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Home My WebLink AboutMEADOW RIDGE ESTATES NORTH ADD BLK 6 LT 8Onsite File Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191040 PID Number: 051-531-19 ❑ New ❑✓ Upgrade Name: Weiss Family 2005 Trust ABSORPTION FIELD ❑ Deep Trench F1 Shallow Trench F-1 Bed ❑Mound Address 25115 Homestead Road ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Meadow Ridge Est N. Add 6 8 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 n/a n/a n/a n/a n/a TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1250Gal. Surface Water 100+ n/a n/a n/a Material Number of compartments Lot Line 5+ n/a n/a n/a Steel 2 NA Foundation 10+ n/a n/a n/a LIFT STATION Manufacturer Capacity Curtain Drain 50+ n/a n/a n/a Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Jr's Septic Services Drainfield CO/I`vIT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 572.5ft Inspection�5, 05/09/19 Location and description 2nd dates: 3° 4th NW BOTTOM HOUSE TRIM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp C}>~�� Conditional Approval: Date � * 'teve n ''Pc W6ne'� CE 8 9 Approved Date 5 — I wpccuuI i r�upvl t_!- i- i c.voc _,)---,,SEPTIC AREA I / U I ! INSTALLED 25 108 SEPTIC TANK i ABANDON 12508 SEPTIC TANK (E) 1 ty/ DCO AFTER AND PER CODE y I FOUNDATION CLEAN OUT INSTALL 1250g SEPTIC TANK (P) C1 2'< T; I WITH DOUBLE CLEAN OUT R MOVED 12500 SEPTC TANK E INSTALL FOUNDATION PER MOA CODE CLEAN OUT ' I � ,� rf T1 FC I \J,/ / DRAIN FIELD (E) / APPROXIMATE LOT VACANT 4BR 595 NO WELLS OR SEPTICS 550 HOUSE (E) 1 - �555 / ; / 590 \ '� ! 7 / 70�` / \ - \ _ - 5305 i1 ALL MEASURMENTS i t 0' ` T/��TYj�s ��\� !� _15i5 \ _--_ — !\ / / \ FMSn/T ' i1 570 I A B \ \ '� .,� (� 565 _ T1 25.4- 14.3 \ i�"' �� 5s0 T2 31.3 21.1 DC01 1 35.2 1 24.1 DCO2r36.201 24.60 HOMESTEAp IROAp — ELEV. 572.5 z r O O QO 0 Z Q �W OU J O z w U O Z 4 U o 56 1250 g SEPTIC TANK PROFILE SCALE: NTS CONNECTED TO EXISTING DISCHARGE LINE NOTES: PA:NNONE ENG SVC, LLC ��OF A �� Dote RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 �E • ! qsl5/9/zols DRAWN BY: PHONE (907) 272-8218 FAX (907) 272-8211 yP�� Sci le 50 ACP...... . . .I.D. NO MEADOW RIDGE ESTATES NORTH ADD, BLK6, LT8 � 051-531-19 WEISS FAMILY 2005 TRUST % Steven R. Pannone PERMIT N0. 25115 HOMESTEAD ROAD r� �Fc'• CE 814_®OSP191040 PLAN CHUGIAK, AK 99567 Sheet i� FROFES510JP� 20F2 0"'a"' MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program r I PO Box 196650 4700 Elmore Road �i�, 14 + Anchorage.Alaska 99519.6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.orglonsite06 I Department On-Site Wastewater Disposal System Permit Permit Number: OSP191040 Effective Date: 2/21/2019 Work Type: SepticTank Upgrade Expiration Date: 2/21/2020 Tax Code Number: 05153119000 Site Legal Address: MEADOW RIDGE ESTATES NORTH ADD BLK 6 LT 8 G:1462 Site Mailing Address: 25115 HOMESTEAD RD, Chugiak Owner: WEISS FAMILY 2005 TRUST Lot Size in Sq Ft: 21149 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well 0 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: 1,„/ Date Issued By: kl/(10,r / Date: 2–/Z.—( //g' evy,ory �I tt. est MUNICIPALITY OF ANCHORAGE • 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. 051-531-19 Property owner(s) WEISS FAMILY 2005 TRUST Day phone Mailing address 25115 HOMESTEAD RD, CHUGIAK AK 99567 Site address 25115 HOMESTEAD RD Legal description (Sub'd., Block & Lot) MEADOW RIDGE EST NORTH ADD B6 L8 Legal description (Township, Range & Section) Lot Size 21,149 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank Upgrade x❑ 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. v (Signatur- of propert owner or authorized agent) Permit/Rush Fees: AAJ- Waiver Fees: Date of Payment: oZl 00119 Date of Payment: Receipt Number: a�$�Qy Receipt Number: Permit No. 05P 19 logo Waiver No. Permit App__- ::....c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191040, Deb Wockenfuss, 02/21/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191040, Deb Wockenfuss, 02/21/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191040, Deb Wockenfuss, 02/21/19 NAME 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 LEGAL DE~;RIPTION LOCATION ] Well ] Absorpt on ~ ! Dwelling Manufacturer __ ' Materi~l Liq. ,a cit in a ons InsideJength Widt i DISTANCE TO' /Well ~/1~welling I D S I~ell FoundetJo. ~/~ Nearest lot ] No. of lines ~ [ Lengt~of~ct~line Total len~ I ~ I ~ . ~ inches Top of tile to finish grade ~ ~ Material beneath tile ]Length Width / Depth / ~ inches ~ Type of crib Crib diameter ~ Crib depth DISTANCE TO Well Building foundation Nearest lot line Class Depth . , ~ ~¢~.~ Distance to lot line DI~TA~ ;~ ' Building foundation Sewer line Septic tank IPHONE [] UPGRADE NO. OF BEDROOMS No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. ~1 ~--. Distance between lines Total e f f ec~__~o(~ti~a rea PERMIT NO. PERMIT NO. Absorption area(s) Total effective absorption area OTHER PIPE MATERIALS iNSTALLER REMARKS LEGAL MUNICIPALITY OF ANCHORAGE Department f Health and Environmenta_ ?rotection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~ ,~,~.~.¢ , WELD~.:~/~y~A~OR ON-SITE SEWER PERMIT /~,. Applicant: ~/~ J Mailing Address: ~ ~ i Phone N~mb~r~ / ~ ~-~ Location: Legal Description: Type of Soil. A~,sorption System Is: Trench: ,'X- Drainfield:~m~---~,Seepage Bed: Holding Tank: _~_~__ Maximum Number of Bedrooms: ~ Soil Rating (sq. ft/br) The Required Size of the Soil Absorption System Is: 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(~LD~q~2) TANK SIZE TM ~~~ 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. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * z 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..~stall the system in accordance with codes. (3) I und~rs~ th~the on-site sewer system may require enlargement if ~e~re~~/~ re.//modeled to include mo re~ ~droo.~/_ ,~ S igne~: ~ ~/~/~//~-~_~- Issued by:~. ,V ~ ~ A ~i:a~t-- "~ Date: ~'~ /,~/~ ~ SWP/024(1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: '¢'"~ g~ ~'~ (~ LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 [~(,-~1~'~ 5~J~ DATE PERFORMED: SLOPE SITE PLAN ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE '~//~ (minutes/inch) 14 15 16 17 18 19 2O TEST RUN BETWEEN , FT~ND -- FT co--.TS / PERFORMED BY:[ '~f~ ~,iT ,*~,~-.09'Z9 CERTI FI 72-008 (6/79) / DATE: "~,/~t¢~/~/~'~ // MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Comp~lete legal description Lot 8; Block 6; Meadow Ridge Estates North Addition Location (site address or directions) Property owner Mailing address Lending agency Mailing address A.H.F.C.ff57711 Day phone 520 East 34th Avenue, Anchoraqe, Ak. 99503 Day phone Agent Lori Crowder JACK WHITE COMPANY Day phone Address 109¢8 F_ag£~. ~'u~ ~n~d; Eag2~ ~,¢u~: A/~. 99F;77 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water 4 % XX NOTE: 694-5500 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: X× If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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. Phone ~ ~L~_~_~ 1 '1 S & S ENGINEERING Eagle River, Alaska 995~ Name of Firm Address Engineer's signature DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~ ot-+~J ._~ T/I t'F~- Date 'f; ,qi[fli 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 hemes 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) Bac~( MOA #21 Municipality of Anchorage ~, Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~...c~ ~ ~-p~.,~-. ~c, l~.~q:,.~ '[;~LI;x.~cel I.D. A. WELL DATA Well type A Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow If A, B, or C, attach ADEC letter. Date completed Cased to FROM WELL LOG Pump level SEPARATION DISTANCES FROM W~L~~.' Septic/holding tank on lot Absorption field on lot Public sewer main Sewer servic~ WATER~PLE RESULTS: ~ofmsam-~le: Nitrate ADEC water system number 7--~,~ ~'~ ~ Driller Casing height Wires properly protected (Y/N) AT INSPECT~~ MUNICIPALITY OF ANCHORAOE m [;.'VI~ONMENTAL SERVICES DIVISION L~(; 0 g 1991 g.p.m. 'RECEIVED ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~>"~ ~°c>~z~ Cleanoutsd~/N) y Tank size Foundation cleanout {~'N) Compartments '~ Depression (Y/~ hJ Well(s) on lot To propertyline ~o Surface water/drainage High water alarm (Y~ /J Date of pumping -~ ~ ~ ~\ -~ Pumper PARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ~ ~ [ ~ On adjacent lots . ~/~ Absorption field ~ ~ Alarm tested (Y/N) ~///4 Foundation Water main/service line 72-026 (Rev, 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at ~f ~ level at High water alarm level ---~"'~"'"~ Cycles tested Meets MOA electrical codes (Y/~-"~ SEPA~NOE FROM LIFT STATION TO: W. eh~o n lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~;, .--zp ~ ~ Length "~2~ Width Total absorption area ~" Depression over field (Y4~ Resultsk_~fail) Peroxide treatment (past 12 months) (V~ Soil rating Gravel thickness Cleanouts present ~/N) Date of adequacy test for- ~).___~._ O //-,,-./O ~J~,J If yes, give date System type Total depth \ Y bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot '~ ~"~' To building foundation On adjacent lots -5-c, Surface water Curtain drain ~ On adjacent lots ¢)/~ Property line lot A-- To existing or abandoned system on lot ~'~ Cutbank M, ~ ~ Water main/service line L'C;, ~ '+ Driveway, parking/vehicle storage area "~c~¢~_ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines S & S ENGINEERING Signature 17n3a ~.-,~f,~ ......... m .... _==_, r. ,~ Eagle River, Alaska 99577 Engineer's Name Date ~ ~4:~ ,~ / HAA Fee $ Date of Payment Receipt Number in effec..t.O~ .~he date of this inspection. Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 WALTER J. HICKEL, GOVERNOR ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 (907) 563-6775 December 9, 1991 FOR: S & S Engineering PWSID Cf 211431 My review of the records on file in this office reveals that the Dawn Water Company Class "A" Public Water System, is in compliance, for the month of December 1991, with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer BR/cf MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # _/)- _~"'/- O~.~'/~ / '~ NAA# (~ ~ _ ('"~ ~0~ :~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) _.. , Lot 8; Block 6; Meadow ~dge. ~u~iv~s~on Location (address or directions) Homestead Road (b) (c) (d) Property owner Gibeault .- · Mailing Address Lending Institution CENTRUST Telephone: (home) Business Telephone 561-4930 Mailing Address' 4000 Old Seward Highway, Anchorage, Alaska 99503 RealEstate Company and Agent JACK WHITE COMPANY/Carolyn McPhee Address 10928 Eaqle River Road, Eaqle River, Alaska 99577 Telephone 694-5500 (e) Mail the HAA to the following address: (or check herein, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eaqle River Loop Road, Suite 204 Eaqte River~ Alaska 99577 2. TYPE OF RESIDENCE Number of bedrooms __ Single-Family:~ 3. WATER SUPPLY Individual Well [] ordered by Carolyn McPhee Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4, SEWAGE DISPOSAL On-site:G[ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page t of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION A§ certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is 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 Address Date 17034 Eagle River Loop Roaa No, 2ua Telephone 6. DHHS APPROVAL Approved for~bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) MUNiCJ'~I ~,~{~/~3roval (HAA) SEP.! 2 ]988 Legal Description: ~ A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth_ Cased to Static Water Level Casing Height Above Ground Electrical Wiring ih Conduit (Y/N) RECEIVED A Date Completed Depth of Grouting If A, B, C, D.E.C. Approved Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots '~ .4- ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC~G TANK DATA Date Installed 1~--"5 ¢~i~ Size Standpipes ~;)N) Depression over Tank (Y/(I~ Air-tight Caps To Water-Supply Well To Property Line To Water Main/Service Line Pumping/Maintenance Contact on File (Y/N)i~ Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: ~¢:;d2 ~.4- To Building Foundation t~ I~ To Disposal Field To Stream, Pond, Lake or Major Drainage Course ~, ~ )''+' Commehts ~-.'~:'~ (~ ~ ~'1:::~L~ No. of Compartments ~ Foundation Cleanout([~N) , Date Last Pumped ;for Temporary Holding Tank Permit 15" i¢._ 72-026 (Rev 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y~ Type of System Design '"'~~ Length of Field ~'~ ' Depth of Field Gravel Bed Thickness Statndpipes Present~J) Date of Last Adequacy Test ~ ..-q ~ ~'i~ Results of Last Adequacy Test ~~)"~,/'"~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundatio~j Lot ~r To Water Main/Service Line To Property Line 1 C:2 IA"- To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) t~/~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION ~/^ Date Installed / /'"~- Dir~s'ions Size in~J,~.~ Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments "Pump Off" Level at Vent (Y/N) uring Adequacy Test, **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 Company Date MOA No. S & S ENGINEERING 17034 P..agie Ri~er Loop Road No. 204 i~gle R|ver~ Alaska 99577 Receipt NO. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No.- ~ Waiver Fee: $ Date of Payment Page 2 of 2 ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE, AI~S]CA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: PWSID: 213001 To Whom It May Concern: According to the records on file in this office, the CHUGIAK UTILITIES/_.NO._R?_D._W_9.QDS/_M~E~.g)OW}Q[D~. Water System is in compliance with the State of Alaska Drinking Water Regulations~ SWE:pkk Sincerely, Steven ~ng, PE Distrid-t Engineer APPLI( NT FILLS OUT UPPER HAl, ONLY Address Zip Code Lending Inslitution ,~.::~, ~/~ ~ Phone Realty Co. & Agent Phone Address Zip Code Legal Description /r25 ~ ~ /~/~.~' ~ ~'~ ~'--~t~2F.~:~-.~ U ~..~ ~ Street Location Type of Residence ~, Single Family [~ Multiple Family No, of Bedrooms L] Other Water Supply [3 Individual ~~¥' ~ ~_ ~ ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. ~'"*CommunltyJ~- ' For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal [~ Individual Year Individual Installed:' /'?~,~ __ [] Public Utility When Connected to Public Utility: __ [~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: -- -- ( ~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received