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Home My WebLink AboutHANE TR 2Tract 2 #015-271-12 Municipality of Anchorage Development Services Department Building Safety Division On-Site Wa:er and Wastewater Program. 4700 Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci anchorage ak.us (907) 343-7904 Permit Number: Page/ of ~ ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PID Number: __~3/_~S' - ~-.'7 1 - I~ Wastewater System: I--J New r~ upgrade ABSORPTION FIELD LEGAL DESCRIPTION Well: E.~Jsh',~ [] New [] Upgrade SEPARATION DISTANCES Septic Tank Sewer Line 1,2 TANK J~ Sepbc [] Holding [] S.T E.P. [] Other LIFT STATION Gal BENCH MARK Inspections performed by: Fl,*/'/"r, '7"¢¢J~ ..~c.~, Dates: 1"' ,1~/2 /oJ"' 2nd ~:/2 /03" Development Services Department Approval Reviewed and approved by: .O~/~('//'t.~ /~..~/'-Date: ~-/e-OS ,,. / Engineer's Stamp ~.... ~.... ~, .. '..t '. p........................[ PERMIT NO: SW050249 ~.PAGE 2 OF 2 , / PID NO: 015-271-12 "A" .R LL A COR. B COR. C TO. S.T.C.O. D 29.5 67 12~ALLON TR.M.T."H" 135' 6~' .-'"~ N~ 59~OOT LONG x 5~OOT WIDE SOIL ABSORPTION D~INFIE~ ~ ~,~ ~ ~ 4'+ SOil co ',; ORIG. GROU~ ', ', ELEV. 86.6' r125~GALLON~~INV. , , 91.8' :; SEPTIC TANK " '81 3'=N~ 59-FOOT LONG x 5*FOOT ~DE ':~'~:~.~:..~ELEV. .... ...~..- , T~CT 2, HANE S/D ...... BOIL ABSORPTION D~INFIELD ~ === ~= ~ ~ ~78.3 SEPTIC SYSTEM UPG~DE ,, =~'.; '?:;~;w. 3.0 FEET G~L UNDER PIPE ~.~?~:;??~;~ ~ AS-BUILT INSPECTION REPORT ,' ,' BOSOM T.H. ~1 PROFILE VIEW ELAwoP TECt~ICAL SERVICES SCALE. AS NOTED ' ' EL~. 70.6' , ,~ NOT TO SCALE MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK gg51g-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 25, 2005 Expiration Date: Jul 25, 2006 Permit Number: SW050249 Legal Description: HANE TR 2 Design Engineer: 0019 Flattop Technical Services Owner Name: BENTON DIBRELL Owner Address: 10930 HANE STREET ANCHORAGE, AK 99516-1438 Parcel ID: 015-271-12 Site Address: 010930 HANE ST Lot Size: 78408 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail requirements specified in Anchorage Municipal Cede 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By:. ~-~' ~) ~J~u~>~. Issued B~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWERNVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Number SW Propertyowner(s) ~ /~ Jo~, Mailing address (1) 14) ~ _~o Mailing address (2) /4-n¢ ~ o,-a,?,q. /)-~ Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size "~', ~00 Day phone Zip Code Acr~ Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool [] Well Only [] [] Water Storage [] [] Jacuzzi [] [] Water Softening Unit [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: L TTOP . 'TECHNICAL. SER '! CES CD'IL & ENVIRONMEN?AL ENGiNEERiNG · ENERGY CONSERVATION & ANALYSIS TIIEODORE F. MOORE,. P.E. Pth (907) 345-1355 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 July 21, 2005 14530 ECIIO ST. ANCllORAGE0 ALAS KA 99516 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to upgrade the wastewater disposal facilities on Tract 2 oftlane S/D, Ioca'ed e.t 10930 Hane Street. Soils logs, pert test results, a site plan, design d.'awings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material b~low 4.5 feet is a coarse unstable gravelly sand with a measured pert rate of much less than I minute per inch. Despite the rapid measured perc rate, because fl-e n.ztive material is sand no additional sand filter should be required. Using the soil application rate of 1.2 gp6tsq, ft. specified in the wastewater ordinance, this 4-bedroom residence requires a total ab~;orption area of(4 x 150)/1,2 = 500 square feet. A standard 5-foot wide drainfield would thus be 100 fe,~t long, however by placing 3 feet of gravel beneath the horizontal distribution pipe the required length of the proposed drainfield is reduced to 59 feet. The topography of the lot in the area of proposed construction slopes do~vn tox~'ards the west at approximately 20%, The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-surface and subsurface, or on drainage. Please g~ve me a call at 345-1355 ffyou have any qt~esuons on thts submittal. Sincerely, Ted Moore, P.E. TRACT 1 J/ HANE S/D NO SEPTIC WITHIN 100' R 100;~~ ' WELL : INSTALL NEW ,' ,, t250-GALLON ~ ,, ....... , SEPTIC TANK \ , EXISTING ",, ' SEPTIC TANK ~ O PiT -.. AND BACKFILLED) ~~~ ~R~: HAND SlD CONSTRUCT N~ ~1 -~~ 59-FOOT LONG x 5-FOOT ~DE ~ SOIL ABSORPTION D~INFIELD w. 3.0 FE~ G~VEL UNDER PIPE LOT 20 VACA~ '~' .3~ ~'*~ SEPTIC SYSTEM UPG~DE · mEO~RE~.U~ * } ~ 14530 ECIIO ST~ET D~WN BYTFM % ..... 9 ~ ~,~ JULY, 2~5 V&~ % ~c-o~o ., ~ ~ ANCIIO~G~ALAS~516 _-L ................. ~ ~ ~ ~ NOTE: THIS IS NOT A SUR~YED P~T. .~.":~.~__ ALL LOCATIONS SHOWN ARE APPROXI~TE. t' DIA. D-3034 CONNECT -~ <50' FROM END ~INSTALL (2) 4~DEGREE BENDS AT TIE-IN TO EXISTING LINE INSTALL NEW t250~ALLON SEPTIC TANK CONSTRUCT NEW 50-FOOT LONG BY 5-FOOT WIDE SOIL ABSORPTION DRAINFIELD WITH 3.0 FEET , ~ EFFECTIVE GRAVEL BELOW DISTRIBUTICN PIPE ~' DBL. C,O. ~ 50 4" DIA. F-810 PERF. PIPE ~ 'A' '-~' ~: ~ 7~ ' .... ~--MT co--/_ I · ' PLAN VIEW .... ~ "A" SCALE: 1" = 10' MONITOR TUBE CLEANOUT MOUND BACKFILL 6" ~--- ORIGINAL GROUND 3.5 FABRIC 4" DIA. F-810 PERF. PIPE -- 1/2" - 2 1/2" SEWER GRAVEL -BOTTOM OF EXCAVATIOEI CROSS-SECTION "A - A" SCALE: 1" = 5' TRACT 2, liAblE S/D SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOP TECIINICAL SERVICES 14530 ECIIO STREET ANCtIORAGF~ AK. 99516 SCALE: AS SI I05.~ DRA X~,~I BY: TFM JULY, 2005 r lTESTHOLE# ! LEGAL DESCRIPTION: DATE PERFORMED: PERFORMED FOR:~. DEPTH -- (feet) 1 2 3- 4 5 8- 9 10 12- 13- 14 15 16 19 -! 2O -! Tract 2, Hane S/D___ ___7113/2005 Benton_ Dibrell Pt. SM Reddish gravelly sandy loam ML Brown sandy silt Sidewalls smear SP Coarse gravelty sand Sidewalls very unstable FLATTOP TECHNICAL SERVICES 14530 ECHO ST, ANCHORAGE. ALASKA 99516 SOILS LOG - PERCOLATION TEST S TE PI. AN EXISTING SEPTIC '-~', T... #1 _ J Depttlto Groundwater J Date : ; !- No-groundwater .... ~. 7113/05 ..... i Monitor tube dr'/ __ ~. 7/20/05 .... SLOPE I Clock I Not Time Time ~ (minutes) Percomet~r Net Drop Reading (inches) 2 23:'i6~.. __. ~1/4 ~0 ~ ............. 8 ...... PERCOLATION RATE~..~< <_lL__ (minute s/inch) PERC HOL¢- DIAMETER. 8"-. -- TEST RUN BETWEEI~_6.5___FTAND.__7,0 _ FT COMMENTS:__Despite.~apid .measured perc fate ~o sand filter should be required because native .matenel is already sand._ ........ ._Recommend 5-foot wide trench design because sidewalls too unstable for a trench ..................................... PERFORMED BY FLATI'OP TECHNICAL SERVICES, I _.,~~ ......... CERTIFY THAT THIS TEST WAS PERFORMED tN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:_ _'~,.ff_Z~_.~_~.,¢' ..................... G~ttop Techn~a£$emdces 14530 ff. cho Street, Anchorage, AK99516 Phone (907) 345-1355 Tract 2, ltane S/D 10930 llane Street Wastewater disposal system installation Specifications 1.0 General: ! .1 The scope of the project consists of abandoning an existing septic tank and installing a new 1250-gallon septic tank that discharges effluent into a new 59-foot long by 5-foot wide drainfield with an effective gravel depth of 3 feet. i.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allo~ved or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 Unless agreed otherwise, the contractor shall be responsible for any tree clearing and grubbing necessary to complete the project. 1.5 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after seUlement and that them are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lax~ areas. 1.6 Unless specifically agreed otherx~se, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing septic tank ~'hich is not retained in service must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil. 2.2 The new 1250-gallon, 2 compartment septic tank shall be Municipally app~ovcd and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4' cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall haxe a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. Two :45..degree separated by at least 3 feet of straight pipe shall be used at the point of ue-~n to th existing waste line from the house· A double cleanout shall be installed within 5 feet do~astream of the septic tank. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 5-foot wide trench to a depth of 8.5 feet below ground level as measured on the high side of the natural topography.. The long axis of thc excavation shall parallel an existing contour· 3.2 The bottom of the excavation shall be level. 3.3 A total of 3.5 feet of approved sewer gravel shall be placed in the bottom of thc excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 3.0 feet above the bouom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened graYel, with less than 3% passing the #200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in ff.e locations shown on thc design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over thc entire top surface of the sex,'er gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil co, er thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. The top surface of the cover material shall be raised a minimum of 6 inches higher than the 3.6 . surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed othem'ise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement ofadequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections. 4.1 A total of 4 engineering inspections will be required during the course of the project: (I) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have bean laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. oGRE -?ER ANCHORAGE AREA BOr -' UGH De part me nt ~3E;~irs~e~;nta I Q ua lit Y Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL / ~¢'g) INSIDE LENGTH /-/- NUMBER OF MANUFACTURER S7~/¢¢~ ~/~ MATERIAl ~? ~ L COMPARTMENTS. 2~ INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY / ~-~--O GALLONS. SEEPAGE PiT: NUMBER OF PITS__/ DIAMETER OR WIDTH LENGTH DEPTH /~ ~ LINING MATERIAL/¢~-( ¢~;/~/~CRIB SIZE: DIAMETER DEPTH ~ i DISTANCE FROM: WELL BUILDING FOUNDATION ~ /~- NEAREST LOT LINE ~ //' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) A//~ SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE ~-'/,/0 / BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE ! TANK /' SYSTEM //¢ DISTANCES: INSTALLED BY: C/~/~ f=-/'Z PIPE MATERIAL: ~__~,z~ 7-- ~7-,¢¢>~4~) LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM ~/L. ~..(" ~/ DATE APP ROV ED~/~__, G.A.A.B. ,GREATER ANCHORAGE AREA BOROUgkH INSTALLATION OF: SEPTIC TANK -- ~ SEEPAGE PIT~., DRAIN FIELD , OTHER FINANCED THROUGH TO BE INSTALLED .~ SOiL TEST ~ESULTS ~/~P~/~ NOTE: THI~ PERMIT I~ NOT rVA~D WITHOUT ~OIL ~T FINAL INSPECTION: 24 HOU~ NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL I~PECTION BY THE DEPARTMENT OF ENVIRONMENTAL ~UALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~ FOUNDATION TO SEEPAGE PIT ~ / SEPTIC TANK TO SEEPAge PIT Wall SEPTIC TANK ,~JK' , SEEPAGE PIT TO NEAREST LOT LINe. WELL TO SEPTIC TANK J~/~ / DRAIN FIELD WATER MAIN TO SEPTIC TANK ~/~/~ / DRAIN FIELD , DRAIN FIELD ALSO CONSIDER AREA WELLS. / , SEEPAGB PIT SEPT'C TA.K, //~/~ ~ SEEPAGE PIT /~ .... DRAIN FIELD TO river, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND into CRIB CROSSING GAP OF EXCAVATION 5 feet INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit FITTED WITH AirtigHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH ~:~EGULATIONS REGARDING INSTALLATIDN. OR SEEPAGE AREA $1ZB ,~'~"¢--/"~"~ TYPE ~-[;'~-~* DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WiTH THE REQUIREMENTS OF GREATER ANCHORAGE AREA B~ROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. //~ G~TER ANCHORAGE AREA BOROUGH Depa[ 'ent o,f Environmental Quality 33130 "C" Stree'~ Anchorage, Alaska 99503 L, epth Feet Performed ?orr I~r. Jo~e Hane Date performed N~ay ~O~,197'4 !:~:~al D~.~.:ccription:Lo$ l~Ract~2~H~a~, e ~u~di~isi~ec.~21~ ~ .R3W, Sewa~_ ~eridian T.... form reports: So.ifs log X P~'CO!atidn test Sm Sil~y Sand Gm Sand Silt & GraYel 13 14 - 1'6 ' Was 'ground water en(:ountered? If yes, at what depth? ' ' . Re~ding Date Gross Time ! ~et Time Depth to I!20 Net Drop Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite RUSH!, (907) 343-7904 ~,~ , CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING '/ Parcel I.D. o~5-27i-~2 1. GENERAL INFORMATION Complete legal description Hane S/D, Tract COSA # Expiration Date: Location (site address) :Lo93o HaneStreet Current prOperty owner(s) James & Susan Rainforth Day phone Mailing address · o93o Hane St., Anchorage, AK 995~6 Lending agency Day phone Mailing addre§s Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 TYpE OF WATER 'SUPPLY: IndividUal Well. Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [~ [] Individual Holding Tank r-] [] Community On-site E~] [] Public Sewer r-1 The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 M~icipality of Anchorage files and from my investigation ar~. nspection, the on-site water supply and/or~wa~eW~ter disposal system is(are)in compliance with all applicable ~i~iAal..and State codes, ordinances, ~J~ulations in effect at the time of nsta lation. ~ ~ ~. ': ~ Name of'Firm Pannone Engineering Services, LLC Phone 272.-8218 Address P:O. Box ~oo2~7, Anchorage, AK 995~o Engineer's Printed Name Steven R. Pannone, P.E. Date 1 .r [[ d' [ Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. · . . The operational hfe of all wells and septm systems depend on the local soil condition, ground water _~,~ fy- ~.~ii_ levels that may fluctuate during the year, and the water usage of the family being served by the system· These conditions are outside the control of the evaluator of this system. All systems eventuallv fail and ~ c9~o~" l satisfactory te.st results do not guarantee future performance of the system, nor do they puarantee that ~ '¢ *" ~ TH '~ ther~e are no hidden defects or encroachments. PES can therefore not provide any warranty for future ~.,.-[.t~~ ...... ~,.,,2~ perlormance nor give any estimate of how long the system wilt continue to meet the operational ~¢- requirements o.f the MOA DSD. The content of this report is for the sole benefit of the owner listed ab~ve.Anyrehanceup~n~ruse~fthisrep~rt~yany~therpers~n~rpartyisn~tauth~rize~n~r~i~~it '~-,,. No.¢£ 8149 confer any legal right whatsoever. *~ ....... ,"~ 5. DSD SIGNATURE **;~ l/Approved for ~ bedrooms· Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X By: (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other /':~2~ OZ~riOrigina, Certificate Date: //~" Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program ' 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650' www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Hane S/D, Tract A. WELL DATA Parcel ID: o=5-a72-2= Well type Private Date completed 2h.l',_n?a_ Totaldepth 7_.J~ ft. IfA, B, or C provide PWSID #~ Sanitary seal (Y/N) Y Cased to ~"~. ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~/'~,- colonies/100 mL Arsenic: /..~'.O ugll B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) AT INSPECTION g.p.m. ... 5+ g.p.m. Nitrate /,,O,t mg/L Date of sample: IO/'~,,~/I) Collected by: 3C:>'~'' 5. in. Tank Type/Material ,~f"~R~-r,~j4j.~/,_,~l"~=~--/..._ Date installed ~ Tank size !Z,,~ gal. Number of Compartments ...'Z-- Cleanouts (Y/N) {~ Foundation cleanout (Y/N) ~ Depression over tank (Y/N) ~17 High water alarm (Y/N) /~J Date of pumping ffp/2.G/ll Pumper ~.-/- J'/O~-E-VI~-,~-~ C. ABSORPTION FIELD DATA Date installed 81~12eo5 -Length 59 ft: Width 5 Total-depth ~ ft. ~Eft. absorption area 500 ft= Date of adequacy test ~ Results (Pass/Fail) Fluid depth in absorption field before test _o in. Elapsed Time: _o min. Final fluid depth _o in. Any rejuvenation treatment (past 12 mo.) (YIN & type) Soil rating (g.p.d./ft2 or ff2/bdrm) ~.= _apdlsf System type Wide Trench ft. Gravel below pipe _~ Monitoring tube Y Depression over field N Pass For & bedrooms Water added6ee gal. Absorption rate >= 600+ N New depth_o in. g.p.d. If yes, give date LIFT STATION Date installed "Pump on" level at~ Datum Size in gallons in. "Pump off' level at ~ in. Cycles tested E. SEPARATION DISTANCES Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1004. Absorption field on lot lOO+ Public sewer main 75+ Sewer/septic service line 25+ Animal containment areas 50+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation F+ Water main lO+ Wells on adjacent lots lOO+ Property line lO+ Water service line 2,;+ On adjacent lots lOO+ On adjacent lots lOO+ Public sewer manhole/cleanout lOO+ Holding tank lOO+ Manure/animal excrete storage areas zoo+ Absorption field 5+ Surface water lOO+ Water main 75+ Driveway, parking/vehicle storage Water Service line 104. Curtain drain 50+ F. COMMENTS in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line lO+ Building foundation -,0+ Surface water 10o+ Wells on adjacent lots ~.00+ lO+ G. ENGINEER'S CERTIFICATION I certify that lhave determined through field inspections and review of Municipal m~s that the abOve systems' are conformance with MOA COSA guidelines in effect on this date. Engineers Pdnted Name Steven R. Pannone, P.E. COSAFee $ ~0~ ~- ~ ~ Waiver Fee $ Date of Payment I I- d'~'"' I( Date of Payment Receipt Number ~~ ~ Receipt Number (Rev. 11/05) SGS Ref.# 1115268001 Client Name Pannone Eng. Srv. Printed Date/Time 11/01/2011 15:14 Project Name/# HANE SD TR 2 Collected Date/Time 10/25/2011 15:00 Client Sample ID HANE SD TR 2 Received Date/Time 10/25/2011 15:25 Matrix Drinking Water Technical Director Stel~hen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic 5.00 U 5.00 ug/L EP200.8 C (<10) 10/25/11 10/27/11 NRB Waters De~)ar tment Total Nitrate/Nitrite-N 0.100 U 0.100 mgfL SM204500NO3-F B (<10) 10/27/11 AYC Microbiology Laboratory E. Coli Total Coliform Negative I 100mL SM20 9223B A 10/25/11 DLC Negative 1 100mL SM20 9223B A 10/25/11 DLC _.~ROM :Alpine Drillin9 FA× NO. :987 345 8282 Nov. 01 2011 08:35AM P2 Aarow Pump & Well Service, LLC P.O. BOX 110496 ~l.~f Anchorage, AK 99511 1 Office: (907) 346-9355 · Fax (907) 333-8976 Eagle River: (907) 622-9335 CUSTOMER ~ ~ JOB SITE No. 9178 ~BOR HOURS RATE AMOUNT TOTAL M~T6R IAL WORK ORDERED BY[ 'DATE COMP, --~AL I PaY THIS AMOUN~ ~' Thank You SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for In 90 days I agree to allow Aarow Pump & Well Service, L.L,C. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment,) TERMS: ACCOUNTS PAYABLE AT lOTH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.$% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. A+ INVOICE CUSTOMER 7501 E. 1.40th Avenue Anchorage, Alaska 99516 345-1890 P~-one ~gmee~i~g Block DATE DESCRIPTION AMOUNT $165. 17~ Gallons ~' Septic TOTAL REM'~RKS I..,^_ / " .... I ~. Leach Area ~ Holding Tank _ [] PROBLEM AREA -- CALL FOR MORE INFORMATION C_~GEEDS TO BE DONE AGAIN IN 6 MONTHS ood Shape ~ Sludge buildup on bottom [] Jim cap missing or I-~ Cut standpipe to 1' above ground needs replacing ~- _ Standpipes [] Floater on top ~ Needs Septictrine Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O, Box 196650 Anchorage, AK 99519-6650 www,ci,anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Or&'- ~.'71 - I Z 1. GENERAL INFORMATION Complete legal description Location (site address or directions) HAA# 05 ~)1-~ Expiration Date: Current Property owner(s) Mailing address Lending agency Day phone' A-,.~o.--e~Vq. ~ Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: I~o cc,, ~'~t",,F,,¢~ ~',.,,/~ te:~. ,4.~,*o,- v,~e.. .4-,,- 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are redluired for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional englneer's work. 4. 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 Health Authority 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. NameofFirm F'l~,/--/c,/,) ')-~cA/;~¢o/ £¢,.--~,¢~, Phone Address Iq5'3~ ~,o -~;. ,A~¢4o~',=,~,~. ,,9¢c ~..¢'/~, Engineer's Printed Name -7'A~,o,,~.eo,.-~ /='./-~oo,-¢ Date DSD SIGNATURE !,/"' Approved for Disapproved. Conditional approval for bedrooms. bedrooms, ~th the following stipulations: Additional Comments Attachments: HA,& Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Datei Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST ' Tr~cF '~, I-/*-¢. .~/~0 Parcel ID: IfA, B, or C provide PWSID # ' Sanitar7 seal (Y/N) Y' Cased to'~ '~o ft. FROM WELL LOG Legal Description: A. WELL DATA Well type ~,'1~ Date completed ~ Total depth ?_o¥ ft. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~) colonies/100 mi. Arsenic: -- rog. Il. B. SEPTIC/HOLDING TANK DATA ft* g.p.m. Nitrate ~',~'.! mg./I. Date of sample: ~/~/o~ Well Log (Y/N) iV' Wires properly protected (Y/N) ~ Casing height (above ground) ~ ?,. in. AT INSPECTION Other bacteria Collected by: g.p.m. Tank Type/Material .5'¢/,Y-,'¢ / £/'-~g f Tank size I~,$~ gal. Number of Compartments ~ Foundation cleanout (Y/N) Y' Depression over tank (Y/N) /~ Date of pumping /V.~. (H~,.~,') Pumper C. ABSORPTION FIELD DATA Date installed ~!3/O~' Soilrating (gp.d./ft2orft2/bdrm) Length ~'~) ft. Width ~ ft. Total depth~..~ ft. Eff. absorption area~Oo, ft2 Monitoring tube . Date of adequacy test ~k/. A.. ('/g ~ ~.,,,) Results (Pass/Fail) Fluid depth in absorption field before test ~ in. Water added o' gal. Elapsed Time: ~_2 min. Final fluid depth O in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~ colonies/100 mi. Date installed Cleanouts (Y/N) High water alarm (Y/N) System type .5"- ,<.,,~'e ,=:~-~,%,C,e/,.,( Gravel below pipe ?. c~ ft. ¥' Depression over field For 5" bedrooms New depth ¢';, in. Absorption rate >= O"'OO g.p.d. If yes, give date H. ,4., D. LIFT STATION A/, ~,. Date installed 'Pump on' level at __in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off' level at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankJliff station on lot Absorption field on lot Public sewer main ~J. Sewer/septic service line ~, ~.~" in. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots ';> ~'~., ' · On adiacent lots "~ ~o~, Public sewer manhole/cleanout Holding tank ~/. 4-.. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation. ~0" ~ Property line ~' ~-' Absorption field · 5'~ ' Water main ~/. ~4. Water service line ~> to' Surface water '~ too, Wells on adjacent lots ~. (oo ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line O"'o'"' Building foundation .Y'~' Water main A/.,4. Water Service line ~> ~O' Surface water ",> /~' Driveway. parking/vehicle slorage Curtain drain ~ .~'~'m Wells on adjacent lots ~ /oo, F. COMMENTS G. ENGINEER'S CERTIFICATION I cerfify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name '"/-/~.,~--~'~ /:-. r-.~c.,o,,-~' Date ~'/ in. HAA Fee $ Date of Payment Receipt Number (Rev 12/01) Waiver Fee $ Date of Payment Receipt Number &,....: ....................... ~....g S 8g~58'3 ?'~N AS-BUILT SURVEy SCALE: .. 0~-15-05;10:30 ; ;907 561 5301 # 1/ 1 SG$/CT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria SAMPLE TYPF.: I~ RoutJn, I~ Repe~t Sempl~ Phone #: Fax it:. ' 290 W. POT'r~R DRIVE ANCHORAGE. ALASKA 'lei: 007-562-2343 Fax: 007.56%$301 1055064- n Trea~ Water ~ Unt;~eted Water ) ~ RU~H SAMPLE ;dembrane Fi2ter hIMO-MUO (P/A) Repoded By:~ Form # F~V- ~,53 12J17:03 M~_MBRANE F~l-rr~ Rr~ULT~: I'"1 Faxed ~SaYsfactory Unsatisfactory ~04~UG IPIN RF.~ U~.I~: LC~ / SGS Rtl.# Client Name Project Name/# Client Sample ID Matrix 1054781001 Flattop Technical Srv. Tract 2 llane S/D Tract 2 tlane S/D D6nklng Water All Dates/Times are Alaska Standard Time Printed Date/Time 08/08/2005 14:52 Collected Date/Time 08/01/2005 10:30 Received Date/Time 08/01/2005 11:26 Technical Director Stephen C. Ede PWSID 0 Sample Remarks: AHowablc Prcp Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Waters Department Nitrate-N 0.100 U 0.100 mg/L EPA 300.0 B (<-I01 08/01/05 JEM Hicrobiolocj~r Laboratory TotalColiform 49OB. NoColi col/100mL SM209222B A (<=11 08/01/05 TLF 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) 1¢)9 ~O /-¢~,~ ~'/'. Property owner Mailing address Lending agency Mailing address Agent IV o~ ¢ Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng 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-O25 (Rev. 1/91) Front MOA #21 Engineer's signature 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. NameofFirm ~'/'~,¢/~,~ ~-~c~'~c~/ ~Cc,~_( Phone Address ~ .~c~ .~.,~c~o~-,~~~ ~'~Z-/~' DI~S SIGNATURE Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date 9- C" ~L~ _x-.} 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. MUNICIPALITY OF ANCHORAGE ENVIRONMENTAl SERVICES DIVISION Municipality of Anchorage AUI~ 0 7j ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502- Anchorage, Alaska 99501. (907)343-4744 R E C E Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal Health Authority Approval Checklist 'T'Fa/rt-~., ~J,e-~.~ -~/'b ParcelI.D.: T N 015--2,71 If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ~ FROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION lid" Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 Co( / ( O0 rn ,~ Date ofsample: ~ / E/ 9fi' B. SEPTIC/HOLDING TANK DATA g.p.m. ~. / -'r g.p.m. Nitrate ~ O. I ~C/q/t,.ff Otherbactefia IVo~e Collectedby: Flo~h~ Tec I~ ..( o'~ Date installed ~lr IO / 7 q Tank size I gffO~l Number of Compartments __ Cleanouts (Y/N) High water alarm (Y/N) ~, A, Depression (Y/N) At Pumper /~O ~ ~Oo ~ r- Foundation cleanout (Y/N) Y DateofPumping 8lq / qS' C. ABSORPTION FIELD DATA Date installed 6'/tfo/79t Soil rating (g.p.d./fi2 or fl2f0drm) Systemtype ~'eCt¢. P,'P Total depth I Z* Length ~ I Z Width ~ I Z Gravel thickness below pipe Effective abso~fion ama ~ 23d Mo~tofing Tub~ pms~nt~. Y . Depressiun over field ~ Date of adeq~ mst ~ / Z / 9 ff Results ~ass~l) ?~ For U be~ooms Fled dep~ in abso~fion field before test (in.); ~ff I~ately ~erTq~ gfl. water added (in.): ff~ ~/~ Fl~d dep~ q] 3/~ (i~.) ~nutes later: ~ff Abso~fion rate = ) ~ O O g.p.d. Pero~de ~ea~ent ~t 12 monks) ~ Nbo~ ~no~ ffyes, ~ve ~te N, ~, D. LIFt STATION Date installed Size in gallons Manhole/Access (Y/N). "Pump on" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Lift station "Ptm~p off" level at* tO0 ' Waiver Fee $ Date of Payment Receipt Number I-IAA Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: h~.wk.doc SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~t ~ fr~ c.c. Property line ~ tO' Absorption field I,~- ' Water main/service line > to ' Surface water/drainage '~ too' Wells on adjacent lots '~ too, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ,.5-! ' f~,'~ ¢. o, Property Line ~ Surface water ~. t OO ~ Driveway, parking/vehicle storage area ~ ~ o ' Curtain drain /V a r~ ¢ .c~'e,'/ Wells on adjacent 10ts ~> ! oO ' ENGINEER' S CERTIFICATION . _:,?:~i~. ~ ~.,. I certify that I have determmed thrufield inspections and review ofMumc~pal recorc[~, tt~at'tlie a~Ove ?ystdm~ are tn conformance wtth MOA HAA gutdehnes tn effect on thts date. Signature Engineer s Name "7'~¢~Ot'orl~ /=, p-too,-~_ 08707/~ Og:~g CTgE ES[ AHCHORAGE ~ 907~451355 HO. 522 D04 CT&E Environmental Services Inc. Laboratory Division :ZOO W. Potte¢ Drive Anchorage, AK 99518-1605 Tel: (907) 562-2343 Fax: (907) 561-§301 CT&E Ref.# 963487002 Client Name Flattop Technical Project Name/# N/A Client Sample ID Tract 2, Hat~e $/D Matrix Drinking Water Ordered By PWSID S~npie Remarlc~: Cliem PO# Printed Date/Thne Co{letted Date/Time Received Date/Time Technical Director Relea~qed By 08/06/96 13:56 08/02/96 12:30 08/02t96 13:25 Parameter Resu{:$ POL Units Nethod Limits Date Date Nitrate-N O.IOOU 0.t00 mg/L EPA 353.2 08/02/96 Yeti{ Coliform 0 0 ¢ol/100mL Sff18 9~2Z8 0B/02/96 TAV ~-.~ ~S Member of ~he SGS Group ($oci,.-~ G~n~rela de SurveNiance} ENVIRONMENTAL FAC~LITI[$ IN ALASKA, CALrFORNIA, FLORIDA. ILLINOIS. MARYLAND. MICHIGAN, MISSOURI, NEW JERS;I_:Y, OHIO, WEST VIRGfNIA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~n[~ ~in Telephone: Home ~ ~-~o,~ Business (c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~xplain); (d) Lending Institution ' ~~-~ Telephone Address (e) Real Estate Company and Agent Address (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family 1~ Multi-Family [] Number of Bedrooms /1/ Other WATER SUPPLY Individual Well I~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite I~ 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. 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 /~(~/-¢-o/¢ 7'-~.'.(,*n[¢~ ( ._~"d~¢~_~ Telephone Address Date I~¢~ ( ~ I~ 3' ~'5-- * Engineer's Seal DHEP APPROVAL Approved for ' ~/ bedrooms by /~iZ ~...¢~L.~ Approved ~ Disapproved Conditional \ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: ~-~/,~C'~' MAR .1. 8 lg85 RECE WELL DATA Well Classification ~.."~"~ ul ¢~¢c~l If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~ Date Completed ( ¢ '7¢ Yield Total Depth I:~o ~ (.¢~.zpc~-/,~z.,) Cased to ~'~ ~ Depth of Grouting (.-~ ~" Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results ¢-~ Pump Set At f.~¢ R' Sanitary Seal on Casing (Y/N) '¢ Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~-~4 .~'¢~,' ; Date _ 7 ¢1, lt. Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~t/(O/'?~ Size Standpipes (Y/N) ~ Depression over Tank (Y/N) [~( Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) N~f~ Separation Distances from Septic/Holding Tank: To Water-Supply Well J ~ ¢ ' To Property Line ~ ~5~2~ To Water Main/Service Line /~ 4~ · Air-tight Caps (Y/N) No. of Compartments Foundation Cleanout (Y/N} Date Last Pumped ~l'~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation L~O ~ To Disposal Field '~/ ¢ To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~"/1¢ / 7¥ Width of Field ~ ia-' (t/o/ Type of System Design Length of Field ~-~ Depth of Field Gravel Bed Thickness f~r.z'--b~&l/ Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on Square Feet of Absorption Area N.o¢' ~/~,,~ Depression over Field (Y/N) N Results of Last Adequacy Test ..~x.~4~f. zc/-¢~-? Separation Distance from Absorption Field: To Water-Supply Well / O '¥ ~ To Building Foundation ~,RI ~ Lot '~ 4¢(.2 ~ ; On Adjoining Lots To Water Main/Service Line ~{, ~t-. To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course '~- ~OO ~ To Driveway, Parking Area, or Vehicle Storage Area 3~¢! ~ Comments /~ecZ ~'~t~ ,~((o4z a/cao,/-er ~ c~"46 D. LIFT STATION i~,~, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'~'-'~,~.¢-~.,c ~ ?2t~,~,z Date 3/I Company ~//'¢/' 7'~c~ ~r~_c~' MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 {11/84) Engineer's Seal DEPT. 07 [F-,~LTH & ,; MUNICIPALITY OF ANCHORAGE ENVIRONMENI'AL PF, OTECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 .RECEIVED. REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing, 1.~PROPE'-RTY O~NER~~I[ PHONE MAI LING ADDRESS PR OP E~7~f d fffe~fr °m a~ C~ PHONE 2l By%ER PHONE MAIEING ADD~ESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT [ PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION 6. TYPE OF RESIDENOE LEFAMILY ~ i-our [~Two [] Five Three [] Six [] Other ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) ~_, ~-~f 8. SEWAGE DISPOSAL SYSTEM [~DIVI DUAL/ON-SITE** [] PUBLIC UTILITY "7¢ If ~ndlwdual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION F, EE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010(3178) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR I NSP ECTOR INSPECTOR DIRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY (r2 ~-- "~? (/: Connection Verified INSTALLER []Sep~_r [] Holding Tank Size: ~ ~,.J If 3'ank is homemade SOILS RATING give dimensions: l ~'?',>~ .~ TYPEOFTANK MANUFACTURER ~, ~--~ TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tanl~ZlAbsorption Area Sewer Line I Nearest Lot Line I I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FO. .EDROOMS [] CONDITIONAL APPBOVAL {letter must accompam/certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev, 3/78) JML dohnM. Lam[m, P.E. .4303 North Star Street Anchorage, Alaska, 99503 907.279.8056 NEW PHONE NUMBER 276-4113 SO, IL ,ABSO,RPTION SYST..~4 TEST PERFORMED FOR: / Z57 - 7757 TELEPHONE: A7 4- &,g~5- DATE OF TESTS: ?/~ ~ 7/,3 LEGAL DESCRIPTION:-[~'" ~ ~r~,'~,~,~'~_ No. OF BED~0OMS:, ~ ~ ~CO~S O~ ~z~: ~,~ TEST PERFORMED IN ACCORDANCE WITH ~L STANDARD PROCEDURE ACCEPTED BY MUNICIPALITY OF ANCHORAGE, DEPT. OF ENVIROnmENTAL QUALITY ON WITH THE FOLLOWING MODIFICATIONS: SURGE CAPACITY" SOIL ABSORPTION SYSTYiM (SAS) ~-~ ~-~ SEPTIC TANK PLUS SAS ABSORPTION RATE ~_~ AVERAGE 24 hrs ~/5~~ ~gJ~?~ STEADY STATE OBSERVATIONS: RISE JML I John M. L~ml~, P.E. 4303 Nor~ star Street Anchorage, Alaska, 99503 907-279~056 DATE ?','Z-7~ PERFORMED LEGAL. DESORIPTION: 7~¢T -DEPTH BELOW ' METER READING GALLONS PUMPED - TIME ' ~'~ ' JML ' ' OF¸ dohn M. Lambe, P.E. I 4303 North Star Street Anchorage, Alaska, 99503 907-279-8056 DATE ~7/-Z- Y~ P ERFO I:hV~m"D LEGAL DESCRIPTION: