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HomeMy WebLinkAboutTRAILS END BLK 8 LT 7Trails End Block 8 Lot 7 #015-191-49 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 o Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: 0 1!-- Name: 1,� -,'b)'1A S t.0OA Wastewater System: El New Upgrade Address: J �OG A, ABSORPTION FIELD Phone: No. of Bedrooms: FOD:eNp'lkench 0 Shallow Trench 0 Bed El Mound 5-)Crther LEGAL DESCRIPTION . Soil Soil Rating: — Total Depth from origipflgrade: GPD/Sa. Ft. Lot: Block: Subdivision- -7 t^JP 6 Depth to pipe bottom from '1� grade: Gravel dept"e' neath pipe Ft. Ft. Township: Range- I I Section: Fill added above original grade"11- 'l length: 9�e Ft. n New El Upgrade" Gravel width: 'N<Zr of lines: Distance between lines: Ft.. Ft. Classification (Private, A, Total Dept -Cased To: Total absorptiopAre-a: Pipe mall%: _C!��Ft. ' Ft. SQ. Ft. Driller: _'tQ4te Drilled: Static Water Level: Date installed: I Ft. Yield: Pump Set at: Casing"Above Ground: TANK Plvl Ft. Ft. SEPARATION DISTANCES 13 Septic Holding El S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacit in gallons: From Tank Field Station Tank Sewer Lines , 1-1 Well- W ( /J- 4 t+ > Material: 4� Number of Compartments:: Surface Water LIFT STATION Lot Size in gallons: Manufa 1 Line.`4-0 1 Foundation i 2, "Pump on" level at: [­ump_Pw- revel at: water alarm at: Curtain ?4 1,,31 Pump Mak _§Amotrel- I Electrical inspections performed by: Drain :,Oat Remarks: BENCH MARK .40EX) Location and Description: Assumed Eleva ion: 00 Pt ENGM41EE-90§1 65' Q Sp U, Q Inspections performed by: Dates: 1st �/`/ 2nd ey A. Garness CE-7953 Department of Health and Human Services approval Reviewed and approved by: Date: _1/-t-/`7 2-013 (Rev. 9/91) MOA 25 ROk PERIMETER . *aAwnowcD IN k*cs �a^ `r'A' � -75 FOOT WELL RADIUS | *000 sxLLow xoLzoms TANK 00 FOOT WELL RADIUS 75 FOOT WELL RADIUS SOUTH PROPERTY LINE�"-� B TO CO2 = 41 NOTE, THE INVERT OF THE HOLDING B TO COG' = 34 TOP OF TANK = 9544 (SOUTH END) TO PREPARED BY; ALASKA WATER & WASTEWATER —7953 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON -SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970364 DATE ISSUED:10/14/97 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES EXPIRATION DATE:10/14/98 OWNER NAME:PATE LAURA J & OWNER ADDRESS:11500 BROWDER AVE ANCHORAGE, ALASKA 99516 PARCEL ID:01519149 LEGAL DESCRIPTION: TRAILS END BLK 8 LT 7 LOT SIZE: 22800 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: HOLDING TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE:-97 ISSUED BY: ,% >_�f�- .,�' r? ._ DATE: 3 8471 Brookridge Drive Anchorage — Alaska. 99504 (907) 7-6179 Fax (907) 338-246 Consulting Engineers October 7, 1997 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref Sewer Upgrade for Lot 7, Bk 8, Trails End S/D. HOLDING TANK To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The drainfield is operating in a surcharged and must be upgrade prior to the sale of the house. Five test holes were dug on the lot and the conditions were found to be unsuitable for an onsite septic system. Attached is a copy of the soils report I prepared for the homeowners. Given the site restrictions it is my recommendation that your department allow us to install a 4000 gallon holding tank. The new holding tank will be located near the northwest corner of the house. There is intermittent ponding of water near the south lot line. The new holding tank will be approximately 80 feet away from this area. There was no standing water present on 10/7/97F ANCHORAGE FOR BOUYANCY FORCES: If the groundwater conditions in the area of the new holding tank are the same as in the test hole area, hold down anchors will be required to resist buoyancy forces. The buoyancy force on a 4000 gallons tank is approximately 33,400 pounds. The resisting force is the soil cover (assume 2 feet of unsaturated soil) and the weight of the tank. The weight of the tank is about 3000 pounds, and the weight of the soil (assuming 90 lb./ft3) is approximately 19,300 pounds, for a total force of 22,300 pounds. Providing a factor of safety of 1.5, the total resisting force should be 50,100 pounds. The anchors should provide a resistance of 27,800 pounds (50,100-22,300 = 27,800). We are proposing to use ten (10) Manta Ray utility model 88-DB utility anchors (literature attached), which are rated for 3000 pounds each. Rather than using galvanized steel cables, we will use stainless steel cable so that corrosion will be minimized. The cables will be slipped through rubber hose (steel braided) so that the tank coating is protected. I am unaware of systems. If you 1-800-481-1162. any adverse impacts this installation would have on adjacent wells or septic have any questions, please contact me at 337-6179, or on my digital pager at Thank you for your assistance. S. a a GENERAL LOCATION OF SEPTIC SYSTEM /—TH ff4 t-TH 4#5 a _j Ljj z Z CL < m w fn > z a- p pq ra 0, G4 r-1 %, w L-:E (4 0 -j r f::4 r:l p -j w w oz< D� L' Elzwwo -i bi 4000 GALLON HOLDING TANK LOT 8, BK 8, TRAILS END S/D, PVT, WELL AND SEPTIC SYSTEM. LINE LOCATION OF BURIED ELECTR-TC—S@ZVlCE— ANEW 4000 GALLON HOLDING TANK XISTING BE D TO BE ABANDONED IN PLACE 4 INCH DIA. PVC WELL SLOPED AT 1/4' HOUSE PER FOOT THE NEW HOLDING TANK SHALL BE ANCHORED TO RESIST BOUYANCY FORCES, SEE THE COVER LETTER OF THE DESIGN PACKAGE FOR ANCHORAGE REQUIREMENTS, W FOUNDATION C/O NEW C/ i 0 C) VHT 43 TH #2 �TH #1 SOUTH PROPERTY LINE EXISTING SEPTIC TANK TO BE CRUSHED -AND FILLED WITH SOIL PER THE UNIFORM PLUMBING CODE 7. tiV LOT 6, BK 8, TRAILS END S/D, PVT, WELL AND SEPTIC SYSTEM, '' / WELL IS >> THAN 100 FEET FROM THE PROPOSED HOLDING TANK, SEPTIC UPGRADE/ HOLDING TANK: LOT 7, BK 8 TRAILS END S/D, PREPARED FOR1 MARY TOMASIEWICZ & LAURA PATE PREPARED BY: ALASKA WATER & WASTEWATER DATE: 10/6/97 1 DRAWN: GARNESS I SCALE: 1' = 30' ROX, RADIUS FOR WELL LOT 6, BK 8 . .. .. ...... . r A. Garness: —7953 'f r - f Phone #,, i # 338-3246 Consulting Engineers October 2, 1997 Mary Tomasiewicz and Laura Pate 11500 Browder Ave. Anchorage, Alaska 99516 ze t 5ra cc�93 + Subject: Septic System and Soils Evaluation at Lot 7, Bk 8, Trails End S/D. Dear Mary and Laura: Per your request we evaluated the adequacy of your existing septic system. As you know, we found the drainfield (bed system) to be grossly surcharged with a liquid depth of 24 inches. In short, it is technically failed. We then evaluated the soils on your lot, and explored the feasibility of upgrading the septic system. Attached is a copy of your as -built survey, which shows the location of the test holes, the existing septic system, and the protective well radius. In test holes 1, 2, & 3 there was either unsuitable soils (organic fill, or impermeable/saturated silt), or shallow groundwater immediately below the organic layers. In addition, there was ponded surface water along the mid point of the south lot line, and on the lot to the south.. M.O.A regulations dictate that a septic system must be at least 100 feet away from a surface water. In short, the area to the south of the existing drainfield was quickly ruled out as a suitable site. In test hole 4, the soil visually appeared to be suitable (although there was seeping at a depth of about 4.5 feet), however, further testing about 20 feet to the east (test hole 5) found unsuitable conditions again. In test hole 5, the water was weeping profusely below the organic soils, at a depth of approximately 30 inches. In short, the soils encountered in test hole 4 were isolated to a very limited area. Test holes 4 & 5 were not logged. Further limiting the suitability of the area near test hole 4 is the fact that a new drainfield would have to be at least 10 feet away from the existing drainfield. Based upon our assessment of the site there does not appear to be suitable soils, and/or adequate space available, to support a conventional or innovative septic system upgrade. An innovative septic system would be a risky installation at best. In short, it is my recommendation that a holding tank be installed. If you have any questions, please contact me at 337-6179, 244-9612, or on my digital pag- at 1-800-481-1162. Jeffrey A/ Jq#nb E., M.S. GINEER'S SEAL) ef-t o Municipality of Anchorage a°;•°••, DEPARTMENT OF HEALTH & HUMAN SERVICES �qT•� 825 "L" Street, Anchorage, Alaska 99502-0650 • • • • • • •' SOILS LOG — PERCOLATION TEST •• • • • • • : JAM S P. WILUAMS ° PERFORMED FOR: r iT,�S✓ i0'wstE(C i- DA ep• bl .• 4 oZ7a LEGAL DESCRIPTION: ?_A) GNO NO L �j Township, Range, Section: DEPTH SLOPE SITE PLAN _(FEE ) a��S I , 1 — -- --- N sw 3- 4- 5- 6- 7 8 9 10 11 12 13 14 15 16 17 18 19 20 C COMMENTS 0; ,1 g' � �� �� JAMES ,,. L to MS .9'soa •M$ UND WATER kll,�F1 NTERED? t7 IF YES, AT WHAT DEPTH? S SaF-PIm L a� P E Depth to Water After t Monitoring? 3 Date: a I?( T1s• Reading Date Gross Time Net Time Depth *W or Water Net Drop 9 : 3 Ic M'r' 4 << CY ry 1 t. It PERCOLATION RATE I ()+f- (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN_ FT AND 3 00 FT J'Z52 C)IN ` S c't'4 � t---.PT t C- . PERFORMED BY Y V \j V\Lvv'- I 111 11 v - CERTIFY THAT HIS TIST WAS PERFORMED IN ACCORDANCE I H ALL STATE AND MUNICIPAL GUIDELINES [ EFFECT ON THIS DATE. DATE: i ` 1+ 72-008 (Rev. 4/85) «.... ER'S SEAL) Municipality of Anchorage « DEPARTMENT OF HEALTH & HUMAN SERVICES ° ° ° ° ° ° ° • ° ° • •O ° • K 825 "L" Street, Anchorage, Alaska 99502-0650 • SOILS LOG -- PERCOLATION TEST �o s�sloa PERFORMED FOR: fJ tfl4�T4w_wS1gw/Cr- DATE PE sr4• "� c5t 1/ LEGAL DESCRIPTION:�(GAILS �ND} '0 b-2M Township, Range, Section: ` SLOPE SITE PLAN i ` 2 3 S 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 �S � - O2c . SILT 6M -- SAruOWV Q15y spy �R F Alq a 90 g °..� . JA S IL IAWS : ° °.No.. .« ° OF WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT 2 L DEPTH? P u MT E Depth to Water After Monitoring? NSTPrL t EO Date: ■.■■■■® E mtm mmm mmmmrrm T Reading Date Gross Time Net Time Depth to Water Net Drop 20 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER / TEST RUN BETWEEN A1� FT AND IJIA FT COMMENTS . LS l� lL t f1. �►�1`St7� � /L PERFORMED BY: �y ��(�AI 4Jt�i.• I - V M-L— CERTIFY THAT THISTESTWAS PERFORMED IN ACCORDANCE WI H ALL STATE AND MUNICIPAL GUIDELINES EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) �y� , Mo0000 ®p@®mod® Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 49M �• 4:..� 825 "L" Street, Anchorage, Alaska 99502-0650 . �� . • ... e o ®. SOILS LOG — PERCOLATION TEST JAMS PWI SON : w� PERFORMED FOR: VEW1G 9��� !`�`t®• d"' DATE PERFORMED: i LEGAL DESCRIPTION:C �IyO S/Q, L �� �O Township, Range, Section: ��epTN SLOPE SITE PLAN T 4. *3 2 ORrr Goan N &also OICS 3 �r�(s AAL a!_ tJSr i LT 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS t �— g MTV- 0 �FNCfl�1�bT� G S IF AT WHAT L 0 DEPTH? P E Depth to Water After ©� Monitoring? ' Date: 3- I Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TE(SST RUN BETWEEN _LIL_(-FT AND —FT PERFORMED BY: It `' t VVVAA/4,✓ I 1y -vim! 'ERTIFY THAT TH S TE TpWAS PERFORMED IN ACCORDANCE W ALL STATE AND MUNICIPAL GUIDELINES I EFFECT ON THIS DATE. DATE: Oct�2� ` 72-008 (Rev. 4/85) II W I zlo i `tWc3 Y30.01 I O 1-3 Y3 ;0I � H18ON I _ — — — 16.611 — I * W z r I I I noo 'I I O 'CYj N W I t2 I 0o� I m 0 G Oo I I I Z I �� m 01 O. 16 mm zzz I 00'OZt 00'OZt 00'0Zl Z6'6l1 Z6'6S9 HDJON _ I 00'OZl 00'0Zl 00'OZl Z6 6lt Ii r W m J - z WIci � t �ns3 t!1t1,S a I tws7 Y3� .ot II 3 Y3�.Ot f6�611 I II I to I m to w Irn o Z 00'0zl Od'OZl I 00'OZl b6'6ll IVA 1,6'699 M.,Sy,ZO.00S _ u n^ Y �BV�J 8X'tY Ab'199 MllAfd0.ODS z I n I ai I m Q Z U 1 Q Q I i V C..7 i 1 ¢{i k t 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 i.rp;Ae_ Wovdw,,-K!� IPHONE 26 XNEW ED UPGRADE MAILING ADDRESS 65 q 46 2-6' II'le-17 LEGAL DESCRIPTION LOCATION 62r,:, d NO. OF BEDROOMS 0 x DISTANCE TO: Well If + Absorption area Dwelling e7 ot- i") PERMIT NO. /I 417d e U:-, z UJ < Manufacturer 6,_e C- Material 6' Ive f No. of comartments p Liq. capacity 1in gallons 2 _S 6) 1 IF HOMEMADE: Inside length Width Liquid depth Z DISTANCE TO: Well Dwelling PERMIT NO. 0 Manufacturer Material Liquid capacity in gallons Uj DISTANCE TO: Well Foundation, Nearest lot line PERMIT NO. Lu _j LL Z Zw :R cc No. of lines 6� Length of Uch I' a 1 J i 5� �'3 '3'� E4X ' 0 Total length Ff,)VS 4 t� Trench 'd h M inches Distance between lines I.- . . Top of tile to finish grade 3 Material beneath tile Total effective aft tion ea inches LU Length Width Depth PERMIT NO. 0 1 < I,- 0.— Uj (L Type of crib Crib diameter Crib depth Total effective absorption area U.1 CA) DISTANCE TO: Well Building foundation Nearest lot line _j Class Depth Driller Distance to lot line PERMIT NO. _j W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS PVL SOIL TEST RATING i S-c a'A INSTALLER lj;,tn Moker REMARKS 6 e ero,, &,N1j1y idc f";'y 7A e bs Sal v "s 4u/ 11;4?�Vely I ('447-le— In L /I "'It, 11'�o �r F C N- 1 4 .4� /W&/t 3F gi6 APPROVED DATE LEGAL 3-aie- 231 k 9 /� a/ Z4, t- 13, 07/10/84 �ANT: LUPINE WOODWORKS ANCHORAGE, AK 99504 DESCRIP: SUBDIVISION: TRAILS END LOT: 7 SECTION.- 24 TOWNSHIP: 12N RANGE: 3 Em 1A (SQ. FT. OR ACIRES) ify that: am familiar with the requirements for on -site w r orth by. the Municipality of Anchorage (MOA) and the will install the system in accordance with all MOA .nd in compliance with the design criteria of this e will adhere to all MOA and State,of Alaska r quire €3 istances from any existing well., 'wastewater, disposal ;ewerage system on this or any adjacent or nearby lot . I "TSTATION IS INSTALLED ` IN AN AREA COVERED BY MOA B1 i AN ELECTRICAL PERMIT AND INSPECTION MU T BE C €TA I I IOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPO] ICAS... WORK MUST BE DONE BY A LICENSED ELECTRICIAN. DDT :ANT: LUPINE WOODWORKS, BY DATE: MUNICIPALITY OF ANCHORAGE Department. 1 Health and Environmenta. ?rotection 825 L Street, Anchorage, AK. 99501 264-4720 /_;' # HANDWRITTEN PERMIT # # Permit # �`"� �' � ����' WELL AND/-- ON -SITE SEWER PERMIT Applicant .�^AIE 1 J Mailing Address: Attd Location: Phone Number: 42t_11) Legal Description: (-7 k X :Z% Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) IS The Required Size of the Soil Absorption System Is: � f E DEPTH LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). # REQUIRED SEPTIC(HOLDING) TANK SIZE = -� GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. ' * # * TWO(Z) INSPECTIONS ARE REQUIRED # Backfilling of any system without final inspection and approval by this departmen- will be subject to prosecution. Minimum distance between a well and any on -site sewage disposal system is 100 fee - for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. # # PERMIT•EXPIRES DECEMBER 31, 1 9 9 I certify that: (1) I am familiar with the requirements for on -site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on -site sewer system may require enlargement if the resid nice e deled to include more th 3 bedrooms. Signed: Issued by: App scant Date: --� SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE Department Health and Environmenta' irotection 825 Street, Anchorage, AK. )501 264-4720 C1 HANDWRITTEN PERMIT Permit F Oc� Lg 1,0 _W P nV-" ON -SITE SEWER PERMIT Applicant: C�-t'ailing Address Location: Phone Number: Legal Description: L- -7 Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: C Soil RaJ:r�q.ft/br) The Required Size of the Soil �sorptioh System Is: DEPTH LENGTH 36 - GRAVEL DEPTH WIDTH The length dimension is the length(in :ebtct,%f"� depth of a trench or pit is the distan 7 the bottom of the excavation(in feet). There i The gravel depth is the minimum depth of gravel the bottom of the excavation(in feet). REQUIRED SEPTIC(W�LN G) TANK SIZ /6 Permit applicant has the responsibility to info m this installation inspections of any ells adjacent t�i to this of residences that the well will erve. I TWO(2) INXPECTIONS ARE REQUIRED t ckfilling of any system without final inspection and approva 11 be subject to prosecution. -n i rni -i rn distance c i- n n e- ci Ingni- gZ well I rq any sewage a the trench or drainfield. The n the surface of the ground and s n,6 set width for trenches. % between the outfall pipe and department property GALLONS * * during the y and the number disposal Ba 1 by this department wi Minimum en y on 7"s 1 system is 100 fee, for a private well 0 15 0 to 200 feet from a public well depending upon the type of public well. Mini ' mum distance from a private well to a private sewer line is,25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to",this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper", -.,installation'. PERMIT EXPIRES �,ECEMBER 31, 1 9 3 3 I certify that: (1) 1 am familiar with the cements for on -site sewers and wells as set forth by the Municipality of Anchorage. (2) 1 will install the system in accordance with codes. (3) 1 understand that the on -site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. Signci-d: Issued by: Applicant Date. '7- "in the event that a lift station Is Installed an electrical permit and inspection must be SWP/024(1/81) L-- obtained. As-builts cannot be approved un- "(Le"'A til the electrical inspection is received in this office. The electrical work must be per- formed by a licensed electrician." S & S TGINEERS, INC tX SOILS LOG 7125 Old Seward Hwy, Anchorage, Alaska 99502 PERCOLATION 349 )61 TEST r%so SOILS LOG -- PERCOLATION TEST BEDROOM PERFORMED FOR. PO 6 Y LEGAL DESCRIPTION: LOT 5 6 7 10 11 12 13 14 15 16 17 18 19 0- /. 0' ORGAN IC stiT ! if I E PLAN T UT -it -VT 'A -Y 10'- 3.5 SANK wl Some 6RAVCL, + -- TRACE 5/Lr'BRow,�� POORLY &I'ALED, SuS F" BRNb, , rr' 1 IS -13.01 .51L-T vl/TRACF- 70 SoroiE SAND a GRAVELGIRAYI poo�Ly CrRADED, sufSR"'Q() WELL Q)WPAC7-&t�� hoN-' I tit 6VL < 2. 0 " o -T--- %A' 7E�S T _2 r! I I I b W 7-7 WAS GROUND VJ,, I ENCOUNTERED? See cowme')f-5 IF YES, AT VV A DEPTH' Depth [1, Net A'a I e Drop 20 -1 1 VAL- H:S-T RUN BE [All COENIs A-,'AC.i4A,-Wi, RA7-,E 'WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geclogicel 5.. Geophysieoi Surveys ` Drilling Permif No. LOCATION OF WELL (Please complete either to, lb or Ic.) A.D.L. No. io, Borough..Suubdivisi n LotBlocck Ib. 1/4gIrs. Section No. Township N� Range EO Meridian i� t3 —of—of—of SO W� Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL �{ n Address: 6 0 F CC7 Street Address and Area of Well Location 2. WELL LOG Feel t Below Surface 4. WE L DEPTH: (finch �pZ.L� 5. DATE OF COMPLETION (/ Material Type Top Bottom ft. Q / 1/ t 8. Coble tool Rotary Driven Dug p4/ 4"'- �7 / r� Augur Jetted ❑ Bored Other: ^ r� (7 C Ei(i� �n SA/rr� �jr v¢ g �& 7. USE: N Domestic Public Supply Industry s yd {„-.,1c�'r �• Irrigation Recharge Commerical t,'� (' / '-7 7 k (7y.'�/ Test Well 11Other: _ Ex'A � �4 i7' ` v ` r /6 ` 10 C' 8. CASING: 0 ThSe/gded CZ Welded 4V iti t-fC-- ^JC�,4 _>,41 .� r•i4i/ 1 (� f L� 7 dlam. in. to//f% if. Depth Weight r Its. ft. rj Ard r} 6 , ke. 1 f ( % diam,_ in, to ft. Depth Slickup_1 ft. `� ���� % l� 9. FINISH F WELL: AAt fo �p 4"d b Type: c i lq l _ Diameter: Slot/Mesh Size: Length: h w Set between Qi�� �0(7ft. and �� it. y`. Backfiiling ._ _ Grovel pack _ "f 10. STATIC WATER LEVEL: fi. r/ Dote Above or Below land surface % rk'-Q?.5 Equipment used: / 11 . PUMPING LEVEL below land surface and YIELD ft. after _2�, hrs, pumoino a.I, ft. after hrs. pumping g.p.m. 12.GROUTING Well Grouted: Yes allo Material: Neat Cement Other: 13. PUMP: (if available) HP G) Length of Drop Pipe I'L capacity g.p.m. N r O Subm. Jet Centrifical Other 0 14. REMARKS: z 0 f6. WATER WELL CONTRACTORS CERTIFICATION: . 15. Water Tampera+•..�r� .,_._....� � F � C This well was drilled under my jurisdiction and this report is !rue to the best of my knowledge and belief; —---� y�---- Regis Bred Busin 14ame " Controct Licens Nue mber 'Address: v Signed: Date: .. -Auth^d joepre3entolive, Form 02-WWR (11/61) Copy Distribution: WHITE State DGGS, PINK - Driller, CANARY- Customer Municipality of Anchorage Development Services Department Building SafebJ E;vislcn OmSite Water & Wastewater Prcgram 4700 South Bragaw SL P.O, Eex 196650 Anchorage. AK 99519-6650 www.d,anchorage.ak, us (§07) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-191-49 1. GENERAL INFORMATION Expiration Date: Completelegaldescfiption TRAILS END SUgDIVISION; LOT 7~ BLOCK 8 Location (site address or directions) 11500 BROWDER AVENUE~ ANCHORAGE, AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address 99516 MIKE McDANIEL Day phone CONTACT AGENT 11500 BROWDER AVENUE, ANCHORAGE, AK 99516 Day phone. GEORGE McCOY w/ PRUD. JACK WHITE Dayphone 3201 "C" STREET, ANCHORAGE, AK 99505 783-2937 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 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 ~___ Communi~ On-site II 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 valid for 90 days from the date cf 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. (Ce~ficates may be reissued for a peded of up to one year with valid water samples.) Certificates are valid for one year fcr properties served by Class A or B wells or a public water system. The Municipality cf Anchcr-=~e is ncr responsible for e."rcrs or emissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $800.00 at, or prior I to closing for the engineering services provided. 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 Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS. INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504- Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provfde a thorough, cons~ientious engineeting analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered et the t/me of the test, and separation distances measured to readily Identifiable features. The operational life of a# wells and septic systems depend on the local soils condition, graundwater levels that may fluctuate durfng the year, and the water usage of the family being sen/ed by the system. These conditions ara outside 'the control of the evafuator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. A WWC, Inc. can therefore not provide any warranty or futura estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal tight whatsoever. 5. DSD SIGNATURE Approved for ~ Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms. bedrooms, with the t~lowing stipulations: Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: I I - I ~J - ~ ( , Legal Descd~on: A. WELL DATA Well type ~v^; Date completed Total depth 12o Municipality of Anchorage Development Services Department BuMlng 6a;e~ Oivtskm On-~te W~ter & W~mtswster Program P.O. Box 196650 Anchorage, AK ~9519-6650 HEALTH AUTHORITY APPROVAL CHECKLIST TRAILS END SUBDIVISION; LOT 7, BLOCK 8 Parcel ID: 015-191-49 IfA, B. orC provide PWSID# N/A 5/29/84 Sanitary seal fi/N) YES It. Casedto 116 ft. FROM WELL LOG Date of test 5/29/84 Static water level 52 .lt. Wall production 5 g.p.m. WATER SAMPLE RESULTS: Date of sample: 11/7/2001 B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL We, Log (Y/N) Wires property protected fi/N) Casing height (above ground) AT INSPECTION 11/7/2001 33 .ft. 3.0+ g.p.m. YES YES 12"+ in. Nitrate 0.5 mgJL. Other bacteria 0 colonies/100 mi. Coll~ by: AWWC~ INC. Date installed 10/27/97 Tank size 4000 gal. Number of Compartments 1 Cleanoute (Y/N) YES Foundation deanaut (Y/N) YES Depression over tank (Y/N) NO High water ala~n (Y/N) ~ C. ABSORPTION FIELD DATA Date Installed ~ Soil rating (g.p.d./lt~r ~/bdrm) System type__~ Length ~lt. Width ft, G~v/,qJ,balO~ pipe ft. Total deplh fl. Eft. ebco~on area ft~ ,~,~__,Dg, tul~~ Depression over nation treatment (past 12 mo.) (Y/N & type) If yes, give date D. UFT STATION Data installed Size in gallons ~__ _ "Pump on" level at in. "Pump off' n. High watar alarm level at __ .in. Da.~m Cycles tested. Meets alarm & drcult requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tsnk/litt station on lotN/A Ab~orpfion field on lot N/A Public sewer main N/A Sewer/septic sendce line 25'+ On adJacent lots. 100'+ On adjacent lots. 100'+ Public sewer manhole/desnout Holding tank 75'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Absorption field N/A Surface wats;: 100'+ Property line 5'+ Water service line 10'+ Building foundation 5'+ Water main N/A Wells on adjacent lots 75'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Bulidlng fou dn aflon.~t~--.--------'-'--'-/ Water service line ~______._~e.~e~ Driveway, parklng/vehlole storage C~~ Wells on adjacent lots. F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field Inapec~ons and review of Municipal records that the above systems ere In conformance with MOA I-IAA guidelines In effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date HAA Fee $ Date of Payment Receipt Number (eev. 12/m) Waiver Fee $ Date of Payment Recelpt Number - RELEASE OF CONDITION MUNICIPALITY OF ANCHORAGE D r EPARTtv'IENT OF HEALTH & HIJMAN SERVICES Muf 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 015-191-49 Parcel I.D. # HAA # 1. GENERAL INFORMATION Complete legal description Lot 7; Block 8; Trails End Location (site address or directions) 11500 Browder Ave. Anchorage, AK Property owner Mike McDaniel Day phone - Mailing address 11500 Browder Avenue Anchorage, AK Lending agency Day phone - Mailing address Agent Day phone - Address Unless otherwise requested, JHAA vvill be held for pickup. 2. NUMBER OF BEDROOMS: 4 S. TYPE OF WATER SUPPLY: Individual well XX Community well Public water 346-1022 99516 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF W,-V3-T!_:'j1JA7="R DDISIPOSAL: Individual on -site XX Holding -Lank 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 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 Address Engineer's signature 6. DHH SIGNATURE J Approved for Disapproved. __�; v bedrooms. Conditional approval for Phone "7,r„;i' Date 7 / z / 0 i.«•,. yea �, 'i�5a�.asso.,o o-a,a� r rh Garness a3 4L C=-7953 bedrooms, with the following stipulations: Additional Comments Ga"vC( ov`G V- kPc (�l 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 f � r4 F � • . 1.. Consulting Engineers July 12, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Attn: Donna Mears Municipality of Anchorage Dept. Health & Human Services Ref. Release of Conditional Health Certificate for Lot 7, Bk 8, Trails End. Dear Ms. Mears: The area over the new 4000 gallon holding tank now has 4 feet of soil cover. We are requesting that you issue a non -conditional HAA at this time. If you have any questions, please contact me at 337-6179, or 244 P612. Thank you for your assistance. Qin�arPw E., M.S. MUNICIPALITY OF ANCHORAGE MU LITY OF ANL6u" DEPARTMENT OF HEALTH & HUMAN SERVICES INV, L SERVICp-1 DJUr L Division of Environmental Services VJSJOIy On -Site Services Section MU 0 199 7 P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 RECEIVED CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # HAA # P\ EV1_) 0 1. GENERAL INFORMATION Complete legal description L-0-4 —7 -1 t-, S G;'j Location (site address or directions) JIS700 Property owner ry Day phone Mailing address .&J C_ 4. sc- I _G7 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: � Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. 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 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 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 Alaska Watsr Address Engineer's signature i /-OD 4D0 i Tl GAJ A-f_- ea(_"2oj) 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. r X Conditional approval for k-r'L)2 7q�,,,) P_ C3 i , OI'Ic7 W Additional Comments 2 (f Phone �37--61 Date /0 bedrooms, with the following stipulations: r'r i/t? 6r_ 0 � J i!p Cfi lrje Date 111 q _ 9 7 o 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 D. UET STATION Date installed Manhole/Access (Y/I _ Size in gallons Absorption field on lot N jp� On adjacent lots 100 + Public sewer main JA Public sewer manhole/cleanout IJ iA- Sewer /septic service line i DO Lift station tJ ("A SEPARATION DISTANCES FROM /HOLDING TANK ON LOTTO: Foundation d Property line -7 "' Absorption field t` ' Water main/service line 10 c Surface water/drainage 100 Wells on adjacent lots SO*IQN DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water n drain F. ENGINEER'S CERTIFICATION dati Water main/service line Driveway, parki Wells on adjacent lots area Signature 4 _j Engineer's Named 3 ,A. , a.�. 953 Date O 4t tSp u4 4yr GF QF"'p3�$ 4u e i v. 4 yf HAA Fee $ a Waiver Fee $ n. .- , cf ,.,, , ..+ / n-+- -f Facsimile Transmi"Itta!" 011SUItIng Engineers Comment(s): -T- Sy I-T o!2- AD 0 1 -T-70AI HUD goG, cy— A,D c-F (2- W 1-1714 L/C) L,,,I 12- 5��) i--� - i Reply requested: LJI Yes - No 8471 Brookridge Drive * Anchorage, Alaska 99504 * Phone: (907) 337-6179 * Fax: (907) 338-3246 Anchorage, J'A 4 0-11 7 6- MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE I. General Information Application Date ZL-&- a,' (a) Legal Description (include lot, block, subdivision, section, township, range) _0 -T- 'j (b) Applicants Name w Telephone - Home Bus iness Applicants Address (c) Applicant is (check one) Lending Institution 9 Owner/builder Buyer Other [::] (explain); d ) L e nd i ng Institution Telephone 2' 7WZ �D Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family 1 Multi -Family Other .(describe) Number of Bedrooms _4__ 3. Water SuDvl . Ly Individual Well ' Community E::] Public E] Note: If community well system, must have writter. confirmation from the State Department of Environmental Conservation attesting to the legality and status. 0 4. Sewage Disposal Onsite 5zf 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. C3 [Page 1 of 2] 5. Engineering 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 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 on -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 / V(-' . Telephone,,:-? `! 19 .,.'S� ) Address Date C 'S 'egy$® TH (ENGINEER SEAL® 6. DHEP Approval Approved forvL bedrooms By Approved Disapproved Terms of Conditional Approval -7 ®TH T'Hone. 600 . s�s @�� 2248-E � Condition THE �UNICIPALITY OF ANCHOPAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DEEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH. J ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEEr, -REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OIL HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DEEP SEAL) RR4/ej/D18 [Page 2 of 2] 7--19-84 MUNICIPAUly OF ANCHOR t)EPT. OE HEAL NVIRONsME iTAL r :., ECTiOJN MUNICIPALITY OF ANCHORAGE (MOA) ` HEALTH ALTI'HORITY APPROVAL, (HAA) CHECKLIST FEBRUARY 1984 RECEIVED A. WELL DATA Legal Description: E3' 1 Loci 4 V---Ct ( l .5` a:' _ Well Classification J#Z1Vti-A1 If A, B, cr C, D.E.C. Approved(Y/N) iJ? A Well Log Present (Y/N) \ADate Completed -- 3 J Yield r �,OM Total Depth' ` Cased to ! I 1 Depth of Grouting/ Static Water Level 2 2, r Pump Set At Casing Height Above Ground 2_f Sanitary Seal on Casing (Y L\lf Electrical Wiring in Conduit `(Y/N) 1(L.5 Depression Around inbilhead (YIN) IQ C Separation Distances from Well: To Septic/Holding Tank on Lot � 2-4,$ On Adjoining Lots %'' WO To Nearest Edge of Absorption Field on Lot 1 ; On Adjoining Lotsc To Nearest Public Sewer Line 0 To Nearest Public Sewer Cleanout/Marhole rJ 16 To Nearest Sewer Service Line on Lot, Water Sample Collected By &cVrZAC-C, &mP t Date j -r 004- Water Sample Test Results ,t H-- Comments B. SEPTIC/HOLDING TANK DATA Date Installed 2,3_101i Size 1 ` .S; t G No. of Compartments Standpipes (Y/N) �Jr-5 Air -tight Caps (Y/N)14(5S, Foundation Cleanout (Y/N)NE Depression over Tank (Y/N) RJ0 Date Last Pumped Alkq Pumping/Maintenance Contract on File (Y/N) for AJ6& Holding Tank High -Water Alarm (Y/N) 6aA. Temporary Holding Tank Permit (YIN) Separation Distances from Septic/Holding Tank: To Water -Supply 'till 1 To Building Foundation To Property Line '' To Disposal Field r To Water Main/Service Line To Stream, Pond, Lake, car Major Drainage Course / 1A Comments [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of system Design Date Installed -2 - 4 Z2 Jj Nj Length of Field Width of Field zo Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) Depression over Field (Y/N) /VO &te of Last Adequacy Test AJ 1A Results of Last Adequacy Test *J 1A Separation Distance from Absorption Field: To Water -Supply Well 130 / To Property Line To Building Foundation 2-C), To Existing or Abandoned System on Lot Af on Adjoining Lots > 2_00 To Water Main/Service Line A114 To Cutbank(if present) nflA To Streain/Pond/take/cr Major, Drainage Course A[Z4- To Driveway, Parking Area, or Vehicle Storage Area > ,S-C)/ Comments D. LIFT STATION /V6rT-- A PR- I CA 8 L-65 Date Installed Dimensions Sim in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments Check Permitted Bedroom Rating Against HAA Request 14 I certify that I have checked, verified, or conformed to all MOA HAA Gui �A , nes in effect on the date of this inspectico. A7 1� 1 4�� 0 QD.0 0 Signed Date- 00 00 , 0, MOA No 7- 0* 0 000*00 0 S Conpary .7 0, KB1/d5/s T 10M S R. SMITH . 09224 , -E 8 (Page 2 of 21 2-15-84