aubry Davis The following separation distances are approved. 1. 575.8 feet: Abandoned well on David Lee Lot 1 to Advantex Tank and Pod. 2. 65 60 feet: Abandoned well on David Lee Lot 1 to absorption field. 3. 81 8-2 feet: Well on subject lot to Advantex Tank and Pod. 4. 95 76 feet: Well on subject lot to absorption field. 5. 40 feet: Well on subject lot to sewer main. 6. 80 86 feet: Surface water to Advantex Tank and Pod. 7. 85 72 feet: Surface water to absorption field. 8. 5 7 feet: Advantex Tank and Pod to foundation. 9. 4 feet: Advantex Tank to Absorption Field 10. 4.5 feet Absorption field to crib 11. 5.5 feet foundation to foundation cleanout This waiver approval applies to the proposed septic system only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. X The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. Waiver is Granted: X Date: 7 i i .n Approved by: Waiver is not Granted: T -- e of Reviewer MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-261-10-000 Property owner(s) Cory & Aubry Davis Mailing address 10103 VFW Road Eagle River, AK 99577 Day phone 290-9834 Site address 10103 VFW Road, Eagle River, AK 99577 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T14N R2W Sect. 11 Lot 66 get Lot Size 5,410 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: (El all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage APPLICATION IS AN: Initial Upgrade Renewal 2 TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Well separation distance on property, separation distance to inactive well on adjacent property, separation distance to surface water Distance: 'e' a'Utl,menk I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 07-6a (Signature of property owner or authorized agent) Permit/Rush Fees: 41577 60 fi Date of Payment: 6/1//4 Receipt Number: SO/fZ' Permit No. 05/9a /,5-0 Permit App_:- Waiver Fees: t4'/ Z� Date of Payment: 6%//6 Receipt Number: Lb /S`' Ze Waiver No. Ora /6/06,y ALASKA RIM ENGINEERING, INC. ENGINEERS — PLANNERS — SURVEYORS 9131 E. Frontage Road Palmer, Alaska 99645 Telephone (907) 745-0222 Fax (907) 746-0222 Online at: www.alaskarim.com June 6, 2016 Mr. James A. Crewdson, P.E. Municipality of Anchorage - Development Services Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519 RE: T14N R2W Section 11, Lot 66 (Remainder) 10103 VFW Road, Eagle River, AK 99577 Subject: Wastewater Permit & Waiver Request — Design Narrative (Revised June 27, 2016) Dear Mr. Crewdson: The home on the subject lot is a two bedroom single family constructed in 1976, with a basement. The subject property is served by a private well and a septic system. During the process of completing a COSA on the existing septic system, the septic system was found to be in a failed condition. This design narrative is to provide you with the information required for the replacement septic system and to request for separation waivers is summarized as follows: • Abandoned well to AdvanTex Tank and Pod for Lot 1 David Lee Subdivision • Abandoned well to absorption field for Lot 1 David Lee Subdivision • Onsite well to AdvanTex Tank and Pod for T14N R2W Section 11, Lot 66 (Remainder) • Onsite well to absorption field for T14N R2W Section 11, Lot 66 (Remainder) • Onsite well to sewer main for T14N R2W Section 11, Lot 66 (Remainder) • Meadow Creek to AdvanTex Tank and Pod for T14N R2W Section 11, Lot 66 (Remainder) • Meadow Creek to absorption field for T14N R2W Section 11, Lot 66 (Remainder) • Onsite absorption field to foundation for T14N R2W Section 11, Lot 66 (Remainder) • AdvanTex Tank and Pod to foundation for T14N R2W Section 11, Lot 66 (Remainder) This is a replacement and betterment for this onsite septic system. TOPOGRAPHY The property slopes at 8%-10% toward the southwest, away from the on-site well, the adjacent well and toward Meadow Creek. The wells are to the north of the septic system and Meadow Creek is to the west. SOIL CONDITIONS Previous approvals and waivers for the subject lot indicated the receiving soils are well graded sands and gravels. Additionally, the surrounding property onsite soil logs were researched and indicate similar soils. For the purpose of this submittal we have assumed the same. In the essence of time and money we are requesting to conduct a test hole and percolation test while the excavator is on site installing the ALASKA RIM ENGINEERING, INC T14N R2W Section 11, Lot 66 (Remainder) Charles A. Leet 2 June 6, 2016 AdvanTex system. We would submit our findings with our inspection report. If deviations were required we would request a change order per MOA code. With well graded sands and gravels there is a possibility that the receiving soils could percolate faster than one minute per inch. Our design consider this possibility and our field design allows for a 2 -foot sand liner to be placed under an absorption bed. Wastewater System DESIGN FLOWS Based on a two bedrooms double occupancy the design flow is 300 gallons per day (GPD). The minimum tanks size within the Municipality of Anchorage (MOA) is 1,000 gallon, two compartment tank. In the basement, there is submersible grinder pump that pumps the basements wastewater up to the first floor prior to exiting the dwelling. PROPOSED TANK AND FIELD REPLACEMENT The existing tank is reported to be concrete and will be replaced. We a proposing an integral 1,500 gallon AX 20 — AdvanTex tank with an AX 20 Pod. This serves two purposes; first it reduces the foot print of the tank and AX 20 Pod and subsequent drainage field. Secondly, the advance treatment helps reduce the impact of the septic system on the environment. DRAIN FIELD DESIGN The proposed dwelling is two bedrooms, with a daily flow of 300 gallons. The prescribed application rate is 6.0 gallons/ft2. The required area is 50ft2. We are proposing a 6 -foot absorption bed that is 10 - feet in length for a total of 60ft2. Water System SUBJECT LOT The subject lot T14N R2W Section 11, Lot 66 (Remainder) is served by a private well. The well log for T14N R2W Section 11, Lot 66 (Remainder) is attached. On May 11, 2016, a water sample was collected and submitted to SGS for analysis of Coliform, Total Nitrates and Arsenic. The results were compared to test results from April 27, 2012. The table below show the results. Sample date Coliform Nitrate Arsenic 4/27/2012 0 0.344 Non Detect 5/11/2016 0 Non Detect Non Detect It would appear that the water quality has been improved over time, (it needs to be noted that both tests are a snap shot in time and do not necessarily indicted future test results). In all cases minimum allowable limits were not exceeded. It would appears that the existing septic system had no effect on the total nitrates. ALASKA RIM ENGINEERING, INC Engineers... Planners... Surveyors ALASKA RIM ENGINEERING, INC TI4N R2W Section 11, Lot 66 (Remainder) Charles A. Leet 3 June 6, 2016 Well Perforation Discussion and Variance/Waiver Request We have reviewed the well log for the subject lot and concur with the department response. Contrary to the report presented by others the well is perforated between 24-25 feet below ground surface. Nevertheless, in spirit of all fairness and public health, welfare and safety, this well has been providing safe drinking water for the past 40 -plus years. The Municipality has had numerous opportunities on previous COSA and Health Authority approvals to make some form or change or alteration. With document I would like to formally request a variance/waiver to the 40' perforation requirement. I make this request based on a historic water sample results and current sampling; the current sampling indicates clean water with no detectable Nitrates. As a mitigating solution we propose the original well drillers recommendation of periodic tests. I would offer that water samples for bacteria and total nitrate be collected at a minimum of annually and kept with the wastewater service records; and made available at the Municipality request. In requesting this variance/wavier it is not to create a new standard or precedence but to formally acknowledge this well status for future owners, reviewers and engineers. SURROUNDING PROPERTIES - LOT 1, 2 AND 3 DAVID LEE SUBDIVISION Attached is the available well logs and well information obtained from the MOA data base log for Lot 1, 2 and 3 David Lee Subdivision. Lot 1, No water samples were taken on this neighboring lot. This well, which is no longer in use, see attached photo does not have any information in the database. Though not in use the lot is occupied and has a single family residence on it. Lot 2, No water samples were taken on this neighboring lot. This well, which is reported to be drilled to 100 -feet on paperwork found in the data base. No well log was found. Lot 3, No water samples were taken on this neighboring lot. This well, which is a Class C well serving Lots 3 and Lot 6, is reported to be drilled to a depth of 76 -feet, with a static water level of 17 -feet. No well log was found. Both wells are identified on the attached site plan. Waiver and Separation Distances The proposed separation distance waivers being sought for are: • 58 — feet Abandoned well to AdvanTex Tank and Pod for Lot 1 David Lee Subdivision • 60 — feet Abandoned well to absorption field for Lot 1 David Lee Subdivision • 82 — feet Onsite well to AdvanTex Tank and Pod for T14N R2W Section 11, Lot 66 (Remainder) • 76 — feet Onsite well to absorption field for T14N R2W Section 11, Lot 66 (Remainder) • 40 — feet Onsite well to sewer main for T14N R2W Section 11, Lot 66 (Remainder) • 86 — feet Meadow Creek to AdvanTex Tank and Pod for TI4N R2W Section 11, Lot 66 (Remainder) • 72 — feet Meadow Creek to absorption field for T14N R2W Section 11, Lot 66 (Remainder) • 6 — feet Onsite absorption field to foundation for T14N R2W Section 11, Lot 66 (Remainder) • 7 — feet AdvanTex Tank and Pod to foundation for T14N R2W Section 11, Lot 66 (Remainder) ALASKA RIM ENGINEERING, INC Engineers... Planners... Surveyors ALASKA RIM ENGINEERING, INC T14N R2W Section 11, Lot 66 (Remainder) Charles A. Leet 4 June 6, 2016 Based on this submitted information, it is our opinion that the lesser separation distance has not and will not have an adverse effect on the groundwater or the public health, welfare or safety. We further add that no mitigation is required, in light of the historical use of this onsite septic system. • Any leaks from the septic tank would need travel through sandy and gravel prior to reaching the ground water. EPA states the within 2 -feet of a leach field there is significant water quality improvement. • Should the untreated septic effluent reach the groundwater is would be carried southwesterly away from the drinking water sources. • The topography of the parcels indicate surface and ground water flow is away from the wells • The existing system has been operating under the same existing waivers and the test results from water sampling show negative impacts. We do not anticipate any adverse effects on the neighboring, septic systems, reserve areas or drainage patterns by the installation of the proposed replacement septic system. This subdivision is served by a private wells. Should you have any questions or comments please do not hesitate to contact me by telephone or email chuck@alaskarim.com. Sincerely, Alaska Rim Engineering, Inc. %%%%%%%%%% ` _�.�� _% A(4Slirl '�• �4 •VV A"S•i riett • 6C..rr !Zia: Ch'arlee A. Leet • 4'— �C`r!•. CE10180 • Cts.► ,,,f C4FE Ztsec% Charles A. Leet, P.E.. Project Engineer Encl: Permit Application Permit fees Site Plan (3) Cc: Client AK Rim File # 16-00348 ALASKA RIM ENGINEERING, INC Engineers... Planners... Surveyors NOTES: 1. THERE EXISTS AN ENCROACHMENT EASEMENT RECORDED 3-21-2006, SERIAL NO. 2006-017654-0. N00 N 0 —/ Lot •�RTION OF LOT 66 DEEDED TO OWNER OF LOT 2 1 10' BUILDING SETBACK EXISTING SEPTIC TANK, DECOMMISS IN ACCORDAN C -WITH CODE EXISTING 8'x8' SEEPAGE PIT DECOMMISSION IN ACCORDANCE WITH CODE / • *! 49TH %\ !.,,,,,,&0 10% Charles A. Leet s ° CE 10480 �d PRO SS -1' SE TIC LPGRADE DESIGN SITE ?LAN Legal Description: T15N RIW Sect. 8 Lot 45 Parcel ID: 051-093-02-000 <<`z7t14- Alaska Rim Engineering, Inc. ENG 9131 E FRONTAGE RD. PALMER, ALASKA 99645 PHONE: (907)745-0222 FAX: (907)746-0222 WO: 1600348 Da„ 5/26/16 PAGE 1 OF 4 1"=40' TBMA - 100.00 ASSUMED ELEVATION SOUTHEAST CORNER OF SIDEWALK &I FND CL G UT TBM( VANTEX AX -20 O .ALLON TANK EXIST/N SYSTEM DEC IMMISSION IN ACCORDANRE WITH CODE / / / / / • • 0 i 6o BL CLEA 10' / PRO. OSED TEST HOLE LOCATION 'Wx10'L TRENCH OIL ABSORPTION SYSTEM 2' SAND FILTER SITE CRITERIA: NUMBER 1�F BEDROOMS: GALLONS ER DAY: APPLICATION RATE: MINIMUM DRAINFIELD AREA: DRAINdELD CRITERIA MAXIMUM EXCAVATION DEPTH: LENGTH: WIDTH: EFFECTIVE DEPTH: EFFECTIVE' AREA: 2 300 6.0 GPD/FT' 50.00 FT' 2.5 FEET BELOW INVERT 10 FEET 6 FEET 0.5 FOOT 60.00 FTj OQ Charles A. Leet e c9 QQ r CE 10480 v�ad %-sy :49TH ". <* DD 0000000 SEPTIC U?GPADE DESIGN SITE PLAN DETAIL Legal Description' T15N R1W Sect. 8 Lot 45 Parcel ID: 051-093-02-000 XASK RIM ENGINEER' INC. 'IzAftih P.O. BOX 2749 PALMER, ALASKA 99645 PHONE: (907)745-0222 FAX: (907)746-0222 WO: 1600348 Alaska Rim Engineering, Inc. Date 5/26/16 PAGE 2 OF 4 1"=10' 6' JIM 6APNNNN. ADVANTEX AX20 PCDAIR W.N1 PASSIVE INSULATED RISER Treatment Systems Oa AX20 - Mode la 9=2,-- 1500 ram--1500 Gallon Fiberglass Tank 3-4 bedrooms 6' PUMP -OUT 6' COUPLING GLUED TO TANK (PTIONAL SLIDE SECTON OF 6' PIPE OVER THIS CONNECTION TO PROVIDE SHEER PROTECTION- EXTEN0 TO BRIDGE EXCAVATION 500 A LOV R CV55 LIFTS ATICN S° P'*°°49TH 000 °o ° Charles A. Leet °e°� ° CE 10480 ?P�QQQ,oOFESSSSI\ ccld O%oo Leai Description: ADVANTEX SYSTEM DETAILS T15N R1W Sect. 8 Lot 45 Parcel ID: 051-093-02-000 ASKd1 CAL.. RIM ENG NEE 1\ INC. Alaska Rim Engineering, Inc. P.O. BOX 2749 PALMER, ALASKA 99645 PHONE: (907)745-0222 FAX: (907)746-0222 Date 4/14/18 WO: 1600348 PAGE 3 OF 5 SCALE: 1" = 50' 0. 0 en en N to0 N r N tTn 0 retinm a N Z 0 a 4" PVC 02% - DOUBLE CLEANOUT INV. IN 95.5± 10' MONITOR TUBE MONITOR TUBE PLAN VIEW NOT TO SCALE TBM ASSUMED ELEVATION 100.00 GROUND SURFACE 399.00 GEOTEXTILE FABRIC e p 4" PERFORATED PVC 0 INVERT 95.5 95.0 ASSUMED ELEV. 93.0 ASSUMED ELEV. 89.0 ASSUMED ELEV. 87.0 3' NATIVE BACKFILL OR rr 2' W/ 2" INSULATION D 2' MOA APPROVED FILTER SAND 4' 7 GROUNDWATER 6' BEDROCK NOTE; CONTRACTOR TO EXCAVATE TEST HOLE PRIOR TO CONSTRUCTION. CONTRACTOR TO INSTALL GROUND WATER MONITORING TUBE. CROSS SECTION NOT TO SCALE 6' 2" CLEAN ROCK 6" CLEAN ROCK ez,,0000%`% K•..• aF° aC9P�U0D ,9 D ter° 49TH /\ * vD ove. :nee nba, ob a..f .....Q Pt Charles A. Leet , e c p ; CE 10480 QPQU a �dd00�oo�d" SEPTIC L PGRADE DESIGN ABSORPTION BED DETAILS Legal Descriptiorn T15N R1W Sect. 8 Lot 45 Parcel ID: 051-093-02-000 Ai,t,24SK RIM ENG EENJ. INC. ALAtfr P.O. BOX 2749 PALMER, ALASKA 99645 PHONE: (907)745-0222 FAX: (907)746-0222 WO: 1600348 Alaska Rim Engineering, Inc. Date 5/26/16 PAGE 4 OF 4 NOT TO SCALE ALASKA RIM ENGINEERING, INC. ENGINEERS — PLANNERS — SURVEYORS 9131 E. Frontage Road Palmer, Alaska 99645 Telephone (907) 745-0222 Fax (907) 746-0222 Online at: www.alaskarim.com June 29, 2016 Mr. James A. Crewdson, P.E. Municipality of Anchorage - Development Services Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519 RE: T14N R2W Section 11, Lot 66 (Remainder) 10103 VFW Road, Eagle River, AK 99577 Subject: Request for Additional Information Dear Mr. Crewdson: You have requested additional information regarding the separation distance from the tank and absorption field to the foundation. That portion of the house east of the porch is a full basement and the portion of the porch and westward is on piers typical of post and beam construction, therefore the potential for undermining the footing/foundation is minimal. We have provided a drawing to help illustrates how the lesser distance is mitigated Furthermore due to the postage size lot, the waiver is being requested to stay within the available space this lot has. We do not anticipate any adverse effects with the lesser separation distance on the tank, field or the house and its inhabitants. Should you have any questions or comments please do not hesitate to contact me by telephone or email chuck@alaskarim.com. Sincerely, Alaska Rim Engineering, Inc. Charles A. Leet, P.E. Project Engineer Encl: Cross section foundation Cc: Client AK Rim File # 16-00348 `�. %%%%%%%%% OF ALgS'II .1qPs• ORIGINAL GRADE ' SEPTIC TANK 6' / 18° FOUNDATION WALL FOUNDATION TO TANK DETAIL SCALE: 1" = 5' P 'SP�� OF A�U'9 z,_ P'* 49TH %\ eek �QQQQfs*70 CE es A.104 Leet 'er 9 CE 10480 a timed V 1/ ? PROFESS Rp[ o\ cr { (z< SEPTIC UPGRADE DESIGN ABSORPTION BED DETAILS Legal Description, T15N R1W Sect. 8 Lot 45 Parcel ID: 051-093-02-000 1(o Alaska Rim Engineering, Inc. N,ASK RIM ENC NEE , INC. P.G. BOX 2749 PALMER, ALASKA 99645 PHONE: (907)745-0222 FAX: (907)746-0222 WO: 1600348 Date 5/26/16 PAGE 5 OF 5 NOT TO SCALE SGS SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1162329001 AK Rim Engineering T14N R2W Sec 11 L66 REM T14N R2W Sec 11 L66 REM Drinking Water Printed Date/Time Collected Date/Time Received Date/Time Technical Director 05/31/2016 7:49 05/11/2016 13:36 05/11/2016 14:50 Stephen C. Ede Sample Remarks: Parameter Results LOQ Units Method Allowable Prep Analysis Container ID Limits Date Date Init Metals by ICP/MS Arsenic Waters Department Total Nitrate/Nitrite-N Microbiology Laboratory E. Coli Total Coliform ND ND Negative Negative 5.00 ug/L EP200.8 C (<10) 05/12/16 05/26/16 EAB 05/17/16 NEG 0.100 mg/L SM214500NO3-F B (<10) 1 100mL SM21 9223B A 05/11/16 ACF 100mL SM21 9223B A 05/11/16 ACF ..: DRILLING, Inc.l.'' 4-tI31::. 111 Dawson .._ . AC$O73Ta•IT41 . A{.! ;`.' CUOMO; AL CCA.S600' 1.. ",_.�y^'•� . . tv �• Welt Omer tlarl • 1tt. 4. •w- , a kt ii of Wen 'Dot ecl i • ,,1, •.• • ••r l.00ait •.• BIC it/mown; or,dlatance Main islet• : t• j ';� ti._ -• *etL.O./ ;h. o.k i •r k -it-!Y -• .•.. vr"•`- t Ain of tort line • • •47.'Ike; 1L'+•Tl*i flY. Ea 'floor .:• -1. of casing d >7ept of Hole ••� {eot ` •t( Cased WI` 65 feet i Static wa��level e *' - (tate) (below) land surface. finish of well (check one) open orad r•• • Screen ( + -1;.7..PerforatedT. _ •). .•Deterlbeaereen or perforationtils ants: Well pumping test'at i, goons per Q.7V of drawdown from static levet - • Dale of completiiin ' •d 1p_41 1y$ -. •• • Depth in feet from T.:, ground sutface • .. - ' Give details of formations penetrated, size of material, color and hardness v c i ,••. < : A •' 1•r0 • ' . • Sandy tiraval . . �.. . . C. --71.:—.10 ,id' • Mutter • 1r (&/n•).`.inns- apt It T.nla -•• (minute)•L+r 4-! hours lvttb_il _ft • Will too . . *�. •s6 �i TIC TO._ " �. ' F "' IN 11 f ■flit//1 siaye nave anlltlai; .tee&Sftaranti steel •• � •• .,�. in • tarn' 'eel •j•0 'f!1 ,. •. 31.144ts aaatu iltwTI . •wJ 11.4.011• •attt.•atff t ' . 'l.• r• . .T a ty Antral I: • • • tt3 • fTr .. l TO_pe� 3 TO • TO ! r%• • r P I r. • RI toy nr•...1 . nt.fe .1 Tet? Tit -lltir at • The nl� iT tell. •ran T.aOn..•• t It ',TV net a.1TA•f • until it 1s a bigeton./sbale and to further•vaterp er po•fl'•lttr te•er ot, ►•-- ower k••••• ersenMfanA til wtr • knowledge. Tharorfon. the cell was perforator{.sad e---1 ta4 -e aL--__ It to mint: -at -0 tun+ 4k• 1%+• '.•'be taken to the Borough health Supte for perSgdte ' '. •s warts R. Yestberg Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw SL P.O. Box 196650 Anchorage. AK 99519-8050 Page 1 of 2 www.d.ancho".ak.us (907) 343.7904 ON-SrrE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW050461 PID Number. 050-261.10 EN STIRK &water System: ❑ New ❑ Upgrade Adda.: ABSORPTION FIELD D Dwp Tnrrdi O St -,,h a Bed O Mount O Deur. Pnm,: Fwnew a B.dppnu: 565 -MOS 2 LEGAL DESCRIPTION "Ra Tau Mpe+ aia.d. Bbck La: &40N.lom Dept b p" babm fmn ala. Wa :M dpm breads P"s 66 oe Ft 70�10nip: Rwp: a.aalaic Fa Wd datum WO. pant Dr .•Nlr 14N 2W Z11� Ft. Ft. Well: New ®Upgrade tkn.arides t«,�«ar.. Drr ol�Iwri; _ Ft. Ft DluMluwn IPrnra. A B, Ck Twl Dpn:G.ad tr. W. ToW .Dvpnm Poe kww PRIVATE 120 Ft. Ft Ft' D~ 1 Do* Daw auto Wrr La M Do* InNWM. SULLIVAN 1012006 1 35 n I EXISTING r,rd. Pump sr r: a.+w wv. neon. G, . TANK 15 DPM 110 FI. 1.7 FL SEPARATION DISTANCES ❑ Septic ❑ Hokding P. ❑ other. To Septic Absorption OF Holding lublWPrtate 'a . From Tank Station Tank sewer uns EXISTING —or. WN 86' rVFiell D _ _ 4,r MW MnDw— r. sW1=,wrr — — — — LIFT STATION ¢e. N: CW N 'Pump on' bvN at •Poop olr r. Npn vrr Yrm a. FauWbn — — — — — _ h Pury Me" t ENcb d Vop n y prlanrd b Cutin DrW Fee "wt"BENCH ONLY NEW WELL WAS INSTALLED. MARK Loueon ab D.wVtan. Mrrian. Ft E c q eS�„4.F.M.A Inspections performed by: NIA Dates: 10 NIA 2nd NIA Development SerrvicesDepartment Approval i gIRiSTOPHER �Ey; CE OUT Reviewed and approved by: Lk -C”" LftOJ� 1 Date: jlAja . p` G ' IOP1N i Permit No. SW050461 Page 2 of 2 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT ON—SITE WATER & WASTEWATER PROGRAM 4700 SOUTH BRAGAW STREET P.O. BOX 196650, ANCHORAGE, AK 99519-6650 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: T14N, R2W,SEC11, LOT 66 050-261-10 LOT3 \ SCALE 1\0-3V e LOT2 � I ' ABAN D E WELL I o \LU � �RyV • yO�SF o. `tel 3� a ,p / W LOT 1 \ I U W / O / O - CLEAN UT I — WELL FfM � SHED Cf — Mo OR TUBE 01-05-06LOT6 6 • -. ENGINEER'S SEAL oopo4pp .. ASpNgCT QF A��oo4p •. .•. o �P4 .S *0 , APPROX �....: :.. SEWER MANHOLE •. CHPoSTOPHER R. WOOD: O uo O�o�,D����o 01/05/2006 16:17 6882259 SULLIVAN PAGE 01/01 �ertifie� *t"tting log by Doc Co. dba SULLIVAN WATER WELLS P.O, BOX 070272, CHUoiAK, ALASKA 99557 OTELEPHONE 6Be-2758 OWNER OF LAND: ADDRESS: LEGAL DESCRIPTION: T Iq �J L97 r DATE:._ PERMIT NUMBER: Date of lssuel �.— � TAX IDENTIFICATION NUMBER: _O.'y-- a / _ 10 Is well located at approved permit location? LI -V O No Method of Drilling: dell rolary O cable tool Depth of well: ju d Casing Type_lUti-Mall'thickness 0 92 5-"P Inches Diameter- - / Inches, depth _ (Q gR feet UnerType: /)O&JZ Casing Stickup Above Ground: a• feet Static Water Level:- 3 C feet Recover Rate: /igpm Method of Testing: Al I Well Intake Opening Type: 0 open end &Vj5�n hole 0 Screened; Start feet Stopped feet 0 Perforations Start M Slapped feet Grout Type: az=!A �AJ4-r Wfume 0 aaAd ' Depth: from n . feet, to —49 D -- _ feet Well Disltfected Upon Comp1e1l0117 `IbA r0 No Method of Disinfection: Comments. C.r��S'iNC� T i IGIC✓� oyar8 .lco ,J' .ric; r 6.co,r,, lit ✓�- r�.�� Z .SNr9c. �i O _ SAS': a -✓R= S�7yRrF ' I Driller's Name l7- ATTENTION: It Is ft responsibility of the Property owner to submit a copy of the well log to the Proper authority. Municipal of Anchorage: Department of Health d, Human Services and/or Department of F-nvim=ontat Conservation. MatSu 6oroug Department of Environmental Conservation, Jan 09 06 03:29p e � Mork Bepfch Mayor Jim Sullivan 907-688-2543 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragow Street P.O. Box 196650 Anchorage, AK 99519-6650 �.munl.orq/mmite (907)343-7904 Pump Installation Log Well Drilling Permit Number. SW -0-25K) tfG / n. --t 1a...wres6an N..mher:OSb L 94 -/G Date of Issue: /L L%/5 Legal Description e_. for 66, S Gc- 111 T /YA) k 2 t,✓ A Property Owner Name & Address: M42 r Syr%/c /c/o.) Pump Installation Date: f/.y C& Pump Intake Depth Below Top of Well Casing: V1 feet Pump Manufacturer's Name: Qear,OsYtC/ Pump Model: MdFz v p57 Pump Sizc V2, hp Pitless Adapter Burial Depth: /0 feet Pitless Adapter Manufacturer's Name. Pitless Adapter Installer: / ./V gzwe l t ri/ St+Ket Well Disinfected Upon Completion? ['Yes ❑ No Method of Disinfection: Comments: Pump Installer Name: Py/w"e- PeMr/o Q Ice 4"rr Selz v Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. January 5, 2006 EagleRiver Engineering R.E. 10103 VFW ARCTIC PUMP & WELL INC. Jim Sullivan PO Box 770197 Eagle River, AK 99577 (907) 688-2510 On 115106 We abandoned A well on this property. We also installed A new pumping system in the new well chlorinated and flushed every thing is working good Thank's J' Sullivan MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Upgrade Permit Number: SW050461 Legal Description: T14N R2W SEC 11 LT 66 REM Design Engineer: 0848 Eagle River Engineering Services Owner Name: MATTHEW STRICK Owner Address: 10103 VFW ROAD EAGLE RIVER , AK 99577 - Date Issued: Dec 29, 2005 Expiration Date: Dec 29, 2006 Parcel ID: 050-261-10 Site Address: 010103 VFW RD Lot Size: 5410 SO. FT. Total Bedrooms: 2 Permit Bedrooms: 2 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. a.) The proposed well shall be cased to a minimum of 40 feet below the ground surface. The outer annular space for the entire length of the well casing shall be grouted with bentonite slurry or granules. b.) The existing well shall be permanently decommissioned in accordance with AMC 15.55. Received By Issued By. ersEar,, Date./2/30%5— Date: /a/a9/0/0Cfc Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 • ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. DO- - /O Permit Number SWOr 4(0 Property owner(s) '991af7'/1.tt1) f/irk_ Day phone 950 - y595" Mailing address (1) / 0/O3 t/FPO Rd Mailing address (2) ea i✓J- L , fLiL Zip Code 19 517 Legal description (Lot, Block & Sub'd.) 1_07 GG Legal description (Section, Township & Range) 5 cc-. 12 , 7/4 g ,c.W Lot Size 5, 9/o Acres[ Ei Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only 0 Well Only Sewer and Well 0 Water Storage Sewer Upgrade 0 THIS PROPERTY CONTAINS: Hot Tub 0 Jacuzzi Swimming Pool 0 Water Softening Unit Therapy Pool 0 0 certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling an. is In y ccordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: tRev. 12/00) $/h. av /c/ '/4 Waiver Fees: SI iccn.co Date of Payment: Receipt Number: tor 0.510_34a Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW Road Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax December 22, 2005 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: T14N R2W Sec. 11 Lot 66 Well Permit and Waiver Request from on-site well to seepage pit and sewer main, and seepage pit to surface water and adjacent property inactive well. Dear Mr. Roth: Eagle River Engineering Services (ERES) is applying for a waiver of separation distance to 98' (allowing for several feet from the standpipe to edge of seepage pit) from the proposed new onsite well for the above referenced property, to the edge of the seepage pit installed on this same property in September, 1971, and the on-site septic tank 88'away from the proposed new well. There is a current Health Authority Approval in the works for this lot awaiting the result of this Well permit and new well, and Waiver Request. Additionally, we are requesting waivers for seepage pit to surface water of 85'(Meadow Creek), and from the property's seepage pit to the neighbor's inactive well on Lot 1 David Lee Subdivision, installed in 1956, for a distance of 67'. Finally, we are requesting a waiver from the on-site well to the sewer main running up VFW Road. To our best knowledge, the distance from the on-site well to the sewer main is 40'+/-. We list the following factors and characteristics in support of this waiver: Soil Characteristics: The original inspection report indicated that the soil was well graded gravel and sand -type material, which is consistent with the well log detailed below. Well Characteristics: A well log was found on the DNR website identified as "Lot 66 and 67". The well log indicates sandy gravel from 0-15 feet below ground surface, with silty/clayey material from 16-24 feet. Twenty-four to 28 feet is water bearing gravel layer. Deeper than 28 feet is silty gravel then clay to 90'. The well is cased to 40+ feet below ground surface. It is unknown at what depth the casing is perforated, but to our best assessment, it is deeper than 40'. We have also included a well log from Lot 3, David Lee Subd., which is approximately 150' to the North. ERES believes that the silt and clay create a barrier, filtering and/or stopping septic effluent from reaching the water supply. X2003\05-126Wa1,PeantrrWNvatNA utM vs Surface Slope: Surface Slope is at 8%-10% toward the Southeast, away from the on-site well casing, away from the adjacent well, and away from Meadow Creek. The wells are to the North of the seepage pit, and Meadow Creek is to the West of the seepage pit. Other Factors: There is a 30+ year history of continuing use of this well and septic system. Current water samples indicated no fecal coliform or other bacteria, and 0.419 mg/L nitrate, well below the allowable limit of 10 mgt. AWWU Sewer main characteristics: The AWWU sewer main was installed in 1995, and is approximately 40' from the property's well. The sewer lines consist of dual 10" polyethylene pipes at approximately 10' of burial. The nearest manhole is over 100' from the subject property's well. No other area exists on the lot in which to install a new water well meeting all of the MOA water well code requirements. The area to the north of the fencline on this property has been deeded to the owner of Lot 2 in exchange for Lot 66's house, deck, and fence encroachments onto their lot. By drilling a new well 5' to the north, we are maximizing the distance from the on-site septic system to the new proposed well. The granting of this well permit and waivers is crucial to providing this residence with a potable water source, and we cannot see any adverse impact on human health or future development if this waiver is granted. The existing well shall be abandoned per the new MOA Water Well Code. Thank you for your timely consideration of this Well Permit Waiver Request. We have attached the adjacent well log, water sample results, and septic system asbuilt. If we can provide any more information for you to expedite this well permit and waiver request, please call our office at 694-5195. Sincerely, EAGLE RIVER E INEEG SERVICES Christopher R. Wood, P.E. Principal \2003\05-I26 W EUPERM rr W AIVE RNAannn V E / — ---`` _• \ / -•••-- �- / // / / 7011, / SEPTIe‘ AREA,( / 1 \• AREA OF LOT DEEDED TO OWNER OF LOT 2 PROPOSED NEW WELL LOT3 100' NEIGHBOR'S WELL RADIUS 1 I \ / I \ / I I 1 /LOT2 i i t1 iii 1 / I 1// I 1/ I I 3 • 0 4 �///// / / / i SEPTIC AREA; PIT — - APPROX SEWER MANHOLE TEST HOLE SEWER CLEETUAN OUT WELL EASEMENT PROPOSED LEACH FIELD EXISTING LEACH FIELD DRIVEWAY SEPTIC AREA J NOTES 1. ALL WELL DRILLING AND PUMP INSTALLATION SHALL BE IN ACCORDANCE WITH A.M.C. CHAPTER 15.55 WATER WELLS 2. NO KNOWN CURTAIN DRAINS 3. NO SEPTICS WITHIN 30' UNLESS NOTED 4. NO OTHER SOURCES OF CONTAMINATION ARE KNOWN OF OTHER THAN THOSE SHOWN WELL 8c WAIVER SITE PLAN LEGAL: T14N R2W SEC11 LOT66 OWNER: MATTHEW STIRK CONTRACTOR: UNKNOWN JOB# 05-126 DATE: 12/22/05 SCALE 1"=40' AEAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 .,OFl/147;'4# - i� 90 i •.CHRISTOPHER R. WOOD.% 0 CE -10387 ; `. „'� • et 4k1 PRRES51oNN c Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW Road Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax November 22, 2005 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: T14N R2W Sec. 11 Lot 66 Waiver Request from on-site well to seepage pit and sewer main, and seepage pit to surface water and adjacent property inactive well. Dear Mr. Roth: Eagle River Engineering Services (ERES) is applying for a waiver of separation distance to 93' (allowing for several feet from the standpipe to edge of seepage pit) from the onsite well on the above referenced property to the edge of the seepage pit installed on this same property in September, 1971. There is a current Health Authority Approval in the works for this lot awaiting the result of this Waiver Request. Additionally, we are requesting waivers for seepage pit to surface water of 85'(Meadow Creek), and from the property's seepage pit to the neighbor's inactive well on Lot 1 David Lee Subdivision, installed in 1956, for a distance of 67'. Finally, we are requesting a waiver from the on-site well to the sewer main running up VFW Road. To our best knowledge, the distance from the on-site well to the sewer main is 40'+/-. We list the following factors and characteristics in support of this waiver: Soil Characteristics: The original inspection report indicated that the soil was well graded gravel and sand -type material, which is consistent with the well log detailed below. Well Characteristics: A well log was found on the DNR website identified as "Lot 66 and 67". We do not believe it is the well log for the well that is currently in use, but we can use it to determine subsurface geology for the purposes of this waiver. Our measured static water level of 29' is quite a bit different than the well Tog's static water level of 11'. Additionally, the static water level that we encountered is below the level of the perforations indicated on the well log (24-25'). The well log indicates sandy gravel from 0-15 feet below ground surface, with silty/clayey material from 16-24 feet. Twenty-four to 28 feet is water bearing gravel layer. Deeper than 28 feet is silty gravel then clay to 90'. The well is cased to 40+ feet below ground surface. It is unknown at what depth the casing is perforated, but to our best assessment, it is X2003\05.126 WntvERLEnER deeper than 40'. We have also included a well log from Lot 3, David Lee Subd., which is approximately 150' to the North. ERES believes that the silt and clay create a barrier, filtering and/or stopping septic effluent from reaching the water supply. Surface Slope: Surface Slope is at 8%-10% toward the Southeast, away from the on-site well casing, away from the adjacent well, and away from Meadow Creek. The wells are to the North of the seepage pit, and Meadow Creek is to the West of the seepage pit. Other Factors: There is a 30+ year history of continuing use of this well and septic system. Current water samples indicated no fecal coliform or other bacteria, and 0.419 mg/L nitrate, well below the allowable limit of 10 mg/L. AWWU Sewer main characteristics: The AWWU sewer main was installed in 1995, and is approximately 40' from the property's well. The sewer lines consist of dual 10" polyethylene pipes at approximately 10' of burial. The nearest manhole is over 100' from the subject property's well. Thank you for your timely consideration of this Waiver Request. We have attached the adjacent well log, water sample results, and septic system asbuilt. If we can provide any more information for you to expedite this waiver request, please call our office at 6945195. Sincerely, EAGLE RIVER ENGINEERING SERVICES 777,-/dir/ Christopher R. Wood, P.E. Principal \2003\05-1 26WAIV ERLETrER Munici�alii�T of Anchorage ,.. ,.., CO. [Lt� 1'.Kif:� • Muharu);c. Aloslu, •J.Ail9�fif:-A • Tcliphonc (�) 313•B'f01 •rat (!)iq) 33&R°IN) 370() 8n��w• Strcct • Anchom�!c. Aluskn �JS).�7 �s • " Ti� mim munl.mg Mayor 3lark Begic/t BttIlding Safety Division 1/18/2006 Eagle River Engineering Services P.O. Box 773294 Eagle River, Alaska 99577 Subject: Waiver Request for T14N, R2W, Section 11, Lot 66 REM Waiver Request #WR050111 Parcel ID #050-261-10 Permit # SW050461 and COSA # IIA050603 Dear Mr. Wood, Your request for a waiver of the required separation distances has been approved. The approved separation distances are as follow: 1. 40 feet from the well on subject property to the sewer main; 2. 79 feet from the septic tank on the subject property to surface water, 3. 77 feet from the absorption field on the subject property to surface water, 4. 86 feet from the well ori the subject property to the septic tank on the subject propertY: 5. 97 feet from the well on the subject property to the absorption field on the subject property" 6. 86 feet from the well on David Lee, Lot 2 to the septic tank on the subject property; and 7. 95 from the well on David Lee, Lot 2 to the absorption field on the subject property This waiver approval only applies to the existing separations noted above. Any future upgrade to the on-site wastewater disposal and/or water supply system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. �Sincerely, —Julie Makela, P.E. Civil Engineer On -Site Water & Wastewater Program Conznzzznity, Security, Prosperity Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchoragc.ak.us (907) 343-7904 Waiver Review Worksheet WR#: WR050111 PID#: 050-261-10 HA#: HA050603 Permit#: SW050461 Date Received: 1111012005 Legal Description: T14N. R2W. Section 11. Lot 66 Engineer: Eagle River Enaineerina Services Box 773294 Eagle River. Alaska 99577 Applicant: Matthew Stirk Waiver Requested: 40 feet from subiect wetl to sewer main: 79 feet from subiect septic tank to surfacq water: 77 feet from sublect absorption field to surface water: 88 feet from sublect wet( to subiect septic tank: 98 feet from subiect well to subiect absorption field: 86 feet from David Lee. Lot 2 well to sublect septic tank: 95 from David Lee. Lot 2 well to absorption field Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: y•n to • V -3 Total: 1 (9.3 Waiver is Granted: Waiver is not Granted: List Conditions or Reasons for above: Date: hOpi ala 'S By: IS tj ame o Reviewer l^ Q4 _a" Rec#: 76636 Amount: 51150 Date Paid: 1111412005 T14N, R2W, Section 11, Lot 66 Parcel ID: 050-261-10 Waiver for 40 feet from subject well to sewer main; 79 feet from subject septic tank to surface water; 77 feet from subject absorption field to surface water, 88 feet from subject well to subject septic tank; 98 feet from subject well to subject absorption field; 86 feet from David Lee, Lot 2 well to subject septic tank; 95 from David Lee, Lot 2 well to absorption field Issued December 29, 2005 General 1. Total coliform and other bacteria were not detected for the water sample collected from the well on the subject lot. A nitrate concentration of 0.419 mg/L was reported for the water sample. The well on David Lee, Lot 2 is out -of - service. A water sample could not be collected from the David Lee, Lot 2 well. 2. The existing well on the subject property was installed on April 16, 1974 at a total depth of 90 feet. The well is cased to a depth of 90 feet with perforations from 24 to 25 feet. The existing well is to be properly decommissioned. The proposed well is to be installed a minimum of 40 feet into the unconsolidated material. The outer annular space for the entire length of the well casing shall be grouted during construction. The well log for this property identifies a silt/clay layer from 16 to 24 feet. 3. The existing wastewater disposal system on the subject property was installed on September 8, 1971. The septic tank is constructed of concrete. The seepage pit consists of 2 precast 3 foot height concrete rings. 4. Due to lot size and location of septic systems and water wells on surrounding properties, there does not appear to be an area on the subject property to meet the current minimum separation requirements for a wastewater disposal system or water well. ADEC Criteria Points 4.0 Water Table 40 feet Minimum depth of proposed well feet Approximate depth of sewer main -1030 feet Soil Sorption Outer annular space grouted entire length of well casing permeability Outer annular space grouted entire length of well casing Water Table Gradient Assume -5% slope Horizontal Separation 40 feet between proposed well and sewer main x=15/25+0.7 x=1.3 6.0 3.0 2.0 1.3 Total Points 16.3 As per ADEC waiver guidelines a point value of 16.3 is almost sure to be free of any form of contamination from household sewage. GAA8-H0.1 ,:R ANCHORAGE AREA BOR( ' JEIMRTMENT OF ENVIRONMENTAL QUALM 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME 77 O® MAILING / 3/p PHONE.f'��e a��� ADDRESS�//'�l/r LOCATION LEGAL DESCRIPTION z i/. - / l�T 1,6 s sri. SEPTIC TANK: DISTANCE FROM WELL •% D LIQUID CAPACITY 75Z NUMBER OF MATERIAL Ga/c/e COMPARTMENTS / LIQUID GALLONS. INSIDE LENGTH INSIDE WIDTH c— DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: G /�fi�� soiZ- cow/n4�f / 7 NUMBER OF PITS / OUTSIDE DIAMETER 4OR WIDTH �/� C3 -9-r.7' C�fjCff.r 4J.e/�/� / / LINING MATERIAL C-4),./0/0��Nef - DISTANCE FROM WELL NEAREST LOT LINE 0 %O .2 .` TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) i LENGTH c, / DEPTH BUILDING FOUNDATION 33 SQ FT / TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION NUMBER OF LINES i TANCE BETWEEN LINES ' ENCH WIDTH ABSORPTION A SQ FT LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE NEAREST LOT LINE TOTAL LENGTH OF LINES IN TOTAL EFFECTIVE IN ABOVE TILE WELL: LOT LINE DISTANCE FROM WATER TYPE -ev/v/e • DEPTH /'""/= , BUILDING FOUNDATION SAMPLE ----C.-4'S NEAREST NEAREST SEPTIC/ OTHER SEWER LINE TANK J) SYSTEM l , CESSPOOL £ SOURCES %p/> DISTANCES: /7 zoG-so' gfOC=P3' GF'E,rf! DIAGRAM OF SYSTEM DATE y"4 -n 77-7/ -APPROVED G.A.A.B. 6pt*las Mu NIGI PALITY oF ATcHoRAGE Development Services Depafiment On-Site Water & Wastewater Section Phone: 907-343-7904 Fax: 907-343 -7997 Certificate of On-Site Systems Approval Parcer r.D. 050-261-10 1. GENERAL INFORMATION Complete legal description T14N, R2W, Section 11, Lot 66 REM Location (site address) 10103 VFW Rd., Eagle River, AK 99577 Current property owner(s) Jeremy & Tavai HOlt Day phon eg}7'242'2538 Mailing address Real estate agent Sabra Gilliland ! Day phone 907-341-3720 TYPE OF DWELLING: tr Single Family (w/wo ADU) I Duptex n Muftiple Dwellings (Single Family and/or Duplex) Expiration Date: ,,L*() + I7 r- g 0 2Cj 3. 4. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public:Water System tr T T T TYPE OF WASTEWATER DISPOSAL: Private Septic tr Holding Tank, nCommunity tr Public Sewer I Waiver request for:Distance: Received by:Date: cosA r". g , #Q l, waiver Fee $ Date or Paymen . Q["71H&Date of Payment Receipt Number t,L Receipt Number Waiver # COSA to be released to the erpineer, unless othenruise requested by the engineer. cosA # oiL?nII,g, __ _ 5, STATEMENT OF INSPECTION BY ENGINEER As cenified by my seal affixed hereto and as of the validation dd€ sholvn beloi/, I vedfy that my investigation, basedon ptocedures outlined in the C€rtificete of On-Site Systems Approval Guidelines for tfiis appliiation, sio,ra itrat ttre on-site weter supply and/or waste\ tater dispGgal system is (are) safe, functionel and addquate for the number of bedroom! and type of structurc indicated herein. I further verify that based on the informetion obtained ftom the Municipality of Anchorage files and trom my inrrestlgation and inspection, the on-site water supply and/oi wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinenc€s, and regulations in effec{ at the time of installation. I acknorrrledge thai On-Site slaff riray visit th€ site to verify the information s:ubmitted. Name of Firm Crewdson Engineering LLC phone 907-280-9493 Address PO Box 671389, Chugiak, AK 99567 Engineer's Printed Name lgmgs Crewdson Date 4'21-2020 6. DSD SIGNATURE J System #1 Approved for System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms I .{.s OF I Vlt v"- , WnfEn AND The Municipality o{ AnriKtrage Oer.elopment Seruicae Dlvision (DSD) issua! Ceftificat€s of On-Slte Syrtetris Appip\rat (COSA) based onty upon th€ r€pEsentafons giwn in palagr9ph 5 by an indepandent prolbssional dvil engineer regist€red in the State ot Alaska. The Muntctpality ol Anchd-ago ls not reaponeible lor enprs or omission$ in th€ proGssional erEinee/s utork : T4 ft I ( $s '(tir,4 J . t $r-$ trQ, 2 R ( ,\\ v\ASTW & 6=?ri \s 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA Checfiist blue she€t X Nitrate Advisory Arsenic Advisory Other '! 07/23/2019 15:39 8686770 APLUS 329 558 pill"aim BONN onsomessome Boom also ff 11111111 OR Hanson ON BE 0 PAGE 07 8 a I Rom am A Non so am a L ` r P tMAY 4rmerTrurk[N # pH (6-9))) { P -aster TYpical Jeremy & Tavai Holt ❑ Earthy tarry Betts Mon -typical 8ne AOrsss Q Cabb Gontatt Pho,7nW- 1©103 VFW Road, Eagle Rivet AK 99577 (907) 555-5555 AX She ID a County ID # Pod # RfU "tuL # Date of Last tresmaon AX -139686 OSP161150 423367 RTU133418 01111/2019 Retrieve O&M Info Daffy flow Recirc ratio_ T&mr setting;: Check for earthquake damage Perform Field SamplingJObseivations NTUBe (15 & NTUs) pH (6-9))) 110(22-6) TYpical 17, Musty ❑ Earthy Odor of Sample fge �a Previous Current Previous TYpical 17, Musty ❑ Earthy ❑ Moldy Mon -typical SufFtla Q Cabb 0 Decay 01tY film ht PVU ❑ Yes (,GI No Foam In tank []Yes 7 No Check Control Panel Racire Amps Discharge Amps 1 r. Audlble and visual alarms rZoK Dial ton lemetry only) til Yes ❑ No Insprtctlelearl am r Inspect Clean Risar/Ud .....................0 --, Splice Box .................. Float Cords ....... . .......... . Floats....................... Pump ....................... 8iotubeO Niter ................. Biotube Pump Vault ............ Recirculating Splitter Valva...... . Signature Measure Sludge/Scum sludge 1st Compartment Current z Previous Current Previous 2nd Compartment Current Previous Current Pmulous Inspect(Clean AdvanTex Filter Ueor: Normal ❑ Pungant f Blomst Normal E]Excessive Bridging/Ponding: NcnefMlnor ❑ Excessive InspectfCtean Discharge Pump System Inspect Risor/Ud 0 Splioe Box ❑ Float Gorda 0 Inspect Clean Latarak 4rifica> Pod Bottom Intake vent Inspect Ctlaatn Floats Pump ❑ C' inspectfService Other System Components, Inspect Clean lru. peat Giem Disinfection Equipment X )�Er Dispersal tErteraW0dfices observations t, Additional Services "ered ❑ CIoanod t wllc sheets? ❑ Replaced Uv Items'? F1 Raptaced/Used other items? PaTtS Used: W = Warranty, B - Billable (vr approprlate selection) w B Item Number DesaftUan Final/Safety Inspection RSV reinstalled 611anifold reconnected; flush valves dosed Summary/Reeommendations ❑ System podorming; no iurther action need ❑ Cali for service Date Fax completed form to 1-866-384-7404 [X1 uds bolted on Control panel reactivated ❑ Tank needs pumping 0 Other? MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this -Th Day of MR 1 L of 26 ED, by and between NN-e� , � , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Orenco Advantex located at (legal description) T14N R2W Section 11 Lot 66 REM 2. Maintenance Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Pim Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. 11i Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfeld replacement. (rev. 05/18/2018) Page I of 3 -� Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. AIA Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. AAN Owner agrees that the AW WTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. M Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6, Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 0511$1201$) Page 2 of 3 OWNER.: B� ,g�1 � (signature) Date: iV11),2-0 ANDVLIM M�PC-\,�D (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this (J"day of 20 20, by M 1 B51\ £2oz `t t ue� saaidY3 u°iss!wwoJ AW Oa 04VIS TARY PUBLIC FOR ALASKA �jjgncjSelv JelON �i�gnd tie�oN My Commission expires: t / 1 t 12-c:>2-5 H3An5'WnS53NVA MUNICIPALITY: By: %J (signature) 4L,e CC � C / (Print name) Date: �f3 �D2G r f Title: (rev. 05/18/2018) Page 3 of 3 Parcel I.D. 050-261-10 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Expiration Date ltd -zl-l� 1. GENERAL INFORMATION Complete legal description T14N R1 W Sec 11 Lot 66 REM Location (site address) 10103 VFW Road Current Property owner(s) Cory and Aubry Davis Day phone 280-9834 Mailing address 10103 VFW Road Real Estate Agent Kelly Harris Day phone 357-4663 2. TYPE•OE DWELLING: E] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System WaiverNariance reque or: Received COSA to be released to 2 QUBMITTAi gi JUL 2 0 2016 16 Gretchen Stulier TYPE OF WASTEWATER DISPOSAL: he engineer, unless otherwise requested by the engineer. Individual Holding Tank Community Public Sewer Distance: Date: 7/4,n COSA Fee $ (If C0Q-20 4. It'a It'7e" Waiver Fee $ Date of Payment 9-20 `((o Date of Payment Receipt Number eXCHO ab Receipt Number COSA # 05C (o(2Q9 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 C&M Engineering Address 30840 prudhoe bay ave Engineer's Printed Name Charles Balzarini 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By: Phone 7/17/2016 Date 7/17/2016 L ° • 7 �. ...... .: �pm ; Charle . Balzarini o` 7 75,, CE 13854 .° man 8iteamut's UN -SITE S7 WATER AND m WASTEWATER <: PNOGRAM • Original Certificate Date: 7` Z1 ` 1 C The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible For errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet_S c Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the tot: COSA Checklist # 1 of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: T )'41V Rol (A./ SEC (( Lo T 6 6 A. WELL DATA Parcel ID: O c - 11 0 Well type //211,0‘ F °tW irrEYbS If A, B, or C provide PWSID # Well Log(63/N) Date completed 1/ J/ o & Sanitary seal &DIAS Wires properly protecteder/N) YEs Total depth IX ft. Cased to 10?' ft. Casing height (above ground) 4-,2.0 in. FROM WELL LOG AT INSPECTION Date of test 1 / 312906 ©7//6/A9/6 Static water level 5 ft. 1 ft. Well production )5 g.p.m, -f' 5 g.p.m. WATER SAMPLE RESULTS: Coliform 14&17 colonies/100 mL Nitrate F/ 0 mg/L q Arsenic /,/�� ug/L Date of sample: b X 11 Ips� 6 Collected by: A K Sx� ENGTdsnn2,✓6 B. SEPTIC/HOLDING TANK DATA / Tank Type/Material 4 DV4.i 7 X / F t ,Ep. &MZ' Date installed 7 / 7/ 14 Tank size 1560 gal. Number of Compartments 3 Cleanouts i,'l) YES Foundation cleanout (a) YDS Depression over tank (Y-;1` jO High water alarm 4'N) >$ Date of pumping N/A Pumper WA- C. ABSORPTION FIELD DATA Date installed 7/(//4 Soil rating (g.p.d./ft2 or ft2/bdrm) 1€ a System type 13P.1S Length' . . -10 a41. + Width 45 ft. Gravel below pipe 0. 6 ft. Tot th .. J _ ft. P_kalgsorption area 6 0 ft2 Monitoring tube 9 Depression over field /" * . ,' .. r f):,,• 'r D •ef.adequacy.test... 4 Results lYFail) _ For bedrooms tit N Flt nnitigs%q ippffite(ffijs{bre test 0 in. Water added P) gal. New depth 0 in. EIarailtirri e 881 al•,nim''• • Final fluid depth 0 in. Absorption rate >= 3 0 0 g.p.d. Any rejuVeriatibnftrel�past 12 mo.) (Y/N & type) /(/O If yes, give date N/4 •... 'a D. LIFT STATION A/O �ZF7 Date installed Size in gallons "Pump on" level at — in. "Pump off' level at in. Datum — Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot t/ 1 c Absorption field on lot c� /i J ', Public sewer main 4-10' Sewer /septic service line 4a_s Animal containment areas '{' [00 SEPTIC/HOLDING TANK ON LOT TO: Building foundation J Property line 4 5 Absorption field Water main 4. to e Water service line 41 D Surface water Sit - Wells on adjacent lots 7 Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots Ha, r On adjacent lots fa,' Public sewer manhole/cleanout -J,s Holding tank -1- 75 Manure/animal excrete storage areas 4- 4 10 SO r ABSORPTION FIELD ON LOT TO: Property line10 e Building foundation * (0 Water Service line etae Surface water Driveway, parking/vehicle storage f 85'1( Water main -1.10 r / Curtain drain s4 Wells on adjacent lots eh -1 4 10'# F. COMMENTS .: SEE IngP5CTTA.✓ g CP0127 Tok WA-ry&tzt7E'rATLs,Lutrtek N iL/ S YSrEenn 5 e ? I TG ls € t t, TSS i N 'Iblooti lam_ ✓ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name C rn (i}-(ZL- 5 N.-MR/ma R/ma Date 7/1/ f ry COSA canary sheet_2-6-15.doc ?c%.... 'q4444 • 4 harfea G. Babdi ; i CE 13854 ' r r 1'0 r i �� .Lti -..•.•• '' d` / / ivjett""D /i/Notes; / / 1. There exists an Encroachment Easement recorded 3-21-2006, Serial No. 2006-017654-0. i 2. The boundary for this parcel was determined from / / Information found o7 adjacent Plat No. 63.65 (David Ler( Subdivision). ! / 3. The metes and bounds description as denoted in the / Encroachment Easement and in Warranty deeds is / incorrect. / N I 1 \ �\ \ / f 8436\( _/ \ Lot 9/ - \� 11 / \ /\ N. 1 N. 1 / 1 \ / \ Lot 2 1 /\ 1 100' Well radius 1 ortion of Lot 66 deeded to / owner of Lot 2,ci I 1 D / CO/ / Iw / / -Sr q o// `Well °' Lot 1 'PC // I louse encroaches.0.-a 91:" Culvert / / Wel hain link fence (typ) P \ f \\ f a gFiveway / / o • \ / cv $ W eck en • oaches 2.0"± 0 0 89°58 63.95 BLM Lo /N?'• •`s/r- �I '• 49th *••/ :w4 �•.f"red Walatko. Is' jc�f•3255 - S • 11444i. ' ' •�po SCALE: 1 "= 30' •`sionto. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. on, BE z 100' Well radius / HIDDEN HAVEN DAVE BLM Lot 74 RECERTIFIED 7.14-16 w, AS -BUILT NO COR RS SET THIS DATE I hereby certify that I have performed a Mortgagee's Inspection of the following described properly: Portion Lot 66. SECTION 11. T14N, R2W. Seward Meridian. AK Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property fines and do not overlap or encroach on the property tying adjacent thereto, that no improvements on the property tying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage. Alaska this 4th day of MAY 2016 FRED WALATKA & ASSOCIATES Engineers and Surveyors wmaAR_1RRRN Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 050-261-10 COSA# osala tail Expiration Date: 9 2 1- l a- 1. GENERAL INFORMATION Complete legal description T14N R2W SEC 11(Lot 66 Rem) Location (site address) 10103 VFW Road, Eagle River, AK 99577 Current Property owner(s) William Bellucci Mailing address same Lending agency Mailing address Real Estate Agent Craig Lightle Day phone 441-4114 Day phone Mailing Address Anchorage Day phone 441-4114 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well 2 TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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, 1 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 NorthRim Engineering Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Engineer's 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 sepf 9 sy tatha are subject to these various and dynamic characteristics and are outside the control of the Q` evaluator of the well and septic system. Phone 694-7028 Date 6/11/2012 5. DSD SIGNATURE Approved for 2. bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X j= ON-SITE WATER AND '11q WASTEWATER PROGRAM E& 1jtSE,R�GI\��� Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 6-2/-0-- Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: / /VA/ /Q 2V.( 5EC l f 4, or cc ,tEwt A. WELL DATA Well type P If A, B, or C provide PWSID # Well Log (YIN) Y Date completed_ Sanitary seal (Y/N)/ Wires properly protected (Y/N/) Total depth ft. Cased to ft. Casing height (above ground) in. Parcel ID: QSo QC%—/a Date of test Static water level ft. Well production / S FROM WELL LOG /AA -46 3.S WATER SAMPLE RESULTS: Coliform 0• colonies/100 mL Arsenic: ___ mg/I B. SEPTIC/HOLDING TANK DATA Tank Type/Material C_c»t Cir-e-te Tank size 7 SB gal. Number of Compartments Foundation cleanout (Y/N) Y Depression over tank (Y/N) g.p.m. AT INSPECTION S"/3,// z /9 ft. g.p.m. Nitrate a.3VVmg/L Other bacteria 0 colonies/100 mL Date of sample: �/07%� 2 Collected by: A/2i�F—nir Date of pumping 6 /*/ Z Pumper C. ABSORPTION FIELD DATA Date installed 477/ Soil rating (cd:p-dift2-or ftt2lbdrm) c,�9C Length p ft. Width O ft. Date installed 7/7( Cleanouts(Y/N) >/ High water alarm (Y/N) Total depth 9 ft. Eff. absorption area /9'2 ft2 Date of adequacy test CA 7/1- Fluid /ZFluid depth in absorption field before test.i, O in. System type Gravel below pipe pi •_p,.t Monitoring tube Depression over field A/ Results (Pass/Fail) le S -f ForZ bedrooms Water added/Oaogal. New depth CC in. ft. Elapsed Time:2L/ w4U. 64e. Final fluid depth �o in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Absorption rate >= <.?010 `/ g.p.d. yid/,L If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in "Pump off' level at Cycles teste E. SEP RATION DISTANCES AC SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main 8F/ le O' Sewer /septic service line 2 S ."1- Animal 'f Animal containment areas /ad �d- Mgneple/Access (YIN) High water alarm Meets ala el at circuit requirements? On adjacent lots /0014- On adjacent lots /Q®'t Public sewer manhole/cleanout /00 i t Holding tank N4 r Manure/animal excrete storage areas /co r" SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 '- Property line /0 116- Water tWater main A►,' Water service line 2 S r4 - Wells on adjacent lots 86 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101-1- Building foundation Water Service line 23 + Surface water `7 % Absorption field Surface water 7? 1 `Q f Water main Nr4 Curtain drain 7%/at' Wells on adjacent lots TS' F. COMMENTS 7 Waiver& X.- Pr re G. ENGINEER'S CERTIFICATION I certify that l 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. c� Engineer's Pri ted Name Date ‘G/(( 2 Driveway, parking/vehicle storage / Q �� OF tt \,)� rwAy • .Pee...`. ,Rpicot ' es. I( 0 CV Eng z 1 • COSA Fee $ `CZo` Date of Payment Receipt Number (Rev. 11/05) to tt aira 6tQRa& Waiver Fee $ Date of Payment Receipt Number Ac,ft .1J vjC-e> Municipality of Anchorage Development Services Department % / Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O 50 A61-10 COSA # o c9n3 Expiration Date: 14 C2= n 1. GENERAL INFORMATION Complete legal description TI 4 nh )a.? t,0 r SSG II / r7T (o L, — Location (site address) 10103 VFW ZD. Current Property owner(s) MA T Het&) STI Rte. Day phone 5&6- 8000 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. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ individual Holding Tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite 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 Onsite 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 Eagle River Engineering Services 104211 VPVV Rd., 6uite 284 Phone bey — 519 5 Address Eaole River. AK 99577 Engineer's Printed Name ChrLez r k yr R. 1 and Date f /12- /0 6 5. DSD SIGNATURE _V*� Approved for _t bedrooms. Disapproved. Conditional approval for bedrooms, with the following CHRISTOPHER R C@10387 Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory . Other I,j,..o*, ._UIAL. Original Certificate Date: lb If/ :rte (Pa .11105) Municipality of Anchorage Development Services Department Building Safety Division ` On -Site Water b Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: TI4 VJ , 5E6 II , WT (o(o Parcel ID:0 50 - NY 10 A. WELL DATA Well type R&014e- If A, B, or C provide PWSID # _ Well Log JDN) j�ES Date completed I 3 Owe Sanitary seat N) Wires properly protected (ON) W_5 Total depth —0ft. Cased to 10 d ft. Casing height (above ground) g24 n. FROM WELL LOG AT INSPECTION Date of test 1/3/06 AIrL�) COn1ST. Static water level 36 ft. ft• Well production I$ 9.p -m. WATER SAMPLE RESULTS: Coliform __0_oolonies/100 mL Nitrate <9J-_ mg/L Arsenic.<S.O I Date of sample: �O(o B. SEPTICIHOLDING TANK DATA Tank Type/Material 5C41?_r1(_ / 5 TEE L Tank size -150 gal. Number of Compartments Other bacteria W colonies/100 mL Date installed °I % 1)9-1 I Cleanouts ON) K=_s Foundation ciesnoutON) Jt 5 Depression over tank (`la 0 High water alarm (10 A/0 Dateofpumping V_4�/05 Pumper JP -'S _FUHF>,4rr_ C. ABSORPTION FIELD DATA Date installedl/9'69-71 Soil rating ( - or feWrm) i System type C11-= pi T Length S ft. Width S ft. Gravel below pipe fc ft. Total depth 1.5 It. Eff. absorption area 1 a-fe Monitoring tube d Depression over field IVO Date of adequacy test ►O/ Alps Results as aiQ SS For3'4 bedrooms Fluid depth in absorption field before lest 5_ In. Water added q5O gal. New depth_ in. Elapsed Time: lao min. Final fluid depth J5'I in. Absorption rate >= 1450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YO& type) 4tJF Ifyes, give date rJ (A— D. LIFT STATION Date installed Size In gallons 'Pump on' level at _ in. 'Pump off' level at Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Idt station on lot & ' Absorption field on lot C1-1 Public sewer main — c} Sewer /septic service line t A5 _ Manhole/Access (Y/N) alarm level at in. Meets alarm b circuit requirements? On adjacent lots -t IOU' On adjacent lots a - I tk> Public sewer manhole/deanout +100. Holding tank +-1z; Animal containment areas +100' Manuretanimal excrete storage areas + 1 Ott' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation _ -t S Property line -t s , Absorption field r Water main -t' I t1 ' Water service line + 10 ' Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line + 1 t_1 ' Building foundation t I0 Water main _ t I C), Water Service line 't 10 ' Surface water. -I 1 I Driveway, parkingtveNde storage c o ' Curtain drain 1• I) ' Wells on adjacent lots qS ' F. COMMENTS ^SS02-85 Lt GNrp� AOR 3 BD�M G. ENGINEER'S CERTIFICATION I car* that I have determined through field inspect/ons and review of Municipal records that the above systems are /n cmformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name lA'1)02) 4, r - Y Alm. IS.:I COSA Fee S Waiver Fee E _ Date of Payment I A C; Date of Payment Receipt Number Receipt Number. (Rev. 11/05)