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HomeMy WebLinkAboutSAND LAKE #2 BLK 3 LT 12F � � L+s V�1�,4'2a X611 -X34-3& ,a) Ll-�- a,r. lbs- � ~ 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 NAME r t PHONE spy UPGRADE MAI G AD8 6S ZION 1� LEG (�L DE1I��S�`JJ.CRIPTI � L/ 3 l ���L � � e LOCATIO 14 n L NO. OF BEDROOMS U DISTANCE TO: Well t - ou Absorption area Dwelling PERMIT NO. .Y 1.- 2 wF ManufacturerMaterial I, No. of compartments rn Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth J V'2 DISTANCE TO: Well- Dwelling PERMIT NO. O z Q 2_F Manufacturer Material Liquid capacity in gallons 0 LU DISTANCE TO:UJ Well ®F C, Foundation Nearest lot line PERMIT NO. H U. 2 w No. of lines' Lengt f each Total lengt 0 lines Trenc idth inches Distance b twe n lines R cc F p Top of tile to finish grade Material beneath the 7� inches Total a ctive absorption area 73— w 0 Length Width Depth PERMIT NO. a F w ° Type of crib Crib diameter Crib depth Total effective absorption area W DISTANCE T0: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER , IkA + '� PIPE MATER �.5� SOI L TEST RATI L45 INSTALLER REMARKS 1 APPROVED - DATE LEGAL e. - - � :I 72-013 Fje . 3/78) J HPPLICANT RICHIE C. SMITH SRH BOX 1447~D 99507 345-5802 LOCATION SAND LHKE LEGHL L12 B] SAND LRKE #2 LO -i" SIZE 6750 SQUHRE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT/BR)= 125 THE OF THE SOIL ABSORPTION SYSTEM IS: Q FEE F" V 1-1 — A. 121 L - EEL ��M 1-1 =-- 0: OR: �§�;:: F -,g %VP KEE U Ell ����� �ny: � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT lS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCHVHTION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCHVHTI0N (IN FEET). �M His U I lot lE17 Rou 4=1���711-,:1 C_ 'Y FA PO4 If< ����� ��-m-%,F ������153- PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPHRTMEVAIT DURING THE INSTHLL�TION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE N8MBER OF THAT THE NELL WILL SERVE. ~ ��� BACKFILLING OF HNY SYSTEM WITHOOT FINAL INSPECTION HND HPPROVHL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL FP -JD ANY 010 -SITE SEWHGE DISPOSHL SYSTEM L00 FEET FOR A PRIYHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PLE-:LIC WELL. MINIMUM DISTANCE FROM H PRIVATE WELL TO R PRIVHTE SEWER LINE IS 25 FEET HND TO H CMMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MHY RIPPLY. SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO PROPER INSTHLLHTION. ���F� 1: V � _1 PoEwE-f­_".-, ����M 0 FEE F;�-.,. A ... .... ���� I CERTIFY THAT ` ��� 1 C;1 1010- 'Y ���� U I HM FHMILIHR WITH DEPA. RTMENT OF HEALTH HND ENYIRONMENTHL PROTECTION loo�� ^/J 825 'L/ STREET, ANCHORAGE: HK 99501. °�� 1164­4120!��0/] ]� I UNDERSTAND TM T 1': -1-1--E, EEE Nln 1 E,�.__ �����E-HE F' EEE: F `l- -I X -V � PERMIT NO. ( 820001 ) INCLUDE MORE AdHN ] BEDROQMS. K HPPLICANT RICHIE C. SMITH SRH BOX 1447~D 99507 345-5802 LOCATION SAND LHKE LEGHL L12 B] SAND LRKE #2 LO -i" SIZE 6750 SQUHRE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT/BR)= 125 THE OF THE SOIL ABSORPTION SYSTEM IS: Q FEE F" V 1-1 — A. 121 L - EEL ��M 1-1 =-- 0: OR: �§�;:: F -,g %VP KEE U Ell ����� �ny: � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT lS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCHVHTION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCHVHTI0N (IN FEET). �M His U I lot lE17 Rou 4=1���711-,:1 C_ 'Y FA PO4 If< ����� ��-m-%,F ������153- PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPHRTMEVAIT DURING THE INSTHLL�TION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE N8MBER OF THAT THE NELL WILL SERVE. ~ ��� BACKFILLING OF HNY SYSTEM WITHOOT FINAL INSPECTION HND HPPROVHL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL FP -JD ANY 010 -SITE SEWHGE DISPOSHL SYSTEM L00 FEET FOR A PRIYHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PLE-:LIC WELL. MINIMUM DISTANCE FROM H PRIVATE WELL TO R PRIVHTE SEWER LINE IS 25 FEET HND TO H CMMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MHY RIPPLY. SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO PROPER INSTHLLHTION. ���F� 1: V � _1 PoEwE-f­_".-, ����M 0 FEE F;�-.,. A ... .... ���� I CERTIFY THAT U I HM FHMILIHR WITH THE REQUIREMENTS FOR ON_SITE SEWERS HND WELLS HS SET FOR -1."H BY THE MUNICIPHLITY OF HNCHORHGE. 2� I WILL INSTHLL �HE WITH THE CODES. ]� I UNDERSTAND TM T ~SITE SEWE STEM MAY REQUIRE ENLHRGEMENT IF THE RESIDENC�_]�� REMOD���D/�O INCLUDE MORE AdHN ] BEDROQMS. �� CANT ISSUED BY_~~ RI��1E C� SMITH � 1.~~~DHTE.0 � kru 93 F-7 fir -4 00-- IDEPHRHEALTH HND TO�H ' ` 825 'L' STREET, HNCHOR�fGE/ HK 99501 =� � / Xq~~w/ 264-4720 ��� �������� �������� �������y / _ PERMIT NO. ( 810888 ) — APPLICANT RICHIE C. SMITH SRH BOX 1447~D 9,507 ]45-5802 LOCATION 5]]5 WEST 82 HVENUE LE, 8LL �2 B ] SH -ND LAKE S/D #2 LOT SIZE 6750 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BE[)F-03MS SOIL RATING (SC.! F,T/��F�)� 1�5 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: FEE 9-A �L� ��������� ��� ������ ����j� � —`` THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TREN[H OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET)� ` -1- 11.4 _72" _114 1 PA r--' LEE 4::- _T_ 1 CR r-1 F94 F�;! EEE F�� EE C-9 L-1 -1. F;;! EE E-7- BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND HPPROVHL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MIf`JIMUM DISTANCE BETWEEN H WELL HND ANY SEWAGE DISPOSAL S9'_ -;TEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM A. PRIVATE WELL TO H PRIVHTE SEWER LINE IS 25 FEET AND TO H COMMUNITY 5EWER LINE IS 75 FEET. OTHER REQUIREMENTS MA"; APPLY. SPECIFICAT IONS AND CONSTRUCTION DIAGRAMS ARE HVHILABLE TO INSURE PROPER IWSTHLLHTI0N. F:"REEFRM I -F �XF:' I E74 E=' EL_ q -'l EEE Ft` I CERTIFY THAT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON�SITE SEWERS AND WELLS AS SET FQRTH BY THE MUMICIPHLIT9 OF HNCHORHGE 2� I WILL INSTHLL THE SYSTEM IN ACCORDANCE WITH THE CODES.. ]� I UNDERSTHND THHT THE OP -4 --SITE SEWER SYSTEM MAY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN BEDROOM:--,. SIGNED RCHIE C. SMITH c� ISSUED _------ ------ .~~TE~2��.�/�.~-��\~ (j PERMIT APPLICANT HAS THE RESPONSIBILITY TO IHFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE 'NUMBER OF RESIDENCES THAT THE WELL WILL SERVE -1- 11.4 _72" _114 1 PA r--' LEE 4::- _T_ 1 CR r-1 F94 F�;! EEE F�� EE C-9 L-1 -1. F;;! EE E-7- BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND HPPROVHL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MIf`JIMUM DISTANCE BETWEEN H WELL HND ANY SEWAGE DISPOSAL S9'_ -;TEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM A. PRIVATE WELL TO H PRIVHTE SEWER LINE IS 25 FEET AND TO H COMMUNITY 5EWER LINE IS 75 FEET. OTHER REQUIREMENTS MA"; APPLY. SPECIFICAT IONS AND CONSTRUCTION DIAGRAMS ARE HVHILABLE TO INSURE PROPER IWSTHLLHTI0N. F:"REEFRM I -F �XF:' I E74 E=' EL_ q -'l EEE Ft` I CERTIFY THAT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON�SITE SEWERS AND WELLS AS SET FQRTH BY THE MUMICIPHLIT9 OF HNCHORHGE 2� I WILL INSTHLL THE SYSTEM IN ACCORDANCE WITH THE CODES.. ]� I UNDERSTHND THHT THE OP -4 --SITE SEWER SYSTEM MAY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN BEDROOM:--,. SIGNED RCHIE C. SMITH c� ISSUED _------ ------ .~~TE~2��.�/�.~-��\~ MUNICIPALITY OF ANCHORAGE;', Department 7f Health and Environmenta Protection 825 L Street,Anchage, AK. 99501 20 # # # HANDWRITTEN PERMIT * * * ON-SITE SEWER PERMIT`�`�' Applicant: Mailing Address: gleW Ex /�el7 1� -�l/I g Location: er2�t Phone Number: 3`/S� & o Legal Description: �/„ f J %S/ If` Lot Size: Type of Soil Absorption System Is: "40 &_f�1409l Trench: L-�Drainfield: Seepage Bed Holding Tank: Maximum Number of Bedrooms: �a Soil Rating(sq.ft/br) 1,2•x+ rte/ The Required Size of the Soil Absorption System Is: / DEPTH / y LENGTH S z GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS # # 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 well will serve. # # # TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department) will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well 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. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 1 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the sidence 's modeled to include more ;2 3 bedrooms Signed:A � �� Issued by: z' Applicant Date: SWP/024(1/81) ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE • +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: f�`.�.�tC S DATE PER LEGAL DESCRIPTION:..�i-A COMMENTS SLOPE J WAS GROUND WATER - t�/.=y S ENCOUNTERED? _}�� OL P IF YES, AT WHAT E DEPTH? SITE PLAN w Y ks1 K "rte 3 Reading DEPTH Gross Time Net Time (FE T- Net Drop 00 00 00 0aav0 oovIry 0 0 0 coo fat 000 3 g o o e C 0 0 oeDe 0000"] 4 OZog0" 0 9 0� 000 ova 5 n 0'0 0c)000v 0 0 to Obl°p D° 6 0o c0 e 06 0 7 o 00q� °c�0 v0 uooaq 9 �ouo0 0q 0 °toopOJO 10 uto°e00 uo 00 0000 0° 0°0� 0 o 11 000°0 0 0 °006 O 12 6o a°w° So o soe oo$�o 13 000°oe 000� 0°p�0o °0oa0 14 °o°e°�e gel 15-00°°A0 ` 16 17 18 19 20 COMMENTS SLOPE J WAS GROUND WATER - t�/.=y S ENCOUNTERED? _}�� OL P IF YES, AT WHAT E DEPTH? SITE PLAN w Y ks1 K "rte 3 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes) TEST RUN BETWEEN FT AND FT PERFORMED BY: �`'tpJr-T -4- �r,2%- CERTIFIED BY: 72-008 (6/79) DATE: oZ� ro 1 V7 Gr- 'QTER ANCHORAGE AREA BORO►' H HEALTH DEPARTMENT N? 193 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING 'i; ,/", r� PHONE fI% SEPTIC TANK: UMBER OF DISTANCE FROM WELL �� / MATERIAL Gr�C-jst�' COMPARTMENTS x`-3%7 llj4zw/;x %��G a '���;�� LIQUID i LIQUID CAPACITY `6_ ^�=GALLONS. INSIDE LENGTH INSIDE WIDTH. - DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS _ OUTSIDE DIAMETER OR WIDTH c;23�4 LENGTHS DEPTH LINING MATERIALCi-O/L�L'��'/_�� .����✓� =f .DISTANCE FROM WELL BUILDING FOUNDATION _��', NEAREST LOT LINE .5y TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) �7 SQ. FT. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL_ FOUNDATION NEAREST LOT LINE NUMBER OF L S DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSOR ION AREA SQ. FT. LENGTH OF EAC LINE L DEPTH: TOP OF TILE TO FINISH GRADE DEPTH O BENEATH TILE IN. ABOVE TILE WELL:DISTANCE FROM WATER TYPE �'✓ '� - �¢ DEPTH��'� , BUILDING FOUNDATION. SAMPLE ,4r1u NEAREST NEAREST `/SEPTIC' SEEPAGE e � OTHER 4- LOT LINE %U SEWER LINE TANK �� , SYSTEM �G , CESSPOOL SOURCES_ TIIA(_RAM r)P CYCTFM 1s''O, .41r' DISTANCES: fayd = i4 DATE - - � APPROVED- - HEALTH AUTHORITY GAA- GREATEI ANCHORAGE AREA UROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT Case No. _2L__Y �d 9i MI -71 NAME OF APPLICANT I ti� c m �1n MAILING ADDRESS �o-A d -���7 PHONE NQ. 4y -c RESIDENCE ADDRESS S 319llz; LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK —, SEEPAGE PIT L/ DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH —TO BE INSTALLED BY &e 4--F PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION c2l 1W 11GE BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT tr0F, a 4 - THIS THIS IS TO SERVE AS M 2 , PERMIT TO INSTALL A G�/e�c1 5�P►�/� AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED'TS SEPTIC TANK SIZE ��S ® TYPE 09MEN 1 SEEPAGE AREA- TYPE DIAGRAM OF SYSTEM DISTANCES: sL,i�.�e L. L. i v ) �_ arvk - SZ} 1, a) dxr b— /do' L, V EALTH AUTHORITY OR LICENSED DESIGNER I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. j DATE %U APPLICANTS SIGNATURE `/� ��'17 r '.EATER ANCHORAGE AREA BOROUGH r HEALTH DEPARTMENT CASE it 327 EAGLE STREET ` ANCHORAGE, ALASKA 99501 Performed For Richie Smith Date Performed 9,/4170 rA,.gal Description: Lot 12 Block ivzsion Sand Lake #2 This Fcrm Reports a: Soils Lov, xx tercolation est Depth Feet Soil C`aracteriSti^S brown sandy silt (ML) gray fine to medium sand (SP) ° gray sand with gravel 10-4 l lenses (SW) 12-- — i Looation Sketch wr Y F^�t:�lsed in 7775P2r>nke t'Yt inlete.ae,.._:._.. – T --.0 ile,�th To iioitorn Cf PitCOMMENre:;cd 138 square feet of drainage surface is required er bedroom.._-� Test Performed By:_R.®E. Carlisle t1eSe Tec>>^ endati ns r;,e computedaYto:r, - "– visual observation ani: based on the uni.• Data Certified By: fled classification system, National Testing Service Inc. Date: —... .i wr Y F^�t:�lsed in 7775P2r>nke t'Yt inlete.ae,.._:._.. – T --.0 ile,�th To iioitorn Cf PitCOMMENre:;cd 138 square feet of drainage surface is required er bedroom.._-� Test Performed By:_R.®E. Carlisle t1eSe Tec>>^ endati ns r;,e computedaYto:r, - "– visual observation ani: based on the uni.• Data Certified By: fled classification system, National Testing Service Inc. Date: —... M -W DRILLING, Inc. i P. O. Box 4-1224 • 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 DRILLING LOC, Well Owner P01'Iesti.0 Use of Well Location (address of: Township, Range, Section, if known; or distance main road ;?,T(jCk i Sa17J T -:t;r, 13'tb. �. Size of casing Depth of Hole--2_612----feet Cased to 2 `3 1- - ) 7'feet Static water level j4? ft. (above) (below) land surface. Finish of well (check one) open end Screen ( ) Perforated Describe screen or perforation lIAA Well pumping test at 10 gallons per (Hour) (minute) for 1 hours with 100" ft, of drawdown from static level. Date of completion "nlfnr:ihf-- /i , QT11;1 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material color -and. -hardness 0 TO L Casing stickup TO Lawn —TO 1 ; si 1 t -Y sand - hr•atan (J imp) _-1 5 TO 14 Rrnwn ail ty cnrid f,pr�vel t dzm}�� .-TO-- I '�Lujj - __.. 't TO lii�) -.__ lrn:-_l__'•:nvv .lat�Cl11'lU�- 1 '1'0 -i 1 tv 2 1 i TO 2 6 — - C, I` V 260 TO 252 ''.,7 TO c !/ — 7 TO 2 TO -i1VWVV C%erNtic�onC tnactue Certificate No's. 814 & ir3 . 3 — CONTRACT(e-- ` 1~r -V C3F=- DEPARTMEY 8F HEALTH AND ENVIRO'NIMENT. . PROTECTION 825 /L/ ST8EET� ANCHORAGE. AK" 99501 264-4720 WEEL-1_ F=" FEE", M 1 -r PERMIT NO. ( 820018 ) APPLICANT SMITH RICHIE C. SRA BOX 1447~D ANCHORAGE AK 345-5802 LOCATION 5335 W. 82ND LEGAL L11 83 SAND LK SUB #2 LOT SIZE 6750 SQUARE FEET Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 15D to 200 feet from a public well 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" Well logs are required and must be returned to the department within ]O days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. F-n��-t^ Vex r> :L r- e� c-:5. 1:3 e.- c---e*an t> c= r- �I :1. 5' IL"��0 J__:3 I certify that 1: I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. 2: I will install the system in accordance with the codes" SIGNED: APPL���N� ��ITH RI�HI� C" ISSUED BY L "MUNICIPALITY OF ANCHORAGE --, Department Health and Environmenta_ ?rotection 825 L Street, Anchorage, AK. 99501 264-4720 # # # HANDWRITTEN PERMIT # # WE�.�.L knUA ,R'ti o t,T�t=� ..=arc PERMIT Applicant: i (G IE �14V /"Tl-( Mailing Address: Location44K Y Phone Number: ^ -2- Legal Legal Description: Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank: Maxim m Number of BGeuv edroo s' Soil Rating(sq.ft/br) L -_L ---The irecl S` e of the Soil Absorption System Is: DEPTH LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS # # 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 well will serve. # # # TWO(2) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well 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. Well logs are required and must be returned to this department within.30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 2 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the Z e is re deled to include more that 3 bedrooms. Si ned: g (e- �i :�,E�/� Issued by Applicant Date: `� v SWP/024(1/81) MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Imo) 11 Parcel I.D. # ZA HAA # `�2=ot1-iI'-I-3-1 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) 7-11-12- 344 e �) JAVh t,4,t.4ff_ y fEG /o Location (address.ordirections) '�U %iLLL,02 L!3 01 533 Sy� (b) Property owneru� Telephone : (home) Business Mailing Address �D� W 4//` �6 372:-�- (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent fil*ef G� 76 -lace/ Address Telephone '74r, /.717 (e) Mail the HAA to the following address: (or check here if hold for pick up.) List contact person and day phone number below: Agr's dle/L uP 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 3 3. WATER SUPPLY Individual Well Community ❑ 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 DISPOSAL 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 legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 L -/z, a 3 AM "*-L 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 Address Date r= 3i -1-6-0 Telephone Z79 -5S;, 99�<O'j yds o aeeaeoaoao e, •�' P ROY CREID, JR. ve S' �a 8�"Y a CE -'2251 .e �R a• eem J'f • `5 ` � e i� e„ c' @•t.u. Sa.S3�.� . 6. DHHS APPROVAL Date Approved for 3 bedrooms by ZT ApprovedDisapprovedConditional Terms of Conditional Approval 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 orderto 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) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) IPALITy %6eA*orIIy Approval (HAA)a MENTALSEIZVI��bJJ- FEBRUARY 1984 343-4744 MAR 13 1989 Legal Description: (.11-12133 5f1/Ho &e 5. 3.3S I.e% �sv� T 121) R 4w Scc. ID A. WELL DATA RECEIVED Well Classification �il JQ If A, B, C, D.E.C. Approved (Y/N) Well Log Present ON) Date Completed 11 �� l �� g� Yield !9' 66t- - 7�rA Nin,. Total Depth(*/ Cased to 2,61' _ Depth of Grouting i4 Static Water Level Pump Set At k114 Casing Height Above Ground % Sanitary Seal on Casing &N) Electrical Wiring in Conduit ON) SEPARATION DISTANCES FROM WELL: Depression Around Wellhead (Y& To Septic/Holding Tank on Lot 6, g / A ; On Adjoining Lots /D42'+ To Nearest Edge of Absorption Field on Lot /00 r� ; On Adjoining Lots 100'f - To Nearest Public Sewer Line 1V(A To Nearest Public Sewer Cleanout/Manhole N\4 To Nearest Sewer Service Line on Lot .E, 2$ Water Sample Collected by Ra( N«� �4 6 G.S_ Water Sample Test Results Comments vliytl 1VW QJU 7�_'3T" 3-1—�9 B. SEPTIC/HOLDING TANK '�1bA Date Installed Size 12!5y No. of Compartments Standpipes (ON) Depression over Tank (Y)Q Air -tight CapsgN) Date eci4 Foundation Cleanout (Y/Q Date Last Pumped N -o), -M (ISAK6 `tom ,,PA) Pumping/Maintenance Contact on File (Y/N) for Holding Tank High -Water Alarm (Y/N) VI Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCE S,FROM SEPTIC/HOLDING TANK: To Water -Supply WeTo Building Foundation /d �� To Property Line To Disposal Field 24r,> t4- To Water.Main/Service: Line 1� r 4` 11 To Stream, Pond, Lake -or Major Drainage Course /00 r Comments I 1Z -6-m /1J.""1" Z. .dzzc/ B.4 r—/ev"## 72-026 (Rev. 7/88) Front Page 1 of 2 G //-/2 $ S SAnD AKe �i4 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 12 6' Type of System Design7r-e ^ Date Installed C) Length of Field �5 Width df Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area Y20 Statndpipes Present QN) Depression over Field (Y49 Date of Last Adequacy Test 03,01 Results of Last Adequacy Test —/7th SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well ��%� To Property Line -,- 2C� To Existing or Abandoned System on To Building Foundation Lot CAr1X noW To Water Main/Service Line 2S / 4'- On Adjoining Lots To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area I n 14-- To .r To Cutback (if present) UA Comments LIFT STATION Date talled Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for 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 MOA and HAA guidelinW*itpVf %%jn the date of this inspection. '�, OF A4 ®Q� Signed ave s leo /y TPi .'p Company�Gpir�er'SSeal Date ,3-/0-57 MOA No. 6 �&)1) 7 Receipt No. v j Date of Payment 3- 1-5-- f119 Amount: $ /70 `OC7 72-026 (Rev. 7/88) Back w� ® OY C. REID, JR. o- 6 e� ° CG - 2.251 Q� s61 4,°°°.°°..°°° Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date yl 7-9 MB 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) f' �t 11 17 /91,c l- 3 Sante lfx l= e � 2 S f la Location (address or directions) . ti- 3 3s- Lfi'• 2 A 04 (b) Applicant Name Ty'n Dci v'f Telephone: Home 2 y3 7 7 yr Business Applicant Address s-33'4- RZ n oT (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder EZ ;Buyer ❑ ; Other ❑ (explain); _ (d) Lending Institution 1-�6me Fedenr( //-0 Telephone Address (e) Real Estate Company and Agent I vVyI r rTv r FV'I — ✓rc_�. Address 1001 FA Ti E AIJ 0 U Telephone Z-- / 1' (f) Mail the HAA to the following address: Ho('1) n2LR l�rcWu0 2. TYPE OF RESIDENCE Single-FamilyUg Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well IS Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite N 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 (11i84) l 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seat 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 F4zNs'n �rc�in�cu/ SCo t�ccct/ Telephone Address l `�S G L—c�a 5 �. /�ncfierarge /% /c Date 49 * Q ..... ................of �A �sTHEODORE F. MOORE: ` 0 - CE - 3589 •: , j � QAPd .. r.y 19 k �PrvksSWA7 6. DHEP Zg APPROVA� j Approved for::� bedrooms by Approved DisapprovConditional Terms of Conditional Approval cihep CAUTION The Muncipality of Anchorage Department 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 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 MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANC14ONCoILLTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & CHECKLIST-- FEBRUARY 1984 ENVIRONMENTAL PROTECTION[ 264-4720 MAY 19 1986 Legal Description: LoA,S 1f► !Z aloes 3 aad- Gcrtce #2 A. WELL DATA RECEIVED Well Classification - Fri va% If A, B, C, D.E.C. Approved (Y/N) N.A. Well Log Present (Y/N) Y Date Completed n / y t 61 Yield 3.0 M Total Depth 2s E Cased to 261 Depth of Grouting N.4 Static Water Level l'I(O Pump Set At 6(4k Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot 70 ; On Adjoining Lots 104, r - To Nearest Edge of Absorption Field on Lot !UO ; On Adjoining Lots I oot" To Nearest Public Sewer Line MA • To Nearest Public Sewer Cleanout/Manhole AL14,To Nearest Sewer Service Line on Lot Water Sample Collected by T= 1`iooee ; Date `l Ila /'04dr Water Sample Test Results Comments Da4t -rami e4LGS CAeicA-rk(;� e&feo( !2/10/ey k)a tab rre&w C_(w4m Sfrtce ;ytuf' oCaFee B. SEPTIC/HOLDING TANK DATA Date Installed 91 2b/7a Size 2�/__- No. of Compartments Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped / 25- 1 �6 Pumping/Maintenance Contract on File (Y/N) M A • -;for Hill - Holding Tank High -Water Alarm (Y/N)Temporary Holding Tank Permit (Y/N) �g- Separation Distances from Septic/Holding Tank: To Water -Supply Well 6&; To Property Line yo ` To Building Foundation 10 t_* To Disposal Field Un ko~4 To Water Main/Service Line 1 U To Stream, Pond, Lake, or Major Drainage Course - > I&a Comments DccAn 7''0m 40CS C OCACA?k /!a!&:r -well —sem {Tc dgAwAee uwetfvw C des 68 ` d)e 04ec_ r i/6/&y ho wcrr-a41- c6ara7 sar since *r -CS c ee(rIfy L Page 1 of 2 lOgrc�e� / cet" u�, CGrnCp� Ci. ly qw 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ! 257 Ctr /e3 9:'('" Type of System Design T✓C�<S Date Installed /* /&Z Length of Field 35r' Width of Field 31 Depth of Field /O i Gravel Bed Thickness Square Feet of Absorption Area `t u/ Standpipes Present (Y/N) y' Depression over Field (Y/N) A/ Date of Last Adequacy Test to/ Results of Last Adequacy Test Pads. d 0 $ d ; •4�9— �. * 0 Separation Distance from Absorption Field: Page 2 of 2 To Water -Supply Well rad To Property Line �a To Building Foundation To Existing or Abandoned System on Lot uh k On Adjoining Lots > 30 1, To, Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course Ua' To Driveway, Parking Area, or Vehicle Storage Area loo ' Comments ocf/w ._FM^ AC -CS c61eelielrf 12-/to/ay no crena, -en< nAanglz/ " v D. LIFT STATION N+A. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) 'Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** 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 A44%e Date t/ l46/6410, Company 1�/� SlIc-4 MOA No. (�%c11 Receipt No. �L) 1 C)'0 \®� A';4f �, Date of Payment1 9 — g � ir�S '�� • • •' •' � �P • •. ®®® �0 Engineer's Seal Amount: $ .e(-). 0 $ d ; •4�9— �. * 0 nc 7400+L A Page 2 of 2 • THEODORE F. MOORE � ®®� CE - 3589 >•S§0v 72-028 (11/84) �0% 4 pp g 4F 4 ` Arotessip�a� y♦® r MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date /Fly (a) Legal Description (include lot, block, subdivision, section, township, range) ieel UD ,+K6- �p_ Location (address or (b) Applicants Name l W Telephone Syme �1�'& lS - Home Business Applicants Addres (c) Applicant is (check one) Lending Institution Owner b ilder�[ \ �j Buyer � ; Other = (explain); •-( —' (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: r) 4� z 2.. Type of Residence Single -Family Multi -Family Number of Bedrooms Other (describe) 3. 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. 4. Sewa a Dis osal Onsite Public Community Holding Tank Note: I community well system, must have written confirmation from the State Departm nt of Environmental Conservation attesting to the legality and status. [Page 1 of 2] /l �1 L) it 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage 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 regula- tions in effect on the date of this inspection. Name of Firm Address Date 6. DHEP Approval Approved for Approved (ENGINEER SEAL) Disapproved Terms of Conditional Approval CAUTION Telephone THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE Ai CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 �• /� MUNICIPALITY O ," NCH G ' - ENVI�OiVFJLNii,L P..":_�iiON i MUNICIPALITY OF ANCHORAGE (MOA) DEC 17 1984 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Legal Description: 1, 11 2' ] x � P Well Classification w1Vok If A, B. or C. D.E.C. Approved(Y/N) Well Log Present Y I) Date Completed 1 14 1 tit Yield Total DepthCased to Depth of Grouting M Static Water Level _ j�D,5b-ID Pump Set At U,,kYLa Casing Height Above Ground Sanitary Sanitary Seal on Casing Y ) 'Electrical Wiring in Conduit Y� ,Depression Around hbllhead (Y ) Separation Distances from Well: To Septic/Holding Tank on Lot '40 On Adjoining Lots q--IDo To Nearest Edge of Absorption Field on Lot it On Adjoining Lots j -l00" To Nearest Public Sewer Line N Ift To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot N lei - Water Sample Collected By r„.y✓ Date to 1,61 Water Sample Test Results R 2 Comments ©�Q1LQ� 1031 `�i B. SEPTIC/HOLDING TANK DATA . Date Installed Size f` -6D No. of Ccopartments Standpipes 4Y ) Air -tight Caps Y ) Foundation Cleanout (Iffl Depression over Tank (Y Date Last Pumped /0�3crg�l Pumping/Maintenance Contract on File (YM) for Holding Tank High -Water Alarm (YM) Temporary Holding Tank Permit (Y/V)Af Separation Distances from Septic/Holding Tank: To Water -Supply TAb ll $'' To Building Foundation /0'�` To Property Lire Lit, To Disposal Field kAtKYL"M � C04 2 To Water Main Service Line z��� / .{-(p � To Stream, Pond, Lake, or Major Drainage Receipt # 6I,5x-J Date Paid: 13- Amount:c�15 [Page 1 of 21 2-15-84 l., // W /A R-3 C. ABSORPTION FIELD DATA Soils Rating in Absorpt•on Strata % s Type of System Design -=k Date Installed �'I- Length of Field Width of Field_ Depth of Field 0 1 ' �,� Gravel Bed Thickness �s _ 4(r -Square Feet of Absorption Area F 40 Standpipes Present 01!) Depression over Field (Y)2)) Date of Last Adequacy Test 10 3( —_ O Results of Last Adequacy 'lest /'!�� �_; 7 Separation Distance from Absorption Field: To Water -Supply w4e ll I po / To Property Line ) �� To Building Foundation x-1;61 © To Existing or Abandoned System cn Lot ��,rtyn© On Adjoining Lots (- 3n 1,)t - To Water Main/Service Line } IF)/ To Cutbank(if present) AJ To Stream/Pond/Lake/or major, Drainage Course }-4ti9Q� To Driveway, Parking Area, or Vehicle Storage Area J() ,,,�1„,'d7� 01\01\ CommenAts��L�� \\ 6"7e/�) . � 11 . n _� mY N,�' .I,,,.t..M, ,. �, __[Y � ; , "L'A` ""�n�,'F: �ti `�Vlj: V• ?.�AYi�bu D. LIFT ON Date Installed Size in Gallons _ "Pump on" Level at High Water Alarm Level at Tested for _/ ss (Y/N) } Off" Level at - Vent (Y/N) Pumpr, C cles during Adequacy Test. Meets MOA- ig:: , y Electrical Codes(Y/ Com, vents ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect v,E on the date of thi inspection. C2 Do Signed vY�RJt% Date orC� COmpariy/1\%. MOA No. KBl/d5/scr oy C. Reid, No.225i•E [Page 2 of 21 2-i5-£34 ALASKA Ci UIROIlmMAL COnTROL RUM, InC. Engineering & enuironmental Studies DECEMBER 14 1984 THOMAS A DAVIS 5335 WEST 82ND AVENUE ANCHORAGE AK 99502 SELLER — ROBIN SMITH BUYER — 5335 WEST 82ND AVENUE SUBDIVISION — SANDLAKE #2 BLOCK — 3 LOT — 11 & 12 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 420 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 1400 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON OCT 31 1984 A FLOW TEST WAS PREFORMED ON THE WELL. 558 GALLONS OF WATER WAS PUMPED AT A RATE OF 3 GPM OVER A DURATION OF 3 HOURS. THE DRAWDOWN WAS 20' WITH A RECOVERY TIME OF 120 MINUTES AND THE STATIC WATER LEVEL WAS 140 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. 1200 West 33rd Auenue. Suite B • Anchorage. Alaska 99503 • (907) 561-5040 ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 December 6, 1984 274-2533 RECEIVED DEC 1 0 1984 Ms. Gwen Turner Alaska Environmental Control Services 1200 West 33rd Avenue Suite B Anchorage, Alaska 99503 SUBJECT: Waiver Horizontal Separation between Well and Septic Tank, Lots 11 and 12, Block 3, Sand Lake Subdivision # 2 (8521 -WA -080) Anchorage Dear Ms. Turner: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic tank to 68 feet on the subject property for a 3 bedroom single family residence only. Sincerely, rug - cel Erickson District Engineer BEE/dd �� BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 December 6, 1984 274-2533 RECEIVED DEC 1 0 1984 Ms. Gwen Turner Alaska Environmental Control Services 1200 West 33rd Avenue Suite B Anchorage, Alaska 99503 SUBJECT: Waiver Horizontal Separation between Well and Septic Tank, Lots 11 and 12, Block 3, Sand Lake Subdivision # 2 (8521 -WA -080) Anchorage Dear Ms. Turner: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic tank to 68 feet on the subject property for a 3 bedroom single family residence only. Sincerely, rug - cel Erickson District Engineer BEE/dd s /' - - G;,ERECEIVED r. INSPECTION APPOINTMENTS ' � t TIME tA SINGLE FAMILY TIME TIME r - s 7. WATER SUPPLY [X INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled E:3COMMUNITY PATE kDT E e TE DAINSPECT E OR INSSPEC R _ ❑ INDIVIDUAL/ON-SITE" MUNICIPALITY OF ANCHORAGE ❑ PUBLIC UTILITY MUNICIPALITY OF ANCHORAGE EPT, OF HEALTH & NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE71 ONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 - • AUG 2 0 1381 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 vv APPROVAL OF INDIVIDUAL WATER AND SE k ILiTO REQUEST FOR DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE 9 MAILINGADDRESSSS O 11-7 49 U PHONE PROPERTY RESIDENT UT oi'fferent.from abo� .q/h(}�O " �,,,� /I fJ1 i J &-s.1 vv _ PHONE 2. BUYER MAILINGADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE kf7eil;✓JVVI- MAIiiDDRESStnL /LM /1YPPS04— /' 5. LEGAL DESCRIPTION {-�� �U /- / e e -1 ,(J� L STREET LOCATION :3 -3 � {1'!•r// UX i- 6. TYPE OF RESIDENCE NUMBER OF BED/ROOMS ❑ One ❑ Four ❑ Other tA SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three E❑ Six 7. WATER SUPPLY [X INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled E:3COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM 70 ON-SITE SYSTEM WAS INSTALLED. �Q ❑ INDIVIDUAL/ON-SITE" ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. (Rev. 6/79) X72-010 � �� j -a THIS SIDE FOR OFFICIAL USE ONLY r 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS r s ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX PERMIT NUMBER 2. WATER SUPPLY ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY DATE DRILLED ❑ PUBLIC UTILITY LOG RECEIVED Connection Verified 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ❑INDIVIDUAL/ON -SITE DATE INSTALLED ❑PUBLIC UTILITY Connection Verified INSTALLER ❑Septic Tank or ❑ Holding Tank Size: / �-- -<0 If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER R TOTAL AB TIOIJIAREA MATERIAL 4. DISTA S Septic/Holding Tank Absorption Are Sewer Line Nearest Lot Line WELLTO: Absorptio ea to nearest Lot Line , 5. COMAPNTS AQ 0 n • Cd�K�Y � APPROVED FOR BEDROOMS �^ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY � �� j -a