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Home My WebLink AboutGINAMI HILLS LT 7AMunicipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~ 1~)~"~'~ PID Number: 4:~)I~0J'~ Name: N~ U pg rude -.Jo.141d ~ ,¢ NIJ~___~,,/¢;~, ,~t,~b,,bJ.~k[ Wastewater System: ~ New Address: I~t ~t~l ~. ~i~ ABSORPTION FIELD ~ No. of Bedrooms: Phone~ ~~ ~ ~eep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION So,lRating: ~.~ GPD/Sq.F,. Total Depth from ori~l?rade: Lot: ~ Block: ~[~ ~Subdivisi°n:] ~~ Depth to pipe bottom from original~grsde: Ft. Gravel depth..beneath pipe ~l Ft. Township: Range: Section: Fill added above original grade: Gravel length: WELL: D New D Upgrade Grave~:¢~ ~ Ft.-~ I [~f Ft. Numbe~ines: Dis ance be ween nee ation(Private. A,B,C): Total Depth: ~ Cased To: Total absorption area: Pipe materiak~ Driller: Date Drilled: StaticWater Level: Installer: Date installed: Yield: Pump Set at: Oasin; Hsight Above Ground: ~ s,. ~. TANK SEPARATION DISTANCES Ceptic ~ Holding ~ S.T.E.P. TO Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Surface W~ter 1~'~ IbD~ -- -- ~ LIFT STATION Lot Size in gallons: Manufacturer: Line ~[~ ~'~ -- -- -- ¢¢, ¢ __ CurtainDrain ~O ~ ¢ ~~ ~ ~ Pump M~. Electrical Inspections pedormed by: Remarks: ~i¢TI ~ ¢~~,¢/ BENCH MARK Location and Description: Elevation: ENGINE~:S.SEAL Department of Heal~ and Human Services approval '~:~>-',~ v~,. Reviewed and approved by: Date:/ff-3~- W 72-013 (1/91)MOA 25 Page ~ of ~ Municipality df Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report 72-013 A (2/91) MOA 25 ' PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SWg10273 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:SWANSON JOHN E & MARY E OWNER ADDRESS:12301 GINAMI ST ANCHORAGE, ALASKA 99516 PARCEL ID:01546130 LEGAL DESCRIPTION: GINAMI HILLS LT 7A DATE ISSUED: 9/06/91 EXPIRATION DATE: 9/06/92 LOT SIZE: 40477 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: i -? ISSUED BY: ~_~z_~_~ ~-o~C~ DATE: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. September 2, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot ?A; Ginami Hills Subdivision; Request you issue a permit to upgrade the septic system located on the referenced property. An adequacy test was performed on the existing system on July 23, 1991 for Health Authority Approval purposes. However, the absorption capacity was found to be inadequate for the existing 3 bedroom house. The proposed upgrade consists of a series of 3 absorption trenches to be added onto the existing seepage trench. We do not anticipate any adverse affects on neighboring properties by the installation of the proposed upgrade. If you have any questions, or require additional information for your review, please contact us. Sincerely, RJS/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE ./ SCALE 1 2 3- 4 5 6 7 8 9 10 11 12 13 14 15 16 17, 18- 19- 20- COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~' ~5:;.%~ DATE PERFORMED: Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? L IF YES, AT WHAT O DEPTH? p E Depth to Water A.~IB~.~ , Monitorino? '[.?~'""'/ Dal,: '~'~'~'7"'"4:~I SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE "~'7 (minutes/inch) PERC HOLE DIAMETER PERFORMED. : Eagle River, Alaska 99577 ' ' \ /'. I ~ ,"? ,...,~:~' ! ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT O1~ THIS DATE. DATE: -[ '~' ~ [ ~ 72-008 IRev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMEN-I:AL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEINAGE DISPOSAL SYSTEM AND/OR B/ELL INSPECTION REPORT PHONE [~N EW [] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION I DISTANCE TO; ~ Manufacturer Lq capac tv in gallons I ' I 2-50 ............. I~,~ I DISTANCE TO: iWell 0z"~ ~ Manufacturer 13 [ IWell d=l DISTANCE TO: ~u .T ~ [ No of lines [ Length of each line/ El.- Top of tile to finish grade . u~ Length Width ,~1- I Type of crib Crib diameter ~ [ DISTANCE TO: ~, [Class Depth .~ [ Building foundation I DISTANCE TO: Absor pti~ar~a Dwelling ~._0/ W0th ¢ NO. OF B.~DROOMS PERMIT NO, No. of~mpartments Inside length Liquid depth Dwelling PERMIT NO. Liquid capacity in gallons Material Nearest I~e/ Trench~;.~// inches F ou n d~o~_ / Total le?t~_o~lines Material beneath tile / ~ inches Distance between lines Total effective absorption area Depth PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line Sewer line Absorpt on area(s) Septic tank OTHER PIPEMATERIALS SOILTEST RATING REMARKS ! APPROVED DATE LEGAL WATER WELL LOG ,~ ,~\ 1336 Ingra Street ~.,~' ~chorage, ~aska 99501 ~ FEET OF DRAWDOWN. REMARKS DATE C OMPLET ED -/__~_~_~' ~ to / to to__ to__ to__ to__ to___ ,,to to ,. to__ ,to ,,to to ,to__ PUMP TO BE SET AT~ tO PERMI'r NO. APPL I F:RNT LOL-:RT I ON LEGRL WILLIAM G CLAR!i.~ GINH['II ~ I~.EET [.?R GINRMI HILLS ~LIAD 5904 PROSPERITY DRIVE · ,-] RBSOF.'.BTION z,z_,TEM I_. TRENCH T'z'F'E OF _~U I L ,~, ,c ,~. MAXIMUM NLIMBER OF BEDROOMS = ---'. SOIL RATING LOT SIZE ,:: SQ FT,..'BF.: ) = THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [-~EF'I- H= -1 -_1_ LEr~L~TH= 42 ,_~R R"-.-' E [_ [:.EPTH= 6 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E~CRVRTION (IN FEET). 'rHERE IS NO SET WID'rH FOR TRENCHES. THE GRAVEL r)EPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE E>;CRVRTION (IN FEET). PERMIT APPLICANT HAS THE RESPOWSIBILITY TO INFORM THIS DEPARTMENT DLIRING THE ~- , CTIAN5 OF RWY WELLS RD.~RCENT TO THIS FROFERT~ AND THE INSTALLATION IN~FE' - = ' " NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. BACKFILLING OF AN9 SYSTEM WITHOUT FINAL INSPECTION AND RF'PROVAL BY THIS DEPARTMENT WILL 8E SUBJECT TO PROSECUTION. ' ~?-' ~"q -' I~ MINIHLIM DISTANCE BETWEEN R WELL RND ANY ON-SITE SEWAGE DI:,FI_:,HL. :,~_TEM ~0 FEET FOR R PRIVATE WELLJ OR i58 TO 2EiO FEET FROM R PUBLIC WELL DEPENDING UPON THE TYFIE OF F'UELI[ WELL. WELL LOGS ARE REQ_IRED AND F1UsT BE RETURNED TO THE DEF'RRTHENT WITHIN 2~0 DRYS OF THE WELL COMPLETION. .... ~ ,- OTHER REQUIREMENTS HAY APPLY. $PECIFIbRTILN:, AND CONSTRI_ICTION DIAGRAMS ARE RVRILRBLE TO INSURE PROPER INSTALLATION. .~.~, ._. PE~'I I T E~MF' I ~.E~- - I CEF.:TIFY THAT =,EWER-. AND WELLS H:, SET i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE '- .c -,- FORTH E:'f THE MLINICIF'RLIT'~' OF ANCHORAGE. 2: I WILL INSTRLL THE =Y~TEM IN ACCORDANCE WITH THE 3: I IJNDERSTRHD I'HRT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT RESIDENCE IS F:EMC,[~)TO INCLLIDE MORE THAN 3 BE[:,ROOMS. RFPLIC~[.~itLLIRM G CLARK ~ ' I F THE July 30, 1976 No. 656275 Phillip Allen 1011 Strawberry Street Apt 1 Anchorage, Alaska 99502 RE: Test Hole and Soil Log Report for Sanitary System Ginami Subd. Lot 7A Sec 21 T12N R3W Dear Mr. Allen: [. We are submitting herewith the tdst boring results and our comments regarding soil conditions encountered at the subject site. This investigation was ]performed in accordance with your request of July 23, 1976 and those procedures outlined in a letter, dated July 15, 1975, by Hr. Roll Strickland of the ¢~reater Anchorage Area ~Porough Department of E~]vJronmental Quality. A single test hole was put down within the subject site for the purpose of defining general subsurface soil conditions for thc proposed sanitary system. Excavation was accomplished with an auger type drilling rig and the test hole was extended to a total depth of 18.5 feet below ground surface. The final ]ogs prepared for the tef;t holes has been included in Drawing A-01. Ground water was not encountered Jn test hole while dri]linq. We appreciate being given this opportunity to be of service to yau. Should you ]]ave any questions with regard to the sbove, ?.]ease do Hot hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. James W. Rooney V~ce President J%.~l/ddp xc: G~ TH 1 0 Ginan%i Street w/Some 'FE Sand 18.5' ~ ~andv Silt Silty Sand sand w/some silt 11' silt w/some Sand Water Table W.D. This log represents subsurface soil conditions within Ginami Subdivision lot 7A Sec. '~,~. T12N R3W I I P.:'!O,t. NO ,'~ ::: ,:. 2 ? 5 ~, Performed For legal Descrintion: Lot~ A__~B1 ock .... This form Renorts Soils Log C!)EAT'.,:'.I? At!cur!PAGE ~!:i-.~. gOR¢)LIGU DEPARTPFUT OF F.'.,iVIRO~'r..;,,[Ai. qUALITY ANCHORAGE~ ALASKA gAS~2 (~vm~s Date Performed Subdivision ~(kq ~V~[ Percolation Test ~eDth .. Feet Soil Characteristics 1 5 6 10', Was Ground Water Encountered? If Yes, At what Denth? Percolation Rate Hinute ~'~ Proposed Installation': Seenaae Pit )<L Drain Field .; - De~h of Inlet De~th To Bottom Of Pit Or Trench' Data Certified By: . ~ ~-." J R'eadin.q Date Gross Tim'e Net Time, Depth to H20 Net. Dro)~ ·I ~ ' "~' I , , I ..... i ..'~ TIME 10:30 10:31 10:32 10:33 10:34 10:35 10:36 10:37 10:38 10:39 ]0:40 10:45 10:50 10:55 11:00 t1:10 11:20 11:30 PERCOLATION TEST P}IILL I[~~ ALLEN R a M NO. 656274 ',ELAPSED TiME 0 1 2 3 4 5 6 7 8 9 10 ].5 2O 25 3O 4O 5O 6O 60, Minutes DROP IN ii277iES _ v' :* 0 .5 .5 .5 0 0 .5 0 .!5 0 .25 .5 .25 .5 .25 .75 .75 1.00 Total 6.25 Drop In Inches , / 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description Lot 7A; G~ami" H~S;~g~6div~sion' Location (site address or directions) 12301 Ginami~ Anchorage, AK 99516 Property owner Mailing address Lending agency Mailing address Agent Add ress 3ohn Swanson 12301Ginami Dr. Day phone (w) 753-2671 Anchorage, AK 99516~ (h) 345-6318 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well XXX 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 Public sewer NOTE: XXX ~ If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA~21 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 onCsite 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. S & S ENGINEEEING Name of Firm i ~-o,~,i ~agie AJver Loop R~oad ~1~,'~__[[-4~ Phone Address Eagle River, Alaska 995~ / - Engineer's signature D~S SIGNATURE Approved. forT-/d~'~---~ bedrooms. Disapproved. Conditional approval for Date -~'~'/~'~ ~-~ bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representauons 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 engir,~er's work. Municipality of Anchorage Department of Health & Human Services HEAl. TH AUTHORITY APPROVAl- CHECKL. IST Legal Description: ~-~'~' '~/~ ~ ~ ~ A,-~,/t t. ~-~.~..-~% Parcel I.D. 0 / ~- - A. WELL DATA Well type Y~,"J/~ If A, B, or C, attach ADEC letter. ADEC water system number Log present ~/N) X~ Date completed "'~ ~ \ ~'' ~ ~ Driller Totaldepth ~, L~c:~ Casedto "~'7.~-L ~-->,~--. Casing height Sanitary seal~Y-~N) FROM WELL LOG Date of test ~ -- \ ~ ' ~ ~ Static water level \7~) Well flow \ L~ Pump level ~ ~ Wires properly protected Y~N) SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ \ ~' Absorption field on lot \'"'~ ~'-P~ Public sewer main Sewer service line AT INSPECTION \,~ g.p.~ g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ['--~ ~,--~ WATER SAMPLE RESULTS: O I COL-[ C I'form ~-~ /\ °c~'~ ~ Nitrate Date of sample: "~" \ ¢'/--' - ~ ~ B. SEPTIC/HOLDING TANK DATA Date installed q ~ ~ ~0~ Cleanouts (~/N) ~( High water alarm (Y~ Collected by: Date of pumping Other bacteria & $ ENGINEEEING Eegle River, Alaska ~29577 Tank size \ '~'-~ Compartments Foundation cleanout (~N) V D e p res s ~.~n/(Y/~ J ~armtested .: .- "'"~ ' ~'"~ ~"~'~"~ Pumper:'":' ~'¥' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Foundation Well(s) on lot k ~ ~' To propertyline ~- ~ I Surface water/drainage On adjacent lots Absorption field Water mai n/service Ii ne 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Manufacturer "Pump on" level at Meets MOA electrical codes S~ROM LIFT STATION TO: Well on lot On adjacent lots Manhole/Access (Y/N) ycles tested Surface water D. ABSORPTION FIELD DATA Date installed \ O ~ \\ ~q k Soil rating Length ~'~ ¢-t, ~ Width Total absorption area "~ Depression over field (Y~ Results (pass/fail) /~'~-~ -% '1~'~-1~1 Peroxide treatment (past 12 months) (Y~ L~'~[ ~.r--~.~System type Gravel thickness Total depth Cleanouts present) ~ Date of adequacy test for If yes, give date bedrooms To building foundation On adjacent lots ~ Surface water \ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ '"1 t.~~ On adjacent lots \ ~-O L ~ Property line ('~ ~:~ To existing or abandoned system on lot Cutbank ~o ,~ ¢:..~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERT F CATION I cdr fled, or conformed to all MOA and HAA guidelines in effect on ~h~..date of this inspection HAA Fee $ '~ -') 0 ,LDO Date of Payment Receipt Number 72-026 (Rev. 3/91) B~ck MOA 21 Waiver Fee: $ Date of Payment Receipt Number )IP~LITY OF ANCHORAGE:b.;~:-:_ DEPARTMENT OFHEALTH & HUMAN SERVICES 1. GENERAL INFORMATION Complete legal ~escriPfion[ APPROVAL FOR ASINGLE FAMILY ' '. I-it ~t 7A~ Gi~ H~ S~vision~ . .: F{ Location (site a~dress or directions) 2301 Ginami St~-~ Pr°pertY.own~? Mailing addres~ ~ending agenc: 12301 Ginam~ · DaTphone 2~ 25 An~hOrarq~, AE. c'~516 Da:' Dhone Mailing addres~ Agent Address D~,' phone Unless othem"::-e requested, HAA wii: be held 'for pickup. 2. NUMBER OFBSDROOMS: 3. TYPE OF WA'i'ER SUPPLY: ..... Irdividual well NOTE: TYPE OF WASTE[WATER DISPOSAl' l~ividual on-site .'; i-~lding tank Community on-site NOTE: Community well ' ~:- P~blic water ._ If corr, znunity well system, l~,ovide written confirmation from State ADEC attest- ing to the legality and status of system. . . P~blic sewer ~ If communit~/ wastewater system, provide written confirmation from State ADEC attes;i~g to the legality and status of system. 72-{325 ~-e~. 1/91) Front MOA~2'- m, uewwoo leUO!l!PPV 'f~/11/-. '- ': :suo!~elndp, s I~u!MOIlOl eq~ Hj!M 'SLUOOJpeq JO~ le^oJdd~ leUO!~!puoo 'peAoJddes!a 'SLUOOJpeq Jori peAoJdd¥ . ~ m.-InJ.~fN~>lS SHHO~ '9 . 'g Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ I ~, !.h~-~. ] -~II~.D~; ~_~('~'~¢~X~Oarcel I.D. WELL DATA Well Log present) Total depth Sanitary sea~) If A, B, or C, attach ADEC letter. ADEC water system number ~'-~/.~ Date completed ~ -[~ - ;:~<:~ Driller"~---' Cased to .- '~ ~/ :_Casing height Wires properly protected (~.~) N PE~'~''- MUNIC PALl'P( OF ANCHORAGE FROM WELL LOG AT I S ,.,.IOEI~tP, oNMENTAL SERVICES DIVISION Date of test '~ ~ ~'/-~ ~_-'~ ~' '[~ '~ ocT 1:8 1991 Static water level [ ~/ ~' ~ " Well flow J~ g.p.m. ~',+ EIVED Pump level ~~ ~ ~t~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot '1 Absorption field on lot Public sewer main ~,~ Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank t~ %_4. WATER SAMPLE RESULTS: Coliform ¢ Ox~[/l~E~v~,t Nitrate Date of sample: l(~ !~¢)1 ~I Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed --Jr Cleanout~N) Y High water alarm (Y/N) Tank size Foundation cleanou~N) y Depression (Y~ /'--~ · //)~-. Alarm tested (Y/N) Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 1~ I On adjacent lots To property line f~--~"~ / Absorption field Surface water/drainage Foundation ¢~"/ Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical co. de~(Y/N) S EPARATI?~ 14~STANCEFROMLIFTSTATIONTO: Well on lot On adjacent lots Manufacturer ~ M a n h~Ce-/A~ss (Y/N) "Pump on" level at~...~~'~ "Pump off" level at J Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed /O'-' // ¢~;~ Length ql~' Width Total absorption area ,-"~'~ Depression over field (Y~ Results (pass/fail) Peroxide treatment (past 12 months) (Y~ Soil rating ~)' ~ ~l'[~l~r"f"~ystem type-~ Gravel thickness ~ Total depth ,~ ! Cleanouts presen (~N) "~ Date of adequacy test L[,/~ 'l for ~ bedrooms 1'~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots [Z~,,--_.)/%_ Property line To existing or abandoned system on lot Cutbank ~,,~O k[~_~ Water main/service line Driveway, parking/vehicle storage area [E)r4- Well on lot l'~ ! To building foundation ~:~1 On adjacent lots ?249 Iq__ Surface water 1 ~(~l _~ Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ~ ~, ~?,~'~' %~ '~ Engineer's Name Date $ & $ ENGINEERING 17034 l~agle River Loop Road, No. 204 Eagle River, Alaska 99577 HAA Fees //7 Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number