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Home My WebLink AboutMOORE LT 43A-1 Municipality of Anchorage Page 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 PermitNumber: ,St, t/ c/100 ~$ PIDNumber: O I ~ /~I ,2 ~D Name: (~[.]R~' BUR GOYNE Wastewater System: ~New D Upgrade Address: 3/OD E. ~2 ~, ~cE. ~/~ ABSORPTION FIELD NO. of Bedrooms: ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTI ON so. Rating:o, ~ GPD/Sq. Ft. Total Depthl2froml original grade: Lot: Block: Subdivision: Depth to pipe botlom from original grade: Gravel depth beneath pipe ~3 A ~ - Noo~E ~.O ~t. d. o ~t. Range: Section: Fill added above original grade: Gravel length: Township: l~N 3~ ~g 0.~ ~t. T~c I'l~ Ft. Number of lines: O~stance between lines: WELL: EX1571~ New D Upg.rade Gravel depth: ~. ~ FL 2 I~ Ft. Classification (Private, A,B,C); Total Deplh: Cased To: Total absorption area: Pipe material: D- Ft. Ft. 1380 SQ. Ft P~C F-SIC Driller: Date Drilled: StaticWalerLeve[:F,. Installer~.L,~ ~?'~ Dateinstalle~/ Yield: Pump Sot ~t: I Ca=i~g Height Above Ground: TAN K GPM ' Ft.I Ft. SEPARATION DISTANCES ~septic ~ Holding ~ S.T.E.P. Water ~/oO ~/Oo ~ ~ >/~' LIFT STATION ~.~. Lot Line I O~ ] ] I ~ / Size in gallons: Manufacturer: Foundation ~0 ~ ~ 2 I ~ ~ 0 ' "PLJmp on" level al: "Pump off" level al: High water alarm at: Curtain Pump Make & Modal I Electrical Inspections performed by: Drain ~ ~ ~ ~ I Remarks: ~o~¢ ~ ~ ~ ~e~o~(~ BENCH MARK ~¢~n~ ~e~V~ ~e~ ~ ~ ~Cf Localion and Description: O~ ~e ore~ Ortq,nally ~/~n~e~ ~r ~ - I Assumed Elevation: Inspections performed by: FZ4~oP TEEd. 5Vc~ ...... Oates:lst ~/9/ffI ~:*~TH~)~C Department of Health and Hu~n SErvices approval ~ ~o~o~ Reviewed and approved by: , ...... Date: ,~/o/q[ '~;?~ ...... 72-013 (1/91) MOA 25 Permit No. $1~¢' c~ I OO ~ 8 Page ~- of ~ Municipality of Anchorage : DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Le ~al Description: LOT qsA HooRE 5/D PID No.: -~ .. E. I,-I.2 ,AvE 30o IEoO ~.AI. l y; ?~ ' LoT q3 A -~IELL ..Fl~attop Technical Services 14530 Echo Street ~[nchorage, Alaska 9951~ ENGINEER S SEAL 72-013 A (2/91) MOA 25 P~rmit No. SM c~/OC)l~'E Page ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN sERviCES of ~ ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: L. ur3A HOOI~E' _~]D PID No.: O l~ Icj2~0 JOO C~O VERTiCAl.. 5C. AZE': I =5 HoRI'ZoNTd~. NOT TO ~CAI..E 72-013 A (2/91) MOA 25 ~ C/O.C/' Borfl ENbS - M.T..,T,#. #~ SO.q U--~ DRY Fl tt T ti ca! 14530 Echo Street. ~c.h~rc~e, Alaska 995~6 ENgINEeR'S SEAL '~ · · ,~sm~°°o~ ~..~oo~ :~ PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 SH 4 5 6 7 8 9 10 11 12 13 14 15, ~6., B.I-I. 17 18 19 20 ~attop Technica! Services 14530 Echo Street Anchorage, Alaska 995]R Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST CARL ~URGOYNE LoT ur'~A MOORE REgblSH ~//~ Township, Range, Section: SEC. 3~ 'T' 12 N R 3 'vv' SLOPE SITE PLAN £A'Nb¥ Lo~ 51L~ 5ANb oF (~RAVEL WAS GROUND WATER ENCOUNTERED? POC K~T5 S YES, AT WHAT IF DEPTH? p E Deplh lo Waler Alter P/,T;. O,/y~.- Monitoring? Dole: Reading Date Gross Net Depth to Net Time Time ~'f'?/%) Water Drop ~'~ ) PERCOLATION RATE lO (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~.() FTAND 9-,~ FT COMMENTS ~OIL IN 'THIS 'TE~T ~JOLE I$ 5I~llLtA~ ~0 THAT PERFORMED BY; FLATTOP T~Ca SVCS I ~ ~ CERTIFY 1HA1 1HI8 TEST WAS PERFORMED IN aCCORDANOE WITH AlL STATE AND MUNICIPAL GUIDELINES iN EfFEC~ ON THIS DATE, DATE: ~/~ 72-008 (Rev. 4/85) PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910088 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:BURGOYNE CURT L & OWNER ADDRESS:3100 E 142ND AVE ANCHORAGE, AK 99516 PARCEL ID:01819240 DATE ISSUED: 5/29/91 EXPIRATION DATE: 5/29/92 LEGAL DESCRIPTION: MOORE LT 43A SEC. 33, T12N, R3W, SM LOT SIZE: 40708 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD 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 (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~_ DATE: ,~'~",~?';;,;".'"~;~ ' ."~" ...... '~'4~",',"?x,~;'.?;>~. ;'~;':~'?A;',';; ~";'"" ,:;:'" ;,':":~'"~:'"~'~"t""9~?'-%.~ ~ ~I~1~ & ~RO~M~T~L ~RI~ · E~¥ ~O~S~R¥~ & ~L¥~ TH3EODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355lv:''ayo", 1991 ANCHORAGE, ALASKA 99516 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: By means of this letter we are requesting issuance of a permit for the installation of a 5 bedroom wastewater disposal system to serve the Burgoyne residence on Lot 43A of Moore S/D, located at 3100 East 142nd Ave. Soils logs, a site plan and design drawings are enclosed. Groundwater monitoring conducted this spring demonstrated that there is no groundwater to 16 feet. The measured percolation rate of 14 minutes per inch applies to all of the material below 6.5 feet. The system is conservatively designed utilizing an application rate of 0.6 gpd/sq, ft. = 250 square feet per bedroom. Thus a 5 bedroom residence requires 5 x 250 = 1250 sq. ft. of absorption area which is accomplished by three 38 foot long soil absorption trenches with 5.5 feet of sewer gravel beneath the distribution pipes as designed, with a total of 1254 square feet of sidewall area. The site plan indicates a proposed site for a replacement system just north of the proposed system. The test hole locations were chosen to be representative of soil conditions in both the original and replacement sites. The site plan indicates the locations of neighboring wells and septic systems and other relevant features within 200 feet of the proposed facilities. The topography of the lot is generally level with a low rise in the vicinity of the proposed replacement system and a gentle 5% slope to the south in the vicinity of the proposed construction site. The proposed construction will eliminate an existing separation distance problem and a failing septic system. There will be no measurable impacts to wells or wastewater systems serving adjacent properties, nor will it have any impact on reserved space/surface and subsurface, or on drainage. Please give me a call if you have any questions. Sincerely, Ted Moore, P.E. 'LOT 2.1 i 100t "FO vdE/-L ' I E. i'+2 AVE, L E Flattop Technfcal Services 14530 Echo Street Anchozage, ]:~.lo:s]ccz 995]6 RECEIVED Mun~c,pah~y mt Anchorage Dept. Health & Human ServicerS/ LoT L~3 A MOORE S/D .SEPTIC SYSTEM REPLACEMEI' S~TF PLAN SCALE 1" DATE: Ur/qf NOTE: THIS IS Nc A SuRVEYEb pL, ALL LOCATIONS AR~ 'LoT LIA 'fo L2A BRA~OL F- LO-r 2~ E, l Ur2 AVE, oN LOT ~.~., 300t LOT t.k3 A ,.T. iC~t i , Lo'f 1 I BousE I,¢ EL L Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 % %'~.,~, · ...... _ ~:~ LoT u~3 A MOORE s/D SEPTIC S/STEM REPLACEMEI SITE PLAN SCALE: 1%-5o, DATE: q-/ql ~)w~l BY: ~. NOTE: THIS I$ N~ A SuRVE¥ffb pL /~LL LOC AT~ONS AR~ APPP-oxtH/ Ar-, NoN- PERI= PLAN · To'('/~ ~' C~RAVEL bE, PT H F I LI',ER 'F/:IBR I. C ~'" J S',,5' ~eP'r~ ~ ,,, ~!attop Technical Servic~ 14530 Echo Street J~ - /~ Anchorage, Alaska 995: LOT ~-3A MOORE s/D SOIL ABSORPTION TRENCH PLA N ~' CRo5%- $[c'T ion SCALE DATE' PERFORMED FOR: LEGAL DESCRIPTION: 3 4 7 g 10 11 12 13 14, 15- 16 17 18 19 20 Flattop Technical .~ervices 14530 Echo Street Anchoracm, Alaskc~ 99518 Munlclp~llly of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST CARL 15UR GOYNE LOT NF.3A M00I~E' ~//~ Township, Range, Section: SEC 33., T 12 SLOPE SITE PLAN GRAVEL FILL SILTy COMMENTS PP-Rk. 'TE~'F 5LI.roHTL¥ SILTY gANI) .SOME COBBLES LOOSE, DRY WAS GROUND WATER ENCOUNTERED? Depth to Water After Monitoring? DR'/' Oale: IF YES, AT WHAT 5~[ MO~E DEPTH? COHESIVE tN THIS 'Zone Reading Date Gross ST/i ~t Time 2: ~E 3:10:oo Net · T!me (~ 3: qo: 30 15" Net Crop PERCOLATION RATE I t~ (minutes/inch) PERC HOLE DIAMETER , TEST RUN BETWEEN ,~.~'. FTAND '~.O FT V/~Lib BC-'TN/K~ S.S ' A~.I'O 16 ' PERFOnMEDa¥: FLATTOP T'.=Ct-I..c,V'e_.~ ,...,~.~X')/-/.r...<_~ OERIlF Y 1 HA'I '1 HIS TEST WAS PEFIFORMED iN AOOORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE8 IN EFFECT ON THIS DATE. DATE: 72-008 (Rev, 4/8~) PERFORMED FOR: LEGAL DESCRIPTION: 1 5~ 2 3 SM 4 5 6 7 51,4 8 9 10 11 12 13- 14 15 ~ B.~. 17 18 19 20- Flattop Techn~ca! Services 14530 Echo Street Anchorage, Alaskc~ 99516 Munlclpallly o( Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST CARL ~R~OYNE LO"[ %3 A MOORE' ~/~ Township, Range, Section: SEC 33 j T 12 N., R 3 ~ SLOPE ~,TH ROOTS'} 6RA~ SILTY ~ANb DRy~ HAN~ COBBLE5 GRAY 5Li&HTL"I SILTY 5~Nb, DR~ $OFTEP~ DIGGING WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH;) p E SITE PLAN s~ ,4 ,'A b Del)Ih to Water Aller ~_., Reading Date Gross Net Depth to Net Time Time Water ' Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND __ FT COMMENTS PERK ~/~TE ~E/~Su12E-b FoR; T.~ ~l APPLIE~ TO ~HIS T~ST HoLE ~L5o. P~nrOnU~DDV: FLATTOP TECH, ~VC~ m ~, ~ CEIllltY1HA1 1HIS TEST WAS PERFORMED iN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES m~ ~F~OT ON THIS DATE. DATE:., 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: PT I 2 4- 5 6 9 lO 11 12 13- 14 15 ~6 B.~t. ~7 ~8 Flattop Technical Services 14530 Echo Street Anchorage, Alaska 9951~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST CARL BURGOYNE LoT UrhA MOORE ~/~ Township, Range, Section: SEC B3 T [2 SLOPE SITE PLAN R£DblSH 5AND~ LoAM P0c K~T5 oF WAS GROUND WATER 5'l'/)Nb PtP£S ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth to Water Alter Monitoring? Oate: Reading Date Gross Net Depth to, Net Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN __ FTAND __FT COMMENTS ~OI/ tN. -'rJJrl5 'I"E~T ~OL~' I<~ 51MiLiAI~ --re THAT FovNb iN T.H.'.~ ffl · '~2 . .E.~O.MEDa¥: FLATTOP T~ECf~. _qVC..~ , ~--.~.~r~.,..,..~ CEm'"V~HA~H,STES~WAS~ERFORMED~N ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85} Flattop Technical Services 14530' Echo Street, Anchorage, AK 99516 Phone (907) 345-1355 Lot 43A Moore S/D 3100 East 142nd Avenue Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project includes abandonment of the existing septic'system and const~:uction of a new 5 bedroom wastewater disposal system consisting of a 1500 gallon septic tank followed bY three parallel soil absorption trenches each 38 feet long with 6 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requirements. 1.3 All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.4 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 2.0 Septic Tank: 2.1 The septic tank shall shall have 2 compartments and a capacity of 1500 gallons and be Municipally approved. The tank 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. 2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of !/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. A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 2.3 The existing septic tank is to be properly abandoned by pumping, crashing and burying on site. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating three 38' long trenches to a total depth of 12 feet. 3.2 The bottom of the trenches shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 A total of 6 feet of sewer gravel shall be placed in the trenches. The sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.4 The perforated distribution pipes shall be laid level with the bottom of the pipes being 5.5 feet above the bottom of the sewer gravel. Particular care shall be taken to ensure that the distribution pipes and the non-perforated manifold are all laid at the same elevation to encourage even distribution of effluent between the three trenches. 3.5 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.6 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. Approximately 6 feet of soil cover is to be placed over the filter fabric. The top surface of the cover · material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. 3.7 The existing soil absorption trench is to be abandoned in place with the standpipes removed. 4.0 Inspections: 4.1 A total of 4 engineering inspections will be required during the course of the project: (1) 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 been laid and connected up to.the septic tank, but prior to placement of the filter fabric, and (4) after final 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. Flatto~ Technical Services 14530 Echo Street Anchorage, Alaska 99516 ./ Well Owner FvI-W DRILLING, Inc. P.O. Box 10-378 * 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Use of Well Domastic / Location (address of: Tow~nship, Range, Section, if known; or distance main road Lot 43-B l%ore Subdivision Size of casing_ Static water level Screen ( ); Describe screen or perforation None Well pumping test at 10 gallons per (~ of drawdown from static level. Date of completion Aug:hist 2; 1983 .Depth of Hole 130 feet Cased to 129 feet 90 ft. (~ (below) land surface. Finish of well (check one) open end ( xx ); Perforated ( ). (m~nute) for i hours with 100% ~ WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO__ 2 Casing sticlcao 2 TO. 30 30 TO 80 80 TO~ ___]J_D_T O 127 127 .TO 130 .TO .TO .TO. TO TO TO Brcr~n clay and ~ravel Brown clay and graval_(dz~Ap) (Pra~v silty grava_] Gray h~rd Waterbearing gravel NWWA Cern, iliad Conh',~cLu,e Certificate No's. 814 & 973 1- CUSTOMER ~_,~. 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 MAiLI-I~b-ADDRESS- ~ ~ / ~/ LEGAL ~ESCRIPT~ON LOCATION ~~[ Well Absorption area Dw;lling , PERMIT NO. Material ~ ~ No. of compar~ents ~ Z Manufacturer ~ k Inside length Width Liquid depth Liq. c~t~ in gallons IF HOME.DE: ~M~hufa~turor '~~ " Foundation Nearest Iot~oline, PERMIT N~ ~=.~ DISTANCE TO: Well/¢~, ~ Distance between~2~ ~ No. oflines, Lengthofeachline_~_,, Totallengthoflines~.~ Trenchwid,~. inches ~k Materi'al beneath tile Total effective absorption area Top of tile to finish grade~ Type of crib ~~ ~on Nearest lot line ' DISTANCE TO: ~ Clas Depth Driller Distance to lot line PERMIT NO. m , Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: PIPE MATERIALS ~ SOl L TEST RATING ~ , INSTALLER ~ REMARKS / -013 (Rev. 3/78) F ERH I T NO. FIF'F'L T CRNT LOCFt-F T ON LEGRL. DEPFtRTMENT O~:-*'HERLTH FIN[::, ENV)~RONMENTFIL Fh~..OTECTION 825 '" L. 264-~.472F'~ FINE:,F.:EI.,~ L _ r EF.. [:,ERRHOUN ,?., SRE: I NE L. 4.2: S2.::~: I]..-=N F.'.]:N 7E90 [:,EE:RRR -tf;=..:OE; LOT ~;IZE 7 6'76 }i: FIRE FEET T'Y'F'E OF SOIL RBSOF.:E:TION _T:.TEH I TF.:ENCH HR~-,;~f'IlJH ~&IHBEF.: OF E,'E[)ROOHS = 2; SOZL 'F.:RT~N6 ':ST.~ FT,.'"BR::'=: THE REL=.!I_I~.RED SZZE i:IF THE SOIL RE:SORF'TIL3N S'¢STEH ~S: [:. E F" qF' b-~ == THE LENGTH DIHEN'::.;~ON 1'S THE LENGTH ".:ZN FEET) OF 'THE TRENCH OR DRR:(NFZE[..I.".:'. THE DEPTH OF' FI TRENCH OR PET Z~; THE [:,TSTRNCE BETI.,.IEEN THE SURFRCE OF THE GROUND FIND THE BOTTOH OF THE EXCRVFIT]ON ,::ZN FEET::'. 'THERE ~S NO SET N~E:,'f'H FOR. TRENZ:HES:;. THE GRF]VEL DEF'TH ZS THE H]:N.T. HLtH DEFq-FI OF ISRFIVEL BETNEEN THE OI_ITFFILL. P~F'E RND THE BOTTOH OF THE EXC:FtVFFf'ION ,::~N FEET). F'EF.:HIT FIF'F'LICRN'f' HRS THE RE'SPONSIE:IL. ZT'¢ TO INFOF.'.F'I THIS [:,EF'FIRI"HENT [,I. 1~;']'[.~ THE ZNSTRLLRTZON ~NSPEC"I'~ONS OF FIN'¢ NELLS RD.ZRCENT TO TI-lES PRZF'ERT'T' R[.,IE:, THE NUt,IBER OF' RES~E:,ENCES THRT THE 1.4ELL NZLL SERVE. BRCKFZLLZNG OF RNa' 5'¢5TE1'1 NZTHOUT F'ZNRL ]:NSF'ECTZON FIND RF'PROVRL. DEPRRTHENT 14ZLL BE SUB.]ECT TO PROSECLFZON. f,IZNiHUH DISTI~NCE BE'f'NEEN R FJEL_L FIND RN'Y' ON-SITE 5ENRGE DISPOSRL S'T'STEfq FEET FOR R F'F:I',,,'F~]"E 14ELL.~ OR TO 2¢0 FEET FR3H R F'UE:L. IC NELL. [:,EF'ENDING UF'ON THE T'¢F'E OF P_EI_IC I.,.IELL.. OTHEF: REQUIREr'lENTS HR'¢ FIF'F'L'¢. SPECIF'ICRTIONS RND CONSTRUCTION [:,IFIGRI~H5 RRE R'¢R]:LRBLE TO INSURE PROPER INSTFII_LRTION. I CER'f'IF'¢ 7'HAT · 1.!_: I Rf"l F'FIHIL. IFII~: NITH TFIE F.:EL=.!UIF.:Er,'IENTS FOR ON-SITE SEI.,.tERS FIND NELLS 8S SET FCRTH E:'¢ THE f,tUNICIF'FtLIT'~' OF FiNC:HOF..:RGE. 2: I NILL INSTFILL ]"FIE :,~:,rErl IN RCCOR[:,FINCE NI]'H THE CO[;,EE;. 2:: I UN[:,ERSTFIN[:, TNRT THE ON-SITE SENER S'T'S-FEf'I HFI'~' RE'::.~IJ]F.:E ENLRRGEHENT IF' THE F.:ESIE:,ENC:E IL5 F.:Ef,IODELED T~:,E HOF.'.F THFff.,I 2: E:EDROOf'IS. '.E; I ,:iN E[::,: ~ ~ ~,.~ ............................ ..:....m ..... '.[ SSUED E 'Y' I I FE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222lr SOILS LOG- PERCOLATION TEST SOILS LOG PERCOLATION TEST / LEGAL DESCR,PT,ON: L,~---4 g ) ;>~,~; ss.r ~ t~ 8 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE WAS GROUND WATER ENCOUNTERED: IF YES, AT WHAT DEPTH? SITE PLAN 14e+ Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE 1'7 minutes/inch) TEST RUN BETWEEN 4-~ ~ FT AND ',~-~' FT 72-008 (7/76) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONIViENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Desccption (include lot, block, subdivision, section, township, range) Locati~j~s or d.j.ctions) (b) Applicant Name _~/'U ,~"/~'~--C¢_~ Telephone: Home3~ Applicant Address / ~/ ~'~ ~~-) (c) Applicant is (check one): Lending Institution ~; Owner/builder; Buyer ~; OtherD (explain); (d) (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ~( Multi-Family Number of Bedrooms Other WATER SUPPLY individual Well~' Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ..~ ' %r *' ~i! ., 4. SEWAGE DISPOSAL Onsite 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 72-025 (11/84) ENGINEERING FIRM PROVII~ItWG INSPECTIONS, TESTS, FILE SEARCH, b1~:rA AND INFORMATION · t 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 ~ Address SJJ B 1~]( Date F-..~kGLE RIVER, AK 99577 Telephone DHEP APPROVAL Approved for /' ~ Approved ~%------'~ Terms of Conditional Approval ,~ \'~.i/:) , CA U TI O N The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representahons 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. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: ~ M~JNiCiPALITY OF DEPT. OF HE/,LTH & I]NVIRONMENTAL PF:OTECTION 2 1986 WELL DATA Well Classification Well Log Present (Y/~i) Total Depth ~¢~o Static Water Level ~. [¢~' If A, B, C, D.E.C. Approved (Y/N) Date Completed ~F~¢[~ J~'il~-~ Yield Cased to J~ i'1¢ Depth of Grouting ~" ~¢~.0~ Pump Set At O[/-- Casing Height Above Ground ['7~ Sanitary Seal on Casing~N) Electrical Wiring in Conduit (Y~ ~ Depression Around Wellhead (Y/~]) Separation Distances from Well: To Septic/JCefdf~g Tank on Lot [ ¢:~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~ c2~27..~ ; On Adjoining Lots Nearest Public Sewer Line ~.~ ~r--]~ To Nearest Public Sewer To Cleanout/Manhole ~"','/~' To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results _~'.~,r'~ ¢~, ~-~'~,~-~ Comments ~..~ ~=~"~..- ,..J t. ~ '~-~i¢~..~ ~--~ G~[:~ J¢' B. SEPTIC/14~L-BtNC=~-TANK DATA Date Installed 1'~'-'2-""7'¢~ Size t ~;;~c~ N6. of Compartments 7..- Standpipes~/N) Air-tight Caps'/N) Foundation Cleanout (Y~ Depression over Tank (Ye _ , Date Last Pumped ~:~' ~ ' ~ Pumping/Maintenance Contract on File (Y/N) ~j ~/~ ; for / /~ Temporary Holding Tank Permit (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/H,P.~.g Tank: To Water-Supply Well To Property Line ~ ~'~' To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84} C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed __ I..J¢~... ~ '-~ Width of Field "~ ~ '~""/-"'~ ~~ Type of System Design Length of Field Depth of Field ~ "2.,- Gravel Bed Thickness ~:' Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation '¢~ ~:>~ Lot Standpipes Present Date of Last Adequacy Test To Property Line To Existing or Abandoned System on I To Water Main/Service Line ~ ¢' ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ; On Adjoining Lots To Cut[lank (if present) D, LIFT STATION 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 t~AA guidelines in effect on the date of this inspection. S & S FNG!NI~FD_IN6 Date ~,/~,, ...~/~ Signed CompanySRi~ 196X MOA No. ~'~'/O...?_~ .... EAGLI~ RIVER, AK 99577 9'0~ Receipt No. Date of Payment ~' '~..~1-~[,,, Amount: $ Page 2 of 2 72-026 (11/84) APPLICANT FILLS OUT UPPER HAl. '- ONLY · ~Pr~p~,?ty ~ . (~ Phone Address Zip Code Lending Institution & V ~ ~ rq Phone Realty CO, & Agent ~/~' CO ~C:~ Phone Address Zip Code St~et Locati~ ~ ~__-- Y~ Type of Resi~nce ~ Single Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply ~ A~ACH WELL LOG. A w~J log is required for all wells drilled since June 1975. Individual :~ ~.n .~ Communityx~'~'~.- For wel~s drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal individual Year Individual installed: tj~:: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time -- Date Date Date Date Inspector Insp~tor Insp~tor Insp~tor , 0 ~ ' . ~. ~ '"~o~c~o~ ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ~:DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE J ~ SoiJs Rating Date ~wer Installed Well To Absorption Area JO~ ~ WelJ Log Received Well to Tank ~ Septio T~k Size 12.023 (3182) October Joseph Co -ioore SiLA Box 246-[~ Anc~]orage, AK 9950'7 Sub3ect: Lout 43A, ?ioore Subdivision ApDrovai for the individual se:;~er and water ..... ''''' ~ be granted until tile following items have been completed: · VlOmat_oll E~,~posed electrical wires to the ~,,,el! head are in ~ ' ~ ~'i~ of the ~unicipality o~ Anchorage codes and must be ~ncased in conduit, We have no record of the on-site permit nor as-builts for the sewer system. Please submit your copies or check the above legal in case they are file(] under another legal description o Please notify this Department for a reinspectio~ when ~'~ noted d~oc~.~,.)anclc~ l~ave been corrected If there are any ~urther questions~ please call this of[ice at 264-4720. oincerely~ (mgo/ej/~2 Cory Willis, Acting Sewer & ~ater Pro~jram ~-~aaage r _uepartmenj; If} E.nv ~ro~en t~'~ug; i tv Street, .An~t~a~e~o~[ 9~503 274-4561 t Ih . I ime of Inspection -- ~ Date of inspection ~ REQUEST FOR APPROVAL OF 1. Approv, equested by: Mailing A. dress:, NDIVIDUAL SEWER & WATER FACILITIES 1/, ih. 2. Property Owner: Robert D. & Cheryl A. Bush Phone: Phone:~ Mailing Address: Star Route A Box 246-B, Anchorage 99507 3. Legal Description: Lot 43 NW~ Sectio~!$~ T12N R3W S.M. ?. Location: Brandl and Eas~ 142nd 349-2408 Type of facility to be inspected Single Family We]] Data: Indivi~6~ A. Type C, Construction 7. Sewage Disposal System: A. Installed ¢. Septic Tank: D. Seepage Pit: E. Disposal Field: Distances: 1. Size 1. Absorption Are~ Total length of lines A. Well to: Septic tank (Rabbit Creek Small Tracts) , Sewer Lines C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages B. Foundation to septic tank Nearest lot line , Absorption area , Other contamination , Absorption area No. of bedrooms 2 B. Depth 90' ~ D. Bacterial Analysis~ On-site system. B. Installer 2. Manufacturer 2, Material Page 2 of two pages - Re~,.~.~t for Approval of Individual .~ 'r & Water Facilities Legal Descrip,tion T,ot 43 .lXlW~ Sect±on 33 T12txl R31~ $.M. (Rabbit Creek 8mall ri'tact Comments Approve, Disapproved . ;~:' .... .. 1 Valid for one year f~om~da,te §igned nchorage Ar~a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 333D "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA 2. Prope'rty Owner: Bush, Rober± D. & Cher¥ A. Mailing Address: SRA Box 246-B Anchorage, Ak 99507 3. Name of Buyer: Mailing Address: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: FHA CONV Day Phone 349-2408 Das Phone Phone Doris Timperley--Dyqamic RealTy, Inc. 3380 C St Suite 104 Anchorage, Alaska 99505 Phone 279-76 . Legal Description: Lot 43, NW¼, Sec 33, TI2N, R3W, S.M. (Rabbit Creek Small Tracts) Location: Brandl & E. 142nd. St. right Go I/3 mile up DeArmoun, Turn ~ on Sabine, TaKe next left, look for ~ sign on righf siae of sTreeT. Type of Facility to be inspected: SFR No. Bdrms. 2 Nater Supply Type of Supply: Public Utility Individual xx If Individual, number of dwellings presently served I If Individual, depth of well 90 Ft. Sewage Disposal'System Type .of S~stem: Public Utility If Indiv'idual, date of installation Individual (onmsite) xx GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection FOR Approval'requested by: ~ :.~ ~ ~~C ~. Phone: ~ ~ ~ ~ Phone: ~/~ No. of bedrooms Mailing Address: 2. Property Owner: Mailing Address: 3. Legal Description: 4. Location: 5. Type of facility to be inspected Well Data: A. Type ~. -~-~ B. Depth C. Constructionf,~_.x'~_~_-~--~/x~.z/~ D. Bacterial Analysis Sewage Disposal System: A. Installed C. Septic Tank: 1. Size D. Seepage Pit: E. Disposal Field: B. Installer / ,5",~ oy, 2. Manufacturer 1. Absorption Area~V.~SL(o 2. Material Total length of lines 8. Distances: A. Well to: Septic tank 7~! , Absorption area Nearest lot line/'~ //~ , Other contamination z/'~,/~/~,/.~ B. Foundation to septic tank ~ , Absorption area C. Absorption area to nearest lot line ~ ~'-' EQ-034 (1/74) Page 1 of two pages Page 2 of two p.a. ges - Re~c"~t for Approval of Individual ~r & Water Facilities L'egal Description Comments Approved ~ ~-/¢-'~_.../"__._,..,~. Disapproved Date Approval.Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM ) certify that the information contained in this request for approval to be a true and ccurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (7/74) REQDEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Tmiplicate) .of person mequesting approval ~ ~ Number.~o~, ~edrooms in house d~~-- Watem Analysis: Well data: a0 b. C, d. Type ! . Distance from well to closest existing om proposee: 1. Sewe 1~ line 2. Septic tank 3. Seepage Area C~sspool' 5. Property Line Other sources of Possible contamination, i.e., creeks, lakes, houses, barn, d~ainage ditch, etc. Sewage disposal system. a. Age of system ~)/W~ ._. b. Septic tank capacity in gallons c. Name of septic tank manufact~m~.m 1. If "home made" show diagram on revemse Side of this foPm. Disposal field op seepage pit size and type ~p~ ~t~ 1. Distance to p~operty line to house foundation Percolatlonx Te'st 'Y'esults f. Percolation Test performed by Diagram should include Use the reverse-side of this form to show diagram. -the following information: ~operty lines;.wetl location, house location, ~ptic tank location, disposal area location, location of percolation test, a~ direction of ground slope. The i~£or~tion on this form is true and correct to the best of my knowledge. Date Signed' Signature of Applicant TO BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL ~'T[e above described sanitary facilities are hereby approved, subject to the i°llow~ng conair'tons: Conditions :__ ~<) ~- ~_ 7 The above described sanitary facilities are dissoproved for the following reasons: ~ · Signath~% of ~f~i~.i%~ ........ =." ":, ~'' ~ i ' Date ~,' Approval is valid rom one yeam following the date of approval. CPJ: cw VETERAN'S ADM INIST~qATION The following statement of account is for your information m connection with the sale of your property. 1o DAT. E OF STATEMENT 2~=~,UNPAiD PRINCl~A~ BALAN 4. INTEREgT ACCRUED THROUGH(~te ~llo~ In Jtem]] 5, BALANCE IN TAX AND INSURANCE ACCOUNT 6, DELINQUENT pAYMENTS (If =ny) 7,AMOUNT ~8, ~y INTEREST RATE 9. INFORMATION ON PAYMENTS AND INSURAN~[ kMOUNT OF MONTHLY PRINCIPAL AND INTEREST $ Y~* ~ ~ iNSTALlMENT APPLIEDTf TAX AND INSURANCE ACCOUNT $ ~. O~ ~ ~e~~7 ' AMOUNT OF COVERAGE ~ HAZARD AMOUNT OF PREMIUMS S -~ INSURANCE TERMS ~EXPIRATION DATE OF POLICY y~ Upon completion of the sale of your home, please send us the information or documents checked below so that we may adjust our records. Instrument of conveyance showing recording information. Evidence showing hazard insurance transferred to the new owner. Your authorization for transferring funds in the tax and insurance account to the new owner. COO ;, FL 26-580 FEb 1972(RS) Show veteran's ~#1I name, FA file numbez, and social s~curity number on all correspondence. If any payments are received or disbursements raade for taxes, insurance, etc., after the date of this statement or if any checks for payments heretofore credited to the account become uncollectable, an adjustment will b~ necessary in the tota. 1 a~nount owed, It is important that you kccp the Veterans Administration informed of your current address as you al'c liable for this loan until it is repaid in full. FL 26"580 FEB 1972(R$) enu e.~,~, qqOg i ~?