HomeMy WebLinkAboutSKYHILLS PH 1 BLK 2 LT 25
kyh1*11s #1
Block 2
Lot 2
#011-122-26
Municipality of Anchorage Page 1 of 3
Department of Health and Human Services
Division of Environmental Services
Onsite Services Section 825 •L• Street Room 502
P.O. Box 196650 Anchorage. AK 99519-6650
www.d.anchorage.ak.us (907) 3434744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SWO10027 PID Number: 011-122-26
Nem*:
The Petersen Group, Inc.
Wastewater System: New
Address:
3820 Lake Otis Pkwy. Anch. AK 99519
ABSORPTION FIELD
mxnbe, a eeasane:
562-1170 Four 4
Deep Trench
LEGAL DESCRIPTION
Soa Ratug
Tda DapM hom agny grade:
.6 GPIVFI•
11.5 Ft.
ek Gk: LM: subdrtum:
Depth M PDS bMm ham orp�nel grade:
Grew depM beneath k e:
2 2 Sk hills No. 1
3.5
8
Ft.
Ft.
Twnel.p: Range: sec :
Fal addax above ongmel grade:
Gravel Le,wgih:
1 Ft.
64 Ft.
Well: City Water
Gravel wMM:
Numbe,or knes:
auence balween lvMa:
3 Ft.
1
N/A FI.
aasukaum (R"te. A e. cl:
Teel DepM: Used M:
Tblel absapbm e,ea.
F" wter :
Ft. Fl.
1,024 FP
I ASTM D3034 PVC
Drawer:
Dale Dnked: SIabe Wale, Level:
klMaaer:
Dale Mallei
Ft.
Kincaid and Sons
4/18/01
Tield:
Panp set W:
Cas" MAbb"Grburwd:
TANK
Gvkr
Ft.
FI
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
Lift
Holding
bl"Pnvate
u<e,.
Dao". MIUS.
From
Tank
Field
Station
Tank
Sewerune
Anchorage Tank
1,250
Wee
>200'
>200'
N/A
N/A
>25'wail.
Steel
ba padmenw.:
Two (2)
Solace Wawe,
>100'
>100'
N/A
N/A
LIFT STATION — NONE ON LOT
(a ran.
>5'
>10'
N/A
N/A
w r
Get
FaMdewaa
>5'
>10'
N/A
N/A
-717mppnkeviat.p
at.
I
ti.
In
In,
rm,:r dun
None
INoted
I
IL\
Mme Make. Ladel
Ebctrral irapapgna Womkod by:
Remarks:
BENCH MARK
bon a ptaaw:
Garage Slab
N.alkm:
100.0 FL
.r. Ormvj
F A4 to
4918
Inspections performed by: Mike Anderson Dates: 1st 4/18/0100
*' .........� • • • ... r
2'b 4/18/01 0
..f>Gi�t ..
>o MICHAEL E. ANDERSCN•�'t •�
Department of Health and Human Services approval '
° c •. cE -4331 .� r
Revgewed and approved by: Date: -' / �� �
8 L" •. • •vim.:
f f
io It
It
F
Municipality of Anchorage Page 2 of 3
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-6650 - 343-7904
Onsite Wastewater Disposal System or Well Inspection Report
Permit Number SWO10027
_ Water Service
Line
PID No. 011-122-26
N 90000'00"E 207.83'
1=
GRAVEL DRNE' \ C4
O \
W o
C;
U)
p
30' 0:
? M Four.
Bedroom
Alternate Home
Site
//
3
h
0
2
0
aft
SD
S1
��'ytO gq�e9 C=279Sg• R=570.00•
�P��•'. Cqs�®e o
�1✓�...:-GfuoC;--� ORS
-MICHAEL E ANCERSCN ,2� r
CE -4331
IFO`` CLP`fESS��Yta."`,
PLAN AS -BUILT
SCALE 1"= 30' „
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-66650 - 343 7904
Onsite Wastewater Disposal System or Well Inspection Report
Permit Number SWO10027 PID No. 011-122-26
r 1 N rqm
Page 3 of 3
20'
M
E= U
Ceotextile, Fab
0 Drainfield Roc
--n .✓ .� P� 80.0+
.` 49IH%`v * 39.5' 24'
p7.
. Trench Length - 64'' _
0, M-CHAZL E AMJERSCN W
s;. CE -4331 PROFILE AS -BUILT
1"-10•
OG/PT
Fine Sand
Some Silt
SM
Was Groundwater
9 Encountered? No
If Yes, What Depth?
10 Depth to Water
After Monitoring None
11 Date: 4127101
12
13
14
15
Bottom of
Hole
See Site Plan
Reading
YY
Net
Time
Depth To
Water
Net
Drop
1
8 -Apr 11:10
JW
*�
Municipality of Anchorage
4%✓.�
Department of Health 8 Human Services
p : MICHAEL E. ANDEQSCN ; O
r
825 L Street, Anchorage, AK 99502-0650
�� ��� •,• CE .4381 ��,`;
SOILS LOG- PERCOLATION TEST
•:
11.41
`a�o �\``:�o"
Ilk
Performed For. The Petersen Group Date Performed:
4118101
Legal Description: Lot 2. Block 2. Sky Hills. Phase I
12:41
SLOPE SITE PLAN
OG/PT
Fine Sand
Some Silt
SM
Was Groundwater
9 Encountered? No
If Yes, What Depth?
10 Depth to Water
After Monitoring None
11 Date: 4127101
12
13
14
15
Bottom of
Hole
See Site Plan
Reading
Date Gross
Time
Net
Time
Depth To
Water
Net
Drop
1
8 -Apr 11:10
1.75"
2
11:40
30
4.25"
2.5"
3
11.41
1.75"
4
12:41
30
4.13"
2.38"
5
12:42
1.75"
6
1:12
30
4.13"
2.38-
Perc. Rate: 13 MinAnch Perc. Hole Diameter. 8"
Test Run Between 4 Ft. and 5 Fl.
Comments: Soils Encountered are Identical to Those In Testholes 4 and 6. Percolation Rate Slightly
Faster. Test Hole Pre Soaked Prior to Testing.
Performed By: Mike Anderson. I, Michael E. Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 8130101
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
MEMORANDUM
DATE: September 5, 2001
TO: Jeff Poet
FROM: Mike Anderson, P.E.~' " IJA'4�1
SUBJECT: Lot 2, Block 2, Skyhills Phase 1
Septic System As-Built/Certificate of Health Authority
Attached is the revised as -built for the subject lot. I have included a letter stating the
reasons for the relocation of the septic system. Also attached is the test hole
completed in the area of the revised location along with additional percolation data.
have also reviewed your third comment concerning the depth of the test hole. The hole
was 18' deep and 1' of fill has been added above original ground. The top elevation of
the test hole was originally 98.0' making the bottom of the hole 80.0'. This depth is
more than 6' below the bottom of the trench which is shown as 86.9'.
Please let me know if additional information is required.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522.6779 (FAX)
June 26, 2001
Municipality of Anchorage
Building Safety Division
On -Site Water and Wastewater Program
4700 S. Bragaw Street
Anchorage, AK 99507
Attention: Jeff Poet
Subject: Lot 2, Block 2, Skyhills Subdivision Phase I
Septic System Location
Dear Jeff:
The owner of Lot 2, Block 2, Skyhills Subdivision Phase I moved the location of the new
house on the lot after the septic system permit had been issued. The new location
required the rerouting of the driveway over the proposed alternate septic site area. The
house was moved approximately 70' east making the planned location for the septic
system unfeasible. A third test hole was placed near the location for the new septic
system. Soils were found to be identical to those in the other two test holes previously
placed on the lot. A percolation test performed indicated a rate of 13 minutes per inch,
which was slightly faster than other soils encountered. The slower rates were used,
however in the design for the relocated system.
The soils on the lot were found to be consistent throughout and were primarily sand with
a small amount of silt. These soils are found uniformly throughout Skyhills Subdivision.
The new location of the septic system does not conflict with other systems in the area.
It is also further from the water service line than the original design location. We hereby
request the revised location of the septic system be approved.
Sincerely, QA
F_
Michael E. Anderson, P.E,
Attachment
"..•' / ;Z AV. zA,5PS-c7ioti,
Permit Number: SWO10027
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
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
3 .' God; •� .
Pr (%I o,t,
Date Issued: Mar 01, 2001
Expiration Date: Mar 01, 2002
Parcel ID: 011-122-26
Legal Description: SKYHILLS PH 1 SUBDIVISION BLOCK 2 LOT 2
Design Engineer: 0014 Anderson Engineering Site Address: 8050 SKYHILLS DRIVE
Owner Name: THE PETERSEN GROUP, INC. Lot Size: 40168 SO. FT.
Owner Address: 3820 LAKE OTIS PARKWAY, SUITE 204 Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE, AK 99502 -
This permit Is for the construction of:
M✓ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy M 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: (Sc C5 a d`_
Date: 3-1-01
Municipality of Anchorage
• Development Services Department
i
.Building Safety Division
Onsite Water and Wastewater Program _ ,
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 011 —122 — 2 6 Permit Number SW 0/0027
Property owner(s)The Petersen Group, Inc: Day phone 562.1170
Mailing address (1) 3820 Lake Otis Parkway Suite 204 Anchorage AK 99508
Mailing address(2)805•0 SkYN)Lts DRIVE Zip Code
Legal description (Lot, Block & Sub'd.) Lot 2, Block 2, Skyhills Subdivision lam ph
Legal description (Section, Township & Range)
Lot Size 40,168 SF Acres/Sq.Ft. Number of Bedrooms Four (4)
THIS APPLICATION IS FOR:
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. 1 further certify that this application is being made fora
Single Family Dwelling and is in accordance with applicable Municipal Codes.'.
(Signature of property owner or authorized agent)
Permit Fees: Waiver Fees:
Date of Payment: Date*of Payment:
Receipt Number: _f/� Receipt Number:
(Rev. 12/00) .. -
ANDERSONENGINEERING
P.O BOX 240773'
ANCHORAGE, AK 99524
5227773 ;;'522.6779 (FAX)
February 28, 2001
Municipality of Anchorage
Development Services Department,
On -Site Water and Wastewater Program
4700 South Bragaw Street
Ahchorage,'AK 99519-6650
Subject Lot 2, Block 2, Skyhills Subdivision Phase 2
Septic System Design and Permit Application :
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
: The owner of Lot 2, Block.2,'Skyhills Subdivision Phase 2 intends to construct a four
bedroom home on the currently vacant lot.'.We are therefore applying fora permit to
construct a new septic system on the lot to serve the new home. The attached'Site
Plan and, backup documentation identify; the `location and configuration of the'new
:septic system and the parameters used inthe design. It also shows the'location of the
-alternate site and the water, service line.:'The subdivision is currently served by the..
:..Municipal water system. .'.
Two test holes were placed on the lot at the locations shown which indicated silty sand
with some gravel to depths of.18'. No groundwater was noted in either test hole during;'•
excavation or during the monitoring period. , We are therefore proposing to place a 3':
wide by 63' long absorption trench with'8'.6f drain.field rock beneath the distribution.:
pipe.The :pipe will be placed at 3.5' below the existing ground surface and the total
depth .of the. trench will be 11.5'. A minimum of 3' of cover will be placed over the .
trench to prevent frost penetration and possible freezing.
The ground surface on the lot slopes as shown on the attached Site Plan. The area for,
the new absorption trench,• however, is fairly flat. The new trench will be constructed
parallel to the contours of the surface .in conformance with Municipal requirements.'
Grading wilf be accomplished to assure surface drainage is away from the,new trench:
'If the; system is constructed in accordance with our design the following .statements
apply.
L'. The system, if constructed as designed will have no adverse impact on the wells
in the area'or those to be constructed in the future The subdivision is currently
'.seryed by the Municipal water system. •
2. The system, if constructed as designed, will have no adverse impact on existing `
septic systems in the area or those to be constructed in the future.
SkyHills Subdivision
Test Hole Locations
LOT 2, BLOCK 2, SKYHILLS SUBDIVISION N0. 2
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home Deep Trench System
Perc. Rate: .19 Minllnch 1,250 Gallon Septic Tank
Application Rate: .6 GPD/SF, 8' Drainfield Rock
4 Bedrooms X 150 GPD /.6 GPDISF = 1,000 SF of Absorption Area
1,000 SF/16 SF/LF = 62.5 LF Trench Length
Therefore: Construct an Absorption Trench 63' in Length by 3' Wide With 8' of DrainSeld
Rock Beneath the Distribution Lateral. Distribution Lateral to Be
Placed 3.5' Below'
Existing Ground. Total Depth of Trench to Be 11.5' from Existing Surface. Mound Over `
:Trench if Necessary to Provided Minimum Cover of 3'. .
���.. -i
.. � /ss.\\s •\ate \w . _ ' a /s/ as
s a .. •.. .
Natural.
216"
Backfill
Geotextile.,
6
Fabric
4"'Perforated
8'
PVC (Slots
Down),
�.. /
Drainfield
Rock
TYPICAL DEEP TRENCH SECTION
` SCALE)
> (NO
NOTE: Grade Area Over Trench to Drain Away.
Minimum
,tt
�s °
'�
6' Separation From Bedrock.„i
Minimum 10' Separation From Lot
�i t
Line.
Minimum 10' Separation From Water Servico Line
Minimum 4' Separation From Groundwatert?.t
•
a�L(r.
F.�LS'ws�� ,
eo
a
. - rr�7�a�:F` as y,Yl"•1�: F. M�
' - - - ,py ii', �.•. rip=iX ��i
. 1a} t
Municipality o1 Anchorage , i`
DEPARTMENT OF HEALTH 8 HUMAN SERVICES y,ypM�.�tea•`• • '
ry/re7���7j �r
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST S`:�[`�i't.. .•;�i:`_
PERFORMED FOR: 1Z r F.L {{11 Construction, Inc. DATE PEi�FORMEO:
LEGAL DESCRIPTION: l./Z, %F •7 5/t> Township, Range, Section:
,. DE T' 6, � SLOPE . SITE PLAN
10 , - WAS GROUNDWATER / _ -
( - ENCOUNTERED? /y -
11 s
IF YES, AT WHAT L
12 DEPTH? _ F
E
'
Dep b Wyer AeipP
13 / Iia b ngT DatC 14 IP6
14 _ • : - Reading Date - Grms T� - T� Depth to Net
Water Drop
15
16
17
A: ex)
18
19
20
PERCOLATION RATE Ib tmmutevmchl PERC HOLE DIAMETER 6 i
TEST RUN BETWEEN FT AND' FT
COMMENTS Pere -cavity Was presoaked prior totesting - - -
.PERFORMED BY:. —��/ - ( TIFY THAT THIS TEST WAS PERFORMED IN
Michael B. Anderson •L .La �0/ .
- ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
N
/
o
01
b
c3�v
I
10 , - WAS GROUNDWATER / _ -
( - ENCOUNTERED? /y -
11 s
IF YES, AT WHAT L
12 DEPTH? _ F
E
'
Dep b Wyer AeipP
13 / Iia b ngT DatC 14 IP6
14 _ • : - Reading Date - Grms T� - T� Depth to Net
Water Drop
15
16
17
A: ex)
18
19
20
PERCOLATION RATE Ib tmmutevmchl PERC HOLE DIAMETER 6 i
TEST RUN BETWEEN FT AND' FT
COMMENTS Pere -cavity Was presoaked prior totesting - - -
.PERFORMED BY:. —��/ - ( TIFY THAT THIS TEST WAS PERFORMED IN
Michael B. Anderson •L .La �0/ .
- ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
.1
�11 •.• ♦.1� ��iii•✓/�
• - Municipality of Anchorage • , . `A
DEPARTMENT OF HEALTH & HUMAN SERVICES is.�
825 "L" Street. Anchorage, Alaska 99502-0650 .413 f�; ailw
SOILS LOG — PERCOLATION TESTu'
PERFORMED FOR:
L H Construction,'Inc.
DATE PERFORMED:
LEGAL DESCRIPTION: w, D���,�j/b Township Range Section'
DEPTH SLOPE SITE PLAN -
1
r•'
rl/DL—
Z.
•�.
M�-.
3
- ENCOUNTERED? -
11
�fS
'/••
IF YES, AT WHAT / 0
6
e•.•
_
DEPTH? fP p
_
8
8°00
- Depth to Wsa Mer -' .
B lgl�s
0Re,.
S.
�n��? Dale
G
14 Co e6.44 /O• .
: 4
15 °c �
oD0 Dy
. .16 O OO f
17 -
P&O
18
19
%201
PERCOLATION RATE —1`• Irtunutevmchl PERC HOLE DIAMETER to 1'
TEST RUN BETWEEN �4– FT AND ..C�FT - - -
COMMENTS' Perc Cavity Was presoai:ed pri" to testing -
PERFORMED BY: - / - ✓V 1 TIFY THAT THIS TEST WAS PERFORMED IN
Michael E. Anderson
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
j_
10
WAS GROUND WATER
- ENCOUNTERED? -
11
�fS
'/••
IF YES, AT WHAT / 0
. 12
e•.•
_
DEPTH? fP p
■i�■iiia
., 13
8°00
- Depth to Wsa Mer -' .
B lgl�s
0Re,.
S.
�n��? Dale
■
5
i■�■s
e
G
14 Co e6.44 /O• .
: 4
15 °c �
oD0 Dy
. .16 O OO f
17 -
P&O
18
19
%201
PERCOLATION RATE —1`• Irtunutevmchl PERC HOLE DIAMETER to 1'
TEST RUN BETWEEN �4– FT AND ..C�FT - - -
COMMENTS' Perc Cavity Was presoai:ed pri" to testing -
PERFORMED BY: - / - ✓V 1 TIFY THAT THIS TEST WAS PERFORMED IN
Michael E. Anderson
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
j_
10
WAS GROUND WATER
- ENCOUNTERED? -
11
�fS
'/••
IF YES, AT WHAT / 0
. 12
e•.•
_
DEPTH? fP p
., 13
8°00
- Depth to Wsa Mer -' .
B lgl�s
0Re,.
S.
�n��? Dale
G
14 Co e6.44 /O• .
: 4
15 °c �
oD0 Dy
. .16 O OO f
17 -
P&O
18
19
%201
PERCOLATION RATE —1`• Irtunutevmchl PERC HOLE DIAMETER to 1'
TEST RUN BETWEEN �4– FT AND ..C�FT - - -
COMMENTS' Perc Cavity Was presoai:ed pri" to testing -
PERFORMED BY: - / - ✓V 1 TIFY THAT THIS TEST WAS PERFORMED IN
Michael E. Anderson
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 2, BLOCK 2, SKYHILLS SUBDIVISION No. 2
GENERAL:
1. The scope of this project includes the procurement and placement of a
new 1,250 gallon septic tank at the location shown on the site plan.
Work also includes the construction of a new 63' long X 3' wide X 8'
effective depth absorption trench at the location shown. The
distribution line in the trench will be placed at 3.5' below the existing
ground surface. Total depth of the trench will be .11.5' below, the
existing ground surface. All components of the septic system must
be placed a minimum of 10' from the water service line on the lot.
.2. Construction shall be in accordance .with the approved :site plan
design drawings, Municipal Permit with any special provisions. or.
conditions, and all applicable State and . Municipal . Wastewater
Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of.the septic system and verification of the
location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall- be
responsible for final grading areas subsequently depressed from soil
settling. - Property. owner shall . be responsible .for revegetation of
affected areas unless specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1.' A new 1,250 gallon septic tank must be be procured from an approved
source and installed at the location shown.
2. A septic tank is to be constructed by a certified'septic. tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extenda minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
6. A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
• Lot 2, Block 2, Skyhills Subdivision No. 2
February 28, 2001
Page 2 of 3
7.
Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD
CONSTRUCTION:
1.
The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level
2.
Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3.
A silt barrier.or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4.
Monitor tubes must be 4" in diameter and installed at the locations
shown on the design.: The portion below ground must be perforated
5.
Contractor. shall verify the septic tank and drainfield are a minimum .
100' away from any private water wells in the area, 150' from a Class
s
"C" Well or 200' from any community well
6.
-Direct bury insulation must be placed over the distribution system if
less than V of backfill depth is available. Finish grade over the trench '
must be mounded to prevent settlement or depressions:
7.'
Grade area surrounding the absorption trenches to drain away: •. .
8..
A minimum 2' of accepting soil is required below the drainfield rock for
_
a 5' wide trench. ` Contractor shall verify this condition prior to:
placement of the rock. All pockets of unacceptable materials must be,
removed and "replaced. .
MATERIAL SPECIFICATIONS:
1 `.Septic
tanks must be constructed by a municipally approved septic
tank manufacturer.
2.
The following pipe materials are approved for use in septic'system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034, or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated,' but not solid) and
:ASTM D2662 or A.B.S. (perforated and solid): .
3.,'
Insulation shall be at least 2* thick extruded direct burial polystyrene . ;
Dow Chemical Co. Styrofoam HI orequal).
4.
Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal)..
Lot 2, Block 2, Skyhills Subdivision No. 2
February 28, 2001
Page 3 of 3
• •
GE
Municipality of Anchorage
On-Site Water and Wastewater Program "r-311
..3
(907) 343-7904 SA ETY
Certificate of On-Site Systems Approval
Parcel I.D. 011-122-26 Expiration Date: 2 -26 — ��
1. GENERAL INFORMATION:
Complete legal description Skyhills Phase 1; Block 2, Lot 2
Location (site address) 8050 Skyhills Drive*Anchorage,AK 99502
Current Property owner(s) Matt Hegge Day phone 394-6713
Mailing address
Real Estate Agent Brett Hull Day phone 351-8047
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ® Public Sewer ❑
WaiverNariance request r: Distance:
Received by: Date: iliG(/*2
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 5-910 Waiver Fee $
Date of Payment 3tI3/i Date of Payment
Receipt Number Qo23WC9 Receipt Number
COSA# O3C 1710F1 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road,Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: 3 eb 4c3
ooQo0Opp•
In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system oOF
in accordance with the guidelines and regulations established by the Municipality of Anchorage and ` ....•• �;p�
industry practices. The reported results describe the condition of the system/s on the date/s of the O P.• QO
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or O�
encroachments may exist that were not identified during the evaluation. The operational life of all wells 9 T ,7*V00
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and 0
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and . . . .
are outside the control of GEG. Satisfactory test results do not guarantee future performance of theff `'� ss
system/s;therefore, GEG makes no warranty (express or implied) regarding the future performance of 0Q 3 .
CES •'• �
the well or septic system. GEG makes no representation whether an alternative well or septic system 0 4.. v • •ce0
can be installed on the property in the event either of the current systems fail to perform adequately in 4 ere 3 .,i7 ./s�cAp
the future. The content of this report is for the sole benefit of the person/party that retained GEG to 0fess;o0o\
perform the evaluation. Reliance upon the information provided in this report by any other person or ��OOOOoq�
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for t( bedrooms
System #2 Approved for bedrooms
\N-(`( OF q/1/0
Disapproved C4 yG
Conditional approval for bedrooms, with the follovtjfbg stl uta ih : G.
WATER AND .
`;', WASTEWATER
•
PROGRAM
rlFa� C•
C1
3 \1\`'•
By: 1 �— �;G�WX Original Certificate Date: 1
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist Nitrate Advisory •
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_10-10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist # of___
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Skyhills Phase 1; Block 2, Lot 2 Parcel ID: 011-122-26
A. WELL DATA PUBLIC
Well type If A, B, or C provide PWSID# Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N
Total depth ft. Cased to ft. Casing height (ab. - ground) in.
FROM WELL LOG AT I CTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RES :
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
enic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 4/18/2001
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Yes
Foundation cleanout (Y/N) f Depression over tank (Y/N) No High water alarm (Y/N) N/A
Off- C
Date of pumping-1-C' ii-41 4 Pumper /I\ -r f-V`u�e- Jere c e
C. ABSORPTION FIELD DATA *Below Existing Grade at MT
Date installed 4/18/2001 Soil rating p.d./ or ft2/bdrm) 0.6
System type Deep Trench
Length 64 ft. Width 3 ft. Gravel below pipe 8 ft.
Total depth *12.8+ ft. Eff. absorption area 1,024 ft2 Monitoring tube Yes Depression over field No
Date of adequacy test 2/17/2018 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 18 in. Water added**758 gal. New depth 38 in.
Elapsed Time: 120 min. Final fluid depth 34 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date -
2,000+ gallon pre-soak was performed on 2/16/2017
**The last 124 gallons introduced caused only 4 inches of rise
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm & circui -suirements?
E. SEPARATION DISTANCES
PUBLIC
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/sep . ervice line Holding tank
mal containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+ PVT/200'+ Public
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain None Known Wells on adjacent lots 100'+ PVT/200'+ Public
F. COMMENTS
ao6000
OF Atyk4
G. ENGINEER'S CERTIFICATION QOoP,`, `1• IS, 40 o
I certify that I have determined through field inspections and "�r':l t 9 H ' ..3 0
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on thisVA . PA
date. v J= r A. •�• n3ss:
Engineer's Print d Name JEFFREY A. GARNESS On/3 / E 79 3 \co`k
f3 43 � °,. • '•3 •�u�1''� °Ao
Date 3 � �4p�r fess\0 c
40000
#AECC884
(Rev. 11/05)
Municipality of Anchorage
• llt#t�31
On -Site Water &Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 011-122-26 Expiration Date: G - 3 " /
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owners)
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
SKYHILLS S/D PHASE 1 BLOCK 2, LOT 2
8050 SKY HILLS DRIVE, ANCHORAGE, AK, 99502
COLLEEN PETERSON Day phone
8050 SKY HILLS DRIVE, ANCHORAGE, AK, 99502
230-0317
MIKE MCLANE W/ PRUDENTIAL Day phone 227-1533
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
E
Public Sewer
❑
Received by: o Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
W
COSA Fee $ ` ',// 6 - Waiver Fee $
Date of Payment Wzox/.3 Date of Payment
Receipt Number Al�l �oa� Receipt Number
COSA # Os ��31a�{5 Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, U0. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines B Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, CTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content 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 orparty is not authorized, nor will it confer any legal sight whatsoever.
6. DSD SIGNATURE
L System #1 Approved for bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
By:
bedrooms.
Phone
337-6179
Date 17
oo600p�0
bedrooms, with the following stipulations:
CE -79 3
Pr o f e s sio�oc
Original Certificate Date: l ( - f/ �_' - I
The Mdnicipalht or,,khchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. 11/05)
Nitrate Advisory
Arsenic Advisory
Other
ON-SITE
WATER AND
WASTEWATER^
NROGRAMI
Original Certificate Date: l ( - f/ �_' - I
The Mdnicipalht or,,khchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. 11/05)
Nitrate Advisory
Arsenic Advisory
Other
If more than I septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: SKYHILLS S/D PHASE #1; BLOCK 2, LOT 2 Parcel ID: 011-122-26
A. WELL DATA
Well type
Date completed
Total depth ft.
Date of test
Static water level
Well production
WATER SAMPLE
PUBLIC WATER
If A, B, or C provide PWSID#
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
Coliform colonies/100 ml. Nitrate mg./L.
Coliform
ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N)-
Wires properly protected
Casing height (abo n
AT
Collected by:
ft.
in.
Tank Type/Material SEPTIC/STEEL Date installed 4/18/2001
Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A
Date of pumping /1-3 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 4/18/2001 Soil rating 022 r ft2/bdrm) 0_6 System type TRENCH
Length 64 ft. Width 3 ft. Gravel below pipe 8 ft.
Total depth * 12.3 ft. Eff. absorption area 1024 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 6/3/2013 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 57 in. Water added 800 gal. New depth?2 in.
Elapsed Time: 130 min. Final fluid depth 68.5 in. Absorption rate >= 600+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed Size in gallons - Manhole/Access
"Pump on" level at in. "Pump off' level
E. SEPARATION DISTANCES
level
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
On adjacent
On adjacent lots
Holding tank
PUBLIC WATER
manholelcleanout
containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots N A 004 QvL)11,-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway,parking/vehicle storage 4'+
Curtain drain NONE KNOWN Wells on adjacent lots N A .ZOb,r As Wel.
F. COMMENTS
G. ENGINEER'S CERTIFICATION
OF A
I certify that t have determined through field inspections and �:' y ' ' -v*review of Municipal records that the above systems are in .... .... ' ' ...' """"
conformance with MOA COSA guidelines in effect on this ....
date. e f A Ga ness.:
Engineer's Printed Name JEFFREY A. GARNESS049 CE, -7,953 o
Q m„ 6lI.J'1.�. o°o
Date 617113 �D�1da._,
(Rev. 11/05)
I
a
48-!!4
SKYHILLS SUBD., PHASE 1
LOT 2, BLOCK 2
40,169 S.F.
m J —Ci V I L„ j
i NEREDt C7 UFY THAT I HAVE SURVEYED THE
GiSTALD4 UNO SURVEYiNC
PROPE871' AEPIC= ASOYE AND RAT Ho
iNCR0ACt1UENT5 ibsE EXCEP7 AS INUCAED,
JEFF A GSWFALCt, R.LS.
D s THE RESpONsimm OF THE anzn TD
�.d1#t6ayi
f C5F
+
4720 NEWT WTH A YfNNE
OCMUNE RIE 00MU4OE OF ANY EUEUMM
d',,P; •• •
ANCHORAZE. ALASM 09302
CUVDV 775 OR RESIR;CAONS NTDct{ OD NM
PHONE 240-5554
APPEAR ON TEX RECOiOED SUDDM CR PUL
/y 9$7:3
crud pTE
UN' �......»..........,
DER NO MMUSTANCCS SHOIQD AM' 61
,HEREON BE USED FOR ODNSi
2232 ib/iTf2Q91
EN,, 1 OR FOR
STAdtF_}{u#D ROOIIR4FiiCE RY 6R 1(l1iE,
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s.a, xa No.
AL:C1i0fULE P.ECf3ROWtDISDIM, ALIIM
V P
bi-Pi 4iS122
ROTE: NO CORNERS SET THIS DATE.d�___
O
Mumc><pality of Anchorage
• -� Development Services Department �•
Building Safety Dnis,on_I • `
Onsite Water and Wastewater Program ,
% :4700 South Bragaw SL?
s P.O Bbx 196650 Anctiorage; AK'99519 6650
' wwwci.ancnorageak.us,
(907) 343-7904 i
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FORA'#S W GLE .FAM I0Y4 DWELLING
Parcell D' 011"12226t HAA# f�`a/bLilo-
EXPII*'atidn Date
1 GENERAL INFORMATION� , )1 sa• '
� r
�p
Complete.legal description Lot 2 Bibace Whills Phase 1
Location (site address or directions), - in ram Straet and Skvhills Dnve =.
ry
4 Current Property owrier(s) > The Petersen Group,,InG' .Day phone' 562-1170" '
-Mailing address P` 3820 Lake Otis Pkwy Sude 204 i Anch'3AK99519' +
<' Lending agency r
r , f Day phone
Mailing address
k+ Real Estate Agent
phone
1
Y,
r `+ Mailing'Address,, ~
Unless otherwise requested HAA --till be held by DSD for pickup
2 NUMBER OF BEDROOMS- Four 4
3 ' TYPE OF.WATER SUPPLY TYPE OF WASTEWATER DISPOSAL
Individual Well ElIridrvidual On site
Individsiat Water' Storage '_ =❑ Individuatfioldm tank
g O
CommunityClass . Well ❑ Community On-site > . E]
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
engineers work.
4. 'STATEMENT OF INSPECTION BY ENGINEER•. .
.As certified by`my'seal:affixed hereto and as,of the validation"date shown below; 1 verify'lh6(rny irrvesfi stion;
based `on procedures outlined iri the Health`Authonty Approval Guidelines for this application, shows that
on-site'water,supply arid/or wastewater disposal'system is(are) safe; functional and •adequate for the number of
bedrooms'and type of stricture indicated Herein 1 further "verifylhat based on the information obtained fforn the i.
Municipaiityiof'Anchorage filesiand from'.my,mvestigationand,inspection; the .on-site water;suppty;and/or;
wastewater'disposal'system' is(are) incompliance with all 'applicable Murncipal_and State codes,' ordinances,'.
and regulations in effect at the time of installation: . .
t. 'Phone' 5224773
Nems of Firm' Anderson Engineerinii ,
[ ,
Address'. P.O.- Box 240773 (Anchorage: AK 99524:.
Engineer's Printed Name't MicFiael E: Anderson: P.E : ' :Date i-, 813012001'
�w ;,. eto: .
ray^'t,'.. + OF. A7
.F i r,� i nor ,'. ? '`� '$ .' �•Xv', �XjA9{,tEl2'J11�,
ii •' ' ie: r' <' ! ' t / ' � \ ' if, NUCW,EI E. ANDERSON:
:���
-`CE-438]`
�' ...
5' DSD SIGNATURE ;'.' • :•" '- •, ., . � ..
h Z P
i :•::�%';'`ApProJed for = ' becJrooms� >' I 1� ; OFESSIO
Disapproved:
;Conditional approval four' Jbedrooms "with the'following'stipulations:''
,
..., � ..�.., - :. �• �. mat.:. G1
Additional Comments`, WA�TERA� n :.n=.
r �yHs 1 t WATER';
_; PRor,
• ., ,\`� - •• ''4'.t Jam.^R^1RA
Attachments: '
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: Original Certificate Date:
(rev. 12=1
Municipality of Anchorage .° .
' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 995196650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 2. Block 2. Skvhilts Phase 1 Parcel ID: 011.122.26
A. WELL DATA
Well type _ If A. B. or C provide PWSID # _
Date completed _ Sanitary seal (Y/N) _
Total depth ft. Cased to ft.
FROM WELL LOG
Date of test
Static water level ft,
Well production g.p.m.
WATER SAMPLE RESULTS:
Colform colonies/tooml. Nitrate
Date of sample:. Collected by:
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N)
Wires property protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
mg.A. Other bacteria
Tank Type/Matenal SepticlSteei
Tank size 1.250 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y Depression over lank (YIN) N
Data of pumping
C. ABSORPTION FIELD DATA
Pumper
ft.
g.p.m.
Date installed 41`18=1
Cleanouts (YM)
High water alarm (Y/N) N
Date installed MOM Soil rating (g.p.dN or ft2/bdrm) .6 GPDISF System type Deep Trench
Length 74 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth 12.5 ft. Eftabsorption area 1_ 024 ftr Monitoring tube Y Depression over field N
Date of adequacy test Results (Pass/Fail)
Fluid depth in absorption field before test _ in. Water added_ gal.
Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >=
For _ bedrooms
New depth_ in.
Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons
'Pump on' level at _ in. `Pump off' level at _in.
Datum
E. SEPARATION DISTANCES
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAtft station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
Manhole/Access (YM)
High water alarm level at in.
Meets alarm 3 circuit requirements?
On adjacent lots
On adjacent lots
Pudic sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >S Property line >S
Absorption field >5'
Water main WA Water service line >10'
Surface water MW
Wells on adjacent lots MW
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line MW Building foundation >10'
Water main >10'
Water Service line Mir Surface water M00•
Driveway, parking/vehicle storage MW
Curtain drain None Noted Wells on adjacent lots MW
F. COMMENTS
Ur A ,. .. 0
?S1�
G. ENGINEER'S CERTIFICATION
.`�p�•''
I certify that I have determined through field inspecIbm and
4911.4
rev/ewof Municipal records that theabove systems are in
d• • •••••• ••••• •••
conformance with MOA HAA guidelines in effect on this date.
r •••• •••••>
rF .M!chn.Et IiSt ^ cNi i
Engineer's Printed Name Michael E Anderson, P.E.
Date &308001
`C� Y hnc.Scr.Fd`�y
HAA Fee $ coc- i ) Waiver Fee $
Date of Payment3�0 a/n 1 Date of Payment
Receipt Number 9—gS1 Receipt Number
(Rev. 12W)