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HomeMy WebLinkAboutLILAC PARK BLK 1 LT 7Lilac Park Block Lot 7 #015-211-22 ,RCV UU/UL/ 1 OJ Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211103 PID Number: 015-211-22 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade Name Griffith Steiner & Laurie Gregory Revocable Trust ABSORPTION FIELD El Deep Trench El Wide Trench El Bed ound Site Address 12100 Lilac Cir, Anchorage, AK 99516 El Other Phone Number of Bedrooms Soil Rating Total depth fr original grade 441-2721 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Lilac Park 1 7 Fill added above original gr Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well >100' N/A N/A N/A >25 TANK ❑� Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Greer 1250 Gal. Surface Water >1 N/A N/A N/A Material Plastic Number of compartments 2 Lot Line >5, N/A N/A N/A NA Foundation >1 o, N/A N/A N/A LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank Tank to D3034 drainfield D3034 Installer PCN Drainfield D3034 CO/MT D3034 Inspector J. Mlllette BENCH MARK (Assumed elevation) 100 ft Inspection15t 5/7/21 Location and description dates: 2 nd tt"h Bottom of siding @ point B 3rd 4 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF Conditional Approval: Date � ' 'QcQll�$ co - �¢ ®:49TM •* BSchiller Septic System y ���9F�, • • Approved--- li Date 5- Z –Z CE 12592 ���rs 5/11/21• �slF�Fo • �� pROFES9101�- Note: this approval does not include well permit requirements. �� ,RCV UU/UL/ 1 OJ LILAC PARK SUB, BLOCK 1 LOT 7 PERMIT # OSP211103 P I D # 015-211-22 1 TALUS WEST B2 LOT8 !O'T & E EASEMtENT I LOT 9 \_ LOT 10 EXISTING TRENCHES TO REMAIN IN SERVICE. DRAINAGE TO BOTH TRENCHES WAS CONFIRMED AT CONSTRUCTION. 1250 -GAL SEPTIC TANK w/ 20" MANWAY 2CO S LOT 6 MH SCO 100' WELL RADII 4-BDRM\,HOME A B EXISTING WELLS fxs CO 16.0 23.0 MH 29.4 24.5 SV . �9� ?8.6 2CO 34.3 PEEP O�PGE EXl ISTING TANK DECOMMISSIONED IN PLACE PER UPC CO 16.0 23.0 MH 29.4 24.5 SV . �9� ?8.6 2CO 34.3 30.6 TH ENGINEERING ;eniaoin Schiller CE 12592 5/11/21 PROF PLAN AS -BUILT 11 50 100 im w iin FEET 1 11=50' LEGEND CO -CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPUTTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LILAC PARK SUB, BLOCK 1 LOT 7 PERMIT # OSP211103 ENGINEERING P I D # 015-211-22 «�j PROFILE AS -BUILT (NO SCALE) TH Ben.. ........... a in Schiller CE 12112 5125121 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: OSP211103 Work Type: SepticTank Upgrade Tax Code Number: 01521122000 Site Legal Address: LILAC PARK BLK 1 LT 7 G:2736 Site Mailing Address: 12100 LILAC DR, Anchorage Owner: STEINER GRIFFITH REV TRST 50% Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Scl Ft Total Bedrooms: m�nr �� rS G h n llep!al rtment 4/12/2021 4/12/2022 74507 ❑ Disposal Field R 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 Received By: Date: Issued By:PUV­�_A_ Date: O 51 MUNICIPALITY Community Development Department Development Services Division On -Site Water & Wastewater Program r� �.� -..+ • ice= l Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-211-22 Property owner(s) Griffith Steiner & Laurie Gregory Revocable Trust Day phone '4''4'1-2721 Mailing address 12100 Lilac Cir, Anchorage, AK 99516 Site address 12100 Lilac Drive Legal description (Sub'd., Block & Lot) Lilac Park Sub, Block 1 Lot 7 Legal description (Township, Range & Section) Lot Size 74,507 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) IN (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex ❑ (D) Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: 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: ` , 5 Waiver Fees: Date of Payment: y 9 a 0 21 Date of Payment: Receipt Number: C 9 is % D 6 Receipt Number: Permit No. O a 1 I I D Waiver No. Permit App__- : ..:c April 6, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 4/6/21 Subject: Lilac Park Sub, Block 1 Lot 7 – Lilac Drive Septic tank replacement Dear On-Site Services Engineer: The owner of the above lot has an existing 4-bedroom septic tank that has exceeded its 30-year life expectancy. Therefore, we are submitting this permit application for its replacement. Wells on this lot and adjacent lots are shown on the design. No septic system on this lot or adjacent lots will have any effect on the proposed septic tank location. The tank will be greater than 10’ away from the building’s foundation and at least 5’ away from existing deck or retaining wall structures. The existing tank will be pumped and decommissioned in place per U.P.C. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211103, Rebecca Carroll, 04/12/21 2 C O 1"=50' EXISTING TRENCHES TO REMAIN IN SERVICE. LINE FROM TANK TO NORTH FIELD MAY BE OBSTRUCTED. CHECK TO ENSURE WATER IS FLOWING TO BOTH TRENCHES. 4-BDRM HOME NOTE: ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND LILAC PARK SUB, BLOCK 1 LOT 7 LILAC DRIV E FEET 0 50 100 4/6/21 EXTEND EXISTING SEPTIC PIPES TO BE ABOVE GRADE AS NECESSARY EXISTING WELLS 100' WELL RADII ADJA C E N T SEPTI C AREA 10' T & E EASEMENT 10' T & E / GA S EASEME NT 40 ' PRI VATE PL ANTING & VEGETATI VE RESERVE EASEMENT NEW 1250-GAL SEPTIC TANK w/ 20" MANWAY. MAINTAIN 10' MIN FROM FOUNDATION AND 5' MIN FROM RETAINING WALL. DECOMMISSION EXISTING TANK PER UPC ADD CLEANOUT DIRECTED TOWARDS FOUNDATION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211103, Rebecca Carroll, 04/12/21 *0-'49 TH 0 0 s SHANE A. HOLT �� e e LS -6914 essiona� Lo UAC THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OFRECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON (UNLESS INDICATED) NOTE: FENCELINES THAT MAYAPPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS -BUILT SURVEY 11" =401 NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT7, BLOCKI, LILACPARKSUB ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 5TH DAY OF APRIL , 2021 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 0458, FB 127-72,73 212-27 3455513 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street. Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPEC'rlON REPORT N.me DISTANCES  SEPTIC ABSORPTION L~ DESO.mT,O. L0T LINE ]0~ /0 z.~ Township, Range, Section ~S-BUIL'r DIAGRAM (Show Iocanon of well, septic system, property TTZ~ ~ ~ ~ ~Z-~ driveway, water bodies, etc.) TANKS ~ SEPTIC ~ HOLDING _ Manulacturer Capacity ~n gallons Material No. of Compadments TYPE OF SYSTEM C] TRENCH ~ BED X W. DRAIN ~ OTHER Depth to pipe bottom from Total depth , ..... iginal grade FiD added above original grade~, t, FT Gravel depth beneath pipe~ FT Gravel length Gravel width Total absorption area Distance be,ween midas WELLS ~ PRIVATE ~ OTHER fldentifv} Classincanon (A,B,C) Total Depth ~ Cased to FTI ET In~J~ller D~Je JnstBlled: RE~ARKS: Inspections Pedormed by: I ~ , ~6[~ ceHlly Ihal Ihis inspection was pedormed according Io all Municipal and Slate guidelines in effect ~ dale: ,_ /~ 72-013 (3/85) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF' NATURAL. RESOURES Division of Geological I~ Seophysicol Surveys LOCATION OF WELL (Please complete either lo, lb or lc.) Drilling Permit No. ~ANCE AND DIREC'TION FROM ROAD INTERSECTIONS ~ ~. OWNER OF WELL: Material Type Feet Below Surface Top Bottom WELL LOG 4. WELL DEPTH: {final) I 5. DATE OF COMPLETION _J_q_a:_.. __?_ - _ 6. []Cable teal ~Rolary []Driven [] Dug DAuger [~ detfed ~ Bored ~ Other: ~ mrrig=lron ~ Rechar9. ~ Commerlca) ~ Tm~t w~m ~ Other: 8, CAS)NG: ~ Threoded ~ Welded Depth Stickup_ ~ ff. 9. FINISH OF WELL: Blot/Mesh Size: Length: Sel between fl, and fl, ,0. STATIC WATER LEVEL:. /1~ ft. ~ Above or ~gelo~ tonal ~urface Oate ft. efter_ [ hrs. pumping / ~ g.p.m. 12,GEOUTING Well Grouled: ~ Yes ~ ' Material: ~ Neat Cement ~ Other: 16. WATER WELL CONTRACTOR'S CERTIFICATION: Th I~.water Tomperoture is well was drilled under my jurlsdlcHon nd this r lln'n r ;ll .:.,^ xC,~ ep°rtislruet°lheb~etst.°f.~m¥ k~wledgeandbelef; ~ ~giste~ Business ~ame ..... -- t~,'1 )/~ ~ ~' ~ .~ i Contract License Number ~orm 02-WWR (11/81) __Copy Distribution: WHITE-Stale DGGS, PINK-Driller, CANARy-CUslOmer E}F ~c M I.! 1".1 I C ;1: I:::' A L :1; I' Y 0 I:::' A N C H C) R A G De!::;,ar'tml.:~:,nt c~t' H!aal't:.h &: Human I'-"l[:;!',':.'; I.... S't:.r. ee'L, Anchl::ir'age, A:l.a',~il,:a 9"-;.~L'i,:}:l. 343..'..472C) OI".I.....SI'I"E Slili;Wliii:Fl & SEI::'TIE~ "I'ANK ~,: Wli!}...L I:'.:'lii!:l:";:l"l]:"l' Date Issued ~ (::11i]12.5 995()~;' F'a r' (::: e I I d ~:() .I. ,..~-,::. 1 ?,'( ~ ~ L.o'L L. ega:l.',~ ~:-;ubd:i.v:i. sion~, I...II...A[:/X. Lo'L: 7 Blocl.::: 1 I...(::)+. Size ~32205 (SCl,, ~"L. o[' act, es) Max Beclr'cx:)ms~: 'T'his I:'ePm:i.'~,.[] 4 ']"c)CA]. Capac:i.'Ly: 4 'Lank rnus'l:, have at :l. 6:,as'L :?. c:c, mpar'l:.mer'rLs, 250 gallo)ns,, Day liii:a(:::h sept :i. Dep'Lh t,:) tc)p (:.':,~-' ~.E~t::~t.:i.(::: 'Lank(s) < 4,,0 i,',JI!}!]...L: I..'.)g mu~.'l:, be su. bm:i.'L'Le>d '1'.(:) Mu. riJc:Ll::~al] i' v cJf' Ancl'~H:,r'ag(~? Depar'tm[~::,n'L (:.~{' Health and I".h..m>..:.u'] ,Ci;erv:Lc:es w:i.'Ll"~in 30 days (::).[' v,~6:,].1 c:C, ml::~l(:..H:..:i.c)n, I N~:i'T AI....I.... I::'l}:l::l A"I"'I"A'I"E:HEI}~ [!:lq[')) :1: Iq[F.:I~]:TS l)l::i:,c.~ I Gh.I ~, W ]: ]:)E DRA I Iq F:' ]: ELD: 5 ' I,,,I I Dl!ii: [!].'~1. ' I...OIqG W :1: 'I"H 2. ' 0t:::' GRAVEl .... 'T'H I S I:::'[i!:RM I T .'[ [iii I S!iil..ll~:O FOR A SII,,IGL.I~i: I:::AM]:I...Y DWEL. L. IIqG ONLY AND EXI:::']:I.:',~E!i!~ 01',1 :1.2./:.'!i :!. /88,, ]: CI:ii:I~:UF :1: I:::'Y "t'HAT: 1. 71: am familiaP w:i.'l:.h 'LI]e requ:i, pexile~n'L~; t'c)r, cin.-..~;:L'Le se~4ems and Ne].].s as set t'clr'th by 'Lhe Mun:[cipality of Anchcmage (MOA) arid the State o[' A1asl<a,, 2. I ~i:t. 1 :i. ns'La].]. 'Lhe sy~H:.em in ac(:::c)r'darx::;e with all MOA codes anti r'ex~julat:i.c~ns, and :i.l'] c:cH~lt:]].ial"l(::~,, wi'Eh thE, design cpitef'ia of ti]is :]',,, :1: w:i.].]. ,:adher'e to al.I. MOA and ~J~H:.ate tit' hlaska Pequ:i.l-emerfl'.s t'(:)r' 'Ll']e sec I::)a<:::l.:: d :i,~;'t:,al]::('~i ~ r' orn any ex i sC :[ ng we 1 i, was'Lew~teP d i SQE)~6~'~ ], ~yE~.[~m IH' I:t~..{]:) ], J, C: sewer' age system on th:i.s c)P any ,:aclj acel]'L (:gr' r'uz.)ar'by ].o'L,, zl.,, I ur'~derstand that th:i.s per'mit is va].J.[:J J'cJP a rhax:L[llL.Lin al. so und[)..)r'.~;'l'..ar'ld 'Lha'L th(.~:.) c:apac::l.'Ly (::)J' 'Lhe tc)'Lal sys'l'..Eem ~.~; q. I::)edr,(:~oms and any er'J].ar'(r'~?mer'lt ~,~i].]. r'equ:Lr'e an adclitic)na], pePm:iC. (m0n{,~:,r' :> ~'' '~ ..................... ALASKA ENVIRONMENTAL CONTROl. SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 S,EET NO. / OF CHECKED BY, DATE SCALF i 0 0 1 0 Ui ooon~oU]7- ~ DZ LO JI C. REID, JR. 2251 PLOT PLAN ~ AS BUILT SCALE .1":~' ~NNETH G. LANG, L.S. 1731 GEORGE BELL CIRCLE, ANCHORAGE, ALAi'KA 99515 (907) 345-6476 I HEREBY CERTIF'Y THAT I HAVE SURVEYED THE i~OLLOWING DESCRIBED MENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND DO NOT ENCROACH ONTO THE PROPERTY D2?JACENT THERETO~ THAT NO IMPROVEMENTS ON THE PROPERTY LYING ADJACENT THERETO ENCROACH ON THE SURVEYED PREMISES AND THAT THERE ARE NO ROADWAYS~ TRANSMISSION LINES OR OTHER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT-AS INDICATED /LER EON. DATED THIS THE (~..."~t DAY OF ALASKA. -- , 198~, AT ANcHoRAGE, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~.~%_ ] ~ - 2251 DATE PERFORMED: LEGAL DESCRIPTION: / ? .~/ ,~//~_.-~ /Z~,,/.~/~ Township, Range, Section: ~--/,,~,,1/ 1 2-- 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19. 20- COMMENTS, ~ 5'- / ~,, J~ SLOPE SITE PLAN WASGROUND WATER ENCOUNTERED? s IF YES, AT WHAT L DEPTH? ~ pO ~E ,e,,h ~o Wa,er A% Meniloring? . "'~ Dale: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __~ (minutes/tach) PERC HOLE DIAMETER TEST ,UN '~ETWEEN. FT AND __ FT PERFORMED BY: __ ~. /~'~ ~ ~ I ~ 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) ALASKA enulR0rlmsnTAL COFITROL S[ RUIC8$, IRC. ~n§interin9 6 ~nuirenmcnlal $tu(Jics SPECIFICATIONS FOR ,\ FT~VF .... If,T J3! LOT 7, BI.O(,'_< i, LILAC PARK 1.0 GEXElh~\I, The ,.h'aw:~ngs, ," o-' . .~ th~s ' .:,ne:.c~, [ through 4, sha]3, be a part o= spenJ FJ ~atJ. o~, Ali materimls and wo]'lqnalmh:ip shall meet I:he requ:irements ef 'the Xunic~pa[Lity of Anchorage, Department of Hoa!th & llulllal~ Se~'vtces, (DII]I~;), the comlJ ti. ohs of tl~e per]nit:, and all applicuble rules and A].}. elevations and deptlm a~'e advi'4ot'y ail(l at'e t.o be vepif'ic'd or modified itl the giel. d by a D[{tIS approved inspect:o!-. the responsJbi}:ity o~ i:he an ..... tiler 1'o adhere to approved designs fou i. nst:~tl]ak:Jon, m~Jntein the spec f~ed separati, on dj. stances, and have the appropriate inspections. 1.5 If the insta]iahJon 5s not inspected h,y an Al'SCS engineep, AECS wi.I] not be responsJ, b]e for klm ~nsta]!ed sy:.~kem, fin engJneep aL AECS should be collstllLed 1)l'J. of 2o COiIS~I'Ur~JoH, ho de{iorB/iito the nUlnber of :inspections that w:i]i[ be required and to expla:in what these inspect:i.t)ns will involve. 2 , 9 2 3 The existing sept{c tank nuW I:)e used, i/' Jk meel:x Elm capacJLy requirements for the res2dence and the approval of OlltlS, Older 2.2 through 2.6 al)ply, ':'he septic tank shall be a lJPC approved t~,o con/parOnen[ Lank, construct:ed of .l. 2--gauge steel with ])Jt. qlnastic cou. tJltg, set level ()~ tmdJ s Lttrbed soJ ! ~A~(I insulated ~,J. th over ! yi~g ]ayer of 2 iuch burial type polystyrene. The sepkJc tank .uha]l be :t .m:it~'[xlum o? 5 feel.' :["rom the house fOtllldatJoI:, alld a lll.[llillltlllt ()f 5 fe()t fl'OBI till? absorption area. Thc septic 'Lan]< und dru:in[:[e]d shall, be a minJmmn of' 100 feel: from any prtvake weJ. 1 op body ol! ~:a?.e.p, ~50 feet from Class 200 ?eek FTcom Class A or B ~,e]ls, unle.ss othem~Jse spec:i[.[ed. Less than the required .sepapatJ. ol~ distance, lilt!sic have prior approvul ~a J Vel' by a_[aska I)epartm(.'n I: of ].:ilv:lr'omnenLaJ. (;o:ns Pfping shaJ] be ?Jhted with a ntechanlca5 watertight {:alder coup]J, ng of the inlet and ou[:!eh o:[ Lira septic Lank, P~!)ing shall be 4 inch AST3~ 03034 or cast it'on, sl. oped a lltJIlillttlXl O:~' l~/,'J JllCh per fleet :From the house to the tank and i/8 inch per 1200 ~Jesl 33rJJ Auenue, Suite J~ · Anth0raqe, Alask~ 99503 · (907) ~!-)~]X 561-504 0 p;-!in caps (Jim caps op ectt!Jva~ol~t), and extobd a Ini~!J.)t!ui, of 2 fee~ above g"OUl~Ci ~evn} , 8.0 DRAINFIELD SYSTEM_ The gpavc~_ :For 'the clpaJnfJe!d _sha/] be 0.5 I:o 2.~ inch, screened r-( with less than 3% passillg l:he ~00 sieve. ,'x]]. ~ubst, Jhutes must have pi'Jot DHIIS approval . 'J'he bo[ tom al](t o'd ,,o..,e o.[' [ho excav~!L[Oll .~dla]] be raked ~5th tl)e baclchoe b]nde te ensuFe tha: itt has not been coml)~tctied (:hu'Jng excavation: The bo It LOll! e ] oV~:l'L J on sh~li 1 be 1 ev(~ 1 . Monitor standpipe(s) shai3 be p!ac, ed as shown in tim draw]n~s, and shal] be rigid PVC AST~i I)3034. or 4 5nth cai:;t ipou, The ae(;~[on show~l wJth boles may be drilled 0.5 ~nct] holes on the fi inch nenter~ on oppos:[Le sides o[ the pipe, or a regu[~u' ~ec',.~on of perforated sewer' pipe, clamped to a sottd secti.n, with elthe~' a no hub coupling o:,' a so!venL .jo:hlk. A ,'ubbep ruin cap [Jim cap or equiva]eni:) ~;hal! be placed over the top of ~he pipe. 3.4 The dis't:r[bution pJpe sllal] be i inch rigid PVC with a m:inJmum cpush stl-engt 1 of 1500 lbs o]' equal AIl dj ;kp bltiop p.ipes .... .. · , om!ii be laid ~eve] , grave], Jnsul~!t;on Js required us:}ng Dow extruded })]tie styrofoam boapd or equa]. There shat] be 1 inch of 5nsu]akion ft)r cv,??y fo(,C of soil less than the requJ, i, ed 4 feet nf cover, but thei'e mtmk be so].id pipe extending from the septic tank or lift station Lo ~he di'ain:fJeld shall also have 4 fce'L o:C cover op an equivalenh layer' insulation ~o pi'event freezing of the line. 7C [nsu]ai'ion ia nok neces,qaiW, _I~' gravel ~;lla!l be covered wt[h a l aye? of nollwovt¢ll ellgJliee!'Jl)g fab_'in, 3,'7 VJ. CJllJ[}; Of ~_]lO draJnfiel, d shal3 be l)]~n[ed with a white Cesotie mix oP Kent:ucky hJue grass:. :; . ] trench. The fi. rs[ inspeckion ;,.'ill be of the excavakJon to verify .2 .3 The ishe ~'round %faded. 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. 015-211-22 1. GENERAL INFORMATION Expiration Date: � "2- I — Z Complete legal description Lilac Park Sub, Block 1 Lot 7 Location (site address) 12100 Lilac Cir, Anchorage, AK 99516 Current property owner(s) Griffith Steiner & Laurie Gregory Revocable Trust Day phone 441-2721 Mailing address Same Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -550 Waiver Fee $ Date of Payment Receipt Number COSA # 05C,2_11250 Date of Payment Receipt Number Waiver # Distance: 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 Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller Date 5/12/21 4' OF Agc�pl� TH 6. DSD SIGNATURE System #1 Approved for bedrooms r Ben'a�er System #2 Approved for bedrooms Fri,; CE 12592 ..5/12/21 AM - Disapproved l�>rpROFESS00 Conditional approval for bedrooms, with the following stipulations: .p� WATER AND WASInVATR Z' PROGRAMA O SER}, . By: ` LAI 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 COSA Checklist blue sheet COSA Checklist Legal Description: Lilac Park Sub, Block 1 Lot 7 Parcel ID: 015-211-22 If more than 1 septic system on lot: COSA Checklist #. of Structure served by this system A. WELL DATA R Well log is filed with Onsite (or attached) Date drilled 7/28/88 Total depth 192 ft Cased to 192 ft ®❑ Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 16 in. Date of flow test for COSA 4/7/21 Static water level at beginning of test 120 ft. Comments B. TANK DATA Age of tank(s) <1 years Tank type/material SEPTIC/PLASTIC Measured operating fluid level in septic tank N/A FE -1 Standpipes/foundation cleanout per record drawing Date of pumping Tank installed on 5/7/21 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 1988 ❑® ALL standpipes present per record drawing Total measured depth from grade 7.5/7.5 ft (max) Measured depth to pipe invert from grade 5.1/6.1 ft (min) ❑ N/A — pressurized field X Monitor tubes go to bottom of effective. If not, state depth into effective 1.4 ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 7.1 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ Nc Fil Coliform bacteria is Negative Nitrate 1.69 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L © Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 4/7/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 4/7/21 Results Z Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 845 gal New depth 9.5 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' E✓ Yes Community Sewer Manhole/Cleanout > 100' r✓ Yes if No ft Q Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 7 Yes if No ft 7 Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' �✓ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5'✓❑ E✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' Yes if No Water Main > 10'✓Q 0 Yes if No ft Community Wells > 200' 0✓ Yes if No Water Service Line > 10' F 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' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' Fv Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100' ✓M Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEERS CERTIFICATION OF l certify that / have determined through field inspections and review e C? - of Municipal records that the above systems are in conformance with ;49TH - - MOA -COSAguidelines in effect on this date: • • • r �--� ' Benjarr ylschiller �� �F� • CE 12592 • c�`�®� �iS'lF' . • 5/12/21 • . •�t �� PROF!i si0' COSA Checklist yellow sheet ft ft ft ft F. \LU + @\\ § ' }§k \ \LU § e aI j < < } §±/\ /%$\ §» \)z z y& a \m\ W LU \�? / \/\ fe® ®5 ) _\ \%2 \\\ \\0\�Q §+ Cf§§J§\ Cf 0> M:0 [#® \ ») LU m <Woo< ) LU/\ }e�\e� \K? \(/§§ + 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015 ~ ,2-.11 1. GENERAL INFORMATION Complete legal description Location (site address or directions) 1~.~¢2 ¢ Lt[~ Property owner Mailing address Day phone Lending agency Day phone Mailing address Agent M.~-~ ~ ~- Address ~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WA'rER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of sysfem. 72-025 [Rev. 1/91) Front MOA~f21 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 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. Name0fFirm'~-~cG]~,~ ~,u~-kL,~,,¢¢2 ~'~ Phone Address ~<P ~ v/o' 1 5, ,L~ ~' 2-c~ ~, Engineer's signature DHHS SIGNATURE //--____ Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: '- 'f Date .~"/~,2~, 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 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 enginee¢s work. 72~)25 {Rev. 1/91) Back MOA #21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST' Parcel I.D. A. WELL DATA Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. / Date completed Cased to I dj 2-- Casing height Wires properly protected (Y/N) ADEC water system number ?" ~.~¢- 8~, Driller FROM WELL LOG AT INSPECTION Date of test '7/'~ q//~' ~ ~/~ ~//~'¢" - Static water level J Well flow I ~ g.p.m. /¢~ g.p.m. Pump level J SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot II D Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout r,,'/,~ Petroleum tank ~,.I J o WATER SAMPLE RESULTS: Coliform ¢ Date of sample: ~/¢-,5'/'T Nitrate Collected by: Other bacteria _ B. SEPTIC/HOLDING TANK DATA Date installed ~ o/¢..'l ]g~ Tank size J ~ '~o Compartments Cleanouts (Y/N) ,2_ Foundation cleanout (Y/N) ~" "' Depression (Y/N) hq High water alarm (Y/N) lk//,~ Alarm tested (Y/N) Date of pumping ~/,2--~,/?Z_ 'Pumper A~4 d~. ~.~_~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ! ~2 To property line ~, ~o Surface water/drainage On adjacent lots ~. I z~-~:) Foundation _Absorption field I0 ~ Water main/service line 72-026 (Rev. 7/91) Fronl CONTINUED ON BACK PAGE 205 WEST 15YH. AVENIIE SUITE 206 ANCHORAGE, ALASKA ?9502-5904 (907) 279-3916 LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: FROM I'"lUIq :( (3 ]; PAL RIE[}OI::~D,ci~ TANK',', Anchorage 'T'ank 1250 Gal. 'l"wo Cc)mparts. ABSC)RF:'TZON SYS'I"IEH~ W:i. de 'l"r'ermh ABSOI:RI:::'T I C}N AREA: 600 Sq SO :l; I.... RAT ;( I',IG: 150 :t: NSTAI,..L. AT :I: CIN DATE [)ATE OF LAST PLIMF:'ING: Anl:::h. C(,:~ss F:'cx::)]. Marcl'", 26,~ .I.' c,..,,.? ;,.,: DATE OF TEST: ]'EST PROCEDURE: Sys'l':em was :i. nspec::tl~;~d and measur~,::,d,, "I'a~)l.:: was 'f:oLtri(J with 8 .Feet c,f cover- arlcJ T'r"ench c::l. ear~ outs w(c~r"t:.:, Tr"om 5.5 to:> 9.5 c:le~:,~p and dr'y. -I'rer"~cl'~ mc~r'~:i.'t:c:)r tubes ~,~(:~1'"(-'.? 7.5 and 8Cx} (la:). ]. c)ns c:).[: c:l. ear) water' was adch::.:,d to the tr'{>:)r'u::l') ¥..x=:r!:(.:?r l(.:.?vels :i.n the rani< ar'u:::l 'l::l'",,~::z, r, oni't:cw" tube t4ere m(::ln:i.t,:::w"ed. The wat(.::.:,r" ]. c<,vt.:e]. :i. ]'1 'l:'.l')~::;~. tar)k d:i. d rio'l: change .~ wh :i. l i::.) 5 :i. rx:::ll(:~)s !:id'~ov.x!:.~d up :i.r't c:,n(a (::,.f: the mc:,r'l:i, t(:)rs. The r'p}z;.,"l: (::lay 'l:ha't: mon:[ 'I:(::H'" t.,..h~.~¢.-., dl.'"'>/,, TEST RESULT: 'r'hi s 't:l )(:.: Heal 'L:h and S(:x:: J. al Set v:i. ces ~}el:)e,r"tmeri'l.:. (::?¢ the NO"I'E TI'm? c~p er at:::i. ]. oca]. soi I c:or)d :i. 't: :i. ohs r grc)ur'x:J~.:~t(.?r 1 (~?v,:..~l s tl"~at may .F ]. u(:::tuat,::.? by the system,, 'f'hese eval uatcx.' (::H: tl~:i. % Em)pi: j. (::: sy~F~.(:em, b~i~e (::akr~ tll~:el"'ct'for[.? not g:i. VE, al'ly E: L.t r i'" ('?1] 'ti C:) r '{: L.t t Lt r E.:.) C} C; C;: LIp a fi t E~ ,, 205 ME~T I5TIt. AVENUE SUITE 206 ANCHORAGE, ALASKA 97502"3704 (907) 279-3916 L.EGAL: I-OCATION: OWNER: TYPE OF WELl_: WELL LOG AVAILABLE: I NSTAI_I..AT I ON REQU I REMENTS MET: Y WELL. YIELD FROM WELl._ LOG: 18 Ga]Ions I:',~:'r Minute PUMP YIELD FROM TEST: DATE OF INSPECTION: TEST F'ROCEDURE: Well was gal. ]. c}r')~.~, p~?~r- minute .For a p(.~)ri od o~c 2 hours.~ 15 mil"n.d~es. A ~,~a'ker 1 e,.'~.:,l I::,~:'.:,l ow 97 d: 0.?e'l': ,, TEST FOR E. COL. I Al,ID TOTAL NITROGEN: Wa'l:'.(::?r' was tested -For ,~}!:. Col :i. and tcrt':al n:ii:r(::~g~:~rt on MArc:h 26~ 1992 E,, Col :i. (),, 'T'c)t:al N:i. trcx;'l('.'.',n O, 56 m(~/1 . Flax ,, al 1 (:)w,::~bl ~:-2 'l"crkal Ni 't:r(:)g(.~,,n :1.0 mg/].. TEST RESULTS: "l'l~:i. s w~:.:~:171, meets the requ:i, r'~:m~:.:~r~'Ls o-f: 't':t~:.:.:, tvh..uIJ, c:i. p,':~]. J. '~'.y c:)'(: Anclaor-age,, _THIS_ ~I_E_L~L WILL ~.)_R~p_U_B_E blORE THAN :S GALLONS PER MINUTE FOR MORE T_H_AI'..~[ F_0_..U_R_'. U_0_UR'IL - - .............. 'l"he I"lur~i c:i.l:::,al r'equ:i, remerit .i:or we11 -{:1 [:)t,,~ :i. s 150 gal 1 ohs o.F water p(.:E,r l::)(~:~cIl'"c:~c:~ffi 13~:.~1,.. CI,':!¥',, 'T'h:i.s well exce(.~:,cl thits rE.)(::lt.~:[f"eTff~(.:.:~F.it,, ]"Il0? ass(~:.)ssm(.:,n.[: (::).~c 'l'.'.l"n.:~) [::E)l-'~c~:i. ti. E)r'l i::).~: thE:, cor~(::litic~s as c,.F th,:.:~:, day '(:6;,sted. fh(.:.) .{::[()~.¢ ~'Fd'lC] ,::::~'i~t,tt')(:J¢.:.~ J. r'l '[':h6:~ 1[ &ti'Id t.t~s~.:-~ ~f'l(J c)'[':hE2r CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 / Member of the SGS Group (Soci~t¢ G~n~rale de Surveillance) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location Ca~s~,~lrectlons) Pro ~e rt'" (b) p ~.. Mailing A~dres¢, Telephone: (home) Business (c) Lendinglnstit*ufion' v Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ~[, if hold for pick up.) List contact person and day phone number below: 'TYPE OF RESIDENCE Single-Family'i~ Number of bedrooms WATER SUPPLY Individual Well *~. Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site~¢. Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 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 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 Date 6. DHHS APPROVAL Approved ~or beOrooms by Approved_ ~,,~ ._Disapproved Terms of Conditional Approval Date 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 S above by an independent professionalengineer 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 DHHSdonotconductinspections or analyze data beforeacertificateisissued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev 7/88)Back Page 2 of 2 ct ~' MUNICIPALITY OF ANCHORAGE (MOA) ~¢.~'~` ~,~'~ Heallh Authorily Approval (HAA) .~C~ ~t,,~" ~,,~'~ CHECKLIST- FEBRUARY 1984 343-4744 A. WELL DATA Well Classification ____ Log Present(~N) __ Well Total Depth /CZ--" Cased to Static Water Level //~ Legal Description: Z-- '7 /~ / Z-//-~ ~',4¢E,~ Date Completed 7 /~'~/ Depth of Grouting Pump Set At Casing Height Above Ground /"~ Sanitary Seal on Casing L"~N) Electrical Wiring in ConduitON) Depression Around Wellhead (Y(~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line 4J//~- To Nearest Sewer Service Line on Lot Water Sample Collected by If A, B, C, D.E.C. Approved (Y/N) ,~'/,~f Yield /~' Water Sample Test Results Comments / /// ; On Adjoining Lots /7-7, ~' / ; On Adjoining Lots /~'~ To Nearest Public Sewer Cleanout/Manhole /'),/~ ,,~/,J/~a--/,/ ;Date ~"'~ / B. SEPTIC/HOLDING TANK DATA Date Installed /¢' -~-E-'~ Size Standpipesi~'N) /~"~'~ No. of Compartments Air-tight Caps ~N) Foundation Cleanout ~N) Depression over Tank (Y(~) Date Last Pumped /J/,~' Pumping/Maintenance Contact on File (Y/N) ~/,~ ;for Holding.Tan'g F~igh~Water Alarm (Y/N) ,~/¢~ Temporary Holding 'rank Permit (Y/N) SEPAR~ATION¢,D~I~-AN0~,FROM SEPTIC/HOLDING TANK: / TQ W~t,~r-SupC)ly ~1]!? ~'-: ~: ::~/// To Building Foundation TO PrOperty Line /~)/¢'~ To Disposal Field T~'Wai0~ Maih?SCr¢ic~':Li~;:; t.' /0/.¢-~ To Stream., PonO,Lake~'or' Major Drainage Course Comments ' ' : 72-026 (Rev. 7/88) Fronl 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 (Ye Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot ~J/,~r To Water Main/Service Line Type of System Design Length of Field ~ ~ 5/'¢" =- ~'¢'" Depth of Field ¢~" / Gravel Bed Thickness ~' Statndpipes Present ~N) Date of Last Adequacy Test /J/Pr To Property Line To Existing or Abandoned System on ; On Adjoining Lots /~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D, LIFT STATION Dat e~'r'~¢......~.~ Dimensions Size in Gallons ~___..~ Manhole/Access (Y/N) "Pump On" Level at '~__ "Pump Off" Level at High Water Alarm Level at ~'~.~.~ Vent (Y/N) _ Tested for ~*~'"~.__ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ~_~ Comments .~.~.~ **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. Signed Company Date MOA No. Receipt No. d.~/..? ,~ / (7:~ ~) Date of Payment ~-.'~ '--~/~- Amount: $ ,// .~ ~ ,- ("..) ('~ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~:~'~ 5633 S STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 ~,,.~~,~ FEDERAL TAX ID # 92-0040440 Client Sample ID:L7 B1 LILAC PARR PWSID :UA Collected AUG i 89 O 15:35 Es. Received AUG 1 89 @ 16:00 hrs. Preserved with :AS REQUIRED Analysis Completed :AUG 2 89 Laboratory Supary~sgr :~TEPIIEN C. EDE Released By : ~ ~/.~_/ Special Instruct: ANALYSIS REPORT BT SAMPLE £or Mork Order ] 15449 Date Report Printed: AUG 3 89 @ 23:12 Client Name : A E C S Client Acct: AKECSRP P.O.~ NOllE REC'D geq ~ Ordered By : L. REID Sand Reports to: 1)A E c s 2) Chemlab Ref ~: 6729 Lab Smpl ID: i Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 0.36 ms/1 EPA 353,2 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY A. WIEN. Tests Performed ' See Special Instructions Above UA=Unavailable None Detected "See Sample Remarks Above Not Analyzed LT=,Lees Than, GT=Greater Than