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Home My WebLink AboutT12N R3W SEC 22 LT 9 S2S2 (2) MUNI~IRALITY OF A~G~O~AGE Environmental Health Division ]4530 Echo ~reet 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720~C~OT~, ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT m~ DISTANCES l ARRY ~ ~ SEPTICTA~K A~8~RPTI~NFi[[~ WELL Permit NO. No. o~edrooms 27q - GSOE 5wqlooo~ tE~ =~.c.,..,o. LOT LINE 1 2 ' I O x ~0' Lot ~ SIOCk ~ Subdivision F0U,O~T~0N 30' ~' 2 2 Township. Range. Secbon AS-BUILT DIAGRAM (Show location o[ well. septic system, property lines, foundation. ~ 8EPTIO ~/LJFT STA, g HOLDING Manulaclurer Capacity in gaUons ANCHorAGE ~ANK 2000 % / / Material No. of Compadments 5TE~L 2 / TYPE OF SYSTEM ~_ BDEH ~CRtuE/ ~/~0. / Depth to pipe bottom from Total depth from original grade /, / in added above original grade Gravel depth beneath pipe ~.o FT O.S' ~" ~"~ Distance between lines ~ ~ Total absorption area ~O 8g FT ~ t ~2 E2' Number of lines Soil rating Pipe matedal Installer ~J-- (~J~ ~E~J ~001 WELLS ..... ~ PRIVATE JS~IN ~ OTHER (Identify} SCH~b ~b Clarification (A,B,C) Total Depth FT Cased to % ~ I J.~ ~ Instaner Date InstalJed: REMARKS: ~ o(~ ~'c ~n~ ~ ~n~ Municipal and State guidelines in effect on Ibis date: ~/2~[ ~[ / /~ v.. ~ C_ - gu. ) , .~ Health DepadmentApproval: . . _ Date:. 72-013 (3/85) o o o 0 ~- 0 I I t ~ [ ! [ I o~ {hdNIC-iPdkLC~ Y' OF ANC;-IORAGE;, BU!i.[')INt.~ SAFETY DIVISION e:On c/',. ] L?..)(~R POAD ~ .................... :;~ ';v .................................... *N(DH~,~ION (907; 7860211 M ECi-i f'iNAL ..... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744 HAND WRITTEN PERMIT Permit Number: SW91~z~o/ Date Issued: Design Engineer: Owner Name. ~Jc~ Owner Address: ~. /~ Permit Type: ~7~ ~ Expiration Date: /-3~k Day Phone: Parcel ID: ~rJ-- I~f-~V ' ~, /~! ~ ~ Lot Legal: Subdivision: A/~ Lo't': 9 Block: ~.~ Section: ~ Township~'~ Range: '~5~ i Lot Size:~z/~--o (sq.ft. or acres) Max Bedrooms: This Permit: ~ Total Capacity: ~- SEPTIC TANK: Minimum septic tank capacity: /.~6~ gallons. Each septic tank must have at least 2 compartments, insulation is required if depth to top of septic tank(s) is less than 4.0' Lift stations require an appropriate electrical inspection. WELL LOG: A copy of the well log must be sent to DHHS within 30 ~ays of the well's completion. I CERTIFY THAT: 1. I will install the on-site sewer system and/or well in accordance with all codes and regulations of the Municipality of Anchorage (MOA) and State of Alaska , and in compliance with the design criteria of this permit. 2. I will adhere to all MOA and State of Alaska requirements for separation distances from any existing well, septic system, or surface water on this or any adjacent or nearby lot. 3. I understand that this permit is valid for a single family dwelling with a maximum of bedrooms. I also understand that any enlargement will require an additional permit. · 4. I understand th~s permit is issued for ~~ ~ ' and expires on ~ ~ ~,~ ......... ~ 5. I will not~fy D~HS prio~ to all inspections by the engineer or well driller. ~/designeL~ SSUE DATE:r /3/9/ db/ll5 15o~ 5~co~D C,O, 'to EXISTI lq6 I$OO Ha?'clc TA ~, t<, ~S- BDRM VACANT LOT LOT Cl 1~~ FRo~ pROP.~INE ff.` LoT 1o B ~o B~ .. pEo PoSE b ~IB$o~PTm~4 BED 330~ s?z, s~ LoT cl H O U/S E~ Jj ~VELc ~ I ~aito'~ Tech'hic~I Se~,¢ia¥~ 14530 Echo Street -g. nchorage, 2dcmka 99516 5k2, LoT .SEPTIC SEC 22 ,TI2N, R3h/ 5~(S'T E[',h UPGRADE SITE PLAN SC~,LE: 1' =50 bATE; q/ciO DW'N BY: ~ NOTE: TH IS 15 SuRvE'tEb PLATt ~IPPRoXI COId,,AEC'[' -1'o E[15TtN(~ ~15oo GAL 'g£73'~c TA, i'AI~ PLAN VIEW Pv¢ 38' ~ IA> .SECTION Flattop Technical Servlc 14530 Echo Stree~ Anchorage, Alaska 995 Lq, ,SEC 22 , TI2N~ 5OiL ABSoRPTiON PLAN h~l) CROSS R3W BED SECTION ,..SCALE: AS NOTED DATE: q/fro D~N BY: ~ Plattop Technical Eervlces 14530 Echo Street Mnchorage, Alaska 99518 N1/2, Sl/2, BLM Lot 9, Sec. 22, TI2N, R3W, S.M. 10850 Our Road Septic System Upgrade Specifications and Design Notes 1. The scope of the proiect includes the installation of a lift station in a 500 gallon tank located downstream of the existing septic tank, and a new 25' x 38' soil absorption bed with a pressurized distribution system. The configuration shall be as shown on the site plan and design drawings, except that minor modifications may be allowed or required by the engineer conducting the inspections. 2. The proposed configuration will have no impact on the ability to develop on-site water and wastewater facilities on adiacent properties, or on drainage patterns and reserve area considerations. 3. The size of the soil absorption bed is based on a measured percolation rate of 2 minutes per inch for the shallow reddish sandy loam stratum, which requires an absorption area of 125 square feet per bedroom. Sand of equal or greater permeability is to be placed as needed to create a level base for the bed at the elevation of the highest point of the native sandy loam stratum. The required absorption area for this five bedroom residence is 5 x 125 x 1.5 = 938 square feet which is best accomplished by a bed having dimensions of 25' by 38'. 4. A waiver of the 15 foot width specified in the wastewater ordinance for soil absorption beds is requested. If the width were held to 15 feet, the length would have to be 63 feet, which would be less practical to construct on this site due to topographic conditions. 5. All construction practices and material specifications shall conform with Municipal and State requirements. 6. A cleanout is to be installed on the second compartment of the existing 1500 gallon septic tank, and the top of the tank insulated with 2 inches of rigid insulation. The integrity of this tank shall be verified by the engineer. 7. A new Municipally approved lift station package (Orenco or equal) shall be installed in a separate 500 gallon tank located downstream of the septic tank and greater than 5 feet from the property line. Control and alarm floats are to be set per the supplier's instructions, and an audible and visible alarm mounted inside the dwelling to alert the residents if the pump is not working. Flattop Techn~caI Services 14530 Echo Street /~inchorage, Alaska 99516 8. The property owner shall arrange to have a surveyor flag the south property line in the vicinity of the proposed soil absorption bed, to ensure that the required 10 foot separation distance is maintained. 9. ']'he soil absorption bed shall be constructed by clearing .trees and' stripping only the organic peat stratum off the designated area to expose the top of the underlying reddish sandy loam stratum. Sufficient imported medium sand is then to be placed on top of the loam stratum to create a level surface of the required dimensions. A total thickness of 9 inches of approved sewer gravel is to be placed on the bed, with the distribution laterals buried level in the gravel such that the bottom of the pipes is no less than 6 inches above the top of the sand leveling course. The top of the sewer gravel shall be covered with filter fabric and 2 inches of rigid, burial type insulation, and then 2 feet of unclassified HII material placed on top. Monitor tubes shall be installed .in the locations shown. The sides of the cover material shall be sloped down to the existing terrain at 3:]. 10. The pressure line leading from the lift station to the absorption bed and the manifold shall be 2~ diameter Schedule 40 PVC. The distribution laterals shall be 1.25" diameter schedule 40 PVC, and shall have 1/8" diameter holes drilled in the bottom, spaced every 36 inches. The hole spacing results in a total of 65 holes, which will pass the 34 gpm output from the lift station pump with a 5' pressure head loss across the holes. The ends of all laterals are to be capped, and all PVC joints in the pressure distribution system are to be glued. A total of 5 inspections will be required during the course, of the construction: ( 1 ) initial stakeout~ (2) after the peat is stripped, but before placement of the sand leveling course, (3} after placement of the sand leveling course, (4) after the gravel is in place and the pipes are laid and connected up to the lift station, but prior to placement of the insulation and backfill, and (5) after final backfill is complete;. PERFORMED FOR: ~iattop Technical Services 14530 Echo Street Anchorage, Alaska 9951¢ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST T, N. =~ I LARRY BOOTS LEGALOESCRIPTION: N~/2, 5~/~ BLM LoT fl 1 2 3, 4- 5 6 7 8 9 10- 11 PT' RL REDDISM SANb',/ /oAM SILT"/ S.fiNb-SOME CoBBL~ SoFT ~1~0 SEEPS 13 14 15 16 17, 18- 19- 20- Township, Range, section:TI2, N, R3~, SEC 22 L SITE PLt ~N '"' t ,.~ SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? ~EEP& Deplh lo Waler Alter ,K].~" Monitoring? -/"/ Date: Reading Date Gross W~Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN _. FT AND FT CERIlFY THAT THIS TEST WAS PERFORME~ ~N ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: . ~ ~7 ~ 72-008 (Rev. 4/~) PERFORMED FOR: ~latfop Technical Services 14530 Echo Street Anchorage, Alaska 995]¢ Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST T, ~. ~+2 LARRY BOOT5 1 2, 3- 4-- 5 6 7 8 9. 10- 11 LEGAL DESCRIPTION=. ~/~. 5~/~ BLM LOT q PT SLOPE 5]v[ ~EbblSH SANDY LoAM SLIGHTL~ 51LT~ SANb ~IT8 POCKET~ OF ~L D~N~E pOCKETS oF SP CLEAN GRAVELLY WAS GROUND WATER ENCOUNTERED7 , 13 14 15 16 ~ - 17- 18- 19- 20- Township, Range, Section:Tl;Z N, R3~ 5£c 22 COMMENTS S YES, AT WHAT tF DEPTH;) p E Depth to Water After Monitoring? Dale: Reading Date Gross ~Net Depth to Net Time Time Water Drop ~to ~:o~ 2q Y~ g~23:3o ~ 2~ ~ 2 YV PERCOLATION RATE "~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN "~ . FT AND ~'~-~ , FT ConDuCTED lU~~ E:A~T oF' T,~,#2 FL PERFORMED By; nTToP 5VCS. I "'" CER'IIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: . ,~'~---"7~'~¢:3 72-008 (Rev. 4/85) PERFORMED FOR: Flattop Technlca! Services 14530 Echo Street Anchorage, Alaska 9951~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LARRY BOOTS LEGAL DESCRIPTION: ~,~/:Z. ~.~/:~ ~LM LOT c~ Township, Range, Section:TJ'~l~, R]t~, SEC 22 PT 5M ML 1 2 3 4. 3AND~/ SILT GRA~ ~RAvE~L~ 51~T SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Oeplh lo Waler After ~'/On~,f' ~"oC~, ~. ~f~ Morfiloring? Date: ~/i~/~ 5 6 7 8 9 10 1:3- 14- 1§ 17 20- COMMENTS I~K ~'&~T Reading Date Gross ;4'N et Depth to Nat Time Time PR£So/tK cl/lq Jqo 3: q ~ 25" ~30 3:~2:30 3:57:30 ~:oB:3o *~20 ~:oq PERCOLATION RATE . 2 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN [ FTAND ~'~' FT 1~/ E~T OF T,H. ~3 PER~:ORMED'ev: FLRTTOP 'T'~c~/. 5VCS. , .'~..~.,~..~,...~ CER1 IFY THAT THIS TEST WAS PERFORMED iN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: , ~q /~ ~--~" ~'~;;~ 72-008 (Rev. 4/85) MunicipalityofAnchorage REQUESTFORVOUCHER CHECK FROM: Dept. Health & Human Services (DEPARTMENT) TO: MUNICIPAL CONTROLLER DATE: November 28, 1994 R 33158 THIS SECTION FOR ACCOUNTS PAYABLE USE ONLY VOUCHER NO. PAYMENT DT. V VENDOR NO. iNVOICE DATE iNVOiCE NO. 3HECK NO. CHECK DATE PREP APPR 1. REQUEST THAT A MUNICIPALITY OF ANCHORAGE CHECK BE ISSUED TO: Name S & S Engineering Address 17034 Eagle River Loop Road, Suite 204 Eagle River, AK 99577 2. THIS PAYMENT IS FOR THE FOLLOWING (SUBSTANTIATION ATTACHED): Owner withdrew request for Health Authority Approval. New buyers will assume existing loan - therefore no Health Authority Approval is now required. Please refund the HAA fee of $300.00. Receipt ~00509 for T12N, R3W, Sec. 22, N2, S2, BLM Lot 9. 3. DISPOSITION OF CHECK: (1) ~XMAIL TO PAYEE (2) [~ MAILTO PAYEEW/A~CFACHMENT (3) ~] NOTIFY PAYEETO PICK UP I NTREASURY Name' Phone No,: 4. ACCOUNTS TO BE CHARGED: AUTHORIZED USE ONLY (6) [] NOTIFY DEPARTMENTEMPLOYEE WHEN CHECK IS READY IN FINANCE Name: Org. No.: PhoneNo.; ITEM ENTER ALL POSITIONS OF ACCOUNTING DISTRIBUTION NO. DESCRIPTION Or 'CC ACCt/Ob Task Opt · Cost Ctr. WA/WO AMOUNT 3I} 1 2 .1 ~ 8 R ~ fu nd 2 5 7 0 9 4 2 6 · 300.]0i S, TOTAL AMOUNT OF CHECK $ 300. 6. SIGNATURES plo~y~.~-~ ~O.~G.A_J 343-4744 Em Phone No. Approving Authority 7. INSTRUCTIONS a. To be used only when payment cannot be made by purchase order, travel expense report, travel authorization or petty cash. b. Must be approved by department head unless approval authority is delegated in accordance with Policy and Procedure 24-7. c. Retain carbon copy for your file· 40~01 (Rev. 2/91) MOA #15 Municipality of Anchorage MEMORANDUM To: From: Date: Subject: DHHS Accounting & Budget On-Site Services, DHHS November 28, 1994 Request for Refund - Account #2570-9426 Please make the necessary arrangements for the following refund. The property owner decided to withdraw his request for a Health Authority Approval from this department. Therefore, a refund is required. Please send to the address listed below. Thank you. S & S Engineering 17034 Eagle River Loop Road, Suite 204 Eagle River, AK 99577 Receipt # 7896/00509 Amount: $ 300.00 Account # 2570-9426 T12N, R3W, Sec. 22, N2, S2, BLM Lot 9 Kathy B ouschor On-Site Services cc: File .I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box196650 Anchorage[Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description N~, S~, BLM Lot 9, S~c. 22, T12N, R3W SoMo Location (site address or directions) 10850 Our Road Property owner Mailing address Anchorage, AK John & Shelby BlOmfield Day phone P.O. Box 110105 Anchorage, AK 99511 274-1000 Lending agency Mailing address Day phone . i :~?:~:, .~', ' Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 5 TYPE OF WATER SUPPLY: Individual well XXX Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 79-025 {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 rny 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 Address EngineeCs signature Phone (°ti ~/- ~/7 ¢~ Date I///,I DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date By: 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 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 engineeFs work. 724T25(Re¥,1/91) Back MOACY21 Municipality of Anchorage · · , Department of Health and Human Services Legal Description: N~ ..~¢. LdFq ..~'CZ.'Z. 'f?7~O/~$~ $,/"/, Parcel I.D. A. Well Data Well type Log present I~)c~,, ~ Total depth ~' Sanitary seal (~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed --~/~-~'/?cc> Driller Cased to FROM WELL LOG Date of test '~'/~' (~/'~°~ Static water level ~--~ Well flow 9, ~'~ Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/i~ek~4,q~tank on lot Absorption field on lot Public sewer main Wires propedy p~otected(~/N) AT INSPECTION Z?/' Sewer service line /OO % /0o % Casing height ; On adjacent lots /00 ; On adjacent lots /OO L/- Public sewer manhole/cleanout /O 0/¢"~ Petroleum tank ,'(JO B. SEPTIC~TANK DATA Date installed, "~' ]//:// ~/ Cleano,u,ts~) 'Y/O-~ WATER SAMPLE RESULTS: / Coliform (~)//(DO~ ~ Nitrate ~,~'(~'~'~/~ Other bacteria ~::~//'~o/~.~ Date of sample: , ////~ ¢~ ~/~ Collected by: Tank size ~OO ~ Compa~ments Foundation cleanout~) ~ Depression (Y~ High w~te~alarm (Y~ ~O Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/U~ r',~,~= TANK TO.' Well(s) on i0t ./O~B 17z'~- On adjacent lots To prope~y ne Absorption field /O Su~ace wateddrainage /O~O/~ 72-026 (3/93)* Front Foundation Water main/service line CONTINUED ON BACKPAGE C. LIFT STATION Date installed Manufacturer Manhole/Acces~_.)N) "Pump off" Level at Cycles tested "~ Size in gallons Vent (Y~ ,.'L-/b "Pump on" level at High water alarm level z~f-iL-// Meets MOA electrical codes~N) ~"~ ~ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot /~(~ (-f-- On adjacent lets Suffacewater / Co ~ Length Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) ,.A~.,~J'~ D. ABSORPTION FIELD DATA Date installed (/I[ ~ r Width ¢/~O / ~ ~ Result~"~fail) ,~4-&"..~ for ~,//~ After test Soil rating (/~- / 'Z-~- z:~',,/~/~- System type ~- ¢ Gravel thickness O, ~' ' Total depth Cleanout present(~) o¢/.¢¢ Depression over field (Y/~ .~-- ~("~/c,/~ ') Bedrooms .If yes, give date /'~///~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //00 To building foundation On adjacent lots ~---0 Surface water /'0~ Curtain drain ./0/'¢ '~'~- E. ENGINEER'S CERTIFICATION On adjacent lots f'OO (,..L Property line To existing or abandoned system on lot Cutbank .~O /q~- Water main/service line Driveway, parking/vehicle storage area /rD / A-;c<- I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. '~, CE-880~ /.~ ~ , ~%. ..".J ¢ ~ t~,~ ...... , ..... ,'¢ Engineer's Name Date Ea~le Ri~ar, Alaska HAA Fee $ :¢) (~) Date of Payment //-',~ / ' Receipt Number ~7"~? (/' ('/ 7OPr~;') 72-026 (3/93)° Back Waiver Fee $ Date of Payment Receipt Number 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 10t, block, subdivision, section, township, range) (b) Location (address or directions) fid Property owner Mailing Address .- Telephone: (home) :39'<¢-27gp Business (c) Lending Institution N,~-. Telephone Mailing Address (d) Real Estate Company and Agent Address ~¢'00 ~¢-~ ~,~ Telephone ~ ~ 7 ~ 0[5- (e) Mail the HAA to the following address: (or check here ~', if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 5-- 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note:. If community well system, must have written confirmation from the State Department of Environmental Cdnservafiod ~iResting to th legality and status. 4. SEWAGE DISPOSAL On-site [] 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 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 F/~(-'~f 7-~_c/~.nic~[.~c.'~' Telephone Date ~-T~n 25'- 1¢'91 6. DHHS APPROVAL ~ Approved E'"~--- Disapproved Conditional Terms of Conditional Approval. Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 (Re'/. 7/88) Back Page 2 of 2 Well Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY i984 343-4744 Legal Description: ~ V~,. Well Log Present (Y/N) ~' Date Completed Total Depth ~P,.~ Cased to Eq ~ Depth of Grouting N,~-, Static Water Level P6=9' 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 If A, B, C, D.E.C. APproved (Y/N) N,//, 5-/2,,C/78 Yield ~ q~Pm ~¢~'~ P/d'(9o Pump Set At --:> ~'0 Sanitary Seal on Casing (Y/N) 'r' Depression Around Wellhead (Y/N) ; On Adjoining Lots 1"/6-/ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Flc'f/°~ T'~ch ~'~,,¢ ; Date Il/S- t'9 ! WaterSampleTestResults .~'c,.~.~.,-C~c,-I~r,y - 42 co!~f'o,,',, t/',"ooml.~ c~, Za ~,.~ /.~ B. SEPTIC/HOLDING TANK DATA t/ti/pi Size ~O00~,al No. of Compartments '~ Date Installed Foundation Cleanout (Y/N) Y' Date Last Pumped /¥"~- ; for Temporary Holding Tank Permit (Y/N) fl, 4-. Standpipes (Y/N) ~' Air-tight Caps (Y/N) Depression ove~' Tank (Y/N) tV Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) N, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Building Foundation To Disposal Field To Water-Supply Well I 2 ~ ' To Property Line I 2 ~ To Water Main/Service Line ~ (oo' To Stream, Pond. Lake or Major Drainage Course Comments ~'?-/--(c /-o-~l~- ¢o,~-~;..," ~,~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed I/If Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test / 25- ~' Length of Field '~ ~¢ ' Depth of Field / Gravel Bed Thickness 75',,'~ Statndpipes Present (Y/N) /¥ Date of Last Adequacy Test Type of System Design SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well / To Building Foundation Lot ~ 2i'o ' To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line lO ~ To Existing or Abandoned System on ; On Adjoining Lots .~ 2~O ' To Cutback (if present) I\1, A, ~.~ (0o~ D. LIFT STATION Date Installed I/t¢ Size in Gallons 5"¢¢',,:),'o! ¢~/~r.z tn "Pump On" Level at .~.or'~--4. aC /fo" High Water Alarm Level at (.orcx¢ Tested for N, A-. Meets MOA Electrical Codes (Y/N) Comments H~'h I~'¢( Dimensions tn $,d¢ '8o00 ~,~/ .¢~¢¢/~ /~ Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA g. pjcleline, s,~(0 effect on the date of this inspection. ~-?;-~"0~': /'~ ~. Signed ~.j-~ ~. ~ MOA No. ¢¢ -cfc Receipt No Receipt No Date of Payment /- ~ '-3- - ~ // / Waiver Fee: $ ~-0~0 (R,,. z/a0)~ook Page 2 of 2 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 PHONE [] NEW Larry & June Boots 349-1338 ~UPO~AdE MAILING ADDRESS SRA Box 1722.K Anchorage, Alaska 99507 LEGAL DESCRIPTION Lot 9 Sec.22 T. 12N,R.3W. SM LOCATION NO. OF BEDROOMS Our Road (O'Malley area) 5 WelJ I Absorption area Dwelling PERMIT NO. DISTANCE TO: 12d FL_ 74 ft. 21 ft, 790206 ~ ~ Manufacturer Material No. of compartments ~ ~ ~r~~ steel 2 Liq. capacity in gallo s' ' Inside length Width Liquid depth ] 500 ~ IF HOMEMADE: ' ~ Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in ~aHons ~ DISTANCE TO: 190 ft. 103 ft. 15 ft. + ~ ~_ No. of lines 1 Length of each line9.~ ft.. Total length of lines93 ft. Trench width.~ ft. ~; Distance ~etween lines N~'A':; ~ 2-7 ft. due to slope M'+~ screened gravel ,4,~ inches 1-930 sq. ft. m DISTANCE TO: OTHER ('~IL Plastic ,~ SOIL TEST RATING {%~/° ( /og~ ~ ~ INSTALLER ' ~ ) C & J Excavating 1st In~p~ntlon 5-21-79 2nd Inspection 5-22-79 I+ 72-013 (Rev. 3/78J PERM I"r NO. RI::'Ft_ I L. OCFIT ~( ON t..RRR'¢ & .:rL.INE BOOTS OUR ROFID L::i) S22 T~.2N F;'.:~:P,I SM 8('_:;;~ii) JI:;IDE ZT LOT SZZE ;~'.¢~ 2i: 55;47 44866 SQURRE: FEE;T ]"T'PE OF ZOIL t::IE:'-:~(]RE:T.~ON S"r'S'f'EH tZ: [>RFIZNF:[EL.D PII::I::'::IMUM P,It.I~'!EfER OF BEDROOMS = 5 SO):L RF!]'ING (~]~! FT/F_:R)= ~ixLe~~-,--- THE REg!L!ZREE:, .:,:[,~E U, 1HE ::,U:(t.. HE, z,(~E:i~Cd',I .::, -r =, f Efl l=,. ............... --. ~._.. EE~ ~'-a ~::;~ T' ~---~ =:~ :~ ~J CD ~%~: ~:~ %." E~ ~ ....... ~X:. E~: F' "? F'-{ == THE LENGTH DIMENSION I'.E; THE LENGTH (ZN FEET) OF THE TRENC:H OR [:,RR):NF)'EL[':,. THE DEPTH OF R TRENCH OR PIT ZS THE DIZTFINCE BET!,.IEEN THE %URFRCE OF THE GROUND RND '['t4E BOTTOM OF THE EXCFP,~RTION (IN FEET). THE 61:;;'.F:IVEL DEPTH X:E; THE MZNZMUM DEPTH OF GRRVEI.. BE'THEEN THE OUTFRI...L F'ZF'E RND THE BOTTOM OF THE EXCFIVI:Tt'ZON (ZN FEET). PERH ):"i' i~PF:'L :( CRNT Htg:S THE RESF'ONS :(B I I_ ! T'.r' TO ):I'.4F'ORM 'f'H Z S; DEF'RRTMENT I}tJR I NG THE: !'NS;TFIL_LF~-I'ION ):NS;I::'I:SC:TIOi'.~S OF F!N"r' WEL. I_S FtDJFICENT TO THZS; F:'ROF:'ERTS' FIND THE NUI'"IEar'-::R 01::' RESZDE. I'-~'CI'SS THF:IT THE WEL.L I.,.!ZLL SERVE. M~NIMUM [:,.'[STF:ir.,IE:E BET!-4EEN R P.IEL. L laN[) FIN'¢ ON-S;):TE .'SEI4RGE DISPOZF:IL. S'¢STEM IS ~.0!:3 FEET FOR R F'F..'ZVRTE I,.IE[_.L.~ OF-:.' :[.SEi TO 26C~ FEET FRCd','I FI PLIBL.'rC 1.4ELL DEPENDING UPON THE -I"'¢PE OF PLIF)I_ZC NELL, OTHER REg!U]:REMENTS FIR'¢ FIPPL.'¢. SPECZFZCRTIONS RND CON'STRUCT~ON DZFIGRRM% FIRE F'IVRZLRE:LE TO ZNSURE PF..'OF'ER ZNSTRLL.FiT]:Or.,!. I CERT)]':'"¢ THFIT :'L: :( RM FRM](LIRR !-,.IITH THE REg4UIREMENTS FOR ON--SITE SEWER:S RN[:, I.,.IEI..LS t~S SET FORTH 8Y THE MUN~C!PFIL. ZT'¢ OF RNCHORFIGE. 2: :( P.I:[LL ZNS'TRLL THE SVS;TEM ZP,I RC:COR[':,Fff.,ICE 1.4]:TH THE COl)ES. 2~:: I UNDERSTFIN[:, THRT THE ON-SZTE S;EI.qER :SMZ'fEM MFI~' REgILIZRE EI'qLF~RGEMENT ZF THE RES Ii DENC:E IS REMODELED TO ]iNCLUDE MORE THRN 5 8EDF;'.OOMfS. Z GNED: _.~ S; ..... ................... .. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222f SOILS LOG - PERCOLATION TEST [] SOILS LOG [] PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION; J~/ /~ IV' ///,-9~ J///;,q~ ,;LoT- q ,, ~LOPE SITE PLAN 3 4- 5- 6- 7 8 9- 10- 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS , / WAS GROUND WATER ENCOUNTERED? '~ IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop P~-~. .G'-/B ~0 rn,~, /-~r ~-~ ~-- Ig '" " 4<5 . _..'..'..'..'..'..'~);~v PERCOLATION RATE ~7~0~- 5 (minutes/inch) TEST RUN BE~EEN ~ ~ FT AND ~ FT PERFORMED BY: 72-008 (7/76) CERTIFIED BY: FEET P1;[I',!If'IUI','I DIS"f'Ri'-,IC[F.~ [3ETHEEi",I R H_r.:_:L_L. FIN[) FIN'.¢ Oi'.,f..-L.7,]:TE '.:.;EI.qFIGE DZSF'OSFIL SY!S'I'Ei'"I d. EiE'~ I:::'IEET FOF?. R F'R]:',/FtTIE HELL..: ±56!i "r'o 2EIE'~ FEET I.:'i.:?.Or,1 Fl F'LIE:I..ZC !*IE:I.~L. I.)EF'ENDZNG UPON THE TYPE OF PLIEd__.iC F4ELt_. ' !.4EL.L LOOS FIF?.E F'.Eg!LIIF;'.E[::, RND r,IL.IS"I" 13!E F:ETLIF?.I',IED '['O THE [:,EF'FIF?.TI"IENT OF' '1"HE 14E!...L COr,IF'LET):OI',~. O'THEI:;;'. F,?.EQLIIF;'.EP!ENTS h'tl::l'-/ F:iPF'L'.r'. E;F'E;E:]]I::'iCFIT:[ON% RI'q[) COI'.~STRUCTION [>IRGF.?.I'-"Ii','IS FIRE FI',,,'R ]: LFIBL.E TO INSURE F'ROF'EF'. :( i'4%TRLLFF!" I ON. .~ CER-!".~F:'h.' TF!F:FF :i: I Rhl FrFII',I);L..];I:::II;~'. H]Z'T'I4 THE: REQUIRE!'qENT% FI:3R ON-~5ITE 5EI.,.IEF'.S FIND F.IE[_L.~¢ RS 2;ET FORTH E:'¢ THE ?tLII'.~ :1: C ~ F'FtL ~ T'¢ Ot::' RNCHOF~'.RGE. 2: :[ !.,.IZLL ~:NSTFII..L_ THE: %'.r%TE:FI ZI'.,! FIE:E:ORDFINCE I.,.lz-rl.-I THE COE)EES. OEpT. OF H~:ALTt4 & [~£CEJVED December 29, 1978 ~780295 Larry/June Boots Star Route A Box 1722K Anchorage~ Alaska 99502 Subject: T12N R3W Section 22 Lot 9 N½ N½ S½ A permit issued by this department for well and/or sower system has expired. Permits are issued on a calendar year basis, as stated on the permitv by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, Les No Buohholz. RoSo Senior Environmental Specialist NB/ljw enc: copy of permit F Department ~ ~F' ~,~3_30. "C" Street, Anchorage, Alaska 99503 274-4561 ~ ~-~~ ~ ~ ~' Date Received ~~ ' '~/ -- ~/ "~Time ' ~~ Date of Inspection ~~.. 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: 3. Legal Description: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 4. Location: f~c~ 5. Type of facility to be inspect No. of bedrooms 6. Well Data: A. Type ~.-~'~'~/~/--~ B. Depth ~_~G C. Construction Phone: .Phone: D. Bacterial Analysis Sewage Disposal System: A. Installed ~_/~ /o~G B. Installer /-/~/~ D. seepage Pit: I. Absor~i~K6n-Area--- 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank ~C~ , Absorpt a 7 ~., Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re~..~t for Approval of Individual ~ er & Water Facilities Comments Approved~x~C~J/~ Disapproved Date & Appr°Val Valid for one year from date signed Greater Anchorage Ar~a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED ?~/~ ~ ~¢~¢/~' Date ¢-~ ~' 7 '~'// . 06-1~20(a) Rev. 1978 ALA[ ~DEPARTMENT OF HEALTH AND SOCIAL S['~-'~ES · DIVISION OF PUBLIC HEALTH Las Na. INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL4WATER ANALYSIS . OFFICE INDIVIDUALz[~~ / SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO NAME ' /: ~ %' / ' / ADDRESS AnalysTs shows thb Waler SAMPLE to be: ~..-S(~[ls factory ~ [] UnsalJsfaclor¥ [] Questionable [] Sample too long in transit; sample should not be over 48 hours old. at examination to indicate reiiabJe resq~Jls. Please send new sample. CITY J / , ZIP CODE c..- :~.~ ADDRESS OF SOURCE 'i COMPLETE THIS SECTION- ONLY IF WATER IS AN INDIVIDUAL' SUPPLY SAMPLE COLLECTED BY / ~ ? //( DATE COLLECTED'/'' '? '/ 7(/ TIME COLLECTED // ?" -) ~''/ Diameter of Well Depth , Feet. Well Casing Material Diameter Depth PUMP LOCATIO]~: [] In Well [] Basement [] In Basement [] Room [] Of Well [] Other [] Battle brohen in transit, please send new sample. SANITARIAN'S REMARKS PURPOSE OF EXAMINATION: Illness Suspected? [] Yes [] No READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE 06-1220 ,o BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1973 Dale Received ~ /' (~, Time Received t.~ . .~ pm' L~b, No, Lactose Broth 10¢c 10cc 10cc 10cc {0cc T.0cc 1.0cc 24 Hours EMB AGAR Laclose Broth, 24 hrs. 48 hfs, Gram~s stain CoBForm Density (Mosl probable No. per 100cc) MF Results This analysis indicates Coliform Organisms to be: ( Absent