HomeMy WebLinkAboutSPRING FOREST BLK 1 LT 10i~ 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 INSPFCTION REPORT
NAME PH O~N ~ ~ · [~NEW
~-~1LI N G ADDRESS
LEGAL DESCRIPTION
LOCATION I.~uO6K :~ .5P~lNg, ¢OteES% SUG
Well Absorption area Dwelling PERMIT NO,
O~STA,CS TO: 2~ ~4 ~L> ~, 7
~ ~ Liq capacity i Width
~Z5 ~) IF HOMEMADE: Inside length ~ i Liquid depth
~ ~ DISTANCE TO: Well ~ ~ /~ Dwelling PERMITNO.
O Z ~ Manufacturer Material Liquid capacity in gallons
DISTANCE TO:
~ Length o~ line Total length~f~es Trench~d~, Distance between lines
~ ~ Top of tile to finish grade~z~t~'"~ Material~.~ .beneath4 ~A3~tile~ ~)~ ~ches Total,, effective~ ~abs°rp~°n~ area
Length Width Depth PERMIT NO.
~ ~ T~Oe of crib Crib diamot . Crib d0pth Total effective absorption area
m Well Buildin~ foundation ~eatest lot line
~ DISTANCE TO:
~ Class Depth / Driller Distance to lot line PERMIT NO,
Building/~da n Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
SOIL TEST RATING
INSTALLER
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~]
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
SLOPE
2
~ ML
6
7
~ brou~nsi ~¥
9
10
11
12
13
SP
Cl
14
15
16
17,
19-
20-
COMMENTS
WAS GROUND WATER
ENCOUNTERED? N (~ SI-
C
P
IF YES, AT WHAT E
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
oq:zo-~o Io 2.qo ,02
Oq: ~o -~ 2, ~ --
o~'~"30 2.,~ --
~:q0- 5o --
~:S~- ~ lO 2.qq
PERCOLATION RATE
q' in 5P, t fa
150
CERTIFIED BY: '~,~
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O, Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D.
CERTIFICATF OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1, GENERAL INFORMATION
Complete legal de~cription
Location (site address or directions)
Property owner
Mailing address
Lending agency
Day phone
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
Day phone.
Day phone
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-
ing to the legality and status of system.
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 #21
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Legal Description:
A. WELL DATA
Well type. /Z~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
If A, B, or C, attach ADEC letter.
Date completed
Casedto
ADEC water system number
Driller
Casing height
Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION
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
Nitrate
Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed /¢//~/'¢"~'~/ Tanks, ze __/~ '~ L~
Cleanouts (Y/N) _/-~- _ Foundation cleanout (Y/N)
High water alarm (Y/N) ~/,//A-
Compartments
/ 1,l~/(~ Depression (Y/N)
Alarm tested (Y/N) P///~
Date of pumping ~'/O g~//¢/~ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To propertyline _~ ,,5"0
Surface water/drainage
On adjacent lots
Absorption field
Foundation.
Water main/service line
72-026 (Rev. 7/91) Fronl CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D, ABSORPTION FIELD DATA
Date installed O ~/Z,/~¢
Length ~ O Width ~'.'~
Total absorption area ~,O-~
Depression over field (Y/N) J~
Results (pass/fail) "~¢~ ..~ .~
Soil rating //~f2 System type / ~ c-~
Gravel thickness ~ Total depth /-~
Cleanouts present (Y/N) J~ / ~7
Date of adequacy test d) t/O '.5 / ¢/2,-
for L/ bedrooms
Peroxide treatment (past 12 months) (Y/N) ~
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lets
Surface water
Curtain drain
On adjacent lots ~////--X Property line
To existing or abandoned system on lot
Cutbank 1"¢/~_.~ 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 inspection.
Engineer s Name
Date
HAA Fee $~/¢7'D .E~
Date of Payment / ~'~
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
203 ~ES~ 15¥H. ~VENUE ~U[TE 206
hNCHOR~GE, AL~SK~
(907) 279-~916
_SEPTIC SYSTEM ADEQUACY TEST
LEGAL:
LOCATION:
OWNER:
Rc)ber"tl and Claudia Smit. h
RESIDENCE: Sin,:;I].e Family, 4 Bedr
WELL:
Valli Vu~:~.) Cornmun:i,'l:y System PWBID 2'1 ')605
SEPTIC SYSTEM:
I:::R[]M MUNICIPAL.. RECORDS: 4 B(~?droom System
'['ANI':::~ Anchc:~rag~,~ Tank 1250 Gal. Two Comparts.
ABS[)RP'T' I ON SYS"r'EM: Tr enc h
ABSOI:~F'"f'iON AREA: 6Cx) Sq ,. Ft,,
SO I L.. RA'T' I NG: 15C)
:[I~IS'T'ALLATION DA'TE: April 1'2,~ 1984
DATE OF LAST PUMPING: Anch,, [].::.~ss Pool Jan 6,~ 1992
DATE OF TEST:
,lan. 3, :1.992
TEST PROCEDURE: System was inspected and measured,, Tan l.:: was
.~ound with 6 {:eet (:)t:: cover and with a liquid level o~ 47 :i. nches~
No trenc::h clc~an c)ut. Trench mc)nit, or tube was 12 deep wJ.t,l"~ 16
inches (:ff sludge.
500 ~;;lal 1 c:~r"fs (::ff (:::].ean water was added to the 't':r'encla wh:L ].e 'L:hu~
water" levels in t?.hc.~ 'l:.ar~l.:: and the monitor 't:. Ltl] (~ wer'e mon:l'tior"ed. "l"l-~e
W;;t't:,~:~l'" :l, (.:?V(~]. :i. r'~ '(:h6~ i:anl.:: c:l:L d not change ~ whi I e the 1 eve]. :i. n the
mc)l']:Ltc21" r"os~:,:, to 2J~J :i. rlchc~s ~.~tel'- 't:.h6~ add:J.t:(or3 o~ 15() (~g~L&I].QI'H~. The
wat.~:?r" level r"ema:Lr)ecI a'b this level w~'(:,l"~ the addition o~ the n(:.;:xt.
550 gal 1 on%. 'Fbi s observati or'i (::or'r¢il'"rfH~ the test done i n ].989.
"rEST RESULT: 'T'h:i,s system mee'lis-I:.he cc)de
t h e H e a 1 t h a n d
Dep,':.~.r'L'm(~.~H']'l:. (:).~: the J"lur'l:i.c:::i. 13a].ity
r' (~c:j Lti r (=,. m c~r"~ '1:. s o,¢-
,:~(:3c i ,ii 1 S (,::~ r V J. (:: 67S
NOTE Thcs, operati(::)nal ]. :i.~,Ce (:)-2 al 1 sept:i.c sys'l:,ems depends on 't:,he
]. (:)c:al s(:)i ], c:c311(:| i ti i (],r'~s ,~ gJ'-oLtr'lcIwatc, r 1 evel s that
(::h..trir~:] 'U.h(-:.:,~ year~ ar'id th~:::, war. er usage o.¢ the .Family be:i. rH;;j served
by '!'.',J"l(.~ syst. em. -I"l'",ese c(::H'](:~i't:ic)r'l~,~, arE,;, (::)L,t'l,:'.~Ki.d(~'? 't".h~'~ (::or3trc)l
,~.'..?v,?:i ii. L.ta't: OF' O'~: t h :i. s '::~.(E'p '['. J. c: t:i~'~i;'l:; 6,~:rn ~ W(.9 c: (~lr"~ t her c.).J: c~r(.;e I"~
e~di:i, ma'(ie o.,~ how long this s.~ys't'.'.em will 4:t.u]c:.t:ic:)r~l <.y~.a.'c:i.!L=,.¢a(:tory .J:(::H'"
[::: L.L ¥" r" ¢ ri '[: C-,,I~ J,,: L.t 'J~ t..t I'" E.? C) C. E: I.~ ti ~?:~. I] 'ti S ,,
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
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 lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner_
Mailing Address
(c) Lending Institution
Telephone: (home) Business
Telephone
Mailing Address
(d)
(e)
Real Estate Company and Agent
Address
Telephone
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'S, Public [] Community [] Holding Tank []
Note:/11' 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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MUNICIPALITY OF ANCHORAGE (MOA)
ANCHOR~alIh Authority Approval (HAA)
o,¢ .cKusT - .E..UA.V 4984
M^R 2 .989
, RECEIVED
A. WELL DATA
Well Classification _
Well Log Present (Y/N)
343-4744
Legal Description:
Date Completed
If A, B, C, D.E,C. Approved (Y/N)
Yield
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed /.V'/~,,./ _Size
Standpipes (Y/N) ~ _Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarrn (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
No. of Compartments
.~ Foundation Cleanout (Y/N)
Date Last Pumped ~/I ~E~
; f o r
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Water-Supply Well ~;~ ,¢~ ¢~
To Property Line ..'~c~ ¢'
To Water Main/Service Line ~ '"~ ~¢'
To Stream, Pond, Lake or Major Drainage Course .
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed L/ / L~ hz
Width of Field .~ G '~
Square Feet of Absortion Ares
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design --F I~. ~ ~4 L N
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ,,> ~ ~
To Building Foundation ~ c> ''/"
Lot I'4/,,N
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~
To Cutback (if present)
t'¢/',~
D. LIFT STATION t,,/ o/'4L~.
Date Installed
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)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed '~ ~
Date
MOA No.
Receipt No. ~
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Engineer's Seal
Date of Payment
Page 2 of 2
NCHORAGE/WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 1334
ANCHORAGE, ALASKA 99503
563-6775
DATE:
PWSID:
To Whom It May Concern:
According to the records on file in this office, the ..... '-'~ ~:
'~ : Water System is in compliance with
State of Alaska Drinking Water Regulations.
the
MPL:pkk
Sincerely,
Michael ?. ,Lewis, PE
Environmental Engineer
/~NG ENGINEER
_.., ,203 W. 15th AVE "C" SUITE 203
ANCHORAGE ALASKA 99501
~ TE -EPHONE: (907) 279-3916
SEPTI_______qC SYSTE_____~M ADEQUAqy ~EST
LEGAL: Lot 10, Block 1, Spring Forest
LOCATION: 6010 West Tree
OWNER: Alliance Bank
RESIDENCE: Single Family, Four Bedrooms
WELL: Community Class A System
SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: 4-bedroom system
TANK: Anchorage S~eel, 1250 gal, 2 comp.
ABSORPTION SYSTEM: Trench
ABSORPTION AREA:-.600 sq. ft.
SOIL RATING:. 150
INSTALLATION DATE: April 1984
DATE OF LAST PUMPING: March 1, i989, Marx
DATE OF TEST: February.28, 1989
TEST PROCEDURE: System was inspected and measured. Tank was
found with 5.5 feet of cover and 47 inches of liquid. Trench
sump was 11.5 feet deep and dry.
600 gallons of clean water were added to the trench at a
constant rate of 7 gallons per minute. The first 150 gallons
caused a water level of 22 inches to be measured in the sump.
The next 450 gallons caused the water level to rise 2 more
inches, indicating that the bottom 2 feet of the trench was
plugged and that the ground absorbed water at the rate of
inflow.
TEST RESULT: This system meets the code requirements of
the Health and Social Services Department of the Municipality of
Anchorage.
N '
~OTE The operational life of all se ......
±ocal soil condit'Lons - _ . ~ systems ~epends on the
~ , groundwater Levels that may fluctuate
~uring the year, and the water usa e - · . ' '
Dy the system. These co~__ ~ g of. the fammly being se v
.... ~u~s are outside the control of rt~
evaluator of this septic system. We can therefore not give any
estimate of how long this system will function satisfactory for
current or future occupants.
1o General Information
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL ttEALTH
DEPARTMENT OF I~ALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR I ~{EALTH AUTHORITY APPROVAL CERTIFICATF,
Application Date "~//~/~,~
(a) Legal Description (include lot, block, subdivision, section, towns}~.i~, range)
Location (address or directions)
c._ _.
(b) Applicants Name~-~?./pD/o ~.%~'f/~ Te!epho~e - Home Business
Applicants Address~pp~ JlO-I I.j Jt, lgh~),r~l-~~ /%Kgg~) I1
(c) Applicant is (check one) Lending Institution ~ ; ~ner/builder ~ ;
(d) Lending Institution Telephone __
Address
(e) Real Estate Co & Agent
Address ~ ~). /'
Telephone ::'% <-{ ~ -2~:5._~2C~" ' '
(f) ~ail the 1~ to the following address:
2o ~ype of Residence
me
Singls-Family ~L]
Number of Bedrooms
Multi=Family~_~
Other (describe)
4. S,_~e~
Onsite ~ Public .~_~ Commu, i~y'~/ Holding Tank E----'~-
Note: If community well system, must have wriCten cortflrmation from the State
Department of Enviromnental Conse~atiop aggesting to the legality and status.
[Page 1 of 2]
Individual Well ~t Community ~ Public ~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
5. ~E~gineering Firm Providin~~ions, Tests, File Search~ Da__ta 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 ~nicipality 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 regula-
tions in effect on the date of this inspection.
e
~' 4'~" ~ ~
Approved for~ bedrooms By ~~
Approved ~ Disapprovea" __~ 7% --
Terms of Conditional Approval
CAU£ION
THE, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRO~R~ENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA° THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
T~IIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN ~{E PROFESSIONAL ENGINEER'S WORK.
RR4/eJ/D18
[Page 2 of 2]
(DHEP SEAL)
//,
7 -19-84
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH ADs~ORITy APPROVAL (HAAi
CHECKLIST - FEBRUARY 1984
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
APR
RECEIVED
PumD Set At
Well Classification
Well Log Present (Y/N) /3(/%.
Total Depth AJ//k Cased
Static Water Level ~)
Casing Height Abov~ Ground
Electrical Wiring in C~mduit (Y/N)
Separation Distances f~:cm Well:
To Septic/Holding Tank on Lot
Legal Description:
If A, B, C~ C, D.E.C. ApprovedL~/N)
Date ~le~d ~ Yield ~O~
~9th of ~outing
Sanit~ ~al on ~sing (Y~)~
~ession ~ound ~l~ead (Y~)~.
oOQ~)/~. ; On Adjoining Lots
To Nearest Edge of Abs(~tion Field on Lot ,2)~3/0/d- ; On Adjoining Lots ~/~
To Nearest Public Sewe~. Line
Cteanout/Manhole
Water Sample Colle(~ed By
Water Sample Test }~sults _
CQ~[~ents
FJI,,4. To Nearest Public Se~r
To Nearest Sewer Service Line on Lot
~/4- , .; Date /g/~
B. SEPTIC/HOLDING TANK DATA
Date Installed 5~//~/~V Size 1~.~-0 No. of Cc~gartm~nts P_
Sta~i~s ~) Aid-tight ~ps ~) Foundatio~ Clea~out~)
~ession o~ Ta~ ~Y~ ~te ~st P~d '~ ./~
P~ing~intenan~ ~n~a~ on File (Y~) P/~; fo= ~
Holding Ta~ High-Water Ala~ (Y~) ~ ~ra~y Holdi~ Tank ~t (Y~) ~/~
Sep~ation Distan~s ~ ~ptic~olding Tank:
To Water-Supply ~11 ~OO/~ To ~ildin~ F~ndation '~r~/~
To ~o~rty Li~ ~ To Dis~sal Field ~-
To ~ter ~in/Se=vi~ Li~ J~ To S~e~, ~nd, ~e, ~ ~jor ~aina~
Receipt ~
Date Paid:
Amount:
[Page 1 of 2] 2-15-84
ABSORPTION FIELD DATA
Soils Rating in Absorption Stmata
Date .Installed ~//2/~ 6f
Width of Field ~ /
Square Feet of Absc~ption Area
/~b--d3~ Type of System D~sign
Length of Field ~O /
Dapth of Field I ~ '
Gravel Bed Thickness O' '
Standpipes Present ~{~)
Depression over Field (Y~ Date of Last Adequacy Test c~/O{~-
Results of Last Adequacy Test f~(h
Separation Distance from Absorption Field:
To Water-Supply Well ~Q~OD/-~ To Property Line /~, /
To Building Foundation o~/~ To Existing or Abandoned System on
Lot AT//~ ; On Adjoining Lots ~O /
To Water Main/Service Line ~<-/~ To Cutbank(if present) A3~
To Stream/Pond/Lake/or Majo~ D~ainage Course /O°/~
To D~iveway, Parking Area, or Vehicle Storage Area ~/~ <D
,F
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level
Tested for
Electrical Codes(Y/N)
Co~nts
Dimensions
Manhole/access (Y/N)
"Pump Off" Level at
Vent !.Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
** Check Permitted Bedroom Rating A~ainst HAA Request **
I certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
KB /d5/s
No.
[Page 2 of 2]
DEPT. OF ENVIRONMENTAL CONSERVATION
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA g9501
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
To Whom it May Concern:
According to records on file in this office the
]~Cr(~)Y~F)~ Water System is in compliance with the St~e Drinking
Water Regulations
Sincerely,