HomeMy WebLinkAboutBOB WELLS BLK 1 LT 6Bob Well
Block
Lot 6
#067-042 -06
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231401
Work Type: Septic Initial
Tax Code Number: 06704206000
Site Legal Address: BOB WELLS BLK 1 LT 6 G:0363
Site Mailing Address: 26020 LOG CABIN CIR, Eagle River
Owner: LUNDEEN JEFFREY E & KETRA K
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
�,
Department
12/15/2023
12/14/2024
64719
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
-Ra a : Zs�> /�,/ 40
Issued By:
Date:
Date: Z�S�zOZ 3
2
��Municipality of Anchorage
Department
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV231062 COSA#: Permit#:OSP231401
PID#: 067-042-06
Legal Description: Bob Wells Bilk 1 Lt 6
Engineer: Garness Engineering Group
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 foot.
This waiver approval applies to the proposed 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.
Waiver is Granted: X Waiver is not Granted:
Date: l Z�S/Zzj Approved by: o
Name of Revipr
......................................................... ■ ................. ■ 1
**** VARIAN C E/WAIVER REVIEW ****
IVIOUNICIPALITY-OFANCHORAGE
Development Services Department %= Phone: 907-343-7904
On -Site Water & Wastewater Section, 3_
Fax: 907-?�•� � 7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 067-042-06
Propertv owner(s) JEFFREY & KETRA LUNDEEN C/O ARM SEPTIC SERVICES Dav phone 907-688-9433
Mailing address 26020 LOG CABIN CIRCLE, EAGLE RIVER, AK 99577
Site address 26020 LOG CABIN CIRCLE, EAGLE RIVER, AK 99577
Legal description (Sub'd., Block & Lot) BOB WELLS; BLOCK 1, LOT 6
Legal description (Township, Range & Section)
Lot Size
Sq. Ft. Number of Bedrooms 1 (SEPTIC SIZED FOR 2)
APPLICATION IS FOR:
APPLICATION IS AN:
(2 all that apply)
Absorption Field
0
Initial ❑
Septic Tank
0
Upgrade ❑
Holding Tank
❑
Renewal ❑
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
TYPE OF DWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D)
iviuiupie Dweiiings
(SF and/or D)
rlie}-ance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: S Waiver Fees: 0 S \(2 3 I O6 2
Date of Payment: 11 Z 2-J Z-� Date of Payment:
Receipt Number:
Permit No. OSP 'L S l Y o /
Receipt Number:
Waiver No. $ ZZ 5
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
❑ ADU ONLY
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231401, Deb Wockenfuss, 12/15/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231401, Deb Wockenfuss, 12/15/23
•,�.. . -' a •' •
SYSTEM
DESIGN CRITERIA (REVISED):
NUMBER OF BEDROOMS: 1 (SEPTIC SIZED FOR 2)
GALLONS PER DAY (GPD): 300
PERCOLATION RATE/S: <1 MINUTES/INCH
PROPOSED APP, RATE: 1.0 GPD/SQ.FT.
MINIMUM DRAINFIELD SQ.FT.: 300
DRAINFIELD DESIGN (REVISED):
MAXIMUM EXCAVATION DEPTH: 8 -FEET
MINIMUM EXCAVATION DEPTH: 7 -FEET
WIDTH: 5 -FEET
LENGTH: 2 Oa 30 = 60 -FEET
M.O.A. APPROVED FILTER SAND: 2.2 -FEET
EFFECTIVE: 0.5 -FEET
ACTUAL SQ -FT.: 300
NOTE: CONTOURS SHOWN ARE
FROM THE MOA GIS MAPPING
j AND ARE 5 -FOOT INTERVALS
HAVE THE EAST AND SOUTH
LOT LINES FLAGGED BY A
REGISTERED LAND SURVEYOR
PRIOR TO CONSTRUCTION.
GEG, Ltd. HAS AN 8 PAGE SPECIFICATION LETTER
THAT PERTAINS TO THIS DESIGN. BY PROCEEDING
FORWARD WITH THIS INSTALLATION, THE }
ENGINEER, WELL DRILLER, CONTRACTOR AND
PROPERTY OWNER AGREE THAT THEY HAVE
READ THESE SPECIFICATIONS AND AGREE TO
ACCEPT THE TERMS AND CONDITIONS OUTLINED.
25' UTIL
Sy O` ESMT.
I
r
/
RESERVE SITE DESIGN CRITERIA:
NUMBER OF BEDROOMS: 1 (SEPTIC SIZED FOR 2)
GALLONS PER DAY (GPD): 300
PERCOLATION RATEIS: d MINUTESBNCH
PROPOSED APP. RATE: 14.0 GPDISO.FT.
MINIMUM DRAINFIELD SQ.FT.: 75
'USING CAT 11 AWINTS APPUCATION RATE
RESERVE SITE DRAINFIELD DESIGN:
MAXIMUM DEPTH: &FEET (7 -FEET MINIMUM)
WIDTH: 5 -FEET
LENGTH: 15 -FEET
M.O.A. APPROVED FILTER SAND: 22 -FEET
EFFECTIVE: 0.5 -FEET
ACTUAL SOYT.: 75
JNVALL•F+Lbw*�S' TT
i' col
.'• : : �� COI .•—_—.
J co /
TH#1
PROPOSED DRAINFIELD.
SEE DESIGN CRITERIA.
DURING PRE-CONSTRUCITON
LAYOUT, ENSURE 30'+ TO TOP
SOF ROAD DITCH CUTBACK ,
WELL RADIUS
(WELL APPEARS
UE INACTTIVE)
INST
/�--RESERVE SITE.
WILL REQUIRE
(
AWWTS. SEE
I
RESERVE SITE
I
DESIGN
1
a`r I
�tQ(1d�X
PROPOS M-1060
INFILTRATOR OR,'
INSTALL
-4f 1000 -GALLON GR&R
FOUNDATION
SEPTIC TAN
CLEANOUT
JNVALL•F+Lbw*�S' TT
i' col
.'• : : �� COI .•—_—.
J co /
TH#1
PROPOSED DRAINFIELD.
SEE DESIGN CRITERIA.
DURING PRE-CONSTRUCITON
LAYOUT, ENSURE 30'+ TO TOP
SOF ROAD DITCH CUTBACK ,
WELL RADIUS
(WELL APPEARS
UE INACTTIVE)
INST
/�--RESERVE SITE.
WILL REQUIRE
(
AWWTS. SEE
I
RESERVE SITE
I
DESIGN
1
a`r I
�tQ(1d�X
00 1
�LctD\ti4S
�_
\ SEE CROSS-SECTIONAL~
.\ DRAWING, PAGE 3 OF 3 \\
♦
PQ
,♦ SE,,..... a
ENGINEERING „ SALES CONSULTING
3701 E, TUDOR ROAD, SUITE 101'ANCHORAOE, ALASKA' PHONE (907) 337.6170' WE801TE: www osM##wnon"".tam
PREPARED FOR: JEFFREY & KETRA LUNDEENPHONE NUMBER: PAGE NUMBER:
C/O ARM SEPTIC SERVICES 907-688-9433 2 OF 3
PROJECT/LEGAL DESCRIPTION: DRAWN BY:
BOB WELLS; BLOCK 1, LOT 6 J.L.M.
TYPE OF WORK: DATE: REVISED
REVISED DESIGN FOR NEW SEPTIC SYSTEM 6/24/24
c...
I� rey A` arness Ul AV
�1�'JW C -79F53
LICENSE M%%� ESS,���•
#AECC884 %%Ik
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231401, Deb Wockenfuss, 12/15/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231401, Deb Wockenfuss, 12/15/23
LOT 5
;
;
;;;;;
;
;
;
;
;;;;
;
;;
;
;
;
;
;
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
O
H
U
OH
U
OH
U
OH
U
OH
U
OH
U
℄ LOG C
A
B
I
N
C
I
R
C
L
E
℄ E
A
G
L
E
R
I
V
E
R
R
O
A
D
LOT 4
LOT 1
LOT 1
BLOCK 2
50.
0
'
2
5
.
0
'
50
.
0
'
2
5
.
0
'
GRAVEL DRIVEWAY
25' UTIL. ESMT.
12.
5
'
25.
0
'
10' UTIL. ESMT.
E
D
G
E
P
A
V
E
M
E
N
T
GRAV
E
L
D
R
I
V
E
W
A
Y
W
S
S
S
SS
S
S S S
SHED
SHED
SHED
WOOD
SHED
N3
3
°
1
0
'
1
2
"
E
1
7
2
.
3
7
N0
1
°
3
0
'
0
0
"
E
1
4
8
.
0
0
L=22.23R=50.00
L =3 6.14R=5 0 .00
N75° 33'
3
3
"
E
1
7
3
.
8
7
L =5 3 .6 3
R =1 7 5 .0 0
N58°
0
0
'
0
0
"
E
7
6
.
2
0
L
=
3
8
.50
R
=
2
0
.00
N
5
2
°
1
6
'
5
0
"
W
9
1
.
7
3
L=201.17
R=1096.00
ADU
21
.
1
10.
6
20
.
4
44.
5
32
.
0
19.
9
11
.
1
16.
3
20
.
6
18.
9
21.6
1
2
.
1
10.
6
8.2
9.8
17
.
3
24.
5
3
1
.
2
1
0
.
3
8.4
9.0 7.0
1
0
0
'
W
E
L
L
R
A
D
I
U
S
4
8
.
3
3
4
.
4
84.
1
76.8
80.6
82
.
5
19
.
4
38
.
2
1
4
7
.
5
G
E
E
G
Lot 6, Block 1
Bob Wells Subdivision
64,719 Sq. Ft. +/-
26020 Log Cabin Circle
2 Story Log Home
& ADU
PREPARED BY:
FRONTIER SURVEYS, LLC
650 W. 58th AVE. SUITE E, ANCHORAGE, AK 99518
907-460-1686
DRAWN BY:
CHECKED BY:
DATE:
SCALE:
DRAWING ID:
SHEET 1 of 1
1.Excepting for gross negligence, the liability for this survey shall not
exceed the cost of preparing this survey. Dimensions to property lines
are plus/minus 0.1ft.
2.This document is created by Frontier Surveys for the purpose of an
as-built survey for ARM Septic Services, only.
3.This document is based on Plat No. 79-32, Anchorage Recording
District.
General Notes DisclaimerLegend
1. This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible
improvements and conditions at the time of the survey. This document does not constitute a boundary
survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the
responsibility of the Owner to determine the existence of any easements, covenants, or restriction
which do no appear on the record plat. Under no circumstances should this document be used for
construction or for establishing a boundary or fence line.
PS 1" = 40ft
09/20/2023 23-367KC
Scale 1" = 40'
AN AS-BUILT SURVEY OF
LOT 6, BLOCK 1
BOB WELLS SUBDIVISION
26020 LOG CABIN CIRCLE
CONTAINING: 64,719 Sq. Ft. +/- (RECORD)
RECORD PLAT: 79-32
Gas Meter
Electric Meter/Outside Power
Deck
Septic
Telephone Pole
Fence
Overhead Utility
Water Well
G
E
S [
W
Culvert
Sep 20, 2023
R
E
GISTEREDPROFESSIO N A L L A N D S U RVEYORPierre M. Stragier
No. L.S. - 9812
Municipality of Anchorage :..'.."
Development Services Department :,~,~" =r':-
Building Safety Division
On-Sde Waler and Wastewater Program. 4700 Bragaw St, '
P.O. Box 196650 Anchorage. AK 99519-6650 Page J of~
www,ci.anchorage ak.us (907) ~43.7934
o.-s~,E W^STm^TE. D~sPos,, S~'STEM
Permit Number: 5~0~ ~?d PID Number:
"'~h,~i~.~ ~.~/7 WastewaterSystem: DNew ~Upgrade
;~ z¢&h,,,~ ~,~r,~qs zzL~/ ABSORPTION FIELD
~~ ,, ~.L~'~,~ 1~1~-07
SEPARATION BISTANOES ~s~t,~ D
Tank Fiald Sta~on Tank S~r Dne
,-- q7' '--'-'
~ ' ~ Engineering . _.:~. ~..
Devel~mept Se.ices Dep,~ent Approval
Conditional Approval~/~ ~. ~ Date:
P£RMIT NO. SW070276 PAGE 2 oF 3
DEPARTMENT OF HEA~.THAND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
· P.O. Box 196650 ~_Amchor~geo A_losk: 99519-665? · Te, l.e~hone:. 343-4744
ON-SITE WASTEWATER DISPOSAL ~YSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 6, BLOCK 1, BOB WELLS S/D
LOT 1
P.I.D. NO. 067--042--06
100' WELL RADIU
APPROXIMATE LOCATI(
LOG
00' WELL RADIUS
a, PPROXIMATE LOCATION)
100' WELL
XIMATE
TRENCH
& DBL2
NEW 9000
'SEPtiC TAN~
100' WELL RADIUS
~,PPROXIMATE LOCATION)~
LOT 1
SETBACK FROM SLOPE 25X+
%,
P£R.~iT NO. SW070276
P~C£ 3 OF 3
MuniciDal. itv oF Anchor'aae
DEPARTMENT OF'HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
· P.O. Box 196650 SAnchoroge, Al_~sk~ 99519-6650 · TeJ.ephone, 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL NSPECTION REPORT
L£O^L LOT 6, BLOCK 1, BOB WELLS
P.I.D. NO. 067-042-06
ST1 ST2/84.3'
G~NEW 1000 ~
~0"5'~ I GALLON I''8°'1'
I SEPTIC TANK J
MT1 =84.9'
FINAL GRADE/
MT1=72.8'_/
MT2=73.9'
'~-- C02=79.8'
N. T. $.
, NO WATER FOUND~'~F
8 .8' ..o...
~-;--~;-.~-~
A B
FCO '2.0' 4.0'
C01 74.5' 69.5'
ST1 56.5' 81.0'
ST2 56.0' 84.5'
DBL1 54.0' 85.0'
DBL2 52.5' 85.0'
MT1 47.5' 86.0'
C02 52.5' 102.5'
MT2 50.5' 101.5'
I hereby, certify that'I h~-e ~ey~ .~ followt~'
~chomge Recording i~eln{ lhika, ~ndtlt t~
~p~ve~a~ situa~d,t~on ~ within thc prope~y
~mg ~a}ac~nt th~eto, ~ no ~pr~em~n~ on
t~y l~ing adjacent tho~ ~m~ on tho prem~ in
~ueshon a~ thai t~,n~ a~ no r~way& ~n~i~ton
~m~s~r o~er va~ble *ssements ~ said prop~ ex.pt
Phone 6~-2543
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/VVELL SUBMITTAL COMMENT SHEET
To: Bob Shafer
Legal description: BobWells Block I Lot 6
r-lPermit [--~C.O.S.A. [~]lnspection Report
The attached paperwork has been reviewed and is being returned for the following reasons:
1. Additional fill to be placed over tank by 6-1-08.
2. Excavator- No DNL.
Name of reviewer: Jeff
Date: February 21, 2008
Please supply the necessary information and re-submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program . . A \ /_~- -
P.O. Box 196650, Anchorage, AK 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT ~,\\
Initial
Date Issued: Oct 04, 2007
Expiration Date: Oct 03, 2008
Permit Number: $W070276
Legal Description: BOB WELLS BLK I LT 6
Design Engineer: 0003 S & S ENGINEERING
Owner Name: CHRISTINA HANSEN
Owner Address: 26020 LOG CABIN CIRCLE
EAGLE RIVER, AK 99577-9631
Parcel ID: 067-042-06
Site Address: 026020 LOG CABIN CIR
Lot Size: 64179 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] DisposalField [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DaD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special previsions.
THE ENGINEER NEEDS TO DO AN ADDITIONAL PERCOLATION TEST PRIOR TO CONSTRUCTION OF THE
SEPTIC FIELD. THE PERCOLATION TEST PROCEDURE IS TO FOLLOW TABLE 3-8 OF THE EPA DESIGN
MANUAL. PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE AS-BUILT INSPECTION REPORT. IF
THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE SYSTEM WILL STOP PENDING
ON-SITE REVIEW AND APPROVAL. ~.,~ I0/$~? ~
Received By;. ~ Date:
Issued By:. ~ ~/O~'_ ~~...~ Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.munl.org/onsite
(907) 343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Property ownerCs).~'~/';sTL'''''/~ ~/'~ ~/q Day phone
Site address
Legal description (Sub'd. Block & Lot)
Zip Code
Legal description (Township, Section & Range)
LotSize ~,,. I'~Q~ Sq. Ft.
Number of Bedrooms
THIS APPLICATION IS FOR ([~all that apply):
Absorption Field [~
Septic Tank ~
Holding Tank []
Privy []
Private Well ~
Water Storage
THIS APPLICATION IS AN:
Initial []
Upgrade
Renewal []
I certify that th~ above inform~her cedify that .this application is being made for a
Single Family Dwelli~~al Codes.
(Signature of property o~e~,,~'/
Permit/Rush Fees:
Date of Payment:
Receipt Number,
(Rev, 11/05)
Waiver Fees:
Date of Payment:
~'////'~/Receipt Number,
ROBERT C. COWAN, P.E.
September 21, 2007
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 6; Block l; Bob Wells Subdivision
It is requested that you issue a permit to upgrade Ibc septic system to serve thc
existing tbrce bedroom dwelling on the referenced properlT. The existing system is ia
failure.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
Enclosure
· 577 ,
1" = 60' DESIGN SITE-PLAN
0
\
\
\
= 40'
C)
DESIGN
/
/
/
/
SITE-PLAN
/
/
/
/
/
/
/
/
(.no
/
/
/
/
/
/
/
/ /
/
/
/ /
/ /
/
// / .C~'~"~,//
/
1" = 10'
DESIGN J
~// /
PROFILE
Legal Desctlpllon:
2-
3-
4.
§.
6-
8-
g.
10-
11-
12-
13-
14.
15-
16-
10-
20-
Municipality of Anchorage
Developmen! Services Depafimen!
Oufldl,g Safely Dlvblon
On-Site Water e~ Waslewalef P~m,
47~ Soulh D~egaw SL
P.O. ~o~ 1~650 Anchorage. AK 99519-6650
~r=L~e~
{O0?) 343-?~4
Soils Log: I~ercolation Test
Slope
$11e Plan
rieedlng Dele 0ro$$ Tkne kiel 11,19 De~lh Io Walm Net D,op
w~ /~/~ o ~ ~"
~ (o ~" ~"
'tO" ~ I~" (~/0"
Time~' ' Time T~me
Date '
Date
Inspector Inspector Irt~pec[or
Comments T I ' Conditional Approval '
Date Sewer Installed Permit No. Septic Tank Size
, HO
Idlng Tank
Soll~ ~tlno ~,11 To~b~orCtlon~m~ ' ~ t ~ll ~ ~,¢~lv~d '
Well to Tank ~ t _
APPLI T FILL OUT LOWER HALF ONLY
'Pr~Per~y ~Wn~r ~ ~ ~ C ~ r i ~g ~'~ ~ ~ ' Phone
Buyer ~ l~ ~/ /~.
Lending Institution ~~ F~-~ ~ ~1'~ r ~ ~ ....... ' ' Phone
Realty Co. , &Agent L = f k~'H ~- u ~sT~ ~ ~~ , ~'.., ~.e~~ . _ :~a' '~,- ~ · , ~-~ '1~ ~7~ Phone
StreetLocatlon E~ = ~O' ¢
Type~ Reeldence ~ ,
Mu t p e F~m~, ~ . No. of ~rooms ~
A~ACH WELL LOG. A well I~ Is required for all wells drilled since June
~ Community 1975. For wetl8 ~i~o~that~ gl~ ~l~t~t~g If
Q Public Utllty_ _ , , ~ .~,~ available.) ~r~, -~ f ~ [- ~' ~
~lndivldual ' Year Individual Installed: f ~ ' ~
~ Public Utility :- ' When Copnected to Pub lc Utility: ....
~ Holding Tank : : '
NOTE: THE INSPECTION FEE MUST ACCOMPANY ~CHREQUEST BEFORE PROCESSING CAN BE INITIATED.
GREH i ER ANCHORAGE AREA BOkvUGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME /'08 we//S MAILING ADDRESS -' /&'//c/'4 PHONE Gr 9/ "! ..37
LOCATION ' f � � /eiveQ edo. LEGAL DESCRIPTION1'1 N1(R\ W1 d��1NS14 �Iyti�"ti
SEPTIC TANK: /a/G / a'3 - / S i3 P/s)4'‘J�1
DISTANCE `���//%�
FROM WELL MANUFACTURER t
INSIDE LENGTH INSIDE WIDTH
MATERIAL
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY 4 ddG7 GALLONS.
CNfj�
SEEPAGE :
y
NUMBER OF PITS rg' ' DIAMETER OR WIDTH �, LENGTH_, DEPTH
LINING MATERIAL CRIB SIZE: DIAMETER44 DEPTHAZA •DISTANCE FROM: WELL /e
T ' veH V'. /4e Ai
GUi T// G / Seer-ewe(>1,erlve/
(2 A)0ri' 1-7I YC-•.
TOTAL EFFECTIVE !r C'
BUILDING FOUNDATION NEAREST LOT LINE /5 ABSORPTION AREA (WALL AREA) ! G' SQ. FT.
ADDITIONAL ABSORPTION
s r,f//eo fief re/0 )(e.
WELL:
TYPE ,i4 ///e.
BUILDING 1-1.
FOUNDATION i')(4/1-1"1147
CESSPOOL
CESSPOOL /1/fl ,
APPROVED
Glc// .�'�UC . o T') I ' "7 Ni
�) f- // a � S c_
CONSTRUCTION Algt DEPTH !� DISTANCE FROM:
NEAREST ' NEAREST SEPTIC 5-4 ! SEEPAGE
LOT LINE rSEWER LINE TANK W , SYSTEM /e""/
OTHER SOURCES
DISAPPROVED REMARKS FAA/ /1014.-S C.- fit w"O,9-flci;v 67,6 1,, 0 i),eop'
,}//P,eeX /5' T' revive li •
DISTANCES.
INSTALLED BY•
PIPE MATERIAL. nit his /
w/► ra�,�r- give IN Te«eg.
LOT SLOPE:
REMARKS• 5O17/ 7C r
o(7C jmb ?2
7 4 0 re /3- /ss;'
Form No. EQ -031
DIAGRAM OF SYSTEM
lee,lee,4, elf r 34x/
41 ifPlfvrl- /!/ ',atoll -int" frs
o.oreg
(. iuir�° pi PG
eieHer
1
/,®v"
e19i/.til SePii&
/4K'k A/0;14 eLeAN
3`
cletiw
,./ e e L /t -i) .
e" p,;,4
does
DATE
APPROVED
G.A.A.B.
NAME OF APPLICANT
GRr TER ANCHORAGE AREA B( DUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
MAILING ADDR SS
PERMIT NO
e:944:233
INSTALLATION LOCATION ?,;ei,5LEGAL DESCRIPTION S --z 7-/J9-/PkJ /011A-�5�4-
INSTALLATION OF: SEPTIC TANK e.... ----SEEPAGE /PIT DRAI 1Fi OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED ��ym /� " "" ^-�' ,Cr e ! - ��"'
FINANCED THROUGH/TO BE INSTALLED BY
•
SOIL TEST RESULTS
"(/Z zz� //Z V.) `[✓ NOTE THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE /0(2
L<` TYP
MINIMUM DISTANCES, REQUIREMENTS
SEEPA�EA SIZE
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT DRAIN Tt[tD ((J
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE PIT DRAIN FTE640
TO NEA EST LOT LINE.
WEL O SEPTIC TANK Zy
DRAIN FIELD
SEEPAGE PIT
/'CST
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, //13
SEEPAGE PIT
TO RIVER, LAKE, STREAM.
dor
41‘)/
DRAIN FIELD
/�" a
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS. ager?
GRAVEL BACKFILL 7Z G/ ‘LA
CONFORM TO BOROUGH REfdJJLATIONS REGARDING INSTALLATION.
G.A.A.B.
OR
LICENSED DESIGNER
774
GRAM OF SYSTEM
,1 P
/ Aoard
r I
400K
j
Ai
As
GJ
r
jg
+
•...
11,
r
/
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER AN HORAG AREA BOROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE
DESCRIBESYSTEM 1S IN ACCORDANCE WITH SAID CODE.
DAT�// APPLICANT'S SIGNATURE
FORM NO. EQ -016
/-/,q/v1/To A/ t)Ceorl r/..
0 8- E GEOTECHNICAL & DEVELOPMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 688-2280
Soils Ft Foundations Land Development
SOIL LOG
Performed for: Name: 8c 5 VVEe. s Tel. No.
Mailing Address:
Legal Description: NIA/'/ ,$E j4L, 5E Va , SEc 23, 7/4-A/, /Z / vV, S. W .
Depth (feet) Soil Chalacterjstics
0
1
2
3
4
5
6 J4 a -T V .c4N0 s- 6,641)E4, 21 c
6
7
8
9
10
11
12
/6
P- S 4/a SJ •6.2.41/A-- 4- / /�/9c6
Ground Water Encountered:
Yes
3 d rTd 1;7-
_
No If yes, what depth
Proposed Installation: Seepage Pit Drain Field 0 --
Comments:
/2
Performed by: " did j., Date: " , ,2 ?, /f 73/
EXCAVATION
ROBERT A. SHAFER
WORK,
April 2, 1982
CIVIL ENGINEER
694-2979
Pate Fitzhugh
c/o Aumiller
SRB 71188
% mile Badger Road
Fairbanks, Alaska
99701
[)ear. Mr. Fitzhugh,
Reference: Lot 6; Block 1; Bob Wells Subdivision
A sewer system adequacy test was performed on the system located on
the referenced property as you requested. The septic tank was pumped
and verified to have a capacity of 1000 gallons. The absorption trench
was tested for a two bedroom residence by a continuous flow of water
over a period of 24 hours. There was no adverse effect on the system
resulting from this test.
It can be concluded from this test that the waste water disposal system
is currently functioning adequately for the two bedroom residence located
on this property. However, the system cannot be guaranteed against
subsequent failures.
if we may be of further service, please do not hesitate to call.
Home Federal Savings and Loan Association
Lethen Investment Corporation
ATTENTION: Arnie Tigner
Municipality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA
............ _______L____ .................... JL ..............
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received January 26, 1976
l. Approval requested by: Peoples Bank and Trust Company
Mailing Address: Pouch 7007, Anchorage
Phone: 279-7511 x 42
2. Property Owner: Stuart W. Fitzhugh
Phone: 344-7423
Mailing Address: General Delivery, Eagle River
3. Legal Description: Lot 6 Block 1 Bob Wells Subdivision
4. Location:
Mile 7% Eagle River Road
5. Type of facility to be inspected Single Family No. of bedrOoms 2
Well Data: Individual
A. Type ~/~//~
C. Construction
B. Depth ~c~X'-~u~3 '
D. Bacterial Analysis
Sewage Disposal System: On-site system. Z'-~'~)~'~-~
A. Installed ~'P~- .~' B. Installer /~///,~/~ ~rC '
C. Septic Tank: 1. Size ~ O0 0 2. Manufacturer /-/J.~,~X 7-~
D. Seepage Pit: 1. Absorption Area .~7Z.2~ 2. Material
E. Disposal Field: Total length of lines
e
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
, Absorption area /~ /
, Other contamination
/-/~ ~ , Absorption area
, Sewer Lines
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Re ~st for Approval of Individual 'er & Water Facilities
Legal Description Lot 6 Block 1 Bob Wells Subdivision
Comments
Approved
~/,"/~.~. Disapproved Date o~
Approval ~.Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
EQ-034 (1/74)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO
2. Property Owner: STUART W. FITZHUGH
VA X FHA
MUNICI Li OF/ NCHORAGE
DE 6 t975
CONV
Mailing Address: General Delivery, Eagle River, AK
Name of Buyer: STUART W. FITZHUGH
Day Phone
Mailing Address.General Delivery, Eagle River, AK
4. Name of Lending Institution: PEOPLES BANK & TRUST COMPANY
Mailing Address: Pouch 7007, Anchorage, Alaska 99510
5. Name of Realtor or Agent:
Mailing Address:
Day Phone
Phone 279-7511 Ex. 42
Smiley's Realty--Rick May ~°~q-qqqS]
Phone 694-2114
Legal Description: Lot 6; Blk. 1 Bob Wells Subdivision
Location' Mile 7 1/2 Eagle River Road, Eagle River, Alaska .99577
Type of Facility to be inspected:
Individual Sewer & Septic Tank
Individual Well
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
No. Bdrms. 2
Individual X
If Individual, depth of well
Sewage Disposal System
Type of System:
If Individual, date of installation
Unknown
Public Utility
Unknown
Individual (on-site) X
EQ-037 (1 ~74)
NOT PROC~G$ LOAN
3330 "C"
o
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
Street, Anchorage, Alaska 99503 274-4561
Date Received December 1/, 1975
Time of Inspection
Date of In )n
REQUEST FOR APPROVAL OF ~l~
VA
Approval requested by: Peoples Bank and Trust Company
Mailing Address:
Property Owner:
Mailing Address:
Pouch 7007, Anchorage 99510
Stuart W. Fitzhugh
General Delivery, Eagle River
Phone: 279-7511 x 42
Phone:
Legal Description: Lot 6 Block 1 Bob Wells Subdivision
Location: Mile 7 1/2 Eagle River Road
Type of facility to be inspected Single FAmily No. of bedrooms 2
6. Well Data: Individual
A. Type B. Depth
C. Construction
D. Bacterial Analysis
7. Sewage Disposal System: On-site system
A. Installed
B. Installer
C. Septic Tank: 1. Size
2. Manufacturer
D. Seepage Pit: 1. Absorption Area
2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank
, Absorption area
, Sewer Lines ...,
Nearest lot line
, Other contamination
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
Pag.e'2 of two pa~s - Re st for Approval 6f Individual ' ~r & Water Facilities
.Legal Description
Comments
Lot 6 Block 1 Bob Wells Subdivision
Approved
Disapproved Date
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
~ L,v,e ' ~e ~a. ne
Date ~a~e ~ate
Insp~tor Ine~clor InSpector
~m~n~ ~( ~n~Itlonal Ap~oval
Date Sewer In~tall~ Pe~l~ ~0. ~tlC l~nk ~e ~ O0 '
~o.s ~tmg We:l To A~llon Area
APPLICANT FILLS OUT LOWER HALF ONLY
'""'
TyD8~ ~es~o~o
~Slngle F~mlly
wat~u~my ~ c ( I
~ Ina~vidua~ A~ACH ~ELL L~. A we~l ~g Is fe~u~ for 411 ~ellt drlll~ ~lnce June
~ ~blmc ~lmlty ~n ~nn~te~ to P~llc Utllmt~
~ HolUIn~ Tlnk
~OT~ THE IN~PE~ION FEE MUST ACCOMPANY ~CH REQUEST BEFORE PROCESSiN~ CAN ~ IN~TED.
CERTIFICATE
FOR A
0
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 ~~/'/~
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
OF ON-SITE SYSTEHS APPROVAL
SINGLE FAHILY DWELLING
Parcel I.D. 067-042-06
1. GENERAL INFORMATION
COSA#
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
BOB WELLS S/D; BLOCK 1, LOT 6
26020 LOG CABIN CIR. *EAGLE RIVER, AK 99577
CHRISTINE HANSEN Day phone
26020 LOG CABIN CIR. *EAGLE RIVER, AK 99577
Day phone
696-5556
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well · Individual On-site ·
Individual Water Storage [] Individual Holding tank []
Community Class Well [] Community On-site []
Public Water System [] Public sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family On-site wasteWater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEt'~{ENT OF INSPECT!ON BY ENGINEER
As certified by my seal affixed heroic 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 a;~posa! system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further 'eerier that based on the
h~formation obtained from t,~e Municipality of Anchorage files and fro,,m my investigation and inspection, t,he
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 instaflation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E: TUDOR ROAD, SUITE 101 * ANCHORAGE, .AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone
Date
337-6179
,', :ii ;, -';
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted 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 t,ffe
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 w,~atsoever.
DSD SIGNATURE
Approved for '~
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulatio[~¢~' OF
' VA~STEWATER
~,7~n" ....' ¢~ ~'
.*.V.L~Ch ~u, ~,~.
COSA Chec~,i~
Septic System Advisory
Well Flow Advisory
Arson c
Maintenance Agreements
Supplemental Engineer's Report
Other
(Rev. 11/05)
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.munLorg/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
t. GENERAL INFORMATION
Complete legal description L~t 6; I~lock 1; Bob Wells Subdivision
Location (site address) ~o020 Log Cabin Cir. £agle River, AK 99577
Expiration Date:
Current Properly owner(s) Chris,ne Hansen
Mailing address same
Day phone¢~6'55'~
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
B~an Brbdedck I Prudential
Day phone 227.7671
Unless othenvise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class ~ Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding Tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties sen/ed 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 ara 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 show~ below, I vedfy 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 vedfy 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 cedes,
ordinances, and regulations in effect at the time of installation.
· Name of Firm s& s Engineering Phone
Address ~ 5861 s. Birchwood Loop Rd. Chug~a~. AK 99567
Engineer's Printed Name Robert A. Sharer
5. DSD SIGNATURE
Approved for ~
Disapproved·
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ~ "]r~ - / '0
Municipality of Anchorage
Development ServiCes Department
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:
A. WELL DATA
Well ly;e ~1
Date completed ?
Total depth -~ ff.
IfA, B, or C provide PWSID # ~
Sa nitar'/s sa, _~) ~'~'..~
,l~Cased to
FROM WELL LOG
Date of test - o~u~-
Static water level - oDE-
Well production - UL3K- g.p.m.
WATER SAMPLE RESULTS:
,__ L Nitrate ~$m.
Coliform ~) .coloniesll00 m g
Arsenic: ~',O l) uglL ' dateofsample.'_~O
SEPT~C~.OLD~.OTANK~*~* / '
~.~ Typ,~,t~a~ ~ [/ %~L
Tank size /~O gal .: Numar of Compa~ents
Foundation cleanou~)
Dale of pumping
~B$ORPIIOR
We, too (V~ ~0 _,'
Wires properly protecte~N)
Casing height (a~ve ground) in..
AT INSPECTION
g.p.m.
Other bacteda ~) 'coloniesll00 mL
'Co,ected by: '~'~'1'~ ~"-~
Date Installed /~//E~//O~
'Cleanouts(~N)
Depression over tank (Y~) ]",}~,~ ~High water alarm (Y/~) ~
, umper
Date installed I~1i ~ IS/~"~Soil rating (gP.d.lft' or ft'/bdrm) ]o ~ system type ~~.,~
Length ~ ! fl. Width ~ fl. Gravel below pipe ~ t ft.
Totaldept~'l-'~` Eff. absorption area ii'It' Monitoriggtube ~[~ Depression'overfield ~0
Da~eofad~uacytes, ~/~/10 Results~a~ ~ For~ bedrooms
Fluid depth in abso~tion field before test ~ ~lin. ,' Water added. ~gal. New depth~ in.
Elapsed Time: ~ min.' Final fluid depth ~ In. Absorption rate >= ~+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (~ ~pe) ~ ~ If yes. give date ~
/
O. LIFT STATION ~
Date installed
'Pump on" level at
Datum
E. SEPARATION DISTANCES
Size in gallons
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
Animal containment areas
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
Building foundation ~' 'f
Water main f~ ]~
Wells on adjacent lots ~/~/'~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Property line ...~/'~' Absorption field
Water service line /~ ~ Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '/~) ~ Building foundation
!
Water Service line. /'~ -h Surface water ./
Curtain drain ,~gV,~ K/JO~/,,) Wells on adjacent lots ~"~
I certify that I have determine~h"h~ugh field inspections and
review of Municipal records that tt~,~ above sy~Efn~ are il~
Engineer's Printed Name ~"'~/~'4:~//,~/7(-~ '~/~7~'"'~/
Date ~"*~*/~ Z//0 /
/ /
COSA Fee
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
F. COMMENTS~.'~'~-c-- F~z~/,~.)
G. ENGINEER'S CERTIFICATION
Water main /~ ~
Driveway. parking/vehicle storage ;/~-
Jim Sullivan
688-2510
or
258-2510
745-2510
Fax 688-2543
N-° 10196
Alaska
CO.rETE w Distributor
P.O. Box 770197
Eagle River, Alaska
99577
NVVWA CERTIFIED PUMP INSTALLER
Payment due on receipt of invoice unless other arram
Customer Order No.
~me /~'
Address Z~? /~,. /~ ~...
Q~. Description Price Amount
~ .~ / ?... ~ :,; ~
~..,~ ~.~ ,/~
,eceJved in Satisfacto~ Condition
/~OTAL
· Please pay by Invoice. All ac, be
THANK YOU