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HomeMy WebLinkAboutABBOTT LOOP MANOR BLK 2 LT 2Abbott Loop Manor Block 2 Lot 2 #014�181�15 G R ANCHORAGE AREA BOROL�,;H Depari-nent-of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME Callrl(f MAILING ADDRESS i6VA LOCATION. AW044C JZZee��LEGAL DESCRIPTION __14! SEPTIC TANX.&OX DISTANCE f FROM WEI 1 ?40 MANUFACTURER PHONE '2C5_:3!_ 6 MATERIAL NUMBER OF —COMPARTMENTS INSIDE LENGTH INSIDE WIDTH—ff::::' LIQUID DEPTH ___=��.__LIQUID CAPACITY-/92LOGALLONS. TILE DRAIXFIT' r 11 c -A ELD: TOTAL LENGTH DISTANCE FROM WELL 05- FOUNDATION 5. 0 NEAREST LOT LINE 30 OF LINES 3-7 NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTI,� IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE I DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE _!41LMATERIAL BENEATH TILE 72- IN. ABOVE TILE 5?"N. WELL�:� CONSTRUCTION ---DEPTH —DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION_ LOT LINE—, SEWER LINE_ TANK_ SYSTEM CESSPOOL—. OTHERSOURCES APPROVED — DISAPPROVED— REMARKS DISTANCES: DIAGRAM OF SYSTEM < 110'z =.2101 INSTALLED BY: (In-ecke SEWER LINE DEPTH: 37 'r Oin� 401% x is PIPE MATERIAL: w Q r, -,c r LOT SLOPE - 57 REMARKS- ��2r� DATEt//7/27 APPROVED G.A.A.B. FormEQ-032 Ar LZi4 /0 7�4/0 1:5-V INS PECTION e%fORT, ON-SITE SEWAGE DISPOSAL bfSTEM SP . TI . C'TiNK: /4 11111:SrAl Bt4ll- 3111 Distance from well Material —La—levAunber of compartments --L Liquid capactty.L� �O) allons. Inside length Inside width Liquid depth SEEPAGE SYSTEM: Seepage Pit: Number of pits Outside diameter or width P/ I leneth V depth q, lining material Distance from well building (wal foundation nearest lot line 12- /Total effective absorption area area).1�-(v/sq. TILE DRAIN FIELD: Distance from well found I ation nearest lot line Total length oflines Number of lines Distance between lines Trench width in. Total effective absorption area sq* ft. Length of each line Depth: Top Of tile to finish grade Depth of filter material beneath tile inches. Above tile WELL: Type Distance from building ioundation nearest lot line.. nearest sewer lln�.q septic tan�__, seepage systevL__, cesspook—_1 other sources A 1, -8 - / C IV b - A -I -D f -V t — 4V " A Ir r — -90' I I (I i J,�. .P, ,I )I � , J�, -C, k .-> NVIC : Well llv:sr Vy� R11) Uirej /00 -0. rr—eitl CZ �-Co_ GRE�,,-;R ANCHORAGE AREA BOR6UGH DE PARTMENT OF ENVIRONMENTAL QUALITY 3330 "C"!VRr.+ ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT ada lr-,, - TO BE INSTALLED BY SOIL TEST RESULTS NOTE3 THIS PERMIT IS NOT "LID WITHOUT SOIL TEST 04AMZ OF APPC,CANT &r -re~ 5n-s-e�, /V77 X. MAILING ADDRESS OIEP�-> H INSTA c X/, 7- c' A- 2- Of /1-1/1�/Lfc LEGAL DESCRIPTION ef,// -I h a e' 1 INSTALLATION OF: SEPTIC TANK A, :j7'jA'GE DRAIN FIELD OTHER%= TYPE AND SIZE OF FACILITY TO 19E SERV 0 3 /--1 1 FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS NOTE3 THIS PERMIT IS NOT "LID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED6" &r -re~ 5n-s-e�, /V77 FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL 13C SUBJECT TO PROSECUTION. I SEPTIC TANK SIZE TYPE MINIMUM DISTANCES. REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL — SEPTIC TANK — SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK. — SEEPAGE PIT TO RIVER. LAKE. STREAM. — DRAIN FIELD SEEPAGE AREA SIZE I'll I � - ' T'erE DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. — SEEPAGE PIT DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIS CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO I3ORoUGm REGULATIONS REGARDING INSTALLATION. /L-�f- dg��' tlG.A.A.D. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. '7 DATE 1-4-&' /;L- ol 74 APPLICANT'S SIGNATURE EQ -016(3-75) DIAGRAM OF SYSTEM I/ V 1- 1 F , _7. 1,f- jo y TfT I X. ewc! -zol T 'T� c TF -I h a e' 1 A, I -T Ef 0-- 3 :!;, -4� C" 5--� - AREA BORQUGH ORDINANCE NO. 2a.68 AND THAT THE ABOVE ol� YOM' S�x ple No'ge SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT 3771 �a='�'o'f Applicant J411o,i .71, Mailing Address-c:7P - R,, N Ph Residence Address Location of Installation Legal Description LoT Abb,N4,,, p Menge- 5A Application to Install: Septic tank�L_, Seepage pit -,.X, Drain fields Other To Serve the Following Facility �mA41- Financed Through To be Installed by Ar, klh,-,�mj Percolation Test Results_ 0 A4 I AJ Anticipated Date of Completion BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT This Is to serve as Alt. 'a permit to install a z5;,(,t0;X -�,6��as described below. Size of unit to be served CePtic tank size -2Y Typ��Veepage Area Type Lety det"Y �1,0' DIAGRAM Or SYSTEM DISTANCES: qj- qq I ,tie <=- tAl a 51 T�v 5�t\v tA 15' \i� �9OA As A& 4 1 /03 MIN -le, I certify that I am familiar Vith the re/qOU1.3reementS of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. MWOPALMY OF ANCHORAGE DEPT. OF HEAU44 & ENVIRONMENTAL I [ECTION NOV 18 1976 RECEIVED te s IA" 1 'rx7r- �'�Sv 7 rl� e"g 7C Ak /,�, . d4f�c- : I-rx, lAr- C/O Se -4( /5 0,s�� 0 ;,j eel C�a 74 tj h, -le- A log k" C,/� 4 lu'al . 7A4 0 � 4(%'*Y-' AAJ 4e"i'l4f,, IH4-� A.5-z� AL- -57 -,1- c c J"41 November 12# 1976 701 Whom It May Concern SUBMXT: On-site Sewer System Lot 2 Block 2 h tt Loop Manor Subdivision This office has no objection to the escrow of a sufficient a &mount of money (as ref lected by two (2) bids) to upgrade the existing subsurface &**page area for the on-site sawor system on the above cited property, The upgrade of the hystax is to be completed by July lo 1977. A permit to upgrade wit3i detailed instructions has been furnish" V*ryl Purbough. If there are any questions,, please contact this office at 27642221# extension 291. Sincerely# Joseph S. Blair$ n.s. Zavironmental Services Manager J"/Ijh a January 11, 1977 Coast Mortgage Company Post Office Box 1200 Anchorage,, Alaska 99510 . t rf/r— te,( �eljl-D Subject: Lot 2 Block 2 Abbott Loop Manor The well serving the subject property in approved construction and has a satisfactory analysis. The newer system has been tested and found iaa4e� for the dwelling. The sewer must be upgraded per specifications issued on a permit obtained November 12, 1976,, by the owner. This department would grant a temporary approval if funds are escrowed to upgrade the sewer by July 1� 1977. Also funds should be sat aside to pump the system an needed until the upgrade is complete. If there are any further questions* pleas* contact this office at 279-2511, extension 224. Sincorelyo Los N. Buchholz Saftitaktan LNB/ljh ancz permit copy ral Municipality of Anchorage POUCH 6 650 ANCHORAGE, ALASKA 99502 (907) 279 2511 GEORGEM SULLIVAN, AfA YOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (825 "L" Stmed April 5, 1977 Spokane mortgage Company 3201 C Street, Suite 250 Anchorage, Alaska 99503 Subject: Lot 2 Block 2 Abbott Loop Manor Subdivision The well serving the subject property is approved construction and has a satisfactory analysis. The sewer system has been tested and found inadequate for the dwelling. The sewer must be upgraded per specifications issued on a permit obtained November 12, 1976 by the owner. This department would grant a temporary approval if funds are escrowed to upgrade the sewer by July 1, 1977. Also, funds should be set aside to pump the system as needed until the upgrade is completed. if there are any further questions, please contact this office at 279-2511, extension 224 or 225. Sincerely, Les N. Buchholz, R.S. Sanitarian LNB/ljh A L ASK A T E S T L A B Sheet of 1940 Post Road WO No la- O -k Anchorage, Alaska Dat� "*Client T.H. No. FHA No. Tech. Location, Lot oe Block oe Subdivision evdAeAe Z.Qco PERCOLATION TEST D4TA Depth Soil Class Pop. t Visual - Unified Location Skotch 0 Ron ENFINIIN 00610110 ME Ph 11 M 1111111011110 NEW IN MENMWIMMIN mmm= MEMO 0 I Rc.ading Dato Gross Time Not Time Depth to 1120 Net Drop 0 4 5 6 7 10 lcrcolationyiat� I " " �Wl- IV ri io� H IUMLZ VNIUUZO 0 TESTING 0 EXPLORATION 0 CHEMICAL 0 MATERIALS 0 INSPECTION 1940 POST ROAD PHONE 272-3428 ANCHORAGE. ALASKA 9950f August 28, 1968 W.O. 8965 Allison & Son Construction Co. Star Route A Box 478 Anchorage, Alaska 99502 Dear Sir: On 28 August 1968 the undersigned performed two percolation tests. Qneercolation tes was performed on lot 2, block 2,.4bbott LoDu 27 feet North and 12 feet West of the soutbeast corner 10 of the lot. The percolation test at this location was performed in an 8" 0 diameter hole 6' below ground level In a layer of Silty Gravelly Sand of an unknown depth, overlain by 3' of Brown Silt. The percolation rate at this date and time was one inch per 20 minutes. Water table at this loca- tion is unknown. The second percolationtst was performed on lot 6 of Joe Von Subdivision 9;_�North and �48 a�stof the southwest corner of the lot. The second test was performed in an 8" diameter hole 6-21' below ground level In a layer of well graded Medium Sand of an unknown depth, overlain by a 5' layer of Silt. The percolation rate at this date and time was one inch of drop in 1. 05 minutes. As in the first test, water table at this'location Is unknown. If we may be of any further assistance, please do not hesitate to contact our office. Very truly yours, AIASKA TESTIAB APPROVED:4L.'_4 By ; �, - Z�f �r-_,7e,,, Brent Barnes Senior Technician BB:ld I L/ tAUNICIpALITY OF ANC1,101AGE MUNICIPALITY OF ANCHORAGE IJ EMIRONMENI'Al. SERVICES DIVISION DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES i9ff FITIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL HRI-C6.�cg NOV 12 OF ON-SITE SEWER AND WATER FACILITY 264-4744 RECEIVED Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot. block, subdivision, section. township. range) ZA1 '.) 5-a 'Ar Location (address or directi6ng) 7(06 4bibr bZ. (b) Properly Owner Telephone: Home — Business Mailing Address� � , j0A ;e—, 1011)6 (c) Lending Institution —, - - . I A6kA!5DTeIephone 2e� -/Vs-/ Mailing Address- 1106Z nmt.- f mr— (d) Real Estate Company and Agent V137;f ez^ Address Telephone -7 ( 03 (e) Mail the HAA to the followina address: or: Check here or if hold for pick up. List contact person and day phone number below. AZ5 2. TYPE OF RESIDENCE Single-Family)91 Number of Bedrooms _3 3. WATER SUPPLY Individual Well)K CommunityO -PUblic[3 Note: If communitywell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPDSXAC`\ Onsite 13 Pu OK lCommunity 13 Holding Tank 13 C' Note: I nwell system. must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-075 IA" 81861 Fwl 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Are -5 "5-41-61540 Name of Firm Telephone Address 120t) d 33110 A4r. _%u -171r Z Date 11-6--e7 see n' 00, plot 40 6. DHHS APPROVAL Approved for aat(l)_ bedrooms by Date Alhtflea= Z41YEZ Approv Disapproved Terms of Conditional Approval Conditional CAUTION 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 Stateof Alaska. The DHHS does this as a courtesyto purchasers of homes and theirlending 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. Page 2 of 2 72 025 CA" 8 $61 Bork MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY Of ANQ­1OXAGE HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICES DIVISION CHECKLIST - FEBRUARY 19M 264-4744 NOV 12 1987 Leg=cription: 107-Z- A054 7- AA '?� -'Orva RECEIVED 7-17AI ZJd 50Z Zr A. WELL DATA Well Classification If A, B. C, D.E.C. Approved (Y/N) A Well Log Present (YG)' Date Completed 4w� Yield 6M Total Depth n1 //& Case5 to Or) Pe, Depthlof Grouting .0/4 Static Water Level Gh (0 1/- Pump Set At — 6)MI Casing Height Above Ground Sanitary Seat on Casing 6Y N) Electrical Wiring in ConduitON) Depression Around Wellhead (Y49 Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots y To Nearest Edge of Absorption Field on Lot On Adjoining Lots /OV To Nearest Public Sewer Line /00 !2P To Nearest Public Sewer Cleanout/Ma �rest Sewer Service Line on Lot Water Sample Collected by 145-g_� A, IVICA) ; Date lo -z7 -F7 Water Sample Test Results *M42f Comments W 5' /M fL�' /11�-" -PA* fiwmi4_4 oeZ4 bejaxpas zryuer- B. SEPTIC/HOLDING TANK DATA a�'a'led Size S 3 D� nd is es Air_tlght Caps (YIN) p p Depression over Tank (Y PumpinglMal ntenance Contract on Y/N) Holding Tank High -Water Alarm (Y/N) - Separation Distances from Septic/Holding To Water -Supply Well To Prop J Page* I of 2 72-M6 IR" 8 861 Roffl r o. of Compartments Foundation Cleanout (Y/N) Date Lost Pumped ; for Temporary Holding Tank Permit (Y/N) To .� To Disposal FielZl-�.� To StreaR��nd. Lake. or Major Drainage 4��15z_ 1*1641­ C. ABSORPTION FIELD DATA 7 ., oils Rating in Absorption Strata ft led Date 'led Width o �Fleld_ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: do To Water -Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT iTATION Date Installecl-=—__� Size in Gallons — "Pump On" Level at — High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments — — Type of System Design Length of Field — . Depth of Field Gravel Bed Thickness — Standpipes Present (Y/N) — Date of Last Adequacy Test To erty Ulne V. To Existing or Abandoned System on On Adjoining Lots if To Cutbank 1(if present) Dimensions Manhole/Access (Y/N) "Pump Off' Level at ent (YIN) P Pu� mpi g umping Adequacy Test. Meets MOA Check Permitted Bedroom Rating Against HAA Request*. I certify that I h Wed,veri eQ, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No. At�, OF A4 Receipt No. Date of Payment 2 lr4— * . ,Goof Amount: $ Page 2 of 2 72-026 (Rey 8'861 Back ALASKA NOW -WELL VERN'S DRILLING & ENTERPRISES Star Route A Box 1560 12241 Avion St. ANCHORAGE, ALASKA 99507 Phone345-4417 All claims and returned g�ds "Thank cYou 4 7 2 8'- FAUST be acccrripaniod by this bill., 'k, Je-1-1 r'4) f CHEMICAL& GEOLOGICAL LABORATORIES OFALASK4, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 KOO U7-'C.K BY S�YTLE Client PO4 : VERBAL Req 1: Client S-,pl ID: L2, B2 A38C^77 LM? M.'TCR, 10-27-87 Se�ple Rec'd : OCT 28 87 Ordeced By : A. WEIR Send Reports To: A= 1200 W 33RD AVE, 0 B IUXICUGGE, Ar. 99503 Special Instruct: Chemlab Ref #: e179 Lab Sc;I 11); 1 Parameter Tested NITRATE -N Saple RGUTIll! SWL! Renirks: AKUYSIS =LEVED: 10-28-67 EAKPAIM XPERVISOR- T170 C. K.2 Matrix: Water Result/UnIts Imil.10) F2/1 Volk Orcer No. : 3641 Client Account : AIECSF-2 Date Report Printed: OCI 30 8? 9 15:00 Released By : 2 Ve (�- Reports Address Q Al lowable Method Limits 4 �� I Tests Performed See Sptclal IRstructicns Above ND-- None kte-.ted See Sar -;Ie Resarks Above fi.�= Not Analyzed LT -ass Than, Cr4reater Than 10 4'LftVICIP IFAVg R%,'f A'/7)'0 V/c AFS Qz4C ke DIVI"CAt - , "y (Y.2 cel vcr4o I — 0 -A M, 0 0 flo�l h4UNICIPALITy OF uj ANc�,jo? ENVIRONMENTAE s 'AGE ERVICES 01"'I:ION 2 1937 < 00 ZZ ME z RECEIVED z 0 lUOd3U N01133dSNI H3A%3S U) Q uj lb 6, — — — — — — — — — — — — LLJ r 0 z ui z z %Q < ui 0 L) 7630 o9dobe tj ul �— —2 14 w 0 w 1 0 z z u W < < CIL e Vs c ui VI Cc LU (.0,0 U) LL ui 0 :L B:: z f uj 0 LU z z U) 0 L) 0 < /% 0 r) CL 0 < Akc tt R a i LU ui CL V) z 0 uj 0 < 00 ZZ ME z LLI L4 z 0 lUOd3U N01133dSNI H3A%3S U) Q r) CL 0 < Akc tt R a i LU ui CL V) z 0 APPLIC�NIT FILLS OUT UPPER HAI-'*'�ONLY .- Time 6operty owner are A An Phone Me Ing Address Z/ Zip Code Buy.r Date Address ZIP Code Lending Institution J-jl Phone Address �) (i k ri o r Zip Code Field Notes: Realty Go. & Agent rte, 1 r Phone Address Zip Code Legal Description mryc—r 0e, Z---/ Street Location ate Tytp%1f Residence Ingle Family AUG 161WU'� /'�O-Multlple Family No. of Bedroom 0 Other (5 APPROVED BEDROOMS Water Supply �<Indivldual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. 0 Commun� Ity For wells drilled prior to that date, give well depth (attach log If available). 0 Public Utility AL Sewer Disposal �—j Individual Year Individual Installed: 0 Public Utility When Connected to Public Utility: [I HoldingTank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. %-�. -. o " n t , �-� , -, n Time Time Tim Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: Ao� MUNICIPALITY OF A14CHORAGE DEPT. CF HEALTH & piloTECrION F.NVIRO,.,41,A2NTAL AUG 161WU'� (5 APPROVED BEDROOMS *CONDITIONS OF APPROVAL DISAPPROVED CONDITIONAVPPR AL DATE BY: 4�1--- Solis Rating Date Sewer Installed Well To Absorption Area Well Log Received -2-10 1-'5'- / 7-7 7 lWell to Tank Septic Tank Size 72� CM 1p K. 3 - 2. x4D ALA.SKA CHUIROWnTAL COnTROL WuffS, InC. Enynterinq & Enuironmental Stdits AUGUST 17 1983 MARGARET ANIBIS 7630 ADOBE DRIVE ANCHORAGE AK 99507 SELLER — MARGARET ANIBIS BUYER — CHARLES RAYON SUBDIVISION — ABBOTT LOOP MANNER BLOCK — 2 LOT — 2 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A UNKNOWN WITH AN UNKNOWN AREA. THE SYSTEM IS CAPABLE OF ACCEPTING 640 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 675 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON MAY 1983 SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. 1200 Wtst 33rd Auenue. Suile 6 * Anchoroqt, Alaska 99503 * (907) 276-1361 . . I August 23, 1983 James R. and Margaret A. Anibas 7630 Adobe Drive Anchorage, AK 99507 Subject: Abbott Loop Manor, Lot 2, Block 2 Approval for the individual sewer and water facilities cannot be granted until the following ite.ms have been completed: 0/�Exposed electrical wires to the well head are in violation /of the Municipality of Anchorage codes and must be encased in conduit. The septic tank pumped with a receipt submitted to this department. An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. Please notify this Department for a reinspection when the nated discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. JR9/cj/E2 Enclosure Sincerely, J. S. Roberts Assistant Environmental Specialist LJJ lb INSPECTION APPOINTMENTS DAIERE EIVED ;�AOLQ. TIMF TIME UME DATE DATE DA INSPECTOR INSPECTOR NUMBER OFBEDROOMS SINGLEFAMILY I 0 Two 0 Five MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF 1::ALTI I & 825 L Str"t - Anchorage, Alaska 99501 ENVIROWIENT,"' ;,"..�IZCTION ENVIRONMENTAL SANITATION DIVISION MAR 2 0 1980 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUA I L WATER AND SEWERE4kWED DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE D. z . s 34441 ND _A21'e1111;1e_! -6 MAILINGADDR ESS 76 So �9,p6 PROPERTY RESIDENT IF-p—eld above) PHONE 6' Pm -YEAR ON-SITE SYSTEM WAS INSTALLED. — T BUYER MAILING ADDRESS 3. LENDING INSTITUTION I F; P S T 1v,97-,'t1V4i -80/vK (1"Stu'ml PkAlvrfl� fAAILING ADDRESS _?4 7114 C S"rVecT a7kil 4. REALTOR/AGENT C -cg/- Nary PHONE MAILING ADDRESS go / or '3 rA /9 V142— 1019 IV C /9 5. LEGAL DESCRIPTION 17-% .:' 2L AVA&7-7- L66)0 ��41vdP_ STREET LOCATION 7iAo )9nj)A�P_ S7-)-e�_-F 6. TYPE OF RESIDENCE NUMBER OFBEDROOMS SINGLEFAMILY 13 One [3 Four 0 Other 0 Two 0 Five MULTIPLE FAMILY Three 1:1 six 7. WATER SUPPLY I& INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled 0 COMMUNITY since June 1975. For wells drilled prior to that date, give well 13 PUBLIC UTILITY depth (attach log if available.) SEWAGE DISPOSAL SYSTEM INOIVIDUAL/ON-SITE** -YEAR ON-SITE SYSTEM WAS INSTALLED. PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATEDL 72 GiO (R�. 6179) If V -f THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE 0 SINGLE FAMILY 0 MULTIPLE FAMILY NUMBER OF BEDROOMS 0 ONE 0 THREE 0 FIVE 0 TWO 0 FOUR 0 six 0 OTHER 2. WATER SUPPLY 0 INDIVIDUAL 0 COMMUNITY 0 PUBLICUTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM 0 INDIVIDUAL/ON -SITE OPUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER OSeptic Tank or 13 Holding Tank Size: - I I Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Septicl Holding Tank Absorpt,onArea Sewer Line Neare st Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 0�� APPROVED FOR BEDROOMS E3 CONDITIONAL APPROVAL (letter must accompany certificate) 0 DISAPPROVED DATE _7Y � . 01, 72-010 (Rev. 6/79) #1: Time Date MUNICIPALITY OF ANCHORAGE DEPARTMEPOOO�OF HEALTH AND ENVIRONMEN% PROTECTION 825 L Street, Anchorage, Alat.-a 99501 279-2511, ext. 224 or 225 Date Received: May 16, 1977 #2: Time #3: Time Date Date Insp Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Spokane Mortgage Company Mailing Address: 3201 C Street Suite 250 Phone: 277-0543 2. Property Owner: Mailing Address: Charles C/Veryl Perbaugh Phone: 3. Legal Description: Lot 2 Block 2 Abbott Loop Manor 4: Single Family Residence: (39 Multiple Family Residence: ( ) 5. Well System: Permit # Construction Number of Bedrooms: Number of Bedrooms: 2 individual Well (�j Community/Public System ( ) Depth of Well Well Log on File Bacterial Analysis 6. Sewage Disposal System: On-site System Public Utility Permit # Installed Installer Septic Tank Size Manufacturer Absorption Area Soils Rate — Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line 5 .,Page Two Department of Health and Environmental Protection Request for Approval of individual Sewer and Water Facilities Legal Description: Lot 2 Block 2 Abbott Loop Manor Subdivision Comments: Affadavit Attached: Letter Attached: Approved: Date: Ile— Disappro4dj Date: Department Worksheet: MUNICIPALITY OF ANCHORAGE C:PT. 0, 1; *.- L T, I DEPARTMENT OF ENVIRONMENTAL QUALITY 1'K");:C7jC ' Sewer and Watei Section, Fourth Floor, 825 L Street, Anchorage, Ala'sla 99501 Attention: Laura Harrison 11AY 16 1977 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES kRECEI-VE0 1. Type of Inspection: CMRO — VA XX FHA — CONV 2. Property Owner: PURBAUGH, Charles C. & Veryl Mailing Address: Day Phone 3. Name of Buyer: SPOTTS, Michael D. & Kathryn I. Mailing Address: 3002 Dawson #B, Anch., Ak. 99503 Day Phone 277-9274 4. Name of Lending Institution: brWIRPM rIVNIURUL W. Mailing Address: 3201 "C" Street, Suite 250, Anch., AkPhone 5 Name of Realtor or Anent: ��L Qn�l Mailing Address: 1031 Cordova, Anch.. Ak. 6. Legal Description: Lot 2, Block 2, Abbott Loop Manor Location: 7630 Adobe Street, Anchorage, Alaska 277-0543 Phone 272-3180 or 277-1443 - unit 100 7. Type of Facility to be i�spected: SingleFamily — No. Bdrms. 2 8. Water Supply Type of Supply: Public Utility — Individual xx If Individual, number of dwellings presently served unknown If Individual, depth of well unknown 9. Sewage Disposal System Type of System: Public Utility — Individual (on-site) xx If Individual, date of installation 5-16-77 EQ -037 (1174) r4�MUNICI PALITY. OF ANCHORAGF�) DEPARTMENT,-wF�HEALTWAND ENVIRONMENTAL -PROTECTION I.:. 825 L Street, Anch6rage, Alaska 99501 279-2511, ext. 224, 225 Date Received: March 24, 1977 Ist Inspection: Time Date inspector 2nd Inspection: Time Date Inspector REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Spokane Mortgage Company Mailing Address: 3201 C Street 99563 Phone. 277-0543 2. Property Owner: Charles C/Veryl Purbough Phone: Mailing Address; h V'1 01r, I) S19n 3. Legal Description: Lot 2 Block 2 Abbott Loop Manor Subdivision 4. Single Family Residence: (x) Number of Bedrooms: 2 Multiple Family Residence: Number of Bedrooms: S. Well Data: Type individual Depth &a Well Log Filed Vj� Construction Bacterial Analysis 6. Sewage Disposal System: on-site system (x) Public Utility Permit f Installed installer Septic Tank Size Men" Manufacturer Absorption Area Soils Rate "'90 Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Lines Nearest Lot Line I Absorption Area to Nearest Lot Line IZ94 low), IIPzt(3e T;40 :'De'pairtme'n't -'of - Health an�i "Env ironmenta 1'�'Pr6tec tion PNequest for Approval'of Indivi - dqaL S -ewer and Water racilities Legal Description: Lot 2 Block 2 Abbott Loop Manor Affadavit Attached: U) Letter Attached: (0100, Appro _d: Date: Disapproved: Date: Department Worksheet: `0 _,9 GREATER ANCHORAGE AREA BOROUGH �/V -Department of Environmental Quality 4 3330 "C" Street.- Anchorage, Alaska 99503 274-4561 rw/ Date Received October 14, 1976 Time of Inspection Date of Inspection 10- 5-76 Friday NeaX REQUEST FOR APPROVAL OF NDIVIDUAL SEWER & WATER FACILITIES FOR Conv. kApproval requested by: National Bank of Alaska Mailing Address: Post Office Box 3-3859 99509 Phone: 2. Property Owner: Charles & Veryl Purbaugh Phone: 283-4806 Mailing Address: Post office Box 3756 Kenai, Laura Lee Calhoon 3. Legal Description: Lot 2 Block 2 Abbott Loop Mapbi',' 4. Location: 7630 Adobe 5. Type of facility to be inspected single Family No. of bedrooms 3 6. Well Data: Individual A. Type . L -ow:"— B. Depth I C. Construction D. Bacterial Analysis 0,6 /0�. 7. Sewage Disposal System: On-site system k./P A. Installed B. Installer r C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: I.- Absorption 0ea 2. Material E. Disposal Field: Total length of lines 8. Distances: I P A. Well to: Septic tank Absorption area Nearest lot line Other contamination B. Foundation to septic tank' , Absorption area C. Absorption area to nearest lot line EQ -034 (1174) 16 X I SewerLines Page I of two pages tTI/ wv�` I'T Oil 0 Page 2 of two pages - Re-�'!st for Approval of Individual "4er & Water Facilities Legil Description, Lot 2 Block 2 Abbot Loop Manor Comments Aagfi6K Disapproved Date Aocval,Valid for one year from date signed Greater Anchorage Aria Borough, Department of Environmental Quality DIAGRAM OF SYSTEM k L certity tnat tne intormation contained in tnis request Tor approvai to De a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date C�' 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorap, Alaska 99504 276-2221 1. Type of Inspection 2. Property Owner: Mailing 3. Name of Buy REQUEST FOR APPROVAL OF ! " 7 f' - , k/ - - INDIVIDUAL SEWER and WATER FACILITIES L. V L 0 000 CMRO—VA—FHA—CONV--!f!!� 0 Age.P�AA Mailing Address: Day Phone: 4. Name of Lending Institution: A467- Z2-,qAMe AOL— OgeAW-4109 Mailing Address: Phone: - 5. Name of Realtor , g '. -/ A56 0�4�hl Mailing Aciclress.'� /14W440",/.7�(- Phone: CQ:;�- K#771 7. Type of Facility to be Inspected: f3AUZZ15 No. Bdrms. 8. Water Supply Typeof Supply: Public Utility—Individual IWE41- If Individual, number of dwellings presently served 4A&E 0/ If Individual, depth of well 9. Sewage Disposal System 72-003(3t76) Type of System: Public Utility—Individual (on-site) If Individual, date of installation P MUNICIPALITY OiF ANCHORprt DEPT. OF HEALTH & ENVIRONMENTAL PROTEC!i�,,j MAR 2 4 1�li RECEIVED' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY- Sewer and Water Section 35LI&xrxx)Mmcla=,AROxKKwx***ktRR5Rx-2"x-2222xi�mx2W 825 "L" Street, Fourth Floor, Anchoraget Ak. 99503 279-2511 Ext. 229 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO - VA XX FHA �* CONV 2. Property Owner: PURBAUGH, Charles C. & Veryl Mailing Address: 3. Name of Buyer: SPOTTS, Michael D. & Kathryn I. Day Phone Mailing Address: 3002 Dawson #B, Anchorage, Ak. 99503Day Phone 277-9274 4. Name of Lending Institution: Spokane Mortgage Co. Mailing Address: 3201 "C" Stree t, Anchorage, Ak 99503 Phone 277-0543 5. - Name of Realtor or Agent: Willy Sherman Mailing Address: 1031 Cordova, Anchorage, Ako Phone 272-3180 or 277-1443 -' unit /UU 6. Legal Description: Lot 2, Block 2, Abbott Loop Manor Location: 7630 Adobe Street, Anchorage, Alaska 7. Type of Facility to be inspected: Single Family Residence No. Bdrms. 2 8. Water Supply - Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System unknown - Individual unknown xx Type of System: Public Utility Individual (on-site) . xx If Individual, date of installation unknmm EQ -037 (1/74) GREATER AWWRAGE AREA BOROUGH Department of Environmental Quality 3" Tudor Road, Anchorage, Alaska 9M7 279-8N6 Date Received -2/—Z/ :2 2 3 . I I Tivne of Inspection 10! 3 0 Date of Irmpection. 2LI 2 73 REQUEST FOR APPROVAL OF iNDivrDUAL REWER & WATER FACILITIES FOR 1. Anproval Requested Byt &A44Z� 22 d�&-a-ZI44 Address. QI%6L.4 W- A-)dalwv-�. -.-- / Phone s etvl 1 2. Prooertv Owner: Uwn�lj Phonet3:6/q - 3 3. Legal Description. -_Z. 2-,f 2 'f 4. Locat'.ont C) 5. Type of Facility to he Inspectede Nutsher of Bedrooms: 6. Wel I Data: ID vx A. Type D -vt A.4 -j C. Constructi an jz*-t! 7. Sewage Dle,30sal Systems A. Installed C. Septic Tank: 1. Size B. Depth D. �acterlal Anal 9. Installer 2. Manufacturer D. Seepage Pitt 1. Size 2. Material H. Disposal Field: Total Length of Lines 9. Distances: I A. Well Tat Septic Absorption Area Sewer Lines C. , Nearest Lot Line . Other Contamination Foundation to Septic Tank 2-& "t. Absorption Area Absorption Area to Nearest Lot Line it for Approval el,,�,.ndlvidusl Sewer So Water Fscll'�6s Comments 0 4p 1 Aonroved �Disavprovec��- ��Bte ApprOV81 Vblid for ar From Date Signed Greater Anchorage Area Borough, Department of Enviro=r.ental Quality DIAGRAM OF SYSTEM. 100 L I %t 5 fmgi rA e- 5V N, I cart1fv that the information contained in this request for apprOV81 to be a true anoi accurate representation of the sublect newer and water facilities located at: SALCONDARY TNIATWNT consists of 0 Tile disposal held. Seepage pits. Other Tile Disposail field: Distance from: Well,_ feer; foundation. _ feet; ncat-st lot line at (3 front. [3 side, 0 rear.— feet. Total length of tile lines.fiect. Number of lines._. Distance between lines,—fiect. Trench width,_inches. Total effective absorption area in bottom of trenches.—Uluire feet. Length of each line. 0 feet. Depth. top of tile to finish grade, —inches. Type of filter material: 0 Gravel. 0 Broken stone. Oth — Depth of filter material beneath tile..imbes. Depth of filter material over file. inches. swelm" pow Number 44 pits—. . Outside diametef.—fect. Depth,_feet. Lining material Distance fir"m: WclI,_feet; building lioundation,—fiet; nearest IN line at 0 fronL 0 side, 0 rear,—firet. hu",petion me" says 0 State. 0 County. [I Local Health Authcqiry. Inspected Date of inspetti.in . 19— ("T") REPORT OF INSPECTION—INDIVIDUAL WATER -SUPPLY SYSTEM DiStAnCe 10 nearest public water main,_(eet- Sin of main. -inches. Indivi,hual wells [3 are [I are not cusiontary in neighborhood. Give most fttent word 44 failure of wits in immediate vicinity to furnish adequate supply of water properties in neighborhood 0 are 0 are nor being developed with both individual water -supply and sewage-dispoial system. 1,.t siw:—fmt wide.—fecir deep. Dwelling set back from front property line—leet. Individual water supply from: 0 D"lled well. C] Driven well. [3 Dug well. C3 liored well. IN'tauvto of was from Building foundation. fitet; nearest lot line at 0 front, 0 side, 0 rear. — feet. ,ast iron sewer.—lect; tile sewcf.—liet-. septic t2nk.—fM*- disposal field,—fm; seepage pit._fc"; ctssptx)l,—fcet; other sotirces oi possible pollution.—icet. WeIll 4"Oftwet"I Diameter.—inches. Tout depth,—fe". Type of casing.— Depth of casing.—firet. Approximate depth to pumping level of water in well�fca. Approximate yield.-galloris per minute. Scaled watertight to depth of -lea. FAterior spue around casini; stated with: [3 Cement grout. [3 laiddled clay. [3 Ordinary backfill. Well cover: [3 Concrete. [3 Wood. [3 Meal. Openings in well cover watertight: [3 Yes. 0 No. Pumps 0 Shallow well. [3 Deep well. Length of drop pipe,—feet. Pump capacity.—gallons per minute. I.Aicatec! in: [] Basement. [] Pumproom off basement. 0 Pumphouse above ground. [3 Pump pit. Pumproom propetly drained: [I Yes. [3 No. Pump mounting watertight: (3 Yes. [3 No. Type of storage: [3 Pressure. [3 Gravity. CAPacity,-9410ths- Has bacteriological examination of water been made? [] Yes. [3 Nca. If answer is -yes." give date Quality of water [3 is 0 is not satisfactory for human consumption. Installation [3 does 0 does not comply with approved exhibits, if any. Inspection made by: C] State. 0 County. [3 Laical Health Authority. Inspected by. Date of inspection 19— (TITUS) HUD -Wash, D. C. 19- Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMs APPROVAL Parcel I.D. 014-181-15 Expiration Date: / 6) — 1. GENERAL INFORMATION Complete legal description ABBOTT LOOP MANOR, BLOCK 2, LOT 2 Location (site address) 7630 ADOBE DRIVE, ANCHORAGE, AK99507 Current Property owner(s) WILLIAM A. WOODLAND — Day phone Mailing address Real Estate Agent 7630 ADOBE DRIVE, ANCHORAGE, AK 99507 2. TYPE OF DWELLING: N Single Family (wfwo ADU) El Duplex [I Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual R Individual Water Storage El Holding Tank F� Community Class_ Well El Community Public Water System El Public Sewer WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otlherw�l/p raq�estedl by the engineer. COSA Fee $ Date of Payment Receipt Number COSA # Dlt)L Waiver Fee $ Date of Payment Receipt Number Waiver # 6. STATEMENT OF INSPECTION BY ENGINEER As certified by my sea] affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 6/26/13 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the controf of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. Apr 4 H 17 9T H* 6. DSD SIGNATURE ___�Systern #1 Approved for 3 bedrooms. nNNETH"I D 01111� System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: By TW�2'1 at of Anc ge Development Service, D .. sion (DSD) issues Certificates of On-Sfte 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 ofAnchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbi�h�t 11)-M12.d.. If more than 1 septic system is on the lot: COSA Checklist # —of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: ABBOTT LOOP MANOR, BLOCK 2, LOT 2 Parcel ID: 014-181-15 A. WELL DATA* Well type PRVr If A, 8, or C provide PWSI D # Date completed Unknown Sanitary seal (YIN) Y Total depth 116 ft. Cased to 116 ft. FROM WELL LOG Date of test Static water level Well production ft. 9 P.M. WATER SAMPLE RESULTS: Coliform -Az�y— colonies/100 mL Nitrate �JL�) mg/L Arsenic: AJI) ug/L Date of sample: 612412013 B. SEPTIC/HOLDING TANK DATA - PUBLIC SEWER Tank Type/Material Tank size _ gal. Number of Compartments Foundation cleanout (YIN) Depression over tank (YIN) Date of pumping Pumper C. ABSORPTION FIELD DATA - PUBLIC SEWER Date installed Soil rating (g.p.d ./ft2 or ft2 /bdrm) Length ft. Width ft. 2 Well Log (YIN) N Wires property protected (YIN) Y Casing height (above ground) 12+ in. AT INSPECTION 612212013 ft. 9 p -m Collected by: ARCTERRA Date installed Cleanouts (YIN) High water alarm (YIN) System type _ Gravel below pipe Total depth ft. Eff. absorption area _ft Monitoring tube Depression over field ft. Date of adequacy test Results (Pass/Fail) _ For bedrooms Fluid depth in absorption field before test — in. Water added al. New depth_ in. Elapsed Time: —min. Final fluid depth — in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at — in. Datum Size in gallons "Pump off"Ievel at — in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot NA Absorption field on lot NA Public sewer main 751+ Sewer /septic service line 254 Animal containment areas 504 SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Water main Wells on adjacent lots Property line Water service line ABSORPTION FIELD ON LOT TO: PUBLIC SEWER Property line — Water Service line Curtain drain F. COMMENTS Well data from MOA record documents. G. ENGINEER'S CERTIFICATION Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots NA On adjacent lots NA Public sewer manhole/cleanout 100'+ Holding tank NA Manure/animal excrete storage areas 100'+ Absorption Surface water Building foundation Water main Surface water Wells on adjacent lots Driveway, parking/vehicle storage I certify that / have determined through field inspections and review of determined through field inspections and review of Municipal records that inspections and review of Municipal records that the above systems are i . n Municipal records that the above systems are in conformance with MOA above systems are in conformance with MOA COSA guidelines in effect on conformance with MOA COSA guidelines in effect on this date. COSA guidelines in effect on this date. on this date. Engineers Printed Name - KENNETH M. DUFFUS Date 0612612013 COSA brown sheet-10-10-12.doc F ' Q Al- 41sl� 4 q TH 111%Nff�I�D Nk �41ij; in.