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HomeMy WebLinkAboutTANAINA VALLEY LT 7 MUNICIPALITY OF ANCHORAGE DE RTMENT OF HEALTH AND HUMAN SER ES[-/~'!/~//'~ ~.~/ ~ ~'~ Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl. INSPECTION RI=PORT Address Phone(s) Perm~/ No [No. o~ Bedrooms I 't _ o ,/ ?'"IZ^/ ,~ TANKS SEPTIC [] HOLDING -Ma~utactur er Capacdy ,II galrons / 2 ___~ T' [~ ~ L. TYPE OF SYSTEM ~'TRENCH El BED [] W. DRAIN [] OTHER original grade ~, ,5-- FF /c~ FT 0 FT ~" FT ~ / FT 3 FT '"J~, SOFT ~ FT t/~ ~ ~/ WELLS PRIVATE ~ OTHER (Identify) FTJ_ FT DISTANCES WELL LOT LINE FOUNOATION SEPTIC ADSORPTION TANK FIELD CC'PA~[/i,a ~ T ^I A 7"~,~ ~..~' .~ ~ ' Io' REMARKS: Scale: /" Inspections Pedormed by: ~unicipal alld 8tale §uid¢ines in ellecl off this date: _ cer,,tily that Ihie inspection was perloreied according to all ^~ichael E. Agcl~[sgn 4381 -E 72-013 {3/85) ~/ $O~LS LOG IVIUNICIPALITY 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: SLOPE SITE PLAN // '~ 10 11 12 13 14 15 16- 17 18 19- 20- WAS GROUND WATER S ENCOUNTERED? /'~/~) k O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND ---- FT COMMENTS 72-008 (0/79) K)' I' ll~ lb 18 § ~.to.~' $ 16 8 14 13 E. Andorson 4381, E \ II ze{"~ ]0' ,[me~q~cy ~oad ~,,,,- Act'esl EO~ .-..'"~\ ~ :ZeO.02'-- \ N 09°§0'40'*~: - O60. O~'(ld) S 89°98'41 "W * $09,90'(R XP60-138) C-9 l, Lot 17 HOUSE DETAIL SCALE: 1"=30' � `WOODEN WALKWAY 7.0'x8.0' PORCH 1.5'x7.2' CANT Lot 6 0 NOTE: LOT IS SERVED BY A COMMUNITY WELL PLOT PLAN AS BUILT X SCALE 1" —=6(y GRID SW 2122 Project No. 17-452/R1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, i n c . (907) 522-6476 Phone 000vOp�O (907) 522-4625 Fax o0 0F Professional Land Surveyors kenOlangsurvey.com c •. . q Q jonothanOlongsurvey.com DOP s DO I hereby certify that I have surveyed the following described property: LOT 7, TANAINA VALLEY SUBDIVISION (PLAT 86-91) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated this the -&& Day of 40V I , at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. �?� 49TH • �>+� KENS •• NG ••o l � •.LS -5 t(28�L1 •� �� �� 02.•' S�0 0 AR aoo 40�� EFSSIONAI- �o AECC963 FA r1�G1891� V. r E. NO'i2 2 20'1 )l'' •_ Municipality of Anchorage ��� °` ' On-Site Water and Wastewater Program i + : n�` 5 (907) 343-7904 •••24,.....,w.. Certificate of On-Site Systems Approval Parcel I.D. 011-051-82 Expiration Date: The c 0 i a01 & 1. GENERAL INFORMATION Complete legal description Tanaina Valley Lot 7 Location (site address) 7050 Lowell Circle Current Property owner(s) Sarah Tugman & Gregory O'Keefe Day phone Mailing address 7050 Lowell Circle Anchorage, AK 99502 Real Estate Agent Day phone 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Q Individual Water Storage ❑ Holding Tank ❑ Community Class A Well El Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: 'Received by: ` �/i�p r t 0 I \ a Date: ' + 12. 1I I requestedbyengineer. COSA to be released to the engineer,unless of -rvnse 4 g COSA Fee $ 5024, Waiver Fee $ Date of Payment /l/aVi?" Date of Payment Receipt Number 003861 Receipt Number COSA# Q5G1? '/ /" Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems 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(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at the time of installation. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 11/21/2017 OF .S C'P TM i\ 9*rl 6. DSD SIGNATURE4•••• • f System#1 Approved for '• '' '`... bedrooms •Sieven f2.•Pannone System#2 Approved for bedrooms � 9,•• CE-8149 Disapproved ll\\`g`Or Conditional approval for bedrooms, with the following stipulations: •• 0 OF rx0ON-SITE ��;; VII TER AND o WASTEATER oz W pROGRAM - l�p47F•NT SER�\G��O By: /ire &tee(i1G/ Original Certificate Date: Dec d 1 .2O 1 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_S c If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Tanaina Valley Lot 7 Parcel ID:011-051-82 A. WELL DATA Well type A If A, B, or C provide PWSID# 214706 Well Log (YIN) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/25/88 Tank size 1250gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 1/11/2017 Pumper Northland Pumping C. ABSORPTION FIELD DATA Date installed 7/25/$$ Soil rating (g.p.d./ft2 or ft2/bdrm) 150 SF/BDRM System type TRENCH Length 61 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 10 ft. Eff. absorption area 732 ft2 Monitoring tube Y Depression over field N Date of adequacy test 11/21/2017 Results(Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 610 gal. New depth 1 in. Elapsed Time: 120 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 1 0+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION pF AL4 Nkk qf- I certify that I have determined through field inspections and tb.• �) $7 review of Municipal records that the above systems are in 0*:49 TH /\ •,* �/ conformance with MOA COSA guidelines in effect on this date. / •• h •• , • Steven Pannone Engineer's Printed Name 877;:tle,;erW0diriOrie.:••/iv Date 11/21/2017 9 c�9�, CE-8149 •, COSA canary sheet_2-6-15.doc I Lot 17 II �/ II I N ' Lot 18 .......... D Lot 5 I z I o I Lot 19 S 110' T&E EASEMENT s Si. I L w 2¢F 3 , \ \ Lot 6 o sCA s \ \ / 0 8.2'x10.2' SHED IS�o \ // ISEPTIC PIPES - \ \ Lot 20 \ \ // / IASpi., • / I OR,�. N • Ay• . \'INII H - ► 3S. / ?49 Lot 7 4, 34,550 s.f. V 2S.77, oo .V HOUSE DETAIL SCALE: 1"=30' Lot 8 (i,o 7' 0 24.2 ti V (1 �V 0 ,x.5 3. / '..'4.1(2.110 N ,•) / V A4.0' 2 STORY / pi 3.0' RESIDENCE />/ G0• o �''�' / o / O ���� 1.5' CANT DECK 26?. N. cyWOODEN WALKWAY / 7.0'x8.0' PORCH DFCk 1.5'x7.2' CANT NOTE: LOT IS SERVED BY A COMMUNITY WELL PLOT PLAN AS BUILT X SCALE 1" = 60' GRID SW 2122 Project No. 17-452/R1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates , inc . (907) 522-6476 Phone 4000Op�0 (907) 522-4625 Fax oa O F A C��� Professional Land Surveyors kenOlangsurvey.com ,c:74=5::. jonathanOlangsurvey.com d'� . ' .*•'f-40 I herebycertif that I have surveyed the followin described roe QoP �'\ �0� LOT 7, TANAINA VALLEY SUBDIVISION (PLAT 86-91) property: *:' 49TH /� • * Anchorage Recording District, Alaska, and that the Improvements situated thereon are D within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed 0'A KENN NG premises and that there are no roadways, transmission lines or other visible Y ��, 00 easements on said property except as indicated hereon. QO s� 1(Zg[l� QQ� Dated this the Zg> Day of N D•ksv-\C�oto , -/tD , , at Anchorage, Alaska ,,,N. ••• 1,S-5 og.•.. ePa a to ,.:::%, 404ROpfSSIONAL\)•'=7 It is the responsibility of the owner to determine the existence of any easements, DOOOOo�a covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 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 1. GENERAL INFORMATION Complete legal description Lot 7; Tanain~ Valley $~bdivisZon; Location (site address or directions) 7050 Lowell .......... = Pr'0pe~rt~' 0wnbr ': Cha'~"~'-& Marlen~ W~in~ · Day phone ' 243-7831 --- - Mailing address- 7050 Low~__ Cx~r¢Ze Anchorage.. AZas/~¢~ 9950~ Lending agency Day phone -- Mailing ad'tress_ · AgentEil~¢n Me Gauran HOME~UITY/CALIFORNIA Day p~one_ (4151246-6558 Address ?. o. Box 4039 Conco.~r,~. Cc~¢.Lfor~x'a 94524-4039 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Xx '/(/ ,,.. Community well Public water NOTE: If community well system, provide written confirmation from State AD£C attest- ,,., ing` t_o the legality and status of system.: .,, 4. 'rYPE OF WASTEWATER DISPOSAL: " XX Individual on-site Holding tank Community on-site Public sewer NOTF: If community wastewater system, provide written.confirmation from State ADEC attesting to the legality and status of system. '~tJOM Sp@eU!§U@ II~UO!SSeJoJd @LI~ U. SUO[SS!LUO JO SJOJJi~ JOJ eiq!suodseJ ~ou s! eI~JOLIOUV ~o ~.led!o~unl~ eqJ. 'penss! s! m~o!~!~eo ~ eJo~eq ~p ez/~l~ue JO suo!~oedsu! ~onpuoo ~ou op SHH(3 ,[o see/~olduJ~ .s~ueuJeJmbeJ e~,~ls pu~ eJepe~ ul~Jeo ~s~s o~JepJo u suo ~nl ~su~ Dulpue Jle~ pu~ seuJoq ,[o sJeSeqoJnd m ~smJnoo e s~ s~q~ seop SHHC] eq.L '~)tSel¥ Jo el~,S eLl~ Ul peje~ml~@J jeeu~5ue ~UOlSSe~oJd ),uepuedepu! u~ ,~q e^oq~ S ~d~Jl~aJ~d u! ue^!l~ suop, a~ueseJdeJ eq~ uodn ~lUO pes~q sm~o.~!~JeO I~^oJddv /~uoq~,nv q~ ~eH senss! (SHHQ) se°!MeS u~uJnH pu~ q~l~eH ~o ~ueuJ~J~deo e6~Joqouv ,~o Xql~dp!un!~ eqJ. :suo),~lndl~s [~U~MOIIOJ eLp, H~,~M 'suJooJpeq 'swooJoeq JO~ I~AoJddl~ jeUOl:Jlpuoo' 'peAo]dd~s!C] Joj pe^oJdd¥ '-~-- ~IlJllJ.~/N!DI~ SHHa ~9 eJnlauBl$ sjeeu.Du.':J  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ._~c,'¢ q.~g~_~. "~*~-¢-t ~[~- Parcel I.D. A. WELL. DATA Well type_ ,,~ Log present (Y/N) Total depth__ Sanitary seal (Y/N) . Date oftest Staticwaterlevel Well flow Pump level if A, B, or C, attach ADEC letter. Date completed_ --- Cased to_ FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot __ ¢-¢~:>* ~ AbsorpiiOn field on lot ¢,_~-, ' ~' F;~bli~ sewer main Public sewer Service line. WATER SAMPLE RESULTS: Coliform Date of sample: S. SEPTIC/HOLDING TANK DATA Date installed '~-- ~'¢i _~.'~ Clean°ut~N) ~ High water alarm (y/~ __ ~-,~__ Date of pumping '~_.-~o * ¢1.1 ADEC water system number _ '~ Driller_ -- Casing height_, Wires properly protected (Y/N) _ A'r INSPECTION g.p.m. ---; On adjacent lots _ ; On adjacent lots_ Public sewer manhole/cleanout Petroleum tank Nitrate 'Other bacteria Collected by: Z o o ...., £"~ . Tank size L'Z,.'~ c, Foundation cleanout~'N)_ -~. -- Depression (yf~ Alarm te~e,.d (y/N),, --.. A_+ . SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK TO: Well(s) on'lot~_ '?~;= c~ ~ ' ~l~. m .,' .On ~djacent lots .Foundation To property line__~"~ ' Absorption field _ ~' ~, ' ' -- --. ~,Water main/serviceline ,. Surface water'drainage .__ I or~ ~ ~'' ' 72-026,1Rev. 3/9.1) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) _ . "Pump on" level at High water alarm level N~ Meets MOA electrical codes (Y/ SEPAR~E FROM LIFT STATION TO: W.~ lot On adjacent lots Manufacturer _ Manhole/Access (Y/N) ~ level at _ ~ested Surface water D. ABSORPTION FIELD DATA Date installed ~ L~ngth f~'~' _Width Total absorption area _ Depression over field (Y~ Results ~ail) _ _ Soil rating- ~'~ C;~¢- Total depth - _ Gravel thickness - /~' Cleanouts present (~7N) _ System type ~,O' Date of adequacy test for. __~'o~ ¢-- ('¢f~ If yes, give date Peroxide treatment (past 12 months) bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: ~ ~ ¢'~_ Property line Well on lot- -¢.-c:> c:> On adjacent lots--- · To building foundation ¢-~ ~ To existing or abandoned system on lot On adjacent lots Surface water Curtain drain .Cutbank ¢J/A, Water main/serviceline-- ~ c:~' '~' _ Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION ,.. I certify that I have checked, verified, or conformed to all MOA and HAA guideii~es in effect on the date of this inspection. Signature Engineer's Name _ Date S & S ENGINEERING Ea~le [giver, Alaska 99577 HAA Fee $ Date of Psyment Receipt Number 72-026 (Rev. 3/91} B~ck MOA 21 Waiver Fee: $. Date of Payment Receipt Number 01! 82- ~UN~OIPAUTY GF ANCHORAGE D~P~RTM£NT 0~ H~ALTH & H~MAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMI'I'TAL) (a) Legal Description (include lot, block, subdivision, section, township, range) LoT Location (address or directions) (b) Property Owner Z>~,~/4¢.'¢5 Mailing Address 7~8/ (c) Lending Institution (;b'~T~5~ Mailing Address ~ooo ~¢~ ~/~ - (d) Real Estate Company and Agent Address Telephone: Home . ¢. 4;, ~p, Telephone Business :~¢'?-gof ~/ Telephone (e) Mail the HAA to the followino address: or: Check here El, if hold for pick up. List contact person and day phone number below. ~ E'~-/T'~O ST- /)7 z~ 7'-~/d ,~ ~ -,'z' 2. TYPE OF RESIDENCE Single-FamilyJ~ Number of Bedrooms WATER SUPPLY Individual Well [] Community ~ Public [] Note: If community well system, must have written confirmation fi'om the State Department of Environ mental 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. Page 1 of 2 72-025 fRev 8/861 Front '~]OM s,]aau!Gua leUO!Ssa~o]d eql u! SUO!SS!LUO ]0 sJo]~a Jol alq!Suods@~ leu si e6eJoqeuv Jo/~I!led!olunlN eql 'penes! s! eiea!j!peo e aJoleq elep eZAleUa ]o suo!loedsu! ionpuoo ~ou op SHHQ Jo sea/,oldCU~ 'e~uaLua]!nba] eleis pue laJepaj u!epao X~s!~aa oi Jap~o u! suo!ln~!~su! 6u!puel qeqi pue seu~oq lo sJaseqa~nd oi/,sea]nee e se s!q~ seep SHHQ eql 'a~SelV jo eieiS eql u] paJe~s!Ga~ ]eeu!5ua leUO!eSelo~d luepuadapu! ua ,~q e^oqe S qdeJ~a~ad u! ua^ID suo!~eiuasa]de~ eq~ uodn AlUO paseq seiea!J!~Jea leAoJddv A~poqinv qlleeH senss! (SHHC]) seo!A~eS UeLUnH pue qlleaH Jo ~uaLupedeQ e6e~oqouv to A~iled!olunlAI eq/ NOIJ. nvo le^oJddv leUO!i!puoo ].o ewfla/ I~UO!]qpuoo pa^oJddes!a ~ peAoJddv ,~.4¢~.~/~ ,~q s[uooJpeq~ Jo, paAoJddv "IYAO ~,-td ¥ SNNO '9 leas s,Jeeu!Su3 'uo!joadsu! s!ql ~o eiep uo ]oelle ul suol]eln¢e~ poe 'seoueulpJo 'sapoo e]e]S pue ledla!unw lie q~!~ eaue!ld~oo u! s! ~e]s~s lesods!p Jo/pue ~lddns Ja~ a]!s-uo aq~ 'uo!~oedsu! pue uo!]eS!~seAu! ~ ~o~ pue Sel!l eSe~oqauv paule]qo uo!~e~Jo~u! eq] uo peseq ~eq] ~l!Je~ ]eqMnl I 'uleJaq pa~eo!pu! am]onJis lo ad~] pub s~ooJpaq elenbepe pue leUO!]aunj 'ejes s! ~e~s~s lesods!p ]a]e~e~se~ Jo/puB Xlddns ~a~B~ e]!s-uo aq~ ]eq] s~oqs leAoJddv ~]poq]nv q]leeH s!q~ ~o UO!~BB!]SeAU! ~ ]eq~ ~ipeA I '~oleq u~oqs eiep UO!~Bp!IBA eq~ Io se pue o~eJeq pax!lie lees ~ ~q pe[j!~eo sv .g ~O¢,~9~ MUNICIPALITY OF ANCHORAGE (MOA) O~ ¥;A',O%'~ HEALTH AUTHORITY APPROVAL (HAA) ~ .,,.~, ,.,~;k~;~ CHECKLIST - FEBRUARY 1984 WELL DATA ~ Well Classificatio~ ~t~u~ ~ If A. ~. C. D.E.C. Approved [Y/N) Well Log Present ~Y/N] Date Co~ plated Yield Tote Depth _ Cased to Static Water Level Casing Height Above Ground Electrical Wiring ~n 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 San- p~e Collected by Water SarT p~e Test Results Comments f,C..c, TI~¢. f.% Depth of Grouting Pump Set Al Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots : On Aejoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date . B. SEPTIC/HOLDING TANK DATA Date nstalled Standpipes (Y/N) _ y _ Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) r~olamg Tank High-Water Alarm (Y/N) Senaraaon Distances from Septm/Hold~ng Tank To Water-Supply Well To Property Line ~' To Water Main/Service _ ne ~' Cc Jrse No~ { ~ Comments ~TI~ TA~ Size/~2,,~0 No. of Comoartments 2~ _ Air-tight Caps (Y/N) _ ,,V Foundation Cleanout (Y/N) ~ Date Last Pumped ~¢l.d ¢_'O¢~ST~OcTIO.d Temporary Holding Tank Permit (Y/N) . /z,/// To Building Foundation ! To Disposal Field To Stream. Pond. Lake or Major Drainage Page 1 of 2 72-026, 11/84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7/~z/A'a° Width of Field /.5o Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot filo~e o~ (.o1' To Water Main/Service Line Type of System Design Length of Field Depth of Field Gravel Bed Thickness ~' · Standpipes Present (Y/N) Date of Last Adequacy Test To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~bGO~.i~7-/o~q' FIE/_/3 ~_~ AtEcO //,.r-rt2 . Y ?o Property Line 3 ,~' To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) kf o ^l~ /,~ LIFT STATION /4/.-// Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Oft" Level 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 MO/~ and J-IAA guidelines in effect on the date of this inspection. Signed ~J¢."~.~' (~~e ~/~/~ Company ~¢~J ~. MOANo. Receipt No¢~O~ O~ ~ Date of PaYment ~¢~ Amount: $ /~0. O0 Page 2 of 2 72-O26 (11/84) DEPT. O]F ENVIRONMENTAL CONSERV&TION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 July 10, 1991 WALTER J. HICKEL, GOVERNOR 563-6775 FOR: S & S Engineering PWSID #214706 My review of the records on file in this office reveals that the Country Lane Estates Subdivision Class A Public Water System, is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Sincerely, Keven K. Kleweno Lead Engineer aNCHORAGE. ALASKA 99503 STEVE COWPER, GOVERNOR $63-A77$ To Whom It May Concern: Accordinq to the records on ?ile in this o??ice, the _Co~O~<.~ ...... ~,x~ _~..~,~_.L~Water System is in compliance with the 'qt~te o? Alaska Oninkin( Water Requ]ations. Sincer',~.l~ . Environmental Field OFficer