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HomeMy WebLinkAboutCONIFER HEIGHTS BLK 3 LT 18~ubUC, IPALIT¥ OF ANC, H(~t~t: ~t_ SEP. ViCES DtVI$1ON Municipality of Anchorage Page I of 0:,T ~ 0 1995 DEPARTMENT OF HEALTH AND HUMAN SERVICES ~F~.~ ~gx ENVIRONMENTAL SERVICES DIVISION ~EC . 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 on-site Wastewater Disposal System and/or Well Inspection Report Permit Number: ,.~ 14,,' ?~O ~ I~ PID Number: ~ ~0 Name:~ ~ P~ ~~¢~ee Wastewater SYstem: ~ New ~ Upgrade Address: ~ 771~ Pouf ~r~ ~ ~. ~1~ .~:ABSORPTION FIELD Phone: No. of Bedrooms: ,. ~ ~DeepTren;h D Shallow Trench ~ Bed D Mound ~ Other LEGAL DESCRIPTION so, Rating: Total Depth from original grade: ~' ~ GPD/Sq. FL I~.~' Lot: Block: Su~div~ton: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: ~ Range: J Section: Fill added above original grade: Gravel length: I I O*~' Ft. ~' Ft. WELL:- E~f, ~ New ~ Upgrade Gravel width: Number of lines: ~Oistance between lines: ~.5" Ft. I I - Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~.~t~ Ft. Ft, ~7 SQ. Ft. ~-~ Driller: Date Drilled: Static Water Level:Ft. Installer~ ~ . ~e ~ ~ Date installed: I~[ Yield: GPM ~ Pump Set at: Ft. ~ Casing Height Above Ground:Ft. TANK I I SEPARATION DISTANCES = Septic ~ Holding ~ S.T.E.P. TO Septic Absorption Lift Holding ~ubllc/Prlvate Manufacturer: , Capacity in gallons: From T.nk Field Station Tank Sewer Lines ~ ~r~, ~ ~ t Material: Number of Compa~ments: Well- 190, I~~ . . ~ ~'~ ~el Su~ace Water >1~' >~o' - - - LIFT STATION Lot Size in gallons: I Manufacturer: Line ~' I~ - -- I Cu~ain Pump Make & Model I Electrical Inspections pedormed by: Drain - -- - -- I Remarks: ~~ ~P~'c ~ ~o~~ BENCH MARK ~r ~f ~ ~i4~ ~ ~ ~o~ ~ Assumed Elevation: Inspections performed by: ~l~f '~.~ ~c Dates: 1st I~/u/~' S ;~ · THEODORE F, 'T~ 't~;~, '. CE - 3589 Departmenl of Healt~d H u rvices approval ~f~:~:~:;,.. ... 72-013 (Rev. 9/91) MOA 25 PERMIT NO: SW950215 ,, PORT ORFORD DRIVE , , BLOCK 3 T.H. '- #2 ', NEW 39' LONG SOIL ABS. TRENCH "K" WITH 10.0' OF SEWER GRAVEL ~ THEODO[~E F. ~OORE ~ CE-3589 8 BDRM HOUSE SWING TIES FROM: COR. "A" COR. "B" TO: S.T.C.O. "E" 16.5' 25' S.T.C.C. "F" 21' 27' DBL. C.C."G" 23.5' 28.5' COR. "C" COR. "D'~ PAGE 2 OF 3 ", NEW 1000 GAL. ,~ TAN K DBL. ORIGINAL ',,~r'-TR ENCH "BULL RUN" DIV. VALVE DIV. VALVE "H" 25.5' 30.5' C.O. "1" 21.5' 20' C.C. "J" 67' 70' C..O "K" 94' 89' TR. C.O "L" 104' 108' TR. C.O. "M" 98' 80' TR. M.T. "N" 99' 81' LOT 18, BLK. 3, CONIFER HEIGHTS SEPTIC SYSTEM UPGRADE AS-BUILT INSPECTION REPORT FLATTOP TECHNICAL SERVICES SCALE: 1" = 30' 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 OCTOBER, 1995 PERMIT NO: SW950215 PAGE 3 OF 3 PID NO: 01509305 INV. ~ 94,9° 1000 GAL. SEPTIC TANK GROUND ELEV. 99.5 -- FINAL GROUND ELEV, 78,9' PIPE INVERTS ELEV, 75.0 (BOTH ENDS) LONG SOIL ABSORPTION TRENCH -- BOTTOM EXCAVATION ELEV, 64,9' BOTTOM T,H. #2 ELEV. 58.9' DRY. 10/11/95 LOT 18, BLK. 3, CONIFER HEIGHTS SEPTIC SYSTEM UPGRADE AS-BUILT PROFILE FLATTOP TECHNICAL SERVICES NOT TO 'SCALE 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 OCTOBER, 1995 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950215 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:BARKHOEFER EDWARD L & OWNER ADDRESS:7718 PORT ORFORD DR ANCHORAGE, AK. 99516 DATE ISSUED: 8/11/95 EXPIRATION DATE: 8/11/96 PARCEL ID:01509305 LEGAL DESCRIPTION: CONIFER HEIGHTS BLK 3 LT 18 LOT SIZE: 50358 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AMD 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 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 RECEIVED BY: ~q~/P. DATE: DATE: CF~ & ENV~ON~NT~ ENG~EER~G · ENERGY CONSERVA~ON & ~Y~ Tt~ODORE F, MOORE, P.E. 14~30 ECHO PH: (907) 345-1355 August 7, 1995 ~CHO~GE, ~~ 99516 M,O,A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to upgrade the wastewater disposal system serving the 3 bedroom residence on Lot 18, Block 3, Conifer Heights S/D, located at 7718 Port Orford Drive. The present soil absorption trench is no longer able to absorb the wastewater flow emanating from the residence. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 2. As can be seen from the soil log, the native material between 4.5' and 13 feet below ground level is a silty sand with a measured perc rate of 10 minutes per inch. Using a slightly conservative soil application rate of 0.6 gpd/sq, ft. specified in the wastewater ordinance for soils with perc rates between 15 and 30 minutes per inch, this 3 bedroom residence requires a total absorption area of (3 x 150)/0.6 = 750 square feet. The proposed 42 foot long trench design with 9 feet of sewer gravel beneath the horizontal distribution pipe has a total absorption area of 756 square feet. The topography of the lot in the vicinity of the proposed construction slopes down towards the northwest at approximately 15%. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space- surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. ..~~ ///C ~ £.~o,.,,~,~ Sincerely, ~ -' Ted Moore, P.E. ,' -- , PORTORFORD DRIVE , , , LOT 19 ,~ , , , BLOCK 1 , ,' ,' ' ' ' / ~ / :::::::::::::::::::::::::::::::::::::::::: / . i .... I ......................... _/ ', .-1-'- ........ ============================================ ::'--- ,, ', - , .~ ........................ , ....... ~, , WELL~ ~ ~ z =================================== / -.., , ~ ~ :::::::::::::::::::::::::::: ;~ , ~ ~ ~ ::3: ::::::' ~':::::: ~ / _ . . ~'~ - ~ ........ ~.: ...... ~ , WELL ~ =================================== , / .' , ~ ....... ::::::::::::::::::::::::::::: , ,' ~ LOT 17 I / , BLOCK 3 ................. :::::::::::::::::: , '", ~ ' T H ' ::::::::::::::::::::::::::::::::: "' NEW 42' LONG SOIL AB:~:~':'~'~:~:~CH ' '- ~--~_/--- oo ~ ~ ,""~--., % .................................. ------ .~ o2---- -- -- o SEPTIC % .... / :X~ SYSTEM o % % ( ~ ~ NEW 1~O GALX o LOT19 % X ~"L ~ SEPTIC TANK '~ o ~~-:~ X~ ~:-:~~ OLD SEPTICTAN~ ~ ." .."' / "~ ~ ~ ', (TO BE ,,BANDONE~) , · ~ / ~ X~T.H. , ~" ~ .-' ,' / % ~ / ~ X ~1 ', ./ ~ ." , / % ~/ ,-- , .~ .' ,' / x =/ .~ x ,._.~ ~ ... ,, X / / ,, ~ x.~z/ ... / ,,, ~ //,'" LOT14 ~ ,' /,',,, L 18, BLK. 3, CONIFER HEIGHTS S/D SEPTIC SYSTEM UPGRADE SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 AUG UST, 1995 NOTE: THIS IS NOT A SURVEYED PLAT, ALL LOCATIONS SHOWN ARE APPROXIMATE. "A" ~ MONITOR TUBE ~ /, EDGE OF TRENCH EXCAVATION PLAN VIEW SCALE: 1" = 10'- 0" -- MONITOR TUBE CLEANOUT -- MOUND COVER MATERIAL 12" SECTION "A - A" SCALE: 1"= 5'- 0" GROUND . MATERIAL LTER FABRIC DIAL F-810 PERF, DIST. PIPE --112" - 2 112" SEWER GRAVEL OF TRENCH LOT 18, BLOCK 3, CONIFER HTS. S/D SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOP TECHNICAL SERVICES 14530 ECHO STREET ANCHORAGE, AK, 99516 SCALE: AS SHOWN DRAWN BY: TFM AUGUST, 1995 Flattop Technical Services 14530 Echo Street, Anchorage, AK99516 Phone (907) 345-1355 Lot 18, Block 3, Conifer Heights S/D 7718 Port Orford Drive Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of installation of a new 1000 gallon septic tank plus construction of a new 42 foot long soil absorption trench with a total of 9.5 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessm'y utility locates, and to work around any buffed utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 1.6 The owner shall be responsible for delineating the location of the property line in the vicinity of the new soil absorption trench. 2.0 Septic Tank: 2.1 The existing septic tank may be retained in service, only if it's su'uctural integrity has been verified by the inspecting engineer, and if it has functional cleanout pipes with airtight caps, allowing pumping access to each compartment. Any existing septic tank or seepage pit which is not retained in service must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil. 2.2 The new 1000 gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compat~nent shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slor~e of 1/8" t)er foot A cleanout shall be installed within 5 feet of the building foundation, and a doubl~ clean'out ~hall be'installed within 5 feet downstream of the septic tank. Additional cleanouts shall be installed in the wasteline between the septic tank and the new soil absorption u'ench such that no portion of the wasteline is more than 100 feet from the closest cleanout. 3.0 Soil absorption system: 3.1 The soil absorption system shall be consu'ucted by excavating a 42 foot long u'ench to a depth of 13 feet below ground level. The alignment of the u'ench shall roughly parallel the contour of the original ground. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infilU'ation. 3.3 A total of 9.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 9.0 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the enth'e top surface of the sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 12 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote revegetation of areas disturbed by the consta'uction. 4.0 Inspections: 4.1 A minimum of 4 engineering inspections will be mquh'ed during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the inf'fltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the disu'ibution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requh'es one inspection after it is set level and the piping connected, but prior to back.fill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. TEST HOLE FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: DATE PERFORMED: PERFORMED FOR: Lot 18~ Block 3, Conifer Heights Subdivision July 14, 1995 Ted and Para Barkhoefer DEPTH SLOPE (feet) 1 11 COMMENTS: Pt SM Reddish sandy lomn GM Gray silty sandy gravel ML Gray silt ML Gray gravelly sandy silt SP Medium sand (moist) Water seeps ML Gray sandy silt B.H, Depth to Groundwater Date Seeps (~ 16' 7/14/95 Monitor tube dry 8/1/95 o, Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) 7/14 12" Presoak Start 12:42 23 5/16 #1 1:02 20 22 7/8 7/16 -- Add water 1:03:30 23 1/2 #2 1:24 21 23 1/16 7/16 Add water 1:25 23 1/2 #3 1:45 20 23 1/8 3/8 PERCOLATION RATE 60 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 6.0 FT AND 6.5 FT CERTIFY THAT THIS TEST WAS PERFORMED IN TEST HOLE # LEGAL DESCRIPTION: DATE PERFORMED: PERFORMED FOR: DEPTH (feet) 1 2 FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST Lot 18, Block 3, Conifer Heights Subdivision July 14, 1995 Ted and Para Barkhoefer Pt. SM Reddish sandy loam 11 SLOPE GM/SM Sandy silty gravel should perc at least as well as underlying SM SM Gray silty sand Soft, easy digging Variable lenses of ML & SP D ep,!,h !%G ro,_.,,u n d water /No Groundwater 7/14/95 ;t ] Monitor tubedry /] . 8/1/95:.;/ GP Somewhat silty sandy gravel (coarse) B.H. PERCOLATION RATE 10 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 7.25 FTAND 7.75 FT Soils in this location should be better for construction of a soil absorgtion trench than in area et' test hole #1 and there should be Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) 7/14 12" Presoak Start 2:21:30 24 0/16 #1 2:31:30 lO 23 0/16 I Add water 2:31:45 23 1/2 #2 2:41:45 10 22 1/2 1 Add water 2:42:00 23 7/16 #3 2:52:00 10 22 5/16 I 1/8 COMMENTS: less liklihood of high seasonal groundwater. PERFORMED BY FLATTOP TECHNICAL SERVICES. I ,~ ~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. CERTIFY THAT THIS TEST WAS PERFORMED IN DATE:  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 LOCATION NO. OF BEDROOMS Well I area DISTANCE TO'. ~ ~ Absorotio~ / D~ollin~ / PERMIT ~O. ~ ~anufacturo~ / M ~o. of Liq. caoacitg in ~allons ~ In~ido length ~idth Liquid de~th t ~ ~ IF HOME'DE: ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ - ~ Manufacturer Material Liquid capacity in gallons Q Well / Foundation/ ' Nearest lot line/~ / ' PERMIT NO. ~= DISTANCE TO: ~ ~o. ofl,ne, Lon~thofeach~ I Totall~n~thofl~ I Trench~,dth 'Distancebet~ee~ ;~ TOp of tile to finish grade ' Material beneath tile / Total effective absent, area Lon~th ~idth Do~th ~fi~MIT ~0. ~ Tg~e of crib Crib diamot~r Crib dopth Total offectivo absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO, ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER SOIL TEST RATING REMARKS FIF'F't. I CANT [_OCR]" I C N L. EGFIL DEPARTMENT OF ,'iEFIL.]"H AND ENVIRONMENTFIL PR ..... (EC:TION 825 '" L '" STREETF, RI",ICHORFIGE., 81<. d. ~, 4 - 4 ,' ,::. ::1 "FEB, E:ARKHCIEF'EF.: L."L:::: 83: C ON I FER HTS L. OT '-'-'' .::, I ,."E ,:1. 9'S~ S';:'~ S F..). UI::IR E T"r'PE OF SOIL. FIE:SCI'R[~:.:T!ON S'¢S'FEM :IS' TF::Er.4c:H MFIXIMI...iI'd NI..IME:ER OF E:EE:,ROOMS = S3II .... RFIT!NG ,::Si.".:! F"I",-.-'E:R)= 2'5']0 THE RE(.:~U I RE[:, S I ZE OF TFIE SCi I L ABSOF.'.F'T I ON S"r'STEM I S ' THE LEI'.4G'rFI DIMENSION IS THE L. ENGTH (IN FEET) OF THE TRENCH OR [)RFIII'.,IFIELD. ]"HE DEPTH OF FI TRENCH OR PIT IS.; THE DISTANCE E:ETHEEN THE SURFACE OF THE GROUND FIN[) THE BO]"TOM OF THE EXCAVFITION (tN FEET). THERE IS NO SET H:[[:,TH FOR TRENC:HES. ]"PIE GRAVEL. DEF'TH :IS THE MINIMUM DEPTH OF GRFIVEL. BETWEEI'4 'THE OU'f'FFIL.L PIF'f::".< Fff.,ID THE BOTTOt'd OF THE ENCR'v'FITION (IN FEET::,. F'ERM I T FtPPL I C:ANT HAS THE; RESF'ONS I E: I L I T'¢ 'ro I IqFOF.'M TH I S E:,EF:'FIF.:TMEI'.4T [)UR I NG' "t-.tF' INSTFIL. LR]-ION If4.:FE-.TIOfL:"'; OF FtN'Y HELLS R[:,JRf3ENT TO THIS F NUMBE;R OF RESIDENCES THFIT THE HELL. P.IIL. L SEF.'."E. T ~--.i C:! ,:: ;:-.~_' :;, I ['-,! .'.E; F" I:Z ti:: 7- I EEl I"-,I BRCKF ~LL. I f.,I6 OF FII'-,IY =,'r =, rEl'l W I THOUT F I NFIL INSPECT I ON FINE:, RPF'RCPv'Ftl E:'T' TH l' S BE [:'EF'FIRTMENT t4 ! LL SUE: ~EC:T TO F'R ElSE '"_:t 7' I ON. MINIMUM DISTFINCE BETWEEN R HEL. L AN[::' AN"r' ON-SITE SE].'.IRGE DISF'OSFIL. S'¢S"f'EM !?, ::LOE,~ FEET F'OR FI PR IVFITE' HELL.; OR :.1..50 TO 200 FEET FROM F'I PI..IBL. IC: WEL. L [:,EPENDING UF'OI",I "FHE TYPE OF I::'LfBLIC': HEI..L. WELL LOGS ARE REQUIRED FIND MUST 8E RETURNED TO THE [:,EPFIF.:TMENT WITHIN i'".::(i~ [:'FI'T':~; OF' "f'FIE HEI_L COMPLETION. OTHER REC!UIREMENTS MR'¢ RPPL.'~'. SPEC:IFICRTIONS AN[:' CONSTRLICTION DIFIGF.:FIMS ARE R'v'FIIL. FIBI_E 'fO INSURE PROPER INSTFILLFITIOI'4. I CERTIF"r' THFIT ±: I FiM FFIM!L. IFIR WITH THE RE(:]UIREMENTS FOR ON-SITE SEWERS FIN[::, WEI...LS.; FIS SE'T' FORTH B'Y THE MUNICIPFIL. IT'T' OF' FINCHORFIGE. 2: I 14ILL INSTALL THE SYSTEM It'.,I RCCORDFINCE HITH THE CO[:,ES. _7:: I UNDERSTFIIqD THAT THE ON-.SITE SEWER S'T'STEM MR'T' REC!UIRE ENL. Fff;.'.C~EMENT IF THE RESI[:,ENCE IS REMODELED TO INCLUDE HORE ]"HRN 3':: BEDROOM'_-T,. S I iS N E [:' ' FIPPL I CFINT TIE[:, E, HF..k.H _ EF EF. Mt_IN I CZ PI:iL I TY 01:' Al'-4;' ~'-117_IRI-~I.~I~ DEPARTMEt,. OF HEALTH 8ND ENVIRONMEN],,L PROTECTION, $25~ ~L ~ STREET, 8NCHORFtGE, BK.. , ' 264-4720 WELL H'~4D ON--SITi _ C:EI~JER, pER[.ii LEGFtL /.../~2 ~ ~ LOT'SIZE .~,,~ SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEbl I:S' MAXIMUM NUMBER OF BEDROOMS = ~ SOIL RATING THE REQUIRED SIZE OF THE: SOIL ABSORPTION SYSTEM IS' , r EPth= // LEN,- TH= 7d" C-EPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH AR DRAINFIEED. THE ~EPTH OF 8 TRENCH~OR PIT IS THE dISTANCE BETHEEN THE SURFACE OF THE GROUND AND THE BOTTOM~ OF THE EXCAVATION <IN FEET). ' THERE IS NO SET WIDTH, FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETHEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE, EXCAVATION (IN FEET). i~:E~LI 'r F-.:E[-., _C:EF'T T L--: TI--~I'-,IK :5 T --'-"'E= l/~)~,¢ ~.3FILLC, I'-.I'_:, F'ERMIT FtPPLICANT HAS THE RESPONSIBILI'r'¢ TO INFORM THI¢ DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY. ANd THE NUMBER Of RESIDENCES THAT THE WELL WILL SERVE. ' TWi3 ( 2 )' I ~4SPEO~' I mlmr-4c RRE ~:EQLi I RED B~CKFILLING OF RN~ S'¢STEM WITHOUT FIN8L INSPECTION AND RPPROVSL B'¢ thI~ DEPARTMENT WILE BE SUBJECT TO PROSECUTION. ~ F'IlNIMLIM DISTANCE BETWEEN R WELL AND RNY ON-SITE SEWRGE DISF'OSRL S~'5TEM IS i00 FEET FOR ~ PRIVATE WELL~ OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE [:,EPRRTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REt~UIREMENTS MAY 8F'F'LY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE RVRILRBLE TO INSURE PROPER INSTALLATION. F'ERr¢I I T EXP T F:ES B-,ECErdE:EF-: ---.-:-1 .. -1 .~ ,---- .-~-- L--~ ! CERtIF~ THAT 1. I AM FFIMILIFIR W~TH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS FI~ SET FORTH bM THE MUNICIPFILIT'¢ Of RNCHARAGE 2' ! t4ZLL INSTALL THE S'¢STEM IN ACr:ORDANCE WITH tHE C:ODE$. -<' I I.INDERSTAN[~ THRT THE AN-SITE SEWER SYSTEM MRY RE/?..UIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN '"' E:EE>ROOM'-~ Applicant April 19, 1979 R&M No. 656235 Mr. Jim Doss 3201 'C' Street Anchorage, Alaska 99507 Re: Test Hole and Soil Conifer Heights. Dear Mr. Doss' _rt for Sanitary System Lot 18, Block 3,~ This letter is submitted as a supplement to our report of May 17, 1976 on the subject project. In that report the depth at which the percolation test was performed was inadvertantly deleted. Our standard procedures would require that the test be performed at a depth below 4.5 feet in the SM material which is expected to be utilized for the proposed drainfield. We can assume that the staff geologist who per- formed the test, being aware of subsurface conditions and system require- ments, ran the test at the proper level and the results should be considered correct as shown. Very truly yours, R&M CONSULTANTS~ INC. Gary ~/ Smith Sen io~/fGeologist GS/rm/Lt-O CONSULTANTS, INC. ANCilORAGE FAIflBANKS JUNEAU EAST 51'~T AVENUE * P.O, BOX 60B7 · ANCHORAGE. ALASKA 99503 "' TF"LEPHONE 907-279-.04.83 · TELEX May 17, 1976 R & M No. 656235 Mr. Jim Doss 3201 C Street Anchorage, Alaska 99507 RE: Test Hole and Soil Log Report for Sanitary System Lot 18 Block 3 Conifer Heights Dear Mr. Doss: We are Submitting herewith the boring log, percolation results and our comments regarding soil conditions encountered at the subject site. This investigation was Performed in accordance with your request of May 14, 1976, and those, procedures outlined in a letter dated July 15, 1975 by Mr. 'Rolf Strickland of the Municipality of Anchorage, Department of Environmental Quality. ._ A single tes~ hole was put down within the Lot 18 area for the purpose of defining general subsurface soil conditions and conducti'ng percolation tests for the proposed sanitary system. Excavation was accomplished with a tractor-mounted auger type drilling rig and the test hole was 'extended to a total depth of 19.0 feet below ground surface. The final iog prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R '& M CONSULTANTS, INC. James W. Rooney{~ Vice President JWR/PJ/pe xc: Municipality of Anchorage TIME 12:40 12:41 12:42 12:43 12:44 12:45 12:50 12:55 1:00 1:05 1:10 1:15 1:20 1:25 1:30 1:35' 1:40 PERCOLATION TEST JIM DOSS R & M NO. 656235 ELAPSED TIME 0 1 1 1 1 1 5 5 5 5 5 5 5 5' 5 5 5 60 Minutes DROP INCHES 0 1 1 3/4 1 4 1/2 4 3' 1/2 3 1/4 3 3 2 3/4 2 1/2 2 1/2 2 1/4: 38 1/2 Total Drop O TH1 TH 1 ORGANICS (PT) SILTY SAND W/ SOME GRAVEL (SM) SILTY SANDY GR~VE~ (~ SILTY SAND W/SOME TO TRACE GRAVEL (SM) SANDY SILTY GRAVEL (GM) 11.0' 14.0' Scale Log Represents Location of Test Hole Lot 18 Block 3 Conifer Heights Subdivision DWN: CKD: pJ 5-17-76 SCALE= 1"=3 ' SAND~ GRAVEL W/SOME SILT (SM GM) (230) No Water Table 2.30' Log of Test Hole Jim Doss Anchorage, Alaska PROJ. N0. 65623.5 I,DWG-N0' A-01 ~eo!^Je~ u~ eBeJoqou unH '~ 411eeH ',tdeo ~ ~.o ,~l!led~o!un~ £ STATEMENT SYREN BROS· DRILLING, INC. 270! Eagle Street Anchorage, Ala,~ka 99503 Phone, 2?4-6437 ;.~ay 2, 1979 :iR. TED ~IRKOEFER c/o B&D CONSTRUCTION SRA Box 7iR Anchorage, Alaska 99507 L _J DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT. 20 ' WATER ?~ELL CASED TO 237(~" ) ~- ~i9.oo ~E~,fFT ..... ~6G~0.00 O~ZVE s~o~ ............... ~?ELL SEAL N/C Redlf.?rm 8S 884 Poly Pak (50 sets) 8P884 PAID BY CHECK NO. "q r - C) Vl CY) CD m co Iq 'IT CIO co r- ti O O o0 L � n ter{ 1j" r C® V rrU^^ (fV ) �. � L^` Q r M N CU O'� 06 U) L Q O > U) 00 A. N O N N O ill cu 0 C 0 co .Q X W 0 0 O i LO O I cy') O') CD Ln r O N U co n O LO C) ^Q W co L- 0 0 U Q elf O U— O 0- 00 ti U) U O ca m W, N O O U m O 0 0 Q Q a� L cu U) 0 U) N U) C O H KR c 0 cu Z3 .2- 0 0 0 N ui 0 0 O U M, 9 L) o 0 0 Q. fn c4 0> ,� •U fn •t� N 4 _ cc -0 i N cCC L = O O N Q O N X O N ai O 0 O U C N N O o Q ,N ami U) >1 o (L) CU N N0 N U LLQ O 3 O Q. O .N 0 3 z cn L +, N cc O > Q OO O O Q Q. 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LU o ❑ E s O Q a0 co U)U)c Q cn a W O W � O A V n aa) U) ' Z � w LL �' � a > ~ O O U N w a� m Cs cn a O 0 a zi Lw co O H H w cn 0) Q m Q ?a c� > N M et (n (D 3: W M 0 T LLQi 11,�, a� I c a� E, LL 0 Qa ca 0 (D co COSA Checklist Legal Description: Conifer Heights; Block 3, Lot 18 Parcel ID: 015-093-05 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 5/2/79 Total depth 320 ft Cased to 237 ft 0 Sanitary seal is functioning correctly n Wires are properly protected Casing height (above ground) 12+ in Date of flow test for COSA 8/17/23 Static water level at beginning of test 196.2 ft. Comments -,r-- V I.; I -r- bre If B. TANK DATA 4B.5 Measured operating fluid level in septic to k* l O/q- Date of pumping 10/2/23 ❑ Required maintenance completed, if AWWTS Comments: - D. ABSORPTION FIELD DATA Which system tested (date installed) 10/12/95 FE ALL standpipes present per record drawing Total measured depth from grade 14.16 ft (max) Measured depth to pipe invert from grade 4.25 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. Monitor tubes go to bottom of effective. *** If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) none If yes, enter date Well production at time of test 4.8+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes R No © Coliform bacteria is Negative Nitrate G --�S mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ©'Arsenic less than MRL (ND) Collected by GEG, Ltd. Date 3 liJ2,A C. LIFT STATION ❑ Required maintenance conjA Age of liftstation years Lift station vial Adequacy test date 8/17/23 Results Q Pass Fluid depth prior to test 91 in Water added 468 gal New fluid depth 105 in Elapsed time 120 min Final fluid depth 98 in Absorption rate 450+ god FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 120 in Effective depth used 98 in Effective depth remaining 22 in Comments/Deficiencies: *No septic pipes for 1979 reserve trench were found - Condition is unknown. COSA Checklist June 2022 Cbe"3I,pe�L G31 L-/ q E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' OYes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft 0 Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) *5'+ Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' 0 Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS 0 Yes if No ft 0 Yes if No ft 0 Yes if No ft Yes if No ft *Met code at time of installation. Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' 0 Yes if No ft 0 Yes if No ft If tank or field is under driveway comment below G. CERTIFICATION & 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 Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Garness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Gamess Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may o Q'Fi AZ exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing C } { the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not 6�11 .- :.. � ........ ........ guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform ... Q J fret' A. Garness adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG 0, � to perform the evaluation. Reliance upon the information provided in this report by any other person or party Q��s CE( -73 (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022LaasEFessgao� 4#AECC884 30p'p'O NO �- r Z v {- Q) ry N L 4.1 LJ m a Loa QJ LL! U > N V o LLJ 41 fS O E Lu 3 o 0 3: L bzLnL E X ++ i U O N E vi 0 O t 4- E cn O a) L f0 .aCB L U i 4-J a) N fv fo Q N �- LJ_ U N a) L N Q) + E N iJ > N � L cv U hA N -a °' z ELnL Ln 00 -r- aJ CD m a-+ O d Q W O 4O N . � U O W Q � �-1 ° Ln L O N 3: Q) 0 N C J � N a) (3) U mU N aA Q N > fY) 0 ttA 4A W f0 — Q =' fQ Q U Q) d m m O O O a1 0)-1-j W 0 U +j -C ca 40 W a a) +J o Q �...� a.., tB CO ° c m N L v > 0) ° Q E E 07 o s `� E 4, o� >- 0 ai O fB L M a) O M a--+ O L C icB > > a) w E Q ° i ?� a� > cB 0 :3 Q �" 4- 0 — 1�- H c Z O w U � N Q � a +� LU 3 O Ln a) W + M' v N LLJ i H tnM z L L w 1 O M a � � o a� E LU in 0 O 3 aJ Y Y 0 0 Q C a-+ a) C) O v a O M (o O �o v E t to .L 0 a) a E m X C) c ca .N +� CU L a -C O N Q io L C:Ln O O O 0 O 4- O a•J � 0 cu U 0 ro cu ~ r Ln O U C 4 U N � Ln � N O 3t f6 > O Q Q cu N > N i7i O O J M _Ile m � HiQ 2 L v a) O Lo O >' 00Q N N L v ° Q En t 4.1 L O w U a) U U >, Uj ro o •N c fo U E L O Q Q O L O dA > `" � 4J E CU � 4— O Ln O U — co O a� ro ate•+ fB c4 -0i1 E O cu c, CO _O cn 'E'er U Q Ln F aa) N v c �- 00 > cu N ai O U V) I-- vC: H aJ Y Y 0 0 Q C a-+ a) C) O v a O M (o O �o v E t to .L 0 a) a E m X C) c ca .N 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. # _. O/5" 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 I~ ~ c ~ ~-~( rJ,.r Address ~ ¢"oO Day phone_ ~Y~' -/730 Day phone ~zz-~ao~ Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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 #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. Address Engineer's signature Phone DHHS SIGNATURE J,//" Approved for 'T"H/~'~'~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of He~i[h 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.-025 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage DEPARTU;NT OF HEAL, rH&HUUAN S;RWO; £P 1 0 Environmental .sewi'ce~ 'Division MUNICIPALITY OF ANCHO~',AG-- 825 L Street, Room 502 · Anchorage, Alaska 99501 · (9~~~ Health Authority Approval Checklist Legal Description: Z._,,~/' t~. ~ I/<- ~ ~,,.,.C~- /-j~ Parcel I.D.: A. WELL DATA Well type IfA, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) /V' Date completed ~ I ,~ ?~e Total depth :72¢Y (?~r r~¢,~,?/! Cased to ~_~7' (/~, r~,,~,..~ Casing height (above ground) Sanitary seal (Y/N) Y' Wires properly protected (Y/N) T FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. ~, ~ g.p.m. WATER SAMPLE RESULTS: Coliform C:P ¢'o (C~, ~ //(oO ,,~..~ Nitrate Date of sample: · ~. ~'/m~,./..E Other bacteria Collected by: B. SEPTIC/HOLDING'TANK DATA Date installed ~./~- 'Tank size I¢'¢~ ~, Foundation cleanout (Y/N) Y' Depression (Y/N) k/ High water alarm (Y/N) /V. ,~/.. Date of Pumping ~/7 / ~' Pumper _T-_c ¢~ ¢~ ¢ ~' C. ABSORPTION FIELD DATA Number of Compartments C Cleanouts (Y/N) ~' Date installed I~/?,,4'- Soil rating (g.p.d./fF or fF/bdrm) ~, ~"~/"~ System type Length ?~ ~ Width ~, ,5- Gravel thickness below pipe I0. t Total depth Iq.j' Effective absorption area '7~ 7 ~'° Monitoring Tube present (Y/N) 'r Depression over field (WN) Date of adequacy test ~ / .? / ~ ~ Results (Pass/Fail) ~',~.cj For ~ bedrooms Fluid depth in absorption field before test (in.); &'~- Immediately afterT~'ogal. water added (in.):' 8 Fluid depth (ins) Minutes later: [ ~ Absorption rate = '~ 5/5"0 g.p.d. Peroxide treatment (past 12 months) (Y/N) ~' If yes, give date ,~'. xf, 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (WN) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line R SEPARATION DISTANCES FROM WELL ON LOT TO: i 90' ~/. A. "~ zs" Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ?' Property line ,5-0' Water main/service line SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I ?-' Building foundation ~o ' Surface water Curtain drain ~o~¢ On adjacent lots ~ t~'o, On adjacent lots '-,> /oo, Public sewer manhole/cleanout /~'. A. "Pump off" level at* Absorption field ~ too Wells on adjacent lots Water main/service line "~ Driveway, parking/vehicle storage area '> '~c~ ' Wells on adjacent lots -> t o o, ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Mumctpal recor~t~at :t~;abo~o.!*y~t~s are in conformance with MOA HAA guidelines in effect on this date. Signature T~_ ~ ~ Engineer's Name ~b ~o ~ ~. ~oo ~ Date ¢4= /9 9S HAA Fee $ -~C? ~oo Date of Payment 'P/GO/Pr Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ztK CT&EEnvironmentalServiceslnc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 983952003 Flattop Technical Srv. n/a Lo/' t~ ~ I~ ~. !~°!2 Conifer Heights Drinking Water Sample Remarks: Client PO# Printed Date/Time 09/09/98 08:34 Collected Date/Time 09/03/98 12:30 Received Date/Time 09/03/98 16:35 Technical Director: Stephen C. Ede Released By.~ ~ Parameter Results PQL Units Allowable Prep Analysis Method Limits Date Date Init Total Coliform 0 col/lOOmL SM18 9222B 09/03/98 KAP Nitrate-N 2.61 0.100 mg/L EPA 300.0 10 max 09/04/98 09/03/98 GCP - Y OF ANC.O MUNICIPALITY G',: ANCHONA~d I IT RAGE DEPT. O,  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO[I~i¢i~,Oh;iv'~[ NI'AL P;,~I ECTION 825 L Street - Anchorage, Alaska 99501 ENVIRO.MENTAL ENGINEERI.G DIVISION SEP 2 1 ! Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be processed. Please allow ten (10) days for processing. MAILING ADDRESS PROPERTY RESIDENT {If different from above~ PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION ' ~ PHONE I MAI LING ADDR ESS 4. REAL~OR/AGENT ] PHONE I MAI LING ADDR ESS 5. LEGAL DES'CRIPTION STR E ET LOCATION 6. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] ~A-wo [] Five ~ Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** [] 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.) **If individual/on-site, give installation date ~f 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 INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE r--I PUBLIC UTILITY Connection Verified []Septic Tank or []Holding Tank Size: !~'3C_X) If Tank is homemade give dimensions: [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SlX 4. DISTANCES WELL TO: PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING TOTAL ABSORPTION AREA MATERIAL i Septic/.ol.in Absorption Area to nearest Lot Line [] OTHER Sewer Line INearest Lot Line 5. COMMENTS ~APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE 72-010 (Rev. 3/78)