HomeMy WebLinkAboutLILAC PARK BLK 1 LT 3A1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmenlal Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name ?/ DISTANCES
Address / TAN K FIELD WELL
Phone(s} Pe WELL
I Subdivision
Lot ~ Block / /_/~'d-. ~K FOUNDATION
Township, Range, Section
~z-~ R3zJ ~'~-- 2~2~ driveway,AS'BUILT DIAGRAM{Sh°wl°ca"°n°'well'septicsystem'pr°perWhnes'l°undati°n'~wa,er bodJes, etc.)
TANKS ~ ~- ~ ..... N
Manulacturer CapacJly in gallons
Malarial NO. ol CompaAments
TYPE OF SYSTEM
~TRENCH ~ BED ~ W. DRAIN ~ OTHER ~' .,q
Depth to pipe boltom from Total depth Irom original grade
original grade ~ FT /2~ ET
Gravel length ~ F~ i Gravel width ,~ FT
Told absorption area Distance between lines
Installer Date installed
WELLS
~PRIVATE ~ OTHER (Identify)
~c.le: ~' ENGINEER'S SEAL
Inspections Pedormed by:
Municipal an~ Slale guidelines in elfe~ on Ibis dale:
72-013 (3/85)
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENTOF NATURAL RESOURES
Division of Geological d Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL (Please complete either la, to or Ia.) A.D.L. No.
la. Borough Subdiviaian Lot Block Ib. 1/441rs. Section No. Township N ❑ Range E ❑ Meridian
t jAL 3 _of_of
—o1- - S❑ Wo
Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
3. OWNER OF WELL: I
/
Lr.4— it 7w-^;sVWsQo %
Address:
Street Address and Area of Well Location
2. WELL LOG
Feet Below
Surface
4. WELL DEPTH: (final)
S. DATE OF COMPLETIo1l
f1.
_ z
Material Type .Tap
Soltom
.�...G
2J#4
2L
S, ❑ Cable tool aitotary ❑ Driven ❑ Duq
❑ Auger ❑Jetled ❑ Bored ❑ Other
♦
/�
7. USE: gDomastic ❑ Public Supply ❑ Industry
❑ Irrigation ❑ Recharge ❑ Commerical
Test Well ❑ Other:
i
B. CASING: ❑ Thn ode � Welded
dlam.&—in, to epth Weight J7n lbs./ ft.
♦
401
w}t.
Mani Io�Q It. Depth Stlakup e9 It.
1
,
9., FINISH OF WELL: /
TYDe: plaineta I%
-
Slot/ ah Sln: Length:
Set between ft. and ft.
Backfilling Grovel pack
10. STATIC WATER LEVEL: ISO ft. A S
❑ Above or ❑ Below land surface Date
Equipment used:
11 . PUMPIN LEVEL below land surface and YIELD
�}t. after Z his. pwmping L g.PPm.
_ft. alter _h,&, pumpinq _ q.p.m.
'
12.GROUTING Wall Grouted: ❑ Yee ❑ No
Material: ❑ Neat Cement ❑ Other:
13, PUMP: (If available) HP
Length of Drop Pipe ft. capacity q.P.m.
❑ Suture. ❑ Jet ❑ Centrifical ❑ Other
14,REMARKS:
IG. WATER WELL CONTRACTORS CERTIFICATION:
la. Water Temperature ❑ F ❑ C
Thi& wol wan drilled dei u/istllcl on and• Is rapart Is true to l e/best of my knowledge and belief;
W., q/ o 8
Re ietared Bus' ase No
Contract LI c s/a Numb/er®
Address: ♦
signed:Pr
Dale: r
Authorized Repr enfotive
Form 02-W WR (11/BI) Copy Distribution:
WHITE -State DGGS, PINK-Drllleq CANARY-Cuctomar
n
O
n
P Iii: R M :I: T
AI',ICHORAGIE :, AK
S,::'c t :i. c!n: 22 Tc:~,.¢r'~.sh i p: :I. 2N Range: 3W
Lot
Max B~:.:,d r' i:::,c!ms
Day I:::l~'m~lle:
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arid J.n comp :1. :i. an(::(a ~,,~i't.h 1:.l'"~<a (::16:,-:::i.l:jr'i er" :i.t(.:::'P J.a~ (::~' tJ'i :[ :::. ]::)ePm:i.t ,,
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sea,Jer, age? ::~ys'l:..<:xn c)n '['.h :i. s cH" any aclj ~:~ l::: 6:)1' ~ '1:. C)I" I"l (.:.:,) ,:: [' ]:)y ]. (]'~
4,, :1: L.(f](:h:.:,r':::'L<:.:l'id that this per'm:i.t is wa:l. id [c:)r' a. maxirr~L(t'n c:)[' 4 I::x'ed!"c)(::xf'Js,, :!:
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..,..,,.{¢.f%d .....................................................................................
((:k,,~n:::.m) C;AI'qSIE:, CARl::::, I:::'l'.::]'l:::l::~S(]lq
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ALASKA fflUIROFIm F1T^L COFITROL SgI UlC $, IrlC.
~nqJn¢¢rJnq 6 (~nmronmenl~l $1u(Ijcs
SPECIFICATIONS FOR A TRENCH-TYPE WASTEWATER DISPOSAL SYSTEM
LEGAL DESCRIPTION: LOT 3, BLOCK 1, LILAC PARK SUBDIVISION
1.0 GENERAL
1.1 The Drawings, sheets 1 thru 6, shall be a part of this
specification.
1.3
All materials and workmanship shall meet the
requirements of the Municipality of Anchorage,
Department of Health & Human Services (DHHS), the
conditions of the permit, and all applicable rules
and regulations currently in effect.
1.3
All elevations and depths are advisory, and are to
be verified or modified in the field by the
engineer.or inspecting agency.
1.4
It is the responsibility of the property owner or
installer to adhere to approved designs for
installation, maintain the specified separation
distances, and have the appropriate inspections.
1.5
It is the responsibility of the property owner or
installer to report to the engineer any observed
conditions which would put the sytem in violation
of state or Municipal regulations.
1.6
If the installation is not inspected by an AECS
engineer, AECS will not be responsible for the
installed system. An engineer at AECS should be
cousulted prior to construction to determine the
number of inspections that will be required and to
explain what these inspections will involve.
3.0 SEPTIC TANK
3.1
If there is an existing septic tank, it may be
used it if meets the capacity requirement for the
residence and the approval of the MOA.
2.2
The septic tank shall be a UPC-approved
two-compartment tank, constructed of 12 gauge
steel with hitumasttc coating and set level on
undisturbed soil. If the tank is buried at a
depth of 4 feet or less, it must be Insulated with
an overlying layer of 2 inch burial type
polystyrene rigid board Insulation.
2.3 The septic tank and trench shall be a mlnimnm of
1412 WCS'E 331~0 Av6nu6 · Ancho~&q~., &[&$k& 99503 · {907) 279-5553
2.4
2.5
2.7
100 feet from any private well or body of water,
150 feet from Class "C" wells, and 200 feet from
Class "A' or "B" wells, unless otherwise
specified, Less than the required separation distance
must have prior approval or waiver by ADEC or MOA.
The septic tank shall be a minimum of 5 feet from
the house foundation, and a minimum of 5 feet from
the absorption area.
Piping shall be fitted with a mechanical
watertight calder coupling on the outlet and inlet
of the septic tank. Piping shall be 4 inch solid
PVC ASTM D-3034 or cast iron, sloped a minimum of
1/4 inch per lineal foot, If the piping is buried
at a depth of 4 feet or less, it must be insulated
with an overlying layer of 2 inch burial type
polystyrene rigid board Insulation.
Cleanouts shall be installed as designated and
capped with air-tight rain caps (Jim Caps or
equivalent), and extended a minimum of i foot
above ground level.
If a lift station is required it shall be a
combination lift station septic tank per Anchorage
Tank and Welding, Inc. design. Specifications and
design drawings are on file with the Municipality
and the engineer.
$.0 ABSORPTION AREA
3.1
The gravel for the trench shall be 0.5 to 2.5
inch, screened rock with less than 3 percent
passing 'the No. 200 sieve. All substitutes must
have prior DHHS approval.
3.2
The bottom arid sides of the excavation shall be
raked with the backhoe blade to ensure that it has
not been compacted during excavation. The bottom
elevation shall be level,
3.3
Monitor standpipe(s) shall be placed as shown in
the drawings, and shall be 4 inch rigid PVC ASTM
D-3034, or cast iron. The section shown with
holes may be 0.§ inch holes drilled on 6 inch
centers on opposing sides of the pipe, or a
regular section of perforated sewer pipe clamped
to a solid section with either a no hub coupling
or a solvent joint. A rubber rain cap (Jim Cap or
8.4
8.5
8.6
3.7
equivalent) shall be installed over the top of thc
pipe.
The distribution pipe shall be perforated 4 inch
PVC with a minimum crush strength of 1500 pounds
and shall meet the approval of DHH8 for use as
drainfield pipe. All distribution pipes shall be laid
level.
Trenches may be paralleled, but must have a
minimum separation distance between the trenches
of 10 feet or 2 times the gravel depth (which ever
is greater). 75 feet is the maximum allowed
linear length of any trench.
If the final grade over the trench is less than 4
feet above gravel, insulation is required, using
burial type polystyrene rigid board tusulatton.
There shall be 1 inch of insulation for every foot
of soil less than the required 4 feet of cover,
but there must be at least 24 inches of soil cover
even though insulation is used. The solid pipe
extending from tile septic tank 'to 'the drainfield
shall also have a minimum of 4 feet of cover or an
equivalent layer of insulation to prevent freezing
of tile line.
If Insulation is not necessary, the gravel shall
be covered with a layer of nonwoven Geotexttle
fabric (such as Mirafal, Flbretex 200 grade, Poly
Filter X or equivalent).
4,0 INSPECTIONS
4.1
A minimum of two inspections are required for the
installation of the trench. The first inspection
will be of the open excavation to assure that the
system is tustalled in the proper soil strata,
correct depth and meet minimum specified design
parameters.
4.2
The second inspection will be after placement of
the gravel, monitor standpipe and distribution
pipe to verify proper installation and position
prior to backfill.
4.8
The inspection of tile septic tank installation can
be Incorporated with any one of tile above listed
inspections.
4.4
The lift station will require either an MOA
electrical inspection or certification by a
licensed electrician, dependi~g on whether the
building code applies to this part of 'the city,
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
CHECKEO BY DATE
SCALE
~,~. ~ ~ ~*~ -i ~ ~'"'"~~ ,~'~"~i~'i ~""'"~
......... ~..........~...~ ~......~ ~ ........ ~ ......... ~ ....... ~ ......... ~ ~ ~. ~..~ ~ ~.1~ .......... ~ ~:~ ~ ~ ~ ........ ~ ~L. ~
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.
~. ~ ~ .... ~ ~ ......... ~ .... ~ ~? ~ ....... ~ ~ ~~ ~, ~ ........ ~ ~ ~ .~ ~ ....... ~ .............................
........... ~ ........... ~ ......... ~~ ~ ?~ ...... =~....~.~ ~.~~ ~ ~ ......... ~ ~
....... ....... ~ ~ ~ ........ ~ ....... ~..~.....~ ......... ~ ....... ~ ; ~ ~ ~ ~ ........ ~ ~ ; .~ [ ..... ~ ...... ~ ~ ....... ~ .......... ~ ........ ~= .... ~= ~ ~ ....
.......... ~ ~ ......... ~ ~ ~ ~ .......... , ....... ~ ~ ~ ~ ~ : ~ ~ ......... : .......
....... ~ ~ ~ ~ ~ ~ ? ~ .... ~ ~ ........... ~ ~ ~ ~ ~ ~ ~ ;
.......... E~++:..~..~ ..~.......~~ ?'"'~'~'~ ..~ ~~ ........ ~ ~' ........ ~ ............ ~ ............ ~ .......
.......... ........... ~ ~ ~ ~ .... ~ ~ ........... ~ .... ~ ...... ~..,~ ~ ~~,~;,~' .......... ~ ...... ~...,., ~ .......... : ........ ~ .............
........ ......... ~ ~ ~ ~ ........ ~ ........... ~ ~ ~ ............ ~T~A.....~ .~"-~ ~ ~ ,'~? ~ ~ ~ ~ ~ ~
ALASKA ENVIRONMENTAL
CONTROL SERVICES,. INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99.503
(907) 561.5040
CHECKED BY DATE
sO^,E /;'/~
X
ILl
H
H
PERFORMED FOR:
Munlcipallly of Anchorage ~ ,~
DEPARTMENT OF HEALTH & HUMAN SER~I~I
825 "L" Street, Anchorage, Alaska 99502-0~
SOILS LOG -- PERCOLATION TE~
Township, Range, Section:
1
2
3
4
5
6
7
'8
9
10-
11
12
13
14
15
16
17,
18
19
2O
WAS GROUND WATER
ENCOUNTERED?
SLOPE SITE PLAN
IF YES, AT WHAT
DEPTH?
Oepth to Waler Alter
Moniloring? .
Reading Date
PERCOLATION RATE
TEST RUN BETWEEN
(~ross
Time
Net
Time
COMMENTS ..~o/D ,,c:'~)-! .~?--f'& ,/~' ~47~--b /),7" 2../?''~' AJ,::~'t~7'~b
Depth to
Water
(minutes/inch) PERC HOLE DIAMETER
~ FTAND 7
Net
Drop
A ~'~'" CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDAN~E WITH ALL STATE AND MUNICiPAL GUiDELiNES iN EFFECT ON THiS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:.~'-~""..~ ~/~' /
L/£~_~ /~Z~'Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13,
14
15
16
17
18
19
20-
COMMENTS
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
IF YES, AT WHAT
DEPTH?
flepth to Water After ~?~/'
Moniloring? c.,~-- f Date:
Reading Date
Gross Net
Time Time
---....,
Depth to Net
Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch) PERC HOLE DIAMETER __
FT AND FT
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~'-'-'/(~ ~
72-008 (Rev, 4/85)
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
Date:
To:
From:
March 14, 1989
File; Lilac Park, Blk. 1, Lot
D.N. Bolles, On-site Services
Subject: Plated Easement for Storm Drain.
Per Public Works Lilac Park has not entered into a subdivision
agreement with the MOA. The storm drain has not as yet been
recorded and its outfall may be influencing lots below the
subdivision. Until these problems can be resolved no permit
should be issued for this lot. Any septic system installed must
be 100' up slope of the storm drain or 30' down slope.
db/56
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 563,-5040
SHEET NO / OF
CALCULATED BY DATE
CHECKED BY DATE.
SCALE
,' /. ,: :~,/ ~'%
--'-~ ~ / //'/' -~:~-~-~,,.. ~1 ;~?'
.... " I I I II ~1 ~~ . , ~
U ~ ~ o~
. z ,~%.~ .~~
.......... ....... -' '-
I HEREBY CERTI~ T~T I I~VE SURVEYED THE FOLLOWING DESCRIBED
PROPERS: ~T .~ _, BLOCK ~ , L~ ~ ~e~o~% ,. gYJ'~.
~c~ RECORDING DISTRICT, A~S~, AND T~T THE
IMPROV~ENTS SITUATED THEREON ~E WITHIN T~ PROPERTY LINES
~D DO NOT ENCROACH ONTO THE PROPERTY ADJACENT THERETO, T~T
NO IMPROVE=NTS ON THE PRO~P=TY LYING ADJACENT THERETO ENCROACH
ON THE S~VEYED PREMISES AND TI~T THERE ARE NO ROADWAYS, T~NS- ~ ~ ....
MISSION LI~S OR ~HER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT
AS INDICATED HEREON.
DATED ~HZS THE 1~~ DAY OF ~ ~ 19~%~ AT ANCHORAGE, A~AS~
Tom Fink,
Mayor
Nlunicipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
October 26, 1988
AECS
Mr. Lee Reid, P.E.
1412 W.33 AVE.
Anchorage, AK. 99503
Subject: Lot 3 BI.k.1 Lilac Park
Dear Mr. Reid,
Per our conversation this morning the permit application for the
subject lot will be held until a new absorption area and reserve
site can be found.
If the existing storm drain is to remain on Lot 3 an easement
will be necessary and appropriate setback requirements would be
observed. If, in the course of further investigation, it
becomes necessary to utilize a portion of the fill area for the
septic reserve you would need to document the composition and
thickness of the fill. We also would require data as to the
presence or absence of the native root mat under the fill, as
this could be a conduit for periodic ground water.
Please let this office know if there are any further
developments which may affect the issuance of this permit.
Sincerely,
Daniel N. Bolles
On-site Services
cc: A1 Sundquist, P.E., Manager On-site Services/ Water Quality
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
DATE:
TO:
From:
October 26,1988
File; Lot 3 Blk. 1 Lilac Park
D.N. Bolles, On-site Services
Subject: On-site sewer location.
On 10/21/88 Turner Construction applied for an on-site sewer and
well permit for the subject property. The test hole and site
plan had been performed by AECS, and proposed a 60' trench with
5' of gravel below the discharge pipe. AECS mentioned the storm
drain to the south of the proposed septic reserve area was 77'
away. Upon a site visit on 10/26/88, by this office, it was
discovered the discharge line for the storm drain actually ran
to the north of the platted easement through Lot 3.
Also it was discovered that AECS had knowledge of this and in
fact had dug up a portion of the storm drain while digging the
test hole for the septic system. This was not mentioned in the
permit request to this office and the reserve area did include
the are~ of the storm drain.
At the time of our visit it was also noted that the majority of
the reserve area was within a large fill area, which fill area
covers lots 3,4, and 5, containing trees, logs, and other
organic materials. It is also very unlikely that the native
organic mat was removed prior to the placement of fill in this
area.
Mr. Lee Reid, of AECS, was notified of our findings and told the
septic system and reserve area must be outside the fill area.
The storm drain passing through Lot 3 would also have to be
platted and recorded. He will get Turner Construction to talk
with Mr. Cange, Mr. Carr and/or Mrs. Peterson, the owners, about
these and get back with an appropriate solution.
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
DATE:
TO:
FROM:
October 26, 1988
File; Lots 4&5 Blk.1 Lilac Park
D.N. Bolles, On-site Services~
SUBJECT: Imported fill.
A site visit by D.N. Bolles and S.E. Oswalt, on this date,
revealed that almost all the available area on both the subject
lots had been covered with imported fill material. The
thickness of the fill varies~ however, the eastern extremity
would seem to exceed 15' in depth. This fill material contains
trees and other organic materials, thus rendering it
unacceptable for use by on-site waste water disposal systems.
Another concern is that the native organic mat may not have been
removed and thus act as a conduit for surface and ground water.
Also the storm drain platted along the back of Lots 1 and 2
along the side of Lot 3, discharges through 8 CMP to the north.
This pipe crosses Lot 3 and may cross over portions of Lots 4
and 5 as well.
Until these items can be taken care of the subject lots cannot
receive approval for on-site well or septic. The storm drain
must be platted and an easement grante~ also no septic system
may be allowed within 100' up slope or 30' down slope of the
storm drain. The fill area must be probed and the content and
depth determined.
ALASKA nulRonm nTAL COFll'I OL $6RUIC $, IFIC.
[~n§ineerin§ $ [~noironmenlo] $1u~iies
SPECIFICATIONS FOR A TRENCH-TYPE WASTEWATER DISPOSAL SYSTEM -
LILAC PARK SUBDIVISION, LOT 3, BLOCK 1
1.0 GENERAL
1.1 The drawings, sheets 1 through 4, shall be a part of this
specification.
Ail materials and wcrkmanship shall meet the requirements of
the Municipality of Anchorage, Department of Health & Human
Services (DHHS), the conditions of the permit, and all applicable
rules and regulations currently in effect.
1.3 All elevations and depths are advisory, and are to be verified
or modified tn the field by the engineer or inspecting agency.
1.4
It is the responsibility of the owner or installer to adhere to
approved designs for installation, maintain tile specified separation
distances, and have the appropriate inspections.
1.5
If the installation is not inspected by an AECS engineer, AECS will
not be responsible for the installed system. An engineer at AECS
should be consulted prior to construction to determine the number of
inspections that will be required and to explain what 'these
inspections will involve.
2.0 SEPTIC TANK
2.1 If there is an existing septic 'tank, it may be used if it meets the
capacity requiremel~t for the residence and the approval of the MOA.
The septic tank shall be a UPC-Approved two-compartment 'tank,
constructed of 12-gauge steel with bitumastic coating and set
level on undisturbed soil. If the tank is buried at a depth of 4
feet or less, it must be insulated with an overlying layer of 2 inch
burial 'type polystrene rigid board insulation.
2.8
The septic tank and trench shall be a minimum of 100 feet from any
private well or body of water, 150 feet from Class C wells, and 200
feet from Class A or B wells, unless otherwise specified. Less than
the required separation distance must have prior approval or waiver
by ADEC or MOA.
2.4 The septic tank shall be a minimum of 5 feet from the house
foundation, and a minimum of 5 feet from the absorption area.
2,.5
Piping shall be fitted with a mechanical watertight calder coupling
on the outlet and inlet of the septic tank. Piping shall be 4-inch
solid PVC ASTM D3034 or cast iron, sloped a minimum of 1/4 inch per
lineal foot. If tile piptug is buried at a depth of 4 feet or less,
]200 UJcsl 33rd Aucnu¢, Suil¢ [~ · ~,¢horoq¢, A]osk~ 99503 · (907) 276-]36]
it must be insulated with an overlying layer of Z inch burial type
polystrene rigid board insulation,
2.6
Cleanouts shall be installed as designated and capped with air-tight
rain caps (Jim caps or equivalent), and extended a minimum of 1 foot
above ground level.
2.7
If a lJ. ft station is required it shall be a combination lift station
septic tank per Anchorage Tank and Welding, Inc. design.
specifications are attached.
3.0 ABSORPTION AREA
3.1
The gravel for the trench shall be 0.5 to 2.5 inch, screened rock
with less than 3% passing #200 sieve residual. Ail substitutes must
have prior DHHS approval.
3.2
The bottom and sides of the excavation shall be raked with the
backhoe blade to insure 'that it has not been compacted during
excavation. The bottom elevation shall be level,
3.3
Monitor standpipe(s) shall be placed as shown in the drawings, and
shall be 4 inch rigid PVC ASTM D3034, or cast iron. The section
shown with holes may be 0.5 inch holes drilled on 6-inch centers on
opposing sides of the pipe, or a regular section of perforated sewer
pipe clamped to a solid section with either a no hub coupling or
a solvent joint. A rubber rain cap (Jim cap or equivalent) shall be
installed over the top of 'the pipe,
3.4
The distribution pipe shall be perforated 4 inch rigid PVC with a
minimum crush strength of 1500 lbs and shall meet the approval of
DHHS for use as drainfleld pipe. All distribution pipes shall be
laid level.
3.5
Trenches may be paralleled, but must have a minimum separation
distance between the trenches of 10 feet or 2 times the gravel depth
(whichever is greater). 75 feet is 'the maximum allowed linear length
of any trench.
3.6
If the final grade over the trench is less than 4 feet above gravel,
insulation is required, using burial type polystyrene rigid board
insulation. There shall be I inch of insulation for every foot of
soil less than the required 4 feet of cover, but there must be at
least 24 inches of soil cover even though insulation is used. Tile
solid pipe extending from the septic tank to the dralnfield shall
also have 4 feet of cover or an equivalent layer of insulation 'to
prevent freezing of the line.
3,7 If insulation is not necessary, tile gravel shall be covered with a
layer of nenwoven 6eotextlle fabric (such as Mirafai, Fibretex 200
grade, Poly Filter X or equivalent).
4.0 INSPECTIONS
4.1
A minimum of 'two inspections are required for the installation of the
trench. The first inspection will be of the open excavation to
assure that the system is installed in the proper soil strata,
correct depth and meet minimum specified design parameters.
4.2
The second inspection will be after placement of the gravel, monitor
standpipe and distribution pipe to verify proper installation and
position prior to backfill.
4.3 The inspection of the septic tank installation can be incorporated
with any one of the above listed inspections.
PERFORMED FOR:
LEGAL DESCRIPTION:
Municipality of Anchorage ~'~,; 4
DEPARTMENT OF HEALTH & HUMAN SERVICES g
825 "L" Street, Anchorage, Alaska 99502-0650 ~~~.~.....~ ~.~
~
so, s
J...~ ZT/ Z'//'w.. ,D~r/ Township, Range, Section:~-/,~/jf--~_~z.o
1
2
3
4
5
6
7
8
9
10
11
12
13-
14
15
16
17
18
19
20
COMMENTS
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED? /t~
IF YES, AT WHAT
DEPTH? ""---'
Deplh to Water Alter
Monitoring? ~ ~f Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
'~/~/~z' ;/~ /~ - /~ '~ '7' ~.~ 7 ~ ~
PERCOLATION RATE /' / (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN _,~"¢-'- FTAND ,~', ~) FT
PERFORMED BY: 'J~' J ~ ~/, ~- ~' ~
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: . / ~)/~t/&:~''''
72'008 (Rev. 4/85)
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO. / OF
CALCULATED BY CATE
CHECKED BY DATE
SCALF
iii
ii1
II
~ .J
Z j
H ~
( Z
U~ H
H
tU Z
n (3
O J
0
J
§
Z
0
0 ' O] ~, 0 0 0
O~O u-~ 0(:30
Ooo
PLOT ~)I, AN ~<
KENNETH. G. LP2,1G, L.S.
AS BUILT __ " SCALE
1731 GEORGE BELL CIRCLE, ANCHORAGE, ALASKA 99515 (907) 345-6476
I HEREBY CERTIFY THAT I HAVE SURVEYED' THE FOLLOWING DESCRIBED
PROPERTY: LOT .~ , BLOCK I , ~~>lv~
~ RECORD,I, NG b~RICT, A-LA-S~HAT THE t
iMPROVEMENTS SITUATED THEREON ARE WITHIN 'THE PROPERTY LINES
AND DO NOT ENCROACH ONTO THE PROPERTY ADJACENT T}r~RETO, THAT
NO IMPROVEMENTS ON THE PRO:PERTY LYING ADJACENT THERETO ENCROACH
ON THE SURVEYED PREMISES AND THAT THERE ARE NO ROADWAYS, TRANS-
MISSION LINES OR OTHER VISIBLE EASEMENTS ON SAID PROPERTY' EXCE'PT
AS INDICATED HEREON. ·
DATED THIS THE 14j& DAY OF .(Pc.~ro~r~ , 19~%%, AT ANCHORAGE, ALASKA
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
DATE:
TO:
From:
October 26,1988
File; Lot 3 Blk. 1 Lilac Park
D.N. Bolles, On-site Services
Subject: On-site sewer location.
On 10/21/88 Turner Construction applied for an on-site sewer and
well permit for the subject property. The test hole and site
plan had been performed by AECS, and proposed a 60' trench with
5' of gravel below the discharge pipe. AECS mentioned the storm
drain to the south of the proposed septic reserve area was 77'
away. Upon a site visit on 10/26/88, by this office, it was
discovered the discharge line for the storm drain actually ran
to the north of the platted easement through Lot 3.
Also it was discovered that AECS had knowledge of this and in
fact had dug up a portion of the storm drain while digging the
test hole for the septic system. This was not mentioned in the
permit request to this office and the reserve area did include
the area of the storm drain.
At the time of our visit it was also noted that the majority of
the reserve area was within a large fill area, which fill area
covers lots 3,4, and 5, containing trees, logs, and other
organic materials. It is also very unlikely that the native
organic mat was removed prior to the placement of fill in this
area.
Mr. Lee Reid, of AECS, was notified of our findings and told the
septic system and reserve area must be outside the fill area.
The storm drain passing through Lot 3 would also have to be
platted and recorded. He will get Turner Construction to talk
with Mr. Cange, Mr. Carr and/or Mrs. Peterson, the owners, about
these and get back with an appropriate solution.
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. Cf
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, blo~.k, subdivision, section, township, range) ,,7
Location (address or direotions)
Z / .
(b) Property owner ~¢~ ~~' ".~:eleph0ne: (home) ~ Business~/
Mailing Address ~ ~¢Z ~¢~ ~~~,
(c) Lending Institution ff/~ Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
(e)
Mail the HAA to the following address: (or check here Id for pick up.)
List contact person and day phone number below:
2. TYPE OF RESID~_~E
Single-Family ~ Number of bedrooms /.__Z____
3, WATER SUPPLYy
Individual Well [i~ Community [] Public []
Note: If=commur)ity.well system, mus,~ have written confirmation from the Stat'e Department of Environmental
Conservation attesting to th legality and status. ' :' " '"
4. SEWAG~SAI' .
On-siteL~ . 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,
72-025 (Rev. 7/88) Page 1 of 2
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suo!ss!u~o ~o s~o~Jo ~oJ elq!suods@] leu s! el~e~oqou¥ jo Xl!led!o!unl~ eq.L'ponss! s! e]eo!~!]~oo B eJojeq e~,ep ozXIBUe ~o
suoRoedsu! ]onpuoo leu op SHHQ jo SeeXoIdLU~ 's~ueuJe~!nbe~ e~e]s pue le~epeJ u!e~eo,~s!]Bs m, ]@pJo u!
~u!puel J!eq:~ pue SOLUOq JO sJoseqo~nd o~, /~se),Jnoo e SO S!q~, seep SHHO eql 'e~SelV ,~o @~B~S @q~, u! poJe~,S!6OJ
Jeeu!bue leuo!ssejoJd ~,uepuedepu! ue,~q eAoqe ~ qde46eJBd u! U@A!~ suoR~ueseJdeJ eq~ uodn ,~lUO peseq
le^oJddV ~!Joq~nv q~,leeH senssj (SHHQ) seOJAJ@S UeLUnH pu~ q~leeH ~o ~,UeLU~Jedeo e~BJoqou¥ ~o X~!lBd!o]un~ eq.L
leUO!t!puoo
leAoJddV teuo!~!puoo to SLUJO/
pe^o]ddBs!G 2/. pe^oJdd¥
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Aq smooJpeq ~ Jc;t p@^oJdd¥
'I'VAOIJcldV SHHO '9
leos sjeeu!Su3
pue led!o!unv~ lib q~,!M eoUeildtuoo u! s! LUO~,S/,S lesodsip JO1BMO~SBM Jo/puB/~lddns JO~BM el!s-uo eq~, 'uoRoedsu!
pub uo!leDRSeAU! Xw woJJ pue SeliJ ebeJoqouv jo Xl!lBd!olunlAI oq~, woJ~ peu!e~qo uop, BwJoju! oq~, uo pesBq
~,eLl~ ,~!Je^ Jeq]Jn~ I 'u!eJeq pm, Bo!pu! eJn)~onJ),s ~o ed~, pue swooJpeq ~o ~equJnu eq~, Joe e~,Bnbepe pue iBuop, oun,t
'e~Bs s! we~s/,s IBsOds!p ~e~BMe~seM ~o/puB-,~lddns ~e~Bt4. e~!s-uo eLl~ ~Bq~ S~OMS le^oJddv ~poq~nv q~lBeH'
s!q~ jo uoRBDRse^u! Xw ~eLl~ X~pe^ I 'Moleq UNiOqS e~Bp uoReP!lB^ etl~ ~0 SB pUB o~,e~eq pex!BB IBOS Aw Aq pe!¢!~eo sv
NOIJ.¥1NI;IOJNI ON'¢ ¥.L¥0 'HOEIV~S =1'114 'SJ.S=1.L 'SNOI.LO=1dSNI 9NIOIAOI~d INI:II-I !DNIH=1=INIgN=1 .cj
A. WELL DATA
Well Classification
Well Log Present (Y/N) ~
Total Depth /'7'7/Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
MUNICIPALITY OF ANCHORAGE (MOA) ~
MU Nl¢l~H.altl~l=A~t~f~J~j3A p p r o v a I (HAA)
~~l~ON~ ~[~ ~I~UA R Y 1984
343-4744
JUN 2 [ [990 Legal Description:
~ ~ ~ If A, B, C, D.E.G. Approved (Y/N).~/~
_ Date Completed
Depth of Grouting
Pump Set At
'~>//,~ // Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Water Sample Collected by
Water Sample Test Results
Comments ~ ~'~
To Septic/Holding Tank on Lot /'~Z~C'~/' ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /~'(~"~ / ; On Adjoining Lots
To Nearest Public Sewer Line /(J'/,,z~ To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot //~ /
-~'~./'~¢(~_ ~L::;~- L/7~/// ;Date
/
B. SEPTIC/HOLDING TANK DATA
Datelnstalled c'?//~/(~"~ize /~-¢~:~'(~ No. of Compartments
Standpipes (Y/N) ~'/ _Air-tight Caps (Y/N) _ .Y Foundation Cleanout (Y/N)
Depression over Tank (Y/N) ~ Date Last Pumped //L'/z~--'/
Pumping/Maintenance Contact on File (Y/N) /U//~r- ; for
Holding Tank High-Water Alarm (Y/N) //L-~-./),,~ Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well /~'~ / To Building Foundation
To Property Line ~'~C'¢/ /(/', /~ To Disposal Field
To Water Main/Service Line ~ -//'~:) /
To Stream, Pond, Lake or Major Drain§ge Course
Comments ,~'~F/-CE///~-,¢:¢/ ~'./g'/~/OC'~
,?, O /
72-026 (Rev. 7/88) Fronl Page t of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ':~'~///'~ff~'
Width of Field ,_~
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field ~--~'~
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well /,~c"~ !
To Building Foundation '~'~ / To Existing or Abandoned System on
Lot /t..J//¢~ ;On Adjoining Lots
To Water Main/Service Line ~//~2~--~ / To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
/
To Driveway, Parking,Area, or Vehicle S. torage Area /~ 'f'-
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm I
Tested for
Meets MOA Electrical Codes
Comments
Dimensions
Manhole
(Y/N)
Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Ra
I certify that
inspection.
Si,
Corn
Date
MOA No.
Against HAA Request**
or conformed to all MOA and HAA
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
the date of this
Seal
.j
~IS¢.- $ ':) '- ~3rm" "*4
O~
· ' AS BUILT ./. SCALE
!73] GEORGE I~ELL CIRCLE ANCHORAGE, AI~hSKA 99515
(907) 3A5-6476
i HEZEEY C£F.'!iFf TiL:.,T i FJ. VE SURVEYED TH?. FOLLOWIX~ DESCRIBED
~'~e~L~ RECORDING DISTRICT, A~SKA, .~{D T~hT THE
!i'I?EOV~,fE3.~S SITUATED THEREON ~E WITHIN Th~ PROPERTY LIh~S
A]'~, DC NOT ENEROACH ONTO THE PROPERTY ADJACEh~ Th~t~O, T~AT
~O 2~IFIOV~-~TS ON THE PROP~TY LYING ADJAC~Z THERETO ENCROACH
3N Z~ SURVEYED PRE~;ISES ~D TI~T THERE ARE NO ROADWAYS,
."CESiON L!}(ES OR OY~IER VISIBLE EASE>~EI~S ON SAiD PROPERS' EXCEPT
.:.5 i}OICATED HEREOX.
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
ATE WATER SYSTEM
Name
Phone No.
Mailing Address
Cily State
Mo. Day Year
S/~/~PLE TYPE:
r~Y' Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
Zip Code
) [] Treated Water
[] Untreated Water
SAMPLE
NO.
I
I
I. L,,OCATIO,
Time Collected
Collected By
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
TO BE COMPLETED BY LABORATORY
saSiS shows this Water SAMPLE to be:
tisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received
Time Received ~ {'~ ~___r~
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Result*
- I CCI
J I-']-1
BACTERIOLOGICAL WATER ANALYSIS RECORD
Analyst
Membrane Filter. Direct Count.
Verification: LTB
Ccllform/100ml
· BGB
Final Membrane Filter Results
TNTC = Too Numberous To Count
OB =.- Other Bacteria
Collform/lOOml
Time: //~-~ [,~-'-~ a.m.
p.m.
R~MAIf, i:)ER TO FOL, L,O~
LAB INSTRUCTIONS for Work Order I 22S83
Date Report Printed: JUN 21 90 e 15:$4
Client Sample ID:L3 B1 LILAC PARK
PWSID :UA
Collected JUN 19 90 ~ 16:00
Received JUN 19 90 @ 16:25 hrs.
Preserved with :AS REQUIRED
Client Name : CORWIN & AS30C
Client Acct : CORWINP
P.O.I NONE RECEIVED
Req !
Ordered By : BRUCE CORWIN
ChemLab Ref. ! :901956
Analyeie Completed : ~e-~D-~) Send Report8 to:
Laboratory Supervieo: :STEPHEN C. EDE I)CORWIN & ASSOC
Relea.ed By : Cyo.~r~%~ 2)
Special
Instruct:
Chemlab Client Parameter
Sample ~ Sample Do.cription Matrix To Test Method Unlt~ Result
MUNICIPALTY OF ANCHORAGE
MEMORANDUM
Date:
TO:
FROM:
SUBJECT:
June 26, 1990
Accounting and Budget
DHHS
On-site Services
DHHS
Request for Refund - Account # 2570-9426
Please make arrangements for the following refund. This is
a duplicate application of the same property and function.
The owners decided to pursue the application thru the other
application (Corwin) .
Thank you.
Alaska Environmental Control Services
PO Box 240668
Anchorage, Alaska 99524
Amount: $170.00
Receipt #21975/6381
Account #2570-9426
Lot 3 Block 1 Lilac Park Subdivision
Health Authority Approval
Laura J. Montgomery
On-site Services
/'
Municipality of Anchorage ~ OS--
DEPARTMENT OF HEALTH AND HUMAN SERVICES 2,~_ 9 75
Environmental Services Division -
Telephone: 343-4744 .......
ON-SITE SERVICES FEE DOCUMENTATION
Name of Payer: (Name on C~heck)
Mailing Address: (Off of check) .. .
_ /~ 7 -~ --~. -, n.-'%dz~ ~ J ,.
Legal Description(s):- ~ '-~ ~ ./ ~ '~ ,./C~-
Permit Number:
Receipt #:
Check #:
Type of Payment: (Indicate Amount Paid)
Health Authority: ? ~ff'~ ,~i~9
~.~er & Well Permit:
Well Permit:
Sewer Permit:
Copy Request:
72-034 (Rev. 10/87)
Excavator Permit:
Engineer Permit:
Pumper Permit:
Well Driller Permit:
Tank Manufacturer:
(Waste Treatment)
DISTRIBUTION:
WAIVERS:
Lot Line:
Well to Tank:
Well to Field
Field to Surface Water
Tank to Surface Water
WHITE--MASTER FILE CANARY--PROGRAM FILE
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPFIOVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include t0t, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner 7'u ~-~ e.¢ Co~,rCV'~,~-'/~/o~. TelephOne: (home)
Mailing Address'_ ~ ~ ~0~ F? .~a~e ~
_ Business
(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:
2. TYPE OF RESIDENCE
Single-Family~/ Number of bedrooms
3. WATER SUPPLY
Individual Well ~
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 J~ Public r-] 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,
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functionalcmd 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 /~ L~~' ~zTS-~c Telephone
Address ~ ~ ~Y~ ~ ~ ~ ~ ~.y
Approved for bedrooms by Date
Approved _. Disapproved/
Terms of Conditional Approval I O ~"
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 ANCHORAOE
ENVIRONMENTAL SERVICES DIVISION
JUN 2 1 1990
RECEIVED
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST- FEBRUARY 1984
343-4744
Legal Description: ~-'~ ,~/
A. WELL DATA
Well Classification
Well Log Present CN)
Total Depth /~/ Cased to J2~
Static Water Level __ ? / ~
Casing Height Above Ground /~' /
Electrical Wiring in Conduit CN)
SEPARATION DISTANCES FROM WELL:
If A, B, C, D.E.C. Approved (Y/N)
Date Completed /O////~'~' Yield
Depth of Grouting ~',~/:,~-,~.
Pump Set At /?j.. z
Sanitary Seal on Casing (~4)
Depression Around Wellhead (Y~)
To Septic/Holding Tank on Lot ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ' [,.~ ' ; On Adjoining Lots
To Nearest Public Sewer Line ~/~ To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot ~'-~
Water Sample ColJected by ~o¢~,~ $,~/-¢r~,~J-~- ; Date
Water Sample Test Results /~. e'/,' ~ /V, Y'¢ e,~£; ,~
Comments
SEPTIC/HOLDING TANK DATA
Date Installed ~-~-z~-~? Size
Standpipes (Y~)
Depression over Tank (YN~
Pumping/MaintenanCe Co'ritacto,.n File (Y/N)
/,~'-~) No. of Compartments
Air-tight Cap (.~N) Foundation
Cleanout~_,)N)
,/
Date Last Pumped /'J/,~
A)~4~ 'for
Temporary Holding Tank Permit (Y/N)
Holding Tank RJgh-~Wate?'Alarm (y/N)
SEPARATION"DiSTAN~'~. ~.R,~¥'~.bPTIC/H O LDING TANK:
..... . ...... ,., ,p CZ..O /
To Water-Supply Well
To PropertY'Line, ~' :iu,.: , ;?~: /t;/,~ o
, .';"...t: ~. ,~ ,~.,/
To Water Mai'n/Se~'bice Line ~,
To Stream, Pond Lal~e,or. Maj~¢'Drainage Course
Comments
To Building Foundation
To Disposal Field /?
72-026 (Rev. 7/88} Fronl 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(~)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well /0/¢~ ~
To Building Foundation
Lot /,///'CF
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
StatndpipesPresen (Y~)
Date of Last Adequacy Test
To Property Line 7
To Existing or Abandoned System on
; On Adjoining Lots
,/
To Cutback (if present)
Comments
D. L~ON
Date I nstalle~d-----.
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
· "Pump Off" Level at
~ Vent (Y/N)
~ ~Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I cert,fy that l have checked, verified, o.r conformed to all MOA and HAA ¢~e~ ~s,~pl~e.~_Lon the date of this
inspection.
~ / ~, ¢ ~ ~ ~noineer's Seal
MOA No. ~ 70
Receipt No. ~ [ Y /_~ / ~¢)// Recei~~ '
Date of Payment ~ "-~¢' ~ Waiver Fee: $
Amount: $ /~() t~ Date of Payment
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