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HomeMy WebLinkAboutT12N R3W SEC 15 LT 113 Tom Fink, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 May 12, 1994 Gene B & Jacque~Line Lettis 4910 East 101st Avenue Anchorage, Alaska 99516 6307 Subject: T12N R3W Section 15 Lot 113 Permit ttSW930093, PID #015=484-07 The subject permit, issued May 12, 1993 by this office for a single family well and/or on-site wastewater system, has expired as of May 12, 1994. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, this office for documentation close the permit. a well log must be sent to of the installation and to If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, 'the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. ~r~,z y tSinc ely, ~/~ ~ Robert W. Robinson Acting Program Manager On-site Services Copy of Permit cc: Steven Pannone, P.E. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-66!50 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930093 DATE ISSUED: 5/12/93 ENGiNEER:U~KH--RRCq4~T-E~pS~-EN~E~-Rg~~ EXPIRATION DATE: 5/12/94 DESIGN OWNER NAME:LETTS JACQUELINE KAY OWNER ADDRESS:4910 101ST AVE ANCHORAGE, ALASKA 99516 PARCEL ID:01548407 LEGAL DESCRIPTION: T12N R3W SEC 15 LT 113 LOT SIZE: 46200 (SQ. FT.) NUMBER OF BEDROOMS: 6 THIS PERMIT: 6 THIS PERMIT IS FOR THE CONTRHCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQU·[REMEN S 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343--4329 OR 343-4681 AFTER BUSINESS HOURS 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: 1. ORIGINAL SYSTEM BASED ON OLD SOIL TEST. ENGINEER MUST VERIFY PERCOLATION TEST DURING INSTALLATION. 2. NEW PORTION OF SYSTEM DESIGNED FOR 6 BEDROOMS BUT WILL BE CONNECTED TO EXISTING 3 BEDROOM SYSTEM. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 3. INSTALL DOUBLE CLEA,3~O~,UTS AFTER SEPTIC TANK. RECEIVED BY: ~..~-~3%°<J- c~ DATE: DATE'. PAGE 2 OF 2 April 26, 1992 Department of Health and Human Services Anchorage, Alasks Re: Onsite Sewer system design for the Gene Letts residence Lot 113, Section 15 Township12 N Range 3W Dear DHHS, This is $ request for an onsite sewer permit for a existing residence located at the above address. The owner is adding on to his house and needs the septic system upgraded. Due to the good soils, a whole new system will be added and the ()Ed system abandoned. The new system is designed as a six bedroorn system, therefore the existing tank will be reused (pending inspection) and a new tank will be added to get the required capacity. No impacts to the surrounding properties are foreseen. All have onsite systems already and appear to be performing adequately. The required set-backs and reserve areas are easily obtained due to the large lot size and good soils. No problems with any of the surrounding systems have occurred. The topography of the area is approx, flat with the ground just outside the lot area sloping appro)(. 30% on the West and North sides. The lot footprint is rectangular shaped~ in the North-South direction. The general area has excellent soils (thick sand layers} therefore the drainage above and below ground is good. Sincerely Steven R. Pannone P.E. PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3- 4- 5- 6- 7 8 9- 10- 11 13- 14- 15- 16- 18- 19- 20- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG --, PERCOLATION TEST ( DATE PERFC /..~.~L [[~ ~,,/5- T"I Z..N (~.5~Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? /~ O S L IF YES, ATWHAT O DEPTH? p E Deplh to Walet AII, r ./ SITE PLAN I 11'''' Gross Net Dopth to Net Reading Date Time Time Water Drop ~'11¢¢~ ~lr..-~-,,*~. - ~'~.n;~ ~-.~'.._. n ~ PERCOLATION RATE ~' (m~nutes,mch) PERC HOLE DIAMETER TEST RUN BETWEEN ,~'-:,C)_ FT AND ~ ~'' FT PERFORMED BY: ~~&ff~Ud I ~'¢~'~ ~e-* .... ~ . CER~IFYTHATTHISTESTWASPERFORMEDIN ACCORDANCE WI~H ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: ~ ¢ ~ ¢ ~ 72 008 IRev. 4~85) IOl 5%, hi ,,. 0 ~o ~I~,'![ERS - PLANNERS - SURV, ]RS 1610 DIMOND DRIVE ANCHORAGE~ ALAS~4A c~t~507 SOILS LOG -- PERCOLATION TRST PERC~.JLATION TEST LEGAL DESCRIPTION: 1 2 3 4 7 8 O 10 11 12 13 14 18- 18- 20 SLOPE S~TE PLAN ENCOUNTERED? .... tF YES, AT WHAT [.NVtRONMEN1ALENGIN£{H~NG ON SITE S[WAO~ DI~(3SAL SYSTEM AND/OR WELL IN~ECTION REPORT D~?A~Cf ~0 OTHER RATING INSTALLER REMARKg ;.....~.......... ....... ,...~ LEGAL l'f, Rr,l.I (."1 blt Ill .' VAI lit', r I lmxl'w2oo .................... CElT*FI This do~um ............ ~c)~' bt ti~"'~ orruP. ' ......... ~O~pJl~O0' ~ , ~El~OOg rooU ON-;-iSITE PERMIT N0~ -' DATE ISSUED: ,..: RPPLICRNI':~ i, ,I ii' ADDRESS:. '~' CONTACT PHONE "~ LEORL DESCRIP: ~Ei.-IEZt~ 047047~ OLENW S & JEF:ItlIE CRLE¥ SRFt BOX l?4OC 10200 OUR ROAD ANCHORAGE, AK 99507 346-1874 & IqELL LOT ~IZE; LOT LOCRTION: MRX BEDROOMS: F' E R I~l I 'r GRAVEL DEPTH (Fl'. > ?. 0 0, TOTAL DEPTH (PT,) ii. 0 4. ~RRVEL WIDTH (Fl', > 2. 5 17. 'GRAVEL'LENGTH (PT,) 27. 0 34. GRAVEL VOLUHE (Cfi YD~. ) ' 18. 7 21. TANK SIZE (GALS) , ' l~ 0~0. 0 ** l, 000. SOIL RATING <$Q. FT, /DR> t25 125 LISTED BELOW ARE THE OPTIOHS R',,,'FtILAE:LE TO YOU IN DESIGNING VOUR SEPTIC StCSTEt'I. CHOOSE THE OPTION THAT BEST FITS YOUR ~ITE. Tr~Et-,IC H 19ED N. DER DEPTH TO PIPE BOTTOM (FT. > 4. 0 4. 0 4, e 7. 4i. :30. i, 000. 12=j ** TANK MUST HAVE RT LEAST TWO COPIF'RRTMENTS · i' 'I CERT:IFV TFIRT: l, !'AM FAMILIAR WITH THE REQUIREMENTS FOR ON-S~TE SEWERS RHI], WELLS RS SET FORTH B~,' THE ~IUNICIF'RLIT~ OF ANCHORAGE (FLOR) AND THE STATE OF ALASKA. 2. I W~LL INSTALL THE S'¢S, TEM IN ACCORDANCE WITH ALL NOR CODES AND REGULATIONS, '~RND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3, I 14I[.L FIDHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE ~ET BACK D~STRNCES FROM ANY EXISTINO WELL, WRSTEI48TER DISPOSAL 5YS'rEM OR PUBLIC SEWERROE SN'STEH ON TI4IS OR FtNY ADJACENT OR NEARBY LOT, 4, I UNDERE;TRND THAT THIS FERtlI r IS VALID FOR R MRXINLIM OF 3 BEDROOHS AND RNV ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. ZF R.LIFT ST¢ITION IS INSTALLED IN RH RRER COVERED BM NOR BU[LD~NO COD~S~ THEH (l> AN E:LECTRICRL PERMIT At.iD INSPECTION HUST BE OBTRINE[u ~2> RS-BUILTS I,IIt. L NOT BE APPROVED WITHOUT AN ELECTRICAL ZHSPECTZON REPORT~ AND (3) THE ELECTRICAL WORK MUST Be: [.,OUF B',' ¢1 LICENSE[* ELECTPI¢.~RN -4 ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~ ~' ~'- -~-~/~L~-~----- Type of System Design -.. Date Installed ~1~_~; ~/_ c~_~. .................. Length of Field Width of Field - ~'" Square Feet o! Absorption Area Depression over Field (Y/N) ---~ Results of Last Adequacy Test . Separation Distance from Absorption Field. To Water-Supply Well .~(~.~" 3'0 Building Foundabon ~ 5' Lot -....~, To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, o;' Vehicle Storage Area Comments ~ ~l,,,Sj ~_~,__~t _ __ Depth of Field "~ ~° ~" o/~..~l, ~-. Gravel Bed Thmkness Standpipes Present (Y/N) - ~ Date ol Last Adequacy Test .--~t'--~ ._ TO Property Line __2,~'--~-- To Existing or Abandoned System on ; On Adjoining Lots -.:;~----~- ' ...... To Cutbank (if present) -~" D. LIF¥ STATION Date Installed Size In Galtons "Pump On" Level at High Water Alarm Level at Tetaed for Electrical Co, es (Y/N) Dimensions Manhole/Access (Y/N) -. ~-- ~ "Pump Off" Level at ........ Ve~t {Y/Iq) ..... Pumping Cycles during Adequacy Test. Meets MOA Commenta '° Check Permitted Bedroom Ratm(J Against ! fAA Re~luest ** I certify that I have checked, ve~'dmd, or conformed to afl MOA end HAA gu~dehnes in ell°ct on the date of this Palp! 2 Of ? DEP[, OF H~A. LIH & 2 1 RECEIVED A, WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 19~4 2~1,-4720 Well Ciassdicahon .__~_~i~*Y_~_~_ ............... If A, B, C, r)EC. Approved (Y/N) Well Log Pre~nt (Y/N) _._~ ..... Dale Completed _~~ Yield _..~ ~ ..~P~ .~P~ TotAl Deptt~ .__~ .... Ca~ to _.. ~.~_~. Depth of Grouting _~,~... Slahc Waiur L~el ~_~__. Pump ~t At ~. Casing Hmght A~ve Ground .... [ ~ ~ ~mtary Seal on Casing (Y/N) El~tricml Wiring in Condu~t fY, N) ..... ~_ ........... Depress,on Around Wellhead (Y/N) .~ ~)paration Distances from Well To ~ptic/Holdmo Tank on Lot .... ~(.~ /' ; On Adioinlng Lots ~~ .......... To Nearer Edge of Absorption Fmid on Lot __~_~) ~ ~-; On Adjmning Lots To Nearest Public Se~r Lme ._~_~ · . _~_ To Nearest Public Sewm Cleanou~Manhole ._~ ~ To Nearest ~wer ~ice Line on Lot .~_ .... Water ~ample Collected by -~ ~' ; Date .... ~/~ /~' '~ . -- ~mments ...... B. {;EI:~ICIHOLDIN~, TA[~,IK DATA Date Installed..lj,/_.~j'~___ size ..~C[~'afl - No. of Compa.ment8 ~- StaHdpl~ (Y/N) .:. ~ ..... Atr-h~ht.Cnps (Y/N) ~ Foundation Cleanout (Y/N) ~ ~ Depression over Tank (~N) ~-~-~' Date Last Pumped _~, ~ : - Pumping/Maintenance Contract on File (Y/N) ~ ...... ~ ; for ........ Holdtng Tank High-Water Alarm (Y/N) ~~ Temporary Holding Tank Permit (Y/N) L~ ~paralton Distances from ~ptic/Holdtng Tank: To Water-.qupply Well To Property Line To Water Mein/,gervlce Line Course To Building Foundation ~O ~ ~~ To DIspotla{ Field ..... ~,,,r. .... To Stream, Pond. Lake, or Major Drainage Pegp 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TE.'.STS, FILE SEARCH, DATA AND INFORMATION As Cerhfied by my seal affixed herolo .~nd as of the vahdat~on date shown below. I verify Ihaf my mvesbgatlon of th~s ~[th Authorlly Approval shows that the on-rote water supply end/or wastewater disposal system ;s ~e. funcb~l and ad~uate for the RumOr Of ~drooms and type el sh ucture intimated herein. I further verify that ba~d on t~ reformation ~ from the Municipalily el Anchorage hies and from my mvesbgation and trisection, the On-s~te wafer supply an(Eot wastewater disposal system ~s m comphance with all Municipal and State codes, ordinances, and r~u~ti~s in efl~ on the (late of this ins~tion. Name of Firm _~ ~,~c~!~;~ ~ Telepho~ _ ~,'1~ ' 13~'.5' ~ ndiflonel CAUTION The Munc:lp#ltty of Anchorag# Departmenl of Heatlh end Environmental Prot~ctiott (DHEP) MUNICIPALrl Y OF ANCHORAGE DEPARTME~4'! OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTI~-tCATE OF iNSPECTION FOR HI~ALTH AUTHORITY APPROVAL OF ON-SITE St'WElt AND WATER I'AC. ILI1Y 264-4720 Application Date GENERAL INFORMATION Letlal Description {in~lude lol, block, subdw~s~on, soctJon, town~hip, lango) ~ L~stion (addre~ or d~rectiom,) (b) App C ..... -~- ...... (C) Applicant is (check one). Lending Instdulion g , Owner/builder ~; Buyer ~; Other ~ (~xplaln); Lending Institution Address __~'relephono (e) Real Estate Company and Agent Address (f) Telephone Mail the HAA to the following addfe~.s: 2. T~PE OF RESIDENCE ~ngle. Famlly J~ Multi-Family ri Other .Numbar of Bedrooms. .v'~. ..... 3. WATI[R SUPPLY :. I,'~dlvidual Well ~ Community ['"J Public ri ' Note; If community well system, must have written confirmation from the State Department o; Environmental Conservation · attainting to the legality and status. 4. BEWAQE DI6POSAL Onelte J~ Public ri Community ri Holding Tank J~ ' Note'. If community well syalem, must h~ve written confirmation from the State Department of Environmental attainting to the legality and Page t el 2 NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & I:NVIRONMENTAL PROTECTION ENVIF~ONMEN'I'AL ENGINEERING DIVISIDN 825 L Street- Anchora§e, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ' P-Fie N E £ '3 '/6 ~]UPGRADE ~(enn MAILING ADDRESS LEGAL DESCRIPTION LOCATION I F ~OOMEMA Dr I-I I iside I~n.~gth Widt ~ Well IDwellin§ NO. OF BEDROOMS PERMIT Liquid depth PERMIT NO. DISTANCE TO: Manufacturer Material Liquid capacity in §aliens Nearest lot llne Well DISTANCE TO: f:oundation Total leah of lines Trench width ~ o~ inches PERMIT NO. Distance between lines No. of lines Top of tile to finish grade Material ben0ath tile Total effective absorption area ~'0 II ~¢ inch0s ~¢ ~ Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area W61l Building foundation DISTANCE TO: Class Depth [Driller Building foundation Sewer line DISTANCE TO: OTHER PiPE MATERIALS SOIL TEST RATING Nearest lot line Distance to lot line PERMIT NO. Septic tank Absorption area(s} v/e/e,/, DATE LEGAL E:,EF'FIF~:TlrlENT OF:' I.I:EI::II.."FH FIN[::, IEI',I',/]:I:~:EINI'IIEN.1"FIL PIq:O'I"ECTZON 825 L. :iiFIFI:;:IEE:.1'., I::INCHOF:FIGE., F:IK I,. ;[ .':S"FE:E:, liJ~E£1,,.Ol,I I::IF4:II:; "I'I'IE: I::I:F:'T:I:Cd'.I::E; I:::i',?IFI]:LI::I[I:',LE "FO '¢OU ;[hi DE:I::;]:EiN:[NG h"OUR 'JI:;E:PTZC ':S"75;.1'.1E1'1. CI'IOO5;E THE: OIF"I" I:: C)l",! 'l"Hl:a.1' E',[ECST F:' :[ 'I"~E; '¢OIJl:;?. 5; Z TE. FI.'S SET I:::OI:;I:TH 1:3'.r' '1'.1.1E HI.JI'-,I :I: C ;[ F:'FIL ]: T"? OF:' I::I:I"I:C:I:'IE[I:;.::FIGE (I"'tOIF[) FINE) THE STRTE O1::' FI:L.I::IS;I::::I::L ;:IF Z I.,.I)~L.L. ]:N':'2;-I:'FIL.L. 'FHIE 5;"r':il:;'l:.1EH :[h,I FI:C:COF?.I:)FINCIE I,.I]:TH I::I:L.L. MOFI E:ODE'.'S FIND I::II",[D ): H COI"IF'I... ]: IFINC[I:: I.,.I ]: TH THE [::,EE; ]: C'iN E:I:R Z TE;R :[ F:I OF:' TH 1' ~ F'EF'.M :[ T. .'i::. I:: 1.4]:I_.L. I:I[)HE~FI:E .1"O FII:..L. I'iOFI I::ll",lJ3, :S'IF[:'~TE l:3F FIL..IFt:~i;I':::FI F~'.ELT.!I:JZ[;?.Ei"I:[i~I"4T';-::; F'OI;~: THE SIE.1' E:FICI:'.:: E., :[ :I:i;TFii:.,ICt!~:E; I::-I;?.i::)l'1 F:I:N"r' I:i::i:':: ]: ~!;"1~ ]; IqG HII:.'L.L., I,I:FI'."STEI.qI::ITEI:~: B', ]: 'IF;F'OS;.,FIL '.I:?'r'5;TEM OIq: F'UI31.. :i: C Fi!;II::I.,.I[EI::;:I::~G[!i :ii;"r':!2;TEFI CIN TI"I:I:'.I:i; O1:?. F:I:Iq~T~ F:ID..'rI::IC[I::I'.,IT (::iF='. I",IEI::II:;;:E?'r' LCI.1". ]; UI"I:[:)[!i:I:;'.:B.1h31",II:) .1']IIF'IT 'Fl'l:[:~i; I::'lE:l:,d"l];T ]:'S '¢FI[.. ]: E:' I::'C_II:;?. I::1 I'dFI:X:[I'*IUM {:IF' ::~: B[E[::'F~:OOI:dS.; FIND FI:N"r' E;t%ILI::II:;~:GI!'"-"I'IE':I",FI" t.'.[I::L.L. I:;?.E(J:!U:[FI:E: I:::l[",i IFIDE)].'T:[OiqI::IL NEF_']RS - PLANNERS - SURV, ]RS 1610 DIMOND DRIVF ANCI'~ORAGE, ALAF3KA 99507 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3- 4- 6- 7 8 9- 10- 11 13- 14- 15- 16- 17- 18- 19- 20- SLOPE SITE PLAN / WAS GROUND WATER ~/n S ENCOUN'rERED? /V[z L O P E IF YES, AT WHAT DEPTH? Gross Net DepH1 to Net Reading Date Time Time .-. L-,. 4N ~ ~,-,~' t, Drop , : c '~ ,' ~:,~:...!~ '" """ /S~ ,::,~,;' PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT 72-008 (6/79) 0 (907) 243-2282 KEN JOHNSON GLENN Ci~LEY ( SR~t ttNCHOR~tGE, ALAbKA RE~ Lot ].13 Sect. 0 ft to 5 ft 5 ft to 10 ft ]0 :Ct to 12 ft 12 ft to 2]. ft 21 ft to 23 ft 23 ft to 31 ft 31 ft to 4-3 ft 43 ft dj 55 ft 55 ft to 62 ft 62 ft ~o 71 ft ?1 ft to75 ft ?~ ft 'to 82 ft 82 ft to 8~ ft 8~ ft to 90 ft 90 ft to 99 ft 99 ft to 116 ft 116 ft to t28 ft 128 ft to 1~9 ft 1~9 ft to 170 ft 170 ft to 185 ft 185 ft to 191 ft ~91 ft to 195 ft 195 ft to 201 ft 201 ft to 20~-6 201-6 to 211 ft 2].1 ft to 213 ft 2t3 ~t to218 ft 218 ft to 228 ~t 228 ft to 232 ft 232 ft to236 ft 236 ft to ~5 ft 2~5 ft to 252 ft 252 ft to 25~ ft 2~ ft to257 ft 257 ft to 258-6 258~6 to 260 ft KEN'S COMPANY WATER WELL DRILLING PUMP SALES & SERVICE 30 YEARS ALASKA DRILL. lNG 3163 LINDEN DRIVE ANCHORAGE, ALASKA 99502 Jeany ) 99507 ( 346-18?4 15 TN12 N R3W S~I WATER WELL LOG Fill Brown silt & fine gravel Silty sand & fine gray Si] ty sand Med, gray & gray silt Course grav& gray silt I~;led. gray & brn silt Brn silt & fine ~rav Brn silt & med gray Same with 2 ft open hole Course gray & brn silt Same with courser gray ( -tight ) IVied grav& sandy silt ( wet ) Course gray & it brn silt ( tight Cours gray & gray silt " JYJed gray & gray slt ( i~- open ) Cours grav& gray silt ( tight ) Courser grav Same with cobbles course ~rav & brn silt Cobbles ( conglomerate ) very [¥~ed gray & brn slt ( 2' open ) Course grav& brn slt Weeps Cours gray & cobbles..Brn Cours gray & brn sand ivied, brown sand Cobbles Weeps..small seams..tight,.3 ft. Dirty brown sand weeps.. ~led. sand & brown silt Med gray & brn silt..some cobbles ~ater bearing Med. & fine sand 9' Course grav& brn silt dry ~Teeps Clean Med~ Sand & gravel., tight.. 16 ft head Test bailed ].~ hours at 7 GP[v[ one ft drawdown., bottom stable.. Total casing 260-8~ tight slt.. dry.. head, o head.. very clean.. MUNICIPALI'IY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAl. HEALTH E;E,:]-I IFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWE_R AND WATEFt FACILITY 264-4720 GENEHAL INFORMATION (a) Application Cate Legal Descriptio~n (include lot, block, subdivision, section, township, range) Location (address or directions) (c) Applicant is (check ()ne): Lending Institution [];Owner/builder ~2.~; 13uyer [] ;Other [] (explain); (d) Lending Institution ......................... Address __ Telephone (e) Real Estate Company and Agent Address Telephone (f) 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 writton confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite I~ Public El 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 72025(11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA'fA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, J verify that my investigation of th~s Health Authority Approval shows that the on-site water supply and/or westewater disposal system is safe, funcbonal 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 tiles and from my investigation and inspection, Jhe on-site water supply and;or wastewater disposal system is in compliance with ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Appreved for-~-~'-L--bedrooms by Approved ..... ~ .... Disapproved Terms of Conditional Approval nditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based aolely 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 eourtesy 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 ia not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCttORAQ~ DEPT, OF HI:ALTH & ENVIRONMENTAL PROTECTION AU6 '1 5 RECEIVED MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: _ ~.,O~' /'13 A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth. ~'O Cased Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E,C, Approved (Y/N) Date Completed ,.~/1~ {¢~'~ Yield Depth of Grouting Pump Set At _ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N} ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ___~ ~,-2 ~ ~' ; On Adjoining Lots '~. loc ' To Nearest Public Sewer Line I~h/l- . To Nearest Public Sewer Claanout/Manhole ~!~/~ To Nearest Sewer Service Line on Lot N,/I . Water Sample Collected by Water Sample Test Results Comments [3, SEPTIC/HOLDING TANK DATA Date Installed ~ {~/'~ Standpipes (Y/N) t ___ Air-tight,Caps (Y/N) Depression over Tank (t~¢N) Pumping/Meintenance Contract on File (Y/N) ~J- Holding Tank High-Water Alarm (WN) ~¢/J', Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line .'~5'-~ ' To Water Main/Service Line ~(~, Course ~,,',,',,',,',,',,'~-- .~-'~ Foundation Cleanout (Y/N) Date Last Pumped N,A, ~ ; for __ Temporary Holding Tank Permit (Y/N) To Building Foundation '~.O ' To Disposal Field _ tO'" To Stream, Pond, Lake, or Major Dra nage Page 1 of 2 72-026(1~/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ///~/~y Width of Field ~ocr~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well I~' To Building Foundation ~ To Water Main/Service Line Nr~t¢, To Stream/Pond/Lake/or Major Drainage Course To Driveway. Parking Area, or Vehicle Storage Area Type of System Design Length of Field '~¢ ¢ "¢¢ Depth of Field ,x,x,x,x,x,x,x,x,x,~ Gravel Bed Thickness '? Standpipes Present (Y/N) Date of Last Adequacy Test _ I~/¢ .~. 'To e,~ ch To Property Line 5%'s To Existing or Abandoned System on ; On Adjoining Lots '~ ~¢~ ¢ To Cutbank (if present) i'k/,~. D. LIFT STATION Cf, ,/4-, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments Signed ~J-4¢~.~._ Company F¢~ ¢'~/~,~ Receipt No. Date of Payment Amount: $ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA g uidelines in effect on the date of this inspection. Page 2 of 2 72-O26 (11/84) Date: WATERWELL - TEST PUMP REPORT Well Information: Ttl. Depth ~2._Depth of Casing ~Screen From~ To Fiemarks ~ --~ Pump Information: Intake Depth 2~Pump Size ~//~ ~ Air Line Depth Drawdown ~ PumpOn: Time ~,~,¢ ~__Dat .e/.;~r_PumpOff: TIme/.~h _Data WATER PIEZO- FLOW W TIME LEVEL TUBE GPM REMARKS . REMARKS