HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 16 LT 11NAME
MUNICIPALITY OF ANCHORAGE ~
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
LEGAL DESCRIPTION
/i
LOCATION
~ell
DISTANCE TO: 112),'~,~/. Y-/(~ O
Manufacturer
Liq. capacity in gallons
Wel I
DISTANCE TO:
Absorption area
inside length
Dwelling
DISTANCE TO: Well Foundation
No. of lines Length of each line Total length of lines
Top of tile to finish grade
Material beneath tile
Length ~'~/O ! Width 22! Depth
Type of crib~/v~
DISTANCE TO:
Crib dia m et %~,~0~
Well
Crib depth
Building foun
Driller
DISTANCE TO: Sewer line
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS/ I
Dwelling
/0,~-
I Materia~_i/,~l
IWidth
Material
INearest lot line
Trench width
inches
inches
NO, OF BEDROOMS
PERMIT NO.
No. of eomDartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between lines
Total effective absorption area
PERMIT NO.
Total effective absorption area
Nearest lot line ,/ . ~
Distance to lot line
Septic tank
APPROVED
72-013 (Rev. 3/78)
PERMIT NO.
Absorption area(s)
DATE LEGAL Lo'l- Il
DEPRRTMENT OF HERLTH RND ENVIRONMENTRL PROTECTION
825 L STREET, BNCHORFIGE) RK 9050t
264-4?20
FERflIT NO:
I}FITE I S::-.',UED:
840001 ENGINEERED
.L,~.,' ..~.L:~,.' o-':.
F"E F.._' I'.1 I T
FIF'F'L I CRNT:
FID[:'RESS '
CONTFICT F'HONE ·
FIRC:TIC DEVELOPMENT
FINCHORFIGE, RE 09507
561-8076
L. EGFI[.. DESCRiP:
LOT SIZE:
I CERT'IF~/ THRT:
2.
"::1.., _IPP, t ~,,'t,- t i"'l~.~~,~..~, ~..:, .~ _.,,. NORTHWC OD"_-] .~4
-,E_.T].L~g. ~: TOWNSHIP: 1...N
3:1OOO ,::SLzL FT. 3F.' ACRES)
LOT:
RHN.~E. lP.I
BLOCK: 16
t FIM FRMIL. IRR I~IITH THE RE6~UIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTFt 8'¢ THE MUNICIPRLIT'¢ OF FINCHORFIGE (MOFI) FIN[:, THE STFITE OF FILRSKFI.
I NIL.[. INSTFILL THE S'¢STEM IN RC:CORDFINCE WITH FILL MOFI CODES FIND REGUI._RTIONS.,
FIND IN COMPLIFINCE WITH ]'HE DESIGN CRITERIFI OF' THIS PERMIT.
I WILL RDHERE TO FILL MOB FIND STRTE OF RLFISKFI RE6!UIREMENTS FOR THE SET BFICK
DISTFINCES FROM FIN"r' EXISTING WELL, I.,.IFISTEWFITER DISPOSFIL S't'STEM OR PUBLIC
SEWERRGE S'¢STE["I ON THIS OR RN't' FID..TFICENT OR NERRB'¢ L. OT.
:IF Ft LIFT STFI]'ION IS INSTFIL. LE[:, IN FIN FIF. tEFI C3VEF.'ED B'¢ MOB BUILDING CODES.,
THEN (±', RN ELE_.TRICRL-' ' FE. RHIT-'- ' ' RND IN.:,FE. UTION- "--' M .... '~"I' BE OBTRINE[:v '""~.. Hz,-E,_ ILT=.-'- '11
WILL NOT BE RPPROVE[) WITHOUT RN ELE..TFiCRL- -' ' INSPECTION REF JR] ," ' "r -'. RND (2%, THE
EL.E .... ~I_.~tL.. WORK MLIST~ BE ~NE B"r' R LICENSE[:, ELECTRICIRN.
............................... ....
RF'PLICRNT: ~q" I C [:,EVELO~ME:NT
.~ ~ MUNICIPALITY Of ANCHORAGE
Department f-~ Health and Environmenta]~rotection
825 . Street, Anchorage, AK. !501
264-4720
Permit.~# ~4~,0o/ * * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
Applicant: ~Z~/~t~e/ ~,,x~I Mailing Address: ~4~O
Location: Phone Nu~er: ~ ' ~'
Legal Description: ~// ~ /~ ~~~ Lot Size:
Type of Soil ~sorp%ion System Is: ~C
Trench: Drainfield: Seepage Bed: ~ Holding Tank:
Maximum N~ber of B~rooms: ~ _ ~il Rating(sq. ft/br) / ~
The Required Size of the Soil ~sorption System Is: '
'' "
DEPTH LEN6TH ~ 6RAVEL DEPTH ~ WIDTH
The~length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /0~0 GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection.and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a.private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMI! EXPIRES DECEMBER 31, i 9 8 3 * * *
I~certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) .I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that_3 bedrooms. ,
Appli~ ant ~ ' ~//~ /~ ~
Date: / //~/~
swP /0z 4
' " I OILS LOG
MUNICIPALITY OF ANCHORAGE L~PE O ~ JRCOLATI N
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~L 2
3
4
5
6
7
9
10
11
12
13
14
15
16-
17
18
19
2O
WAS GROUND WATER SL
ENCOUNTERED? __/~ 0
IF YES, AT WHAT
DEPTH? ~'
Gross Net Depth to Net
Reading Date
Time Time Water Drop
~ ,~>i/~ ~,~, ,:,~:~ 7~ "' /~"
.-PERCOLATION RATE -~- /D./~/(,4~S ,,del" /~(minutes/inch) TEST RUN BETWEEN ~'~ ., FT AND ~'q . FT
TE: ~
~2-008 (6/79)
b1 8 9 70 ' O
•
• -c Municipality of Anchor n ,•:). ' _° : ...``_
On-Site Water and Wastewater Progr•m JUL 5 2017 n
(907) 343-7904 m SA r c T.
�s
CERTIFICATE OF ON—SITE SYSTEMS <<ROVAL �cu
a 6 8 L9->
Parcel I.D. 051-064-23 Expiration Date: ( ) u(i) 2 1 , )0 1 S
1. GENERAL INFORMATION
Complete legal description NORTH WOODS UNIT 4 BLOCK 16, LOT 11
Location (site address) 21705 SHELTERING SPRUCE;4•CHUGIAK,AK 99567
Current Property owner(s) BRIAN A. FELTS Day phone
,k.ace
Mailing address 21705 SHELTERING SPRUCE', AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (wlwo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual IZI
Individual Well ❑ Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class Well ❑ Public Sewer ❑
Public Water System El
WaiverNariance request for: Distance:
Received by: 44 i %'T/f /Li- Date: 7-c.?/-//
•
COSA to be released to the engineer, unless olh isvE requested by the engineer.
COSA Fee $ g-710 r — Waiver Fee $
Date of Payment 7 ! La /( 1 Date of Payment
Receipt Number CA-16t 1 Receipt Number
COSA# oSC (1/a 1 1 Waiver#
• 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,
based on procedures outlined in the Certificate of On-Site Systems 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. 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(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER,AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 7/1/2017
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with
ADEC and MOA regulations, The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use,
local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the
system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen +��\
encroachments,deficiencies or discrepancies exist. 4i. \ `
Ar
149T111 $ * t
6. DSD SIGNATURE / •
System #1 Approved for ��'
y pp 3 bedrooms. + i
fit
System #2 Approved for bedrooms. + h� 116 r�� `'
% 7 ` '
de
Disapproved. 1
Conditional approval for 2 _ bedrooms,Iwith the following stipulations:
old . aquL4 1,'t �2 5 l
-V-a.(\12.3 LO 02 a () V
"4 OF Attic.
ON-SITE -,
WATER AND rn
WASTEWATER
PROGRAM `.
By: I�v11r,CA11 C�ti�� � Original Certificate DaterfA,:7r2,1 2O 17
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10.10-12 dcc
•
If more than 1 septic system is on the lot:
COSA Checklist# of _
Structure served by this system _
Certificate of On-Site Systems Approval Checklist
Legal Description: NORTH WOODS UNIT 4 BLOCK 16, LOT 11 Parcel ID: 051-064-23
A. WELL DATA — PUBLIC WATER
Well type If A, B, or C provide PWSID # Well Log (Y/N)
Date completed Sanitary seal (YIN)Y Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC 1 STEEL Date installed _413/1984_
Tank size 1000 gal Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N
Date of pumping 711/2017 Pumper One Stop
C. ABSORPTION FIELD DATA
Date installed 4/311984 Soil rating (g.p.d./ft2 or ft2/bdrm) 172 System type BED
Length 40 ft. Width 22 _ ft. Gravel below pipe 0.5 ft.
Total depth 3.2 ft. (Measured 711/17) Eff. absorption area 880 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 7/1/2017 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 625 gal. New depth 2 in.
Elapsed Time: 5 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N _ If yes, give date
J ,✓.�.. �y ' +.y- �� SIS jw.
D. LIFT STATION
Date installed Size in gallons Manhole/Access(YIN)
"Pump on" level at_in. "Pump off' level at in. High water alarm level at _ in.
Datum Cycles tested _ Meets alarm&circuit requirements?
E. SEPARATION DISTANCES -PUBLIC WATER
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot _ On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ _ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 200'+
F. COMMENTS
Septic tank levels appeared to be at acceptable levels and 1000-gallons pumped. Approximately 32"cover over field as stated in
2012 COSA with no known freezing issues.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
.<„;
OFAI
Air
Engineer's Printed Name KENNETH M.DUFFUS A`Z� �tS ,1
Date 7/1/17 Tl
4' Ir �'} Ail _`
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COSA canary sheet 2-6-15.doc + 's 4.
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NOTE: LOT IS SERVED BY A
Lot 10
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PLOT PLAN
AS BUILT X SCALE 1" 440'
GRID NW 1460 Project
No. 17-211/R1
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Lang &
Associates, inc.
(907) 522-6476 Phone
9oovpppp
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Professional
Land Surveyors
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EASEMENT
Lot 11
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30,708 s.f.
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4.8'x10.4' BALCONY
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1 hereby certify that I have surveyed the following described properly:
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LOT 11, BLOCK 16, NORTHWOODS SUBDIVISION — UNIT X14 (PLAT 83-333) o 49?"
Anchorage Recording District, Alaska, and that the Improvements situated thereon are"""""""
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed'KENNETH ; NG r
premises and that there are no roadways, transmission lines or other visible Oo
easements on sold property except as Indicated hereon.
,.. �� •'•.•�5-5202.•'• 0J0
Dated this the > Day of i at Anchorage, Alaska �O�p •••••. a0o
40oR0�FSSIONAI �o
It is the responsibility of the owner to determine the existence of any easements, DOpppp��
covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963
UIrCT
NOTE: LOT IS SERVED BY A
PUBLIC WATER SYSTEM
O
PLOT PLAN
AS BUILT X SCALE 1" 440'
GRID NW 1460 Project
No. 17-211/R1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang &
Associates, inc.
(907) 522-6476 Phone
9oovpppp
(907) 522-4625 Fax
oo
Professional
Land Surveyors
kenOlongsurvey.com
jonothanblongsurvey.com
OF
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1 hereby certify that I have surveyed the following described properly:
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LOT 11, BLOCK 16, NORTHWOODS SUBDIVISION — UNIT X14 (PLAT 83-333) o 49?"
Anchorage Recording District, Alaska, and that the Improvements situated thereon are"""""""
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed'KENNETH ; NG r
premises and that there are no roadways, transmission lines or other visible Oo
easements on sold property except as Indicated hereon.
,.. �� •'•.•�5-5202.•'• 0J0
Dated this the > Day of i at Anchorage, Alaska �O�p •••••. a0o
40oR0�FSSIONAI �o
It is the responsibility of the owner to determine the existence of any easements, DOpppp��
covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963
i
MUNICIPALitY OF ANCHORAGE
DMSION OF ENVIRONMENTAL HEAL~I~H
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH ALrl~ORITY APPROVAL CERTIFICATE
Information Application Date ~/~/d~
1.
General
(a) bagel D~sc~iption (include lot, block, subdivision, section, township, -~ange)
Location (add~ess or directions)
(c) Appliqaant is (check one) Lending Institution ~; Owner/builder ~;
Buyer ~--~; Othe~ ~ (explain);
(d) Lendir~3 Institution Telephone
Address
· (e) R~al Estate Co. & Agent
Address
Telephone
2. Type of ~sidence
Single-Family ~-~
Numbe~ of Bedrooms
3. Water Supply
Individual Well ~
Mult i-Family ~
Other (describe)
Note: If ~nity well system, must have written confirmation f~cra the State
Depa~tn~nt of Environmental Conservation attesting to the legality and status.
well adequate for the number of bedrocms specified in this HAA .~/N)
Is
the
4. Sewage Disposal
Onsite ~ Public ~-~ Col,~l~lnity ~-~ Holding Tank ~-~
Is the wastewater disposal system adequate fc~ the rianber of bectrocms d~/N)
[Page 1 of 2]
2-15-84
5~. .Engineering Firm Providing Inspections, 'I%sts, Data and Information
I certify that I have checked, verified, or conformed to all ~VOA HAA Guidelir~s in
effect on the date of this inspection.
Sig~d ~
Date ~~'t~
( ENGINEER SE.~L)
Date 4/~/~
6. DHEP Approval
Approved for .~ bedr corns
Approved ~ Disapt~o~d ~
Terms of Conditional Approval
Conditional~
Date
The Municipality of Ap~chorage Depa~tmmnt of Health and Environm~ntal Protection dces
not guarantee the continued satisfactory performance of the water supply and/or the
wastewater disposal system. This approval indicates that~ as of the ~alidation date
shown above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater, disposal system is safe and fun¢~
tional for the numbe~ of bedrooms and type of structure indicated.
(~PSEAL)
7. ~il t~ HAA to ~ roll, lng ~ess:
KB2/d5/s
[Page 2 of 2]
2-15-84
ao
WF.~,~. [IATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUI~ORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
I~UJ',IlCJPAgTY OF ANCl.'IoRAGI~
D~-PT. OF HEALTH
ENVIP. ON~ENTAL pROTI~CTIOI"J
RECEIVED
Date Completed /t]//~ Yield
Well Classification
Well Log P~esent (Y/N)
Total Depth ;~)/;~. Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances f~cm Well:
To Septic/Holding Tank on Lot
Pump Set At
Depth of Grouting ~U/.~
Sanitary Seal on Casing (~
DePression Around Wellhead (Y/N) ~
; On Adjoining Lots ~/~
ft'//~,~- ; On Adjoining Lots
~J'//,~- To Nearest Public Sewer
fL/~L- To Nearest Sewer Service Line on LOt
To Nearest Edge of Absamption Field on Lot
To Nearest Public Sewer Line
C leanout/Manhole
Water Sample Collected By
Water Sample Test ~sults
Cc~ents
B. SEPTIC/HOLDING TANK DATA
To Water-Supply Well
To Water Main/Service
co se
Date Installed ~/-%/~4 Size /OOC~ No. of Compartments
Standpi~s ~) Ai~-tight Caps ~)
Foun~tion
Clean~t
~p~ession o~ Ta~ (Y~ ~te ~st P~d ~/~.
P~ing~ainte~n~ ~n~a~ ~ File (Y~) ~/~ ; for ~/~
Holding Ta~ High-Wats= ~a~ (Y~) ~/~. ~rary Holdi~ Tank ~r~t (Y~)
~p~ation Distan~s ~ ~ptic~olding Ta~:
To ~ilding F~n~ti~ . ~
To Dis~sal Field ~ ~O/~' /
TO S~e~, ~d, ~e, ~ ~jor ~aina~
Co, ments
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /~ ~.~4o~Type of System Design
Date Installed
Width of Field
Square Feet of Absc~ption A~ea
Depression over Field (.Y~
Results of Last Adequacy~Test ~/~
Separation Distanc~ f~c~ Absorption Field:
To Water-Supply Well ~{~ To P~operty Line
To Building Foundation 9' A-'F'~ ~ To Existing o~ Abandoned System cn
Lot ~u//Jr ; On Adjoining Lots
To Water Main/Service Line ~/~! To Cutbank(if p~esent)
To St~eam/Pond/Lake/c~ Major D~ainage Course
To D~iveway, Pa~king A~ea, c~ Vehicle Stc~age A~ea
D. LIFT STATION
Date Installed A//~
Size in Gallons ;U/~
"Pump On" Level at /~
High Water Alarm Level at
Tested for F~//v
Electrical Codes (Y/N) MJ//~
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes P~esent
Date of Last Adequacy Test
Dimensions /%3//4
Manhole/Access (Y/N)
"P~ Off" Level at
Vent (Y/N)
Meets MOA
Pumping Cycles du~ing Adequacy Test.
Comments
** Check Permitted Bed~ocra Rating Against HAA Request
I certify that I have checked, verified, c~ confc~m~d to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed Date
'
~-~5-8~