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Home My WebLink AboutPROSPECT HEIGHTS #4 BLK 1 LT 3Onsite File v 2' 1° F� tom, Inspection Report_1-1-12.doc Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171064 PID Number: 015-091-54 ❑ New ❑✓ Upgrade Name: James Witthaus ABSORPTION FIELD ❑ Deep Trench El Shallow Trench El Bed El Mound Address 9801 Sidorof Ln ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Prospect Heights #4 1 3 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field LiftStation Tank Line FtZ Ft. Well 100+ N/A N/A N/A N/A TANK Ej Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1,250Gal. Surface Water 100+ N/A N/A N/A Material Steel Number of compartments 2 Lot Line 5+ N/A N/A N/A NA Foundation 5+ N/A N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain 50+ N/A N/A N/A RemarksNew Tank Only Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer A+ Home Services Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 100ft Inspecttiones: 1�` 5/8/2017 Location and description 2nd Bottom of Trim 3rd 4U, COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OF'•4�,Qsii� Conditional Approval: Date A .`�G • .�. •,• ��.teven F�annorae•� E 8149 AW Approved a Date 11 17 lei` ftFB QO . Inspection Report_1-1-12.doc DC /REMOVED & REPLACED T2 1,250g SEPTIC TANK 0 PER MOA CODE / 5.3' O BASED ON 1984 INSPECTION REPORT 1 1.0 EXISTING 3 BR SFR DRIVEWAY I WELL E / o � A o 0 0 0 TEST HOLE EL. 92.51�7 0Z Z w Z Jz (n< Z)w Li J 0 J C)EL. 99.2 U 0- Jo o U EXISTING EL. 98.4 CO CLEAN OUT NO. PROFILE MT MONITOR TUBE NO. 11j, 5.3 DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM N0. BEDROOM: 3 TANK SIZE: 1250g USED: 1,250g STEEL SEPTIC TANK ABBREVIATIONS NOTES: RECORD DRAWING DRAWN I NJC SITE PLAN TYP TYPICAL PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 PROSPECT HEIGHTS #4 131 L3 JAMES WITTHAUS 9801 SIDORF LN ANCHORAGE, AK 99507 SWING TIES A B T1 6.5 TH TEST HOLE EL. 92.51�7 1,2508 SEPTIC EL.92.3 (P) PROPOSED TANK NEW (E) EXISTING CO CLEAN OUT NO. PROFILE MT MONITOR TUBE NO. NOTES: RECORD DRAWING DRAWN I NJC SITE PLAN TYP TYPICAL PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 PROSPECT HEIGHTS #4 131 L3 JAMES WITTHAUS 9801 SIDORF LN ANCHORAGE, AK 99507 SWING TIES W W — WATER LINE / WELL RADIUS — ss — ss — NEW SEPTIC Date 10/6/2017 • _• Scale *:.49TH ':* = 50' ... .... . . .. .... P.I.D. NO 015-091-54 •• }� •�'��Cn�Ol4e PERMIT NO. CE 8149 OSP171064 ... ;�� Sheet �" 2 01 2 A B T1 6.5 33.6 T2 12.8 38.2 W W — WATER LINE / WELL RADIUS — ss — ss — NEW SEPTIC Date 10/6/2017 • _• Scale *:.49TH ':* = 50' ... .... . . .. .... P.I.D. NO 015-091-54 •• }� •�'��Cn�Ol4e PERMIT NO. CE 8149 OSP171064 ... ;�� Sheet �" 2 01 2 - 14-t3/)1 �JH`(,FA �ly� MUNICIPALITY OF ANCHORAGE ,,,,, „,_ / On-Site Water & Wastewater Program N. : 'S ;, / PO Box 196650 4700 Elmore Road t. Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 „- httpa/www.muni.org/onsite Apericlucir o l,:u uncut 'yC MUn On-Site Wastewater Disposal System Permit Permit Number: OSP171064 Effective Date: 4/26/2017 Work Type: SepticTank Upgrade Expiration Date: 4/26/2018 Tax Code Number: 01509154000 Site Legal Address: PROSPECT HEIGHTS #4 BLK 1 LT 3 G:2441 Site Mailing Address: 9801 SIDOROF LN, Anchorage Owner: WITTHAUS JAMES K & Lot Size in Sq Ft: 93383 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3 This permit is for the construction of: El Disposal Field 0 Septic Tank ❑ Holding Tank El Privy El Private Well ❑ Water Storage All construction shall 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 (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907)343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing r r40 /Elh:L-Skr-'01.).__4 oOT 1— Received By: . SA , .A i1 4 I Date: Issued By: PAMINIWINMWd Date: '�l -6i l7 r� MUNICIPALITY OF ANCHORAGE Community Developmentp Department J Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-091-54 Property owner(s) James Witthaus & Dorothy Yee Day phone Mailing address 9801 Sidorof Lane, Anchorage, AK 99507 Site address 9801 Sidorof Lane Legal description (Sub'd., Block & Lot) PROSPECT HEIGHTS #4 B1 L3 Legal description (Township, Range & Section) Lot Size 93,383 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x (wlwo ADU) Septic Tank ❑Q Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. -41-111411'- gnature of property owner or authorized agent) Permit/Rush Fees: 2/5- Waiver Fees: Date of Payment: (I((57/9 Date of Payment: Receipt Number: aqg Receipt Number: Permit No. OSP17(01.4 Waiver No. Permit App_ - : ..c Pannone Engineering Services ac Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com April 24, 2017 Subject: PROSPECT HEIGHTS #4 B1 L3 Emergency Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 1250g Septic Tank to be issued for this property. The existing 1,250g tank is collapsing. It will be decommissioned per code and replaced. Currently the lot is developed. The proposed system will utilize a replacement 1250g Septic tank that will be connected to the existing drain field. The existing tank is located approximately 100'+ from the well. The proposed tank will be placed outside the existing well radius. All required separation distances will be met. 1. Upgrade Tank Design. A double clean out will be installed after the tank, and a foundation clean out installed before The tank will be located: 5'+ from any property line or building foundation 10'+ from any water line 100'+ from any surface water 100'+ from any private wells 200'+ from any public wells The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, S �*OF Ara.�4',,..` Jam. 5 1 logeo04.____ . ... „....." ... ...... , ... I. 1 i Steven R Pannone��jj 1..` :-....t 81 �.r• 14•1 .. Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~ ' ~ IPHONE [~NEW MAILING ADDRESS LEGAL DESCRIPTION NO. OF BEDROOMS ~ DiSTANCE TO: IWel' [74 / IAbsorDti°narea , D~iiin~ PERMITNO. ~ ~ Manufacture~ Material No. of compartments ~ Liq. ~n gallons Inside length Width ; . I F HOME,DE: Liquid depth ~ ~ DISTANCE TO: Well Dwelling ~ ~ PERMIT NO. O~< Manufacturer ~~ ~ ~~al Liquid capacity in gallons Q Well ~ Found i ~ ~ J DISTANCE TO: Nearest lot line PERMIT " .~ N°'°flines Length of~ach line Total length~f lines Trench w, dth Distance ~An lines [ ~ Top of tile to finish grqde Material beneath ~ ,, t~ // Total effective-a~so~tio~a~ inches Length Width Depth ~ PERMIT NO. ~ - r Total effective absorption area ~ ~ISTANCE TO: Building foundation Nearest Jot line ~ I Distance to lot lin~ PERMIT~ ~ DISTANCE TO: Building foundation Sewer lind/~ Septic tank I 7~ / Absorption are~(~O, OTHER PiPE MATERIALS SOIL TEST RATING REMARKS / '~ -- APPROVED ~,~ ...... ~ ¢~;~ DATE LEGAL 72-013 (Rev_ 3/7R) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol 8~ Geophysicol Surveys Drilling Permit No. LOCATION OF WELL (Please complete either la~ lb or lc.) A.D.L. No. 'I': ['.:; ~ ?/, "' ~ of~ of--of .~ 'r -- S [3 wE] I-C~.. IDISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3, OWNER OF WELL; Street Address and Areo of Well Location 2. WELL LOG Feet Below Surface 4. WELL DEPTH: (final) 5. DATE OF COMPLETION 7. USE: ~ Domestic ~ Public Supply ~ Induetry ~ :.~ ~ Irrigation ~ Recharge ~ Commericol ~-r-'-. .... . ,~.._, ~ Test Well ~ Other: ~;'-' 8. CASING: ~ Threaded ~ Welded ; ~ :?'~,'~ ~:- : ~'~ ~:,~ ~./~,:, diam. ~'. in. to__ ft. Depth Weight ~'] lbs./ft. ?{:i:~ . "~ / :' 'r'~:i : {~:~) '?~:;~ diam. in. to ft. Depth Stickup~ft. 9. FINISH OF WELL: ' ~'~' '~/~ Type: Diameter: · - ~ ~ ?/(? . '.?~[.c.) Slot/Mesh Size: Length; "'~q' ~' :;~'~i;'~;'~ ~']~) ?/~'~ Set between ~ ft. and ff. - ~ /'~4 '~:~ Backfilling Grave~ pack .- ~O~G~ ;':'~' ~':~:'~'~:) :;-v~ ~' -' ~ ~ ?~:~"~ ~":~ I0. STATIC WATER LEVEL: ~ O /. ~ Above or ~ Below land surface : I. PUMPING LEVEL below Iond surface and YIELD Q~ ' -- ,,. after, hrs. pumping g.p.m. IR.GROUTING Well Grouted: Muferlul: ~ Neet Cement ~ Other: IS. PUMP: (if .wiloble) HP Length of Drop Pipe ~ft. cop~city g.p.m. 14. REMARKS: ~6. WATER WELL CONTRACTOR'S CERTIF~CATIO~: 15. Water Temperoture o ~ F ~ C :..-~,~:~,~ ~,~ ;:,,- ..... ~,. Rag ~red ~'~ Name Form 02-WWR 01/81) Dopy Dislribulion: WHITE-Stole DGG8~ PINK-DrHIer~ CANARY-Cuslomer DEPRRTMENT ( HEALTH AND ENVlF.:ONMENTRL "-XOTECTION 825 L STREET., RNCHORRGE., RK 99b~t 264-4720 ~]~4 .....$1' TE · --C-E~4ER.. ~% l...IEk_L PE~:~-I 'f T PERMIT NO: DATE ISSUED: APPLICANT: RDDRESS: CONTACT PHONE: 840284 ~,,'~4,-."~4 TOM MCGEE 1280i FLORAL LANE RNCHORRGE, RK 995i6 ~45-00~2 LEGAL DESCRIP: LOT SIZE: LOT LOCRTION: PlAX BEDROOMS: SUBDIVISION: PROSPECT HEIGHTS ~4 SECTION: i3 TOWNSHIP: 9~8~ (SQ. FT. OR RCRES) SIDOROF LOT: 2 BLOCK: RANGE: ~W LISTED BELOW ARE THE oPTIONS R',,,'RILRE:LE TO YOU IN DESIGNING '¢OUR SEPTIC SYSTEM, CHOOSE THE OPTION THRT BEST FITS YOUR SITE. T~:E~-~C:H DEPTH TO PIPE.BOTTOM (FT.) 6. 0 GRAVEL DEPTH (FT.) 4.0 TOTRL DEPTH ~FT, ~ ±0.0 GRRVEL WIDTH (FT.) 2.5 GRRVEL,LENGTH (FT.) 57.0 GRRVEL VOLUME (CU. 9DS. ) 2Z ? TRNK SIZE (GRLS) ±,000.0 SOIL RRTING (SQ. FT.?BR) 150 · * TRNK MUST HRVE AT LERST THO COMPRRTMENTS 2.0 0. 0 i O~ 5.0 29. ~. ±.¢'-'~0._.. '~ :+::+: .1., 000. ~-'-'~ *.",-: I CERTIFY THRT: · . IRM FRMILIAR WITH THE REQUIREMENTS FDR ON-SITE SEWERS AND WELLS RS SET FORTH B~ THE MUNICIPALIT9 OF RNCHORRGE (MOA) AND THE STATE OF ALRSKR. 2. t WILL INSTALL THE SVSTEM IN ACCORDANCE WITH ALL MOA CODES BND REGULATIONS, RND IN COMPLIRNCE WITH THE DESIGN CRITERIA OF THIS PERMIT. ~. I WILL ADHERE TO RLL MOR RND STRTE OF RLASKR REQUIREMENTS FOR THE SET BRCK BI_TMN~E_, FROM AN? E,:,I=,TINU WELL., WRSTEWATER DISPOSRL SYSTEM OR PUBLIC SEWERAGE SVSTEM ON THIS OR RN9 ADJACENT OR NERRBY LOT. 4. I UNDERSTAND THRT THIS PERMIT IS VRLID FOR A MAXIMUM OF ~ BEDROOMS AND AN9 ENLARGEMENT WILL REQUIRE AN RDDITIONRL PERMIT. IF A LIFT STATION IS INSTALLED IN RN RREA COVERED BY MOA BUILDING CODES~ THEN (±) AN ELECTRICRL PERMIT AND INSPECTION MLIST BE OBTAINED; (2) AS-BUILTS ~ILL NOT BE APPROVED WITHOUT RN ELECTRICRL INSPECTION REPORT; RND (2) THE ELECTRICAL WOR~{_MUST BE 90NE B~' A LICENSED ELECTRICIAN. hPPLICANT: TOM MCGEE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl_ PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST J~SOI LS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE SITE PLAN ~-~-~N~.'.'.'.'.'.'.'~'~, ~"~WAS GROUND WATER S P IF YES, AT WHAT Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE COMMENTS 72-008 (6/79) (minutes/inch) TEST RUN BETWEEN CERTIFIED BY: FT AND I FT DATE: IVIUNICIPALITY 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/'~/~,~ GENERALINFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name _~¢~ ~G~ Telephone: Home ~ "~l~ Applicant Address~ ~ ¢ f $/~ ~ O ~ ~% Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain); Business (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Singre-Family ~ Multi-Family [] Number of Bedrooms ~ Other 3. 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. 4. SEWAGE DISPOSAL Onsite--~' Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attest ng to the legality and status. ~Page I of 2 72-025 (tl/84~ ENGINEERING 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 ot Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with arJ Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm .T~/~;~/~ ~'~,~,~'~-~ ~ Telephone _ ~ '~ ~ ~. Address ~ _~~ ~ ¢ ~ Date ~/~__ Engineer's Seal 'Approved ~ DisapprovedN- ~C Te, rms of Conditional Approval '~Date ~ditional _, 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. Page 2 of 2 WELL DATA Well Classification '~. ~'~ Well Log Present (Y/N) 'y 264-4720 Legal Description: ~ HL3V3H 30 'ld3G B~OHDNV ~O ~I1V~IDIN~ Total Depth c~7~' Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved (Y/N) Date Completed O~ -~,~ .. ~ Cased to ~ + ,~/Depth of Grouting ~ ~ Sanitary Seal on Casing (Y/N) Y' Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot [""7 Li _ ; On Adjoining Lots TO Nearest Edge of Absorption Field on Lot / ~0-~-'~'~'~ On Adjoining Lots /~0~. To Nearest Public Sewer Line ~ O ~/,..~ To Nearest Public Sewer Cleanout/Manhole [%[0 ~, ~ To Nearest Sewer Service Line on Lot /00 7/' B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Y Air-tight Caps (Y/N) Depression over Tank (Y/N) ~ Pumping/Maintenance Contract on File (Y/N) ['¢//~ Holding Tank High-Water Alarm (Y/N) ~¢'~/~ Separation Distances from Sep..~tic/Holding Tar)k~ To Water-Supply Well ! / ¢ ~ To Property Line ~O f- To Water Main/Service Line ,/(-::) ~ Course ~1( O N ~* Size /'~2- ~ O No. of Compartments Foundation Cteanout (Y/N) Date Last Pumped ~ ~-, ~,/ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ~ To Disposal Field ,,~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /' 0/,,~/,¢--~/' Width of Field ~/ Square Feet of Absorption Area 7 7' Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Fiel.!¢: To Water-Supply Well To Building Foundation Lot /~/'0 f~ ~ To Water Main/Service Line /C) '/~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage A~ea Type of System Design Length of Field "~('/ Depth of Field Gravel Bed Thickness Standpipes Present (Y/Ni Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) 'NoN 5 o 'P 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, ver~,~ed, or conformed to ~It MOA and HAA guidelines in effect on the date of this inspection. Signed .~"~'~~c¢..,~ .~ Date __'~*~ O~,-' ~- ¢ ' Company ~&4.J~J MOA "Ol ~¢¢ ~-- O [ / / Receipt NO. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-391 I; SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: TEST PROCEDURE: TEST RESULT: LOT 3, BLOCK 1, PROSPECT HEIGH #4 9801 SIDOROF DRIVE JAMES EGAN SINGLE FAMILY, THREE BEDROOMS ON SITE WELL FROM MUNICIPAL RECORDS: TANK: STEEL TANK, 1250 GALLONS, COMPARTMENTS ABSORPTION SYSTEM: DEEP TRENCH ABSORPTION AREA: 574 SQ. FT. SOIL RATING: 150 INSTALLATION DATE: OCTOBER 1984 NOT PUMPED. SYSTEM LESS THAN ONE YEAR OLD NOT TESTED. SYSTEM LESS THAN TWO YEARS OLD TWO The operational life of all septic systems depends on the local soil conditions, groundwater 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 septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requirements of the Municipality and State. '203 W. 15th AVE 'C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: LOCATION: OWNER: LOT 3, BLOCK 1, PROSPECT HEIGHT #4 9801 SIDOROF DRIVE JAMES EGAN TYPE OF WELL: RESIDENTIAL WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: .75 GPM WELL YIELD FROM TEST: .92 GPM PUMP YIELD: MORE THAN 6 GPM. DATE OF INSPECTION: JULY 3, 1985 TEST PROCEDURE: WELL WAS PUMPED FOR 25 MINUTES WITH D AND FLOW MEASURED[ RECOVERY WAS MEASUt 15 MINUTES. ~ FOR TEST FOR COLIFORMS: NEGATIVE TEST RESULT: land the well. THIS WELL MEETS THE RE( ~ OF THE MUNICIPAL CODE. The Municipal requiremen~ for well flow is 150 gallons of water r bedroom per 24 hours. This well surpass, this requirement. The assessment of the ndition of this well applies only to the c~ ~s as of this date. The flow rate o the well may change due to subsurface condJ ions that may not be observed from the su] ace, and changes in use and other fa( that may impact conditions of tl feeding the MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRON~ENTAL HEALTH DEPAR~MENT OF HEALTH AND ENVIRONI~ENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date _ (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Name '----~p_W, ~k~(~E~- Telephone- Home · Business Applicants Applicants address Iz f-~iJ ~~ (c) Applicant is (check one) Lending Institution Buyer ~ ; Other ~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single-Family~ Number of Bedrooms 3. Water Supply Individual Well[~ Multi-Family Other (describe) Community ~ Public Note: If community well system, must have written coL~irmation from the State Department of Enviror~ental Conservation attesting to the legality and status. 4. Sewage Disposa~l Onsite ~ Public ~-~ Community ~__~ Holding Tank ~ Note: If community well system, must have v~'itten confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. 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 regula- tions in effect on the date of this inspection. Name of Firm '-~--,,~C3~Q~CL~ I~-P (~' Telephone Address ~P~ ]~bC~<~ ~;.-%/.7~ (,-~ .... · OF Al ' · DHEP Approval --~"~"% CE- 3a16 Ap proved for ~ [~ bedroom8 By ~-~--r .... A~}~?.~B~.~,}~j~? ~7 Approved /~ Disapproved __ Condition~ Terms of Conditional Approval CAUTION THE I~ICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRO~NTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENt- ATIONS GIVEN IN PA~iGRAPH 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 REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-].9-84 ae MUNICIPALITY OF ANCHORAOE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classif ~atign "Do,-i~. . - ,. ~ / Well Log P~esent (Y/N) Legal Description: OCT 4 1984 RECEIVED Total Depth ~'7~ ~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances f~cm Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot TO Nearest Public Sewer Line ~./~ If A, B, o~ C, D.E.C. Approved(Y/N) Date Completed ~/~ ~- Yie{d Cased to ~'~ ~ Depth of G=outing. : Pump Set At Sanitary Seal on Casing (Y/N)7~ Depression A~ound Wellhead (y/N)¥o~ ; On Adjoining Lots i~O"~'- J~,~)" ; On Adjoining Lots To Nearest Public Sewer Cleancut/Manhole .~/~ To Nearest Sewer Service Line on Lot Water Sample Collected 'By "~'~ ~5ct~ ; Date i~-~/Z ~ Water Sample Test Results ~T]k.~-a~, ComTents B. SEPTIC/HOLDING TANK DATA Standpil~es (y/N) y~ Air-tight Caps (Y/N)~?~ Foundation Cleanout (Y/N)~ DePression over Tank (Y/N)~d~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N)~/~ ; for Holding Tank High-Water Alarm (Y/N)- Temporary Holding Tank Permit (Y/N) Separation Distances f~cm Septic/Holding Tank: To Water-Supply Well J7~ / To Building Foundation To P~ogerty Line ~Z-/ To Disposal Field To Water Main/Service Line '~ ~-- TO St~e~, Pond, Lake, c~ Majo~ D~ainage course Conlrents [Page 1 of 2] 2-15-84 C. ,~ORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field .. Type of System Design Length of Field ~/ ~ Depth of Field f O Gravel Bed Thickness ~- ~' Square Feet of Absorption A~ea ~_~7~- Standpipes P~esent (Y/N) ~p~ession ove~ Field (Y~). ~ ~ ~te of ~st A~a~ Test Results of ~st A~a~ ~st ~/~ ~ ~paration Distan~ f~ ~sorption Field: / To ~te~-Supply ~11 .~O ~ To ~o~ty Li~ To Building Foun~tion ~ ~ / To Existing or ~ndo~d System Lot ~/~ ; ~ ~joining ~ts ~ ~ To Wate~ ~in/~vi~ Line '~ .~ TO ~t~( if pre~nt) To St~e~ond~ke/~ Majo~ ~ai~ ~se To ~iveway, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea ~ ~ / C~ments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level a~ Tested for -'~ Electrical Codes (Y~) Confronts / ~Df~ensions. Manhole/Access "Pun~p Off" Lew Vent Pumping Cycles (Y/N) 1 at dequacy Test. Meets MOA-,~'~' ** Check Permitted Bedroom Rating Against HAA Raquest I certify that I have. checked, verified, or conformed to all MOA on the date 0~/thi~"inspection- Signed ' I - ~ ~ Date Company ~~ ~ ~<-~ MOA No. KB1/d5/s [Page 2 of 2]