HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 7 LT 2 Municipality of Anchorage Page 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: ~'3°~ c=J °O °~ ~ PID Number: O~o~7 Name:'7b,~O~,-' ~ 'Ly~* ~ws Wastewater System: ~New ~ Upgrade Address: ~~'~' ABSO R PTI O N FI ELD Phone: ', No. of Bedrooms: ~Su~ ~ ~_ ~ ., ~ Q Deep Trench ~ Shallow Trench ~ Bed ....... ~ Mound ~Other LEGAL DESCRIPTION so, Rating: O. ~ GPp¢~q. Ft. Total Depth ~fr°ml original grade: Lot: Block: Subdiv~ion: Depth to pipe boltom from original grade: Gravel depth beneath pipe Township: J Range: Section: Fill added above original grade: Gravel length: I WELL: ~New g Upgrade Gravel width: j~/ Ft. Number~of lines: Bistance~.~between lines:Ft. Classification (Private, A.B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: Pump Set ah I Casing Height Above ~rgund: SEPARATION DISTANCES ~ Septic U Holding ~S.T.E.P. TO Septic Absorption Lift Holdin9 =ublic/Private Manufacturer: Capacity in gallons: Fr~m Tank Field Slation Tank Sewer Lines A~ (~O~ ~ Material: Number of Compartments: Surface W~ter ~oo'+ ~oo'~ ~o'~ ~ ~ LIFT STATION Lot ~ I / Size in gallons: ~ Manufacturer: O~CO/~O~ o / "Pump on' level at: "Pump off" level at: High water alarm at: Pump Make & Model Electrical Inspections performed by: Curtain ~O~ Remarks: BENCH MARK Location and Description: Assumed Elevation: Inspections performed ~& S ENGINEEEING ...... ~ates: 1st_ ~-~ '~ ~O~Eagle River hoop ~oao, ~o, Department of Health and Human Services approval 't:' ;-.~ ............ 72-0t3 (Rev 9/91) MOA 25 SW950092 2 2 Permit No. 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 LOT 2, BLOCK 7, RIVERVIEW ESTATES 05079102 Legal Description: PID No.: ~-99i0' 98 2' MI-I/ i /-FINAL GRA!Dg i : [ [ ~INSULATION :: i :: . _ d ~ 97.8~% ~ ~ ~FINAL GRADE · ................. ............. ............ ............. ................ ............................... 94. 0,/ 1250 GAL ~93.8' ~ ~ ~.T.~.P. INSU~ION sYs~ ~ ~ 94,8' : ..................... ...................... ...................... :. ...................... :: ........................ ~ 89.8' WATER POUND 5 18-95 I;:A B ~ FCO 2' -- ST1 :~9' 28' ST2MH ~1::17,6' 3556, MT1 13' 29' MT2 ::23' 35' MT3:~5~' 22' : : MT4 ;29' 15' ~: .......... ; ............... ~ ~ ...................... .............. I ........... : ...................... .............. I ...... ~ .... ~ ~ ......... ~'"~'u~ ............ ¢ ........... ~'~{ BED ' > ~ L0T 1 A B FCO 2' __ ST1 9' 28' $T2" 1'6' 35' MH ~17' 36' MT1 1,3' 29' MT2 2,5' ,35' MT3 ~35' 22' MT4 ;29' 15' 72-013 A (1/93)' KIND OF' CASING From FI. m__ Fl · Ft From .Ft. to Ft __ From_.~Ft. to ~Ft, From_ .FI, to_ Ft, F,om_ _~,,,o R~E~.EIVE~ From From_ INFORMATION: DRILLER's NAME , ~-' d -..',:';~ .................. 300 W. SWANSON, SUITE 110 WASILLA, ALASKA 99654 (907) 373-1851 7/14/95 Memo This memo is in regard to the work performed in Eagl~ Kivcr off of Hiland road for Dtmcan Purvi,s. Tho installation of the seplic system fox' Mr. Put, on, as completed by Guroley Excavation. All work performed was done under ~ septic installer EX 95- 086. This certification number is listed trader Bailey's Backhoe. Crumley Excavation has be~n given permission by Bailey's Backhoe to perform this work under their certification number. Tttank You. Anthony J. Cruml~y S~p.18 '95 10:26 0306 SHELTON ELECTRIC TEL 907-561-4255 SECI - I . IIII II¢ II ...._.. $~ELTON ELECTRIC COMPANY ~}~',: INCORPORATED ;:~,i '1720 Eest 591h ANCHORAGE, ALASKA 99507 j~!~,'Q~) 563-3249- (907) 376-5794- (907) 503-,3695 ~" ~ Contractors Reg. ~/A 10905 S8ptember 18, 1995 S & S EngineerSng Atth~ Ray Electrical wiring on lift sewer system at Lot 2 Block 7, Riverview EStates ha~ been installed and m~ets Municipality code R~quirem~nts. Any questions, please call. I P. i Sincerely, License #82580 kls/JS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950092 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:PURVIS DUNCAN W & LYNDA M OWNER ADDRESS:P.O. BOX 244111 ANCHORAGE, AK99524-4111 DATE ISSUED: 5/25/95 EXPIRATION DATE: 5/25/96 PARCEL ID:05079102 LEGAL DESCRIPTION: RIVER VIEW ESTATES BLK 7 LT 2 LOT SIZE: 40000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / 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 {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 ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. HEAl TH AUTHORitY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERINGSTUDIES AND REPORTS WELL INSPECTION & FLOWTEST ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTLJRAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN May 19, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 2; Block 7; Riverview Estat¢~ Request you issue a pcrmitto drill a w~llandinstalla septic syst~l t~ 6~veth~propo~dth~b~xl~oom ho~¢ on th~r~fe~n~prop~¢. A test hole, was excavated and a percolation test performed. The approximate location of the t~st hole i~ located on the attached site plan. At the time of excavation, water was encountered at 6.5 feet and after seven day ground water monitoring water was found at 6.5 feet respectiv~y. This property has enough ~cea for a future septic upgrade which can be seen on the, attached site plan. We do not a~Aiclpate any adverse effects on neighboring properties by the i~tatlation of the proposed septic syste~. There are, no points of contamination within the proposed well radius which can be, seen on the attached site plan. If you require additional information, please contaat us. Sincerely, Robert ~. Co~n, P.~. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 LEGAL LOT 2, BLOCK 7, RIVERVIEW ESTATES S,/D DRAWN D.H.L iCKD. R.C.C. DATES--17--95 iSHT. 1 OF 2 STRUCTURES, EASEMENTS, OR ENCROACHMENTS SHOWN ON THIS SITE PLAN ARE AS SHOWN ON AN AS-BUILT SURVEY DRAWN BY: WILLIAM D. FLEMING IT IS THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPERTY LINES PRIOR TO CONSTRUCTION. CHUGACH STATE PARK DESIGN CRITERIA: 5 BDRM = 450 GPD SOILS = 0.8 GPD/SQ.FT. 450/0.8 = 562.5 SQ.FT. REQ'D. BED DESIGN-: 2' DEEP DIST. PIPES TO BE PLACED IN 1' OF GRAVEL WITH 6" OF GRAVEL UNDER BOTTOM OF PIPES 1 5' WIDE ~E~ o. LOT , 38' LONG 2oo'* AWAY DISTRIBUTION SYSTEM: PUMP = 20 OBI 05HH 5 STAGE (~30 GPM) 5 LATERALS @ 52' LONG = 10 GPM/LAT. 10 HOLES/LAT. (5' O.C.) 30 HOLES TOTAL -- 1 GPM/HOLE I/4" DIA. HOLES FACED DOWNWARD i 1/4" DIA. LATERALS 3" DIA. SOLID MANIFOLD LOT 1 REMOVE ORGANICS ALL PORTIONS OF SYSTEM WITH LESS THAN 3.5' OF COVER REQUIRE INSU~TION. LOT 2 PROPOSED PRESSURIZED ABSORBTION BED: 1250 GAL. S.T.E.P, SYSTEM ~ PRO ..... ~'cD ,'22 .......... .'.., ' CONTRACTOR iS REQUIRED TO OBTAIN UTILtTY LOCATES PRIOR TO ANY EXCAVATION WORK. LOT 5 ~u~ o~ RO^~ CLIENT RIVER PARK DRIVE LOT 2, BLOCK 7, RIVERVIEW ESTATES S/D ~',,.,"/ . 'm%:/ "..5:_~., · ,.,.-?,:.%.... - · MT MT 2" INSULATION-~ ~~-FINAL GRADE ~ FILTER FABt~IC-.~..~.: / EXCAVATE <R~,HovE ORGANIOS> , ? Ii ~ I1 ~ INSTALL DIST. PIPES IN 1' OF --4.5'-- . PIPES SEWER ROCK BELOW BOTTOM 15' WIDE OF PIPES THE ENO[N££R MAY VARY THE EXACT DIMENSIONS AND DESgGN PARAMETERS IN THE FIELD, IF NECESSARY, TO MEET SiTE CONDITIONS. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERF~ LEGAL DESCRIPTION: ~::q"'~---~ ~J/~ ~ ~'~ q ~¢?,5 Township, Range, Section: 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~t ~) DEPTH? p E SITE PLAN Depth to Waler hHer ~, Monitoring? (_,,o ,% Date: ~"~ ~'"'%'~ Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~-'~- (m~nutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT COMMENTS S & S ENGINEERING PERFORMED BY: ~, 70~ E~-~!-~ ~!¥e? l:~3a~[~.'~0~.Y¢"~.~'~v'&:~/~ CERTIFY THAT THIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 2, Block 7, Riverview Estates S/D May 18, 1995 GENERAL: The scope of this project includes the installation of a 1250 gallon wastewater S.T.E.P. system (septic tank) and a pressurized absorption bed to serve the proposed three bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 2, Block 7, Riverview Estates S/D May 18, 1995 Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. o Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. PRESSURIZED MOUND SYSTEM INSTALLATION: 1. Any peat or organic matter must be removed from the elevated mound site. The bottom of the basal bed area as well as the top of the sand filter is to be within two inches of level. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. The side slopes of the top layer of the mound system must not be steeper than 33% (3:1). De The top of the mound shall be covered with a minimum of 6 inches of topsoil and vegetated sufficiently to prevent erosion. The distribution pipes are to be embedded in sewer rock. Care should be taken to backfill in such a way as to preven't damage to the piping system. Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Page Three Lot 2, Block 7, Riverview Estates S/D May 18, 1995 Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM FS10 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal)· Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the %200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 2, Block 7, Riverview Estates S/D May 18, 1995 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill° The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 2, Block 7, Riverview Estates S/D May 18, 1995 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER ,Il (3 ?64 DEPARTMENT OF IlEAl/f II AND ENVIttONMENTAL PI'{OII:_C-IION Permit #: 840054 January 31, ]_985 TO: Permit Applicant SUBJECT: Lot 2 Block 7 River View Estates Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984 . Permits are issued on a ca].endar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log :needs to be sent te this Department fer decumentatien ef the instal]_atien and te close the permit. If a private engineer inspected the installation of the eh-site sewer system, the eriginal as-built inspection repert and the yellew copy must be sent te this elf ice fer review and appreval, and fer documentation. If there are any further questions, please cai]_ this office at 264-4720° Sincerely, Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 IF:::" !EiE IF;'~: It'"1% 'qF .... 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' ......... ~"~ P~rmit 9 Applicant: Location: Health and Environmenta~ Department 825 ~ Street, Anchorage, AK. ~501 264-4720 * * * HANDWRITTEN PERMIT * * * WELL AND/~ ON-SITE SEWER PERMIT ~©/-- Mailing Address: -otection Phone Number: Legal Description: /0~ ~ /'~/~-'7 Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Maximum Number of Bedrooms: Lot Size: ~ Holding Tank: Soil Rating(sq.ft/br) /~,~-- The Required Size of the Soil Absorption System Is: DEPTH ~-~ , LENGTH /y . WIDTH GRAVEL DEPTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(H(DtEFI-NG) TANK SIZE = Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and' approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 S 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as (2) (3) S igne~: set forth by the Municipality of Anchorage. I will install the system in accordance with codes. I understand that the on-site sewer system ma~require en~rgement if the residence is remodeled to include more th~edro~. ~ ~Plican~/ ~./~//~' Date: ~ ~ SWP/024 becon:ber 21, 19~i3 ~lr_'o Jack Lyons ~'~ <}~ hex i9!3 tla._j!e i{iver~ AK 99677 Subjecu: }]FFO~S on HandwFi. tten PeFmits Lyons ~..e have discoveFed calculation et-rous on llive Der~aits issued to I,ot 5, Block 7, ~{iveli'view Estates Lot 6, ~.~].ock 7, Rive}_'view Estates I.ot 3 , ~lock '1 , I{iveFvi[oW Estates 1,or 2, i%lock 7, River'vj. ew Estates :5 i ncexe ty, ~;ntjil~eerin{j Technician s~)i/ej/ui0 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 DATE PERFORMED: / - '~""~? ' ~"~ ~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19, 20~ COMMENTS SLOPE SITE PLAN ENCOUNTERED? , o P IF YES, ATWHAT E OEPTR?¢ Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND PERFORME 72-008 (6/79) --, FT CERTIFIED ~DATE: • 6E, 8p UF;a //-- Municipality of Anchorage �p' :.. ri + {+mss ' On-Site Water and Wastewater Program d'„' (907) 343-7904 SA ETY CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-791-02 Expiration Date: / ( / 1 1. GENERAL INFORMATION Complete legal description RIVER VIEW ESTATES BLOCK 7, LOT 2 Location (site address) 20839 RIVER PARK DRIVE, EAGLE RIVER,AK 99577 Current Property owner(s) DAVID &ALLISON GOVE Day phone Mailing address 1570 BULL PEN WAY, IDAHO FALLS, ID 83401 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class_Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: .,� '_4 // Date: CO.SA to bereleased to the engineer,unless othe � jested by the engineer. COSA Fee $ 6 Waiver Fee $ Date of Payment 511,310 Date of Payment Receipt Number OVOlb Receipt Number COSA# 3ba 81 469 Waiver* 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 ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 8/7/2018 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,.CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineers 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 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 +"‘..\NIL encroachments,deficiencies or discrepancies exist. OF AL 6. DSD SIGNATURE 1 * 49TH /\ Ata * ` System #1 Approved 1, ;149TH y for 3 bedrooms. -�. KEIZET 1. Doe System #2 Approved for bedrooms. t ,5, o"'eo 9 Disapproved. Alr ,\,po s;o"!'�� \\`.�f- Conditional approval for bedrooms, with the followi g stipulations: c. Pk ' -4-ciA4 ,.( z_ ty.potet n- vt.c S ( .e/2 7 C 4_01„,s ;S 2C) ,„av' 0cs 4� �, /y�l N? ...., t... 14417.„ . ,, 73 WASTE SAND r 12 PROGRAM R .� . - L., C----70e-Al Original Certificate Date: g— E�'1V The Municipality of Anchorage Development 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 the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Ov � w COSA blue sheet_10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist# Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: RIVER VIEW ESTATES BLOCK 7, LOT 2 Parcel ID: 050-791-02 A. WELL DATA Well type PRVT If A, B, or C provide PWSID# Well Log (Y/N) N Date completed 6/1995 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 200 ft. Cased to 37 ft. (INTO BEDROCK) Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 6/1995 8/112018 Static water level 7 ft. 22 ft. Well production _ 1.75 g.p.m. 4.38 g.p.m. WATER SAMPLE RESULTS: I r/� Coliform NEG colonies/100 mL Nitrate N;/ mg/L Arsenic: /VPug/L Date of sample: 8/1/2018 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP I STEEL Date installed 7/1995 _ Tank size 1250 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) Y Date of pumping 8/1/2018 Pumper ONE STOP C. ABSORPTION FIELD DATA Date installed 7/1995 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type BED _ Length 38 ft. Width 15 _ft. Gravel below pipe 0.5 ft. Total depth 2.8+ft. (IR:INSULATED) Eff. absorption area 570 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/1/2018 Results (Pass/Fail) PASS _ For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 460 gal. New depth 0 in. Elapsed Time: 1 min. Final fluid depth 0 in. Absorption rate >= 450+g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) N _ If yes, give date D. LIFT STATION Date installed 7/1995 Size in gallons 1250 Manhole/Access(Y/N) Y "Pump on" level at 42 in. "Pump off" level at 32 in. High water alarm level at 44 in. Datum BOTTOM OF TANK Cycles tested 2 Meets alarm&circuit requirements?Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 8' (PER IR) Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I 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. <S, �F ALS Engineer's Printed Name KENNETH M.DUFFUS / ��' Date 8/712018 A,9�'N / COSA canary sheet 2 6-45.docgi % KENNET' , 7 t: Pieo MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT (fie 907-343-7904 On-Site Water and Wastewater Section \ `/` Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval # OSC181409 Subdivision: Riverview Estates Block: 7 , Lot: 2 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 23 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. ? as}Y22 :,P*1,1 z', • tt 4^t • `�. A f 4 IS&� --i • ,gyp - 'F '' V.. 4 .47 *1 1 l i • , a ;Y L� 'r' -1/4-.*:;,-; \� o / „,,,,4 AY,A' 1 ' 2g .. 22 Mailing Address: P.O. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org MUNICIPALITY OF ANCHORAGE seveloServices p l ° � ') ...�� Site Water&Wastewater Section Phone:907- t3 7 O 9 `\` l 7 _, Fax:907-34 -7997 Lift Station/Pump Vault Maintenance Log Owner _ 4 Street Address_2PB3 t Phone_ Legal Desc.._ -__ - PID Septic Tank: -Sludge level inches •Pumping:required -Pumping completed 1110110,1.Q Liftstation: -Pump basket cleaned OM • -Effluent filter cleaned -Control floats cleaned .- -Proper float settings confirmed a. -Operation satisfactory CO no Alan tem• -Dedicated electrical alarm circuit CI no -Audible and visual alarm inside dwelling 0 no -Alarm system operation _ .. o aitsfector�C 7 Manhole Riser :.Ground water intrusion at riser to tank connection yes_ -Ground water intrusion around pipe penetrations yes-� -Weep hole functional ,F, nn -, -Manhole lid: Functional "`r Insulated S� ne Properly Secured Other -All manufacturer required inspections and maintenance completed \J\J Commenter 10 no . Coen • aintenance Provider Technician r r'y 6 a \\S Date of maintenancela_.H c5) ompany L-4-S S€\c- V k(-N_Je ` Signature <'w- = ate�2 )41}Q Mailing Address: P.O.Box 196650Anchorage,Alaska C51) www.munt Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 470~ Bmg~w. S.tre~t P.O. Box 196650 .... Anchorage, AK 99519-6650 "'" www.muni.org/onsite .--c~.- (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 050-791-02 1, GENERAL INFORMATION COSA# L.,,.~> Expiration Date: Complete legal description RIVER VIEW ESTATES S,/D; BLOCK 7, LOT 2 Location (site address) 20859 RIVER VIEW DRIVE * EAGLE RIVER, AK * 99577 Current Property owner(s) DUNCAN & LYNDA PURVIS Day phone Mailing address 20859 RIVER VIEW DRIVE * EAGLE RIVER, AK * 99577 Lending agency Day phone Mailing address Real Estate Agent KATHLEEN POULIN W/ KELLER WILLIAMS Day Phone 242-4223 Mailing address 101 W. BENSON BLVD, #503 * ANCHORAGE, AK * 99503 Unless otherwi's,e.requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System [] 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 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 certi£ied by my' seal affixed heteto and as of. the validation date shown below, I verify thst my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this appfication, 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 £'om 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. Phone 357-6179 Address ,5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system ,. accordance with ADEC and M°A DSD Guidelines & Regulations. The repoded results described the performance of the ~. - ' " ~ systemundertheconditionsencounteredatthetimeofthetes, andsepa~tion distances measured to readily identifiable features. The opemffonal life of all wells and ' "" septic systems depend on the local soils condition, groundwater levels that may fluctuateduringtheyear, an dthewaterusageofthefamilybeingse~edbythesystem. ~/~ ~. ~ ' These conditions are outside the control of the evaluator of the system. Satisfacto~ test ~.~ results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects orencroachments. 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 repoR is for the sole benefit of the owner listed above. Any reliance upon or use of this repoR by any other person or paRy is not authorized, nor will it confer any legal right whatsoever. . ~ ~ · . pproved for bedrooms. WATER ~~ : WASTEWATER Disapproved. Conditional approval for bedrooms, with the following st~pulabons' ~, Attachments: OOSA ,.,hec,,,,st Septic System Advisory Well Flow Advisory i~lU ~Le ~U vlSu~z ,/'~ ..'./' (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report utner /~"-~'~'- Original Certificate Date: Municipality of'Anchorage Development Services Department CERTIFICATE OF Legal Description: WELL DATA Well type PRIVATE Date completed Total depth 200 6/1995 ft. 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 ON-SITE SYSTEMS APPROVAL RIVERVIEW ESTATES S/D; BLOCK 7, LOT 2 *TO BEDROCK, If A, B, or C provide PWSID# N/A Sanitary seal (Y/N) YES Cased to *37 .ff. Date of test Static water level Well production 1.75 WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi. Arsenic: i~ ug./L. SEPTIC/HOLDING TANK DATA FROM WELL LOG 6/1995 7 ft. g.p.m. Nitrate J~l.0 mg./L. Date of sample: 9/15/2010 CHECKLIST Parcel ID: (~ L~'~O - ~' ~/' 4) ~ Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 9/15/2010 8 ff. YES 4.5 Other bacteria . Collected by: YES 12+ in. Date installed 7/5-6/1995 Cleanouts (Y/N) YES High water alarm (Y/N) YES 6/15/2010 Tank Type/Material S.T.E.P./STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping dR'S PUMPING Pumper ABSORPTION FIELD DATA [*BELOW EXISTING GRADEI Date installed 7/5-6/1995 Soil rating ~or ft2/bdrm) 0.8 System type BED Length 38 ft. Width 15 ft. Gravel below pipe 0.5 ff. Total depth *2.8-3 ft. Eft. absorption area 570 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 9/15/2010 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 541 gal. New depth 0 in. Elapsed Time: - min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - *NOTE: TRENCH WAS INSULATED PER INSPECTION REPORT. g.p.m. ~ colonies/lO0 mi. GEG Ltd. D. LIFT STATION Date installed 7/5-6/1995 1250 "Pump on" level at 42 in. 32 in. Datum BOTTOM OF TANK .3 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons "Pump off" level at Cycles tested. 100'+ Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas. 50'+ Manhole/Access (Y/N) YES High water alarm level at 44 Meets alarm & circuit requirements~ YES in. / On adjacent;lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ Building foundation Water main Wells on adjacent lots SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 5'+ Property line 5'+ N/A Water service line 10'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation. 10'+ Water service line 10'+ Surface water 100,+ Curtain drain NONE KNOWN Wells on adjacent lots 100,.+ COMMENTS Absorption field 5'+ Surface water 100'+ Water main N/A Driveway. parking/vehicle storage 10'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through; field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelir~es in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date C:~/~-~//~~ COSA Fee $ q Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment ReCeipt Number 3AIBO NB¥~ B3AIB MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES_ Division of Environmental Services On-Site Services Section P.O. Box196650 Anchorage,' Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0£0~'7~1-O% 1. GENERAL INFORMATION Complete legal description Locatiop,(si~te address or directions) ~', Property owner LOuncan g Lynda Purvis "~a[ling address ....... P2~O. Bo>: 244111 ",, -t~ending agency -. - ' ':~ailing address - ^g~nt .. Address NHN River Park Driv~ Ea~l~ River, AK Day phone Anchorage, AK 99524 Day phone 762-~399 Day phone Unless otherwise requested, HAA will be held for pickup. 2.' NUMBER OF BEDROOMS:` "."'" '~' ~"i"' ~i;'-!"'"~'~:~E' OF'WATER sUPp~-:Y:"":':'''' -'' '' ".i '-? "'"i' '--":?~:"";::':":' .... ........ Individual Well' '- ' ' 'v'xx . i.i. ,...,;::';i-,':.;..'. :.- -Community well .',.i~i- .~ - ......... Public Water 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 ......, -' :'"!: ¢ ':..-, - '" Ho'ldi'ng"tani~'- . '" :?-.".;' ' , .... Co mu ityo ~site '; ' ":':-' ;' m n n .,. ;.-, ,: ..,, Public sewer , ...:,.~:~ : r= ' ., NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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. S & S ENGINEERING ~ Name of Firm ....... ,--, ................. Phone ~) - ~-~/'7 Ad dress Eagle River, Al a s k~- ~'~" EngineeCs signature _~~ ~ Date 6. DHHS SIGNATURE AP pr ed for Disapproved. bedrooms. conditional approval for bedrooms, with the following stipulations: . ~" -' ' :~--- "~". ' '~:i':~ . , '."~'"' By: / ~, Date /O -2_ - ~'_~- 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 this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. . ~ 72-025(Rev. 1/91) ~ack MOA~I Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: A. WELL DATA Well type Log present ~ Total depth Sanitary seal Health Authority Approval Checklist ¢,~,.4c~ ~ ¢._,,d.¢._~t~.kt i ¢_,.~. ~:.~Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date completed (.~o- q 5" Cased to '5~) ~ ~,lt~. Casing height (above ground) Wires properly protected {~',I) ~/ FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform O Date of sample: ~] ~ L, - 5'5' B. SEPTIC/HOIA~NG TANK DATA Nitrate tg, / o Other bacteria Collected by: S & S ENGINEERING i703q ~a§ie River Loop Road No. 204 Eagle River, Alaoka 9957'7 Date installed U ~ C-~ 5-~ Tank size ~%~-c~ Number of Compartments Z-- Cleanouts Foundation cleanout ~ u/ Depression t.Y~)_ ,-~ High water alarm DateofPumping k~ ]~-/'~ Pumper '}'{A C. ABSORPTION FIELD DATA Datemstalled '-7 ~C~cl~' Soilrating (g.p.d./fl20rft2/bdnn) E>.r6 Systetntype ~¢x~g%og-~h_r> ~r~r-~ Length --~z-~a~ ~ Width \ ~ ~ Gravel thickness below pipe Effective absorption area ~10 ~g Monitoring Tube presen~qq) Date of adequacy test 4 ]~ ~¢ tA Results (Pass/Fail) Fluid depth in absorption field before test (itl.); ~ ~ Fluid depth ~//k Minutes later: Peroxide treatment (past 12 months) Total depth Depression over field (Y~ ~J For ~ bedrooms hnmediately after --~gal. water added (in.): (itl.) Absorption rate = ~ g.p.d. ~-~ If yes, give date r~ ~ ~, D. LIFT STATION Date installed Manhole/Access High water alarm level at* Cycles tested Size in gallons "Pump on" level at* "Pump off' level at* *Datum ~ ~ o~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/hotd~ tattk on lot [ 'L,~ ~ · On adjacent lets Absorption field on lot I O t ~ Public sewer main ~{~.. ; On adjacent lets Pnblic sewer manhole/cleanout Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/,,,_?~D.,,$TANK ON LOT TO: Foundation ~5 ~ Properly line /_,,~- ~ Absorption field cl ~ Water main/service line 2-5-~ Surface water/drainage I ot~ Wells on adjacent lots \ ,mc::, \~r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation \~:2> L Water main/service line Surface xvater \ o ~ t 4.- Driveway, parking/vehicle storage area Cttrtam drain ~ I~...~ Wells on adjacent lots I F. ENG~ER'S CERTIFICATION 1 certify that I have determined thrufield inapections and review of Municipal recorcts~2 in conJbrmance with ~10~ ?(¢4 guidelines i~gfjkct on this date. Sin Engineer's Name ff~-e r (. (~wd~ .................................. HAA Fee $ Date of Payment Receipt Number Rev. 8/95 ODS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number