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HomeMy WebLinkAboutALPINE TERRACE BLK 4 LT 5 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage. Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS % ~ ~ ~O~, ';~ ~"'[ -- O IPHONEI [] NEW XUPGRADE LOCATION H '~_.. ~:~-S l~J IBC % ~ ~ t~-~.~. C)~- ~"~ ~. L- ~- S ' ~ ~'. Well DISTANCE TO: Manufacturer n gallons IF HOMEMADE: D,STANCE TO: Manufacturer Well ~\or DISTANCE TO: Length of eac.~li~ No. of lines ~. Top of tile to finish grade NO. OF BEDROOMS Material Nearest lot Jine · Total lines length of '-~ 5 Trench w.[~lt~::~ Material beneath tile ~ ~, ~) ~l PERMIT NO. _[.~){~)...~ O(o No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons Foundation inches PERMIT NO.. Distance between lines ~J / ~ inches Length . t(, ~ Width ~ Depth PERMIT NO. Type of crib ;rib diameter Crib depth Totel effective absorption area Well Building foundation Nearest lot tine DISTANCE TO: Class Driller Distance to lot line Sewer line Septic tank DISTANCE TO: Total effective a~,.~ti~,~_~ area PERMIT NO. Absorpt on area(s) OTHER SOl L TEST RATING I NSTA b LER REMARKS DATE .013 (Rev 3/78) LEGAL RF:'F:'L ]] CI=IN T L..O ':;:F~T I :'.' N LEGRL ~'"11 IU If'...~ ][; ,"_"": :E IF' FRI L. 3[ T' ".,,-" DEF'FIF::THEI"4T OF "IERL. TH RNE:, EN',,,'I F.:ONHEI'4TFIL F :'32:_= '" L." STREET., FINC:HORF:IGE., FIK. ,::-.~,:.4.% ,-_' "_=.:."; E ~-.-i EE ~;:.:." IU F" C::i f~,'. f~ E:, EE.". F' EE ~';.:.'"~ ~"."!t ][: 'T' GEOF~:GIE H l LL_EF.: C I RCLL'.:.: [:,F::. LT. ~: E:L.K. 4 RL. P INE TEF4:F.:RE:E L:i;,.."D LOT E; ]: ZE 2 L::OC~3 :.".-;L::!IJFtF'.E F:'EE:T T"r'PE OF 'L'-.';O]:L FIE:E;OREFf'ION L:;'¢ETFEH I:E;' TF.:ENC:H I"IF]::':: ]: HUH 1'41..Ir,IE:ER OF E:EE:,F.:OOr'tE; = ~: THE F.:EQI..I I RE[::, :.2; I ZE OF THE=,J:[L'""~ ..... HE, a,.. F. F"-' ] """"1 ION :,T--.'-' "-'TE. fl' IE; · THE LENGTH DIMEI".4E;tON IS 'THE LENGTH (IN FEE;T::, OF: THE TF..:ENCH OR E.',F.:F:~INFIELD. 'T'HE [.':,EP]"H OF' R TRENCH (:iR PIT I.S THE DTE;TFINCE BETI.,.IEEI'4 THE '.:..;UF.:FFtCE OF' THE: GRL')LIN[.', RI'.4D THE BOTTOf'I OF THE E',:.:',CFI',,,'FITION (.'[1'4 FEE:]".'.',. THERE IS 1'40 SET H IDTH FOR 'T'REI'4CHE'_:;;. THE GRFIVEL DEPTH I"5 THE I'IINtI"IUt"I DEPTH OF' GRFtVEL. BETI.4EEN THE OUTF='RLL F.'IPE FIN[) THE BOTTnH OF "Fi4E E',:.::CR',,,'RTIOI'4 ,::II'.,I F'E:ET::,. f~ .... .-~ F~."E:~-] ~5:.,.I.J ."E F;?,".EE E::, ."£C:;; E: F" 'T ][ C: 'T"FIINt<: :% ][ ;~:'. E'. =".:::: %-'..~,;~5~ (-.':.~" I."}aFIIIL L_ CT~I'-415.E;; I:::'EI:;~:H I T RF'F'L. I Cf:INT HFIE; ]"HE RESF'OI'.,IS I E: I L I 'T'-r' TO I NFOF.:I"I TH I S E:,EF'RRTHEI'.,IT E:,L F.: I NC. ii TH.E I NE;TF:ILLI::IT 1[. ON ]:I",I:.~;F'EC:T 1' O1'.,155 OF FIN"r' I,.IEI_L.~; fhl).3'F:ICEI",IT 'T'O TH I E; F'ROF'E:.F;~:T'~" I::IND THE I",IUHBEI:~: OF F.:E"SIDENC:EE; THF'IT ]"HE I,.IEL..L I,.I:[LI_ LSEI'~:',,,'E. 'T' t.-..I ,::~ ,:: ;;'~ ::, ]: t'-~ ";C; F' E: C:: T ]: ,::, I'-~ 55; [:~ F.:: E FL'. EE: ,'2:.,. L.I ][: F.~:: EE: E:::,, E;RCKF I LE 1' NG OF RN'¢ "2"r".:..':TEH l,J I THOUT F' Z NRL. I N'SF'EC Tt ON RND HF F 'F.. P L B"J" TH I E; [:'EF:'F~f~:TP1ENT 14ILL BE E;UB..TECT TO F'F.':OL:;EC':I...ITI'FIN. MINtf'IUH [:,IS"['Ffl'.4CE BETHEEN 1.3 NELL FINE:, Rr.4Y ON.--SITE ':.3EHRGE DIZ, F'O'BRI.. S'¢$'T'EP1 I:5 t00 I=EET FOR R PF.'.I',,,'FITE NEL. L..~ OR :LE',O 'TO 2F¢3 FEET FROf"I R PUBLIC HELL DEPEN[:,ING I...IF'ON THE T'¢F'E OF F'I...IBL:[C HE?.I....I. .... O'T'HEF.: REQL.(IF.'.EHFI'4TS I'IFIY RI:'PL."?. ::SF'ECIFIOFITION:; f::IND CONE;TRUCTION DIREiF.'.FtH:!:~; FIf',?.E FI',,,'FI I LRBLE TO I NSURF PF.'.OF'E:I~: l NE;TFILLFCr I ON. I C:ERTIF'Y THR'r 1: I Al,1 FRI','IILIRR NI]"H THE REQUIREMENTS FOR ON-SITE SEHEF.:S RND HE.L.L.E; F:rEi :~.:, E!: "I" F'C'~F:TI.4 B'¢ THE: HUNICIF'RLIT'¢ OF RNCHORRGE. 2: I NILL INSTFILL THE '::;'¢$"rEH ]:N FICE:ORDRf.,ICE HI]"H THE CO[:,ES. 2i:: :[ UN[:,ERS]"RND THRT TIqE OI'4-L:;ITE SEHER S'¢'STEf'I t"lR"r' REE!LIIRE ENLRRGEI'IENT ]:F THE RIESIDENC:E IS REHODELE[::' Ti]) I NCLU[:'E HOF.:E THFIN 5 BEDF.'.oor,IS. GRE. ER ANCHORAGE AREA EOF Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 UGH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME~/}~'i/rl,,/'I/L~z'~ /:ER,Nfi~DEZ MAILING ADDRESS ~ - ~'~e"~ LOCATION ~ O~//~ LEGAL DESCRIPTION SEPTIC TANK: DISTANCE NUMBER OF FROM WELL ~Ol MANUFACTURER ~R£~ MATERIAL -~"/'~r/ COMPARTMENTS INSIDE LENGTH - INSIDE WIDTH " LIQUID DEPTH '"' LIQUID CAPACITY/,~-O GALLONS. SEEPAGE PIT: NUMBER OF PITS I DIAMETER ~ OR WIDTH LINING MATERIAL~:~.~L~ CRIB SIZE: DIAMETER BUILDING FOUNDATION ~/~*, NEAREST LOT LINE ADDITIONAL ABSORPTION LENGTH /~','~ DEPTH ~'~ DEPTH ~ ) _ DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ,~ ~' WELL: TYPe J~l ~/EO CONSTRUCTION. BUILDING ; NEAREST FOUNDATION /~2 ¥", LOT LINE CESSPOOL "= , OTHER SOURCES APPROVED f DISAPPROVED NEAREST , SEWER LINE DEPTH ~ ~ DISTANCE FROM: SEPTIC /,,~1 SEEPAGE ~ , TANK 7 , SYSTEM /O-~ REMARKS DISTANCES: INSTALLED BY: ,]~'~"~ Z~..~' ~ PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. EQ-031 DIAGRAM OF SYSTEM DATE APPROVED G.A.A.B. GREATEr ANCHORAGE ArEA Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD OTHER FINANCED THROUGH TO BE INSTALLED BY ~/~/ ~ ~/ ~ ~ ~ SOIL TEST RESULTS ~ ~//~ ~ COMPLETION DATE ANTICIPATED NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTIC~N BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE MINIMUM DISTANCES, REQUIREMENTS / FOUNDATION TO SEPTIC TANK / FOUNDATION TO SEEPAGE PIT ~// DRAIN FIELD / SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK J~/ SEEPAGE Pit ~ / . ., DRAIN FIELD TO NEAREST LOT LINE. / WELL TO SEPtiC TANK ~/~ ~ i SEEPAge PIT J~// / DRAIN FIELD ALSO CONSIDER AREA WELLS· WATER MAIN TO SEPTIC TANK / ~ I SEEPAGE PIT DRAIN FIELD /~' / SEPTIC TANK, ,"//~" j / FIEbl~ SEEPAGE PIT , : DRAIN TO RIVEr, LAKE STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP Of EXCAVATION 5 FEET INTO UNDISTURBED SOil. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G .A.A.B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge Area BOROUGH ORDINANCE NO. 28-68 AND That THE ABOVE DATE . APPLICANT'S SIGNATURE , . FORM NO. EQ-01 6 Certified Well Date completed ........... J:,LY~e...2.~.., .19~. ~ IviUNICIPALITY OF ANCHORAGE ................................. IIEPT:' OP'HEAt:TH' &. Depth of well 6 ~ ~6 ~ ~c ENVIRONMENTAL PROTECTION 33 Feet Distance to water while pumpin~ ...... , .......... ~..~......;..~,.-. ....................... at rate of ................ ~0.0 ................ : ...... s~!.o~, per Bolders and clay ...... '..."~,,.. " o j 5 Sand' and '" ' ~' "~V~ ~ '~ "" 5 ] 20 .~ ~ravel , ,-~, ~ ,~ ~ ~ ,, ..~,. '~" '~'~' ' ' ~' '" ~ ' d ~ ;~ ~ ~'~' ~ ~ ";~"g' ' -'~! -an~ san .~.,,~~..,~ ...... 55 61 · -~ ;~'-. ~ '' ~ . ~ ~a . ' "~.~ ' , .: ..--., ~ ~ ',.,-- ~ I .~ ;. -,..,.- ,..- . "... :. . . ~' ~l i,~,,~-..t,.'~. ~..; = ' . , I certify the abo~e ~r~e .1i!1. d co~t i~~...";'-: ' ~'ff'~" ~ ' ' "' ' ' ' ' ' .-SOMMERVILLE WELL DRILLING GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY Case # 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed For /~o / /cc~[jlc~c/~_ Legal Description: Lot ~/ Block ~- This Form Reports Soils Log_. ~ - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics lO-- Was Ground Water Encountered.* If Yes, At What Depth? Dated Performed Subdivision /~2/~..~c~- Percolation Test Reading Date Gross Time ,ss Time Net Time Depth to H20 Net Drop / I Percolation Rate Minu,_ Proposed Installation: Seepage Pit Drain Field Depth of Inlet__ Depth to Bottom of Pit or Trench' ' COMMENTS: Test Performed BY ~(/0~ ~.~_( Date Certified BY: Date: 0 0 ~ NOT SUBDIV{DED N O0° 02' E °1 RABBIT I 45,00' N OC N O0° 02' W Easement 180.00' 0~' W N O0° 02' W 200. m S O0° 02' W lO' b © IbO,O0 180 00' I01.93' ~_ S O0° 02' W 486.9~: ~ ,DRIVE -% CREEK OF BEAR~NO N 00056' 30"W Z03. $ O0° 02' E NCi:T I $ 2 i, 4__.9' ROAD 215,00' 152.01' N 00° 02' W 214 01' N O0° 02' W ...... '~"~-- Ut H I t y -[~ a s~e m e n-t N 00°01' 50" W Eoseme RABBIT ~31;~9' -- 130,00'-- - -- --N C 276.§3' Noo. o2'E 0 III I 209.94' 240 74' S O0~ © Z. 40 25' ' -- -- ( 0 19~11~ S 0o0{'69"W P DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR 274-2533 May 28, 1985 Ms. Gwen Turner Alaska Environmental Control Services, Inc. 1200 l~,f. 33rd Avenue, Suite B Anchorage, Alaska 99513 SUBJECT: Waiver Horizontal Separation between Well and Septic Tank, Lot 5, Block 4, Alpine Terrace Subdivision, Anchorage, Alaska (8521-WA-171) Dear Ms. Turner: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic tank to 81 feet 'on the subject property for a 5 bedroom single family residence only. Sincerely, Steven W. Eng P.E. District Engineer SWE/msm MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) !1~¥~ ~0-_(. Lp_ bP-lv'tr-.-- Property owner __~/~T't-~'- I Mailing address Lending agency Mailing address c. oo LT"~--. 1~ Day phone .'~-/~ - ,,2/,.~ 2_. d_t,~.C., L ~:? 'Ih f~l V~---- Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well ~ Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. , ,. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm I-"-~,~,.~ ~---.~,u.~-~t~,_,~/' '~- ~ Phone Address ~ ~ ~ /~ ~ ~o ~ ~~ ~ Engineer's signature '~ ~~ Date DHHS SIGNATURE Approved for DisapProved. Conditional approval for bedrooms. b~ with the fo!lowing stip, ations: Additional Comments The Mi!niCipality b~Anchorage Department of Health and Human Services (DHHS) issues Health Authority ApprOval C~ertifict~t~s based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HE,~LTH & HUMAN .... Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501· (907) Health Authority Approval Checklist Legal Description: A. WELL DATA Well type '~ Log present (Y/N) Total depth Parcel I.D.: PlS--~Ur~- I q If A, B, or C, attach ADEC letter. ADEC water system number y Date completed ~'/~-'"/I *7 ~ ~:~,1 Cased to ~ ~'~ ' Casing height (above ground) Sanitary seal (Y/N) , V / FROM WELL LOG Date of test {~//~ 7/7 ~ Static water level '~ ~ b'J( Well production IT) . g.p.m. Wires properly protected (Y/N) , AT INSPECTION ,/ WATER SAMPLE RESULTS: Coliform ~~-o/ Nitrate 2._ /7. 14'tt~/~_ Other bactem !~ Date of smnple: ~ ~ Collected by: '~ ~. B. SEPTIC/HOLDING TANK DATA Date installed ~ /~17~ Tank size 1[25o * ~oo Number of Compartments 1 4' £ Cleanouts (Y/N) . Y Fluid depth in absorption field before test (in.); Fluid depth ~ ] (ins.) Minutes later:' '~ Peroxide treatment (past 12 months) (Y/N) ImmeAiately after ~gDgal. water added (in,): Absorption rate = 7 7~'D g,p.d, ffyes, give date Foundation cleanout (Y/N) x/ Depression fi/N) ~ High water alarm (Y/N) ~.1 Date of Pumping Pumper c. A so. PTION m, D DATA Date installed 7/~/'7 % Soil rating (g.p.d./ft: or ft:/bdrm) Length '~+ Width ~4'~Z~+ Oravel thickness below pipe Effective absorption area q ~ Monitoring Tube present(Y/N) ~ Depression over field (Y/N) Date of adequacy test '~/:g o/~}b, Results (Pass/Fail) '~ For ~ bedrooms LIlT STATION Date installed Manhole/Access (Y/N) Size in gallons High Water alarm level at* "Pump on" level at* "Pump off" level at* Cycles tested *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot t~d~ (~O ! q &-..~ ; On adjacent lots Absorption field on lot ~ ~ t I D ! ; On adjacent lots Public sewer main ~"'J//~ Sewer/septic service line ~ ~ ~ Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 13~ ~ ~ ~ Property line ~ I D Absorption field Water main/service line ~,,~ Surface water/drainage ~lO Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Ur -~ Water main/service line Surface water /~,.~b,I . Driveway, parking/vehicle storage area Curtain drain tq ID ~ ~/7 Wells on adjacent lots ~, t ~C)! Property line ENGINEER'S CERTIFICATION I certify that I have determined thrufield inspections and review of Municipal reCords?hat thcS'above sys~ms are in conformance with MOA HAA guidelines in effect on this date. Date ~'~[~_e~ 21~ Iq(It,. ',~,-:.:,'~-;r':::.".' .. Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number Address Address MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTHENT OF m~..ALTH AND ENVIHONHENTAL PROTECTION APPLICATION FOK HEALTH AUTHORITY APPROVAL CERTIFICATE Info~mation Applicatiou Da~e ..... a) Legal Descriptiou (include lo=~ block~ : ....... ~ -.. ~-~ / ~.., .... ':.'~:~: b) Applicants Name '~ ~~ '~e~epnone- e / , ,,,. _ , .... ~~~ ~~~ , , , -(d) L~ndin~ lnsCiCu~ion Telaphon,~ , , ,, Telephone (f) Mail the HAA to the folloving address: 2. Type of Residence Single-Family Number of Bedrooms .i(::'~': "'. 3, Water Supply Multi-Family ~--~ Other (describe) Zndivid~i Weii~ .T~_~ Communi~7 ~ Public n-~ Note: ~ communi~ weii system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. 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] Tests. File Search~ Data and Information t? ~:ta in compliance ~th .all Nnn~cipal and State codes, 6~ ~n ~ect on the ~te of :~a ~ns~ct~on. ,/...S~. D~ sapproved Co~ ~ ~ion~ by my sea~ affixed hereto and as of the validation date sho~n below, I that my investigation of. this Hea~th Authority Approval sho~s that the ou-si~e .~ply an~/or ~aste~ater d~sposal system is safe, func=iona~ and adequate for of bedrooms and ~ype of structure indicated herein.- I further verify =hat, ~he inffoz~ati0n ob=a:£ned from the N~nicipality o~ Anchorage files and from my ion and ~nspection, the on-site ~ater supply and/or ~astewater disposal ordinances, and regu~a- Telepho ne ~/-~V~ Approvad_~ :e~ns of Cond~tiona~ Approva~ THE MIINICIPALITY OF ANCHORAGE ~EPARTMENT OF hEALTH AND ENVIRONMENTAL PROTECTION (DHBP) ISSUES HEALTH AUTHORITY APPROVAL CERTLFICATES BASED SOLELY UPON THE REPRESENT- G~VEN IN PAI~ 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED i:~N THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQULRE- MENTSj EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS :.0~ (~IISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. F,.BA/eJ/D lB [Page 2 of 2] (DHEP SEAL) 7-19-84 .J ae MUNICIPALITY OF ANCfDRAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORA(~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECFIC~J Well Classification Well Log P~esent ~N) Total Dspth %~ ~ / Cased to Static Water Level , ~ ' ~ Casing Height Above Ground Eleut=ical Wiring in Conduit ~N) Sepa=ation Distances f=cm Well: MAY 5 0 1985 RECEIVED Legal Description: , , Sanita=y Seal on Casing ~N) Dep=ession A=ound Wellhead (YA~ If A, B, c~ C, Date Ccmpleted Pump Set At To Nearest Edge of Absc~ption Field on Lot .; )~)i~.-' ; On Adjoining Lots~/D~/w To Nearest Public Se~sr Line .... ~ ~ To Nec=est Public Sewer Cleancut/Manhole , ,/%A,%------ To Nec=est Se~sr Service Line on Lot Water Sample Collected By ~ ; Date .~-'/~. !~',5"" Water Sample Test Besults ~l-i~]c/ki77)~Y ; On AdjoiningLot~...~/~ B. SE~IC~O~I~TANKf~LTA [Page 1 of 2] ~ate Installed i~L~~) ~ ~q~) Size J~-D~ ~ ,~b~~) NO. cf Ccmpa=t~ents Stan~i~, ~) . Ai=-ti~t-~p,~) . F~n~tion C~an~t~) P~ing~inte~ ~n=a~ ~ File (Y~)~ ~ ~= Holding Ta~ High-Ware= ~a~ (Y~) ~ldi~.Tank ~t (Y~)~/~ ~ation Distils ~ ~ptic~oldi~g Ta~: To ~te=-Supply ~11~ ~; ~ ~0'~ ~- To ~ildi~ F~ndati~ To ~=ty Li~ Ir 9I ~ ~ ~'~ ~ TO Dis~sal Field To ~te~ ~i~i~ Li~ ,+ ~1~ To S~, ~, ~e, ~ ~jor ~aina~ · , ' ' ~ I~ ) ~ ' t 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Abso=ption S,t~ata Date Installed ~ [l~ {~ Width of Field 4wSqu~e Feet of Absc~ption A=ea Depression over Field (.Y~)) ~Results of Last Adequacy Test Do Depth of Field / 0 ' Gravel Bed Thickness ~ / Standpipes P~esent ~N) Type of System Design 77~/Udi~,, Sepa=ation Distance f=cm Absc~ption Field: To Water-Supply Well ]! O/~6- To P=operty Line To Building Foundation ~ ! ~'-' TO Existing or Abandoned System cn Lot 5'd) ; On Adjoining Lots ~ 30/ ' To Water Main/Service Line To Stream/Pond/Lake/or Major D=aina~e Course. TO DrivewaY, Parking A~ea, or 'Vehicle Stor. age A~ea ~,~1~(- ,' ~- , -~, ',, LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Leve. Tested for Electrical :nsions Off" Level at Vent Pumping Cycles du=ing Adequacy Test. Meets MOA ** ** Check Permitted Bed~ocm Rating A~ainst HAA Request I certify that I have checked, verified, or confcz~ed to all MOA HAA Guidelines in effect on the datejf this ~pecticn~ si ,d ,, KB1/d5/s [Page 2 of 2] -%~ )y C. Reid, Jr. ~~~ No. 2251-E , ~ ~ 2-15-84 ALASKA E IidlRO[lmE I1TAL COFITROL SE RuICE $, I[1C. I~nclineeHnq 6 I~nuironmental Studies DONNA NETZKE 11845 CIRCLE DRIVE ANCHORAGE ALASKA 99507 SELLER-SAME MAY 29 1985 DONNA NETZKE 11845 CIRCLE DRIVE ANCHORAGE ALASKA 99507 50194 LEGAL:ALPINE TERRACE BLOCK 4 LOT 5 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-MAY 9 1985 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN UNKNOWN AREA. THE SYSTEM IS CAPABLE OF ACCEPTING 750 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 782 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 5 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1750 IS ADEQUATE FOR THIS 5 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON MAY 10 1985 . FLOW TEST ON WELL WELL FLOW DATE-MAY 9 1985 A FLOW TEST WAS PERFORMED ON THE WELL. 782 GALLONS OF WATER WAS PUMPED AT A RATE OF 5.5 GPM OVER A DURATION OF 2.5 HOURS. THE DRAWDOWN WAS 40 ' WITH A RECOVERY TIME OF 30 MINUTES AND THE STATIC WATER LEVEL WAS 23 FEET. THE WELL IS ADEQUATE FOR THIS 5 BEDROOM HOME. 1200 U Jest 33rd Aucnu¢, Suite ~ · Anchora§¢, Aloska 99,503 · I907) 276-1361 MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPRO~,/AL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) davs for processing. 1. PROPERTY OWNER I PHONE MAILING ADDRESS ~ PROPERTY RESIDENT (If different from abdve) PHONE ¢¢ 2. BUYER PHONE MAI LING ADDR ESS '- LENDING INSTITUTION PHONE REALTOR/AGENT PHONE MAI LING ADDRESS ~,,,~' to/ ......................... 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] Two ~ Five [] Three [] SiX [] Other 7. WATER SUPPLY .1~' INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON'SITE~* [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) ' ~//p **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONL'~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE E~ PUBLIC UTILITY Connection Verified [~]Septic Tank or §ire dimensions: [] Holding Tank If Tank is homemade TYPE OF TANK TOTAL ABSORPTION AREA [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL [] OTHER 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line Septic/Holding Tank ]Absorption Area ISewer Line Nearest Lot Line 5. COMMENTS DATE E~]-~'-APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED BY (Title) ' LEGAL DESCRIPTION 72-010 (Rev. 3/78) JML John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907-279-8056 NEW PHONE NUMBER 276-4113 S.OIL ABSORPTION SYSTEM TEsT PERFORMED FOR: TELEPHO~m: $4~.- '~"?E~ DATE OF TESTS:7/Z~/WR N0. Or BEDROOMS: ~ R~CORDS ON rZLE: ,",fJ~ ~Y~,~,~~ CRIBi DRAINFIELD ,,,-- , ~, ~EE~ ~ ~ , MUNICIP~ITY OF ~CHORAGE, DEPT. OF ~VIRO~ENTAL QUALI~ ON'~/~ WITH THE ~LLQWING MODIFICATIONS: SURGE CAPACITY: SOIL ABSORPTION SYSTEM SEPTIC TANK PLUS SAS ABSORPTION RATE AVERAGE hrsO, OBSERVATIONS: (SAS) ~. ~ ~, ~..~. ,~, STEA~Y STATE ~ RISE ~7E_,.-' PERFORMED BY:. ~~ R~ORT BY:~ SUPERVISED BY: ~~ ~./~_/_/ ~/--~ , TEST DATA ATT~ED I I I John M. Lambe, P.E. 4303 North Star Street Anchorage~ Nad;a, 99503 907-279-8056 JML 'SH~ ~-- OF ~ John M. Lambe, P.E. I 4303 North Star Street Anchor~le, Alaska, 99503 907-279-8056 DEPTH BELOW METER READING GALLONS PUMPED TIME REFERENCE , , , (..GALLONS ) .. ( NET ) , i ~ i