HomeMy WebLinkAboutT12N R3W SEC 27 LT 3 S2
Municipality of Anchorage Page
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: ,5'WqL/O&~ PID Number:
Name.~_. Wastewater System: [] New .~ Upgrade
Address: ABSORPTION FIELD
~W~A~ ~ ~/~ a Deep Trench ~Shallow Trench D Bed 0 Mound ~ Other
Tota[ Depth from original grade:
LEGAL DESCRIPTION so[i Rating: /. ~ GPD/Sq. Ft.
Lot: ~c~;~ ~=,v~: Depth to pipe bosom from original grade: Gravel depth beneath pipe
Township;/~ ~~ Range: ~ ~T Section~ Fill added above original.~ ~grade:.~ Ft. Gravel ~ength: ~f Ft.
WELL: ~ New D Upgrade Gravelwidth: Numberoflines: Distancebe~eenlin~:
~Fb
~zv~ /2~ FL ~/~ F~. ~ Se.F~. ~ ~ ~V.C,
Yield: / U/~ / ~. TANK
SEPARATION DISTANCES ~s~pt,c ~ Holding ~ S:T.E.P.
From Tank F[e~d Station Tank Sewer Lines ~C~ ~
Wel~ ~ l~t _ ~+ Uatedak ~&~
su~c~ '~ ' ~ LIFT STATION
Water /~ ~ ~
Lot
Line /O - -
Foundation
Cu~ainDrain ~ . ~O~g ~( ~ ~del Electrical Inspections pedormed by:
Remarks: BENCH MARK
Assumed /~' ~ ~t,
Im ~'~ AL
S & S ENGINE~RIN~ ' ~: "'
17034 Eagla River Loop Road~ No. 2~ ,~' ~ ~,~;,~:..c~,,,,,~:.,,,~,~,' P
Inspections performed by: ~.,i~,,. ~,~k, ~,s~ Dates: 1st ~ -~2-~
man~r~ ,~ '¢~% .,..~'
Department of Hea Hu vices approval ~. ~' ......
Reviewed and approved by: , - Date: /~ '~~
72-013 (Rev. 9/91) MOA 25
Permit No~.w940337
2 2
Page of
Municipality of Anchorage
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
,. . .SOUTH 1/2, LOT $, SEC.27, T1ZN, R3W 01705120
Legal L~escnpuon PID No.:
75 O'
i COl C0~/FiNAL ~RADE'"'~.___.._~' ~
~ 94.3'
SEP~rlC TANK
WELL
GARAGE
NEW
STRUCTURES, EASEMENTS, OR ENCROACHMENTS
SHOWN ON TIllS SITE PLAN ARE AS SHOWN DN
AN AS-BUILT iSURVEY DRAWN~ BY:
JACK ~. GARRISON
IT IS THE RE~PONSIBILTIY OF THE CONTRACTOR
TO VERIFY Ek~SEM£NTS, REQU!RED SEPARATIOi$1
CONSTRUCTIOn. i
~'~-~ ?0.4'
........... .............. ......................................
!co~)
,~ATER FOUND 1(~/6/94.
SEAL
C. COWAN
CE-8801
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.0. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE)
PERMIT
PERMIT NUMBER:SW940337
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:RENNER TERRY D
OWNER ADDRESS:P.O. BOX 141046
ANCHORAGE, AK 99514
DATE ISSUED: 9/07/94
EXPIRATION DATE: 9/07/95
PARCEL ID:01705120
LEGAL DESCRIPTION: T12N R3W SEC 27 LT 3 S2
LOT SIZE: 108900 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD 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 (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 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
· THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: ~ ~
ISSUED BY: ~~
DATE:
DATE:
ROBERTSHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER &WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOiL TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
Munieipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 'L' Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: South ~ of Lot 5; Sec 27; T12N, R3W, S.M.
th,~ee bed, ttoom house on .the referene~ prope,%,ty.
A test hole was excavated and a percolation t~st performed in the area
of the proposed upgrade. The approximate lo~ation of the test hole is
located on the attaehed site plan. The monitoring tube within the t~st
hole ha~ been checked and found to be d~y. A~ached is the proposed
upgrade design.
We do not anticipate any adverse effects on neighboring properties by
the instal~t~on of the proposed septic system.
There are no protective w~ll rad~ which encroach upon the property.
If you have any question, or require additional information for your
review, please contact u~.
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP · SUITE 204" EAGLE RIVER, ALASKA 99577
~} .g. Vl~t (IVOE,~x aOaI×om'~,VO'}t ,OC~
1
0
z
2:, o
3ClV~IOd f/ J
ROBERT SHAFER, P.E.
ON-SITE ~ASTEOIATER PlSPOSAL $¥.gI*EI4
CONSTRUCTION PI~CTICES
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
REFERENCE= So~t_]~ ~ o{ Lot 5, Sec 21, R3~, TI£N,
GENERAL:
The scope of this project in,des the install~ion of a five
foot wide drainfi~ld to serve the existing three bedroom
r~sidence on the referenced property. The ex~ting septic tank
is to be excavated to verify integrity. If of poor integr~y,
the tank is to be pumped, crushed and abandoned in place and a
n~w 1000 gallon septic tank installed. The existing crib and
trench is to be abandoned in place.
Construction shall be in accordance with the approved site plan
and design drawings, Municipal permit with any specia~
provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regu~ons.
3. The contractor shall be responsible for obtaining any necessary
underground utility locates.
U~less specific~y agreed otherwise, the property owner shall
be responsible for final grading ar~as subsequently depressed
from soit settling. On all leachfi~ld mound systems, the
property owner sha~l be responsible for ensuring a satisfactory
vegetation growth over the mounded ~ea.
Contractors insta~ng wastewater d~posal systems mu~t be
c~c~ified by the Municipal H~alth Department for system
installations. 0wn~rs installing their own systems must also
receive prior approval from the Municipal Health Department.
SEFFIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank
manufacturer. Construetion shall inctude two 4" ~Icanout~ for
pu~ping access.
2. The septic tank sh~ll be sufficiently bedded to prevent
s~ling or shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum of 12
· inch~s above final grade.
4. Septic tanks installed with less than 4' of cover shall be
insulated.
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP ° SUITE 204" EAGLE RIVER, ALASKA 99577
Page Two
A foundation eleanout shall be installed one to four feet from the
building foundation. In the line between the tank and the leachfield
there shall be two adjacent cleanouts (u~ess an effluent pumping system
exists within the septic tank). These cleanouts shall be located on
undisturbed soil not more than 10' from the tank. The first cleanout,
in line, shall be to clean toward the leachfield. The second cleanout
shall be to clean tawurd the septic tank.
Final grading over the septic tank shatl be such that a positive slope
exists away from the septic tank.
ABSORPTION TRENCH/PRAINFIEL~ INSTALLATION:
Excavate the proposed trench to the d~ensions shown on the design. The
bottom of the excavation shall be within 2 inches of £evel. If the
sidewalls of the excavation become smeared, they must be raked or
scratched (roughed-up) before gravel (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to be installed
level with the perforations faced downward. Gravel is then to be placed
over the distribation pipe to provide a mi~mum of 2 inches of cover
over the pipe.
A silt barrier must be installed between the final gravel layer and the
native soil backfill. Ensure the silt barrier covers the entire gravel
surface before placing backfill.
Monitor tabes shall be of four (4) inch diameter and installed
approximately in the locations shown on the design. The portion of the
monitoring tabe extending through the gravel shall be p~rforated from
the bottom of the trench to the invert of the distribution pipe. This
is equivalent to the effective depth of the gravel as noted on the
design.
Backfill over the final gravel layer must not be less than twenty-four
(24) inches. Insulation mast be installed when the backfill depth is
less than thirty-six (36) inches. The finish grade over the trench mu~t
be moanded to prevent the formation of a depression after settling.
~INIUUU UATERIAL SPECIFICATIONS:
I. Any septic tank proposed for installation must be constructed by a
Municipally approved septic tank manufacturer.
Page Three
The following pipe materials are approved for usg
installations in the Municipally of Anchorage:
in septic system
Type of Pipe Perforated
Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed a§ove must be approved by the
inspecting engineer.
3. Insalat~on sh~ be at l~t 2" thick extruded d~eat bu~alpolystyrene
(Dow Chemical Company Styrofoam HI or equal).
4. Septic tank i~ets and outlats shall be fitted with wateatight couplings
(Cau~der, Fernco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal)
must be inst~ed ben, ween the final leachfield gravel layer and the
native so~L~ backfill.
6. All leachfield gravel (sawer rock) shall be 0.5"-2.5" sexeened gravel
with less than 3% passing the #200 sieve.
7. When sand is being used us a filter material, its gradation
spe~fica~Lo~ must conform to current M.0.A. or D.E.C. requirements.
I~SPECTIOH$:
Typically there will be a minimum of three (3} inspections required during the
inst~ation of the wastawatcr d~sposal system. These i~pcations will occur as
follows:
I. The first inspection must be conducted after the excavation of d~tches,
pits, trenches, or beds and before the instal~on of any gravel. A
septic tank may be set in place, but may not be backfl£1ed before this
inspection.
2. The second i~peation m~t be conducted after the p~ceme~ of the s~t
barrier, gravel, distribution lines, standpipes, Mcanouts, and
i~ation, but before thc placement of any other backf~.
Page Four
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required, especially with the
installation of multiple trench~s, sand filters, pressurized diatribution
systems, ~tc. Thu~, the inspecting engineer is to be contacted ~ least 24
hours prior to the start of construction. If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractor's activities.
The owner shall contract with the contractor to perform the work out~Lned in
th~se specificaY6ions and plans and in accordance with the attached M.0.A.
permit. There will be no contractual arrangement exisling between the
contractor and S & S Engineering. S & S Engineering shall be the owner's
representoutive and will inspect the work a~ stated above to document the
contractor's activities. Final acceptance of the contractor's work rests with
the owner and the M.0.A.
S & S Engineering sh~ll have no liability to the owner or to others for acts or
omissions of the contractor or any other persons performing work on this project
or the fail~re of the contractor to carry out the work in accordance with these
construction documents. S g S Engineering 'S inspecting engineer will not be
responsible for the constru~on means, mcthod~, techniques, sequence,
procedures or the safety precautions in~Ldent to this project.
CONTRACTOR/INSTALLER
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~'-~'-~'~ ~NJ~J~c~
LEGAL DESCRIPTION: ~']~)~ ] LO'(' .~/
I.,'/ L t 6.H"~
10
11
12
13
15
16
17
18
19
20
WAS GROUND WATER ~
ENCOUNTERED?
IF YES, AT WHAT ~
DEPTH? pO
E
Deplh to Water Alter [~[
Township, Range, Section: ~--C. ¢')..-c~! ~'h).j~ ! t'~Ud ( ~.~,
SLOFE S,TE FLA~
A
Gross Net Depth to Net
Reading Date Time Time Water Drop
:to ,~,~, ~Y~ ~"
~ ~ %~,~ 3'1~ l"
PERCOLATION RATE __
'lEST RUN BETWEEN
(minutes/inch) PERC HOLE DIAMETER
FTAND ~ FT
COMMENTS
S & S ENGIr~ERING
17034 ~:~ji~ [~iver Loop Road No, 204
PERFORMED BY: -~-~!~ [~['.;e~', ~!~__e~ ~_~.'77 I
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE:
72-008 (Rev. 4186)
NAME
LEGAL DESCRIPTION
LOCATION
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
Well Absorption area Dwelling
IF HOMEMADE:
Dwelling
DISTANCE TO:
Manufacturer
Liq. capacity in gallons
DISTANCE TO:
Manufacturer
DISTANCE TO:
w.. \ CO
I Length of .ach'li~e~
No. of lines
Material
Top of tile to finish grade
Width
Material
Foundation~, ~ ~'~ NeareStTrench lot line
Total length of lines wldtl)
Material beneath tile ~.~' O inches
NO. OF BEDROOMS
PERMIT NO.
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO. ~'~ ~)O ~(42~'-'~
Distance between lines
Total effective absorption area
Length Width Depth PERMIT NO,
Crib depth
Building foundation
LEGAL
Well
DISTANCE TO:
~.~,~) Depth Driller
DISTANCE TO; Building foundation Sewer line
OTHER
PIPE MATERIALS~?gl.¢ /
SOl L TEST RATING
iNSTALLER
REMARKS
DATE
72-013 (Rev. 3/78)
rTotal effective absorption area
Nearest lot line
Distance to lot line
Septic tank
FI!='J'"[. :!:
L C[C:F:I'[' :~
L.E:GFIL.
..:i iE F?.R ¥ E:.
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SOIL_ F'IBSOF;:EFI" ]: ON S'¢%'T'EI'I IF:i: 'TRENC:H
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iiX:,, EC F" "~-~ ]:'q~ =:= :::L. I!2b~ IL._. [:F:: Ih ,.-ii C:~ ' ~'"' ~'~ ........ :::~_ ~.::!~ E~ ~: Fell %,,,~ ~iiC ~ ....
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I}i[;?.l~)i..j~'~[) l:::J[4E:' THE E~O"l'TCIfq OF' THE E:',;4E:Ff,/F~"t ZCIN ,:: ):t'.,I F:'EE:T;,.
'['!..IEE!';?.[}: ]:f5 i",lO :E;EJT t.,tZE:,TH F:O[;:
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I::'C$;:TH E~"¢ THE: PIUh!:!iC:ZF'F:!L.Z'F"r~ O1= F!hIC:HOF;:!::IGE.
~'.: :[ F]XI..i. ]:N~;'[I::'IL.L. I"HF ?/:E;TE~d :iH FIC:CORDI=II',IC:E N!'I"!I THE
.'~:: :[ UN[;:'E([;?.%TF~ TI¢II::I'f' THE: ON"d~;Z'f'E: S~;E!.'I[~?. :~;"¢E;TEPI P'ff::l? !:~:E~;:¢.J;(?.E
I;:E%Z[)E:NCE Z:¥ TO :[NC:[U[)E P'tCd:~:E: THI=I[",! :~:
FIF'F'[.. X C[':
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAl.. PROTECTION
Pouoh 6,650, Andnorag~, Al~k~ 99502 270,222'~
SOILS LOG - PERCOLATION TEST
~ SOILS LOG
[] PERCOLATION
TEST
SLOPE
1
2
3
4
5
6
7
8
9
I0
11
12
13
14-
19-
20-
DATE PERFORMS=D: ~)/~ ~/7~
SITE PLAN
ENCOUNTERED? ~ ~
P
IF YES, AT WHAT -
DEPTH?
Gross Net Depth to Net
Reading Date: Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
FT AND
(minutes/inch)
FT
72-oo~
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. #
1. GENERAL INFORMATION
Complete legal description
CERTiFiCATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
S~ of Lot Si S¢¢." 27; TI2N~ RSW
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Cannon Road
Anchorage, AK
Te. cry R~nn~ Day phone
P.O. Box 141046 Anchoraq¢, AK 995~4
Day phone
345-1504
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
.
NUMBER OF BEDROOMS: ,~
TYPE OF WATER SUPPLY:
Individual well
COmmunity well
· .,~ ~'1I,/' ",.
Public water ~ "'~' ~ J "; :~ '
If community well system, provide walden confirmation from St~te ADEC attest-
ing to the legali~ and status of system. %; uL ~,~;,',~v~
NOTE:
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
XXX
Holding tank
Community on-site
Public sewer -
NOTE: If communify 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.
Narne of Firm s & s ENGINEERINC. Phone
17034 Eagle River Loop Road No. 2l)4
Address ~.¢-_ ~!~,_~.-, ".!--!:~ -~=~~
EnaineeCs sianature ~~~,~ Date
DHHS SIGNATURE
~ Approved for ~
___ DisapprOved.
____ Conditional approval for
o
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending insti(utions 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 om~seions in the professional engineer's work.-..
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:.~rr~ ~z oF Lo'c ~ ~-121~ I '~'~ ~J Parcel I.D.
705'/2 0
A. Well Data
Well type
Log present (Y~
Total depth
Sanitary seal (~N) ~/~'
If A, B, or C, attach ADEC letter. ADEC water system number /~./,,~-
Date completed U;/K- Driller
Cased to ~'0 ',% . CaSing height /
Wires properlY protected (~N) Y'~s
FROM WELL LOG
Date of test
/
Static water level //
Well flow
Pump level1 ,//
SEPARATION DISTANCES FROM WELL TO:
Septic/I,,~dfl'fg tank on lot
Absorption field on lot /,o2_ '
Public sewer main
Sewer service line
g.p.m.
; On adjacent lots /~' -/-
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Collected by:
Other bacteria
B. SEPTIC~TANK DATA
Date installed ~ - .~,~ - E 5'
Cleanouts (~) ~'~
High water alarm (Y~)
Date of pumping /J,/,/#--
Tank size /~c~o ~,~z, Compartments
Foundation cleanout (~) /v~.~- Depression (Y~. ,/,Jo
/J~ /~/~ Alarm tested (Y~ ,~-Jo/J//4~
/L~ ETU '7-,~-,tJ/~- Pumper
SEPARATION DISTANCES FROM SEPTIC/H,~LD'.:;.3 TANK TO:
Well(s) on lot /~c~
To property line //7'
Surface water/drainage
On adjacent lots
Absorption field
/Or)
Foundation
Water main/service line
72-026 (3~3)' Fro~t CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed ~ Manufacturer J ~
Size in gallons ~ Uanhole/Acces~-Y/N~.
Vent (Y/N)_ ."Pump on" level~t-~a - .~"~"Pump off" Level at
High water alarm level ~.~Cycles tested ~
Meets MOA electrical codes (Y/N) ~ ~
SEPARATION~FT STATION TO: ~
Well o[~~ On adjacent lots Surface~er
D. ASS""~RPTION FIELD DATA ~
Date installed ~- .~o - ¢/4' Soil rating (GPD/FF)
Length 5-/' Width 5- ' Gravel thickness
Total absorption area ~'..,"~? ~ Cleanout present {~N)
Date of adequacy test/~./~ ~'~ ~'Y'~'~>, Results (pass/fail)
Water level in absorption field before test ~/~z~ After test
Peroxide treatment (past 12 months) (Y~ ,..~c~ /~/.~-
System type D~,~
Total depth 7,
Depression over field (~
for ~/~ Bedrooms
If yes, g~e date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /~
To building foundation
On adjacent lots
Surface water
Curtain drain /-~ ~.~-'
On adjacent lots r'' . /~ '~-- Properly line
~$ / To existing or abandoned system on lot
Cutbank ~'o ' ¢- Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I ce¢'fy that I have checked, verified, or conformed to all MOA and HAA
of this inspection.
Engineer's Name
Date I <:) / ) f~ / ~ ~
HAA Fee $ ~g"g~) ' ~/~
Date of Payment
Receipt Number /_~z/
Waiver Fee $
Date of Payment
Receipt Number
72-026 (8~3)' Back
10/11/94 09:26 CT~E ENUIRONMENT~L L~B SERUICES ~ 90?6941211 N0,~44 P04
Commercial Testing & Engineering Co,
Environmental Laboratory Services ~~e,j~-~-f~se-~'~'J~J~'~J'J~e'Ja
LABORATORY ANALYSIS REPORT
C'l'&;g lzxL # 94,5133.1
Clie)lt Sample ID $1~ L3 TI2N R3W SEC27
Matrix WATER
Cl[emNmr,¢ S & S EN¢JlNEERING WORK Order' 82707
~(l~red By R. 8~gll Prinicd Date ] 0/11/94 ~ 07:31 tu'~.
Collected [~te 10106/~ ~13:00 lus.
PmjectN~e Rec~v~te ll')/06194 ~13:45 l~s,
~oject~
PWSII) IJA
Technic~ ~rector S~P~N C. EDg
Qc Allowable Ext. Anal
Paraln~er Results Qual Uaii,s Me0~od Limits [late Dale Init
* $¢¢ Special ln~tn~ctions Ahoy e UA = Ihmvailable
** 8¢eStonple Re. nmrks Above NA=NotAnalyzed
U = U~.det~t¢4 Rq~ort~dval~ is thc practical qtm;tiikatioa limit. LT = l.~ss 'lhalt
D =Secoadary dilution, OT = O~t~cr 'Iha~
5635 8 9trsst, Anchorage, AK 99618-1600 -, Tel: (907) 582-2343 Fax: [907) 561-530]
ENVIRONMENTAL FACILITIEg IN ALASKAi COLORADO, FLORIOA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
_. ,, INSPECTION APPOINTMENTS
DEPT, OF HEALTH &
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~NVIRONMENTAL PROTECTION
SEP 9 1980
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 .RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
PROPERTY RESIDENT (If different from above) } PHONE
~o~%
PHONE
4, REAL~OR/AGENT ] PHONE
MAILING ADDRESS
5, LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
~ SINGLE FAMILY
[] MULTIPLE FAMILY
[] COMMUNITY
[] PUBliC UTI LITY
NUMBER OF~BED~.I~ROOMS
~ One ~ Four ~ Other~
~ Two ' ~ Five
~ Three ~ Six
* 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.) '~--~'~, ~O ~C ~(-'CI
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTI LITY
YEAR ON-SITE SYSTEM WA'S INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQ~ST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MUL'rlPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tanl~ or [] Holding Tank
Size: ( }3~) If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL yL~_~ d'~c~"7
4. DISTANCES Septic/Holding Tank AlJsor~tion Are~/I~ewer Lie Nee 'es~d_ot Line
WELLTO:
/
Absorption Area to nearest Lot Line
5, COMMENTS
/AAFPROVEDFO. SEDROOMS
[] CONDITIONAL APPROVAL (letter must ec~certificate)
; D SAPPROVED
72-O10 (Rev, 6/79)
PENINSULA
ENGiNEErINg
2820 C Street, Suite 3
Anchorage, Alaska 99503
276-4885
September 24, 1980
Jill M. Parson
Century 21 - Heritage Homes
207 East Northern Lights Blvd.
Anchorage, Alaska 99503
RE: Sewer System Adequacy Test
T12N R3W Section 27, S½ of Lot 3 S.M.
Dear Jill:
As per your request of September 15, 1980, I have per-
formed an Adequacy Test in accordance with the Munici-
pality of Anchorage recommended procedures for the on-
site sewer system for the above listed property.
The subject is a 3 bedroom home in the DeArmoun Road
area which has a septic tank, crib and additional drain-
field. The drainfield was added to the original sys-
tem in 1978 in accordance with the best information
available.
The test was performed by pumping water directly into
the septic tank at 10 g.p.m, and monitoring the levels in
the tank and drainfield at 50 gallon intervals. A quanti-
ty of 500 gallons was applied on two successive days. The
septic tank level was found to remain constant throughout
the entire testing period and the trench area appeared to
be absorbing the effluent at an acceptable rate without
any back-up. It was not necessary to pump the system to
evaluate it at this time, however, it is recommended that
it be pumped on a regular basis to provide normal operating
maintenance and prolong the life of the system.
In conclusion, the test results indicate that the system
has passed the adequacy test for a 3 bedroom home and should
perform effectively for the new owner providing normal main-
tenance is maintained.
Sincere ly,
Wayn~ Henderson, P.E.
WH: z c-p
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT ON; ., ..... ~ ....... ;, ;c
DIVISION~, ~'~i;:: i,:,.; ,~[,:.L i ~:~, C~i,:)N
ENVIRONMENTAL
ENGINEERING
Telephone 264-4720 /.,::,:; -] ~j ~ '.,~:
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACl ,LITIES ....
IIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPER WNER ~,
PHONE
PHONE
PROPERTY RESIDENT (If different from above)
2. BUYER PHONE
MAILING ADDRESS
AAILING ADDRESS
4. REALTOR/AGENT
IPHONE
MAI LING ADDR ESS
6. TYPE OF RESIDENCE [~ SINGLE FAMILY
[] MULTIPLE FAMILY
7. WATER UPPLY
~ INDIVIDUAL*
LJ COMMUNITY
[] PUBLIC UTI LITY
NUMBER OF BEDROOMS
[] One [] Four [] Other~
[] Two [] Five
[~ Three [] Six
* 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 [f available.)
8. SEWAGE DISPOSAL SYSTEM /?~
'~i~ **If individual/on-site, give installation date F--
INDIVI DUAL/ON-SITE** If system is over two (2) years old an adequacy test is required
[] PUBLIC UTI LITY by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
,~ INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR I NSP ECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
2. WATER SUPPLY PERMIT NUMBER
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Com~ection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED,
[]PUBLIC UTILITY
Connection Verified
INSTALLER
[]Septic_ ...,..Tank or [] Holding Tank
Size: //c~.%'~'~ IfTankishomemade SOILSRATING
give dimensions:
TYPE QF TANK MANUFACTURER .~L.~,
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septi¢/RoldingTank Absorpti~n Area Sewor Lino I Near0st Lot Lino
I
WELL TO:
ABsorption Ar~a to nearost Lot Lin~
iROVED FOR
BEDROOMS
ET CONDITIONAL APPROVAL (letter must accompany certificate)
d~"~ISAPPROV ED
DATE
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
'J L
John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907-279-8056
NEW PHONE NUMBER 276-4113
SOIL ABSORPTION SYST~4 TEST
PERFOPA~ED FOR:
LEGAL DESCRIPTION: ~, Z~r -~' A"~-9 ~Y
NO. OF BEDROOMS: ~ RECORDS ON FILE:
TELEPHONE:
DATE OF TESTS:
~/2 ~ ~ ~
~ ~ ~,'/I~H JML STANDARD PROCEDURE ACCEPTED BY
TEST PER~Oi~MmD IN ACCORDANCE" m
MUNICIPALITY OF ANCHORAGE, DEPT. OF ENVIRC~D~ENTAL QUALITY 0N ~
WITH THE FOLLOWING MODIFICATIONS:
SURGE CAPACITY:
SOIL ABSORPTION SYST~4 (SAS)
SEPTIC TA~UK PLUS SAS ~/~ ~ SC~r o~ ~T
ABSO~TION '~ - I re"
A~RAGE ~ hrs · 0 7 ~ STEADY STA~~ .~,~,:~c~ ~
John M. Lambe, P.E. 4303.North Star Street Anchorage, Alaska, 99503 907-279-8056
DEPTH BELOW METER READING ~' GALLONS PUMPED TIME
REFERENCE ( GALLONS ) ( NET )
John M. Lambe, P.E. 4303 North Star S'a'eet Anchorage, Alaska, 99503 907-2798056
Ek=ISTiNG DRAIN- Fi~T.,.D TEST - PERCOLATION AD~
REFERENCE: .~-~ '
DAT~ P~O BY: ~
LEGAL DESCRIPTION: ~ ~
DEPTH BELOW METER READING GALLONS PUMPED TIME
R, EFE~ENCE ( GAT,I~gNS ) ( NET )
1~4o -. ~ -4 973- ~ 40 ~Z ,'40
II
zCll I 25' togo ~; 13-
I
John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907-279-8056
DEPTH BELOW METER READING GALLONS PUMPED TIME
REFERENCE ( GALLONS ) ( NET )
,~;?~ it,o".. -s-'14t-4o ~
!
lC~'' a.-t 447.$ 7,~_~
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~ '-~s ~a %~.n'-1.7 z: ~'~5/
t - 7 4s'..% ,~
t '- ~" 4~-~,cD t3 ,o ~ Z ~40"~
,'-7" 4~-~.,? $ ,7 '2, g\