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Home My WebLink AboutSOUTHPARK #2 BLK 1 LT 29 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Na.~ DISTANCES ~ r- ~ e,", L~-o~_~- 7L¢'..,c//o-~ ~ SEPTIC ABSORPTION WELL ^ddre,~ '-', TANK FIELD Towaship, Range, Section AS-BUiLT DIAGRAM (Show Iocatioa of well, septic system, p~ope~y Unes, foundano~, TANKS ~' SEPTIC ~ HOLDING Manufacturer Capacity in galJons TYPE OF SYSTEM ~/, ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER Fill added above original grade Gravel depth beneaIh pipe Number of lines SOU rating Pipe materia~ installer Cate mnstalJed ~ PRIVATE ~ OTHER Ildentifv) In Date Installed: REMARKS: _ ~1[ Inspections Pedormed by: Municipal and Slate guidelin~ in eflect on~s date: . 72-013 (3/85) M lJ Iq I C I F:' A L.. I I' Y 0 I: A N C H El R A G E 0 N '- S I T E S E W E R P E R M :( T TURNER CONS'I'RUC!~ION I -~L.I E_K, AK D~b.q.5 Day Phone~ 7-1,. 8..-,...~ t' Pal*l::eZ :l:d." 0~=:'.0.,-()52'.-;=!'.9 Lo'l:. Sect:Lan: 5 T'ownsh~p: :I, 1N Range: 3W I..crL Size 26573 (sq. ~t,, of acPes) ~(:[:lr'~3c)ms~ ]'hJ.s F:'el'mit~ 4. 'lot. a.], Capac:ity~ 4 Block." I i.iC i'ANK~, M:i.n:i. mur~ t(:){al septic t. ank -. !.iqF:DI,ti~i D,,It,,II,,S,, PF;:IOR 'T'O 1S'1' & 2?ND INSPECT'IONS BY ENGINEER, IF ¢.:d ;l::i; t',: ; JiCE I,-IOURS~ CALL :345..-46E~i AND LEAVE A tdlESSAGE. C[)NSItdJCI PER ENGINEERS A'f'TRCHED APPROVED DESIGN. IHJ:t; i'~ ',d',t]l EXF'iRES 12/3:1./88 AND VALID F:'OR A SINEILE FAIdlLY HOME. ~op'Lh I.:)y Lhe MI,mJCil::~aZ:i.'l:y (){ Anchepage (MOA) arid the St.~,d:.e (:it' Alaska. '.',. ! ~.l:i] I insta:l.! Lhe syst~:.~m :i.n acccmdanc:e t~J.'Lh a].l MOA cod6~s and r, egu].atians,~ and in c:ompliance with the design 6i".:[t(~)r':[a o[' this pei'miC. · 5. .l: wilt adher'e I:,o ,ail MOA and State cH Alaska r,e'~quil, ement:.s I(:u" 'Lhe set. back dis'l,ances fr'om any ex:i. stJ. ng t,¢e],l, t4~iE¢'[.e]~ga'lLeP d:i. sposal syst. em tip pubJ.:i.c ~J,, Zi ~u~der. starld t. ilaC this per, mit, :i.s¢, v¢~lJ.d ¢(:)1" a ms)4J, mLt¢i) 0~' 4. bedr,[:oms,, 1 ;ti, so ~u'~dc.:p:,lalid 'Lha!:. '[.he capac:i, ty (:)f the total si~ys't, em :i,!~i 4 bE~I:;IPOi:III~B ar'id any (,,en].ar'gemmrlt wi].]. PequiPe an additiona], pePm:i.'L,, (O(*,~r"~e?) 'TUI::(NER CONSTRUC]'ION MUNICIPALITY OF ANCHORAGE 'rill.; 'EURNER COMPANY DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT l 0 t988 RECEIVED October 10, 1988 TO WHOM IT MAY CONCERN: I hereby authorize Alice A. Smith to act as a representative for The Turner Company. Please allow her to pick up the Sewer Permit for Lot 29/Block 1 South Park on my behalf. P.O. Box 3489 Palmer, Alaska 99645 (907)745-8334 · ALASKA eFIUIROIhrllelhTAL COIqTROL $8RUICe$, IBC. SPECIFiCATiONS FOR BED WASTEWATER TREATMENT SYSTEM LEGAL DESCRIPTION: LOT 29, BLOCK 1, SOUTH PARK TERRACE #2 1.0 1.2 1.3 1.4 1.5 2.0 2.:i 2.2 2.3 2.4 2.5 GENERAL The drawings, sheets 1 through 4, she]! be part of this specification. A!1 materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Rea]th & Human Services (DHHS), the conditions of the permit, and all applicable rules and regulations currently in effect. Ail excavations and depths are advisory, aud are to be verified or modified in the field by the Engineer or inspecting agency. It is the responsibility of the owner or installer to adhere to approved design for the iastallation, to maiutain the specified separation distances and to have the appropriate inspections. If the installation is not inspected by an AECS engineer, AECS will not be responsible for the installed system. An engineer at AECS should be consulted prior to construction, to determine the number of inspections that will be required and to explain what these inspections will involve. SEPTIC TANK If there is an existing septic tank it may be used if it meets the capacity requirement for the residence. The structural integrity of the tank must be verified. The septic tank shall be a UPC-Approved two-compartment tank, constructed of 12 gauge steel with bitumastic coating and set level on undisturbed sail. If the tank is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 iuch burial type polysWrene rigid board insulation. The septic tank shall be a minimum of 5 feet from the house foundation, and a minimum of 5 feet from the absorption area. The septic tank and bed shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class C wells, and 200 feet from Class A or B wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by DHHS or Alaska Department of Environmental Conservation (ADEC). Piping shall be fitted with a mechanical watertight calder coupling on the outlet amd inlet of the septic tank. Piping shall be 4-inch solid PVC ASTM D3034 or cast iron, sloped a minimum of 1/4 inch per lineal foot on the inlet side and 1/8 inch per foot on the outlet side. If the piping is 1200 ~Uest 33r~ ~ucnut Suile B · ~ach0ra§¢, Ahska 99503 · (907) 276-1361 2.6 2.7 3.0 3',1 3.2 3,3 3.4 3.5 3.6 3,? 3.8 buried at a depth of 4 feet or less, it mnst be insulated with an overlying layer of 2 inch burial type polystrene rigid board insulation. C,eanout~ shal] be insta]!ed as designated and capped with air-tight rain caps (Jim caps or equivalent), and extend a minimum of 1 foot above gromnd level. If a lift station is required it shall be a combination lift station septic tank per Anchorage Tank and Welding, Inc. design. See attached specifications. SEEPAGE BED The gravel for the bed Shall be 0,5 to 2.5 inch, screened rock with less than 3% passing the 1200 sieve residual. All substitutes must have prior DHHS approval. The bottom of the excavation shall be level and raked with the backhoe blade to insure that the bottom has not been compacted daring excavation. Sand, for leveling, shall have a size distribution which meets the requirements of MOA code 15,65.077. The distribution pipe shall be perforated 4-inch rigid PVC with a minimum crush strength of 1500 pounds and shall meet the approval of DHHS for use as drainfieid pipe. All pipes shall be laid level, and spaced according to the drawings. Monitor standpipes shall be placed as shown in the drawings. They shall be 4-inch rigid PVC ASTM D-3084, or cast iron. The section shown with holes may be either drilled 0.5 inch holes on 6 inch centers on opposing sides of the pipe, or a section of regular perforated sewer pipe may be clamped to the solid section with a no-hub coupling or solvent joint. Perforated sectioa shall be located in gravel only. The portion of pipe above the sewer rock shall be solid. A rubber raincap (Jim Cap or equivalent) shall be placed over the top of the pipe. Insulation is required, using burial type polystene rigid board insulation. There shall be 1 inch of insalation for every foot of soil less than the required 4 feet of cover, but there must be at least 24 inches of soil even though insulation is used. The solid pipe extending from the septic tank to the drainfield shall a/so have 4 feet of cover or an equivalent layer of insulation combined with soil. The side slope of the mound shall be sloped 1 foot vertical to 3 foot horizontal. The the bed sha]i be planted with a white clover and red fescue mix or blue grass. 4~2 4.3 INSPECTIONS This bed will require a minimum of three inspections. The first inspection will be of the open excavation, to assure that the system is installed in the proper soil strata, correct depth and meet minim~lm specified design parameters. The second inspection will be after placement of grave], monitor standpipes, and distribution pipe, to verify proper installation and position of pipes prior to backfill. The third inspection will be after final backfill and grading to ensare that adequate soil cover has been provided over the bed. The inspection of the septic tank or lift station installation can be incorporated with any one of the above listed inspections. ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. i~/12~ West 33rd Avenue, ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEE? NO '] OF CALCULA'rED BY CHECKED BY DATE JOB ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. ' [200 west 33rd Avenue. Suite B ANCHORAGE. ALASKA 99503 (907) 561-5040 SHEET NO OF CHECKED BY SC^LE / ~-- ~ /"~ ~/~ 8 10 - 11 1 3 - 14 20- COMMENTS PERFORMED BY: . ,LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST SLOPE WAS GROUND WATER ENCOUNTERED? SITE PLAN IF YES, AT WHAT DEPTH7 Gross Net Depth to Net Reading Date Time Time Water Drop 4>/~ o /~ '~ ~ /. 2~ "'. Reid, Jr. PERCOLATION RATE ~ ~/A. (minutes/inch) No. 225BE /.// TEST RUN BETWEEN ~(//~ - FT AND FT / ' CERTIFIED BY: :PLOT PLAN ~.~ AS BUILT SCALE JJ'~ ~-fD' ;.'~. NNETH G. LANG, L.S. 1731 GEORGE BELL CIRCLE, ANCHORAGE, ALASKA 99515 (907) 345-6476 PROPERTY: LOT Z~ , BLOCK / ' '~c:~'~'h't~'~'~-'~'J~P'u'c~'°Ur A"c:'c'~:'Z- ' ~o~ RECO~ING DISTRICT, ALAS~, AND T~T THE IMPROVE- M~TS SITUATED T~REON ~E WITHIN THE PROPERTY LINES AND DO NOT . ENCROACH ONTO THE PROPERTY ~JACENT THERETO, T~T NO IMPROVEMENTS ON THE PROPERTY LYING ~JACENT T~RETO ENCROACH ON THE SURVEYED OT~R VISIBLE EAS~ENTS ON SAID PROPERTY EXCEPT AS INDICATED : ~REON. ~ ~H~S ~H~ q~ ~ 0~ ~ , ~, ~ F'O b ~,~Zl 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264 4111 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840724 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 29 Block 1 Southpark Subdivision #2 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. 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 as-built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720° Sincerely, Keith E. Bandt, SupeYvisor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 MU~ IICI F'~LI-['~ O~= A~SC~OR~SEE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE~ AK 99501 264-4720 PERMIT NO.~ DATE I SSUEI): 840724 08/27/84 APPL I CANT: ADDRESS: []ONTACT PHONE: LANDMARK-VENTURE LTD P 0 BOX 111654 ANCHORAGE, AK 99511 345-4807 LEGAL DESCR~P: ._OT SIZE: MAX BEDROOMS: ~SLIBDtVISION: SOUTH PARK $~ LOT: 29 SECTION: 3 TOWNSHIP: llN RANGE: 5W 26575 (SQ.FT. OR ACRES) 4 BLOCK: Listed below are the options available to system. Choose Lhe optien you in designing,your septic that best £its your site. TR~£NC..~ ~ED ~ ~ ~)Fq:A ][ N DEPTH TO PIPE BOTTOM (FT. ~ .4.0 4.5 4.0 GRAVE[. DEPTH (FT.) 4.0 0.5 5.0 TOTAL DEPTH (FT.) 8.0 5.0 '7.0 GRAVEL WII)TI~I (FT.) 2.5 22.0 5.0 GRAVEL LENGTN (FT.) 76.0 '~ 42.0 71'.0 GRAVEL VOLUME (CU.YDS.) 31.7 34.5 46. 1 TANK SIZE (GALS) 1,250.(} '~ 1,250.0 ~'~ 1~250.0 ~ SOIL RATING (SQ.FT. /BR) 152 152 :[52 ~ GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ~'~ TANK MGST HAVE AT LEAST TWO COMPARTMENTS cert i ~'y that: 1. I am ~'amilia~~ ~ith the requipements for' on-site seweps and ~m].ls as set £orLh by the Municipality o~' Anchora~e (MOA) ~nd the State o~' Alaska. 2. I ~ilI instaI] the system in accordance ~.~ith all MOA code~ and negulation~, and in compliance wlth the design cpitepia o~ this permit_ 3. I wil) adhere to alt MOA and State o{ Alaska requi~ements fop the set back distances ~pom any existing well~ wastewa{ep disposal system op public se~erage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum :)F 4 bedrooms and any enlargement will requipe an additional pepmit. IF A I_IFT STATION IS INSTALLED IN AN AREA COVERED BY MO~ BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE AF'PROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) ]'HE SIGNED ~ ' DATE: /-"~UNICIPALITY OF ANCHORAGE D[PARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage. Alaska 99501 264-4720 ............ L-----~JOI LS'L-OG':*-p ERCOL-ATION T EST PERFORMED FOR: LEGAL DESCRIPTION: 2 3 7' 9 10 11 12. 14. 15- 16,,, 17- 18- 19- 20- DATE PERFORMED:~ SLOPE ~r ~ SITE PLAN 7'/1 -oLI6m WAS GROUND WATER ENCOUNTER ED7 IF' YES. AT WHAT DEPTH? -/ 7i/ ,! :/ / , / Gross Net Depth to Net Reading Date Time Time Water Drop ~ m'~7 'Lo .l~ ,17 ~0 I~.'~ · ' · ' ~ ~ ', . ~ '/2-. · Reld, Jr. PERCOLATION RATE (mtnute~linch) ,- 4.. TEST RUN BETWEEN - FT AND , FT PERFORMEb BY: , CERTIFIED BY: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 0~0 ~ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: Day phone 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. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my 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 2.0'~ t,Z/ /~-/~¢~ ~ ~ b Engineer's signature ~ ~ DHHS SIGNATURE ~ Approved for Disapproved. Conditional approval for ~_A_//~- ?/) bedrooms. bedrooms, with the following stipulationS: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS 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. 72~25 (Rev. 1/91) Back MOA fY21 Municipality of Anchorage ,~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Log present (Y/N) _ Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protect'ed(Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed \ \l ~ ~) Tank size I ~7-~) ~ Compartments. Cleanouts (Y/N) ~/ Foundation cleanout (Y/N) ~ Depression (Y/N) High water alarm (Y/N) ~4~.¢~ Alarm tested (Y/N) Date of pumping "~/~ 7/~-~ P~lmper ~'~q."¢ "~ ~- N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots b¢//'/'~ Foundation Absorption field ~ Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at 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 Itlc~l¢~::~ Length 5~¢, ~- Width Total absorption area lO0 6 - Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating I _'~ Gravel thickness Cleanouts present (Y/N) Date of adequacy test for /~ System type Total depth Y bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I'J//~, On adjacent lots ~¢'//2k Property line To building foundation On adjacent lots ~. Surface water t'"- I Curtain drain ~-.L E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guideline¢ifi eff, ect:on the date of this inspection Signature '~.~ , --T" III (' ~. I HAA Fee $ ,'/'~D¢ Date of Payment Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 (907) 349-7755 March 22, 1993 Mr. Tobben Spurkland SUBJECT: South Park Terrace Subdivision Class "A" Public Water System, PWSID 213475 Dear Mr. Spurkland; I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water' System and found the following: 1. The last ~atisfactory Total Coliform Bacteria Sample results was submitted to this Department on February 4, 1993.. This does meet the provisions of 18 AAC 8o.200(a), of the State Drinking Water Regulations. 2. Tl~e last Inorganic Chemical Contaminants Sample results were submitted to this Department on November 5, 1992. This does meet the provlsions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 3. The last Radioactive .Contaminants Sample results were submitted to the Department on December 10, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations, 4. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on November 6, 1991. Based on analysis of the previous VOC samples results have been satisfactory, This does meet the provisions of 18 AAC 80,200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System la In compliance with other provisions of the State Drinking Regulations, If you have any questions on the above information, please do not hesitate to contact this office at 349-7755, Sincerely, Michael Lu Environmental Eng. Asst. II MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~ , HAA # .. 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (b) Property owner (c) Lending Mailing Address Telephone: (home) Business Telephone (d) Real Es'(ate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here'l~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE ! Single-Family'S(- Number of bedrooms ,/-'// 3. WATER SUPPLY Individual Well [] Community"~ Public [] Note: If community well system, must have written confirmation from the state Department of Environmental Conservation attesting to th legality and status. 4. 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'$NOI.LO~IdSNI 9NlalAONd INI:IIJ ~ MUNICIPALITY OF ANCHORAGE (MOA) (~,~/-~/ Health Authority Approval (HAA) \~,,~;~/ cHEcKLIST - FEBRUARY 1984 MUNICI~F ANCHORAGEr 343-4744 ENVIRONMENTAL SERVICES DIVISION Legal Description: ,¢.o7-' MAR 2 0 1989 A. WE,LD^TA RE £ E lYe,g,,., Well Classification If A, B, C, D.E.C. Approved(~N) __Present (Y/N) Date Completed Yield Cased to Depth of Grouting _ _ __ ..... Pump Set At __ ~..~_ __ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit ~J,~.,~ __ Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WEJ.~ To Septic/Holding Tank on Lot ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~ ; On Adjoining Lots To Nearest Public Sewer Line To Nearest P~anout/Manhole ; Date ~ To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed /O-//-,¢~' Size Standpipes (~YN) /~-5'b No. of Compartments ~ Air-tight Caps(~N) Foundation Cleanout (Y~N) Depression over Tank (Y~ Date Last Pumped '~./"" Pumping/Maintenance Contact on File (Y/N),I: ,,J/R,- ; for Holdin~j~..~g~-¥~,~.~larm (Y/N) ~/~ Temporary Holding Tank Permit (Y/N) SEP~e~ ~ISTA~OM SEPTIC/HOLDING TANK: Tq~-S~g~q~ ~ To Building Foundation To~ro9ertv Line ~/~ ~ To Disposal Field To S~'P~.~.~N~:'~jjor Drainage Course /~ * Comments,~, ~,;;' ~,;'? .-, ? 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA cods Rating in Absorption Strata [)ate Installed Width of Field / Square Feet of Absortion Area Depression over Field (Y(~ Results of Last Adequacy Test /-///4- SEPARATION DISTANCE FROM ABSORPTION FIELD: 'Fo Water-Supply Well To Building Foundation Lot ,~/~' To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field .-~ Depth of Field ~/o5' / - Gravel Bed Thickness ¢ ' ~' / Statndpipes Present(~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) ~/'~ ' High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments 't~J, I,~F~ STATION Dat~~ Dimensions Size in Gallons % Manhole/Access (Y/N) "Pump On" Level at ~ "Pump Off" Level at -'~""~"~ Vent (Y/N) "'~-..-~~ d u ri n g Ad eq u acy Test. **Check Permitted Bedroom Rating Against HAA Request** '"~ certify that I have checked, verified, or conformed to all MOA and HAA guidelines ' inspection. signed Company Date MOA No. Receipt No. Date of Payment Amount: $ Receipt No. Waiver Fee: $ date of this Date of Payment 72-026 (Rev 7/88) Back Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 316 ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: March 15, 1989 PWSID: 213475 To Whom It May Concern: According to the records on file in this office, the SOUTH PARK TERRACE S/D NORTHis in compliance with the State of Alaska Drinking Water Regulations. Sincerely, v RA E. cRAiG Environmental Field Officer