HomeMy WebLinkAboutGREENLAND BLK 7 LT 4 Municipality of Anchorage Page _~ of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-474.4 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~kf',J c~ -70cO-~-- PID Number: O1~- ~: ~l~l~ ~c~ WastewaterSystem: ~ New ~ Upgrade Address:~O ~. II~ ~ , ~¢'~' ABSORPTION FIELD Phone: ~ ~ ~ ~ ~ No. of Bedrooms: ~ ~ ~ Deep Trench ~'ShallowTrench ~ Bed ~ Mound ~ Other Total Depth fro~ original grade; LEGAL DESCRIPTION S°ilRating: I e'~ GPD/Sq. Ft, ~- 7' Lot: ~ BIock:~ ~~Subdiv~i°n: ~ Depth to~,pipe bottom7/ ~fr°m original~ ~g]ade: Ft. Gravel depth beneath~ pipe Ft. Township:~ Ran~. Se~ Fill added above~ginal, grade: Ft, Gravel length: ~ / Ft. r ~~ U New ~ Upgrade/ Gravelwidth: ~' Numberoflines: Distanceb~iwee~lines: Ft. ~ ~ ~ Ft Classification (Private. A~ Total Dey ~sed To: Total absorption are~: Pipe material: '~~ ,,~, Set ~t: ~. C~,i,~,,i~,~:~t. TANK SEPARATION DISTANCES ~s~,tic u .o~d~ U S.T.~.~. TO Septic Absorption Lift Holding Public/Private Manufacturer: Capscity in gallons: From Tank Field Station Tank Sewer Lines ~ , ~ ~() O Surface > ' ~ ~ LIFT STATION Water ~ ICC ~00 >~1 Line Foundatio~ ~4~ ~ ~ "Pump on" level~~~High water alarm at: CudaiR ~ ~ ~ k , ~ ~ ~~de, Electrical inspections ,e~ormed ~~ Drain Remarks: ~'~ ~o~ ~;~ BENCH MARK Location and Description: ¢~ ti I Assumed Elevation: Inspections pefformed b,: 4¢;;~',*¢'Dates:ls, 3[,* 7 Department of Health and Human Services approval -,;,-. ¢, Reviewed and approved by:~~ ~- ~~_ Date: ~ -2/- ¢ Z ", 72-013 (Rev. 9/91) MOA 25 EAST i:t2TH AVENUE TRENCH NEW 1000 GALLON SEPTIC TANK c/n CIO 25' M,Tr #E,~ AC = 29,4 BC = 65,8 AD = 32,2 BD = 62,9 AE = 4.9,8 BE = 43,4 AF = 66,3 BF = 60,5 C/I SEPTIC UPGRADE~ _TERNAT[]R DOUBLE C/0 LOT 4, 31< 7, GREENLAND PREPARED FOR: VIRGINIA ALLEN PREPARED ]~yl ALASKA WATER & WASTEWATER NEW RENCH, 50 FEET _ONG, AS-BUILT 13RAWlIqG TOP DF TANK = 96..64 Z~n ~~vp.~ NEW 1000 GALLON SEPTIE TANK, INLET INVERT = 9G,09, OUTLET INVERT = 95,88, FROH OOUSE, INVERT AT HOUSE 96,6,8, DROP FROM HOUSE TU TANk: = ,59 Fr, SLOPE 1,Dx (APPROX,) GROUND OVER TANK : 9B,7+ NOTE, TOERE IS 8 INCHES OF INSULATION OVER ALL THE SEWER LINES FROM THE HnUSE 'FO ]'HE TRENCH, IN ADOITION, THERE IS 8 INCHES OF INSULATION OVER TOE SEPTIC TANK AND TRENCHr GROUND ELEV, OVER TRENCH VARIES, FROM 98,4 MIN, COVER : 2,3-~- FOR LOCAI'ION OF M,T SEE PLAN DRAWING --~~~/~ FILTER FABRIC lIVER INSULATION  DRAINROCK, A, INVERT OF DRAINPIPE = 95,73 AT EACH END 8, BOTTOM OF TRENCH = 98,7 C, NO GROUNDWATER l'O DEPTH OF 16 FEET D, TRENCH LENGTO = 50 FEET E, TOTAL ABSORPTION AREA = 431 SQ, FTr 5,00 SEPTIC UPGRADE: LOT 4, BK 7, GREENLAND PREPARED FOR: VIRGINIA ALLEN ALASKA WATER & WASTEWATER ! ]]ATE~ 3/19/97 I ]]WN~ GARNESS ! SCALE]: NTS Rick Mystrom, Mayor Mtmicip ality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska99519-6650 March 21, 1997 Jeff Garness, P.E. Alaska Water and Wastewater 8471 Brookridge Drive Anchorage, Alaska 99504 Subject: Waiver Request for Lot 4 Block 7 Greenland Subdivision Waiver Request #WR970009, PID #015-171-09, HA970094, $W970035 Dear Mr. Garnes8: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is from the east end of the trench to the property line of 7 feet. This approval applies to the existing on-site wastewater disposal system lot: line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there any further questions or concerns regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth On-site Services ljw #7 Allen MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~ WR970009 PID~ 015-171-09 Date Received: March 20, 1997 Legal Description: Lot 4 Block 7 Greenland Subdivision Engineer: HA# HA970094 Permit ~8W970035 Jeff Garness, P.E., Alaska Water and Wastewater 8471 Brookridge Drive, Anchorage, Alaska 99504 Applicant: James & Virginia Allen Waiver Requested: Lot line waiver of'~the east end 'of th& trench to the property line of 7 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: 3. Other: Waiver is Granted: ~ Waiver is NOT Granted: List Conditions or Reasons for above: Date: ~ -2 /-~7 By: Rec #: 02462/6058 J~nount: $ 115.00 Name of Reviewer Date Paid: 3-20-97 March 19, 1997 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519..6650 8471 Brookridge Drive ~ Anchorage - Alaska 99504 Phone (907) 337-6179 - Fax (907) 338-3246 Consulting Engineers Subject: Septic System Lot Line Waiver for Lot 4, Bk 7, Greenland S/IL To whom it may concern: According to the 1978 inspection report, the old trench system (2.5feet wide) is 26 feet from the north lot line; however, based upon the as-built survey (8/25/87), and swing tie measurements (Leroy Reid, P.E., 1987), the east end of the trench is only about 7 feet from the property line. This encroachment has existed since 1978 with no adverse effects that I am aware of. Furthermore, the encroachment does not appear to restrict the potential for future septic upgrades on the adjoining properties. In short, I am unaware of any adverse impacts associated with this waiver. It is my recommendation that the subject separation distance be waived to 7 feet. If you have any questions, please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Thank you for your assistance. Sincerely,/~//ff~ J ! Garness, P.E., M.S. Principal 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 NUMBER:SW970035 DESIGN ENGINEER:ALASICA WATER & WASTEWATER SERVICES OWNER NAME:ALLEN JAMES W & VIRGINIA C OWNER ADDRESS:4640 E ll2TH AVE AMCHORAGE, ALASKA 99516 PARCEL ID:01517109 PAGE PERMIT DATE ISSUED: 3/17/97 EXPIRATION DATE: 3/17/98 LEGAL DESCRIPTION: GREENLAND BLK 7 LT LOT SIZE: 18090 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDAMCE WITH: 1o 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 (18A3tC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 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 A_ND CLOSED ON THE SAME DAY B. COVERED, SEALED A_ND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ISSUED / DATE: ~?/z//~ ~7_ DATE: 3-/7.~Y7 8471 Brookridge Drive ~ Anchorage - Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers March 11, 1997 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Sewer Upgrade for Lot 4, Bk 7, Greenland S/D. To whom it may concern: The existing 3 bedroom house is served by private well and septic system. The drainfield will not pass an adequacy test at this time (no surge capacity), and must be upgraded prior to the sale of the house. Comments regarding the proposed upgrade are summarized as Follows: 1. SOILS: Attached is a log which shows the soil profile, and the percolation test results. At both depths tested, the percolation rates were in the 1-5 minute/inch design range. In short, the soils are very good. 2. TRENCH DESIGN: a. Percolation Rate: varied from 2.5 minutes/inch to 3.6 minutes/inch. b. Allowable Application Rate: 1.2 gallons/day/fl2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 375 fl2 f. Effective Depth: 3.0 feet g. Reduction Factor = .58 h. Width: 5 feet minimum i Minimum Length: 43.5 feet. Will make trench 50 feet long j Effective absorption area = 430 ft2 (>375 fl2 OK) We are proposing to install a diverter valve so that flow can be periodically alternated between the old and the new trenches. 4. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic upgrade. 5. TOPOGRAPHY: See the 1" = 200' site plan for topography information. The lot is generally flat from north to south and slopes gently downhill (< 5%) from east to west. At the west property line, near the northwest corner of the house, a 25-35 % cutbank exists, which drops offto the adjacent lot. The new trench will be approximately 25-30 feet from this cutbank. The existing crib has been located next to this cutbank for over 30 years without daylighting. The slope angle from the new trench to the base of the cutbank should be less than a 25% slope. In short, I don't see this as a legitimate concern. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Thank you for your assistance. Sincerely, . d 'Teffr A]. Gar'iIesg, P.E, MS. Prin ~al' Ginger Allen Design Package.wps T12N, R3W, SEC SOUTH 1/2 BF AND SEPTIC SDU'¥H 1/2 UF THE PRIVATE WELL ~R M,D,A RECORDS. EAST ~ISTH AVENUE TI~N, R3W, SEC ~, S[]UTH 1/2 DF THE SU[JTH 1/2 DF LOT ~, PRIVATE WELL AND SEPTIC SYSTEM PER M,O,A RECORDS, \'/ELL IN HOUSE PER M.O,A COMPUTER SEARCH. VERIFIED LQCATID DF WELL WITH HOHEE]WNER, LOT 5, BK 7 GREENLAND S/D ~YSTEM, 3, BK 7 ~LAN9 S/ 20 FOOT ¢IDE ALLEY ND CONCERNS SEPTIC AREA (DT 8, BK 7, ~DT 9, BK iDT 10, ~K'~; GREENLAND GREENLAND GREENLAND\ S/D, PVT, S/D, PVT, S/D, PVT, WELL & SEPTI WELL & SEP WELL & SEF NO CONCERNS SEPTIC UPGRADE~ PREPARED PREPARED DATE~ 3/11/97 LOT 4~ BI< 7j GREENLAND VIRGINIA ALLEN ALASKA ~ATER & ~ASTE~ATER ]]RA~N~ GARNESS SCALEI ]' = 100' CE-7953 2 EAST ll_?_-I;h AVE,/ s TRENCH ASSUMED LOCAT!I~N BF CRIB PERIMET[~R. aWD FILLED ~ITH~ SUMP--~ SOIL, ~ ~ C/[] ~~~ . " NEW ~000 X ~ %- ..... ' GALLON ~ SEPTIC,l i e~~ . · , ]-~NI< ~_ / ~ ~ .. , ' , NOTES: 1, THE EXISTING SEPTIC -rANK IS BELIEVED TB EXIST SOMEWHERE BETWEEN THE HOUSE AND THE CRIB. ]HE CBNTRAC'~OR SHALL FIN]) THE OLD TANK AND ABANDUN IT, a, THE CONTRACTOR SHALL VERIFY THE SEPARATION DISTANCE TO ALl_ ADJACENT WELLS, SEPTIC UPGRADE' L_BT 4, BK 7, GREENLAND PREPARED FOR: VIRGINIA ALLEN . PREPARED 3Y~ AL. ASI<A WATER & WASI-EWAI-ER DATE~ 3/11/97 DRAWN; GARNESS SCALE: THE TRENCH SHALL HAVE A MINIMUM LENGTH OF 50 FEET. MONITORING TUBE (TYP.) PERFORATED IN DRAINROCK. BACKFILL WITH NATIVE BOlL AND MOUND. TOPSOIL & RESEEDING SHALL BE RESPONSIBILITY OF HOMEOWNER. PROVIDE £ INCHES OF BOARD INSULATION IF BOIL COVER IS LESS THAN 3 FEET. INBULATION SHALL COVER THE ENTIRE WIDTH OF THE TRENCH. FILTER FABRIC SILT BARRIER DRAINF{OCK SHALL SCREENED PER M.O.A SPECIFICATIONS. · TOTAL DEPTH OF TRENCH BHALL ~ NOT EXCEED 6 ~ FEE T. NO TE: 5 FEET WIDE 1. TRENCH SHALL RUN PARALLEL TO THE SLOPE CONTOURS. 2. FOR LOCATION OF CLEAN-OUTS AND MONITORING TUBE SEE THE SITE PLAN. 3. CONSTUOTION PRACTICES, AND MATERIAL SPECIFICATIONS SHALL COMPLY WITH ANCHORAGE MUNICIPAL CODE 15.65, "WASTEWA TER DISPOSAL REGULATIONS". 4. INSTALLATION SHALL COMPLY WITH SPECIAL PROVISIONS NOTED ON THE SEWER PERMIT. 5. SMEARED BOTTOM AND BIDEWALLB SHALL BE RAKED. 6. BOTTOM OF TRENCH SHALL BE LEVEL. 2 INCH MAXIMUM VARIATION BETWEEN HIGH AND LOW SPOTS. DETAIL FOR 5 FOOT WIDE SHALLOW TRENCH: PREPARED FOR: GINGER ALLEN ALASKA WATER & WASTEWATER SERVICES DATE: 3/11/97 DWN: GARNESS SCALE: NTB INCH DIA., ASTM F810 PERFORATED PIPE. HOLES DOWN. PLACE £ INCHEB OF DRAINROCK OVER TOP OF PIPE, AND ACROSS ENTIRE WIDTH OF TRENCH. PIPE BHALL BE INSTALLED LEVEL (WITHIN .01 FEET). ! / / / ~,/' / ! J ? ? Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE LEGAL DESCRIPTION: ~'_~L' ~ ~ (FEET) ~ 3 4 5 6 7 8 9- 10- 11 12 13 14 15 16 17 18 19 20 Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? SITE PLAN Depth to Waler Alter Monitoring? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop ~--¢T~ 3,Ot -zD :~.~-' PERCOLATION RATE ¢'~- ~* ~m~nutesnnch) PERC HOLE DIAMETER ~ // TEST RUN BETWEEN ~FTAND F~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) '""~'AM E MUNICIPALITY OF ANCNORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTF-CTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPFCTION REPORT YASUAG ^DDR S LEGAL DESCRIPTION LOCATI~ N ~ I DISTANCE TOWell ~ ~ I Manufacturer ~ ~Liq, capacity in gallons IF HOMEMADE: ~ ~ Well ~ ~ I Type ~ crib ~ ~Cl~ De~R PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS DATE LEGAL OTHER PHONE Absorption area Dwelling Material Wdt~ Inside length Liquid depth Dwelling PERMIT NO, Liquid capacity in gallons I Material Foundation ~ Nearest ]otljn~A · Total leneth of JJ, nes Material beneath tile Depth inches inches L~NEW ,~UPGRADE NO. OF BEDROOMS PERMIT NO. No. of compartments PERMIT I~10. __ Dist,~//~tween d n es Total dffecdve absorption area P~NMIT NO, Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorption area(s) !"l!lii: L.!ii:i",ffi:i'l'l' ! I:i:, :!: I'l!::-:l",!t!!; :1: 0t",! :i :!!; TH!!i: I.EI",I(:iT~I ,:: ]: H !::: li:E:'f ::, E!F TIlE TFi:!i:'HI:::I.i 01-;;: 'ii'fl:ii: .:':,F'l::"r'.. Eft:' t:1 "I"I';i:!!i:F,IE:H Eli;:: I::']:T )::~i; ~.'I"11::: D:!i:!i!;!'!::i?',lt:::!:i: li?,[il;tl,.ff!3:::i'.,! '!'!.IF: :ii.'L.~:::;: :::,?i ~!::: 'ri.fi!:: (:!iF:C!Lfl'.,E:, l:::ff-,IE:, 'I1.11!; ti?,CFt"i'Cq'I OF:' '!"l...l!i:i' !::i:::.:;~?f::l'v'Fl'T~:Oh! ,:::!:i'.,I !::'!i~IEi ll't!F:l:;;:l'i!: :i::~; ?',!E~ :~i;!!:~l' I.,.I :!; I:::, IH F:'Cq:;;: Till!: (:iiF;:l:::i',,,'l:i:L. I::,EF"fH :1: :ii~; 'FILE H :f: t'.,! :I: H!.ll','i _r::,F!:F'TI.! CtF: CiI:;i:F:I',,,'!:::L E',l_'i!: I'i,IE::Et',I THE l::il'.,!l'::, 'T'HI:~; E',Cr}"'IOi'"! Cfi::: I'HE; Ei:;:.::C:FIVF!'I :!:07.,! ~:1'.,! SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~E, PERCOLATION TEST Pouch 6-6§0, Anchorage, Alaska 99602 276-2221 SOILS LOG - PERCOLATION TEST 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE SITE PLAN :'f:::' ....-i r ! I ] ' WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? p ~- ---; .... i TD" tTd" Gross Net Depth to Net Reading Date Time Time Water Drop ~/"4'.o- I~o ~-Z~- ~-'--,~" 'i;,,;~ . V t: 4-0 /o ~-n'~cTl'/--- - ~ . / .t :,~-~., _, tO_ ,cc, ~r'- ii 'I4. I /' ~ttO I~ .L ~,,~ ~'4 ~ (minutes/inch) TEST RUN BETWEEN FT AND ~ FT COMMENTS ~ PERFORMED BY: GERT FlED B DATE: 72-008 (7/76) Alpine Drilling & Enterprises INVOICE Domestic -- Commercial N_° 2 0 6 6 .~ Pump & Water systems Anchorage, Alaska 99511 , (,o,)3,5.0202 QUANTITY DESCRIPTION AMOUNT Thank You SIGNATURE (I Hereby Acknowledge Ihe Satislactory Complelion of Ihe Above Described Work ) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. 3,1 13. 7(-)' () / I_ P 'J )< ~ /o0.f?~, /// :-_ ~(_)/ AS.BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mcrrtgagee's inspection of the following described property'..__~ /- 0 / /t~ ~?,' ( ',/~ '"/' ","' ."// /." .' ,'~," L"~ Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property ~y_lng adjacent thereto, that no improvements on prpp- ~y lying-~jacent thereto en~oach on the premxses in question and that there are no roadways, trans- mission lines or other visible easements on said prop- erty except as indicated her~n. Dated at Anchorage, ~aska ..... /ll .'.."/'7/,~l,Z.~/- t~s~ '' day ~~__, 19 ...... IIEWI~ V. LO~SBURY & ASSOC~8 Engineers, Surveyors & Planners FIELD BOOK No._._~c_ ALASKA ENVIRONMENTAL CONTROL SERVI( , INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 CALCULATED BY CHECKED BY SOALE I '~20' OF J ~/~ DATE DATE T~ ~I~ / / / / / / / / ,/ / / Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Sit~ Services Section P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description ~O'T'-' 4-,~ ~ ~- -/2 Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF I]EDROOMS: ._7 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 o 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 com ~liance with all Municipal and State codes, ordinances, and regulations in effect on the date of ti Name of Firm Address Engineer's signature DHHS SIGNATURE /~ Approved for 2 Disapproved. Conditional approval for bedrooms. is inspection. :daska Wa~er &~hone stewater Services ! :r¢_'-roo.'-:.r!do9 Dr. ~cl ,., AK 9.. ,04 ~ Date bedrooms, with the following stipulations: Additional Comments Date ~''-/'z/ - ¢ 7 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS 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. 72~72.5 (Rev. 1/91) Back MOA ~1 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0 t.¢'-- / '7 / --09 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ~¢5,,~.~$ J~ M~¢'~"~I~' Mailing address ~ ~"-~,~-- Lending agency ~,J J~ Moiling address Day phone ~4--~ - / 7~'~/ ¢r4'O- 4,'/;~' Day phone Agent ~-2~..//-'t¢~ .J '-r-A,'d/~-.6,~ ~¢.E--~ Day phone Address ~)..(~0~ ~.42p.-.00~/~ 9~T-, ,~ ' ~<~-, 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- lng 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~I STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investiga, t!o,n ,,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 th~ ~ate of this inspection. A!a. ska W~tFf .~ : Name of Firm ~-'V.a-s.~k~~ ~? Phone Address ' / ~ 7/~///~ ~ ~'~ Engineer's signature / J)~//~//-- ~'-~.. Date ,//9/,-/ 6. DHHS .SIGNATURE Approved for Disapproved. X Conditional approval for -~' Additional Comments bedrooms. bedrooms, with the following stipulations: T/4F_ tCZC~VE .rF~7-~p CO/~2/?/o~/ ~ ~0 Date The Municipality of AriChorage Department of Health and Human Services (DHHS) issues Health AuthoritY 'Approval Ce~ifica~¢,C'"baS~ only upon the representations given in paragraph 5 above by an independent pro~essi0nal engi~ieer registered in the State of Alaska. The DHHS does this as a courtesy to pu rchesers 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 engin~r's work. 72-025 (Rev. 1/91) Back MOA#21 Municipality of Anchorage ~R 20 199Z /~ DEPARTMENT OF HEALTH & HUMAN SERVICES . . [[~) Environmental Services Division ~I-~"IVFD~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) ~-~4-- ~ Legal Description: A. WELL DATA Health Authority Approval Checklist 31~--'"7~, ~6z,¢_.¢,._~¢ Parcel I.D.: Well type ~vT" Log present (Y/N) ! Total depth ~'~' Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Ik3 Date completed 1~4' ~Ft~J-2 ~,.6 Cased to ~ ¢¢/ Casing height (above ground) Wires properly protected (Y/N) "~-------------------~:¢$ FROM WELL LOG Date of test Static water level AT INSPECTIOp Well production Tank size g,p.m. ~"7 WATER SAMPLE RESULTS: Coliform ~ :~/Kt/,¢? Nitrate Date of sample: Foundation cleanout (Y/N) Date of Pumping g.p.m. 7.3 ~"¥?j¢ "' Other bacteria Collected by: Number of Compartments "~ Cleanouts (Y/N) ~ Depression (Y/N) /~O High water alarm (Y/N) t,J/o¢ · Pumper ~ ~ C, ABSORPTION FIELD DATA Date installed ,~//~/~ 7 / Length .~t9 Width Soil rating (g.p.d./fF or fF/bdrm) /, Z. . System type / Gravelthickness below pipe .-~ Total depth Effective absorption area ~ J Date of adequacy test t,J~..cJ Fluid depth in absorption field before test (in.); Fluid depth / (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Monitoring Tube present (Y/N))/ Depression over field (Y/N) /'JO Results ~Fail) _ ~,//~ For .~ bedrooms Immediately after ~ gal. water added (in.):'"" Absorption rate = /'~ g.p.d. If yes, give date / 72~026 (Rev. 3/96)* Date installed ~~_ ~allons__ ,, Manhole/Access (Y/N) ~evel at* - "Pump off level at* High water alarm 'leve'l *¢~''~'~ *Dat~ E. SEPARATION DISTANCES K Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I O ~, ~' / -e Ic>l On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ,-q'7~ ~ Property line ~/~' Absorption field Water main/service line ~ IO Surface water/drainage '~co / ! ~ ~o0 7~_~ Wells on adjacent lots ~' I C~O / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: · '¢ ' oep '/-¢'z~._,~ ¢44 Propertyline i~/~¢~¢-rCzF..~c44 Building foundation---'~/~ Water main/se~ic¢ line Sudace water ~ I OO( Driveway, parking/vehicle storage area Cu~ain drain ~oN~ ~¢~ Wells on adjacent lots ~ ;o0' ENGINEER'S CERTIFICATION I certify that I have_det#r~ined ~J~u j~,l~/inspections and review inc°nf°rmanc/~.~/~H/~eli~sineffect°nthisda'te' Signature ~. ~//~////~",~' (~,'~-, Engineer's Nam/ ~/ v~,j~ ,"~- ~____~,,~,~,~_~ are HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number March 19, 1997 8471 Brookridge Drive ~ Anchorage ~ Alaska 99504 Phone (907) 337-6179 - Fax (907) 338-3246 Consulting Engineers MgNI~IPAI4'[¥ OF ANCHORAGE ~,NVIRONMENTAL SERVICES DIVIglON MAR 20 1997 RECEIVED Municipality of Anchorage Department of Health & Human Services Division of Enviromnental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: HAA for Private Well & Septic System. Lot 4, Bk 7, Greenland S/D. To whom it may concern: The subject lot has a 3 bedroom house on it which is served by a private well and septic system. The septic ,ystem was upg~'aded on 3/19/97. The results of the well test are summarized as follows: A. WELL: On the day of my inspection (3/19/97) the static level was 47 feet below the top of the casing (B.T.C.). Water was pumped from the well at an average rate of 2.95 gpm for 240 minutes (708 gallons). The maximum drawdown attained was 83 feet B.T.C.. Given the drawdown of 36 feet, the casing volume provided approximately 54 gallons. The net production of the well was approximately 650 gallons in 240 minutes (2.7 gallons per minute). When the flow rate was maintained in this range, the water level would fluctuate around 81-83 feet, indicating a steady state condition. In short, it appears that the well will continuously produce 2.7 gallons per minute. Any attempt to increase the flow rate above 2.7 gpm resulted in the water level dropping below the pump intake. Based upon this data it was determined that the capacity of the well exceeds the Municipal requirements for a 3 bedroom house (450 gallons per day). Given the fact that the last 18 months have been extremely dry in the Anchorage area, and that late winter is, typically, the most conservative time to test a well, it is reasonable to assume that the aforementioned test results are fairly conservative. Per the 1987 HAA report, the well produced 3.1 gallons per minute at that time. B. OLD TRENCH LOCATED APPROXIMATELY 7 FEET FROM LOT LINE: Attached is a letter requesting a waiver of the required 10 foot separation distance. Also attached is the $115.00 waiver fee. If you have any questions, please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Thank you for your assistance. Sincerely, ~ ~less,~l~.E., M.S. 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Telephone: Home ~7~' ~0~ Business Telephone Mailing AddreS,§~ .: , (d) Real ~Estat~ Corripany and Agent Address /2.1 ~d'. ,~//~gT,,J~'~ Telephone (e) Mail the HAA to the followina address: or: Check here I-1, if hold for pick up. List contaCt person and day phone number below. TYPE OF RESIDENCE Single- Family~¢. Number of Bedrooms WATER SUPPLY IndividuaIWell~ 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 1 of 2 72-025 rRev 8f861Fronl WELL DATA MUNICIPALITY OF ANCHORAGE (MO,-,/ MUNICIP^EITY OF ~~,UTHORITY APPROVAL (HAA) DEPT. OF H~^L'fH &CHECKLIST - FEBRUARY 1984 ENVIRONMENTAL P~T~CTION 284-4720 UUN 2 5 1987 Legal Description: ~~¢¢~ RECEIVED Well Classification '~-')~t~/c/'/PT-~:-- If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Yc~2_ ~ Date Completed ~'"~/L4'"'~ud Yield Total Depth ~ ~, ~as~d to ~ ~" Depth of Grouting ~/~ Static Water Level ~ ~ ~ Pump Set At ~/~ ~' ~ / Sanitary Seal on Casing~) Depression Around Wellhead (~) Casing Height Above Ground Electrical Wiring in Condui¢~;c)N) Separation Distances from Well: To Septic/Holding Tank on Lot /- /~r.? ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot '/~ ¢u'/~?tx// ;Date ~-/d"%~/ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by ~ / ; On Adjoining Lots /¢'d ,~-' Water Sample Test Results Comments /¢'o SEPTIC/HOLDING TANK DATA Date Installed Standpipes ~¢~N) ~t"~ Air-tight CapsL-~>) Depression over Tank (Y~I~,~)/ Pumping/Maintenance Contract on File (Y/N) / Holding Tank High-Water Alarm (Y/N) '~///~ Separation Distances from Septic/Holding Tank; To Water-Supply Well To Property Line To Water Main/Service Line Course /d-¢ Size ¢¢x/'~/J¢"/"-/ No. of Compartments Foundation cleanout (Y/~) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation / To Disposal Field /-~ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) CnEM C AL ~ ~EOLOGICAL~ LABORATORIES O_.F _AL,Ag ' ~ 'lEA, INC.~~" :~ FEDERAL TAX ID # 92-0040440 i4epO[ r S '~'0; ,"~(2!; CHEMICAL! & GEOLOGICAL LABORATORIES OF ALASKA, INC ~ ' Anchorage, Alaska 99518 q((¢(~ Dnnkin WaterA ' . ; . ~ nalysls Report for Total Cohform Bacteria ~ ? TO BE COMPLETED BY WATER SUPPLIER E] PUBL'C WATER SYSTEM i.D.# t'~PRIVATE WATER SYSTEM Name Mailing Address City State Zip Code MO. Day Year SAMPLE TYPE: "'~ Routine [] Check Sample (for routine sample with lab ref. no. I~ Special Purpose El Treated Water ~ Untreated Water TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: (~ Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received .~__.'/~' ?. _ Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi. SAMPLE NO. LOCATION Time Collected Collected By Lab Fief. No, Result* Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC OB = Membrane Filter: Direct Coun! Verification: LTD_ __BGB Final Membrane~salts ~ = Too Numberous To Count Other Bacteria Coilform/100ml -- Collform/100ml MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF ~NSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date / GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directi~ Applicant Name ~ ~ ~0~ Telephone: Home . ~ :~ 7 Business Applicant Address ~' 112 Applicant is (check one):' Lend'lng Institution ~; Owner/builder ~; Buyer [] ;Other ~ ~explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address (f) / Telepho~,,cj' Telephone ~ Mail the HAA to the following address: _, . TYPE OF RESIDENCE Single-Family ~ Multi-Family [] 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. SEWAGE DISPOSAL Onsite [[]' Public E] Community [] Holding Tank E] 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 z2-025 m/84) ENGINEERING FIRM PROVIDINu 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 Healtf) 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 disposat system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address DHEP APPROVAL."~ _k"-':/// Approved _ ~ Disapprove~ 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 riot responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) ' ,O,<,,O~¢~ MUNICIPALITY OF ANCHORAGE (MOA) ,~ ~.?,..,,6 ~Ct.\O~' HEALTH AUTHORITY APPROVAL (HAA) ? .. CHECKUST- FEBRUARY 1964 ,(~q~,~ O'<_~' ~ 264-4720 ,¢.'5 ~;~.¢ ~,,4'''0 ~ Lega~ Description: WELL DATA Well Classification ~ r~ If A, B, C. D.E.C. Approved (Y/N) Well Log Present (Y~ ~ Date Completed _ ~~ Yield Total Depth ~¢~/¢ ' ~ Cased to 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 To Nearest Public Sewer Line Cleanout/Manhole t~//'~ Water Sample Collected I)y _-~. Water Sample Test Results Comments ':~ ~'E~ Depth of Grouting _ _ Pump Set At Sanitary Seal on Casing ~N) Depression Around Wellhead (Y~ ; On Adjoining Lots ! O0 / ¢' I 2~" ; On Adjoining Lots ¢'O0 To Nearest Public Sewer To Nearest Sewer Service Line on Lot /V'//¢.~ ;Date 1 l/..~/~:)~ Date Installed (~/VO(,/-'/N' Standpipes (~/N) Depression over Tank (Y/~ SEPTIC/HOLDING TANK DATA Size ~/~/~0f~/'~ o. of Compartments Air-tight Caps ~N) Foundation Cleanout (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line ;~(~ To Water Main/Service Line Course /~)O Date Last Pumped ///¢/~r'~C ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field _ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/~) Results of Last Adequacy Test Separation Distance from Absorption Field: 720 Type of System Design Length of Field /7/0 / Depth of Field /..~ / Gravel Bed Thickness (¢ / Standpipes Present f~'N) Date of Last Adequacy Test To Water-Supply Well il ~' To Building Foundation 62 / Lot To Water Main/Service Line ; On Adjoining Lots To Cutbank (if present) /U//~ 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 Comments D. LIFT STATION 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) ~..- - "Pum~p Off" Le_L..,~ __ /'~//~/P~(gY~;)cle~du~iing Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certHy that I ~.~/~h::~ed., v~rified,, or conformed to all MOA angl HAA guidelines in effect on the date of this inspection. Q.,,.~J//' ~ Signed Date Company ~ ~Cr MOA No. ¢Trf~¢~NlZ ~1 ~ElL¢E~3 ,~EPO4f ~age z of z ~,~ '~_.~ . 72-026 (11;84) ALASKA IUIROIqBE F1TAL COIqTROL S [qUICES, IlqC. ~nqincmnq ~- ~nui~onrncnlol $1udies SHEL IIENSLEY 121 WEST EIREWEED LANE ANCHORAGE AK 99503 i1/13/$B SELLER-PETER & MARY JEROME SItEL HENSLEV 121 WEST FIREWEEI) LANE ANCItORAGE AK 99503 60,594 LEGAI.:GREF, NLAND SUBDIVISION BI,OCli 7 I,OT 4 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST J)A'PE--10/3:I/86 THE TYPE OF ABSORPTION SYSTEM IS A TRENCII WITIt AN AREA OF '720 SQFT. THE SYSTEM tS CAPABI,E 0F ACCEPTING 450 GALLDNS 0F WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 685 GALLONS. BASED UPON THE TEST DATA Till,; SYSTI",M IS ACCEPTABLE FOR A 3 DEI)ROOM ItOME. SEPTIC TANK ADEQUACY TIlE EXISTING SEPTIC 'rANK VOI,UME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THI'] SEPTIC TANK/PACKAGE PLANT WAS PUMPEU ON 11/04/86 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATF, R SYSTEM. FLOW TEST ON WEI,L WEI,L FI,OW DATE--10/31/86,'l A FLOW 'PEST WAS PERFORMEI) ON TItE WEI,L. 685 PUMPED AT A RATE OF 3.11 GPM OVER A DURATION OF TILE, DRAWDOWN WAS 12.5 ' WITII A RECOVERY TIME GE AND ri'HE STATIC WATER LEVEL WAS 48.9 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM ItOME. GAI,I,ONS OF WATER WAS 5.25 ItOURS. 70 MINUTES ADDITIONAL COMMEN'PS : ISAACS PUMPING SERVICE PUMPED 1500 GALLONS FROM TANK ON 11/04/86 TANK APPEARS TO BE AT LEAST A 1000 GALLON !I.'AN K. 1200 ~Ucsl 33rd A,enu¢, Suile g, ]~nchoro§¢, Alosko 99503 o(907) 561-50z10 DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECt-O? ~ MUNICIPALITY OF ANCHORAGE ,MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION DEPT. 825 L Street - Anchorage, Alaska 99501 ENVIRQIVMEN1/kl ...... ~ uc'rloN ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not he processed. Please allow ten (10) days for processing. 1. PROPERTYOWN~ ~ ~ ~ / / ~PHONE MAILING ADDRESS / -- PROPERTY RESIDENT (If different from above) ~ PHONE ER ~ PHONE STREET LOC_..,~TION / :/ 7 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [Z~ Six [~] Other 7. WATER SUPPLY INDIVIDLJAL* [] COMMUNITY [] PUBLIC UTILITY ATTACH WELL LOG. A well log is required for all wells drilled since June 1975, For wells drilled 'odor to that date, give wel depth (attach log if available.) /'~ / 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE~* [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED ~J ~ [~]PUBLIC UTI LITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: I ~ ~-- TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL (~' '-~..~..,L{ 4. DISTANCESwELL TO: Septic/Holding! ~; O Tank Absorption~ ~f--5~ Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS []~]'~PP R O V E D FOR .'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~ DATE BY OTECTION I[~LX.-JL- _~ :MUNICIPALITY OF ANCHOR GE  DEPARTMENT OF HEALTH & ENVIRONME 825 L Street - Anchorage, Alaska 99501'"~.._~ ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will oct be processed, Please allow ten (t0) days for processing. 1. P~OPERTY OWNER - ' PHONE PROPERTY RESIDENT (If di~erent from above) ,/X I~ -' PHONE -- PHON~ 3, LENDIN~ INSTITUTION , ,PHONE MAI LING ADDRESS ~ . ~ . .~t ~.. ~ .~ 4. REALTOR/AGENT ,f~ , / ~ ~ ~ _ ~ I PHONE MA~LINGADDRESS . ~ . _ ,~ ~ fi~.. 5..L'EGAL DESCRIPTION , ~TREET LOCATION ~ ~ s. 'rYPE OF RESIDENCE f .0~0  ' [] One [] Four SINGLE FAMILY F-I Two [] Five [] V1ULTIPLE FAMILY ~. Three [] Six [] Other 7. WAT E R~,~J PP L Y ~ INDIVIDUAL* ' ATTACH W["LL LOG. A well Icg s required for all wells drilled ~ COMMUNITY since June 1975. For wells drilled prior to that date, give well ~ PUBLIC UTILITY depth (attach Icg if available.) S, SEWAGE DISPOSAL SYSTEM  , INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY ** f individua I/on-site, give installation date . If system is over two (2) years old an adequacy test is reouired by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010(3/781 THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE : I NSP ECTOR I NSPE-CTO R INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] 'SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [~]~' MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF T~,NK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank AbsOrption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [] CONDITIONAL APPROVAL (letter must accompany certificate) E~ DISAPPROVED 72-010 (Rev. 3/78) JML John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907-279.8056 Y,E',V PHONE NUMBER 276-41 1} SOiL ABSORPTION SY~TPA T~ST DATE OF TESTS: L~,~ D~S~RIrTIOJ. .,O. OF ..:~DROO,'2): R~uORDo ON o ~ .... ~.,u~:',~ WITH S~A:,D..~ r:,u~uu.~ ...... ~ ....BY ~.,,fI~O,,,',~.'ITAL QUALITY ON MU}[ICiPALITY OF ANCHORAGE~ DEPT. CF ~"~ ' :'~ PLUS SEPTIC T=.~K ABSORPTION RATE AVERAGE ~ hrs--. John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907.279,-8056 EXISTING DRAIN FIELD TEST r. PERCOLATION ADEQUACY REFERENCE: T~o/= oK -~-~'T/C ,," ~,~/z./' L'"b-",,¢/~-.r ..... DATE~,//E,/7~ PERFORMED BY: LEGAL DESCRIPTION: /~7- ~ ~//~ DEPTH BELOW METER READING GALLONS PUMPED TIME ~7 ~ '" ./o~ ,, ,'/?.. ~ '¢ ' : oa ' - c?'' 4 ~ ?'00 .s-' © ~ .. / ; 4 2 ~ % " Dc ?"e.~ ~ ..co, / ~c~ ./ : ~/ ~ ~%~ t7~"e ~,~ o .'~ ' '~- ~ o ~ , 3 23, ~J~.'~'~ ' ~ '~ .......... v.----"' ,~ ~ ~ _~__'- -=-- -- =-~'~'~-.' t John M. Lambe, P.E. 4303 North Star S~eet Anchorage, Alaska, 99503 907.279-8056 EXISTING DPJ[IN FIELD T~.2T ~- PF~COLATION ADEQUACY LEGAL D~CRIPTION: /~ ~ ~//~ ~ ~-g~z_4~/o