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HomeMy WebLinkAboutSCHROEDER EAST BLK 7 LT 8 Municipality of Anchorage Page DEPARTMENT. OF HEALTH AND HUMAN SERVICFS ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Ihspection Report Permit Number: ~W'~H¢)~'70 PID Number: 0,.~007//0 Name: ,/-/,e/- ~. ~ ~~ ~ ~n~ Wastewater System: D New ~ Upgrade Address: ABSORPTION FIELD ~4¢~¢ ~,v~%.,R~ ¢9~77l ~ g Deep Trench D Shallow Trench ~Bed DMound BOther L E G AL D E S C R I PTI O N Soil Rating: ~, ~ 6PD/Sq. F. Total Depth from original grade:fi '~/~. Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel length: ' ' - ' ¢% ~ Ft. ~ ~ Ft. WELL: ~New ~ Upgrade Gravelwidth: ~/ ~¢/ Number of lines: Oistancebelweenlines: ~ - Ft. ~ ~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~/0 ~¢, ~/F~A~ /~ Ft. ~.~ Ft. /[~ SO. Ft. ~T~ ~0~ P.V.~. Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: ~0 GPM Pump Set at: U/~ Ft. Casing Height Above~Ground:Ft. TANK SEPARATION DISTANCES ~Septic ~/E% U Holding U S.T.E.P. To Septic Absorption Lift HoJding >ubHc/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~-~ ~ ~ ~ ~ Material: Number of Compartments: WelF /~ / /~/ / ~ ~ ~ ~ ,~ LIFT STATION Surface Water /~ /~ ~' Lot ~_~ ~ Size in gallons: Manufacturer: Line ~ ~ ~ ~ "Pump on" level at: ~ff" level at: High water alarm at: Foundation ~l /~ t CurtainDrain ~0~ ~ K~( W~ /Pump M~I Electrical Inspections performed by: Remarks:~/V~ ~D ~o~ ~S BENCH MARK Location and Description: ~ Assumod Elovmiom 17034 Eagle River Loop Road, No, ~ River. Alaska 995~ Dates: 1st /0 Inspections performed by: 2nd /~ ~/q ~vices approval'~ Department of Health.add Human: ;. / Reviewed and approved by' ~¢~~¢~- Dat8 // ~/~: ":tm ..-'.',¢:':??' Permit Nog.w940570 2 2 Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES FNVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report ~ SCHROEDER EAST SUBD.; BLOCK 7, LOT 8 05007110 Legal uescription: PID No,: C.Ot C.O~ : ~ FINAL GRADE~ C03 ~ ........ :-- , ......... 92.D; (C06) .... "'I~ ............... 100' WELL WATER FOUND 9-23-94 FCO COg CO3 CO4 C05 C06 MT 1 MT~ EXIST, ilO00 GAL. SEPTIC :. TANK co NEW AB:SORPTII BED SCALE t" = 40' ENGINEERiS:; ~L 72-013 A (1/93)' 0CT-04-94 TIJE 1 i :41 A~ $1JLL I~A~ NATER ~4ELL$ 688 275'D444444444444 P. 01 by SULLIVAN WATER WELLS BOX~?02?2, CHU(IIAK, ALASKA g9567 · TELEPHONE ~ Ended _ [ ~ ~ ..... DATE PERbtIT NUMBER KiND OF FORMAT[ON: Ftom=t~ ~. Ft. to ,J'~ _.Ft. ~2 ~)~:&' ~,,2 d,%'~,"" From=.. ~,~,..:,_:_~,.,o~: ~,.-Z:m~,~z.c~ ~.~t~,- F~0.~4,2~'*' FL " " " ,~ ~ 0 ~o~~ ~._Ft,_~,,.:l)z"oC ( /.~.c. ~'~.~ "~ Fl, {o ...... .-FI', to.__ Ft. (O _~_ Ft. to~ MI$CL. INFORMATION: ..s' ,,-Y' (., ,v '?'o ?",~.c C" (:: ,+..r,,J 6 PAGE 1 OF 1 MUNICIPALITY OF 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 (UPGR3LDE) PERMIT PERMIT NUMBER:SW940370 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:HARPER HAL D & PAMELA E OWNER ADDRESS:12607 SPRING BROOK DR EAGLE RIVER, AK 99577 DATE ISSUED: 9/30/94 EXPIRATION DATE: 9/30/95 PARCEL ID:05007110 LEGAL DESCRIPTION: SCHROEDER EAST BLK 7 LT 8 LOT SIZE: 22754 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. 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). THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 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 THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: DATE: Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O, Box 196650 Anchorage, Alaska 99519-6650 September 30, 1994 Robert C. Cowan, P.E. S & S Engi~elTing 17034 North Eagle River Loop, Suite 204, Eagle River. Alaska 99577 Subject: Waiver Request for Lot 8, Block 7, Schroeder East Addition Waiver Request #WR940053 Dear Mr. Cowan: Your Request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is five (5) feet. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will requh'e all separations be inet or another approval fi'om this department. (7]/~erely' Cross, ~rogram Manager On-site Services MUNICIPALITY OF ANCHORAGm Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~ ~ ~).~-_~_ PID# 0~"0 ~ %i ~'0 HA# Date Received: Legal Description: ~-~ Engineer: ~ ~ S C~%J~ I~/~--~-~m ~J~-~ Waiver Requested: Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: 3. Other: Waiver is Granted: J Waiver is NOT Granted: List Conditions or Reasons for above: Date: Rec 9: O~[~,L~ . ****** Nale 6f Reviewer Amount: $ I Ig'~__ Date Paid: ROBERTSHAFER, P.E. September 21, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY 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 & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 "L" Street P. O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 8; Block 7; Schroeder Subdivision East Division Request you issue a permit to drill a well and instm] 1 a septic system serving t]~e three bedroom house on the referenced property. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation, water was encountered at 9 feet and after seven day ground water monitoring, water was found at 9 feet. Attached is the proposed upgrade design. The upgrade is being constructed over the old system because there are no other alternatives except for a holding tank. The old portion, under new system, will be removed and filled with pit run material. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. There are no points of contamination within the proposed well radius which can be seen on the attached site plant. If you have any qustions, or require additional information for your review, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/JA/lt 17034 NORTH EAGLE RIVER LOOP o SUITE 204 · EAGLE RIVER, ALASKA 99577 HEALTH AUTHORI I~ APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ON-SITE WA~TEWATER DISPOSAL SYSTEM CONSTRUCTION PRAC'fI CES MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 R~m'~&~2E:Lot 8; Block 7; Schroeder Subdivision East Addition The scope of this project includes the installation of an absorption bed to serve the four bedroom residence located on the referenced property. If of poor integrity, the tank is to be abandoned and a new 1000 gallon septic tank installed. The existing leachfield is to be abandoned in place. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. o Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4' of cover shall be insulated. 17034 NORTH EAGLE RIVER LOOP , SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 8~ Block 7; Schroeder Subdivision East Addition September 21, 1994 A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10' from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. LEAC~FIELD BED INSTALLATION: Excavate the proposed trench to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation b~comes smeared, it must be raked or scratched (roughed-up) before gravel {sewer rock) placement. If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall be a minimum of twelve (12) inches. The perforated distribution pipes must be no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. o Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed at the locations shown on the design° The portion of the monitor tube extending through the gravel depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finished grade over the bed must be mounded to prevent the formation of a depression after settling. Page Three Lot 8; Block 7; Schroeder Subdivision East Addition September 21, 1994 1. MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved the inspecting engineer. by 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). o A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPMCTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. Page Four Lot 8; Block 7: Schroeder Subdivision East Addition September 21, 1994 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER 3d¥~Odn  Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 4/ ' ,'- / ' Range, LEGAL DESCRiPTiON: I 4~-''~ ~ ¢ _.~'~'? >/'~/~Township, 10 11 12 13 14 15 16 17 18 19 2O COMMENTS SLOPE F: Sec,,on: :/cee./ WAS GROUND WATER ENCOUNTERED? / S IF YES, ATWHAT ~.~ / L O DEPTH? __/ p E Oeplht°WalarAlter ¢/ hlonitoring? Date: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop I 7" // / ~ - 14¢/¢ ' r(./~./f~ ~ '7 ,, .~ PERCOLATION RATE _.~/~¢,~ (minutes/inch) PERC HOEE DIAMETER TEST RUN BETWEEN . PERFORMED BY: $ & S ENGINEEEING 170~4 Eagle River Loop Eead No. q FT AND ~ F'I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 6 7 8 9 (ENGINEER'S SEAL) DATE PERFORMED: Township, Range, Section: , ~/)~¢c¢/ SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O k i~eading Date Gross Not Depth to Net Time Time Water Drop WAS GROUND WA~'~ ENCOUNTERED? '~ IF YES, AT WHAT ~ DEPTH? //' Deplh lo Water After ~  ~,., Moniloring? ? Dale: COMMEi~T,~ $ ENGINEEI;~ING PERCOLAfTION RATE ?~ (mlnutes/inCh)qERC HOLE DIAMETER TEST RUN BETWEEN FT AND _~'-- FT - ~ 7c~'~,a Eagle ....... Lcep PERFORJ~l~.~iver, Alaska 995?7 I CERTIFY THAT THIS TEST WAS PERFORME ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEL[NES iN EFFECT ON THiS DATE. DATE:  MUNICIPALITY OF ANCHORAGE , DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L 8treat - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME 1PHONE /~f NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION ~ DISTANCE TO; Well ~[~ I Absorption area ~ , Dwelling ¢1 PERMITNO. ~ Z Manufacturer ~ ~-¢~ Material ~ ~ No. of compartments ~ ~ Liq. capacity in gallons Inside length Width Liquid depth ( 000 IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling ~ PERMITNO. ~ ~ ~ Manufacturer Material Liquid capacity in gallons Q DISTANCE TO: Well ~ ~ 0 l Foundation ~ 1 Nearest lot line PERMIT NO. ~ ND. of lines ~ Length of each line : Total length of lines Trench width Distance between lines ~ ~ ~'.~'+,~ ~/ ¢~ inches Top of tile to finish grade Material beneath tile I [~,~, Total effective absorption area Length Width ~ Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ DISTANCE TO: Well Building foundation Nearest lot line 4~ Class ~¢'f V~ ~¢ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTFIER ~~ -PIPE MATERIALS ~ ¢' pVc3 SOIL TEST RATING ~ ~ INSTALLER - _..,,,,,. %7¢Z~ ........ t:,,~%~ - % . ~ ] [ti'-,l'r'/,..~l C 'T I:::' H [] HIE ~ JE [']tql.... ..C)T !!!~ ]i ZIE ',', (") ii, / "~c:l / :: ur:i I, fIT ~: :' :F:' iq L.:I:F::-I" STF:'F'I":[[3N ZS;; IhlS'I"AL.I....IED :I;1",1 F:~l'~l ¢11:;'.E¢i [;:[:)",?I!~:F'L'I!!i:D i:'T'," I'"'l[]iA ~i',L~]:[.):)]:I\I[{~ (][]i:)l!ii:!i~u "H!:~!:I",I (:!.) ~ql",l E{I..]EC;'FFR:I:(::;¢~L.. I:::'I!!!:FRH]:T ~qlq:';.') :[N~!H:::'ECT:[[:H",I i"iLJ!i!FF ~{'~ii'.; (]I3'T'{'~:[hlE:I)'j (2) ~ :[ I. %l',If:)'i" ~::+:E: F~F::'F'F:;'.[:;~VJ:!L[) (4 :[ 'l"H[:lt..!'l" F'}lxl EI..E:CTF;'. _1; ChgL_ :1: I'.,E!~I:::'E:ETI' :[ [:dq l::il:!i:l::;'(:.31:~"i" ii ¢:d'.,!.i:) (;?.; ::' 'T!'iE: i:L..!E[:;'T'F;: :[ (iF:ti.,,. I...',.IE:)I::;'.I.::: !"ILJS'T !:-!q:!!: i:)(:ZH'ql!i!: )',:)Y ¢1 L.. ]: (:]I!!i:NSI!!!:~) !EI,,.I!!!:[:;'i"F;: :[ C :[ F:~I",! ,, SE!:CT :1: E)lXl ~,, :[ TDI,',JI'q!3H ]: F:' ,", :1. ;~? 2 7 :::.!; Zl. (!iil D ,, I:::"r' ,, C)R'.~("',l::'d~ '~.. ) CORWIN & ASSOCI~ .:S, INC. Consulting Engineers 4321 Grape Place Suite 204 ANCHORAGE, ALASKA 99504 SHEET NO. CALCULATED BY DArE CHECKED BY DATE SCALE ~-'~/ t/ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99B01 264-4720 SOILS LOG -- PERCOLATION TEST ~ SOILS LOG [] PERCOLATION TEST 1 2 3 4 6 7 8 SLOPE SITE PLAN 10 11 12 13 14 15 20 WAS GROUND WATER S ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time 'rime Water Drop · '"r' '1 r'r ol.!. .;. ',: (; , (minutes/inch) DATE: PERCOLATION RATE ~ . I I TEST R~JN BET~/EEN FT AN(~ COMMENTS ~ b~%~ ;3,- b.~ r~k.d ~~ PERFORMED BY: ~' ~a.A¢ CERTIFIED BY: 72-008 (6/79) COPWIN & ASSOCIATES, INC, CONSULTING ENGINEERS 1549 E. TUDOR RD., SUITE 204 ANCHORAGE, ALASKA 9950? (907) 561-6151 SPECIFICATIONS FOR WASTE-WATER DISPOSAL Schroder East Lot 8 Block 8 1.0 GENERAL 1.1 The drawings shall be part of this specification 1.2 Ail material and workmanship shall meet the requirements of Anchorage Department of Health and Environmental Protection 1.3 Ail excavations are advisory and are to be verified or modified in the field by the Engineer It is the responsibility of the Owner to obtain all necessary permits or easements The gravel for the drainbed shall be screened to the sizes indicated The septic tank or bed must not be closer than 100 feet from the well 1.4 1.5 1.6 2.0 DRAINBED 2.1 Excavate to the GP layer approximately 3 feet below the existing grade, and fill with clean sand to achieve 4 feet above the water table 2.2 Gravel for the drainbed should be placed on the sand 2.3 Bed bottom should be level CORWIN & ASSOCII S, INC. Consulting Engineurs 4321 Grape Place Suite 204 ANCHORAGE, ALASKA 99504 SHEET NO OF___ CALCULATED BY DATE CHECKED BY DATE CORWIN & ASSOCI, 'S, INC. Consulting Engin~rs 4321 Grape Place Suite 204 ANCHORAGE, ALASKA 99504 SHEET NO. CALCULATED BY CHECKED BY CALE OF DATE DATE_ CORWIN & ASSOCIA :, INC. Consulting Engineers SHEET NO 4321 Grape Place Suite 204 CALCULATED BY ANCHORAGE, ALASKA 99504 CHECKED BY ~o,,~E N,T, 5, OF DATE DATE by . t ,. DOC Co, dba SULLIVAN WATER WELLS P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759 OWNER OF LAND ~ ADDRESS '. LEGAl, DESCRIPTION DATE- Started PERMIT r~UMB~R From_ ~ '_Ft. to From_ ' Ft.'t0_ From Ft. to From Ft. to From Ft. to From Ft. to From Ft. to KiND bF F6RMATION:. , From` ~) ' Ft. to' ~'"': Fron~'~t"~_Ft. to /~'; Ft. From~/ ~ Ft. to--Ft. '-TFrom_~ ~'_Ft. to & 7 Ft. From_ ~9 ~ Ft. to ~'~ Ft.-- From_ ~ Ft. to 5~'~ ,Ft. From.. ~ Ft. to ~ From Ft. to Ft. From_ _Ft. to From_ '_Ft: to Ft. Ft Ft. Ft.__ ~2Ft. Ft <- < Ended DEPTH OF WELL ~,- co STATIC LEVEL OF WATER FT. DRAW DOWN FT. From__Ft. to Ft. From Ft, to Ft. Fro~' ' Ft. to Ft. F~:om Ft. to __Ft From Ft. to . Ft. From Ft. to Ft. GALS. PER HR _ ,'~ <] ¢) KIND OF CASING ~ 3~0//'.~ ' From' Ft. to__Ft. From_ Ft. to Ft From .__ From · From From ....... - From ' ~ From From From Ft. to Ft ~UNIcz~, Ft. Ft. to~t. /g~ .,. ___Ft. to ~Ft. Ft. to Ft MISCL. INFORMATION: = ] DRILLER'S NAME 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 Parcel I.D. 1. CERTIFICATE O.F HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-07i-10 GENERAL INFORMATION Completa legal description ~.ot 8, Location (site address or directions) HAA# H,q el Expiration Date: Block 7, Schroeder East Subdivision 12607 SprinRbrook Drive Current Property owner(s) Mail!ng address Lending agency Wes Erb Day phone 688-8935 23832 Immelman Circle, Chugiak~ AK 99567 Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class .~ Public Water System Well [] [] [] 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 5 by an independent professional civil engineer registered in the State of AJaska. 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 hcmeowners. 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 valid for cna year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not respcnsible 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 of Firm Address ENGINEERING . . ........ River. Alaska Engineer'sP~intedN~me .Robert C. Cowan, ?.£. Date · DSD SIGNATURE . - / Approved for Disapproved. ConditiOnal approval for bedrooms, with the following stipulations: Additional Comments By: Attachments: HAA Checklist Septic System Advisory . Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: .~-"-/O ' O / Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Westewater Program 4700 Sou~ Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchomge.ak.us (SO7) ~-7~0~ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT'S/' ~ ~j ~:>~ ~n~- "Parcel iD: A. WELL DATA Well type Date completed Total depth /'~ ft. IfA, B, or C provide PWSID # Sanitary seal (Y/N) Date of test Static water level Well production FROM WELL LOG .. Well Log (Y/N) /¢'"~' Wires properly protected (Y/N) ¥/E-5 Casing height (above ground) / ~ in. AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform ~) colonias/100 mi. Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate /.eT mgJI. Other bacteria O colonies/10Oml. by: Tank Type/Material ~ Tank size/~C~) gal. Number of Compartments Foundation cteanout (Y/N) ~[_ Date of pumping '~/'~/g~ ABSORPTION FIELD DATA Date installed .~ Soilrating (g.p.d./ft2or ft2/bdrm){/~, 4 Length '~"~ ' ft. Width O-- ~.~ ft. Date installed Cleanouts (Y/N) Depression over tank (Y/N) /,,/O High water alarm (Y/N) Pumper ~,~'-/'"~ '~ Total depth ~" ff.-- .Eft' absorption ama t/..-~ Monitoring tube Fluid depth in absorption//field before test .4~Jr'in. Water added~'~)gel. Elapsed Time:~_.~. min. Final fluid depth,~ in. Absorption rata >= Any rejuvenetion treatment (pest 12 mo.) (yIN & type) /~,~./(-- ~l/d~',/V' Ifyes, givedata System type ~ Gravel below pipe ~) ° ~ ft. Depression over field ,&fO For -,~ bedrooms New depth '~'~in. D. UFT STATION Date installed ~ ~ in gallons on" level at ~.._~. 'Pump off' level at 'Pump Datum ,~/ Cycles tested E. SEPARATION DISTANCES Manhote/Acc _J~__~ (Y/N) High water alann level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/li~:~,tetltm on lot Absorption field on lot Public sewer main ,=J~,ve[ Iseptt~ service line On adjacent lots On adjacent lots Public sewer manhote/cleanout SEPARATION DISTANCES FROM SEPTI~ TANK ON LOT TO: Building foundation ~'- / Water main ^///~ f Wells on adjacent lots [~)0 ~- Property line. ~' ~ Absorption field ~' ' ~ / Water service line /~) ~ Surface water /C70 /+' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line -~' ,3~'-' Building foundation / ~) '~- Water main ~.///4- / Water Service line /~(:~:)/-4''' Surface water ~C) ~) / ~ Driveway, parking/vehicle storage Curtain drain ~ Wells on adjacent lots /(:90 F. COMMENTS E.eI.EER'S CEa .CATIO" ...... I ce~ that I ha~ dete~ined ~m~h fie~ ~ns a~ mv~w of Muni~pal m~s that the a~ s~e~ am ~ ~. ...... ~n~an~ ~ MOA H~ gu~eUnes in eff~ ~ ~ date. r,,~_=.~r Date ~ /~/0 I HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) 3OO. 0o3qo7 Waiver Fee $ Date of Payment Receipt Number 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. # O ,¢-oo -7 I I 0 1. GENERAL INFORMATION Complete legal description HAA # IJ q Location (site address or directions) 12607 Spt±hq Brook Dr(~ge ~!~gl¢ I~i~r~ Al~,~jCa 99577 Property owner _ u~] n. ~ pamela R. aaEper Dayphone. Mailing address Lending agency Mailing address 1.2607 Sprin9 Brook Drive, Eaqle River 99577 Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 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: xxx 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 :. :' :3 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 o.f st!ucture indicated h.e. re'n I further ver!fy tha supply and/or ! ba.sed on the information obta ned from the Munic~pahty of Anchorage flies and from my investigation and inspection, the on-site water wastewater disposal system is in compliance with all Municipal and Stat(; Codes, ordinances, and regulations in effect on the date of this inspection. Address 1703 _¢ E,4-C~,~ Engineers s,gnature Phone Date 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 this as a courtes and their lending institutions in order to satisfy certain federal and state requirements I ~ I~opurchasers of homes COnduct inspections or analyze data before a ce ..... ' '" P YeesofDHHSdonot responsible for errors or omissions in the professional engineer's work. , mncate is issued. The Municipality of Anchorage is not 72.025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:--~,,-/f,~-oe'D~',g. ,Z~,~s~ /~z. oc~. 7)/-o-J?Parcel I.D. ¢~-007 IlO A. Well Data Well type /"~,,g-/v,-~ ~-~- Log present (~N) ~/~'S Total depth /~O / Sanitary seal (~N) ~/~.s Date of test '"~'/~..~-L" If A, B, or C, attach ADEC letter. ADEC water system number Date completed _ /o/R'-f Driller Cased to FROM WELL LOG /o/q'l Static water level /2 ~ Well flow 2 d Pump level1 U/l<. SEPARATION DISTANCES FROM WELL TO: Septic/h~,dic~j tank on lot /dC ' Absorption field on lot /d/ Public sewer main 2,¢" v- Sewer service line /d) ' ¢- ??. ,¢ ' Casing height ~_' Wires properly protected (~',N)_ AT INSPECTION z LL~ g.p.m. g ~z - ? .g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform O (,¢/,~ ,¢~,//¢¢/*/ Nitrate O,.~/ /~,¢,// Other bacteria Date of sample: /C) '-/~ ~(¢ Collected by: B. SEPTIC/HOLDING TANK DATA Cleanouts (~N) Y~s High water alarm (Y~) Date of pumping Date installed / - 2~' - ~' Tank size /oO¢ ~-,~, Compartments 2L Foundation cleanout (~N) ~'~s Depression (Y~) ,A)O /d./// Alarm tested (Y~ A Jo ~/,,~ ~,,.//g//~ ~' Pumper SEPARATION DISTANOES FROM SEPTIC/.HOLDii'¢~ TANK TO: /'%/O Well(s) on lot ldo ' On adjacent lots /~J '*- To property line Z~ ' Absorption field / ' Sudace water/drainage /¢¢ ' f Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE SEPARA~ LiFT STATION TO: ___On adjacent lots D. ABSORPTION FIELD DATA C. LIFT STATION Date installed. ~-- Manufacturer Size in gallons _ ~~- Manhole/Ac_~,e~/N Vent(Y/N)__ ~~'~'~~ ),~,~ High water alarm level _ ~/~ O~ested~Ump off' Level at Meets MOA electrical Codes (y/N)...~/ [)ate installed /~_/,0 _ ~._..~ _Soil rating (GPD/Ft2) ..~ ~/ Length 5'?' Width ~ - 27' - .~System type .,~__,~,~'o,,~_..~/o,,v ,¢?_~_~_~ __ Gravel thickness_ ?'~ Total depth__ ,p' ~ _ Total absorption area _. __Z~?~'~ _Cleanout present (~) __Y~s ~_Depression over field (Y~) Date of adequacy test_.~,g. ~_~ sy~.~_,~ Results (passifail) _ W~/,,~ __ __for ~ ~ Bedrooms Water level in absorption field before test __ ~ -- ~ _Aftertest _ __ ~ __ Peroxide treatment (past 12 months) (y~.~ ~ ,,~,~__~__.. __ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on Iot~ /~2/' -----____ On adjacent lots /¢~ /.~ __ Properly line To building foundation /5~' ~ ~To existing or abandoned system on lot On adjacent lots__ ~z'o '¢-__ ~Cutbank_ __~o '-,~ Surface water__ _./_,~ '~ ~ ~Water main/service line /o ','- _Driveway, parking/vehicle storage area /~ Curtain drain _ dzV___d.~ ~)~-.~,vEl:t-~'.fo©$~ t",-'4~',,E,t o-,~,~ ,'~o/C ,L*~J 7'- //.,7 ~,..,2(2 *'2'O LO}-- ,,_~,.,~. E. ENGINEER'S CERTIFICATION . I cern'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effec! ~?n~ (he, date of this inspection. Signature _ ~- ' - Engineer's Name ,Y~'.~..~ ,--- ~-'. (--~,,,~ ~ Date / c~ /A~ HAA Fee $ Date of Payment Receipt Number 72-026 (~), ~ck Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONiVIENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORIVIATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 8 Block 7 Schoreder East Subdivision Location (address or directions) Springbrook Road (b) Applicant Name Steve SkaAgs_ Telephone: Home .................... Business 688-2831 Applicant Address PO Box 670690 Chugiak,~Alaska 99567 (c) Applicant is (check one): Lending Institution []; Owner/builder F~.; Buyer []; Other I~1 (explain); (d) Lending Institution A,~. Address ~_O_.Eox 10_~_.~g_agle Rive~c~__Alcs_ka~_5.77 (e) Real Estate Company and Agent P~?_kJ~n.s~ Rea~Lt~z~, Inc. Address 17_1__9 Eag%e_ River RoadL_ga~gle River, Alaska Telephone 694-3594 ] elephone __6~94-9571 99577 (f) MailtheHAAtothefollowingaddress: George Perkins, 6~%~¢70/694-3594 TYPE OF RESIDENCE Single-Family¥.~ Multi-Family [] Number of Bedrooms three(3) Other WATER SUPPLY Individual Well ~x Community ['-'J Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite:E~:x Public E] Community E] Holding Tank [] Note: If community well system, must have written confirmation from the State Department el Environmental Conservation altesting to the legality and status. Page 1 of 2 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 ti~at 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 Telephone Address Date Engineer's Seal This Department has received a satisfactory water sampling report and this property is now approved, DHEP APPROVAl. '-'~--~-~-'~ ~"'~-. /."'?-.z ~.~ z~x~ Approved for' three (_3_)_ bedrooms by ' ApprovedXxx×x Disapproved ___ Conditional Terms of Conditional Approval Date November ~= 1985 CAUl'ION The Muncipality of Anchorage Depadment 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 does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DI-IEP do not conduct inspections or analyze dala 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 , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORFI-Y APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472O GENERAL INFORMATION (a) (b) (c) Application Date. Legal Description (include lot, block, subdivision, section, township, range) LoT Location (address or directions) Applicant Name ~~%~~lephone: Home Applican~Address _~ ¢~0~' ¢7~ ~¢¢ Applicant is (check one): Lending Institution []; Owner/b,~uil~_ejr [~; Buyer []; Other [] (explain); (d) Lending Institution _&__l~'~_ ~'2~_. Telephone ~'-~ '~z'../.--~'~'~_ (e) Real Estate Company and Agellt ~1 ~'~ -~ ~-L~- '~-~ ~___ (f) Mail the HAA to the following address: O~~ TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms ~-'~* Other WATER SUPPLY Individual Well []~ Community [] Public ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [~ Public [] Community [] Holding Tank [] Note: If COmmunity we system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (~ 1/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMAflON 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 ~'~)~'k/~ll~ ¢~2-~_~(~,/.,'¢r 7"(;~, I_~phone _ ~ '~_~'a_.l Engineer's Seal 6...DHEP APPROVAL ~ppceved for'//¢¢~;<'~'~/_ bedrooms by ~-¢-~ ~"~;~ Date Approved ' Disapproved Conditional -' ..----- O~ // ~ ~ - :'-..' - CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authorily 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 does 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 WELL DATA Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALIYY OF ANCHORAGE D~PT. OF HEALTH & ~NVIRONMI~NTAL PRO fECTION 1985' Legal Description: [~¢:r'~' ~ R ~L~ V~_ D Well Classification ~:;:~-~,J V,'~'_T"~~:: If A, B, C, D.E.C. Approved (Y/N) Y Log Present (Y/N) Date Comp}eted J ~/~ ~ ~i,Yield Well Total Depth ~O / Cased to ~ ¢.~ Depth of Grouting Static Water Level ~ t Pump Set At Sanitary Seal on Casing (Y/N) '~ ~ ~ Depression Around Wellhead (Y/N) ; On Adjoining /.ots. ! -J ¢ ;;~ ; On Adjoining Lots To Nearest Public Sewer To Septic/Holding Tank on Lot To Nearest Edge of Absorption EJeld on Lot To Nearest Public Sewer Line _ Cleanout/Manhole __ Water Sample Collected by Water Sample Test Results Comments To Nearest Sewer Service Line on Lot .= /'-.//,~" ~. j~:~t¢' ~4f,/~-/~'l~ . Dat.e.~- .... ~'~'~ _ ~*') B. SEPTIC/HOLDING TANK DATA Date Installed I-Z.E~%C~Dsize J~:,¢O ~-~,,4/-.,No' of Compartments ~' Standpipes(Y/N) '~.~'~ Air~tight Caps (Y/N) -%--~ Foundation Cleanout (y/N) I~epression over Tank (Y/N) ~ O [)ate Last Pumped N/,~ Pumping/Maintenance Contract on File (Y/N) N/~ ; for Holding Tank High-Water Alarm (Y/N) /k///~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: -ro Water-Supply Well To Property Line To Water Main/Service/~ine /~. Course To Building Foundation /~2 ! To Disposal Field '-~- ¢ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(111841 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed I ~ ~" ~__ ~ Width of Field ~ I Square Feet of Absorption Area Depression over Field (Y/N) ~d~---~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line . /0(¢I, . To Stream/Pond/Lake/or Major Drainage Course To Drivewa,,~y, Parking Area, or Vehicle Storage Area Comments ~ ~¢~/]'~_~ Type of System Design Length of Field Depth of Field ~l~ Gravel Bed Thickness ~ ¢ ~ ~'/' Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line / [2 I To Fxisting or Abandoned System on ; On Adjoining Lots /0 I /~Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check/~¢itted B¢oom Rating Against HAA Request ** I certify tlla~t/~ have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S igne~/////./~/~4~,/~'~ ~-~' '~. ~ Date ~'-~ ~ Date of Payment Amount: $ ~,-~', Page 2 of 2 72-026 (11184)