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Home My WebLink AboutWYNTER PARK #1 BLK 1 LT 22 MUNICIPALITY OF ANCHORAGE DE '~TMENT OF HEALTH AND HUMAN SER~. ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl. INSPECTION RI"PORT Address lEGAL DESCRIPTION TANKS SEPTIC [] HOL. DING FROM DISTANCES WELL -- WELL LOT LINE FOUNRATION SEPTIC ABSORPTION TANK FIELD ~-O~ .4 ~,c'.~ ,t~ TYPE OF SYSTEM ,L~TRENCH [~ BEE) Lq W. DRAIN [] OTHER 0/~ F'r FT FT PRIVATE OTHER fldentifvl REMARKS: .- . 34 Eu lo Ewer ~oop .oad ~o. 2~ . I ,~-O ~~ _ .~ certil~lhat Ih~s inspeclion was podorllle~ accordinjl to all . E~gle River, ~aeka 99~77 ~ x ~ municipalalldSlate~uidelinesJneflectonthJsd~t~: ~> /~ ~ Health Depadmen, Approval: ~~~~ 72 013 (3/85) Par c:a, J I d 05 :j.. Zl(.? 1 .-.:;F, :[ !i;} 6:,E: ~'. :i. t:;)l-~ ~, :t () I,..o't:. S:izc~, ;;~2()00 (,.:~q,, ti'.,, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SEAL) 1 2 3 4 5- 6- 7- 8- 9- 10- 11 13- 14= 15- 16- 17 18 19- 20- LAN WAS GROUND WATER ENCOUNTERED7 S L IF YES, AT WHAT DEPTH7 pO E Deplh Io Water AFter ,//~ ~,., Mae,er,,,? Reading Date Gross Net Depth to Net Time Time Water Drop ?- -- e '~ ~ ~,~ _ ~ ~1~'; ly~" ~ ~ /~ ,, ,~',,, ,, TEST RUN BETWEEN -- g - FT AND -f7 FT COMMENTS ,~ ,~_~ S & S ENGINEERING /' 17034 Eagle Rivet' Loop Road Ne. PERFORMED BY: ~ ~ )//~ CERTIFY THAT THIS TEST WAS PERFORMED ACCORDANCE WITH ALL ST:;~;~:'~:'I~TP:L G UID~FECT ON THIS DATE DATE: 72-008 (Rev. 4/85) IN · 'E ANCHORAGE AREA Bor'"F Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTI.:M LOCATION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MAILING ADDRESS PHONE ~l~0a--2~/~) LEGAL DESCRIPTION ~/~/~'~)- ~ ~ ~, __ INSIDE WIDTH _LIQUID DEPTH I_IQUID CAPACITY /~ .GALLONS. SEEPAGE PIT: NUMBER OF PItS ~/ LINING MATERIAL BUILDING FOUNDATION__ ADDITIONAL ABSORPTION CRIB SIZE: DIAMETER.(~ DEPTH ~_ DISTANCE FROM: WELL /~1 TOTAL. EFFECTIVE NEAREST LOT LINE ABSORPTION AREA (WALL AREA) ~)~ SQ. FT. TYPE __CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVE[) DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK__ SYSTEM REMARKS DISTANCES: INSTALLED BY: PIPE MATERIAL - LOT SLOPE: REMARKS: _ Form No, EQ-031 DIAGRAM Of SYSTEM D G,A.A.B, GRE ANCHORAGE AREA BOP'"-" Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS LEGAL DESCRIPTION SFPTIC TANK: PHONE &gl~ '2(~1~ DISTANCE FROM WELL INSIDE LENGTH . MANUFACTURER ~-//( .~/~e/..- MATERIAL INSIDE WIDTH LIQUID DEPTH_ NUMBER OF COMPARTMENTS _LIQUID CAPACITY. /~g~ GALLONS. SF-EPAGE PIT: NUMBER OF PITS LINING MATERIAL DIAMETER _'gCz CRIB SIZE: . OR WIDTH //I, LENGTH /~/I, DEPTH DIAMETER[' DEPTH .DISTANCE FROM: TDTAL EFFFCTIVE BUILDING FOUNDATION____ NEAREST LOT LINE WELL ABSORPTION AREA (WALL AREA) FT. ADDITIONAL ABSORPTION WELL: g, gflgl lrf' TYPE _ CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CE'SSPOOL . OTHER SOLJRCES APPROVED . DISAPPROVED DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK SYSTEM REMARKS DISTANCES: INSTALLED BY; PIPE MATERIAL: LOT SLOPE: REMARKS; Form No, ED-D31 DIAGRAM OF SYSTEM App R OV ED//'~'~ [/f._ ~_'/ ~.._~// APPLI NT FILLS OUT UPPER HA, ONLY I~r o !e~-t ~-O w n e r~ (~,,~U ~ ~ ~/~/~ ~,~ ~ Buyer Phone Address Zip Code Lending InsBtullon AI~ k~ ~-/~ ~:~-~C( ~rr~d~//~ ~)/~ I'o~l Address Zip Code Realty Co. &Agent ^ddross (~. O, Phone Phone Street Location A) I/-A) ,l~l, ~.~4/ff'~',l'/-;I' .?~/)/( Type of Residence ;[~Slngle Family [] Multiple Family No. of Bedrooms [] Other Water Supply O Individual ATTACH WELL LOG. A we~l log is requl~ed for all wells drilled since June 1975. ~' Community For wells drilled prior to that date, give well depth (attach log If available). Public Ulillly Sewer Disposal ~ Holding Tank Year Individual Installed: I 7~3_ When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Tine Time Dat~.. Date Date Date Inspector Inspector Inspector Inspector Field Notes: & ' ~....0 ,. ~ ~ ~.~ ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' Soils Rating Date ~wer Installed Well TO Absorption Area Well Log Received EXCAVATION ROBERT A. SHAFER WORK CIVIL ENGINEER 694-2979 July 17, '1982 Totem Realty ATTENTION: Bob Wamboltz P.O. Box 911 Eagle River, Alaska 99577 Dear Mr. Wamboltz, Reference: Lot 22~ Block ii Wynter MUNICIPALITY OF ANCHORAGE , UL 2 7 ]982 R£CI IVF_D Park subdivision A sewer system adequacy test was performed on the system located on the referenced property as you requested. The three inch standpipe, to the septic tank was replaced with a four inch standpipe and the septic tank was pumped and verified to have a capacity of 1000 gallons. The seepage pit was charged with 1000 gallons of fresh water and after a period of 24 hours all the water which had been added to the crib had percolated out. It can be concluded from this test tha~ the waste water treatment plant serving the three bedroem residence located on this property is currently functioning adequately. However, the system c~nnot be guaranteed against subsequent failures~ If we may be of further call. service, please do not hesitate to Alaska U.S.A. Federal Credit Union Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVEFI, ALASKA ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: PWSID ~: To Whom It May Concern: Accor. d~nq to the records on ¢ile in this oPPice, the t,d~.__ ~ ............ Water System is in cornpliance with the qta~e o? Alaska Orinkinq Water Requlations. Sincerely. Erlvironmental Field Ot:f'icep RSK:sa Ek M MUNICIPALITY OF ANCHORAGE Development Services Department - _' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-491-31 1. GENERAL INFORMATION Expiration Date: Complete legal description _WYNTER PARK #1 BLOCK 1, LOT 22 Location (site address) 24304 HEARTHSTONE DRIVE, CHUGIAK, AK 99567 Current property owner(s) DANIEL & JAMIE MARIE GRAY Day phone Mailing address Real estate agent 24304 HEARTHSTONE DRIVE, CHUGIAK AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -50 Date of Payment joz/ l Receipt Number COSA # 0 -SG Waiver Fee $ Date of Payment Receipt Number 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 9/30/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q:•' for current or future occupants or guarantee that no unseen encroachments, deficiencies or ��•' '.� J discrepancies exist can be given by First Water Consulting & FKS *• 9 ili •'* �r 6. DSD SIGNATURE ' • . • "' "' . ' • • Curtis Huffman System #1 Approved for bedrooms �� Fc��• CE 128991 ••��.'� System #2 Approved for bedrooms ��l>>F�pRO ES oN��~ Disapproved Conditional approval for bedrooms, with the following stipulations: `gJ ON-SITE WAST ]VATER z= J� PROGRAMPcr-nN 1\ Original Certificate Date: 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 I • ; Legal Description: WYNTER PARK #1 BLOCK 1, LOT 22 Parcel ID: 051-491-31 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system A. WELL DATA – COMMUNITY WATER ❑ Well log is filed with Onsite (or attached) Date drilled. Total depth _ft Cased to _ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) — in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) 7 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 51" ® Standpipes/foundation cleanout per record drawing Date of pumping 6/10/2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 5/3/1988 ® ALL standpipes present per record drawing Total measured depth from grade 12.8 ft (max) Measured depth to pipe invert from grade 6_3 ft (min) ❑ N/A – pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate _mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 9/28/2021 Results 0 Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed time <1 min ®Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons FW Comments/Deficiencies: NEW MONITORING TUBE INSTALLED AT TESTING. .> E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No *5+ Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ❑ Yes if No ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' F] Yes if No ft ❑ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' _® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *PER CODE AT INSTALLATION. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. low f � •� �� Curtis Huffman X29, •. CE 128991 •��,'� ft ft ft ft ft ft ft ft Dig HEARTHSTONE DRIVE 0 0 EAST 115.00' 04 N Lot 22 22,179 S.F. CONC. 22.2' 0 t� N 45.9' PORCH IN 22.0' \ 2.0' \ O 1 STORY iv CANT SEPTIC r Lot 21 I RESIDENCE Vol / 1 PIPES Lot 23 O ' 24.9' 44.2' V) O .. — �. Z CONC. I WOODEN FENCE 14.2'x12.1' SHED ' WOODEN FENCE _-- ----- —"_ ��— " 116.1 __--- S 81'58'56"W 4-10' UTILITY EASEMENTS --- ( Lot 12 Lot 11 NOTE: THE LOT IS SERVED BY A COMMUNITY WATER SYSTEM. MORTGAGE SURVEY _x_ SCALE _ 1" 40 GRID NW_1361 Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inC. (907) 522-6476 Phone (907) 522-4625 Fax �ooc'OQO�O�� Professional Land Surveyors ken0langsurvey.com `` OF A L �� jonathan®langsurvey.com I hereby certify that I have surveyed the following described property: LOT 22, BLOCK 1, WYNTER PARK SUBDIVISION No. 1 (PLAT No. 7149)p°* 49TH Y D� Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a""""""""' ""' """ representation of the conditions that were found on the date the survey was performed. Q This survey does not constitute a boundary survey and is subject to any inaccuracies.. • • • • • 0 that a subsequent boundary survey may disclose. The information contained hereon shall 4 ICENIVEi' lA o not be used to establish any fence, structure, or other improvements. QA s� lVS [LL ('Z•( D� •.LS-5202.•'' gJp� Dated this the Day of __ cc_arL = __, at Anchorage, Alaska 4p oR foo 44��o It is the responsibility of the owner to determine the existence of any easements, OFfSSIONAG �Opslowa- covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 M Lot 23 czi 0 N H O Z HEARTHSTONE DRIVE EAST 115.00 I Gravel C; driveway WAI ERLINE PER LARS SPU RKLAND, PE & I MOP IR DOCS. NEW MT INSTALLED 2021 FOR ADEQ. TEST septic V nt0� APPROX. LOC. M"r Cp rte. deck SCALE: 1 "= 30' 22.0 0 Lot 21 Water Keybox Community W 22.0 0 u? N = 1 Story Frame House 2.0 OH �— d � p CO S�tic ve�� Z 44.0 Shed Lot 22 septic "e/7t' 11 1 `Easement 116.14 - � X81058'561 E Lot 12 Lot EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. Plot plan _--- AS -BUILT NO CORNERS SET THIS DATE I hereby certify that i have performed a Mor22 tgagee's inspection of the following described property: OT ai nC tc s WYNTER PARK SUBDIVISION No 1 Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not overlap or encroach on the property ging adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 17th day of Jui V,2p14. FRED WALATKA 8 ASSOCIATES BE Engineers and Surveyors ( g{I7-248-1666} MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAl,. SERVICES OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date. ,"'~///~//~'~ GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location '(address or~ c~irections) (b) Property Owne?_ Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Telephone: Home _ Telephone (e) Address '"' //¢ ~ ~:::~,.~o CE~.-]/~,r,-~e/'j Telephone ~¢5~/'~ /~' ~ Mail the HAA to the followina address: or: Check here ~, if hold for pick up. List contact pe~n¢~g~umber below. 17024 Eagle Rlve~ I.~ Roa~ No ~ Eagle River, Alaska 995~ Business TYPE OF RESIDENCE Single-Family)Z~/ Number of Bedrooms' WATER SUPPLY ndividual We, [] Communityrn Pcb,e,i , Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, 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, Page 1 of 2 72-025 trey 8'861 Front 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 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 5 & '. ,-NGiNEF. RiNG Address 17¢J34 Eagle RiYer Loop Road NQ, ?04 Date Eagle RJver~ Alaska 99577 Telephone DHHS APPROVAL Approved for - ?)bedrooms by Approved /~'~ Disapproved Terms of Conditional Approval Conditional CAUTION 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduot 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 fRev 8/86) Back ,.~\C\~F'¥ ~{¢,.%~''' MUNICIPALITY OF ANCHORAGE (MOA) ~k%~ ~(~ HEALTH AUTHORITY APPROVAL (HAA) %~ ~ ~ ~ ~ CHECKLIST - FEBRUARY 1984 2 -4744 ~x~ Legal Description: ~Z WELL DATA Dato CompletoO GaseO to Static Water Level ~ Casing Height Above Ground ~~ Electrical Wiring in Conduit (Y/N) Separation Distances from WeN: To Septic/H~a~nk on Lot ~ ~ ~ To Nearest Edge of Absorption Field on Lot ~¢ To Nearest Public Sewer Line Cleanout/Man hole Water Sample Collected by Water Sample Test Results Comments B, C, D.E.C. Approved (Y/N) Yield _ Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~'~, QO Adjoining Lots ~ ; On Adioinifig-Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/-~,H~L~,~.TANK DATA Date I nstalled~_¢~ ~r~ Size __-,/-~2~-~'~__N)No.caPs(~ of Compartments Standpipes~; / Air-tight Foundation Cleanout (Y~ Depression over Tank (Y~ Date Last Pumped ~/l' ¢~ Pumping/Maintenance Contract on File (Y/N) ~/~ ; for Holding Tank High-Water Alarm (Y/N) ~ ~ { Temporary Holding Tank Permit Separation Distances from Septic/Mc~,~:,,~"Tank: To Water-Supply Well To Property Line TQ ,w~ter Main/Service Line · CouCse To Building Foundation To Disposal Field ~,~ ~-- ~ ----¢" To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026 fRev 8/861 Fronl ABSORPTION FIELD DATA Date Installed Width of Field Z /,..~'~" ! Square Feet of Absorption Area Depression over Field (YN~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ~- "~ To Water Main/Service Line . /"4~ '¢~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments /t.J D ~ Type of System Design Length of Field ~ / Depth of Field ,'/(~" Gravel Bed Thickness ~--0 " Standpipes Present &) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Dimensions Size in G"7~G~~ Manhole/Access (Y/N) "Pump On" Level at % "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for ~--~Pum ' ~cles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ..... ~ ~ Comments ~ Check Permitted Bedroom Rating Against HAA Request ** IsiC~rntie'dy t~t I~l:~_.~hN;~k;ld,N~:~rified, or conf~ratmeed to,¢~l/~A;n,.~A¢~g uideli nas in effect on the date of this inspection. ~.~70~Eagle Rwer L~p Road No. 2~ ~ / ~ o C°mp"'~agle River~ Alaska ~2577__ ~OA No. _~ ~ ~ Race,pt No. ~ 7Jy -- Date of Payment ~ //~ ~ ~ Amount: $ / ~ 0 Page 2 of 2 72 026/Rev 8 861 Back