HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES #1 BLK 5 LT 7
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ASBUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
/%�6".,/�✓Ti�i!/l/.dGIC��d�.9TES/�-O�✓, iYo/GoT'�/,,,a�'.ti'
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 SUBDI—
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND—
ARY LINES.
S57ARD & ASSOCIATES LAND SURVEYING 694-082
SCALE:
%h
DATE: X ���. Q Q �-1
co 1
A' * THi
GRID: � ... .....,.. ,..
Duane Mark Seward p
FB: LS -69
54P
DRAWN:
Municipality of Anchorage Page / of ,.~_
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number:.-5'V-/ ¢'EO/¢~ PID Number: Cftc -&g/- /d)
Name: ~7'~O.~_c/:~-./O½j / ¢~/~ Z~ Wastewater System: ~ New ~ Upgrade
_ ~¢ ~/a¢~, ~ 9¢~'~ ABSORPTION FIELD
Phone: ~ FY -?:~ 5/ No, of Bedrooms:
~ ~ Deep Trench ~ Shallow Trench ~Bed ~Mound BOther
Soil Rating: Total Depth from.original grade:
LEGAL
DESCRIPTI
ON
X ¢ GPD/Sq. Ft.
Lot: 7 Block: ~-~ ¢c~/¢~Subdiv~iom~/~¢~ ~'F¢] I Depth to pipe boSom/from/original grade: Gravel depth beneath pipe
. Ft. ~ Ft,
~I Section:
Township: ~ ~an~e:' Fill a~0od a~ove, ~al 9rado: Gravel Iongth:
Number of lines: Distance between ~ines:
WELl,,: ~ New C Upgrade Gravelwidth: ~ Ft. / ~ Ft.
~ass~ication (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Driller: Date Drilled: Static Water Level: Installer: Date installed:
~ ¢ ~ [ ~/ Pump Set At: ' Casing Height Above Ground:
SEPARATION DISTANCES B'Septic D Holding [3 S.T.E.P.
To Septic Absorption Lift Holding Public/Privat~ Manufacturer: Capacity in gallons:
From Tank Field Station Tank SewerLines I ~¢ ~ 0¢~ 0¢ ~
/ Material: Number of Compadments:
S..~oe ~ LIFT STATION
Water / 001'~ / 00(¢~
-- Lot /~ Manufacturer:
Line ~ / L/~ / Size in gallons:
Foundation
CuAainDrain ~ /ol/~ /¢~¢~ i~~l ~Electricallnspectionspedormedby:
Location and Description:
. ~umsd Bevation:
Depadment of Health and Human ~e~ices approval ' '-"
72~013 (Rev, 9/91) MOA 25
PERMIT NO. SW980163 PAGE 2 Or
Municip(~tity o¢ Anchon~ae
DEPARTMENT OF HEALTH AND HUIVFAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
· P.O. Box 196650 ~hnchorage, Ataska 99519-6650·Te[ephone~ 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
L~'.GAL LOT 7, BLOCK 5, MOUNTAIN VALLEY EST.¢'[ P.IJ). No. 050-661-10
10
qEW
WELL
-TBM
~TH
TH ~P
NEW 1000 GAL.
SEPTIC TANK
LOT 8
TRENCH
DBL1
DBL2
0
8CA~B 1" = 40'
RO,~GRr' C. CO?VAt~ f o-
CE - ?;~:3 i /
'%- ,~" ......
PER~IT NO SW98016~ PAGE 3 OP 3
rvlunicip, ~it oF Anchor-~e
DEPARTMENT OF HEA~_THAND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,O. Box 196650 ·Anchoro. ge, Ato, skc~ 99519-6650· TeLephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEN AND/OR WELL INSPECTION REPORT
LEGAL LOT 7, BLOCK 5, MOUNTAIN VALLEY EST. P.I.D. NO. 050--661--10
A B C
7C0 - 4.5', 28.5'
ST1 78.0' 61-0 _
ST2 82,0' 66.0' -
DBL1 85,0' 69.0' -
DBL2 86,0' 70.0' -
001 103.0' 85.0' -
~ltl 104.0' 86.0' -
002 - 57.5' 71,0'
~T2 - 56.0' 69.5'
CO1
MT2 C08 MTI~_jC01 = 90.0'
/ {co~ og.a'
~,...-FINAL GRADE
INSULATION __JCO1 = 85,2'
/C02 = 85.3'
MT2 = B2,7' MT1 = 82.9'
77.7' WATER POUND
73,7' B.O.H.
N, T, S.
by
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 870272 CHUGIAK ALASKA ggSfl? · TELEPHONE 888-2769
OWNER OF LAND
OEPTH
ADDRESS
qc ^L DESCR, T,ON "
~iamete, ~'n he,, 'depth I j ~ feet
asing 8ticku~.Above Ground: ~ '" feet
ratio Water'Level (from ground level): ~ feet
~umping level: ..... feet a~er he. pumping ........ gpm
ecover Rate: /~ gpm
e/hod of Testing: ~IA
~ell Intake Opening Type: ~End ~ Open Hole
~ Screened: Sta~_ feet S~eR~d , feet
~ Po,orations St~,~_._:_ ~J 'Stopped J ~ ~;
~epth: from ~ feet, to ~ feet
~ -
Cutup Intake Dept~: feet
~ump Size hp Brand Name
Well Disinfected Upon Completion? ~ ~ No
.
I\E~EI V EL/
NOV 2 5 1998
. Mtmiclp,q'ht~, o1: Ancnoraga.
...... F~,-, .... ~,~-, *~,",u.,m,our¥1ce8' '
Driller's Name
:'NTION: It I's the responsibility of the. property owner to submit a copy of the well Icg to tho pioPor authority, Municipality
6f Anchorage: O'epedment of Heel!h &'Human Services and/or Department of Environmental Conservation, MatSu Borough;
I~epartment of Environmental Conse~atlon.
i }
~ 'd ~U[-t,69-L06 -131 ISSO3 ~10_:1 HIFIOS p~:O'[ 86, ST 'n°N
5K/NICIPALITY OF ANCHOR_AGE
DEPARTICfl~NT OF HEALTH D_ND HU/VU%N SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHOR3kGE, D, LASKA 99519-6650
PAGE 1 OF
ON-SITE WELL /LND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW980163
DESIGN ENGINEER:S & S ENGINEERING
OWNER ND~E:JD~NKE JOSEPH F III &
OWNER ADDRESS:P.O. BOX 770567
EAGLE RIVER, ALASKA 99577
DATE ISSUED: 6/09/98
EXPIR3kTION DATE: 6/09/99
PARCEL ID:05066110
LEGAL DESCRIPTION:
MOUNTAIN VALLEY ESTATES $1 BLK 5 LT 7
LOT SIZE: 54430 (SQ. FT.)
~ER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 ~%TD 15.65 AblD THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) ;uND DRINKING WATER REGULATIONS (18P2kC80).
THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
D. BSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED ~kND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
1
SPECIAL PROVISIONS:
DATE:
ROBERT C. COWAN, P.E.
HEALTH AUTHOR)TY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SiTE PLANS
ROAD OESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
WAST E~NATER
DISPOSAL SYSTEM
DESIGN
June 4, 1998
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNIC1PALITYOFANCHORAGE
Depa~mentofHealth and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 7, Block 5, Mountain Valley Estates Subdivision
Request you issue a permit to install a septic system and well to serve the proposed
three bedroom house on the referenced property.
One test hole was excavated and a percolation test performed. The approximate
location of the test hole is located on the attached site plan.
At the time of excavation 11/18/97, water was not encountered in the test hole. After
grotmd water monitoring, the seasonal high ground water level was found at 8'.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas, or drainage patterns by the installation of the proposed septic system
There are no points of contamination within the proposed well radius that can be seen
on the attached site plan.
If you require additional information, please contact us.
Sincerely,
Robert C.' Cowan, P.E.
RCChng
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · -EAGLE RIVER, ALASKA 99577
1" = 40' DESIGN DESIGN
~ /~/ ~ /PROPOSED ~ ~ V
HO
HOUSE
0 I~1 o/l~
......-- -- --
. _ > -. >
~i~ MICHAEL 9RIVE
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
L,o'r
Township, Range,
Section:
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? """-'""-" p
SITE PLAN
Depth to Waler Altor '
Monitoring? '~' Date: ~'"/~ p/~j ~"
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE "~ (mlnutesnnch) PERC ROLE DIAMETER
TEST RUN BETWEEN ~ FT AND '~ FT
PERFORMED BY: 17034 I~a~_Je River Loop Road No. 20~, ' ~ CERTIFY 9'HAT 9'HIS TEST WAS PERFORMED IN
Eaole River, Alaska 99577 f~ /If lq ~,/
ACCORDANCE WITH AL'~ STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72~008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14-
15-
16-
17-
18-
19-
20-
COMMENTS ~,,(,'"'),~ ' ~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION 'TEST
~O¢~lO~ DATE PERFORMED:,. ' .11,.
Township, Range, Section:
C~ /%
WAS GROUND WATER 1
ENCOUNTERED?
S
IF YES, AT WHAT ~;:~i OL
DEPTH? p
~,1~ I~1~ ~. '/~.' ,~...1~.~/~E
Deplh lo Water After
Monitoring? '~' Date: I'Z-
Gross Net Depth to Net
Reading Oate Time Time Water Drop
PERCOLATION RATE __
TEST RUN BETWEEN __
I' ~ (m~nutes/~nch) PERC HOLE DIAMETER
2 FTAND 3 -FT
17034 Eagle River Loop Road No. 2041
PERFORMED BY:
E~ctle Rive]', Alaska 99577
ACCORDANCE WITH,~LL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
CERTIFY THAT THIS TEST WAS PERFORMED IN
c
72-008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
I
2
3
4
5
6
7
8
9
10
11
12
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14-
15-
16-
17
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19-
20-
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
,.,.." .,.~ .'..:? -
Township, Range, Section:
~ ~ ~,SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH? ~Y /
"7 ,~-
Oeplh to Wal~r Alter t
Monitoring? ~. ~ Dale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ]' '~ (m~nutes/inch) PERC HOLE DIAMETER
~_~/~. /~ TEST RUN BETWEEN FTAND -- FT
COMMENTS ~~-~l''~'ft/j' -- ~ ~ ~ ~
S & S ENGINEERING , ~ ' '
ACCOrDaNCE W~T~k~~8~ GU~g. UNES ~N ..~CT ON m~S OA~E. gATE: ¢ /~ /~ ~
72-008 (Rev. 4/85)
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. _O.~O -- ~, I- I O'
GENERAL INFORMATION
Complete legal description' L,,,"~
Location (site address or directions)
HAA# {.[~)1_~
Expiration Date:
Current Property owner(s),
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER oF BEDROOMS: ' ..~
e
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class.
. Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[~ Individual On-site ~
[] Individual Holding tank []
[] Community On-site I--]
[] Public Sewer []
The Municipality of Anchorage Development Services Depadment (DSD) Issues Cedificates of Health Authority
Approval (HAA) based only upon the representations .given in paragraph 4 by an indepehdent Professiohal civil
engineer registered in the State of Alaska. Cedificates 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.
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.ci.anchorage.ak.us
' (907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A..WELL DATA
Well type ~
Date completed
Total depth II 7 ft.
IfA, B, or C provide PWSID #
Sanitary seal (Y/N)
Cased to I I'7 ,fl.
FROM WELL LOG
""l lr ..
ft.
g.p.m.
Nib'ate 0,' I~1 mg./I.
Date of sample: ~'//~V/V
Date of test
Static water level ',~ g:, .
Well production I P.-.
:WATER SAMPLE RESULTS:
'.Coliform ~;~ colonies/100 mi.
Arsenic: I"I/A,- mg./l.
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
b '7 ft.
~ g.p.m..
in.
Other bacteria N ~ colonies/100 ml.i
Collected by: ~ S j~u.," k.l,~ ,
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material ..~r~;~
I
' Tank size Icv ~ gal. Number of Compartments
Foundation cleanout (Y/N) ._~ Depression over tank (Y/N)
Date of pumping Pumper
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
ABSORPTION FIELD DATA
Date installed I/o ~- ~1~ Soil rating
Length .'~ ~:)
Total depth ~ ft.
Date of adequacy test
Fluid depth in absorption field before test ,~-.... in.
Elapsed Time: '""/'min. Final fluid depth ~
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
(g'.p.d./fl2 or fl=/bdrm) I o ~,
ft. Width ~ fl.
Eft. absorption area ~'7 ~..ft= Monitoring tube .
P'/a~//Oq Results (Pass/Fail) "~
System type
Water added Z~ gal.
in. Absorption rate >=
Gravel below pipe ~ ft:
",/ Depression overfleld
For ~--~ bedrooms~
New depth
:
t.4~O' g.p.d.
ff yes, give date
· FROH : V~nDerM~mrLLC F~% NO. : ~07~94G234 Apr. 10 2E~34 E~:3OPM Pi
' SE~/AI1D & ASSOCIAIES L.~J~'D SLrRVEy~G 594 082~
! HEREBY CERTIFY .THAT I HAV~ SURVEYED TH~ S~, ~ .... "-~,~ o~-u~__.
FOLLOWING D~SCRIBED PROPERTY,
INDICAte. IT IS THE RES~.,m,-,~
~_~_~ERMINE THE ~IS~EECE
] .~~TS, COVENANTS, OR RESTRIC~O~ '"~ ~ .~ '"~ ...... ~,;.~
'VISION p~ .........
~Y DATA H~N BE US~ FOR ~N~n~l~u I
A~ .,~3IN~, OR FOR EST~L~HINS ~D-
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 F%MILY DWELLING
050-661-10 NAA # kl ~.'~,C~C>~
GENERAL INFORMATION
Complete legal description
Lot 7, Block 5, Mountain Valley Estates #1
Location (site address or directions)
Property owner~. :-_J°s_eph F. Janke III
Mailing addressPO Box 770567, Eaqle River, AK 99577
Lending agencyv-i.~-. Mnwt-g~g~,/Miah~l lc: C)l qv~=~- '
Day phone ,694=43~1
Day phone 6R9-6456
Mailing address16635 Centerfield Drive, Suite 103, Eagle River, AK 99577
Agent Target Realty/_Pete os~iek Day phone 694-2388
Address PO Box 774627, Eagle River, AK 99577
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
xxx
NOTE: If community well system, provide written confirmation from State ADEC attest- '
lng to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
XXX
Public sewer
If community wasteWater System~ provide written confirmation from State ADEC
attesting to the legalitY and status of system.
?2-025 (Rev. 1/91) Front MOA#2t
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.
S & $ ENGINEERING 6'¢1 ~ - ~-~ 7 ~
Name of Firm 17034 E,~ule 2:-iol- L~.~p ,~c.~,d ,";~,, 204 Phone
Address Eagle River, Alaska 99577
DHHS SIGNATURE
~/Approved for
Disapproved.
Conditional approval for
bedrooms.
.,,,.
~ ~,, ROBERT C. CCW/.H ¢ ~ ~
bedrooms, with the following stipulations:
Additional Comments
Date
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.
72~025|Rev. 1/91) Back MOA~21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICESF~rB
Environmental Services Division ¢~ur~C~PAU~¥ O~ AN,C, HO
825 L Street, Room 502° Anchorage, Alaska 99501° (rg~O§~T4~V~'~ES
Health Authority Approval Checklist
Z.-~/
LegatDescription:/-'°F '7 8~oc,< S' 1,~¢~.~r~,¢ V~'-L,~y ~' Parcell;D.: 05'0 r-(,61 "1~
A, WELL DATA
Well type ~°R ~'~/tT ~-
Log present (~/N)
Total depth
Sanitary seal {~/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed '?//G /'¢~ ~
Cased to ) I 7 Casing height (above ground)
Date of test
Static water level ~ ~'
Well production ~ ~
WATER SAMPLE RESULTS:
Coliform 0
Date of sample: '~ / ~' 6 / ~ ~
B, SEPTIC/HOLDING TANK DATA
Date installed i/ / ,~,/~ Tanksize
Foundation cleanout (_.~/N) ¥ ~/- J'
Date of Pumping P//"/ "-/'"~/ Pumper
FROM WELL LOG
g.p.m.
Nitrate O. 3 7
Collected by:
Wires properly protected
AT INSPECTION
g.p.m.
Other bacteria 0
,/0oo
Depression (Y/(~)~
S & S ENGINEERING
17034 Eagle River Loop ~oacl ~',!o. 204
Eagle River, Alaska 99577
Number of Compartments ~. Cleanouts ~/N). Y¢'J'
/,,, o High water alarm (Y~,~ A,, O
C. ABSORPTION FIELD DATA
Date installed ~ (/~' / ~ ~
f.
Length ~' 5. Width
Effective absorption area 3 '7
Date of adequacy test/'-//'~ -
Soil rating ~or fF/bdrm) I. ~ System type ~ ,~
,.C Gravel thickness below pipe ~ TOtal depth
7-
let Monitoring Tube present ~i~/N) ¥ ~.$ Depression over field (Y/~
Results (Pass/Fail) For
Fluid depth in absorption field before test (in.); ~~ .... gekwater-added (in.):
Fluid depth (in_~s~ Absorption rate = .g.p.d.
Peroxide t~s~ 2 months) (Y/N) If yes, give date
bedrooms
72-026 (Rev. 3/96)*
LIFT STATION
Date installed
Manhole/Access (Y/N)
Size in gallons
"P~ump off" level at*
High water alarm level at* ~ *Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
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 ~' ¢1 Property line L~ I Absorption field
Water main/service line /o 4-- Sudace water/drainage. /00 ~ Wells on adjacent lots
)0
/oo '~
I0
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
Building foundation ~¢'$- Water main/service line
~'- Driveway, parking/vehicle storage area
~ ~ ,'-' Wells on adjacent lots / 9 o
ENGINEER'S CERTIFICATION
.~ ~"'..~'~.~... ~- OF
I certify that l have determined thru field inspections and review of Municipal recor~t~...,~:~ ebo~e,8)c~ms are
in conformance with MO~ HAA g~elines~n effect on this date.
Signature ~-~, ~ ,'
/
HAA Fee $. C~L0 ¢2." ' Waiver Fee $.
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Date of Payment
Receipt Number