HomeMy WebLinkAboutPTARMIGAN ROOST BLK 2 LT 36 ?tarml9an Roost Lot 3 Bloch a 0c; 0 - ova - Li Development Services Department Building Safety Division On -Site Water & Wastewater Program /s 4700 Bragaw Street P.O. Box 196650 Mark Begich Anchorage, AK 99519-6650 ` Mayor www mun. nrq/ons,tL (907)343.7904 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: / /13 7 Parcel Identification Number:� -tL4- -73 Legal Descriipttio�nProperty Owner Name & Address: '-T�V /y(Lrj�L(1 sy �G�/S S^ y a4'a A v,0 �.J ow L 3 /6/3 L SAS i°ii°c R JOe AA -h 'v..o.e. 49 Pump Installation Date: 3 - 3 Q- 0 7 Pump Intake Depth Below Top of Well Casing: ,? Vf feet Pump Dianufacturer's Name: Xta 7, Pump Model: GA(S /L f/_6 Pump Size 3,/, hp Pitless Adapter Burial Depth: / p feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Completion?,®, Yes ❑ No Method of Disinfection: Comments: Pump Installer Na ANCHORAGE WELL & PUMP SERVICE, INC 330 EAST 76TH AVE. ANCHORAGE, ALASKA 99518 (907)243-0740- FAX:(907)243-0742 E-MAIL: pumpmanjim@att.net Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. t Municipality of Anchorage Page _I of — DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 94 Gt if q. PID Number: Name: WILL .4 Y Wastewater System: R New 0 Upgrade A0 t�o8' 1o16c8 ANcN QgSlo ABSORPTION FIELD Phone: 3 y 9 2 t{. 5'f No. of3 rooms: O Deep Trench R Shallow Trench O Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: 00 S" - /' It 0.2 GPD/Sq Ft Lot: Block:,gra Subdivision: r to pipe bottom from original grade' O Gravel depth beneath pipe 0•S goo$ 3 L f( SKA'tJAAJ loos/ F1 FI. Township: f t N Range: W Section: Z Fill added above ori incl grade: (Fie/1 Gravel length: : Z ` TOTaiL 3 Ft. Ft WELL: RNew ❑Upgrade Gravel depth: , NumberZol lines: Disu oes lows FtFt Classdicpn (Pnvate, A,B,C): LTJ Total Depth: Cased To: Total absorption area: 12616 s= 1130 Pipe material: ,/ 'Moss 280 Ft. ZD FL SO Ft. Dauer A9M.og2T Date Drilled: P- Slabc Water Level: /o Ft. Installer. C 1t Air coNST1 Date Installed: Va. 10-ss Yield:Pump Set at: Gsmg Height Above Ground: TANK GPM Ft. _11". / Ft. SEPARATION DISTANCES 9,Septic 0Holding ❑S.T.E.P. To Sspuc Absorption uh Holding bkrJPrivate Manufacturer.Cspecify In gallons: From Tank Field Station Tank Sower Urias AM411 AAIX. 000 s s • s Material: Number of Compartments: Well +100 -►toO -+ +f0a !(. STEEL- Z. waters +,too' +100' - - — LIFT STATION Lot• Sb e +-Ly. -- _ — Size In gallons: Manu er; Line Foundation r +Y r +k(p — — — "Pump on" level al "P oil" leve . High water alarm at: Curtain— TSO +"$O — Pa Wel Electrical Inspections performed by: Drain Remarks: Xr to✓ai ow OntcS BENCH MARK & Id 0. �C a. l a. t. � L S/�� ✓ G Location and Description: �jA,G A SGA OF k E wi f h CC/j k.CC-W jave Sevlei Si0.✓e'l 1�0 e.$it/✓t ,SC p1. /L.�/Ota. Assumed Elevation �Op —.Ft ENGINEER'S SEAL Yeti Of At4ti11 . COPT ENC,2s - �'�!-9G w/�/j/ "/��I Inspections performed by: Dates: lst N. y. w/eso.✓ 2nd 7-2o-9& 844,TM yfy 10-20-yt rSACiJFitGOK a.a.e'.............aa...a./ �`.�` IM ' o: t.= I0 MORE aA[r(AfCt-2E'gD Dep- of Health and Human Services approval ��%ti �p W i�, f Wee AV �— 'fid ��b Reviewed and approved by: �''r DatepP 72-019 (1N1) MOA 25 h 2 v Permit No. 96 O /YY 5 9� Page 2 of Municipality of Anchorage DEPARTMENT OF HEALTH AND HU N SERVICES ENVIRONMENTAL SERVI DIVISION P.O. Box 196650 • Anchorage, Alaska 1 6650 • Telephone: 343-4744 On -Site Wastewater Disposal jMern a /or Well Inspection Report 1 0n21 nucnrintinn• L $132 PID No.: r"17 A(PW. V91) MOA 25 Go/fK6f-7CF'q S^1'^J/ T/E Ro osT Swh TIES Nw Sw 8 I ° 17"5 M O fe° Som W.►t1.1' 00 tj a Low 0 � h I J M • -.�pA7�` tro. nas•e ��� it E��! r"17 A(PW. V91) MOA 25 Go/fK6f-7CF'q S^1'^J/ T/E m -�i 0 Z r O 0 L EN Permit No. IF&D l q y Page 3 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 I unnl neer,intinn• 1-3 8 Z PT.4/R tm l ci 4m K005% PID No.: 72-013 A CR". "I) MOA 25 FND c,o. NoT SFlownl a ft R, 1 N 4 ' A .o '^ A iX.. o % E c.o• t m Vin' I� A H 'ptvt0 lZ G.o, G.O, 1u i C. 0, ENGINEER'S SEAL N OF &�dt' to 1 N o �.IN .... m O pi :^ Arl a E z r N s ,r! 72-013 A CR". "I) MOA 25 FND c,o. NoT SFlownl 1201 Ramona St. .99515 ANCIIOIiAGE� ALASKA 344 -*714 SIX INCH WATER WELL "DRILLED• ----------OUT TO THE DEPTH OF ' 280 'feet: X23.00 Charge for 275 ft - DRILL . ED t.DRILLED AT THE RATE OF PER FOOT.Steel casing seated out .to 2.0 ft. Mr. -Will Gay :349-2454 PROPERTY OWNER 77 LOCATION OF WELL. SITF Lt 9 Blk 2 .''Sub.- t'rAlzA( A Y A N� DRILLER Bernie Claus of Rampart•Drilling Works.. WELL LOG: 0 _ 51'Silty'gravel., 5 20' Conglomerate.-(Bedrock)`broken Itp'enough to drive casing 20 feet. 20 2801 Hard bedrock'with enough•:wo.ter:bearirig.fissures to produce a full three gpm. This 19ell will produce 3 '1/2 grin after full • drnridown for short duration of 30 minutes k then droD to Pbout 180 rrallons ner hour. Water re- covery,is back.•ug to•less then:ten­feet'of surface. One horserower sub mersible rump should'be install ed :to ten feet•oif bottom. (10 to 15.ft.) " No.charee*for Well•Cap & ritless adapter inst&lled. This Well has been'•paid `for in .full by 19i11 Gay: (All water production is coming out of fissures & cracks in the bedrock, starting.at 195 feet'&`increasing in 'yield thru to 280 ft.'.The last 25•ft improved, the, well for 2 'gpm to a Ju"li 3 gpm: ) RECCiVED Nov 15 Munrcipar,ly UI Hucnorage Dept. Health & Human Services COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE UM OF THANK YOU VERY MUCH.' BE@NIE CLAUS OF RAMPART DRILLING ,WORKS DATE August 20,`. 1996... SERVICE CHARGE OF IK% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. ( ' PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE -0 DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960144 DATE ISSUED: 6/24/96 DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC. EXPIRATION DATE: 6/24/97 OWNER NAME:GAY WILLIFORD W & /1 i ]�vSl �'19I`16 �i3oAM OWNER ADDRESS:PO BOX 101608 ANCHORAGE, AK. 99510 PARCEL ID:02004271 LEGAL DESCRIPTION: PTARMIGAN ROOST BLK 2 LT 3 LOT SIZE: 57723 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 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 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 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:,4 div VAIIoD2 64BE4- Z;Wv decul?sfleam o )44 d't/fsc 6!�vAt[y Olvlon TNC- EFfLvrnrr IAI7 RECEIVED BY:— DATE: ISSUED BY: DATE: G r f 165th AVE. �w Lit Li PROPOSED WIDE TRENCHES REPLACEMENT TRENCHES 1 pA hn DIU T ti I I J ALL �Q� 5 aP�J I \ _I SEPTIC SITE PLAN LEGAL: L01331_OCK 2 PTARMIGAN ROOST IN NW 1/4, S2, T11N, R3W, SM OWNER: WILL GAY PHONE: 349-2454 DATE: 6/1/96 SCALE: CONSTRUCTING ENGINEERS 346-2000 0.601 BUDDY WERNER DRIVE ANCHORAGE. ALASKA 99516 NOTES: 1. CLEANOUTS RECUIRED PRIOR TO BENDS. 2. PROVIDE 4" RIGID INSULATION OVER SEWER LINE IN DRIVE/PARKING AREA. 3. L, T AXEA AJM,.A/_cS Fora Sv,w.IZElgoSF- UNDEVELOPED X (:ia TM� ri 3 TH2 PROPOSED C WELL 'III�TH3 1 UNDEVELOPED 1 I oz /00'. 1 OF 2 O 0 ,1.. ti .� - NO, n32 -E 47� D LEGEND O ENO 51V REBAR ' © CXIS WG WELL �I PROPOSED wE" EASEMENT p tr4eK ,1.. ti .� - NO, n32 -E 47� ABSORPTION SYSTEM DESIGN DETAILS WIDE DRAINFIELD HOUSE CLEANOUT 1' TO 4' FROM FOUNDATION WALL SEPTIC TANK 1000 GALLON CLEANOUT$ O SEPTIC TANK OPP09NC _ CLEANOUTS \i CLEANOUTS SOLID PIPE TO ENTER PERFORATED PIPE AT I MIDPOINT OF DRAINFIELD � I I. MONITOR TUBES I PLAN VIEW - SCHEMATIC NIS MOUND SURFACE VARIES 6' OL 2" RIGID INSULATION OR ',IACKFILL TO 1' � +j' BACKFILL 1' 6• -2" GRAVEL OVER PIPE GRAVEL 1 _4^ PERFORATED PIPE(PERFS DOWN) 2' MIN. ACCEPTING SOIL ttq'e, `;�j�i .10 • •�•Nw M� VAI 1���+ 4' MIN, STRATA BELOW DRAINFIELD 6' MIN. SEA50NALLY HIGH 2 OF 2 GROUNDWATER TADLE BEDROCK OR IMPERMEABLE LAYER SECTION (END VIEW) TYPICAL OF EACH TRENCH NIS SCOPE: NEW ABSORPTION SYSTEM FOR A THREE (3) BEDROOM HOME. THE SYSTEM WILL BE A WIDE TRENCH WITH 6LLOF GRAVEL BELOW THE PIPE. ABSORPTION AREA CALCULATIONS: MINIMUM REOUIRED: 3 BEDROOMS X 150 GPD/BEDROOM =450 GPD CAPACITY SOILS RATING AT PROPOSED SYSTEM = 0.8 GPD/SF MINIMUM SIZING = 450/.8 = 563 SF TRENCH WALL AREA LENGTH = 563 SF/5' WIDTH 15' = 113 FT USE 2 60' LONG 5' WIDE DRAINFIELDS WITH 6" SEWER ROCK BELOW PERFORATED PIPE. DRAINFIELDS MUST BE 10' MINIMUM APART. IMPACT ON ADJACENT LOTS: THERE ARE NO PRIVATE WELLS WITHIN 100' AND NO PUBLIC WELLS WITHIN 200' OF THIS ABSORPTION SYSTEM. THE PROPOSED ABSORPTION SYSTEM HAS NO IMPACT UPON ANY ADJACENT LOTS AS SHOWN ON THE ATTACHED SITE DIAGRAM. DESIGN DETAILS 4` OF At 1 LEGAL: LOT3BLOCK 2 PTARMIGAN ROOST"'••;4S��� IN NW 1/4, S2, T11 N, R3W, SM e t �L' q ��% OWNER: WILL GAY PHONE: 349-2454 �. .. „..«.»«.«.......0 t�.Q; NM 17324 DATE: 6/1/96SCALE: NO SCALE ttq'e, `;�j�i .10 • •�•Nw M� VAI 1���+ CONSTRUCTING ENGINEERS 346-2000 9601 BUDDY WERNER DRIVE 2 OF 2 ANCHORAGE. ALASKA 99516 . enrT K. Wilton ' 601 Budd] Werner Dr achartge, Att,,9e33e 07-166-1000 PERFORMED LEGAL DESCR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS �F. OF _QC.ti 91. ,,r �EJiOTNEE SSEAI %f' �! j rr n,k Jll C � •h p'. a iK,n., ,• Constructing Engineers, Inc. Engineers, Surveyors n32 -E C SOILS LOG — PERCOLATION TEST �1,� •� . WILL C/{ DATE PERFORMED: / ION: i- 315Z d r e w I(- h0 Township, Range, Section: T-11 N R3 w S 2 1 00 $ j SLOPE SITE PLAN UJ?Alp SOAJG 1-i _ 0-05-, O✓gah1C5J# si 1+ FFT-71 51 �if JL�d'J l,�✓.�Vt� C ►vl TN 0/ p N d s J WAS GROUND WATER G S ENCOUNTERED? f IF YES, AT WHAT t DEPTH? "W4? - r'S8 t ft -11w 5.30.9 NwAr Rending Date Gross Time Not rime Depth to Water Net Drop O 7 ,v3 rr .. wt •' 2 ++ — 3rr L 4/.. " 3 . 7 7 S. ,. PERCOLATION RATE 7 (mmutevmch) PERC HOLE DIAMETER 8 f � TEST RUN 13ETWEEN FT AND / r FT PERFORMED BY: C E I ////* "' A0 �1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 5-30-V(. Z. --w-s C 1 M4GINEEP5SElil1'e VV, ^ fi r V T11 1 V t •a X. Wilson Ce. a / x i.•• ao1TDuady •erne` or 'aaereQ`• Alt, 99514 Engineers, Inc. 17-344-2000t4.��, k0. ?732-E Engineers, Surveyors 22.1 SOILS LOG — PERCOLATION TEST dl�Sr «•�:�U��-'� PERFORMED FOR: tofu' r j / DATE PERFORMED, 5-116 1e `36) / b -3 /�49 Z LEGAL DESCRIPTION:[- IfAfl�,J/V .y OoS/ Township. Range. Section: %//A/ /Q .5 CU Lr Z DEPTH p / SLOPE SITE PLAN w/No SO,V CS D/Q IFEETI Qom/ Di-feiiics ) afll 1 2 /-0/1V 0/O a 3- 4- 6 4 6 7 8 9 10 11 12 13 14 16 16 17 16 19 20 COMMENTS NONE Groh Time Net Time Depth to Water NESE /'2ESd EO ■EE■ S", 30 ems--■ 3 — • "MIEN E®E■ NONE /J Ie7yvz,. EEEE y ZoM EEEE S'r fiL., EEEE EEEE ■EEE. WAS GROUND WATER y/� ENCOUNTERED? ` IF YES. AT WHAT G DEPTH? Deoin "?? Mer.S. % - S' 30' G Reeding Date Groh Time Net Time Depth to Water Net Drop /'2ESd EO S", 30 — 3 — • /J Ie7yvz,. y ZoM ,5w1 S'r fiL., PERCOLATION RATE /0 (mmuaennch) PERC HOLE DIAMETER 8 V/ TEST RUN BETWEEN /'FT AND / FT PERFORMED BY: GIC I �,+ /JG� CERTIFY THAT THIS TEST WAS PERFORMED IN or. 30' ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE SG QF A • •• (ENGINE6R55EAy� � earl K. mllsonp7 :Ol ludOT Lerner or F•ewl 1I nesorage, 36[,.99514 Constructing Engineers, Inc. ii 17-344-2000 I.« .www...uwewwr Engineers, surveyors 41,�+, eu T732 -E C4ryi'. 7cne 33,1Wd SOILS LOG —PERCOLATION TEST PERFORMED FOR: '�' �2Ail DATE PERFORMED;.' L3 8' LEGAL DESCRIPTION: PTAtMj0AAJ 1e00j7' Township. Range. Section: rllA.% IC54o S2 SLOPE DE►TH (+ 1 IFEETI �'� �15c•1Ai/C.Sj V/�� 3 51;';4 Afq 4 SM 5- 6- 74 8 9 10 it 12 13 14 15 16 17 18 19 N h l WAS GROUND WATER ES ENCOUNTERED? S IF YES, AT WHAT G / OL / O DEPTH? P E coo III wow Aw G 11181111111`09? — 04, x'30.96 Reading Date Grow Time Not Tum Deoth to Wow Net Drop P,eFs A/GEO S•3o - '• 7," 7," 3 Vr_ ' L /S� M ^ L" �s'1 M (p •' �/1 �' 20 t_1 JI PERCOLATION RATE / 5,e Iminutasrmcnl PERC MOLE DIAMETER 8 o S 1eTEST RUN BETWEEN / FTAND / FT COMMENTS re -1.7 PERFORMED BY. Gr C' 1 �• • /''/' 6011:24 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: :5.30 -�G D2 1 11 1 ANCHORAGE FAtJUNEAU U COV9ULTA'VTS 1NC. �utiEAUewu 269 EAST 51ST AVENUE . P.O. SOX 6057 • ANCHORAGE. ALASKA 99907 • TELEPHONE 907-279-0193 . TELEX 090.25919 June 23, 1975 R & M No. 562050 Mr. Ray Walker Polar Realty 101 E. international Airport Rd. Anchorage, Alaska 99502 RE: Test Hole and Soil Log Report for Sanitary System Lot 3 Block 2 Ptarmigan Roast Subdivision Dear Mr. Walker: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This inves- tigation was performed in accordance with your request of June 16, 1975, and those procedures outlined in a letter dated December 19, 1974, by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental.Quality. A single test hole was put down within the Lot 3 area for the purpose of defining general subsurface soil.conditions for the proposed sanitary system. Excavation was accomplished with a tractor -mounted backhoe and the test hole was extended to a total depth of 15.0 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & 14 CONSULTANTS, INC. Q.ysw/ ///, James W. Rooney Vice President JWR/WED/sc Enclosure L,�c: GAAB M/ r� T.H. No. 1 6-19-75 0.0' ORGANICS I ��""""""III 1.0' ORGANIC SILT, TRACE SAND 2.0' SILTY SANDY GRAVEL (GM) NSILT, TRACE SAND (ML) SAND, TRACE SILT (SP) SILT, TRACE SAND (ML) SAND, TRACE SILT (SP) No Water Table Log Represents Lot 3 Block 2 Ptarmigan Roast Subdivision Enginee►inq 8 Geological Consultants Inc. ANCNORAOC iAIR BANK$ A LA SKA JUNEAU DATE 6-19-75 SCALE 1"=3' 10wN BY WED CNKD BY 1JED 4.5' 5.5' ,5' .5' 0' T.D. Polar Realty Log of Test Hole Anchorage, Alaska NO. 562050 DwO No. A-0 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services 60 On -Site Services Section CUS P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.O. # M n - (” 1LN 21 1 HAA # 1 VNSS M 1 1. GENERAL INFORMATION Complete legal description 6 3 %3L %'i �2MiC��}n1 /Zoo Si 7-//A/ 2 3 u, eS Z Location (site address or directions) NE GOR. G vN4 §T— OGF C7O1.t74FNyiEiU Property owner tVILL 6714,y Dayphone 3Y -r 7273 Maiiingaddress Po$ 101too$ AtJL1f 17It!rl l Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: i /f/26-4= v �O'`�si• ENGr2S 3. TYPE OF WATER SUPPLY: /} AJG/¢' Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. Tt-025 (R«. 1Ntt F O MOA n1 S. 1.1 M 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 GouSr Env 6 A-5 Phone 3516 -Zc o o Address 96C'/ Zvop Engineer's signature WE-deN62 ?j2 /1/( CA-- DHHS SIGNATURE -�� c Approved for THA E bedrooms. Disapproved. Conditional approval for Additional Comments Date S'" Z - i6 U Na 17324 JI" 22. 1p" bedrooms, with the following stipulations: �2fiLf-,/ /.1/. Date CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a Courtesy to purchasers of homes and thei r 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-=(P ,..1N1) 6� MOAM Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 4 825"L' Street, Room 502 • Anchorage, Alaska 99501 • (907) t 1 V ED AUG 0 6 1998 Health Authority Approval Checklist MUNnpALITY OF ANCHORAGE Legal Description: G 3 3 Z R74,eM I G A IJ Parcel I.D.: - vlRontMENrAL SERVICES S Drvlslo^' /x00,5% A. WELL DATA Well type P If A, B, or C. attach ADEC letter. ADEC water system number Log present (YIN) t Date completed Total depth 'Z r0 Cased to Z D Casing height (above ground) Sanitary seal (YIN) Date of test Static water level Well production Wires properly protected (YIN) FROM WELL LOG /qv.� 20 yt, /O 3 g.p.m. ZV9 WATER SAMPLE© St1L�S� r<S f. � 66 Coliform O L Date of sarttpie: 7-1T - 9P B. SEPTIC/HOLDING TANK DATA AT INSPECTION /o—ZI-7Y iv 3.3 g.p.m. / �t'� Nitrate 01141- Other bacteria O _/ Collected by: 1,f • Al. Date installed 7 - yG Tank size '/000 Number of Compartments L Cleanouts (Y/N) 1r Foundation cleanout (YiN) Depression (YIN) Al High water alarm (Y/N) A/ Date of Pumping Pumper. C. ABSORPTION FIELD DATA Date installed 7-71e Soil rating (g.p.d./ft' or ft'Ibdmt) 0.93 System tree 3ArAtGra/ 7,4eEA1C# Length I Z & i1 -41l Width 5— Gravel thickness below pipe G z� Total depth /Z'y Effective absorption area 650 Monitoring Tube present(Y/N) Depression over field (Y/M /o • Z/•Tp'3 Date of adequacy test A4F4',-A- Results (Pess/Faii) /4'7 For bedrooms Fluid depth in absorption field before test (in.); 0 Immediately afte&T? 7 1. water added (in.): C7 Fluid depth (ins.) Minutes later: Absorption rate R.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date D. LIFT STATION d146rA Date installed Size in gallons Manhole/Access (Y/N) High water alarm level at" Cycles tested E. SEPARATION DISTANCES "Pump on" level at* "Pump off' level at* 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Scptic/holding tank on lot r'1406 ' Absorption field on lot '`/,040 r Public sewer main 0 Z 00 r On adjacent lots 0/pa On adjacent lots "` /00 i Public sewer manhole/cleanout 4 ZOO Sewer /septic service line Y4 r Lift station 'f //o r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation f S Prop", line 11-50 r Absorption field 49d r Water main/service linerama S9 Surface water/de 8 too' Wells on adjacent lots f /&a r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation +0 Water main/service line t YO Surface water +106 Driveway, paring/vehicle storage area f 30 Curtain drain t SO F. ENGINEER'S CERTQ7CATION Wells on adjacent lots t/00m� r Propeline f LS / certify that / have determined thru field inspections and review ofA4unicipal recoil in conformance wiilth,,AkLOA ILAA guidelines in effect on this date. Signature rIO '�VrrSh� .+ Engineer's Name A AGU/GSO,t7 — a oA,)Ji 15Wt. gJ Date Al L ?Y V4. HAA Fee $ Date of Payment Receipt Number Rev. 8195 OSS: haa.wk.doc Waiver Fee S O Date of payment jJ8/ Receipt Number WX trace