The URL can be used to link to this page

Home My WebLink AboutDELUCIA LT 38!/-~.,~[~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT IPHONE I ~I~'NEW LOCATION NO. OF BED~S To: Dwellin~ [ PE~T~ '~Z<~ Manufactur~ ~ .,~e / N°'°fc°m~artmentsz - ' ~ Inside len~ Width Liquid depth ~OZ~ ' DISTANCE TO: Well ~ Dw~nh PERMIT NO. O z ( Manufacturer ~ ~ 7 Material Liquid capacity m gallons , We20~ Foundati~o Neare~e , ~ DISTANCE, TO: ~ le~f lin~ Trench w¢~ Distance bet~ e Ii s ~, ~ ken,th ~each lin~ Total ~O inches p~ ~',~ Top oftiletofinishgra~ ~ ~ ~ ~ ~ /~ i- ~a~or ea : M~rialL~eneat~il~¢ Total ef inches Length ' Width Dbpth / PERMITNO. ~ ~ Tgpe of crib Crib diameter C Total effectiue absorption area m Well B~lding foundation Nearest lot line ~ DISTANCE TO: Driller Distance to lot line PERMIT NO. ~ Class~ Depth m Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: PIPE MATERIALS ., -' I , -' ,ws,..., ' - ~ 72-013 MUNICIPALITY OF ANCF, ,AGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE., AK 99501 264-4728 PERMIT NO' [)ATE ISSUED: 0[-4--5 I TE- '_=.EL,lEA 840480 ~ k~_,,, l~,. ~_,4 F'EE'I'.I I T APPLICANT' ADDRESS- CONTACT PHONE' PAT TILTON X SiS ENGINEERING EAGLE RIVER, AK 99577 LEGAL DESCRIP' LOT SIZE' SLIBD I V I S I ON' DELLIC: I R SECTION' ~ TONNSHIF'- i5N i5000 (SQ. FT. OR RCRES', LOT' 2:8 RANGE: iW BLOC:K' NA I CERTIFY THAT: i. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS, 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 NELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. IF A LIFT STRTION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (i) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT~ AND (3> THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED APPLICANT' ISSUE[:, BY ~ ~' ~ yl~ $01L$ LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: ,t~,~ LEGAL DESCRIPTION: 8 9 10 12 13 SLOPE ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PL/~ S L O P E 14 ! ~,Reading IGr°ss Net Depth to Net Date Time Time Water Drop t5- (minutes/inch) COMMENTS PERFORMED I FT SOl LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 5 6 7 8 9 SLOPE DATE PERFORMED: SITE PLA 10 11 12 13 14 15 16 17 18 19 2O COMMENTS PERFORMED 72-008 (6/79) ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? ! Gross Net Depth to Net , Reading Date Time Time Water Drop · / PERCOLATION RATE TEST RUN BETWEEN FT AND CERTIFIED B~ (minutes/inch) FT GRE' 't ANCHORAGE AREA Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL """ INSIDE LENGTH MANUFACTURER INSIDE WIDTH ~ ~ ~-~ MATERIAL LIQUID DEPTH_ ~'~,~,~,,. NUMBER OF COMPARTMENTS LIQUID CAPACITY /~i~ GALLONS. SEEPAGE PIT: NUMBER OF PITS ( BUILDING FOUNDATION__ ADDITIONAL ABSORPTION CRIB SIZE: DIAMETER DEPTH ~ DISTANCE FROM: WELL TOTAL EFFECTIVE , NEAREST LOT LINE__ ABSORPTION AREA (WALL AREA) ~ SQ. FT. WELL: /~/e'f~ TYPE BUILDING FOUNDATION __ CONSTRUCTION NEAREST NEAREST , LOT LINE , SEWER LINE DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK , SYSTEM C ESSPOO L OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: REMARKS: Form No. LQ-031 GreaTEr ANCHOragE ArEa BorOUGh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456! SEWAGE DISPOSAL SYSTEM I APPLICATION AND PERMIT PERMIT NO. ,NS' A,_'ATION ,-OCAT,ON '_EGAL DESCR,PT,ON INSTALLATION Of: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SEEPAGE PIT L/~' DRAIN FIELD TO BE INSTALLL~~ BY PHONE '~$ ?--/O2-/ OTHER SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS fOUNDATiON TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPT,C TANK TO SEEPAGE P,T WALL'~/$/ SEPTIC TANK ~ TO NEAREST LOT LINE. WELL TO SEPTIC TANK SEEPAGE PIT ,DRAIN FIELD /// DIAGRAM OF SYSTEM DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE Pit DRAIN FIELD SEPTIC TANK, .,SEEPAGE Pit .,DRAIN FIELD TO RIVER, LAKE. STREAM. CAST IRON INTO AND OUt OF SEPTIC TANK AND INTO CRIB CROSSING GAP O~F EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PI~_ FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BORO~..~ REGULATIONS REGARDING INSTALLATION, ~ ICENSED DESIGNER I CER~.~Y THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE Performed For Legal ~escrintion: This ~orm Re~orts "One test is worth a thousand opinions" 582~ TUDOR ROAD. ANCHORA(~£. AL..AIKA 89507 · TELEPHONE 333-847~' Lo t_~B 1 ock~$ubdi ¥~ si Soils Loo ~l~ Percolation Test .nenth Feet Soil Characteristics 3 5~ 9 Was Ground Water Encountered?_~ I~ Yes, At what Denth? Readinq Date Gross Time Net Time Depth to H20 Net Dron Percolation Rate Minute Proposed Installation~ SeenaQe Pit_~ Drain Field ~Cn~ME~h of Inlet --~/ Dent~To Bottom Of Pit O~ Trench ~~-~ D--J~ C--~r~i fi ed ~~ Date: ~'~--~ ~_~_ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address '~,~, Lending agency / Mailing address Day phone Agent Address Day phone ~'-~/ZJ~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ 'w TYPE OF WATER SUPPLY: 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. 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. 72-025 (Rev. 1/91) Front MOA #21 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 Address Engineer's signature David R. Dayton P.E. 20210 Denalar St. Phone DHHS SIGNATURE ,~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date //~- ?- 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 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, 1/91) Back MOA ~t21 ( Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~T- ~)(~) D~-t. Lc-/~ ~ Parcel I.D. A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~/~z-.~,~,,J Driller Cased to //--" ~ Casing height ~,2~" Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION MUNICIPALITY OF AN(SHOP, AGE ////~/~' 2_ EH_vtI~ONMENTAL SI-'RVICE$ DIVISION P "c IV D SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ~/~- ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank 4//~- WATER SAMPLE RESULTS:, 4::). ///* ~/~,~ Coliform <3~(' ///; z./fS~z//Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size I O~:)~C) Compartments Foundation cleanout (Y/N) Y Depression (Y/N) ~J/~- Alarm tested (Y/N) ////ff/~ ~ Pumper ~,'~/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ,/'~' ~ On adjacent lots To property line ~"~! Absorption field S u rface wate r/d rain age J~D~"J~- /'.~ '~_5'- Foundation I Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Manufacturer Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water Soil rating ,/~ z~//~'~-System type Gravel thickness //42 Total depth ,/'~ Cleanouts present (Y/N) Y Date of adequacy test t/// for D. ABSORPTION FIELD DATA Date installed ~/~///~/ Length ~ ! Width Total absorption area ~) '~;~' Depression over field (Y/N) ,/~ Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot To building foundation On adjacent lots .~:"o'~- Surface water Curtain drain ....~ ! On adjacent lots ./~' ~ ~ Property line ~ ¢ To existing or abandoned system on lot Cutbank ~ ~ Water main/service line '~<:~'~'~- E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. David R. Dayton P.E. 20210 Donalar St. Signature ..._ ~. ,,i__~__ ,.,...--~ .----, Engineer's Name '~.'_~ ~'~::~--/~~ ~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number D. R. DAYTON, P.E., R.L.S. ~~~xX~ Chugiak, Alaska 99567 20210 Donalar Street [907)~~ 696-2417 November 16, 1992 WELL FLOW TEST Legal Description: Lot 38, Delucia Subdivision Date of Test: November 13, 1992 Well Depth: 165 ft. Static Water Level: 154 ft. Requirements: 450 gallons per day for 3 bedrooms. Test: The well was pumped at' varying rates until the draw down stablized. Pumping was then continued for a total of 4 hrs. 56 min. Results: The well produced 1.5 gallons per minute with a draw down of 7.1 ft. Conclusion: The well is currently functioning adequately for a-3 bedroom home. D. R. DAYTON, P.E., R.L.S. ~~~ Chugiak, Alaska 99567 20210 Donalar Street (907) ~x~ 696=2417 November 16, 1992 ADEQUACY TEST Legal Description: Lot 38, Delucia Subdivision Date of Test: November 13, 1992 Absorbtion System: 20' x 10' effective depth trench Septic Tank: 1000 gallon, 2 compartment, steel tank Soils Rating: 100 sq. ft. per bedroom Daily Design Flow: 450 gallons per day for 3 bedrooms. ( DHHS Records) ( DHHS Records ) (DHHS Records) Test: 456 gallons of water were injected into the absorbtion trench in a 4 hr. 56 min. period. Results: The absorbtion trench accepted the daily design flow in 4 hr. 56 min. with a 0.2 ft. rise in the monitor tube liquid level. After water injection was stopped, the liquid level in the monitor tube returned to the original level in less than 20 minutes. Conclusion: The absorbtion system is currently functioning adequately for a 3 bedroom home. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS RESULTS for IN~0ICE ! 60647 Chemlab Re£.t 92,6297 Sample t 1 Natrix: FAX: (907) 561-5301 Client Sample ID : L38 DELUClA SUB. Client Name :DAVID DAYTON, P.E. PWSID : UA Client lcct :DAVIDDA Collected : 11/12/92 ~ 14:00 h~s. BPOt : Received : 11/13/92 ~ 11:15 h~s. Req$ : P~ese[ved with : AS REQUIRED O~de=ed By : POt :NO~ RECEIVED Analysis Completed : 11/13/92 Labozatory Supezvl%oz,_LSTEPHEN C. EDE Released B~ : ~ j. ~ Send Repo[ts to: i)DAVID DAYTON, P.E. 2) Parameter Results Units Method Allowable Limits NITRATE-N 2.24 mcj/1 EPA 353.2/300.0 10 Sample ROb'lINE SAMPLE COLLECTED BY; D.R.D. Remarks: mmmmmmmmmm~mmmmm~gmm~m~mmmmm~mmmmmmmmm~mmmmm~mmm{mmmmmmmmmmm~mm~m~mmmmtmmmmmm~m~mmmmm~mmmmmmmml~m~m~m~mmmm=mmm~mmmm~m~mmmm 1 Tests Performed ' See Special Instructions Above UA-Unavailable ND- None Detected '* See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT-Gzeatez Than Member of the SGS Group (Socibt(~ Gbnbrale de Surveillance) MUNICIPALITY OF ANCHORAGE , DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRO~iENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1 General Information Application Date ~//~/~k/~ · '/ z/ (a) Legalpes_cr~ption~-~inc~ludezlot, ~o~D subdivision, section, township, range) Location (a~d~re~! or directions) /V ! (c) Applicant is (check one) Lending Institution ~--~ ; Owner/builder~; Buyer ~--~ ; Other ~ (explain); (d) Le nd i n~I ~stitutio n~~'~ B~/.~ ./~z~ ~z~/ Telephone Address ~/~ ~. - (e) Real Estate Co. & Agent Address Telephone (f) Mail the H~ to the following address: 2. T'pey of Residence Single-Family~ Number of Bedrooms Multi-Family ~ Other (describe) 3. Water Supply Well~ Community~-~ Public~-~ Individual 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. Onstte~ Public ~ Community ~-~ Holding Tank ~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] En~ineerin8 Firm Providing Inspections, Tests, File Search, Data and Informatioa As certified by my seal affixed hereto and as of the validation date shown h~low, verify that my investigation of this Health Authority Approval shows that the 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 based on the information obtained from the Municipality of Anchorage files and investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Telephone Address Date DHEP Approval Approved for ~li ~i_(__.bedrooms Approved~ Terms of Conditional Approval CAUTION THE bRINICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH kND ENVIROnmeNTAL PROTECTIO: (DHEP) ISSUES HEALTH AL~HORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENt- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES kYD THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ~*2qD STATE REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A® WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH ALrI~ORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 Well C lass i f icat ion f'~7 ~/¢~ Well Log P~esent ~ Total Depth ~ &C%'~/ Cased to Static Water Level ~/ ~ Casing He igh. t,. Above Ground .~ ¢ /f Electrical Wiring in Conduit (~.~Y~ ~UNICIPALITY OF ANCHO,gA~...5 DEPT. O:F HEALTH & ~'NVIRONM~NTAL ?;:~C TEC i'ION '$£P 2 5 RECEIVED Legal D/escription: ./_~ /)~/~-£~ (/g /~ Yield Date ~leted ~ ~ - ~pth of Grouting ~ ~t At Sanit~y ~al on Casing~ ~ession ~nd ~l~ead Separation Distanc~..s from Well: To Septic~ Tank on Lot To Nearest Edge of .Absorption Field on ~ot /"~,~' f~ Seweri.,Line. /¢/~ To Nearest Public Sewer To Nearest Public AJ/ /1% To Nearest Sewer Service Line on Lot C leanout/Manhole Water Sample Collected By %, ~ <]~/~¢ef/F& ~; Date Water Sample Test Results ~9 ~/~' ~:~:;' '7'"~ ~'7 Ccm~ents On Adjoining Lots ; On Adjoining Lots Be SEPTIC/HOLDING TANK DATA Date installed 7/¢~ ¢ Size /~ Standpipes ~ // ~.~ Air-tight Caps (Y~' Depression over Tank (~f!~ Date Last "J,'Pumped Pumping/Maintenance Contract on File (Y./NCJ/~9- ; for Holding Tank High-Wate~ Alarm (Y/N)/~//A~ ~Temporary Holding Tank Permit Separation Distances from Septic/Holding Tank: To Water-Supply Well /~3~ ~ To Building Foundation To Property Line /~ ! To Disposal Field To Water ~service Line ~C'~ ! Cour se No. of Ccmpartments ~ Foundation Cleanout ~) (y/N) To Stream, Pond, Lake, (r Major Drainage Con~ents Receipt 9 Date Paid: Amount: ~". [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7/y/~/ Width of Field Square Feet of Absorption Area Depression over Field (Y~ Results of last Adequacy Test Separation Distance from Abscrption Field: Type of System Design~/~ ' 'Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~Y~) Date of last Adequacy Test To Water-Supply Well To Building Fcundation ~C9 ~ Lot ~ ZC I~ ; On Adjoining Lots To Water Mi~./Service Line ~&~ ¢ To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course To Drlveway,/Park. lng Area, or Vehicle Storage Ar~a To P~operty Line /'~ To Existing or Abandoned System D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Ele ctr ical Code s (Y/N) Di~e ns ions ,,apJ~ole/Access (_Y/N) f" LeVel at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments Check Permitted Bedrocm Rating A~ainst HAA Rmquest I certify that ! have checked, verified, cr conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Company KB1/d5/s [Page 2 of 2] 2-15-84 ~' k_¢ D~Ti~ RECEIVED INSPECTION APPOINTMENTS DATE DATE DATE NSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE /vlUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchora~, Alaska 99501 [NVb ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 o. DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proce~ed. Please allow ten (10) days for processing. P~PERTY RESIDENT (If ~fferent from above) .~ PHONE MAILING ~DRESS 3.~__r LEND~-~BTtTUTION O. ' ' '~5 -~X~.~ PHONE M~~D D R ESS 4. R~A.~p~/5~ENT ~ MAI LING ADDRESS t ~ - 5. LEGAL DESCRIPTION l., . 6.TYPE OF RESIDENCE "[~., SINGLE FAMILY I--7t MULTIPLE FAMILY NUMBE~F,BEDROOMS~ One ~ Four Two ~ Five Three ~ Six [] Other 7. WATER SUPPLY I NDIVIDUAL* COMMUNITY [] PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE'* EAR ON-SITE SYSTEM WAS INSTALLED. [] PUBliC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ~,-o,o,,.~. ~,~_,d~ ! "'ir L....-- ~,~ ,. * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) ~,.Ov\~.., C~L)Ct',I "" i(C THIS SIDE FOR OFFICIAL USE ONLY ,] 1. TYPE OF RESIDENCE E~"~'~l NG L E FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE E~THREE [] FIVE [] OTHER [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 2. WATER SUPPLY E~"~INDIVI DUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [~'11~1 VI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified E~'S'~ptic Tank or [] Holding Tank Size: /~0~ ¢,~ If Tank is homemade give dimensions: TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING MANUFACTURER~ MATERIAL ,Clef ]~~ I Septic/Holding Tank IAbsorption Area Sewer Line [ Nearest Lot Line DATE []~'-- APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany Certificate) [] DISAPPROVED 72-010 (Rev. 6/79) David and F~oberta ,.~:or .h_ad ~eedles Road, I,ot 3~q Delucia Chugiak, AK 99567 Subject: Lot 3~, Delucia Subdivision Approval for the individual sewer and water facilities cannot be qranted until the following items have been completed: ~e water analysis reDort needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. The sentic tank ~umpe~ with a receipt submitted to this the actual nmnber o-~ ~t1:~,. ~u~d-..,, Thi~..is .tO-v~rif~ the~? An test needs to be performed on the existing ~dequ~cy leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 26~-4720. Sincerely, Enclosure npii 5/pt,..p, Robert C. Pratt Associate Environmental EXCAVATION ROBERT A. SHAFER WORK CIVIL ENGINEER 694-2979 June 14, 1982 MUNICIPALITY OF ANCHORAGE ~'~T ~'~ '.'~'~r'4 ~. ENVIg,:~!. :t,,A. ~ ,o E -.. i Jeannie Erhart 4797 Business Park Building F-6 Anchorage, Alaska 99 503 2 1982 RECEIVED Dear Mrs. Erhart, Reference: Lot 38: DeLucia Subdivision A sewer system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The seepage pit was charged with 1000 gallons of fresh water and after a period of 24 hours all the water had percolated out. It can be concluded from this test that the waste water ' disposal system serving the three bedroom trailer located on' this property is currently functioning-adequately. However, the system cannot be guaranteed against subsequent failure. If we may be of further service, please do not hesitate to call. Sin(- ' ~ of cc: Municipality Anchorage Department of Health and Environmental Protection Commonwealth Area Realty SRB 196X EAGLE RIVER, ALASKA