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Home My WebLink AboutTANAINA VALLEY LT 15 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND I'IUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl. INSPECTION REPORT TANKS SEPTIC [~ HOLDING TYPE OF SYSTEM TRENCH [~ BED ~//W. DRAIN ~] OTHER on§inal grade J/ FT_ ,5' F'r .J,.~q~ 8QFI WF-LLS PRIVATE ~' OTHER (Identify) Depth ET Cased to FT REIVIARKS: DISTANCES ~ TO FRO~ WELL LOT LINE FOUNDA'[ION SEPTIC TANK ABSOItPTION FIELD /&pl WELL Municipal and Slate guidelines in ellecI Oll Illis dale: . Health Deparlment Approval: '~ ~" /- 72 013 (3/85) ~l,~7,~cediJ, y Ihal lhis inspeclion was periorlned according Io all M IJ N I C I I:::' A I- ]: T Y (] F:' A I'1 C I'1 0 R A i3 E Dl~l:)ar, tl¥~-HYL o{' Health 835 L. St, r'eet~, Anchor'agE:,, Alaska 99501 343-.4720 0 Ixl .... S ]1] IE !3 E: W E R F) E R M Per, mit Number'~ 8EKX)7 Oate Issued: 06/02. Eng z r'leeP DesignE~d I}E~31131q,S Iisi 70~:?.1 DRIF:-I'W[IOD L. ANE ANCHORAGE:, Al< Day Phone: 349-80 14 I:::'aP c:e i I d: 0 :L :L-'05 :i,-.90 I....o'L I...egal.". E~ubdivi~ion." TANAINA V~L..L;E¥ ~UBD,, E~ect ion~: 4 'Townsl"~ip, 1~%t Range, 4w Lot, ~3:i. z e Max Bedrooms: This I::'er'mi'L~ 4 Total Capac:ity~ 4 SIEPTIC, 'TANK:~ Mir~:l. mum total septic 'Lard.:: capacity,". J.~,:?,50 gallons. [ii'.ac:h septic 'Lank must. h~w.~ at Ie~s'L 2 compal, tmerrLs. DE, p'l:.h 'Lo t. op o{: s~eptic 'Lank (s) < 4.0 INl:::[)Rlvi :O.. H, H, E)., Pl:tI[ll:~ TO :I. ST & ~)NI:> INSPEC'FIOixhS BY AI:;']'I:ZR [)F:'I:::'I[:',E IIOUREi []ALL, 343-4681 AND LEAVE A i]ONEFH:;~LICT I:::'1}!]1::~ I:i]xl(i]IlxlEE:.'R~ ATTACHIED AI:::'PROVED DESIE)Ixl IHIS I:::'EI:~MIT I:~:XPIRES T'i.I I ,{'3 I:::'E,I:;~M I 'F I:.'OF~ A ,S I NEiI...,IE: F;'AM 11_Y R F-:,~3 Z DIE,:NCE ONI.,Y Cli~i]:~"l' I F:'Y FHAI'~ I alii }'alll:i ] :LaP ~i'Lh t, hE:~ I"~qL~il'~!l~le?~)'~.~ f'£]P ~FI"-'!~i~'~.E~ ~e~ti:q'Ei aFid W~;I ].~!~ ~'~ ~;i~.~'~'.. fortl'l by the Mur~icipaJ, it, y of Anchor, age~ (MI]A) and 'Lhe , LaLe o~' Alaska. ~l'll:J J. rl c:omplJ, arll:::e wi'Lb 1:.h¢~ (:l(a~L~Jf] cpiter, ia of this permi'L,. I ~:i,],l adher'e to ali. M[]A and S'La'Le of hlasl-::a f~.~qLlil"lallleITl:.~i rOI" the ~l.::~t. bacl:: d i~)'l:.a~l"ic;E~s f I"(;:)rll ~;~l"ly ~x i~'lL :[rig we]. ]., wastewat, er' d ~.~posa]. .sy.stem or pub 1 ic s(.:;~wePa~ge s'ystem on 'Lhis oP E'd'ly adjac;ent oP near'by lcd:,. I t,.U'lElE:)r'E~ta':ugd 't,l'h'~'l:. t, his per'mit :i.s va].id fop a also undep~d',.ancl 'that t.l'~:~ c::ap~'Ly of the t.o'Lal ~y~te,I is 4 bedl'ooms ar'id a~llS' (~)Fllal"ql(.~fll(~arYL u$il], pl~cll.iiP~ju'l additiona:L I::)er'mi'l', ssued By: . DATE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 %." Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:__ DATE PERFORMED: LEGAL DEECRIPTION: /-.-O-/- / ~- 1 2 3- 4 - 5 - p~/E£ L 7 8 9 10 11 12 13 - 15- !//~.~££~./Township, Range, Section: ~;¢7C7- ,'C- ELOPE SITE PLAN 17 - 18 19 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? pO E Dep~ t~ Watu ~er MoniLoring? ~_ Dale: Reading Date Time Time Water Drop / " .¢ .~ ?,2'~ i,o ~ " d ~ ~ o d~-1 ,3, ~o 20 PERCOLATION RATE =?...&., ~'~' {m~nutes/mcb) PERC HOLE DIAMETER ---- TI-'ST RUN BETWEEN ~'~ FT AND ~ FT COMMENTS ._~-b mO~l, AOOORBANCE WITH ALL STATE AND .UNIOIPAL GUIDELINES IN 72-008 (Rev. 4/~) ~ / ,',, I '1 5 Michael E, Andorso~] 438~ E RASPOERRY T 6 16 $1:040 t& I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I,D. ~ CERTIFICATE OF HEALTH AU'rHORITY APPROVAL FOR A SINGLE FAMILY DWELLING - c~ O '~ NAA# _ 1. GENFRAI. INFORI~IATION Complete legal description Location (site address or directions) ~_ocuCL, L_ ~P.~U~ OFF: Property owner Mailing address Day phone .5'¢.¢- ,5 /l..~ __ Lending agency Mailing address Day phone Agent Address Day phone Unless olherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. 'rYPF OF WATER SUPPLY: NOTE: 5/ \f Individual well Community well Public water 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 ADE. C attesting to the legality and status of system, ;'2-025 (Rev 1/91) Fronl MOA ~21 STATEMENT OF INSPECTION BY ENGINEER .., As certified by my seal affiX~J~"h'~'~:et'0 and as of the validation date shown below, Ii~erify that 'my investigation of this Health Authority'Approve app cat on shows that theon-sit~ ~yater supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herei'n. I ffirther 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 wastew~ter disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection Name of Firm Address EngineeOs signature DHHS SIGNATURE ' X App;o~ed fo; ~--C'¢~''- (z/,) Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments /~.~..._~ · ~,¢,~-x% Date By: 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. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: _ & [5 TAklA/klA \/A I leu A, WELL DATA Well type CO ~nl fJ/J I~¥_ If A, B, or C, attach ADEC letter. Log present (Y/N) [:)ate completed Total depth Cased to Sanitary seal (Y/N) FROM WELl. LOG Parcel I.D. _O II- 0,~'/ ~ cio Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Pubtlc sewer main Public sewer service line ADEC water system number Driller Casing height Wires properly protected (Y/N) AT INSPECTION MtJNICIPALI fY OF ?d,l,q IORAG}} ENVIR()NM~NrAL SERVICk$ DIVISION g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout_ Petroleum tank __ g,p,m. RECEIVED WATER SAMPLE RESULTS: Coliform Nitrate _ Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ---.¢- Z ~ - <~,¢ _ Tank size /Z 5"O Cleanouts (Y/N) ,'/ Foundation cteanout (Y/N) /V High water alarm (Y/N) __ hJ//¢ _ Alarm tested (Y/N) Date of pumping ~-- - /¢, ---~ Z.~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ¢ 3~' To property line z/'~, Surface water/drainage __~.~ Otherbacteria Compartments 2_ _ Depression (Y/N) On adjacent lots //¢ __Foundation Absorption field Water main/service line 72-026(Rev. 3/91) Front MOA21 CONTINUED ON BACK PAGE LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed ?/2 ~.//~'~ Soil rating Length ~-~J Width .~ / Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot ¢¢'¢' P~)r4m¢,~,'~ Surface water System type Gravel thickness 5, 5 ' Total depth Cleanouts present (Y/N) Date of adequacy test. for ~/- _ bedrooms If yes, give date Property hne To building foundation On adjacent lots Surface water To existing or abandoned system on .Cutbank ~4o~ ipA~A Watermain/serviceline Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name /Y/J,(.:4q,4-t;'g, ~-'/'~~ Date ~/1~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number WALTER J. HICKEL, GOVERNOR DEPT, OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 (907) 349-7755 August 14, 1992 Mr. Dale Kruger 7041 Lowell Circle Anchorage, AK 99502 SUBJECT: Tanaina Valley Subdivision (Country Lane Estates) Class "A" Public Water System, PWSlD Z1,1706 Dear Mr. Kruger: I have completed a review of this office's files concerning the status on the above- referenced Class "A" Public Water System and found following: Inorganic Chemical Contaminants: Date of last samples on record: Organic Chemical Contaminants: Date of last samples on record: Volatile Organic Chemicals (VOC's): [:)ate of last sample on record: Radioactive Contaminants: Date of last sample on record: Total Coliform Bacteria: Date of last sample on record: Final Operation Certificate: Date Issued: Outstanding Violations: 18 AAC 80.200 5/04/90 18 AAC 80.200 11/16/91 18 AAC 80.400 11/16/91 18 AAC 80.200 12/05/90 18 AAC 80.200 7/14/92 Country Lane Estates Well ¢/-2 10/29/87 No Based on the above information, this Public Water System is in compliance with State Drinking Water Regulations (18 AAC 80). Dale Kruger 2 August 14, 1992 If you have any questions on the above comments, please do not hesitate to contact this offioe at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II ML/of MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) l. egal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~//~ ~ Telephone: (home) ~- ~/~7 BusinessZ~' ¢~/ Mailing Address ~¢¢/ ~¢~// (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 3. WATER SUPPLY Individual Well [] Community El'"" Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4, SEWAGE DIS/POSAL On-site~ 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(Re¥.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 vaJidation 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 sdequate 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 sll Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm /~/,J/) ~.So~J ~-'/,J~,,Jc;~/L41d(~ Telephone ~ ~7~ ~- Address Date Engineer's Seal 6, DHHS APPROVAL Approved for ~ bedrooms by Approved Disapproved Conditional Terms of Conditional Approval ,//~/~.Z~ Date [~F- 't'.4,'~M[']{ r~ rff 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. MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: A. WELL DATA Well Classification Well Log Present (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 To Nearest Sewer Service Line on Lot WaterSample Collected by WaterSample Test Results Date Completed __ Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date Comments ~' I~' ,~_._ SEPTIC/HOLDING TANK D~,TA Date Installed 7'2-~-~¢~ ~ize 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 'YANK: To Water-Supply Well ~ To Property Line ,,,_z,¢¢" To Water Main/Service Line -.~/ To Stream, Pond, Lake or Major Drainage Course Comments /Z~b No. of Compartments )/ Foundation Cleanout (Y/N) Date Last Pumped ~/Z ~,¢~ ~" ;for /~¢0 Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field 72-026 (Rev 7/88) Ftont Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Gravel Bed Thickness 7,~' Y Statndpipes Present (Y/N) Date of Last Adequacy Test /'2,4 5 5 E.D SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line ~ ? ' To Property Line To Existing or Abandoned System on ; On Adjoining Lots /o~ To Cutback (if present) /6 To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ../¢'~.¢~.~'/,¢ ,~-/~P ,-t/ '""'I~L~ STATIO N Date~ . 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 MOA inspection. Signed Company /¢r~ ~ ~'/'L,l O~ Date MOA No. uidelines in effect on the date of this Engineer's Seal ReceiptNo. _~c~-/~.~;) _~¢ 0 ~ Date of Payment Amount: $ Receipt No. Waiver Fee: $ Date of Payment 72-026 {Rev 7188) Back Page 2 of 2 DEPT. OF ENVll~ONMENT/kL CONSEilVATION STEVE COWPER, GOVERNOR ANC[IORAGE T,r,,e,l,T~ nTC'T~Tmq~ OFFICE 3601 C ........... , SUITE 322 ANC~JORAG. ,, ALASKA 99503 563-6775 FOR: Wayne McFadden Auguat 29, 1990 PWSlD: !t214706 ,~UO..~, i. J99~ ~ ':' ,: %(~ i~!¥(N~ I~I!S. BIO. According to the records on file in this office, the cgun~.[y Lane Estates 'Panaine Valley Water System is in compliance with the State of Alaska Drinking Water Regulations. st MUNICIPALITY OF ANCHORAGE Department of Health & Human Services r)IVlSION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) /~/~ q-A~A~ VAL&~U, '~,/ TIT~I ~q uti Location (address or directions) Ckl (~iO~_J,._L~i o,C:F (b) Property owner ,17¢51~,,,/.5 !/,/ IA.f O0 o Telephone: (home) Mailing Address '?&ZI D,~ hCTUJ O05 · . Business (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here D. if hold for pick up.) List contact person and day phone number below: 2, TYPE OF RESIDENCE SinCe-Family N mber of bedrooms_' 3. WATER SUPPLY Well [] Community ~ Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site~l~ 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. 72~25 (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 th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functiona end 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 ./~/J.0~-//_5o~J ~'~6),~'~"~"')~-v~/~ Telephone -.~.~7-~7 Address ~D. ~o~ Z~77~ ~CHC~ 6~ ~ ¢¢¢~¢ Engineer's Seal 6. DHHS APPROVAL Approved for /7/ 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. 7/88) 8ack Page 2 of 2 MUNICIPALI'[ Y OF ANCt IORAGE ENVI?,ONMENTAL SERVICES DIVISION MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ~.-,¢'7- ', ",, '. 1 I. J!)88 RECEIV.ED A. WELL DATA Well Classification Well Log Present (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 To Nearest Sewer Service Line on Lot WaterSample Collected by WaterSample Test Results Comments ;~ 'Z~'I~ Date Completed Depth of Grouting I~)B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed _?/Z~//~-f2~ Size Standpipes (Y/N) y Air-tight Caps (Y/N) Depression over Tank (Y/N) _ /t,J Pumping/Maintenance Contact on File (Y/N) ~ ~. Holding Tank High-Water Alarm (Y/N) N lA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: IZ %~_ No. of Compartments )/ Foundation Cleanout (Y/N) _.,V' Date Last Pumped NF_.x.d ; for ^//4 Temporary Holding Tank Permit (Y/N) To Building Foundation '~' To Disposal Field _ To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments /,IL- u.) .'~0 ,~ %"F; ~ ,4 ~F_~?J.//¢ 7--~-'_ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area ,b"?,5" Depression over Field (Y/N) /L/ Results of Last Adequacy Test L~ / Type of System Design Length of Field (~:¢ -'~/ Depth of Field r?, ~ / Gravel Bed Thickness ,-~, ~" Statndpipes Present (Y/N) / Date of Last Adequacy Test NE'Cd Coo SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~7-~~ To Building Foundation 7~/' Lot /kit;nc ¢~ I ~- To Water Main/Service Line ,.~ '? ~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Al~- l.d QOd%Tl~uc'r-~ o ~d - To Property Line /¢' To Existing or Abandoned System on ; On Adjoining Lots ~O' '/- To Cutback (if present) ,L/o ~JE~ /~ rE'.5~-ca 7' Dimensions ,S, ize in Gallons ~ Manhole/Access (Y/N) Pump On" Level at -'~-._ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for Meets MOA Electrical Codes (Y/N) Comments during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA gui,c~'~'"~Cc~t on the date of this inspection. ,~.,~4¢. 01' ~ Company ~ ~ t~'b~ ~~ ~ ~~'~TH ~,. ~., .=_ ~}~ ~, -,~ ~'~"~ ~. ~ Date ~* ¢~ ~t&ch~el E Anderson , ~ Receipt No, d~-~¢7~/ ~L)7~ Receipt NO Date of Payment ~0 '~//~ ~ Waiver Fee: $ Amount: $ / ~- ~ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 DEI~]~. OF ENVIRONMENTAL CONSERVATION ANC'HORAGE/JESTERN DISTRICT OFFICE _,601 C STREET SUITE 1334 A~',ICHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOI~ To Whom It May Concern: accordinq to the records on File in this oFFice, the _CoOrD}4~ ..... · _~:y~4;~_~6~.~x~,~.~,~)Uaten System is in compliance with the ~tate 0¢ Alaska Orinkinq Water Requlations, PSK:sa Sincerely, Environmental Field OFt~icer