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HomeMy WebLinkAboutSPRING FOREST BLK 1 LT 15 UBMITTAL Municipality of Anchorage Community Development Department APR 2 3 2018 Page 1 of 3 • On-Site Water&Wastewater Program 4700 Elmore St. •P.O. Box 196650 Anchorage,AK 99519-6650 •http://www.muni.org/onsite•(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181040 PID Number: 015-321-19 ❑ New "'Upgrade Name: JACOB DUNSTON ABSORPTION FIELD SOUTH/NORTH Address: ■ Deep Trench 0 Shallow Trench 0 Bed 0 Mound 6120 WEST TREE DRIVE*ANCHORAGE, AK 0 Other Phone: No.of Bedrooms: Soil Rating: Total Depth from original grade (205) 937-2231 4 0.8 GPO .Ft 10 (MAX) Ft. Depth to pipe invert from original grade: Gravel depth beneath pipe LEGAL DESCRIPTION SEE DWG. Ft *6 Ft. Subdivision: Block: Lot: Fill added above original grade: Gravel length: SPRING FOREST 1 15 SEE DWG. FL *36/35 Ft. I ownship: Range: Section: Gravel width: Beds Number of lines: Distance between lees SEPARATION DISTANCES 2.5 Ft - Number of Ft. Total absorption area. trenches: Dist.between tranches: TO Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines 852 SO.Ft 2 12+ Ft. , Well N/A N/A N/A N/A N/A TANK • Septic 0 S.T.E.P. ❑Holding 0 Other Manufacturer: 'Capacity: Surface Water 100'+ 100'+ GREER 1,250 Gal. Material: 'Number of compartments: Lot Line 5'+ 10'+ N/A STEEL 2 Foundation 10'+ 10'+ LIFT STATION Curtain Drain NONE KNOWN Manufacturer Ca.: -: Gal. Remarks: OLD SEPTIC TANK DECOMMISSIONED PER UPC PER 'Pump on level at: "Pump off level at: High water alarm at: CONTRACTOR:EASEMENT AND WATER LINE PROFESSIONALLY LOCATED:BOTTOM OF SOUTH TRENCH,TOP OF TANK, AND Pump Make Si Model: Electrical Inspections performed by. LINE FROM TANK TO FLOW-SPLITTER INSPECTED BY MOA ONSITE EMPLOYEE TIM ECKLUND.•DRAINFIELD DESIGN MODIFICATIONS PIPE MATERIAL VERBALLY APPROVED BY REBECCA CARROL ON 4116/2018. House to tank EXISTING/D3032 Tank to D3034 drainfield Installer WILCO EXCAVATION Drainfield D3034 CO/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Ft. Inspection Dates: 1st 4/17/2018 2nd 4/17/2018 Location and Description: 3rd 4/17/2018 4th 4/18/2018 BOTTOM OF TRIM AT SOUTH HOUSE CORNER ENGINEER'S S- L 4oaoo Community Development Department Approval oo � 0 Conditional approval: Date: 0� 4_ •. Oh i :* .t • . i?%\ '•�*QO D D p •..J• ; - •. Gorness v QQ49� ' • CE—' ' • �QQ Approved: afke.S CLLUQQDate: `� 21/11 �4pk-d•p �2.Q •tg=7 I LICENSE Q Ofess\O�o0 #AECC884 D�Ooo�4c::" Inspection Report_1-1-12.doc • ID C PERMIT OSP181040 RECORD DRAWING PARCEL NUMBER: 1 015-321-19 A B C __ WEST TREE DRIVE DBL1 17.8 19.7 52.1 „...------ - DBL2 18.6 19.7 52.0 -- _. ST1 19.4 19.8 51.9 -� ST2 28.4 22.8 51.6 APPROXIMATE LOCATION OF WATER LINE AND KEY BOX; _�__ DBL3 30.3 24.0 51.9 PROFESSIONALLY LOCATED BY WILCO CONTRACTORS AFTER INSTALLATION OF THE SEPTIC SYSTEM DBL4 31.3 24.6 52.0 FD 32.8 25.5 52.1 • • FS 65.8 34.1 20.9 CO1 64.5 34.0 25.7 . MT1 64.5 34.2 26.2 40 a CO2 96.0 67.9 53.1 MT2 95.6 67.3 53.1 CO3 75.7 43.0 18.3 MT3 76.6 44.1 20.4 C04 104.0 73.5 52.7 MT4 103.3 72.4 50.9 • 44/ z w WATER LINE LOCATED BY WILCO w CONTRACTORS AFTER CONSTRUCTION \\ w AND"SWING TIES"WERE PERFORMED BY _ 7z \ )- GEG;EASEMENT AND LOT LINE /, \ 7, p PROFESSIONAL LOCATED BY SHANE C�. \\ HOLT,PLS PRIOR TO CONSTRUCTION \ o 4 BEDROOM CO3- \ HOUSE ,, MT3 \ \ FS MT4 T4 B, 604 s �-�~~J IU .PATIO �' .��^_.CO2 / 11 MT // /// A ST1 i / ST2 / DBL1&DBL2 J „ ice/ NEW DRAINFIELDS (/ FD \ NEW 1250 GALLON \ STEEL SEPTIC TANK\/ � / \00 J / \ O DBL3&DBL4 % j / \ / t. % // \F /' / I `_ -. I 1984 TRENCH(FLOW DIVERTER INSTALLED FUTURE USE) SCALE: ri 1'=40' .,--.0401112444 ..��\\\t♦ ,I 1 �� P�•.OF 4 . •i GARNESS ENGINEERING GROUP, Ltd r '• �'-` * '• CIVIL&ENVIRONMENTAL ENGINEERS y ' 3701 E.TUDOR ROAD.SUITE 101'ANCHORAGE.AK 99507'PHONE(907)3374179'FAX(907)338.3246'WEBSITE www gam.Hen9ineemg corn �y •• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JACOB DUNSTON (205)937-2231 2 OF 3 ��G�`:, C '79 ss 5 •• : LEGAL DESCRIPTION: DRAWN BY: ••,��• ''•• (l��i(7 1$ems, SPRING FOREST; BLOCK 1, LOT 15 L.K.B. p'�O•�••'j(�. . P� •� TYPE OF WORK: DATE: LICENSE♦4II "" E-- AS-BUILT 4/20/2018 #AECC884 il.11111111:11%. PERMIT NUMBER: PARCEL ID NUMBER: OSP181040 RECORD DRAWING 015-321-19 FINAL GRADE=99.55-99.57 BOTTOM OF SOUTH TRENCH,TOP OF TANK,AND LINE FROM TANK TO FLOW-SPLITTER INSPECTED ST1 ST2 BY MOA ONSITE EMPLOYEE TIM ECKLUND A o TOP OF TANK TOP OF TANK AT INLET=95.57 AT OUTLET=95.51 NEW 1250 GALLON STEEL INVERT OF BUNG SEPTIC TANK AT INLET=95.14 (RATED FOR 10'MAX BURIAL) INVERT OF BUNG AT OUTLET=94.86 NORTH SOUTH TH#1 MT CO FINAL GRADE= ORIGINAL GRADE MT CO FINAL GRADE= TH#1 98.45-98.83 ©HIGHEST 98.79-99.03 POINT=98.4 FILTER FABRIC FILTER FABRIC INVERT OF INVERT OF PIPE=94.4 •• ••••••••• PIPE=94.4 'e:• C ••: ,e • 'e 12'+ 'e 'e 'e ie• , ,e i, BOTTOM OF BOTTOM OF gee TRENCH=88.4 TRENCH=88.4 • 1• (e ,e iI ,e • RELATIVE ELEVATION OF RELATIVE ELEVATION OF BOTTOM OF TH#1=82.4 BOTTOM OF TH#1=82.4 (TESTHOLE DRY ON 4/16/2018) (TESTHOLE DRY ON 4/16/2018) SS 406,10V III 4 ii GARNESS ENGINEERING GROUP, Ltd " 4,iI . , , •••, 411 . i� • • CIVIL&ENVIRONMENTAL ENGINEERS 0 3701 E TUDOR ROAD.SUITE 101'ANCHORAGE.AK 99507'PHONE(907)3376179'FAX(907)330-3246'WEBSITE www gamessengineaing corn 0 is. ••• 0 • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 '• -ff • A.G. ess .��W, Si JACOB DUNSTON (205)937-2231 3 OF 3 • 0 . E-7953 •�: LEGAL DESCRIPTION: DRAWN BY: IIl...• a; SPRING FOREST; BLOCK 1, LOT 15 L.K.B. ��j' �.Zo I' �'.� TYPE OF WORK: DATE: LICENSE• "' ESS\" ,4 SEPTIC TANK&TRENCH PROFILE 4/20/2018 #AECC884 k%%\ ' ' '- 30' 3UILT SURVEY 1" =01' _ `__,�_ -��__.� nD'V ?iart.e ..TN SSI ._-_-- ---`-'� _�__-�.r.__ REBY CERTIFY THAT I HAVE PERFORMED A SURVEY FO - -`- HE FOLLOWING DESCRIBED PROPERTY 15, BLOCK 1, SPRING FOREST SUB. /�' ORAGE RECORDING DISTRICT, ALASKA, AND THAT THE BLE IMPROVEMENTS SITUATED THEREON ARE WITHIN PROPERTY LINES AND NO VISIBLE ENCROACHMENTS T OTHER THAN NOTED. N 85 49' 48" 0 AT ANCHORAGE,ALASKA THIS_19 TH DAY OF W 138.17 PRIL , 2918. L = 4.53 HOLT WA*e NFl.aYTs 251�� .. N PFM A* WAIL * (I IS7-7O.7S N1DO1''M)41.1S13•'° HMP' V UNTION HEREON IS I 'ODE USE Of LENDING INSTITUTIONS SPEC (ALLY TO SHOW ANY • Z TS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/. EASEMENTS;AND IS BE USED FOL POSITICEQNG ADDITIONAL STRJ[TUES, MEOW S,OR FENCELINES. i FTS OF WOW.OTIEII THAN THOSE APPEARING OM THE REC. LAT,ME NOT 9CM 1(UNLESS 1NDICATEb) i FENCELINES THAT. Y APPEAR ON TOES DRAWING ARE NOT • BE USED TO DUMB*TY LINES ON POSITION'comma I1reovam 1FTS. 4, RIA NE SM M/REOM MY BE APPRONUMTE DUE TO EXC.•SIVE SNOW ND/OI ICE. / x // <E$ a CO pll '.." t. a NA lii AllV FSM 0 c e • Bo 0 o \1% ' ••,.../ Z ---Ola Z / 0 w 0 (A) e e ✓ o000000�. "Ae o/�P . ,;S s%�pp01 Bo ,e,. 49 TH o * 0 to 0 S �, fi� ., 'o Z pp± '. SHANE A.HOLT a)O� _ e ��� p a •. LS-6914 . . �i,e,: `--_�� .,.91-5.-- . 44��Aro,ees�ons, loo N 89 51' 13" E 27148---- =' p�00000� MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP181040 Work Type: Septic Upgrade Tax Code Number: 01532119000 Site Legal Address: SPRING FOREST BLK 1 LT 15 G:2538 Site Mailing Address: 6120 WEST TREE DR, Anchorage Owner: ALFORD-DUNSTON 2016 FAMILY Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 4/5/2018 4/5/2019 41555 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 pecial Provisions: Contractor shall locate water service line prior to beginning construction to confirm 10 foot separation to proposed tank and drainfields. R", se cis; c L ti -6 (2> 35 if f �f Received By: Issued By: �i f R ltC O d � 5 Date: t I t Date: Y/5 4 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site SeweNWell Permit Application For A Single Family Dwelling Parcel I.D. 015-321-19 Property owner(s) JACOB DUNSTON Day phone 205-937-2231 Mailing address 6120 WEST TREE DRIVE *ANCHORAGE, AK 99507 Site address 6120 WEST TREE DRIVE *ANCHORAGE, AK 99507 Legal description (Sub'd, Block & Lot) SPRING FOREST; BLOCK 1, LOT 15 Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: (® all that apply) Absorption Field Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: N/A TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: Oqio1G'� Permit No. Q�JL0 Waiver Fees: Date of Payment: Receipt Number: Waiver No. (Rev. 01 /11) qua_� __ e , GARNESS ENGINEERING GROUP, Ltd Advanced T. atmcnt S�—_ [em CIVIL & ENVIRONMENTAL ENGINEERS -- March 29th, 2018 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 i5 Ref: Proposed Septic System Upgrade for Spring Forest; Block 1, Lot To whom it may concern: The existing 4 -bedroom house is served by a community well and private septic system. The drainfield is in a state of failure and needs to be upgraded. One testhole was excavated on the property and the drainfield is designed around its 30 foot radius. All adjacent lots are on the community well. We are proposing to install a new 1250 -gallon steel septic tank and 5 -wide dual trench type drainfields. Comments regarding the design are summarized as follows: 1. SOILS: See the attached soil log shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface water concerns. 4. TOPOGRAPHY: As can be seen on the attached design drawing, the average topography around the proposed drainfield is less than 25%. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assist4ce. JbffrerynA.arne , P.E., M.S. Presid nt 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com DESIGN CRITERIA: NUMBER OF BEDROOMS: 4 GALLONS PER DAY (GPD): 600 PERCOLATION RATES: 8.5 MIN/INCH PROPOSED APPLICATION RATE: 0.8 GPD/FTI MINIMUM DRAINFIELD SQ.FT.: 750 FT' DRAINFIELD DESIGN: MAXIMUM DEPTH: 10 FEET WIDTH: 5.0 FEET LENGTH: 2 AT 40 FEET EACH (80 FEET TOTAL) EFFECTIVE: 4 FEET REDUCTION FACTOR: 0.5 ACTUAL SQ.FT.: 800 FT' APPROXIMATE LOCATION OF EXISTING SEPTIC TANK TO BE DECOMMISSIONED PER UPC APPROXIMATE LOCATION OF EXISTING DRAINFIELD PER CLEANOUT LOCATION GEG, Ltd. HAS A 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. 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. CONTRACTOR SHALL HAVE THE WATER KEYBOX AND WATER SERVICE LINE LOCATED PRIOR TO BEGINNING CONSTRUCTION EXISTING 3 BEDROOM HOME x NOTE: THE CONTRACTOR SHALL HAVE THE EAST EASEMENT & SOUTH LOT LINES, FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. PROPOSED 1250 GALLON STEEL SEPTIC TANK; N INSTALL DOUBLE CLEANOUTS BEFORE AND AFTER v TANK; INSTALL FLOW DIVERTER AFTER TANK PROPOSED FLOW SPLITTER - EXTENDED ABOVE GRADE n v APPRO IMA I t LOCATION O T.H. 11 SEPTIC ARE Ao GARNESS ENGINEERING GROUP, Ltd ----- ----- -- -� CIVIL & ENVIRONMENTAL ENGINEERS-== 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 33&3246 • WEBSITE: w .gamessengineedng.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JACOB DUNSTON 205-937-2231 2 OF 2 PROJECT/LEGAL DESCRIPTION: DRAWN BY: SPRING FOREST; BLOCK 1, LOT 15 D.J.G. TYPE OF WORK: SEPTIC SYSTEM DESIGN UPGRADE DATE: 4/2/2018 DRAINFIELD 0 N V SCALE: 1"=40' .......I .......................... A.G ; a ess -OAr #jib•: C - '�`i �i�� y i•P�'. E�,♦♦•• LICENSE ��\\, #AECC884 GARNESS ENGINEERING GROUP, Ltd ENGINEERING -SALES CONSULTING - 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 338-3246' WEBSITE w gai—engineering-m SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: SPRING FORREST; BLOCK 1, LOT 15 PERFORMED FOR: JACOB DUNSTON DATE: 3/28/2018 DEPTH (feet) ORGANICS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 GM TEST HOLE #1 SOIL CLASSIFICATIONS DEPTH TO DATE GROUNDWATER DRY 3/28/2018 DRY 4/4/2018 I SITE PLAN SEE ATTACHED SITE PLAN DATE READING CLOCK TIME 11111111111 am 1611191 3/28/2018 1 WMA - 6" - 2 12:00 30 yYY1i 4.5" MORA 12:00 - 6" - 4 12:30 DEPTH TO DATE GROUNDWATER DRY 3/28/2018 DRY 4/4/2018 I SITE PLAN SEE ATTACHED SITE PLAN DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 3/28/2018 1 11:30 - 6" - 2 12:00 30 1.5" 4.5" 3 12:00 - 6" - 4 12:30 30 2.25" 3.75' 5 12:30 - 6" - 6 1:00 30 2.5' 3.5' 7 1:00 - 6" - 8 1:30 30 2.5' 3.5' 19 PERCOLATION RATE 8.57 (MIN./INCH) PERC. HOLE DIA. 6 TEST RUN BETWEEN 4 FT. AND 5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES NO SOILS LOGGED BY: DAVID GARNESS PERCOLATION TEST PERFORMED BY: LANDON BRUCE COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: (INCHES) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAI LI~NG ADDR~'~S LEGAL DESCRIPTION LOCATIO~ ~-- Well /'~ Absorption area/ ~ ~Liq. capacity in gallons ] ............ Ioside length Well. /~ DISTANCE TO: ~-_',~.'.~/?~ ll No. of lines/ j Length o~.a?~ ne Fou ndat. ion/ Total I e~n ~¢~l~n e s Dwelling M at e.r. Ja] / Wdt~ PEI~T NO. No, of compartments Material Neares't ot line T r e ¢c.~ width L~&depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Top of tile to finisl~ grad~.~ ~ Length Width Material beneath tile Depth inches Total e f¥~'~i~fe~absor pti o Q. area PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS j ~ REMARKS APPROVED~ DATE LEGAL 72-013 (Rev. 3/78) Permit # Applicant: HUNICIPALITY OF ANCHORAGE Department Health and Environmenta? rotection 825 ,, Street, Anchorage, AK. ~501 264-4720 * * * HANDWRITTEN PERMIT * * * r WELL AND/OR ON-SITE SEWER PERMIT / . _ ~:_ .~j~_ , Mailing Address: Location: Phone Number: Legal Description: ~7m ~ ~//~ / ~tr~'/AflS,7~Ot Si~e: Type of Soil Absorption System Is: Trench: / Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: The length dimension is the length(in feet) of the trench or drainfie!d. 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 = ll~ '>~--~C-~GALLONS * * * ~erm±t applicant has the responsibilit~ to inform this dep&rtment during the installation inspections of any wells ad~&cent ~o this property and the ~umber of residences that the we~l will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and app=oval by this dep~rt~ent w±ll be subBect to prosecution. Minimum distance between a well and any on-site sewage disposal system is !00 feet for a private well or 1.50 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 * * 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) ~ will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if ~ residence is remodeled to include more that 3 bedrooms. ~ Signe : s ued by: Date: ] -- ~0 ~ ~ SWP/024(1/81) MUNICIPALITY OF A,NCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, A~aska 99E01 264-4720 SOILS LOG- PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: ~, \\ ~.~rr._ ~¢' ¢'"'n DATE PERFORMED: LEGAL DESCRIPTION:. -% ~, m~ ~ ~ ~ ol~ ~'~- 1 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YE~, AT WHAT DEPTH? COMMENTS .~c~' ~ r~,'~C[ ~ Gross Net Depth to Net ~ i~_Reading Date Time Time Water Drop PERCOLATION RATE ~"- ~) (minutes/inch) TEST RUN BETWEEN ~ FT AND ~'/l_ FT PERFORMED BY: ~'-j ~ .J ~. r~ q. CERTIFIED BY: DATE: 72-008 (6/79) 7 rme uny oncorsMunicipality Ah - t1 _ APR 2 0 2018 On-Site Water and Wastewater Progra :A� la I-I / (907) 343-7904 . `1.. A F E T Y '2 cs h Certificate of On-Site Systems Approv_' 6 8 G a Parcel I.D. 015-321-19 Expiration Date: 4I&A / -2Y 2Y O2 1. GENERAL INFORMATION: Complete legal description Spring Forest; Block 1, Lot 15 Location (site address) 6120 West Tree Drive*Anchorage,AK Current Property owner(s) Jacob Dunston Day phone (205)937-2231 Mailing address Real Estate Agent Natalie Lewis Day phone 865-6406 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) E Duplex ❑ 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 0 Holding Tank 0 Community Class Well ® Community ❑ Public Water System 0 Public Sewer 0 WaiverNariance request for: Distance: Received by: (-7/ Date: Li 1)-41(3 c_ -- COSA to be released to the engineer,unless otherwise requested by the engineer. ( COSA Fee $ o� S Waiver Fee $ Date of Payment Li -2-3---ig Date of Payment Receipt Number OD364 C) Receipt Number COSA# DSC g O 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: Garness 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: l/ -2-r'It`6 00000 .p4 In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system , F 4 in accordance with the guidelines and regulations established by the Municipality of Anchorage and o K\'-.Or `- industry practices. The reported results describe the condition of the system/s on the date/s of the O n evaluation. Separation distances were measured to readily identifiable features. Hidden defects or "...'_ • 1 v encroachments may exist that were not identified during the evaluation. The operational life of all wells �;• Li ,�� •••*VV and septic systems depend upon a variety of variables, including but not limited to, soil conditions, 0 Q groundwater levels (that may fluctuate during the year), quality of construction (materials and t% / VA workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and . are outside the control of GEG. Satisfactory test results do not guarantee future performance of the AA • J- r:, A. Gor ess. a • system/s; therefore, GEG makes no warranty(express or implied)regarding the future performance of UO m • C 795 ,a the well or septic system. GEG makes no representation whether an alternative well or septic system Qii�9� .. ••• •cg'4 can be installed on the property in the event either of the current systems fail to perform adequately in 'l .. .• 1`v °cam the future. The content of this report is for the sole benefit of the person/party that retained GEG to "1%\%'°:,professionOpo� perform the evaluation. Reliance upon the information provided in this report by any other person or \' ' • �� party (including subsequent property purchasers) is not authorized, nor will it confer any legal ri ll2t`\( OF A i _�O whatsoever. \\ V�' . V #AECC884 6. DSD SIGNATURE -' ON-SITE G) c-' WATER AND X System #1 Approved for / bedrooms :ocrl WASTEWATER o System #2 Approved for bedrooms PROGRAM • \_ Disapproved '44,� c<` 74fin Crp\l\fC Conditional approval for bedrooms, with the following stipulations: By: Ativ dA (i�( . Original Certificate Date: �I1,/2.(7//if / r/ 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc 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 SPRING FOREST; BLOCK 1, LOT 15 IC' Legal Description: Parcel ID: 015-3214g A. WELL DATA Well type COMMUNITY If A, B, or C provide PWSID# 213564 Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (abo ; •round) in. FROM WELL LOG AT IN " TION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULT : Coliform colonies/100 ml. Nitrate mg./L. Collected by: Ars-•. : ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA **DOUBLE CLEANOUTS BEFORE TANK Tank Type/Material SEPTIC/STEEL Date installed 4/17-18/2018 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N)**YES Depression over tank(Y/N) NO High water alarm (Y/N) N/A Date of pumping NEW Pumper - C. ABSORPTION FIELD DATA I'BELOW FINAL GRADE Date installed 4/17-18/2018 Soil rating (g.p.d./ft2or t/bdr� 0.8 System type DEEP TRENCH Length 71 ft. Width 2.5 ft. Gravel below pipe 6 ft. Total depth 10.1+ ft. Eff. absorption area 852 ft2 Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test - in. Water added - gal. New depth - in. Elapsed Time: - min. Final fluid depth - in. Absorption rate >= - g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) - If yes, give date - • INFORMATION REGARDING 1984 TRENCH IN MOA RECORDS D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at .• wa er alarm level at in. •• Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES COMMUNITY WATER SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main ' . : • ewer manhole/cleanout Sewer/septic service line Holding tank Anise- -. ainment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+PVT&200'+PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 41-04 Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE Wells on adjacent lots 100'+PVT &200'+PUBLIC F. COMMENTS \ 'Qr * 19 L( C; ' iS a\c * ' ' c v r, ,i 20P'• L;:‘,., 4.4,1aks11114 it �* ` Or, .. 4,-,1. 4 G. ENGINEER'S CERTIFICATION •••1:,\ .•• ••,.•• •. I certify that/have determined through field inspections and 49 �• Or o review of Municipal records that the above systems are in / `"+�i� •••• conformance with MOA COSH guidelines in effect on this • •• • •• •• • date. ♦ -f r; A. k: • .s•: w= Engineer's Printed Name JEFFREY A. GARNESS �•�♦�S,'.. CE-795 �•: ��.: 1./AFS•••. Z� .\-F.• Date `� j Z �t �'\4PROFESS\ -;,••• //// LICENSE lllk4"`likii. #AECCB84 (Rev. 10/12/12) Municipality ®f Anchorage „�'. P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Department On-Site Water and Wastewater Section **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV181 xxx COSA#: OSC181160 Permit#: PID#: 015-321-19 Legal Description: Spring Forest Block 1 Lot 15 Engineer: Garness Engineering Group Applicant: Jacob Dunston 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 5.0 feet. This waiver approval applies to the existing 1984 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: 1/2z7/20 I8 Approved by: fiee..A ealvr--”, . Name of Reviewer **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name _~"~.O~IN ~.~¢4 ~ Telephone: Home Business Applicant Address _~ ~1~O ~g~ (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other E"I (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent ,~,Ca ~,~1~ ./ '11~,"'/", Address .?~¢~¢,~ / ~'~' ~~--~ Telephone ~ ~ "-' ,~(~ (f) Mail the HAA to the following address: TYPE OF RESI[)ENCE Single-Family~ Multi-Family FI Other Number of Bedrooms '~ 4 WATER SUPPLY Individual Well [] Communit~_~l~ublic [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the ~egality and status. SEWAGE DISPOSAl. Onsite/~ Public [] Community [] Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM I=ROVIDIN,., INSPECTIONS, TESTS, FILE SEARCH, DAfA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approvat 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. ~, NameofFirm '~"~ __~¢~~~ Telephone Address _ ~' __fl'~O ,'~ f~ Engineer's Seal CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level Cased to MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 L~/L/L/~_5~I Description: Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ,~ 2~ ~ To Nearest Edge of Absorption Field on Lot _~7 "z..¢..~ To Nearest Public Sewer Line_ Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Date Installed_ Depression over Tank (Y/N) . SEPTIC/HOLDING TANK DATA Size _/,,~'~L"") No. of Compartments Air-tight Caps (Y/N) N Foundation Cleanout (Y/N) Y ,/~ Date Last Pumped Pumping/Maintenaflce contract on File (Y/N) A//z~ Holding Tank High-Water Alarm Separation Distances from Septic/Holding Tank: To Water-Supply Well PrOperty tJne TO T0 Water Main/Service Line.'~-- Course -E//~ Comments Page 1 of 2 ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field _ To Stream, Pond, Lake, or Major Drainage /~iNlei~AiJiy OF ANCHoRAGe: DEPT. OF HEAl TH & ENViRoNMENTAL PROTECTION RECEIVED 72-026(11/84) ABSORPTION FIELD DATA '? Soils Rating in Absorption Strata Width of Field ,J!q 33/ Type of System Design Length of Field ,,~7'/ Depth of Field /q / Gravel Bed Thickness /~V?'0Dat o_~f L ~ st A. dequacy Te Standpipes Present (Y/N) Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ,o, To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course TO Property Line To Existing or Abandoned System on ;On Adjoining Lots To Cutbank (if present) To Driveway. Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify th I ha,l,J_~.~ checked, verified, o~conformed to all MOnA and HAA guidelines in effect on the date of this inspection. Signed ~ Date (~-~, -/~ ~ Company " MOA No. Receipt No. 4' Date of Payment Amount: * Page 2 of 2 72-026 (11/84) Engineer's Seal 203 w. 15th AVE "c" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 2'/9.3918 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOT 15, BLOCK 1, SPRING FOREST LOCATION: 6120 WEST TREE OWNER:" JOHN KEHP RESIDENCE: SINGLE FAMILY, FOUR BEDROOMS, VACANT WELL: COMMUNITY CLASS A SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. 1500 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 1340 SOIL RATING: 331 (ADJUSTED) 300 UNADJUSTED INSTALLATION DATE: JANUARY 1984 DATE OF PUMPING: OCTOBER 29, 1986. ISAACS DATE OF TEST: OCTOBER 17, 27, 28, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH THREE FEET OF COVER AND WITH A LIQUID DEPTH OF 47 INCHES. TRENCH HAS TWO SUMPS. ONE WAS FOUND TO BE 111 INCHES DEEP AND HAD ONE INCH OF SOFT MATERIAL IN THE BOTTOM. THE OTHER SUMP WAS 168 INCHES DEEP AND HAD 23 INCHES OF WATER. THIS PIPE WAS BENT AND COULD NOT BE VISUALLY INSPECTED. WATER WAS ADDED TO THE SYSTEM VIA THE FIRST STANDPIPE. AFTER ADDING 300 GALLONS THE WATER LEVEL IN THE SECOND STANDPIPE HAD RISEN 1.5 INCHES. THE ADDITION OF ANOTHER 150 GALLONS CAUSED THE WATER LEVEL TO RISE 21 INCHES. 130 ADDITIONAL GALLONS CAUSED THE WATER LEVEL TO RISE FOUR INCHES MORE. THE WATER LEVEL IN THE TANK DID NOT CHANGE. THE INFILTRATION RATE WAS MONITORED FOR 19 HOURS. AFTER SEVEN HOURS THE WATER LEVEL IN THE SUMP HAD DROPPED 4.5 INCHES. AFTER 19 HOURS THE DROP WAS 15 INCHES, INDICATING AN INFILTRATION RATE OF APPROXIMATELY 250 GALLONS PER 24 HOURS. ON OCTOBER 27 AND 18 THE SYSTEM'WAS CHARGE AGAIN. ON THE 27TH. 700 GALLONS WAS ADDED TO THE TRENCH CAUSING THE WATER LEVEL TO RISE 19 INCHES TO A TOTAL DEPTH OF 68.5 INCHES. THE NEXT DAY 900 GALLONS WERE ADDED, CAUSING THE WATER DEPTH TO BE 87 INCHES. THE LAST 200 GALLONS CAUSED A UNIFORM INCREASE IN THE WATER DEPTH OF WITHIN 12 INCHES OF THE PERFORATED PIPE. AFTER FOUR HOURS THE WATERLEVEL HAD DROPPED 4.5 INCHES SHOWING AN INFILTRATION RATE OF 300 GALLONS DURING THIS PERIOD. AFTER 21 HOURS THE DROP WAS 16 INCHES SHOWING AN INFILTRATION RATE OF 650 GALLONS PER 24 HOURS. Tobben Spurkland P.E. Septic System Adequacy Test Lot 15, Block 1, Spring Forest John Kemp October 28, 1986 Page 2 of 2 TEST RESULT: THIS SYSTEM MEET THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, an4 the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONmeNTAL HEALTH DEPARTMENT OF HEALTH AND E~%n;IRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Info~-mation Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicants Address (c) Applica~is (check one) Lending institution Buyer'~ 2-~ ; Other ~I (explain); (d) Lending Zns¢itu~on Address Telephone - Home Business Telephone (e) Real Estate Co. & Agent Address Telephone (f) Mail the IIAA to the following address: 2. ~X~ of Residence Single-Family Number of Bedrooms 3. Water Supply Individual Well Multi-Family ~ Other (descrJbe) Community ~l Public Note: If community we].l system, must have written confirmation from the State Departmeat of Environmental Conservauion attesting to the legality and status. 4. Sewage Disposal Onsite ~ Public [i~ Community ~i i[ Holding Tank L2J~[ Note: If community well system, must bare. written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] Engineering Firm Providing Inspections~ 'rests, File Search, Data an~d Infon~tation 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 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 flies 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 regula- tions in effect on the date of this inspection. Address Telephone 5 u,' '~ (ENGINEER SEAL) DHEP Approved for L,/- bedrooms Approved :'( Disapproved Condit ionml ¸ff', Ter~ns of Conditional Approval CAUTION THE MIJNICIPALITY OF ANCHORAGE DEPAR%~ENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES }H~ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIOMS GIVEN IN PAlhkGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIObIA. L ENGIneER REG]iSTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCItASERS OF HOMES AND THEIR LENDING iNSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUiRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCIIORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN TIlE PROFESSIONAL ENGINEER'S WORK. (DHEP SEA3~ ) RR4/ej/D18 [Page 2 of 2] 7.-19-.84 ae L1_.¢131 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH ALYZ~HORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORA6E DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED Well Classification __~_~_ Well Log P~esent (Y/N) ~/]4. _ Date Completed _ .. 4~,/~ Yield Total Depth ~ ~,/1,4 Cased to , Static Water Level /L~/t% . Pump Set At Casing Height Abo~ Ground ~./s/.¥~ Electrical Wiring in Conduit (.Y/N) ,~/t,~ Separation Distances from Well: To Septic/Holding Tank on Lot-- ~DU, O ' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ') ~2~2! ; On Adjoining Lots To Nearest Public Sewer Line C leanout/Manhole. Water Sample Collected By Water Sample Test Results Depth of Grouting_ A?,/,~?- _ Sanitazy Seal on Casing (.Y ,/N)~/~ Depression A~ound Wellhead . To Nearest Public Sewe~ To Neazest Sewe~ Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed I: 0o ~,~, NO. of Co,%~a~tmants ~ Standpipes ~/N) Ai~-tight Caps ~) Foundation Cleanout ~) ~p~ession ove~ Ta~ .(Y~ ~te ~st P~d .<,,lid ' P~ing~intenan~ ~n~act on File (~ ; fo~ 4~/~ Holding Ta~ High-Wate~ Ala~ (Y~) ~/~ ~a~y Holding Tank Pe~it !~) .~/~ Sep~ation Distan(~s :~ ~ptic~olding Tank: To Water-Supply Wa 11 ~ To P~operty Line I0 'c- TO Water Main/Service Line Cour~ ~,/~ To Building Foundatic~ } ")~ To Disposal F~eld t~ To Stream, Pond, lake, c~ Major D~ainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed //~ ?/~ % Width of Field ~" Square Feet of Absorption A~ea Depression over Field (Y~ ~ t O { Type of System Design Length of Field ~ ~ ~ Depth of Field ! ~ I~O~j Gravel Bed Thickness /O/') Standpipes P~esent ~//N) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~/~O ~ To P~operty Line I O ~'~- To Building Foundation ~1 ~ To ExistinG or Abandoned System cn Lot ~ ~/ ~ ; On Adjoining Lots > 30~ To Wate~ Main/Service Line ~/A~ To Cutbank(if present) To St~eam/Pond/Lake/or Major D~ainage Course ~/~ To D~iveway, Parking A~ea, or Vehicle Storage A~ea ~9~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm I~vel at Tested for ~.~/~ Electrical Codes(Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conforwed to all MOA HAA on the date of this inspection. Signed Z~ (L~)~\ ~~ Date ~/~ ~/~ ~- Company /~-~, //uc MOa No. g'~ KB1/dS/s [Page 2 of 2] 2-15-84 KILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 274-2533 PWS i,D. # To Whom It May Concern: A~cc~rding ~,o r~cords on file in this office the //~".~//,/_/~/~ ~/~ater System is i n comp I ianc~ with Water Regulations. Si ncerely,