HomeMy WebLinkAboutMCKINLEY VIEW ESTATES BLK 2 LT 14McKinley View Estates Block 2 Lot 14 #051-792-18 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231363 Work Type: Septic Upgrade Tax Code Number: 05179218000 Site Legal Address: MCKINLEY VIEW ESTATES BLK 2 LT 14 G:1459 Site Mailing Address: 22525 HOMESTEAD RD, Chugiak Owner: GRINDE DAVID L & LINDA L Design Engineer: CREWDSON ENGINEERING, LLC This permit is for the construction of: Effective Date Expiration Date: Lot Size in Scl Ft: Total Bedrooms: 1»cnt r Department 11 /7/2023 11 /6/2024 20103 Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ 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: 15.5 u-� 7_43 C-(-( w O S o, Date: Issued By: L \__ Date: It Z ?/ "Z-o z 3 3 MUNICIPALITY OF ANCHORAGE `� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-792-18 Property owner(s) David Grinde Day phone Mailing address PO Box 771702, Eagle River, AK, 99577 Site address 22525 Homestead Rd., Chugiak Legal description (Sub's., Block & Lot) McKinley View Estates, Block 2, Lot 14 Legal description (Township, Range & Section) Lot Size 20,103 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank ElUpgrade R Duplex (D) ElHolding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A 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 of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: to Z3AZ_ 3 Date of Payment: Receipt Number: 04 ql Z G Receipt Number: b 3 3- Permit No. Waiver No. n S V GADevelopment Services\Building Safety\On Site Water and Wastewate r\Forms\C lie nt Forms\Permit Application.doc James “Jay” Crewdson, P.E.  Email: CELLC.1@outlook.com   Cell/Text: (907) 280‐9493  Fax: (907) 688‐2295  PO Box 671389 ● 18368 Amonson Road ● Chugiak, Alaska 99567  November 6, 2023  Onsite Reviewer  Municipality of Anchorage  On‐site Water & Wastewater Program  4700 Elmore Road    Anchorage, AK 99519‐6650  Reference:  McKinley View Estates, Block 2, Lot 14  Septic Drainfield Upgrade and Lot Line Waiver Request  Design Narrative  Septic Drainfield Upgrade: The owner of the 3‐bedroom single family home would like to upgrade the  existing drainfield, which will be decommissioned in place.  The proposed Wide Trench will be located  near Test Hole 2, approximately 6‐inches from the north property line, 5‐feet from the existing septic tank,  and five‐feet‐plus from the house and garage foundations.  The drainfield is not within the house or garage  structural foundation soils bearing prisms.  The free draining soil at this location meets the requirements  for Hydrologic Soils Group A (HSG‐A), which uses a 45‐degree liquid infiltration line.  As shown on Detail 1  of the Design drawing, the top of the drainfield is lower than the house and garage foundations and given  the HSG‐A soils is of no concern regarding an impact to either of the foundations.   Lot Line Waiver Request: The groundwater elevation at soils test hole TH1 in conjunction with the long  distance from the septic tank would not allow gravity feed to the drainfield, thus requiring a lift station.   While lift stations are certainly an option, it’s desirable not to use them if possible due to their ongoing  need for maintenance and the potential for mechanical failure. Using soils test hole TH2, the design is able  to use gravity flow without the need for a lift station. The pr oposed drainfield near TH2 is located 6‐inches  from the north property line.  The adjacent property, Lot 15, has adequate space to upgrade the septic  system without the need to be near the shared property line and is not impacted in any meaningful way  by the proposed drainfield for Lot 14.  We feel this adequately justifies the proposed drainfield location  and as such are requesting approval of a zero‐foot lot line separation distance waiver.   Closing Statement: There are no anticipated probable adverse impacts to adjacent properties if the  drainfield  is  constructed  as  designed.    This  includes:  a.  Wells;  b.  Wastewater  disposal  systems;  c.  Replacement disposal sites; and d. Drainage flowing onto and off of the subject property that could  adversely affect performance of the wastewater disposal system.  Please feel free to contact me if you have any questions.  James “Jay” Crewdson, P.E.  75' POWER 2 / LINE EASE T FLAT SHED (P) DRAINFIELD TH2: 1-5 MPI, H20: 11.2'BGL, AR: 1.2 GPD/SF, RF: 0.73, 2'EDx6'Wx46'L (INLCUDES COMBINED MAIN RUN AND TWO SIDELEGS), TD: 7.3' (E)CO / DECOMMISSION (E) DRAINFIELD IAW CODE TH1 IS .. • • 'l— DETAIL 1 SCALE: 1" = 4' 7.3' DF FLAT FLAT WOODEN FENCE DC 0M_` _ // Lot 15 5TH2® 6' \// / 1 C3 (E)FC M1 e A 6' 6, 5'+FAT PL C 5'+ M'C a% / 313R SFH 5'+ FLAT / GARAGE / 1 ASPHALT I ' :PAVEMENT 1 J 15' T&E EASEMENT GRAVEL nn -----_--------------- --��� W. HOOMESTEA RI-0 D 33' SECTION LINE EASEMENT Cre►nedson Engineering, LLC I McKinley View Estates, Block 2, Lot 14 SEPTIC SYSTEM DRAINFIELD DESIGN %%ft1choor-'r "' Prepared for: Date: 11-6-2023 C1v111kbNhunrroi Ei g Ing David Grinde PO Box 671389 Chugiak AK 99567 a cellc.1@outlook.com Permit: OSP231363 Page: 1 of 2 Cell/Text:907-280-9493 a Fax:907-688-2295 ALL INFORMATION SHOWN ON THIS DOCUMENT IS THE PROPERTY OF CREWDSON ENGINEERING, LLC AND SHALL NOT BE USED FOR ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION FROM CREWDSON ENGINEERING, LLC PLAN SCALE: 1 "=30' of '�sill .... ..II .� .. Ja A. Crewdson C11527 i AW �l �F, PROFESSIONP- ALLC #112279 NOTES 1. All septic system construction shall be IAW MOA code. 2. Survey: All property lines, easements and 100' well radii within 20 feet of the proposed septic system shall be flagged by a licensed surveyor prior to construction. 3. Pipe 3.1. All pipe shall be 4" 0 ASTM D-3034 SDR-35 PVC 3.2. Conveyance pipe slope: 2% minimum 3.3. Drainfield distribution pipe slope: 0% (level) 4. Insulation shall be IAW code and the following requirements. 4.1. 25-psi minimum burial grade rigid foam boards 4.1.1. The insulation board thickness (IT) and horizontal extension (IHE) beyond each side of the insulated component below it shall be in accordance with the following schedule: DRAINFIELD SEPTIC TANK PIPE(ST to drainfield)* Soil Cvr IT HE Soil Cover IT HE Soil Cover IT HE >3' none reqd >4' none reqd >4' none reqd 2'- 3' 2" 1' 2'- 4' 2" 1' 2' - 4' 2" 2- * All conveyance pipe from buildings to septic tank Soil Cover Soil Cover IT IHE Soil Cover >7' none reqd 4'-7- 4" 4'** <4' not allowed **or IHE-2' with vertical insulation extending down 6" below pipe invert. 5. Inspections (INSP) & Notifications (NTC): Note: Installer shall contact the Engineer at 907-280-9493 for all inspections and notifications. MOA Inspections and Notifications: 24 hr NTC prior to the start of construction 2 hr NTC prior to septic tank/drainfields BOH Engineer Inspection and Notifications: 24 hr NTC prior to preconstruction meeting 2 hr NTC prior to top of drainrock NTC when final backfill/grading is complete Crewdson Engineering, LLC OWI Ilk mortal 8 Show ng McKinley View Estates, Block 2, Lot 14 SEPTIC SYSTEM DRAINFIELD NOTES LEGEND Prepared for: David Grinde POBox671389ChugiakAK99567 • cellc.1@outlook.com Permit: OSP231363 Cell/Text: 907-280-9493 • Fax 907-688-2295 LEGEND (E) - existing (P) - proposed AR - application rate BGL - below ground level BOH - bottom of hole/excavation BR - bedroom C# - cleanout DC - double cleanout ED - effective depth EG - existing ground F# - foundation CO FG - finish grade GPD - gallons per day IAW - in accordance with M# - monitor tube MPI - minute per inch PL - property line RF - reduction factor SF - square foot SFH - single family home TD - total depth Date: 10-30-2023 Page: 2 of 2 �� of A�q ail ��P . s,� 1 rco .-y *: 49 TH 1 i rS•?,�a.o� Pa fl. I WVVUJUI1 C11527 A AN /'ROFESSIONP� ��'—' Municipality of Anchorage Development Services Department On -Site Water and Wastewater Section a� 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Soils Log - Percolation Test Performed For: David Grinde Legal Description: McKinley View Estates, Block 2, Lot 14 TH1 Depth 1- OG 2- 3- SP I with Silt and Gravel 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- COMMENTS O Design WAS GROUND WATER Yes ENCOUNTERED? IF YES, AT WHAT DEPTH? 8E Depth to Water After Monitoring? 7 Date Performed: 10-18-2023 ee Site Plan L , See Design Drawing Reading Date Gross Time Net Time Depth to Water Net Drop 10-18-2023 minutes inches 10.0 5-2/16 10.0 5-1/16 10.0 5-1/16 10.0 5-0/16 10.0 5-0/16 10.0 5-0/16 PERCOLATION RATE Z.0 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 3 FT AND 4 FT PERFORMED BY: Crewdson Engineering i James Crewdson CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 10-18-2023 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Section 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Soils Log - Percolation Test Performed For David Grinde Legal Description: McKinley View Estates, Block 2, Lot 14 TH2 Depth (Feet 1-I OG 3- 4 SP with Silt and Gravel 5- 6- 7- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- COMMENTS bee Design Drawing WAS GROUND WATER ENCOUNTERED? No s IF YES, AT WHAT DEPTH? L Depth to Water After O Monitoring? 1114" E Date:10-24-2023 4 TH� . :. V; A 'Jam A. Crewdson�: 0,11527 t t 1 O\pROFESSIONP�� Date Performed: 10-19-2023 10-30-2023 11'6" Site Plan See Design Drawing Reading Date Gross Time Net Time Depth to Water Net Drop 10-19-2023 minutes inches 9.0 6-0/16 9.0 6-016 9.1 6-0/16 9.1 6-0/16 9.1 6-0/16 9.1 1 6-0/16 F'tKI:ULA I IUN KA I E 1.0 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 3 FT AND 4 FT PERFORMED BY: Crewdson Engineering i James Crewdson CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 1 0-1 9-2023 / Lot 12 / 75' POWER LINE EASEMENT Lot 15 l SEPTIC PIPES 15' TBCE EASEMENT _ S 9 • S l J7.1 4 a 2.0'x223' CANT 21 WOODEN FENCE I- 12.2'x16.2' 5'2'x8.2' „2. 33' r G - / SHED SHED A � ✓ b / / `3Qo V 42j0 ` I ` 74.3' Lot 31 f' 25.0 E s c 2&.z' E Lot 13 c' 4 Gp�pGE N 33. ' 1� Q tij 1 t1 00 2-0'x9-7' CANT f zez, «„ !O '6.7' LANDING —J Q ASPHALT 6.4.4xgx9.0' DECK — PAVEMENT N Ln —J GRAVEL O m CV S 89'52'45"W 242.87' 15' T&E EASEMENT FZ a 0 33' SECTION LINE EASEMENT W. HOMESTEAD ROAD NOTE: THIS LOT IS SERVED BY A COMMUNITY WATER SYSTEM. PLOT PLAN —_.— AS BUILT X_ SCALE _ 1 —40-_ GRID NW 14_59 _ Project No._- 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone ken0langsurvey.com4- AMW Professional Land Surveyor 5 jonathan6langsurvey.com .� ! OF A� travis*langsurvey.com ����! ' - - . +� I hereby certify that I have surveyed the following described property: -AWG3 '9 LOT 14, BLOCK 2, McKINLEY VIEW ESTATES SUBDIVISION (PLAT No. 82-225) *; 49 TH • * �� 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 premises and that there are no roadways, transmission lines or other visible KENNETH G. LANGert easements on said property 1� P P Y except P as indicated hereon. G' No.`5202 Doted this the `�4z ------Anchorage, _ Da of ��-�»«- _, ___�-='_, at Alaska • • ° ----- y��, p`��ffSSI0NA1.�•��4 It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963 UBMITTA le, MP Municipality of Anchorage AUG 11 414 On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141319 PID Number: 05179218000 Dwelling: • Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ■ New ■ Upgrade Name: Davie & Linda Grinde A= • ORPTION FIELD Dee. Trench ❑ Shallow Trench ❑ Bed G Mound IN Other Address PO Box 771702 Eagle River AK 99577 Phone 907-22ci -86ia0 Number of Bedrooms 3 Soil Rating c•0ISF Total depth f original grade Fl. LEGAL DESCRIPTION Depth to pipe invert from original • -de Gravel depth beneath pipe Ft. Subdivision Block Lot McKinley View Estates 2 14 Fill added above original gr:: - Ft. G .: I length Ft. Township Range Section 15N 1W 4 Gravel width Ft. Beds: Number of Lines Dist. • - between lines Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total a• - orption area Ft2 Number of trenches Dist. between ches Well 100'+ _- -- r _ TANK Septic ■ S.T.E.P. • Holding ■ Other Manufacturer Anchorage Tank Capacity 1,000 Gal. Surface Water 100'+ — — — NA Material Steel Number of compartments 2 Lot Line 5' — — L TATION Foundation 5.9' -- — _- Manufactu Capacity Gal. Curtain Drain -- Remarks Old septic tank - corrosion throughout Pump on level at Pump • • ev-. - 1 High water alarm at in. lower half of tank on sides and ends, both Pump make . • • odel Electrical Inspecti• erformedby inlet and outlet stubs corroded off. Installer Martin Construction Co. - Royce Martin PIPE MATERIAL House to tank D3034Tank to 03034 drainfetd Drainfield NA CO/MTD3034 BENCH MARK (Assumed elevation) 100.00 ft Inspector Rodney Kinney Location and description Top of back entry deck Inspection 1°' 8-20-14 dates: 2 3w amh COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Conditional Approval: Date Engineer's Stamp OF q�qs�� i i co: 4— i gTH it *A/ in I Approve. ( / is l 1 ?j Date 1102/09 st If y•1) RODNEY P. gNNEYJ� I Qs .• No. CE7955 e ttt`, o e r Inspection Rejtort�9-1-12.doc SWING TIES FROM TO DISTANCE A STCO#1 23' B STCO#1 5.7' NOTE: ® AND ® ARE CORNERS OF HOUSE INSTALLED NEW 45° BEND, CONNECTED TO EXISTING 4" PVC EXISTING 4" PVC TO FIELD INSTALLED NEW DOUBLE OPPOSING CLEANOUTS INSTALLED NEW 45° BEND INSTALLED NEW 1000 GALLON SEPTIC TANK PROPERTY LINE STCO#2 STCO#1 DECK FC0 FOUNDATION LINE ASSUMED BENCH MARK EL.=100.00' TOP DECK AT ENTRY AS -BUILT PLAN SCALE 1"=20' 2' MAIN FLOOR OVERHANG -110 - 100 - 95 -90 CONNECTED TO FINISHED EXISTING 4" PVC, GROUND STCO#2 DC0#2 STCO#1 DC0#1 1 1 1 —11.1111.11,EL.=99.89'± II II II II II NEW 4" SOLID D3034 EXTENDED TO NEW TANK EL.=94.94I_ NEW 1000 GALLON 1 SEPTIC TANK 8' 32" NEW 4" SOLID D3034 S EL.=94.78' H '=10' V AS -BUILT PROFILE 110- 100 - 95- 90- 1"=5' OFLN qk 0.. 4f ,p %Rodney P. Kinney Jr.: m e+'. ••• CE7955 sof Ak®eci Pp. Nofession'_, RNA (Neel Elia Asseelett$* MCKINLEY VIEW ESTATES BLOCK 2, LOT 14 AS -BUILT PLAN AND PROFILE 8/22/14 FIGURE 1 i On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141319 Tax Code Number: 05179218000 Work Type: SepticTank None Permit Effective Dates: August 12, 2014 to August 12, 2015 Design Engineer: RODNEY P KINNEYASSOC INC Subdivision: MCKINLEY VIEW ESTATES Site Legal Address: Owner/Address: MCKINLEY VIEW ESTATES BLK 2 LT 14 G:1459 GRINDE DAVID L & LINDA L PO BOX 771702 EAGLE RIVER AK 995771702 Site Mailing Address: 22525 HOMESTEAD RD, Chugiak Lot Size in Sq Ft: 20103 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must 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 must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: lS Date: 5- MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SI,Ti4WER/WELL PERMIT APPLICATION ,,s �r Parcel I.D. 051-792 1113 Property owner(s) David & Linda Grinde Mailing address P.O. Box 771702 Eagle River Alaska 99577 Day phone 907-229-8660 -1 Site address 22525 Homestead Road, Chugiak Alaska 99567 Legal description (Sub'd., Block & Lot) McKinley View Estates, Block 2, Lot 14 Legal description (Township, Range & Section) T15N R1W Sec 4 Lot Size 20103 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage Initial Upgrade Renewal TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Not Applicable (NA) Distance: NA ❑X I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (S erty owner or authorized agent) Permit/Rush Fees: i 3qq - Date of Payment: ?italic/ Receipt Number: 17-9595' Permit No. 0510/4/3/9 Permit App__- Waiver Fees: Date of Payment: Receipt Number: Waiver No. Rodney P Kinney Associates, Inc. August 12, 2014 I[Iq llgIlvus & Simms Municipality of Anchorage Development Service Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Attention: Ms. Deb Wockenfuss Subject: McKinley View Estates, Block 2, Lot 14 Emergency Tank Replacement Revised Letter Dear Ms. Wockenfuss: Please reference our telephone conversation this date regarding my submittal and request for approval to replace the subject septic tank. The purpose of this letter is to provide you with additional details regarding the proposed work. The existing ground above the effluent end of the tank is depressed and the tank should be replaced as soon as possible. The existing tank will be removed and disposed and the new 1,000 gallon tank will be installed in accordance to AMC 15.65.050, also meeting necessary separation distances as identified in item A of this code section. There is an existing foundation cleanout; however, there are no double opposing cleanouts on the effluent side of the tank. The Installer, Mr. Royce Martin, will be required to install the double opposing cleanouts no more than 10 feet from thetank, as well as a cleanouts for each compartment of the tank. All cleanouts will have an airtight cap. The adjacent properties should not be affected by the location of the proposed improvements in regards to wells, septic systems, reserved space, and drainage. The new tank will be installed in the same location as the existing tank. An existing 37.5 feet wide utility easement is located along the western property line. A 15 feet wide electric and telephone easement and a 3 feet wide section line easement are located along the south property line. There are not any known easements along the north property line. The septic tank is located near the north property line; therefore, the new septic tank should not be located within any easements. 16515 Conlerllel0 Drive ■ Suite 101 ■ Ea0le River, Alaska ■ 99577 907.694.2332 ■ Fax 907.694.1807 ■ www.reka.oel McKinley View Estates, Block 2, Lot 14 Emergency Tank Replacement Page 2 of 2 Based on my site visit and existing record documents, there are no known public water wells within 200 feet or residential water wells within 100 feet of the septic tank. The water service line enters the property from the east and then enters the building in the northeast comer, approximately 21 feet from the sewer line exiting the building. Please call (907) 694-2332 if you have any questions. Sincerely, RODNEY P. KINNEY ASSOCIATES, INC. odney P ' nney, Jr., P.E Project Engineer RPK:djm 1r - ► 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 NAME 6:., edx; c 'C.'Scc iA-ti ii''r-i fA .1 d:, PHONE Ld'NEW ❑ UPGRADE MAILING ADDS_ :'.7)�,,, f !.. ` ' " k3 (.) G ...> .,, -1 1`i I 101 0..i.._ -.i{2_ i I N1 t—. LEGAL DESCRIPTION L- =r /4 13 -K. Z.., ale-K h/l..t=%'eE=,C,. Sa; LOCATION NO. OF BEDROOMS �..d SEPTIC TANK DISTANCE TO: Well t'0w+ratLi 647'7'f' Absorption rea r' f? "" Dwelling / PERMIT NO. is t— e Manufacturer . �C K (.7 Material_, �)J _ �?."d-„ No. of compartments Liq. capacity in gallons ", IF HOMEMADE: Inside length -- ---_ Width __..__.._____. Liquid depth ® Y �c= TZ EF DISTANCE TO: Wen r� Dwelling PERMIT NO. Manufacturer �% /V Material Liquid capacity in gallons TILE DRAINFIELD TRENCH DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. No. of lines Length of each line N Total length of lines Trench width inches Distance between lines Top of tile to finish grade Material beneath tile inches Total effective absorption area SEEPAGE PIT Length „_ f Width i CA Depth/ / tr 7 re ef- e 5, z. r.,,vp,!a. r 6, 'ovoz PERMIT NO. a Type of crib Crib diameter (j Crib depth Total effective absorption area 45_( -(f l i4 �, / DISTANCE TO: Well a a ill/110V 2T Building foundation t? Nearest lot line / it! ul Class `y C 2 tri I' 21 Deptht/^-�T.,✓ �% /l 1111/ fF f / ( . '? 7' D illeerr _ S / ..,, /''r Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption areals) OTHERPi PIPE MATERIALS fr C SOI L TE� RATIN �v / 5t � INSTALLER REMARKS `7-`---Cg.-(10,1 T (VA,C) 'i' i. F (c i. l C -" I c:,, OAC : r (E�.1,�\ r) \f 1 i. i /4-'415 1 LI iy r 1 tl i RI 2 y 4° f APPEIED /,,! ,% / DATE LEGAL n.)Yi 1� ii dPe.. j.. ... 3rt.df 1 7 721Jd'1,$ (Rev. 3/78) Permit # MUNICIPALITY OF ANCHORAGE Department f Health and Environments Protection 825 L Street, Anchorage, AK. 99501 264-4720 HANDWRITTEN PERMIT * Applicant: ,�-( Location: WELL AND/OR. ON-SITE SEWER PERMIT Mailing Address; Phone Number: Legal Description: (L 62 /17 tD/NL, Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Maximum Number of Bedrooms: of Size: Holding Tank: Soil Rating (sq. ft/br) /77 /6ziw The Required Size of the Soil Absorption System Is: DEPTH f LENGTH 70 ( GRAVEL DEPTH / / 2 i WIDTH `_7L) 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(H EB+NG) TANK SIZE = C -)C) 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 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Muni ipality of Anchorage. (2) I will '.stall the a stem in accordance with codes. (3) I undd`rs.and that 'i e on-site sewer system may require enlargement if the'resoe , i emodeled to include more tha 3 bedroom Signed:Issued by: L licant Date: swP/024(1/81) PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST SOILS LOG Li PERCOLATION TEST 6//3,( xc DATE PERFORMED: 7 S - LEGAL DESCRIPTION: D E PT H (A,E 1 — ,EX• 2 — , 3 4 0 I) 5 — 6 — 6 7 — 8 — (O, 9 6 10 - 13 — 14 — 17 18 — 19 — 20 — -,- 14 i)cff, 5i-)iVL)y 'iVL ie Sfv,)Vfio iE /6147-ir - COMMENTS PERFORMED 72-008 (6/79) % / o r Ili mc)e,"/L c '12 SLOPE SITE PLAN AS GROUND VVATER NCOUNTERED? YES, AT WHAT sL IN. zi6 (4. Reading Date Gross Time Net Time Depth to Water Net Drop . PERCOLATION RATE TEST RUN BETWEEN FT AND CERTIFIED (minutes/inch) FT DATE 7---/17 ' 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I D # DJ`/'7q,2 1. GENERAL INFORMATION Complete legal description HAA # 1-(A 9i 5O 1 44,f, 13// z l `t-eae7 'i Location (site address or directions) Z zSZS Go. f��, 8- Property owner G Day phone 6yg% Mailing address 2252 a/, klreS�P2�,C,lt�yi4.Z/ le- ff,- 2 Lending agency Day phone Mailing address rn Agent Day phone Address o z Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water actAIA m � Z r. m 5 nZ t" N z 7b 2/o(a'77 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 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. 1/91) Front MOA 021 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 /07 40 effie / _1)24 v/ - Phone 67'/-5-/ = 7 Address /v//3 .J'„N ./ek 0, . le 4/c !� S7 7 Engineer's signature -.7/Date l �S p t:rinur ,,.ni.;,U CE 4392 6. DHHS SIGNATURE v` `cy Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: B Additional Comments CAUTION 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 and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: - 07 /``"/ /3/I L Parcel I.D. AC 4,1 ()(e) 4r74 A. Well Data C Well type If A, B, or C, attach ADEC letter. ADEC water system number -2 /O6 7 7 Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test c. o z_ Static water level 7°1 ly -es T J Well flow g.p.m. g• tryl co c Pump levell cp SEPARATION DISTANCES FROM WELL TO: f't n 4 Septic/holding tank on lot ; On adjacent lots o z Absorption field on lot ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA A Date installed ` ` 7 /6 -S Tank size /� � �f d Compartments % Cleanouts (Y/N) ! Foundation cleanout (Y/N) v N Depression (Y/N) /V High water alarm (Y/N) /- 4 �r Date of pumping f %'1c Alarm tested (Y/N) Pumper ���.Yr 1 Eo(fll1 I Uo Foundation /D SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots r� To property line /d Absorption field �v le Water main/service line Surface water/drainage /J ©�dl4a / //� c s f��� ,),-r., 6_ i / f CONTINUED ON BACK PAGE 72-026 (3/93)* Front 4 C. LIFT STATION Date installed !U Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump on" level at "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water N D. ABSORPTION FIELD DATA /3 e 1 /10-%'7/4 clvy,_, Date installed L�1 G 3 Soil rating (GPD/Ftz) System type � C��f Length z % / Width / G (7 Gravel thickness / (4 fl"cTotal depth` Jae 717)(e/ Total absorption area 6/50 t1 Cleanout present (Y/N) / Depression over field (Y/N) I Date of adequacy test g//0s Results (pass/fail) / �/� for ) Bedrooms/ Water level in absorption field before test ✓li After test 07/7 /4 L12',- Peroxide treatment (past 12 months) (Y/N) -AYIf yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /(1," On adjacent lots 71M i'h v� Gam/ Lf'2✓" /?/4 ✓ Property line /t To building foundation /0 To existing or abandoned system on lot On adjacent lots Cutbank A1/_ /v4 Water main/service line Surface water / Driveway, parking/vehicle storage area Curtain drain A) �7 FE. ENGINEER'S CERTIFICATION /o! I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on, fherdato of this inspection. Signature Engineer's Name Date q// / / HAA Fee $ c�ff1U tet) Waiver Fee $ Date of Payment /-' `o -t%// (�`: Date of Payment Receipt Number JJ .3 ���'' ) Receipt Number 72-026 (3/93)` Back MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Atik dhh�S, CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # HAA # I� 1 I 1 1C -".n2 • 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 14; Bach 2; McKLnfey View E4.a-te6 Location (address or directions) Homestead Road at Barron PnLue. (b) Property owner Steve Lu -then Telephone : (home) 376-8897 Business Mailing Address P,:'O.Box 870989 alaziL2a, Ata3Fza 99687-0989 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here, if hold for pick up.) List contact person and day phone number below: S & 5 ENGINEERING Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-FamilyX$ Number of bedrooms 3 3. WATER SUPPLY Individual Well ❑ Community K. 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 ax. 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 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wa::itewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effE:ct on the date of this inspection. Name of Firm Add cess Date, Telephone Loop Road No. 204 Eagle River, Afas.c `I7:;/? 794/-z97 6. DHHS APPROVAL Approved for 3 bedrooms by Approved Disapproved Terms of Conditional Approval Conditional Date z2d 4T2 Sq/Yrt 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 ar 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) Reck Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 A. WELL DATA E' <ur)!. ;_} tli, c, 3iC;iio isye Services Dept rie.iw Well Classification f \ Legal Description '`k•` 13t✓%4_,. 2_ 4t,,41. -s1 \e_vA �"3C , C, D.E.C. Approved) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 'Z®& ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot -D0' ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments P�5 VO 7,-iO bell B. SEPTIC/HOLDING TANK DATA Date Installed 1-1 -55 Size \c O2s No. of Compartments Z - Standpipes CON) Si Air -tight Caps0N) \i/ Foundation Cleanout/N) 7 Depression over Tank (Y, 4 Date Last Pumped 1— Pumping/Maintenance A Pumping/Maintenance Contact on File (Y/N) Holding Tank High -Water Alarm (Y/N) ; for Temporary Holding Tank Permit (Y/N) ' 1) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well ° To Building Foundation To Property Line Z�� To Disposal Field Lo`V To Water Main/Service Line lca' °V' To Stream, Pond, Lake or Major Drainage Course 1®2:3° Comments \-70t-A?eO 54 -11F, ' Po P�r�ltri 72-026 (Rev. 7/88) Front Page 1 of 2 C. AI3SORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed C.> 45(2.._ Type of System Design tJ Width of Field 1 Le' Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area 11'4 L' sli Statndpipes Present 0/N) Depression over Field (Y/b I� Results of Last Adequacy Test - G SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well Date of Last Adequacy Test 1' "Ll -c)\ Fo- To Property Line To Building Foundation / 10' To Existing or Abandoned System on Lot "JPr ; On Adjoining Lots \ To Water Main/Service Line -j a To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments \ooh `Y D. LIFT STATION Date Installed '`c.Ize iLL-C Mons "Pump On" Level Dimensions Manhole/Access (Y/N) "Pump Off" Level at Fligh Water Alarm Level at Iestedfor Meets MOA Electrical Codes (Y— Comments C; „Vent- /N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or confovmed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company n , .:,r�: lfivt;:r Loop hoad tela. 22(14 Aluda A 9957 Date 12 £Y/9 / MOA No C �` `�O Receipt No. P-.1_-16 , Date of Payment Amount: $ 72-020 (Nev. 7/88) Hack A. Ehgineer's Seal Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVTRONMENTAL HEALTH Z'J.EeL.WgjaLl: HENA-11 110-J.Z.j,EITY APPROVAL. rERTIPICLIE 1. General Information Application Date (a) ilegal Dascription (include lot, block, subdivision, wction, township, range) / . •) Nef 1:7H1:1 S Location (addcess or directions) (b) Applicants Naffe / Applicants Address //CO (c) Applicant 3 (check one) Lending Institution r ---T Owror/bolider <4• ; Other r I (explain); (A) ri...3nding Institution TelgOone Address TelE2212.21._e. I '„., i2 (e) Peal Estate Co. & Agent Addiuss ''" 7 '7 .7 2. TyDe of Rsidoncle Single -Family Number of Bedrcx,ffs 3, WaterSuppp. Individual Wellr Coromnitvi Other describe) Note: If conainity wall system, must have written confirmation from the State Department of. Environmental Conservation attestirq to the .legality and statue, Is the well adequate for thenumber of b,',:drcGms specified in this fikA (Y/N) 4. ,SLe_we. Disposal Onsite Gti'L Public Oommun'4CEL Holding Tank Is the wastewater disposal system adequate for the rumix3r of bedrooms (Y/N) [Page 1 of 2] 2-15-84 5 „ EnairiJeri.ryilirm Providing Inspections, Tests, and Information I certify that I have checked, verified, or conformd to al.]. MDA,HAA Guidelines in effect on the date of this inspection. Signe.d2,11., .`.-' r,11 -00 :11 Nam c)f 'F.' i /la S ef :::':, e,,::i: 41•60, At j, s _ /,1 4:- rib lephone Address_L (ENGINEER SEAL) . 6prOV Aporoved fortx-droatz Approved _A_ Disapproved r--11 Terms of Conditional Approval deing1=V: t..,:V6%., rif,am OF 0% At'•;11, " 1, . n% 'Ir5 E. SAAUOril , . „ 'fp) 'IrEMt, 5. 4,1 541 By 11 1 Date Corsilt lanai. •-vy ---,a_ The Municipality of Anchorage Department of fiaalth and Environrrental Protection dces not guantee the continued satisfactory performance of the water supply and/Or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished ty an erygineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the nmibe of bedrooms and type of structuee indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 2] A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: G /eildt ey 06:-/V Esm TES S o MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION' JUS Well Classification CUNIMUNot i(> B, or C, D.E.C. Approved(Y/N) Yr.:5 Date Completed /J71,0 Yield ./A Well Log Present (Y/N) )/A Total Depth X Cased to Depth of Grouting Static Water Level .-- Pump Set At v Casing Height Above Ground Sanitary Seal on Casing (Y/N) 7� Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot * ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot >-/00/ ; On Adjoining Lots it„/4 To Nearest Public Sewer Line /k/1-1 Cleanout/Manhole /C//1 Water Sample Collected By 6,:f -/U 6' Y or7 .C; Date Water Samr le Test Results Curren 3' PL 1, % `c = Z'7 { 4 % , - �' . C. ( 17) 7) 4- iE To Nearest Public Sewer Tb Nearest Sewer Service Line on Lot ru'AA B. SEPTIC/HGLD1NG TANK DATA Date Installed % -7 - 3 Size /000 64L No. of Compartments L Standpipes (Y/N) e , Air -tight Caps (Y/N) Yez, Foundation Cleanout (Y/N)\-tiC7, Date Last Pumped N 41 f' Depression over Tank (Y/N) �,((;,. � / �'- Pumping/Maintenance Contract on File (Y/N) ti,JA ; for Holding Tank High -Water Alarm (Y/N) ,;/A Temporary Holding Tank Permit (Y/N) r Separation Distances frau Septic/l Tank: To Water -Supply Tull '> Es > i To Building Foundation To Property Line 26:1 To Disposal Field 6 "j' To Water Main/Service Line > `a/ To Stream, Pond, Lake, or Major Drainage Course N `/l Convents Ki/ 'r c io =S' L FQLtx"/ 1,a.1/ii1( izt/liA?. f:A("Ac".`, (1}dei >zh r = tt"eiTI C::: ik P U1�i) [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /c0 Date Installed ` .- 7 -B 3 Width of Field Square Feet of Absorption Area 416'1 /,3,e. Type of System Design Length of Field Depth of Field 1 cl if scb 7' Gravel Bed Thickness Depression over Field (Y/N) Results of Last Adequacy lest _1,?61 Separation Distance from Absorption Field: To Water -Supply Well ,`>- 2(r)(..)1 To Property Line ( 01 Standpipes Present (Y/N) t('(2 Date of Last Adequacy Test AA tiY -tiL To Building Foundation 101 To Existing or Abandoned System cn Lot PJ/A ; On Adjoining Lots F To Water Main/Service Line S./C.O; To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course AJ/'f( A)(1it To Driveway, Parking Area, or Vehicle Storage Area 1 L , Corrnrents ( A 7771 f'/IS _ &)i47• . D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at Ai , pi) ,4i; t. c Dimensions Manhole/Access (Y/N) "Pump Off" Level at High Water. Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Electrical Codes(Y/N) Comments lest. Meets MOA ** ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA HAA Guidei,i,s in effect on the date of this inspection. Signed -7177 * ,_ %VL-/ Company .54., 0‘,16(tv&--&-RS /4C MOA No. sr 5! a).7- KB1/d5/s [Page 2 of 2] 2-15-84