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Home My WebLink AboutBENITO BLK 3 LT 11 Onsite File Benito Block 3 Lot 1 1 #050 - 272 - 13 Existing drainfield and seepage pit are sized/approved for 3 - bedrooms (combined) . Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. - P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite - (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171374 PID Number: 050-272-13 E] New Z Upgrade M Deep Trench F] Shallow Trench F� Bed [] Mound Address 17226 FOOTHILL AVE 0 Other Phone Number of Bedrooms Soil Ratma Total depth from original grade LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth b ath pipe Ft. :7� Ft. Subdivision Block Lot BENITO 3 11 Fill added above original grade Sravel length Ft. Ft. Township Range Section Gravel width --- Ft. eds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES Tol Septic Absorption Lift Station Holding Sewer ion area m Nu ber of trenches Dist. between trenches From Tank Field Tank Line Ft. Well 94.0 N/A NIA N/A N/A TANK [D Septic El S,T.E.P. R Holding F1 Other Manufacturer ANCHORAGETANK Capacity 1250G,I. Surface Water 100+ N/A N/A N/A Material Number of compartments Lot Line 39.9 N/A NIA N/A STEEL 2 NA Foundation 5.7 N/A N/A N/A LIFT STATION Manufacturer Capacit Curtain Drain 50+ 1 N/A N/A N/A Gal. Remarks TANK REPLACE ONLY Pump on level at at in. High water alarm at in. INSTALLED IN EXACT LOCATION OF THE ORIGINAL 1971 TANK Pump make ode[ Electrical Inspect ions performed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield JR'S SEPTIC Drainfleld CO/MT 3034 Inspector PANNONE ENGINEERING SERVICES BENCH MARK (Assumed elevation) 428 ft inspection Location and description 3 Id 0' SE BOTTOM HOUSE TRIM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp A�,jk_k� Conditional Approval: Date OF. TH VA Approved Aq- .Miv=""v"xvvvv_-/'/z.voc RECORD DRAWING REVISED PER MOA COMMEN i�H 10/26/18 DRAWN I ACP —1 SITE PLAN WEJLLSFD42:5 BD / | |DECKSEPTIC TANK PER MOA CODEINSTALLED NEW 1250a SEPTIC TANKA W1 FC BEFORE AND DCO AFTER ^ ' EXISTING EEPAGE DRAIN FIELD ^ i � � D D 0 0 0 � o —` ~ OG, FO. " oo 428 4.0 TANK PROFILE SCALE: l^=1O' / ��/ /c-�_ PANNONE ENG SVC, LLC P.O. 8O% 102954 ANCH0KACE, AK 99510 PHONE (907) 272-8218 FAX (307) 272-8211 BEN|TO B3 Ll1 BRAD 8c BERNE|TA N(]RR|S 17226 FOOTHILL AVE EAGLE R|VER, AR 99577 FC 153 14.6 DCO 22.0 21.7 RECORD DRAWING REVISED PER MOA COMMEN i�H 10/26/18 DRAWN I ACP —1 SITE PLAN WEJLLSFD42:5 BD / | |DECKSEPTIC TANK PER MOA CODEINSTALLED NEW 1250a SEPTIC TANKA W1 FC BEFORE AND DCO AFTER ^ ' EXISTING EEPAGE DRAIN FIELD ^ i � � D D 0 0 0 � o —` ~ OG, FO. " oo 428 4.0 TANK PROFILE SCALE: l^=1O' / ��/ /c-�_ PANNONE ENG SVC, LLC P.O. 8O% 102954 ANCH0KACE, AK 99510 PHONE (907) 272-8218 FAX (307) 272-8211 BEN|TO B3 Ll1 BRAD 8c BERNE|TA N(]RR|S 17226 FOOTHILL AVE EAGLE R|VER, AR 99577 PERMIT NO. She Municipality of Anchorage_ P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http:llwww.muni.org/Onsite On -Site Water and Wastewater Section PAPAPMWA IF I L wwlitlb Waiver#: OSVI81090 COSA#: Permit#: OSPI71374 PID#: 050-272-13 Legal Description: Benito Block 3 Lot 11 Applicant: Brad & Berneita Norris 911"I'MI Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 94.0 feet. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. a 0 0 K 9 a a a M a a M N a a a a 0 a a 0 a a a M a U a ff a 8 E N 2 a a a 0 a a a a a M a a a a a 0 a a a 0 N 9 9 a = a a a a a 2 a ff a a 5 N a a a a a 9 a I Waiver is Granted: X Waiver is not Granted: Date: Approved by: aytg Name of Reviewer 1 11 1111, oll jrij� 1 11-414, : MUNICIPALITY OF ANCHORAGE I) On-Site Water&Wastewater Program r r PO Box 196650 4700 Elmore Road ... Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 httpl/www.muni.org/onsite • tela I)c•p:irtntc nt 4"vcHo_q AGE On-Site Wastewater Disposal System Permit Permit Number: OSP171374 Effective Date: 12/22/2017 Work Type: SepticTank Upgrade Expiration Date: 12/22/2018 Tax Code Number: 05027213000 Z12-2-/ Site Legal Address: BENITO BLK 3 LT 11 G:0052 Site Mailing Address: 17226 FOOTHILL AVE, Eagle River Owner: NORRIS BRAD & BERNEITA& Lot Size in Sq Ft: 15651 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field II Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: A double cleanout is required downstream the septic tank. Received By: /4/ �� ' � ,, Date: / 27.-//'-'7 Issued By: 0 H2O,PA • .1 - Date: 2/2Q/! - \n( ---/ \► 1 MUNICIPALITY OF ANCHORAGE C• 1 Community Development Department ,ii Phone: 907- • 67e04 70-Development Services Division Fax: 90 s ' •97 �7 On-Site Water & Wastewater Program ,v -.777-- ON-SITE SEWER/WELL PERMIT APPLICATION a DEC 2 ! 2017 A ` A nI• v yam ,., Parcel I.D. 050-272-13 /, C�_�"c`. 6 Property owner(s) Brad & Berneita Norris Day phone Mailing address 17226 Foothill Ave. Eagle River, AK 99577 Site address 17226 Foothill Ave. Legal description (Sub'd., Block & Lot) Benito Block 3 Lot 11 Legal description (Township, Range & Section) Lot Size 15,651 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) U (w/wo ADU) Septic Tank ❑X Upgrade ❑x Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well I 1 Water Storage n THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. _ ___ ' yx2_____. ______ _, (Signature of property owner or authorized agent) Permit/Rush Fees: ais- Waiver Fees: Date of Payment: /9-/ .•°11 Date of Payment: Receipt Number: n OT3� Receipt Number: Permit No. l3SPri'l3 Waiver No. Permit App_ - • .:..c Pannone Engineering Services ac Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com December 21, 2017 Subject: Benito Block 3 Lot 11- EMERGENCY Tank Replace Pern:ilti Design Narrative This is a design narrative for a permit to install an upgrade 1,250g Septic Tank to replace an existing 1,000g Septic tank to be issued for this property. The existing tank has completely collapsed. It will be decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement 1,250g septic tank that will be connected to the existing drain field. The existing tank is located approximately 94' from the well. This tank exceeded the separation distances required at the time of its installation. The proposed tank will be placed in the same location, meeting or exceeding the existing separation distances. All other required separation distances will be met. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5'+ from any property line, building foundation or drain field 10'+ from any water line 100'+ from any surface water 100'+ from any surrounding private wells 200'+ from any public wells The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, .•' OF q.. . 49 . •II I j tt��: I i � : i : Steven R.Pannone 2/f,/ V8149 c-3.. .7 III........ Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~--~'J"/~"J"C. o"~ord~J~ ~oc;'~k;'~ SEPTIC ABSORPTION Aadress I ER 0 M~'~"'"'""'~ TANK FIELD WELL PBone(s) ' ' 'lPerm,t.o', ' .o.~'S~ro,~j ) WELL / OO I ~N~O FOUNDATION Township, Range, Section JO ~/~ ~; '~~ 5~0 ~ ~ driveway, water bodies, etc.)AS'BUILT DIAGRAM (Show location of welt, septic system, prope.y lines, foundation, TANKS ; ~ ~'~ N ~ SEPTIC ~ HOLDING ' / ' Capacity in gallons [' I . . I Manufacture~ MateriaJ~ ~ No. of Continents e TYPE OF SYSTEJ [TRENCH g BED g W, D~AIN g OTHER Depth to pipe botto~ from Total depth trom original grade °riginal grade ~ FT ~n5 FT Fill added above original grade Gravel depth b pipe Gravel length Gravet width -- # ~ ~ FT ~, ~ FT Total absorption~ ~ area~ ~ SO FT Distance betwee~l~,e~ FT Installer e ~. 0~ Date Installed ~ PRIVATE ~ OTHERlldentifv) Ct ~,~"'" ~'ll" Installer Date Installed: " u i " / REMARKS: I S & $ ENGINEERING I J ce~lfy that lhis. inspe~ion was pedormed according to · Onl~lp h ate ';"' Health Depa.ment Approval: ~ D~te: 72-013 (3/85) ,:rl:.r, Anchor'a.ge~ Alaska 99501 ..... 4...,- 0 N .... S .1; 'T' E S E W E R F'er'm:i.t NLtmber'~ 890127 Upgr'ad~ Date Issued: 07118/89 Engineer- De?:~igned P E R M I T Owner' Name:: ES'I"ATE OF DOROTHY DOUTHIT Owne. r Addr'ess.. F:'. 0. BCIX 77()4T7 EAGI...E RIVER, Al< 99577 Day Phone: 694 .-.. 3 '7 88 Parcel Id.". 050-2'72-:1.:5 I.,..ot L. egal: Subd:i. vis:i, on: B£NITO~ L°t! 11 Sec:tion~ 12 Township: 1.4. N Range: Lo'L Size 15'718 (sq.t't,,, or acres) Max Bedr'ooms: 'Th:i.s I::'et-m:i,t: 2 'Total Capacity: !:.:)EI:::"T'IC: "I"ANK: tvlinimum total, sept:i.c tank capac:Lty: 1,000 gal:l, or~s, liFac:h sept:Lc tank mused'., have at leas't.. 2. compaPtmerl'Ls,, Depth t.o top of septic 'kanl.::(s) < Zl.,,O (eet r'e,,qu:i.r'es insula'Lion over' tank(s). I:::'IE:IqlM I T E X I'.::' :1: RE!:E~ .OE[',I:ZMBER ::!!', :1. ~, 1989. I:::. N (::~ .I. NE.I::.I,~ ~ ......... ~ ............ ' t,,)F'~ MU,::~ I VET, RIFry .l.I I I I:.GR'.E'T'Y OF:' EXIS'T'ING SEP'T'I[; I'I'ANK ..... ' :[NSTAL..L NEW :1.000 GAI...L..ON TANK. Iqo"r'IFY DI...IHS 01:::' INSFZ'IEC;TIC)IqS AT 343-4'744 OR 343.-3681. 1. I am f'amil.~.ar' with 'Lhe r'equiPemen'k~ for' on.....s:i, te seweps and wel].~ as set ~'or. th by 'Lhe Municipality of Anchor'age (MOA) and the State o[ Alaska. 2.. I will install t. he system in acc:ordance with ail MC:)A c:odes and r'egulatior~s, and in compliance with the design Cl-i'Ler'ia o{' this per, mit. 3. I w:i. 1]. a(::thepe to all MOA and State of Alaska r'equir, ements t'~r the set back dis'Lances fr'om any exist:i, ng Nell, wastewat, eP disposal system or public sewepage system ~J.,s oP any adjacent, oP r~eal"by ].o'L. 4, I Llrld e r's'kal"ld t..~ tl"li~ per. mit is valid he capacity of the 'Lot. al system is .... beclPoo~s and also und~)r's'l:~d that ~ .... (Owner) ~~:' DOROl"HY DOUI"HIT SCALE 2~oi o~ Munlclpallly of Anchorage :,,,,L~?.~.r.*° e~~'~!~-' :' ~.4u'~. -"~ '~ , 825 "L" Street, Anchorage, Alaska 99502-0650 ~* **~;~..~Z~;~--'" SOILS LOG -- PERCOLATION TEST ~~~ LEGAL DESCRIPTION: ~[ ~ ~ ~ Township, Range, Section:~~ Ct~'~.l~ SLOPE SIT~ PLAN 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth to Waler Alter ~-I~ ' ~:~ Monitoring? ~ Date: Reading Date Gross Net Depth to Nat Time Time Water Drop TEST RUN BETWEEN~ AND 7 FT COMMENTS ..... u,..,4 t~. 204 ~ Z/ A7034 Eagte PERFORMED ~: ..... ACCORDANCE WITH ALL STATE AND MUNICIPAL ~UIDELi~FFECT ON THIS DATE, 72-008 (~ev. PERCOLATION RATE \~ (minutes/inch) PERC HOLE DIAMETER CERTIFY THAT T~JS TES/T WAS PERFORMED iN DATE: ~//~'/q~"Y GD-C~TER ANCHORAGE AREA BORO~'~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N°. 815 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM ATERIAL COMPARTMENTS LIQUID LIQUID CAPACITY /~.3~:>~ GALLONS. INSIDE LE INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH / ~ LENGTH ~'~) , DEPTH ~ ., LININO MATERIAL ~z~'~((~)/'~'~ ('// ~' 9 . DISTANCE FROM WE re~)"///"~, BUILDING FOUNDATION . NEAREST LOT LINE o TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATIOJ~--'--~'~ , NEAREST LOT LINE NUMBER OF.j.j~~ /~ DISTANCE BETWEEN LINES WIDTH ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH OF LINES DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TYP/('//~/f~''~-E''-~/ ~-- '~"~/ , DEPTH~ ~ "/) DISTANCE FROM WATER , BUILDING FOUNDATION. SAMPLE NEAREST SEPTIC SEEPAGE LOT LINE SEWER LINE , TANK SYSTEM , CESSPOOL , NEAREST OTHER , SOURCES~ DISTANCES: 7,' DIAGRAM OF SYSTEM DATE HEALTH AUTHORITY GrEA'rEr ANCHORAGE Area BOrudgh DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 995102 · TELEPHONE 279-8686 PERMIT NO, ~ SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT LEGALDESCR,PTION ~'"r'F// /~ ,~' '~.~' INSTALLATION OF: SEPTIC TANK X FINANCED THROUGH SOIL TEST RESUltS ~/~P~/; * I I COMPLETION DATE ANTICIPATED NOT VALID WITHOUT SOIL 1'E$1' FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPtiC tank SiZE /~ TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK~r~ FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WAL[ , SEEPAGE PIT SEPTIC TANK ,.~l TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, ~-- , SEEPAGE Pit TO RIVER, LAKE, STREAM. DRAIN FIELD ., DRAIN FIELD SEEPAGE PIT /Od ALSO CONSIDER AREA WELLS. SEEPAGE PIT ., DRAIN FIELD CAST ll~n~i ,,~ A~D OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 PEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGI~ ,PIT FITTED WITH AIRTIGHT REMOVABLE CAPSk GRAVEL BACKFILL CONFORM TO BOROUgh REGULATIONS REGARDING INSTALLATION. HEALTH AUTHORITY 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 D E S C R I ,~'t't'~SYSTEM Is IN ACCORDANCE WITH sAID cODE° BAT APPLICANT'S SIGNATURE GRFATER ANCHORAGE AREA BOROUGH DEP/~ 'ENT OF ENVIRONMENTAL QUAL~ 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE # Performed For ~..j~ 'k/u/,~,~a5 c~,,~,.i,~,~' Date Performed ~ z5- 7/ Legal Description: Lot ii 'Sub[liVi~ion This Form Reports Soils-E'6-g .?d ..... Percolation Test Depth Feet Soil Characterist. ics 5 6~ 7~ 8 C4'W Was Ground Water Encountered?~ If Yes, At What Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop 'Percolation Rate M4 ~,,+~ ..... N Proposed Instailation." Seepage Pit.~ Drain Field Depth Of Inlet Depth To Bottom Of Pit Or Trench COMMENTS: ~5 Ft'/heJro.~ -- Test Performed By_ :_~-//.. ~-'~. / //7 Certified B~: Date: MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) LOT 11, BLOCK 5, Be~ito Subdivision Location (address or directions) 17226 Foot/'~lZ Drive_ (b) Property owner contact Carol Do~thit Mailing Address Business (c) Lending Institution n/~ Telephone Mailing AddreSs (d) Real Estate Company and Agent' Address Telephone (e) Mail the HAA to the following address: (or check here I~, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 ~_-_~le River Loop Read No~ ,).___1~_ Eagle River, Alaska ~57Z. TYPE OF RESIDENCE Number of bedrooms Single-FamilyX[~ WATER SUPPLY Individual Well ~X Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site,~X Public [] Community [] Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 · >po~ s,Jaau!Bua leUO!SSajoJd aql u! 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(SHHC]) seo!^JaS uewnH pue q~leeH lo luacu~JedaQ e6eJoqou¥ lo ~l!led!o!Unl/N eq.L e~eQ I~UO!l!puoO leAoJdd¥ leUOp,!puoo ~o swJa/ paAoJddes!cI ~ pa^oJddv /~q SLUOOJpa~JOJ peAoJddv 'lVAOtiddV SHHa '9 euoqdale&- wJ!..-I ,to eWeN 'uop, oedsu! s!q), to e),ep eq), uo ),oet~a u! suoReln6eJ pu~ 'saou~u!pJo 'sapoo e),~IS pue led!o!unR lie ql!M aoue!ldtuoo u{ s! wals~s lesods!p JaleMm, SeM Jo/pu~ Xlddns JeleM mjs-uo eq~, 'uoRoedsu{ pue uoRe§!lSe^U! ,~uJ uJoJ~ pue SelY aS~Joqou¥ ;o ~),!l~d!o!unlAI eq), uJoJ; peumlqo uop, muJolu! aq), uo peseq ),eLi], ~,t!JeA JeLl),~nl I 'u!e~eq pal~o!pu! eJnlonJls to edX), pu~ swooJpeq ;o Jeqwnu eq), Jo,t e),~nbepe pue 'ales s! LUa),SXS I~sods!p Ja),~Me~SeM JO/pUe ~lddns Je~eM el!s-uo aq), leq~ SMOqS le^OJdd¥ X),POLI~n¥ qll~eH s!q), lo uo!),e§!lsaAu! Xw ),eq), ~liJeA I 'MOlaq UMOqS a),ep UO!:~epII~A eq), ~o s~ pue o~aJeq paxwe leas ~w ~q pe{l}~Jeo sV NOIlVlNI:IOdNI aNY V-Va 'HOI:IV=IS :1'114 '$/S~1/'$NOI&O=IdSNI ONlalAOIdd INI::II-i ONIId=I=INIIDN:I 'g //~'~O~,~;~:L~IICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: ~ Well Classification .~.,~'~l~ ~'~'¢n'~)~ Well Log Present (Y/N) Total Depth OK' Cased to Static Water Level ~/~ ' If A, B, C. D.E.C. Approved (Y/N) ~J Date Completed ~h~ Iq':H ~r/~/'7;;Z Yield z~o~l' Depth of Grouting Casing Height Above Ground /,~ Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on LOt To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Al ; On Adjoining Lots / coco / ~ 'f ; On Adjoining Lots / ~o To Nearest Public Sewer Cleanout/Manhole ! Water Sample Collected by .._~'~ ,~ ~__~4~,/'0¢__..~¢',r0~ ~ /~ ~.)uM~.'.~________? Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Installed ,~.'~.,, I~'~l Size Standpipes (Y/N) Y Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) td/l~ / OOOf~ I No. of Compartments ,;2_ Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) /~ Date Last Pumped / ~- ,-_}~ ~/~ ;for Id~IA Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation ~' '~- ! To Disposal Field .¢~ ~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed _%O ~,~1~ ~ . Width of Field ,:~-, ~'-; Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field / / Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well / (20 To Building Foundation [ ~ Lot / 0/+ / To Water Main/Service Line [ (9 7c To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course / OO _/L TO Driveway, Parking Area, or Vehicle Storage Area To Property Line / o ~-~ To Existing or Abandoned System on ; On Adjoining Lots .._& 0 / '/- Comments D. LIFT STATION Date Installed %,, Dimensions Size in Gallons 'XX,. ~/ /n ManhOle/AcCess (Y/N) "Pump On" Level at ~L~/~ "Pump Off" Level at , High Water Alarm Level at ~ Vent (Y/N) Tested for '~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed;to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. S & S ENGINEERING 17034 Eagle Ri~er Loop Road No. 204 ~atp~ ~"'" ~"--~ ...... Receipt No. c:~/Z/¢ ~?~~ Date of Payment 0~-/7/--OE~ Amour, t: $ /? ¢- 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ANALYSIS REPORT EY SAMPLE for Work Order # 14169 Date Report Printed: JUN 20 89 @ 16:40 Client Sample ID:Lll, B3 BENITO PWSID :UA Collected 3UN 19 89 @ 10:20 hzs. Received 3UN 19 89 ~ 14:00 hrs. Preserved with :AS REQUIRED Client Name : S & S ENGR Client Acct : SNSENGP P.O.# NONE REC'D Req # Ordered By : Analysis Completed :JUN 19 89 Laboratory Supg~v~sqr &STEPHEN C. EDE Released By : ~ <~.'~/~ Send Reports to: 1)S ~ S ENGR 2) Special Instruct: Chemlab Ref #: 5825 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 0.75 mg/1 EPA 353.2 iO Sample ROUTINE SAMPLE. Remarks: SABLE COLLECTED BY RJS. I Tests Performed * See Special Instructions Above UA-Unavailable ND- None Detected ** See Sample Remrks Above NA- Not Analyzed LT-Less Than, GT-Greater Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street i Anchorage, Alask~ 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D.# /~ PRIVATE WATER SYSTEM Name Phone No. ~ S ENGINEERING City State Mo. Day Year SAMPLE TYPE: i~ Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose Zip Code [] Treated Water [] Untreated Water SAMPLE NO. I 31 I 41 I TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: e~atisfactory [] 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 ~-/~P"ff~' Time Received /~0-~ Analytical Method: Membrane Filter * No. of colonies/100 mi. Time Collected Lab Ref. No. Result* Analyst Collected .~ I i-1-1 I I ~ [ I ~ READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter: Direct Count .Coliform/100 mi Verification: LTB BGB Final Membrane Filter Results' Reported By ,~.~,~---~~,~..~..,_ Date Time: TNTC = Too Numberous To Count OB -- Other Bacteria Coliform/100 mi /',~'~C.~ a.m. PART ! OF 2 REMAitIDER TO FOLLOW J~ne 7, I971 Faders! Housing Administration Box 480 Anchorage, A)aska 99502 5ewer Facility and Wstar SupplV for Lot 11, Block 3, Bonito aubdivisiono Harold L. Carlos, owner. Public sewers are not available to the sub}act lot so that sewage disposal must be by septic tank - soil absorption system. Soil tests fro~ lots adjacent to the subject lot show acceptable conditions for on-site sewage disposal sn~ it is probable that an approved sewage dispossI system can be tnstalle~ on the sub~ect lo~. O~r files indicate wells on near~y lots to ran(la in depth from BO' to 110' deep. Sincerely, John R. Lee, R.S. Sanitarian cc~ a~. Harold L. Carlos ky FH~ ~ ~'m~,~7.~ U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Form Approved Rev. Jult '958 FEDERAL HOUSING ADMINISTRATION Budget Bureau No, 63-R0296 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--tO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. MORTO*GO" O" SPONSO" PROPE"TY ADDRESS ......................... TOTAL NUMBER: Can ~c or o~er a~a be made into BASEMENT ~ New instaJJation additional b~oms? ............. (lf Yes, how Wl~l SUPPLY BY: J SYSTEM DESIGNED FOR ~ ~blic system ~ Ommunity system ~ Individual I ~ Yes ~ No HEALTH DEPARTMENT INSPE~OR'S SKETCH 4 ~ ..... ~ H , .... ~ ...... ~-~ ~-~ .......... ~ ....... ~-..~ ........ ~- ~ ~ ~ ..... ...... ..... ............. -- 'x: C- It is ~he opinion ~ S~te ~ Coun~~ ~ Local Dep~rtment of He~]th ~ha~ th~s individual water-supply system is ~ is not satishctory a~ a domestic water supply for the subject propers. It i, the opinion of the ~ State ~ County ~ Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: ~Can expected to satishctorily, ~ expected to satishctorily function and Onnot be function is not likely to create an insanita~ condition [SIGNATURE J T,TLE NOTE: The health authori~ should complete the appropriate opinion statement above and affix date, signature and title in the spaces provided. Use of the above grid for Health Department Inspector's sketch as well as use of the back of this form Is at the option of the heal~ authority. PART III.~FOR USE OF FHA OFFICE TO THE CHIEF UN~RWRITER: I have r~iewed the foregoing and the pe~inent FHA Compliance Ins~ion Repo~, and recommend that the Individual water-supply system ~ considered ~ Acceptable ~ Not Accepmble ~wage dis~sal ~ considered ~ Acceptable ~ Not Acceptable. DATE ~ SIGNATURE CHIEF ARCHITECT D~PUTY FOR CHIEF ARCHITECT HIALTH AUTHORITY APPROVAL INDIVIDUAL WATIR SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2S73 Rev. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. Septic Tank: Distance from well feet. Material Total liquid capacity, Inside length, __fret. Inside width, Distance from: Well, feet; fi~undation,__ Inside diameter, feet. Depth, SICONDARY TREATMENT consists of [] Tile disposal field gallons. Capacity inlet compartment, f~et. Liquid depth, [] Cesspool. Number o( compartments feet. feet; nearest lot line at [] front, [] side, [] rear. feet. Liquid capacity, gallons. Lining material [] Seepage pits. Other Depth of filter material over tile gallons. Tile Disposal Field: Distance from: Well Total length of tile lines,.__ Trench width Length of each line Type of filter material: [] Gravel. Depth of filter material beneath tile~, Seepage Pits: Number of pits .... Outside diameter, feet. Distance fr.m: Well, feet; building foundation, Inspection mada by: [] State. feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, .__feet. Number of lines Distance between lines inches, Total effective absorption area in bottom of trenches feet. Depth. top of tile to finish grade, [] Broken stone. Other inches. square feet. inches. inches. Depth, feet. Lining material feet; nearest lot line at [] front, [] side, [] rear, . [] County. [] Local Health Authority. Inspected by 19__ (TITLE) Date of inspection. REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main, __ --feet. Size of main, inches. Individual wells [] are [] are not customary in neighbgrhood. Give most recent record of failure of wells in immediate wcinity to furnish adequate supply of water Properties in neighhorhot)d [] are [] are not being developed with both individual water-supply and sewage.disposal systems. Lot size: feet wide ..... feet deep. Dwelling set back from front property line,, feet. Individual water supply from: [] Drilled well. [] Driven well. [] Dug well. [] Bored well. Distance of well from: Building foundation cast iron sewer,. seepage pit, Well construction: feet; tile sewer, feet; cesspool, .feet; nearest lot line at [] front, ['-I side, [] rear,. f~et; septic tank,_ feet; disposal field, feet; other sources of possible pollution, feet. Diameter, .inches. Total depth, feet. Type of casing, Approximate depth to pumping level of water in well. feet. Approximate yield, Sealed watertight to depth of feet. Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill. Well cover: [] Concrete, ['-] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No. Pum~: [] Shallow well. [] Deep well. Length of drop pipe, feet. Pump capacity, Located in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground. [] Pump pit. Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. [] No. Tyl~' of storage: [] Pressure. [] Gravity. Capacity, gallons. Has bacteriological examination of water been made? [] Yes. [] No. If answer is "yes," give date Quahty of water [] is [] is not satisfactory for human consumption. Installation {-] does [] does not comply with approved exhibits, if any. Inspection made by: [] State, [] County. [] Lot'al Health Authority. Inspected by Date of inspection 19 Depth of casing, .gallons per minute. gallons per minute. (TITLE) feet; feet, GPO 889-088 GREATER ANCHORAGE AREA BOROUG, DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 ~ DATE RECEIVED:. INSPECT: TIME: APPROVAL ADDRESS: PHONE: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES FOR REQUESTED B~~.~ LEGAL DESCRIPTION: TYPE FACILITY NUMBER OF BEDROOMS: WELL DATA: B. DEPTH~~ C. D. PROPERTY OWNER: ~'~ · PHONE: TO BE INSPECTED; '~'~/,~~TREET: SEWAGE A. DISPOSAL SEPTIC TANK 1. 2. 3. 4. s z z E CONSTRUCTION BACTERIAL ANALYS'I$ SYSTEM:. (IF HOMEMADE, SHOW DIAGRAM ON BACK) SIZE..~_~_~ MANUFACTURER~ INSTALLER APPROVAL REQUEST FOR SEWER & WATER FACILITI~ PAGE TWO SEEPAGE PIT s zE IS'"' C. DISPOSAL'T~ELD 1. NUMBER INES LEN 2. TOTAL 0~~ REQUIRED MEASUREMENTS A. WELL TO SEPTIC TANK B. WELL TO SEEPAGE PIT C. WELL TO SEWER LINE D. WELL TO PROPERTY LINE E. WELL TO OTHER POSSIBLE CONTAMINATION F. FOUNDATION TO SEPTIC TANK / G. FOUNDATION TO SEEPAGE PIT H. SEEPAGE PIT TO PROPERTY COMMENTS: A P P ROVE D,~'~~ ~/, ~~,m~ D I S AP PROVED: APPROVAL VALID FOR ONE YEAR FRoM DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY