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HomeMy WebLinkAboutSUN VALLEY BLK 2 LT 7Sun Vail Y Block 2 Lot 7 #078-111-06 Perm;t Numbe~ SW020120 Name: JOHN THOMSON 17545 SANTA MARIA DRIVE * EAGLE RIVER, AK 99577 (907) 240-2020 LEGAL DESCRIPTION 2 7 SUN VALLEY 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 On-Site Wastewater Disposal System and/or Well Inspection Report PIP Numbe~. 078--111 --06 Wastewater System: · New Pqge 1 of 3 Upgrade ABSORPTION FIELD WELL: · New r-I Upgrade 5 PRIVATE I 132 r~ 132 SULLIVAN WATER WELLSJ 6/05/02 26 ~. SOUTHFORK CONSTRUCTION 4 c~ UNKNOWN rLJ 2 ,~ TANK SEPARATION DISTANCES TO SepUCTank Ab'F~r~d~°n StauonUft HoldlngTank ~/~'~ ANCHORAGE TANK 1000 Wail 100'+ 100'+ -- -- 25'+ 5'q'EEL Trench IlShollow Trench l'lBed nMound mother 1.2 ~/s~. ~ 6.5 MAX r~ 2.48 MAX ~ 4.02 rt 1.60-2.87 ~ 45 rt D 3034/ F-810 ~* 6~8/02-7/2/02 Surface Water 100'+ 100'+ - -- -- Lot Une 5'+ 10'+ - - -- Foundation 5'+ 10'+ -- - - Curtaln Omln NOiNF KNOW~ Remarks: 2 LIFT STATION BENCH MARK TOP OF' CMU FOUNDATION Inspections performed by: AKWWC, INC. Dates: 1st 6/28/2002 2nd 7/1/2002 3rd 7/2/2002 Developme.n.~ Service~ Department Approval. Ro~v}e~w~)ed and approved by:/~/ ,/C/. //<~,~ Date:// P . .uM.ER: AS BUILT DRAWING .ARc ,D SW020120 . ~' 078-111-06 j INOTE: THERE IS A STEEP SLOPE ON THE WEST SIDE OF ~ ITHE DRIVEWAY; BUT AT A 25 PERCENT SLOPE 2 FE'EI' .. ~ ABOVE THE DISTRUIBUT1ON UNE, THE 25 PERCENT SLOPEI ,, ~ ~ ,WILL NOT DAYLIONT IN 3§ FEET. 3]-i!1 NEW 1000 GN.t.0N · \~, ~z~ 5'-..-"..:.: ~__ \ \ . ~. ':,.~,.. ~ ~ - v ~.' "'"' I I'~''- \ \ ..'.." ,,,. ,..~ \ \ -- '..~" ~.." ~.;. ~ ~ , I I ~ ~...---N.TERN~'/E SITE. MAY RrqUIR~' ~ .,'~.'~':', ~_[~ ' I I _..~.....~ '~H£ USr' OFA UFT ~TATION. --, \ _',-~'.'. '-J.;,-e~2 !! \ ,~, _....,e,"~... ! ! ~ ~APPROXIMA'I~ LOCATION \ ' .:'?. :;/- "~ I I ALASI~ WATER & WAS'I'E~,~,WI'I£R CONSULTANTS. INC. ~ PREPARED FOR: PHONE NUMBER: JOHN THOMSON 240-2020 LEGAL DESCRII:q3ON: LOT 7, BLOCK 2; SUN VALLEY SUBDIVISION T(PE OF' WORK: AS-BUILT DRAWING OF WELL LOCATION AND SEPTIC SYSTEM DATE: 11/11/2002 DRAWN BY: C.J.G. SON. E: 1" = 40' PAGE NUMBER: ~. A B ST1 6.92 50.46 ST2 13.2 51.8 DBL1 15.23 52.74 DBL2 16.36 53.21 C01 18.31 54.72 MT1 19.24 57,85 C02 62,21 92.13 MT2 59.09 92,78 SW020 i 20 AS-BUILT DRAWING TOP O; TANK AT~ [~LEr -- 95.23 ~, / IhNERT OF BUNQ ~ AT ~ -- 94.78 F1NAL NEW 1000 GALLON SEPTIC TANK GRADE - 99.31 (AVO.) - 95.25 ~'%N'-INVERT OF BUNG AT OUTL~; - 94.46 PARCE/. ID NUMBI:R: 078-111-06 RELATIV~ ELEVAT10N OF' BOTi'OM Or T~STHOLE . 82.70 ~i~.b~HOLE DRY) ALASILa~ WATER & WASTEWATER CONSULTANTS. INC. PREPARED FOR: PHONE NUblgER: JOHN THOMSON 240-2020 'LEGAL D~3CRIPT~ON: LOT 7, BLOCK 2; SUN VALLEY SUBDIVISION 1YPE OF WORK: PROFILE AS-BUILT OF SEPTIC SYSTEM 11/12/2002 0RAWN BY: SCATS.: C.J.G. N.T.S. £rtifiet ri[I. ing Kag by SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 ,, TELEPHONE 688-2750 OWNER OF LAND: ,J~)/4,~J "i"'~.4'Oo,~"~,~, ADDRESS: LEGAL DESCRIPTION:.(;"J ~J cJ/'J/--" ~"/'* Z~T' ::7- DATE: PERMIT NUMBER~ ?'3,.~ O/,~ D, Date of Issue .3~''' .~.~o - ..O_.~ TAX iDENTIFICATION NUMBER: O '7.'I~ - Is well located at approved permit location? ~s :,.I No Method Df E~'ill[ng: /..I.~'rOtary ~ cable Depth of well: / Casing Type ~Wall Thickness , Diameter ~O il inches, depth / ~' ~' Casing Stickup Above Ground: ~. feet Static Water Level: C~ (,,. feet Recover Rate: Methed of Testing: Well Intake Opening Type: ~:::ll~n end M open hole .I Screened; Start feet Stopped feet ~.J Perforations Start fee,.Stopped feet Grout Type: ~F,,~?';'''~ ''¢£ Volume Depth: from .~0 feet, to ~ O ~ feet Well Disinfected Upon Completion? ,~=t,-Ye's .I No Method of Disinfection: Cl e/,~ ~',,,~ E BORE HOLE DATA DEPTH ~" // '71 /;,,5- ~hes lOS' feet Comments: Driller's Name A'I-rENTION: It Is the responsibility of'the property owner to submit a copy of the well log to the proper authodty. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation, MatSu Borough: Department of Environmental Conservation, ./ MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wsstewater Program 4700 South Bragaw Street P.O. Box f96550, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: May 20, 2002 Expiration Date: May 20, 2003 Permit Number: SW020120 Legal Description: SUN VALLEY BLK 2 LT 7 Design Engineer: 0041 AK Water & Wastewater Consul[an' Owner Name: John Thomson Owner Address: 17343 Santa Maria Dr. Eagle River, AK 99577- Parcel ID: 078-111-06 Site Address: 002933 SUN VALLEY DR Lot Size: 114970 SQ. FT. Ts[al Bedrooms: 3 Permit Bedrooms: 3 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. Ail 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) 043-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. Fram 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: ~/.1~ J~ D at e: ..~ -cx~ / °~"~c'~ Issued By: ~~ ~. ~ Date: .,~/~. O/(~ ~. 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 wwv.ci,a nchorage.ak.us (907) 343-7904 Parcel I.D. ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAHILY DWELLING o'7c( Permit Number Property owner(s) Mailing address (1) Mailing address (2) JOHN THOMSON 17343 SANTA MARIA DRIVE * EAGLE RIVER. AK Day phone 694-4955 Zip Code 99577 Legal description (Lot, Block & Sub'd.) LOT 7. BLOCK 2: SUN VALLEY SUBDIVISION Legal description (Section, Township & Range) N/A Lot Size I I/~, ~ '70 Acres/Sq.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool 3 Well Only Water Storage  Jacuzzi Water Softening Unit [] 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. ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. (~;ignaturc of propcdy owncr or outhorizcd ngcnt) Permit Fees: Date of Payment: Receipt Number: Waiver Fees: Date of Payment: Receipt Number: ALASKA WATER WASTEWATER CONSULTANTS, INC. April 29, 2002 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water 8,: Wastewater Program 4700 South Bragraw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Proposed and Well Septic System Design for Lot 7, Block 2; Sun Valley Subdivision To whom it may concern: The proposed 3 bedroom house will be served by a private well and septic system. The proposed well is to be drilled in the area shown on the site plan and design drawings. Two test holes were excavated and logged by Michael Anderson, P.E. in the area of the proposed septic system. The primary drainfield will be designed around the 30 foot radius of test hole #2. We are proposing that a 1000 gallon septic tank and a five foot wide drainfield be installed. Comments regarding . the proposed design are summarized as follows: I. SOILS: See the attached logs which shows the soil classificat!ons, groundwater monitoring, and the percolation test results. It is our opinion that an application rate of 1.0 gallons/day/ft2 should be used. 2. TRENCII DESIGN: a. Pemolation Rate: 3.5 & 4 minutes/inch b. Allowable Application Rate: 1.0 gallons/day/ft2 c. Number ofBedmoms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 450 ft2 f. Total Depth: 6.5 feet (max.) g. Effective Depth: 4 feet h. Width: 5 feet i. Reduction Factor: 0.50 j. Minimum Length: 45 feet long k Effective absorption area: 450 ft2 6901 Dcbarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Wcbsite: akwwc.com 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPtlY: The topography in the area for the proposed drainfield is a 1 to 20 percent slope running from approximately east/southeast to west/northwest (see topography information on design drawing). There is a 50~: percent slope west ofthe proposed drainfield. We request that the 50 foot setback to this slope be waived to 35 feet. Given the porosity of the soil and the heavy vegetation on the slope, it is our opinion that there is little risk with the granting of this waiver. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. (t~cere' Yi~ ,PE,MS NOTE: Attached is a site platt drawing, a design drawing, two Michael Anderson, P.E. soils logs, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com SUN VALLk"Y LO"/ 6, BLOCK 2, LOT 7, ¥~¥ Hot.[ ~'~ PERFORMED BY MICPA[L ANDERSON, TOP /,~. SUN VAIl. E/' S/D; ~,~, ,. LOT is, BLOCK 3, I ',/! LOT 9, ~O~ I PROPOSED SEPTIC SY~ PAGE 2 OF 2) ;3 ISEDROOM HOUSE \ \ t;e,PROPOS[D W£LL . ~ ~, / SUN VN. Lry LOT iS. BLOCK 2, DATE:  4/29/2002 DRAWN ALASILA WATER & %kSTEWA'I'ER J.LM. CONSULTANTS, INC? PRF..PA.RED FOR PHONE NUMBER: PAGE NUMBER: JOHN THOMSON 240-2020 1 OF 2 LOT 7, BLOCK 2; SUN VALLEY SUBDIVISION SITE PLAN FOR PROPOSED WELL LOCATION AND SEPTIC S'~'STEM SUN VALLEYS/O; LOT 4, 8LOCK 1, SUN VALE-fY LOT $, BLOCK 1, NO CONCERNS V~LL AND SEP~lC 100'+ FROM LOT UNE \ \ \ \ \ I V pERFORMED BY UtCHA[L~ ANDERSON, P.E. \ \ \ \ ALASRA WATER & WASTEWATER CONSULTANTS. INC. PR[PARED FOR: PHONE NUMBER: JOHN THOMSON 240-2020 LOT 7, BLOCK 2; SUN VALLEY SUBDIVISION DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM DAT~ 4/29/2002 DRAWN BY: J.LM. $C~.~ 1" = 40' PAGr HUMBER: 20F2 / / 14- 15- 16- 17- 18- WAS G~OUNO WAT~N I''/~'~L/ CO0~) 31X['i3 -1~3 6tCLOS~ST8 XY,'I Ot:~n dla ~fl/on/en T*d �6I89 lo �1 r P to., ,(•hfc2019 '" Municipality of Ancho t 1 • D = ; r.A 2 On-Site Water and Wastewater Prog : Lw' (907) 343-7904 5 6- w CERTIFICATE OF ON—SITE SYSTEMS r Parcel I.D. 078-111-06 Expiration Date: 1. GENERAL INFORMATION Complete legal description Sun Valley BIk 2 Lot 7 Location (site address) 2933 Sun Valley Drive Current Property owner(s) Andrew & Cynthia Sandusky Day phone Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) �j Duplex n Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank Individual Water Storage I I Community Community Class Well Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ _ 550 Waiver Fee $ Date of Payment 5-1(0f I9 Date of Payment Receipt Number 4&$'/ Receipt Number COSA# 0 C(4)// ' Waiver# 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 Sewer Manhole/Cleanout > 100' ® Yes if No ft RI Yes if No ft Neighboring Tank > 100' ® Yes if No _ ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank> 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) BuildingFoundations > 10' 6.7 ❑ Yes if No ft Surface Water> 100' ®Yes if No ft Property Line>5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' lia Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' ® 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: • Water Main > 10' ® Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS Driveway has been expanded and now covers approx. 30% of leach field. Owner has provided letter stating they have had no problems over freezing since constructed. First CO under concrete cover. Tank to foundation meet code at time of instalation. G. ENGINEER'S CERTIFICATION 4.1.-r\C .'44 44. ♦ •. I certify that I have determined through field inspections and review ? c?r' % y 1� of Municipal records that the above systems are in conformance with : LEGEND: MEASURED DATA 12.5' \ RECORD DATA N 90°00'00" W RECOVERED 5/8" REBAR 0 1103 1 ((', LOT 6 35` I \<'' (i) \\S, 03 C7.1 Gf�`t WOOD N60 �'16� o \ -9 FENCE In 2 SEE HOUSE �G �v\ DETAIL: 1. 61s3 ...� 6 ` • j 73 � t..1t..1`,. Il <- S/Ps '. 08.4'x4.2' N W cc.‘ SHED . (31 e� <' 16::!.....''''' 10'x12` ti 61› ©� �\\� • PAVILION .N pY `l'o 2-.. ��,, ---- 15. \LOT 7 G� '•4 TWO STORY w GRAVEL 114,970 Sq.Ft. ‘-'6'�, WOOD HOUSE 1 DRIVE 2' WELL \ 100' WELL �4 1g 1-3 i RADIUS • 2ND STORY � �" ` 14.5'x10' � / � ��, \ 7J DECK �� o All N �. SHED y / tr O o 2' lk con 335.11' rnf o Qo��� N o \ MTA PED. S89.57'50"E 51 2ND ao STORY TRANSFORMER DECK LOT 8 \ 5/13/2019 To whom it may concern... My wife and I are the original owners of the property located at 2933 Sun Valley Drive in Eagle River Alaska, and we took possession of the property after completed construction in November 2002. We have lived continuously in the home since it was completed and can affirm that there has never been a freezing related incident or any other problems related to the septic system's function. Further, it continues to function today completely unchanged from the day we moved in. Feel free to contact me if you have any further questions. Regards.... 7#'0IfteutSlazed4 Andrew L. Sandusky 2933 Sun Valley Drive Eagle River, Alaska Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 078-111-06 1. GENERAL INFORMATION Expiration Date: .2 - ~ ~'""~ °5 Complete legal description SUN VALLEY SUBDIVISION; LOT 7, BLOCK 2, Location (site address or directions) SUN VALLEY DRIVE * EAGLE RIVER (HI[AND}, AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOHN THOMSON Day phone 240-2020 17343 SANTA MARIA OR.' EAGLE RIVER, AK 99577 Day phone EVA LOKEN w/ PRUDENTIAL VISTA Day phone 689-6476 16635 CENTERFIELD DRIVE * EAGLE RIVER. AK 99577 Un/ess otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OFWATER SUPPLY: Individual Well ~ Individual Water Storage Community Class Well [-1 Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~] Individual Holding tank Community On-site [~] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 pdvate or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells er a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. INote: Alaska Water and Wastewater Consultants, Inc. shall be paid $ to closing for the engineering se~,,ices provided. 4. STATEMENT OF INSPECTION BY ENGINEER at, or pdor I As certified by my seal affixed hereto and as of the validation date shown below, I verily 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 vedfy that based on the information obtained from the Municipality of Anchorege files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS. INC. Phone Address 6g01 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. (;ARNESS, P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results desctfbed the performance of the system under the conditions encountered al 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 cf the system. SatisFactory test results do not guarantee future performance of the system, nor do they guarantee that there ara no hidden defects or encroachments. AKWWC. Inc. can therefore not provide any warranty or futura estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal #ght whatsoever. 5. DSD SIGNATURE ~ Approved for .~ bedrooms. Disapproved. Conditionalapproval for __ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing stipulations: ..... : Manitenance Agreements Supplemental Engineers Reo~ Other (Re~. 12)01) Original Certificate Date: / / '..~_.,.~- C'~,2.- Municipality of Anchorage Development Services Department Building 6afet~ Olvlslm on-Site Water & Wasmwamr Program 4700 South Bragaw SL P.O. Box 196650 NIchomge. AK 99519-6650 www.cLanchorage.alcu~ (907) 343-79O4 ,O Legal Oesctlplton: A. WELL DATA HEALTH AUTHORITY APPROVAL CHECKLIST SUN VA[Lr'Y 5UBDMSION; LOT 7, BLOCK 2, Parcel ID: Well type PerVA~ It A. B, or C provide PWSlDft N/A Date completed 6/5/2002 Sanitary seal (Y/N) YES Total depth 152 f. Cased to 1,12 ff. FROM WELL LOG Date of test 6/5/2002 Statlo water level 26 lt. Well production 4 g.p.m. WATER SAMPLE RESULTS: Coliform , ~ colonies/lO0 mi, Arsenic: /~J/l~ moji.. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tank size, 1000 gal. Number of Compartments FoundaUon deanout (Y/N) YES Oate of pumping NEW ABSORPTION FIELD DATA 2 Depression over tank (Y/N) NO Pumper pBELOW FINAL GRADEI 078-111-06 well ~ fi/N) ~S Wires properly protected (Y/N) , YES Casing height (above ground) .24 in. AT INSPECTION Other bacteda _,~ colonies/lO0 mi. Collected by;. AKWWC, INC. Date installed 6/28/02-7/2/02 Cleanouts (Y/N) YES High water alarm (Y/N) N/A Date installed a/2e/o2-7/2/o2 Soil rating (~or ltarodrm) 1.2 Length 45 lt. Width 5 fl. fl. Totaldepth ,ej.-~/~ lt. Eff. absorpUonaraa 450 ff~ Mo~itottngtuhe ,YES NO Date of a~lequacy test NEW Results (Pass/Fall) - For 3 bedrooms Fiuk~ depth In abempflon field before test - in. New dept~ -- in. Elapsed'time: - min. Final fluid depth - - g,p.d. Any raJuvenatlon treatment (past 12 mo.) (Y/N & type) It yes, give date - System type TRENCH Gravel below pipe 4.02 Depression over field~ Water added '-gal. in. Absorption rate >= D. LIFT STATION Date install~:l "Pump on' level at in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: SIze in gallons "Pump ~ level et Cycles tasted Septic tank/lift station on lot100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/sepfl= service line 25'+ IN. Manhole/Acc~<; (Y/N) High water alarm level at Meets alarm & circuit requirements?. On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line Water main N/A Water service line 10'4- Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 10'+ Surface water 100'+ Wells on adjacent 10ts 100'+ Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections end rm4ew of Municipal records that the above systems ere in conformance with MOA HAA guidelines In effect on this date. JEFFREY A. GARN~ Engineers Printed Naine Data ,/ // ,/0 ~. Absorption field 5'+ Surface water 100'+ Water main N/A Driveway, parking/vehicle storage HAAFee$ . ,1 Date of Payment. Receipt Number (~' (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number in. ,5'4- I HEREBY CERTIFY ,THAT I HAVE SURVEYED FOLLOWING DESCRIBED PROPERTY~ AND THAT NO ENC~Q4CHMENTS EXIST INDICA~, IT IS THE RES~SlBILI~ OF ~ ~ D~/RMINE T~ ~ST~ OF E~T~, ~NA~S, OR ~1~ ~ NOT ~ ~ THE RE~ VISION P~T. UND~ NO CIRCU~ST~CES ~Y DATA H~ BE US~ F~ CON~ION AEY LINES. SEWARD & ASSOCIATES LAND SURVEYING 694-082~ '...?,_