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Home My WebLink AboutALPINE WOODS BLK 5 LT 4Alpine Woods Block 5 Lot 4 #015-234-34 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 NAME PHONE NEW %'' 0L fola / ❑UPGRADE MAILING ADDRESS 20 ,sr 5-U LEGAL DESCRIPTION AL PIA) "U 0 L) S LOCATION / NO. OF BEDROOMS (J� F /1�1 /l1' Q' / /� �- l°f Well Absorption area Dwelling PERMIT NO. V Y DISTANCE TO: GO M v 44, 43.3 F- Z uJ a Manufacturer G n Material --EEL No. of compartments 2 ~ s` to Liq. capain gallons /z cit Q IF HOMEMADE: Inside length Width Liquid depth Y DISTANCE TO: Well Dwelling PERMIT NO. JC1Z O Z < Manufacturer Material Liquid capacity in gallons D DISTANCE TO: Well Foundation 1 Nearest lot line / PERMIT NO. JZ Z No. of lines Length of each line Total length of Ii7s Trench width etween lines F Z W l (p -7 % & f inches FTop of tile to finish grade ^^�� Material beneath tileQ Total effective absorption area inches �C7 Length Width Depth PERMIT NO. LU Qa a~. W Type of crib Crib diameter Crib depth Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOI L TEST RATING f 150 INSTALLER t tj 5'0 we nOLIAJ REMARKS c /A- T 0 Y2. 7-6 1 3 VCC s Xs 7-r M. c H r c i- l d APPROVED DATE LEGAL �r /1411 4 J �J y� 60 7 72-013 (Rev. 3/78) 1-111 r-4 I C_ I*'F1 L_ 1 0 F�-_ Fl r-4 " -__) F-i'F4 f-3 E: � DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 /L' STREET, ANCHORAGE, HK. 99501 264-4720 K_ -v -F E= "T EO NJ lE= FZ F=U F;c'1111 I K PERMIT NO. ( 830679 ) APPLICANT MAX E BOLIN 3]2] ROBIN ST HNCHORHGE,HK 995 2496681 LOCATION LOT4 BLOCK5 ALPINE WOODS SBDV LEGAL SEC 2]-T12N-R]W LOT SIZE 76200 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 150 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E>E=F"JFVA= 03 L_E=V4CAIFVA= 10CA THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELC\ THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). �EE LJ I Fe& EN ��FF" _T I f=1 01 K E; :[ ZE E: to C3 Ci FA L_ L_ CA 14� 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. �Nj 171 K.'�� I�� n FQ Ew ��I�� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ��11 -F ��I F-"- EE "I E> E7 C7 K Ul E3 EF F? 71 AL fIL <9 E3 7A I CERTIFY THAT 1: I HM FAMILIAR 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 THE CODES. K I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE HORE THAN 4 BEDROOMS SIGNED: H ISSUED BY -",--/-_D V4.0 ^^�� CAF-- DEPHRTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, HK. 99501 264-4720 DEPARTMENT nr HEALTH AND 1,NVIRONMENTM i'ROMC-TION 825 ''L z "S TREE T, ANCHORMEa r AK. 99301 264-4720 SiO679 ) 8pPL. tCjZWJT MAX E €OLIN 3323 " ROBIN ST 19NCHORAGS- nK �5�5 3*96&3t LOCA T I CN LO T4 SLOCK5 AL P I NE 11OODIi S80Y L.EORL SEC 23--Tt2N-R3W LOT atm 762013 IJR TYPERE Fl; IV `3C IL ASSORPT IO N SYSTEM IS: TRE? H f,lR,X ff*jN NUMBER OF GCOROOPM - 4 SOIL RATING (SO P T, -'GR) = L'54 THE REQ*U f pEo SIZE OF THE 1.501L ASSs]RPT C ON SYSTEM IS: THE LEt4i3rH D I MEM I QN t S THE LE'i4 i I`N < I N FEE T> OF THE TR`e"a CSR t�RA I I I Gi .v. THEr DEr rN R rREt :H OR PIT 163 THE DISTANCE BETWEEN THE SURFmE T GROUND AND THE BOTTOM tom" THE E` 0WATION � tN Ferri. THERE t; No SET 14 t O T14 FOR TReNCHES. FHE CRAY T H IS TW.MINIMUM DEPTH OF -ORRYM BETWEEN T; iE OUTFMA- PIPE t N@ Ti -W_ 90T'TOM O THE EXCHVPTION CIN FEET). q PERMIT ADPL I ��At4 l N TW � RESFONSIE1-�#.,:I TY , T4 t WORM TH t 5 DEpAR it' eN T 0UR T W T#�? 2 # T ILL H T t e3N I NSFEtCT t %SNS flI�Y WELLS F Ii-�. -ENT- TL Thi � I�Rt #� � #�i�a T'NE I•4S:pt R ASF Rei I wE5 THAT THE I -JELL WILL SERVE. 8H+aW t(J- j NG 13 RNY '5YS T'EM WITHOUT MAL L I NSPEC T t'm AND APPROVI GY f'N 15 DEPART vJet4r WILL BE SUVEt` T O PROSECU r t0k I;tlt�Ttt i''I GIST'r NIX BETWEEN A WELL. ANO ANY ON-SITE 5044 DISPOSAL SYSTEM I� PEST FOR . A , PRIVATE WELL OR 1`50 TO 200 FEET FROMR PfJ� It= WELL t t�D lt#Ci UPON THE rlPE OF PUBLIC M -L. flXt'TIMiJ14 DISi'AMM FROM ,A -PRIVATE WeLli TO A PRIMATE SafER LINE IS 25 FEET RM TO A COMMUN I TY 'EWER L. INE t S 75 FEET. OTHER REQU I M)EN TS MAY APPLY. SPEC I F I CAT I ONS AND CONSTRUCTION D I RGRM S ARE . _:tit+tilLt eL9 TO INSURE PROPER iNsTmuirtim. t*.,EkTtFV r140T i.: I Aid FAI4 IL I RR WITH THE REQU I R91.18N rS FOR ON-SITE S"Ei•!ER'S AND G AS SET Ft3RTH BY THE PlUN IC I PflL I T Y OF AMHt 2t I WILL INS TALL THY 5'r'S TCH IN WITH THE CODel 3: I UNDERSTAND THAT rW GN -SITE SE14ER 5'r15TEN MRY REQUIRE ENLARMIENT IF TM :i RESIDENCE IS REMODELED TO INCLUDE 1-10APE THAN 4 BEDRODWa. 14PPL I CA,% mAX E ESLL-� N _ t_ 744 4a 4 i 3_a#gip e_ - r� _ ' ___,---__r�rC- _�F __ ;G DEPAR THEN r OF WEAL TH Rim' CNN i R0NllENT9L PROTECT VON -. ,— r,—.r-.—,r _%ter,. a.—.�. W_� c14t_ !!kemr %A xSOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION El PERCOLATIONTEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: MIPS\k 1 0 DATE PERFORMED: r-+ �J LEGAL DESCRIPTION: 61 i�C� ill %l�� 1lll LJ I SLOPE SITE PLAN 1 2 Date P�. f � J 3 , ` J• 4 '. 7 10- 11 12 �►1_�u 31415 13- 14.- 15 16- 17 18- 19- 20- WAS 81920 WAS GROUND WATER S ENCOUNTERED? � L 0 P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop I I PERCOLATION RATE (minutes/inch) COMMENTS S01'/ Kdfe-d X11 6- _RUN BETWEEN EFT AND FT PERFORMED BY:1W W 5hd raal) CERTIFIED BY: DATE: AIM X53- G2 -y 72-008 (6/79) 1.e i Municipality of Anchorage --. Development Services Department Building Safety Division `i Onsite Water and Wastewater Program s 4700 Bragaw Street P.O. Box 196650 1 C k' / I H G t ov Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D._O/S'—Z3Y-3Y COSA# 6�oay_J5 Expiration Date: S — / vZ — Q3 1. GENERAL INFORMATION Complete legal description Le t 1Y,3A/fi,nn TYPE OF WASTEWATER DISPOSAL: Individual Well woo dl -f A Individual On-site Individual Water Storage ❑ Location (site address) 56 70 hl C� nn 4z/w0! Dr r �- e Current Property owners) l ecare ito f>~de;n Day phone 3YS- `1YOP Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 1333 "Pr St. A} ,e,4c L5; o_ Ale 9,9SOl Day phone 131t(eh*e2.,. Prc.oeenfled Dayphone 2 Y 29—&on 35c l e'en fer•pa,,1- Dr. s kyloqj� k 99 so? Unless otherwise requested, COSA will be held by DSD for pickup. Plea e evil Rea Jia , 13,e k limen 2. NUMBER OF BEDROOMS: _ " 229-� qoo 4Z Aee �afr} E. reo�,ry fns 1r,e k -cy, 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class 'r Well ® Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm Flag T�ctinf cn I Se✓vlr•rl Phone 3145'- 13Ss Address H53O .Ec/ro• 6menYo^ f r.X Engineer's Printed Namefin c_� 5. DSD SIGNATURE _Approved for Disapproved. bedrooms. Date 41 7 2Uri6 Y Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: GL/ • Original Certificate Date: (Rev 11105) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST ZD Legal Description: Lof 4, Aldir e k-1cae6 -C-lb ParcellD: 015--23Y-39' A. WELL DATA Well type _C&<r Date completed _ Total depth ft. Date of lest Static water level Well production If A, B, or C provide PWSID # 213396 Well Log (Y/N) Sanitary seal (Y/N) _ Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: ft. 9.p -m. Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL Arsenic: _ ppb date of sample: _ Collected by: S. SEPTIC/HOLDING TANK DATA Tank Type/Material Sn e frc I Sf>! el Date Installed b / y Z / 6',3 Tank size / 2S0 gat. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) _J High water alarm (Y/N) N, A. Date cf pumping -71 ZS/OB Pumper A -t C. ABSORPTION FIELD DATA Date installed E/ 63 Soil rating (g.p.d./ft= or fte/bdrm) /s--46"— OR,Y System type Length 6 7 ft. Width 31 S ft. Gravel below pipe 7 ft. Total depth 2 ft. Eff. absorption area938 ft2 Monitoring tube Y Depression over field N Date of adequacy test J-12.9 /10 7 Results (Pass/Fail) Pal/ For 'Y bedrooms Fluid depth in absorption field before test 8 in. Water added,(_yigal. New depth in. Elapsed Time:10 Z min. Final fluid depth9 in. Absorption rate >= 6p0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Nonce. If yes, give date N - A. r ' D. LIFT STATION N /? Date installed 'Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons `Pump off" level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: N• A. Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Manhole/Access(Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation �/� r Property line 7 i t Absorption field 2 y r Water main >10f Water service line > lc r Surface water > /00' Wells on adjacent lots > 200' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line > 'Vol Building foundation 7 Z' Water main > i'o' Water Service line > to Surface water > [GO' Driveway, parking/vehicle storage 20' Curtain drain: Arc ne Wells on adjacent lots > 2G0 ' in. F. COMMENTS G. ENGINEERS CERTIFICATION �' 1 '- • . _ „y •,+, r �, by t.?t •+ r•br.•f �f="�;�>, •4.18 I certify that I have determined through Field inspections and of Municipal records that the above systems are in r"••• • ••••••••••••••••�•••� rr review ••f •••t conformance with MOA COSAg uidelines in effect on this date. 1'' "• °�`'• t} t,: �7i ieUCQ1E'., hOOPE� t.f Engineer's Printed Name 771,,oAore is Hoo -Y' e ' �.; Cf . jj9b"• x : Date r 200 COSA Fee $ 13 O = Waiver Fee $ Date of Payment 8/d' i0. -r- Date of Payment Receipt Number �� b_ Receipt Number, (Rev. 11105) FENCE A 83-210 ALPINE WOODS SUBDIVISION LOT 49 D70 B SOCK 5 0' a .ti r� SEPTIC SYSTEM Z ' .0. Y! EXISTING BUILDING s• I I Acy°Nq 1�1 1bl I+ L — — — — — — -- — — — — — — — — — — — — — — 1 \ 10'T.&E.ESMT. - - - - - - - - - - - - - - - - - - - - - - - - \1+ 15' EQUESTRIAN do UTIL ESMT. GASTALDI LAND SURVEYING, LLC JEFF A. GASTALDI, R.L.S. 2000 E. DOWLING RD.. SUITE 8 ANCHORAGE. ALASKA 99507 PHONE 248-5454 I GRID 2738 I DATE 8/7/2008 I F.B. I JOB NO. 08-07 AWS45 I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT. ALASKA NOTE: NO CORNERS SET THIS DATE WALL AC. DRIVE x RELINING WALL s 'x__x 1 11=40' 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 # k-,� 19r',LD L Ol n 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4, Blk 5 Alpine Woods Location (address or directions) 5870 Alpine Woods Drive, Anchorage. Ak (b) Property owner Seattle 1st Nat' 1 Bank Telephone: (home) Business Mailing Address P.O. Box C-34401, Seattle, Wa 98124 (c) Lending Institution N/A Mailing Address Telephone (d) Real Estate Company and Agent Marston / Phyllis Stebbins Address 2804 W. Northern Lights Blvd., Anchorage, Ak Telephone 248-2804 (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: Pick up by Engineer 2. TYPE OF RESIDENCE Single -Family ® Number of bedrooms 4 3. WATER SUPPLY Individual Well ❑ Communityfl 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 ® 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 5. 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 Eaalse Rha -_r E3c;ire-_�na Senzires Telephone 694-5199 • .. •• _ • - - •LL�rr Date 6. DHHS APPROVAL Approved for 4— bedrooms by J Vit" �� S r�� (n+ Date ApprovedDisapprovedConditional Terms of Conditionai Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 oranalyze 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. 7/88) Back Page 2 of 2 J 0 \G`4S MUNICIPALITY OF ANCHORAGE (MOA) ��y �5�� • Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: A. WELL DATA Well Classification `% If A, B, C, D.E.C. Approved (Y/N) % Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed y?,P 3 —Size Z-2-5-11 ,*st No. of Compartments Standpipes (Y/N) —Z Air -tight Caps (Y/N) % Foundation Cleanout (Y/N) to r Depression over Tank (Y/N) N Date Last Pumped //,Z Pumping/Maintenance Contact on File (Y/N) ; for 'V �4 Holding Tank High -Water Alarm (Y/N) ''°" Temporary Holding Tank Permit (Y/N) "� 44 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well — ��`'°` To Building Foundation 'y'6 To Property Line To Water Main/Service Line ti.0 / To Stream, Pond, Lake or Major Drainage Course Comments To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 -.2.,y / C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata yf'¢Z�2 Type of System Design T.-e�`� Date Installed 8V8s Length of Field G 7 Width of Field Depth of Field 9 Gravel Bed Thickness 7 Square Feet of Absortion Area Sap Statndpipes Present (Y/N) I Depression over Field (Y/N) H Date of Last Adequacy Test �iZ2 - 8�5� Results of Last Adequacy Test SS n�rsadfa.-, ��ra^-6n y .rg'.e use�,p SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Property Line Id To Building Foundation 7-z' To Existing or Abandoned System on Lot 11'11+ ; On Adjoining Lots - 10 To Water Main/Service Line tiv" To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION A114 Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments To Cutback (if present) °y11.f Dimensions Manhole/Access (Y/N) "`Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in.gffec.t .o.n the date of this inspection. Signed` f ;F t Company Eagle River Cngincerinn services 6, V P. 0. f;ex 773284 m.Erlgin`�rs Seal Date &.1z iro Eagle River, AK 99,577 694"5195 MOA No. iU- �-+� ','. a ueres' IQ r 3v lbs Receipt No. Receipt No. Date of Payment �3 --,�6 Waiver Fee: $ — Amount: $ �/ % %�r �V Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 3 d : ;Dat� 4sTT adS Tvqu9wuO3TAus DlVUD `R MA •SU0TlvTn6ald J84eM bul�UIJC TNSVTV 40 a4e4S 094 4ITM 00UvTTdtu00 UT ST III04CAS 204QM NOISTAluts scloobi . K'i7 944 'a0TJJ0 ST144 UT aTTJ ua SPJ000a ;9qI 01 buTr.`T000 T69 -M# :QISMd 0661 'q xdgtu MON G4t9-E99 HONVA09 'HUM0J 3A3 -LS TZassnu :uggv 6UTJ00UT6uR 70ATd OT6'T :WA E 0 S 6 6 VXSVUV ' aDVU0HDKV ZZE aling liza is 0 loq~ 901,110 10lxssla NHausam aovlaoHDNV #:L6 E�B9 FQH�S Wb T:YI; i)c,_FL-lL; t�1 „i0?u010101_ OX:�A IN;S Eagle River Engineering Services 11940 Business Blvd, Suite #205 P.O. Box 773294 694-5195 Eagle River, A. 99577 Fax 694-3297 Legal: 4/1,,;Q Owner: r Date: Type of test; ❑ Well Flow Test Vf Septic Test Only ❑ Well & Septic Test ❑ Other: Time )V Meter Reading Monitor Level Well Level Tank 'sLevel GPM PSI Remarks �� nl 3 0 0 .? it g A 5