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Home My WebLink AboutSOUTHPARK #2 BLK 1 LT 2 Municipality of Anchorage ::~ ~' ,.'.':. ~:. Development Services Department :~.._'~. Building Safety Division ~.,..,,5~.. · On-Site Water and Wastewater Program, 4700 S. Bragaw SL ~ P.O. Box 196650 Anchorage, AK g9519-6650 Page of ~we~.ci. anchorage.ak.u$ (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: .~,/ LEGAL DESCRIPTION ~ New PID Number:. WastewaterSystem: [] New [] Upgrade ABSORPTION FIELD ,..,.-- o.,.,..,.,. Iol~lO ~' TANK SEPARATION DISTANCES E~septic I-IHolding OS.T.E.P. I"lOthec Septic Abso~tion Lift Holding Public/Private Tank Fietd Station Tank Inspections performed by: "~'~- ,-~. Dates: 1" I~/z"Z'/~'t. 2"" Io/~../o Z., Development Services Department Approval ~,, ,:-,o)Reviewed and approved by: r~,'"'~ Date: I t/I/.T ~E ! ! ~ ~ ~ ~,+~,,,, ...... H~ ~ '/~ . ~ ~ ......... 203 W 15~. ~NUE ANCH. ~.~9~1 ~61 SO~H PARK BLU~ OR~ (gO7) 27~ 5glE SPTfllfl2~Vfi pE~IT ~ SV020425 PIE i )u~ 00~ 0 0 0 Standard Trench, 2' Vide 52' Lon9 11' Deep ~5' Se~er rock 3-5' Cover ~.o Slit ~arrler NB SCALE 5.5 £t oF Septic Rock Effective x/F H ° n l t ° r Cleanout$ . 5' Cover %~., = = 1250 gal. septic 'tank NO SCALE TBBBEN SPURKLAND P.E. E03 V15th Ave Anchorage Ak 99501 I L OT 2 BK 1 SOUTHPARK TERRACE BILL KAKEL SEPTIC SYSTEM SCHEMATXC 'hATE' OC?'. $1o 2002 SHEET, 3/3 GRITM 3235 PERJiff t $P/020425 PARCEL I0 t 020-52-02 SPTOIO2J. OWG MUNICIPALITY OF ANCHORA GE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.*6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Oct 18, 2002 Expiration Date: Oct 18, 2003 Permit Number: SW020425 Legal Description: SOUTHPARK #2 BLK 1 LT 2 Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Bill Kakel Owner Address: 4561 SOUTHPARK BLUFF DR ANCHORAGE, AK 99516-4822 Parcel ID: 020-052-02 Site Address: 004561 SOUTHPARK BLUFF DR Lot Size: 29372 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 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. 5. The following special provisions. Bottom of absorption field must maintain 4 feet separation from groundwater monitoring of 15 feet on 10-15-02. Received By: Issued By: Date: Date: 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 ON-SITE SEWEPJVVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Farce!I.D. Permit Number SW Property owner(s) Mailing address (1) Mailing address (2} Legal description (Lot, Block & Sub'd.) ,.~ca, des.npt~on (Section, Township & Range) LO; S;ze ~(~7~- Acres('~'~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Day phone Zip Code Number of Bedrooms [] Well Only F"i [] Water Storage E~ [] Jacuzzi' [] [] Water Softening Unit ~_j 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. (S~.c.~ature of property owner ~: authorized agent} Permd Fees: D.~',e of Payment: ~'/"~ Waiver Fees: Date of Payment: Receip', Number: (Rev 12:00) Receipt Number: P.E. 20~ W 15th. Avenue. Suite 20~ ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 2 BLOCK 1 SOUTHPARK TERRACE S/D BILL KAKEL Municipality of Anchorage Development Services Deparlment Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519-6650 October 17,2002 We are submitting an application for the upgrade of the septic system for this lot. The submit+al consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet I/3), the proposed improvements of the lot, ofwhlch only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests ofapplicable test holes are also enclosed. The present system is failing. A multitude oftest holes were excavated on the lot. All ofthem but two reviled huffed waste material from the construction oftbe subdivision. The present drain field was also found to have been installed where waste from clearing operations had been buried. The design of the proposed ~placement system is based on the following: Ground Waterat 15iL Use Standard Trench Soil Rating. From Test hole 09/17102 3 mia/in - 1.2 gal per sq.fffday No. of Bedrooms 4 Required Area per Bedroom: 1501 1.2 = 125 sq.iL Total area required: 125 x 4 ~ 500 sqR Bottom Rock At I I feet Top Rock At 5.5 feet Rock Depth At 5.5 feet Minimum Trench Length 500 1 11 = 46 iL Use SO fl SYSTEM CONFIGURATION STANDARD TRENCII TOTAL LENGTti 50 FT TOTAL WIDTH 2 leT TOTAL DEPTII I I FT ROCK DEPTH 5.5 FT COVER 5.5 FT REPLACE SEPTIC TANK 1250 GAL The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface nmoffwill not result from this installation. [OBSEN SPU£KLAND P.E. 203 W 1511'1. AVENUE ANCN. Iii(. 99501 (907) 279-$916 B, BLOCK 1 $OUTItPARK ~CE Bill KUKEL 4561 SOUTH PARK BLUFF' DRIVE SEPTIC ~Y~TEW DESIGN DATE: SEPT. 27, 2002 SHEET: 1/$ GRID: 3256 PERMIT tt SVO2OXXX PID # O£O-.~-OB SPrOIO£1.BV6 \ TOBBE~ PURKLAMD/~.E. 203 FI 15TH, AVENU£ ANCH. AK...9?501 (907) 279 pERNIT # SVO£OXXX SEPTIC SI'STD, I DESIGN O4TE: SEPT. 27, 2002 SHEET: 2/3 GRID: 3236 1250 §al Septic tank Standard Trench, 2' Vide 50' Long 11' Deep ~5' Semer rock 3-5' Cover Slit Barrier 6.5 Pt of' Septic Rock Effective NO SCALE ..~.,~,Honltor Cleanouts . 1250 Dat. septic tank NO SCALE TOBBEN SPURKLANB P.E. 203 ~15th Ave Anchorage Ak 99501 LOT 2 BK I SOUTItPARIC TERRACE BILL KAKEL SEPTIC SYSTEM SCHEMATIC E)ATE* S~P[ 27, 2002 SHEET, J/J GRID, 3236 PERWff ~ $WOSOXXX PARCEL ID j~ 020-52-02 SPI'OIO2J. OWG Municipality of Anchorage Developmenl Services Departmem Soils Log - Percolation Test ' Si/l-/ 7- 8.',,. ~ I.-4, 9-'-- - :2. 16 .... 20-[, WAS GROUND WATER ENCOUNTERED? N cD $ L IF YES, AT WHAT D£PTH'~ 0 o.,,,.ow.,.,,,., Monilorlng? °'" '/"7 Reading Date Gross Time Ne! Time DeDth I0 Wale' &'/v PERC HOLE OlAMETE~ ~:) FT cERrCC~MEO BY ~ ~ I J..~ CERTIFY THAT THIS TEST '~'o',~S =E ~-'CR'..IED ,i'i ACCOROANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE. ~/~--'7/~ Z,. 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 DISTANCES .S' T E'~'E ~7" ~'~ h ~-! ~. ~ ,,~---....,~ TO SEPTIC ABSORPTION Addressrflullt ~ , TANK FIELD WELL Phone(s) Permit NO. No. ot Booms WELL ~ ~/~ (~ ~ ~?~ ~ / ~'/ LOT LINE ~*~.~c.,~T,O. 5~' ~ ~ '+ Lot 2 8~ock/ ~7-HP~I~ ~ ~/-I ~['~- ~ FOUNDATION TANKS U ~ SEPTIC D HOLDING TYPE OF SYSTEM ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER - ~ ET ~, ~ FT Gravel length Gravel width SQFT As~ 3o~q WELLS ~z' .... ~ PRIVATE ~ OTHER (Identify) FT REMARKS: I , ' - cedily Ihal this inspe~ion was pedormed according Io all ' :'" - ' 72-013 (3/85) F:' E. R Id I T O~,~n"~eP NaI~:~e: S'TEiVE[ ST JOFII~J C)~x~c.,e~' Adcleess: 405:2 WES'T' 89[]-I COURT ANCHORAGE):, AK 9950:~ Par-eel id~ ~..<:.'~20 02 - Lot. Leg~:l.~ Subd:i, visior'~ SOUTHF'AI:;~K ADDN. 2 LoC~ ;2, BIock~ I Day Phone: ,:E:.I-1].~., lANK: Minimum tc:'LaI sept.:Lc T. ank c.ap~:c..~...y~ ~'r) ].~a .... 2 · 'L~nk mus'L have) a.t. '~'~' c::orr~paPtmei~t.s. Depth 'Et:) top I::)~' septic: ]:NFrOF-d'~ .,'.:). H,, H,, S~ F:'R]:C)R TO 1S'[' & ?.ND ]:NSF'EC]'*]:ONS BY ENGINEER~ IF AF:"I-i~:R (:)F:F::i:CI~: HOURS CAI..L. 343.-...4A8:!, AND LEAVE A I~II~:SSA(3E,, CONSTR~ICT F:'I~IR ENGZNEESRS ATTACHED APPROVED DESIGN. TH]:S I::'EF~MtI" EXF'IRES !2./31/89 AND VALID F'OR A S[IgG[,.E F'A~ZLY I...IOMEE. A two I::O[yl- SANO F:II...TER MUST BE F'LACE BELOW SEWEI:~ ROCK AND PERF,, F:']:PE IN ABSORPTION FIELD,, CEF:t'I"IF:'Y 'THAI: 1. ! am fam:i, liap with the r, equ:i. Pement, s rcm on--s:[t,,e sewe~s and we].].~ as s~t ~or. bh by t. he Municipality o¢ Aru:::ho~'age (MOA) and tine S'Lat. e o~' Alaska,, ;:?,,,I will :i.r"m~ta:t.Z the syst(:,m in acc:or'dance with all MOA c:odes and PeguZat.:[ons, 3,, I ~ill adhePe to a]Z MOA and Stat. e of Alaska PequiPement..s fc:m t. he set. bac:k distance~ ~r'om any ex:i. st. irlg w~l].~ wastewat~~ d:i. spc~sal system cap public seF~wePage sys'Lem c)n this cm any adjacent, oP r~eaPby lc:)t., 4, I Lu'~dem~tarad 'Ehat t. his peg"mit is valid [c:m a maximum of 4 ar.y enl. a~gement w:~! 'eqL Jr'e~x~:,ddit. ional per~mi'L~ · ..................................... Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 '%" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: OATEPERFORMED: LEGAL DESCRIPTION: ~ ~-~ g/z ~V ~Av~ L 2 4. W,I EL I_. Township, Range, Section: SLOPE S ,~ '7'-//,~/ /~ ~ ~' SITE PLAN 10- 11- 12- 13 14 15 16 17 18 19- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? R~cling Date Time Time Water Dro= I t PERCOLATION RATE (mtnutes~inc~) PERC HOLE DIAMETER TEST RUN 8ETWEE~ FT AND FT ~2~8 (R~. ~) MUNICIPALITY OF ANCHORAGE DEPARTMEN'T OF HEALTH AND ENVIRO~,:MEt~TAL FROTECTIOr~ 825 L. Street. Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: I 2 3 4 5 6 7' 8 9 10 11 12 13 14 15 16 17- 18- 19- 20 6-5 , RWd, J~'.; WAS GROUND WATER ENCOUNTERED? F YES, AT WHAT DEPTH? PERCOLATION RATE (minutel/Inch) 72.008 (6/79) Parcel I.D. # MUNICIPALITY OF ANCI:IORAGE 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 HAA # RECEIVED JUL 2 1993 MUnicipality of Anchorage Dept. Health & Human Services 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Day phone Mailing address Agent Address Day phone 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: ,/ If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 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 inves_ti_gation 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 ,/~)C/Z.St~J ~,~J~//~ ~-~"~,'J& Phone. Z;~/~ c~3,z'~ Address [~ ~. ~o~ Z~O'7~ ~c)~ &~' ~Z. ~¢5-Z-¢ Engineer's signature ~~~ ~~ Date 7/~/~ ~ DHHS SIGNATURE Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does tills as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: J.-~-; A. Well Data Well type Log present (Y/N) ~//~1' Total depth Sanitary seal (Y/N) ECEI VED JUL 2 1993 Date of test If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N). FROM WELL LOG AT INSPECTION Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: .g.p.m. Septic/holding tank on lot [~W,~ )' ~0~I Absorption field on lot ~//~f' Public sewer main J~./'~ Sewer service line ~/~ WATER SAMPLE RESULTS: Coliform ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout ~/,A" Petroleum tank M~' t~,.1"1~.~ ~H L~T Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed I I Cleanouts (Y/N) T High water alarm (Y/N) ~,/A/' Date of pumping Tank size I'~ d Al i~,,5 Compartments Foundation cleanout (Y/N) 'f Depression (Y/N) Alarm tested (Y/N) q/A/ Pumper _~ ~'~C'/~ I I SEPARATION DISTANCES FROM SEPTIC/~-=.,;..;.z',~,~i TANK TO: ell(_-, ?" '~" On adjacent lots M/A L~,/5) Foundation To property line ) ~?~ Absorption field )' ~ Water main/service line Surface water/drainage 72-026 (3/93)* Front CONTINUED ON BACK PAGE Manufacturer ~.._~ Manhole/Access (Y/N) High water alarm level ~~8~ed __ D, ABSORPTION FIELD DATA / c Length I°P/ Width Total absorption area ~'~ Date of adequacy test ~, ¢,~ 4. 7 Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Cieanout present (Y/N) Soil rating (GPD/FF) Gravel thickness Results (pass/fail) System type W!r'/l~. Total depth ~,1~~ Depression over field (Y/N) for ~ Bedrooms After test / Ifyes, give date ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~J/~ On adjacent lots ~/,A Propertyline_ ~' To building foundatien To existing or abandoned system on lot On adjacent lots > ~¢' Sudace water > ~'~ Curtain drain ~/r~ Cutbank water m~i./service line Driveway, parking/vehicle storage area E, ENGINEER'S CER'rlFICATION I certify that I have ct~ecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer's Name Date '7tZ' /~Z~ HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Mich(:el /~. Andorson ¢ 4381 -E P Waiver Fee $ Date of Payment Receipt Number ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 July 23, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Attention: Susan Oswalt Subject: Lot 2, Block 1, Southpark Subdivision, Addn. No. 2 Health Authority Approval Dear Susan: The owners of the subject property removed all the cleanout and monitor tube risers shortly after taking possession of the house. They felt the tubes detracted from the appearance of their back yard and lawn area. In order to obtain Health Authority Approval they were required to replace all the risers to system as-built condition. The locations of the risers were found using the cross ties on the system as-built and raised to grade. A new monitor tube was placed in the northern leg of the system as the original could not be found. We also found a diversion valve had been placed in the system which accounts for the 6" riser. This valve was not required by the design and not noted on the system as-built. We, therefore, removed the diversion valve and capped the 6" riser below ground and buried it. All risers and monitor tubes are now in place and the system is again in original as-built condition. The well and septic system can now be certified for Health Authority Approval. Sincerely, Michael E. Anderson, P.E. MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner .~7'EV,_~ 5T-l"'oh,,.~ Telephone: (home) 2 dg-&Z~4 Business Mailing Address ~/,~5'Z. ~¥. $'? E,~u~r' (c) Lending Institution /.~/~.g'Z-,,/g"~//,/.z~ /~.',¢.~/"'~.d~',~' Telephone Mailing Address (d) Real Estate Company and Agent . Address (e) Telephone Mail the HAA to the following address: (or check here [~'~hold for pick up.) List contact person and day phone number below:., . : 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms ~7/ 3. WATER SUPPLY Individual Well [] Community .[~ Public [] Note: If community well syste~,, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site I~~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe. functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm /--O/,J~L--/~$O~ ~-'~'G//,J&'~="I~,IN~ Telephone ~7- ~(~7 Address Engineer's Seal 6. DHHS APPROVAL Approved for ¢___ bedrooms by Approved ~ ___Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 1/88) Back Page 2 of 2 .~c~ _O ~,~(~~ MUNICIPALITY OF ANCHORAGE (MOA)~ Health Authority Approval (HAA) ~'~. ~,O .,,C~ ~// CHECKLIST- FEBRUARY 1984 ~ ~v~ ~ ~ ~ 343-4744 ~ Well~ssification C~ ~ ~ If A, B, C, D.E.C. Approved (Y/N) Y Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments $~'~- AT~ A~/~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA' Date Installed 5'/Z~./,~¢ Size /Z '~-~ No. of Compartments Standpipes (Y/N) "/ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well £~,,c,' ~ To Property Line 55 ' To Water Main/Service Line ~'-~' To Stream, Pond, Lake or Major D_r_a!nage Court_se Comments ~E~-/~ ~y~;' ~,,~ I$ ~.c,~.~. ~.,.~ Foundation Cleanout (Y/N) Date Last Pumped ~J¢~' ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIEI. D DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field _~ ~ ~' Depth of Field 5, 5' Gravel Bed Thickness z. ' .s-,,¢,¥~,~ Statndpipes Present (Y/N) Date of Last Adequacy Test To Water-Supply Well To Building Foundation Lot /Voz/E ~,~ SL=PARATION DISTANCE FROM ABSORPTION FIELD: Z~,~'~ To Property Line Z5/' To Existing or Abandoned System on ; On Adjoining Lots To Water Main/Service Line &Z_' To Cutback (if present) To Stream, Pond, Lake, or Major Dra_ip_age Co~urse /¢~';¢ / To Driveway, Parking Area, or Vehicle Storage Area ~'~ ' Comments ..¢~.'~c,,¢pz-/~ .s~:r.,--~,x/) /.s D'~ct F..T_..~T I O N Date I nsta'll~ Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all inspection. Signed ~~-, Company/~J Date MOA No. Date of Payment Amoant:$ 72-026 (Rev. 7/88) Beck Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 in effect on the date of this Engineer's Seal ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 DATE: Auqust 18, 1989 PWSID: 213475 563-6775 According to the records on file in this office, the South Rark S/D Water System is in compliance with State of Alaska Drinking Water Regulations. the Sincerely, Cindy Thomas Environmental Engineer