HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 8 LT 2Riverview
Estates
Block 8
Lot 2
#050-792-32
IOTIII rg LVVI
Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 e Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/'or Well Inspection Report
Permit Number: \yl % (),ad 1 PID Number: 0 50 " -12 Z "' 7—
Name:
Wastewater System: ❑ New ❑ Upgrade
Address:
ABSORPTION FIELD
IL G
C_L �
Phone:
No. of Bedrooms:
Deep Trench ❑Shallow Trench El Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
ci GPD/S . F[.
Lot: ry Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
6
,y
c4 Y6•� �4 1 sTfit
3 Ft,
Ft.
Township:
Range:Section:
Fill added above original grade:
Gravel length:
0 Ft.
Ft.
WELL: [hew ❑ Upgrade
Gravel width:
Number of lines:
Distance between lines
Fl.
I
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:]Ft
Total absorptioi area:
Pipe material:
q,• (
[i0 Fl.
� �
6 SQ. Ft.
P- G 3b 3Driller:
Date Drilled:
Static Water LInstaller:
Date installed:
L
S q�
�,o
Yield:
Pump al:
Casing Height Above Gr
TANK
GPMI�o�tl
PS2et
Wt Ft.
.,,.
SEPARATION DISTANCES
Xseptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
61 } . T-(4
pL 6 0
Material:
Number of Compartments:
well
la F. L
-
Surface
LIFT STATION
Water
ly O,
Lot_
I
t
Size in gallons:
Manufacturer:
Line
10 _6
& d
"Pump on" level at:
"Pump oft" level at:
High water alarm at:
Foundation
Aa
bo
Curtain.,1
Pump Make &Model
Electrical Inspections performed by:
Drain
,�)
1 ` o ley
BENCH MARK
Remarks:
Location and Description:
JJ
P •2 l Q
s Assumed Elevation: �}
EfJGINBER'$,$�AL
/ J`z
e
4/! 4
Inspections performed by: u 6 Dates: 1sf �� �tG
2nd i
Department of Heat and man Services approval
Reviewed and approved by: )CM,Date:
72-013 (Rev 9791) MOA 25
2.5
i
0 25 50 75 loo
SCALE 1 " = 5U F T. /
aaa�r�rrY�♦0
a� OF �♦
SU
P^.......��SI♦♦ // \ F
.\
49th / PRIMARY TRENL7\
LLL4 /
.... r.....
' T❑ BEN SPURKLAND / a (l�PLACFl1ENT TRENCH
�•. _/
CE -2225 4 s
ar
19
♦♦� �rrE SaaaOa
/ .
SWING TIES:
AC 25
BC 18
AD 39.5
BD 35
AE 54
BE 47.5
AF 54
BF 74
TOBBEN SPURKLAND P.E. LOT 2 BLOCK 8 RIVERVEN ESTATES SEPTIC SYSTEM AS BUILT
203 W 15TH. AVENUE DATE: D£C.5, 1996
ANCH. AK. 99501 FALLING WATER DRIVE
FRffLAND BUILDERS SHEET: 2/3 GRID: S141035
(907) 279-3916
SW960201 PID // 050-792-32 RVE08022. DWG
Standard Trenches
2' Wide
58' L ong
9.5' Deep
6.5' Sewer rock
3' Cover
0
REPLACEMENT TRENCH
Double Clean Gluts
1250 gal Septic tank
Na SCAL E
Founda tion Clean out
.�0
q 444
1- .............. S
49th /� 0
`''''...........
. �....................
. " 0 0
;d...:..... kSr& ... ® l' lli! Cove
r
S TOBBEN SPURKL AND p Over Tank
C%�A iieQ1?OLlt5 --
No, CE -2225
Monitor
►� pRDFESS��AOo
N►����� ii ' j 3' Cover 1£ 92.4 lE 92.78
90±
IE 86.0-� 1250 gal, septic tank
SIL T BARRIER 1E 86.0
79.5 79.5
6.5 Ft of Septic ROCK
REVISED: JULY 16, 1996
ND SCALE
BENCH MAI& FINISH FLOOR
ASSUMED ELEV. 100.00
TOBBEN SPURKLAND P.E. LOT 2, BUCK 8 RIVER VIEIy ES'7ATES SEPTIC SYSTEM DESIGN
203 W1550', Ave FREELAND BUILDERS DATE JUNE 20, 1996
Anchoro-ge Alk 99501 KEN JOHNSON SHEL1: 313 GRID!J-V035
SW9602.01 PID // 050-792-32 RVE08022.DWG
-PANIC
t*
ag wrrti Irb to I v g
DOC co, aba
SULLMN WATER WE] IS
P.O. BOX 670272, CHUGIAK, ALASKA 99667 - TELEPHONE 68 .2759
j
R OF LAND DEPTH Or WT 1.1
ST �I I( 1,E\ EL f �%ATrR FF
Us 15
L DESCRIPTION
'"IDRAW DOWN r -r
-Started Ended (IALS. PER HR
IT NUMBER KIND OF C.AI.s'JN(
OF FORMATION -
Ft. to c
F From—— Ft. (u- Ft.
Ft. to 1--Ft-
From Ft. to Ft.
-�L Ft. to
Ft- ?Ftorn--Ft, to --Ft
/V)— Ft. to 2 1 FL r I. f
Ft. to- --Ft. From -- --Ft. to-- —Ft
4-�Ft. to Ft. i", if j, Fron)
—Ft. to Ft.
�6 rt- tojj�_rt From Ft- t"— Ft.
Iv o
Ft. to -Ft.
Ft.
From Ft, tn— --Ft
r From —Tt. to—.
UFt. to� Fc rom—Ft. to-- �ft-
"J
�to_._ --Ft. ff Ft. to-Jf
—Ift �6 ::k�! -6-S-f- ; /'
1
ti
ill—- Ft. to
I!Ft. to—kVJFc..j �S� -- .—Ft._
Ft. to -- -- From --Ft. to— —Ft.
Ft. to -Ft. From
-- --F(', to— —Ft.
From -- -Ft. to— —Ft.
to ----Ft From ---Ft. to
C -f -I
fNFORMATION: DEC 199(3
DOW- Heaft,", u 10i Hoe
Marl Sorvic,(,c;
DRMLER'SNAME
m el` y PAGE 1 OF I1
MUNICIPALITY OF ANCHORAGE
1,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW960201
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:FREELAND BUILDERS
OWNER ADDRESS:8229 RACE CIRCLE
ANCHORAGE, AK. 99504
PARCEL ID:05079232
LEGAL DESCRIPTION:
RIVER VIEW ESTATES BLK 8 LT 2
DATE ISSUED: 7/30/96
EXPIRATION DATE: 7/30/97
LOT SIZE: 41138 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 t EU(Sa) `7lZjj)?(RW 3 16, �(&w
THIS PERMIT IS FOR THE CONSTRUCTION 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:
ENSURE ADEQUATE AREA AND SOILS FOR THE
REPLACEMENT TRENCH. SHOW REPLACEMENT
TRENCH AND
RECEIVED B
ISSUED BY:
DATE: /3
`C()L)
DATE : o �L3a A7
T.SPURKLAND P.E.
203 W. 15th. AVE. SUITE 203
ANCHORAGE, ALASKA 99501
(907)279-3916
Fax (907)-276-6013
James P. Williams
Municipality of Anchorage
Department of Health and Social Services
820 I Street
Anchorage, Alaska 99501
Subject: SW 960201
PID 050-792-32
Lot 2, Block 8 Riverview Estate
Gentlemen;
RECEIVED
JUL 26 1956
Municipality of Anchorage
Dept. Health & Human Services
July 26, 1996
The owners of this lot has decided build a four bedroom house. The permit issued on 7/17/96 was
for a three bedroom house. The attached revision to the design have increased the tank and the
drainfeld to meet the requirement for a four bedroom house. The depth of rock has been changed
from 6 feet to 6.5 feet and the trench length from 50 feet to 58 feet. A 1250 gallon tank is shown.
Please issue a revised permit.
Yours
\� rnd
T. SpurklP.E.
`C„SJR��i1 D)
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 2, BLOCK 8, RIVERVIEW ESTATE
FREELAND BUILDERS, KEN JACKSON
REVISED: July 26, 1996
No Ground Water or Impervious Layer to 15.5 ft.
Use Standard Trench
Soil Rating.
6 min/in = Use 0.8 gal per sq.ft/day
No. of Bedrooms 4
Required Area per Bedroom: 150/.8 = 187.5 sq ft
Total area required: 4 x 187.5 = 750 sq. ft.
Finish Floor Elevation 644
Ground Elevation at Absorption Field 630+ -
Top of Rock 627 3 feet of cover
Testhole Total Depth 15.5 ft Elev. of bottom 614.5
Bottom trench elevation
Rock depth 6.5 ft.
Length of trench 750/13 = 57.7 ft
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH
58 FT
TOTAL WIDTH
2 FT
TOTAL DEPTH
9.5 FT
ROCK DEPTH
6.5 FT
COVER
3 FT
SEPTIC TANK
1250 GAL
620.5
The installation of this septic system will not prevent wells from be installed on the adjacent lots.
There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will not result from this installation.
UL 26 1996
I TOBBEN SPURKLAND P.E. I I LOT BLOCK 8 RIVL'1>MMY E'STATE'SI I SEPTIC SYSTEM DESIGN
203 W 15TH, AVENUE DATE: JUNE 20, 2996
ANCH. AK. 99501 FALLING WATER DRIVE
„�_,�, FREELAND BUILDERS SHEET: 2/3 GRID: SW0 5
0 49th
TUBB[N SPURKLAND
No, CE -2225 ,•
...............•
�O�rpRUFESS1�N�o��
Mrafi 140
6,5 Ft of-' Septic
Standard Trenches -
2' Vide
58' Long
9,5' Deep
6,5' Sewer rock
3' cover
REPLACEMENT TRENCH
NU SCALE
■
a
Foundation Clean out
O
1250 gal Septic tank
O
and
IVU OG. JLC REVISED: JULY 16, 1996
BENCH MARK, FINISH FLOOR
ASSUMED CLEV 644,00
TLIBBLN SPURKLAND P.E. LOT 2, RLOCK B RIVERVIEW ESTATES SEPTIC SYSTEM DESIGN,
203 W15th Ave
Anchorage Ak 99501 FREELAND BUILDERS DATE' JUNE 20, 1996
a7s-�9,� KEN JOHNSON SHEET J/3 6RID: EV03
/Vfd 4- COP/
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 AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW960201 DATE ISSUED: 7/16/96
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. EXPIRATION DATE: 7/16/97
OWNER NAME:FREELAND BUILDERS
OWNER ADDRESS:8229 RACE CIRCLE
ANCHORAGE, AK. 99504
PARCEL ID:05079232 n
LEGAL DESCRIPTION:
RIVER VIEW ESTATES BLK 8 LT 2 \ /
LOT SIZE: 41138 (SQ. FT.) �a\;
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 �� ✓ �51� Y,~G�`�
THIS PERMIT IS FOR THE CONSTRUCTION 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:
ENSURE ADEQUATE AREA AND SOILS FOR THE
REPLACEMENT TRENCH. SHOW REPLACEMENT
TRENCH AND APPROPIATE T)STHOLE(S) ON ASBUILT. /`
RECEIVED BY: %C DATE: �! ' c! rfl 6
ISSUED BY: G�Y%DATE:
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 2, BLOCK 8, RIVERVIEW ESTATE
FREELAND BUILDERS, KEN JOHNSON
No Ground Water or Impervious Layer to 15.5 ft.
Use Standard Trench
Soil Rating.
6 min/in = 0.8 gal per sq.ft/day
No. of Bedrooms 3
Required Area per Bedroom: 150/.8 = 187.5 sq.ft..
Total area required: 187.5 x 3 = 562.5 sq ft.
Finish Floor Elevation 644
Ground Elevation at Absorption Field 630+ -
Top of rock 627 3 feet of cover
Testhole Total Depth 15.5 Elev. of bottom 614.5
Bottom trench elevation 621
Rock depth 6 ft.
Length of trench 562.5 / 12 = 46.8 Use 50 ft.
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH
50 FT
TOTAL WIDTH
2 FT
TOTAL DEPTH
9 FT
ROCK DEPTH
6 FT
COVER
3 FT
SEPTIC TANK
1000 GAL
The installation of this septic system will not prevent wells from be installed on the adjacent lots.
There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will not result from this installation.
Lar 12
i
VACANT /
� L
T � \
50 0 / (00 I5�200 250 _ 0 `jun \
S\ P -100 FL Well \
,\ LOT F
/ \
LOT , /
VACANT / / B CK
LOT 3 �\
I VCAR, W \ lA TES
\�\ / VACANT
\
VACALOT 4 \
NT
.���r,.owrrow
LOT 4\ r ♦1♦ \
� 49th
/ \ BL LICK 5.... .............. .....,
ot
LOT 3
SRURKLAND
CE-?2ak ti
IIOBBEN SPURKLAND P.E. LOT 2 BLOCK 8 RIVLRVFlJW ESTA7E7S SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE SEC TOWN RANGE DATE: JUNE 20, 2996
ANCH. AK. 99501
(so7) ?z2-3916 11 NAME SHEET: 113 GRID: SU/035
a
\
480
25 o 25 so 75 Loa Ips \ \
0
.••��arrrr�e�
.� 49th, °. ♦OCL / I
. ;,...... , .......,.. �y
SPURKLAND 1
�Cf�O NO. CE -2225 p ti
♦♦♦�®�i:pROFEssio- �1
6470 \ \
REPLACEMENT
fF 644.0
� v YYell "jam • /
\lid
\\
rA
\
I TOBBEN SPURKLAND P.E. I I LOT 2 BLOCK 8 RIVERVEITY L'STAMSI I
SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE DATE: JUNE 20, 2996
ANCH. AK. 99501 FALLING WATER DRIVE
(907) 279-3916 FREELAND BUILDERS SHEET: 2/3 GRID: SW035
Standard Trenches;
PI Wide
50' Long
9' Deep
6' Sewer rock
3' Cover
Nl ro Fi 140
D Ft of Septic k
REPLACEMENT TRENCH
NO SCALE
Founda t✓on Clean out
O
1000 gal Septic tank
O
•.' ?
49th
... A2 ...
�:• TOBEN SPURKLAND"i j
v w
o.
CE -22,25
= _
ar
•d ,.•��AW
IVLI JLHLL
and
BENCH MARK FINISH FLOOR
ASSUMED ELEV 644.00
TUBBEN SPURKLAND P.F. IJO//� �' 1�T o/'�TJ O 7�Ti77,� 7�TJ7T�TA) ]�['�/J�,I TFiS SEPTIC SYSTEM DESIGN
203 or uge Ave 1 1 BLOCK RIVE II 1i 71 H 11SJ DATE: JUNE 20, 1996
Anchorage Ak 99501
_ 7s- 39 f _ KEN JOHNSON SHEET: 3/3 GRID:.SW03.
'
• `r MUnlVp41Itty of Mchmp•
DEPARTMENT OF HEALTH t HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0850
SOILS 1.0a .— PEACOLATION TEST
,
• �y .'' 1 � I:4 �.
PERFORur.o FoR, K.AME2T
DATE PERFORMBp)
LEGAL. DEStRI►'(IOW Lcvr2 bUr,5 RI�.lc%FZv'I�t�) Rc;l-: Township, Rango.3ociion: -r1�,.N gj,
Op&' .ti ICS, SLGPE SITU 01,
1 C7. o,
2 ° ME' IwAN ?M i
3 GrJ•GMrw�h—GSfAN
� � las •F.�j ladr
11
12
13
14
16
16
17
18
19
20
COMMENTS
2. z pI; Ck k,
YNQ4Ai0+nn &11v •,e• 4,
vLA�, ; 5
AfmVZi , � Ic�p.
5.O. W .
(,ns*,tied 7 Vc
PERCOLATION RATE - IminuleVinch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND
,FT
PERFORMED Fly:
I CEFl7JGV
IWAL GUIDELINES IN EFFECT ON THIS DATE DATE:
ACCORDANCE WITH ALL STATE AND MUNIC
72.008 (Rev. 4.851 —�
T THIS TEST WA8 P&ArORMEO IN
(ENQINEER'S SEAL)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST�j��u��I
PERFORMED FOR: I=— N ]io 0 -I SC DATE PER.FORMEgI.
LEGAL DESCRIPTION:_LC'� Township Range Section'
DEPTH��¢Yt�,_ c7��� SLOPE SITE PLAN
(FEE]') VC
�[WICc...t C7 Yat-V�C
r 1
2 c �' I N
4
aI
6 �rc tNt
r1q't .S-� S G<VI. rl
8
S
CL1nCir Gl
L
O
.'r
v S C3
E
Depth la Water A(ter�
10
rc
Reading Date Gross
Time
Net Depth to Net
Time Water
r
Drop
11
12
a
e
13
r
c
r
y0
c
14
�q
'i O /7/L
C7 �4s
c
� C r
U /
416 �o �H w� [Dc ie -
17
18-
19
20
COMMENTS
WAS GROUND WATER
Fnirni inrrcocni KI r,
PERCOLATION RATEr r ER
(minutes/mc�h)ERC (P�HOLE DIAMETER
TEST RUN BETWEEN �• FT AND FT
PERFORMED BY: I _ U CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: f qq b
72-008 (Rev. 4/85)
S
IF YES, AT WHAT
L
O
DEPTH?
P
E
Depth la Water A(ter�
Monitoring?
Reading Date Gross
Time
Net Depth to Net
Time Water
Drop
o 7
— v
r
y0
I�
20
�q
'i O /7/L
C7 �4s
i!
U /
PERCOLATION RATEr r ER
(minutes/mc�h)ERC (P�HOLE DIAMETER
TEST RUN BETWEEN �• FT AND FT
PERFORMED BY: I _ U CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: f qq b
72-008 (Rev. 4/85)
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD.
THE DEPTH OF H TRENCH OF, PIT 15 THE DISTANCE gETWEEN THE SURFACE OF THE
GROUND HND 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 OUTFHLL PIPE
HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
S"O C)
I F-aEECA �L-- r- -IF Ia1m: -IF �P-4 VC 1 ;2" UE -iMmINEWMIRN F -P L_L-0���
PERMIT APPLICANT HFiS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF AN -r' WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
7"�11,111 ;R 1E������1 Ch 1,-4,C_= F --i F-_- ����Y F"E-- C.,:-
BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND HPPROVHL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTHNCE BETWEEN H WELL AND AN',.' ON-SITE SEWAGE DISPOSAL 5Y5TEM IS
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM H PRIVHTE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND
TO H COMMUNITY SEWER LUJE IS 75 FEET.
OTHER REQUIREMENTS MHY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
HVHILHBLE TO INSURE PROPER INSTHLLHTION.
ic "r ����Fe. ���IEE 11-1 CE3 U_ F? ��� ��UE-i"�
I CERTIFY THAT
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON~SITE SEWERS AND WELLS HS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2� I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]� I UNDERSTHND THAT THE 8N~SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE
RESIDENCE I'S RIENODELED TO INCLUDE 11ORE THAN 2qBEDROOP1_S
SIGNED:�����
8P��ICHNT JOHN GROSS
/~(/. �7
ISSUED BY~� _�_~��������~~�~~DHTE��/_~/�_..�_�__ V4.0
�U V -j 1 Y 0.,::" P -A L... 1 %-4 CH F�- ���C., 0--A r" F�Z." F:1 0-39, E'_'
DEPARTMENT O/ �EHLTH AND ENVIRONNENTHL F TECTION
vL/
825 'L' STREET/STREET/ANCHOR
�OE/ HK. 99501
264-4720
C-0 F-11 l -Y F=-
E�:- 1-4 ff F-" F-4 U FP-, V11 1^'
PEP -1,11"I"
NO� ( 8]0006 )
HPPLIcHP-iT
jOHN G�OSs
PO BOX 1161 99577 694
91]8
LOCATION
RENEWAL PERMIT #82002]
LEGAL
L2B8 RIVERVIEW ESTATES
LOT SIZE
^
TYPE OF
SOIL ABSORPTION SYSTEM IS:
TRENCH
^
MHXIMUM
NUMBER OF BEDROOMS = 0 ]
'/ SOUL RATING (SQ FT/BR) 150
THE REQUIRED
SIZE OF THE SOIL ABSORPTION
SYSTEM IS:
�Ez F,
11-11 � K^.�P-4 1C."i -F i"
IN& ������. ����F-A
6-3
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD.
THE DEPTH OF H TRENCH OF, PIT 15 THE DISTANCE gETWEEN THE SURFACE OF THE
GROUND HND 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 OUTFHLL PIPE
HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
S"O C)
I F-aEECA �L-- r- -IF Ia1m: -IF �P-4 VC 1 ;2" UE -iMmINEWMIRN F -P L_L-0���
PERMIT APPLICANT HFiS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF AN -r' WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
7"�11,111 ;R 1E������1 Ch 1,-4,C_= F --i F-_- ����Y F"E-- C.,:-
BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND HPPROVHL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTHNCE BETWEEN H WELL AND AN',.' ON-SITE SEWAGE DISPOSAL 5Y5TEM IS
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM H PRIVHTE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND
TO H COMMUNITY SEWER LUJE IS 75 FEET.
OTHER REQUIREMENTS MHY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
HVHILHBLE TO INSURE PROPER INSTHLLHTION.
ic "r ����Fe. ���IEE 11-1 CE3 U_ F? ��� ��UE-i"�
I CERTIFY THAT
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON~SITE SEWERS AND WELLS HS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2� I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]� I UNDERSTHND THAT THE 8N~SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE
RESIDENCE I'S RIENODELED TO INCLUDE 11ORE THAN 2qBEDROOP1_S
SIGNED:�����
8P��ICHNT JOHN GROSS
/~(/. �7
ISSUED BY~� _�_~��������~~�~~DHTE��/_~/�_..�_�__ V4.0
MUNICIPALITY OF ANCHORAGE
Department Health and Environmental rotection
825 L Street, Anchorage, AK. 99501
P
264-4720
,J`�rn , ��� �C�a # HANDWRITTEN PERMIT
WEi—iV13�R- ON -SITE SEWER PERMIT
Applicant:-i� Mailing Address :&01C.
Location:�/� CAnZ Phone Number: L` r
Legal Description: LOJ 1� ivef vlE TSI, I Size: _
Type of Soil Absorption System Is:
Trench: 'x_ Drainfield: _ Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br) _ 5
ii The Required Size of the Soil Absorption System Is:
DEPTH 1 LENGTH _ GRAVEL DEPTH _eV WIDTH
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(HOLDING) TANK SIZE _ GALLONS
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
epartmentwill 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 3 2
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 b room
Signed: -- Issued by: E� ��C���-f9�• -Cl
plicant f
Date: x 03 lot q_ ?_
SWP/024 (1/81)
Lt- SOILS LOG
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: �.Jz:'M'H If e->j�,���s DATE PERFORMED:
LEGAL DESCRIPTION: tc-'kj — -T-'Z;r-e-z—
DEPTH SLOPE SITE PLAN
(FEET)
2
3
4
6
7
8
9
10
12
13
14
15
16
17
18
19
20
COMMEN
PERFORMED
72-008 (6/79)
?c4"1
WAS GROUND WATER _ r % S
IF
ENCOUNTERED? L
P
YES, AT WHAT /j! E
DEPTH?
0
i
R
Reading
Date
Gross
Net Dept, t p, Net
Time
Time ''a'',+.��� Drop
... If
PERCOLATION RATE
TFB-T)RUN BETWEEN
FT AND
-vqs-
(minutes/inch)
— FT
CERTIFIED BY.y-f--G4= � DATE:
eL0
•, r� Municipality of Anchorage ,Nti
On-Site Water and Wastewater Program
(907) 343-7904
a �
Certificate of On-Site Systems Approval << ecu
6 L 9
Parcel I.D.050-792-32 Expiration Date: r3-I *.
1. GENERAL INFORMATION:
Complete legal description River View Estates; Block 8, Lot 2
Location (site address) 21245 Fallinq Water Drive*Eagle River,AK 99577
Current Property owner(s) Lisa and Spencer Van Meter Day phone 907-622-5000
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
n Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550 Waiver Fee $
Date of Payment L L 1J19 Date of Payment
Receipt Number Oa 17 I Receipt Number
n
COSA# OS((�l iogo 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: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: ;1-Let)t to
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and �000.0��
industry practices. The reported results describe the condition of the system/s on the date/s of the o OF 004
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or .9 cc��N
encroachments may exist that were not identified during the evaluation. The operational life of all wells per*..•• ' ..•. Q
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, di
1;. '..-7
X00
groundwater levels (that may fluctuate during the year), quality of construction (materials and d f IO
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and / Qare outside the control of GEG. Satisfactory test results do not guarantee future performance of the / VA
system/s; therefore, GEG makes no warranty(express or implied)regarding the future performance of , ,r
the well or septic system. GEG makes no representation whether an alternative well or septic system Q ,o f e •. orness.: 0
can be installed on the property in the event either of the current systems fail to perform adequately in VA 9 •. C _79 3 . �f;,:::,
G/
the future. The content of this report is for the sole benefit of the person/party that retained GEG to VV , 7� ,c O
perform the evaluation. Reliance upon the information provided in this report by any other person or 04fe� •--1•
••• O
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right 4�edprofesslo^°' n�,
whatsoever. �p44O `Tv
6. DSD SIGNATURE
Y System #1 Approved for bedrooms A. 4 3S
System #2 Approved for bedrooms
Disapproved ``s..k "►�/I`
Conditional approval for bedrooms, with the followlr� stiptl�lic$1�'E �3G
WATER AND rr
WASTEWATtK �:
o
PROGRAM £o
a9'4.417 SERV‘��S�
-lar-------1-7, —__&-----tal"---rOriginal Certificate Date: 7 -3 `/ 7
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 engineer's work.
7. ATTACHMENTS:
COSA Checklist Nitrate Advisory •
•
Septic System Advisory Arsegtic Acgvjory. T , T
Well Flow Advisory Other ° C�J i f-tte 0(
COSA Checklist
Legal Description: RIVER VIEW ESTATES; BLOCK 8, LOT 2 Parcel ID: 050-792-32
If more than 1 septic system on lot: COSA Checklist# 1 of 1 Structure served by this system 1
A. WELL DATA
❑� Well log is filed with Onsite (or attached) Well production at time of test 6.9+ gpm
Date drilled 8/96 Water storage tank volume N/A gallons
Total depth 200 ft Well disinfected for coliform test? ❑ Yes U No
Cased to UNKNOWN ft E Coliform bacteria is Negative
• Sanitary seal is functioning correctly Nitrate mg/L V1 Nitrate less than MRL (ND)
Wires are properly protected Arsenic ug/L Arsenic less than MRL (ND)
Casing height (above ground) 18+ in. Collected by GEG, Ltd.
Date of flow test for COSA 3/21/19 Date of Sample 3/21/19
Static water level at beginning of test 3.5 ft.
Comments
B. TANK DATA C. LIFT STATION
Age of tank(s) 22 years ❑ Required maintenance completed
Tank type/material SEPTCSTEEL Age of lift station - years
❑■ Standpipes/foundation cleanout per record drawing Lift station material -
Date of pumping 3-2 f Comments: 49" LIQUID DEPTH ON 3/21/19
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/16/96 Adequacy test date 3/21/19
❑■ ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms
Total measured depth from grade *10 ft (max) Fluid depth prior to test 0 in
Measured depth to pipe invert from grade **3.3 ft(min) Water added 625 gal
❑ N/A— pressurized field New depth 3 in
❑ Monitor tubes go to bottom of drainfield. If not, state 200
depth into effective 6.33 Elapsed time min
❑■ Code-required soil cover over field Final fluid depth 0 in
Absorption rate 600+ gpd
❑■ System presoaked
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) NONE
date of test)
Gallons introduced 2065 gallons If yes, enter date
Comments/Deficiencies: 'AT MONITORING TUBE"AT WEST CLEANOUT
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout > 100'
❑✓ Yes if No ft E Yes if No ft
Neighboring Tank > 100' QYes if No ft Private Sewer/Septic Line > 25' E Yes if No ft
Absorption Field on Lot > 100' EYes if No ft Holding Tank > 100' nYes if No ft
Neighboring Absorption Fields > 100' Animal Containment> 50' n Yes if No ft
TI Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 2 Yes if No ft nYes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑✓ Yes if No ft Surface Water> 100' E Yes if No ft
Property Line > 5' nYes if No ft Driveway/Parking > 0' E Yes if No, comment
Absorption Field > 5' QYes if No ft Wells on Adjacent Lots:
Water Main > 10' ✓n Yes if No ft Private Wells > 100' E Yes if No ft
Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' E Yes if No ft
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' 2 Yes if No ft Driveway/Parking > 0' n✓ Yes if No, comment
Property Line > 10' E✓ Yes if No ft Wells on Adjacent Lots:
Water Main > 10' Q Yes if No ft Private Wells > 100' n Yes if No ft
Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' n Yes if No ft
Surface Water> 100' n Yes if No ft
F. ENGINEER'S COMMENTS
oo�o�:p4
G. ENGINEER'S CERTIFICATION d
I certify that I have determined through field inspections and review Q'' ' •v00f
of Municipal records that the above systems are in conformance with ,C/).: 4 9 n
MOA COSA guidelines in effect on this date.
vA
// vA
•03 ��-ff ev i e ness.
• CE 795 Q
�p e'e, ..... 3(z9 f.3'��o�
COSA Checklist yellow sheet 440 ro f ess+o a�
#AECC884 ��0 .�o
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 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 # 0SC191090
Subdivision: River View Estates Block:8, Lot: 2
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 22 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.
`' k ' 745,
f _
1 � f.
ilik ,J,' 111":79h. ,,,.. ,
13t f �
ft y
sem.,, .,T"T- 'M , l /`
r w✓ ..' * 6 t t ti t d'� ...--4.
•
7•, . 4 ' 7t ' g,,,4ktl:! ‘r ,tii,...- . ,,
'iso",i c.,!rL. _._h. _ .J.,c, . . _
Mailing Address: P.0. Box 196650*Anchorage,Alaska 99519-6650*www.muni.org
w � is
k z — � � y le LIQ 5
�� TF 51 3 meq)
10' UTILITY EASEMENT \ S 60.r,
' ���
Cet4,
II --,1:19.45, p\
��� Lot 2 �. \ \
0
Lot 1 .off 41,138 s.f.
0
NC? ?.5'
'' SEPTIC PIPES
7.0'x8.1' SHED � `� ds, `a
1. h`�' Lot3
2 ry
1,-
r-
.--
489�o`J \
\ •
\ O4., 0 \
y \ J�`': �� WELL moo° ,tio \
--, 454, ::. . I
3.4'x10.0' DECK 2.0' CANT 8866- 5.4'
4SHED
IIUWr \ "56- \ Lot 4 /
29.3' °
J 20.0 • BALCONY `�SaO
b• / 2.0'x6.3' CANT ��Nc 1j10' UTILITY/EASEMENT
s l[ /
0 26.3' "9Gp 1) 1.
Alt
F \
II '? • °GjQ / \er0cs
\Q PORCH h
'V'
\
11.8a F
u 1.0' CANT
LA.
28.7'
HOUSE DETAIL DECK NOIII
Scale: 1" = 30'
PLOT PLAN AS BUILT x SCALE 1" = 60' GRID SW 0357 Project No. 19-092/R1
11500 Daryl Avenue, Anchorage. Alaska 99515-3049
Lang & Associates , inc .
(907) 522-6476 Phone Qoo04p�0
(907) 522-4625 Fax oo F A �Op
Professional Land Surveyors kenOlangsurvey.com • ,q Q
JonathanOlangsurvey.com 4:17,, ,(. ...
• S Q
' P pQ
I hereby certify that I have surveyed the following described property: °(/).•
°�.• 49Th i` Q
LOT 2, BLOCK 8, RIVER VIEW ESTATES SUBDIVISION (PLAT No. 79-5) * : •• *j Anchorage Recording District, Alaska, and that the improvements situated thereon arewithin the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed •13 KEN1--Q6: e:
premises and that there are no roadways, transmission lines or other visible '2' .
easements on said property except as indicated hereon. Q
3(25 l� ••' a
qP .• 520 . J
Dated this the Day of Anchorage, Alaska 4lie,o •
• .xkOo�G
at
4pRO�SSiONAt-`o
It is the responsibility of the owner to determine the existence of any easements, �4pO0o��
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
Municipality of Anchorage
Development Services Department ^ '
Building Safety Division
On -Site Water and Wastewater Program ,
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-792-32 COSA# 10
Expiration Date: 30-/0
1. GENERAL INFORMATION
Complete legal description Riverview Estates, Block 8 Lott
Location (site address) 21245 Falling Water --
Current Property owner(s) John Cook Day phone 240-4258
Mailing address 21245 Fatting Water
Lending agency Day phone
Mailing address
Real Estate Agent Jan Deering Day phone 240-4258
Mailing Address RE/MAX of Eagle River
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
El
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 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 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 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 NorthRim Engineering Phone 694-7028
Address P.O. Box 770724
Engineer's Printed Name Steve Eng Date
5. DSD SIGNATURE
I/ Approved for 1 bedrooms.
Disapproved.
3/23/10
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: � Original Certificate Date: 3-30—lo
(Rev 11105)
Municipality, of Anchorage +,.eke
•� Development Services Department y.
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore 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: Riverview Estates, Block 8 Lot 2 Parcel ID: 050-792-32
A. WELL DATA
Well type _P If A, B, or C provide PWSID # _ Well Log (Y/N) Y
Date completed _B.L96 Sanitary seal (YM) Y Wires properly protected (Y/N) Y
Total depth _2QQ_ft. Cased to 40, n+ Casing height (above ground) 24• . In.
FROM WELL LOG AT INSPECTION
Date of test 81/96
Static water level ft.
Well production 2 g.p.m.
WATER SAMPLE RESULTS:
Coliform _0_colonies/100 mL Nitrate
Arsenic: U� ug/L date of sample: 3/9/10
B. SEPTIC/HOLDING TANK DATA
20 ft.
PS g.p.m.
Other bacteria no colonies/100 mL
Collected by: NRE
Tank TypeiMaterial AnrharnBP Tonk (steel) Date Installed 9/10/96
Tank size t ?SOgal. Number of Compartments P_ Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/Np _N High water alarm (Y/N)
Date of pumping f Pumper J
C. ABSORPTION FIELD DATA
Date installed 9/17/965oil rating (g.p.d./ t2 or felbdrm) 0.8 System type
Length 58 ft. Width
Trench
Gravel below pipe 6.5 ft.
Total depth Eff. absorption area 754it2 Monitoring tube Y
Date of adequacy test 3/9/10 Results (Pass/Fail) Pass
Fluid depth in absorption field before test 0 in. Water added12CA1.
Elapsed Time:69hin. Final fluid depth 0 in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
unk
Depression over field N
For 4 bedrooms
New depth- in.
Absorption rate >= 700+ g.p-d.
If yes, give date
D. LIFT STATION NA
Date installed
'Pump on' level at _ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump off" level at —in.
Cycles tested
Manhole/Access (YIN)
High water alarm levet at
Meets alar ti circuit requirements? _
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 100' + On adjacent lots
Absorption field on lot
Public sewer main
100' +
NA
On adjacent lots
Public sewer manhole/cleanout
100' +
100' +
NA
Sewer /septic service line 25' + Holding tank NA
Animal containment areas 100' + Manure/animal excrete storage areas too' +
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5' + Property line 5' + Absorption field 5' +
Water main NA Water service line aS• +Surface water ion,
Wells on adjacent lots inn' +
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
10'+
Building foundation
10'+
Water main NA
Water Service line
10' +
Surface water
100' +
Driveway, parking/vehicle storage 25' +
Curtain drain NA
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Wells on adjacent lots 100' +
I certify that I have determined through field inspections and
s +� �.gTH F." d
review of Municipal records that the above systems are ind.
• •.. • a�
conformance with MOA COSA guidelines in effect on this date.
✓ • ••
Engineer's Printed Name Steve Eng
w. Eng J!.', 4
3/23/10GF
6"56 �= a
`s8 �y ••,��23(id ^'< "
Date
• 4 ie
�' C ��
COSA Fee $ Waiver Fee $
Date of Payment -3b /d Date of Payment
Receipt Number Ll rll/ �' Receipt Number
(Rev. 11105)
Northrim Eng
Attn: Steve Eng
17237 Bear Paw Circle
Eagle River, AK 99577
907-694-7028
Fax: 907-694-7026
Client Sample ID:
Sampling Location:
Client Project:
Sample Matrix:
COC #:
PWS#:
Residual Chlorine:
Comments:
Riverview Est. .6 k L Z
Riverview Est. B� /—,?—
Drinking
LDrinking Water
73492
Lab#: A1003086 -01A
SP-Analylica, Inc. -Anchorage
4307 Arctic Blvd.
Anchorage, AK 99503
Phone: 907-258-2155
Fax: 907-258-6634
Report Date:
3292010
Receipt Date:
3/92010
Sample Date:
3/92010
Sample Time:
11:OO:OOAM
Collected By:
SE
Flae Definitions:
MRL = Method Reporting Limit
MCL = Maximum Contaminant Limit
B - Present also in Method Blank
FI - Exceeds Regulatory Limit
M = Matrix Interference
J = Estimated Value
D = Lost to Dilution
• • = RL higher than MCL; target not detected
TNC = Too Numerous to Count - result rejected
CF = Confluent Growth - result rejected
TCNG = Turbid Culture No Growth - rejected
Analysis MOW Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Anahst
92238 -PA (Aqueous) -Coliforms in DW Test was conducted by. Anal lca - Anchnra e
9 Coli Pass PASS/1 All. 3/9200 3/92010 RS
1.0 1 3/92010 3/92010 RS
Total Coliform Pass PASS/FAIL 1.0 1
lab#: A1003086-OIB
Analysis Method Prep Prep Analysis
Fl... X1121. MCL Method Date Date Arnl%st
4.)UU-NVJL tAqueous/ - wu14.c-1
Nitrate -Nitrite as Nitrogen <MRL
lab#: A1003086 -OIC
Analysis Dlethod
Arsenic
pres
mg/L
0.10 10
Units Flags 111RL
0.400 ug/L
was
MCL
Test was
0.15 10
Page 3 of 3
3/17/2010 3/172010 JQ
Prep Prep Analysis
Method Date Date
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!rl 64045'41 W BB.roro
BALL/NE- WATEfi pA•Itr
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Oe1B re ; -c-,vow {SCC
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5d.60:5164771V 7/. Z2
AS -BUILT— NO CORNERS SET THIS DATE .
i
OF q��1
�Pq ..-• ......1i 1!
Fred walar4
°'♦r 1 NO. 0753 J�
�� forme ...»...•'�o��
:►_ �fiSlnnaLt ..
EASEMENTS OF RECORD, OTHER THAfJ
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. FJ, 7G- 3
or
e.E
1 hereby certify that I have performed a Mortgagee's Inspection
of the following described property:.(` z=
BLOCK 01 12/I1AgV1Fu/ ST47F_S
!f"sgnrr/5vdn/
Anchorage Recording Precinct. Alaska, and that the '
improvements shorted thorson are within the property Ines and
do rot overlap or encroach on the property lying uWant thereto.
that no Improvements on property fying;adjacent thereto .
encroach on the premises In question and that there are no
roadways• transmission lines cr other visible easements on said
property except as Indicated hereon.
Dated at Anchorage, Alaska
this <, +A Cay of GGCEM t16
FRED WALATKA d ASSOCIATES
(907) 248.1666 . Engineers and Surveyors "
♦
J.
I ;w
3••
i
q
v
a
!rl 64045'41 W BB.roro
BALL/NE- WATEfi pA•Itr
0 .
SCALE" 1 f
.WELL .j"•sof • 1,
u, , A�CrviWdY:.Loc.�r,IW
Oe1B re ; -c-,vow {SCC
, I
i I .
,
N
5d.60:5164771V 7/. Z2
AS -BUILT— NO CORNERS SET THIS DATE .
i
OF q��1
�Pq ..-• ......1i 1!
Fred walar4
°'♦r 1 NO. 0753 J�
�� forme ...»...•'�o��
:►_ �fiSlnnaLt ..
EASEMENTS OF RECORD, OTHER THAfJ
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. FJ, 7G- 3
or
e.E
1 hereby certify that I have performed a Mortgagee's Inspection
of the following described property:.(` z=
BLOCK 01 12/I1AgV1Fu/ ST47F_S
!f"sgnrr/5vdn/
Anchorage Recording Precinct. Alaska, and that the '
improvements shorted thorson are within the property Ines and
do rot overlap or encroach on the property lying uWant thereto.
that no Improvements on property fying;adjacent thereto .
encroach on the premises In question and that there are no
roadways• transmission lines cr other visible easements on said
property except as Indicated hereon.
Dated at Anchorage, Alaska
this <, +A Cay of GGCEM t16
FRED WALATKA d ASSOCIATES
(907) 248.1666 . Engineers and Surveyors "
Municipality of Anchorage
'4E BU,
• Development Services Department a,
Building Safety Division
On -Site Water and Wastewater Program `
4700 South Bragaw St. s E T.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING /
Parcel I. D. O S0 -7 9.1- 3 a HAA #_ ' �kLb / o,2/ 7
Expiration Date: J '%--O /
1.GENERAL INFORMATION
Complete legal description Lot 2; Block 8; Riverview Estates
Location (site address' or directions) 21245 Falling Water Dr Eagle ; c_, Au 99577
Current Property owner(s) Julie Brandenburg Day phone 694-4881
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
HC 85 Box 9203 Eagle Rivee Apt ggs77
Day phone
Day phone
Unless otherwise requested, HAA will be held by DSD for pickup. ' A W2 i<_
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well E
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
Individual On-site]
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
encineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 less than 30 days old. (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 Health Authority 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.
5& S ENGINEERING Phone 61 4t -;I % 79
Name of Firm
Address Eagle River, Alaska 99577
l� !3 .�— C• Cd Date °I / r/d 1
Engineer's Printed Name '
�I. p ROBERT C. COWAN ,?
5. DSD SIGNATUREV400�, %, CE -8801
Approved for bedrooms. ...........
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments PROGRAM =
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By:
Original Certificate Date: % O
(Rev. 12100)
'.its tt
Municipality of Anchorage
Development Services Department
Building Safety Division
On Sfle Water & Wastewater Program
4700 South Bragaw St.
l+ P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 3437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: jet L p Vt 4SST SID Parcel IDd 60 :N;?-
A-
N2A. WELL DATA
Well type�V4�TL- H A B, or C provide PWSID # = Well Log (Y/N)
Date completed41
b Sanitary seal (YIN) Wires properly protected (YM) _
Total depth �ft. Cased to l�- �R. 70s ng height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test 41& Z O
Static water level
Well production 2 g.p.m. 3.7 g.p.m.
WATER SAMPLE RESULTS:
Coliform O colonies/ 100 ml. Nitrate t7.5 mg ll. Other bacteria O colonies/100 mi.
Date of sample: O I Collected by: <4 5 & r n.l C�fC2 1 �I G
B. SEPTIC/HOLDING TANK DAT
Tank Type/Material
Tahk size 1 gal, -'. Number of Compartments Z- /
Foundation cleanout (Y/N) - Depression over tank (YM)
Data of pumpingT g
C. ABSORPTION FIELD DATA
Date installed 4 / 4 to
Cleanouts (Y/N)
High water alarm (Y/N)
Pumper TR -16
Date installed Soil rating (g.p.d./fe or ft'/bdrm) 0-1-0
Length 5V ft. Width
System type %&e j C t/
Gravel below pipe L • S It.
Total depth 10 t ft. Eff. absorption area 7-5-4—fe Monitoring lube 41-5 Depression over field h 0
Date of adequacy test Results (Pass/Fall) For A bedrooms
Fluid depth in absorption field before test _,d in. Water added &gal. New depth in.
Elapsed Time: &1 min. Final fluid depth 0 in. Absorption rate >= 6,00 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM 8 type) Al If yes, give date
D. LIFT STATION
Date installed Size in gallons
`Pump on" level at _ in. "Pump otr level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankA*MWb—n on lot / DO 1 -o --
Absorption field on lot f O O r
Public sewer main A.1 /A
,r
S er /septic service line 2`✓
Manhole/Access (YM)
High water alarm level at In.
Meets alarm d circuit requirements?
On adjacent lots / d 0 r -t-
On adjacent lots /00 /-r-
Public sewer manhole/deanout /V It
Holding tank N /A
-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 r� Property line �a Absorption field
r
Water main %11 ti, Water service line 1 0 f Surface water to
Wells on adjacent lots 10 O t f -
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
0 ' '
Property line � #' Building foundation 1 O t- Water main MAI-\
Water Service line If Surface water 100 '+- Driveway, parkinglvehide storage 1 0 1 l -
Curtain drain Not* VQV W rJ Wells on adjacent lots 1 Ano +
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidefines in effect on this date. �o ��o...
Engineer's Printed Name �[ 0drtA, C. CJrJA.✓ % `ti': CI w µ
Date ,.. , _»...•`
HAA Fee $
Date of Payment
3 0®. •°
9/6 /0 /
Waiver Fee $
Date of Payment
Receipt Number 00 q i a 7 Receipt Number
(Rev. 12/00)
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. #
1. GENERAL INFORMATION
HAA # L� 63 �
Complete legal description �!g:rx'C IE-
le 59 , to O i -z-
Location (site address or directions) P&I-L.ihl4. uZ/4Tlz,(L 712-i v'i.`
Property owner Fs L�ti ��--1��� ✓S Day phone 2`40— M78
Mailing address �' � 9 ��c'e C' -I rWe
Lending agency t 1�� r �qn.0 4e-- Day phone ,1277— 1 `7qZ
Mailing address N - cAr
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
T
3. TYPE OF WATER SUPPLY:
Individual well
Community well
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
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
T.SPURKLAND P.E.
203 W. 15th. AVE. SUITE 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
Municipality of Anchorage
Department of Health and Social Services
820 I Street
Anchorage, Alaska 99501
Subject: Conditional HAA
Riverview Estate Bk 8, Lot 2
PID 050-792-32
Gentlemen;
RECEIVED
JUL 10 1997
Municipality of Anchorage
()ept. Idealth & Human Services
July 9, 1997
A conditional HAA was issued for this property in early January 1997. The conditions of this HAA
have been meet. The standpipes were replaced on June 28, 1997. Please issue an unconditional HAA
Yours
T. Sprd kland P.E.
T.SPURKLAND P.E.
203 W. 15th. AVE. SUITE 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
Municipality of Anchorage
Department of Health and Social Services
820 I Street
Anchorage, Alaska 99501
Subject: HAA and As Built
Lot 2, Block 8 Riverview Estate
Drainfield Stand Pipes
Gentlemen;
December 24, 1996
We are requesting approval of this system in spite of the fact that F-810 pipe was used for stand
pipes. These pipes will be replaced after breakup. The justification for doing the work after
breakup is that if done at this time, there is a good possibility that the 3034 pipe will be damaged
during backfilling. 3034 pipe is more brittle than F-810, the backfill will consist of frozen soil and
cobbles that will not fill the void around the pipe and easily crush or break the pipes. Safety of the
construction equipment is also another factor. Access to both the lot and the system is along steep
and icy roads.
If you insist to have the pipes replaced at this timed, the contractor still needs to return after breakup
to reinstall the pipes.
You have approved of F-810 pipes as standpipe in the recent past.
Yours
T. Spurk and P.E.
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
Parcell.D.# 060 -7q2 -3z HAA # iAfR 1lnO 37,
1. GENERAL INFORMATION
Complete legal description Lb 1 �2.13 V— P� R t V E 2 V I E\161 ESTATE
Location (site address or directions) FALL I rl C-, IYiAS E rL -D R-ty t~
Property owner FI?P_E1.AmD R0(I,plertS Dayphone 2yo--3876
Mailing address e P47-9 -AGE C, r -c -L L
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
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
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 N21
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.
Name of Firm 1 dbbe�
Sour L4vt al E Phone DLit{ 39 I
Address ��i ► J *n 20 3
Engineer's signature f - Date 4,
��.\ "., i� Iii...• 1/. I/ ./ .A�
t
f f�
�} as ♦ 1 ?
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
xxxxx Conditional approval for four(4) bedrooms, with the following stipulations:
0
Money shall be put in escrow in sufficient amount to have A.S.T.M.
specification F-810 riser pipes exchanged for A.S.T.M. specification D3034
on the newly constructed wastewater system serving this property. The
as -built inspection report shall remain un -approved until this is accomplished.
Th -112 conditional ah 11 ha Q aYi c f a },3 nn 1aT'ar rh n T ne 151 1997 btoney in
escrow shall not be realeased until this office has given final approval.
Additional Comments
%OTIC
Date December 27, 1996
.The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of. Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA W21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: _Uq T Qr, 5V–,q jl;F¢4-- Parcel I.D.: d 50 – 7q 2– 3 Z
A. WELL DATA
Well type 12 -
Log present(Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number N/A
Date completed 8/,?
i
Total depth ao-O Cased to qt) Casing height (above ground) 02
Sanitary seal (Y/N) `
Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION
rr+
Date of test �i 9 (o
o
Z'
Static water level b CJ
�
Z r
D
Well production
g,p,m,
gym -
WATER SAMPLE RESULTS:
Coliform Nitrate
Other bacteria N
c
or
Date of sample: i q i
�—
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 7/1v 9 Tank size —/;Z -5C) Number of Compartments _� Cleanouts (Y/N) _
Foundation cleanout (Y/N) _�_ Depression (Y/N) N High water alarm (Y/N)
Date of Pumping C"/ Pumper
N
C. ABSORPTION FIELD DATA
Date installed q//7l / 4 Soil rating (g,p.d./ftz or dfffl) 0, P, System type v gh
f i
Length J Width Gravel thickness below pipe �- 5 r Total depth
Effective absorption area Monitoring Tube present (Y/N)_ �_ Depression over. field (Y/N) hI
Date of adequacy test Results (Pass/Fail) 7 For y bedrooms
Fluid depth in absorption field before test (in.); Immediately after ✓gal. water added (in.):
Fluid depth (ins) Minutes later: '� Absorption rate = v g.p.d.
Peroxide treatment (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)'
D. LIFT STATION IN 0 N L
Date installed
Manhole/Access (Y/N)
High water alarm level at* _
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
"Pump off" level at*
Septic/holding tank on lot t 1 3 r On adjacent lots /tr-t-ID
t
Absorption field on lot I 360 On adjacent lots 7 t rs-0
* t /
Public sewer main ' `i 0 14 Public sewer manhole/cleanout NO 1. -e—
Sewer /septic service line 7 5 D
Lift station t� G
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
_ i t
Foundation ao t Property line 6-! Absorption field �O
Water main/service line >95 Surface water/drainage O y L Wells on adjacent lots > /"
,
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
r /
Property line /00 Building foundation 6 Water main/service line 7 �2 6
Surface water ,Nn H -e—Driveway, parking/vehicle storage area > o
Curtain drain 1 �c oy! e- Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records that the above Sys s are
in conformance with MOA HAA guidelines in effect on this date.
i
Signature u'
Engineer's Name -ek u +' tri[a
Date c Qt
O�
HAA Fee $ �d� �^ Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Date of Payment
Receipt Number
JALCT&E Environmental Services Inc.
.rorrirrirrriirrrrriiriiri4
CT&E Ref.,
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
966413001
Tobben Spurltland P.E.
L2 BS Riverview
Potable
Drinking Water
Client POn
Printed Date/Time 12/09/96 11:2
Collected Date/Time 12/04/96 15:25
Received Date/Time 12/04/96 16:05
Technical Director: Stephen C. Ede
Released By
Allowable Prep
Parameter Results PQL Units Method Limits Date
Nitrate -N 0.100 u 0.100 mg/L SM18 4500-NO3F 10 max
Totat Coliform 0 0 col/100mL SM18 92226
C L5[C
Analysis
Date Init
12/06/96 EMB
12/04/96 TMu