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Home My WebLink AboutEVENSON BLK 1 LT 2A MUNICIPALITY 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?;;<HV 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. 011 421 02 EVENSON 1 2A GRUMBLIS ROBERT A 7420 SAND LAKE RD ANCHORAGE, AK 99502-1829 04 28 2023 110 A.Y. MCDONALD 23050V3LB .50 10 MARTINSON PELLETS ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET ANCHORAGE AK 99518 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 Permit Number: ~lt~.l~"r/3¢~l,C).~ ~)J~L,,//PID Number: Numa: J~ I ~[['~ [~,A,_~ ~ Wastewater System: ~ New ~Upgrade Address: ~o ~N~ ~K~ ~o~ ABSORPTION FIELD Phone: ~' ~ No. of Bedrooms: ~eep Trench ~ Shallow Trench ~ Bed ~ Mound. ~ Other LEGAL DESCRIPTION Soil Rating: O~ ~GPD/Sq. Ft, Total Depth from odgi~a~rade: Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township{~ I Range:~ ~ Section: ~ Fill added above origijal grjde: Ft. Gravel length: 50 Ft. WELL: ~ New ~ Upgrade Gravel ~ Number of lines: Distance ~tween lines: Ft. ~ ' ' Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: ] Pump Set at: Casing..,~*~ow ~roun~: TAN K GPM~ Ft. Ft. SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Privat~ Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Material: Number of Compa~ments: well [ ~ D Surface w.t~r ~ 3 D L I FT STATI O N Lot Size in gaflons: Manufacturer: Line "Pump on' level at: "Pump off" level at: High w~ter alarm at: Foundation JO ~ CUDrainrtain ~ ~ ~ Pump Make & Model Electrical Inspections performed by: Remarks: BENCH MARK Assumed Elevation: E~INEER'S SEAL Inspections performed by: Dates: 1st 2nd , Department of Heal. and Human Services approval ,, . ~oviewed and approvod by: Date: 72-013 (1/gl)MOA 25 I LDT £~ ~ ~ ..... LOT 1 '~ ,.. ~ - '" ~5 8 B5 50 75 188 1~5 15 SCALE: 1' = 50 FT, W. DI~IOND BLVD. A~CHORAGE, ALASb] 99502-3904 (907) 279-39i6 D.~¥:~sion o~ EnvJr-onmenLat HeaiU~ D~par[ment of Heail:[~ and ~c~(::iai_ Services 820 7[ Si:reel: Anci~ora~?~ Alaska 99501 MUNICIPALITY OF ANCHOR,~,OI~ ENYlRONMENTAL SERVICES DIVISION ,AUG - 9 199 RECEi V D D~r'Jr~g ~n HerA in~pectien on subject ic~t i~: was discovered tt~at U~e absorpt:[on system instal]ed in t977 had hewn modi-ficd by the ~ns'tal]a'[ion o-f ar~ additional trench. "[her~a is nc~ documentation .~.f '[:J~Js 'f:rench~ however an HAA was approved in :L986~ arm it is bors *~:o~ h~:~'[h trcnche',s are avai~abl~ and the diLch t~ne ¢.,~ a,i(-:~quacy 'lest wa~;~ !:~er~or'm[-~d oJ"~ the sys~:em on August 2~ &993. i000 gallons o-~: wa[er was added to th~ system via the after tank c:],¢~an ouk. At: that time th~ monitor for the 1977 trench warn not avai[abie~ but the monitor Cot the undocumented b-'erich ~as in .... tack. Before U~e 'Lest this m(m~tor was dry. The add.~'bi~:m ~ Li~e [eve.t was 7 incht3s. During the (esi:lng period th~:] re~:Jdem::e end of the original trend] ,¢,,as ~>,'pos[-~d and U]i:~ sa[fie day to depth of .Ia feet Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: '(~ DATE PERFORMED: SITE PLAN (ENGINEER'S SEAL) lO 11 12 13 14 15 16 17 18 19 2o COMMENTS WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P Deplh to Water After Monitoring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop / t (minutes/inch) PERC HOLE DIAMETER ~.~ ;' FTAND /*,/,~ /~-' FT ,.~ :, ( PERFORMED BY: '~.~,- '::'~ I ~¢' ) CER3 IFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72 008 (Rev. 4/85) 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 Permit Number: ~.~O0(¢~1 PIDNumber: 0110,5-22'7 Name: Wastewater System: Lq New [3 Upgrade Address: ABSORPTION FIELD ~TLfOLF 5ANb LAI<E R~ /~t4d.t Phone:~ur ~ . 2 ~ ~ { ] Deep I rer~ch L.] Shallow Trench iL] Bed [.3 Mound L] Other LEGAL DESCR I PTI O N so, Rating: Total Deptb from original grade: GPD/Sq. Fl Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: Range: Section: ~ Fill added above original grade: Gravel length: I~ fl ~ W Ft. Ft. WELL: D New ~ Upgrade Gravelwidth: Number of lines: Pistance between lines: Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: lotal absorption area: Pipe material: Ft. Ft. SQ, Ft. Driller: Date Drilled: Static Water Level: b~staller: Date inst~?~ Ft. ~ ~LIs EXCAVATING Yield: Pump Set at: Casing Height Above Ground: TAN K GPM Ft. Ft. SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding ~ul)lic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank s .... L, ..... ANCHORAGE TANK 1~50 Material: Number of Compartments: Well IO I STEE~ Surface w~t~, >~oo LIFT STATION Lot Size in gallons: Manulacturer: Line "Pump on" level at: "Pump off" level at: ~ High water alarm at: Foundation I CurtainDrain ~ Pump Make & Modal Electrical Inspections performed by: BENCH MARK Remarks: ~p~Ac~N~ ~pT~c Location and Description: I Assumed Elevation: ~l~ttS~ Yec~ical Se~ices ENGINEER'S SEAL Anchoraqe, A]~sk~ 99516 Inspections performed by: FZA%TOP TEc~. SvCg. Dates: 1st_ ~/ff/92 Department of Health and Human Services approval Reviewed and approved by "~ Date: ~-/f ~7.m 72-013 (Rev. 9/91) MOA 25 permitNo. $1,v q2ooGCl 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 Legal Description: LoT 2A, BLK I~ F_.I/ENSDN PiDNo.: 01105"227 D~w'~ ~"A¥ SCALE: ' (~LEVAToN jN~RT ELEV :~2.0 OUTLET I NYE P..T INLET' FlattOp Technical Servic ' 14530 Ebho Street Anchorage, Alaska 995 72-013 A (2/91) MOA 25 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:SW920069 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:KIMURA SAM I & JOAN A OWNER ADDRESS:7404 SAND LAKE RD ANCHORAGE, AK 99502 DATE ISSUED: 5/01/92 EXPIRATION DATE: 5/01/93 PARCEL ID:01105227 LEGAL DESCRIPTION: EVENSON BLK 1 LT 2A LOT SIZE: 54384 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK 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 (18AACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ~(~ DATE CIV1L & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 April~z~, 1992 ANCHORAGE, ALASKA 99516 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design nan'ative in support of our application for permit to replace a collapsing septic tank on Lot 2A, Block 1, Evenson S/D, located at 7420 Sand Lake Road. A site plan is enclosed for your review. The proposed project will have no impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any impact on reserved space/surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. LoT I LoT 2.1~, 'WELL S~PTI¢ T~NK TO LOT 2A Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 LoT 2A, BLKI SEPTIC TANk SCALE: I"= 50' DATE : H-/qZ D~N t3'/: ~ EVENSON SuB. RE PLACEMEN'T PLAN NoT£: THiS IS NoT F~ 5u~VE'~EI) PLAT'. ALL LoCATioNS ARE APPRoxINIATE Flattop TechnicaI Services 14530 Echo Street, Anchorage, AK99516 Phone (907) 345-1355 Lot 2A, Block 1, Evenson S/D 7420 Sand Lake Road Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of installation of a new 1250 gallon septic tank to replace a failing septic tank. 1.2 Construction shall be as depicted on the approved site plan. Minor deviations from these drawings may be allowed or required by the engin~r 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 1250 gallon septic tank shall be Municipally approved with two compartments, and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. ,~ 2.2 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 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A double cleanout shall be installed within 5 feet downstream of the septic tank. 2.3 The existing 1250 gallon fiberglass septic tank shall be properly abandoned by pumping, cutting out it's top, and backfilling with clean soil. 3.0 Inspection: 3.1 The septic tank installation requires one inspection after it is set level and the piping connected, but prior to backfill. 3.2 The installer shall coordinate the timing of the inspection with the engineer sufficiently far in advance to ensure the availability of the engineer. Municipality of Anchorage DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION POUCH 6-650 ANCHORAGE, ALASKA 99501 INSPECTION REPORT ON ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL NAME ADDRESS PHONE(S) LOCATION LEGAL DESCRIPTION Z~#OF BEDROOMS SEPTIC TANK \ %50 MANUFACTURER %'k~ .~ ~'-~' CAPAC TY IN GALS. MATERIAL ~- '~)~(~g..~LR%% #OF COMPARTMENTS INSIDE DIMENSIONI LENGTH ~11~ /WIDTH ~1~ DEPTH ~t~ SEEPAGE SYSTEM [] TILE DRAINFIELD NUMBER OF LINES LENGTH EACH TOTAL LENGTH DISTANCE BETWEEN LINES TRENCH WIDTH '$~ DEPTHS: ',~ '~'C' ~-~FT ~)U. TILE TO GRADE FILL BELOW TILE FILL ABOVE TILE ~"SEEPAGE TRENCH OR [] PIT [] LOG CRIB [] RINGS- DIA. FILL MATERIAL DEPTH DEPTH TOTAL EFFECTIVE ABSORPTION AREA: '\'7--C~,0 SQ. FT. WELL CLASSIFICATION DEPTH INSTALLER PIPE MATERIAL REMARKS SEPTIC TANK WELL LOT LINE FOUNDA- TION DISTANCES SEEPAGE SEWER SYSTEM LINE · ~- .'S'o ~ SYSTEM DIAGRAM CESSPOOL WELL !nlst~nc~ pumping .... :~. ....... ........ x. ....... :...gallons per hour.' tnd correct, Io~n~ i:;:, i::!: F' I: :1 F: i" !"i t!!: i'.,! i .... .:',;:::% '"1 ..... ~.,,.ll tiE:: ii...., li ..... ii:::::ii It".,,ii ii..::::,, ~: "'¢~ ih.,,il ........ :ti:ii;; ::ii:: "t1'" liE: ::iiii:;; il:E: ii.....11 ltEi!: iF;::: I~ f . t, ~:.. Ii % "11 "-'- -- ,' '?'? :!!;~!:.:'.; Hf::I:>:;:t:HLIi'"I hil...IHE;EI:::: Oi:::' ::::::::::::::::::::::::::::::::::::::::: = ,4 "il.Iii:: L.I:::i',i(::i'I"I.t I.::,:I:HE:N::::;:!:Cfl",I :1.~!::; '1'1111::: L.J:i:i'.,l(:!i"l"H ,:::I:N t:::'E:E:'T';, O1:::' "1"1...1t::: 'TI::::ENE:H Oi:',:: "i"lii:i: [::,l:i::t:::'"i"i-.I Ol:::' I:::1 'TF::E:t'.,iCi. I Off:: I:::'I'T :[ti:i; 'r'HE :::::::::::::::::::::::::::::::::::: t31E'T'I.,II:i:I:i:N THE '.:ii;I...tF~:i:::t:::l(:::l!!:: i:::d:::' 'T'Ht:i!: ~::il;::EIUI'.,Ii:::, t:::li',l[::, "f'HE: iii:',EFF'f'I::)H Ed:::' TI.tE I!i!:;>:',Cl:::lk,q:::t'T']:Ot'.,I ,:: :l:l'.,I ::::::::::::::::::::::: "I"t. Ii:::I:;::IE :~:'.:::; t'.,JO :i:;t::::'t' I.,.I:[I:::,'I"H i:::'Ol:;:: TI..tiii: i::iil:;::l:::l',,,'lii::l..., t:::,l:ii:F"f'H :i:::i; "l'Hli: i','I:[N:[['"ILIH I:::,EF'"I"H I::)t:::' (:iiF::t:::I',/E:L. E:E:"i"HI::i:E:I'.4 'T'Hili: OU"l¥::'l:::fi...t... I:::I?.,E:, "i"i. IE: I:!i:l::)T"lEd"l ElF' 'T'HI::: li:i:;:.O:::Fl',,,'f::Ff':[Ed'.4 ~:::t:t'-,I :::::::::::::::::::::::: Per¢ormed For Lenal ~escrtDt(on: L o t_~/k_B 1 o c k_L__S u b d t v t s t ° n.--~e~-~n This Korm Renorts Soils Leo Yes Percolation Test 2204 Cleveland Anchorage, Alaska 99503 Sam Kimura 08t~ Performed 9-24-77 yes Feet. Soil Characteristics Perc Test Brown Sandy Silt Bottom of Test Hole Was Ground ~ater Encountered? No IF Yes, At what Depth? 10-7-77 ....................................... 0 ............ 5 1/~' . 2 .2/_8~" ......... ':"j ......... ~5¥7~')5/~'~~' '-~t~ c~t~f,~ ~: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Day phone Lending agency Mailing address Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~;~. Address ,.~ ~ Engineer's signature Phone DHHS SIGNATURE /~' Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional enginder's wor. k. 72-O25 Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~a'~:~/~,'.~K'~ t~ t~'~.~c~-~/j) Parcel I.D. A. Well Data Well type Log present (Y/N) '~/ Cased to Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION ' %/'7'7 i, tot Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number Date completed i'~A~/~ ~ Driller ii ~ Casing height g.p.m. ; On adjacent lots ; On adjacent lots Publio sewer manhole/cleanout Petroleum tank SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: .% Nitrate O.l 0 Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ./5',/~/~ Z- Cleanouts (Y/N) 7 High water alarm (Y/N) Date of pumping Foundation cleanouf (Y/N) Tank size j ,¢[.~C~ Compartments 'k./ Depression (Y/N) Alar/m tested (Y/N) I~//..~ Pumper j ,'~ ~.~.E ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot } O i To property line ? / Surface water/drainage On adjacent lots .~ /'~-~) Absorption field J ~:~ ~ Foundation ~'~' Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION I'~//t_t~ Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at .Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed /' 77 Length 7~2~ '/' ~ Width Soil rating (GPD/Ft2) ,, ~'~ Gravel thickness System type Total depth Total absorption area /,,~¢/~ ~ ~/"~ Cleanout present (Y/N) Date of adequacy test ~/X./~ ~5 Results (pass/fail) Water level in absorption field before test /~'/.z~/ ~' L~ Peroxide treatment (past 12 months) (Y/N) N Depression over field (Y/N) for After test r C/..Z'~/Z' .If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ To building foundation On adjacent lots /~-.~ Surface water Curtain drain '~. On adjacent lots .,~ ~,,~'~> Property line ,Z//'~p To existing or abandoned system on lot Cutbank N L~ ¥1 ~ Water main/service line ~. i0--~ Driveway, parking/vehicle storage area ~'~) E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer's Name ~ ~~.(~LVJ ~--~ Date /~r-(.,(~'~ ~ ~ I ~ "~ ~ HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number RECEIVED () E' O ..-,,-., 9 ~:~ "ii", , ,- ~ of Anchorage COMMERCIAL TESTING & ENGINEERING CO. Chemlab Ref.~ :93.381'7-3 Client Sample ID :L2 Bi EVERSON Matrix :WATER REPORT of ANALYSIS 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :TOBBEN SPURRLAND, P.E. Ordered By : Project Name : Project~ : PWSID :UA WORK Order :69034 Report Completed :08/06/93 Collected :08/02/93 @ 21:30 hrs. Received :08/03/93 @ 09:30 hrs. Technical Director:ST£P~.J:LC. EDE Released By : ~~ ~-~_._ Sample Remarks: ROUTINE SAMPLE COLLECTED BY: T.S. QC Allowable Ext. Anal Parameter Results Qual units Method Limits Date Date Init Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 08/04 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Aloove NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than ~SGS Member of the SGS Group (Soci~t~ G~n~,rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) / Location (address or directions) (b) Applicant Name.,~''~/'4 /(Z/~tO~ Telephone: Home ~,~..~,2.~ ? Business Applicant Address '~/.'/'.~0 ..~',~/~,/) .ZR'#~ /~,/~z) / /~,AT~b~,~' (c) Applicant is (check one): Lending Institution I-I; Owner/builder []; Buyer,~; Other [] (explain); (d) Lending Institution ¢/'¢""~ Address ~ ¢¢.~"" ~r* ' ~' .,~'- ~'~ (e) Real Estate Company and Agent Address Telephone Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~;¢., Multi-Famil~ll~ /..~ther Number of Bbdrooms WATER SUPPLY Well'~ Community [] Public [] ndividual ! Note: If community well sysmm, must have written confirmation from the State Department of Environmental Conservation attestin§ to the legality and status, SEWAGE DISPOSAL Onsite'~ Public [] Community [] Holding Tank [] Note: !f community well system, must have written confirmation from the State De partment of Environmental Conservation attesting to the legality and status. : ~' 11/84) ENGINEERING FIRM PROVIDIN6..,SPECTIONS, TESTS, FILE SEARCH, DA'i ~. AND INFORMATION:~ i'! : * 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 ~'V~ ,~',,'t,~, ~ ~~ Telephone ~/~ Date DHEP APPROVAL Approved for .~_~z~ (/¢) bedrooms by Approved ~)~ ,. Disapproved Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH ENytRoNMENIAL pROTECTION RECEIVED Well Classification ~'~'z.~ ~j,~.~"F~: If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) '~'/ Date Completed [~-~- ~7"7 Yield / Total Depth I [ ?... Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~ ~ ''~' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 't ~ -~ ; On Adjoining Lots To Nearest Public Sewer Line ~ c>o + To Nearest Public Sewer Cleanout/Manhote Water Sample Collected by Water Sample Test Results Comments ! To Nearest Sewe~ Service Line on Lot ~L~ ; Date B. SEPTIC/HOLDING TANK DATA Date Installed I O-7~'7 '7 Size t'~.~O ~,,~j_. No. of Compartments Standpipes (Y/N) xt/ Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) 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 I ~ o --+ Course toO -~ '1' Date Last Pumped lC.)--?..'?_.- ; 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 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed I O- Z. ~,'- -/'7 Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well t O0 4- To Building Foundation ~7-- I Lot ~ 0 ~.~, ~ To Water Main/Service Line I ~o -~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Gravel Bed Thickness ~ Standpipes Present (Y/N) V Date of Last Adequacy Test Type of System Design ~-~-~ Tf'~ ~-' t-~ Length of Field ~'Z~ Depth of Field I ! To Property Line 5--7 To Existing or Abandoned System on ; On Adjoining Lots I 6~o 4-- To Cutbank (if present} t--._'.'.'.'.'.'.~,~..3 G 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 ~:-.~i2~c~ ~,--c't-~C.r~o/J Date Company ~[~,z~T-,j~ Fc~Y"~£t~MOA No. ReceiptNo. ~J~ Date of Payment ~- 1 ~ ~ ~ Amount: $ ~ ~ Page 2 of 2 72-026 (11/84) APPLll NT FILLS OUT UPPER HAl ONLY Buyer ~ Address / ~'~ '~"~'/~:~ / ~ ~L.. Zip Code Address Zip Code Phone Reatty Co. & A~nt Address Zip Code Street Locat[~ ? ~ {) Type of Resi~nce ~lngle Family ~ Multiple Family No. of Bedroo~ ~ Other Water ~upply ~ndividual ATTACH WELL LOG. A wall Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available). ~ .;Community ~?Public Utility Se~Disposal ~ Individual Year Individual Installed: ~ 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 (' ~ ~-', 4', ("~ '~ Date Date Date Date Insp~tor Insp~tor Insp~tor Insp~tor Field Notes: MUNICIPALI~ OF ANCHORAGE RECEIVED (~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE ~'~ ' ~ ~ ' ~'E~ -~ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received Well lo Tank Septic T~k Size 72.023 (3182) MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PRO1EC~io~,~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street- Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 .RECEIVED REQUEST FOFi APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all perts on pege 1. Incomplete requests will not be processed. Please al[ow ten (10) davs for processing. 1. PROPERTY OWNER I PHONE Sam I. KimuraI 243-2369 MAILING ADDRESS 7404 Sand Lake Road, Anchorage, AK 99502 PROPERTY RESIDENT (If different from above) PHONE Same as above same 2, BUYER PHONE Owner/Builder - Sam I. Kimura 243-2369 MAI LING ADDRESS 7404 Sand Lake Road, Anchorage, AK 99502 3. LENDING INSTITUTION I PHONE Security National BankI 276-6800 MAILING ADDRESS 2525 "C" Street, Suite 502, Anchorage, AK 99503 4. REALTOR/AGENT I PHONE I none MAI LING ADDRESS 5. LEGAL DESCRIPTION Lot 2A~ Block 1, Evenson Subdivision STREET LOCATION 7420 Sand Lake Road, Anchora~e~ AK 99502 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [~[] Three [] Six [] Other 7. WATER SUPPLY [] INDIV,IDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for ail wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date Oct., 1977. If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONL DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED F-I PUBLIC UTILITY Connection Verified iNSTALLER []Septic Tank or r--IHolding 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 ISewer Line I Nearest Lot Line I I WELL TO: Absorption Area to nearest Lot Line 6. COMMENTS ~'/APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Tide) LEGAL DESCRIPTION 72-010 (Rev. 3/78) INDIVIDUAL SEWAGE AND WATER FACILITIES ' (Fill out in T~iplicate) .... .of person requesting approval ~¢~. ...~.~g/~..~y~j Numb~. o£ bede'DOSS in house Water, Analysis: a. Bact%~ al b. Detemgent Well data: a. Type~~ Depth__ .~ / . Dis:ance from well to closest existing Or propose 2. Septic tank ~7 ! ' 3, Seepage Area ~0' . /~" 5. Property Line_ / Other sources of possible contamination, i.e., creeks, lakes, houses, barn, dralnaEe ditch, etc. . Sewage disposal system. a. b. C, Age of syste .. 79&/ . Septic tank capacity in gallons · 1. If "home made" show diagram on revemse side of this form. Disposal field or seepage pit size and type 1. tance to proper .... [ f to house foundation Percolatio~,Test'~esults f. Percolation Test performed by Use the reverse side of this form to show diagram. Diagram should include -~he following information: p~operty lines;.well location, house location, c6ptlc tank location~ disposal area location, location of percolation test, and direction of ground slope. 9, The l~for~.ation on this form is true and correct to the best of my knowledge. Signature 'of Appilc~nt ' D~te Signed TO BE FILLED OUT BY HEALTH DEPARTr.~F-.NT PERSONNEL ~--~'The~ above described sanitary facilities are hereby appr. oved, subject to the ........... ~611owing conditions: Conditions: The above described sanitaryfacilities' ' ' are disappr, oved for the following reasons: ~'~ignature Of ~f~'i'¢f&~i .~'~.~,.'~ Approval is valid for one year following the date of approval. CPJ:cw