Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutPARADISE VALLEY BLK 4 LT 14 MUNICIPALITY OF ANCHORAGE
On-Site Water& Wastewater Program Sf;
PO Box 196650 4700 Elmore Road f. .
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 f�•,
http://www.muni.org/onsite
)e partInc ttt
4HORPGE
On-Site Wastewater Disposal System Permit
Permit Number: OSP171241 Effective Date: 9/6/2017
Work Type: Septic Upgrade Expiration Date: 9/6/2018
Tax Code Number: 02041122000
Site Legal Address: PARADISE VALLEY BLK 4 LT 14 G:3538
Site Mailing Address: 18240 NORWAY DR, Anchorage
Owner: KEETER MICHAEL W & KELLY J Lot Size in Sq Ft: 18397
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3
This permit is for the construction of:
El Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
11. A test hole is to be provided at time of construction to confirm separations to groundwater and impermeable
barriers. Locate test hole a minimum of 5 feet away from the bed. Construction may proceed at your own
risk before the 7-day water monitoring is complete. If the results require a design change, construction of the
system shall stop pending on-site review and approval. Please submit stamped and signed test hole results with
the inspection report.
+„c sheII-rtot-we♦ d—
`1/12 17 CV It Desi elk)? due Iv 771 it C i frto
btd -l-0 S - opici
11,1_,4/1 /Received By �,� � �� Date: (://6t J �
effifi.VAA
Issued By: i Date: 6 O17
MUNICIPALITY OF ANCHORAGE
(
Community Development Department vilPh• . - •S
Development Services Division ' - : ' 997
On-Site Water& Wastewater Program
AUG z i
ON-SITE SEWERNVELL PERMIT APPLICATION AP CO
Nor
Parcel I.D. 020-411-22 a 6 8 G 9
Property owner(s) Michael & Kelly Keeter Day phone
Mailing address 18240 Norway Drive, Anchorage AK 99516
Site address 18240 Norway Drive, Anchorage AK 99516
Legal description (Sub'd., Block & Lot) PARADISE VALLEY B4 L14
Legal description (Township, Range & Section)
Lot Size 18,397 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑X Initial ❑ Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑ Upgrade Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
t41,
ink
(Signature of property owner or authorized agent)
Permit/Rush Fees: 50 Waiver Fees:
Date of Payment: S f o-2v0 Date of Payment:
Receipt Number: /� nG/�7[oo2,14 Receipt Number:
Permit No. 051"/ / L / Waiver No.
Permit App_ c
Pannone Engineering Services ac
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
August 18, 2017
Subject: PARADISE VALLEY B4 L14
Septic System Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade septic system be issued for this property.The proposed
system will serve an existing three (3) bedroom house. Currently the lot is developed. The system will utilize an
upgrade absorption field removing and replacing the original field. This lot and the surrounding lots are served by
private wells. There are no wells or surface water within 100' of the proposed septic system.
1. Soils.One test hole was performed in the vicinity of this system in June 1983, and groundwater was not
encountered. Bedrock was not encountered in the test hole.There are established test holes throughout the
subdivision that exhibit a similar soil profile and perc rate for those soils.
Based on the results of the percolation tests and overall soils appearance; an application rate of 1.2
gallons/day/square was used for a conventional wastewater system in the area of the system.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field.The
proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches.
4. Topography: The existing topography on the lot generally slopes from the northwest to the southeast at 15%-
20%. There are no steep slopes near the proposed absorption field.
5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the
review is complete and that there are no further comments is received from MoA On-Site Department, the note will
be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of this or the surrounding lots. If you have any
questions or concerns, please contact me at 272-8218.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
Co * 1
1 / / / i REMOVE EXISTING ABSORPTION FIELD & BIOMATTED
/ / / ..-- --
A
MATERIAL IN AREA OF NEW FIELD. _
01 / \ *1' / f
le * % / / INSTALL ABSORPTION FIELD (P)
f ***** - / v / (2EA)19LFx5.0'Wx4.0'E.D.,6.5'T.D. -
** 1 7�l - 1.25" PIPE W/ 0.125"o HOLES DRILLED 18'O.C. W/ 2"
% '01/, i / / / 41 / R.I., INSTALL MIs IN EACH END. REMOVE ANY
i J.
/ / / BIOMATTED MATERIAL IN OVERLAPPING TRENCH AREAS
4 s. / /` / / w ENSURE 2" R.I. OVER LINE UNDER DRIVEWAY
/NOR,N r,+y. 5,9 ALE : ,•yso' l' / / %1 Q
S� / �j - ��
P
/ / �/ / / / i \'0 10-1-\/ / lip. %,, IL rr+,e gRpTiC
/ �/
_ -4 til/ / / 70321 .ro �, /
/ .Ock7
tI:
v / 100.3 �:�� M -� - -
...
/ / 100.6 1 4 v / ` • 1 -�
/ s / / / / ‘1,-
1
�4% i 15
/ W / / /I,ozel �� / / i ``, ` 1 / �� if
/ / 1
/ / / / / : r' �4!
/ / / / ozo� / / 102.7 --
%,/
// /� .., / \// / 13 / • / / � � � . .
\ / 1 / / 7
/ WELL (E)ii,
l� / / ,0,61 / 1oa.s� ; 3 g / / '\ i
i/ / AA 1 WELL E
// / W / / �/ / / / _ ' `1 0--�WELL CO
/ / / -7. W / on / ..----
i -
// 1 // SART1 // /�
WELL E
/ / /
/ / / //
// 1/
! / r / / \ \ \ 16
I /
—/ / / / !1
/ / / `/ II �Cy /17
' "----
/
/ 1 /
I /I 1 W I j
DESIGN PARAMETERS ��
PRIMARY SEPTIC SYSTEM 1 - — W l�
NO. BEDROOM: 3(450 gpd) 18 1 \ / \ j
TANK SIZE: 1250g STEP (E) 1
PERC RATE: 1.7 MPI
/SOIL RATING: 1.2 GPD/SF \ A____ ---
AREA
AREA ROD: 375 SF
REDUCTION FACTOR: 0.5 — ABBREVIATIONS
ADJUSTED AREA REQD: 187,5 f
SYS. TYPE: WIDE TRENCH 4.0'ED TH TEST HOLE
MIN LENGTH: 38.OLF (P) PROPOSED
-(E) EXISTING
USE: . CO CLEAN OUT NO.
(2EA)19.0LFx5.0'Wx4.0. E.D., 6.5' TD MT MONITOR TUBE NO.
TOTAL AREA: 190SF f� TYP TYPICAL
s- _
NOTES: PANNONE ENG SVC, LLC D08 18/2017
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, A 99510 p ••'
PHONE (907) 272-8218 FAX (907) 272-8211 scale
*•'� * 1" = 50'
• ,, ,•• y .•l.•• • P.I.D. NO
PARADISE VALLEY B4 L14 ' �� c-'` 020-411-22
MICHAEL & KELLY KEETER f �,••�}°yen �••��n�e PERMIT NO.
DRAWN JRL 18240 NORWAY DRIVE •'••RFv�be�i1ro1,, OSP171241
SITE PLAN ANCHORAGE, AK 99516 ••••••••• Sheet
ti 1 OF 3
C`/,II C` I nn nr-n!I/ll A TI nnI Tr-C`T
SLOPE
#t
BOH
DATE PERFORMED: 11SEP17 WAS GROUND WATER
ENCOUNTERED. N
IF YES, AT WHAT
DEPTH? —NA—'
DEPTH TO WATER AFTER
MONITORING?—
DATE: TBD MY
1011-1/1-7
READING DATE
TEST HOLE 1
NET TIME
WATER
LEVEL
READING
OR
TOPSOIL
1
1105
Orange Silty
2
SP
SAND
9.65 MIN
11.700"
3
1.66"
3
1126
4
4
1136
10 MIN
SM/GM
Brown SANDY
5
5
1137
GRAVEL
6
6
1147
7
11.900"
6.0
1.67"
8
9
SM/GM
Brown SANDY
10
GRAVEL
C`/,II C` I nn nr-n!I/ll A TI nnI Tr-C`T
SLOPE
#t
BOH
DATE PERFORMED: 11SEP17 WAS GROUND WATER
ENCOUNTERED. N
IF YES, AT WHAT
DEPTH? —NA—'
DEPTH TO WATER AFTER
MONITORING?—
DATE: TBD MY
1011-1/1-7
READING DATE
CTIMEK
NET TIME
WATER
LEVEL
READING
NET DROP
(MPI)
1 11SEP17
1105
5.900"
P.I.D. NO
020-411-22
2
1115
9.65 MIN
11.700"
5.8
1.66"
3
1126
5.900"
4
1136
10 MIN
11.900"
6.0
1.67"
5
1137
5.900"
6
1147
10 MIN
11.900"
6.0
1.67"
SLOPE
TH 1
SOIL TEST RESULTS/ANALYSIS
• PERCOLATION RATE 1.7 (minlinch)
(Hydrologic Soils Group: HSG A)
• PERC HOLE DIAMETER 6"
• TEST RUN BETWEEN 4.5 FT AND 5.5 FT.
• TEST RUN FOR OVER AN HOUR, LAST
THREE READINGS PROVIDED.
COMMENTS: Test hole excavated by A+ HOME SERVICES.
PERFORMED BY: Joseph Lawendowski. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES:
PANNONE ENG SVC LLC
P.O. BOX 102954 ANCHORAGE, AK 99510�i
PHONE (907) 272-8218 FAX (907) 272-8211p'•••
••
•••• •• •••
•• }ems^ •�• �d���a
CE 8149
'••
Date
09/11/2017
FOR CONSTRUCTION
Scale
NTS
PARADISE VALLEY 134 L14 �-
MICHAEL & KELLY KEETER
18240 NORWAY DRIVE
ANCHORAGE, AK 99516
P.I.D. NO
020-411-22
DRAWN JRL
PERMIT NO.
osP171241
SOILS LOGS
Sheet
2OF3
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION 01
ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55.
2. SCOPE OF WORK: INSTALL NEW SOIL ABSORPTION SYSTEM,
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 10 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 10 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC
LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED
SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK.
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING
AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER.
8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE
ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND
TANK ELEVATIONS.
10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION,
TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING.
11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE
PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER
(OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE
CONTRACTOR.
12. THE CONTRACTOR SHALL SIGN THE FOLLOWING:
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED.
CONTRACTOR:
BY: . TITLE:
DATE:
NOTES: PANNONE ENG SVC, LLC ADote
OR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 '(F'9 08/18/2017
�'
PHONE (907) 272-8218 FAX (907) 272-8211 •.. �1 Scale
*I • • I. /" .•* NTS
.•• •• P.I.D. NO
PARADISE VALLEY B4 L14 c
—�+ 020-411-22
MICHAEL & KELLY KEETER rtr�•a1a4G^^°!° PERMIT NO.
iRAWN JRL 18240 NORWAY DRIVE 4'•gE �$`�lr OSP171241
ANCHORAGE, AK 99516 '-oi' Sheet
DESIGN NOTESz OF 2
~ ~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
~ ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
N-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE I ~NEW
C OE>iN Ki ~ t//- q~.. ~ UPGRADE
MAIL~NGADDRESS
LEGAL DESCRIPTION
' · ~ NO.S~BED~0OMS
LOCATION
Well Absorption area Dwelling PERMIT NO.
~ ~ Man ufacture~ ~ ~ ~ Material~r~ ~ No. of
Liq. capacity in gallons Inside Jength Width Liquid depth
/ ~ ~ ~ IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ~ Manufacturer ', Material Liquid capacity in gallons
~ Well Foundat]o~ Nearest lot line PERM~.~ ~
~ ~ DISTANCE TO: t&~ ~'
~ No. of lines Length of each line
Trench ~ between lines
Total lenqth of lines Distance
~ ~ Top o~ile to finish grade Material beneath tile Total effec~rption area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class ~S Depth ~ Dril~¢______ ~ Distance~to ,l°t line PERM~.
~ DISTANCE TO: Building foundation~o Sewer line~ Septic tank/¢~ Absorptlo~
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS " ~
- J
APPROVED DATE LEGAL
:DEF:'ARTMENT OF FIE]ALTH AND ENVIRONMIENTAL. F?ROTECTION
825 L STREET~ ANCHORAGE. AK 9950
26 ,q. '"" 4 '720
05/3'~ ,c ·
CHRIS KOS]:NSK I
6236 E 12TH ¢I:A-P
SUBD ]: V ! S ] ON :', F'ARAD I SE VALL, EY
SEC]"ION: !:L TOWNSHIF': :LiN
:!.8900 (SQ,,I:::'T,, OR ACRES)
NOR. NAY ):}RIVE
3
::, L :.~ .. h {e 'I ('; N al" E-} ', !"~ ;''~ ';i,p ,.1_'. ii. CiI"i ~il ~avai ii ]. aii:] ] TM {' "~ } OLi J. 1] iilJ(:,:~!il ii. g! !"i ]. f'H::! VOMP '!~i{{{~i::) {' ii. C:
4 ,, ()
2 ,, ()
2 5
64 ,, ()
14..- 9
1,000,,() e.~.
DEiii:::'TH "I"Ci !:::' ]: F'E B{XNI"TCIP! (F:'T.)
GRAVI!i:].... )::)liil]:::'TH (F:"T',,
TOTAL DEF'TH (I:::T.
GRAViEL. WIDTH (FI",,
GRAVEl.. L. ENGTH (F"T'
GI::i'.AVEI.. VOI....UMIE (CU
'I"ANI< S!ZiE (GAI....S)
SO I L RAT t I'.IG
].' ,;::: e i" '.',.'.. :i. {' y t h a t:
:!.,, 1[ am f'aifi:i.].:i.a!" wi'Lb the ?equi~-s:~mer'rl:...ss..: fop cm~......~ei:i.t.c;.~ s(;-:.:we?~;~; and (.,~et].s as set
fcn"Lh by 'l'..l]e Hun:i.c:i.j]a] :J. ty of Ai"ic:hc)i"a(~:le iMOA) a~.f]ct 'Lhe St.a'Le of AZl. as!<a,
2. 1[ ?,i:i. ]. ] :i.l"l~mLa] ]. the s'/sdl.,:~.)m :i.n ac:,::::oi-dar!ce ~,~i'Lh ali. 1i. MOA
a!ld :i.n c:(:;)~l!i;:l] ;i.&nc:e w~.th tl"t~?) cles;L~N~ (:;:P ].'Ls'.!,l~ :i.a of tl"i~.s
t ~.....,~,... ' "' ........
4 ]1 un~el"s'Land 'L ~a'L 'Lh:~.s pe~-m:i.t :~.s wY:ti, id {oi" s ma::<imLiiYi ot' 3 !::n:-H:li"{:x:mis end
any E.}I']].ail"q(.i:.}i¥i(,~}i']'iL ~i. ]. ]. I"E.H;.iLI:i. i'~{~}} ali'] ?:~t{::ld :~.'L !i.(::i!"N~s]. i:]~X~I'~Yi :i,t ,,
I F A .... I I:::'"F STAml" I ON I S ]: I\IS]"~.k..L.E)2~ ]1N AN AREiA iiiXi]VEFi:IED BY. MOA BU 1i1 !....D I NG CO!)i{H!i,
THiEN ¢ '.I.') AN ,r:it. ECTF;'. ]: CAI.... Pliii]::IN .'I: ]" AND I I',tSI::'ECT ]: ON MUST BE OB'T'A :!: NED !~ (2) . AS-BU .'I: !..TS
N :i: L.I,.., gO]" BE AI:::'F:'ROVE)::) N I TI'"IOUT AN IEL.ECTFi'. I CAL I I'.ISF:'!ECT :I: OH i":;~EI:::'ORT ~l AN:I:) (3) THE
E L.E,% T R I CAi ....v,ti..."d'., h'iU~::~ I ~ DONJi~ ~:., ~' i,..~ ~.....,, d::.~x~::~::~.. I:::,.,i.L. !!"..~. ,~.~ .[ Ar,!.
c:) J. L,'Ilx!t.:.L, ' ' ' ~../.','1 I I:::, ,i
AF'PI.... I {:]AI',I]" :: CHR 1i1S K0S I 1',1.~31< ]1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 g Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
//~ SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION: 'p~r-cx.~,,'.~.~ '~/¢~t1~
2
3
4
5
6
7
8
9
10
11
12
13
14
15-
16
17
18
19
20
Lot 1
SLOPE
DATE PERFORMED: 6- ,~-"~ - 8.'~
WAS GROUND WATER S
ENCOUNTERED? ~"~0 (~
P
E
SITE PLAN
r.sI
I
IF YES, AT WHAT
COMMENTS
· Ir,~_ Gross Net Depth to Net
~'l~ading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN . FT AND
FT
PERFORMED
CERTIFIED BY:
DATE:
!
L .. tIP, g~, '
/$
~=~, 7~,~
1'7
6-11-~5
Static Water Level
Dr~ Do~n
10
feet
feet
Material Drilled~
0 feet to
to 50 %!~t 'y~v cl~v
Lot 14 Blk. 4
Psrsdise Valley
Gallons Per Minute
Total Feet of~asir~ 60
50 feet
to 60 Or~¥e~/~,~ter
to
, to
to
Hefty Drilling
8.R.A. Box 1553 H
A nchorage,Alash~
115"'
Lo4' iq, i51~. !--t,
N DT~'~
I. L]&r.,.. H/E¢...cu'¢_-/ FLu~,,T
;
...5 O0
The SurvivorsT" 300E:
duplex automatic operation.
Should any switch fail, the pump
will not be damaged and can be
temporarily operated manually.
A full selection of compatible
accessories for indoor and outdoor
service is also available including
alarms, check valve; basins and
covers.
THE SURVIVORS. Designed tO
insure a lifetime of rugged service.
A vortex impeller fOr v, rtually Clog-free
pumping of fibrous materials & solids.
~~, ; APPLICATIONS
Effluent and small waste removal,
: dewatering; sump draining, liquid
transfer; flood control, circulation
for:
· Homes
~ :Fa[ms
· Apartment Buildings
· Mobile Home Courts
· Hotels/Motels
i · Hospitals
The Survivors 300E submersible · Package Lift Stations
pumps are ruggedly built to handle · Commercial/Industrial
effluent, drainage, seepage waters Installations
and other fluids where ,c, log-free ~ _~ wear Ejector vanes provide seal
solids handling up to 3,~ in diameter uiJ . ~. protection. ®General Electr c
is required. ('(" ' ~L SOLI ,D, S HANDLING--Handles u,p
Easy to service and totally field '~ ~ to 3/4 spherical solids with a 11~
repairable The design permits easy - · ·
· ' .......... '
replacement of all Inalvlaual
components without special tools
..... ' i/~., , , -H coz[om sucuon, ueslgnea for
~:~e~encPt~i~vPo~aUoS~,P~nS~ n..reoau~din- ~~~ maximul~ vortex pumping efficiency
u , ~ ~ ~1-=--1~ ~H - and easy motor housing/impeller
continuity tests priortoleaving : i ~l~=~-~l J~l~ I~ assembly removal
factory. I~-I I ~ J~] SHAFT SEAL--1/~" with Buna-N
Lightweight in design to facilitate ~ [~tl I~"iq:~,~[q~ ~III ~ bellows, carbon and ceramic
qu. ick.a,nd,easy i.nstallation, ~__..}J;~[~" ~ ~ ~ sealing faces, stainless steel metal
scneoule(~maintenanceisnot... ~. :.~-z~;~. ~~ parts
required~A! castings are :-~ ~,~':."~]~ , f'~J¢"~:__l~. .,,-~'~ ~ ~-=..~=o^.~-,,~= Cont n
!nterchangeable to reduce '%~ ~ ""~"'"" "-.':' .... .' '~.'?.^%-~ -
inventory requirements. .... uous operauon up t.o, ]4u ~-.,
Choose frOm a variety of Separate : ~P~O ~W-rE,.~R, ,C;~ ;R~-~l.~5,,,h,e..a.v~ d.u~t..y~l 6-
cmoenr~rUo~lYefrls°~ot?eVTi~Cehres~man~ ALL COMPONENTS ARE EAsY TO ~1'~.~: ~'L"l~i~'t;'~l',~l~'~:i~'a~l'¢s~e';i;~ to
p ex or SERVICE. ELIMINATES NEED TO prevent oil wicking and provide
REPEACE ENTIRE MOTOR;~
BEARINGS AND MECHANICAL
SEAL PERMANENTLY LUBRI-
CATED WITH FDA APPROVED
WHITE MINERAL OIL, WHICH
PROTECTS PUMP EVEN IF BASIN
OR SUMP ACCIDENTALLY
RUNS DRY.
FEATURES & SPECIFICATIONS
MOTOR--I/3 HP, 1550 RPM, 115V
or 230V, lj3, 60 HZ. Built-in thermal
overload protection with automatic
reset. Motors are oil-filled for
permanent bearing and seal
lubrication and efficient heat
dissipation.
MOTOR HOUSINGS--Constructed
of rugged cast iron. Buna-N O-ring
for positive water and oil tight
sealing.
IMPELLER--Fiberglass reinforced
Noryl®, with brass insert, multi-
vane, vortex impeller with integral
rim protects pump casing from
moisture protection in case cord
damaged. Stainless steel cord
connection.
HANDLE--Permanently attached
steel handle makes it easier to
carry, position and install pump.
EXTERIOR TRIM & NAMEPLATE--
Stainless steel screws and bolts for
maximum corrosion resistance to
allow easy removal after extended
service. Stainless nameplate'
provides permanent identification.
WEIGHT--30 lbs.
PERFORMANCE
CAPACITY -- M)/HR
0 4 S 12 16
4O
~ 3o
o
0 10 20 30 40 50 60 70
CAPACITY -- U.S. GPM
Flow Total Head
(GPM) (Feet)
0 24.0
10 21.5
20 19.5
30 17.5
40 15.0
50 13.0
60 10.5
Max. Load Amps
115V-12A
230V-7A
DIMENSIONS
ORDERING INFORMATION
Model Motor Phase/ Approx.
Number HP Voltage Cyclea Ship Wt.
PWE3B01 1/3 115 1/60 30lbs.
PWE3B02 1/3 230 1/60 30lbs.
VORTEX IMPELLER RESISTS
CLOGGING. HANDLES SOLID
MATERIALR UP TO 3/4".
Specifications subject to change without notice.
STA-~ RITE
Individual pre-engineered accessories
and systems available...
designed for trouble-free set-up
BASINS/COVERS
SIMPLEX
DUPLEX
Distributed by:
SWITCHES
From Bulletin PW80-4
SINGLE BULB SWITCH
.Fyom Bulletin PWS0-5
DOUBLE BULB SWITCH
From Bulletin PW80-11
DUPLEX CONTROLLER
For complete information on
accessories, request bulletins:
Single Bulb Mercury
Float Switch
Double Bulb Mercury
Float Switch, NEMA1
Double Bulb Mercury
Float Switch, NEMA 4
Duplex Controller
High Water Alarm,
NEMA 1
High Water Alarm,
NEMA 3
Check Valve
Basins/Covers
PW80-4
PW80-5
PW80-10
PW80-11
PW80-12
PW80-13
PW80-7
S3213
STA~r~ITE
a WICOR company
293 Wright Street
Delavan, Wisconsin 53115
414/728-5551
· Oklahoma City, OK · Ledgewood, NJ · Orlando, FL · Los Angeles, CA · Atlanta, GA · Delavan, WI · Twin Falls, ID
Bulletin No, S3263 (4/84) © Copyright Sta-Rite Industries, Inc., 1983, 1984 Printed in U.S.A.
MUNICIPALITY:OFANCHORAGE
DEPARTMENT OF HEALTH &i HEIMAN SERVICES
Division' of. Environmental Serv.fces
On-S~te Serwces Sect on
P'.O. Bo~(' 196650 Anchorage,,Alasl~a~ 99519~6650
343~-4~7~,4.
CERTIFICATE OF H EAETH AUTHORITY
Parcel I,D. # _~C)- L~\ -~;c~,=~
GENERAL INFORMATION
Complete' ega,descrpton _ 'P~:,~A'~I~I= %/AtLL~ ~
Location (site address or directions) 1 ~,~..:MI:) ~O'¢2¢,//~"7/
Day phone:
Day phone
Agent
Address
Property owne~:
M~iiling address
Lending agency
Mailing address
Day phone:
Unless otherwise requested; HAA will' be held for pick. up.
NUMBER' OF BEDROOMS:: ~
TYPE OF WATER: SUPPLY:
In dividual well: ~'
Community well
Publicwater
NOTE If community well, system; provide Written. confirmation, from State. ADEC attest~
lng. to the'legality and status: of system:.
TYPE OF WAS.TEWA~ER~ BlS1 - ,
I
NOTE:
Cc
Publ
attesting:
72-025 (Rev. 1/91) Front MOA #21
As cert!fied by my. seal affixed hereto an d asofthevalidat/io n, date shown below, I verify that my
investigation' of, th~s Health Authority Approval~ applic~trion.shows that the-on-site water supply
and/or wastewater disposaF§ystem is:safe, functional ar~d~adequate for the~number o~ bedrooms
and-typeofstructu re indicated:herein. I fu
the Municipality of~Anchorage;-filesand
supply.
ordinances~ and~regulationsdn~effect on th~
Name of Firm
Address ~-0,"~ d~J/ / ~/-~/.
Engineer's signature:
on obtained-from
the on:site, water
pal: and' State codes;
'Phone-.
~H, ~S~, SIGNATURE
'~._ Approved' for ~
Disapproved.,
Conditional', approval~ for
bedrooms.
bedrooms, with', the, following stipulations:
A, pproval~ Cei:tifiCA~,es~-.?:l~a~ed.0nly~ dpon, the: representations- g yen' in paragraph' 5 above by an ndependent
P r0fSSSior~al.'6ngi'b~'r'~ii~t~;ed4 q;the State o~Alaska: The DH~tS does'this as a courtesy to purchasers of homes
and;~ei(!endiilgi[n¢fitUti~'p§'i~'0irde['t0~satii~fY certainfederal, a~nd State reqUirements, Employees of DHHS do not
condu;c~ i~S'l~ti~n'~':'0~"arial~ei/d~a:~befC)[~'a';i.certif Cate,- s iSsUed~ The, Mun c pa ity of' Anchorage s not
reSponsi§l~ifs~' ei:r0rS' or o'rniSSi0~i in',. the'profeSSional: engineeCs Work.
72-025 [Rev,,1/9:l) Back, MOA#21
825"L, ~
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitaw seal (Y
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
FROM~WELL LOG
I0!. ~ ~ -,
Date
B. SEPTIC/HOLDING TANK DATA
Date installed
Foundation cleanoUt (Y/N)
C. ABSORPTION FIELD DATA
Length ~ ¢' Width
Soil rating (g.P:d./ft3;or ft/bdrm) ' 8'~'~
Date of adequacy test
Fluid depth in absorption
Fluid depth ~._~ : ' (ins.)
Peroxide treatment (pas
ts(Pass~fiil) . ~'.
For
D. LIFt STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump off' level at* ~ g tn
*Datum I ,~.,, ~
"Pump off" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
; On adjacent lots ~ I ohm
; On adjacent lots ~ to'~:~
Public sewer manhole/cleanout b4~
Lift station I I 1~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~6,t Property line a~eff_r~ Absorption field
Water main/service line '~ I~ Surface water/drainage f'q I O Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation ~..O I Water main/service line
Surface water f~//O
Curtain drain ~t I o
Driveway, parking/vehicle storage area
Wells on adjacent lots lit 4- Property line
ENGINEER'S CERTIFICATION
I certify that l have determined thrufield inspections and revie~ of Municipal
in conformance with MOA HAA guidelines in effect on this date. ~'~
Signature
Engineer's Name
Fee $ ,
Date of Payment ~?'/~D,
Receiptmumber_ ~)7/ ('72"~]7 ~
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHO~GE
MEMORANDUM
SEPTIC SYSTEM ADVISORY
HEALTH AUTHORITY APPROVAL NO./6/~7~F~--
Prior to a recent adequacy test on the septic system for
this lot, 2~ inches of standing water was observed in
the absorption field. This indicates that approximately
q~ % of the absorption area is inundated. Although
this system passed the adequacy test, the remaining life
expectancy may be limited.
This advisory must be attached to all copies of the subject
Health Authority Approval.
T.SPURKLAND P.E.
203 W. 15th. AVE. SUITE 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEP 11 t$ 7
unici ality ol Anchorage
DeMpt. HeaPlth & Human Services
Dan Roth
Municipality of Anchorage
Department of Health and Social Services
820 1 Street
Anchorage, Alaska 99501
Subject:
HAA Lot 14, Block 4, Paradise Valley
Pink Sheet
September 11, 1997
Gentlemen;
You questioned the test procedure used in evaluating this septic system, and if the trench was
surcharged during the test. This septic system consists of a 1000 gal septic tank, a 500 gallon lift
station and a drainfield 56 feet long, 4 feet wide and with 24 inches of rock. The theoretical void
volume of this drainfield is 64.8 cubic feet or 486 gallons per foot of rock (54x4x.3x7.5) Since
effluent is pumped up to the drainfield any water surcharging the field will drain back to the lift
station, assuming that a check valve has not been installed to prevent drain back.
The test procedure was as follows: A float was placed in the monitor with a marker at the top of
the pipe. Metered water was discharged to the lift station in an amount sufficient to raise the flag
a sufficient distance to indicate that the trench was being surcharged. The water was then shut off
and the excess water drain back into the tank. After drain back the flag was 2 inches higher than at
the start of the test. 4 hours later the flag was at the top of the monitor, indicating that the water
discharged had been absorbed. Again a metered volume of water was added to the lift station, this
water was in addition to the previous drain back. The flow was cut off when the flag rose rapidly,
indicating that the distribution pipe was filling. After drain back the flag was again 2 inches higher
than at the start. After 4 hours the sequence was repeated. A total of 670 gallons were added to the
drainfield over an 8 hour period without surcharging the field. This indicates that the drainfield has
a charge capacity of 200 gallons and that these 200 gallons will be absorbed in less than 4 hours.
TY. s~~kl~
MUNICIPALITY OF ANCHORAGE '
DEPART~;'I~IT OE Hi~ALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE~SEWER AND WATER FACILITY
264-4720
GENERAL INFORMATION
(a)
Application Date
Legal Description (include lot, block, subdivision, section, townshi 3, range) Lot 14 Block 4 Paradise Val~ey Subdivision
Location (address or directions)
18240 Norway Drive
Applicant Name Chris Kosiniski Telephone: Home 337.4348 Business
Applicant Address P.O. Box 11-2307 Anchorage, Alaska 99511
(b)
(c) Applicant is (check one): Lending Institution []; Owner/builder [[~;~uyer []; Other [] (explain);
(d) Lending Institution Rainier Mortgage
Address .
Telephone
(e) Real Estate Company and Agent
Addrsss
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family J~xMulti-Family []
Number of Bedrooms three(3)
Other
WATER SUPPLY
Individual Well F~xx Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite ~xx 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 (11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, 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 regulations in effect on
the date of this inspection.
Name of Firm Tobben Spurkland Telephone
Address
Date
Engineer's Seal
This department has received written confirmation from the engineer
regarding the Conditional Approval of November 27, 1985.
The corrections have been accomplished and an inspection has been
completed by the engineer. The subject property meets with Municipal
standards and is now approved.
DHEP APPROVAL
Approved for l;hTqee(3'~ bedrooms by
Approved ~X~X~X_XXXXX Disapproved
Terms of Conditional Approval
~;~cv~iZ~'~/ Date June 23_. 1986
Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given i,..paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work. ~,.~ ""
Page 2 of 2
72-025 (11/84)
DIVISION OF ENV~
DEPARTMENT OF HEALTH AND ENVI
Re.- Conditional Health Authority
Paradize Va] y
~ApprOvall, Lot 14
Block4
Gentlemen;
On November 27, 1985, a.con~
lot. The conditions for the apPr~va~ have been met. A cleianout
next to the ta~k has been insta~i~d and thelpowercab~e ~o
liftstation buried
Please furnish the
Yours
c/c Kris Kisinski '
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTiFiCATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Dato
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name~'~__
Applicant Address
(c) Applicant is (check one): Lending Institution []; Owner/.b.t:,td~ [~; Buyer []; Other [] (explain);
(d) Lending Institution
Address
Telephone
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family.~ Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Well.,,J~ Community [] Public []
Individual
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite~ Public[] Community[] Holding Tank[]
Note:/' 'If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
F2-U25 (11,84)
Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, 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 regulations in effect on
theNamedate of this inspection. ~ j~
of Firm ~~.~. Telephone ~'"~ ~ ' ~ q/~
Address / ~ ~ j~_~
Date ~ l/ ~ ~, / ~'~ ~
DMEP APPROVAL .~ ,g,~_~-~
~pproved for ~(-%) bedrooms by Date
Approved Disapproved __ Conditional ~%
Terms of Conditional Approval ¢:~.~u¢¢~,~¢~ - ~-.,~ ~' ,~%- /] ~
CAUTION ~ ~~
The Muncip~lity of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does tiffs as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP de not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
· Page 2 of 2
'/'~' MUNICIPALITY OF ANCHO~GE
DEPT. O~ HEALTH & *
MUNICIPALITY OF ANCHORAGE [MOA) ENVI~N/V~NTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984 NOV 2 5 ~'
264-4720
Legal Description,~...~
~IN -~,~' _
WELL DATA
Well Classification
Well Log Present [Y/N)
Total Depth ~ O Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring:in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
f A. B, C, D.E.C. Approved (Y/N)
Date Completed ~,'//~ ~'~ Yield
~,C~ Depth of Grouting N O
Pump Set At
~1~// Sanitary Seal on Casing (Y/N)
~ Depression Around Wellhead (Y/N)
; On Adjoining Lots
To Nearest Edge of, Absorption Field on Lot ~; On Adjoining Lots
To Nearest Public Sewer Line /~N~' To Nearest Public Sewer
Cteanout/Manhole /'~ Otl/~----,-- To Nearest Sewer Service Line on'Lot
Water Sam pie Collected by '~" --'~ ; Date
Water Sample Test Results ~ ~¢.~/~,,/,,~.44
Comments
SEPTIC/HOLDING TANK DATA
Date Installed ~ 7/~-~ -- Size
Standpipes (Y/N) 7'~O Air-tight Caps (Y/N)
Depression over Tank (Y/N) /'~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) ~f/'/~
Separation Distances from Septic/Holding Tank:
To Water-Su pply Well / ¢ ~
To Property Line ~'
To Water Main/Service Line
Course
No. of Compartments
N ot,
Foundation Cleanout (Y/N)
Date Last Pumped
:for
Temporary Holding Tank Permit (Y/N) ~'~'~,
To Building Foundation '~ 7
To Disposal Field
To Stream. Pond~ Lake, or Major Drainage
Comments
Page 1 of 2
72-026111/84~
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 A 9sorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line ~ /L~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness ~
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 ~n Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/Nj
Comments ·
//..///
Dimensions ~'~ ~
Manhole/Access (Y/N) ~
"Pump Off" Level at ~ '~
Vent (Y/N) ~w
Pumping Cycles during Adequacy Test. Meets MOA
I~0 / I
** Check Permitted Bedroom Bating Against HAA Request **
I certify that I have checked, verif, md, or conformed to all MOA and EAA guidelines in effect on the date of this inspection.
Signed '"'~J~- ~ Date
Company- ~--~,--~,~. MOA No.
/
Receipt No. "~ t.~ L~ I ;~ '-~
Date of Payment I 1 - or~-~ ~
Amount: $ ~__~ ~ Engineer's Seal
Page 2 of 2
72-026 (11/84)
tB$ORi~FICN FIELD DATA
Soils ~ting in Absorption Strata
Date Installed
Width of Field
Squa~o ~t~et of Absorp.tion Area
Dep~Ossion over ~ield (Y/N)
Resu]:t,~ of Last Adequacy Test
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
Sepa~fation Distance frcm Absorption Field:
To Wat~-Supply Well
To Building Foundatio~
Lot
To Water Main/Service Line
To Property Line
To Existing or Abandoned System cn
; On Adjoining Lots
To Cutbank(if present)
To Stream/Pond/take/or Major D~ainage Course
To D~iveway~ Parking Area, or Vehicle Storage Area
Co~f~nts
Do LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at /~ ;'
High Water Alarm Level at
Tested for
Dimensions
Manhole/Access ~(Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
Meets MOA
Electrical Codes(Y/N) ~.~-3 ....
Check Permitted Bedr°cra Rating Against HAA Request
I."certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on tlm~date of this inspection.
KB1/d5/s
[Page 2 of 2]
Date_
MOA
ENGINEERS
SEAL
2-15-84