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RIVER VIEW ESTATES BLK 4 LT 8
Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON -SITE WASTEWATER INSPECTION REPORT Permit Number:,OSP231333 PID Number: 050-721-03 Dwelling: 0 Single Family (SF) El with ADU El Duplex (D) R Two Single Family Project: El New Upgrade Name JOEL M HELGERSON ABSORPTION FIELD - EXISTING R Deep Trench [:1 Wide Trench R Bed El Mound Site Address 21211 RUNNING BROOK CIR, EAGLE RIVER _T�� El Other Phone f Bedrooms Soil Rating depth from original grade 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot RIVER VIEW ESTATES 4 8 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width 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 Fl? Ft. Well 100'+ 25,+ TANK ED Septic [I S.T.E.P. El Holding F-1 Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ I Material Number of compartments Lot Line 10'+ NA HDPE 2 Foundation 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by Installer JRS PIPE MATERIAL House to Tank to 3034 drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection dates: 1s' 10/19/23 2 nd 10/19/23 Location and description 3 rd 4 th FOP MH ON -SITE WATER AND WASTEWATER SECTION APPROVAL or- A • Conditional Approval: Date 7H .... .... .. ......... _-Q.9 zp- - Septic System Approved Curtis Huffman - L Date 27 20 2- CE 128991 10/24/23. . AVA, PROF�S$10 Note: this approval does not include well permit requirements. ki ev vwvci 1 ) PID:050-721-03 PERMIT:OSP231333 FIRST WATER CONSULTING RIVER VIEW ESTATES BLOCK 4, LOT 8 .. CC C C LC QC C 8 C L ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: RIVER VIEW ESTATES SUBDIVISION LOT 8 BLOCK 4 PLAT 75-131 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoul4 any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E-MAIL: OCT 21, 2023 1 "=50' schuller@ak.net 2 3 — 1 0 8 DRAM BY: CHECKED BY GRID NUMBER: B000PAGE: JLS SW0357 230338 * — FND 5/8" REBAR p F PA .... ...... VA / ....... "...................... .� •.Jf3HN L. SCHULLER: LS-10408 �ee 'AW `fir°fG�\ MW essionoN �•s."yw ��p A � 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227--1455 office (907) 274--4992 fax 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: OSP231333 Work Type: SepticTank Upgrade Tax Code Number: 05072103000 Site Legal Address: RIVER VIEWESTATES BLK 4 LT 8 G:0357 Site Mailing Address: 21211 RUNNING BROOK CIR, Eagle River Owner: HELGERSON JOEL M Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: �tl�cnt s, Depal'tnlent 10/4/2023 10/3/2024 55639 ❑ Disposal Field Q 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 iv�Y=U ej Date: Issued By: Date: 3 MUHMP AUT YOF '\ HCH0v2Oc Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section--- Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-721-03 Property owner(s) JOEL M HELGERSON Day phone Mailing address 21211 RUNNING BROOK CIRCLE, EAGLE RIVER, AK 99577 Site address 21211 RUNNING BROOK CIRCLE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) RIVER VIEW ESTATES BLOCK 4, LOT 8 Legal description (Township, Range & Section) Lot Size 55639 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 Septic Tank 0 Upgrade X pg (w/wo ADU) (D) El Holding Tank ❑ Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A 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 Fees: S Waiver Fees: Date of Payment: J 2 5 201 -Z 3 Date of Payment: Receipt Number: �y Z Receipt Number: Permit No. TS� .L 3� 3 3 3 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! September 29, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: RIVER VIEW ESTATES BLOCK 4, LOT 8 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. There is higher groundwater in the site and area and an Infiltrator septic tank or an epoxy coated steel tank may be required. A 1500-gallon tank may be installed for future consideration or flexibility. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231333, Deb Wockenfuss, 10/04/23 FIRST WATER CONSULTING RIVER VIEW ESTATES BLOCK 4, LOT 8 DESIGN DETAILS: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231333, Deb Wockenfuss, 10/04/23 Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSPl11208 05072103000 Septic 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 Upgrade Permit Effective Dates: August 25, 2011 to August 24, 2012 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: RIVER VIEW ESTATES Site Legal Address: RIVER VIEW ESTATES BLK 4 LT 8 G:0357 Owner/Address: MENARD DENNIS P & MENARD ELEANOR H HC 85 BOX 9299 EAGLE RIVER AK 995779401 Site Mailing Address: 21211 RUNNING BROOK CIR, Eagle River Lot Size in Sq Ft: 55639 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y SepticTank 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. //' Date: ~/~' 4~'""/,! Date: Community Development Department JVJUNICIPALITY OF ANCHORAGE Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D.C.~"C, --TZi-c ~' Property owner(s)~',,,.zL'~ ~,~ ~c-/~:..¢4.~,,¢._ .~/¢~.0 Day phone Mailing address I~ ~Z~ ~ ~~ ~ll/~ ~ ,~ Site address '~z~t ~0~, ~' ~ Legal description (Sub'd., Block & Lot) ~1~¢~ ~1~ ~¢T~. I Legal description (Township, Range & Section) Lot Size ¢~ 6~i Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: ([] all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage THIS APPLICATION IS AN: Initial [] Upgrade ~ Renewal [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (StgcCat~re of propert~c~wner or authorized agent) Peri, Rush Fees: Date of Payment: Receipt Number: Permit No. ~ %, Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11) Pannone En§ineerin§ Services LLC Steven R. Pannone, Principal Re§istered Professional En§ineer E-mail: steve@l~anen~;ak.¢om August 25, 2011 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: River View Estates, Block 4, Lot 8 Septic System Permit Upgrade Request Ladies and Gentlemen: I am writing to request a permit to construct an upgraded septic system be issued for this property. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The lot is served by a private well. The existing drain field is in ground water and shall be abandoned per code. A new drain field will be installed north of the house and will be sized to handle a three-bedroom waste stream. This lot has a newly constructed garage with a proposed septic system for the garage only, (Permit No. OSP 111116) that will be built separately. The surrounding developed lots are served by private wells. The wells are located over 100 feet from the proposed soil absorption system. 1. Soils. One test hole was excavated by Pannone Engineering Service in August of2011. See the soil log attached. Ground water was monitored for seven days. No ground water was monitored to a depth of twelve feet (12') below ground level after the monitoring period. Bedrock was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square feet should be used, using a conventional wastewater treatment system. e Soil Absorption System Design. a. See Sheet 2 of the design package 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and the existing drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The average topography in the area of the proposed septic system is approximately 15- 20 percent based on the survey information in the area of the septic system. There are no steep slopes within the vicinity of the proposed drain field. MailingS: P~O~ Box t002t7~ Anchol~a6e, A,K 99510-02!7 P~--~ysics/: t315 i~as~ 82® Ave, Cui~e B6~ Anchor's~e,, AK 9950S Telephone: (907) 272--82~8 FAX; (907) 272--8252 Page 2 of 2 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On-Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Maiiing: P,O~ Box 100217, Anchorage, AK 99510--0217 Physics}: 615 East 82r~'''~ Ave, Suite B6~ Anchoritsle, ~2~< 99503 Telephone: (907) 272--8218 FAX: (907} 272--82ii IOA ...... , ....... . ~E 44~ T~~. ' AND DCO (P) .... AREA ~ ~ -. - ,~ .... ~ m . /~ '/' ........... , / ' L " z k " '' "'~ ~" . NOTES: P~O~ ~O ~C, L~ FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 ..' 8/25/11 ~...'~ ~ ~ '... ~ ~"=~o' ~ ....(3 ~ ....... ~ P.I.D. NO RIVER VIEW ESTATES BLOCK 4, LOT 8 ~~&.~.050-721-03 DENNIS MENARD '¢~ ~-.~;~'%%"%CE 8149 .... .%~: ~ 'PERMIT NO. 21211 RUNNING BROOK CIRCLE ~?~.. ..~ f~ . ~. 0SPl11208 PLAN EAGLE RIVER, AK 99577 ~o~sgbA~'*~ ....... ~-~ Sheet SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 5. SCOPE OF WORK: INSTALL NEW 1000 GALLON SEPTIC TANK AND NEW SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS NOT OBSERVED AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 12.0 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. 1.5' FILL WITH TOP /'-6" TOPSOIL & VEGETATE //--INSULATION ///'-4" PERFORATED LINE 1 .3///~'- LT////FI.3ER FABRIC GP/SP 10.0 SECTION -12 ~OH 2" WHERE COVER'm IS LESS THAN .3 FEET\ _ ~ I DE i j . cRApE i2" R.,. ¢' MIN .............. ~NEW1000g r ' __ J SEPTIC L4" R.I. I . , I TANK UNDER DRIVEWAY TRENCH, SEE DESIGN DESIGN PARAMETERS PROFILE REPLACEMENT SEPTIC SYSTEM NO. BEDROOM: .3 (450 gpd) ABBREVIATIONS LEGEND TANK SIZE: lO00g PERC RATE = 1-5 MPI CU COPPER -- W-- WATER LINE/ SOIL RATING: 1.2 GPD/SF DIP DUCTILE IRON PIPE WELL RADIUS AREA RQD: ,375 SF TH TEST HOLE SYS. TYPE: WIDE TRENCH 1.0' E.D. FC FOUNDATION CLEAN OUT -- SS -- NEW SEPTIC RF: 0.87 T# TANK CLEAN OUT NO. MIN LENGTH: 65.25 LF C# CLEAN OUT NO. USE: M# MONITOR TUBE NO. R.I. RIGID INSULATION (2EA) `35 LF X 5' WIDE, 1.0' E.D., DCO DOUBLE CLEAN OUT 2' TD DV DIVERTER VALVE TOTAL AREA: 448 SF FS FLOW SPLITTER NOTES: PANNONE ENG SVC, LLC FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510~__,,,~'~,~'~..?' .... ¢-~I~, 8/25/11 N*.:49 TH ~ '.., ~ NTS RIVER VIEW ESTATES BLOCK 4, LOT 8 ~ P.I.D. NO 050-721-05 DENNIS MENARD~ .~teven ~. Ponnorqe ~ ¢~ ________________~~~-.-.,~, PERMIT NO. 21211 RUNNING BROOK CIRCLE ~i;~,~.. ....,~ osP1112o8 DESIGN DETAILS EAGLE RIVER, AK 99577 ~ :~,, '- ...... '~"~'--' Sh~.t SOILS LOG - PERCOLATION TEST TEST HOLE 1 ROOT MASS SLOPE OR 1 ORGANICS 3 SILTY SAND/ , ROCKS UP TO ~ M" , SHED (E) 8-- x BOH 13 -- WAS GROUND WATER SLOPE 14 -- ENCOUNTERED? N 15 -- IF YES, AT WHAT TH 16 -- DEPTH? - -' X 17 -- DEPTH TO WATER AFTER MONITORING? -DRY- 18 DATE: 8/12/11 CLOCK WATER DATE PERFORMED: 5/23/11 READING DATE TIME NET TIME LEVEL NET DROP READING ~ 5/23/11 9:10 --- 2.40 --- 2 9:20 10 MIN 6.17 3.77 3 9:20 -- 2.40 -- 4 9:30 10 MIN 6.06 3.66 5 9:30 --- 2.40 -- 6 9:40 10 MIN 5.97 3.57 PEROLATION RATE 2.8 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 3 FT AND 4 FT COMMEN~'S: ~'est bole e×cavated by BLRCHWOOD ~,×CAVA?fNG. Proc bole was pr¢soa_Eed. 3'est t-uz~ tot- one bout-. [,ast 3 t-¢adJz~¢;s ~-epoz-ted P;EP,?ORM;EE) ;BY: Stevezz P,. P~o~e~ P.~. I CB~I~ ~ ~HIS ~S~ WAS PBR~O~MBD ~N ACCORD~CB ~~. D a t e NOT S: FOR CONSTRUCTION P.0. BOX 102954 ANCHORAGE, AK 99510 · · ~IV~ VIEW ~STAIES B~OC~ 4, kOl ~ . ~nno~e.~ 050-72~-03 DENNIS MENARD '¢~~%~2 .... ~"_~ PERMIT NO. 21211 RUNNINO BROOK CIRCLE ~~~ Sheet SOILS LOG EAOLE RIVER, AK 99577 5 OF5 CLOCK WATER READING DATE TIME NET TIME LEVEL NET DROP READING ~ 5/23/11 9:10 --- 2.40 --- 2 9:20 10 MIN 6.17 3.77 3 9:20 -- 2.40 -- 4 9:30 10 MIN 6.06 3.66 5 9:30 ___ 2.40 __ 6 9:40 10 MIN 5.97 3.57 Permit Number: Tax Code Number: Work Type: Permit Effective Dates: Design Engineer: Subdivision: Site Legal Address: Owner/Address: On-Site Wastewater Disposal System Permit OSPl11116 05072103000 Septic June 29,2011 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 Upgrade to June 28, 2012 PANNONE ENGINEERING SERVICE RIVER VIEW ESTATES RIVER VIEW ESTATES BLK 4 LT 8 G:0357 MENARD DENNIS P & MENARD ELEANOR H HC 85 BOX 9299 EAGLE RIVER AK 995779401 Site Mailing Address: 21211 RUNNING BROOK CIR, Eagle River Lot Size in Sq Ft: 55639 Total Bedrooms: 1 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. Date: Date: IViUNICIPALITY Community Development Department Development Services Division On-Site Water & Wastewater Program Mayor Dan Sullivan OF ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. (~"'O'. Property owner(s) ./)~/V/¢i5 ./t/Z:?/¢,,¢. £/D Day phone Mailing address ~/'(_.~5- ,~'~' ~qq ~ L'~'~;~:..'~ ¢,~VCT¢~: .4~.¢J[" Site address '2JZll ~.,~¢¢,¢id~'- J~/zw&,' Legal description (Sub'd., Block & Lot) Al ¢g~ t)l/:?~ gs-r,,~'-lz::-$ ~ ~ q,~ Legal description (Township, Range & Section) Lot Size I~/(¢;3¢i Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: ([~ all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well THIS APPLICATION IS AN: Initial [] Upgrade Renewal [] Water Storage [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: '--D~e~ of Payment: Receipt Number: Permit No. ~.~.~.~ ~" Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 ) Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com June 27, 2011 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Riverview Estates, Block 4, Lot 8 Septic System Upgrade Permit Request Ladies and Gentlemen: I am writing to request that a permit to construct a new septic system be issued for this property. The proposed systems will serve a proposed detached garage. The lot is currently developed. The garage will be a residential detached garage with one restroom. The proposed scope of work is to install a new 1,000 gallon septic tank and absorption system, that will serve only this garage. The surrounding developed lots are served by private water systems. The private wells are located over 100 feet from the proposed soil absorption system. 1. Soils. One test hole was excavated by Pannone Engineering Service in May of2011. See the soil log is attached. Ground water was monitored for seven days. Ground water was monitored to a depth of five feet (5') below ground level in TH-1 after the monitoring period. Bedrock was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square feet should be used, using a five foot (5') wide trench. Soil Absorption System Design. a. See Sheet 2 of the design package 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and the existing drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The average topography in the area of the proposed septic system is approximately 15 percent based on the survey information in the area of the septic system. There are no steep slopes within the vicinity of the proposed drain field. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification Mailing: P.O. Box 100217, Anchorage, AK 99510~.0217 Physical: 61.5 East 82® Ave, Cuite B6~ Anchorage, At.( 99503 TeJephone: (907} 272-82~L8 FAX: (907} 272~82t5 Page 2 of 2 that the review is complete and that there are no further comments is received from MoA On-Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the furore development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, .. ~ '-,.,.~ ~, ~.....~....~...).¥....-~...k...~.....~ Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Mailing: P,O. Box 100217, Anchorage, AK 99510~0217 ?hysical: 61,5 East 82r~c~ Ay% S{~it:e B6, Anct~orage, AK 99503 Telephone: (907) 272-8218 FAX: (907} 272--8211 i ¢ I C SEPTIC -~o ~ NNING ~ ~ ~4 ~ ~ / ~ ~ BROOK ~ / ~LL(E) ~ ~ DETACHED ~ ~ GARAGE ~ 1 BATHROOM ' PRIMARY FIELD (P) / o/ ~o /~ ~ i ~w~ 25LFxO.5EDx5W, 1 TD / / / o/ x ~ ' / ~'...~' -. z'"', 1, ~ / ~ / / ~ ~ ~ EXISTING SEPT C / FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 6/27/11 PHONE (907)272-8218 FAX (907)272-8211 ~..~ 1"=50' ~w.-~ P.I.D. NO RIVER VIEW ESTATES BLOCK 4, LOT 8 '- anno~e ~:050-721-03 DENNIS MENARD '¢~~"'~g~ PERMIT NO. 21211 RUNNING BROOK CIRCLE f~l~.. .~ 0SPl11116 PLAN EAGLE RIVER, AK 99577 ~.~9~ Sheet ,~~ 1 OF SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. .3. SCOPE OF WORK: INSTALL NEW 1000 GALLON SEPTIC TANK AND NEW SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS OBSERVED AT 5 FEET BELOW GROUND LEVEL AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 5.0 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. 2' FILL WITH TOP //~6" TOPSOIL & VEGETATE INSULATION 4" PERFORATED LINE FILTER FABRIC -,.5 -- 410I--5.0----I~XXX'q~DRA'N'~;OCK k~'-0.5' FILTER SAND ~~-REMOVE ORGANICS GP/SP GROUNDWATER @ 5' 5/3o/2ol 1 SECTION -11.5 .o. GROUNDWATER @ 8' 5/23/20 ~ ~ z~u ~,,<, OF-- ~3Z Z Z 'Jz - = - 1NEW10O0~ [ t - /SEPTIC I ' ] ' ' ' ' ' -- ! TANK ~ TRENCH, SEE DESIGN PROFILE DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM A~ ~ R EVIATI 0 N S LEG END NO. BEDROOM: 1' (150 gpd) CU COPPER ~W- WATER LINE/ TANK SIZE: lO00g DIP DUCTILE IRON PIPE WELL RADIUS PERC RATE = 1-5 MPI TH TEST HOLE SOIL RATING: 1.2 GPD/SF FC FOUNDATION CLEAN OUT ~ SS ~ NEW SEPTIC AREA RQD: 125 SF T~ TANK CLEAN OUT NO. SYS. ~PE: WIDE TRENCH 0.5' E.D. C~ CLEAN OUT NO. MIN LENGTH: 25 LF M~ MONITOR TUBE NO. USE: R.[. RIGID INSU~TION 25 LF X 5' WIDE, 0.5' E.D., DCO DOUBLE CLEAN OUT 1' TD DV DIVERTER VALVE TOTAL AREA: 125 SF FS FLOW SPLICER NOTES: ~G Dete ~ ~ ...... ~:~i* Sc~1e6/27/11 ,ox oo2 7 ,,SlO ~,0~[ (~07) ~7~-~ r~x (~07) ~7~-~ NTS .... Z ,o RIVER VIEWDENNisESTATESMENARDBLOCK 4, LOT 8 ~. o5o-721-o3 r~%~ CE 814~[~ PERMIT NO. 21211 RUNNING BROOK CIRCLE ~i~%~'. .~ osv~l~6 ~ ~?&" ...... '~%~ Sheet DESIGN DETAILS EAGLE RIVER, AK 99577 ~0~~ 2 OF 3 NEW 1000g [ SEPTIC ] ] ..... ""' SOILS LOG - PERCOLATION TEST TEST HOLE 1 SLOPE 1 OR ROOT MASS -- ORGANICS 2 3--: i , Q _~ ~1~1 RUNNING 5-- ~ gI-~'-"~-~ / \~\ .~.,~,-,,~~ / ~'":\ BROOK 6 -- GP/SP GRAY GRAVEL / ~~k.,I~L, Lr- /SAND ROCKS 7-- 8-- 9-- TH lO -- , 12-- BOH 13 -- WAS GROUND WATER SLOPE 14 -- ENCOUNTERED? Y 15 -- IF YES, AT WHAT TH 16 -- D E PTH ? -8-' x 17 -- DEPTH TO WATER AFTER MONITORING? -5- 18 DATE: 5/30/11 WATER CLOCK DATE PERFORMED: 5/23/11 READING DATE TIME NET TIME LEVEL NET DROP READING I 5/23/11 10:52 --- 5.55 --- 2 11:02 I 10MIN 11.36 5.81 3 11:02 --- 5.55 --- 4 11:12 10 MIN 10.64 5.09 5 i 11:12 -- 5.55 --- 6 11:22 10 MIN 10.55 5.00 PEROLATION RATE 2.0 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BE-I-VVEEN 4 FT AND 5 FT COMMENTS: Test hole excavated by BIRCHWOOD EXCAVATING. Prec hole was presoaked. Test run for one hour. Last 3 readings reported PERFORMED BY: Steven R. Pannone~ P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: PANNONE ENG SVC, LLC __-_%¢ Dote FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 ~.~"" %~"'~.~, 6/27/11 PHONE (907) 272-8218 FAX (907) 272-8211 ~'*."~¢,gTH ~ '".¢r~ Scale NTS RIVER VIEW ESTATES BLOCK 4, LOT 8~~ n~,~R~'P,O~ ~~'"-"~'~':-~--n'n'(~'~ 050-721-05 DENNIS MENARD~'t~%~*"' CE 8149 -.~-~-'~ ~' PERMIT NO. 21211 RUNNING BROOK CIRCLE ~ ~,~. ..~.~%_~.~ 0SPl11116 SOLES LOG EAGLE RIVER, AK 99577 ~,~o'~;~2;~.~io.~'~%~ Sheet -~,~,,~-~.~ 3 0 F 3 WATER CLOCK READING DATE TIME NET TIME LEVEL NET DROP READING I 5/23/11 10:52 --- 5.55 --- 2 11:02 10 MIN 11.36 5.81 3 11:02 --- 5.55 --- 4 11:12 10 MIN 10.64 5.09 5 11:12 -- 5.55 --- 6 11:22 10 MIN 10.55 5.00 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 e Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~1/,~ I~ ~ ~;;~¢,c~ PID Number: 4~'~)'~'~"'1 ~m~:~~ ~. ~~ Wastewater System: ~ New ..~ad~ Address;~ ~ ~ ~~ ' ABSORPTION FIELD LEGAL DESCRIPTION soi~ .~i~: ~. ~s~. ~, 'ro~ ~.~o.~i3~ ~: Block: Subdivision: Depth lo pipe bottom from original g~: Gravel depth beeeath pipe Lot: ~ ~ ~ V~ ~5. ~-~ Ft. ~.~__ Ft~ . Gravel~cpth~. i.~ ~ ~ Number of lines: ~Oislance betweenlinss: W~LL: a New Q Upgrade ~ ..... ~ F* Classification (Pzivato A B C): ~ ~ Case~To Total absorption area: "Pipe mater a Driller: ~(~, ~ Date Drilled: Static Water Level:Ft. _~~~~lnstaller: ~_ ~_~~__ Dale installed: ~'i~ld: -Pump Set at: ' Casing Height Above Ground: ~' L ~t. ~. TANK SEPARATION DISTANCES ~eptic ~(~.~,(~ oldinj~ ~S.T.~.P. ............ ~ept~;~ Absorptio-~ Li/~:~H;l~i~;--:L~li~/~ri~at% Manufacturer: Capacity in gallons: From Tank Field Slation ] Tank S ...... Linos lO~I al ' ~y Material: Number of Compartments: Water IOO + IOO +' ~ LIFT STATION Lot ~7 ~¢l --- ~ ¢ Size in gallons: ~anulacturer: Line .... ~ ~t "Pump on" level at: ] "P~-r~el at: High water alarm at: Foundation Drain ~ O~ _~ PurnpMake&~ Electricallnspectionsperlormedby: Remarks: BENCH MARK ~~-~~ ~ ~_ocationandDescription:~¢ .~ ~, Elevati~n:~ inspections performed by:¢4~ ~la~ d~ates: Department of Hea[~, ~n Ser~es approval '~'~;"" Reviewed and approved by:~~ Date: 72-013 [1/91)MOA 25 Permit No. /-~'D~/~[~ ¢'~Z1¢'~ Page ~-/ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION of P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report 72-013 A (2/91) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910348 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:WATSON GEORGE L & OWNER ADDRESS:BOX 9295 SR2 HILAND RD. EAGLE RIVER, AK 99577 PARCEL ID:05072103 4 LT LEGAL DESCRIPTION: RIVER VIEW ESTATES BLK 8 LOT SIZE: 55639 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 10/28/91 EXPIRATION DATE:10/28/92 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 (18AACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: DATE: DATE :/~,/~ HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. 0~tob~r 23, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 8; Bloc~ 4; Riverview Est~es OCT 2 4 991 Request you issue a permit to upgrade the septic system s~ruing the referenced property. A conditional Health Certificate was issued on the property on October 15, 1991 requiring the system to be upgraded due to its encroachment upon the bedrock. The proposed leachfield consists of Bo, 5 ft. wide drainfields installed 6 ft. above bedrock and 4 ft. above groundwater. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed upgrade. If you have any questions or require additional information for your review, please conta~ us. Sincerely, ROGkR J. SHAFER, P.E. RJS/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE SCALE PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: Township, Range, Section: 6 7 8 9 10 11 12 13 14 15 16 17 18- 19- 20- SLOPE IF YES, AT WHAT I L E Beplh to Walor Aller~ ~ Monitoring? ~t -" Dale: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ~-- ~'.~d" ~,~, PERCOLATION RATE 'f~ Imlnutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN ~'/ FT AND ~ FT COMMENTS 'wo~4 ~aCe R~,er L~p Road No, _2~,,f (~~~ ~ PERFORMED BY: Eagle ffiveF, A]~G ~5~ RTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: ~ ~ ¢~ 72-008 (Rev. 4/85) NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephon0 264-4720 ON-SITE SEWAGE DISPOSAL SYSI'EM AND/OR WELl_ INSPECTION REPORT · PHONE ~UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION jWell ,~'.~-. Absorpti~.~area ~ DISTANCE TO: \ ~ .~ ~' I Liq. capacitv ~ gallons ~ I ~ [ IF HOMEMADE: ~lnside,ength c~ d LU No. of Length of each line Hnet I -'~-'2- p T- DISTANCE TO: I Well I Dwellh~g DISTANCE TO: Foundation Top of tile to finish grade Lengtt~ Width Type of crib Crib diameter Well Depth Total length of lines Material beneath tile Depth IDwelling Mater;at Width NO. OF BEDROOMS l-French width z~_ ' inches PEI~biIT NO ~ t No, of compartments Liquid depth PERMIT NO. JMaterial Liquid capacity in gallons Nearest lot line PERMIT NO. Distance between lines Total effective absorption area PERMI'r NO. -- ~IT NO. IAbsoq~on a~area(s) Crib depth -- T~Tootal effective absorption area DISTANCE TO: Building foundation Nearest lot line Class Driller Distance to lot line DISTANCE TO: Building foundation Sewer line Septic tank PIPE MATERIALS OTHER SOIL TEST RATING INSTALLER REMARKS MUNICIPALITY OF ANCHORAGE DEPT. C)F i' ':Tii & ENVIRONMRNu':,L ,: ~ t ECTION JAN ? i!:}8! RECEIVED APPROVED DATE LEGAL -i 72-013 (Rev. 3/78) F'E F.:i'"! :[ T t',10, [:,EPFIRTMEI"J!"I ....... HEFIL.'TH Flt.~[:, EN',,,' I ROi",II'"IENTFiL. '"'"'OTE~]:T I ON :~.,'2!?J". '..E;'t"REET., f:~i'4C:HOF.'.RGI~L, fiE. :~:64...-4720 E E,_ L_ R hi [> ,3 F,! .-- Z5 Eli: T' I~E ,,5 E l-Jt E 800574 F:IF'F'L I CRhlT LOCFIT :1: Obi I...EGRL. 'f"¢F'E OF '_"7, ClII... FIBSORPTION S"6TEFI IS: 'FREPJC:H PIlR',-'.:',IPll..IM i'CIHE:ER OF BEE:,ROOMS = ..'7. SOIL RFITING ,::SQ FT,-"BR)= 85 ]"HE F.:Eg!UIREB, F:;IZE OF THE SOIL FIE:SEIRPTIOf.,I S'='$'FEM mT'HE I..ENGTH DIMENSION I:E; THE I._Ei"~[3'T'H (:I;N FEET.'., OF 1"HE TRENC:H OR E.',RFIINFI'ELD. THE DEPTH OP R TRENCH OR PIT I:5 THE E:,ISTFII'.ICE BETI.qEEN THE SUF.".FFIC:E OF' THE GF.:OUNE:, RI",ID THE BO"F'l"Oi"l OF' THE E',:.::C:R',,¢FtT]:ON (IN FEET). THERE :[E; NO ~:E:'r [,.IIE;FH FOR i"RENCHE'.5. THE ~3RFI',,{L B, EPTH IS THE M.I'I'.4IMUf,1 E:,EPTH OF GRRVEL BET[4EEI'.,I THE OLITFRLI~.. F:'ZF'E RND THE BOT"I"OI',I OF 'THE E',:-:',CR',,¢R'T'I'OI'.,I ,.':IN FEET). F'ERI',II T FIPPL I CFINT FRS; THE RE'_=.;PONS I B I L. I "l"V 'FO INFORM "FH I S B, EPRRTi',IEN"i" I}UR I N(.] THE INSTFLL. RTION Ii'.,tSPECTIONS OF RN'¢ ~,.IELLS FI[:,JFICENT TO THIS PF.:OPERT'/ FIN[:, THE 1'4UMBEF.: OF RE::::ID, ENCE':Z, THFIT THE I.,.IELL f.4ILL SER',,,'E. BI:;ICI.::}"ILLING OF RI'6' '.'5'¢FrEi',l [,~]:THOLIT FINRL. INSPECTION RND RPPF.:O',,,'RL. B°¢ THIS [:,EI:'RRTI',IEi'.~T I.,] ILL.. E:E SLI[~,'JECT 'fO PROSECLrT I ON. MINIi','IUI',I DIS'I"RNCE E~ETI.,.IEEN Fi F]EI_I.. ting, RI'6' ON-.:51'TE SEt.,IFIGE DI'_:;POLgRL E;'.r'STEr"I I2'.'; iL;JO F~TET FOR ¢'.~ PRI'¢FtTE WELL OR ±5(1 T£) 2F'~6.~ FEET FROM R PUE:LIC ~,~I!_'"L.[_ [:,EF'ENDIt',Ir.3 UF:'ON ]"HE "t"./PE OF PUBL. IC I.,iELL. I"IINIi"IUI"I [:,ISTRI'.,IC:E FROI',I FI PR I ',,,'RTE I.,.IELL TO FI PRI',,,'I=ITE SEI.,iER LINE ]:S 25 FEET RND TO FI (:Of"II',IUNIT'¢ SE[,JER LIi'.,!E ]:E; 75 FEET. I.,.IEL.L LOGS FIRE REI~UIRE[.', RND i'"IUST BE RETIJRI'.E[) TO 'I"HE I;',EPFlRTP1ENT 14ITHIN 30 [:,fl'CS OF THE kiel.& COP1PI...ET]:.ON. OTHER RE~;!U.'[RE:MENT:::i MFI'/ FIPPL'/. SPECIFICRTIONS FIi'.~E:, CONSTRUE:TION [)IFIQRfli',l::-; FIRE R',/R I LF-IE~LE "FO :[t'.,ISURE PROPER I N'.'C, TFtLLRT I ON. l' C'.ERTIF"," THRT ::C: I BM FRf'IlLIFIR I.,ilTH THE REQUIREMENTS FOR OI'.,t-.5ITE ':7, EI.dERS RNE:, I.,EI...L$ PIS 2:;ET FORTH E:'.,.' THE r,IUNICIPRL.:[T~' OF RNC:HORFtGE.. 2: I I,IILL INSTFIL[.. ]'HE: S'~.'STEf,1 IN FICCORB, FINCE [{[TH 'THE CODES. :~:: I UNDERSI"FINE:, THFIT I'HE ON-Si[TE :.:;EHER S'¢STEi','I i',R'/ REtT~U]:RE ENLFII'~GEMEI',IT IF THE F.:ESZI)EI'.~CE ]:S REMO[:,ELEL":, TO IN~::LLI[:,E.'. I','IORE THFII,,I ]: BEDRO01',I~..i. 0 ]. 10 . - 11 12 ..... 13 14 17 WEATHER: /t~;,~)~ ~% 'T-~%.~, TEST HOLE N0. : ~ LOCATION SKETCH Parcel I.D. 050-721-03 Certificate of On -Site Systems Approval Expiration Date: 2 tj Legal description RIVER VIEWESTATES BILK 4 LT 8 Site address 21211 RUNNING BROOK CIR Eagle River AK Current property owner(s) HELGERSON X The On -site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: c Original Certificate Date: 10/27/2023 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 Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 M UNM A U Y OF ANCHORAGE Development Services Department `` 3 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-721-03 Complete legal description RIVER VIEW ESTATES BLOCK 4, LOT 8 Location (site address) 21211 RUNNING BROOK CIRCLE, EAGLE RIVER, AK 99577 Current property owner(s) JOEL M HELGERSON Day phone 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS 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 NEW - 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 $ 550 Date of Payment /0 zo/ :5 COSA # OS C_ 2 3 I `I 1© Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: RIVER VIEW ESTATES BLOCK 4, LOT 8 Parcel ID: 050-721-03 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 10/10/1980 Total depth 80 ft Cased to 16 ft (INTO BEDROCK) Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 9/27/2023 Static water level at beginning of test 14 ft. Well production at time of test 3.6 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 9/20/23 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping NEW TANK Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 3/29/2011 ALL standpipes present per record drawing Total measured depth from grade 4.9 ft (max) Measured depth to pipe invert from grade 2.7 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) 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 gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 9/27/2023 Results Pass (N/S Trenches) Fluid depth prior to test 0 / 0 in Water added 450 gal New fluid depth ½ / ½ in Elapsed time <10 min Final fluid depth 0 / 0 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 12 in (MOA 1’ ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 12 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximate. COSA Checklist.docx 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’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ 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’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 10/24/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 10/24/23 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 8; Block 4; Riverview Estates Location (site address or directions) NHN Running Brook Circle Eagle River, AK ., "Rrbperty owne¢ .: Mailing address : Lending agency ,. Mailing address Uames Maupin C/O Ptarmigan Rea] Day phone Box 671109 Chuqiakt Day phone AK 99567 Agent Betty Fields/ Ptarmigan Real Estate Day phone 688-2034 Address Unless otherwise requested, HAA will be held for pickup. 3 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: xxx Public water If community well system, provide written confirmation from State AD£C attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: xxx Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~25 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone C- ~7 ~¢ - ~ c/-7 ~ 17034 Eagle River Loop Road No. 204 Address Eaqle River'. Alaska 99577 .~ DHHS SIGNATURE ,y Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev. 1/91) Back MOA~21 MUNICIPALITY OF ANCHoRAQ~ ENVIRONMENTAL SERVICI~$ DIVI$10~ Municipality of Anchorage .~ DEPARTMENT OF HEALTH & HUMAN SERVIOE~' 2,5 1997 Environmental Services Division 825 L Street, Room 502. Anchorage, Alaska g9501. (!~1~-~' ¢4~-J4¥/~J~ D Health Authority Approval Checklist Legal Description: 'L~ ~ ~r ~\/~.f'V)'¢4.O ~%l'r).'lt,<, Parcel I.D.: A. WELL DATA Well type Log present Total depth Sanitary sea~) Date completed Cased to [/r~ ~ '721 ~ Date of test Static water level If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) properly protected (~N) Wires AT INSPECTION FROM WELL LOG g.p.m. Well production WATER SAMPLE RESULTS: Nitrate Coliform Collected by: Date of sample: /7¢9'7 B. SEPTIC/HOLDING TANK DATA Date installed J - ~ ~ Tank size Foundation cleanout (Y/I~ Date of pumping, C. ABsORpTION FIELD DATA Date installed Length ~./ Width i; ~ Gravel thickness below pipe Effective absorption area ~Z¢ ~c-},~'' MOnitoring Tube present ~N) ~'~ Date of adequacy test ~/~ ~/~. '~,,-ResultS(Pass/Fail) I1 Fluid depth in absorption field before test (in.); Fluid depth ~ (ins) Minutes later: ~.o ~,¥,w Peroxide treatment (past 12 months) (Y~ [ g.p,m. Other bacteria i one Number of Compartments ~- Cleanouts Depression (*4~) ~k/~) High water alarm'(Y/N) ~ Pumper ~. ~'~8 7 Soil rating (g.p.d,/ft2 or fF/bdrm) ~ ~ ¢~¢~System type ~g.~ 5 / Total depth ~ I . Depression over field (Y~ For ~ ~ ¢.¢~ bedrooms Immediately after ~ gal. water added (in.): Absorption rate = ¢~ ~ g.p.d. If yes, give date ~/~ 72-026 (Rev. 3/96)* LIFT ST~ATIO N Date installed ...... Manhole/Access (Y/N) High water alarm level at* Size in gallons level at* Cycles tested E, SEPARATION DISTANCES "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot If'X;/+ On adjacent lots Absorption field on lot I r'~_'¢ + Public sewer main ~ / ~ Sewer/septic service line 2~,~-'¢ / '~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ,?..¢9' + Property line Water main/service line iO~'F On adjacent lots Public sewer manhole/cleanout I O' + Absorption field -~ f + Surface water/drainage IOO/~ Wells on adjacent lots Iz::~O/ +' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line t O' 4, Building foundation Surface water ioo ~ + Curtain drain ~//~ HAA Fee $ Date of Payment Receipt Number Water main/service line io/~ Driveway, parking/vehicle storage area ~O' ~ Wells on adjacent lots i b,O~ ENGINEER'S CERTIFICATION I certify that / have determined thru field inspections and review of Municipal records],~t~e~..~..~ ~s are ,,conformancewithMOA~HAAguidelinesineffectonthisdate. Signature Date 6 ~r/~ ~ ~-~ ...... ¢-~ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* , :nvi~onm~ntal Sen4ces Inc. Client Projcd Client Matrix Ordered Pwsm ~'75t19001 ~'. & S F~ngiueefing .g ~a, Rivet'view Estates 'A; B4 Rivcrview Estates D:inking Water Client PO// Printed Date/Time 06/20/97 16:16 Collexted Date/Time 06/17/97 19:00 Received Date/Time 06/I 8/97 09:00 Technical Director: Stephen C. Ede ReaUtt$ PQL Units Method At towabto Prep Anal yu i,; L imi ts Dote orate I r,i t )litrate'lJ 0.~00 U 0.100 rn~/L $M18 4~O0-NO3F lO max 06/18/97 J~1L Toro[ Cot i'?o' 0 co[/lOOmL SI41§ 9222B 06/I~/9F RAH MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 05072103 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING NAA# %'~ l~O~ \ ~ ~Lo 1, GENERAL INFORMATION Complete legal description River View Estates, Block 4, Lot 8 Location (site address or directions) NHN Running Brook Circle Property owner .. Mailing address Lending agency Mailing address Agent Address Georqe and Sonia Watson Day phone 265-8976 or 694-3426 Box 9295 SR2 Hiland Road, Eagle River, AK 99577 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: 3 '-4 Individual well xx Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: xx If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature Note: Phone S & S ENGINEERING 17034 Eac~le Ei,ve~- Looa Re~,M M,~ ~ Eagle ~ive~, Alaska ~¢5~ Date I~ ~ ~he con~b~ons o~ ~he Hea[bh Au[ho~&b~ A~B~ova[ o~ ~0/~5/9~ have bee~ meb. bedrooms. DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) 8ack MOAlY21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # C'ERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 8; Bloc~ 4; Riv~vi~v Estates Location (site address or directions) ~HN Running Broo~ Circle Property owner Mailing address Lending agency Mailing address. Agent Address Box 9295 Sonia Watson SR2 Hiland Road, Day phone ~65-8976 694-5426 Eagle River, Ak.99577 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: -Individual well Community well NOTE: XX Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: ×X Individual on-site Holding tank Community on-site Public sewer If community ~vastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~025 (Rev. 1/91) Front MOA 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/orwastewaterdisposal system is safe, functional and adequate for the number of bedrooms and typeofstructureindicated herein. I furtherverifythat based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & S ENGINEERING 17034 Eagle Ri,vet Loop Road Eagle River, Alaska 99577 Phone DHHS SIGNATURE ~. Conditional 'approval for bedrooms. ,~ (~) bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 a~ove by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) BacX MOA ~1 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~---¢'1' ¢' ~z~_,¢~ ~'~¢_.~V~p~v~ Parcel I.D._ A. WELL DATA Well type l~,,j Log present ~¢~N) Total depth Sanitary seal~N If A, B, or C, attach ADEC letter. ADEC water system number Date completed/'L)-Io- ~,~ Driller ~, tr4~o Casedto ilo .(i ~<¢-,4>~;asing height Wires properly protected~N) ~ Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION MUNICIPALII'Y OF ANCHOI~,Gr: \O -' ~ O ¢-~'~ L,:, ~/~nNMEN~At, S~RVICES DIVISION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots__ \~ ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: ~"~ ~ ~-'~ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts ~N) High water alarm (Y~J~ Date of pumping Nitrate Collected by: Other bacteria $ & S ENGINEERING 17034 Eagle RTver ~-oop i~oa~ ~o. Eagle River, Alaska 99577 Tank size ~ c::~C~C~ Compartments Foundation cleanout~N) '¢ ~ Depression (Y~) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I ,c.~ ~ ~' To property line ~C~ ~'~ Surface water/drainage 72-026 (Rev. 7/91) Front On adjacent lots Absorption field Foundation ~O ~ 4- Water rnain/service line ~g:>~ -F CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA ele~s (Y/N) SEPA~N DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer "Pump on" level at "Pump off" level at ~ Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed Length ~'~ Width Total absorption area Depression over field (Y/~ Results~E~;)fail) Peroxide treatment (past 12 months) (Y~ Soil rating .Gravel thickness ~ ~ Cleanouts present (~'N) Date of adequacy test for "1~ ¢--~-¢~.~ ('_'_~ System type Total depth If yes, give date bedrooms Well on lot To building foundation On adjacent lots "~¢ ~'~'~ Surface water Curtain drain E. ENGINEER'S CERTIFICATION SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots I ~o ~ Property line ~ ~;;~' ~' To existing or abandoned system on lot Cutbank /'~/,A~ Water main/service line ~o~'~ Driveway, parking/vehicle storage area HAA Fee $ /"~ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA $ & $ ENGINEERING Signature 1~,n'~,t i~1~, r~;,,,~,,, I ~ ~ ~ ~ ~agle River, Alaska 995~ Engineer's Name Date R ¢ - ¢ / Waiver Fee: $ Date of Payment Receipt Number I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect, On. rth,e date of this inspection. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAIdPLE for WORt(orderS 37880 Date Report Printed: SEP ? 91 ~ 1i:52 Client Sample ID:L8 B4 RIVERVIEM EST. PWSID :UA Collected SEP 3 91 @ l?:O0 hfs, Received SEP 4 91 ~ 14:30 hrs, Preserved with :AS REQUIRED Analysis CompLeted :SEP 6 91 Client Name :2 & S ENGINEERING Client Acct :SNSENGP BPO $ PO I~ NONE RECEIVED Ordered EM :R. SHAFER Send Reports to: Laboratory Supervisgr :,$T~HEN C. EDE 1)2 ~ S ENGINEERING Released Ey : ~4_~~ 2) Chel'nlab Rof $: 914580 Lab S]~pl ID: 1 ~atrix: W~TgR Allowable Parameter Tested Result Units I~ethod Limits NITRATE-N 0,14 mg/1 EPA 353.2 lO Sample ROUTINE SAt~PLE COLLECTED BY: RAY, Remarks: t Tests Performed ' See Special Instructions Above UA=Unavailable ND= None Detected "See Sample Remarks Above NA= Not Analyzed LT~Loes Than, GT~Greatez Than Member of the SGS Group (SociGt6 GGnGrale de Surveillance) SCALE _ _-' --~ ,r DATE RECEIVED T~ME TIME ~,~,., ' ~ TIME I NSPECTO R INSPECTOR I NSPECTO~h MUNICIPALITY OF ANCHORAGE ~U~iCI~ALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT~NMEN]AL .... 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION ,~A~ ~ 9 'i981 Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACIliTIES DIRECTIONS: Complete alt parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing, PHONE ~AILING ADDRESS , PROPERTY RESIDENT (If different trom apov ~ PHON~ 2, BUY6R ~, L~NDINGINSTIT~iON I PHONE MAI~ING ADDRESS 4. REALTOR/AGeNT ~ PHONE MAILING ADDRESS L?c~L DESCRIPTION :~ ,.-.~. ~TREET LOCATION TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [~]' SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other~ 7. WATER SUPPLY INDIVIDUAL* COMMUNITY [] PU3L(C UTILITY ATTACH WELL LOG. A we(I log is required for ali wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYST EM )ND~VIDUAL/ON-SITE** PUBLIC UTILITY ./? YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [~INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified E~Septic Tank or []Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATEINSTALLED INSTALLER SOl LS RATING MANUFACTURER MATERIAL Septic/Holding Tan k Absorption Area ISewer Line INearest Lot Line 5. COMMENTS DATE [~' APPROVED FOR .~ BEDROOMS [] CONDITIONAL APPROVAL (Petter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79)