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HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 5 LT 15iver View lock Lot:[ 7 050-792 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221202 PID Number: 050-792-18 Dwelling: © Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Upgrade Name Justin Wood A ORPTION FIELD ❑ De Trench ❑ Wide Trench V Bed ❑ Mound Site Address 7447 Waterfall Dr. Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 3 !S F Ft. LEGAL DESCRIPTION Depth to pipe invert from original g de Gravel depth beneath pipe 11 Ft. Subdivision Block Lot River View Estates 5 15 Fill added above original grade Gr I length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dist a between lines FL SEPARATION DISTANCES To Septic Absorption Holding Lift Station s Sewer Total absorption area Number of trenches Dist. between ches From Tank Field Tank Line Ft2 Well 100+ 25+ TANK ✓❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal, Surface Water 100+ Material Plastic Number of compartments 2 Lot Line 5+ NA Foundation 10+ iTATION I Manufacturer . Capacity Gal, Remarks Field verified 5'+ tank to bed Alarm location Elects taped by PIPE MATERIAL House to tank Tank to D3034 drainfield D3034 Installer Person Construction Drainfield CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100ft Inspection n 1 Location and description dates: 10/16/22 2"11 10/16/22 3'd 10/20/22 41h Roof Corner ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp "'I& *ALTA A,E 07 Conditional Approval: Date �s�p� 04;$ � a a Y. B c� KENNETH US �+ Septic System ,.� Approve Date 44�s� CE 7 e-- Note: this Note:does include approval not well permit requirements. (Rev ubluzii6) AS—BUILT SYSTEM DETAILS/SITE PLAN Permit EISP221202 RIVER VIEW ESTATES BLOCK 5, LOT 15 PID# 050-792-18 DEC bDRIVEWAY0 EXISTING 0 BUILDING 0 lid hgk C B VELL ........... . . .. SCALE, 1' = 301 A -C=15,0' B -C=25.1' A -D=19.0' A -E=20.2' B -E=25.9' A -F=20.0' B -F=27.7' _j C3 SCALES NTS ldsp�� OF AZ ............ PREPARED FOR; JUSTIN WOOD 7447 WATERFALL DR TH EAGLERIVER, AK S T �*H 0. FIELD BOOKS compuTED: KnENNETH CE CE 11 '04 BWNDAR DRAWN: Y- N /A KSD K, 1 CHECK N/A `KIVID A STAIUNG, LT. DAM As"U' sslo'�011 Air __. WALATKA 11/i/ DWG. FM GFJD: 1%ow4b; - I sw031r ACAD METOB No.: 22155 ' FILE SCALE, NTS A 13 0 > L I r% 122 ■ T AW ,`P. • .5,� �� ,� `'?' 49th ® . . 10 rc, % Elizabeth L. Walatka ; ®� ���F • 8036 - LS • J4� SCALE: 1 "= 50'B ®� ' • y "" +! %olFESSIONAt- LOT 15 rsQado N87044'58"E 105.35 LOT 16 LOT 14 RECERTIFIED 10-27-22 C'G AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 15 BLOCK 5, RIVER VIEW ESTATES SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 28th day of September , 2010. EASEMENTS OF RECORD, OTHER THAN I U ` '7G • 0 2._- THOSE SHOWN ON THE RECORDED FRED WALATKA &ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON FB 22-3, pg 74 Engineers and Surveyors BE 907-248-1666 UNLESS OTHERWISE NOTED. FB 10-6, pg 62-63 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. RIVER PARK DRIVE o co O m 3 N89058'50"E 150.00 . /��rt ------------ 10' Utility Easement— > 30 I M i 0I I I M 00 J � 1 � to LLL I --55.4 so -`—�7. W I s4ra\L �y0 s —= a F_ a A °o M F0 ca ' ° rr r Q. I Q i Z 9°0 o s Q am �° O I I ry6. Z 30 aweu AW ,`P. • .5,� �� ,� `'?' 49th ® . . 10 rc, % Elizabeth L. Walatka ; ®� ���F • 8036 - LS • J4� SCALE: 1 "= 50'B ®� ' • y "" +! %olFESSIONAt- LOT 15 rsQado N87044'58"E 105.35 LOT 16 LOT 14 RECERTIFIED 10-27-22 C'G AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 15 BLOCK 5, RIVER VIEW ESTATES SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 28th day of September , 2010. EASEMENTS OF RECORD, OTHER THAN I U ` '7G • 0 2._- THOSE SHOWN ON THE RECORDED FRED WALATKA &ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON FB 22-3, pg 74 Engineers and Surveyors BE 907-248-1666 UNLESS OTHERWISE NOTED. FB 10-6, pg 62-63 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221361 Work Type: SepticTank Upgrade Tax Code Number: 05079218000 Site Legal Address: RIVER VIEWESTATES BLK 5 LT 15 G:0357 Site Mailing Address: 7447 WATERFALL DR, Eagle River Owner: WOOD JUSTIN SHANE Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date Expiration Date: o��»ent �r n llepartment Lot Size in Sq Ft: Total Bedrooms 9/15/2022 9/15/2023 41274 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. Verify 5' separation to septic bed by installing a cleanout in the bed Received By: Issued Bye Date: Date: 7-1 S ^Z 3 MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 050-792-18 ANCHORAGE ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) Justin Wood Day phone Mailing address 7447 Waterfall Dr. Eagle River, AK Site address 7447 Waterfall Dr. Eagle River, AK Legal description (Sub'd., Block & Lot) River View Estates Block 5 Lot 15 Legal description (Township, Range & Section) Lot Size 41,274 Sq. Ft. Number of Bedrooms 3 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) IN (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) El Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permi ush Fees: �011�1 ate of Payment: q L�1 la -a Receipt Number: 041 Permit No. DFJ1?ZZ 1.3 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc September 7, 2022 CONSULTING, INC 20441 Ptarmigan Blvd, Eagle River, AK 99577 Office (907) 696-6111, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On - Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Tank Replacement Permit — River View Estates Block 5 Lot 15 Wnicipality of Andiorage On-site Water and Wastewater REVIEWED FOR CODE COMPUANCE OSP221361, Tim Eddund, 09/15/22 On August 26, 2022, an inspection was conducted for proceeding with a COSA submittal. While the leachfield passed the test, during the inspection the aged septic tank showed indications of failure. We propose to replace the existing 1000 -gallon steel tank with a 1000 -gallon HDPE tank. The soil log information on file shows a depth of 12 feet with no groundwater noted. We do not expect there to be any adverse effects to the existing well or this septic system operations in the existing location. If you have any questions, please contact meat 696-6111 /FAX 868-8793. Respectfully submitted, ArcTerra Consulting, Inc. Attachment On -Site Tank Permit Design 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 Minicipality of Anchorage On-site Water and Wastewater WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PL ,361,TmEcv-d, RIVER VIEW ESTATES BLOCK 5, LOT 15 PID# 050-792-18 ` DECi DRIVEWAY a \ EXISTING TANK o TO BE REMOVED \ BY CODE EXISTING° o BUILDING TM w,__ � 4,_ S�"�� ��� 1000 GAL TANK TO BE INSTALLED PER CODE ,A M VILL f ' SCALEt 1' = 30' 1, DECOMMISSI❑N EXISTING SEPTIC TANK PER CODE. 2, INSTALL NEW 1000 GALLON DEEP BURIAL STEP TANK PER C❑DE, 3, TANK TO HAVE MIN. 20' MANWAY RISER. 4. MAINTAIN 10'+ FROM FOUNDATI❑N & 51+ EXISTING FIELD. 5. MAINTAIN 1001+ FROM PRIVATE WATER WELLS. NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. OF .A. _�S L� TH KENNE S' xESS101AW AV NOTES NO WELLS ON ADJOINING LOTS ARE WITHIN 100' OF PROPOSED TANK PLACEMENT. NO SURFACE WATER NOTED WITHIN 100' OF PROPOSED TANK PLACEMENT. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INT❑ SEPTIC TANK, CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... PREPARED FOR: JUSTIN WOOD 7447 WATERFALL DR EAGLERIVER, AK FIELD BOOKS BOUNDARY: N ZA STAWNG: N /A ASBUILT: WAL DWG. FILE: AOND FILE: FILE COMPUTED - A": KSD CHECKED: KM❑ DATE 9/7/22 22 GRID: SWO357 'OB N°' 22155 Municipality of Anchorage Page I 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: ~7~ 10 ] / _ pl~D~Number: ~-~-~2~ 7~- N~,,,~ LOUSE ~(J ~E~ Was~ewater System: ~New D Upgrade Address: ~flSO C~IJ FO~O q~Z ABSORPTION FIELD Phone: No of gedrooms~,~ ~ Deep Trench ~ Shallow Trench ~ged ~ Mound ~ Other Sod Raling: 3 LEGAL DESCRIPTION ~ r*'yg~m ~ ~o,~, ~,~,~o~ or,~n~: . Subdivision: Depth to pipe bottom [rom original grade: Gravel depth beneath pipe ~, ~ ~t. Township: ~ Range: ~eotio~: Fill added above ob~inal grade: , Gravel leogth: - ~. ~ ~t. WELL: ~ New ~ Upgrade iGrave~idth: Number of ~ines: /N+. ~. Classification (Private, A,B,C): Total Depd~: Cased TO: Total ~bsorplion area: Pipe maleriah Driller~ J~'f~'~DateDrilled:. StalicWaterLevet:~ Ft. Installer____~ ~_~ Date installed: /~Z. Yield: J Pump Set ~t: Casm9 Heighl Above,~rgund: ~, ~GPM ~ IL Ft 1 ~,l~ ~. TANK SEPARATION DISTANCES ~Septio ~ Holding ~ S.T.~.P. TO Sephc Absorpl~on Ldl Holding Public/Priva[e Msnu[~cturer: Oapacity in gallons: ~,'/ o3' I / ~ 25'+ ~,~b~,: 5~ ~ ~ L.u~o, s~,~ ,+ LIFT STATION Lot / ~ Size in gallons: ~oun~,io~ D' ~' -- --~ "P~,m~on",~~'""~v~'. ~,: ~.,~h~,~'~.~': Curtain Remarks: PO~T ~CT- ~0 Z~P~C~O~= BENCH MARK _ = Location a~d Description: ~ ~ ~ ~ ~ ~/~ // Assumed Elevation: ' ENGINEER'S SEAL D~tes: ~st ~ho J~ ...... Inspections performed by: ]~2 ~;~ 2nd-~~ Department of Health and Human Services approval Reviewed and approved by: ~ ~ _ Date: /~ F~e:a 72 0~3 (Rev 9/91) MOA25 Permit No. 851011 2 2 Page of Municipality of Anchorage 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 RIVERVIEW ESTATES SUBDIVISION, LegalDescription: BLOCK 5, LOT 15 PIDNo.: ~- 7'~2-/o CO1 98.6' EXISTING 1000 GAL SEPTIC TANK C02 ~FINAL GRADEk 95.5' / MTi _///-98,9' 96,_// MT2 ,, SR~I RIVER PARK DRIVE ~.G~. /- BED IN~ lNG · u~2~ ff i983 /: ~ DOCUMEI ~LL ~o/ GAL SEPTIC T 0 ED ~ ' LLE[ i983 )~ ~LL LOT t5 SCALE 1" = 40' 72-013 A (2/91) MOA 25 A B FCO 25.0 16.5 C01 27.5 ]17.0 C02 $2.0 19.0 MT1 /41.0 114.0 MT2 156.5 123.0 ALLED [TED Subject: FOLO To: RECEIVED NOV 2 4 199~ Municipahty ol Anchorage Dept. Health & Human Service~.~ MESSAGE ROBERT A. SHAFER, P.E. 694-2979 FAX: 694-1211 HEALTH AUTHORITY APPROVALS EXCAVATING I CIVIL ENGINEERING WORK ARRANG ED / ADEQUACY TESTS I SOIL TESTS WATER & SEWER LINES & MAIN EXT. ON SITE INSPECTIONS DATE OF MESSAGE [ ROUTING SYMBOL REPLY From: DATE OF REPLY SIGNATURE OF REPLIER IROUTING SYMBOL TITLE OF REPLIER RETAINED BY ADDRESSEE PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930444 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:BRUNNER LOUIE K & CATHERINE OWNER ADDRESS:6950 CRAWFORD ST. ANCHORAGE, AK 99502-2727 DATE ISSUED:10/21/93 EXPIRATION DATE:10/21/94 PARCEL ID:05079218 LEGAL DESCRIPTION: RIVERVIEW ESTATES BLK 15 5 LT LOT SIZE: 41274 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL 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 (18AACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 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: RECEIVED BY: ISSUED BY: DATE: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. October 20, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services Attn; Robby Robinson P.O, Bo~ 196650 Anchorage, AK 99519 REFERENCE: Lot 15; Block 5; Riverview Estates Dear Robby, Please issue a well permit on the referenced property. Existing well has a cracked well casing and is contaminated with too numerous to cou~t - other bacteria. A revised as-built will follow after completion of new well. Tha~ RAYMON;~L. SHAFER Engineering Technician RLS/gk ENCLOSURE 17034 NORTH EAGLE RIVER LOOP · SUITE 204 . EAGLE RIVER, ALASKA 99577 Municipality of Anchorage / . Page I~of- DEPARTMENT OF HEALTH AND HUMA~ SERVICES ENVIRONMENTAL SERVICES Dr~eSTI~N P.O. Box 196650 $ Anchorage, Alaska 99519-665¢' e Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~);~10 I1 PID Number: N~,,~: ~O~ ~~ Wastewater System: ~New D Upgrade Address ~ C~~~ ~ ABSORPTION FIELD Phone: ~No of Bedrooms: ~ ~ Deep Trench ~ Shallow Trench ed ~ Mound ~Other Soil Ratin~X Total Depth from origin~r~e:, LEGAL DESCRIPTION ~¢ Z~ Lot: ~ Brock: ~~J~l~Subdivisi°n: ~ Oeplhlopipebotton, fromodginalgrade,¢.~ 'Ft. Graveldepthbeneatnpipe: Township: ~ Range: Section: Fill added above original grade~ Gravel length: ............. Ft. Ft. WELL: ~ New ~ Upgrade Gravel width: / ~ IFt Number of~ lines: Oislance betweenlines:~,~/Fl. C~cation (~rivate. A.B.C): Total Depth: Cased To: Total absorption area: Pipe material: ~/~ D~~ .~ ~a:~:~5 Static Water Lov;;: Installer~ Oateinstalled:/~ SEPARATION DISTANCES CSeptic ~ Holding ~ S.T.EP. Surface .... ManufaCturer: Lot / / Size in gallons: Foundation ~ I I~, -- -- "Pump on" level at~ level at: ' -[~igh water alarm at:. O;::¢,i,. ~,~¢~ /~/ ¢~ : "' ~ LELectricallnspectionsperformed by: Remarks: ~ ~ ~g%- ~O BENCH. MARK / Location and Description: t ~ Assumed E~evation: / ' ' ENGINE~R',S SEAL S & S ENGINEERING Department of Health and Human Services approval , . .... , .: ,~. ,~,, Reviewed and approved by: Date; 72 013 (Rev 9/91) MOA 25 Permit No. 831011 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 a, Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report RIVERVIEW ESTATES SUBDIVISION, Legal Description: BLOCK 5, LOT 15 PtDNo.: COl 96.~ EXISTING 1000 GAL SEPTIC TANK C02 FINAL GRADE NTt ./98.9' INSUI&TIO~ 95.5' MT2 RIVER PARK DRIVE 100 SEPTIC TANK INSTALLED WELL (To Be ~bandon~OdT)15 SCALE t" = 40' 100' WELL RADIUS "~PROP. WELL 72-013 A (2/91) MOA 25 L CO BED INS ur2 1983 DOCUME; 8/93 20' A B FCO 25.0 16.5 C01 27.5 1~7'0 I C02 ,32.0 19.0 I MT1 41.0 I14.0 I MT2 56.5 23,oI MT3 59.0 31.5] ALLED TED ENGI~EEB'.§r$~AL HEFTY DRILLING 3540 ARULA DRIVE TELEPHONE: ANCHORAGE, ALASY,.A 99516 ' {007) 34'5-0593 Date Drilled : OCt I9th 1993 Static Water. Level 5. Feet Draw Down__N/A . . ~eet Louie Brenner 6950 Crawford Anchorage, Ak. Riverview Estates. Lot 15 Block 5 Gallons Per Minute 2½. Total Feet of Casing .20 Type Material Drilled: ___~to 16 ffLL Sand ~/ r~cky ~¼nl~ 16 ft. to 165 ft, ...B~drock ,(Shale w/fra~aur~ g ~m~]] mm~,~n~ ©F water a~= ll0ft.) to Drilled to 165 ft total to to to to to to to HEFTY DRILl. lb/It' 3540 AKULA DRi~ ANOHORA(3t~o AK (007) 345-0503 ~.~:;75 "' L "' ~!!;TF~:E:E'T'., I::lt"~(::HC$;:FK]i[~:., FIlE ;;;!: d; ,::l. -. 4. ? ;?. Et : I::II",I(:':HOI:~'.f-~(:~E 69,q-.-;~'.J..:}~::].. : EI::IG[..E RI',,,'ER FIF'F'L. Z CF]i'.,F[': i....'¢Cff.,l¢~; CON~;'TRLiCT ]: ON F'HOhlE: E~F:IGL. 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HI'ffZNT:E; i.,.IHZC:H :I::E; F'RRT O1:: THIS F:'ERi~11 'T'. :i~:. :1: Uhli:::,EF?.~?l¥:tht[::, THI:::IT 'TFIE ON--'SZTIE :SEI4ER :~i;"r%TEM MF:I"r' F;:E6:liJ:I:F~:E E:NI...FIRGEMI[ChlT :IF: THE F;:E2i; :i: [.'[~:NC:E Z :E; RI~MO[::'E:L[;~:[:, TO :[ NC:I_U[:'E I"tORE THFII",I :~: I~EDROOMS. I:::'EIRI"I :I: T Fff:'F'L. :[ C:FII",tT FIF:I:~i; THE i:;U:~:SF:'Cdq~!~ :[ E= :1: L :1: T'T' TO I NF'OF'.M F'ERSCff',II"4EL THE ]: I",I2;'i"F:IL.L. FtT :[ Ol',l :[ I',[:F2;F'IEC:'I" Z Oi",IS OF' RN'T' 1.4EI..X...:~; FI[:'.J'FICIEI"4T TO -I"H :1: rE; F'ROF'ERT'¢ FIND THE NIJME',ER O1:::' RE:~;:I:I::'iE:i",iC:ES THFIT THE I.,.IELL. },.I:[L.L. ZF' R I....:[F'T S'TRTION Z:[~; :[N:E;TFtL. I....ED., F~l",l EL. EE:TR:[CI::II... I:::IE[q:HI't" laND IhlSF:'ECTZOI"4 MI...I:E;T [?,[~ (::t[~F['I:::1:1: hiE[::'. FtS-E~Ij ~ I...TS CFINNOT E',E FIF:'F'F;tlZIYE[::, I.,.I ]: THCIUT FIN E:I_IEE:TF?. I C:FI[... Z I",ISF'E:CT Z O1",1 REF'CdRT. 'THE: El....[ I.,.IORf,:: ML.IST E',E I::'ONE: ECT' Ft L. ZCE:I",I~E;EI::, EI..EC:TF;:ZE:IFIN. :~i; ]: GNE[:': F:I P I:::'t.,., :1: C F:I N "l" ]: F:; ::.:, I...I E [::, PERFORMED FOR: LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST //~ SOILS LOG [] PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE SITE PLAN COMMENTS 72-008 (6~79) WAS GROUND WATER S ENCOUNTERED? · /¢-//~ L O P IF YES, ATWHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN //'~' '~ ' (minutes/inch) FT AND -- FT CERTIFIED ,¢'"~"~- ~. DATE:~ ~//' ~ WA~EP, ',VEl I RECORD SIATI! OF Al ASKA I)EPARTMfN f OF NAT.',JRAL RES(.)URES Divis,on al Geoio9~col ~A 6cophysical Surveys MUNICIPALITY OF ANCHORAGE Development Services Department rr Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-792-18 Legal description River View Estates Block 5 lot 15 Site address 7447 Waterfall Dr. Eagle River, AK Current property owner(s) Wood Expiration Date: X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: 2-10-2023 bedrooms, with the following stipulations: Original Certificate Date: % l L9^ ZZ -- This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) islare in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcell.D. 050-792-18 Complete legal description River View Estates Block 5 Lot 15 Location (site address) 7447 Waterfall Dr. Eagle River, AK Current property owner(s) .Tustin Wood 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: Q Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel © Plastic ❑ Concrete ❑ Fiberglass Age New - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ S Q Waiver Fee $ Date of Payment ) 21 2Z Date of Payment COSA # _ 0S C-_221 _ 2 9_ _ Waiver # COSA Application—June 2022 Legal Description: River View Estates Block 5 Lot 15 Parcel ID: 050-792-18 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑✓ Well log is filed with Onsite (or attached) Date drilled 10/19/1993Total depth 165 ft Cased to 20 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 25 in. Date of flow test for COSA 8/26/22 Static water level at beginning of test 5 ft. Comments B. TANK DATA Measured operating fluid level in septic tank New Date of pumping New 10/16/22 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 1983 W ALL standpipes present per record drawing Total measured depth from grade 3.4 ft (max) Measured depth to pipe invert from grade 2.9 ft (min) ❑ N/A — pressurized field. © Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 2.0 gpm Water storage tank volume - gallons Well disinfected for coliform test? ❑ Yes ❑✓ No © Coliform bacteria is Negative Nitrate 0.254 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑� Arsenic less than MRL (ND) Collected by Arcterra Consulting Date 11/2/22 IFT STATION ❑ Require -0 Age of lift station _ Lift station material Comments; completed Adequacy test date 8/26/22 Results 0 Pass Fluid depth prior to test 0 in Water added 450 gal New fluid depth 0 in Elapsed time 1 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' M Yes if No ft F%/1 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No ft 0 Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ✓❑ Yes if No Tank to Property Line > 5' ✓❑ Yes Field to Property Line > 10'✓❑ Yes Water Main > 10'✓❑ Yes Water Service Line > 10' ❑✓ Yes F. ENGINEER'S COMMENTS if No ft Wells on Adjacent Lots: if No ft Private Wells > 100' if No ft Community Wells > 200' Yes if No ❑✓ Yes if No if No ft If tank or field is under driveway comment below ft ft ft G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date ff A/zz­ 1 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. OC�RAtA The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system: The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen 110 encroachments, deficiencies or discrepancies exist /� �� KENNETH MI wush, 7 COSA Checklist June 2022 Parcel I.D. = 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 050-792-18 GENERAL INFORMATION Complete legal description Location (site address) COSACf O.~CI017-~'7 Expiration Date: / - .-Z/-- i i RIVER VIEW ESTATES BLOCK 5, LOT 15 7447 WATERFALL DRIVE, EAGLE RIVER, AK 99577 Current Property owner(s) Eric I. C)uam Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 Day phone 7447WATERFALL DRIVE~EAGLERIVER, AK 99577 Day phone Day phone m TYPE OF WATER SUPPLY: Individual Well, Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: [] 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 ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 10/14/2010 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life o fall well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. DSD SIGNATURE ~,/Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: 0N-SITE [ WASTEWATER : Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: M icipality of Ancho ge DevelOpment: se ices Department Building Safety DivisiOn On-Site Water & 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 CHECKLIST Legal Description: RIVER VIEW ESTATES BLOCK 5, LOT 15 A. WELL DATA Date completed, ld0/19/I993 Sanitary seal' (Y/NJ _Y Total depth 165 ft. Date.of test Static water level Well production 2;,5 WATER SAMPLE RESULTS: Coliform NF.G colonies/100mL Nitrate Cased to 20 (BR) ft. FROM WELL LOG 5 ft. g.p.m. ND mg/L Arsenic: ND mg/I Date of sample: 10/06/2010. B. SEPTIC/HOLDING TANK DATA Parcel ID: 0,50-792~18 Wires properly protected (Y/N) Y__ Casing height' (above ground) 24 in. AT INSPECTION o/06/2010 4 ff. 2.35 g.p,m. Collected by:. AtcTerra Tank TYPe/Material Septic/Steel Date installed 1983 Tank size 1000 gal. Number of Compartments _2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N__ High water alarm (Y/N) N Date of pumping 10/06/10 Pumper IRs ABSORPTION FIELD DATA Date.installed 1983. Soil rating (g.p.d.fft2 or ft2/bdrm) 85. System. type Bed Length 24 ft. Width 18 ft. Gravel below pipe 0.5 ft. Total depth 3.4 ft. Eft. absorption area 432 ft2 Monitoring tube Y Depression over field N Date of adequacy test 10/06/2010 Results (Pass/Fail) Pass For 3_ bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in. Elapsed Time: <l min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N_lf yes, give date ~ D= LIFT STATION Data installed "Pump on" level at Datum E. SEPARATION DISTANCES Size in gallons "Pump off' level at in. Cycles tested Manhole/Access (Y/N). High water alarm level at in. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankJliff station on lot 100'+ On adjacent lots Absorption field on lot I00'+ On adjacent 'lots PubliCSewer main ~5'+~ p Animal containment areas 50'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main I0'+ Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water Service line 10'+ Surface water 100'+ Curtain' drain 50'+ tNone Kaew~) COMMENTS lO0'+ 100'+ Manure/animal excrete storage areas 100'+ Absorption field 5'+ Surface water 180'+ Water main 10'+ Driveway, parking/Vehicle storage Wells on adjacentiots 100% 10'+ G. ENGINEER'S CERTIFICATION I certifythatlhave determined through field inspections and review of Municipal records that the above systems are conformance with. MOA COSA guidelines in effect on this date. Engineer's Printed Name KEN-IVETH M. DUFFUS Date 10/14/2010 COSA Fee $490.00 Waiver Fee $ Date of Payment [ O -- / (~' - / ~) Date of Payment Receipt Number O ~ ~" 3 ~' ~ Receipt Number (Rev. 11/05) 8354L RIVER PARK DRIVE N89°58'50"E 150.00 10' UTILITY EASEMENT ~. . - o 0,4 ' I LOT 15 ~ 5~ ~ N87.~'58"E 105.35 LOT ~6 LOT 14 SCALE: 1": ~? ~ ~) ~ EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON, Fb 10-6, pg 62~3 AS-BUILT NO CORNERS SET THiS DATE I hereby certify that { have performed a Mortgagee's inspection of the following desc~bed prope~7: LOT 15. B LO~ .~, RIVER VIEW ESTATES SUEDIVISI(~N 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. # _~J_-~"%, - ~ cl .._~ _\ ,~ 1, GENERAL INFORMATION Complete legal description Lot 15; Block 5; Riverview Estates Location (site address or directions) River Park Drive Property owner Mailing address Lending agency Mailing address_ Louie Bruner 6950 Crawford Anchoraqe, Day phone. 243-2284 AK 99502 Day phone. Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX 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 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe. functional and adequate for the number of bedrooms and type of structure indicated herein. I further 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. Firr~ & S ENGINEERING Address ,. Eagle-l~ver, Alasl~a c~c]~?~'' / / Engineer ssignature ~'¢//'¢"-"- /' Date //'~//~¢/¢~-? DHHS SIGNATURE Approved for '7-/~-------------------~(/:~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 DH HS does th is as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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. 72~25 [Rev. 1/91) Back MOA #21  Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST EIv~(~ VI EkJ Legal Description: ~LOC~ _5, LOT I~ Parcel I.D. 0~%--d2-~ A. Well Data Well type _ ~¢~kxl Log present ~/N) Total depth Sanitaryseal 5IN) FROM WELL LOG If A, B, or C, attach ADEC letter. ADEC water system number Date completed-'~\~ - \ ~ --~% Driller Cased to ~' 5./2, Casing height Wires properly protected ~.~/N) /22 AT INSPECTION Date of test Static water level Well flow % '~'' g.p.m. Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ~J' Sewer service line ENVIRONMENTAL SEEk ICES DIVISION / f!(,',,/ ]9 199~ g.p.m. RI{El!IVIeD ; On adjacent lots / 0 ("') ff' ; On adjacent lots ,/4~)(/'~ ' -/' Public sewer manhole/cleanout /'~'(~)/~J Petroleum tank ~/ /%/ WATER SAMPLE RESULTS: Coliform Date of sample: /,/ B. SEPTIC/HOLDING TANK DATA Date installed iq ~ ''~ Cleanouts (~N) High water alarm (Y/~) Nitrate ¢..,, / O Other bacteria Collected by: 5 ¢ ._~ ~'f~? Tank size /O0_f~ Foundation cleanout ~N) (~ L. Compartments_ y Depression (Y/~.~ Alarm tested (Y/(~ J~J ~lg~J TFt~JK Date of pumping ~l,ru~-o /~c~x Pumper On adjacent lots /¢0 ' '/~ Absorption field ~-~ / Well(s) on lot_ /(0~ ' To property line -.~ ~' Surface water/drainage Foundation . Water main/se~ice line 72-026 (3/93)* Front CONTINUED ON BACK PAGE LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~.,~'~Cycles tested Meets MOA electrical cedes (Y/N) SEPARATION DISTANC, B-FF~OM LIFT STATION TO: Well on~2t~'~ On adjacent lots D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) ~ .-~---~~ Level at Surface water Date installed Length ~/-~./__Width Total absorption area ~¢/~.,~,, z;b Cleanout present ~N) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/~) Soil rating (~:~! System type Total depth SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Depression over field (Y~ f After test (~" If yes, give date /~,///~ Well on lot //._~" To building foundation On adjacent lots ~'~) '-/- Surface water Curtain drain /~d/(~ , On adjacent lots /("~(~) ' -/' Property line ,/(/~ ' To existing or abandoned system on Jot. Cutbank /~/(~ ~ ~' Water main/service line //~ ~ ' -/- Driveway, parking/vehicle storage area -~Ot Bedrooms E. ENGINEER'S CERTIFICATION /certify that lhave checked, verif~d~onformedtoall MOA and HAA guidelines in Signature HAA Fee $ --~ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number ~tltl~. COMMI~.RCIAL"i"ESTING & ENGINEERING CO. ~'~l~ ENVIRONMENTAL LASORATO.¥ ~ERVICE~ .......... R!~ORT Of ANALYSIS Chemlab Reff.~ :93.6202-3 Client Sample ID ~Ll5 B5 RI\r~RVlt~ EST, Matrix :WATER Client Name :S & S ENGINEERING Ordered By tRAY Project Name : ProJect~ : PWSID :UA TEL. (9C7 562-2J.i3 FaX ¢~07~ 561.5301 WORK Order :73297 Repor{: Completed ;i1/19/93 Collected ;11/16/93 @ 10~00 hfS, Received :11/16/93 @ 16:25 hrs, Technical Di~ector:$~_C, EDE . Sample Remarks: ROUTINE SAHPL~.Z COLLECTED BY: RAY. Qc A%lowab!e Ext. Anal Parameter ~esu].t.s Qual Units ~-~.ethod Ltmlt5 0ale D~te Init Nltrate-N 0.10 U m~/L EPA 353,2/300,0 10 ii/i7 LLH * See Special Instruc'tion~ Above UA = Unavailable *'* See Sample Remark~ Above; HA = Not AnalyZe~ U = Undetected, Reported value is the practical quantificatio¥~. ]lmit, LT = IL~SS Than D = Secondary dilution. GT = Greater Than the $G6 G~oup ',Sc, ci6!e 0~¢~¢a;6 d~, c' ~ ' ENVIRONMENTAL SERk,'K~E~ IN &LASKA, C. OLORADO, U',r,'~,-,', ILLINOIS Ol~ilO, MAP,¥LAND. W~ST VIRGIhHA, NEW. ~,~$='~ SOUTH CAROLINA