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HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 3 LT 9Onsite File Great Land Estates #3 Block 3 Lot 9 #051-133-38 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201048 PID Number: 051-133-38 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name SHANDA & JAMES LOHSE ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 19930 QUIET WAY, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 4 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot GREAT LAND EST. #3 3 9 Fill added above original grade 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 absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'+ -- 25'+ TANK © Septic ® S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 5'+ -- NA Foundation 10'+ -- LIFT STATION Manufacturer GREER / ORENCO Capacity 1500 Gal. Remarks Alarm location BACK SW ROOM Electrical installed by DRS ELECTRIC PIPE MATERIAL House to tank 3034 Tank to 3034 Installer JRS drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 151 6/30/2020 2nd 6/30/2020 Location and description 3'd 03/11/2021 4'" TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVALlow • �' �} Conditional Approval: Date t� ....•: epdstem APProe .......... Curtis Huffman � 9 CE 128991 ` �,0' Date $ p�Da� ��'�'lF.•. I//14/2z .-�*G AAw w ���F'�pROFESSiO�P -� Note: this approval does not include well permit requirements. kmev eoiuu 10) 3/26/2020 13030 Sues Way, Anchorage, AK 99516 907-350 -9566 / firstwaterAK@gmail.com March 3, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: GREAT LAND ESTATES #3 BLOCK 3, LOT 9 PHYSICAL: 19930 QUIET CIRCLE, CHUGIAK, AK 99567 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank and lift station on the above referenced lot. We propose to install a 1500-gallon HDPE STEP tank to serve the existing 4-bedroom residence. The lot and area are served by private water with no tanks within 100’ of the proposed tank. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201048, Rebecca Carroll, 03/25/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201048, Rebecca Carroll, 03/25/20 Municipality 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: Nama: Wastewater System: Q New ~Upgrade Address: ABSORPTION FIELD Phone:~ ~N~ofBedrooms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mound OOther Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION ~,~ ~,o/s~.~. ~ ' Block: Subdivision: Depth to pipe bottom from original grads: Gravel depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel length: WELL: ~,,~,~ New ~ Upgrade srave~ ~:~ Number of lines: Oislance ~tweeMines: Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: StaticWater Level: Installer: ~/_ ~/~ Date installed: Yield: Pump Set at: ~Casing Height Above Ground: · . TANK SEPARATION DISTANCES a s.pti. ~ Ho~i,g ~ S.T.E.P. To Septic Absorption Lift Holding Public/Pdvat~ Manufacturer: Capacityin gallons: Material; Number of Compadments: Size in gallons: Manufacturer: CuHain Pump Make &Model ~ Electrical Inspections peHormed by: BENCH MARK Location and Description: Assumed Elevation: Department of Health~~man Servi~ approval Reviewed ~nd approved by: _ . ~ ate: Permit No. _c-~. 9/~ t/; Page of_ 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report NO WELLS, SEP]qC, S~RUCTURES +200' ~' =' TES~ HOLE ' . - MONITOR }UBE o - SE~ER CL~NOUT ~ - WELL ,,~ ~, I',HV,',HH- PROPOSED L~CHFIELD 72-013 A (2/91) MOA 25 Permit No. ~'~' ~'/°/'' ~ Page "3 of ~' Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report ENGINEER'S SEAL . ~: ,-~'-t,,' :::,'.~., '-~.:, :. _ ':' '' 4;:' ,: r,~:Sr"~i 72q313 A (2/91) MOA 25 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 NUMBER:SW910118 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:THOMSON JOHN E ~ WALTRAUT B L OWNER ADDRESS:P.O. BOX 671433 CHUGIAK, ALASKA 99567 PARCEL ID:05113338 LEGAL DESCRIPTION: GREAT LAND ESTATES #3 BLK LT 9 LOT SIZE: 87556 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF £-~1-'~1 PERMIT DATE ISSUED: 5/29/91 EXPIRATION DATE: 5/29/92 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: BASE AREA OF THE BED MUST NOT HAVE LESS THAN A TOTAL OF 750 SQUARE FEET. RECEIVED BY: ~'~~ DATE: 0~/~c~/<9/ DATE:.5--- 2 ?' ?/ Louis Butera, P.E. Registered Civil Engineer May 17, 1991 John Smith, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Great Land Estates//3, Lot 9 Block 3 Narrative Dear Mr. Smith, The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: The area has large lots of 1.5 acre minimum size allowing sufficient room for well sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, homes are existing on each side. 4. Drainage will not be effected and is not a major consideration in our design. The existing septic system is capable of accepting +450 gallons of water per day, however, it is lacking in surge capacity. The adequacy test results are attached and it should be noted that there was a constant 15-20 GPH flow into the system from a leaky toilet, prior to, and during the test. The proposed upgrade will provide 600 S.F. of additional leaching area, and in combination with the existing leachfield will provide sufficient absorption area. We are requesting approval of the system upgrade on a 60-75% slope as there is no other site available that is satisfactory for construction outside the well radius. The existing system is located on a similar slope and is not performing adequately due to improper soil rating. The slope is naturally vegetated and the system will be located in natural ground below fill. The installation of two leachfields should not result in effluent daylighting or slope instability. Please reference our attached profile drawing. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. Vax t907~ 694-3297 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Lot 9, Block 3, Great Land Estates//3 GENERAL 1. The septic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. workmansh p 3. All materials and i shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. LIFT STATION/EFFLUENT LINE 1. The existing effluent pressure line is to be replaced from lift station to leachfield utilizing 1¼" PVC solvent weld piping with no cleanout, and invert into existing 4" leachfield piping. 1. The trench is to follow the natural land contour to maintain uniform total depth of the bed bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed t~'~ a~ any point. ~eachfletd-is--to-.be-placed in original~ground below fiIT~--. M~___The_efftuent_tine_i~_to-be_connected__into~_the existing leach-tine-~o allow effluent overflow to the upgraded leachfield. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of3~' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS TOTAL DEPTH = ~ GRAVEL DEPTH = 6i~ TRENCH LENGTH = TRENCH WIDTH = ~Y"/F/ SOIL RATING = 0.8 GPD/FT~ BEDROOM CAPACITY = 4 Total SEPTIC TANK SIZE = 1,250 / ,,2.%, / / ~ / / / / NO KNOWN CURTAIN DRAINS %EPTIC %ITE PLAN__ LEGAL: LOT 9, HLK ,_5, GREATLAND EST. -~WNER: THOMPSON' CONTRACTOR: N/A 60' JOB 91 DAT~: 5/ SCALE 1" = EAGLE RIVER ENGINEERING SERWCES A P.O. Bo~ 773294 EAGLE RIVER, JI<. 99577 " (907) 694-5195 FAX: (907) 694-3297 ~ - TEST HOLE · - MONITOR TUBE o - SEWER CLEANOUT + - WELL ~_ PROPOSED LEACHFIELD __ -- - EASE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 925 L. Street, Anchorage, A!aska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: ~' ~'~/'~ ~'~'~ J' ' ~/ DATE PERFORMED: SOILS LOG PERCOLATION TEST 1 2 3 4 5- 6 7 8 9 10 11 12 13 14 15- 16- 17- 18 19 2O SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop i C~:r- ~/~/,~,,~ /~ .... ~ ~ ~, ~ /' PERCOLATION RATE / ? (minutes/inch) TEST RUN BETWEEN <~' FT AND .?-.~ FT PERFORMED BY: CERTIFIED BY: DATE:. SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Lot 9, Block 3, Great Land Estates #3 A. GENERAL 1. The septic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. B. LIFT STATION/EFFLUENT LINE The existing effluent pressure line is to be replaced from lift station to leachfield utilizing 1¼" PVC solvent weld piping with no cleanout, and invert into existing 4" leachfield piping. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the bed bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 11' at any point. Leachfield is to be placed in original ground below fill. 4. The effluent line is to be connected into the existing leach line to allow effluent overflow to the upgraded leachfield. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 4' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS TOTAL DEPTH = 11' GRAVEL DEPTH = 6' TRENCH LENGTH = TRENCH WIDTH = 30" SOIL RATING = 0.8 GPD/FTa BEDROOM CAPACITY = 4 Total 50' SEPTIC TANK SIZE = 1,250 (existing) EAGLE RIVER ENGINEERING SERVICES P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 SHEET NO. OF CALCULATED BY CHECKED BY. DATE SCALE EAGLE RIVER ENGINEERING SERVICES P, O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 SHEET NO. OF CALCULATED BY ~ ~ DATE CHECKED BY. DATE-. SCALE '1'//~ ' DETAIL - LEACHFIELD CONNECTIONS PLAN - N.T.S. CO LIFT STATION * . MONITOR TUBE o - SEWER CLEANOUT ............ LEACHFIELD LEGAL: LOT 9 BLK 5, GREATLAND EST. CONTRACTOR: N/A EAGLE RIVER ENGINEERING SER VICES ' A ' E~CLE RIVER, AK. 99577 .. ~'' (907) 694-5195 FAX: (907) 694-3297 NO WELLS, SEPTtC, OR STRUCTURES +200' / 70Y. \ / / / / / / NO WELL~. SEPTIC. OR ~'~RUCTUR£S +200' / NO KNOWN CURTAIN DRAINS NO SURFACE WAIER +100' SEPTIC SITE PLAN LEGAL: LOT 9, BLK 5, GREATLAND EST. ~WNER: THOMPSON CONTRACTOR: N/A JOB // 91-048FDATE: 5/16/911 SCALE 1" = 60' EAOLE RIVER ENCINEERINC SERVICES A P.O. Box 773294 EAGLE RIVER, AK. 99577 ' (907) e04-5~95 r.~x: (907) s94-3z97 NO WELLS, SEPTIC, OR SIRUCIURES +200' [] - TEST HOLE · - MONITOR TUBE o - SEWER CLEANOUT + - WELL ~H~- PROPOSED LEACHFIELD __ -- - EASEMENT PERFORMED FOR: LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION B2B L, Street, Anchorage, Alaska 99B01 264-4720 SOILS LOG- PERCOLATION TEST DATE PERFORMED: SOILS LOG PERCOLATION TEST SLOPE SITE PLAN 7 8 9 '/~ lO WAS GROUND WATER 11 ENCOUNTERED? 12 IF YES, AT WHAT DEPTH? 13 Gross Net Depth to Net Reading Date Time Time Water Drop 14 15- 16 17 18 19 20 COMMENTS PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN (~ . ET AND ~ , FT Eagle Rivcr Engineering Services PERFORMED BY: P. 0. Box 77R2.Cl4 Eagle R!ver, AX 99577 694-5195 CERTIFIED BY: ~ DATE: Louis Butera, P.E. Registered Civil Engineer May 23, 1991 Robbie Robertson Municipality of Anchorage D.H.H.S. 825 L Street Anchorage, AK 99501 seo!^~es Ut~LUnH r~ q~l~e-H. 'Idac} Re: Great Land Estates//3, Lot 9 Block 3 Dear Mr. Robertson, On behalf of my client, Mr. John Thomson, I am requesting a permit for a septic leachfield on a slope of +25%. This location is the only practical location for this leachfield. The engineering basis for this request is attached. I do not believe that our request will result in any type of seepage or discharge from the slope. The slope is well vegetated and there are no groundwater or impermeable layer concerns. There is no development possible down the slope and the lot below this point is undeveloped. Ground water mounding under the trench should not occur with this type of system and soil type. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. EAGLE RIVER ENGINEERING SERVICES P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 JOB G?~t T,~Q~ ~$t: ~3, Lot 9 SHEET NO.. OF CALCULATED BY LAB DATE CHECKED BY DATE 05/23/91 SCALE i ~ ...... ~ i i ~i ....... ~'~?~ab{i{~'~°~ ~"tt~a~'(~fi~)' '~ ........... i i i ....... !. !..Qi ..... i.=i ~wast~water lbad~gl .... ~ ~ .....i-60~.~al/aay-~ i ~' i ~ .......................... }' i i ~ i ~ ~ iii il i i ...... ...... .......... ...... ......... ........ i i~ i i !9~o~tr~nc~ i i i i i i i ...... ....... ....... ...... "i .......... ~' i i ~ ........ ~ ..... i ....... i i .... i '~ ....... i i ........ i ..... ~'" ~ ....... i ~ ....... ~ ~'~f~'"~i~ ....... i ........ ~ ......... i .......... i .... ~' ~ i ! ......... i ...... Qi ~ -6.6 ~ 13.~ g~/ft~of {renah/ay.i(ona..siae...df...xanch.fa~ing...d~wnhill)i ......... i ...... { ~ i i .... i"~ i"er°ss'}s~{iona'aa ~f'flo~ ...... ~ ~ i ~ ~ i i ~ i ~ ...... ~';'"'"'~ ....... ~ ...... . ~ ....... ~.. ~ } ........... ~ ~ ........ ~ i i s¢fl:t6gshoWs....5~ o~.pe~migble~soi} :uffder. isys~em~...w~lt-rog.~hoCs..~-'""} i'" ~i ~ ..... ~ ~ ~ ~ ~um~ ~or~ ~a~e (~o~e~ti~e) that ~hm is~o~y 5L.ofpermiable..~oili.at ~ i i ~ . ! iA~ i =i ....... l 5~t' fori.dfxenc~...,i i i i i ii! ~ =i ~h~dralicigr~diehtn~eis~tdpr6videthe~owlratd i } } i ! ~ ....... ...... i i : i ..... ................ ~' i A{~bte;hydralic gradle~l 0;g6 ¢xc~s that r~Ui{a ! } .... JF16~ ?ate!~TM n$t likel~ efitb~ki } ~ ~ .... i ~ ~ Thisi~ as~u~ng~°~st.~S~ ~. ~ i i ! EAGLE RIVER ENGINEERING SERVICES P. O, Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 SHEET NO.. CALCULATED CHECKED BY DATE SCALE / /6 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Lot 9, Block 3, Great Land Estates #3 A. GENERAL 1. The septic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. The excavation is to be exactly in the area shown on the site,plan, any deviation requires engineer approval. B. LIFT STATION/EFFLUENT LINE The existing effluent pressure line is to be replaced from lift station to leachfield utilizing 1¼" PVC solvent weld piping with no cleanout, and invert into 4" leachfield piping. C. BED 1. The bed is to follow the natural land contour to maintain uniform total depth of the bed bottom. 2. The bottom of the bed shall be level, plus or minus 1.5". 3. The total depth of the bed excavation is not to exceed 2' at any point. 4. The bed gravel is to be covered with typar fabric material. 5. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 6. The area over the bed is to be finish graded to prevent ponding of surface water runoff. 7. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS TOTAL DEPTH = 2' GRAVEL DEPTH = 6' BED LENGTH = 31.25' BED WIDTH = 24' SOIL RATING = 0.8 GPD/FT2 (SAND) BEDROOM CAPACITY = 4 Total SEPTIC TANK SIZE = 1,250 (existing) 600 GPD/0.8 = 750FTz req. bed area ~_.~ ........ ~ ~ ~ . ¢~ ~ Lou,s A. autera  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  M ~ No. of com ments ~ ~ Manufacturer ~ ~ Liq~a~i~alions IF HOMEMADE: Inside length~ ~ Width __. ~ Liquid de~ ~ DISTANCE TO: Well ~Z ~ / ~ Dwelling PERMITNO. ~_~OZ~ Manufacturer /w ~ ~-~ Material Liquid capacity in galJons  ~ Well/~ , Foundati~.~ , Nearest~e ~ PE~.I~7~. - · ~ Distance 5et~n li~es D,STANCE TO: Length of e~eI Tota] ,engine, Trench ~ inches ~ N°'°flines 4in, grade ~ Top of tile to Material beneath tile ~ I. T°tal ef~a~rF 'ea./ inches Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area a Well Building foundation Nearest lot line ~ DISTANCE TO: j Class ~{D Depth / :~ 0 / Drill~t~bl~ Distance to lot line PER~) ~ Building foundation Sewer line Septic tank Absorption area(si ~ INSTANCE TO: // ~ /_ ~ / REMARKS ,. 3N-SITE SE~E'~ ¢ ~4E,..L P~ R 4~.T NO~ ...... DAT~ ~SUED. 9/11/ APPLICANT: C/O S '~ S ENG",J JOHN ~ T~O~SON S,ECTION: 10 TO4NSH~P: 15N RANSE~ 1~ LOT SIZE: ~.O1A (S(~.FT. OR AC~ES) BLOCK= 3 · :~ CEP, T-iFY -THA-T~ - 1. t A:i4 I.~R ~ZTH :TH:-'. RE,~UIR?i:,ENTS FOR ~)?SiTE SEWERS AND ~JELLS AS SET OF ~N~HORA,SE (t',~,~) A~JO TH~ STATE OF ALASKA. AND iN CC:,iPLiANCE WiTH T~<:: DESIGN CRITERIA OF THIS PE~P:T. 3. i WiLL ADHERE TO AL.~ MOA ARiD ST~TS 'DF ALASKA ~EaUIFE?iENTS FOR THE SET ........ D~STA~CES :FRC';q ANY EXISTING WELL~ WiSTSWATEP -)iSPOSAL GYSTEJq OR PUBLIC iEAGE SYSTE?; O-:~ THiS ~R ANY ADJACEqT O-R NEqR~Y LOT. DERSTAN~} THAT THIS F~CR?~ZT IS VALID FO~ A ~qAX!~4UM OF 4 ~EDR-OO~N~S AND .... lAxLY E~iLARGE:'iEqT WiLL REQUIRE AN ~DiT[ONAL if A LIFT STATZOC4 ZS I,'~STALLED i~'¢ :~N AREA COVEEED :'~Y ¢,i0~ ~UILDING CODES. -~ .~. ~ .......... ~ .... - ~.'=~ ~D ~'o~CF~ON MUqT S~ OF~.TAIIED$ (2) AS-GUILTS -T-H~-IN ~-I~ M~--~Z~-~-F~ -~ ~ m~ ELECTRICAL WORE /4~ST ~¢E~SY A L,CE;'4~EO ELECTR.~!AN. / /, PERFORMED FOR: LEGALDESCRiPTiON: ~--- ~'~ 4 5 6 7 8 9 10 11 12 13 14 15 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG-- PERCOLATION TEST XSOILS LOG [] PERCOLATION TEST SLOPE SITE PLAN O j' 'lldAIZ, T WAS GROUND WATER ENCOUNTERED7 16- 17 18 No. IF YES, ATWH/ DEPTH? 19 Date et Depth to Net Water Drop PERCOLATION RATE (minutes/inch) TEST~"N BETWEEi~ . FT Z~ND __ FT by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER Ended DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From Ft. to Ft. From Ft. to Ft From Ft.t~__Ft From Ft. to Ft. From Ft. to___Ft. From Ft. to Ft. From. Ft. to Ft From Ft. to Ft From Ft. to_ Ft. From Ft. to Ft, From__.Ft. to Ft. From Ft. to__Ft. From__.Ft. to___.Ft. From Ft. to Ft. From__.Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From__Ft. to Ft. From Ft. to_ Ft. From__Ft. to Ft. From Ft. to FL From Ft. to Ft From Ft. to__Ft. From. Ft. to___Ft. From Ft. to Ft. From__.Ft. to Ft. From__.Ft. to__Ft 'From__Ft. to__Ft From__Ft. to__Ft MUNICIPAL!TY OF ANCHORAge From Ft. to__~D~· OF HEALTH & ENVIRONMENTAL P~O ~ ~ iON From Ft. to Ft From Ft. to F~.C'[ ~ 3984 From__Ft. to--R.F, C, E ! V E D From Ft. to Ft MISCL. INFORMATION: 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 GENERAL INFORMATION Complete legal description Lot 9; Block 3; Great, and Estates ~ Location (site address or directions) Property owner Mailing address Lending agency Mailing address FANNIE MAE 19930 Quiet Way Chugiak~ AK 99561 C/0 Dynamic ProperZi~SDay phone 3111 "C" Street, Suite 100 Anchoraq¢, AK Day phone 99503 J Agent Bob Brock/ DYNAMIC PROPERTIES Address 3111 "C" Street Suite I00 Day phone 261-7613 Anchoraqe, AK 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 N TYPE OF WATER SUPPLY: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 72-025 (Rev, 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves_ti_gation 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. $ & $ ENGINEERING Name of Firm ............ ~ __ Phone Address, Ea~le.lver, Ala,ka ~7 / ~ Engineer s signature ~~~~ Date DH/~ SIGNATURE Approved for ~"~(/'~/ bedrooms. Disapproved. Conditional approval for 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 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 engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (~U) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed "] --- ~ ~- ~ ~ Driller Total depth Sanitary seal Cased to ~ i 'P Casing height Wires properly protected ~1) / FROM WELL LOG AT INSPECTION ~,o g.p.m. 5'~ 4- Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot '~ "~ Absorption field on lot \ Public sewer main Sewer service line g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank r~ ~j WATER SAMPLE RESULTS: Coliform (~ Date of sample: Nitrate /, ¢/ Other bacteria Collected by: "/~/-~ ~-~L~ ¢.~ B. SEPTIC/HOLDING TANK DATA Date installed c~ ..%~ ~,A Cleanouts ~N) V High water alarm (Y/~) Date of pumping Tank size Compartments Foundation cleanout ~/N) y Depression (Y~I~) ~ Alarm tested (Y/N) ,,~/,~ ~ ~.~ Pumper _~/'/--~ ~_c.~/'~ 4- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~ "Z. On adjacent lots To property line 1 ~ Absorption field Surface water/drainage -/ P ~ Foundation Water main/service line /~ /4- 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons vent d N) High water alarm level "Pump on" level at Manufacturer Manhole/Access ~N) "Pump off" Level at Cycles tested Meets MOA electrical codes (~4) ,¢' SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot I ~5' ' On adjacent lots / D o J '~ Surface water D. ABSORPTION FIELD DATA Date installed C,, -~ ~ \ Length '~ "~-\ Width Total absorption area Date of adequacy test Soil rating (GPD/Ft2) ~ ~ Gravel thickness Cleanout present ~/N) Water level in absorption field before test Peroxide treatment (past 12 months) (Y~I~ LcCp/P'¢'~ System type [~ '~--E> O ,.5- ~ Total depth '¢- / Depression over field (Y/~ /,J for Z/L Bedrooms After test ~ If yes, give date ~/~' SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain \ On adjacent lots /,~ ~ \ ~'' Property line / c~ I 4.- To existing or abandoned system on lot Cutbank ~a Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION /certify that lhave checked, verified~c~n~edtoall MOA and H/~ guidelines ineffect on the date of this inspection. S & S E'.N~.U~.,,,I~2,.-, . ....... ~'~" / ~ ~ ~:':':~i!i~ ~ . Encnoor's ~ame ~ -"u'~ ,~,~ur~la~l~a 99577 / ' ,,..,e Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 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. GENERAL INFORMATION Complete legal description Great Land Estates #3, Lot 9 Block 3 Location (site address or directions) T15N R1W Sec. 10 19930 Ouiet Way, Chuqiak Property owner Mailing address Lending agency Mailing address Agent Ad d tess John E. Thomson Day phone P.O. Box 671433, Chugiak, AK 99567 N/A Day phone Eva Loken / ReMax Day phone 16600 Center Field Dr., Eagle River, AK 99577 696-5070 694-4200 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest~ lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: 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 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 Eagle River Engineering Services Phone Address p.o. Box 773294: Eagle River~ AK 99577 Engineer's signature 694-5195 Date DHHS SIGNATURE ~'.~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: Date ~ _ ~ . The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS 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. 1/91) Back MOA #21 Legal Description: A. WELL DATA Well type /~,~' '-'~ Log present (Y/N) Total depth /"?/ Sanitary sea~) Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Date completed ?J,P'¥ ?-'/-~(' Driller Casedto /.7// Casing height ~ Wires properly protecte(~) If A, B, or C, attach ADEC letter. ADEC water system number FROM WELL LOG Date of test Static water level // Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main P~b!~c sewer service line g.p.m. AT INSPECTION ; On adjacent lots -'-/~'~ / ; On adjacent lots Public sewer manhole/cleanout /" Petroleum tank "~'"~ WATER SAMPLE RESULTS: Coliform ~ Date of sample: /'///'~//~',/ Nitrate /' -? '"~P/'~- Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed /~ '~z/ Cleanouts (Y/N) water alarm ('~1~')~ High Date of pumping ~Zl/~cl Tank size /..z,~-~ Compartments Foundation cleanout (Y/N) /~' Depression (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~r.~ ' On adjacent lots To property line ~"' / Absorption field Surface water/drainage Foundation Water main/service line 72q)26 (Rev. 3/91)Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) Manufacturer 7' 9' ¢,~x_ "Pump on" level at Manhole/Access (Y/N) X,~-' ~-'~ ~"*'~' "Pump off" level at Fligh water alarm level Meets MOA electrical codes~) Cycles tested ,,20 SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot //5-/ On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/,//?z /':/; '/~/( Length -~-~ ' Width ~¢ / Total absorption area ,~' Depression over field (Y/N) "~" Results ~il) Peroxide treatment (past 12 months) (~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /~'-¢' To building foundation On adjacent lots Surface water Curtain drain Soil rating ¢, ~' ¢'"~/rr~' System type Gravel thickness ~" Total depth Cleanouts present (Y/N) Date of adequacy test for If yes, give date On adjacent lots ,~"¢ '~" Property line To existing or abandoned system on lot Cutbank -~-~ ~ Water main/service line Driveway, parking/vehicle storage area ¢"~' bedrooms 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 ./-- ;~ ~.. +'e '"-- Date ~'~'?//'~ ~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number GENERAL INFORMATION (a) ,.'"'-' : '~'" MUNICIPALITY OF ANCHORAGE: DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ,, r; DIVISION OF ENVIRONMENTAL HEALTH [,,,:~i ~& 0 ~g85 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPR~V~ OF ON-SITE SEWER AND WATER FACILITY,.~ E IV E D 284-4720 '- ~'~ Application Date_ / / / Legal Description (include lot, block, subdivision, section, township, range) (b) ~ (c) · Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); Location (address or directions) Applicant Name ~.~ ~/'t. 7~'/'/.J'O c~/ Tele p ho ne: Ho me Applicant Address ~'~ ~.~'~ B usi n ess~ ~;~/~- ~-~ ~"'~ (d) (e) (f) Lending Institution /-'¢¢" si' ~.-c~. ~c////~/,~/O/,J. Telephone Address Real Estate Company and Agent Address Telephone ~'~t~ee HAA to the following address: 2. TYPE OF RESIDENCE Single-Family,J~ Multi-Family [] Other Number of Bedrooms r'~L WATER SUPPLY Individual Well,~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental 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. Page 1 of 2 72-025 (11/84) ~EI~GINEERING 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 Aufhority 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 ~- ~ .r, · .~ Telephone Address Date 1- 12- , {/,./ ' DNEP'APPFIOVAL ' ~- Approved fo,r ~g~,~ ~-~ .bedrooms b 'ate Approved ' ~' ' Disapproved Conditional Terms of Co'nditional 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 DIVISION OF ENVIRONMENTAL ~R. ALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLIC/LTION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date /-- 7-'80- (a) Leg~.l Description (include !o~,/block~ subdivision, section, township, range) Location (address or directions) (b) Applicants Name ~% /~. Telephone - Home Business (c) Applicant is (check one) Lending fnstitution ~; Owner/builder ~; Buyer Ot er ( plain), Ad~s s (e) Real Estate Co. & Agent Address (f) Tel. e, phone ' the HAA to the following address: Zo Type of Residence Single-Family.. Number of Bedrooms 3. Water Supply Individual Well~ Multi-Family Other (describe) co uni y Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewa____~e Disposal 0nsite~_ 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] 5- En~ineerin§ Firm Providin~ Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of ~he 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 om-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm~___~~,m,-%~,~. ' Telephone / ~~ ~ .... ~ ~2'~' ' Approved Disapproved CoMition~ CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY U~ON THE REPRESENT- ATIONS GIVEN IN PAi{AGRAPH 5 A~OVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES TML~ AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERJkL AND STATE REQUIRE- MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MONICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/Di8 [Page 2 of 2] 7-19-84 WELL DATA Well Classification Well Log Present ~N) Total Depth /~O ' MU CIP Z OF mC mS . (MOA) H zra A mO TY mPROV CHECKLIST - FEBRUARY 1984 Static Water Level Cased to Legal Description: ~ ~5 If A, B, C~ C, D.~.C.. ~pro~d(Y~) ~/~ ~te ~leted ~/~ ~ Yield W0 % ~pth of ~outing ~ Casing Height Above Ground J/' ,~,~6 ~o/~;m~VT~ ) Sanitary Seal on Casing ~N) Electrical Wiring in Conduit ~) Separation Distances from Well: To Septic~ Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line C leanout/Manhole Water Sample Collected By Water Sample Test Results Depression Around Wellhead~~f ; On Adjoining Lots /62~ ~ /~P ' ; On Adjoining Lots /~ /~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~ 2-~ Date Installed ~'-2~- ~ Size /~- ~g) No. of Cc~,~a~tments Stan~i~s ~) Air-ti~t ~ps ~)" Foun~tion Cleanout ~p~ession o~r Ta~ (Y~ ~te ~st P~d ~ P~ing~intenan~ ~n~a~ on File (Y~) ~ ; for Holding Ta~ High-Wate= Ala~ (Y~) /~ ~r~ Holdi~ Tank ~t (Y~) ~p~ation Distance ~ ~ptic~ Ta~: To Water-Supply ~11 /~ ~ To ~ilding F~ndation , To ~c~rty Li~ . /~ /~ To Dis~sal Field To ~ter ~ip/~=vi~ Line Co~ To Stream, Pond, Lake, cz Major Drainage Con~%ents Receipt ~ Date Paid: Amount: ~ ~- [Page 1 of 2] 2-15-84 Ce ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed 4" ~ ~ Width of Field 50 1~ Square Feet of Absorption A~ea Depression over Field (Y~ Results of Last Adequacy Test Separation Distance f~cm A~sorption Field: Type of System Design Length of Field ~~~) / / Depth of Field Gravel Bed Thickness ~/? Standpipes P~esent _~_/N) Last ad-=quacy Test To Water-Supply Well TO Building Foundation ~ ? Lot ~//~ ; On ~djoining Lots To Wate~ Main/Service Line A~ To Cutbank(if present) To Stream/Pond/Lake/c= Majo= Drainage Course TO D~iveway, Parking A=ea, c= Vehicle Storage A~ea To Property Line / O /'/' TO Existing or Abandoned System cn Comments D. LIFT STATION Date Installed Size in Gallons /~6) ~/~b. Manhole/Access ~Y~N) "p~ On" Level at .~ i~ ~fD/~ /~d;77~W~"Pump ~f" ~vel at ~ ~r P/~DW ~6,y~/W High ~ter ~ ~1 at ~/~ /~'6 L~/~'~)vent (Y~ Tested for ~ /~ ~ing Cycles ~ing Adeq~ ~st. ~ets ~A Elec~ical Co~s (Y~ (~'~ W~m~3'~ ~ ** ~e~ ~tted ~ Rating ~ai~t ~ ~quest I ~rtify that I ha~ ~ecked, ~rified, or ~nfor~d to all ~A ~ ~i~li~s in effect on the date of this inspecticn. Signed ' ~ & ~,~.~l~%lN[{ . ~F,5, ';t,,.,,,, . , .. Date ///2~-~ J MOA No. KB1/d5/s [Page 2 of 2] 2-15-84