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HomeMy WebLinkAboutSEACLIFF BLK 3 LT 5v,.R.sa s 4 o t\- a a 4000") Municipality of Anchorage Page l of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .5(,j q3 rd Cjt PID Number: 0)1Z2__147 Name: �'r�ARi S�� Tri. Wastewater System: New ❑ upgrade — Address: Address: 7-15-1 kan1G Sil2.�T ABSORPTION FIELD Phone: No. of Bedrooms: D� ❑Deep Trench XShallow Trench El Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Q 8 Total Depth from original grade: /V GPD/Sq. Ft. tM Lot:_ rr Block: Subdivision: gina Depth to pipe bottom from oril grade: Gravel depth beneath pipe' / 3 J� '_L/� Ft. 4 Ft. Township: Range: Section: Fill added above original grade: Gravel length: �7 0 a Ft. ` 5 Ft. WELL: El New ❑Upgrade Gravel width: GL Number of lines: Distance between lines: J4 Ft. /%d Ft. �(C�J`,as.,slfication (Private, A,B,/CJ's d rt Total Depth: Cased To: Total absorption area: ^ Pipe material: AS % /✓1 l) 3071 in/1M uN 11 t lac—it�5 % i Ft. FL %S 0 SQ. Ft. F" M Driller: Date Drilled: Static Water Level: Installer: % //+N %iiT( Date i stalled: ,! 4 Ft. 1��Sr: G % Yield: Pump Set at: Casing Height Above Ground: TANK GPM FL Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lin Holding Public/Private Manufacturer: –7-'� tom Capacity in gallons: .s+s� lr Z, 510 From Tank Field Station Tank Sewer Lines LS // Well >Z d r >ZOD, SZD0 Material: S t"(� de Number of Compartments: Surface /,j/A LIFT STATION Water Lot�/� i %() I A 11 Size in gallons: Manu er: Line Foundation ,, I ' j �y f /Z I /A 4 )� "Pump on" level at: "Pum evel at: High water alarm at: �� N A 6 Z / /H Curtain,, J /� Pump Make & Electrical Inspections performed by: Drain ^ BENCH MARK Remarks: 11 /� i�1� rn u t f�SV Yl QrYI Location and Description: ?S. Assumed Elevation: 0 -ENGINEER`S SEAL E 'r 1 Inspections performed by: 14 Dates: 1st 3 J :S_ ,s. 2nd , h,ichau r uaur� i Department of HealM and Human Services approval F, ; Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 Permit No. 5 q 7> O 1 Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ? 9W U(. 3, Sty, C-U iz:= Svl3. PID No.: pll 147 4 I r,. I o� I8/ Municipality of Anchorage Page _S of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: slyer' PID Number: oil -Z-Zr47 r pC%1 01v �l •� f�OpnO _ �a'Gil" .oG 0 1 91YJJ ��� �% % Y l��o Tia c•,vo'c�rS�"`i =", cr iChad L. Anj `:;r" cell r T7 X� ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 February 23, 1994 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 5, Block 3, Seacliff Subdivision Certificate of Health Authority Approval Dear Onsite Services Engineer: The septic system for the subject lot was originally designed as a deep trench with a total depth of over 13'. During construction it was impossible to keep the trench walls from caving in at this depth. The system was therefore redesigned for a 5' wide trench system with 4' of drain rock beneath the distribution pipe. Soils encountered were a clean gravelly sand with a percolation rate of 5 minutes per inch. The system was designed for a slower rate of between 5 and 15 minutes per inch. The wide trench system will function as well or better than the originally designed deep trench. The as built drawing submitted with this letter accurately reflects the constructed condition of the new system. Sincerely, Michael E. Anderson, P.E. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT.NUMBER:SW930501 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:QUIGLEY ENTERPRISES INC OWNER ADDRESS:7751 KING STREET ANCHORAGE, ALASKA 99518-3055 PARCEL ID:01122147 LEGAL DESCRIPTION: SEACLIFF BLK 3 LT 5 LOT SIZE: 13050 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 q:) � -ti-9q DATE ISSUED:12/27/93 EXPIRATION DATE:12/27/94 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: ISSUED BY: ADATE: /'z - '-x 7 " 7 -3 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 December 14, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 5, Block 3, Seacliff Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: The terrain of the subject lot is fairly flat with no drainage problems or surface water. The drainage pattern will not be affected by the development of the lot. The subdivision is served by a community water system with no conflicts with setback distances. If the system is constructed as designed the following statements can be made: 1. The system, if constructed as designed, will have no adverse impact on the wells currently in use or those to be constructed in the future since the subdivision is served by a community water source. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. Sincerely, Michael E. Anderson, P.E. Sc tom. 1/1;7 30' JOB v� i. i � �W -1 SHEET NO. OF CALCULATED BY DATE CHECKED BY DATE PFMrr 1L1 FREE 14*US-M Lot 5, Block 3, Seacliff Subdivision DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Deep Trench System Percolation Rate: 7 Min./Inch 1,250 Gal. Septic Tank Application Rate: .8 GPD/SF 7.5' Gravel Below Pipe 4 Bdrms. X 150 GPD / .8 GPD/SF = 750 SF 750 SF / 15 SF/LF = 50 LF - 7.5' of Drain Rock Therefore: Construct Deep Trench System with Two Laterals Each 25 LF. Pipe Set 6' Below Ground with 7.5' Gravel Beneath Pipe. 1 n e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED. (ENGINEi R S SEAL) �v 3 •:rson , E•. C -� DATE PERFdRM�Sf 3, n F. LEGAL DESCRIPTION:' ! 1 Township, Range, Section: SLOPE SITE PLAN 6 Gross Time Net Time Depth to Water Net Drop 93 9- �•/ , o/nom 10- 11 10 11 12- 2 13- 131415 14- 317-5 15- y 7.88 16- 16 S7r! S/O 17- 1718 18 " L`/3 19 i' S�bl I9 20 / •fPERCOLATION RATE �• t� ' _.Z_ (minutes/inch) PERC HOLE DIAMETER L TEST RUN BETWEEN �' FT AND 71- - FT COMMENTS �-�ST �C!/� W—AS lartiIS0&-k ./ WAS GROUND WATER . 1 ENCOUNTERED? /+ S IF YES, AT WHAT L DEPTH? O P E Depth to Water After Monitoring? —s— ' Date: Reading Date Gross Time Net Time Depth to Water Net Drop 93 0-' ZS 7.6 9 317-5 y 7.88 z,sS S7r! S/O to /oo/ 7.B/ L`/3 6 i' S�bl I9 /O,Gie S 2,2s Sla/ /o iOc� �•S PERFORMED BY: ,c�� I ' ' % `-''� CER IFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72nna 10— nicer (ENGINEEA' SE c r= e � .Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES c 825 "L" Street, Anchorage, Alaska 99502-0650 Ar4i e;l L. nders�n o t' SOILS LOG — PERCOLATION TESTi,<`.`•; ejU �°oma �' v ea GU�G�I.EYIt ,io PERFORMED FOR: DATE PERFORMED. LEGAL DESCRIPTION: ! / #%3/ !JGlt�L� �� Township, Range, Section: 1 2 3 4 5 6 8 9 10 SLOPE 12- 13- 14- 15- 16- 17 2 1314 151617 19 20 a��L COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Afle� Monitoring? Date: S L 0 P E SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop I /7. , 93 3:57 .j 12- 13- 14- 15- 16- 17 2 1314 151617 19 20 a��L COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Afle� Monitoring? Date: S L 0 P E SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop I /7. , 93 3:57 rrlLo�- '(-:o, ¢:obi i0 /l•Of, ,7S Z,2S zS—, 11./3 s 71 1S3 /o1111 11 PERCOLATION RATE 7 (minutes/inch) PERC HOLE DIAMETER 8� % TEST RUN BETWEEN& '� FT AND 7 7/ FT PERFORMED BY: I "'�"�^^"""�-= �' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: �Z/�7/5ey IVIIUH0 PAUTY OF Development Services Department On -Site Water & Wastewater Section --/ Parcel I.D. 011-221-47 ANCHORAGE Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Seacliff, Block 3, Lot 5 Location (site address) Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: 9402 Endicott Street Anchorage, AK Current property owner(s) Robert & Patty Itchoak Day phone (907) 632-6555 Mailing address 9402 Endicott Street Anchorage, AK 99515 Real estate agent 2. TYPE OF DWELLING: ❑° Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ❑® Water Storage ❑ Holding Tank ❑ Community Well ❑-3 Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 660 (,Oy I n Date of Payment7�G�20 Receipt Number 021Iz Q Waiver Fee $ Date of Payment _ Receipt Number _ COSA # O S C2_�I�3 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 7/16/2020 6. DSD SIGNATURE System #1 Approved for 1— bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: z O+ PRGGlk N r w.. (` d✓ Original Certificate Date: a The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 0.QQ � W,65, i(11 COSA Checklist blue sheet Legal Description: Seacliff, Block 3, Lot 5 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments COMMUNITY WELL PWSID 210485 B. TANK DATA Age of tank(s) 26 years Tank type/material SEPTIC/STEEL** Parcel ID: 011-221-47 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by _ Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Measured operating fluid level in septic tank 9"*** Lift station material ❑ Standpipes/foundation cleanout per record drawing Comments: NA Date of pumping 7/13/20 - Northland Pumping **Septic tank located under deck. Not all vents are found on surveyor as built, but are found in field. ***Septic tank pumped the day before the field inspection. No indication of leaking. D. ABSORPTION FIELD DATA 5' Wide Shallow Which system tested (date installed) 1/4/94 ❑ ALL standpipes present per record drawing Total measured depth from grade 9.3 ft (max) Measured depth to pipe invert from grade 6.4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 2.9' ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: Adequacy test date 7/14/20 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 14 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate >600 gpd Any rejuvenation treatment (past 12 months) No If yes, enter date ***Tank pumping receipt from 7/14/20 indicates 1,250 gallons removed from tank which would indicate no leakage. Septic tank is more than 5' from foundation which met Municipal Code at time of construction. Tank is,more ,than 5', from deck supports. COSA Checklist yellow sheet E. SEPARATION DISTANCES - Lot IS served by Public Water System From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No >5 Community Sewer Manhole/Cleanout > 100' Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25 ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft ft If septic tank is under driveway comment below F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No >5 ft Surface Water > 100' Yes if No ft Property Line > 5'✓71 Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' F/ Yes if No ft Private Wells > 100' ✓v Yes if No ft Water Main > 10' ✓1 Yes if No ft Community Wells > 200' ✓Q Yes if No ft Water Service Line > 10' ✓/ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 121 Yes if No ft if absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 7 Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS Lot is served by Public Water System No. 210485. G. ENGINEER'S CERTIFICATION Qr � N��� I certify that l have determined through field inspections and review�;.••'`'!""•�� of Municipal records that the above systems are in conformance with ��° "•-y MOA COSA guidelines in effect on this date. ° 49th .. ...............................i........ Vi n'•, N41CHAEL E. ANDERSON No CE 4581 �C�P'•., 7/16/20 COSA Checklist yellow sheet��i�AD� S'��1�®��� MUNICIPALITY OF ANCHORAGE    DEVELOPMENT SERVICES DEPARTMENT    907‐343‐7904  On‐Site Water and Wastewater Section                                                                                           Fax: 343‐7997  www.muni.org/onsite         Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org      Septic Tank Advisory   Certificate of On‐Site Systems Approval # OSC201331  Subdivision:  Seacliff  Block:3, Lot: 5  The septic tank for this property is 26 years old.  The average life for a steel septic  tank is 20 years. Typical replacement costs range from $7,000 to $11,000.   This advisory must be attached to all copies of the subject Certificate of On‐Site  Systems Approval.               This is an example of what the metal of a 30 year old steel tank MAY look like.      Lot 12A I Lot 4 - -- N89058'00"W 145.00 30 Wood fence (typ) o N Septic vent (typ) -33.7- 33 7O 0 O 42.0 deck O t O ° ° 2 Story Frame o N Asphalt W mI House Qa) E I o O 00 CO ° o Y16.0 +� C:)w 2 0 0 W. 94th Ct. EO f deck o Lot 5 0 O ° :DI ° 28.0 2.0 OH 0 (-) zo z o Lot 11A 2.0 OH Z W N N89058'00"W 145.00 30 Lot 6 AS -BUILT NO CORNERS SET THIS DATE �► `� �� . AC q >� A • • I hereby certify that I have performed a Mortgagee's inspection in �P, ,S� r accordance with ASPLS Standards of the following described property: LOT 5, BLOCK 3, ® 49th ���� ® SEACLIFF SUBDIVISION 00 ' • ' ®f Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines �, . Ijzobeth L. Walatko . '8,00 and do not overlap or encroach on the property lying thereto, that no improvements on the lying Wadjacent 4�1®� �srF property • • 8036 — LS • • Jam+ adjacent thereto encroach on the premises in question and 4'Fo • , • o _® pROFEssIONAL ��'°s that there are no roadways, transmission lines or other visible easements on said property except as indicated SCALE: 1"= 30` { ® 1®\4' hereon. Dated at Anchorage, Alaska "7y 2—(-3 this 13th day of JULY 2020. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON Engineers and Surveyors UNLESS OTHERWISE NOTED. FB 20-3, pg 37-38 BE 907-248-1866 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original - client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply . and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from 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 H�7e7z_SQ�J E�GC'r 2d/J Phone .5 ` q— 4551 Address FP Sox /SIL_. 995Zq Engineer's signature � Date z zz�g� cr �� e4 n `D44 vi l� - �Jl � irn4 af3.: �_r1 ✓ �3, ot�, .�?>e,.�. :YI{ OG 440 O 40 eD f4? O4 �� G0 And6TSOn.p -Michael C. a Cj ee 4341 Vj <D O44 (``'si1 oprroj_ 6. DHHS SIGNATURE Approved for bedrooms. ' Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date.3 — 2 L 471Z -The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority t Approval C@rtificateshased 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 courtesyto 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. 1/91) Back MOA 821 Municipality of Anchorage ® Department of Health and Human Services - HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ScA ILL) I=F Parcel I.D. Q/ I z z -N A. Well Data Well type Log present (Y/N) _ Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 7 Zt)O / Driller Casing height Wires properly protected (Y/N) �ir.YS I� 7,1D,485- AT INSPECTION g � c oz n _ mV p.m. g.p.m. rn \ (n M �r M N G 0" ; On adjacent lots z Absorption field on lot 5 zoof ; On adjacent lots Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria Date installed � . 7�9� Tank size /.2- 0 6.4 L— Compartments --T�w0 Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y//N)) High water alarm (Y/N) _ lJ(/ Alarm tested (Y/N) �./ `i Date of pumping 4 STMJ j Cr /D Pumper /J 1A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: r r I Well(s) on lot 7 ZOD On adjacent lots ? -tD0 Foundation 7 /Z �B To property line 7/C7 Ab�sorptionPfield i1��2� ater main/service line Surface water/drainage /J d ^d a 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level i"i //1 "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed 1hy )q 4 Length 7.7 / Width Total absorption area 7-7 On adjacent lots 1=77 Z, Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested _Soil rating (GPD/Ft2) Gravel thickness Cleanout present (Y/N) Date of adequacy test A� C0,0s'77 Results (pass/fail) Water level in absorption field before test A O rJ a - Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot > ZOO / To building foundation On adjacent lots_ i On adjacent lots Surface water • �� ' / _System type Total dept W/h � �JL{rl� (fa h /©/ `R Depression over field (Y/N) &L F� AsS for FOUA-- Bedrooms _ _After test rVy PI > ZVO If yes, give date Property line >/0 1 Z I/Z- To existing or abandoned system on lot "N'l /4 50' Cutbank ^J () A C Water main/service line > `� U r Surface water _ Al O AJ C Driveway, parking/vehicle storage area Curtain drain /\/C) til E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. a HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number i Receipt Number_ 72-026 (3/93)' Back OS / S J C^ ?- /_ ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 March 24, 1994 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Attention: Dan Roth Subject: Lot 5, Block 3, Seacliff Subdivision Health Authority Approval Certification Dear Dan: RECEIVED MAR 2 41994 Municipglky of Anchorage Dept. Health & Human Services On Wednesday, March 23, we reinspected the septic system installation on the subject lot and verified caps had been placed on all cleanouts and monitor tubes. The system can now be accepted as complete. Please let me know if you have further questions. Sincerely, Michael E. Anderson, P.E.