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HomeMy WebLinkAboutFIRE LAKE BLK 2 LT 5AFire Lake Block 2 Lot 5A #051-361-13 Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage Alaska 99519-6650 s (907) 343-7904 • Fax (907) 343-7997 http://Www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP121190 COSA#: Permit#: PID#: 051-361-13 Legal Description: Fire Lake, Block 2, Lot 5A Engineer: Garness Engineering Group Applicant: Marcus Horner Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ..... mum ..................... MONO ............. Von .............. Nano ............ Waiver is Granted: X Waiver is not Granted: Date: / i Approved by Name of Reviewer ............. Now .................... a........ ................................. Rec#: 05688G Amount: $200.00 Date Paid: 7/11/2012 **** VARIANCEIWAIVER REVIEW **** July 9, 2012 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Lot Line Waiver Request for Fire Lake; Block 2, Lot 5A, To whom it may concern: d�6g8lr pia �l�d We request that your department issue a 5 -foot lot line waiver from the north property line to the existing drainfield. The existing drainfield on Lot 5A has a separation distance of approximately 5 feet to the north property line, which borders Muldrow Street. In short, there are no drainfields on adjacent properties for at least 60 feet. We are unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com rz 3 Q t fii 10p p� sem. ! .-.: -a% \ •.- •1i�SVV� ` J — •- C u C O iG.. atn- j SJ ��' i �...� o r i • oJ�� a n � � o e � c � `c � � �d � '1. 1^ 1 ;�.t�.�o� c�i�cE=.. 'c :l.{ ♦1t _9c o ? lu! l m a m -'v/ wa v li.i U{ AV co vy� (Vtiti .••• 0*mB o c _ Y lvt�"cam. ct.cemc�'-' 01 F- ` 1 W7 9 7 C 0 E 0 00 p n u m o wW .6 - 0 1� I 1 7 I h� ' C .t•9Z . t 1 i 1.11",. >� i � � -. .ip• is O LO � m Kzz I 111111 V 02 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% �T L S e r_ _ -- PHONE�J C� (3 ��a.J EW UPGRADE MAILING ADDRES ei LEGAL DESCRIPTION (_54 AD,✓e SID LOCATION �I ISR A L Y C- i` NO. OF BEDROOMS lie Uy DISTANCE TO: Well Absorption area Dwelling PERMIT NO. t 2 w 4 w F. Manufacturer Material No. of compartments rn Liq. rapacity in gallons IF HOMEMADE: Inside length Width Liquid depth y DISTANCE Well Dwelling PERMIT NO. _ H Manufacturer I Material Liquid capacity in gallons w= DISTANCE TO: Well C.� �j.t� Foundatio �('® 'r Nearest lot line PERMI ()6 J LL Z Z w PRM No. of lines n Length of each line Total length of lines Trench widt inches Distance betty en lines GU ¢ H in Top of tile to finish grade �fc Material beneath tile nches Total effect i r tion area w Length Width Depth PERMIT NO. Q1– w° Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE T0: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot II1Te PERMIT_UO. 3DISTANCE TO: Building foundation -1 Sewer line —1.V Septic tank Absorption area(s) OTHER 1 PIPE MATERIALS lCJ SOI L TEST RATING INSTALLER REMARKS +f ftd,L 4 -ted 14D eW4341r4l rt I' t APPROVED DATE LEGAL & _ 72-013 (Rev. 3/7) 1 w GAAB-"D I GR' ER ANCHORAGE AREA BOROI' I DEPARTMENT OF ENVIRONMENTAL QUALI i r 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279.8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME -L L.Ly Wi;. -c -------------- ADDRESS-�-�/ PHONE - LOCATION IL" ? L k' 1 F L L'c LEGAL DESCRIPTION -1-1 ' f�. /'IX��//'t SEPTIC TANK: DISTANCE FROM WELL LIQUID CA PACITY.__lh NUMBER OF MATERIAL ���/t'T'/c/ __COMPARTMENTS LIQUID GALLONS. INSIDE LENGTH__ INSIDE WIDTH DEPTH _ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS__-- / _ __OUTSIDE DIAMETER_ _OR WIDTH_ /_�LENGTH DEPTHS, 7 i LINING MATERIAL �L/1'['h'C Z11 DISTANCE DISTANCE FROM WELL BUILDING FOUNDATION NEAREST LOT LINE__n __- TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) __—SQ. FT. TILE DRAIN FIELD: DISTANCE FROM W NUMBER OF LINES_'._— / ABSORPTION Ad{ A ___DISTANCE BETWEEN LINES DEPTH: TOP OF TILE TO FINISH GRADE SQ. FT. LENGTH OF EACH LINE NEAREST LOT LI TRENCH WIDTH TOTAL LENGTH OF LINES AL EFFECTIVE PTH OF FILTER MATERIAL BENEATH TILE IN, ABOVE TILE WELL: - _ DISTANCE FROM - i WATER TYPE ��K� IIT 1.1 DEPTH , BUILDING FOUNDATION.__- ' _SAMPLE NEAREST i NEAREST SEPTIC c SEEPAGE OTHER LOT LINE ��C. Vic' ��'_, SEWER LINE , TANK ' SYSTEM__�c 1 __, CESSPOOL— SOURCES_ DISTANCES: l7Sl -;nil 1iS DIAGRAM OF SYSTEM DATE APPROVED A.A.B. HPPLICHNT JHMES GHLLIEN LOCHTICIN FIRE LHKE LEGHL I B2 FIRELHKE HLHSKH S/D PO BOX 249 EHGLE RIVER TYPE OF SOIL H8SORBTION SYSTEM ISTRENCH �u.ouy� ,� A- MR! " MHXIMUM NUMBER OF BEDROOMS � 4 SOIL RHTING (SQ FT/BR)� 125 THE REQUIRED SIZE OF THE SOIL H8SORPTION SYSTEM I S � �LY L 9�3 -1 1 lfb:- 9 IIYYY: � 0 Jr.:::::. 11�� � THE LENGTH DIMEHSION IS THE LENGTH ON FEET) OF THE TREHCH OR DRRINFTELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETQEEN THE SURFHCE OF THE G�OUND HND THE BOTTOM OF THE EXCHVRTION (IN FEET> THERE IS NO SET WIDTH FOR TRENCHES THE:, GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE HNr) THE BOTTOM OF THE EXCHVHIf. ON (IN FEET). IFT: 111 oil R. j 1: W K R? yK EYE IF,, W 1 co '1 :1 �!'_� 5 11--Y �o ��K—V—11" J�\ PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DUR}NG THE INSTHLLHTION INSPECTIONS UF HNY WELLS HDJACENT TO THIS PROPERTY RND THE NUM81Y.*R OF THHT THE WELL WILL SERVE ��_ �:�::- ���������P-4 F:P:'ll �����" BHCKFILLING OF HNY SYSTEM WITHOUT FINAL. INSPECTION RND HPPROvHL BY THIS� DEPHRTMENT WILL BE SUBJECT TO PROSECUTION MINIMUM DISTHNCE BETWEEN H WELL RND HNY ON`SITE SEWBGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIvHTE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL OTHER REQUIREMENTS MHY HPPLYSPECIFICHTIONS HHD CONSTRUCTION DI8GRHMS HRE HVHIL1: -, IBLE TO INSURE PROPER INSTHLLHTION. WEY11FRIWI X -T ��R::';?' :1. �:'YYA "Y� �::� I CERTIFY THHT 1� I flM FHMILIHR 141 FH THE REQUIREMENTS FOR 0N'^15I1E SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2� I WILL IHSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]� I UNDERSTHND THHT THE ON�SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN 4 BEDROOMS , GREA fER ANCHORAGE AREA BOk%-.�UGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279.8686 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT PERMIT NO/'3 /7 17 NAME OF APPLICANT L, '_ `�!._ MAILING ADDRESS �,/ �� PHONE // INSTALLATION LOCATION 414 ! • _ ` � � 1 LEGAL DESCRIPTION jr7lI C v INSTALLATION OF: SEPTIC TANK I' /SE/EPAGE PIT DRAIN FIELD /OTHER TYPE AND SIZE OF FACILITY TO BE SERVED` wl FINANCED THROUGH TO BE INSTALLED BY��i�' SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST ------------ COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE F 2 TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK - 5--/ f GS FOUNDATION TO SEEPAGE PIT 7 '^C DRAIN FIELD / SEPTIC TANK TO SEEPAGE PIT WALL 15-1 SEPTIC TANK , SEEPAGE PIT DRAIN FIELD -Ls� TO NEAREST LOT LINE, - %��,y/�,�• I� WELL TO SEPTIC TANK /� ^'•'" r / SEEPAGE PIT /ego 4���G DRAIN FIELD ZL-'L/ ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TFjNK /O SEEPAGE PIT DRAIN FIELD J'� � SEPTIC TANK, Z, SEEPAGE PIT L DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH AUT ORITY OR LICENSED DESIGNER AREA SIZE TYPE DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE, DATE APPLICANT'S SIGNATURE / INANCE N0._28-68 AND THAT THE ABOVE �. it fir:. '%.•.-�...�.», APICHORAl -!."I Performed For Lef;a], Drscriptj.<n o',� , , irI*„ Perfarr•1eCl_ /3 �� /c;�� 'PhisF'crm Reports Depth ..... .. .2 — T/ic Gw Jus /v T a /Oce 3 � /J7ois7rrirr co.,frrr t 4t-- Gw i /<r c� 6i! / 0 /u S i Was Ground Water Encountered? Ifs, At at 1,e1`th t t_ S YeFih, z�- f Frcpo4ed InaCall,tt�i'nns'�Seepape Dent2, 01 Irrint �• -- �J....... _. Ur;:.n ir_l.;i COM�1ENTS: i ."wer.w�+.r W r•+•rr•.a.nnv�v.+rne.n�•+.r4.e.n,urr.ow ww.�.u..„+.wn•.a� Test Performed By: i Data Certified By: THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED- TIME TIME TIME DATE DATE DATE INSP CTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OFBEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY W INDIVIDUAL ED COMMUNITY PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM U<DIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER - ❑Septic TanLor- ❑ Holding Tank Size: / .5w If Tank is homemade give dimensions: SOI LS RATING TYPE OF TANK MANUFACTURER _ W TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic Holding Tank Absorption Arei Sewer Line Nearbst,Lot Una - Absorption Area -to nearest Lot Line 5. COMMENTS (g]/APPROVED FOR `_ BEDROOMS 13 CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE f BY Title LEGAL DESCRIPTION 72-U10 ( Hay. 3/7U) REALTORS" REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV x 2. Property Owner: Mailing Address: 3. Name of Buyer: 113 REALTOR"' - 790,`s YA76IN11 Day Phone A/oNE ye r Mailing Address: Day Phone Name of Lending Institution: /yj NIV VeT Mailing Address: Phone Name of Realtor or Agent: $USAN GAS 1-ioN Mailing Address: %°Ur• /JO>, C yYY �jQR�A ) Phone FA6-Ine lflye�P 111t `?l577 (,9S/ y775� ilb`d�ll Legal Description: /�,C,i1� aZ ol-07 Ctf f/tE IW&F gX�yfkA Location: 7. Type of Facility to be inspected 8. Water Supply _1vOmE No. Bdrms. 7 Type of Supply: Public Utility Individual __ If Individual, number of dwellings presently served If Individual, depth of well _1/ 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation: AREA, INC. REALTORS Anchorage "C" St. Office 3300 C Street (907) 278-2525 East Anchorage ❑ Eagle River Eastgate Office Parkgate Office 5437 E. Northern Lights P.O. Box 249 (907) 278-2525 (907) 6949555 4. 5. ,3 6. 1 113 REALTOR"' - 790,`s YA76IN11 Day Phone A/oNE ye r Mailing Address: Day Phone Name of Lending Institution: /yj NIV VeT Mailing Address: Phone Name of Realtor or Agent: $USAN GAS 1-ioN Mailing Address: %°Ur• /JO>, C yYY �jQR�A ) Phone FA6-Ine lflye�P 111t `?l577 (,9S/ y775� ilb`d�ll Legal Description: /�,C,i1� aZ ol-07 Ctf f/tE IW&F gX�yfkA Location: 7. Type of Facility to be inspected 8. Water Supply _1vOmE No. Bdrms. 7 Type of Supply: Public Utility Individual __ If Individual, number of dwellings presently served If Individual, depth of well _1/ 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation: AREA, INC. REALTORS Anchorage "C" St. Office 3300 C Street (907) 278-2525 East Anchorage ❑ Eagle River Eastgate Office Parkgate Office 5437 E. Northern Lights P.O. Box 249 (907) 278-2525 (907) 6949555 July 31, 1978 R&M No. 851571 Alaska Mutual Savings Bank 1503 West 31st Avenue Anchorage, AK 99503 ATTENTION: Smitty RE: Adequacy Test on Existing Sanitary Sewer System; Lot 5A, Block 2, Firelake Subdivision, Eagle River, Alaska Gentlemen: Per your request of July 24, 1978, we conducted a test of the sanitary sewer system on the above described property. The septic tank had been pumped prior to the performance of the test on the crib. During the test the liquid level in the crib was measured before and after the addition of 250 gallons of water. The total depth of the crib was 8.5 feet. All liquid levels were measured below the top of the stand- pipe and are summarized in the following table: Liquid Level Before Water Added 4.2' Liquid Level After Water Added 3.2' Total Rise in Liquid Level 1.0' The water level rose 12 inches with the additional of 250 gallons of water, indicating an acceptance rate of 28.3 gallons per inch. Twenty -fours hours later the liquid level was again measured and found to be 4.3 feet. It had dropped l.l.feet or 13.2 inches. This indicates an average effluent acceptance rate of 373.6 gallons per day for the surrounding soils. If the 4 bedroom residence on the property is to house 8 people, the average load on the system can be expected to be 600 gallons per day. We can therefore conclude that the system is not disposing of effluent at the adequate rate for a 4 bedroom redisence. AhCMU11A1:1 1A111I1F11.1, 1, 114LA0 Inl.0 l.r 1IA511_1_A July 28, 1978 Alaska Mutual Savings Bank Page -2- We appreciate this opportunity to be of service to you. Please contact us if you have any questions regarding this letter or we can be of additional service to you. Very truly yours, R&M CONSULTANTS, INC. Lynne Kosikowski Staff Geologist GS:LK/kky IoM Ga Smith Pr ject Manager Municipality of Anchorage , Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-361-13 COSA# QSC/ a1/aq23 1. GENERAL INFORMATION Expiration Date: % 0 ` tl 8 � 4.2— Complete .2 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address FIRE LAKE; BLOCK 2 LOT 5A 18108 MULDROW STREET *EAGLE RIVER AK 99577 MARCUS HORNER Day phone 242-9404 18108 MULDROW STREET *EAGLE RIVER AK 99577 Day phone JEFF BAILEY W/ KELLER WILLIAMS Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 696-6512 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ■ Individual On-site 1 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 On -Site 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 samples. (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 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system unde- 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 served 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. GEG, LTD. 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 right whatsoever. 5. DSD SIGNATURE _Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following Attachments: COSA Checklist Septic System Advisory Well Flow Advisory INS= Date 337-6179 .A .tr: }.:...Y-L.�.I. f . I I........... Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory Other By: (Rev. 11155) .... ....... y rness: CE -7953 OF ON-SITE WATER AND WASTEWATER Original Certificate Date: / "— / 13`/�— Municipality of Anchorage • '� Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 CERTIFICATE OF ON—SITE SYSTEMS APPROVAL CHECKLIST Legal Description: FIRE LAKE; BLOCK 2, LOT 5A A. WELL DATA *PER AAROW PUMP & WELL SERVICE REPORT Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed PRE -9/1 7/71 Sanitary seal (YIN) YES Total depth *42 ft. Cased to *40+ ft. FROM WELL LOG Parcel ID: 051-361-13 Well Log (YIN) NO Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION Date of test NO WELL LOG 7/2/12 Static water level ft. 21 ft. Well production g.p.m. 4.11 g,p,m, WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 4.69 mg./L. Collected by: GEG. Ltd. Arsenic: ND ug./L. Date of sample: 6/29/12 B. SEPTIC/HOLDING TANK DATA'* Oouble CLec�,no f- Bcre—i TANK Tank Type/Material SEPTIC/CONCRETE Date installed 9/17/71 Tank size 1250 gal. Number of Compartments 1 Cleanouts (YIN) YES Foundation cleanout (Y/N);_ Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping Pumper JR'S PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE TO BOTTOM OF SUMP/MT 9/17/71 100 SEEPAGE PIT rm Date installed 8/11/78 Soil rating (g.p.d./ft2or /bd1 E5 System type TRENCH 15 1 6 Length 44 ft. Width 3 ft. Gravel below pipe 6 ft. *8.7 360 Total depth *7.5 ft. Eff. absorption area 528 ft Monitoring tube **YES Depression over field NO Date of adequacy test **7/2/12 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test***0 in. Water added 980 gal. New depth*32•5n. Elapsed Time: 120 min. Final fluid depth ***24 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date — 1978 TRENCH WAS TESTED. **TRENCH SUMP ONLY EXTENDS 56" BELOW INVERT. SEEPAGE PIT WAS DRY ON 7/2/12. D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Manhole/Access "Pump ofr level High water alarm level Cycles tested Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOTTO: Septic tank/lift station on lot *81, On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 52+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line **5' Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 0' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *MEETS MOA CODE AT TIME OF INSTALLATION. **SEE ATTACHED WAIVER REQUEST. G. ENGINEER'S I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fee S qq o Date of Payment Receipt Number QQ�a aC7 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number AAROW PUMP & WE[( SERVICE, LLC � P.O. Box 110496 Anchorage, AK 99,511 No9463 Office: (907) 346.9355 • Fax (907) 333-6976 Eagle River: (907) 622-9335 L DATE ! GUSTDPdER ISWL 11:e_s JOB SITE argo ho 7 p LABOR HOURS RAPE AMOUNT TOTAL MATERIAL TOTAL LABOR a itd PAY THIS AMOUNT Thank You SIGNATURE it Hereby Acknor todge the Satisfactory Computiou of the Above Described 'Mork and agree that if above work is riot paid for in 90 days I agree to allow Aruw Pump 5 "Nell Service, R-.L.G- the right to remove unpont toy a(itupment and charge for labor thready performed Z labor to remove unpaid for dpuipraent.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE. OF 7.545 PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. nw� FIFy. (M1WAEV) - — - —_ ___--__-_-_ __ ___ __ ruv. gswan) xawc timet "T stained x ,VX MULDROW STREET N89a 59' 30"W 170.00' ace staimw, Srrerac to GRAVEL C.O.S W�325 DRIVE Oo�rcM 6 z TAEXISTING HOUSE 3A 98.0' o c 0 O N O O (n a WELL HED _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 10' UTIL ESMT 170.00' S89^ 59'30"E UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE ONES. THE SURVEYOR TAKES RESPONSIBIUTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCAUNG. REPRODUCTION MAY CAUSE ERRORS IN SCALE. Lj LOT BURLEY SURVEY TYPE ❑ FOUNonnO4 AS-OWLT SYMBOLS ❑ FINAL STRUCTURE AS-BUILT SET REBAR' '' DRAINAGE 0 ASPHALT D PLOT PLAN ... AS-BUILT .. ,LOT SURVEY ... rOPOCRAPNY ..e:::: o FOUND REBARe-0� W000 FENCE CONCRETE AS-WILT... NO OOFI SET M REC TRCAION AS-BUILT... NO CORNeRS SET 00 ASSUMED ELEV.-;r-;rc METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION ®®�®, Prepared by PLOT PLAN �P�E oF•,q . a nnan m qe wm aw w q. art er wy 1700 Brink Drive. ANCHORAGE, ALASKA 30504 Scala: 11I _ �e0` - Ret, Lot S.F. Rec. Plat File Na. FOUNDATION 1 ® '.. .. O� AS-BUILT �•,.••' •.W .... V A RM1 E ,Hn., 4., Inaey wily qat Iww wwaw n `a ft —1.1 q. /CYnblbn m qM bl n° gait dl qa O •• ...... •.......•.. • •..•. •..,..1/ Date Surveyed: 7�1 ZI12 Drawn by. REJ Checked b�p Av w .me ee rgmwsm ®Nw, :• OBER NS ! IVPI\ n,,. eq n .w.mnane .aw uNw wen an..l... ` .... A •• '• ® a ®®9 �•• Date Drown: y / / 1 Z/ 12 Grid NW0453 W.O. 12-255 FINAL STRUCTURE!S-BUILT I, amo-. E req+. x, I•e.nr wBN gait 1 2� •' �'V� 0 fie'•., ♦ Legal Description: lee prlamw m Are,e vwY of tlw ,.• pt O ., . S O pr Lot 5A BLOCK 2 • od®w 4 FIRE LAKE Municipality of Anchorage �r Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 %v wv.ci.anchorage.ak.us (907) 343-7904 CFRTIFICATE OF HEALTH Au i'HORI T Y APPROVAL FOR A SINGLE-FAMILY DWELLING Parcel I.D. 05'1-36L1-13 1. GENERAL INFORMATION HAA # 0 3 0 G I.7 Expiration Date: ? — 16 Complete legal description Lot SA• Block 2 • Firelake AK Subdivision Location (site address or directions) 18108 K„ 1 d row S t, Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Mark Shearer Day phone 696-3531 18108 Muldrow St. Basle liver, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. Day phone Day phone -7� 4L l ;'%/c%.3 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 sample results. (Certificates may be missued 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 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 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 S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date _ I;Lhr v 3 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments WATER AND : + WAST WER Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other BY a=f!L Original Certificate Date: (Rev 01102) ........ ............ 7 ... ......... •..........,. Municipality of' Anchorage Development Services Department Building Safety Division 1� 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 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SA ' �LOt K 7i' 6 ac- ( Ar � �K Parcel IDAFZ • 34 / • 13 A. WELL DATA Well type 49:�7 If A, B, or C provide PWSID # = VJe!I Log (YIN) %A Date completedy-fV Sanitary seal (YIN) Y .- Total depth �/ ft.. Cased to ft. /s�W MO/jEGr9 FROM WELL LOG Date of test Static water level _�� �\ ft. Well production r 9•p•m- WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate �l�mg.11 Arsenic: � mg.A. Date of sample�0 B. SEPTIC/HOLDING TANK DATA Tank Type/Material /CPT7(, II w --'v." Tank size I Z,5D gal. Number of Compartments / Wires properly protected (YIN) Y Casing height (above ground) —16—in. AT INSPECTION I f 03 Z ft. — o ( g.p.m. Other bacteria O colonies/100 ml. Collecled by: 5 V^J6 /..1 EFYJNG• Date installed/ Cleanouts(YIN) y Foundation cleanout (YIN) y Depression over tank (YIN) N High water alarm (YIN) Date of pumping_[ D 3 Pumper J 15 C. ABSORPTION FIELD DATA Date installleed, A1,��'► i , Soil rating (g.p.d.lftZ 2 bdr L System type .46g /f Length 1 / `T eft. Width ✓? ft. Gravel below pip to I'ft. Total depth 9 ft. Eff. absorption ar a SZSft2 Monitoring tube y Depression over field Date of adequacy test f 1 1 03 3Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before tes I I in. Water added-00Ogal. New depth 60 in. Elapsed Time: 18Q min. Final fluid dep th71V- in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date -Y-* TRa- C -N w4-5 Tr—rrXa D. LIFT STATION Date installed .+ "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at _ in. Cycles tested Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift-ete4en on lot 8D r'1- *— On adjacent lots /OQ �r- Absorption field on lot /OD .1 On adjacent lots Public sewer main Public sewer manhole/cleanout N /4 3ewef /septic serviceline r4- Holding tank IV 1A SEPARATION DISTANCES FROM SEPTIC/HOt M TANK ON LOT TO: r � Building foundation r✓ t Property line Absorption field_ Water maint A Water service line to "�' Surface water /00 r7 Wells on adjacent lots ( dO r} SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line 10+ Building foundation 10 + Water main 'J 1a r Water Service line Surface water 110 Q t{- Driveway, parking/vehicle storage 10 It Curtain drain ONS ow J Wells on adjacent lots too t F. COMMENTS Pruett, T7) /0/3/j G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name 1�aQSR r �. �Oa✓gtiI �'•�V Date �/r11/03 IOlr -- It HAA Fee $ 360-` Date of Payment G (° I Receipt Number o n f - S" i (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number ST WAS SDS OFq`� Q, ......... . rff;t5 �(�'i1 ROBERT C. COWAN / @ CE - 8801`��°', ....... ......... . —S—GS- SGS ReLq 1037123002 Client Name S & S Engineering Project Name/# NA Client Sample ID L5A,B2 Firelake Alaska SID Matrix Drinking Water PNYSID 0 All Dates/Timts are Alaska Standard Time Printed Date/time 11/20/2003 11:56 Collected Date/time 10/30/2003 14:00 Received Date/time 10/31/2003 13:20 Technical Director Slep)ten C. Ede Released Sample Remarks: Corrected Report. Sample ID changed by client. Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Waters Department Nitrate -N 3.21 0.100 Microbiology Laboratory Total Coliform 17�i; Ncr-FC, I �Izlo Sop) rVD CO mg/L EPA 300.0 D (<=10) 11/01/03 JJD col/100mL SM189222B A (<=1) 10/31/03 DKC 112-11b-03;12:16 ;CT and E 5 8 5 Engineering ;56+53011 a 2 SGS/CTE ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM IDS I�PRIVATE WATER SYSTEM /"' [3 Send Resutls Send Invoice 200 W. POTTER DRIVE ANCHORAGE. ALASKA 99518 Tei: 907-562-2343 Fax: 907-561-5301 Lab Ref No. � RE11,111111,111111 ioa7sos�L • VA Ai ArRUM Sent to Client: SAMPLE COLLECTION: SAMPLE TYPE:. FrrW.w�..wMMinuuM�wA�nMM.MNmpl.mYaMn, d�•f� Date: © F 03 M` outine 0 Treated Water • M..m o.1. r... Time: ��/� AM PM i*d.r.l Repeat Sample Untreated Water Location: L / — t� % !g �' (refer to lab no. 1 eolleetor. ❑ Special Purpose Transported• to Lab By: Same as coliector Other Prinra Nr.. TO BE COMPLETED BY LABORATORY Sample Receiving: Date: _ %'2 1 X07 ❑ Sample over so hours old; ❑ RUSH SAMPLE Time: Delivery Method: Received Bye Comments: Resuns may be unretlable ❑ 4e hour WeMr Phone #; Fs�"Locatlos,,, Fax #: .................................................................................................................................... t.......... Bacteriological Water Analysis Record: Sent 1, ADEC: MMO-MUG (PIA) RESULTS: ANC FBK JUN AnalysisSellan: IZI?71h?i 1'i'�D� TotalCdifortn: Datelfmw Analyst: -T7 0!j 'Analytical Method: ® Membrane Filter MMO-MUG (P/A) E. Coll: Sent to Client: MEMBRANE FILTER RESULTS: Phoned ❑ Faxed Direct Count _Colonies/loam[ Datetrime: Vertlicatlorr. 5 oke with: r.weae.. LTB: BOB: Satisfactory Ec: ❑ Unsatisfactory T're•TN NuwMCenl Reported By: y. ck:f+ OateTme:r (Zislipt�, e..11... slpna11ur. Form # FW- 0053 10/24)03 \ypetra\pubUc\DOCUMENTIFORMSWicro\Coli Form.xls Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program s T 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. '050-361-13 HAA# d41-0(QSS0 Expiration Date: 1. ,GENERACINFORMATION Complete legal description Lot 5A Block 2_, Fi rP T,akP taw S/D Location (site'address or directions) 18108 Ifuldrow Street Current Property owner(s)mark Shearer Day phone 266-2423 Mailing address 18108 Muldrow Street, Eagle River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: lI 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site MR Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 5 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 sample results less than 30 days old. (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. T 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 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 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. S & S ENGINEERING Phone qy-ag79 Name of Firm +70-14 0919 c:...,- Lear Read No 204 Address Eagle River, Alaska 99577 Engineer's Printed Name Robert C. Cowan, P.F. Date ..0 .0 r .......... 5. 5. DSD SIGNATURE ROBERT C. COWAN i4 �� • CE -8801 Approved for bedrooms. s Disapproved. 1 t1`;`z�`�.�� Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory M (Rev. 43/CO) X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ^ . '•�•r.••STT!!'•� 1 ♦R ^•.^r Y c T... n 1� r vft �1 t'-.1�:. r. •, v Ir ` 11 �i\ ,_,IYYt '',ta •.. r � , Jt ', :. 1 ` r' 4, pr • / t f " t1 t � I!t" t t, 7 1 �j i 1i+ i ( r•`` ' 1 � +1 1 :v it1 11+ Y T l ,� 11 I i t.. 1. t r t •• t • i Y f' Mumcipal>ity of'Ancliorage�, I r ; *11 1 iT rr.•, f r+ t, 7•j y r I ..y I ( e- -'tr�p evelopmentjServlces Department 4 a; Irl` C' j�l ,tr th 111}'.1 ``I a'� ' '+., ,.< i • ' l\ f r _ I, r r' t• t +� ,';1y,i I;! Bullding,SafetyDivlsi6n'I e; 'is'tf+ ' s• ETY 'On -Si 6Water&`Wastewater Program '., Y / • 4 I t' iij ltt.e 11 t�{ !4700 South B.ragaw St " ! i{'♦.ttlI It r P.O., Box 196650 Anchorage, AK 199519 6650 a ji , r'' , r ' 1 :'�w,mrci'anchorageakus'l" `t{<;ti f dll ryd 1 { r♦ t jl ,I I11l1 1 t It.'r ar r I r rIr r.1 f J n' d 4 4\ (907) 343-7904 ''. I i ' ,i r{ t r I l i Sp ri / 1111 TIN i }0 v t f {T'..• ♦if'....t 1 4 �♦ w,• .e ♦ en r , ..1 ;r( T' , HEALTH yAUTHORITY��?►PPROVAL`FCHE,CKLIST '; L, 1 C i. si i!r' ;t-� I :"• it It�50',3, ` F F ' r' G , 1,1 1`T I i/•�c.���-'(GS 'ParcellD f3 1 Legal Descnpti n ,LDTI 5A ) tG .2 t:,r l f t r it : > ,. J r 1,♦t i \ rJ r 7. l 1 } '. , •:i ea �4r +• s 9(j �V , 1 ) �, i 'ra 4 44 {.• i +.1 1.�'.., Ir I A WELL; DATAd { ft' r s ♦. r t u 11 s 21e/�TIfA;'B o�CpowdePWSID# ,, {L ,r �1,Velltogt(YM). ;Well type , Tv.. }� r. t t '1n i , \ D I 1 �! �, i;r 1 'P ' 1 I ,i �i' ' ' I ' :1 I, , "Date completed` /r ;;, Sanitary'sealt(Y1N) ,` r .Wires properly protected (YIN) + I ,1> i♦ �A 1t, '' ', 4i"I(A �I I� `� t.."1 !'iCr.'l M{) rj� 1 p ' /1`» . (; ♦ t j ° ^(I ` ft'.''1 , •'' '. I 1Casing hb*ight�(above'ground)thin Total depth 5 �: ft' Cased to •, ��. I P 4- A •♦ .:� r4 �•I la i,ll, s iPc�e'rloa fir �-, I� AT INSPECTION (I} L'+ 'FROM WELL LOG IT r 22 6l I ( tl' t .♦ 1 ,}r it} , i \ I : "C ` 1 19 ` .. i 'Date of test w' j'.. } I,1 I I ;' I4i ! d < I I i��,� I f <' �.r( 1 '� ''D� 1 �•• { t.. 'ft l f '', + i1,;' ' Stabcwater. level ft a r. 9 P m {' Well production i� 4 iV. I. 1 { r v t ✓ , , ♦ 't ' h • ',," n, 41 1 ' '; I WATER'SAMPLE RESULTS:i11„\',ft` colornes1100 ml Coliform colonies1100 ml Nitrate m9 n Other bacteria777 —7 S & S ENGINEERING a rCollected by IV LQ Pmd k; IIDate or sample r wr NK DATA ;ra3le River, Alaska 99577 1 ' B SEPITICIHOLDING TA 4 } '` { '�`� , 'l' ,. _ f` • r. . .t ♦ 1. .� , `\ 4• s', Date rnstalled� ' Tank Type�Material 1 ^� -777---7— t' t+ �� ;'Tank slze;l ✓ •'gal * , t4 Number of Compnertmenis r Cleanouts [6 1 a iJ0 I Hi h water alarm YIN N <F Foundation cleanout (YIN) Depression over tank (YM) . 9 ) '--�-- rF to (``i.. Iy4 ` 't1 ! {.. r 1'1 , t i \•, r WI F. Date cr pumping'Q: I°� 6 °�%�' 1 ,Purriper G.' ABSORPTION FIELD DATI. fA L D i 2 t S stem a i5 ✓l�L�lGf/ Date insta►led � 'O Soil rating (g•p if d /ft r L� Y type i ” Greve) below pipe ft I i'Length it _ 'n - Depression „ I : 1 ..Total depth – Eff absorption areafP I Monitoring tube . over field %V t7 I ♦ r /A A .• 1 Results (Pass/Fail) ASS t For Date of adequacy�test.. { I r d�01.3 al Nevr de th �3 In ' "Fluid depth in absorptjon field before test ijn Vater adde g P E.apsed Time: f0 min. Final fluid depth jn ' Absorption rate >_ 4. ' Ariy, rejuvenation treatment (past 12 mo) (YM.& type) JVD If yes, give date - a SUlil?C-> !� /N FA/LU2�, Gf/ 7 1 -11 -'aW1 '11111. T. T\ �ri..i v� •(( l �!+++•ttti •y''I ' .� t i i, t , a .i t. fY ,. , a8 t, '',iT�ta;�il£ r" 11 L•r a'Y 4 ,..* !, ('I a, a )y_ t- . r,T� a r a, n+'4y h.,III .4'JI,{,f I , I 1. }-r I11n1 Sr a'.•a� 11� ! �i 2 r `•i,� ,j S � i. i.1 r 1 r � J' ? ( 1 1 ,. , r 1 I .i,p r Li.r. 1; It•. 1 � `;„!•. �' t t,.,, r' "•ri 1 ,,j r7 / lit 17I' i\ t ? 7vi i''.,4 hi it + ffj !' 711 r,. �{ , tACrt , ivf 1 t� ' .j., �Tf9J4 i"t aft' t4ii .,1'. r17 f , fr .1 ,t , Ppr Vl.i N 1 r t.. I , wh Y+,li Y: y{ r !' A 1 D! 11F7'STATION, ,f,t , ", "' �a �Fitr" d, j rr I4a z,ll;i�t u,i ; "'� E t i r ', i'41 iaf i •' Y'✓:b} 1!'1 1t rl J i.ad j, �+r lk}.. .') jk 'I j.'•}ihl' 1. Vd o� S' 1!'F` ` r� 4j c p Size In gallons 1 I �' Date installed •: r ,/..(1„ l.,j i! rau�ti{,},Aij�..yrt,}); r} IL.1, •tlti.��i) �IA1� �� i,',.t '� 1, ,., .{ L , ' Pump or{'• level at in I Pu;4 ofr 1e�iel .li,s+irJ �iv,(i 7•r7 Ln ;I. yfl .a l} DY, �,* J?e . ., t l! C ( ...r}:j ' .•t� ri t ;a rl !I "�1;`' L, ' ••.'.'� '`I.. , �lr ,1 :�y ei ; r lir '� r Sl 7� �.. r y ! ♦ �. .r. ,l V' .:i#.t a Datum " ' 1 ` a` rCycles testedi ' ?i7t °lArl ' I1ah,eets alarm{ cgcu tituirerpe .. .i,.'j 710 'yQj f ' , n i i ( i iy-J , (ia2w ' lrh ' J _�:. i r.:k•l.I re ,... 1.. k r ,. l•i E. ' SEPARATI N DISTANCES ..+ w.. . r yaw . •a .,.r • m , Ir CI x R"Y f J iJI i'j jl •� X(^7"'• , ' x! trt ".l r„7 ('C { , i a , 1SEPARATION DISTANCES FROM WELL ON LOT,7T0 „ !..' I / J ! • r i l I. i t r+ , 1 IK ••(• , 11 • tl IF'd'1 1 " ! ► r �{ dr X45 3 ' a On adlace�t lots A � P 11!. ,': I Septic tanji/j ion on lot I / '• �'.� ,! ' '' ;v , i ;f. r Dn adjacent I tS,id' _°i. rJ`%O .l: au l`. 5:f n FI ' ,.' Absorption field on lot 1 < r ,: ,' Y F4 ✓ I J , ti:l✓ ',. j a'll, >�i. h( r Public sewer manholOf e/cleanout t Public sewer main` ` ` ��1, , r'J. i'15 t1 Yr If JP, #w�Holdmg tank,, 'S r/septic service ine ;� ,r , ,, is :1 (I .r,r ,ki ' ii� ,SEPARATION DISTANCES FROM,SEP,TIC/HOLDING TANKiON LOTTO r .Jiti ' i r Ifl:it 1 ( i }•! i 1, l ii M b i ,, , r < i t of i ! 11:t �f n(t �a`� , �f at: . , i!j t -t.' ;propertyAbsorpfio� fie'd Budding founda4ion , ,, i .4 .. t r T 1 I' "' 1 l0<) s`- ' ' ` ;,Water service line;If' Surface wate�" / Opp ' s Water main i 4 , 'r r 1! } , ae r ♦,^it 7 * i� Ita i ar , �� 5' rt ". �, n'. ', i?."I'Ij f•a ;,l\`r �� l ' ♦' I1. 1. i. l7pf / .1 l:• JfI[j'' , it ,r {, ' , It .i l Wells on adjacent tots / + j; Ii t , ii( h t J F, i aP I, iI J' 1 ll' '!,Y.� 14 v t, F; til'{a' t .f ,� l S S f il. ' t✓i , y , ,1 a ♦ ' r ,'.r tel^ I' SEPARATION DISTANCE FROMABSORPTION FIELD;ON LOTTO Building foundation +7`' �kWater main i 1 r Properfy line' , r it t. ,4•: � li r ' E,h ittl IYLlr? I4 a� r ,IriJl I�i t.,,, �\ ,�7i +i^i t eJ Surface water l i` r4A nveway, parfcing/vehicle storms e � !Water Service line f J , ,r; t' q 7 f ,, .,. i. _I ( 1 '' 1` %'•11!r�t c.{t !n" yn.•'„TI f 4 Ali'yi i I�slfWellson`adlacentlots�:+;j` `.. CUrtalf� drain ' i t. •+ „� l{ A r; , , 'L t,i+ ), i 1VI)f Ij. :i .,">. ,V r. 1•• r17 ,1 ` i 'l\itt[1l, lir r I, ,lases �f �,;. ii}}iC 1 ail i'1 rt w,, r..{{ , ,i �c9 "., ' ',' 1 F.' COMMENTS`:•., LrL{, 7j, r+fy r1S (J '4.�j'7 i :] t"j �I t;? .i )l I'i rr t, ,•t lA i r. ''J�./'�J�t 4t ' ' i, ...,tl �„ Iln.] ✓ >S" 7 ' ' T l: r, ,'..I '•!:' Il ✓� r rJ ;n , ,Sr=t�'�rrr✓�1;\/!G !'`/nrS-moi ''ti.P' /93: aS��t�!1 { ~ � Az/' S V ,•'`r i �i l.,l '1 # : l �11 ,y! ,rY"4! "A 3��4�2 \ �14..` t• .. G. ENGINEER'CERTIFICATION+','�, ,+.: ,'' ?`•`ij ";'; S ,1.;� ..•w• • ;,,..'QS 4, f \' �wv.: ,r •. r I I ,F 1, J.i:C M, . r i , - ff. ,, ' , I i! 1 (y�.: r S,t! �: r , �ji4 r .� `_ Jil. •,} r',; 1 'ci +1 certify. that 1 have determined through field rnspectiorjs and}: Wk ;i.Ireview of Municipal recorthat the abotsaem , conformance viith MOAHAA guidelines lri'effect on this date?,,,p,� f; te E , i' f, t� , y ff "! ` }7'Q i �ti/L j, T 1� i 1 � b✓A� A � ':. i i i+ { r �';0, ERT C CO WAN a' f �Q `�� 1✓'�•-�' Engineers Printed Name / /l r _ 1 t r, J• ''+ t. ,� �;1 c CE 8601 I v 1 r ' ! \ t i' b''/� O/� /! l d,, and r 'i f ,r j 1 i! i i+:��rtRr hT Date' .,t r I r '1 2i _ire G I •J.' tt Fv i If .r , td ti ''r '1, i •:, "Ir rJ �L`—�C Com'_ K . t . t , I 1jS i ! (. 11! l ! I � h•� f ' ,i'�r wZ'.�.�•'G�4, 11 1 a i.—' `,. NAA Fee $ 3 `0 t �t� Waiver Fee T r ♦ , t 1' ?I� �•Sr' , '.' !f Cv' , Ijl �,�. i t' 1 Date of Payment` , a 8 to f �, Q r� Date of Payment 17,g; lal t, ., :, ii 1 ,.;�:''11h ,y .+J'a T1� , ` \, !„' u; 1 �* ? I Receipt Number o O Receipt Number ( 4' tRev. 12a00 ,, , l , i i,� i\ '�4 i�1 a..i1 �, } rrF 7 `•�'d' ,7 ,'. , ' , li4 7 ,l} A4�r ' t. 1' 'rl r ' 1h���t'1 ' 1t' JI �fi '.r�k ;e t �S -•,' I,{', • 1 , 5• R !t jtl i ,;'� C, y of l i } � � ` i J •'\ , !�, It • 1 i I' ,`i ,' \ 1 ..iJ`� :.1. 11 j',1 3 ••I ¢ '1'1% 1• 11 ~ ..