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Home My WebLink AboutNORTH SLOPE BLK 1 LT 1 , ,' MUNICIPALITY OF ANCHORAGE ~ ~ , DEPARTMENT OF HEALTH AND HUMAN SERVICES , Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Nar. e DISTANCES % ~ %~\0"-~ SEPTIC ABSORPTION ~ ~ Permit NO. NO. of rooms Township, Range. Section AS-BUILT DIAGRAM (Show location of weft, septic system, prope~y lines, ioundation, ~t~~ ~ ~l¢~ ,~~ ddveway, water bodies, etc.) TANKS ~ SEPTIC 0 HOLDING Material No. of Compa~ments TYPE OF SYSTEM ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER Depth to pipe bottom from ~ Total depth from odginal grade original grade ~ FI 2 ,~ I FI Gravel width FI FT Totalabsorptionarea~ S~ FI Distance bet .... lines ~/~ Installer Date Installed WELLS ~ PRIVATE ~ OTHER (Identifv) Classification (A.B,C) Total Depth ET Cased to mnstaUer Date Instamled: REMARKS: 72-013 December 13, 1990 ROBERTSHAFER, P.E. ROGERSHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AuTHoRITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ~,~ ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SiTE WASTEWATER DISPOSAL SYSTEM DESIGN work 6ho~ be completed by Summer 1991. ~JS/gm cc: Jim Tin, us Mu~pa~it~ of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: 'Lot ~ Block Ii North Slop~ Su6~v~ionl Scp~c P~it A~ch~d ~ a copy o{ th~ on-~ ~p~c i~p~on r~port {or th~ ~p~c upgrad~ r~c~ i~d on th~ r~{~nc~ prop~ty. Th~ ~p~C ~nh ~ approx~ 1.5 - 2.0 {t. o{ ~v~. ~ to th~ {ro~t d~pth th~ ~ a ~tron~ po~ib~ o~ d~agin~ th~ ~p~c ~nh i{ o~i~ 4~p~c i~p~on r~po~ u~ th~ ~nh i~ ~po~d ~ i~grity and ~th~ i~u~d or ~v~d with 4 {t. o{ {i~. T~ 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 James R. Tinius HC 83 Box 217C Eagle River, AK. 99577 February 24, 1993 Municipality of Anchorage Department of Health and Human Services 825 L Street P.O. Box 196650 Anchorage, AK. 99519-6650 Attn: Mr John Smith, P.E. Program Manager On Site Services RECEIVED FEB 6 199 Municipality of Anchorage Dept. Health & Human Service~ Re: Septic Permit # 900377 Dear Mr. Smith A new leach field was install on our property, Lt 1 Blk 1, North Slope Subdivision, in December 1990, designed by S & S Engineer- ing and installed by South Fork Construction. The septic tank was not inspected and insulated until June 1991. We have notified S & S Engineering numerous times, and we have never received the final inspection approval report. They in- formed us that you had lost the papers they forwarded to you, and that they would resubmit them. On another occasion they informed us that a 2nd set was submitted to you and they would notify us as soon as they received them from you. We have not heard from them, we inquired in July or August, S & S said they did not know why they had received them from you and for us to contact you directly. We are looking forward for a prompt reply from you. S~cerely, cc: S & S Engineering Robert A. Shafer, P.E. Attachment: Ltr from S & S Engineering Dated Dec. 13, 1990 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST ROAD OESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694-2979 15, 1990 FAX 694-1211 MUNICIPALITY OF ANCHOEAGE DEPT, OF HEALTH & ENVIRONMFNTAL PROTECTION Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 1 4 1990 RECEIVED REFERENCE: Lot I; Block I; North Slope Su§division; Septic Permit #900377 Attached is a copy of the on-site septic inspection report for the septic upgrade recently installed on the referenced property. The septic tank has approximately 1.5 - 2.0 ft. of cover. Due to the frost depth there is a strong possiblity of damaging the septic tank if it were uncovered to verify integrity at this time. We are holding the original septic inspection report until the tank is exposed to v~rify integrity and either insulated or covered with 4 ft. of fill. This work sho~ be completed by Summer 1991. J / ,J~YBERT A. SflAFER, P.E. ~JS/gm Jim Tinius 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 I~lOIJO3/O~d 'IVIN=It~NO~IAN~1 -'~ It.L-W:IH -IO 3~VO~ / / Tom Fink, Mayor Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519~6650 January 10, 1991 Jim Tinios HC 83 Box 217C Eagle River, Alaska 99577 Subject: Lot 1 Block 1 North Slope Subdivision Permit #900377, PID #050-511-28 The subject permit, issued by this office for a single family well and/or on-site wastewater system has expired as of December 31, 1990. A new permit must be obtained 'from this office for a well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built inspection report (three-part form) must be sent to this office for review, approval and documentation. All .inspection reports must be submitted within 30 days or'construction completion. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sir er ly, J~n Smith/~/P.EXV~k3 P~ogram Ms~hager On-site Services JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" Tom Fink, Mayor unicipality of Anchor ¢ Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 November 28, 1990 Robert Ao Shafer, P.Eo S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Lot 1 Block 1 North Slope Subdivision Dear Mro Shafer: This will respond to your letter dated November 26, 1990 requesting that you be permitted to verify the accepting soil of the proposed wide drainfield during the construction phase. As you are aware, the two soil test sites were located such that the extremities (12 to 15 feet) of the proposed absorption system fell outside of the mandated 30 foot radius of influence. According ~to the soil test logs dated November 17, 1990, the depth to groundwater decreases towards the southeast portion of the proposed drainfieldo There must be a soils test hole with a groundwater monitoring tube installed near the southeastern extremity of the proposed wide drainfield with monitoring continued until stabilization occurs. The groundwater will be considered to be stabilized after three consecutive 24 hour monitorings show no change in the depth to groundwater. If there are further questions, please call our office at 343-4744 o Jdh¢ Smith, · P-r~gram Manager, On-site Services RWR:ljm:301 November 26, 1990 ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE .PLANS ROAD DESIGN SOILTEST Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ATTN: Robbie Robinson 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot I; Block I; North Slope Subdivision; Dear Mr. Robinson, In reference to the location of the soil test performed for the design of the septic system upgrade on the referenced property, we offer the following justification. Over the years we have performed numerous soil tests within the North Slope Subdivision. We have found the soils to be relatively consistant throughout. B. The two soil tests which were performed showed relatively consistant results. The ~isting design will require each section of the trench to extend approximately 10' beyond the specified radius in the current ordinance. Up until recently the location of these test holes would have been more than adequate for the design of thi~ system. Based upon our ~xperience with the soils in this Subdivision, we feel that adequate verification of design can be accompl~hed during construction. Request that you allow us to verify the soils on each end of the proposed trench during the construction phase, with verification submitted along with as-built drawings. PERCOLATION Sincerely, TEST /~ STRUCTURAL& A. SHAFER, P.E. MECHANICAL INSPECTIONS 'gm ON SIIE DISPOSAL SYSTEM DESIGN If you require any further information please contact us. MUNICIPALITY OF DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 19°,90 RECEIVED 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P,E, ROGER SHAFER November 23, 1990 CIVIL ENGINEERS (907) 694-2979 FAX 694o1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ATTN: Robbie Robinson 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 MUNICIPALITY OF ANCHo~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION NOV 2 6 RECEIVED REFERENCE: Lot I; Block I; North Slope Subdivision; Dear Robbie, On November 21, 1990 you t~ephonically informed us the septic upgrade permit we have requested on the referenced property could not be issued because the design did not comply with AMC 15.65.060EI. This states that "single segments of subsurface disposal fields must not exceed 100 ft. in length." As can be seen from our design, the total proposed trench length is 113 ft. However, we propose to "tie into drainfield such that no one run exceeds I00 ft." In the past we have used thi~ method of connecting into drainfield trenches to better dose the drainfield and to comply with maximu~ trench length restrictions. If connecting into this drainfield where proposed, does not act to create two segments out of the one trench, then the proposed design does not meet AMC 15.65.060EI as you have informed us. Therefore, we ask that you waive the 100 ft. maximum trench length requirements by exercising the authority granted to you under AMC 15.65.030H. For the following two reasons we feel the proposed system will function as ~,f,~ectively as a system that conforms to the ordinance: One way to achieve conformity is to tee into the trench with a 10 ft. space separating two trenches. Th~ would create two separate trenches each less than 100 ft. in length. However, this would also create a total pipe length of 123 ft. as opposed to 113 ft. as originally designed. The lengthening of the overall pipe length by creating two trenches seems to oppose the intent of the ordinance. We could place two drainfi~Ids side by side, however, due to the 8% slope, the drainfields would need to be stepped with a spill-over connecting the two trenches. This spill-over would decrease the ability to evenly dose the entire drainfield. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Page Two Lot I; Block I; North Slope Subdivision; November 23, 1990 If you have any questions or comments, please contact us. ///go~?r ~. s~, P.~. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: '~-.~'~ [ ~:)L.~¢,~-. ~, J~O,'~D~'_ Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ¢/ L DEPTH? j~ pO E Depth to Water A~e.~ ~ ~ Monitoring? ~. ,~ gate: '~\"i(." "cFc' Gross Net Depth to Net Reading Date Time Time Water Drop '~ ,4o - ~o ,~ (," ~ PERCOLATION RATE '[~' (minutes/inch) PERC HOLE DIAMETER 1 2 3 4 5 6 7 8 9 10 11 12 13- 14- 15 16 17 18 19 2O TEST RUNBETWEEN ~--~TAND ~ FT COMMENTS & $ ENGINEERING PERFORMED B~ CERTIFY THAT TH~ T 8 72-008 (Rev. 4/85) ~T PERFORMED IN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 10- 11 12 13 14 15 16 17 18 19 20- ~~AL) 1 DAT~~F Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ,~ ~--'~'~ ENCOUNTERED? IF YES, AT WHAT [ OL DEPTH? I~ P~ Depth to Water Alter Monitoring? L~,~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ ~ (minutes/inch) PERC HOLE DIAMETER · TEST RUN BETWEEN ~'' FT AND ~ FT COMMENTS ~ ACCORDANCE WITH ALL STATE AN~MONICIPAL GUIDELIN~ IN ~FFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ~ / / PERFORMED IN November 19, 1990 ROBERTSHAFER, P.E. ROGERSHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot I; Block I; North Slope Subdivision PERMIT REQUEST NARRATIFE Request you issue a p~rmit to upgrade the septic system on the referenced property. Due to the large lot size and existing w~l and septic locations in the immeditae area of the referenced property, we cannot forsee any "probable" impacts to adjacent property as a result of the proposed septic system. We feel the proposed septic upgrade design is the best for this property and will impact adjacent properties the least, because of the following reasons: I. The proposed location of the septic system is over 100' away from the closest septic system and will not effect any of the n~ighboring reserve areas. 2. Length of the proposed drainfield follows the contour of the slope which exists. If we may be of further service, please contact us. PERCOLATION TEST A. SHAFER, P.E. STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE GREk~,'ER ANCHORAGE AREA BOEx.'JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska ggs03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL [ INSIDE LENGTH MANUFACTURER ~r, ,~2_~:~~ MATERIAL NUMBER OF COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY//*¢0~ GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL /~'~/ FOUNDATION /'~ / NUMBER OF LINES ~ DISTANCE BETWEEN LINES ABSORPTION AREA '-~-'~'-- SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE~ ~ / MATERIAL BENEATH TILE TOTAL LENGTH NEAREST LOT LINE ~'~'~J OF LINES ~-~--? / ~--'"'---' TRENCH WlDTH~ IN. TOTAL EFFECTIVE IN. ABOVE TILE ~//~ ~ IN. WELL: TYPE__ CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION LOT LINE_ SEWER LINE SEPTIC, TANK CESSPOOL OTHER SOURCES . APPROVED DISAPPROVED REMARKS DEPTH SEEPAGE SYSTEM DISTANCE FROM: DISTANCES: //~ '~) = J~O¢;~ / c_ ~.- /~O/ INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: Form ECQ-O$2 DIAG RA~O~SYSTEM ___. _¢-,. ,__ __ '~ DATE')""'--~}--77APPROVE~~_-,'-4~C~____~._G.A.A.B. · OWNER OF ADDRESS LEGAL DESCRIPTION DATE- Started ~ t,~ PERMIT NUMBER ~ ~ ~ B'I;.ON,V~NL,~j. A & L DRILLING COMPANY DEPTH OF WELL STATIC LEVEL OF WATER FT. d~/-,/c' / /'llo~/h'/->t..&-z,~'/0 DRAWDOWNFT. Ended ~,,t'~' '~,~_'~"~ '~?'~/ GALS. PER HR / KIND OF CASING KIND OF FORMATION: From O Ft. to // From I ] Ft. to ,~ ~ From _z-,:) Ft. to _~'q'- ,'-'Z" (:,c) Ft. From -~.'~ Ft. to From Ft. to Ft From Ft. to_ ---< Ft.. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft._ From Ft. to.__.Ft. _ From Ft. to___.Ft._ From Ft. to. Ft. From Ft. to. .Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From From From From From From___ From From From-- From From From Ft. to-- Ft. to Ft. to Ft. to FI to- _ Ft. to Ft. to __Ft. to __Ft. th Ft. tO Ft. to Ft..to Ft. to Ft. to Ft. to __Ft. to Ft. to Ft. Ft. Ft. Ft Ft. Ft. Ft. Ft. "· Ff. Ft. Ft Ft . Ft Ft Ft. Ft. Ft MISCL. INFORMATION: DRILLER'S NAME : ~{:; /,' '~ ,! ..... ~> ' RF'F'L I CRNT L 0 C: FI T I 0 N LEGAL. · ]'I-:tMES T I I',1 ].' .1~:; F'~UDHOE E:RY FIVE L.:L L,.L NOF.':TH :E;I. J3F'E LOT SIZE TYF'E OF SOIL. FtE':J~FIF.'E:TIEIN =,~:,TEH I:.:.;: TRENCH P'IRNIHI.JH NL.IHEiEI:;.: OF E:EE:,I:;.:OOH'='; =-" THE REQUIRED SIZE OF ]"HE: SGIL. REiSOF.:F"T'ION S'-t:DTEH IS: THE LENG"FH [:,IHEN'J~ION IS THE L. ENGTH ,.'.'IN FEET'.'.', OF' THE TRENCFI OF~: [)RR:[NFIEL..D. THE C, EPI"H OF' R TF..'ENCN OR PIT I£5 THE C,I.STRNCE E;ETHEEN THE SLIF:F'RCE OF' THE GROUND RND THE BOI"TOH OF:' THE EXCRVRTION ,.'.'IN FEET.':,. THERE IS NO '=;ET klIDTH FOR TRENCHES. THE GRRVEL E.',EP"f'H ):S THE HINIMUH DEPTFI OF GRRVEL. E:ETI.qEEN THE OUTF'AL..L. F'ZPE RND THE E:OTTOP1 OF THE EXCR',,,'R'rZON ,:::[1'.,! FEET). ; BRCI.,:.'FILLING OF F:INY SYSTEM HITHOLIT FINRL INSF'ECTIGN RND RPPRO'v;RL BY THIS DEF'FIRTHENT HILL. BE LT, LIB3ECT TO PROSECUTION. HINIHUM DISTRNCE BETHEEN R HELL RN[:, ANY ON-SITE SEHRGE DISPOSFIL '=;'.?STEM IE; d.¢8 FEE]" FOR R PRIVRTE HELL OR 288 FEET FOr4: R F'LIE:LIC HELL. HELl,.. LOG2; RRE RE6gJIRE[:, RND MUST BE RETURNE:[:, TO THE [:,EPFIRTHENT klITHIN 3:E~ [:,FlY[E; OF' TF1E HEL. L COHPLE:TION. SPEE:IFICRTIONS FINE:, I])ON~;TRUCTION DIRGRRMS RRE R'v'AIL. RE:LE T[) INSURE I::'ROF'ER I NSTFtLI_RT t ON. I CERTIF'T' TNR'F t: I FIPI FFIHII....IRF:'. HITH "FHE REQUIREI"'IENT'.5 FOR ON-'SITE SEHERS RND FiELL.S RS SET FORTH BY THE MUNICIF'FtL. ITY OF RNCHORRGE. 2: I HILL INSTRL.L TNE SYSTEM IN RCCORDRNCE HITH TNE CODES. 2:: I UNDERSTRND TFIRT THE ON-SITE :E:EI.4ER SYSTEM MRY RE~21.JIF:E ENL. I::IRGEMENT ZF:' "I"I'4E: F;:E'=;I[:,ENCE IS REMODEL. ED ]"O INCLUDE MORE THAN 3: BEDROOHS. ~; Z GNEC,: ....~~~~ ..................... 'PLICRNT .:rRrlE:; TINILtS Russell Oyster 694-2774 Soils 8' Foundations Performed Lega1 Description: Depth (feet) E GEOi2CHNICAL 8- DEVEL~,?MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Name E~rl Ellis Land Development 15 16 Yes No Ground Water Encountered Proposed )nsta]lation: ~ Comments: Performed by:~ '~'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 April GENERAL INFORMATION (a) (b) (c) 1986 Legal Description (include lot, block, subdivision, section, township, range) Lot 1; Block 1; North Slope Subdivision~l Location' (address or directions) Mile 10~, Eagle'River Road - left on Prudoe Bay Applicant Name Blanche Tinius Telephone: Home 694-2318 Applicant Address SR Box 217C, Eaqle Riverr Alaska 99577 Applicant is (check one)i Lending Institution []; Owner/builder ~:; Buyer []; Other [] (explain); Business 271-5178 or 258-1071 (d) Lending Institution First Interstate Bank Telephone Address Anchoraqe, Alaska (e) Real Estate Company and Agent none/refinancing Address (f) Telephone ~tC~e HAA to the following address: S & S Engineering SRB 196X Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family IXI Multi-Family [] Number of Bedrooms 3. Other WATER SUPPLY Individual Well [] Community-il Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: if corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and s[btus. 72~025 (11/84) Page I of 2 EI~GINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certified by rny 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 ,S & S Engineering Address SRB ~Cx, Date En~le ~tver, AlasKa Telephone DHEp Ap pR O V~ ~(~" '~.,/) ~ ~[~ /¢ A p p rov ed f o r~//~?~-.¢,'~ bedrooms b~/~..'~ Approved //~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchora~8.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. Page 2 of 2 72-o25 (1 ENVIP. OtqM~NTAL pROTECrIOI'4 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) ,~,P~ CHECKLIST- FEBRUARY 1984 Legal Description: ~, , WELL DATA Well Classification Well Log Present~_.Y~,b~ Total Depth /~/'/~¢ ~/ Cased to Static Water Level. .~,~ ! Casing Height Above Ground /2 /~/'- Electrical Wiring in Conduit~;/,N~ If A, B, C, D.E.C. Approved (Y/N) Date Completed '4¢'~/~) ~ ¢7 Yield Depth of Grouting Pump Set At ~-'//¢" Sanitary Seal on Casing ~¢~'.z.N'~ Depression Around Wellhead,('%¢~) Separation Distances from Well: To Septic/Holding Tank on Lot', z/Co ~ ,z~ ; On Adjoining Lots To Nearest Edge of Absorption Field on/L/et ?D,:D z ,' ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer C eanout/Manho b Water Sample Collected I~y Water Sample Test Results /~0 ~ To Nearest Sewer Service Line on Lot ¢.~O t,~L ,~ ~/ .~ ~,A//~/A/'~//',~ ; Date ~ ~ ~ ~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed Stand pil)es ~(~4k~ Depression over Tank Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water MraiR/Service Line Size /¢Oo No. of Compartments Air-tight Caps~,'/~ Foundation Cleanout JCY~ ,~///D~ate Last Pumped ; for Temporary Holding Tank Permit (Y/N) Course To Building Foundation To Disposal Field /O/ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11t84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~Q [ '~- To Building Foundation Lot To Water M2~i,~/Service Line '~/Q · ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present.~ Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots "~"'~/ To Cutbank (if present) Comments 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 HAA guidelines in effect on the date of this inspection. Signed Company Receipt No. Amount: $ MOA No. ~'"~'-~ ~--~ Page 2 of 2 72-026 (11/84)