HomeMy WebLinkAboutKNIK VIEW BLK 3 LT 6Knik View
Block 3
Lot 6
#051-031-54
Municipality of Anchorage ..':~ .,~,,
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program. 4700 S. Bragaw SL
P.O. Box 196650 Anchorage. AK 99519~650 Page
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number:. 5 ~A~"~O.~' PID Number:. O ~
"'"':/~'"'~"'-~-"r'.,'/~./L~/'ov/'~/d~'/'ryl~/q,,v.__.......___ WastewaterSystem: ~[New [-IUpgrade
'~'"'P,~.go~ ~700q_~]Zh.5;nk /~l~ 0~5~, , 7 ABSORPTION FIELD
LEGAL DESCRIPTION I · '~
'--'": "'- '-- "'~---"": 0 St
Well: [] New [] Upgrade ¢~.
.,.., ,...,..~,c, ,, '"'"~'" 506 ,,
SEPARATION DISTANCES Iii septic [] Hok:ling [] S.T.E.P. [] Other:.
Tank Field Station Tank Se~e Une
~ IqO' IH'"?' I q~': --- :25'-r -'h' OP£ "~'"'"'- ~ .....
~..w.,. I00'+ I00¥ I00¢ \ / UFTST^T~ON
"'"~'~ BENCH MARK
(~ pm/~ Ioo"
~?'x ~,,.'' ^ "..,¥.:-~
S & S ENGINEERIN~
17034 Eagle River Loop Road, No. 204 la · ,, . .
Development Services Department Approval
b~ '~;%"-.. , ....';'.f.~ .-'
Reviewed and approved~ Date:Jr", t/g,. t~,/
P£mm? NO. $W000205
Municip. oti't oF .A.n_c h.o m.g g.e.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 eAnchor'o, ge,, Ato. sko, 995tg-6650eTetephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LECAL LOT 6, BLOCK 3, KNIK VIEW S/D
P.[.D. NO. 051-031-54
LOT 3
LOT 7
LOT 2 LOT 1
10'
SCALE: 1' - 60'
PERMIT NO..sw000205
Mulnicip. oAi-t oF .A.n_c .h.o, .r' g g.e.
DEPARTMENT OF HE,~THAND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION ,
P.O. Box 196650 ~,A,'",chor'o. ge, Alaska 99519-6650 JTelephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEH AND/OR WELL INSPECTION REPORT
LEGAL LOT 6, BLOCK 3, KNIK VIEW S/D
P.I.D. NO. 051--031-54
MT2 =
MT2 MT1
v[T1
= 101.1'
GRADE
2" INSULATION
PIPE
MT2 = 97.7 '~MT1 : 97.7'
A B C
FCO 34.0' 28.5' -
ST1 45.5' 40.0' -
$T2 44.5' 44.0' -
C01 44.0' 46.5' -
MH 44.0' 48.5' -
MT1 7.5.0' - 80.0'
MT2 108.5' - 90.0'
PRESSURE DISTRIBUTION SYSTEM:
PUMP -- BLASTER EB20 (~30 GPM)
I LATERALS ~ 86' LONG =~ 30 GPM/LAT.
26 HOLES (3.4' O.C.) = ~! GPM/HOLE
3/16"~ HOLES PACED DOWNWARD
I 1/4"~ LATERALS
1 1/4"¢ SOLID MANIFOLD ·
WATER FOUND
83.7' B.O.H.
93.3'
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFOR,,'EDFOR: L¢"~'/ A~,',¢¢
· ECA, OESCR,PTION:~ ~'¢ ~ ¢'~ ~'~ ~-'
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16.
17-
18-
19-
20-
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Monitoring? ' &~ Oate:
SITE PLAN
Reading Date Cross Net Depth to Net
Time Time Water Drop
1 ~ ~ '~ I ~ V~- I"
PERCOLATION RATE "~ (m,nute~'mch) PERC HOLE DIAMETER
~'TEST RUN BETWEEN /'~'- FT AND ~'o~ FT
;:OMME.,S~'~'', ~'~' ¢-~.'¢ ~ ~,,.,.¢¢,,.,. ,~,~,,,,.,,~ .-,,., ,.,,,,,,.,.- ,~,-..v,~,~
PERFORMED BY: ,r~ <~ ~-,~ )a ¢r~,a?- ,DL1 I ~.~/,~/J 0 CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/*'~/~/
(Rev, 4/85)
by
SULLIVAN WATER WELLS
P.O. BOX 870272. CHUGIAK, ALASKA 99587 · TELEPHONE 888-2759
OWNER OF LAND ,'7-~" ~ .V ~'/.//.~_..C'! Z.L"~/~_ '
ADDRESS
LEGAL DESCRIPTION.,
PERMIT NUMBER~ Da~ of I~ue~-~
T~INDENTIFICATION NUMEER~- O~-
Is well Io~ at appmv~ pe~it Io~ion? ~ ~ No
Method of DHIIIng: ~ ~ ~ble tool
Depth of w~lh G /
CasingType.i"76'?_L WallThickness *~_~"~ Inches
Diameter ~ [/ inches, depth ~, ! feet
Uner Type:
Casing Stickup Above Ground: ~ feet
Static Water Level (from ground level): ~" feet
Pumping love1; f~el after, hrs. pumping gpm
Recover Rate: ..?o opm
Method of ~'esting:
~en End
Well Intake Opening Type: D Open Hole
[] Screened; Stad feet St~pped feet
i~ peffora{ions Start ,fqe~. Stopped feet
Depth: from ~ feet, to - -- fee{
Pump Intake Depth: feet
Pump Size hp Brand Name
Well Disinfected Upon Completion? ~ [] No
Method of Disinfection:
cor ents: 1.7//a
BORE HOLE DATA
DEPTH
Driller's Name
AI'rENTION: It Is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Servicea and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Consewatio~,
'TO/TO 39~d H~^IT?~ 6~::B89 TB:B0
EAGLE
ELECTRIC
April 19, 2001
M2C1 Construction
P.O. Box 670045
Chugiakl AK 99567
RE: Septic Lift Station
This letter is written verification for your records.
The septic lift station located at Lot 6 Block 3 Knik View Estates has been wired to N.E.C.
standards. The installation was completed on March 27, 2001, as per our contract agreement.
If you have any questions or concerns regarding the 'above information, please do not hesitate
to contact me @ 344-7121.
Eagle Electric, LLC
EAGLE ELECTRIC, LLC · ELECTRICAL CONTRACTOR
Commercial ,, Industrial · Residential · Maintenance" StatewideService · Licensed, Bonded and Insured
7721 gchoon Street, Suite I · Anchorage, Alaska 99518-3038 * (907) 344-7121 · Fax (907) 344-0827
3850 Bogard Road · Wasilla, Alaska 99687 · (907) 373-6881 * Fax (907) 373-6879
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343.4744
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Jun 30, 2000
Expiration Date: Jun 30, 2001
Permit Number: SW000205
Legal Description: KNIK VIEW BLK 3 LT 6
Design Engineer: 0003 S & S Engineering
Owner Name: Ted Schmelzer
Owner Address: 12032 South Tomi Dr.
Phoenix, AZ 85044-
Parcel ID: 051.031-54
Site Address:
Lot Size: 57350 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail 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 engineer must noti~ DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
June 29, 2000
ROBERT C. COWAN, P.E.
CML ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Deparmaent of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 6, Block 3, Knik View S/D
It is requested that you issue a permit to install a well and a septic system to ser~e the
proposed four bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test was performed. The approximate location
of the test hole is located on the attached site plan. At the time of excavation 7/20/95 water
was not found. Alter ' . ; monitoring, water was found at 7.4 feet.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
consm~ction of this system will not prevent any future development on any of the adjacent
pmperties.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
Enclosure
RECEIVED
JUN 000
I~,UINJCIPP4.1II OI- ,.~ICHOI~AGE
'"!lf~'~AI. SERVICES I~IVlS'"
17034 NORTH EAGLE RIVER LOOP * SUITE 204 * EAGLE RIVER. ALASKA 99577
DRAINFIELD CRITERIA:
3.0' DEEP
1.0' EFFECTIVE {R = 0.87)
5.0' WIDE
87' LONG (2 @ 44' EACH)
I,OT 6, BLOCK 3,
B.J.J. R.C.C.
iN CRITERIA:
4 600 GPO
SOILS : 2 GPD/SO.FT.
600/1.2 = 500 SQ.FT. REQ'D.
LOT 3
LOT 4
UNDEV£
LOT 7
KNIK VIEW S
6-29-00
LOT 2
/
/
/
/ .,
/
/
1 OF 1
CONTRACTOR IS RE,
OBTAIN UTILITY
PRIOR TO ANY EXC
WORK.
10
CE- 8801
FLAT~
LOT 5
UNDEV£LOPEDb
LOT 1
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage, Alaska 99502-C650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR~~''
LEGAL DESCRIPTION: ~c>~' b (Z.~,~ ~--~,1~.- \[ ~a.,.[ Township, Range. Section:
SLOPE SITE PLAN
1
2
3
4
5
6-
7-
8~
9-
10-
11
12
13
14
15
16
17-
l
WAS GROUND WATER [
ENCOUNTERED? I~' C~
19-
20-
COMMENTS '"'J"~i'~l~~ '
Gross Net DePth to Net
Reading Date Time Time Water Drop
I i ~:, -/,..9.$" -.---" ""'~.," -"-'"'
--~ q ,...s $' I'
'~ ~' ,"'.-' ~' I"
PERCOLATION RATE ~ (m:nuteshnch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FTAND ~ FT
s
ENGINEERING
[~'~l t~e ~ CERTIFY THAT THIS TEST WAS PERFORMED
PERFORMED BY: 17034 Eagle Ki~r Lmap ~..G.~ ,~;. ~
ACCORDANCE WITH A~~UIDELINES IN EFFECT~ON THIS DATE. DAT~ ~ ~q ~q ~
" znq
Knco~'.o~
TEST
ROBERT C. COWAN. P.E.
CML ENGINEERS
(907) 694-2979
FAX (907) 694-1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 6, Block 3, Knik View S/D
lane 29, 2000
GENERAL:
The scope of this project includes the installation of a 1300 gallon Premier
polyethylene septic tank and a drainfield trench to serve the proposed four
bedroom residence located on the referenced property.
Construction shall be in accordance with thc approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary underground
utility locates.
Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for' system installations. Owners installing
their own systems must also receive prior approval fxom the Municipal Health
Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer.
Consb'uction shall include two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
17034 ~10 RTH EAGLE RIVER LOOP ~ SUITE 204 ~ EAGLE RIVER, N.A~KA 99577
Page 2
Lot 6, Block 3, Knlk View
June 29, 2000
All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. ·
Septic tanks installed with less than 4 ft. ofcover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level. If thc sidewalls of the excavation bocome
smeared, they must be raked or scratched (rafted-up) before gravel (sewer reck)
placement.
Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches ofcover over the pipe.
A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations
shown on the design, and extend a minimum of 12 inches above final grade. The portion
of the monitoring tube extending through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is equivalent to the effective depth of
the gravel as noted on the design.
Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The
finish grade over the trench must be mounded to prevent the formation of a depression
after settling.
Page 3
Lot6, Block 3, KnlkVlew
June29,2000
MINIMUM MATERIAL SPECIFICATIONS:
I. Any septic tank proposed for installation must be constn~cted by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
T.vpe of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM FSI0 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type ofpipe other than listed above must be approved by the inspecting engineer.
Insulation shall be at least 2" thick exlxuded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or
equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing thc #200 sieve.
When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
Lot 6, B'ock 3, Knlk View $/D
June 29, 2000
The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often them will be moro than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct
or control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be
the owner's representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
cany out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Parcel I.D. 051-031-54
1.' ~ GENERAL IN'FORMATION
'~.'- 'Complete. legald6scription 'got 6, Block 3, Kntk VJ. ew Subdivision
_ Location (site'.addre'ss or directions) NEN B'lrch Creek Drive
', '~ \ · '"' ..... '"" i .'T '
'.; ' :}:.Current propgrty o~ner(s) M2Cl Inc./I, eroy Alderman Day phone.
:-.:-: Mailing address PO Box 670045, Chugtak, AI~'~99567
Lending agency Day phone
CERTIFICATE OF HEALTH AUTHORITy. APPROVAL
FOR A SINGLE.FAMILY DWELLING
H A# H,9o!017
Expiration Date:
223-8100
· ..:~,, Mailing address
. ,'~-"Real Estat6 Agent
~ . J. .......... :..':?:: ~- ..........
....:~ ' .,'" Mailing Addre~ss
· , .~_~ln/es.s. o!herwis, e' .?..quos!ed, HAA v~}l be held by ~)'SD forpi~l~up.
2. NUMBER OF, B~DROOMS:
3. '~YPE OF WATER SUPPLY: _
~' 'IndiVidual Well
i~d[vi-d~al W~'ier Sto~'age
Community Class Well
Public Water System .
Day phone
TYPE OF WASTEVVATER DISPOSAL:
!ndividual Holding tank
Community On-site E~
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 wastewater disposal and/or water
supply system· DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
va d for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with
new water sa,;ni31e results less than 30 days old. (Certificates may be reissued for a period of up to one year w th
valid wa~e~ samples.) Certificates are valid for one year for propei'ties served by Class A or B ~vells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the pr.o. fessional
engineer's work.
4. 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 HeaIth Authority Approval Gutdetlnes for this application, shows 'that the
on-site water supply and/or wastewater disposal system is(aro) 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-sita water supply and/or
wastawatar disposal system is(aro) In compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm ~$ & $ ENGINEEEING
;~'~ Eag;e River Loep Road No. 2G4
Address Eagle Rlverr Alas~:a ~:~'~
Engin~er'~ Pdn'ted Name':Eobe['t: C. Co~,an~ P.E.
5. DSD SIGNATURE
I./.. Approyed for.
Disapproved.
bedrooms.
Conditional approval for
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
. Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Odginal Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
Or, Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescrlption: J-,PT' (o ~i-OCK' _3 K~}¢ Vi~,~' 'S/g) ParcellD:OS/-O3/--5'~
A. WELL DATA
Well type~'~ wit
Date completed 7/
Total depth G ~,
Date of test
Static water level
Well production
If A, B, or C provlda FqNSID # ~ Well Log (~t'N)
s~ary se~ ~;N)'¥~ -r w~es propedy protected (~N)
Cased to (o / lt. Casing height (above ground). ~. ¥4 in.
FROM WELL LOG AT INSPECTION
~]C O g.p.m. ~/' g.p.m.
WATER SAMPLE RESULTS:
Coliform , 0 colonies/100 mi.
Date of sample: ff/~' 6//~ t
B. SEPTIC/HOLDING TANK DATA
Ni~a~e ~' S" mg.fl.
Other bacteria O colonies/100 mi.
Collected by:
S & S ENGINEERIN~
17034 F. ogle River Loop Road Ne, ~O4
F.a~lo River, ~i~l ~5~
Tank Type/Matedal ,.~¢pr ~ (., ~~'ID[3 ~
Tank size J 300 gal. ' Number of Compartments
Foundation cteanout (~rN) yt, J' Depression over tank (Y4~
Date of pumping ,~/A- - /~ Pumper.
Date installed '*1///7/0o
High water alarm (~1) ¥~ J
Ce
ABSORPTION FIEI.~ DATA
Len~ ~ ~ fl. ~ ~ fl. Gra~ bel~ pipe
Total depth ~//~ fl. Eft. ab~fion ama EO ~ ~ Moni~ng ~be ~f J Depress~n over field
Date~ad~uaw~t ~/~ -~&~ ~ For ~ b~r~
F luiddap, ina.o.fl~. ~ ~.r~. ~. N. dep. in.
~psed ~me: ~. F~I flu~ de~ In. ~o~ rote >= g.p.d.
~~~ ~t ~t 12 mo.) ~ & ~e) Ify~, g~e da~.
UFT STATION
Date installed h
'Pump on' level at
Datum T~h
Size in gallons
'Pump off' level et
Cycles tested
Manhole/Access~/N) Y~- J'
High water alarm level at '.f ,~. 5- in.
Meets alam~ & circuit requireme~s? 'Y,~ J
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic ten,iff station on lot! OO ~
Absorption field on lot / 0 e '~
Public sewer main ~'/A-
Sewer/septic service line ~' ';"
O~ adjacent lots
On adjacent lots
Public sewer manholaleleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~.O Property line ~'
Water main I~ lA Water sewtce line
Wells on adjacent lots ! 00 -~
Absorption field
Surface water ! 00 '-~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~1 '~ Building foundation
Water Service line 10 '+ Sudace water /0o
Curtalndrain /~,"~ ~:,.,o~,.~ Wells on edjacent lots )00
Water main F"/4
Driveway. partdng/vahide storage
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name
Date Y/~. (.
HAA Fee $
Date of Payment
Receipt Number
(l~BrV. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
CT&E ~nvlronmemai Services ~nc.
I_~ hnrn t~? EHvJs!on
:200 W. Pot~er Drive
Ancflofa~e. AK 99518
T~' (c~07) 562-2345
Parameter Results PQL Units
Total Co,farm {MF) O r~O0
N;trate 0.5 U 05 m~j~L
SMg222U
EPA 300
