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Home My WebLink AboutTONJESS ESTATES BLK 2 LT 9 .~ Municipality of Anchorage Page 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 Name: Wastewater System: ~ New D Upgrade Add,ess: ~.~. ~. ~ ABSORPTION FIELD Phone: ~ NO. of Bed~oms: D Deep Trench D Shallow Trench ~Bed D Mound D Other LEGAL D ES CR I PTI O N so, Rating: Total Depth from original grade: ~.~ GPD/Sq Ft Lot: Block: Subdivision: ~pth to pipe bottom Irom original grade' Gravel depth beneath pipe Township: I Range: Section: Fill added above original grade~ / Gravel length: WELL: D New D Upgrade Gravelwidth: Number of lines: Disance~twe~lin~: Classification (Private, A.B.C): Total Depth: Cased TO: Total absorption area: Pipe material: ~ Driller: ~ Date Drilled: Static Water Level; Installer: Date instal/ed: ' ~ Pump Set at: ~ Casing Height Above Ground: TAN K S EPARATI O N D I STANCES ~Septic ~ Holding ~ S.T.E.P. TO ~pI,c Absorplion Lift Hold~ng ~ubliclPrivale Manufacturer: Capacity in gallons: From Tank Fietd Station Tank Sewer Lines ~~ ~ ~ ~ / 2 ~ Materiah Number of Compa~ments: Surface Water /¢~¢~ /¢O'~ -- -- -- LIFT STATION Foundation ~,. /~. -- ___ "Pump °n" level at__el at: I High water alarm at: CurtainDrain ~O~ ~, ~ ~ ~ Electrical Inspections pedormed by: Remarks: BENCH MARK Location and Description: Assumed Elevation: ENGINEES'S SEAL Department of Health and Human Services approval - '~~ 72-013 (Rev. 9191 ) MOA 25 Permit No..SW930383 Page 2 of 2 Municipality of Anchorage 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 ?ON JESS ESTATES, BLOCK 2, LOT 9 05183220 Legal Description: PID No.: CO! C02~ .............................. .H ....................... NEW ~6 96.8"' 1250 GAL , 99.9< 96.4'--~ i · 89.9' NO WATER FOUND 95.9'J MT2 N.T.S. A B C FCO- 21 -- gO1 -- 12.5 34.5 ~02 ~ :7;5~ 42.5 ~03 47 34 -- gO4 14 35 -- Frt 34 12.5 -- · r2 37 ~46.5 ~ 72-013A(1/~3) * :~c. t/A [-'F' AS-BUIZ,T ! her~,by certify fha! I hav~ ~urveyed the ~ollo~v~n~ described Anchoragr Recordin8 hfcinct, Alaska, and that the ~ents s~tuated thereon ~n~ withh~ the pr~.~y lines and ~o twerlap ur encroach on the ~rope~v lying ~diacent lhe~to, that no im~ruvement~ on pror~y I~i~ ~d~cegt thereto en~'ruach on the premLies in qu~on an~ Ihat the~ are no roadwaw. transmissio~ lines or uther eLiXir eaiemenfs On said prope}ty ex~pt as ~dicated her~n. {)ated at Eag~ River, Alaska' RO~ERI' C, JOHNSON ~ ~ 5~AI.I?: f~giste~d ~nd ~u~eyor 1" - ~ ' ~.~x 774~56, Eagle Rivet, Alaska ~one (9~) 694:25L~ ? ° I Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 3 5- 8 9 11 12 13 14 15 16 18 19 20- ~-~ ~:z~',~-j"~--~/..~Township. Range. Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? Daplh tO M0ni~rin§? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ m~nutes~nch) PERC HOLE DIAMETER TEST RUN BETWEEN __ COMMENTS, .S & S ENGIN~'~RIN(~ 17034 Eagle River Loop Ro~d No. 204 Eegle River, Alaska 9~577 PERFORMED BY: I FT THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN! ON THIS DATE. DATE: 72-008 (Rev. 4/85) PAGE 1 OF 1 MUNICIPALITYOF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930383 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:ALASKA USA FEDERAL OWNER ADDRESS:P.O. BOX 196613 ANCHORAGE, AK 99519-6613 DATE ISSUED: 9/22/93 EXPIRATION DATE: 9/22/94 PARCEL ID:05183220 LEGAL DESCRIPTION: TONJESS ESTATES BLK .2 LT 9 LOT SIZE: 87125 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL 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 (iSAAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 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: /'7 ISSUED BY: . DATE: DATE: HEALTH AUTHOR r~Y APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS September 13, 1993 ROBERTSHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 REFERENCE: Tonjess Estates Subdivision, Block 2, Lot 9 We request you issue a permit to drill a well and install a septic system to serve the proposed th_tee bedroom house on the referenced property. no test holes were performed on the property. The approximate location of the test holes are located on the attached site plan. The monitoring tubes within the holes have been checked and found to be dry. This property has enough area for a future septic upgrade, which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information Ifor Y~~ew, please contact us. ROAD DESIGN ~ SO'~TEST /~Kob~rt A. Shafer, P.E. PERCOLATION TEST STRUCTURAL MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN KAS/LSU/lSu 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 HEALTH AUTHORi~'Y APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIl~ TEST PERCOLATION TEST STRUCTURAL & MECRANtCAL I~SPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. September 17, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 unici aiity ot AnChorage Oe~t. Heaplth & Human Services REFERENCE: Tonjess Estates Subdivision, Block 2, Lot 9 We request you issue the pe~mit which was requested on 9/13/93, to drill a well and install a septic system to serve the referenced property, for a four bedroom house. This property has enough area for a future septic upgrade, which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed seDtic system. If you have any questions, or require additional information Ifor ~w, please contact us. S~E o / s/ ,SU/lsu 17034 NORTH EAGLE R~VER [OOP · SU~T5204 · EAGLE R~VER. A[ASKA99577 0 z ~ o ~> ~o~ Om~O 8 8 ~.4 Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST PERFORMED FOR: ~,~J'"r~,-~, ~-~"'~ LEGA' DESO.,PT,ON: gz Township, Range, Section: SLOPE SITE PLAN DEPTH i'VE E~f~ ~ r ( ~ WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? ~pm ~ waer After ~. Moni~ring? ,1 I Gross Net Depth to Net Reading Date Time Time Water Drop IllC/O,,~ -- .~ ., : '-t~ ~. ,2~' ~'4" PERCOLATION RATE /~') (mlnutes~mch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ND ~ FT COMMENTS ACCORDANCE WIIH ALL STATE AND MUNICIPAL GUIDELI~ECT ON THIS DATE. DAT~ 72~8 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~-----~ L'i~ '['-I~_ LEGAL DESCR,PT,ON:' I %/L'7, 1TM :2 7 13- 14- 16 17 2O ,,'~-'~,'C..,,,..~ .... ~' ,.,'.~ DATE PER Township. Range. Section: WAS GROUND WATER ENCOUNTERED? $ IF YES, AT WHAT -- ~) DEPTH? p E Depth to Waler Nt~.[.._ ,..~/,~_, ~ Monitoring? ! :~Z.y Oat~: SLOPE SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop I1~Oo~ -- ~:',, ~ go ~ ~" ~" PERCOLATION RATE I~.~ (m,nutes~,nch~ PERC HOLE DIAMETER FT AND ~ FT · , ~ TEST RUN BETWEEN ~· r COMMENTS PERFORMED BY]~ I_~~ - CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE ~ CT 72~8 (Rev. 4/'~) 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 7..~ o HAA # '~'\(%"~ ', ':': ! ' 1. GENERAL INFORMATION Complete legal description L, ocation.(site address or directions) .:..; Property owner ' ..... Ma'i g - ,, lin address ', ~Lending agency -, . Mailing address Agent ~t _'~. Day phone Day phone Address i:..03~ I..,I ¢_ ?.~. ¢-.¢.(...t.0 ¢.,v~,~'. Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ Day phone ~q~-' '""' ' 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. 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. I/~1) Front MOA 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 S & $ ENGIN£EEING 17034 Eagle River Loop Road I'~o. 204 Address Ea~lle River, Alaska 9cj577 Engineer's signature "")/¢/(/~'~,/P ! bedrooms. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Phone ~ el '''/- ~ ~ 7 ¢7 Date "7/¢~'/~7S~ bedrooms, with the following stipulations: Additional Comments 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 RECEIVED Municipality of Anchorage JUl DEPARTMENT OF HEALTH & HUMAN SERVIC~=,~NIQp,,,u~/01; ANO. I Environmental Services Division ENWONA4~T~.SaWlCZS 825 L Street, Room 502 * Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Health Authority Approval Checklist '1'o~.,'--E,5~ ~'tC) Parcel I.D.: Well type Log present {~N) Total depth Sanitary seal If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to I '~ ~'~o ~¢~. Casing height (above ground) Wires properly protected Date of test Static water level Well production FROM WELL LOG AT INSPECTION 6,0/ '~'+ O.P.m. 5 l' g.p.m. WATER SAMPLE RESULTS: Bi Coliform O Nitrate ~-. ~ ~ Other bacteria Date of sample: ~ Collected by: S g~ ~, E~ Cq ,~v~r~.w~ SEPTIC/HOLDING TANK DATA D'~ J"~''d--~ ' ~ ** J ~ ~. . . r Tanksize tZS'O~i, Numberof Compertmentso 7_. Cleanouts(~) Foundatloncleanout(~lN) c1~ Depression(Y~) tJo Hlghwateralarm(Y/l~ MIA I Date of Pu..,mp.fg',' :'~!~ J~IB Pumper AB$Oi~IIoN. FI£M3 DATA.~ '~ '1 ~-.*.. ratlng(g.p.dJlfforfff/bdrm) i~,~' Systemtype Date ~stalled. J O I :~)'[ 3 r i'SoII Length....:...z~,5 I Width': ' ~O1 Grav,I thickness below pipe ~, 5 ! Total depth Effectlvd a~bsorptlon area ~ Monitoring Tube present (~%1) c~r~5 Depression over field (Y~_) Fluid depth I,Q, Bbso~]z/~on field before tas[ (In.); ~ Immediately after ::J*~[ OBJ. water added (In.): ~///'7.,/ ~/." Ruid depth~_l::~,..~ (ins) Minutes later. ,'h') ~,v, Absorption rate = (,~D g.p.d. Perexidetreatm~nt(pastl2months)(Y/N) hJONe) ~ Ifyes, glvedate ~' - 724326 (Rev. D. LIFT~ Date installed -"-,,~ ~ Size in gallons Manhole/Access (Y/N) "Pum~ "Pump off" level High water alarm level at* *Datum "--,,~ * Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I ~t .), On adjacent lots Absorption field on lot i{~1~t ~ On adjacent lots Public sewer main IJI ~ Public sewer manhole/cleanout Sewer/septic service line ' ~' '' "l" ' Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~J ~-)' Property line [; ~'{' Absorption field. Water main/service line I D Surface water/drainage I~) D ~ ~' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I ~ Building foundation [ ~ Water main/service line Surface water I DO ~ -~ Driveway, parking/vehicle storage area ~/") Curtain drain ~_[o ~J E~ K I~o,~u ~ Wells on adjacent lots [ ~) ~ '¥ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal reco~ls_~tems a~e Engineer's Name ,/~_._-~ ;-- ~'- ~0 ~/f,~ -. ~~,~--~..~1 Waiver Fee $ HAA Fee $. ~ Cr-O ' CT'~) Receipt Number ~'~"~ F'Z-~ ~2 Receipt Number 72-026 (Rev. 3/96)* JUL-O?-lg9@ $2:21 CT&E ESI ANCHORPSE )rinking Water Analysis Report for Total Coliform Bacteria ;oow. ,,,,, Anchormg~, AK 99518.1 · "-40 I~¥STR[/C~ION$ ON R£Y£R.~£$1~£ Z£tOl£ COL££~TINg,,~4MP££ Tel: [~ 562.2343 PUBLICWAT£R$¥ST£MI.D.# l_ I:1 I:l -I-:1 PRIVATE WATER ~Y$"TEM Moat~. ~ Y~ar hx: 1907] 5eT.5301 TO BE COMI~LLrTI~D BY ~BO~TORY O 5~lm ~w 30 ho~ el& ~ulU may S~pIc ~ Im~ In ~Jit: s~ple should ~c ~c ov~ 4l h~ old mt c~i~io. . ~ MMO.bIUG · Numlxr o t'col~|es/I O0 mi. ...... ?,liglle A.al)'II BACTgRIOLOGICAL WATER Afl'ALYSIS RE:COl?J) v~iflce~m: L'%11 ~ .... COI.IRI~4' ~,~~ ..... , ~.. cr.~ o,oi, m ~S TOT/iL P.05 JUL-O?-1998 1~:28 CT~E ESI ANCHORAGE 90?5615301 P.OJxS$ CT&E Ref.# 983339002 Client Name S & $ Engineering ~Toj act Ntme/# N/A Client Sample ID B2 L9 Tonjess $/D Matrix Drinldng Water Ordered By PW$1D S~nple Remarks: Client PO/ Printed Date/Time 07/07/98 12:0~ Collected Date/Time 07/02/98 15:58 Received Date/Time 07/02~98 17:30 Technical Director: Stephen C. Ede Tote[ Cottform iitra~e-N o PaL Units cot/lO0~ o.10o rng/L Attouab[e Prep Anatysia sN18 9222B 07/02/98 EPA 300.0 lO max 07/06/98 07/06/98 Parcel I.D. # MUNICIPALITY, OF ANCHORAGE ;'-' !'.., ! /'~"~. ,- ..... '- ":: *'"...',,.'~';'., DEPARTMENT OF HEALTH & HUMAN SERVICES * ~ Divislor~ 'of En~iron'rhental Services ' .. , . ~.~'. ~,: :: On;Slte'S~rviceSSection;~. ,~::,'.'~.. "',P.O; Box,19'6650; ~nchora'ge.'Alaska 99519-6650 ..... ,,u.,.'.....;...-,.-.-- ~im:,,.":343-4744.., ,-- ~, ' .. ": '... .' · · ' ' .. CERTIFICATE O~,HEALTH'AUTHORITY ' ' 'APPRO'V~,L FOR ~ ,, ... ,: ,',J ,,';'{:[ ~';."? ;,,E!)~' GENERAL INFORMATION Oomplete legal description Lo~ 91 l~oc~. ~; Toni~ E,s,t,~.;L'~ Location (site address or d.i[ect!ons) i',,;..,' .,... ':' property owner Mailing address Lending agency . .: · Mailing address '- .":~:' '".' ..'Agent Day phone , ~,.,.:.-,., AK 99567 .... Day phone .-'xma"~--"~'o'~e ;'; : ~' : ' .-.' :--. · - -Address :. . Unless otherwise requested, H,A,A'Will be 'held for. pickup: -. 2. 'NUMBER OF BEDROOMS: ! ~', · , .. ;.....~ .......... ' 3. TYPE OFWATER SUPPLY: '.: Individual weJl ' NOTE: · Community well " - . · · . .... , , .,j~'?:',,:, Public water .- : ":'~ ":- ing to the' le gaiity'an~l' ~t~t'U's"~)i ~y"stem. .: .-. '. .............. -.., J, .;.,.: ...... · 4. '~YPE OF WASTEWATER DISPOSAL: If community well system, provide written confirmation from State ADEC attest-: , :: - Community,on-site.- :- .:.,,.: . : Public.sewer..,..· ?. NOTE." If community'wastewatg)sYSte,rn; 'provideW~'it~eh'c'onfi/'~nation from Stato'ADEC'. attesting to the legality~ndr'~t'~iUs °f~,s~'em:. :.i ~',y.,:..: .... .. :..; . ., ,' ':.' ':' ; ' : 72~25(Rev. 1t91) Front MOAt21 ' ' '' ....' ' '.'. ! "~JoM s,Je~.~ §ua leO0!sSejo]~ eql u! suo!ss tu° JO sJOJJe Joi e q!suOdseJ .' -,( ;,.' .~:i? ~,!! : ' :. . lou m' e6eJoqouV l0/qiledtolt~n161 a~L: '~3enss**~feleO~plJ'ao'~ 9J0'J~l e~P!azXleue Jo ~uoiioed~m'*l{)~ps0o: . !: ~ ~';~ * *," i './ lou op SHHO jo see/~OldtU3 'slueLueJ!nbeJ elels PUe leJapej U!elJaO ~s!ies 01JepJo u! suoilnl!lsu! 6u!puel J!aql pue. . .:': seuJoq IO sJeseqoJnd ol ,~SalJno~ e Se S!ql se°p SHHC] eqJ.'mlSelV to elelS eql u. paJalS!SeJ Jeeu!§ue leUO!SSaloJd ' "' ;' '. ' ' luapu~dapu! ue Xq e^oqe g qde~§e~ed u! ua^I§ suo!leluase~deJ eql uodn XlUO paseq saleo!l!lJaO I~^o~dd¥ ~lHoqln¥ qlleaH sanss! (SHHC]) sa3!/uaS ueuJnH pue qlleeH ,to luacuiJedao e§eJoqouv 1o ~l!led!o!unl61 eq.L eleO s;uewwoo leUO[l!pp¥ ..... 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" : ' : a~NIDN~ 'Aa NOILO~dSNI ~O ~N~H~V~S Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORI'D' APPROVAL CHECKLIST Well Data Well type'~¢--- '~ ~/~'1~_. If A, B, or C, attach ADEC letter. ADEC water system number Logpresen~--~N). y Datecompleted '~-~.~'~'~ Driller ~ ~ ~ 'T~,~ I ~/-- I~.[~ Total depth ~"~"' / Cased to /~ / ,~.'/-~'~-~.Casing height ' /~- ' '/'- Sanitary seal~.N) ~/ Wires properly protecte(~N)y FROM WELL LOG AT INSPECTION Date of !~.st ./~'° '~"'¢¢~-~ r Jl : c~'~"°O'NMENTAL SER¥1CESJ~UNI~IPALIP/(Jl' AN'.HO,,~UI::DiViSiON Well flow ~ ~ ~ x g.p.m, g Pumplevell , ' Z'j/(/ RECEI SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot lf,~ t../. '. , On adjacent lots /z:~;~ / t Absorption field on I~t /~'Z) t./~_ ; On adjacent lots / ~ ~ ~ Public sewer main /"/'~'-/~' Public sewer manhole/cleanout /"') ~ Sewer service line ~--~ I''/''' Petroleum tank '/'-'/ WATER SAMPLE RESULTS: Coliform ~ Nitrate ~9, ~ ~ /'~//.... Other bacteria Dateofsample: ,.~/~/¢)'~ Collectedby: ,~ ~( .~ ~t.J,~ I~.] B. SEPTIC/HOLDING TANK DATA Date installed /~)- 5~ -~' .~ Cleanout~/N) (y(~ High water alarm Date of pumping Tanksize /~-.~ ~'~'~/'-- Compartments Depres.si0n (Y~) Foundation cleanou~'d) Alarm tested Pumper ~ '~U--,h:' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: . Well(s) on lot To property line /~ I"/"- Surface water/drainage .On adjacent lots ~/~ '''~'' Absorption field z~ ~ Foundation .Water main/service line 72-026 (3/93? Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) , ' ' r Man-factu'---~u ~ . ccess (Y/N) .'Pump on" level at J . '~ -' 'Pump o. ff"·Level ~t High water alarm level / Cyc!es tested Meets MO,A electrical codes ~)~~ , SEPARATION D!S~,,~FROM LI~F'r STATION T.O: Well on lot / .~ On adjac6nt lots .Sudace water. D. ABSORPTION FIELD DATA Date installed ' Length ~'~" ' Width Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y~__~. Soil rating (GPD/Ft~) ~f~. ~ ?J ~ / Gravel thickness ' ,~. ~' / ,Clea~ou~pr~sent~N) Results (pass/fail) System type /~ ~-~/~ Total depth ~dF J , ". _Depression over field (Y~[~ /~ After test ~ ~. If yes, g~e date ~/~ ' On adjacent lots Surface water Curtain drain . ~(Jo~.J~ SEPARATION DISTANCE FRoM ABSORPTION FIELD TO: Well on lot / ~ '"~--' On adjacent lots ~ ~ t ._/.__ property line To building foundation /0 / To existing or abandoned system on lot ~ ~"~- Cutbank ,,5-~ / Water main/service line ~ ~ ~ ~ Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I cerb'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on th.e. dat~.-~f this inspection. . ,. . .~-¢ ~...',' ~J~ .'~'- S nature Date Eagle R~, Alaska 995~ H~ Fee $ Date of Payment Receipt Number 72-~26 (3/93)' Back Waiver Fee $ Dat6 of 'Payment Receipt Number