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Home My WebLink AboutHIDDEN HILLS BLK 1 LT 36Hidden Hills Block 1 Lots 36 & 37 #011-121-99 MUNICIPALITY OF ANCHORAGE DL RTMRNT OF HEALTH AND HUMAN SEL, ES Environmental Health Division 825 " I_" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NameDISTANCES TO — SEPTIC ADSORPTION Address / _7 x'00 ae �% �� 9 ?� � FROM � TANK FIELD WELL i Phonets - _-- Pcrrmt No. No. of Betlrooms WELL 9G� ria LEGAL DESCRIPTION LOT LINE Z_0 - 53 Lol Block Subdivision�1� / `'----- —__a _ �hh,5_A /x'10 FOUNDATION 9�.�v Township. Range. Section ty 5t7,L�J l:eG `� AS-f1UILT DIAGRAM tShow location of well. sepnc system. property IineCs, Ioundalion. driveway. water bodies, etc.) TANKS ��- —r— — —r7�— 7 T l— --f rT— )CL SEPTI: ❑ HOLDING Mmwacturcr e�x Capacity in gallons Material No. of Compartments / — � TYPE C S (STEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom Iron �iI depth Iron original grade original grade __ � FT )f"/ FT Rn added above ouginal grade Gravel depth beneath pipe _ FT p FT Gravel length - _ __ width aaGravel /O fT -al �, i / FT a----- Totbsorption area ff0 ---- Distance between fines 80 FT A11A FT nes tl rating Number of tiSo Pipe matenalM RF -�-- /0 SO FT Soc1D b 303¢G.i._ Installer Date Installed q LJ�R �if exe. pp// 7—/X—Ute WELLi3 6 � PRIVATE ❑ OTHER (Identify) ' Glassi citation�A, B.C7 I otal Depth Cased to FT insiaaci .. .-- — -. — Date Installed: REMARKS: Municipal and State guidelines in ellect on this dale. Health Department Approval: 72-013 (3/85) --- - i1✓C /�✓� �uPi�lCy l�r16�1,XIfT�Ej scale:- -___ Inspections Performed by ------ Date. �i certify that this inspection was perlonned according to all T— Dale. 0 /4 ENGINEERS SEAL JOW IS -1 RAI . 1: 171 1: To" WN; 0 TY T�- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264_4720 ** TANK MUST HAVE AT LEAST TWO COMPARTMENT3 l certify that: 1" I am familiar with the requirements f,or on~site sewers and wells as set [orth by the Municipality of Anchorage (MOA> and the State o{ Alaska" 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria othis permit. 3" I will adhere to all MOA and State CH Alaska requirements Ior the set back distances �rom any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4" I understand that this permit is valid 'or a maximum of' 3 bedrooms and any enlarOement will require an additional permit, IF A LIFT 5TATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST 8E ODTAINLEY) UILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SlGNED �*TE: -7y«� 4��!��. e� ~_v��__ ISSUED RY DATE: / ��........ ............�� 4 A RAI--T� 1 17~1 - 147 M R "Z IN X~I PERMIT NO: 860221 ��/�y7 DATE ISSi]ED: 07/07/8 6 ANN ICAM R DOT3ONJ} ^ ADDRESS: 790O L.UCY S'O: (EET ' ANCHORAGE" AK 99502 IV 4?/�� ' [J]NTACT F1fONE: 243-6178 ' / LEGAL DESCRIP: SUBDIVISION: HIDDEN HILLS LOT: 36 BLOCK: 1 SECT}ON: 9 TOWNSHIP: 12N RANGE: 4W LOT SIZE: 18969 (SQ.FT, OR ACRES) LOT LOCATION: 790O LUCY MAX BEDROOMS: 3 Listed below are the options avail�ble to you in designing your septic system. Choose the option that best fits your site" �.... .... �^�� 11'.01 DEPTH TO PIPE 801 -TOM (FT.> GRAVEL DEPTH (F T.> 10,0� 0^5 3^5 TOTAL DEPTH (FT") 14"0 GRAVEL WIDTH (FT.) 2"5 19.0 5.0 GRAVEL LENGTH (FT.) 23^0 36.0 49,0 GRAVEL VOLUME UDI ^YDS") 22^4 25,4 36"3 TANK SIZE (GALS> 1,000.0 ** 1,000.0 ** 1,000.0 ** SOIL FIM lNG (SQ^FT./8R) 15O 150 150 ** TANK MUST HAVE AT LEAST TWO COMPARTMENT3 l certify that: 1" I am familiar with the requirements f,or on~site sewers and wells as set [orth by the Municipality of Anchorage (MOA> and the State o{ Alaska" 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria othis permit. 3" I will adhere to all MOA and State CH Alaska requirements Ior the set back distances �rom any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4" I understand that this permit is valid 'or a maximum of' 3 bedrooms and any enlarOement will require an additional permit, IF A LIFT 5TATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST 8E ODTAINLEY) UILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SlGNED �*TE: -7y«� 4��!��. e� ~_v��__ ISSUED RY DATE: / ��........ ............�� GREA ' ANCHORAGE AREA BORA TH Department of Environment Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM _ NAME S /`I "') — MAILING ADDRESS 13/0XI612ri �iit��__ PHONE _ LOCATION _ ��-� ^J�� t LEGAL DESCRIPTIONJ_ --� ) .L//IIL/�l�a'u 1J///f SEPTIC TANK: _ DISTANCE FROM WELL K� MANUFACTURER _ MATERIAL INSIDE LENGTH _ INSIDE WIDTH LIQUID DEPTH TILE DRAIN—F-JZLD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA FOUNDATION DISTANCE BETWEEN LINES DEPTH: TOP OF TILE TO FINISH GRADE NUMBER OF COMPARTMENTS _ LIQUID CAPACITY� GALLONS. 3T—AL LI NEAREST LOT LINE_ — OF LINES TRENCIi,Vf1DTH— IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF ESI-L-rNE a---_.___i1E XT CJS F I LT E R MATERIAL BENEATH TILE WELL: TYPE OID11tO_CONSTRUCTION .IN. ABOVE TILE IN. DEPTH DISTANCE FROM: BUILDING NEAREST , i_ NEAREST SEPTIC ' SEEPAGE j FOUNDATION V LOT LINE_ �U—, SEWER LINE TANK SYSTEM CESSPOOL _ APPROVED— - OTHER SOURCES DISAPPROVED DISTANCES: — INSTALLED BY: SEWER LINE DEPTH: -- PIPE MATERIAL;o /t, — LOT SLOPE: REMARKS: ��L o�, F�� Fnrm PW.027 REMARKS DIAGRAM OF SYSTEM /l T/�/1 /1 %�/' � /�//%�lC��> //✓ /j % ='-- �%c: �"��e<<. /% � s' //l/1��Glf 7�D� DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-6686 SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMIT PERMIT NO. 'r/ Z- NAME OF APPLICANT MAILING ADDRESS �eL -��-__ pI10NE INSTALLATION LOCATION LEGAL DESCRIPTION - •� Q� ��l�l_/ /�/��f,1--,�f/�G� f_ L�.>/� , ' _—__— —. INSTALLATION OF: SEPTIC TANK _�b _SEEPAGE PIT---_. DRAIN FIELD I_ OTHER —_ TYPE: AND SIZE OF FACILITY TO BE SERVED_— FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS COMPLETION DATE ANTICIPATED NOTE: THIS PERMIT 1^a NOT VALID WITHOUT SOIL TEST FINAL INSPEC'T'ION: 24 HOUR NOTICE REQUIRED. ®AC ILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION IDY THE HEALTH DEPARTMENT AUTHORITY WILL. HE SUBJECT TO ROSECUTION. SEPTIC TANK SIZE � " ., TYPE GL.1.w C�<.'.�i.r� / SEE GE AREA SIZE TYPE 0/✓✓ MINIMUM DISTANCEb, REQUIREMENTS DIAGRAM OF SYSTFM FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD -TIC TANK TO SEEPAGE PIT WALL --- SEPTIC TANK 5i. SEEPAGE PIT slK� DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK �_�SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. s WATER MAIN TO SEPTIC TANK ------ SEEPAGE PIT _-Z-6-2__ _ DRAIN FIELD SEPTIC TANK, ! SF_EPAGE PIT �� / DRAIN FIE[ -.D i TO RIVER, LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS, GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH AUTHORITY OR LICT_NSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 26.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID c.:ODE. /7 /9 DATE --f! �..( „� _!`� APPLICANT'S ;31G NATURE /1 l,r j ALASKA Ei 01ROWnTAL COUROL SekuIUS, InC. Cngineerinq & Cnuironmental Studies July 3, 1986 Municipality of Anchorage Department of Health and Human Services 825 L. Street Anchorage, Alaska 99501 Attn: Susan Oswalt Dear Susan: t/1jNiCIPALITY CF',,,NCr-;JRAGt DEPT, OF FIE/.LTf1 & E-NvjroiJMENTAL PPOTF(:TION ECE.1VE J This is in regards to Hidden Hills Block 1, Lot 36. Recently I did a soils log on this lot. The soil was a very clean sand and gravel mixture, with slightly more gravel from 2 to 4 feet and sand predominating below. Normally, I would have rated this soil visually at 125 to 150 square feet per bedroom. But because of the rules in the new ordinance, Lee has been having us run percolation tests on each soil strata and sieving the soil actually removed from the percolation hole. The percolation test results show that the rate is better than one minute per inch, or 85 square feet per bedroom. However, this does not accurately represent the soil, because there is so much sand in the soil which eventually will clog up over the years due to the filtering effect of the sand. As AECS has observed many times in the field, any clean soils, whether pure sand, pure gravel, or any kinds of mixes of clean sand and gravels, always pere out at better than 85 square feet per bedroom. Therefore, a sieve analysis was run according to the unified ASTM system. According to the sieve analysis, the soil is a "coarse grain sandy soils. The soils are poorly graded sand (SP)." According to Municipal Code, the rating given an SP is 150 square feet per bedroom. When the sieve analysis data is plotted on a graph, it can be seen that part of it falls within the MOA requirements for a sand filter, and partly outside due to the coarser size materials. The fact that it does not fall entirely within the filter material category indicates it can not be used as filter material, However, that is not the issue at all. The issue is, does there exist enough sand in between the gravel so that a normal septic system can be built without bringing in filter material. The answer to this question is yes, which is proved by the sieve rating of SP and the fact that there is sand falling inside the MOA filter material criteria. In addition, if you look carefully at my soil log, you will notice "a fine sand" from 11 feet to 13 feet. I did not run a separate percolation test or sieve on this because of the extreme danger of standing around in an 11 foot deep test hole whose sides are about to cave in, however, I can safely say there is an abundant filtering 1200 West 33rd Auenue. Suite B • Anchorage. Alaska 90,50391907) %1-5040 material in this gravel -free fine sand strata. I feel there is enough sand between the gravel in this soil log to filter effluent properly. This is confirmed by the sieve, analysis. There does not appear to be any health danger from building a normal septic system without imported filter material. If you have any questions please call our office at 561-5040. Sincerely, i Darcy B;;Ins Engineering Geologist Approved by: PERFORMED FOR: Gkr(�G/kcav DATE PERFORMED: 2-3 .Jwie LEGAL DESCRIPTION: /-� ddew //�/!/S (1B1 L 36 Township, Range, Section: q T/2. f.f W' �hSLOPE SITE PLAN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST ( E'T 1 I I OL oManfc Stn 1 2 I I UU 3 d) J prtrq rCAJ Sewee- ro0L Silt. 4 ^; p 5 t I (ScWe erw•1lcfS� ® S �� avtci gravels 6 7 8 -i 9 de) 10- 11 12 13- 14 3 14 15 16• 17 0 18 19 a Tin¢ SanCt, WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? ,JO S L O P E Beplh to Water Aller N 3v June Monitoring? Y Bale: _ Reading Date Gross Time Net Time Depth to Net Water Drop Ju'le Z3 /: 14S �110,IN 60 / 1''Y6 ! 00 Eo 160 q8 -- O — 3 D0 ,60 Reading Date Gross Time Net Time Depth to Net Water Drop Ju'le Z3 /: 14S - 60 / 1''Y6 ! 00 Eo 160 q8 -- O — 3 D0 ,60 20 i I 6 IL_ JI PERCOLATION RATE < ,minulesnnch) PERC HOLE DIAMETER �n TEST RUN BETWEEN 4 /l FT AND 5 —FT / COMMENTS i /ctit'oi ! /J Qt �/d 6adC'Y rTj Weyim. Cte[K�1fr_T (itJ;6at`$j PERFORMED BY: SCS /^c STF 6 D �� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDE INES IN EFFE TON THIS DATE. DATE: 3U .%k �_ 72-008 (Rev. 4/II5) 5- /' UNIFIED SYSTEM ASTM D-2487 ,JUNE 27 1986 HIDDEN HILLS BLOCK l LOT 36 SAMPLE IDENTITY D-4 PASSING #200 SIEVE: 0.70% RETAINED PASSING # 40 SIEVE: 14.30% RETAINED PASSING # 10 SIEVE: 72.90% RETAINED PASSING # 4 SIEVE: 82.30% RETAINED PASSING 1/2 IN SIEVE: 92.70% RETAINED PASSING 3/4 IN SIEVE: 95.80% RETAINED PASSING 1 INCH SIEVE: 100.00% RETAINED PASSING 2 INCH SIEVE: 100.00% RETAINED PASSING 3 INCH SIEVE: 100.00% RETAINED D10 IS/ 40.00 MM. D30 IS 20.00 MM.. D60 I'S 10.00 MM. THE LIQUID LIMIT IS UNKNOWN THE PLASTIC LIMIT IS UNKNOWN THE PLASTICITY INDEX IS UNKNOWN CU 0.25 CC 1.000 THE % MOISTURE OF THE SOII, IS %9999.00 THE SOILS ARE COARSE GRAINED SANDY SOILS THE SOILS ARE POORLY GRADED SAND.(SP) 13.60% 58.60% 9.40% 10.40% 3.10% 4.20% 0.00% 0.00% 0.00% MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION THESE SOILS HAVE A FROST CLASSIFICATION OF -NFS- JUL :? 19F DECEIVED 1d �'. ��n i• 22 � - •� vu 02.00, �-Sl.(�_ 1 a 111481 °► !� �o e < ��`, fs 21 31 07 14302 I\\ P 17,889 8 la 0 29 0° f I b - 15,100 0 1 19,973 rNAl I p ti° T2°Io'D2"ly S I o rr�� I 20 ,Lb 110.29 e _ 3G \ /{4.{• 9a.00 fo v N ''a II iI - •'^ �{ - w% I I I ia,e90 rooWOODS 1e .^ se a°s ,50 e9'sIaR"aC eN1 s0 2028016 1 19 '0 14 _! 1 17,220 a i b I � °� • 1 >- �_�„p. 33 qp e4'11°w v g No oa:c.Ke q. 1 Sf 1!0.00— e — IOL.Oprof.00— ` no-- ws = Till f _ 116.05 _ 4 - Ze! 1 ou O 1� 40 000• 39 41 1 ,�o 604 y 12,273 0 10,541 1 1 ,r o a 1 VACANT 1 .00 `f.00 -Lot 36 it 6.tT � s.0 - I 23,042 • s S ,p,AaBQ th �4/.a, r 4 ,4 7.1•Hg ffl•00 � � flov 1e 2 -P ° I 114 b 1 ��. • �JCJ - — J ° e• ,� \010 17,f>68 N 18,269 �•* 4jo 10 it K .p 1 s n to a-afaa••zz - 105.6%°P c' R f 02.55' 50"[ 060.04 ins. s1,9hf /1 /oye Loc K j . 0 -� ,d Cie., o"r YOLoT �n nerd N 1 f 27 906d I -cot Aolf Hi �t�e ffl�c S 1"_ /00' ;ITE PLH� a /4,rF -rii. cr P'-. <4 rya. r� ✓11�G�1d` G✓Pr 7` of •r'efll ijol[ f! J o � L X< V 70 1 - w 74 e f71r f v� ell .fi' d MMILAPALITY OF ANC WIGE DEPARTMENT OF PUBLIC WORKS CONSTRUCTION DIVISION TEST NO. PROJECT DATE CONTRACTOR LOCATION SAMPLED BY COMMENTS REPORTED TO PLOTTED CHECKED BY ri 01ia )' MATERIALS SUPERVISOR FILE NO. INSPECTOR'S COMMENTS SIEVE ANALYSIS SIZE OF OPENING I INCHES UMBER OF MESH PER INCH U.S. STANDARD •- w� ■�w�.Q�ww�w� w w / / ww ww w� ■mow .��wYi!■w=� ■ w w�lw�w� w�w� w1 =w\\ ww1� �.ww_ �� ■■■ ■■■■ ///.�10 w ■�w� w �■www■.= ■_■ Iwo ww .mow w�wwlel■ ■ww�■i ■ � .. • MINIM■�w�wwl�� wwls■■Im■ MINIM www■�w=Iw�wEw ww Im =�mwjwvmI1MMw .iw MENEM mE m■ m MINE r'� l�w�w�w■ml�wwl IL �wi law w�w�wwwl■NAM No l■ ■. IN ■ILI■■ ■� \E "7 ■ \■ •ftw� ' .. mwww■■1 IN IN 1iwwl M■�wMww�l�wma � IN ,\■��\ �_� • w—■� MINIM MINIM MINIM �0 01111 ■. IN �wmw ___■mmiIiiiiim �� r• •. r� �w ommw ummow� ME11 w■■1 \mow ■o■.�� ME IN Elmo • "ElmoOnEmm� momiI IM �� M10111IMMUM mm M1111MMM M11111 mm M No WIN IN • M111111I=■ ■.I■m wrw�www\w■■m■■1■= rr, ■I�■.I � .. w ww. ■l iw . w w�w■ww ■■■ww . ./w� ww■■iliwl'iw wwww ■wwww �■il■ ��mm1011MMIN ME• 01 mm mu .r�'ii.ur�ll�rllwr�Ir�w�'. ri�rr/�i�il a/..Ix • MINIMii■ww � www■��w�w�w�i�■�iiw w��11\I ■Ilw■wl�wl■■\I.I■ww■� �11�. E�/C ml ..It/w►�' • • • • .. AAA • • ® • • IM FINE_ SANO INSPECTOR'S COMMENTS EPtAiJS • B 4E: Municipality of Anchorage i' On-Site Water and Wastewater Program id I a (907)343-7904 S a r ! r Certificate of On-Site Systems Approval u Parcel I.D. 011-121-99 �/Expiration Date: O I - tq 1. GENERAL INFORMATION Complete legal description Hidden Hills B1 L36 & 37 Location (site address) 7900 Lucy Street Current Property owner(s) Andrew & Jennifer Lewallen Day phone Mailing address 7900 Lucy Street Anchorage, AK, 99502 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q 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 $ SJv Q Waiver Fee $ Date of Payment c40- !lq Date of Payment Receipt Number 0(NO ?6i Receipt Number COSA# 050 4) l DV' 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. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R Pannone, P.E. Date 2/15/2019 * 4A 311 i` •* 6. DSD SIGNATURE t\ A. System#1 Approved for bedrooms —Moven -anlnop° CE 8149 • ... System#2 Approved for bedrooms ' I „.".. •.•'.� Disapproved t Conditional approval for bedrooms, with the following stipulations: '`�”. -e, rL., 1w��RITE c. 5 WASTEwAT D �i \ OGRAM R o SEPvtC' (� :y. _ /11 / Original Certificate Date: 3-4- (• I The Municipality of Anchorage Development Services Divis on (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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_E . COSA Checklist Legal Description: Hidden Hills B1 L36 & 37 Parcel ID: 011-121-99 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA Cl Well log is filed with Onsite(or attached) Well production at time of test 3.2 gpm Date drilled Water storage tank volume n/a gallons Total depth ft Well disinfected for coliform test? ❑Yes ❑D No Cased to ft U Coliform bacteria is Negative Q Sanitary seal is functioning correctly Nitrate mg/L U Nitrate less than MRL(ND) 0 Wires are properly protected Arsenic ug/L ❑Q Arsenic less than MRL (ND) Casing height(above ground) 18 in. Collected by PES Date of flow test for COSA 2/8/19 Date of Sample 2/8/19 Static water level at beginning of test 117.6 ft. Comments No Well Log B. TANK DATA C. LIFT STATION Age of tank(s) 47 years ❑ Required maintenance completed Tank type/material Septic* Age of lift station years Measured operating fluid level in septic tank * Lift station material n/a ❑■ Standpipes/foundation cleanout per record drawing Comments: *Concrete Tank, Tank pumped prior to Date of pumping 2/1/19 test. Foundation clean out present D. ABSORPTION FIELD DATA 7/86; 10/72 Which system tested (date installed) 10/72 Adequacy test date 2/8/19 ❑D ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade 14.5 ft(max) Fluid depth prior to test 30 in Measured depth to pipe invert from grade 7.0 ft(min) Water added 450 gal ❑ N/A—pressurized field 47 New depth in 0 Monitor tubes go to bottom of effective. If not, state Elapsed time 140 min depth into effective IDCode-requiredsoil cover over field Final fluid depth 42 in Absorption rate >=450 gpd CI System presoaked n/a (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: 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' 95* Community Sewer Manhole/Cleanout>100' ❑Yes if No ft ✓Q Yes if No ft Neighboring Tank> 100' 0 Yes if No ft Private Sewer/Septic Line > 25' lE]Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields> 100' Animal Containment>50' ✓❑Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage> 100' Community Sewer Main > 75' ❑✓ Yes if No ft 0 Yes 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' Q✓ Yes if No ft Property Line > 5' ✓l Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells >200' 0 Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below ** Property Line> 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells> 100' D Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells>200' ❑✓ Yes if No ft Surface Water> 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *Acceptable in 1972.** Waiver on file for Crib separation to lot line, Trench is 10'+. Drain field 30-40% used, Crib is dry. G. ENGINEER'S CERTIFICATION OF I certify that I have determined through field inspections and review e 4 of Municipal records that the above systems are in conformance with */49 M. i' '%* MOA COSA guidelines in effect on this date. .. , . • ..Steven -t annope • CE 8149 I • • . .• COSA Checklist yellow sheet Municipality of Anchorage ` =_ On -Site Water &Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel LD. 011-121—.Expiration Date: 1. GENERAL INFORMATION Complete legal description HIDDEN HILLS: BLOCK 1 L01536 3� Location (site address) 7900 LUCY STREET *ANCHORAGE AK 99502 Current Property owner(s) ZANE DOTSON Day phone 243-6178 Mailing address 7900 LUCY STREET *ANCHORAGE AK 99502 Real Estate Agent MARGARET TOVREA W/ PRUDENTIAL Day phone 563-5500 2. TYPE OF DWELLING: E Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: 1`> Date:1 ✓A COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Ll" I b hh Date of Payment Si 13 r.!`'' Receipt Number COSA # 05)f t -j y Waiver Fee $ Date of PaymenttJ Receipt Number (a (�!l Waiver # a j o' a 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 1 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 Address GARNESS ENGINEERING GROUP, Ltd. 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: r_ , In conducting this evaluation, GEG, LtD. attemped to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phofle' 337-6179 Date _Ah bedrooms, with the following stipulations: Original Certificate Date: -6 — ) fo ) The Nrunici4afiVOI Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: - -, COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 111/05) Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: _HIDDEN HILLS: BLOCK 1, LOT 36 Ov 3 2 Parcel ID: 011-121-64' 99 A. WELL DATA *PER GEG INSPECTION **PER SURROUNDING WELL LOGS Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed PRE -1972 Sanitary seal (Y/N) YES Total depth * 140'+ ft. Cased to **40'+ ft. FROM WELL LOG Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION Date of test NO WELL LOG 4/17/13 Static water level ft. 115 ft. Well production g.p.m. 7.55 g.p.m. WATER SAMPLE RESULTS: Coliform��770 colonies/100 ml. Nitrate&L0_ mg./L. Collected by: GEG. Ltd. Arsenica• a9-1g./L. Date of sample: 4/17/13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/CONCRETE Date installed 10/30/72 Tank size 1250+ gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 10/3/12 Pumper AK SEWER AND DRAIN C. ABSORPTION FIELD DATA *BELOW EXISTING GRAD TESTED 1986 TRENCH. CRIB DRY. 7/1&/86 Date installed 10/30/72 Soil rating (g.p.d./ft or /bdrm 50/85 System type TRENCH/CRIB Length 30/12 ft. Width 2.5/12 ft. Gravel below pipe 8/**6 ft. Total depth *_14.50 ft. Eff. absorption area480 **288ft' Monitoring tube YES Depression over field NO Date of adequacy test 4/22/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 2540gal. New depth 65 in. Elapsed Time: 910 min. Final fluid depth 20 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — **PER FIELD MEASUREMENT OF CRIB D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Manhole/Access "Pump ofP Ilevel High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot *50'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manholetcleanout N/A Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Properly line 5'+ Absorption field 5'+ Water main N/A Water service line 102+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1986 TRENCH/1972 CRIB Property line 10'+/**1' Building foundation 10'+/10'+ Water main_ N/A Water service line 10'+/10'+ Surfacewater 100'+/100'+ Driveway, parking/vehicle storage 1Q'+/10 + Curtain drain NONE KNOWN Wells on adjacent lots 100'+ 100'+ F. COMMENTS *ACCEPTABLE PER 1972 CODE. **SEE ATTACHED WAIVER REQUEST 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 COSH guidelines in effsd on this date. Engineer's PrintedN m� JEFFREY A. GARNESS Date 5763 (Rev. 11/05) OF A. Garness; 53 s- April 23, 2013 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Lot Line Waiver for Hidden Hills Subdivision; Lot 36, Block 1, To whom it may concern: During our inspection it became apparent that the reserve system was less than 10 feet from the property line. The as -built survey confirms a distance of 7 feet from the property line. The crib is 12 feet wide per the inspection report. Therefore, we assume the drainfield is approximately 1 foot to the property line We request that your department issue a 1 -foot lot line waiver from the east property line to the existing drainfield. The existing system has functioned this way for 35+ years without any apparent problems. I am unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If you have any questions, please contact us at 337- 6179. Thank toVAr your assistance. M.S. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 hftp://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program meat 4. O. N Department **** VARIANCE/WAIVER REVIEW **** Waiver#: osp131082 COSA#: osc131174 Permit#: PID#: 011-121-99 Legal Description: Hidden Hills B-1 L-36&37 Engineer: Garness Engineering Group Applicant: Zane Dotson Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 1.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: " / 3 Approved by: ............................................ :..y ". .�?: .................. Rec#: 099618 Amount: $200.00 Date Paid: SM13 **** VARIANCE/WAIVER REVIEW **** /_L2s IS Zee p RU I Al 0- AAVE0 0F•ALQ 1I' Yy ORIUEWAY R. L. Bueon o T� IP,F '.• LS -1192. ' . kl sr 66 • J AW m ' il9FOp°j•..«...•••�05 � O�R�FES519NA1.L� j / C)% s13'c� L�T 29X 37. STA NO. FfcES 1 _. �Lf � � e !!913 S.F. m LOT O P-�Q�6 5 2y es n �' 7 Pn2 ,- /_L2s IS Zee p RU I Al 0- AAVE0 0F•ALQ 1I' Yy ORIUEWAY R. L. Bueon o T� IP,F '.• LS -1192. ' . kl sr 66 • J AW m ' il9FOp°j•..«...•••�05 � O�R�FES519NA1.L� j 30= 30° at3(o�37, Block / Hidden Hills Suf di vision nchoroge Recording District, AlaskaEasements of cord other than those shown on (70- 338) record plat of record am not shown hereon unless, othere[ee noted. LOT SURVEY CERTIFICATION LEGEND hereby asrtlty that I hove surveyed the property Chown and described 0 Bross or Aluminum capped monument recovered mant and that the improvements situated hereon are within the prop- oIron pipe and/or rebar recovered- ! Ilnes and do not overlop or ener6aeh on adjocent property and that ❑ 2x 2 hub rx tock recovered lnpravaeMfc on adjacent property overlap or encroach oa the premises a 5/8° x 50° rebar set this survey iueetlon and that them are no roadways, afll[ty tines, or ether visible x Fence Line (Approx. L=ction ) eemerte on said property except ac Indicated hereon. cEe /,I, 4OR. L. BUT7*OAI p Oto /�- o - Prepared by: Registered Lard Surveyor L (907/279-6200 519W Eighth Ave. Anchorage AlasM9a50/ VV t 2222 F.B. No�-/ZCO I Property Of:Claul font f zpnf SofJon I ll._...1 Lo". 34, 2 ii, J, 1. iliddon j.;; yl C."w, Lot 330 Blk 1 - Hidden hills 0 - 36' sand Gravel 36 w 72 Gravel 72 a 96' band Gravel. 96 - 123 Clay Gravel 1.23 - 160' Graven. 1.60 a 170' Fine S7.lt Ga,nd 170- 7.75' t:oux:se Gravel with water 175' of 6" casing. Bailed 10 GPM 30' water in well Anclaor Drilling G v`__ As wArER WELLS GGi W e 117(1 Avrill, min / AtIC)" rngc, ALlsk,l 99502 WE LI CONS i R LIC r k 01 1. OG _ I,oJmno raL 36d O.19U 6 �3J od d 6.t� . 0 i if iiq: Cc._ ._.__. .��_{,[—_ USGS na. Otlilet _Type of sip G!�"C .,.4�� C _Ogle well / Well owner .. e ommnu i (y Well 10111 Jot' (a Ad l est K Ie Cal de 5 c ipl ion).—_--___— Location sketch os Iemei k DePlh al ac ll,,,,�.i �-�_._.I!, Gating AO RIII�L_I__1 1. 6inm,—,t��in. Static xalel I•vcl�`'s,_.—II. (a llov^D, Ne lux) san0 sus lace, Da to ___L2S �� I`� F rnisli 01 Bull: (ope n_cnil, scl co n, pcf i ora tell, ores he le, of lid r) Ile SCIlhc int cl vats sell y 1 ltl les lett 1'Y U:bmpi jig, Lai ling, air) at,�\ f oI _._/.,,__,.UDUIs •1111 It. of draw tl own Isom sWt is Ie YI'1, DRILLER'S MAURIAL LOG it pth oc lGn IanJ Give Ile SCIIon (iDI slr, la .ui lac[ In tact p Ve nat ra ted nia l e is 1, calor, h, nl u'ss DI III i I IinQ, anA walar con l G I,I rl - _....�,-...I a ...... _.. _.........._ ._-.....-----.____ ._ . 7_Y5: II MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES R Division of Environmental Services 14 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. # QLl 1 \ - I HAA # _1�ig 1. GENERAL INFORMATION Complete legal description Location (site address or directions) -7 R 0 0 L Property owner, —� �a L °'� Day phone %l 3 Mailing address 77 6-0 Lending agency !- N i3 ' Re 14 4+f 44- 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 t 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_ Holding tan1C' Community on-site I t... 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 f Lza vow pBe (L6/1 A9H) 9ao-ZZ •ilaoM s�aeuibua leuoissa;oid ay, ui suolsslwo ao saoaaa ao; elglsuodsaa IOU si aBeaopuy ;o Aj!jediolunN eye, ponssi sl aleolipoo a aaojeq elep azAleue ao suopedsui lonpuoo }ou op SHHa;o s99Aojdw3 sluawaimbei alels pue jeaapa; uleuao �4siles olaapio ui suollnipul Buipue logl pue sawoy;o saasepind of Asalinoo a se slylsoop SHHa ayl TNsely;o alelS ay> ui paaalslogi aaauiBue leuolsse;oad luapuadepui ue Ag anoge g gdeaBeaed ul uanlb suollejuasaadaa eyl uodn Aluo peseq saleoillpoo lenoaddy Aliaoylny ylleaH sanss! (SHHa) seoinaaS uewnH pue U11e9H {o luawlaedaa 96eaogouy;o Al!ledlolunw aUl � r v :suollelndlls Buimollo; ayl Ul!M .'swooapeq ao; lenoidde leuoll!puoo r , . panoaddesiQ _...... 'swooapaq _ JO; panoaddy ..._ x.. z®tea®e\ 3unIVNCJIS SHHO ._. g .® yiao�ss3." ®e �� Szzz ao �' . •e J� .d� �_ _ . PUDIIin gueago • yd ri • •• ••.0..• •• Sol ..t �} moo �`�Z �z�.eo. rc,,��{••� � �.. E�rI,1 \` 1. r'� . �.j -_ __ .. �., � ...\ � .1 .,, - z SILL _ . ala •.0 aa.n;eu6is sA9ulbu3>. ssaaPPV b E-auoud waif }o aweN _... . ii, •uolloedsul slgl;o alep ay; uo loage ul suollelnft pue 'seoueulpio 'sopoo alelS pue ledloluny4 jle y;inn eouelidwoo ul el wa}sfs lesodslp aalennalsum ao/pue Alddns Jelem ails-uo ayl'uolloedsui pue uolleBllsanui ALU woe; pue sell; aBeaogouy;o Al!led!o!unyj ay; woe; paulelgo uollewao;ul ay; uo peseq legl A;laan aaulan; I •ulajeq poleolpul ainlonjls;o ads j pue swoapeq;o aagwnu ay; ao; alenbepe pue leuolloun;'a;es sl walsAs lesodslp aalemalsum io/pue Alddns aalem ails-uo ay; leyl smous uolleolldde lenoaddy Aliaoglny ulleaH S1141 ;0 uolleBllsanu! Aw leyl A;!Jan I 'Molaq unnoys alep uollep!len ayl;o se pue o}aaay poxi;;e leas ALu Aq pal;lvoo sy t133NIJN3 AS NOLLOUSNl d0 LN3W31b1S 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: _ e, 1 [it -C!'! I A t (4 5, Parcel I.D. 0/1 —of - 1— 6 1 A. WELL DATA Well type Z If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N)_ Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level — Date completed ppr-Q-- /17?_ Driller Cased to Casing height �� r w� �r)tx-- FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot (?6 ± Absorption field on lot I Wires properly protected (Y/N) AT INSPECTION g.p.m. g.p.m. ; On adjacent lots _i /0Z0 ; On adjacent lots Public sewer main _ �'4/A Public sewer manhole/cleanout Sewer service line >4,�2__G Petroleum tank WATER SAMPLE RESULTS: Coliform yl/ Nitrate __ �f ;�_ Other bacteria Date of sample: 1/�P Collected by: ya 13. SEPTIC/MOLDING TANK DATA Date installed /3OL72 Tank size _15)°-0 Compartments Cleanouts (Y/N) I . Foundation cleanout (Y/N) x Depression (Y/N) N High water alarm (Y/N) / N% Alarm tested (Y/N) Date of pumping If R Pumper _o T , Cc, o4e ,r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wel I(s) on lot L —On adjacent lots ! �r� Foundation -fib To property line _Z�Q Absorption field _Water main/service line _ i 50 Surface water/drainage N /0 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION N/ Date installed Size in gallons Vent(Y/N) High water alarm level — "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: liIV[al[.Ti7ren D. ABSORPTION FIELD DATA On adjacent lots "Pump off' level at Cycles tested Surface water . Date installed �(� Soil rating System type Antirc Length 30 Width Gravel thickness r Total depth �• '4' Total absorption area 171R-0 Cleanouts present(Y/N) Depression over field (Y/N) Date of adequacy test Z_ Results (pass/fail) for 2S bedrooms Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: If yes, give date Well on lot /u91�5 On adjacent lots > i Property line To building foundation -50 To existing or abandoned system on lot On adjacent lots > ✓50 Cutbank 160 Water main/service line. 33 qD t Surface water % 1:5'0 Driveway, parking/vehicle storage area Curtain drain N E. ENGINEER'S CERTIFICATION 50 l certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name 0 w_ .p Date HAA Fee $ /7b `6'7� Waiver Fee: $ Date of Payment 4—;?- 7`ii Date of Payment Receipt Number Z?2 (i� 7C/�2`!) Receipt Number