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BEAR PARK LT 13
Bear Park Lot 13 #051 � 042 � 77 Municipality of Anchorage Development Services Department Building Safety Dtvlslo~ On-Site Water and Wastewater Program, 4700 S. Bragaw St. P,O. Box 196650 Anchorage, AK 99519-6650 www,d.anchorage.ak,us (907) 343-7904 Permit Number: SW020337 Name: Jarrod Haffield 22738 Ursa Major, Chugiak, AK 99567 Page of ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PID Number: 051-042-77 Wastewater System: [] New [] Upgrade 688-4858 3 LEGAL DESCRIPTION 13 Bear Park [] Upgra~'~ SEPARATION DISTANCES Septic Absorption Uff Holding Tank Field Station Tank 100'+ 100'+ NA NA Well: [] New Private Well s.,~. w.., 100'+ 100'+ NA NA Mu,. 5'+ 10'+ NA NA F.~,~ 5'+ 10'+ NA NA NA NA c,,.,.~.~ NA '50'+ *none known Existing field & tank abandoned Insulation over tank ABSORPTION FIELD 0.6 ..~e 5.3 - 5.95 4.26 - 4.93 ,.. 1.02 - 1.03 0 F.. 132(2x66) 5 n. 2 10 I 750 ~e D3034 & F810 Calklns Const. 9/2~/2002 TANK Septic r~ Holding [] S.T.E.P. Anchorage Tank Steel LIFT STATION [] Other:, 1000~.,. 2 BENCH MARK Cement slab at bottom of deck steps 100 FL Engineer s Stamp Inspections performed by: KND Enqineerin(I. Inc. Dates: 1" 9/24/2002 Development Seryices Department Approval AS-BUILT SYSTEM DETAILS/SITE PLAN Per~I~ svo~o237 BEAR PARK SUBDIV, ISION LOT 13 PID#051-042-77 ~ ~ L~---..._~"~ ~ ~~ FINAL GRADE / --" ~" Ng _._ TRENCH 1 ~ SE~ER ROCK ~ ~ TRENCH a PREPARE~ FORm A-C= 37.4' B-C= 4713' A-D=43.4' B-D= 45.3' A-E= 51.8' B-E= 42,9' A-F= 64,G' B-F= 26,9' A-O= 126,9' B-O=79,7' A-H= 113,9' SCALE, B-H= 79.7' JARROD HATFIEL~ PO BOX 670734 CHUGIAK, AK. 99567 (907) 698-4858 ,~c~n, mO2064.DWG ,mem.= 02064 SCALE, NTS 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 [[' '.:.¥::-:.:-:.:.T.>: :.: '. T. :.: 7.:-::%:!: :. :. :. '-:. '..T. :. :. :. :. :-:. :. :. '., :. :; :::: :. :::.'.. ::-:-> ;:Y: :.T,T.:.!. ;-'-'::: '::-;.:. '.:.:-:-::: :?]l (9o?)~o6-6i n/~AX (9o?)690-6ni MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 q I Z.'c ON.SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 12, 2002 Expiration Date: Sep 12, 2003 Permit Number: SW020337 Legal Description: BEAR PARK LT 13 Design Engineer: 0070 KND Engineering Owner Name: Jarrod Harfleld Owner Address: PO Box 670734 CHUGIAK, AK 99567-0734 Parcel ID: 051-O42-77 Site Address: 022738 URSA MAJOR CIR Lot Size: 46968 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage Ail 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By:- ~.~~ 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.ci.a nchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-042-77 Permit Number SwOZdJ37 Property owner(s) darrod Hatfield Mailing address (1) PO Box 670734, Chugiak, AK 99567 Mailing address (2) Legal description (Lot, Block & Sub d.) Bear Park Lot 13 Legal description (Section, Township & Range) Lot Size 1.08 ~s~ THIS APPLICATION IS FOR: Number of Bedrooms 3 Day phone 688-4858 Zip Code Sewer Only [] Well Only [] Sewer and Well [] Water Storage [] Sewer Upgrade [] THIS PROPERTY CONTAINS: Hot Tub [] Jacuzzi [] Swimming Pool [] Water Softening Unit [] Therapy Pool [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: ][~'~ ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 August 28, 2002 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Septic Upgrade - Bear Park Lot 13 Gentlemen: The owner has requested we proceed forward to obtain a septic permit on the subject lot to upgrade the failed system. On August 21, 2002 one testhole was performed for the proposed septic system upgrade. The results of this test are attached. The general slope of this lot is from south to north at a grade of approximately 3-6%. We have designed our system utilizing the existing testhole that was excavated for the existing 3-bedroom house. The lot is served by a,n. individual well, located on the eastern portion of the lot. We propose to install two 2 wide deep trenches. Water was not encountered during the excavation but during monitoring at 13'. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, ~1~'~ Engineering, Inc. Attachments: On-Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test WELL & ,/ASTE /ATER DISPOSAL SYSTEM DETAILS/SITE PLAN BEAR PARK SUBDIVISION LOT 13 o,d la / DESIGN DETAILS 9 BDRM X I~O GPB - 450 GPO 450 GPD/O,6 GPO PER SQ, FT, (15.96 MIN/IN.)= 750 SQ. FT (750/5'(V)) X 0.7'(REF) (2.0' GRAVEL) = 105 FT, TRENCH USE 2 TRENCHES - 53 (L) X 5' (V) X P.O'(D) Tot"t depth oF system Is G.O' from orlgln,~t O~'mde. Totmt depth oF groover be[ow distribution plpe Is 2.0' . NDTES' I. CONTRACTOR & ENGINEER TO VERIFY INTEGRITY OF SEPTIC TANK AND REPLACE AS REQUIRED. INSULATE TANK IF (4' COVER. 2. INSULATE TRENCHES ~/ITH 2' HI] BURIAL FOAM. 3. CONTRACTOR VILL ENSURE HINIMUH 2X SLDPE INTO SEPTIC TANK. 4. ADDITIONAL FILL ~/ILL DE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER IF REQUIRED. 5. CONTRACTOR VILL ENSURE ALL SEPARATIONS TD ADJACENT VELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS. PREPARED FDRI JARROD HATFIELB PI] DBX 670734 CHUGIAK0 AK. 99567 C907) 668-4858 BOOKS ~ LANTECH m~,,~ VBG ~ KMD ~ 9/6/02 ~ N~ 558 ,~m ~ 02064.DWQ ,~e ~ 02064 Sc~te, 1'= 100' PAGE 1 DF ~ ]-~ ~]~ ENGINEERING 20441 PTARMIGAN BLVD, EAGLE RIVER, AK 99577-8736 (907)696-611 I/FAX (907)696-6t t! WASTEWATER BEAR PARK 1J DISPOSAL SYSTEM SUBI)IVISIBN LBT 13 F_I~L DETAILS KiD 30' 10' 0 ~e' ~-EX~ lO00 PREPARE]) FBR, JARRBD HATFI£LD PB ]~BX 670734 CHUGIAK, AK, 99567 (907) 688-4858 FIELD BOOKS ¢oumn~m mx, eAm~. LANTECH m4A~. VBO ~ ~m 9/6/02 ~ ~ ~ N~558 AC. AO~m.mO2064.DWG .mN,., 02064 Soo. re, 1'= 20' PAGE 2 DF 2 ~) ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 II' :.:.:-:.:-: :.:-:.: :;:: ::.: :-' '..: :.'..'..:.'..:.:.:.'..:.:.:.:.:-:.: :::.:: ~.:,:: '..Y..F.,'..?.:.::>:-:.~-~-:.~.;-Y/+'..~.F/..'.:.:.:.'] ] (907)696-611 I/FAX (907)696-8111 .NGINEERING,,NC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 Performed for: SOILS PERCOLATION TEST Jarrod Hatfield Date Performed: 08/21/2002 Proieet: Bear Park Lot 13 TEST HOLE # 2002-1 Depth (Feet) 7 '~: 10- ,i Org/SM - brown, sandy gravelly silt w/organics, moist SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO Depth to water after monitoring? 13' SM/GM - gray sandy gravel w/ Reading Silt & cobbles to 6", mod. dense What depth? NA B.O.tL Date? 8/28/02 Date Gross Net Depth to Net Time Time Water Drop 1 8/22/02 I:00 7' 2 1:30 30min 4 15/16' 2 1/16" 3 * 1:31 7" 4 2:01 30min 52/16" 114/16" 5 * 2:02 7" 6 2:32 30 rain 5 2/16" 1 14/16" 16- 17- 18- * Water Added 19- 20- HOLE PRESOAKED PRIOR TO TEST Percolation Rate 1~5.96 (rain/in) Perc Hole Diameter . Test Run Between 4 feet and ~ feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. MUN C PAUT¥ OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ]PHONE ~AI LING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS DISTANCE TO: ~ ~ Manufacturer Material No. of compartments Liq. capacity in gallons Inside length Width Liquid ~mh ~ OO~ IF HOMEMADE: ~ ~ Well ~/ Dwelling PERMIT NO. ~ DISTANCE TO: O ~ ~ Manufacturer' /~ Material Liquid capacity in gallons "~ Well Foundat~ / Neares~l~i% PER~ ~_ I DISTANCE TO: 1 ~ ~ I . ~ ~ ~ ~ ~ N°'°flines ~ Length°~li"e Totallen~in,s Trenchwi~ inches Distancebetweenline~/~ ~ Top of tile to finish grade Material beneath tile Total effective absorp~n area L ~ ~ inches ~ Length Width ~ ) / Depth PERMITNO. Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ ~ Class ~ / ~t ~t~ Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ~ ~ ~,~ ~'~ SOIk T~ST INSTALLER ~ REMARKS APPROVED ~ ~[ ~ ~.'~li~ll~-~ DATE LEGAL '~ ~' ~tVER, ALASKA '~57~ ' '""'"~ PH, 694-2979 72-013 (Rev. 3/78) Time · Drill Lo~l Casin~ DuRbiN DRi[[i.~ C;o. Mile 1.2; Lucas Road P.O. Box 871348 Wasilla, Alaska 99687 (907) ~ Job Location:LO Crew: Date: Notes: 7/.~ter level: Well MUNICIPALITY O'F ANC3-1Ot~GE DEPT. OF H:ALTH & FNVIRONMENTAL PROTECTION ~ ! ~50 PJOU RECEIVED ROBERT A. SHAFER July 20, 1986 CIVIL ENGINEER 694-2979 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 ATTENTION: Susan Oswalt REFERENCE: Lot 13; Bear Park Subdivision ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST S/ss SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN An on-site wast~wat~r disposal system was installed on the referenced property under permit #850124 on May 16, 1985. Inspections were performed and are documented on an inspection report on file in our office. This report has not been submitted for record due to non-payment of fees MUNICIPALITY OF ANCHORA(3E DEPT. OF HEALTH & ENVIRONMEN]'AL PROTECTION 2, 11986 RECEIVED SRB 196X EAGLE RIVER, ALASKA 99577 'fl*"dl IL.II I1",,-!1 ~ ~E~: ][ IF:::" ~ls~ II ........ ][ -1F' %"' CZ~ IF=:=.- i~l111'"'41 ,'C..~: II*-I1 III 11:~4: ,,F':.:~I~ ~EE~i tel DEI:::'f~RTMIEIxlT [)1:::' FIl:"'i:F.ll_'l'*l'*~ ~IxlD ENVIF:~'.[)IqI"IFZI',I'I"¢.:q .... IEl;:..'~!; I... S'I"I:RI:[E[T :, ~qNCHC)I:R,.'2dSE ,, ,.':.d< 99!50 1 I:::'E[I:::.:I"I ]: 'l" NIl :: I:)ATI.::'.: I !:LSLII::i:I:) :: ['~ ='(" 2 ~.~ ..~ :I ()4/25/El5 AF'I:::'L.. i C Al',ll"',", A It) D IR E.:. S S L. OT S ;1: 2; IE = I I....OC~ql" I (31',1 t'q[A X 1'3 E: D I:'~ C) O I"1E:.~ St. JDD I V ]: S I Qf',I ::.~ I:::.iqt-: F'F.~I::;:I< SE::C'I" I (.':)lq ,', Zl. 'T'[LtI,',II',tSH I F' ~: I~.51",1 1. OE~F.~ (SG!. F'T. OR ¢::ff:',F;.:[C!:~) F;'.f.:~lql'.':: I N F;'.C)~qI:)/UI::;:St.'~ !"I.P..,.]CJIR C ]: F;'.CL. tE: LC)T: I::~¢~NE.)E::: 1t/,I - DI:'[F::"I"H 'l"O F:' I F:'E E~[TI"'I"OI"I (F:'T,) GF';:P~VI'i'iI .... DIE. 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W :i. ]. ]: P 6.'(.:, q Li. :i. P (.?;." .:':~ r'i ~;~ d d :i. t :i. o ['} a~ ]. [.~ E:..', r' ¢¥1 :i. 'I.L. ]:F: (.l L. IF:'T....,c:'r""~"vr'"V., 't"HE:;N (1) ~ql",l If.[I....t'."'!Z".F'I"F'~]:[.~[.'.fi .... ::, ::' c, ~¥ " "r rql',lD bJIL. 1 .... NOT E:I...I!T.[:;TF~ I C;(..~I....b4(:'.lF¢l'::: I"tUST BIE I;)ONE!: BY .~ I.... 1: CENSI'ZD E: L E".' [:FI" F'~ :1: C ;t: [.'.flq,, E!~ :1:{::~1 I1:::. I.) T..) ~I:::1:::% I [~.:~:~N"t" ~ CURT HE:.E:S COIxtS'I'R [] 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 PERFORMED FOR: .. DATE PERFORMED: LEGAL DESCRIPTION: 1 2 3 7 8 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) lbo, bert &.Shater 1~4o. i ,457..E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop ATION RATE TEST RUN BETWEEN FT AND CERTI FI ED (minutes/inch) FT SOl LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION:' ~ ~1 ~ I ~ '~ ~ ~'~ CLE4# ¢ Z, ooz,£ SLOPE [] PERCOLATION TEST DATE PERFORMED: 4 U~"~, .~ ~",/ SITE PLAN lO 11 12 13 14 15 16 17 18 19 2O COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop r.z,'.._? PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND ~ FT CERTIFIED BY: ~~ ~fi~' DATE: 72-008 (6/79) 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.ci.anchorage.ak.us (907) 343-7904 CERTifiCATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051.042-77 1. GENERAL INFORMATION Complete legal description Bear Park Lot 13 Expiration Date: Location (site address or directions) 22738 Ursa Major, Chuglak, AK 99567 Current Property owner(s) Jarred Hatfield Day phone 688-4858 Mailing address PO Box 670734. Chugtak. AK 99567 Lending agency Day phone Mailing address Rear Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class Well [] Public Water System [-I TYPE OF WASTEWATER DISPOSAL-. Individual On-site Individual Holding tank Community On-site · Public Sewer [] [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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 of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer s work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I vedfy 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(aro) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm KND ENGINEERING, INC. Address 20441 Ptarmigan Blvd., Eagle River, AK 99577 Engineer s Pnnted Name Kenneth M. Duffus 5. DS~D.~NATURE ~ Approved for Disapproved. Phone ¢907) 696.6111 Date 09/27102 Conditional approval for bedrooms, with the following stipulations: Additional Comments ' Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer s Report Other Odginal Certificate Date: c7 (Rev 01~)2) Legal Description: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 So.uth Bmgaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Bear Park Lot 13 ifA, B, orC provide P1NSID # Sanitary seal (Y/N)Y Cased to 162 ft. FROM WI~LL LOG 4/24/t985 t30' ft. 10 g.p.m WELL DATA Well type private Date completed 4/'24/t985 Total depth 162 ft. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0, colonies/100 mi. Arsenic: tlA mg./I. Parcel ID: 051.042.TZ well Log fi/N) Y ~rns propedy protected (Y/N) y Casing height (shove ground) ~' AT INSPECTION t30' ft, 4.8 g.p.m. Nitrate 0.808 mg./I. Date of sample: 9/20/02 6EPTIC/NOLDING TANK DATA Tank Type/Material ~eofl; I Steel Date installed 9/24/02 Tank size t.000 gal. Number of Compartments g Cleanouts (Y/N) ~ Foundation cleanout (Y/N) Y__Depression over tank (Y/N) gHigh water alarm (YIN) NA Data of pumping NA - New Tank Pumper ABSORPTION FIELD DATA Date installed 6/24/02 Soil rating (g.p.dJft2 or ~/bdrm) 0,6 System type Trellch Length 132 (2 x 66' ) fl. Width 5 fl. Gravel below pipe 1,0 Total depth 6.0 ft. Eft. absorption ama 750 ft2 Monitoring tube If._ Depression over field N Date of adequacy test NA - New System Results (Pass/Fall) Pass For L bedrooms Fluid depth in absorption field before test in. Water added gal. New depth Elapsed Time: min. Final fluid depth in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date Other bacteria 0L colonles/lOO mi. Collected by: KND Eflalneedne. Inc. g.p.d. O. UFT STATION Date installed NA Pump on level at __in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer/septic sewice Iloe 25'+ Size in gallons Manhole/Access (Y/N) Pump off level at __ in. High water alarm level at Cycles tested Meets alarm & cimuit requirements? On adjacent lets t00'+ On adjacent lots t00'+ Public sewer manhole/cJeanout Holding tank t00'+ 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line ~'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water t00'+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Water main t0'+ Driveway, parking/vehicle storage 25'+ Property line t0'+ Water Service line I~'+ Curtain drain 50'+ COMMENTS Building foundation 1~1'+ Surface water t00'+ Wells on adjacent lots t00'+ G, ENGINEER S CERTIFICATION I certify that I have deten~ined through field inspections and rm4ew of Municipal reco~ls that the above systems ere in conformance with MOA HAA guidelines in effect on this date. Engineer s Printed Name Kenneth M. Ouffus Date 9127102 HAA Fee S375.00 Date of Payment Receipt Number (~. 1~1) Waiver Fee $ Date of Payment Receipt Number 6EP-26-OZ O9:I?AU FI~U,-CT&E ENVIRONI~NTAI. 61~V '~fK CT&E Environmental Services Inc. 9075615301 T-761 P.0Z/03 F-63t CT&£ Ret.# Client Name Project Na med~ Client Sample ID Matrix 1026240001 KIqD Engineering Bear ParkLl3 Bear Park L13 Drinking Water PWSID 0 Sample Remnrks: AH Darted'times are Alaska Sl~ndard Time Printed Date/TIm~ 09/24/2002 11:42 Collected Dated'rime 09/20/2002 12:30 Received Datc/'fime 09/20/2002 15:10 Technical Director Stephe~'~ fde Relea~"d By ~~ UniLs ' Method LJTI~t~ ]}ate , Date Init Ni~n~e-N O.808 0.200 mg/L EPA 300.0 (<-10) 09/20/02 IS ~,'Lc ~ob t, olog'/ Laborat:o=~ Total Colifonn col/100mL SMI8 9222B 09/20/02 SBH 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 Parcel I.D. # (-%,,Z~ _ (,.-~,L~\~,_-'~'-~ 1. GEN, ERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Day phone e Lending agency Mailing address. Day phone Agent ~.~o / .~0 c~.~ ~ Address" "~-- ~~. ~:~f~r ~'t ~ Unless othe~ise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ ~,~ , Day phone 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 X 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 ~t21 J STATEMENT OF INSPECTION BY ENGINEER i As certified b? 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 .K.N..D. E_ngineering Phone /~ ~ -/~ / J'./ ~,u,~] ~arrnigan Blvd. Ad.ess Eagte River, AK 99577-8736 Engineer's signature ~-.-~:~ · ~ Date //.~h~'~ DHH$ SIGNATURE b"/' ApprOved for Disapproved. "i' H ,E E bedrooms. Conditional approval for 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 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, /2.,025(Rev. 1/91) Back MOAIr21 Municipality of Anchorage ~0¥ ~ ¢ ~ DEPARTMENT OF HE/[,LTH & HUMAN SERVICES ~l~^J~ ]'~~ Environmental Services Division ~.~'~;~.~c~ Room 502 · Anchorage, Alaska 99501 ° (907) 34 - ~4~ 0 1998 Health Authority Approval Checkliat Municipality of Anchorage DepL Health & Human Services Parcel I.D.: Date of test Static water level Well production WATER SAMPLE RESULTS: Well type /~/[/JC., IfA, B, or C, attach ADEC letter. ADEC water system number . Log present (Y/N) Y Total depth ./~Z/ Sanitary seal (Y/N) . y Coliform ~' Nitrate 0' GO r~g//- Other bacteria . Date of. sample: ./~ Collected by: /~'/b/D ~'~..,,3,a/~ ~.y'/.,/a~ B. SEPTIC/HOLDING TANK DATA Ce . /0, g.p.m. FROM WELL LOG Cased to //~ ~ ' Casing height (above ground) Wires properly protected (Y/N) AT INSPECT'ION /52., Date installed .~/,~' Tank size IOOO Number of Compartments ~--. Cleanouts (Y/N) ¥' Foundation cleanout (Y/N) .. ¥ Depression (Y/N) /~/ High water alarm (Y/N) Date of Pumping ~l.'zq\ck% . Pumper ABSORPTION FIELD DATA Date ins,lied ~'/e~.~'"'-. . . . 8o,1 rating (,3,1~,el.,,~ ~ £l '5 System type ]),~ Length ~, ~ i Width. ~,, :5' t Gravel thickness below pipe ~-- . . Total depth Effective absorption area ~ Monitoring Tube present (Y/N) ~,.-. Depression over field (Y/N) Date of adequacy tsst /O/~ ~/~',~ Results(Pass/Fail) /c2 For ~- bedrooms Fluid depth in absorption field before test (in.); I"/~ Immediately after4'6'O gal. water added (in.): Fluid deptht ~*r (ins) Minutes later:, t~-~d,O , Absorption rate = .~5 C~ · g.p.d. __~_r:.r,~. t-,' ~-I- ,/ -, ,~.~. ' o P/~iaf/-.~... eatment (past '~2 months) (Y/N) .. r ~fyss, u~ve data e,l~ ~, r,,~ 72-026 (Rev. 3/96) LegalDesoription: ~'~/'~ ~'~, ~,~/ A. WELL DATA LIFT STATION Date installed Size in gallons I Manhole/Access (Y/N)I High water alarm levellat* J *Datum Cycles tested SEPARATION DISTAI~ICES SEPARATION DISTAI~CES FROM WELL ON LOT TO: Septic/holding tank on!lot! /~O ' '~ Absorption field on Iot~ ,/0 O ' + I Public sewer main ,/,¢~ ~ '+ Sewer/septic service ~e ,~ ~ ' + Lift station SEPARATION DISTAN~.~ES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation //C Property line / C) ~ + Water main/service line ,~ ~ Surface water/drainage//QC~ ~ SEPARATION DISTAN ~,E FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Pump on" level at* ~ump off" level at* On adjacent lots On adjacent lots Public sewer manhole/cleanout + Absorption field Wells on adjacent lots Building foundation / D /'/' Water main/service line . ~-~'- '+ D~veway, parkin~vehicle storage area /D + Wells on adjacent Io~ / ~ ~ ~ · F. ENGINEER,S CERTIilCATION I certify that I have de~ermined thru field inspections and review of Municipal recor~1e -e~ ~xstems are Signature ~. ~ '~' ~ 'h~'~ HAAFee $ ~z:r"D '~ 72-026 (Rev. 3/96)* - ! Waiver Fee $ Date of Payment Receipt Number NORTHERN TESTING LABORATORIES INC. 3330 INDUSTRIAL AVENUE 8005 SCHOON STREET POUCH 340043 FAIRBANKS, ALASKA 99701 ANCHORAGE, ALASKA 99518 PRUDHOE BAY, ALASKA 99734 ! (907) 456-3116 , FAX 456-3125 (907) 349-1000 · FAX 349-1016 (907) 659-2145 · FAX 659-2146 KND Engineering 20441 Ptarmigan Blvd. Eagle River, AK 99577-3736 Attn: Client ID: Bear Park L13 Client Project #: Source: NTL Lal~: A158834 Sample Matrix: Water Comments: Method Parameter Report Date: 11/2/98 Date Arrived: 10/22/98 Sample Date: 10/22/98 Sample Time: 12:00 Collected By: ** Legend ** MRL = Method Report Level MCL = Max. Contaminant Level B = Present In Method Blank E = Estimated Value M = Matrix Interfet~ence H = Above MCL D = Lost To Dilution Units Result Date Date Prepared Analyzed SM 4500 NO3 E Nitrate-N mgn. 0.60 O. 10 11/2/98 Reported By: Stephanie K. Cowling Quality Assurance Manager Rug 30 98 09: 13a JERRY LERCH (907) 694-8501 p. 1 RECEIVED AUG' mea~ & Human Serv~cee To: DHHS Date: August 30, 1998 We hereby notify DHHS as requi~ed by permit of the intention .to terraliR the follow~g property. Lot: 13 Block: N/A Subdivision: Bear Park, Chugiak. Address: 22738 Ursa Major Circle, Chugiak, Ak. Engineer Consukation: Yes x No Engineer Consulted: Alaska Water and Wastewater Jen*y Leach Alaska Drain field Restoration Presiden.t FROM : ALASKA WATER & WASTEWATEr' PHONE ND. : 90?3383246 Oct. 21 1998 02:53PM P1 Alaska Water & Wastewater & Wastewater Consultants "/32'0 East l~hester 'llenghts' C'nrde'~ .... Anchorage ~ Aiask~ 99504 Phone (907) 33%6179 ~ Fax (90"/) 338-3246 August 16, 1998 REMAX Properties 2600 Cordova Street Suite 100 Anchorage, Alaska 99503 RECEIVED NOV 7 0 998 D MUnicipality of AnCho~aoe ept. Health & Htlman ,Ser.~:~e,~ Attn: Carol Douthit Subject: Well & Septic System Inspection at Lot 13, Bear Park S/D. 22"/38 Ursa Major. Seller: Ewout Vanderwende Dear Carol: Per your request, we performed adequacy tests on the subject well and septic syster~ The results of the field investigation and adequacy tests are summarized as follows: A. WELL: The static water level on 8/12/98 was 132 feet below the top of the casing (BTC). Water was pumped from the well at an average rate Of~m for a total of 120 minutes (609 gallons), which caused the level in the casing to drop 5~a depth of 137 feet BTC. Based upon this data it was determined that the capacity of the well exceeds the Municipal requirements for a 3 bedroom house (450 gallons per day). Well production fluctuates seasonally, consequently, future variations in the well production should be expected. No guarantee is made regarding the future performance of this well B. SEPTIC SYSTEM ADEQUACY TEST: The drainfield is a deep trench type system that was installed in May of 1985, making it approximately l 3 years old. Accord~ to the M.O.A documents, the trench is 3.5 feet wide, 68 feet long, and has an effective depth of 60 inches. Prior to introducing water into the draintield, the liquid level in the sump was 31 inches (65 inches bom drainpipe invert to bottom of sump). Over a period of 2 hours approximately 606 gallons was introdueed, which rose the level ofthe system 15 inches, to 46 inches (70% full). The level dropped 4 inches over 1249 minutes (20.8 hours), indicating an absorption rate of 186 gallons/day, which does not meet the MOA requirements for a 3 bedroom house (450 gallons/day). On 8/13/98, starting at 5:12 PM, an additional 806 gallons was introduced into thc trench over a period of 158 rrfinutes. This caused the level to rise fi:om 41.5 inches to 60 inches (92% full). The level dropped 4.5 inches over th© next 13 hours, indicating an absorption of 15.'1 FROM : ALASKA WATER & WASTEWATEF PHONE NO. : 907338~246 Oct. 21 1998 02:54PM P2 gkilons/hour. This corresponds to an absorption rate o1' 362 gallons per day, which is less than the 450 gallons per day required to meet MOA standards. In short, the drainfield is failed. it may be possible to enhance the peffomnnee ot' the system by jet cleaning the system and chemically treating it. Old McDonald's Pumpi~ (338-4476) charges roughly $1:200.00 for this treatment. Another option would be to Terralifi the system (Alaska Dminfield Restoration,. 694-$500), which typi~ rum about $2200.00. Either one of these processes may jump start the system enough to meet the 450 gallons/day absorption requirement. The MOA won't issue a non-conditional Health Authority Approval until the system has been tested 90 days aiter treating it. The ability of either of these treatments to provide long term rejuvenation is uncertain. If you bare any questionsj/ple, ase contact me at 33%6179, or 244-9612. President [ 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 1. GENERAL INFORMATION Complete legal description Lot 13; B~ar Park Subdivision Location (site address or directions) Property owner Mailing address Lending agency Mailing address Mark ~ Dina Bowen P.0.Box 670616 CITY MORTGAGE ATTN: Don Eagl.e River, Alaska Day phone .Chugiak, Alaska 99567 688-0559 Press er Day phone 696-0701 Agent Denny Wood HOME REALTY Address 5700 Old _qe~a~d Highway #206 Anchorage, Ak. Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone 563-5700 9 953 8 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XX 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 Sm 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 ofithis 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 !~.:,.:: :, ::;:~3i,~ l-liver Loop Road No. 204 :~a~Ja i~jwr, Alaska 9957~ Engineer's signature Phone Date DHHS SIGNATURE ~ Approved for Disapproved. .~-,~bedrooms. Conditional approval for 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 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 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAl. C~HECKI.IST Parcel I.D. A. WELL DATA Well type~c~_~ If A, B, or C, attach ADEC letter. Log present {~N) NI Date completed Total depth t L~ "J..~ Cased to 1 L~ ! Sanitary seal ~N) y Date of te~t Static water level I~,',',',',',',',','~ ~ FROM WELL LOG Well flow Pump level ~=~ g,p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ C:~~ Absorption field on lot J I'1 ~ Public sewer main ~ J t~ Public sewer~ service line ~ J~ ADEC water system number ,~ - '2.. 'R' - I~G" Driller Casing height Wires properly protected ~.'.'.~N) ~;~J/Ici;,~ DiVi~i~Oi~ AT INSPECTION , , ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~.~.. WATER SAMPLE RESULTS: Coliform ~ /~.O~ ~.~. Nitrate Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Other bacteria .~ ,~ ~ $ & $ ENGINEERING 17034 E~gle River Loop Road No. 204 Eagle RiVer, Alaska 99577 Date installed Tank size Foundation cleanout ~/N) Cleanouts (~)/N) High water alarm (V~) · Date of pumping ~"- l~'"~./ '~:~', If-. Alarm tested (Y/N) P~,~ ~./,,./~, SEPARATION DISTANCES FROM §EPTIO/HOLDING TANK TO: Well(s) on lot ! O/-/' To property line /'0 Surface water/drainage '~, On adjacent lots Absorption field Compartments Depression (Y~) Foundation Water main/service line lC) 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed ....... Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at High water alarm level Meets MO Aelect~ ~ on lot ' On adjacent lots ~" P_~.tmta-off"T~el at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed ~-' / ~, , ~,-~- Length ~'~' _Width Total absorption area Depression over field (Y/(~l) ~ Results ~;[[~Zfai I) ~,-~ Peroxide treatment (past 12 months) (Y~ Soil rating ~.2-~' //~... Gravel thickness '~"' ' Cleanouts present.N) Date of adequacy,test for '7"~c~...~'_ C)/,/~ ~/o v.//d' If yes, give date System type Total depth Y 5'- (32 bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot I t'l t On adjacentlots ~ . . Property line To building foundation '~" To existing or abandoned system on lot On adjacent lots '~ Cutbank ~ I~,. Water main/service line Surface water I c)~ ~'~'" Driveway, parking/vehicle storage area Curtain drain ~J/~- E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature' 5 & $ ~:NGtNE~R~,NG 17034 Eagle P. ivsr Loop I{oad No. 204 Engineer's Nar~,g.le River~ Alaska 99577 Date ~"-/l-" I 4~::~ (' HAA Fee $ / ~C/~ ~ Date of Payment '~-"-- ,~/'-- ~./ Receipt Number ~/~ //~' Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALI$IS REPORT BI SAMPLE for ~OR[order$ 34216 Dats Report Printed: MAI 15 91 ~ 15:05 FAX: (907) 561-5301 Client Sample ID:L13. BEAR PARK Client Name PWSID :UA Client Acct CollectedMAY 13 91 e 14:00 hrs. BPO t Received MAY 14 91 e 14:00 hrs. Req ~ Preserved with :AS REQUIRED Ordered By ENGINEERING :SNSENCP PO t NONE RECEIVED Analysis Completed :MAY 15 91 Send Reports to: Laborator7 Supery~o.r .'~T_~EPHV. N C. EDE 1)$ & $ EN§II~.RING Released By : ~~~ 2) Chemlab Ref t: 911996 Lab Smpl ID: 3 Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N 0.56 mci/1 EPA 353.2 10 Sample ROWINg SAMPLE COLLECTED BY: RAY Remarks: ! Tests Performsd * See Special Instructions Above UA-Unavailable ND- Nons Detected '* See Sample Remarks Abo~e HA- Not AnalTzed LT=Less Than, G~-~reater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal D~ (include lot, bloc~subdivision~ion, township, range) Location (address or directions) (b) Applicant Name /L~/~~~Home Business (c) Applicant is (check one): Lending Institution []; Owner/builderJ~; Buyer I"1; Other [] (explain); (d) Lending Institutiongff~c~/~'~-~~~~~ Telephone Address (e) Real Estate Company and Agent _~orle (f)' .Ma~the HAA to the following address: TYPE OF RESIDENCE Single-Family [~/ Multi-Family [] Number of Bedrooms d Other WATER SUPPLY Well [~ Community [] Public 1"1 Individual Note: If community well system, must have written conf,irm.ati0n from the State Department of Environmental Conservation attesting to the legality and status. .. SEWAGE DISPOSAL ' Onsite,~ Public [] Community [] Holding Tank [] ' Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDIN~ ;NSPECTI.ONS, TESTS, FILE SEARCH, DA'i ,., 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 regulations in effect on the date of this inspection. Name of Firm ~ & ,~ .... ,~.--P ..... Address e,, = t nzv Telephone Approved for '~ Approved ~.---"~' bedrooms by .~ ' DisapPr°vedU Conditional Terms of Conditional Approval CAUTION . The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP do.es this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) WELL DATA CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: /--- ./-~' Static Water Level/ ~ //,,~./__ Casing Height Ab{~ve/Ground Electrical Wiring i~ Conduit~N) Separation Distan.:es from Well: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT 2 21g RECEIVED Welt Classi ficatio r~:::)J (~/~¢> If A, B, C, D.E.C. Approved~l) Well Log Present~qJN) Date Completed ~' /~' Yield ~'~'~//~ ~. ~ ~ ~_~ , . /~- · / . - 1, Total Depth ~ ~ Cased to ~ / Depth of Grouting ' ~ ~ Pump Set At ~ ~ Sanitary Seal on Casin~N) Depression Around Wellhead (Y~ To Septic/~ To Nearest Eddie To Nearest'Public Cleanout/Mm Water Sample Col Water Sample Tes Comments B. SE PTIC/I'J~I$;~ Date Installed ~ Standpipes ON) Depression over T Pumping/Mainten~ Holding Tank Higl Separation Distain To Water-Supply To Property Line To Water Main/Se Course Comments Page 1 of 2 72-026(11/84) Tank on .Lot /~'~ 4~ ' On Adjoining Lots )f Absorpt on Field on Lot z)'/7 r , On Adjoining Lots Sewer Line A/7,/'~).. To Nearest Public Sewer hole' /J~- To Nearest Sewer Service Line on Lot ~-.~' ~ '/' acted by $ ,*.'~' ~'~/~YI~ ' Date /'~3 - Results ~ ~'~ ~r/-~'/~,..~ ¢ ~ TANK DATA /&"/~'~ Size /_/"J~/'~ No. of Compartments Air-tig ht Caps(~/N) Foundation Cleanou~_~) ank (Y~ Date Last Pumped ~nce Contract on File (Y/N) /"////~J' 'for t-Water Alarm (Y/N) /,//,/d,_ Temporary Holding Tank Permit (Y/N) :es from Septic/I-I~fd~ Tank: Veil /'~ ~" To Building Foundation /~ ~ To Disposal Field · vice Line To Stream, Pond, Lake, or Ma~or Drainage ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~ ~'//~/~/~ Type of System Design Date Installed ~.//~ &/~'~'- Width of Field /"/'~ ! I Square Feet of Absorption Area Depression over Field (YN~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /17 I Length of Field r Depth of Field ~;~ Gravel Bed Thickness ~, ~¢3 '~' . Standpipes Present ~I) Date of Last Adequacy Test / To Property Line To Existing or Abandoned System on · On Adjoining Lots .!7'D To Cutbank (if present) To Building Foundation Lot To Water Me~/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Manhole/Access (Y/N) ~/~//"/.P/~m p Off" Love at /~/~ Vent(Y/N) // Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed $&$ENGINEERIN~3 Date ,/0--2.~- I~' ¢ CompanySR B 196X EAGLE RIVE_E, _AK 99577 Receipt No. ~ Date of Payment /¢//z. ~/,~L~Z~ Amount: $ _~D.~, ~ MOA No. Page 2 of 2 72-026 (11/84)