HomeMy WebLinkAboutGREENLAND BLK 7 LT 10
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: -~'fxf~c~¢'O'~¥'8 PIDNumber: 0'1,.¢'1'7115""
Name: Wastewater System: [] New [] Upgrade
Address: ffT~lVE 113 ~ ~ ABSORPTION FIELD
No. o~ Bedrooms:
Phone: 3 ~' ~5-~ 7 3 ~ Deep Trench U Shallow Trench U Bed U Mound Q Other_
Soil Rating: ~,~'~ J~ ~ Total Depth fro~ original grade:
LEGAL DESCRIPTION ~,~ ~,~ ~*~/s~.~. ,3 _
Lot: ~ Bloc~: ~ ~¢¢¢~Subdivisi°n:/~ Depth to pipe bottom~ from original grade: Ft, Gravel dept~neath~ pipe Ft.
Township: Range; Section: Fill added above origin¢l grade: Gravel length:
O Ft. ~ I Ft__
WELL: E~ u New ~ Upgrade Gravelwidth: Number of lines: aistance between lines:
Classification (Priwte, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Ft. Ft. 7
Driller: Date Drilled: Static Water Level: Installer: t Date installed:
Yield: GPM ~p Set at: Ft. Casing Height Above Ground:Ft., ~'AN K
SEPARATION DISTANCES ~ Septic U Holding ~S.T.E.P.
TO Septic Absorption Lift Holding Public/Private Manufactur?r: Capacity in gallons:
From
Number of Compartments;
Surface LIFT STATION
Water ~{00' ~' >100' ~
Size in gallons: Manufacturer:
Lot O~ ~ ~n~l
Line J ~O' ~0'
"Pomp on" level at: ~ "Pump off" level at: High water alarm at:
Fou.d~t,on ¢~' ~-~' ¢~' - - ff~"I 3~" ~¢ _
Curtain Pump Make & Model I Electrical Inspections pedormed by:
Remarks: ~~ l~/~¢~ p~¢ BENCH MARK _
' ~ Location and Description:
Assumed Elevation:
ENGINEER'S SEAL
,.'
Inspections performed by: ~/~/ ~ %¢c Dates: 1st
b,a,, ..~ Services approval
Department of Heal d
Reviewed and approved b L~ Date
72-013 (Rev. 9/91 ) MOA 25
PERMIT NO: SW 960242
PID NO: 01517115
NEW 1250 GAL.
~NK
,,,~PAGE 2 OF 2
45'
SWING TIES
FROM: COR. "A" COR "B" -
'tO:
STEP C.O. "C" 64' 98'
STEP M,H, "D" 72' 104,5'
M,T. "E" 78' 55'
NEW 45' LONG - ' "E"
SOIL ABS
W. 8.0' SEWER GVL.
PLAN VIEW
SCALE: 1" = 30'- 0"
1.25" DIA.
SCHED. 4O PVC
3BDRM
HOUSE GAR,
WF_LL
LOT 10
BLOCK 7
EAST 113TH AVENUE
WELL-
INSULATION (WESTERN 16' ONLY) II
II
1250 GALLON INV.
STEP TANK 89.0'
PROFILE VIEW
NOT TO SCALE
BOTTOM OF TRENCH ELEV. 85.9
BOTTOM T.H. #1 M.T. ELEV. 79.9 MAX 3" WATER 4/96
LOT 10, BLOCK 7, GREENLAND S/D
SEPTIC SYSTEM UPGRADE
AS-BUILT INSPECTION REPORT
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, ALASKA 99516
SCALE: AS NOTED
DRAWN BY TFM
SEPTEMBER, 1996
-? coNSPICUOUS PLACE
.......... POST IN A
24 HOUR NOTICE IS REQUIRED FOR INSPECTION SERVICE
ELECTRICAL
APPLICATION AND PERMIT , .
Municipality of Anchorage ' ) '.,, i
Building Safety Division
3500 E. Tudor Road Phone 786-8376 INSPECTION 563-3,164
Bu Iding, Address .... , Date [ '
.. ,, , , ~i - ' ~
Permittee Owner
i I~division , ELECTRICAL PERMIT FEES NO, @ FEE
Lot Io k Su
Contractor ~ , Phone No, ' TEMPORARYSERVICE '
DUPLEX, NEW
Description of Wor~;- VALUATION
New L~ Addition ~ Repairs [, Signs [~ ,
II others, specify 2, .~'
Remarks :-
I have read the above application and know tile con- TOTAL FEE
tents thereol; the same is t~ue and correct. I further
agree the above work will be done in accordance with Fee received
all state and municipal laws and ordinances.
PERMIT EXPIRES IN 360 DAYS IF By '; L' Date
WORK IS NOT COMMENCED Permit approved & issued:
Signature of Permittee/Agent ; ; ~ ,
X By Authorized Official .....
84-009 (Rev. 3192) DisTribution: WhitE.Original Yellow. Customer Pink-Inspectors Gold-File Card-Posting Copy
PAGE
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:SW960242
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:SMITH CLARENCE D JR & L E
OWNER ADDRESS:4701 E ll3TH AVE
ANCHORAGE, ALASKA 99516
PARCEL ID:01517115
1 OF 1
DATE ISSUED: 8/08/96
EXPIRATION DATE: 8/08/97
LEGAL DESCRIPTION:
GREENLAND BLK 7 LT 10
LOT SIZE: 18000 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
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 AND 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: ,~/.~_
DATE:
C1VIL & ENVIRO/~IMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSI~
THZ;ODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907)345-1355 July 17, 1996 ANCHORAGE, AIASKA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sh's:
The purpose of this letter is to provide the required design nmTative in suppolX of our application for a
pelrnit to upgrade the wastewater disposal facilities on Lot 10, Block 7, Greenland S/D, located at 4701 E.
113th Avenue. Soils logs, perc test results, a site plan, design ch'awings and specifications m'e enclosed
for your review.
The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil
log, the native material between 5' and 9' below ground level is a silty sand with a measured perc rate of
30 minutes per inch, and the soil between 9' and 12.5 feet is a coarse gravely sand with a percolation rate
of less than 1 minute per inch. Because this latter stratum is sand, no additional sand filter is needed.
Based on these perc rates, a trench with 7 feet of gravel extending between 5' and 12' below ground level
has 4 feet of sidewall rated at 0.6 gpd/sq, ft. and 3 feet of sidewall rated at 1.2 gpd/sq, ft. for an
equivalent of 5 feet of sidewall height at 1.2 gpd sq. ft. This 3 bedroom residence mquh'es a total
absorption m'ea of (3 x 150)/1.2 = 375 square feet. The proposed 45 foot long trench design with 8 feet
of gravel has a total effective absorption m'ea of 450 squm'e feet.
The topography of the lot slopes down towards the west at approximately 3%.
The proposed project will have no significant impact on present or future water supply and wastewater
disposal systems selwing adjacent properties, nor will it have any significant impact on reserved space-
surface and subsurface, or on ch'ainage.
Please give me a call at 345-1355 if you have any questions on tlfis submittal.
Sincerely,
Ted Moore, P.E.
MUNICIPALITY OF ANC, HORAG~
ENVIRONMENTAL SERVICES DI¥1$10N
dUL 3 0 IBB(i
RECEIVED
HOUSE
LOT 4
LOT 9
ABAN
EXISTING
SEEPAGE PITS
INSTALL 1250 GAL . - ' '
STEP TANK
,'HSE
WELL
LOT 4, BLOCK 6
HOUSE j
LOT 5
LOT 6
(VACANT)
20' ALLEY ,'
' "OVERHEAD POWER L
o
CONSTRUCT 45' LONG
ABS. TRENCH
W. 8' SEWER GRAVEL
O O
O
INSTALL
3BDRM
HOUSE GAR.
LOT 10
7
HSE
LOT 11
EAST 113th AVENUE
. -_ ';-~-....- LOT 2, BLOCK
LOT 10, BLK, 7, GREENLAND S/D
WELL AND SEPTIC SYSTEM
SITE PLAN
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, ALASKA 99516
1 INCH = 50 FEET
DRAWN BY TFM
MAY, 1996
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
1/4" DIA FLEX --~ "A" 45' LONG SOIL ABSORPTION TRENCH
/
~ I . . . DI,~. SCHED 40 PVC~
~_1250GALLON ~ A w. 3/16 DIA, HOLES
STEP TANK SPACED 2.5' ON BOTTOM
4" DIA, D-3034
FROM HOUSE
PLAN VIEW
SCALE: 1" = 10'- 0"
MOUND BACKFILL 12"
-- MONITOR TUBE
ORIGINAL GROUND
FABRIC
1.25" DIA, SCHED. 40 PVC DISTRIBUTION PIPE
W. 3/16" DIA, HOLES SPACED 2.5' IN BOTTOM
1/2" - 2 1/2" SEWER GRAVEL
DTTOM OF EXCAVATION
SECTION "A - A"
SCALE: 1" = 5'- 0"
LOT 10, BLK. 7, GREENLAND S/D
SEPTIC SYSTEM UPGRADE
PLAN AND CROSS-SECTION
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, AK, 99516
SCALE: AS SHOWN
DRAWN BY: TFM
MAY, 1996
Flattop TechnicaI Services
14530 Echo Street, Anchorage, AK99516
Phone (907) 345-1355
Lot 10, Block 7, Greenland S/D
4701 E. ll3th Avenue
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of abandoning an existing septic tank and two seepage pits and
installing a new 1250 gallon STEP tank which discharges effluent into a 45 foot long soil absorption
u'ench containing 8 feet of sewer gravel
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations fi'om these di'awings may be allowed or requh'ed by the engineer conducting the inspections.
All construction procedures and material specifications shall confom~ with Municipal and State
requh'ements. All sepm'ation distances shall be in conformance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work m'ound any
bmSed 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 m'e no residual
depressions. Insofar as possible the conta'actor shall minimize damage to trees and existing lawn m'eas.
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.
2.0 Existing System:
2.1 The existing septic tank and two seepage pits must be properly abandoned by thoroughly
pumping, removing the tops and backfilling with soil.
3.0 STEP Tank:
3.1 The new 1250 gallon, 2 compm'tment STEP tank manufactm'ed of 10 gage steel shall be
Municipally approved and shall be set level on undisturbed soil. Each compm'tment shall be equipped with
a watertight manhole cover and a 4" clemmut. If the tm~k is buried less than 4 feet, it shall be insulated
with 2 inches of approved bm'ial type, rigid insulation. The lift station shall be installed in the second
compartment of the septic tank which has an additional 250 gallon capacity. The lift station package shall
be an "Omnco" system as supplied by Anchorage Tank.
3.2 The contractor shall be responsible to obtain the necessary Municipal electric permit and
inspection, and shall provide a copy of the electrical inspector's report to the engineer overseeing the
construction of the wastewater disposal system.
3.3 The lift station shall be equipped with a watertight, insulated manhole riser and cover extending a
minimum of 6" above final grade with positive sm'face di'ainage away from the manhole. The contractor
shall be responsible for determining the necessm'y length of the manhole riser.
3.4 The on, off, and alm'm floats shall be set at the elevations specified by the lift station supplier, and
theh' proper operations shall be verified by the contractor. The pump conu'ol box and almun shall be
mounted inside the garage.
3.5 The dischm'ge line from the lift station to the soil absorption system shall be 1.25" dia. flex PVC.
All pipe connections to the tank shall be equipped with waterproof mechanical couplings. A cleanout shall
be installed within 5 feet of the building foundation.
4.0 Soil absorption syste~n:
4.1 The soil absorption system shall be constructed by excavating a 45 foot long trench to a depth of
13 feet below ground level in the vicinity of test hole #1.
4.2 The bottom of the excavation shall be level. Any compacted or smem'ed surfaces shall be raked to
allow proper infiltration. Sand for leveling or serving as filter material shall comply with Municipal
specifications.
4.3 A total of 8.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with
the perforated dista'ibution pipes laid level such that the pipe invert is no less than 8.0 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.
4.4 The distribution pipe shall be 1.25" diameter schedule 40 PVC with 3/16" diameter holes th'illed in
the bottom, spaced 2.5' on center. All pipe connections in the distribution system shall be glued, and the
ends of all pipes capped. Monitor tubes shall be of 4" diameter and installed in the locations shown on
the design di'awings. The pollion of the monitor tube extending through the sewer gravel shall be
perforated.
4.5 Approved filter fabric shall be placed over the enth'e top sm'face 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 enth'e top surface of the gravel, in
addition to the filter fabric.
4.6 The top surface of the cover material shall be raised a ntinimum of 6 inches higher than the
sun'ounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
4.7 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 rapid revegetation of all m'eas disturbed by the consu'uction.
5.0 Inspections:
5.1 A minimum of 4 engineering inspections will be required dm'ing the com'se of the project: (1)
initial stakeout with the conU'actor 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
infiltrative sm'face to ensure that it is level and at the fight elevation, and conforms with the soil test
info~xnation, (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 STEP tank requh'es one inspection after it is set level and the piping connected,
but prior to backfill. This inspection may be incorporated with any of the above inspections.
5.2 The installer shall coordinate the tin~ng of the inspections with the engineer sufficiently far in
advance to ensm'e the availability of the engineer.
TEST HOLE
LEGAL DESCRIPTION:
DATE PERFORMED:
PFRFORMED FOR:
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
Lot 10, Block 7, Greenlaad S/D
April 22, 1996
Rod Engle
DEPTH
(feet)
Pt,
SM Reddish silty loam
ML Gray gravelly silt
Frozen
SM Silty sand
SLOPE
SITE PLAN
T.H.
#2
HOUSE
SP Gravelly sand
Coarse
Depth to Groundwater Date
No ~roundwater 4/22/96
i8' - 9" 4/29/96
ML Gray gravelly silt
SP/SM Fine, somewhat
silty s,'md
Clock Net Time Percometer Net Drop
Date Reading Time (minutes) Reading (inches)
4/22 12"Presoak
Add water and start 1:49 23 1/2
#1 2:19 30 22 3/8 1 1/8
Add water 2:19:30 23 5/8
:02 2:49:30 30 __ 22 i/2 1 1/8
Add water 2:50 23 5/8
#3 3:20 30 22 9/16 1 1/16
PERCOLATION RATE 28 (minutes/inch) PERC HOLE DIAMETER 7"
TEST RUN BETWEEN 6.?5 FTAND ?.25 FT
COMMENTS: The percolatioa test data shown .,applies to the stratum between 5' ana 9' B.G.L.. See lo~ for test hole #2 for secoad perc test
conducted on sand stratum between 9' and 12.5'.
PEFIFORMED BY FLA'FrOP TECHNICAL SERVICES. I ~".,~.~_ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: '7 / / "7 / ¢ o~'
TEST HOLE # 2
LEGAL DESCRIPTION:
DATE PERFORMED:
PE-'RFORMED FOR:
DEPTH
(feet)
COMMENTS:
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
Lot 10, Block 7, Greenland S/D
April 22, 1996
Rod Engle
GM Gravel fill material
SM Reddish silty loam
SM Gravelly silty saad
Lenses of ML
Sinfilar to T.H. #1
Small water seeps
ML Silt
SP Cleaa gravelly sand
Similar to T.H. #1
ML Sm~dy silt
Dease, gravelly
SLOPE
Depth to Groundwater Date
Small seeps @ 10.5' 4/22/96
Monitor tube dry 4/29/96
SITE PLAN
T.H.
#2
t. S~HED
HOUSE
SP/SM Fine, somewhat
silty sm~d
B.H.
PERCOLATION RATE <1 (minutes/inch) PERC HOLE DIAMETER 10
TEST RUN BETWEEN 10.0 FIAND 10.5 FT
This perc test was actually conducted in T.H. #1 at a deeper depth than the perc test shown on the log for T.H. #1
Clock Net Time Percometer Net Drop
Date Reading Time (minutes) Reading (inches)
4/22 12" Presoak 3:48 28.5
3:53 5 20.0 8.5
Add water 3:55 29.5
4:00 5 23.25 6.25
4:02 2 20.25 3
4:05 3 18.25 2
PERFORMED BY FLATTOP TECHNICAL SERVICES. I ~'"_~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/,/ 7 //dO'"'
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
Parcell.D.# ~)~'~/ '~/t'3-- HAA# i"~L3~,
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
¢
p. ~. fF~o,~ /t 1 I ?-.~ /~,,~cAo "~? ~
Day phone
Day phone
Address
Day phone
o
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~
TYPE OF WATER SUPPLY:
Individual well ~
Community welt
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 I~gality and status of system.
72-025(Rev. 1/91} Front MOA #21
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 ofstructureindicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage flies 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
Address / Y~"30
Engineer's signature
bedrooms.
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval fo?
bedrooms, with the following stipulations:
Additional Comments
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 ~f21
~UNICtPALITY OF ^NCHORAGI:
j~.NVII~NMENTAL ~RVIC~S DiViSION
Municipality of Anchorage ~
DEPARTMENT OF HEALTH & HUMAN SERVICES SEP 2 5 ~997
Environmental Services Division
825 L Street, Room 502. Anchorage, Alaska 99501, (907) ~~l''V~[
Health Authority Approval Checklist
Legal Description:
A. WELL DATA
Hell type (~ ~,'/-
Log present (Y/N)
Total depth 73~ ~ea_¢ 2/2o/9? Casedto
Sanitary seal (Y/N)
FROM WELL LOG
Parcel I.D.: ~2 13"1 '"711~
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed (.,tn ~c, cc, n - , f'r¢- 1~7~~
7..3 ~ Casing height (above ground)
Wires properly protected (Y/N) _
AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~ col
Date of 8ample:
B. SEPTIC/HOLDING TANK DATA
Date installed
Foundation cleanout (Y/N)
Date of Pumping /V.
C. ABSORPTION FIELD DATA
Nitrate
Tank size
g.p.m. 6", ~/5' + .g.p.m.
¢. 5'"/,m,j~. /'~ Other bacteria
Collected by:
Depression (Y/N)
Pumper /V. ~.
Number of compartments ~? Cleanouts (Y/N).
High water alarm (Y/N)
Date installed
Length ~5-' Width ~ E',5-' Gravel thickness below pipe
Effective absorption area 7 ~ ¢' Monitoring Tube present (Y/N)
Date of adequacy test. Jr'. ,~, ~' ~ ~r.4_~,~ Results (Pass/Fail)
Fluid depth in absorption field before test (in.);
Fluid depth . (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N) /v, ,~.
Soil rating (g.p.d./fF or ft~/bdrm) ~,,~,¢o.~ System type
Immediately after
Absorption rate =
If yes, give date
~ ' Total depth /,~ '
__ Depression over field (Y/N) ___
For ~
__ gal. water added (in.): __
.g.p.d,
A/./¢.
/V
bedrooms
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested /V, ,4,
SEPARATION DISTANCES
Size in gallons
"Pump on" level at*. '-/E" "Pump off" level at* '~
*Datum .,~'(~,or o~
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Absorption field '~ '
Wells on adjacent lots / CO '
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots ~./co '
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot I O~ '
Absorption field on lot /d~ 3
Public sewer main A/.
Sewer/septic service line '~ '~ 3~' Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~' 3' Property line I
Water main/service line ~> lO' Surface water/drainage ':~ ~'oo'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line IO' Building foundation
Surface water '~. t
Curtain drain /Vt, n e ...c.e_ e,~
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal
in conformance with MOA HAA guidelines in effect on this date
Signature ~ ~. ~
Engineer's Name %~.o~ ~. ~o~ ~
Date ~ ~ I~7
HAA Fee $
Date of Payment ~/~"~¢/
Receipt Number
72-026 (Rev. 3196)*
Waiver Fee $
Date of Payment
Receipt Number
CT&E Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
Sample Remarks:
Peremeger
Nttrate-~
?erst Cot{form
This is
975667002
;Flattop T¢chnicaJ Sty.
N/A
Lot 10, Blk 7, Greenhnd S/D
Drinking Water
0
a l~relt:mtnaz, y report;
Client PO//
Printed Date/Tinle 09/25/97 12:07
Col/coted Date/Time 09/19/97 14:00
Received Date/Time 09/19/97 15:50
Technical Director: Stephen C. Ede
Released
Results PQL Units
~ethod L~B{tS Bate Date Init
$.5& 0.100 r~/L EPA 300.0 10 max 09/23/97 GCp
0.00 co[/lOOmL $fl1§ 922~G 09/19/97 T~
DEPARTME
825
MUNICIPALITY OF ANCHORAGE
OF HEALTH AND ENV!RONMEN"
L Street, Anchorage, AlasJ.~
279-2511, ext. 224 o'J: 225
Date Received:
Time
Date
Insp
PROTECI'] ON
99501
June 13, 19'77
~3: Time
])ate
Insp
~ / ""' ~._{OVAL OF INDIVIDUAL SEWER AND WATER ~AC.[LIP._ES
R[',QJES.[ FOR AP~ " ' - "'r~' '
Lending Tnstitution Request: First Federal Savings & Loan Association
Mailing Address: Post Office Box 4-2200 99509 Phone: 274-6561
2. Property Owner: Clarence D./Lillian E, Smith
Ma:Lling Address: Star Route A Box 1721C 99507
Phone: 344-5111
Legal Dc. scr:iption: Lot 10 Block 7 Greenland Subdivision
Sim lo Family Residence:
4: .J
Number of Bed:rooms: 3
Multiple Family Residence: ( )
Number of Bed:rooms:
:5. Well[ Sys±:em: Individual Wcl] (xM Community/Public System ( )
Po-Fruit # .......................... Depth of Wcll Well Log on File ( )
Cons['.ruction ~- c ' - sis
L~a.'teL3. u]. Analy
oewa~__ Disposal System: On-.-site System ( x, ux Public Uti].i'ty ( )
Requesting no adequacy test, as a refinance.
t>ermit # installed Instal 1er
Sc}~tic TaN. k Size Manufacturer
Absorpt.ion Area Soils Rate Mater:iai
Distances: Well to Septic Tank
to Sewer l,ine Nearest Lot lJue
to Nearest l, ot Line
AbooI D~.iOD .Area
Absorption Area
MUNICIPALITY OF ANCHORAGE ':";
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
Type of Inspection: CMRO VA
Property Owner: Clarence D. & Lillian E. Smith
FHA CONY xx
Mailing Address:SRA Box 1721C, Anchorage, AK
Name of Buyer: Same
Day Phone 344-5111
Mailing Address:
4. Name of Lending Institution:
Mailing Address:Bo× 4-2200, Anchorage, AK
5. Name of Realtor- or Agent: None
Mailing Address:
Day Phone
First Federal Savings & Loan Assn
99509 Phone
Phone
274-6561
Legal Description: Lot 10, Blk 7, Greenland S/D
Location' NHN ll6th Avenue, Anchorage, AK
7. Type of Facility to be inspected: Single Family Residence
No. Bdrms. 3
8. Water Supply
Type of Supply:
Public Utility
Individual XX
If Individual, number of dwellings presently served 1
If Individual, depth of well unknown
9. Sewage Disposal System
Type of System:
Public Utility
Individual (on-site) XX
If Individual, date of installation unknown
10. An adequacy certification test is not requested.
EQ037 (1/74) , James D. Fish
.,- Loan Officer
/
Department. of He¢.,.lth and Er~vironmental qrotectiorl
]Request for Approval of Individual Sewer and Water Facilit-ies
Legal. ,,=' "'¢''
D(...,cr.h[ t..~ on:
Lot 10 Block 7 Greenland Subdivision
A£fadavit Attached: ( ) Le-hte:c Ah~zached: ( )
Approved: DaLe:
Disapp'r;ov'ed: Date:
