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#01§-242-28
i~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME , IPHONE I []NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
]wen ~ ~ Absorptioo ~r~ ~ Dw~i~iog PERMIT NO.
~ ~ Manufscturer Msterial No. of oompsrtmeots
~ -.
Liq. c~%,~n gallons IF HOMEMADE: Inside length Width Liquid depth
9~ DISTANCE TO: Well t J I * Dwelling PERMITNO.
~--~ M%nufacturer I ~ I ~ Material Liquid capacity in gallons
~=~ DISTANCE TO: Well ~5~' Foundation ~, ~earestlotl,ne~
~ NO, of lines Length of each line~ Total length of
~ ~ ~ I ¢ Trench wid Distance between lines
Q ~ Top of tile to finish grade ~ , Mator,albo~.athtile
ken,th ~idth Depth PfiBMIT ~0.
~ Typeofcrib Crib diameter ~[A Cribdepth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~M Class Depth~& J~/~ Driller Distance to lot line PERMITNO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST R~TING
INSTALLER ~
INS Y :
APP~ ]~ f.~ ........ ~,~'~}~' ~ DATE LEGAL
(Rev. 3/78
DEPARTMENT C HEALTH AND ENVIRONMENTAL 3'I"ECTION~
825 i_ ,STREET, ANCHORAGE, AK 99bul ~,
.' 264-47~0 ' ~
C)N--S I "l'E SEWEF~ PERM I '~
PERM I T NO:
DATE ISSUED:
APPL I CAN'T':
ADDRESS:
CONTACT PHONE
850311
06 / 17/85
TIM BYERS
7701 WINDY CIRCLE
A.NCHORAGE, AK 99516
561-2571
LEGAL DESCRIP:
LOT SIZE:
MAX BEDR[)OMS:
SUBDIVISION: COLD WINDY DESOLATE
SECTION: 24 'TOWNSHIP: 12N
159774 (SO.FT. OR ACRES)
4
LOT: 5
RANSE: 5W
BLOCK: N
Listed below are the options available to you in designing your septic
system. Choose the option that. best ~'~ts your site.
TREN[]F~ BE~D W. DRA, I N
DEP'I"H '1"(]) PIPE -BOTTOM (FT.)
GRAVEL DEPTH (FT.)
TO]~AL DEF'TH (FT.)
GRAVEL WIDTH (FT.)
GRAVEL I_ENGTH (FT.)
GRAVEL. VOLUME (CLJ. YDS. )
TANK SIZE (SALS)
SOIL RATING (SQ.F'T'. /BR)
5.0 ** 4.0 4.0
8. O 0.5 3.5
11.0 4.5 7.5
2.5 2~.0 5.0
· 58.0 41.0 65.0
.50.0 55.5 48. ~
1,250.0 ** 1,250.0 ** 1~,250.0 **
150 150 150
** DEF'TH TI] PIPE BOTTOM < .5.5 FT. REQUIRES INSULATION
** DEPTH TO PIPE BOTTOM < 4.0 FT, MAY REQUIRE A LIFT STATION
.~* TANK MUST H~VE AT LEAST TWO COMPARTMENTS
I certify that:
1..I am familiar with the requirements ('or on-site sewers and wells as set.
Forth by the Municipality oF Anchorage (MOA) and the State oF Alaska.
~. I will install the system in accordance with all MOA codes and regulations~
and in compliance with the design criteria oF this permit.
.5. I will adhere to all MOA and State oF Alaska requirements For the set back
distances From any existing well~ wastewater d~sposal system or public
sewerage s~stem on this or any adjacent or nearby lot.
4. I understand that.this permit is valid For a maximum oF 4 bedrooms and
any enlargement will requi~e an additional permit.
IF A LIF"T' STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
:/-/'7--4
SLOPE SITE PLAN
1
2
3
4
e 0
0
0
0
o
d
0
o
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
0L
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
Corwin
CE-5283
PERCOLATION RATE
(minutes/inch)
.. , TEST RUN BETWEEN F/T,-yAND ~ FT
COMMENTS 'q'P~P--- ~u W~ V~U,~LLV' ~~ ~~/'~ '~ 15' ~ ~ W~L~
PERFORMED BY: ~a[}~ ~ ~t-~ V CERTIFIED BY: DATE:
72-008 (6/79)
ANCHORA6E AREA BOR' " H
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ADDRESS _~?~2~) ~-'2//~oA/d
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUFACTURER -~'/---~-/C$;~) MATERIAL ~"~;~/
INSIDE WIDTH LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY /g~:) GALLONS.
SEEPAGE Pit:
NUMBER OF PITS / DIAMETER OR WIDTHa~,
LINING MATERIAL /~/N6..5 CRIB SIZE: DIAMETER~/
BUILDING FOUNDATION~O
ADDITIONAL ABSORPTION
LENGTH~'''~ DePtH
/
DEPTH ~ DISTANCE FROM: WELL //U ~7~'
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~.~7~' SQ. FT.
WELL:
type [").~///~4~),
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST NEAREST
, LOT LINE SEWER LINE
, OTHER SOURCES
DISAPPROVED REMARKS
DEPTH · DISTANCE FROM:
SEPTIC SEEPAGE
, TANK __ , SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
Form No. EO-O31
DIAGRAM OF SYSTEM
]3 ?;o?'~ ]
DATE
,7,
GREaTer ANCHORAGE AREa BOROUgh/
DEPARTMENT OF ENVIRONMENTAL QUALITY .
3330 "C"/S~REET ANCHORAGE, ALASKA 99~0~
/{'~ ~ /! TELEPHONE 274-456! /I .-/t'
SEWA~GE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
pERMIT NO.
INSTALLATION Of: SEPTIC TANK ~ SEEPAGE PIT ~ , DRAIN FIELD OTHER
FINANCED THROUGH ~,_:~').~~~ TO SE INSTALLED BY
SOIL TEST RESULTSe~''~ ~'/ ~"' ~' -=~.~r.,.,-" ,~,~,,,"~ ~ . ...~E~~~ OTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED ~.'
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE TYPe
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SeEPAge PIT ~
septic TANK TO SeePAge Pit WALL /'J~
SEPTIC TANK ~/ , SEEPAGE Pit
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK ./_~/~ /~ DRAIN FIELD
WATER MAIN tO SEPTIC TANK /~' /'~
DRAIN FIELD
.... SEEPAge Pit
TO RIVER, LAKE STREAM.
DRAIN FIELD
DRAIN FIELD
seepage Pit-- .4 ./ ~,.~
ALSO CONSIDER AREA WELLS.
, SEEPAGE PIT /~:~
DRAIN FIELD
CAST IRON InTO AND OUT OF SEPTIC TANK AND INTO CRiB CROSSING GAP OF
EXCAVATION S 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.
G .A.A .B.
OR
LICENSED DESIGNER
SEEPAGE AREA SIZE~- ~A-''-~ ~ /T ~.-.--tYPE
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER A~H~QRAGEJ~E~OROUGH Ol:~I~ NANCE NO. 28-68 AND THAT THE ABOVE
FORM NO. EQ-016
I certify that the above drawing is true and correct to the best of
my knowledge.
Municipality of Anchorage
· Development Services Department
Building Safety Divisicn
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING "'
GENERAL INFORMATION
Complete legal description /-~ :~
Location (site addreSS'or, directio'n~) '
Expiration Date:
Day phone
,,4-~ '9'~'11 "
Day phone
Current Property owner(s)
Mailing address
Lending agency
Mailing address 15"00 tx,,, ,~tn. con gl t,,~t'~ ,,~-r, a6 ~
RealEstateAgent pt~cm d~r~ Rz ~ P~ Dayphone
Mailing Address ~o~ ~.~o~ ~/> ~or~/ ~
Unless othe~ise mquested. H~ will be held by DSD for pickup.
2. NUMBEROFBEDROOMS: ~
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class __
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank
Community On-site
[] Public Sewer
The Municipality of Anchorage Development Services Depadment (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of AJaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. 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.
based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) 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(are) in compliance with all applicable Municipal and State codes, ordinances.
and regulations in effect at,the time of installation.
NameofFirm Fl~/op
Address I¥_~.~ ~c~
Engineers Pdnted Name
5. DSD SIGNATURE
~, Approved. for: ~ . bedrooms...
, Disapproved.
Conditional approval for
Phone"
· Date.
· ~. ~'...
bedrooms, wit~ the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Odginal Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bregaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(SO?) ~,3-?g04
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Parcel ID: O ~ ~"- ~ y Z - z~:
Well type ~av7' If A, B, or C provide PWSID #
Date completed I~e.~.. i~-'/~e77¥ Sanitary seal (Y/N)
Total depth'~,~-z~' ff. Cased to.44,e~ ft.
FROM WELL LOG · '
wa Leg (Y/N) /~
WIras properly protected'(Y/N)
Casing height (above ground)
AT INSPECTION
in.
Date of test
Static water level ft.
Well production g.p.m.
g.p.m.
WATER SAMPLE RESULTS:
Coliform O colonias/100 mi.
Date of sample:
Nitrate ~o.,~- mg./I. Other bacteria C,~ colonies/100 mi.
Co~ected by: F /a /4o ? 7'.r.~ .C',. c
B. SEPTIC/HOLDING TANK DATA
TankType/Material .,c¢? ~c ~'
Tank size I'Z-5'O gal. Number of Compartments
Foundation cteanout (Y/N) ¥ Depression over tank (Y/N)
Data of pumping ~ / 19/?_~o0 Pumper p¢~ I,'
C. ABSORPTION FIELD DATA
Dateinstelled ~'//'7/~-
Cleanonts (y/N)
N High water alarm (Y/N) ,~/. ~
Date installed
Length '~
Total depth IO..~' fl.
Date of adequacy test
Soil rating (g.p.dJft~ or ft=/bdrm) 15'O..~...~,.,,.,System type
ft. Width :~ ft. Gravel below pipe 8 ft.
Eft. absorption area ~o¢~ Monitoring lube 'r' Depression over field
For ~/ bedrooms
Results (Pass/Fail)
Fluid depth in absorption field before test ~ in. Water added~ gal. New depth ~ in.
Elapsed Time:"Z,~'" min. Final fluid depth O in. Absorption rate >= ~'o~) g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) .Uu~,~ I, cno,..<., .,, If yes, give date M. ~.
D. LIFT STATION /~/..6.
Date installed.
'Pump on" level at
Datum
Size in gallons
In. 'Pump off' level at
Cycles tested
E. SEPARATION DISTANCES
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
.F.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/llft station on lot
Absorption field on lot
Public sewer main /~.
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~-3' Property line ~ ~ Absorption field ~"
Water main '~ 5'-0 ' Water service line '~> ~'~; Surface water
Wells on adjacent lots '~ (c,o '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Pmpertyltne "~ to~
Water Service line '>5~, '
Curtain drain A/o,~¢ ..s'e*'~ -
COMMENTS
Building foundation '~>
Sudace water ~ ~o0 '
Wells on adja.cent lots '1 2-5' '
G. ENGINEER'S CERTIFICATION
I certifY that I have determined through field inspections and
review of Municipal recoMs that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name "~o~:~'or*¢ F. /'1'0o,"~_
Date ~ / 2. 7/01
Water main '~ ~'~, '
D~'iveway, paddng/vehicie storage ; o '
HAA Fee S ~,~.,~
Date of Payment
Receipt Number
(R~. 1~)
Waiver Fee $
Date of Payment
Receipt Number
AUC-ZZ-(II 18:51 FI~0U-CT&E EfiVIR~I,EfiTAL
,~K CTIE Environmental Servlces Inc.
9075GI5301
T-205 P.0Z/0] F-044
CT& £
Client Sample ID
~atrlz
Ordered By
~WSZD
Sample Remarks:
1015359001
FlatTop Technical Sty.
L3, Col~.Wlndy, Desolate His
L3, Cold, Windy, Desolate IlLs
Drinking Water
Clleot PO# Pre-Paid Colis/NO3
Printed Dstt~'TIm~ 0S~2~00l 17:23
Collet~ad Date/Time 08/15/'2001 I 1'90
R~elv~d Date/Tlma 0g/] 5~001 14:09
Teehn~al Director · Stephen C, S'de
Rel~sm~ B~ ~
Watorn De,ar tmen~
Unils M~ho~
Allow~lg Prep Analy~s
Limits D~e Date Init
0,500 U 0,500 m~/L EPA 300.0 (<10) 08/15/01
SCL
Total Coliform
0 cul/lOOmL SMI89222B
08/15/01 SKW
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory.
Health Authority Approval # 010456
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block ~ , Lot 3 of Cold,Windy, Desolate
subdivision, the well's productivity .was determined to be .82 gallons per
minute. The minimum well pro~iuctivity required by this Department (AMC
15.55) for a 4-bedroom residence is .41 gallons per minute. Although the
subject well currently exceeds this minimum requirement, all parties
concerned are advised that the i~roduction capacity of the well may fluctuate.
Restriction of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This advisory must be attached to all copies of the subject Health Authority
Approval.
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES JUL ! 5 988
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER26,.,744AND WATER FACILITY R E C E !¥ E D
Application Date "7~ ~ ~ -- /R88
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a)Legal E~escription (include lot, block,...subdiv!sion, section, township, range)
jZ o -t- , l o l., -, 'o l (..d , ct7
Location (address or directions) /
~ f[/[ ~ Telephone: Home
(b)
Property
Owner
Mailing Address ~ 2- ~---0 ~..,~, ~) ~'/I/~ ~ ~
(c) Lending lnstitution ~~ Telephone
Mailing Address ~
(d) Real Estate Company and Agent ~OLA ~
Address
Business 3z'¢/q -~ ~%~ t
Telephone
(e)
Mail the HAA to the followino address: or: Check here ~, if hold for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-Family ~
Number of Bedrooms
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.
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 CRev 8/86~ Front
NOI.I. flYD
'9
'S
MUNIClpA!ITy OF ANCHo
DEp~ OF HEALTH & RAGE
£NV~ON~ENT'~L P~OT~c'r~ON
'JUL 1 $ t988
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4744
f~
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N)..J~.J/3
Date Completed
Total Depth ~ ~
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Yield ~).9 o~"P/'~ ~(-
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N) ~,~
Depression Around Wellhead (Y/N)
I
IOO 4-
· On Adjoining Lots
I ~-O I ' On Adjoining Lots I OO~ 4
To Nearest Public Sewer ~
To Nearest Sewer Service Line on Lot 2~
; Date
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line v~o~,'t_ E.~
Cleanout/Manhole v~Ovt ~.
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed (-~-! 7-~ Size / ~'"0 No. of Compartments
Standpipes (Y/N) ~ E~,~ Air-tight Caps (Y/N)
Depression over Tank (Y/N) Vt.~
Pumping/Maintenance Contract on File (Y/N) VtO
Holding Tank High-Water Alarm (Y/N) ~A.O
Separation Distances from Septic/Holding Tank:
To Water-Supply Well I I ~
To Property Line ~-- !
To Water Main/Service Line .~C) ~
Foundation Cleanout (Y/N) ~S,
Date Last Pumped ~---? -' ~
'for
Temporary Holding Tank Permit (Y/N) '~
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72~026 (Rev 8/86~ Front
C. ABSORPTION FIELD DATA
Width of Field
Soils Rating in Absorption Strata I '~'--O E2 /'~:~__c~(.9~ Type of System D~sign
Date Installed ~--t ~ ~ ~ + ~f ~
Length of Field
Il
Square Feet of Absorption Area
Depression over Field (Y/N)
d 40
Results of Last Adequacy Test .~i~t$,% ~
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot ~_O 4-
To Water Main/Service Line
, ¢
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
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 2_C.~ ~ ~
To Cutbank (if present)
v~_ O ~,~ ~--
D. LIFT STATION
Date Installed ~OV~. ~..,
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 Pe~room Rating Against HAA Request **
I certify t hat/I hjLfi_e chec, ke~, verifi~:~r conformed to all M (},~.,And HAA g/~;~nes in effect on the date of this inspection.
Signed ~.~-"~_~ ~f/'~f'~ Date
Company~& ~~~ MOA NO.
Receipt No.
Date of Payment
Amount: $
0
Page 2 of 2
72-026 (Rev 8/86) Back
LOCATION:
~SSE, BPPS & PUTTS
2220 EAST 88 AVEm~UE
A~G~, AK 99507
(9O7) 349--6451
WATER W~.rJ, TEST
Lot:
Block:
Address:
TESTER:
Initial Reading on Meter: /~J)~Y~/ ~o >¢;z_
DRAW GALLONS GA/~LONS FIFJ~D METER
DO~CN TIME GPM ~ VOLUME TOT~J~ MONITOR LEVEL READING
Production RaEe: G2>! 24-Hour Capacity Gallcns
NORTHERN TESTING LABORATORIES, INC.
600 UNIVERSITY PLAZA WEST, SUITE A
2505 FAIRBANKS STREET
FAIRBANKS, ALASKA 99709
ANCHORAGE, ALASKA 99503
907-479-3115
907.277-8378
Besse, Epps, & Ports
2220 East 88th Avenue
Anchorage, Alaska 99507
Attn: Andy Ports
Source: Cold Wind
Sample ID#: A061588-25
Date Arrived:
Time Arrived:
Date Sampled:
Time Sampled:
Date Completed:
o6/15/88
1650
06/15/88
1410
06/21/88
Parameter Unit Result ADEC MCC*
Nitrate-N mg/1 <0.1 10
Reported By: ~ ~ Date: 06/21/88
Francois Rodigari, Anchorage Operations Manager
* MCC = Msximum Contaminant Concentration
NORTHERN TESTING LABORATORIES, INC.
600 UNIVERSITY PLAZA WEST, SUITE A
2505 FAIRBANKS STREET
FAIRBANKS, ALASKA 99709
ANCHORAGE, ALASKA 99503
907479-3115
907-277-8378
Quality Control Report
Client:
ID#:
Besse, Epps, & Ports
A061588-25
Listed below are quality control assurance reference samples with a known
concentration prior to analysis. The acceptable limits represent
a 95% confidence interval established by the Environmental Protection
Agency or by our laboratory through repetitive analyses of the
reference sample. The reference samples indicated below were analyzed
at the same time as your sample, ensuring the accuracy of your results.
Sample # Parameter
Unit Result Acceptable Limit
EPA 378-12 Nitrate-N mg/1 7.37
7.17 - 8.01
Reported By: L~ & ('"'~' Date:
06/21/88
Francois Rodigari, Anchorage Operations Manager
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)
_ LoT
Location (address or directions)
(b) Applicant Name ~/'"y~ ~L-~'/~6/'~6 Telephone: Home
Applicant Address
Business ~/'
(c) Applicant is (check one): Lending Institution [] ' Owner/builder []; Buyer ~; Other [] (explain);
(d) Lending Institution A~-~¢/~ t~7~7/"-~' ~'f~¢ Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family J~ Multi-Family []
J
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 1 of 2 72-025 (11/84)
Address
Date
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
NameofFirm~/~0rl/'lj~ '~.~,1.~ /¢ES~f.~b~L",~ Telephone
DHEP APPROVAL y~~ ~a
Approved for ~r~~ bedrooms b .. te
Approved ~ Disapproved Conditional
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
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
WELL DATA
Well Classification //tO/PI ~)/DU.~/-..- if A, B, C, D.E.C. Approved (Y/N) ~//4'
Wel Log Present (Y/N) /t~O Date Completed /I/.~) //..he/'/ JO~ ~¢T.,(2_~~¢...
Total Depth ~ ~¢" Cased
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) Y
Depression Around Wellhead (Y/N) /~
Separation Distances from Well:
To Septic/Holding Tank on Lot
!!!
; On Adjoining Lots
/~Z ~ ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by ~.-~/'/~/~3 ; Date O/~/~
Water Sample Test Results ~,~~
B. SEPTIC/HOLDING TANK DATA
Size IS-~O No. of Compartments ~-~
Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N)
Date Last Pumped /~ ~://~J
/"'//~ ;for
Temporary Holding Tank Permit (Y/N)
Date Installed
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 J
To Property Line "~¢'~ ~
To Water Main/Service Line Course /~J/A
To Building Foundation ~-~ /
To Disposal Field ~ i
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/~5
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field ~
Depth of Field 11
Gravel Bed Thickness ~ !
Standpipes Present (Y/N) Y
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well [ ~:~?~ I
To Building Foundation ~ ~ !
Lot "~ ~;
To Water Main/Service Line '¥'~ JO0
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~r-
To Cutbank (if present)
Comments
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check P,~
I certify
S igne
Coml~n~
A gu~dehnes ~n effect on the date of this inspection.
Receipt No. ~/
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
' E _n'~l~. Seal
',/.'-
~.~.; ............ =, ,, ~
Corwin
& associates,inc.
Consulting Engineers
1549 E, Tudor Road · Suite 204 · Anchorage, Alaska 99507 · (907) 561-6151
June 5, 1985
Mr. Tim Byers or Ms. Mary Finstead
SUBJECT:
SEPTIC TANK, WELL, AND HEALTH AUTHORITY APPROVAL ON
LOT 3, COLD WINDY DESOLATE HEIGHTS
Dear Mr. Byers or Ms. Finstead:
We completed the inspection of the above referenced property and
have made the following conclusions:
The septic system is adequate for a three (3) bedroom
home and we would recommend that the sewer from the
Guest House be disconnected or plated off. There are
two (2) reasons for this as follows:
Se
The system is not built for more than 3 bedrooms
and we would not recommend using it for 4 bedrooms
without modification.
be
The sewer service line from the Guest House is too
close to the well and would require a waiver in
order to gain approval.
The well is adequate and meets requirements.
The septic tank should now be pumped and all caps
should be installed as required.
We appreciate this opportunity to be of service and our Invoice
is attached. Should you have any questions or need any further
information, please let us know.
Ve~ truly y~urs,
in, P.E.Pres~ ~t
BGC: k- h
Enclosure
xc: Health Department
FIELD PUMPING TEST
DATA SHEET
-LOCATION OF WELl (Legal Description): ~27& ~:_:~; ~/d N,/~-~] Z~_,?~/z:2.~L(: ~,
[/ELL DEPTH: FT. CAS [NG: FI SCREE~'I:
DATE DR[LLIfIG COI.1PLETED:
DRILLER:
STATIC WATER LEVEL (Top of Casing):
FT
· E]apse'r~ Time Since,
ClOck Pumping'Started/ Depth to Drawdm.m/ Pumping Remarks
T~me' . Stopped, Min. ,Water, ft. Recovery Rate, GPM
0 (swl) 0 0 Start
10:o~ ~ ~?.~
lo, ~ 2~ ~4~.~' ~,4o I
io.'~ ~5 t [~7 ~.,o
10:~ 35
4o " ..
., io:~" 45 "/w~,~ ,4q~
IZ.z~ ' ' .12o (2 hours) Iq4'
~:~ 240 '{4 hours) ~ZO~ ~.~
· . RECOVERY
o I
5 I
,. 1o I
15
.;. I 2s' i
35
50'
55 -- '
6o {I ,our),
W.W. ¥1JJ4m
2O60 Dinond BLvd.
AnehceISo, Alaska
g9S02
Lot 3. CoXd, WAnd~. De~oXate ifttsht Subdivta6mn
The subJoot Jot had an on41te sower beanie ~enRxN~ted e4~Aie~ tills ousmow.
An tuopoR~ou was :qulumtad en thts system by ~ho emenvetor. Th~s DepeFt-
umnt went to the site end found T~. system had been batk~LXXad befo~ A~mo
baotaat, ts. The emoavmto~ (HoRou ~a~) va/ tu~onmd of thb and etwtad
· o~oot~vm awttou uouXd be taken.
The emtR~ system ts not,,, ~ and to In vioX&tien of aox,o~,W,h oadl~me~.
advised that the sevow system v~ have to be ~speRed and ap-
ldo Buehho~s. R.S.,
Sen~t~ttan
RECEIPT FOR CERTIFIED MAIL--30c (plus postage)
SENT TO
STREET AND NO,
-P~., STATE AND ZIP CODE
OPTIONAL SERVICES FOR ADDITIONAL FEES
RETURN ~ 1. Shows to whom and date delivered ........ ~5¢
With delivery to addressee only ............ 65¢
RECEIPT p 2. Shows to whom date and where delivered .. 35¢
SERVICES With delivery to addressee on y ............ 85~
DELIVER TO ADDRESSEE ONLY ...................................................... 50~
~PECIAL DELIVERY (extraf~equired) ....................................
POSTMARK
OR DATE
PS Form
3800
Apr. 1971
NO INSURANCE COVERAGE PROVIDED-- (See
NOT FOR INTERNATIONAL MAIL
~. ¥. Wflso~
2~ 01~. Blvd.
~, Alaska
S~ECT: Lot 3, Cold, Wtn~, ~ola~ ~tghts ~dtvtston
Dea~ Hr. tfllson:
T~ subject lot had in on-st~ sever ~t~ mst~ ear11~ thts si.
~ tns~tm was ~s~ on ~ts sys~ b~ ~ exc~itor. Thts ~-
ctl~. ~ wu also ~ q~tt~_u to ~e se~tc ~k ~t~ t~11~
recttve action vould ~ ~ken.
Jt ts nov ~ ~10 ~ N~r a~ ~ze-~ ts tn ~ near ~re. The
extsttng sys~ ts not a~ed ~ ts tn v~latten of Bo~h ~tninces.
Pleise ~ a~ls~ ~at ~ sewer s~ vtll have to
proved to ~lx vl~ ~ ~h ~tninces.
Sincerely,
les Buchholz, R.S.,
Sanitarian
LB/ko
£nclosure: Pemtt