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HomeMy WebLinkAboutSUN VALLEY BLK 3 LT 9Sun Valley Block 3 Lot 9 #078-111--04 Municipality of Anchorage e 'e' , }} iI> L� Permit Number. Development Services Department Building Safety Division " •. Onsite Water & Wastewater Program, 4700 Bragaw St. a. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907) 343-7904 Page 1 On-Site Wastewater Disposal System and/or Well Inspection Report SW080013 PID Number 078-111-04 tZ • of 3 Nome: BRIAN LANCE Wastewater System: • New ■ Upgrade Address: 2812 SUN VALLEY DRIVE ' EAGLE RIVER, AK ABSORPTION FIELD Phone: No. of Bedrooms: (907) 622-3712 3 ()Deep Trench 0Shallow Trench II Bed ()Mound ()Other LEGAL DESCRIPTION Sol Rohm 0.7 ceona. n. local Depth horn original /rode: 2.5 TO TOP OF SAND n. Block: Lot: Subdivision: 3 9 SUN VALLEY DPU to pipe bottom from anginal grode: SEE DWG. R Crory depth beneath pip.: 0.5 n. Township:Ronge: Section: — — — re added ow engine/ prodsprodsGm avSEE DWG. n. d length: 36 n. WELL: ❑New El Upgrade Arent width: 18 R Number Ines: D tone. bets leer: el 3 6 n. Cbpitcolion (Privets Ab.C} Tata) Deo n. Cots' lo:�pgyii n. Total absorption armPip. 648 so. at) lMeabl: 3034/ F-810/SCH 40 AW. \ S-�\NCJ Dot. Drilled: Static Water Lam: n Mole Date M 2/29-3/3-4/08 GEG. Ltd. Yield: COS Pump set At FL Casing H•kht Above Ground: n TANK SEPARATION DISTANCES ()Septic 0 Holding ■ S.T.E.P. 0 Other* To From Septi' Tonk Absorption f"dld Lift station Hddinq Tonk PuliAc/Pdrol• lkiw Mo"Wectorer' ANCHORAGE TANK Capacity Si pollens 1250 Well 100'+ 1001+ 1001+ — 25'+ Yaler.i: STEEL Nunes el cre pommw.4: 2 Surface Water 1001+ 1001+ 1001+ — — LIFT STATION Lot Line 51+ 101+ 101+ — — Si.. w polkas 1250 ANCHORAGE TANK Foundation 51+ 10'+ 10'+ — — 'Pump on' level et. 41" •Puny al' Merl et: I 41" High tooter skarn et: 45" Curtain Drain Sump Yoh. ori weed: 20-051-05—HHF e.chleel Up.etkns performed by: RISING SON ELECTRIC KNOWN NONE Remorks: TO BE TOPSOILED AND SEEDED IN THE BENCH MARK SPRING OF 2008 towbar end D..erlphon: BACK DOOR THRESHOLD OLD SEPTIC TANK WAS PUMPED, FILLED WITH DRAIN ROCK, AND COMPLETELY ABANDONED A.Y.m.e 0•00t/On: 100.00 FL Inspections performed by: GEG, Ltd. Dates: lst 2/29/08 ENOSIEF 0 �� ` �. ✓•:`Jef i oOy... I' 04p°paressta�aa 400o�p00 1 o_oF I �`'t‘ 0. LO��� S�llo •'•.ye 00 A. Car '`fro• r 2nd 3/3/08 3rd 3/4/08 Development Services Department Approval Conditional approval: `/J/{)�} (!/. Oote Y" / Trpcnb/P Seco by /"bc c_crt /tit L.. /C-0R Reviewed and approved by: p !Y• 0 Dote 63-13- OS (Rev. 4106) �J PERMIT NUMBER: SW080013 A B ST1 28.25 52.29 ST2 43.75 57.51 MH 45.78 59.60 MT1 43.31 38.39 AS -BUILT DRAWING 1 • • 1 \ •• • MT2 59.86 47.95 MT3 65.89 73.89 MT4 73.92 75.61 \ \\\\ 11 \ \ • 1 • • \\ \\ NEW 1250 GALLON \ ' S.T.E.P. TANK • • • \ \ \ • • GARAGE \ \ \ PARCEL ID NUMBER: 078-111-04 • • \ • • • • \• •1 ./ • \ 1• • • ___ 100' WELL RADIUS 0 / / - EW DRIANFIELD .10,0 0 1 TH/1 . M13Li • • • • 20' DRAINAGE EASEMENT GVO I ATIT A Nf1S SOUTH FORK ROAD (UNDEVELOPED) GAR NESS ENGINEERING GROUP, Ltd. '- CONSULTANTS & GENERAL CONTRACTORS 0,700.007.en...7...,... a..� 3701 C. TIM 00.0. We[ 101 • MUO,.G[. M 10307 • AOC (107)337-4111 • FM (107)310-3241 . Or '^_ ..L.,.•Mm,n PREPARED FOR: BRIAN LANCE LEGAL DESCRIPTION: PHONE NUMBER: 622-3712 SUN VALLEY, LOT 9, BLOCK 3 TYPE OF WORK: AS—BUILT DRAWING PAGE NUMBER: 2 OF 3 DRAWN BY: K.D.M. 5 E: 1'4.40 DATE: 3/11/2008 A. :rness; E -7Q53 eG ' 31.011.72' QO ProlessloWoao 40000�� TOP OF TANK AT INLET - 94.80 ST1 FINAL GRADE - 99.22-99.25 5T2 INVERT OF BUNG AT INLET ow 94.58 MH TOP OF TANK AT OUTLET - 94.80 2' PVC LINE TO DRAINFIELD TOPSOIL AND SEED IN THE SPRING OF 2008 ORIGINAL GRADE 99.30 FINAL GRADE •• 102.63-103.64 FILTER FABRIC NSULATION ORIGINAL GRADE 101.30 TOP OF SAND 4. 98.80 INVERT OF DRISTRIBUTION UNE •• 99.30 BOTTOM OF SYSTEM •• 96.30 THE DISTRIBUTION UNE 15 1.25' PVC WITH 1/4' HOLES SAPCED 3. ON CENTER. 10 HOLES PER LATERAL, 30 HOLES TOTAL BOTTOM OF JnItM - 98.30 RELATIVE ELEVATION OF BOTTOM OF TEST HOLE I. 88.80 (H20 0 92.80)—Q5— sAliet GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS• ••�•..-a�a.�+..�. Jwl c TIMOR 1010. SUITE 101 • MOORAGE. MI row) • FMK 0107)337-4I79 • FAX (07)3311-3249 • Or tow.4pmenongineelrox cent PREPARED FOR:PHONE NUMBER: PAGE NUMBER: BRIAN LANCE 622-3712 I 3 OF 3 LEGAL DESCRIPTION: SUN VALLY, LOT 9, BLOCK 3 TYPE OF WORK: AS -BUILT PROFILE DRAWN BY: K.D.M. DATE: 3/11/2008 Mar 11 2008 9:21RM Rising Son Electric, Inc. 907-622-6777 March 11, 2008 Gamess Engineering Group Attn: Kyle 3701 E. Tudor Road, Ste. #101 Anchorage, AK 99507 Re: Lot 9 Block 3 Sun Valley Dear Kyle: Rising Son Electric. Inc. 14916 Woodland Drive Eagle River, AK 99577 (907) 622-6/// The lift station at the above referenced property has been wired in accordance with NEC and State/Local codes. Thank you. Sincerely, 1ferai.ic.j�'sG' KeviK S. Hornbuckle, Owner Administrator Ucense Number 1284 Specialty Contractor Ucense Number 27285 cc: file P•2 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW080013 Legal Description: SUN VALLEY BLK 3 LT 9 Design Engineer: 0855 GARNESS ENGINEERING GROUF Owner Name: BRIAN LANCE Owner Address: 2812 SUN VALLEY DRIVE EAGLE RIVER , AK 99577- 2 2'1'0 c. 2:Oct 3,-3 - o g 0 /2:30 Date Issued: Feb 22, 2008 Expiration Date: Feb 21, 2009 Parcel ID: 078-111-04 Site Address: 002812 SUN VALLEY DR Lot Size: 74053 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: E 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 ( 18AAC80 ). 3, The engineer must notify DSD 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. L 2/29 ,4m.,.nr •r Sa.J to chant. 6r� p¢ r7Ar1N en 146 agh.'/ sac &at 2Yi' Sant 04 1xt clownh,Y( 5:at. Nix s t ) tA. s'61-",: ft 7, l9"et vote3.2 Received By. C71 61"/,!/L,✓t t/f� Date / -5./o Issued By: ��11,(/pf/� Date: 2/frZ/09 Parcel1.D. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING h fl - 1 I /-014 Property owner(s) BRIAN LANCE Mailing address 2812 SUN VALI EY DRIVE a EAGLE RIVER. AK Day phone 622-3712 Site address Zip Code 99577 Legal description (Sub'd, Block & Lot) SUN VALI EY. LOT 9. BLOCK 3 Legal description (Township, Section & Range) N/A Lot Size �t I . 05 3 Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR (® all that apply): THIS APPLICATION IS AN: Absorption Field 0 Initial 0 Septic Tank 0 Upgrade Holding Tank 0 Renewal 0 Privy 0 Private Well 0 Water Storage 0 I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. Permit/Rush Fees: ffi 4 Co U. 0 0 Waiver Fees: Date of Payment: a/a 0/ O$ Date of Payment: Receipt Number: 9 3 Co cf 0 Receipt Number: (Rev. 11/05) GARNESS ENGINEERING GROUP, Ltd. • CONSULTANTS & GENERAL CONTRACTORS a > " February 18, 2008 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic Upgrade for Sun Valley; Lot 9, Block 3, To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The septic system is in a state of failure and needs to be upgrade. We are proposing to install a new 1250 gallon S.T.E.P. tank and a bed type drainfield. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which show the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: In order to fit the proposed drainfield between the well radius and the easement linetthe drainfield will be 30 feet long and 18 feet wide. The area for the proposed drainfield is less than a 10 percent slope and will not adversely affect the additional width of the proposed drainfield. See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPIIY: As can be seen on the attached design drawing the proposed drainfield is right at the base of a hill that is a 10-20 percent slope which transitions to a 5-10 percent slope that runs northeast to southwest. The drainfield will be on a 5-10 percent slope. The topography below the proposed drainfield is a 1-5% slope. We arc unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any test' ns, please contact us at 337-6179. Thank you for your assistance. erely, Presi ., M.S. NOT . Attached is a site plan drawing, a design drawing. one soil log, which are all part ofdie design package for this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246 Website: www.gamessenginecring.com N. \ \ \ \ \ SUN VALLEY BLOCK 3, LOT 7 CHUGACH STATE PARK 1 1 1 / / / ) 1 / / 1 1 1 SUN VALLEY BLOCK 3, LOT 8 r \ \ `SUN VALLEY BLOCK 3, LOT 9 / \\ \ 1 _1 `-VACANT THE CASCADES 8100K 2, LOT 5 L7.- — EXISTING 3 BEDROOM I HOUSE 1 SOUTH FORK ROAD (UNDEVELOPED' THE CASCADES BLOCK 2, LOT 4 `-VACANT / \ \ \ CTRACT A USATO \ / \\\ \\\ \ \ / \ \\ \ \ \ \ / THE CASCADES \ \ \ / BLOCK 2, LOT 6 \ \ \ / \ \ \ �'vACANT \\ \\ \\ \ \ \ \E 1 I GYM A311VA \\ 11 SUN VALLEY \BLOCK 2, LOT 7 SUN VALLEY BLOCK 2, LOT 8 `-VACANT ROPOSED SEPTIC SYSTEM CHUCACH HILLS SUBOMSION BLOCK 2, LOT 1 GARNESS ENGINEERING GROUP, Ltd. -. - . • • CONSULTANTS 3 GENERAL CONTRACTORS ..��...��....��...,..,_..., ]101 c 11.€01 ADW. evt[ 101. NCCtY[ r 19907 • 1•1•3,K (101)301-17e • Olt (907)338-37441 .EWT ....q.n.ary..uy...s PREPARED FOR: (PHONE NUMBER: PAGE NUMBER: BRIAN LANCE 907-622-3712 1 OF 3 LEGAL DESCRIPTION: SUN VALLEY SUBDIVISION, BLOCK 3. LOT 9 DRAWN BY: K.D.M. WACANT s E 1' le 100 TYPE OF WORK: SITE PLAN FOR SEPTIC SYSTEM UPGRADE (Rev 01105) DATE: 2/15/2008 AS A. M7 ess. EII-79 3 . • .`p dp 1 o/e ss100�a/ ��O0000 EW.RIIERIA: NUMBER OF BEDROOMS: 3 GALLONS PER DAY (GPD): 450 PERCOLATION RATE/S: 1 MIN./INCH PROPOSED APPUCATION RATE: 0.7 MINIMUM DRAINFIELD SOFT.: 643 DRAINFIFI D DESIGN: MAXIMUM DEPTH: 3.0 FEET WIDTH: 18 FEET LENGTH: 36 FEET M.OA APPROVED SAND FILTER: 2.0 FEET EFFECTIVE: 0.50 ACTUAL SO.FT.: 648 GEC, Ltd. HAS A 7 P/Z -SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION. THE ENGINEER, WEU. DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDRIONS OUTLINED. NOTE: THE CONTRACTOR SHALL HAVE THE SOUTH EASEMENT UNE, AND WELL RADIUS FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. GARAGE 100+ WE4 RADIUS 0 100' WELL RADIUS 1 EXISTING 1000 GALLON SEPTIC TANK TO BE PUMPED AND FILLED WITH SOIL N. PROPOSED 1250 GALLON S.T.E.P. TANK \ \ EXISTING DRIANFIELD TO BE COMPLETELY ABANDONED \ \ PROPOSED DRIANFIELD J 20' DRAINAGE EASEMENT GVO J Jl311VA Nf1S t SOUTH FORK ROAD (UNDEVELOPED) 5 E. 1. u• 40' GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS ••••••-••••••••--...-• ...�,.—,.., 3701 1. Haat now. curt 101 • Neoax kg 49507 • NeC (407)337 411711 • FAX (007)336-3244 • W091L' .•..r.,,.,,.6044.f4 . PREPARED FOR: PHONE NUMBER: PACE NUMBER: BRIAN LANCE 622-3712 2 OF 3 4 4 LEGAL DESCRIPTION: SUN VALLEY, LOT 9, BLOCK 3 DRAWN 8Y: K.D.M. D 0 A la Je r A. ness.. Ito; . E-79•$3 4p . e• I I g �cetg tY Pro Tsesor`o�oac ��OO000�ra TYPE OF WORK: PROPOSED UPGRADE SEPTIC SYSTEM DESIGN (Rev 011051 DATE: 2/18/2008 18 IDE r L 0' CPAT C MTO •3 OM7 36' LONG J MTO JI 1.5• PVC PIPE FROM S.T.E.P. TANK NOTE : THE DISTRIBUTION LINE IS TO BE 1.25" PVC WITH 1/4" HOLES SPACED 3' ON CENTER, 10 HOLES PER LATERAL, 30 HOLES TOTAL TOPSOIL AND SEED • 3' .1AX 2'• INSULATION FILTER FABRIC ROVIDE 6• DRAINROCK BELOW INVERT OF PIPE MT RIGINAL GRADE J., `r(n_ Cs, .. ?Cr v a - 4•c e� `A a - C ‘7•.411:?.....!‘1.1 1 !w .! w .ky1 s. .1r. �.i r T ` a r ":.Tial V •_` 3 f._i "' +• ` ,r. rthb ;1.."::.2, FEET MINIMUM 1404 •APPROVED $AND FILL&Tel"•:„.'„'` i =a ..?.`lr:�: a:�?.alY ��rai '�x4. w.- 1":: d;:� s `.,_]�.. . '."t. '"i till:. -;2, ,��..: :: 4i a^'`Z tip .. GARNESS ENGINEERING GROUP, Ltd. - , CONSULTANTS 3 GENERAL CONTRACTORS+z�.•..a ........,,.. 1701 L 11ACM Il0.0. WR 101 • NOCRCC. MC 11507 • ,1CIC (107)337-114 •IAC (YOli33 -3240 • ITL ntgv.rnrw"Yyq„n PREPARED FOR: PHONE NUMBER: PAGE NUMBER: BRIAN LANCE 622-3712 3 OF 3 LEGAL DESCRIPTION: SUN VALLEY, LOT 9, BLOCK 3 DRAWN BY: K.D.M. TYPE OF WORK: PROFILE DRAWING (Rev. 01105) DATE: 2/18/2008 y Arness:• / CE -7 3 `G to a erO Tee slon00oo >D�00p0 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 370; L n100R IIQ10. SUR 101 • MSC. LEGAL DESCRIPTION: 41501 • P410RE: /107)337-4171 • Mt (107)336-3246 • rasa 4-^4•••^vinmel^P SOIL LOG - PERCOLATION TEST SUN VALLEY, LOT PERFORMED FOR: BRIAN LANCE DATE: 2/8/2008 DEPTH (feet) • 1 1 1 1 1 1 1 6- 7- 8- 9- 10 — 11- 12 — 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Y 1 1 13 — 14- 4- 15- 15- 16- 16- 17- 17- 18- 18- 19 19 8.0.11. ORGANICS GP—GM GM DENSER w/DEPTH 20 SOILS LOGGED BY: COMMENTS. TEST HOLE #1 SOIL CLASSIFICATIONS EM 11;1119I remFEIRAY I��Illllasaw GW GP GM GC SW SP SM SC ORG ML CL OL MH CH OH DEPTH TO GROUNDWATER DATE 2/8/2008 DRY 2/9/2008 10' 2/15/2008 8.5' 10:00 — moo 0 D v SOUTH FORK ROAD_(UNDEVELOPED) E SCALE: 1" - 100' DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 2/9/2008 1 10:00 — 6" — 2 10:06 6 0" 6" 3 10:06 — 6" — 4 10:12 6 0" 6" 5 10:12 — 6" — 6 10:18 6 0" 6" PERCOLATION RATE TEST RUN BETWEEN 1 4.5 (MIN./INCH) FT. AND PERC. HOLE DIA. 6 (INCHES) 5 FT. A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ® NO ROB CAMPBELL PERCOLATION TEST PERFORMED BY: KYLE MAUS PERFORMED BY CEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFO MED IN ACCORDANCE '7 X15 WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 0' • MUNICIPALITY OF ANCHORAGE r 2 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION \f 1 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME 'PeEW C._ --SrP PHONE bn.4...Z7 t-73❑ UPGRADE ./h MAILING PA, PTJ.0 6---N eti ve //v4 -- S�B 1 c/ `c J 4 -C— R, LEGAL DESCRIPTION L.0-r- 9 5L -ie 3 S «N V L� LOCATION ) f / /J 1 L-1Aa7/) NO. OF BEDROOMS:3 tJ .Y . ‹Z, wF @ DISTANCE TO: Well or l n / v 'V � Y Absorption a -a Dwelling y3� / PERMIT O 1 T Oqi) 34) , CCC / Y� Y-,`7" Manufacturer j1 � Materia . _� j L. Width rn No. of compartments Liquid depth Liq ca i gyllons Ll IF HOMEMADE: Inst a len th e- r- I] X J 0 Z _ ? crt DISTANCE TO: Well ,t i / Dwelling PERMIT NO. Manufacturer jV9. Material Liquid capacity in gallons 1 TILE DRAINFIELDI TRENCH DISTANCE TO: Well A Foundation Nearest lot line PERMIT NO. No. of lines Length of each lin A Total length of lines Trench width inches Distance between lines Top of tile to finish grade Material beneath tile inches Total effective absorption area w 0 a[ 1 ei m to Length L./ Width r/ Crib dian ter meg,/ , e ,l� j Crib depth G /t S f e /L Total effective a • j`isV/r]r PERT c� 0 /�/ epi / `7�'� Type of crib �__-, DISTANCE TO: Well ",a r ,IA Buildi jfo,}tpd ion ••7 Driller r Nearest lot line �D Distance to lot line PERMIT NO. _i Class , Depth DISTANCE TO: Buil. .-fot , tat on- Se -r in? Septic tank Absorption weals) OTHER PIPE MATERIALS, � `-A/ 1 — (` SOILTEST RATING /2-5 711/),13n— 1 INSTALLER, 1 w I>F:-.A1--.1 c .4 fir, Ox b;id--l02 REMARKS I Mf.) 5'y cram ims.-OL-A rfE . , 7:- L'rt S( '-L � , �✓ '� ' C)E—�-30416 d f \ T.'41/' l= ,',r r, ,, £ � 6 . '^p "0.14b" d, � r x.19\ M T' -� r Ijd dl c, rMOFEteu\0,t_-' 01— 'TO SPA r l / k�,-,:o- P- S""r12aM / D 3 n APPROVED �. a i 1f� NLIEHIN0 Ail i 5 (.140.1i x,L11.i Ct1ULri, 1-02. ;+• vac - ��� uta ann h 72-013 (Rev. 3/781 _�. PERMIT NO: GATE ISSUED: APPLICANT: ADDRESS: N'•b U N• -•N I w_. I F' k-1 L. I `T "-r' or R N'-•tl c H cl F° IAl 3 EE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET: ANCHORAGE: AK 99501 !64-47200 ON -SIM . _'- IE L•.II O FP: a W IE L. L... r E F;: 6I 840304 051 /07/84 CONTACT -PHONE: LEGAL DESCRIP: LOT SIZE MAX'BEDROOMS: DEAN CONST. S&S ENGINEERING EAGLE RIVER: AK 99577 '6.S.4-2979 - •SI_IADIVISION: SUN VALLEY LOT: 9 SECTION 33 -TOWNSHIP: 14N RANGE: 1W 74053 (SQ. ET. OR ACRES) LISTED BELOW FIRE THE OPTIONS AVAILABLE TO -SYSTEM: ._CHOOSE THE`OPTION THAT BEST FITS DEPTH TO PIPE BOTTOM (FT. ) GRAVEL DEPTH <FT. ) • TOTAL - DEPTH (FT. ) GRAVELWIDTH (FT. ) CiRAVEL LENGTH {FT ) •`GRAVEL VOLUME CCU. YD'S: "TANK: SIZE (GALS) SOIL RATING <SQ: FT. /BR) 2. 5 0: 5 3. 0 17: 0 34.0 21.4 1: 000:0 ** 125 BLOCK: 3 YOU :IN DESIGNING YOUR SEPTIC YOUR SITE. *;;-DEPTH TO PIPE -BOTTOM C 3. 5 FT. REQUIRES INSULATION **:;DEPTH•TO' PIPE BOTTOM C 4.'0 ET. MAY REQUIRE A LIFT STATION ** TANF(-MUST,HAVE-AT" LEAST TWO -COMPARTMENTS • I' CERTIFY `THAT. 1. 1 AM FAMILIAP WITH -THE' REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET ,FORTH' BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. "-2.' I MILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGU[..ATIONS:- 'AND IN COMPLIANCE -WITH THE DESIGN CRITERIA OF THIS PERMIT. 3:'I WILL. ADHERE -'TO -ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE'SET BACK DISTANCES FROM ANY EXISTING WELL.: WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY -ADJACENT OR NEARBY LOT. UNDERSTAND' THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 3 BEDROOMS AND: .:ANY -ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. - If.A' LIFT'STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES: THEN';1+ AN ELECTRICAL PERMIT -AND INSPECTION MUST BE OBTAINEDi (2) AS--BUILTS' 'WILL 'NOT 'BE APPROVED WITHOUT ANELECTRICALINSPECTION -REPORT; AND (3) THE ELECTRICAL --WORK 'MUST BE DONE BY A -LICENSED ELECTRICIAN. SIGNED, f` �4 APPLICANT : ' DEAN -r�T: ISSUED BY _ f L � A ) DATE: DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: 11EZ"/ CPA/ S•rre-4cria^l SOILS LOG PERCOLATION TEST DATE PERFORMED: Id7617e- CV/9151 LEGAL DESCRIPTION: dT / Scie3/ �i/Aj %cc&y St O Set Zs %/ 174N/ K ie/a/ S/�( SLOPE - SITE PLAN DEPTH (FEET) ‘r4 -sr e So7c-- - CP J 4 tv/ y (p,Pat 4 c tj rrjl ep&tQt.tr-S l /2 tt Ss'wFe- 8- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - Vis' t�.,,,0 1 Or�644:4 t't��p fi`AY,a oorAnonao°�_aa 0 fro-- °`gza r-�' q IVeto °,oUo lL�% .,.!, 9MM0 4',- Ruuell L. Oyster a" a°`'V No. 428SEio ^ �� W l WAS GROUND WATER ENCOUNTERED? l�[J 0 P IF YES, AT WHAT 7S F - DEPTH? L(c Z? eyo Reading Date Gross Time Ne Time Depth to Water Net Drop 11 PERCOLATION RATE TEST RUN BETWEEN FT AND COMMENTS Se-DrpCr 4-r 'L..- Secr/o, / NfflMa %cc -sr ro'7— /C3r- �•r _I ,t /JFQA) 6NS'rft'Cr7ef/n PERFORMED 8 . -I s i --,c 72-008 (6/79) CERTIFIED BY: (minutes/inch) FT /4eWccr D/r ,Gieralock DATE: e/-2,4 fry .ON OF WF.LL (Piano comploto alth r la, Ib or lc.) WATER WELL RECORD STATE Of' ALASKA DEr.,RTMENT OF NATURAL RESOURES Division of Geological U Geophysical Surveys Drilling Permit .No. A.D.L. No. Borough ,..Subdivision Lot Dlocr IbJ 1/4 qtrs. l-�I� Anch )1in iz/k _cJ—of—of_-_of.—. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Well // 1 Slrool Address and Aroo of Wall Lacallon Soclion No. Tonnohlp No SO Range Enl Meridian WO L• 3. OWNER OF WELL. Mrs Carl Disotell Eagle River, Ak. Addroea: i2 WELL LOG Material Typo Boulders and soil Gravel ad soil Pool Below Surloco Top Bottom 4. WELL DEPTH: (final) a. DATE OF COMPLETIONq� 77 ft. . 6 e—L — 84 0 3 J 11 Clay and gravel —77- 1117'7— --tare, bil t, tramtf "WECtiUr I Iy --7 9 G. O Caelo. tool )nary LJ_Drivon 0 Dug Augur 0 Jelled :[], Bored Olhor: 7.9fAXial,Domestio Public.SupplyO Indu sl ry O Irrigation u Recharge Commorlcal Toil Well (Mori 0. CASING' L1 Thraadod YiJAYreldod diem. 6 In. to Ii__ it. Depth Wolgh1.,1_l_—Ibs./ f1. diam. In. lo 11. Depth Stickup_ _ 11. 9 FINISH OF WELL: Typo: Diameter:__ Slot/Mo sh Sleo: Lo ngth:___ Sol bolvoon 11, and ft. Bockfilling Gravel path -M OfPALLT_Y OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PR&T€ETIQN I 'tea 0.-1995 10. STATIC WATER LEVEL.r__ 3 fl. O Above or laKelon land surface Equipment used: 6/15 Data 11, PUMPING LEVEL bolos, land surfing and YIELD ft. of for __.hrs. pumpingg. p.m. alter hero. pumping g. P.m. RGmEW- 16. WATER WELL 00NTRACTOR'S CERTIFICATION: '2.GR0UTING Well Groutod: LJ Yes O No Motorial: LJ Dont Conlon? Othsr: 13. PUMP: (If ovollabio) HP Lenglh of Drop Pipe ft, capacity _ __p. p.m. 0 Subm. 0 Jet ❑ Conhltleat Other 14.REMARKS: 5 GPM production 15. Wolof Tomporalure This well was drilled under my jurisdiction and this roporl Is Irue lo the best of my knowladgo and ballet; Magnuson Drilling AA 5385 i°1blo144norrr"HNp5b4 Eagle River_ p Aka CoqgEJralrronso Number Address: Stoned: Tll/1- Tc_rvt7L.. %%l/i `I LL,rr Date:June 15, 1984 A lhorl zod FleproscinlalIve Form 02-Y/O11 (II/01) Copy Dislribulion' WHITE' Stale OGGS, PINK -Driller, CANARY - Cuslomor ON 10301 s9sn Municipality of Anchorage Development Services Department ) 'fl/ Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Pc- ISSucnc CERTIFICATE OF ON-SITE SYSTEMS APPROVAL 1 FOR A SINGLE FAMILY DWELLING 8' 0 ^7 Parcel I.D. O! -7 g- -ill -O V COSH# 0 O Expiration Data: _,` %,S 0 R 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SUN VALLEY, LOT 9, BLOCK 3 2812 SUN VALLEY DRIVE * EAGLE RIVER, AK 99577 BRIAN LANCE Day phone 622-3712 2812 SUN VALLEY DRIVE • EAGLE RIVER, AK 99577 Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: 111 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 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE. AK 99507 Engineer's Printed Name JEFFREY A. GARNESS. P.E. 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 d 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 Idontifiable 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 tho system. These conditions are outside the control of the evaluator of the system. Satisfactory Lost 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 tho systom will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Phone 337-6179 Date 4/17-0€ '• ONSITE : m WATER AND bedrooms, with the 'Bowing stipulations: ; WASTEWATER PROGRAM J • /4. • ..•..• ••cp Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory y (Rev 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other Original Certificate Date• 6o — /3 — r Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw 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: SUN VALLEY, LOT 9, BLOCK 3 Parcel ID: O 72 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 6/15/1984 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 77 ft. Cased to 77 ft Casing height (above ground) 24 in FROM WELL LOG AT INSPECTION Date of test 6/15/1984 1/24/2008 Static water level 3 ft 23 ft. Well production UNK g.p.m. 1.65 g.p m WATER SAMPLE RESULTS: Coliform colonies/100 mi. Nitrate mg./L. Other bacteria colonies/100 mi. Arsenic: ug./L. Date of sample: Collected by: 'GEC Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size 1250 gal. S.T.E.P./STEEL Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping NEW C. ABSORPTION FIELD DATA Date installed 2/29-3/3-4/08 Soil rating •.p.d./ •r ftT/bdrm) 0_7 System type BED Length 36 ft. Width 18 ft Gravel below pipe 0.5 ft. Total depth •3.83 ft. Eff. absorption area646 ft2 Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test =in. Water added =gal. New depth =in. Elapsed Time. = min. Final fluid depth= In. Absorption rate >= 450+ g.p.d. Pumper Date installed 2/29-3/3-4/2008 Cleanouts (YIN) YES High water alarm (Y/N) YES oana^IAmaraNEa;,aaa Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, givo date - D. LIFT STATION Date installed 2/29-3/3-4/08 Size in gallons 1250 Manhole/Access (YIN) YES "Pump on" level at 41 in. "Pump off" level at 41 in High water alarm level at 45 in. Datum BOTTOM OF TANK Cycles tested NEW Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001+ On adjacent lots 1001+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 101+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and p e 0 review of Municipal records that the above systems are in 0""' " ' o conformance with MOA COSA guidelines in effect on this date. Engineers Printed Name JEFFREY A. GARNESS Q O Date 6'121og Orite�..'4/(i i./€1....e4f, OIte /4% -rotes sior`coa O�40�o>`''' ,. ess• COSA Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 11/05) Waiver Fee $ GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS June 12, 2008 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragraw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Request for non -conditional COSA for Lot 9, Block 3, Sun Valley Subdivision To whom it may concern: The mounded drainfield on the subject property has been top soiled and seeded; therefore, we are requesting an iuance of a non -conditional COSA. ut erely, JefTi Pres , M.S. NOTE: Attached are a COSA package, an as -built survey, and a pumping receipt. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 • Website: www.garnessengineering.com Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL r�� FOR A SINGLE FAMILY DWELLING Parcel I.D. OW' ' i fr O y 1. GENERAL INFORMATION Complete legal description COSA# SUN VALLEY, LOT 9. BLOCK 3 hvoqi Expiration Date: 6 - / ✓� -' 09 Location (site address) 2812 SUN VALLEY DRIVE • EAGLE RIVER, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BRIAN LANCE Day phone 622-3712 2812 SUN VALLEY DRIVE * EAGLE RIVER, AK 99577 Day phone Day phone Unless otherwise 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 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. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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. Phone 337-6179 Address 3701 E. TUDOR ROAD. SUITE 101 * ANCHORAGE. AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 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 alt wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. Q Je f' A. Gomess: 0 e • —7953 :• e`O 0�4rer ..fq/.oe'•• (AS' 4'� Pro fesslo^oo '444400'� 5. DSD SIGNATURE Approved for bedrooms. Disapproved. .1 Conditional approval for -' bedrooms, with/the 'flowing stipulations: —Pep Sci/ d— SeerA1(A c?C b el 'o L- c0� ie-Pet17> �t-/.S-oQ Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory By: (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other a/ , nOriginal Certificate Date: 14 — 2 1 - 03 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orgfonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SUN VALLEY, LOT 9, BLOCK 3 Parcel ID: 07g -I11-09 A. WELL DATA Well type PRIVATE If A, 13, or C provide PWSID# N/A Well Log (YIN) YES Date completed 6/15/1984 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth 77 ft Cased to 77 ft Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 6/15/1984 1/24/2008 Static water level 3 ft. 23 .p. , Well production etr 5 gm. 1.65 g.p.m, WATER SAMPLE RESULTS: C) Coliform b colonies/100 ml. Nitrate'N 0 mg./L. Other bacteria (._ i 'colonies/100 mi. I I Arsenic: it 0 ug./L. Date of sample. LO A / 0 51 Collected by GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material 5.T.E.P./STEEL Date installed 2/29-3/3-4/2008 . , Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) ' YES Foundation cleanout (Y/N) YES Depression over tank (YIN) JQ. High water alarm (YIN) YES [ Date of pumping NEW Pumper . — C. ABSORPTION FIELD DATA Ii1:121017111711tWatie•Lley 1 Date installed 2/29-3/3-4/08 Soil rating407Eifill or ft2/bdrm) 03 System type BED Length 36 ft. Width 18 ft. Gravel below pipe 0.5 ft. Total depth *3.83 ft. Eff. absorption area 648 ft2 Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS For _3 bedrooms Fluid depth in absorption field before test — in. Water added — gal. New depth — in . Elapsed Time: — min. Final fluid depth — in Absorption rate >= 450+ g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) ' NO If yes, give date D. LIFT STATION Date installed 2/29-3/3-4/08 Size in gallons 1250 Manhole/Access (Y/N) YES 'Pump on' level at 41 in 'Pump off' level at 41 in. High water alarm level at 45 in Datum BOTTOM OF TANK Cycles tested NEW Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 1001+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main 5'+ N/A Property line 51+ Water service line 10'+ Absorption field Surface water 5'+ 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 10'+ Building foundation 10'+ Water main N/A P Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. 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. JEFFREY A. GARNESSOtte.: Engineers Printed Name �� o• ' Date 14-111,103 ut ss. 0 el tiff olessloPee COSAFee $ q 30 - ill 6a tornth!ion4/ Waiver Fee$ Date of Payment 1 I / 7/ 0 a' Date of Payment Receipt Number &P 3 Receipt Number (Rev. 11/05) SCS Ref.N Client Name Project Name/N Client Sample ID Matrix PWSID 1081326001 Garncss Engineering Group, Ltd. Sun Valley 133, L9 Sun Valley 133, L9 Drinking Water 0 All Dates/Times are Alaska Standard Time Printed Date/time 04/11/2008 15:52 Collected Date/Time 04/02/2008 9:00 Beech ed Date/Time 04/02/2008 16:05 Technical Director Stephen C. Ede Sample Remarks: Parameter Results PQL Units Method Allowable Prep Analysis Container ID Limits Date Date Init Metals by 2CP/MS Arsenic Waters Department Total Nitrate/Nitritc-N Microbiology Laboratory Colony Count Total Coliform Fecal Coliform ND ND 0 0 0 5.00 ug/L EP200.8 C (<10) 04/03/08 04/07/08 NRB 0.100 mg/L SM20 4500NO3-F 13 (<10) cot100m1, SM20 922213 co1/100mL SM209222B cot100mL SM20 9222B A A A 04/11/08 LCP 04/02/08 DLC 04/02/08 DLC 04/02/08 DLC ■� Apr -18-08 12:44pm From- Ile " Boos;,'' 9 / fft risi T-585 P.001/001 F-584 it ro �ea1't.--r y9cr zo;472 /i1.6w.Moto c �i-'/i^/i'B pZ ASBUILT-NO CORNERS SET THIS DATE. SEWARD 1 HEREBY CERTIFY TSCALE' :THAT I HAVE SURVEYED THE ,�:yo'. FOLLOWING DESCRIBED PROPERTY: �rel.c7;•r7/�O if-3'77dA (23 & ASSOCIATES LAND SURVEYING 6884566 r44V Y%%2ZV rote! dorf BGF: o-' ' DATE: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS �p INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANYRI s�yAsf, EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. FB: _77- o DRAWN: £wx +0OA; • F A4 4• S 49 1k /% • A,,A AA>4we.Tr Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 078-111-04 1. GENERAL INFORMATION HAA# CgO Expiration Date: ir/ i(cz Complete legal description SUN VALLEY SUBDIVISION; LOT 9, BLOCK 3, Location (site address or directions) 2812 SUN VALLEY DRIVE • EAGLE RIVER, AK 99577 Current Property owner(s) PAMELA PAGE Day phone 696-7920 Mailing address Lending agency Mailing address Real Estate Agent Mailing address P.O. BOX 771843 • EAGLE RIVER, AK 99577 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer • 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 28 * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. 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. AKW WC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _..4t Approved for 3 bedrooms. Disapproved. Conditional approval for Phone 337-6179 Date kt Witt bedrooms, with the fllowing stipulatior* fQi•,. % % . rTh C ----"c.• . WAtfilAcfsw _.. • oFR 0 Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: der*? I (Rev. 12101)IJ Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SUN VALLEY S/D; LOT 9, BLOCK 3, Parcel ID: 078-111-04 A. WELL DATA Well type PRIVATE If A, 5, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 6/15/84 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 79 ft. Cased to 77 ft. Casing height (above ground) 18+ in FROM WELL LOG AT INSPECTION Date of test 6/15/84 7/12/2002 Static water level 3 ft. 0 ft. Well production 5 g.p,m, 6.0+ WATER SAMPLE RESULTS: Coliform 0 colonies/100 mt. Nitrate O.2 mg /L Other bacteria 0 colonies/100 ml. Arsenic N/A mg./L. Date of sample. 7/26/2002 Collected by' B. SEPTIC/HOLDING TANK DATA AKWWC, INC. Tank Type/Material STEEL Date installed 6/9/1984 Tank size 1000 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 7/30/02 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA *FILLED TO TOP OF LATERAL Date installed 6/9/1984 Soil rating (g.p.d./ft'otbdrm) 125 System type BED Length 34 ft. Width 17 ft. Gravel below pipe 0.5 ft, Total depth'n.25 To 2.5ft, Eft. absorption area 578 ft' Monitoring tube YES Depression over field NO Date of adequacy test 7/12/2002 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 2 in Water added 480 gal. New depth 7In Elapsed Time: 1075 min. Final fluid depth 2 in Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN "SEE COMMENT SECTION ON BACK OF BROWN SHEET. If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/A "Pump on" level at in "Pump off" - - in High water alarm level at in Datu Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Public sewer manhole/cleanout On adjacent lots On adjacent lots 100'+ 100'+ Sewer /septic service line 25'+ Holding tank N/A N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation $'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 1001+ *FROM NEAREST PIPE TO NEAREST POINT OF CREEK SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A P Water service line 10'+ Surface water *103' Driveway, parking/vehicle storage 5'+ Curtain drain NONE KNOWN Wells on adjacent Tots 100'+ F. COMMENTS APPROXIMATELY 20 INCHES OF COVER OVER BED. NO FREEZING PER HOMEOWNER. G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Na1me Date ihoa JEFFREY A. GARNESS HAA Fee $ 375• - Date of Payment Receipt Number (Rev. 12/01) S/5/o2 0,7Qo Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE i` DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I D # 178 - /f/ _p HAA# /YN ICOOci/ 1. GENERAL INFORMATION Complete legal description I.-,. ere: 1 K 3 StAh VociteJ Location(siteaddress or directions) SEA -41 V Dc 14' la 6 5 g It 8 Property owner ? c' l.etti0-61€4. Mailing address of 77 3 i 5.2. e 2 - Lending agency CH Isto49a�< t E.R-- Mailing address Day phone &n - 7363 Day phone (e9t, -0701 Agent C trek, Lo Day phone 6 %' -4- Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 021 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in Leffect on the date of this inspection. %C� Name of Firm Ohem ` DU ( -cuA 'isPE Phone �` ` Address Engineer's signature Date 6. DHHS SIGNATURE k Approved for 9' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By. Additional Comments Date 3-& 7j CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 12-025 (Rev. 1/at( flack MOA 121 Legal Description A. WELL DATA `S Well type Log present (Y/N) Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Lq'f K3 v /j Parcel I D O7(S III —0 LI If A, B, or C, attach ADEC letter. ADEC water system number Total depth 7 9 Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Date completed ' /6' 8 ( Driller eco 14.4,1..4gon) Cased to 7 9 Casing height B FROM WELL LOG 3Y Wires properly protected (Y/N) AT INSPECTION c2 -/o .43 rc 7 s> :._ �1 n am nn D Ti; ego -146M rri 22 A'•1n F .11 < . E � F-; 7 cni En CD 0 c. 7 ; On adjacent lots > 11 D H 0 0 I ; On adjacent lots ��n SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot )I$ gpm Absorption field on lot ) Public sewer main Sewer service line > .2S WATER SAMPLE RESULTS: Public sewer manhole/cleanout Petroleum tank N-1 it, Coliform Nitrate 1\I Other bacteria Date of sample: '2"A)/'3 Collected by. ��rA_ B. SEPTIC/HOLDING /TANK DATA Date installed �! 9�3 N Tank size f� Compartments z Cleanouts (Y/N) High water alarm (Y/N) Foundation cleanout (Y/N) Depression (Y/N) Date of pumping `27// 6793 Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot—_11-.5 On adjacent lots i /5D To property line > I D Absorption field Surface water/drainage > /0-0 72-026 (Rev. 7/91) Front \l Foundation 43 Water main/service line > g 47 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELDDATA Date installed GA/ Soil rating / a5 System type Oe Length 3 Li Width 1 7 Gravel thickness Total depth 3 Total absorption area 5 7R Cleanouts present (Y/N) Depression over field (Y/N) NI o Date of adequacy test 2 • /0 - 4 3 Results (pass/fail) for 3 Peroxide treatment (past 12 months) (Y/N) N SEPARATION DISTANCE FROM ABSORPTION FIELD TO: If yes, give date bedrooms Well on lot � 1/.) � On adjacent lots > /3-0 Property line t To building foundation { 3` To existing or abandoned system on lot t -/A 2-0 On adjacent lots > Surface water > / rro Curtain drain P -1I Cutbank oNC Water main/service line >CO E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area /0 1 certify that 1 have checked, verified, or conformed to all MOA and MAA guidelines in effect on the date of this inspection. Signature 1 - I Engineer's Name OIIO $ fa 14 RIO +' Ida - Date r-eJo 1 l q13 HAA Fee$ /76`4)0 Date of Payment , 2 _2-z/ - '3 Receipt Number -L/4 •6 C66D 2-- 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY :.�1•. A DIVISION OF COMMERCIAL. TESTING & ENGINEERING CO. Aga LAEORATORY 5633 El STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FAX: (907) 561-5301 Chorrinb Raft :93.0556-1 Client Sample ID :6/3 SUN VALLEY Metrix : WATER Client Name :TOBBEU SPURKSAND, P.K. Ordered By :TOBBEN SPURKLAND Project Name Projeet4 PPiSID :UA Sample ROUTINE SAMPLE, COLLECTED BY: STUART. Remarks: Parameter NITRATE -N REPORT of ANALYSIS Collected :02/10/93 014:00 hrs. Received :02/1.1./93 4 14x:00 hrs. WORK Ordar :63095 Report Completed :02/12/93 Technical Director :3TEP,JEP& C_ ED& Belonged By ,�% QC Allowable Extinct Analysis Results Ounl. Unita Method Limits Date Data Init 0..10 U m0/1. EPA 353.2/300.0 10 02/12/93 02/12/93 LL11 See Special Instructions Above See Sample Remarks Above NIA „ Unavailable NA ^ Not Analyzed U „ Undetected, Reported value .is the practical quantification limit. LT Loss Than C1' Greeter Than D = Secondary dilution. P SGS Member of the SGS Group (Societe Generale de Surveillance) sa®1!®B®110111111111•11i911111ilai9®®01611139cesMeagai.m,wo...nm..... 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) tot 7 As'//r 3 Scin d�•/iey ny /' y e so c_ Location (address or directions) (b) Applicant Name Car r/ 1Y,-ra *e» Telephone: Home �l'S"757 Business G `>i/ S 7S 7 Applicant Address -5'R 9 3 es- , c.S (ie /fi ve /T 22 5"-7 (c) Applicant is (check one): Lending Institution CI ; Owner/builder; Buyer 0 ; Other 0 (explain); (d) Lending Institution /10- Telephone Address (e) Real Estate Company and Agent yil/� Address Telephone (0 Mail the HAA to the following address: I°i c!n ip .e5',Y Fns e 2. TYPE OF RESIDENCE Single -Family% Multi -Family 0 Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public 0 Community 0 Holding Tank 0 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 /2-025 (11,114 5. ENGINEERING FIRM PROVIDING INSPECTIONS, 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 regulations in effect on the date of this inspection. EAGLERIVER ENGINEERING SICE9 Name of Firm �RVTelephone EAGLE RIVER, AI( 99577 Address Date ✓—AVFs 694-5995 6. DHEP APPROVAL Approved for �-�,4?22_.bedrooms by"£ °%?%' ^t ^ 'A•= Date Approved Disapproved Conditional 'C.� 0000 ° 7eY os* �� > �..> r SI e.LIr>;:% rj0 onc°0oe,o Uo;t9S..ocn. oa000rl. CO s 1 o CF 5736 ° 1.1 <0 °o i'.a G111 �f Rta-__toNPver 1' Engineer's Seal Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DI -IEP) 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description' 2 ° t 9 T_3L N /2 / w Sc MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION I;;AY 10 1965 'RicI V P, //e _c, s'3 A. WELL DATA Well Classification /let t" - If A, B, C, D.E.C. Approved (Y/N) N/4 Well Log Present (Y/N) y Date Completed 6//5-,L/ Yield G/°f Total Depth 77 Cased to _7 / Depth of Grouting /4 Static Water Level 3' i Pump Set At We., %tom,-.-. Casing Height Above Ground a 9 r Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) _ y Depression Around Wellhead (Y/N) 4/ Separation Distances from Well: To Septic/Holding Tank on Lot /'o t To Nearest Edge of Absorption Field on Lot /60 * ; On Adjoining Lots /G" t • On Adjoining Lots /00 d To Nearest Public Sewer Line /Urn -e Cleanout/Manhole U' To Nearest Sewer Service Line on Lot Water Sample Collected by 45-2 An ee r - ; Date .'7 /! ri/&S" Water Sample Test Results �z'rf� 1ti Comments J',fr r›, erea-xi on rvG// Froren r // /cf 0,,y To Nearest Public Sewer B. SEPTIC/HOLDING TANK DATA Date Installed /nV `F""e Size /OUO /, No of Compartments Standpipes (Y/N) y Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) y Depression over Tank (Y/N) Ai Date Last Pumped New Cohs2"r"c %.L. Pumping/Maintenance Contract on File (Y/N) NAI • for Holding Tank High -Water Alarm (Y/N) /v/A Temporary Holding Tank Permit (Y/N) 41/41 Separation Distances from Septic/Holding Tank: To Water -Supply Well 'Ot) a- To Building Foundation 3 6 e To Property Line /G * To Disposal Field / 9 To Water Main/Service Line /O To Stream, Pond, Lake, or Major Drainage Course 40 1 - Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / -) S46 Type of System Design SE a Date Installed /1'1/ cnt ne_ Length of Field d 3 Width of Fie d / 7 / Depth of Field 3 1 Square Feet of Absorption Area .S 78 Depression over Field (Y/N) Results of Last Adequacy Test N N/A Gravel Bed Thickness Sal Standpipes Present (Y/N) Date of Last Adequacy Test ive`ti Co„cf'en Separation Distance from Absorption Field: To Water -Supply Well /Va " To Property Line /e 7 To Building Foundation 38 To Existing or Abandoned System on Lot /Vane • On Adjoining Lots h) 3o - To Water Main/Service Line /O To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /0 To Driveway, Parking Area, or Vehicle Storage Area X17 Comments D. LIFT STATION NA Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request *" I certify that I ha checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signe l/57-�-e- Date S//&1/4 -5' - Company g`15 k rf<6-e E11"1 e'..2MOA No S t 2 6 S. Receipt No. .3s`63a��%p\> c z ° @ pDBB 0 aOo [i,�;i` Date of Payment 5 -iv- 5 �fof �n z o ✓ -t�� Engineer's Seal A /0?-:a3) 't T H� _ "r �' a .Doaeoe Q m2 ° Louis A. D'ufera /Cc,: Page 2 of 2©�NA okve4:77:;:fef CE-6736 ° 'El r2-026(11/84) Amount: $ ��U�