HomeMy WebLinkAboutMOUNTAIN VALE LT 4Mountain Vale
Lot 4
#020-581-09
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
www.cl anchorege.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO90163 PID Number. 020.581.09
Rw` William B. Carey b Kathleen Rice
Wastewater System: ❑ New ® Upgrade
A�8741PaineRoad Anchorage,AKS9516
ABSORPTION FIELD
prwra N~ of aeamnr 4
0 Dwp Tmrn O swxw Tr p SW O Mp O omr
`
Ta. o.an
LEGAL DESCRIPTION
.7 GPDct
si 0 Ft.
Buck Lao Suo>wean:
D.pm al pp. apeomahae arpmr paps'.
Gr owtnp mpm
Mountain Vale
FI.
Fl
TawnNp Ranps sd u
FM aapeC sao a aapar paaa.
cim. Lryn:
4.2-4.3 FI.
43
Well: [I New El Upgrade
C� wan.
N�«a r .
15 FI.
Ft
Cuaanrman (Forms. A S. C),
T" D.pn:
Caw m
Taus .ewrpwe rw
Pp M.uxw
Existing
Ft
Ft
645 Ft
I ASTM D3034 PVC
DaIW'.
on. caw
Su WMN LM
IMIaIW
[Atte IMMYw.
Ft
Phillips Construction North
8127-0(31/09
Yore
Pump su a
D ng Hagm App,( Grua
TANK
GPM
FI.
Ft
SEPARATION DISTANCES
0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
lift
Holding
lublicIPMle
mzu•O1•"
Y
From
Tank
Field
Station
Tank
Sewer Lina
Anchorage Tank
1,250 GM.
MV"
Nur W Campamlrx.
w.a
>100'
>100'
N/A
N/A
>25'
Steel
Two (2)
suraaswar
>100'
>100'
N/A
N/A
LIFT STATION
.mow.'
La'
>T
>10'
N/A
N/A
Gr
'Puny m Nwl k
'Pump arr Mr•I u
MpI r.W arm u
Fau iw
>5'
>10'
WA
N/A
PMN. a Mp
up
Ele I.WC"P.rto VY
C~ orris
None
Noted
"'mr"'BENCH
MARK
Existing Septic Tank Pumped, Crushed and Backfilled.
Canaan Bra owWom.
Existing Absorption Bed Tied in For Future Use.
Concrete Step Bottom of Stairs to Upper Deck SE Comer.
uv.uan
100.0 Ft
Inspections performed by: M. Anderson Dates: 1" 8127/2009
4402QF At II
2ne 8126/2009
,r,`P�•'•a••'Qs�,j�
Development Services Department Approval
* ' 4918*.•'
Conditional Approval Date:
......�•...�►........
..
ss : MICHAEL E ANDERSON V
CE -4381
-7 , 0
lV
�I j
Reviewed and approved by: . Date:
,,RO;;S=:��•�
(R« oval
S 89'42'00' W 175.00' Page 2 of 3
PID No. 020-581-09
Permit No.: SWO90163
0 0
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N N
2.a 348-
S2 29a 397
C3 S09 197
C4 74 A' N.S
MI 82.7 93.S
DV 32.T 41.9
M2 10.9 11.9
NOTE:
�,\` Existing Septic Tank Pumped
` t.Nsnw and Burled On Site.
Existing Absorption Bed Tied
in for Future Use. W
O I C3 O
O y
O Y 00
p O
Z Existing Z
Absorption
Bad
Original
nt
Throe
Bedroom ams
Existing
I Wall
1
I
LEGEND _ PAINE ROAD ................ �q��•
DV —Flow Diverter Valve C.;,
CO — Clean Out /:t;' 1}
MT — Monitor T• ; 49th
Tube
TFI —Teat Hale PLAN AS BUILT �...
a� s MICHAEL E. ANDERSON /
No. CE-4381
SCALE t' = 40'.�;72,f.•''
h �Ess1a'�.•'
Municipality of Anchorage
Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-0655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number. SWO90163
PID No. 020-581-09
99.1
U N y UU
Wbp�
YrY0E
1,250 Gallon
Septic Tank
93.0 2.85
L� 9
i
94.3 Topsoil 8 Seed) 94.2
Geoteztile Fabric
_
90.85 Drainfield Rock
90.85
89 8. 90.35 1' Coarse Sand
90.35---"89.8'__
_ ___....
Original Ground � (Average)
_—_ ..
.._
Original Ground
80.8 —� 43' (Bed Length)
Groundwater C 84.3
8!30109
/94.2L)
Topsoil & Seed
Geotextile and 2' Insulation
ZGround
Ir
9085
1'Coarse Sand
_. __ .._OriginalGrouts _ _
89.8'
89.890.35' (Average)
�gp„gjj\\
♦�1
..�'�♦♦
� �� 49th
�.... .i.... ....... i.... �.
.....
�
PROFILE AS-BUILT
��:, MIONEL E M19ERSIH �
'
No Scale
'♦�C� No. tt-43aI '��
IE ''•••.,, —7f,." `�
441,40s
ass
O
Drainfield Rock
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
9 -2'7 -el a / *0 Z
p -;2-`6'o`1 J. q.tvp
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SWO90163
Legal Description: Mountain Vale Lot 4
Date Issued: Aug 24, 2009
Expiration Date: Aug 24, 2010
Parcel ID: 020-581-09
Design Engineer: 0014 ANDERSON ENGINEERING Site Address: 8741 Paine Rd.
Owner Name: William B. Carey & Kathleen Rice Lot Size: 51977 SQ. FT.
Owner Address: 8741 Paine RD. Total Bedrooms: 3 Permit Bedrooms: 3
Anch, A 99516 -
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
1. Perk test must be performed prior to install to cover north half of bed.
2. Bottom of sewer rock must be 6 feet above ground water reading of 8/23/09.
H. e t /J.�j ,,I- fi e, y ,;u a l,•t m S'r "t t ))i /C'
. ?4`1 p r� - t'e's7` n
Received By:
Issued By.
Date:
8'2LY'0 f
Dale:
'rl
Parcel I.D. 020-591-09
RUSH!
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519.6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Property owner(s) William B. Carey and Kathleen Rice Day phone 240-0024
Mailing address P.O. Box 8174 Ketchikan, AK
Code 99901
Site address 8741 Paine Road Anchorage, AK Zip Code 99516
Legal description (Sub'd., Block & Lot) Lot 4, Mountain Vale Subdivision
Legal description (Township, Range & Section)
Lot Size 51.977 Sq. Ft.
THIS APPLICATION IS FOR (S all that apply):
Absorption Field
S
Septic Tank
S
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms Three (3)
THIS APPLICATION IS AN:
Initial
❑
Upgrade
El
Renewal
❑
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: 7 C) 4- 31 R Waiver Fees:
n _
Date of Payment: - 2 7 - 0 7 Date of Payment:
Receipt Number.0 /, � & 0 Receipt Number:
(Rev. 11/05) 0'7 0
g 18
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
August 24, 2009
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Subject: Lot 4, Mountain Vale Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The existing absorption system on the subject lot has failed and must be upgraded prior
to issuance of a Certificate of On Site System Approval for the property. We are
therefore requesting a permit be issued for the upgrade of the septic system to
accommodate the three-bedroom home on the lot. The attached Site Plan and backup
documentation identify the location and configuration of the existing and proposed
septic system. The existing 1,250 Gallon Septic Tank will be uncovered, inspected and
tested and verified sound for continued use. If it is found defective it will be replaced
with a new 1,000 Gallon Septic Tank. The existing absorption bed system will be left
intact and tied to the new system with a flow diverter valve. Also identified on the plans
are the locations of the existing well on this and adjacent lots and adjacent septic
systems. No conflicts exist between the proposed septic system and those on adjacent
lots. Drainage arrows are shown indicating the current drainage patterns. The
drainage patterns will be maintained after construction.
The test hole recently placed on the lot indicated sandy gravel with some silt (GW/GM).
The percolation rate was determined to be 4.5 minutes per inch. A previous test hole
placed several years ago resulted in a similar percolation rate We are proposing to
place a 43' long by 15' wide absorption bed as the groundwater table was recently
monitored at 5.5' below the surface. The bed will be constructed .5' below the surface
and provide a separation of 5' from the water table.
The ground surface on the lot slopes slightly to the northeast in the area of the
absorption bed. Organic material will be removed in the area of the bed and sand will
be used to level the area prior to placement of the drainfield rock. The bed will be
Lot 4, Mountain Vale
August 24, 2009
Page Two
placed slightly off parallel to the contours of the ground but will remain in the material
represented by the percolation test. A minimum of 100' will be maintained between all
components of the septic system and the any surface water or wells in the area.
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
yYf
Michael E. Anderson, P.E.
Attachments
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Expose, inspect Verity
for Continued Use Existing
Gallon Septic Tank.
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Replace R Gallon
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LEGEND
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CO —Clean Out
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MT — Monitor Tube
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TH — Test Hole
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TH — Test Hole
SITE
PLAN
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��'; MICHAEL E. ANDERSON
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SCALE
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LOT 4, MOUNTAIN VALE
DESIGN FACTORS: SYSTEM REQUIREMENTS:
3 Bedroom Home Shallow Bed System
Perc. Rate: 4-5 Min./Inch 1,000 Gallon Septic Tank
Application Rate: .7 GPD/SF 1' Total Depth Drainfield Rock
3 Bedrooms X150 SF/Bedroom/.7 GPD/SF(Application Rate) = 642.8SF Absorption Area
642.8 SF/15 LF (Width) = 42.8 LF Bed Length
THEREFORE: Construct a 43' Long x 15' Wide Shallow Bed as Shown Below.
Place Distribution Piping at Original Ground Surface. Remove Organic Material and Replace
with Coarse Sand. Level Bed with Coarse Sand Prior to Placement of Drainfield Rock. Place 3'
of Cover Over Bed and 4' of Cover Over Septic Tank. In Lieu of Fill Provide 2" of Insulation
and 2' of Fill.
Place Topsoil and Seed Over Disturbed Area
1 �Natural Backfill � 1
5, O Drainfield Rock O Existing Ground
Coarse Sand Leveling Material
Underlying GM
2.5' 5' 5' 2.5'
TYPICAL BED SECTION
(NO SCALE)
NOTE: Grade Area Surrounding Bed to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
Minimum 100' Separation From Surface Water or Streams.
Minimum 10' Separation From Water Service Line.
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19-- SOILS LOG
MUNICIPALITY OF ANCHORAGE
• ..a� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TESTO CATION
826 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG - PERCOLATION TEST (�
PERFORMED FOR: C� Than_¢ 1_\J'Y O1 rJ 1 DATE PERFORMED: 1D 11 Q
LEGAL DESCRIPTION:'y1
�Ui���l.l�� `t �lQi PoIU G)�'
Otrl" I R l l
(FEET) 1
1 XIIII OI -
2 CA
rw5yi tt�dDump
3 7
4 (j Z JII�
t
5 GH
5 n i e.1 50-Vyiiind
7 ISZ-
- 8
tcav 10 5
9
10
11
12
13
14
15
16
n
18
19
20
PERFORMED
12-006 (6/79)
WAS GROUNDWATER S
ENCOUNTERED? LO
P
IF YES, AT WHAT � (� E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
Lp/
5p#_3
q:644
S ir�;,�.
o: zv
, 2'7
+1120
W11#3
bow
min.
fN2D 3.
BIIfl83
'S;�Z
Smir1.
;67)
c0
S'min.
0.60
PERCOLATION RATE .3. • Iminutas/inch)
I
TEST RUN BETWEEN FT AND ---::a2 FT
MOfi "510 -5 -- DZL(
CERTIFIED
0
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 4, MOUNTAIN VALE SUBDIVISION
PERFORMED FOR: KATHi FEN RicF
DATE: 8/13/09 PROJECT No.:
PARCEL ID#: TECHNICIAN: A. HARALA
DEPTH TEST HOLE 1
(feet)
1
OB/OG
NET TIME
(MINUTES)
4'-
NET DROP
(INCHES)
2
TEST HOLE PRESOAKED PRIOR TO TESTING:
8/13
3
n
1.38"
'•
SANDY GRAVEL W/SILT
2
6:47
SM
5
•.
6
;
1.50"
7
7:20
30
8
w
5
a''
9
' '
BOH @ 9'
6
1 O WAS GROUND WATER ENCOUNTERED, No
IF YES? WHAT DEPTIP
I I DEPTH OF WATER AFTER MONIMRNG: 5.51
DATE OF MONITORNG: 8.25,04
17
13
14
15
16
17
18
19
IllaNWJ,11
SEE SITE PLAN lk
DATEIREADINGIGROSS
TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
8/13
1
6:17
1.38"
2
6:47
30
8.38"
7.00"
3
6:50
1.50"
4
7:20
30
8.25"
6.75"
5
7:22
1.38"
6
7:52
30
8.07"
1 6.69"
PERCOLATION RATE. 4.5 (MIN/NCH) PERC. HOLE DIA V (INCHES)
TEST RUN BETWEEN�—FT. and 3 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICIIAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 8/23/09
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 4, MOUNTAIN VALE SUBDIVISION
GENERAL:
The scope of this project includes the excavation to expose, inspect, test and
verify for continued use the existing 1,250 gallon septic tank currently on site.
If it is defective a new 1,000 gallon septic tank must be procured and placed.
Work also includes the construction of a new 43' long X 15' wide absorption
bed at the location also shown on the Site Plan. The distribution line in the
trench will be placed at the existing ground surface. Total depth of the bed
will be .5' below the existing ground surface. Organic material must be
entirely removed in the area of the bed and coarse sand used to level the
area prior to construction of the bed. The new absorption bed must be placed
a minimum of 100' from all wells and 100' from any surface water in the area.
A minimum of 3' of cover is required over the absorption bed. A flow diverter
valve must be placed and the existing absorption bed system tied in for future
use.
2. Construction shall be in accordance with the approved site plan, design
drawings, Municipal Permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the location
of all lot lines. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
4. Unless specifically agreed otherwise, the contractor shall be responsible for
final grading areas subsequently depressed from soil settling. Property
owner shall be responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Development Services Department Building Safety Division On Site
Water and Wastewater Program for system installations. Owners installing
their own systems must receive prior approval from the On Site Water and
Wastewater Program before beginning system installation.
SEPTIC TANK INSTALLATION —VERIFY EXISTING FOR CONTINUED USE
If required, a new 1,000 -gallon septic tank must be procured from an
approved source and installed at the location shown.
Lot 4, Mountain Vale
August 24, 2009
Page 2 of 3
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
3. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial
insulation.
6. A foundation cleanout shall be installed one to four feet from the building
foundation. Two cleanouts are required between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive slope exists away
from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the design.
The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a level
bed of drainfield rock. Rock should then be placed over the pipe to provide a
minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield rock
and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations shown on
the design. The portion below the distribution line must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum 1 00'away
from any private water wells in the area, 150' from a Class "C" Well or 200'
from any community well.
6. Direct bury insulation must be placed over the distribution system if less than
3' of backfill depth is available. Finish grade over the trench must be
mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for a 5'
wide trench. Contractor shall verify this condition prior to placement of the
rock. All pockets of unacceptable materials must be removed and replaced.
Lot 4, Mountain Vale
August 24, 2009
Page 3 of 3
MATERIAL SPECIFICATIONS:
Septic tanks must be constructed by a municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and
solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662
or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the
#200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These inspections
must be conducted under the supervision of a professional engineer registered
in the State of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled.
The second inspection must be conducted after the placement of the geotextile
fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No
backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction notes
for use in preparing the certified as -built of the completed system.
MM -- ave -1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
f
C(�,.�' K�1 �,
PHONE
n3 �3 3
ONEW
❑ UPGRADE
MAILING ADDRESS
U1,60 ll
LEGAL D� RIP'
_ n
LOCATION I
NO. OF BEDROO�f4S
U Y
DISTANCE TO:
Well
w
Absorption area
�p
Dwelling i
PERMIT NO,
`7 l �d
w2!
I—
Manufacturer
Cif C��%
Material ,
No. of compartments ,
rn
Liq. capacityIn
allons
IF HOMEMADE:
Inside length
�.
Width
Liquid depthtj �a
XDISTANCE
J � Z
TO:
Well
Dwelling
PERMIT NO.
2 z
Manufacturer
Material
Liquid capacity in gallons
O
w 2
DISTANCE TO:
Well
rx)l In
Foundation I
Nearest lot line _
PERMIT N_ O. _
J z Lu
F _{l/r1
rc
No. of lines,
Length ofreach line
Total length. f Ijnles
J
Trench width,
x ra Htehes-
Distance betwee]r .IiPes
cc I.-
0
Top of tile to finish racle1�, �
k%"A' 1/1Su a4y
Material beneath tile
/ _
V inches
Total effective bSprption area
��() r'
LL!
0
Length
Width
Depth
PERMIT NO.
4 h
el
Type of crib
Crib diameter
Crib depth
Total effective absorption area
N
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
Lu
�
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
-At
SOIL TEST RATING
INSTALLER
REMARKS
Io
QZI
� n e b
I
APPROVED
aun 154--all,H
DATE LEGAL
Yl
72-013 (Rev. 3/78)
MUNICIPALITY OF ANCHORAGE
Department f Health and Environmenta'
825 Street, Anchorage, AK.
264-4720
P't #l�`��`�lt HANDWRITTEN PERMIT #
Protection
9501
ermi�ar el
ON-SITE SEWER PERMIT
Applicant: Z£iQr.�2 ca%we, Mailing Address: 0301 $�SFuJocici
Location: Phone Number:
Legal Description: M r (ft,_& I'ac Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed: l✓ Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br) //a2 irt,
The Required Size of the Soil Absorption System Is:
DEPTH , LENGTH 3T . GRAVEL DEPTH • S WIDTH 16-
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE _ /0 OZ) GALLONS #
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
# # TWO(2) INSPECTIONS ARE REQUIRED # #
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the esidence is remodeled to include more that 3 bedrooms.
Signed: AL1 O Issued by: & .A6�
pl' nt 816ATS,
Date:
"9n the event that a lift station is insiaTled an -►� S��« f�EtA
Irks FSrS+L
el t I
ec I ca permit and inspection must be
SWP/024 (1/81) obtained. As-buiits cannot be approved un-
fit the electrical inspection is received in this
office. The electrical work must be per-
formed by a licensed electrician."
LAY SOILS LOG
� MUNICIPALITY OF ANCHORAGE
• 1 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
II I TEST
\\ �/ 825 L. Street, Anchorage, Alaska 99501 2644720
\\\ SOILS LOG — PERCOLATION TEST
IF
PERFORMED FOR: Cu\1 )C .1yLL NUt`vwr'�) DATE PERFORMED: /0.1. /P3
LEGAL DESCRIPTION: 1 \�)�� 1 \l>1.�� �`�'�Qs ®� L� li�1ln o'<
SLOPE SIT PLAN
DEPTH 111
(FEET) }
1
l l i 1 I Ut-
2 CIM
3 %Y'uml
til a/�fi
4� . 7- J
7 7�1 v 1 I 2U
8 � Cub bL�S
lD`
9
10
11 I o
(r�
12-
13— No
14-
15-
16
41516
17-
18-
19-
20
7181920 -[_
COMMENTS I I
WAS GROUND WATER S
ENCOUNTERED?� L
D
P
IF YES, AT WHAT E
DEPTH? It
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
%T AND
FT
iJ
�•U
>l
(5`01
PERCOLATION RATE
3.
9_
(minutes/inch)
I I TEST RUN BETWEEN
L... 11 1111
%
�"" J
%T AND
FT
iJ
PERFORMED BY: 0 t ' 1 I CERTIFIED BY:
N10V1 c�r�3-5 C)2 _�{
72-008 (6/79)
DATE: I ({J
ALASKA 610ROWnTAL COnTnOL SMINS, InC.
engineerinq & 6nuironmenlal Studies
SPECIFICATIONS FOR SEEPAGE BED TREATMENT SYSTEM — MT. VALE SUBDIVISION
1.0 GENERAL
1.1 THE DRAWINGS, SHEET'S 1 THRU 2, SHALL BE A PART OF THIS
SPECIFICATIONS.
1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE
REQUIREMENTS OF ANCHORAGE DEPAR'LMENT OF
ENVIRONMENTAL PROTECTION PERMIT.
1.3 ALL ELEVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE
VERIFIED OR MODIFIED IN THE FIELD BY THE EXCAVATOR.
1.4 IT IS THE RESPONSIBILITY OF THE OWNER TO OBTAIN ALL
NECESSARY PERMITS OR EASEMENT'S.
2.0 LIFT STATION (IF REQUIRED)
2.1 THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER
GALVANIZED STEEL (ASTM A-4444-76), OR ALUMINUM CULVERT,
CAPABLE OF BURIAL TO 10 FT.
2.2 THE 24" PIPE FOR THE LIFT STATION SHALL HAVE A WELDED
WATER TIGHT BOTTOM OF THE SAME THICKNESS AND
COMPOSITION AS THE CULVERT.
2.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED
AND WA'T'ER TIGHT. ALL WELDS SHALL BE CLEANED OF SLAG.
WELDS ON GALVANIZED STEEL WILL BE SPRAYED WITH ZINC
:RICH PAINT OR COATED WITH BITUMASTIC.
2.4 THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED
WITH SCREWS.
2.5 ALL ELECTRIC FITTINGS AND CONNECTIONS IN THE LIFT
STATION SHALL MEET THE REQUIREMENTS FOR A WATER TIGHT
SERVICE.
2.6 THERE SHALL BE A HIGH LEVEL ALARM, PEABODY BARNES 6147
OR EQUAL SET AT THE LEVEL OF THE SOIL PIPE FROM THE
SEPTIC TANK. THE BUZZER SHALL BE LOCATED NEAR THE
ELECTRICAL CONTROL PANEL OR IN A LOCATION DESIGNATED BY
THE HOMEOWNER.
2.7 THE SUMP PUMP SHALL BE CAPABLE OF DELIVERING 10 GPM AT
A HEAD OF 20 FEET.
2.8 THE SUMP PUMP SHALL BE SUSPENDED NOT MORE THAN 6 INCHES
OFF THE BOTTOM OF THE LIFT STATION WITH A CHAIN OR
NYLON LINE.
3.0 SEPTIC TANK
3.1 TANK MUST BE A TWO COMPARTMENT, MUNICIPAL APPROVED
TANK, SET LEVEL AND INSULATED.
3.2 TANK INSULATION SHALL BE 2 INCH HIGH DENSITY BURIAL
TYPE STYROFOAM OR EQUIVALENT.
3.3 A MINIMUM OF 5 FEET OF UNDISTURBED EARTH SHALL SEPARATE
THE FOUNDATION FROM THE TANK AND ALSO THE TANK FROM
THE DRAINFIELD.
3.4 THE TANK SHALL HAVE TWO CLEANOUTS. CLEANOUTS ALSO
REQUIRED AT ALL 90 DEGREE BENDS BEFORE TANK INLET AND
A CLEANOUT REQUIRED 1' TO 4' FROM FOUNDATION.
ALL CLEANOUTS MUST COME AT LEAST TO GROUNDLEVEL AND
HAVE AIR TIGHT CAPS (JIM CAPS OR EQUAL). CLEANOUTS
MUST BE EITHER CAST IRON OR ASTM D3034 PVC PIPE.
4.0 SEEPAGE BED
4.1 THE GRAVEL FOR THE BED SHALL BE SCREENED TO THE SIZES
1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503 • (907) 276-1361
INDICATED; 0.5 TO 2.5 INCHES.
4.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE
BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN
COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL
BE PLUS OR MINUS 2'.
4.3 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE
DRAWINGS. IT SHALL BE RIGID PVC, ASTM D-3034. THE
SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5" HOLES
AT 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A
SECTION OF REGULAR PERFORATED SEWER PIPE MAY BE CLAMPED
TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT
JOINT. A RUBBER RAIN -CAP (JIMCAP OR EQUAL) SHALL BE
PLACID ON THE TOP OF THE PIPE.
4.4 IF INSULATION IS REQUIRED THE INSULATION SHALL BE 2"
HIGH DENSITY EXTRUDED OR MOLDED BURIAL TYPE, MOLDED OR
EXTRUDED RIGID POLYSTYRENE BOARD INSULATING MATERIAL
RATED AT NOT LESS THAN 2.4 #/CU. FT. DENSITY, COMPRESSIVE
STRENGTH OF NOT LESS THAN 35 PSI, AND A WATER ABSORPTION
OF NOT GREATER THAN 1% BY VOLUME.
4.5 THE TOP AND SIDES OF THE BED SHALL BE PLANTED WITH A
WHITE CLOVER AND RED FESCUE MIX OR BLUE GRASS.
4.6 THE SEPTIC TANK OF BID MUST NOT BE CLOSER THAN 100 FT.
TO ANY EXISTING WELL OR BODY OF WATER.
4.7 IF INSULATION NOT REQUIRED, THE GRAVEL SHALL BE COVERED
WITH A LAYER OF UNTREATED BUILDING PAPER OR A NONWOVEN
FABRIC SUCH AS MIRAFIR, FIBERTEX 200 GRADE, OR POLY -
FILTER X OR EQUAL.
4.8 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR
POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL WITH HOLES
DOWN.
4.9 THE BERM AROUND THE SEEPAGE BED SHALL BE CONSTRUCTED OF
IMPERMEABLE MATERIAL, AND ON A SLOPE OF 1 FOOT VERTICAL
PER 3.0 FOOT HORIZONAL.
ALASKA ENVIRONMENTAL JOB H�. Vale Su�- (-'-A1'6a✓e fro
CONTROL SERVICE INC. SHEET NO OF
1200 West 33rd Avenue Suite B r1. `Q,,; c
ANCHORAGE, ALASKA 99503
CALCULATED BY DATE
Phone 276.1361
CHECKED BY DATE_
PRWp Mi a lm.Grtm. Wn41411.
Z- = 35
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_ �C'cJ G/Z755 52L-YIOYi:
:
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PRWp Mi a lm.Grtm. Wn41411.
ALASKA ENVIRONMENTAL
CONTROL SERVICE INC.
1200 West 33rd Avenue Suite B
ANCHORAGE, ALASKA 99503
Phone 276.1361
JOB 114, VP
SHEET NO. OF 2_
CALCULATED BY
-H, . LO.A DATE oe /j%/6'5
/6'5
CHECKED BY
DATE_
SCALE 1Ao JGAI�
PRWJU X4 -1a Im. GM , Mm 01471.
MUNICIPALITY OF ANC !' ' .1, E
.
Development Services Department P�.p e: 907-343-7904
P P OC'i v ��io
On-Site Water & Wastewater Section ),;'ax: 907-343-7997
4c->
Certificate of On-Site Systems •p al /;
� s8Lg
020-581-09
Parcel I.D. Expiration Date: I ��
1. GENERAL INFORMATION
Complete legal description Mountain Vale, Lot 4
Location (site address) 8741 Paine Rd
Current property owner(s) Allison & Leon Galbraith Day phone 240-8189
Mailing address 8741 Paine Rd, Anchorage, AK 99516
Real estate agent Day phone
2. TYPE OF DWELLING:
LI Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well El Private Septic Ix I
Water Storage ❑ Holding Tank
Community Well I I Community
Public Water System ❑ Public Sewer ❑
Waiver request for: Distance:
Received by: 1,�/jl1P,41� �� Date: /(�f�//t
COSA to be released to the engineer, unless o herwise requested by the engineer. I
COSA Fee $ 52J/ — Waiver Fee $
Date of Payment 1615118 Date of Payment
Receipt Number QgLt1' b Receipt Number
COSA# GSC 171533 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation.
Name of Firm Forge Engineering Phone 907-522-7773
Address PO Box 240773, Anchorage, AK 99524
Engineer's Printed Name Benjamin Schiller, PE Date 10/3/18
t
Agrk
E*:STH /\ •*9
6. DSD SIGNATURE ''
System #1 Approved for 3 bedrooms . Benja4 chiller
System #2 Approved for bedrooms ��f t,/.q. C10 3/18 ••..4t,,%?
Disapproved t1iFnPROFESSI�N +
Conditional approval for bedrooms, with the following stipulations:
OF,vtic
.# ON-SITE
WATER AND '
• WASTEWATER o
PROGRAM
F'v SER\I\
By: Wim" Original Certificate Date: KO '0-
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other •
COSA Checklist blue sheet
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: Mountain Vale, Lot 4 Parcel ID: 020-581-09
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) N
Date completed Unknown Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth >49*ft. Cased to >49 ft. Casing height (above ground) 36 in.
FROM WELL LOG AT INSPECTION
Date of test Unknown 9-27-18
Static water level ft. 17 ft.
Well production g.p.m. 6.7 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate •499 mg/L
Arsenic ND ug/L Date of sample: 9/24/1 8 Collected by: Forge Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SeptlC/Steel Date installed 8/31/2009
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A
Date of pumping 9-27-18 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed $/27/2009 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.7 GPD/SF System type Bed
Length 43 ft. Width 15 ft. Gravel below pipe 0.5 ft.
Total depth 4.3 ft. Eff. absorption area 645 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 9-27-18 Results (Pass/Fail) Pass For 3 bedrooms
3.5 - 0
Fluid depth in absorption field before test
35-0**. in. Water added gal. New depth in.
Elapsed Time: 1440 min. Final fluid depth 1'5 - in. Absorption rate >= 450 g p d
N
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on- level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100' On adjacent lots >100'
Absorption field on lot 00' On adjacent lots >100'
Public sewer main >75' Public sewer manhole/cleanout 100'
Sewer/septic service line >25' Holding tank >1 00'
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 1 Property line >5 Absorption field >5
Water main Water service line Surface water 00
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
>10' >10' >10'
Property line Building foundation Water main
>10'
Water Service line Surface water 100Driveway, parking/vehicle storage
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
*Well information taken from previous COSA
**Trench pre-soaked immediately prior to test
G. ENGINEER'S CERTIFICATION 41�t�.X‘zo
9F A tkl,
I certify that I have determined through field inspections and ,� cp
review of Municipal records that the above systems are in ��)P• •'�
conformance with MOA COSA guidelines in effect on this date. *:.49 Ii d\ •
Benjamin Schiller,Engineer's Printed Name
PE �
--•
1 •_0/3/18 � . . . . . . ' . . . . . . .
Date 6 •• Benjarrt rl chiller : .
. 4
� • CE 12592 <�/
��,Z ... 10/3/18 •,,It ..r.'
slit PROFESS\O ' `
COSA brown sheet 10-10-12.doc
Municipality of Anchorage
--. Development Services Department
Building Safety Division
i On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
020-561-09
1. GENERAL INFORMATION
Complete legal description Lot 4, Mountain Vale Subdivision
Location (site address) 6741 Paine Road Anchorage, AK99516
COSA # 0 9 0 312 -
Expiration
2.Expiration Date: I a — CY — O �r-
Current Property owner(s) William B. Carey and Kathleen Rice Day phone 240-0024
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
6741 Paine Road Anchorage, AK 99516
Day phone
Day phone
Unless otherwise requested, COSA will be held by DSD forpickup.
2. NUMBER OF
3. TYPE OF WATER SUPPLY:
Individual Well i]
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
r0Q_
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of Onsite 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 Anderson Engineering
Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 9/W009
%
r �Q�� O•F •q��s�,,
low
10
' f
31Ac E ANDERSON
b. DSD SIGNATURE I `�•., CE -4381 25.7
Approved forbedrooms. +���rpFB.Q; 07�0)•••�y�`"
Disapproved./�,`;0;`5a;:e�`•
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other_
By: Original Certificate Date:
(Rw.. 1105)
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water& Wastewater Program t "'
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsfe
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVALCHECKLIST
Legal Description: Lot 4, Mountain Vale subdivision Parcel ID: 020.581-09
A. WELL DATA
Well type Private
Date completed unknown
Total depth 49'+ ft.
Date of test
Static water level
If A. B, or C provide PWSID #_
Sanitary seal (Y/N) Y
Cased to 49'+ ft.
FROM WELL LOG
Well production
WATER SAMPLE RESULTS:
Well Log (Y/N) N
Wires properly protected (YM) Y
Casing height (above ground) >24 in.
AT INSPECTION
816/C9
ft. io ft
g.p.m. 3.5 g.p.m.
Coliform o colonies/100 mL Nitrate •542 mg/L
Arsenic: NID mgn Date of sample: 816109
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septictsteel
Tank size 1.250 gal. Number of Compartments Two
Foundation cleanout (YM) Y Depression over tank (YM) N
Other bacteria 0 colonies/100 mL
Collected by: A Harala
Date installed 8130109
Cleanouts (Y/N)
High water alarm (Y/N)
Y
M
Date of pumping New Construction Pumper
C. ABSORPTION FIELD DATA
Date installed ernrz009 Soil rating (g.p.d./ft2 or ft2/bdrm) •7 GPD/SF System type shallow Bed
Length ` 43 ft. Width 15 ft. Gravel below pipe •5
Total depth +6.2 ft. Eff. absorption area 645 ft2 Monitoring tube Y Depression over field N
ft.
Date of adequacy test New Conte Results (Pass/Fail) For _ bedrooms
Fluid depth In absorption field before test in. Water added gal. ' New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type)
If yes, give date
D. LIFTSTATION
Date installed Size in gallons _
Manhole/Access (Y/N)
'Pump on' level at —in. 'Pump off* at —In.
High water alarm level at In.
Datum Cycles tested
Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100,
On adjacent lots >100'
Absorption field on lot >100'
On adjacent lots >100•
Public sewer main N/A
Public sewer manhole/cleanout NIA
Sewer/septic service line >26
Holding tank N/A
Animal containment areas None
Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line 15'
Absorption field >5'
Water main N/A Water service line
>70' Surface water >100'
Wells on adjacent lots >100•
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >t0' Building foundation >10' Water main >10'
Water Service line >10' Surface water >100'
Driveway, parking/vehicle storage >25'
Curtain drain None Noted Wells on adjacent lots
>100'
F. COMMENTS:
G. ENGINEER'S CERTIFICATION '� ��:•'••"•'•A
1
•`.'�Q:•' •?ref-�j �'
I certify that I have determined through field inspections and w'*:' 49-DIH
review of Municipal records that the above systems aro in 0 ........ .... .....J'�:..:y. �
conformance with MOA COSA guidelines in effect on this date. �• ,� .••.:�.irt�:::$..rrj� .
Engineer's Printed Name Michael E. Anderson. P.E. j° ;MICIfAEi-L AMWON
CE'I381 •�.z`d'
Date 9/5/2009 I�,1 � RO%�01�• �a�
lit -
COSA Fee $ i' I 'q US L Waiver Fee $ -
Date of Payment R (7 Date of Payment
Receipt Number 6 % Receipt Number
(Rev. 11/05)
*; TM . ....
I
•Steven Callaghan• •: Q j
No.12034
11I f9f�oR0 c.... `gip ��
Certifying location of Monitor
and Cleanouts Only
SURVEY CERTIFICATION
R HAM
.a
FOUIOATON AS-H1lT
1N4L SDUCTIK AS41ILT
LOOT SURVEY
EOMOAION AS -OMT
TSN{, SRRKTME A T
ROE RAN ... AE -MALT . .
PAINE ROAD i
Prepared by
Robert E. Johns, Jr. & Assoc.
Professional Land_ Surveyors
f Y\ SWr lR = 601 Roo. IM S.F. RNR. Rot FM R0.
Data sv..T.&F
OBERT Date 0--: 7_31-09 ma zj4L TLa
A�A�
iLeo D"miptiom
�1 r er .,wad•� Lot.4 "atmtain Vale
PE SYMBOLS
R SET ROTAR DRAINAGE Q ASMULT
a FOUND REHNE 4,..-..-• wow FENCE CO ORM
R.OeRMRa•— - _ --`_' — ADolp ASSUMED E3EV. M-4I—W METAL FENCE - ® DOD DEC(
s THE RESPON9ERLnY of THE BUILDER OR OWNER. PRIOR TO I ONLY THOSE MPROVEMUf 9 ABOVE GROUND AND VMH3LE WL DE
ISTIRJCTON, TD VERIFY PROPOSED BUI DRND GRADE RELATIVE SHOW FENCES. V& -LL% S O CLEANOVTS. 89WWALM D1BVEwAYS.
FNISHED GRADE AND UTRPiY CONNECTIONS AND TO DETERMINE ITC.. ARI IpNDWN N THOR APPROXIMATE LOCA7100. ONLY. SNOW
OOSIENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS MAY PREVENT BONE PAPRCVC69 NTZ FROM BEING SEEN AND LOCATED.
CH 00 NOT APPEAR ON TIF RECORDED SI.IBDIVISION PLAT ALL DNITANCCS ARE RECORD UNLESS OTHE "0190 NOTED.
UNDER NO C0tGUh TAHCES SHOULD AN AS—BUILT BE USED FOR CONSTRUCTION OR FOR ESTABt14RN0 BOIROMRY OR MOM LNE4
THE SURVEYOR TAKES RESPONSOLryy FOR TIE VanAL TRN6ACTON ONLY AND ASSUMES FINANCIAL LABERY ONLY FOR THE COST' OF THE SURVEY'
LISTED DSTANCE3 PREVAA OVER SCALING. REPRODUCIMOM MAY, CAUSF. ERRORS N SCALE