HomeMy WebLinkAboutPARADISE VALLEY BLK 4 LT 15 SUE3MITTAL
Municipality of Anchorage AUG 0 7 2018 Page 1 of 3
Community Development Department
On-Site Water&Wastewater Program
4700 Elmore St. •P.O. Box 196650 Anchorage, AK 99519-6650 fittp://www.muni.org/onsite .(907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181029 PID Number 020-411-23 ❑ New ❑Upgrade •
Name: ABSORPTION FIELD
JUSTIN HARDGROVE
Address: 0 Deep Trench 0 Shallow Trench 0 Bed P ound
18300 FINLAND COURT*ANCHORAGE,AK 99516 0 Other
Soli Rating Total Depth from origin :tide
Phone: No.of Bedrooms:
(907) 373-7433 3 GPD/Sq.FL Ft.
Depth to pipe invert from original grade: Grave --pith beneath pipe:
LEGAL DESCRIPTION ` F,
Subdivision: Block: Lot: Fill added above original grade: �`N0 Gravel length
PARADISE VALLEY 4 15 `
Ft. Ft
t ownshlp: - Nange: - Section: - Gravel width: ,_..1...` Beds Number of lines: Distance between lines:
Ft. Ft.
SEPARATIONDISTANCESTotal absorp area: Number of trenches: Dist.between trenches
To Septic Absorption Lift Holding Public/Private
From
Tank Field Station Tank Sewer Lines SO.Ft. Ft.
Well 100'+ 100'+ - 25'+ TANK 0 Septic ■ S.T.E.P. ❑Holding 0 Other
Manufacturer Capacity:
Surface Water 100'+ �� 100'+ - ANCHORAGE TANK 1500 Gal.
tth
Material: Number of compartments'
Lot Line 10'+ 10'+ - N/A
*STEEL 2
Foundation 10'+ 10'+ LIFT STATION
Curtain Drain Manufacturer Capacity:
NONE KNOWN ANCHORAGE TANK **500 Gal.
Remarks: 'EPDXY COATED STEEL SEPTIC TANK"SECOND COMPARTMENT "Pumpon'levelat Pump off leveler: Nrgh water alarm at.
44" 40" 46"
OF STEP TANK
Pump Make 8 Model: Electrical Inspections performed by:
PF200511 MOA
PIPE MATERIAL EXISTING/
House to tank D3034 Tank to EXISTING
drainfield
EXISTING/
Installer
A+ HOME SERVICES Drainfield EXISTING CO/MT D1785
Inspector GEG, Ltd. BENCH MARK (Assumed elevation)
100.00 Ft.
Inspection
Dates: 1st 7/24/2018 2nd - Location and Description
3rd - 4th - BOTTOM OF TRIM AT NE CORNER OF HOUSE
ENGINEER'S L
Community Development Department Approval oo�o p
4
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Conditional approval: Date: 1, .....'f-t)0
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Approved: Date: II' E LICENSEOQ trofesslo�v
#AECC884 0�000�0"z:"'
Inspection Report_1-1-12.doc
/ PERMIT NUMBER: PARCEL ID NUMBER:
• OSP181029 RECORD DRAWING 020-411-23
I
APPROXIMATE LOCATION OF EXISTING DRAINFIELD PER 1988 INSPECTION
REPORT AND SURVEY(OF PIPE LOCATIONS)BY SHANE HOLT,PLS
-DR1vE
NORWAY
NEW 1500 GALLON EPDXY
/- COATED STEEL SEPTIC TANK
/'
1
FCO 20.3 18.9 41.9 L--1 • 1
ST1 33.7 13.6 51.7 1 J OLD SEPTIC TANK
ST2 39.9 16.8 54.2 — A DECOMMISSIONED PER UPC PER
MH _ 41.1 _ 18.0 55.2 CONTRACTOR
T1
Mre Cs
PARADISE VALLEY; —--- EXISTING 3
BLOCK 4,LOT 14 — HOME-- — BEDROOM �, _
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/ice // 7°°, .t.;':.•s''....ID•RIVEWAY�`. '• 0
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1 / ��l SEMEN] \
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II \\ J�J`' BLOCK 4,LOT 16 / I I // 11
PARADISE VALLEY;
\BLK 4,LOT 17 � �
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GARNESS ENGINEERING GROUP, Ltd - 4 4: •\�'� •••
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3701 E TUDOR ROAD.SLATE 101•ANCHORAGE.AK 99507•PHONE(907)337-6179•FAX(907)330-3246•VERS/TE www yamessenyh»nny corn I. „ ..
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ] N
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JUSTIN HARDGROVE 907-373-7433 2 OF 3 •jai•; CE 79 3 '• �
LEGAL DESCRIPTION: DRAWN BY:
oto •13)6 /B•••°'� :
PARADISE VALLEY; BLOCK 4, LOT 15 D.J.G. e
'.AF0�••• •(�p\, yes
TYPE OF WORK: DATE: LICENSE♦14i..fl?O ;;;�.�4•
SEPTIC TANK RECORD DRAWINGS 8/6/2018 #AECC884 J
i PERMIT NUMBER: PARCEL ID NUMBER:
, OSP181029 RECORD DRAWING 020-411-23
FINAL GRADE=99.28-99.42
TOP OF TANK ST1 ST2 MH 2"INSULATION PER CONTRACTOR
AT INLET=95.84 C. ` TOP OF TANK
AT OUTLET=95.85
riiii,,ilii. i/,,,,,,,,,,,,,,,,.
INVERT OF BUNG NEW 1500 GALLON EPDXY
AT INLET=95.24 COATED STEEL S.T.E.P.TANK
V kl
GARNESS ENGINEERING GROUP, Ltd , .e::.•e•.:9QI..
ENGINEERING-SALFS 7 CONSULTING • • -- ki •r
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3701 E TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507•PHONE 190713376179•FAX(907)336-3246 v
3346•WEBSITE. ww.9amesse Ouneenin9.com
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 Je y A-7.
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JUSTIN HARDGROVE 907-373-7433 3 OF 3 • 0 i 3 :�•
LEGAL DESCRIPTION: DRAWN BY: ��� •� p / �
PARADISE VALLEY; BLOCK 4, LOT 15 D.J.G. � e••••� 4.
.
TYPE OF WORK: DATE: LICENSE*-� "'1 ESS\�i*
SEPTIC TANK PROFILE RECORD DRAWING 8/6/2018 #AECC884 11111111%1111�� j
tociPAL/i,o� MUNICIPALITY OF ANCHORAGE
till l 11
On-Site Water&Wastewater Program �,, � S
r PO Box 196650 4700 Elmore Road
� '
� Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r.
471* a far httpa/www.muni.orglonsite
I)cpartIncnt
4kCHOR NO' ki
On-Site Wastewater Disposal System Permit
Permit Number: OSP181029 Effective Date: 3/19/2018
Work Type: SepticTank Upgrade Expiration Date: 3/19/2019
Tax Code Number: 02041123000
Site Legal Address: PARADISE VALLEY BLK 4 LT 15 G:3538
Site Mailing Address: 18300 FINLAND CT, Anchorage
Owner: HARDGROVE JUSTIN & SARA S Lot Size in Sq Ft: 19229
Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3
This permit is for the construction of:
❑ 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
Received By: 3/�hs Date: 2
Issued By: 1 Date: SAO S
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On-Site Water & Wastewater Program
Mayor Dan Sullivan
On-Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 020-411-23
Property owner(s) JUSTIN AND SARAH HARDGROVE Day phone 373-7433
Mailing address 18300 FINLAND COURT*ANCHORAGE, AK 99516
Site address 18300 FINLAND COURT*ANCHORAGE,AK 99516
Legal description (Sub'd, Block & Lot ) PARADISE VALLEY; BLOCK 4, LOT 15
Legal description (Township, Section & Range)
Lot Size Sq.Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING:
(®all that apply) Initial ❑ Single Family (SF)
Absorption Field ❑ ® (w/wo ADU)
Septic Tank ® Upgrade Duplex (D)
Renewal ❑
Holding Tank I I Multiple Dwellings ❑
Privy I I (SF and/or D)
Private Well ❑
Water Storage
THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR:
N/A Distance: -
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: a Is Waiver Fees:
Date of Payment: (oll teS� Date of Payment:
Receipt Number: t-( �� I Gj Receipt Number:
Permit No. Of I%10-q Waiver No.
(Rev 01/11)
gcs
. t- ,..... z
Advanced Treatment System
GARNESS ENGINEERING GROUP, Ltd Dealer
ENGINEERING SALES CONSULTING
March 15th, 2018
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed STEP Tank Upgrade for Paradise Valley; Block 4, Lot 15
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. The
existing STEP tank was inspected by A+ Home Services and they noted that it was
"near or at the end of life". Tim Ecklund with your department physically inspected the
tank and determined that it must be replaced. Per the request of the seller, money will
be escrowed and the tank replacement shall occur after the sale of the home (during the
spring/summer 2018 once the ground has thawed). It is our understanding that the
buyer is escrowing funds for the upgrade. We are proposing to decommission the
existing STEP Tank per UPC and install a new 1500 gallon epoxy coated steel STEP
tank. See the attached design which shows adjacent well and septic locations and the
proposed STEP Tank location.
We are unaware of any adverse impacts this installation would have on adjacent wells
or septic system . If you have any questions, please contact us at 337-6179. Thank
you for your ass' ance.
Sincerely,
eftre I a ness, P.E., M.S.
Presi e
3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259
Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com
• / ,\
\ GEG,Ltd.HAS A 8 PAGE SPECIFICATION
\ NOTE:THE CONTRACTOR SHALL HAVE
\ THE NORTH&WEST LOT LINES,AND LETTER THAT PERTAINS TO THIS DESIGN.TO
\ ALL PERTINENT WELL RADII FLAGGED OBTAIN A COPY OF THE LETTER CONTACT
\ BY A REGISTERED LAND SURVEYOR GEG.BY PROCEEDING FORWARD WITH THIS
PARADISE VALLEY; PRIOR TO CONSTRUCTION.
BLOCK 5,LOT 8 INSTALLATION,THE ENGINEER,WELL DRILLER,
CONTRACTOR AND PROPERTY OWNER AGREE
N. — THAT THEY HAVE READ THESE
PARADISE VALLEY; ' SPECIFICATIONS AND AGREE TO ACCEPT THE
VACANT VACANT BLOCK 5,LOT 7 TERMS AND CONDITIONS OUTLINED.
APPROXIMATE LOCATION OF EXISTING DRAINFIELD PER 1988 INSPECTION
REPORT AND SURVEY(OF PIPE LOCATIONS)BY SHANE HOLT,PLS
------E-------
--- PROPOSED 1500 GALLON EPDXY COATED STEEL STEP TANK;
NpRW AY pR1vE APPROXIMATE LOCATION OF EXISINSTALL 10 FEET TING STEP
TION
/ TANK TO BE DECOMMISSIONED PER UPC
/'/ [_� 1 EXISTING FCO;FUNCTIONALITY
/ ( — J , OF EXISTING FCO TO BE
- CONFIRMED BY CONTRACTOR
/
/ ;MI
PARADISE VALLEY; EXISITNG 3
BLOCK 4,LOT 14 ------ BEDROOM
i HOUSE ,
/
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// / //�/ ---\ \ •.'t!:.;*-• "'j`t' 0
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// / // GARAGE•y f` •<•:;:�.�'1••:.'•-.
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\ —— � PARADISE VALLEY;
............. BLOCK 4,LOT 16
\ — _ SCALE:
—.........._— 1"=60'
PARADISE VALLEY;
\ BLOCK 4,LOT 17
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.4414.0100S% 111
Addindlibli
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GARNESS ENGINEERING GROUP, Lt 1 , 49/1. ••
CIVIL&ENVIRONMENTAL ENGINEERS 0 � " •
3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE,AK 99507'PHONE(907)337-6179'FAX(907)338.3246'WEBSITE:www.ge'nessenginee4Ing.eom K,-,
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 ` A. - ge,SS : 1
JUSTIN AND SARAH HARDGROVE 373-7433 1 OF 1 0�J,•�; C -79 3_ ;'"_e
PROJECT/LEGAL DESCRIPTION: DRAWN BY: .. • t I S-7913_
•
•'�NI �
PARADISE VALLEY; BLOCK 4, LOT 15 D.J.G. ..FO.'/���,U,�� (,'p,,
44.
TYPE OF WORK: DATE: LICENSE1111 E�`� �••
STEP TANK DESIGN UPGRADE 3/15/2018 #AECC884 �%���
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Nar. e DISTANCES
~'~ O O'-] LL~//! ~"~"~' ~ SEPTIC ABSORPTION WELL
Address ~__~.~/j~,./~'~)7~ ~1 ~/~/ TANK FIELD
Phone(s) WELL
Township, Range, Section
AS-BUILT DIAGRAM (Show location of well, septic system, properly lines, foundation,
~/~A~ ~ ~// driveway, water bodies, etc,)
TANKS
Manuiacturer Capacity in gallons
Material~ / No. of Compa~ments
.,
.
TYPE OF SYSTEM
D TRENCH ~ BED D W. DRAIN D OTHER ~. ';' ~;; ~ ,~_.,~
Depth to pipe bottom from ' Total depth from original grade
original grade ~ ~ -3 FT ~,J'--J. ~ FT
Fill added above original grade Gravel depth beneath pipe '~
Gravel length Gravel width
~ ~ +/) FT /~ + ~ FT
Total absorption area Distance betwe~ I~es
~¢ SQ F1,~,' FT
Number of lines Soil rating Pipe material
WELLS ~~1 - ~
~ PRIVATE ~ OTHER [Identify)
Classification (A,B,C) Total Depth Cased to J:'
installer ~ Date Installed: /
REMARKS:
/ / Scale: ~ ~ ENGINEER'S SEAL
/~ ~, inspections Pedormed by:
I /' /¢~-~ ce.ify that this inspe.ion was pedormed according to all
HealthDepa.mentApprova,: ~ ~ ~
72-013 (3/85)
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
puoumlo 'S 01,6
FOOTING [] ELEC. TEMP· __ ~ PLBQ. i~Ni~O=R. ~ . [] "-]
FOUNDATION [] ELEC. SERVICE '~ [] PLBG. F~qUGH []
BOND BEAM __ [] ELEC, ROUGH [] GAS TEMP, __ []
FRAMING [] ELEC. FINAL __ .[~ GAS []
INSULATION __ [] OTHER [] MECHANICAL--~ []
SHEETROCK [] MECH. FINAL'_
STRUCT FINAL _, [] FIRE FINAL [] PLBG. FINAL _
OTHER [] ZONING [] OTHER []
,,~NO NONCOMPLIANCE OBSERVED [] CORRECTIONS ESSENTIAL AS
INSPECTION REPORT .....
MUNICIPALITY OF ANCHORAGE, RUILDI NG SAFETy DIVISION
350O EAST TUDOR ROAD
INSPECTIONS (9071,¢63-3464
' ' ,~ ~ INFORMATION (907) 786-821'~
· ' O~ (~' [ t' .,.," f
.... ~ SUBDIV.
EXPLAINED BELOW
[] WILL REEXAMINE AT NEXT INSPECT ON [] DO NOT CONCEAL UNTIL REINSPEC1 ED
COMMENTS ~
· ' ' INSPECTOR DATE
LWHEN CORRECTIONS ARE MADE PLEASE CALL FOR INSPECTION
84-002
DO NOT REMOVE THIS NOTICE
I C I P A L. I T Y 0 F' A N C H 0 R A G E
Department c.~F Health &. Human ~ervices
Street, Anchor-agra, Alaska
F:'e:r. mit Number: 88()1 :L~
Engineer' Designee1
Owner Name.:..,: TERRY ELJ,..I,SON
C)wnel- Acldr'ess: ,.~.(.) L.,AKE OTIS PARKWAY ~.1.()1
AI',ICHORAGE, AK 99507
Day Phone:
,~ 49'-'~6 12.
F'arce]. Icj." 020-411-2,3
Lot Legal:: ~,aubdivision: PARADISE VAL. LEY L..ot.~ 15 Block: 4
Section: ].1 Township: llN Range: 5W
Lot Size 19229 (sq. ft. op acres)
Max Bedrooms: This Pepmi'k: 3 'Total Capacity:
SEt'.:)TtC TANK: Minimum total septic tank ¢.::apac. ity~ 1,000 gallons. Each septic
tank must have at least 2 compaptments. Depth to top of septic tank(s) < 4.0
feet r'equires insulation over' 'Lank (s).
WEL.L: L.og must. be submitted 't.~ Municipality of' Anchorage Department of Health
ancl I'"lLunaFI Set'vic:es NJ. thin :];0 days o~' well c:omplet~on,,
INFORM D.H,,H.S, PRICtR TO 1ST & ~hlD INSPEC]'IONS BY ENGINEER, IF
AFTER OFF:i:CE HOIJRS, CAI...L ::54:5-4681 AND L. EAVE A MESSAGE,
CC)NS"i"I::~LK:TI" PER ENGINEERS ATTA[]HED APF:'ROVED DES:[GN.
THIS F'EF~MIT EXPIRES ].2/31/88
]"HI8 I::'EF;'.MIT VAL. ID FDR A SINGL. E FAMILY RES]:DENCE ONLY
I CE:FU['IFY 'T'HA]":
:1,. I am' faaliliar wi'Lh the requ].rements .{'op on.....s:i, te sewers and wells as set
Forth by the Munic:tpality of Anchorage (MOA) arid the State oF Alaska.
~?,. i will :install, the system in accordance wi'Lb a].l MOA codes and regulations~
and J.l"t c:omplJ, an~:l~ wi'kh the design triter'ia of this permit.
:5. I will adhere to all MOA and State of Alaska requir'mments for the se'L back
d:i.s'Lar~ces from any existing well, wastewater disposal system or pt.tblic
sewerage system on this or any adjac:ent or nearby lo'L.
4. I understancl that this permit :i.s valid for a maximum oF 3 bedrooms. I
also understand 'Lhat the capacity of the 'Lotal system is 3 bedrooms and
any enlargement will require an additional perm:i.t.
(Owner) TERR':f EI.J.]ISON '
Tom Fink,
Mayor
unicipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
July 12, 1988
Alaska Environmental Control
Services, Inc.
1200 West 33 Avenue, Suite B
Anchorage, Alaska 99503
Subject: Waiver Request for Lot 15 Block 4 Paradise Valley S/D
Waiver Request ~WR~8-031
Dear Mr. Wien:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved.
waived distance is 5 feet.
The
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Serivces
DJR/ljW~7
ALASKA 6nuIRoIlm611TAL CONTROL $6RUIC6$, IgC.
I~nclineeri~§ ~ ~nuironmenlal Studies
,June 30, 1988
Municipality of Anchorage
Department of Health & Human Services
825 L Street
Anchorage, AK. 9950]
Re: Lot 15, Block 4, Paradise Valley
The subject lot is applying for a sewer permit. Referring to the attached
design, the proposed bed is 5 feet from the north lot line which borders Norway
Drive. There are no utility easements, other sewer systems, reserve areas or
wells that this system will encroach on. The road is built up higher than the
lot. This area closest to the lot line has a shallower slope which will allow
easier construction of a bed system.
We request that you grant a lot l~ne waiver of 5 feet for the new system.
If you have any questions, please call.
Sincerely,
Alan C. Wien
Engineering Technician
Approved by: *
1200 LUcst 33rd ~uenu¢. $uii¢ [~.~nc~oroq¢. Alaska 99503'(901) 561-50zj0
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561r5040
SHEET NO, t/
CALCULATED BY /1~!, ,/J/~--~'X/
CHECKED BY
DATE -
SCALE
....................... i .......... i ............ i ............ i ........ i .........
:~ ~ ............... i i i ............ i ........... i ............. i ............ !. ...........
.........
:::~ ........... ............. .............. .............. .......... ............ ..........
~:::~ :.:~ ~:...:~......, ............. , .............. , ........... ........... i ......... ~ ~. ..........
JJ
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 56],-5040
JOB
SHEET NO.
C^~CD~^TED ~¥ A"
CHECKED BY
DATE
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561,5040
SHEET NO,
CALCULATED BY
CHECKED BY
SCALE
?
/
,
DATE
PERFORMED FOR:
·
Municipality of Ancnorage
DEPA.R,T.MENT
825 'L' Street, Anchorage, Alaska 99502-0~~~~
so, s _ .-...
DEPTH
2
5-
6
7
8
11
12
13
14
15-
16-
17-
18-
19-
20-
COMMENTS
~I~INEER'S SEAL)
Township, Range, Section: '~?/d /'z.5~ .~:. //
PERFORMED BY: /~g~5
SLOPE SITE PLAN
I
N
WAS GROUND WATER ~'~--~
ENCOUNTERED?
S
/ L
IF YES, AT WHAT ~/ O
DEPTH? P
Depth to Water After ~.~
Monitoring? Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE --
TEST RUN BETWEEN -- FT AND
~/~/~ ??~-m ~. / ~ '-/-',-
(minutes/inch) PERC HOLE DIAMETER --
FT
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
SEA.)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES~
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DESCRIPTION: ~'/~ &Z~ ~I%~ ~LL~/ Township, Range, Section: ~/~/ ~_~ %~. //
SLOPE SITE PLAN
DEPTH
(FEET)
4
6
7
9
11
12
13-
14-
15-
16-
17
18
19
20
COMMENTS
WAS GROUND WATER
ENCOUNTERED.)
S
Depth lo Water After,,,7' /
Monitoring? / Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER __
TEz~RUN BETWEEN __ FT AND __
FT
PERFORMED BY: /~': /Z~. ~,,]]E~Z/ ~ ,---~,'!- ' CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ ' ~ ~
72-008 (Rev. 4/85)
ALASKA i nuIRoI]mI IqT^L CONTROL $ RUIC $, II'lC.
~n§ine~ri~§ 8 ~nuironmenta[ Studies
SPECIFICATIONS FOR BED WASTEWATER TREATMENT SYSTEM LEGAL DESCRIPTION:
LOT 15, BLOCK 4, PARADISE VALLEY SUBDIVISION
].0 GENERAL
The drawings, sheets 1 through 3, shall be part of this specification.
1.2 All materials and workmanship shall meet the requirements of the
Municipality of Anchorage, Department of Health & Iluman Services (DHHS),
the conditions of the permit, and all applicable rules and regulations
currently in effect.
].3 All excavations and depths are advisory, and are to be verified or
modified in the field by the Engineer or inspecting agency.
1.4 It is the responsibility of 'the owner or installer to adhere ~o approved
design for the installation, to maintain the specified separation
distances and to have the appropriate inspections.
1.5 If the installation is not inspected by an AECS engineer, AECS will not
be responsible for the installed system. An engineer at AECS should be
consulted prior to construction, to determine the number of inspections
that will be required and to explain what these inspections will involve.
2.0 SEPTIC TANK
2.1 If there is an existing septic tank it may be used if it meets the
capacity requirement for the residence. The structural integrity of
the tank must be verified.
2.2 The septic tank shall be a UPC-Approved two-compartment tank, constructed
of 12--gauge steel with bitumastic coating and set level on undisturbed
soil. If the tank is buried at a depth of 4 feet or less, it must be
insulated with an overlying layer of 2 inch burial type polystyrene
rigid board insulation.
The septic 'tank shall be a minimum of 5 feet from the house foundation,
and a minimum of 5 feet from the absorption area.
2.4 The septic tank and bed shall be a minimum of 100 feet from any private
well or body of water, i50 feet from Class C wells, and 200 feet from
Class A or B wells, unless otherwise specified. Less ihan the required
separation distance must have prior approval or waiver by DHHS or Alaska
Department of Environmental Conservation (ADEC).
2.5 Piping shall be fitted with a mechanical watertight calder coupling on the
outlet and inlet of the septic tank. Piping shall be 4--inch solid PVC
ASTM D8034 or cast iron, sloped a minimum of 1/4 inch per lineal foot.
If the piping is buried at a depth of 4 feet or less, it must be insulatcd
1200 LUcst 33rd ~ucnue, Suite B e~nchorocle, /~laska 99503e(907) 561-50/40
2.7
with an overlying layer of 2 inch burial type poiystrene rigid board
insulation.
Cleanouts shall be installed as designated and capped with air-tight r~in
caps (,Jim caps or equivalent), and extend a minimllm of 1 foot above
ground level.
If a lift station is required it shall be a combination lift station
septic tank per Anchorage Tank and We].ding, Inc, design. See attached
specifications.
3.0 SEEPAGE BED
3.! The gravel for the bed shall be 0.5 to 2.5 inch, screened rock with less
than 3% passing #200 sieve residual. All substitutes must have prior
DHHS approval.
3.2 The bottom of the excavation shall be level and raked with the backhoe
blade to insure that the bottom has not been compacted during excavation.
3.$ Sand, for leveling, if applicable, shall have a size distribution which
meets the requirements of MOA code 15.85.077.
The distribution pipe shall be perforated 4-inch rigid PVC with a mlnimum
crush strength of 1500 pounds and shall meet the approval of DHHS for use
as drainfield pipe. All pipes shall be laid level, and spaced according
to the drawings.
Monitor standpipes shall be placed as shown in the drawings. They shall
be 4-inch rigid PVC ASTM D-S034, or cast iron. The section shown with
holes may be either drllled 0.5 inch holes on 6 inch centers on opposing
sides of the pipe, or a section of regular perforated sewer pipe may be
clamped to the solid section with a no-hub coupling or solvent joint.
Perforated section shall be located in gravel only. The portion of pipe
above the sewer rock shall be solid. A rubber ralneap (Jim Cap or
equivalent) shall be placed over the top of the pipe.
Insulation is required, using burial t~pe polystene rigid board
insulation. There shall be 1 inch of insulation for every foot of soil
less than the required 4 feet of cover, but there must be at least 24
inches of soil even though insulation is used. The solid pipe extending
from ~he sep%ic tank to the drainfield shall also have 4 feet of cover or
an equivalent layer of insulation combined with soil.
3.7 The side slope of the mound shall be sloped 1 foot vertical to 3 foot
horizontal.
3.8 The top of the bed shall be planted with a white clover and red rescue mix
or blue grass.
4,0
4.1
4.2
4.3
4.4
INSPECTIONS
This bed wi]] require a minimum of three inspections. The first
inspection will be of the open excavation, to assure that the system is
installed in the proper soil strata, correct depth and meet minimum
specified design parameters.
The second inspection will be after placement of gravel, monitor
standpipes, and distribution pipe, to verify proper installation and
position of pipes prior to backfill.
The third inspection will be after final backfill and grading to ensure
that adequate soil cover has been provided over the bed.
The inspection of the septic tank or lift station installation can be
incorporated with any one of the above listed inspections.
MUNICIPALITY OF ANCHORAGE
Development Services Department '4 Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 020-411-23
Certificate of On -Site Systems Approval
Expiration Date5/6 Z 3
Legal description PARADISE VALLEY BLK 4 LT 15
Site address 18300 FINLAND CT
Current property owner(s) BRIAN & MEGYN WEIGAND
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories: Septic tank was pumped May 2023.
L_�
cu—
By: Original Certificate Date: 6/6/2023
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 X
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
MUMCIPAUW OF AmcHORAU GE
Development Services Department P P 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. 020-411-23
Complete legal description PARADISE VALLEY; BLOCK 4, LOT 15
Location (site address) 18300 FINLAND COURT ANCHORAGE, AK
Current property owners) BRIAN WEIGAND Day phone 907-717-6619
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: M Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age —5 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
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 $ V Waiver Fee $
Date of Paymentr Date of Payment
COSA # y5 L 2 ;1 Waiver #
COSAApplication_June 2022
Legal Description: PARADISE VALLEY; BLOCK 4, LOT 15 Parcel ID: 020-411-23
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
FM Well log is filed with Onsite (or attached)
Date drilled 7/25/1988 Total depth 200 ft
Cased to *57 ft
A Sanitary seal is functioning correctly
Well production at time of test 3.1+ gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes 1011 No
Coliform bacteria is Negative
9 Wires are properly protected Nitrate , 1 mg/L ❑ Nitrate less than MRL (ND)
Casing height (above ground) 18+ in. Arsenic ug/L Arsenic less than MRL (ND)
Date of flow test for COSA 5/11/2023 Collected by GARNESS ENGINEERING
Static water level at beginning of test ** ft. Date 5/3/2023
Comments ASSUMED CASED TO BEDROCK "WELL WAS ARTESIAN UPON ARRIVAL. AWPS INSTALLED PLUG TO PREVENT WATER FROM DISCHARGEING AT THE WELLHEAD
B. TANK DATA
Measured operating fluid level in septic tank 48.5
Date of pumping r,3,;m;. � C' j`
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
C. LIFT STATION
[`r Required maintenance completed
Age of lift station -5 years
Lift station material *STEEL
Comments: *STEEL IS EPDXY COATED
Which system tested (date installed) 1988
Adequacy test date 5/11/2023
N ALL standpipes present per record drawing
Results Q Pass
Total measured depth from grade *6.2 ft (max)
2.75
Fluid depth prior to test in
Measured depth to pipe invert from grade 4.4 ft (min)
Water added 600 gal
❑ N/A - pressurized field.
New fluid depth 4 in
❑ Per record drawings, field is insulated.
Elapsed time 120 min
❑ Monitor tubes go to bottom of effective.
Final fluid depth 2.75 in
If not, state depth into effective 4.9"
Absorption rate 450+ god
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) NO
If yes, enter date
Comments/Deficiencies: *AT MT
COSA Checklist June 2022
FIELD STATUS - POST RECOVERY
Effective depth (per record drawings) 6 in
Effective depth used 3.75 in
Effective depth remaining 225 in
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' Community Sewer Manhole/Cleanout > 100'
QYes if No It ❑■ Yes if No ft
Neighboring Tank > 100' ❑i Yes if No ft Private Sewer/Septic Line > 25' QYes if No ft
Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' ❑ Yes if No ft
Neighboring Absorption Fields > 100'
0 Yes if No ft
Community Sewer Main > 75' 0 Yes if No ft
Animal Containment > 50' Q Yes if No ft
Manure/Animal Excreta Storage > 100'
Q 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' g Yes if No ft Surface Water > 100' Q Yes if No ** ft
Tank to Property Line > 5'
Field to Property Line > 10'
Water Main > 10'
Water Service Line > 10'
Yes if No ft
❑ Yes if No *51 ft
Q Yes if No ft
0 Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100' FE -1 Yes if No ft
Community Wells > 200' 0 Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
*WR88-031'+ **TO HOLDING TANK ON BLOCK 4, LOT 17 - MET CODE AT TIME OF INSTALLATION
-DURING THE TIME OF THE TEST THERE WAS PONDED WATER THROUGHOUT THE LOT; HOWEVER, IT IS SPRING BREAKUP AND IT IS ASSUMED TO NOT BE SURFACE WATERS
THE SUMP PUMP FOR THE CRAWLSPACE DISCHARGES ADJACENT TO THE SEPTIC TANK. IT IS RECOMMENDED THIS BE REROUTED AWAY FROM THE TANK
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 Gayness Engineering Group, LTD. (GEG)
Engineer's Printed Name Jeffrey A. Garness
Phone 907-337-6179
Date
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in
accordance with the guidelines and regulations established by the Municipality of Anchorage and industry
practices. The reported results describe the condition of the system/s on the date/s of the evaluation.
Separation distances were measured to readily identifiable features. Hidden defects or encroachments may
exist that were not identified during the evaluation. The operational life of all wells and septic systems depend
upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate
during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing
the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding
the future performance of the well or septic system. GEG makes no representation whether an alternative well
or septic system can be installed on the property in the event either of the current systems fail to perform
adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG
to perform the evaluation. Reliance upon the information provided in this report by any other person or party
(including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever.
COSA Checklist—June 2022
OF A
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J r A. Garne s:.
LICENSE4�� professi0� a�
#AECC884
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC231168
Subdivision: Paradise Valley, Block: 4, Lot: 15
A water sample revealed a nitrate concentration of 8.31 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
h �Vlail�ng Address P O Box 196650 *,Anchorage, Alaska 99519 6650 *www muni org
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Ma�hrag Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www mum org f
(9--(j .0(( Co 8 9 70 77 •
`i i_ Municipality of Anc ;:
� y jt '� :31)."
On-Site Water and Wastewater •La!ram y n
(907)343-7904 a tv4;ii g CtJl a SA E„
ti
Certificate of On-Site Systems 'A,9 . •V. c.
Olgg � 9 I
Parcel I.D. 020-411-23 Expiration Date: 7- f - I
1. GENERAL INFORMATION:
Complete legal description Paradie Valley; Block 4, Lot 15
Location (site address) 18300 Finland Court*Anchorage,AK 99516
Current Property owner(s) Justin&Sarah Hardgrove Day phone
Mailing address
Real Estate Agent Natalie Lewis Day phone 865-6406
2. TYPE OF DWELLING:
❑ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System Cl Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date: 3/Z5 ) l B
COSA to be released to the en„neer,unless otherwise requested by the engineer.
COSA Fee $ 5g1,0--&2-7q-f Ib2,0 Waiver Fee $
Date of Payment 3)I c iif Date of Payment
Receipt Number Receipt Number
COSA# 05aIr/O3'(, Waiver#
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) omfo, functional and adequate
for the number of bedrooms and type of structure indicated herein. | further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inapection, the on-site water
supply and/or wastewater disposal system is(arm) in compliance with all applicable Municipal and 8baba codes,
ordinances, and regulations ineffect otthe time ofinstallation.
Name of Firm: Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness |
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the systemls on the datels of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future perfon-nance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
#AECC884
6' DSD SIGNATURE
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System #2Approved for b8d[norns
Disapproved L//V-8/7E
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By Original Ce��note Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph s 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:
COSACheck|hst Nitrate Advisory
Septic System Advisory / Arsenic Advisory /
Well Flow Advisory Other
COSAblue meet-,��2.doc
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Paradise Valley; Block 4, Lot 15
Parcel ID: 020-411-23
A. WELL DATA *Per 1988 HAA (casing depth per driller)
Well type Private If A, B, or C provide PWSID# N/A Well Log (Y/N) Yes
Date completed 7/25/1988 Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Yes
Total depth 200 ft. Cased to *57 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 7/25/1988 2/6/2018
Static water level 20 ft. 19.6 ft.
Well production 20 g.p.m. 6+ g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 6.33 mg./L. Collected by: GEG. Ltd.
Arsenic: ND ug./L. Date of sample: 2,/6/2018
B. SEPTIC/HOLDING TANK DATA *EPDXY COATED
Tank Type/Material STEP/*Steel Date installed 7/24/2018
Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Yes
Foundation cleanout (Y/N) Yes Depression over tank (Y/N) No High water alarm (Y/N) YES
Date of pumping NEW Pumper
C. ABSORPTION FIELD DATA I *Below Existin Grade
Date installed 11/14/1988 Soil rating (g.p.d./ft2o ftZ/bdr 150 System type
Length 43+11 ft. Width 15+5 ft. Gravel below pipe
Bed
**0.5 ft.
Total depth *5.0-7.5+ ft. Eff. absorption area 700 ft2 Monitoring tube Yes Depression over field No
Date of adequacy test 2/6/2018 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 621 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date —
Drainfield remained dry throughout 2,000 gallons pre—soak, adequacy test was performed
immediatley following pre—soak with no liquid level rise observed. A total of 2,621 gallons was
introduced.
**MT extends approximately 4.92 inches into 6 inches of effective
*Second compartment of 1250 gallon STEP tank
D. LIFT STATION **See maintenance report (attached)
Date installed 11/14/1988 Size in gallons *416 Manhole/Access(Y/N) **
"Pump on" level at ** in. "Pump off' level at ** in. High water alarm level at ** in.
Datum ** Cycles tested ** Meets alarm &circuit requirements? **
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *5'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain None Known Wells on adjacent lots 100'+
F. COMMENTS
*WR88-031
G. ENGINEER'S CERTIFICATION v
I certify that I have determined through field inspections and p* •'' • ,
review of Municipal records that the above systems are in v
VA
conformance with MOA COSA guidelines in effect on this v
date. y e f'; A. .• ,ss... 0
JEFFREY A. GARNESS 43-"::.
E-79 3 e
Engineer's Printed Name Q � O
Date VIS-11 `3 0 3.A5 1.b 0,Z
‘IVIP 4�°O0000��
#AECC884
(Rev. 11/05)
SURVEY ORDERED BY:
DAR 'vVALDEN @
KELLER WLLI AMS
THEINFORMATION HEREON IS FOR THE USE Or LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXIST IPTG STRUCTURES AND PLATTED LOT LINES AND /OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN
HEREON ( UNLESS INDICATED}
NOTE: FENCELIMES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE S14OW ANDYOR ICE.
AS -BUILT SURVEY 1" = 30
NO CORNEAS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 15, BLOCK 4, PARADISE VALLEY SUB. C PLAT 87-16
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE,ALASKA THIS 9 TH DAY OF
AUGUST , 2018
HOLT LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
1632, FB 187-9,189-58 345-5513
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT i•
907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC181086
Subdivision: Paradise Valley, Block: 15, Lot: 15
A water sample revealed a nitrate concentration of 6.33 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.0. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
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
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address -~ ~-~-
Lending agency
Mailing address t,,) ~:~
Day phone
Day phone
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~-~
Day phone
TYPE OF WATER SUPPLY:
Individual well
Community Well
NOTE:
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
Public water
If community well system, provide written confirmation from State ADEC att
lng to the legality and status of system.~..-~:, "
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
· 72-025 (Rev. 1/91) 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 that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verifythat 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.
A~aska Wa~tsr & // Phone
Name of Firm ;','~,~,' o~, vic~
8471 Broo~ri?~e D~.~
Address ~ct~/. ~ 9. s~ ////- ~
Engineers .,gn.ure ~1/~~ ~ .
DHHS. SIGNATURE
Approved for ~--
Disapproved.
Conditional approval for
bedrooms.
Date G/~/~'~o
bedrooms, with the following stipulations:
Additional Comments
,~he 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 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.
72-025(Rev. 1/91) B~ck MOA#21
DEPARTM
25 .L treet. Room
Legal
Health Author ty APprova Checklist
A. WELL DATA
Well type
Log present (Y/N)
Total depth
If A. B. or C. attach ADEC letter: ADEC
FROM WELL LOG
Date of test
Static water level ~_.~
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample: .
SEpTIC/HOLDING TANK DATA
Date installed
Foundation cleanout (Y/N3
2asin~ h?ight (above ground)
Wires properly protected
"
AT INSPECTION
Collected by: ~' ~$~ .
Tank size / g fO NUmber of Compartments ~-' Cleanouts {y/N) y
Depression(Y/N) /oO ] '
ABSORPTION FIELD DATA
Date installed S0il rating (~':6r R2/bdrm)
Length ~3~-II Widtfi I~-~' Gravel thickness below pipe ,~t;"~T°taldepth"'
Effective absorption area ~t>O Monitoring Tube present(Y/N) ~ Depression over field (Y/N)
Date of adequa~ For ~
Fluid depth in absorption field before test (in.); ~"~lg n -!Immediately after[~'g4'gal.
Fluid depth ~- ~ (ins.) Minutes later:
Peroxide treatment (past 12 months) (Y/N) ~'/~,oM If yes, give date
LIFT STATION
Date installed
Manhole/AcCess (Y/N)
High Water alarm level at,
CYcles tested
Size in gallons
"Pump on" level at* 40. ~;"~ "Pump off" level at*
*Datum ~ ~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot [ ~ {~ t._& ; On adjacent lots
!
Absorption field on lot ~ ?-~. ~' ; On adjacent lots
!
~ lC~D
Public sewer main b.l~ Public sewer manhole/cleanout
Sewer/septic service line ~ I 1~ oP~o~.~ ~
~..oO~ t~- Lift s~tion [ ~ ~ ~
SEP~A~ON DISTANCES ~OM SE~C~OLDING TANK ON LOT TO: '
Building. foundation ~ t+ t
Pr6pe~ line ~ ~ Abso~tion field ~ ~
Water m~se~ice line ~ tO~ Suffac~ wateffdrainage ~ t~t Wells 0n adjacent lots
SEP~A~ON DISTANCE ~OM ~SOR~ON ~E~ ON LOT TO:
Building foun~tion ~g.6 ha- $u)~w* Water m~se~ice line >~o
Surface water ~ t°ot ~ ~ Driveway, p~kin~vehicle storage area
Curtain drain M 0 ~ ~O~d Wells on adjacent lots > ~O t Prope~ line
effec, on this date: ~..~'
in c°nf°rman? ~th ~/~~' of Municipal reco~t~,.~s are
Engineer'sName~C~ fl. ~;
Date ~/Z ~/~
HAA Fee $ ~
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
June 25, 1996
Alaska Water & Wastewater
8471 Brookridge Drive~ Anchorage .... ~ Alaska ' 'l~9~-z~
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
Municipality of Anchorage
Dept. Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O Box 196650
Anchorage, Alaska 99519-6650
Ref: HAA for Lot 15, Block 4, Paradise Valley S/D.
To whom it may concern:
The subject property has a 3 bedroom house which is served by a private well & septic system.
Comments regarding the well and septic are as follows:
WELL: The static level was 19.5 feet. Water was pumped at a rate of 6.7 gpm for a total of 95
minutes (636 gallons). The water level in the casing quickly dropped to 28 feet, and stabilized
thereafter. Upon completion of the pumping period, the well recovered completely in less than 30
minutes. Based upon this data, the well was deemed to be adequate for a 3 bedroom house.
SEPTIC SYSTEM: The bed system had an initial liquid depth, in the monitoring tube, of
4.3125 inches. Water was introduced into the lift station, at a rate of 6.7 gpm, for a total of 95
minutes (636 gallons). The flow was stopped at the end of a pumping cycle. The liquid level in
the bed rose 1.25 inches, corresponding to 509 gallons/inch. The recovery period was monitored
for 50 minutes, during which time the level dropped .81 inches (413 gallons). Based upon this
data, the septic system was deemed to be adequate for a 3 bedroom house.
It was noted during the inspection that the east clean-out invert was slightly submerged in water
(prior to starting the adequacy test). I did not see any water in the west c/o. This is probably the
result of the drainpipe being slightly out of level. The performance of the system does not appear
to be adversely effected.
NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not
limited to, seasonal surface water infiltration, groundwater variations, septic system
maintenance (frequency of septic tank pumping, usage of biological additives), condition of
drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age),
type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects),
and the amount of water being introduced on a continual basis. Consequently, the results of this
adequacy test are only valid for the specific day of the test. Furthermore, because of the limited
nature of this investigation, it is possible that there are hidden defects which may not have been
detected No warrantee is made regarding the future performance of this septic system
If you have any questions, please contact me at 337-6179, or on my digital pager at
1-800-481-1162. T__hank_y~ for your assistance.
Sincerely,
Jeffr~
t~su~taenS~, P.E., M.S.
c.c. Kay Ellison
~J
1632
5 '?
1;he location of tho struc'ture(.~)
as shown o~1 t,~,,; [...' ,ro drawing
[ASEHENTS OF ~~THER T~N TttOSE
BHO~ ON THE RECO~ED P~T, ARE NOT
~H0~ HE~ON
AS - BUILT ( NO CO~ERS SET TItIS DATE )
I hereby certify =hat I have per~orme~ a Mortgag
inspection of the following de~cribed property
Lo~ ~5, Block 4t Par-~ee V~ley ~b. .....
Anchorage Recording precinct, Alaska and ~hat the
-ments situa=ed ;hereon are within the property
do no~ overlap or encroach on the pro~rty.lyin~
thereto, tha~ no ~mprovem'~nts on property lying
thereto encroach on the premisaa in question
~here are no roadways, transmission lines or
ble ea~ement~ on ~ai~ p=operty excep~ as indicat.'~
on'. Date~ a= Anchorage, Alaska.
HOLT & ASSOCIATES ~ SUR~EYOR~
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
. .Ld'~ation (8~ldr. ess or directions)
(b) Property'owner
(c) kendin~ Institut.io~
~ailin~ Addross
Telephone: (home)~Y' ¢ -¢'¢'/2 Business
Telephone
(d) Real Estate Company and Agent
Address
Telephone
Mail the HAA to the following address: (or check here r-I, if hold for pick up.)
List contact person and day phone number below:
(e)
2. TYPE OF RESIDENCE
Single-Family¢ Number of bedrooms
3. WATER SUPPLY
Individual Well/1~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site¢l~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 shows that the on-site water supply and/or wastewater disposal system is safe,
functional end 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 ~L~-C~ -~-~ Telephone ¢¢- ? ~ ~ ~-J'-/-'-~
Address /c//¢7 /'¢ ~3~-,-J ,"~' /,¢Z~,/~'~,~.~, ~7 ~'~'.,~-~ ~
6. DHHS APPROVAL
Approved for -~
Approved' ' _,~ .',^_ Disapproved
Terms of Conditional Approval
bedrooms by ~)~-~ ~/ '~Date Conditional
*f4,' I II [']
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 order to satisfy certain federal and state requirements. Employees of DHHS do not conduct insp~ct!ons
or analyze data before a certificate is issued. The Mu n icipality of Anchorage is not responsible for errors or om ~ss~ons
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
HAA # ~--~Oc~ - ~;~(~--~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner ~/~Y
Mailing Address
(c) Lending Institution
Telephone: (home) ;3'? ¢'-_¢-z/Z_Business3'-'
/'~,-~-,~? ///~ /
Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here [], if hold for pick up.)
List contact person and day phone number below:
TYPE OF RESIDENCE
Number of bedrooms
Single-Family.~
WATER SUPPLY
Individual Well,E~
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DISPOSAL
On-site,~ Public [] Community [] Holding Tank []
Note: if community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
Name of Firm
Address / Y'
5. ENG'INEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 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.
Telephone c~"~
6. DHHS APPROVAL
Approved for
Approved
Terms of Conditional Approval
Note: The well for this
Municipal Codes.
Disapproved Conditional
F
~ro~e~ty meets e×istinq State and
· ~e~e are nit~ates ~esent~ ~owe~e~
it is suqqested tAat ~e~iodic testlnq be pe~o~ed to
insure the wells continued suitability. Nitrate
concentration is 6.2 mg/1. EPA maximum concentration is
10.0 mg/1.
The Mu nicipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The M u nicipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev, 7/88) Back Page 2 of 2
A. WELL DATA
MUNICIPALI1Y OF ANCt~.a~=
ENV ~ON,VI~,~Vi~L~oT~gC~ALITY OF ANCHORAGE (MOA)
(,,~j~_,~ H~'alth Authority Approval (HAA)
r \~1 CHECKLIST - FEBRUARY 1984
! ?(, ..~ i~.~ ~ 343-4744
RECEIVED
Well Classification )~c~ ~ ~
Well Log Present~N)
Total Depth ZOO Cased to ..
Static Water Level .~,o
Casing Height Above Ground
Electrical Wiring in Conduit ~',1)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by ~'-
Water Sam pie Test Results ~, 7
Co m me nt st~/t~,,.,~/ 'rf~ ~.}
~ ~ ~,-,//~
Legal Description: ~'~/2.
~-//-t~ ~ Z"~ 57/
Date Completed ~'2/,.? ~-/~,~
.f? / '~¢Depth of Grouting A,,~,~¥,~,
Pump Set At U,~/~,~,~,'-t ·
/'/- / Sanitary Seal on CasingS)
Depression Around Wellhead (Y~'~'
If A, B, C, D.E.C. Approved (Y/N)
Yield ~,1, ~?~,~
; On Adjoining Lots
/~.~'5~ ; On Adjoining Lots /¢¢ ~''
To Nearest Public Sewer Cleanout/Manhole '~//'"/
/
2. I?~, ~ ; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed ~//~/~-~'- Size
Standpipes t~N) Air-tight Caps(~N)
Depresmon over Tank (Y~
Pump ng/Maintenance Co.ntact on File (Y/N)
Holding Tank Hjg~:Watet'Atar[~.,Y./N) ~'/~- Temporary Holding Tank Permit (Y/N)
SEPARATIO. N rDtSTA.NCE$ ~S?.TIC/HOLDING TANK: ,
To Water-Su'lspl~Wdll .... 7'~'¢'~'z -': To Building Foundation
.... ~/',.' To Disposal Field ~/
To Property,'Line
To Water Ma:in/Service Line' ~-;~ ~¢ [
To Stream, Pond, Lake or Major ~D~ainage Course ~
No. of Compartments
Foundation Cleanout(['~N)
Date Last Pumped
; for ---'--
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed / o
Width of Field /-~- ~.,
/
Square Feet of Absortion Area
Depression over Field (Y~
Results of Last Adequacy Test /L//
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well { 2_ .F',
To Building Foundation
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
~ "/,~' Type of System Design
Length of Field ~' ,7 / //
Depth of Field
Gravel Bed Thickness
Statndpipes Present ~/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots .> ~zo ~
To Cutback (if present)
Comments
D. LIFT STATION
Date Installed ~/&
SiZe in Gallons //~/~)"'~
"Pump On" Level at
Dimensions '-~'-~ ~ ~'e;~,TZ/c 2~ -, ~'
Manhole/Access(~N)
"Pump Off" Level at O~-~c~ ~',~_~..
High Water Alarm Level at fS?.~'~J-( 0 S'/z--~ · Vent (~N)
Tested for Pumping Cycles during Adequacy Test.
Meets MOA Electrical Codesc~N)
Comments
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have ch~cked, verified, or conformed to all MOA and HAA on the date of this
inspection.
Signed
Company .
Date
MOA No. ~'~'
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2