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AUDUBON HILLS BLK 1 LT 3
Audobon Hills Block 1 Lot 3 #015-231-48 Municipality of Anchorage Development Services DepartmentBuilding li6ikl Safety Division — On -Site Water and Wastewater Program, 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage ak us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWO90019 PID Number: 015 - 231- ve Ramaf Fg. Wastewater System: ElNew 0 Upgrade jn Acidnss (01040 A.Jahen pn✓e ABSORPTION FIELD Pnone Nw of Bedrooms 4 O Deep Tl.rrJl D sh.now TnnrT )a(Bad D Mound D Other LEGAL DESCRIPTION sort Ramp a. TOW Depth eom enpnsi grad. GPD/FI' 53 FI. Block Lot su"Moon 4,4d,46, Depm b taps wtiom can ongmai anon Gravel depth beneathpps 113 -%N; 115 a.to Ft. 0. j Ft To snp Range Sarmon FY edcied above ong," precis t Gravel L*Vh I� 0 — Z. Fi. .72 FI. • Well: j ❑New ❑Upgrade Gravel vadlh las Numberol Mas 3 Pnenee batvnlM lnee 3 5 Ft. FI ciesuh0aborl(Pnvaie .B. c) TOW Depen cased TOW sbwpbon area /�/� '�1Ise P'. Melenel 4,0 Ft. FL Fir Sch Drdler Dab DNled Stabc Water Lsvai Inst r D J11 Cgvua ia Wad 0a� ! - FL Yield Pump Set at. ceung 1,1e gnt Above GrourU TANK GPM Ft. R SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. 00ther. To Septic Absorption Litt Holding ubhUPrfvate Men'r • '"'r fAAk apaolr C/y� %—C;00 From Tank Field Station Tank sewer Line A („•n Gel W" (00 } s loo+ 1 lco t /VIA ZSL} 7 M.bnal _ ' Z S Numo.r of cwlp.rinbn.� sunaa water a r N.O. tai Ni O, {- �, N A LIFT STATION Lot lme 5 1 + I D i" 54 N L, Sze 1.500 Gal iGwer �•�' 1 An I7.M o IM• 6.J LourMebon 1 5 + 1 ID 1'Pump 5 + N A on. ievel at 25 'Pwrp orNuel at Wgh v Yarm n. 12 J /l N41 in 2Z In GunnDrun I/p, N.0. N.C. N A Pimp Make a Model 0a,l�juLo Eleanul a,spa ons penomrd Or R~s BENCH MARK ri� Loraban and DeamPbOn. Gq it r 1 arp ,m f o la wmW EleraiOn. Ico FL Inspections performed by: Lnn SPurkiar>L Dates: list _2 1 09 EnginP,�{��1,� 2nd '} 09 Development Services Department Approval Conditional Approval Date: i •, SPURKLAtrD: LAnS E. Reviewed and approved by: Date: (iw M.db) LOT 4 Gv: TRACK A-1 OF 444*oIS �.•�P E.........gC q�, •• 49th jog .......... ...............% /. TRACK A-2 LAR SPLRKLAND ' 7 / \ •fir '• No. CE -11500 • 25 0 25 50 75 107 125 150 ••1 f ���� �ss �'• SCALEr 1' = 50 FT SPURKLAND ENGINEERINGAUDUBON HILLS BLOCK 1 LOT 3 11 SEPTIC SYSTEM ASBUILT 103 W 15TH. AVENUE JIM FERGUSON DATE: AUGUST 5, 1009 (NCH. 99501 (907) ?779 16 11 11040 AUDUBON DRIVE SHEET.• 2/3 GRID. 2739 -39 PERMIT 0 SW090079 PID k 015-231-48 AUBUBONHILLSBIL3B2.BW6 Xi IN A l A 1/QI C00£ R hP Y N \ iP I\ / ��j9Jp©\ STALLED 4-9£OROOAI S£P77C SYSTEM 1500 CAL ADVANTEX TANK W/ AX10 POD d i - X 32' ABSOPRT70H DED TOTAL DEPTH.• 13 fEET j IMPORTED 2 fEET MOA APPROVED ALTER SAND ROCK DEPTH. 0.7 FEET NSULA170H 1INCHES 1 � COVER., 2+ FEET Gv: TRACK A-1 OF 444*oIS �.•�P E.........gC q�, •• 49th jog .......... ...............% /. TRACK A-2 LAR SPLRKLAND ' 7 / \ •fir '• No. CE -11500 • 25 0 25 50 75 107 125 150 ••1 f ���� �ss �'• SCALEr 1' = 50 FT SPURKLAND ENGINEERINGAUDUBON HILLS BLOCK 1 LOT 3 11 SEPTIC SYSTEM ASBUILT 103 W 15TH. AVENUE JIM FERGUSON DATE: AUGUST 5, 1009 (NCH. 99501 (907) ?779 16 11 11040 AUDUBON DRIVE SHEET.• 2/3 GRID. 2739 -39 PERMIT 0 SW090079 PID k 015-231-48 AUBUBONHILLSBIL3B2.BW6 I 6' r''P rl ADVWEX AXYO POD INSULATED RISER ELEV.= 101.5' 6' PUMP -OUT .�I���L`L•1� SLIDE SECTION OF 6' PIPE OVER THIS CONNECTION TO PROVIDE SHEER PROTECTION - EXTEND TO BRIDGE EXCAVATION J L. 101.5' ELM= 95.6' 49th LARS 1500 GALLON ADVANTEX TANK BENCH MARK GARAGE SLAB ASSUMED ELEVATION 100' SPURKLAND ENGINEERING AUDUBON NII.G4 BLOCK I LOT 3 SEPTIC SYSTEM AS -BUILT 203 W15th Ave JIM FERGUSON DATE, AUGUST 5. 2009 Anchorage Ak 99501 12010 AUDU60N DRA2. AACNM04.. AK 99516 SHEET] 3/4 GRID- 2739 PERMIT f SW090079 PARCEL ID j 015-231-48 AudubonH4llsB1L3D3.dwg RISTALIED ORENCO LRT STATION 115' DLI OR SO 4 ASTALL M0Y?OR TUBE 2 E[[T COVER (1014) ASTALL 2 -INCA ASUUnON ASTALL 13TUR EAMIC [LEY.= cur.- ,w.a 12.5' D 74VC SOX. ABSORPT,ON BED A3TALLED WACO 1500 GALLON ADVANTEK TANK 1-1 Ro UN? I COVSTRUCTED 32' LONG BY 125' W7DE SOIL ABSORPTION BED W/ 0.5' [EE[CTIVE DEPTH SEWER RACK t 2't MOA APPROVED IXIER SAND UNDER DZMBUIION PIPAC 49th LARS UnCMT WASHED SEWER ROCK 115' DLA. SCH-40 PVC W/ 3/16' HOLES 24' ON CENIER BENCH MARK CARAC[ SUB. ASSUMCD [IEYAWN 100. ISPURKLAND ENGINEERING I I AUDUBON HILLS BLOCK 1 LOT 3 I I SEPTIC SYSTEM AS -BUILT I 203 W. 15th AVE JIM FERGUSON DATE, AUGUST 5, 2009 ANCHORAGE, AK 99501 279-3916 12040 AVOLMN ORM, ANCHORAGE, AK 99516 SHEET, 4/4 GRID, 2740 PERMIT f SWO90079 PARCEL ID J 015-231-48 AudubonNi11s81LJD4.dwg MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 04, 2009 Expiration Date: Jun 04, 2010 Permit Number: SW090079 Parcel ID: 015-23148 Legal Description: AUDUBON HILLS BLK 1 LT 3 Design Engineer: 0007 SPURKLAND ENGINEERING Site Address: 012040 AUDUBON DR Owner Name: JIM FERGUSON Lot Size: 0 SO. FT. Owner Address: 12040 AUDUBON DR Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99516 - This permit Is for the construction of: Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by tatting (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By Issued By Date: 6 Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEPTICMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015, - a '; I.- L/ si Property owner(s) - l "(- u on Day phone 30- s22(o Mailing address 1'2.040 Anc�omjc. . AK Zip Code 951 b Site address Safnm ; — Zip Code Legal description (Sub'd, Block & Lot) A to w%on 1h\\s Cilk \ Ll 3 Legal description (Township, Section & Range) Lot Size Sq. Ft. THIS APPLICATION IS FOR (®all that apply): Absorption Field FRI Septic Tank 19 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 4 THIS APPLICATION IS AN: Initial ❑ Upgrade 19 Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature oftproperty owner or authorized agent) Permit/Rush Fees: Date of Payment: So - Waiver Fees: Date of Payment: Receipt Number. oroo (023 Receipt Number: (Rev. 11105) k, spuM and Eflgonec ftu Environmental Consulting and Design SEPTIC SYSTEM DESIGN AUDUBON HILLS BLOCK 1 LOT 3 Municipality of Anchorage May 18, 2009 Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 Subject: Septic System Installation Permit 12040 Audubon Drive Ladies and Gentlemen: I am writing to request a permit for the upgrade of the septic system for the above referenced property. The proposed system will serve a 4 -bedroom single-family residence. The lot was developed in the mid '80s and the existing septic system is operating in a surcharged condition. A soils log, site plan, design drawings and construction specifications are enclosed for your review. The existing system was installed in December of 1984 and consists of a 1250 gallon septic tank followed by a lift station and a 21 foot wide by 40 foot long mounded soil absorption bed. According to the home owners the system has been backing up frequently. I inspected the system several times in April and May and found the bed surcharged. There was no evidence of septage day lighting during my inspections. A test hole was excavated on April 15'6, 2009 to the north east of the existing septic tank to a depth of 10 feet. Beneath a shallow layer of organics a silty material with some gravel present was observed. Water seeps were observed several feet below the ground surface. Water monitoring was conducted through May 13'", 2009 and was observed at a depth of 18 inches. A percolation test was not conducted because we did not observe 2 feet of native unsaturated soils. A soils log May 25h, 1982 reported that the native material consisted of a sand R silt mixture, silty gravel, and silt to a depth of 15 feet. Ground water was not observed at that time. Based on these observations the only viable approach appears to be to rebuild a new absorption bed in the same location as the existing system. We proposed installing a CAT 111 Advanced treatment system with effluent pumped into a mounded bed. The bed will be sized based upon a conservative application rate of 2 gpd/sq.fi. All contaminated soils will be removed and a minimum of 2 feet of MOA approved filter sand will be used to reconstruct the subsurface below the proposed absorption bed. Design Cafes: Groundwater at I8 inches below ground surface (5/132009) Use 1500 gallon Advantex tank, AX20 treatment unit Soil Rating. From Testhole 528/1982 5.7 minlin = 5 gal per sq.f /day Design application rate 2 gpd/sq. ft. No. of Bedrooms 4 Required Area per Bedroom: 15012 =75 sq.ft. Total area required: 75 x 4 = 300 sgft 203 West 1516 Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, LspurklandCagci.nct 6' F OPTIONAL SLIDE SECTION OF 6' PIPE OVER THIS CONNECTION TO PROVIDE SHEER PROTECTION - EXTEND TO BRIDGE EXCAVATION 1500 GALLON ADVANTEX TANK -V: � 0 NHUNKLAND LNUINLLKINVSEPTIC SYSTEM DESIGN 203 N15th Ave AUDUBON HILLS BLOCK 1 LOT 3 Anchorage Ak 99501 JIM FERGUSON DATE 60 MAY I8, 29 ..,.......1 12040 AUDUBON DRM. ANCHORAGE AK 99516 SHEET, 3/4 GRIDS 2739 I PERMIT { SWO90OXX PARCEL ID } AudubonHW1s8IL3D3.dwg I 12.5' WSIALL MOWOR WSTALL ORD LFT STAIRIN 1.15' DG WE OR SCH 40 PVC FOOT PRINT OF EX/SANO SOIL AILSORPDON BED 32.0' WSTALL MONUOR TUBO 2 FEET COVER (MLN.) WSTALL 2-WCH WSLRA110N PWALL FILTER FADRK: 12.5' EXISTWc soa ABSORPTION em INSTALL ORENCO 1500 GALLON ADVANIIX TANK C -INSULL ORENCO AX 10 TREATMENT UNn CONSTRUCT 32' LONG BY 12.5' W/0£ SOIL ADSORPTION BED W/ 0.5' £17£CMT DEPTH SEWER ROCK Q 2'+ MOA APPROVED ntl£R SAND UNDER DISIRUBUTION PIPING 0.5' £TFECTTVE WASHED SEWER ROCK 3 1.15' DU. SCH-40 PVC W/ 3/16' HOLES 14' ON CENTER 1203 V. AN31 tNlr1NLLKIN(� I I AUDUBON HILLS BLOCK I LOT 3 I I SEPTIC SYSTEM DESIGN I AN O 15th AVE JIM MOWN DATE- MAY 18, 2009 ANCHORAGE, AK 99501 279-3916 11010 AUDL/BON DRAT, ANCHORAGE, AX 99516 SHEETS 4/4 GRID 2740 PERMIT / SWO90OXX PARCEL ID / AudubonHi11sB1L3D4.dwg Municipality of Anchorage Development Services Department Building Safety Division y1 On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995198650 www.muni.orglonsile (907)343.7904 -� rf•Soils Log - Percolation Test Performed For. AJ imL11 64,4"0 /, Date Park A Legal Description: ulo,n 4;iks Biki LF3 Township. Range. Section: Depth 1- 2- 3- 11- 12- 13- 14- 15- 16- 17- 18- 19- S;1t q Some Gec.. A l (ML) WAS GROUND WATER ENCOUNTERED? 1 AT WHAT DEPTH? Z'3 s L IF YES, BA.N, OePth to Water Monioring? After O n e Doe: O tS1 ,. f t sse, h 49TH v3 PERCOLATION RATE PERC HOLE DIAMETER S1 l T 1 TEST RUN BETWEEN—�—�—FT AND FT COMMENTS fffLol7l Tion 1[S(T,, /1✓J4 Co+k�. <d PERFORMED BY: 1J /1 w (' (L1 ` ( CERTIFY THAT THIS TEST WjS PERFORMED IN ACCORDANCEIVATH ALL STATE AND MUNICIPAL GUI CLINES IN EFFECT ON THIS DATE. DATE: Jr 21 Def PERFORMED LEGAL n n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Gn L StnM. Awct•erep. Atwks IMS 2"ArJO SOILS LOG - PERCOLATION TEST c (O.L)- orgaanic,si(+ I{SNI -sara sili mixture ,ciravels L�-silk sunt, yrove10ckeA5 of (sM) WAS GROUND WATER ENCOUNTERED? 1 IF YES. AT WHAT DEPTH? SOILS LOG • PERCOLATION TEST PERFORMED: Ll • as& a Z PERCOLATION RATE PERFORMEDBY.GN�P�CERTIFIED stow 46/79) em • � • I I � ���:4a i.M 1• PERCOLATION RATE PERFORMEDBY.GN�P�CERTIFIED stow 46/79) em r►��: �pa��0�a�d ��go�c��r�o�g Environmental Consulting and Design Single Family On-site Wastewater Disposal System Construction and Material Specifications Subject Property: Audubon Hills Block 1 Lot 3 Date: May 18, 2009 General: 1. The owner shall contract with a contractor to perform the work outlined in these specifications and plans in accordance with the attached MOA permit. There Is not contractual arrangement between the contractor and the Engineer. The Engineer shall be the owner's representative and will Inspect the work to document the contractors activities. Final acceptance of the contractors work rests with the owner and the MOA. 2. The scope of the project Includes the procurement and Installation of a 4 -bedroom on- site wastewater disposal system at the location depicted on the attached site plan drawings. The scope of the work also Includes the Installation of an Advantex 1500 gallon tank, an AX -20 treatment pod, a lift station, and a mounded soft absorption bed, 12.5 -feet wide x 32 -feet long, with 0.5 feet of septic rock below the distribution piping. The scope of the work Includes the excavation of the existing drain field and all contaminated soils. Placement of a minimum of 2 feet of MOA filter to rebuild the bottom of the system to the same elevation as the existing bed, or higher. All components of the proposed septic system must be constructed a minimum of 100 feet from any surface water or water wells in the area. A minimum of 4 feet of earthen cover is required over the septic tank and a minimum of two feet of cover is required over the drainfield. In addition to the required earthen cover, 2 -inch thick, 40 psi, direct bury board foam shall be installed directly over all installed piping. 3. Construction shall be in accordance with the approved site plan and design drawings and any special provisions noted on the Municipal well and/or septic permit. All materials, components, workmanship and construction practices shall comply with the Municipality of Anchorage's latest ordinances regarding wells and septic systems, as well as MOA, Development Services Department, On-site Water and Wastewater Program (DSD) policies. 4. The contractor Is responsible for obtaining all underground utility locates, layout of the proposed system, and verifying and maintaining all required separation distances to lot lines, surface water, wells, steep slopes, etc. S. The property owner shall be responsible for final grading any depressions formed from settlement of backfill material. The property owner Is also responsible for vegetation of all areas disturbed by septic system installation activities. 6. Contractors Installing wastewater disposal systems must be certified to do so by the MOA DSD, On-site Water Wastewater Program. Property owners installing their own systems must receive advanced approval from MOA DSD prior to system installation activities. 7. The contractor shall ensure that ALL materials being used are in compliance with the most current guidelines established by the Municipality of Anchorage. Refer to 203 Nest 15'" Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, LspurklandCagci.net Y Environmental Consulting and Design "Standards and Specifications for Component Parts and Materials Used in the Construction of On-site Wastewater Disposal Systems", Dated December 2000, as provided by MOA DSD, On-site Water and Wastewater Program. Septic Tank Installation: 1. A new septic tank, of the size specified In the design drawings, shall be procured from a qualified manufacture/supplier if the existing septic tank Is found to be defective. . 2. The burial rating of the tank shall be adequate for the actual burial depth encountered. 3. The tank shall be level and sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the tank shall extend a minimum of 12inches above the final grade. 5. Tanks installed with less than 4 feet of cover shall be insulated. 6. The sewer service line from the house to the tank shall have a minimum slope of 2% unless prior approval Is obtained from the engineer. 7. The Inlet and outlet lines from the tank shall be bedded in drain rode or the soil shall be sufficiently compacted to prevent future settlement of the soil. 8. Septic tank Inlets, outlets and deanouts shall be fitted with water tight couplings. 9. A cleanout shalt be Installed 1 to 4 feet from the foundation. 10. Post tank deanouts shall be Installed per MOA requirements. Does not appy to pressurized lines. 11. In areas with high ground water, the septic tank shall be sufficiently anchored to resist buoyancy forces when there Is not adequate soil cover to resist uplift force. The contractor shall refer to the engineer for direction regarding this matter. 12. The tank backfill shall be graded sufficiently to ensure positive drainage away from the tank. 13. All holding tank and lift stations shall have an audible and visible alarm inside the residence being served. 14. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform Electrical Code. A municipal electrical permit and Inspections must be obtained where required by the MOA. 15. The contractor shall verify that the septictank/lift station Is a minimum of 100 feet from any residential water well, 150' from any dass'C' well and 200 feet from any community water wells. Additional separation distances must also be maintained. 16. The contractor shall remove or abandon the existing tank in compliance with the Unform Plumbing Code. Drain field Construction: 1. The drain field shall be excavated to the dimensions outlined in the design drawings. If any discrepancies are noted, contact the engineer Immediately for clarification. 2. The drain field shall be installed parallel to slope contours. 3. The bottom of the drain field shall be within 2" of level. If the sidewalls or bottom of the excavation become smeared, they must be raked or scarified prior to the placement of filter sand or drain rock. 203 West 15'" Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, I-spurklandCgci.net tea. J, Environmental Consulting and Design 4. The drain field must be a minimum of 5 feet from the test hole excavation. S. Distribution pipe is to be installed level with perforations facing downward, atop a level bed of drain field rock. Septic rock shall then be placed atop the distribution piping to provide a minimum of 2" of cover, level across the entire width and length of the trench, above the piping. 6. A silt barrier must be installed at between the final drain rock and the native soil backfill. The silt barrier shall cover the entire drain rock surface. 7. Monitor tubes must be 4" in diameter, installed in the locations depicted on the design drawings, and extend a minimum of 12" above final grade. The portion of the monitoring tube below the septic rock must be perforated and the portion above the drain rock shall be solid. S. Backfill over the final gravel layer must not be less than 2 feet. Insulation must be Installed when the backfill depth is less that 3 feet. 9. Drain field back fill shall be mounded to prevent depressions from forming due to subsequent settlement of backfill material. 30. The contractor shall verify that the drain field is a minimum of 100 feet from any residential water well, 150' from any dass'C well and 200 feet from any community water wells. Additional separation distances must also be maintained. Inspections: 1. A minimum of two Inspections are required by the Municipality of Anchorage. These Inspections must be conducted under the supervision of a Professional Engineer licensed to practice in the State of Alaska. 2. The first Inspection must be conducted after the excavation of the drain field and before the placement of any gravel. The septic tank. may be set In place, but may not be backfilled. 3. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, stand pipes, deanouts, and insulation, but before the placement of any backfill. 4. The contractor shall provide a legible copy of all field notes relating to system layout and construction to the engineer for the use In preparing the record drawings. S. The contractor shall coordinate all Inspections with the Engineer. A minimum of 24 hours notice is required prior to the start of construction. If necessary, a preconstruction meeting will be held on-site. 203 West 151" Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, LspurklandCagci.net ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREE51ENT MEMORANDUAI OF UNDERSTANDING BETWEEN MUNICIPALITY OF ANCHORAGE AND -07m Fiabuson THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this Day of /VE of 20�L9 by and between�GfG.59AI herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as _�� a,..}ex located at (Zoyp �w�y6on S{reoi' Anchorage, Alaska. 2. DefnItions. A. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AWWTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality Pursuant to Anchorage Municipal Code (hereinafter, "AMC 15.65. B. Certificate of On -Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On -Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On -Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 I Fee. Owner shall pay to Municipality an annual fee of lr (S_$� .00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the AWWTS. The term begins on the date of approval by the Municipality of the installed system and shall continue while the AW\VTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On -Site approval is issued to the new owner or transferee of the property. S. Alterations, installation and Removal of Additional Equinment. Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Construction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWIVTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws, regulations, rules and orders for the AWWTS. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AWWTS Operating Permit is: &Awc.11y C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. F. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AWWTS is the governing professional guidelines for the construction, maintenance and repair of the Owner's AWWTS. 7. Nonwaiver. The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Owner: ,T.. �cc,45on Anchomee: Purchasing Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Tbird Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govem the rights and obligations of the parties under this Memorandum of Understanding. 10. Severability. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. OWNER: By 46Lf-'--� Date:G•2n-02 02 STATE OF ALASKA THIRD JUDICIAL DISTRICT MUNICIPALITY: By: Title: Date: ) ss. The foregoing instrument was acknowledged before me this net � day of 20� 6y 7m__f_er _ � PUBLIC G1,�1s +oTa,pi I Y FOR ALA � = 1 Commission expires: 3 aoi3 ' « p tr t .. f- 72-013 (Rev. 3/76) le4(- 8¢ - MUNICIPALITY OF ANCHORAGE 1 +11 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ��' ENVIRONMENTAL ENGINEERING DIVISION 825 L'Street • Anchorage, Alaska 99501 Telephone 2644720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME _ PHONEf7]NEW �i�/,J^I ❑UPGRADE MAILING ADDRESS A 7 LEGAL DESCRIPTION ,4,44t)n I-AiiS 810(t- 407-3 LOCATION rr �f vNa Jim, �r/ I' C- NO. OF BEDROOMS O DISTANCE TO: Well IDD - Absorption a�� Dwelling PERMIT NO. if Q e) Manufacturer /x.l.t Material No. of compartments W2 < C- -� N~ Liq. capacit in gallons IF HOMEMADE: Inside length Width Liquid depth l d YDISTANCE Jt�Z TO: Well Dwelling PERMIT NO. I=F Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well Foundation Nearest lot line PEH O. r0 .7n No. of lines aof gach��e Total length of lines Trenc'tid%h, Distance between lines 2 ,S•.- r M Top of the to finish grade Material beneath tile Total effective e¢sorp 'on area inches 5' y� Length Width Depth PERMIT NO. W 01_ Type of crib Crib diameter Crib depth Total effective absorption area W a' W Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS 12V C - SOIL TEST RATING i �C /3()17/1 S' } t INSTALLER %C REMARKS #'nst44 kJ i. APPROVED DATE LEGAL 72-013 (Rev. 3/76) le4(- 8¢ 11 r34 -AP. 345 4- I- fqul i C I F F-1 L_ I -k V ID F= F-fFJGH4F�'f=100: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4120 �r 7—=ITE =•EWES[ -S': LJEILL F•EF;;:1'1 I T PERMIT NO`. DATE ISSUED: APPLICANT: ADDRESS:, CONTACT PHONE LEGAL DESCRIP LOT SIZE: LOT LOCATIO14: 840070 ENGINEERED DESIGN 03/22/84 ALMOND, INC PO BOY, 112247 ANCHORAGE, AK 345 21 SUBDIVISION: SECTION: 23 1. 5A (SG.. FT AUDUBON DRIVE 99511 AUDUBON HILLS LOT: 3 BLOCK: 1 TOWNSHIP: 12N RANGE: <W OR ACRES) I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREPIENTS FOP. ON-SITE SEWERS AND WELLS AS SET FORTH BY THE HUNICIPALITY OF F.!f=HC-:AGE (NOR) AND THE STATE OF ALASKA.' 1 WILL INSTALL THE SYSTEM IN F.::=u-.:-INCE WITH ALL PICA CODES AND REGULATIONS, P;!D IN COMPLIANCE' WITH THE DE= DI:; CRITERIA OF THIS PERMIT. 7. I WILL ADHERE TO ALL MOA AND TF,TE OF ALASKA REQUIREMENTS FOR THE SET BACK Di-TANCES FROM ANY EXISTING WELL: H!iSTEWATER DISPOSAL' SYSTEM OF: PUBLIC 61EF..AGE SYSTEPI ON THIS 1R ANY P NEARBY LOT. IF F. L:FT S1 Tf!`_i AN Wf I _!_ i is iT BE ELC. :CRL W IIs _ _ Y Fd! COVERED BY MOA BUILDING CODES,. T APlD T''-" iu + ST BE OBTAINED; (2) AS-BUILTS u'- rud ELECT;:i�AL. INSPECTION F:EFiRT; AND C3> ,THE ',0' c BY A L<C-ii=ED ELECTRICIAN. , DATE: DATE: -- �P Z PERMIT NO~ i-ILI~-,I I C: I F-~-FIL I T'T' C,F F-I~-IC:H"'~F:FIi]E DEPARTMENT L HEALTH AND, ENVIRONMENTAL , ..OTECTION 825 "'L"' STREET, ANCHORAGE, AK. 995~--1i 264-4?20 I--I~~,i--"~~- ITE "----;EL.-IEE: F"EE_"I'-I I T ( ,'_--:5:0i6,.-" ) RPPLICANT LOCATION LEGAL GLORIA BOWMAN L 3 B i AUDUBON HILLS PO BOX 6502 99502 LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MA;:<II'dUM NUMBER OF BEDROOMS = 4 SOIL RATING (SD FT?BR)= i~0 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:,EF'TH= _---:: L E 1'-.il3 TH = _~---~-i ISRR%.'EL E:,EF'TH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE .GROUND AND THE BOTTOM OF THE E×CAVATION (IN FEET). THE T~:E~-,ICH L~ I [:,TH I Z] 5. LD~Z~E~ FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REL]!I_I I I~:EE:, SEF'T I C: TI=II-.IF:-'. S I ZE= -'I 25E1 I-~I:tL LI]Ii'-,I'_-] PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INST8LLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T[~CI (2) I ~-,ISF'EC:TI Cl~-~_~. RD:E F:EL]!LII Y:EE:, BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS DEPRRTMENT HILL BE SUBSECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEP1 IS ±00 FEET FOR A PRIVATE WELL OR i50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE A\~AILABLE TO INSURE PROPER INSTALLATION. F'EE.~F1 I T E)-(P I RES [)ECEr'18EE: ]:l_- ID:Bi: I CERTIFY THAT i: I AM FAMILI8R WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERST8ND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: APPLICANT GLORIA BOWMAN ~Permit ~: 820395 January 31, 1983 TO: Permit Applicant Subject: Lot 3 Block 1 Audubon Hills Subdivision A permit issued by this department for an individual well and/or on-site sewer system has expired' as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call this office at 264-4720. Sincerel% Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 r•lUr4 I G I F�F1L- I IF OF' FF r•4 CH ClFZF=l 1-3E T DEPARTMENHEALTH AND ENVIRONMENTAL �OTECTION 825 STREET, ANCHORAGE, AK. 9% J1 • 264-4722 Ohl—fN- I TE S=EIIEFZ F•EFZM I T PERMIT NO. C 820395 ) APPLICANT GLORIA BOWMAN PO BOX £502 274-3222 LOCATION LEGAL L381 AUDUBON HILLS LOT SIZE 52306 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER, OF BEDROOMS = 4 SOIL RATING CSO FTIBR)= 130 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: EI r=-: Fl IFH= M: L_E-7"0TH= Sal GFZF=l 'v'EL GNEF•TH= 1 THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IFI FEET). THE IF FZ EE t4 C3 VA IJ I GtiTH I on Z5. EDE CA FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IFI FEET). F Er CA LJ I FQEP S=EF'T jr Cl IFFIr4K Ss 12"E= 1^L ED C3FIL_L_CDt•dlc=. PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTION'= OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWCD C Ta? I r4inF'ECT I C P4 in FFFZE FZECAtJ I F_EC• --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. jo,.MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F•EFRUI I T EK<F" I FQ00 [7ECEME:EFZ "Il r 1Sa^2 I CERTIFY THAT 1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGFIED:------------ "-------------------- ISSUED BY - ICANT GLORIA BOWMAN V 4.. 0 !�3 13f/yam MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 4 7 8 9 10 11 12 13 14 15 16 17 18 20 COMMENTS PERFORMED BY: WAS GROUND WATER ENCOUNTERED? SLOPE SITE PL~.N O P E IF YES, AT WHAT LL .: I. ~i TI4Z DEPTH? Hc l . Gross Net Depth to Net Reading Date Time Time Water Drop +H2o G.z(o iO:O8 -g 3.17 o Z0 iOtZO ~ .. Z I0:~ ~ 0 O. xI I(;OZ i0 Z,ql ~.Z~ PERCOLATION RATE \5C ? (minutes/inch) Z FT AND ~ ) FT TEST RUN BETWEEN 72-008 (6/79) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 19 2O COMMENTS PERFORMED BY: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE WA,~GROUND WATER '[~O SL PERCOLATION TEST DATE PER FORMED: ~__~~--~ oc/r 1, SITE PL~AN ENCOUNTERED? O P E IF YES, AT WHAT )EPTH? 4o1 8" 8" Gross Net Depth to Net Reading -- Date Time Time Water Drop · HzO ~.Z~ ~10:o8 ..~ 317 O .'l _ IO: ZO I O ,3.'3~o .HZO I0:~ ~ ~.L8 IO:E~ ID 2 YZ PERCOLATION RATE ~m. ion.~te$/inch) .TEST RU~I BETVYEEN 7~-; >T2N-'~ _~' ~,:, %.,... · ~.'..~ ~, '., ..,.~- ALASKA , VIROFImEFITAL COFITROL IBC. I~ncline¢~incI IS I~nuironmcnlal Studies SPECIFICATIONS FOR SEEPAGE BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM- LOT 3, BLK 1, AUDUBON HILLS SUBDIVISION 1.0 GENERAL 1.1 THE DRAWINGS SHALL BE A PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE, THE CONDTIONS OF THE PERMIT, AND ALL APPLICABLE RULES AND REGULATIONS CURRENTLY IN EFFECT. 1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE VERIFIED OR MODIFIED IN THE FIELD BY THE ENGINEER. 1.4 IT IS THE RESPONSIBILITY OF THE OWNER OR INSTALLER TO OBTAIN ALL NECESSARY PERMITS, EASEMENTS, OR WAIVERS REQUIRED FOR INSTALLATION OF THE SYSTEM. 2.0 SEEPAGE BED 2.1 THE GRAVEL FOR THE BED SHALL BE SIZED BETWEEN 0.5 TO 2.5 INCH AND FREE FROM SILT OR SAND. 2.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL BE PLUS OR MINUS 2" WITHIN LEVEL. 2.3 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL. 2.4 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL BE RIGID PVC, ASTM 3033 D-3034. THE SECTION BELOW GROUND LEVEL MAY BE EITHER DRILLED 0.5" HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A REGULAR SECTION OF PERFORATED DISTRIBUTION PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP THE PIPE. 2.5 THE GRAVEL SHALL BE COVERED WITH A LAYER OF UNTREATED BUILDING PAPER, A NONWOVEN FABRIC? (SUCH AS MIRAFAR FIBRETEX 200 GRA~E, POLY-FILTER X, OR EQUAL.), OR A LAYER OF VISQUEEN. 2.6 IF INSULATION IS USED RATHER THAN MOUNDED BACKFILL, THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM BOARD OR ARCO GEOFOAM EMBANKMENT INSULATION BOARD OF THE REQUIRED THICKNESS (I" PER FOOT OF SOIL LESS THAN 4 FEET OVERLYING THE BED). 2.7 THE TOP OF THE BED SHOULD BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX. 2.8 IT IS CRUCIAL THAT CARE BE TAKEN IN CONSTRUCTION OF THE BED TO ENSURE PLACEMENT. INTO THE PROPER SOIL STRATUM FOR PROPER OPERATION OF THE SYSTEM. 1200 UJcsl 33rd Auenu¢, Suite B * AncHoroq¢, Aloske 99503 .[907) 561-5040 ALASKA ENVIRONMENTAL CONTROL SERVICE~NC. 1200 West 33rd Avenue .uite B ANCHORAGE. ALASKA 99503 Phone 276-1361 SHEET NO. OF CHECKED BY DATE SCALE ALASKA ENVIRONMENTAL CONTROL SERVICE~'~INC. 1200 West 33rd Avenue ~uite B ANCHORAGE, ALASKA 99503 Phone 276-1361 JOB SHEET NO. ~ ~ OF CALCULATED BY DATE CHECKED BY DATE SCALE ~ ALASKA ENVIRONMENTAL .CONTROL SERVICE~-'~NC. 1200 west 33rd Avenue .,uite B ANCHORAGE. ALASKA 99503 Phone 276-1361 JOB SHEETNO ~ "'"' OF '~ CALCULATED BY DATE CHECKED BY DATE SC^LE ALASKA E-'JIROFImI FITAL COFITROL IrlC. ~nqincerinq g ~nuironmcnlol $1u~ies SPECIFICATIONS FOR LIFT STATION: Loc 3 Block 1, Audubon Hills Subdivision 1.0 THE LIFT STATION 1.1 THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER GALVANIZED STEEL (ASTM A-4444-76), OR ALUMINUM CULVERT, CAPABLE OF BURIAL TO 10 FT. 1.2 THE 36" DIAMETER PIPE FOR THE LIFT STATION SHALL HAVE A WELDED WATER TIGHT BOTTOM OF THE SAME THICKNESS AND COMPOSITION AS THE CULVERT. 1.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED AND WATER TIGHT. ALL WELDS SHALL BE CLEANED OF SLAG. WELDS ON GALVANIZED STEEL WILL BE SPRAYED WITH ZINC RICH PAINT OR COATED WITH BITUMASTIC. 1.4 THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED WITH SCREWS. A TWO INCH LAYER OF POLYURETHANE FOAM SHALL BE GLUED TO THE INSIDE OF THE TOP CAP. 1.5 ALL ELECTRICAL FITTINGS AND CONNECTIONS IN THE LIFT STATION SHALL MEET THE REQUIREMENTS. FOR A WATER TIGHT SERVICE. 1.6 THERE SHALL BE A HIGH LEVEL ALARM,PEABODY BARNES 6147 OR EQUAL SET AT THE LEVEL OF THE SOIL PIPE FROM THE SEPTIC TANK. THE BUZZER SHALL BE LOCATED NEAR THE ELECTRICAL CONTROL PANEL OR IN A LOCATION DESIGNATED BY THE HOMEOWNER. 1.7 THE SUMP PUMP SHALL BE CAPABLE OF DELIVERING 10 GPM AT A HEAD OF 20 FEET. 1.8 PROVIDE A CALDER COUPLING AT THE CONNECTION OF THE SOLID PVC INFLUENT PIPE AND 4" STEEL NIPPLE. 1.9 THE PUMP SHALL BE CONTROLLED BY A DIFFERENTIAL MERCURY FLOAT SWITCH, ADJUSTED TO ALLOW A TWO FOOT SPAN BETWEEN 'ON' AND 'OFF', AS SHOWN IN THE DRAWING. ALL RELAYS AND ELECTRICAL CONTACTS SHOULD BE LOCATED OUTSIDE THE CHAMBER TO PROTECT THEM FROM CORROSION, PREFERRABLY IN A DRY LOCATION WITHIN THE HOME. 1.10 COAT THE INTERIOR OF THE CHAMBER WITH BITUMASTIC PAINT OR TAR TO APPROXIMATELY 3.5 FEET ABOVE THE BOTTOM. 1200 UJcs! 33rd Auenu¢. ~uite l~. Ancho~o~, Aloska 99503 e(g07) 561-5040 1.11 MOA BUILDING CODES: WHEN LIFT STATIONS ARE INSTALLED WITHIN THE MUNICIPALITY~ AN ELECTRICAL PERMIT AND INSPECTION ARE REQUIRED. IN AREAS NOT COVERED BY MOA BUILDING CODES~ THE SYSTEM SHALL BE INSPECTED BY A LICENSED ELECTRICIAN TO INSURE THAT THE ELECTRICAL INSTALLATION IS IN ACCORDANCE WITH APPLICABLE CODES AND REGULATIONS. ALASKA ENVIRONMENTAL , , CONTROL SERVICE~''' INC. SHEET ,0. O; · ,* 1200 West 33rd Avenue ~uite B ANCHORAGE, ALASKA 99503 CA,CULATEO BY D^TE * Phone 276-1361 CHECKED BY DATE SCALE .... i ........ ~ .... ~ ...... ~.-.J, ...... ~ ~ cc=.,_,.,~~ c.~,~b ,. ................. : ~-~- "~ ~ ~-'~ -~-"~ :'""'~"':-'>: ~ ~'""/-4':'~ ~'~ ~~ .... ~ : ~~~ ':' U~ '~' ': ': ' ' ' , ' '" 'N ~ : ~ ~ ', ~ ........ ; ......... : ' ~ ........... :....11. ~~ ....... ~: ~ It ...... ::. .... ~~ "; ~ ........................... :" ' ~ i : ~ : ~ .-: . : : : ~ :~ ~ ...~~.~ ..~~~. H ~ ..... ~,~~,~.-: ...... ~ ~~~/.: ~ ~ ~~ - ..: ............. ~ ...... ~ ~ ...... ~ ...... .~~:.. ~ ........ ~ ............... : ...................... t C. iReid,~ No;"' 225'1';E ~ WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ Geophysicol Surveys Drilling Permit No. ,Ieee either la, lb or lc.) A D.L. NO. /~,L/~5 / _o,_o,_o,_ so wo I'~JDISTANCE AND DIRECTION FROM ROAD INTERSECTIONS $. OWNER OF WELL: Street A~dress and Areo of Well Locolion Materiel Type TOp Bottom :ir~.~ ni~_4 / z ~o ,...:~....,,,c o,-,,. ,.,.,, o ,.d.,,,, ~rel 5~1~ ~_ 71 0 T..,W.,, 0 ,,0.. [~ ,.. ,0~ ,,..,,, w.,,,, 17 ,../,,. · . ~IHIS~ O~ Slot/Mesh Size: Length: .~ Sit bltwlln ft. and ft. ';2 ~v. ~ r,:k~_~ I0. STATIC WATE.~-~EVEL: [~ .~ ,~?.- ' Above or ..~C~ ~,u,,...,...,: t~.~ i ~_~ ~,.- .o ,,..,,., ~ ,,,. ,.~~.,... .... ft, after . hfs, pum~ g.D.m. 12.GROUTING W. ll Grout.d: ~ Ye, ~ No Iollrlol: ~ Neat Cement ~ Other: Length of Drop Pipe ft. capocity __g.p.m. 14. REMARK~ 16. WATER WELL CONTRACTOR'S CERTIFICATION: tS. Water Temperoture e ~ F ~ C Thls~ ~/~weil wes ~/~/~drilled under my~jur isdi~ion~ end this reporl is true to the best ~°f my~f~kno~ledge ond belief; R~gi~tered Business Nome Co~lroct LIcen~e Number -,,.,,, :~O~x /Io4~tc. ~,c/~ora~. , ~ ?95// ' Aufhorlze~ Rl~re~enfafiv~ nrta 02-WWR (H/81) COpy Diltribution: WHITE-Stole D6G~ PINK-DrilIIr~ CANARY-CulIO~Ir I~.. 'ECTION REPORT * , h,.,,.i[::IF'ALIT¥,,~" OF ANCHORA[E, B~ILDIN[,. SAFETY DIVISIOh'. 3500 EAST TUDOR ROAD I~L?F'ECT]:ON$ (~07) 5~3-34~4 ADMINISTRATION (~07) T~6.-'82tt PERMIT NO PHONE DATE 84--044G 344--.3834 . NAME: RICH'S ELEC., CHG. , STREET ADDRESS: AUDUBON DRIVE * LEG0[..: AUDUBON LOT ~ BLOCK . COMMENT: KEY OVER FRT.DO INSPECTIONS RE:QUESTED: ELECTRICAL ',-~.O ELEiC FINAL ER Fi'.ORS · * COMME"NT$: * ! I NO NONCOHF'LIANC[,OBSERVED I * I t WILL REEXAMINE: AT NEXT t , iINSPECTION * t~1' FINAL INSPECTION APPROVED , ! ~ AF'PR',]¥~D CONi)iTIONAL FO~ ....... DAY~ * F'INAL · I CORRECTIONS ESSENTIAL, AS EXPLAINED ABOVE I DO NOT CONCEAL UNTIL REINSPECTED * FINISH TIME: :~, FiNZZ;H MILEAGE: * START TIME: :~;i. $~ART * WORK UNI'~$: :~, / TO~;AL ~ISTANCE~ * WHEN CORRECTION-~-ARE~N~D~ U.5 E R ® Municipality of Anchorage27 5 a V 3 On -Site Water and Wastewater Program (907) 343-7904 S A f E T Y Certificate of On-Site•Systems Approval 3 a 00 1C Parcel I.D. 015-231-48 Expiration Date: 1. GENERAL INFORMATION: Complete legal description AUDUBON HILLS; BLOCK 1 LOT 3 Location (site address) 12040 Audobon Drive *Anchorage Current Property owner(s) James Ferguson Day phone 907-360-5226 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class_Well Public Water System 4 Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual ❑ Holding Tank- ❑ ❑ Community ❑ ❑ Public Sewer ❑ Date of Payment 1011 3/ ,�M2 0 Receipt Number G 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 ( /2-0 Engineer's Printed Name: Jeffrey A. Garness Date: i DJ t 3 / 2 0 a l In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and 000�Op industry practices. The reported results describe the condition of the system/s on the date/s of the o" OF evaluation. Separation distances were measured to readily identifiable features. Hidden defects or o ��,.• "' ;•.•.q �i encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions,f; t groundwater levels (that may fluctuate during the year), quality of construction (materials and �✓� X491' :7 workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the ' �J system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of Imo` j� ; ,r�' • • • • • • • • • •?.. • • • • the well or septic system. GEG makes no representation whether an alternative well or septic system Q, _ '.Jerfre,t A. Gorness• can be installed on the property in the event either of the current systems fail to perform adequately in V0 101.* . '•�f —-7 9S'�!!• the future. The content of this report is for the sole benefit of the person/party that retained GEG to 4� sol perform the evaluation. Reliance upon the information provided in this report by any other person or 4Q eap�ofessp"O party (including subsequent property purchasers) is not authorized, nor will it confer any legal right � whatsoever. #AECC884 6. DSD IGNATURE System #1 Approved for _Y_bedrooms System #2 Approved for bedrooms Disapproved \§-�G�Qp _ITYtpF���/����i Conditional approval for bedrooms, with the following atiord �n lv'S1TE VV 5Z m-- J�o OG� A o Original Certificate Date: ©- ' Z.0 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_ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other qA1 I'D j,312b COSA Checklist PB pn Legal Description: AUDUBON HILLS; BLOCK 1, LOT 3 Parcel ID: 015-231-48 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 W i� Z m s CZ 6 I C to L --Z- v e-tv t- W. ,v4 A. WELL DATA �,.,... (Jug -..P Q--�J PfrU✓E 2 ,u r; ❑ Well log is filed with Onsite (or attached) Well production at time of test 2+ gpm� Date drilled 5128/84 Water storage tank volume N/A gallons Total depth 73 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to 73 ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by GEG, LTD. Date of flow test for COSA 6/16/20 Date of Sample 9/28/20 Static water level at beginning of test 12.8 ft. Comments Water Sample Results above are for Wellte#1r Well #2 is negative for coliform, Arsenic <MRL (ND), Nitrate 1.08 mg/L .l ` Onr B. TANK DATA Age of tank(s) 11 years Tank type/material STEP+STEEL Measured operating fluid level in septic tank N/A ❑ Standpipes/foundation cleanout per record drawing Date of pumping SEE ATTACHED MAINTENANCE D. ABSORPTION FIELD DATA BED C. LIFT STATION ❑ Required maintenance completed Age of lift station 11 years Lift station material STEEL Comments: ADVANTEX SYSTEM Which system tested (date installed) 7/6/09 Adequacy test date 6116120 ❑ ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 3.41 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade ft (min) Water added 625 gal ❑ N/A — pressurized field 2 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 30 depth into effective ` Elapsed time min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced N/A gallons If yes, enter date N/A Comments/Deficiencies: `MONITORING TUBES SET TO THE SAME ELEVATION COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100'Community 0 Yes 50 + Sewer Manhole/Cleanout > 100' ❑ Yes if No ft Q Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25'71 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No 50'+ ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑ Yes if No ft M Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [E] 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' 0 Yes if No ft Surface Water > 100' ❑ Yes if No 50'+ ft Property Line > 5' F,/J Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' M Yes if No ft Private Wells > 100' ❑ Yes if No 50'+ ft Water Main > 10' M Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' R71 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' M Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' ❑ Yes if No 50'+ ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' ❑ Yes if No 50'+ ft F. ENGINEER'S COMMENTS *CAVEAT - THERE IS A SMALL STRUCTURE ON AUDUBON HILLS; B1, L6 BUT NO MOA RECORDS OF A WELL OR SEPTIC SYSTEM **PER LARS SPURKLAND, P.E. 2009 INSPECTION REPORT G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet #AECC884 Unsubdivided _ 4 89c57'�•Z,t�r _170.00 8489T10' r- Utility Easement y\ o_\ m, 01) CP. CP- \ LOT 3° \\ Fire pit � <,( \ SCALE: 1 "= 50' \ Wel! o W a � j Lot 2 Lot 6 \ �?�� p� 0 Gravel J ._-- , O LLJ , �o p 2, �oG �d r26 1k 2.0 ONeiIO 0 CP �O pt,. p OF �C /_, l.7 01-1 O O Q 0° y �gCO 2.0 OH °t ° °? 49 th ° � fig' \ 2.0 off . � a. ° / �; -; •a ° ; 0 ! f �� ° ;.'yam.. ,a�,�-��V• �.� r+'J Qr . `y �Qr�� � P °a ".'Elizabeth L. 'Nalatka '� Septic �� ° • 8036 — LS • ° `:� 8 system Lot 4 OF�SSIOPdn� 1 ' ( Septic vent I (LIP) (yet. wall (h'p) AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following �✓\ �� described property: LOT 3. BLOCK 1. AUDUBON HILLS \ 0\� Anchorage Recording Precinct, Alaska, and that the +JQ improvements situated thereon are within the property lines P and do not overlap or encroach on the property lying �s adjacent thereto, that no improvements on the property lying / adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 2nd day of _JULY 2020. EASEMENTS OF RECORD, OTHER THAN FRED WALATKA & ASSOCIATES, L.L.C. THOSE SHOWN ON THE RECORDED Engineers and Surveyors Lantech, FB 20-4, pg 8-10 PLAT ARE NOT SHOWN HEREON. 907-248-1666 BE UNLESS OTHERWISE NOTED This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a bound7any and is subject to any Inaccuracies that a subsequent boundary survey may disclose. The Information contained on this drawing shall not be used to estafence. structure or other improvements. T his drawing shall only be used for a single property transaction. Use o; this drawing by ttte original client or by o tater date withrnit the rnngant of Pli,nhotr, i inr. I.fL: 1� � ,, ice,; ,.a c„a..r..1 I ,.... I_ ___ ___---__"--- _ - ,. .. 10/06/2020 12:22 0686770 APLUS PAGE 01 1010512020 13:071 r2cnorage TankAl,)907 277 3715 P1001/001 370 414 MITI on 11 » M oil M meson MM Mn 11 Ill oil no all *Ivanl 6x' Field Mainftnance Repqrt Annual In: ri ecton Anchorage�"ank .t _ 937-272-3543 _—....W_— Jim Ferguson OYomia a(teAcktrc�a ---- — ,....... ._.....r�_.._.....— Larry Betts JA 12040 Audubol Drive, Ancnarage AK 99516 C6094t Phorw(907) 349-1870 AX P010 y county Y.} a Fod a ftru MPJL N AX -121835 ` A090U/9 408643 Dem 2/LA'020 f?TU1-is740 Q9i22/202U Retrieves Q8M in s Measure Sludge./Scum nattync,v___ ulp� UCltrff c.,..... ReCiro natio Timor rrtanas: Perform Field : a iplinglabGervatfons Pfi1.1 (1 6 ^ NTUs) Pk(8-9) iXJ} bdor of Somple Typical D arty [ garmy I _i FA01cfy No::•ypicat < Mel* CGsbbope Cbecoy oily film in vU L Ycs No Foam nt tank ❑ Yes ly,". Check Control Pa !ei Ne1braAmps 0loehartgeArnp, f ).—L / 2 r Audible and vIsL ib lam5e XOK Lein! ton. tclemMn r nlvl ZYev L7too InsoeGtfClean Put 10 SVgteM hspect dear Riv.'r/Vo ........ ............ Y-' Spliuc Box ....... ............ Ffoat Cords ...... ............ F1Got9........... ....... ......../ Pump ........... ....... Biotube'G Fitton ... ..... , .. ( ` Biolubo Purnp Vet:t ..... , ...... P,o': irctiatfng Splif , 'i!E!Ive. _..... J Comment. _ •.�. 1!31 CgmuartmmtCurrent may/ Pievi�tt l Cu tc tt --� _. PrMvioua 2rd Comparimon± CurrGrtt lzrcvious Cunene P>avlous in!gctlClear„ QclvanTex Fitter Odor. �Nonrab i.,.) Pungent Rinmat Normat O Fxceslivc BridginglPmc+ng None/Minor ._lExce.:.iv6 lnsppGtllCiean i3 scharge Pvrltp System inspect Riner/Lid �[ Splice Bcx }{ F1oot curds fa� frtBps-ct Glean I.atGralslO ,flee; Pod 6011&' Intehc vrnt inspect C!ean Float$ Pump (� / IrasPectlService Other SYStam Compcments fnBpect Ctren trtspect oisiniectlon Equipment / V Disperses! LetaroF^/Orfices� Obrser,wjorla Additional Sorvices Re»tiered Cleoned ter itG sheets9 (_ Repiocod UV Iternst L� Replaced/tj:e 0111er (term? parts Used: leu = Warranty, B = silicibic W af nroprlato selection) `N D llom N—rb*p CaxR�Um. Rna efoty rnspection RSV trinstmletl t5ds boltocf on Me nifold reconnorted; tluah vaivr)s dosedCnntrof acrid reectivptad aummaiVII46commehtiations J n System perfrrnting; no further acflonneedetj Tank needy pumpkig 17 Cnif forvfnrirc I [ O1ne'7 _ 3igneture—_,� r -8x COMPla ed farm to 1.860-384.7404 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT TI -11S MAINTENANCE AND .REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this Day of of) 0 E ` ' , by and between herein the "OWNER." and the Municipality of Anchorage, herein the "MUNICIPALITY', in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Svstems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as ` a located at (legal description) 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Nlunicipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. ---lt shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically S400 to S600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance; repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of ,r Owner acknowledges that the Municipality may request recor - ds of maintenance and 1, ? , repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. C - Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. T_ Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality arc the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Terre. The term of this Agreement shall begin on the date of approval by the ivlunicipality, to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonivaiver. The failure of the Municipality- at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor- in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof'. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severabilitv. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of OWNER: 0 By: Q Date: -int naive) STATE OF ALASKA ss. THIRDJUDICIAL DISTRICT The foregoing instrument was acknowledged before me this day of by (print name) Title: (rev. 05/18/2018) Pa2e 3 of 3 NOTARY PUBLIC FOR ALASKA L My Commission expires::' N 0 T A 10, puiba f MUNICIPALITY: (111)I li (signature) Date: to- J ^� (print name) Title: (rev. 05/18/2018) Pa2e 3 of 3 C•v Municipality of Anchorage ' Development Services Department j Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-231-48 HAA# f-/ A (' 10 Gi 1. GENERAL INFORMATION Expiration Date:4.1 02 Complete legal description 'AUDUBON HILLS SUBDMSION: LOT 3, BLOCK 1, Location (site address or directions) 12040 AUDUBON DRIVE • ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address ROB STONE Day phone 276-4190 12040 AUDUBON DRIVE " ANCHORAGE. AK 99516 Day phone CLAIR RAMSEY w/ DYNAMIC PROPERTIES Day phone 3111 'C" STREET ' ANCHORAGE. AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 261-7552 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) 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 sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1550.00 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 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system fs(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn ALASKA WATER do WASTEWATER CONSULTANTS, INC. Phone Address • 6901 DEBARR ROAD, SURE 28 • ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AMC, 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. 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 ofthis 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 YApproved for 4 bedrooms. Disapproved. 337-6179 Date IIZ 01 Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineers Reort Other ftz/By: Original Certificate Date: O2 (Rev. IZW) Municipality of Anchorage Development Services Department " J lding So" Division Onsite Water Wastewater Program 47W South Bnpaw SL P.O. Baa 1MIXI Anchorage, AK gg511t46= www,d.anGwrage.akus pn 943-71104 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: AUDUBON HILLS S/D: LOT 3. BLOCK 1. Parcel ID: 015-231-48 A. WELL DATA Well type PIATE If A, 8, or C provide PWSID0 N A Date completed 5/28/84 Sanitary seal (YM) YES Total depth 73 ft. Cased to 72 ft. FROM WELL LOG Date of test 5/28/84 Static water level 0 ft. Well production 2.25 9— p.m- WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.5 mgA. Well Log (Y/N) YES Wires property protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 8/28/01 22 ft. 2.25 g.p.m. Other bacteria 7 colonies/100 ml. Date of sample: 12/4/2001 Collected by: AWWC, INC. B. SEPTICfHOLDING TANK DATA Tank Type/Material STEEL Date Installed 6/28/84 Tank size 1250 gal. Number of Compartments 3 Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (Y/N) NO High water alarm (YM) N/A Date of pumping 8/24/01 Pumper ISACCS PUMPING C. ABSORPTION FIELD DATA Date installed 6/28/84 Soil rating (g.p.d ffib lbdrt 130 System type BED Length 40 ft. Width 21 ft. Gravel below pipe 0.5 ft. Total depth --2-&—ft. Eff. absorption area 846 fe Monitoring tube YES Depression over field NO Date of adequacy test 11/20/01 Results (Pass/FSH) PASS For 4 bedrooms Fluid depth in absorption field before test 3 in. Water added736 gal. New depth 3 In. Elapsed Time: 0 min. Final fluid depth 0 In. Absorption rate >■ 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) TERRA—LIFT If yes, give date 9/15/01 1 1 D. LIFT STATION Date Installed 6/28/84 Size in gallons 100 Manhole/Acoess (Y/N) YES* j"Pump on' level at 7� "Pump of - level at 8 High water alar level at 6# Datum TOP OF TANK Cycles tested 3 Meets alar & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A 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 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'+ *PER INSPECTION REPORT SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: WAVER REQUESTED. Property One 07' Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkingIvehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS NOT A STANDARD MAN HOLE LID. SMALL HOUSE WITH PLYWOOD COVER OVER LIFT STATION. G. ENGINEER'S CERTIFICATION I cerf ly that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date HAA Fee $ 3aa . o Date of Payment / a - / 4 -6 Receipt Number 013 5/n n (R«. 12MM Waiver Fee $ / /5 •' Date of Payment /,;) -/4-0/ Receipt Number t3 13 765,0 Alunieipahty of Anchorage George P. A'uerch,Mayor Department or Pttblic Works Building Safety Di -s isioil P,O. Dox 196fk50 a4700 S. Bragaw Street Anchorage, Alaska 99519.6650 a (907) 343-;301 h tt p://n�iv.cLmtchomge.ak.us AK Water & Wastewater Consultants, Inc. ATTN: Jeffrey Gamess, PE 6901 De Barr Road, Suite 2B Anchorage, AK 99504 - December 18, 2001 Subject: Waiver Request forAUDUBON HILLS BLK 1 LT 3 Waiver # WR010102 Lot Line Request for Parcel ID 015-231-48 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the lot line has been approved. The approved separation distance is 7 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely�G��,�/ Jeff Poet Engineering Technician III On -Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On -Site Services Waiver Review Worksheet WR* 010102 PID#: 01523148 HAM 010644 Permit#: _ Date Received: 12-14-01 Legal Description: Audubon Hills Subdivision Lot 3 Block 1 Engineer. Alaska Water and Wastewater Consultants 6901 DeBarr Road. Suite 2B Anchorsae Alaska Applicant: Rob Stone .......... Waiver Requested: Absorption Field to Proaerty Line of 7 feet Criteria: 1. Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: 2. Special Conditions: 3. Other. .......... Waiver is Granted: Waiver Is not Granted: List Conditions or Reasons for above: Date: By: .......... of Rem Rec#: 1244-01 Amount: (115.00 Date Paid: 12-14-01 Rut 23 01 03t28p The Ramsay Taal. 907-261-7555 p.1 w e,rL _29-qE THU 1E:2E Lc,,.-�h F- . 0 2 N 89'57'42" W 170.00' '0' UTIUTE CASEUENT V)o `�y\ LOT 3 s � 1 'o. . [AS E W « [wSTWU4� m s f �O°oe 4 °o Ct..........!4..,9 4n 49r1j ''•.y m mm Im^'p I. Dreyer,•' Va M.�reullpnet �•� �I � O� ��'•��M1�ci.71=Y' O -_-o.u:v:i ww ' fY0.VlO4 NO1fT N 4 NI «rMf nNMif,N1Y N �elamNe IFGINO '41 fvf� •• 1 I' P H A fV 1 E With CI EY M ORTCAE;E Ne w'r1aN. w «I MebnM11. «R.ad1 W4SIYn.w/w* a' «"x'01.«Ner.eerae..ed: Nsr.w1r; M1.Y en C, ! -3a't 4 K �e$��i V.ea .e oeeeeslwa ae.r4 «f Vele naa« 01 Vose ra I.,.Vw:ibn a ra Val. .4 =113" Z leo • Wa r WN.LY UNNIfjtlpN. lMi(G1 n.1 eeM.aN w oeenuM !♦� YeI1'I% ai.N er ae,a1Y t Me.n M NU aLNy aa.e del NIa Y^OnT+Mb pvllU NW '.e19 ONI- CiRxW ® Via. .IIn1. N. MWaIY MI M M U dual .InM Nw eolH. W. yyK{• 1,r' r._. _Lante .ANO a CUNSIIlVG f10N SUa VEY045-PLANNERS-CNGNEERS A'�""DUILT OV, L:UI OCfeNS Noce . KIIIC YII«RYe I.fAIA:. 9�w. [ 103 WINNA ANI UAM ANi v1ArAN, 92303 �tiw uM1YP 907) 6E2-SI91 LOT 3, BLOCK 1, M�0 w. {� 9oo''°'';a ; e026 AUDUBON HILLS SUBD3-L-489A ° �S e ALASKA WATER & WASTEWATER CONSULTANTS, INC. December 14, 2001 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4800 South Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Lot Line Walver for Lot 3, Block 1, Audubon hills Subdivision To whom it may concern: According to the inspection report issued in 1984 the existing drainfield is 7 feet from the nearest lot line. We request that your department issue a 7 foot lot line waiver from the southeast property line to the existing drainfield. I am unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If you have any us at 337-6179. Thank you for your assistance. M.S. 6901 Debart Road, Suite 2B • Anchorage, AK 99504 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: akwwc.com To: Jim Cross From: Alaska Water and Wastewater Consultants Inc. Date: 1/4/02 Re: Audubon Hills Lot 3 Block 1. Septic system lift station manhole cover A manhole cover was installed on the subject lift station per Municipality of Anchorage. This was done on January 4, 2002 by A+ Home Services. 1p i • ` .�Ci r17%i1Jc7 i1t 1.'i b HIP ���r� `.✓ x.159 jo 1��;1.aF1?L•Tr.'��rM��r�:�It�t2?�tr�Firn ��1i,1 (7b���ir.* � +tl�'-k•1i�Ci:1��X�'�.�:'�I7<I'1CT"i�JkIiCJ��C,� `r u ° _tI�iiL�+�1lC�7Ci��� �rr�r,� ,=3C�Gvz�lii� Xr Uailr•,i+,i art!) 54 •--i ':r:.�`ll'�'�(.�.i:�'� t • 411E i . (N7 :: • : • � �N...'p il(1�:1.7T1�l11• 1.1.11 l •f �(� � . • �• (r _ -� -. ¢ � _ 41Mn "�� •i•�f:J `F7�i,7 rl • 1E i • (.. II C,'wJn 1f'll�T (11 : :• .►5M �G�;.iuT]�lr} i1:jfIT'�F�7�t�LdSTL�]filTi2,'�7'Idi��ul�siiL�-x•I�il�ii7ii:.I�GII�� �., �•s�i6���1i�,^i LiT1tTsL(L•iiiititiltYiit�Y'TiI�„Y �' - � _ ,...- ...__ .. c_ IR T'Ct..•Z(+)] 7 l .1-PEIrl i 'u il,Tlr l�Cl ]I,KfiiiillCLiliT ii1 1 T lII�I � � 1 ��w�=t!w11L?CIiJpX.C��'I'.�:l�Gii11�.�'.t•IiN�T.k • ' a.:: r(�f�t-T* z: 11 . E�' 11;5'• • ��� ` - � .4w� 'A/ll'.C:.C1: 1l.Yi'..r�ill• i�ai�"�: • t'.1 • .''il li�� _ -. � ' zF'r `�•izi+rl��.t•1+� J1w�:illEt i• -,•• - I • ��:z ';c:I�-I+�(�• �it7iriTi�t:�i�;L•1►iiCu'uF Y� : —TOi �.1.(Il�. 4: 1 . Vill i• #- ". + ... r�- hl1► . 1 "i-:s'GEi!iiikllit+'illl4•ai1*;P;•7+iL� ► ' _ '.... At R - . [ ' DEC -31-01 08:16AM FROM-CT&E ENVIRONIENTAL SRV 9075615301 T-331 P.02/03 F-421 AL s CT&E Environmental Services Inc. .� `�rrrirrrrrr�rrrrrrr�, .. _.. . CT&E Ref .# COent Name Project Name/q Client Sample 10 Matrix Ordered By PWSID Sample Remarks 1018564001 AK Water & Wastewater Consultants Inc. Audobon Hills, Lot 3 Dk 1 Audobon Hills, Lot 3 Bk 1 Drinking Water 0 Client POO Printed Date/Time Collected Date fame Received Date/rlme Technical Director Released D�/ 12/28/2001 14:15 12/20/2001 10:45 12/20/2001 12:20 V.* Stephhen C. Ede V. �� Allowable Prep Analysis Parameter Results PQL Units Mnhud Limits Date Date [nit Waters Department Nitrate -N Microbiology Laboratory Total Coliform 0 n r 2.25 0 0.200 mg/L EPA 300.0 (<10) 1220/01 SCL coV1O0mL SM18922213 (<1) 1220/01 KAP CT&E Environmental Services Inc. fi Laboratory Envision ►riiniiniai�� 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria Ter lathte. A2343 18-1605 READ INSTRUCTIONSONREVERSE SIDEREFORECOLLECTING SAMPLE Fax: (907) $61.5301 I:1i 1 o PUBLIC WATER SYSTEM I.D. N D PRIVATE WATER SYSTEM DGD Sea//nwlre Sea/.Rrat�uw e+ + a + O Send Results O Send tn.eice vs SAMPLE DATE: L' L!d rTM Mouth Day Year SAMPLE TYPE: D Routine Cl Treated Water o Repeat Sample (for routine sample �t>f� Untreated Water with lab ref. no. ) O Special Purpose Time Collected SAMPLE LOCATION a�ClCollected By ,)NB �jlt�5 t��3 tt • rkr ►..r TO BE COMPLETED BY LABORATORY A�lslysis shows this Water SAMPLE to be: Satisfactory D Unsatisfactory O Sample over 30 hours old. results may be unreliable O Sample too long In transit. sample should not be over3lVhours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received 12w Analysis Began —I L30 Analytical Method: '�k Membrane Filter D MMO-MUG • Number of colonies/100 m1. Lab Ret. No. Result* Analyst �b Sent In A.D.E.C. Anch Fbks Jun ❑ Fated Date: Time: Client notified of unsatisfactory results: Pheard Spoke whit Fased Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Collform E Ceti Atembrane Filter. Direct Count Colonies/100 ml Verification: LTB BCD COLIFIRM Mc. rM Nw/I+I re CWN Fecal CollformConfirmation ON .ae..a..u..+ Final Membrane Filter Resulls Cnllform/100 ml Reported By cC-----8nte I G Timeit,* bra Comments: dhcw C .. . .. .--- IZ►-3 HAD'd KE -1 IOES19St06 ASS 1Y1N311,10alAN3 311"OSI VIY91:80 10 -IE -33C KNZICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH ADTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) . L? 8 / Ne J)r hK /f S Location (address or directions) (b) Applicants Name F SZdj,, ,,41 -Telephone - Home Business Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder[ ; Buyer Q ; Other Q (explain); 7� (d) Lending Institution Telephone Adhi t kpa (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence.. Single -Family Multi -Family r__1 Other (describe) Number of Bedrooms 3. Water Supply Individual Well T Community Q Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage -Disposal Onsite r_-VT Public Community Holding Tank Q Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] n rn 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the oa-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect l on the date of this inspection. Name of Firm ,4/-/lA Telephone (V-Szl'iC� Address Date / Y-'4LV (ENGINEER SEAL) 6. DHEP Approval Approved for(//bedrooms By i Approved Disapproved Conditional Terms of Conditional Approval CAUTION Leroy C. Reid, Jr. • No. 4251-E , •;vim _;' .o°•« «•.•.•;moi.:, 1w ROFESSI��`..t. THE MUNICIPALITY OF ANCHORAGE DEPARMMNT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT— ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY . CERTAIN FEDERAL AND STATE REQUIRE— MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER`S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: Well Classification ~t~!va/~ Well Log Present~) Total Depth ~' C s~ to Static Water Level Casing Height Above Ground /,/ Electrical Wiring in Conduit Separation Distances from Well: To Septic/Holding Tank on Lot /~PD /'~- To Nearest Edge of Absorption Field on Lot If A, B, or C, Date Completed Pump Set At D.E.C. Approved(Y/N) ~--/~O ,~'.9f Yield Depth of Grouting d~/Fg- Sanitary Seal on CasingS) Depression Around Wellhead ; On Adjoining Lots ~/~ /~-/F ; On Adjoining Lots To Nearest Public Sewer Line ~g//~d- To Nearest Public Sewer Cleanout/Manhole /f//~-~ To Nearest Sewer Service Line on LOt Water Sample Collected By ~ ;Date / / / F-/~/ Water Sample Test Results · '~/5'~'7-~/~/ Be SEPTIC/HOLDING TANK DATA Date Installed ~,/~//~. ~ J Size /'2~) No. of Ccampartn~nts Standpipes ~)t~ ~Air_tight Caps,) Foundation Cleanout ~N) Depression over Tank (Y~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) /tJ~ ; for Holding Tank High-Water Alarm (Y/N) /~/~ Temporary Holding Tank Permit (Y/N)~/~-- Separation Distances f~om Septic/Holding Tank: To Water-Supply Well /~/~¢ To Building Foundation To Property Line .~ ?~D' To Disposal Field /~ Water Main/Service Line ~~¢~$"~To Stream, Pond, Lake, cr Major Drain. age To Course 4- Receipt ~ Date Paid: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/Z~//Y~/~/ Width of Field ..~k// ~ Ts%ge of Length of Field Depth of Field System Design Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Gravel Bed Thickness ~f~/~ Standpipes Present ~) Date of Last Adequacy Test Separation Distanme from Absorption Field: To Water-Supply Well /3 b-'~ To Property Line To Building Foundation Lot To Water Main/Service Line 4/ ~-~ To Existing or Abandoned System cn ; On Adjoining Lots ~ 2~/ ~-~// To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course .~-/P~ / To Driveway, Parking Area, c~ Vehicle Storage Area /~' ~ D. LIFT STATION Date Installed Size in Gallons ~/~:~ "~amp On" Level at High Water AlarmLevel at Tested for Electrical Code~N.) Dimensions Mar2~oie/Access ~'~/N) "Pump Off" Level at Vent (Y~ Pumping Cycles during Adequacy ~%st. Meets MOA ** Check Permitted Bedrocm Rating Against HAA Request I certify that I have checked, verified, or confcrmed to all MOA HAA Guidelir. es in effect on the date ~this inspection. Comany [Page 2 of 2] MOA NO. 2-15-84