HomeMy WebLinkAboutSIEFKER TR 14Si
fker
Tr 14
#015-281-13
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On-Site Water & Wastewater Program
(~ Phone:907-343-7904
Fax:907-343-7997
ON-SITE SEWERANELL PERMIT APPLICATION
Parcel I.D. 015-281-13
Property owner(s) Elias Wilterding
Mailing address 12240 Avion Street, Anchorage, AK 99516
Day phone
Site address 12240 Avion Street, Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Tract 14, Siefker Subdivision
Legal description (Township, Range & Section) T13N R3W SM
Lot Size 49500 .Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
([] all th~ apply)
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
TYPE OF DWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D)
Multiple Dwellings
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance With
.al~piic~ble Municipal Codes.
(Sign'~._~prope~.. (f~vner 6r a~rized agent)
Permit/Rush Feesi*~'~ I~ O J;) 4.2 z¢ ! ~_._~ Waiver Fees:
Date of Payment: ~'p,//'~, Date of Payment:
J
Receipt Number'~O0q/'Jo¢, ~¢. ~ Receipt Number:
Permit No.. ~).-~P/~ / (O c'l Waiver No.
Permit App_:- :: ',2.Jc:
Permit No. 0SP161104
Municipality of Anchorage
Development Services Department
BUILDING SAFETY DIVISION
Page 1 of 7
W.O. 16120
Date 5/12/16
P.O. Box 196650 *Anchorage, AK 99519-6650' Tel: 343-7904
On-Site Wastewater Disposal System-SITE NARRATIVE
Legal Description: TRACT 14, SIEFKER SUBDMSION PlO No. 015-281-15
SITE NARRATIVE
TRACT 14, SIEFKER SUBDIVISION (THE SUBJECT LOT) IS 1.14 ACRES AND IS BORDERED ON
THE NORTH, SOUTH AND WEST BY DEVELOPED LOTS OF THE SAME ACREAGE; AND ON THE
EAST BY A DEDICATED 60' PUBLIC RIGHT OF WAY (AVlON STREET). SEE SHEET 5. THERE
IS AN EXISTING WELL AND SEPTIC SYSTEM ON THE LOT WHICH WERE INSTALLED IN 1966.
THE EXISTING SEPTIC SYSTEM IS FAILING AND IS SCHEDULED TO BE ABANDONED WHEN THE
NEW SYSTEM IS INSTALLED. THE NEW SEPTIC SYSTEM IS DESIGNED FOR A FOUR (4)
BEDROOM HOUSE.
WELLS:
THERE IS AN EXISTING 6" RESIDENTIAL WELL LOCATED ON THE PROPERTY; AS WELL AS ON
ALL ADJACENT LOTS. THE PROPOSED SEPTIC SYSTEM CAN BE INSTALL ON THE SUBJECT
LOT WITHOUT IMPACTING EXISTNG OR FUTURE PROTECTIVE WELL RADII. SEE SHEET 5.
SEPTIC SYSTEMS:
THERE ARE EXISTING SEPTIC SYSTEMS ON ALL ADJACENTS LOTS. DUE TO THE LARGE SIZE
OF THESE LOTS, THE PROPOSED SEPTIC SYSTEM CAN BE PLACED IN A MANNER AS TO NOT
IMPOSE ANY RESTRICTIONS ON THE FUTURE PLACEMENT OF SEPTIC SYSTEMS ON THE
ADJACENT LOTS.
DRAINAGE & STREAMS:
THE LOT SLOPES TO THE WEST AT APPROXIMATELY 4% SLOPE. THE LOT CAN BE GRADED TO
PREVENT ANY PONDING OF WATER AROUND THE PROPOSED SEPTIC SYSTEM.
THERE ARE NO CUT BANKS, STREAMS OR DRAINAGE CHANNELS (OTHER THAN ALONG THE
EXISTING STREETS) ON THE LOT.
ALL DISTURBED AREAS WILL RECEIVE TOP SOIL AND SEEDING TO PREVENT SOIL EROSION.
5-12-16
Permif No. OSP16il04
Municipality of Anchorage
Development Services Department
BUILDING SAFETY DIVISION
Page 2 of 7
W.O. 16120
Dale 5-12-16
P.O. Box 196650' Anchorage, AK 99519-6650' Tel: 343-7904
On-Site Wastewater Disposal System-DESIGN CALCULATIONS
Legal Descripfion: TRACT 14, SIEFKER SUBDMSION PID No. 015-281-1;3
SYSTEM DESIGN CALCULATIONS
FOR
WIDE DRAIN FIELD
1, NO. BEDROOMS = 4
2. USE WIDE DRAINFIELD SYSTEM
3. ABSORBTION AREA = (# BEDROOMS)(150 GPD/BR)
TRENCH APPLICATION RATE
= (4)(150)
0.45*
4. WIDE DRAINFIELD REDUCTIN FACTOR:
IF DEPTH OF GRAVEL = 4,0'
WIDTH OF DRAINFIELD = 5'
LENGTH OF TRENCH = 155';
= 1333 SF
DEPTH
REDUCTION FACTOR = 0.58
USE TWO TRENCHES @ 78.0' EACH
PERCOLATION RATE
*1
MIN/INCH
0-1
1-5
6-15
16-30
PIT & TRENCH
APPLICATION RATE
GPD/SF
NOT SUITABLE
1.2
0.8
0.6
31-60
0.45
GREATER THAN 60
FILTER LAYER
NOT SUITABLE
1,0
Permit No. 0SP161104
Municipality of Anchorage
Development Services Department
BUILDING SAFETY DIVISION
Page 5 of 7
W.O. 16120
Date 5'12-16
P.O. Box 196650' Anchorage, AK 99519-6650' Tel: 343-7904
Proposed Well & On-Site Wastewater Disposal System
Legal Description: TRACT 14, SIEFKER SUBDFv-ISION PID No. 015-281-1,5
HOUSE
8FF=101.7
BFF=92.2
DRAIN FROM:-
HOUSE.
INV=9(]
60' 78.0'
FOUNDATION C.O.
GROUND &
FINISH GRADE
96.3+
2EA. (5' WIDE TRENCHES)
PVC MONITURINO TUBE (2
PERFORATE LOWER
93.5±
OUT
END OF
~E~-C~- --
1250 GALLON, TWO
COMPARTMENT STEEL sEPTIc TANK
TANK TO BE INSTALL LEVEL
*ALL ELEVATIONS ARE TO INVERT OF
PIPE UNLESS OTHERWISE NOTED
4" PVC PERF
PIPE (D$054)
~83.0 BOTTOM
OF TRENCH
ROCK
PROFILE
SCALE: NTS
PROFILE-~ENCH
Permit No. 0SP161104
Municipality of Anchorage
Development Services Department
BUILDING SAFETY DIVISION
Page 6 of 7
WoO. 16120
Date 5-12-16
P.O. Box 196650 ® Anchorage, AK 99519-6650' Tel: 343-7904
Proposed Well & On-Site Wastewater Disposal System
Legal Description: TRACT 14, SIEFKER SUBDMSION PID No. 015-281-13
ORIGINAL
TOP SOIL & GRASS
ROOTS TO 24"
2% A.~IR TIGHT CAP__STABiLiZED WITH TOPSOIL
/ac'&: GRASS
MONITORING TUBE
BACKFILL
SANDY SILT (ML)
NO WATER TABLE
5~
FABRIC
PERFORATED
BISTRIBUTION PIPE
(D303~)
ROCK PER
M.O.A. SPECIFICATIONS
PERFORATE ONLY THAT
PORTION OF THE MONITORING
TUBE BELOW THE DISTRIBUTION
PIPE.
TO SEASONAL HIGH
WATER LEVEL
= 16.5
TO BEDROCK OR
IMPERMEABLE LAYER
TRENCH SECTION
16120SSC6R
Permit No. OSPI§ll04 DHI CONSULTING ENGINEERS
Legal Description: TRACT 14, SIEFKER SUBDIVISION
Page. 7 of 7
W.O.. 16120
Dote 5/12/16
NOTES:
ALL CONSTRUCTION SHALL BE IN ACCORDANCE WITH CHAPTER 15.65. WASTEWATER DISPOSAL REGULATIONS
OF THE MUNICIPAL CODE. AND MOA STANDARD SPECIFICATIONS FOR STREETS, DRAINAGE, UTILITIES AND PARKS
(MASS) 2009 AS CURRENTLY AMENDED, AND ALL APPLICABLE STATE AND FEDERAL REGULATIONS.
2 INSTALL NEW 1250 GAL. 2 COMPARTMENT, STEEL SEPTIC TANK AS SHOWN ON THE DRAWINGS. SET TANK LEVEL,
3 EXISTING STRUCTURES, WELLS, SEPTIC SYSTEMS OBSERVED WITHIN 200 FT. OF THE PROPOSED SYSTEM ARE
SHOWN ON DESIGN DRAWINGS°
4 ANY DEVIATION FROM THE DESIGN MUST BE AUTHORIZED BY THE ENGINEER AND THE M.O.A. PRIOR TO ITS
INCORPORATION INTO THE SYSTEM,
5 CONTRACTOR TO LOCATE ALL UNDERGROUND UTILITIES, PROPERTY LINES, EXISTING WELLS, WATERWAYS,
SURFACE AND SUBSURFACE DRAINAGE FACILITIES, LAKES, PONDS, AND OTHER FACILITIES REQUIRING
SEPARATION DISTANCES FROM THE PROPOSED SEPTIC SYSTEM.
6 CONTRACTOR TO STAKE PROPOSED SYSTEM & NOTIFY THE ENGINEER OF ANY OBSERVED
CONFLICTS PRIOR TO CONSTRUCTION. STAKE LOCATION OF EACH TRENCH END. NOTE DEPTH OF CUT ON LATH.
CONTRACTOR SHALL HAVE SURVEY LEVEL AND ROD SET UP ON SITE DURING CONSTRUCTION.
7 CONTRACTOR TO NOTIFY THE ENGINEER AND ON-SITE SERVICES 24 HOURS PRIOR TO COMMENCING WITH
CONSTRUCTION. A MINIMUM OF THREE SITE VISITS ARE REQUIRED. THE FIRST VISIT SHALL BE OF THE
SUBGRADE PRIOR TO PLACING THE SEWER ROCK. THE SECOND VISIT SHALL BE AFTER THE PLACEMENT OF
SEWER ROCK, DISTRIBUTION PIPING, STANDPIPES, AND OTHER COMPONENTS AS SPECIFIED. THE THIRD
VISIT SHALL BE AFTER THE WORK IS COMPLETED.
8 CONTRACTOR SHALL DELIVER TO THE ENGINEER A SET OF RED-LINED, AS-BUILT DRAWINGS SHOWING ALL DATA
AS SPECIFIED IN SEC. 15.65.F. 2, 3, 4, 5, 6 OF MUNICIPAL WASTEWATER DISPOSAL CODE WITHIN FIVE DAYS OF
THE FINAL VISIT. INVERTS AND SWING TIE LOCATES SHALL BE TO THE NEAREST TENTH OF A FOOT. THESE
AS-BUILTS SHALL BE USED BY THE ENGINEER TO PREPARE AND SUBMIT RECORD DRAWINGS TO ON-SITE
SERVICES.
9 ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE
ENGINEER IF ACTUAL FIELD CONDITIONS VARY FROM THOSE USED TO PREPARE THE DESIGN.
10 BOTTOM OF TRENCH EXCAVATION SHALL BE LEVEL. SIDEWALLS SHALL BE SCARIFIED. RECORD
ELEVATIONS AT BEGINNING, MIDDLE, AND END OF TRENCH BOTTOM.
11 PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK.
LEVEL ROCK SURFACE TO :J: 0.1' PRIOR TO INSTALLING THE PERFORATED PIPE.
12 ALL PIPE SHALL BE PVC CONFORMING TO ASTM D3034. ALL JOINTS SHALL BE SEALED WITH APPROVED GLUE°
CLEANOUTS SHALL BE INSTALLED AT THE END(S) OF THE TRENCH(S). 4" MONITORING TUBE(S) SHALL BE
INSTALLED AT THE END OF EACH TRENCH, WHERE SHOWN ON PLANS.
13 COVER THE DISTRIBUTION PIPE WITH MIN 2" SEWER ROCK, BEFORE PLACING INSULATION AND/OR GEOTEXTILE,
FILL, AND TOPSOIL.
14 MINIMUM SOIL COVER SHALL BE 3 FEET OVER THE PIPE AND 4 FEET OVER THE SEPTIC TANK. ALL INSULATION
BOARD SHALL BE 2 LAYERS OF 2" THICK BY 4' WIDE POLYSTYRENE, DOW H1-35 OR ENGINEER-APPROVED EQUAL.
CENTER BOARD WIDTH OVER PIPE.
15 AN APPROVED GEOTEXTILE FABRIC SHALL BE INSTALLED BETWEEN THE SEWER ROCK AND THE
BACKFILL.
16 MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS.
17 SLOPE ALL FILL MATERIAL AND TOPSOIL TO DRAIN AT 2% MIN. SLOPE, AND IN SUCH A MANNER THAT
PONDING AT OR NEAR THE DRAIN FIELD DOES NOT OCCUR. THE FILL SHALL BE LEFT 6" HIGHER THAN
SHOWN TO ALLOW FOR SETTLEMENT. THE TOP 4" OF COVER SHALL BE TOPSOIL. SEED SURFACE AFTER
COMPLETING INSTALLATION AS PER MUNICIPAL SPECS.
18 CONTRACTOR TO BE RESPONSIBLE FOR THE REMOVAL AND DISPOSAL OF CONTAMINATED MATERIAL FROM THE
EXISTING TRENCHS, IF ENCOUNTERED.
19 CONTRACTOR TO DECOMMISSION EXISTING SEPTIC TANK AND ABSORPTION FIELD IN ACCORDANCE WiTH AMC 15.65.
SOILS LOG-PERCOLATION TEST
TEST HOLE 1
PERFORMED FOR: ELIAS WlLTERDING DA~ PERFORMED: 5--2-16 ~ ~ %,
LEGAL DESCRIP~ON:TRACT 14, SIEFKER SUBDIVISION
5-12-16
2 :' : · .'z. :~ > '/- SLOPE Sl~ PLAN
3 ~'/' '>-
7 _):z. _
8 .;:/..
· ./'/. SANDY SILT (ML)
~' '~:' NO WATER TABLE
'/' '~: WAS GROUND WA~R S
10 ~' -/ ~
,:~..~ ENCOUN~RED ? NO L
11 ~:~;.; ~F ~S. AT ~AT p
,'/..) DEP~ ~
.;-/.. ' E
12 : .~-/~ DEPTH OF WA~R
/. -~" AFaR MONITORING ~ NONE DATE: 5-12-16
15 ;-/.. ~ ~ ~-lS ~ .,, s- o.~
16 ~-
~ BOSOM OF ~ST HOLE
17 '
18
19 PERCOLATION RATE: 53 (MINU~S/INCH.) PERCHOLE DIAMETER: 6"
20 TEST RUN BETWEEN: 4.5 FT. AND 5.0
COMMENTS:SOILS ~RE PRE-SOAKED PRIOR TO RUNNING PERCOLA~ON TEST.
PERFORMED BY: DEE HIGH I, DEE HIGH, HEREBY CERTIFY THAT ~IS ~ST WAS PERFORMED IN ACCORDANCE WITH
ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON ~IS DA~. DATE: 5-12-16 W. 0.16120
MUNICIPALITY OF ANCHOEACE '~' ~'~ O~ '~/~.~ ~ I~
DEP^R~ENT OF ~*~H ~ ~ S~C~ ~'~,.__ ........ .~:%..~
SOILS LOG-PERCOLATION TEST '
PERFORMED FOR: ELIAS WlLTERDING DA~ PERFORMED: 5-2-16 ~&~2"*.
LEGAL DESCRIP~oN:TRACT 14, SIEFKER SUBDIVISION -~'~'
5-12-16
, '/.. z SLOPE SI~
3 ,:<.
,:<..> -
6
7 ->'/'"
8 ./.
>;<>.~ SANDY SILT (ML)
9 r;<>.2 OCCASIONAL BOLDER TO
'/'-~;! NO WA~R TABLE
· ./.. WAS GROUND WATER S
10 ~;/.¢ ENCOUN~RED ? NO L
'>'/'..q' 0
11 ~'>~;~.. . IF%S, ATWHAT p
,'/../ DEPTH ~
.>./. ' E
12 : .~[~: DEPTH OF WATER
/../ AFaR MONITORING ? NONE DATE: 5-12-16
14 *;~' '/ ~ ~-~s ~. s" o.~
16 ¢..
/~ BOSOM OF ~ST HOLE
17
18
1 9 PERCOLATION RATE: 52 (MINU~S/INCH.) PERCHOLE DIAME~R: 6"
20 TEST RUN BE~EN: 4.0 FT. AND 4.5 FT.
COMMENTS:SOILS ~RE PRE-SOAKED PRIOR TO RUNNING PERCOLA~ON TEST.
PERFORMED BY: DEE HIGH I, DEE HIGH, HEREBY CERTIFY ~AT THIS ~ST WAS PERFORMED IN ACCORDANCE WITH
ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DA~, DA~: 5-12-16 W. 0.16120
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC251014
Parcel ID 015-281-13
Legal description SIEFKER TR 14
Site address 12240 AVION ST
Expiration Date: 10/15/2025
Current property owner(s) WILTERDING ELIAS O & KATRINA A
X The On-site system(s) is/are approved for 4 bedrooms
By:
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
Original Certificate Date:
2/5/2025
Thi�s.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 Service 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 submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section �' Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 015-281-13
Complete legal description Siefker Tract 14
Location (site address) 12240 Avion Street
Current property owner(s) Elias O & Katrina A Wilterding Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: X 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 8 - 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 $ -�
Date of Payment
COSA # 05 G 2--5
Waiver Fee $
Date of Payment
Waiver #
COSA Applicalion_June 2022
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume 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
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
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)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_June 2022
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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with ADEC & MOA guidelines and regulations. The reported results describe the performance of the system
under the conditions encountered at the time of the test, and separation distances measured to readily identifiable
features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that
may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside
the control of the evaluator of this system. All systems eventually fail, and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore, we
cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this
report is for the sole benefit of the owner listed above.
Name of Firm
Phone
Engineer’s Printed Name
Date
AsBuilt
12/18/24
1"=50'
0 50