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HomeMy WebLinkAboutSOUTHPARK BLK 4 LT 1A ~ "~ MUNICIPALITY 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 [] UPGRADE MAILING ADDRESS LOCATION ~ ' ~ ~ell ~.~ Absorotion area ~ / PEBMII ~0 ~ DISTANCE TO: ~C~ ~*~] J [ Dwellin9~ ~ Z Manufacturer~z Material No. of compartments Uq. c~ ~sagons IF HOME~DE~ Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material kiquid capacity in gallons ~ W I , Foundation Nearestlotline]v Distance between ~ines ~Z No, oflines ~ Leng'h~fe~ ~ Total'T Trench wid~,~ ~ ~ Top o' ,lie to fin,sb ,rada ~ Material Beneath the ~ ~ inchOSlnch.s Total .ffeet,v~b~r~tio~ m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ CJass Depth Driller Distance to lot Jine PERMIT NO. ~ DISTANCE TO: Building foundation Sewer llne Septic tank Absorption area(si OTHER INSTALLER / REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) PERMIT NO. MLI~'-t I: C: 1' ~ FILI T"¢ L]F FIi'--I¢:H__-F:t-]GE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 8-'--"5 "L' STREET., ANCHORAGE., AK. 9950± 264-4?20 CIN--S I TE SE~4ER F"iE:f4 I T ( 821091 ) APPLICANT LOCATION LEGAL UNLIMITED 7800 DEBARR ~206 99504 LiB4 SOUTHPARK ~ LOT .~I-E ~49-80±4 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRRINFIELD MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SD FT?BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [)EPTH= 6 LE~-~GTi4= 44 GAR'eEL [)EPTH= ----< THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAtNFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE 8ETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE TRE~46:H 14 I [)TH IS .~ 00El FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE 80TTOM OF THE EXCAVATION (IN FEET). REL~U I RE[) SEPT I C: TA~4k'- S I ZE= ±El80 GALLE~F~S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE NELL WILL SERVE. T~llw (2) I~SPECTIO~S ARE RE~]IJIRED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A NELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS t08 FEET FOR A PRIVATE NELL OR 150 TO 200 FEET FROM R PUBLIC ~4ELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERI-4 I T E:~-~F" I RES [-~ECEI~18ER __?-i.. 19:[32 I CERTIFY THAT t: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BV THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ]: BEDROOMS. ......... SIGNED: APPLICANT [:,&S UNLiMITECI ~ ~¢ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: * DATE PERFORMED: SLOPE SiTE PLAN 10 11 12 -- 13 14 15 16 17 18 19 20 WAS GROUND WATER j~ ! S ENCOUNTERED? ~/VG OL iF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) COMMENTS PERFORMEDBY: ~'~'~'~'~ CERTIFIED BY: 72-008 (6/79) Si REI 1 tORAGE, Al ASKA 99501 I 2Gi ,lill January 4, 1982 Dick Goslin P.O. Box 261 Wasilla, AK 99687 Permit ~ 810989 ~ Subject: L1 B4 Southpark ~t~zz~u~-~ A permit issued by this department for a well system has expired as of December 31, 1981. Permits are the permit, and/or sewer issued on a calendar year basis, as stated on by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, ~eroSg~mB~hnha~lerZ~c_~~' Sewer and Water Program Enclosure: Copy of Permit PEEIIT FtF'F'L ~ CFI~.,!T LOE:AT Z ON LE)3F~L DEPFtRTi"IEN"I" Or' I'4ERLTH R~',IE) EI",!',¢':[F..'OI",!MENTRL PROTECTZON 825 264-,4728 [:,IE:K 61J~L"~-_, P. 0. SOUTHPFIRK Li B4 %OLITHPRRK ~, LOT SIZE 4]:560 S};!LIRRE FEET T?PE OF ~.::;--I_ RESO,~'PTi:N ..-¢_,TEll : "IF.E.,IL.H ~,F!XIi',1L.I[,! F4LIi',IE;ER OF ~3EL")~'COi',F; = 4 SOIL ERTIN.~ THE RE~ZIIF'Fn, ._,Z .... OF THE: :,LIL FtE:SORF"rloN S'-?S;TEM THE [..EF,~GTH £.II'!Ef'LIUI! ].=, THE L~Eit(-~TH ,::'rl,.~ FEET) OF THE Tf4. Ei'L.H OR E:,F...'RIf..IFZEL[:,. 'rl.4E E:,EF'TH OF FI TRENC:H OR F'ZT ZS THE [:~ZSTFII';!~:E BET.~,.IEE;'.,I THE E;URFFICE OF THE ~]l~'.OLIk~[:, Ri'.,IE:, THE E~OTTOi',t t~F TI-IF ¢;,.,;C:~¢FIT:[;iE~N ",:';IN FEET", THE; Gf4. FI'¢EL B, EF'T~-t ~S THE l,'i;[l'.,!II'~tl~lf,1 DEPTH OF G.RFiYEL BE'f}.EEN "}IE OI. ITFFIL_. PJ;F'E F:IJ'.,!B, 'EIE ELi F FUI','t OF THE E -',LH ?PI7 ~UI'-~ ,' Z!'.~. FEET). F'E~'.I,1:[T FF'F'LI-Rr. JT F. ld:, THE RESF'Of'.L~IE:ILIT'-? TO I~-,iFORi','! THIS £EFHf~.T.tENI [',IIR'I~.,Fi THE I~,I.:71--LLH'I ILN I~t_FEL. T.t _N:, OF RN'-r' I.,ELLS RD,.;rRi;;:ENT TO 'THt_ r'r',_r_r~'~ RI',I..P., THE NIII"tBE~;' OF R~.=,:(E,-'[,IL.E::, THEft THE ~'.IELL ~,L~LL ~";EF.:",,'E. E,i"IL.,~--.F ZLL.[I"L~ OF FtN'¢._ '¢-.,TEi'I I-IYTHr~IIT ....... F'rNI=IL [i~',!"%F'E-:TZ ~i",l RI",tE:' FIPPRO',,'RL E;"r' T."IZ:,~ ' '- [:'EF'RRTI'IENT ~'-!;[LL E~E SUEL'rECT TO F'F'~SEZ t¢ I'.,rr I',t .... If't. E:,I STRI',!C:E E:ETt.4EE.! Fl ~.~IE:LL Ri'.!E:, RN'¢ ]'.FG~[ TF ....... ':-'-,bl..IHl=E' - '" ' E' I:,,'-r':' k,l'-IL':: S'¢STE!"I _'r':_ ±00 FEET FCt~' R F'RI',,,'FITE [,.IE:LL _-iR :1..50 TO 20E F'EE;;'r F'ROH R F'UE:LZI3 J-,JELL I.F,."'i'-! THE T?F'E OF FUE, L~.C .~,ELL ~,., ,~.~ FEET TO R COM,~,tt,jNZT'¢ SE~,.!ER LINEI...'~ ?5 FEET. :' .~,.IEIl. ,_._ LI]Fi';_ ~ _ FIRE: REi;!UIREE:, Fti'-.!B, t"IlJ~T~ b,._-:'~' RET:O¢:NE[.', 'r~z THE E:,EF'FtF'Tr,EN"r.. . . I.,.I;I.'THZi'.,I 3:0 [.H'r:,'",-' "- OF' THE .t,.IELL COi"IPLET:~ON. -}'HER' ....REIZIlREMENT9 f'tR"? RF'F'L?. c'-",_,hE_." -'TFIL. H F.[LN:,-' .... '- Ri",~P _"':l]l'-,?~Ty' ..... ":Tt-N DIRGRRi','t$ FI',,,'FIILFiE:LE TO INSURE F'ROF'ER :[t'-fSTFLLRT;[C~N. ! C:ERTIFY THFtT l: I FtP1 F?]I"IILIFIR E[TH THE RE~ZIIRE1ENTS FOR ON--SITE SEERS RND [,.IEL. LS FIS SET FORTH E¢ THE MU~.~ZC:ZPFILI'T'¢ OF RNCHORFIGE. 2: Z I,.IILL INSTF~LL THE SYSTEM IN RC:COR:DFtI',ICE I,~ITH THE CO[:,ES. 3:: I LINDERSTRND THRT THE ON--.SI"rE SEI.qER S'¢9TEr,1 t,'lR'¢ RE~;~UIRE ENLRRGEf,IE~.~T IF THE RESIDEd,ICE IS REMODELED TO INCLUDE MORE THRN 4 8EDROOf,IS. S I GNE'E,: FF L.t .~.171 [:,ICi-,:; ........... ,. E?¢ - ..................... [:'FITE. , ',,,'4.. 0 F~d',] [ r i' ,o. u. OOX '-;XS~,, HffS[LLR, t'lfl:.'~[i"~Jit HiJNS-c_-F: ,3F L-¢,EzO~CION5 = 4 PERFORMED FOR: 2 3 4 § 7 8 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST , , -~, . ~/~ ' '' SLOPE ~ SiTE PLAN f, OILS LOG [~P~RCOLATION TEST 10 11 12 13 14 15 16 17 18 19 WAS GROUND WATER ~ 0 Sd ENCOUNTERED? L O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop 20 PERCOLATION RATE O~. ~ · (minutes/inch) TES~ RUN 6ETWEE. ~ E~ :D''~' 0 'PT PERFORMEDBY: K~ ~ t~ ~ 72-008 (6/79) 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 1. GENERAL INFORMATION Complete I~gal description Lo~-- (j CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING - Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent -~ ~V-- Address' Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: Individual well Community well ~C Public water NOTE: if community well system, provide written confirmation from State. DEC attest- lng to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: Individual on-site H01di~ig'tank L Community on-site Public sewer ~UNICIPALITy ~ · ~ ENVIRoNME~.,~-..' ~F ANCHoP, AGE ;. . '~L SERVICE8 DI~ISIo~ :.-RECEIVED NOTE: If Community waStewater system, pro'vide written confirmation from State ADEC attesting to the legality, and status of system. 72-025(Rev, I/91) Front MOA#21 'As certified by my seal affixed hereto and as of the validati0n date shown belo~v, 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 [hu~ plM; ~,nCid~;~tYwaOsfte.~;aCtheOrl;igs; foils;~ ;ynsdt~l rmO ,n~ ,mnyc~n~lsitiagn cat~;it~ndall n;Puen ic~i;:,I ordinances, and regulations'i, effe6t (~nthe ~[at(~ Ofthis'inSpection."'.~ : ". '.-" . Engineer,s signature ~.~¢/~/~, ~/ .~¢'/~/,/( h 'Date Disapproved. Conditional approval for bedrooms, with the following stipulations: Additioha~Comments The Mun c pa ty of Andhorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates 'basc:~ only upon the mpr~entations givee in paragraph 5 above by an independent profeesional engineer registered in the State of Alaska. TI!e DHHS doesthis as a courtesyto purchasers of homes . and their lending institutions in order to sati~ffy certain federal and state requirements. Employees of DHHS do not conduct inspections o,r/analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errom o~' omissions in the professional enginesr's Work; LegalDescription: i..-o'T~ (j /~j~z~- MUNiCIpALITY OF ANCHORAGE~,,.,~=~I Municipality of Anchorage ENVIRONMENTAL sERVICES u,~,?~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division JU~[ 0 2 1997 825 L Street, Room 502 · Anchorage, Alaska 99501· (g07) 34~ ~z~ iV- ,7, ~ D. Health Authority Approval Checklist ~./ Parcel LD.: ~2-D --0~/~ A. WELL DATA Well type I~B, or C, attach ADEC letter. ADEC water system number Static water level , ~;,~ ,, Well production WATER SAMPLE RESULTS: Coliform Date of sample: Collected by: g.p.m. T~~/N ) Date completed Cased to Casing height (above ground) Sanitary seal (Y/N)'~ Wires properly protected (Y/N) Date of test ~ ~SPECTION... Nitrate Other b~,,,,,,,,.,,~ B. SEPTIC/HOLDING TANK DATA Date installed / 0,~'~- Tank size /(~ Number of Compartments Foundation cleanout (Y/N) ~ ~(~ Depression (Y/N) /JO Date of Pumping ~"/~-'7/~ Pumper /~' 'to -- Cleanouts (Y/N) High water alarm (Y/N) C. ABSORPTION FIELD DATA Date installed [ O/~?~, Length ,~llrZ~ Width Effective absorption area ~ '7~ Soil rating ~ft~or ft~/bdrm) /~'~'~ System type Gravel thickness below pipe ~:'/'Total depth Monitoring Tube present (Y/N) 7 Depression over field (Y/N) Date of adequacy test/~'"/)-,~/~':~- Results(Pass/Fail, p,.~c,~' For J~ bedrooms i1~~' 4 Z 0n.): /~Fluiddepth ~" (ins, Minutes later:_~ _ Absorption rate =_ ~4~ .g.p.d. LPeroxi~eatment (past 12 months)(Y/N) - ~ 72-026 (Rev. 3/96)* Date installed --.. Size in gallons Manhole/Access (Y/N) ___~~ "Pump off" level at* High water alarm level at* "~ *Datum -'""~'~'~._ Cycles~~~'~- E. SEPARATIGN DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ,,~/,,// Septic/holding ~ On adjacent lots Absorption field on lot ~~~~ /... -~..~._.... Public sewer main .-.- ..~----'"~ Pub c sewer man~ Sew. e r/s~.~.~c.-se~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation -~ -- Property line ~' I0 '~ Absorption field Water main/service line '~,/0 Surface water/drainage "~lO0' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIE~I~ ON LOT TO: Property line ~ 0 "' P'~'~'- l¢lS'Z' I/4~'P' ¢,6¢on-'?--'*'~"-" Surface water Curtain drain / Building foundation /~ .Water main/service line ~'/O Driveway, parking/vehicle storage area I¢/.~c~-,.J¢...¢ Wells on adjacent lots ~' Z~ P~J &L.f~.~ · F. ENGINEER'S CERTIFICATION i I certify that lh/¢~ ~errn',Jn~¢ n~field inspections in conforma~e I~.~01~ ~A u,~,,~ in effect on this date. Engineers N~/~d ~'~ ~ ~ Date ~/'A~ ~/~ HAA Fee $ Date of Payment Receipt 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number M~y-23-g7 08:33A Bo)~nie Mmhnmr & Associate 907762-1858 .L MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date / GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) (b) (c) (d) Location {address or directions) Property Owner/"~-~',~"~ /~.~'~;"¢~/~ Telephone: Home Mailing Address'"'/~2;~,'') ~' ~.,.2,¢'?~/t~,4~ ~-';~'~,./:~': (Y.-)/~.'< /~ Lending Institution. Telephone Business Mailing Address Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here ~(~, if hold for pick up. List contact person and day phone number below. ~ TYPE OF RESIDENCE Single-Family/~/ Number of Bedrooms WATER SUPPLY Individusl Well [] Community [] PublicA Note: If community well system, must have written confirmation from the State Department of Environmental Conservation SEWAGE ~.ISPOSAL 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 (Rev 8/86) Front 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 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 Mueicipality 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. Nameof Firm ./~,~5'~ ~¢/e.~$ ~//~/"~ Telephone Address '~-'~ 2.--¢:~ ~./J¢,53- ~> ~ DHHS APPROVAL Approved for _~.~./,J_/(/~?~bedrooms by Approved /~ Disapproved Terms of Conditional Approval Engineer's Seal Conditional CAUTION 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. Page 2 of 2 72 025 IRev 8/86) Back WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) MUNiCi?ALi.[,~H.~AI,~'JrI~I~HORITY APPROVAL (HAA) ENVtgONM~N~AL $;~F,~, ,G~E~:KI~I~,,tl- FEBRUARY 1984 264-4744 Legal Description: ~' /,'~ "~//'~' '~ ~/~? :~ ~' ,'~'- If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) /'/'/~ Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around WelLhead (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (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 Cleanout/Manhole Water Sample Collected by Water Sample Test Results ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Size Date Installed Standpipes (Y/N) Y' Air-tight Caps (Y/N) Depression over Tank (Y/N) L Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: TO Water-Supply Well To Property Line /~' r To Water Main/Service Line No. of Compartments ~ Foundation Cleanout (Y/N). ''/ Date Last Pumped ~'/~5'~ /~'~'~ ;for Temporary Holding Tank Permit (Y/N) . To Building Foundation ~ / To Disposal Field //z To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026 fRev 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed J O,~./ ~' lI ~' ~''~ Width of Field '/~d~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test J7¢ ~'~' ,,7 Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot . ~.. z-/~,.~,.._ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments /'~¢/ /4'~'~" ? To Property Line /'~-"'/~' ''~ To Existing or Abandoned System on ; On Adjoining Lots To 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 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 Date Company MOA No. Receipt No. ~ -(~'O/"%~ O/~ Date of Payment /o~ Amount: $ ! o ¢ ~ Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 "C" STREET, SUITE 1334 / ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: PWSID #: ___21~4Z5 ......... To Whom It May Concern: According to the records on file in this of?ice, the E~!8!E~__~UBQIWI~IO~ ....... Water System is in compliance with the State o? Alaska Drinking Water Regulations. Sincerely, Ronald S. Klein Environmental Field -~o* **r Or e' / / o%/ q LEGEND 0 NOTESx' LOT CORNERS FOUNDATION ORAINAGE ARROWS I. IT BHALL IE THE REBPONBIDILITY OF THE IUILDEB OR OWNER TO VERIFY THA~ BUILDING LOCATION EHOWN MEETC ALL BUICIVIBION COVENANTS AND ZONiNg OROINANDEB. , B. IT Ii THE REEPONCIRILITY OF THE BUILDER TO VERIFY ALL ELEVATIONB WITH RESPECT TO ALL UTILITIES, N DRAINAGE. B. TNIB PLAT REPREBENTB THE PARCEL OF PROPERTY DEBCRIRED BELOW TAKEN FROM THE RECORDED PLAT DEBDBIBINO THAT PARDEL. INBTRUMENTC REDOROED ~FRIOR 'TO OR AF'~'ER' THE FiLiNG OF THE RECORDED PLAT ARE NOT EHOWN ON THIS PLAT. 4. THE INFORMATION ON THIB PLAT lB FOR THE UBE OF LENDIN~ INETtTUTIONB SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXIE'rlNO STRUCTUREE AND PLATTED LOT LINER OR EABEMENTB , THE PLAT I! NOT TO BE USED FOR FOEITIONIN~ ADDITIONAL STRUCTURSB OR FENCES. BESSE, EPPS IA POTTS 2220 E. 88'th. AVE. 349-6451 ANCHORAGE ~ ALASKA 99507 344-1352 ORAWNDY, K~L. IeOALE' '"~0' IC-C IDw'*No* CHK. SY~ DATE~ ~ ,/~J FLD.