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FIRE LAKE #2 BLK 1 LT 4A
Fire Lake #2 Block 1 Lot 4A #051-351-30 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191147 PID Number: 051-351-30 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: KEVIN & ANGELA TURKINGTON ABSORPTION FIELD - EXISTING Address El Deep Trench ❑ Shallow Trench El Bed ❑ Mound 18625 COLLETT DRIVE, EAGLE RIVER ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. FIRE LAKE #2 1 4A Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Ft2 Number of trenches Dist.between trenches From Tank Field Tank Line -- -- Ft. Well ' 100'+ NA NA NA i NA TANK ®Septic ❑S.T.E.P. [' Holding ❑ Other Manufacturer Capacity Surface Water 100'+ NA NA NA ANCHORAGE TANK 1000 Gal. Material Number of compartments Lot Line 5'+ NA NA NA STEEL 2 NA LIFT STATION Foundation 10'+ NA NA NA Manufacturer Capacity Gal. Curtain Drain l NA NA i NA NA Pump on level at Pump off level at High water alarm at Remarks Existing septic tank decommissioned per UPC, new tank installed 5'+ from & in. in. in. connected to existing field. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer CRs drainfield Drainfield CO/MT 3034 Inspector FWCS / MNA BENCH MARK (Assumed elevation) 100 ft Inspectio 15' 6/18/19 2' 6/20/2019 Location and description da3`° 4th BOTTOM OF SIDING COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL .41.- i �. OF 4 Conditional Approval: Date /� ' ...7 ' . /*49TH iC *t SMICHAEL N. ANDERSON. / No. CE 9489 • w 6/20/19 � Approved t... �‘_ _ Date 7-p---/7 ‘ FSSIOx s. ... Inspection Report_9-1-12.doc PID: 051-351-30 FIRE LAKE #2 BLOCK 1, LOT 4A PERMIT: OSP191147 it20.2' D- I� 57.0' a I- d• 23.5' ami' EXISTING o 0 N A 3BR HOUSE., , o ui 0 20.0' 'R 23.7' ri 26.5' Z Z Q 10.0' I FCO B N, num I A Q ZO IN GRAVEL CO n w Lo H 0 D/W 0 C O m Q 0J Oo DECOUMI SONE°COSTING&T. ° O O O ° PER PC&INSTALLED WI M N W 1000-GAL CO. O SEPT TANK IO'FROM • Z PJ FDUNOAT• &5'FROM FIELD. 3 Q WELL S N m \ N▪ ® M ~ In I In z R:n R 1" A o C) Cn Q 00p 00 > N •. z 0 6 GRAVEL, D/W 10' UTILITY ESMT , N00'07'08"W 150.12' (N00'03'25"W 150.05' R) 24.5' (25' R) SCALE: 1' = 50' FCO I CO CO ,(`CO IVERTER A-C=2 3.8' l� CO -\ 40 FINAL GRADE- Q 7 B-C=20.1' 98.41 98.29 A-D=28.0' I5 B-D=25.3' 93.17 1.000 GALLON \00 STEEL TANK E%ISTNG FIELDS SEPTIC SECTION SCALE: NTS PREPARED FOR: SUPPORT,SERVICES: —�_�\ KEVIN & ANGELA TURKINGTON tAigi��� OF AL�s, FIRE LAKE #2 B1, L 4A �`� � 'i- y 18625 COLLETT DRIVE, E.R., AK 99577 C *49TH /N 9* #I ivew(/,%/A.K4 Michael N. Anderson, P.E. DATE: 6/28/2019 / MICHAEL N. ANDERSON i 4661 Notrone Ave. 1No. CE 9469 `�cli Anchoroge, Alaska 99516 DRAWN: FWCS t 6/28/19 ' ss1olo'x. i (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' �`__4111' / / . / / /'` A` r`• MUNICIPALITY OF ANCHORAGE cn i ,\ On-Site Water&Wastewater Program ,'`� t. .S' ti .PO Box 196650 4700 Elmore Road ; ;. Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 �; \ http://www.muni.orglonsite n \ - grti N 'Nc o��� 1 elmrtmcnt On-Site Wastewater Disposal System Permit N Permit Number: OSP191147 Effective Date: 5/9/2019 Work Type;. SepticTank Upgrade _ _ _ . .. Expiration.Date: _ 5/8!2020 . Tax Code Number: 05135130000 Site Legal Address: FIRE LAKE #2 BLK 1 LT 4A G:0454 Site Mailing Address: 18625 COLLETT DR, Eagle River Owner: TURKINGTON KEVIN&ANGELA Lot Size in Sq Ft: 45018 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field Il Septic Tank ❑Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation, The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907)343-7904(24/7). 4. From October 15 to April 15,a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day,or b. Covered, sealed, and heated to prevent freezing • Received By: �� �/�/ Date: $ / ( 1 Issued By: `�JJ , ,, _ ,� _ _. Date: 5 / / P4WS MUNICIPALITY OF ANCHORAGE 1 . 4sr Development Services Department i1 • ;77,'"'� Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-351-30 Property owner(s) KEVIN & ANGELA TURKINGTON Day phone 9072230778 Mailing address PO BOX 201914, ANCHORAGE, AK 99520 Site address 18625 COLLETT DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) FIRE LAKE #2 B1, L4A Legal description (Township, Range & Section) Lot Size 45018 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank (9 Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal n Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. FWCS - Brent Western (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: q f Lq j q Date of Payment: Receipt Number: 6l3,p Receipt Number: Permit No. OSPI 11 10" Waiver No. G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 May 7, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: FIRE LAKE #2 BLOCK 1, LOT 4A To whom it may concern: The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 3- bedroom house. The lot and area is served by a private water and will not impact any of the neighboring properties due to the lot layout. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191147, Deb Wockenfuss, 05/09/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191147, Deb Wockenfuss, 05/09/19 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 SUBMITT ON-SITE WASTEWATER INSPECTION REPORT DEC 10 20FJ Permit Number: OSP131433 PID Number: 051-351-30 Dwelling: E Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New E Upgrade Name: Kyle & Christy Kle in er ABSORPTION FIELD E Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 18625 Collett Dr., Eagle River, AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 8.50 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.45 Ft. Gravel depth beneath pipe 4.05 Ft. Subdivision Block Lot FIRE LAKE NO. 2 1 4A Fill added above original grade 0.45 Fl. Gravel length 47 Ft. Township Range Section Gravel width 3 Fl. Beds: Number of LinesDistance -- between lines -- Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 380 Ft2 1 -- Ft. Well 100+ 100'+ 100'+ NA NA TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer EXISTING Capacity 1 1000 Gal. Surface Water 100'+ " 100'+ 100'+ NA Material Number of compartments 2 Lot Line 5'+ 10'+ 5'+ NA NA Foundation 5'+ 10'+ 5'+ NA LIFT STATION Manufacturer Capacity Gal. Curtain Drain NA °50'+ NA NA Remarks .*Non known. Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer Northern Excavation PIPEMATERIAL Housetotank3034 Tank to 3034 drainfiekl Drainfield 3034 CO/MT 3034 Inspector ARCTERRA BENCHMARK (Assumed elevation) 100 ft Inspection 1`11/26/13 11/26/13 Location and description 2nd 3r0 12/03/13 4" Bottom of siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL += i �� AL q �, Conditional Approval: Date TH �— � fit, KENNETH M. DUF / 7116 Approved Date � � FTISION .i eer's Stam Inspection Report_9-1-12.doc AS -BUILT SYSTEM DETAILS/SITE PLAN Permit 11SP131433 FIRE LAKE SUBD NO2 B1 L4A PID# 051-351-30 589'55'26"E 300.02' Pa` exp z GRAVE 00 D/W CS O W O O ® r'V GRAVEL u- 0 D/W _ m N UT �IO 0 O INSTALLED EXISTING U! N DIVERTER & 1000 -GAL x I NSTALLED DSL cct S.T. NEW TRENCH 1 _ � F .LETTN 4 0/W M C E%I RNG BENCH !IVE CO A TA 3-1 N89'55'37"W 300.03' \\ VACAN BASIS OF BEf 1 LOT 5 5 � y r �2A-C=110' H "B -C=88' PA -➢=158' = flnn_w95.67 ,B -D=132' FILTER g 4 gn A EXISTING 90,80 y 1000 -GAL m v S.T. 5.0• FINALL GRADE SEWER ROCK 47' OF<QSf�1 PREPARED FORT KYLE & CHRISTY KLEPINGER r / co 18625 COLLETT DRIVE 1 / * 9 TH* 0, Eagle Rlver, AK 99577 U rn KE DU/ FIELD BOOKS COMPUTED: 9DUNDARY:BOUNDARY DRAW: BMW 11./e2/lG/!3�'yti�"N STAKING CHECKED: KMD AS9UILT. JLS DATE: 12/16/13 SSIO�P DRG. FILE: GRID: NW454 AGAR FILE' FILE ao9 Na: 13-216 R) 51� y I'IIII i °a LOT 4A BLOCK 1 SCALEI V = 50' 9 M Fq AK. 99577-51' NTS O r7 SAVAGE DRIVE _ a V1 N00`07'20"W 150.10' (150.03' R) ` LOT 4A BLOCK 1 DECK 20.2' ^ ECK � 57.0' 23.5' EXISTING o 0)HOUSE N N C0 v 23.7' i 20.0' 26.5,' Z Q 10.0' n - Q NO COVERED W U') Q pGRAVEL ENTRY L,J O D/ O O r0 TPNn •20.2' (tYp) (nQ WELL T] Nto M00M 0 0V)� m 00 •• Z GRAVEL D/W 10' UTILITY ESMT N00'07'08"W 150.12' (NOO°03'25"W 150.05' R) = FND ALUMINUM MONUMENT OO = FND 5/8" REBAR ANCHORAGE RECORDING DISTRICT, ALASKA ASBUILT OF: FIRE LAKE SUBDIVISION NO.2 LOT 4A BLOCK 1 PLAT 86-136 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachmcnts exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 13-045-2 JLS I NW454 I 1 5 24.5' (25' R) H E-1 W O f::� ...AZA 11 TH ............. . i :. K..JOHN L. SCHULLER.: o LS -10408 : �t PDL�DR a 2� xi 0. � c� r 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131433 Tax Code Number: 05135130000 Work Type: Septic Permit Effective Dates: November 14, 2013 to November. 14, 2014 Design Engineer: ARC TERRA CONSULTING INC Subdivision: FIRE LAKE #2 Site Legal Address: FIRE LAKE #2 BLK 1 LT 4A G:0454 Owner/Address: KLEPINGER CHRISTY L & KYLE W 18625 COLLETT DRIVE EAGLE RIVER AK 995777507 Site Mailing Address: 18625 COLLETT DR, Eagle River This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank Lot Size in Sq Ft: 45018 Total Bedrooms: 3 N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-351-30 Property owner(s) KYLE & CHRISTY KLEPINGER Day phone Mailing address 18625 COLLETT DRIVE, EAGLE RIVER, AK 99577 Site address 18625 COLLETT DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block &Lot) FIRE LAKE #2 BLOCK 1, LOT 4A Legal description (Township, Range & Section) Lot Size 45018 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field [ Initial ❑ Single Family (SF) [x] Septic Tank ❑ Upgrade (w/wo ADU) Duplex (D) ❑ Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Siof property owner or authorized agent) Permit/Rush Fees: 3u_ Date of Payment: �J Receipt Number: O57(�y P Permit No. 05,PI31A3'5 Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. o Q+RCTERR,q 9h�'3YILTING November 7, 2013 ARC 1 rRRA CONSULTING, INC 212 E. 51st Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Sewer Permit — Fire Lake #2 Block 1, Lot 4A It has been determined that the absorption field of the subject property is saturated. Subsequently, the owner has requested we proceed forward to obtain a septic permit to upgrade the septic system. The general slope of this lot is from southeast to northwest at a grade of approximately 3-7% over the septic area. On October 30, 2013 a testhole was performed to investigate soils and groundwater. The results of this test are attached for your review. The proposed upgrade will serve the existing 3 - bedroom house. We propose to install one 47' long trench. Groundwater was not encountered at excavation or at monitoring. The property and adjacent lots are served by private and community water. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 868-3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. Duffus, Attachments: On -Site Sewer Application Wastewater Absorption System Details/ Site Plan Soils Log/ Percolation Test 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA FIRE LAKE SUBD N02 Bl L4A U IAT FLAG PROPERTY LINES WELL RADII & EASEMENTS PRIOR TO C❑NSTRUCTI❑N NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPPED WELL EXCEPT AS NOTED. � SOF �A * THNE � * �� I`C -7/1184 \ SS10 w Scale) 1'= 100' PREPARED FOR, KYLE & CHRISTY KLEPINGER 18625 COLLETT DRIVE Eagle River, AK 99577 FIELD BOOKS BOUNDARY: NA STAKING: NA ASBUILT. JLS Dw nM - A"' n"'FILE COMPUTED: ORA": BMW CHECKED: KMD DATE: 11107 / GRID: NW454 'IDB N0'` 13-216 DESIGN DETAILSPAGE 1 OF 2 3 BDRM X 150 GPD = 450 GPD l.q 1°"A 450 GPD/ 1.2 GPD PER SQ. FT, E49 MIN/IN. 375 SQ. FT (375 / 2 x (4' GRAVEL) = 47 - - USE 1 TRENCH - 47' (L) X 2' (W) X 4' (D) Total depth of system is 8.5' MAX from original grade. Total depth of gravel below distribution pipe Is 4' . NOTES: 1. CONNECT TO EXISTING SEPTIC SYSTEM W/ DIVERTER 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF ( 3' OF FILL. MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ. 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK. 4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... PREPARED FOR, KYLE & CHRISTY KLEPINGER 18625 COLLETT DRIVE Eagle River, AK 99577 FIELD BOOKS BOUNDARY: NA STAKING: NA ASBUILT. JLS Dw nM - A"' n"'FILE COMPUTED: ORA": BMW CHECKED: KMD DATE: 11107 / GRID: NW454 'IDB N0'` 13-216 WASTEWATER DISP❑SAL SYSTEM DETAILS FIRE LAKE SUBD NO2 131 L4A I ® WELL e GRAVEL D D/W D _ D O I J� 27.5' J GRAVEL c I D/W y in r m o N 4.7' m Zm O X o J�)9 0 5.0' o 3�y INSTALL INSTALL EXISTING :1E-1 m J NEW TRENCH DIVERTER & 1000 -GAL O z DBL. COs S T C G-) N 91 m MT CO COs cn_ M >>S` CO FCO 31.7' C01 CO EXISTING TRENCH CO s 0 0 00 �q I TH13-1 s N89°55'37"W 300.03' (300.14' R) VACANT BASIS OF BEARING N m 9 s NO SLOPES >zsi FLAG PROPERTY LINES W/IN loo' OF PROPOSED TRENCH WELL RADII & EASEMENTS a m PRIOR TO C❑NSTRUCTI❑N Scale, 1 30' PAGE z OF 2 OF<Q�' PREPARED FOR: gC Ejlp KYLE & CHRISTY KLEPINGER 18625 COLLETT DRIVE v w* . 9TH * �I Eagle River, AK 99577 / / m r KENNETH M. D S FIELD BOOKS cwru,Eo: x CE -7118 xl� loo BOUND` NA DRAW BMW a STORING: NA cmEcKm: KMD t AmuLLT: JLS DAIS: 11/7/13 �'•�+�-- ,�q!' m \ "�'ESSIOT�= DWG. rlu- GRIM NW454� u \`_ ACRD MEJ09 Na: 13-216 'PiyF�`S12TING (� FILE AK. 9957-7-15 1 QsRCTEgRq e� Al2C 1m >rRRA lv CONSUI,TING, INC y 212 E. 51" Ave, Anchorage, AK. 99503 g,eq feNn sP�e Office (907) 868-3791, Fax (907) 868-3793 SOILS PERCOLATION TEST Performed for: Kyle & Christy Klepinger Date Performed: 10/30/2013 KENI OLH 16 M. llUlf(tiiS� a / -,17 f 'OF'E-951OS .I Project: Fire Lake #2 Block 1, Lot 4A TEST HOLE # TH 13.1 Depth (Feet) SEE ATTACHED SITE PLAN Org/OL GM B.O.H. 15- 16- 17- 18- 19 - HOLE PRE SOAKED 20- PRIOR TO TEST FOR HOLE LOCATION Was Ground water encountered? NO What depth? NA Depth to water after monitoring? NO Date? 11/6/13 Reading Date Gross Time Net Time Depth to Water Net Drop 1 10/30/13 1:00 6" - 2 1:10 10 min 10/16" 5 6/16' 3 * 1:11 6' 4 1:21 10 min 11/16' 5 5/16' 5 * 1:22 6' - 6 1:32 10 min 11/16' 5 5/16' * Water Added Percolation Rate 19 (min/in) Perc Hole Diameter 6 Test Run Between 5 feet and 6 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. CRAWS MUNICIPALITY OF ANCHORAGE Development Services Department \ `' :t ) Phone: 907-343-7904 On-Site Water & Wastewater Section = Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 051-351-30 Expiration Date: /0-- Sr> .--1 ct 1. GENERAL INFORMATION Complete legal description FIRE LAKE#2 BLOCK 1, LOT 4A Location (site address) 18625 COLLETT DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) KEVIN &ANGELA TURKINGTON Day phone Mailing address PO BOX 201914 ANCHORAGE, AK 99520 Real estate agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Private Septic Private Well ® Holding Tank ❑ Water Storage Community ❑ Community Well A ❑ Public Sewer n Public Water System ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 55 Waiver Fee $ Date of Payment 6/(91l iq Date of Payment Receipt Number O qt/' 5Z) Receipt Number COSA# 0 j(1411.2(p(p 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. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION&ENGINEERING Phone 345-3377 Address 4641 SHOSHONI DRIVE,ANCHORAGE,AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 06/26/2019 Comments:This investigation was completed in compliance with MOA guidelines,regulations, ` and best industry practices/methods. The assessment of the condition of the well and septic �_G+ applies only to the conditions as of the day tested.The flow and absorption rates may change �^ O_i' AZ A 1 due to subsurface conditions that may not be observed from the surface,changes in land use, air local soil characteristics,groundwater levels that may fluctuate during the year,quality of I r,c construction(workmanship&materials),the water usage of the family being served by the v�. --I-- .°y h system and maintenance. The operational life of all well and septic systems are subject to *.)....21.. ,:4 9 TSi i *�/ these various and dynamic characteristics and are outside the control of the evaluator of the , well and septic system. Therefore,any estimate of how long a system will function satisfactory / /�L l�(�� for current or future occupants or guarantee that no unseen encroachments,deficiencies or discrepancies exist can be given by FWCSand Anderson Construction&Engineering. # . ' CHART. N. ANDERSON•' / ., No. 6/ 8489 �/ •, .6/26/19 6. DSD SIGNATURE , w� • •• ssioto- d► iC System #1 Approved for 3 bedrooms \14l►.�� System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipu��01/2 i4�<((((���� � P,I)TY OF�^7/,���,i�'i `�`` GHQ -v ',',,, ''1.ta ON- .._ ANp m� WASTEW �. PROGRAM R Q� i)1))1/11 i0i _____ 4____ r c� I By: Original Certificate Date: 7 —ZS 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 Checklist blue sheet COSA Checklist Legal Description: FIRE LAKE#2 BLOCK 1,LOT 4A Parcel ID: 051-351-30 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Water storage tank volume NA gallons Date drilled 8/1993 Well disinfected for coliform test? ❑ Yes ® No Total depth 120 ft ® Coliform bacteria is Negative Cased to 120 ft Nitrate 5.04 mg/L ❑ Nitrate less than MRL (ND) ® Sanitary seal is functioning correctly Arsenic ug/L ' Z Arsenic less than MRL (ND) ®Wires are properly protected • Figs Casing height(above ground)_ 18+ in. Collected by Date of flow test for COSA 5/17/2019 Date of Sample 6/18/2019 Static water level at beginning of test 96 ft. Well production at time of test 2.4 gpm Comments B. TANK DATA—6/18/2019 - NEW 1000-gal C. LIFT STATION -NA Age of tank(s) 0 years ❑ Required maintenance completed Tank type/material SEPTIC/STEEL Age of lift station years Measured operating fluid level in septic tank Lift station material ® Standpipes/foundation cleanout per record drawing Comments: Date of pumping NA—NEW TANK D. ABSORPTION FIELD DATA—47'L x 3'W x 4.05'ED—1.2 GPD/SF=380 SF Which system tested (date installed) 11/26/2013 Adequacy test date 6/18/2019 ® ALL standpipes present per record drawing Results f g Pass For 3 bedrooms Total measured depth from grade 8.95 ft(max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 4.9 ft(min) Water added 450 gal ❑ N/A—pressurized field New depth 0 in ® Monitor tubes go to bottom of effective. If not, state Elapsed time 10 min depth into effective ® Code-required soil cover over field Final fluid depth 0 in ID System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies:All standpipes present per IR COSA Checklist copy.docx E. SEPARATION DISTANCES—Per MOA record docs&observations 5/17/19. From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' ® Yes if No ft ® Yes if No ft Neighboring Tank> 100' ® Yes if No ft Private Sewer/Septic Line >25' ® Yes if No ft Absorption Field on Lot> 100' ® Yes if No ft Holding Tank> 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' IS Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage> 100' Community Sewer Main >75' ® Yes if No ft ®Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Wells on Adjacent Lots: Property Line >5' ® Yes if No ft Private Wells> 100' ® Yes if No ft Absorption Field >5' ® Yes if No ft Community Wells > 200' ®Yes if No ft Water Main > 10' ® Yes if No ft If septic tank is under driveway comment below Water Service Line > 10' ® Yes if No ft Surface Water> 100' ®Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No —ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells> 100' ® Yes if No _ft Water Service Line> 10' ® Yes if No ft Community Wells >200' ® Yes if No ft Surface Water> 100' ® Yes if No ft F. ENGINEER'S COMMENTS ..' �EOFAlq‘‘ G. ENGINEER'S CERTIFICATION .17:1\‘).**. `' •• A'.lb ow h.•• 1 certify that I have determined through field inspections and review S* 49TH �N ••• *�� of Municipal records that the above systems are in conformance / with MOA COSA guidelines in effect on this date. 0 / .MICHAEL N. A DERSON•.ck' COSA Checklist copy.docx i .. tr� �`' • MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • ` i 907-343-7904 On-Site Water and Wastewater Section % Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # OSC191266 Subdivision: Firelake #2, Block: 1, Lot: 4A A water sample revealed a nitrate concentration of 5.04 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address:P.0.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org N 89 55'26'W 299.94 °will a 1 02 , rz LL.. -J$ a5 O :t0 QC d ea R e 0 e b e e 99.7 g t N 89 55'37'W 300.14 AS-BUILT SURVEY NO CORNERS SET THIS DATE I HEREBY CERTIFY 1 OF THE FOLLOWING C LUT 4-A,BLOCK L,FIRE LAKE NC ANCHORAGE RECORDIP I %/TCTRI c TMDD(1\/CMCI • '� Municipality ofP^T-TALlu On-Site Water and Wastew . r Pr�rJrno 7 M5 (907) 343-7904 ' i3re$Clleat ;y$Uller CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-351-30 1. GENERAL INFORMATION Expiration Date: I Ll� 1 Complete legal description FIRE LAKE #2 BLOCK 1 LOT 4A Location (site address) 18625 COLLETT DRIVE, EAGLE RIVER, AK 99577 Current Property owner(s) JAMES & THERESA ATON Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: PO BOX 230414, ANCHORAGE, AK 99523 ® Single FamiIV(w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for:, Received by: Z� U, IC___ Date: la - 1 V - i r COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 52C, Waiver Fee $ Date of Payment ion �''l`j Date of Payment Receipt Number ©��{� Receipt Number COSA# vet J��SjJ 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 9/28/15 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 �- OFAZ encroachments, deficiencies or discrepancies exist. / �f 6. DSD SIGNATURE �U System #1 Approved for bedrooms. ,) r nsT 7irs OUT s System #2 Approved for 'Ea 1 Disapproved. Conditional approval for bedrooms, with the following stipulations: M Original Certificate 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 forerrors 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 shest_latanzdae 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: FIRE LAKE #2 BLOCK 1, LOT 4A Parcel ID: 051-35130 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Date completed 811993 Sanitary seal (YIN) Y Total depth 120 ft. Cased to 120 ft. FROM WELL LOG Date of test 811993 Static water level 92 ft. Well production 6.3 9— p.m- Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24 in. AT INSPECTION 10/16/2013 ft. WATER SAMPLE RESULTS: Coliform NE(s colonies/100 mL Nitrate 3.29 mg/L Arsenic: n/D ug/L Dateofsample: Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC / STEEL Date installed 9/22/1993 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping 9124/15 Pumper JRs C. ABSORPTION FIELD DATA Date installed 11/2612013 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type DEEP TRENCH Length 47 ft. Width 3 ft. Gravel below pipe 4.05 ft. Total depth 8.95 ft. Eff. absorption area 380 fl? Monitoring tube Y` Depression over field N Date, of adequacy test NA — NEWER SYSTEM Results (Pass/Fail) For _ bedrooms Fluid depth in absoUpfion field before test in. Water added_ gal New depth_ in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1001+ Public sewer main 75'+ Sewer /septic service line 251+ Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 1001+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ Building foundation 5'+ Property line 51+ Absorption field 5'+ Wafer main 10'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 1061+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main 10'+ Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (NONE KNQM Wells on adjacent lots 1001+ F. COMMENTS Newer system constructed and well flow performed less than 2 -years. 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 COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 912812015 COSA canary sheet_2-5-15.doc in. • '� Municipality of Anchorage P On -Site Water and Wastewater Program (907)343-7904 _. .CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-351-30 1. GENERAL INFORMATION Complete legal description FIRE LAKE #2 BLOCK 1 LOT 4A Location (site address) 18625 COLLETT DR EAGLE RIVER AK Expiration Date: 5 2 7 _Current Property owner(s) Kyle & Christy Klepinger Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 18625 Clooett Dr. Eagle River AK 99577 ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance request for: Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: . Date: COSA to be released to the engineer, unless othervrise requested by the engineer. COSA Fee $ 2 65,1 Date of Payment2�Z S/ l Receipt Number COSA # 05G 1 LA I 0 5 '-1 Waiver Fee $ Date of Payment Receipt Number 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 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 2/27/2013 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 OL, A�� ` occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. d �2� 'doer4q'rtc 6. DSD SIGNATURE > System #1 Approved for bedrooms. " t"r A 3 , s System #2 Approved for bedrooms. ci/ P�F�SSI�N� Disapproved. Conditional approval for with the following By: Original Certificate Date: 2 Z The Municipality of Anchora 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 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: FIRE LAKE #2 BLOCK 1 LOT 4A Parcel ID: 051.351-30 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Date completed 811993 Sanitary seal (Y/N) Y Total depth 120 ft. Cased to 120 ft. FROM WELL LOG Date of test 811993 Static water level 92 ft. Well production 6.3 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 2.71 mg/L Arsenic: ND ug/L Date of sample: 211112014 B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) Y Wires properly protected (YIN) Y Casing height (above ground) 24 in. AT INSPECTION 1011612013 84 ft. 3.3+ g.p.m. Collected by: ARCTERRA Tank Type/Material SEPTIC/STEEL Date installed 9/2211993 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 811312013 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 11126113 Soil rating (g.p.d./f:2 or fiz/bdrm) 1.2 System type TRENCH Length 47 ft. Width 3 ft. Gravel below pipe 4.05 ft. Total depth 8.95 ft. Eff. absorption area 380 fl? Monitoring tube Y Depression over field N Date of adequacy test NA -New System 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 >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access(Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 1004 On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 1004 Manure/animal excrete storage areas 1004 Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 101+ Surface water 1004 Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 104 Water Service line 101+ Surface water 100'+ Driveway, parking/vehicle storage 104 Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 1004 F. COMMENTS G. ENGINEER'S CERTIFICATION t certify that t 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 KENNETH M. DUFFUS Date 212012014 COSA brown sheet 10-10-12.doc OF ALS 7, 4 9 TH �* in. KENNET 71 6I� / a FEsstoN�' ,� ��__-40� Municipality of Anchorage o ,C• i • "° Development Services Department Building Safety Division „ Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING r Parcel I.D. 051-351-30 HAA# 1. GENERAL INFORMATION Expiration Date: Complete legal description FIRE LAKE SUBDIVISION #2: LOT 4A, BLOCK 1 Location (site address or directions) 18625 COLLETT DRIVE • EAGLE RIVER Current Property owner(s) ROLAND & ANGELA BASSEK Day phone 696-6016 Mailing address 18625 COLLETT DRIVE • EAGLE RIVER 99577 Lending agency Day phone Mailing address Real Estate Agent F.S.B.O. Day phone Mailing address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ s. 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. V 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 I' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for 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 ALASKA WATER do WASTEWATER CONSULTANTS, INC. 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, 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. S. DSD SIGNATURE (/1 Approved for 3 bedrooms. Disapproved. Phone 337-6179 Date 5 U7e3 Conditional approval for bedrooms, with the fllowing stipulations: OF et. A....... ar 55::... —7953 o O c,p ore4sion Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 6.18 mg/1. EPA MAXIMUM concentration is 10.0 mg/1. More information on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: HAA Checklisty� Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other ByOriginal Certificate Date: 61' - `7` - 0 3 (Rev. 11101) 0 _..-.....__.__..__._........... ........ ._. Municipality of Anchorage • Development Services Department u Building Safety Division II , OnSite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.d.anchorsge.ak.us (907) 543-7904 HEALTH AUTHORITY APPROVAL_ CHECKLIST Legal Description: ARE LAKE SUBDIVISION #2; IAT 4A, BLOCK 1 ParcelID: 051-351-30 A. WELL DATA Well type PRIVATE If A. 8, or C provide PWSID# N/A Date completed 8/1993 Sanitary seal (Y/N) YES Total depth 120 ft. Cased to 120 ft. FROM WELL LOG Date of test 8/1993 Static water level 92 ft. Well Log (Y/N) YES Wires properly protected (YM) YES Casing height (above ground) 12+ in. AT INSPECTION 12/28/2001- 96 ft. Well production 6.3 g.p.m. 4.1 O.P.M. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate.' /+ mgJL. Other bacteria .-colonies/100 ml. Arsenic: N/A mgJL. Date of sample: 5/20/2003 Collected by: AKWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date Installed 9122/1993 Tank size -1000 gal. Number of Compartments 2 Cleanouts (YM) YES Foundation cleanout (YM) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 9/19/2002 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 9/22/1993 Soil rating ED* ftlbdrm) 122 System type DEEP TRENCH Length 40 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth B.25 ft. Eff. absorption area 400 ft' Monitoring tube YES Depression over field NO Date of adequacy test ,12/28/2001 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test39 in, Water added 720'04'1, New depth 39 in. Elapsed Time: 145 min. Final fluid depth 35 in. Absorption rate >= 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons "Pump on" level at in. E. SEPARATION DISTANCES High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1000+ Absorption field on lot 1009+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 1000+ On adjacent lots 1008+ Public sewer manhole/cleanout N/A Holding tank N/A 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 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property tine 101+ Building foundation 10'+ Water main N/A Water service line 25'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION .�, Vi.. „PN_, V• - 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. e of a Gilrf�ssi Engineer's Printed ame JEFFREY A GARNESS ��q 7953 Date rs^e p►o f eestc�°` �c4 HAA Fee $ 39 5 -� Waiver Fee $ Date of Payment 5 -,3o -o3 Date of Payment Receipt Number ,3(a 277 Receipt Number (Rev. 12(01) 01!07/02 _, MUN, Uy: 1: FAX .907 U 91 4.99J. .._ 3 ffccosT,veo N�? I coci.errr _ -� E LOr .Tn �/L ParJ ' a �. � 1 i ^� h ,N' 0141. -PR'O,[cnaa IPnrn!n 1;:roror rv00Dmor �A A. fE NOU.'.E -7!i (; o C3 es,ole sv �r. N R9' Ila Ov m NOTE: ALL BEAR114CS AND DISTAuCES SHpMT+ ARC ruECORI), UNLESS mlEO CIIir. t1mr EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE MIES TO OCTER14111E TI:E EXiSTAurF' OI:AIIY EASU,E1115, COVENANTS. OR RESTR16TIONs WHICH D -j NOr APPEAR ON THE f•ECORUED sUBmvisto I PIAT_ UNDER N0 CIRCUMSIANCES SHOULD ANY VAf.A IIEREON BE USED FOR CONSIRUC11011 OR WR ESTABLISIIRIC BOUNDARY OR FENCE LINES. AS-13UILT CERTIFICATE: I HEREBY CERTIFY THAT 111A'JE SUR%TPEO TIIE FOLLOWlff, DrSCPIOLD PROPERIT LOTI-A. Bto x � FIRS tains s'r�nrsiolk'___...._._.._� AND THAT NO EPICSOACHMENTS Exist L•Cr.PT AS INOICAIEO. 6 �c; `. 9�j 'sworosiol-F/J;�' GAtP1r r0l?l'OlL1Tl011r .vn .M.n_MM4 M... • P • t1{/. M INI. 49 thw p 1,0 lR. OJY%S'!O/V IPO. .P.� .�._.-frnl ,l�-aw, I.P ITeq ye ."l- -f SEcnn« }I -1 -0; TJ N R.n,t,I 1Y pn. M.NMO• IN L:wV. »y ' 93-09.03 93.1IM. I. p� _SEWARD 4EPOW1 %G% Erie 'P. rugiee rt S•': Pur nN. •_ — s'rw• - eN:a." .- i i 93-09.03 �. PIo.r21e-s �S 1"=F,n' Err c, ANCHORAGE PcccnoN,n r -Stec, r_ 51 PIri. t. 5; ,�1 F ' - UI L 7 I % I P .J E LOr .Tn �/L ParJ ' a �. � 1 i ^� h ,N' 0141. -PR'O,[cnaa IPnrn!n 1;:roror rv00Dmor �A A. fE NOU.'.E -7!i (; o C3 es,ole sv �r. N R9' Ila Ov m NOTE: ALL BEAR114CS AND DISTAuCES SHpMT+ ARC ruECORI), UNLESS mlEO CIIir. t1mr EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE MIES TO OCTER14111E TI:E EXiSTAurF' OI:AIIY EASU,E1115, COVENANTS. OR RESTR16TIONs WHICH D -j NOr APPEAR ON THE f•ECORUED sUBmvisto I PIAT_ UNDER N0 CIRCUMSIANCES SHOULD ANY VAf.A IIEREON BE USED FOR CONSIRUC11011 OR WR ESTABLISIIRIC BOUNDARY OR FENCE LINES. AS-13UILT CERTIFICATE: I HEREBY CERTIFY THAT 111A'JE SUR%TPEO TIIE FOLLOWlff, DrSCPIOLD PROPERIT LOTI-A. Bto x � FIRS tains s'r�nrsiolk'___...._._.._� AND THAT NO EPICSOACHMENTS Exist L•Cr.PT AS INOICAIEO. 6 �c; `. 9�j 'sworosiol-F/J;�' GAtP1r r0l?l'OlL1Tl011r .vn .M.n_MM4 M... • P • t1{/. M INI. 49 thw p 1,0 lR. OJY%S'!O/V IPO. .P.� .�._.-frnl ,l�-aw, I.P ITeq ye ."l- -f SEcnn« }I -1 -0; TJ N R.n,t,I 1Y pn. M.NMO• IN L:wV. »y ' 93-09.03 93.1IM. I. p� _SEWARD 4EPOW1 %G% Erie 'P. rugiee rt S•': Pur nN. •_ — s'rw• - eN:a." .- i i 93-09.03 �. PIo.r21e-s �S 1"=F,n' Err c, ANCHORAGE PcccnoN,n r -Stec, r_ 51 PIri. t. 5; ,�1 F ' - UI L 7 Municipality of Anchorage, • Development Services Department j' Building Safety Division .. .. Onsite Water 8 Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 www.cl.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-351-30 HAA# 1-140,;20009 1. GENERAL INFORMATION Expiration Date: 4.1I0IO2 Complete legal description tvFIRE LAKE SUBDIVISION $2• LOT 4A BLOCK 1 Community Class Well ❑ Public Water System Location (site address or directions) 18625 COLLETT DRIVE " EAGLE RIVER Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DONNA HIGGINS Day phone 696-8790 18625 COLLETT DRIVE • EAGLE RIVER 99577 Day phone ROLF MILTON w/ PARTNERS REAL ESTAT5ay phone 694-4994 11940 BUSINESS BLVD., SUITE 100 • EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ 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 Waterand Wastewater Consultants, Inc. shall be paid $1310.00 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, I 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 Js(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 riles 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 tk WASTEWATER CONSULTANTS, INC. Address• 6901 DEBARR ROAD, SURE 2B • ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, 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 lire 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. AWWC, 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 ownerlisted 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 V Approved for 3 bedrooms. Disapproved. Phone 337-6179 Date f&OZ Conditional approval for bedrooms, with the flowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other MUM t1 T€R ANB- WASTEWATER By: Original Certificate Date: �Z (Rm. 1iAn Municipality of Anchorage , Development Services Department Building Safety Division OnStte Water & Wastewater Program 4700 South Bregaw St. P.O. Box 190850 Anchorage, AK 99519.6650 www.d.enchorage.ek.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: FIRE LAKE SUBDIVISION 112: LOT 4A. BLOCK 1 Parcel ID: 051-351-30 A. WELL DATA Well type PFWAIE If A, B, or C provide PWSID# N/A Date completed 8/1993 Sanitary seal (YM) YES Total depth 120 ft. Cased to 120 ft. FROM WELL LOG Date of test 8/1993 Static water level 92 ft. Well production 6.3 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 4.73 mgA. Well Log (YM) YES Wires property protected (YM) YES Casing height (above ground) 12+ in. AT INSPECTION 12/28/2001 96 ft. 4.1 g.p.m. Other bacteria 0 colonies/100 rd. Arsenic: 0.002 mg./L. Date of sample: 12/28/01 Collected by: AWWC. INC. B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date installed 9/22/1993 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YM) YES Foundation cleanout (YM) YES Depression over tank (YM) NO High water alarm (YM) N/A Date of pumping 1/4/2002 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Data installed 9/22/1993 Soll ratlng .p.d ft°Ibdrm) 1_2 System type DEEP TRENCH Length 40 ft. Wldih 3 ft. Gravel below pipe 5 ft. Total depth 8.25 ft. Eft. absorption area 400 ft= Monitoring tube YES Depression over field NO Date of adequacy test 12/28/2001 Results (PasstFall) PASS For 3 bedrooms Fluid depth in absorption field before test29 in. Water added 720 gat. New depth39 in. Elapsed Time: 1455 min. Final fluid depth 35 k1. Absorption rate » 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOTTO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 100+ 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 25'+ Surface water 1001+ Driveway, parkingivehide storage 10'+ Curtain drain NONE KNOWN Welts on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and * T review of Municipal records that the above systems are In "•"' . .. .. • """" conformance with MOA HAA guidelines In effect on this date. e A. Gamess.. Engineer's Print"me me JEFFREY A. GARNESS —7953 ��� L 0 � Data +•'•�Pd w HAA Fee $ 9.7 5 0 Waiver Fee $ Date of Payment lb 0 2 Date of Payment Receipt Number 014-19 L Receipt Number (Rev. 19101) %.� stir 0,eo- O,j r 1 O 1/07/02 _JIO 1_ O9: 12 PAX.90799t/995..... ..r•,- I REcmFREo lu 2l I 0 I.., . U t 1. is �� II I 0 for JA �°:2—.. Cl� � j'c.F'' } —IN• au rsorrcnav Awnn -sroRl• wvov T �- RAJF NOUS `-7 45.0la sa rr. a !2 In; ...r•_ ./� � as At— JOo. I N 89'55'J7" NOTE: ALL bEAR91GS AND DISTANCES SHOWN ANC RE.BORD, GNIEss uO1E0 ON¢Ilwist. EXCLUSION NOTE: R IS THE RESPONSIBILITY OF THE ONDER TO OCTERIIINE THE EXISTAW:E 01•AITY EASEWENIS, COVENANTS, OR RESTRICTIONS WHICH O•J NOE APPEAR ON INC PE.GORUr.O SUBLwsloll PEAT. UNDER NO CIRCUMSTANCES SHOULD AN`( DATA HEREON BE USED EOR CONSTRUCIWII OR Wit ESTABLISHING BOUNDARY OR FENCE ONES. AS -BUILT CERTIFICATE: 1 HEREBY GERM THAT 1 HAVE SURVEILD 711E EOILOWaIC DESCRICLD PROPERIT: LOTI—� F. Fiv —_--- AND 714AT HO ENCROACHMENTS EXIST RCEPr AS INOICAIED. •••• �. y�A' wt: Q a.ocA: ' 6i'BFi_HSJ�NfA�� '1 IMIIWWlFiRi GAJt'F. 6 COR/AO/L1T/OA's® .fvf 49th P• Sli901YlSlON NO. ? ��•"����"•�'°"�..ay.r "•' _ ^tnr, +rrwr ra Iraq v..wn °,�' - • tctKN J 1 toMrslav 15 N n Kc I w e.R ,» r..w. A, __ SEWARD Ka°rer :LI/ 93-09.03 9311M 12 ENC'P. Fu9leslad Yw -i •_._. -.. .•'-__ nAt Rw 93-09.03 Rw• wr °. AIP Ne.721a-S c,�C ANCHORAGE. etzoAo.•o amara qq1"=6f•T' EPF O E�a0�,%SSIORS���:•°• w a. rlw S5A f1 +..]' -=1J LII L 1 b- 1. is for JA �°:2—.. Cl� � j'c.F'' } —IN• au rsorrcnav Awnn -sroRl• wvov T �- RAJF NOUS `-7 45.0la sa rr. a !2 In; ...r•_ ./� � as At— JOo. I N 89'55'J7" NOTE: ALL bEAR91GS AND DISTANCES SHOWN ANC RE.BORD, GNIEss uO1E0 ON¢Ilwist. EXCLUSION NOTE: R IS THE RESPONSIBILITY OF THE ONDER TO OCTERIIINE THE EXISTAW:E 01•AITY EASEWENIS, COVENANTS, OR RESTRICTIONS WHICH O•J NOE APPEAR ON INC PE.GORUr.O SUBLwsloll PEAT. UNDER NO CIRCUMSTANCES SHOULD AN`( DATA HEREON BE USED EOR CONSTRUCIWII OR Wit ESTABLISHING BOUNDARY OR FENCE ONES. AS -BUILT CERTIFICATE: 1 HEREBY GERM THAT 1 HAVE SURVEILD 711E EOILOWaIC DESCRICLD PROPERIT: LOTI—� F. Fiv —_--- AND 714AT HO ENCROACHMENTS EXIST RCEPr AS INOICAIED. •••• �. y�A' wt: Q a.ocA: ' 6i'BFi_HSJ�NfA�� '1 IMIIWWlFiRi GAJt'F. 6 COR/AO/L1T/OA's® .fvf 49th P• Sli901YlSlON NO. ? ��•"����"•�'°"�..ay.r "•' _ ^tnr, +rrwr ra Iraq v..wn °,�' - • tctKN J 1 toMrslav 15 N n Kc I w e.R ,» r..w. A, __ SEWARD Ka°rer :LI/ 93-09.03 9311M 12 ENC'P. Fu9leslad Yw -i •_._. -.. .•'-__ nAt Rw 93-09.03 Rw• wr °. AIP Ne.721a-S c,�C ANCHORAGE. etzoAo.•o amara qq1"=6f•T' EPF O E�a0�,%SSIORS���:•°• w a. rlw S5A f1 +..]' -=1J LII L 1 b- Municipality of Anchorage Page —_L_of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report k) 3oa, Permit Number: PID Number: Name: Wastewater System: Of New ❑ Upgrade Address: 2j I 3u 5- ABSORPTION FIELD PhoneCIL0 No. of Booms. Deep Trench 11 Shallow Trench 11 Bed 11 Mound 1:1 Other LEGAL DESCRIPTION Soil Rating Total Depth from orininaI grade: i GPD/Sq. Ft. Lot: Block: Subdivision Depth to pipe bottom from original grade: Gravel depth beneath pipe firL 1A Ft. Ft. Township: r Range: I Section: Fill added above o inal grade, Gravel length: kj FL Ft. WELL: New ❑ Upgrade Gravel width: 3 Number of lines: / Distance between lines: Ft Ft. Classific 'on (Private, A,B,C): Total Depil CasedTo �' Total absorption area: Pipe material: Q Ft. /0 Ft. S.9. Ft. )O I, Driller DateArylled: * Static Water LKvgl, Instal 4 Date installed: t Yield: Pu jmp Set at: Casing Height AboveGround, eG/ TANK GPM /�I�C/1C/-I /�.s /J Ft. rFt. SEPARATION DISTANCES 9Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lin Holding Public/Private Manufacturer: Capacity in all From Tank Field Station Tank Sewer Lines i?Jls: Material: Number of Comp rtments: Well 0 Surface Water LIFT STATION Lot / Size in gallons: Man rer: Line "Pump on" level at:"Pu ' leve High water alarm at: Foundation Curtain .,1 ,) /� Pump Maker el Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Descri ion. 41, alava�el)k /olat r Assumed Elevation ENGINY AL C 41 !^I a•aeon.ea 1 11 aw Inspections performed by: �Z'"SW4i-L Dates: 1stq ZAJ57�3 ` 2nd Howard C. Holion 4. 33"F Department of Health ium n ices approval ���; Ha by: Date: Reviewed and approved 72-013 (Rev. 9/91) MOA 25 P N o "' z� RECOVERED H&T I\ i1 COLL_, TT � o AS -BUILT LOT 3A S 89°55'26" E 299.94 WELL M O 1 -STORY WOOD O LOT 4-A -- FRAME HOUSE 45,018 SQ. Fl. \'nFF = 112 c TH. #2',� �— n ' PORCH 1 28.6 O �l \\ VENTS 6/0 ti. 1 t\—LE-ACH SEPTIC TANK'LZ.H, #30 i FIELD N N 89°55'37" W 300.14 F �C PROJECT BENCHMARK r rn� r�r-i rri �r-n VI V —Ll L_ V L_L_Ll, L_lJ L,j F l TOP Al MON. / ASSUMED ELEV.=100 0 SCALE: I"=60' NOTE: ®,SIV U � ��°��•.. 0°eon®a a T�9 o noe eeeee ee eeo �� 1t `go Howard C. Holton , ®q U ) e No. 3063-E o eo�C' 4 %e, ® oFEssioN�� 100' RADIUS FROM ADJACENT WELL, (TYP) / 100' RADIUS /FROM ADJACENT SEPTIC, (TYP) SHT 1 OF 2 ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE. 01/00/1 SUBDIVISION: _117�ZR_167 -L-A / PEWIT • 930241 0, , e e • ,• ' � J I LOT 3A S 89°55'26" E 299.94 WELL M O 1 -STORY WOOD O LOT 4-A -- FRAME HOUSE 45,018 SQ. Fl. \'nFF = 112 c TH. #2',� �— n ' PORCH 1 28.6 O �l \\ VENTS 6/0 ti. 1 t\—LE-ACH SEPTIC TANK'LZ.H, #30 i FIELD N N 89°55'37" W 300.14 F �C PROJECT BENCHMARK r rn� r�r-i rri �r-n VI V —Ll L_ V L_L_Ll, L_lJ L,j F l TOP Al MON. / ASSUMED ELEV.=100 0 SCALE: I"=60' NOTE: ®,SIV U � ��°��•.. 0°eon®a a T�9 o noe eeeee ee eeo �� 1t `go Howard C. Holton , ®q U ) e No. 3063-E o eo�C' 4 %e, ® oFEssioN�� 100' RADIUS FROM ADJACENT WELL, (TYP) / 100' RADIUS /FROM ADJACENT SEPTIC, (TYP) SHT 1 OF 2 ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE. 01/00/1 SUBDIVISION: _117�ZR_167 -L-A / PEWIT • 930241 0, , e e • ,• ' N2 NEW 3 DED. c• Y S HOUSE o OSo O p v N QSR Y o�o c 2O2 O O l�nry mV0 2 yy 1 N ggI 1 1 � IJ:I:I I I I CCI: mm � � gOA o•� .I�kI � � �� o r 92, IIN 111 11.1:1:111 LFII' T g � 41 °Nm ig EFF. p DEPTH �• �,.......... c + \ p k 4k7 �`, • V `� p p / N (Ii • do o0All, ap F` _ •' Gj i p �� �FFH� a • *����rr� O n �; II r N 1 u1 vA Z 1` 1 y O t,' b n� r � ti �• .� s to N N �7 o L o ro Z- 4 A �oZ a' v sn mks s° Qi �� • w Oi PAGE 1 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930241 DATE ISSUED: 7/20/93 DESIGN ENGINEER:ACUMETRIX CORPORATION EXPIRATION DATE: 7/20/94 OWNER NAME:TAYLOR CHARLES RUSSELL OWNER ADDRESS : NC 33, BOX 3085 � WASILLA, AK 99687 PARCEL ID:05135130 LEGAL DESCRIPTION: FIRE LAKE #2 BLK 1 LT 4A LOT SIZE: 45018 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE TOTAL DEPTH OF THE DRAINFIELD FOR THIS SYSTEM SHALL NOT EXCEED 7.5 FT. UNLESS A TEST HOLE IS DUG PRIOR TO CONSTRUCTION TO VERIFY SEPARATION TO BEDROCK IS A MINIMUM OF 6 FT. PAGE 2 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 SEE ALSO PERMIT #SW930272 FOR WELL PPEGGRMIT. q RECEIVED BY: ` rUe Gv/►�E?i� DATE: % ISSUED BY: '�6� / DATE: r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT N BER:SW930241 DESIGN EN NEER:ACUMETRIX CORPORATION OWNER NAME: AYLOR CHARLES RUSSELL OWNER ADDRES :NC 33, BOX 3085 ASILLA, AK 99687 PARCEL ID:051351`�L0 LEGAL DESCRIPTION: FIRE LAKE #2 BLK 1 LT 4A LOT SIZE: 45018 (SQ. .) NUMBER OF BEDROOMS. 3 T S PERMIT: 3 THIS PERMIT IS FOR THE CON UCTION OF: DISPOSAL FIELD /SEPTIC TANK STEM ALL CONSTRUCTION MUST BE IN A ORDANCEITH: 1. THE ATTACHED APPROVED DESIGN. PAGE 1 OF 1 DATE ISSUED: 7/20/93 EXPIRAT N DATE: 7/20/94 5 t)j 13 2. ALL REQUIREMENTS APROVISIONS. IED IN CHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AE STATE ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAND DR KI WATER REGULATIONS (18AAC80 3. THE ENGINEER MUSTFY DH S AT L AST 2 HOURS PRIOR TO EACH INSN. PROVIDE OTIFICATION BY CALLING 343-4329 34 4681 AFTER US HOURS / 4. FROM OCTOBER 15 TI 15 A SUBSURF E SOIL ABSORPTION SYSTEMCONSTRUCTION D ING FREEZING WEATHER MUST BE E(/ A. OPENED AND CLOTHE SAME DAY B. COVERED, SEALEHEATED TO PREVENT F EEZING 5. THE FOLLOWING SPEROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ISSUED BY: DATE: 1 V a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST % �Q J PERFORMED FOR: I3RANJ�F6 FNTet? pR/st5 DATE PERFORMED: Howurd (-. Holton mow/ No. 3063-E LEGAL DESCRIPTION:_ G07'YAgr,J.3/pch I /')jcZ.Are5p.Lj gWnship, Range, Section' v DEPTH SLOPE SITE PLAN OR4ANie- YHAT GLNy, 2 3 T 4- OIL- 6 7 8 9 10 11 12 13 14 15 16 17 1s 19 20 -z Ho" ,i _ - j �Z,4G�50� 5, Lr� Sa w9+ Gm Glay, f3o.N, WAS GROUND WATER /D, ENCOUNTERED? A I plop 0 MM001 ' PP Reading Date Gross Time Net Time Depth to Water Net Drop -� 931230 15 4 - i y5- s6-0-93 6 -0-73 YO y Yr 3S6 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER 1/ TEST RUN BETWEEN y FT AND 6 —" FT COMMENTS — No'c LOCI Prc5oci4ed Prior '70 '7- -t- 7-yi / PERFORMED BY: _ �cr`� p_�`S� raQU% CERTIFY T�HJAT HIS EST WAS PERFORMEDIN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) i Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST �j PERFORMED FOR: (,) _)FAN+OEE ENTER P,PIFE-$ DATE PERFORMEDI : LEGAL DESCRIPTION: LOT_°��RGou1!� )'f �{esµblyTOWnship Range Section• T/SN.j RJw DEPTH SLOPE SITE PLAN CCCTI -- 1 2 • 3 4 4. 5 r 6 ti tu!y8 v 9 10 1rl`� 13- 14- 15- 16- 17- 18- 19- 20 314151617181920 0iF(4A1qrc. WAT-. G LAY pERL POLE 7"k,4GE3 07" S/*/>y SAND 51Iont up fo G'M' 3" /•i WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? IUD , S N,=L 0 P E Date Reading Date Gross Time Net Depth to Time Water Net Drop G-19-93 1,30 /s 41 %c /9-53 05- - -53 vo -' z25 -4 30 - 9-93 S' S u -- PERCOLATION RATE �3. G (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN_ FT AND �_ FT COMMENTS HOle- L -J&6 Prt SO-OLi4d l�fiGi� YG Y,ES7— PERFORMED BY: _.�O De r0� D %JUS„r %L I CERTIFY THAT T TES AS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE.- 72-008 ATE72-008 (Rev. 4/85) 1 /V FORMULA: ABSORPTION AREA = (150 GAL)(3 BR) 0.8 (BED APPLICATION RATE) 562.5 = 3 X 187.5 562.5 X 1.045 = 588 S.F. w m GENERAL NOTES �z 1. MAINTAIN MINIMUM 4' — GROUND COVER OVER 1 DRAIN FIELD. MINN 2. ALL PIPING SHALL BE 4" DIA., ABS SCHEDULE 40 SLOPE LINE, P.V.C. PIPE, UNLESS NOTED OTHERWISE. Sp1000 � GAL. SEPTIC TANK ✓ SEWER ROCK T le'ap S . " LIMITS OF , (M N� TEST HOLE TH #1 FEETDEPTH ORIGINAL GROUND 0 ORGANIC MATERIAL I CLAY 2 SILTY SAND, G ., TRACES OF CLAY 3 STONES UP TO 18" ° -PERC. RATE _ 6 - w PE. HOLE 3.6 MIN. PER. IN. e -- 12 13 BOTTOM OF HOLE (NO TMCE OF WATER) RECOVERED H&T COZZ,rl-T DRAM' �"•.���!\ate_ CAPPED CLEANOUTS — FILTER FABRIC CAPPED MONITOR TUBES ORIGINAL GROUND TO 1 1/2"— SEWER ROCK 4' MIN. COVER, OR EQUAL / PERF PIPE (HOLES DOWN) .1, INSTALLED LEVEL b 10 L.F. ABS SCHEDULE 40 PIPE (SOLID) ,SE'CTION NO SCALE e y A 3' CLR. (TYP)• a• NEW 1000 GAL, 0 SEPTIC TANK 0 U MONITOR TUBES (TYP) PERF. PIPE (TYP) SOLID MANIFOLD PIPE 10 L.F. ABS SCHEDULE 40 PIPE (SOLID) PLAN DETAIL NO SCALE PROJECT BENCHMARK h TOP Al MON. ASSUMED ELEV.=100 PLAN SCALE. 1 "=60' 100' RADIUS FROM ADJACENT WELL q WATER IMPERM14BLE LAYER f- oaE 1 9 / 100' RADIUS /FROM a I/ SEPTIC soo Cpo �"•.���!\ate_ CAPPED CLEANOUTS — FILTER FABRIC CAPPED MONITOR TUBES ORIGINAL GROUND TO 1 1/2"— SEWER ROCK 4' MIN. COVER, OR EQUAL / PERF PIPE (HOLES DOWN) .1, INSTALLED LEVEL b 10 L.F. ABS SCHEDULE 40 PIPE (SOLID) ,SE'CTION NO SCALE e y A 3' CLR. (TYP)• a• NEW 1000 GAL, 0 SEPTIC TANK 0 U MONITOR TUBES (TYP) PERF. PIPE (TYP) SOLID MANIFOLD PIPE 10 L.F. ABS SCHEDULE 40 PIPE (SOLID) PLAN DETAIL NO SCALE PROJECT BENCHMARK h TOP Al MON. ASSUMED ELEV.=100 PLAN SCALE. 1 "=60' 100' RADIUS FROM ADJACENT WELL q WATER IMPERM14BLE LAYER NOTE: ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE. W. :•' °��ei� SUBDIVISION: CORPORATION e °FIR * E LAKE WASILLA, AK 99854 4900 PALMER—WASILLA HWY., SUITE 3 ew ew Ie• e SUlFPZVISlON NO. X (907) 376-8800 FAX (907) 376-9629 • °° • • • °:•,e WE JOB NUMBER: DESIGN BY: p t . ¢ ® APPD: 1n : Howard . Holton ; �� 7/8/93 93-09,03 H.H. J+•y No. 3063•E : ��o► SCALE: DRAWN: CHECKED: s 9 *Sao**��— AS'E'PTIC PLAN FESSO—,w AfVVYCZP.4"TY OF AJVCIIOJ4g6W:) NOTED epf / 100' RADIUS /FROM ADJACENT SEPTIC soo Cpo NOTE: ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE. W. :•' °��ei� SUBDIVISION: CORPORATION e °FIR * E LAKE WASILLA, AK 99854 4900 PALMER—WASILLA HWY., SUITE 3 ew ew Ie• e SUlFPZVISlON NO. X (907) 376-8800 FAX (907) 376-9629 • °° • • • °:•,e WE JOB NUMBER: DESIGN BY: p t . ¢ ® APPD: 1n : Howard . Holton ; �� 7/8/93 93-09,03 H.H. J+•y No. 3063•E : ��o► SCALE: DRAWN: CHECKED: s 9 *Sao**��— AS'E'PTIC PLAN FESSO—,w AfVVYCZP.4"TY OF AJVCIIOJ4g6W:) NOTED epf Howard C. Holtan, P.E. P.O. Box 243193 Anchorage, Alaska 99524 August 31, 1993 Municipality of Anchorage Department of Health & Human Services Environmental Health - On -Site Services 825 L Street, #502 Anchorage, Alaska 99501 RECEIVED SEP 8 1993 DMunfc(p...I Y of Anchor ept. Health & Human Se vgices Ref: Revised Plan for Well and Wastewater Disposal Systems Lot 4A, Block 1, Fire Lake Subdivision No. 2 Gentlemen: This letter is to request approval of a revised location plan of the well and wastewater disposal systems on the referenced property. Following your approval of a location plan for the well and wastewater disposal system, the well driller found it necessary to move the location of the well as shown on the attached plan. The change required relocation of the disposal system, also shown on the attached plan, to provide adequate separation distances and for an alternate absorption area. A new test hole was excavated at the field locations to confirm previous percolation tests and that at least the minimum depth to any water table was attained. Please call if you have any questions or you require additional information. Since Howard C. Holtan, P.E. CE -3063 attachment: V, N n O �Q)O Q RECOVERED H&T? \I\ COLLETT-D.RfVE Q z ALTERNATIVE PVEL SYSTEM POSED SED OR \ � /P 0 P N O N I \ T. H. J2 70.4 .9 O PROPOSED 1—STORY /' R>30 T' 6 i✓ i WOOD FRAME HOUSE I� I•� n FF= 102 T.H. J/30 i/ o?S•n 300.14 , N 89 55 37 Ni f o I �0o� PROJECT BENCHMARK Ll j F; o / TOP Al MON. ti o / ASSUMED ELEV.=100 C) A SCALE: I"=60' — — Ni nTF, W 100' RADIUS FROM ADJACENT WELL, (TYP) 0. �o r� M / 100' RADIUS /FROM ADJACENT SEPTIC, (TYP) 0 too r" CPo po v1 ,SHT OF z ����+-����,• ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE. OF ���P� ........,,;�9♦ LOT: BLOCK: un, rcLmRiX s V.1 ��SUBDIVISION:_FIRE' LKEA' CORPORA TIONSU.&_,WVISION NO. 2 4900 PAL WASILLA SUITE 3 WASILLA, AK 99654 •••• •••'•••••L••••• (907907 ) 376-880000 FAX (907) 378-9629 Eric P. Fuglestad j % APPA: DATE: JOB NUMBER: DESIGN BY: Ar ��°• • No •o°'c��� 8/23/93 93-09.03 H. H. D \ A'r ••,•'•,r,,,,•"'•'''• \O •` ,S.�'PTIC PL.�1.1� SCALE: DRAWN: CHECKED: ,♦,,��1�JIOtv,���•• �rLIUNICIPALlTY OF ANC.5rOR4GE) NOTED epf � � I L'� L W �w o LOT 3A C) Q S 89'5526" E ��9 LOT 4—A 299.94 o 45,018 SQ. FT. 0 NEW WELL V, N n O �Q)O Q RECOVERED H&T? \I\ COLLETT-D.RfVE Q z ALTERNATIVE PVEL SYSTEM POSED SED OR \ � /P 0 P N O N I \ T. H. J2 70.4 .9 O PROPOSED 1—STORY /' R>30 T' 6 i✓ i WOOD FRAME HOUSE I� I•� n FF= 102 T.H. J/30 i/ o?S•n 300.14 , N 89 55 37 Ni f o I �0o� PROJECT BENCHMARK Ll j F; o / TOP Al MON. ti o / ASSUMED ELEV.=100 C) A SCALE: I"=60' — — Ni nTF, W 100' RADIUS FROM ADJACENT WELL, (TYP) 0. �o r� M / 100' RADIUS /FROM ADJACENT SEPTIC, (TYP) 0 too r" CPo po v1 ,SHT OF z ����+-����,• ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE. OF ���P� ........,,;�9♦ LOT: BLOCK: un, rcLmRiX s V.1 ��SUBDIVISION:_FIRE' LKEA' CORPORA TIONSU.&_,WVISION NO. 2 4900 PAL WASILLA SUITE 3 WASILLA, AK 99654 •••• •••'•••••L••••• (907907 ) 376-880000 FAX (907) 378-9629 Eric P. Fuglestad j % APPA: DATE: JOB NUMBER: DESIGN BY: Ar ��°• • No •o°'c��� 8/23/93 93-09.03 H. H. D \ A'r ••,•'•,r,,,,•"'•'''• \O •` ,S.�'PTIC PL.�1.1� SCALE: DRAWN: CHECKED: ,♦,,��1�JIOtv,���•• �rLIUNICIPALlTY OF ANC.5rOR4GE) NOTED epf NEW SEPT NO SCALE TEST HOLES TH j 1 TH #2 PERC. RATE = PERC. RATE = 3.5 MIN. PER. IN. 3.6 MM. PER. IN. p c� ORIGINAL GROUND p r�mTM ORIGINAL GROUND ORGVIIC MATERIAL ORGANIC MATERNAL t CLAY t CLAY SILTY SAND, y ' - SILTY S4ND, _ G.M., TRACES OF CLAY G.M., TRACES OF CLAY STONES UP TO 8" 3 STONES UP TD 8" 4 5 — PERC. HOLE 5 PERC HOLE t tl t 80TTOAl OF HOLE BOTTOM OF HOLE (NO ]PACE t)F MF ) (AV IRIC£ OF gT]FR) TH #3 p[v w p r¢r ORIGINALGROUND ORGANIC YATER/4L t CLAY —_ - SILTY SAND, G.M., TRACES OF CLAY 5 STONES UP TD B" 4 — 5 _- 8 t ti 770M OF HOLE CARPED CLEAN—OUT NEW (YP) EPDC TANK MONITOR TUBE \ PERF PIPE (TYP) 40* MDTH OF "BUCKET" � uMlTs of D 3034 PIPE, OR EOUAL IXC. 10' MIN. SEWER ROCK 40' LONG "DEEP TRENCH" EFFECTIVE DEPTH = SO' PLAN 1q_L'TAIL NO SCALE lER ERMWBLE �., ER FORMULA: LENGTH = (3 BR)(150 GAL) (2) (5<EFF. DEPTH>)(1.2 APPL RATE) L = 37.5' CONSTRUCTION LENGTH = 40 FEET GENERAL NOTES 1. MAINTAIN MINIMUM 4' GROUND COVER OVER DRAIN FIELD. 2. ALL PIPING SHALL BE 4" DIA, ABS SCHEDULE 4D P.V.C. PIPE UNLESS NOTED OTHERWISE. LD��tZ=l 7"�E-NCl_q SHT 2 OF 2 (Asioa��' MumWipality of AMehor09gDEPARTMENT OF HEALTH & HUMAN SERVICES 825 "G" Strait, Anehorago, Alaska 99502-0850 SOILS LOG PERCOLATION TEST P$pFOPIMeU Fp R' / 15'AWDE,4T�cti•� r Irl ;,;� DATE remFORMF.D; LAGAL OCSCRIPTION: Or A JRiem 1, !'tYc.1-ieSL-e�,l;,gwnship, Range, Section, ir�4-n1 2 3- 4� S- 8- 7- 9- 9- 10- 11 - 12 13� 14- 1s � 18 17 1a 19 20 C3RCA��n<, moor GL MY, j>B r C- Noir. i r?.dc�3 Q'� S. Cfy Sw rar, 36.h. WAS GROUND WATER IINCDUNTEREb7 it<0, S PERCOLATION HATE 3.15-P Iminutwinchi PVC HOLE DIAMBTEA TEST ALIN 8ETWEEAI _ FT AND FT COMMONT9 �%� Lum< ^�ry+Sma.�ed Pr,.r__{?a 7�� 7•' iN'� / PERFORMED SY: — F;0 �rV- CERTIFY TH T T IS TEST WA$ PBRFORMkD IN ACCORDANCE WITH ALL SW11 AND MUNICIPAL, GUIDELINES IN AFFECT ON THIS DATE, DATE 9 ?2.004 IRw. Aua81 5 IP YES, AT WHAT I L I A, ^ N a �—� ^" Depth to W►Ier After MgnOtlring7 r ` A1u:.�"_'`•n�' 'L`�'--``�� 1 Readlhq Date Gross TiMe Nat Depth t9 I , Iii--� i 'Nater Drpp +- v1 Yy- i PERCOLATION HATE 3.15-P Iminutwinchi PVC HOLE DIAMBTEA TEST ALIN 8ETWEEAI _ FT AND FT COMMONT9 �%� Lum< ^�ry+Sma.�ed Pr,.r__{?a 7�� 7•' iN'� / PERFORMED SY: — F;0 �rV- CERTIFY TH T T IS TEST WA$ PBRFORMkD IN ACCORDANCE WITH ALL SW11 AND MUNICIPAL, GUIDELINES IN AFFECT ON THIS DATE, DATE 9 ?2.004 IRw. Aua81 5 IP YES, AT WHAT L I I ••,,W�".1 _1-^—+ OEPTHP O I Depth to W►Ier After MgnOtlring7 r ` A1u:.�"_'`•n�' 'L`�'--``�� 1 Readlhq Date Gross TiMe Nat Depth t9 -NET .V i Time 'Nater Drpp Yy- i PERCOLATION HATE 3.15-P Iminutwinchi PVC HOLE DIAMBTEA TEST ALIN 8ETWEEAI _ FT AND FT COMMONT9 �%� Lum< ^�ry+Sma.�ed Pr,.r__{?a 7�� 7•' iN'� / PERFORMED SY: — F;0 �rV- CERTIFY TH T T IS TEST WA$ PBRFORMkD IN ACCORDANCE WITH ALL SW11 AND MUNICIPAL, GUIDELINES IN AFFECT ON THIS DATE, DATE 9 ?2.004 IRw. Aua81 MUMICIPAIlly 01 Anchorage DEPARTMENT OF HEALTH A HUMAN SERVICES 825 "L" Stroot, Anchorage, Aiaske 99302-()55D SOILS LOG — PERCOLATION TEST PERf'ORt Eeo FOI9i —az/-1 0 ,�"T/%"/;r-� • DATE PERFORMED: LE43AL DESCRIPTION: LOr_ Nff %?,',e rf / Ale, Section: DEPTH WI SLOPE 61TEPLAN r 2 V 4 (FEET} t L'LAY A PF'W. HOLD= 7—IZ4Gk5 OT $, /J} !;A IV P, G.Yn, I WAS GROUND WATER ii BNCOUNTBRED? 5 IF YES, Ai WHAT L 4 DEPTH? D �P hI F 04om to Wdet AM�r MoNtormq? ._,! ? Date, 7Reaaing Dolt Grosi Time t■wo Nyt Drop 9 9 i,, 3 , t1 ,S /T v " �. ., -1 7Reaaing Dolt Grosi Time t or Doom to Wotor Nyt Drop 9 9 i,, 3 , t1 ,S /T v " �. ., -1 20 �� N -- PERCOLATION KATE. Im1nUIow1ncnl PSRC HOLE DIAMETER TEST RUN METWEEN PT AND . �' .FT COMMENTS NO L--dou Prt S(j.LMrj pefor- �t7 Y'CSi' -� 'd PERFORMED BY: a bP rT jq-:�'/ J td t� 14e CERTIFY TH T T IS TEST WAS PERFORMED IN ACCORDANCE WITH AU. STATE AND MUNICIPAL GUIDELiNES IN CPPECT ON THIS DATE. DATE 72-008 i.AgV, elMl Moniulpollty of Anchorage 0EPARTMENT OF HEALTH & HUMAN SERVICES 825'•L' Street, Anchorage, Alaska 98502-0650 $01LS 4OG -- PeRCOLATION TEST • 1 /.. • N.M�1.. C Howard C. ►loikae d� e s�Re/ NO. 3063-1 ,.r•��} ar PERFORMED FOR; lJ rOFti—yF1r A'7 4,Cr "r. � ::. DATE PKRFORMED: LEGAL 09SGAIPTIDN;.,,Cpr Township, Flange, SeCtlon: 7~iS Ni l r/ PT /`'° 2 � SLOPS 917E PLAN 1 P E H Tl t—T""`TT7 T l�j�-�j Yj (9 teat r.4 M•fT. i0 WAS GROUND WATER MEN ENCOUNTERED? 1 IF YES, AT WHAT 12 DEPTH? Depth to water After 13 �! MonNohnp7 �� '�-- 14- is t4 15 r 1 is I 17 16 Wil /h, M ■ONNI mm - mm RelClnq Date Gross Net Depth to .. Net Time Ttme: Water Or^ ovv .w 20 PlFlCOLATION RATE IminuleLinCnt PeAG HOLE DIAM6Ttlp TdST RUN eETWFEN FT ANO PT COMMENTS �7 � V'tSG:41 S'6Q W.4TrW tiomrtTet,'ir for- -rrrV &l PCRFORMED BY; -�!o L'h'rtl' l], �t5 A rat Lr1L� CERTIFY THAT T IS ST WAS PERFORMlIiD IN ACCORDANCE WITH ALL $TAT@ ANO MUNICIPAL GUibet,INERS IN EFFECT ON THIS DATE. DATE: 72.006 (Rev. 4186) NOON NOON MEN M ■ONNI mm - mm RelClnq Date Gross Net Depth to .. Net Time Ttme: Water Or^ ovv .w 20 PlFlCOLATION RATE IminuleLinCnt PeAG HOLE DIAM6Ttlp TdST RUN eETWFEN FT ANO PT COMMENTS �7 � V'tSG:41 S'6Q W.4TrW tiomrtTet,'ir for- -rrrV &l PCRFORMED BY; -�!o L'h'rtl' l], �t5 A rat Lr1L� CERTIFY THAT T IS ST WAS PERFORMlIiD IN ACCORDANCE WITH ALL $TAT@ ANO MUNICIPAL GUibet,INERS IN EFFECT ON THIS DATE. DATE: 72.006 (Rev. 4186) PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE eflo DEPARTMENT OF HEALTH AND HUMAN SERVICES q-!�j P.O. BOX 196650, 825 "L" STREET, ROOM 502 o ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW930272 DESIGN ENGINEER:ACUMETRIX CORPORATION OWNER NAME:TAYLOR CHARLES RUSSELL OWNER ADDRESS:HC 33, BOX 3085 WASILLA, AK 99687 PARCEL ID:05135130 LEGAL DESCRIPTION: FIRE LAKE #2 BLK 1 LT 4A LOT SIZE: 53783 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 8/04/93 EXPIRATION DATE: 8/04/94 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 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: DATE: ek /?� A `V- 100' RADIUS FROM ADJACENT WELL ---- PRC `•WOG rF O IRI Tl S 00 0%,20 Lc •150.: CJ i \ •1.7 Isko 1T . 102\ _'•. i ' Q LOT 3A \ ;13' 100' RADIUS DO FROM AO✓ACENT �3 sTC 1 PROPOSED`, I W1_L 0 L'I.FV. (TYP) Ry `•. OUSE . e.1. Lr) LUT 5 \(' .. I � O .........:1.... 10' UTILITY ESMT. GRECOVERED #5 15010 REBAR (TYP) i LOT 1IRMO i I 1 a" n� EXISTING 5Ptil L'I.FV. (TYP) Lr) LUT 5 I � Z I PROJECT BENCHMARK TOP Al MON. ASSUMED ELEV.-100 RECOVERED Al MON. NOTE: ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE. EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITIES CONNECTIONS, AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. PLOT PLAN CERTIFICATE: I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 4—A BLOClI > FIRE L 4KA' SUBDIVISION _N0. 2 _ AND THAT THE PROPOSED IMPROVEMENTS AND DRAINAGE PATTERNS ARE AS SHO_WN HEREON. — LOT: BLOCK: 40*. �F ,VJ ���,,'• ��At1a CA� �f}'r .#. susDlvlswN:mom CORPORATION V i 49 h i} , 4a00 PALMER-WASILI-A HWY., SUITE 3 WASI", AK 99654 ,,,,,,,� SllglJlYISlON (907) 376-8e00 FAx (907) 37e -9e29 0 SECTION31 TOWNSHIP 15 N RANGE 1 �4/ EP:l J03 NUMBER: F.B. NUMBER: nin„ a Howl �Y�SEWARD MERIDWJEric P, Fuglastad _i PLAT No. v93-09.03 92- 01.43 m 86-136 DRAWN: CHECKED: P '�. No.7218-5 r " ',` .��1,0 •,"s ANCHORAGE_ RECORDING DISTRICT 1 ``�� EPF TLI\l ♦ n(9 .h�puuN�N �0 0 MAP No. �+4���ZOO- �� GRID NW 454 PLOT 1.1��-AN /� %% 7- _ I I FORMULA: ABSORPtiON AREA = (150 GAL)(3 BR) 0.8 (BED APPLICATION RATE) 562.5 = 3 X 187.5 562.5 X 1.045 = 588 S.F. GENERAL AQrES 1. MAINTAIN MINIMUM 4' GROUND COVER OVER DRAIN FIELD. 2. ALL PIPING SHALL BE 4" 01A,, ABS SCHEDULE 40 P.V,C. PIPE, UNLESS NOTED OTHERWISE. m M IW zr SEWER UNE, SLOPE I -2X • CAPPED CLEANOU)S FILTER FABRIC CAPPED MONITOR TUBES 1 � ORIGINAL GROUND it r• V,v COVER, OR 3/4" TO 1 1/2'- - EQUAL -� DIA. SEWER ROCK s PERF. PIPE HOLES DOWN) ,� v INSTALLED L L + WATER 10 L.F. ABS SCHEDULE 40 PIPE -.(SOLID) IMPERMIADLF. LAYER 1000 GAL. SEPTIC TANK SEWER ROCK LIMITS OF EXC. TH #1 I PROJECT BENCHMARK DEPTH • FUTrj EET ORIGINAL GROUND - a ORGANIC MATERIAL I F. CLAY 2 SILTY SAND, _ G.M., TRACES OF CLAY 3 - - STONES UP TO 16' PERC. HOLE PERC. RATE •• 1"=60 3.6 MIN. PER, IN.. -F �-- BOTTOM OF HOLE NOTE: (NO MCE 0v WATER) H 8 o "'`°o 3 Nto WO o� RECOVERED H&T-1 \� COLL.B'TT 17f711�8' �o LOr 4—A 45, 016 SQ. FT ALTERNATIVE SYSTEM !i l k o y �: X CLR. (7YP) ,5.,6'CTION NO SCALE ' 6' (MAX NEW 1000 GAL.I 0 SEPTIC TANK 0 MONITOR TUBES (TYP) PERF. PIPE (TYP) SOLID MANIFOLD PIPE 10 L.F. ABS SCHEDULE 40 PIPE (SOLID) PLAN D.�'TAIL NO SCALE LOT 3A 99'55'26" E•..: • "' <� 299.9f SEL PRP 5 ED GRA ORN .............. A � I .s!•Q a,. . .: b • O i' 70.4to p PROPOSED 1—STORY ° a WOOD FRAME HOUSE �• r M FF — 102 300.14 N 89055'31 W rO C, 9� 0 1 100' RADIUS FROM ADJACENT WELL o rr`` N q 100' RADIUS FROM ADJACENT SEPTIC If - -, 4 0 0 `C I PROJECT BENCHMARK ? - a TOP Al MON. / ASSUMED ELEV.-100 ..............1V ' c�_ I�l PLAN ............. ................ SCALE: 1"=60 • — —"" NOTE: ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE. % OF 44� Q� �'tp'•••°e•w••••a0•° s �, ., REVISIONS: LOT: �/ </`" �( BLOCK: —L`1 / ACUp� p��€ G'A Y2a o°'f A�\ it .4 ` �0 )� •N ••••.. /J G�tS Howard . Nonan j I J+A e� No. 3063•E v��a SUBDIVISION:FZR-657 CORPO -4TION lvq .5"Ug ON 4900 PALMER-WASILLA HWY., SUITE 3 WASILLA, AK.. 90654 (807) 376-8000 FAX (907) 376-029 APPU: DATE: JOB NUMBER: DESIGN BY: 7/8/93 93-09.03 H. H. S.�'PTI�' PLAN SCALE: DRAWN: CHECKED: (dfl1Nl0drpALlTY O.F' NOTED epf C � t tae Dritting i[vo by DOC Cv, Ebe SULLIVAN WATER WELLS P.O. BOX 670272, CHllOIAK, ALASKA 89587 + TELEPHONE 688.2759 OWNER OF LAND �H7� . ' � � .. r lel Z4;XDEPTN OF WILL ADDRESS ... �J.-.-- G+Vt 144+f � 1C 910/ p LEVELOFWATF.RCI LEGALt)iSCRtPTION1-_..-+-1� 1---�i1W DOWN FT. —..,. - DATF. • Started Ended .._ GALS. PER HR PERMIT NUMBER __ ._—.._ ..---_-,.-- KIND OF CASING d KIND OF FORMATION: From. -�- Ft, to� Ft.__ � ,JC . ---r! C'r-J From- U cr .40 0 to Ft._ From -.`f_ -Ft, to,,�-Ft, �1... ?(!�'� `+-... Fromt to- Ft.___�_. From ?-Ft.lv_44 .Ft._...J LA f...,.. cN4_.-O s C7ft/4`Jt+�'From_. FI. w .Ft _ From—From Fl,iv_.----Ft...._,_�_�b �'� r__ ..._-.. From-4t7.,p __Ft, to_.ESL Ft. r�1d1�� _�jQ >= ... rum Ft. to—,.-. Ft. - t From-� Ft. to tJf,Z__Ft.,._. �9 +� s �� -A:-h5L rori Ft, tu, FL From -'V -Ft. to -&.0-0' o FL_�1.,�L�_1. 4►..5'"t% :.I1�'"rmtt_._Ft, Iv Ft._._ From . _ ! �t� From Ft. to- ,. Ft.-� -�--- �--- r.+' Ft. From _-Ft. to MUNICIPW From Ft. to, i �1 f�1__�...__�-1 r[ ENVIRONMENTAL SERVICES DIVISION From _—._._ Ft. to..—_,..Ft.__..Q.ti.�- l--- ---- From ..._—_. Ft. to_.__Ft. _ From- .-_-Ft, to.. _-_Ft... Front_._....—Ft, to From. .--..Ft. to Ft-_- Frorn_._.. _— Ft. to Ft From—_. Ft. to 0 11 2 6 1993 From.. --Ft. lu... •-� �t� L. 1 V, From—.....FI. to.. .—Ft.,.-- -- ---- From__ . - Ft. [o. Ft. -- F[Om—..FI. to. From—, .-Ft.to.__ Ft._-......—_._.., .._ From..._--Ft.to—_.._Ft-. MISCL, INFORMATIO,pN: Tb_ C,A s .,•,U(, 1)RILLtR'S NAME p MUNICIPALITY OF ANCHORAGE 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 4 APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I. D. # 0,51HAA # L\ C) 7L -)Lo Lb'-� 1. GENERAL INFORMATION 2. S'3(o Complete legal description ���1 �7 ` WK %Ll 2 L&- X)I> , 44,1,7 Location (site address or directions) Property owner ).`yar,-&, e %�4lrlylISeL Day phone�* %'V ' i/ n Mailing address On r/1�Lk/!l%f,'(/ ells_%Cl��� Lending agency �!�/r 2l 7hlts 1�/t/Y�� Day phone Mailino nHrirPQQ Agent Ad d re: Unless otherwise requested, HAA will be held for pickup. 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 $21 C\1 7 ��-ate S. STATEMENT 'IF INSPEC;IOM 3Y=�IGI`IEH: ........... , As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation of this Health Authority Approval application shows :hat the on-site seater supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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. Name of Address Engineer' 6. DHHS SIGNATURE Approved for Disapproved. M of{�� Hawurd C. Halton No. 3063-r kit' Fp .: bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments uiTfr 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 engineers work. 72-025 (Rae. 1/91) Beck MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �lJt 17~/4 A&L / r Parcel I.D. 0,5-j j 36 3n A. WELL DATA Well type ��iy� e If A, B, or C, attach ADEC letter. AD C water system number //� II`' Log present (Y/N) Date completed ®03 �U Driller All Total depth 1201 `I Cased to Casing height Z Sanitary seal (Y/N) Wires properly protected (Y/N) VP.S I - Date of test Static water level Well flow Pump level FROM WELL LOG ,3 a !2 ,�,60 g.p.m. (, 4l (.t)/__ SEPARATION DISTANCES FROM WELL TO: AT INSPECTION r q 42 Septic/holding tank on lot /DLa ; On adjacent lots Absorption field on lot /0q, ; On adjacent lots �� f Public sewer main Nllq Public sewer manhole/cleanout Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: Petroleum tank 0 IYI' Nitrate _� , 1�ti Other bacteria Collected by: B. SEPTIC/HOLDING T/yANK DATA Date installed W , —Tank size �•�n Compartments 99 Cleanouts (Y/N) 7 Foundation cleanout (Y/N)S Depression (Y/N) Ak High water alaim (Y N) A)Alarm tested (Y/N) Date of pumping , 1A) 0D0JfrO(1h (' A Pumper A)1A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot f0I0 On adjacent lots ��/�" Foundation �J To property line (� Absorption field �Db�� Water main/service line Surface water/drainage ]Lap 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed N/A Manufacturer Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water Date installedvl /,_v��/'�/�a / Soil rating System type Length / Width I �t 0 Gravel thickness __ . t`� -Total depth q Total absorption area Bio-/An(�(�� )L� Cleanouts present (Y/N) Depression over field (Y/N) Date of adequacy test . A 1,1 1 i` \ Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) A)D If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: bedrooms Well on lot ILE On adjacent lots /2 0(f �,)/ 1261L—�C�Propertyline , f To building foundation � To existing or abandoned system on lot On adjacent lots ,� '�( ✓e>Q 1 ����*—Cutbank ��%� Watef-main/servic�line / Surface water hq Driveway, parking/vehicle storage area �O Curtain drain --24A E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in Signa Engin Date HAA Fee $ ��U UU Waiver Fee: $ Date of Payment... `1J Date of Payment Receipt Number c26_3 84S 6 ) Receipt Number 72-026 (Rev. 3/91( BeCk MOA 21 _ this inspection. t% _ .... « .. :1 C0 V, !� Y �. •-n ( %. • .0 fr HOWurd (� Holton o 1< i No. 3063 -Ear a� ���®a OOFFSSIONP;®®��