Loading...
HomeMy WebLinkAboutSIEFKER TR 3YC3 Lcc. - 'If c - �K)1s-ail-a.o MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name II �n d ✓ S r ❑ BED DISTANCES Depth to pipe bottom from TO FRDM SEPTIC TANK ABSORPTION FIELD WELL Address aY nd Phone(sy, / o Permit No. (, No. of Bedrooms 21 � L J WELL �O O '� �� 7 - LOT LINE Gravel depth beneath pipe LEGAL DESCRIPTION Lot 3�` Block _ Subdivision :5-/ e- FOUNDATION /Of l ,Z ., Township, Range, Section �„-L "i 2 Ikj cj';�/ AS -BUILT DIAGRAM drlveway. water bodies, (Show location of well, etc.) septic system, property lines, foundation, . TANKS SEPTIC), ❑ HOLDING Manufacturer '�r ( Capacity in gallons Material No. of Compartments TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade 0,5- FT / r,J"- FT Fill added above original grade Gravel depth beneath pipe Z FT O r S� FT Gravel length ., Gravel width a 6, FT FT Total absorption area .F' Distance between lines / 7, 50 FT is FT Number of lines Soil rating Pipe material �% ,2p/ SQ FT 3(2,3 A- FS/ D Installer �i �, I L JLL� Dale lnslalle sae/ C' ir• !4ob // WELLS ❑ PRIVATE ❑ OTHER r/CV) Classification (A,B,D) Total Depth Cased to (9 FT FT V,-- Date Installed: _ REMARKS: 0��.�57%t'r r I7r r Jlra., •S 9 c T rt _ PL u la Yz a •� •mac. 3 1 04 Inspections Performed by: / ) Cr��•a /I�FecY YFr4rx9 I r` Data: —� r„2 /Y$ %, roo,.er� C_�%✓ �'' /—moo �e K certify that this inspection was performed according to all Municipal and State guidelines in ellect on this date: Zee Health Health Deparlment Approval: 72-013 (3/85) Date:a42 5 aG N #4 d- 01 - ENGINEER'S SEAL MUNICIPALITY OF ANCHORAGE Uepartment o[ Health & Human Services 825 L Street�`Anchorage, Alaska 99501 343 ON-SI[E SEWER PERMIT Pormit Number: 880247 Upgrade Date Issued: 11/03/88 Engineer Desiqned Name: INUR lD FAUSER Day Phone: �wne. ApIrews: 2Z41 wANGE RU" 279-6010 ANCHORAGE, AK 9951� Parcel Id: 015~281~20 Lot Legal: Subdivision: SlEH(Eli Lot: ` 81ock: ^ Section: �1 lownship: 12N Range: 3W TRACT 3 LoL Size 46200 (sg.ft" or acres) Max Uedrooms: [his Permit: J 1La1 Capacity: 3 :�PTiC TANK: Minimum total septir tank c�'apacity: 1,00O gallons. Each septic must have at 1eatst 2 compartments" Depth to top c:H septic tank(s) < 4.0 requires insulation over tank(s)" lNS|ALL PER ENGlNEERS A[TACHED DESIGN, NOTIFY DHHS PRIOR TO Irl ION BY THE ENGlNEEH. THIS PERMIT IS ISSUED FOR THE �(<S|IN; * vEDROUM SINGLE FAMILY DWELLING ONLY AND EXPIRES ON 12/31/88. LAT C[RICAL. PERMIT I5 REQUIRED FROM BUILDING SAFE[Y" I LH<TIFY lHA|: 1, l am familiar with the or on^site sewers and wells as set {orth by the Municipality of Anchorage (MOA) and the Statew of Alaskat ^ 2" I will install the sysLem in accordance with all MOA codec.i� �.and regk..�lations� and in comp1iance with the design criteria of this permit. 3. I will adhere to all MOA and �r-;tate oI Alaska requirements {or the set back distances from any existing well� wastewater disposal system or public sew�rage system on this or any adjacent or nearby lot" 4 r understand that this permit is valid For a maximum of 3 bedrooms" i a1so understand that the capacity o[ the total system is 3 bedrooms and any en addiLiona] permit. SigneJ: OH[E: (Owner) .1, NCO INSPECTION REPORT MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION 3500 EAST TUDOR ROAD r �i iAnll ccs anan INFORMATION (907) 786-8211 j NAME STREET ADDRESS - LOT / BLOCK / - SUBDIV t / PERMIT NO / PHONE - / DATE FOOTING FOUNDATION BOND BEAM FRAMING INSULATION SHEETROCK STRUCT. FINAL OTHER ❑ ELEC. TEMP. ❑ PLBG. UNDGR. ❑ ELEC. SERVICE-.' ❑ _ 'PLBG. ROUGH ❑ ELEC. ROUGH fn GAS TEMP. ❑ ELEC. FINAL ❑ GAS ❑ OTHER ❑ MECHANICAL ❑ MECH. FINAL ❑ FIRE FINAL ❑ PLBG. FINAL ❑ ZONING ❑ OTHER ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ .0 NO NONCOMPLIANCE OBSERVED ❑ WILL REEXAMINE AT NEXT INSPECTION ❑ CORRECTIONS ESSENTIAL AS EXPLAINED BELOW ❑ DO NOT CONCEAL UNTIL REINSPECTED COMMENTS ' INSPECTOR - DATE WHEN CORRECTIONS ARE MADE, PLEASE CALL FOR INSPECTION DO NOT REMOVE THIS NOTICE 84-002 (Rev. 11/87) ALASKA HUIROnMenTAL COnTnOL SRUS, InC. Engineerinq & enuironmental Studies SPECIFICATIONS FOR BED WASTEWATER TREATMENT SYSTEM LEGAL DESCRIPTION: TRACT 3, SIEFKER SUBDIVISION 1.0 GENERAL 1,1 The drawings, sheets 1 through 3, shall be part of this specification. 1.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & Human Services (DHHS), the conditions of the permit, and all applicable rules and regulations currently in effect. 1.3 All excavations and depths are advisory, and are to be verified or modified in the field by the Engineer or inspecting agency. 1.4 It is the responsibility of the owner or installer to adhere to approved design for the installation, to maintain the specified separation distances and to have the appropriate inspections. 1.5 If the installation is not inspected by an AECS engineer, AECS will not be responsible for the installed system. An engineer at, AECS should be consulted prior to construction, to determine the number of inspections that will be required and to explain what these inspections will involve. 2.0 SEPTIC TANK 2.1 If there is an existing septic tank it may be used .if it meets the capacity requirement for the residence. The structural integrity of the -tank must be verified. 2.2 The septic tank shall be a UPC -Approved two-compartment tank, constructed of 12 -gauge steel with bitumastic coating and set level on undisturbed soil. If the tank is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch burial type polystyrene rigid board insulation. 2.3 The septic tank shall be a minimum of 5 feet from the house foundation, and a minimum of 5 feet from the absorption area. 2.4 The septic tank and bed shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class C wells, and 200 feet from Class A or B wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by DHHS or Alaska Department of Environmental Conservation (ADEC). 2.5 Piping shall be fitted with a mechanical watertight: calder coupling on the outlet and inlet of the septic tank. Piping shall be 4 -inch solid PVC ASTM D3034 or cast iron, sloped a minimum of 1/4 inch per lineal foot on the inlet side and 1/8 inch per foot on the outlet side. If the piping is buried at a depth of 4 feet or less, it must be insulated with an 1200 fest 33rd Auenue, Suite 3 9 Anchorage, Alaska 99503 • (907) 276-1361 overlying layer of 2 inch burial type polystrene rigid board insulation. 2.6 Cleanouts shall be installed as designated and capped with air -tight rain caps (Jim caps or equivalent), and extend a minimum of 1 foot above ground level, 2.7 If a lift station is required :it shall be a combination lift station septic tank per Anchorage Tank and Welding, Inc. design. See attached specifications. 3.0 SEEPAGE BED 3.1 The gravel for the bed shall be 0.5 to 2.5 inch, screened rock with less than 3% passing the #200 sieve residual. All substitutes must have prior DHHS approval. 3.2 The bottom of the excavation shall be level and raked with the backhoe blade to insure that the bottom has not been compacted during excavation. 3.3 Sand, for leveling, shall have a size distribution which meets the requirements of MOA code 15.65.077. 3.4 The distribution pipe shall be perforated 4 -inch rigid PVC with a minimum crush strength of 1500 pounds and shall meet the approval of DHHS for use as drainfield pipe. All pipes shall be laid level, and spaced according to the drawings. 3.5 Monitor standpipes shall be placed as shown in the drawings. They shall be 4 -inch rigid PVC ASTM D-3034, or cast iron. The section shown with holes may be either drilled 0.5 inch holes on 6 inch centers on opposing sides of the pipe, or a section of regular perforated sewer pipe may be clamped to the solid section with a no -hub coupling or solvent joint. Perforated section shall be located in gravel only. The portion of pipe above the sewer rock shall be solid. A rubber raincap (,Jim Cap or equivalent) shall be placed over the top of the pipe. 3.6 Insulation is required, using burial type polystene rigid board insulation. There shall be 1 inch of insulation for every foot of soil less than the required 4 feet of cover, but there must be at least 24 inches of soil even though insulation is used. The solid pipe extending from the septic tank to the drainfield shall also have 4 feet of cover or an equivalent layer of insulation combined with soil. 3.7 The side slope of the mound shall be sloped 1 foot vertical to 3 foot horizontal. 3.3 The the bed shall be planted with a white clover and red fescue mix or blue grass, 4.0 INSPECTIONS 4.1 This bed will require a minimum of three inspections. The first inspection will be of the open excavation, to assure that the system is installed in the proper soil strata, correct depth and meet minimum specified design parameters. 4.2 The second inspection will be after placement of gravel, monitor standpipes, and distribution pipe, to verify proper installation and position of pipes prior to backfill. 4.3 The third inspection will be after final backfill and grading to ensure that adequate soil cover has been provided over the bed. 4.4 The inspection of the septic tank or lift station installation can be incorporated with any one of the above listed inspections. ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite 6 ANCHORAGE, ALASKA 99503 (907) 561.5040 JOB SHEET NO. / OF CALCULATED BY A-, DATE / CHECKED BY DATE eW.171+16 72gAIVro Soft 7Fsr srJs T , �i,�_ P.iN"E�r Zot3DM. -4f� 3 13b2M5x 20/ x F-E�071-1 �-5 uSE: 39' LZ14711 /. S TTAL 7W �7 ToP of fjM So/L� r 9/z- �o✓ER __h�A rrliT� L•r %f uR/i¢L__ /,<J9ue.Asli�.. SEBTie-. WWe 7A It /0 6AC _ /9l h 7`,4d,< 7&R bleARA4E' 77tAbe ,paw.ea eY A v •®F• ��• 0 gT11*%AY, �A ,t/o r�i�'k tba/iuGT/,slfi r� �,J�U-4 a2 SEk�E,�S TIZ s��r z aG 3 !%/z'—.S 7 - ► zdoo o0' ,5-x1s7�hJ�/ SYSTEM N uFr a ° Z-2 r��oseb tV r{� 3ED u�b& \ `\ m • r PeA 3�' '01 1 I • � �/�/�� i r I 20.00 mE ST a A, • / *�� a o••n• N•O�N•s 0 9 .•• CE 2251 •90 \4.� �� � & v 9 L (� sr Traci 3 Lot , Block _ Anchorage Recording Precinct, Alaska LjD SURVEY CERTIFICATION shown and described I hereby cerlity that I have wrveyed the property hereon,and tw the improvements situated thereon are within the p� ert y lines and do noi overlop or encrooch on adjacent properly a DO im, rovements on odjocent property overlap or encroach on the premises in question and that there ore no roadways, utility lines or other visible eosernerds on said property except osindicated hereon. scale d D DATE----__--- LEGEND ® : Bross ccc rna'u' 1 recovered a : Iron pipe and/or rebar recovered d = 2 x 2 hub alack recovered . : 5/6"x 3j'rebor set this survey Date 7—/2-7 F B. No. /, ;� !� ly Prepared by: N. L. i i ur RegisterLed ond SurveyoF (9071279-6200 519 W. EigAM• Ave. AncAaoge, Alaska 99-' Property 0 JJ {•t �}lj^{{ , e r or 70 i I s��r z aG 3 !%/z'—.S 7 - ► zdoo o0' ,5-x1s7�hJ�/ SYSTEM N uFr a ° Z-2 r��oseb tV r{� 3ED u�b& \ `\ m • r PeA 3�' '01 1 I • � �/�/�� i r I 20.00 mE ST a A, • / *�� a o••n• N•O�N•s 0 9 .•• CE 2251 •90 \4.� �� � & v 9 L (� sr Traci 3 Lot , Block _ Anchorage Recording Precinct, Alaska LjD SURVEY CERTIFICATION shown and described I hereby cerlity that I have wrveyed the property hereon,and tw the improvements situated thereon are within the p� ert y lines and do noi overlop or encrooch on adjacent properly a DO im, rovements on odjocent property overlap or encroach on the premises in question and that there ore no roadways, utility lines or other visible eosernerds on said property except osindicated hereon. scale d D DATE----__--- LEGEND ® : Bross ccc rna'u' 1 recovered a : Iron pipe and/or rebar recovered d = 2 x 2 hub alack recovered . : 5/6"x 3j'rebor set this survey Date 7—/2-7 F B. No. /, ;� !� ly Prepared by: N. L. i i ur RegisterLed ond SurveyoF (9071279-6200 519 W. EigAM• Ave. AncAaoge, Alaska 99-' Property ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 jOB �%Z�iCT J/EFC'EK zz SHEET NO. J ,,/ OF J CALCULATED BY 14' IV16 �-/( DATE /0 CHECKED BY DATE PROW 2W M_-A.z irc. aam. um 01411, 6 s(�I®61T�6 Municipality of Anchorage • +•�' Lee eee°a°° a e°e¢. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650°° y, ¢° s Y C. REID, JR. ge A SOILS LOG — PERCOLATION TEST �� CE.2251 �. PERFORMED FOR: -Z-AI6 � DATE PERFORMED" LEGAL DESCRIPTION:—T/4—e7— j S/5�eg�'e Township, Range, Section: -7-1,ul Zjt,) SES Zd _ DEPTH %P -r SLOPE SITE PLAN 1 Depth to Water FjqT I � hRa✓Eu,� ta,419 2 >/t7� lM�IY FiT,�✓6Y 3 4 5/I -T 6 OCeo471P/44. SA•o/D SEi4/1 7 8 RFn/D 9 10 WAS GROUND WATER ENCOUNTERED? 11 s IF YES, AT WHAT L 0 12 DEPTH? P E 13 Depth to Water Alter \ Monitoring? w Date: -60 1214 14 15 16 17 18 19 Reading F Date Gross Net Time Time Depth to Water Net Drop 20 PERCOLATION RATE /6'6 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 1,50' FT AND -2-- FT COMMENTS SO//- 7-6 47' Z o/'I ze e&aA/ PERFORMED BY:vL-- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /0 _Z6 72-008 (Rev. 4/85) Municipality,®f Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 June 5, 1989 Alaska USA Federal Credit Union 4000 Credit Union DR. Anchorage, AK 99510 Subject: Tract 3 Siefker Subdivision. Dear Sirs; A The conditional health approval issued for the.subject lot on November 29, 1988 has been extended to June 15, 1989. If the terms of the conditional approval have not been met by that date the certificate will be disapproved. Should you have any questions regarding this matter please contact my office at 343-4744. Sincerely, �,ar,,Xz ly Daniel N. Bolles On-site Services db/74 "Kids Are Our Future" cu i 3 It�ev..sf Rsl U MUNICIPALITY OF ANCHORAGE ®_ O' 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 - PHONE NEW I)C ❑ UPGRADE 16i5g8 MAILING ADDRESS J& A lJ LEGAL DES)CR PTION HGF \ l Ate' >" AC'�r-" LAC) LOCATION NO. OF BEDROOMS O Y DISTANCE TO: Well Absorption narea i h'C• Dwell' y n PERMIT NO. �_, i�f r— n Z Ma ufacturer MaterJi'aI % No. o�compartments Liq. capacity in gallons �Q IF HOMEMADE: Inside length Width Liquid depth DISTANCE T0: Well Dwelling PERMIT NO. ja Z oz Manufacturer Material Liquid capacity in gallons = DISTANCE T0: Wel Foundation 1 Nearest lot line PERMI W G Lu E Z No. of lines Length of line Total length li Z ejiclt o es Trench width Distance bgt een lines p L _ TL{ - inches i4/ - I- 0 Top of tile to finish grade � '� Material beneath tile inches Tot I effective abso ption area a � -�_. W Length Width Depth PERMIT NO. ai- W °. Type of crib Crib diameter Crib depth Total effective absorption area W to DISTANCE TO: Well Building foundation Nearest lot line W Class Depth Driller Distance to lot line PERMIT J W %�/ � DISTANCE T0: Building foundation Sewer line , Septic tank Absorption areas) OTHER PIPE MATERIALS SOIL TEST RATING -t - INSTALLER l ZiEC,� -- inIgkA(_'Ix1 REM RA KS f f^: 16 r APP ED (jDATE LEGAL cu i 3 It�ev..sf Rsl U TYPE OF SOIL HBSORBTION SYSTEM IS� TRENCH MHXIMUM NUMBER OF BEDROO�S = ] SO�L RHTING (SQ FT/B�)� 125 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� ��... PERMIT HPPLICHNT HHS THE I:::. TO 1NFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS CIF:* A�Y WELLS A�JH�ENT TO THIS P��P�RTY HND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE ��� BHCKFILLING OF 11P.,11-11SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION ����IF". IE:� asm CONSULTANTS, INC, 5024 CORDOVA ® BOX 6087 9 ANCHORAGE, ALASKA 99542 Y PH. 907-2]9'0483 9 TLX. 090'25360 ENGIN EE FIS - GEOLOGISTS PLANNEGS SURVFVORS November 23, 1977 Ziegler Excavating 8850 Runamuck Anchorage, Alaska R&M No. 751254 Subject: Soil Investigation for Sanitary Sewer System, TR 3, Siefker Sub- division, Anchorage, Alaska Dear Mr. Ziegler: At your request of November 7, 1977 we conducted a subsurface soils investigaton at the proposed location of the sanitary sewer system on the subject lot. The investigation complied with those procedures required by the Municipality of Anchorage Department of Health and Environmental Protection. This investigation which was accomplished on November 7, 1977, consisted of a test hole excavated to a depth of 13 feet below the existing ground surface. The test hole was sited and excavated by you and its location is shown in attached Drawing A-01. Excavation was accomplished with a backhoe. A sample was taken of the typical soil shown on the soils log in Drawing A-01. The sample will be held in storage at our lab for approximately six months. The topography at the excavation site is generally horizontal. At the time of the investigation the site had original vegetation consisting of alders. The top of the test hole was located at original ground surface. The soils encountered in the excavation are shown in the test hole log in Drawing A-01. The symbols used in Drawing A-01 are explained in Drawings B-01 and B-02. This log displays specific conditions encountered at the test location. However, subsurface conditions may vary in other parts of the lot without any apparent surficial evidence of the change. Groundwater was noL_.encrLntered in the test hole. Bedrock was not encountered. At the time the hole was excavated, seasonal frost was present from the surface to a depth of 2 feet. Perafrost was not encountered. A percolation test was performed in an 8 inch diameter, 24 inch deep hole, dug at the bottom of the 6 foot deep backhoe pit. All depths were measured _from the top of the hole. The data in Table 1 show average infiltration from t e epths indicated to the bottom of the hole. The measured percolaton rate was 4.0 minutes per inch, ANCHORAGE FAIRBANKS JUNEAU VALDEZ WASILLA November 23, 1977 Ziegler Excavating Page -2- We appreciate this opportunity to be of service to you. Please contact us if you have any questions concerning this letter or if we can be of additional service. Very truly yours, R & M CONSULTANTS, INC. Dave Hackney Jim McCaslin Brown, Ph.D Staff Engineer Head, Earth Science Department DH/JMB/kah Attachments: Drawings A-01, B-Ol, B-02, Table I N[d cor TR 3 LOCATIOCI SIMTCH 50'-� O 13' deep backhoe pit 6' backhoe pit (Sanitary Sewer —"st Hole) HUFFPW-1 ROAD t10T TO SCALE Distances shown are anoroximate and have not been measured by surveying methods. TR 3, SIEFKER SUBDIVISIM ANCHORAGE, ALASKA 11ov. 7, 1977 Test Pit Log Scale 1" = 3' Organic Material 1.01 SIL^_ W/`.T'RAC'T', (-3IRAVEL (PTL) brown, dry 1.3'T.D. Groundwater was not encountered. This log depicts subsurface soils observed within the test pit at the location shown. See Drawings 9-01 and B-02 for explanation of symbols. DWK F--) Q F8. CKD. R✓yMCOiVSIILTANTSLOCATION SIMMI At1D GRID. 5 Dare. oEa...L.GISTS PLANNER. UINC`7 pe mi;ST IIOLr. LOG 3IEGLrR ESCAVATI'1G PROJ.NO. - ern SCALE.DWG.N0.. TIME TABLE I PERCOLATION TES'_" ZIEGLER EXCAVATING R&M NO. 757.254 ELAPSED TIME IIICHES 3-53 0 3:54 1 0 3:55 2 0.5 3:56 3 1.0 3:57 4 1.5 3:58 5 2.0 3:59 6 2.5 4:00 7 3.0 4:01 8 3.5 4:02 9 4.0 4:03 10 4.5 4:08 15 5 4:13 20 6 4:18 25 7 4:23 30 8 4:33 40 11 4:43 50 13 4:53 60 15 L DROP III IIICIIES 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 1.0 1.0 1.0 3.0 2.0 2.0 15 inches total drop 4 min/inch V ISON WELL DRILLA 1305 W. 45TH STREET ANCHORAGE, ALASKA 99503 PHONE 272-9343 DRILLING LOG Well Owner A Use of Well _ Location (address of: Township, Range, Section, if known; or distance main road Size of casing Depth of Hole feet Cased to feet Static water level ft. (above) '(below) land surface. Finish of well (check one) open end ( ) Screen ( ); Perforated ( ). Describe screen or perforation p,1L;NlCipAi lry OF ANCHORAGE! Well pumping test at gallons ) ' (minute) DEPT. OF HEALTH & p p' g g per (hour) minute for__}�p}tr�qWi0s t. of drawdown from static level. Date of completion JAN G 19R7 WELL LOG �`���_LI " LD Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness TO TO TO TO -- TO ,TO- TO- -TO OTOTO TO- TO- MUNICIPALITY OF ANCHORAGE • T 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 Parcel I.D. # 16�_ 2�g �/_Gcl_� HAA # 11801— 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) `Trr�&7' 3 51,61`X-6zZ sak --,� /z 3 c.1 sem- z1 Location (address• or direct[Qns) . (b) Property owner .IAA'Re� Telephone : (home) . Business Mailing Address (c) Lending Institution A ASA F4 acbl-r uAlla Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 3 3. WATER SUPPLY Individual Welt-,Q'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 legality and status. 72-025 (Rev. 7/88) Page 1 of 2 ",�T 3 sir -fry 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 / CJ` Telephone 2,7 /7-.5�O Address 1417, /J 4 Aja Date (0 'Z-,3 +„o��e� Ccxl��Tioa//<L 77�Ho��� _ sG OF A<��e op000 e.eo foes: �. .....sews 0*004see o a Rel 0/ ) d.4 ;j 9969*040, Is, 6. DHHS APPROVAL Approved for .3 bedrooms by / tate Approved �Disapproved Conditional — 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 order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze 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)Balk Page 2 of 2 MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services -. . DIVISION OF ENVIRONMENTAL SERVICES ; �� �1 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 4Zgz .mak) HAA # 1-1 2R—C)'C� 1 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) •d; 7 say Location (address or directions) (b) Property owner 1 v`2 Ste' Telephone: (home) Business Mailing Address/ q Cie (c) Lending Institution /��ar�z l(s9 eek/ 0�41, 7� Cc; a/ Telephone Mailing Address r (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here IR, if hold for pick up.) List contact person and day phone number below: LYS _/'r oP79rST� 2. TYPE OF RESIDENCE Single -Family,' Number of bedrooms 3 3. WATER SUPPLY Individual Wello 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 I5 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 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 d(cS J�r Telephone �_12i-s r.e-? Address /f f,;?Z /-�) -33 c1 ft, e ,¢�t� G eM 2f'R X 3 Date // // r1�r �i2Vnd {�a✓S. Cie ciS o�^ / .0;%W* % OF A.<q 40 aA, / ......• LER C,' 5eet Sial ��+�• fCE - 2251-0 $ Professi�aalF��i �%aw,,o400 6. DHHS APPROVAL Approved for S bedrooms by 2 Date �9 Apprevett' 9+�F! Conditional T _ Terms of Conditional Approval /652,,'�C/ aur N .�o�H�( l��t< ,Pss/o�c mos 7— o A1,Q7? &,e 7CoY �tS�Yv�CJ 7�i /YIc?eTS &Xi.9Y/:- S'�ttTG rl�cd %'u<r� ir� Cotes✓ /ivcu cry / /�! 7'i�?�S /a �� /a ne sr'�t T/7_/44' L r /s co�rrn�scc ( 1-44 7- .Su<!�ez-5 6e c%oHlam rCpitt vu<���•'lz -5r1<,)4/O n 7 o r�1/Z -7— W" Z/ sur /`sye/e COKTsrt/GI C(YP Co t4 We ZY717/t Fov 6?/Y*Tr5 / t G�Gvvt Gf'i %�y GVA fir- /,S �QiQ iat��� CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (MAA) t CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: A. WELL DATA Well Classification A -/UP_ 4 If A, B, C, D.E.C. Approved (Y/N) A -)Z -i Well Log Present5N) Date Completed / A?,, jl Yield Total Depths Cased to Z Y Depth of Grouting 94, , Static Water Level ya' S� Pump Set At Casing Height Above Ground Sanitary Seal on Casing (9N) _- Electrical Electrical Wiring in Conduit&Y N) Depression Around Wellhead (Yo SEPARATION DISTANCES FROM WELL: i To Septic/Holding Tank on Lot On Adjoining Lots /oo't To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots >ieo To Nearest Public Sewer Line _ WIA-- To Nearest Public Sewer Cleanout/Manhole 'yllf To Nearest Sewer Service Line on Lot > ze) /' Water Sample Collected by Z, 2Etd ; Date // Water Sample Test Results 7- --0- Comments till/oiy?�er rev�oti� eel/�L<�J�r B. SEPTIC/HOLDING TANK DATA Date Installed 7r Size /©00 No. of Compartments Standpipes 6N Depression over Tank (Y,9 Air -tight Caps./N) 0 - Foundation Foundation CleanoutaN) Date Last Pumped I-OA6- Pumping/Maintenance Contact on File (Y/N) for lt�1�2 Holding Tank High -Water Alarm (Y/N) A/� Temporary Holding Tank Permit (Y/N) SEPARATION, DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply We.II'�3U / To Building Foundation To Property Line /©f / To Disposal Field /S{ To Water Main/Service Line zo r To Stream, Pond, Lake or Major.Drainage Course �l�d Comments S z,.r e .00/.�_d r"- 72-026 (Rev. 7/88) Front Page 1 of 2 7-44-E7" 3 51CFX0r— C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design. 15 Q Date Installed __� ykn- Length of Field .1 r/ " Width of Field "" / Square Feet of Absortion Area Depression over Field (Y/60 Results of Last Adequacy Test Z Depth of Field Gravel Bed Thickness S-/ , Is- - S _ Statndpipes Present,�01\1) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well /y/ " To Property Line :�-c To Building Foundation _,1,W - 6 , To Existing or Abandoned System on Lot % Z0 ' On Adjoining Lots _ �? 2-0 / To Water Main/Service Line 2� / To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course -_>/00 To Driveway, Parking Area, or Vehicle Storage Area SO It / CommentsClodr &„ �� ld i(/eeds fig Si h ee dt �-i�� ris !� n D. LIFT STATION Date Installed 1/ / Dimensions e 75,4 ;qW % Size in Gallons �bo Manhole/Accessd9N) "Pump On" Level at d pr'k/co 5'ot r "Pump Off" Level at High Water Alarm Level at A'fe­t�a, 457 Vent/N) Tested for /J/,# Pumping Cycles during Adequacy Test Meets MOA Electrical Codes (Y N) %_ dsoe�-� 2�siv� Comments _E711 ckav-as. 7_� /A9 ®ice ---APS �, e-_+. _✓_ � '*Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA gu inspection. Signed ��� / �S Company _ �_ _V, C Date 010099 .... ..... MOA No. A Receipt No. 05-,VM5 W33 Receipt No. Date of Payment 101--3 Z-3 Waiver Fee: $ _ Amount: $ �% 0•OD Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 2n the date of this 6 ,0 g0 eer s Seal Y�v soeo�+eea•o.ee�jC. REID, JR. o f1 - 2251 eo o°a CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ' '% 5633 4 STREET ANCHORAGE, ALASKA 99510 TELEPHONE (907) 562-2343 inaorxnro wiss FEDERAL TAX ID N 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 10472 Date Report Printed: NOV 17 88 @ 10:48 Client Sample ID:L3, SIEEKER OUTSIDE TAP PWSID :UA Collected NOV 15 88 @ 09:30 his. Received NOV 15 88 @ 11:00 his. Preserved with :NONE Analysis Completed :NOV 16 88 Laboratory Supe vi ox STEPHEN C. /E.DE Released By : 6_ W-C-� Special Instruct: Chemlab Ref #: 3443 Lab Smpl ID: 1 Matrix: WATER Parameter Tested Result/Units --------------------------------------------------------------------- NITRATE-N 6.0 mg/l Sample ROUTINE SAMPLE Remarks: Client Name AECS Client Acct AKECSRP P.O.# NONE: REC D Req # Ordered By Send Reports to: 1)AECS 2) Allowable Method Limits ------------------------------------ EPA 353.2 10 1 Tests Performed See Special Instructions Above UA -Unavailable ND= None Detected See Sample Remarks Above NA- Not Analyzed LT=Less Than, GT -Greater Than MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE ; DEPT. OF HEAl-TI-I & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT' R�ON / �IVVIRONMENIAL PROTECTION B25 L Street - Anchorage, Alaska 99501 ej 197 ENVIRONMENTAL ENGINEERING DIVISION .IUL,1 Telephone 264.4720F r -y ❑ One ❑ Four ❑ Other F REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE�R°FAPIVIES" DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten 110) days for processing. 1. PROPERTY OWNER INDIVIDUAL* III L1NGA RES ❑ COMMUNITY PROPERTY RESIDENT (If different from above) - - PHONE - 2. BUY - - - � /GC��` � s/ /CSC ���/t..� - �PHONE -- �',S '•� MAILING ADDRESS ❑ PUBLIC UTILITY 3. LEND1,7 INSTITUT��-' _ 1�`y"f/ �J/9/� - -PHONE MAILING ADDRESS � 4. REALTOR/AGENT -NONE MAILING ADDRESS 5. LEGAL/DESCRIPTIONe / STREET CATION - 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS —' ❑ One ❑ Four ❑ Other M/SINGLE FAMILY ❑ .Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATERS PPLY 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 L\d INDIVIDUAL/ON-SITE** - - - - **If individual/on-site, give installation date_ .!LL - If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE L:1SINGLE FAMILY ❑ ONE El THREE ❑ FIVE ❑ OTHER ❑ MULTIPLE FAMILY ❑ TWO O FOUR ❑ SIX PERMIT NUMBER s 2. WATER SUPPLY ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY DATE DRILLED ❑ PUBLIC UTILITY Connection Verified.__— LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER !s ❑INDIVIDUAL/ON-SITE DATEINSTALLED ^� ❑PUBLIC UTILITY Connection Verified ❑Septic�Tank ❑Holding Tank INSTALLER - � koor Size: 00CD 1f Tank is homemade SOILS RATING q give dimensions: I�� TYPE OF TANK - MANUFACTURER TOTAL ABSORPTION AREA MATERIAL —! Septic/Holding Tank Absorption Area 4. DISTANCES 3 WELLTO: Absorption Area to nearest Lot Line ------------- 5. COMMENTS \\ ` p 1 APPROVEDFOR BEDROOMS ❑ CONDITIONAL A'PPRAOVAL er St a SAPPROVED Y� B(Ti�� tie) LEGAL DE6UKIV 72-010 (Rev. 3/78) ;ewer Line _ _ I Nearest certificate)