HomeMy WebLinkAboutCHANDELLE ACRES LT 26Onsite File
Chandelle
Acres
Lot 26
#051-822-05
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201296 PID Number: 051-822-05
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
MELISSA HAWKS
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
23827 CHANDELLE DRIVE, CHUGIAK
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
3
GPD/SF
JTotal
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Fill added above original grade
Ft.
Gravel length
Ft.
CHANDELLE ACRES 26
Township Range Section
Gravel width
Ft'
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft'
Ft.
Well
100'+
__
25'+
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1000 Gal.
Surface Water
100'+
--
Material
HDPE
Number of compartments
2
Lot Line
10'+
--
NA
Foundation
10'+
__
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks Tank installed 5'+ to deck supports.
Alarm location
Electrical installed by
Installer PCN
PIPE MATERIAL House to tank 3034 drainfield Tank to
3034
Drainfield CO/MT 3034
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspection1s` 9/23/2020 nd 9/24/2020
Location and description
�
3`d 4'"
TOP OF DECK SUPPORT / SONO TUBE
ON-SITE WATER AND WASTEWATER SECTION APPROVAL�'�l
OF A
4.
Conditional Approval: Date
•
TH
.. .....�... �
. Curtis Huffman
����•,• CE 128991 ..•�w���
'3'> • 1/2 9/2 1 • �`
Septic Syste
Approved - /
l �ii�'Ot Date a i �o i
. .
Note: this approval does not include well permit requirements.
(Rev 05/02/18)
LOT 25
r."
C-� 27
-
U
ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
CHANDELLE ACRES SUED
LOT 26 PLAT 79-190
SURVEY CERTIFICATE: I, John L. Schuller. Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance should
any information on this drawing be used For construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORN ORDER NUMBER: D %Ar 9" r -'A'-'
JAN 72, 2021 1"=40'
21-014 IDRAM Or, 101EOCED BY GWD R USM, ena Aw-:
JLS NW1560 210116
AW
F . AZ!11 ii
* : 49
e, r
3 L. SCHULLER.- o
+�nev LS -10408 '0�
c
r�hz f�8si0na� 4°~
DLAND
� r
to n
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
MUNICIPALITY OF ANCHORAGE
�scnt
On-Site Water & Wastewater Program SP
�.+ Pp Box 196550 4700 Elmore Road a G
Anchorage, Alaska 98519-8550 Phone: (907) 343-79x4 Fax (907) 343-7997
http,iAvww.rrtuni.org/onske MAW
11 ei " n
ttni%l
ANCHOnRGE
On-Site Wastewater Disposal System Permit
Permit Number: OSP201296 Effective Date: 8/1412020
Work Type: SepticTank Upgrade Expiration Date: 8114/2021
Tax Code Number: 05182205008
Site Legal Address: CHANDELLE ACRES LT 26 G:1560
Site Mailing Address: 23827 CHANDELLE DR, Chugiak
Owner: HAWKS MELISSA A Lot Size in Sq Ft: 51204
Design Engineer: FIRST WATER CONSULTING Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with. -
1 -
ith: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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: The water service line shall be located prior to construction to confirm separation to septic
system.
Received By.
Issued By:
8/1412020
Date:
Date. � a
13030 Sues Way, Anchorage, AK 99516
907-350 -9566 / firstwaterAK@gmail.com
August 3 , 2020
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: CHANDELLE ACRES LOT 26
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank to serve the
existing 3-bedroom residence. The lot and area are served by public-class A water. The design
will not impact any of the neighboring properties. Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201296, Rebecca Carroll, 08/14/20
FIRST WATER CONSULTING
CHANDELLE ACRES LOT 26
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201296, Rebecca Carroll, 08/14/20
NAME
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
[] UPGRADE
MAILING~A~rl~) SS
LOCATION
[~ DISTANCE TO: ~¢~ ~ Absor~ area Dwelli~z/
; ~ Manufacturer Gre~,.~ M:~~
DISTANCE TO: ~ /~] Dwelling
Manufacturer
DISTANCE TO:
Top of tile to finish grade
Length ~,~'~,~ /k
Type of crib
Crib dia.meter
We l I
Foundation
Total length of lines
Material beneath tile
Depth ~_~ {
Crib dept.___hh
DISTANCE TO:
Class Depth .. Driller
DISTANCE TO: Building foundation Sewer line
Bull din~g~ fou nda~oQ/,
Material
Nearest lot line
Trench width
inches
inches
NO. OF BEDROOM~,~
No. of compartments~
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between lines
Total effective absorption area
ITotal effective aT~jo~2~e~//,
Nearest lot ,:
Distance to lot line PERMIT NO.
Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
iREMARKS ./
?OFE%:;~'>
72-013 (Rev. 3/78)
D~
MUNICIPALITY OF ANCHORAGE
Departmen~f Health and Environment"' Protection
" 825 L Street, Anchorage, AK. 99501
264-4720
{t) * * * HANDWRITTEN PERMIT * * *
Permit ~~rA~ WELL AND/OR ON-SITE SEWER PERMIT
Applicant: ~/~ ~/~. Mailing Address: ~~
Location: Phone Number:
Legal Description: /0 ~-~:~ ~/~~/--~ /~~ ~ ~Ot Size:
Type of Soil~sorption System I$:
Trench: ~ Drainfield: ~_ Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: ~ .. Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
LENGTH GRAVEL DEPTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
· * REQUIRED SEPTIC(HOLDING) TANK SIZE = /'mmO GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
· * * TW0(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this departmen
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
· * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as~
set forth by the Municipality of Anchorage.
system in accordance with codes.
the on-site sewer system may require enlargement if
2 z w± still thF
((3)) I u~e~d ~ i include more that 3 bedr~
modeled to
Date:
· / -- [] SOILS LOG
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
/
DATE PERFORMED:
SLOPE
[] PERCOLATION
TEST
SITE PLAN
10
11
12
13--
14
15
16
17
18
19
2O
COMMENTS
~,c~ed A. 5h~f~r
Nc. 1457-E
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ (minutes/inch)
TEST RUN BETWEEN y . FT AND ~ FT
MUNICIPALITY OF ANCHORAGL
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
$25 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
SOILS I_OG
~PERCO LATION
TEST
PERFORMED FOR: I~'0~.~
LEGAL DESCRIPTION:
DATE PERFORMED:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
72-008 !.£,, 7 9)
..')I
/;,':2,
SLOPE
ENCOUNI EI~ED~
IF YES. AT WHAT
DEPTH?
SITE PLAN ,~7 /... ,.?.-~..
Reading
Dale
· ;.:~- -, -
II
PERCOLATION RATE
TEST P,'JN BETWEEN
Time
Depth to Net
Water Drop
'- /. 70 :.,..
- /. 2~- ...... /-~---
//'? ,c, ¢
~ '
._.-/, ~- $ ,~.~-"---
t . .:/ ~/
Time
/~
.Z/ f;.} Iminule.~/inch)
.~-.. ..
" ~ F"l: AND ( '-
Ct RTIFIED BY:." 'l
•
i Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904 N. II III
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-822-05 Expiration Date: / C-2JY 1 r
1. GENERAL INFORMATION
Complete legal description _CHANDELLE ACRES LT 26
Location (site address) _23827 CHANDELLE DR
Current Property owner(s) WERNER WAAK Day phone
Mailing address SAME
Real Estate Agent Day phone
2. TYPE OF DWELLING:
4-N
� �
® ),Single Family (w/wo ADU) g Oct ' ff : '
❑ Duplex :ET
❑ Multiple Dwellings (Single Family and/or Duplex) op/
7
r/4)
3. NUMBER OF BEDROOMS: 36 g
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class A Well ® Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
'4COSReceived by: 44 Date: 7197'�i 0'49--
COSA
A to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ tJ 04 Waiver Fee $
Date of Payment IoIA, 117 Date of Payment
Receipt Number r9,G4 G' Receipt Number
COSA# Q5C1? 15-0/ Waiver#
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,
based on procedures outlined in the Certificate of On-Site Systems 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.
Name of Firm MIKE N ANDERSON. P.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON. PE Date 10/23/17
rte" ,•+' ., •
ij
• '.z —
v •;
e 6 t �C P O! 1 �0 .. O o sn o•
6. DSD
�SIGNATURE • � •.L:CHAEL N.
System #1 Approved for 3 bedrooms. •
c i.,f •••(1/(77/1//
9,• .. •
System #2 Approved for bedrooms. 1k*`. /''(1 C;••
.'
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
' ITY OF `�,
( 3 Li/t/ ae �;Q 4, <<
A-Vel\-a-Te r 5 04 ea.A.d
- � ONtiSITE
WATER AND is
mWASTt
WATER z'
, _ ROI;RAm
1. 1/4911iNg;
By: ( MA/1 f �/i/(� Original Certificate Date: /0'-Z�—(
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10.10.12 doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system _
Certificate of On-Site Systems Approval Checklist
Legal Description: CHANDELLE ACRES LT 26 Parcel ID: (151-822-05
A. WELL DATA
Well type CLASS A If A. B, or C provide PWSID#213807 Well Log (YIN)
Date completed Sanitary seal (Y/N) Wires properly protected (YIN)
Total depth ft. Cased to ft. Casing height(above ground)
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS
Coliform colonies/100 mL Nitrate mg/L
Arsenic: _ ug/L Date of sample- Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC!STEEL Date installed 5-3-83
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) NA
Date of pumping V- 17^17 Pumper e
C. ABSORPTION FIELD DATA— 1985 SYSTEM TESTED
Date installed 5-3-83 Soil rating (sf/bedroom) 284 SF System type BED
Length 60 ft. Width 18 ft. Gravel below pipe 0.5 ft
Total depth 4.0 ft. Eff absorption area 1080 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 10/7/2017 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 500+ gal. New depth 0 in
Elapsed Time: 60 min. Final fluid depth 0 in. Absorption rate >= 450+ g p.d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWN If yes. give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in.High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 54. Property line 5'+ Absorption field 5'
Water main 100'+ Water service line 25'+ Surface water 100'+
Wells on adjacent lots 100'+AND 200'+FROM CLASS A
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 100'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(None Known) Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATIONow/,cam OF 1�f ; ).,
I certify that I have determined through field inspections and . y•• • ,
•
review of Municipal records that the above systems are in * 49T`+ ;,_ ; .;: ,+,
conformance with MOA COSA guidelines in effect on this date. 4'
1. • • ••• I
Engineer's Printed Name MIKE N. ANDERSON, PE � 0• MICHAEL N, AKDL SCN ;.
Date 10/26/2017 � f.•dic„•_.�€,J 946 �•f,;_,.� ,
tl �•
tt ��''�~
COSA canary sheet 2-6-15.doc
. .
- '
----• • -— , -
410..et:.
.•
//,\:\•;. /'
•
1-7.',-• 1//me ,.././.•,/V
„-••, / I
•
..".i.1
• k • ' 1
• \I :'.”: /
-,
'a '
' Sk-
.• %),• .
1 1
:\\____ 7,4,4. "! i'.77,1•:.'S,0a,:"' ,.__L_,,22.1, n „ : ..,
; --6- • ."' ' -47.-' -• ea...? ------1-;:---------,.,,,,,---,?.----''t
Z-. ... 74'-
,n*Ye
% 1
N,,,
' 4r' -,,,q- ,4, - i-- --,,ij_____
z, _1.
• c..1 . ,. r— '
L /-
.•
• • kt 1
' ..j• t \I I!
.• - I ! ,
1 fr. I-': 17.....e ere' 4‘.7 Ar..7.i•-..zr-,•••••,:re---- '
ASBUILT .4-,."4tee.(4-Ve'r- ...,:f-< SEWARD & ASSOCIATES LAND SURVEYING 6 9 4-0824
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE`
"..',-1-
FOLLOWING DESCRIBED PROPERTY: 411. OF Arol
...,,_ %
'r-.•-----
DATE. , •• k.P t.
AND THAT NO ENCROACHMENTS EXIST EDCCEPT AS -!-:. .K:- Ark'.... 44 •-
.,7"-e")4--• .Cr. • , .., 2
tNDICATED. IT IS THE RESPONSIGtLITY OF THE y •';' AZ1.±1::/),/ .„. t
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: y
• / y f"
EASEMENTS, COVENANTS, OR RESTRICTIONS ri,(11/
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- -- *A... puma mktk
VISION PLAT, UNDER NO CIRCUMSTANCES SHOULD r19: •. • 4 t.$...
...: ,. •
•
ANY DATA HEREON BE USED FOR CONSTRUCTION t ‘t-4,;.,...7
'.1. •P,,,, . -.1.i OF FENCE LINES, OR FOR ESTABLISHING BOuND-
DRAWN;
ARY LINES. - -",,t.N.,-..-r-'•
XA'---).
•
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # ~ ~ - ~ ~- ~' ~:~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lOt, block, subdivision, section, township, range)
Lot 26 Chandelle Acres
(b) Property owner
Mailing Address
Location (address or directions)
Chandelle Drive
Judith Lee
Telephone'(home)
~usiness
(c) Lending Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent Re/Max- A1 Romaszewski
Address 16600 Centerfie]d Dr.~ ~201, E~gle River, Ak. 99577
Telephone F,c~4-4?Ot~
(e) Mail the HAA to the following address: (or check here~ hold for pick up.)
List contact person and day phone number below:
S & $ ENGINEERING
17034 Ea~jle Ri,vet L~p Road
EagJe River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms 3
3. WATER SUPPLY
Individual Well [] Community [~ Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ~ 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.
72-025 (Rev. 7/88) Page 1 of 2
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.
Name of Firm Telephone ~'~ ~'z/~ ~_~ ~' 7~
Address
Date
S & S ENGINEERING
Eagle River, Alaska 99577
6. DHHS APPROVAL
'
Approved for~'-~)bed rooms by
Approved ;~ Disapproved
Terms of Conditional Approval
Conditional
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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. 7/88) Back Page 2 of 2
~ ,,~,~:I~.NICIPALITY OF ANCHORAGE (MOA) ~
[;"~r~r..~O~' ,~,~o~i~-Iealth Authority Approval (HAA)
~,~5~'h CHECKUST - FEBRUARY 1984 ~
a~,~ ~:~ 343-4744 ~
~ ~ ,' .~ Legal Description: ~ ~
A. WELL DATA
Well Classification ~ If A, B, C, D.E.C. Approve~)
Well Log Present (Y/N)
Date Completed Yield
Total Depth Cased to
Depth of Grouting
Static Water Level
Pump Set At
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot "~::~ ''~ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot
· ; On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by
; Date
Water Sample Test Results
Comments ~, ~"'~' ~-
B. SEPTIC/HOLDING TANK DATA
Date Installed ~'"~-~)'~ Size ~ No. of Compartments
Standpipes ~1) y Air-tight Caps(~N)
Depression over Tank (Y~]~
Pumping/Maintenance Contact on File (Y/N).
Holding Tank High-Water Alarm (Y/N) ~'~/,~,/
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well ~ I,.~ To Building Foundation
I
To Property Line \ c::, -'~ To Disposal Field.
To Water Main/Service Line ~
To Stream, Pond, Lake or Major Drainage Course \ ~ I
Comments '~'-~;~--~ ~_-fc::~--~--~c:x~..- _'~-~ .~1 ~-~.
'-/4 Foundation Cleanout
D~tA,= Last Pumped
I,~ ;for '--~
Temporary Holding Tank Permit (Y/N)
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata "~---~f' ~//~%(~-~- Type of System Design '~
Date Installed --~:,;'"'~- ~:~'~ Length of Field
~ I
Width of Field \ ~;' Depth of Field
Gravel Bed Thickness
Square Feet of Absortion Area'''~ I '-~<~:~C>'ge' Statndpipes Present{~?N)
Depression over Field (Y/~ ~-~ Date of Last Adequacy Test
Results of Last Adequacy Test ~'1~, ~ _~--~, .~/ -- ~
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To BuildingLot Fou ndati~n/~
To Water Main/Service Line
I
'~..-,c:l~ ~-- To Property Line I ~-~ "t"-
!
"~ To Existing or Abandoned System on
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments~ ~,~' ~ ~
; On Adjoining Lots
~ C:, ~ --~ To Cutback (if present) r~/,z~
D. LIFT STATION ~,~ //~r~
Dimensions
Date I~alled
Size in G'a~
"Pump On"
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect
inspection.
Signed
Company
Date
MOA No.
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
- Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE, AK 99503
STEVE COWPER, GOVERNOR
563-6775
FOR: S & S Engineering
DATE: Ma~ 3, 1989
PWSID: 213807
To Whom It May Concern:
According to the records on file in this office, the Chandelle
Acres Water System is in compliance with the State of 'Alaska
D--~ing Water Regulations.
Sincerely,
Environmental Field Officer
VEC:kk
APPLIC'- iT FILLS OUT UPPER HA!- ONLY
Property Owner ,~2,~ 4/ ~j/.~ ~./t'~,.~/.~ .~ ~ ~.r~ ~ Phone
Lending institution / ~ ~ ~4~ ~:~ f~ Phone
Address ~ ~g'~/~ ~ / ZiP Code
Realty Co. & A~nt ~ /C ~ ~ ~ /~y:~g~ Phone
Legal Description ZtT ~g 6A'~P~
Street Locati~
Type of Resi~nce
SingleFamily
~ Multiple Family No. of Bedrooms
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A wal Icg is required for all wells drilled since June 1975.
Community For wells drilled prior to that date. give well depth (attach Icg if available).
Public Utility
Sewer Disposal
~ Individual Year Individual Installed: ~ .~Y
Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
( ~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAP~OVED
( ) CONDITIONAL A~PROVAL*
DATE ~~~ 3
Well to Tank Septic T~k Size ~
72-023 (3/82)