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HomeMy WebLinkAboutSPRING HILLS ESTATES BLK 1 LT 12MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program POBox 18665 470OElmore Road Anchorage, Alaska 8S519-6G50 Phone: '7904 Fax: (907)343-7987 On -Site WastewaterD^sposa8 System Permit Permit Number: {}GP281119 Work Type: SepticTankUpyrade Tax Code Number: 01505150000 Site Legal Address: SPRING HILLS ESTATES BLK 1LT12 {]:2436 Site Mailing Address: S721SPRING HILL DR, Anchorage Owner: SAUTNER8TEVE&0K8BERLEY Design Engineer: HUBERENTERPRISE This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 5/2O/2026 5/20/2027 Non -Public 171 Disposal Field Z Septic Tank 11 Holding Tank EJ Privy El Water Well El Water Storage All construction shall beimaccordance with: 1. The attached approved design. 2. All requirements specified inAnchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (1 8AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Coodinate with On -Site staff regarding preferred method. 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: o. Opened and Closed onthe same day, or b. Covered, sealed, and heated boprevent freezing Issued To: HUBERENTERPR|GE Date: 5/2O/2026 Issued By: Curtis Townsend 5/20C2028 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section ON -SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 01505150000 Property owner(s) Sautner, Steve & Kimberly Mailing address PO Box 244376, Anchorage AK, 99524 Day phone Site address 9721 Spring Hill Drive, Anchorage AK, 99507 Legal description Spring Hill Estates, BLK1 LT12 Number of Bedrooms 5 Engineering Firm Huber Enterprise AK Building Permit Number Not Applicable ❑■ APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Disposal Field ❑ Initial ❑ Septic Tank 0 Upgrade El Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: No Waivers Requested Permit/Rush Fees: 2- _ Waiver Fees: _ Date of Payment: /� L Date of Payment: Permit No. L` -S P Z f i 1 `) Waiver No. May 2025 Distance: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261119, Curtis Townsend, 05/20/26 Spring Hill Estates BLK1 LT12 SepƟc Tank Design NarraƟve Project NarraƟve/DescripƟon: Spring Hill Estates BLK1 LT 12, beƩer known as 9721 Spring Hill Drive, is an exisƟng 5-bedroom residenƟal property. Based on available as-built informaƟon, the residence has an exisƟng sepƟc system that was installed in 1993 and consists of a single 1500-gallon sepƟc tank connected to a Deep Trench AbsorpƟon Field. The exisƟng absorpƟon field has been inspected and is in operable condiƟon, however, the tank is failing and is in need of replacement. Design CalculaƟons Flow Rate: 5 Bedroom Main Residence at 150GPD/Bedroom - Design Flow = 5 bedroom X 150 GPD/bedroom = 750 GPD SepƟc Tank Size: Minimum Tank Size shall be 1000 gallons plus 250 gallons for each bedroom over 3 per - 1000 + (250 x 2) = 1500 gallons AbsorpƟon Field: - Based on available asbuilt informaƟon, the exisƟng deep trench absorpƟon field is 59 feet long with an effecƟve depth of 8 feet. This provides 944 SF of absorpƟon area. Soil condiƟons at the Ɵme indicated an applicaƟon rate of 0.8 GPD/SF. This meets current standards for required absorpƟon area. I am unaware of any adverse impacts this installa Ɵon would have on any wells or sepƟc systems constructed in the adjacent area. Should you have any quesƟons or require any addiƟonal informaƟon, please do not hesitate to contact me. Sincerely, Logan M. Huber P.E. (772) 528-6287 Lhuber87@gmail.com W Feet 0 20 40 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261119, Curtis Townsend, 05/20/26 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: .~'/a.J 9,.?0..72- & PID Number: Address: ?72/.~'~,~,,~/¢,~c /.2~ ABSORPTION FIELD Phone: No. of Bedrooms: . ~ ~.DeepTrench [] Shallow Trench [] Bed []Mound []Other LEGAL DESCRIPTION Soil Rating: Total Depth frorn original grade: ~. ~ GPDISq. Ft. ,- Lot: Block: Subdivision: 0epth to pipe bottom [rom original grade: Gravel depth beneath pipe Township: Range: I Section: Fill added above original grade: Gravel length: J ~ / Ft. ~'~ Ft. WELL: [] New [] Upgrade Gravelwidth: Number of lines: Disancebebveenlines: Classification (Private, A,B,C): Total Depth: Casod To: Total absorption area: Pipe material: ~..~<:~,~'~ Driller: Date Drilled: StalicWaterLevel: Installer: Date installed: Yield: Pump Set at: Casing Height Above Ground: GPM Ft Ft. TANK SEPARATION DISTANCES (~ Septic [] Holding LR S.T.E.P. To Septic Absorption Lill Hoidin9 Public/Prwate Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines /~,~ ~- ¢~',/<:2~. a~- ~-,~' 7~/L)/~ Water /<POi+ /oo '+" ..... LIFT STATION Lot '-'/' Size in gallons: I ~ Line /¢ 10 *'¥ ..... , I i,,.~,~ I "Pump on" level at: "Pump of~High water alarm at: Foundation Curtain ~ , /L~ O,,K.) ~: /~'/f,)O ~' j,~ Pump Make & Model Electrical Inspections performed Drain~, Remarks: BENCH MARK Location and Description: Assumed Elevation: /OO, O Fl. ENGINEER'S SEAL 17034 Eagle River Loop Road, No. 204 ,':/,, -' , / - Inspections performed by: Eagle River, Ala~ke 99~i77 Bates: 1st./¢-z'~-e~ .,- ............. ~,.¢,~ . Department of Health. and Human Services approval 72-013 (Rev. 9/91) MOA 25 Permit No. sW930326 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF I-IEALTH 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 L. egalDescri3tion: SPRING HILLS ESTATES, BLOCK , LOT 12piDNo.: 01505150 C01. bog ['! C03 78.7' NO WATER FOUND A B FC0 8.5 6.0 CO1 10.0 7.5 CO~ ..1~..0 :: 1~,.~ C03 37.0:: 34.0 C04 34.5:: 49.0 MT 37.5i 35.0 LOCATION OF WELL SUBDIVISION LOCATIONISK~]'CH: BOREHOLE DATA: Mateti~l Type and Color From To :' ~E OF ALASKA DIVISION OF WATER WATER WELL RECORD Oept, WE, LL OWNEI'{: L]s ~w I WELL DI-:PTH: ,~ .~ / OATE OF COMPLETION Depth of hole: ~ E~ ft DEPTH 1'0 STATIC WATER E] public ~up~Jy ~ other. ............................ CASING 871C:~-UP; ~ R. Diam: ~ ~n. to. f~ ~ pedomt(',d' ~ oper, hob Depths of oponms;: .......... [o ....... ft 80REEN TYPE: ................. D;am~ ................. in., 81otYMOsh Sb.e: L ?ngth: ............... GRAVEL PACK TYPF.; Mu Um~ u~.~d: .............. GROUT I'Y PIL. Volume: Depth: ~rorn P, ~.0 ft PLEASE MALL, WHITE COPY OF LOG;]~O: DNR/DIVI$10N OF WA~'ER .~, ' PO ~OX 722116 .... ~GLE f(lVE~ AK 9~577-~'116 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930326 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:HAGMEIER JOHN C & JUDITH A OWNER ADDRESS:9721 SPRING HILL DR ANCHORAGE, AK 99507 DATE ISSUED: 8/26/93 EXPIRATION DATE: 8/26/94 PARCEL ID:01505150 LEGAL DESCRIPTION: SPRING HILLS ESTATES BLK T 12 1 L LOT SIZE: 45337 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALI, 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 (iSAACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 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: RECEIVED BY: DATE: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P,E. ROGER SHAFER, P.E. October 9, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 RECEIVED Municipality of Anchorage OCT 1 1 199; DEPARTMENT OF HEALTH AND HUMAN SERVICES Municipality of Anchorage 825 L Street Dept. Health & Human Services Anchorage, AK 99519-6650 REFERENCE: Spring Hills Estates Subdivision, Block 1, Lot 12 We request you re-issue permit #SW930326 to drill a well and instafl a septic system to serve the proposed five bedroom house on the referenced property. The ex/sting permit was issued on 8/26/93 for a four bedroom home. The owner now wishes to install a system large enough for a five bedroom home. This property has enough area for a future septic upgrade, which can be seen on the attached revised site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. ~f~A. Shafer, P.E. S/LSU/Isu 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. August 12, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUPLAN SERVICES 825 L Street Anchorage, AK 99519-6650 REFERENCE: Spring Hills Estates Subdivision, Block 1, Lot 12 We request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the referenced property. Two test holes were performed on the property. The approximate location of the test holes are located on the attached site plan. The monitoring tubes within the holes have been checked and found to be dry. × This property has enough area for a future septic upgrade, which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. ROAD DESIGN S i n c e ert A. Shafer, P.E. SOIL TEST PERCOLA¥1ON ~/// RAS/LSU/lsu STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP . SUITE 204 · EAGLE RIVER, ALASKA 99577 NV-ld 311t PERFORMED Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: L/~',,~ [~//~'~rl,-{ix~ ~.~, g/~,Township, Range, Section: SLOPE SITE PLAN ENCOUNTERED? s IF YES. AT WHAT ~ O DEPTH? p E 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- Oeptl~ to Water Aller ,~.~ ~_ Monitoring? ~.~lb~ Da~e: Gross Net Depth to Net Reading Date Time Time Water Drop _ ; IO /o ff '/~ /'/~ _ PERCOLATION RATE e {minutes/tach) PERC HOLE DIAMETER PERFORMED BY:Eag,eT~4 Ea~,e Rive., .~p ..Rlyer. A,as~~ Q ..... ~ ~// ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AN~AL GUIDELIN~IN E :ECT 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 PERPORMED FO.: 'b,qu LEGAL DESCRIPTION:6)"r ~2{ ~ Ii ~1~¢ ~Icc~Township, Range, Section: WAS GROUND WATER ~ ENCOUNTERED? C~ S L IF YES, AT WHAT ""'"' O DEPTH? p E 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18-- 19 2O neplh to Water Alter "~/2~'~ ~ I~onitoring? ~)I'L¥ Dale: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE g (minutes/tach) PERC HOLE DIAMETER __ ............ 17034 Eagle River Lo~p Eead .~.~, ~ ,// / ~ CERT FY THAT THIS TEST WAS PERFORMED .............. Eatlla River, Alaska 99577 ' '- ' /,~ ~/' " IN ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINE~8/II~-~ECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) / ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Spring Hills Estates Subdivision, Block 1, Lot 12 GENERAL: 1. The scope of this project includes the installation of a 1250 gallon septic tank and a leachfield trench to serve the proposed four bedroom residence on the referenced property. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. o The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. o Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. o Septic tanks installed with less than 4 ft. of cover shall be insulated. Page Two Spring Hills Estates Subdivision, Block 1, Lot 12 August 12, 1993 A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed- up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. o A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. o Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. o Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three Spring Hills Estates Subdivision, Block 1, Lot 12 August 12, 1993 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tvpe of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. o Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). o Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). o A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Spring Hills Estates Subdivision, Block 1, Lot 12 August 12, 1993 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. o The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. o The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # (~,j\ z~_~,z~\~ ~Lt'~ HAA# GENERAL INFORMATION Complete legal description Lo~..12;/, Blo.¢k,, t; ~Spring. :Hills Estates Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address John ' Hagmei~r_ 2204 Clevland Day phone_ 248-6789 Anchorage, AK 99517 Day phone_ Day phone_ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XXX If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX 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 e),eQ m, uewwoo leUOi~!ppv :suollelndp, s I~U!MOIIOJ eH1 H:~!M 'suJooJpaq JOJ leAoJdde leUO?,!puoo 'peAo~ddes!O 'SLUOO~peq .~- ~OJ po^o~ddv ~ :~I:II~.LYN~IS SHHa '9 ~ ~ ~ ~.-~- eUOLId ~_~. ............. LUJ!4 JO eLUeN 'uo!~oadsu! siq~ jo elep eq~ uo ~,oejJ, e u! suop, elnBeJ pue 'seoueu!pJo 'sepoo e~e~S pue led!o!unR lie q~!~ eoue!lduJoa u! s! LUe~SXs lesodsip Je~e~m, se~ ~o/pue Xlddns ~e~e~ m,!s~uo eq~ 'uop, oedsu! pus uo!]eSp, se^u! XLU LUO~J pue sel!J eSe~oqau¥ Jo/q!led!o!unlAI eq~ ~uo~j peu!e~qo UO!~eLU~OJU! eql uo peseq ~eq~ ~Jpe^ ~eqMn,t I,.'u!e~eq pe~eo!pu! eJn~om~s jo edX~, pue suJoo~peq jo ~eqLunu eq~ ~oj elenbepe pue leUOl~ounj 'ejes s! Lue~sXS lesods!p ~e~e~e~se~ Jo/pue. ~lddns Je~,e~ e~fe-uo eq~ ~,eq~ s~oqs uo!~eo!ldde le^o~dd¥ X~poq~nv q~leeH s!q~ jo uoile6Rse^u! XLU ~eq~ XJHe^ I '~oleq ut~oqs e~ep uo!~epile^ eq~ jo se puc o~e~eq pex!ge lees/u~ Xq pe!jlMea sV t:E]=INI~DN=I XG NOIIO=IdSNI .dO IN=I~=IIVIS Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~OT l~, ~;~_~C [/ ~%"~gdS-~/LL~ ~Z. Parcel I.D. __ A. Well Data well ~pe ~,I~7~ If ^, B, or C, attach ^DEC letter. ADEC water system numbe~r Log present (Y/N) V~S Date completed I~-/¢~l .~~ Driller Total depth ~ t ~ Cased to ~;~-- I Casing height Sanitary seal (Y/N) ~ Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: g.p.m. Septic/holding tank on lot Absorption field on lot Public sewer main /U//~ Sewer service line L~" (~ A/T INSPECTION g.p.m. ; On adjacent lots /CO '¢ ; On adjacent lots /~0 '¢ Public sewer manhole/cleanout ~L~//;~ Petroleum tank ©~J ~ WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: ¢'~ ~ ~ - (~ ~ SEPTIC/~ TANK DATA Date installed _ /O/~O/?~ Cleanouts ~N) ~ High water alarm (Y/N~. Date of pumping /L//z~ Tank size ~). ~ ~ ~/~-~ Other bacteria Collected by: % ~ % FCZ~I'~G'I~---FcU~O- /~flO F___.4~C Compartments Foundation cleanout ~/N) _ y Depression (Y/~ fL)/~-,L Alarm tested. (Y/¢ j/~/~d 7/~/dE Pumper SEPARATION DISTANCES FROM SEPTIC/I TANK TO: Well(s) on lot I,.~ To property line ~(~ Surface water/drainage On adjacent lots Absorption field. [00 "~ Foundation Water main/service line ~ '~' 72-026(3/93)*Front CONTINUED ON BACK PAGE Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTA..NCEq~OM LIFT STATION TO: Well on.lot--'"'""- On adjacent lots D,ABSORPTION FIELD DATA Date installed [0 Length ,Z~-?,~ Width Total absorption area ~Z-/L~ ~-- Date of adequacy test /,J/~- Water level in absorption field before test Peroxide treatment (past 12 months) (Y/~ Manufacturer Manhole/Acce,' __"Pump off" Level at tested Surface water Soil rating (GPD/FF) ~ ~ Gravel thickness Cleanout present {~yU) .../V' Results (pas~fail) ¢/¢ ~ / Total depth /~ Depression over field (Y/~ for --~ Bedrooms After test /~/,4~ 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 l0~) t'/ Property line I ~ ~ '~ To existing or abandoned system on lot Cutbank /V/,/'F Water main/service line Driveway, parking/vehicle storage area ~ r E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conforme~ MOA and HAA guidelinesin ,ffect on the ?re of.this inspection. 'g a ue .... ~,~,~,~,~F~/ ~ ~ .' Engineer's Eagle River, Aias~-'a :;; ' Date ~ /o ~ / HAA Fee $ Date of Payment Receipt Number Waiver Fee'S Date of Payment Receipt Number 72-026 (3/93)* Back