HomeMy WebLinkAboutMAGNIFICENT MT SLOPES TR 8B-2 Magnificent
Mountain Slopes
Tract 8B-2
#050-521-89
Municipality of Anchorage Page I ol ~_.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Perelit Number: ~ ('/'') (~0(~) j ~0 PID Number: ~'0
Phone: d~-- ~5~0 No. ofBedroe,..: ~ DeepTrenoh .ShallowTrench ~Bed ~Mound DOther
LEGAL DESCRIPTION 9oim.aling: O.~ CPD/Sq. FL folalDepgtfromorigill~mgmde~
Driller: ~ Date installed:
Yield: Pure Set at:
SEPARATION DISTANCES ~Seplic U Holding U S.T.E,P.
SurfaCewater 10Or+ ~OO~* ~
Remarks: ¢¢¢¢T¢~ ~,~ ~4~ BENCH MARK
$ & $ ENGINEERING
Reviewed and approved by ~.
72-013 (Rev. 9191) MOA 25
PERMIT NO. SW000160 PAGE 2 OF 3
Hunicip. o~i~ o£ AnchoraQe
BEPARTIVlBNT OB HEA~THAND HUMAN SERVICES
BNVIBONiVlENTAL SERVICES DIVISION
P,[3. ]Box 196650 oanchoro9e, A~asko 99519 66500Te(epho~e~ 343 4744
Oki=SITE WASTEWATER DIS?OSAL S¥STE~I ANB/OB WELL IkiSPECTION RE?ORT
LSC-AL TRACT 8B-2, MAGNIFICENT MT. SLOPES S/D P.I.D. NO. 050--521--89
PERMIT NO.~SWO00160 PAGE 3 OF 3
Nlunicipo,
DEPARTHENT OF HEALTH SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.~. Box 196650 OAnchopcge, A[askc 99519-66500Telephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL TRACT 8B-2, MAGNIFICENT MT. SLOPES S/D P.i.D. NO. 050--521--89
FINAL GRADE
98.3'
~wr-z-:~,,;. :~/,z~,,.~;'/,.,,z,:~,r,z,,x-,z-,'x,.',z,:~'~ I N S U LA T I O N
93.8' NEW 1000 GAL.
POLY. TANK 93.5'
A B
~ FCO 13.5' 38.5'
ST1 19.0' 43.5'
ST2 22.0' 46.0'
DBL1 24.0' , 48.0'
C01 DBL2 25.5' 49.0'
MT1- C_02_ MT2~jC01 = 53.?' !C01 173.5' 177.0'
~ ICO~ = 55.0' MT1 171.0' 175.0'
C02 162.5' 186.0'
/-'~AL GRADE MT2 163.5' 187.0'
%'~- MT2
WATER FOUND ~ 44.2 t ~/ ~o~ c. cow*~
A B
FCO 15.5' 58.5'
ST1 19.0' 43.5'
ST2 22.0' 46.0'
DBL1 24.0' 48.0'
DBL2 25.5' 49.0'
C01 175.5' 177.0'
MT1 171.0' 175.0'
C02 162.5' 186.0'
MT2 163.5' 187.0'
Municipalily of Almhorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
~jfj,.~tl~ ROBERT C. COWAN
CE-SBm
DATE ............ .,~¢~Jz~_,~ ~'.~~;....,,,' ,,~. --
' ~ '.-,, ~ ,~ Or £
~ownship, Range, Seclion:
?
12
13
18-
1~-
COMMENTS ___
SLOPE
WAS GROUND WA] ER J
SITE PLAN
PERCOLATION RATE __
TES1 RUN BETWEEN
t ~'~ ImlnuleS/Jnch) PERC HOLE DIAME'[ER
PERFORMED BY: 17034 Ea~l~ Div,r,r I ~0~ ~¢~ ~. ~ I CER11FY THAI THIS 7EST WAS PERFORMED
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jun 09, 2000
Expiration Date: Jun 09, 2001
Permit Number: SW000160
Legal Description: MAGNIFICENT MT SLOPES TR
Design Engineer: 0003 S & S Engineering
Owner Name: Kathleen & James Blaney
Owner Address: 25154 Eagle River Road
Eagle River, AK 99577-9690
8B-2
Parcel ID: 050-521-89
Site Address: 025154 EAGLE RIVER RD
Lot Size: 80856 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
Private Well
[] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AA080 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Net 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.
Received By: ~f ¢ --
Date:
ROBERT C. COWAN, P.E.
SEWER &WAI'ER
INSPECTION
ENG)NEERING STUDIES
ANO REPORTS
WELL INSPECTION
& FLOW TEST
STRUCIURAL&
MECHANICAL
INSPECT[OHS
June 6, 2000
CIVIL ENGINEERS
(907) 694-2979
FAX(907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Heakh and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REEERENCE: Tract 8 G - '~ Magnificent Mountain Slopes S/D
A test hole was excavated and a percolation test performed. The approximate location of the
test hole is located on the attached site plan. At the time of excavation on 5/25/00 water was
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 developrnent on any of the adjacent properties.
If you require additional information, please contact us.
Sincerely,
cc/jtm
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
1" = 100' SITE PLAN DESIGN
SCALE
· .
/'~_,~-,j~.~.'~ Mumclpallty of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
SOILS LOG -- PERCOLATION TEST
t ~,,
~EGAL DESCRmTION: /~ ~, -~ - ~ Township, Range, Section:
/ SLOPE SITE PLAN
4
5-
6-
8-
10 57
11
13-
14-
15-
16-
17-
18-
19-
20-
WAS GR(~J~ND WATER
ENCOUNTERED?
S
IF YES, AT WHAT / 0L
DEPTH? /0 p
Depth to Water After ~
Monitoring?[ Date:
Gr~os$ ~ Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
7EST RUN BETWEEN 4- FTAND "~ FT
COMMENTS
S & S ENGINEERIN~ ~ ~ '
72-008 (Rev. 4/85)
ROBERT C. COWAN, P.E,
ENGINEERING STUOIES
.6/qO REPORTS
WELL ~NSPECT[ON
& FLOW lEST
ROADDESIGN
SOIL TEST
PERCOLATION
TEST
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
@N-S~'F~ WAST~WAT~. D]IS?OSAL
C@NST~UCTION
I%~JIAT~IAL SPEC~C~CA'~@NS
Tract 8.G -- 3. , M~gnificent Mountain Sloped S/D
June 6, 2000
Thc scope of this project includes the verification or installation of a 1000
gallon septic tank and an absorption bed to serve the existing three bedroom
residence located on the referenced property.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit or ADEC Authority to Construct with any special
provisions or conditions, and all applicable State and Mtmicipal Wastewater
Disposal Regulations.
The contractor shall be responsible for obtaining any necessary underground
utility locates.
Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling. On all
leachfield mound systems, the property owner shall be responsible for ensuring
a satisfactory vegetation growth over the mounded area.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department or ADEC if required, for system installations.
Owners installing thek own systems must also receive prior approval from the
Municipal Health Department.
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent settling or shifting of the
tank.
17034 NORTH EAGLE RIVER LOOP ' SUITE 204 · EAGLE RIVER, ALASKA 99577
Page 2
Trac~ ~,~,2, IV~agnificen~ M£ Slope= $/D
June 6, 2000
3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
4. Septic ranks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation. In the
line between the tank and the leachfield there shall be two adjacent cleanouts. These cleanouts
shall be located on undisturbed soil not more than 10 fi. from the tank. The first cleanout, in
line, shall be to dean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
Final grading over the septic ta~k shall be such that a positive slope exists away from the septic
tank.
BlED INSTAdLLATION:
Excavate the proposed Bed Area to the depth shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared,
it must be raked or scratched (rafted-up) before gravel or sand placement.
Ifa sand layer is required, place sand over entire excavation to the required depth shown on the
design. The top of the sand layer must be within 2 inches of level.
Sewer rock shall be plaeed uniformly throughout the entire bed. Perforated distribution pipe
must be installed level with perforations down. Gravel depth below the perforated pipe shall be
a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of
two (2) inches. The total gravel depth throughout the entire bed shall be a minimum of twelve
(12) inches.
The perforated distribution pipes must be no more than six feet apart. The distance between
the outermost perforated distribution pipes and the sidewall of the absorption bed must be no
more than three feet.
Silt barrier material must be installed between the final gravel layer and the native soil backfill.
Ensure the silt battier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed at the locations shown on the design,
and extend a minimum of 12 inches above final grade. The portion of the monitoring tube
extending through the gravel depth shall be perforated six (6) inches below the bottom of the
horizontal distribution lines. The monitoring tube should not extend below the bottom of the
gravel surface.
Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must
be installed when the backfill depth is less than thirty-six (36) inches. The finished grade over the
bed must be mounded to prevent the formation ora depression after settling.
Page 3
Tract 81t -2, ~]lagnlflcet~t Mt. Slopes $/O
June 6,
8. A mound system is to have the upper six inches of top soil and be seeded for vegetation.
g4IIN~ l~&cr~gllAL S?~C~CATI[ONS:
Any septic tank proposed for installation must be constructed by a Municipally approved septic
tank manufacturer.
The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
TD~pe of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F$10 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company
Styrofoam HI or equal).
Septic taxflc inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or
equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5"~2.5" screened gravel with less than 3% passing
the #200 sieve.
When sand is be'rog used as a fiker material, its gradation spec'rfications must conform to
current MOA or ADEC mqukements.
~S?ECTI@NS:
Typically there will be a minimum of three (3) inspections requked during the installation of the
wastewater disposal system. These inspections will occur as follows:
The first inspection must be conducted al'~er the excavation of ditches, pits, trenches, or
beds and before the installation of any gravel. A septic tank may be set in place, but
may not be backfilled before this inspection.
Page ~
Trac; · f~--2, It~agnlflcent .~';t. Slopes $/D
June 6, 2~
The second inspection must be conducted alter the placement of the silt barrier, gravel,
distribution lines, standpipes, cleanouts, amd insulation, but before the placement of any
other backfill.
3. The final inspection is to occur upon final grading of the property.
Often them will be more than these 3 inspections requked. Especially with the installation of multiple
trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be
contacted at least 24 hours prior to the start of construction. If necessary, a pre°construction meeting
will take place on*site. The inspecting engineer will not coordinate, dkect or control in any way the
contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications and
plans and in accordance with the attached MOA permit or ADEC Authority to Construct. There will
be no contractual axrangement existing between the contractor and S & S Engineering.
S & S Engineering shall be the owner's representative and will inspect the work as stated above
to document the contractors activities. Final acceptance of the contractors work rests with the
owner.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S & S Engineering's inspecting
engineer will not be responsible for the construction means, methods, techniques, sequence, procedures
or the safety precautions incident to this project.
CONTRACTOR / INSTALLER
MUNICIPALITY OF ANCHORAGE
'~~ D/EPARTMENT 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
NAME PHONE ~NEW
MAI LING ~DDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
I Well Absorp~narea Dwellin~ [~ / PER
~ ~z Manufacturer Ge~ '" Mater,$~ No. of c~partments
Liq/c~a~t~ gallons IF HOMEMADE: /ns,d. ~7~ WMth~/.
~OZ~ ~ DIST~NCETO: ~eil ~ ~n~ PERMITNO,
O ~ ~ Manufacturer Material Eiqaid capacit~ in ~allons
Well Foundation L30 / Neare~l~ ~.e PEBM T NO
~ ~ NO. of lines~ Length of each li.e Total length o~ li~es Trenc~th Dista~c~
~: ~ 1~ ~¢/ [~ / ~ inches e~weenlines
~" ~ Top of tile to finish grade ,~ / Mater al beneath tle [ Tota~ effecti2e ab~grption area
-' ~, ~ .~ / ~/~.~/rn-/~ - ~ .~,~ch.~~ ' ~~
Length Width Depth - PERMIT
g~ Type of crib Crib diameter ~ th ~tal effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
.j Class Depth .D~ller Distance to lot line PERMIT NO.
~ Building foundation ~ 'line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
SOIL TEST RATING
REMARKS : ~, . __
/
72-013 (Rev. 3/78)
PE RI,i ! T NO:
~ATE ",', r,'.
APPLICANT:
LOT' SIZE:
RLOCK: NA
34)702,
,.]9107134
C/O S z S EM4'5 C¢31LL~C CnNSTqUCTiC
:~.UH:tIV~S~O~I: t'iAGNiFICE>~T-MTN SLO LOT:
~0553 (Sq. FT. O? AC°ES)
- - :,tA-X :BEORO0,"I$: - .S -
- ~.~J, O YOU
, ' '~S ,/A~L~,¢~LF- T3 YOU IN gFS ....
r~,_L:~, ARE T:-iE O~'TiO~' A ' '
..... 5-yEFT~4,- CHOOSE--THE-Og-TION ~HAT :~T ~* .
- O.~;':lT~ TO.~IPE ~O:FT)k (FT.) 4.0 4.3
p~,PTR (FT ) 5.'0 ~ '5 5
~ 3RAV;,E:L ..... · ....
TOTAL DEPTH (, ~.) o ;'~ "
· -TANK S['~ (6AE~) ' l~,On').q¢,. ,_.~* 1¢9u9.;)
SOiL RATING (Sq. FT,,/:~P.) ¢4! ':,Z9 44t
-. . F *" 75 FT EACH)
.... · * G~A:V~L LE-NG~H > 7! CT. R~'~U, TS "ULYiDL'~ ~,U ,S ('4OT
~* I'AN~ ',lUST HAV2 &T L:~A.;T T.~ '¢u r'D',OARTt,~ENTS~., :
i CERTIFY THAT:
1, f AM FAMILIAR wITH THC NE:~U'ID{'42N~S FOR ()q-SiTE SEWERS ~ND ~ELLS AS SET
-LF'DRIH-.OLY- T-H~',u~-~,""'"' ~To~..rTV. OF ANCHOR~E:E (~'Ot,.,. ,) AN0 THE ST&T;: OF A~-ASKA.
?. ! kILL ,N;~,NL.~ Th[: :~YST;~N ~N ACF'ORD'~NC~ VJITq ~L~ NIO& CO'DES [~Ng ULATIONS¢
~j .... 4.-.i UN:9~RS-~.4NO ~ '"' ~1I~ - ~ VAL COP '" *' '
-',~"~ Wr' ' :] ~ AN A)DI'T'rn'J*; PE:nt'r'r
ANY CNLAF. G~ ..... T .uc. FT~UiR : .. ~,~'~
.... ;--.F-A.k-tFT. SJ'J*'c;.3N-~S .~NSFALL~:O ;N A~.~ ~,RS~ (OVE~(ED :;Y ?i0~ P',JtL-DENG CODES,
, ,..;N ~,ItJ~ ~E O:'~TAINEO; (2) AS-~UILTS
THEN (1) AN EL~CTR!C.At. P,~R~iT ~NO IN'3P'{CTr'' ' b,
r~".'r:~L IHSOF-rTiON f~EPORT; ~,N9 (3) THF:
,~2LL NOT BE APDRO~ZD ' "THO¢ ......
& ENGINEERS, INC. SOIL LOG
7~2~ OLO SEWA.. H,G.WA¥ P ERCO LATIO N T EST ~ BEDROOM.*
ANCHORAGE, ALASKA 99502
(907) 349.6561
JOB NUMBER:
FOR:
PERFORMED
SLOPE
SITE PLAN
13 -[z
I-FT>
14~-~
15
16 '
~7--
20
DEPTH
(FEE'ri
Reading
Date
Gross Net Depth to Net
Time Time Water Drop
PERCOtATION RArE
TESTRUN BETWEEN ~/~t
Y
3 <N
■
<
<
ou z
cc >
zw >
u
cr
JZ
<
mjY
U)
,j <
J
m <
w
c X
C, 0
co
w
LU d
a:
0
MD
2
0
z
z
z
O
z
0 0
0
w
114 w
L14
0
E-4
0
0
E-4 0
0
E.
E--;
LLd
44
0
,OZ
Ov
IZ7 -
w
E-4
LT. 44
E-4
LL4
"4
0
0
0
F4
E4
wLL,
w
1--;
w
w�4
00000000.
w
0
MUNICIPALITY OF ANCHORAGE
Development Services Department `
- / Phone: 907-343-7904
On -Site Water & Wastewater Section - ' Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-521-89
1. GENERAL INFORMATION
Expiration Date: z0z
Complete legal description MAGNIFICENT MT SLOPES TR 813-2
Location (site address) 25154 EAGLE RIVER RD, EAGLE RIVER AK
Current property owner(s) EVANS Day phone
Mailing address 1459 N FORT LN, LAYTON, UT 84041
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:_
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Q
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Received by:
COSA to be relea
to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Ib -50 +
Date of Paymen /_'F 2 z
Receipt Number OSIZtl q
COSA #
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
Distance:
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E. Date $-2-22
6. DSD SIGNATURE
By:
' System #1 Approved for _?� bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
F.
OW
'•; �,t
f
✓ *: 49TH •, �:
�� �•• MICHAEL N. ANDEMN 0 ;d
with the following stipulatioo���;��-�'�
Y�01"
�` r /�
' 0
SITE
m=
WAST`=vMATER z�
Jro CGFAM o
�1
Original Certificate Date: — ii I - z-2-
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: MAGNIFICENT MT SLOPES TR 813-2
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 6/21/07
Total depth *360 ft
Cased to 40'+ ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 20 in.
Date of flow test for COSA 7/7/22
Static water level at beginning of test 236 ft.
Comments *well was deepened TO 360 IN 2007
B. TANK DATA
Age of tank(S) 612,100 years
Tank type/material a tv -DPE
Measured operating fluid level in septic tank **46"
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 8/9/22
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/21/00
FOR ALL standpipes present per record drawing
Total measured depth from grade 7.6 ft (max)
Measured depth to pipe invert from grade 4.6 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced 0 gallons
Comments/Deficiencies: "' PLASTIC TANK OLD STYLE
COSA Checklist yellow sheet
Parcel ID: 050-521-89
of Structure served by this system
Well production at time of test 1.0 qpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (NO)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by MNA
Date of Sample
7/7/22
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 7/7/22
Results ❑✓ Pass For 3 bedrooms
Fluid depth prior to test 12 in
Water added 450+ gal
New depth 13 in
Elapsed time 1440 min
Final fluid depth 12 in
Absorption rate 450 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
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'
0✓
Yes
Community Sewer Manhole/Cleanout > 100'
2✓ Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' Q Yes
if No
ft
Private Sewer/Septic Line > 25' Q✓ Yes
if No ft
Absorption Field on Lot > 100' [j Yes
if No
ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
0✓ Yes if No ft
Water Main > 10'
Animal Containment > 50' Yes
if No ft
0 Yes
if No
ft
0✓ Yes if No ft
Water Service Line > 10'
0✓
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway comment below
Community Sewer Main > 75' Yes
if No
ft
✓M Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0✓
Yes
if No
ft
Surface Water > 100'
Yes if No ft
Property Line > 5'
✓0
Yes
if No
ft
Wells on Adjacent Lots:
Q
Absorption Field > 5'
❑✓
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'
Q
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Q
Yes
if No
ft
Private Wells > 100' U Yes if No ft
Water Service Line > 10'
Q
Yes
if No
ft
Community Wells > 200' 0✓ Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
� '0 1
%''�' 49TH • u��,
@'P l .....:...rf
1 10 •• MICHAEL N. ANDERSON : ar ,�d
CE 9
v�; ;,ESSIZI "zW
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www. cL anchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
1. GENERAL INFORMATION
Complete legal description
HAA# ,/t///~ ~.~',,~--~L'~ ~' ,'_f~7'
Expiration Date:
Tract 8B-2, Magni£icent Mountain Slopes S/D
Location (site address or directions) 25154 Eagle River Road
Current Propertyowner(s) James & Kathleen Blaney Day phone 694-8560
Mailing address 25154 Eagle River Road, Eagle River, AK 99577
Lending agency
Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: ~Z~7~
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates oi
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by
a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates
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.
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 Health Authority Approval Guidelines for the Health Authority Approval
application show 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Engineer's Printed Name /~OF~f~.'L~- ~' , COi~,4,,.-' Date
DHHS SIGNATURE
P'"'/ Approved for .~ bedrooms,
Disapproved.
Conditional approval for __
S & S ENGINEERING
Name of Firm 17034 Eagle River Looo ~,.,=.fi Ne. 204 Phone
Address Eagle River, AlasJca
bedrooms, with the following stipulations.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date: / ¢ -,/ -% -~ oo
Original Certificate Date: ~- ,/ ~ - 0 0
Reissue Date:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICESJUL
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 ·
Health Authority Approval Checklist
Legal Description: ~,~T ~ ' ~/U/~'/~//G(~'~Tv/[" Parcel I.D.:
/~O(//JT~¢ I IV ~¢LP/~¢~
A. WELL DATA
Well type PC/
Log presently/N)
Total depth
Sanitary sealer'S)
IfA, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to ,/~Z// '
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Casing height (above ground)
Wires properly protected (~)
FROM WELL LOG AT INSPECTION
g.p.m.
Nitrate
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Collected by:
g.p.m.
Other bacteria ~
Eagle Rlver~ Alaska 9~577
Date of Pumping
c. ABSORPTION FIELD DATA
Date insta led (9 .-?.A~o
Length /7/ ' Width
Effective absorption area
Date installed ~'-~/-00 Tanksize /~?-~'~'d~/~NumberofCompartments ~- Cleanout,~)~'~
Foundation cleanout~)N) (~'~ Depression (Y(/~ /%/~ High water alarm (Y/N) ~,/'!//'~
'"'--¢'u m per --
Soil rating ~/_~r ft2/bdrm)
? Gravel thickness below pipe ~ ~
Monitoring Tube present,N) ¢~/~ Depression over field (Y/~
For '"'/~- bedrooms
~ gal. water added (in.):
System type ~{~//O(--
Total depth
Date of adequacy test ,/I,/6'''''f/t~ "--- Results (Pass/Fail) ,J/4--
Fluid depth in absorption field before test Iin.); "/4 Immediately after
Fluid depth ~ (ins) Minutes later: ~ Absorption rate = ~ .g.p.d.
Peroxide treatment (past 12 months) (Y/N) ~
If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N). "Pump?n~.Jevel-~.t*
High water alarm level at*f ,~--~-~-*Datum
Cycles tested .¢~-~-----
"Pump off" level at*
E. SEPARATION DISTANCES
Septic/holding tank on lot
Absorption field on lot
Public sewer main
SEPARATION DISTANCES FROM WELL ON LOT TO:
Sewer/septic service line ~_~¢- / ,¢_ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ,/~.-- r.¢__ Property line ~- /'1 Absorption field ~ ',~
Water main/service line /O~ Surface water/drainage //~'~/ /'/-Wells on adjacent lots
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line / UO / Water main/service line
¢- ' Building foundation /~'"~ '~/-
Surface water '//4"2-~ /4- Driveway, parking/vehicle storage area
Curtain drain /~fO/~./'~ ~"~/¢7;,d/,/ Wells on adjacent lots
F, ENGINEER'S CERTIFICATION
....
I cert f that I have determined thru field nspections and review of Municipal records
. Y .....
~n conformance w~th MOA NAA gu/del/neon effect on this date.
Signature ~/~~ ~
HAA Fee $ ~-~D'
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date ef Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
WATER WELL ADVISORY
HEALTH AUTHORITY APPROVAL NO. 000 ~ ~
During a recent Health Authority Approval on-site inspection
and test of t~e potable water supply well on ~t 7'~t ~ ~
Block '--- of~[~/J¢~ /~u~.~]~S~bdivision, the well's
productivity was determined to be O,~-gallons per minute.
The minimum well productivity required by this Department
(mMC 15.55) for a ~ bedroom residence is ~. ~ gallons
per minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate.
of non-critical water uses such as washing cars
lawns and gardens may be required.
This advisory must be attached
Health Authority Approval.
Restriction
and watering
to all copies of the subject
IIOSEIII O, OOWAU, ~.E.
IICI]El! I A. SI IAFER, t~.E.
CIVIL. El,lOll[, EE
(001} D94-2079
WELL FLOW TEST DATA
I.EGALI)ESCIII,',IO.: ~ ~ - ~ /~ ~f ~O/~
CASING IIEIOlI[: { ~ SANITARY SEAL:
WIRES IN CONI)Uj[: ~ ~. GRAI)INO O.t(.;
BAC I'ERIA ANI) NI1RATE SAMPLES COLLEClEU Idal.l:
TEST DA1A:
cLocK
'1 IME
METER
READING
PUMPING
RATE
(GPM)
/,/ ~G
DEPTII TO
WATER
(FTI
REM^RI(S
WELl_ CURllEN ! LY I'ROl)UCES
OPM WIIII A j.~..~ I)RAWI)OWII
FLow RA1E NOT OU^RAI,IIEEI)--SU~JSEQUENr VARIATIO,8 CAN OCCUR.
lo;.1 O A, I VEIII(OP.~ lIE2 ,I,EAIiEIiIVFII, AIASI(A,~IS?~
ROAD DESIGN
¢
ROBERT C. COWAN, P.E.
HOBEItT A. SI IAFEFI, RE.
WELL RECOVERY TEST DATA
CLIENT:
WELL LOCATION (legal):
TEST DATE:
WELL DEPTH:
CIVIL ENGINEERS
(907) 694-2979
FAX (gO7) 694-121 !
CASING DEPTH: /'~ / /
TESTED BY:
WELL DRILLER:
DATE DRILLED:
TEST PROCEDURE: MISC DATA:
l) Draw water down to pump. Casieg Itelghl:
2) Shal pump off 15-60 min. Sanitary Seal?
~record lime Wires In Conduit?
-record meier reading Grading O.K.?
3) Turn pump on. Drawdown, Pump Depth:
4) Shnt pump ofl. Sa~nples Taken?
-record time Date:
-record meter reading
5) Calculate gal./mi, recovery.
TEST DATA: START TIME:
STATIC WATER LEVEL: ~/z-~ /
TRIAL II PUMP II TIME II METER II GAL/MIN.
OFF
8 ON
OFF
OFF
4 ON
OFF
OFF
~ ON
OFF
RESULTS: WELL CURRENTLY PRODUCES:
FLOW RATE NOT GUARANTEED-SUBSEQUENT VARIATIONS CAN OCCUR.
17034 NO[ITl I EAGI E [lIVER lOOP · SUI]'E 204 · EAGLE [lIVER, ALASKA 9957
b[UNICIPALITY OF ANC~IORAGE
DIVISION OF ENVIRONMENTAL ItEALTH
DEPAR2~lENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date _.A~oril 25z~1985
(a) Legal Description (include lot, block, subdivision, section, township, range)
_~a.~g_nificent Mt. Slopes Lot 8B-2 Sec. 23 T14N R1W
Location (address or directions)
(b) Applicants Name Dave Cree._q~_~r~c_c_q~q GEOLA~lephone- Home Bus iness3~-80~2
Applicants Address c/o GEOLAB 1131 Eo ?6th Ave° Anchoraq~ Alask~
(c) Applicant is (check one) Lending Institution ~ ; Owner/builder ~--~ ;
Buyer ~ ; Other ~ (explain);
(d) Lending Institution Alaska Muhu~nl Bank Telephone 2V~-3561
Address
(e)
601 W. 5th Ave., Anchoraqe, Alaska
None
Real Estate Co. & Agent
Address
Telephone
Mail the HAA to the following address:
_c_q~_ OEOLAB
].].31 E. 76th Ave. el01
. AnchoraGe, Alaska 99502
2o ~Mpe of Residence
Single-Family~
Number of Bedrooms
Multi-Family~_~
Other (describe)
Water S up_~j[
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Sewage Disposal
Onsite ~...X..~ 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]
5. Engineering Firm Prow[ding In_s_~e~tions, Tests,_ File Search, Data 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 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 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 regula-
tions in effect on the date of this inspection.
Name of Firm GEOLAB
Address
Date
Telephone_~~__
1131 E. 76th Ave. ~101 Ancho?a_~, ~a~sk.~99502
Disapproved Conditional
DHEP Approval
Approved for ~ _
Approved
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DttEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY ~N INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN TIlE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURC}~SERS OF HOMES
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE tS SOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN TltE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 441
Date .Installed. 9/26/84
Width of Field 36"
Square Feet of Absorption A~ea
Depression over Field (Y/N) No Date of Last Adequacy Test
Results of Last Adequacy Test NA - new
Separation Distance frcm A~sorption Field:
To Water-Supply Well 114' To Property Line
To Building Foundation 30' To Existing or Abandoned System cn
Lot NA ; On Adjoining Lots 100'+
To Water Main/Service Line NA To Cutbank(if present)
To Stream/Pond/Lake/c~ Major Drainage Course NA
To D~iveway, Parking Area, or Vehicle Storage Area 10'
Coh~t~nts *Original final qrade was 0.5' to 1.5 feet lower. been recently regraded.
sq.ft./BR Type of System Design trench
Length of Field 141 ' 2 lines 1@75' 1~6.6~'
Depth of Field*After final qradinq4 ' -5.' *
Gravel Bed Thickness 5 '
1410 sq.ft. Standpipes Present (Y/N) Yes
None - new
fill bank
The system has
D. LIFT STATION
Date Installed NA
Size in Gallons ~
"P%n~p On" Level at
High Water Alarm Level at~
Tested for
Electrical Codes(Y/N)
Comments
Dimensions
MaD_hole/Access (Y/N)
"Primp Off" Level at
Vent (Y/N)
cles ~ring Adequacy Test.
Msets
** Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, or conformed to all MOA HAA ~Li~es in effect
on the date~.of ~t~%.s inspection.
[Page 2 of 2]
2-15-84
ae
HEALTH AUTHORITY APPROVAL (HAA) AIPil 2 6 1985
CHECKLIST - FEBRUARY 1984
Legal Description:
Lot 8B-2, Sec 23 T14N t~IW
Well Classification Individual
Well Log Present (Y/N) Yes
Total Depth 195' Cased to
Static Water Level 120 '
Casing Height Above Ground 1.5'
Electrical Wiring in Conduit (Y/N) Yes
Separation Distances f~cm Well:
To Septic/Holding Tank on Lot 102'
To Nearest Edge of Absonlption Field on Lot 114'
To Nearest Public Sewer Line NA
IVIUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
Slopes
If A, B, c~ C, D.E.C. Approved(Y/N) NA
Date C~t~leted 7/30/84 Yield
53' Depth of G~outing. None
Pump Set At
5 gpm
Sanitaz-f Seal on Casing (Y/N)Yes
Depression Around Wellhead (y/N)No
; On Adjoining Lots 100'+
; On Adjoining Lots 100'+
To Nearest Public Sewer
Cleanout/Manhole NA TO Nearest Sewer Serviu~ Line on Lot NA
Water Sample Collected By W. Slater/GEOLAB ; Date
Water Sample Test Results
Coa~ents
B. SEPTIC/HOLDING TANK DATA
Date Installed 9/26/84 Size 1000 No. of Compartn~nts 2
Standpipes (Y/N)Yes Air-tight Caps (Y/N)Yes Foundation Cleanout (Y/N) Yes
Depression over Tank (Y/N) No Date Last Pumped NA - new
Pumping/Maintenance Contract on File (Y/N) NA ; for NA
Holding Tank High-Water Alarm (Y/N) NA Temporary Holding Tank Permit (Y/NiNA
Separation Distances from Septic/Holding Tank:
To Water-Supply Well 102'
To Property Line 85'
To Water Main/Service Line
Course NA
Connmnts
NA
k
To Building Foundation 16'
To Disposal Field 15'
To Stream, Pond, Lake, c~ Major Drainage
[Page 1 of 2]
Receipt ~
Date Paid:
Amount:
2-15-84
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL HEALTH CASE REVIEW WORK SHEET
CASE NUMBER
S-5393
[~] PLATTING BOARD EJ PLANNING & ZONING
NAME
Magnificent Moun%ain Slope Subdivision
[)ATE RECEIVED
May 28, 1980
COMMENT TO PLANNING BY
June 18, 1980
EOR MEETING OF CASE OF
L~'-PUBLIC WATER NQ~F AVAILABLE TO PETITION AREA
/'~ I",/,.o' -', '
PUBLIC SEWER ~OT AVAILABLE TO PETITION AREA
71 014 (Rev, 2~78)
ACTL 80--1343
! ~,. 5 B.K;qD YOUNG 77, ~ ~22 Hay 80
i :~c::-{St i~,n: TRACT: 8B.~~ ...... S'a}~SivJ si3:c Magnificent Mt. Slope .
,. ~ XXXXXXX .
0 TOP SOIL
2
4 , ,_a ~x~DY GRAVEL (OW)
-8
~4
16
SANDY SXL'PY GRAVF5
BOTTOi~I OF TRENCIt
i:
22 :<::.y 80
ti 5 3 9 3 ,JUL
MUNICIPALITY OF -~NCtlORAGE
A and Environn~enBal
Fourth Floor West
825 I, Stree~
Anchorage, Alaska 99501
264-4720
................ -I~-~'i)'ECTION REPORT ON-SI'I'F SEWAGE DISPosAL 5YSTE/~
.......... ;=~ ...... ~ .................................................... ~ '~ '~--~-'-:~ ~6 ~, /e. G?~I-- 9'~ ~'-~
~'>~ ~ X~,~q man ~N~ AmmUSS _ .,>.~--~:~,~ ........ ~ ..... : ....... intONE
...... ~' -' ~" ~ _~Z~f SZ~' ~ ~2~Y ~T'~7 'i~ ...............................................................
SEPTIC 1-A[~ K:
NUMBER OF
l~2!ll)E LENGT[ ............. INSI[)E WI[)IIt~--.'-'~ ....... LIQUll9 DFPl}t .~ .......... LIQUID CAPACITY ..~GALLON$.
{ ~ / TOTAt. LENGTH
~',:~ C)[ r:I ~0~ A~FA ~O ~ L SQ. FT, LENGTH OF ~AClt LINC
....... ~ OEPTII OF [ IL.TER --
SEEPAGE PiT:
Db~MET ER ..... OR WI[)TIt .... LENGTH ...... F)EPT kt
Log C'rib ..... Rings__~ Crib Size: DIAI,4L'IE!{ .... L)EPFtl ..... {)ISTAN£[ FP, OM: WEft .................
IO]'Pt. EFFUCT/VE
BUIL DI[ , ~ _,,~;IDAIlO~I ...... NEARLSF LOT t INE ..... A[~bORPIION AREA (WALL AREA) ............. SQ. FT.
~-, ,L~,d-,,-~ , I I ' ' : .[. L..: ..... 1 l.._l._
~ ,/ ~ ' / : I .... ~ - ' '-"
:]g: .~-'_~f2J" Jcwer Lzne: -'- / i .........
po Materials: $,.,)~j~_~.. ,._.._
of Bedrooms:~- ..... J
marks:
I
TIRRC:T 6:K-: i',tFpSi'.~ I F: I I::ENI' HT '.SL_CrPi:E
H.
LCI'f '.512't:
~'1-% rfir: ':~;Oll.. 12E:S;OF.:E;TICIN :'-:,','STEI'I I3;: TIREhlf:t4
L ]tilll'l HLiI,1E:EF:: Cfi-- I:_:EI[:,tl:OO'IS ".:'
:LT'¢_'-:~6:~E~E'~ ':SC!l_ll':~l;:E F:'EEY
'SOIL F:FI'FING ,::'.SC! Fq",."E:R:~= J-~-:...
,'.F: F'I{C!I_I1F:t:D '.SiZ[~ OF THE S, OIL I::IP-,-c-O~:F'T1F~N .:-,'rz, TEI1 IS;:
· 1~ l:"]-I-t .... """---': I--F:l''4~.Ui''l-I--l== -'~¢~-" ~L;iF;':F:~%"I'=-L[- [::'EEF'qI-H'=-:
]tie I..EHGTH D]~I'IEi"~:T,~ON :iS THE I.ENGTH ,:IN FEET) OF THE TRENCH
'lHk- [:,E'F'TH OF Fi ]'RENC:H OR F'IT [~ 'file D~STFINCE DETPlEEN TI-gE SIJRP-FiCE OF THE
q~F:OLINC' RN[:' THE E;OTTCIhl OF THE E~.-::(::IR',,,'Ft'I-)'C~i"~ (~f'4 FEET),
THEI';:E ;IS NO SEY HTr)TH F'Of~: TF4ENCHES,
THE GF.:FIVE!._ DEF'TH ['S THE I'IINIMUM DEPTH OF GRFIYEL BE'rNEEN THE OUTFFitJ- F'IPE
mr41) THE E',OTTOH ElF THE EMCFIVF<fION (]'N FEE-f').
[,:: ~]5! LI ]: i;: E: [:' ::S: l-E F' -I'- I ~:: -r FI 1"-4 I'-=:] "'"S'; I Z ES == :J_ :4:.:" .%? ¢b 1:3 Ff L. L. ~? t"-4 ~'"-~
(l I-iLI_if'4G OF' FtN"r' S'¢%'rEM p]ZTHCd_I'I' FINF'tL IN:~F'EC:TIL-ff4 Fd'.4£) F. IF'F'ROVFtL ~::',r' Fl'ii%
i:ud;::ll,lEN'f' HLL.L.. E',E S, LIE',$EC:T TO PROS, Ecu'rJoN.
:tliI.ILH'I [.., ][ %'[ Ffi',ICI:( E',ETHF:ISN IR L4ELL FINE) Ftl'.,l',r' OH---:S].'FE SEI,IRGE I),ISPO%F~L. S;'.?STEH IS
,-~ FEL:/I' FC.N: R F'RI'v'RTE I,~ELL CiR 2(:JE'~ FEET FOR fl F'LIE:L ]r C: [4EL. L.
'[-C ! F I Cf:~T ! OH% RI'.4E:, i::ONS-FRLICT ~. Oi'.4 E:, ! RGI;:RI'1% FIF:E F¢,,,'f:~ :.!' LI::~E',LE TO ! i',ISIJ,~:E
! ,~:'-:] t:ILL_[:;i]~ ! Of',,I.
] Ffl'l F'Ffl,IlLIFd? HI'IH THE REQLIIF::EMEhITS FPl.;' OH-SITE SEF4ERS RND HEI_I_S tis 9;fEl"
,I."1~1 E:'T' THE I,II_II.~ICiF'~[_
I 14ILl. INS'l'FILL 'T-E SYSTEM IN R~¢~F;:DRNC:E HI'IH 'I'FIE CODES. . .. .
'4II.,E~ICE ~: F'.EI'IODELE%, TO [~.~t.lE~ I'IOF~E 'I-HFIN ,t f?,E[::RO01'I'.:,.
(~N[.! : :
-
lhis furm fL:purLs: ,Soils lo!] ............................ Perco'l-a-[]Oi 't.b~'t~ ..... T--. ...........
Dep th
Feet
(L~'Zl,'I..) '~ lo, oo
~.;as ground water encountered?/ .... _~.~::._. If yes, at what depth? ~/2. /
._ .~ ...... ~'~,~ /~_ ~'~,~, ........................................ : ........ : ..... ,... ................
,~cdd~ng Date Gross Tin~ Net l'ime UepLn to Wah:r [ Itel Uro)
I'ercolation taLe minute.
-['r'Ul~OSed im;t. allatl )n ,eepaUc' Pit ~/ grain Field
IX.'pth Of Inlet I)epL~--t}~"~b~}'~'l])~'~-'l)it or trench
......... "~ .... ' ~ ' . ............ 'T
'1