HomeMy WebLinkAboutBRATSLAVSKY LT 2su-aml
1 1 AL
.IaN 0 2 2019
Municipality of Anchorage
Community Development Department Page 1 of 3
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181249 PID Number: 018-322-42 ❑ New ✓❑ Upgrade
Name:
ROMAN & TANYA BRATSLAVSKY
ABSORPTION FIELD
❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
15300 OLD SEWARD HIGHWAY
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
6
1.2 GPD/SF
17 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
9.0 Ft.
Gravel depth beneath pipe
8.0 Ft.
Subdivision Block Lot
BRATSLAVSKY 2
Fill added above original grade
0.0 Ft_
Gravel length
50 Ft.
Township Range Section
Gravel width
1.5 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft_
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
800 Ft2
1
N/AFt.
Well
100+
100+
N/A
I
N/A
100+
TANK El ❑ S.T.E.P. El Holding El Other
Manufacturer
ANCHORAGE TANK
Capacity
2000Gal.
I I
Surface Water
100+
100+
N/AI
N/A
Material
Number of compartments
Lot Line
45.3
33.1
N/A
N/A
STEEL
2
NA
Foundation
13.4
10.0
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
50+
50+
N/A
N/A
Gal.
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank 3034 Tank to
drainfield 3034
DOUG GREY
Drainfield 3034 COIMT 3034
Inspector PANNONE ENGINEERING SERVICES
BENCH MARK (Assumed elevation) 100.0 ft
Inspection,
dates: 1" 11/13/18 2"1 11/14/18
Location and description
Sd 11/14/18 4"' 12/26/18
SW BOTTOM HOUSE TRIM
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
OF.
Conditional Approval: Date
.
,� 'CSGA.
TH
...I`.
tteven I�annoRe
Approved mac, Date '( f? 17 1
C 8149
�t 0PR
II J�PUU(IUII RCPUU_I-I-IL.UU(.
DESIGN PARAM[�TERS
E
A
UPGRADE SEPTIC SYSTEM ry
NO. BEDROOM: 6(900 gpd;
TANK SIZE: 2000g
41.9
—FC
T1
24.2
PERC RATE: 3.2 MPI
T2
SOIL RATING: 1.2 CPD/SF
ROD:
AREA 750 SF tl
SYS. TYPE: DEEP TRENCH 8,0' ED
w
MIN LENGTH: 46,9 L,
-
USED:
M2
50LFx1.5'Wx8.0' E.D., 17' TD
38�6
TOTAL AREA: 800 SF
REMOVED i 500a EXISTING
74.5
SEPTIC TANK PER MOA CODE
M3
1 69.4
10.5
INSTALLED 2000o SEPTIC TANK
W/ FOUNDATION CLEAN OUT��
BEFORE AND DCO AFTER
DCO
k DRAIN FIELD E /o
DECOMMISSIONED PER MOA CODE
10
/C� C5' T2 T
TH - I M2
/� / INSTALLED DRAIN FIELD
50LF x 15W x 8.0'ED x 1 7.0'TD
INSTALLED CO AND MT AT EACH END
REMOVE AND REPLACE FOR RESERVE
A
B
21.2
41.9
—FC
T1
24.2
47.0
T2
19,5
60.9
DCO
20.2
63.6
—C1 33.3 34,2
M 1 34.9
M2
—33.4
40.0
38�6
C2
74.5
13.6
M3
1 69.4
10.5
/C� C5' T2 T
TH - I M2
/� / INSTALLED DRAIN FIELD
50LF x 15W x 8.0'ED x 1 7.0'TD
INSTALLED CO AND MT AT EACH END
REMOVE AND REPLACE FOR RESERVE
z
<
o,
od
2000g SEPTIC
TANK CONNECTED
TO CORNER
OF TRENCH
PROFILE
SCALE: NTS
�'w
Z
100
DRIVEWAY
C1 -TH-2
110 .0 '2
01.0 C 1 2
33' ROADWAY AND
I Y
UTILITY EASEMEN
NND
'EL WITH
NO AND
WITH
2018
NOTES: Date
RECORD DRAWING PA-MONE ENG SVC, LLC OF A .1
1/7/19
P.O. BOX 100217 ANCHORAGE, AK 99510 Scale
PHONE (907) 272-8218 FAX (907) 272-8211 1 "=30
DRAWN BY:
4 TH
ACP - P.J.D. NO
BRATSLAVSKY, LOT 2 ...... .. .... -M-322-42
Steven Pannone PERMIT i ROMAN & TANYA BRATSLAVSKY IT No,
CE 814
15300 OLD SEWARD HIGHWAY OSP181249
PLAN ANCHORAGE, AK 99516 Sheet
lk�, 9?0FTESzrS1 2 OF 3
0
Z
<
U
0
z
<
u
0
z 0
< 2
0
n n
z
<
o,
od
2000g SEPTIC
TANK CONNECTED
TO CORNER
OF TRENCH
PROFILE
SCALE: NTS
�'w
Z
100
DRIVEWAY
C1 -TH-2
110 .0 '2
01.0 C 1 2
33' ROADWAY AND
I Y
UTILITY EASEMEN
NND
'EL WITH
NO AND
WITH
2018
NOTES: Date
RECORD DRAWING PA-MONE ENG SVC, LLC OF A .1
1/7/19
P.O. BOX 100217 ANCHORAGE, AK 99510 Scale
PHONE (907) 272-8218 FAX (907) 272-8211 1 "=30
DRAWN BY:
4 TH
ACP - P.J.D. NO
BRATSLAVSKY, LOT 2 ...... .. .... -M-322-42
Steven Pannone PERMIT i ROMAN & TANYA BRATSLAVSKY IT No,
CE 814
15300 OLD SEWARD HIGHWAY OSP181249
PLAN ANCHORAGE, AK 99516 Sheet
lk�, 9?0FTESzrS1 2 OF 3
1
2
3
4
5
6
7
10
11
12
13
14
15
16
17
18
19
20
21
22
23
TEST HOLE 2
OR ORGANICS
SMI BROWN SAND
GM AND GRAVEL
I WITH FINES
IGRA
SM/ I y SAND
GM AND GRAVEL
WITH FINES
SOILS LOG - PERCOLATION TEST
SLOPE
--SITE PLAN
TH-
WAS GROUND WATER
ENCOUNTERED? N
IF YES, AT WHAT
SM CLEAN SAND DEPTH? -DRY
DEPTH TO WATER AFTER
MONITORING? -DRY
DATE: 11/13/2018
BOH
DATE PERFORMED: 11/612018
SLOPE
TH
x
READING
DATE
CLOCK
TIME
NET TIME
WATER
LEVEL
READING]
NETDRO
1
11/6/18
9:05
---
5.900
2
9:15
10 MIN
9.900
4.00
3
9:15
---
5.900
---
9:25
10 MIN
9.300
3.40
9:25
---
5.900
6
:35
10 IN
9.150
5
9:35
---
0125
5.900
0
—
6
9:45
10 MIN
9.110 .1
3.21
PERCLATION RATE. 3.1 (min/inch) PERO HOLE DIAMETER 6 inches
TEST RUN BETWEEN 4 FT AND 5 FT
COMMENTS: Test hole excavated by A+ HOME SERVICES
PERFORMED BY: Dan Moran. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES:
PANNONE ENG SVC, LLCDote
RECORD DRAWING oF. A�,, 1 /7 /19
DRAWN BY: TH
P.O. BOX 100217 ANCHORAGE, AK 99510 q
PHONE (907) 272-8218 FAX (907) 272-8211 NTS
P.I.D. NO
BRATSLAVSKY, LOT 2 en oe 018-322-42
ROMAN & TANYA BRATSLAVSKY p
CE 8IZ9 OSP181249 PERMIT NO.
15300 OLD SEWARD HIGHWAY
Sheet
ANCHORAGE, AK 99516
SOILS LOG 3 OF 3
040.002
Client: Pannone Engineering Services
Z__
Project: 15300 Old Seward Highway
Date: July 18, 2018
Crowther Associates
Particle Size Distribution Table
(percent passing sieve size)
Sample Source
Test pit
Sieve Size
Pei -cent Puler
Percent Finer
Percent Finer
Percent Finer
.3 inch
100
1-1/2 inch
100
3/4 Inch
100
#4
100
#10
99
#40
98
#100
56
4200
37
0.02 inna
Classification
Silty Sand
(SM)
1632Belle),iteCircle I.,4itchoi-cT,c,,?llaslia 99515
Telephone (907) 349-21981 E mail: et owther@alaskadiet
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N`C1PA`/rY MUNICIPALITY OF ANCHORAGE 11
On-Site Water&Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.org/onsite —11161:4Tri
Depart mcnt
NICPOfl
On-Site Wastewater Disposal System Permit
Permit Number: OSP181249 Effective Date: 9/18/2018
Work Type: Septic Upgrade Expiration Date: 9/18/2019
Tax Code Number: 01832242000
Site Legal Address: BRATSLAVSKY LT 2 G:3134
Site Mailing Address: 15300 OLD SEWARD HWY, Anchorage
Owner: BRATSLAVSKY REVOC TRUST 2018 Lot Size in Sq Ft: 69138
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms:
This permit is for the construction of: 90)L
0 Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
c1/25i/S c# 1 : t size Sr-len-7 +Iv Le boom.-
f /�Ul /1414 $1 Date:/ JReceived By: ` 1. / q/Iq u s
p
Issued By: �`�/ � il�r•� �w fie. Date: -f 40-/!$
eiRePtn1111
MUNICIPALITY OF ANCHORAGE
Community Development Department r �' Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 018-322-42
Property owner(s) Roman & Tanya Bratslayski Day phone
Mailing address 15300 Old Seward Highway, Anchorage, AK 99516
Site address 15300 Old Seward Highway
Legal description (Sub'd., Block & Lot) Bratslaysky)Lot 2
Legal description (Township, Range & Section)
Lot Size 69,138 Sq. Ft. Number of Bedrooms (r ` CO
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(Z all that apply)
Absorption Field U Initial ❑ Single Family (SF) X
(w/wo ADU)
Septic Tank ❑X Upgrade n
Duplex (D)
Holding Tank ❑ Renewal ❑ —
Multiple Dwellings
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
V)\(7
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5(01 Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number: DpOo1Receipt Number:
Permit No. OS P 17 14 1QWaiver No.
Permit App_-:- c
Munidpality of Anchorage
On-site water and Wastewater
REVIEWED FOR CODE COMPIJANCE
Pannone Engineering Services [lc OSP181249,Deb ftckenfuss,09/18A
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:steve@panengak.com
August 29, 2018
Subject: Bratslaysky, Lot 2
Septic System Install Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade septic system to be issued for this property.
The proposed systems will serve an existing five bedroom (5) bedroom house. Currently the lot is
developed. The existing drain field is in failure and will be abandoned per code. This lot and the
surrounding lots are served by private wells. Required separation distances to wells will be maintained.
1. Soils. One test hole was performed on this lot by PES in July of 2018, and groundwater was monitored
for at least seven days. Ground water was not observed to a depth of 18' below the surface in the test
hole monitor tube after the 7 day monitoring period. Bedrock was not encountered in the test hole.
Based on the results of the percolation tests and overall soils appearance; an application rate of 1.2
gallons/day/square feet was used for a conventional wastewater system in the area of the test hole.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field.
The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
4. Topography: The existing topography generally slopes from the north to the south in the area
surrounding the septic system at approximately 5%-7%. There is a slope to the west that will be avoided.
There are no steep slopes within 50' of the proposed drain field. The proposed drain field will maintain
50' separation all steep slopes.
5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that
the review is complete and that there are no further comments is received from MoA On-Site
Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of this or the surrounding lots.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
t
•
WELL (E) % 1 /.)
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.. --
• •
i ---
- DRIVEWAY
,, r
15008 CONCRETE SEPTIC TANK (E) 1 // ' i� -----
DECOMMISSION
�W
DECOMMISSION PER CODE AND ; ; /
INSTALL 2000g SEPTIC TANK (P) ' . 6-
INSTALL DCO ' O� \
• i i
DRAIN FIELD(E) ;'
1r. DECOMMISSION PER CODE 6BR HOUSE \
/ 'oh t TH-1
^T I _� - SS CC . .. 4 \
/ ! ;' 33' ROADWAY AND •
/ / / , UPGRADE DRAIN FIELD(P) UTILITY EASEMENT �
' / / / 5OLF x 2.5'W x 8.0'ED x 12.0'TD 33i•'...-...f.___„..--' 3Q /�
/ ! : / / INSTALL CO AND MT AT EACH END (v I
' / / / ` / REMOVE AND REPLACE FOR RESERVE
r f�.--It-•' rf---'!---- • O I I• • 0�
i
' !/ /' SEPTIC AREA(E)
! • ! ; ,
•
I
DESIGN PARAMETERS ABBREVIATIONS
UPGRADE SEPTIC SYSTEM TH TEST HOLE
NO. BEDROOM: 6(900 gpd)
TANK SIZE: 2000g (P) PROPOSED
PERC RATE: 3.2 MPI (E) EXISTING
SOIL RATING: 1.2 GPD/SF CO CLEAN OUT NO.
AREA RQD: 750 SF MT MONITOR TUBE NO.
SYS. TYPE: DEEP TRENCH 8.0' ED TYP TYPICAL
MIN LENGTH: 46.9 LF
USE: W WATER LINE/
5OLFx2.5'Wx8.0' E.D., 12' TD WELL RADIUS
TOTAL AREA: 800 SF
SS NEW SEPTIC
NOTES: •`��.�\\ Dote
CHANGE ORDER PANNONE ENG SVC, LLC ���
P.O. BOX 100217 ANCHORAGE, AK 99510
,c�OF AC, 0S1,k 9/25/2018
�74P' .I Scole
PHONE (907) 272-8218 FAX (907) 272-8211 /�. �.� ':9 v 1"=50'
DRAWN BY: %*C 4•9 __ Pk/OW,*
DRM /•' '. ' '• t "NIP ' P.I.D. NO
— BRATSLAVSKY, LOT 2 �2 . .�•. ,,R.
. , 018 32-2 42
ROMAN & TANYA BRATSLAVSKY d S'teven R. Ponnorae PERMIT NO.
15300 OLD SEWARD HIGHWAY l4r4,, CE 8149 . •4,:„;; OSP181249
PLAN ANCHORAGE, AK 99516 fl,`\\Q�`\O-C- Sheet
3
\\�
Munidpality of Anchorage
On-site water and wastewater
TEST HOLE 1 SOILS LOG - PERCOLATION TEST REVIEWED FOR CODE COMPLIANCE
OR ORGANICS SLOPE ` /1'1
��� /
PLAN OSPI81'4• ►` us.09/W
W (p
4 /3
// / // / •100
SMI BROWN SAND V // //
5 GM AND GRAVEL 7 //
WITH FINES
6 X �Z 4 ( /
TH � '\ TH-1
7 �h / Q X ) /1
0) 0)
8 — - \ -,-,-- /
/ 33' ROADWAY AND
9 I UTILITY EASEMENT
10
11 SMI GRAY SAND '
GM AND GRAVEL I 1 l I
12 WITH FINES \
/ 1 t
13
WAS GROUND WATER SLOPE
14 ENCOUNTERED? N
15 IF YES,AT WHAT TH
16 SW CLEAN SAND DEPTH? -DRY X
17 DEPTH TO WATER AFTER
MONITORING? -DRY
18 DATE: 7/30/2018
BOH
CLOCK WATER
READING DATE TIME NET TIME LEVEL NET DROP
READING
1 7/16/18 10:00 --- 3.34 --
2 10:10 10 MIN 7.50 4.16
DATE PERFORMED:7/16/2018
3 10:10 --- 3.34 --
4 10:20 10 MIN 6.81 3.47
5 10:20 --- 3.34 --
6 10:30 10 MIN 6.54 3.20
5 10:30 --- 3.34 --
6 10:40 10 MIN 6.51 3.17
PEROLATION RATE 3.2(min/inch)PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 4 FT AND 5 FT
COMMENTS:Test hole excavated by A+HOME SERVICES
PERFORMED BY: Dan Moran. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES: PANNONE ENG SVC, LLC �4 OF/���l Dote
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 -4 .••••'•...ts, i 8/9/2018
PHONE (907) 272-8218 FAX (907) 272-8211 .4 g'`P ,...4.,...1.--7 Scole
DRAWN BY: %*: 4,9•t-1 1 * /
/
DRM • ••••• o P.I.D. NO
BRATSLAVSKY, LOT 2 / .4�\ / 018-322-42
ROMAN & TANYA BRATSLAVSKY St'e'ven R. Panriorie PERMIT NO.
ll ;2'�•. CE 8149 •c• oe OSP181249
15300 OLD SEWARD HIGHWAY i) sf .\fir
SOILS LOG ANCHORAGE, AK 99516 1l,l\\\\�```� � Sheet 3
Municipality of Anchorage
Q l�Wut, j Wu.4 r
REVIEWED FOR CODE CANCE
OSP181249,Deb lhfxkenfuss,09/18/'
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55.
2. SCOPE OF WORK: VERIFY SEPTIC TANK, INSTALL SOIL ABSORPTION SYSTEM.
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 18 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 18 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC
LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED
SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK.
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING
AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER.
8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE
ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND
TANK ELEVATIONS.
10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION,
TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING.
11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE
PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER
(OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE
CONTRACTOR.
12. THE CONTRACTOR SHALL SIGN THE FOLLOWING:
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED.
CONTRACTOR:
BY: . TITLE:
DATE:
NOTES: PANNONE ENG SVC, LLC -``OF At, Dote
CONSTRUCTION :(16,,k1 P.O. BOX 100217 ANCHORAGE, AK 99510 r�� 2018
PHONE (907) 272-8218 FAX (907) 272-8211 /�aj�P `ti••1y+r Scale
DRAS
WN BY : •••X14*/� .. .1k•,�� P.LD.NTNO
BRATSLAVSKY, LOT 2 018-322-42
ROMAN & TANYA BRATSLAVSKY r Steven R. Pannopefrer PERMIT NO.
•15300 OLD SEWARD HIGHWAY /0 •. CE •8149 `e OSP181249
PLAN ANCHORAGE, AK 99516 +ilr`\�• OFESSlO`� � Sheet 3
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0�� NOTES
�o� S7, \ ' 1. RECORD DATA SHOWN HEREON IS PER PLAT 2015-27,
�p^^ 20' TELEPHONE AND ANCHORAGE RECORDING DISTRICT.
AD ELECTRIC EASEMENT SAF
. . \`\ _22 Ia 2. THIS DRAWING IS BASED ON A FIELD SURVEY PERFORMED
`\\ 22, BY EDGE SURVEY AND DESIGN, LLC ON 8/21/2018.
70• /
\
\\ �� 3. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE n-
\ THE EXISTENCE OF EASEMENTS, COVENANTS, OR o
\\ RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED N
LOT 1 • P '9� SUBDIVISION. THIS AS-BUILT SURVEY SHOULD NOT BE
BRATSLAVSKY SUBDIVISION ��. USED FOR CONSTRUCTION OR BOUNDARY LOCATIONS. ci
PLAT 2015 — 27 \`\\ ��� 50' 25' 0' 50' 00
Lq evP 1„ = 50' "
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84.0' `\ / \
0 'L `\ �' \ 1.1
11'
c FA `5 i/ s' ,,'` oc5 \ LEGEND
LOT 2 `'F,'04, `s�;� �•°? -\\ \\
BRATSLAVSKY SUBDIVISION
-Ks, ‹<,
-9,�, / C)°` /^\ \ PROPERTY LINE .3
Co PLAT 2015 — 27 Fti .' / \ n'
°' 69,138 Sq.Ft. , / �/' `\\ \\ - - - - - ADJACENT PROPERTY LINE Q
C•1
// `\\ N - - EASEMENT AS NOTED
co
i. THREE-STORY FRAME BUILDING ,�� \`\ BUILDING
AS-BUILT DATE 8-8-14 / `\
To
in /' OW WELL m
o / \ / LOT 1 A \\`\ • SEPTIC CLEANOUT 3
Z /� 28.3, i GOLD PAN ESTATES \`\ 0
/e I PLAT 2011 - 111 \
rn
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362, i co
L 37.8'
6?s• SURVEYOR CERTIFICATE A
SEPTIC CLEANOU TS 46.2' 1 _b , I HEREBY CERTIFY THAT I HAVE PERFORMED AN ���\\\\� Q
• 1 _ I AS-BUILT SURVEY ON THE PROPERTY SHOWN �~ of A it E D G E
33' ROADWAY ;�, I >,
HEREON AND THE IMPROVEMENTS EXIST AS i�P • •:1&_1i, SIIIVEY ANN RESIGN, LLC Co
AND UTILITY
4 SHOWN. FIELD SURVEY: 8/21/2018 /O> • `'i •9 �j 12501 OLD SLWAKU, U ANCt10RAGE, AK 995 15 N
Phone (907) 344-5990 Fax(907) 344 7794
EASEMENT ``� *••�Tlfi I\ ••* AS—BUILT SURVEY Co'0
_ I , _J
S89'58'51"W 182.46' ?Ze.i-- ... ... .... / LOT 1 BRATSLAVSKY SUBDMSION co
� PLAT 2015-27 ANCHORAGE RECORDING DISTRICT N
6 .. Mark A.Aimonetti •:
9/1 7/18 1'.. •... No. 13022-S .•.�,� DRAWN BY: DATE: MOA GRID: -o
LOT 232illi
1 ``9 •.9117/18 .•,:.. -^.
MARK A. AIMONETTI 1kk OFESSI0NN.`��.� MA 9/17/2018 •SW 3134 a
PLS 13022 �X\\�>>� CHECKED BY: SCALE: SHEET: j
•TD 1"=50' 1 OF 1 a
~[:LE,~.TER ANCHORAGE AREA. BOROUGH
'~ · ~ .... '~' G~TER ANCHORAGE AREA BORO~-~qH
Dep~ment o~ ~nwronm~n al Q ~.. ~y
3500 Tudor Road -- Pouch 5-050 ' An~eraqe, B.].s~ 99502
987
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILING ~ ~ ~'~'~ =, - )
ADDRESS ~'~'L'~' ////~.Lb/~.~)~)xC '///~'.7~ PHONE?~r-~./-~
LEGAL DESCRIPTION
DISTANCE FROM WELl /"~
LIQUID CAPACITY
(/°)"0 ~F.~;' b ') MATERIAL L~'~o/L'~'~ ~ 7~
GALLONS. INSIDE LENGTH
NUMBER OF
COMPARTMENTS '(?'~J ~-~
LIQUID
INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATERIA~ ("~/~('-/,~'- ~'(~- ~ i~/Ai~J'.~ ,
NEAREST LOT LINE ,~(~ / 7~ ~/' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
OR WIDTH / , LENGTH ~/ , DEPTH
DISTANCE FROM WELL /~ .~f.~?~,'JBUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL .~.~cO0-NDATIO]~ . NEAREST LOT LINE
NUMBER OF LINES ///~DISTANCE BETWEEN LINES~ ~
ABSORPTiON/A~EA/-
SQ. FT. LENGTH OF EACH L~x~E~
TOTAL LENGTH
, OF LINES
.~IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE--
WELL: ~E~ 0 ~? 6~q ~SL 60c/? ~/ DISTANCE FROM
TYPE , DEPTH _, BUILDING FOUNDATION
NEAREST C/ SEPTIC ~/ SEEPAGE
LOT LINE ~, SEWER LINE , TANK. ., SYSTEM
~ .... WATER ~'~
SAMPLE__, NEAREST
/- OTHER
~' ,CESSPOO[ c_ , SOURCES __
DISTANCES:
DATE
DIAGRAM OF SYSTEM
APPROVED (-~. - "' ~
~EAL1H A~JIHORIT¥
GrEA*'ER ANCHORAGE AREA BOROUGH
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
PERMIT NO.
COMPLETION DATE ANTICIPATED
, DRAIN FIELD
NOTE~ THIS FERMIT lB NOT VALID WITHOUT BOIL. TEB'I'
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO pROSECUTION.
MINIMUM DISTANCES, REQUIREMENTB
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE Pit
SEPTIC TANK TO SEEPAGE PIT WALL
· DRAIN FIELD
SEPTIC TANK SEEPAGE PIT ' , DRAIN FIELD
TO NEAREST LOT LINE,
WELL TO SEPT[C TANK ~} SEEPAGE PIT /~/~/~
DRAIN FIELD ALSO CONSIDER AREA WELLS.
,'
WATER MAIN TO SEPTIC TANK ., SEEPAGE PIT
DRAIN FIELD
S EPT,C TANK. -. SErRAtE P,T
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTLC TANK AND INTO CRIB CROSSING GAP OF
DIAGRAM OF SYSTEM
GRAVEL BACKFILL
CONFORm TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUgh ORDINANCE NO. 28-68 AND THAT THE ABOVE
Soil Log
performed for: Mr. Joe Scheffield
705 Muldoon Rd. # 168
Anchorage, Ak. 99504
Soil Characteristics
1-.c
6~~ Well sorted sand & gravel
7'l clay
8J
9'~ well sorted Sand & gravel
icj
at;
Lot 210 Section 33
To~.mship 12N~ 3W SM
(corner Old Seward ~y
& Rabbit Creek Road)
no ground v~ater was encountered.
170 ft2/ bedroom 4 bedroom house
general slope of land is to the northwest.
test performed by Karen S. E~et on : March 31, 1972
GREACER ANCHORAGE AREA BOROUGH
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO,
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
COMPLETION DATE ANTICIPATED .
OTHER
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION,
sEPtiC TA"K ~'~E /~'5'-~'; ('/~Z ~ ,q ~.~J~,~ d~,.~r~z~:~.~ ..~ ~,~ .~/,~- %0//{~d/-
/
MINIMUM DISTANCES, REOUIREMENT~
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT ~'~-J~' DRAIN FIELD
SEPTIC TANK TO SEEPAGE PiT WALL
t
SEPTIC TANK ~-~-'
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK ,
DRAIN FIELD ·
J¢o
_. SEEPAGE PIT .
_~.ALSO CONSIDER AREA WELLS.
-. SEEPAGE PIT
/0
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK. . SEEPAGE PIT , DRAIN FIELD
TO RIVER. LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK A~ND INTO CRiB CROSSING GAP OF
" HEALTH AUTHOoR -I~/~TY
LICENSED DESIGNER
I CERTI fY THAT I Am FAMILIAR WITH ThE REQLII,E~IENTS OF GREATER ANCHORAGE AREA BO,~GH~?' NANCE NO.
DESCRIBED SYSTEM IS IN AOCORDANCEWITH SAID CODe. X - /* // //
28-68 AND THAT THE ABOVE
MUNMPALITY OF ANCHOR -AGE
�
Development Services Department �� r,� Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
018-322-42-000
Parcel I.D. rf Imo. Expiration Date: 13 Z �Q
�-
1. GENERAL INFORMATION
Complete legal description Bratslaysky L2
Location (site address) 15300 Old Seward Highway
Current property owner(s) Roman Bratslaysky Day phone
Mailing address
Real estate agent Day phone
2. TYPE OF DWELLING:
F-71 Single Family (w/wo ADU)
❑ Duplex'
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
FLI
Private Septic
R
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date of Payment A a/Zo
Receipt Number 07SUE,
Date:
Date of Payment
Receipt Number
COSA # _0_--,G2-0151 f 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA
-COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time
of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on
the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not
guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot
provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole
benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly
recommends buyers hire their own engineer to evaluate this report.
Name of Firm Pannone Engineering Services Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E. Date'f"7"
OF Aqs���
a
6. DSD SIGNATURE •'• V,
System #1 Approved for .� bedrooms A Ste n R. panI—, e
Fc . CE 8149
System #2 Approved for bedrooms. r •, o��
Disapproved �D
Conditional approval for bedrooms, with the following stipulations:
WAI LK ANU
r
PROGK
O N
By: Original Certificate Date: 22 Zd
The Municipality of Anchors a 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
COSA AILED
Checklist r-/ -I
Legal Description: Bratslaysky L2 Parcel ID: 018-322-42-000
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1972
Total depti ft
Cased to 12 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 9/15/20
Static water level at beginning of test 48.4 ft.
Comments � ICO,,J- -�,
B. TANK DATA
Age of tank(s) 11
11
3!2618 years
Tank type/material steel
Measured operating fluid level in septic tank new
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 9/18/20
D. ABSORPTION FIELD DATA 11/13/2018
Which system tested (date installed) na
❑ ALL standpipes present per record drawing
Total measured depth from grade 17 ft (max)
Measured depth to pipe invert from grade 9 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
Structure served by this system 1
Well production at time of test 4.3 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑✓ No
] Coliform bacteria is Negative
Nitrate mg/L 9 Nitrate less than MRL (ND)
Arsenic x.147 ug/L ❑ Arsenic less than MRL (ND)
Collected by Pannone Engineering
Date of Sample 9/2/20
R
Em -
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date na
Results [Z]Pass For 05 bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
❑ Code -required soil cover over field Final fluid depth in
❑ System presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: new System 11/2018
COSA Checklist yellow sheet
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'
0
Yes
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft
M Yes
if No
Neighboring Tank > 100' Yes
if No
ft
Private Sewer/Septic Line > 25'✓M Yes
if No
Absorption Field on Lot > 100' Yes
if No
ft
Holding Tank > 100' ❑✓ Yes
if No
Neighboring Absorption Fields > 100'
Yes if No.
Water Main > 10'
Animal Containment > 50' ® Yes
if No
F71 Yes
if No
ft
0 Yes if No.
Water Service Line > 10'
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' M Yes
if No
ft
[Z] Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0
Yes
if No
ft
Surface Water > 100'
Yes if No.
Property Line > 5'
0
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
if No
Yes
if No
ft
Private Wells > 100'✓0
Yes if No.
Water Main > 10'
Q
Yes
if No
ft
Community Wells > 200'
0 Yes if No.
Water Service Line > 10'
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'
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' U✓ Yes if No
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' Q✓ Yes if No
Surface Water > 100'
F/I
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that l 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.
COSA Checklist yellow sheet
ft
ft
ft
ft
ft
ft
ft
ft
ft
ft
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
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
~?..~_.~ '"~-C~C.. Dayphone S¢5-- 57e~
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
- lng to the legality and status of system:
TYPE OF WASTEWATER DISPOSAL:
Individual on-site /
NOTE:
If community well system, provide written confirmation from State ADEC attest-
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.
72-025 (Rev. 1191) Front MOA
5. STA'r'EMENT OF INSPECTION BY ENGINEER
As 6ertifie8 by rdy ~eal affix(~d he~-et0 and aS 0~ th~ validation date shown bej°w, 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, funotional and adequate for the number of bedrooms
and type of structure indicated herein. I fur[her 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 compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm /;bb.~ ~?~..,,r~,~.~.~o~ '~. ~_ Phone ~¢- %~ 1~
Address ~0~ ¢ I~ ¢ ~O~
o
Engineeds signature
DHHS SIGNATURE
,'~'. Approved for 4 bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and thei r 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.
~UNICIPALIIY OF ANCHORAGE
ENVIRON~EN[AL SERVICES DIVISION
Municipality of Anchorage SEP 2 0 1996
DEPARTMENT OF HEALTH & HUMAN SERVICE~ E C E
Environmental Services Division J V E D
825 L Street, RoomS02 · Anchorage, Alaska 99501 · (907) :34:3-4744
Legal Description: LoT
A. WELL DATA
Health Authority Approval Checklist
~-~C- ~' ~: T' I ~[,I,~ ! Parcel I.D.:
Well type
Log present (Y/N) ~
Total depth ? ~/1~
Sanitary seal (Y/N) y
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to ~ .~ Casing height (above ground)
Wires properly protected (Y/N)
Y
Date of test
Static Water level
Well production
FROM WELL LOG
AT iNSPECTION
g.p.m. ~' g.p.m.
WATER SAMPLE RESULTS:
Coliform ¢ Nitrate ~.j~ Other bacteria ~ 5
/
Date of sample: c//lol c/~ Collected by:
SEPTIC/HOLDING TANK DATA
Date installed //-/~-' 7 ~ Tank size /~'oc) Number of Compartments / Cleanouts (Y/N)_~
Foundation cleanout (Y/N) y Depression (Y/N) ~ High water alarm (Y/N) ' ~
Date of Pumping ~ b~ ~ Pumper /
ABsoRpTIoN FIELD DATA
gate installed lTJ'/O-7/-~- Soilrating ~o~ft%'bdrm)
Length' <;)--/ Width J ~, Gravel thickness below pipe
Effective absorption area
Date of adequacy test
Fluid depth in absorption field before test (in.);
Fluid depth ~ ~ (ins) Minutes later:.
~' ~) Monitoring Tube present (Y/N)__/~_ Depression over field (Y/N) __
<?/lo/~ ~, Results(Pass/Fail) '~' For Y
~) Immediately after ~,~D gal. water added (in.):
Peroxide treatment (past 12 months) (Y/N)
System b~pe ~
Total depth
! ~" Absorption rate = .~ ~O'¢~ g.p,d.
J'~ If yes, give date
bedrooms
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Size in gallons
Manhole/Access (Y/N)
"Pump on" level at*
"Pump off" level at*
High water alerm level at*
*Datum
Cycles tested
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
On adjacent lots
On adjacent lots '.~
Public sewer manhole/cleanout ~'~/~r,~ ~-~
Lift station ~/
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ~'Y'¢,'¥~ ,% ~
Foundation _ c~ I /::::~ . Property line .~ I~ ~-'~ Absorption field /n/
Water main/service line .~ ,'~O ~: Surface water/drainage '/%l¢ ~4~- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line '~ I 0 ~"~'~ Building foundation '~, ~ r~ ~-~. Water main/service line
Surface water [~,~. o V~J2 Driveway, parking/vehicle storage area ~
Curtain drain ~'~ 0,¢. &_ Wells on adjacent lots I 0 ;~ ~'
ENGINEER'S CERTIFICATION . /'
I certify that I have determined thru field inspections and rewew of Mumc~pal records'th~'t~e ~bO~/~ sycCtCrn9 are
in conformance with MOA HAA guidelines in effect on this date. ,
Signatur: -- '~-'~ .~ ~'~?~, ,4
Engineer s Name ~-~ ~ ~.~
HAA Fee $
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number