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Home My WebLink AboutT12N R3W SEC 24 N2NE4SW4SE4SW4 PARCEL 17Onsite File T12N R3W SEC 24 N2NE4SW4SE4SW4 PARCEL 17 #015-242-06 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 uP R^ E MAILING ~DDRESS LEGAL DESCRIPTION DISTANCE TO Well Dwelling PERMIT NO, inches Distance~7~n lines Material DISTANCE TO: ,~)/ FOU ndation~:~(~ J Nearest Tota,,eng J, s I Tronc¥ Ch,; Top of tile to finish Material beneath tile Length Width Depth Type of crib Crib depth Total effective Well Building foundation Nearest lot DISTANCE TO: Class Driller Sewer line DISTANCE TO: OTHER Septic tank PIPE MATERIALS SOILTESTRATING/ , INSTAI~LER REMARKS LEGAL 72-013 (Rev. 3/78) · [MUNicIPALITY' OF 8NCHORBGE DEPARTMENT OF HEALTH AND 'E~t~V~RONMENTAL PROTECTION RN~.HORRGE., RK 825 L STREET.. "' r ' 9950i C~N--S I TE SE&4ER 8: [,JELL PERt"i I T PERMIT NO: DATE ISSUED: 05/1±/84 APPL I CANT ADDRESS: CONTACT PHONE: DONALD E. BIGELOW SRA BOX ±681 Y, OMEFA C~IRCLE 8NCHORAGE, 8K 9951~ ~5-9348 LEGAL DESCRIP: SUBDIVISION: NAS LOT: N8 SECTION: 24 TOWNSHIP: i2N RANGE: ~N LOT SIZE: t. 25A (SQ. FT. OR ACRES) WAX BEDROOMS: 4 BLOCK: NR LISTED BELOW 8RE THE OPTIONS AVRILRBLE TO VOU IN DESIGNING VOUR SEPTIC .~' "- t9 - - z--,TEM. ,.HuObE THE OPTION THBT BEST FITS ~'OI_IR SITE. TRENC:H BE[:, !.-,3. DRfl DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL DEPTH (FT.) ?.5 0,5 3.5 TOTRL DEPTH (FT.) ii. 5 4.5 ?.5 GRAVEL WIDTH (FT.) 2.5 27.8 5.0 GRAVEL LENGTH (FT.) 70.0 GRAVEL VOLUME (CU. VDS. > 5~.8 5~.0 8~.7 TSNK SIZE (GALS> 1,250.0 ** ~,250.0 ** ~,250. 0-** SOIL RATING (SQ. FT.?ER) 262 2~5 GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EBCH) TANK MUST HBVE AT LERST TWO COMPARTMENTS I CERTIFV THAT: t. I~AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET · FORTH B'¢ THE MUNICIPALITY OF RNCHORRGE (MOR) RND THE STRTE OF RLRSKR. 2. I WILL INSTALL THE 5~STEM IN RCCORDRNCE WITH RLL MOR CODES RND REGULRTIONS., RND IN COMPLIRNCE WITH THE DESIGN CRITERIR OF THIS PERMIT. ~. I WILL RDHERE TO 8LL I'IOR RND STATE OF RLRSKR REQUIREMENT- FOR THE SET BRCK DISTRNCES FROM 8NV EXISTING WELL~ WBSTEWRTER DISPOSBL S'z'STEM OR PUBLIC SEWERRGE _,~:,TEM ON THIS OR RNM RDJRCENT OR NEARBY' LOT. 4. I UNDERSTRND THRT THIS PERMIT IS VRLID FOR R MRXIMUM OF 4 BEDROOMS RND RNa' ENLRRGEMENT WILL REOUIRE RN RDDITIONRL PERHIT. iF A LIFT STATION IS tNSTRLLE[:, IN AN AREA COVERED B~' MOA BUILDING CODES, THEN (1) FIN ELEL. TRI..RL PERMIT AND INSPECTION MUST BE OBTAINED.~ (2) AS-BUILTS WILL NOT BE RPPROVED WITHOUT 8N ELECTRICAL INSPECTION REPORT~: 8ND (3)-THE ELECTRICBL WORK .MUST BE [>ONE B'Y'R LICENSED ELECTRICIBN. ............... ....... ~PPLICfN,~ . &. -E~G~NEERS, INC: ANCHORAGE, ALASKA 99~O5 ~ ~ . 549-6561 ~ 'q"C~'~',,~N,~;, LOG VE RC()I. At I()1~ I'ES1 5 6 7 8 9 12 t9 20 / 2 /0 APPLICANT LOCATION LEGAL DEPARTMENT OF HEALTH AN[:, ENVIRONMENTAL PROTECTION 025 "L'" STREET., ANCHORAGE., AK. D'_--,,502L 264-4.72E'~ [)ON BIGEL. OW SRA BOX :L68::LY '_=.~D5E'I7 ]:45-_-.-::25"1 N2N2E2SW4SE4SI.44'I'::L2N RZ-':W S24 LOT SIZE D_q._q. DDD. SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEN IS: TRENCH NUMBER OF BEDROOMS = 4 SOIL. RATING (SQ FT/BR)= 262 THE REQUIRED SiZE OF TNE SOIL. ABSORPTION SYSTEM IS: THE LENGTH DII"IENStON tS THE LENGTH (IN FEET.':' OF THE TRENCH OR DRAINFIEL[.',. THE DEPTH OF A TRENCH OR PIT IS TNE 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 MINIHUM DEPTH OF GRFIVEL BETNEEN THE OUTFFILL PIPE AND THE BOTTOM OF THE EXCAVATION (iN FEET). R E~;-.~Li Z F~:E [) _C;EF"-F Z ,]: -~"~R f-~-'-: '-2:-1 ~ ZE--- ±25~Z~ F'~ F~L- L E'J~'-,t'---=, PERNiT AF'F'L. ICANT HAS THE RESPONSIBILITY TO iNFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER GF RESIDENCES THAT THE WELL WILL SERVE. BACKFILLING OF AN"¢ S"r'STEt"I P.IITHOUT FINAL INSPECTION AND APPROVAL BV THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINtI'IUM DI'_-ZTANCE BETWEEN A .WELL AND ANY ON-SiTE SEWAGE DISPOSAL SYSTEM IS '1.00 FEET FOR A PRIVATE WELL OR ±50 "FO 200 FEET FROf"t R PUBLIC WELL DEF'ENDING UPON THE TVPE OF PUBLIC WELL. HINIHUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS :;"5 FEET AND TO A COMMUNIT'?' SE!.4ER LINE IS 75 FEET. OTHER REQUIF=:EMENTS MA'T' RF'F'LY. SPECIFtCRT!ONS AND CONSTRUCTION DIRGRRt"IS ARE AVAILABLE TO INSURE PROPER INSTRLLRTION. i CERTIFY THAT f: IRM FAMIL. IRR ~..tITH THE REQUIREMENTS FOR ON-SITE %EWERS AND t.4ELLS RS SE]' FORTH BY THE NUNICIPALIT'¢ OF ANCHORAGE. 2: I WILL IN'~]TALL THE S¥S]'EN IN ACCORDANCE WITH THE CODES. ].: i UNDERSTAND THAT THE ON-%ITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROONS. .., I bNE[.: ............... RF'PL ICRNT DON BZGELON 1%~SI_IED BY ....... : - '- ................ & ,'£~GINEERS, INC. 7125 OLD SEWARD HWY. ,~NCHORAGE ALASKA 99503 349 - 65bl 3 5 6 7 8 9 ~10 12 ]5 ]6 ]7 18 ~9 20 % JO o SWANSON~ 1834-E / 2 /o o WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 8, Geophysical Surveys Drillin9 Permit No. either lb or lc.) A,D.L. NO. "~ ,l~"oto'y [] on,e. [] rD. STATic wn~[. LEV[L: ~'. / / i ~ Above or ~ Below Io~d surface ~[~OH~~ ~KUI~'~ ~ ft. offer ~hrs. pumping ~g.P.m. ~l~~ ' Material: ~Neat Cement ~ Olher: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6550 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~'~.-OG NAA# GENERAL INFORMATION Complete'legal description Location (site address or directions) } ~ ;LO I O- ~%4 ~,~ Property owner Mailing address Day phone Lending agency Mailin. g address ' Agent Address Day ~hone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well ~ Community well Public water If community well system, provide written confirmation from State ADEC at,est- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 5. 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 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 s & S ENGINEERING 17034 Eagle River Loop Road No. 204 Address E:~,!-~ P.!ver, .~.!a_~k: 99577 Engineer's signatu're ~'Y.~.!/2 ~z'/~--- Date I O f j DHHS SIGNATURE ///' A. pproved for FO U ~ Disapproved. __ Conditional approval for bedrooms. bedrooms, with th-e following stipulations: Additional Comments //// / 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: Health Authority Approval Checklist ~H , T~ ~3 ~ ParcelI.D.: A. WELL DATA Well type Log present Q/N) 'Y/~ Total depth Sanitary seal ~/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~' / %~ ~ Cased to 3 ~ ' ?'o 8~,,~,( Casing height (above ground) Wires properly protected ~/N) Date of test Static water level Well production FROM WELL LOG AT INSPECTION / g.p.m. 0, H ~ g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: eLI ~ ~q ~ B. SEPTIC/HOLDING TANK DATA Date installed °o I/~/ ~' ¥ Tanksize )~-~'0 Foundation cleanout ~r/N) Date of pumping / C. ABSORPTION FIELD DATA Date instailed Length '70 Width Collected by: Number of Compartments __ ~- Depression (Y/~ ~ 0 High water alarm (Y/~. Pumper /~ +- //0~,4 .c~.,~,c~ ~f O Other bacteda S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 ~ Cleanouts~/N) Soil rating (g.p.d.~t~ ~ ~' & ~ System type 7~ ~ c N Gravel thickness below pipe -~ '/~ Total depth 70 Effective absorption area /o ~o >~ ~- Monitoring Tube present (~/N) Date of adequacy test cl./7q / c~ ¥ Resultsl~/Fail) Fluid depth in absorption field before test (in.); (~ / Fluid depth G ' ~l" (ins) Minutes later: '70 Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* __ Depression over field (Y~) __ For Immediately after~ ~ gal. water added (in.): Absorption rate = 6 00 ¥ g.p.d. ~"~ Ifyes, give date '-- bedrooms ~7 ~0" D. LIFT STATION Date installed Size in gallons .--~'"'-~' Manho e/Access (Y/N), "Pump on" leve~level at* Nigh water alarm level at* ~*Datum Cyc~~/ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ '/' Property line ~. t+_ Absorption field Water main/service line /o 4- .Surface water/drainage /°° ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ) 0 Building foundation / 0 + Water main/service line Surface water ) Oo ¢- Driveway, parking/vehicle storage area Curtain drain ~ ~ '~ ~ :~ '~ o ~ ~' Wells on adjacent lots / 0 0 F. ENGINEER'S CERTIFICATION I certify that l have determined thru field inspections and review of Municipal records,,jh~tT~e..,~..,.,_v~.~ms are in confo~ance wit~ M~ H~guidelines in effect on this date. ~ ' ~', ........... Signature Engineer's Name ~ ~ ~ ~ C . ~o~v 4 ~ ~ ,. ...... ~...,~,-~ ~.~,,,~,~;;,. .~-~ Date Io ~, ~,.., HAAFee $ "~ DD , DD Date of Payment /~g)/P //~z) Receipt Number z-/./~7,/~ 72-026 (Rev, 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE H E M O R A N D U M WATER WELL ADVISORY HEALTH AUzMORI~ APPROVAL NO. ~ ~ ~ ~ 2~ During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot /~/~//~ /~/~/3L) ~ ~/~ Block ----- of ~-/~/2 ~ S ~/2 ~O.~SubdivisiOn, the well's productivity was determined to be O,~ gallons per minute. The minimum well productivity required by this Department (AMC !~.55) for a ~ bedroom residence is p. gallons per mmnute. Although the subject well currently exceeds tnz~ m_n~mu~ ~,'~_~qu__eme_~,~ ~ ~ ~ all ~arties concerned are advised that the production capacity of the well may fluctuate. of non-critical water uses such as washing cars lawns and gardens may be required. This advisory must be attached to all Health Authority Approval. Restriction ~nc watering copies of the subject · ROBERT C. coWAN, P.E. ROBERTA. SHAFER, RE. WELL FLOW TEST DATA ENGINEERING STUDIES AND REPORIS WELL INSPECTION & FLOWTEST CLIENT: DO~/ ~ ~, ~ t-.O t,~, CIVIL EhlGINEERS (907) 694-2979 FAX (907) 694-1211 WELL DEPTH: ~ WO/ CASING DEPTH: /¢ O DATE DRILLING COMPLETED: ~ / ~; "/ DRILLER: MISC. DATA: CASING HEIGHT: / SANITARY SEAL: WIRES IN CONDUIT: ~'~ $ GRADING O.K.: BACTERIA AND NITRATE SAMPLES COLLECTED (date): DATE: TEST DATA: METER PUMPING DEPTH TO CLOCK READING RATE WATER REMARKS TIME (GAL) (GPM) (FT) '7 ', '~L~ 0,~, ~ ~ -~ ~ swl RESULTS: WELL CURRENTLY PRODUCES 0, ~2 GPM WITH A ! ~ DRAWDOWN TESTED BY: /~0 ~ (~ , FLOW RATE NOT GUARANTEED--SUBSEQUENT VARIATIONS CAN OCCUR. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 OCT-OZ-9g 16:~1 FRO~,I-CTE E~¥iROH~Et~TAL 5615301 T-TIO P.O~/03 F-78~ .~tr~ CT&E E,vitonmental Servi~:e~ Inc. CT&E ReL# Client Name Frojec~ Name/// Client Sample ID Ordered By PWSID 985637001 5 & S l~ag~nccrmg N2,N2,B2,SW4,SFA Sec[ion 24,T12N,R3W D~Laldng WaIer S~i~'Remark$: Client PO// Printed Date/Time 10102/95 14:10 Collected Date/Time 09/29/98 10:00 Received Date/Time 09/29/95 10:45 Technical Director: Stephen C. Ede Rel~sed B~ o o,156 pOL cot/1OOink Sal8 9~aZ~ o.100 mg/L EpA 5OO.O Dg/zg/9B ~,p max 09/[9198 09/Z9/98 GCP ~ICIPALITY OF ANCHORAG~ ' DIVISION OF ENVIRONMENTAL HEALTH j DEPARTHENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~ ' A~PpLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 3/1/85 (a) Legal Description (include lot, block, subdivision, section, township, ra~e) N% N½ E½ SW% SE% SW% Sec 24 T12N R3W Location (address or directions) N%. N% E½ SW% SE% SW% Sec 24 T12N R3W Graiff Street GEOLAB (b) Applicants Name Don Bigelow Telephone - Home Business 344-8042 Applicants Address c/o GEOLAB 1131 E. 76th Ave. ~101 Anchorage, Alaska (c) Appliqan~is (check one) Lending Institution ~ ~ 0~ner/builder ~; (d) Lending Institution Alaska USA, Petra Telephone 786-2884 Address (e) Real Estate Co. & Agent None Address Telephone (f) Mail the HAA to the following address: Don Bigelow c/o CEOLAB Anchorace. Alaska 2.. TTpe of Residence Single-Family~ Multi-Family~ Other (describe) Number of Bedrooms 4 3. Water Supply Note: If community well system, must have w~itten confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite~ Public~ Community~ Holding Tank~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] E_n. glneering Firm Providin~ Inspections, Tests~ File Search~ Data and Informati_~, As certified hy my se~ ~ftxe4 hereto and as of the validation date sho~ below, verify t~ m~ i~vest~sa~ion of. this ~e~th ~hori~y Approval sho~ that the on-site water suppl~ a~/or ~stewater disposal s~stem is safe~ f~ction~ a~ ~eq~te for the n~er of ~edrooms.a~ ~pe of structure indicated herein.. I f~rther verify that, based on the info~tion obtain~ from the ~icipality of ~chora~e' files a~ from my investi~a~io~ ~ fnspec~o~ the on-site ~ter suppl~ a~/o~ ~stewater system is in c~pliance ~th ~1 ~n~ctpal ~ State codes~ ordinaRces, t~o~s in effect o~ the 4ate of this inspectio~. Name of Fi~ GEOLAB Telephone3~-8042 Address 1131 E. 76th Ave. ~101 Anchorage, Alaska ...... l ( /1 %[%%%, Approved Disappro iou~ Te~s of Coudition~ Approval ~AUTION THE MUNICIPALITY OF ANGHORAGE DEP~R%TMENT OF HEALTH A/qD ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGR~ 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN Tm~ STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS 0R OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK° (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Legal Description: MUNICI?t',LiT'f OF /:i<~- FCE V D N½ N~ E½ SW~ SE~ SW~ Sec 24 T12N R3W Well Classification Individual If A, B, C~ C, D.E.C. Approved(Y/N) Well Log P~esent (Y/N) Yes Date Cc~pleted 8/9/84 Yield 1 gpm Total Depth ~40' Cased to 32' * Depth of G'~outing None Static Water Level 3~/~-~ Pump Set At Casing Height Above Ground ~. Sanitary Seal on Casing (Y/N~es Elect~ica! Wi~ing in Conduit (Y/N) Yes Depression A~ound Wellhead (Y/N)~o Separation Distances f~cm Well: To SeDtic/Holding Tank on Lot 170'/ ; On Adjoining Lots 100' + To Nearest Edge of Absorption Field on Lot 120' ; On Adjoining Lots 100' + ~-~-. To Nearest Public Sewe~ Line NA ~ To Nearest Public Sewe~ Cleanout/Manhole NA TO Nearest Se~ Service Line on Lot NA Wate~ Sample Collected By D.A- .qf~nl~v ; Date Wate~ Sample Test Results C~ents * Well casinq set 5' into bedrock B. SEPTIC/~OLDING TANK DATA Date Installed 8/14/84 "'"' Size 1250 gal "'"'~' NO. of Ccmpa~ents 2 ~' Standpipes (Y/N) Yes ~ Aid-tight Caps (Y/N) Yes~Foundation Cleanout (y/N)Yes~-~' Depression ove~ Tank (Y/N) N~ ~ Date Last Pumped x~. ~ =l~?f~m Pumping/Maintenance Contract on File (Y/N) NA ; fo~ Holding Tank High-Wate~ Alarm (Y/N) NA Temporary Holding Tank Permit (Y/N) NA Sepazation Distances f~c~ sePtic/Holding Tank: To Wate~-Supplywell 170' ~--- To P~ope~ty Line 35' ~"- To WaterMain/Se~viceLine NA Course None/ To Building Foundation 17' ~'~'~ To Disposal Field 5' ~ To Stream, Pond, Lake, c~ Majo~ D~ainage Com~nts Receipt ~ Date Paid: Amount: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed 8/14/84 Width of Field Square Feet of Absorption A~ea Dep=ession over Field (Y/N) No Results of Last Adequacy Test 1050 262 sq.ft.BRTyps of System Design ~rei~.ch Length of Field 70' Depth of Field ] ] ,. Gravel Bed Thickness 7. Standpipes P~esent (Y/N) NA Yes Date of Last Adequacy Test None - new Separation Distance f~cm A~sc~ption Field: To Water-Supply Well 120' ~ To P~operty Line 10' To Building Foundation 32' To Existing or Abandoned System cn Lot NA ; On Adjoining Lots 100,+~ To Water Main/Service Line NA To Cutbank(if p~esent) NA To Stream/Pond/Lake/c~ Major D~ainage Course NA TO D~iveway, Parking A~ea, o~ Vehicle Storage A~ea 15' Comments D. LIFT STATION Date Installed NA Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Cor~nents ** Check Permitted Bed~oc~ Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA on the date of this inspection. Company MOA No.STSC-007 KB1/d5/s in effect [Page 2 of 2] 2-15-84