MOUNTAIN VALLEY ESTATES BLK 1 LT 18
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
/ 15
HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES BLK 1 LT 18Mountain Valley Estates Block 1 Lot 18 #050 - 641 - 17 Heal "UNICIPALITY OF ANCHORAGE and Environmental Protec )n Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SI-i'E/SEWAGE DISPOSAL SYSTEMf(% NAME. - _ 1J �II�h� 1 -o -MAILING ADDRESS Ger:bt ' it ((►.�31.1 ?PHONE y, -9I 2 LOCATION�!-�� � L EGAL DESCRIPTION L. tlrl�' Uq.11ey S SEPTIC TANK: wax? FROM WELL_ /QO 4' MANUFACTURER (2 Pax MATERIAL _`e ' INSIDE LENGTH INSIDE WIDTH NUMBER OF COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY"GALLONS. TILE DRAIN FIELD7t:14111)41291" DISTANCE FROM WELL Lwat FOUNDATION_�O + NEAREST LOT LINE OF LINE TOTAL LENGTH # of Lines DISTANCE BETWEEN LINES A/A* TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA cs 0 SQ. FT. LENGTH OF EACH LINE DEPTH. TOP OF TILE TO FINISH GRADE 14' SEEPAGE_: PIT: DEPTH OF FILTER -` MATERIAL BENEATH TILE _(0v___IN. ABOVE TILE L IN DI METER OR WIDTH_ LENGTH__, DEPTH Log Crib Rings Crib Size: DIAMETER __DEPTH_ _ DISTANCE FROM: WELL TOTAL. EFFECTIVE BUILDING FOUNDATION NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. Well '?V?.`)? 7 Class: 15na. Depth: Well Distaince To: Lot Line L Bldg: 140 Sewer Line: Pipe Materials: Was.. . # of Bedrooms: 3 Installer : N MDp C ons4 . Remarks: sohi $54( 1 tt DATE 9'1-5:1413 APPROVED • n,I Q 1 .1 i.— Imo, i.. __ _r . QS I, II DATE 9'1-5:1413 APPROVED • RPA I PIEA -F CHF INR Ihm IcaH' ov-yrimpiE TIE HEALTH AND ENVIRONMENT --F$TATIA-ITTFcOPM__ STREET, ANCHORAUE, Al. J9501 PA FEU [1:::111P.A1 11E" "=::V.:;!! IF" 11-.11 1. -11 TIERMIA-Ra ,77160 in;.no pnk 1,PPLICMIr 11111.T5 BULITWIT ONGEN. . E.R. . //WAS LOCATION BIRDSONG DR. 17.1a114.: LA . ITE v our y --ETE E SOIL -A BSC R -SYS1"EF.11 s : TRENCH - -LOT-SIZE- 51000 -SQUARE 17E1' TWNIMUM -NUMBER-OF -BEDROOMS z SOIL -RATING 111E -REQUIRED sIZE u1,- THE suiL ABSORPTIoN- sYSTEK IS: CD .. ILA 11,;;!:11-11%,..," O.__ -THE LENGTH-DTMENSTON- IS THE LENGTH (IN FETETY OF THE TRENCH OR DM:WHET:b. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND HND THE EOTTOM JAE EXCAVATION <IN FEET). THERE IS r' SET WIDTH FOR IskTIKME. THE GRAVEL DEPTH IS THE !J II DEPTH OF GRAVEL BETWEEN THE OUTFALL -PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). 11 F." 11 _IL H..: 7 .. . F." FA C.: !KARI w.3 IF" H H".4 in -F I CD PA -- .......... -- • A PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: I. EITHER A CLASS I OR II NSF APPROVED PLANT MAY BE t11 111 2. H CLOATNUOJS MAHIM'IANCE AGREEMENT IS 1- 1111 IF A MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE suIL ARsoRPTION EYSTFM AND/OR YOH MAY BE UE:JEET TO PROEFTliTOW 1- JA ifj <H2-2! :':)1 P-4 V-- 1E= F J. ci P-4 JA F=. 1GA! H,1La› BAGKEILLING or ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL. BY THIS DEPARTMENT WILL BE SUBJECT TO 1 il11111.':01. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR FI PRIVATE WELL OR 200 FEET FOR 1 PUBLIC WELL: WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ZO DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APH...Y SPECIFICATIONS AND cuNSIRUcTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATIOK I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS t'''i: uN-SITE SEWEks AND WELLS AS SET FORTH BY 11-11- MUNICIPALITY OF ANCHORAGE: 2: I WILL INSTALL THE SYSTEM IN AccuRDANCE WITH THE CODEa -I-TRIXETAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BETIROMe& APH T :::::II, T AMOS ..II. I NGTON :NqUED RY D A T - 3 7 ;:u';=CIP<ALLT'Y OF NC O:RAC D,o>rtme of :.f.alth and Environ_aantal ? tecti_on Pe_rfor:::ea for SOILS LOQ PERCOLATION TEST Amos Bullington Date Performed 8/24/77 • Legal Description Lot 18, Block 1, Mountain Valley Estates - 4j. c1' • O • r • 10 . c a • s ' a 12 - o ••o • 14 -. A a •' 16-.• 0 . • 18 -- 20 -- Red -broom silt w/organics (ML) Brown, well -graded, sandy gravel (GW) 85 ft. /bdrm. Total Depth = 17 feet No water table encountered AVERAGE ABSORPTION AREA REQUIRED FROM SOILS LOG = 85 ft.2/bdrm. Date Net Time _ Depth Net Drop _ Percolation Fate minute CFIAMPION DRILLING COMPANY, INC. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0-5-0 HAA# 65035-5- GENERAL INFORMATION Complete legal description"/i!T4J VALLI-SST Location (site'address or directions) 4/9''// girt/sou Current Property owner(a)Atn, o S %3Ultnq fo„ Day phone ‘c9?—cz/7c Mailing address . .P0'((1'-ifloa3 EP61s-kwe, t\(L- gel 53 Lending agency # Day phone Mailing address Real Estate Agent Eva. LoK¢,•� ' / f n Day phone,l�Q— 4/ 7( Mailing Address fruchit licl/V isia n i� �e _ Rivtc Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: .3 Expiration Date: / O — 7- 0 5' BLOCI; / Lor 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer a The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 Health Authority 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. 1 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 effectefeat the time of installation. V Name of Firm / 6 r &AG% EA 9. Address / 7.23 7 herr AGfj Cart. Engineer's Printed Name Stein, 5. DSD SIGNATURE ✓ Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Phone C70-702, Date 7/22/ OS Additional Comments 11 Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: 7, (Rev. 01/02) Original Certificate Date: 7- a 7 - oS Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.clanchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 414 Til/ V.IL [�S/ ,Ei f ' g / L la Parcel ID: Ci 6-O - 4 el /- /7 A. WELL DATA / Well type / If A, B, or C provide PWSID # _ Well Log (Y/N) N Date completed X77 . Sanitary seal (Y/N) Y Wires properly protected (Y/N) Total depth r3 ft. Cased to t a ft. or $eciextjasing height (above ground) Q in. FROM WELL LOG AT INSPECTION Date of test -^ 7/7/65 Static water levet ft. 72.4 ft - Well production g.p.m. 3- g.p.m. WATER SAMPLE RESULTS: '/ Coliform 0 colonies/100 ml. Nitrated /9 mg./1. Other bacteria ,, /0 colonies/100 ml. Arsenic: — mg./I. Date of sample: 71/05 Collected by: /1/O4 Roti. F_ni. 8. SEPTIC/HOLDING TANK DATA Tank Type/Material Gr« rl src& Date installed /777 Tank size /000 gal. Number of Compartments 2 . ` Cleanouts (YIN) 1/ Foundation cleanout (Y/N) / Depression over tank (Y/N) !Y High water alarm (Y/N)( N/4 Date of pumpingS•0 Alotineeper %/2i/es C. ABSORPTION FIELD DATA Date Installed /977 Soil rating (g.p.d or ftp/bdrm) 5,3- System type TesacH I Length Z•15- 11 Width _ 3 ft. Gravel below pipe s ft. I q 1 Total depth I ft. Eff. absorption area 24° ft2 Monitoring tube Depression over field A/ Date of adequacy test 7/7/65 Results (Pass/Fail) AMU' For 3 bedrooms Fluid depth in absorption field before test i. 5 in. Water added Qgal l- New depth S in. Elapsed Time:/20 min. Final fluid depth 0 in. Absorption rate >= ..�' SO g.p.d. t Any rejuvenation treatment (past 12 mo.) (Y/N & type) /JA/k If yes, give date 1 i A { D. LIFT STATION Date installed 'Pump on" level at Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /CB /4 - Absorption fAbsorption field on lot /136'r Public sewer main N/4 Sewer /septic service line /60)1- Size O0 * Size in gallons 'Pump ofr level at in. Cycles tested Manhole/Access (Y/N) High water alarm leve t in. Meets alarm & circuit equirements? On adjacent lots ADD On adjacent lots Public sewer manhole/cleanout Holding tank /1//4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ' r Building foundation S 't Property line /0 /f Absorption field r � Water main /V//}' Water service line f Q * Surface water MO f Wells on adjacent lots MI 0 /4" SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / 0 if Water Service line M 14 - Curtain Curtain drain if/4k F. COMMENTS Building foundation /a 'f Water main NIA ` /f Surface water /00 /� Driveway. parkinglvehicle storage L __iL_ Wells on adjacent sots /00 1+- G. t G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Sr64/E EAIG " Date 7/.22/45 q o . op HAA Fee $ Waiver Fee $ Date of Payment 0''9" C)"diz/ as Date of Payment Receipt Number 113/8 Receipt Number (Rev. 12/01) y ar7 coo 'a✓ _cro, et. 458 Ul LT Art a VII 1 HEREBY CERTIFY THAT 1 HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LZiyr�yy.%gLlErjEly�lS"Lor /se B,f:/ • AND THAT NO ENCROACHMENTSeEXIST 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 SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. • 7 ' f 4r SEWARD & SCALE= i • DATE: GRID= re✓6soci FB: /07 r7 DRAWN: .oaf ASSOCIATES LAND SURVEYING 694-0829 .. .� Du.n. Mirk Seward !LS -6918 ' _.A' Mat -Su Test CHEMISTRY Water Lab of Alaska Quality Testing Email: plat-sutestlab(drogershsa.eom - Mile 3.2 Palmer-Wasilia Hwy. Midtown Community Business Park Phone: (907) 7453005 P.O. Box 2749 Palmer, Ak. 99645 Fax: (907) 7453010 Client: North Rim Engineering 17237 Bear Paw Circle Eagle River, Ak. 99577 Attn.: Client ID: Lot 18 Block 1Mtn. Valley Est. PWSID #: Source: M.S.T.L.#: 51518 Sample Matrix: Comments: Date Arrived: 7/12/05 Report Date: 7/15/05 Sample Date: 7/12/05 Sample Time: 1100 Collected By: N.R.E. Method Parameter Units Results MDL Date Prepared Date Analyzed MCL SM 4500-NO3-E Nitrate -N mg/L SM 4500-NO3-E Nitrite -N mg/L Total Nitrate/Nitrite mg/L Legend: MRL = Method Report Level MCL = Max. Contaminate Level B = Present In Method Blank E = Estimated Value N = Above MCL D = Lost to Dilution esow- d 4.19 0.52 4.19 0.50 0.05 0.50 7/15/05 7/15/05 7/15/05 7/15/05 10.0 7/15/05 1.0 7/15/05 10.0 Re. • ed By Jon Paul Campbell Lab Manager Mat -Su Test Lob 190774E3012 07.'13/06 C7sO2pn P. 003 Matsu Test Lab of Alaska Vila 3.2 Palmnr-Wanilla tlwy Midtown Community Business Park P.O. Box 2740 Palmer, Alaska 99044 Phone: 745-3005 Fax: 748-3010 Drinking Water Analysis Report Total Coliform Bacteria LCfient:: G` t^et 1 Address: PWSID# applicable): v,`-� � e d � ,t. fi ti 51h,U� a Z Paid. Ph ot7rr #: t o2 ' rax #: b i '' " --This Section to be cOFripfeted by Sampler. Legal Description of Property: 44.77u �4LLg'1 es -t- B f L 1 i G ttY' Sample Site Location: Fel' 'ct -J (I.E : kncnen sink. baUvoom snit, outside hose bit) Time Sampled: 1 i d 0 Date Sampled:%/(Z(os Sampled by: AJdrill Beth tot ✓- Delivered to Lab By: MJC1 fafrt— Es 5 t Sample Type: Routine Treated:0 Untreated:[] Repeat Sample #: This Section to Be Completed by Lab Analysis Results: QSatisfactory ❑Unsatisfactory ❑Sample too long in transit (greater than 30 hrs.) 'Request resample. Co , Sent to State: Yes _t w ChromogenicIFluorostenic Method Results: A Total Coliform Present (P)/Absent (A) Lab I.U. #: c5 /6 V-- r� E. Coli Present (P)/Absent (A) 9 Q g Date Received: 7/ 40� Time Received: 1 tt 30 Received by: !, ` Date Test Begun: 7/R Time Test Begun: _ /GJo Analyst: Date Completed: 7/13 Time Completed: /G.h Analyst: Refer to Back Side for Instructions MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTIECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL l=�la- OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date November 11, 1986 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 18, Block 1, Mountain Valley Estates T13N,R1W, Sec. 8 Location (address or directions) Eagle River (b) Applicant Name EiMOS Bullington Telephone: Home 694-36.5 Business 659-8591 Applicant Address P.O. Box 771623 Eagle River, Alaska 99577 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder K1; Buyer ❑ ; Other 0 (explain); (d) Lending Institution First National Telephone 694-2103 Address P .0. Box 770548 Eagle Rivers Alaska 99577 (e) Real Estate Company and Agent N/A Address N/A Telephone N/A (f) Mail the HAA to the following address: picku by engineer 2. TYPE OF RESIDENCE Single -Family 0 Multi -Family 0 Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well ® Community ❑ Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite © Public ❑ Community 0 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 72-025 (11/84) 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 Telephone Address EAGLEBLVER_ENGINFFRINI; SFRVICES Date 1///&/Er‘ EAGLE RIVER, AK 99577 P. 0. BOX 1/3294 694-5195 6. DHEP APPROVAL Approved for 3 bedrooms by Approved , Disapproved a�di, pp `1f cee h nr C' el (.;j ,<:° e: > 0 -;z �.., �rtglr�er s feel (gyp io n ,, I r5).''__ a e> .1 7 40�iave 4.JG"`v'9ecce�,. ,'�¢,n , v iyA ouou.. o>aaoe . onone c� f�4 1"� o Louis A. Butera �� ©sia ;- 'ee CG67. 6 ^.�N A' Conditional Date //-2/RCit' Terms of Conditional Approval FiWe 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 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 (11/84) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION NOV 2/79986 RECEIVED A. WELL DATA Well Classification s /614 / MUNICIPALITY OF ANCHORAGE (MOM) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: j o f & / /--?//c- j //,6,7 fs /te r ,773 /-✓ le/ by c_ - If If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ,y Completed % 9 7 7 Yield �. r� A...)Date Total Depth -, -..0Y- Cased to�y�" �se"""-/Depth of Grouting 'L'`` Static Water Level >> " /e/N %/2 012 4 s"" S Pump Set At 8 3 < Casing Height Above Ground27 , Sanitary Seal on Casing (Y/N) / Electrical Wiring in Conduit (Y/N) i Depression Around Wellhead (Y/N) res yrs( /✓ Separation Distances from Well: To Septic/Holding Tank on Lot //5 / ; On Adjoining Lots/oa To Nearest Edge of Absorption Field on Lot /moo ; On Adjoining Lots //v6.2 To Nearest Public Sewer Line 10 To Nearest Public Sewer Cleanout/Manhole /U To Nearest Sewer Service Line on Lot //t- Water Sample Collected by 1ys/& /`' " 5""tee " f ; Date //ll 34=96 Water Sample Test Results � ,s c Comments r Ve// /a -✓lc _1 f!-‘,>->-. G✓��"yam, C. -v^ B. SEPTIC/HOLDING TANK DATA Date Installed /777 Size /uv° 5 / No. of Compartments ;.Z Standpipes (Y/N) / Air -tight Caps (Y/N) Depression over Tank (Y/N) /✓ Foundation Cleanout (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) p//,‘ Date Last Pumped Separation Distances from Septic/Holding Tank: To Water -Supply Well //-5 ;for 'mak Temporary Holding Tank Permit (Y/N) To Building Foundation To Property Line r/'D To Disposal Field To Water Main/Service Line /o / To Stream, Pond, Lake, or Major Drainage Course /1//,, Comments Page 1 of 2 72-026111/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7 Type of System Design Length of Field �6 i Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area o 5-7 Standpipes Present (Y/N) i Depression over Field (Y/N) it) Date of Last Adequacy Test ii//.3A- Results of Last Adequacy Test fi sf Ifo Separation Distance from Absorption Field: / To Water -Supply Well To Property Line *�o / To Building Foundation (26To Existing or Abandoned System on • On Adjoining Lots 3 t To Water Main/Service Line t/o / To Cutbank (if present) Lot '�76t To Stream/Pond/Lake/or Major Drainage Course /% To Driveway, Parking Area, or Vehicle Storage Area too Comments D. LIFT STATION /�J 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. Signed � Date Company r; MOA No S Receipt No. 500/ —moo/r. //—ZG Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) 6,5-: 0 Eagle River Engineering Services P. 0. Box 773294 Eagle River, AK 99577 694-5195