HomeMy WebLinkAboutTURPIN BLK 1 LT 14 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: '~J.~ I 0 "~'~-"J-'~ PID Number: ~-/'~./~ -/J q ~1~'~
Name:
[,J, IL,~ll~t'~l .-J. "1"~¢-.~'"'~' IwastewaterSystem:
[]New
ABSORPTION FIELD
LEGAL DESCRIPTION
Block: livision:
Lot 't
Township: Range: Section:
WELL: [] New [] Upgrade
Yield:
From
Well
Surface
Water
Lot
Line
Curtain
Drain
GPM I Pump Set at:
Trench [] Shallow Trench [] Bed [] Mound [] Other
Total Depth:Ft. Cased To: Ft.Ft. Totai absorption area:
Casing Height Above Ground:
Ft. IFt.
SEPARATION DISTANCES
Remarks:
Soil Rating: ~,. ,~ Total Depth from original grad/e:
Depth 1o pipe bottom from original grade: Gravel depth beneath pipe
Fill added above original grade: Gravel length:
TANK
;
Material:
[] S.T.E.P.
' Capacity in gall°nsi {~)~.~ i~)
Number of CompartmentS:
LIFT STATIC?
Size in gallons: Manufacturer: ~
Pump Mak'~odel I Electrical Inspections performed by:
BENCH MARK
Location and Description:
: 49T._~.H
Department of Health and Human Services approval
Reviewed and approved by: ~ ~_..0-,~,-,..~ Date:.//-/~-~7!
72~)13 (1/91) MOA 25
Po.~..o. ~---~~ Pa~a ?~o~~
Municipality of Anchorage
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
Legal D es c ript i o n: "r~l~lLl[~l'~
72-013 A (2/91) MOA 25 I = ~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 NUMBER:SW910354
DESIGN ENGINEER:S & S ENGINEERS
OWNER NAME:TACKETT WILLIAM J &
OWNER ADDRESS:6410 E 9TH AVE
ANCHORAGE, AK 99504
PAGE 1 OF 1
(UPGRADE) PERMIT
DATE ISSUED:ZZ/01/9Z
EXPIRATION DATE:il/01/92
PARCEL ID:00609214
LEGAL DESCRIPTION:!TURpIN BLK
1 LT 14
LOT SIZE: 9135 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT:
THIS PERMIT IS FOR THE CONTRUCTION 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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
Tom Fink,
Mayor
unicipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
November 4, 1991
Roger A. Shafer, P. E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 14 Block 1 Turpin Subdivision
Waiver Request #WR910051, PID #006-092-14, SW910354
Dear Mr. Shafer:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 5 feet on the east, west and south property
lines.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Robert W. Robinson
Civil Engineer
On-site Services
Concur: / ~
On-site Services
ljw~7
ROBERTSHAFER, P.E.
ROGERSHAFER
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUD]ES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
October 22, 1991
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, Alaska 99501
MUNiCiPALITY OF ANCHORAGE
~NVJRONMENTAL SERVICES DIVISION
oCT 2 8 1991
RECEIVED
REFERENCE: Turpin Subdivision, Block 1, Lot 14
Request you issue a permit to upgrade the septic system
serving the referenced property.
An adequacy test was performed on the existing system and the
absorption capacity of the system was found to be inadequate.
Two test holes were excavated and percolation tests performed
in the area of the proposed upgrade. Attached is the proposed
upgrade design with an alternate site depicted.
To maintain a 10' separation distance to the existing trench
a 5' property line waiver will be required to the West, East,
and South property lines. At this location the closest
neighbor's septic system is still approximately 25' from our
proposed trench.
The lots in this area are served by a Municipal water and
there are no wells within 200' of the septic upgrade.
Although the lots in this area are-small we do not anticipate
any adverse effect on the surrounding properties with this
septic upgrade.
If you have any questions or require additional information
for your review, please contact us.
Sincerely,
ROGER J.
RJS/lsu
ON SITE
WASTE WATER
OISPOSAL SYSTEM
OESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
SCALE
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
FERFORMED FOR:
LEGAL DESCRIPTION:
1
3
Township, Range,
SLOPE
7
8
9-
10-
11
13-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
Deplh to Water After t~ _~
Monitoring? ¥~ Dote:
DATE PERFORMED
Section:
SITE PLAN
'1
N
14-
15-
16-
17
18
19
20
Gross Net Depth to Net
Reading Dare Time Time Water Drop
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN E~ETWEEN ¢;[ FT AND ~ ~;' FT
COMMENTS
$ & S ENGINEERING
17034 Eagle Ri,vet Loop Road N~, ~ /~ ~\ A
,-oU.~ *...-,~, ~ ~,a~..o x~'..,,r,r ~ ~ '~'~' ~1' CERTIFY THAT THIS TEST WAS PERFORMED IN
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LECAL OESCR,PT,ON,
5
6
7
8
9
10
11
12
13
14-
15
16
17
18
19
2O
2
DATE PERFO[
Township, Range, Section:
WAS GROUND WATER
ENCOUNTERED?]'~'
IF YES, AT WHAT
DEPTH?
Depth to Water After I
Monitoring? ~ ~
SLOPE SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE --
TEST RUN BETWEEN
~' ~> (minutes/inch) PERC HOLE DIAMETER
~:~ FT AND I 2 FT
COMMENTS
$ & S ENGINEERING
17034 Eagle R~er Loop Road bio. 204 ~ //'~/'-") J A
PERFORMED BY ..... , , .~.~-.-. ' ~--~-~... ~ d / L-/ t f CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ ~' [ ~ ~:~ /
72-008 (Rev, 4/85)
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 INSPECTION REPORT
NAME PHONE ~'/-~'¢'/d// [] NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO, OF BEDROOMS
iw.,, ~)1 Ab~o~,.io. ~.~ Dwelling PERMIT NO.
DISTANCE TO: ~ ~- ~4/~/20~ ~ I~ ~
/teF~,-I~,,~,~. OTHER
72-013 {Rev. 3/78)
MUNICIPALITY OF ANCHORAGE~
Department~f Health and Environmenta protection
825 = Street, Anchorage, AK. ~9501
264-4720
~ HANDWRITTEN PERMIT * * *
Permit ~ ~ I{~
Applicant:
Location:
Legal Description: Wi ~ ~ I
Type of Soil Absorption System Is:
Trench: Drainfield:
Maximum Number of Bedrooms: ~
WE~/OR ON-SITE SEWER PERMIT
Phone Number:
Lot Size:
Seepage Bed: ~/ Holding Tank:
Soil Rating(sq.ft/br) l0
The Required Size of the Soil Absorption System Is:
DEPTH ~q~o~ ~' LENGTH fO GRAVEL DEPTH ~ oV~m WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /(~0 :: GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without fin~i inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days Of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
z certify that:
(l) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more t~a~
Date: :/~/
SWP/024(1/81)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
5-
6-
7
~-~8
9-
SOILS LOG
MUNICIPALITY OF ANCHORAGE
[] PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
SLOPE SITE PLAN
DATE PERFORMED:
10'
11
13-
WASGROUNDWATER //~,/~ ~
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
14-
15-
16-
17-
18-
19-
20-
COMMENTS
PERFORMED BY:
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN
FT AND FT
72-008 (6/79)
LEGAL DESCRIPTION:
1
2
~3-
--------4-
5-
6-
7
9
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
~2§ L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SLOPE
SOI~S LOG
[] PERCOLATION
TEST
SITE PLAN
10
11
12
13
14
15
t6
17
18
19
20-
WAS GROUND WATER ,~//~ ~
ENCOUNTERED? pO
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE minutes/inch)
TEST RUN BETWEEN ,~ FT AND -- FT
GAAB-HD.I
GRFJ~TER ANCHORAGE AREA BOROU~,~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 ~..,'9-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
MAILING ~ ¢/'j'~)
ADDRESS PHONEr''~'
LEGAL DESCRIPTION ~
SEPTIC TANK:
DISTANCE
LIQUID CAPACITY
LIQUID
GALLONS· INSIDE LENGTH INSIDE WIDTH DEPTH___
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE
SEEPAGE PIT: C/~-/¢,~,~-~'~-''- ~'m/'/'J,~.~,<'
OUTSIDE DIAMETER OR WIDTH ~ . , LENGTH , DEPTH
· DISTANCE FROM WELl
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
· BUILDING FOUNDATION
.so. ET.
TILE DRAIN FIELD:
DISTANCE FR M WELL UNDATION , NEAREST LOT LINE. ., OF LINES
ABSORPTION AREA_ SO. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
~ ,A ,t, .DISTANCE FROM/ WATER
WELL: TYPE DEPT~//BUI~ING F/~D_AT[~) SAMPLE__ . NEAREST
NEAREST /,. OT.ER
LOT LINE , SEWER LINE ,TANK , CESSPOOL , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
HEALTH AUTHORITY
GREATEL ANCHORAGE AREA .,OROUGH CsseNo.
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511 (~¢~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT.A~,~'.~'~'/'~
NAME OF APPLICANT {~.~/~ ,,~./~t//.,.._~. ~ MAILING ADDRESS ~q/D ~'", ~¢~ ~Y'~",/~/~PRONE NO.
RESIDENCE ADDRESS ~"~'"' LOCATION OF INSTALLATION '7'"~/AJ ,,~,~'
LEGAL DESCRIPTION Z~)"/'~"~/
APPLICATION TO INSTALL: SEPTIC TANK ,SEEPAGE PIT / , DRAIN FIELD. , OTHER
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
· SEPTIC TANK SIZE
,PERMITTOINSTALLA ~~
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED / /r~-~.,
.TYPE SEEPAGE AREA /.,2. ~ / ~.~ . TYPE
DIAGRAM OF SYSTEM
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No, 28-68 and that the
above described system is in accordance with said code.
DATE . APPLICANTS SIGNATURE .
' · APPLI' ~NT FILLS out UPPER HA:'i? ONLY
Proc?arty evener ~/¢ ~1) /~.~ ,~ Je~ov/~ h Phone
, ~
Type esi~nce
~ Multiple Family No. of Bedroo~
Water Supply
~ Individual A~ACH WELL LOG. A w¢l log is required for all wells drilled since June 1975.
Sewe isposal
~ividual Year Individual Installed:
B Public Utility When Connected to Public Utility:
¢olding Tank 9
NOTE: THE INSPECTION FEE MUBT ACCOMPANY EACH RE~EST BEFORE ~OOESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
[:'..~_~.~.? /~P MUNICIPALITY OP ANCHORAGE
RFCFIVFB
( ~PPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAP~OVEO
( ) CONDITIONAL APPROVAL*
72-023 (3182)
February 7~ 1983
~.ranK Jerkovlch
6410 E. 9th St.
Anchorage ~ AK 99504
Subject: Lot 14 ~I,~,..K I Turpin S-'~ ;
Approval for the in~,ividual sewer an.. water facll3, tle,,] cannot
be granted until the following ite.,'us have been completed:
T'he water facilities were not tur~ed on at the time of the
schedul~] inspection. Pl~.~se call this o~ffice for another
are met betweeri~e well and sewer~ s~st~u.
%'he septic tank pur~ped with a receipt sub~nitted to this
department. The total number of gallons pu~]ped needs to be
on the receipt and verified by a registered enginee]3 as
the actual l]u:~aber of gallons pr!aped, qThis i.s to verify the
~size of the septic tank.
cc~nk ,~an~lole to v~if?
~/ fin ad?quacy test needs to be perf<)rT~/ed on the existing
~ ~/ leaching area. ~hi.s t~st will ~tetermine if tho systera ~,s'
~ ~ adequate accordinq to ~atio~aal Standards. A listing of
private ~_ir,a~ per'fettling t~e test
needs to be submitte~ to this o~flc, f~r our review.
Please p. otl.cy ~h~£, £)epa~;tment lot~ a ~:einspection when the
noted ¢]iscrepa~ncies nav. been corrected°' If there are any
further questions, please call this office at 264-4720.
Sincerely~
,:t']:,.7 ~ /p/,,. 1
Enclosure
Ji~ ?,ober ts
,~,~o¢.iat_ Envi!:onP~ental ,-
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. # 00609214
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA # ~C~ \ ('-~L.{ ("%
1. GENERAL INFORMATION
Complete legal description Turpin Subdivision, Block 1, Lot 14
Location (site address or directions) 6410 E. 9th Avenue, Anchorage, AK 99504
Property owner William J. Tackett
Mailing address same
Day phone 337-3137
Lending agency
Mailing address
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3 'w
TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
xx
Individual on-site
Holding tank
Community on-site
Public sewer
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, 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 a. nd 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
Engineer's signature
S & S ENGINEERING
~ . r Loc,.. NO
Eagle Rivert Alaska 99577
6. DHHS SIGNATURE ~<_.
Approved for
Disapproved.
bedrooms.
Phone
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: ~ (~.4-~,~ Date
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 DHHS doesthis 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.
72~25 (Rev. 1191) Back MOA ¢Y21
Municipality of Anchorage ~i~
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:'~'~.~t--~ -~------~!'~: '~l~)/~J~-/[ i
A. WELL DATA
Well type~'{[Jf',-[ t/~--II~:;~k"~, B, or C, attach ADEC letter.
Parcel I.D.
ADEC water s
Log present(Y/N)
Date completed Driller
Total depth Cased to ht
Sanitary seal (Y/N)
Wires properly
(Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
AT INSPECTION
leU NtCI P~P~.GE
E~i~ONMENTAL SERVICES DIVISION
g.p.m.
NOV 1 2 1991
SEPARATION DISTANCE,"
Septic/holding tank on lot
Absorption field on lot
; On adjacent lots
; On adjacent lots
RECEIVED
Public sewer main
Public sewer manhole/cleanout
Sewer service line
Petroleum tank
WATER SAMPLE RI
Coliform __ Nitrate
Other bacteria
Date of sam
Collected by:
: DATA
Date installed "~" ~r'" ~ ~ Tank size
Cleanouts CN) Y Foundation cleanout CN)
High water alarm (Y/N) ~ /~ Alarm tested (Y/N)
Date of pu~'lping.. 10 *'?,~-. {~ I Pumper
Compartments ~
Depression (Y~) d
SEPARATION DISTAI~CES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot J~,J' ~.. On adjacent lots '~L/~ J~' Foundation
TopropertYline J I~ I . Absorption field
Surface water/drainage J~ f"~
Water main/service line
72-026 (Rev. 7/91) Front ,, ": i'' CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (y/N~V'""
SEPARATION DISTAN~b~ROM LIFT STATION TO:
Well on lot ?_.-~' On adjacent lots
Manuf~
~ _ M~..~le,~A'"'c c e s s (Y/N)
"Pump on" ,ev~/.--"- Cycles te'i~e~mp off" level at
Surface water
D. ABSORPTION FIELD DATA
Date installed I1 ' '"Jr'' ~ I
Length --JF'~) / Width
Total absorption area ~c"') I
Depression over field (Y~
Results (pass/fail) k/~"~'~ ~L~
Peroxide treatment (past 12 months) (Y~
Soil rating
Gravel thickness
Cleanouts present (1~)
Date of adequacy test
~'~)//~,'~,'~! 15~System type
Total depth
for "~
bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots .~.~¢)~ I ~ Propertyline
l C) ! To existing or abandoned system on lot
Cutbank k.J. ,O f,...~¢~'. Water main/service line
~ (~-/,~ I .+_ 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,
Signature $ & S ENGINEERING
17034 Eagle RiYer Loop Read Ne, 204 ~
Engineer's Name Eagle River, Alaska 99527 '--- ~
HAA Fee $ /,~
Date of Payment
Waiver Fee: $
Date of Payment
Receipt Number
72~02S (Rev, 3/91) S~ck MOA 21