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HomeMy WebLinkAboutGLACIER VIEW HEIGHTS #4 BLK 1 LT 6Municipality of Anchorage On -Site Mater and Wastewater Program - (907) 343-7904 Mage 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: WO0303 PID Number: 050-401-52 Dwelling: Q Single Family (SF) Duplex (D) Multiple (SF anchor D) Project: 0 New [V Upgrade Name: Thomas & Janet Flanagan FIELD addressP.C�_ Bax 772573 El Deep Trench [9 Shallow French D tied [] Mound El other Phone Number of Bedroom]ABSORPTION Soil Rating �GPD/SF epth from original grade 004-7380 Four (4) 6 4.214.5Ft. LEGALDESCRIPTION ,Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Loth Ft. 3.0 Ft. Glacier View Heights No. 4 1 _ :� Fill added above original grade Gravel length Township Range Section 2.312.0 Ft. 120 FL Gravel width Beds: dumber of Lines Distance between lines SEPARATION DISTANCES 5.0 Ft, Ft. Tai Septic I Absorption 'i Holding ? Sewer Total absorption area Number of trenches Dist, between trenches From Tank Field Lift. Station Tank Line ,053 Ftp 00' 0 FL TANK El C Well �. � I ' peptic S.r.r ., _ ❑ Holding � 00 , � "i 00 > � CTC} j >25 = g � Gather Manufacturer Capacity Anchorage Tank SurFaae water i >100' I >100' 1 >100' 1A 0 1,500 Gal. Material Number of compartments Lot Line _ I >10' i� >10' >100,N/A steel Three (3} .._._ ..-. 3 ...._......_�.....,...._....__ Foundation >10' >10" >100' N/A f A LIFT T`ATT iN Manufacturer Capacity Curtain Drain j Kane ; NotedGal. Anchorage Tank/Orenco 250 Remarks Pump on level at Pump off level at High water alarm at Existing septic tank decommissioned _ per SQA Cade Existingabsorption_ trench 42 in. 8 in. 44 m. abandoned in place. Pump make and model Electrical Inspections performed by Orenco Billy Marshall { MATERIAL House to tank x3034 Tank to 3034 Installer draintield Charles Barr Contracting Drainfield 1 3034 ccrMTT r Inspector MEA BENCH ARK (Assumed elevation) 100 ft Inspection�.ts� 0120/00;x, 9/28100 Location and description ars f4i Top of concrete steep at stairway. COMMUNITY DEVELOPMENT DEPARTMENT APPRO 'AL Engineer's Stamp Conditional Approval: Date .__ _AW•' ,, Wig• •; __. ____ — _ e 9 1H Michael E. Anderson.. 4331-E Approved CfrC Ylow Date ._i � . PRO ESSi Inspection Report 9-1-1?.dac Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT On -Site Wastewater Disposal System or Well inspection Report 4700 South Bragaw Street Anchorage, AK 99519-6655 - 343-7904 Permit Number,- SW60303 PID No. 050-491-52 0 LO 0 0 0 0 N M1 A I B S1 27.7' 57.5' S2 62,1' M11 373' 164ff M1 114.1'{27.6' M2 123.9'' 129.4" OF J 49th hrr "I" 0�k*,MICHACL E. ANDERSON Na CE -4381 NOTE: Drawing not completed from surveyed as built., Locations are not exact. H Y MH S2 S'l r1' Four &Wram ,u= Rom A ti 10' T & E EASEMENT PLAN AS -BUILT SCALE V = 40' Existing Well 0 Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: SVV00303 98.0 Final Grade 1,500 Gallon STEP Tank 94,05 102.0 NORTHLEG 60' (Trench Length) 99,8 PID No. 050-491-52 SOUTH LEG 60' (Trench Length) PROFILE AS -BUILT No Scale 49th ................... . .... . .... k *. MICHAEL Na CE 4361 96.3 49 H Municipality of Anchorage �� .Fff1 tti4 CA a.0 -•I Lt+.�� Department of Health & Human ServicesPO ;MICHAEL E. ANDEMN is 825 L Street, Anchorage, AK 99502-0650 0 s� CE - 43C, SOILS LOG - PERCOLATION TEST �0 fTfp' • •'� `�� ECO`; OrESS�o��� Performed For: Chuck Barr Date Performed: 9/209(p0�� Legal Description: Lot 6. Block 1. Glacier View Subdivision SLOPE SITE PLAN 1 4 Perc. Zone 5 6 7 8 9 10 11 12 13 14 15 16 17 18 OG/OL See Site Plan SM Silty Sand with Gravel Was Groundwater South Encountered? Yes If Yes, What Depth? 9.5' Bottom of Depth to Water Hole After Monitoring Date: Reading Date Gross Time Net Time Depth To Water Net Drop 1 9/20/01 2:15 1.13" 2 2:45 30 2.63" 1.5" 3 2:26 1.25- 4 3:16 30 2.75" 1.5" 5 3:17 1.13" 6 3:47 30 '2.63" . 1.5" Perc. Rate: 20 Min./Inch Perc. Hole Diameter: 8" 21 Test Run Between 4 Ft. and 5 Ft. Comments: Testhole Presoaked Prior to Percolation Test. Same Material as Previous Test Hole Performed By: Mike Anderson. I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 6/15/01 . . A Permit Number: SW000303 MUNICIPALITY OFANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 3434744 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade G _ 2 o -oa e s: se Date Issued: Aug 16, 2000 Expiration Date: Aug 16, 2001 Parcel ID: 050-491-52 Legal Description: GLACIER VIEW HEIGHTS #4 BLK 1 LT 6 Design Engineer: 0014 Anderson Engineering Site Address: 022466 COLUMBIA GLACIER LOOP Owner Name: Thomas & Janet Flanagan Lot Size: 51803 SO. FT. Owner Address: PO Box 772573 Total Bedrooms: 3 Permit Bedrooms: 3 Eagle River , AK 99577 - This permit is for the construction of. n✓ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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 engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, seated, and heated to prevent freezing. 6-27-00 Received By: Issued By: SJEE tfjv6-1NEc7Jl I rl?cH 0 /9MF-tiD6rJ D'E6160 vA7rEo 6 -20 -Op Date: UK -©b Date: 6 _/8 _4 MEMORANDUM RECEIVED AUG 21 2000 DATE: August 20, 2000 pe t nicipality of Anchorage TO: Dan Roth P Health & Human Sefylces FROM: Mike Anderson, P.E. ` SUBJECT: Lot 6, Block 1, Glacier View Heights No. 4 - Revised Septic System Design Upgrade Permit No. SW000303 Insufficient drop in grade exists between the existing.septic tank and the proposed absorption trench to allow gravity flow. We have revised the design therefore to include . a new 1,500 gallon STEP Tank and pressure distribution system. The owner.of the . property has also requested the new system be upgraded to accommodate a four- bedroom home. The attached documentation shows the location of .the proposed STEP tank and .the new absorption trench. . Two trenches will now be placed a minimum of 10' apart for a total length of 120'. The total depth of the trenches will remain at 4.5' to allow sufficient separation from groundwater. Please review the attached information and revise the permit to allow construction of a pressure distribution system and an absorption system to serve a four-bedroom home. Thank you for your help with this permit. a ANDERSON ENGINEERING P.O: BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) August 13, 2000 Municipality of Anchorage Department of Health and Human Services` 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 6, Block 1, Glacier View Heights Subdivision Addn. No. 4 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption trench on Lot 6, Block 1, Glacier View Heights Subdivision Addition No. 4 has failed and must be replaced as soon as possible. We are therefore applying for a permit to construct a new absorption trench on the lot to serve the three- bedroom home. The attached Site Plan and backup documentation identify the location and configuration of the existing well and new septic system and the parameters used - in the design. It also shows the 100' protective radius from the well on the lot. The existing septic tank will be exposed and inspected for continued use. If it is found to be leaking or other damage is found it will be replaced. A test hole recently placed on the lot in the area of the new absorption trench revealed silty sand with some gravel with a percolation rate of 20 minutes per inch. Groundwater was encountered in the excavation at a depth of 9.5' below the surface and remained at that elevation during the monitoring period. We have therefore designed a 5' wide absorption trench with 3' of gravel beneath the distribution pipe. The total length of the trench will be 88'. The total depth of the trench from original grade will be 4.5% which will be a minimum of 5' above the present level of the groundwater. The ground surface on the lot slopes from north to south at approximately 2%. It also slopes from east to west again at 2%. The new trench will be constructed parallel to the contours of the surface in conformance with Municipal requirements. Grading will be accomplished to assure surface drainage is away from the new trench. Mounding will be required over the trench to provide a minimum of 3' of cover or 2" of insulation . will be placed and 2' of cover to provide protection against freezing. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future: 2. The system, if constructed as designed, will have no adverse impact on existing Lot 6, Block 1, Glacier View Heights August 13, 2000 Page Two septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. �,�'P• �' T ��. �� Attachments LAX io, C: t-G •i i THIS PROJECT . • 4(4 Fd0 Jf 1 o7 Ac. t 2 J.c9S! Jr L19Ac 3' S( 4/t Sf ZMAt. ij'. 0 eos F O P `" ~ MflT �I'00•Y / . 223.60 I ' - LIQ 7IZ5 1.00 Ac- Arc L(v co' Je tg vo \.. Je'�•�Fx'• oe fns 9YI'A/. AI�n. �' �� � � . . �'�• :.� C*1�1 �� ' {` �� AREA MAP - `;,��: SCALE 1" = 100' `� •), `4-' ••r.,: 4 ^� LOT 6, BLOCK 1, GLACIER VIEW HEIGHTS SUBDIVSION ADDITION NO.4 SCOPE OF WORK: 1. Verify the Foundation Cleanout. Place New if Necessary. 2. Pump, Crush and Remove Existing Septic Tank. 3. Place New 1,500 Gallon STEP Tank at the Location Shown 4. Place 2 — 60' Long X 5' Wide X 3' Effective Depth Absorption Trenches. 5. Place Pressure Distribution System. ' I 6. Place Insulation or 3' of Protective Cover. 7. Regrade All Disturbed Areas. 8. Revegetate Area As Required. N 2 - 60•' Long . X 5' Wide X Exi ting 3' Eff. Dept . FI Abs ption Trench Tre h 22 pp an Fo,s r Ber Houseoo Existing Well Yi6� "EIS,� x r4' r SITE PLAN.... SCALE 1" = 40'!'� c w- .. LOT 6, BLOCK 1, GLACIER VIEW HEIGHTS ADDITION NO.4 DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home 5' Wide Trench System Perc. Rate: 20 Min /inch 1,500 Gallon STEP Tank Application Rate: .6 GPD/SF 3' Drainfield Rock Pressure Distribution System 4 Bedrooms X 150 GPD 1.6 GPD/SF = 1,000 SF of Absorption Area 1,000 SF/5 LF (Width)•.57 (Red. Factor) = 114 LF Trench Length Therefore: Construct 2 — 60' Long X 5' Wide X 3' Effective Depth Absorption Trenches a Minimum of 10' Apart. Flowline Elevation in Trench to be 2.0' Below Original Ground Surface. Total Depth to be 5.0' Below Existing Ground. Mound Over Trench to Provide Minimum of 3' of Cover. .5' .3' Natural.Backfill (2' Minimum) 2" Insulation or 3' Cover 1" PVC (Holes Down) Drainfield Rock Hole Diameter — M" Hole Spacing — 4 . TYPICAL WIDE TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 10' Separation From Lot Line. Minimum 4' Separation From Groundwater. 1 JlrA' CIyL, �A't'%I A. ANDERSON ENGINEERING P.O. Box 240773 ANCHORAGE, AK 99524 (907) 522.7773 Cell (907) 4414000 ,qB 10r6 9W -W-1 6UIUCR VICW 1-6 SHEET ND. OF CALCULATED BY MCA —DATE .��0 00 CHECKED BY DATE Eu�rlii-Ip.J-_�- /Git65+_� lScs+Aa.L<__ a.� I I I �)AME-TER-.off I _DIS'rR-1gVT.iD�1__..C.I�3E.—,.._' �— fkc,�._,S��u�c--/..t_lDlsr�,Bv„u•.l_4NF� P___TrzANs'orL-._j._Lnt C --I-- � i I - I /z.y ./87 -- I t��l ` 11. I j ion-9s')—r!--oj9Zr- .5)y.81 _ � -I —1--I -� r I— I i I __• I �—i i i I--� r-�- -, - , t --.-;i. __�._.4-i.- ,_.�_-1_.._I _rt -• t._�. C �---!'-� �._-I I��i';w __-��'j. tT ;.�'i/t-. I •� i �O !D%�-iFl �$.._�__� � � � J P./T�+i�IG—�----� _..'�/"'f.;A�R��L'�.�`NI ft OFF � rnmin m Hry. a.w a+, rr.n 1 11 W -413414—f 1 11 50.0( 50.0( ,30.5G 5.00 10.()0 15.00 20.00 25.00 1J100 35.00 40.00 45.00 50.00 �f L9, 7- Y NET DISCHARGE, GPM 2826 - COLONIAL - R , GA M5, -INC COLONIALR - DROSEBURGOR0470 O03)673ib165 i PUMPS -U1 EFFLUENT EFFLUENT 1/2 H 01 1/2 Hp to 11/2 Hp SINGLE PHASE, 60HZ t SINGL P t.., 1]5/230 VOLT ! 11 /230' PC#2 7-PC#_ It -200SI15HHF-9stage�! it 05/92 7: 4� stage -200511 it ? '77 .... .. U.J.. it. it ;j L OSI 05 HHF - 5 -7 -4- .4.4 I+ : 40 OSI US HH - 2 stage' -L1 it it t 77.* 7 20 OST 05 HHF - 5 stage w / 1/4" flow controller i i i jj f i; i I 5.00 10.()0 15.00 20.00 25.00 1J100 35.00 40.00 45.00 50.00 �f L9, 7- Y NET DISCHARGE, GPM 2826 - COLONIAL - R , GA M5, -INC COLONIALR - DROSEBURGOR0470 O03)673ib165 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 6, BLOCK 1, GLACIER VIEW HTS. SUBDIVISION No. 4 GENERAL: 1. The scope of this project includes the removal of the existing septic tank and the procurement and placement of a new 1,500 gallon combination septic tank and lift station and pressure distribution system. Work also includes the construction of 2 - 60' long x 5' wide x 3' effective depth absorption trenches at the location shown on the attached Site Plan. The new trench distribution piping shall be constructed 1.5' below existing ground level to provide a minimum of 4' separation from groundwater. Direct bury insulation may be required to provide the minimum coverage required over the new trench. In lieu of insulation 3' of cover may be placed atop geotextile fabric over the new trench. ' 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK/LIFT STATION INSTALLATION 1. The 1,500 gallon septic tank/lift station must be constructed by certified tank manufacturer. Construction shall include an 18" manhole to provide access to the lift station. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 5. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. Lot 6, Block 1, Glacier View Hts. August 20, 2000 Page 2 of 3 6. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. The lift station must be constructed by a Municipally approved septic tank manufacturer. An Orenco 20 OSI 05 HHF-5 pump is recommended. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Lot 6, Block 1, Glacier View His. August 20, 2000 Page 3 of 3 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" In diameter with less than 3% passing the #200 sieve. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. Performed For: Chuck Barr Date Performed:+t�111 Legal Description: tot 6. Block 1. Glacier View Subdivision SLOPE SITE PLAN 2 3 4 Perc. Zone 5 10 11 12 13 14 15 1E 17 18 OG/OL SM Silty Sand with Gravel Bottom of Hole North 11 South Was Groundwater Encountered? Yes S J. 9.5' L Depth to Water Municipality of Anchorage r::: • • "' Department of Health & Human Services :lg 825 L Street, Anchorage, AK 99502-0650 �r�� o• .4,•w��1 t ts4• SOILS LOG - PERCOLATION TEST _ .>' Performed For: Chuck Barr Date Performed:+t�111 Legal Description: tot 6. Block 1. Glacier View Subdivision SLOPE SITE PLAN 2 3 4 Perc. Zone 5 10 11 12 13 14 15 1E 17 18 OG/OL SM Silty Sand with Gravel Bottom of Hole North 11 South Was Groundwater Encountered? Yes S If Yes, What Depth? 9.5' L Depth to Water O After Monitoring 9.5' P Date: 7/17/00 E See Site Plan Reading Date Gross Time Net Time Depth To Water Net Drop 1 6/21/00 10:00 1.5" 2 10:30 30 3" 1.5" 3 10:31 1.25" 4 11:01 30 2.75" 1.5" 5 11:02 1.5" 6 11:32 30 3" 1.5" • Perc. Rate: 20 Min./Inch Perc. Hole Diameter: 8" 21 Test Run Between 4 Ft. and 5 Ft. Comments: Testhole Presoaked Prior to Percolation Test. Performed By: Mike Anderson. I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 7/25/00  MUNICIPALITY OF ANCHORAGE ~'~,~L~ i) 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 NAME.b V ..... P"ON MAILING ADDRESS '~ IZ,~ OLD ~'~uA-P~ f-lw~/ ~.~',h~/~4~:-/ ~ iLEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ~' DISTANCE TO: Well /~PO ' IAbs°rP~:~a~a Dwelling Z~ PE~ ~<Z Manufacturer fl~ Ma,er~ No. of compartments Liq~Y in gallons IF HOMEMADE: Inside le,~h/~ Widt~/~ Liquidity_ We~ PERMITNO. '- ~ ~anufacture, i~ / ~ Material Liquid capacity in gallons .... Well , Foun~tion 4~b ,ea~s~t line PERMIT ,O. ~ ~o. oflines ~ Length ¢~ ~i¢a Total I~ ~ 'h ¢~nes ,~ Trench'width ~¢~ inches Distance between lines '" ' cti~ absorption area ~1~, Top of tile to finish grade ~ I~ / Y~Z"~M't~ialbene~htile ~ ~ 'Totalefr....~% ....... Length Width Depth ~.< PERM[T'NO.; < ~ %type of crib Crib dia Crib depth Total effect ve ab~6rpt On,ar~a ~ : ~. ~ Well Building foundation Nearest lot lin¢"~ ~; Z ~ DISTANCE TO: ¢(~'~/' ¢~--- Distance' to I o~ If~~'" ., LU Building foun~aU~n I Sewer line Septic tank ~o,~ 2248-E PIPE MATERIALS ~ ~ ' 2' -~~/ INSTALLER ~ REMARKS ~ ~' ~ c'~ o~ou~% ,~x;/h~z~ Pz~,~ '( ~d,~-~'t-~ ~ Z'/ 5'~:P~/( ~oc/c; , ~f ~f~ ~ -- dtM]CP,.~[ "O~2~RAG[ . ./ . . . __ AU8 I? ;8~ _ 2-013 (Rev. 3/78) DEPARTMENT OF HEALI"H AH[:, ENVIRONMENTAL PROTECTION 825 L STREET., ANCHORAGE., RK 995~3'1. 264-4720 ~ERH I T NO: ~RTE IS'5LIED: L4~_,,. id ,' ,.' tPF'L t CANT: tDDRESS: ::ONTRCT PHONE: .EGRL DESCRIP: .OT SIZE: 'IA,s,', BE[:,ROOMS: [:,RVID CREEGEF.'. 7t25 OLD SEI.4RR[:, HHY ANCHORAGE., RK SUE:DIVISION: GLRICER ',,,'IEH SECTIOH: ±6 TOHHSHIP: ±4N ±R (SCL FT. OR ACRES) ]: LOT: 6 BL. OCK: F..HNGE: )EPTH TO PIPE BOTTOM (FT.) 3RAVEL DEPTH (FT.) FOTRL DEPTFt ,'..'FT. ) 3RAVEL HIDTH (FT. ;:, 3RAVEL. LEHGTH (FT.) .~RAVEL. VOLUME (CU. YDS. i:, - - ' '~ YFLF.' SEPTIC: .ISTE[:' E:ELOH ARE THE C~F'TIONS H',,,'HILRBLE: TO YOU IN [E_IGNING .. . ~,"r'STEM. CHOOSE THE OF'TIOH THAT E,E_,T FITS YOUR .SITE .... 4. 8 C4. 5 ~ 5' :3. G 4. 5 ~7. 5 GRR'v'EL LENGTH > ~'~ FT. REC¢..I~RES MULTIPLE R_IN=. NOT E sc. EEEZNG 75 FT. EACH) TANK MUST HAVE RTL. ERST THO COMPARTMENTS CERTIFY THAT: ±. I RH FAMILIAR HITH THE REL.]UIREMENTS FOR OH-SITE SEHERS AND HELLS RS SET FORTH BY THE I'dLINICIPRLITY OF ANCHORAGE (MOA::, AND THE STATE OF ALASKA. 2. I HILL. INSTALL. THE SYSTEM IN ACCORDANCE HITH ALL MOA CODES AND REGULATIONS., AND IN COMPLIANCE HITH THE DESIGN CRI'fERIR OF THIS PERMIT. 3:. I HILL ADHERE TO ALL. MOA AND STATE OF ALASKA REC~UIREMENTS FOR THE SET BACK DISTANCES FROM FINY E~<IS'T'ING HELL, .WRSTEWRTER DISPOSAL SYSTEM OR PUBLIC: SEHERRGE SVSTIEM ON THIS OR ANY RDJRCENT OR NEARBV LOT. 4. I UN[:,ERBTRND THAT THIS PERMIT IS ',/RI. ID FOR R MAXIMUM OF ]~ BEDROOMS AND ANV ENLARGEMENT HILL REQUIRE RH ADDITIONAL PERMIT. IF R LIFT STATION IS INSTALLED IN RN AREA COVERED BY MOA BUILDING CODES., fHEN (±) RN ELECTRICAL PERMIT AND INSPECT,ION MUST BE OBTRINE:D.~ (2) RS-~BUILTS HILL NOT BE RPF'ROVED HITHOUT RN ELECTRICAL INSF'ECTION REPORT.~ AND (~) THE ELECTRICAL HORK MUST BE DONE: BY R LICENSED ELECTRICIAN, ISSLtEI]:' BY ~ ~% ...... ~.. DRTE: s & IFNGINEERS, INC. s 7125 OLD SEWARD HIGHWAY ANCHORAGE, ALASKA 99502 (907) 349.6561 PERFOBMED FOR SOiL LOG PERCOLATION TEST JOB NUMBER - ~ ~)I/-L¢~C C (,~.~ U(-F/f..)A.I DATE PERFORMED 14-- 2O DEPTH (FEETI SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? W E IF YES, AT WHAT DEPTH? Date , Reading Time 5 1~420 IZ~3o ~z:5 0 Net Depth to Time Water ? Net Drop i-~A~' I z t,*--j ..... CZ.~" FT AND ~r' FI PERCOLATION RATE TEST RUN BETWEEN PERFORMED B,'. tV/ BfwH/$*.J~. CE*T,~,ED B~ DATE DOC CO. dba SULL[Vt WtTER WELLS P.O, BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ADDRESS DATE - Started __~/ PERMIT NUMBER DEPTH OF WELL ST:VI'lC LEVEL OF WATER FT. C~JDRAW DOWN FT. GALS. PER HR____t , /)O KIND OF CASING KIND OF'FORMATION: From 0 Ft. From ~ Ft. From Ft. From .~"'~ Ft. From.__--Ft. From (,,,},.e~'* Ft. From O ~L_Ft. From_/2~ $" Ft. From__~__Ft. From__ Ft. Fronl ..__Ft. From _._Ft. From , FL From ,__Ft. From __Ft. From __Ft. to-,i~ .-Ft. O ~,/t~2¢,/'.:]~i~7)H.~7d ,~ From .... Ft. to__ Ft. to. t ...... ~__ - -. From Ft. to~ ~)~ , *~' ...... From Ft. to Ft From ...... Ft. tg. Fmm _ Fk Ira ...... Ft From Ft. to Ft From __.Ft. to__ Ft to L_Ft. Frolll _ Ft, to ..... Ft to _Ft From Fl. to ..... Ft to .... Ft.. From__Ft. to .... Ft to.__Ft. From ........ Ft. to Ft. to_ From Ft. to Ft. to _Ft From Ft. to_ .Ft MISCL. INFORMATION: DRILLER'S NAME MUNICIPALITY OF ANCHORAGE DFPARTMENT 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 Lic'~ / - _~,t.~ HAA # ~..~ ~c~.-?~¢% 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent ~:~)¢.~4¢~ ¢]~ f~4~ ~v,.~,4.~,//~¢~.-~,,/~,'~,~./ Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '---~ ''~ TYPE OF WATER SUPPLY: 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: 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 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/orwastewaterdisposalsystem is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, lfurtherverifythatbasedontheinf°rmati°n°btainedfr°m 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 Address Eng neers s'gnature -David ,~. Dayf~on-P~p-. 20210 Donalar St. Chuglak, A~7, / Phone Date DHHS SIGNATURE ~" Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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~)25 (Rev. 1/91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type PF~I Log present (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ¢/¢ ¢/ Driller Total depth I~ / Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 Cased to FROM WELL LOG _ Casing height Wires properly protected (Y/N) g.p.m. AT INSPECTION MUNiCIPALiTY OF ANCHORAGE ~.NVIRONMENTAL SERVICES DIVISION SEP 3 5 1993 g.p.m. RECEIVE[) SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping C.), I O Other bacteria Collected by: .~_ ¢ Tank size / ~O ~ Compartments Foundation cleanout (Y/N) M Depression (Y/N) Foundation Water main/service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot //O~ On adjacent lots /'o(~¢D TO property line ~:~ Absorption field /~' Surface water/drainage 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surtace water D. ABSORPTION FIELD DATA Date installed Length Total absorption area Date of adequacy test Width ~¢':7z Cleanout present (Y/N) Soil rating (GPD/Ft2) 'L-Z ~)- Gravel thickness Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) System type ;/ Total depth 7" Depression over field (Y/N) Res,ults (pass/fail) ,/~ for ~ Bedrooms After test ZJI/~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots /:~--~ Surface water ) ¢ ~ ' ~" Curtain drain On adjacent lots /"7-.~~ Property line To existing or abandoned system on lot Cutbank )~ o ~G- Water main/service kine Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to ali MOA and HAA guidelines in effect on the date of this inspection. David R. Daylon P.E. 20210 Donalar St. Signature Ch ugia~¢¢ Alaska,,~6~ Engineer's Name /L~,/~ _~.¢~-:~.¢¢'~--~ Date ~~.~ FtAA Fee $ ..,pD (--)0 o o Date of Payment ~' /~' ~ ReoeiptNumber 72-02~ (0/~$)~ Back Waiver Fee $ "'%',;,,:.~.:.~..;~¢ Date of Payment Receipt Number D. R. DAYTON, P.E., R.L.S. ~:~:~t:~;~ Chugiak, Alaska 99567 20210 Donalar (907) 696-2417 September 10, 1993 WELL FLOW TEST Legal Description: Lot 6, Blk 1, Glacier View Heights #4 Date of Test: September 3, 1993 Well Depth: 161' Static Water Level: 30' Requirements: 3 BR - 450 gallons per day Test: The well was tested with the existing pump with the valves fully open. Volume and drawdown were measured at regular intervals. Results: The well produced 463 gallons in 85 minutes at a flow rate of 5.45 gallons per minute. The maximum drawdown was 10'. The drawdown was fully recovered within 10 minutes. The well is currently producing adequately for a 3 BR home. D. R. DAYTON, P.E., R.L.S. ~xx'~7~[~ Chugiak, Alaska 99587 20210 Donalar (907) September 10, 1993 ADEQUACY TEST Legal Description: Lot 6, Blk 1, Glacier View Heights #4 Date of Test: September 3, 1993 Septic Tank: 1000 gallon, 2 Compartment, steel tank Absorption System: 75' long x 5' wide x 3½' deDp trench Soils Rating: 225 sq. ft. per bedroom Requirements: 3 BR - 450 gallons per day Test: Water was pumped onto the absorption trench while measuring volume, time and water level rise. After pumping was stopped, the water level drop was measured at timed intervals. The results were plotted on a graph of time and gallons absorbed and extrapolated to 24 hrs. Results: The system is currently functioning adequately for a 3 bedroom home. Note: There was 35" of water standing in the trench before and after the test. This may indicate the system is in its waning years. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES 1;' ~ CERTIFICATE OF INSPECTION FOR HEAL TH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4?44 Application Date Hay 4, 1987 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, [??nship, range) r.ot 6; Block 1; Glacier View Heights =~(~r/ Location (address or directions) ~t~La Glacier Drive (b) Property Owner AHFC Telephone: Home Mailing Address Business (c) Lending Institution First National Bank of Ancho~l~4~phone 694-2103 Mailing Address P.O. BOX 548, Eagle River, Alaska 99577/A~ENTION: (d) Real Estate Company and Agent JACK WHITE COMPANY/Lori Crowder Address P.O. Box 771699¢ Eagle River, Alaska 99577 Telephone 694-5500 Leta (e) MailtheHAAtothefollowinaaddress:or:Checkhere;~, ifholdforpickup. Listcontactpersonand day phonenumberbelow. S & S ENGINEERING 17034 Eagle River Road, Suite 204 Eagle River, Alaska 99577 ordered by Lori Crowder TYPE OF RESIDENCE Single-Family [~ Number of Bedrooms WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAl. Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 fRev 8/86~ Froni 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. S & S ENGINEERING Name of Firm 17034 Eagle Ri~/e~ Loop Road No. 204 Address Date Telephone DHHS APPROVAL Approved for ~"~/,-~'~.~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services fDHHS) 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. Page 2 of 2 72 025 (Rev 8 86) Back N'~c~O\"I~5\MUNICIPALITY~'C'~'~ OF ANCHORAGE (MOA) .~\C\?P'~'~'< ~,~,%g%'4~ ~ HEALTH AUTHORITY APPROVAL (HAA) WELL DATA Well Classification Well Log Present(~.~/N) _ Total Depth //¢' / Cased Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (~/N) Separation Distances from Well: If A, B, C, D.~.C. Approved (Y/N) Date Completed X/,¢ .¢' Yield Depth of Grouting Pump Set At Sanitary Seal on Casing b/N) Depression Around Wellhead (Y,~ To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ~//~ Water Sample Collected by ,.~'~;t- ~ ~_..'~J,(..~,,,.z 8_~"f'L.~t~ ; Date Water Sample Test Results Comments t ; On Adjoining Lots //! ~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot / B. SEPTIC/HOLDING TANK DATA Date Installed ~/~ Standpipe~;~N) Depression over Tank (Y(~ Pumping/Maintenance Contract on File (Y/N) /N' Holding Tank High-Water Alarm (Y ~ _ Separation Distances from Septic/Holding Tank: To Water-Supply Well _ /' To Property Line To Water Main/Service Line Course M/,,~. . Comments ~ ¢"~0¢'Ar~e.''/b Size ,,'c.-,-,-,-,-,-,-,-,~b No. of Compartments ~ Air-tight Caps~N) Foundation Cleanout ~/N) Date Last Pumped ,-~//~/¢_~-' '~ '-~ &"/IA- ;for /(~//X Temporary Holding Tank Permit (Y/N) /"~///~r' To Building Foundation To Disposal Field _ / To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption ~Strata _ Date Installed -! -! Width of Field $ ~'~ '/¢///"~,/~- Type of System Design Length of Field ~ Depth of Field ~ ' Square Feet of Absorption Area Depression over Field (Y/b Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well __ /// / To Building Foundation /7/5. Lot Gravel Bed Thickness ~. f / ' ' Standpipes Present ~N) Date of Last Adequacy Test To Water Main/Service Line /65 L[ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line /c') '.4' To Existing or Abandoned System on ; On Adjoining Lots ,.~c~ /¢ To Cutbank (if present) Comments D. LIFT STATION Date Installed Dimensions Size in Gallons / ~ Manhole/Access (Y/N) "Pump On" Level at ~ "Pump Off" Level at High Water Alarm Level at _ Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** 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. ,5- ! / Signed~ & S ENGINEERING 20~ate 17034 Eagle Rbrer Loop Aoad No. Comp~ti~llc R!ver, _&la~Ea 99577 MOA No. Receipt No. / ~) ~ / ~ ¢ ~ Date of Payment.~//¢/~ Amount: $ /Oo ~/ Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMi~NTAL HEALTH DEPARTMENT OF [DJALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR t~ALTH AUTHORITY APPROVAL CERTIFICATE 1o General Information (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name ~%~-~.__~~&.~q~hone - Itome Business Applicants Ad d r e s s__~_~Z~.~__j~ (c) App~eanL is (check one)Lend~ng ~nst*~ution Buyer [~ ; Other ~] (explain); Te]_aphone ~p ~ M ~3 i/ (f) Mail the HAA to the following address: 2. Tyoe _o~f Resid__el~c__e Single-Family [~--~i Number of Bedrooms 3. ~ja t e r_~S u~o~E~ £ndividual Well ~il Hulti-Family Other (describe) Note: If community well system, must have written confirmation from the State leoa~.ity nod status° Department of Environmental Conservation attesting to the o ~- 4o Sewage Disoosal Onsite L~3_/~. Public Community t{olding, Ta .k ii_.1 Note: If community well system, must have written com?irmation from the State Department of Environmental Conservation attesting to the legality and status° [Page 1 of 2] ......En~ineerin~ Firm ProvJdin~. Inspections~ Tests~ File Search Data and In. fon~mtion 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 obtain~ 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 ~th ~.1 Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Fir~.- ~__~Z/~/~. /~C Telephone ~9 Approved :~___ Disapproved __~.__ Condi o~al / · Temns of Conditional Approval CAUTION THE MUNICIPALITY OF ANCliORAGE I)EPARiNENT OF ltEALTH AND F.~VIRON~.U£NTAL PkOTECTiON (DIIEP) ISSUES HEAl,TH AUTIIORITY APPROVM, CERTIFICATES BASED SOLEI.,Y UPOb; TNE REPRESF, NT~- ATIONS GIVEN IN PAJ~G~kPH 5 ABOVE BY AN INDEPENDENT PROFES~k~ ENGIHEER REGIS'PERED IN TI-H{ STATE OF ALASI~. Tile DHEP DOES TItIS AS A COI~TESY TO PURCHASERS OF NOblES AND Tt~IR LENDING INSTITUTIONS IN ORDER TO SATISFY CERT&IN FEDE~ AND STATE REQUIRE-- MENTS. ~iPLO~ES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~JAJ.,YZE DATA BEFORE A] CERTIFICATE IS ISSUED, TIIE MUNICIPALITY OF ANCttORAGE IS NOT J?.ESPONSIIH,E FOR ERRORS] OR OMISSIONS IN T~ PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] ? ~ 19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: Well Classification JAJa! Well Log P~esent (Y/N.) ~(~.. Total Depth 'l~) I Cased to Static Water Level ',~ ~ ! Casing Height Above Ground ~ Electrical Wiring in Conduit (Y/N) Separation Distances f~om Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Ix)t To Nearest Public Se~r Line Cle snout/Manhole /~ ! Wate~ Sample Collected By Water S~ple 'rest Besults C~m,ents ~A]~C]_ Lf~ ; On Adjoining Lots ~ ZOO / ~ ~ ~ ! ; On Adjoining Lots ~%'~_C~) 1 To ' To ~est ~r ~]~vi~ Li~ on ~t B. SEPTIC/HOLDING TANK DATA Date Installed .~/~L3~ ~(~ Size l~f)f) ~g- No. of Co,vartments ... ~ . . Standpi~s (Y~) ~f5 Ai~-tight Caps (~)W~ Foundation Cleanout .(y~). , ~ession ove~ Ta~ (Y/N) ~O ~te ~st P~d ~O'~ APPD~C~ . P~ing~aintenan~ C~n~a~ ~ File (Y~)~/~ ; for _..~/~ ,, Holding Ta~ High-Water Ala~ (y~)N/~ ~rary Holdi~ Tank ~t (Y~) ~ Sep~ation Distan~s ~ ~ptic~olding Tank: To Water-Supply ~%11 To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field I~ To Stream, Pond, Lake, o~ Major D~ainage Conments [Page 1 of 2] 2=15=84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed _~ ~)& ~ Width of Fie].d .... bO" Length of Field __~- ! E~pth of Field . /~ / ~ ~ravel Bed Thickness ~,, Square Feet of Absorption A~ea & ~ ~/ ~/3 Standpipes Present (Y/N) Depression over ]Field !Y/N.) A~ O ~te of Last Adequacy Test Results of Last Adequacy Test _AJ,/~ ~,dJ .3~.,$/r~Y~ __ Separation Distance from Absorption Field: To Water-Supply Woll /// ~ To P~operty Line ,~ / To Building Foundation ~t~/ To Existing or Abandoned System cn Lot _A)//~ ; On Adjoining Lots > /~ / To Water Main/Se=vice Line /V,/~L To Cutbank(if present) To Stream/Pond/Lake/or Major DEainage Course To Driveway, Parking A~ea, or Vehicle Storage Area ~f~ z Conm~nts D. LIFT STATION /j,~77~ /~-ioidz_IC/~.i~L~-- Date Installed Size in Gallons "P~,~p On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dir~nsions Manhole/access (Y/N) "Pump. Off" Level at Vent (Y/N) __ Pumping Cycles du~ing Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. KB1/d5/s Date [Page 2 of 2] 2-15-84