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Home My WebLink AboutCINERAMA TERRACE BLK 2 LT 2 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: -~/",J' ~.'~~--Z-. PID Number: , Name: ~/O ~ ~ ~ ~ Wastewater System: ~New ~ Upgrade Address: ABSORPTION FIELD Phone: ~~ ~~/ INo.~drooms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other LEGAL DESCRIPTION S~l~ing:~~, ~ GPD/Sq. Ft. Total Depthfromoriginalgrade: Lot: ~ Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Numb~ lines: Distance~etween lines: WELL: ~New ~ Upgrade Gravel width: ~5 Ft.~ ~ Ft. Classif~ation (Private, A,B,C): Total Depth: Case~ To: Total absorption area: Pipe material: Drill~'. ~,~ Date Drilled: Static Water Level: Installer: Pump Set at:/ ~ - C~sing Height Above Ground: ' / Yield: ~ GPM ~'~ Ft. /~ ~ ,,. TANK SEPARATION DISTANCES ~Septic ~ Holding D S.T.E.P. From Tank Field Station Tank Sewer Lines Well- [~[/ [~ [ ~i~ ~ ~/ Materia~~~ Number ~ompartments: Surface Water ~ ~ ~ LIFT STATION Foundation ~ ,~ 7~t' ~ ~{ alarm at: i "Pump on" level at: ~~w;ter Curtain Drain ~ ~/~ ~/~ Pump Make & M°de' I Electrical Inspections performed by: Remarks: ~n C,/~r/~? ~~, BENCH MARK ~. ~-~' '~Y~~ ~ ~~ LocationandDescription:~ ~~ Department of Health,a'h~Hu~a~S~ice~appr~val~ Reviewed and approved by:~,"'*~'~ .,~3~~ Date: ~ 72-013 (Rev. 9/91) MOA 25 Permit No. ~ \~/c~ 4::~ ~-<~ 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: J-- 0-7" Z....~/~¢-- ¢---. fN~--~A~'T'F.C---~F~E- ~I~D No.: 72-013 A (1/93) * ENGINEER'S SEAL Permit No. S~-,/c/,__~ O 4~.~.._ 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: L_t~,T 2__ I~CI/VN~RA>,"V'~ T~,~F~Ae£ PID No.: 72-013 A (1/93) * ENGINEER'S SEAL :~,,,,~ ..... . ..... . .... .....:;... I, '-'(" i-F¢ ~ I~~''- PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 lO 11 12 13 14 15 16 17 18 19 20 / Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ]__~_._tl;~ ~.,~--__//~-~c~/~/~ ~ Town~hip, Range, Section: --r"///x~//~_.~/~/' SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L , IF YES, AT WHAT O DEPTH? P E Depth l0 Water After Monitoring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop .~/~ -;11 PERCOLATION RATE ~' ~ (minutes/inch) PERC HOLE DIAMETER ~:~ · TEST RUN BETWEEN "~"' ~ FT AND ~FT . . ' ........... J" ~d~ ~~'~ ~~~~~ ~RTIFY~ATTHISTEST, WA SPERFORMEDIN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: ~ / I ~/, I / f I 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: L--- ~ ~:~/¢C f'*3///~ ! c Township, Range, Section: :///~/ ' - SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 14 15 16 ~7 20 WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Depth to Water Alter Monitoring? Date: A Gross Net Depth to Net Reading Date Time Time Water Drop ,, ~,__/O ~F'~ ~/r ~' _Pr'if r-_i/ ~ ;~'[ /0 ~ ,, ~/ /~ 'z/!~ PERCOLATION RATE '['~/ (m,nutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN "~ FT AND "'~* ~ FT PERF;RMiD BY: J: : ;~~:':: >~--~::~ERTIFY THAT THIS TEST.AS PERFORMED IN /- 72-008 (Rev. 4/85) RCRERGE SYSTEMS INC. ID:907-345-2125 RPR 29'93 13:59 No.O01 P.02 FAX # S4§-2195 FACSIMILE TRANSMITTAL COVER LETTER THIS DOCUMENT (WITH COVER SHEET) TOTALS ONE PAGES SEND TO: NAME: V4)Y-T-~ COMPANY: DATE: lggS/O4/gg FAX # 2§$~4486 NAME: TAMARA SA. ND~RSON SENDER FAX NUMBER: ~45--21~5 PROBLEMS~? CINERAMA CIRCLE CINERAMA TERRACE SUBDIVISION, LOT NE1/4 S1 TllN RSW SM AK INFORMATION: NUMBER g3041988 INFORMATION: DESCRIPTION SEPTIC SYSTEM ~NSTALLATION ~NBTALL 1,250 ~ SEPTIC TANK FOR A 4 BEDROOM SYSTEM. EXCAVATE S/PT1C TRENCH SYSTEM A~ PER MUN~ PERMIT. CORD[MATE AI_L ENGINEER~NO, PERMITS & CONSTRUCTION. [N~TALL PATH TO REACH SEPTIC SYSTEM. TOP SOIL AND S[~D ALL D]STURBEB AREAS. BID INCLUDES ALL MATERIALS, LABOR AND EQUIPMENT. TOTAL: $ 8,000.00 THIS ~$ NOT A BID OR CONTRACI'. A FORMAL BID CONTRACT MUST BE SIGN AND RETURN NITHIN THIRTY DAYS TO ACTIVATE INFORMATION. -'~ V, ZTHANK YOU FOR CALLIN~ ACREAOE s ,e .~t ,~ ~, - ~ ,.,TEMS, IN(. TAMARA SANDERSON RFFFIVED ;.¢ .... ~ .................................................................. NOV 2 8 1994 !,LEA,.~E r~t'rURN Tt~ FA,,,/'~i'--'H'~'ii"iti';i-'~i; L ] PLEAS'E r)O THE ABOVF NORK.' ' ' ~';~ . ..... ~,,~no, age Dept. Heaith& Human Services [ ] DO N~T PREFORM t'ltE' AZC)VE ~JC)RK, [ ] PL. FASE SE'ND FOF.)MAI. ~:1.0 CONI'RACT, S 16NATI.JRE %%'... .... ... :X~L~IO~ ~OTES: It i~ t~e ~n~' ~e~p~ibilit~ t~ dele~min~ LE6END', ~ET FND ORDERED BY: the existence of ony eosements, covenonts, or restrictions 5/8"RE W/CAP~ ~ O I ~ E ~ WI ~ O which do not eppeer on the recorded subdivision pier. NOTE: ~,25" AL.EON, ~MONUMENT Under no circumstences should ~ny dote hereon be used for HUB & TACK ~~ construcUon or for esteblishing property lines. FENCE- X~ X SURVEY CERTIFICATION: LANTECH has conduc(ed e O~RHANG- dr~win~ ond thor the improvement~ ~[tuated ~here-CO~C~[~- on ~re within ~he properly lines ond no encrooch- ~S~HACl- ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: A S -- ~ U I L T O F: LEGAL DESCRIPTION: SEPnC STANDPIPES- WATER WELL- LAND ~ CONSTRUCTION SURVEYORS-PLANNERS-ENGINEERS 440 WEST BENSON BLVD. ¢ 103 ANCHORAGE, ALASKA 99503 (907) 562-5291 b O T ~ ~ b O C K 2 WORK ORDER NUMBER: DA~: SCALE: 8/23/94 1"=60' (fax) 561-6626 )RA~ BY; CHECKED BY: ~RIO NUMBER: slona9419 md ken 5541 525/57 ClNERAMA HEIGHTS SUBDIVISION 344-?714 SIX INCH WATER WELL DRILLED DRILLED AT THE RATE OP ~22. PROPERTY OWNER ~:!r. V~yf.e.k LOC2~ION 265-6'711 OF WELL SIT~ Lt. OUT TO THE DEPTH OF 25_) fe ~e,~ PER FOOT. Steel casing seated ~t to 53 ft. 8'72 ;~ Beachwood Cir. Anch., AK 99~5'2 B.~k. ~ub. DRILLER Bernie Cqa,].~ of Ramoart Dritlin~ Works. WELL LOG: · ) _ 18~ Silty sandy ~ravel. ~.~% clay binder. 1~ - 29' A broken, weathered conglomerate of bedrock. 29 - 5}' Bedrock. Fairly firm material t but able to drive steel casing. 50 - 250' Bedrock. A hard sedimentary rock. No wate~ Production showing until about 155 ft. A yield of 1/2 gpm. By 2~0 fttt water yield was up to one 6pm from cracks & fissures in the rock. Accumulated 0reduction of water out of granulated & porous rock, especially in the last 2'~ feet of drilling shows a full production of three gpm. 180 gallons of water oer hour. The quality of water is also very good. Water recovery comes back up to within six feet of surface. 3/4 horse submersible should do a very good job 0umping the water. Pump should be install about 20 feet off bottom. No charge for mob or demob or set up. No charge for installing weld on pit- less adapter. $55.0~ charge for adapter. Cost of Drilling: $22.D3 per ft. x 25~ ft: $5,5~0.00 Adapter $55.00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF $5,555.03 RT DRILLING WORKS DAT~ T~,~.~=y, a,:gu_~t 18, 1994 SERVICE CHARGE O F 1½% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. Rick Mystrom, Mayor Mtmicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 November 14, 1994 Mr. Voytek Wito 8720 Beachwood Circle Anchorage, AK 99502 Subject: Lot #2 Block #2 Cinerama Subdivision Permit #SW930422, Parcel ID g020-033-11 Dear Mr. Wito: The subject permit, issued October 11, 1993 by this office for a single family well and/or on-site wastewater system, has expired as of October 11, 1994. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If the on-site wastewater system has been completed and a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. q~rely, Program Manager On-Site Services JC/kb cc: James F. Sizemore, P.E. 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 WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930422 DESIGN ENGINEER:JAMES SIZEMOORE & ASSOCIATES OWNER NAME:WITO VOYTEK & ULI OWNER ADDRESS:8720 BEACHWOOD CIRCLE ANCHORAGE, AK 99502 DATE ISSUED:10/ll/93 EXPIRATION DATE:10/ll/94 PARCEL ID:02003311 LEGAL DESCRIPTION: CINERAMA TERRACE BLK 2 2 LT LOT SIZE: 79538 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL 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 (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS 6410 Switzerland Drive (907) 345- 1572 James Sizemore & Associates Civil Engineers & Surveyors Anchorage, AK 99516 Sept. 8, 1993 Mr. Voytek Weito Anchorage, Alaska REFERENCE : L2B2 Cinerama Terrace Subdivision Dear ~. Weito: Today, as you requested, I checked the water level in the monitoring tube located on Lot 2 Block 2 Cinerama Terrace Subcivision at the location ot the proposed subsurface disposal bed as shown on the Plot Plan that you furnished. The water level in the test hole was 8.5 feet below ground surface. ~~~sF. Siz~Sincerely ~,urs D 1'.1 - S I "f' E S E W E R i~ W E L L F' b: Ft M ~ 'ir' P~mmit Numbt~.r: Date I~ued'-' 0~I~:5189 Engineer Designed Owne.,r Name: 3ERP, Y P· ROY Qwner Addres..~: 6760 LUNAR DRIVE ANCHORAGE,. AK 99504 Parcel 'Id: 020--055-11 · .Lot Legal: Subdivision: CINERAMA TERRACE Lot: 2 Block: 2 -.'?,:~¢: Lot; S&ze 78905 (sq. ft. or 'acres) M~'~;Bedr~oms: This Permit[ 4 Total Capacity: SEPTIC-TANK:---Minimum total--septic tank capaoit,/:- t,250 ,iai. tons. Each ~ept'/c tank must have at ],east 2 compaptments.. Dep(h to top f.~c~t, requires ln~Ltlati.]n over Lank (s). WEt. L: Loc; mL~ be submitted to MuniciPality of Anchorage DeDartment o{ Health and Human Services within .~] da'Cs o¢ well It,tF:ORM D.H.H..S, PRIOR TO INSPEC't'IOb]IS BY ENG[NEER~ IF AFTER ,OFFICE HOIJRS~ CALL ~4-5-4~81 AND ~EAVE A MEs,.A~E. CQHSTRUCT PER ENE-)INEEF:S ATTACHED AF'PROVED DESIGN. THIS F':'EPM[T EXF'[RES 12/:5t/8~ AND VALID Ft]I:~: A SINOLE FA~IL/ HOi'IE. CERTIFY THAT: ~l. I am familiar wi.ih, the requirements for on-,.~ite se~erz and well~.~ ,i~ set forth by. the Municipality oF Anchorage (MOA) and the irate ~. Ala~d~a. ~. I will inst. al~ the system in accordance ~;ith all MOA Codes and regulatic)ns, and in compliance with 'the design crlt.,.r ia of this permit ,:,. I will adhere to all MOA and State of Alaska requirements for the set b ...... distances 'eros any e>~i. sting well~ ,wa~'tewa{er disp(~sal.sy'~t, em ~ public ~ewe~age.mystem on this or any ad.jacent ~ nearby lot. I understand that this permit is valid for a maximum Of 4 bedr,~oms. I also understand that the capacity of the t. ota~ system · any enlargement will requi~' an additional permit. ~iligned: ' /~, ¢ DA TE: -. ....... (Ownep'~JERRY ~. ROY ~ / LEGEI '~ 0 CORNERS FOUNDATION -- DRAINAGE ARROWS NOTES ' // I. IT IflALL IE THE RESPONSIBILITY OF THE IUILOER OR OWNER TO VERIFY THAT BUILDING LOCATION IflOWN IdEIrTI ALL IUIOIVIIION COVENANTB AND ZONING OROINANGEI. E. IT II THE NEIPONIIIILITY OF THE IUILDER TO VERIFY ALL [LEVATIONI WITH REIFECT TO ALL UTILITIEI,~ & DRAINAQE. S. THII PLAT REPREIENTI THE PARCEL OF PROPERTY DEICRIIED BELOW TAKEN FROM THE RECORDED PLAT DEICRIIING THAT PARCEL. INITRUMENTI RECOROED PERFORMED FOR: LEGAL DESCRIPTION: L- Z 7 8 9 10- 11 12 13 14 15 16 17 18 19 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 "L" Street, Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~A/,4 D /// 1.4/,0 f") ~ Township. Range. Section: 2-/2- ,~/ /~ Z ~/ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTER S L IF 'YES, AT WHAT / 0 DEFTH? // p E ~ t~ !!1t Grots N~ / Deoth to Re~limJ Date Time Tim Wat~ D~ / / ~-/~- e~ ~ o I 3 7" 2, /' /~ /~ 3 ~. 5" · ~" ~ " ~ /~ ~F ' ' ~-" ~ ,' ~o ~ o ,.¢~. ~ , ~" ~ " 70 ~0 ~?" , ~" PERCOLATION RATE Z/~) (mmum~,mcn! PF.P,C HOLE DIAMETER _ TEST RUN BETWEEN z/ ~ AND '~-~ FI' ;' '?'~ .": ,~-./~?/~ COMMENTS .'~ /~E.C /~/ PERFORMED aY: ~. )...~Xr ~1, ~ ~',k I I ~1 CfJ~ ~'C ~ ~t &~TI~ THAT THIS T~T WAS P~FORMED IN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 'L" Street. Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: OATE PERFORMED: ~/Z ?/~ 1 3 4 $ 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ~IE'LL Township. Range. Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES. AT WHAT · DEPTH? 0faa a wa~ AIt~ O¢ou Net / Deoth to Net Re~lin~ Date Time Time Wete~ Droo / i PERCOLATION RATE __ (mmule~u,ncll) PERC HOLE DIAMETER TE~T RUN BETWEEN __ FT AND __, FT COMMENTS PERFORMED ElY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCOROANCE WITH ALL STATE AND MUNICIPAL GUIOEMN~S IN EFFECT ON THIS DATE DATE 72-.~08 IRev. 4/85) 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 Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: e NOTE: X 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. 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 it21 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 inves.ti_gation 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-~c-~/"27~ ~~'~/~'~/~A~'~'7.~ , Phone Address ~[~ ~',/kF~l~ ~., ~ ~h ~ Eng~n~ s~gn~um ~ ~DHHS SIGNATURE y ' '-~ Approved for ?, Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date 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 engineers work. Back MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /--. ~-~ ~ ~-~ C/~/,"2~/~c.2/"/~..-p ~7~/~/'~d'Parcel I.D. A. Well Data Well type ~ Log present (Y/N) Total depth Sanitary seal Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG g.p.m. .~(~ Casing height Wires properly protected (Y/N) AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank o,s ^.c s Septic/holding tank on lot / / / Absorption fieldon lot/ ~ /' Public sewer main /~v//A Sewer sewice line .~ ~ Nitrate ?.~:>.~' ~:~ Collected by: ',~ Other bacteria Tank size / ~ ~ Compartments Foundation cleanout (Y/N) ,~ Depression (Y/N) Alarm tested (Y/N) ~.-C,(/' .~ ~'~,2'7~'~ Pumper WATER SAMPLE RESULTS: Coliform Date of sample: /'~ B, SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Well(s) on lot TO property line Sudace water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: On adjacent lots ~ /d~ ~'.) Foundation [ Absorption field / ~-~ Water main/service line 72-026 (3/93). Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ~ Manufacturer Size in gallons ~~~~'~-~s (Y/N)_ Vent (Y/N) ~ "Pump off" Level at High water alarm level Meets MO~-elec~al codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water. D. ABSORPTION FIELD DATA Date installed /~ ~ ~ /~ )~'d/.~ Soil rating (GPD/FF) 4:~,~-~ Width (/,_~ Gravel thickness System type ,~,~ Total depth ,..~- ~;- Total absoq:)tion area ~, ~ ~---,-/~ Cleano~ut/~esent (Y/N) /~/ Depression over field (Y/N) Date of adequacy test ~c~-?C ~ '~ C~ ~ Results (pass/fail) -- for Water level in absorption field before test ~ ~ ~.2 ~ ~/'~'>'-/:- ~'~dter test Bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ~ To building foundation On adjacent lots ~ _/'~ Surface water ~ Curtain drain ~ C//") ~--~ On adjacent lots Property line To existing or abandoned system on lot Cutbank ~ /~..~ Water main/service line 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 t~.of this inspec~on. ~,~'~,,. ~.. A ~ ~.. HAA Fee $ ~4::;) ~ ~ Waiver Fee $ Date of Payment /~/~ ~ ~ ~"-'-- Date of Payment Receipt Number ~ ~)(~'~7) Receipt Number 72-026 (3/93)* Back Commercial Testing & Engineering Co. E~vironmental Laboratory, Services ~'~'~'.~.~'.~.a'~'~'~a'~-.a~-.~-~.~.,,~.a~-~~~~~ " E~33 3 S~ree~ Anchorage; AK 99518-i 500 Tel: (907) 562-2343 II SA-.\~LE DA.wE: DaM 0 RoutLue n [] . Repeat Sample (for routL~e sample ¥+ith tab reft no. ) "[] Special Purpo.~e Ti. me S.~.M~PLE LO CATION Collected '~ea r Treated Water Untreated Water ColJected By .1 -. 7.--.~--: TO SE CO:-~r = ,-?--.D BY / Sad~ac:aO, ~ U~a~fac~oW U S~le over 30 be ,~-eHab!e nc~ be ov~ 48 hom-s old / Date Received T~e ReceNed Anal?'.¢is Began Analytical Method: * N,zmbcr of coio~5~sl] 00 ~2. Lab Reft h'o. R~ui:* .A~ab'sr Phoned Spok= Da:=: Ti-..-": F-', '.-'d BACTERIOLOGICA. L WATER .-%N.4.LYSIS P-LECORD MMO-.~'FUG R~ut:i Total CoLiform Membrane Filter: DL~cr Count Verification: LTB' Fcc~l Col/form Co/~fuwnad~n FLual M-~mbmne Filter R~uir~ BGB 0 Colonicdl 0O rrd C 0 LIFL--'a,M Co[iforrrffI O0 rrd CT&E Ref.$ Client Sample ID Matrix Commercial Testing & Engineering Co. Environmental Laboratory Services I_~BORATORY ANALYSIS REPORT 94.6340-1 : TAP WATER (U1TTRF~ATED) L2 B2 CL~VEP-~tA* WATER Client Name SIZEMORE, JAMES WORK Order 11725 Ordered By Printed Date 01/04/95 ~ 17:43 hrs. Project Name Collected Date 12/30/94 ~ 03:00 hrs. Project~ Received Date 12/30/94 ~ 15:45 hrs. PWSID UA Technical Director STEPHEN C: EDE Sample Remarks: SAMPLE COLLECTED BY: J. SIZEMORE. *TERRACE Qc Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 0.11 mg/L EPA 353.2 10. 01/03/95 'CMR ' See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not A~alyzed ~U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than ± 5633 B Street, Anchorage, AK 99518-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA. COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA Tom Fink, Mayor Ntunicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 January 8, 1990 Robert M. Herz 6760 Lunar Drive Anchorage, Alaska 99504 Subject: Lot 2 Block 2 Cinerama Terrace S/D Permit #890271, PID #020-033-11 The subject permit, issued by this office for a .single family well and/or on-site wastewater system has expired as of December 31, 1989. Permits are issued on a calendar year basis by authority of the Municipal Code of Regulations. A new permit must be obtained from this office for an well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built inspection report (three-part form) must be sent to this office for review, approval and documentation. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sincerely, John Smith, P.E. Program Manager On-site Services JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" kl IE f ....t .... F:' iii: R I"1 Z T :!: Cli!i:t::;..'T :1: F::'Y 't"I'-t~.:~'T'~ :1.,, :1: am famJ.].iar v~:i't.h 't. he i"(~(::it..t:i.~-t~)~l~i~.~rl't:,~; for c,'~-..~[i:l'L~:.:.~ ~;¢,:,~m~ms ar'id i'or.'l:.h l::~y t.!"l(~.) Mt.~n:i.c::i.l::~a].J.t,y of ~nc:horag~.:.~) (MOik) and 'Lhc-:~ St.a'L(+)~ of and ~.n cc)Mi::):[ J,,~:w'~c:~+:, ~:[ ~:.1"~ 'Lh~:~ d[+~:i, gn c:p :L'k,~r' :la of Ch :i.~ p~.~r'mJ.'t. ,, :3, ]: v.~i:l.], ac::lhc~r'e '1:.o ali. M[3~4 it~rld St. aC(~ of ~,~:l.a~[~l.::a PE~(::IL.i~P(.~eM(~:~FI't'..~!~ (C)F' 't. he 4,, :[ ur'td~.~m~[;t, and 'Lha'L t.l"lJ.~ p~)r'rn~.'L :is ',za].J,d for' a ma:~.~J, mL.u~ c:~f 4 b~.:.:.:,drc~c:,m~, a:l.~(::) Lu"~d(~,):,r~'Lar'ld 'Lha'L ~'..f'l~:4~ Cal::)ac:::i.'Ly (:)f Lh(.:.~) 'Lo'La]. ~[~y~;'l'..~em :[~ 4. l::)~:.:,clr'c:)c~m.~ ar'id a, r'l y' e n 1 a r g E, m ~,~, n 'L. ~,~ :i, ]. :1. r' e:.~ q u :i, ~ a n a d d J. ~:. J. t::)n a 1 p ~ p m :i. t.. (Ov.~r'm~r') ,J E: IR I::~ Y F,' ,, c~ 3 ~ ~ ~MJchael E. Anderson ,% 43 .E I~ fco~ CORNERS FOUNDATION DRAINAGE ARROWS NOTES ,% I. IT IHALL BE THE REIPONIIIILITY OF THE BUILDER OR OWNER TO VERIFY THAT BUILDING LODATION I#OWN IdEETI ALL IUIOIVIIION ¢OVENANTI AND ZONING I. IT II THE REIPONIIIILITY OF THE BUILDER TO VERIFY ALL ELEVATIONI WITH REIPEOT TO ALL UTILITIEI~, & DRAINAGE. 31. THII PLAT REPREIENTI THE PAR(=EL OP PROPERTY DEICRIIED BELOW TAKEN PROM THE RECORDED PLAT DEICRIIINB THAT PARCEL. INITRUMENTI RECORDED PRIOR TO OR AFTER THE FILIMI PERFORMED FOR: LEGAL DESCRIPTION: 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE '1 WAS GROUND WATER ENCOUNTER ED? /E.~ ~\~/ /AIE'L ~ IF YES. AT WHAT / 0 ~ o~o oErm? // e SITE PLAN !tiI Gro~ Net ! De)th to Net Re*cling Date Time Time/ Wate~ Oro~ ~. ,, 15 I~- ~ ?, 5" , ~" , ~ " 70 ~0 $~" , ~'~ PERCOLATION RATE '~ {mmutes~,nc.n! PERC HOLE DIAMETER ~'" TEST RUN BETWEEN ~ FT AND '~ FT COMMENTS E / ~' P~FOR~O ~Y: ~ , ~ ~ ~ ~r~ , ~1~ ~ ~ ~$ ~TI~ THAT THISiT~Tt W~ p~FORMEO IN ACCORDANCE WITH A~ STATE 72-008 {Rev. 4~85)