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Home My WebLink AboutTALUS WEST BLK 2 LT 6 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 Add,ess L---- V'e f' ~ 7C/' ~'/~ I~"~ ~ ~ ~ SEPTIC ABSORPTION Pho,~,, JP.r~UNo. ND. Of o~ WELL TANKS Manufacturer Capacity in gallons ~J TYPE OF SYSTEM ~ ~TRENCH ~ BED ~ W. DRAIN ~OTHER ~ original grade ~'~ FT ~ ~T Fill added above original grade Grave} depth beneath Ripe ~ : ~ Total absorpaon area Dista.ce between lines , Number of lines So,I rating Pipe material "1'~' WE CS ., ~ PRIVATE ~ OTHER fldentifv) Cla~ificagon (A.B.C) Total oepm FT C"sed to /, ~ / ~ ~ld ~a3c ¢~.A $~d fo.r o~,~ ,nspecUonsPedormedby; Municipal and Slale guiflelines in eilecl on Ibis dale: ~,/~/~ 0 , t 72-013 (8/85) ALASKA E nUIROIlmI rlTAL COI1TROL $1 RUICE$, IrlC. ~n~lineerinq ~- ~nuironmenlal Sludic$ SPECIFICATIONS FOR BED WASTEWATER TREATMENT SYSTEM LEGAL DESCRIPTION: LOT 6, BLOCK 2, TALUS WEST SUBDIVISION 1.0 GENERAL 1.1 The Drawings, sheets i through 4, shat1 be part of this specification. 1.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & Haman Services (Df{tlS), the conditions of the permit, and all applicable rules regulations currently in effect. 1.3 All excavations and depths are advisory, and are to be verified or modified in the fie]d by the Engineer or inspecting agency. 1.4 It is the responsibility of the property owner or installer to adhere to approved design for tile installation, to maintain the specified separation distances and to have the appropriate inspections. 1.5 It is the responsibility of the property owner or installer to report to the engineer any observed conditions which would put the system in violation of state or Municipal regulations. 1.6 If the installation is not inspected by an AECS engineer, AECS will not be responsible for the installed system. An engineer at AECS should be consu]ted prior to construction, to determine the number of inspections that will be required and to explain what these inspections will involve. and 2.0 SEPTIC TANK 2.1 If there is an existing septic tank it may be used if it meets the capacity reqairement for the residence. The structural integrity of the tank must be verified. 2.2 The septic tank shall be a UPC-approved two-compartment tank, constructed of 12 gauge steel with bitumastic coating and set level on undisturbed soil. If the tank is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch burial type polystyrene rigid board insulation. 1412 W~$t 33~b ,~.v6nu6 · ,kncho~q¢, 3.(ask~ 99503 · (907) 279-5553 3.5 3.6 3.7 3.8 pounds and shall meet the approval of DHHS for as drainfield pipe. All pipes shall be laid level, and spaced according to the drawings. use Monitor standpipes shall be placed as shown in the drawings. They shall be 4 iuch rigid PVC ASTM D-3034, or cast iron. The section shown with holes may be either drilled 0.5 inch holes on 6 inch centers on opposing sides of the pipe, or a section of regular perforated sewer pipe may be clamped to the solid seclion with a no-hub coupling or solvent joint. The perforated section of the monitor tube shall be located in gravel only. The portion of pipe above the sewer rock shall be solid. A rubber raincap (Jim Cap or equivalent) shall be placed over the top of the pipe. Filter fabric is required. The side slope of the mound shall be slope 1 foot vertical to $ feet horizontal. The bed shall be planted with a white clover and red fescue mix, or with Kentucky bluegrass. 4.0 INSPECTIONS 4.2 4.3 4.4 4.5 This bed will require a minimum of three inspections. The first inspection will be of the open excavation, to assure that the system is installed in the proper soil strata, correct depth and meet minimum specified design parameters. The second inspection will be after placement of gravel, monitor standpipes, and distribution pipe, to verify proper installation and position of pipes prior to backfill. The third inspection will .be after final backfill grading and seeding to ensure that adequate soil cover has been provided over the bed. The inspection of the septic tank or lift station installation can be incorporated with any one of the above listed inspections. The lift station will require either an MOA electrical inspection or certification by a licensed electrician depending on whether the building code applies to this part of the city. 2.3 2.4 2.5 2.6 2.7 The septic tank shall be a minimum of 5 feet from the house foundation, and a minimum of 5 feet from the absorption area. The septic tank and bed shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class "C" wells, and 200 feet from Class "A" or "B" wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by DHHS or Alaska Department of Environmental Conservation (ADEC). Piping shall be fitted with a mechanical watertight calder coupling on the outlet and inlet of the septic tank. Piping shall be 4 inch so]id PVC ASTM D-$034 or cast iron, sloped a minimum of 1/4 inch per lineal foot on the inlet side and 1/8 inch per foot on the outlet side. If the piping is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch burial type polystyrene rigid board insulation. Cleanouts shall be installed as designated and capped with air-tight rain caps (Jim Caps or equivalent), and extend a minimum of 1 foot above ground level. If a lift station is required it shall be a combination lift station septic tank per Anchorage Tank and Welding, Inc. design. Specifications and design drawings are on file with the municipality and the engineer. 3.0 SEEPAGE BED 3.1 3.2 The gravel for the bed shall be 0.5 to 2.5 inch, screened rock with less than 3 percent passing the No. 200 sieve. All substitutes must have prior DHHS approval. The bottom of the excavation shall be level and raked with the backhoe blade to ensure that the bottom has not been compacted during excavation. 3.3 Sand, for leveling, shall have a size distribution which meets the requirements of MOA code 15.65.077. 3.4 The distribution pipe shall be perforated 4 inch rigid PVC with a minimum crush strength of 1500 ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO. J OF ~' SCALE /q--~' Y/ is John tlc. 3510-S · P~.kA LEGEND "/ 0 cot C~N£RS FOUNDATION §yRVEYOfl'8 CERTIFICATION II HENtEY CEHTIFY THAT ! HAVE EURVEYED THE Al 8HOWN ON THII PLAT, 0.....,. to,.~.o._gpt ,,,~7 · . -- DRAINAGE ARROWa ... NOTES' · ,, I, IT IHALL BE TH]r REEPOHIIIILITY OF THE BUILDER OR O~I/NgR TO VERIFY THa' BUILDING LOCATION SHOWN MEI[TI ALt. BUIDIVIBION COVENANTS AND ZONINl BESSE, EPPS 8~ POTTS 2220 E. 88'1h. AVE. 349-6451 ANCHORAGE, ALASKA 99507 344-135: PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE P~RFORI LEGAL DESCRIPTION: ~ g ~ P__ ~/~' /'¢~-7L 5'~ Township, Range, Section: ~--/o~/tJ /~..~-~, .~' ~__ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS //~ ~ ~ SLOPE SITE PLAN WAS GROUND WATER IF YES, AT WHAT //, j"- SL DEPTH? . pO E Depth to Water Alter Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN __ (minutes/inch) PERC HOLE DIAMETER FTANDZ,? FT PERFORMED BY: ~/ ' /~4 ~'''/ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ¢ ,r/'~ ~"7/~' ~) 72*008 (Rev. 4/85) Department of Environmental Quail y 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION MAILING ADDRESS ?¢~::5c/ /~)U. Kc' PHONE,~UT'? LEGAL DESCRIPTION ~-£>)- SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH ! MANUFACTURER i~''~/L~ INSIDE WIDTH MATER IAL '-~-'~{ r 'J -< NUMBER OF COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY /Z?.$'(~ GALLONS. SEEPAGE PIT: / NUMBER OF PITS ] DIAMETER OR WIDTH~/ , LINING MATERIAL~[d~{) /"'~c.m~ CRIB SIZE: DIAMETER BUILDING FOUNDATION ~--'~' I , NEAREST LOT LINE ~-' ~ LENGTH~'-)'7 , DEPTH /~¥ / :'~' DEPTH ¥~ DISTANCE FROM: WELL //~; / TOTAL EFFECTIVE c-/ ~7~.~ ABSORPTION AREA (WALL AREA) ~ SQ. FT, ADDITIONAL ABSORPTION WELL: /;,%O¢':; :~.~:o.t TYPE i~'l)i~J'~(J~(¢;) CONSTRUCTION BUILDING NEAREST FOUNDATION -- LOT LINE CESSPOOL_ OTHER SOURCES APPROVED DISAPPROVED NEAREST SEWER LINE REMARKS / DEPTH /~ DISTANCE FROM: SEPTIC SEEPAGE TANK __ SYSTEM DISTANCES: INSTALLED BY: ,]~t [7L/,g PiPE MATERIAL: LOT SLOPE: REMARKS:-(-/6(?:? DIAGRAM OF SYSTEM -i-~t~i,,~ ;~/;,, ~';,~ /~ DATE ~)('--(" L~ /~: 'Z ¢ APPROVED G.A.A,B. Form No, ED-031 GreaTEr ANCHOrAgE Area Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE~ ALASKA 99503 TELEPHONE 274-456 ! SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. - INSTALLATION LOCATION LEGAL DESCRIPTION TYPE AND SIZE OF FACILITY TO BE SERVED =[~~/~2~ ~ ~'~" "= ~ ~ '= ~ p FINANCED THROUGH SOIL TEST RESULTS SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. ~ ' ~:~/~.~/~/~ StZE SEPT[C TANK SIZ~--~--- - ~'~TYPE SEEPAGE AREA MINIMUM DISTANCES, REOlUlREMENTB FOLINDAT[ON TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT <~ , DRAIN FIELD SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK ~'-/ SEEPAGE Pit '~ WELL TO SEPTIC TANK ./'~)-- ~0 SEEPAGE PiT WATER MAIN TO SEPTIg TANK /~ j SEEPAGE Pit / , SEPTIg TANK, ~ ~ SEEPAG~ PIT DRAIN FIELD TO RIVER, LAK~, STREAM, GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR DIAGRAM OF SYSTEM I ~ERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GRE ANCHORAge AREA BOROUG DINANCE NO. 28-68 AND THAT THE AI3OVE iGREATER ,ANCHORAGE AREA BOROUGHt ~J HEALTH DEPARTMENT ' ~/ CASE # 327 EAGLE STREET ......... ANCHORAGE~ ALASKA99501 This Form Reports a. So~ls Lo6 .... ~ Percolation Tes~_~___. ,,, Soil Characteristics Depth Feet Location Sketch Was Ground Water Encountered? If Yes~ At What Depth lO Reading Date Gross Time Net Time Depth To H20 Net Drop Proposed lnstal~Seepage Pit ~-/ Drain Field Depth Of Inlet D - "' , ~ epth To Bottom,Of Pit Or '~enc~---- ,,, ] ~ ...... / ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Day phone Day phone~ Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: /~*" TYPE OF WATER SUPPLY: ndividual well Community well Public water NOTE: 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 / V NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-O25(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 verifythat 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. NameofFirm '"1 ~J~J<)~*~, ~"~u~-~,_L**.,,,~t/ 'p.~_- Phone Address ¢,~ .~ ~.¢. /.~/..~ /4~ Engineer's signature DHHS SIGNATURE -/ Approved for ~'~0~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 D H 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 engineer's work. 72-025 (Rev, 1/91) Back MOA t¢21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 34;~P~4~. Legal Description: Health Authority Approval Checklist ~ ~ T/~'~-~.~ \x/y~.~-- Parcel I.D.: MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION A. WELL DATA Well type Log present (Y/N) Total depth / Sanitary seal (Y/N) Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ~/-J, O -/ FROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform ~ Date of sample: L////._~.-/ Nitrate /. O ? t4,~-/~ Other bacteria / Collected by: "'T--. -~ B. SEPTIC/HOLDING TANK DATA Date installed [ ~7~ Tank size /~,~O Number of Compartments I Cleanouts (Y/N).__ Foundation cleanout (Y/N) ~/ Depression (Y/N) /~ High water alarm (y/N) ~'~ Date of Pumping I~/j~/~ ~ Pumper A ~ C. ABSORPTION FIELD DATA installed 7/~,~//~"~ O Date Length Z./,~ Width Effective absorption area //J Date of adequacy test /'/'/~--/~ Soil rating ~g.p.d./ff~ or fF/bdrm) /~/~ 7 Gravel thickness below pipe Monitoring Tube present (Y/N) y Results (Pass/Fail) '~ System type ~) ~d~ Total depth ~3 , Depression over field (Y/N) W For ~ bedrooms Fluid depth in absorption field before test (in.); Fluid depth ~ (ins) Minutes later: Peroxide treatment (past 12 months) (y/N) Immediately affer~g) gal. water added (in.): Absorption rate = '~' ~Or~.) g.p.d. If yes, give date ~ 72-026 (Rev. 3/96)* D. LIFT STATION r~/,~ Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* *Datum Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Io '7 "Pump off" level at*. On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation / j I Property line ~ /~, I Absorption field ~, / Water main/service line SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain E ENGINEER'S CERTIFICATION ~ I certify that I have determined thru field inspections and review of Municipal records that tile abdv~ ~stcms are · inconformancewithMOAHAAguidelinesiq¢ffectonthisdate. ,',"~'' ' I=,nineer's Name i ~., ~1,~..~ ~1 '~P ~'' v-V...,t-A ~,L~/~ .~'-,'~ ~, ',"-',,'-~/~ ': "~ Building foundation ~:~. I Water main/service line Driveway. parking/vehicle storage area Wells on adjacent lots ~' / HAA Fee $ 5~') "- '''~ Date of payment '~/~,~/'~,~ Receipt Number /' Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* CT&E Environmental Service~ Inc. CT&E Ref.~¢ Client Name Projec~ Namel¢/ Client Sample ID Matt'ix Ordered By PWS1D 991586001 Tobben Spurkland N/A Lt 6 Bk 2 Talus West Dri~dng Water Sample Remarks: Clieat Printed Date/Tmle 04/19/99 t3:21 Collected Dal;e/Tim~ 04/15/99 Received Dalt~/~J)~p' 04/15/99 ]4:15 Technical Director: Steph~n C. Ede 1.07 O.§O0 m~/L $M18 9~8 EPA )oO,O 10 m~x 0~115/99 K-,AP 0;Z15/99 D~/15/99 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) (b) (c) Lending nst tuhon.- 'i .- ;~ Telephone Property'0wner,~=~..~.~e.~.~:/-/z ;/.~e.~..~,/ Telephone:(home)-,TYJ"'-)3~'~' Business Mailing Addr~'s$'~-~ ~ ~'~ 0 ~/u.r ,,Or/v.4P /¢~ ce/ ,,,¢-,~- '~ ~'J"/..~ Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here,~2~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family,,~ Number of bedrooms 3. WATER SUPPLY Individual Well)~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting 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 ce trifled by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is 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. J 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 ,,'z/1-~'~c~' ~ Address /k~ ~o-~¢ ~_FO~¢ ~ Telephone Approved for ¢ bedrooms by ..... Date Approved ?~._ Disapproved Conditional Terms of Conditional Approval 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 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: T/,~/'o /P_.7~ A. WELL DATA Well Classification pr'/Ua Well Log Present (Y{~ . Date Completed Total Depth /2.*¢- Cased to ,-~ ~¢)/ Depth of Grouting Static Water Level Casing Hei.ght Above Ground /¢ / Electrical Wiring in Conduit(C~/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 Water Sample Collected by ~/ , /:~>-¢ 4o/ Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) "'ur//'¢ Yield ,.¢', ¢' c-, .~'~ ~,,~,/f,o Pump Set At '-- Sanitary Seal on Casing~N) Depression Around Wellhead (Y/~ To Nearest Public Sewer Cleanout/Manhole .,> '¢o / ;Date ~//'1//¢ 0 ; On Adjoining Lots ; On Adjoining Lots Comments B. SEPTIC/HOLDING TA~.~., DATA Date installed /~/?¢ Size /ZJ"o No. of Compartments / Standpipes ~)N) Air-tight Caps O/N) Foundation Cleanout~N) Depression over Tank (Y/~ Date Last Pumped ~/*~ Pumping/Maintenance Contact on File (Y/N) ~ ; for Holding Tank High~[~[~'~l~¢~(Y/N) ~/~ Temporary Holding Tank Permit (Y/N) SEPARATIO~ DI.STA~¢¢~:~SEPTIC/HOLDING TANK: Tn i~kv % ,~ ~, /;~ TO Budd~n Foundaton To Property Line /~ · To Disposal Field To Water Mair{~St~t'vi~ To Stream, PCB~;~.I-a~.o (~r MaJ0r:,D[amage Course Comments . 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~./,z-/¢ ~ Width of Field 02- Square Feet of Absortion Area //.7 cf/ Depression over Field (YI~ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /'~) ¢ / To Building Foundation Lot OW To Water Main/Service Line ~ ~'Y'-/ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present,N) Date of Last Adequacy Test / To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ ~ To Cutback (if present) D, LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Ac~9.Ces~Y/N) "Pump On" Level at ~2~'¢mp Off" Level at High Water Alarm Level at ~.. // Vent(Y/N) _ Tested for /./'"/~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guideli inspection. ~~/ Signed Company L/) ~'¢~' ~ Date ,~'/$/'¢ ¢) MOA No.~--~ ?~ --0 Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No, Waiver Fee: $ n.e~4['~.fect on the date of this 0 '/ii ~.~ t~~/~%¢~gineer s Seal Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE ~J'~ DIVISION OF ENVIRONMA~NTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONbIENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (a) (b) Applicants Name ~Apz Applicants Address Telej~hone - Home Business (c) Applicant~is (check one) Lending Institution ~---~ ; O~mer/builder ~ ; Buyer~ ; Other~. (explain); . ~t.,.lo,"---~~- (d) Lending Institution Telephone Address (e) (f) Real Estate Co. & Address -P~''?O Telephone ~_~7. ~-- ~_7~I Mail the HAA to tha following address: 2. T_iip_~__pf Residence Single-Family~ Number of Bedrooms 3. Water Supplz- Individual Well~ Multi-Family Other (describe) Community~--~ Public~_~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ~ewage Disposa~ Onsite~_~ Public~ Community~ Holding Tank~--~ Note: If community well system, must have ~itten confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] En~eerin8 Firm Providin~Inspections, Tests~ File Search~ Data and Information Aa 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 regula- tions in effect on the date of this i~stail~ti~on. Name of Address Telephon% ~z/~'-~t/~7 (ENGINEER SEAL) DHEP Approval Approved for.~ZF/~- bedrooms Approved ~ Disapproved __ Terms of Conditional Approval B M~Z~-~q ate ~'--~' iondition2'p -/~/f~/F~ CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH A~D ENVIRONM~NTAL PROTECTION (DHEP) ISSUES REALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER tLEGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EI~PLOYEES OF DHEP 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. (DHEP SF~) RR4/ej/D18 [Page 2 of 2] 7-19-84 ae DEPT, OF HEALTH & ENVIRONMENTAL pROTECTION Well Classification Well Log P~esent (Y/N) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHOP~ITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: ,8E . 2 8 1984 .RECEIVED If A, B, o~ C, D.E.C. Approved(Y/N) Date Completed Total Depth /_-~-~/ Cased to Static Water Level -- Pump Set At Casing Height Above Ground / Electrical Wiring in Conduit (Y/N) Separation Distances f~om Well: To Septic/Holding Tank on Lot /~LD / TO Nearest Edge of Absorption Field on Lot To Nearest Public Sewe~ Line --- Yield (~/ Depth of G~outing. -- Seal on Casing (Y/N) Sanitary Depression A~ound Wellhead (Y/N) ; On Adjoining Lots /~,~ ~ ,; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Wate~ Sample Collected By ~-~ ~l' ; Date ~/~ ~/~ / Wate~ Sample Test Hesults B. SEPTIC/HOLDING TANK DATA ! Date Installed /~,/¢2~/ Standpipes (Y/N) ~ Depression ove~ Tank (Y/N) si~ / ~ , , Ai~-tight Caps (Y/N) ~V . Date Last Pun~ped No. of Compartments ) Foundatio5 Cleanout (Y/N)~ Pumping/Maintenance Contract on File (Y/N) ~/ ' ; for -- Holding Tank High-Wate~Ala~m (Y/N) /?//~ Tempora~YHoldingTank Permit (Y/N) Separation Distances f~om Septic/Holding Tank: To Water-Supply Well /;z-~ ~ To Building Foundation / To P~ope~ty Line /6 ~ To Water Main/Service Line Course To Disposal Field ~ / To Stream, Pond, Lake, c~ Majo~ D~aina~e Cofm~nts [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils l~ating in Absorption Strata Date Installed ~_ ;~,/~ Width of Field fl~ / Square Feet of Absorption A~ea Depreession ove~ Field (Y/N) A/ Type of System ~sign Length of Field -p~?/ Dapth of Field I~ ~ Greavel Bed Thickness -~ Standpipes P~esent (Y/N) Date of last Adequacy Test.. Results of Lest Adequacy Test ~75~75~w~ Separation Distance from Absorption Field: To ~tere-SupplyWell To Building Foundation Lot ~ To Wate= Main/Se=vice Line To St=eam/Pond/Lake/c~z Major D~aina~e Course To D~iveway, Parekin~ A~ea, c~ Vehicle ate=age A~ea , Con~n~nts II~ / To P~operty Line I~ / To Existing or Abandoned System ; On Adjoinin~Lots ~//~ /~,~ To Cutbank(if p~esent) Date Installed Size in Gallons "Pump On" Level at High Wate~ Alarm Level at Tested for Elect=ical Codes(Y/N) Dimsnsions Manhole/Access (Y/N) "Pump Off" Level ~t Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Con~n~nts ** Check Peremitted Bed~ocr~ Rating A~ainst HAA Request ** I ce~'tify that I have checked, ve~'ified, ore ~nf~'n~d to all MOA H3~ on the date of th~s ~,~ ....... ~$T4~t~4/ Signed _~/~ ~ ~ . .~> Date ~P/~ ~/~?/ Co, any f~W~F~ ~( ~ t ~c MOA No. KB1/d5/s in effect [Page 2 of 2] 2-15-84 Location: BESSF., EPPS & POI~S 2220 EAST 88 AV~qUE ~/~ORAGE, AK 99507 (907) 349-645]. WATER ~ELL TEST subdivision: Lot: Block: Client's Name: Address: Tester: 2~'"J..J. Initial Reading on Meter: TIME GPM A ¥OLUME TOTAL VOLUME /: .'.,'g 6, I ~z ,¢'/~'.Z Production Rate: (~,/ GPM 24-Hour Capacity ~ Gallo~s September 27, 1984 Municipality of Anchorage Department of Health and Environmental Protection 825 "L" Street Anchorage, AK 99501 Attn: Keith Bandt Re: Adequacy Test - Talus West Subdivision Lot 6, Block 2, Anchorage Dear Mr. Bandt, On September 25, 1984, the referenced on-site lot septic tank was pumped out and approximately 1500 gallons were recovered. The following day over 600 gallons of water were pumped into the on-site leach field and the field was found to be adequate at that time. Sincerely, Dale R. Merrell, ~.E. Engineer RPW/lbs ENGINEERING, PLANNING, SURVEYING 2220 E. 88th Ave./Anchorage, Alaska 99507/Telephone 907-349-6451/344-1352 "Providing a quality personalized service to those building Alaska's future" 3330 'GREATER ANCHORAGE ARE/~ BOROUGH Department of Environmental Quality "C" St,, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Owner: (-~/A ~-~. Mailing Address': .~0~ 3. Name of Buyer; xS~~ VA FHA CONV ~ &2). ,~-.,~ Day Phone.~-7~L-d)~,~i, · Mailin§ Address: ~m~..-u,'~. DaN Phone 5.Name of Realtor or Agent: 0 Mailing..Address: ,Phone Legal Description:' Location: ~ · Type of Facility to be inspected: ~ater Supply Type of Supply: Public Utility If Individual, number of dwellings No. Bdrms. Individual presently .served if Individual, depth of well Sewage Disposal'System . Type .of S~stem: Public Utility If Individual, date of installation Individual (on-site) ,.~ . pr & Water Facilities Page 2 of two pages - Re( ~t for Approval of Individual ¢ ~ Legal Description ~ ~:~/~ 7~/4~ ~m_~S~~' Comments Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM Date certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facitit~s-~n~ ~hese facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) /~tI~HHI$)~) GREATER ANCHORAGE AREA BOROUGH II1 / ~ Department of Environmental quality ~~ 3330 C Street, Anchorage, Alaska 99503 274 ~'~ ..~ ~CS~ ~..~ ~ x~ ~' REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval requested by: Mailing Address: '~ 3. Legal Description: ~ ~ ~-~/U~/_~~- 4. Location: .~/~Z~ ~Z ~/~,~ 5. Type of facility to be inspected .~F /) No. of bedrooms 6. Well Data: /o ~/-~¢ /,/ ~-¢, ~ , ,~ /;~',,¢,,]'~¢ B. Depth o A. Type __Z--~). ¢. Construction o~d Sewage Disposal System: A. Installed /~7~/ C. Septic Tank: D. Seepage Pit: E. Disposal Field: D. Bacterial Analysis~' B. Installer ~1]~/~ 1. Size /~-~7~/ 2. Manufacturer 1. Absorption Are~ ~2~~]' 2. Material ./ Total length of lines-, Distances: A. Well to: Septic tank Nearest lot line ~J¢( B. Foundation to septic tank ~! C. Absorption area to nearest lot line , Absorption area Other contamination , Absorption area /?' , Sewer Lines , EQ-034 (1/74) Page 1 of two pages ~0~0~ ~V~IO~ ~ " Zt i~ the respon~fb~,lH:y of the o~er O~ · ~. ~.* ~o,,.~ .., .., propo,,ed buihlh~g m-de relative to ~in. /i)~// ~ *~,~, ,~a~'%o. ...... ' ..~ >..." ~e,J g~ade ~nd ,fl. !dy connections and determine the (*:i.u.'nee ol any ea~- ~o not Op)ear on tke r~rded ~ubdivl ,.. ~lon p at, I LEGEND: ~ Brass Cap Monument LOT SURVEy CERTIFICATION · Steel Pin Lot ~ , Block ~' ~ Survey Hub a Tack Anchorage Recording Precinct, Alaska REWS~O~S OA~E PreporedBy: ~DICRIN~N ~WhLD.WhLCH.LCC of: ~ C~GI~CCR¢ ANCHORAC[. AtASKA