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SMITH LT 1
? f, Smith Lot 1 #051-154-51 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 34.3-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number 5W PID Number. ""ne l k L, �C'.V'c'. C. c�..�r $z-tti System:' )! New O Upgrade z.�— �t fWaste"Ewoater ABSORPTION FIELD — Z Z 1 of bedfoomw seep Tronch D Shallow Trenehd ❑Mound D other LEGAL DESCRIPTION boll"'&V t M ra TOW Dsptn t tt� Rammki. Lot I atodC DOOM b pipe bomm flan W*w Wa* CiravN r Zt �J• + 'a eft Townemp: / r• L 1 IG ��1 Ranpc . n 1 V V 3+etiorr ! c.! Fill added above original grads: o, r_- Gravel Wngm 40 ft WELL: &Keew 13 Upgrade Gft%,W width: j rj Nun-d ar of 6nee: Doom 118 A "M .s3:7 Ft CWsaibeation A. Ir; vn TOW OMMT zz FL I k. Toil absorption 00 Frye mm. hED�C Drftr. A.ey(,� 'ir.\h 'at •t $6v41 Oriaed: 3 I -Zo �� 11mewaimLent rp U Pt In ow.. / .f HCPAT- 5Cv-%/.Ct) DateineWled: Yrdd:at wigea Am.. Dtara�a Z - P Lt.S . t0a. 'S'/" i4N K w . 3 s cPea a Ft SEPARATION DISTANCES ?�seoUD D towing D S.T.EP. To flan anise To* Absonftw ua from Boom .. M.Par TW* Eewt nr- •.. 1 01,<(unr 6r11t / -Rtt Capacity it jollw K I Z-50 welt .,C,J NIK �; `�) tRatarlat: c+ : Number Of comoerbnZ Surface LIFT STATION No L► fi 4�frt 1 Uno Foundation ' I V 0 'Pump on' bol at 'Pump it Hign vrrbr a4rm at / curtain A 1 IL KOV mats i mom Iectbra palonaed b S, Remarks: BENCH MARK `Tw ci r c 6t v� c (.� • Location &WDaecrilow: �u lee + :ti + — 1.tlts1' �Qrll"Gii �jrALL'i ib�L-� - �l'��00V' GZT _ f In:�Y -� C 1 � S 5 r- tL ek� v 'Avr d E ewwn: ro0 ,� �t , ::•• q9 �*'dTH ' I tions performed �N to �1 E= Dates: 3 l VO cJ 3 Pe by L-ty`t-` ` 6..:.. .. .... ..: . 0 2n :. GREGORY ALAN E6ERLE Department of Health and Human Services approval rel '• cEs2sa��� '•. .• ,.. Reviewed and approved by: [late: 3 .� 7- d 3 w.'3 ams m... SMn ►row zs Lt -k Undeveloped Lot DRIVEWAY D H❑USE A NEW WELL A NORTH SWING TIES A 8 C D COI -- 18.5 6.6 42.0 TCM -- 671 65.E 90.0 TCO2 — 74.6 73.3 97.7 CO2 -- 77.0 75.7 100.0 CO3 -- 78.0 76.8 1012 NTL -- -- 123.0 143.7 NT2 -- -- 146.1 171.0 C04 — -- 143.6 171.8 COS -- -- 147A 173.0 C06 — -- 1491 1732 C07 — -- 150.4 174.6 NEW WELL 17.0 50.5 — — DENCNNARK -- 7.0 17.7 — WELL / A col 0 40 80 it SCALE LOT 1 1250 gal TANK TCM c 15 ft B FFA CETM 00 COFM =1 7' U CORNER SHED 4NDONED 80• 40 ft • �ti TEST PI��!!Lj C and NT C04 NOTEi BLUE BOARD INSULATION PLACED OVER THE TANK AND OVER THE SEVER LINE FROM THE HOUSE TO THE TANK r brie ever clmvet I PROPERTY LINE ABANDONED K• 3IZ`l 1015 . TANK L ❑ T 2 SHED SITE PLAN -- AS -BUILT Walu NU.i U3-UU1 I JJA I LI a/ifb/U EBERLE ENGINEERING SERVICES 3875 MARIAN DRIVE EAGLE RIVER, AK 99577 907-696-0402 (phone and FAX) vl� W. 2 z& House 0 ---64' L-401 i coy Invert els. 97.31ft Foundation 1250 pal. Tank LOT LINE ;W -40j, —1 -131 MT Cos 1 FINISH GRADE -100.6' N Invert In Bed . n VL Elevatlon — 89.60 ft — Top of 1 ft Thick Gravet Layer Elevation — 95.10 ft Bottom of Gravel Layer Elevation — 94.10 ft Bottom of 2 ft Thick Sand Fitter Elevation -- 92.10 ft Notes Elevations based on assigned el. of 100 ft on top of faucet nut, east watt of house PROFILES -- AS -BUILT I KAU I UK/.HUlL1JLK: A+ HUML SLK\ NO.: 03-001 DATE: 3/26/0 EBERLE ENGINEERING SERVICES 3875 MARIAN DRIVE EAGLE RIVER, AK 99577 907-696-0402 (phone and FAX) NOT TO SCALE *.49TH •?fir// ��•, GREGORY ALM EBERLE rl� CE SN 1 • W. 312(. 1 0_3 MARK HLiNSEN P.E. CONSUO VG EN7 H:Vo 7t9nN0 LABORAIUMY P.O. Do- Q23 ►o"er, AK 09016-4u. Mor« (347) 743-021 ran: (907) 746-4721 December 23, 2002 Work Order: 0207 North Star Earthmovers, Inc. HC 01 Box 6195 Palmer, AK 99645 Fax: 745.3114 Project: Materials Testing Subject: Sieve Analysis Gentlemen: The following Is the sieve analysis of the c;grc:; ata sample taken on 12121/02. MOA Filter Sand Sieve Percent Passing Spec: #4 100 100 #10 76 #20 43 #40 10 #60 1.5 #100 0.5 0-2 #200 0.3 0 =1 The sample conforms to the above sp©cifiM':.:na. Approved By Mark Hansen To*8 1ZLt• 5t•4 L06 ' 3'J'N3SNtfH'NNUW Wel ££:10 ZOOZ-£Z-33a MAR -25-2003 12:05 AM P.01 FROM : RIplW DRILLING FI7I� no. t 907 345 020. t1ar. 21 2003 01:32P11 P2 /04-MPW Municipality of Anchorage Department of Health and Human Services azo at: stun I& p o Box 1 M850 Anftr"% Alaska ti96'19�660 I�Ck W4r.jA,tiw.0LwW %p-yk.n+ bbywr Prank Number: AW 23 Date of Lsaet 3-13-M Dab Started. 3-10-03 Date Comptatod: 9:20$ IAPI D sm pnpedY 0+raerName d: Addnu: GwWd Lenart 20037 Crabltroe Pared Identineadom Number: 051-1501 Is well located at approved permit toeadon? a Xea No Swebok Data: Depth (ft) I Method of DA tn9 ® air totwY O cable ttxtl Sol •t�' 7wda%m a Watw Etaw From To CtlsitrY type: d 0 2 Wall Thicjom: M inches shok UP 2 3 Dlsmet": l bxhes Depth: jAl feet tXpttnics d BNt 3 13 Liver Type: aa.,aa comy vivo Diamew. laches Dtpft fat grsvory aw 13 36 CA&W ask" abowc ground? $ feet sm 36 41 $relit water Itvd (tigm ground level): PAfect gravoy),sm 41 46 pumpinkV*1:1g¢_feotaRa silly sands' grove! "t 46 48 Z boors pum14n8 Elim gmvvw sin 46 81 Recovery Rater ¢Q+ am s&y xandygMW 87 108 Method of Testing: altj(G' gmVew tw 108 113 Wta Intake Openb g Type sity waW wnd A gravel 113 118 open Emu ❑ OPm Role GISeteened Stat fe„c Stopped frit aeftak 116 122 O p"k4V;oaz Start fees Stopped 4iet Grow Typctn_�S Volumes J bz Depth: start Q tear S"Pad teat Pnap: Intake Depth .het aIzo be Brand Name Wen DWRbeted Upon Compkliea? Yes O No Metbad of DhiSfectiob: chyle tabbfa Cemmeab: Well Driller: Alone DriNing 6 Erfterpriaes PO Box 1104!76 Aft*" a Neska 99611 r (hall provide a wall log to the pwparty owner within 30 days of aomltle6011 and the property JLMUtaou..1h�evM11drl:l • •t......n._ ..._.:n•.. �na.__.e.....t..: _ U .. Ml.. .t It •�. �..���.. .. .�. 1+.... ......... . . MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW030043 Legal Description: SMITH LT 1 Date Issued: Mar 13, 2003 Expiration Date: Mar 12, 2004 Parcel ID: 051-154-51 Design Engineer: 0821 Eberle Engineering Services Site Address: 020037 CRABTREE ST Owner Name: Gerald Larsen Lot Size: 50971 SQ. FT. Owner Address: 20037 Crabtree Total Bedrooms: 4 Permit Bedrooms: 4 Chugiak , AK 99567 - 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 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: Issued By: Date: j r Date: 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 0,0 s0 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. O 5-1 - 1-1-4 — D Permit Number SW 03004.3 Property owners) PofiRLF_ /VF LARSTA/ Day phone � ! 6-05-7 Mailing address (1) Z 37 CRAB % REF Mailing address (2) C )Y U &)9 C U. AR Zip Code 9956 7 Legal description (Lot, Block & Sub'd.) 5M/T& LOT / Legal description (Section, Township & Range) Lot Size 'S -O q ZZ Acres/6 THIS APPLICATION IS FOR: Number of Bedrooms 4 Sewer Only ❑ Well Only. ❑ Sewer and Well ® " Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. of property owner or authorized agent) Permit Fees: O°O aeci2 S6rrc /SOV_ Waiiver Fees: Date of Payment: - .3 13 O Date of Payment: Receipt Number: 3 2 `TL/2 8 Receipt Number: (Rev. 12100) Mumcipalit3T of Anehorage George P. 11'uerch, Mayor Building Safety DiVIsion P.O. Box 196650 •4700 S.. Bragaw Street Anchorage, Alaska 99019-6600 • (907) 343-5301 h ttp:/h����e.ci.nnchorn�c.alc.us June 10, 2002 Gerald Larsen 20037 Crabtree Chugiak AK 99567 Subject: On -Site Water and/or Wastewater Permit. Permit Number:.SW010262 ILegal Descri tion: Smith Lo p t1 Dear Gerald Larsen: An On -Site Water/Wastewater Permit, number SW010262, issued by this office for a single-family system, will expire on July 24, 2002. This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A new permit for a second year may be issued for a fee of $100.00 if the renewal application is received on or before the expiration date of the original permit. When applying for a new permit, the fees are: $400.00 for a wastewater permit and $150.00 for a well permit. If you have any questions, please call this office at 343-7904. V19 b o14 s, P.E. Manager On -Site Water and Wastewater Program Enc: Copy of permit ` MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Permit Number: SWO10262 Legal Description: SMITH LT 1 Design Engineer: 0821 Eberle Engineering Services Owner Name: Gerald Larsen Owner Address: 20037 Crabtree Chugiak , AK 99567 - Date Issued: Jul 24, 2001 Expiration Date: Jul 24, 2002 Parcel ID: 051-154-51 Site Address: 020037 CRABTREE ST Lot Size: 50971 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: R Disposal Field F� Septic Tank E] Holding Tank F] Privy Q Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3_ The engineer must notify 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: Issued By: Date: Date: 7 — 2 4 -- O% 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.manchorage.ak.us (907) 343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. e7 S/ - /54 -S I Permit Number SWO/0262 &Property owner(s) ba R/e n e /-a r.sc n %� •bS9Z Day phone l 14.0+;4wj Mailing address (1) I, SMe4iag address (2) 200 �;7 C_Az, GP_ Zip Code Legal description (Lot, Block & Sub'd.) Sm; 7-A /,of I Legal description (Section, Township & Range) Lot Size;5'40271 Acres/Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms 4 Sewer Only ❑ Well Only IR Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. M (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Waiver Fees: Date of Payment: Receipt Number: ( I (p I ' nfor-Receipt Number: (Rev. 12/00) "��� d LOT 1. SMITH SUBDIVISION EBERLE ENGINEERING SERVICES PLAN VIEW Undeveloped Lot — ` LOT 1 rnuS � w1 ; oarm+c i may. i \ � vElL EDRNEv�Ar LOT 2 Horse Pasture Horse Shelters Undeveloped Lot Woods RECEIVE JUL 23 2W Municipality of Anch OF NOTESi ,%gyp• S 1 1. EXISTING WELL TO BE ABANDONED. ,ir'••'9t�1 2. EXISTING SEWER LINE TO BE TRUNCATED.;*** 4K �•..�.w •............. go �r�!cco�rwui� l� CE 9254 ; w 0 100 200 ft. SCALE .e;,:;.. i\���� MUNICIPALITY OF ANCHORA GE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Permit Number: SW000448 Legal Description: SMITH LT 1 Design Engineer: 0821 Eberle Engineering Services Owner Name: Gerald Larsen Owner Address: 20037 Crabtree Chugiak , AK 99567 - Upgrade Date Issued: Oct 20, 2000 Expiration Date: Oct 20, 2001 Parcel ID: 051-154-51 Site Address: 020037 CRABTREE ST Lot Size: 50971 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: Disposal Field O Septic Tank Holding Tank E] Privy El 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 ( i8AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions: THE SAND USED IN THE FILTER LAYER MUST BE A CLEAN COARSE SAND WITH 4% OR LESS PASSING THE #100 SIEVE AND 2% OR LESS PASSING THE #200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED ON THE SAND USED OR OBTAINED FROM AN APPROVED SOURCE. Received By: Issued By: V Date: it ! d Date: -0 "w Eberle Engineering Services Greg Eberle, PE 3875 Mariah Drive Eagle River, AK 99577-9757 Phone/FAX (907) 696-0402 LOT 1, Smith SUBDIVISION—Pmt Application The attached site plans shows: a) Locations of the proposed on-site wastewater (WW) disposal system with all its components as well as adequate area for a replacement WW disposal site. b) Measured dimensions of the proposed on-site WW disposal field, tank, and distribution piping. c) Measured distances to all WW disposal systems, wells, surface water or drainage courses, roads, property lines, and structures within 200 feet of the location of the proposed and existing WW disposal systems on this lot. d) Location of the percolation test/test pit where the water -table monitoring tube was placed. e) Topography is universally essentially flat—no slope arrows drawn. The proposed well and septic system will have very limited impact on adjacent properties for the following reasons: a) The surrounding lots have sufficient room for septic sites. b) Immediate neighboring septic systems are all +30' distance. c) Reserve space is adequate, due to absorption capacity. d) Drainage will not be affected and is not a major consideration in our design. No impacts of the WW disposel system on adjoining properties are anticipated. All requisite separation distances telative to adjoining wells, WW disposal systems, and this lot's backup site are met herein. There are no known curtain drains. SPECIFICATIONS FOR ONSITE SEPTIC SYSTEM LEGAL: Lot 1, Smith Subdivision October 11, 2000 A. GENERAL 1. The septic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 9. Any remaining open test hole excavations shall be filled. 10. The existing septic tank shall be abandoned: pumped, cut open, and filled with compacted soil. B. BED 1. The bed is to follow the natural land contour to maintain uniform total depth of the bed bottom. 2. The bottom of the bed shall be level, plus or minus 1.5". 3. The total depth of the bed excavation is not to exceed 8' at any point. 4. The sewer line is to replace the existing sewer line that leads to the existing tank shown on plot plans. The effluent line within the bed shall be laid level within 0.03'. 5. The bed gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' minimum or equivalent is to be placed over the leachfield. 7. The area over the bed is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH= 8' maximum GRAVEL DEPTH = 0.5' under pipe, 2" over pipe BED LENGTH= 40' BED WIDTH = 15' SOIL RATING = 1 GPD/sgft (w/ sand filter) BEDROOM CAPACITY = 4 SEPTIC TANK SIZE = 1250 gals. SAND FILTER = 2 ft thick (below1 ft thick layer of sewer rock/gravel) Twenty-four (24) hours notice required for all inspections. LOT 1, SMITH SUBDIVISION EBERLE ENGINEERING SERVICES PLAN VIEW o loo zoo rt SCALE OFA TH f; �� �•. GFw60,"1'ti A! {ani E?:fllE :��y✓, CE 9254 m a RIVEW NORTH WELL DRIVEWAY LOT 1, SMITH SUBDIVISION EBERLE ENGINEERING SERVICES PLAN VIEW 2 Undeveloped Lot HOUSE , 1 0 WELL 1 , MEMO 0 50 100 ft SCALE LOT 1 /I / .Backup SlteKT — / \ TAO( CDS . tact -P 40ft v Q� a 0 W SHED � Lq`OA • .,,�11 .�.H d/f ... .... ...• ... .. / .•. vv GREGGRY" EBERLE ; • ,r, /1 CE 9254 • c r n LOT 1, SMITH SUBDIVISI❑N EBERLE ENGINEERING SERVICES PLAN VIEW 3 NORTH LOT 1 (/" I / Backup Site — o PERC. a\ TEST PIT nd MT , `Cos TANK 0 20 40 rt SCALE 40 ft SHED 0 1 5 W n 0 .5 f W }�- . * ..... gTM ! ........:..� �v%N•,. ., GREGORYAMNEEERtE CE 9254r LOT 1, SMITH SUBDIVISION EBERLE ENGINEERING SERVICES PROFILE/ELEVATION House c0 Invert els. 97.27 ft at Foundatlon Exit Notes Elevatlons based on arbitrarlly assigned el, of 100 ft on top of faucet nut, back wall of house C133 0 20 40 ft SCALE MT MT Cas COs CO CO Grads Invert In Bed 94.60 ft Invert els. -- 95.01 T 50 gaL 94.84 WL Elevatlon -- 89.60 ft - Top of 1 ft Thick Gravel Layer Elevatlan -- 95.10 ft Bottom of Gravel Layer Elevatlon -- 94.10 ft Bottom of 2 ft Thick Sand Filter Elevatlon -- 92.10 ft `�.-..ae>>xX �� �.� ACS► ,ow t � TM�• •:syr*rri 49TM ..:...... . ....:. 1 C£ e.2�i1 Fa i 1'• LOT I VkS'10K Foy Ai - 0 v- S�v�, .�� l♦tv l3e.cS �etk- pe,f1-• �'�� gewev Reclr�GVI. Z�h,pV'. sVLY O or O bar . �i��• 9Jbs-�ow Seed go (truer 0101 .00*:49TH . �.. ............... r /..... .� IoM o0 �/! •,. GREGORY ALJUI EBERLE ,•\�% D yh�vts t c �S CE S w BeA _ (Lth i� Mality of Anchorage. j C2.. DEPARTMENT OF HEALTH HUMAN SERVICES ` TN 'r L 950 825 "" Street. Anchorage. Alaska 92-0650 f.. r.. ..-- . .....`.� - SOILS LOG — PERCOLATION TEST %•:. .. •arc Irl I��Y'���I Se-� �(r1ECDE PERFORMED FOR. DATE LEGALDESCRIPTION* Lfl 1 45V':\ ` , SY TOWnshio, Range, Section O : 1 O NG l.wu ��l YY=l �S �brToWI1 I:Yr►o.It� � toav's� SAND Gsp� I 2 -• r 3 l ��� 4 •. morsf; wit(— �►.n,d�d ' S a- 7- '9 9. SLOPE \� W� WAS GROUND WATER �eS ., ENCOUNTEREDT � rr IF YES, AT WHAT LO • (3 7 d 5 . DEPTH? ii . i P 12 E 13 �� rn.3' p� ro 00 14- Is- 16- 17- IS - 19 41516 171s19 SITE 201_j PERCOLATION RATE (mmIminCh) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS 14 1 vi,J l0. a f! J'� ; bilL 108VOWVlr Z 1-K d M 4—S -- kt4v va'S i a.v i 1�.-u11 c. Less AAiSK Z o PERFORMED BY. 1 �� CERTIFY THAT THIS TEST WAS ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE �I 0 00O 00 72-0OB (Rev. vas) IK ) IN 151p,l GREA,cR ANCHORAGE AREA BOR( /GH "t Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAMEt%/'3-lJ/Ci c//////dL MAILING ADDRESS LOCATION 1& _. YYW(A-MA W_ ' -LEGAL DESCRIPTION SE-PTIC TANK: DISTANCE / _. , NUMBER OF FROM WELL MANUFACTURER yi(J�l6—MATE RIAL �'��OMPARTME,,N��T��S''^^�' - INSIDE LENGTH_-- INSIDE WIDTH___ LIQUID DEPTH _ LIQUID CAPACITY_/` -)`GALLONS. ///��� TOTAL LENGTH�7 / DISTANCE FROM WELL L& FOUNDATION /'�1� _NE,A�RREEST LOT LINE -OF LINES SGx NUMBER OF LINES DISTANCE BETWEEN LINES �� TRENC/HWIDTH_Y�71N. TOTAL EFFECTIVE ABSORPTION AREA le''r�/�iSQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH; TOP OF TILE TO FINISH GRADE,2-$i /' MATERIAL BENEATH TILE d�e JN. ABOVE TILE _. _IN. WELL: _,Vo', TYPE �?.'G,-.Lu -CONSTRUCTION------ ------DEPTH DISTANCE FROM BUILDING NEAREST NEAREST SEPTIC FOUNDATION_ LOT LINE , SEWER LINE , TANK_ CESSPOOL __ OTHER SOURCES APPROVED- _ DISAPPROVEDREMARKS DISTANCES: __j/9 V!5�l=__P's /C6 INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL', LOT SLOPE:4' REMARKS: _�L- sp� A_11 Form EQ -032 SEEPAGE_ SYSTEM_ DIAGRAM OF SYSTEM r x�sr�u�9 9�' DATE�`�APPROVED /L_It I //// G.A.A.B. TYPE UF SOI| 88S0R8TION SYSTEM TRENCH M8XTMUM NUM8ER OF BEDROOMS � I SOIL RHTIN1 T/BR)� 85 THE LENGTH Fm, IMEN5ION IS THF 1 FNqTU ().N F[ET) 0F THE TRENCH OR DRHINFIELD TOR PIT IS THE 1.)IS1 H1, .1CE BETNEEH THE SIjRFACE UF THE GROUND HND T||E BOTTOM UF THE E1C11V8TI1 N FEET) THERF I6 Nn �I T HIDTI FOR TRENCHFS THE GRHVEL DEPTH TS If: MINIMUM 01 -PTH OF GRHvEL BETWEEN THE OUTFH�]- PIPE HND THE BOTToM OF THE �XCHVHTN (.1N FEET) ����&��� ������� �-��UU� �����V �����' ji 0. it r dk_U—i: R 11�� to ��� ����������� ��� ���k����K� DHCKFIL| lNG Al: ANY SYSTEM WITHOUlFINH| INSP�CTI()@ ;ND GPP�0VR[ BY TH/� DFPHRTMENT WIU' BE SnRJECT TO PROSECUTION MINIMUM DE RETWEEN R WELL HND HNY UNITE SI .WHGE DIFPn.RL SYST81 IS 100 FFET FOR 0 PRIVHTE WB-| OR 200 FFET FOR R PUBLIC WB1' SPECIFICRlIONS HND CONSlRUCTION DIHGRRMS HRE T.'01 111 TO INSURE PROPER INSlHLiRT7ON ���V it 'D, �1 - F, 111���U«U 0 Et E GEO't .eCHNICAL Ef DEVEL�, MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils Et Foundations Land Development Performed for: Name:- ). N- V�_� otl �� �� Tel. No. Mailing Address:_ eN-„ Legal Description:_' L De th feet ate..., 2 I 4 A 6 7 10— — So i ChLrractedstics 1 i,7, 13- 14- 15___ 3-14 15 16 X52-? l�ton�9� � ARCS ice' �� Ground Water Encountered: Yese NoIf yes, what depth_ Pr,Wosed Installation: Seepage Pit Drain FieldComments: 4— _✓ Performed by:_^ .� � Date:_ e S ea �1 Z7-s5%P MUNICIPALITY OF ANCHORAGE o DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Environmental Health Division CASE REVIEW WORKSHEET CASE NUMBER: S-7075 —� DATE RECEIVED: COMMENTS DUE BY: May 26, 1983 --- June 10, 1983 SUBDIVISION OR PROJECT TITLE: Lots 1, 2 Smith Subdivision ( ) PUBLIC WATER AVAILABLE ( ) PUBLIC SEWER AVAILABLE ( ) COMMUNITY WATER AVAILABLE COMMENTS: a 95. f / f 1 71-014 (Rev. 5/83) vIUNICIPALITY OF ANCHORAGE DEPARTMENT OI' HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 025 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: L�1-1 1�) �_ DATE PER FORM ED: • 7r7_ J �ez7 /�L cr , ��,' LEGAL DESCRIPTION: Y<� l� "%/Cll/ lI /1.1 C'].e1 �-._. ,- i l r 12 13 14- 15 4 15 •`�: � ' � w`�{� ISS l„ ,rqq �t 9 17 181•-P '""v iilYW�hr 19 20'h k'w whw COMMENTS SLOPE WAS GROUND WATER S ENCOUNTERED? _ L O P IF YES, AT WHAT -7 ! E DEPTH? v ITE PLAN Roading DEPTH (FEET) b UI 1 Water to er Not Drop ,/ Rio sIL�Y so-fje 2 3 fS p 4 G J GW 8 5 o d t� p O S 7{1 /6 G It 7 8 9 10 12 13 14- 15 4 15 •`�: � ' � w`�{� ISS l„ ,rqq �t 9 17 181•-P '""v iilYW�hr 19 20'h k'w whw COMMENTS SLOPE WAS GROUND WATER S ENCOUNTERED? _ L O P IF YES, AT WHAT -7 ! E DEPTH? v ITE PLAN Roading Date Gross Time Not Time Water to er Not Drop i PERCOLATION RATE --(minutes/inch) TEST RUN BETWEEN FT AD}) _—, FT/ PERFORMED BY:���,� ? S 51CC'?1CINEMING CERTIFIED AIASKA £M'1! 297£1 72008 (6/79) C E �o • ,L I an — o m ^ cg's O 2 h N C � d N F ¢ a ��s�yp3 o h b E � Q a � O. C I c Q n Ntd q C 1^ N V I I U we o "c �oQ I F a I =Zt R v ryy� U mp E., O � O o Q v m W b m> u v� U L a' E y$ E w _ Q not, N� a� m ro o O . °mR�& of �° I m U Q hall ¢„-g �S'. \> .-�me° oYmR _ YVBtl 0!'099 Mil1,91a00M b"'a yz I \ m 0 U � d OOtl[I [[Ofl -Of o /> - i II I QE a y _bac£ o< ti yoy Lp z mliE d ww J h J'� BALL _ f P �II�P ev m $ a � ° >�vovaoa NO/170/030 iNON .W_°oson Hot of C E �o • ,L I an — o m ^ cg's O 2 h N � d N F ¢ a ��s�yp3 o h b E � Q a � O. C I c Q n Ntd q C 1^ N V I I U we o "c �oQ I F a I =Zt R v ryy� U mp E., O � O o Q v m W b m> u v� U L a' E y$ E w _ Q not, N� a� m ro o O I I U I m U Q hall _ YVBtl 0!'099 Mil1,91a00M I \ m � d OOtl[I [[Ofl -Of o /> i II I a 0 Lp z mliE d ww J h J'� BALL _ f P �II�P i NO/170/030 iNON V N I I I Q I 1 C E ov �o • ,L I an — o m ^ cg's O 2 h N � d N F ¢ � Q o h E � Q a � O. C I c Q n Ntd q 1^ N V n U we o "c �oQ Q =Zt R v ryy� U mp E., O � O o Q v m W b m> u v� U L a' E y$ E w _ Q not, N� a� m ro o O a°u ci U U Q hall � o a 0 ov �o • ,L I an — o ^ cg's I y ry F ¢ x x ov �o • ,L I an — o ^ cg's ¢=m ry F ¢ x x E � c a � O. C I iA v � _ n Ntd q ti m`m tars 0 U we o "c �oQ ryy� U mp E., O � O o Q v n �o stilts ' — o MA, ry i o g�c`a 4 N O. C Q q Ntd q tars ¢ O ` C C o "c �oQ U mp E., O � o Q v m W b m> u v� U L a' E y$ E w _ Q not, N� a°u ci U U Q hall n �o stilts ' — o MA, ry o g�c`a Q q Ntd q ¢ O ` C C "c �oQ U mp E., O � m W b m> u v� U L a' E y$ E Q Q j L[ 4 OO C Q not, N� n Municipality of Anchorage Development Services Department Building Safety Division � On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 f s, www.ci.anchorage.ak.us (907) 343-7904 N CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-154-51 x/31/° 5 ^� HAA Expiration Date: 2' —0 5 GENERAL INFORMATION Complete legal description Lot 1 Smith Chu iak Location (site address or directions) 20037 Crabtree St. Chu iak AK 99567 Current Property owner(s) Charles Lanstrell Mailing address 7134 3 ) Lending agency Mailing address Real Estate Agent Mailing Address Day phone 222-3462 Day phone Day phone 440-4976 unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 3. TYPE OF WATER SUPPLY: ® Individual On-site Individual Well ❑ Individual Holding tank ❑ Individual Water Storage ❑ Community On-site ❑ Community Class Well ❑ Public Sewer ❑ Public Water System 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) on properties re served eto home singlefamily Certificat s of Health Autter hority Approval osal and/or are supply system. DSD also issues HAAs uponq rties served by a private or Class well and may reissued with valid for 90 days from the date of issue for propelid for one new water sample results less than 30 days old. Certificates are vaf responsible properties erserved for or omissions lin the oB wells or a public water system. The Municipality of Anchorage is not professional engineer's work. (Rw II/M 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 Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on- site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone En 1. Svc. AddressP.O. Box 102954 Anch AK 99510 Phone 272 8218 Engineer's Printed Name Steven R. Pannone P.E. Engineers Comments: In conducting an adequacy t Date enginetting analysis of the V cY es41 attempt to provide a thorough, conscientious reported mulls describe the perfomtance of the rystance etm Imdcr the conditions rncountGuidelines & ered t the t me of �� ••CF \ the test, and separation distances measured to readily identifiable features. The operational life of all �P� ••� wells and septic systems depend on the local soil condition, ground water levels that may fluctuate • ��•••'• during the year, and the water usage of the family being served by the system. Thesc conditions are outride the control of the evaluator of this i q tH or not guarantee future Performance of the�cm. All systems eventually fail and satisfactory test results % ""' ' '• •••••.. estior encroachments. PCS can therefore not prosvidc any wm, nor dartanty for they future pe oee that �rmance nmeet the oor giere am no ve anremy cf� ;, Z� mate of how Ion thenue "' ' "•' '••• •• •••..•..... MOA DSD. The content off thisreportfor the sole benefit of the owner listed above Any rcEaCtt upon ♦1� °• No. CE 8149 Perational Steven R. Ponno or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 6. DSD SIGNATURE ♦♦ wr _ Approved for 4 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Maintenance Agreements _ Supplemental Engineers Rep Well Flow Advisory ort 1 Other � By: — I1 / /.C� s . p Original Certificate Expiration Date: (Rw tide) Reissue Date: 13 Municipality of Anchorage • Development Services Department ° Building Safety Division On-site Water and Wastewater Program s 4700 South Bragaw Street P.O. Box 198850 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type i Date completed 3120/2003 Total depth A22_11 If A, B, or C provide PWSID # Sanitary seal Y Cased to 118 ft FROM WELL LOG Date of test 312012003 Static water level 60 It Well production 60 9 -p.m Well Log Y Wires property protected i Casing height (above ground) 24+ in. AT INSPECTION 8M812005 49 It 5+ 9 -p.m WATER SAMPLE RESULTS: Colif0rrn7:3f--colonies1100 ml Nitrate L' 14)omgA Other bacteria colonies/100 ml Date of sample: 8M=005 Collected by: Laura Pennons Arsenic NIA mgA B. SEPTICIHOLDING TANK DATA Tank Type/Material Anchorage Tank Steel Date installed 3M912003 Tank size 1250 gal Number of Compartments jt Cleanouts Y Foundation cleanout Y Depression over tank jl High water alarm NIA Date of pumping SM812003 Pumper JR's C. ABSORPTION FIELD DATA Data installed 31912003 Soil rating (g.p.d.R or fe/bdrm)1 System type Bed Length4Aft Width A¢_ ft Gravel below pipe 0.5 ft Total depth JA It Etiective absorption area IMP? Monitoring tube 11 Depression over fleld Date of adequacy test 8/1812005 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test Q in Water added= gal. New depth2 in. Elapsed Time: Q min Final fluid depth Q in Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 8 type) No If yes, give date (Rev. 11199) D. LIFT STATION Data installed � S 'Pump on' level at in'Pump Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankhift station on jot 11� Absorption field on lot 150+ Public sewer main 100+ Sewer /Septic service line 50* Manhole/Access in High water alarm level at _ in Meets alarm d dr cu t rsquiremer>ts? On adjacent lots 100+ On adjacent kits 100+ Public sewer manhole/Geanout09-- Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 30+ Property line A Water main 100+Absorptionfield 10+ Water service line W+ Surface water 100+ Drainage 100' Wells on adjacent lots 10—� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1�_ Building foundation -Lq. Water main Water Se 100+ rvice fine � Surface water 100+ Curtain drain Driveway parking/vehide storage •••ta. done— Obe=� Wells on adjacent k>fs 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION --7-- oils• • .............. • I cerlily that I have determined throughspecbbns and �_ `P •• c!• review ofMun field in �-6 7� oornformance w�MO�wds that the above systems are in `+ u HAA guidelines tin eAbct on anis date. !9 Engineer's Printed Name Steven R. Pa nnona P E ^^ Ste e^ R, Rc.,^, ra Date_ �lvr riill:r .n^ ..•� Date of Payment Receipt Number3 9 (Rev. 11/88) /" r Waiver Fee $ Date of payment Receipt Number .: LO N T 0 J N 0 J .a .0 CO 5— N s U T 0 J T 00 O M N w O BO O M co G a± C N }Ce w d m u w w ru d .o 2 w E Fc O d o O co M s U � 101 •pgns sua�!V 00*M MLL,%XON 0 c 50 I I a s Yz I I N (6 I I rte I I o I I FO*Oz 8Sf10H Bw2J j /4oj$ Z ra=Z 00'OL6 M&Sz IRON �o 133uis 33ulaV 0 z 101 O M . O O O N W O 00 0 rn co p� N 0 J s�. L w �mO0 Owdix w U Z Cc ON °o ca xw N wW� too u6 is W m Municipality of Anchorage O .16n :771'f • � Development Services Department Building Safety Division ?i: T. `�,y�= On -Site Water and Wastewater Program y` 1�=m ° 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. Jt^ l t �7 l 5 l HAA f j A Q Expiration Date: 7 - / G '3 1. GENERAL INFORMATION Complete legal description �O t �VW� ` Sig bc�� V 5 t c t.� Location (site address or directions) Ct`- ^ ] 'e;k El- k Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address (21(e- R" W f07 `( � � f1L0.V C K� Day phone �� I Z Z Aq¢.w Fw o) (-,& wu 0-0� L4. .TX 'I t g Unless otherwise requested, HAA v✓ill be held by DSD for pickup. 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. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown Ibelow, 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 ks(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality�of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I Name of Firm �PC. y-�c, Phone Address _ ?7�* j•'tCly-Ic`� �v';+�'L�"E:9�L(� �'LY 230 1Z26 Engineer's Printed Name Gy -g_! Eyy' �1 A% 1=-_k.7-,' le-- Date __5 1:15 10J 5. DSD SIGNATURE Approved4or.• Disapproved. L bedrooms. - Conditional approval for Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory W' I < EN :i ;• QNE.ER S-0'�: ^,STAAr1P ; 313, M, •• .... 1. .. ��) I • CL 02.54 •• .�•:v� bedrooms, with the following stipulations: ,;t((t((U((//r�i, (NATES PID • rr••: 1A1AeTe!n1A7cn F�OGnAM = 'lj .. 'r�Vl �3..• Maintenance Agreements Supplemental Engineer's Report Other By:/ `G // �' ��/ • �c`='I Original Certificate Date: G / (Rev. 121C% 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.ct.anchorage.ek.us (907) 343-7904 HEALTH AUTHORITY APPROVAL { OVAL. CHECKLIST Legal Description: LQ 4 ` 5 � % ` }rl J' -1V i,4 l0P*cei ID: 51' S — j A. WELL DATA Well type PY'i V0.fL If A, B, or C provide PWSID # Date completed�ZD/3 . Sanitary seat (Y/N) —y— Total depth ! 22. ft. Date of test Static water level Well production Cased to iLS ft. Well Log (Y/N) Ye- S— Wires property protected (Y/N) _ Casing height (above ground) �in. FROM WELL LOG AT INSPECTION NLI,t� 31-20103 g.p.m. g.p.m. a t$r;r WATER SAMPLE RESULTS: ale Coliform _4colonies/100 ml. Nitrate —4mg..A. Other bacteria onies/100 ml. Date of sample: 3 Z3 /Y R fi42 Collected by: l_ 1t t!T / r� �� B. SEPTICIHOLDING TANK DATA TankType/Material J l'-' - Date installed vc zO°3 Tank size I tg�7© gal. Number of Compartments Z Cleanouts (Y/N) L' 2 - Foundation cleanout (Y/N) De ression over tank (YIN) Ivo High water alarm (Y/N) v d 03 Date of pumping 3 + ` Pumper C. ABSORPTION FIELD DATA Date installed3 t ! o3 Soil ratin(g.p.d /ft' r ft'lbdrm) Systern type _POCK_ Length q _ ft. Width .Va 1 S ft. Gravel below pipe _ 0 A S ft. t� Total depth $ ft. Eff. abso tion area 600 fe Monitoring tubs * Depression over field _L 0 3l Date of adequacy test Results slFail) For' bedrooms 1 11 - Fluid depth in absorption field before test V`��, Elapsed Time: _ min y rejuvenation treatmi Water added^ gal. fluid depth _ in. 12 mo.) (YIN & type) New depth, in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION 11 Date installed \\ "Pump on" level at _ in. Datum E. SEPARATION DISTANCES L4 -t- 54Z4-7 ize in Gallons Cycles tested at _ in. SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/N) High water alarm level at Meets alarm 8 circuit requirements? Septic tan Jiff elation on lot On adjacent lots _ 8 Absorption field on lot �Q �_ On adjacent lots Public sewer main ti 7 Public sewer manhole/cleanout NZA Sew !septic service line © Holding tank (�1�4 SEPARATION DISTANCES FROSEPTI /Ht3l: Wfe-YANK ON LOT TO: j L Building foundation -T ` Property line e( r Absorption field 4 ' rq / Water main t� Water service line lG l Surface water Me Ke - Wells e -Wells on adjacent lots In. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r . •Property line 3 Building foundation 1 (I Water main No (4.I JW M °Li K Water Service line r Surface waterI1¢- (!jr�lv parking/vehicle storage �s ' r Curtain drain NC Wells on adjacent lots z �i F. COMMENTS G. ENGINEER'S CERTIFICATION '� CR.•' �'' �— THI* 1 certify that I have determined through. field inspections and ;011 • • • • • • .... �;,, review of Municipal records that the above systems are in .,. • . .. ...�,.�..,....... conformance with MOA HAA guidelines in effect on this date.mtn�t0-400 Engineer's Printr7- HAA ame �1oA pif c6 Date ' Fee $ Waiver Fee $ Date of Payment 2i C) Date of Payment Receipt Number C) L Receipt Number (Rev. 12/00)