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EAGLEBROOK #1 BLK 2 LT 5
aglebrook #1 Lot 5 Block 2 #017-121-57 Municipality of Anchorage Page 1 of `3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4-744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number:, SW990576 PID Number:, 017--121--57 tCam":RON AND JANE BAIRD Wastewater System: [] New · Upgrade 6200 ANDOVER CIRCLE ANCHORAE, AK 99516 ABSORPTION FIELD Ph°ne:(907) 258--8818/545-5751 ~o. of B~d~rooms: mD~ep Trench BShallow Trench BBed mMound BOther LEGAL DESCRIPTION o.6 ~/~.. *`3.o Lo'u Blo~lc Subdivlelan: D~ t~ p~pe ~ fnx~ o~lnel ~ ~ ~ ~ 5 2 EAGLEBROOK 0.5 - (+)1.4 F~ 0.5 F~ WELL: [] New [] Upgrade 15 ~ ,3I 4 / ~ ~ 750 ~. ~ ASTM D-50~4/F-810 ~ A+ HOME SERVICES 11/15-17/99 SEPA~TION DISTANCES = ~pUe a Holding a S.T.~P. Tank ~on Tank ~ U~ ANC~ORA~ TA~ ~ 000 Well ~00'+ ~00'+ -- 25'+ STEEL 2 s~. ~o'+ ~oo'+ - - LIFT STATION Water Hn~ 5'+ ~ 0'+ - - FoundaUon 5'+ 10% - - Drain NC~E KNOW~ ~emarks: * ADDED 2.0 TO ~.8 FE~ OF M.O.A. APPROVED BENCH MARK SAND FILTER. BOSOM OF SIDING AT POINT "B" 100.00 Department Of Reviewed and approved bY~ Date:~~'~ PERMIT NUMBER: AS-BUILT DRAWING PARCEL ID NUMBER: SW990376 017-121-57 - [ / , DBL1 32S 26.0 - ~AS~ WA~R ~ WASTEWATER CONS~T~S, ~C. [~[~oo~ ~,~,o,; ~o~ ,. ~[o~ ~ ~ ...... 'w"~"~ ....... : .... PREPPED FOR: PHONE NUMBER: 258-~8~8/~4s-37~1 RON AND JANE BAIRD (907) ~.r.. ~ ' . ..'~e~ DATE:i~/~O/99 ID~WN ~y: S~: J.L,M. 1 = 40' 2 OF A B C01 ST1 29.5 22.1 ST2 31.8 24,7 DBL1 32.5 26.0 DBL2 52.9 26.4 C01 77,4 91,2 MT1 82,9 - 26,8 C02 77.5 92.3 C05 80.6 - 27.4 004 91.7 - 28.1 MT2 - 84.4 18,4 C05 - 76.1 19.8 ~,%~: A S - B U I LTD R A W I N G PS;%'?=f~-~: IN~:LI-AllON '-~ F FI~ ~ /~ l~,14 (AV~.) PI~ d~ ~ IN~AflON ~ 97,7l-~.~ / ~PIL~ P~IC X c~ ~ I leo ~ co - ~~:?...,.,....~ ............................. ~..,....-. ~ ~., ......,. ..... ~AS~ WATER ~ WASTEWATER CONS~T~S, ~C. EA~LEBROOK SUBDIVISION; LOT 5, BLOOK 2 ............... PROFILE AS-BUILT OF SEPTIO SY~TE~ UPGRADE PREPPED FOR: PHONE NUMBER; RON AND JANE BANRD (9O7) 258-8818/345-~751 .. ~:m:-7953 .." ~?,, ... ~. ....'_~,~ %v~o/~ I~ "~: I'~: J.L.M. N.T.S. 3 OF 3 '~~rofess~Oo ~ e MUN~IeCIPALITYOFANCHORAGE~-~ ~'~ On-Site Services Program ~' 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 995~9-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 06, 1999 Expiration Date: Oct 05, 2000 Permit Number: SW990376 Legal Description: EAGLEBROOK#1 BLK 2 LT 5 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Jane Baird Owner Address: 6200 ANDOVER CIR ANCHORAGE , AK 99516-4349 Parcel ID: 017-121-57 Site Address: 006200 ANDOVER ClR Lot Size: 50240 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage 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 ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~//~Z, fl ~'~/~_. Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B - Anchorage ~ Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers September 24, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade Design for Eaglebrook Subdivision; Lot 5, Block 2, To whom it may concern: The existing 3 bedroom house is served by a private septic system and a private well. The existing septic system consists of a 1000 gallon septic tank and a bed type drainfield. The existing bed is completely surcharged and must be upgraded. One test hole was excavated on the property. Comments regarding the proposed upgrade design are summarized as follows: 1. SOILS: Attached is a log which shows thc soil profile, and the percolation test results. The soils below the organic layers are a SM material to a depth of 3 feet and than transitions to a SM/GM material to a depth of 11 feet (bottom of test hole). Groundwater was encountered at 7.5 feet during the excavation of the test hole and ten days later, groundwater was found to be at 5.5 feet. Two percolation test were performed in TH#l, one between the depth of 2.5 feet to 3.0 feet which had a percolation rate of 25.2 minute/inch and the other between the depth of 4.5 feet to 5.0 feet which had a percolation rate of 2.8 minute/inch. 2. TRENCH DESIGN: a. Percolation Rate: 25.2 & 2.8 minutes/inch b. C. d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 750 ft2 £. Total Depth: 3 feet (maximum) g. M.O.A. Sand Filter: 2 feet Allowable Application Rate: 0.6 gallons/day/fi2 average Number of Bedrooms: 3 h. Effective Depth: 0.5 feet i. Width: 15 feet minimum j. Minimum Length: 50 feet long 1. Effective absorption area = 750 ft2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the topography site plan drawing, the area where the proposed drainfield upgrade is generally flat; in short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. larness, P.E., M.S. NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, two soils logs and a 4page construction specification letter which are all part of the design package for this septic system. LOT 10, BLOCK 1 SEA TURN S/D LOT 11, BLOCK 1 SEA TURN S/D J PROPOSED (SEE DESIBN, PAGE 2 OF I I I SEA TURN S/D LOT 6, BLOC]~ ~ EAOLEBROOK'S/D EXISTINB BEDROOM LOT 4, BLOCK 2 EAGLEBROOK S/D C~SEPTIC LOT 3B, BLOCK 2 EAGLEBROOK S/D ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, BU~TE 2B. ANCHORAGE, AK. 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 TRACT A-1 C UNDEVE .OPE SEPTIC SYSTEM LEGAL DESCRIPT[ON: EAOLEBROOK SUBDIVISION; LOT 5, BLOCK 2 OF WORK: SITE PLAN FOR SEPTIC SYSTEM UPGRADE PREPAREO FOR', RON AND JANE BAIRD PHONE NUMBER: (907) 258-8818/$45-5751 JSCALE: PAGE: 1 = 100' 1 OF 2 -7953 ..' LOT 3A, BLOCK 2 EABLEBROOK S/D I 3) THE CONTRACTOR SHALL HAVE THE SOUTH PROPERTY LINE FLAGGED BY A REGISTERED / ] LAND SURVEYOR PRIOR TO CONSTRUCTION. / A 2) THE CONTRACTOR SHALL FIELD VERIFY ' THAT G~VI~ FLOW CAN BE ACHI~ED PRIOR 3 FE~ DEEP ~IMUM BY 50 ~ % i ~ INSTALL DOUBLE LONG BY 15 FE~ WIDE. ADD 2 FE~ ~ ~ 1 - o~ ~.o. ~..ow~ ~s~ w~ ~ w~s~w~ co~s~s, mc. DESIGN Of SEPTIC SYSTEM UPGRADE PREPPED ~OR: PHONE NUMBER: A.C.G. 1 = 40' 2 OF 2 ALASKA WATER & WASTEWATER CONSULTANTS, INC. ~.~-'~'~,~ 6901 DEBARR ROAD, SUITE 29 * ANCHORAGE, AK. 99504 ' '. ISO,L LO(; - PERCOLATION TESTI 'F*~""" 4~'~'i~ LEGAL DESCRIPTION: EAGLEBROOK SUBDMSION; LOT 5, BLOCK 2 ......... ~'-~ '~'~ PERFORMED FOR: ROE AND JANE BAIRD ~ -,~q:~, ,~,~!~,~,,.. ,~, ,.....J k"~._{J ,f re) DATE PERFORMED: 8/30/99 /0~/_"~. I cl.'+7953 -- ORGAN,c ITEST HOLE #1I "~(~'.*;'"""( ....... I~EPTH ~ feet)' ~: SM IL FC T S ' / .~4!:...~,.,~ ~ E PLA,N1 ,, , GM i x CL I / \ --------- :GC OL I .~ o~SW MH SC ~ "' SM/GM SROUNDWATER DEPTH TO DATE Ii~]~ 'TH#1/~.,.,~/ ~.5' 6/30/99 ~ ~ ~- ~, / - 5.5' 9/10/99 I ~% k& 11 DATE READING CLOCK NET TINE WATER LEVEL NET DROP TIHE (HINUTES) READING (INCHES) 12 8/31/99 PERC, HOLE W~ PRESO~ED 4+ HOURS PRIOR TO 13 1 5:00 ~ ~-~ 5:30 30 4 13/16" 1 3/16" 14 ~ 3 5:31 6" ~ 4 -- 6:01 30 4 1~/16' 1 3/16' 15 -- 5 6:02 6" 16 ~ 6:32 ~ 30 4 13/16" 1 3/16 17 , 19 PERCOLATION RATE 25,2 (NIN./INCH) PERC. HOLE DIA. 6 (INCHES) 20 TEST RUN BETWEEN 2,5 FT. AND. 3,0 FT. COHNENTS: PERCO~ON DATA ON ~IS PAGE FOR UPPER BENCH PERC. HOLE ONLY. H~ ~INS AND P~ALLY OPEN TEST HO~ PRO~LY ~E THE GROUNDWATER DONITORING R~IN~ CONSE~ATIVE, PERFORMED BY A~S~ WATER · WAST~ATER, I, JEFFR~ A, GARNESS, CERTI~ THAT THIS WAS PERFO~ME~ IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: ~/ DEPTH TO DATE SROUNDWATER 7.5' 8/30/99 5.5' 9/10/99 ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 D£BARR ROAD, SUIT~ 2B * ANCHORAGE. AK. 99504 I SOIL LOG - PERCOLATION TEST I "' "' LEGAL DESCRIPTION: EAGLEBROOK SUBDIVISION; LOT 5, BLOCK 2 PERFO.MED FOR: RO" *.0---- DATE PERFORMED: 8/30/99 ~o~.'.'"3.' -([~-7953 ..."~.~ I I DEPTH -- (foot) TEST HOLE #~ 2-- SSIFIC ;~,.;<,~,.~ GW ~ ORG 3-- ~ GP ~ ML '~ GM_ __~ CL 5-- ~~ ~ SP~ CH ~-- ~ ~SHsc OH SEE PAGE 1 OF 2 Z 7-- 0 DEPTH TO DATE ~ 3 ROUNDWATEE 8-- ~ O~% 9~ 0 10~ 11 ~ ~ DATE READING CROCK NET TI~E WATE~ LEVEL NET DROP ~ TI~E (HINUTES) READING (INCHES) 12~ z 8/31/9~ PERC, HOLE W~ PRESO~EO 4+ HOURS PRIOR TO ~INO ~ 1 5:02 13-- ~ ~ 2 5:12~ 10 2 7/16' 3 9/16" ~ 3 5:13 6" 1~--I ~ 4 5:23 10 2 7/16" 3 9/16" ~ 5 5:2~ ~ 6' 15-- ~ 6 5:34 10 2 7/16" 3 9/16" 16-- ~ 7 5:35 _ ~ 8 5:45 10 2 3/8" 3 5/8" 17-- ~ 9 5:46 6" 10 5:56 10 2 ~/8" 3 5/8" 18 -- 11 5:57 ~ 19-- ~ 12 6:07 10 2 ~/8" 3 5/8" PERCOLATION RATE 2.8 (HIN./INCH) PERC. HOLE DIA. 6 (INCHES) 20--~ TEST RUN BETWEEN ~.5 FT. AND 5.0 FT. COHHENTS: PERCO~ON DATA ON ~IS PAGE FOR LOWER BENCH PERC. HO~ ONLY. PERFORMED BY A~S~ WATER · WAST~ATER. I, JEFFR~ A. GARNESS, CERTI~ THAT THIS w,s PE~FO~UE~ ~N *CCO,D*.CE W~m *LL Sm~ *ND MU.~C~P*L ~U~DEUNES ~N EFFECT ON DEPTH TO DATE 3ROUNDWATE~ LOT 10, SEA TURN 5 BLOCK1 s/o LOT 6, 99504 NAME MAll-lNG ADDRESS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONiVlENTAL PROTECT~,i~Ci%~f~y,.,~,. O? ENVIRONIVlENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-472~ViRONMENTAL_., ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION LOCATION ~ ¢'ef~. Well . I Absorption area I ..... I IF HOMEMADE: NO. OFBEDROOMS DISTANCE TO: Manufacturer Liq. ca in DISTANCE TO: Manufacturer 'NO. Material A ,,~ No, of compartments //// Inside length Width Liquid depth Well Dwelling PERMIT NO. Materiel Liquid capacity in gallons Well DISTANCE TO: Foundation Nearest lot line PERMIT NO. No. of lines Length of each line Top of tile to finish grade Total length of I nos Material beneath tile Trench width Distance between lines inches Total effective absorption area inches Type of crib i~,2//¢¢ DISTANCE TO: DISTANCE TO: Width / Crib diameter/~]/~ Depth Building foundation ,/ ~ PERMIT NO. Crib depth ~/~//8¢ Total effective absorption area ..... ~7,/~O~ ng foundation Nearest lot line ~ -~r Distance to lot line PERMIT NO, Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER ~E~A~K8 APPROVED r , ~ g DATE LEGAL-- MUNICIPALITY OF ANCHORAaE Department ~ Health and Environmental ~rotection 825 Street, Anchorage, AKo ,501 264-4720 ~ :'~ * * * HANDWRITTEN PERMIT * * * Permit # C{(~C>C]~ ,W~m~:~D/0R ON-SITE SEWER PERMIT Applicant: Location: ~Y ~. ~ Phone Number: Legal Description: ~< ~,,7/~/~'~[~/ Lot Size: ~ Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed; Holding Tank Maximum Number of Bedrooms: ~ Soil Rating (sq. ft/br) Mailing Address ..... .~ .......... ,~ . ~-.- /- The Required Size of the Soil Absorption System Is: DEPTH .~/~ LENGTH GRAVEL DEPTH ~ '/ ' WIDTH The length dimension is the length(in feet) of the trench or drainfieldo The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet)° There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS ~ * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve° * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. ~inimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion~ Other requirements may apply. Specifications and construction diagrams are available to insure proper installation° * * * PERMIT EXPIRES DECEMBER 31, 1 9 * * I certify that: (1) I am familiar with the requirements for on=site sewers and wells as set forth by the Municipality of Anchorage~ (2) I will install the system in accordance with codes. (3) I understand that the on=site sewer system may require e] 'ement if the residence is remodeled to include more the bedroc Signe~: ~ ', ~/ ,' L / /, ~ Issued by: ' ~,! Date: MUNICIPALITY OF ANCHORAGE Department f Health and Environmenta Protection 825 ~ Street, Anchorage, AK. 99501 264-4720 HANDWRITTEN PERMIT Permit Applicant: Mailing Address: Location: ~~ ~ ~'/~ f~'- Phone Number: Legal Description: ~ .6) ~ ~ ~~o~ ~ Lot Size: Type of Soil Absorption System Is: ~/~/~/~'/~_~/~/~ ~-/~A/ Trench: ~- Drainfield: Maximum Number of Bedrooms: -~-~ Seepage Bed~ ~ Holding Tank: Soil Rating(sqoft/br) ~_~ DEPTH The Required Size of the Soil Abso.rpt~n Sy~.tem I~s: LENGTH ~ . GRAVEL DEPTFI WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = _./~ GALLONS * * Permi~ applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimu/n distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the System in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more tha% 3, bedrooms. Applicant ~0o,"-~0 /~ Zy/~a~ ~.. Z 2/'24/:: 4 L. EGRL DESCRIP: SUBDI'VZSION: SECTI ON: TOi,;.IH::'.:;H ]: F:': 999 L:OT !.:;IZEE: ,.'.'Si:;). F:'T. OR FIC, RES) MR',*; EK;DROOH:,:;: L OiT LZ.: t El. EFL]H RRE THE OPTIONS Ff,/FtlLF:E~LE TO "¢0U tN [:,ESIGNING "¢OUR SEF'T lC: .::,, ;:, [ [:al L CHOOSE THE: OF'T I ON THFFT E~EST [" .I...:' '¢OUR S t TE:. [:,EPTH TO PIPE EK]TTOM ,::F-T'. ) GRRVE]_ DEPTH <F'T, TOTFIL.. DEPTH ,::FT. > GRRVEL. k~Zl]:rFH (F'T'. GRRVEL L:ENGTH (F:'T.) GRF¢,,,'EL. VOL. L.IME (CU. '¢[:,S. ::, TF~NK SIZE (GFIL. 5> SOIL RFBTING ,:;SQ. FT. /DR) 4=0 4,.E~ 4.0 3, 5 0. 5 ;,2, 5 7. 5 4. 5 E;, 5' 2. 5 22. 0 5. 0 DS. 0 ms ¥S. 0 84. 8 :+:m ]:5. :I. S5. 8 46. 6 228 ;299 228 :+m,: GRFF,/EL. L, ENGTH :::. ""~':. FI". t:;i:EQUIRES MUL. TIF'LE RUNS (NO]" E;:<:::EEDZN3 :'*, .. FF. EFICH) :m+: TRNK MUST HFtVE RT LEI:::IST ]"F.tO CC$'IF'RRTMENTS t CERTZF"r' THFtT': :1.. I P3M F'Rh'IILIFIR NITH THE REQUIREME;NTS FOR ON-'SITE SEI4ERS FtI"4D NEL. LS RS :SET FORTH B'¢ THE MUNZCZPFtL. ZTW OF IgNCHC)RFK:~E '::MC)F~) FIND THE STRTE OF RLF~SKF:I. ;2. I NZL. L INSTRLJ_ THE S'¢STEM ZN F~CCORDFINCE NITH RLL MOB CODES FiND REGOLF~T'ZONS., RND IN COMPLIRNCE NITH THE DESIGN CRITERIR OF THZS PERMIT. ]:. I NILL FtDHERE TO FILL. MOR RND STFtTE OF RL, FE~;Kfl REQLItRE]*KENT'S FOR THE SET BFICK DISTFfi'.~CES FROM FIN'.¢ E;:< I ST :[ NG FKEL. L, NRSTEI4RTER DISPOSRL, S',r'STEM OR PUBLIC SEI4ERFK]~E S'.¢STEM ON THIS OR RN',¢ RDJFICENT OR NERRB9 LOT. 4. I UNDERSTFIND THFFF 'T'I,"~IS PERMZT IS VF:tL:ED FOR R MR;:<ZMUM OF 3 BEDROOMS RND RN'-/ E:NL,FIRGEME:NT 14 IL.L. REQU I RE RN FtDE:,Z"FtONRL, PERMIT. It:"-" f:l LIFT 5TFFI'I. ON tS tNSTFILLEZ[:, IN RN FIREFI C:OYERED B"¢ MOP, BUIL.[:,.TNG CODES, THEN (:L) RN EL.E:CTRICRL PERMIT fiND INSPECTION MUS]' E:E OEFFRINED.* (2) FtS-BUI NIL. L, NOT BE RPPROVED 1,4ITHOUT FIN EL. ECTRZCRL iNSF'ECTION REPORT,; RND 42:) ELECTRII];RL WORK MUST BE DONE E',Y' I:::~ LZCENSED ELECTRICIFIN. 3HEP [:*FFTE: FtF'F'L, I CFff',FF: E:Ft t F::D ~t~ONF:ILC' MUNICIPALITY OF ANCHORAGE Departmen% f Health and Environmenta Protection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~ ?~a~:~ ~:~ :~p /: WELL AN~ ON-SITE SEWER PERMIT Applicant: .77?~ L, ,./:-C~ Mailing Address: ~:~- Location: Phone Nun~oer: Legal Description: ~!./~:-t:- /~/~:~ ~ ~F~ A~X~ ~_¥':~ot Size: Type of Soil ~sorption System Is: Trench: Drainfield: ~-~/~epage Bed: Holding Tank: Maximum Number of Bedrooms: .~ Soil Rating(sq.ft/br)~%-:~" The Required Size of the Soil ~sorption System Is: GRAVEL DEPTH ::-: WIDTH The length dimension is the length(in feet) of the trench or drainfield, The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the o~tfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = ~ __ GALLONS ~ * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve, * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution, Minimum distance between a well and any on-site sewage disposal system is 100 feel for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion~ Other requirements may apply. Specifications and construction diagrams are available to insure proper installation° * * * PERMIT EXPIRES DECEMBER 3L 1 9 * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may ~quire enlargement if to include more thai bedrooms. the residen~ee is.remodeled A~plicant SWP/024 (l/S1) Issued b Date: ,- (-~7- ~ -- ~'>/7~ ~ ~¢'SOl LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG = PERCOLATION TEST ffEROO LATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 10 11 12 13 ~'~~~ DATE PERFORMED: ~.~/"~_/~ SLOPE SITE PLAN WAS GROUND WATER ~_~ S ENCOUNTERED? 14 15 17 18 19- PERCOLATION RATE TEST RUN BETWEEN COMMENTS ~.~.%~--~t~ _~_~ ~ PERFORMED B Y: ~Q ~,~ 72-008 (6/79) Gross Net Depth to Net Time Time Water Drop 9 CERTIFIED BY: J.% _ FT AND FT 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 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? DATE PERFORMED: ~'~ SLOPE SITE PLAN 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: __~ (minutes/inch) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 204-4720 SO~LS LOG = PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMED:~V [~.~ / 8 ~' 2 4 5 6 7 8 9 SLOPE SITE PLAN 10 11 12 13- 14- 15- 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Gross Net , Depth to Net Time Time (~i~) Water Drop ,oH PERCOLATION RATE ] ~ (minutes/inch) TEST RUN BETWEEN ~ FT AND ~ t/~ FT 72-008 (6/79) ALASKA r UIROrlmEIBTAL COIqTROL SEI LIIC S, IiqC. Enqineerinq $ ~nuwonmenk~l $1udies SPECIFICATIONS FOR ELEVATED MOUND DRAINFIELD SYSTEM - LOT 5 BLK 2, EAGLEBROOK #1 SUBDIVISION 1o0 GENERAL 1ol THE DRAWINGS SHALL BE A PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE, THE CONDITIONS OF THE PERMIT, AND ALL APPLICABLE RULES AND REGULATIONS CURRENTLY IN EFFECT° 1o3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE VERIFIED OR MODIFIED IN THE FIELD BY THE CONTRACTOR° 1.4 IT IS THE RESPONSIBILITY OF THE OWNER OR INSTALLER TO OBTAIN ALL NECESSARY PERMITS, EASEMENTS~ OR WAIVERS REQUIRED FOR INSTALLATION OF THE SYSTEM° 1.5 SOIL CONTINUITY: DIG ADDITIONAL SHALLOW TEST HOLES PRIOR TO EXCAVATION OF THE BED TO ENSURE CONTINUITY OF THE 2 FOOT SILTY SAND/SILTY GRAVEL SEAM INTO WHICH THE SYSTEM IS TO BE PLACED° THIS STEP IS STRICTLY PRECAUTIONARY, TO ENSURE THAT THE SYSTEM CAN INDEED OPERATE PROPERLY AND TO AVOID UNNECESSARY EXCAVATING EXPENSES SHOULD THE AREA PROVE UNSUITABLE° 2.0 SEPTIC SYSTEM 2ol THE SEPTIC TANK SHALL BE A UPC APPROVED TWO COMPARTMENT TANK, SET LEVEL, AND INSULATED WITH AN OVERLYING LAYER OF 2 INCH BURIAL TYPE POLYSTYRENE° THE SEPTIC TANK SHALL REST ON UNDISTURBED SOIL. 2°2 INLET AND OUTLET PIPING SHALL BE FITTED WITH WATER- TIGHT CALDER COUPLINGS° PIPING SHALL BE 4 INCH SOLID PVC SLOPED A MINIMUM OF 1/4 INCH PER FOOT, WITH A MINIMUM OF 4 FEET OF COVER° IF LESS THAN 4 FEET, USE 1 INCH OF POLYSTYRENE FOR EACH FOOT OF COVER LESS THAN 4 FEET° 2°3 CLEANOUTS SHALL BE INSTALLED WITH CALDER COUPLINGS, CAPPED WITH AIR-TIGHT JIM-CAPS (OR EQUIVALENT), AND EXTEND A MINIMUM OF 3 FEET ABOVE GROUND LEVEL° 2°4 THE SEPTIC TANK SHALL BE A MINIMUM OF 5 FEET FROM THE HOUSE FOUNDATION, AND A MINIMUM OF 5 FEET FROM THE DR AINFIELDo 3°0 DRAINFIELD SYSTEM 3.1 THE GRAVEL FOR THE BED SHALL BE SIZED BETWEEN 0.5 TO 2°5 INCH AND FREE FROM SILT OR SAND° 3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION° THE BOTTOM ELEVATION SHALL BE PLUS OR MINUS 2 INCHES WITHIN LEVEL. 3°3 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL° 3° 1200 UJcsl 33rd Aucnue, $uii¢ [~ e Anchoroq¢. Alaska 99503 e[907) 56150z10 3.4 TWO OBSERVATION PIPES SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL BE RIGID PVC~ ASTM D-3034~ THE SECTION BELOW GROUND LEVEL MAY BE EITHER DRILLED 0°5 INCH HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A REGULAR SECTION OF PERFORATED DISTRIBUTION PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT° A RUBBER RAIN-CAP (JIM-CAP OR EQUAL) SHALL BE PLACED ON THE TOP OF THE PIPE. 3°5 THE GRAVEL SHALL BE COVERED WITH A LAYER OF UNTREATED BUILDING PAPER OR A NONWOVEN FABRIC (SUCH AS MIRAFAR FIBRETEX 200 GRADE~ POLY-FILTER X, OR EQUAL.) 3.6 IF INSULATION IS USED RATHER THAN MOUNDED BACKFILL, THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM BOARD OR ARCO GEOFOAM EMBANKMENT INSULATION BOARD OF THE REQUIRED THICKNESS (1 INCH PER FOOT OF SOIL LESS THAN 4 FEET OVERLYING THE BED)° 3.7 THE TOP OF THE BED SHOULD BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX, OR BLUEGRASS. 3°8 IT IS CRUCIAL THAT CARE BE TAKEN IN CONSTRUCTION OF THE BED TO ENSURE PLACEMENT INTO THE PROPER SOIL STRATUM FOR PROPER OPERATION OF THE SYSTEM. MUNICIPALITY DE ANCHORAGE DEPT. OF: HEALTH & ENVIRONMENTAL PROTECTION' MAY 2 1 1984 ALASKA EI~VIRONMEN~AI~ CONTROL SERVICr- INC. 1200 West 33rd Avenu~ Suite,B ANCHORAGE, ALASKA 99503 Phone 276-1361 CALCULATED BY-- -- ~J~ CHECKED BY SCALE - OF DATE w??e ; / . 4~0¥ o-F' ALASKA ENVIRONMENTA~ CONTROL SERVICr INC. 12OO West 33rd Avenue Suite B. ANCHORAGE, ALASKA 99503 Phone 2764136:1 CHECKED BY ..... DATE___ SCALE ALASKA ENVIRONMENTAL CONTROL SERVICr INC. !200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276.3.363. SHEET NO. CALCULATED BY CHECKED SCALE ALASKA ENVIRONMENTAL CONTROL SERVIC[r iNC. !200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-136[ SHEET NO .... ~ OF--.~ CHECKED BY ....... DATE SCALE ..... $,, /',~ p vc ALASKA ENVIRONMENTAL CONTROL SERV~C[r INC, 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-~,36:1 SHEET NO.- OF.- CALCULATED BY /~J~- DATE CHECKED BY DATE SCALE. SURVEYOR'S CERTBF~ATE ,hereby certify that the ~ollowing described property has been Surveyed by myseJf, or ur~der my supervision, and the comner;.~ shown on th~.~ drawing a~'~ e×Jsl[ing ,~s of She .d.a~e of Survey. R~TURN TO: Dlvl$1on of Geological ohyslcat Surveys (DGGSI 3.001 Porcupine Or,ye Jne: 277-6615) Anchorage, Alaska 99501 WATER WELL RECORD Drilling Company Nar~ .OCATION OF WELL I Please complete either la, lb, or lc. la. Boroughq~G~ Subd4~v s °n~ ~, ~ ~L°t ~glock Ilb. Fractlon~ / / / ~ Section NO. WELL LOG Hateria) Type Peet Below Surface Top Bottom Drilling Permit No. A.0.L. No. DEPARTNENT OF flATUfli~L R~I~J;~$* '' meridian J Township N/S IRange E/W J ,, OW.ER 0F WELL: Address: ~. ~ELL 0EPTH: (toe,Dieted) 6. USE: Surface Elevation Oete of oa~p~ let lan [~ Dug FINISH OF WELL: Slot/~sh SIz~: Set betv~en - Fittings: STATIC ~ATER LEVEL: ~ ft. [~Aboee [~eelow land ~urf~ce Ty~ of Heasur~nt: Length: ft. end I0. PUmPiNG LEVEL heidel lend surface ~,:r'_ ft, after __ ~L hrs. p~ing ~$op.-. ~ ft. after ' hrs. pump{ng ~ g.p.m. 11. WELL HEAD COMPLETION: [~] In Approved PIt ~Pltl~s~ Adapter ~ Inches e~ve grade 12. GROUTING: ~11 Grouted: [] Yes [~k~) meter~al: [~Neet Cement [~Other: 13. PUNP: (If available) HP ..... Length of Drop Pipe ~ fL, ca,city .-- . g.P.~ Type: ~Sub~r~lble ~Reclprocatlflg ~Jet ~Ocher: Iq. REMARKS: Water Temperature: 15. WATER WELL CONTRACTOR'S CERTIFICATION: Thls well was drilled under my jurlsdictlo~ and this report is true to the best of my knowledge end belief: Registered Business Name Authorized Repre*enta t Contract L~cense Nun~ber Distribution: WHITE - State DOGS. PINK" Driller, CALORY - Culto~r 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~ ~=~)~-~-~/'~'-'~ NAA # ~O~ GENERAL INFORMATION Complete legal description Location (site address or directions Property owner (~O~J ~L~ Mailing address ~, '2_o0 Lending agency Mailing address L. ~l¢-~ Day phone 3 Day phone Agent .... i~l ./,A- Address I'& [,Ar Day phone Unless otherwise requested, HAA will be held fo~uj~. NUMBER OF BEDROOMS: ~'T-~r-~'~'",/ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on=site Public sewer NOTE: 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 t/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 -q~ __5_~vic~-__~ Phone i~37-~_/79 Address ~'¢r-'"/t ~~~( ~,/ ~'~ ~*~ Engineer's signature __.%~ ~.~. ' ~ DHHS S~GNATURE ,~x~ Approved for Disapproved. bedrooms. Conditional approval for CE~7953 ,, .~ ¢, bedrooms, with the following stipulations: Additional Comments By: 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 engineer's work. 72~)25 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Parcel I.D, Well type ~tVA:T'¢~- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) k¢~__% Total depth Sanitary seal (Y/N) Date completed Cased to Driller VF_.P-~'$ ~ ~_~J_~ ~ 2'-7 _ = Casing height Wires properly protected (Y/N) MUN'~L~' OF ANCHORAGE ENVT~ONMENTAL SERVICES DIVISION FROM WELL LOG AT ,NSPECT,ON JA[4 2 4 i99t Date of test G//'Z'Z./D~ .. ,~/Z~/*, Static water level =¢ RECEIVED Well flow [0 g.p.m. ~ g.p.m. ~ Pump level UN~ U~O~M SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ 12.© ~ Absorption field on lot ONIC¢o~]~ k,~.~F-~-~¢~ ~ Public sewer main Sewer service line ; On adjacent lots , On adjacent lots A~o~ Public sewer manhole/cleanout Petroleum tank ~ /~ WATER SAMPLE~SULTS: Coliform )"' Nitrate Date of sample: / / ,~O/ m~/~ (_/dD) Other bacteria / Collected by: ~:~P'C--~'J ~ -~' -~ B. SEPTIC~HOLDiNG TANK DATA Date installed ~/'r,/ Cleanouts (Y/N)' High water alarm (Y/N) Tank size [(:DO0 ~,LLOIq.G Compartments :2_ Foundation cleanout (Y/N) X/'F~ ~ Depression (Y/N) NO _ Alarm tested (Y/N) Iq//% To property line G ~' Surface water/drainage 72-026 (Rev. 7/91) Front (~ Date pf pump.lng ...... ? ~~;. ~/~1 ...... Pumper SEPARATION D STANCES F~OM SEPTIC/HOLDING TANK TO: Well(s)onl~~:~ ,~ ~:~% . On adjacent lots :' ~0¢~ Foundation ~' ~Absorption field ~ ~ · Water main/service line . OONTINUED ON BAOK PA~E Date installe~ Size in gallons Manufacturer Manhole/Access (Y/N) High water alarm level '~'~--~_ Cy~_.Je~l'~ted ~ Meets MOA electrical codes (Y/N) _ ~ ~- ¢-~ ' W~ On adjacent lots S~face wate~ D. ABSORPTION F~ELD ~ATA Date installed ~// ~ ~ Soil rating I~ System type Length 5~ ¢% Width ~0 ~% ~thickness ~'~ ~ Totaldepth "~ Total absorption area ~ ~%~ ~ Cleanouts present (Y/N) Depression over field (Y/N) ~ 0 ~ ~o~ o~_ Date of adequacy test Results (pass/fail) ~ % ~ for ~~ bedrooms Peroxide treatment (past 12 months)(Y/N) ~. ~ ~f yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO' ~P¢ ~?~ Wellonlot u~o~ ~JOnadjacentlots ~>~ I00~' Propertyline To building foundation u~o~m~ ~ To existing or aba~d~d system on lot ~/~ / ~ ~v~ 0~ ~- On adjacent lots ~ lO F~ Cutbank ~ ~ Water main/service line o~ ~ ~O- Surface water ~ / /~ ~~ Driveway, parking/vehicle storage area E, ENG]NEEff'S CERTIFICATION I certify that I have checked,~rified, or conformed to all MOA and HAA guidelines in effect on ~, t~is inspection Signature Ge - Engineer's Na~/4 ~~ ~. HAA Fee $ / / U Waiver Fee: $ Date of Payment /¢ ~ ¢' ~ ~- , Date of Payment / _\ Receipt Number ~- -~'~ ~,~) Receipt Number CHEMICAL & GEOLOGICAL lABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO, 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX:(907) 56%5301 ANALYSIS RESULTS fo~ INVOICE ~ 50492 Chemlab Ref.~ 92.0224 Sample ~ 1 ~attix: WATER Client Sample ID : ~ITCHEN L5 E2 EAGLEBROOK PWSlD : UA Collected : JAN 20 92 8 08:45 hze. Received : JAN 20 92 ~ 11:25 ks. Client Acct EPO~ : PO~ :NONE RECEIVED Beq$ : Analysl~ Completed : JAN 20 92 Send Report~ to: Laboratory Supexvlsoz : STEPHEN C. EDE I)A~ ~ATER ~ WASTgt~ATER SERVICES Pazamete~ Results U~t8 ~et hod Allowabl~ Limit~ NITRATE-N ND(O. 10) ~/1 EPA 353.2 Sample ROUTINE SAMPLE COLLECTED BY: JEFF GARNESM. 1 Te~t~ ?erfo~med ~ See ~pecial Instruction8 Above UA~Unavallable ND= None Detected *' See Sample Remark~ Above NA- Not Analyzed LT~Less Than, GT-Ozeater Than Member of the SGS Group (Soci~t¢ G~nCrale de Surveillance) Alaska Water & Wastewater Services "Preserving the Last Fron tier" RECEIVED MuniciPality of Anchorage ~.~pt He~ t~ & Human Service~ The Tehtphone - Fax 388-3246 o 8471 Brookridge Drive o Anchorage, Alaska {)9504 Loca6io~' of ~;,b~ (irainfiel, 8 on tho ~r-o:~er~;y Accordin9 -~o 1. General Information (a) Legal Description (include lot, bIock, MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRON~iENTAL HEALTH APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE subdivision, section~ township, range) Location (address or directions) :'7 ' (b) Applicants Name_~pc~_~~___ ~?lej~ne - Home Applicants Address ~ ~j~7~ (c)Buyer Applicant~is~ Other (check~one)(explain);Lending Institution ~ ~ Owner/builder.~ (d) Lending Institution Telephone Address (e) Real Estate Co~ & Agent Address Telephone (f) Mail the HAA to the following address: 2. T~3e of Residence Single-Family.' Number of Bedrooms 3. Wa_ t~r__Su~ppl~ Individual Well:: Multi~Family ~.~ Other (describe) Note: If community well system~ must have written confir~ation from the State Department of Environmental Conservation attesting to the legality and status. 4. Onsite ~, Fublic ~ Community ~ Itolding Tank ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status° [Page 1 of 2] E~ineerin~ Firm Prgvidin~=n~_ec~ioas_~_Tests~ile Search~z_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~si~e 'water supply and/or ~stewater disposal system is sara, functional and ~equate for the number of bedrooms and type of structure indicated herein. I further verify that~ based on ~he info~ation obtained from the Mmnicipality of Anchorage files amd from my investigation and inspection~ the on-site water supply and/or was~ewater disposal system is In compliance with ~1 Municipal and State codes~ ordinances, and regula- tions in effect on the date of this inspection~ Name of Fir . cf:~_ ?-~a~- Telephone ~;f/.-~c,z/~ (E NGINU~ER SEAL) DHEP A~proval Approved for %i~ bedrooms Approved ~ Disapproved Terms of Conditional Approval By Dat~ Conditi~ CAtr£ION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF IU~ALTH AND ENVIRONMENIAL~ iRO~EC%ION~ ~' ~ (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON T~E REPRESENT- ATIONS GIVEN IN PAP~IGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA, THE DHEP DOES THIS AS A COURTESY TO PURC~{ASERS OF HOMES 7nND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE~ MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CEI~TIFICATE IS ISSUED~ THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK° (DHEP SKAL) RR4/eJ/D18 [Page 2 of 2] 7~19~84 WELL DATA Well Classification Well Log P~esent CHECKLI~ - FEBRU~Y 1984 Legal Description: If A, B, ~ C~ D.E.C. App~o~d(J~) Date ~leted ~ 6~/~ Yie ld~ Total D~pth ~ Cased to ,~ Static Water ievel _~~II[~Pump Set At Casing ~ight ~ Ground ~ ~ Elec~ical Wi~inu in ~nduit ~) Sep~ation Distance f~ ~11: To ~ptic~olding Ta~ ~ ~t /~,~ ' ~ Depth of C~outing~ ; 9_.%~. ' Sanitary Seal on Casing Depression A~ound Wellhead _; On Adjoining Lots To Nearest Edge of Absorption Field on Lot _~ Il.} ~; On Adjoining Lots~ To Nearest Public Sew~ Line ~ To Nearest Public Sewer Cleancut/Manhole~ TO Nearest Sewe~ Servic~ Line on Lot _ Wate~ Sample Collected By . ~~; Date 9// /~ ~ .. Wate~ Sample Test Results ~~&F~?; ~) , B. SEPT_IC/HOLDING TANK DATA Date Installed ~ Size ~,~.9C)O No. of Cc~pa~tm~nts Standpipes~N) 6i~-tight Caps ~Foundation Cleanout ~ession o~ Ta~ ~ ~te ~st P~d P~inu&intenan~ ~n~act on File (Y~/~ ; fo~ ~/~ Holding Ta~ High-Wate~ Ala~~~ra~y Holding Tank ~r~t (Y~)~/~ Sep~ation Distance ~ ~ptiC~old~nu Ta~: To Wate~-Supply~ll~ To ~ildinu Foundation ~ _ To ~o~ty Li~ I~ To Dis~sal Field To ~ter Main/Se~vi~ Li~ ~To S~e~, Pond~ ~e~ ~ Major ~aina~ Counts [Page 1 of 2] Receipt ~ Date Paid: Amount: ~ 2-15-84 Co ABSORPTION FIELD DATA Soils Rating in Absorption Strata I~O ~ Type of System Design _~ Date Installed ~//Ki.~,~ Length of Field. ~.~( Width of Field ~ ~ Depth of Field ~ I Gravel Bed Thickness~ Square Feet of ~sorptionA~ea ~>O~ ~ Standpipes P~esent)~_~____ Depression over Field (Y~ Date of Last Adequacy Test~ Results' of Last Adequacy Test__~ Separation Distance f~omAbso~ption Field: To Water-Supply W~ll ~3~I To P~operty Line ~ To' Building Foundation ~L~ To Existing or Abandoned System on Lot ~ ; On AdjoiningLots ~3~~ To Water Main/Service Line _~li~~ To Cutbank(if p~_esen~ To Stream/Pond/Lake/c~ Majo~ Drainage Course~__ ~ To Driveway~ Parking A~ea, or Vehicle Storage A~ea ' ~? D. LIFT STATION Date Installed ~1~__~ Dimsnsions , , Size in Gallons /~/~ Manhole/Access (Y/N). /1fl/d . . :'Pump On" Level at ,'tJ/b~ "Pump Off': Level at _~/Uz .~2' . / High Water Alarm Level at /ti//4 Vent~____r__ Tested for _ ~//~4 Pumping Cycles du~ing Adequacy Test° Meets MOA Electrical Codes(Y/N) ~I//~ comments ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or confo~rr~d to all MOA HAA Gu on the date of this inspection. Company t0 ~l/dS/s Date~ MOA No. ~'~-c ~.~ nes in effect [Page 2 of 2] 2-15-84 rVtUN~C~PAL~ ~'Y OF ANCHOF~AGE MEMORANDUM Signed _ i .... 91-015 (Iq~v. 1/81)