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HomeMy WebLinkAboutPARK HILLS #1 BLK 1 LT 5Park Hills #1 Block 1 Lot 5 #017-142-08 SuB� v-- Municipality of Anchorage 4 Cult. On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP121245 PID Number: 017-142-08 Dwelling: [N Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑ Upgrade Name: DIXINE HARDESTY-SCHIAVI ABSORPTION FIELD E] Deep Trench ©Shallow Trench ❑Bed [3 Mound El Other Address 14500 WOODHAVEN CIR., ANCHORAGE, AK Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPD/SF 4 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1 F1.3 Gravel depth beneath pipe Ft. Subdivision Block Lot PARK HILLS #1 1 5 Fill added above original grade 1-2 Ft.60 Gravel length Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distancebetween lines I Ft. SEPARATION DISTANCES To From Septic Tank AbsorptionHolding Field Lift Station Tank Sewer Line Total absorption area 517 Fly Number of trenches 1 Dist. between trenches NA Ft. Well >100' TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water >100' Gal. Material Number of compartments Lot Line >10' NA Foundation >10' LIFT STATION Manufacturer Capacity Curtain Drain >20' Gal. Remarks EXISTING DRAIN FIELD ABANDONED Pump on level at in. Pump off level at in. High water alarm at in. PER UPC REQUIREMENTS Pump make and model Electrical Inspections performed by Installer A+ HOME SERVICES PIPE MATERIAL Housetotank Tankto dranfied SCH DrainrieldSCH40 CO/MT Inspector ANSON MOXNESS BENCH MARK (Assumed elevation)100 ft Inspeection ction 1� 9/6/12 2-9/6/12 3" 0 Location and description BOTTOM SIDING @ "A" COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Conditional Approval: Date = \,Nmp % �-� OF AC�S��+�l 49TH 'l� LARS SPUR KLANDCz// 11 i (� l �F�PROE SIONP�_ I/C,l Approv Date z�4 v-- SWING TIES F A FB FI£D EXISTING 1500 GAL STEP A SHALLOW TRENCH 4VA77ON DEPTH 4' MAX ER ROCK 3' ILAT/ON 2' TRACT 3 LOT 2C \ ABANOON£D CURTAIN DRAIN TO MAINTAIN 20' SEPARATION FROM PROPOSED ABSOPRTION FIELD axa�y Septic . A \ Area LOT 5 'r ._ Lr « .O l� LEVEL w Well SLOPE - L4p LOT 4 SLOPE -)DZ LOT 6 �— NOTE.- SLOPES EXCEEDING 25X W£RE NOT OBSERVED WITHIN 50 FEET DOWN MDIENT OF THE PROPOSED ABSORPTION FIELD LOCATION. NOTE. THIS lS NOT A SURVEYED PLAT. WELL It SEPTIC LOCATIONS TAKEN FROM ON—SITF WATER AND WASTE WATER DEPARTMENT DOCUMEKATIOAL ALL LOCAnONS SHOWN ARE APPROXIMATE. R5 0 25 50 75 100 125 150 SCALE., I' = 50 FT. 0 ° 49th c +11 LAR•SPURKLAND 'k SPURKLAND ENGINEERING PARK HILLS #I BLK1 LOT 5 SEPTIC SYSTEM ASBUIL 203 V 15TH. AVENUE ANCH. AK, 99501 DIXINE HARDEST Y-SCHIAVI DAT£+ SEPT 7, 2012 (907) 279-3916 11 14500 VOODHAVEN CIR., ANCH0 I SHEET- 1/3 GRID, 3037 PERMIT # 17SPI21245 PID # 017-142-08 PARKHILLS#1BIL5SC50-ASB.DVG 0O O O 1500 Gat 0 �'O"s SX1111, OF ...,, �1���... STEP Tank VfRlf!£D TANK lMfGR1TY 6 �p`P(E. o I 4th ; a �..... ... .. .. / 3 ..... .. (p* ............ .... f 4 LA9 SPURKLAND •• • O ��C�'•. No. 11500 'ti i ShallowTrench (typ), 60' Long 4' Max. Depth ND SCALE 3' Sewer Rock 2' Insulation Distribution Line (typ.) O 3/16' Hole 36' on Center Trench Elevo tion (typ.) Monitor Silt Barrier 2 in, Insulation 743 EUV = 98' 2' Cover E.G. ELEV = I=II IAIWI I I I I I fLEV £LfV = 92.5' 3.0 ft oP Septic Rock H2O ELEV = 86.5' BOH ELEV= 83.5' BENCHMARK BOTTOM SIDING AT A' ASSUMED ELEVATION 100' SPURKLAND ENGINEERING PARK HILLS 11 BLK 1 LOT 5 SEPTIC SYSTEM ASBUILT 203 W15th Ave Anchory Ak 99501 DIXINE HARDESTT-SHIAVI DATE, SEPT. 7, 2012 Q79-391 145" WOMV "V m CIR., ANCUBRACC AK 9904 QWCCT. ONB GOID• 9 7 PERMIT 0 0SP121245 PARCEL IB 6 017-142-08 PARWILLSOBIL503-ASBOV6 Municipality of Anchorage Development Services Department Building Safety Division y� On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 wwwxLanch oraae. ak. us (907) 3437904 Soils Log - Percolation Test ....4JTFi. ............ �'. LAR S E. SPURKLAND. � t1SP0 \C' l lj 3[1 Performed For: DIANE HARDESTY-SCHIAVI Date Performed: Legal Description: PARK HILLS #1 BLK 1 LT 5 Township, Range, Section: _ TP 4t3 SIFT I I I—T-T� 1 11 1 1 1 1 1 1 COMMENTS PRESOAKED WAS GROUND WATER Date ENCOUNTERED? Yes Net Time Depth to Water 5 IF YES, AT WHAT DEPTH? 6' L Depth to Water After O P Monitoring? E Date: Site Plan Reading Date Gross Time Net Time Depth to Water Net Drop 9/4/12 9:20 AM 0MIN. 13.438" 7.875" 9/4/12 9:50 AM 30 MIN. 13.313" 5.563" 8.000" 9/4/12 10:20 AM 30 MIN. 13.313 5.313" 8.063" 9/4/12 10:50 AM 30 MIN. 5.250" PERCOLATION RATE 5.7 (miwu winch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN 3 FT AND 4 FT PERFORMED BY: AASon AOKoi t5j I .t L✓/ SW _ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDIFILINES IN EFFECT ON THIS DATE. DATE: 113113 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP121245 Tax Code Number: 01714208000 Work Type: Septic Upgrade Permit Effective Dates: August 30, 2012 to August 30, 2013 Design Engineer: SPURKLAND ENGINEERING Subdivision: PARK HILLS #1 Site Legal Address: PARK HILLS #1 BILK 1 LT 5 G:3037 Owner/Address: SCHIAVI DONALD F & HARDESTY-SCHIAVI DIXINE L 14500 WOODHAVEN CIRCLE ANCHORAGE AK 995164238 Site Mailing Address: 14500 WOODHAVEN CIR, Anchorage This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank N Privy All construction must be in accordance with: Lot Size in Sq Ft: 48495 Total Bedrooms: 4 N Private Well N Water Storage 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 must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either. A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: PRIOR TO CONSTRUCTION: The percolation rate for the silt loam strata at TH3 shall be established prior to construction. If the results require a design change, an approved change order shall be acquired prior to construction. Received Issued By: I?i MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program ANCHORAGE Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Oil -14Z- 0 % Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) DtXtda 1AAao4sTY - SAiAdj Day phone 34$ -0202 - Mailing address 145M Wwoliyea CA. gntcaolEAKr Ay. 1151(, Site address - Sa�te- Legal description (Sub'd., Block & Lot) PALK NILS "` I I3tK I LT 5 Legal description (Township, Range & Section) Lot Size q `g, yq5 Sq. Ft. Number of Bedrooms "I THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (®ail that apply) Initial ❑ Absorption Field 91 Septic Tank ❑ Upgrade 0 Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 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. of property owner or Permit/Rush Fees: 15 30 Date of Payment: W 10 I I a. Receipt Number: O3155 G Permit No. ©fl![Q\a? kS Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Building\On Site\Farms\Client FormsTermR App 010411.doc (Rev. 1/11) Environmental Consulting and Design SEPTIC SYSTEM DESIGN Park Hills #1 Blk 1 Lot 5 Municipality of Anchorage August 30, 2012 Development Services Department On Site Water and Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Septic System Installation Permit 14500 Woodhaven Circle Ladies and Gentlemen: I am writing to request a septic system installation permit for the above referenced property. The existing septic system is no longer functioning adequately. The proposed system will serve a 4 - bedroom single-family residence. Soil logs, design calculations, a site plan, design drawings and construction specifications are enclosed for your review. Design Calcs: Groundwater observed at a depth of 10 feet below ground surface (7/9/12). Soil Rating. From test hole 6/29/12 3.8 min/in =1.2 gal per sq.ft/day No. of bedrooms 4 Required area per bedroom: 150/ 1.2 =125 sq.ft. Total area required: 125 x 4 = 500 sqft Use shallow trench with 3 feet of sewer rock Minimum trench length 500/5*.58= 58 feet System: Existing 1500 gallon STEP tank, followed by a shallow trench absorption field. The absorption field will be 60 feet long and 5 feet wide and contain 3 feet (517sq.ft. effective) of sewer rock. Soils: Three test holes were excavated on June 29th, 2012. See the attached soil logs. A percolation test was conducted at a depth of 4 feet. The material from 0.5-3.0 feet is the same as that material from 5 to 10 feet, except it is not as compacted. An additional perc test will be conducted in the silt loam at the time of construction. Groundwater was observed at a depth of 10 feet below ground surface on July 9, 2012. Ground water monitoring will continue through construction of the septic system. 203 West 150i Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net SpurMend EimgmMaarmmg Environmental Consulting and Design Surface Water: There are no surface waters within one hundred feet of the proposed septic system upgrade. Topography: The ground level slopes down towards the west at less than 25% grade Waivers: None- A foundation drain was installed along the east side of the garage. A portion of the drain will need to be rerouted to maintain the required offset. The drain does not have water running in it. It collects water from a down spout off the house. The drain will be abandoned within 20 feet of the proposed drain field. The drain does not have a surface out fall. See sheet 2/3. The installation of this septic system will not prevent wells and septic systems from being installed on 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. If you have any questions or concerns, please contact me at 279-3916. Sincerely, I l_V JI;L Lars Spurkland, P.E. Civil Engineer 203 West 151i Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net i � GA' LOT 2C 50 0 50 100 150 200 250 300 SCALE., 1' = 100 FT LOT 2 / LOT I ISPURKLAND ENGINEERING I ( PARK HILLS /1 BLK 1 AK. 99501 LT 5 I (SEPTIC SYSTEM DESIGN I AB03NC W 15TH. AVENUE ANCH. DIXINE HARDESTY-SCMIAVI DATE, JULY 16, 2012 (907) 279-3916 74500 WOODHAVEN CIR., ANCHORAGE, AK 99516 SHffT+ 1/3 GRID+ 3037 I PERMIT # OSP111OXX PID # 017-142-08 PARKHILLS#1BIL5SCIOO.DWG TRACT 3 LOT 2C \ ABANDON CURTAIN DRIlN TO MAlNTA/N 20' ALL 4 -BEDROOM SEPTIC SEPARATION fROM PROPOSED ABSOPPAON FIE SYSTEM LD RNG 1500 GAL. STEP TANK A SHALLOW TRENCH \ 4VATION DEPTH 4' MAX xmc zax ER ROCK 3' SALWIE lot Septic! ILAWN 2 Area ' LOT 5 °' 11plaiLM rza uro �< 9-P s O� ,F � LOT a 1 j<1 $Lay -ju csva 1 Well `r � 1 Wetly � � O LOT 61 I�.•••EOF NOTE • SLOPES EXCEEDING 259 WERE NOT OBSERVED z c • `uc9 II WITHIN 50 f£Ef DOWN GYlAOIfNT OF THE PROPOSED 4L r s} ABSORPTION FIELD LOCATION. j A t 00 NOTE. IH1S lS NOT A SURVEYED PUT. WELL d' S£PTlC 0... (.y .•..••. ............ • :••'••� LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER ,y DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN AR£ ♦ L RS SPURZZD ••: L;� IC APPROXIMATE. 1l ,n e, NO. CE -11500 = 25 0 25 50- 75 100 125 150 II •• j Aw�O ww SCALE 1 — 50 FT SPURKLAND ENGINEERING PARK HILLS #I BU 1 LOT 5 SEPTIC SYSTEM DESIGN 203 V 15TH �AV/ENUE DIXINE HARDESTY-Si BATE, AUG. 7, 2012 0 A939�b t4JDD weV"VtN CYK:, AN& MPAbr, AK' YYJIB 5HErn IPJ blCLD+ 5051 PERMIT 7I 0SP111OXX PlB N 017-142-08 PARKHILLS#JBIL5SC50.BVG Shallow Trench (typ),, 5' Wide 60' Long 4' Max, Depth NO SCALE 3' Sewer Rock 2' Insulation 2' Cover (hind Trench Elevation (typ.) Monitor Silt Barrier - 2 in. Insulation j2' Cover 3.0 Ft of Septic Rock 1500 Gal. STEP Tank VERIFY TANK /NTEOROY Distribution Line (typ.) 3/16' Hole 36' on Center ISPURKLAND ENGINEERING I I PARK HILLS /1 BLK 1 LOT 5 I I SEPTIC SYSTEM SCHEMATIC I 203 W15th Ave DATE: AUG. 7, 2012 Anchorage Ak 99501 DIXIIJE HARDESTY-SMIAVI 279-39IG 14.500 WOOOHAVEY CIA. ANCHORAGE. AR 99516 SHEET, 3/3 GRIDS 3037 I PERMIT # 17SPI21OXX PARCEL 1D # 017-142-08 P4RKHILLS#1D1L5D3DWG I Municipality of Anchorage �gvelneERsa `tj Development Services Department j pj 'f9 Building Safety Division , 49 •• �r On -Site Water and Wastewater Program ; .. 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 / SPURKLAND; cQ7 www.ci.anchoraae.ak.us (907) 343-7904 It �c J.'. • t 1 0 �� Solis Log - Percolation Test iii��PRiSONP�� Performed For: DIXINE HARDESTY-SCHIAVI�� Date Performed:.lUNE 29, 012 Legal Description: PARK HILLS #1 BLK 1 LT 5 -u1 F_ 1 1 L l COMMENTS Township, Range, Section: WAS GROUND WATER Fitt Cong15TIfJtL wJ / 04 '11iat 2- 3- L oa6AMC5 (PEAT Tar& S}um45) O P ® /0/ E 4 5- �X GrAt C010r {rw» 4 7_ BA,i1 1 1 L l COMMENTS Township, Range, Section: WAS GROUND WATER ENCOUNTERED? Yes s IF YES, AT WHAT DEPTH? 61 L Depth to Water After O P Monitoring? E Data: Reading I Date- I Gross Time I Net Time I Depth to Water I Net Drop PERCOLATION RATE TEST RUN BETWEEN (minutesrinch) PERC HOLE DIAMETER FT AND FT PERFORMED BY: LABS 5DURKLAN9 I V14CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL 6VfEdLINES IN EFFECT ON THIS DATE. DATE: 7/16/12 Municipality of Anchorage Development Services Department 9- Building Safety Division �(1.M� ENCOUNTERED? Yes yam. On -Site Water and Wastewater Program Road j 10- 4700 Elmore P.O. Box 196650 Anchorage, AK 99507 / �0 www.ci. anchorage. ak.us (907) 343-7904 / Soils Log - Percolation Test Performed For: DIANE HARDESTY-SCHIAVI Date Perk Legal Description: PARK HILLS #1 BLK 1 LT 5 Township, Range, Section: -0-L Depth (Feet) ,_ >'r�rl ORGANICS 3- ® Si 4AAa. al,9s1trl 749TH 9 i �CAR3A SPURKLAND.:� Reading I Date I Gross Time I Net Time I Depth to Water I Net Drop PERCOLATION RATE (.huWsMch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: LAS SOURK LAND 1 Wb , U (M CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDE NES IN EFFECT ON THIS DATE. DATE: 7/16/12 WAS GROUND WATER 9- �(1.M� ENCOUNTERED? Yes 5 10- IF YES, AT WHAT DEPTH? 6' L " Depth to Water After o P 11- Monhoring? E 12- Data al,9s1trl 749TH 9 i �CAR3A SPURKLAND.:� Reading I Date I Gross Time I Net Time I Depth to Water I Net Drop PERCOLATION RATE (.huWsMch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: LAS SOURK LAND 1 Wb , U (M CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDE NES IN EFFECT ON THIS DATE. DATE: 7/16/12 Municipality of Anchorage WAS GROUND WATER ENCOUNTERED? YES Development Services Department s IF YES, AT WHAT DEPTH? 10' L Depth to Water After P Monitoring? 10' E Date: 719/12 Building Safety Division Net Drop y -r On -Site Water and Wastewater Program 0 1:35 PM 0 MIN 4700 Elmore Road 4 10.375" 7/3/12 P.O. Box 196650 Anchorage, AK 99507 1010 www.ci.anchoraae.ak.us / (907) 343-7904 I Soils Log - Percolation Test 10 MIN Performed For. DIXINE HARDESTY-SCHIAVI Date Perh Legal Description: PARK HILLS #1 BLK 1 LT 5 Township, Range, Section: 43 Depth 1 1 1 ry(b.V21�� Jii�.) I�i51ufDE9 CML) bM) lilt LOAm �RAVULJ Sj� (MLI GM) O'b.N COMMENTS PRE-SOAKED. Site Plan Reading WAS GROUND WATER ENCOUNTERED? YES (rtt ff n pt© 3l�CAL)- 3 ( POL6k, o i s IF YES, AT WHAT DEPTH? 10' L Depth to Water After P Monitoring? 10' E Date: 719/12 510 Net Drop O'b.N COMMENTS PRE-SOAKED. Site Plan Reading Date Gross Time Net Time Depth to Water Net Drop 7/3/12 1:35 PM 0 MIN 13.5" 10.375" 7/3/12 1:45 PM 10 MIN 13.6875" 3.125" 11.0000" 7/3/12 1:55 PM 10 MIN 13.5" 2.6875" 10.75" 7/3/12 2:05 PM 10 MIN 13.625" 2.75" 10.875" 7/3/12 2:15 PM 10 MIN 13.5625" 2.75" 11.000" 7/3/12 2:25 PM 10 MIN 13.875" 2.5625" 11.25" 7/3/12 2:35 PM 10 MIN 2.625" PERCOLATION RATE 3.8 (minut Awh) PERC HOLE DIAMETER 6 TEST RUN BETWEEN L1,01J- FT AND 4k5' FT PERFORMED BY: ANSON MOXNESS I I ""J i0 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL. GUIDE TIES IN EFFECT ON THIS DATE. DATE: 7/16/12 Municipality of Anchorage Page of 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: s W cl 5 0 a-/ 3- PID Number: 0I 7— l4 a' o$ Name: 0Sc4R f`1 • SIeC- Fdf3/`• Wastewater System: ❑ New ❑ Upgrade Address: t. 1 j S-00 L•V0©AN4vf/V ������ C ABSORPTION FIELD Phone: ,3 Y S _ 7 7 '1 G No. of Bedrooms: u 1 0 Deep Trench ❑ Shallow Trench 9 Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: a, V Total Depth from original grade: 1 ).9 GPD/Sq. Ft. Lot: Block: Subdivision: 1 1 Depth to pipe bottom from original grade: Gravel depth beneath pipe •� P%} /f r Lu f it- i Ft. 0. S— Ft. Township: Range: Section: Fill added above original grade: S� Gravel length: �~� 1. Ft. FL WELL: P_)vsnv6-❑ New El Upgrade Gravel width: Number of lines: DistancenlinFt. t. "I - Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: se -W.40 4r1 Ft. I Ft. '7'5'0 SQ. Ft. PVC 4S7- )3031 Driller: Date Drilled: Static Water Level: Installer: Date installed: r Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES O Septic ❑ Holding KS.T.E.P. TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: % From Tank Field Station Tank Sewer Lines 7AAvK S`o,0 Well 1l3 %17 11.3 k1A , /OH Material: STf+ L Number of Compartments: Surfac /oo"+ 100+ ioo n,/q goo LIFT STATION Water LotSize �oS` a �,5 rvIA 5 in gallons: 1 S Manufacturer: -r 41 'lf Line 0 h Y4NCHd/.4C Foundation 7 / lis- 7 /VI4 "Pump on" level at:„ `t3 "Pump off' level at: /, 33 High water alarm at: n `15• Curtain nco,.t �,or,C N0n.EN/ aa�Lr Pump Make B Model Electrical Inspections performed by: I m. A. Drain KNal„w u,�ow,., k, V7v Knrowri OS l 0 S NN o, Remarks: -iF Lm,— Lf vE Warvfee RfQ,v157E1) BENCH MARK Location and Description: I TO PRO v,AE S4,0424; -Io,,, ro Dktv£Way / SNow N F Con:✓e--il G_ARftC,E- S l-. R 13 o./AL . NJ ft4vi25i Assumed Elevation: A -.PT>° /0010 FtE OFl *E 4 kA7 .WMI'%y.M Inspections performed bys &S ENGINEERING .Dates: 1st O 17034 Eagle River Loop Road No.204 2nd 3- `IS ROBERT C. COWAN Jae Cagle River, Alaska 99577 I `g, : CE - 8801 Department of Health d Huma rvices approval �.., ..•� ��� �� ,74...,.... +i. Reviewed and approved by: Date:l 72-013 (Rev. 9/91) MOA 25 Per . mit No. SW950212 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 e Anchorage, Alaska 99519-6650 *Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report LOT 5, BLOCK 1, PARK HILLS S/D #1 01714208 Legal Description: PID No.: MT1 MT2 C01 Co FINAL GRADE -99.8,MH 104.5' � FINAL GRADE .............. ............ ................ . .. ........ . ........ ....... . ............. — L r10,V ...... .......... .. ............... ........................... 93. NEW 1500 GAL 93.5' S.T.E.P. SYSTEM N.T.S. . A 9.7.4' WATER FOUND .................................. ................................... .................... ................................................................ ................. 7=T2=05 ...... ............. ...... ............... NEW ABSORPTION BED: .............. A B C: D FCO 11' 10' EXISTING LEACHRELD ST1 18' 13' DISCONNECTED, CAPPED, AND ABANDONED SUCH THAT rr MAY BE USED IN THE FUTURE. 2 ST2 25' 17' ..................... . .. . .................................. . .... MTIi. MH 27' MT1 19' _6V 86� MT2 701 93' MT3 49' 53' NEW 15001 GAL MT41­1 --161!1 65' S.T.E.P. TANK C SCALE; 17 = 40' 72-013 A (1193) - t ROBERT C. COWAN CE -8801 16. 4; . . ........ 4, INSPECT ICI PI;PORT MUN IC IPi)L ITY OF ANCHORAGE. BU ILD T'lG :aAi TY D IV IS I^uiJ ;,�'Qt} Eti'ctT Ti1fl!.! : ROAD 41 PlAMI::- .1- PHONE t: �J �S: j �t� WV muev l aya- �t ALIL�RE.,S: DATE: LOT: aT.f1CK: J SUBIi: Gtlt� �If f COMMENT : a,IJ -w t----------------.------------------- TYPE OF CNSF'GCT ION: �- t c'4- ------------------------------------------------------ - Ck NO NONCOMPLIANCE OBSERVED C I CORRECTIONS ESSENTIAL AS EXPLAINED BELOW f. I WILL REEXAMINE AT NEXT INSPECTION C I ISO NOT CONCEAL UNTIL REINSPECTED ------------- -----------T -_____ -" - - - - COMMENTS: Aff p..pJecP I ,-c-P S -to- a� ,j �s INSPECTOR: DATE: WHEN CORRECTIONS ARE MADE. PLEASE CALL FOR INSPECTION l wAeipanty of Anch�ragc a Department of Health and Human. Servicesi Rick Mystrom, 825 1" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 October 9, 1995 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 5 Block 1 Park Hills #1 Waiver Request #WR950052., PID #017-142-08, HA950447 Dear Mr. Cowan: Your request for a waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 2 feet from the east property line. 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, ! /, i z/ /� zMUNICIPALITY OF ANCHORAGE` Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#� 9-,Z9�h4n PID# 017-142-08 HA# HA950447 Date Received: October 5, 1995 Permit # Legal Description: Lot 5 Block 1 Park Hills Subdivision #1 Engineer: Robert C. Cowan, P.E., S & S Engineering 17034 Eagle River Loop Road, Suite 204, Eagle River 99577 Applicant: Oscar Siegfried Waiver Requested: Lot line waiver of 2 feet 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: _7� AA/xl� Date: ame of Rev L Rec #: #01363/3434 Amount: $ 115.00 Date Paid: 10-5-95 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE nLxm DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 F�� ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950212 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SIEGFRIED OSCAR M JR & OWNER ADDRESS:14500 WOODHAVEN CIR ANCHORAGE, AK 99516 PARCEL ID:01714208 LEGAL DESCRIPTION: PARK HILLS #1 BLK 1 LT 5 LOT SIZE: 48495 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 8/10/95 EXPIRATION DATE: 8/10/96 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 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PF RECEIVED E ISSUED BY: DATE: DATE: HEALTHAUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN S& Juty 27, 1995 MUNICIPALITY OF ANCHORAGE Depa&tment o6 Hea th and Human Senv,ices P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 5; Beock 1; Patk H.iM 01 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Request you issue a pe&mit to upgrade the septic .system serving the jour bedroom house on the KeSeKenced phopvity. A test hote was excavated and a pencotation test pex6o&med .in the area o6 the proposed upgrade. The appnox-imate tocat%on o6 the test hole .is .located on the attached site plan. At the time o6 excavation, water was encounten.ed at 5.5 beet and a6tea seven day ground water. monitoring water was bound at 7,o beet. Attached .is the proposed upgrade design. We do not anticipate any adverse e66ects on neighbming wed, septic systems on dna.inage patterns by the .instaU-ation o6 the puposed septic system. There ane no points o6 contamination within the wett nad.ius which can be seen on the attached site plan. 15 you n.equ.ine additional .in6onmation, ptease contact us. S.incenety, rn ^�ZIZ Robert C. Cowan, P.E. rn v RCC/gk r m 4 EnctosuAe < v Fi n O m z 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 J 0 w J LL 0 z Era ' It � • RIVE \ �P,.• f . �.��✓,,k1 0 CE U) ZO_ p Wjj W ov/Q\wco r oraa UU `j [O Wox \Oaf ~ _ vCD C •Ir, ., K J Q Rf '" p O ~ < {MA z IXY / o� omFy0 uoa3 No Of O z w Z U O O = 0 ()f <W z<o o ZOw� Ua GU V)a Z w >V)M p(f) V W O]�W w F- of W Z a Z W Z J oz��oa a� W� �aJ.o���w Z J V) w W n� V)Z (,) W V)%d LLI V) Z U)~J L,W QO W z �m� 0 . 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O � n u D_ cn a O� a La U M O d M � U O=> _ O �1 Z to w} F- o_ a U TVIM I 31Id021d 'STN O .. cn a a La J d � U _ O �1 to F- U O d' N w J ly H o E� 0 a �Oco I �� \ Z — — — J ID � W ZEx-���a F W W oat a, x> O 'STN e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "LII Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 0 S C g R S 1 iG F R l 6 t, DATE LEGAL DESCRIPTION: lo t S &K / DEPTH (FVT) 2 ✓' c 6 4 /Loc/c)' 5 CI t,r /yriR 5d� P 6 7 I,- ; $'l 9 13.49. fit. 10- 11- 12- 13- 14- 15- 16- 17 011121314151617 18 19 y/A,Lj #-Township, Range; Section: SLOPE WAS GROUND,WATER ENCOUNTERED? yam-} / S IF YES, AT WHATL DEPTH? S.�' O P E Depth to Water After 7 1 i Monitoring? Date: �^ ral] Reading Date Gross Time Net Time Depth to Water Net Drop Pc E- 0,4 le6,0 T 1 xn3` Y"11 ab (57, 20 PERCOLATION RATE I (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN IX FT AND FT COMMENTS "� NOL '4L Dv 4 /3 V r w4�'i a J9 X PERFORMED BYS & I �Y� � - CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE 1i�rR AA99KNVARl�MRii�Rll &U41NES IN EFFECT ON THIS DATE. DATE: �� y�� Cagle River, Alaska 99577, 72-008 (Rev. 4/85) HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN rnG ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 5, Block 1, Park Hills #1 July 24, 1995 GENERAL: ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 1. The scope of this project includes the installation of a 1500 gallon wastewater S.T.E.P. system (septic tank) and a pressurized absorption bed to serve the four bedroom residence located on the referenced property. The existing septic tank is to be excavated, pumped, crushed, and abandoned in place. Also the existing leachfield is to be abandoned in place. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP - SUITE 204 - EAGLE RIVER, ALASKA 99577 Page Two Lot 51 Block 1, Park Hills #1 July 24, 1995 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic .tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. PRESSURIZED MOUND SYSTEM INSTALLATION: 1. Any peat or organic matter must be removed from the elevated mound site. 2. The bottom of the basal bed area as well as the top of the sand filter is to be within two inches of level. 3. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. 4. The side slopes of the top layer of the mound system must not be steeper than 33% (3:1). 5. The top of the mound shall be covered with a minimum of 6 inches of topsoil and vegetated sufficiently to prevent erosion. 6. The distribution pipes are to be embedded in sewer rock. Care should be taken to backfill in such a way as to prevent damage to the piping system. 7. Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Page Three Lot 5, Block 1, Park Hills 41 July 24, 1995 8. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic_ tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or B.E.C. requirements. Page Four Lot 51 Block 1, Park Hills #1 July 24, 1995 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 5, Block i, Park Hills #1 July 24, 1995 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE `.. DEPARTMENT OF HEALTH 8E ENVIRONMENTAL PROTECTION I� ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE 'NEW /� of CC', �1�2 4r, e d 2y3 by`!p ❑ UPGRADE MAI LING ADDRESS LEGAL DESCRIPTION L 13 7. R 3 66 2e LOCATION / /1 e �Dt2�Gia �q Cr1'r�--+ NO. OF BEDROOMS Well Absorption area Dwelling PERMIT N0. ;Y 6 2 y Z DISTANCE T0: Io� I VY t- Z Manufacturer �nJ Material S_ ( No. of compartments ti Liq. capacity n gallons r IF HOMEMADE: Inside length Width Liquid depth Well Dwelling PERMIT NO. O Y DISTANCE TO: O zQ Manufacturer Material Liquid capacity in gallons 2 F O WellFoundation Nearest lot line PERMIT NO. DISTANCE TO: w= w LL z J No. of lines / Len th of each li e �% Total length Q� I' es Trench width Distance between lines z E lrf' v inches ~ cc Top of the to finish grade 1 Material beneath tile Total effective absorption area inches � Length Width Depth PERMIT NO. Lu c7 Qa F Type of crib Crib diameter Crib depth Total effective absorption area wa W Cn Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J Uj � Building foundation Sewer line Septic tank n Absorption area(s) DISTANCE TO: OTHER 2 PIPE MATERIALS PSL c/ SOIL TEST RATING 15-0 INSTALLER (`%P �-rn1Wi7 M 3 b REMARKS !Sa 6 4�/Vle JwC P� � E �a 2 sXI I at) A sr 0 U{I APPROVED DATE LEGAL 72-013 (Rev. 3178) I Ezd h -J k._.- 5-":. ;u.![;:: [ ,P; a: r,., F' Ix=.1',L('h;l....i"FE_!_:!' T iJ�,f 14. .c .!'+::.� iik:'i is is L..._, L t_I f •<.�: -i..l {jar — : .... rE- D i:.!E L.=1 f1:-• F- . - FtJr'::fi...!1_,1._ k.ljf•:I:..;:.li;f-:,..:1_a`::. .i`i:.,:,° r-:r'.h : ".r] - - =•. ;r f.l:i:l._.i_.. T1`'d: Ft!l...l_. r';.dEi c'r' :..I,.F-!.;i 7:1`'d r'li_:Ci_if C;i=li°'at'�": T- H f!l._L Pii_r (.:t, l_!r__ t=1F.!�;' F6` Y;1 !i_hlhlil!`:I::: F-1NC. I'''1 i.,_!t'II'l...t:ll;',!! r I11:Ir 1Nk I'r TI'! i I;LikF Ef! 1H1 I Er:r'1IT. _. J: !1�:l...i_ !c:!Il�::F i.:: 1'_i tll_.L, rli.'E! 111!1.'A [-.E.I_i!_�FREM�h';l�'_; FC:IF:: .� E ::!:I F,F!i: TOF - E -R D 7: 'T.F>t_i';fyl,_ . _;:�:, :"FE_M CR PUBLIC.' C.' 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ED irl -- -K -3, 1-!r-' ,rsSufD y 6EDleams c /?Ar-iA(G of iso 7--6 A -L 0,6Pr1),0f SYSrZ;41 /'o C� dffTff OF %�/f'� ' T / /rl O. 5 U <c e 6e d/nz�NS/�n/S d �3f� ��� i►�GiN,� /� fif4VU€sT Co��Ei✓TiP�/o��/ Vl�9A/N flX/S' ��iii4�L,�� �o .5'Z�/'� coN'iocllts\ OF J USS Cy -,CAN S/}A/V / jtr"/A4 /TATTFD Al �c X2wedra"A c/? eless rfE GRIDU AID �5-0 R r'A C E- X/E/S'ULAi E /4-/yO llvoolslO .5r,S7—,CM Wily AT LkIS'1- /8 hn A rE-R l A L A/VP r/?F��,eRA /3G y' Ry ..' 34/'t/C 7-4I'Ve S/G Al e a/�'S Po6s/6N 13,45Ao oW TFsT�°L� - 7 /�1. �-��-�����a� ~� . k`i k-1 1-4 7 1 F- F:1 t~OF-- Rr4CHCiRF:�OFE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET/ ANCHORAGE.- Al-,.- 99501 ` 264-4720 ' :E;E�LJEEF.� 'S!- pERMIT NO: 8401]9 DATE ISSUED: 04/05/84 APPLICANT: OSCAR M. SIEGFRIED \~/ ADDRESS: 48]0 CATKIN CIR ANCHORAGE, HK 99515 CONTACT PHONE: 24]-0490 LEGAL SUBDIVISION: DESCRIP� � � PHRK HILLS` /�� LOT: � 5 BLOCK': 1 ` \ SECTION: 34 TOWNSHIP� 12N RANGE: ]W � LOT 'SIZE: 1� 1H (SQ� FT� OR HCR �S) MAX BEDROOMS: 4 � LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOU SYSTE�� CHOOSE THE ORTION THAT BEST FITS YOUR SITE. « ��pTIC~^-` �--�-~--^~----~~-----.^___.^-___~__^_~ El. EE C-0 8�- ����F�I r� � DEPTH TO PIPE BOTTOM (FT ) 6� 5 60 GRAVEL DEPTH (FT. ) �� � 1 0 TOTAL DEPTH (FT � ) - - ��0 T0 GRAVEL WIDTH (FT. 29.' 0 GRAVEL LENGTH (FT. 50 . 0 ** GRAVEL VOLUME (CU. YDS.") 61. 2 194 4 TANK SIZE (GALS) 1/ -� - 25� � ** 1, 250� 0 ** S� OIL RATING <S(l FT /BR) 274 ]]1 � ** GRAVEL LENGTH } 75FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT EACH) TA? -4[:,.** |MMUST HAVE AT LEAST TW���COMPH MENTS� I CERTIFY THAT: !' 1IHMFAMILIAR WITH THE REQUIREMENTS FOR ON -ITE SEWERS AND WELLS AS SET 2 � FORTH �Y /HE MUNIC%F�LIT� OF ANCHORAGE (MOA')'. AND THE STATE OF HLHSKH 1NWl�LL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOH CODES AND REGULATIONS, M b IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT � ' ]� IIWILL CADHERE TO ALL M(}H AND STATE OF ALHSKH REQUIREMENTS� FOR THE SET 8RCK DISTANCES FROM .HNY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE E YS/EM ON THIS OR ANY ADJACENT OR NEARBY LOT./' �INUNDERSTAND T����T THIS PERMIT IS VALID FOR H MAXIMUM F 4 BEDROOMS D ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. ` r�m IF H LIFT STATION IS INSlHLLED IN HN AREA COVERED BY MOH BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTHlNEDi (2) HS ILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REP �uu ELECTRICAL WORK MUST BE DONE BY H LELECTRICIAN. SI--- DATE:, ~�`r/�w�� APPLICANT: SI�GFR�c�� +�'` ISSUED BYI / DATE: / 7r-_�-----�------- PERFORMED FOR:_ LEGAL DESCRIPTION: 1 or - 2 2 i 6 i e Y 4 too 5 f 5 s A, a 7 SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 825 L. Street, Anchorage, Alaska 99501 264-4720 TEST SOILS LOG — PERCOLATION TEST �J DATE PERFORMED: lel/s J'v SLOPE SITE PLAN ��fY1Y�3 (SIC) Si /�Z' 9 ! lse. 10 72-008 (6/79) • �,/ \ �� SOILS LOG MUNICIPALITY OF ANCHORAGE • +� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION 825 L. Street, Anchorage, Alaska 99501 264-4720 TEST SOILS LOG - PERCOLATION TEST PERFORMED FOR: Sl,iil� �j tP� DATE PERFORMED: D LEGAL DESCRIPTION: �t..1 E f l 6 S subd , l� // / , LOIME—f-� 1 2 3 4 5 6 7 8 9 10- 11 - 12- 13- 14- 15- 16 17 18 19 20 COMMENTS PERFORMED BY: Act, &PAW Grade/ ee'4�)Ie/ SLOPE PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN _tel / FT AfNp/ FT CERTIFIEIV BY: 72-008 (6/79) J/1 ee'Y Z-4- Z - DATE ��7 ��������� DEPARTYi�NT 1-11-ALT11 I i9ND 825 L STREET/ HNCHORHGE/ HK 99501 264�4720 , PB?MI9 ' DHTE ISSUED� 04/05/84 HPPLICHNT� OSCHR MSIEQFRIED HDDRESS� 48�0 CHTKIN CIR HNCHQRHGE� HK 99515 CONTHCT PHONE 24]~0490 / ' / 1 LU DEPTH TO ~R.I%JFL DEPT11 `F. 51 �D T~���� ~"''' CT -1 0 GRHVE� WIDTH ( GRAVEL LE'GTH ) o ` 0 *Al GRHVEL VOLUMEYDS ) ` THNK SIZE (GHLS) 1/250.0 ** 0 ** SOIL RHTING (SQ .. �y � I CERTIFY THAT: 1 I HM FHMILIHR QUIREMENTS FOR ON_SITE SEWERS HND WELLS AS SET FORTH BY THE MUNICIP�}-^Y OF HNCHORHGE (MOH) HND THE 'STATE OF HLHSKH �I WILL INST�LL THE SYSTEM IN HCCORDHNCE WITH ALL MOH C�DES HN� REGUL�TIONS HND IN COMPL'IHNCE WITH THE DESIGN CRITERIH OF THIS PERvIT u � / ] I WILL HDH�R� TO Hi.L MQH HND STHTE OF HLHSKH REQUIREMExTS�FOR THE SET B'CK DISTHNCES FROM HNYEXISTING WEL�/ 'WHSTEWHTER DISPOSHL �YSTEM OR PUBLIC M SEWERHGE SYSTEM ON THIS OR HNY HDJHCENT OR NEHRBY LOT � 4 I UNDERSTHN� THHT THIS PERMIT IS VALID FOR H MHXIMUM (F 4 BEDROOMSAND ANY ENLHRGEMENT WILL REQUIRE HN P� HDDITIONHL RMIT. v IF H LIFT STHTION IS INSTHLLED IN HN FK8�H COVERED BY MOH BUILDING CODES THEN (1) HN ELECTRICHL PE�MIT HND INSPECTION MUST BE OBTHINED/ (2) A'S-BUIL'TS WILL NOT BE HPPROVED WITHOUT HN ELECTRICHL INSPECTION �EP 'ELECTRICHL WORK MUST BE DONE BY H L CENSED ELECTRICIHN SIGNED ` DHTE� /=~� ~-~-.����_._�t6, HPPLICHNT: O SIf�GFRIE�� ��--�'-~ AN ISSUED BY DHTE� / ~��___�~__. ..... .... ....... ._ I !r I RETURN TO:- Division of Geological and „�slcal Surveys (DGGS) 3001 Porcupine Drive (Teley�ione: 277-6615) Anchorage, Alaska 99501 W A T E R W E L L R E C O R D Drilling Company Name K __:-_•)t U.S.G.S. Local No. T Drilling Permit No. LOCATION OF WELL Please complete either la, 16, or It. A.D.L. No. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES Ia. Borough Subdivision Lot Block lb. Fraction Section No. Township N/S Range - E/W .Meridian lc. Distance and Direction from Road Intersections i Street Address and Area of Well Location 3. OWNER OF WELL: Address: 2. WELL LOG .- Feet Below Surface Material Type Top Bottom 4. WELL DEPTH: (completed) •�'(:;1 -'! ft. Surface Elevation Date of Completion J : \i 5. [:]Cable tool []Rotary ❑ Driven ❑ Dug ❑Auger ❑Jetted ❑Bored ❑Other: •�� ) , i 1 _ 4- c, i; !.Y 1, .y -, c� J �'� l <: P1 i'11 i,l-:; -1,], L _L t �_'J?; 1,*p =�C -,1, 6. USE:"❑Domestic ❑Public Supply ❑ Industry ❑Irrigation 11 Recharge ❑Commercial [-]Test Well [—]Other: .I 1, is '! 1 ,?rlt 7, CASING: ❑Threaded aWelded •.,''t in. to '.•'i lft. Depth Weight." lbs/ft. in. to ft. Depth 8. FINISH OF WELL: Type: h'.:i1. Diameter. �p,f Slot/Mesh Size: Length: Set between ft. and ft. Fittings: ANCH RAGE DEPT. eF HE-Atltj 27— ENV ." NOV 9. STATIC WATER LEVEL: f[. ❑ AboverDelow land surface Type of Measurement: L 10. PUMPING LEVEL below land surface t el ft. after �.„ hrs. pumping - g,p, m, ft. after hrs. pumping g,p,m, - " 11. WELL HEAD COMPLETION: ❑ In Approved Pit ❑Pitless"Adapter ;,Z, (,� inches above grade ' 12. GROUTING: Well Grouted: ❑ Yes ❑No Material: ❑ Neat Cement ❑ Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity g-P-ff Type: ❑ Submerslble ❑ Reciprocating ❑ Jet ❑ Other: 14. REMARKS: S.atar iP.11l:)1'rattol':J; " - / 15. WATER WELL CONTRACTOR'S CERTIFICATION:// This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief: Registered Business Name _ Contract License Number Address.'- C ! '^ I''` •. TL -':1 i - -•Ir ._ . - - i � n )t'•1 1. Signed: / ,� i Authorized Rep reskntative tci _- - - Date: PGv '1 v 650 ANCH011/ (G`_-. ,1.1 A'-), 90 7) 2(3,1 j 1 A YC) DEPAR f A4eiJT oiHEALTH AND. ( -AL PROTECT oN (Permit #: 820468 January 31, 1983 TO: Permit Applicant Subject: Lot 5 Block 1 Park Hills Addition #1 A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on --site sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call this office at 264-4720. Sincerely Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 a Olt My!! Mcub-i Bill Al Il.iE-. a 'STWO-D HIM, 1-411M D 'i: i .1 EU 1 A 1 W W A IWOU eVALLRAIR .1. E3 55 -T 0±11 oil :0 Sh 7411 W l-I"w, --:::5 RV 13 it! 1E, -:-.J-N -1.. -T. ON Ong Su Ali T I iil- 1 - 1,--1 'l., J I S d, Solo] 02 FUH1141 SUMMUC1 3% (31, 031,1011`1111J. -DE1 CIN14 WIR !.--IZ '51 1141-1 Kf� LJ 0.1 1004 1:93A 1117 Eli SAM U O.J.- "-J, k1C)NIA ThDRUSIG kJAW11,11h :DT -01d AID 38W 711-U. MAT J . life" j: ci 1.J sl MIM; 3,J-, ilei -.!S 011:50,10 AIR Will 7=0133STI* J IDj.. 111M ij: 14911A lf,K)FLi-11.1 -jfP.&j AF)TIT J.".:.1 !J;::� -K: -1 7 K LEI 112 Cy i 01 R. 3e%-�fD.S -11TH sifil M 151-1341 1011-1. 'SLAH J- iN! KE— IM 2E 1 M t D D i,w3jjjK%3Xm-j, :J1,10 3H .1- 1: -, T-11 -ii T, -a, 1 - i J. i 1 J. !i ._r (HORME E11-1.1 AfD 3HAMS 31 -Li. 31-11 S I ,L J.._ jpD pso1quoil 1,.' U. .C:1 i..: 1-119011 AM 51 H.J. NO .3. K13 ON TR -0, .1. cis So .0, :51 6.13isells NOU ..7'_. 0:-� U Ji'D 99as Cj .1310 MASITIST e".' S'TTF.W!RJ !J Q i "I pro 10 YV 113 ny. i A oil MD11311011 :J,F] HJ .. ... 1 �,:A-JIHI' SOILS LOG MUNICIPALITY OF ANCHORAGE .� • +�` DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 825 L. Street, Anchorage, Alaska 99501 264.4720 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: JJ It SIP y'e LEGAL DESCRIPTION: COMMENTS a6 6 4 //d 12 // DATE PERFORMED: /� / f 2 r k /tel /�� S6 Ot r1 /rJ N dr '41 SLOPE SITE PLAN _ WAS GROUND WATER ENCOUNTERED? Aln IF YES, AT WHAT DEPTH? Reading Date V�1 QryZn �• DEPTH (FEET) 1 Net Drop {f 12 -y JyY 2 ©9v S, ,3 4 lSo J 5 A:-, -2 /O S' 2 2 /0 6 �7 8 9 cG) 10 11 Y-Iepsa/ 12 13 14 OFF�/ ,��g1�� �� 15 r �e� "• s : � IF ' STH 9 16 :17 .• . ... ....3..:.::;. C. ftw i►. ; �s 18 �j a�.� 22161 19 ;UFES_ AVv 20 COMMENTS a6 6 4 //d 12 // DATE PERFORMED: /� / f 2 r k /tel /�� S6 Ot r1 /rJ N dr '41 SLOPE SITE PLAN _ WAS GROUND WATER ENCOUNTERED? Aln IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Ir",_ Net Drop {f 12 -y JyY -10 ©9v s7 lSo J A:-, -2 /O S' 2 2 /0 PERCOLATION RATE r..( 2 ;2 (minutes/inch) TEST RUN BETWEEN ._L_ FT AND r_ FT PERFORMED BY: �C'-� r �/ ,?t,YI CERTIFIED BY: DATE: 72-008 (6/79) Parcel I.D. # MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES i 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 0l-2-14')_-C�' 1. GENERAL INFORMATION HAA # �j L1'3 ;,C.Li' i1 Complete legal description Lot 5; Bloch l; Pana H.iUA Subdivision #1 Location (site address or directions) 14500 Woodhaven C.incte Anchorage, AK Property owner 0,6ca1L S.iegga.ied Day phone 345-7746 Mailing address P.O. Box 111703 Anchorage, AK 99511 Lending agency Mailing address. Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. rn 4 v; 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well XXX -� c D z Community well q C Public water y 0rr .z 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 XXX 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 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 furtherverify 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 S & S ENGINEERING Phone ct Eagle River, Alaska 99577 Address Engineer's signature DHHS SIGNATURE Approved for ___L/bedrooms. Disapproved. Date / 6 I W `i j' Conditional approval for bedrooms, with the following stipulations: Additional Comments By: U /;;Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and 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. 72-025(Aev. 1/91) Beck MOA #21 MUNICIPALITY OF ANCHOkAUE Municipality of Anchorage ENVIRONMENTAL SERVICES DIVISION DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division OCT 0 1995 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-474?4 RECEIVED Legal Description: 1-0 7- A. A. WELL DATA Health Authority Approval Checklist j6%x / P'4p:x YlLcy 017 Parcel I.D.: Well type P21y e i E If A, B, or C, attach ADEC letter. ADEC water system number Log present (&N) Total depth c'� Sanitary seal (OPV) Date of test Static water level y t S Date completed 7/ 8� i 1 3 "7 Cased to N O Casing height (above ground) / W s FROM WELL LOG 7/SH GS Well production JL L a o 4 A,s L e WATER SAMPLE RESULTS: Coliform D Wires properly protected (e" Y 5 AT INSPECTION 1 /) y /0/,S- -a - 0/,- g.p.m. Nitrate O' 3`l Other bacteria 0 Date of sample: `� �� y / 9 Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC[HOLPDW4-TANK DATA Eagle River, Alaska 99577 Date installed �/�9 A S Tank size Number of Compartments � Cleanouts 6( N) Yf S Foundation cleanout a" Y t -5 Depression (YG /V O High water alarm Y Date ofPumpingA'/A Pumper C. ABSORPTION FIELa.,DATA Date installed /�°� ° S Soil rating (g.p.d./ft2 or ft2/bdrm) 0-19 System type 6 Length 9()/ Width l Gravel thickness below pipe 0- Y Total depth 3 / Effective absorption area 7,S- 0 Monitoring Tube present(&/M Yf S Depression over field (YO,' A) Date of adequacy test Results (Pass/Fail) 1 '� t^ Fo a oom Fluid depth in absorption fie)dbeforQAest (in.); mmediately after_ gal. water added (in.): Fluid depth lffess later: (in.) Absorption rate = g.p.d. treatment (past 12 months) (Y/1) If yes, give date D. LIFT STATION Date installed (� / 3' ° / ci S" Manhole/Access ((('%m 1/f J High water alarm level at* y Cycles tested 3 E. SEPARATION DISTANCES Size in gallons "Pump on" level at* -1 3 "Pump off' level at* *Datum /107101' vr= T/I,�K lS`uo SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/helding tank on lot t 3 On adjacent tots Absorption field on lot / / 7 ; On adjacent lots Public sewer main )v I A Public sewer manhole/cleanout Sewer /septic service line /C) V Lift station SEPARATION DISTANCES FROM SEPTIC/HGI DW6 TANK ON LOT TO: Foundation 7 Property line 6 'S. Absorption field Al y9 3 Water main/service line 30 -t` Surface water/drainage /0 0 -�- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Water main/service line 3o 6 33 I 0 v •f - Surface }eater l 0 e -t- Driveway, parking/vehicle storage area 1 S i Curtain drain N °"`� teN o w Al Wells on adjacent lots /0 o Y 1.01- L,�' w;4fN L—_1 /�'t¢QV6 Srt�l_) r6 PR,vdw/ry S`4c/0q X) A r) o Al rrvc hu of is s1£ F. ENGINEER'S CERTIFICATION c` A")""-- P e 6° e ,e r y. 1 certify that 1 have determined thru field inspections and revietiv of funicipal record in conformance tivith MOyA�HAA uideli s in effect on this date. Signature '!%a✓/ � iz✓�— // �flEh, 1M/ic7 are t Engineer's Name R O a' e,a r _ C v w41')�................. ROBERT C. COWANCE Date I r 1 F (,. V oil HAA Fee $ � Waiver Fee $ Date of Payment �4 % % 5 Date of Payment Receipt Number 1, c, l o' / Receipt Number Rev. 8/95 OSS: haa.wk.doe MUNICIPALITY OF ANCHORAGE " DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Zcts els i P/aRKHiLCs 7-/z4j 01?3W Scc.3SF Location (address or directions) 4 5 Wck� ii /4A V4 N C YS- -777e- (b) Applicants Name OSCAW 5166Fi jgj) Telephone - Hom usinesse07-S72-Z Applicants Address )%x 763 Povctf 6 7 7, j9�/c /_4 }I r�0 2 (c) Applicant is (check one) Lending Institution ; Owner/builder; Buyer Other (explain); (d) Lending Institution -`A K`.US11 P-L-O&RAL_ ClPtAi r UU;c&) Telephone �7f?6- 766o Address pOuc;+ G�/_3 l9�lJCla, /}►iC "j`P5_0 2 - 0613 (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: t Y i 2. Type of Residence Single -Family 12� Multi -Family Number of Bedrooms LL 3. Water Supply Individual Well Community Other (describe) Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite IZI Public 1= '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. [Page 1 of 2] 5. En ineerin Firm Providin Inspection Tests File Search Data and Information As certified by my seal affixed hereto and as of the valirovalationdate shows thatnthelon-site verify that my investigation of this Health Authority Appte water supply and/or wastewater diisposal system ture iicateds safe,hfunitionallfand adeveaifyfthat, the number of bedrooms and typeof of based on the in obtained from the Municipality files and my investigation and inspection, the on-site water supply system isin compliance m li ncehe dwithate oalthiunicipal and .State codes, ordinances, and regula- tions ineffect �C S l il/C Telephone6 Name of Firm Address _/ 2 a a W 3 3 Date i z 3 6. DHEP Approval for bedrooms Approved rk (ENGINEER SEAL) By Approved -A— Disapproved Terms of Conditional Approval— _ <-O Conditional n Reid, Jr. 2251-E CAUTION NT OF NVIRO AL THE MUNICIPALITY AOF ANCHORAGE DEPARTMELTH AUTHORITY APPROVAL CERTIFICATES TBA5 DDSOLELY UPON NTHE REPRESENT- (DHEP) ISSUESNT RED ATIONS GIVES OF PADA HT ADAEP DOAN ES THISEPASDA CCOURTESYSTO PURCHASERSEOFHOMES EAND REQUIRE - IN THE STATCERTAIN THEIR LENDING INSTOF DHEPS DO ORDER CONDUCTTO ISINSPECT ONS ORDER LYZE DATA BEFORE A MENTS. EMP CERTIFICATE IS ISSUED. THE PROFESSIONAL ENGPALITy INEER'SOWORRCHORAGE IS NOT RESPONSIBLE FOR ERROR OR OMISSIONS (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) NOV 1984 1 CHECKLIST - FEBRUARY 1984 5, 'E- 3 P '• '° , s Legal Description: t0 r i� 1 A. WELL DATA ii /4 i L 15 Well Classification J�e�l U/�T� If A, B, or C, D.E.C. Approved(YM) ,U//,y Well Log Present (/N) Date Completed 7131P Yield Total Depth 132' Cased to c7 Depth of Grouting U cJf� e ecunJ Static Water Level ,S' Pump Set At ? .Scl Casing Height Above Ground Sanitary Seal on Casing Y V) Electrical Wiring in Conduit &N) Depression Around Tibllhead (Y/( Separation Distances from Well: To Septic/Holding Tank on Lot / 0 On Adjoining Lots /O To Nearest Edge of Absorption Field on Lot 1 25 Zai ; Or. Adjoining Lots ) I oo To Nearest Public Sewer Line /Uj} To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line or, Lot Water Sample Collected By �ft LQ G- Date Water Sample Test Results COICHientS J'l It •�. i � � ...�..� Li �LL6ff B. SEPTIC/HOLDING TANK DATA Date Installed g��4- Size !, 2C) No. of Compartments `L Standpipes K�M) Air -tight Caps tVN) Foundation Cleanout (7/N) Depression over Tank (Yn Date Last Pumped Pumping/Maintenance Contract on File (YM)A)//4- ; for T4 Holding Tank High -Water Alarm (YM) 6) Temporary Holding Tank Permit (YM) Separation Distances from Septic/Holding Tank: To Water -Supply 4\b11 To Building Foundation 1 To Property Lire ,) S3' To Disposal Field t s , To Water Main/Service Lire To Stream, Pond, Lake, or Major Drainage Course Comments Receipt # �c 0 Date Paid* ?� Amount: [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /.Sc}� _ Type of System Design Date Installed ?/.716-i Length of Field 381 Width of Field Z Cl- Depth of Field 21 1 _ Gravel Bed Thickness Square Feet of Absorption Area 9112 L71 Standpipes Present W'q )— Depression over Field (YA _ Date of Last Adequacy Test Results of Last Adequacy Test ti z Separation Distance from Absorption Field: To Water -Supply Wall / 2 �_ 11 To Property Line '? To Building Foundation )18( To Existing or Abandoned System cn Lot Nd/,)- ; On Adjoining Lots >3o To Water Main/Service Line &2ZIa To Cutbank(if present) ti�b4 To Stream/Pond/Lake/or Major Drainage Course 4z a To Driveway, Parking Area, or Vehicle Storage Area Ccrmrents C'!r' A LI- D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) ' Coirnrents N/ iD ensions Off" Level at Vent (Y/N) les during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect b + on the date of this inspection. OF Al \ °aoe°�ogo��slf�i Signed _ Date 1D 'z 3 E. ti� s�Q;.•''ARS &� ColTpan� z C ti L MOA No. S r 1@4 -o-z :°� °o V f✓ni,, KB1/d5/s (Page 2 of 21 ¢Oeuan> e .-0. 1.119.9.a 111 �.-.• hG4]` �!'� oy C. Reid, Jr. No.225Y•E ; ,.v 2-15-84