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SPRING FOREST BLK 2 LT 4
Spring Forest Block Lo1- 4 #015- 321-26 Municipality of Anchorage Page i of ~r- DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~;-~'q"]c~zo~'7~) PIDNumber: Ol~ '3 ~ Name: CO~{~ ~ ~[~~ ~::~W~ Wastewater System: O New ~Upgrade Add~,,: ~1 ~T~. ~' ' ABSORPTION FIELD Phone: ~4G- ~3~3 ~No. of Bedrooms: ~ D Deep Trench ~hallowTrench OBed ~Mound DOther Total Depth frqm original grsde: LEGAL DESCRIPTION so, R~,~g: - ~ ~PD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe botlom fram original grade: Gravel depth beneath pipe Townshlp:~ Range: Numbsr of ~ines: Distance ~sen ~ New ~ Upgrade ~ O~a~pth: t, 0 Ft. ~, /~ Ft. Classification (P~B,C): Total De~ ~d To: Total absorption area: rope material: ~t.Ft. ~,~ SQ.~t. 9~3~ ~ F~ lO Driller: Date Drilled: Slalic Waler Level: Installer: CG FL C~ ~~ Dateinstal~d:/ SEPARATION.DISTANCES ~ Septic ~~ Ho ' ~ S.T.E,P. From Tank ~leld StaUon Tank Sewer Lines i S~rf.~w.,~, ~JA ~-- '~ ~ LIFT STATION Line Foundation. ~/~ ~/ ~/~ ~/~ ~/~ "Pump on" level at:~H[gh water alarm at'. Remarks: ~ ~s~ ~ BENCH MARK Location and Dascriptlon: m Assum'edElevation: I~, OD fh P~ Department of Health and Human Services approval 't~;~. Reviewed and approved by: ~ ~"~ Date: ~ ~/~ ''k:~ROFESS'~='' 72-013 (1/91) MOA 25 Permit No. ~¥4 c~ ?_ _O ~'76) . Pag6~.·.-- Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES of ~I- · ... . ENVIRONMENTAL SERVICES DIVISION -. p.o,'Box i'96650 · Ahc.horage, Alaska 99519-6650 · Telephone: 343-_4744 . Oh~Site Wastewater DIspo.sa!iSYstem'a~JllJ~If~C~insPecti°n~R~13°'rt ' ,.~ H_t,. ~LO~ Permit Nd. ~"~ Cl.2. O3"70 P'age~Z~ Munlcipallty of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ~ · , .ENVIRONMENTAL SERVICES DIVISION · ' ' e chora e, Alaska 99519-6650 · Telephone: 343-4,7f[4 p.o. Box 19.6650. An..c,__a_~._, ~,,~,,,. ~.~'.lnspection~R~po'rt 'On-Site Was~ewater Lnspu~a, o~o,~m~. - Alaska Water & Wastewater Services "Preserving the Last Frontier" RECEIVED May 9, 1993 MAY 1 1 1995 Municipality of ~nchorage Department of Health and Human Services Division o'fi EnvironmenSal Services On-Siae Services Secl:.ien P.O,. Box 196650 (:mchorage, Alaska 99519-,6650 Municipality of Anchorage Dept. Health & Human Services Re'l;: Inspection Report 1=or Lot 4, Block 2, Spring Forest S/D To whom it fnay CoRcef'R: Attached is the subject inspection report. The only variations to lshe original design are summat-ized as follows: The majority ot' the new drainfield 'falls ~ithin the 50 foot radius of the original test hole, except for the ~est 15 'feet of each trench. During the installatior~, the accepting soil stratum was found at a similac elevation at both erode o'F the t~mnches. Further'moue, at the t~e I pec'focmed the origina} percolation test (10/10/92), an exploratory hole was dug neac the west emd of the tPelqches, and the soil profile Mas ve~-y si~:~la~ to the soils d}noouRtered iR the actual test hole. Based upon this information I believe the soil pPo¢~le is similac at both ends of the trenches. II'~ additiorl, please note that the accepting soil stPatun~ found at a relative elevat~or~ of 89.90 Pathec than 89.6J6 as I"~oted on the soils ],og; ho~geveu, th8 sand laysc was exter~ded to 89~62 in the north trench. you have any question, please call me a 5~7-61'79. Sincerely ~ ,,/~ O¢~'e P/L~ n ~u I rant JaG/~ag Ho~ard$.WPS Telephone - Fax 338-8246 · 8471 grookridge Drive · Anchorage, Alaska 99504 PAGE i OF i 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:SW920370 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:HOWARD COLIN C & OWNER ADDRESS:5931 WEST TREE DR ANCHORAGE, AK 99516-5108 PARCEL ID:01532126 LEGAL DESCRIPTION: SPRING FOREST BLK 2 LT 4 DATE ISSUED: 10/27/92 EXPIRATION DATE: 10/27/93 LOT SIZE: 43730 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD 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 (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ISSUED BY:/ Alaska Water 8c Wastewater Services "Preserving the Last Frontier" October 18, 1992 Municipality of Anchorage Department of Hea,].tl-i and Human Services Division of Environmental Services On*-SiLe Services Section P~O~ Box 196650 Ancherage ~ Alaska 99519,~,6650 Ref: Septic System Replacement 'for Lot 4, Block 2, Spring Forest Subdivision. T0 whom it may concern: Attached is the application, site plan, and design drawings for the subject septic system replacement;. Comments regarding the proposed system are as follows: 1. TRENCH DESIGN: As can be seen from revieming the attached percolation test r-esults~ the soil "perked" at 10.7 minutes/,inch at the location proposed for the system. For a trench symtem, this corre~sponds to an application rate o'fi .8 gpd/ft2.. Since the existing home has f~ur bedrooms, the total design 'flow is 600 gpd. Based up/this, the minimum amount of absorption area~ is 7:)0 'ft' ~ The proposed oystmm provides 75O ft2. of absorption area. As can be seen in the design drawings, the bottom of the trench wiii be at a relative elevation of 90~33 feet. Since the accepting soil stratum starts at an elevation of 89~65, a sand layer will be installed between the bottom of the trench and this stratum. The purposm of placing the bottom of the trench at 9()~55 feet is to provide a separation distance of 6 feet from the bonded angular rock encountered at 84~35 feet, which was assumed to be impermeable. 2. LOCATION OF CLEAN-OUTS: The clear,-outs normally required immediately downstream from the septic tank have not been provided, since th(~y would not be functional for this design. Inst,~ad, I have placed clean-outs so that jetting of all lines can be accomplished from the end of the trenches back to the septic tank. 5. TOPOGRAPHY: Since the entire lot is relatively flat~ the grades were not "shot". There are no slope concerns. Telephone - Fax $38-3246 · 8471 Brookridge Drive · Anchorage, Alaska 99504 4. UTILIZATION OF EXISTING BED AS STANDBY SYSTEM: Plea.se note that the existing bed is going to remain in place for future use. Clean-outs will be installed en the bed so that it can be "pumped" in the future. An alternator valve will be installed so that the homeowner oan switoh bac'.k and forth between the new and e×isting systems. I am unaware of any impaots that this installation would impose on adjacent wells, oF septio systems. If you have any question, please call me a 557-6].79. Howardl .WPS --ikx~ TAt-W. freyA. Garness CE-7953 Munlclpallly of Anchorage ' ~ I'.~-/~.~...'~'~.--~t'~.-~-~,-;.~ ,"~ I DEPARTMENT OF HEALTH & HUMAN SERVICES SOILS LOG -- PEROOLATION TEST ~~'~ ] Township, Range, Section[ PERFORMED FOR: c~zr' ~/~L,~EGAL DESCRIPTION: q~ 1 2 3 4 5 8 9 10 11 12 13 14 15 16 17. 19- 20- ~OMMENTS t-~ N~/A~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED?' s IFYES, ATWHAT ],,~//~ .'~ ~) DEPTH? p Monitoring? Gro$1 Net ' Depth to Net Reading Date Time Time ." Water Drop V. PERCOLATION RATE O. -~ .!minutes/inch) PERC ·HOLE DIAMETER TEST RUN BETWEEN '~'~*'.~"7-FTAND -/' ~''~ FT PERFORMED BY: '-~f-"~ ~'~"l'~'~J~''~ I "~:;~~3~-~J~--''~-~ CERTIFY THAT THI.,$ TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL (3UIDELINES IN EFFECT ON This DATE DATE /~)//~//~- 72-008 (Rev, 4/85) 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 Name Address LEGAL DESCRIPTION Township, Range, Section [ No. of BCrooms TANKS '~ SEPTIC [] HOLDING Manulacturer Capacdy ~n gallons Material No. of Compadmeats T~PE O[ 8~STE~ ~ BED : W. DRAIN : OTHER TRENCH Depth to pipe bottom from Total depth Item original grade original grade F'I' Fill added a~.~rade FT J Gravel depth beneath pipe Total absorption area ./ /~ Distan~between lines Number gl lines Soil rating Pipe m t~la~ S0 FT '~ FT Installer Date InsJalled WELLS [] PRIVATE ~.,OTHER lldentifv) Classilication (A,B,C) Total Depth ~ Cased to /~ FT FT Installer 3ate Inslalled: REMARKS: DISTANCES WELL SEPTIC ABSORPTION TANK FIELD WELL AS-BUILT DIAGRAM (Show Iocalion of well septic syslem, property hnes, Ioundahon, driveway, water bodies, etc.) I _ ceflily Bat this inspection was periormod according to all Municipal and State guidelines in effect on this date: ~,%7~-~ ~' 72-013 (3/85) Depar. tmer'~t, of' I..l~,:alt. h ~,. Human o I',.l ..... s 3: 'r 1!~s I!i; F' "r' :[ c "f' ,q N I<I=' IZ FI H I '/" Name: CDL. INC. (~d I::l p ~,ss: '..!~ c.~ 5:1. (~F, ICff'.IOF.'(-'tI)!)E, (.~I'::: ~?~?[51A-...A708 34. A..... :1. :];'73 I....cxt. Leg a :1.: SLd::)cl :il v j. ~ ~. ~::~lr'~ ~ ![~1:::'1::~ I IxlE] FCIF~ED"F DLJD;O ,, L..O'L I...ot. S:i. zf:'?'4':5730 (~CI" f't.,, Of ac:r"~.;.~s) I'.'h~:~.x Bex::l r-ooms: 'Th i s I:::'e r' m i t.: 4 Tot. ,':'~ 1 Cap ~c: i Block: · ~...,.~ .. ga 11 c~r'~,, Each seff:~t, lc: t. ank mu~.~M'.. I"l,'av~.:~; f~'L least, l':t COml:~amt. m~rrLs, D~l::rLh to t. op of ~.~ep'Lic: t. au"lk (s) <: 4.,,0 f~.x.:.:.).l:, r'~.=,quiP¢:.¢~!i!~ ir'~.~3uli~;rL:i, ori ovf~.:,r~ t. ar"~k (!s) . :[I'qFC)I::~M D,,H,,I..I,,,r:i~ F:'F~ ]: OF:.'. TC) 1ST ~,. 2.1',1.0 INSF'IL::C;'T:I:C)Ixt,S) BY ElXlE~INEEF~, iF' (~FT'I!!!:I::~ ::::::::::::::::::::::::: I'-IOUI'~S C:(.~I....L. :3Zl. 3-..q. AL:]:t (~lxl]) L. EAVI!ii: A HESS(41::~Ii!i: ]: NS'I'(-~I_L. F:'ER IZIxlE) I NIS[~I:~S (~F'I:::'F;:DVli:-:D (4'f"T'(-~CI..II!~D DES I DN T'H I S I:::'IZF~H I T EXF:' I I::lrss 12./3 1 'H...IIS !:::'Ii[I::;:MITF:OI::;,' ¢~ !i]:r. NGI_E I::(~HILY Fd:ii:SIDENC;I~i: ONL..Y CISI::i'.T :!: I:::'Y "H..l(Zft": :1.,, :1: ,~:~m f','am:i.].i,'ar, w:i.'Lh 'Ll"'m~ r'c..'qLtiPe!m~.?r'lt.!s fop on-'sit, e se~wePs and wells as ~ile~t, fc:,r'T..h I::ty the I~lt.~nicil:a].it.y of' (.~ncho~-ag~, (MOA) and t.h~.~ 2, I t~:i.].l :i. nst. all t.l"m~ sy~d'..c.:.)m :i.r"~ ac:c:cmclar~c:e:, wi'Lin all MOA c:c:lcle~ ,m"~d r'egulat.:i, or~s, ~'~'~ls(:J J.l"! c:c)rrq'.~].ii:~tr'~[:(~.:.:, ~J.t.h T.h~s de!~:i, grl c:r. it.~r'ia or ~h$~ per'mi'L. 3,, t t,~:i.:l.I adl'"m~r'(.~ t.o all MC)Ah and St.,:~t.(.:.:~ o{ (~].asaka r'~:.:~quipe~ment, s fcmt. hw s~t. back d:[s'Lar'lc~s f r'om any ~x ist. ing ~]. 1, ~asM'..e~,~at.~m" d:i. spDsal ~yst.~.:,m oc I:~Cd::~ 1 ic: se~emag~.:.'.~, sy~rL~m c)n 'l:.his ~::)1" any ad.jace~nt, of r'~ear'by lo'L, 4,, I unclc+?r'st, ar~d t. hat. 'Lh~s pe~"rnit, is valid rcm a m~ax:i, mum (O~,,~n~.:.:.m) COL. :l:lxl ~< I~.i:l_ l Z{.~BE:TH ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JOB SHEET NO CALCULATED BY CHECKED BY SCALE OF DATE ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME A.E.C.S took out the permit~ [PHONE [ L~'~EW "' MAI LING ADDRESS LEGAL DESCRIPTION Well ~ ~ Manufacturer Liq. capacityj ~-in ,~'[gall~ns IF HOMEMADE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ ~ ~ Manufacturer Material Liquid capaciw in gallons ~ Well Foundation Nearest lot line PERmiT NOt. --~ ~ ~.~ ~ No. of,ines ~ Lenmh of each ,in~o Tota, ,ength of ,?~¢ Trench width Oistanc. between ,ines ~ ' inches ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption Length Width Depth PERMIT NO, ~ P Type of crib Crib diameter Crib depth I Total effective absorption area ¢ m DISTANCE TQ: Well Building foundation Nearest lot line ~ Class Depth Driller Distance to Jot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) PIPE MATERIALS OTHERp~ ~ SOIL TEST RATING 'NSTALLER s' ~' ,4 REMARKS / APPROVE~' DATE LEGAL 72-013 (Rev, 3/78) MUNICIPALITY OF ANCHORAGE Department f Health and Environment~ Protection 825 ~ Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit # ~/~(~1.% ') '-' W~F_L~-AND/OR ON-SITE SEWER PERMIT Applicant: ~--~Ld Mailing Address Location: Phone Number: j~ ~ ~/~/ Lot Size: ~ Holding Tank: Legal Description: .,b--~?Q~-I___~,~,¢:~ WC~-LC~ / /- ~/ Type of Soil Absorption Syste~ Is: Trench: Drainfield: Seepage Bed Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH LENGTH ~,.]2~F' . 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 = /°>-~F-] 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(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet 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 $1~ 1 9 8 3 * * * 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 residence is remodeled to include more that j~edrooms. S igne~, ~/7 //~¢/~t~- IS sued by: c Applicant Date: ~ ~/ ~- F~...~ SWP/024 (1/81) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 4 B 7 8 10 11 12 13 14 15 16 17 18 19 20 [] SOILS 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 IF YES, ATWHAT DEPTH? SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop NO ,'. z~ ,. bb 72-008 (6/79) PERCOLATION RATE ~ ~0 (minutes/inch) TEST RUN BETWEEN ~,~,~ FTAND ,_~__ FT CERTIFIED BY: PERFORMED FOR: LEGAL DESCRIPTION: ©L 2 3 4 7 8 ~0 ~2 ~3 ~4- ~7 ~8 20- COMMENTS [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST SITE PLAN I ENCOUNTERED? IF YES, ATWHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop /i z'.,o i0 ,Ho PERCOLATION RATE TEST RUN BETWEEN ~-/'~ FT AND L~ ~ FT CERTIFIED BY: DATE: ALASKA ~F1UIRORm~F1TAL COF1TROL $ RUIC $, IRC I~n(lincerin~ 6 {~nuironmcntd $1u~ie$ PERCOLATION TEST DATA SHEET ADDRESS zip CODE LEGAL LOCATION ~. I ]F_J TOTAL DEPTH OF HOLE ,!,[p'12- ft. ZONE TESTED ~/2~ ft TO L~ ft ..... READING # CLOCK TIME NET TIME DEPTH TO NET DROP !R (min/in) DATUM .~ H2.(3 z: ~q ,, tot FINAL PERCOLATION RATE PERFORMED BY (min/in) 1200 ~Jcsl 33rd Aucnu¢, SUl,,!o~', A,cho,o~c AIosko 99503 · [907) 276-1361 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.cLanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI.D. diS"' ~21- ~.~ HAA# Expiration Date: 1. GENERAL INFORMATION Complete legal description Location (site address or directions) ,~-.~ Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone /t// ~'/.. '7'"~ /,~ ,4 ~ - ~',~t.,t r~,~'LL ~ Day phone Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: ~ 5'62- .gY 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 Se.vices 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 upcn 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 va!id for cne 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 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 flies 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 or Firm Address Engineer's Printed Name /['Jg, J /"~',~-~.-' "~,~'-~ 5. DSD SIGNATURE ~' Approved for ? Disapproved. Conditional approval for Phone ~.~ bedrooms. bedrooms, with the following stipulations: NOT~: Engineers letter dated August 6, 2001 shall be part of this HAA package. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~ -/0 -'~) ! Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Westewater Program 4700 South Brogaw St. P.O. Box 196650 Anchorage, AK 99519-6650 (9O?) 343-7~04 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT' ~. ~,r./<' Z ~'~ff;,e,~ ~C~..~S 7" A. WELL DATA Well type ~'¢~ aa m, IfA, B, or C provide PWSID it / Date completed A[//~ Sanitary seal (Y/N) Total depth ..~ff/ '~/ J ' Cased to ft. FROM WELL LOG Parcel Log (Y/N) Wires properly protected (Y/N) Casing height (above ground). AT INSPECTION JrL Date of test . J ,~ Static water level ~/'t~ lt. Well production g.p.m. fto g.p.m. WATER SAMPLE RESULTS: Coliform ~lonie~O~n~ Date of sample: Nitrate Collected by: Other bacteda colonies/100 mi. B. SEPTIC/HOLDING TANK DATA Tank Type/Material $ 7',E'~'/- Tanksize 1,2SO gal. Number of Compartments 2. Foundation cleanout (Y/N) y . Depression over tank (Y/N) . Date ofpumplng ?/2 3 /~t Date installed ~/~3.~ Cleanouts (Y/N) High water alarm (Y/N) Pumper A,Io~ TH ~- ,~ ,4~ o ABSORPTION FIELD DATA Date ,nstailed'~..Cff._C~' Soil rating (g.p:dJ~ ~ ~/bclrm)3~- a.~. Length _'~_-~.~'b_.~'~ fl. Width'"/'- ~ lt. Gravel below pipe ~::7 ~ ~' fi. Total depth'r-_.?..~,~ ft. Eft. absorption area "/&2.5'~ Monitoring tube Date of adequacy test ~!/,~. /01 Results(Pass/Fall) d'~pth~in absorption field before test ~. sed Time: min. Final fluid depth rejuve.~netion treatment (past 12 mo.) (Y/N & type) Water added gal. New depth in. Absorption rate >= If yes, give date Depression over field ~ For bedrooms in. gp.d. Date installed Size in gallons "Pump on" level at in. 'Pump off' level at in. Datum Cycles tested. Manhole/Access (Y/N) High water alarm level at Meets alam'~ & circuit requirements? in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanldlifl station on lot j~ /j~l' Absorption field on lot Public sewer main Building foundation Watermain /%0 IO Wells on adjacent lots /~1/,4 Sewer/septic service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ~' + Property line ~' ~ Water service line )'~' I0 / On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank O. ENGINEER'S CERTIFICATION review of Mun~ipat records that the above systems sm/n conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name A../d~, / /'~.-~ t' /,~v-. ~ '~,~,'*,o CE-4369 o.*~ HAA Fee $ Date of Payment Receipt Number __ (Rev. 12J00) Waiver Fee $ Date of Payment Receipt Number - Absorption field '7- - ~7<::)' :~ Surface water ~' Io ¢3 Water main ~'10/ D~veway, panV. ing/vehide storage Z~:;)/~' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line T- I/3 ~- Building foundation ~ Water Ser~ice line )"~ IO~ Surface water. ~' Curtain drain ,~/,~' Wells on adjacent lots ~/~ F. COMMENTS NHAWTHORNE-ENGINEERING 907'344'4711 August 6, 2001 TO WIIOM iT MAY CONCERN Lot 4 ....... Spring Forest F'.E: lleallh Authority Approval: my ~ A good description of the subject facilities is given in thc IIAA report by Mr. Jclfcry A. G:unesx, P.F.. ~,,,,,.d An, d 10, 1996 anti £ound in tke MOA l ,.pt. ofllcahb ,'md I1uman Services files. 1'5 ava)id cnnfiision, Mr. Garncss' silo i,lai~ b: rcp,-od4ccd, npda;.ed anti a!lact~ed. 'D~c smue riW.: desit;~at:~rs, swing t~.., d_.ur.~, ' ...... ~ ~ .... ' Al; in,Jic.:::ed clean outs, mn,ia, or tube.;,, el;:., :','erg recovc:'cd cn,I alt arc visually iu go,ad cm:d/ti..m et:ct: !,: ll~;:. Ih:: me,:ii,,riag tube for thc c, ld t ,ad had abvut one foot t,f :lift end trash in 'Il'to l.',oltmn. :h. flcl a.~ te~svc,:oss£o: ,dtcmpt lo clean il, a fe2W :uoniU~r tt~be ::az installed'in anticipatim, c. f :.l~c bcd il' rcquircd. Two adcquaey tests wcrc conducted on Ihc du,q si:allow trenches wi!h diffcrcnt results. Ou Jdy 23, * '"' an Jaiaol inspection showed 5.25 inches of wa~ef in Iht mvnitvrJng lube of tl~e. ~cuth I-e:~eJl x ',, .... :~ fi,.a .c.. m d.c north trc ~c ~ ~ as dry. q]ns ]s opposite of what Mr. Gamcss fonnd in 1996. 663 gall(ms of water was added to CO "a" in thc north trench at a rate of 8 gpm. An ad;.iifien:l 83 ,,.';~s t'.:':n added to the south trench Ihrough CO "b". llsing Mr. gamess' cal,:ulation of voiJ Sl;;~,.C(7t; g.;!'in per trench) an inilial absorption rate of over 3000 gpd was calculated for a "constant head" adequacy These results, however, were suspect due to the rate which water left the monitoring lubes on thr fallh~g head test. A rate of somewhat under 400 gpd was calculated over a 22-hour period. :\t Ilmt poinl, it was decided to reel:ack tl:c trcn¢l:ca and, if necessary, pcrfvrm a test on thco',.,' .(,. septic tank was pumped 7/23 and Ihe divcrter valve directed flow to the bcd. A new adequa,:y lest pc~ flu'reed on the dual trenches on Augusl A, 20~I. Thc monitoring lubes in cach trench were dry at tl~c beginning of linc tcst. Clean wet;ar was tart.educed CO "k" at a rate of 7 In 8 gpm. After 60a ,,t,.~l!on~ b2,] been introduced, b~th menitt, ring lubes were (ky and a srrfil amoont of water could be seen in tke in-crt of CO "m". After a total of 765 'fbr, x:Shaat the test nc wakr appeared iu CO "n ', CO "b" or 6m mmfiler h:['e for the south trend. R..,-~ ., ,, ~. "Falhng Ileazr' calculati(m: 25V 7G3 gl'd (fi!::t Health Authority Approval Lot 4, BIk 2, Spring Forest August 6, 2001 Page 2 It should be noted that this calculation uses only one trench void volume (78 gal/in). Using the void volume for both trenches doubles these acceptance rates (if they accept at the same mte and communicate hydraulically). CONCLUSIONS: The trenches pass the adequacy test with an acceptance of more than the required 600 gallons per day. Observations and recommendations are: It is possible that the two shallow trenches do not have ideal hydraulic communication. Additionally, while those two monitor tubes do communicate hydraulically with their individual trenches, test results indicate that communication may not be ideal or immediate. The trench laterals may benefit from a physical cleaning ("pig" or ?) followed by jetting between the pipe end clean outs. The trench laterals are not perfectly level. Also, the trenches appear to not receive flow at the same mte. While those facts aren't all bad, these and other observations indicate that a dosing system could greatly improve the longevity of the system. Perhaps an ORENCO screen and siphon or pump in the existing tank would be best in the future. Any future testing and/or improvements should be performed by someone who understands this and Mr. Gamess' report. The old bed and newer trench systems should be alternated on a 6 month or 1 year frequency. A new handle was installed on the diversion valve for this purpose. The homeowner should keep records concerning when the valve is switched from the bed to the trenches. Results of this adequacy test are valid for this period of time only. Many influences can change the Neil Hawthorne, P.E. Attachment Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH &HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING . ~ "'~WCE$ DiVi$1©N RECEIVED 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent ~- ~J~ ~,~,~ Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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: NOTE: 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. 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. Alaska W~ter & ..... Wastew~te¢ ~ervices Name Of hlrm ¢~'~'~* ~" .~';:¢'.3'* ~r / \ Phone Address / Engineer's signature DHHS SIGNATURE · /~ Approved for bedrooms. .Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Mt}r~ici'pality 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 W21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L' Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Health Authority Approval Checklist LegalDescription: C~oT'-,:~--.~ ~¢-~Z.~ ~Ft"~-~(..~- Parcell.D.: ~--~'Z['-~ A, WELL DATA Well t~e GO~ ~B, or C, attach ADEC letter. ~EC water system number ~resm~t (Y~) Date completed ::~ Cased to_~ Casing height (abovo~ ~ [~- Date oftest ~ ~_ Static water level Well production / g.p.m. ~ g.p.m, WA~R S~~ ~e: Nitrate ~; Other bacteria B. SE~IC~ TANK DATA ~~ Date installed ~ Ta~ size I'Z~O Number of Compa~ments Foundation cleanout (Y~ ~ Depression (Yin) Dateofmumping I~]~/~ Pumper C. ABSORPTION F1E.LD DATA Date installed TO-¢_.Oc~; .~-/c/~ 40 Len~h [~. ~ Width Effective absorption area '~ luid depth in abso~tion field before test (in.); / ~ Fluiddepth_~(ins.)Minuteslater:__ ~Peroxide treatment (past 12 months) (Y~) .2,+ Soil rating (g.p.d,/ft2 or ft2/bdrm) or'b OPP/~:System type Gravel thickness below pipe ' T epth Monitoring Tube present(Y~) ~ Depression over field Results (Pass.ail) p~S ~ For ~ Immediately ~er ' :gal. wate~dded Absorption rate = IO [~- If yes, give date Mani~ole/Access (y~) ~mp off' level at* E. SEPARATION DISTANCES ~ [~ S FROM WELL ON LOT TO: Septic/holding tank on lot ~ ; On adjacent lots Abso~tion field ou lot ' ~t lots Public sewer main ~lic~'? ~~sewer manhole/cleat~ SEPARATION DISTANCES FROM SEPTIC~TANK ON LOT TO: o Bnilding fonndation ~ Prope~ line ~ O/~ Abso~tion field t / Water mai~se~ice line ~ lO Surface water/dr~nage ~ 1~ Wells on adjacent lots SEP~A~ON DISTANCE FROM ABSOR~ON FIELD ON LOT TO: Building foundation ~: q~ r~ Water mai~se~ice line ~ tO Surface water ~ t OO / Driveway, parkin~vehicle storage area Cu~ain drain ~ I~ Wells on adjacent lots ~ [~ Prope~ line F. ENG~ER'S CERTIFICATION f ~ . ~'; OF { cert ~ that l h ~ ~ ~n i ~lhru fi~ ~e~tionx and review o f Mun i cipal re ~*~ ~ ]~, ~ ~ j~ IH col1jormal~ce W~ MOJ ~.gui~lin~ in e~ect on this date. ~ ~ 1[ _ / Date ~ tO/~ % ................................................................................... ~~ HAA Fee $ ~./~, ~-~ Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number April 10, 1996 Municipality of Anchorage Dept. Health & Human Services Division of Environmental Services On-Site Services Section P.O Box 196650 Anchorage, Alaska 99519-6650 8471 Brookridge Drive ~ Anchorage ~ Alaska iPhone (907) 33%6179 ~ Fax (907) 338-3246 Consulting Engineers Ref: Health Authority Approval (HAA). Lot 4, Bk 2, Spring Forest S/D. To whom it may concern: The subject lot is served by a community well and a private septic system. The septic system consists of a 1250 gallon tank (installed in 4/83), a 924 ft2 bed (installed 4/83), and 750 ft2 trench (installed 5/93). There is an alternator valve so that flow can be switched between the two dralnfields. Per the property owner, the ~ld bed was zestedfrom 5~93 until 6~95 (2~vears), and was used from 6/95 until 12/95 (6 months). The trench system has been on line since then (approximately 4 month. O. Comments regm'ding the septic system and the adequacy test are as follows: EXISTING TRENCH SYSTEM OPERATING LIKE A SPILL OVER SYSTEM: I made an initial site visit on 3/22/96 and measured 5.5 inches of water in the north trench and saw no standing water in the south trench. Although both trenches were installed at the same elevation, it appears that the majority of the wastewater is first flowing into the north trench; consequently, the south trench will not receive any significant loading until the north trench first fills up. In short, it is acting like a spill over system. In the future, it would be easy to correct this by installing a flow splitter, and introducing wastewater into the west end of each trench. /Z/hen the septic tan]c is upgraded, in the fi~tm'e, it would be an excellent lime to do this since a backhoe would be on site. Given the fact that the property is served by two alternating dralnfields (bed and trenches), that the bed is well rested Otsed only 6 months in the last 3 yeara?, and that the trenches appear to be adequate (see the next paragraph), I don't think the installation ora flow splitter is justified at this time. The trench system was operated continuously two years, from 5/93 until 6/95, with no problems per the homeowners. TRENCH SYSTEM ADEQUACY TEST: Upon my arrival (4/6/96) I noted that the north trench had 4.5 inches of water in it (dropped since 3/22/96), and that the south monitoring tube did not have any standing water in it, although it may have been slightly damp. Water was introduced into each trench at a flow rate of 6 to 6.5 gpm until each was filled to the 6 inch level. It took 119 gallons to raise the level in the north trench 1.5 inches (79~3 gallons/inch), and it took 457 gallons to raise the level in the south trench 6 inches (76.2 gallons/inch). The total volume introduced into both trenches was 576gallons, These numbers are consistent Mth the pore space in the drainrock of each trench, assuming a 33% porosity of the drainrock ((5 ft. X 75 ft X .5 ft. X 7.48 gallons/ft3 X .33)/6 inches = 77.8 gallons/inch). The recovery of the trenches was monitored periodically over the next 26 hours, and the results plotted on log vs. log paper. Upon reviewing the data it can be seen that, given failing head conditions, the south trench was able to absorb 340 gallons per day, and that the north trench was able to absorb 148 gallons per day, for a total volume of 498 gallons (essentially 500 gallons). However, it is important to note that, when full, the trenches (together) accepted approximately 90 gallons within the first 3 hours of the recovery period, which corresponds to 30 gallons per hour. At this rate, the trenches would absorb approximately 720 gallons per day. In short, assuming the trenches m'e both operated relatively full (constant head adequacy test), they will accept greater than 600 gallons per day, as required for2~4 bedroom house.. Prior to filling the trenches, the alternator valve was turned so that the flow was diverted to the old bed.' The valve was left in this position until 4/10/96 (4 days) when then trenches were reinspeeted, On 4/10/96 both #'enches were con~/ete~v dry (no standitlg water). Flow was then diverted back to the trench system. The alternator valve should be switched in June (1996) so that wastewater is diverted back to the old bed for 6 months. At somepoint in thefiaure, in order to pass an adequacy test, it may be necessary to replace the alternator valve with a flow splitter; so that wastewater can be evenly diverted to the oM bed and the trenches. However, in my opinion, this should not be done until it is absolutely necessary, since the ability to rest the drainfields is critical to enhancing their life span. NOTE: ~lhe adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal surface water i~ltration, groundwater variations, septic ~stem maintenance (fi'equency of septic tank pumping, usage of biological additives), condition of drain pipe and pipejomts (which cw~ be damaged by seismic activ#y and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. ConsequentS, the results of this adequacy wst are only valid for the specific day of the test. If you have any questions, please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Thank you. Sincerely, J~wffr~eYt J~C~)~saur,~ae;~, P.E., M.S. Spring Forest.wps Ma~-25-96 10:57A Bonnie Mehner LOT 5 % 8'.'~ 2:~ z..; El 219,9'7' with JACt< WI.lifE COMPA4Y 96-L-12tA 30' 'o c( LOT 4 IS~ON NOTES: It 1~ lhe owmar'S' resporl~lbilJJrY to d,elerrnln¢ toner:ructiOn 0¢ fo? estobll~hln~ property lin~m, LAND & CONSTI'dJCTIOH SUt~VEYORS-PLANNEP,$-.ENOINEERS ¢40 V/ESI' 9ENSON BI.VD. ~( 103 AN(iHORAOE, ALA3KA 99505 (907) 562-5291 MA¢4 20, !996 1"::40' LOT 4, BLOCK 2, :.:. PRING FOREST sUBD- ,' C .I j~ I 7', 0 /' ~ O) w',!h JACK Wi'tilE COMF'ANY I,,/d'lO & C();'!.~JTfcUC'FIC-~N ?,,URVEYORS-PLANNE'F~$'"ENOIt'IE~-RS 4.4,0 WESt BE'r'fJON I~LVD, /i 103 , ., , ..... a, ~ ,. .... ,.;:..~ , ,,,~? ........ ~.~.~,:.: ............... u-,~,,, .,,,¢-.~,, LOT 4 BLOCK 2, , 'ff 0 'gg5 ' ='3,' " .... .~ 96-L-121A ¢,,:~..,,-,.x,,:;~,,, ..... ,-~:~,;~',,~, .......... ,,SPRING FOREST SUB ri'. MUNICIPALITY OF i%NCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRfINMENTAL PROi'EC]XON APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 2/2]/84 (a) Legal Descripticn (include lot, blcck, subdivision, section, township, range) LOT 4, BLOCK 2, SPRING FOREST SUBDIVISION Location (add~ess or directions) NHN West Tree (off Birch onto West Tree, second house, around first curve (b) Applicants Nar~ CONNIE YOSHIMURA Telephone 274-7362 Applicants Address 510 L Street, Suite #905, Anchorage, Alaska 99501 (c) Applicao~_~s (check one) Lending Institution tX; Owr. er/builder~; Buyer~; Other~ (explain); (d) lending Institution NATIONAL BANK OF ALASKA Telephone 276-ll32 Address Pouch 7-025, Anchorage, AK 99510 ATTEN'FION: Ruth LeBarr (e) Peal Estate C~. & Agent ~ DYNAMIC REALTY, INCo att: CONNIE YOSHIMURA Address 501 West Northern Lights Blvd., ANchorage, AK 99503 Telephone 279-7611 5~lt i-Family ~ four (4) Other (describe) 3. Water Supply_ ..... Individual Well ,~ Conmmn~t!; X~,,' Public { ...... I Note: If ~nmunity ~11 system,' must ha~ ~'itten ~nfir~tion ~ ~e State ~p~nt of ~viro~ntal Conservation attesting to t~ legality ~d status. Is the w~l]. adequate fo~ the nuraber of bedrccms specified in this ~A 4. _Sewage Disposal Onsite ~ iklb!ic ~ Con~unity ~, Holding Taxx F---~, Is tt~ wastewater disposal system adequate for the nun~er of bedrcx~s [Page 1 of 2] 2-15-84 BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION 274-2533 Telephone: (907) Address: 437 E. Street Suite 200 Anchorage, AK 99501 February 21, 1984 To Whom It May Concern: Our records indicate the Spring Forest Subdivision Water System to be in compliance with the State of Alaska Drinking Water Regulation. Sincerely, Environmental Field Officer JFH/msm ao MUNICIPALITY O~ ANCFDP4%GE (MOA) HEALTH AUrHO~TY APPROVAL CHECKLIST - FEBRUARY 1984 Well Classification~r/~z ~ Total Depth A///~. Cased to Static ~ater Leal ~//~k Casing Height Abo~ Ground Elect=ical Wi~ing in Conduit (Y/N) Separation Distances f=c~ Wall: To Septic/Holding Tank c~ Lot ~J/A- To Nearest Edge of Abso=ption Field on Lot To Nearest Public Se~r Line D/~ C leancut/Manhole Wate= Sample Collected By Ware= Sample Test Results ,. Pump Set At |] (h /U//%_ Sanitary Seal cz% Casing (Y/N)~/~ /~//~ Dep~ession A~ound Wellhead (Y~)~/4 ; On Adjoining Lots , On joi ing TO Nearest Public To Nearest Sewer Service' LiDs on Lot C~nt~ B. SEPTIC~OLDING TANK DATA NO. Of C<.~fJa~tments ~- Standpipes (Y/N) 73~' S Ak--tight Caps (Y/N) %%J Fcundaticn Cleanou~) De~ession ore= Tank (Y/N,) a][~c' Date Last Pumped /3/~ Pumgir~intenan~ Contract on File (Y/N) ~(A- ; .oiding ~nk [{igh-Water Ala=m (Y/N) Te X arY ~oiding Tank Permit (Y/N) Separation Distan~s f~cm Segt±c/Holding Tank: To Water-Supply Wan To Building Foundation_ /3//~/ To P=operty Line To Water Main/Service Line Cc~se TO Disposal Field /,:Z / TO Stream, Pond, Lake~ c~ Majo~ D=ainage [page 1 Of 2] 2-15-84 ABSORPTION FIELD 5%TA Soils Rating in Absc~ptic~ Strata Date Installed Width of Field Length of Field ~ ~ Depth of Field ~,~ -3~' - --~a~l B~d Thickness ~,3-/ Depression over Field (Y/N)~~.YDa". ' ] te of Last Adequacy Test Results of Last Adequacy Test . A3//t ~_~/ ~_~-~ .Separation Distance f~c~ Absc~ptic~ Field: , ;3~ To P~operty Line '~ ~ To Water-Supply Well To Building Foundation To Water Ma~n/Service Line To St~eam/Pond/Lake/~ Majo~ Drainage Course To D~iveway, Pa~kinG A~ea, c~ Vehicle Storage A~ea ~/(~_ ! To Existing or Abandoned System cn ; On Adjoining Lots ~ 30 / TO Cutbank(if p~esent) C<~,~ents D. LIFT STATION Date Installed ~/t Size in Gallons "~,~ On" Leal at' High Water Alarm Leal at Tested for ~3 I~ Electrical Codes(Y/N) Pumping Cycles ar~ing Adequacy Test. M~ets Cc~ents KBl/dS/s ** ** Check Permitted Bed~ocm Rating AGainst HAA Request. I ~r.tify that I ham checked, ~rified, or confcz~ed to all MOA HAA Guidelines in effec't on tbs date of this inspection. MOA No. 5tR -OO [Pa~ 2 of 2]