HomeMy WebLinkAboutHENKINS BLK 2 LT 3Henki*ns Block 2 Lot 3 #051-292-14 Municipality of Anchorage Page 1 of 3 Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 T Street Room 502 P.O. Box 196650 Anchorage. AK 995IM650 ~v.ci.anchorage.ak.us (907) 3434744 ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW000319 PID Number: 051_292-14 MM&M Contracting Wastewater System: New Upgrade Aa : P.O. Box 670495 Chu iak AK 99567 ABSORPTION FIELD P�: fF.ntw d Ilea.paae: 688.1236 Three 3 o°Ge°7e.„ ®shann Tewin Daae Lead Dopb Sae Ratng: Taal Oapm hen ag.w y.aae: - LEGAL DESCRIPTION ,8 apt• 5 Ft. 1160a: Lot: s".: D.W W p W. rmm agnal 9.a0e: G, l W.T1n Deneam pipe: 2 3 Henkins 1 Ft. 4 FL 7anmM1p: Itan9e: seems: fM aahU ehp.a a'PnY pada: 2 r, le Length: 57 Ft. Ft. Well: ® New ❑ Upgrade G,a w Jth: 5 reahhm of rtes: 1 : Dala.Ke heh een Lnaa: N/A Ft. FL Classftah (Pnwle. A Q C): Taal Depm: Vaned W: 101 101 Fl. Taal M W1,AXn Wea. 570 Fe Rpe Mate.W.. ASTM D3034 PVC Private FI. Dollar. Sullivan Date D..ed: SIMX Wats L :. 8/23/00 67 Ft. hslaan: MM&M Contracting Date astaaed. - 9/18-20/00 .tela: Pump sel M: C"" A>2Ga,nd: - TANK 30 Gw it. >2 � FL . SEPARATION DISTANCES ®Septic pHolding ❑S.T.E.P. 0Other. To From Septic -Tank Absorption Field Litt Station'. Holding Tank ubhUPrivate Sewer Line VaFzr.T'a"' - Anchorage Tank ym ' 1,000 Well >100'.- >100' N/A N/A >25' Male.W. Steel ' - Numhu peNnams: Two (2) salace Wal« >100' >100' N/A N/A LIFT STATION —.NONE ON LOT Lala. >5' . '21 N/A /A N/A. - cal Fowaaahaa >5' >10' N/A N/A IM -7a.t al. in. p at:wales _ in M. in. Nope Noted pump 1t tib MOWLlecaKal hapecaau ped ed W:. .. culan lkain Rem"ts: •. BENCH MARK Septic Tank and Drainfield Covered with 2" of Direct Bury Insulation. See Lot Line Waiver. loo PkA. Garage Floor Slab . _A.W Eaw.lan. 100.0 FL Inspections performed by: MEA Dates: 1s' ` 9/18/00' 2n° 9/20/00 Department of Health and Human Services approval Reviewed and approved by: at'lW' Date: -Y-0/ AL j Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650.343-4744 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW000A19 PID No. 051-29244 v U 85.0 i 87.4 x � E 2" Insulation & Geotextile Fabric Drainfield Cal Rock 57' PLAN AS -BUILT SCALE 1" = 40' �Ln E U 73. 0± 85.0 80.7 FROM : COUNTRY REALTY OWNER OF LAND PHONE NO. 9076881238 Dec. 29 2000 09:00AM P2 C�ettfYt`X�txt C by ooc eo. ee. SULLIVAN WATER WELLS P.O. BOX 970272, CHUOIAK, ALASKA 99987 • TELEPHONE I88-2761 ADDRESSI-0 n `r LEGAL DESCRIPTION . EA)ej,? W AOT 3 PERMIT NUMBER ObIn;119 Date of IssuelLia Zw TAX INDENTIFICATION NUMBER ASl • ' 9l Is well located at approved permit bcation b>e"m No Method of Drilling: 6414tary Q cab's tool Depth of welt: 1 O Casing Type Wall Thtcknasc r .�5 z Inches Diameter 41h inchee, dept_feet LlnerType: J.JS Casing Stickup Above Ground: CZ feet Static Water Level (from ground Ievdl): feet Pumping level: feet after hrs. pumping 9prn Recover Rate: .gym Method Of Testing: Well Intake Opening Type: en End Q Open Hold O Screened: Startfeet Slopped feet C) Perforations Start �fe/et(,,��Stopped feet OrooType: 6&TU TE Ndume Depth: from Cl, feet, to "'fes feet Pump Intake Depth: feet Pump Size hp Brand Name Well Disinfected Upon Completion? 6-yer C) No Method of Disinfection: elift pff Xl J0ILI Comments: el, I//., b c4rrwf6 S i /c6c,11 r ,i19�J0 ' 6.44J, L }r'�ROPA.v i CON re r I I I Ddller's Name a ems,...An..� ATTENTION: It is the responsibility of the property owner to submit a copy of the Well log to the proper Authority. Municipality of Anohorago Department of HOW 8 Human Servk:ee and/or Department of Envlronmentsl ConservatlorL UatSu Borough: Department of FrNIr rn&nt�l ftnaohrvatinn. eived Time Dec -29. 9:55AM ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) December 29, 2000 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 3, Block 2, Henkins Subdivision Separation Distance Waiver Absorption Trench to Lot Line Dear On Site Services Engineer. The absorption trench on Lot 3, Block 2, Henkins Subdivision was inadvertently constructed within 2' of the south lot line to provide sufficient area for the new house and driveway on the lot. Lot lines were not well defined during the construction process and accurate measurements were not available until the final as -built for the house was surveyed. The lot is extremely narrow with a total width of 100'. Soils on this lot, however, were found to be very effective for the absorption of septic effluent and placement of the trench at this location will not pose a problem to neighboring lots. We therefore recommend the waiver be issued allowing the trench to be within 2' of the property line. Sincer//ely,-- X K' �// Michael E. Anderson, P.E. ' Municipality of Anchorage George P. Where/, Mayor ` Bttiklin(f Safcty Division P.O. Box 10)650 • 4700 S. Brapm Street Anchorage, Alaska ()7519•GCZO a (0)7) 343.8301 h It lr..//w�t�c.cl.nnchort};aalc.us Anderson Engineering ATTN: Michael E. Anderson, PE PO Box 240773 Anchorage, AK 99524 - January 04, 2001 Subject: Waiver Request forHENKINS BLK 2 LT 3 Waiver # WR010001 Lot Line Request for Parcel ID 051-292-14 Dear Engineer: Department of Public Works Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the lot line has been approved. The approved separation distance is 2 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sind Jeff Poet Engineering Technician III On -Site Water Quality Program Gor 310 Fwu,, to bac W kiJ cel. I MICIFALITY OF ANCHORAGE BUILDING SAFETY DIVISION Dept. 34 715.00 SUB -TL .715.00 ITEIf CT 1 TOTAL 715_00 CHECK TD 715.00 CHANGE 0.00 13:27 CASHIERI 01 04E2A 12-29-00 MUNICIPALITY OFANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 3434744 ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial 3-18-oa 6 ;00/�,� Date Issued: Aug 23, 2000 Expiration Date: Aug 23, 2001 Permit Number: SW000319 Parcel ID: 051-292-14 Legal Description: Henkins, Lot 3, Block 2 Design Engineer: 0014 Anderson Engineering Site Address: 15909 Old Glenn Hwy Owner Name: MM & M Contracting Lot Size: 20038 SQ. FT. Owner Address: PO Box 670495 Total Bedrooms: 3 Permit Bedrooms: 3 Chugiak , AK 99567 - This permit is for the construction of: Disposal Field Q Septic Tank Holding Tank ❑ Privy Q✓ 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 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. Received By: _Date: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX), August 13, 2000 Municipality of Anchorage Department of Health and Human Services 825 "L" Street. Anchorage, AK 99502-0650 Subject: Lot 3, Block 2, Henkins Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 3, Block 2, Henkins Subdivision intends to construct a three-bedroom home on the lot. We are therefore applying for a permit to construct a new well and septic system on the lot to serve the home. The attached .Site Plan and backup documentation identify the location and configuration of the well and new septic system and the parameters used in the design. It also shows the 100' protective radius from the well on the lot. The Area Map shows the location of the existing and proposed wells to the north and their respective radii. Two test holes were placed on the lot in the area of the new absorption trench. Silty gravel with sand was encountered in the underlying strata. The material percolated at a rate of 15 minutes per inch. Groundwater was not encountered in the excavation but did develop at 11' below the surface during the monitoring period. We have therefore designed a 5' wide absorption trench with 4' of gravel beneath the distribution pipe. The total length of the trench will be 57'. The total depth of the trench from original grade will be. 5', which will be a minimum of 6' above the present level. of the groundwater. The ground surface on the lot slopes from east to west at varying grades. The new trench will be constructed parallel to the contours of the surface in conformance with . Municipal requirements. Grading will be accomplished to assure surface drainage is away from the new trench. Mounding will be required over the trench to provide a minimum of 3' of cover or 2" of insulation will be placed and 2' of cover to provide protection against freezing. If the system is constructed in accordance with our design the following statements . apply L The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing y ------ --- --VO / 00 / -so z oo .10 / / / THIS PROJECT / Wel / c / VA T •O Wel Ac�AN� . / ,f_ / 74.1. _ .. .. \\ 'O • J m let /. / o` \ / d~ ¢ \ 0 O ........ ., . AREA MAP SCALE 111= loot ! ,Ole 6 �:� �,Qiv ,� LOT 3, BLOCK 2, HENKINS SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom Home 5' Wide Trench System Perc. Rate: 15 Min./inch 1,000 Gallon Septic Tank Application Rate: .8 GPD/SF 4' Drainfield Rock 3 Bedrooms X 150 GPD 1.8 GPD/SF = 562.5 SF of Absorption Area 562.5 SF/5 LF (Width)'.5 (Red. Factor) = 56.3 LF Trench Length Therefore: Construct 57' Long X 5' Wide X 4' Effective Depth Absorption Trench. Fiowline Elevation In Trench to be 1.0' Below Original Ground Surface. Total Depth to be 5.0'. Mound Over Trench to Provide Minimum of 3' of Cover. TYPICAL: WIDE TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 10' Separation From Lot Line. Minimum 4' Separation From Groundwater. 41Z._S i 'Natural.Backfill' ;(2'. Minimum) 6°. :,;;.`.. 2".•Insulation or. 3' 'Cover 6,, d� 4";PVC. Ololes.'Do wn) 41 .: Drainfield'Rocik •` O AER it TYPICAL: WIDE TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 10' Separation From Lot Line. Minimum 4' Separation From Groundwater. 41Z._S Municipality of Anchorage d Department of Health & Human Services 825 L Street, Anchorage, AK 99502-0650 t SOILS LOG - PERCOLATION TEST Performed For. MM&M Contracting Date Performed: Legal Description: Lot 3. Block 2. Henkins Subdivision . SLOPE SITE PLAN 1 7 8 9 10 11 12 13 14 15 16 17 18 OG/OL Bottom of Hole Was Groundwater Encountered? No If Yet, What Depth? Depth to Water After Monitoring 11' Date: 8113100 See Site Plan Reading Date Gross Time Net Time Depth To Net Water Drop 1 28 -Jul 10:05 2.5' 2 10:35 30 4.5' 2- 3 10:36 2' 4 11:06 30 4' 2- 5 11:07 2.5' 6 11:37 30 4.5- 2- Perc. Rate: 15 MinAnch Perc. Hole Diameter. 6' 21H Test Run Between 4.5 Ft. and 5.5 Fl. Comments: Percolation Cavity Presoaked Prior to Testing. Performed By: Tim Kimbroumh, I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 8113100 Municipality of Anchorage Department of Health & Human Services 825 L Street, Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION TEST Performed For. MMSM Contractinfl Date Performed: Legal Description: Lot 3. Block 2. Henkins Subdivision SLOPE SITE PLAN 1 OG10L 2 GM 3 TESTHOLE NO.2 4 5 6 7 10 11 12 13 14 15 16 17 Bottom of Hole Was Groundwater Encountered? No If Yet, What Depth? Depth to Water After Monitoring 11• Date: 8/13/00 See Site Plan Reading Date Gross Time Net Time Depth To Net Water Drop 1 28 -Jul 10:00 2.5• 2 10:30 30 4.5• 2- 3 10:31 2' 4 11:01 30 4• 2' 5 11:02 2.5• 6 11:32 30 4.5• 2• Perc. Rale: 15 MinAnch Perc. Hole Diameter. 6' 21 Test Run Between 4.5 Ft. and 5.5 Ft. Comments: Percolation Cavity Presoaked Prior to Testing. Same Material as Testhole No. 1. Performed By: Tim Kimbroumh. 1, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 8113100 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 3, BLOCK 2, HENKINS SUBDIVISION GENERAL: 1. The scope of this project includes the procurement and placement of a new 1,000 gallon septic tank at the location shown on the Site Plan. Work also includes the construction of a new 57' long X 5' wide X 4' effective depth absorption trench at the location shown. Distribution pipe will be placed at 1' below the original ground surface. The total depth of the trench from original ground will be 5'. Mounding over the trench will be required to provide a minimum of 3.0' of protective cover. In lieu of 3' of cover 2" of insulation and 2' of cover is acceptable. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,000 gallon septic tank must be be procured from an approved source and installed at the location shown on the plans. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. Lot 3, Block 2, Henkins August 13, 2000 Page 2 of 3 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). Lot 3, Block 2, Henkins August 13, 2000 Page 3 of 3 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. • • c.t G • Municipality of Anchorage On-Site Water and Wastewater Program 2 ' :, (907) 343-7904 SA ETV CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-292-14 Expiration Date: 1. GENERAL INFORMATION Complete legal description HENKINS BLOCK 2, LOT 3 Location (site address) 15939 OLD GLENN HWY., EAGLE RIVER,AK 99577 Current Property owner(s) JON H.WHITTAKER&LOIS E CONLEY Day phone Mailing address PO BOX 671936, CHUGIAK,AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) 0 Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: Date: 7/ `///g COSA to be released to t_h_99Agitle-er ess otherwise requested by the engineer. COSA Fee $ X524' Waiver Fee $ Date of Payment 14-2-0- I B Date of Payment Receipt Number CO 2-1 Receipt Number COSA# OCA$ 115L1 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M.DUFFUS Date 4/13/2018 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen -.1.-'411"�\ encroachments,deficiencies or discrepancies exist. OF Az \ Air (sy 1 /* 4• T1I * t 6. DSD SIGNATURE 1_ ���A XI System #1 Approved for —5 bedrooms. ! KENN>t System#2 Approved for bedrooms. 1 5, 71 e�� Disapproved. \ r`• F•ss Conditional approval for bedrooms, with the followinQP��tipt tit j.v v� 01\I-51 A p �A�WATER o W NST A� v; pRIG 4/fA-Ar g17:0 C� . By: Original Certificate Date: 4 -`it/ `( The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist#_of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: HENKINS BLOCK 2, LOT 3 Parcel ID: 051.292.14 A. WELL DATA Well type PRVT If A, B, or C provide PWSID#_ Well Log (Y/N) Y Date completed 812312000 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 102 ft. Cased to 101 ft. Casing height(above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 8/23/2000 4.11-2018 Static water level 67 ft. 71 ft. Well production 30 g.p.m. 5.9 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 1, I$ mg/L Arsenic: ND ug/L Date of sample: 4/1112018 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Date installed 9/18/2000 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N VCR!F,c "r;, Date of pumping 4/11/18 Pumper ARM SERVICES C. ABSORPTION FIELD DATA Date installed 9/1812000 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type SHALLOW TRENCH Length 57 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 7 ft. (Measured 4/11/18) Eff. absorption area 570 ft2 Monitoring tube Y Depression over field N Date of adequacy test 4/11/18 Results(Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 21 in. Water added 500 gal. New depth 29 in. Elapsed Time: 1400 min. Final fluid depth 20 in. Absorption rate >= 450+g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation -9+ f o 4- Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 2'(Waiver on file) Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway,parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Air OF ALA A Engineer's Printed Name KENNETH M.DUFFUS /<�� Date 411312018 * 9 T 4. COSA canary sheet_2-6-15.doc . KENNEl-- 71 P'• 'Es torA'=/ / -4 OF•L'4 1.f{1 11 f�i55 .:X 49 No7E: r P i REFER TO DOCUMENT REGI1pNO r'•55/ECAESS FOR LOT 151 RECORDED i yyS4 , i/ ��, AT S.N.2007-015E03-0. '!,j NN• A.HOL :T.- % LOT 151 111. L3 914 1'0', 7. 4 �/*Fdti'��6- • \0 '00, , Z E` e ki ` ' T/NT PORTON OF ROH OF WAY VACATED BY COMMONERS /i` V� $O,pO / DEED AS RECCRCEO AT BOOK 25$,PAGE 595.DATED JUNE 30. 1977; ...„/ AND CORRECTED DECEMBER 21, 1977 LOT 2 LOT 152 p� 4? i. W e hQJ 00 '00 W '00 C." 4. NOTE 1: LOT 3,BLOCK 2.HENIONS SUB. ( PLAT P-387). _ AND GOVERNMENT LOT 152,SECTION 30,T 15N,R 1W.S.M. Se40 .� 'r., Num P {, AAS-BUILT SURVEY 1" • 30' ,'- • Roma mA NocoNv+ERsseT7wo.*E / -...,A, •••,....: . °�, $ I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY 4,,, � k, '� OF THE FOLLOWING DESCRIBED PROPERTY 5J•4, :,.../ 7pp p'OFF NOTF I tib�~ ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE 'P VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN LOT 4 -!::°41/ THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS TIE TSEONMTION lacca IS FOR TE USE OF LOUIE INSTITUTIONS SPECIFICALLY TO SIOK MY EXIST OTHER THAN NOTED. CONFLICTS MOAN EX STI1c ST0ICTURE3 NO FLATTED LOT LIES NO/Co EASE:MOS,NO IS DATED AT ANCHORAGE,AIASKA THIS +OTE DAY OF NOT TO EE USED FOR FOSITIOQNE AOOITIO U.STRUCTURES,RPROVBIENTS,CO FOEELINES. EASEMENTS DI RECORD,01141 TNM THOSE AMFMON ON TIE MOND FLAT,MI NOT 91OM APRA , 201R NNEMO(AALESS DOICATED) NOTE: FBICELIES TINT MY AHEM ON TMS CRANING ARE NOT TO EE USED TO DETERNE PROPERTY LIES ON POSITION AO ITIONL INNOVEENTS. HOLT LOAD SURVEYING ANY PAVING ROM 140119 MY EE APMIORIMTE MN TO E10E5SIVE SIGN MO/ON ICE. 9319 GROVER 0135E A 000EAGE,M 99507 1Ilss.FR 157.00 MS 5511 • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Parcel I.D. 051-292-14 Certificate of On -Site Systems Approval Expiration Date: 1. GENERAL INFORMATION Complete legal description HENKINS BLOCK 2 LOT 3 Location (site address) 15939 OLD GLENN HWY Current Property owner(s) Alaska USA FCU Mailing address Real Estate Agent Jim Levra Day phone Day phone 786-2709 2. TYPE OF DWELLING: t r may, ® Single Family (w/wo ADU) e 0� L ❑ Duplex; ❑ Multiple Dwellings (Single Family and/or Duplex) FEB 24 2014 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual IN Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ PUulll QVVJer ❑ WaiverNariance request for: NONE Distance: --- 11s� t;;i Received by:.�° �� , �+n 1';`til,, � ` Date:�� COSA to be releaskd tp4he Agineer, unless otherwise requested by the engineer. COSA Fee $ �1a ^1 Waiver Fee $ Date of Payment V 2SJ�1 !y C Date of Payment Receipt Number ip1a 5�J Receipt Number COSA# Ot)(—^ }fit Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 SPURKLAND ENGINEERING Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE _i,/ System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, Phone 279-3916 Date 220/2014 Original Certificate Date: a �& of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r � F �1 with the following stiput t-1 <� Original Certificate Date: a �& of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r If more than 7 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: HENKINS BLOCK 2 LOT 3 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # --- Date Date completed 8/23/2000 Sanitary seal (Y/N) Y Total depth 102 ft- based to 101 ft FROM WELL LOG Date of test 8/23/2000 Static water level 67 Well production 30 WATER SAMPLE RESULTS: ft. g. p. m. Coliform NEG Monies/100 mL Nitrate 2.02 mg/L Arsenic ND ug/L Date of sample: 2/6/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments Foundation cleanout (Y/N) Y Depression over tank (YIN) N Date of pumping 2124114 Pumper Sanitary Pumping C. ABSORPTION FIELD DATA Parcel ID: 051-292-14 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 2/10/2014 70 6.3 ft. g.p.m. Collected by: ANSON MOXNESS Date installed 9/1812000 Cleanouts (Y/N) Y High water alarm (YIN) N Date installed 9/18/2000 Soil ratio 0.8 5 -WIDE g (g.p.d./ft2 or ftz/bdrm) System type Length 57 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 7 ft. Eff. absorption area 570 f:2 Monitoring tube Y Depression over field N Date of adequacy test 2/10/14 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 4 in. Water added 450 gal. New depth 11 in. Elapsed Time: 40 min. Final fluid depth 9 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date D. LIFT STATION Date installed Size in gallons - Manhole/Access (Y/N) _ "Pump on" level at _ in. "Pump off' level at a in. High water alarm level at -- Datum Datum E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot 100'+ Absorption field on lot 1001+ Public sewer main NA Sewer /septic service line 25+ Animal containment areas 50+ Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 51+ Water main NA Water service line 10+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line Building foundation 10'+ Water Service line 10'+ Curtain drain 50+ F. COMMENTS 'Waiver on file. G. ENGINEER'S CERTIFICATION Surface water 100'+ Wells on adjacent lots 100'+ 1 certify that I 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. Engineer's Printed Name LARS SPURKLAND Date 2/24/14 COSA brown sheet 10-10-12.doe Absorption field 5.+ Surface water 100'+ Water main 1 NA Driveway, parking/vehicle storage 10' in. Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 051-292.14 1. GENERAL INFORMATION COSA# r;700y6 Expiration Date:,_ Complete legal description Lor 3: Block 2: Hankins Subdivision Location (site address) 15939 Old Glenn Hwy. Chugiak, AK 99567 Current Property owner(S) Jessica Newton Day phone 265-8157 Mailing address PO Box 672178 Chugiak, AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (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. 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 s a s Engineering Address 15861 S. Birchwwod Loop d. Cho ±. AK 99567 Engineer's Printed Name 5. DSD SIGNATURE Approved for --3 bedrooms. Disapproved. Phone 694'2979 Date -3^2 —co7% Conditional approval for bedrooms, with the following stipulations: COSA Checklist X_ Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Nitrate Advisory Supplemental Engineer's Report Other By: cam✓ Original Certificate Date: 3 (A" 1IMS) Municipality of Anchorage • Development Services Department Building Safety Division ' On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-650 www.muni.org/onske (907)343-7904 CERTIFICATE OFF ON-SITE SYSTEMS APPROVAL CHECKLIST L Legal Description: ar 3i8L�X2,I I16K)� 4� Parcel ID: 061-712-Iq A. WELL DATA Well type VATY_ If A, B, or C provide PWSID # Date completed23/06 Sanitary sear!) IF -s Total depth IDI ft. Cased to (D ( fL FROM WELL LOG Date of test la/Z3 r Static water level 6 n. Well production WATER SAMPLE RESULTS: 060 WellLo&N) ~'SS Wires properly protecte�( ) E S q Casing height (above ground) _!0 t in. AT INSPECTION O`? g.p.m. (9,t7 g.p.m. Coldorm 0 ooloniesl100 mL Nitrate -* g/L Arsenic: iW> mg/I Date of sample: B. SEPTICIHOLDING TANK DATA Tank TypelMaterial--z �_r7w Tank size j �� gal. Number of Compartments 2 Other bacteria cwlonies/100 mL Collected by: r—jV6f 16: le& � Date installed 1B O6 Cleanout.&) `IES Foundation cleanouj§�14) _qr.S Depression over lank(Yo 100 High water alarm ( ISR Ax% Date of pumping o2 at 0 Pumper IS PV 1"ArA4 C. ABSORPTIONFI Date installed 70 00 Soil rating (g.p.d./fe or fefodrm) O. a System type S44U0(' > 1 tesaxt-( r G wrcE Length ft. Width S ft. Gravel below pipe 4.oft. Total depth n. Eft. absorption area s�Qfe Monitoring tube E'> Depression over field Ah Date of adequacy test z%� Resu (Pas ail) f G For 3 bedrooms 1t Ii Fluid depth in absorption field before test W in. Water added,' gal. New depth in. 11 Elapsed Time: -01q 3 min. Final fluid depth �S in. Absorption rate >= ()SQ+ g.p.d. Any rejuvenation treatment (past 12 mo.) ((5& type) /JO If yes, give date D. LIFT STATION k) I Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons Cycles tested at _ in. High water alarm level at SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on lot /004 1 Absorption field on lot Ito 4 - Public sewer main N!•04 r Sewer /septic service line as 4 Animal containment areas SO'4- Meets alarm & circuit requirements? On adjacent lots I >t On adjacent lots /O© r4 - Public sewer manhole/cleanout _I Holding tank A -NI rl Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: / r Building foundation ,�� _ Properly line S '� Absorption field s Water main ADI p Water service line 1 D 4- Surface water I Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1 I Property line a_ Building foundation Water main 1V %a Water Service line Surface water00 / Driveway. t I ( nveway, parking/vehide storage 1 Curtain drain A-VAX)c�AJ Wells on adjacent lots wo -f F. COMMENTS G. ENGINEER'S CERTIFICATION {E_ OF I certify that 1 have determined through field inspections and F*' '. 9! review of Municipal records he above sys s a in`, f conformance with MOA COS gu' n2777�< is te. ...».....»r... Engineer's Printed Name A. sk" Date COSA Fee $ `f Date of Payment Receipt Number /b -W9 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number in. ct- P.itLEfJP 4Au-01' r r too,o 1 1 d r� • t cl ' J T— AS -BUILT I hereby certify that i have suryeeyyed the following described /property: LOT- PI /�•.r-c`f irn 3Oy�i"15'"N1 P 1u/�5M Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, ! transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this Z O T< day of "I r c{, .ROBERT C. )OIINSON SCALE: Registered Land Surveyor No. IS 1" - '0 Box 77-0456, Eagle River, Alaska 99577 Phone (907) 694-2543 all Q o d N • �_ti_ t . ZrAV cn,M. Y 5�,clr,•.,1 AS -BUILT I hereby certify that i have suryeeyyed the following described /property: LOT- PI /�•.r-c`f irn 3Oy�i"15'"N1 P 1u/�5M Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, ! transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this Z O T< day of "I r c{, .ROBERT C. )OIINSON SCALE: Registered Land Surveyor No. IS 1" - '0 Box 77-0456, Eagle River, Alaska 99577 Phone (907) 694-2543 I •, Municipality of Anchorage 0 Department of Health and Human Services x Division of Environmental Services=_^C? On -Site Services Section 825'L' Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-292-14 HAA # D 10 D Off - Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 3, Block 2, Henkins Subdivision Location (site address or directions) Current Property ownar(s) _ GIM&G1 Contracting Day phone 683-1236. Mailing address P.O. Box 670495 Chugiak, AK 99567 Lending agency . Day. phone Mailing address � , Reat Estate'Agent Day phone Mailing "Address Unless otherwise requested HAA wi11 be held by DHHS for pickup. HAA picked up by 2. NUMBER'OF BEDROOMS: Thiee (3) 3 ". TYPE OF"WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: ' idnndual Well Q Individual On-site .Individual Water Storage Q.' Individual Holding tank Q Community Class Well > Q Community On-site "Q PubhcWaterSystem. Q. Public Sewer. Q The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health " Authority Approval (HAA) based only upon the representations given in paragraph 5 by ani independent professional uvil.engineer.regiistered 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 yearfor properties served by Class ,A.ofB`ivells ora public water system. -The Municipality 'of Anchorage is not responsible forerrors or omissions in the professional engineers work. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for 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 stricture 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. Name of Firm Anderson Engineering Phone 522.7773 Address P.O. Box 240773 Anchors a AK 99524 Engineer's Printed Name Michael E. Anderson P.E. " Date 12/29100 t.,,{T lav ' `us P t, 6. DHHS SIGNATURE � s. "r Thr t t r ' A roved for PP 3 bedrooms. tY4•3a�wein rs "a� Disapproved •.;, n. Conditional approval for %b with the following stipulations: 1 Additional Comments ' Attachments HAA Checklist X •` Maintenance Agreements Septic:System Advisory . Supplemental Engineers Report Welt Flow Advisory Other ' By Original Certificate Date. / O Expiration Date: ---� , :: Reissue I.,0MI Datei Municipality of Anchorage Ak Department of Health and Human Services Airm Division of Environmental Services Im On -Site Services Section 825 'L' Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343.4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 3, Block 2, Henkins Subdivision Parcel I.D.: _ 051-292-14 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed a 12 3/ 0 0 Sanitary seat Y Total depth 101 ft Cased to 101 ft . Date of test Static water level Well production FROM WELL LOG 8/23/00 Well Log Y Wires property protected _y_ Casing height (above ground) > 2 4 in. AT INSPECTION 67 ff If 30 g.p.m g.p.m WATER SAMPLE RESULTS: Coliform 0 colontesl100 ml Nitrate 1 .36 mg/l Other bacteria 4 colonies/100 ml Date of sample: 12/27/00 Collected by: MFA . B. SEPTIC/HOLDING TANK DATA . TankType/Material Septic/Steel Date installed 9/18/00 Tank size 1 .000 gal Number of Compartments Two Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm N Date of pumping New conatrnct i on Pumper C. ABSORPTION FIELD DATA Dateinstalled 9/20/00 Soilrating (g.p.d./Vorit2/bdrm) •8 Systemtype Shallow 5' wide Trench Length 57 ft Width ft Gravel below pipe 4 it Total depth 7 ft Effective absorption area 570 It' Monitoring tube Y Depression over field N Date of adequacy test New Const. Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in Water added gal. New depth ` in. Elapsed Time: min Final fluid depth in Absorption rate >= g.p.dt Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date N/A 72 02% (Rev. 01W D. LIFT STATION - N/A Date installed Size in gallons Manhote/Access "Pump on" level at in "Pump ofP level at in High water alarm level at in Datum Cycles tested Meets alar & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot >100' On adjacent lots >100' 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 SEPARATION DISTANCES FROM SEPTICMOLDING TANK ON LOT TO: Building foundation >5' Property fine >51 Absorption field _> s' Water main N/A Water service line N/A Surface water > 10 0 Drainage >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 2' Building foundation >10' Water main N/A Water Service line > 10 Surface water >100, Driveway, parking/vehicle storage > 1 ' Curtain drain None Noted Wells on adjacent lots >100' F COMMENTS See Lot Line Waiver for Absorption Trench.►'1\t►�_ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name MichaAl P.. Andnrsnne P.E. Date 12/29/00 HAA Fee $ Date of Payment Receipt Number Waiver Fee $ _ Date of Payment Receipt Number 72,M (Rev. 01/001• - -