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T14N R1W SEC 25 NW4NE4 PTN 2.33 ACRES IN SW CORNER
T14N RIW SEC 25 NW4NE4 PTN 2.33 ACRES IN SW CORNER #050-381-71 • Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Bax 196650 Anchorage, AK 99519-6650 Page of www.cLanchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: s 1 C'7 y' 0'. 6 O PID Number: U5 0'- 3 Namea o°, lili Wastewater System: ElNew X Upgrade Addfe55 172,015 RWR RcIll ABSORPTION FIELD Phone: Number of Bedraoms:' ❑ Deep TrenchShallow Tl❑Bad ❑ Mound [I Other Soil Rating: Total Depth from orginnl grade: LEGAL DESCRIPTION I: GPDIFt' Fl 81ock: Lot Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: lei Ft. Township- Range: �} So on: I[ JMrli!- / kG Fill added above original grade: FI. Gravel Length: j lL Ft. 1 L�IY L. Gravel width: Numberorlines: 1 Jstance beMeen Ines. ^'- Well: ❑ New El Upgrade Fl. Classirication (Private, A (PriB, Cf: Total Depth'. Cas d lo: Total absorption area: -L Pipe Material: p _ ., � Yai Aii.' �jy_I �L. FL Ft' Driller. / a Dnlled: Sialic Water Level: Installl°er.r!! / t 1 , P X -AAI 'd'i`Ij I Dale Instal -led { T! V L{ FL e 1 Yield: Pump Set at Casing Height Above Ground: TANK GPM Fl. fl DISTANCES septic ❑ Holding ❑ S.T.E.P. ❑ Other: eptic Absorption Lift Holding PubliclPrival Manurecwrer ' carc:y Gal f 2C)C, ank Field Station Tank Sewer Line t5 i ; it Material: �_ NumoerarCompart I�tj I�Ly' LIFT STATION WSEPARATIONEPARATION N N ,� Size: Manufactureri Io �n�tV .N ^1 �% Gal. on' level al: 'Pump ofP level a'.- High water alarm ac[�' hry rPump 7 �yr . lV A in. in. in Pump Make 8 Motlel lachical Inspections performed by: $ �y"7 Al �% '� �% il 7L Remarks BENCH MARK Location and Description: [7U`t tris Aflj) Assumed Bevation: SCC` ih i Engineers Stamp /�`b ( rye Inspections performed by: vl- 1al Dates: 151 '71;L1/f% wNc e?i, --' - 2nd 1•, Development Services Depart t Ap Reviewed and approved by: Date: Conn (aov. Ivool SWING TIES AC = 150' BC = 16�' AD=79 BD = 98' I WTALLE'D STANDARD 5 -NIDE WWI/ \ \ 60 FT LONG 7 FT DEEP — I 3 Fl £fFECTIV£ ROCK MWALLED DIV£RTER VALVE �oC ` #I TN TANK CHECKED FOR CORROSION DAMAGE. I #3 TH e D 12 I rII InsukoW under driveway - -- SoAl pips under drive wa I - O ¢ Well --- I / ' 49th e ..:r .................. TEl1B BtN SPURKLAND�' f No. CE -2225 1 1 1 1 t 1 1 30 0 30 60 90 120 180 SCALE, 1' = 60' IUHCtN JYUKKLANU Yt.I 2,33 AC. SWI14 NW1 4 NE1 4 I I SEPTIC SYSTEM ASBUILT 203 W AK. AVENUE SEC 25 T14N R1W DATE. JUNE 29, 2004 (907) 279-3916 (NCH. 99JIM APREA SHE£r•� 1 2 GRID. SW46 PERMIT # SV040XXX PID # 050-381-71 1401P54.WD6 LXISINNG LENGHT = 42' Standard Trench, 5' Wide 64' Long 7' Beep 336' Sewer rock 4' Cover Silt Barrier ELEV. = 87. A ELEV. = 83.74�—� 3,0 Ft of Septic Rock Effective O Foundation Clean out O 1000 gal Septic tank O DMRTER VALVE LENGHT = 22' SPLHER NO SCALE "ELEV. = 77.5' 1250 gal, septic tank TOBBEN SPURKLAND P.E. I I 2,33 AC. SWI/4 AW114, NEI/4 I I SEPTIC SYSTEM ASBUILT 203 W15th Ave DATE; JULY 21, 2004 Anchorage Ak 99501 SEC. R14NROAD SHEET JIM 3/3 GRID, NW13 PERMIT I SW040XXX PARCEL ID / 050-381-71 1401255.DWG MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jul 12, 2004 Expiration Date: Jul 12, 2005 Permit Number: SW040260 Parcel ID: 050-381-71 Legal Description: T1 4N R1 W SEC 25 NW4NE4 PTN 2.33 ACRES IN SW CORNER Design Engineer: 0007 Tobben Spurkland, PE Site Address: 027205 ROOP RD Owner Name: Jared C. Johnson Lot Size: 101494 SQ. FT. Owner Address: PO Box 416 Total Bedrooms: 3 Permit Bedrooms: 3 Elmendorf AFB , AK 99506-0416 This permit is for the construction of: ❑✓ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. ^0N (1 NO PART OF THE DISPOSAL FIELD MAY BE UNDER THE DRIVE WAY. EXCEPT THAT CONNECTING PIPES MAY BE CONSTRUCTED UNDER DRIVEWAY PROVIDED THAT THE PIPES ARE PROTECTED BY FREEZING. Received By: Issued By: b , Date: �/L t•% Date: ry c Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FORA SINGLE FAMILY DWELLING Parcel I.D. 0 t70-381— 71 Permit Number SW Property owner(s) n j til A Pi-tff /} Day phone Mailing address (1) P -7.z-0 ;5 RC)Q P 1= ct-q i -e- -P— ,-"- Mailing address Zip Code Oyo/ 77 Legal description (Lot, Block & Sub'd.) 2 3& uc- S W 1/4 IN%V I>t N t= tl4 Legal description (Section, Township & Range) `rt q Lot Size & Yr`? q Acre Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or Permit Fees: W Waiver Fees: Date of Payment: Date of Payment: Receipt Number: 5t-( 1" Receipt Number: (Rev. 12/00) VN N °°.SPL 1 AND P3 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN 233 AC. NW1/4 NEI/4 SEC 25 T14N, R1W JIM APREA Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519-6650 June 29, 2004 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable test holes are also enclosed. The septic system design is based on the following : Ground Water @ 11.5 feet. Use Standard 5-WideTrench Soil Rating. From Testhole 06/01/04 2.3 min/in = 1.2 gal per sq.111day No. of Bedrooms 3 Required Area per Bedroom: 150/ 1.2 = 125 sq.ft. Total area required: 125 x 3 = 375 sgft Bottom Rock At 7 feet Top Rock At 4 feet Rock Depth 3 feet Reduction Factor 0.58 Minimum Trench Length 375 x.58/5 = 43.5 ft. Use 50 ft SYSTEM CONFIGURATION STANDARD TRENCH TOTALLENGTH 50:FP- Zar7 t 7 ] TOTAL WIDTH 5 FT TOTAL DEPTH 7 FT ROCK DEPTH 3 FT COVER 4 FT SEPTIC TANK 1250 GAL Existing, Check for corrosion damage. The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. I \ INSTALL STANDARD 5—WIDE TRENCH \ 60 FT LONG \ \ 7 FT DEEP 3 FT EFFECTIVE ROCK INSTALL DV£RTER VALVE o � CHECK TANK FOR CORROSION DAMAGL: TN In#2 I sulBh-wider . 'way . :. SoBd p/pe ander - _ TH 14 TH I � I ' 49th '.R. ............................ ......... .. ..°../.... .......SO.NT�PRKL ggg No. CE -2225.11 O Well / i T 1 1 1 1 1 1 1 1 30 0 30 60 90 120 180 SCALE., 1' = 60' IUNKLN 51 UKKLANU P -l' I 12.33 AC. SWI14 NW1 4 NEI 4 I I SEPTIC SYSTEM DESIGN 203 W AK. AVENUE SEC 25 T14N R1W DA TE- JUNE 29, 2004 (907)279-3 (NCH. 99501 JIM APREA SHEET. 112 GRID: SW46 916 PERMIT # SW040XXX PID # 050-381-71 1401251,WDG u Sit t Standard Trench+ Na SCALE 3,0 ft of Septic Rock Effective 5' Wide 60' Long 7 Deep 3.0' Sewer rock 4' Cover DIVENER VALVE Monitor Cleanout NO SCALE 1000 gal Septic tank 49th 3VEN SPURKLAND No, CE -2225 1000 gal, septic tank w a 3 L2 1203TDBBEN W1 SPURKe P.E. 11 2,33 AC. SF1/4 N)/1/4, NEI/4 I I SEPTIC SYSTEM SCHEMATIC 2D3 WiSth Ave SEC. 25, T14N, 14' DATE: OCT. 26, 1999 Anchorage Ak 99501 RlW ?7g_,y,r, JIM APWA, ROOP ROAD SHEET, 3/3 GRID, NW13 PERMIT / SW040XXX PARCEL /D / 050-381-71 1401253.DWG -1H "1 Municipality of Anchorage e®;?' Development Services Department °• q Building Safety Division ® On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 •eame•a•em s www.ci.anchorage,ak.us (907) 343.7904 ems$ a ®e Soils Log - Percolation Testg� w e..ormed For: // Date Performed: ,,-:z Description: 9,3`3 eLC C" tj X* '%y, � � tl'i Township, Range, Section: - i Illy , Q 1 '►XIS G �%2 Slooe Site Plan I Depth (Feet) 2- 3' i WAS GROUND WATER U:CCIJ?ITERED? 5 IF YES, AT WHAT DEPTH? D Deplh to Wale, Afier P Monitoring? _ E Date PERCCLATIO,9RATE PERC HOLE 01iM=T= TEST RUN 9ETA$EN Fi Alto FT N 01: F0 YL St. P-i1C- �O=iFORPIcD BY: k. �7 1 r CERTIFY THAT THIS TEST S ORMEO IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE Z4 Lv ' H ®� A e Municipality of Anchorage p� eo l Development Services Department 8° a `Q Building Safety Division E `>4 '+ ® -ate On -Site Water and Wastewater Program 'arr✓.ee�-°'"i°®' 4700 South Bragaw St- P.O. Box 196650 Anchorage, AK 99519-6650 aewnnarn+wo?'sr wwwci anchoraae.ak.us € p�}�.�e $n�,trMam e8k (907) 343-7904 d1.N% -,, jR� Soils Log - Percolation Test L 40 '?r4fir'cf'x erormed For. :J`� t M &P r— A Date Performed: E —f - try y Ls -;a, Descr,pticn: 0[„3� tz rlWi Intkt�+t F,jL'i{ Township, Range, Section: I IgN,el u'/, Slope Site Plan 2- 3- 1 - 7- St i It, S 444 {C.O L. LC1 A n D P I+N WAS GROUND MATER E>:Ci.U`I 1 --PED? 11 YES, AT V)PAT DEPTH? Depth to Water After Monitoring? Date: s L 0 P E PERCOLATION RATE tc,acles5ncl) P°RC HCL E DIAJETE3 T E ST RU:`: 9rINEEPI Fi AND FT 11TS Na T 5L)i1613iLE i7orL �eP�te '_.:FCR?dE0 EY. k5 I- CERTIFY THAT THIS ----- I TES V I ACCORDANCE V117H ALL STATE AND MUNICIPAL GUIOELINES IN EFFECT 014 THIS DATE DATE: n Municipality of Anchorage ,o© ®sem) �l Development Services Department? m 3r Building On-Site Waterand W slDivision walerProgram �A 4700 South Bragaw SI. P.O. Box 196650 Anchorage, AK 99519-6650 a k- w,w/cianchoraoe.ak.us (907)343-7904 Soils Log - Percolation Test�`[g V4.A { =T 1. °e" ormad For. J l M AP P— r—.4 Dale Performed: - "".s`,'. `% �1 '1 bJI—�. a'� Descrlplion. A33—at. N U�'/'j (� I^ i) T Township, Range, Section: "'r I,4 �i t (z, I y�/ c ;�S Slone Site Plan G WAS GP.OUND WATER 5 IFV"eS, AT WHAT DEPTH? d Depth to Water AfterP Monitoring? �l �2 E Dale: re—,; ��% 5'rcN � Reading Dale Gross Tim= I NeI Time I Depth to Nlater l Net D= --01... nE. ITS '-?FORMED BY. k, i , I i . CSRTIPY TY.A.T THIS TEST PER=ORt,IED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE (0/2q /0 JJT 10.101(7 ia4YNI r /Z 'L s l 3�' I Irl to I t I -7 I y '� Z ►13J1 I I 10;-6J I I'L'jv 10:40 z. Iz'1 1o:-„ 7'lu y 11 i 1 7 FE3LClATICPI PATE TEST RU`: BETWEEN Irnclesscc'+I ) PERC HCLS 01,:A r l AND bn, -S FT -TER f© '-?FORMED BY. k, i , I i . CSRTIPY TY.A.T THIS TEST PER=ORt,IED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE (0/2q /0 Municipality of Anchorage Development Services Department Building Safety Division On -Site Waterand Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Soils Log - Percolation Test e�ormed For. I I W A- PSI✓ /k Dale Performed: to —(?-0V La- a: Descr l:tion. �, ZiL l�J (I ij �l 1I �f Township, Range, Section: I I4N 4�.l Li/,4, 5ff Q5 Slone Site Plan 3-I 61rar1dy, g. 1d- 7 L V S. WAS GROUNP. --E E::CcI.`I T -_eco? 5 E i -%f}1217 i>/}f,•1 IF YES, AT 4'dHAT DEPTH? 0 Depth to Water After p 610niloring? E Dale: PE-COLaT10N PATS Ir'incles ret FERC HCLE DI Tc3 TEST RU' 9:7`AIEc`l FT AND FT rS N0T 5 u i A B I= aIF" 0- S1=ar1e- q �a .-ORh1ED BY. P �, O CERTIFY THAT THIS TaST V, S °a R=ORM!ED IN ACCORDANCE WITH Al L STATa AND i 1UNICIPAL GUIDELINES li I EFFECT ON T , S DATE. DATE: (.,/,1 /C Municipality of Anchorage Page of Z DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW 480 33S PID Number: 050 — 581 — 7/ Name: Wastewater System: ❑ New (Upgrade Address, U dor Ar-8 ABSORPTION FIELD Phone: No. of Bedrooms: 3 Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: /' Z Total Depth from original grade: GPD/Sq. Ft. J Lot: /+ BI ck: Subdivision: (� Corner 0i � t M6 t ,_ j I�VL'/L2-14 Depth to pipe bottom from original grade: d' Ft. Gravel depth beneath pip Ft. Township: Range: / yN I Section: S Fill added above original gra/de: Gravel length: p 3 Z LV 5,5& Ft. ( Ft. WELL: ❑New El Upgrade Gravel width: S Numberoflines: Distance between lines: NA Ft. Ft. Classification (Private, A,B,C): Total Dept Cased To: Total absorption area: Pipe material: /7 30 3 Ft. Ft. 375+ SQ. Ft. F 8I0 Driller: •1n Date Drilled: Static Water Level: Installer:, Date installed: Ft. CSS W�Q�.�'.' fj' f/r?l( �a iz 9P Yield:/SIS ump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES) Septic ❑Holding ❑S.T.E.P. To Septic Absorption Lift Holding ublic/Private Manu�jtactu�re/p, /� 7-LLYLk Capacity in gallons: �l /OtJ,n From Tank Field Station Tank Sewer Lines /1 r1(iet y Well /QO/ 4Surfac /DDI ,� _ _ .--. Material: / / S e,. Number of Compartments: Watere DD' LIFT STATION Lot !`` ! ` _ Size in gallons: Manufacturer: Line j9+ ✓r Foundationr o -%/0 -i _ "Pump on" level at: "Pu ' level at: High water alarm at: Curtain' I I 00`!4 _ _ _ Pump Make& a Electrical Inspections performed by: Drain B�-i' Remarks: L61 line 4L) - Id wal ve r- BENCH MARK I A A Location and Description: it or��! Assumed Elevation: A O IL ENGINEER'S SEAL OF 4 A�4 '' + .�: Inspections performed by: N ems✓ Dates:1s )0//2/q,0 • • B— e e •e•e .i,e•jo 2nd 8 ... .....: ...;... Kenneth ,���,, Department of Health and Human Services app va(I CE 711 +to�FOPR �e Reviewed and approved by: Date: / - OFESN +mss SO 72-013 (Rev. 9/91) MOA 25 AS—BUILT SYSTEM DETAILS/SITE PLAN RICHARD RAYMOND POOP HOMESTEAD—CORNER OF NW1/4,NE1/4,SEC25,R1W,T14N Permit SW980335 PID#050-381-71 TH MT PRIM RY SYSTEM O E TOP SLOPE C25% > °a O• EXISTING WELL °. SCALE: 1" - 50' Aw OF AL41 * 49TH /... / KENNETH M D CE 7116 cstis'k'/ d p,?DFESS101�FZ' AV 39.2' PREPARED FOR; JARED JOHNSON P.O. BOX 416 ELMENDORF AFB, AK 99506-0416 (907)694-4200 FIELD BOOKS COMPUTED: BOUNDARv: FLEMING DRAWN: KMD STAKING: FLEMING A—C-222' KMD ASBUILT: FLEMING 97.7 10/25/9 DWG. FILE: GRID: B—C=30.5' ACAD FILE 98099.DWG IOB No.: 98099 A—D=27.8' I—n E w B—D=37,0' 9208 FINISHED GRADE 9209 A—E=123.6' B—E=1362' FILTER FABRIC',,VNRIES q A—F=162.2' l000 GAL T SEPTIC 8765 57,69 B -F=175.2' ;� TANK SEWER ROCK .1' 9299 92.8 83.5 c83,52 Aw OF AL41 * 49TH /... / KENNETH M D CE 7116 cstis'k'/ d p,?DFESS101�FZ' AV 39.2' PREPARED FOR; JARED JOHNSON P.O. BOX 416 ELMENDORF AFB, AK 99506-0416 (907)694-4200 FIELD BOOKS COMPUTED: BOUNDARv: FLEMING DRAWN: KMD STAKING: FLEMING CHECKED: KMD ASBUILT: FLEMING DATE: 10/25/9 DWG. FILE: GRID: SW465 ACAD FILE 98099.DWG IOB No.: 98099 SCALE: NTS 77,52 ami J tLly\ ZJ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 e o x oc N� S b4'c o R_ , C� O 0.1 v � 1,71 o 0 9 IOZ �' o u O x• ,� n N y o a m o m to -q rn m� 14, �\\q `rA'RA\ 14 I `6l� • v 1 (� n �� n �� W p V.1 av � n a a ?' o y e e o %�?• � II�r; m 4o n 3.rc noof. • y too \ 1 ix w co m ?o `..� J`�7 .v.. a HJ• n o �� m n C °• � A a? 0 0� I V B• • i i � S� r n •tel O Z Cna ,• ° 4' a e e v •• . VSA rV Z CO Q ^•' ae ~ a i _ w • �j�,•• ••�+�1y����i•• �I c CO .o ke 4W o o a 9 n 0 a n� o �c a RSL 9 r0 l� n m v o o e o w o _. � '•� H ter. n EB m a $ 3 � a c `c p --� n� � �1 N '[� m y p` • m ti N c 0 Z � t. • r a� p O N w b .� p p o E 3 r`�s •t(t��e IUTI C � � �I N 1 x r0 V w m A O D O �� r• ••�! \ O =\1 A � D Orn � � C � • w w m y .� • • .t! `11 JJJ V\V v co co L c o o h -• c p O rw•' m n 0 m N Municipality of Anchorage Department of Health and Human Services 825 "L" Street Rick Mystrom, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 http:l/www.c1. anchorage. ak. us November 4, 1998 Ken Duffus, P.E. KND Engineering 20441 Ptarmigan Boulevard Eagle River, Alaska 99577 Subject: Waiver Request for T14N RIW Sec 25 2.3 Ac. In SW Corner ofNW4 NE4 Waiver Request #WR980087 Parcel ID #050 381 71 HAA# HA980410 Dear Mr. Duffus: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 5.0 feet. This separtion distance is from the absorption field to the west property line. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Add comments / explanations or DELETE If there are any further concerns or questions regarding this waiver, please call our office at 343-4744, Sincerely, ,, s Jeffrey W. Poet Engineering Technician On -Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Date Received: October 30, 1998 Legal Description: T14N R1W Section 25 2.3 Acres in SW corner of NWS NE -1 Engineer: Ken Duffus, P.E., KND 20441 Ptarmigan Boulevard, Eagle River, Alaska 99577 Applicant: Jared C. Johnson Waiver Requested: Lot line waiver of 5 foot from the property line to the leachfield Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: By: G Rec #: 04263/6707 Amount: $ 115.00 0 Date Paid: 10-30-98 Waiver Review Worksheet 050-381-71 HA# RA980410 Permit # Date Received: October 30, 1998 Legal Description: T14N R1W Section 25 2.3 Acres in SW corner of NWS NE -1 Engineer: Ken Duffus, P.E., KND 20441 Ptarmigan Boulevard, Eagle River, Alaska 99577 Applicant: Jared C. Johnson Waiver Requested: Lot line waiver of 5 foot from the property line to the leachfield Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: By: G Rec #: 04263/6707 Amount: $ 115.00 0 Date Paid: 10-30-98 K14D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11/FAX (907)696-8111 October 29, 1998 RECEIVED Municipality of Anchorage Dept. of Health & Human Services OCT 30 1998 On -Site Services Section Mut:iclpality of Ancnorana P. O. Box 196650 Dept- Health & HUMall Services - Anchorage, Alaska 99519-6650 Subject: Upgrade Sewer Permit/Lot Line Wavier — Roop Homestead Corner of NW1/4; NE1/4; Sec 25;R1W;T14N Gentlemen: During the construction of the septic system it became necessary to move the system further away from the driveway due to large boulders encountered in the trench area. As the system was still within the testhole radius and we appeared to have sufficient property to extend the trench we did not anticipate a problem at that time. During the as -built process we encountered a problem with the system being in close proximity to the lot line. Subsequently we had the system surveyed and verified that the system was constructed within 5 feet of the property line (see attached survey). Due to the steep up hill slopes, large underground boulders and driveway there is limited area in which to move the system from its present location. We are therefore requesting a 5-7foot waiver to lot line at this time. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, EHD Engineering Kenneth M. Duffus, P.E. attachments: Survey As -Built Inspection Report HAA w/waters Permit Number: SW980335 /6-)2-7N 3:.0/-k MUNICIPALITY OF ANCHORAGE / ° / 3, q 1. p o 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 Date Issued: Sep 03, 1998 Expiration Date: Sep 03, 1999 Parcel ID: 050-381-71 Legal Description: T14N R1 W SEC 25 2.33 ACRES IN SW CORNER OF NW4NE4 Design Engineer: 0070 KND Engineering Site Address: 027205 ROOP RD Owner Name: Jared C. Johnson Lot Size: 101494 SQ. FT. Owner Address: PO Box 416 Total Bedrooms: 3 Permit Bedrooms: 3 Elmendorf AFB , AK 99506-0416 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements 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. Received i Issued By: J /li✓✓- C Date: o Date: 3 - <78 K14D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-8111 August 14, 1998 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Upgrade Sewer Permit — Roop Homestead Corner of NWI/4; NEI/4; Sec 25;R1W;T14N Gentlemen: At the request of the owners, on August 6, 1998, we excavated one testhole for the subject property to upgrade the existing system, which was identified by another engineer as marginal. The results of these tests and water monitoring are attached. We propose to install a 5' wide shallow trench. The existing testhole had registered no water but due to the shallow nature of the testhole we elected to use a shallow trench. We anticipate additional fill being needed over the system. This lot slopes from northeast to southwest. There is a steep slope in excess of 25% in front of the house. All other slopes are less than 25% in the vicinity of the proposed system. There are no public or private wells within 100' of our proposed system location except as noted. There is neither surface water within 100' nor any known curtain drains within 50'. We do not expect that there will be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, M -14D Engineering Kenneth M. Duffus attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Tests WASTEWATER DISPOSAL SYSTEM DETAILS RICHARD RAYMOND RO❑P HOMESTEAD -CORNER OF NW1/4,NE1/4,SEC25,R1W,T14N M TH #98-1 PRUPCSUD UPGRADE I C° KNo o D INSTALL D ERTER D � 4 � R S ESD 10 C° o D 0 EXISTINE I FX"STING SEPTIC 0 OF ALS \ 1 PREPARED F❑R; JDE PERRDZI 16600 CENTERFIELD DRIVE n TH * +I EAGLE RIVER, AK 99577 * `f- J (907)694-4200 / K� D`/ FIELD ROOKS COMPUTED: ` CE -7116 4� BOUNDARY: FLEMING °RAN" KMD 11T /�/Cg - GtiQW STAKING: FLEMING CHECKED: K M D 6 ASemEr: FLEMING DATE: 8Z1 5 p�FESSIOC}N= DWG. FILE: GRID: SW46` ACRD FILE: 98099.DWG JOB Na.: 98099 Scale: 1'= 20' � PAGE 2 OF 3 HLD ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX 907)696-6111 WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN RICHARD RAYMOND ROOP HOMESTEAD—CORNER OF NW1/4,NE1/4,SEC25,R1W,T14N NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. OF AL4 \ 1 / * 49TH *// I` KENM. DU 5 �C/E 7116 W=14 of � pRDFESSI0�P1 � DESIGN DETAILS 3 BDRM X 150 GPD = 450 GPD 450 GPD/1.2 GPD PER SQ. FT. (1.5 MIN/INJ= 375 SQ. FT (375/5'(W)) X .50 (RF) (4.0' GRAVEL) = 37.5' FT, TRENCH USE 1 TRENCH - 38' (L) X 5' (W) X 4'(D) Total depth of system is 5.0' from original grade. Total depth of gravel below distribution pipe is 4.0' NOTES: 1. USE 1000 GALLON SEPTIC TANK,IF REQUIRED. INSULATE TANK IF <4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM. 3. CONTRACTOR WILL ENSURE MAXIMUM 27. SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN, 3' COVER IF REQUIRED. 5. CONTRACTOR TO VERIFY INTEGRITY OF TANK AND REPLACE IF REQUIRED i6. CONTRACTOR TO INSTALL FCO. PREPARED FORT JOE PERROZI 16600 CENTERFIELD DRIVE EAGLE RIVER, AK 99577 (907)694-4200 FIELD BOOKS PROPOSED UPGRADE BOUNDARY: FLEMING O KMD STAKING: FLEMING wsrAiL n areage K M D ASDUILT: FLEMING I. 6PL, IT. 8Z15 LY STING SEPTIC cx�snnc �cS4 ? SW45E ACRD FILE 98099.DWG ° • EXISTING WELL 'q4 . TOP SLOPE <25X J Bk 1291 Pg 0769 & Bk 2735 Pg 909 e � \. NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. OF AL4 \ 1 / * 49TH *// I` KENM. DU 5 �C/E 7116 W=14 of � pRDFESSI0�P1 � DESIGN DETAILS 3 BDRM X 150 GPD = 450 GPD 450 GPD/1.2 GPD PER SQ. FT. (1.5 MIN/INJ= 375 SQ. FT (375/5'(W)) X .50 (RF) (4.0' GRAVEL) = 37.5' FT, TRENCH USE 1 TRENCH - 38' (L) X 5' (W) X 4'(D) Total depth of system is 5.0' from original grade. Total depth of gravel below distribution pipe is 4.0' NOTES: 1. USE 1000 GALLON SEPTIC TANK,IF REQUIRED. INSULATE TANK IF <4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM. 3. CONTRACTOR WILL ENSURE MAXIMUM 27. SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN, 3' COVER IF REQUIRED. 5. CONTRACTOR TO VERIFY INTEGRITY OF TANK AND REPLACE IF REQUIRED i6. CONTRACTOR TO INSTALL FCO. PREPARED FORT JOE PERROZI 16600 CENTERFIELD DRIVE EAGLE RIVER, AK 99577 (907)694-4200 FIELD BOOKS COMPUTED: BOUNDARY: FLEMING DRAW: KMD STAKING: FLEMING CHECKED: K M D ASDUILT: FLEMING DATE: 8Z15 DWG, FILE: GRID: SW45E ACRD FILE 98099.DWG JOB N°' 98099 Scale: 1'= 100' PAGE 1 OF 2 L(LL\1 JJ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 6 ��• [iN<.;INUIZING * �P,•...... •..• ■ 49111 20441 PTARMIGAN BLVD. ■ EAGLE RIVER, AK 99577-8736 x f :KENNETH M. D 1S'C SOILS LOG - PERCOLATION TEST Si�7FESS1tl Performed for: j_�e �G/-li _Date Performed: rip 9,� •\11�p�� Legal Description: w NE S r1171A R I V4 TEST HOLE # 7 1- L-) rave% 2 h 4/9sav)d 3 - is 6- cobbles -4 lZ" 7- �Q k) W/Sorn s- 6/ 9- 10- V) 11- 3oN 19- 20 - SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? v What depth?_ Date 9P, — 8 i 14 1 Depth to water after monitoring? D, 5 Reading Date Gross Time Net Time Depth to Water Net Drop ! sW s: Iv - Z. 5•� Otx�n/6� l 13/ � 5:x/3 — !o'• -- 8 o� stir k7 Iz lo; 5 %bwt 3 t Percolation Rate .j, (min/in) Perc Hole Diameter/102 "fest Run Between �feet and _._ _ leet I, Kenneth M. Dull us, (TI t I ty that this lesl was performed in acrurdance with Al State and Munhipal guuiclincs in effect on this date: GREOER ANCHORAGE AREA BOOGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME K // C: MAILING ADDRESS L?24 (3 `2/KIV t r PHONE LINING MATERIAL D CRIB SIZE: DIAMETER_DEPTH__T� LOCATION-It/de CK�G><'I LEGAL DESCRIPTION TIFF-R/1AIV 5;:25- IVAV C SEPTIC TANK: DISTANCE j �/- / NUMBER OF FROM WELL MANUFACTURER aC^Q$+��'IMATERIAL/ e COMPARTMENTS Y` INSIDE LENGTH INSIDE W D HC)UID DEPTH LIQUID CAPACITY GALLONS. SEEPAGE PIT: NUMBER OF PITS �. DIAMETER OR WIDTH `g, '' LENGTHjj, DEPTH , LINING MATERIAL D CRIB SIZE: DIAMETER_DEPTH__T� DISTANCE FROM: WELL BUILDING FOUNDATION_, NEAREST LOT LINE ,Z_t. TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: d--MUCIfe, CONSTRUCTION - /Of/QfWIX DEPTH U✓ DISTANCE FROM: TYPE J_eAf If BUILDING NEAREST NEAREST FOUNDATION SEPTICJJ� SEEPAGE / LOT LINE -,SEWER LINE TANK /(& SYSTEM CESSPOOL OTHER SOURCES , APPROVED DISAPPROVED REMARKS l ,,t I9 {� l ,y ✓ ✓;11'iV DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: Well PIPE MATERIAL I f 95 O I -1O et S e IprGj ` LOT SLOPE: 1 REMARKS: ,(/ 1 IcYHq�'%r�Q Y10/Gh Pill 11 �X�5l my d,®Q d C(;6 C., rme of ("Vec io�1 DATE /&;/9Z3 APPR )v'_Y_ Form No. EQ -031 ¢o w e^' NAME OF APPLICANT V -- INSTALLATION LOCATION LEGAL DESCRIPTION _ 10 0 GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH S 1_" 5ae, • 2 SEEPAGE PIT DRAIN FIELD /, L L SOIL TEST RESULTS ` �^"� `"� NOTE: THIS PERMIT COMPLETION DATE ANTICIPATED PERMIT NO OTHER NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE 0.e TYPE SEEPAGE AREA SIZE/v X `-4 l);IA V' MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT `o / DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL / I SEPTIC TANK , SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK � ,SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD /J t SEPTIC TANK, , SEEPAGE PIT ! DO DRAIN FIELD , TO RIVER, LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REG ATIONS REGARDING INSTALLATION. G� r G.A.A.B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATUREI` FORM N Q-016 0 & E AINEERING & DEVELAENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 333-5240 Russell Oyster Earl Ellis 694-2774 333-5240 Civil Engineering Surveying Soils & Foundations Land Development SOIL LOG y, �r�f¢6 lJ aoEe G�wu> \ v L' Performed for: Name: Tel. No. U -)A --Z4 Mailing Address: P0. Z',-, Legal Description: itwY,sib ly v Uj- r 5-:T--2 -s" L'u !v AT Depth (feet) Soil Characteristics 06¢rH S�c7� r �i �� Sou C\a 5.�� esk %7."-c 0 1 O-- \-z.' 2 3 4v, 5 5 F4\ez�Y Y.�NT ca�� 7 g c,a�i waY, ���i—may �ANpy Q ccp u .s 10m� �i_ 1?%f-- 11 -.5, 77 12 _ 9c �.�•�.y `T� rcaT . Ground Water Encountered: Yes No� If yes, what depth Proposed Installation: Seepage Pit �' Drain Field Comments: , � lei sv¢ �c� A x -�:7- 2, -7 --t-'*) k�ass Wes; �a � 4 1-0C'(.gs> tas a 11¢aT'>Lk Performed by: 7E?7� L) , 9, Date: � �uN -73 MUNICIPALITY OF ANCHORAGE Development Services Department , Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 050-381-71 Certificate of On -Site Systems Approval Expiration Date: 7/2/2025 Legal description T14N R1 W SEC 25 NW4NE4 PTN 2.33 ACRES IN SW CORNER Site address 27205 ROOP RD Eagle River Current property owner(s) NOWAK ERIC A X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: By: Original Certificate Date: 7/31/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY OF ANCHORAGE RU.54 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-381-71 Complete legal description T14N R1W SEC 25 NW4NE4 PTN 2.33 ACRES IN SW CORNER Location (site address) 27205 ROOP ROAD, EAGLE RIVER, AK 99577 Current property owner(s) ERIC A NOWAK Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well F Private Well serving 2 dwelling units F] Private Well serving 3+ dwelling units ❑ Community Well or Public R Water Storage 4. TYPE OF WASTEWATER DISPOSAL: Z Private Septic Fj Private Septic serving 2 dwelling units Fj Holding Tank El Community Septic or Public Sewer 5. SEPTIC TANK: N Steel 0 Plastic F Concrete F Fiberglass Age 26 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: E] AWWTS n Bed n Deep Trench Z Wide Trench El Seepage Pit Waiver request for: Expedited review requested: Z Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 'b SO Date of Payment 7Z COSA # 05 C,Z-912!51 Waiver Fee $ Date of Payment Waiver # COSA Appliration.doc COSA Checklist .docx COSA Checklist Legal Description: T14N R1W SEC 25 NW4NE4 PTN Parcel ID: 050-381-71 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled UNKNOWN Total depth UNKNOWN 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 7/2/2024 Static water level at beginning of test 133 ft. Well production at time of test 2.5 gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 7/2/2024 Comments Previous HAA MOA record docs show well log data, but no well log could be found in the MOA or DNR record search & actual drilled date, well depth and casing is unknown. B. TANK DATA Measured operating fluid level in septic tank 48” Date of pumping 7/8/2024 Required maintenance completed, if AWWTS Comments: MUST MAINTAIN PROTECTIVE BARRICADES C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 7/19/2004 ALL standpipes present per record drawing Total measured depth from existing grade 7.6 ft (max) Measured depth to pipe invert from grade 4.3 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective 2.96' ft Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 7/8/24 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 7/9/2024 Results Pass Fluid depth prior to test 0 in Water added 1000 gal New fluid depth 7 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY ED per record drawings) 40 in (MOA 3.36’ ED) Effective depth used 5 in (Final Fluid Depth) Effective depth (ED) remaining 35 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximate 5” of effective depth missing. COSA Checklist .docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 7/26/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 7/26/24 MUNICIPALITY OF ANCHORAGE Septic Tank Advisory Certificate of On -Site Systems Approval # OSC241251 Legal Description: T14N R1W SEC 25 NW4NE4 PTN 2.33 ACRES IN SW CORNER The septic tank for this property is 26 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more, not including engineering, surveying, MOA permitting fees or site restoration. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. rr + I - r . y i J rt` t y fff IF I�tiVk 5 , Ja AC J�:}_i} r. 4 t r '- `.T _��,[�_�,•. ,tom +�'w _,.� - .t Y.•, �■' t� - - ti - .•, `1 .+n_, : rt r= Li, ••�l-r •ri:� + .. LCL- Te � � it � _ �}- - _ - r - �. r.•F:-.•' ,J . .y} + •�' y -+•fix' ••#r•yr'1. _ L�7 '�•,� c_IP ��•I'+l _,� �t Li'l ' '7y- --•. �. k �• ,� - ..•:f ..� , tip' _{���■ -• _� iy. •tiy •_K �Y �1 TX—h••• L • • - •. f L. • i. � .1 - '� - til -S�6FT 1 •y � k . 1 pr r� ,l . � � •. '�,� S': '• - � ■■C ' _ it r+� � � L + � L J:LC ;Pit 2 k 64 UNSU 13 a1 {N W4 -9'57R W 127 PORTION OF THE NYS/4 NE/4 SEC, 25, T14N, RIW, SAL L I PP * gmm HE RADIUS 1 � (DELTA=153'5:2'1 3" TRACT C-lA1 PLAT #2000-108 6>�423„ w ?>3 g g UNSUBDIVIDED 89'49'57" W 127.00' ASPLS MORTGAGE LOCATION SURVEY NOTES: NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE RECORD PLAT. THERE MAY BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE CONDITIONS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION CONTAINED IN THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. LEGEND O RECORD DATA PER WARRANTY DEED RECORDED AS DOC. #2004-056471-0 �9 FOUND 2.5" ALUM. CAP 0 FOUND 5/8" REBAR, NO CAP GRAVEL DRIVEWAY FENCE E E OVERHEAD UTILITIES o P POWER POLE SEPTIC PIPE c" WELL co o � \ o 0 LARGE BOULDER ` DECK / 0 CONCRETE ro / co Ln c0 BRICK PAVERS o II\ \ PORTION OF THE NW/4 NE/4 SEC.25, T14N, RIA S.M. co I I �bry 4' Sb CANT.\ r24 �sf ��4• \ � d V A PP & ELEC. METER 110.7 bb �� \ ESE 100' WELL RADIUS I I 1 I m UNSUBDIVIDED Lo C) ((DELTA=153'5 2'13") (S 89°49'57 " E 70.0( 95.4' 0').0 ARC=134.28') DELTA=36°52'12") C(RAD= 0'(HORD=N 06'08" E) (RAD=50.00') 91)(CHORD=7.4(ARC=32.18') '"W) (CHORD=S 71°23'51" E) (N 26'4958(CHORD=31.62') okb BASIS OF BEARINGS: (S 89°49'57" E 256.01') 255.70'MEAS. LOT 1 BLOCK 1 PLAT #84-287 - 8.15) \ 30' \ \ 30 \ LOT 1 BLOCK 2 \ \ PLAT #84-287 o' 50' 100' SCALE: V= 50 FEET (11"x17") �. OF. A�gsl ••49TH ••*1 J ••Ryan G. Johnson; r�+,••No. 192159 ,•� 71122112024. °SHAW AS -BUILT OF: Municipality of Anchorage 1!`'HPG -BGi • Development Services Department s Building Safety Division - Q On -Site Water and Wastewater Program s 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 r www.ci.anchorage.ak.us (907) 343-7904 w CERTIFICATE OF HEALTH AUTHORITY APPROVAL Aw FOR A SINGLE FAMILY DWELLING Parcel I.D. OSO - 3$l - `11 HAA # OLA Expiration Date: d �z q - 1. GENERAL INFORMATION Complete legal description1l I�l� ; SEC. Z5, 50*.,7�1 4 /tyF-Vq r ' 9 12, e �q Location (site address or directions) zl70r Rola Rare —` Current Property owner(s) J iAN APREA Day phone (016 - (08 i it Mailing address M05 RCOP ROAD a Lending agency Day phone Mailing address Real Estate Agent TOE peRO z -r-,L Dayphone 2-16-24(0 Mailing Address 2(000 Qo AV?s- J ANr-4p(ZA(rE Ak 9w -o3 Unless otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 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 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 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 10V), �6C-N 5,PQRkLANJ) Phone 2-49,-'YII (o Address '203 y:': 1?�'� r�ri}t �� AJVC D -L& . V, TO;Vj Engineer's Printed Name 1636CM _ePL K' LAND Date 5. DSD SIGNATURE !/ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the followin Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By:Original Certificate Date: 7 (Rev. 01102) Municipality of 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 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ��+�+, RIW. SLC 25. 5w'�y y `M,E t)ti Parcel ID: 0S0--.3�11-JI A. WELL DATA Well type Date completed 1477 If A, B, or C provide PWSID # ±1/14V Well Log (Y/N) Sanitary seal (Y/N) Y Total depth 310 ft. Cased to Its ft. FROM WELL LOG Date of test 14-17 Static water level � Lf ft. Well production IC g.p.m. WATER SAMPLE RESULTS: Wires properly protected (WN) Y Casing height (above ground) _'Lin. AT INSPECTION Itc9 ft. C7 g.p.m. Coliform —0--Colonies/100 ml. Nitrate PLLO mg.A. Other bacteria N10 colonies/100 ml. Arsenic: mg.A. Date of sample:C--C."Collected by: I_ 926) B. SEPTIC/HOLDING TANK DATA 12t Fr4cd �W y - Tank Type/Material sve A Date installed(01 121 c°f� Tank size 0-50 gal. Number of Compartments .2 Cleanouts (Y/N) Foundation cleanout (Y/N) —/— Depression over tank (YIN) High water alarm (Y/N) A/ Date of pumping c' Pumper C. ABSORPTION FIELD DATA Date installed 1114101 14G'` Soil rating (g.p.d./ft2 or fty2f/bdrm) I,Z System type - l IZCAi',�1A Length (iC, ft. Width 5 ft. Gravel below pipe 17 ft. Total depth 7 ft. Eff. absorption area 517 112 Monitoring tube Depression over field Date of adequacy test la t w' Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test ✓in. Water added gal. New depth t'�'in. Elapsed Time: ✓min. Final fluid depth ✓in. Absorption rate >= 111!3-42 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ��'A If yes, give date `— D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N T) "Pump on" levgl dt' in. "Pump off" level at in. High water alar evel at in. Datum al Cycles teste Meets al &circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 71X Absorption field on lot 1,100 Public sewer main A�I.J,A Sewer /septic service line '750 r On adjacent lots T IUJ3 r On adjacent lots dG Public sewer manhole/cleanout _ 4A Holding tank &1 A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: d Building foundation i iC Property line l dQ� Absorption field Water main N A Water service line 7 dt! Surface water Wells on adjacent lots >1100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line lo, Building foundation J SO Water main N./A r .1' Water Service line Surface water 4A Driveway, parking/vehicle storage Curtain drain N .` Wells on adjacent lots >tO COMMENTS G. ENGINEER'S CERTIFICATION I ' ! certify that d 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. o Engineer's Printed Name_ Date -7/oq 7 / V Ll HAA Fee $ L% :W �- v�-DU Waiver Fee $ 7 (g81K , - Date of Payment /���D y3� Date of Payment _ Receipt Number r Km Receipt Number (Rev. 12/01) ?01, 25. 2004 9:09AM RE,MA% PiOPERTIFS • ��e�� S� wi�KCrs-Np 2_7C �f Ar" .. .+tri/J',ial fro�sa Na, 2895 P. I I HEREBY CERTIFY THAT I HAVE BURVEYED THE D :� FOLLOWING DESCRIBED PROPERTY: / -.say , ; ar rr � YOA� ;7DAT+ .. ..... .RAND TFfAT NO F.NCk04CIiM NT'8 EXI$1• EXCEPT A8QINDICATED, IT 18 THE RESPONSIBILITY OF THEOWNER TO DETERMINE THE EXISTENCE OF ANY ID:r, • N EASENENTS� COVENANT$, OR RESTRICTION? Sw ytr •• WHICH DO NOT APPEAR ON THE RECORD® SUBDI- ; I V181ON PLAT, UNDER NO CIRCUMSTANCES SHOULD F6 r5 19018 ,is ANY DATA HEREON BE USED FOR CONSTRUCTION /as�b' fy . •b , OF FENCE LINER OR hh FOR ESTABLISHINO BOUND- ARY LINES. DRAWNi hh��` O MUNICIPALITYANCHORAGE ARL • DEPARTMENT OFFHEALTH & HUMAN SERVICES Division of Environmental Services sib On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# X5-0^ 3,51- 7! HAA# 1. GENERAL INFORMATION Lu, Complete legal description forfiim o f t/2/ NW %4/t/zE_ %/ Sem Zt Tly�( R 1�� X111 Location (site address or directions) Z 7205 Property owner - tamed oacs rvn5 G Day phone Mailing address Lending agency Day phone Mailing address Agent !�.L P x2e Day phone 61L- �%2L2L Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. \� 72-025)Rev.1/91) Front MOAn21 S. 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 forthe 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 compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm KJlD E` g+���ing Phone GZ� Address Eagle River, AK 99577-87' Engineer's signature Date s �� 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 3� Date /f` �/" q g 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 their lending institutions in orderto 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. M-= (Pe 1/91) ao k MOA M21 !e Municipality of Anchorage � DEPARTMENT OF HEALTH & HUMAN SERVICESW I Environmental Services Division MNLr,VaA 825 L Street, Room 502 • Anchorage, Alaska 99501 • (90I PMA4 ,irks rnvA Health Authority Approval Checklist Legal Description:AoY v{//{%lf�d�F� ll� e25%/41/ )I4/ Parcel I.D.: 050-3S 1 A. WELL DATA Well type 14671 If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) / Y Date completed 197-7 Total depth 3�/ Cased to Casing height (above ground) l� Sanitary seal (Y/N) / Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION / Date of test /977 7-1—f6 ��✓��i Static water level 341 /3,31 � Well production 12) g.p.m. g.p.m. WATER SAMPLE RESULTS: wee ; ael / ear 3 SE . Coliform Nitrate 7 Other bacteria Date of sample: Collected by: 4/0 14 (f f-1-1 `I B. SEPTIC/HOLDING TANK DATA Date installed o � xg Tank size /X0 Number of Compartments Z Cleanouts (Y/N)_ Foundation cleanout (Y/N) i— Depression (Y/N) A/ High water alarm (Y/N) Date of Pumping & Pumper C. ABSORPTION FIELD DATA / / Date installed /O /2 Soil rating (g.p.d./W or ft2/bdrm) •2— '/ System type / ee keo7 h Len 3% z Width `i• � Total depth Length � Gravel thickness below pipe// p Effective absorption area 3%S "f Monitoring Tube present (Y/N)--L Depression over field (Y/N) Date of adequacy test Results (Pass(Fail) For Fluid depth =:: efore test (in.); Immed' ely after_ gal. water ed (in.): Fluid depthinutes later. Absorption rate = .p.i (past 12 months) (Y/N) , / if yes, 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested G E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* Septic/holding tank on lot /DD -!" On adjacent lots /DD Absorption field on lot / D O On adjacent lots /1)0 1 + / Public sewer main /,O,� /� Public sewer manhole/cleanout /LOC) Sewer /septic service line /0eq Lift station N//A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: i Foundation Property line Absorption field /0 i 1 14- Water main/service line /D 44- Surface water/drainage 400 Wells on adjacent lots /,J 0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: 1� War'✓e✓Q��P-� / 1� Property line 6-, % Buildipfg foundation Water main/service line %U Surface water Driveway, parking/vehicle storage area /U Curtain drain /0 0 4- Wells on adjacent lots /Z% O f" F. ENGINEER'S CERTIFICATION I certify that !have determined thio field inspections and review of Municipal recgpl�tNa„Tja,s'j & q�ytems are in conformance with MOA HAA guidelines in effect on this date. ®,?q ; .**.� + it 49 Signature L ° Engineer's Name ff?nt7e�1� Date Lb%�%� ��•.��.���,�i r'Wo ESS1l1NPi HAA Fee $ �-: ov• fl Waiver Fee $ 1t\ L, L -f Date of Payment n — �� ��/ Date of Payment \L - Receipt Number C Z -7) -S Receipt Number ( (oib'-)) L`{ � 72-026 (Rev. 3/96)* ✓I 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# 40570-39-j-71 if�q��sl. HAA # �r �F 1. 4 3. GENERAL INFORMATION Complete legal description m}4tartfia—`" F���-p}q�d1-R�F9r6ee T 14)v rtr i., <ci o r ?o Location (site address or directions) Mile 7.4 Eaale River Rd at Roon Road Property owner Ken Scollan Day phone Mailing address Lending agency Day phone _ Mailing address Attention: Anita• 11421 Old Glenn Hwy., Ea le River, AK 99577 Agent Robert Bannon, Investment Brokers of Alaska Day phone 277-6 o Address 880 N. Street, Suite 303, Anchorage, AK 99501 Unless otherwise requested, HAA will be held for pickup NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water 2 Installed system for 3 bedroom NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: ' NOTE: Individual on-site xxx Holding tank j Community on-site ,,; .' Public sewer � l ; If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72d25(FtW-1191) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify thatmy 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 compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 t S £r rrrN1� 1ER1.✓ir Phone G q y — ;� `7 -7q Address 170 3`1 94-CL4 k4 Engineer's signature 6. DHHS SIGNATURE X Approved for 2 bedrooms. Disapproved. Conditional approval for Additional Comments 7 Date �O / Al 9 y ;S p ROMPET C. COWAN i o- bedrooms, with the following stipulations: By: Date — 7 — 94 CAUTION %The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority ,Approval Certificatbs based only upon the representations given in paragraph 5 above by an independent pro%sgiop»I engineer registered in the State of Alaska. The DHHS does thisas a courtesyto 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 engineers work. 72-M(8e/.1/91) Beck MOAW21 ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:'xc-. 2-4 � 2S , Ti A �� (Z�� � Parcel I.D. A. Well Data Well type P9- \( AeT-5- If A, B, or C, attach ADEC letter. ADEC water system number aI A Log present QI) .1 Date completed 15 -I'I Driller � L_ Total depth a o Cased to 1 15-, u Casing height 1 z N t Sanitary seal,&) / Wires properly protected (VN) V Date of test Static water level Well flow Pump levell FROM WELL LOG e,� AT INSPECTION 1n- 1`1 -C14 1 D a g.p.m. 3.3 g.p.m. 014- 1 b,2_' SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot %1' On adjacent lots Absorption field on lot too ; On adjacent lots 1 v n ` r - Public sewer main A Public sewer manhole/cleanout '� n Sewer service line ZS I �- Petroleum tank ZS 14 - Z L Q N _i o O = w u m LU N LU a w — V d g W U Z O > Z 1 W WATER SAMPLE RESULTS: Coliform D Nitrate 01 1 b Other bacteria b Date of sample: Collected by: -S -W S Gi-1 . B. SEPTIC/HOLDING TANK DATA Date installed l5119 Tank size 1 o ao Compartments Z Cleanouts I@N) 4 Foundation cleanout (Y& Depression ()Q High water alarm V& Alarm tested (Y/N) Date of pumping -01Pumper �� C �SSPaoL SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ o a kA- On adjacent lots I bn Foundation S 14 - To f To property line I b Absorption field 1 ° r Water main/service line 1014- Surface oi4- Surface water/drainage / ao 14- 72-026 (3W)' Front 4- 72.02st3Wi•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level Meets MOA electrical codes "Pump on" level SEPARATION DJ,STA9CE FROM LIFT STATION TO: lot On adjacent lots D. ABSORPTION FIELD DATA tested at Surface water Date installed 1 `t l I Soil rating (GPD/Ft2) 1 b b � �� System type –T-4" Length _Z_ 5- 1 Width 3 Gravel thickness Total depth 1 D' Total absorption area Cleanout present ®I) _Depression over field (Y&I rJ Date of adequacy test Resuesd:j fail) SASS for 3 Bedrooms Water level in absorption field before test l l After test / Peroxide treatment (past 12 months) (YA® a / Lniaw�nt If yes, give date d SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot t o-r-� (� On adjacent lots I Property line l n ( 4 - To To building foundation 1 0 ` To existing or abandoned system on lot A On adjacent lots 3� Cutbank 'L Mc Water main/service line (0 t k Surface water o i h Driveway, parkingtvehicle storage area ± Curtain drain r` , E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature _��z /tty� Engineer's Name )?o 8e .& r C', Co w 4! , Date /0/'11> HAA Fee $ 3C0• o Date of Payment I0 Receipt Number 0 O,{a S ( ? ` ?( -) - 72-026 (3/93)' Back ROBERT C. COWAN { CE -3301 Waiver Fee $ Date of Payment Receipt Number.