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HomeMy WebLinkAboutSEQUOIA ESTATES BLK 1 LT 7· equo a St. lock I Lot 7 017-152 -'07 Municipality of Anchorage 'Page t of ~ _ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Ilnspection Report Permit Number: ~,~V,J o..~ O ~_2~Z~ PID Number: ..~\'-"~ - ~ ~- Name: ~O ~m~~)~, Wastewater System: 'D New U grade ~ddress: ~1 ~--~UO~ ~'P--~ ABSORPTION FIELD Phone: ~_~ No. of B~rooms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~'Other LEGAL DESCRIPTION ~o~ R;ting: ~otal D~pth from~rlglnal grade:/' I-~ GPD/Sq. Ft. ~ 5 ~ ~ / ,, Lot: ~ BIock:~ ~-~Subdiv~i°n:~{ ~ [ ~ ~, Depth to~,pipe bottom~ / ~fr°m~°rtglnal~ '~g~de:-- Ft. Gravel depth~beneath~ pipe Ft. Township: ,~ lRange:~{~ Section:~/~ Filladdedabove~lnalgrade: Ft. Gravellength~ ~ Ft. ~'~~ ~ Ft. Number{ of lines: Ol~lan~een~ lines'. I U New ~ Upgrade / i Gravelwidth:~/~ Ft. Classification (Priva~~ Total/Depth;/Ft. ~To: Ft. Total absorptlon~ ~'~area:~ SQ. Ft. Pipe~o~materish Driller: Installer: Date Inst~lled; Yield: ~- Pump 8et al: O~sing ~und: / GPM FL ~,. TANK SEPARATION DISTANCES ~ s~ptio ~ Ho~ai~g ~S.T.E.P. TO Septic Absorption Lift Holding =ublic/Private Manufacturer: CapsCity in gallons: From T~nk Field Station Tank 8ewerLines ~)~,~- IS~o, / Material: Number of~padments: Su~ace f I Water ~JOo >,oo >~ >t~/ ~~ON Lot Line IO/~ ~OI lO/~ ~ + ~ Manufacturer:~ , ,~ Foundation ~ I+ ~G I~ t ~ I~ ~ "Pump on" level at: "Pump off" level at: I High Water alarm at: - ~z" ~ ' l ~. Cudain NO~ Drain ~ ,~ ~ ~ Pump Make & Model Electrical Inspections pe~ormed by: Remarks: ~~ (~ OU~-~ i~ ~ENCH Location and Description; . J Assumed Elevation: Inspections pedormed by: ~ ~SS Dates: 1st to ~ ,~,.-,,, 2na ....... Department of Healtkand Human Se~ices approval ~-'~. Reviewed and approved by: · ate: /2 -2 g-~ / [3 72-013 (Rev. 9/91) MOA 25 NEY/ TRENCH, 61' LBNG, TRENCH IS BVERSIZE]] BY APPROX, 5OX, TEST HOLE M,T LOCATION, PERK TESTS V/ERE 3-5 FEET NORTH BF 1,/_~5 INCH PVC PRESgLJRE%x~" LINES (2) TO OLD BED AND NEY/ TRENCH, LINE TB OLD BED ~/AS NOT INSPECTED BY ENGINEER, -- iI M,T, 'F' ° EXISTING BED INCH DIA, PVC ~ FBUNDA]'IBN C/O, NE~/ t850 GALL. BN STEP TANK, THE ls't C/I] BN THE TANK IS PT, THE CENTER OF THE MH IS PE]INT C/D AC = 51,1 BC = 26,6 AD = 5%6 BI) = 24,0 BF = 50,7 EF = 77,2 AS-DUILT DRAWING V/ELL SEPTIC UPGRADE AS-BUILT' PREPARED FORI PREPARE]] BY' DATE~ LOT 7, BK 1, SEQUI]IA EST, GENO KASTIGNETTI ALASKA V/ATER & ~/A§TE~/ATER SERVICES 10/26/96 I)RAV/N' GARNE~S SCALE' 1' = 30' A. GarneS~ ." CE-7953 AS-IUILT DRAWING [iROUND COVER OVER THE TANK IS IS APPROX, 90,5 FEET, COVER = 4 FT, NEW 1250 GALLON STEP TANK. 1,25 INCH PRESSURE ANCHORAGE TANK, INLET INV, -- 4 INCH ~]A. PVC LINE FROM NE~ TRENCH, & BL~ . = 8~,94 HOUSE, INVERT AT FDNDATION C/O TANK SET LEVEL, ~ITHIN .D~ FT, = B8,~, D~OP FROM C/D TO TANK = ~,66 FT, OVER APPROX. 75 FEET, ~LBFE I~ GREATER THAN ~%. THE LINE FROM THE FOUNDATION C/O TO THE S,T,E,P 'rANK ~AS NOT INSPECT- ED ~Y ~HE ~ -FOR LOCATION OF M,T SEE PLaN DRA~ING GRBUN~TRENCH ELEVIs 9~,~BVERDE ~ NIGHER, MINIMUM COVER ~ ~FILTEE FABRIC OVER ~RAINEOCK = 3,1 FEET, ~ ~ / ENTIRE LENGTH DF TRENCH .~ f'~- ~1,~5 INCH ~IA,~ SCHEDULE 40 PVG, ~1~ ~' ~ 3/16 INCH HOLES AT 4 FT I;11;~:,/: C, NB GROUNDWATER OR IMPERMEABLE ~OtL TD ~EPTt. I OF tG FEET, F~ I¢~ ; ~. TRENCH LENGTH : Gl+ FEET E, TOTAL ABSORI TIBN ~ENCHMARK IS TOP DF fi~S LINE ~HERE IT ENTERS THE HOUSE, PREPARE]] BY~ ALASKA WATER ~ WASTEWATER '~.,. DATE, 10/26/96 ])WN~ 6ARNESS SCALE, NTS FROM USPS ANCH PROC/DIST 9~7 288 3'161 !NGPECTION: Voice 563.3464 tNSPtECT1ON.' FAX (B07) 34~2~ , INFO: .... ??~' ...... ~ '~ ......... dj DO NOT R, FMOV5 THIS NO~CE ~ To',rP~ P, ~1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PAGE 1 OF 1 PERMIT NUMBER:SW960334 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:CASTIGNETTI GENO J JR & OWNER ADDRESS:6841 SEQUOIA CIR ANCHORAGE, AK 99516 DATE ISSUED:10/03/96 EXPIRATION DATE:10/03/97 PARCEL ID:01715207 LEGAL DESCRIPTION: SEQUOIA ESTATES BLK 1 LT 7 LOT SIZE: 48472 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 (iSAAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE 8OIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND N~ATED TO PREVENT FREEZING THE FOLLOWING SPECIAL Pi 0VISIONS. RECEIVED BY: ~/~/q ~ DATE 8471 Brookridge Drive N Anchorage ~ Alaska 99504 (907) 337-6179 ~ Fax (90'7) 338-3246 Consulting Engiueers September 16, 1996 Municipality of Anchorage Department of Health & Human Se~wices Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Sewer Permit for Lot 7, Bk 1, Sequoia Estates. To whom it may concern: The subject 3 bedroom house is served by a private well and septic system. The septic system is currently surcharged, and periodically backs up into the residence; therefore, it needs to be upgraded. Comments regarding the proposed upg[ade are summarized as follows: 1. Soils: Attached is a copy of the soils log. The soils from a depth of 2 feet to 7 feet perked in the range of 3-5 minutes/inch. To account for possible changes in the soil profile, and the fact that the home has a hot tub and a water softener, I am proposing to use an application rate of .8 gpd/ft2. 2. Trench Design: g. h. i Width: 2 feet nfinimum j. Reduction Factor = N/A k. Length: 60 feet. 1. Effective absorption area = 570 ft2 Percolation Rate: 3-5minutes/inch Application Rate: 1.2 gallons/day/fi2, but will use. 8 gallons/day/ft2 Number of Bedrooms: 3 Design Flow: 450 gallons per day Minimum Absorption Area: 562.5 fi2 System Type: trench Effective Depth: 4.75 feet Total Depth: 6.75 feet MUNICIPALITY OF ANCHOP. AG~ ENVIRONMENTAL SERVICES DIVISION SEP 5 1996 RECEIVED 3. Surface Waters: There are no surface waters within 100 feet of the proposed septic system. 4. Slopes: In the vicinity of the new trench, the lot slopes downhill (10-20%) from east to west, and is generally flat in the north/south direction. There are no slopes in excess of 25% within 50 feet of the proposed trench. I am unaware of an;g adverse impacts this installation would have on adj.acent wells or septic systems. If you have any questions, please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Thank you for your assistance. Sincerely, ,P.E., Principal m.s. Geno Kastig. nettil.wps AREA LDT 6, ~K 1 SE~UBIA E~T. PVT. ~ELL ~ SEPTIC, SEPTIC LOT 5, ]~K 1~ SEQLIBIA EST, PRIVATE WELL & SEPTIC PER ~HHS RE£DR~):~, TRENCH / ~ELL LBT 8o ~;EQUDIA EST. PVT. WELL / SEPTIC AREA NBTEI THIS IS NOT A SURVEY, THE LBCATIDN DF STRUCTURE~, WELLS, AN]0 SEPTIC SYSTEMS ARE GENERAL, SEPTIC UPGRADEI PREPARED FBRt PREPARED BY' DATE' L. rlT 7, ]~K 1, SEQLJDIA EST, GENB KASTIGNETTI ALASKA WATER & WASTEWATER SERVICES 9/1G/gG i DRAWNI GARNESS ISCALE, 1' = 100' NOTE, TO THE WEST OF NEW TRENCH THE LO]' DOWNHILL_ (EAST TH WE: 10% TO 80×, THERE ARE SLOPES GREATER THAN WITHIN 50 FEET OF TH[ TRENCH, NEW 60 FD[]T TRENCH, [HE '~~..~_._ /---- EXISTING gED .OPES M,T, 1,85 INCH PVC PRESSURE LINE, TIE INTO BED TH, GROUND ELEV, = 9R,O-- BOTTOM DF TH = 76,3, 86,6 NEW 1850 GALLON STEP TANK,-- CID 0,5 CIO HOUSE --~5,4 KISTING FBUNDATIBN C/B, INVERT = 88,6 (APPROX,) 4 INCH DIA, PVC (I)3034) SLOPED AT 1/4 INCH PER FOOT, THE NEW STEP TANK SHALL BE EQUIPPED WITH DUAL OUTLETS, AN]] PLUM:BED SO THAT FLOW CAN BE ALTERNATED DETWEEN THE NEW TRENCH AND THE OLD DRAINFIELD, 'rilE CONTRACTOR SHALL PROVIDE A 1,R5 INCH, SCH 40 PVC, PRESSURE LINE TO THE TRENCH AND THE BED, WELt_ APPROXIMATE LOCATION DF DRIVEWAY SEPTIC UPGRADE, PREPARED FBRi PREPARED DATE, 9/16/96 LOT 7, BK 1, SEQU[]IA EST, GENB KASTIGNETTI ALASKA WATER & WASTEWATER SERVICES DRAWN, GARNESS SCALE, 1~ = 30' [frey A. GarneSs CE-7953 TOTAL ,TRENOH LENGTI~ ~ 60 PEE~. TOTAL ABSORPTION AREA = 570 SQUARE FF~T. WITH NATIVE S'OiL AND MOUND. TOPSOIL ~ RESEEDING- $1~ALL SE' TPIE REPSPON~IBILtTY OF THE PI~OPEt~T~ OWHEF~. FABRIC SILT BARRIER. 2 IN~ OF J3OAI:~Q INSULATION IF SOIL COVER IS LESEi THAN 3 FEET, INSULATION E~HALL COVER THE ENTIRE WITH OP THE TRENOR. !~, 2 FEET MIN. BENCHMARK I$ TOP OF GAS LINE WHERE IT -- 1,2~ INOH SOH 40 PVO. 3/16 INCH HOLES AT. 4'0.0, (16 HOLES TOTAL). ALL HOLES FACE DOWN. 2" OF DRAINROCK OVER PIPE. DO NOT PYRAMID DRAINROOK OVER THE PIPE. DR/~INROCtC DEPTH SHOULD BE- TI:tE SAlr/IE A~S THE ENTI~ WITH OF THE TRENO~ TUBE ~TYP). PERFORATED IN DRAINROCK. NO TE: 1; TRE~HE~ ~ALL RUN PAR~LLE~ ~0 THE 2. F~. [O~TI~ ~ OLE~OUTS AND 3, CON~TRUOTION PRAOTIOES, AND MATERIAL SPFCIFICATION~ SHALL OOMPLL Y WITH ANCHORAGE MUNICIPAL CODE I~.6~, "WASTE- WATER DISPOSAL ~EGULA TIONS". INSTALLATION SHALL COMPLY WITH SPECIAL ~0~0~ A~' ~' OE THE ~' P~ ~A~ BO~T~ A~' ~WA'LL~ SHA~L DRAI~K- ~L ~ ~OREENED PE~ REJEC TED. ENTEF~S- TT'IE HOUse-, A SSUMEi~ ET. EVA TICII~t = IO'O. O0- TRENCH.,DETAIL: LOT 7, BK. 1, SEQUOIA ESTATES PREPARED FOR: GENO" KA'STIGNETTt ALASKA. WATER & WASTEWATER SERVICES · t DATE: 9/-16/96. Dt4/N: GARNESS. SOALE: N~TS Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "t.' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR= ~----~1~ LEGAL DESCRIPTION:, _ 2 ..-- 5 6 10 11 12 13 14 15 16 17 18 19 20- '~OMMENTS _ ~S...'-CTownsh~p, Range, Section: /,J SLOPE , ' ..'SITE WAS GROUND WATER ENCOUNTERED? IF YES, ATWHAT DEPTH? L Gross Net Depth to Net Reading Date Time .Time Water Drop ,4,- ID ~ 3/~~ ' ~ I~ 3, ID ,"'"" (minutes/inch) PERC HOLE DIAMETER ~' FT AND ~ ...... FT ~ ~ .~ c_~,~'/~-'z PERCOLATION RATE TEST RUN BETWEEN 72-008 (Rev, 4/85) . NAME MUNICIPALITY OF ANCHORAGE 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 PHON~ [~-N EW ,~ ~ ~'~ S'~' E~] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO: Manufacturer Well Absorption area i~JoT ~J (I,Z.~ NO, OF BEDROOMS P E R ~T~Nt~'~.~ No. of co~)artments Liq. capacity in gallons IF HOMEMADE: Inside length Liquid de~.th DISTANCE TO: Well --~ Dwelllng..~ PERMIT~ NO, Foundation Total length of lines Material beneath tile Manufacturer Dwelling1'3, Material Depth Materi~al Nearestlot~.z~~ ~1--'~-!line Trench width WO )~ I ~ inches Well DISTANCE TO: ~/O"¢ ~ I~ No, of lineLi .LengtJ~ of eacl).line~/ ,, Top of tile to finish grade Length Width ~ Liquid,~capacity in gallons PERMIT NO. Distance~ bet~een~r n~s. ;~ ,cf,~' , ~.& '"5, Z, $'- Total effective absorption ar~a PERMIT NO. Type of crib ~ Crib diameter ~ Crib depth ~ Total effective absorption area Well Nearest lot line DISTANCE TO: ~ Building foundation Driller Depth Distance to lot line PERMIT NO. DISTANCE TO: Building foundation ~ Sewer line ~ Septic tank Absorption area(s) Class OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS DATE 72-013 (Rev. 3/78) Date Drilled ~ Static Water Level ~.Q feet Draw Down ,',I \ feet WELL LOG qeou~oa Subr!. Gallons Per Minute Total Feet of Casing ~. 7-4- .Type Material Drilled~ ~2D f~ 73~ f~et llefty Drilling S.R.A. Box 1553 H Anchorage ,Alask~ 99507 MUNICIPALITY OF ANCHORAGB OEP'F, OF HEALTH & ENVIRONMENTAL PROTECTION SEP 5 1984 RECEIVED l'lLlf-4 I E: I ElL I DEPARTMENT Oh HERLTH RND ENVIRONMENTRL h'ROTECTION 825 L STREET, RNCHORRGE,. RK 99581 264-472~ g--it4---S I TE SEI~4EF: .~,;'; 1,4Et_L F*EF:t'I I -F pERMIT NO: DRTE ,I::',I.IE[: :=:4E'1291 HAND 1.4R I TTEH 05,."'04/84 RPPLICANT: ADDRE= .... C:ONTH~.T PHONE: CHBRLES HRDDY NEW WORLD INC P 0 80~ ANCHORAGE, Bt{ 995ti 345-3854 LE =AL DP~..F.. I P: LOT :S I ZE: LOT LOCRTION: SUBDIVISION: SEQUOIR ESTATES SECTION: 26 TOHNSHIP: 48472 (SQ. FT. OR RCRES) SEQUOIA CIRCLE LOT: RANGE BLOC. K: '1 CERTIFY THRT: 1.' I BM FFIHILIRR WITH THE REQUIREMENTS FOR ON-SITE SEI.4ERS AND WELLS RS 'SET FORTH BY THE MtJNICIPFtLITY OF ANCHORAGE (MOB) FIND THE STRTE OF RLASKR. 2..I WILL INSTRLL THE SYSTEM IN ACE:OR[:,RNCE WITH FILL MOA (.*.ODES AND REGULRTIONS., : AND IN COMPLIANCE 14ITH THE DESIGN CRITERIA OF THIS PERMIT. ~ I WILL: ADHERE TO ALL MOA AND STRTE OF ALASI<R REC,!UIREMENTS FOR THE SET BRCK ,DISTRNCES FROM ANY EXISTING WELL., WASTEWATER DI'SPO'SRL SYSTEM OR PUBLIC , SEI4ERRGE SYSTEM ON THIS OR ANY RDJRCENT OR NERRBY LOT. IF.A LIFT STATION IS IN_,TRLLE~ IN AN AREA CO',/EF.:ED BY MOI~ BUILDINg3 CODE'-]., THEN ,;:.~) RN ELECTRICAL I""ERMIT AND INSPEC:TION MLIST BE OBTAINED.~q"°'~.¢ AS-BUlL.TS WILL'NOT BE APPRO',,,'E[:, WITHOUT RN ELEL:TF,.IE. AL INSF'ECTION RI_FORT., AND ,:'~) THE ELEC:TF.:ICAL: WORK MUST BE DONE BY A LIC:ENSED ELEE:TRICIRN, BF'PLIC~NT' CHBRL~ HBDD~ NEW WORLD INC ISSUED 'BY ~~ ~~ DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST DATE PERFORMED: Iq ! LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATE~ ENCOUNTERED? SLOPE L O P E IF YES, AT WHAT DEPTH? SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) J , TEST RUN BETWEEN ~- FT AND FT 72-008 DATE: d/~-~2/r~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street ~,,-~ P.O. Box 196650 [ i ~ / www. muni.org/onsite (907) 343-7904 .~ CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o17-z52-o7 1. GENERAL INFORMATION Expiration Date: g/~)l/ Complete legal description Sequoia Estates, BIk z, Lot 7 Location (site address) 684zSequoia Circle Current Property owner(s) Geno & Debra Castignetti Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Day phone Day phone Christine Dooley / Dynamic Properties Day phone 2z+6-7653 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class ~ Well [] Public Water System [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 °hthe information obtained from the Municipality of Anchorage files and from my investigation and inspection, 11~e,:,on~site water suplppwly, andk~r, wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, .., ~di~a~'lees "and regulabons in effect at the time of insta at on Name of Firm Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box zoo2z7, Anchorage, AK q95zo Engineer's Printed Name Steven R. Pannone, P.E. Date :~z/3o/2ozo Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & 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 system. 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. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSD SIGNATURE '/'/ Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: A= Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ..Sequoia Estates, BIk % Lot 7 WELL DATA Well type Private Date completed ?hh. q8,. Total depth 32_~ ft. Date of test Static water level Well production WATER SAMPLE RESULTS: parcel ID: o~7-~2-o7 IfA, B, or C provide PWSID # ~ Sanitary seal (Y/N) Y Cased to 260 ft. FROM WELL LOG 7h1~98~ ~98 7+ Coliform ......Ne§ colonies/100 mL Arsenic: ...ND ug/I B, SEPTIC/HOLDING TANK DATA Tank Type/Material Steel / S.T.E,P. Tank size =.2~;o gal. Foundation cleanout (Y/N) Y Date of pumping ~12_~12o~o C, ABSORPTION FIELD DATA Well Log (Y/N) Y Wires properly, protected (Y/N) Casingheight (above ground) AT INSPECTION ft. 209 ft. g.p.m. . ~.5+ g.p.m. Nitrate o.xx~ mg/L Date of sample: ~x/~912o~o in. Other bacteria Neg colonies/100 mL Collected by: Pannone Engineerin_~ Date installed Number of Compartments _~ Cleanouts (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Pumper A+ Home Services Date installed 3.ol2/.h.~6 Soil rating Length 6~+ ft. Width 2+ Total depth _8 ft. Eft. absorption area 572+ ~ Date of adequacy test ~.~.f,,.12oxo Results (Pass/Fail) Fluid depth in absorption field before test _o in. Elapsed Time: =.2o min. Final fluid depth _o in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) (g.p.d./~ or ft2/bdrm) =.2 GPDISF ft. Monitoring tube Y Pass System type Deep Trench Gravel below pipe ~.7 Depression over field N For 3 bedrooms Water added~52 gal. Absorption rate >=~'; N New depth_o in. ~jO+ g.p.d. If yes, give date D= LIFT STATION Date installed ~ol2,.Iz996 "Pump on" level at AA in. DatUm BOT E. SEPARATION DISTANCES Size in gallons "Pump off" level at AA in. Cycles tested 3 Manhole/Access (Y/N) Y High water alarm level at ~ Meets alarm & circuit requirements? Y in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot zoo+ Absorption field on lot zoo+ Public sewer main 75+ Sewer/septic service line 25+ Animal containment areas On adjacent lots zoo+ On adjacent lots zoo+ Public sewer manhole/cleanout zoo+ Holding tank zoo+ Manure/animal excrete storage areas zoo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation zo+ Property line zo+ Water main ~o+ Water service line 25+ Wells on adjacent lots zoo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line zo+ Building foundation Water Service line =~+ . Surface water zo6+ Curtain drain 5o+ Wells on adjacent lots zoo+ COMMENTS Absorption field ~+ Surface water zoo+ Water main 75+ Driveway, parking/vehicle storage lO+ G. ENGINEER'S CERTIFICATION I 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. Engineer's Printed Name Steven R. Pannone~ P.E. Date COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) zzl~olAozo ~~,,,,,~,,.~ .......... ~,~ Waiver Fee $ Date of Payment Receipt Number S,GS SGS Ref.# 1106272001 Client Name Pannone Eng. Sty. Printed Date/Time 11/24/2010 16:53 Project Name/# 6841 Sequoia Circle Collected Date/Time 11/19/2010 16:45 Client Sample ID 6841 Sequoia Circle Received Date/Time 11/19/2010 t7:17 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 B (<10) 11/23/10 11/24/10 NRB Waters Department Total Nitrate/Nitrite-N 0.113 0.100 mg/L SM20 4500NO3-F C (<10) 11/23/10 AYC Microbiology Laboratory E. Coli Total Coliform Negative I 100mL SM20 9223B A 11/19/t0 DLC Negative 1 100mL SM20 9223B A 11/19/10 DLC ~/30~0~0 10:17 ~68~770 ~P~US PA~E 01 CUSTOMER 7501 E. 140th Avenue Anchorage, Alaska 99516 345-1890 P~-o~e N. ngh~e~i~g INVOICE # 39330 Block Lot DATE DESCRIPTION AMOUNT n-~.~-~o ~.~ sq,~i= &/.~ r~ ~q.~y. t~ ~"~~~~.-, s~6~.c,o ; '. ,: . '~'~ '~'~ .' i ';'"'""1 ..... .'~.r~.: .,,.' .... ,,,,, ,, R RKS ".:c: :,' .,=. ... .... .. · ..,. .: .. ..... ~. ' ~,,,.~.~,, :', ,, ' ?" 'i , ~ ', .... ~ N[E~$ TO ~ DONE A~IN IN 8 MONTH8  ' Good 8haps Jim sap missino or ~ Cut s~ndpipe ~o~' abov~ flmund ~ Needs 8eptictrin, needs ~plaoin~ o~ELL LiFT STATION ASPHALT S 86°~'0~, 'E 2~8.30' THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINE.~ OR LOCATE STRUCTURES. AS-BUILT SURVEY NO CORNERS SET THIS DATE SCALE:I" = 30' I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 7, BLOCK 1, SEQUOIA ESTATES ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THI~ PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXl, OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 1ST DAY OF DECEMBER 2010_, HOLT LA-ND SURVEYING TEL. 345-5513 11450, FB 143-58 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~.¢o - ~,o - o~'- OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) (b) (c) Legal Description (include lot, block, subdivision, section, townshi,.~, range) Location (address or directions) Property Owner [.4dgLE-Y~ V....Jmt~. Telephone:Home ~l~-l&,ol Business 1 Mailing Address fo~ I $.~eu~,~'% ' Lending Institution ~¢~ E~ ~;~ Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or; Check here"J~ if hold for pick up. List contact person and day phone number below. "' /"~ TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms 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. SEWAGE DISPOSAL Onsite~ Public [] Community [] 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 72-025 trey 8/86~ Front '~JJOM s. Jaeu!~ue leUO!SSejoJd aql u! suo!ss!uJo 4o sJoJJe Joj elq!suodseJ lou s! abeJoqou¥ ,to/~l!led!o!unl41 eqj. 'penss! s! e~eoiJ!peo e eJo~aq e~ep ezXleue Jo suo!~oedsu! jonpuoo ~,ou op SHHG jo seeXoldUJ=l 's~ueLue~!nbe~ e~ejs pue le~epe~ u!epeo ,~js!jes o~, Jep~o u! suoRn~!lsu! 8u!puel J!eqj pue seuJoq jo sJeseqoJnd o~,~seiJnoo e se s!ql seop SHHC] eqJ. 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O:1dSNI 9NICIIAOl:ld ~1:11..-I IDNII:I:1:1NIeN=I .g ~ ~ ~ ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O.BOX 6-6650 ANCHORAGE, ALASKA 99502-0650 JUNE 2, 1987 Subject: Ground Water Monitoring Lot 7, Block 1, Sequoia Estate Gentlemen; Per your request a test hole was drilled and a monitoring tube installed on subject lot on May 26, 1987. Total depth of testhole was 19 feet. Ground water was not encountered during drilling, nor was any water observed on June 1, 1987, seven days after installation. Tobb~n Spurkla~d.P.E. MUNl¢lPALl'fy Oi: ANeNt_ .i~f~I~Pf~LITY OF ANCHORAGE (MOA) RV lC ENVtgONMENTAL S~ ~[~A~'~UTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 MAY :1. 3 i9B7 264-4720 RECEIVED Legal Description: WELL DATA Well Classification Well Log Present (Y/N) Total Depth ~ ¢~, ,¢' ~,1~ Static Water Level Casing Height Above Ground Jt'~ ~l Electrical Wiring in Conduit (Y/N) ~ Separation Distances from Well: To Septic/Holding Tank on Lot /~'¢' ¢' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments '~'~- ~ If A, B, C, D.E.C. Approved (Y/N) / Date Completed _~7, 7' /'~¢ Yield Cased to / 77 No/vd Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots / ¢,~ ¢' On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Date "~-/~'~ z'~ ~' B. SEPTIC/HOLDING TANK DATA Date Installed /~/,'~'~"/o~ t// Size t ~ NO. of Compartments Standpipes (Y/N) _'"~u¢'¢ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~x,/ Date Last Pumped ~/~/ Pumping/Maintenance Contract on File (Y/N) ~//~. ; for Holding Tank High-Water Alarm (Y/N) ~4'/,,~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course To Building FOundation J---~ To Disposal Field Iff To Stream, Pond, Lake, or Major Drainage Comments Page I o~ 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~' ' ,~'.~" Width of Field ! Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ~:~ Lot TO Water Main/Service Line .~ ! o To Stream/Pond/Lake/or Major Drainage Course To Driveway,. Parking Area, or Vehicle Storage Area Comments Type of System Design ~ ~.,,D 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 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 ** ~ certify t hat I .~ve~h.ecked.~,. v~rifitd.~r conformed to all M~)A a~nd HAA guidelines in effect on the date of this inspection. Signed ~ ~' Date ~"/~'"-/~' '~ Company MOA No. Receipt No. Date of Payment Amount: $ ~/'d~----~ Page 2 of 2 72-026 (11/84) Engineer's Seal ,~ ~ ~ ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: LOCATION: LOT 7, BLOCK 1, SEQUOIA ESTATE 6841 SEQUOIA CIRCLE OWNER: HUXLEY TYPE O~ WELL: SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 7+GALLONS PER MINUTE PUMP YIELD: 6.5 GALLONS PER MINUTE DATE OF INSPECTION: MAY 5, 1987 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6.5 GALLONS PER MINUTE FOR 90 MINUTES. A TOTAL OF 550 GALLONS WERE DELIVERED. DRAWDOWN AND RECOVERY MEASUREMENTS WERE UNSUCCESSFUL DUE TO O~B~R?C~ONS IN,THE ~ELL CASING AT .2~0 ~E~. TOTAL WELL DEPTH 325 FEET. TEST FOR COLIFORMS: NEGATIVE. WATER WAS TESTED FOR COLIFORM BACTERIA AND NITRATES oN MAY 5, 1987. BOTH TESTS WERE TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from 'the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. CONSULTING ENGINEER ~ u, ,~ ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: LOT 7, BLOCK 1, SEQUOIA ESTATE 6841 SEQUOIA CIRCLE OWNER: HUXLEY RESIDENCE: WELL: SEPTIC SYSTEM: SINGLE FAMILY, THREE BEDROOMS PRIVATE, ON SITE FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. 1000 GAL. ABSORPTION SYSTEM: BED ABSORPTION AREA: 720 SQ. FT. SOIL RATING: 150 INSTALLATION DATE: JUNE 1984 DATE OF PUMPING: DATE OF TEST: MAY 6, 1987. ANCHORAGE CESSPOOL PUMPING MAY 5, 1987 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH 15.5 FEET DEEP, WITH 10 FEET OF COVER AND 48 INCHES OF LIQUID. CLEANOUTS TO BED WERE 10 FEET DEEP AND DRY. MONITORING TUBE-WAS &0~5-EEET DEEP AND HAD 5 INCHES OF LIQUID. 550 GALLONS OF CLEAN WATER WERE ADDED TO THE SYSTEM WHILE THE WATER LEVELS WERE MONITORED. NO CHANGE IN THE TANK, ROSE 2 INCHES. SIX HOURS LATER THE LEVEL IN THE BED WAS 5.25 INCHES. - ....... - TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, 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 this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the MuniciPality and State. ,~3- ;-,,. . bfUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR ~ALTH AUTHORITY APPROV~ CERTIFICATE 1. General Info~ation Applic~tion Date ~7 (a) Legal Description (include lot, block, subdivision, section, to~mship~ range) Location (address or direqtions) 3~s~- (b) Applicants Name ~'~ I~AD~tL Telephone- Itome Buslness~ (c) Applicant is (check one) Lending Institution Buyer ~_~ ; Other L~.-~ (explain); (d) Lending Institution ~_ ; Owner/builder Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the ILgA to the following address: 2. Tyj?e of Residence Single-Family I~ Number of Bedrooms 3. Water Supply_ Individual Well ~ Multi-Family Other (describe) Note: if community well system, must have written confirmstion from the State Department of Environmental Conservation attesting to the legality a~zd status, 4. Sewage Dis_~osal On,lite ~[ Public ~--.~ Community L----~ Holding Tank ~] Note: If community well ~ystem, must haw: written confirmation from the State Department of Envirot~mental Conservation attesting to the legality and status. [Page 1 of 2] 5. J~n__g. ineering Firm Providiq~ Inspections, Testsz. File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval 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, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula~ tions in effect on the date of this inspection. e Name of Firm_~_ ~C~__ Address __J3oO co DHE P.. A__p.~pr o v a 1 Approved for ,~ bedrooms Approved .:.~. ~./ Disapproved (ENGINELR SEAL) Cond i t ional Terms of Conditional Approval CAUTION TIlE HUNICIPALI'I;Y OF ANCHORAGE DEPAR~XqENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DIIEP) ISSUES IIEALTH AUTHORITY APPROVAL CF, RTIFICATES BASED S_0~[_~'[LY_.' UPON TIIE REPRESENT-- ATIONS (lIVEN IN PARAGRAPtl 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTiSRED IN THE STATE OF ALASKA. THE DHEP DOES Tills AS A COURTESY TO PURCIIASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE= MENTS. FJ,1PLOYEES OF DHEP DO NOT CONDUCT iNSPECTIONS OR ~UNALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OHISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DItEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-34 ae WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 - Legal Description: Lo~ 7 Well Classification ~ 4_~, If A, B, Well Log P~esent ~N) Date ~le~d Static Wate~-~1 ~ ~q~ Casing ~ight ~ G~nd ~ ,'~ ' Elec~icaI Wiring in ~nduit ~) ~p~ation Dictates ~ ~11: To ~ptic~olding Ta~ ~ ~t'~ ~5 To ~a~st ~ of ~so~tion Field on To Newest ~blic ~= Line Cl~an~t~a~ole ~'~ ~ ~est ~ ~Vi~ Li~ on ~t Watt= S~le Colle~ed By ' ~, ~~ ; ~te Watt= S~le Test ~sults ~ Sanitary Seal on Casing Y~N) Depression Around Wellhead _(Y~ ; On Adjoining Lot's~ 1('30f ; On Adjoining Lots ~_~' !~)~ # To Nearest Public Sewer B. SEPTIC/HOLDING TANK DATA Date Installed A/~ $ / 8 q Size l OOf9 No. of C~,%~amtn~nts ~ Stan~i~s ~) Air-tight Caps (Y~' Foun~tion Cleanout ~) ~p~ession o~r Ta~ (Y~) ~te ~st P~d ~.~ ,%Xl S ~' P~ing~intenan~ ~n~a~ ~ File (Y/N) ; f~ ~ ' Holding Ta~ High-Wate~ Ala~ (Y~) ~ ~a~y Hold{~. Tank ~r~t (Y~) ~ ~p~ation Dictates ~ ~ptic~old~g Tank: / To Wate=-Supply ~11~ L.~~ To Building Foundation"''l~, ~ To Disposal Field ~4[' Il,~ To Stream, Pond, Lake, c~ Majo= D~ainage ! [Page 1 of 2] C. ABSORPTION FIELD DATA Soils Rating in Absorption St~ata~.~O Date Installed ~ ~ &/A~ ;~ LI Width of Field ~ I~ Square Feet of Absorption A~ea~'~O Depression over Field (Y~ Results of Last Adequacy Test I Separation Distano~ from Absorption Field: To Water-SUpply Well~ ~OI~ To P~o~erty?Line To Building Foundation '~-~{ ! To Existing or Abandoned System on Lot ~ · ; On Adjoining Lots To Wate~ Mafn/Se~vice Line ~ To Cutbank(if presen~)~I To St~eam/Pond/Lake/o~ Major D~i'nage Cou~s~..~ To D~iv~ay, Parking A~ea, o~ Vehicle Storage A~ea ~%/~ Type of System Design of Field Depth of Field ~ q.,.~ Gravel Bed Thickness ~ Standpipes P~esent Y~N) Date of Last Adequacy Test / D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water AlarmLevel at Tested for Electrical Codes(Y/N) Co~nts Dim~ ns ions./~' Manhole/Ac~/.(Y/N ) "Pump Of~FLevel at . / Vent (Y/N) Pumping Cy/~es du~ing Adequacy Test. / / Meets FDA Check Permitted Bed~ocm Rating Against HAA Pequest I certify that I have checked, verified, o~ confo~Ted to all MOA HAA Guidelines in effect on the date of this inspection. Signed.~,~__;~__ Date KB1/d5/s ',t, ~_ %/ \. 1 [Page 2 of 2]