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Home My WebLink AboutHAMPTON HILLS #1 BLK 2 LT 17MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191502 PID Number: 015•JSLI Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name ERIC DINSMORE ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 7601 MCLURE CIR ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 77 4 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot HAMPTON HILLS #1, BLK 2, LOT 17 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ 50'+ TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCH TANK Capacity 1250 Gal. Surface Water 100'+ Material Number of compartments Lot Line 10,+ NA PLASTIC 12.0 Foundation 10,+ LIFT STATION Manufacturer Capacity Remarks OLD TANK DECOM. PER UPC. Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer MIKE N ANDERSON Drainfield Co/MT 3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft 1s` 11-30-19 Inspect Location and description 2 ndion GARAGE SLAB 3rd 41h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date° MICHAEL N. ANDEP,SCIN ``:er° CE- 469 °0°''4« • • r Septic System Appr2- — lh Date ,L 2 Note: this approval does not include well permit requirements. tFCev uowz/ 10) Permit No. OSP191502 Page 2 of 2 Municipality of Anchorage 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 Inspection Report Legal Description: HAMPTON HILLS S/D, BLK 2 LT 17 PID No.: 015-134-63 MARK A IB C01 7 �4 TC01 15 6 TCO2 18 3 02- 23 32 °' moi' / / /'BENCH', "G B \\ , 1 `CO2 03 / TCO / /1 cd2 WELL � \ NEWS 1250 PLASTIC TANK / I _ — — - ASBUI — 1 "=50' col Tcot coz rcoa OF We Air LAS®® AV o® AW' •49THoff ®® 4 95. 1.250 GALLON ........../%j / • ....................... p PLASTIC CREEP TANK , 10 .................................y. ®®..•MICHAEL N. ANDERSON. t5= 91mwr -al—AV ®1®��? No. C 9 69'•AV ® s Z SEPTIC SECTION ®•• �" "' N.T.S. Perwit Number #SW eats of Issue, Parcel Id-cutification Number, Date Started: 7-27-1,R Date Completed. '17 T email locct--d at appr)ved pei-mit locafi.oTV %, Yes Nu f,egal Dcscription, Hampton Hills 41 Sic,,ck -2 Lot 17 Pr4j*rty Owner Name & -Add Er:'c & �-.eaffyer Dinsmoro 7201 b1c Lure Cirde Ancharace, Alaska 9 5077 Borehole Data- Dt�pth (ft) 'chod of DHWv&; x air nAtry ("able, tool Soil 'Type, Thioknes,� ;k- Watel st�uta Froul To caging typc-,, sfec-,[ ex;, ting .h'eR 10 166 Depth: 1.9, feet 'Aj Stad".- 2 ef 166 Lft)er Vpe- gral-,cllv sill" 1615 J 71 Diav)¢ej,,, --muhts Depthl ;zrava,!ound: titiluxq 't gi- gravel, 7 Static Water level tifrcyn, grixtnd level": f69 fet;r Ezap.d !T20 2 gpin Pumping .360 feet aftel- houl� P;irlping tj gp-nj �,Vavefl-v sili Recovej-v Raie, > lei bedrock, I cl: 7 3166 -M e t It jj d o 'f T e S ti. 2' g y Well 1�it-akv 0, --r End x Op��n Hole 7 Siar, ftet �--;topped fQet '�topp=( feet stmt 0 letttseq pmnp� hltakt Dopth fee" Well 1X,1j11&,-tcd Vow), compiefio)ft? fares Fj No M'SinfecTio r1to Me ., Method 11. c' r PO ac 110496 j Alpine Drilling & Enterprises Perwit Number #SW eats of Issue, Parcel Id-cutification Number, Date Started: 7-27-1,R Date Completed. '17 T email locct--d at appr)ved pei-mit locafi.oTV %, Yes Nu f,egal Dcscription, Hampton Hills 41 Sic,,ck -2 Lot 17 Pr4j*rty Owner Name & -Add Er:'c & �-.eaffyer Dinsmoro 7201 b1c Lure Cirde Ancharace, Alaska 9 5077 Borehole Data- Dt�pth (ft) 'chod of DHWv&; x air nAtry ("able, tool Soil 'Type, Thioknes,� ;k- Watel st�uta Froul To caging typc-,, sfec-,[ ex;, ting .h'eR 10 166 Depth: 1.9, feet 'Aj Stad".- 2 ef 166 Lft)er Vpe- gral-,cllv sill" 1615 J 71 Diav)¢ej,,, --muhts Depthl ;zrava,!ound: titiluxq 't gi- gravel, 7 Static Water level tifrcyn, grixtnd level": f69 fet;r Ezap.d !T20 2 gpin Pumping .360 feet aftel- houl� P;irlping tj gp-nj �,Vavefl-v sili Recovej-v Raie, > lei bedrock, I cl: 7 3166 -M e t It jj d o 'f T e S ti. 2' g y Well 1�it-akv 0, --r End x Op��n Hole 7 Siar, ftet �--;topped fQet '�topp=( feet stmt 0 letttseq pmnp� hltakt Dopth fee" Well 1X,1j11&,-tcd Vow), compiefio)ft? fares Fj No M'SinfecTio r1to Me ., Method 11. c' r PO ac 110496 j (907) 243-7893 KEN JOHNSON WATER WELL DRILLING PUMP SALES & sERVICE 3163 LINDEN DRIVE ANCHORAGE, ALASKA 99~0% October 2,1981 Bob Foreman ( 337-6309 ) Lot 17 Blk 2 Hampton Hills Subd. Off Hillsid & Whist Anchorage~ Alaska WATER WELL LOG 0 fro to ~ fto ~ fto 'to 6 fto 6 fto to 11 fro i1 fto to 18 18 fto to 60 ft~ 60 fto to ?0 fto 70 fro to ?? fro ?~ fto to 81 ft. Fill Brown silt Cobbles and brown silt Course ~ravel and brown silt (tight) Med0 gravel & sand with brn silt Course ~ravel ~md ~ray silt Hardpan Course grav and sand .ogray silt 135 ft 'to 140 ft 140 ft to 150 ft 150 ft 'to 165 ft 16~ ft to 166 ft 81 fto to 120 ft Brown silty sando.some Medo grav, 120 ft. 'to 127 ft Same...weeps water.° 127 fro 'to 135 ft Sandy brown silt Course gray & sand ( weeps dirty.° Medo sand Sand with trace of med gravo Clean Med. gravel and sandooWater bearing.° Static water level 1~6 fto ( 19 fro Head ) Test bailed at 5 GPM Drawdown 6 fto ( 152' ) Good recovery Bottom Stable Set pump 3 fro off bottom MUNICIPALI-[Y OF ANCHORAG~ Dr~T Oc ~'!7'~.Z'~ '% Development Services Department Building Safety Division On -Site Water & Wastewater Program o 4700 Elmore Road P.O. Box 196650 a Mark Begich Anchorage, AK 99507 s A E T Y Mayor www.muni.ora/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: 015- 3q-65 Legal Description Ha -ma ->-on 14;ll5 J# / 13 z L 17 Pump Installation Date: Property Owner Name & Address: of tit e Gwae UV� 9`57(t* Pump Intake Depth Below Top of Well Casing. feet Pump Manufacturer's Name: eee&cxc� Pump Model: oSzf Pump Size / hp Pitless Adapter Burial Depth:j 0 feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: 4k)PIS Well Disinfected Upon Completion? eYes ❑ No Method of Disinfection: Comments: Pump Installer Name: ANCHORAGE WELL & PUMP SERV. 330 EAST 76T" AVENUE .,r ANCHORAGE, AK 99518 PHONE: 907-243-0740 AIAroc roNA Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. NAME MAIUNGADDRESS MUNICIPALllY OF ANCFIORAGE 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 I ' NSPE(.TION REPORT LEGAL DESCRIPTION LOCATION DISTANCE TO: Manufacturer IF HOMEMADE: .~ide length Well _ ~ Dwelling ' D'STANCETO: No, of lin? line Top of tile to finish grade Type of crib Width Crib diameter I Total length of lines eneath ~ Crib depth Building foundation Dritler Sewer line tDweJling Width L M_aterial - Trench width ':~ ~, inches !NO. OF BEDROOMS Total effective absorption area PERMIT NO. No, of compartments Liquid depth -- [~ UPG RADI Liquid capacity in gallons -~D. istance between lines inches ~ ,,/,3 DISTANCE TO: Well Nearest lot line Class Depth Distance to lot line P--~_:~RIVII~- NO. DISTANCE TO: Building foundation Septic tank Absorption area(s) OTHER PIPE MATERIALS ¢~ SOl L TEST RATING INSTALLER ~PPROVED DATE 72-013 (Rev. 3/78) LEGAL :~r:;,.} -5 ,.,.,-~ ~ ' L:x;t { I, fl)N (-'.,~'iO 'l',t-j,':- L-:Ol'fi:ff,! q:i: T[);: :C;:-:;CRVi:~ [' [Q;! ,:: [~ [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEC1 'ON B2§ L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 5 6 7 8 9 10 11 12 13 16 1'7 SLOPE DATE SllE PLAN I WAS GROUND WATER ENCOUNTERED? /~ O ~ O P IF YES, AT WHAT E DEPTH? -% I Reading Date Gross I Net Depth to I Net 'rime Time Water Drop F PERCOLATION RATE m nut~s/[~qh TEST RUN BETWEEN FT AND COMMENTS ~l~ ~I&J~G J~ '~ '~ 140~ O~ ~D~TH PERFORMED BY: ~) ~'~ CERTIFIED BY: 72-00~ (6/79) l! ICI LITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water &Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. 015-134-63 Expiration Date: 3 —q _Z-07_0 1. GENERAL INFORMATION Complete legal description HAMPTON HILLS #1 BLK 2 LT 17 Location (site address) 7601 MC LURE CIR, ANCH AK Current property owner(s) ERIC DINSMORE Day phone Mailing address SAME Real estate agent t, 5 6 � 8 o t Day phone 2. TYPE OF DWELLING: ��cz Ela Single Family (w/wo ADU) QFC ❑ Duplex qc% 9 & ❑ Multiple Dwellings (Single Family uplex 8L 9574 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. 1 ash _ COSA Fee $J� 7 330 ' — �� Waiver Fee $ Date of Payment �o� -y-i� C I IIz2 Date of Payment Receipt Number -?Y57701 Receipt Number COSA # oS c i q 15 V 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 12-2-19 ?oaoc=oaa >ac-aoomo n &' 6. DSD SIGNATURE System #1 Approved for 4 bedrooms�- ° CE 9 19 System #2 Approved for bedrooms Disapprovedt�f: Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: HAMPTON HILLS #1 BLK 2 LT 17 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 7/27/18 Total depth *366 ft Cased to 187 ft ❑ Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 10/25/19 Static water level at beginning of test 169 ft. Comments *WELL DEEPENED 200' IN 7/27/18 B. TANK DATA Age of tank(s) NEW years Tank type/material PLASTIC Measured operating fluid level in septic tank NEW 0 Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 9/16/81 OF ALL standpipes present per record drawing Total measured depth from grade 9.6 ft (max) Measured depth to pipe invert from grade 3.6 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ 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 Parcel ID: 015-134-63 Structure served by this system Well production at time of test 2.8+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No 0 Coliform bacteria is Negative Nitrate 3.53 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by MNA Date of Sample 10/25119 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 10/25/19 Results F, -/]Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600+ gal New depth 3 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) UN 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' 0✓ Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft 2✓ Yes if No ft Neighboring Tank > 100' 0✓ Yes if No ft Private Sewer/Septic Line > 25' F,-/� Yes if No ft Absorption Field on Lot > 100' 0✓ Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No ft 0✓ Yes if No ft if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft 21 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' 0✓ Yes if No ft Property Line > 5' 0✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0✓ Yes if No ft Private Wells > 100' dQ Yes if No. Water Main > 10' 0 Yes if No ft Community Wells > 200' ✓0 Yes if No. Water Service Line > 10' M Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓v Yes if No ft Private Wells > 100' 0 Yes if No Water Service Line > 10' ED Yes if No ft Community Wells > 200' M Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS ft ft ft ft ii G. ENGINEER'S CERTIFICATION 1 certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with F f " MOA COSA guidelines in effect on this date. ,L 1),'iluv ,s, A D ... _ COSA Checklist yellow sheet ft ft ft ft J_ W w pr"w 0) Lw� V Z O Q IF D 0 O Z O V\ N 00 L4 O 7 �6� J O D R Oti SEPI\C 2` O e 1jr0lot 90 6 ------------- lifts �O. E,. 1 ;a 0 WWy ., I. &Ir;,:. � �: son) moxo,n A m A ° a F Q a F � � 'a .1qF vim ° � .. F O & Y m 8°m°A QNa q JAZ °mA ,c$amroea 7 J.dpb �pp mmi°. w �oi o°�pppp a�msw am 49 � P.q E I m °e�� y O •• is y •O amq �09Oaa ..macc uS,'Aa 0. .-Ott Ott a�,aC ^° 4 o'a a Z«i.°. w w w. > m O •a & � m a.a mo N LL 1 1 '.:1;- � 0 WWy ., I. &Ir;,:. � �: son) moxo,n Pa oCD Q a F � � .. F QNa N LL 1 1 '.:1;- � 0 WWy ., I. &Ir;,:. � �: o Mdm� Pa oCD � QNa q N LL 1 1 '.:1;- � 0 WWy ., I. urn �a yw Mdm� QNa q MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH &HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519~6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 171 'BloCk 27. H~pton Hills Location (site address or directions) 7601 Property owner Mailing address ALASKA PERMANENT FUND CORP. Day phone 277-2484 C/0 Wi£ey Brooks Co. (Michael Pike) 2525 B~tmbar~.~, q,ti~¢ 204 ~ohn~ag~., AK 345-5532 (mobiZe) Lending agency Day phone Mailing address Agent Michael Pike/ WILEY BROOKS CO. Address 2525 Blueberry St. Anchorage, AK Day phone _277-2484 345-5532 (mobile) Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 '~ TYPE OF WATER SUPPLY: Individual well X×X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. XXX 72-025 (Rev. 1/91) Front MOA 1¢21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 regulations in effect on the date of this inspection. NameofFirm S&$ENGINEERIN~ l/~' / Phone 17034 Eagle River L~op Rca. C/No. 204 Address Eaale ~iver_ Al~b~ QOqT?/ ~' Engineer's signature" Date Approved' for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval CertificaTes based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska, The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satis~ certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors ur omissions in the professional engineer's work. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descript o,: ~T~/~,/~,//~'~_/j/~/ //~/~--~.,,~'rce. I.D. A. WELL DATA Well type %1 Log present(~/N) Total depth Sanitary seal ~N) IfA, B, orC, attach ADEC letter. ADEC water system number :~-~ Date co m p let ed //~'",~ '~ / Driller :~lJ'. Cased to ~ ~1/-' Casing height /(~ Wires properly protected ~)'N) FROM WELL LOG Date of test Static water level Well flow --~ g.p.m. Pump level AT INSPECTION _ 2,~tJNtC~PALITY OF ANCHORAGE ~- / L-(--.~RONMENTAL SER~, ICES DIVISION i V E D SEPARATION DISTANCES FROM WELL TO: I' Septic/holding tank on lot /~)O ¢- Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout /k,.)/j~ Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: Collected by: Other bacteria SEPTIC/HOLDING TANK DATA Date installed c;(_ /g-8 Cleanouts ~N) ~ High water alarm (Y/~__~_ Date of pumping Tank size I~('~RC.-- Compartments ,~ . _ Foundation cleanout (Y/N) /~' Depression (Y/~) )~"~/,~ Alarm tested (Y/N) _ ~/~ ~_jLJ_q~ Pumper ~ ~o~ SEPARATION DISTANCES FROM SEPTIC/H'OLDtN¢~ TANK TO: Well(s) on lot /(2:y--~ ~''(~ On adjacent lots To property line (~ ~E~._> (qb_Absorption field S I Surface water/drainage l(--~ Foundation Water main/service line 72-026 (Rev. 7/91) Fronl CONTINUED ON BACK PAGE D. ABSORPTION FIELD DATA Date installed q~(~ ~) Length ~¢~-~ Width LIFT STATION C. Date instal~ Manufacturer~ Size in gallons % Manhole/Access Vent(Y/N) ~ .... ~ ~Pur~p off" level at High water alarm level ~ Cycles tested MeetsMOAetectricalcodes~~~ SEPARATION DIST.~4~ FROM LIFT STATION TO: Well on~.Jet'''''''~ On adjacent lots Soil rating I~ '%~/'~¢- System type · '~/ Gravel thickness ./¢, Total depth Total absorption area Depression over field (Y/6 Results (~s/fail) Peroxide treatment (past 12 months)(Y/~_~ Cleanouts present(~N) /~/~-~ Date of adequacy test for ~ ~.r~,~J~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots Property line To building foundation ~, 0 '-(- To existing or abandoned system on lot On adjacent lots Cutbank Water main/service line Surface water Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to alIMO/~HAA guidelines in effect on the date of this inspection. 17034 Eagle River Loop Road No, Signature ., , ,~, ~ ':~ , "~ · , ~agle t~lver, Alaska 99577 Engineers Name Date of Payment ~/- 7~ Date of Payment Receipt Number ~ ~-~ (/~ Receipt Number Time Date Fime Date Date Inspector Inspector Inspector Comments Conditional Approva! Approved Bedrooms Disapproved Conditional ApprovaI, L Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank y.g/}~., APPLICANT FILLS OUT LOWER HALF ONLY Prope?ty Owner: '/ ~ ~ ~,Y~ Address" ~ Buyer )~ ~{~- ~ ~ .... P///~:~h o n e Address Lending Institution Address .~.,,4~_,5~/~ Realty Co. & Agent Street Location ~e Typ~gf Residence ~ Single Family ~ Multiple Family No. of Sedrooms ~ Other Phone Phone War.er, Supply ;~J Individual [] Community [] Public Utility Sew~age Disposal ,,~ Individual 13 Public Utility FJ Holding Tank ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) Year Individual Installed: ~¢' ~ When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. DTI000611