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HomeMy WebLinkAboutT12N R3W SEC 33 LT 114ATom Fink, Mayor un cip H y of Anchor ¢ Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 October 22, 1992 Alonzo J. Lyford 14711 Lake Otis Pkwy. Anchorage, AK 99516 Subject: Lot 114, Sec. 33, T12N, R3W, SM; PID #018-252-37 Dear Mr. Lyford: Please be advised the shop building under construction on the subject lot is in violation of the separation requirements specified by AMC 15.65.060. The required separation between an absorption trench and building foundation is 10' As the system is not now in a state of failure no immediate action will be taken. However, prior to receiving departmental approval for refinancing the septic system must be brought into compliance with AMC 15.65.060. Please contact my office if you wish to discuss the matter further. My telephone number is 343-4744. Sincerely, Daniel N. Belles On-Site Services cc: John Smith P.E., Program Manager, On-Site Services Public Works, Building Safety db/194 MUNICIPALITY OF ANCHORAGE DEPARTMENT OI-- HEALTH & ENVIRONMENI'A[ PROTECTION ENVIRONMENTAl. ENGINEERING DIVISION 825 [_ Street - Anchora,qe, Alaska 99501 TelePllone 264-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WEI.L INSPECTION REPORT GARY DRAHOSlt MAIMNGADDRESS 2721 Porcupine Trail, Anchorage, AK 99516 F~ NEW L] UPGRADE I.EGAL DESCRIPTION Portion of West ~ lot 114,~1 -~"~-T ........ ]FZ'' LOCATION NO. OF BEDROOMS 4 PERMIT NO.870243 Section 33 T12N R3W OISTANCETO' I over 100' __ V~n~horage2q.ank' [ ~ 90' Manufacturer · ~'1 Stee 1 I 1500 [ IF HOMEMADE: [W,dth No, of coml)arlments 2 t Liquid clepth DISTANCE TO: ITMLeli Dwelling DISTANCE ¥O: 64 ' over 100 ' PERMIT NO. 870243 NA 40 inches Length of crib Matmia[ Foundation over T(~%e's~'i~t Ii,,,, j'-~, Material beneath tile 30 inchos Class Pr ivata Depth Distan¢l~Jq lot line ~O DISTANCE TO: St, ilcjisg~ foundation Sewe, ire 34' PERMIT NO. Liquid capaciW in gallons PERMIT NO. Fotal effective absorption ~iTea Septic tank over 100' PERMIT NO.870243 OTHER PIPE MATERIALS D266~I{ouso to S.~. F810 Perf,, D3034 Unperf. Outlet of S.T. SOILTESTRATING 125 Sq Ft per BR INSTALLER Gary Drahosh~ Owner REMARKS ~ See attached sheet for location dimensio APPROVED DATE LEGAL 1/t6/88 Portion GE w~ tot BRUST & ASSOCIATES Engineers. Planners - Surveyors 1610 Dimond Drive MUNiCIPALITy OF Anchorage, Alaska 99507 DEPT. OF HEALTH (907) 562-7878 I~NVIRONMENTAL PROTECTt~N April ]1, 19S8 RECEIVED Anchorage Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Attn: Susan E. Oswalt Subject: As-built for' T12N R3W Section 33 Lot 114 Dear Ms. Oswalt, Enclosed is an attachment sheet for the As-built for the subject property, as requested in your recent letter. These reference distances should also serve to describe swing ties to two points. An As-built survey is scheduled in the near future. Elevations of the septic system will be taken at that time and forwarded to your office. Sincerely, Stanley Brust cc Mr. Gary Drahosh NOR~ SYSTEM,_ · DISTANCE IN FEET PART[!SW CORNER SE CORNER NE CORNER FOUNDATION WELL I 33.4 14,8 FOUNDATION ] FRAME NOUSE CLEANOUT 21.0[ 2.4 CLEANOUT 53.7 34.O CLEANOUT 72 . 7 62.9 6) C.O. S.T.C.O. 99.0 92.0 S.T.C.O. 108.1 102.1 ~ C.O. CLEANOUT 109.2 103.6 CLEANOUT 112.8 107.6 LQ! S.T. C.O.s CLEANOUT 173.0 169.0 MONITORING STANDPIPE 165.2 164.5 monitoring ~O ~AWN BY; s b ~""~0"*, 8 ASSOCIATES PORTION OF WEST ~, LOT 114 DAT[i..I/16/88 ~ ENGINEE~-~N~-SU~O~ Rabbit Creel< Small Tra~ts SCAL~, P'=50' 1616 DIMOND D~IVM ~C~AOEA~sRA ~EFERENcE"D~STANCES' .......... [~ JO~ NUU~m 87-3 i ~90~)$B~-~07~ .... 90~ Ior SYSTEM DISTANCE IN FEET FRO~_ PART !SW CORNER SE CORNER NE CORNER FOUNDATION WELL 33.4 14.8 FOUNDATION CLEANOUT 21.0 2.4 CLEANOUT 53.7 34.O CLEANOUT 72 . 7 62.9 S.T.C.O. 99.0 92.0 S.T.C.O. 108.1 102.1 CLEANOUT 109.2 103.6 CLEANOUT 112.8 107.6 CLEANOUT 173.0 169.0 MONITORING STANDPIRE 165.2 164.5 ,? 0 Tom Fink, Mayor Municipality Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 March 9, 1988 Mr. Stan Brust, P.E. Brust and Associates 16].0 Dimond Drive Anchorage, Alaska 99507 Subject: As-built for T12N R3W Section 33 Lot 114 Dear Mr. Brust: We recently obtained your final inspection report on the above property from the owner, Mr. Gary Drahosh. However, we did not receive the attachment as noted under the "Remarks" section. Please forward a copy of the "location dimensions". In addition, we request that you provide us with a drawing depicting elevations on the system from the house to the septic ~ank outfall. It is most unclear as to grade on this line as it appears to be installed on a rather substantJ_al slope. Finally, the inspection drawing must include swing ties to at least two points. Please remember in the future to send inspection reports directly to the department within ten (10) days of the final inspection. This will help eliminate confusion and loss of records. If there are any further questions, please Oall this office at 343-4744. Sincerely, Susan E. Oswalt On-site Services SEO/ljw#6 Anchorage P.O. B~.,, 196650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 r~R~Y~kq~ Tom Fink MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 12, 1988 Gary A. Drahosh 2721 Porcupine Trail Anchorage, Alaska 99516 Subject: T12N R3W Section 33 Lot 114 Permit #870243, Tax #018-252-26 ~/ ' S-~. A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1987. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as2built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. Effective January 1, 1988/ a new fee schedule is in effect. When re-applying for a new permit, the new fees are; $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. ~ly, r ~/~ Program Manager On-site Services RWR/ljw eric: Copy of Permit !~< ¥PT~ C.o. CHECKED BRUST 8~ ASSOCIATES ENGINEERS-PLANNERS - suRVEYoRI 1610 DIMOND DRIVE ANCHORAGE ALASKA 907)5~27678 ,, 9~gLsq~ ANCHORAGE WATER & WASTEWATER UTILITY Engineering & Planning Division 401 W. International Airport Road Anchorag e, Alaska 99518-1104 Tony Knowles, Mayor August 10, 1987 Owned by tile Municipality of Anchorage Stan Brust Brust & Associates 1610 Dimond Drive Anchorage, AK 99507 RE: LOT 114, RABBIT CREEK SMALL TRACT SANITARY SEWER SERVICE Dear Mr. Brust: The purpose of this letter is to con'firm our telephone conversation of August 4, 1987. In 1982, the Anchorage Municipal Assembly approved an ordinance called Hillside Wastewater Manage- ment Plan. within this plan, boundaries are defined establishing areas for public sewerage and private systems. The above referenced lot is outside of AWWU's service area and within the Hillside Wastewater Management area to have private sewer. I recommend you contact the Municipal Health and Human Services Department at 825 "L" Street for requirement of on-site septic systems. Sincerely, R. WAYNE BENNETT Private Development Supervisor Engineering & Planning Division Anchorage Water & Wastewater Utility RWB/dw [wpe.wp.privatedev]19 ] :I~-~"F.~:.,.~. CD ~T-~ ~_] ~)(~ I ~--ES --. SOILS LOG ENL~INEERS PLANNERS - SURVE._,RS 1610 DIMOND DRIVE ANCHORAGE, ALASKA 9x~507 ~ PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9- SOILS LOG - PERCOLATION TEST SLOPE SITE PLAN 10- 11 12 13 14 15 16 17 18 19- 20- ENCOUNTERED? Gross Net De p~_~t~,~,~_~ , Net Reading Date Time Time .... .... ~.-.~ PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT F- ~-- f ,'~, ,~- l, ' , /4~ ~.7~ 77., ,.. , /., ~ ~'-l/~.' PERFORMED BY: CERTIFIED BY: 72 008 (G/79) 7-7? ~-~GINEERS - PLANNERS - SURV~ ORS 1610 DIMOND DRIVE ANCHORAGE, ALASKA 99507 [~/-SOl LS LOG [] PERCOLATION TEST SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE IF YES, ATWHAT :/~Z /¢I¢ P E DEPTN? ¢,//0 //£ DATE PERFORMED: SITE PLAN Gross Net Depth to Net Reading Date Time Time W ~,~' Drop PERCOLATION RATE {minutes/inch} TEST RUN BETWEEN FT AND FT 72-008 (6179) ~ELL LOG Date Drilled: 9-26-87 Static Water Level feet Gallons Per Minute ' 15 Draw Down N/A feet Total Feet of Casing 147 T_ype Material Drilled: 0 feet to 8 Gravel 8 feet to 25 Sandy 25 feet to 38 Cemented clay w/rock feet to _R_O_J~I ay 40 feet 4L-JSe-~t 120 feet to~ w/lgpm to 120 Cemented clay ~/sandy.streaks to 145 clay 145 feet to 147 Gravel w/water to HEFTY DRILLING 3540 AKULA DRIVE ANCHORAGE, AK 99516 (907) 345-0593 RECEIVED Municipality of Anchorage Development Services Department Building Safety Divlslon On-Site Water & Wastewater Program' 4700 South Bragaw SL P.O. Box 196650 A~chorage, AK 99519--665(3 www.cl.anchorage.ak.us (907) 343-7904 -CERTIFI'CA E OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING' " Parcel I.D. 018-252-37 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Expiration Date: _~ . ~ tT/L'~) ! T12N, R3W, SECTION33; LOT 114A, 14711 LAKE OTIS PARKWAY * ANCHORAGE, AK' 99516 Current Property owner(s) Mailing address Lending agency ALONZO LYFORD Day phone · 250-2635 Day phone ' . .... Mailing address Real EstataAgent LEANNE COATES w,/ PRUDENTIAL JACK WHITE Day phone ' 227--3773 Mailing address 3201 'C" STREET SUITE 200 * ANCHORAGE, AK 99503. Unless otherwise requested, HAA will be held by DSD forplckup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-slta Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wasteWatar disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a pdvata or Class C well and may be reissued with new water sample results less than 30 days eld. (Certificates may be reissued for a period of up to one year with valid water samples.) Ce~ficates ere valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER * As cerb'fied by'my sea/affixed hereto and as o~ the velidab'on date shown below, I vedfy that my Investigation, based on procedums~outlined In the Health Authod~y Approval Guidelines for this application, shows that the on-site water supp¥ and/or wsstewater disposal system Is(am) safe, functional and ad. equate 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 Invest/gat/on and Inspection, the on-site water supply and/or wastawater disposal system Is(am) In compliance with all applicable Municipal Name'ofFIrm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, surrE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. (;ARNESS, -P.E. Phone 357-~179 Engineer's Comments: - ' · · · In conducting ~hls evelualion~ AWWC, Inc. attempted to pmvfde a thorough, .'. conscientious engineering analysis of the ~ystem In acoo/dance ~gl ADEC and MOA DSD Guidelines & Regulations. The reported results desonT~d the performance of the system under the conditions encountered at the time of the test, and separalion distances measured to resdl~y Identifiable features. The operelional life of all wells and septic systems depend on the Iocal sotls condition, greundwatsr levels that may . fluctuate dudng the year, and the v, at~' usage of the faml~, being served by the system. These condigons are Outs/de the contrg of the eve]uae'of the system. Salisfactozy test results do not guarantee future pedormanee of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future eslimate of how long the system wlil conlinue to ment the operattonal requfrements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the ov~er listed above. Any reliance upon or use of this repc~t by any other person or pan'y ls not authodzed, nor wt~l lt confer any legal flght whatsoever. 5. DSD SIGNATURE [,"'/ Approved for ~ bedrooms. Disapproved. Conditional approval for ~ bedrooms, with the tilowtng stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manltenance Agreements Supplemental Engineer's Reort Other OriCn Cern,ere Oete: 5z - o / Municipality of Anchorage Development Services Department ' Building Safety Dl~slon On-~lte Water & Wastewater program 4700 Soultt Bmgaw St. P.O. Box 196650 Anchorage, AK 99519-6650 wwv,ci.anctm:~age,ak.us (gO7) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescril~lon: T12N, RSW, SECTION 3,5; LOT 114A, ParcellO: 018-252-57 WELL DATA Wall type P~^~E IfA, B, or C provide PWSID~ N/A Wall I. J3g (Y/N) YES Data completed 9/26/87 Sanitary seal (Y/N) YES Wime properly pmtactad (Y/N) YES Total depth 147 lt. Cased to 147 lt. Casing height (above ground) 12"+ in. FROM WELL LOG AT INSPECTION Data of test 9/26/87 5/5/01 Stafic water level UNKNOWN lt. 117' ff. ,5.68 g.p,m. Wall production 15 g.p.m. WATER SAMPLE RESULTS: Ce Coliform ~ colonies/100 mi. Data of sample: 5/`5/ot SEPTIC/HOLDING TANK DATA Ntimte _~:_~ mg.lL. Collected by: Other bacteria.._~colonies/100 mi. AWWC, INC. Tank Type/Mataflal Tank size 1500, gal. Foundation cleanout (Y/N) YES Data of pumping 5/3/01 ABSORPTION FIELD DATA Data installed ~/~5/e8 Length 64 fl. STEEL Number of Compartments 2 . Depression over tank (Y/N) NO Pumper Soil rating (g.p.dJlt~o~--~) 125 Width 5 It. Data installed 1 / 16/88 Cteanouta (Y/N) YES High watar alarm (Y/N) N/A NORTHLAND PUMPING Total depth 7.0 ff. Eft. 8psoq3fion ama 500 fl~ Monitoring ~be YES Data of adequacy test 5/3/01 Results (Pass/Fail) PASS Fluiddepthlnabeorptionfleldbefomtast 17 in. Wateradded 629 gal. Elapsed Time: 18 min. Final fluid depthlS.25in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type TRENCH Gravel below pipe 2.5 lt. Depression over field NO For 4 bedrooms New depth 19 in. 600 + g.p.d. NONE KNOWN If yes, give date - D. UFT STATION Date installed Size in gallons ~ _ 'Pump ~ High water alarm level at __ in. ~ Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WI~LL ON LOT TO: Septic tenk/li~ station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 2.5' + On adjacent lots. 100'+ On adjacent lots. 100'+ Public sewer manhole/deanout Holding tank N//A N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' + Property line 5' + Water main 10' + Water sewice line. 10' + Wells on adjacent lots. 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation. <.4'+ Water service line I o'+ Surface water 1 oo'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS Absorption field Surface water 5'+ 100'+ Water main 10'+ .Driveway, parldngNehicie storage FROM C/O TO SHOP BUILDINGJ G. ENGINEER'S CERTIFICATION I cerJEy that I have determined through field inspections end rm4ew of Municipal records that the above systems em in conformance wfth MOA HAA guidelines in effect on this date. Engineer's Printed/Name JEFFREY A. GARNESS HAA Fee $ Date of Payment Receipt Number (Rev. 12.m0) Waiver Fee $ Date of Payment Receipt Number T-T09 P.02/09 F-992 ClEat PO~t Printed Date/Time 05/16/2001 9:11 ColEcted Dale/Time 05103/2001 9:38 Received Date/Tlme 05/04/2001 8:42 Technical Director Stephen C.~Ede Rclea~'d B ~'~ Allowable P~p Anal}sis Limits Dale Dam Init Hiuntc-N 0.$00 U 0.500 mg/L EPA 300.0 {<10) 05/04/01 SCL ~crob~olo~ LaBor&~oz7 Total Coliform 0 0 col/lOOmL SMI89222B 05/04/01 KAP ALASKA WATER ~' WASTEWATER CONSULTANTS INC FACSIMILE TRANSMITTAL DATE: MAY 2 4 NUMBER OF PAGES: (INCLUDING COVER) . 6 Alaska Water hnd Wastewater Consultants, Inc. Jeffrey A. Garness, P.E., M.S. COMMENTS: T~ .c~ar,'gi~ di~r~e., &_~4~o~ Cat. ~r~~ 6901 Debarr Road, Suite 2-B * Anchorage, AK 99504 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 HAA ~t '1, GENERAL INFORMATION Complete legal description /.o'F IIq A SEC 33 TI~.~I, ~3k/ Location (site address or directions) I ur]Il Property owner Mailing address Lending agency Mailing address GARY ~RAHoSH Day phone ,3~5- Agent '~aNt4E Hu~Te~, CE~fTu~Y ~1 ~C. N8ffff~ Day phone Address fl~O ~n R~,; ~nc~r~; ~ ~¢~1~' Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ ~ TYPE OF WATER SUPPLY: NOTE: 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. . TYPE OF WASTEWA'rER 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. 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. NameofFirm F/-,~TToP T£cH s~/c5 Phone_3q, g'- 13,~,~- Address IH530 Engineer's signature "-~~ '~. DHHS SIGNATURE Approved for Disapproved. Date bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 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 fending 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. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L eT ItU,4, SE(:: 3~, ~'IzN, ~$k/ Parcel I.D. A. WELL DATA Well type PRIW~T~' Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Date completed Cased to [ ~'/~ ADEC water system number ~/2~//~'7 Driller I~EFT¥ Casing height Wires properly protected (Y/N) ~ Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m, AT INSPECTION MUNICIPALITY OF ANCHORAGE ENV~ONMENTAL SERVICES DIVISION g.p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 1 2. t4 Absorption field on lot ~ IqO Public sewer main '~ /oO Sewer service line ~ ~5 ~ ; On adjacent lots IO~ ; On adjacent lots '~ /o3 Public sewer manhole/cleanout ~./oo Petroleum tank t4e~4 ~ ~5/;~'Z~ b WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ~. ~', ! m, ~'/.~ Other bacteria Collected by: FLATTOP B. SEPTIC/HOLDING TANK DATA Date installed l[! IGI 8~ Cleanouts (Y/N) _ '¥' High water alarm (Y/N) Date of pumping Tank size I Soo Cfi L, __ Compartments '2, Foundation cleanout (Y/N) ~' Depression (Y/N) Alarm tested (Y/N) ~ ./~ . Pumper SEPARA¥1ON DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I 2 ~ To property line ~1o Surface water/drainage O0 adjacent lots ~ leo' Foundation c~2. Absorption field (~,* i.~?. ,'~?,Watermain/serviceline ~ 12o ~./oD ' 72-026 (Rev 7/9t) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~ q ' Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating ]2,5' ,, Gravel thickness 30 Total depth Cleanouts present (Y/N) Date of adequacy test for No~4E K~,lo~l oF If yes, give date. N./~. System type ,5 ~/~bE b~,4/NF/ELD bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot Iqo On adjacent lots > ICc' To building foundation Io8 f Propertyline_l~' ?~¢ I~$P, ~'p. On adjacent lots :> 2o ~ Surface water :> Ioo Curtain drain To existing or abandoned system on lot Cutbank 14.~, -Water main/serviceline '~' //o ' Driveway, parking/vehicle storage area I lo ' 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. Engineer's Name HAA Fees _/~:7~ ¢O Date of Payment ~¢ ~/¢~ ~¢-~' Receipt Number ,~,~),,~-~ 72-026 (Rev 3/91) 8ack MOA 21 Waiver Fee: $ .. Date of Payment ~'~/~) Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING& ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ChOh~lab kof.'i 92.~89! 2a~,pil, ~ 3 1,i'Zr:tx FAX: (907) 561-5301 ])t'L/'t/f0P .~rZllff C,, 1, 2PJI Member O' the SGS Group (Soci~t~ G(}n(}rale de Surveillance)