HomeMy WebLinkAboutFIRE LAKE HEIGHTS LT 2
GRID N W454
Adjoining Poge No,
Adjoining Tax Book No.
Municipality of Anchorage Page / .of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: Soo P~-~:~s-~' PIDNumber: o~-/- ~-/-~7
Name: Wastewater System: D New ~p,~r~
~1~15 ~
~d~,.,: ABSORPTION FIELD
No. of Bedrooms:
Phone: ~-~ ~ ~ ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other
LEGAL DESCRIPTION so, Rating: Total Depth from original grade:
Subdivision: 3epth to pips b01lom from original grade: Gravel depth beneath pipe
Block: ~/~ ~C E~I~H?~ ~' Ft. ~ Ft.
Lot~ ~ -- Fill added above original grade: ~ravel length:
Townahlp: ~ Range: Section:
/~ ~1~ ~C, ~( ~ Ft, ~ Ft.
Number of llnea: Distance ~tw~n lines:
WFI I , D New ~1~ ~ Upgrade oravel~: ~ID~ ~ .L / /~ FL
Clasaificatlon (Private, A,B,C): Total Depth: Caeed To: Total absorptto~ area: PI : ~ 5 ~
~/~ Et. Ft. / ~;¢,,5 . ~o SQ. Et.
Date installed:
Driller: Date Drilled: StatlcWaler Level: Installer:
Yield: ~ Pump Set at: Casing Height Above Oround: TAN K
GPM Ft. Ft.
SEPARATION DISTANCES ~ septic ~ Ho~d~ng ~ S.~.E...
To Septic Absorption Lift Holding ~Private Manufacturer: C~paclty tn gallons:
From Tank Field Station Tank Sewer Lines ~/~/~ · ~ /~5~
Material: Number of ~mpartments:
s.rf.c. F/Z W/~ ~/~ ~/~ ~/~ LIFT STATION
Water
Size In gallons: Manufacturer:
Lot ~
Drain
BENCH MARK
Remarks: UP~D~ ~ ~
Location and Description:
Assumed Elevation:
ENGINEER'S SEAL
inspections performed by: /~/:.~- ' Dates:lst /~
Department ot Health and Human Services approva~ m~, ~4~......
72-013 (1/91) MOA 25
Permit No.
$W920358 Page 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
of_ 2
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Fire Lake Heiqhts Lot 2
PID No.: 051-351-27
S 89°56'0' E
204,95
NEW 1,250 GAL
WELL
TANK
S 89'56'0' E
205.03
~LEVaTIBNS.
(NOT TD SCALE)
TUP DF CONCRETE ~TEP
AT REAR SIAIRWAY
ASSUMED ELEV = 100,00'
ORIGINAL - ~0
96 95.9'
I I
SCALE
SWING TIES
A-C = 15'
B-C = 12,3'
A-D = 19,9'
B-D = 17,4'
A-E = 21.4'
B-E = 18,8'
a-F = 22,7'
B-F : 19,8'
A-G = 56'
B-G = 47.4'
A-H = 58,7'
]3-FI = 49,6'
A-! = 61,6'
B-I = 57,4'
A-J : 41.2'
B-d = 41,6'
A-K = 41'
B-K = 41,6'
1" =40'
TEST HOLE
MONITOR TUBE
SEWER CLEANOUT
WELL
PROPOSED LEACHFIELD
EXISTING LEACHFIELD
EASEMENT
ENGINEER'S SEAL
t~~' ..' -"~.7
~,~, ..' a .. ~
.. ~ %
Louis A. Butera
~'.. CE 6736
m".. ...':~
72-013 A (2/91) MOA 25
LFIT 3 LET 4
NO WELL +200'
SEPTIC +50' []LIVIA DRIVE
S 89'56'0' E 204,95
' 15'.
LIqT 2 I
I
WELL I LBT 5
205~3
NO WELL
ON LOT
~ - TEST HOLE
· - MONITOR TUBE
o - SEWER CLEANOUT
~ - WELL
~- PROPOSED LEACHFIELD
NO SURFACE WATER +100' mlr,',::n- EXISTING L~CHFIELD
NO KNOWN CURTAIN DRAINS EASEMENT
SEPTIC SITE PLAN
LEGAL: LOT 2, FIRE LAKE HEIGHTS
OWNER: CHRIS SWARTZ
ContrActor: N/A
JOB ~ 92-~681 BATE. ~0/~5/921 SCALE 1"= 40'
EAGLE RIVER ENGINEERING SERVICES '~{..., ,,;:-'
P.O. Box 773294
EACLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297 REVISED 10/15/92
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW920358
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:SWARTZ CHRISTINE
OWNER ADDRESS:P.O. BOX 771416
EAGLE RIVER, ALASKA 99577
PARCEL ID:05135127
LEGAL DESCRIPTION: FIRE LAKE HEIGHTS LT 2
DATE ISSUED: 10/21/92
EXPIRATION DATE:10/21/93
LOT SIZE: 36898 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 1
THIS PERMIT IS FOR THE CONTRUCTION 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 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
R .C .IVED BY:
Louis Butera, P.E.
Registered Civil Engineer
October 16, 1992
John Smith, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Fire Lake Heights, Lot 2
Narrative
Dear Mr. Smith:
The proposed one bedroom septic upgrade will have very limited impact on adjacent properties
for the following reasons:
1. The area has large lots allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, due to absorption capacity.
4. Drainage will not be effected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 · Fax (907) 694-3297
LEGAL:
RECEIVED
OCT 1
~v~,~l~nlcipality of Anchorage
SPECIHCATIONS FOR ON-SITE SEPTIC ~..o I~'d. Health & Human Services
LOT 2 FIRE LAKE HEIGHTS
GENERAL
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
TRENCH
1. The trench is to follow the natural land contour to maintain uniform total depth
of the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 10' with relation to
ground at monitor tube.
4. The sewer line is to join the existing sewer line that leads from the existing
trench.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface
water runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 10' GRAVEL DEPTH = 5'
TRENCH LENGTH = 20' TRENCH WIDTH = 3'
SOIL RATING = 0.8 GPD/FT2 BEDROOM CAPACITY = 4 total
SEPTIC TANK SIZE = 1,250 GALLONS
NOTE: Remove and properly dispose of existing 1,000 gallon steel tank.
Twenty-four (24) hours notice required for all inspections.
LOT 3
NO WELL +200' OC~" '~ 6 ,~,,jy.T
4
SEPTIC +50' OLIVIA DRIVE ,,.
S 89'56'0' E
~04,95 I
I
- g ~ .,,X /// /~ NEW LaSO GAL, TANK ,
t LET 5
WELL
I
6/. I NO WILL
205~3
NO WELL
ON LOT
~ - TEST HOLE
· - MONITOR TUBE
o - SEWER CLEANOUT
~ - WELL
JlIIHIHIL- PROPOSED L~CHFIELD
NO SURFACE WATER +100' m',',v, xn- EXISTING L~CHFIELD
NO KNOWN CURTAIN DRAINS EASEMENT
S E P T I C S I T E P LA N
LEGAL: LOT 2, FIRE LAKE HEIGHTS ~....
OWNER: CHRIS SWARTZ ~.' ~ ~.
CONTRACTOR: N/A "'":'"'~~ ..... ~"
JOB ff 92-~661 DATE: 10/15/g21 SCALE 1" = 40' ~~~"~
ENGINEERING SERWCES ~,~:'. c,:-~,'z',~ ¢.~ r
EAGLE
RIVER
'~.~'..
P.O. Bo~ 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297
EAGLE RIVER
ENGINEERING SERVICES
P. O. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
Fire Lake Heiqhts Lot 2 92-168.cal
SHEET NO. OF
CALCULATED BY r,.R. DATE ~/q5 __
SCALE._
One Additional Bedroom
!bedroom = 150 GPD
Dept. Health $, Human 8ervloe.
Percolation rate = 5.3 min/inch;
Deep trench application rate = 0,8 GPD/ft:
Add 1 bedroom to existing system at 150 GPD/bedroom
Additional square feet of absorption area:required:
1 BR = 150 GPD/BR + 0.8 GPD/fl: = 187.5 square feet
Use 5' gravel below pipe
Length of trench = 187.5 ft:/10' = 18.75 feet
Use 20' trench
Trench dimensions:
Depth of gravel = 5'
Length = 20'
Width = 3'
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SqlLS LOG -- PERCOLATION TEST
Dep
R''
OCT 1 6 1992
Jnlcipality of Anchorage
:. Health & Human Services
PERFORMED FOR: ~/~/'/~/~[ ~V/~-."r'~.-
LEGAL DESCR~,T~ON: //~-~ L~I/~ ffrs, ~ Z.
1
2
3
4
5
6
7
8
9
10
11
t2
13
14
15
16
17
18
19
Township, Range, Section:
SLOPE
SITE PLAN
WAS GROUND WATER ,~.,
ENCOUNTERED?
S
IF YES, AT WHAT ~)
DEPTH? ~A'~/4 P
E
Depth lo Water After
Monitoring? ~ Dire: /O/~e/f~
Gross Net Depth to Net
Reading Date Time Time Water Drop
5O A IZ.
. 3:ql -
20 - ':' "~' ::'~;'~;~:"PERCOLATION RATE Z~, ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN"ETWEEN &' FTAND N' £ F~
PERFORMED BY:
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
I MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
- ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
IPRONE ,~ NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
Well ~/~ Absorption area Dwelling i PERMIT NO.
~ Material NO. of compare,ts
Manufacturer ~ ~'r~ ~ ~
~ Liq. capacit¢in gallons Inside length Width Liquid depth
/~OO IF HOMEMADE: ~
~Oz~ ~ DISTANCE TO: Well ~/~ Dwelling PERMIT NO.
O z ~ Manufacturer I '/~ ¢ ~ate}ia~ .... Liquid capacity in gallons
~ Well Foundation Nearest lot line / PERM~NO.
' DISTANCE TO: ~/~ ¢O'¢ . Distance betw~j~
' ~ ;~ Nc. of lines /----~;n~,*l~feac~/., Total length of line, -- Trench width
Top of ~ ~ f~isb grade
Material beneath tile
%tal effective¢~bso~tion area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total t]ffective absorption area
~ Well ~--~ ~uilding foundation Nearest lot line
¢ DISTANCE TO:
~ C~, ~ O~ ~ ~ Depth Driller Distance. to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(~
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
IHo~/~
I NSTA L LER
REMARKS- V ¢ -
,"' [ .
.. -
APP O CE~ D~ LEGAL
72- ~
ON--S I TE
PERMIT NO. < 820??6 >
APPLICANT
LOCATION
LEGAL
r.lUr- T ~ -r PAL T T'v' E~F RNd:HOF;~'-.R6E
E:,EPRRTMENT P'- HEALTH AND ENVIRONMENTAL '"~OTECTTON
825 STREET., RNCHORRGE~ AK. 9.
264-4720
SEWER PERM I T
LINDR PARKER
L2R FIRE LAKE HTS
PO BOX 1465 E.R. 995'77 694-2636
LOT SIZE 999999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER Of BEDROOMS
SOIL RATING
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEF'T| := 10 LENGTH= 35 GRAVEL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) Of THE TRENCH OR DRAINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
REQUIRED SEPTIC TR~-~- SIZE= 1000 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.
TWO ( 2 ;~ INSPECT IONS ARE REQLI I RE[~
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AYAILABLE TO INSURE PROPER INSTALLATION.
PER~I I T E,~P I RES DECEMBER
I CERTIFY THAT
1: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODE~D TO INCLUDE MORE THAN ~ BEDROOMS.
APPLICANT LINDA PARKER
IgSIJEDBY_~__J~~ __DATE__ ~ ~ V4.0
[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
DATE
PERFORMED FOR:
[] PERCOLATION
TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20-
SLOPE
SITE PLAN
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
COMMENTS
TEST RUN BETWEEN
72-008 (6/79)
FT AND -- FT
- ,,/
PERMIT NO.
825 "L" STREET, ANCHORAGE, AK. 99501
264-4720
I~IELL PERI'I I T
( 820964 )
APPLICANT
LOCATION
LEGAL
LINDA PARKER
L2 FIRELAKE HEIGHTS
5724 LUCAS E.R. 99577
LOT SIZE
B94-~62~
999999 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET 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 THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS 8RE
AVAILABLE TO INSURE PROPER INSTALLATION~
F'ERM I T EXP I RI;'S DECFI'-IBFR _--~:'! .. :'1,, %::~8-'::'
I CERTIFY THAT
:il: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS 8S SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
_.I L~NEC ........ ~ ..... RF'F'L I CRNT LIND8 PARKER
ISSUED BY ~ __DATE ....
V4. 0
IV]-W DRILLING, Inc.
~.0. Box 4-1224 · 1310C International Airport Road
(907) 274-4611
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner__ L_ynda Parker ....... Use of Well_
Location (address of: Township, Range, Section, if known; or distance main road
Lot 2 Fire Lake Subdivision
Size of cas~ng_ _5__ Depth of Itole_ ]_l.& .... feet Cased to_ 'LLS.. P-9 feet
Static water level_ 97 ___ft. (¢¢bXCC~X (below) land sm'face. Finish of well (check one) open end
Screen ( ); Perforated ( ).
Describc screen or perforation_. Nrta2__
Well pumping lest ab_~l_[L.gallons per (txmz)
of drawdown from static level.
Date of completion 0£_LOJ2~] 982 .....
(minute) for_ __1 . hours with - 10fl% - ~k
WELL LOG
l)epth in feet from
Lq'otto(1 Slll'face Give details of formations penetrated, size of material, color and hardness
_C~s ins s t ickup
Organics
__ Bio~ _silLy gravel
.... 2m~l de_~
............................................
1 CUS-I'OMER
. 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 ~:"~//~/~ ~
1. GENERAL INFORMATION
(a)
Loc~ation (address or directions)
i!; ;:::: '~' ::~ii{b) APPhcant Name
Legal Description (include I,ot, bloc~, subdivision, section, township, range)
, !
3hone: Home ~~:~o°~- ~'r4~',~ Business
........... ~ ......
i~nlain
OF RESIDENCE
Number of Bedrooms
WATER SUPPLY
Individual Well ~' Community CI Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
SEWAGE DISPOSAL
OnsiteJ~ 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.
at, testing to the legality and status.
Page 1 of 2
72-025 (11/84)
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
$ & S En~ineering
Address
Date Eagle River, =In~"-- ',,~, ,~.--/~'~ ~ ~
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
'~2-025 ( 11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY '1984
264-4720
Legal Descrip?,on f-.
WELL DATA
Well Classification --~l
Well Log Present (~.N~
Total Depth ~_ [ ~ ~ Cased
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on.l~ot
To Nearest Public Sewer Line ~l~ ~.__
Cteanout/Manhole
Water Sample Collected by
Water Sample Test Results
If A, B. C, D.E.C. Approved (Y/N)
Date Completed [O- -'''- - r~'~- Yield
Depth of Grouting '~"-
Pump Set At
Sanitary Seal on Casing
Depression Around Wellhead,~')
Comments
; On Adjoining Lots
~3~~''' ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
/YE ~
;Date
B. SEPTIC/HOLDING TANK DATA
Date Installed ~-.~,,'~;~-'-- Size ~(~ No. of Compartments ~
Standpipes {~J~ Air-tight Caps(~l/,J~ Foundation Cleanout ~/,N'~_
Depression over Tank.~
Pumping/Maintenance Contract on File (Y/N) .,
Holding Tank High-Water Alarm (Y/N) /J~'
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~,~C3 ~
To Property Line ~.c>~ 4-
To WaterM.-J~,/~arvice Line ~ (~t ~
~ Date Last Pumped
~'~/~ J"&'- ;for
Temporary Holding Tank Permit (Y/N) '~,~
To Building Foundation
To Disposal Field
Course
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 .C_.,.~_~¢;::,~--~ ,~
Width of Field ~ ~4
Square Feet of Absorption Area
Depression over Field ~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~. ~'~C> ~ ~-
To Building Foundation ~-ot
Lot
To Wate~,c, CService Line
Type of System Design
Length of Field .~ ~:~ !
Depth of Field ~.(~
Gravel Bed Thickness L~I
Standpipes Present ~
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots -~'~1
To Cutbank lif present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Date
MOA No.
Signed
SRB 196x
Company
Receipt No.
Date of Payment
Amount:
Page 2 of 2
72-026 (11/84)
APPLI( NT FILLS OUT UPPER HA~. ONLY
Phone
Property ow.er
Buyer ~ ~(
Address ~ Zip Code
Phone
Lending
Institution
Address ~ <~,, ~ ,~.,~'~'. Zip Code
Realty Co. & A~nt {. ~/..) Phone
Address Zip Code
Ty~ ~est~nce
~ Single Family
~ Multiple Family No. of Bedroo~
~ Other
~lndivldual 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 log if available).
~ Public Utility
Se~er ~posal
~na~v~uu~
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date U Date
['!'?T C' ?." r'~ ",
gECEI ED
(~) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAP~OVED
( ) CONDITIONAL APPROVAL*
D~TE I~'~1~
Soils Rating Date ~wer Installed Well To Absorption Area We~I Log Received
~ --~ ~ Well to Tank Septic T~k Size
72.023 (31~)
DEPT. OF ENVIRONMENTAl, CONSERV~kTION
SOUTHCEN TRA L REGIONAL OFFICE
MUNICIPALITY OF ANCHORAGE
ENVh ,~! f,,A.; ,o L: ; ,I
RECEIV .D
JAY S. HAMMOND, 6OVERNOR
437 £. Street
SECOND FLOOR
[] ANCHORAGE, ALASKA 99501
(907) 274-2533
P.O. BOX 515
[] KODIAK, ALASKA 99615
(907) 486-3350
P.O. BOX 1207
[] SOLDOTNA, ALASKA 99669
(907) 262-5210
[] P.O. BOX 1709
VALDEZ, ALASKA 99686
(907) 835-4698
P.O. BOX 1064
[] WASILLA, ALASKA 99687
(907) 376 5038
August 20, 1982
Dept. of Health & Environmental
Protection
825 L Street
Anchorage, AK 99501
ATTENTION: Les Bucholtz
Dear Mr. Bucholtz:
There are substantial deficiencies in the Carol Creek Community water
system which will require a major rework to correct.
Needless to say this department cannot give health approval for the
Carol Creek Community water system in its current state.
If you have any questions feel free to contact me at this office.
Sincerely~,
MM/er
cc: Alice Bowles
P.O. Box 302
Eagle River, AK
99577
Mike Mathews
Environmental Field Officer
18-09LH