HomeMy WebLinkAboutCHUGACH PARK ESTATES BLK 1 LT 15o '1
GREA,,.R ANCHORAGE AREA BORC'-'$H
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REP,Oo,~T ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE ~
FROM WELL /~,~> / MANUFACTURER ~, MATERIAL
INSIDE LENGTH. INSIDE WIDTH
NUMBER OF
COMPARTMENTS
LIQUID DEPTH LIQUID CAPACITY g~ ALLONS.
TILE D RA I N,-F4EJ.J~:
DISTANCE FROM WELL /~)~) ~"'FOUNDATION ~-~-~'~ /
NEAREST LOT LINE
NUMBER OF LINES / . DISTANCE BETWEEN LINES --
AREA~-~~/ SQ. FT. LENGTH OF EACH LINE
ABSORPTION
,v~.~./ DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE"7----~.
TOTAL LENGTH
OF LINES ,,~,~
~...~.,_...___TRENCH WIDTH_~ IN. TOTAL EFFECTIVE
IN. ABOVE TILE ~//'~.,~ IN.
WELL: _
TYPE__F/~6/J0. .~-/~ CONSTRUCTION DEPTH
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION~ LOT LINE__, SEWER LINE__, TANK__ SYSTEM
DISTANCE FROM:
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED
INSTALLED BY:
SEWER LINE DEPTH:
LOT SLOPE: Z au - /
Form LQ-032
REMARKS
DIAGRAM OF SYSTEM
I--J E L L ~i~I r~i I-:. il_--, I'-J ~ ~ '1" T ESS ~ ES L-J E F~:
RF'F'LICRI".IT F'~.'.II",IG HARNESS & 0ZEN ,-:Q~:0X 4-2022
DEPRRTMENT C~" HEALTH AND ENVIRONMENTRL F'~OTECTION
725'16 E. ,,_IDOR RD.., ANCHORAGE., AK. 9.'_ .£17
F' E ~.' I"-1
279-74.=_;4
LOT SIZE -%~0 SQI_IAF.'.E FEET
RATING ,:;S6! FT/BR)=' -~-:=-,'~
KULLBERG DR
L&5 B$ CHUGACH PK EST
LOCATION
LEGAL
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
SOIL
MAXIMUM NUMBER OF BEDROOMS
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
B, EF'TH= -1 i LEf4I]TH= 22 GRR'..-'EL E:,EPTH= ¢:-;
THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRRINFIELD.
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 OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
REIi-!LI I F-:EE:, SEF'T 1" f--; TRr-,ii-::.' S I ZE= :_lbl----11L---'1~__--I ISFILLI-~I'-JS
'TL-JCw <2) I NSPEC:TIIZI[-JS R~:E ~:Ew;!i_ll F:EE:,
BRCKFILLING OF RNY SYSTEM NITHOUT FINRL INSPECTION RND RPPROVRL BY THIS
DEPRRTMENT NILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETNEEN R NELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
100 FEET FOR R PRIVRTE NELL OR 200 FEET FOR R PUBLIC WELL.
NELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS
OF THE NELL COMPLETION.
SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER
INSTRLLRTION.
F'ER~'I IT '-.~RLl E) F'I~IF: IlIr4E ','ER~: F--~<'-.~3£-1 I SSi_iE
I CERTIFY THAT
1: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND NELLS AS SET
FORTH BY THE MUNIF:IPBLITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN RCCOR[:,RNCE WITH THE CODES.
2:: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 5: BEDROOMS.
, ~/ ~ /.~ , .
S I GNED ' / ~
-~PFE~C~N~--[~-~"RN~SS t~ 0 ~ ~N CONSTRU,::
ISSUED E:Y ~~~;~ DATE-dO --
GRE,.,l'ER ANCHORAGE AREA bot. ,UGH
3330 "C" STREET ANCHORAGE, ALASKA 99503
T E L EP H O N~74~
SEWAGE DISPOSAL SYSTEM --~::ZlgHf~CATION AND PERMIT
INSTALLATION LOCATION
'EGALDESCR'PT'ON / ,'",/':
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT
DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH tO BE INSTALLED BY
SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
Final INSPECTION: Z, HOUR NOTICE REQUIRED. BACKFILLIN(F.~II~YS~I~I~/~Fli~L~II~ iNSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL B~ SUB.CT TO PRO~CUTION. ~
SEPTIC TANK SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION tO SEPTIC TANK
FOUNDATION tO seEPAGe Pit
SEPTIC TANK TO SEEPAGE PIt WALL
SEPTIC TANK , SEEPAGE PIT
TO NEAREST LOT Line.
WELL TO SEPTIC TANK
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, , SEEPAGE PIT
TO RIVER, LAKE, STREAM.
DRAIN FIELD
., DRAIN FIELD
SEEPAGE AREA SIZE
SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
.,DRAIN FIELD -- --
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
TYPE
DIAGRAM OF' SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ~ . J~ /
DATE APPL,CANT'S S,GNATUREI
EQ-016(3-75)
( er ifie Drilling
b~
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577
OWNER OF LAND .~l~-d~
ADDRESS 3 o~" ~
LEGAL DESCRIPTION
PE~IT NUMBER
· TELEPHONE 694-2588
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
DRAW DOWN FT. 4 0
GALS. PER HR [o,)
O
KIND OF CASING ~ ~ · 49
KIND OF FORMATION:
From 0 Ft. to 2 Ft. tgC/~f~P'_.6~v~'~'''O From__
From C'~ Ft. to 4[0 Ft. ,Y~q'°O ~' ~~ From~
From ~ Ft. to 7~ Ft. fn~D ~/ ~4~C From~
/
From 7~-- Ft. to qO Ft. ~4~ ¢ g~,~ From~
From qO Ft. to I~o Ft. ~0~ ~( From~
F~om I~o ~t. to /~1 Ft. ~T + 6e~ E~om~
F~o~ /70 Ft. to /~Ft.~V CeffU~.~0~a~c~~~ ~o~
F~om Ft. to n.~/ ~F~ E~m
I
F~om /~3 Ft. to ~ Ft. ~[Edo¢< 5oztO
Fromm. Ft. to Ft. ~ ~o~Z 4~
F~om ~E~ Et. to ~o~ Et. /~d~<~ ~o~D
From Ft. to Ft
From ~ Ft. to. Ft.
From Ft. to Ft
Ft. to Ft.
Ft. to Ft.
Ft. to Ft,
Ft. to Ft.
Ft. to Ft
Ft. to Ft.
Ft. to Ft.
__Ft. to Ft.
Ft. to___Ft
__Ft. to.__Ft
From Ft. to Ft.
From__Ft. to__Ft.
From__Ft. to Ft.
From Ft. to.__Ft.
From Ft. to Ft.
From Ft. to Ft.
From__Ft. to Ft
MISCL. INFORMATION:
/~0 ~~ ~ ,,
:~,'E~.~ P
DRILLER'S NAME
MUNICIPALITY OF ANCHORAGE
Department of Health and"Environmental Protection
SOILS LOG
Performed for Butch King
Legal Description Lot 15 Blk
Date Performed 10/16/76
Chugach Park Estates Sub.
6
14
18
20
red brown sandy silt w/organics (MC) perc:275 ft~drm
brown gray sandy well graded gravel (GW)
perc rate = 85 ft2/bdrm
Tnesl Depth = 1~,
no water table encountered
AVERAGE PERC RATE FR0~ SOILS LOG = 95 ft2/bdrm
Date Net Time Depth Net Drop
Percolation Rate minute
. ' MUNICIPALITY OF ANCHORAGE
- MUNICIPALITY OF ANCHORAGE -.
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT~r,~TI~,';;~t,
,L ,h :..,CTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTALENG,NEEmNG DW S,ON DEC 1. 5 1978
Telephone 2~720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S~~L~S
DIRECTIONS: Complete all parts on page 1. Incomplete r~u~ will not be pr~. ~e~ Mia ~
1. PROPERTY OWNER PHONE
MAILING ADDRESS
PROPERTY RESIDENT (If different from ahoy) PHONE
2. BUYER PHoN'E
~ '
MAILING ADDRESS
3. LENDING iNSTITUTION PHONE
MAILING ADDRESS
MAILING ADDRESS
6. LEGAL DESCRIPTION
STREET LOCATION
S. TYPE OF RESIDENCE
~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One [] Four
[] Two [] Five
~- Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)'
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE'*
[] PUBLIC UTILITY
**If individual/on-site, give installation date ~"~'7 ,.
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 ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
I NSP ECTOR INSPECTOR I NSP ECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTI LITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank o_r [] Holding Tank
Size: ! (~(~X:~ If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SlX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
I- --"t rh
INSTALLER
SOl LS RATING
MANUFACTURER
MATERIAL ~..~~
Septic/Holding Tank IAbsorption Area
Sewer Line
[] OTHER
INearest Lot Line
5. COMMENTS
DATE
~;~APPR OV E D FOR
t~EGA L DESCRIPTION
{Rev. 3/78)
~'~ BEDROOMS
CONDITIONAL APPROVAL (letter must accompany certificate)
DISAPPROVED
/~-(:~'~lBY(Title~_______ ~.
MUNICIPALITY OF ANCHORAGE -'-''-'Olt~
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~:~/ Z~ ~// ~/ 0
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ,~ ~)-).., ~c~.~O q
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
CHUGACH PARK ESTATES SUBDIVISION, Lot 15, Block 1; T15N,
Location (address or directions)
PLATSEK D~LIVE - PETERS CREEK ALASKA
R1W, Section 15
(b) Applicant Name JEFF AMISTOSO Telephone: Home N/A Business 694-6001
Applicant Address 12212 OLD GT,'RNN HIGHWAY: KA(',T,F: RZVF~: AK 99577
(c) Applicant is (check one): Lending Institution [] ' Owner/builder []; Buyer []; Other ~[~ (explain);
RW. AT ,UV)R
(d) Lending Institution T~MAR ~, N'RT[q~,~N Telephone 276-_~542
Address ~00 "R" STRk~P~ ,qT]Tq~, 103; ANCHORAGe; AT,ASKA 99503 A~:
(e) Real Estate Company and Agent RT~ ~ PR~P~T~.q A~: ,T~ A~K~O
Address ~22~20T,~ ~T,~ ~A~, ~AOT,~ R~R~ AK 99577
Telephone 69~-6009
(f) Mail the HAA to the following address:
D~BIE
TYPE OF RESIDENCE
Single-FamilyZ][ Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Well~. Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite;~[. Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
A.s 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 EAGLE RIVER ENGIN-~.RZNG SERVICES Telephone 69~4-5195
Address P,O. BOX 773294, EAC?T,g RI-VER, AK 99577
Date .Y-,,/'~
Approved for ,~ bedrooms by .
Approved .~/~, Disapproved Conditional
Date Y-~O--~ 7
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)
MUNICIPALITY OF ANCHORAGE (MO~;
HEALTH AUTHORITY APPROVAL (HAA)
NtCIPALITY OF ANCHORAGE
MU si'CHECKLIST- FEBRUARY 1984
ENVI~,ONMENTAL SERVICES OlVl ON 264-4720
WELL DATA
Well Classification
MAY ,g87
RECEIVED
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N)
Total Depth ._~o~ /
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Date Completed
Depth of Grouting
Yield
Pump Set At ~.~P~' /
Sanitary Seal on Casing (Y/N) ~Y
Depression Around Wellhead (Y/N)
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
/?'~ ~' ; On Adjoining Lots "-/~ '
To Nearest Public Sewer
~,x/,~ To Nearest Sewer Service Line on Lot ~'~
~-¢-'"'J" "~"' 'Date -~-/"~/~ ~
B. SEPTIC/HOLDING TANK DATA
Air-tight Caps (Y/N)
Date Installed Size
Standpipes (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 ,"-/o
Course
No. of Compartments
Foundation Cleanout (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
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ,/~ 7 7
Width of Field ,3 /
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test -~
Separation Distance from Absorption Field:
To Water-Supply Well //~
To Building Foundation ~,~o
L o t
To Water Main/Service Line ~'/~-)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments /~--~ ;~" /-~
Type of System Design
Length of Field ~3, ,~_ /
Depth of Field ,~ /
Gravel Bed Thickness ~"
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
· On Adjoining Lots ~'-~ ~ /
To Cutbank (if present)
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 th~.y~~, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed''~'~ %c5::~'~'~:~ - Date
Company "~"~,~'~"-~ MOA No.
Receipt No. / 00 / ~) O ~--"-~'
Date of Payment ~"-//~'~/~,.~_)L
Amount: $ / G ~ ~
Page 2 of 2
72-026 (11/84)
Eagle River Engineering Services
P. 0. Box 773294
Eagle River, AK 99577
694-5195
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL 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 direc~ions)
(b) Applicants Name
Applicants Address
Telephone - Home ~ BuaA~mm~---
(c) Applicant is (check one) Lending Institution ~ ; Owner/builder ~;
Other 7--] ( plain);
cue
(d) Lending Institution
Address ~- /~t~ /~,
(e) Real Estate Co. & Agent /~
Address ~~
Telephone
(f) Mail the HAA to the following address:
2. Type of Residence
S ingle-Famtly..~--~.. Mul ~i-Family ~
Number of Bedrooms '(
3. Water Supply'
Other (describe)
Individual Well~ Community~ Fublic~--~
Note: If community w~ll system, mus~have ~written ~onfirmation from the State
Department of Environmental ~onservation ~esting to the legality and status.
4. Sewage Disposal ~
Note: If commumity well system,'must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and s~atus.
[Page 1 of 2]
I II
5. En~ineerin~ Firm Providin~ 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 m~ investigation of this Health Authority Approval shows that the on-site
water supply a~/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 i~o~aation obtained from the M~nicipality of Anchorage files and from my
investigation an~ i~pection, the om-site water supply and/or wastewater disposal
system is in c~pliance ~rlth all Mamicipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm
Address
Date
Telephone
_T*,%r.. A '..F ~ ,
% W... .... ' ........... "' ~"~
(ENGI~ER S~. .
_ '~ ~'. JUNE 25, ~71 .'~?~
DHEP Approval
Approved for Oed rooms By
, -
Approved ~ Disapproved
Te~s of CondiCion~ Approval
CADTION
THE MUNICIPALITY OF ANCHORAGE DEPA/~I~iENT OF HEALTH AND ENVIRONmeNTAL PROTECTION
(DHEP) ISSUES HE~TH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGILAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ~J~ASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF H~S AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MEN'rS. ~PLOYEES OF DMEP DO NOT COhIDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. ~ MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS INTHE P 0FESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
R~R4/eJ/D18
[Page 2 of 2]
7-19-84
ae
MUNICIPALITY OF ANCHOI:~GE.
DEPT. OF HEALTH 8,.
ENVIRONMENTAL PROTECTION
Well Classification /::::)~" ~'''~' ~
Well LOG P=esent (Y/N> X
Total Depth ~ ' Cased to
Static Water Leal / ~ 2k /
Casing Height Abo~ Ground /~ '~
Electrical Wiring in Conduit (Y/N)
Separation Distances f~cm Wall:
To Septic/Holding Tank on Lot /~9 ~
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
OCT g ' g84
RECEIVED
/.f- / s-/
To Nearest Edge of Absc~ption Field on Lot
To Nearest Public Se~r Line ~'~(_ To Nearest Public se~r
Cleanout/Manhole /~'~- To Nearest se~r service Line on Lot
Water Sample Collected By ~-;-,j,,,~_.e.,-, ; Date
Water Sample Test Besults
; On Adjoining Lots /&ED 7=
/D6) ~-- ; On Adjoining LOts /~ ~-
C~t~t~nts
S. SEPTIC/HOLDING TANK II%TA
Date Installed /gT? Size /~ ~/ No. cf Ccmpa=tments
Standpipes (Y/N) ~/ Ai~-tight Caps (Y/N) ~/ Foundation Cleanout (Y/N)
Depression ove~ Tank (Y/N) /~ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ~/~ ; for
Holding Tank High-Water Alarm (Y/N) /~/ Teapota~y Holding Tank Permit (Y/N~///~
separation Distances f=cm Septic/~olding Tank:
To Water-Supply W~ll /~)~ + To Building Foundation ~-!
To Property Line /o+ To Disposal Field
To Water Main/Service Line 'g~5' + To Stream, Pond, Lake, or Major D~ainage
Ccm~rents
[Page 1 of 2]
tol l ,v
2-15-84
C. ABSORPTION FIELD [I%TA
De
Soils Rating in Absc~ption Strata
Date Installed / 9 ? ?
Width of Field '~ ~ ~
Square Feet of Absc~ption A~ea ~
Depression over Field (Y/N) ~
Type of System Design
iength of Field ~ '
Depth of Field /7 '
Gravel Bed Thickness ~ '
~-46 Standpipes P~esent (Y/N)
Date of Last Adequacy Test
Results of Last Adequacy Test
Separation Distanoe f~cm Absorption Field:
To Water-Supply W~ll /~ ~- To P~opert¥ Line
To Building Foundation ~t~ ~- To Existing c~ Abandoned System cn
Lot /~)~-- ; On Adjoining Lots
To Wate~ Main/Service Line ~5-~ To Cutbank(if ~m~esent)
To St~eam/Pond/Lake/c~ Major D~ainage Course
To D~iveway, Pa~king A~ea, c~ Vehicle Stc~ac3e A~ea
LIFT STATION ~
Date Installed
Size in Gallons
"Pump On" Leal at
High Water Alarm Ievel at
Tested fo~
Electrical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
M~ets MOA
Cc~ments
** Check Permitted Bed~ocm Rating Against HAA Request
I ~e~-tify that I have checked, verified, c~ confc~med to all MOA HAA ~uidelines in effect
on the date of this inspecti~
Signed~/~_ ~~ Date ' o /~" /cc ~ .....
Cc~pany
KB1/d5/s
[Page 2 of 2]
2-15-84
CONSULTING ENGINEER
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TE LEPHON E: (907) 279-3916
Myrna Johnston
Commonwealth North
Eagle River, AK 99577
October 5, 1984
WELL AND SEPTIC SYSTEM ADEQUACY TEST
LEGAL: Lot 15, Block l, Chugach Park Estates
LOCATION: Peters Creek
RESIDENCE: Single Family, Three Bedrooms
WATER SYSTEM: On site well test pumped at 2 GPM for 4 hours
SEPTIC SYSTEM:
From Municipal Records:
Tank: 1,O00 gallons
Absorption System: Trench, 22 feet long, 5 feet deep,
one foot of rock
Absorption Area: 255 square feet
Soil Rating: 85
Installation Date: 1977
DATE OF TEST: 10/4/84
TEST PROCEDURE: Drainfield was charged with water at a steady flow of 2.0
GPM. A total of 500 gallons of water was added to the trench. Both the
tank and the sump of the drainfield was monitored. The water level in the
tank did not change during the test. The water level in the sump was measured
at 4' below the surface and remained at this level before, during, and after
the test. The trench received the required water without level change so
it is assumed that water in sump is trapped in sump itself. The tank was
pumped on October 5, 1984.
TEST RESULT: This system meets the requirements of the Municipality of
Anchorage as of the day the system was tested. There is no guarantee that
the system will continue to meet these requirements. 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. It is noted that the monitor sump on this system
was plugged by a sewage mixture indicating possible future blockage of leach
line.