HomeMy WebLinkAboutELMORE #2 BLK 9 LT 10
Municipality of Anchorage Page 1 of 2
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4-744-
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW990525 PID Number: 018--175--22
~ame:RiCK MOODY Wastewater System: [] New · Upgrade
Address:
4,351 E. 147TH ANCH. AK, 99516-4110 ABSORPTION FIELD
No. of Bedrooms:
Ph°ne:(907) 545--1999 5 DDeep Trench gShallow Trench .Bed DMound nOther
LEGAL DESCRIPTION o.7 aPb/s,. ~ *3.62 (MAX.) ~
10 9 ELMORE #2 0.57 .- 0.65
- - - 2.1 F~ 45 ..
r~! ANCHORAGE EXC. 9/16/99 - 9/22/99
p, .. TANK
SEPARATION DISTANCES "Septic m .oldlng n S.T.E.P.
To Septic Absorption Uft Ho]ding ~ublic/Pr~vab Manufacturer:, Capacity In gallons:
-rom Tank Field Station Tank Sow,r U,,, ANCHORAGE TANK 1000
We~l 100'+ 100'+ - 25'+ STEEL 2
S,¢ace 100'+ 100'+ - - LIFT STATION
Water
Lot 5't- 10'+ -- - ~z° in gall°"s:I
Line
Foundation
5'+
10'1.
I
I
Remar~: * 2'-~" O~ ~.O.^. ~,TE, S^NO WAS ~NST^,LEO. BENCH MARK
BOTI'OM STEP OF STAIRCASE OFF
THE WEST SIDE OF THE HOUSE.
,nspeotions performed by: AWWC, INC. Dates:lst 9/16/99 ~'" ~-~-~-~ ....
2nd 9/17/99 ~ ~'" ) ,
4th 9/2,/99 lO~¢]';J.' /,~-7953 ...'~
of Health and Human Services approval ~(~%:;:.,~,~ ..........
Department
Reviewed and approved by: /]~//x//~ ~ //-/, /~¢~-~t~ Date: ¢'.~-. ~'~'.¢' ~,~'~,~of.e¢o~'
DBL1 26,5 2~,1 -
DB~ 27,5 22,8 -
MT2 I - 112,8 132,2 ~ cO~ ~
~ ~ ~ ~ t ~2 ~ /FCO~ '
~ffr~ : E. 147TH AVENUE
~AS~ WATER ~ WASTEWATER CONS~T~TS, ~C.
AS-BUlkY OF SEPTIC SYSTEM UPGRADE [-~. ~ ~ ...... 9...:-...~
PREPPED FOR: PHONE NUMBER;
DATE:9/27/99 O~WN BY: sc~: PAGE:
K.D.W. 1 = 40' 2 OF 2
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW990325
Legal Description: ELMORE#2 BLK 9 LT 10
Design Engineer: 0041 AK Water & Wastewater Consulta
Owner Name: Rick Moody
Owner Address: 4351 E 147TH
Date Issued: Sep 09, 1999
Expiration Date: Sep 08, 2000
Parcel ID: 018-173-22 L"~ C,~_~.,:~\-ovot
Site Address: 004351 147TH AVE E
Lot Size: 39520 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE , AK 99516-4110
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 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. THE SAND USED IN THE FILTER LAYER MUST BE A CLEAN COARSE SAND WITH 4% OR LESS PASSING
THE #100 SIEVE AND 2% OR LESS PASSING THE #200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED ON
THE SAND USED OR OBTAINED FROM AN APPROVED SOURCE.
Received By: ~/~J(~/L~ ~('.5~5~
Date:
Date:
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B N Anchorage ~ Alaska 99504
(907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
September 1, 1999
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic Upgrade Design for Lot 10, Block 9, Elmore Subdivision #2
To whom it may concern:
The existing 3 bedroom house is served by a private well and a private septic system. The
existing septic system consist of a 1000 gallon septic tank and a crib type drainfield that is in
groundwater; consequently, it must be upgraded prior to the sale of the house. Two test holes
were excavated. The proposed septic system will be designed around the 30 foot radius of test
hole #2. Comments regarding the proposed design are summarized as follows:
1. SOILS: Attached are logs which shows the soil profile, and the percolation test results. Due
to the better soil conditions in TH#2, we are proposing that the new drainfield be installed around
the 30 foot radius of this test hole. In TH#2, the soils below the organics are a GW material to a
depth of 9 feet (bottom of test hole #2). Groundwater was encountered during the excavation at
6.8 feet and was 5.88 feet below grade 7 days later. A percolation test was performed between
the depth of 3.0 feet to 4.0 feet which had a percolation rate of <1 minute/inch. A M.O.A.
approved sand filter will need to be used.
2. TRENCH DESIGN:
a. Percolation Rate: <1 minutes/inch
b. Allowable Application Rate (Sand Filter): 0.7 gallons/day/ft2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 643 122
f. Total Depth: 3.75 feet (max.)
g. M.O.A. Approved Sand Filter: 2.5 feet
h. Effective Depth: 0.5 feet
i. Width: 15 feet
~ Minimum Length: 45 feet long
. Effective absorption area = 675 122
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: As can be seen on the topography site plan, the lot slopes east to west at
approximately a 3 pement slope; in short, there are no slope concerns.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact mc at 337-6179, or 244-9612. Thank you
for your assistances/
;;~eJJsiedY~nt .i tamess, P.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, two soils logs, a topography site plan
and a 4 page construction specification letter which are all part of the design package for this
septic system.
/ / \
/ \
/J~ NOTE: THE CONTRACTOR SHALL HAVE THE WEST
/ I PROPERTY LINE. SOUTH PROPERTY LINE. AND
THE 100 FOOT WELL RADIUS FLAGGED BY A
/ I RECiSTE.eD LAND SURVEYOR PRIOR TO AN~
~ 5XX\ EXISTING SEPTIC TANK TO I~ / 3EXISTING / '~
>- I \ BE COMPLDELY ~DONED~ ~ / BEDROOM
~ ~ ~ ~ ~ ~ / HOUSE
~ ~MT ~ ~ (~, LOCATION) / ~G~
< I CO
__ I / OF BLUE BO~D INSU~ON~
~ o~ ~.o.~. ~,~ow~ ~ E. 147TH AVENUE
PHONE: (907) 337-6179/F~: (907) 338-32~6
ELMORE SUBDIVISION ~3; LOT 10, BLOCK 9,
DESIGN OF SEPTIC SYSTEM UPGRADE · ..:'
~, ~ff~e~ A~ness..
PREPPED FOR: PHONE NUMBER: .....'~
.~cK UOODY (.07) ~5-~ 99~ ~'~. ~-7~5~
DATE:9/1/99 D~WN BY: SCA~: PA~E:
J.L.M. 1 = 30' 2 OF 2
ELMORE
S/D
/
ELMORE ~2 S/D
~ ~ LOT 3, BLOCK 9
I I / / x
J ~ ~---~-
I
/ E. 147TH AVENUE (SEE DESIGN, PAGE 2 OF 2)
I I ELMORE ~2 S/D E~ORE ~2 S/D
ELMORE ~2 S/D ~ I
~AS~ WATER ~ WASTEWATER CONS~T~TS, ~C.
ELMORE SUBDIVISION ~2, LOT 10, BLOCK 9,
SITE P~N FOR SEPTIC UPGRADE
345-1999
J.L,M.~ 1 = 100' 1 OF 2
ALASKA WATER & WASTBWATER CONSULTANTS, INC. ~'~-
69o~ DE,*R, ,o~. surrE 2, * ~CHO,A~. ^K. 9~504~.~-~--.. - --~"~'~'r:"':~"
·
[SOIL LOG - PERCO~TION TEST] ~?I~ZB~[ '~
PERFORMED FOR: RICK ~OODY [:~d~ ~,~ '~n~:""~
[TEST HOLE ~1 [ "h~:.o;.
] / ....
SP-SM i' II I~ ~NO ~ ~ /
7 ~, ¢¢r DEPTH TO ~
".o%~ W/~/ GROUNDWATER DATE P~O OSED
o°~o~o° S ~ SEP~C
0¢o%o~ 8.5' 8/25/99 I00' / E. 14~H AVENUE
[ B~.H. I
qO ~
~1 DAT~ ~DING C~OCK N~T T]H~ W~T~R ~V~ N~T DRO?
~2
~4
N ) P~RCO~TiO ~ P~RR
18
~9 ~CO~ATION ~T~ - (~IN./iNCH) ?~C. HO~ DiA. - ONCH~S)
20 T~ST ~UN 8~TW~N - FT. ~ND - FT.
CO~NTS: ML ~Y~R W~ ~SO~Y ~0 TO ~ IM~RM~L~. US~ T~ HO~ ~2 FOR PRO?OS~O
UPG~DE.
PERFORMED~Y/A~S~ WATER · W~T~ATER, I, JEFFR~ A. GARNESS, CERTI~ THAT THIS
W~ PERFUMED IN ACCORDANCE WITH ALL ~ATE AND MUNICIPAL GUIDELINES IN EFFECT ON
DATE;
DEPTH TO
GROUNDWATER DATE
8.5' 8/25/99
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
6901 DEELARR ROAD. SUITE 28 * ANCHORAGE, AK. 99504
,.O.E ·
ISOIL LOG - PERCOLATION TEST I ~;..-~fi/~¢-~,~- ....~v~,
PERFORMED FOR: RICK MOODY
DATE PERFORMED: 8/25/99 7~2"~. i E-7953 ..," ~
[TEST HOLE #2[
foot)
2-- S SSI 0 S
:;~.~,:~.~,, GW ..... ORG
:~:~;.,~ ~:- ~ GP HL ~ ~ BEORROM)EXISTING
~ SW ~ HH ~l l. SEP~C . ~ /
7-- ~:;:~'~? ~ DEPTH TO DATE ~ '
~':~?~;'~ GROUNDWATER ~PROPOS[D
~'~ JSiTE PLAN
8 .......... ,, 8/25/99 -UP~D[~
-,.~%,~.~',- / I" = I00 E. 147TH AVENUE
:;;%:~:~:.~ 6.1' 8/26/99
S.O.~. 5,9' 9/2/99 i --- ~
10-- ~ II I
11-- DATE READING CLOCK NET TINE WATER LEVEL NET DROP
TINE (HINUTES) READING (INCHES)
12--
__
18-- 17-- _1}~1~~ ~
lg- PERCOLAT~ON RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (}NCHES)
20 TEST RUN BETWEEN ~.0 FT. AND 4.0 FT.
COMMENTS: M.O~ ~PROVED ~D ~L~R WILL BE REQUIRED.
PERFORMED BY A~S~ WATER · W~T~ATER. I, JEFFR~ A. ~ARNESS, OERTI~ THAT THIS
W~ PERFO~D IN AOOORDANOE WITH ALL STATE AND MUNICIPAL ~UIDEMNES IN EFFECT ON
DATE: ~/~/~
DEPTH TO DATE
GROUNDWATER
6.8' 8/25/99
6.1' 8/26/99
5.9' 9/2/99
A l~zG Inc., Xepteraber 1999
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B ~ Anchorage -Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
Onsite Wastewater Disposal System Standard Construction Specifications
I. REFERENCE PROPERTY: Elmore Subdivision #2; Lot 10, Block 9,
II. DEFINITIONS:
1. Property owner: The legal property owner or his/her representative.
2. Engineer: Alaska Water & Wastewater Consultants, Inc. or AWWC, Inc.
3. Contractor: The company hired by the property owner to install the septic system.
4. DHHS: Municipality of Anchorage, Department of Health & Human Services
5. M.O.A.: Municipality of Anchmage, Department of Health & Human Sen, ices
III. RESPONSIBILITIES:
· Property Owner Responsibilities:
1. The property, owner shall contract with the contractor to perform the work outlined in these
specifications and plans, in accordance with the attached DHHS permit. There is no contractual
relationship between the contractor and the engineer. The engineer shall inspect the work as, required by
DHHS to document the installation. Final acceptance of the contractor's work rests with the owner and the
DHHS.
2. This well and/or septic system design is for a single family residence only. The homeowner is
responsible for notifying the engineer if the residence is used as a duplex, business, or multi-family
dwelling. In such cases, the installation pernfit must be obtained from the State of Alaska, Department of
Environmental Conservation.
3. The validity of the design site plan is limited by the accuracy of the as-built survey provided to the
engineer by the property mvner or his/her representative. The property owner shall notify the engineer
regarding any known inaccuracies associated with the as-built survey. The engineer assumes no
responsibility for the accuracy of the survey.
4. The property owner is responsible for notifying the engineer of any unplatted easements, not shown on
the as-built survey, which the new well or septic system may encmach into.
5. The property owner shall notify the engineer of any seasonal groundwater or surface water runoff
conditions, known to him/her, which could potentially effect the operation of the septic system. The
proposed septic system must be at least 100 feet from any streams, ponds, creeks, swamps, bogs, or any
other surface water as de£med by the DHHS.
6. The property owner is responsible for notifying the engineer if, to his/her knowledge, any of the
adjacent properties are used as a duplex, business, or multifamily dwelling. The new septic tank and
leachfield must be at least 100 feet fi'om any private well, 150 feet from any class "C' well, and 200 feet
from any community well, unless appropriate waivers are obtained.
7. The property owner and/or his contractor shall report to the engineer any observed condition which
would put the septic system in violation of State or Municipal regulations.
1 of 4
AWWC, Inc., September 1999
8. Unless specifically agreed upon otherwise, the property owner is responsible for final grading of the
areas which settle after construction. Prior to awarding the contract, the homeowner should communicate
to the contractor any expectations regarding, but not limited to, post construction site clean-up,
re-landscaping, and restoration of any asphalt, fences, trees, decks, ect. that are effected by the
construction. If the property is being sold, the property owner shall ensure that the aforementioned items
are addressed with the buyer, and, if the work is to be completed after the sale of the property, that
necessary funds are escrowed to fund the completion of the work.
9. If the property o~vner intends to install the septic system he/she must first have obtained approval from
the Municipality of Anchorage, DHHS (343-4744). Homeowner installations typically require more time
for engineer inspections. The homeowner should discuss the additional costs, associated with such
inspections, with the engineer, prior to starting the project.
10. The property owner is responsible for payment of all the engineer inspection charges. The number of
inspections will vary depending on the actual field conditions encountered and the construction methods
used.
· Contractor Responsibilities:
1. The contractor is responsible for locating all buried utilities, easements, property lines, and surface
waters; and shall ensure that ali setbacks are flagged by a registered land surveyor prior to construction.
2. Construction shall be in accordance with the approved site plan and design drawings, and any special
provisions noted on the municipal sewer permit. The contractor is responsible for notifying the engineer of
any discrepancies noted on the design plans or drawings, prior to starting work. The installation, materials,
and workmanship shall comply with all applicable State & Municipal regulations.
3. The contractor is responsible for field verifying the separation distances to all adjacent wells and septic
systems, shown on the design drawings, prior to starting construction. Any encroachments that would
effect the installation, for which waivers do not exist, should immediately be brought to the attention of the
engineer.
4. Ensure that all materials being used are in compliance with the most current guidelines established by
the Municipality of Anchorage. This includes, but is not limited to, the following:
a. Draiurock
b. Sand filter material for conventional beds, trenches, or mound systems.
c. Sand filter material and pea gravel for Intermittent Sand Filters (ISF).
d. Anchorage Sand and Gravel (AS&G) "block pea" material for Upflow Filters.
It is reconunended that the contractor provide the engineer with current sieve analysis' from the
sand/gravel supplier to document the suitability of the material. The engineer assumes no responsibility for
ensuring that the materials delivered meet the MOA requirements.
5. The coutractor shall ensure that the septic tank, lift station, or holding tank purchased has a burial depth
rating suitable for the actual installation.
6. Notify the engineer at least 24 hours prior to starting construction. If deemed necessary, a
preconstmction site visit shall take place. The contractor shall coordinate with the engineer any inspections
which will be required during weekends, holidays, or before/after normal working hours (8:00 am to 5:00
PM). The property owner may incur additional charges for inspections which do not occur during normal
business hours. It is the contractor's responsibility to notify the engineer a least 2 hours prior to any
inspection.
7. The contractor shall report to the engineer any observed condition which would put the septic system in
violation of State or Municipal regulat/ons.
2 of 4
AVVI/VC, Inc., September 1999
8. Any remaining test hole excavations shall be filled and mounded. Unless instructed otherwise by the
engineer, the old test hole groundwater monitoring pipes shall be removed.
9. The contractor is responsible for final grading so as to ensure that surface runoff does not adversely
effect the septic system constructed, adjacent septic systems, or adjacent structures.
10. The contractor is responsible for obtaining approval from the property owner for any additional
construction costs associated with design modifications or changing field conditions, prior to doing the
· Engineer Responsibilities:
1. The engineer is responsible for inspecting the installation of the septic system and preparing as-built
documentation, to the satisfaction of the M.O.A.. Inspections are performed as necessary to document the
construction of the system to the satisfaction of the M.O.A. In all cases, the following inspections shall be
performed:
* The bottom of all trench/bed excavation
* Top of sand on all sand filters
* Top of drainpipe
* Septic tank, or lift station, or holding tank prior to backfill
* Placement of filter fabric and insulation
* After f'mal grading is completed
Additional inspections may be required depending on the construction methods used by the contractor and
the type of system being installed.
2. The inspecting engineer has no direct authority over the contractors activities or construction practices.
Should the engineer identify conditions which dictate a design change, he or she may recommend that
work be stopped,, and/or the design be modified. If design modifications are necessary, the engineer shall
notify the property owner or his/her representative.
3. The engineer shall inspect the condition of the existing septic tank and determining its suitability for
re-use. If the engineer determines the septic tank to be stmcturally unsound, it must be replaced.
IV. CONSTRUCTION GUIDELINES:
· General
Construction shall be in accordance with the approved site plan and design drawings, and any special
provisions noted on the municipal well and/or sewer permit. All materials, components, and construction
practices shall comply with the Municipality of Anchorage's latest ordinances regarding wells and septic
systems, as well as DHHS policies. The failure of the inspecting engineer to notice a material or
construction non-compliance does not relieve the contractor of his/her responsibility to correct such a
deficiency.
· Septic Tank, Holding Tank, or Lift Station Installation:
1. ~l~e burial rating of the tank shall be adequate for the actual burial depth encountered.
2. The tank shall be level and sufficiently bedded to prevent settling or shifting of the tank.
3. All standpipes on the tank shall extend a minimum of 12 inches above final grade.
4. Tanks installed with less than 4 feet of cover shall be insulated.
3 of 4
AWWC, Inc., September 1999
5. The sewer service line from the house to the tank shall be sloped a minimum of 1/4"
per foot, unless prior approval is obtained from the engineer.
6. ~l~e inlet and outlet lines from the tank shall be bedded in drahu-ock or the soil shall be adequately
compacted to prevent future settlement of the soil.
7. A foundation clean-out will be installed, 1-4 feet from the house, if one does not currently exist.
8. Post tank clean-outs shall be installed per MOA requirements. Does not apply to holding tanks or lift
stations with pressurized lines.
9. Ail tanks shall be anchored to resist buoyancy forces in high groundwater areas. This applies when
there is not adequate soil cover to resist buoyancy forces. Engineer shall make this detertnination.
10. The fmal soil cover shall be graded so that there is positive drainage away from tank.
11. All holding tanks and lift stations shall have an audible and visible alarm inside the residence.
12. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform Electrical
Code.
13. The contractor shall remove the old tank, or abandon it in compliance with the Uniform Plumbing
Code (UPC). The contractor is solely responsible for the abandonment procedure.
· Installation of Conventional Absorption Bed & Trenches:
1. Excavate the proposed bed/trench to the dknensions shown on the design. The bottom of the excavation
shall be within 2 inches of level (2 inch max/mum variation between high and low spots). If the sidewalls
or bottom of the excavation become smeared, they must be raked or scarified before placement of the filter
sand or draimock.
2. The trench or bed should be at least 5 feet from the test hole excavation.
3. All soil tests and excavation depths are advisory to the design and are to be verified in the field by the
engineer. If design changes are necessary, and the changes effect the contractor charges to the property
owner, the contractor shall obtain approval from the properly owner prior to proceeding with the work.
4. Once the drainrock is installed, the distribution pipe is to be placed level (0.02 feet difference between
high and low shots) with the perforations faced downward. Drainrock is then to be placed over the
distribution pipe, to provide a minimum of 2 inches of cover over the pipe. The drainrock shall not be
pyramided over the drainpipe but shall be the same elevation over the entire trench/bed width.
5. A silt barrier must be installed between the f'mal draimock layer and the native soil backfill. The silt
barrier shall cover the entire drainrock surface.
6. Monitor tubes shall be installed at the locations shown on the design drawings, and extend a minimum
of 12 inches above f'mal grade. The portion of the monitoring tube extending through the drainrock shall
be perforated from the bottom of the trench/bed to the invert of the distribution pipe.
7. Backfill over the fmal drainrock layer must not be less than 2 feet. Insulation must be installed when
the backfill depth is less than 3 feet. The insulation shall cover the entire width of the trench/bed, the
contractor shall "shoot" the f'mal grades to ensure cover depth is adequate, prior to notifying the engineer
that the work is complete. The f'mal cover over the drainfield must graded so that there is no potential for
water to pond over the trench/drainfield.
4 of 4
00/29/99 WED 09:21 FAX 907 §63 3516
A Fax from Dynamic Properties
Phone (907) 261-7600 Fax (907) 261-7670
Fax~: % ~--/~'5~o Date:
From:
l~001
Reference:
Total pages including cover eheet:
I I II
Message:_
If you did not receive all pages, please notify us at once.
Thank You
3111 C Street, Suite I00, Anchorage. AK 99503 · Phone (907) 261-7600 Fax (907) 26117670
Parcel I.D. 018-173-22
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION:
Expiration Date:�--
Complete legal description ELMORE #2; BLOCK 9, LOT 10
Location (site address) 4351 East 147th Avenue *Anchorage
Current Property owner(s) James & Dianna Blakley Day phone 561-0826
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class_Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment Date of Payment
Receipt Number Receipt Number
COSA #OS C 2 2C�3 5 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
his..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: Garness Engineerinq Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: ZC, I ZZ_
Inconducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
0,�,
041
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
OF
G • . • • •' ' . . �l
encroachments may exist that were not identified during the evaluation. The operational life of all wells
/
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
. �I
groundwater levels that may fluctuate during the ear
g ( y g year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
� t.:
, .*
; .......
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
'r
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
��� J- I .r _y H. rn ess.
can be installed on the property in the event either of the current systems fail to perform adequately in
(1� �. '•• CE 7a
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
2, 2
Glc
perform the evaluation. Reliance upon the information provided in this report by any other person or
d - ... 1-�
41UC
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
�oressl����
`���c'�� J
whatsoever.
6. DSD SIGNATURE
System #1 Approved for -3 bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms, with the fol
#AECC884
Original Certificate Date: (�,9— 36 ^Z>
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
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other -S`t-ee, ( F
fvct t) t
761,
0,�,
041
-9 F T�
g Qr'�'s9yO
_
m 00'
Original Certificate Date: (�,9— 36 ^Z>
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
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other -S`t-ee, ( F
fvct t) t
761,
Legal Description: ELMORE #2; BLOCK 9, LOT 10
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1973(?)
Total depth *44.9+ ft
Cased to UNKNOWN ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 8/16/22
Static water level at beginning of test 26.6 ft.
Comments *PER GEG INSPECTION
B. TANK DATA
Age of tank(s) 23 years
Tank type/material SEPTIC/STEEL
Measured operating fluid level in septic tank
52"
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 8/17/21
D. ABSORPTION FIELD DATA BED
Which system tested (date installed) 9/23/99
❑ ALL standpipes present per record drawing
Total measured depth from grade &•0 ft (max)
Measured depth to pipe invert from grade *2.83 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
Parcel ID: 018-173-22
Structure served by this system
Well production at time of test 7.2+ qpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ Nc
❑ Coliform bacteria is Negative
Nitrate 1.00 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by GEG, LTD
Date of Sample 8/15/22 i£ 8/16/22
C. LIFT STATION
❑ Required maintenance completed
Age of lift station ye
Lift station material
Commen
MT1/MT2
Adequacy test date 8/16/22
Results ❑✓ Pass For 3 bedrooms
Fluid depth prior to test 0/0 in
Water added 787 gal
New depth 0/1 in
Elapsed time 15 min
❑ Code -required soil cover over field Final fluid depth 0/0 in
❑ System presoaked Absorption rate 450+ aDd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A
date of test) NONE
Gallons introduced N/A gallons If yes, enter date
Comments/Deficiencies:*BED IS INSULATED - MT1 EXTENDS 6" BELOW INVERT AND MT2 EXTENDS 33"
BELOW INVERT (INTO SAND FILTER).
- PRIOR TO (AND DURING) TEST BOTH MTS EXTENDED TO THE BOTTOM OF SAND.
. AFTER TEST, MT1 WAS FILLED WITH SAND TO WITHIN 6" OF INVERT. PERFORATIONS
IN MT1 EXTENDS UP INTO THE DRAINROCK.
COSA Checklist yellow sheet
0
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
❑ Yes
if No
Community Sewer Manhole/Cleanout > 100'
R1 Yes
if No
ft
� Yes
if No ft
Neighboring Tank > 100' Yes
if No
ft
Private Sewer/Septic Line > 25' M Yes
if No ft
Absorption Field on Lot > 100' Cj Yes
if No
ft
Holding Tank > 100' 0 Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' Q Yes
if No ft
0 Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' RYes
if No
ft
r-11 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No
*5'+ ft
Surface Water > 100'
❑✓ Yes if No ft
Property Line > 5'
Q Yes
if No
ft
Wells on Adjacent Lots:
Private Wells > 100' [] Yes if No ft
Absorption Field > 5'
(l Yes
if No
ft
Private Wells > 100'[]✓
Yes if No ft
Water Main > 10'
P11 Yes
if No
ft
Community Wells > 200'
Yes if No ft
Water Service Line > 10'
M-1 Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' Q Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10' 0 Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10' Yes
if No
ft
Private Wells > 100' [] Yes if No ft
Water Service Line > 10' Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100' [1 Yes
if No
ft
F. ENGINEER'S COMMENTS
*MET CODE AT TIME OF INSTALL -
ST1
IS 5.33' AWAY FROM DECK POST
(SEE ATTACHED PHOTO)
G. ENGINEER'S CERTIFICATION PT..
I certify that I have determined through Held inspections and review
of Municipal records that the above systems are in conformance with p i
MOA COSA guidelines in effect on this date. * q.
..
f G ness.,
Q 9,-
CE -7153.,
COSA Checklist yellow sheet P
of esslon
#AECC884
www.muni.org/onsite
Septic 'Tank Advisory
Certificate of On -Site Systems Approval #OSC221435
Subdivision: Elmore #2 Block 9 lot 10
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for
this COSA / property is 23 years old. A leaking septic tank may be a source of contamination to
the aquifer. Typical replacement costs range from $10,000 to $15,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of a 16 -year-old septic tank in failure and should be replaced.
Mailing Address P O B6k'196650,-*-" 40, Alaska 99519-6650' * www muni org
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Municipality o.f AnChorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Parcel I.D. 018-173-22
1. GENERAL INFORMATION
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
HA,,,,,,. 14 A
Expiration Date:
'o '200
d_,¢ -/3-03
Completelegaldescription -ELMORE SUBDIVISION #2; LOT 10, BLOCK 9
Location (site address or directions) . 4351 EAST 147TH * ANCHORAGEt AK 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
ROBERT & PATRICIA SClANDRA Day phone 344-3473
4351 EAST 147TH * ANCHORAGEt AK 99516
Day phone
JERRY DEWHURST w/ REMAX PROPERTIES Day phone
2600 CORDOVA * ANCHORAGE, AK 99503
257-0113
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well ~
Individual Water Storage
Community Class Well ~___
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority
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 samples. (Cedificates 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.
INote: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or pfior I
to closing for the engineering services provided.
I
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my
investigation, based on procedures outlined in the Health Authority 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 furfher 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results descfibed 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 soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being se/red by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal fight whatsoever.
Phone 357-6179
Date
DSD SIGNATURE
^pprove ,or
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the fllowing stipulations:
?E
WATER AHD
,'. F OG M.
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date:
Municipality of Anchorage
Development Services: Department
BUilding Safety Division
on.Site water & Wastewater,Program
4700 South 8ragaw SL
P;O?O0x 196650.Anchorage, AKOg519-6650
.. www.cLanchorage.ak.us
(907) ~43-7904
Legal:0es~r~P~0n:
A. WEEL :DATA,
HEALTH AUTHORITY APPROVAL CHECKLIST
ELMORE SUBDMSION f2;,, LOT 10, BLOCK 9 Parcel ID:,
*PER lg73 INSPECTION REPORT
Well:tyPe- ,PRIVAI~ ,, If A. 8~ or C,prevlde PWSID~ N/A, Well Log (Y/N)
0ate completed P~0R 10 e/-/3 Sanitary seal (Y/N), YES
Totaldepth *65=~fL Cased to 40+,,. fL
FROM WELL LOG
Oata of test
Statiowater level
~ .... g,p.m.
WATER SAMPLE RESULTS:
Coliform , ~,, colones/100ml.
Arsenic: N/'A, mg./L.
B; SEPTIC/HOLDING TANK DATA
Tank Type/Material ....... · -.~ , , ,
Tank size, :! 000 ~ ,gal. Number of Compartments 2,
FoundaUoncleanout (Y/N) YES, Depression over tank (Y/N) NO,
Cate of putllp!lng 2/7/2003 .... Pumper
C, ABSORPTION.FIELD.DATA
Datei~stalle~,~,e/ls"22/1999~ ~ . SoD rating ~r ft~/bdrm) 0.7
Total depth, .*5,e ,lt. Eft. abSOrptiOn, area 675 lt* MOnitoring tube YES
Oate of adequacy test =,~.2/7,/2003,.. Results (Pass/Fall) PASS,
Fluid depth:in.absorption fieldbefore, test, 0, in. Water added 706.gal.
Elapsed Time: , 0 min. Finaltluld depth 0 in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN
018-173-22
NO
$~5+ O.P.m-
wires properly protected (Y/N)
Casing height (above ground) ~ 12+,
AT INSPECTION
2/-//2oo
· in.
Nitrate J,:jj mg~. Otherbacterla (~ colonles/100ml.
Date of sample: al C Co,lec ed - . AKWWC,.INC..
Date instaned ,, 0/'16/'1999 ,
Cleanouts (Y/N) YES
High water alarm (Y/N) , N/'A
DENAU PUMPIN(}
Systemtype , BED ,, ,
Gravelbelowplpe T0'65 , fL
Depression overfield NO
For .'~, ,. bedrooms
Newdepth ,0, in.
450+ , g.p.d.
If yes, give data -
D. LIFT STATION
Date installed Size in gallons
"Pump on' level at in. "Pump o.~.~_..[a~-'"'~, High water alarm level at in.
~ Cycles tested Meets alarm & circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main N/A Water service line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Water service line 10°+
Curtain drain NONE KNOWN
F. COMMENTS
Absorption field 5,+
Surface water. 100'+
Water main N/A
Driveway. parking/vehicle storage
Building foundation 10'+
Surface water t 00'+
Wells on adjacent lots 100'+
10' +
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems ere in
conformance with MOA I-IAA guidelines in effect on this date.
Engineer's Printed Name JEFFREY A. GARNESS
Date Of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
Il
\ ,
.t
4-42
?~olC
I hereby certify that I have surveyed the following:
described property: ...........................................
Anchorage Recording Precinct. Alaska. and th;~t
improvemenls situated Ihercon ;Pre within the propelly
lines and do not overlap or oriel'ut*ch on th~' I)r~perly
lying adjacent thereto, that no improvements on prop-
erty lying adjacent thereto encroach on the prvmi'xex
~uestion and Ihat lhere ~ re no ro~dwavs, I 'ansmissio.
lines or other vixible easements on
as indicated hereon.
Dated at Anchorage, Alaska
FREi) WALATKA & ASSOCIATES
Enxtneers and Surveyors
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
018-173-22 HAA# ~l~(~, Otc~ ~'')L~ ~ L'\
GENERALINFORMATION
Lot 10;
Complete'legaldescription
Block 9; Elm0re
Subdivision #2
Location (site address or directions)
4351 E. 147th Avenue
Anchorage, AK
Prope~yowner Rick Moody .Dayphone-345-1999
Mailingaddr~ss 4351 E. 147th Ave. Anchoraqe, AK 99516
L'ending agency Day phone
Mailing address
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
NOTE:
TYPE OF WASTEWATER DISPOSAL:
NOTE:
xx
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
Individual on-site XX
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
724)25 (Re~. 1/'91) Front MOA
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my~seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/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 com ~liance with all Municipal and State codes,
ordinances, and regulations in effect on the date of inspection.
Name ~)f Firm
Address
Engineer's signature
F~ Alaska Water &
Wastewater COnsultants, Inc.
Shall be PAID ,$~, ~/..~' ~ at,
or prior to, closing for the
Engineering Services Provided.
Phone
Date ~l~ ?/./~
6. DHHS SIGNATURE
~" Approved for ~/-//~EE bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional comments
By:
The Municipality of Anchorage Department of 'Health and Human Services (DHHS) issues Health Authority
Approval-~;ertificates based only upon the representations given in paragraph 5 above by an independent
professional en gin eer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
RECEIVFD
Municipality of Anchorage 8EP 27 1<)90
DEPARTMENT OF HEALTH & HUMAN SERVI~t~{~mAUT
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description: ELMORE S/D #2; LT 10, BK 9
Parcel I.D.:
018-175-22
A. WELL DATA
* PER 1975 INSPECTION REPORT.
Well type PRIVATE
Log present (Y/N)
Total depth '65'
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
If A, B, or C, attach ADEC letter. ADEC water system number N/A
NO Date completed PRIOR TO 8/73
Cased to 40'+ Casing height (above ground) 15"
**YES Wires properly protected (WN) **YF.~
** BEING REPAIRED
FROM WELL LOG AT INSPECTION BY HOMEOWNER
52
g.p.m. 5.65 g.p.m.
Coliform 0 Nitrate
Date of sample: 9/g/99 - 9/12/99
B. SEPTIC/HOLDING TANK DATA
Date installed 9/16/99
Foundation cleanout (WN)
Date of Pumping NEW
C. ABSORPTION FIELD DATA
Date installed 9/16/99
Length 45' Width
Effective absorption area 675 SQ FT
Date of adequacy test NEW
O.8B4 mg/L Other bacteria 0
Collected by: A.W,W.C., INC.
Tank size 1000
YES Depression (Y/N) NO
Pumper -
High water alarm (Y/N)
Number of Compartments 2 Cleanouts (Y/N)YES
N/A
*** 2'-5" OF M.O.A. SAND FILTER ADDED BELOW TOTAL DEPTH.
Soil rating (g.p.d./fF or ft2/bdrm) 0.7 System type BED
15'
Gravel thickness below pipe 0.65' Total depth
Monitoring Tube present (Y/N)~5_. Depression over field (Y/N) NO ·
Results (Pass/Fail) PASS For 3
bedrooms
Fluid depth in absorption field before test (in.); I~er aaaea gnJ:
Fluid depth (i~ Absorption rate = g.p.d.
_--P-er~atment (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)*
Date installed_ _ ~ ................
Manhole/Access (Y/N) ~~f~.' level at* "Pump off" level at-
~igh water~ *Datum.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
100'+
100%
25'+
100'+
On adjacent lots
On adjacent lots 100'+
Public sewer manhole/cleanout
Lift station N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+
Water main/service line 10'+ Sudace water/drainage 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line 10'+ Building foundation 1 O'
Absorption field
Wells on adjacent lots
5'+
100%
Water main/service line 10'+
Sudace water 100'+
Curtain drain NONE (NOWN
F. ENGINEER'S CERTIFIOAT,~O~/
I certify that I,~ d~ 'n~fnf/~ thr ~ld inspections
inconforma~ce~ty/~ ~L linesineffectonthisdate.
Engineer's Nan~e ! , JEFFREY A. GARNESS
Date ~' j//~'/ ~'~
Driveway, parking/vehicle storage area 10'+
100'+
Wells on adjacent lots
HAA Fee $ c~
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
