HomeMy WebLinkAboutSPRING FOREST BLK 1 LT 7AOnsite File
#015-321-34
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: OSP191503
Work Type: SepticTank Upgrade
Tax Code Number: 01532134000
Site Legal Address: SPRING FOREST BLK 1 LT 7A G:2538
Site Mailing Address: 5920 WEST TREE DR, Anchorage
Owner: JEPPSON JOHN K & LINDY S
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date
,�1�tien1
`uAi "lial
r
Depa rttnent
Lot Size in Sq Ft:
Total Bedrooms:
11/13/2019
11/12/2020
40332
❑ Disposal Field Q 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
)*k
Received By: ,
Issued By:b&&'(_{6'sul&
Date: // //2'' 1
Date:
4V
MUNICIPALITY OF
Development Services Departments
On -Site Water & Wastewater Section �R
Parcel I.D. 015-321-34
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Property owner(s) JOHN JEPPSON
Mailing address 5920 WEST TREE DR ANCH AK
Site address SAME
Phone: 907-343-7904
Fax: 907-343-7997
Day phone ?-0Z 4Vi2V
Legal description (Sub'd., Block & Lot) SPRING FOREST BLK 1 LT 7A
Legal description (Township, Range & Section)
Lot Size 40,332 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF) 0
(w/wo AD U)
Septic Tank ElUpgrade Fx I Duplex (D) ❑
Holding Tank ❑ Renewal El
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
^ 3�56789��,
O
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:VOILA(, 10
aI n
I certify that the above information is correct. I further certify tht is is in accorda c1 with
applicable Municipal Codes. `�0` q,ti
0 68L99"1
(Signature of property owner or authorized agent)
Permit/Rush Fees: a?5- Waiver Fees:
Date of Payment: 114-0 ����y Date of Payment:
Receipt Number: ZtqoA Receipt Number:
Permit No. Own �b3 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Nov. 5, 2019
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: Septic tank replacement
Legal: SPRING FOREST BLK 1 LT 7A
To Whom it may concern:
This is a request for a septic tank permit on the above referenced lot. The tank is old and needs to be
replaced due to problems with the tank baffle.
This permit will not impact any of the neighboring lots due to the size and good soils.
Sincerely o Y `
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
PROPERTY LINE
EXISTING WATER
SERVICE
ALL LV)TS IN THE
SU(
SION
SERVETIYCOMM.
SPRING FOREST
BLOCK 1,LOT 8
REMOVE AND REPLACE
ORfTANK W/ 1500 GALLON
\0Cd,11 PLASTIC TANK W/ 20"
7',Cd
r"<*
RISER, DECOMMISSION
PER THE UPC.
z-XISTINd,,5
BEDROOM,,
HOUSE
SPRING FOREST
BLOCK I,LOT 7A
NOTE:
LLS WITHIN 500'OF PROPERTY.
NO WE
SPRING FOREST
BLOCK I,LOT6A IS4 SPRING FOREST
TRACtA
..... . . . ..... . ........ . ....... ... .... .... ...
.............
........ ... .. . ....... . ........ .
--------------- - - - - - - - - ----
.. . ........ ........ ... It
-O'MALLEY ROAD -
Septic Tank Replacement
JOHN & LINDY JEPPSON
SPRING FOREST, BLOCK 1, LOT 7A
Anchorage, Alaska
Michael N. Anderson, RE DATE:
4601 NATRONA AVE DRAWN:
ANCHORAGE, ALASKA 99516
(907) 727-8864 / FAX: (907) 345-1391 SCALE:
PROPERTY LINE
*_ F 44
AV
,w
Ar 49 TH
..................... ................ .....
0
0. ..................
0, 0
11/4/2019 0 MICHAEL N. ANDERSON."
No. E P469
DJR
1 11=50'
Municipality of Anchorage Page / of_~/-
· DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL_ SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343~4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Name:~//~/,. --~~' WastewaterSystem: B New ~ Upgrade
Address:
Phone: Ne. of Bedrooms:~ ~eep Trench ~ Shallow Trench ~ Bed ~ Mound
Other
Soil Raling: Total Depth from original grade:
Lot: ~..~ BI'~C~: /~' Subdivision'.~ ~." Depth lo pipe bottom from original grade:~,~ Ft. Gravel depth beneath pipe~,~ Ft.
,Tow~ship:/~ /t IR,.g,: ~ ~ -'rSectio~'-/¢ Fill added above origi~al grade: Gravel length:
~/~ Numbe~f lines: Dista.ce bel~een ,i~es:
WELL:¢~ ~//~ Upgrade Gravel~ept.: ~ FL , . ~ Ft.
Classification (Private, A,B,C):/ Total Depth: Cased To: Total absorption area: Pipe material:
Yield:
TANK
SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P.
TO Septic Absorplien Lilt Holding Public/Private Manufacturer: Capacity in gallons:
Material:. ~ Number of Compartments:
Surface
Lot / Size in gallons: ~ Manufacturer:
Foundation. ~ ~ 2'Y' ~ .... "Pump on" level at: "Pump off" level at: High water alarm at:
Cu~aln Pump Make & Model [ Electrical Inspections performed by:
/ / Location and Description:
EN~,~AL
Department of Health and Human Services approval
Reviewed and approved by: ,L~-~ (&~d~ Date: //-.r- ¢/ ~?/0NAL
72-013 (1/§1) MOA 25
Permit No.
SW910224 2 4
Page of
Municipality of Anchorage
DEPARTMENT OF HEAL1]-I AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ' Anchorage, Alaska 99519-6650 · Telephone 3¢3-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
LOT 7-A, BLOCK 1, SPRING FOREST SUBD.
Legal Description:
01552111
PID No.:
WATER SERVICE
LINE
PROPOSED DRIVEWAY
~Q
SEE ENLARGED DETAIL
ON SHEET 3
LOT 6-A
PLAN
SCALE 1"=60'
Permit No.
:S~910~P4 Page 3 of 4
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,O, Box 196650 ' Anchoroge, Alosko 99519-6650 · Telephone 34-3-474¢
On-Site Wostewoter Disposol System ond/or Well Inspection Report
Legal Description:
LOT 7-A, BLOCK 1, SPRINO FOREST SUBD,
01532111
PID No,:
-FABLE OF REFERENCE DISTANCES
POINT DISTANCE TO
A B C
1 27.8 34,8
2 I 31.0132.3 I
3 I 41.3124.3 I
4 I 43.4122.7 [
5 I45'3 121'3 I
6 I 12681 5 5
7 I 140.91 9.3
8 I 74.9 I 83.3
~ g 31.0 -
INVERT REMARKS
ELEVATIOF
97,89 CLEANOUT
- ST CO
- ST CO
97.25 CLEANOUT
97.14 CLEANOUT
94.45 CLEANOUT
- MONITORING
TUBE
94,53 CLEANOUT
98.29 CLEANOUT
SW910224 4 4
Permit No. Page of.
Municipality of Anchorage
DEPARTMENT OF HEAL'rH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O, Box 196650 · Anchorage, Alaska 99519-6650 · Telephone 54-5-4744
On-Site Wastewater Disposol System and/or Well Inspection Report
LOT 7-A, BLOCK 1, SPRING FOREST SUBD, 01532111
Legol Description: PID No.:
TEST HOLE BOTTOM EL. 82.4,
TEST HOLE TOP EL, 99.4 ..........
/~ J /--2" HI POLYSTYRENE
.%~~ INSULATION .
;.3 -- ..!-'
SEPTIC TANK--'M
MONITC
TUBE'
9 55'
TRENCH
EL, 98.,_3 --
PROFILE
HOR. SCALE 1"=40'
VERT, SCALE 1"=8'
EL. 94.4
EL. 89.5
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (~) PERMIT
PERMIT NUMBER:SW910224
DESIGN ENGINEER:BRUST AND ASSOCIATES
OWNER NAME:FORSYTHE GRANT H &
OWNER ADDRESS:5920 WEST TREE DR
ANCHORAGE, ALASKA 99516
PAGE 1 OF 1
DATE ISSUED: 8/02/91
EXPIRATION DATE: 8/02/92
PARCEL ID:01532111
LEGAL DESCRIPTION: SPRING FOREST BLK
LOT SIZE: 40231 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
1 LT 7
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
THE ATTACHED APPROVED DESIGN.
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 (iSAACS0).
3. , TH, E FOLLOWING SPECIAL P~SIONS.
SPECIAL PROVISIONS: '/~ ~ ii
RECEIVED BY: ~/~
DATE:
ATE: _ 2 - ?/
BRUST & ASSOCIATES
Engineers - Planners ~ Surveyors
1610 Dimond Drive
Anchorage, Alaska 99507
(907) 562-7878
July 7, 1991
Municipality of Anchorage
Department of Health and Human Services
On-site Services
825 "L" Street
Anchorage, Alaska
RE: Lot 7, Block 1, Spring Forest Subd.
This letter and attachments is to accompany a permit application for an on-
site waste disposal system at Lot 7, Block 1, Spring Forest Subdivision. The
following are attached.
1. Drawing of proposed on-site systems, and separation distances.
2. Soils log and percolation test results.
3. Trench design calculations.
4. Compliance letter from ADEC on Spring Forest public water supply.
5. Applicable portion of plat for Spring Forest Subdivision.
This subdivision is served by a Class A well which is not within 200' of the
proposed on-site system. Development of the adjacent properties will not be
adversely impacted by construction of the proposed system as distances to
adjacent features are in compliance with applicable requirements.
The closest feature that could be affected is the proposed water line, which
is about 33' from the closest point of the proposed original system. Slopes
on this lot are moderate. Drainage is to the drainage easement to the south
west. In discussion with neighbors it appears that this is a normally dry
ditch which only flows for a short time during breakup.
Both the replacement and the original system trenches fitted within the 30'
radius circle around the test hole.
It is recommended that a permit for the on-site system be issued.
cc: Spring Forest, Inc.
Sincerely,
LOT 4
8r~-WATER LINE --3 0 TRACT A
-~ 0 5 ~/ ~ ~C~,I /50' RADIUS AROUND
ELECTRICAL
TI
ON
~ % d~p O'MALLEY ROAD
~ NOTES'
~ILT BARRIERi
j_~_ I. TRENCH IS 50' LONG, FOR A 4 BR
DWELLINg.
~ ~ ~ 2. ALL MATERIALS TO CONFORM TO MOA
~RF~RATED ~ REQUIREMENTS.
PiPE ~, SEPTIC TANK CAPACITY IS
SET IN TNE FIELD
~=~ ~ BRUST ~ ASSOCIATES PROPOSED ON-SITE
SB
CHECXED aY: SEPTIC SYSTEM
DATE; 7/5/91 EN GIN PEPS- PLAN NER S- SURVEYORS
SCALE; 1"=100' 1610 DIMOND DRIVE (907)562-7878 LOT 7, BLOCK 1 SH~. 1
JOB NUMBER; 91-15 ANCHORAGE, ALASKA 99507 SPRING FOREST SdBD. ~o~
~'"SOI LS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
8215 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[Z~'~ERCO LATION
TEST
7__
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3-
4-
5
6
7
8
9
10-
11
12
13
14
15
16
17
18
19,
20
COMMENTS
PERFORMED BY:
.' DATE PERFORMED:
> ,/ ' ~LOPE SITE Plan "
w^s GROUND WATER
E.COUm'ERED?
IF YES, AT WHAT
DEPTH?
/
GroJs Net Depth to Net
Reading Date
~ . ~ T.~e Time ~?/~ Water ]p'/, Dro~
........... ~ ~ .Y ,
I
PERCOLATION RATE z/. C~'..,:.~"~' (minutes/inch)
TEST RUN BETWEEN Y/~:" FTAND ~-----~' ~"~'~. FT
72-008 (6/79)
PERFORMED FOR=
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19,
20
COMMENTS
~'~SOI LS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION' TEST
.. . / SLOPE//
[Z~ERCO LATION
TEST
-"'/t-1/
SITE PLAN
NO. 986-E
JCOUNTERED7 ,,4,, L
' 0
P
E
YES, At WHAT
Gro~s/ Net Depth to Net
Reading Date Time Time /~ ~ h . Water ./p, Drop //¢o.
..... ~ ..................... , x .s~ .~,~ , t
................................ 2: ~= -' ? ' ~ ' ~
~ ~ . ~,~
,. ~ .~ .... ~ ~ ~ ~
~ ..... ~::~ .... .. %.~ ~:¢" .,~ .-
/4. ? ~..~
PERCOLATION RATE J'"~ ~ (minutes/inch)
TEST RUN BETWEEN . ..~-~-Z.~ FT AND 6 y~..- FT
PERFORMED BY: ~ · ,/-~f~
CERTIFIED BY: -'~"
72-008 (6/79)
WALTER J. HICKEL, GOVERNOR
DEPT. OF ][~NVlRONMENTAL CONS]~;RVATION
ANCHORAGE DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
May 6, 1991
563-6775
FOR: Mr. Stan Brust, P.E.
PWSID #213564
My review of the records on file in this office reveals that the Spring forest Subdivision
Class A Public Water System, is in compliance with the provisions of 18 AAC 80.060,
State of Alaska Drinking Water Regulations.
S!~cerely,
Keven K., Kleweno
Lead Engineer
IFc
o~, ~
"/5.0O
600.00'
,,(-~-.5.00' R.O.W. DEDICATION~ NO?OS'§7"w
849.77'
285 05'
210.00'
--- N 0°08' 57"W
O0 r,..O (j,J
N 0° 04' O0"W
167. 80'
O0 co 04
· ~ 0'-.4
'~ I ~
I
~> co I I
UTILITY ESMT. ! /
849,77--'
00~
-~0
-88.26
20' UTILITY 0 5,96
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
~.'.~,9..~ -.~1 NAA#
1, GENERAL INFORMATION
J
Complete legal description ,,,
Location (site add'ress or directions)
2/:
Unless otherwise requested, NAA will be held for pickup.
NUMBER OF BEDROOMS: ~
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
to the legality and status of system.
lng
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 1121
s~uewwoo euo!~!PPV
:suop, elnd!~,s 8U!MOIIO¢ eq), LpdM 'SWooJpeq
JOt leAoJdde leUO!~!puoo
'swooJpeq
'pe~oJddes!Q
~o~ pe^o~dd¥ ~
=It:In.L'CN~DIS ~HHQ
'9
Municipality of Anchorage ~
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Well type ~ If A, B, or C, ~taemADE6~etter. ADiCwatersystemnumberjC~M'C/Z>~'~'/-~''~'/~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date completed .~¢/'~ Driller
Cased to /¢/"9 Casing height
/','¢ Wires properly protected (Y/N)
AT INSPECTION
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
g.p.m.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed /~,,/"~ 0/¢/' Tank size _/--~--'¢ O ~¢'~',,~,/,/.,~. Compartments ~
Cleanouts (Y/N) ~ Foundation cleanout (Y/N) ~ Depression (Y/N)
Fligh water alarm (Y/N) ~ Alarm tested (Y/N) /~
Date of pumping %¢~¢~,~ ~/¢~¢ ~,,¢ ~~r
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot '/¢~,/~ On adjacent lots
To property line /~' ~'~' / Absorption field
Surface water/drainage //~'¢"
Foundation J/-~ /
Water main/service line ~7 /.
72-026 (Rev. 7/91) Fronl CONTINUED ON BACK PAGE
LIFT STATION
Date installed
Size in gallons
Manufacturer
Manhole/Access (Y/N)
Vent (Y/N)
"Pump on" level at
"Pump off" level at
High water alarm level
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
ABSORPTION FIELD DATA
Date installed
Length .,~¢ / /
Width
Total absorption area ,_.~"/-/g2
Depression over field (Y/N) /
Results. (pass/fail) ,/~'/%~ %
Peroxide treatment (past 12 months) (Y/N)
Soil rating /~' YP~/~,F ,
Gravel thickness ..~.0 Total depth ,//O.~ /
Cleanouts present (Y/N) /
Date of adequacy test ~,/'2.-'?/y,~
for ¢ bedrooms
System type
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots ~-~
Surface water //..~
Curtain drain
On adjacent lots /4///¢ Property line
To existing or abandoned system on lot
Cutbank /'*¢//¢ Water main/service line
Driveway, parking/vehicle storage area ~-
E, ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this insp, ection.
Signature .~~
Engineers Name
__
Date
HAA Fee $ ,,/~
Date of Payment ~'~
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
Parcel I.D. #
1.
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
· ,. HAA # ...
Complete egal description
/
Location (sit~'~ add'ress or directions)
GENERAL INFORMATION - : ';,
Property owner ~ ~¢ ,~, ' Day phone
Lending e'gen~Y :~~ ~.5~ ¢~X~ay phone' ~-~ *~: ' '
Mailin¢ address~~O ~ ¢¢~~ ,og ~~. ~- ¢~ ' -
Unless otherwise requested, HAA will be held for pickup.· 'r ~ , ~~
NUMBER OF BED'ROOMS: ~ /-' ~.-~,:.,
: -n ~'~ ~,~ ' '
TYPE OF WATER SUPPLY: ~ :, ,, ,, ,
individual well .... ~ ,
Oommunity well / " '
Public water .
NOTE:
4.. TYPE OF WASTEWATER DISPOSAL:
;~''r ~:: ndvdJa on-ste,
....,.~ .' Community on-site
:::,' Public sewer
If community well system, provide written, q_ confirmatioh f(om State ADEC attest-
to the legality and status of system.(.
lng
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72°025 (Rev, 1191) Front MOA #21
Legal Desbription: ~-'/f ~'/;~'~_
A. WELL DATA
Well type ..
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Municipality of Anchorage .
Department of Health. & Human Ser~/icSs
HEALTH AUTHORITY APPROVAL CHECKLIST
If A, B. or C, attach ADEC letter.
,4/',¢- Date completed .
Case~ to
ADE0 water system number
Driller
A'//~' Casing height
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field, on lot
Public sewer main
Sewer service line
g.p.m.
; On adjacent lots
AT INSPECTION
¢//~ g.p.r~ 1~,, '~'O
;On adjacentlots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform /v/~
Date of sample:
Nitrate.
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed ,~/~'¢/¢ / Tank size_
Cleanouts (Y/N) /J'/" _ Foundation cleanout (Y/N)
/
High water alarm (Y/N) "4/r'~ Alarm tested (Y/N) _
Date of pumping /t/',~' ' CL~I.¢¢,~/ '~4~ ) Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well (s) on lot ,'(///~ On adjacent lots
To property line //~::~- ~ /___Absorption field ~'/?/
/
Compartments ~"
Depression (Y/N) ///
Surface water/drainage
Foundation
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION ,~'~
Date installed
Size in gallons
Vent (Y/N)
Manufacturer ,4/,~
Manhole/Access (Y/N)
· A/',4¢ "Pump on" level at
High water alarm level
.Meets MOA electrical codes (Y/N)
"Pump off" level at
Cycles tested
1.·
SEPARA'TI'ON DISTANCE FROM LIFT STATION TO:
Well on lot ,,,I//¢ On adjacent lots
D. ABSORPTION FIELD DATA
Date instal,ed _
Length '-~'" Width ,.~ /
Total absorption area ~'-',~Z2 ,.~'d~¢'. /~.
Depression over field (Y/N) ' /~
Results (pass/fail) //)//,~2
Peroxide treatment (past 12 months) (Y/N)
Surface water
Gravel thickness .,~. c2 Total depth J,E~ ~'
Cleanouts present (Y/N) ,,...i/
Date of adequacy test . /f,/~k///t/~z.4) ~/~'¢"7~.,~')
for ~ bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot '~f/~,~
On adjacent lots
To building foundat, io~3
On adjacent lots /'~/¢ Cutbank
Surface water
Curtain drain1
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature .____....rw~.,.~.
Lng neer's Name
Date
HAAFee$ //7¢, ~
Date of Payment ¢ - ¢ -'---~--~
Receipt Number ~ ~ 7,Z/~
72-026 (Rev. 3/91) Back MOA 21
- ..........
¢¢
Waiver Fee: $
Date of Payment
Receipt Number
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND RLVD., SUITE 3-470
ANCHORAGE, AK 99503
WALTER J. HICKEL, GOVERNOR
FOR: Stanley Brust
May 18, 1992
PWSID # 213564
My review of the records on file in this office reveals that the Spring Forest Subdivision
Class "A" Public Water System is in compliance with the routine coliform bacteria sampling
requirements listed in Table C, and with the inorganic sampling listed in Table B of 18
AAC 80.200.
Sincerely,
Rachel Clark
College Intern