HomeMy WebLinkAboutRABBIT CREEK VIEW & HEIGHTS BLK 4H LT 11A MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~ _ ~ TANK FIELD
Phone(s) / IPermi, No. ' ~ ND. Of Bedrooms WELL /~ ~ /~ ~
Township, Range, Seclion ~ ~ , ~ ~' As-BuILT DIAGRAM ('Show location o[ we~l, septic system, prope~y lines, foundation,
ANKS ._
No. of '
TYPE OF SYSTEM ~4-( [ ~
[~TRENCH ~ BED ~ W. DRAIN ~OTHER J [U~ ----
Tolal dept~lrom original grade ~
Number o, lines Soil raj,no P,pe materiat J ~
WELLS ~ I
~PRIVATE ~ OTHER Jldentifv~ ~ ~ J
REMARKS:
I ..... ~,_.,[. oiv~r LoO~ Roa~o. 204 cBdi~ Ihat th%inspe~io~was pedormed acc0rdi,o 10 all ~
72-013 13/85}
/ unicipali y of. Anchorage
· Department of Health and Human Services.
825 "L" Street
Tom Fink,
Mayor P.O. BOX 196650 Anchorage, Alaska 99519-6650
343-4744
January 9, 1989
Alaska Housing Finance Corp.
235 East 8th Avenue
Anchorage, Alaska 99501
Subject: Lot 11 Block 4 Rabbit Creek Heights Subdivision
Permit ~880073, P.I.D. #020-114-45
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1988.
Permits are issued on a calendar year basis by authority of
Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system
not installed by the expiration date.
If you have drilkled the well, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as-built inspection report
(three-part form) must be sent to this office for review and
approval, and for documentation.
When applying for a new permit, the fees are: $90.00 for
an on-site sewer permit; $50.00 for a well permit; $140.00
for a combined sewer and well permit.
If there are any further questions, please call this office
at 343-4744.
Sincerely,
Daniel J. Roth
Acting Program Manager
On-site Services Section
DJR/ljw
enc: Copy of Permit
0 I"[ .... S ]: T [ii: !i~, liii: W E R 8,: W E L L.. I:::' E R M
E n cj :i. n e e P !)(.~..:., i (:il n e,,::l
Owner. I',lame[: ALASKA HOLISING I:::'II',.hANI::;E COl:q:::',,
er' Acldr'ess:t ].'7()::.~4 I~SAGI....I~'.; RIVER LC}OP ROAD NO,, 2C 4
' .............. A K 99577
[::.~..~bL..l:: R .I. ~E.['~,
Day ;:'hone:
694 "." ::7..'. 9 '79
I:::' a r' c: e! ]. Id: 0?0"-' 114....45
[..(::rL I....ega].: Subd:i.v:i...'..4:i.c)n: t::',:A~:IB]:"I' []F:~E!E~.K I--tEIi!:~ITT~i~ LcH:.-. :i.].
~(~.)c::'l'.. :i. cHI ,"., ]. 'l"c),,,.,r'~ sh :i. I] ," :1. ].N Fla,.r~,:.!e ,~ :}.',W
LcrL S:i.z~<.~ ::!!;/.I.()()0 (sq. f't .... oP ac:r. es)
Max .[.3(~>)dPc, c, ms~ 'l'h:i.s Per'm:i.t: 3 ]"l:~tal Cal:)ac:ity: 3
WEI.,.I,..: I...og must:, be subm:i.t'l:.ed 'l'.c) Munic:i. pal:i.T.y (~f' Anchc)Page Del::)a.r"~:.rnerrL (:)~' Health
ali cl Fh.un/.~.l'i ~::~ .:.~ . \/J. c: ,:.'.H~:~ t,~ :i..I.... h :i. I"l :~S ") d ay~.:~; c) ~" ~.]~.) ]. ]. c: (:::,rap ]. e't. :i. (::)l"~,
]: I~.II::;OI::::M D ,, I"1 ,, H ,, S ,, PR I OR 'FO :1. ST & :::;~lXl:(:) :1: N,c.!~,F:'EC:T :[ ONS BY I:~:htC"'i I I',IIi']:ER, :[ I::'
Al:::3"liii]::l Ol:::'l:::']:C;liii: HOL!RS CA[..I... 343'"~468:[ ANI} I...liii:AVl!ii: h I'dESSA(3[ii:
C;OhI!il;'T'I::;IUCT I:::'[!i]::~: I!."]qGINIJi!:EI::~:S A['TAI3HIED AF:'F:'I::~'.C'IVI]~][}
I"H ]: !!!~ l:::1!i]::::M ]' T IE X I:::' :1: RES ]. ~:'./3 1/8I!]
'['H:[ S I:::'EI::~!d :['T k/AL I.[) F:'OI::.'. A S ]:IqGL..E I::'AMI LY RES ]:DENBE OF. IL.Y
I [;liii:R'T' :1: I:::'Y "1 HAT:
:1., ]: am Fam:L 1 Jar' with 'Lhe Pequ:i Pem(+::rrl:.~ ~:'cH" on~..~:i, te .seweps ar'~d v~e]. ]1.~ as ~(.~)~..
For. th by the Municipa].i'Ly c)f Ar'~c::l'~c)Page (MOA) and 'Lhe S'La'I'..~.~ of A].aska,,
2. .[ u~:i.].:t :i.r~s't. al]. the system in a (::: l::: <::) l~ (::l a r'~ c: (.'..:.:' w:L'Lh a].l MI]A cc)des anti
3,, ][ w:i.].], adl"~z.:H'"(.~) t.o all M[}A and S'Lal'..e (:)f' A].asl...:a Pe[:lL~:i.e(~.:,m(::.tr'lts fop the set back
d:[star'lces ~'Pom any existing well~, wastewater' disposal sys'Lem c)r' pul::]].
the c:apac:ity c)~' the total sys'Lem :i.s :3 becIr'.c)oms and
PeqL~:[r'c.) ar'~ addi'L:i, onal ]]er'm:i.t.
//
HC)I. JS I NG l::: l NAN(:]E
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
EOA .OESCR,PT,ON,_Z /,49
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
3 m
Township, Range,
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
O
DEPTH? p
E
Oepth to Water Alter~ ' Oate:/,,,,~ ~,,
Monitoring? . L.:-~
v-/o
Gross Net Depth to Net
Reading Date Time Time Water Drop
20 ¢"Z- '~
PERCOLATION RATE ~.~.'~ (minutes/inch) PERC HOLE DIAMETER /
Z~e ~, d
- / ; ·
PERFORMEDBY~,.~~~ I ~/ ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE ~~I~IPAL GUIDELIN~FECT ON THIS DATE. DATE: ,b / ~/
72~008 (Rev. 4/85)
SCALE
h
SCALE
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
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
PHONE l NEw
7,~ ~ ~.,~i ~~ LJ UPGRADE
Well ~. ,~ Absorption arena
DISTANCE TO: JO,~ ~/0
Manufacturer
paqtying J
]Inside length
Manufacturer I _-- -I
DISTANCE TO: Well Dwelling
, J Length of eac~ line ~ Totallengtb oflin~s
Material 5eT~o~h tile
~iath' Depth
Length
Crib diame Crib dopth
Well z Building foundation
NO, OF BEDROOMS
PERMIT
No, of compartme~
Liquid depth
PERMIT NO.
Material Liquid capacity in gallons
J N ea rest ,~l~g~,e ~'
I Trench ,~J~ inches
~C2t' incbas
PERMIT NO,
Distance between lines
Total effective absorption area
PERMIT NO.
Type of crib
DISTANCE TO:
Class
DISTANCE TO:
Depth
Building foundatiN /
Total effective absorption area
Nearest lot line
)riller Distance to lot line
S~r line Septic tank
PERMIT NO.
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
~NSTALLER
REMARKS
PEPT.
DATE
C7_ %b .._r/;, 7
MUNICIPALITY OF ANCHORA~
Department f Health and Environmenta Protection
825 ~ Street, Anchorage, AK. J9501
264-4720 ~
* * * HANDWRITTEN PERMIT * * *
Applicant: _~L,/.~~'~z[ ~ Mailing Address: ~/
Location: ~//~ ' Phone Nu~er:
Legal Description: Z~x /J ~'/~ ¢ 4~,[~Y~.~.~)~:~ Size:
Type of Soil ~sorption System Is:
Trench: ~' Drainfiela: Seepage Bed: Holding Tank:
Maximum N~ber of Bedrooms: Soil Rating (sq. ft/br)-- "cSt/'
The Required Size of the Soil Absorption System Is:
DEPTH ['~ LENGTH ?~ GRAVEL DEPTH ~ WIDTH
~e le~9t~ dime~sio~ is t~e le~gt~(i~ ~eet) o~ the t;e~ch o~
the bottom o~ the eNc~v~io~(&~ ~eet). ~e~e is ~o set Niath ~o~
~e ~vel ~epth is the mi~im~ aepth o~ g~avel betNee~ the o~t~all pipe an~
the bottom o~ t~e excavatio~(i~ ~eet).
* * REQUIRED SEPTIC-(~OLDI~TANK SIZE = ~~ GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED ~ * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecuhion.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a co--unity sewer line is 75 feet. Well ].ogs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 g 3 * * *
I certify that:
(1) I ~ f~iliar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
system may require if
(3) theI ~nde~.a~~sidenc~thati, s re~el~tothe on-~p ~de more t~ bedro~ls~rgement
~. /' ~ ~plican ~-~%~"
~.~ ~ ~ Date: ~ ~//~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 k Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~ L--~'""~"'~S O ILS
~RCO LATIO~
TEST
,~G^u DESOR,,TIO.: /--.-. (> 7 ,//
SLOPE
DATE PERFORMED:
SITE PLAN
2
3
5
6
7
8
9
kO CODT~M /M /'-/,Ec>,q-'To
/\
11
12
13
15
16
17
18
19
20
.~ I~ ~" ENCOUNTERED?
-- 0
P
DEPTH?
j
Gross Net Depth to Net
Reading ()ate
Time Time Water Drop
j /z..:o o /,0A o
-J /Woo0,% , .o
/ w 3 o ~). ~j-= o
'///4
PERFORMED BY: k. I_< t.,u i ._'~ LC / ~
72-008 (6/79)
PERCOLATION RATE
-//,..,.~(, / , ¢
- ' ~- t~~-/, x
DATE: -'
7
FROM:
TO:
GREATER ANCHORAGE AREA BOROUGH
'-~ . SUBJEa/'~z'//
INITIATED BY: Y~g ~ ~'(-r 1C R-{ A ~ DATE OF MEMO:
REQUESTED:
RECEIVER:
FOR INFORMATION ONLY
FOR IMMEDIATE ACTION
FOR YOUR CONSIDERATION
O T H E R
REQUESTED ACTION SCHEDULE
PREPARE BACK-LIP INFORMATION
CALL ME BEFORE YOU ANSWER
NEED YOUR RECOMMENDATION
SIGNATURE
Ill I
SCALE: I GRID:
SSS ENGINEERS,
JOB NO
ZONED
DRAWN aY: er.. I CHECKEO BY: ~
INC o
7125 OLD SEWARD HWy.
ANCHORAGE, ALASKA 99502
I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY,
LOT I~ , BLK. ~ , [2~/~ ~t~;GJt( ~H~ANCHORAGE RECORDING DISTRICT, AK.,
AND THAT THE IHPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES
AND DO NOT ENCROACH ON THE PROPERTY LYING ADJACENT THERETO. THAT NO
INPROVEHENTS ON PROPERTY LYING ADJACENT THERETO ENCROACH ON THE PREHISES
IN eUESTION AND TRAT THERE ARE NO ROADWAYS, TRANSMISSION LINES OR OTHER
VISIBLE EASEHENTS ON SAID PROPERTY EXCEPT AS INDICATED HEREON.
BATED THIS ~ DAY OF I~ , ~9¢~, ANCHORAGE, ALASKA.
IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION,
TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISH GRADE AND UTILITY
CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS
OR RESTRICTIONS NHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological f~ Geophysicol Surveys
LOCATION OF WELL (Please complete either [e~ lb or lc.) A,D.L. NO.
'a"llG°r°" hA oh Subdivision Lo,~"'°°k '/..ir,. [Sectien No. TownshlpN
]1' ~of~of~of--- S
ic.J~ DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER
Stroll Address and Ar~ of Well Location
2. WELL LOG Feet Below 4. WELL OI
~,,av~ly '~i~%~. seep
sO
OF WELL:
DEPTH: (final)
I5. DA'rE OF COMPL. ETI(~.~
f t. 0 .... -z
Domestic [~ PubLic Supply [] Industry
Irrigation J~] Rectlerge ~] Comrnsrical
Test Well [] Other:
k~ Ttlreodod ~.,J Welded
____i. to2~9 tr. Depth Weight ___tbs./ft.
WELL:
ft. and fl,
Gravel pack
LEVEL below land surface end YIELD
ft. after hrs. pumpin§ ¢-')__ g.p.rn.
ft. offer hrs. pumping g.p.m.
well Grouted: Eli Yes ~[No
[] Neat Cement [] Other:
(if available) tiP_ ~.~
Drop Pipe ~ ' ft. capaclty
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Se~ices
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
LOT 11; BLOCK 4; RABBIT CREEK HEIGHTS,
Location (address or directions)
Viola Circle
(b) Property owner
Mailing Address
(c) Lending, Institution
MailinglAddress
A.H.F.£,
520
Telephone:(home)
Anch~agQ, A~a~ka 99503
Telephone
Business 561-1900 __
(d) Real Estate Company and Agent MARSTON ;~FAI FRTATE ATTN~ K~m
Address 2,~04 W N~th~ /.~'S B~E. A~ho~, A~. 995~7
Telephone 2~04
(e) Mail the HAA to the following address: (or check here~ if hold for pick up.)
List contact person and day phone number below:
S &5 ENGINEERING ,.
17934-Eag!e
Eagle River, Alaska ~9577
2. TYPE OF RESIDENCE
Single-Family.~ Number of bedrooms
3. WATER SUPPLY
Individual Well I~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ~( PL~blic [] 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.
72-025 (Rev. 7/88) Page 1 of 2
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MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST- FEBRUARY 1984
343-4744
Legal Description:
A. WELL DATA
Well Classification _
Well Log Present (Y/N) 4----
Total Depth~_o Cased to
Static Water Level _
Date Completed /D. -
(¢ "-f Depth of Grouting
Pump Set At
Casing Height Above Ground ~--~ O Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) _ ~ Depression Around Wellhead
SEPARATION DISTANCFS FROM WELL:
To Septic/Holding Tank on Lot / O0 / '~'
To Nearest Edge of Absorption Field on Lot / Co
To Nearest Public Sewer Line /L]/~
To Nearest Sewer Service Line on Lot _
Water Sample Collected by ~:-% ~ ~ ~,~;~'~Oc~e~¢'~_.~ ; Date _
Water Sample Test Results ~')~¢f'/-/'.3'-~'C~e,~l --
If A, B, C, D.E.C. Approved (Y/N)
Yield ?~0o ~ ~
; On Adjoining Lots ! O0
; On Adjoining Lots / OO
To Nearest Public Sewer Cleanout/Manhole A)//} _
Comments
B. SEPTIC/HOLDING TANK DATA
[)ate Installed J~-2. - .~/~8¢ Size /,;7-
Standpipes (Y/N) ~ Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well / CO
To Property Line ,~0
7'o Water Main/Service Line _ (~'-~ ' '/-
No. of Compartments
~ Foundation Cleanout (Y/N)
Date Last Pumped '~ /L.J
/,2//A ;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation.
To Disposal Field
/o -k
/ o 't
To Stream, Pond, Lake or Major Drainage Course
Co m ments 0 /Vk
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /~ -- -~ ! -
Width of Field ~ z/
Type of System Design ~¢J~ ~J
Length of Field (.¢ o ~
Depth of Field -/- ~/;t ~.%~a~o/
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Gravel Bed Thickness (¢
////CE) ~ Statndpipes Present (Y/N)
A) Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation /
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line ~ Ch 9¢-
To Existing or Abandoned System on
; On Adjoining Lots ~ o/,,) ~.
To Cutback (if present) ¢O ~J~
D. 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
Vent (Y/N)
Pumping Cycles during Adequacy Test.
Meets MOA Electrical Codes (Y/N)
Comments ,/2~/'J c-A ,~ ¢' ¢~ ~ ¢~
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed
Company
Date
MOA No.
,~ 8. S FNGINEERING
17034 ~.agle P. iYer Loop Road No. 204
Receipt No.
Waiver Fee: $
Date of Payment
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Page 2 of 2
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # ~;~- \ ~ ~ ~*% HAA ~ ~, ' :""
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner /~/~/:~
Mailing Address _~--ZO
(c) Lending Institution
Telephone: (home) Business
Telephone
Mailing Address
(d)
Real Estate Company and Agent //~/,¢/~ ,.~' 77_~/-~J'
Address ~ ~ 0/-~
Telephone
(e) Mail the HAA to the following address: (or check here F-I, if hold for pick up.)
List contact person and day phone number below:
$ & S ENGINEERING
1703~, Eagle River Loop Road N~., 284
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family/~ Number of bedrooms
3, WATER SUPPLY
Individual Well~ Community [] Public
[]
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SFWAGE DISPOSAL
On-site~v Public [] Community [] Holding
Tank
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status,
72-025 (Rev. 7/88) Page 1 of 2
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MUNICIPALITY OF ANCHORAGE (MOA) ~
Health Authority Approval (HAA)
'CHECKLIST- FEBRUARY 1984
343-4744
Legal Description: ~'// /~/./Z ,///~/ %
A. WELL DATA '
Well Classification/~'d'~'~/'E:~ZZ~ ~///~ If A, B, C, D.E.C. Approved (Y/N) /~
Date Comnleted /¢ ~ ~ Yield ¢/~~ ~
Well Log Presen~ (Y¢~) ___ v Z/~
~ /
Total Depth_~Cased to ~7 Depth of Grouting ~/~
~ump Set At ~ ~
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit/~Y/)N)
SEPARATION DISTANCES FROM WELL:
To Septic/H~M~1~-Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Sanitary Seal on Casing~(~)
Depression Around Wellhead (Y(~
;On Adjoining Lots
·
, On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
Water Sample Collected by~',
Water Sample Test Results
Comments
Date Installed/~.~/"~Size/~/¢,--~-do ~-- No. of Compartmerft~.~
/.% t /
Standpipe (.~.¢4) Air-tight Caps (~N)
Foundation Cleanout(~)
Depression over Tank ('~ Date Last Pumped /?-/~ ~
Pumping/Maintenance Contact on File (Y/N) /"///~- ; for ~
Holding Tank High-Water Alarra (Y/N) /4..7///~ Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/~4~E~DCI~G TANK:
/
To Water-Supply Well ./L:~/::) C--/--
To Property Line ~-~0 ~-/--
To Water Main/Service Line ,~-'-~)
To Stream, Pond, Lake or Major Drainage Course
To Building Foundation
To Disposal Field
Comments
72-026 (Rev 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorptior) Strata
Date Installed /2_~/~/,'/~
Width of Field
Square Feet of Absortion Area. ~'/~Z/
Depression over Field (YN~
Results of Last Adequacy Test
~/LcD Type of System Design
Length of Field C/odD
Depth of Field -~ 2 ~ //
Gravel Bed Thickness ~ //
Statndpipes Presen'~/N)
Date of Last Adequacy Test
/
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well //~(:::::D
To Building Foundation
Lot ~ r
!
To Property Line c.~ ¢' ~
To Existing or Abandoned System on
; On Adjoining Lots ~ ~ ,,,..Z ~
To Cutback (if present)
To Water Main/Service Line ~ ~¢~
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
CommentsT~' ~-¢.-/,~ / (-/ '¢'~ "~' ./
D. LIFT STATION
Date Installed
Size in Gallons ~/.//2~,
"Pump On" Level at
High Water Alarm Level
Tested for
Meets MOA Electrical Code/(Y~)
Comments
Dimensions /~-/¢'
Manhole/Acce (~)
"Pump Off" Level at
Vent (~
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked~ verified, or conformed to all MOA and HAA guidelines in~.f(eet, en. th~
inspection.
Signed
Company
Date
MOA No.
3 ,~, 5 ~NGINEERING
17034 Eagle l¢iver Loop Boad No, 204
Receipt No. ~.D .,~ - ~(,~9~/,Z¢,/ ~'//7~/'~ Receipt No.
Date of Payment ~J'~ -~ '- ~ ¢ Waiver Fee: $
Amount: $ /7~0~ ~
Date of Payment
72 026 (Rev 7/88} Back Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA,_ INC.
FEDERAL TAX ID # 92-0040440
ANALYSIS REPORf BY SAMPLE for Work Order ~ 11484
Date Report Printed: JAN 31 89 @ 14:01
Client Sample ID:LI1, B4, RABBIT CREEK tITS
PWSID :UA
Collected ~ t~s.
Received JAN 30 89 ~ 12:30 hrs.
Preserved w~th :COOL 4 DEG. C
Client Name
Client Acct
P.O.~ NONE REC'D
Req ~
Ordered By
Analysis Completed :JAN Bt 89 Send Reports to:
Laboratory Supervisor LSTEPHEN C. EDE I)S & S ENGR
Special
Instruct:
Chemlab Ref ~: 4099 Lab Smpl Il): I Matrix: WATER
Allowable
Parameter Tested Result/Units Method Limits
NITRATE-N 0.74 mR/1 EPA 353.2 lO
Sample ROUTINE SAMPLE.
Remarks:
Tests Performed See Special Instructions Above UA=Unavailable
None Dstected "See Sample Remarks Above
Not Analyzed LT=Less Than, GT=Greater Than
HAL ONLY
APPLIC- ,IT FILLS OUT UPPER
Property Owner /-L[../L.
Mailing Address Zip Code
Buyer /..?/-\ I'(
~ '~ ' CHk U,(?-[:; /'.\/~t(' 1.-, /..i I<..
Address ~ '~- ji t~'( !: /:'/ i)I:~L>t? / ZipCode
Lending Instilution
Address ~?c/!~'(..~ ,2'~'~' /~{~"{[:''~/ '/-'~ '/~' Zip Code
Phone
Realty Co. & Agent
Address
Legal Description .~.~_¢~//.,.~_ ~.T~//
Street Looalic~ k,~L~ ( /// ~'/'/,./ f. / ~/.
Type of Residence
~[~-....Si n g ~ e Family
': Multiple Family No. of Bedrooms .. ~ __
[] Olher
Water Supply
~.lndivid ual
'~ Community
[] Public Utility
Sewer Disposal
,~ndivid ual
ublic Utility
[] Holding Tank
Zip Code
Phone
Phone
ATTACH WELL LOG. A weU 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: 1-HE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date [)ate Date Dale
Inspector
Inspector
Inspector
hlspeclor
APPROVED
BEDROOMS
) DISAPPROVED
) CONDITIONAL APPROVAL'
'CONDITIONS OF APPROVAL
Soils Rating Date Sewer Installed
Well To Absorptioe Area
Well to Tank /0%
Septic Tank Size