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HomeMy WebLinkAboutSAND LAKE #2 BLK 7 LT 13MUNICIPALITY OF ANGHUHAUF DEI 1,ITMENT OF HEALTH AND HUMAN SERB_ .,_S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES M1':Iza)L L --/14u+ Hr-_eiT-ml 01LAl°=s SEPTIC ABSORPTION Address ao % �C— a jP_r d 4N Lf G 4 51 R LVP FROM TO TANK FIELD WELL WELL e.' Phone(s) 0`2 4- 7 Permit No. No. of Bedrooms LOT LINE ❑ SEPTIC ❑ HOLDING LEGAL DESCRIPTION Lot l 3 Block 7 Subdivision S/� Gt•%V-F- t4 Z FOUNDATION f Township, flange, Section 1 1 .�,U . Z? l% to" /CD AS -BUILT DIAGRAM dnveway. water bodies. (Show location of well, etc.) septic system. property lines, foundation, TANKS ❑ SEPTIC ❑ HOLDING Manuiacturer Capacity in gallons Material No. of Compartments TYPE OF SYSTEM -a ❑ TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER ® itl/ y Depth to pipe bottom from Total depth from original grade LOT' I r original grade FT FT © I 9 FII added above original grade .Gravel Uepth beneath pipe " I e FT FT _ Gravel length Gravel width FT FT Total absorption area Distance between lines SQ FT FT I!r D Number of fines Soil rating Pipe material SO FTIl �. I Installer Date Installed WELLS PRIVATE ❑ OTHER (Identifv) on (A,B,C) / Total Depth Cased to -Pr;Jrile- X70 FT FT Date Installed // REMARKS: Municipal and State guidelines in effect on this date: Health Department Approval: 72-013 (3/85) Scale: If ri- /10r ENGINEER'S SEA_ L Inspections Performed by: Dale: certify [hat this inspection was performed according to all -- — Date: ©, _ _ Division bf Geological 8i GeophysictlSurveys Drilling Permit No. LOCATION OF. WELL (Please complete either. In, lb or Ic.) A; D. L.: No. 1 an. Borough Subdivision Ts� Lot Block Ib. '/4 qtrs. Section No. Torihl PN Range ❑Meridian AN( -H SAN D F 0 f—c DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3.,'OWNtk�T WELL OF, :,,'2' "ali CAD Address: 8348 Endicott <St. Anch., AK - Street Address and Area of Well Location 2.. WELL LOG Feet Below Surface 4. WELL DEPTH: (final) 378 5. DATE OF COMPLETION 4 9" 86 M aterial Type Top Bottom ft. '- Rrown C`R-nd & 75 6. 21 Cable tool nli6ita'ry 0 Driven EJDU 91 gr2yel Brown clay & sand 75 121 []Auger (:]Jetted. ( - ]Bored❑ hOf'0r: gra Blue clay & sand 121 148 - ,.USE: Domestic E] Public Supply -',E] Industry IF Heaving and 148 185 Irrigation, E] Recharge El commerical - Silty sand & clay 185 245 ❑ Test Well ❑ other; Clay With ranks 245 260 8. CASING: 0 Thredde Welded sill, sand & gravel with wat(r 260 275 diarn. 6 in. to 378 ft. Depth Weight1 7 1 bs./ f t. Blue clay 275 M—diam. in. to ft. Depth Stickup ft. Eard1pan 371 376 9. FINISH OF WELL: Water, sand & gravel 376 378, Type: Diameter: Slot/mash size: Length'. Set between ft. and, Backfilling x_ '-Grave hpbck 10. STATIC WATER LEVEL: 1 35 ft. 9/86 ❑ Above or Below land surface Date AN I Equipment used: 'id;(3 11. PUMPING LEVEL below land surface and YIELD 140ft. after 30 hrs. pumping 8 9 -P.m - ft. T after hrs. pumping g.P.m. 12.GROUTING Well Grouted: 0 Yes � No, Material: Neat.Cement Other-, 15. PUMP: , (if"available) HP Length of Drop Pipe ft. capacity 9 -p -m: -0 ` ������!� ny L, I N No too V ��!L-;: 'A' -H OR IIIS ISH ' , DEPARTMENT G``,/HEALTH AND ENVIRONMENTAL ION � ~ 825 L STREET�' ANCHORAGE AK 99501 ' � � 264`4720 WIS-11—Ans][-T-�H, V WIH: IIL.�~ 3E. -F � PERMIT NO: MARKS60 � DATE ISSUED: 10/02/86 APPLICANT: MERRILL LYNCH / T, SPURKLAND ADDRESS: 207 E. NORTHERN LIGHTS BLVD" ANCHORAGE, AK 99519 CONTACT PHONE: 276~1333 � LEGAL DE. -:SCRIP: SUBDIVISION: SANDLAKE 02 LOT: 13 BLOCK: 7 SECTION: 10 TOWNSHIP: 12N RANGE: 44 LOT SIZE: O0 SQ,FT, OR ACRES) I certify that: 1. I am familiar with the requirements or onsite sewers and wells as set �orth by the Municipality of Anchorage (MOA) and the State o{ Alass. ka^ it. I will install the system in accordance with all MOA codes and regulationsit � and in compliance with the design criteria oF this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public � sewerage system on this or any, adjacent or nearby lot^ SIGNED �� APPLICANT: M URK D � ISSUED BY DATE: DATE: i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIROMl)IfE(SIT)AI7`PIWWVn=GE 0* ENVIRONMENTAL ENGINEERiNGEIDIVIM'PIEALTH & 825 L Street - Anchorage, Alaska 99506NVFt &4 ih'bh''df264.-.492GTION ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSIPEE9,T,ION REPORT NAME��JJ PHONE KNEW 1'/06.. I -co -r I^--hrI'J ® 2,x3 -93Z'7 1:1 UPGRADE MAILING ADDRESS O o r:-- _LEGAL LEGALDESCRIPTION $7 C �. —6_2015L7, LOCATION NO. OF BEDROOMS z 4- Lz t c, v T. Well Absorption area Dwelling 1 PERMIT NO. Uy DISTANCE TO: I d - 5 z PZ Manufacturer/p Material No. of compartments W Q (9 2 r � r n~ Liq. capacity in gallonsIF HOMEMADE: Inside length Width Liquid depth Well Dwelling PERMIT NO. D z DISTANCE TO: O Z Q Manufacturer Material Liquid capacity in gallons 3: F_ Well Foundation 1 Nearest lot line PERMIT NO. w= DISTANCE TO: J (J J LL z No. of lines Length of each line ; Total length of lines Trench width Distance between lines Z w _� 1 3 inches � f Top of the to finish grade i Material beneath til � � ; ; Total effective absorption area � inches Length Width Depth PERMIT NO. LU I— Type of crib Crib diameter Crib depth Total effective absorption area i LU LU W Well Building foundation Nearest lot line DISTANCE TO: Class ; I Depth Driller. Distance to lone PERMIT NO. J J Uj n Building foundation Sewer lineJI Septic tank y Absorption area(s) j DISTANCE TO: i SCJ ' D OTHER PIPE MATERIALS a i G . �— 1 - SOIL TEST RATING a INSTALLER I -- REMARKSwill I ♦ � �y _ - _ 44 p—� RV � j j i e Nj s° 6� n s e9 Earl R. Barnard ' tick �9 d�eeo 754-E 'T" l �p CJJl��4i` r APPROVED DATE LEGAL 72-013 (Rev. 3/78) DEPARTMENT HEALTH AND ENVIRONMENTAL �OTECTI0N +^ ^ 825 /L/ STREET/ ANCHORAGE, Al-'. 6:1 ' ~ ` 264-4720 I _FEE T ""r PERMIT NO. ( 8003'02 ) HPPLICANT PAUL ROSEL8NQ BOX 4-1324 99509 24]-0058 LOCATION 84TH & ENDICQTT LEGAL LOT 13 BLOCK 7 SAND LAKE #2 LOT SIZE 6750 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: -1 &ZI �ar-40"IF"- f ---EF. rA-F-A=�Val E:a a F" -F H = 15 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF 8 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). F;: E: r-,-! U 1 F-, F= E -s ����I C- _r f --i r -J F< �I _�-��= PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF 8NY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. _— __ "T- 11-1 C-1 <:R > T P-4 _�_. F::, EE 0- _r I co r_4 _�_- n p3f F= Pic* IF. CA u I F-1: F= CA BAC[. -"FILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM is 100 FEET FOR H PRIVATE WELL OR 150 TO 206) FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LIME IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F� F= I "F ���I F;;."F= u-= ��W--- EF_ M 0 U P, 22- -1 _. �-"=-:I �E)o &-:-I I CERTIFY THAT I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS HS SET FORTH BY 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 PAUL ROSELHNDJ \ 7')�s-��- /]��� ' ISSUED B9 -------------------------------- DATE --------------- Y4.0 -� 0~�� WELL ,325 '.TF'EET, ANCHORAGE AK ?S, i 264-4?20 H t -.t C.- Cir -4—'= I T E ; E L-4 E E' PERMIT NO. C ) APPLICANT�muJQ r_ 920AStscei^J LOCATION 454 LEGAL L / 3 1 � TYPE OF SOIL ABSORPTION SYSTEM MAXIMUM NUMBER OF BEDROOMS =_3 I r F' E F='tl I T 4 -= 12 �L Lt ggs-b 9 ID (C — o 0_�- 8" f a L LOT SIZE �,_)S70 SQUARE FEET IS: � SOIL EATING <Sfz2 FT/BR?= ?S' THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM 1S: C: -EFTA= is I LEt--lti_r" a(0 0FZn%..'EL_ G -EF::* -r =� THE LENGTH DIMENSION IS THE LENGTH IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT 15 THE DISTANCE BETWEEN THE SURFACE !iF THE GROUND AND THE BOTTOM OF THE E,:CA','ATION CIN FEET?. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIM!iM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET?. Ef?F_F I F: E:C� '= EF'T I C` Tt�t-4K I �E= / ©� Gr�L_L�=�tJ PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTION_ OF ANY WELL= ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- T'4Jri <:2 > I ":L.F'Ef,�T 10r4: - F=l F?E F_ElT-)U I E'EC? --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT 14ILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON -=ITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRI+LATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBL I C WELL. MINIMUM DISTANCE FROM A PRIVATE IJELL TO A PRIVATE SEWER LINE IS 15 FEET AND TO A COMMUNITY SEWER LINE I. 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN =0 DAY: OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'EFrtrt I T E:= F' I F*'E=- C?El_ Er1E:EF' 1: 1*_=;l:= 9D I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR OBJ -SITE SEWERS AND WELLS AS _ET FORTH BY THE MiNICIPALITY OF ANCHORAGE. I WILL INSTALL -THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT 1F THE RE`=IDENCE IIS REMODELED TO INCL!SDE MORE THAN 3 BEDROOMS. } I G t I E D : -----_I--_ _� =j -�------ - - APF'L I CANT ISSUED B': ' --t: ATE_ � � — � ---- v 4. 0 F - KSF avow wv MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (] PERCOLATIONTEST 01* Pouch 6850, Anchorage, Alaska 99502 276-2221 SOILS LOG — PERCOLATION TEST PERFORMED FOR: P,4/J,L Ea'ag DATE PERFORMED: rlzlua �9 g LEGAL DESCRIPTION: L 7' I , !7��, ! ��z22�— SLOPE SITE PLAN 12 o//,! 3 t bj!o 17 L /,,;,4VA? L L Y 'g-L'7.4N ,0 Yj//T/I SL/!<!�%LY ��M�/i7' (7,r;,v ve=,L — Y v�.4ns0 S 1 ... OF At 4 *_•49TH 18 �...t ..... - --- 9 F • Earl R. Barnard 19 I�O�jl o% 754E �'•• ....•.••••P � pNS 20 �% ROfESS\OROFESSW PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS �^ �_. �/ ). Z. ALrjEv d WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S L P E v� i I —tom Net Depth to Net Reading Date Time — �- —.- �— -- 3 v� Gross Net Depth to Net Reading Date Time Time Water Drop s em PERFORMED BY: 1-NOINEERING CERTIFIED 203 West 15th Avenue 72-008 (7176) Anchorage, Alaska 99501 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) -- a s Tn Is --7 SA N 0 L—A. V--ge— 4 2 Location (address or directions) �s 3`d 5 (b) ApplicantName —�� LTyL' Telephone: Home Business Applicant Address �'� !!Iw� 14 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ;Other, (explain); (d) Lending Institution r �' Telephone C Address ,, S (e) Real Estate Company and Agent ¢I Address®`7®����t +�" ��7, Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE j Single -Family] Multi -Family ❑ Other Number of Bedrooms 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. 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. 72-025(11/84) Page 1 of 2 5. ENGINEERING FIRM, -PROVIDIN INSPECTIONS, TESTS, FILE SEARCH, DkFA AND INFORMATION A/Firm by my eal affixed hereto and as of the validation date shown below, i verify that my investigation of this Health Appr al shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for of bedrooms and type of structure indicated herein. I further verify that based on the information obtained frunicipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wdisposal system is in compliance withal[ Municipal and State codes, ordinances, and regulations in effect on ththis in ection. Nm y%/ Telephone lye`\�bj' a /:• • q•9 �V f�..e �1 .s'vo•�• 7 � A �. t o. 22 -L Engineer's Seal, •;1' UA 25. 1971 2��.�'�•"'-,moo 6. DHEP APPROVAL ®�bedrooms b Approved for % >�� Y Date - Approved -- Disapproved Conditional Terms of Conditional Approval 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 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AKLIST - FEBRUARY 18THORITY APPROVAL 4HAA) MUNICIPALITY OF ANC ^�gEEC DEPT. OF HEALTH 264-4720 ENVIRONMENTAL PROTECTION t U 6 1986 Le al Description- A. WELL DATA RECI V E D Well Classification /� V V If A, B, C, D.E.C. Approved (Y/N)Well Log Present (Y/N)— Date Completed ' �` g Yield 7 —8 A�atM Total Depth 37 A Cased to _aL7_8 'fDepth of Grouting Static Water Level t 35 Pump Set At �ottatw9 Casing Height Above Ground — Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Hatt#Trrg Tank on Lot �%�� On Adjoining Lots To Nearest Edge of Absorption Field on Lot f-`9 ; On Adjoining Lots >Zn/ To Nearest Public Sewer Line Cleanout/Manhole —� Water Sample Collected by Water Sample Test RespIts Comments B. SEPTIC/HOLDING TANK DATA To Nearest Public Sewer f To Nearest Sewer Service Line on Lot %/Ali Date Date Installed Size X11_- No. of Compartments Standpipes (Y/N) �- Air-llig_ht Caps (Y/N) Foundation Cleanout �Y/IN) Depression over Tank (Y/N) Date Last Pumped - /i 2//��l�.5 Pumping/Maintenance Contract on File (Y/N) ;for A. 1A Holding Tank High -Water Alarm (Y/NTank Permit (Y/N) n% Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation / To Property Line / To Disposal Field To Water Main/Service Line ���/ To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 0 J Type of System De Date Installed Length of Field Width of Field C� Depth of Field �r Gravel Bed Thickness Square Feet of Absorption Area �'' Standpipes Present (Y/N) (Z� Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well /0-9 To Property Line �3 r To Building Foundation J� To Existing or Abandoned System on Lot N�4 ; On Adjoining Lots To Water Main/Service Line ,>/a To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course �YX To Driveway, Parking Area, or Vehicle Storage Area � Comments eAl 41 D. LIFT STATION /t/^ Date Installed (Y ff 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 ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verifie or conformed to all O and HAA guidelines in effect on the date of this inspection. Signed Date �t(o Company MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal .70. ® ®2n CONSULTING ENGINEER MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O.BOX 6-6650 ANCHORAGE, ALASKA 99502-0650 X203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 SEPTEMBER 24, 1986 SUBJECT: Well on lot 13, Block 7, Sand Lake No. 2 Gentlemen; A well was installed on subject lot in October 1980. No log exist for this well, but the owner at that time, Mr. Paul Roseland, was also the owner of lot 14, for which a log is on file. This log shows a total well depth of 263 feet and a static water level of 85. In 1981, Barry Weaver, who purchased the residence on lot 13 from Mr. Roseland, complained about the well. Water was turbid and well yield minimal. In 1985 funds were escrowed to improve the well and an attempt to redevelope the well failed, as did an attempt to redrill and deepen the existing well. The installed well casing buckled. A new well was drilled adjacent to the original well. A well permit was not obtained. According to the well driller the old well was abandoned by cutting the well casing below the pitless and filling the casing with concrete to above the static water level. A p ate was welded to the top of the casing. Yours Tobbe Spurkland MUNICIPALITY OFANCHORAGE 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 -D R Cnn�� 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name D4vv!!j �� Telephone: Home AM Business Applicant Address �C oliV (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution L 6q%e,,+ Telephone Address (e) Real Estate Company and Agent ©WKI4 `- - `1`_ `fie Address 90 -7 I AN,! Li e Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Wel 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 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 (11/84) Page 1 of 2 5. ENGINEERING FIRM PROVIDINV(NlSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 'V ! 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. /0119 Address 6� __,P rl"' _ Date /T s .4 _A s ....°.°.. . t 22?_5-E; :Engineer's Seal JUN` 2b, t971 .; 6. DEEP APPROVA Approved for 4 bedrooms by AITDate f Approved Disappro d Conditional Terms of Conditional Approval 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 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF IAF; A1k1THORITY APPROVAL (HAA) DEPT. OF HEALTH{ECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECT 264-4720 DEC 16 05 Legal Description: Lin t 3, B 71 S41PAD A. WELL DATA RECEIVED Well Classification �Rs S If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) N Date Completed 0 � rI Q&D Yield Total Depth A&C) Cased to 1&0 Depth of Grouting NON1_ Static Water Level 133 Pump Set At la*T-ro `{ it Casing Height Above Ground I � Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Depression Around Wellhead (Y/N) Z To Septic/Holding Tank on Lot 1Q q ; On Adjoining Lots a i D D To Nearest Edge of Absorption Field on Lot On Adjoining Lots !! To Nearest Public Sewer Line NONE To Nearest Public Sewer Cleanout/Manhole MON J. To Nearest Sewer Service Line on Loot/�`,� � 0 Water Sample Collected by �• S _ ; Date t7«✓'x'lr Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Q fQg"o Size 0/000 No. of Compartments 7 4:�'0 Standpipes (Y/N) Y Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N)�for Holding Tank High -Water Alarm (Y/N) WA Temporary Holding Tank Permit (Y/N) #V 4 Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation A�/ To Property Line 13 To Disposal Field -43 To Water Main/Service Line >10 To Stream, Pond, Lake, or Major Drainage Course &0ANIA—Z Comments Page 1 of 2 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata R5- Type of System Design Date Installed �D� / ple-D Length of Field 3 4 I Width of Field so" Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) /1 WQ Depression over Field (Y/N) lY '• Date of Last Adequacy Test L1��85 Results of Last Adequacy Test SP 0 -As gm4o d St Separation Distance from Absorption Field: To Water -Supply Well To Property Line To Building Foundation 33 To Existing or Abandoned System on Lot NO Nt-' ; On Adjoining Lots I To Water Main/Service Line 7 10 To Cutbank (if present) , .2/ To Stream/Pond/Lake/or Major Drainage Course rl O N t To Driveway, Parking Area, or Vehicle Storage Area $o Comments -* Fro' AS 'Ao;1 S D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verifiPP, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date ��- ��1 4$IS Company MOA No. $`✓• Sr f( Receipt No. vl��IXK Date of Payment 1 IL- g,� Amount: $ L•5�dolio• Page 2 of 2 72-026 (11/84) •,�.� .-max:: d � C��• Lt� a, `l • n° Q R hJo. 2225-E J ,vE 25, 1971 .4 Engineer's Seal CONSULTING03 W. 15th AVE "C" SUITE 203 ENGINEER�UV 9 �v�v 2 ATE EPHW ,A,1A�t�'�9V9*DEM. Or THH&RAGE ENVIRONMENTAL PROTECTION OEC 161985 S E P T I C S Y S T E M A D E Q U A C Y T E S T — — — — — — — — — — — — — — — — — — — — — — — — LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: TEST PROCEDURE: LOT 13 BLOCK 7 SAND LAKE #2 8348 ENDICOTT 74 j - BERRY WEAVER SINGLE FAMILY, THREE BEDROOMSf¢"• ON SITE WELL �� < FROM MUNICIPAL RECORDS: TANK: GREER TANK, STEEL, TWO COMP. 1000 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 240 SQ.FT. SOIL RATING: 85 INSTALLATION DATE: SEPTEMBER 1980 DECEMBER 12, 1985 ISAAC PUMPING DECEMBER 12, 1985 1000 GALLONS OF WATER WAS ADDED TO THE DRAIN FIELD. WATER LEVEL IN TANK WAS MONITORED. NO BACKUP INTO TANK WAS OBSERVED. TEST RESULT: MONITORING TUBES WERE NOT INSTALLED IN THE DRAINFIELD. THE LIQUID DEPTH OF THE DRAINFIELD COULD THEREFORE NOT BE OBSERVED. ASSUMING A VOID RATIO OF 39% THE TOTAL LIQUID VOLUME OF THE TRENCH IS 1100 GALLONS. SINCE THE TRENCH ACCEPTED 1000 GALLONS IT MUST BE CONCLUDED THAT THE WATER LEVEL IN THE TRENCH IS MINIMAL. THE RESIDENCE IS OCCU- PIED AT THE PRESENT TIME AND THE SYSTEM IS BEING USED. THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater 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 septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. 03 W. 15th �0 C�a �pQadQ�D� �v�o 2 A CHORAGE,AVE ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 R E S I D E N T I A L W E L L I N S P E C T I O N LEGAL: LOT 13, BLOCK 7, SAND LAKE UNIT #2 LOCATION: 8348 ENDICOTT OWNER: BERRY WEAVER TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: NOT AVAILABLE PUMP YIELD: MORE THAN 6 GALLONS PER MINUTE WELL YIELD: .49 GALLONS PER MINUTE AT 70 FEET DRAW DOWN DATE OF INSPECTION: DECEMBER 12, 1985 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 5.2 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. STATIC WATER LEVEL WAS FOUND TO BE 133 FEET BELOW TOP OF CASING. WELL WAS PUMPED UNTILL WATER LEVEL REACHED 200 FEET. PUMP WAS THEN STOPPED AND RECOVERY RATE MEASURED . WATER LEVEL RECOVERED 5 FEET IN 16.75 MINUTES. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON DECEMBER 12,1985. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOIAR t\J V TIME TIME TIME ❑ One ❑ Four EJOther --'�® SINGLE FAMILY cfl.t '\L'DATEDATn) ❑ MULTIPLE FAMILY Three ❑ Six DATE * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well INSPECTOR INSPECTO INSPECTOR ' ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIWIRON'MENTAL P."VT_CfION 825 L Street - Anchorage, Alaska 99501 • MAY 2 6 1,981 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED [CEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on pa a ncompl0te requests will not be processed. Please allow ten (10) days for processing. G.•ee 1. PROPERTY OWNER � PHONE MAI LING A DRESS PROPERTY RESIDENT (If different from /4above) PHONE V3 4`4 2. BUYER q PHONE MAILING ADDRESS L, 3. LENDING INSTITUTION�` PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS - 5. LEGAL DESCRIPTION STREET LOCATION t\J V 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS - ❑ One ❑ Four EJOther --'�® SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY `-® INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM EJ INDIVIDUAL/ON-SITE** ) YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) , LI T l; THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ SINGLE FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUALJON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER _• ❑Septic Tank or ❑ Holding Tank Size: / 0 UPJ -- If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL .r, 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS EZI-" APPROVED FOR –3 BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72-010 (Rev. 6/79) _ C`� �'�,,��,J�/ his DATE � l� P -/ SUBJECT /-n T / �,�16 SCt4tL� \GZ�i 2% `�% (/ c ' - - MESSAGE 4l u r VT c) -Y, v � � � u-/y✓rte �--�c . ��� ���it%C--Lt,� -�� �L�.� ac,i.��t Z ""7 _ SIGNED f SIGNED DATE REOIFORM a 4$ 472 SEND PARTS t AND 3 WITH CARBON INTACT - ParPAK(50SEis)VA72 PART 3 WILL BE RETURNED WITH REPLY. ;lune 2, 11981 "aul 1Z(Dseland Box 4-1324 Anc:h(,-)rage, Alaska 99`09 Subject: Lot 13 Block 7 Sand Lake Subdi-Vi'."-'-I'MI A pproval for the individual sewer and wat.e,--, faci-lit-Aes cannot be g.t7an 4- ed until the fol I OW4 nCy item,--, have been completed: (1) The water analysis reporL needs to be s,,ibm:itted to this office from the Chem Lab, 5633 13) Street, for our review, '. . 47 (2) Phe iPermit fo- t -h( -:t install' ation oll- an on-sitF, sew -r has expired as of December 31, 1980° We have, not. recei.ved the as--buijlts of the instal-lation in this office, If a prj-,.)ato. reng Lneer inspi--!ct-ed the system, please send us the report for our review and fl .L.Les, if there are any further questions, please call this office at 264-4720. Sincerely; Robert C. Pratt, R.S. As,soc.-J-ate Specialist RCP/3 j I - -iw cc: First National Bank of Anchorage Post Office Box 4-2090 99509