Loading...
HomeMy WebLinkAboutVALLEY VIEW ESTATES #1 BLK 1 LT 1AValley View Estates #1 Block 1 Lot 1 A #050-524-01 r Municipality of Anchorage * .(� •, V Development Services Department / Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page ' of www cl.anchorage.ek.us (907)343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: _!J (A"90 D 60 PID Number: OSI — S'o )q —OI NarW G Q r e L11 Wastewater System: ❑ New Eg Upgrade a�r• y r i — 6 �{ ABSORPTION FIELD 6 Nembw a 9•beemr , O D••0 Tishah O $IIIFMTrarM O Bb O Mb,eW � IMr O' s� LEGAL DESCRIPTION Sod Rob g �D�Fr 7arD•Pema«mg,"7ojl S�rFl Bubdtlal em hm anmovf o•� DaM eapm Wam P;,*iowrr•p I Raq• n FA obino grP•0 WM L•nTn.5T Ft. Ft. Well: ❑ New ❑ Upgrade P9 Men Ft. N,. Wbiwo a•tN,,.b«».nl«•• Ft tpl4^uyn/Q SS Ae.�) rar D.om c...ab L tar.e.«oban«u I.nr A Ft Ot Fe rT �T Ore SI•I,e wN«laM Mn.a«:' r �/ Dole "a" �_ FL V BOJ Yrok Peng S.t FI Ca4rp INp Gr«na, TANK GPM Ft. SEPARATION DISTANCES I Septic [I Holding ❑S.T.E.P. ❑Other: 7o From Septic Tank'']] Absorption Field Lift Station Holding Tank lUbRUPrivate SewerLineI t«r •n«,ty ca WN I ✓''Jr( 1 pStl �1 �_ /t 0��l wl.nr 5 ''{/�( ac«ro.nm.m. s'""'wate, !++ LIFT STATION La Lin. 53, L , Pee _/ L I G&.r,�� 541 C Famerron 1 5 7 L 5 'Pwnp on' I.v.l •1 y 'poop of I•vY a1 High w•I« r«m •1 3 In ak Durtrn Drrn — — / v/� e ro D ir,mO Wk•a FbEN EI.tlrKal h•WFaen• Wrlwm•e by: R•m«Y• opo rtRC��NE J G"' CID. BENCHMARK Lixoo «q D.•mvkan � 11 t1I Aii/�/ �...eon 01n� /W it Engin is _KRIN 17034 Eagle River Loop * :•ii�l Rood, No. at Inspections performed by: MEagle Itim, *!ask. es: 1 r _5711a nd Development Services Department Approval ROBERT COWAN AN f�.tr Reviewed and approved by: A. Dater ' 6' Cos. �t 8§§of ��1� �/»/0S�.• �~ PERMIT No. SW050260 PACE 2 OF 4 Municipalit of Anchora e DEPARTMENT OF HEATH 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 LEGAL LOT 1A, BLOCK 1, VALLEY VIEW ESTATES #1 P.I.D. NO. 050-524-01 i 90 \ NEW I.D.S.F. .�` .Q \MT ATN-1Q't o. by . MT 2 %% \ rvt- aTAM, NEW 550 CALLON ALBERT S.T.E.P. FAT TANK ` EXISTING 1000 CALLON TANK VERIFIED SEPTIC B -9-05C iP B 65 N LOT 2 OLD TRENCHE ALE: 1• 4 . EN�jtiE���1` P ,... ....... ...% l� 150' CLASS 'C' WELL OW %*� -� •� }`��' RADIUS S p ROBERT C_ COWAN Z•! E�01 oS "3 LO\T1 B f PERMIT No. SW050260 PACE 3 OF 4 Municipalityof Anchora e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Te'lephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT 1.ECAI. LOT 1A, BLOCK 1, VALLEY VIEW ESTATES #1 P.I.D. NO. 050-524-01 PROFILE A O' 65' r'Jr 2, EXISTING GRADE 12' "'•—'•�S�9P f N 35' .�RSCALE: V - 10' i '`�..,... �... s 1 t .M p ` ROBERT C. COWAN 4 f C: 88p 1 Q9t � IO/a�`at' WESSSt PERMIT NO. SW050260 PACE 4 OF 4 MunicipaUAt of Anchora - DEPARTMENT OF HE TH AND HUMN 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 LEGAL LOT 1A, BLOCK 1, VALLEY VIEW ESTATES #1 P.I.D. NO. 050-524-01 401'95.7' LECTRICAL ONDUIT EFFLUENT IN FROMSEPTIC TANK' OISCHARGE PIPE 550 GALLON FAT ALBERT WITH PUMP ASSEMBLY MT1=98.8' AITI MT2 MT2=97.7' EXISTING k FINAL GRADE INSULATION w ax.m xncv 1/Y uM uxe emu MT1=94.8' MT1= 94.6' BOTTOM OF SAND=92.6' DIST. LINE=94.9' A GROUNDWATER AT 90.1' N. T. S. 84.1' B.O.H. A Bim_ FCO *1.5 3.5'`�P��` "^•:'ys�1 ST1 35.0 2.5' ST2 36.0 12.5 MH 38.5 78.0 TV _1 20.0 23.0 i TV -477 �O32.0 MT1 49CE .0 45.5 > sa01 W MT2 15.0 32.0 ++II�f�FO C� C1c, 4� HOUSE OFFSET Rlsinp Son Elecirlc Inc. 907 622 6777 09/11/0S 02t4SP P.001 Pising bon 1. LagLe Zver. A4 99577 (907)622-6777 August 11, 2005 S & S Engineering 17034 Eagle River Loop Road Eagle River, AK 99577 FAX #694-1211 Re: Lot 1A Block 1 Valley View Estates - 25745 Wildflower Circle - Eagle River, AK To Whom It May Concern: f The lift station at the above referenced property has been wired in accordance with NEC and State/Local codes. Thank you. Sincerely, Kevin S. Hornbuckle, Owner Administrator License Number 1284 Specialty Contractor License Number 27285 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 28, 2005 Expiration Date: Jul 28, 2006 Permit Number: SWO50260 Parcel ID: 050-524-01 Legal Description: VALLEY VIEW ESTATES #1 BLK 1 LT 1A Design Engineer: 0003 S & S Engineering Owner Name: CHARLEY CRUTCHER Owner Address: 25745 WILDFLOWER CIRCLE EAGLE RIVER , AK 99577-9674 Site Address: 025745 WILDFLOWER CIR Lot Size: 40280 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: p✓ Disposal Field Q✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well E] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: a Date: V; US Issued By: i I I Iv Date: z o ]�littif�ip d Attt hadgt • beVelopMeht Set-Vlces bepadMehl 9ullding Safely blvision On -Site Water and Wastewater Program 90 ` 4700 South 6ragaw Sl. P.O. box 196650 Anchorage, AK 99519-6650 4Avw.ci.anchorage.ek.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION 4r+ FoR A SINGLE rAMILY DWELLING f parcel I.b. _ nco -S2 y u t Permit Number SW property owner(s) G 1%oy1 !j ! i w 4-e kor Day phone 6 ,!�-5CJ / T Mailing address (4) Z5'7 yS WI I F o..lErz C Mailing address (2) Zip / Legal description (Lot, Block & Sub'd.) [ D f I�r /Code R h! k V��v V! er ✓ �SI 1 c4TB Legal description (Section, Township & flange) Lot Size 14c, -z e0 Acres/Sq.h. Number of Bedrooms tHls APPLICATION IS Loft: batt Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewet Upgrade tft PkOPI:kTv CONTAINS: Not Tub ❑ Jacuzzi El Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify (hat the above informalion Is correct. I further certify that this application is being made for a t higle kantlly bftllind and Is In accordance With applicable Municipal Codes. (Slahature bt broperly owner br authorized agent) Permit t=ees: '140 bale of Payment: 7 I727 I" f Receipt Number:/ 2 Mev. 72/00) bate of Payment: tteceipt Number: ROBERT C. COWAN. P.E. ROBERTA. SHAFER, P.E. CtVILENGINEERS (907) 694-2979 FAX(907)694-1211 July 25, 2005 NEALTNAUTH0FM APPROV&S MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 EEMRAWATER Anchorage, AK 99519 MAWUTEM*1 M REFERENCE: Lot IA, Block I, Valley View Estates #1 SEWERS WATER "CTM It is requested that you issue a permit to install a septic sstem u upgrade to serve the existing three bedroom dwelling on the referenced property, � AM A test hole was excavated and a percolation test performed. The approximate location ESTUM3 of the test hole is located on the attached site plan. At the time of excavation (7-20-05), water was not found. After monitoring, ground water was not found. WELL049MM" "iO"'E" We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. ERE PAM If you require additional information, please contact us. Sincerely, AWDDESK, Wt MST / e C. Cowan, P.E. RCGbjj PMOLATION Enclosure TEST ETR X7MAL l MECKMOM E6FEC1p�g ONSNE WASTEWATER DWOSALS"TEM CENGN 17034 NOM EAGLE RIVER LOOP; SURE 204 • EAGLE RIVER ALASKA 99577 U C� U CC i h ,•' � L a o tn Vl X / W / C C' OCM .o U Lou U C� U CC CI E -I L a o tn Vl X / W / C C' OCM r U Lou .� vco -; 7 iiou r p � M co .a . �IoN� i w tr / / 0 O In / N / O n- M (N V / S-, •a <nP �Pn^ �^ 6PNN —Z—<= V 31Ij08d I NOIS30 ,OL = „ v / / W Vl X / W / CLI r a M I / / x U / / w tr / / o w / N / O n- / O 0 o_ O V 31Ij08d I NOIS30 ,OL = „ Municipality of Anchorage Development Services Department Building Safety Division a,e On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Boz 196650 Anchorage. AK 99519.6650 www.cl.anchorage ak uS (907) 343-7904 Soils Log - Percolation Test Performed For.. _ ('400 y Legal Description: L, -r 1 '} ',13 Lmy_1- — oerogiulc.S _G01 uo/cnmcs. C tt�• � 14- 15- 16 - COMMENTS WAS GROUND WATER ENCOUNTERED? 1d_ a IF YES. AT WHAT DEPTH? L Depth to Water After Monitoring? /,Z71- ], �0+ 1 -7) 07E Data: -7�� .:�...`,il4sl l I Tir �•, Cogm K. W::ua-ns ri CE -9867 rcN�,�rn I ivN" it 6p 3 (.neem ) PERC HOLE DIAMETER 6,• TESTRUN BETWEEN . 1� FT AND S FT PERFORMED BY:/[Y F.�w.,(.V/` CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON rls DATE. DATE:.— 1W- �-- r11/7��7 I rcN�,�rn I ivN" it 6p 3 (.neem ) PERC HOLE DIAMETER 6,• TESTRUN BETWEEN . 1� FT AND S FT PERFORMED BY:/[Y F.�w.,(.V/` CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON rls DATE. DATE:.— Municipality of Anchorage Page // 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 Permit Number: ~z.)~'~ ~¢4:~¢¢~ PID Number: ~¢~ ~o~ Wastewater System: ew ~ Upgrade ¢~¢ ~. ~ . ~ ~. ~¢~/ ABSORPTION FIELD Phone: INo. of~drooms: ~DoopTronch ~ShallowTronoh ~Bod ~Mound ~Othor LEGAL DESCRIPTION so,,.~,~.~: ¢'~PD/Sq. Ft. Total Depth from original gra~ LOt: ~ ~ Block: / ~¢~ ~/ Deplhlop~pe bottom fromoriginal~a~e: Gravel depth beneath pipe Township: I Range: I Section: Fill added above original %~ Ft. Gravel length: / ~ Ft. WELL: ~New ~ Upgrade Gravelwidth: ~/ Nu~beroflines: ID~stancebetweenli.es: Classification (Private. A,B,C): Total Depth: Cased TO~ Total absorptio~ area: Pipe material: ~/~ .riiler: . Date Dril ed: Static Wster Level: Instal,er: Date installed: Yield: Pump Set ~t: Casing Height Above Ground: SEPARATION DISTANCES ~Septic 'n~ U S.T.E.P. To Se*tic Absorpt,on Lift Hold,nE 'ublic/P.ivate Ma~¢~__:~¢¢~¢ ~__~ Capacity ingallons: From Tank Ffeld Station Tank Sewer Lines Well ¢~5/ /~¢/ ~ ~ ¢~ Material~ Number of Compartments: Surface CurtainDrai~ - _~ ~ /~ r~ Pun~adel I Electrical Inspections performed by: Remarks: BENCH MARK v I Assumed Elevation: ENGINEER'S SEAL - . - 170~ Eagle River Loop Road, N~. 1st ~ ¢~ 4¢ ~ ,.7,' ~g · Kiver, ~IGSKG 99577 ~ ~ ~/~/~ Department of Healt uman~s approval ~ Reviewed and approved by: te: / · 72-013 (Rev. 9/91) MOA 25 SW950040 2 2 Permit No. ~ Page of Municipality of Anchorage 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 VALLEY VIEW ESTATES SUBDIVISION //1 BLOCK 1, LOT 1 05052167 Legal Description: PID No ' CO1 COZ ~/~-~ Ol 5' j FINAL GP~DE MT1 CO2 -80.6' E~S~NG 1~0 GAL SEPTIC 96.4i MT2 C05 GRADE 62.5' WATER FOUND t/Z6/93 · NEW WELL O3 C04 EXIST, t000 GAL SEPTIC TANK INSTALLED 8/91 BY WATERFIELD ENGINEERING INTEGRITY VERIFIED SCALE 1" = 40' NEW 72~013 A (Rev. 9/91) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITEg~I~L~ WASTEWATER DISPOSAL SYSTEM (UPGRADE) PAGE 1 OF 2 Il ;DD PERMIT PERMIT NUMBER:SW930040 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:JOHNSON DONALD M & H. W. TOBEY OWNER ADDRESS:880 H STREET, STE 200 ANCHORAGE, ALASKA 99501 DATE ISSUED: 3/30/93 EXPIRATION DATE: 3/30/94 PARCEL ID:05052167 LEGAL DESCRIPTION: VALLEY VIEW ESTATES #1 BLK LT 1 1 LOT SIZE: 90458 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 ? THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 2. 3. 4. THE ATTACHED APPROVED DESIGN. 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 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 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 THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. NEW CLASS "C" WELL TO BE DRILLED IN JUNE WILL SERVE THIS DWELLING. 2. EXISTING SEPTIC TANK MUST BE TOTALLY EXPOSED; VERIFY CAPACITY, INTEGRITY,' SEALED MANHOLES, AND CAULDER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 o RECEIVED BY: ISSUED BY: COUPLINGS (OR EQUIV.) ON OUTLET AND INLET. RECORDED EASEMENT FOR WELL AND WATER LINE WILL BE REQUIRED AT TIME OF PLATTING. SECOND POST TANK CLEANOUT NOT NECESSARY DUE TO SLOPE TO FIELD. ENGINEER VERIFIES THAT APPARENT SPRING NEAR ALT. "B" DUE TO POOR FINAL GRADING OVER WATER LINE. BE CORRECTED DURING THIS INSTALLATION. IS PROBLEM WILL DATE: DATE: PAGE 2 OF 2 March 10, 1993 ROBERTSHAFER, PE RCGERSHAFER. P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694 1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST S~TE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES Attention: Susan Oswalt P.O. Box 196650 825 L. Street Anchorage, Alaska 99519-6650 REFERENCE: Lot 1, Block 1, Valley View Estates Proposed Septic Upgrade Dear Ms. Oswalt, Request you issue a permit to upgrade the septic system serving the single family home located on the referenced property. As part of this project we are requesting approval from the State Department of Environmental Conservation to drill a Class 'C' well and to install a wastewater holding to serve the 4-plex located on the property. This submittal is subsequent to your memorandum dated July 21, ~1~93~ to the Department of Economic Development and Planning'for the referenced property. Please refer to the file information copied to you for this property and our letter to Keven K. Kleweno of this date for the history of this property and the current status. On the attached design/site plan we've proposed the installation of shallow drainfield trenches to serve the single family home located on this property. We've also designated two alternate leachfield sites. Shown are the locations of test holes excavated in the area of the proposed upgrade. Also shown are property slopes in the area of the proposed upgrade. The slope varies between 20% and 45%. Therefor, we are requesting a waiver to AMC 15.65.060 A.2.a. requiring septic systems to be installed on slopes less than 25%. We feel this requirement may be waived in this case due to the semi-poor soil Conditions which exist. The silty, sandy gravels which exist will tend to direct the migration of effluent downward into the soils as opposed to horizontally. Thus the potential for effluent daylighting through the steeper slopes will be minimal. We also propose the area ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 p~ge 2 Lot if Block 1, March 10, 1993 Valley View Terrace #1 over the proposed drainfields to be filled with drainage directed away from the system to further prevent the potential for daylighting effluent. As can be seen from the site plan, the proposed septic upgrade is outside of neighboring protective well radii as well as the proposed well radius to serve the adjacent Lot 2. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed upgrade. As you know, we intend to subdivide the property as shown by the proposed lot line. Due to the limited room available on the proposed property for future septic upgrades, we intend to designated the locations of the alternate leachfield sites on the plat in accordance with AMC 15.65.180 B.2. We will also designate the maximum dwelling capacity on this property to be 3 bedrooms. We request you keep this ultimate goal in mind when completing your review and offer comments on how the proposal may adversely affect the subdivision. Our goal is to have the system improvements as well as the subdivision process completed no later than the first of August. Therefor, expedition of your review will be appreciated. If you have any questions or require additional information for your review, please contact us at 694-2979. Sincerely, ROGER J. SHAFER. P.E. Attachments cc: CEDAR BAY TRADING COMPANY Attention: Hal Tobey State of Alaska DEPARTMENT OF ENVIRONMENTAL CONSERVATION Attention: Keven K. Kleweno Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: I~.~ ~:;~ 3 Township, Range, Section: SLOPE SITE PLAN 10- 11 13- 14- 15- 16- 17- 18- 19- 20- WAS GROUND W^TER ENCOUNTERED? I s I L IF YES, AT WHAT pO E Oeplh to Water After,,,,,,! \ Monitoring? ~," Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN __ (minutes/inch) PERC HOLE DIAMETER __ FT AN D /~ FT COMMENTS $ & S ENGINEERING ~ "'~ CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: 17034 Ea§[e River Loop Road NO, 204' ~ ~__ ~ ~-~'"--~ ACCORDANCE WlTH~.~c|~,I~.~-,~I~N~'GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~*~~ DATEPERFORMED: LEGAL DESCRIPTION: L-~ ~:~/ ¢/'~ ~V/\~k~ Township, Range, Section: 1 2 3 SLOPE SITE PLAN WAS GROUND WATER ~ ENCOUNTERED? ~'~ / ,E ES, ATW"AT /I O DEPTH? P E Depth to Water After ~ MoniloriflD? \1 Dele: - ~::~-~)~ Gross Net Depth to Net Reading Date Time Time Water Drop f PERCOLATION RATE 40 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '~- FT AND .-- ''~ FT 6- 7 8- 9- 10- 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: ,~ ~, ~ [~.l~t~ll~l~ I~l~ I ~ ~ 17034 Eaclle Rivel' Loo~ Red. Nh ~ THiS DATE ACCORDANCE WITH ~L ~T~AN~ M~NIQI~O~N[~ EFFECT ON · CERTIFY THAT THIS TES*r WAS PERFORMED IN DATE: '~ <:~ ''~ ~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: f~ ~ DATE PERFORMED: LEGAL DESORIPTION: h-~t 1~ ¢~'1.~'~------'~ J/~'P~'~ Township, Range, Section: ~:;'~ ,~ ~~] SLOPE SITE PLAN 1 3- 4- 9 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? P E Deplh to Water After Monitoring? \"~::~ Date: ~ - ~'~'~ Gross Net Depth to Net Reading Date Time Time Water Drop z. ¢,.?~ r I,%~,,-t. '~/,~" /,% ~ ~'.~0 ~ ~,/~- ~' PERCOLATION RATE '~(~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN "~ FT AND '~ FT COMMENTS $ & S ENGINEERING i ~ PERFORMED BY: 17034 Eagle River Loop Road No. 204 ACCORDANCE WITH ~[~i~!TJ~i'Iv~i~,}'~I~J~I~i~II~iUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS~ A= APPROVAL 'fO CONSTRUCT Plans for the construction or modification of /-,e~L ~- ,. public water system located , Alaska, submitted in accordance with 18 AAC 80.100 have been reviewed and are [] approved. [] conditionally approved (see attached conditions). ~f construction ~as not started ~ithin two years of the approval date~ thie certificate i$ voi~ and ~ew p~an$ and specifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (conlract order no. or descriptive reference) Approved by Date Co APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. The construction of the ,Z~eve, ~/at.~ ~ ~'"~' public water system was completed ~ (date). The system is hereby granted interim approval to operate for 90 days following the completion date. BY TITLE DATE As-built plans submitted during the interim approval period, or an inspection by the Department. has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complele Section C) 3. PINK - ENGINEER/MUNI-BOROUGN (Complete Section C) 626E-~69 (106) ZZg66 VNEV7V 'NNAIN ~7~VN '#OZ 311nS 'dO07 ~]3AIH ~79V3 b£OZI WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 (907) 349-7755 March 17, 1993 RECEIVED Mr. Roger Shafer, P.E. S&S Engineering 17034 Eagle River Loop, Ste. 204 Eagle River, AK 99577 RE: MAR 1 9 1993 ~ Municipality of Anchorage De13t, Health & Hu _m. aq Serv_.i_c~e~_. Lot 1, Block 1, Valley View Estates #1 Water and Wastewater Disposal Systems Improvements; ADEC project nos. 9321-DW-070-066, and 9321-WW-070-055. Dear Mr. Shafer: The Department has reviewed the information received in this office March 11, 1993, regarding the above subject which included a letter describing the current state of the system, a letter to the Municipality of Anchorage for a proposed septic upgrade serving the single family home, and a set of drawings for the proposed upgrades. From the information submitted and a review of this office's files concerning this property the Department has the following comments: Wastewater Disposal System: The previous history of this site has illustrated that due to the poor soils, facility size, high groundwater levels, and lot slope the present conventional on-site wastewater disposal system is prone to failure. In addition, the limited area of the property prevents the installation of an appropriately sized leachfield for the given facility size. Therefore, in accordance with State Wastewater Disposal Regulations (18 AAC 72) approval for the installation of a wastewater holding tank at the proposed location is granted by this Department subject to the following conditions: Submittal of an as-built of the wastewater holding tank system under the stamp of a registered Professional Engineer (P.E.) to verify soils, watertable and impermeable strata separation. Installation of a dual alarm system for the holding tank and regularly scheduled pumping of the tank. 4 Existing leachfleld is to be abandoned as proposed along with effluent lines from the septic tank. Mr. Roger Shafer, P.E. March 17, 1993 Page 2 Preventive measures to discourage parking of vehicles on the wastewater holding tank system. Drinking Water System: The proposed location Of the new Class "C" well appears to meet the concerns of this Department. Therefore, in accordance with State Drinking Water Regulations (18 AAC 80) approval to construct the well is granted. Enclosed is a Construction and Operation Certificate with a signed "ApprOval to Construct". Approval to operate will be granted based upon the ,follov~iBg conditions: 1. Verification that the existing well is abandoned according to DEC recommended guidelines. 2. Location of the well in longitude and latitude. Satisfactory results of water analyses for total coliform bacteria and inorganics for nitrate. 4. Well log. Well yield and calculations to show adequate yield, include storage tanks if necessary to meet peak demand requirements. Verification that no lead solder, flux, or piping was used during the installation of the water system (18 AAC 80.800). Submittal of an engineered as-built of the water system under the stamp of aP.E. The proposed property line as indicated on the submittal does not appear to adversely impact development of this area. However, alternative site 'B' for the proposed drainfield trenches for the single family home appears to be located near a known spring which may make this site unsuitable for the intended usage. Thank you for your cooperation with this Department, if there are any questions or comments regarding the above please do not hesitate to call. Sincerely, Michael Lu, E.I.T. Environmental Engineering Asst. II cc: Susan Oswalt, Municapality of Alaska, DHHS Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.OSO —day -o ( HAA #_ 050 qt4 Expiration Date: 17 — O .S 1. GENERAL INFORMATION Complete legal description "7- IA 6t-oc{c I V,+w,*_Y VIE -u ES?-. 01/ Location (site address or directions) a S 7 1 r W{ t -bi=te W u Ct RG L.6 Current Propertyowner(s) C-f}A4t.4,Y CA✓TCNh.= Dayphone 6`16 JG9y Mailing address Lending agency Day phone Mailing address <.{Nay LINA Co.� Real Estate Agent (_A*Ay-(,ANd A4.ALr y Day phone 69 g Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site N Individual Water Storage ❑ Individual Holding tank ❑ Community Class C 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 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 $11; S ENGINEERING Phone 601 Y — a -q 7-7 '11034 Kagle River Loop Road no. zu4 Address Engineer's Printed Name le 0 oOCA Date `6 ,/ A pc ROBERT C. COWAN 5. DSD SIGNATURE 'CE76801 Approved for �_ bedrooms. ��h`pnCiiSSi+�*� Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: &z. Original Certificate Date: - % - Os (Rw 01102( Municipality of Anchorage .. • Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 2..oT 1>r GLor, 1C I *L-I.Aty Vl6+.�Esr,'t�/.Parcel ID: 0S'o--Sly-01 A. WELL DATA Well type C *ss C If A, B. o C&rovide PWSID # = Well Log Date completed _ Sanitary seal (Y/N)_ Wire rly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well prod n g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate 0.25'I'mg./l. Other bacteria 0 colonies/100 ml. Arsenic: mg./I. Date of sample:761 /aS Collected b�, i S ENGINEERING Na 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Tank Type/Material 3""'C- 1( S T ELL Date installed g / of / Tank size coo gal. Number of Compartments 1 Cleanouts (9N) Y£_5 Foundation cleanout (9N) Yt3 Depression over tank (Y19fO High water alarm (Yp N 0 P P g MIA —NLw pe r P Date ofum in Pumper 5�S jou r.� , N4 9 I oS C. ABSORPTION FIELD DATA Date installed 8 /9 1055- Soil rating g.p.d./ft= r ftZ/bdrm) 2- a System type V Length 3(, ft. Width 1 ft. Gravel below pipe o -mss ft. Total depth ft. Eff. absorption area J 3;fe Monitoring tube y16r Depression over field A10 Date of adequacy test N 14 Results (Pass/Fail) For—Y— bedrooms Fluid depth in absorption field before lest _ in. e5 -i ad gal. New depth_ in. Elapsed Time: _ min. Final flu' _ in. Absorption rate >= g.p.d. Any rejuvenation treatme 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed If' I /Os Size in gallons SS V `Pump on" level at 24 'll in. 'Pump off" level at 3 % in. Datum 13 o rr o r Cycles tested 9- E. SEPARATION DISTANCES Manhole/Access) V f- S High water alarm level at 9 S in. Meets alarm & circuit requirements? yes SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot % S-0 } On adjacent lots O`o (- Absorption field on lot �4 On adjacent lots do 4 Public sewer main /► Public sewer manhole/cleanout 1✓14 Sewer /septic service lines Holding tank N 1.9 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 01 r Property line S -1 Absorption field 1 Water main Jillior 4- Water service line J Surface water 40 d Wells on adjacent lots 1 SO SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation /O �� Water main 10 -4- Water Service line D I Surface water / OD r* Driveway, parking/vehicle storage at) Curtain drain Ju -tit K04M"o' Wells on adjacent lots 1 SJ 3 F. COMMENTS G. ENGINEER'S CERTIFICATION A 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 dale. y WWI G cow�11 RDdE tT C, C�we,� Fc��� CE B 1 Engineer's Printed Name f, %,v/A., Date HAA Fee s Ll 3a Date of Payment e1140j Receipt Number -72AID3 (Rev. 12101) 11 Waiver Fee $ Date of Payment Receipt Number 0 r f L.ei ,:r+•1.. vow, Z — - --- ... t f (-. . AS -BUILT 1 hereby certify that 1 have sun -eyed the following described property: LOT AIA-e�ncf f't--- — Vo- //.-X V•.: w 617, rv: f /1 DD N. f Aja. --- Anchorage Recording Precinct, Alaska, and that the tmprove- ments situated thereon are within the property lines and do not overlap or encroach on the property Ivmg adjacent thereto, that no improvements an property lying adjacent thereto encroach on the premises In question and Ihat there are no roadways, transmission lines or other visible easements on said pmi ertv except as Indicated hereon. Dated at Eagle River, Al�atska this (Lr� day of. C1 v f%�7' 21NL r ., ROBERIC.IOfMSON ;e SCALE: Registered Land Surveyor No. RRO-LS 1" metro' Ikn 77-0456, Eagle River, Alaska 99577 Phone (9(17) 694.254.1 ADVANCED WASTEWATER TREATDIENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BET%NT,EN MUNICIPALITY OF ANCHORAGE AND fD\ THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this ItR day of � of 20C6by and between Cl1jr� U C nit I herein the "ONVNER," 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 WASTER'ATEI2 TREATAIENT Sl'STE111S. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as :V cr`DF located at 6njl I MQvit6 J �_ Sn s, l � � , Anchorage, Alaska. 2. Definitions. 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 AWNN7S that were included in the original design which would allow the AW WTS 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 3. Fee. Owner shall pay to Municipality an annual fee of ($ .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 AWVVTS 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. 5. Alterations, Installation and Removal of Additional F,guipment. 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 AW WTS 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 AWRrrS. 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 AW WTS Operating Permit is: 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. Nomviiver. 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: Anchorage: 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 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 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 Date: of U STATE OF ALASKA THIRD JUDICIAL DISTRICT By: . _� F l Title:CM' Date: _/up ) ss. The foregoing instrument was acknowledged before me this j(Q-"day of, 20jCj by , the Li 12i of t1C7• DG< t, on behalf of the Municipality of Anchorage. �i•`712L �11 `Cl/lc--V/- NOTARY PUBLIC FOR ALASKA My Commission expires: 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 Parcel I.D. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lot IA; Blo¢~ ~ }": V~e~ View:~ E~tates # I Location (site address or directions) Property owner Mailing address Lending agency Mailing address Donald M. Johnson 1400 W. B~on Blvd. Suite 110 Day phone. Anchorage, Day phone 276-2808 AK 99503 Agent Address Day phone Unless otherwise requested, HAA will be held.for pickup. NUMBER OF BEDROOMS: $ /"~' TYPE OF WATER SUPPLY: NOTE: Individual well · Community well XXX Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX 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 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves!Lgat[on 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 Firm ........... ~, ~ o ~ELRtN.~ / Phone ~'~ Address ~7034~agle Riv~oop ~a~ No. 204 Engineers signature _ ~¢~/~ Date o DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: '~ ~?'~ V--- A, Well Data k/t,¢~-¢-~ ~¢-~'lJ'~'"J~l Parcel I.D. Well type ~-~-~ Log presentCN) Total depth Z-~-~ Sanitary seal if A, B, or C, attach ADEC letter. ADEC water system number Date completed C0/~1 '~ Driller ~:~u[b-L,t',./¢~,,,~ Cased to ~,~ / Casing height Wire~ properly protected YIn) V FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~'~ Absorption field on lot Public sewer main Sewer service line [ WATER SAMPLE RESULTS: ~-~L.--~ '~-' Coliform Nitrate ATINSPECTIOX / / // ;On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Other bacteria Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed Cleanout~/N) High water al~'~ arm (Y~' Date of pumping Tank size Collected by: SEPARATION DISTANCES FROM SEPTIC/14~-~,~6-TANK TO: Well(s) on lot k-~ / ~>. On adjacent lots To property line ~-~.~ I Absorption field Surface water/drainage I ~2 ~ ~ J~ ~.~_~ I Foundation ;:~¢-~ ! Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION - ' Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes 0(/N~. SEPARATION DISTANOE~¢i:IOM LIFT STATION TO: Well on lot ,,.// On adjacent lots D. ABSORPTION FIELD DATA Manhole/Access (Y/N) "Pump off" Level at Cycles tested Date installed "~ I'¢~d / ~'~? Soil rating (GPD/FF) Length l ~ ! Width '~ / Gravelthickness '~/ Total absorption area , L),*~ Cleanout present/N) Date of adequacy test t"~-u~-c"/~'Y~-C~Results(pass/fail) k-~/~- . Surface water System type ~ i>, ~ ¢'t~-L.l~ Total depth ~'-, '-~ Depression over field (Y/~ lq. for .~ Bedrooms Water level in absorption field before test ~-~ / ¢~ After test ¢'~'~/ Peroxide treatment (past 12 months) (Y/~} J If yes, give date ¢ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~, ~ / ~. On adjacent lots [ d '~ t Property line To building foundation '¢~ ~ To existing or abandoned system on lot On adjacent lots ~ '"-P' Cutbank ~'~-4~ Water main/service line Surface water I ~ I~.~_ Driveway, parking/vehicle storage area ~__~ Curtain drain ~ ~ E, ENGINEER'S CERTIFICATION I certify that l have checked,/vefliel~,d, or~onformed to all MOA and HAA guidelines in effe~(o¢!he~,c~tce.~¢[ this inspection. HAA Fee $ ~(~O, ©~ Date of Payment / _~%.c~ ~1 Receipt Number ;~)-~. \ 72-026 (3/93)* Back Waiver $ Date of Payment ~-~/-r/0 "/ Receipt Number