HomeMy WebLinkAboutLEWIS & CLARK LT 1Onsite File
Lewis & Clark
Lot 1
#017-074-65
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904
.PN -SITE WASTEWATER INSPECTION REPORT
PermitNUmber: OSPI31316
PID Number: 01707306
Page 1 of 3
Dwelling.- FX Single Family (SF) El with ADU El Duplex (D) El Two Single Family Project- FE -1 New El Upgrade
Name
Brownson
ABSORPTION FIELD
El Deep Trench FE Wide Trench F Bed F Mound
Site Address
Gionet Circle
El Other
Phone N Umber of Bedrooms
Soil Rating
Total depth frorn original grade
406-0792 L5,111,11)
0.8 GPDISF�
6- Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2
Ft.
Gravel depth beneath pipe
4 Ft.
Subdivision Block Lot
Lewis & Clark l1
Fill added above original grade
0.5+
KIFt.
Gravel length
96 Ft.
Township Range Section
T1 2N R3W SEC 25 S2V12MN4SE4 & E2NVV43 E4 & N E4S E4
Grqvelmdth
5 Ft.
Beds: Number
of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
TO
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
I Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
960 Ftz
1
1
1 Ft.
Well
1001+
100'+
100'+
na
25'+
TANK El Septic K S.T.E.P.
1771 Holding El Other
Manufacturer
Anchorage Tank
Capaciti
2000 Gal.
Surface Water
I00`+('-}-
100'+
na
Material
Number of cornpa ents
Lot Line
10'+
10'+
10'+
n a
NA
Steel
LIFT STATION
2
Foundation
10'+
10'+
10'+
tea
Manufacturer
Capacity
Remarks
Anchorage Tank
2000 Gal.
Alarm location
Electrical installed by
House
Arctic Edge
PIPE MATERIAL House to tank D3034 Tank to drainfieldSch4�
Installer
Owner
Sch 40 PVC is
ASTM D 1785-15 Drainfield Sch Q pvc Co/tATD3034
BENCH MARK (Assumed elevation) 100 ft
Inspector NorthRim Eng
Inspedbon 1-t 9127119 9128/19
Location and description
dates: 2"
Deck
3,c 10/23ilij 41t,�
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval.-
Date
OF A4,tNk
.4 9aj
. .. .... ...
Steve Eng
I
A ul� CE -6256 AT
cE-6256
jr
&L ... "A'
s 70
Septic System
Approved /C?"6c� 6""o A( L Date
Note- this approval does not include well permit requirements.
(Rev 05102/18)
AS -BUILT
MEASUREMENTS
A
B
T1
81
20
T2
91
26
T3
98
32
MT1
34
42
MT2
117
73
Upper DeArmoun Rd
NOR THRI M
ENGINEERING
SteveEng. com
PO Box 770724
Eagle River. Alaska 99577
907.694.7028
+•'�� OF 'v`'. LEWIS & CLARK LOT 1
co
' RECORD
T12NR3WSEC25S2W2NW4SE4&NE4SE4
......... .... .
••••••••' LAY❑UT
-u-% = WASTEWATER RECORD _
' STEP/TRENCH °ate
6/8/20
1" = 50'
60
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W
S❑ILS LOG - PERC❑LATI❑N TEST
'I TH I M Date Perf ormed: 8/10/18
F�IZINEERING
Perf ormed For: Todd Brownson
Legal Description: Lewis & Clark S/D, Lot 1
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
DEPTH
(FEET)
T.H. Location: See Location Map
SM/ML
Silty Sand & S i l t
w/Gravel Groundwater? No
Depth
Water Depth
Denser After Monitoring, Date
#
Date
Gross Time
Net Time
Depth
Net Drop
1
9/17
0
--
2.5"
--
2
9/17
1 30
30 min,
6"
3,5 "
3
9/17
32
--
2.5"
--
4
9/17
62
30 min,
6"
3,5 "
5
9/17
65
--
2.5"
--
6
9/17
95
30 min,
6"
3.5"
Percolation Rate 8,6 min,/inch Perc Hole Diameter 6"
Test Run Between 2' and 3'
Comments: Presoaked.
Performed By NorthRim Eng. I
Perf ormed in Accordance with
ON THIS DATE, DATE: 9/17/19
NOR THRIM
ENGINEERING
PO Box 770724
Eagle River, Alaska 99577
907.694.7028
/ 1 / / 17
CERTIFY THAT THIS TEST WAS
tate/Municipal Guidelines in Effect
TESTH❑LE LOG
GE❑TECHNICAL
LEWIS & CLARK S/D
LOT 1
I
TH-A
9/17/19
S❑ILS LOG - PERC❑LATI❑N TEST
p" TH I M Date Perf orr�ed 8/10/18
F� (V IINEERING
Performed For: Todd Brownson
Legal Description; Lewis & Clark S/D, Lot 1
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
DEPTH
(FEET)
TA Location: See Location Map
:;:;:;o;
SM/ML
Silty Sand & Silt
.............. X. w/Gravel Groundwater? No
Depth --
Water Depth
Denser After Monitoring. Date:
#
Date
Gross Time
Net Time
Depth
Net Drop
1
9/17
0
--
2,5 "
--
2
9/17
30
30 min.
6"
3.5"
3
9/17
32
--
2,5 #
--
4
9/17
62
30 min.
6"
3.5"
5
9/17
65
--
2,5 #
--
6
9/17
95
30 min.
6"
3.5"
Percolation Rate 8,6 min,/inch Perc Hole Diameter 6"
Test Run Between 2' and 3'
Comments: Presoaked.
Performed By NorthRim Eng. I
Performed in Accordance with
ON THIS DATE, DATE: 9/17/19
NOR THRIM
ENGINEERING
PO Box 770724
Eagle River, Alaska 99577
907.694.7028
/ 1 / / 17
CERTIFY THAT THIS TEST WAS
tate/Municipal Guidelines in Effect
TESTH❑LE LOG
GE❑TECHNICAL TH-B
LEWIS & CLARK S/D
L ❑ T 1
Job No. 19-136
Permit No: OSP-19143$
Drilling, Inc.
*P.O. Box 110389 ®Anchorage, AK 99511®
*907-345-4000*
GROUNDWATER WELL LOG
WATER Q
UALrry STING
C091form COY,
t 00ML
rsenioL
Well Owner: Big Country Enterprises Use of Well: Domestic
Site Description: 8600 Upper DeArmoun Road, Anchorage, Alaska
Legal Description: T12N R3W SEC 25 S2W2NW4SE4 & E2NW4SE4 & NE4SE4 G:2941
Well Coordinates: 61°6'4"N 149°43'18"W
CONSTRUCTION
Drill Method: Air rotary
Hole Size: 6" Well Depth: 205'
Casing Size: 65/8- Cased to:
103.43' Material: A53B steel Wall: 0.25"
3Casing
_
Stick Up
Well Com letion: I Open end X I Screen
Perforated Method:
Screen/Perforation Description: I None
Fill
6
TO
Grout Notes:
3 Sacks (50#ea) of Bentonite
15
TO
17
Silt: brown, clayey
17
Well Development: I Air surge
35
Well Disinfected: Y I Method: Chlorox
Yield Test at 5 GPM for 2
hour(s) with 100% of drawdown (DD) from static level(SWL).
Method: Air Lift
Static Water Level (SWL): 35'
Start Date: 10/3/19
TO
Completion Date: 10/11/19
Test Pump Date:
41
Final Pump Install Date:
WELL LOG
Depth in feet from top
of casing.
Details of formations penetrated, size of material, color and miscellaneous details.
0
TO
3Casing
_
Stick Up
3
TO
6
Fill
6
TO
15
Silty gravel: brown
15
TO
17
Silt: brown, clayey
17
TO
35
Gravel: medium, wet
35
TO
37 _
Silt: brown'resioem, rVI-W D1111illy, 111C.
nE ntnCertified WslPri titer Gontractor
37
TO
41
Silt: gray Ak Gen Contr Licyo 1000
41
TO
67
Small gravel: sandy, damp
67
TO
84
Small gravel: silty, dry
84
TO
97
_
gravel
97
TO
103
_Cobble
Bedrock: gray black, fractured
103
TO
205
Bedrock: gray black, small water seeps in occasional fractures
On -Site Water & Wastewater Section. Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: asP �q I 9_) U Date of Issue: / a - 3 - lq
Parcel Identification Number:
Legal Description Block Lot Property Owner Name & Address:
-V 0q SF' i 6-Z A) 0
`+SE..( /7GX3 ry7 �C, ,<J eC%•sem
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: /f ", f", feet
Pump Manufacturer's Name: _9r1. ne1rQ -
Pump Model:
Pump Size: ' ,S hp
Pitless Adapter Burial Depth: E`<- feet
Pitless Adapter Manufacturer's Name: �12
Pitless Adapter Installer: !�
Well Disinfected Upon Completion? 69 Yes ❑ No
Method of Disinfection: (...
Comments:
Pu nip Installer Name: U;;4,
Company: 9(.77 L;.../c�2�P/" C_&,,1 moi/• G -
Mailing Address: 12'3 X5e;,-\ ' 7S'
State: A "(- Zip:
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
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"'""`"Y MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program 5�;
`, PO Box 196650 4700 Elmore Road
{ Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r,
"" •
http://www.muni.org/onsite - ..
Department
a'CHOR'C'E
On-Site Water System Permit
Permit Number: OSP191438 Effective Date: 10/3/2019
Work Type: Well Renewal Expiration Date: 10/2/2020
Tax Code Number: 01707306000
Site Legal Address: T12N R3W SEC 25 S2W2NW4SE4 & E2NW4SE4 & NE4SE4 G:2941
Site Mailing Address: 8600 UPPER DE ARMOUN RD, Anchorage
Owner: BIG COUNTRY ENTERPRISES LLC Lot Size in Sq Ft: 2954675
Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 5
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy El Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: This is a renewal of the well portion of permit OSP181316.
Received By: Date: w 3 -edr
1;1'
Issued Issued By: � A C Z�Ze Date: /01 ?
MUNICIPALITY OF ANCHORAGE
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. 017 -O7>-O6
Property owner(s) 721)J) 14[)k4/.4,5 ',v' Day phone /v7` Ya ".(77 .2
Mailing address 36y1, ‘S"� Ave^rve
Site address ') f/0062 /9C,4QMcii✓ 0/9 10
Legal description (Sub'd., Block & Lot) 7 /z N t7k1 5-e. 25" 52 w-?tiw`>'Cr3i •L ti '5e/
Legal description (Township, Range & Section) J-iv(.rtrsej/
Lot Size .2154/67‘ Sq. Ft. Number of Bedrooms c Cc -Zt?//
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
[�!
AbsorptionSingle Family (SF)Field ❑ Initial ❑ (w/wo ADU)
Septic Tank ❑ Upgrade ❑ Duplex (p) ❑
Holding Tank ❑ Renewal 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 Muni '•- - ---
(Signature of property owner or authorized agent)
Permit/Rush Fees: Waiver Fees:
Date of Payment: 0 - - / ,a: Date of Payment:
Receipt Number: bIQ(, S Receipt Number:
Permit No. OSP)' 3? Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
0, MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program •t2�>>r
PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.orglonsite
Ih•I)artuicni
44'C8 OliFVE
On-Site Water & Wastewater System Permit
Permit Number: OSP181316 Effective Date: 9/28/2018
Work Type: WellSeptic Initial Expiration Date: 9/28/2019
Tax Code Number: 01707306000
Site Legal Address: T12N R3W SEC 25 S2W2NW4SE4 & E2NW4SE4 & NE4SE4 G:2941
Site Mailing Address:
Owner: BROWNSON TODD & ELISHA LIVING Lot Size in Sq Ft: 2954675
Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 5
This permit is for the construction of:
Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy E Private Well 0 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
/(1/1
Received By: / . i Date: /t
Issued By: ,,�wi "I J / Date: 0-00/
•
MUNICIPALITY OF ANCHORAGE
Development Services Department -� Pho•: :69+01=3
- ,',7904
On-Site Water & Wastewater Section ��
43-
7997
ry
Ix SEI' 6 i ,.. j i
ON-SITE SEPTIC/WELL PERMIT APPLICATION tea. /- I '
,.1,
t , f
Olt-073-06 1/OI681, a `��
Parcel I.D.
Property owner(s) ZRO&t /(((fCJAr Day phone I06' 0792
Mailing address 3C-410 E " ,4 ie
Site address 4 fG)(c ➢` e fr _3/6 ` C CSC C-6
Legal description (Sub'd., Block & Lot) L J( d v C CA r?f!_ 1--0
Legal description (Township, Range & Section)
Lot Size / liT I Sq. Ft. Number of Bedrooms S
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(E)all that apply)
Absorption Field Initial Family (SF)
(w/wo ADU)
Septic Tank Upgrade ❑
Holding Tank ❑ Renewal Duplex (D) ❑
❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well 71
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.
.7r-
(Signature erty owner or authori d agent)
Permit/Rush Fees: -''a t/ Waiver Fees:
Date of Payment: 4113119 Date of Payment:
Receipt Number: 0460CII Receipt Number:
Permit No. (33P1'313140 Waiver No.
G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
hJCRTFIM
ENGINEERING SteveEng.com
Steve Eng,PE, PH
PO Box 770724, Eagle River AK 99577
907-694-7028
SteveEngPE@gmail.com
Date: 9/6/18 Number of Pages:
To: MOA On-Site Services
Subject: Lewis & Clark Lot 1
Septic System/Water Well
The subject property is the 1st lot to be developed in this subdivision. A new STEP Tank/trench
system to be installed. The design calls for a new 5'- wide trench with new STEP tank. The entire
subdivision is to be on private wells and septic systems. The terrain slopes north to south. The
slightly higher ground required a STEP Tank to access. A proposed water well is also sited.
Please review the wastewater system design for the planned home. I have included design plans&
specs,design guidelines, & soil tests. If there is need for additional information or clarification
please give me a call.
Thanks-Std
\CRTF I N
ENGINEERING SteveEng.com Lewis&Clark Lot 1
SPECIFICATIONS& DESIGN GUIDELINES
Wastewater System Sizing: This is a new 5-bedroom, single family home. The 1st lot of
the subdivision. Neighbor lots are undeveloped,but to be served by septic systems and
private wells;there are no conflicts.The topography slopes from north to south as depicted
in drawing. Recent soil test reveals silty sand w/gravel. An application rate of 0.8
GPD/FT2 will be used for the trench. Length=937.5 FT2/5'x 0.5 reduction factor=93.75'
trench, say 94' (4' effective) 6' total depth. Trench to be covered with insulation or
mound to get required cover.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications(AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• New 2000 Gallon STEP tank. Anchorage Tank or Equal.
• 5' minimum between the tank and trench. 10' minimum to property line from trench.
• 4' of cover and insulation is required for force main; 2" Minimum thickness for
insulation.
• Tank&solid pipe must be set on well compacted, stable soil.
• 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation wall,
prior to any 90 degree bend in 4 inch line.
• All cleanouts must extend to at least ground level.
• In solid pipe runs,ASTM D-3034 may be used in lieu of cast iron.
• Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock.
• Drain rock to be '/2" to 2" screened. Drain rock to be distributed uniformly.
• Force main to be 1.25" Schedule 40 PVC or equal.
• Distribution pipe to be 1.25" Schedule 40 PVC w/ 1/8" orifice @ 18" on-center.
• Silt barrier(filter fabric)to be installed above the drain rock.
• Smeared bed must be raked or scarified before drain rock placement.
• The finish grade must be mounded to promote drainage away from trench.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron,PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
• Insulation board to be extruded direct burial polystyrene(Dow Styrofoam HI/equal)
.°!••••LQsh
•,` **•t
�,
.
(40yieven W. En_
fi
L��
DESIGN NOTES:
1. New Trench Depth At 6',
2. 5'-Wide Shallow Trench,
3. 2' Cover Over Trench + Insulation,
4. Lots Served by Private Water Wells.
5. No Conflicts Within 200'.
6. Additional TH @ Construction.
7, Construct Absorption Trench Parallel To Slope Contour.
Upper DeArnoun Rd
5-107. Slop-
/ /
r�r Ai tel., 5-107. Slope
n
qk Cil PPjpoed / / / �
<Y 4/
ea
-49' /
Rios M
0 G
!� �N 2
„-5
Driveway S
-`'Qfh112 CO Tei
Wells>200'
Sew e?op G Undeveloped
LP Tank a((o
/
Undeveloped
fly
/
etc
5-107. Slope (Qf,,
c'� /
�
P 5-107. Slope
II
NORTHRIM _•,'E+°F`AC''h LEWIS & CLARK LET 1 1" = 50'
ENGINEERING :,`P�. ``�y��i
SteveEng.com 3*.. 49m *i T12NR3WSECE5S2W2NW4SE4&NE4SE4 PLAN
PO Box 770724 I u«.uro ;% LAYOUT
Eagle River, Alaska 99577 ' WY" , WASTEWATER DESIGN , e.907. 694. 7028 +h qADVANCED SYSTEM 9/28/18 r2sEETOf 3
Tank Cleanouts ,�
CO Final Grade
- - 2000 Gallon
STEP Tank
I
4 Foot Cover or EqualUIFiii
111
' !' --.-To Absorption Trench
'164
L=====
1 `'I ��' II M5, 1.25' Schedule 40 PVC Force Main
1
Monitor Tube
CO Slope
III
f",.)0/DESIGN NOTES: Ory9ln •.
1. Depth of Trench is 6'. al top, 11116„.2. STEP Tank & Solid Pipe to be Placed on Compacted, 2' Insulation & Filter
i --f--
Stable Soil, Free from Boulders. Fabri��!■!:7.��.�
3. Sewer Service Line is Minimum 2% Slope & 3' Cover. bra! Ir=•■rrNie.r4 6 6.5'
4. Water-Tight Couplings. 1.25' Schedule 40 OZ./Z.4
5. See Specification Sheet. PVC W/ Orifice 4' 7� iY.iY
Effective Depth_.....- 0 � :
6. All Work To Conform to Municipality of Anchorage (AMC) P �? -7,1,41:"
! t
Requirements & Specifications. :0 0:==.=0:�1
7. Force Main 4' Cover Or Insulate. ►_-5.0---�1
8. Distribution Pipe To Be 1.25' Schedule 40 PVC w/ 1/8' Orifice @ 18' On-Center.
NORTHRIM tl.. z
ENGINEERING ..•: .N, TRENCH END VIEW LEWIS & CLARK S /D
SteveEng.com i* '' • * STEP TANK/TRENCH
PO BOX 770724 —.... .. .. : • . LOT 1
Eagle River. Alaska 99577 ��1
907-694-7028 ;'llifi°i = DESIGN Dote: �^ SE
9/6/18 Iscale: 1, = S r3 of 3
SE
S❑ILS LOG — PERC❑LATI❑N TEST
Date Performed: 8/10/18
N'INGINEERING
Performed For: Todd Brownson
Legal Description: Lewis & Clark S/D, Lot 1
DEPTH
(FEET)
T.H. Location: See Location Map
1 / Organic
SM/ML
4 - Silty Sand & Silt
5 - w/Gravel
6 - ^: ; Groundwater? No
7 Depth
8 - _ Denser Water Depth
After Monitoring. 11' Date: 9/6/18
10 - # Date Gross Tine Net Tine Depth Net Drop
1 8/19 0 -- 2' --
12 - 2 8/19 30 30 min. 6" 4"
13 - Q. ; 3 8/19 32 -- 2" --
14 - 4 8/19 62 30 min. 6" 4"
15 - 5 8/19 65 -- 2" --
16 - 6 8/19 95 30 min. 6" 4"
17 -
18 -
19 -
20 -
21 - Percolation Rate 7.5 min./inch Perc Hole Diameter 6"
Test Run Between 2' and 3'
Comments: Presoaked.
Performed By NorthRim Fng, ICERTIFY THAT THIS TEST WAS
Performed in Accordance with State/Municipal Guidelines in E ect
ON THIS DATE. DATE: 8/19/18
+•'��.°F,'14TESTH❑LE LOG
NORTHRIM TH
ENGINEERING 4" •
GE❑TECHNICAL
•
PO Box 770724 Eagle River, A'°sk° 9957' \ swern"-"°'.. Z. LEWIS & CLARK S/D
907.694.7028 + Date: SHEET:
cl .((r L❑T 1 9/6/18 1
The On-site Water and Wastewater Section (On-site) may issue an approval for a homeowner
to perform work on an on-site wastewater disposal system to serve that individual's owner -
occupied, single-family or duplex home if the homeowner meets and agrees to the following
requirements:
The property owner and excavation equipment operator may perform work on no more
than one owner -installation project in a 12 -month period.
2. Owner's projected active involvement with the installation:
I L)o
3. The name of the excavation equipment operator: f )ULA L)tUAJS0-,1
4. 1 agree that there will be no monetary compensation for installation services rendered.
5. The name of the inspecting engineer: � �i/5 z5yc
6. 1 agree to discuss the following items with the inspecting engineer:
a. Permit design criteria and specifications.
b. Inspection requirements set forth in AMC 15.65.070.
c. Advance notice given to the On-site Water & Wastewater Section for all required
municipal inspections (AMC 15.65.070A).
7. 1 agree to have the project -specific On-site Wastewater Disposal System Permit available
at the construction site for the duration of all related work.
8. 1 agree that if the system is an advanced wastewater treatment system (AWWTS), I will
obtain additional installation instructions and approval from the equipment distributor.
As owner of (legal description)_ 77 7)2 AJ V✓ SEL 2! 'S,? u/ "�.' ``'
I agree that the information above is true and accurate.
Owner's printed name: %►n/�l/t/
}2 2��'�
Owner's signature:_ .�/Ul — -..D_ate: .�o