HomeMy WebLinkAboutTHOMAS LT 1Onsite File
#018-262-26
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191355 PID Number: 018-262-26
Dwelling: 0 Single Family (SF) with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade
Name
Scott & Angela Felger
ABSORPTION FIELD
El Deep Trench Al Wide Trench El Bed El Mound
Site Address
350 Twilight Lade
❑ Other
Phone
Number of Bedrooms
Soil RatingTota(
depth from original grade
4'
4.0 GPD/SF
3.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2.0 Ft.
Gravel depth beneath pipe
1.0 Ft.
Subdivision Block Lot
Thomas 1
Fill added above original grade
1.5 Ft.
Gravel length
30 Ft.
Township Range Section
Gravel width
5.0 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
170.5 Ft!
1
N/A Ft.
Well
100'-1-
100,+
100,+
TANK ❑ Septic »❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1500 Gal.
Surface Water
100'+
100,+
100,+
Material
Number of compartments
Lot Line
51+
51+
5'+
NA.
Steel
2
Foundation
10,+
10,+
10,+
LIFT STATION
Manufacturer
Capacity
Remarks
O re n co
250 Gal.
Alarm location
East side of garage
Electrical installed by
capstone electric
Installer
to
PIPE MATERIAL House to tank 3034 dTankrainfie ld 3034
A+ Home Services
Drainfleld 3034 Co/MT3.034
Inspector Pannone Engineering Services
BENCH MARK (Assumed elevation) 263.0 ft
1'` 10/2/2019 10/2/2019
Inspdeat
Location and description
es: 2�d
3`d 10/7/19 41h 10/18/1 is
Bottom Trim @ point B
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
OF
Date
4"' • •.•
:_49TH '
.... .. .. .......
eannoRe`
CE 8149
•'•.10/23/2019,•'
Septic System
ApprovedDate 10 a ��
Note: this approval does not include well permit requirements.
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' f REVISIONS DATE
RECORD DRAWING P.O. BOX 1807 PALMER, AK b9645 I OF 10/25/2019
PHONE 907 745-8200 FAX 907 745-8207 SCALE
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THOMAS L1
SCOTT & ANGELA FELGER
261 OERTLI LANE HAMILTON, MT
SITE: 3501 TWILIGHT LANE
ANCHORAGE, AK
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PANNONE ENG SVC LLC
P.O. BOX 102954 ANCHORAGE, ICK 99510
PHONE 907 272-8218 FAX 907 272-8211'
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THOMAS L1
SCOTT & ANGELA FELGER
261 OERTLI LANE HAMILTON, MT
SITE: 3501 TWILIGHT LANE
ANCHORAGE, AK
SCALE
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SOILS LOG &
NOTES
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PANNONE ENG SVC LLC
P.O. BOX 102954 ANCHORAGE, ICK 99510
PHONE 907 272-8218 FAX 907 272-8211'
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CE 8149.
..... .
REVISIONS
DATE^
10/23/19
RECORD DRAWING
THOMAS L1
SCOTT & ANGELA FELGER
261 OERTLI LANE HAMILTON, MT
SITE: 3501 TWILIGHT LANE
ANCHORAGE, AK
SCALE
P.I.D.
018-262-2fi
DRAWN ACP
SOILS LOG &
NOTES
PERMIT
OSPt91355
SHEET
3 OF 3
BLM Lot 104
BLM Lot 103
S89059'59"E
10' Utility Easement
r----- —
Lot 1
+� #
o
Septic vent (typ)\Pole,,3
?
Satellit�0!
QQ
36.3 CID
Manhole g
am n
m > N Septic tank
m•�no
C7•–�
o '3 8.0
0
r 44.3 N 06�
deck co 2
t. Q) sGij
Asphalt os�O Ai moo
ps esse�s@ O
�jY S77nP7�CS�j9
o Well
Lot 2
Wood fence
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I I TWILIGHT LANE M
OF . A4'9S`
AW /1
Asw 49th
® Elizabeth L. Walatka
8036 - LS . • �eAW
law
®FO�FESStoNAL•��
SCALE: 1 "= 50' x xXXN:
EASEMENTS OF RECORD, OTHER THAN 10 "I" , - li
THOSE SHOWN ON THE RECORDED FB 19-7, pg 37
PLAT ARE NOT SHOWN HEREON, FB 83-4, pg 56 BE
UNLESS OTHERWISE NOTED FS 19-6, pg 33-34
•OM -
RECERTIFIED 10-10-19&v
AS -BUILT NO CORNERS SET THIS DATE
1 hereby certify that I -have performed a Mortgagee's inspection
of the following described property: LOT 1, THOMAS SUBD.
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 20th day of AUGUST ,2019.
FRED WALATKA & ASSOCIATES, L.L.C.
907-248-1666 Engineers and Surveyors
V)
BLM
Lot
121
O
M
BLM Lot 103
S89059'59"E
10' Utility Easement
r----- —
Lot 1
+� #
o
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?
Satellit�0!
QQ
36.3 CID
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am n
m > N Septic tank
m•�no
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o '3 8.0
0
r 44.3 N 06�
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o Well
Lot 2
Wood fence
•
0
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•
•
s
•
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I I TWILIGHT LANE M
OF . A4'9S`
AW /1
Asw 49th
® Elizabeth L. Walatka
8036 - LS . • �eAW
law
®FO�FESStoNAL•��
SCALE: 1 "= 50' x xXXN:
EASEMENTS OF RECORD, OTHER THAN 10 "I" , - li
THOSE SHOWN ON THE RECORDED FB 19-7, pg 37
PLAT ARE NOT SHOWN HEREON, FB 83-4, pg 56 BE
UNLESS OTHERWISE NOTED FS 19-6, pg 33-34
•OM -
RECERTIFIED 10-10-19&v
AS -BUILT NO CORNERS SET THIS DATE
1 hereby certify that I -have performed a Mortgagee's inspection
of the following described property: LOT 1, THOMAS SUBD.
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 20th day of AUGUST ,2019.
FRED WALATKA & ASSOCIATES, L.L.C.
907-248-1666 Engineers and Surveyors
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP191355
Work Type: Septic Upgrade
Tax Code Number: 01826226000
Site Legal Address: THOMAS LT 1 G:3035
Site Mailing Address: 3501 TWILIGHT LN, Anchorage
Owner: FELGER SCOTT B & ANGELA
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
�TOer�i S
llepartrnent
9/5/2019
9/4/2020
48740
Q Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: The entire drainfield is not within the 30 ft radius of a percolation test. An additional perk
I test shall be completed prior to construction of the drainfield to confirm the application rate. If results require a
design change, construction shall stop pending Onsite review and approval of a change order. Please submit
I i results with the inspection report (or change order, if required).
Received By: _ Date:
Issued By: %��/Cg�� Date: / 5 /
4
EPUWS
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 018-262-26
Property owner(s) Scott & Angela Felger
Mailing address 261 Oertli lane Hamilton, MT 59840
Day phone
Site address 3501 Twilight Lane Anchorage, AK
Legal description (Sub'd., Block & Lot) _'.r�n�� S L
Legal description (Township, Range & Section)
Lot Size 48,740 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑X Initial ❑
Single Family (SF) ❑X
(w/wo ADU)
Septic Tank FX]Upgrade ❑X
Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: S/g6-
Date of Payment: g/ /61/9
Receipt Number: ��11() W� 6
Permit No. 65 101g13J�
Permit App_-'-:.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
WVi
Aja � "� r"�. � • F.._z. ;t �i< . � !' Y1 �— x r w.�a ,.
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panenRak.com
1 October 2019
Subject: Thomas L1
Septic System Permit Request
Design Narrative
This is a design narrative for a permit to install a septic system upgrade to be issued for this property. The proposed
systems will serve an existing three-bedroom (3) house and one -bedroom (1) apartment. Currently the lot is
developed. This lot and surrounding lots are served by private wells. Currently there is no wells within 100 feet of
the proposed system.
1. Soils. Test holes were performed on this lot by Spurkland Engineering in September of 1985, and groundwater
was monitored for at least seven days. Ground water was observed to a depth of 8.0' below the surface in the
test hole monitor tube. Bedrock was not encountered in the test hole. Based on the results of the percolation
tests, overall soils appearance and the selection of the proposed drain field; an application rate of 4.0
gallons/day/square feet was used for a category 3 advanced wastewater system in the area of the test hole.
Pannone Engineering will perform a test hole at time of construction to verify soil profile and percolation rate.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The
proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches.
4. Topography: The existing topography generally slopes from the northeast and southeast to the west across the
lot in the area surrounding the septic system at approximately 0-5%. The lot has been graded in such a way that the
area of the existing and proposed drain fields is flat. There are no steep slopes within 50' of the proposed drain
field.
The proposed installation will not affect the future development of this or the surrounding lots.
If you have any questions or concerns, please contact me at 745-8200.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
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Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191355, Rebecca Carroll, 09/05/19
BLM Lot 104 BLM Lot 103 7989E
S8905959"E 105.00
10' utility Easement
I -----
----
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i Satellite Pate ti9
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6. - 44.3 N 6.
deck co Z
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As halt RD os6 7'roo r Wood fence
C:) so QF0`a °�Zg
CJ i y j °h Liao
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— WEST 187.00
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TWILIGHT LANE �
'NA I AS -BUILT NO CORNERS SET THIS DATE
OF • Ake I hereby certify that I have performed a Mortgagee's inspection
�P, • • ,S,r� of the following described property: LOT 1, THOMAS SUED.
'go �• th
00 '` • ` • Yq ' Anchorage Recording Precinct, Alaska, and that the
00
improvements situated thereon are within the property lines
A •. lzabeth L rWalatka and do not overlap or encroach on the property lying
,4r > adjacent thereto, that no improvements on the property lying
►
ON • • 8036 — LS � • J� ,� adjacent thereto encroach on the premises in question and
>� �o • , • 05 that there are no roadways, transmission lines or other
Q�sstoNAG•�� visible easements on said property except as indicated
SCALE: 1"= 50' ® hereon.
Dated at Anchorage, Alaska
EASEMENTS OF RECORD, OTHER THAN " ` this 20th day of AUGUST ,2019.
THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C.
PLAT ARE NOT SHOWN HEREON. FB 83-4, pg 56 BEEngineers and Surveyors
UNLESS OTHERWISE NOTED FB 19-6, pg 33-34 907-248-1666
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION /~-/~-
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
DISTANCE TO: ell
PHONE ~,,N EW
Absorption arco
IWidth
Well Nearest lot linc
DISTANCE TO: ~ /.~C') I ~' ~/ ~ '~, 42
No. .... of lines ~:? I Length o f/e)~ line ___T°tal bmgth~/~/°fD-lines ___J Trench~?~ 2~width
NO, OF BED GeMS
Type of crib
PERMIT NO,
No, of compartments
[Inside length Liquid depth
Dwelling PERMIT NO.
Liquid capacity in gallons
Foundation
inches
PERMIT N~.
inches
Depth PERMIT NO.
Crib diameter Crib depth Total effective absorption area
Distance between lines
Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
C~ass ~,~ ~/~, ~'~. Depth Driller Distance to lot line [PERMIT NO.
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
/b-O
INSTALLER
'4,~'2 .'
~,,,,,,:- ;,.: ..... -;,:/~:
APPROVED
LEGAL
DATE
?~-013 {Rev. 3/?8)
Dk.I Al [ilk.ill OF~ HEALTIq AND EI;IVIROIqMI~'N'['AL ~ hL I EA.,1 tON
U,:;,. L.. STREET,. ANCHEIRAGE_ . . .~ AK 9950;L ~.
2'.64'""472() ~~
85 :: & 15
. ~/,~,q
AF'I':'L I CANT: RCH3EITI'
ADDI::~ESS~ 2,52~27. ARCTIC BL.VD.
ANCHORABE, ~l'( 99503
C[]NTACT PHONE n 2'76- 12'.3'1
I...,EGAt.,, DESCR I F' ~ SUBD I V I S ]: UN:: ]"HOM~S
SECTION~ 33 TOWNSHiF'~
[.0]' SI Zl:~:~ 1.2:'.5~ (Sill. t::'T, OR ACF:~ES)
MA)( BEDROOMS: 4
12 N
I...,OT~ ,/u~ [: L. OCI'::': NA
RANGE ~
DE]::"TTI 'TI] F:'IPIE BLrI'T'Oi~I ([:3'.)
GRDV]~]... WIDTH (F'T.)
Eff~AVE:I.. LIENBTH (F:'T.)
GRAVEl,,. V[IL. UI'~E (CI.I, YDS,,
'lANK SIZE (EiALS)
SOIl..,, I::i:A]'II~IE~ (S[~. F:'T.
4.0 4 ,, 0 ' 4.0
~,, .~ .... 6,, o fl~'~ q.O ~,, 0
90.0 .~.~. 50 ,, 0 97 ,, 0 .~.,~c.
45 .. 9 48.2 7 :[., 9
250.0 .~+.x. 1,250.0 .~..~. 1 ~, 250.0 .x..~
225 2 :[:$ 225
.x-.~+ GI:~AVEL.. Ir..I:~:I~IGTH > 75 FT ,, F:~EQU I FdES ] ItlL] J. F.I..,.l::.hI.Jl'" xl" (N[Ff k,X(,,[::.k:.D ........... 1 [xll:~ '* "7d' F::"F. Ei:AE;H )
'~*')'," 'I"ANI< I'IU¢~ I HAVE AT I,..EAS]' TWO LC)MI AF~I I Ib. N
I (:::el'~'t, i £ y 'Lhat }:
:1... I am t'am:i, liar
forth by the'Mt.ln:tC:il:]aIity of hnchorage (MOA) and tile StaLe) cD' Alaska.
I wi 11 4nstal 1 ihe ~iyEitl.:~qll ill &IC:COf'CI~:H'ICE} ~J.'LI] al 1 MOA (::odes and
~M"ld J.f'l c:ofliFl].ianE:~ 14:L'[.h '~.I-IF:~ c:h~}sJ, gn c;':i, kef,:[a (:)f 'k,l'~:i.s p¢~rlll:i.'l'..
I ~:i. 1;I. aclh6H-t] to a],]. MI]A ~:~nd ~LatE¢ Cif' A:[¢~P~kl;;l I'G~qLliPE~mE.~ITL~ I'EIP the set back
c:lis'k, arrlt::es fPorr, al'ly exist:D"lg well, waE;tewa'lter, disposal system or public
any errllal,g(.~mellt w:i. ll I"E))CIIAiI'E) 6]1r1 acldi't.:Lor'h:.~l
IF A I..II::'T S"I'A'T'I()N iS ilIS1AI..,,Lk, D IN ANAId,A C[)VEI:rdED BY M()A I:IJlLD.[NG ....... CODES,
THEN (1) AN EI_EC1Fd. E,AI.. I-I.:.hM]. I AND IIqE~F'EC"I"~[)Iq MUST BE [)BThZIqED~ (c,) A,..~ I,
15LE[::D'I:4 ICAL WfJRK__ -iqLIS'[', BE DONE BY ~'~ I CE:NS[ED EI.~.E
]
Ahl
.I.,:~,:~LI[::.D BY -' DATE:
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF MEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEER'S SEAL)
1
2
3-
4-
5-
6-
7-
10-
11
14-
15-
16-
17-
18-
19-
20-
?
WAS GROUND WATER
ENCOUNTFRED?
s
L
IF YES, AT WHAT O
DEPTH? p
E
Depth Io Water Alter
fY1onltorieD? Oale:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND __ FT
COMMENTS
ACCORDANCE WITH ALL STATE ~ND MUNICIPAL GUIDELINES IN~ ;FF~CT ON THIS DATE [)ATE' /~)/zI'TZC¢~,&~ (Rev. 4/85)
SOILS LOG
MtJNIClPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
~V~
2
3
SLOPE
[)ATE PERFORMED:
SITE PLAN
COMMENTS
WAS
GROUND
WATER
S
Gross Net Depth to Net
Reading Date Time Time Water Drop
~-~ '1 o / '~. ~
. ~2"'~ FT AND
TEST RUN BETW EN
(minutes/inch)
//~g-" FT
72-008 (6/79)
Certificate of On -Site Systems Approval
Parcel I.D., 0 18-262-26 1 0)
Expiration Date: - -�A CL n - - 0
1. GENERAL INFORMATION
Ccrrripiete legate description
_-T ornas--Lot _1.
Location (site address) 3501 TwilightLane
Current property owners) Scott &Angela Felger Day phone
Mailing address 261 Oertli Lane Hamilton, MT
Real estate agent Day phone
❑ Single Family (w/wo, ADU)
r_1 Duplex
El Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
FX 1
Private Septic
El
Water Storage
El
Holding Tank
Fj
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA4_._W fw 115 0 6 Waiver #
U. -
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures
outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or
wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated
herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA
COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time
of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on
the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the systema
These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not
guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot
provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole
benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly
recommends buyers hire their own engineer to evaluate this report.
Name of Firm Pannone Engineering Services
Address R.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E.
6. DSDSIGNATURE
/
�/ System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Phone (907) 745-8200
Date 10/23/2019
... .. .......
anna
�. CE 8149
Conditional approval for bedrooms, with the following stipulations:
OF�L`.c(���i.
Xj
N-S1TF
WATER AND m
By: I` �" u, �Cc�tirt Original Certificate Date: /,;l 5
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site,Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: Thomas L1 Parcel ID: 018-262-26
If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 2
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled Unknown
Total depth '40'* ft
Cased to >40'* ft
❑ Sanitary seal is functioning correctly
- ❑ Wires are properly protected - -
Casing height (above ground) 12 in.
Date of flow test for COSA 7/17/19
Static water level at beginning of test 63.7 ft.
Comments * Data from previous Cosa
B. TANK DATA
Age of tank(s) 1f"'9 years
Tank type/material Advantex
Measured operating fluid level in septic tank n/a
0 Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA Shallow trench/ Bed
Which system tested (date installed) 10/2/19
0 ALL standpipes present per record drawing
Total measured depth from grade 4.5 ft (max)
Measured depth to pipe invert from grade ft (min)
❑ N/A — pressurized field
0 Monitor tubes go to bottom of effective. If not, state
depth into effective
Al Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Well production at time of test 5.0 gpm
Water storage tank volume n/a gallons
Well disinfected for coliform test? ❑ Yes ❑✓ No
❑ Coliform bacteria is Negative
Nitrate 3.44 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Pannone Engineering
Date of Sample 7/17/19
C. LIFT STATION
ON Required maintenance completed
Age of lift station 10/7/19 years
Lift station material Fiberglas
Comments:
Adequacy test date n/a
Results []✓ Pass For 4 bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
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'
121
Yes
Community Sewer Manhole/Cleanout > 100'
ft
If absorption field is under driveway comment below
❑✓
Yes
if No
ft
❑✓ Yes
if No
ft
Neighboring Tank > 100'
✓❑
Yes
if No
ft
Private Sewer/Septic Line > 25' ❑✓ Yes
if No
ft
Absorption Field on Lot > 100'
r-,/�
Yes
if No
ft
Holding Tank > 100' ❑✓ Yes
if No
ft
Neighboring Absorption Fields
> 100'
Animal Containment > 50' ❑✓ Yes
if No
ft
✓❑
Yes
if No
ft
---
-Manure/Animal-Excreta-Storage >-100'
----
Community Sewer Main > 75'
MYes
if No
ft
0 Yes
if No
ft
From Septic/Holding Tank on Lot to: (Please
enter distances if less than required)
Building Foundations > 10'
0
Yes
if No
ft
Surface Water > 100' ❑✓ Yes
if No
ft
Property Line > 5'✓❑
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
❑✓
Yes
if No
ft
Private Wells > 100' r7l Yes
if No
ft
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200' F,/7l Yes
if No
ft
Water Service Line > 10'
R�
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'
121
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑
Yes
if No 5.8
ft
Wells on Adjacent Lots:
Water Main > 10'
✓❑
Yes
if No
ft
Private Wells > 100' 121 Yes if No ft
Water Service Line > 10'
M
Yes
if No
ft
Community Wells > 200' Q Yes if No ft
Surface Water > 100'✓❑
Yes
if No
ft
F. ENGINEER'S COMMENTS
Double clean out installed before tank and clean out located inside of foundation.
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date. 10/23/2019
COSA Checklist yellow sheet
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this1 Day of _ �7;v- tr , L:20 9 . by and between
en
herein the '-0�3v'�]ER." and the Municipality of
Anchorage, herein the "MUNICIPALITYY". in accordance with Anchorage _Municipal Code
(AMC) 15.65-365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced WasteNvater Treatment Svsteins. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as
located at (legal description) 7 I �,
2. Maintenance, Repairs and Alterations.
(Owner is required to read. understand and initial each section)
Throughout the term of this Agreement. the Owner shall enter into a sery-ice agreement
with an AWW"I'S service and maintenance provider approved by the .Municipality or the
manufacturer`s representative. The AN\. IWTS shall be maintained in a satisfactory
condition capable of performin` as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Ow7.ier during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically S400 to S600).
%r Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative xvill inspect and make any necessary maintenance.
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system. which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Pa -e 1. of 3
Owner acknowledges that the 'Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AR'WTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to (,rant the Municipality reasonable access to test and inspect the
AWWTS. The .ljlunicipality will give at least 24-hour tlotice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems :approval_
Owner agrees that the AVv'WTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction. maintenance and repair of the Owner's Au WTS.
= Ov«ner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The terns of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system. or upon transfer of title. and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
A-reement shall in no way constitute a waiver of the provisions. nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. ,any civil action arising. from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Aureement.
i. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05%18/2018) Page 2 of
OWNER:
By: (signature)
(print name)
�-STr\TE OF ALASKA
THIRD YUDICIAL DISTRICT
Thefore(-YoiiiL,,,i�struiiietit was acicng��yleclged before me thi
-)o i - - I/ -.-- -
NITOTARY PUBLIC FOR ALASKA"
I
My,�&mmission expires: tyi
MUNICIPALITY:
By:��L'0 A,ccTu lc(Sio,_u
-- al
—nature
.cc -a- Cox'ro U (print name)
(rev. 05/18!2018)
Date: j
,U day of
R NOTARY
PUBLIC
Date:
Title:
Page 3 of 3
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE ~ ~,
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES '~(~ ¢?1l('
343-4744 ,.(~ /-,~''~
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLF FAMILY DWELLING
1. GFNERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location ( .~fi~.~r
pro pe~ ~'~*~" **'~G~~ Telephone: (home)
(b)
Mailin¢,Ad~[e~.¢~ .¢> ~'.' ..
(c) Lending T~S~t~utfeR.~,.,**' ~"~,¢~ Telephone
Mailing AddreEs: -' ,,r.~ ,¢ '~*
(d) Real Estate Company and Agent
Address ~ ~ ¢% ~'
Business
Telephone
(e) Mail the HAA to the following address: (or check heretiC, if hold for pick up,)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family'~ Number of bedrooms _ ~
3. WATER SUCPL¥
Individual We/l'~. Cdmmunity [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status,
4. SF. WAGE DISPOSAL
On-site'~. Public [] Community [] Holding 'rank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025(Rev. 7/88) Page 1 of 2
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le^oJdd¥/q!JOq~nv q~leeH senss! (SH HQ) seo!^Jes ueLunH pub q~lBeH lo ~ueLu~Jed@c] eDeJOqOUV to ,~!lBd!o!un~ eq.L
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NOI~BOJNI ~N~ ~a 'MOB~tS tllJ 'S~St~ 'SNOI20~dSNI 9NIglAO8d ~alJ 9NIB~NISN~ 'g
MUNICIPALITY OF ANCHORAGE! (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
Well Classifica~Ltio~ ......... ~'~/~'4/,'¢4~-.~---~-~- .... %.~[If A, B, C, D.E.C. Approved (Y/N)
~11 Log Present (Y~ Date Completed ~ ~'~ ~ Yield
Static Water Level _ ~' /
Casing Height Above Ground
Electrical Wiring in ConduitON)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results ~ 7'
Comments g A/~¢¢'/.~
Pump Set At /.')/,~
/
Sanitary Seal oe Casing~N)
Depression Around Wellhead (Ye
; On Adjoining Lots
/~'~ '¢' ; On Adjoining Lots
_ To Nearest Public Sewer Cleanout/Manhole
; Date
B, SEPTIC/HOLDING TANK DATA
Date Installed /~¢~-~'-~Size
Standpipes
Depression over Tank (Y~
Pumping/Maintenance Contact on File (Y/N) ~ ;for
Holding Tank~t~larm~ --~~--~ (Y/N) __ ~ Temporary Holding Tank Permit (Y/N)
To W~~~:~~ To Building Foundation
To p~f~e~¢ ~ ~. ¢ TO Disposal Field
To Str~:~d, E~e ~r ~,Drainage Course
/ ~'~"'¢ NO. of Compartments
Air-tight Caps ~YN) _ Foundation Cleanout(~(N)
Date Last Pumped
72-026 (Rev 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
Depression over Field (Y~.~
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot ,,,v//
To Water Main/Service Line
/o'/'
/4/'¢-
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes PresentON)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots /~ 'P
To Cutback (if present) ,~/~
/cd/,¢
D. LIFT STATION
D a"'"'"~l'~t e t~ Dimensions
Size in Gallons ~'----.~ Manhole/Access (Y/N)
"Pump On" Level at ~'"~_ "Pump Off" Level at
High Water Alarm Level at ~'"~'--.~_ Vent (Y/N) _
Tested for -'"~'"'"~_.......~mping Cycles during Adequacy Test.
cM;r~t~eMnt% Electrical Codes (Y/N)
**Check Permitted Bedroom Rating Against HAA Request** '~
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed ~ ~/t'~"~
Company
Date
MOA No,
Receipt No.
Date of Payment
Amount: $
er's Seal
.o '"""'
Receipt . ~
Waiver Fee: $
Date of Payment
CItEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELI-2PHONE (907) 562-2343
FEDERAL TAX ID # 92-0040440
ANALYgIO hEPORT BY SAMPLE £or Work Order t 12112
Date Report Printed: }dAR 14 89 ~ 10:38
Client Hample IDAC, THOMAS SUB PRESSURE YAHH
PWSID :UA
Collected ~IAR 9 89 ~ l?:O0 hYs.
Heoeivod HR 10 89 @ 14:00 hrs.
Preoerved with :HOSE
Client Hame
Client Acct
P,O.{ HOHE NEC'D
Req #
Ordered By
Analysis Completed :MAR 13 89 Send Reports to:
1)A E C S
Laboratory Dupery~so/;_:S~gPHEN C. EDE
Special
Instruct:
Chemlab Rof #: 4491 Lab Bmpl ID: I Matrix: WATER
Allowable
Parameter Tested Hesult/Unlts Method Limits
NI~HATE-N 0.21 nH/1 EPA 353.2 lO
Bample ROUTINE SAMPLE.
Remarks: 8AMPLE COLLECTED BY g.P.
Tests Performed See Special Instructions Above UA-Unavailable
None Detected '* See Sample Remark8 Above
Not Analyzed LT-Lees Than, OT=Greater Than
A CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
/,""'*'~* ..... ~ Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATEF1 SUPPLIER
~¢ PRIVATE WATER SYSTEM
Name Phone No.
Mailing Address
City Sthto
SAMPLEDATE: ['~--T~ ~' ~]Mo.
SAMPLE TYPE:
,~ Routine
Ch.e. ck Sample (for routine sample
w~th lab ref. no. .)
[] Special Purpose
SAMPLE
NO. LOCATION
31
4 L 4 _
Zip Code
TO BE COMPLETED BY LABORATORY
Analysl~i ~hows this Water SAMPLE to be:
~:'at I~'f actory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new s, ample via special delivery mail.
Date Received ~, --/0 '~' ~
Time Received _ / (¢,od~
Analytical Method: Membrane Filter
/[~Treated Water
Untreated Water * No. of colonies/100 mi.
Time Collected Lab Ref. No. Result*
£~ I ~.RI I I-I~
I I-F1
I
Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
TNfC = Too Numberous l'ol
OB = Other Bacteria
Membrane Filter: Direct Count
,~/orlflcatfon: L'r'B BGB.
hFInal Membrane Filter Results _
teported Bye-' -Date
Time:.
Count
BACTERIOLOGICAl. WATER ANALYSIS RECORD
Collfor~nll00ml
Coilform/100ml
, /
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL H["ALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL.
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date IO/~/_/~
(a)
GENERAL INFORMATION
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ~ ~-- Telephone: Home ~7~ "/~1 _~ Business
Applicant Address ¢~¢ --~ ~¢~ ¢¢~'~ ~
(c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer~; Other ~ (explain);
(d) Lending Institution _ Telephone
Address
(e) Real Estate Company and Agent
Address
(f)
Telephone
Mail the HAA to the following address:
TYPE OF RESIDFNCE
Single-Family/~ Multi-Family
Number of Bedrooms
Other
WATER SUPPLY
Individual Well~ Community
Public
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAl.
Onsite~ Public [] Community r~ Holding Tank []
Note: If!community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, [)ATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that rny investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein, I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, tile 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 _ ~ - Telephone __¢~'"~¢~'
Address ~,O _~, ~ /
DHEP APPR O)f~..
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues FleaRh Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHF_P does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
MUNICIPALiiY OF ANCHORAQF:
DEPI', OF HEALT;I
MUHICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA) "')-'
CHECKLIST - FEBRUARY 1984
264,,4720 ~/~
Legal Descripr,on: .~' ~.7
71 [ isV E D
T/
WELL DATA
Well Classification r~.,~> if A B, C, D.E.C. Approvea (Y/N)
Well Log Present (Y/N) i"/ Date Completed ~/'~-~¢4,'"'¢~'t Yield
Total Depth _ ? '~/(~ ~' Cased to ~ ~;/(.-'/ ~"~ Depth of Grouting .
Static Water Level ~-~
Casing Height Above Ground /~~-¢~
Electrical Wiring r~ Conduit (Y/N) _ Y'
Separation Distances from Well:
To Septic/Holding Tank on Lot >//o
Pump Set At 1~,; ¢'-/~, ,-¢./
Sanitary ,~eal on Casing (Y/N) ~"
DePression Around Wellhead (Y/N) ~/
: On Adjoining LOtS
To Nearest Edge of Absorption Field on Lot _~ 1 ~O _: On Adjoining Lots ~
To Nearest Public Sewer Line ¢'/~' All---'- To Nearest Public Sewer
Cleanout/Manhole ___/,40 hl IE- To Nearest Sewer Service Line on Lot ;~'
Water Sample Collected by _ ~-~.. . Date /o/.~.,¢..~
..,
Water Sample Test Results ~',"-?-~ ~'
Comments
B. SEF'TIC/HOLDING TANK DATA
Date Installed l/'z¢ ¥~
Standpipes (Y/N)
Depression over Tank (Y/N) by'
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) _ h/~//-~
Separation Distances from Sepuc/~o~amg Tank:
To Water-SL pply Well _
To Property Line
To Water Main/Service Line
Course
Size /~)-~( ! ~ No. of Con- ~artments T¢-''~'D
Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) ~'/
Date Last Pumped I~l~'~'~-/
:for
Temporary Holding Tank Permit (Y/N)
· To Building Foundation ~--' ~'
To Disposal Field ,/~-
To Stream Pond, Lake. or Major Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date InstalJed / t:~','~//~S:'~
Width of Field
Square Feet of Absorption Area f ¢~'¢'~-to
Depression over Field (Y/N) ~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ?/,'~~~?
To Building Foundation .~/c-%~
Lot ~O/~/~--
To Water Main/Service Line ~¢ E~
To Stream/P~nd/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field ~¢~' '~
Depth of Field //'/'~-~'~
Gravel Bed Thickness /-'~//
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line ~'~
To Existing or Abandoned System on
; On Adjoining Lots ~>
To Cutbank (if present)
D. LIFT STATION N 0 ~'~ '~
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating. Against HAA Request **
I certify that I.have checked, verified.pr conformed to all b~OA and HAA guidelines in effect on the date of this inspection,
_ _ // IV ~ .
./
Date of Payment
Amount: $
Page 2 of 2
72 026 (11/84)
Engineer's Seal