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HomeMy WebLinkAboutOVERLOOK ESTATES BLK 1 LT 6Overlook Estates Block 1 Lot 6 #068 - 041 - 06 MUNICIPALITY OF ANCHORAGE DL._,RTMENT OF HEALTH AND HUMAN SER,,,__ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name 2/H/-16,4 GC. .0./,- c7,4, 7 DISTANCES Address 6oX 874 C)2? 'hone(s) 3 76 --3778 Ge/as /74- Permit No. No ".S"®moo 5-7 9r6�7' of Bedrooms FROM T00 SEPTIC TANK ABSORPTION FIELD WELL LEGAL DESCRIPTION .ot Block / Subdivision e!, ea /c 7A7-# - WELL LOT LINE //0 60 y -ownship, Range, Section Sec s' 7 j /2 / /� FOUNDATION /a y8 AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway, water bodies etc.) TANKS SEPTIC ❑ HOLDING Manufacturer Material ,e Eis.Q Capacity in gallons / CP' ®® No. of Compartments Z TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade y 0 FT Total depth from original grade FT Fill added above original grade i FT Gravel depth beneath pipe 8.v FT Gravel length z171 FT Gravel width Total absorption area Number of lines Distance between lines 8 4' SQ FT on% Soil rating Pipe mater 1 85- SQ FT Installer OC✓N . /�1�C.n,ricLj C -0,,,-71"'.7`"r"" e FT •`e Wee 6 / 0 GA /C !/G Date Installed WELLS likr PRIVATE ❑ OTHER (Identify) Classification (A,B,C) ..- Installer 5.,..„‘ 4/ ,....fr 7 �LLG/v/�N G,/'— aJ REMARKS: Total Depth /y0 Date Installed: FT Cased to /4/0 FT a/RSA T M /87/ ///51/t/7/PC E= 0 Jr cam,+-a—LJ Scale: Inspections Performed by: F-5-3 00 GNE < Date: certify that this inspection was performed accord Municipal and State guidelines in effect on this date: Health Department Approval: 72-013 (3/85) Date: i.rn C. fiagmaier C # 6266 lfr t -8s` PI LJ P.41 IF* 14 7ine C3 P- WIA. IC; IHOE3F6nti GHEE DEPARTMENT OF HEALTH AND ENVIRONMENTAL -PROTECTION 825 LANCHORAGE,'AK 99501 GTREET,• A , 264-472O Clir%1_�'TEE DJ EE FR g, •1141E1.K F'"E-EFZP.13: lr PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACTPHONE� LEGAL DESCRIp: LOT SIZE: LOT LOCATION: MACEDROOMS: 850657 10/07/85 ` HEINRICH CONST 2440E'TUDOR SUITE 1140 ANCHORAGE, AK 99507 561-7421 • SUBDIVISION: OVERLOOK ESTATES LOT: 6 SECTION: 25 TOWNSHIP: 14N RANGE: 1W 37682 (SQ.FT. OR ACRES) MAGNAVIEW AND VANTAGE 3 BLOCK; 1 Listed below are the'options available to you in designing your septic system. Choosethe option that. best fits your site, _ ~ � _ _ _ 11-1REEPAC3V4 EIEELDI WI~ 13F4.Ph 1 N.11 |8EPTH�T8 PIPE BOTTOM (FT") 4.0 4^0 4.0 | GRAVEL DEPTH (FT.) 9.0 0.5 3.5 TOTAL DEPTH (FT.) 12.0 4.5 7°5 GRAVEL WIDTH (FT.) 25 14.0 5.0 GRAVEL LENGTH (ET.) 16.0 28.0 28.0 'GRAVEL VOLUME (CU.YDS.) 12.6 14.6 20.8 H-ANK SIZE (GALS) 1,000.0 ** 1,000.O ** 10000.0 ** SOIL RATING lSQ.FT./BR} . . 85 � 85 85 I ** TANK MUGT HAVE AT LEAST TWO COMPARTMENTS � certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State'of Alaska" 2, I will install the system in accordance with all MOA codes and regulations, and in`comPliance with the design criteria of this perm|t. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater.disposal system or public sewerage system on this or any adjacent or nearby lot. 4.-understanda s I that thi permis it valid for a maximum of 3 bedrooms 4nd any enlargement will require an additional permit" 4F A LIFTSTATIQN IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THENy1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICALINSPECTfON REPORT; AND (3) THE 'ELE|TRICALMORK MUST BE DONE BY A LICENSED ELECTRICIAN. APPLICANT: HEINRICH Ca ISSUED BY DATE: ' DATE: /4/�� ��� FRONTIER. ENGINEERS INC. Cp 2440, E. TUDOR SUITE 1140 3 SOIL LOG ANCHORAGE, ALASKA 99507 PERCOLATION TEST PERFORMED FOR: ��,)/iP/C/1 Co����-r, vc 77,C.A/ L SOIL r— „ -v K PERCOLATION TEST BEDROOMS JOB NUMBER. bs 1 DATE PERFORMED 9 - LEGAL DESCRIPTION: .�©T�✓ .c / 7b-.' 2/ Oo.e �S/ HTes- SLOPE SITE PLAN 7 — e ..* 64 .*Ier.7'..4 8 , , Gw 9 - Q6. 10• - • 12 - ' ` A•F,E 9 v e06i✓ PT G'e// 7rac74ue• a q� 5/. %7`' 11- 13 14 15 16 17 18 19 20 NEM IMPS MIRO MIK 111111111 ■f■ •iH 111/111111 of 1, ■1■ WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? Reading /V© Date Gross Time S L 0 P E C7, lrN v E Net Time Depth to Water Net Drop C ",agrT is Cr.] 6,265 DEPTH (FEET) ' COMMENTS s e 6. tf7'C/^� 'PERCOLATION RATE 1//..rvA4. TEST RUN BETWEEN FT AND (minutes/inch) FT PERFORMED BY: 72-008 (9183" CERTIFIED NN N` yL die � Fourro qa eavit 9 a ly 0 0 0 's G,y 82.05 goTI[.t'J loo wCLL 91 n146 N W=4'3' -5l" 4 1'6133 - 0 Y.4NlAG,E fiVENUE Gia it" NW 5c.5_ LOT A A • 37)(oSZ5R. Nor--. - FOUN'pk:r10N ONL.,' PLOT PLAN AS BUILT )C SCALE \"=5d KENNETH G. LANG, L.S. 1731 GEORGE BELL CIRCLE, ANCHORAGE, ALASKA 99515 (907) 345-6476 I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT (o , BLOCK 1 , OVE2-U.DcA= -STATES 40.C.40R.pCS RECORDING DISTRICT, ALASKA, AND THAT THE IMPROVE- MENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND DO NOT ENCROACH ONTO THE PROPERTY ADJACENT THERETO, THAT NO IMPROVEMENTS ON THE PROPERTY LYING ADJACENT THERETO ENCROACH ON THE SURVEYED PREMISES AND THAT THERE ARE NO ROADWAYS, TRANSMISSION LINES OR OTHER VISIBLE EASEMENTS ON.._.SAID_.-PROPERTY EXCEPT AS INDICATED HEREON. DATED THIS TE Up DAY OF S-MPTLR y r_. , 1985, AT AIJCHORAGE, ALASKA. 020.,ce OF 00GJ•• '�p.•• b••, . * • i msmoom KENNETH ' MO �'4 LS -5202, •, by _.DOC co. dba- SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND JD bi& ? Ait Jo•) DEPTH OF WELL /1 o " Tc ADDRESS b oa f 4,04&'•) L' 4"'a L ▪ • rs. STATIC LEVEL OF WATER FT / 043 LEGAL DESCRIPTION L 6 aL K 1 #V LooKa. c r -DRAW DOWN FT. DATE . Started e(f f . Ended 09 PERMIT NUMBER KIND OF CASING 6 -i d 0 GALS. PER HR /eP a KIND OF FORMATION: From D Ft. to Ft From 3 Ft. to at Ft. From Ft. to Ft From c)4, Ft to 7S Ft From Ft. to19,,,� Ft. From 75Ft. to /O'�+ Ft From_ /0)0 Ft. to /3t Ft From. Ft. to Ft. From /33 Ft. to /9/ Ft From Ft. to From Ft. to From Ft to From Ft to From Ft. to From Ft. to From Ft. to From Ft. to Ft. .SA41.4 644.1E[ IDag. 9E.eS ,S epve 6,20,-,6- /P1 ,20p.,e -/P'I rx6 0 G4.01111 64441E( pet f XLH! S'4_4 64.1err�_ 4.Jrtre.t Ft. Ft, Ft. Ft. Ft. -Ft. o Ft. From ' Ft to Ft. From Ft to Ft From Ft to Ft. From Ft. to Ft From Ft to Ft From Ft. to Ft. MUNICIPALITY OF ANCNORAOE. Ft. DEPT. OF HEALTH & From Ft. to ENVIRONMtNTAL PROTECTION From Ft. to Ft. NOV i 1985 From Ft. to Ft: From Ft. to Ft. From Ft. to Ft. From Ft to Ft From Ft. to Ft From Ft to Ft. From - Ft. to Ft. From Ft. to Ft. From Ft. to Ft RECEIVED MISCL. INFORMATION: DRILLER'S NAME &c .4-( Parcel I.D. 068-041-06 Municipality of Anchora"gel. , . „ On -Site Water and Wastewater Program , (907)343-7904 Certificate of On -Site Systems Approval Expiration Date: 7/V 5 70 RUSH! APR i72015 1. GENERAL INFORMATION Complete legal description Overlook Estates; Block 1, Lot 6 Location (site address) 27441 Vantage Avenue Current Property owner(s) Clark Keyong Day phone c/o Ag Mailing address Real Estate Agent 27441 Vantage Ave., Eagle River AK, 99577 Jay Osbourne Day phone 345-4663 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 ❑ Public Sewer 0 WaiverNariance request for: Septic Tank to Foundation Received by: COSA to be released to the engi eer, unle s otherwise requested by the engineer. Date: Distance: 3.5' COSA Fee $ 5740 Date of Payment 171/4S ! 75- Receipt Number 541 Vk COSA# ©scasal�l� Waiver Fee $ 0`115 Date of Payment '1 //,l/' Receipt Number b 33 p s Cn Waiver# Y/5-102-1 414(411.60 iff 6-044606 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Garness Engineering Group, Ltd. (GEG) Address 3701 E. Tudor Road, Suite 101, Anchorage AK, 99507-1259 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 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 on 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. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report. 6. DSD SIGNATURE X System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved trrndifi-nal opprnval fnr Phone (907) 337-6179 Date ~ . .swiss*ta-- 1 t fp 1 c 11 no effrey A. Gamessrzr CE -7953 /As, o 6.442115 -11/Coot es*. Stre II WM** s</(WAA,, ,, , oN-SITE 'm;: WATERAND n., WASTEWATER p Cyd bedrooms, with the following stipulations: By: 1*-‘' (Xlc-14Original Certificate Date: (.'//Z0,% The Municipality of Anchora evelopment Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in theprofessional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 8-1-12.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: Overlook Estates; Block 1, Lot 6 A. WELL DATA Well type Private ' Date completed 8/1984 Parcel ID:068-041-06 If A, B, or C provide PWSID # n/a Well Log (Y/N) Y Sanitary seal (Y/N) Y Wires properly protected (WN) Yes Total depth 141 ft, Cased to 140 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 8/1984 3/30/2015 Static water level 100 ft. 110 ft. Well production 8 g.p.m. 2.6+ g.p.m. WATER SAMPLE RESULTS: Coliform U colonies/100 mL Nitrate I .1 "t/ mg& Arsenic NtO ug/L Date of sample: 3/30/15 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Conventional/Steel Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Yes Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) . N/A Date of pumping 8/21/2014 Pumper Sanitary Pumpers Collected by: GEG, Ltd. Date installed 9/20/1985 C. ABSORPTION FIELD DATA Date installed 9/20/85 Soil rating (g.p.d./ft2 o "/bdrm 85. System type Deep Trench Length 24 ft. Width 3 ft. Gravel below pipe 8.0 ft. Total depth 13.45 ft. Eff. absorption area 384 ft2 Monitoring tube Y Depression over field N For 3 bedrooms Fluid depth in absorption field before test 26.5 in. Water added 777 ' gal. New depth 25 in. Elapsed Time: 0 min. Final fluid depth 25 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None -known If yes, give date n/a Mg IA ar S4 ION) Ott.. Q M04 Date of adequacy test 3/30/2015 Results (Pass/Fail) Pass D. LIFT STATION Date installed Size in gallons Manhole/ "Pump on" level at in. "Pum = in. High water alarm level at in. D Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1001+ Public sewer main N/A On adjacent lots 1001+ On adjacent lots 1001+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 1001+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation *3.5' Property line 5+ Absorption field 5'+ Water main N/A Water service line 25'+ Surface water 1001+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water Service line 101+ Water main N/A Surface water 100'+ Driveway, parkinglvehicle storage ee Curtain drain None Known Wells on adjacent lots 100'+ F. COMMENTS *See attached waiver request letter. **Approximately 5' of the trench is located underneath the driveway, approved per 4/20/9FCOSA. 2006 G. ENGINEER'S CERTIFICATION Per GSA tots I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Jeffrey A. Garness Date COSA brown sheet 10-10-12.doc Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.munLorgiOnsite Development Services Division On -Site Water and Wastewater Program -poent s, 10 F 1)eparttnent ****:VARIANCE/WAIVER REVIEW **** Waiver#: OSV151021 COSA#:.OSC151146 Permit#: PID#: 068-041-06 Legal Description: Overtook EstatesBlock 1 Lot 6 Engineer: Garness Engineering Group Applicant: Clark Kevonq Your request for a waiver of the required 5 feet horizontal separation from the septic tank to the foundation has been approved. The approved separation distance is 3.2 feet. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. The affected adjacent property owner(s). have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. z Adjacent properties are not affected by this waiver ........•........-......a •................... Waiver is Granted: X Waiver is not Granted: Date: Y/Z!//-� Approved by:Aet — / Name of Revie .....mmmm mp4i mm • m mp mmmmm p mmmmmmmmm......r......r........■. .....■.....■...... **** VARIANCE/WAIVER REVIEW **** GARNESS ENGINEERING GROUP, Ltd �CIVIL & ENVIRONMENTAL ENGINEERS March 31, 2015 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 Ref: Overlook Estates; Block 1, Lot 6 — Waiver Request for Tank to Foundation Separation Distance. To whom it may concern: While onsite for a recent well and septic adequacy test, GEG, Ltd. (GEG) observed that the separation distance from the septic tank first compartment cleanout pipe to the foundation is exactly 5.0'. It is assumed that the actual separation distance from the closest corner/edge of the septic tank is approximately 3.5'. We are requesting that your department issue a waiver for a horizontal separation distance of 3.25' If you have any questions, please contact Jeff Garness or Rob Campbell at (907) 337-6179. 3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com 1"=5' GRADE MEASUREMENTS AND MEASUREMENT TO SLAB TAKEN BY GEG, LTD. 42' CONCRETE SLAB (ASSUMED 4') O OUTCROPPING WITH CMU FOUNDATION 3.9' AT CLOSEST POINT FCO LL 6 z O LL 1000 GALLON SEPTIC TANK STI ST2 SCALE: PROFILE DRAWING STI ST2 EXISTING GRADE ASSUMED 16'x16" FOOTER 79.75" 7.„45 1000 GALLON <'0 4 SEPTIC TANK \TAOyT TO DRAINFIELD GARNESS ENGINEERING GROUP, Ltd , CIVIL & ENVIRONMENTAL ENGINEERS = a 101 E. TUDOR ROAD. SUITE 101' ANCHORAGE AK 18507•PHONE (g0718378178•FAX (son 3384246WEBSITE: wvu.gamesseylneeny.wm PREPARED FOR: CLARK WOODWARD PHONE NUMBER: (907) 345-4663 PAGE NUMBER: 1 OF 1 • • • • • ce • ♦1a� i �. vm$$.i IAV_ I♦� CE -795 �S^ LEGAL DESCRIPTION: OVERLOOK ESTATES S/D; BLOCK 1, LOT 6 TYPE OF WORK: WAIVER DRAWING FOR TANK AND FOUNDATION DRAWN BY: A.J.G. DATE: 4/20/2015 J Page 1 of 3 Wockenfuss, Deborah M. From: Jeff Garness [Jeff@garnessengineering.com] Sent: Tuesday, April 21, 2015 9:09 AM To: Wockenfuss, Deborah M. Cc: Rob Campbell; Pierce Blewett Subject: Overlook Estates, B1, L6 - Encroachment of septic tank upon foundation. Hello Deb. Looking at the photo, it appears that the portion of the foundation that the tank encroaches upon is associated with the fireplace enclosure. Given the fact that encroachment is at an angle and near the end of the tank, the portion of it that is within 5 feet of the foundation is very limited. Without performing a structural evaluation I cannot be certain, but it appears that the floor and roof loads are not transferred directly to the foundation in the immediate area of encroachment. As is always the case, when the tank is upgraded in the future, care will need to be taken to insure that the foundation is not compromised. If the tank collapses it will likely be from the top (in the interior portion of the tank) and not from the end -wall near the encroachment, thus limiting impact to the foundation. The only way to avoid any risk would be to fill the tank with concrete and install a new tank further away from the house. Given the age of the tank (30 years old) it is reasonable to assume that the tank will need to be replaced in the not too distant future. Please include this email as an attachment to the COSA. If you have any questions, please call or email. Jeffrey A Garness, P.E., M.S. President Garness Engineering Group, Ltd 3701 East Tudor Road, Suite 101 Anchorage, Alaska 99507 Ph: (907) 337-6179 Cell: (907) 244-9612 Fax: (907) 338-3246 Website: www.garnessengineering.com From: Wockenfuss, Deborah M.[mailto:WockenfussDM@ci.anchorage.ak.us] Sent: Monday, April 20, 2015 3:56 PM To: Jeff Garness Subject: 4/21/2015 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel LD. (��-('X +(-n(o COSA# Oto020r+ Expiration Date: 9 - .S- 0 (n 1. GENERAL INFORMATION Complete legal description 0 VVE2 Look EST.QTGf $LoCte / LaT Location (site address) Z 74/4// V2L. /% 4Q6 Current Property owner(s) C L /FF VO C Day phone faci— SO 7i_ Mailing address .PO ` (7/46k44 Lending agency Day phone Mailing address Real Estate Agent ISA Lr, (cC&/ Day phone <d'i Mailing Address P,2cJDSJT/.¢( vtdrt OF e4Cte 12/t/P Unless otherwise requested, COSA will be hold by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System0 0 Well 00 TYPE OF WASTEWATER DISPOSAL: 0 0 Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm /.(r'Rini &i . Phone K?4/ 70? P Address / 7.137 Seta.- Pc�J Orr it Engineer's Printed Name s Date ao/06 -c o epi � K' OF Az..4%�1 .•�j. '•.9t°o ' * �`,'=ERA\ *'4 '�9L a ,4.4131:16:" .9�1. Steven W. Eng .. 4' b •... PE 6256 • (5:. tidFo•••..e...•,lc- -.. pnCIFES50 ' 5. DSD SIGNATURE 1.- Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: a : ON-SITE •'. �y" WATER AND : m. WPROGRAAST6W4TCR M .iJ ... 44Atm ®vr f�•/n; /4//1111)))))))1) Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory By:4277%. ,9 - (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: to — S' Oho Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal DescriptionitVf_�[QOR EJT/fres BLOCLC(Parcel ID: OGS -041-Orp A. WELL DATA Well type _a If A, B, or C provide PWSID it Well Log (Y/N) l Date completed WEN Sanitary seal (Y/N) 4_ Wires properly protected (Y/N) V Total depth Ail ft. Cased to /!/!/ ft. Casing height (above ground) 3C in. FROM WELL LOG AT INSPECTION�/ .�y Date of test a/frq 3!/O is Static water level /60 ft. 7& 7 ft. Well production ifr g.p.m. S 9.13 -111 - WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 2. 3I mg& Other bacteria 0 colonies/100 mL Arsenic: X0./5 rr ll -ctil RL Date of sample: 4 6 Collected by. B. SEPTIC/HOLDING TANK DATA Tank Type/Material le reit /cSYCCt Date installed 9//2/i'S Tank size /080 gal. ,Number of Compartments Z Cleanouts (Y/N) Y Foundation deanout (Y/N) y Depression over tank (Y/N) gl High water alarm (Y/N) /1t Date of pumping 9A/G 5 Pumper ct.41e /Titter /..141 ?.r C. ABSORPTION FIELD DATA Date installed ?//2/t5. Soil rating (g.p.d.4e or ft2/bdrm) tS System type 77? EAr0/l Length Z ft. Width 3 ft. Total depth /2 ft. Eff. absorption area NW ftp Monitoring tube Depression over field Ai Date of adequacy test 3131/O ‘ Results (Pass/Fail) /ee(f f For 3 bedrooms Fluid depth In absorption field before test 3_ in. Water addedt gal. New depth 3 in. Elapsed Time:&Q_ min. Final fluid depth B in. Absorption rate >= .500 g.p.d. Gravel below pipe ft. My rejuvenation treatment (past 12 mo.) (Y/N & type) idiffte If yes, give date D. LIFT STATION Date installed Size in gallons 'Pump on level at in. 'Pump off- level at in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /0014 - On adjacent lots On adjacent lots Manhole/Access (Y/N) High water alarm Meets alarm & Absorption field on lot /Q 6 'r Public sewer main if/4 Sewer /septic service line 2S ' f" t rcuit requirements? C it in. /00 '4 - Public sewer manhole/cleanout Holding tank 4/4 A3/44 Animal containment areas A1/4 Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S '•r Property line /04— Water 0"*Water main AO Water service line /0 14" Wells on adjacent lots /ad '*- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /41 �Building foundation /6 f" Water main Af/4 Water Service line /Q'r Surface water /0011- Driveway, parking/vehicle storage Curtain drain UN/— Wells on adjacent lots /Od f' - F. COMMENTS At/..9 Absorption field S /• Surface water / 0 (T C3 G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name STEVE /=NC Date 4{//2 0/0 s COSA Fees 4 3 0 Date of Payment --54)-s49.4///��� 3--2 C-06 Receipt Number g° 0 7 (Rev. 11/05) 4 sal. '•,,yid/ :*.p t•n$Mvuri M/. Fgt' -.441I /�lti•. PE 6156 :�,I 9 �• t.sfu- Waiver Fee $ Date of Payment Receipt Number ANALYTIC/\ North Rim Eng Attn: Mr. Steve Eng 17237 Bear Paw Circle Eagle River, AK 99577 907-694-7028 Fax: 907-694-7026 Client Sample ID: Client Project: Location: Sample Matrix: COC #: PWS//: Residual Chlorine: Comments: AX 2196 Overlook Est. B1 L6 North Rim Eng Overlook Est. 131 L6 Aqueous Lab#: A0604044 -01A Analytica International, Inc. 5761 Silverado Way, Unit N Anchorage, AK 99518 Phone: 907-258-2155 Fax: 907-258-6634 Report Date: Receipt Date: Sample Date: Sample Time: Collected By: 4/13/2006 4/5/2006 4/4/2006 5:00:OOPM SE Flag Definitions: MRL = Method Reporting Limit MCL = Maximum Contaminant Limit B = Present also in Method Blank 11 = Exceeds Regulatory Limit M = Matrix Interference J = Estimated Value D = Lost to Dilution •• = RL higher than MCL; target not detected Analysis Method Parameter Result Units Flags MRL Prep Prep Analysis MCL Method Date Date Analyst 4500-NO3E (Aqueous) - Nitrate Nitrate as N 2.31 Lab/I: A0604044-0IB mg/L Test was conducted by: Analytica - Anchorage 0.50 /0 4/8/2006 4/8/2006 AJ Analysis Method Parameter Result Units Flags MRL Prep Prep Analysis MCL Method Date Date Analyst 200.8/200.8 (Aqueous) - Family Well Water 1 Arsenic <MRL ug/L Lab#: A0604044 -01C Test was conducted by: Analytica - Thornton 0.15 /0 200.8 4/11/2006 4/11/2006 MCG Analysis Method Parameter Result Units Flags MRL Prep Prep Analysis MCL Method Date Date Analyst 922213 (Aqueous) - Membrane Filtration MF Bacteria, Other <MRL CFU/I00mL Total Coliform <MRL CFU/I00mL Reported by: Krissy Plett, Laboratory Project Manager Test was conducted by: Analytica - Anchorage 1.0 4/5/2006 4/5/2006 KP 1.0 / 4/5/2006 4/5/2006 KP Page I of 1 Y41409Ve• .40,'E- ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: THATENCROACHM NTS EXIST EXCEPT AS INDICATED. IT 1S THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS V."CH DO NOT APPEAR ON THE RECORDED SUBDI- 1 .SON PLAT. UNDER NO CIRCUMSTANCES SHOULD CTION OFFENCEFENTA HEREON BE USED FOR NCE LINES,OR FOR ESTABLISHING BOUND.. • ARY LINES. DRAWN: .vel SEWARD SCALE: 5 74 & ASSOCIATES LAND SURVEYING 694-0829 DATE: y//� GRID: sec" 51:0 - FB: ///- 6 9 ell � ' ........ ~ 'f 1 of • ;7.7 • Dup.. mark bw.rd f ITS • LS/6918 • t �Ar 4 • i 't MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I D # C11. -A l - i.( o HAA # V\ <7"11`1Th?_n`1 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 6; Block 1. Overlook EstatPG Location (address or directions) (b) Property owner Tomamichel Telephone : (home) Business Mailing Address (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent RE/MAX OF EAGLE RIVER - narl Pna Ni o1 yuan Address Telephone 16600 Centerfield Drive, Suite 201, Eagle River. Alaska 99577 694-4200 (e) .Mail the HAA to the following address: (or check here El, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 294_ Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family El Number of bedrooms 3\N' 3. WATER SUPPLY Individual Well ® 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 ® Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty 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 and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone f 9 Z-9 29 Address Date 3 & 5 ENGINEERING 17034 Eagle River Loep Road No. 204 .,agle River, Alaska 99577 6. DHHS APPROVAL •. Approved for r5 bedrooms by �ioiin/t l SAA.i-N-+ Date &/90 V Approved V Disapproved Conditional Terms of Conditional Approval 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 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 MUNICIANCHORAGE 343-4744 ENVIRONMENTAL SERVICES DIVISION J U L 2 5 199O'' A. WELL DATA REC IVfDM.1y Well Classification i Ng a t" A Legal Description• Let to y $l oe..< .Z) (verIooKCsfgte5 Well Log Present (Y/N) t. Date Completed Total Depth /moi (/ Cased to ty / Depth of Grouting Static Water Level q r'( Casing Height Above Ground 3 2' tt Electrical Wiring in Conduit (Y/N) If A, B, C, D.E.C. Approved (Y/N) 2 `1P M S - /0 Yield C SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 110 To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /0/141 , Pump Set At (Z° Sanitary Seal on Casing (Y/N) : H Depression Around Wellhead (Y/N) N On Adjoining Lots / oco + i I l j ; On Adjoining Lots / OO f To Nearest Public Sewer Cleanout/Manhole 414 To Nearest Sewer Service Line on Lot ZS ,t Water Sample Collected by `F• s ENl iiJ e'er( 1 Date '7 -t `t -10 Water Sample Test Results �� S 1 t�c-�o et/ — AJAR t e4't 14 Y- A)� 1_ik,to 5 Comments B. SEPTIC/HOLDING TANK DATA Date Installed ' —(2'8 Size (O191nia1 No. of Compartments Z Standpipes (Y/N) y Air -tight Caps (Y/N) LI Foundation Cleanout (Y/N) Depression over Tank (Y/N) 1J Date Last Pumped ` 2.S 0 Pumping/Maintenance Contact on File (Y/N) A.V1A ; for 10/1A Holding Tank High -Water Alarm (Y/N) n)(1/- Temporary Holding Tank Permit (Y/N) /J/14 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: (to / To Water -Supply Well To Property Line �(7 To Water Main/Service Line /bit To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course /1 - Comments -Comments St t rG PUMped tot .4 its Ce S pooJ Pc) MntN4 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata e S 4/61T Type of System Design Date Installed 1 ` (2 -86- Length of Field 2...4 r Width of Field 3 Depth of Field IL' ( iterJLf Square Feet of Absortion Area Gravel Bed Thickness 'g 3$44543 Statndpipes Present (Y/N) Depression over Field (Y/N) IJ Date of Last Adequacy Test -7 --14' qO Results of Last Adequacy Test A -1-(S frgc.toIN -- 3 .geC)room, SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 1 l S ' To Property Line z-lz{ 1 I '' To Existing or Abandoned System on 5 0 ' 1 - To Building Foundation Lot IU(A To Water Main/Service Line ; On Adjoining Lots To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutback (if present) (nd 2a r D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. 5 & S ENGIN 17034 Eagle River Loop Road No. 204 Eagle River, 7 2956 v CF' Qo—c.3 Receipt No. aav (9 3 1 as) (U Date of Payment 1- ac-ett) Amount. $ 1`iC-)•cO 72-026 (Rev. 7/88) Back Receipt No Wave J 4 {'A (Ai fie. eae F.t.. Of CO Waiver Fee. $ Date of Payment Page 2 of 2 B •. 1/4 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET • ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343 FEDERAL TAX I. D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order 1 25725 Date Report Printed: JUL 23 90 @ 17:59 Client Sample ID:L6 B1 OVERLOOK ESTATES PWSID :UA Collected JUL 19 90 @ 15:30 hrs. Received JUL 20 90 @ 15:00 hrs. Preserved with :AS REQUIRED Analysis Completed :JUL 20 90 Laboratory Supervis.r : TEPHEN C. EDE Released By : Client Name : S & S ENGINEERING Client Acct : SNSENGP P.O.1 NONE RECEIVED Req 1 Ordered By : R. SHAFER Send Reports to: 1)S & S ENGINEERING 2) Special Instruct: Chemlab Ref 1: 902569 Lab Smpl ID: 3 Parameter Tested Matrix: WATER Result Units Method Allowable Limits NITRITE -N Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY RDJ. 0.27 mg/1 EPA 353.2 10 1 Tests Performed ND- None Detected NA- Not Analyzed • See Special Instructions Above •• See Sample Remarks Above LT -Less Than, GT -Greater Than UA -Unavailable MUNICIPALITY OF ANCHORAGE -' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date /4?../-r07/4"Cf' 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Ze a- �, 494' / ®6r.6 -4F1 Cr9 rgr SES' J %'/5'1,(,. /Q/ G!, .5-, Location (address or directions) , ,,,/e ``e ®s7 s'vs✓e- AP, .<5.• ie 4, 340o 1'+er1!!e rrls'Gw,rs� (b) Applicant Name if/e/09,,./e4 Ce,"1 750- Telephone: Home Business �%�—dy.f ' Applicant Address ®s< cP76 ®2 9 e,t0®,r'/4. 994-0 7 (c) Applicant is (check one): Lending Institution 0 ; Owner/builder ® ; Buyer 0 ; Other 0 (explain); (d) Lending Institution ✓574-, Telephone .9ggeV Address 0Sn®® GO/ fie'asr®e� o�sa ,494- ( e ) _9°S(e) Real Estate Company and Agent e m 4 Address Telephone (f) Mail the HAA to the following address: 674)x 87' 2 9 5' 'Wm "IX" 9OW.6 c 9 '493 2. TYPE OF RESIDENCE Single-Familyg Multi -Family 0 Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well = Community 0 Public 0 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$ Public 0 Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11184) 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 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. es..._.so ® Name of Firm ,o'osawe>er .e-or�.�, oe., J cTelephone .5-e/- 7,Z/ Address a ieVe, 6' 7cs®a.e A'®. Ses, 'ie., /./ c' reeves/ "514 Date /®/�G,��.e. 6. DHEP APPROVA Approved for Approved Disapprove • Terms of Conditional Ap;roval P OF' f ;9 ,,''q)1 4, ,°a°°°a °a 0a leu a a ° ao�o� 60 :49 �3/4'6 , Ona°°°e°°ec°°ec=- 0 %o0Willi ee ° wj 8 •Z 0 CE #� 6266 V: -, Q ESS\ON'. Engineer's Seal Date `/ onditional dhep CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) A. WELL DATA MUNICIPALITY OF ANCHORAGE (mci4JA1 3 3 a HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 98 AON 264-4720 TK)11.11O21d 1V1N3WNOblAN3 Legal Description- 1e,4401:1tl9.4Q/1d340 ver/.k F0.7` eery Sec ZS Tjd}INnv� ginf/e 7�+«+: 4 we // Well Classification ASP If A, B, C, D.E.C. Approved (Y/N) $'"Jle 2C.~04 wyl% Well Log Present (Y/N) ye. Date Completed 4/2 y" Yield PI+'7 Total Depth /V0 ft Cased to /yam fit Depth of Grouting 04,.,e, rgrdr,u:re.! Static Water Level /40 fL` Pump Set At /Z O ,Fe 4. Casing Height Above Ground 36 Sanitary Seal on Casing (Y/N) yes Electrical Wiring in Conduit (Y/N) ye.S. Depression Around Wellhead (Y/N) /!o Separation Distances from Well: To Septic/Holding Tank on Lot //0 .ski ' ; On Adjoining Lots 7C o?'4e. eyePee..vs ir, To Nearest Edge of Absorption Field on Lot //8 ft-*; On Adjoining Lots ise a "4e.- s .f: a sys).,.s i. en I4:.rey 1:741 To Nearest Public Sewer Line hef •o.o.,'(e'%/eTo Nearest Public Sewer Cleanout/Manhole /,,,40, To Nearest Sewer Service Line on Lot Nyi! Water Sample Collected by °S.4".)/e0•• Ey%....r: ; Date /50i�rs- Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 0Z/�✓r� Size y0c",,9•/No. of Compartments 2. Standpipes (Y/N) yes Air -tight Caps (Y/N) yes Depression over Tank (Y/N) /7O Pumping/Maintenance Contract on File (Y/N) 'sew, Foundation Cleanout (Y/N) yeS Date Last Pumped pew ;for Holding Tank High -Water Alarm (Y/N) /4s7` 45,0'( nporary Holding Tank Permit (Y/N) 4..7` Separation Distances from Septic/Holding Tank: �+ To Water -Supply Well /l © fle To Building Foundations T Z To Property Line f2,' To Water Main/Service Line /.• •erY 74.41. To Disposal Field /O fL "'CP fL! To Stream, Pond, Lake, or Major Drainage Course ..4•749e* 10 744•^ 2©p fZ` Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata e 5 ftko Date Installed 02.,./J�� Width of Field .3 f6 Type of System Design l7.sep %re.re� Length of Field .24/ f d Depth of Field /Z f d Gravel Bed Thickness Square Feet of Absorption Area 38 Y SF Standpipes Present (Y/N) Depression over Field (Y/N) 01 Date of Last Adequacy Test rltw eo r$74reic)4.., .— Results of Last Adequacy Test ofeuJ oe.�lfr✓eS' •' Separation Distance from Absorption Field: To Water -Supply Well /46) 7Czie To Building Foundation /ro , ce pe • 4414.+44. ./ Lot 744. r /.16' To Property Line 4' Y ft' To Existing or Abandoned System on As e •7`.4 er s.or�'.'s sjetemr , s . y •.r 41../.reC, 7• /e7'.s To Water Main/Service Line nr.re 744.1 On Adjoining Lots $ #t To Cutbank (if present) rom s e rerese., 2" rYi err f /i r.s .2 ©O „ea, ✓ z© fe To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No Receipt No Date of Payment i`i b Amount: $ 1. Page 2 of 2 72-026 (11184) Engineer's Seal PS-3OO