HomeMy WebLinkAboutNORTH WOODS UNIT 3 BLK 11 LT 2North Woods
#3
Block I I
Lot 2
#051-732-04
Municipality of Anchorage Page / of 3
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: -5WgSF014 f PID Number: 0J5_1 7320
Name:
001 w�®p S t C Wastewater System: )(New 1:1Upgrade
Address,
'3 tI c sr. u s s-�- A�.cHon�c 4K ABSORPTION FIELD
Phone: No. of Bedrooms:
❑ Deep Trench ❑ Shallow Trench Bed XMound ❑ Other
LEGAL DESCRIPTION Soil Rating: n Total Depth fromoriginal grade:
Lot: Block: //
S b ivision:
/ �%� GIwl, 3
GPD/So. Ft.
Depth to pipe bottom from original grade:
`
V
Gravel depth beneath pipe
Holding
Tank
Imps
/.3 Aeat✓6 0� . ��D/
Al a
Township: Range:
Section:
Fill added d above origin I grade:
Ft.
Gravel length:
Surface
I�i�'�
00
20
WELL: ❑ New
❑ Upgrade
Ft.
Gravel width: /
Ft.
Number of lines: Distanccee between lines:
Classification (Private, A,B,C):
/� '` k/
"` ol"` N/v /%P
Total D Cased To:
Ft.
Ft.
Total absorption area:
3
Pipe materi •'/tel
'PVC
Driller:
Ft.
SQ. Ft.
`/
Yew `j®
� 9 /
Date Drilled: Static Water Level:
Ft
Installer:
Date installed:
tf'
Yield: Pump Set at:
Casing Height Above Ground:
GPM
Ft. Ft
TANK
•/0A E
/Y
SEPARATION DISTANCFs � „_,-,__
TO
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
Public/Private Manufacturer: ,/� Capacity in gallons: `�®^
Sewer Lines // /+r�'� / 0
Weill-
N
fj//�
�
�(�
it Materi L _ Number of Compartments: 12
Surface
I�i�'�
/00
%Dp®`r
�✓��
i�la LIFT STATION
LotLine
c�/3 /
/Y `
-/ /
/v/i7$1Ze
ir;lions:
Manufacturer.
Foundation
/
�%J'/
� 9 /
„, /
/v
_ 1 'Pura on" level at: "Pump oi�evel at: High wale al �p at:
/V
Curtain
Drain
•/0A E
/Y
x�✓Dl.�
Pump Make & Mo e, Electrical Inspections performed by:
mS/ o�H,/
Remarks: , �To/7GESS S;VAI Y��iEfP BENCH MARK
Location and Description:
iE tNi�2rtiT 4v7 Dos,N� %. /J� OF y�1�%h%/rj�DL�
vt
3 4 AiA LC14It /,�f�L,.I rte® /iNQ 0/�l G1Y�/ f�G/%%i�
L4'4/LE/i fNs�d /y Li
d Assumed Elevation: /000
PGFL F02 f'/ia r LetoOF 44 EN 1
:.............
S&SENGINEERING rw�ti�.j •9
117034 Eagle Riof,,r Lrrp Road, ft ✓ h t.
Inspections performed by: 911R:velr, elm, 99, s7yDates 1s-��• » `» »`» "�••'""»'
�� _ dd.....,... ..
2nd i T ROBERT C. COWAN Q
Department of Health and Human Services approval _v -�g °'�`'` ce-a$o,
�, PProval Pita; ••h.. ,..••• ����_:
Reviewed and approved b �(/�1/-, �✓ 1i/ b"
PP Y Date:l/_�_9S�
72-073 (Rev. 9/97) MOA 25
1
PERMIT' No. 2W9801 41 PAGE 2
of 3
Municipalit of Anchora e
DEPARTMENT OF HEATH AND HUKAN SERVICES
P-0- BOX 196650 0 ENVIRONMENT SERVICES DIVISION
343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM e, Alaska LAND/OR 9-6650 o Tel
REPORT
LEGAL LOT 2, BLK 11 NORTH WOODS S/DUNIT III P.I.D. No. 05173204
PERMIT No. SW980141
PAGE 3 OF 3
Municipalit of Anchora e
DEPARTMENT OF HEATH AND HLIKAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM e, Alaska LAND/OR 9-6650 0 Tet hon
pINSPECTION REPORT
LEGAL LOT 2 BLK 11 NORTH WOODS S/D UNIT III P.I.D. N0.
05173204
F� FINAL GRADE
100.5' / /-100.5'
MTI =101.4' LMTI
MT2=102.0' \ MT2
h" PNS.LArip A]
NEW 1300 GAL.
POLY. TANK 96.6
N.T.S.
MT3
FINAL GRADE MT4
INSULATION
=102.2'
=102.0'
RIu"J
1/Y AfR Un r9A1VD
MT1=98.3' MT3=98.4'
MT2=98.4' MT4=98.2'
BOTTOM OF SAND=96.2'
DIST. LINE=98.6'
N.T.S. GROUNDWATER AT 93.7'
87.2' B.O.H.
GRADE
ROBERT C. COWAN
CE - 8801
?� f
t
PERFORMED FOR:
L
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
LEGAL DESCRIPTION: 112 S//
DEPTH ,cam n
�-
3
4
—)s
Net
Time
Depth to Net
Water Drop
�f
5
c
6
r �6
7-
<�
-y--1
8
8-
9-
9
,� u
10-
-7 <
11
11
12
1 1
13
14
15�
16
17
18
19
20
COMMENTS Cr!-5� e Cr e5l-
( so.,YN)
Range, Section:
SLOPE
WAS GROUND WATER '
ENCOUNTERED?�—
� S
IF YES, AT WHAT L
DEPTH? �� O
P
E
Depth to Water --4#P ,
Monitoring? Date:
SITE PLAN
Reading
Date Gross
Time
Net
Time
Depth to Net
Water Drop
g
`
-y--1
r 7 V
/�
,� u
t
-7 <
17
k4 i U'
PERCOLATION RATE L.�_ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN SFT ND FT
PERFORMED BY: S & S ENGINEERING I av-t— _CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 Eagle River Loop Road No. 204
ACCORDANCE WITF�S� A GUIDELINES IN EFFECT ON THIS DATE. DATE: 1)
72-008 (Rev. 4/85)
I
PROPERTY OWNER AGREEMENT
FOR THE MAINTENANCE OF AN
ON-SITE WASTEWATER DISPOSAL
SYSTEM
This agreement, dated dVtVf 1998', is made between the Municipality of
Anchorage Department of Health and Human Services (DHHS) and the property
owner(s) of:
This agreement is made for the purpose of maintaining an on-site wastewater disposal
system on the subject property.
The property owners agree to the following:
Submit to the Municipality of Anchorage, on an annual basis, an inspection and
operation statement from a registered professional engineer. This inspection and
operation statement shall verify that the engineer has inspected all effluent and air
pumps, timers, and alarms, and that any deficiencies have been repaired and that the
system is functioning as designed.
(Signature) (Signature)
(Printed Name) (Printed Name)
(Notarize Here)
Subscribed ana sworn to before me
thisg—day of_ 19 M_ _
Not2ty Public
My Commission Expires
y
11/03/1998 15:05 9076941211 S AND S ENGINEERING PAGE 03
__IYVY C1J�JQ Il .YJL map �•nYG1VL{{/1.1O finlGVl VV VJ JV/1
• • T
94a"I`�I�CGs�r��i `�IiGrQlci�uy
491 11OW gree' • Wasilla, Alaska 99654
Phone# (907) 373-3893 • Fax# 373-3894
rn 1
ytC'r.°n SC'
9 i (o -`/8 ) p w,
PAGE �1 OF 1
MUNICIPALITY OF ANCHORAGE /! 7- q 76
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW980141 DATE ISSUED: 6/01/98
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:NORTHWOODS INC EXPIRATION DATE: 6/01/99
OWNER ADDRESS:3111 C STREET, #555
ANCHORAGE, ALASKA 99503
PARCEL ID:05173204
LEGAL DESCRIPTION:
NORTH WOODS UNIT III BLK 11 IT 2
LOT SIZE: 26982 (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:
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 PROVISIONS:
THIS PERMIT ISSUED FOR THE CONSTRUCTION OF AN ALTERNATIVE
INTERMITTENT DOSING SAND FIL WASTEWATER SYSTEM. THE
ATTACHED PROPERTY OWNER EEME TO HAVE A PROFESSIONAL
ENGINEER INSPECT THE S TEM ALLY SHALL BECOME A PART OF
THIS PERMIT PACKAGE. ,
RECEIVED BY:
ISSUED BY:
DATE:
DATE:/�- 2-9B
May 19, 1998
POPPRT O OnWAKI 00
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
SEWER&WATER
Anchorage, AK 99519
MAIN EXTENSIONS
REFERENCE: Lot 2; Block 11; North Woods Subdivision Unit 3
SEWER&WATER
INSPECTION
Request you issue a permit to construct a Bottomless Intermittent Sand Filter
System on the referenced property. This system will include a 1500 gallon STEP
tank and will be adequate to serve the proposed four bedroom home.
ENGINEERING STUDIES
AND REPORTS
The construction of the wastewater disposal system will not adversely effect the
adjacent properties. The construction will be in accordance with the attached
drawings sheets 1 - 4.
WELL INSPECTION
&FLOW TEST
This home will be connected to an existing key box on the Municipal Public Water
System.
SITE PLANS
If you require additional information, please contact us.
Sincerely,
ROAD DESIGN
/'�/
�//r�'`i."rt
2be
SOIL TEST
C. Cowan, P.E.
RCC/gk
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
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• Municipality of Anchorage
t DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
ROBERT r. COWAN
DATE
PERFORMED FOR:
z/'/C%J/� S ( O /147 1 g�6^
PERFORMED: `'
LEGAL DESCRIPTION:/, 2 /Vd✓ % b/�csJ� pJTownship, Range Section:
DEPTH® SLOPE SITE PLAN
(FEET) –
)—r—t------- r ------ Z
10
11
12
13-
14-
15-
16-
17
314151617
18
19
20
COMMENTS
p `` WAS GROUND WATER
O �0 INA. , ENCOUNTERED?
� S
IF YES, AT WHAT
Net
Time
DEPTH?
2
�• 9
pate; GS
2
p
3
N4 1 hl
/ L
t7 ,
4
rr
3
5
tj
31
6— %j
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7
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8
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9
t
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10
11
12
13-
14-
15-
16-
17
314151617
18
19
20
COMMENTS
p `` WAS GROUND WATER
O �0 INA. , ENCOUNTERED?
� S
IF YES, AT WHAT
Net
Time
DEPTH?
2
Dep1hto Water Afl 5 C
Monitoring? —
Monitoring? S
pate; GS
0
NNINNINNINIONIN
IMINSESSENININ
EMEMENNEEN
Reading
Date
Gross
Time
Net
Time
Depth to Net
Water Drop
2
S`U J} v(
Foe /Q
'L..
N4 1 hl
/ L
rr
3
.. k.
31
h ,.
,e
AA cr
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND 3 FT
PERFORMED BY: ,(��I� I CERTIFY THAT THIS TEST AS PERFORMED IN
ACCORDANCE WI914LL'S IA%NICD4&R VIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 5 Z– �
72-008 (Rev. 4/85)
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
ROBERT C. COWAN, P.E.
ALAIKA
May 19, 1998 CIVILENGINEERS
(907) 694-2979
FAX(907)694-1211
7APPROVALS
BOTTOMLESS INTERMITTENT SAND FILTER SPECIFICATIONS
Lot 29 Block 11, North Woods Subdivision, Unit No. 3
EXTENSIONS
GENERAL STATEMENT OF WORK
The work covered by these specifications and the plans consist of furnishing all labor,
materials, tools, transportation, and equipment necessary
SEWER&WATER
INSPECTION
to complete an intermittent sand filter
system as described herein and on the attached drawings.
All work under this project shall comply with the latest edition and addendum to all applicable
codes,
ENGINEERING STUDIES
ordinances and standards including Municipality of Anchorage -Dept. of Health and
Human Services (MOA)-(DHHS) septic installation
AND REPORTS
guidelines and On -Site Waste Water
Disposal Systems permits.
4 Bedroom single family home = 600 GPD
WELL INSPECTION
Use 2.0 GPD/SF for polished effluent
&FLOW TEST
300 S.F. required
18'X 20' sand filter and absorption area
Sand filter to be constructed on accepting soil
SITE PLANS
SITE INVESTIGATION
ROAD DESIGN
The Contractor who proposes to complete this project must carefully
examine the project
documents, have full knowledge thereof, have investigated the site, and be satisfied
SOIL TEST
with the
conditions affecting the work. Conditions include, but are not limited to those bearing upon
transportation,
disposal, handling and storage of materials, availability of labor, water, electric
power, roads, and uncertainties of weather, physical conditions at the site including all
underground utilities, the conformation and condition the
PERCOLATION
TEST
of ground, the character of equipment
and facilities needed preliminary to and during prosecution of the work. The Contractor must
be satisfied with the character,
quality and quantity of surface and subsurface materials or
obstacles to be encountered insofar
as this information is reasonably ascertainable from an
inspection of the site, including all prior exploratory work,
STRUCTURAL&
MECHANICAL
INSPECTIONS
as well as from information
presented by the plans and specifications made a part of this project. Any failure by the
Contractor to become acquainted
with the available information will not relieve him/her from
responsibility for performing the work as stated in these
specifications and drawings.
ONSITE
WASTEWATER
DISPOSALSYSTEM
)ESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
Page 2
,Lot 2, Block 11
North Woods Subdivision
May 19, 1998
Location of utilities will be the contractor's responsibility. At least forty-eight (48) hours prior to
commencing work, the Contractor shall contract all local utility companies to obtain underground utility
locates. The Contractor shall exert due care to prevent damage to utilities. Should a utility be damaged,
the Contractor shall notify the utility company and shall have repaired at his own expense any damage
resulting from failure of the Contractor to request an underground utility locate or to exert due care. If any
utility company determines that a utility has to be temporarily raised, lowered, moved, guyed, shored,
braced or otherwise protected during construction, it shall be done at the expense of the Contractor to the
satisfaction of the utility company.
INSPECTIONS
Typically, there will be a minimum of four (4) inspections required during the installation of the waste
water disposal system. These inspections will occur as follow:
Inspection of work in progress may be made by the Engineer and MOA-DHHS at any time. The following
schedule of required inspections is to be adhered to. Twenty-four (24) hours notice is required prior to each
inspection. Inspections can only be arranged during weekdays and during normal working hours. The
following inspection schedule is to be strictly adhered to:
1. Septic tank/lift station is in place, but not backfilled. Sewer pipingfrom building to tank is
construction.
complete and properly bedded. Sand filter location is excavated and prepared for filter
2. Engineer to be notified with Contractor's schedule during actual construction of the sand
filter to allow spot inspection during construction. Any deviation from reported schedule is
to be reported to the Engineer.
3. Final inspection of the sand filter with all pressure piping in place, but prior to placement of
cover material. Test pressure piping to ensure adequate flow and pressure, (requires
completion of lift station wiring and piping prior to this inspection).
4. Inspection of final grading and adequate cover.
The Owner shall contract with the Contractor to perform the work outlined in these specifications, plans
and in accordance with the attached MOA permit. There will be no contractual arrangement existing
between the Contractor and S&S Engineering. S&S Engineering shall be the Owners' representative and
will inspect the work as stated above to document the Contractor's activities. Final acceptance of the
Contractor's work rests with the Owner and the MOA.
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
Page 3
,Lot 2, Block 11
North Woods Subdivision
May 19, 1998
responsible for the construction means, methods, techniques, sequence, procedures or the safety
Precautions incident to this project.
All landscaping, fences, sidewalks, paving, driveways, utility markers and other improvements, removed to
facilitate the Contractor's operations shall be fully restored to their original condition and location by the
Contractor unless otherwise directed by the Engineer.
Items damaged by the Contractor during removal, storage, or restoration, shall be repaired or replaced in
kind by the Contractor. This work shall be considered incidental to the project.
MINIMUM MATERIAL SPECIFICATIONS
I. 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 ohne
Perforated
olid
Cast Iron
Yes
Yes
ASTM D3034 (PVC)
Yes
Yes
ASTM F810 (HDPE)
Yes
No
ASTM D2662 (ABS)
Yes
Yes
ASTM D2241
Yes
Yes
ASTM D2239-74
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 water tight couplings (Caulder, Femco, or
equal).
SEPTIC TANK/LIFT STATION
A. General
The work under this section consists of the performance of all operations pertaining to
furnishing and installing the septic tank/lift station and piping to the sand filter.
Page 4
.Lot 2, Block 11
North Woods Subdivision
May 19, 1998
B. Materials
1. Tank for Lift Systems
a. Septic tank shall be a 1500 gallon two compartment tank specifically
for use with Orenco Systems, Inc. patented lift station assembly
Orenco No. 4200, or approved equal.
b. The tanks shall be designed for adequate burial depth as required by
MOA and State regulations. The design or analysis shall be in
accordance with accepted engineering practice and local regulatory
agencies.
c. In areas with high ground water, the tank shall be adequately weighted
or anchored to prevent flotation if the tank is pumped.
2. Risers
a. First compartment shall have a separate 4" pump out riser. The
second compartment shall have a separate 4" pump out riser.
b. An additional second compartment manhole riser shall extend above
surface grade, shall have a minimum nominal diameter of 24", and
shall be capable of being equipped with the following:
1. A junction (Nema 4x) box or equal, bonded or attached to
the riser.
2. UL listed electrical cord grips, installed in the J -box.
c. A lid - shall be furnished with the riser. It shall be constructed to meet
H-10 loading requirements and have a latching mechanism.
d. Riser installation - each riser shall be sealed or welded to the top of the
tank in such a manner as to prevent infiltration of ground water.
e. Lid insulation - 4" rigid extruded polystyrene shall be placed inside
and attached to the lid.
f Riser insulation - 2" sprayed shop applied urethane on circumference
Of riser with 46465 Tnemec coating.
Page 5
Lot 2, Block 11
North Woods Subdivision
May 19, 1998
3. Effluent Pumping Assembly
a. Effluent pumping assembly shall be Orenco systems (TM) Mode120-
OSI-05-HHF series, or approved equal consisting of the following:
1. 1/2 H.P. 110/120 volt or equal U.L. Listed effluent pump.
2. Screened pump vault (U.S. patent No. 4439323) 59" deep,
3/16" thick high-density PVC cylinder houses the pump,
level controls and screen and serves as a baffle to prevent the
screen from clogging.
3. Fifteen 1 1/2" diameter holes are drilled in the vault at a level
that places them at about the midway point of the depth in
the septic tank.
4. Flap check: Allows the vault to drain when removing the
tank. Screen: 15" diameter cylinder of high-density
Polyethylene 1/8" mesh.
5. All piping shall be PVC or other non -corroding material.
b. Pump controls and alarm system shall be Orenco systems
SICTETMRO 110 volt with the following options consisting of
Event counter
2. Elapsed time meter
3. Program timer
4. 10 watt heater
5. Remote alarm panel option with a minimum of 80 DB sound
Pressure at 24", operating temperature 30°C to 65°C,
continuous sound to be located inside the home.
6. Oil -tight visual alarm with push -to -silence feature.
Automatic audio -alarm reset.
7. 15 amp motor rated toggle switch, double pole, double throw
with three positions; manual (man), automatic (auto) and
center (off) (H.O.A.).
Page 6
Lot 2, Block 11
North Woods Subdivision
May 19, 1998
8. Nema 4x -rated, fiberglass, or equal, enclosure with hinged
cover.
9. All controls to be installed as per manufacturer's
recommendations.
10. Control panel to be installed on outside wall of home within
sight of septic tank/lift station.
c. Piping from the septic tank to the sand filter is to be 1 1/4" PVC
schedule 40 solvent weld piping properly bedded and sloped to drain
back to the septic tank. Insulation board 2" thick and 2' wide centered
over pipe is to be placed where soil cover is less than 4' depth over
pipe.
CONSTRUCTION SEQUENCE
In order to ensure proper installation, the system is to be installed in the following order:
1. Sewer line from house to tank
2. Septic tank/lift station
3. Sand filter
4. Final grading
CONSTRUCTION
I • Pipe Grade and Alignment
Variance of individual pipe sections from established line and grade shall not be greater
than 0.05 feet, providing that such variance does not result in a level or reverse sloping
invert.
During the progress of the work, the Contractor shall provide in such as transits,
or levels, for transferring grades from offset hubs or other construction guides from the
control points and bench marks provided to the Contractor by the Engineer. The Contractor
shall provide qualified personnel to use such instruments and who shall have the duty and
responsibility for placing and maintaining such construction guides.
2. Pipe Laying
All pipe shall be laid with Class C bedding, free of large stones and organic matter.
Page 7
Lot 2, Block 11
North Woods Subdivision
May 19, 1998
Each section of pipe shall be handled carefully and placed accurately, the spigot end shall
be fully inserted pointing in the direction of flow and glued in place to make a water tight
seal.
Each section of pipe shall be properly supported to ensure true alignment and an invert
which is smooth and free from roughness or irregularity.
At all times, when work is not in progress, open ends of pipe and fittings shall be securely
fittings.
and satisfactorily closed so that no undesirable substance will enter the end of the pipe or
3. Bedding of Pipe for Sewer Lines
The pipe should be bedded with Class C bedding materials, compacted to 95%. Native
materials may be used as back fill material above the pipe, provided it is free of large stones
and organic matter to a point one (1) foot above the top of the pipe.
All pumping services shall be installed in accordance with the manufacturer's
recommendations and standards. Electrical installation is to be to code by a licensed
electrical contractor, with Municipality inspection where required. If MOA inspection is
not required, a licensed electrician is to provide a letter to the Engineer stating that the
system meets or exceeds all applicable codes.
4. Tank Installation
Excavate to proper depth to allow gravity flow, install tank level, tolerance 0.1 foot, end to
end, on undisturbed or compacted to 95% classified sand fill material. Line excavated tank
pit walls with 2" +35 PSI burial foam full depth of tank. Back fill between tank and foam
and compact in a manner to prevent damage to tank surface coating.
Create a level sand surface over the tank and add 2" burial foam +35 PSI directly over tank.
Mound unclassified soil over tank location to a depth of 2' above finished grade to allow
Positive drainage away from tank and counteract buoyancy.
5. Connections
All connections to be as per MOA-DHHS and UPS requirements PVC 3034 piping with
Caulder or equivalent couplings for inlet riser pipes.
All tank connections are to be completely water tight.
Page 8
Lot 2, Block 11
North Woods Subdivision
May 19, 1998
SAND FILTER
The work under this section consists of materials and construction/installation of the sand filter.
A. Materials
1. The Contractor shall provide a washed sand to meet ASTM C-33 Concrete
Sand Specifications with the additional requirement that all but 1 % of the
materials passing the #100 sieve be removed. A sample may be taken from the
sand bed during construction for purposes of quality control. If the sample does
not meet specifications, all sand will be removed and replaced.
2. The Contractor shall provide pea gravel that shall be a washed material
containing no fines (0% passing the #100 sieve) and a maximum size of 1/4"
diameter.
3. The Contractor shall provide round rock that shall be washed gravel with
rounded edges, well graded with maximum diameter of 1/211
.
4. The Contractor shall provide the manifold assembly. The manifold assembly
shall be the Orenco Model SFM 1036 or equivalent with orifice shields and
flushing assembly. All drilled holes to be cleaned of burrs and pipes flushed,
prior to assembly. Flushing valve to include riser to +12" above finish grade
with extension handle provided to operate globe valve from the ground surface.
5. Side walls and top of the filter box to be insulated with 2" direct burial
Polystyrene insulation and be inside the plywood box.
6. The Contractor shall provide the filter fabric.
7. The linear air diffuser line and compressor are available from Orenco, no model
number available. The feed line from the house to the filter is HDPE arctic
insulated pipe 3/4"-2" SDR -11 Maskell-Robbins or equivalent. The
compressor will have a gauge (0-10 psi) and be installed in a heated area, crawl
space, or garage.
B. Construction of Sand Filter
The sand filter construction is to follow procedures as outlined in the Orenco Installation
Manual as applicable to this design.
Rock, pea gravel and filter sand are to be hand leveled to proper depth (tolerance within
0.05 feet) in filter, taking care not to allow mud or fine soil material into the filter or rock
layers. This would include any soil material picked up by excavation machinery buckets
Page 9
Lot 2, Block 11
North Woods Subdivision
May 19, 1998
while loading specified material. The Contractor should estimate filter material volumes
such that allowance is made for wastage of material in contact with the ground at site.
Work on the sand filter may be suspended at the Engineer's discretion due to inclement
weather conditions, such as rainfall. The sand filter and material stockpiles will be
completely covered by a tarp over night during construction until finished. Filter internal
construction should be accomplished in one (1) day's time.
The area over the sand filter to be finish graded with a minimum of 2 feet of cover and to
prevent ponding of surface water run off. Side slopes shall not exceed 3:1. Six inches of
top soil and seed are required over the entire sand filter when the side slopes approach 3:1,
or at the discretion of the M.O.A.
The Engineer will reject any sand, round rock or pea gravel that does not meet
specifications or is contaminated in transit or while handling. If such material is placed in
the filter, all soil material may be required to be removed and replaced with new material.
CONTRACTORANSTALLER
D
Municipality of Anchorage
Development Services Departmer`
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsne
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
i
Parcell.D. OSI -q= 59-D COSA#
1. GENERAL INFORMATION Expiration Date:
Complete legal description NORTHWOODS SUBDIVISION N3: LOT 2. BLOCK 11.
Location (site address) 23125 SHELTERING SPRUCE AVENUE • CHUGIAK. AK 99567
Current Property owner(s) LAURA LINKINS Day phone c/o AGENT
Mailing address c/o BROOK STILTNER w/ REMAX PROPERTIES !
Lending agency
Mailing address
Real Estate Agent
Mailing address
Day phone
I
BROOK STILTNER w/ REMAX PROPERTIES Day phone 694-4800
16600 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
SEPTIC' SYSTEM SIZED
2. NUMBER OF BEDROOMS: 3 1 FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
I
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Weil
❑
Community On-site
❑
Public Water System
0
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 Onsite 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 samples. (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 seat 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 riles 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. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysts of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system undor the conditions encountered at the time of the lost, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local sols condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory lost
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the solo benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
337-6179
Date ?/;--I 10f,
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
• VIw.7c
WATER AND •:
WASTEwAl R
PROGRAM
By:
� v��� �� �r Original Certificate Date:
Ip_ 11A %
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water 3 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orylonake
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: NORTHWOODS SUBDIVISION L'3: LOT 2. BLOCK 11, Parcel ID: '
A WELL DATA
Well type
Date completed
Date of test
Static water level
Well production
PUBLIC WATER
If A, S, or C provide PWSID# _
Sanitary seal
Cased to ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate
B. SEPTIC(HOLDING TANK DATA
ft.
—
9 -p.m -
Well Log
<tVKs- property protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
Date of sample: Collected by:
ft.
_9113 -m -
Tank Type/Material PLASTIC/S.T.E.P. Date installed 9/24-10/13/98
1300/
Tank size 500 gal. Number of Compartments _9L1_ Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YIN) : YES
Date of pumping 6/19/2006 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date Installed 9/24-10/13/98 Soil rating gj. ft%bdnn) 2_0 System type BED/I.S.F.
Length 20 ft. Width 18 ft. Gravel below pipe � 0.3 ft.
Total depth •3 s ft. Eft. absorption area 350 fe Monitoring tube YES Depression over field NO
Date of adequacy test 7/14/2006 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth In absorption field before test DRY in. Water added 607 gal. New depth DRY in.
Elapsed Time: 0 min. Final fluid depth DRY In. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
SEPTIC SYSTEM SIZED FOR 4 BEDROOMS
D. uFT STATION
Date Installed 10/13/1998 Size In gallons 500 ManholelAccess (YIN) YES
"Pump on" level at 42 in.
Datum BOTTOM OF TANK
E. SEPARATION DISTANCES
'Pump ofP level at 32 in. High water alarm level at 44 in.
Cycles tested 3 Meets alarm & circuit requirements? YES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAtft station on lot
Absorption field on lot
Public sewer main
Sewer /septic service
areas
PUBLIC WATER
On adjacent
On adjacent
sewer manhole/deanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main
10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+/2000+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent kits 100'+/200'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspectlons and
review of Municipal records that the above systems are in
conformance with MOA COSH guidelines in effect on this
date.
Engineers Printed Name JEFFREY A. GARNESS
Date 9/7/06
COSA Fee t Lf 3 a
Date of Payment % / 31 Z D b
Receipt Number
(Rev. 1IM)
Waiver Fee E
Date of Payment
Receipt Number
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ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN MUNICIPALITY OF ANCHORAGE
ANDt�bCVA- f)RO-V-7
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
Day of U( of 20D by and between KDik'- {�2rJ7
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
1. ADVANCED 1VASTEWATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Wastewater
Treatment System (AWWTS), described as Z• D.S •F located
at Moylrr1 IKIDOM `Y6 , -BLV— II LTZ Anchorage, Alaska.
8.3196 sh,uievn 5pyu G
2. Definitions.
A. Alteration. Any change to the design or function of an AWWTS that
Includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design. Prior to
performing any alterations to an AWWTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65.
B. Certificate of On -Site Systems Approval. An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
These approvals certify that the systems are adequate for the homes that
they support and meet the codes that were in place at the time of system
construction.
C. Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
D. Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AW WTS that %were included in
the original design which would allow the AWWTS to continue to
perform as designed.
E. Permit (Construction) An On -Site Wastewater Disposal System
Construction Permit as defined by AMC 15.65.
F. Permit (Operating) An Advanced Wastewater Treatment System
Operating Permit. An annual permit, issued by the Municipality, that
allows the Owner to operate an AW WTS, upon meeting all the
requirements of this agreement, the conditions of Operating Permit, the
requirements of the On -Site Wastewater System Construction Permit and
all relevant provisions of AMC 15.65
3. Fee. Owner shall pay to Municipality an annual fee of ;7_eV_n
($ .00), payable on or before the issuance of the operating permit and annually
thereafter. The annual fee is due on or before the anniversary date of the approval by the
Municipality of installed system.
4. Term. The term of this Memorandum of Understanding shall be for the life of the
The term begins on the date of approval by the Municipality of the installed system and
shall continue while the AWWTS system is in use or operational or until the property is'
sold or title is transferred by owner and a new certificate of On -Site approval is issued to
the new owner or transferee of the property.
5. Alterations, Installation and Removal of Additional Equipment. Owner agrees
not to make any alterations, removal of parts or additions to the AWWTS without a
Construction Permit from the Municipality.
6. Maintenance and Repairs.
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AWWTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
i
renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2)
maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
rules and orders for the AWWTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's AWWTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AWWTS
Operating Permit is:
C. Owner acknowledges that the fine schedule for failing to maintain and repair an'
AWWTS are codified in AMC 14.60.
D. Owner agrees that only maintenance, repair personnel certified by the
Municipality will inspect and make any necessary maintenance, repairs or permitted
alterations to the system.
E. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
F. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
G. Owner agrees that the relevant provisions of the standard specification guidebook
for AWWTS is the governing professional guidelines for the construction,
maintenance and repair of the Owner's AWWTS.
7. Nonwaiver. The failure of either party at anytime to enforce a provision of this
Memorandum of Understanding shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of Understanding or any part
hereof, or the right of such party thereafter to enforce each and every provision
hereof.
S. Amendment.
A. This Memorandum of Understanding shall only be amended, modified or changed
by a writing, executed by authorized representatives of the parties, with the same
formality of this Memorandum of Understanding was executed and such writing shall
be attached to this Memorandum of Understanding as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this contract, the only authorized representatives of the parties are:
Owner:
Anchorage: Purchasing Officer
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of
Understanding shall be brought in the Superior Court for the Third Judicial District of the
State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and
obligations of the parties under this Memorandum of Understanding.
10. Severability. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
OWNER:
MUNICIPALITY:
By:
By:
Date: A" C>6
Title:
Date:
STATE OF ALASKA
)
) ss.
THIRD JUDICIAL DISTRICT
)
Th rey ' , iqs ent vas acknowledged before his —0 day of ,
20 , b as �ell7f ,the i l 111 1t/
My Commission expires:
Zae-
+pTAR}r
PUBtV
Municipality of Anchorage
Development Services Department
• +� Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Jeff Gorness
Legal description: Nor-thwoods #3 Block 11 Lot 2
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design. _
❑ Additional soils information needed.
❑ Water monitoring results inadequate.
❑ Discrepancy in information submitted.
❑ Topographic information missing or Inadequate.
® Incomplete; missing Maintenance Agreement
® Incomplete; missing Lift station information
❑ Additional adequacy test information needed.
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing. _
❑ Locations of all soils, percolation and water monitoring tests not shown. _
❑ Proposed system too deep for soils Information submitted.
❑ Well log required.
❑ Omission in narrative.
❑ Insufficient fill over tank or field._
® Other. Lift station lid not secured.
Name of reviewer: Poet
Date: 8-2-06
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
C,
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 051-732-04 �' HAA # I,I Q'E IL) Sl i
1. GENERAL INFORMATION
Complete legal description
LOt 2, Block 11, Northwoods Unit #3 S/D
Location (site address or directions) NHN Sheltering Spruce
Property owner Laura Lee Linkins Day phone 907-428-3105
Mailing address 'g T, Dy 't fi- r ficC,",4, ,a 5d,. N S-�1S
Lending agency Day phone
Mailing address
Agent Dick Brown/Target Realty Day phone 694-2388
Address 17034 North Eagle Riypr roon Road, Fag1P R;vps nx aar)77
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water XXX
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 x21
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
17034 tagle
Address Eagle River, Alaska 99577
Engineer's signature
6. DHHS SIGNATURE
V Approved for
Disapproved.
E6 U f': bedrooms.
Conditional approval for
Additional Comments
By:
Date / o / P )-/ q
` O F
4.1
ROBERT C. COWAN
�)i '•,
CE -8801
....
bedrooms, with the following stipulations:
Date II -q- 9Q
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 engineers work.
72-M (Rev.1/91) Bank MOA 021
Municipality of Anchorage OCT 22
JIM
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division AN(-tj�x
825 L Street, Room 502 • Anchorage, Alaska 99501• { 't rices niw rON
Health Authority Approval Checklist
// , 11 / Url is
Legal Description: Z-oi ,2 81-06h- �� JVo)?7V 1 Joob � Parcel I. D.: 0517.3,2
A. WELL DATA
Well a A If A, B or C, attach ADEC letter. ADEC water system number a'/ 3 o o
Log present {Y Date completed
Total depth Cased to Casing height (above ground)
Sanitary seal (`(/N) Wires properly protected (Y/N)
FROM WELLLOG AT INSPECTION
Date of test
Static water level
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 01 ' Z fr Tank size 13 0 0 Number of Compartments 2 Cleanouts 49/N) y't J
Foundation cleanout O/N) Y Depression (Y/& A/ High water alarm (Y/N) S)1g r„w
Date of PumpingN % — N �"� Pumper
C. ABSORPTION FIELD DATA
Date installed `'�� �gSoil rating (g.p.d./ft2 or ft2/bdrm) System type BFB J3e'rbMLESS
S,9 MD 117'.ER
Length'. .2� F Width ($ Gravel thickness below pipe-3 Total depth0 0
Effective absorption area 360,,,7* Monitoring Tube present (Y/N)—)/- Depression over field (Y/N) /Y
r1 x/�c) Sys, M
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test (in.); Immediately after^ gal water added (in.):
Fluid depth (ins) Minutes later: Absorption rate = g.p.d.
Peroxide treatment (past 12 months);(Y/N) `If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed< 2��/' 9y Size in gallons N 14
Manhole/Access (Y/N) /€5 "Pump on" level at* 412 / "Pump off' level at*
High water alarm level at* 2141 *Datum 8 o rr o M
Cycles tested 2
E. SEPARATION DISTANCES
SEPARATION CES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main Public sewer manhole/clean
ou
Sewer /septic service line Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
FoundationProperty line Absorption field
Water main/service line 30 / Surface water/drainage 't' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line �� Building foundation 93 Water main/service line SOS
Surface water ADO Driveway, parking/vehicle storage area GAO f
Curtain drain D�/E ��� Wells on adjacent lots /00
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal
in conformance with MOA HA guid lines in effect on this date.
Signature —�� -- Z`�"`._
Engineer's Name D 6 ✓e AL r C
Date f o I -A J,
On adjacent lots
r�^aeiaoent lots
HAA Fee $ %--,'
Date of Payment i
Receipt Number
72-026 (Rev. 3/96)*
I
64/37
Waiver Fee $
Date of Payment
Receipt Number
M9
do
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are
