HomeMy WebLinkAboutPROSPECT HEIGHTS #1 BLK 2 LT 21MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion?  Yes  No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. 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 NAME.j~,-,~ ~,']~OL-'~ ~X~V~IL~G ~ -- PHONE J ~NEW LEGAL DESCRIPTION LOCATION Well Absorption area Dwelling PERMIT NO. N ~ Manufacturer Liq. c~pa~y~ gallons IF HOMEMADE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer · -- ~ Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO. ~ ~ DISTANCE TO: --~ ~ ~ No. of lines/ Length of~each~ line Total length~o~ [ines~ Trench ~ inches Distance between~/~lines ~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area ~ Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter ~ ~ Crib depth Total effective absorption area ~ DISTANCE TO: Well Building foundation Nearest lot line ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS · ~ C5 p~ ~e APPROCED DATE LEGAL Box 1369~ ~ITAR Ro~"r~ A ANCHORAGE~ ALASKA 99502 3 20 ~D( INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DFIILLED AT THE RATE OF $2.0.00 PER FOOT. PROPERTY OWNER ~7 o~ b~ ~, ~ LOCATION OF WELL SITi~ DRILLER ,,, Be/'ul/~ WELL LOG':~ .. 42---320t Be.d~c£. ~ .o~.~ ,~ock,. A,~,o~ o,~ ?o~ou, o zcz,.t~J, p,,~odu, cJ~¢ '. 2.83--286' ?o-t.ou~ ,'t.ock, .oh. o0JZn.¢ 7/2 ~P/~o . ~ 315-,318~ ,%,~ou.~ ar~ ¢.tan. wLw't. ,'cock. p,*_o~q. 1 1/2 ~. 1/2 ,f.o 3 co~P/// wZ.f.h, 275 ,Z.e.~ o~. za~e,~ ,~,tand.,b~ ,tn. ' c,~.b~: 1o6 ~ pe..~ ~oo,5, 440 ~ o,¢.and~¢, Ocm.,, 4000 ~ a~vaZA, aJz,/.¢ 2.4 h, ou,,, ~ ./.,taSmo Orm . floozie 5u,~e.,~g.b.Le ?u~p. ,~Aou,,~ zac ,bv~ed 15 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF THANK YOU VERY MUCH. DAT~.' ' BERNIE CLAUS OF yAMPART/DRILLING WORKs ' · ERVICE CHARGEOF Iv.q/, Pg:n MOhrl'H WILL BE Aggl='~,~eD ON I~A~,T ~U~AC~I~OUN~ ~" : [.,r:F"-"- 'HR] .... MEN '-"' HERL'rH RND ENVIF.:ONMEN'TF!L ::OTECTION. .... :._ --'l. ': TF.,~'FT., RNCHORFfEiE., FfK. 264-472F1 ':' ,:,i~l,_-,i,-' ', F!F'PL I CFtNT ~~OC:R'r I Z f-., L. EGRL NEI.,-.T 3N EXCRYFIT ING .=,LP. LUI'1 DR L2::L 6'2 F'ROSF'EC.T HEIGHTS F;:::'x!:7 E. 22i",I[:, FIVE L.O T S i Z E ':.':"~:'::':-- ? f=i¢-] :'/0Z~OE0 Sg!Lhq. RE FEE]' TYPE iF SOIL FiBSORPT:(CLN '?'?STEM IS: TRENCH MR>.','iPI~M N P'EER OF BEE:,R'Z 3t',1S = ,4 SOIL F.'RT'rN3 ,'SQ FT',--'BE":,= THE REC!UIRED SIZE FiF THE SOIL RE:SORPTION SYSTEM iS: THE LENGTH DIMENSION IS 'THE LENGTH (iN F'EET) OF THE TRENCH OR DRRINFr!EL.D. THE DEPTH OF R TRENCH OR PIT IS 'THE DISTRNCE BE'T'WEEN THE SURF'RCE OF THE GROUND RND 'THE BOTTOM OF' THE EXCR",,'RTION (IN FEET). TFiERE iS- NO "-:;ET FIIDTH FOR TF.:ENCHES. THE GRRVEL DEF'TH IS ]'HE MINIMUH DEPTH OF GRR',/EL. BETWEEN THE OU'T.'FFIL. L PiPE RND THE BOTTOM OF -/'HE: EXCR',,,'RTION (IN FEET)· HE...MIt FIPPLi"R~''r. , HR':;.._ 'rwF`-,,._ RESF'ONSIE:I'L_.?T-r"' 'TO INFOFd',t THiS [:,EPRF..:TM[:I'.,!T DI_IRING THE: I J':-l]"=l~ -'T ' _ _ · t'_ . ~LH. I_lq I.NSF'E['TIqi'.$'q CF-- Fll",!"r' ,WELLS RE:'.J'RCENT TZ T.UiS PF:CF'EF'TY FII'.,tD THE i'.41_IMFEE' .... OF F..b.-:,,F..',ENCES THF!T THE [,-!El_I_ kIILL _,bF.,,c'-, E.' E:FIC?:F!LL. ING OF RNY ............... ':'-nZ'TF~ t,JJ"T'~-I'~ T FINFIL INSPECTION RN[:, Hr-FR_I,H_-~ ' 'F'" i E:Y THIS ~'CPFtR ~ F J ' C~[,'-.T,'L.N] P.,..LL. BE SUBJECT TO F'ROSE':_TZON. MINIMUM D!STFINCE BE'T.'P~EEN R i4EL. L FiND RNY ON-SITE SEI,.IRGE DISPOSRL. S:;'¢STEM IS '1_0E; FEET FOR R F'RIVRTE .WE:LL OR ±50 TO 2,'.3E.~ FEET FROM R PUBLIC 14ELL I}EPENDING L!PON -/'HE T'¢F'E OF PUE:L!C NELL. MINIMUM DISTRNCE FROM R PRI'¢RTE ,WELL '1"0 R PRI',/RTE SEF.!ER LINE IS; 25 FEET RND TO R COMMUNITY :SE.WER LINE IS 75 FEET. OTHEF.: REE!U!REi"IE!',,~TS MRY RPPLY. E;PEC!FICR'f'IONS R.ND CONSTRUCTION E:,IRGRRMS RRE R","RIL. RBLE TO INSURE PROPER INSTF!LLR]"ION. I CERTIFY 'THRT :!.: I RM FFIMILIFIR .WITH THE RE~]QUIREMEN'TS FOR ON-SITE SEWERS RND I.,.IELLS RS SET FORTH BY THE MUNICIPFILITY OF RN. CHORRGE. 2: I I,.!IL.L. INSTFILL THE SYSTEM IN RCC:ORDRNCE !.,~ITH T!iE CODES. ~: I UNDERSTRND THRT THE ON-SITE E;Eb.!ER SYSTEM .MRY RE[.]UIRE ENLRRGEMENT IF' ]"HE RESIDENCE iS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG-- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST "ERFORMED FOR: LEGAL ~ESCR,PT,O,~: --/" '('-Z/ d/O~-L z 6 7 8 9 10 ~--11 12 13 14, 15 16 17 18 19 20- SLOPE SITE PLAN ?--,/1 PERFORMED BY: WAS GROUND WATERj~ S ENCOUNTERED? · ~/O' L ? E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: (minutes/inch) FT AND ~ FT .:::.._// 72-008 (6/79) MUNICIPALITY OF ANCHORAGE It -4 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-091 1. GENERAL INFORMATION Expiration Date: /— /,P--zo ZZ Complete legal description PROSPECT HEIGHTS #1 BLOCK 2, LOT 21 Location (site address) 9301 SLALOM DRIVE, ANCHORAGE AK 99507 Current property owner(s) JOANNA MENAKER REVOCABLE TRUST... Day phone Mailing address Real estate agent 9301 SLALOM DRIVE, ANCHORAGE AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ _6.6_0 Date of Payment Z:ey Receipt Number .3/1()72- COSA # DsCZ 11587 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. 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 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 9/30/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the "vq well and septic system. Therefore, any estimate of how long a system will function satisfactory r�g.�Q: • • • • • !f9 �� for current or future occupants or guarantee that no unseen encroachments, deficiencies or �* •' _•* �J discrepancies exist can be given by First Water Consulting & FWr 9 TM — .. ...... 6. DSD SIGNATURE • Curtis Huffman j System #1 Approved for bedrooms �� Vs•• CE 128991 System #2 Approved for bedrooms ��i1;F�PROFESSONt`���� Disapproved Conditional approval for bedrooms, with the following stipulatio �TYt OF4rr����i WATER AN m� J � AST_V.1ATER z ; J 1 :: 00. J�>��NT SERVI��S,��• Original Certificate Date: 9? -2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory � Other Legal Description: PROSPECT HEIGHTS #1 BLOCK 2 LOT 21 Parcel ID: 015-091-24 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 5/10/1981 Total depth 320 ft Cased to 320 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 8/6/2021 Static water level at beginning of test 140 ft. Well production at time of test 0.65 gpm Comments B. TANK DATA Age of tank(s) 14 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 50" ® Standpipes/foundation cleanout per record drawing Date of pumping 8/5/2021 D. ABSORPTION FIELD DATA Structure served by this system _ Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by FWN Date of Sample 9/23/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Which system tested (date installed) 11/16/2007 Adequacy test date 8/6/2021 ® ALL standpipes present per record drawing Results M Pass For 4 bedrooms Total measured depth from grade 16.8 ft (max) Fluid depth prior to test 29 in Measured depth to pipe invert from grade 13.9 ft (min) Water added 600 gal ❑ N/A — pressurized field New depth 35 in (AT INVERT) ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 1420 min depth into effective 2.9' OF THE 4' ED ® Code -required soil cover over field Final fluid depth 28 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: 2007 FIELD OPERATING AT TOP PORTION OF 4' ED. RECOMMEND SWITCHING DIVERTER TO ORIGINAL FIELD WHICH MT WAS DRY AT TESTING NE E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 1.0' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Aaw .. ......... f Curtis Huffman �� �'c�b� •. CE 128991 .• i�`4� coils/�1 • \\U A -W PR©FESSOkl' ft ft ft ft ft ft ft ft Municipality of Anchorage A Development Services Department Building Safety Division a ...CrA'F -Y On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage. ak. us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC211587 During a recent COSA on-site inspection and test of the potable water supply well on Block 2, Lot 21 of Prospect Heights #1 subdivision, the well's productivity was detennined to be .65 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is .41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 1dNOISS3�p�d�O1 izoZ/st/ot r 0� Zi86-s1 • N �y // �018 Ism i tj A O IG@A UI GIDDS 0 09 02 0 •aull aqua; jo ,Oepunoq a 6ulgsllgelsa jo; jo uoporulsuoo jo; pasn aq luawnoop slgl pinogs soouelswnoilo ou japun "geld pooai agl uo ieadde ou op golgm uolloulM Jo 'slueuanoo 'sluawasea Aue;o a:)ualslxa agl aulwjalap of jauMo aql;o Allllglsuodsal agl sl ll 'leanaJ hew AoAjns Aiepunoq luanbasgns a legl saloeimoew Aue of loafgns sl pue AGAMS tiepunoq a alnlllsuoo lou saop luawnoop slgl • (anms aql;o awll agl le suo!l!puoo pue sluawanoidwi alglsln sluesajdai /amns egl'spiepuelS uolleool @WPON SIdSV eq) qi!m salldwoo Awuns s!gl'l vz 6107 / 6q YICU � ���qs • / afeae0 ae0 Z pa�loeldb WMA m��� aoo�ti�� / asnoH auleaf pooh tiolS �c�,�'�, anuo cuole/S G0C6 ��,' o 'fid' / /+ saaod OZ Z �`� / k 'ON -uppV uols►nlpgnS s4u6laH loadsoad ams / Z X10019 `G Z 407 CdAl) CP. / 06, i OC7 107 a3HS Z 9 O3HSS 9 S s JaLulopsi(7 •��p�sla 2uPoDab a2eao43uV'£Z-L9 'ON jeld uo paseq si juawnoop sigl •Aluo'ssoiD Aespull aoj Aanans;llnq-se ue jo asod.lnd aq; ao} sAananS jailuo.y Aq paleaj:) si luawn:)op slgl -:UT-0 snuiw/snld ace scull Aliadoid o} suolsuaw14 •Aanans slgl 2upeda.ld jo Iso aqj paa:)xa jou llegs Aanans slq} aoj AIlllgell a4va:)ua2112au ssoa2 col 2uljdaox3 ZZ 107 a, w o s \ 9 a�tl 4 y5 \ a apr. 4� IJanlnD jegab punoj 0 a}aa:)uoD 0 DdApunoj T IIaM J@Ie/N (M11 oi}d@S $; .Z N°aa ® lelsapad •:)a13 V37 v Ja}aW seg 'e' lelsapad •lal Vl7 v .Z a10d auogdalal c0'aaIalnl :)ul:)913 saJON IaaauaD puaba7 \ .09 = ..Z ale:)S Y N 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) B2 1_21 7'/;zA/ 5 c, 1_3 Location (address or directions) ¢3oi (b) Applicant Name ~5-'7'~/~ ,~I Applicant Address (c) Telephone:Home -,~ 4/'~ '"/4¢ 4~ f'// Business Applicant is (Check one): Lending Institution []; Owner/builder [~; Buyer []; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-FamilyJ~ 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. SEWAGE DISPOSAL Onsite C~' 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 I of 2 72-025 (11/84) ,5. EN'GINEERING FIRM PROVIDII~G 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 ~ ~...(--), i/Vt; Telephone Address /~ ~ ~.~~[J~ ~ ~ ~ / DHEP APPROVAL Approved fbi' Approved , Terms of Conditio'nal App'roval bedroomsby ~'~/ ~/ Date /'~--,.~O--<:~' Disapproved Conditional 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 DNEP 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) ,.\~'~ d<G¢v~ ,.~G~ i HEALTH AUTHORITY APPROVAL (HAA) ~ .~ ~.~ ~ CHECKLIS~.F~UARY 1984 WELL DATA Well Log Present ~N) ~ Date Completed ~ ~//O/~/ Yield Total Depth ~O ~ Cased tb ~O ~ Static Water Level ~ ~ Casing Height Above Ground /,~ / Electrical Wiring in Conduit ~N) Separation Distances from Well: To Septic/Holding Tank on Lot ~ ~ ~ To Nearest Edge of Absorption Fiel~ on Lot /~/ ; On Adjoining Lots To Nearest P~blic Sewer Line ~ To Nearest Public Sewer Cleanout/Manhole ~/~ To Nearest Sewer Service Line on Lot ,37 Depth of Grouting /V//'~ Pump set At Sanitary Seal on Casing CN) Depression Around Wellhead (Y/i~ ; On Adjoining Lots / 00/ B. SEPTIC/HOLDING TANK DATA Date Installed . ~/L~/¢ [ Standpipes (~/N) Depression over Tank (Y~) 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 Main/Service Line Course ~00 Siz~ Air-tight CapsON) No. of Compartments ~"' Foundation Cleanout CN) Date Last Pumped [ ,~/~P~' ]1/'//~ ;for /~//~ Temporary Holding Tank Permit (Y/N) /V'/'/) -- / To Building Foundation To Disposal Field _ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata, Date Installed '~¢//7z/o62/ 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 ~t'¢0 / To Building Foundation ~ ~-~ / Lot / To Water Main/Service Line 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 /4// / Gravel Bed Thickness ~ / Standpipes Present ~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots .~O ./.. To Cutbank (if present) /00 25/./-. Comments LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at .. ~'~_ '"-':"P;n~'p ~ High Water Alarm Level at ~/U ~ent (Y/N) /_.~-~ Pumping Cycles during Adequacy Test. Meets MOA Tested for ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have, cbec(ked, verificcd, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed C~,// ' .,~_ _ ~¢~,,¢.~.~ Date Company Amount: $ Receipt No. / Date of Payment Page 2 of 2 72-026 (11/84) ALASKA dlROFIIlleFITAL COF1TROL SeIul'CeS, ~ngi~eerJn§ & (~nuironmental Stu~lies STEVE MENAKER 9301 SLALOM DRIVE ANCHORAGE AK 995]6 SELLER-SAME I2/23/8B STEVE MENAKER 9301 SLALOM DRIVE ANCHORAGE AK 99516 60649 LEGAL:PROSPECT HEIGHTS BLOCK 2 LOT 21 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-12/19/86 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 340 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 700 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PI,ANT WAS PUMPED ON 12/i9/86 THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE-12/19/86 A FLOW TEST WAS PERFORME~ ON THE WELL. 500 GALLONS OF WATER WAS PUMPED AT A RATE OF 2.37 GPM OVER A DURATION OF 3.16 HOURS. THE DRAWDOWN WAS 230.6 ' WITH A RECOVERY TiME OF 180 MINUTES AND THE STATIC WATER LEVEL WAS 69.4 FEET. THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME. 1200 [[Jcsl 33rJ Au~r~u¢. $ui1¢ B. Anchoraqe, Alaska 99503.,{907) 561-5040 ALASKA ENVIROI~,ENTAL OONTROL SERVli. ~, INC. 12OO West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 CHECKED BY DATE sc^LE I "~ 30' ¢ ' ; / D/~TE RECEIVED ' * INSPECTION APPOINTMENTS TIME :TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSPECTOF{~ I AGE M~i~iCIP~L~TY OF ANCHOR ENVIRONMENTAL p:,:OTECT ON : MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~j~ 825 L Street- Anchorage, Alaska 99501 RECEIVED ~ Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete aH parts on page 1. I~complete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PROPERTY RESIDENT (If different from above) PHONE 2, BUYER : PHONE MAILING ADDRESS 3. LENDING INSTITUTION [ PHONE 4. REALTOR/AGENT ~ PHONE I MAIEING ADDRESS 5, LEGAL DESCRIPTION STREET LOCATION SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM J~ INDIVIDUAL/ON-SITE*'* NUMBER OF~BEDROOMS [] One ~ Four [] Two [] Five [] Three [] Six [] Other * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) :' ~ ~/~/ THIS SIDE FOR OFFICIAL SE ONLY 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 [] IN DIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY P~~¥~. ~ .... Connection Verified INSTALLER r~Septic Tank Or []Holding Tank Size: /~.~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area ISewor Line ] Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS r ~A~OVED FOR ~ BEDROOMS [] CONDITIONAL APPI~OVAL (letter must accompany certificate) [] DISAPPROVED DATE BY~~__~