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Home My WebLink AboutT15N R1W SEC 5 LT 85 Municipality of Anchorage Page I 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: .~U.}9 "J 0 ~ PID Number: O~'l - O~l Nam ·Wastewater System: D New ~ Upgrade Addr.ss: ~: VI~GL"~A ~¢~E~O ABSORPTION FIELD I Nc. of ~edrooms: Phone: ~fl~--~O0 ~ ~ ~ Deep Trench ~ShallowTrench DBed ~Mound ~Other Total De th from orl inal grade: LEGAL DESCRIPTION Soil Rating: I-0 GPD/Sq. Ft. Lot: ~ ~ Block:~ Subdiv~ion: ~ 3epth to pipe bottom fromo.odginal~ grade: Ft. Graver depth beneath~.pipe ~t Ft. Fill added above original grade: Gravel length: Townshi~ ]Range: j~ [Section: S =.~' ' ~' Ft. (~ ~ ~ Number of lines: ]Distance between lines: WELL: Xl~/~a ~ Ft. ~] ~O Fi. ~ New ~ Upgrade Graver width: Classification (Private, A,B,C,: Total Depth:~ ~o: Ft. totalabsorption area:~O SO. Ft. Pipe materia,:~.~ 0.o~. /~,JO Driller: ~ ~te Drilled: StalicWaterLevel: Instalter: Date Installed: Yie,d: j Pu~p s~t ~t: J Casing He[ght A~ve 6r0.nd: TANK ~PM Ft. Ft. SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P. To Septic Absorption Li~ Ho~ding =~blic/PrNate Manufacturer; Capacity in gellons: From TanA Field Station Tank Sewer Lines ~C~ ~ ~ I~O t I Number of Com~ments: Wel~ JO~ J00~ ~ ~ 251~ Material: Su,a~, -- LIFT STATION Water 1~+ I00~ ~ Size in gallons: I Manufacturer: Line "PUmp on" level at: J "Pump off" level at: J High water alar~ Foundation ~01~ ~Ol~ ~ -- -- ~aI ~,lm Pump Make & Model Electrical Inspections peHorme~by; Remarks: g~,~,~c L~+.c(~,~a BENCH MARK Location and Description: -' - J Assumed Elevation: ,.' Inspectionspedormed by:S&SSN~N~E"I~e _ . . g~[es:lst Io-Z?-~T ~'~ 11034Fagld~iver[oop~oaa, No.~ 2nd /,-2S-q3 '~,~.~ c~-88o1 Ea~le River, Alaska ~S1~., 3t~ .~ '~ ~ % ..':~ Department of HealLh a~d Human Se~ices approval '-~,<'~' '~'',.,~,~ .,...,- .... ,,, Reviewed and approved bY: Date://-/]-~] ~ 72-~13 (Rev. 9/91) MOA 25 ~ ~I0, SW970369 I~,GI~ 2 I:~ 3 iVlunicipo,(ik oF Amchor'o,c~e DEPARTMENT OF HEA~THAND HUHAN SERVICES ENVlRONHENTAL SERVICES DIVISION P.O. Box 196650 eAnchor'o, ge, A[o.$Ro. 99519-6650eTetephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOT 85, SEC. 5, T15N, RIW ~',.LI). lifO. 051-081-29 DBL1 55.5' 51.5' )BL2 56.0' 52.0' ST1 40.5' 56.0' ST2 47.0' 62.5' MH 4.9.0' 64.0' MT1 51.0' 74.5' MT2 78.0' 89.5' MT,5 72.0' 95.0' } WE~ MT4 94.5' 108.0' I % PARKING /'-..J _- ,T:~ NEW PRESSURIZED / / /..................................... ~::."'" ;' .~ .... :,,,.r ........ 50' PATENT R.O.W. EASEMENT .~,.,~., ........... SCALE 1" = 40' ~ NO. $W970369 ~ 3 0]1' Municip. ~[i~ o~ Anchor~ae DEPARTMENT OF HEA~THAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,B. Box 196650 eAncho~-o, ge, Ato.$1<a 99519-6650eTetephone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOT 85, SEC. 5, T15N, RIW 051-081-29 ST1 $T2 ~r96'7' ~ MH ~97.3' FINAL GRADE FINAL GRADE-x~IT1 / , MT1 = 97.7 MT3 . M 8 , MT3 = 98.4 MT4 = 98.3' MT~ = 9j.7 MT4/ _ -- MT2 = 95.0' MT3 = 95.6 MT4 = 95.5' · WATER FOUND 89.0' 87.0' B.O.H. ELECTRIC Electrical & General Contractor ELECTRICAL CONTRACTOR LIC. ~601 Hal Kostlln P.O. BOX 1864 'Jr PALMER, AK 99645 745-8883 'k 696-8883 To: Dean Construction SR Box 9352 Eagle River AK 99577 Date 11-01-97 Ref Permit: Lt. 85,T15N, R1W, Sect 5, SM This is to certify that on site sewer lift station at above mentioned property has been wired in accordance with the standards of the National Electrical Code and manufactures specification. Systems were checked and performed as specified in the systems manual. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMA~ SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970369 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:BAKER JOHN W OWNER ADDRESS:16600 CENTERFIELD DRIVE EAGLE RIVER, AK 99567 DATE ISSUED:10/15/97 EXPIRATION DATE:10/15/98 PARCEL ID:05108129 LEGAL DESCRIPTION: T15N R1W SEC 5 LT 85 LOT SIZE: 98988 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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: RECEIVED BY: ISSUED BY: DATE:~ ROBERT C. COWAN, P.E. CIVIL ENGINEEP~S Septmeber 22, 1997 (907) 694-2979 FAX (907) 694-1211 SEWER&WATER INSPECTION ENGINEERING STUOIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS SOILFEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 85, Section 5, T15N, RIW Request you issue a permit to upgrade the septic system serving the existing three bedroom house on the referenced property. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavtion, water was found to be at 7 feet. After seven day groundwater monitoring, the monitoring robe within the test hole has been checked and water was fbund to be at .~ feet. Attached is the proposed upgrade design. We do not anticipate any adverse ettbcts on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robe~l C. Cowan, P.E. P, CC/jlm Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Ir,13~qSV] ~AO~J IN31Vd 'lJ og 3SflOH z NUI.~J fJ ¥02 ~ ~ c~ NY Id -~IIS ,09 = ,,~ z o qlV±30 'S"J.'N PERFORMED FOR: LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~¢ Township, Range, Section: SLOPE SITE PLAN 1 2 4 5- 6- 7- 9- 10- 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS WAS GROUND WATER ~ ~ ENCOUNTERED? s I L IF YES, AT WHAT "~ O DEPTH? p E Deplh Io Water ARer -'1 t Monitoring? ~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~- (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ,~1 FT AND ~ FT ACCORDANCE WI~*~E~um~AL GUIDELINES IN EFFECT ON THIS DATE. DATE; SEWER&WATER INSPECTION ENGINEERINGSTUDIES AND REPORTS WELL INSPECTION & FLOWTEST SiTE PLANS ROADDESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ROBERT C. COWAN, P.E, ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 ~EFERENCE: Lot 85, Section 5, T15N, R1W September 22, 1997 GENERAL: The scope of this project includes the installation of pressunzed five foot wide drainfield~'and a 1250 gallon S.T.E.P. tank to serve the proposed three bedroom residence located 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 comractor 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. 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: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLE RIVER, ALASKA 99577 Page Two Lot 85, Section 5, T15N, RIW September 22, 1997 Septic tanks installed with less than 4 ii. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/D~LD INSTAIJ~ATION: 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 (rafted-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the holes faced downward. The distribution piping is to be ofPVC (ASTM D3034 or equal). All joints are to be solvent cemented. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt ban/er 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. Monitor tubes shall be of four (4) inch dimneter, installed approximately in the locations shown on the design, and extend a minimtm~ of 12 inches above final grade. 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. Page Three Lot 85, Section 5, T15N, RIW September 22, 1997 5. 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. 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: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTMFS10 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 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, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever specifications applies. Page Four Lot 85, Section 5, T15N, RlW September 22, 1997 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. The second inspection must be conducted at, er the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there w'dl 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. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement exist'rog between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and w'dl inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME ~'~;~"/~,~ ,~,"~/~'~"~ ADDRESS LOCATION ~ ~/~)~ ~ ~LEGAL DESCRIPilON SEPTIC TANK: DISTANCE FROM WELL ~'~ '~ NUMBER OF MATERIAL ~ ~'6~'~~ COMPARTMENTS ~'~_~4~z~"~ ,~'~' ~:::~' ~,'/,~ ~¢;' LIQUID LIQUID CAPACITY ,/'~'2 ~'~ ~"~-' GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH.__ SEEPAG~E SYSTEM: SEEPAGE PIT. NUMBER~~OF PITS IAMETER~ ELL (~W~ LENGTH~ , DEPTH LININ ,//UILDING FOUNDATION NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. ET. TILE DRAIN FIELD: DISTANCE EROM WELt ~f NUMBER OF LINES '~ ABSORPTION AREA ~-~"~ ~ ~ DEPTH: TOP OF TILE TO FINISH GRADE ~'"~' · · FOUNDATION ' , NEArESt LOt DISTANCE BETWEEN LINES ~ / TRENCH WIDTH SQ. FT. LENGTH OF EACH LINE~' ~*~ ' DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH ,OF LINES ~ IN. TOTAL EFFECTIVE IN. ABOVE TILE ~' // WELL: TYPE~/~/~-~=z'/~ , DEPTH. NEAREST LOT LINE ~.~0 ' ~ , SEWER LINE .,----- DISTANCE FROM ~' WATER /j~(_~ ., BUILDING FOUNDATION ' · SAMPLE , NEAREST SEPTIC ~;~ ~ SEEPAGE ~ ~ OTHER ~ ., TANK , SYSTEM , CESSPOOL - , SOURCES DISTANCES: DIAGRAM OF SYSTEM HEALTH AUTHORITY "~ DATE ,'//~'~ APPROVED GAAB-fID-2 GREATEY~"~,NCHORAGE AREA ~--~ROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 9950I 279-2511 Case N o. ~-~'~/ SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT(.') ~'~ RESIDENCE ADDRESS ~'"'-"~"" LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS MAILING ADDRESS ,4~)~,,~'~'~.~ PHONE NO. LOCATION OF INSTALLATION ~'~x~'~ SEEPAOE PIT. ~, DRAIN FIELD , OTHER TO BE INSTALLED BY, ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT T,,S,STDSE,VEAS nq q, T aXO .PERM,TTO,NSTALLA . SEPTIC TANK SIZE /~0 {) TYPEUE~EPASE AREA TYPE DIAGRAM OF SYSTEM DISTANCES: LICENSED DESIGNER UTHORITy I certify that I am familiar with the requirements of Greater Anchorage Area Boroug~h Ordinance No. 28-68 arid that the ) I ' above described system is in accordance with said code. /~/~ DATE 0 APPLICANTS SIGNATURE /~"'~REA'rER ANCHORAGE AREA HEALTH DEPARTMENT 327 EAGLE STREET ANCHORAGEs ALASKA 99501 CASE # ormed For ~ Date Performed This Form Reports a: Soz]s Log_~.~_ -, . .Percolation Test Depth Feet Soil Characteristics Was Ground Water Encountered?__~__. ~9~I-- If Yes, At What Depths__ .: .~ Location Sketch Reading Date ercola~ion J:ate 1"/ " Gross Time me De o Net Drop Proposed Instal~Seepage Pit z/ Drain Field Depth Of Inlet. ,,,~/'-3~' .... Dep~it Or COMMENTS :. . ~ ~ .. ~- ~, 7~ .... . . Test Pemfommed B · Data Certified By:~ Date: MUNICIPALITY'OF ANCHORAGE ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 =NVIRONMENTALSERVICES DIVISION 343-4744 NOV 0 7 1997 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A S INGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Sec 5; Complete. legal description HAA # T15N: R1W; Lot 85 · Locatio,~ (site address or directions) ;~'i-..~'~...'.~,.'.~ "J '.'~ Chuqiak, .~,;',.-?:,,. ' .... '. P, r.~..e~y owner Pstate _of John Baker C/~O Remax of Eagle River ~4~'~ fi~?add~es~' '"15600 Centerfield Drive g, en~lng agency M~iling address Agent 21123 Alluvial Street AK Day phone Day phone Virginia Kohfield/ Remax of Eagle Ri~phone 69424200 Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community well system, provide written confirmation from State ADEC attest- in~ to the legality and §tatus of system, If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, I/91) =font MOA#21 o STATEMENT OF INSPECTION BY ENGINEER 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 application 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 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 Address EngineeYs signature $ & $ ENGINEERING I/'034, ~.agle E~ver Loop Road NO. 204 Eagle River, Alaska 99577 Phone Date // /'7 /'~ 7 DHHS SIGNATURE f'~" Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date//-/.~ '¢? The Municipality of Ar~chorage 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 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 o~ Anchorage is not responsible for errors or omissions in the pr(~fessional engineer's work. 724~5 (Rev. 1/91) Back MOA ~21 ~v~UiNi~.it~^LITY OF Municipality o! Anchorage ~NVIRONMENTAL$t~RV~j~.~ON DEPAFITMENT OF HEALTH & HUMAN SERVIOE$ Environmental Services Division ~JOV 0 825 L Street, Room 502 · Anchorage, Alaska ggS01 · (gO7) 343-4744 RECEIVED Healti~ Authority Approval Checklist LegalDescription: [,o~' ~'~ _~ec~'~oG .~ "(,5¢~. I~,t¢ ParcelI.D.: O~1 A. WELL DATA Well type ~0 ~ ~.'r~' Log present (Y~) Total depth Sanitary seal (l~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed I). Cased to U/o~ -F Casing height (above ground) Wires properly protected (~)'N) Date of test Static water level Well production FROM WELL LOG AT INSPECTION g.p.m. ~ g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate 4~). J Other bacteria Date of sample: I I B. ~t~l~l~M~l~ TANK DATA Date installed to- ~ ~-1 Tank size Foundation cleanout (~,~l,~ Depression (Y/~. High water alarm (~N). Collected by: $ & $ ENGINEERING 17034 Eagle River Loop Road, Ne. ~. Eagle River; Alaska 99577 Number of Compartments ~-- Cleanouts (~YN)_ ~/E5 Date of pumpid~.' I~E t,3 '. Pumper C. ABSORPTION .... FIELD DATA .. ~ (~A¢O ~ Date installed, . I O-2~-~ : Soil rating ~r fF/bdrm) J. O System ~pe Width Gravel thickness below pipe ~.~ Total depth Effective absorption area Monitoring Tube present (~N) YE5 Depression over field (Y~ Date of adequacy test ~ ~ ~ R~sults (Pass/Fail) ~ For ~ bedrooms Fluid depth in absorption field before test (in.); ~ Immediately a~er -- gal. water added (in.): Fluid depth (ins) Minutes later: Absorptio~ rate = g.p.d. Peroxide treatment (past ~ 2 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (~)'N) *¢ E-~ High water alarm level at* /¢~f" Cycles tested ~ Size in gallons "Pump on" level at* "Pump off" level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I O Absorption field on lot I oo Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~-~o ~ Property line cf~; t 4- Absorption field I OI Water main/service line IO~L Surface water/drainage I°o1+ Wells on adjacent lots I0ol4¢ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line (o o'."r_ Building foundation -.~'ot;b Water main/service line lOI+ Surface water ! co ~-~ Driveway, parking/vehicle storage area -/-~ ~+----- Curtain drain I'~,~, ~o~ ~J Wells on adjacent lots ! OO~ 4' F, HAA Fee $_ c~ ' ~ ENGINEER'S CERTIFICATION ..... -~-.-,¢- ~ -,~ OF I certify that l have determined thru field inspections and review of Municipal recor~t~F..~beoeb~ ~¢ms are in conformance with MOA.~A guidelines in effect on this date. Signature I~W' ~ Engineer's Name /~d~.l~ C. ~o~ Date of Payment ///~¢2/-- . , Receipt Number ,.."~' ¢ CY~':~/ ./ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* NOV-11-1gg? ~1:1~ CT~[ ~SI ANCHORAGE ~pl~ Rem~rk~i 10 r~ax 11/07/97 ~P