HomeMy WebLinkAboutOUR MOUNTAIN BLK 2 LT 6Our Mountain
Block 2
Lot 6
#051-111-60
Municipality of Anchorage
On -Si.- JVater and Wastewater Program • (907) 34_ /904.:i�e
ON-SITE
WASTEWATER
INSPECTION REPORT
APR 13 2018
Permit Number: OSP171116
PID Number: 051-111-60
Dwelling: ® Single Family (SF)
❑ Duplex (D)
❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade
Name:
BRETT & DONA LUNA
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
20607 Edward Circle, Chugiak, AK 99567
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
OUR MOUNTAIN
2 6
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range
Section
Gravel width
Ft.
Beds: Number of Lines
--
Distance between lines
-- Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Fe
--
-- Ft.
Well
100+
--
--
NA
_-
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1 1000 Gal.
Surface Water
100'+
--
--
NA
Material
Steel
Number of compartments
2
Lot Line
5'+
__
__
NA
NA
Foundation
10'+
-
--
NA
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
*NA
--
--
NA
Remarks *None known. New 1000 -gal S.T.
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Installed per code.
Pump make and model
Electrical Inspections performed by
Installer JRs - Flintstone
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Drainfield COIMT 3034
Inspector ARCTERRA
BENCHMARK (Assumed elevation) 100 ft
Inspdection 1" 6/19/17
2nd 10/31/17
Location and description
3`d
4°i
FF -Garage Slab
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engin
�- '%,
OF ALS \
Conditional Approval:
Date
j `��
�01 9 T H
KENNETH M. F S
/
Approved a6'J'1'
()
caJux
Date `(I 1
�cr
1 s� 71 � /
per/
SSi
eer's Stam
IIMPULuun MUPun_a- i - IZ.aoc
a
AS -BUILT SYSTEM DETAILS/SITE PLAN
Permit ❑SP171116
OUR MOUNTAIN
LOT 6 BL 2
PID# 051-111-60
s ss
O B C-24.0'
0'
13.6' (/)
'OA—D=21.0'
v o
O"�
u u Uu U FINAL GRADE
B—D=28.0'
v
�
4 0, ��
0-)
�
VARIES
VI
J
A
GAL
1000 -CAL
O
m
SEPTIC
m
TANK EXISTING FIELD
a
LD
I.
I
97.4
97.2
A
2 8 0.
FCO
43.7'
6 D
C
CO B
p COS
^ry
CO___NEW 1000 -GAL S.T.
L 0 T 6 �c0
B LK 2
AI.
�
3
v
%
O
m
Q
rn
0
O
SCALE: 1'
= 30'
a
lU4,lU
103.7
m A—C=16.5'
o�
s ss
O B C-24.0'
N a
� W
q
J J JJ J
'OA—D=21.0'
O"�
u u Uu U FINAL GRADE
B—D=28.0'
o
�
VARIES
VI
J
A
GAL
1000 -CAL
T
SEPTIC
m
TANK EXISTING FIELD
a
LD
I.
I
97.4
97.2
'��°F�®1
Al 1
KENNETH D US /
CE -7116 00
e
A S�,.S/OVA�' O
PREPARED FOR:
BRETT & D❑NA LUNA
20607 EDWARD CIRCLE
CHUGIAK, AK 99567
FIELD BOOKS
BOUNDARY: N /A
STAKING: NSTAKING: N/AA
ASBUILT: SLS
DWG. FILE
AGAD FILE` FILE
COMPUTED:
DRAWN: BMW
CHECKED: KMD
DATE-- 11- 11 /
GRID: NW13E
JOB No.: 17059
BCH
SCALE: NTS
IN
l MAMMA A
I EDWARD
ANCHORAGE RECORDING DISTRICT, ALASKA
ASBUILT OF:
OUR MOUNTAIN SUBDIVISION
LOT 2 BLOCK 2 PLAT 76-311
SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: 16NM SCAB E-MAiU
OCT 31, 2017 1"=40'
17-059 DRAM BY: CHEOKM BY GRK) NUM OL BOOK ACE
JLS NW1361 170202
O = FND REBAR
0 F
? 49TH
C
CD '.J L. SCHULLER:' 0
LS-10408
LOA
�i10
\` fessionot CP
�''
\ LOT 4
LOT 5
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
MUNICIPALITY OF ANCHORAGE
tits r n r
On-Site Water&Wastewater Program `S;�
PO Box 196650 4700 Elmore Road f .
4 Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r,
http://www.muni.org/onsite L �
l)cpartntunt
On-Site Wastewater Disposal System Permit
Permit Number: OSP171116 Effective Date: 6/2/2017
Work Type: SepticTank Upgrade Expiration Date: 6/2/2018
Tax Code Number: 05111160000
Site Legal Address: OUR MOUNTAIN BLK 2 LT 6 G:1361
Site Mailing Address: 20607 EDWARD CIR, Chugiak
Owner: LUNA BRETT M & DONA D Lot Size in Sq Ft: 44974
Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
/
Received By: / �/
Date: (((
Issued By: Date: .7// 7
MUNICIPALITY OF ANCHORAGE
it
Community Development Department Phone: 907-343-7904
Development Services Division `-' Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-111-60
Property owner(s) BRETT & DONA LUNA 227-5349
Day phone
Mailing address 20607 EDWARD CIR., CHUGIAK, AK 99567
Site address 20607 EDWARD CIR., CHUGIAK, AK 99567
Legal description (Sub'd., Block& Lot) OUR MOUNTAIN BLOCK 2, LOT 6
Legal description (Township, Range & Section)
Lot Size 44974 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑ Initial ❑
Single Family (SF)
(w/wo ADU)
Septic Tank [ Upgrade Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature o .prb rty owner or authorized agent)
00
P It/Rush Fees: Waiver Fees:
Date of Payment: 6-1- I`� Date of Payment:
Receipt Number: D ( `W7-(L Receipt Number:
Permit No. OSS ` 11-11)
1- 11) (Q Waiver No.
Permit App_9-1-12.doc
p cTE/
•'� ARC ,ERRA
,
• - CONSULTING, INC
mb 0 . 212 E. 51st Ave,Anchorage,AK.99503
Office(907)868-3791, Fax(907)868-3793
June 1, 2017
Municipality of Anchorage
Development Services Department
On-Site Water& Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Septic Tank Upgrade Permit- Our Mountain Block 2, Lot 6
The owner has requested we proceed forward to obtain a septic permit to
upgrade the failed septic tank.
We propose to decommission the existing 1000-gallon septic tank per code and
install a new 1000-gallon tank in the same location to serve the existing 3-
bedroom house.
The adjacent lots are served by private water. There is no surface water within
100' of the proposed tank. We do not expect there to be any adverse effect on
adjacent lots by the development of this tank. If you have any questions, please
contact me at 868-3791 / FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
en 4) . Western
O • •is Representative
Attachments: On-Site Sewer Application
20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793
MUNICU'ALIT(OFANCHORAGE
‘;--7'f. DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION
1 f ENVIRONMENTAL ENGINEERING DIVISION
\\ 826 L Street-Anchorage,Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME , PHONE/S7 1NEW
!/V'L
(3-1.r G S " L ,r✓i �
e.s 0�-f'7_ 6,9T - 271I 0 UPGRADE
MAILING ADDRESS1 C:'
/ " � YIdilf,L___41.j 5f sre a /�-6vC eee 51J '
LEGAL DESCRIPTION i!
LOCATION �0 —1�— , / 141 NO.OF BEDROOMS 3
Well `` Absorptions=/ t Dwelling PE �IT N 7J�
DISTANCE TO: NI by (� N,oi 11,4 t.,J z,S 1"
U
2 Manufacturer /fi -a. Mtp L No.of compartments z.
a 1.
F
y Liqiicaacity in gallons IF HOMEMADE: Inside length Width Liquid depth
a yDISTANCE TO: Well f Dwelling PERMIT NO.
-J02 IY_
02 4 Manufacturer Material Liquid capacity in gallons
I 0 Well F undation Nearest lot line PERMIT NO.
w= DISTANCE TO: k
ui u.Z No.of lines Length of each lineal length of lines Trench width Distance between lines
I-2 ta inches
�a H Top of tile to finish grade aerial beneath tile Total effective absorption area
0 inches
Length 1 Width / i // PER 7
pkt)c
wType of crib Crib diameter Crib4epU Total effective absorption area("3��
ur
,,,) DISTANCE TO Well Buil mg found ion Nearest lot line ( St[,
rJ crt— i hl l O I {�
Class A Y D D ill r Distance to lot line PERMIT NO.
- r` x I STI t''.(
$ DISTANCE TO: Building foundation Sewer line Septic tank Absorption weals)
OTHER '
PIPE MATERIALSIDD1__ — SOTTO SCA-I- . N
lr'
SOI L TEST RATING I ~i t We-64._ ye rr.
/am i2a
— A..--' 5 -Ne— 'ILL,...)
4, I.
2017 SEPTIC TANK UPGRADE: — s' i' a _ 1 c.T.
Li Decommission existing septic tank per -- -- • Ai?
J
code& install new 1000-gallon septic ri - 1 S at _ _
tank and two post-tank cleanouts per ��� le
C 6 , ; B�
,
code, maintaining 5'+ from foundation & , "
existing field, 100'+ from wells and --- 11---76_____ 4- SMC.. PIP ,
surface water and 10' + from water line. '(`
APPROVEDS C4 : I;.,IyS,`; Ni`Ily, DATE LEGA /
'el AC
'?1. % ,.,.f` % A'''te/// 6.I ti Ar-/
J UL.C.G.GKXJ4 J•.7Jr11 r'�:t .. rr.ur i t . any�v.•�+*•;C. r'.GAG
•
e
e
l • .Ye . 1
• A .1 .
,y 1e C
' 1/ �O i ' ,
n
. to ;
• f .0 ► t
‹- .7 •* i
I! h-i.y
}
1
1F14
514r i; -e• ,,,... •
/,7,�
041.-1.-:k$ •;;....4_,.....0' .c
• .
I
'
, 17,49 E-X I S'I'Viii t—
I /oov- 0142 g.1-
a
// NOTES j •
. �`; 1. No wells on subject or adjoining
lots are within 100' of proposed
tank placement.
2. No surface water noted within
100' of proposed tank placement.
As- U1Lr
• a4a1. 1 hcraby certify that r have suiveyad !ha following described
p ty; 407-• 6 , €'• ' .k .2....
. .� �'► t arse Recording cinct..11ladca, and that tat h1
merits Moat►tl thaeaan ant wltflst the wiping lines and dha not
''. overlap or Ines;%on Melanin/Ito scent thcrolu,that
'
7rt' ' sF.�'•oy• ta onp thereto encroach
74 • • � rat t1� L q4q � and at nnroadways,
• rtragi sW or V1Mbkaasemrrks on said propurty
4 a
. .
•
t�af4d of Ex*RIvc kI*1 ca
,.l ,, this. - . day of~�� 10MNSON �!►
.. ..7•.:.,- 1 t•r' . Registered Land Striveyor obi -111(14.S
l. ~ Sow
79 ho RivQr,Masks 99577
1
MUNICiPALIT, 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
o
PHONE
�KNEVV
❑ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTIONf �}/,/ W y -',r /
_
LOCATION /�ryry _`_ J %
NO. OF BEDROOMS
DISTANCE TO:
WellAbsorptionprpa
Nee- �/q
,�
Dwelling
-r I �,
PEF2'TN
,.� L L��4 (
CL Q
Manufacturer
�`�
M ra,.
No. of compartments
2
w -
l C=AL
N
Liq'cap city in gallons
00
1 IF HOMEMADE:
Inside length
Width —
Liquid depth
°
DISTANCE TO:
Well /� (
DwelI!rig
PERMIT NO.
�z
2 FManufacturer
Material
Liquid capacity in gallons
O
DISTANCE TO:
Well
�.
F undation
Nearest lot line
PERMIT NO. 4®
w =
LU u 2
No. of lines
Length of each line
r tal length of lines
Trench width
Distance between lines
� 2 W
inches
¢ a
Top of tile to finish grade
aerial beneath tile
Total effective absorption area
B
inches
Lu
Length /
Width /
Qq tt //
PER T
41
u1
Type of crib
Crib diameter
Crib,t�,ep.tLt�-�
Total effective absorption
area�.3 Q�
N i[JLJ�
DISTANCE TO:
Well
Building foundation
�-- I h,f,
Nearest lot line
L�-('� l
^LU,•�{L(
—
a
Class
D
Drill r
Distance to lot line
PERMIT N0. "
J
1
w
�
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area (s)
OTHER
PIPE MATERIALS
SOIL TEST RATTIN�G►
per,
l `/1`o
INSTALLER
C
REMARKS
k(C
L
a [
i
(./--,) lig c. F F" ISL t-
_
I .r
- JY3, ( 4 t
! -
�
--
t
K; ¢i,"
/6
APPROVED _ rr,l t '""fl'.t DATE LEGAL/
i'1A��InP.'.. 1�I Wt t"1� � LL `�✓ r
_
L'
WATER WELL RECORD
\_ STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological D Geophysicol Surveys
Drilling Permit No.
LOCATION OF WELL
(Please complete either to, Ib or Ic.) A.D.L. No.
Io. Borough Suyb,�dirlsi.(onG Lot block Ib. t/4 qtrs. Section No. TownshlpN❑ Range E6 Meridian 21 Rang
U'YU LC IL
V� —of" of _of� S❑ WO
Ic. 019 TA NG£ AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: l�RYr
a y — cC
y
Al �7 — LJ OCA
Street Address and Ana of Well Location
Address: - MY -e -r -s -4-'o n-s-tr-urt1 on
Chugiak, Ake
2. WELL LOG
Material Type
Feet Below
Surface
Bottomp,
WEL�H:
5. AT_E OF CMpLET,I0_N8
4op
6. 0 Cable loo( MRotary E3Driven® Dug
® Auger Jetted ❑ Bored p Other:
7. USM Domestic [3 Public Supply ❑ Industry
Irrigation 0 Recharge Cl Commerical
seer Well
p p Other:
rave, sore , s
Grave , si1t, -w--a-Fe-r---53----5-7—
Gravel and clay 57 77
_ Gravel,
clay—,'—s1-1T---77---85-
6. CASING: Threaded �Xrelded
diam.6 in.�35 ft. Depth W4101 1bs./ft.
dlom. In. to ft. Depth Stickup _It.
-
Silt clay
y y 85 95
Silty clay 98 108
C ay,
graveZ—
9. FINISH OF WELL:
Type: _ Dlomefer
Slot/Me.h Size:—__ Length:
between ft. and f1.
Backfilling Gravel pack
_ Clay, silt9—gr—ave-1--i —24 128.
'—^CIay,
graved
-----'--Set
Si1t, gravel; water =-7-35
of. Heal.
16. WATER WELL CONTRACTORS CERTIFICATION:
10. STATIC WATER LEVEL: ft. _ z �
0 Above or 0 Be:ow land surface Date
Equipment used:
II . PUMPING LEVEL below land surface and YIELD
ft, after hre. pumping g.p.m.
ft. offer Me. pumping q. p.m.
12.GROUTING Well Grouted: 0 Yea ❑ No
Material: C3 N.or Cement O Other:
13. PUMP: (if available) HP N
Length of Drop Pipe ff. capacity q•p.m.
® r
JetSubm. � J� Centrlfical Other n
14. REMARKS: Production of 7 GPM 2
0
15. Water Temptroture .__a D.F
This well was drilled under my Jurisdiction and this report Is true to The best of my knowledge and bellsf;
Magnuson Drilling AA 5385
Registered Business Naere ` �—
Conlrotf License Number
Address:_ P.O. Box 770504 Eagle River. Ak. D(4l,77
Signed:
Authorized Reprnt alive
!FOrm 02'WWR (11/61) _-- _ COPY Distribution:
Date:_ May -3'
5.39�5� cc
E'3 tale DGGS, PINK •Driller, CANARY• Customer
P
C
Pl N_9 L'-4 11 A .-. 1: IF I L_- I _L_ 4ir' A::A F` F-=1 L'-4 #:` H �_ a:R* "- � I'
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ECTION �
825 L STREET, ANCHiDRAaE, AF•:: 995,01.
264-4720
A A L 6 I 'TE-: 7E. IIS.' I ,..5 F—;�' L -" -!%. 14 E: L.._. L.... F-^ [-. F.," r^1 I -
PERMIT NO:
,x.4.0450
DATE I:,E,!_!ED:
06r,'12/84
APPLICANT:
C:,:'O S 8.. S ENG ` G.
is I EBS-MYER,.' CONSTR.
ADDRESS: � :
SRE: 196X
EAGLE RIVER: AK
99577
CONTACT PHONE:
9
694-2979
LEGAL CSESC:RIP:
L!BDIVISION: OUR
MOUNTAIN LOT: 6
SECTION: 10
TOWNSHIP: 151N RANGE: IW
LOT SIZE:
44974 ( G!. FT. OR
ACRES)
LCAT LOCATION:
EDWARD C:I ROLE
MAX BEDROOMS: :
L_ I =:TEE::+ BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DE''::E GN I NF3 YOUR
SYSTEM. CHOOSE SE THE OPTION THAT BEST FITS 'r'tJUR SITE.
E?�' EE [>
DEPTH TO PIPE BOTTOM (FT.) ". b
'�r ++.
GRAEL. DEPTH (FT. 5
TOTAL DEPTH (FT.) 4. 0
GRAVEL. WIDTH (FT. ) 1.9. 0
GRAVEL LENGTH <FT. 36.0
GRAVEL VOLUME ( CL!, YDS. ) 25. _
TANK' SIZE (GAL ) 1, 000. &_i >Y•:+:
;OIL RATING (SQ. FT.: BR) J.51=D
DEPTH TO F'IF'E BOTTOM •': 4. 0 FT. MAY REL-.,UIRE A LIFT STATION
TANK MUST HAVE AT LEAST TEdO COMPARTMENTS
SEPT 10
I CERTIFY THAT:
1. I AM FAMILIAR WITH THE REQUIREMENTS FOR. ON-SITE SEWERS AND WELLS A: , SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE ( MOA) AND THE STATE OF' ALA'=XA.
2. I WILL Itdm.TALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REG!_!LATION'mi,
AND IN COMPLIANCE 1.••EITH THE DE=IGN CRITERIA OF' THIS PERMIT.
I WILL ADHERE TO ALL MOA AND STATE OF ALAN (A REQUIREMENT FOR THE ET I,AC:F
DISTANCES FROM ANY EXI:=TING WELL., WASTEWATER DISPOSAL :SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
4. 1 UNDERSTAND THAT THIS PERMIT I' � VALID FOR A MAS; I MUM OF :3 BEDROOMS AND
ANY ENLARGEMENT 14I LL REQUIRE AN ADDITIONAL. PERMIT.
IF, A LIFT STATION IS INSTALLED IN AN AREA COVERED BY rflOA BUILDING CODES.,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS --BUILT:=
WILL NOT BE APPRO'1 -b ,1I THou-r AN ELECTRICAL I N PELT I O1,4 REPORT.; ; AND () THE
EL.ECTR.T. C:AL WORK MUST ;' -Q�ly 1157' A LICENSED ELEC:TRICIAN.
=•IGNEL:
DATE:
ITE
APPLICANT: C.S, _ ENG' G. G I BBS-M',•'ERS CONSTR.
ISSUED BY � � �— � DATE:
SOILS LOG
MUNICIPALITY OF ANCHORAGE
• A.� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
a
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: 6/ uJ S -- / �G �/° K; T DATE PERFORMED:
L-EGAL. DESCRIPTION: ' -' Z� 01� le 14 %_/l} -� IjQ
1 i [FlEI) 11
2
`;
Gross
Time
17
l�
-o d m ati,Ft
O
�+
3
4
6
ClD
7
OC
8
9
r �f?
10
I: D-�-Oc IL-
11
12
13
14
15
16
Date
Gross
Time
17
Depth to
Water
-o d m ati,Ft
�+
18-
8
19
19
SLOPE
a
x
SITE PLAN
t
WAS GROUND WATERS
ENCOUNTERED?
S
ENCOUNTERED?L
O U
P
IF YES, AT WHAT -- E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
20 c
�: Mce. !.57-a .•' y .'PERCOLATION RATE_— (minutes/inch)
TEST RUN BETWEEN .� FT AND ®.— FT
72-008 (6/79)
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
CERTIFICATE OF HEALTH
04�W
AUTHORITY APPROVAL
I FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-111-60
1. GENERAL INFORMATION
HAA#OW 03SI
Expiration Date: 11 — 16
Complete legal description OUR MOUNTAIN SUBDIVISION; LOT i BLOCK X a -
Location (site address or directions) 20607 EDWARD CIRCLE * CHUGIAK AK 99567
Current Property owner(s) JON MENOUGH Day phone (AGENT) 243-4210
Mailing address 2525 "C" STREET * ANCHORAGE AK 99503 (CO AGENT)
Lending agency Day phone
Mailing address
Real Estate Agent KATHERINE HERFlNDAHL W/ COLDWELL BANKER Day phone 243-4210
Mailing address 2525 "C" STREET * ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
E
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
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 samples. (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 effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
337-6179
Date ¢ o 0
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA P ! OF 1��4
DSD Guidelines & Regulations. The reported results described the performance of the �v .. • "" . _
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and a j •."9*�QO
septic systems depend on the local soils condition, groundwater levels that may • • : ..... ..:....0
fluctuate during the year, and the water usage of the family being served by the system. 0
These conditions are outside the control of the evaluator of the system. Satisfactory test ... . . .. ... ......
results do not guarantee future performance of the system, nor do they guarantee that J G rn e is,
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide QO o E 79 o`p�
any warranty or future estimate of how long the system will continue to meet the �4 s AcoO
operational requirements of the ADEC or MOA DSD. The content of this report is for e y Eo
- the sole benefit of the owner listed above. Any reliance upon or use of this report byanyOQ4 ro essloc"
other person or party is not authorized; nor will it confer any legal right whatsoever.
4opoo 0
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fllowing stipulations:
OF AN
�:• 9N-SITm
�� • WATER AND
--;-d'Nti�T€WATER
• PROGRAM
Attachments:
HAA Checklist [/ Manitenance Agreements J'J/�/ft N i SE�`��� \
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory �v7 Other
By:i , ��fJ • v Original Certificate Date:
(Rev. 12101)
IVIUtl[L/IIJQIILy VIAIIYIIV�—W-
e" v✓yr <
.. .
Develbpmenf $erviFes Department -„..._
a r tir
� Building Safety Division
,
On -Site, Water &,Wastewater Program
Soutfi
ox 9a chor e J� 9959 6650
' �W"�`i.anc�`orage ak us
aeinsa e 6 15 198
ucary seal tnrv� r r , r
OEM-- 1 ft. Casing heigi (Bove gi�oun 12+ In
^* ---
L w
2 226 2l70d
rp—
fi
I/2if04 Y result$ (Pass(Fall) rAoa roi �ouiy i
e ore es._ -. 1 In a eAF d a *�al ew ed p � 6231n. .
"Erna Iw eot .In. %sorO 10 e >-
UaTe or'_ample.
aeinsa e 6 15 198
0 Rig Vat r,p IN
t
Depression over,, an
arm
.. � +B LOW IX STING 'GRADE
”:
�
� E
'
1$'
1984 'Soil rafiri ' p. .lft o-
Ibdrm 14
Sys("em fype"
8VVed pipe`°fig
"
- I
elow
_ ft
I/2if04 Y result$ (Pass(Fall) rAoa roi �ouiy i
e ore es._ -. 1 In a eAF d a *�al ew ed p � 6231n. .
"Erna Iw eot .In. %sorO 10 e >-
l'J
Pump off` a ------n. High water alarm level at
Cycles tested Meets alarm & circuit renuir
On
t
tank
)ections and 4 _
T
ms are in :...
on this date
hY .. 4 {LSnWvt.+T s`t r • ... e .. ..... .......
Waiver Fee $
Date of Payment _.._ ....
•'rt ai f .� �'
I
JUL. GL GGYJ4 0. 0JrI'I r um l ullL rmur LM I IGD ^• 1,j�y�\V . 44G r. GA G
• P � 1 r:
f i
�, ir♦Tn„ ,
' sews-� r 2. � •��s.;,��
o I
0
N•
,
, .y"d4 •l. ,r..q • J
As- UlLT
��'�'�� 1 hemby gerlVy Ih+N T hava�auhrryud the fallowing deaerdwd
. m ,
Anehataee Itsmidhn Nndnd.Alaska, and that tit hnpwvr
mous aheatatl thataat aro within the property lines and do not
ovedopp or month an th* properly lying ad -cent thumta, that
Ito Imtttovemnds an P krty tyln ad`ttont lhomm on meh
WAYMMW1011 i�igt oin f aH&o VIAIW isummti an and pprupoHy
on%" a ladi acrd hehon.
Dated of as,
Sk Riva, Altar
R
sGldoy of Rab Tx. joyNSpN 1 �' Het
tared Land .
7" •rf-fJ W 774416, Bralo River, Alaska 9W?
69F�.
i
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services Ak
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING 1 ��
Parcel I. D. # hJ'�) i — 1 \ \ - ln(-) HAA # �� ��U• � —1
1. GENERAL INFORMATION
Complete legal description Lot 6; BEock 2; Oun Mountain Subdiv,i6,ion
Location (site address or directions)
20607 Edwand C.incte
Property owner Tom Woodward Day phone 561-2220
Mailing address I 20607 Edwand C.incte Eaqte Riven AK 99577 _
Lending agency _ Day phone
Mailing address_
Agent Vickie Botdgett Day phone 561-2220 _
Address 341 W. Tudor Road, Suite 103 AnchoiLage, AK 99503 _
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3 �
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site _XXX
Holding tank
Community on-site --
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1191) Front MOA #21
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
17034 Eagle
Address
Engineer's signature
6. DHHS SIGNATURE
1� Approved for � �Z �� bedrooms.
Disapproved.
Conditional approval for
Additional Comments
am
Phone 6?' -297 9
Date
10
Yr T
R.On¢n
bedrooms, with the following stipulations:
By: ,U �� t..` (k�y� a �e & — Date
UlTir
-Z-��-9✓ _
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(Rov.1/91) Back MOA4121
Municipality of Anchorage
Department of Health and Human Services 04
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: "-r lv &L�--2 boo- yrs Shu _Parcel I.D.
A. Well Data
Well type If A, B, or C, attach ADEC letter. ADEC water system number_ A
Log present ®/N) U Date completed `��'31 8 $ Driller o
Total depth 13s` Cased to 13�t Casing height 122
Sanitary seal ('N) `+ Wires properly protected(PYN)
Date of test
Static water level
Well flow
Pump levell
FROM WELL LOG
S--Z�\—`6+
iL
C> g.p.m.
SEPARATION DISTANCES FROM WELL TO
AT INSPECTION
_1 — 1 �> —C13
Septic/holding tank on lot \1 o t ; On adjacent lots .
Absorption field on lot \�� ` ; On adjacent lots
l
Public sewer main nr Public sewer manhole/cleanout
Sewer service line
ZS � �-
WATER SAMPLE RESULTS:
Coliform D Nitrate
Date of sample:
-C-' l z -9 3
B. SEPTIC/HOLDING TANK DATA
Petroleum tank
a-
> , Other bacteria O
S & S ENGINEERING
Collected by: 117 ;p4zaad-No,204 _
Eagle River, Alaska 99577
Date installed v ' h - g 4 Tank size Compartments
Cleanouts QYN) Foundation cleanout O/N) _��-Depression (Ydbl�
High water alarm (yo) v ` _Alarm tested (Y/N)
\
Date of pumping 1 cl' _Pumper 5 aY _0 M Pf (� 5
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot \ � O On ad'1acent lots l —0
To property line I
Surface water/drainage
Absorption field _
Foundation !D t 4-
S_ Water main/service line / o
72-026(3/93)' Front CONTINUED ON BACK PAGE
m
Z
e
n
m y
M
C
r a
in C
im
l ori
a-
> , Other bacteria O
S & S ENGINEERING
Collected by: 117 ;p4zaad-No,204 _
Eagle River, Alaska 99577
Date installed v ' h - g 4 Tank size Compartments
Cleanouts QYN) Foundation cleanout O/N) _��-Depression (Ydbl�
High water alarm (yo) v ` _Alarm tested (Y/N)
\
Date of pumping 1 cl' _Pumper 5 aY _0 M Pf (� 5
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot \ � O On ad'1acent lots l —0
To property line I
Surface water/drainage
Absorption field _
Foundation !D t 4-
S_ Water main/service line / o
72-026(3/93)' Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed _
Size in gallons_
Vent(Y/N)
High water alar
MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
Manufacturer
"Pump off" Level at
Cycles tested
----Surface water
Date installed Cp t S - (2:, Soil rating (GPD/Ft2) 14-0 �_ ( f?. g_ System type
Length 4S Width /4 Gravel thickness Total depth
Total absorption area O � Cleanout present O/N) Depression over field (Ya
Date of adequacy test - OP -4_13 Result pa /fail) ePA ,is for 3 Bedrooms
Water level in absorption field before test C After test p /
Peroxide treatment (past 12 months) (Y(9 k- D Nt6_ iL/d G If yes, give date ^L�a
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /-),o I On adjacent lots
To building foundation /°
On adjacent lots 3 D Cutbank
Surface water /0 o Drivew
I
Curtain drain ' A
E. ENGINEER'S CERTIFICATION
o b Property line
To existing or abandoned system on lot _
I! A- Water main/service line
, parking/vehicle storage area
�-
Sa r
I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on, th62ihte'of, this inspection.
r
i VF
Signature
NEERING
Enginee s0 4p
i{
Alasks99'377 -� 1A,,3 -E
Date
s i
HAA Fee $ !70 Waiver Fee $
Date of Payment 7-1[o _9- 3 Date of Payment
Receipt Number cl`�p� �/� Receipt Number
72-026 (3/93)' Back
O'7i1E✓93 09:43 CT&E ENUIRONI•IENTAL LAS S
ERVICES N0. 719 pr
y
COMMERCIAL TESTI �'lb'G►I�VL'ERI�V CO. R' DT
CHEMICAL & <'E LOGICAL LABORATORY
�+wX.toar TELE HONE (947) se.?,443, S6L;3 8 5truet
t I Anchorage. AL"ks 995!8
s
orinking Water knalysis Report for Total Coliforms BacteMa
TO BE 001VIpLETED BY WATER SUPPLIER
❑ PUBLIC WATER SYSTEM I.D.
19r PRIVATE WATER SYSTEM
RNQINERRING
u-aia,9 Mftm —1-
86910 RIYer, Aloka 99s"
Cly—.._..."_-- -�-�— - -_............W sow---•----
ik; cocv
SAMPLE DATV: IDIT L_.LJ.�-1
Mo. bay Year
SAMPLE TYPE:
0 --Routine
Rasun' Analyst
❑ Check $ampio (for routine sarnpie
With lab rtf. no.�_6�
Special Purpose
Q Treated Water
❑
Untreated Water
SAMPLE
No. LOCATION
Tlmo Collected
oaftected By
31
I
a
READ INSTRUCTIONS
13EFOAE
COLLECTING SAMPLE
TO BE COMPLETED By LASORATOR`
Analysis shows this Water SAMPLE to be:
atiafactory
n Unsatisfactory
C] Sample too kang in tjansil; sample should
not be over 34 hours old at examination
to indicate reliable 0$uhs. Please send
new sample via spial delivery mail.
Vale Received
Time Received
Analytical Method: M40mbrane Filter
' No. of cc4aniesi100 ml.
Lab Ref. No.
Rasun' Analyst
BACTERIOLOGICAL. WATER ANALYSIS RECORD
Membrane f=itter; parort Count collfami/100 ml
Verifiuilon: L39 BGS
�_-_----
Pecal Conform COrinrmaU4n
Final Membrane Filter Results / e plltprinript) ml
Aspersed By .�/�) c�l`^ Date �`t"f,�>
TNTC _ Ton Numerous To Count.,
OB a Other Bacteria R�►RT aME``OF TWO
1
4$%%'ca—me'Ar—ft REMAINC11C=I? Th Cnt r ni.,.
COMM11RCIAL TESTING & ENCIINEFIAING CO.
ENVIRONMENTAL LABORATORY SERVICES
REPORT of ANALYSIS
5633 E STREET
Chemlab Rei. :93.3365 3 AN(;HQRArt, AK 99bW
Client Sample SD :L6 B2 OUR MOUNTAIN TEL: (907) 662-2343
Matrix 7WATE'R FAX (907)501:5301
Client Name :Sa & S ENGINEERING
Ordered By :RAY
Project Name
Project#
PWSID :UA
Sample Remarks: ROUTINE SAMPLE. COLLECTED BY: RAY.
QC
Parameter Results Qual Units
--------_-__--____------...-------------- _L_..m
Nitrate -N 0110 !U my/[.
WORK Order :68269
Report Completed :07%16/93
Collected :07/12/93 @ 11:40 hrs
Received :07/13/93 @ 17:00 hrs
'T'echnical Director., St EDEA
'Released By L, `_ '-.
Allowable Ext., Anal
Method Limits Date Bate Init
----------------------
EPA
--------------- _EPA 353.2/300.0 10 07/15 LLH
1 (_
see^ specialinstructions Abovev UA = Unavailable.
** See Sample Remarks Above NA = Not Analyzed
U Undetected, Reported value is the practical quantification limit. LT = Less Than
D Secondary dilution. GT = Greater Than
.0 =rjB Member of the SGS Group (Soo,616 GI)n6ra!e de Surveillance)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO. UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL 11PALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE_
Application Date
-L /r�' j
r ____
1. General Information
(a) Legal Description (include lot, block, subdivision, section, Wnship, range)
Location
(address or directions)
(b) Applicants Name /?j�._!l�S/v�l"ele�nlione Home _ Bus nes'
Applicants Address
(c) Applicant is (check one) Lending Institution �^ ; Oemer/builder',
Buyer Other F-�l (explain);
(d) Lending Institution
Address
(e) Real Estate Co. & Agent
Addi':ess
Telephone
(f) Mail the HAA to the following address:
f�
2. ..lam._.—T e of__.�Residence
Single -Family rH-7�
Number of Bedrooms
3. Water Suppl—.Y
Individual Well -,1-4
Multi -Family IT
7
Community
Ty _� Tel.ephone�_�,.__a.__r__...-_.
Other (describe
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 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 I of 21
5. Engineering Firm Providing Inspections, Tests, File Searches 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 regula-
tions in effect on the date of this inspection.
Name of firm Telephone
AddressMix
Av{ ;,A g,J/� (rr� •/ ee .J�
Date
foe 5,
_. ....�... _ 0 +l
•i9 BB ' b
F
(ENGINEER SEA.I •' < •^94 40 f
�f
No.
5 C5
6. DHEP Approval iQe�FC)p °'�._�,°° hCv
Approved for bedrooms By �//�Cttt--tctU .ta r
Approved !� Disapproved Conditional =�A
Terms of Conditional Approval
a�,�-�,�"=-t/�.
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 REQUIRE-
MENTS. 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.
(DHEP SEAL)
RR4/ej/D18
(Page 2 of 21 7-1.9--84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
A. WELL DATA
MUNICIPALITY OF ANCHORAOr
DEPT. OF HEALI'f 1 &
ENVIRONMENTAL PROTECTION
'AUG 1 ';19 11
RECEIVED
Well Classification s , If A, B, or Cr D.E.C. App oved(Y/N)
Well Log Present hyN!— Date Completed � S-3 I t� Yield ?XV
Total DeptL,. Cased to / � Depth of Grouting,®
Static Water' Level Pump Set At
Casing Height Above Ground tl Sanitary Seal on Casing ])�
Electrical Wiring in Conduit�YY N) Depression Around TAbllhead (Y )_
Separation'Distances from Wbll:
To Septic/Habik ig Tank on Lot ,Lf o ; On
To Nearest Edge of Absorption.Field on t ZC? i ;
To Nearest Public Sewer 4ge .y 14 - To
Cleanout/Manhole`
Water Sample Collected By S,5n fig;
Water Sample Test Resullt8-1.
Care
B. SEPTIC/H&N3ER C -TANK DATA
Date Installed Size
Standpipes 1%N) Air -tigh
Adjoining Lots
On Adjoining Lots ell'T1L�
Nearest Public Sewer
Nearest Sewer Service Line on Lot GM T
Date__g i
is 17
/ (J7y No. of Ccapartments
2_
t
Caps �6N) Foundation Cleanout QN )
Depression over Tank (� Date Last P dZs��
Pumping/Maintenance Contract on File (Y ) A ; for
Holding Tank High -Water Alarm (YM) �A Temporary Holding Tank Permit (Y/N)
Separation Distances Ffrom Septic/g ' Tank:
i i�.
To Water -Supply �11 _ lid To Building Foundation 2,n
To Property Line _ �% To Disposal Field
To Water Main/Service Line IA14 To Stream, Pond, Lake, c>r Major Drainage
Course 'y X - --
Comments
�-0 C
(Page ]. of 21
2m15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design dr-;�
Date Installed /S Length of Field
Width of Field J 7 Depth of Field
Gravel Bed Thickness & q DNea (JNOC,2
Square Feet of Absorption Area �.�2� Standpipes Present d-�)
Depression over Field (Y—AO
Date of Last Adequacy Test 211 C�
Results of Last Adequacy `lest ~J �
Separation Distance from Absorption Field: ! 1
To Water -Supply Well 7-Q To Property Line
To Building Fo ndation 130 — To Existing or Abandoned System cn
Lot �� On, A/,joining Lots 3D
To Water Main/Service Line To CutbapK(if present) _fid
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Areac9
Continents
D. LIFT STATION
Date Installed
Size in Gallons
"Pu.-np On" Level at
High Water Alarm Level at
Tested for
Electrical Codes
Dimensions
Manhole/Access (YIN)
"Pump Off" Level at
Vent (Y/N)
ing Adequacy Test. Meets MOA
r
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or, conformed to all MOA HAA
on the date of this inspection. .�
Signed .$44C' "- G1Wr-BRJN(4 Date / � V
5AFT9�Tii�
Company .1, Jr I SIV NI LASKA ` 857'1 MOA No.
! zea
KBl /d5/s
(Page 2 of 21
in effect
22
P •, �kobart A. 3keiaf �
c� •,, Mo 1437-i l a
920Z :
