HomeMy WebLinkAboutT12N R3W SEC 33 LT 71
Tom Fink,
Mayor
Municipality Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
March 31, 1992
Sam Gaston
3540 East 144 Avenue
Anchorage, Alaska 99516
Subject: T12N R3W Section 33 Lot 71, PID #018-261-02
As-built Inspection Report
Dear Mr. Gaston:
The upgrade work on your septic system was apparently completed
on November 11, 1989. In order for this system to obtain
approval from the Department of Health and Human Services
(DHHS), the inspecting engineer must prepare and submit an
"as-built" drawing of the new or upgraded septic systems. One
of the requirements of this approval process is a copy of an
electrical inspection performed by the MOA Public Works
Department or a certified electrical contractor.
We have repeatedly attempted to have the inspecting engineer
(Mr. Mark Pearson) provide this informatli0n, however to date,
such is yet to be done. Until such time! that the as-built
drawing is approved by this office, your septic system cannot be
considered as a legal installation. This will be a serious
problem at such future time that you consider sale and/or
refinancing.
We believe
situation.
office at 343-4744.
Sincerely, ~
/ Robert w. Robinson
Civil Engineer
On-site Services
that it is only fair that you be advised of the
If you need additional information, please call our
RWR/ljm: 415
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
DISTANCES
TANK FIEL~
WELL I OG- / J I O /
Per mr[ NO
TANKS
TYPE OF SYSTEM --
aTRENCH ~ BED ~ W. DRAIN ~ OTHER _
'~PRIVATE ~ OTHER (Identify) cj,5 I /
FT FT
Municipal and Slate guidelines In effect on Ibis date:
72-013 (3/85)
MOUNTAIN ENGINEERING
10251 CRESTVIEW EAST
EAGLE RIVER, ALASKA 99577
(9071 696-17OO
(S001 478-0101
MUNICIPALITY OF ANCIdOP. AQE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
flfiT l f' 'l:}Sg
RECEIVED
'
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATEPERFORMED: ~
LEGAL DESCRIPTION:
5
6
7
8
9
10
11
13-
14-
15-
16-
17-
18-
19-
20-
TOWRShip, Range, Section: '[~~'~l~, ~...~V~.J SLOPE S~E PLAN
WAS GROUND WATER
ENCOUNtERs-O?
IF YES, ATWHAT
DEPTH?
Oeplh to V/aler Alter,cc~
Menitoring? (.,~
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __
(m~nutes/u/ch) PERC ROLE DIAMETER __
TEST RUN BETWEEN FT AND FT
· I
PERFORMED BY: ~1~1~¥~, ~1 01~1~¢_4~..~I I ~J~¢¢~ ~ DER] IFY THAT THIS TEST WAS PERFORMED IN
ACCORDANOE WITR ALL STATE AND MUNICIPAL OUIDELINES IN EFFECT ON TRIS DATE DATE:
72 008 (Rev 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED EOR
9
10.
11
13
14
15
16-
17
18
19
20.
1
2
3
4
6
7
8
DATE PERFORMED:
Township, Range, Section: TIC_..l'J, /
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
OeCh lo Water Alter ,0
Reading Date Gross
Time
Net Depth to Net
Time Water Drop
PERCOLATION RATE
-- (minutes/tach) PERC HOLE DIAMETER
TEST RUN BETWEEN --. FT AND FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE
72-008 (Rev. 4/85)
MOUNTAIN ENGINEERING
10~51 CRESTVIEW EAST
EAGLE RIVER, ALASKA 99577
[600] 478-0101
GR[ Ell ANCHORAGE AREA BOROU '
D£PARTMI:N'r OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
iNSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION__-'~,~-/~'~";~:
SEPTIC TANK:
DISTANCE FROM WELL -'-"~'f~-'"~ '/
LIQUID CAPACITY '/~'~:~z~'~-
.MATERIAl =-5'/'/f'"~'~-~/~'/Z'Z_ /Z,,~'~C~ NUMBER OF
COMPARTMENTS
_ ~GALLONS. INSIDE LENGTH~ INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
'~'~ / / LENGTtt ~1'/// /
/' oRWIDTH~ ; -/"-(' Z>'~'3 DERTH_
N~JMBER OF PITS . OUTSIDE DIAMETER __ - '
LINING MATERIAL-/ ~'&~'c/'~ L--f;~:7~"~ ' D~STANCE FROM WELL_ BUILDING FOUNDATION
NEAREST LOT LINE _',~> .... TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
NUMBER OF LINES_ ~ TRENCH WIDTH
ABSORPTION AREA_ SQ. FT.
DEPTH: TOP OF TiLE 10 FLNISH GRADE__
WELL: T y p E ~'~/~j/~ ~'.'~/'2,5 DEPTH_
· ? NEAREST
LOT LINE ~ , SBWER HNE.
DATE
TO[AL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE_ IN. AB-O¥&-TJL~-
, BUILDING FOUNDATION._ SAMPLE
SEPTIC ~/ SEEPAGE ,/ OTHER
~ SOURCES.
, TANK , SYStE~ ~f , CESSPOOl
~IAGRAM OF SYSTEM
G,A.A.B.
ATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAl. QUALITY
3500 TUDOR ROAD POUCH 6 650
ANCHORAGE. ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
2186
NAME OF APPLICANT ~,~/~'/~-
INSTALLATION LOCATION
LEGAL DESCRIPTION //
INSTALLATION OF: SEPTIC TANK
"i~'~ ~3 A / /9 //z*~.~ '
FINANCED THROUgh TO
COMPLETION DATE ANTICIPATED --
/-
MINIMUM DISTANCES, REQUIREMENTS /
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE Pit ., DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL :-~ /
SEPTIC TANK, '('-¢;(~' , SEEPAGE PIT/~'~("-----" , DRAIN FIELD
GRAVEL SACKFILL
~ CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUG~'I ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
R&M
Civil En9ioeers
JAMES W. ROONEY, P. E.
MALCOLM A. MENZIES, P.E.~ L.S.
JAMES FI, WELLMAN, P,E.
]tRy 31, 1972
ENGINEERING & GEOLOGICAL CONSULTANTS
229 EAST61st. AVE.--P.O. BOX6087 .ANCHORAGE, ALASKA99503
TELEPHONE 907-279.-0483 TELEX 090 35419
Geologists Land Surve?ors
RALPH R. MIGLIACCIO
No, 26540.42
Mr. llobert Thomas
Star Route A, Box 245
Anchorage, Alaska 99507
Test Hole & Soil Log Report for Sanitary System
Lot ?1, Section 33, T 12 N, R 3 lA/, Seward 1V[eridian
Dear ]V[r. Thomas:
We are submitting herewith the test boring results and our comments regarding
soil conditions encountered a~ ~he subject site. This investigation was performed
in accordance wi~h your request o~ Ju]2z 25, 1972 and ~hose procedures outlined in a
letter dated September 13, ]971 by ~[r. Roll Strickland of the Greater Anchorage
Area Borough Department of Environmental Quality.
A singl& test hole was put down within 'the Lot 71 area for 'the purpose of defining
general subsurface soil condikions for 'the proposed sanitary system. Excavation
was accomplished with a 'tractor-mounted bacldToe and the test hole was extended
'to a total depth of 12 feet below ground surface. One sample was recovered from
the bottom of the test hole and retained for grain size analysis. The sample will
be held in storage, up to approximately one month, for possible testing before ~t
is discarded. The final ].og prepared for the test hole has been included in 1)raw.-
ing A-01.
Ground water was not encountered in the test hole.
We appreciate being given 'this opportunity to be of service ~o you. ShouId yo¢1 have
any questions wigh regard to the above, please do no~ hesitate ~o contact us.
Very truly yours,
R & ~¥[ ENGINEERING & GEOLOGICAL CONSULTANTS
~,/ j~une,.~ W. Rooney --
JWI~.: wb
xc: Greater Anchorage Area Borough
7-25-72
ORGANICS
SANDY GRAVEL
Brown to Grey
(sw)
9 O'
SILTY SANDY
GRAVEL (G M!
No water table
flare: Hole excavated wilh tractor mounted backhoe.
Robert -Fhomms Property
lEi3gln:eerimg ~ Geolo.qicml Con.-:~ul'i'anf,~ LOG Oi:: TEST BORING
Anchor¢Ige Alaska
& W, GRAIIAM PHON~ FA 22219
J~u '
L',]?,:LVO ]. ('?:
;' :'l.110
MUNICIPALITY OF ANCHORAGE ,~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage. Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Lot ~/, T12N, :~.3~'7, _S33~
Location (site address or directions) 3540 East 144th Avenue
Property owner
Mailing address
Lending agency
Mailing address
Sam & SusaD CaRton _ Day phone_
3540 Fast 144th ~O.~3.ge_r AK 99516
Day phone
~44-1717
Agent
Address
Day phone
Unless otherwise requeste'd, HAA will be held for pickup,
NUMBER OF BEDROOMS: 3
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 wrilten confirmation from State ADEC
attesting to the legality and status of system.
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EI:I::INIgN::I 3,8 NOI.LO~dSNI 40 .LN:IIN:I/V/$ 'c;
Legal Description:
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Dot ~.¢~¢ T 12 N, R 3 W, S 33 Parcel I.D.
A. WELL DATA
Well type Private
Log present (Y/N)
Total depth 83 '
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter.
Y
Y
ADEC water system number
Date completed 8/2/65 Driller Alaska Services ./
Cased to App. 80' Casing height *--Pit W~I-1 I~- I/ _~¢
Wires properly protected (Y/N) Y
Date of test
FROM WELL LOG
812/65
AT INSPECTION
MUNIC!PALITY (~F ANCHORAGF
4/21/9~ ENVIRONMENTAL SER% IC~$ OlVISlON
Static water level Artesian
Well flow 4 gpm g.p.m.
Pump level Non-Submersible
__ Artesian -1' ¢ ~ ]993
t EIVED
Non-Submersible
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 106 '
Absorption field on lot 110 '
Public sewer main
Public sewer service line N/A
; On adjacent lots >200'
; On adjacent lots >200'
Public sewer manhole/cleanout N/A
Petroleum tank N/A
WATER SAMPLE RESULTS:
Coliform 0
Date of sample: 4/20/93
B. SEPTIC/HOLDING TANK DATA
Date installed
Nitrate
11/8/89 - 11/11/8%ank size
Collected by:
1,250 gallon
Cleanouts(Y/N) ¥
High water alarm (Y/N)
Date of pumping ~' ~/93
Foundation cleanout (Y/N) ¥
Alarm tested (Y/N)
(Lift Station)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Otherbacteria 0
]:~ent .Eaton
_. Compartments 2
Depression (Y/N) N
N/A
Surface water/drmnage 40 fRabb] t Cr~kl ~ %
* *'W~t-~.gonsists of a 48" dia. by 10' deep s~~/ a plywood Insul. top
72-026 (Rev.~r~lr~k fl~r~t~as ~S ~yll¢~.~h CONTINUED ON BACK PAGE
carries a small~~l casing extends 7' ~ve the ~~
~_ flor
To property line 75 ~ Absorption field 40 '
Water main/service line N/A
Well(s) on lot 106 ' On adjacent lots__ >200 ' Foundation 85 '
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) Y
11/8/89 - 11/11/89
"Pump on" level at
Manufacturer Orenco Svstems~ Inc,
Manhole/Access (Y/N) Y
5 '(7" "Pump off" level at 6 ' 0"
High water alarm level
Meets MOA electrical codes (Y/N) Y
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot 110' On adjacent lots
D. ABSORPTION FIELD DATA
Date installed 11/8/89 - 11/11/89
Length 2 @42' Width 5' ea.
>200'
Cycles tested
Total absorption area 600 Sq. ft.
Depression over field (Y/N) N
Results (pass/fail) Pass
Surface water 140' (Rabbit Ct.)
System type Wide Drain
Total depth 5.5 '
N (Pressure System)
4/21/93
Soil rating 150 Sq. ft.
G ravel thickness 2 '
Cleanouts present (Y/N)
Date of adequacy test
for 3
bedrooms
Peroxide treatment (past 12 months) (Y/N) ~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
If yes. give date
Wellon lot 110'
To building foundation 65 '
On adjacent lots >200'
Surface water
Curtain drain
On adjacent lots > 200 ' Property Pine
To ~ki~ or abandoned system on lot
Cutbank N/A Water main/service line
180'
N/A
15'
200'
N/A
(~abbl t Cr · ) Driveway, parking/vehicle storage area 100 '
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect O~t.fi~"~?~tif~ inspection.
Signature ~ :, , , · ~,~
Mark W. Pearson !~,,,,~,~., ~..~
Engineer's Name
Date
4/26/93
HAAFee$ /"76: '~
Date of Payment .-> ..s.o
Receipt Number ,~>- /? ' ~*
72-026 (Rev. 3/91) B~ck MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 I] STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
,:t'l(.)~,~ HOR L71 %% /2'fir R3[~, 5['J33
Co. Llected :04/20/93 (j 20200
t,]Old( ('h.'de r :65712
Re})ol ~: (;ompl.eted ~04/73/93
Member of the SGS Group (Soci6t~ G~.~rale de Survmllsnoe)
Letter to DHHS regarding T12N, R3W, S33, L 71
Page 2
May 18, 1993
2) The material in the bottom of the CMP is very porous gravel. In fact, when we
were testing the well, a leak in the piping was producing a continuous flow of water
from the service line. Due to the course nature of the soils in the bottom of the CMP,
there was no standing water. Also, no standing water has ever been observed in the
bottom of the CMP, even during break-up.
3) The bottom of the CMP is near the original ground surface. The homeowner
placed approximately 5 FT of fill and used the CMP to protect the well-head. The
surrounding topography is such that soils are mounded around the top of the CMP. In
order for any water to flow into the top of the well casing, the entire area would need
to be inundated with sufficient bead to overcome the natural artesian head of the well.
4) Being a flowing artesian well, the act of raising the casing might increase the
likelihood of freezing and other potential problems.
For these reasons, we see little benefit to increasing the casing height. The attached
Health Authority paperwork assumes that you agree with this position. If you have any
questions, would like to discuss or inspect the well, or if you find this condition
unacceptable, please contact me at 562-1500.
Sincerely,
MOUNTAIN ENGINEERING
Mark Pearson, PE
INSPECTION REPORT
MbNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION
3500 EAST TUDOR ROAD,
INSPECTIONS (907) 563-3464 _ i I(NFORMATION (907) 786-8211.
NAME
STREET ADDRESS
/ PERMIT NO.
/ PHONE
; / DATE
LOT / BLOCK / SUBDIV.
FOOTING [] ELEC. TEMP.
FOUNDATION --- [] ELEC. SERVICE
BOND BEAM -- [] ELEC. ROUGH
FRAMING [] ELEC. FINAI~
INSULATION -- [] OTHER ' '
SHEETROCK -- []
STRUCT. FINAL [] FIRE FINAL -
OTHER . [] ZONING
[] PLBG. UNDGR. -- []
[] PLBG. ROUGH -- []
E] GAS TEMP. __ []
;El GAS []
,[] MECHANICAL- []
MECH. FINAL []
[] PLBG. FINAL -- []
[] OTHER []
E] NO NONCOMPLIANCE OBSERVED
E] WILL REEXAMINE AT NEXT INSPECTION
CORRECTIONS ESSENTIAL AS
EXPLAINED BELOW
DO NOT CONCEAL UNTIL REINSPECTED
COMMENTS
INSPECTOR DATE
WHEN CORRECTIONS ARE MADE, PLEASE CALL FOR INSPECTION
DO NOT REMOVE THIS NOTICE
MUNICIPALITY OF ANCHORAGE
OF HEAETH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
FICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date 5~/,~i/~..y"
tNFOitMATION
'~i.~j~jI t.)c$cript~on {Incluoe Ici. DIOCK. subdiwsion, section, townsh p, ra 1ge)
Location (address or directions)
(c)
Apphcant Name .~I~/E~Z. ?-~40/V~.8~ Telephone: Home ~ .'~' '"~'.~ ~ d/~ ¢'; Business .~,~;~"~--'--,P~'~ 70
Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other I-i (explain); ......
!: (d) Lending lastitution ~2J././~- Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family [~ Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Well [~ Community [] Pubhc []
Note: If community well system, must have written confirmation from the Stato Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite '~ Public [] Community [] Holding Tank []
Note: If commumty well system, must have written confirmation from the State Department of Environmental Conservation
altesting to tho legaldy and status.
Page 1 of 2
i~,jt}pi!¢;~IONS, TE~TS, FILE SEARCH, DATA AND INFORMATION,
tlt~ of the validation date shown below, I verify that my investigation et
Wilier s Jpply and/or wastewater disposal system is safe, functional and
tdfHcture indicated herein. I fudher verify that based on the information
find from my investigation and inspection, the on-site water supply ar
fll.nce with all Municipal and State codes, ordinances, and regulations in effect
DHEP APPROVALt ~.. _,~ ~
Approved for ~-~& bedrooms by~'~~-~-,~.~_.c~(~Date
Approved __?( ....... DisapprovS"d" Conditional ___
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the 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 requirements. Employees of DHEP do not coeduct 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
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
'7/
'7~[~ N R ~ ~',m.
'w~NTAL PROTECTION
RECEIVED
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth ¢,.~ Cased to
Static Water Level _ Ar']"es
casing Height Above Ground '~ Pt}" f,U¢ll
Electrical Wiring in Conduit (Y/N}
Separation Distances from Well:
To Septic/Holding Tank on Lot'~ ~ ,~'
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~"&,4.
Cleanout/Manhole I~ ~' · ·
Water Sample Collected by "r'~/
Water Sample Test Results
If A, B. C, D.E.C. Approved (Y/N) ~J.
Date Completed ¢~'/~/Cb- Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
'~¢--; ¢',; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on
;Date _
SE PTIC/H O L~T~A~
Date Installed
Standpipes (Y/N) ~ Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
Size _lOOOd¢~[ No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped _ ,~-/~ ] /'~
;for
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well '*~ ~
To Property Line '~2' ,'~'¢
To Water Main/Service Line
Course __lO0' ~
Comments ~ ~ ~l( - ~ "~
To Building Foundation '7[ ~
To Disposal Field 6~ ¢
To Stream, Pond, Lake, or Major Drainage
72-026(11/84)
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Width of Field ~.., I~~
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test ~,~.
Separation Distance from Absorption Field:
To Water-Supply Well I i.~ ~ro,~
To Building Foundation /0,5'
Lot I~A,
To Water Main/Service Line ht~/~-.
To StreamlPond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design 5ee? e ?,'t'
Length of Field _ i ~ I; ¢-._;~ ~
Depth of Field I1'
Gravel Bed Thickness ~nl~
~r /~.- ~-~l~ Standpipes Present (YIN) ~~--/~.-' , ~
-- ~ ~ ' . ~ , .' ,~ ~
To Property Line 80 ~
To Existing or Abandoned System on
; On Adjoining Lots ~ ..~O '
To Cutbank (if present) N, ~,
Comments
D. LIFT STATION
Date Installed
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 during Adequacy Test. Meets MQA
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.
Signed G~'-J~_ .~..~'//~¢~,~. Date '5~'/3i/'~---4-
Company ~[~z/'/¢~_ ~edllU(~( ~r~¢MOA No. ~"~'~
Receipt No. ~%[//~ ~ -~
Date of Payment ~" "¢' 'N~¢
Amount: $ ¢~ ~"~>
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