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Home My WebLink AboutOVERLOOK ESTATES BLK 4 LT 2Overlook Estates Block 4 Lot 2 #068-041-23 " 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 NAME PHONE ~NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well Absorption area Dwelling PERMIT NO. ~ ~ Material No. of compartments ~ z Manufacturer ~ ~ Liq, capacity in gallons Inside length Width Liquid depth ~ .. ~O IF HOMEMADE: - ~ ~ DISTANCE TO: Well Dwelling ~/_ PERMIT NO, ~ ~ ~ Manufacturer/~ Material Liquid capacity in gallons ~ll Foundation Nearestlotline ~ PERMITNO. ~ O ~ DISTANCE TO: ~OS~ ~OI ~ ~ [~ No. oflines ~ Lengthofeach~,¢ *otallengthofH~l Trenchwidth~oinches~ Distancebetweenlines ~ ~ : ~ ~ I ~. Material beneath tile Total effective absorptio~ area :~ Top of tile to finish grade ~ ~inches ~Z~ Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ¢ DISTANCE TO: JJ Class ~ ~" '[~Depth~ ~,~¢~ ;~)Drille~ Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER ~ ~ ~ ~, ~ PIPE MATERIALS I ~. [ ~ ~ fl~ SOIL TEST RATING iNSTALLER REMARKS · .: , . _ , · .... APPROVED ~ ~ 8RD lg6~ - DATE 72-013 (Rev. 3~78) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13- 14- 15- 18- 19~ 20- COMMENTS PERFORMED BY: 72-008 (6/79) MUNICIPALITY OF ANCHOR~G~/ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST q SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN Gross Net Reading Date Time Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN FT AND ,~ r~H' ~.7.u~.~,~-'~.:r~ ' (minutes/inch) FT __ DATE~ WATER WELL RECORD ',~ STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ GeophysicoISurveys complete either la, lb or lc.) ~CATiON OF WELL d Borough I.,).~ Subdivilion Lot Stack ~1 I/e qt rs' inch [e'r'l nn!c 2 4 i_of_ o~_of ',.~.J DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Street AddreEs end AreCJ of Well Location WELL LOG Stickup Gravel and boulders Top Bottom 0 2 Grey clay and gravel Black slate 2 Bmdrnok- ~lmrm 105 Hard black bedrock - quartz 135 at 780 ft 365 Drilling Permit No. A.D.L, No. Meridian 85 105 135 365 /'5O OWNER OF WELL: Hr. ~a~ne BaEer Eagle River,Ak. 99577 WELL DEPTH; (final} 5. DATE OF COMPLETION 45(} fl. 8 - 1 - 85 ?.UBE~.~ Dom,,fic [] Public Supply [] Industr7 r--I' Irrig'oflon' ~:] Rech~rg; O'C ..... ico" ~ Te~t Well ~ Other: 8. CASING: ~] Threaded [] Welded ~io~. 6 ~,,. ,o109 diam. in. Io ft. Depth Weight ft. Depth Btickup__ ft 9. FINISH OF WELL: I~. STATIC WATER LEVEL: 110 ff. 8 / []Above or :~ ~e~ow tend ~urface ,8[ PUMPING LEVEL below load surface and YIELD ft. after hrs. pumping __ g.p.m. ft after hrs. pumping -- 12.GROUTING Well Grouled: [] Yes [] No Moterial: [] Neat Cement [] Other: __ PUMP: (if aveilebLe) HP Production of 90 GPH 16. WATER WELL CONTRACTOR'S CERTIFICATION 15. W3ter Temperature Magnuson Drillin~ AA DEPARTMEN'¥ ~)~HEA[/T'H AND ENVIRONMENTAL ~.2)TECTION 825 L STREE]", ANCHORAGE, AK 99501 264-472O PERM I T NO: DATE IGSUED: 85()424 }7 / 19/85 APPLICANT: ADDRESS: CONTACT F'HONE: SOLITH FORI< CONST P.O. BOX 770567 EAGLE RIVER.~ Al< 694-'4351 995'77 I..EGAL DESCRIP: LOT SIZE: MAX E EDROOM SUBDIVISION: OVERLOOK ES'FATES SECTION: 25 TOWNSHIP: 14N 49251 (SQ.PT, OR ACRES) 5 LOT.".=° BLOCK: 4 RANGE: 1W L. isted beIow are the optzons ava].lable to you zn design;.ng your septic system. Choose the option that best. £its your site. -~-RE~CF.~ BEE]]) W .. DRA ][ DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL D_EP'TH (F'I".) 4.0 O. 5 3.5 ~TOTAL DEPTFt (FI",) 8.0 4.5 7.5 GRAVEL WIDTH (FT,) 2.5 22%0 5.0 'GRAVEl_ LENGTH (FT.) 79.0 *~ 43.0 68.0 GRAVEl-. VOLUME (CU, YDS. ) 33.0 35. 1 50.4. TANK SIZE (GAl_S) 1,500..0 ** 1,500.0 *~ 1,500,0 ** SOIL RA'T'ING (SQ. FT. /BR) 125 125 125 GRAVEL LENGI"H > 75 FT,, REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) '}"ANt::: MUST HAVE Al' I_EAST TWO COMPARTMENTS I certify that: 1. I am t'amil~ar with the requirements For' un-site sewers and wells as set forth by the Municipality oF Anchorage (MOA) and th'e State of Alaska. I will ins'Lal], the system in accordance ~ith all MOA codes and regulations, and in compliance with the design criteria oF .this permit,, 3. I will adhere to all MOA and State of Alaska requirements for the set back distances From any existing well, wastewater disposal system er.public sewerage system on this or any adjacen't, or nearby lot. 4. I understand that this permit :is valid £of a maximum oF 5 bedrooms and any enlargement will require an additional permit. IF A'LIF"F STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN EI_ECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPRGVED WITHOUT AN EL. ECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MLIST BE.DGNE BY A LICENSED ELECTRICIAN. APF'L I C, ANT: . ISSUED BY .... ~_~.~_.~ .......................... DATE: PERFORMED FOR: LEGAL DESCRIPTION: I 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 AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TESTf SLOPE SITE PLAN WAS GROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop / / PERCOLATION RATE /,~ (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: 72-008 (6/79) Municipality of Anchorage Development Services Department Building Safety DMston On-Site Water & Wastewate~' Pr°gram 4700 South Bragaw St. . P~O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ek, us (907) 343-7904 Parcel I.D. 1, GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APpROvAL FOR A SINGLE FAHILY DWELLINg Ob . oql7o2 OVERLOOK ESTATES SUBDIVISION; LOT 2, BLOCK 4 Location (site address or dlrecti0ns) 27530 VANTAGE DRIVE * E/i~GLE RIVER, AK Current Property owner(s) Mailing address Lending agency'i Mailing address Real Estate Agent Mailing address WAYNE BAKER Day phone 694-4465 P.O. BOX 201714 * EACLE RIVER, AK 99520 ' Day phone. 689-6464 JERRY CURLEE w,/ PRUDENTIAL VISTA Dayphone 689-6464 1~§,35 CENTERFIELD DRIVE * EAGLE; RIVER. AK 99577 Unless otherwise requested, HAA will be held by DSD for plckup. 2. NUMBEROF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage · Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site 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 wastewater disposal and/or water supply system. DSD also Issues ~ upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are 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 certified by my seal affixed hereto and as o/~he validation date shown below, I vedfy that my invest/gaEon, based o~ p~cedureS o~rtiin-ed in the Health Authority Approval Guldeline~ for this application, shows that the on-site water supp~ and/or wastewater disposal system Is(are) safe, functional and adequate for the ~2umber of bedrooms and ~e of structure indicated herein. I further vefi~y that based on the Inforrnafioh obtalned from the Munlclpali~y of Anchorage files and from my Investigation and inspection, the on-site water supply and/or Wastewater disposal system is(ere) In compliance v, fth all applicable Municipal and State codes, &rdinances, and regulations In effect at the t/me of Installation. Name of F.ir~.' ALASKA WATER &: WASTE-WATER CONSULTANTS. INC. Phone 337-6179 Address. 6901 DEBARR ROAD..SUITE 2B * ANCHOP~GE. AK 99504 Engineer's. Printed Name JEFFREY A. GARNESS. P.E. Date Engineer's Comments': ' In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, consdon§ous engineering analysis of the system in accordance wf~h ADEC and MOA DSD Guldetinea ? Regulaffens. The reported results described the perfon~ance of the system under the conditions encountered at the time of the tes~ and separation distances measured to readily IdentltTable features. The operational fife of all wells and septic systems depend on the Iocal soils condit/on, grouncl~+ater levels that may · fluctuate durtng the year, and the water usage of the femliy belng esrved by the system. These conditions am outside the conb~ of the et,aluator of the ~Tstem. Satisfactoo/ test resutts do not guarantea future performance of the system, nor do they guarantea that there are no hidden dofect~ or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the sYStem wfll conb'nue to meet the operational r~qulr~nents ~f the ADEC or MOA DSD. The content of this report Is for the sole benefit of the ovmer listed above. Any reliance upon or use of this report by any other peraen or panT is not authorJzed, nor wlti lt confer any legal dght whab-.~:xwor. 5. DSD SIGNATURE ._ ~ Approved for ,~ bedrooms. Disapproved. : Conditional approval for __ bedrooms, wlth the fllowing stipulations: Attachments: NAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements SuppIemental Engineer's Reort Other .,,'-'.~ ~'..' ' .,~:~--.. . -..,-',.p~ WATER AND . W,~.STEWATFR ..' : 'PROGRAM · ..-" Original Certificate Date: '7- //-'~ ' ~ / Municipality of Anchorage Development Services Department On-Site Water & Wastevmter Program 4700 Scom Bragaw SL P.O, BOX 196650 Anchorage, AK 99519-6650 Legal Dasc~ption: A, WELL DATA HEALTH AUTHORITY APPROVAL CHECKLIST OVERLOOK ESTATE~ SUBDMSION; LOT 2, BLOCK 4 Well type PmVAT~ If A, B, or C provkle PWSlD# N/A Date completed 8/5/1985 Sanitary ~ (Y/N) YES Totaldepth 450 It. Casedto 109 ft. FROM WELL LOG Da~ of test s/1/198s Stall= water level 110 ft. Well production 1.5 g.p.m. Well Log (Y/N) Wlre~ properly protecM (Y/N) Caalng halght (above ground) AT INSPECTION 7/5/'2001 13,t .lt. O.6 .g.p.m. 12+ In. WATER SAMPLE RESULTS: / Coliform ~ colonies/100 mi. Nltmte0o G(~ mg./~. Date of ~ample: 7/5/2001 CallectacI by:. B. SEPTIC/NOLDING TANK DATA Tank Type/ldaterlal STEEL Tank size 1750 gal. Number of Compe~tmenta 2 Foundafion deanout (Y/N) YES Dapmsslon over tank (Y/N) NO C. ABSORPTION FIELD DATA p{~a.ow fINN. Date installed Leng~ · 58 lt. Width 2.5 .lt. Soil rating (g.p.d~) 150 AWWC, INC. Date Installed 7/25/1985 Oeanouta (Y/N) YES High water alan~ (Y/N) N/A JR'a PUMPINING Toteldepth 12 tL Eff. absorpfionarea 928 tt' Monltadngtube YES Date of ededuacy test 7/5/01 Results(Pass/Fall) PASS Fluid depth In ab~ field before test 0 in. Water added 750 gal. Elapsed'lime: 0 min. Final fluid depth 0 In. Absorption rate Any rejuvenation B'eatment (past 12 mo.) (Y/N & type) NONE KNOWN System type DEEP TRENCH Gravel below pipe 8 fL Dapresalon over field NO For 5 bedrooms Nowdepth 0 in. 750+ g.p.d. ff y~s, give date - D. UFT STATION Date installed Size In gallons "Pump on" level at F- SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic te~ station on lot, 100'+ A~on field on lot 100'+ Public ~wer main N/A Sewer/eep~c eewlce line 25'+ I-ti~h l~ltef il~lfm level et In. Meets alarm & circuit requirements? On adjacent lots. 100'+ On adjacent lots, 100'+ Publlo sewer manhole/cteanout Holding tenk N/'A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Bulldlng foundation 5'+ Property ;ne 5'+ Absorption field. Water main N/A Water eer4ce line 10'+ . Surface water Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water eewlce line 10'+ Curtain drain NONE KNOWN F. COMMENTS Bulldtng foundation 10'+ Surface water 100'+ Wells on adjacent lots. 100'+ 100'+ Water main N/A Drk, eway, bertdng/vehlcle storage 5o'+ G. ENGINEER'8 CERTIFICATION I certify that I have determined through field Inspeca~ end review of Municipal records that the ebove sy~ems ere In conformance wfth MOA HAA guidelines in effect on this date. Engineer's Pdntec} Na~e Date ~oi JEFFREY A. GARNESS H.~Fee$ .~oc,. ~ Receipt Number Waiver Fee $ Date of Payment. Reeelpt Number MUNICIPALITY OF ANCHOP~.GE '.' ., MEMORANDUM WATE~'WELL ADVISORY During a recent Health Authority ~pproval o~site inspection and test of the potable water supply.'well on Lot. ~ '-' .' Block ~ of OV~RL0o~ Subdivision, the well's '. · ' ~ 0 ,'G .gallons pe~ minute. productivity was.determlned't be'~ . ......... ~. .. . The minimum well productivity'reguired.by this Department '(~C 15.55) for a ~'. bedroom'residence is ~i~ gallons per minute. Alth0u~h the subject well currently.exceeds th~s' - .. minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing'cars and watering. lawns and gardens may be required. This advisory must be attached to all copies bf the subject Health Authority Approval. g ASBUILT SEWARD & ASSOCIATES LAND SURV] I HERESY CERTIFY .THAT I HAVE SURVEYED THE SCALE, ~ ~ D~ER~INE THE ~ISTENCE OF ANY 6RID= ....... ,,,, .-. E~ENTS, COVENANTS, OR RESTRI~IONS . VISION P~T. UND~ NO CIRCUMSTANCES S~ F~ ~. '. ts-69~8 .' ~ FENCE LIN~, OR FOR E~LISHING ~ND- DRA~, ARY LINES. JUL-O~-,O.I 00:01 FIE~"T&E ENVII~I~NTAL SRV ~l~ CT&E Environmental ~efvlcen Inc. 9075615301 T-611 P.03/05 F-T20 CT&£ Ret'.# CTient ~ame Project Name~# Client Simple ID ~atrl~ O~ered B~ PWSID -~ample B. cmarks: 1013963002 ~ Water & Wastewater Consuttm~ta ~n¢. Overtook Est. Owrlo~k Est 1.2, B4 OuTside HB Drinking Water Printed Dat~/Tlme 07/05/2001 23:42 Colleaed Date/rime 07/03/2001 12:15 ~elved I~le/Time 07/03/2001 15:12 Tecbnkal DIrector,,~ ,/ Stephen C. Ede Releas4*d By ~ ~ Allowahte Prep Analysls Limits . Date D&tc lnlt Nitrate-N 0,688 0.500 m~Jl., F. PA 100.0 (<10) 07/03/01 SCL Total Coliform 0 col/lOOmL SMIS9222B (<i) 07/03/0t Y. AP ~ MUNICIPALITY OF .~_~/ ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~/'~'t~. ~:;~,e~:~t~- Telephone: Home '~q -~_~t'~ Business Applicant Address ~ ~ .~' ~ (~"'~ ~ ~ ~ ~' ~ 'c"~c't' ]- ,/~L~ (c) Applicant is (check one): Lending Institution []; Owner/builder~ Buyer []; Other [] (explain); (d) Lending Institution .~.~-, t~L~'I'~'L~ ~"~,,a~[/__. Telephone Address ~L..~.. ~~-j ~- (e) Real Estate Company and Agent ~ ~ Address (f) Telephone ~ the HAA to the following address: ~Rl~ 195x TYPE OF RESIDENCE ~ingle-Family,~ Multi-Family [] Number of Bedrooms Other 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. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDI SPECTIONS, TEST ', FILE SEARCH, DA~-A~AND INFORNIATION ~ ~ As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies 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 s ,~. ~ F-~;-~r!.h,-~ Address J~agJe ffiver, Aiasl¢a ~ Date Telephone /~;Pp;~vedO '~¢'~'//~' be~ri ;;~p~obvea Conditi Date Terms of Conditional 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 cou~esy 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 72-025 f~ 1/84) MUNICIPALITY OF ANCHORAGE (MO~'~ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~---,~' '~' 1986: WELL DATA Well Classification Well Log Present(~N) Total Depth ~'~"~ Static Water Level Casing Height Above Ground _ Electrical Wiring in ConduitS/N) Separation Distances from Well: To Septic/l~li'ffg Tank on Lot Cased to Ii A, B, C, D.E.C. Approved (Y/N) Date Completed ~;;;~ \ '~ ~ Yield I [?"JCl Depth of Grouting Pump Set At "~t.¢ Sanitary Seal on Casing([~YN) Depression Around Wellhead (Y~ ; On Adjoining Lots To Nearest Edge of Absorption Field on ~_ot I"¢-~' ; On Adjoining Lots To Nearest Public Sewer Line ~.f~//~ To Nearest Public Sewer Cleanout/Manhole ,'- To Nearest Sewer Service Line on Lot ~'~ Water Sample Collected by '~ ~, ~ ~(--~t.r~'~:~ ; Date Water Sample Test Results ~"%~ ~ Comments B. SEPTIC/J~-DIR'G TANK DATA Date Installed "~-Z-~-~ Size Standpipes (~/N) Air-tight Caps C/N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) /. Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line [ C:~ I..~ TO Water Main/Service Course No. of Compartments '~- Foundation Cleanout CN) Date Last Pumped / ],~ ;for '"-'--' Temporary Holding Tank Permit (Y/N) / To Building Foundation "~ To Disposal Field t ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-02601/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ""/ -"Z...~ ~ Width of Field Square Feet of Absorption Area Depression over Field (Y/,~. Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Presentd~N) pate of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To BuildingLot Foundatio~/p To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line / [_'~'~-P' To Existing or Abandoned System on ; On Adjoining Lots L~ ~ ~.~,,/¢¢t_.1:~'~i~:¢'~ To Cutb~nk (if present) ~""~/~" D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ~. _ S 8, S Engineerir~l Date Compan~g~. ',iv,r: Alas~a ~5~ MOA NO~ No. Date of Payment 1- ~ ~ ~ Amount: $ - Page 2 of 2 72-026 (11/84)