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VALLEY VIEW TERRACE BLK 1 LT 2A
Onsite File Valley View Terrace Block 1 Lot 2A #050 - 352 - 45 Berm must be maintained , as shown on permit 0SP181224 . MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241229 Work Type: Septic Upgrade Tax Code Number: 05035245000 Site Legal Address: VALLEY VIEW TERRACE BLK 1 LT 2A G:0159 Site Mailing Address: 23307 EAGLE RIVER RD, Eagle River Owner: FEVURLY THOMAS GUY & Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 8/26/2024 8/26/2025 40158 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 3 Special Provisions: During construction, berm to the west of the septic system is to be verified for construction. See construction detail Section A -A on OSP181224. Verify extents of berm to ensure it directs any surfacing effluent away from surface water. Received By: �-'�Jl I _0 %q-uTT-- 114 Date: Issued By: �(/ C"' Date: t' Y C MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 050-352-45 ANCHORAGE JR05VI ON -SITE SEPTICMELL PERMIT APPLICATION Property owner(s) Thomas Fevurley Day phone Mailing address 23307 Eagle River Rd, Eagle River AK 99577 Site address 23307 Eagle River Rd Legal description (Sub'd., Block & Lot) Valley View Terrace Blk 1 Lot 2A Legal description (Township, Range & Section) Lot Size 40,158 Sq. Ft. Number of Bedrooms 3 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ® Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank ® Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: F ( F, (-D M P P l- a2''15' C_I -- i, Distance: 5�1_ I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Z S Date of Payment: Z�Wzy Date of Payment: Receipt Number: 00 4 37G Receipt Number: Permit No. 05p2y l 22q Waiver No. Z 'Po ` / GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241229, Curtis Townsend, 08/26/24 * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV241041 COSA#: PID#: 050-352-45 Permit#: OS P241229 Legal Description: VALLEY VIEW TERRACE BILK 1 LT 2A Engineer: ArcTerra Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on -site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: , X Waiver is not Granted: Date: -Z 2, Approved by: _ N Narffe o R viewer **** VARIAN C E/WAIVE R REVIEW **** Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241229, Curtis Townsend, 08/26/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241229, Curtis Townsend, 08/26/24 I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. ARCTERRA CONSULTING, INC 20441 Ptarmigan, Eagle River,AK 99577 Office (907) 696-6111, Fax (907) 868-3793 SOILS PERCOLATION TEST Performed for: Date Performed: Project: TEST HOLE # TH Depth (Feet) 1- 2- 3 - 4- 5- Reading Date Gross Time Net Time Depth to Water Net Drop 6- 1 7- 2 8- 3 * 9- 4 10- 5 * 11- 6 12- 7 * 13 - 8 14- 9 * 15- 10 16- 11 * 17- 12 18- * Water Added 19- B.O.H. SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? What depth? Depth to water after monitoring? Date (Depth below grade) Percolation Rate (min/in) Perc Hole Diameter Test Run Between ________ feet and _______ feet - Perc Bench #1 @3 7/11/24 - 1 Valley View Terrace Block 1 Lot 2A Thomas Fevurley 0 - 2 Org 2 - 12 GW 12 7/11/24 11Yes 11 7/18/24 12:00 6 3.0 3.5 12:07 7:00 3 0/16 9 0/16 6 1.16 12:08 3 0/16 3 0/16 3 0/16 9 0/16 9 0/16 9 0/16 7:00 7:00 7:00 12:15 12:16 12:23 12:24 12:31 6 6 6 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241229, Curtis Townsend, 08/26/24 AS -BUILT OF: VALLEY VIEW TERRACE LOT2A BLOCK PLAT 85-113 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shout( any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE- SCALE: E-MAIL AUG 9, 2024 1 ::-- 40' schullerakOgmail.com 2 4 — 0 9 2 DRAWN BY, 1CHECKED BY: GRID NUMBER: BOOK AGE: JLS SW01 60 240273 FND ALUMINUM MONUMENT FND 5/8" REBAR A0000 0 F SO? AWW 0 A W_ . I %I�� ..41P *'.� � 49TH ............. Con ?1 ................................. ••,J4 N L. SCHULLER.- 0 LS-10408 1*4041 i . • •�41 1831 Talkeetna Street Anchorage, Alaska 99508 t� N Ll � of\'0 dW (907) 227-1455 office esiono\ Aaw (907) 274-4992 fax m 4 Z; qf; �A� � Municipality of Anchorage Community Development Department AUG 2 3 201l8ge Lof 1 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181224 PID Number: 050-352-45 ❑ New ❑ Upgrade Name: Larry Moran ABSORPTION FIELD Address ❑ Deep Trench El Shallow Trench ❑ Bed ❑ Mound 23307 Eagle River Road El Other Phone Number of Bedrooms Soil Rating Total depth from original grade withheld by request 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. Valley View Est 1 2A Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line Ft2 Ft. Well 109 N/A 25+ TANK ❑Septic ❑S.T.E.P. ❑Holding 0 Other Manufacturer Capacity Surface Water 38 N/A Existing Greer 1000Ga1. Material Number of compartments Lot Line 30 N/A STEEL 2 NA Foundation 10+ N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ N/A Gal. Remarks Pump on level at Pump off level at High water alarm at Exposed tank and found it to be solid with no leaks and performing its intended function. See Picture. in. in. in. Installed berm per design. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer drainfield JR's Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) ft Inspection is, 8/17/18 d Location and description dates: 2" 3rd 4th COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp ...i.' OF AC l� Conditional Approval: Date P' •'QS 1k �o*0..i ' TH %\ 9*+� t- d_ . •Steve ..F5annorae• •a,� 76-0,•• CE 8149 ,-� Qc. >1ot�)�ec�0Q90vXve e0( F �'► -- 124-ex-La. Date 8/2 -1 g i9 kt A4oFESS,0 �.." f Inspection Report_1-1-12.doc ,e,,..:, , „,,,--,_ ......,r -,.. 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Y � _ •'. •• • .k,' i '. 4*. - • is.,.. 3 $1;ori" `•. • ' • f ; a st' dTr' ti 4 . t _ • �+- ;. p �' r° s rZ1 .`s• '. i ,_ • V I III ii ,. kip• 6 • .', • 4• r - .fie. x• it OP S 4 it go • Ili • '�t e • , 4 listilt s- ii .. ._ ., .. . . . v " r 0. 4 jit - #F r0 '- • S • tl • 71.II irl yh� 1 ( ,.'�b•�f ,<' •It t, ey Y ..>. it,.. ...4„... :41.11 pi l� tom , Y .� ', l; r �1 .Y "`: • ,tr ., 413 .rr.� a ao VP rr 4; , e:_t_P A L.i.r,,,,o, MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program ��, S ,. PO Box 196650 4700 Elmore Road _ Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http:/lwww.muni.org/onsite -- illiiiiiif 1)(tartin nI 4hC)/ORN''E On-Site Wastewater Disposal System Permit Permit Number: OSP181224 Effective Date: 8/7/2018 Work Type: SepticTank Upgrade Expiration Date: 8/7/2019 Tax Code Number: 05035245000 Site Legal Address: VALLEY VIEW TERRACE BLK 1 LT 2A G:0159 Site Mailing Address: 23307 EAGLE RIVER RD, Eagle River Owner: MORAN LARRY L & Lot Size in Sq Ft: 40158 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 'y---- ' VI 4 i V1 \ II Received By: ' Date: ` v Issued By: ,,C.C'A Cp.„14 Date: 8e 1: • Municipality of Anchorage P.O. Box 196650 e 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Department On-Site Water and Wastewater Section **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV181054 COSA#: Permit#: OSP181224 PID#: 050-352-45 Legal Description: Valley View Terrace Block 1 Lot 2A Engineer: Pannone Engineering Services Applicant: Larry Moran Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the surface water has been approved. The approved separation distance is 40.0 feet. Approval is based on providing and maintaining a berm, as shown on approved permit drawing, to direct any surfacing effluent away from the surface water. This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: $ 1 Approved by: 4,6(9,6ci 670-0, Name of Reviewer **'k* VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department V Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-352-45 Property owner(s) Larry Moran Day phone Mailing address 23307 Eagle River Road. Eagle River, AK 99577 Site address SAME Legal description (Sub'd., Block & Lot) Valley View Terrace B1 L2A Legal description (Township, Range & Section) Lot Size 40,158 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family(SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: Septic Tank to Surface Water. Dis tance:40' I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: #2 15 _ Waiver Fees: g5 9 Date of Payment: 7/02 5/ 1E Date of Payment: 812/18 Receipt N umber: 09 030 6 Receipt Number: O 5 a 6.E 6 Permit No. O 5 e 1g 12 2 N Waiver No. DSV 181 0 51/ Permit App_:-:•._..:c Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com August 1, 2018 Municipality of Anchorage Development Services Department On-Site Water&Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: Valley View Terrace B1 L2A Ladies and Gentlemen: I am writing to request that a permit to install a new 1000 gallon septic tank be issued for this lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The existing 1000 gallon septic tank is in failure. The existing tank will be removed per MOA code. The existing tank is located outside the 100' well radius, the proposed tank will be placed outside the 100' well radius. The surrounding lots are served by private wells, and there are no wells within 100 feet of the proposed septic tank. PES will verify all required separation distances at time of installation. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set • 2. Surface Water: There is an intermittent surface water from a spring approximately 40' from the existing septic tank and drain field. The intermittent surface water disappears under the MEA Access road south of, and downhill of the drain field. The proposed tank will be placed in the same approximate location. A berm will be constructed to prevent possible overflowing effluent from entering surface water. When the septic system was installed in 1985, it met all the separation distance requirements. This intermittent drainage was dry in June of 2018, but recently surfaced when researching the tank replacement. A berm will be constructed as shown on the attached plan sheet and a 15% longitudinal grade to the south such that any spilled sewage will overland flow in excess of 100 feet before it enters the drainage channel. :907) . .��: i907 2_ 2.i .r �? itCi 'Cnt: ,=-3tt -. _��:,=_.� `,-5,i. .7i�:1 272-3211. Page 2 of 2 3. Topography: Lot 2A slopes from north to south at approximately 15% in the area of the tank replacement. The proposed installation will be located in the southwest portion of the lot next to the existing septic tank and absorption system. 4. Waiver: We would like to request a waiver for separation distance between the proposed tank and surface water on the adjacent lot. The existing tank is approximately 40' from surface water. The proposed tank will be placed at least 40' from surface water. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, .4;r OF q�,,�11 / / //♦ % Steven R.Pannone• 10 if 1111,1 ; - '*4.4• Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: • M iitht4: P.O. Box 100.21 AK 9951.0-!12._. P)lly:iica : 515 East 32''..1'.1_ _;Ii__ 3 Li,:Aiichorage, AK 9951 913",'. 2:12 -] X: (907) 272-8211 W X N \ \ ' � 14 \ \ 1 \ \ 'aIo I _ T f 1 \ � '_ \ \ � — ` \• �\ ,v0 iv N \ \ \ N \ — �\S K// \ \ _ \ \ \ '--.. aos _ _ _ \• N \ �� N` \ \ APPROXIMATE LOCATION \ ) 2 A \ IVC\��\ \ - \ - _ _OF SPRING 600 • -- ` SHEDS �� /41 • \ t..,/, N \ \ / \\ \ -595 - \ \�' �� _ REMOVE SEPTIC TANK (E) /� \ -� \ \ -- ,\ PER MOA CODE sso / �� \ \ O 3 \ \ N N p ` sas _� `� 0�2 BDDR \\ N _ � N. \ - 38.4 �FA bor.._ �� \ SPRING DISAPPEARSSAUNDER ira\ /XI N N \ ACCESS ROAD '580./ _/ ej �'— ����, WELL E �\ 7 i�S�f.-.w© 103.7 yd` - , N �"' ` _ — \\ qua _ 555 N X570 ��� T! \+ \ IN TALL 1000g SEPTIC TANK (P) N ��\ �s N � ' \ I W/DCO AFTER CONNECT TO CENTER 55s OF EXISTNG TRENCH UNABLE TO LOCATE 560 \ \ \ /�\ - \ 1` \ \ rJe SURFACE WATER SOUTH \ \ "1\,... DRAIN FIELD (E) \ / / N OF ACCESS ROAD \ 1 \ \ �\ - - L / 1 \"....„---,,,, ANTICIPATED OVERLAND FLOW- / CONSTRUCT BERM (P) FROM BASE OF N \, DIRECTION (TYP) HILL TO ACCESS ROAD TO PREVENT \ .... \ EFFLUENT FROM ENTERING SURFACE WATER, L - \ WORST CASE SCENARIO N N N OVERLAND FLOW DIRECTION , N N W �s W \ F R/fr —w —w — WATER LINE / F \ WELL RADIUS R Req —ss\ss — NEW SEPTIC \ ABBREVIATIONS TH TEST HOLE (P) PROPOSED (E) EXISTING CO CLEAN OUT NO. - 3.0 7•TOPSOII St WO MT MONITOR TUBE NO. TYP TYPICAL 1.0 ' ���� \�i >i / i ;,���i Oil\� \ �\ \yUr' SECTION A-A SCALE: NTS NOTES: PANNONE ENG SVC, LLC Dote FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 4G i 1;'! 7/31/18 PHONE (907) 272-8218 FAX (907) 272-8211 �Q'••• 1 Scale _ *.:49 TH _I 1" = 50' ��� 11. •• • P.I.D. NO VALLEY VIEW TERRACE B1 L2A .�� 2-45 LARRY MORAN • •vim:•Pannone PERMIT NO. DRAWN ACP 23307 EAGLE RIVER ROAD i.'• / U •- SITE PLAN EAGLE RIVER, AK 99577 .,•• Sheet 1 OF 1 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 INSPECTION REPORT NAME MAILING ADDRESS LEGAL DESCRIPTION PHONE ~.N EW LOCATION Absorption area Dwelling Mat erlal~,~_~¢~/ W dth DISTANCE TO: J We~ Manufacturer Liq. capacity in gallons /00~ F HOME,DE DISTANCE TO: Well Manufacturer NO. OF BEDROOMS PERMIT NO. DISTANCE TO: I /Oo / No. of hnes / Length of each llne / Length ' "Width Type of crib Crib diameter DISTANCE TO: Building foundation DISTANCE TO: Well Class Depth OTHER PiPE MATERIALS Inside length Liquid depth Dwelling PERMIT NO. Material Liquid capacity in gallons Foundation ~ Total length of ]in~/~// Nearest lot line / /~/ Trench width_ /h~hes Material beneath tile Depth PERMIT NO. ~- o~o ~/ Dis~,~7~between lines Totareffective bsorptlon area PERM)T NO. Crib depth Tote] effective absorption area Building foundation Nearest lot line Driller Distance to lot fine PERMIT NO. Sewer line Septic tank Absorptio~ area(s) ~.,;;-- ~ /oo ~ /oo / DATE LEGAL iii "'l~-~D'~( I CC I ~:'AD-- I ]FYr 'OF DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE~ AK 99501 ~64-47~? PERMIT NO: 85-4~4 DATE ISSUED: 07/09/85 AF FLICANI. ADDRESS: CONTACT PHONE: EAGLE RIVER ENG'G P 0 BOX 77~294 EAGLE RIVER, AK 99577 694-5195 LEGAL DESCRIF': · L. OT SIZE: MAX BE])ROOMS: SUBDIVISION: VALLEY VIEW TERRACE SECTION: 15 TOWNSHIP: 14N 40000 (SQ. FT. OR ACRES) 3 [.[IT: 2A BLOCK:' 1 RANGE: 1W Listed below are the options available to you( in designing your septic system. Choose the option that best (its your site. DEPTH TO PIPE BOTTOM (FT.) GRAVEL DEPTH (FT.) TOTAL. DEPTH (FT.) GRAVEL. WIDTH (FT.) GRAVEL. LENGTH (FT.) GRAVEL VOLUME (GU. YDS. )' TANK SIZE (GALS) GGIL. RATING (SQ. FT. /BR) 4.0 5.0 44.0 28.6 000. () '~* , , · :~ DEPTH TO F'IPE BOTTOM < 2.0 FT. REQUIRES ADDITIONAL GROUND COVER ~'~ DEI='TH TO F'IPE BOTTOM '< 3.5 FT. REQUIRES INSULA:ION ~ DEPTH TO PIRE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION ~ 'TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certi£.y that: 1. I am £amiliar with the requirements £or on-site sewers and wells as set ~orth by the Municipality o( Anchorage (MOA) and the State o~ Alaska. I will install the system in accordance with all MOA codes and regulations, and in compliance with the des{gn criteria or this permit, I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposaI system or public sewerage system on this or any adjacent or oearby,].ot.' I understand that this permit is valid ~or a maximum of 3 bedrooms and any enlargement will require an additionai 'permit. IF A I_IFT STATION IS INST~LLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL F'ERMIT AND INSPECTION MUST BE-OBTAINED; (2) AS-BUILTS WILL. N[IT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REF'ORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICEN~EI) ELECTRICIAN. S I SNED AF'PI._ I CANT: ISSUED BY ~ .................... i .... DATE: EAGl.E RIVER ENG'G ,~ SOILS LOG MUNICIPALITY OF ANCHORAGE [] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L, Street, Anchorage, Alaska 99501 2644720 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEG^LOESCR~PT,ON: /_o-r ~A ~¢//¢ / T//-/~' SLOPE SITE PLAN : 6- 7- 10- WAS GROUND WATER ENCOUNTERED? O ,-,- ,,-~/'"/~ F E IF YES, AT WHAT R~ .......... RATE Gross Net Depth to Net Reading Date Time Time Water Drop 11 13- 14- 15- 16- 17. 18. 19- 20- TEST RUN BETWEEN (minutes/inch) FT AND -- FT COMMENTS PERFORMED BY: ~.~ CERTIFIEDBY: ~- ~ DATE: 72*008 (6/79) V( 1 8 9 i0 � • ti = ="n '; A� •'�� _ Municipality of Anchorage ,, j $ - On-Site Water and Wastewater Program °- g .:j t i (907)343-7904 h Certificate of On-Site Systems Approval °a 6 e 9 Parcel I.D. 050-352-45 Expiration Date: Nov a 1 I ,�01 1. GENERAL INFORMATION Complete legal description Valley View Terrace Block 1 Lot 2A Location (site address) 23307 Eagle River Road Current Property owner(s) Larry L Moran Revocable Trust Day phone Mailing address 23307 Eagle River Road Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family(w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received • : � �.�� '' A6, Date: e616/IS COSA to be released to the engineer,unless otherwis reque ted by the engineer. COSA Fee $ af.o Waiver Fee $ Date of Payment '?/ 9/! D Date of Payment Receipt Number a l Y. DD Receipt Number COSA# O 5C l g l a7 Waiver# 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, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are)in compliance with all applicable Municipal and State codes,ordinances,and regulations in effect at the time of installation. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R Pannone Date 8/21/2018 Air'��of •710 k Or'4:1 t___,t 4 6. DSD SIGNATURE 7C System#1 Approved for 3 bedrooms •Seven R. Pannone• j System#2 Approved for bedrooms ' CE-8149 • i` Disapproved11A\N. l`7- ... s .H___t-- Conditional approval for bedrooms, with the following stipulations: �± c -4-iw,,fc - �l r� .C--f-e7 ( s 1 � 5 2 ears C9ld .C.42_ �4-6,01.6 ,( 1,W i1 -v t�� ., ...,, :Z� /' ON_S1ZE Gcs _,... -_,.. wPS o° Ew ATER G2. W, .aROGRw F\ rr By: —.��% / Original Certificate Date: O 2—idN1—( e The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory , Well Flow Advisory Other X `C / _ 1 • ais f O?/ COSA blue sheet f '• . ., If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Valley View Terrace Block 1 Lot 2A Parcel ID:050-352-45 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log(Y/N) Y Date completed 7/11/1985 Sanitary seal (Y/N) Y Wires properly protected(Y/N) Y Total depth 117 ft. Cased to 117 ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 7/11/1985 6/19/2018 Static water level 30 ft. 90.3 ft. Well production 10 g.p.m. 3.2 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 0.416 mg/L Arsenic ND ug/L Date of sample: 8/14/2018 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/1/1985 Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout Y/N) Y Depressio rank(Y/N) N High water alarm(Y/N N/A Date of pumping r1# g m 1$ Pumper :. iiiiliF s =.Z�-.:Arst1►.-1; OR's 'Furey C. ABSORPTION FIELD DATA Date installed 7/1/1985 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 SF/BDRM System type 5-Wide Trench Length 44 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 9.2/8 ft. Eff. absorption area 375 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/19/2018 Results(Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 35/20 in. Water added 450 gal. New depth 36/36 in. Elapsed Time: 180 min. . Final fluid depth 35/20 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment(past 12 mo.)(Y/N &type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access(Y/N) "Pump on"level at in. "Pump off'level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 42+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 25+ Driveway,parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Exposed tank and found it to be solid with no leaks and performing its intended function. System approximately 70% used. Waiver on file. G. ENGINEER'S CERTIFICATION .�...r. OF. AL lk,� I certify that I have determined through field inspections and /,,vip>'�P' 7 . `4 �.�+#0 0 review of Municipal records that the above systems are in *;49 TH /\ ••* 0 conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven Pannone • W.'Porinori ;..oi 8/21/2018 OCE-8149 Date � q{! . ... -Ar �/ COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • hfr''`2 907-343-7904 On-Site Water and Wastewater Section \ `S T Fax: 343-7997 www.muni.org/onsite \—...---- Septic Tank Advisors' Certificate of On-Site Systems Approval # OSC181428 Subdivision: Valley View Terrace Block:1, Lot: 2A The septic tank for this property is 33 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. ...„.- , •-4. ":4;-;..._.,4,.,-. : ;;,:, .''..;' -Ay,.•-•:_:.-41 _..,,,i, .,....4-' p 4s -Y Wit` ,R r .., i\ , ti! ,,4 m ' �o ,p g� 1 t P 'a'r.Y *-45. w �.M•g:. - .\ 'y' Y i . y�:W� n r fC i .-.. ,.t":. e 2' 1.a.'`r d, y ka Mailing Address: P.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org K E 4fri , „ Ct- FLINTSTONE ENTERPRISES C._ LLC DIVISION JR'S SEPTIC PUMPING LLC P.O Box 773415 Date: 8/23/18 Eagle,River,AK 99577-3415 Phone: 907-694-6454 Fax 907-344-9821 Invoice: 1844 Invoice to: Larry Moran Job Location: 23307 Eagle River road Eagle River AK Worked Preformed:on 8/17/18 Checked tank levels pumped tank. Installed Berm per Engineers Design Excavated a round existing septic tank checked for holes. Tank appeared to be in good conduction. Back filled and grade disturbed area Thank You for your Business BALANCE DUE $3,775.00 Please Make Check Payable to Flintstone Enterprises All accounts over 30 days will be subject To interest and all collection fee's 411/ • . j • • awe cam. h ----S• •a V E7A1:7 • 3/' iA 'N ��1 ,lid X01 +i ^ �� IC O�V �L� r .Ahab '7 2 l� 'tea .. r Y �z fti • aQ • t '-�`b �`o AI kt t .. F • 'Nt\% std 1 a. . Id . 'I °'11 v o i . ----. O I ff ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 69!4-0829 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: -1� + FOLLOWING DESCRIBED PROPERTY: J Ye' -"*.j O ' . . I 4 ��l l y/ i7 � �"fro, �arz9(�,l!/ • DATE: �� OF.... ', �* AND THAT NO ENCROACHMENTS �XIST EXCEPT AS �Z/-- ,w f�4,.' 's,,�,4 INDICATED. IT IS THE RESPONSIBILITY OF THE Cri.):.4 4H '• F f OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: 10 EASEMENTS, COVENANTS, OR RESTRICTIONS Ssc.,ACV f 1. WHICH DO NOT APPEAR ON THE RECORDED SUBDI- 1 " qi, ' '""`rd �'� } Duone Mark Sewerd • R VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' I< "'•• lS-6918 ANY DATA HEREON BE USED FOR CONSTRUCTION ioG ' • .5�� OF FENCE LINES, OR FOR ESTABLISHING BOUND- ,c , ,i� .' i ARY LINES. DRAWN:....7"?..:.'"-- � b,,,t Parcel I.D. # MUNICIPALITY OF ANCHORAGE ,~ Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING HAA # ~('~q t m-q -I 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 2A; Block I; Valley View Terrace Subdivision; Location (address or directions) 1574 Eagle R~ver Road, Eagle River, ,¢~zska (b) Property owner Jerald & L~cinda DcCh~.fSTelephone: (home) 694-9272 MailingAddr~ss-.. 1574 Eagle River Road, Eagle River~ Ak, 99577 (c) Lending Institution Telephone Business Mailing Address Real Estate Company and Agent Address Telephone Mail the HAAto the following address: (or check here ~$if hold for pick up.) List contact person and day phone number below: (d) (e) S & S ENGINEERING 170,~4 F.~o~ Ri,v~r L,~op Road Eagle River, Alaska 99577. 2. TYPE OF RESIDENCE Single-Family [~[X Number of bedrooms 3. WATER SUPPLY Individual Well,~ Community [] Public [] N0te:::lf:community weti system, must have written, confirmation. . from the State.. Department~ of: Environmental Conservation ~(testing to th legality and status. 4, SEWAGE DISPOSAL On-site [~x, 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 I 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. Name of Firm ........... '~ ....... Telephone ....... ,:r,.jle ldwr Loop Itoad No. 204 Eagle River, Alaska 99577~ Address Date 6. DHHS APPROVAL Approved for--~ bedrooms by Approved ~/,~_._ Disapproved Terms of Conditional Approval Conditional 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 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. 7/88) 88ck Page 2 of 2 A. WELL DATA ~)~,~C~('~ MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: /~o'? if A, B, C, D.E.C. Approved (Y/N) ~ Yield 'wT.. ,~ ,~ D ~v~ Well Classification ~,~ Well Log Present (Y/N) ~ Date Completed TotaIDepth [l'"~/Casedto /I ~ /Depth of Gr0uting Static Water Level ~ 0 Casing Height Above Ground Electrical Wiring ,in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: (oo + To Septic/Holding Tank on Lot Pump Set At O Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot ! O© ?c ; On Adjoining Lots ( CO ~ ; On Adjoining Lots [ DO To Nearest Public Sewer Line "/~ To Nearest Sewer Service Line on Lot Water Sample Collected by .~ ~L .~, E.~ water Sample Test Results ~'~ ~ t .~ ~6~.~t9/' ~ -- Comments To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date installed '~.-I -,~%- Size Standpipes (Y/N) c1 Depression over Tank (Y/N) Air-tight Caps (Y/N) Pumping/Maintenance Contact on File (y/N) No. of Compartments "~ Foundation Cleanout (Y/N) Date Last pumped ;for / Holding Tank High-Water Alarm (Y/N) ~/iA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line [o/.t- To Stream, Pond, Lake or Major Drainage Course Comments ~ W. pt(' ,vD ,,/v, :n~O/ Temporary Holding Tank Permit (Y/N) ~ ~ To Building Foundation To Disposal Field 72~026 (Rev. 7/88) Front Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed -~ Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test ~.~.~.~.~.~.~.~.~.~' ' Depth of Field '~-' Gravel Be,~ Thickness .,, Statnopipes Present (Y/N) /',) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ! (.~c, / ~ To Property Line To Building Foundation '~ ~ / To Existing or Abandoned System on Lot ~J/Y5¢ ; On Adjoining Lots To Water Main/Service Line { c~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~ O - Comments P. LIFT STATION 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 Company Date MOA No. S & 5 ~¢NGIk[F~EtNG Date of Payment Amount:$ '/ 7 //'-,~ _~'~/ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 t~'", MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) (c) Applicant is (check one)J Lending Institution []; (wner/builder/~'; Buyer []; Other [] (explain); (e) Real Estate Company and Agent Address Telephone (f) ~.J~,~rthe NAA to the following address: 2 TYPE OF RESIDENCE Single-Family,,~ Multi-Family [] Other Number of Bedrooms ~-'~ 3. WATER SUPPLY Individual Well,~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite,,[~' 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 (11/84) Page I of 2 ENGINEERING FIRM PROVIDIN~ I~ISPECTIONS, TESTS, FILE SEARCH, DA'IA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verity 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 inlormation 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· r.,. '¢. '~o ~f4it~ Telephone Name of Firm ,~ -.. ~ $)~ Address ' ~ ~w~, A~ &~ 4A Date ........ Approved for~'~'~5--A~( ~ bedrooms by t.~ J'~'/'~' ~'~/"-~--'/~'~-,--~-~_~Date Approvea '~' Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations 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 their lending institutions in order to satisfy certain federal and state requirements. 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 the professional engineer's work. Page 2 of 2 · 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALT. AUTNO.ITY APPROVAL CHECKUST- FERRUARY SS4 OCT 264-4720 LegalD~scription: ~ ~ e EIVED N~UNICtPA~TY O~ ANCI"IO~-A~E DEPT. OF HEN.TH liNVlRONMENfAL PROTE~ Well Classification Well Log Present~'N) Total Depth ~. ~,"~ ! Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~:~N) Separation Distances from Well: To Septic/l~Tank on Lot ' To Nearest Edge of Absorption Field on Lot If~A, B, C, D.E.C. Approved (Y/N) Date Complete~i ~'~- [ ~ - ~' Yield ~ ~.,~ I Depth of Grouting "' Pump Set At '~L¢," Sanitary Seal on Casing~N) Depression Around Wellhead (v.~ ; On Adjoining Lots ,~.~;:~t~. ; On Adjoining Lots To Nearest Public Sewer Line ji~/~' To Nearest Public Sewer Cleanout/Manhole ~-. To Nearest Sewer Service Line on Lot Water Sample Collected by ~-~J~ ~..~(,~t~,~_~'z4,~ ; Date Water Sample Test Results '~"f~, / Comments B. SEPTIC/bLOM~NG TANK DATA Date Installed "~ - I ~ ~ Standpipes ~;~N) Air-tight· Caps./N) Depression over Tank (Y/~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) · Separation Distances from Septic/,M~Mtrf~ Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Size ~ ~ No. of Compartments ~ Foundatio~ CleanoutCN) Date Last PumPed I'~:;~'--~ ; for ~/~ Temporary Holding Tank Permit (Y/N) TO Building Foundation To Disposal Field To Stream, Pond, Lake, or M~jor Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed "~ f Width of Field Square Feet of Absorption Area Depression over Field (Y/,t~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line ~ ¢ t .p To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Presentd~YN) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots .~ ~ To Ct~tbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N} Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** 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 8 R ~,_I~ ~.~. Date °mRany ~H. ~9~¢97~ MOA No. Receipt No. ~59SS / Date of Payment ./O ~O ' ¢~¢ Amount: $ &¢O~ Page 2 of 2 72-026 (11/84)