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Home My WebLink AboutHAMANN LT 6A ' Municipality of Anchorage Page [ 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 Inspection Report Nam~/~.~ Wastewater System: D New ~ Upgrade Phone: ~.~ ~ ~ IN°~BedrO°ms: ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION ~o~, Rating: ~ ,~ GPD/Sq. Ft. Total Depth from original gr~ / Lot: ~ Block: ~~ ~epth to pipe bottom from origina~d): Gravel depth beneath pipe , Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: Gravel~: ~ ~ ~ , I Number of lines: Distance be~e~n lines: WELL: D New ~ Upgrade ~ Ft. I I ~/~ Ft. ~ification (Private, A,B,C): Total Depth: Cased To: Total absorption area: l Pipe material~ {~ . ,riller: Date Drilled: Static Water Level:F,. ~lnstaller: ~~- Dateinstalle~/~j~ Yield: Pump Set at: Casing Height Above Ground: TAN K GPM Ft. Ft. SEPARATION DISTANCES ~ptic ~ Ho,di.g ~ S.T.E.~. TO Septic Absorption Lift Holding Public/Private Manufacturer' ~~ Capacity in gallons: From Tank Field Station Tank Sewer Lines ~J~ Material: Number of Compadments: Water Lot Size in gallons: Manufac~~ Curtai~Drain ~ ~ ~ ~ ~V~ , Pump Make & Model Electricallnspectionspedormedby: Remarks: BENCH MARK Location and Description: I Assumed Elevation: Inspect,one performed by. _ ......... 7. zna l' Department of Health and Human Services approval Permit No. ~'age 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: 72-013A(2/S1)MOA 25 by SULLIVAN WATER WELLS P.O, 80X $70272, CHUGIAK~ ALASKA 99567 * TEL EPHONE 688.275,q OWNER OF LAND __ aotmess '/~,', ~?,:?,;s.._'Z7/ LEGAL DESCRIPTION DATE- Starlrd PERMIT NUMBER E,ded 5~.':?'_ ......... S'I'Aq'IC II!VEL OF WA II-R I, I'. I)RA~.¢ DOWN I-' f. GALS. PER H'R .... KIND OF CASING KIND OF FORMATION; From O ' FI. Frmn c'.~' . Ft. From_</' Ft. From .Ft. Fro,. ,.)' ~ ri. From From i':~ From ~7~ FI, From fl d3.. Ft. From, From / Fro n ~/.: ,'d.....Ft. From ~ Ft. From ~[L Ft. Ill .... Ft. re__Fl, FI, to ....... FL. ................ _Ft. lo ........ I-'I..... .FI {~s ....... Fl___ From Ft to ........... Fl.. ................... · . Fl, to .......... _1"1. fo__ _t"l.. ............................... I"L In ... I"1. . ......... ......... FI. to .... Fi: · . I-'1. ~ FI. __ Fi', to ..... Fl ................. Ft. to Ft .... .FI, to ..... Ft ............................ Ft. to ..... FI ................................... MISCL INFORMATION: :, ':.', DRILLER'S NAME 'f.:}~:-- ~ .1:d~; "/ ....... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920055 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:SHAFER ROBERT A & SALLY OWNER ADDRESS:17034 EAGLE RIVER LOOP, STE.204 EAGLE RIVER, ALASKA 99577 DATE ISSUED: 4/15/92 EXPIRATION DATE: 4/15/93 PARCEL ID:05061131 LEGAL DESCRIPTION: HAMANN LT 6A LOT SIZE: 77743 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL 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 (18AACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1.~?PROVIDE: A MINIMUM OF 24 INCHES FINAL BACKFILL OVER TOP ~F INSULATION/FILTER FABRIC. MOUNDING OVER TRENCH WILL · BE NECESSARY. RECEIVED BY: DATE April 14, 1992 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESI~3N SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 REFERENCE: Hamann Subdivision, Lot 6A We request you issue a permit to drill a well and install a septic system to serve the proposed 4 bedroom house on the referenced property. A test hole was performed on the property on March 25, 1992. The approximate location of the test hole is located on the attached site plan. The monitoring tube within the hole has been checked and found to be dry. This property has enough area for future septic upgrades, which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. Sincerely, RJS/lsu 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9- 10- 11 12 13- 14 15~ 16 17, 18- 19- 20- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE WASGROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~ DEPTH? p E ~10nit0ring? Y t~-~ ! Dale: , . SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop I .¢-)-2./,4'2- ~:~ 4-~t,.~"'- ~ / ¢ ,~ ., ~ ,1~',~/~ ,, ¢:~ ,, G,/¢,, ~/~', / f ,, ~ ~,~ ,, ~,/~,, ~/e,. 17034 EaCe Eiver Loop Roa~ No. PERFORMED BY' ~ ' ~agle Eiver, Alaska V PERCOLATION RATE I _;~.:~(minutes/inch)PERC HOLE DIAMETER ~ "'' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: z~.~ 72-008 (Rev. 4/85) 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. # 05f)-611 -3t 1. GENERAL INFORMATION Complete'legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING · HA^ #. Lot~,6A; Hamann:Subdivlsion Location (site address or directions) 24132 Alpenglow Drive Eagle River, AK Property owner Dale & Kathy Mossefin Day phone (503) Mailing address 2350 S.W. Vermont St. Portland, Or 97219 245-6944 Lending agency .Mailin. g address Agent Carolyn Address Day phone Greiner/Remax of Eagle RiverDay phone 694-4200 Unless otherWise requested, HAA will be held for pickup. 4 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: xx Individual well 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: XX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of sYStem. 72-025 (Rev, 1/91) Front MOAi121 J 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 structu re 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. N ' -rm ALAS~ WATER &~V~_.__A~r~N~ AI~R ame OT ~-I .... ---ii' Ni:-~ '. Phone Address ~l~~r~~ c[ea~out has been ~nsta[[e~ a~ the bedrooms. over the septic tank. DH2 SIGNATURE Approved for __ Disapproved. Conditional approval for A new septic tank depression has been filled bedrooms, with the following stipulations: 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 satisflj certain federal and state requirements. Employees of DHHS do not conduct inspections or anmyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. - CONDITIONAL 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 APPROVA' FOR A S NS'E .AMPLY DWELUN 05061131'v .HAA#__ 1. GENERAL INFORMATION Complete legal description Lot 6A; Hamann Subdivision Loca(ion (site address or directions) Property owner Mailing address Lending agency Mailin. g address Agent Virqinia Address 24132 Alpenglow Drive .Eagle River~ AK Dale & Kathy Mossefin C/O Remax of Eagle River Day phone 16600 Centerfield Dr. Eagle River AK Day phone Kohfield/Remax of E.R. Day phone 694-4200 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 ~ TYPE OF WATER SUPPLY: Individual well Xx 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: xx If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOAfi21 5. STATEMENT OF INSPECTION BY ENGINEER 'As certified by my sea!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 complia,n/a'~ with all Municipal and State codes, ordinances, and regulations in effect on the date of this~nsj)ection. ,% /~¢~t;3C,.~ I~C. .""- ~'., /. Phone Name of Firm Engineer's signature Date Alaska at closing for engineering services performed. Water & Wastewater Consultan s, Inc. is to be paid REQUEST YOU ISSUE A CONDITIONAL HEALTH_AUTHORITY APPROVAL DUE TO WINTER CONDITIONS. WORK TO BE COMPLETED BY 15 JUNE, 1999. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with th~ following stipulations: The repairs to this septic system pursuant to the attached engineer's report shall be completed no later than June 15~ 1999. Money shall be placed in escrow for 1½ times the high bid from a minimum of three (3) bldR. The balsnm~ mC thm mmgrmw fundR ~hmll ha r¢l~m~d mfr~r an mpprnved Certificate of Health Authority Approval has been issued by this department Additional Comments Date /'Zf' 9~-~ 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 satisfy 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 or omissions in the professional engineer's work. 72-025(Rev. 1/91) Mack MOAi~21 Legal Description: ~A~A~I~ ~'/~ t Municipality of Anchorage E DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division JAN 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3~qq~c~y EbIVlRONMENTAL SERVI(~b Health Authority Approval Checklist [-ol' ~',~ Parcel I.D.: 050- A. WELL DATA Well type Log present ~1~ t Total depth Sanitary seal ~N) Date of test Static water level Well productio~ ~)~tVA'¢£ If A, B, or C, attach ADEC letter. ADEC water system number "~'~ -~ Date completed 5;/'1 ~- Cased to c~ Casing height (above ground) I~," ,,~'~___~ Wires properly protected (Y/I~. FROM WELL LOG AT INSPECTION ' WATER SAMPLE RESULTS: Coliform Date of sample: ~'.o · ~.-/+ g.p.m, g.p.m. Nitrate /' 3 '~ ?'/t./~//_..- Other bacteria Collected by: A.. u J. ~J. E., '~ ! ~ B. SEPTIC/HOLDiNG TANK DATA Date installed C/'Z ~/~/2. Tank size Foundation cleanout (~N) Date of Pumping .'1 C. ABSORPTION FIELD DATA Date installed ~/ZE,/9 2_ I Length ~'/'f' ~ Width Effective absorption area "7G8 Date of adequacy test I'Z/'/ I'Z~o Number of Compartments '~- cleanouts {~N) Depression ((~N) Yp_.c ~ High water alarm (Y/~ ~ o Pumper ~ ~~ ~o~ mfin~ ~o~. ~' ~ ~y~e~ ~ype T~ ~mve~ &h~kne~ be~o~ p~pe ~ ~on~&odn~ Tube pm~en~ ~/~). Y~ Oepm~on Results (~) ?~ ~ For ~ bedrooms Fluid depth in absorption field before test (in.); 13¢,¢ Immediately after ~';~?gal. water added (in.): Fluid depth O~"t (ins) Minutes later: I ,~.J. Absorption rate = ~,oO4 .g.p.d. Peroxide treatment (past 12 months) (Y~) bI ~tI~ I/-~ov' ~/ If yes, give date '~ 72-026 (Rev. 3/96)* D. LIFT STATION Date inst,~d Size in gallons _ ~ Manhote/Ac~ ~~~r~3~~___ "Pump off" levet at* E. SEPARATION DISTANCES Septic/h~-!d!~-2"tank on lot Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: IooLt- ~ t 4' Lift station SEPARATION DISTANCES FROM SEPTIC/H4~L.~G TANK ON LOTTO: I t Foundation _6 4-- Property line ..~ 4- Water main/service line 1 (~1.¢ Surface wateddrainage I °~t' SEPARATION DISTANOE FROM ABSORPTION FIELD ON LOT TO: f~ 14. I ~ Building foundation I z~ Property line Surface water Curtain drain i OOl-~- F. ENGINEER'S CERTIFICATION_i/ I ce~ify that l ha~er~ed~u in conforman~ ~th SignatUre L ~~ g'nee[ s Name/ On adjacent lots On adjacent lots Public sewer manhole/cleanout Absorption field Wells on adjacent lots J ooI -f Water main/service line to Driveway, parking/vehicle storage area Wells on adjacent lots i o,~ inspections and review, ~.s in effect on this date. ~.~ ~o HAA F~e $ ~'~ ' ~ ~' Date of Payment Receipt Number . Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* · Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Rd., Suite 2B ~ Anchorage ~ Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 May 25, 1999 Municipality of Anchorage Attn: Donna Mears Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519-6650 RECEIVED MAY 26 1999 Municipality ot Ancrtorage Oept. Health & Human Services REFERENCE: Lot 6A; Hamann Subdivision Release of Conditional Health Authority Approval Dear Ms. Mears, A Conditional Health Authority Approval was issued on the referenced property on January 2, 1999 (HA 990009). Please be advised, all conditions have been met. A new cleanout has been installed on the septic tank and adequate fill has been placed over the septic tank. Please release the Conditional HAA and issue a full HAA at this time. If you have any que~ions or concerns, please contact us at 337-6179 JEfl~/~s~,r¢ ame ~F. E. M.S. Pres~d6h/ JAG/gd Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Rd. Suite 2B ~ Anchorage ~ Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 January 6, 1999 Municipality of Anchorage Department of Health & Human Services P.O. Box 196650 Anchorage, AK 99519-6650 REFERENCE: Lot 6A; Hamann Subdivision Conditional Health Authority Approval request Request yon issue a Conditional Health Authority Approval on the referenced property due to winter conditions. On December 1, 1998 the well and on-site wastewater disposal system located on the referenced property were tested for purposes of obtaining a Health Authority Approval. Both well and septic meet current M.O.A. requirements for a four (4) bedroom house (see I-IAA check sheets). However, there is a depression next to the septic tank and one of the septic tank cleanouts appears to be missing. Due to winter conditions, we request you issue a Conditional Health Authority Approval. The depression will be filled in and the septic tank cleanout replaced/or repaired on or before 15 June, 1999. ~equire additional information, please contact us. If you have any questions o~ Presiden ~ JAG/gd 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 1. GENERAL INFORMATION Complete legal description Lo.f: 6A..- Hamann Sub~vi~iO~ Location (site address or directions) NHN Alp6nglow Drive, Eagle Riv~ Property owner Pepp~s eon~trgo.,C_ion Day phone 694-9681 Mailing address P.O. Boz 1064 Eaql~ River, Alaska 99577 Lending agency Mailing address Day phone Agent Day phone Address B Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 ' TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XXX 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. 72~025 (Rev. 1/91) Front MOA #21 s~uewwoo leUO!),!pp¥ :suop, elnd!is 6U!MOIIO,t eq), q),!M 'SLUOOJpeq ~o,t leAoJdde leUO!),!puoo 'peAoJddes!Q euoqd 'su. JooJpeq ~ - Jo,t pe^oJdd¥ Bt:IR.LVNOI$ SHHO sseJppv LU~!=I ,tO etueN · uo!),oedsu! slq), ,to e),ep eq), uo ),oe,t,te u! suol),eln6aJ pup 'seoueulpao 'sepoo e),e),S pue led!olunlAl lie qipA eouelldLUOO u! S! Lue),s~S lesodsip Je),eMe),set~ Jo/puc ,~lddns Je)eN~ e),!s-uo ell), 'uop, oadsu) pue uop, eDl),seAu! ~LU UJOJ,t pue seli,t e6eJoLlou¥ ,to X),!led!o!uniAI eq), LUOJ,t peu!e),qo uol),euJJo,tu! ell), UO peseq )~eq), X~lJe^ JeLl)J n,t I 'u!e~eq pe),eolpu! eJn),onJ),s ,to ed~), pue SLUOOJpaq ,tO JequJnu eq), Jo,t e),enbape pue leUO!),oun,t 'e,tes s! LUeiS,~S legodsip Je),e~e)set~ Jo/pue /lddns Je),e~ e)js-uo eq), ),eLl), SN~OLlS uoi),eOlldde leAoJdd¥ ,~)lJoLI),nv LlUeeH s!qi ,[c~ iJOl),et~!),se^u! ,%u ),eq), ~,tpe^ I 'AAOleq U~AOLlS e),ep uoi),eplle^ eq), ,to se pue o),eJeLl paxg,te leas ,~uu ~q pegpJeo sv '9 EIB=INIDNB AB NOI.LOiBdSNI .-I0 .LNBINiB.LY.LS 'G ( Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-~'C (-,,~ ~-pa-A~ 5~,~ Parcel I.D. A. WELL DATA Well type ~1 Log present ~Y~N) Totaldepth Sanitary seal~_~/N) If A, B, or C, attach ADEC letter. Date completed Cased to c~ 'J- Casing height Wires properly protected ((~/N) AT INSPECTION ADEC water system number ~ ~?'" Driller FROM WELL LOG Date of test Static water level ct Well flow Pump level SEPARATION DISTANCES FROM WELL TO: g.p.m. Septic/holding tank on lot ~ c>-1 Absorption field on lot \o ~ Public sewer main ~/J~ Sewer service line '7--~Z ~ Jr~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout ~.~, Petroleum tank WATER SAMPLE RESULTS: B. SEPTIC/HOLDING TANK DATA Date installed ~ ~ 7-,'-~ ~ '~ ~ Tank size Cleanouts I~/N) High water alarm (Y~..I,) Date of pumping /~'/~ /~. Other bacteria ~.-~o ~.t ~ Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, A~asEa 9~$77 Compartments Foundation cleanout~_~N) X~ Depression (Y~ /~ Alarm tested (Y/N) "/L /"///A - /',/~ ~J' Pumper '/'~'//~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot / c, '~ To property line · Surface water/drainage On adjacent lots /o 4) ~ v- Foundation ]~ / .,c AbsorPtion field /o ~ +'- water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical SEP~ FROM LIFT STATION TO', We'll on tot On adjacent lots Manufacturer Manhote/~...~ "Pump on" level at ~ "Pump off" level at ~ Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed I,~ .. ?..% Length ~'~'~ Width Total absorption area Depression over field (Y/~:) Results ( p 2,c s/,~-{+) Peroxide treatment (past 12 months) (YN~ Soil rating _System type Gravel thickness Lc ~ Total depth Cleanouts present~/N) Date of adequacy test for If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon tot /~ /~ On adjacent lots /g"~ /¢'' Property line To building foundation /o I ~' To existing or abandoned system on lot On adjacent lots Surface water Curtain drain Cutbank IA- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ~ date of this inspection. Signature Engineer's Name Date $ & S ENGINEEEIN · 17034 Eagle River Loop Roa~ No. 204 ~':'~q~ f,Hvev, Alaska 99577 HAA Fee $ j Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number