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Home My WebLink AboutSPRING FOREST BLK 1 LT 12 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 Permit Number: 5t~/ ~_~.,~/ PID Number: ,'0/5~ -~--~/ ~//~' Name:~ ~//~ ~/~ WastewaterSystem:DNew ~Upgrade Address:~ SO ~¢~/ ~ ~ ABSORPTIONFIELD Phone: ~ -'~/S No. of Bedrooms~ ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other Total Depth from original 9rads: LEGAL DESCRIPTION Soil Rating: /, ~ GPD/Sq. Ft. ...... Subdiv~i~: ~ Depth to pipe bo}tom from original grade: Gravel depth beneath pipe Township: Range: .... ~tion: Fill added above original~ ~grade: Ft. Gravel length: ~ Ft N~ ~ Number of lines: Dislance belween Ii,es: WELL: ~~ Upgrade Gravel width: ~ Ft / ~ Ft. Classification (Private. A~ Total Depth: Ft. .Ca~To:/ Ft. Total absorption area:~ ~ SQ. Ft. Pipe material:~ ~ Driller: / Date Drilled/ZStatic Water Level: Installs[: /~ Ft. ~¢ ~/~ ~Z Date instal[ed: ~ Yield:/ G,M PumpSet at: F/sing Height Above Grou;:: SEPARATION DISTANCES ¢Septic B Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Private "~'~~ ~/~ Capacity in gallo"s: Sudace w~t~r /¢¢~ /00~ ._ - - LIFT STATION LOt , -- Size in gallons: Manufaotu¢ %/,er alarm Line /~ ~ /~ ¢ -~ ~ "Pump on" level at: ump off" level at: at: Foundation /* I / % CUDrain~ain ~ /~ ~ /¢0 ~ .... Pump Make & M~ Electrical Inspections pedo~by: Remarks: ~ ~¢ ~¢¢¢ ¢~¢~A/~ '~¢~'~¢, BENCH MARK "' I I Assumed Elevation: /~ ENGINEER'S SEAL lnspectionspedormedby: .*//~¢¢~g~[~¢ Dates:ls~ ~¢~9~ ~.%~.~ ~, ~ ~ e e ~ M. Duffus Department of Hea ~ ices a 't:~'.. cz /~. Reviewed and approved by: ' ~ ~'- - Date: .'- . ~-~O-~.~ROF~SS~ 72-013 (Rev. 9/91) MOA 25 AS-BUILT SYSTEN DETAILS/SITE PLAN ?e.m~t sw970B51 SPRINO FOREST SUBBI¥~S~E]N, BLOCK l, LOT ]2 PIO~O~5 32~ ~6 DIVERTER -- ~ ": ~.~ E~ISTING SYSTEN5 c LBT BO A-0=88.8' B-C=80.9' A-O=39.4' LBT 1~ B-D=47.5' A-E=79,4' ]}-E=74,6' A-F=66.9' SCA~E,. l' : 50' LOT 18 B-F=63,9' a w ~ ~ ~ FINISHED GRADE z SEWER R~CK ~,~, ~ ~ CS 7116 ~ ~ PREPARED FBR', I<NO ENGI:NEERING 'i~. z . .~'~ ~044i PTARMIGAN BLVD ~[e~a ~/~/~ · ~+6'~ DANIEL ~ HELEN VETH EAGLE RIVER, 99577 ~P~OP~sslO~b~ ~ 6030 WEST TREE ~RIVE (907)69~-~lll/Fax (907)696-81H --~~~ ANCHDRAGE, ALASKA n~aW~NG DATE~ 9/7/97 SCALE: AS NOTED SEWER ROCI< PAGE 1 OF MUNICIPALITY OF J~NCHORAGE DEPARTMENT OF HEALTH AND HUMJkN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 A~ICHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970251 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:VETH DANIEL R & HELEN J OWNER ADDRESS:6030 W. TREE DRIVE ANCHORAGE, AK 99516 DATE ISSUED: 8/11/97 EXPIRATION DATE: 8/11/98 PARCEL ID:01532116 LEGAL DESCRIPTION: SPRING FOREST BLK 1 LT 12 LOT SIZE: 53067 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE PERFORATED PIPE (DRAIN PIPE) WILL NEED TO BE INSTALLED WITHIN THE FINE SAND LAYER. THE LAYER RECEIVED ISSUED BY: ~~/~~ DATE: DATE: 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 July 30,1997 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Spring Forest S/D, BI, L12 - Septic Upgrade Permit Gentlemen: Following a request from the owner, on July 19, 1997 we dug two testholes for the proposed upgrade. The septic was tested on May 14th and it did not pass. The area and lot is served by community water. The results of the percolation tests are attached. The proposed upgrade system will be placed east of the existing system. As indicated on the site plan there is sufficient grade to maintain a gravity system. The 1250 gallon tank will be inspected and its integrity verified. If necessary the tank will be replaced. The existing system will be retained and a diverter installed for potential use in the future. As indicated by the site plan drainage arrows, natural drainage is away from this site and will be maintained after construction. There is no surface water within 100' of the proposed installation. There are no known curtain drains within 50' of the proposed installation. No wells exist within 100' of the proposed installation and the community well is over 200' away from the proposed site. This upgrade should have no adverse effect on development of adjacent lots. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, ~ ~ Engineering Kenneth M. Duffus, P.E. attachments: On--Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test m WASTEWATER DISPOSAL SYSTEM/SITE SPRING FOREST SUBDIVISION, ]~LOCK 1, LOT PLAN INSTALL EXISTING SYSTEH · SEPTIC LOT I SEPTIC : LOT 13 LUT 11 LOT la LOT 2 LOT 20 LOT 19 SEPTIC · LOT lB ALL LOTS SERVED DY COMMUNITY VATER, NO SEPTIC SYSTEHS ~]THIN 200' DF DESIGN CRITERIA ~. 4 ]]EDROOMS X 150 GAL,/DAY/BEDROOM = 600 GPO 2, SOILS RATING~ 13 WIN/INCH = APPL. RATE ~.2 GPD/SF 3, 600 6PD/I.2 GPD/SF = 500 SF 4, 500 SF /(2' x 7') = 35,7'L 5. MIN. ]]ESIGN SIZE = 1 TRENCH - ~6~ LONG x 2' WIDE x 7~ BEEP 6, DEPTH OF GRAVEL BELOW P~PE IS 7'. 7, TOTAL DEPTH BF SYSTEM IS 12,0' FROM ORIGINAL GRADE, NBTES~ 1. TIE INTO TRENCH AT MIDPOINT. ~. CONTRACTOR TO VERIFY INTEGRITY OF EXISTING SEPTIC TANK. 3. INSTALL 1850 GALLON SEPTIC TANK IF REQUIRED. INSULATE TANK IF <4' COVE 4, INSULATE TRENCH ~/ITH B' HI] BURIAL FOAM IF <3' COVER. 5, CONTRACTOR ~/ILL ENSURE MAXIMUM 2× SLOPE IN'FO SEPTIC TANK, 6. CONTRACTOR TO ABANDON EXISTING TANK IN PLACE IF NEW TANK INSTALLED, 6. CONTRACTOR TO INSTALL BIVERTER, PREPARED FOR: DANIEL N HELEN VETH 6030 ~EST TREE DRIVE ANCHORAGE, ALASKA KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIVER~ AK, 99577 (907)696-6111/F~x (907)696-8111 DATE, 7/a9/97 DRAWING SCALE: l' = 100' 97060-S1 Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Slreet, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED LEGAL 8 9 10 '11 12 13 14 15 16- 17 18 19- 20 ] I ,ESCR,P¥'ON: V';¢ / Lo'/' /7-Township, Range, Sect,on: ~ ~' ~J · ' SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? rc..o, t4. DEPTH?IF YES, Al' WHAT MonilorinD? ~ Gross Net Depth to Net Reading Date Time Time Water Drop g lO:O5 ~o ,..;,~ '~'V4" "//e" PERCOLATION RATE ~ immures/tach) PERC HOLE DIAMETER TEST RUN BETWEEN _ ,~ FT AND ~ ACCORDANCE WITH ALL STATE AND MUNICttCAL ;'2-008 (Rev 4/85) GUIDELINES IN EFFECT ON THIS DATE DATE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION:'~.¢~',~4~',~¢'¢51~ ,,~,/,~ / ,~olL/,~- Township, Range, Section. "~'"/-,1/ ~ / -1 .../ SLOPE SITE PLAN 3 4 5 6 g 10 '1 1 12 14 17 18 B.o, kl 19 2O WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT /~/,~ L DEPTH? .¥,.~ pO E Depth Io Water AIIez~ Gross Net Depth to Net Reading Date Time Time Water Drop / ~.R ,,/;/5 -- /o" _ ~ ~ ~:/2 - q_,, _ ~ ~:~ 7~,'~~ ~" ~ d:¢7 ~ " / /p PERCOLATION RATE TEST ,~UN ~ETWEEN ACCORDANCE WI~H ALL SIA'fb A"r4L) MUNIC!J=t~E GUIDELINES IN EFFECT ON TFtlS DATE DATE '/ / . 72-008 (Rev 4/851 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~ress P~ /~/e~ ~ T~NK FIELO WELL Phone(s) Permit No. No. el Bedrooms AS-BUILT DIAG~AM'(sh~w location el well, sep0c system, prope~y lines, foundahon, ~SEPTIC g HOLDING TYPE OF SYSTEM TRENCH ~ BED ~ W, DRAIN ~ OTHER - - ~eplh to pipo ~mtom Irom~ lo~al ~epth from odoinal o[aOe , above original grade Gravel depth beneath pipe Tolal absorpti ..... ~ 0 SO FT ~/~ FT Pipe mateda, NumbeVOnes Soim~ SOFT ~ ~/ WELLS / ~ PRIVATE ~ OTHER (Idenlifv~ Classification (A,B,C) Total Depth ET Cased to FT ~,- 72-013 (3/85) LoT II ~o,oo PLOT pL-A.i,T ~ .A.E~ ~BT_TILT. ~, 8CALE../'~SO~ GI~.It) '255~ , 3'O~B lq'o '~o'o~> Anchorman/% Alask~ I H~rcby certify that I l~c~v¢ surv~y~rl th~ followi~// d~scrib~ property: ' ~ :riot, Ala:ka, ~nd that the improvimen~ :itu~t~d th~on are - ~;%... ~.-~0~ ~....k~ ,5~'T Z cp' ~ PLOT PLAN ~ AS BUILT b~ SCALE I%?.1)~ GRID kMO~O~ R¢cor~in~ District, Ala~ka, and ~at the improvements situated thereon Dated this th~ ~ Day of ~dL~ , 19 ~O , at Anchorm¢% Alaska or r~tr~ct,o~s wh,ch do not ~ppaar o~ th~ r~cord,d subdivision plat. PERFORMEO E-OR: 2 3 4 5 6 7 8 9 10 12- ~3 14 ~5 16 17 ~8 19- 20- Township, Range, Section: SLOPE S(TtE PLAN WAS GROUND WATER ' ~ 'l'-.-..) ' ENCOUNTEREO? $ 0¢¢h bo W;~r ' ~I-'D g~ I I Read(~j Oate Ticn~ T~me 'Wa~er Orop HOLE DIAMETER __ 4~oo ~.~. I~. NOTE: All Dimensions And Locations Must Be Field Verified Prior To Construction SEWER SYSTEM LOCATION PLAN ~GTIQN/ TOWHSHIP/ RAN~36 ~OTE, NORTH pRE~PARE~O FOR, o. / Parcel I.D. # 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 ¢/5 32- //¢' ', 1, GENERAL INFORMATION Location (site address or directions) b6~ ~6~ ~.~ ~ /.~ Property owner _-T~.-,~/~'/¢/v/~,¢ ~Zz4/ Mailing address Day phone_ ,;~zT/~'~ ~ 3L///' 5 Lending agency Mailing address Day phone Agent "~,*',¢'/~'- /~//J'~ Dayphone ~Z-5/57 Address ..~]~C~ ~)~.~'~L ~ Unless otherwise requested, HAA 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- 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 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my . .ir~vestigation of. this Health Authority Approval application shows that the on-site water supply · 'i · -a'nd/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 KND Engineering Phone 20441 Ptarmigan Address ' Eaqte River, AK 99577-8736 Engineer's signature ,~' ~ ,/~ Date DHHS SIGNATURE ~/ Approved for ~//~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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 D H HS 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.CY21 · · · '¥~kO Mumclpahty of Anchorage ,~',~. o~,~ · DEPARTMENT Of: HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street. Room 502 · Anchorage. Alaska 99501 · (907) 34~¢jr¢.744 Health Authority Approval Checklist Legal Description: .-.~F';rOd /C~r~¢~I~ ~/~-/ LotL /~--- Parcel I,D,: ' A. WELL DATA Wel type ,'~/~/'~/'4~'/¢'~'1f A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) // Date completed Totat depth / Cased to / Casing height (above ground) / / / // Wires properly protected (Y/N) Sanitary seal (Y/N) ,/ /, AT INSPECTION FRC)M WELL LOG Date of test // / Static water level Well production // g.p.m. // WATER SAMPLE RESULTS: Coliform .// Nitrate /× Other bacteria ×/ // Date of sample: /// Coll..ec~d by: .- B. SEPTIC/HOLDINGTANKDATA ... ~. Date installed ~/SO/?7 Tank size Foundation cleanout (Y/N) "/ Date of Pumping g.p,m. /~.5'-~) Number of Compartments ¢-- Cleanouts (Y/N).)/ Depression (Y/N) ,/V/ High water alarm [Y/N) ---'-- Pumper ./V/bT'/-~//~./2/ C. ABSORPTION FIELD DATA Date instal ed ~'/'~:P//~ ~ Length ,/¢'~7~ / Width ,~ / Effective absorption area ' ~--~ .~ /' Date of adequacy test /' Fluid depth in absorpti~d before test (in.); _ Soil rating (g.p.d./fF or fF/bdrm) /, Gravel thickness below p~pe Monitoring Tube present (Y/N) Results (Pass/Fail) Im o~diately after System type ~,~'/2 ¢/¢"~¢-],¢4/'' / Z/e, / Total depth /,~, z/'_ /3, ~ / Depression over field (Y/N) /(// For // bedrooms / ___ gal, water add.edWin,): / / Fluid depth .../' (ins) Minutes later: /// Peroxide ent (past 12 months) (Y/N) // 72-026 (Rev. 3/96)* Absorption rate = If yes, ~ ve date g.p.d. D. LIFT STATION Date installed Manhole/Access(Y/N) // High water alarm level at* Cycles tested / SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line Size in gallons / "Pump on" tevel at* / "Pump off" level at* *Datum / On adjacent lots ; - /' On adjacent lots // Public sewer manhole/cleanout Lift station / / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: / Foundation /O ~ Property line ,,/~) / Absorption field //~ Water main/service line ~-J~ -~' Surface water/drainage /~Z) ¢-/- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: / Property line /~) ¢' Building foundation /~ '/' Water main/service line Surface water /~) O ~'~ Driveway, parking/vehicle storage area Curtain drain /'/~' ,~¢7.~,,¢) /~ / '¢ Wells on adjacent lots /~/-) F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records th~ in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name ,~,~.¢_~-'/L¢1 ~ ,~--.L~,~"~."~ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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 (~\_~-~- ~t~ NAA# 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 Mailing Address /C/~ (d) Real Estate Company and Agent Address ,/~"),X~. "~'f~ ~'/-- E''~Y ,' Telephone: (home) /'~//~ ' Business Telephone (e) Telephone Mail the HAA to the following address: (or check here/[~f 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~ii~ 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"~ 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 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 flies 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. Engineer's Seal 6. DHHS APPROVAL //' Approved for _~_ bedrooms b~~/~''-~ Approved .2'Xv Disapproved __ Conditional Terms of ~oonditional Approval Date The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph§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 DHHSdonot conduct inspections or analyze data before a certificate is issued. The MunicipalityofAnchorageis not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) 8ack Page 2 of 2 A. WELL DATA Well Classification Well Log Present (Y/N)_ Date Completed[ 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 MUNICIPALITY OF ANCHORAGE (MOA) Health Authorily Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: (~ B, C, D.E.C. Approved (Y/N) Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression ~~"~ ng Lots ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Sewer Service Line..prr~ot Water Sample Collected by .../ Water Sample 'r'est Re/suft~' Comments Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~/.,~/'¢~ Size /~.~'LC-'q NO. of Compartments Standpipes (Y/N) ¢"" Air-tight Caps (Y/N) z/,-- Foundation Cleanout (Y/N) Depression over Tank (Y/N) /LJ Date Last Pumped Pumping/Maintenance Contact on File (Y/N) ,,~.,,2,~ ;for Holding Tank High-Water Alarm (Y/N) /~.//lq_ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: 'f'o Water-Supply Welt ~- ~e~2(~ ~' To Property Line '~;7~ ! To Water Main/Service Line .~'/~2 / 7'0 Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~,/,2-C2/~ O Width of Field .~ z Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~' 2--~¢~O / To Building Foundation Lot /D//~/Y~h~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness .~ / Statndpipes Present (Y/N) Date of Last Adequacy Test To Water Main/Service Line ~ ~-;~ f To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~¢.5) / To Existing or Abandoned System on ; On Adjoining Lots .~ /'4¢::~O / To Cutback (if present) /C'////dr- ~/'0 / Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions ~ Manhole/A~ / 'P~.ctm~Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes..~/N~ Comments **Check Permitt.~Yl~edroom Ra/ng Against HAA Request** I certify that I ?av/CTc~eck ~d, ~rifi~, or conformed to all MO~:a'hd inspection.////////// Company~ Date MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 lines in effect on the date of this Engineer's Seal STEVE COWPER, GOVERNOR DEPT. OF ENVIRON~I[ENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCI'IOPJAGE, ALASKA 99503 September 14, ].990 563-6775 FOR: Corwin & Associates Attn: Bruce Corwin PWSID: ~t213564 According to the records on file in this office, the .Sprinq Forest Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VE~vR~r ~mCen~. Ia~ Spe~i al i s t VEC:pf