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Home My WebLink AboutTALUS WEST BLK 2 LT 12 DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Heallh Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGEs.DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name ~Q.~Jt ~(~ /~.Q ,0~T. ,~., ..... DISTANCES Address FROM ~ HOLD'TANK FIELD WELL 2~oo CoRbovA AN~,~k qq~o~ Phone(s)27~ --2~ I 'Per rmlit~oNo.o~O~ No. o~edrooms WELL LEGAL DESCRiPTiON LOT LINE Township. Range, Section SEC 22 T 12 N ~3~ AS-BUILTDIAGRAM (ShowmocaUonofwemm. sopticsystem, propertymmes, foundat,on, TANKS T~L~ 5 m SEPTIC N HOLDING ~NcHORheE TANK 3o~ ~ I Materml No oI Companmems TYPE OF SYSTEM (N. ~d I ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER ~ I I Depth to pipe bottom from Total depth from original grade L I Fill added above origmal grade Gravel depth beneath pipe ~T .,kq B')RI FT, 8Q FI Fl WE~LS ~J r/~O ~ PRIVATE ~ OTHER {Identify) REMARKS: NunJcJpal and Slate guidelines in effect on this date: II [~ [ P~ 72 013 (3/85) ~lattop Technical Services 14530 Echo Street ~nchorage, g_laskcr 9951~ Lot 12, Block 2, Talus West S/D 4900 Talus Drive Holding Tank Installation Spec/fications and Design Notes 1. The scope of the project consists of the abandonment of two existing septic tanks and a seepage pit, and the installation of a new 3000 gallon holding tank equipped with a high level alarm device. The installation of a conventional soil absorption system on this lot is not feasible due to the presence of a shallow seasonal groundwater table, coupled with highly disturbed soils of low permeability. 2. All construction shall be as depicted on the location plan, except that minor modfl'ications may be allowed or required by the engineer conducting the inspections. All construction practices and material specifications shall conform with Municipal and State requirements. The contractor shall arrange for any necessary utility locates. 3. The existing 10.00 gallon and 500 gallon septic tanks are to be pumped and filled with soil or crushed and buried at an approved location on site. The existing seepage pit is to be pumped and completely filled with soil. The existing soil absorption trench is to be abandoned in place with the standpipes removed. 4. A new Municipally approved 3000 gallon steel holding,tank with bituminous coating inside and out shall be installed at the location shown, and connected into the waste line coming from the house downstream of the existing,cleanout. The tank shall be equipped with a watertight access port, and two 4 inch diame)er standpipes allowing the tank to be pumped from a different cleanout than the one in'~hich the alarm float is mounted. The tank shall be set level, and shall have a minimum burial depth of 5 feet. 5. An app.roved high level float shall be installed in the holding tank and set to trigger an audible and visible alarm mounted inside the residence whenever the fluid capacity remaining in the holding tank is less than 500 gallons. 6. The final ground surface over the holding tank and the abandoned components of the septic system shall be mounded sufficiently to allow for subsequent natural earth compaction without the formation of a depression. All disturbed areas shall be graded to smooth contours, then covered with 4 inches of topsoil and seeded with an approved lawn grass seed. 7. A total of 3 inspections will be required during the course of construction: ( 1 ) Init/al stakeout, (2) after the tank is installed and plumbed, with the alarm system in place, but prior to backfill, and (3) after final backfill, grading, and seeding is complete. TALUS DR LoT II 1214 h/~LL LoT 12q.t ~!attO~ Technlcal Services 14530 Echo Street lfnchorage, Alaska 99516 L 12, B2. ~ TALUS WEST S.D. HOLD,N6 TANK INSTALLATmN LOCATION DRAWING DATE: cl/qo SCALE '. I" =~,0/ ~OTE: THIS NO'T A SURVEYED ?L~T, ALL LOCATIO N5 ARE Air'pRo× t MATE L2 TALgS DR~vE L N/ELL L8 I5o/-r WELL WiTH E~LDG. P/ID ~ ~EPTi¢ ~_attop Technical Services 14530 Echo Street Anchorage, Alaskc~ 99516 '~ ~%tHEOoO~e ~. Moore.?, ~%'.. ce. sss~ ., ~- % ~ -.. ...' ~ ~ L 12, B2, TALUS WELl_ ~- _SEPTIC SITE PLA~ SYSTEM BaTE: SCALE: I"= 5'0 No'rE .' THIS IS BlOT ,qLL LOCA 'T 1o NS /~RE ~?PRDVIMATE PERPOS~O ~OS= A H FC Flattop Technical Services 14530 Echo Street Anchorage, Alaskc~ 99516 Munlclpalily of Anchorage DEPARTMENT OF: HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST % REMAX - NILLIE KLEVE~ LEGAL DESCRIPTION: L I:~; I~2,., TA LU~ ~P'C'r"Township, Range, Section:T [2. N R 3 ~v/,: .~ SLOPE · ' SIT)E 1 2 3- 4 5;- 9 10 11'- 12 i3- 15- 16- 17- 1g- 20 COMMENTS SOl L. PT OL ML SM/61'4 VERY WAS GROUND WATER ENCOUNTERED;) ~O IF YES, AT WHAT ~ DEPTH? . pO E Depth lo Water Atler Monitoring?' Date: SEC. 22 Reading Date Gross ~et Depth to Net Time Time Water Drop PERCOLATION RATE (minules/inch) PERC HOLE DIAMETER TkSTRUNeE~WEEN. ~.~ ~^ND ~'~' FT PERFORMED BY: ~='[~O~ 7'~C_~ ._~C~C~ I ?"-~-~ CERTIFY THAT THIS TEST WAS PERFORMED iN ACCORDANCE. WITHALLSTATEANDMUNiCiPALGUiDELiNESiNEFFECTONTHISDATE. DATE: 72-008 (Rev. 4/8S) ~ER~G.~ME~ .OR, A H FC ~F~/c~ttop Technfca! Services 14530 Echo Street Anchorage, Alaska 99~ Murdc~paH(¥ o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~ REMAX - MILLIE KLEVE~ LEGAL DESCRIPTION= L I'~, B.,~.., T/~ LL/S 9- 10 14- 15- 16- PT ~v/~cTTownship. Range. section:"[" 12 N R3 W; SEC. 2 2 SLOPE : SIT)E p WAS GROUND WATER '"'/ES ENCOUNTERED? IF YES, AT WHAT 201l SL DEPTH? ~ Deplh lo Woler After Monitoring? Dote: r Reading Date Gross Net Depth to Net Time Time Water. Drop 19 PERCOLATION RATE __ T. ~, ~2 TEsT RUN BETWEEN __ COMMENTS (minutes/inch) PERC HOLE DIAMETER -- FT AND . FT ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES iN EFFEC~F ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: -. ~/,.~/~q O Flattop Technical Servzces ;~ ..... ~ lt. ~ ~. ~nchorage, ~lask~ 99518 ~ ...........~.....--~ ~ ..... ~.~.' M,nlclpalily of Anchorage ; ~. ~ DEPARTMENT OF HEALTH & HUMAN SERVICES ,~;..~.~..~ 825 "L" Street, Anchorage, Alaska 99502-0650 .I ~ ~ ~.o~o~ ~. ~/,oo~/ ~ ~ ~ : L~A~:5~'SC"~PT~o"=LI2) ~2) TAL~5 ~CTTo nship, Range, Section:T[~N ~.~ ~ SLOP~ . Sl~ P ; ' FILL 11'- 13- 15- 16- 17 18 19- ,. 20- COMMENTS 'PT ~L 5p/~,v~ <JA~-tb., ~ILT WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT ~ DEPTH? . pO E Oepth Io Water After Moniloriag? - Date: Reading Date Gross Net Depth to Net Time Time Water. Drop PERCOLATION RATE . TEsT RUN BETWEEN _. (minutes/inch) PERC HOLE DIAMETER FT AND ~. FT PERFORMED By: F/~'I~~C~ ~'~ ~ ~1' ~ CBRTIFy THAT THIS TEST WAS PERFORMED IN ACCORDANCE W(TH ALL STATE AND MUNiCipAL GUiDBLiNES iN EFF[CT ON THiS DATB. DATE: (Rev, 6 7 9 10 11' 12- 13- 14- 15- 16 - ~! 17 18 19 20 '"K, fl. .~: - COMMENTS Flattop Technical Services 14530 Echo Street .~n.qhqrCa~. ,~lgska 99518 MUmclp~ht~ OF ~ncnornoo DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ";"Township, Range, Section:'1" [2. N, R 3 SLOPE Sl'r~ PLAN WAS GROUND WATER ENCOUNTERED;' IF YES, AT WHAT " DEPTH? . pO Depth lo Water Alter Monitoring? Dale: ;22 Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE I TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER FT AND __ FT PERFORMED BY; ~'./'~.~*/~ 7'¢C~ *.~.~c,~ I ~-*¢..~. ~ CERTIFY THAT THiS TEST WAS PERFORMED iN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72~008 (Rev, 4/$6) .ERFORMEO.O., A FC F/attop Technical Services 14530 Echo Street Afichorage, Alaska 9951R MurilcIpality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST c,/o R[MAX - MILLI£ KL~V'£N LEGAL DESCRIPTION: 2 4- 7 g 12- ~9- 20- -r. ~t. t~ COMMENTS B2. T~LU5 WE~T T°wnship, aange, Secti°n:"'/'/'2 N ~ 3"w',, pT' SLOPE ~ SI~E PLAN ~b 6RAVELL~ SiLT WAS GROUND WATER ENCOUNTERED? ~O tF YES, AT WHAT DEPTH? Oeplh Io Water Alter Moniloring? Oale: Reading Date Gross I~e; Depth to Net Time Time Water Drop t~-; 2s 25 z~ Y~ ~2:~:30 2~ Yq Y~ PERCOLATION RATE . ~O (minules/inch) PERC HOLE OJAMETER . 7 '~ TEST RUN BETWEEN [ FT AND . I,~' PT CERTIFY THAT THIS TEST WAS PERFORMED iN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN ~FFECT ON THIS DATE. DATE: 72~8 (Rev, 4/~) Flattop Technical Services 14530 Echo Street DEPARTMENT OF HEALTH & HUMAN SERVICE~ 825 "L" Street, Anchorage, Alaska 99502-06~ g2~ TALg5 WE~T T°wnship. Range, Section:~12N SLOPE I 2 7 8, 0- 10 12- 13- 14 15 17- 18 - 19- 20 COMMENTS _ WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Deplh Io Water After MonilorJng? Oate: Reading Date Gross Time PERCOLATION RATE TEST RUN BETWEEN I~ $13tE PLAN Net Time Depth to Net Water Drop -- (minules/inch) PERC HOLE DIAMETER PT AND - . FT CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCEWITHALLSTATEANDMUNiCiPALGUrDELiNESiNEFFECTONTH[SDATE. DATE: ~ .~/ ~ 72-008 (Rev. 4/85} i "ERFORMED FDR, A /FC LEGAL DESCRIPTION~ /- /2; 1 2 3 4 5 9 10 11'. 12- 13- 14 15 16 17 18- 19- 20- COMMENT8 -- PJatt6~5 TeC~n~c~z! Sezvices ..... 14530 Echo Stzeet ~.C~oz(zcj'e, _~Ic~sk~z 9951¢; Manlclpallly o! Anchorage DEPARTMENT OF HEALTFI &.HUMAN SERVICES 825 "L" Street, Anchorage, A~aska 99502-0650 SOILS LOG -- PERCOLATION TEST ~A ~//o R~C~A~ -MIL[iE KL£Y£N Township, Range, Section: '7'12 N ~ ~ ~/~ ~£~- 2. 7_ ' SLOPE · {~ S TE PLAN ENCOUNTERED? IF YES, AT WHAT DEPTH? Deplh lo Water A[ler Moniloring? Dale: Reading 4 I~0 Cate PERCOLATION RATE Time Net Time Depth to .Water 11:2{ 22 11: 2~' 27 11:25': 3o 22 Yg i{:2q: 30 2'/ 1:3o 22 ~ 11:3~ 27 ~/~ ~l y~ .7~ (minuJes/inch) PESO HOlE DIAUETER ~" FT AND . ~ FT TEaT RUN eETWEEN ~'~ Net Drop PERFORMED BY: ~ ..~o e..," ' I . ~'"~"~ ~ CERTIFy THAT THiS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. CATE: ~/'-.~/~ 72-~o8 (Rev. 4/~) .. ~ .ERFORMEO FOR: A /FC Flattop Technical Services ~ - ;~ 14530 Echo Street ,,, *: ,+u-- ~ ~Hbhorage, ~Iaska 99516 ~ .......................... DEPARTMENT OF HEALTH & HUMAN SERVICES ~ .4~.rHeooo~ ~. ~O0~Ej~ 825 "L" Street, Anchorage, Alaska 99502-0650 ~'~ '. CE - 3599 SOILS LOG -- PERCOLATION TEST . % ~ ........ .' ~ LEGAL DESCRIPTION: ~./2 ~.~. TI~LU$ ~/EST T°wnship, Range, Secti°n:"T'12 N PT '~ 5j¥~' SLOPE - |.~ SIrE PLAN t4L' 6RAWLCV SILT PT -- ~.H. pbNSELV OOM~cTEb 4 tN LooSE PERK TEST HOLE : o- ~" pT' (~RAVeLL¥ ~ILT ~.. DRY WAS GROUND WATER ENCOUNTERED? NO IF YES, AT WHAT DEPTH? Depth to Water Ailer Moniloring? Dale: Reading Date Gross Time 2;55 q;qo 11'-- L Depth to Net Water Drop 2g'/~ 2~ V~ Net Time COMMENTS PERCOLATION RATE ~ ~0 (minules/inch) PERC HOLE DIAMETER . "7" TEST RUN BETWEEN '~ FTAND . 2.-~ FT PERFORMED BY; [~. T o C ' I ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES N EFFECT ON THIS DATE. 72-008 Rev. 4/85) DATE: He~ ,h and Environmental Prote %on '~' Fourth Floor West ~J 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 INSPECTION/_R~ORT ON-SI'I'E SEWAOE DISPOSAL SYSTEM SEPTIC TANK: ~ROM WEI'.L ~-~-~-fl~ANU FACTURER -- MATERIAL j COMPARTMENTS .... INSIDE ~_ENGTH __ INSIDE WIDTH. LIQUiO DEPTH LIQUID CAPACITY GALLONS, LINE_ OF LINE ~-- DISTANCE FROM WELL /~_~____FOUNDATION/~ /~.NEAREST lOT F~rTOTAL LENGTH / ~ 'of L,nos / _~I~NCE BETWE~ LINES __ ~d.__TRENCH WIDTH~ IN. TOTAL *FFECTIVE OEPl'lh lOP GF TILE TO FINISII GRADE ___~ .... MAFERIAL BENEATH TILE ..... IN. ABOVE TILE _IN, SEEPAGE PIT: Log Crib Rings BUILDING, FOUNDATION DIAMETER .... OR WIDTH .... LENGTH. , DEPTH ---. Crib Size: D AMETER .... DEPTH __ DISTANCE FROM: WELL ...... ]OTAL EFFFCTIVE · NEAREST LOT [INE ....... ABSORPT~O_N AREA (WALL AREA) SQ. F'T. Well clas .r u ?p · Well Distance ~o. Lot Line Bldg: Sewer Line: Pipe ~ate~ials: # of Bedrooms: _ Installer~ Remarks: Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS ~)~/Z~ LEGAL DESCRIPTION SEPTIC TANK: DISTANCE .-~O1 FROM WELL INSIDE LENGTH MANUFACTURER ~'~ ~) '~¢~'~_ MATERIAL~~:~'~'/e f'~ COMPARTMENTsNUMBER OF INSIDE WIDTH LIQUID DEPTH .LIQUID CAPACITY /~::)~ GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER OR WIDTH LENGTH LINING MATERIALC~,/~;~,~ CRIB SIZE: DIAMETER BUILDING FOUNDATIONZ~', NEAREST LOT LINE ~/.. ,DEPTH // DEPTH ~' DISTANCE FROM: WELL //~ , TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) /-'/---~ SQ. FT. ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION CESSPOOL APPROVED C 0 N S T R U C T I 0 N ¢~JF'J~',,¢~,-~ NEAREST NEAREST LOT LINE SEWER LINE DEPTH ?/TL:~~ DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM OTHER SOURCES DISAPPROVED REMARKS DISTANCES: PIPE MATERIAL: LOT SLOPE: Form No, EQo031 DIAGRAM OF SYSTEM ~- DATE ~ - ~ '7~/- APPROVED GREATER ANCHORAGE AREA BorouGh PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PHONE , lB HOT VRLID WITHOUT ~OIi TEST FINAL INSPECTION: 24 HOUR NOT'CE REQUIRED. BACKFIlLiNG OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK TO SEEPAGE Pit WALL-- WELL TO SEPTIC TANK ~:L~ ~J~ SEEPAGE pIT WATER MAIN TO SEPTIC TANK ////) SEEPAGE Pit SEPTIC TANK, /[~)~ SEEPAGE Pit /~ DRAIN FIELD NG GAP OF GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # O[~' - ~ OI - 2,'2. HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) _~.1"2.., 82 , TALUS ~/E$'T SEC '2.2 "[-12N. (b) Location (address or directions) UrClOO T/tLu$ pR I v'E Property owner _¢t ~ F¢-.. ¢/o ~M4~, Telephone: (home) Mailing Address 2GOo Co'~bovl~ ~NE.d. ~ (c) Lending Institution Telephone Business .2 7~, -276/ Mailing Address (d) Real Estate Company and Agent Address _ '~ (~00 ~O~"OOV/~ Telephone '2_.'~(~ - ~_'7~, I REI"IAX ~[LLIE ~LEVE. N (e) Mail the HAA to the following address: (or check here'S, if hold for pick up.) List contact person and day phone number below: FLaTToP TEcI-I · 5v'c. £. 2. TYPE OF RESIDENCE /_/_%, Single-Family'C, 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 certified by my sea[ 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, functiona 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. NameofFirm FLA-I"TOP -J-E(~¢¢ ~'V~<, Telephone ~Z¢,~_ j~,,~-,,_~ Address _ Oete 6. DHHS APPROVAL Approved for _'/7// bedrooms by Approved ~ Disapproved Terms of Conditional Approval_ Conditional The Municipality of Anchorage Department of H~alth 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 professiona engineer's work. A. WELL D~~, MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ].. 12 TALU~ ~v'£~T If A, B, C, D.E.C. Approved (Y/N) N,,~, Well Classification PR W'ATE' Well Log Present (Y/N) NO Date Completed ~'~IoR TO Total Depth ~ lifo Cased to ~ N-O ~ Depth of Grouting Static Water Level ~ I0 ~/00 Casing Height Above Ground I ~" 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 Pump Set At ~ I1,,~/ Sanitary Seal on Casing (Y/N) yE Depression Around Werlhead (Y/N) ; On Adjoining Lots N.A-. ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date ~cT~A To Nearest Sewer Service Line on Lot Water Sample Collected by ~'t./~'Ffe? -I'_~CI4 WaterSampleTestResults ~'~-TtSF/~dTO~Y ~ 0,31 m~/I N~T~.~T~'-N ~ ~ ~(~r~ ~oo~ ~ v No. of Compartments ~£~ Foundation Cleanout (Y/N) Date Last Pumped N,,'~. ; for N,~r, Temporary Holding Tank Permit (Y/N) To Building Foundation' To Disposal Field N.~. B. z~ii~I~/HOLDING TANK DATA Date Installed lo/2.°il~ Standpipes (Y/N) y'E'~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) .Y£5 SEPARATION DISTANCES FROM ~/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-025 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA ~./~. _g in Absorption Strata Type of System Design Length of Field Depth of Field Square Feet of A~ Depression over Field (Y/N) %,_ Results of Last Adequacy Test ~ SEPARATION DISTANCE FROM ABSORPTI-""~FIELD: To Water-Supply Well "'""% To Property Line To Building Foundation ~ To Existing or Abandoned System on Lot ; On Adjoining L"'E'o~ To Cutback (11,,p.~sent) Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D, LIFT STATION Size in Gallon'S'---. "Pump On" Level at~"~ ~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions 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 guid?ines in effect on the date of this inspection. ~¢, :~,.., . ~ MOA No. ~o ~t~ ¢ ¢?~,c;.,:>~:~ r. ~',ooa~ ." N ,e eipt Receipt W iv r ee:* Amount:$ / 2 ~, ~) Date of Payment 7~-o26 (R.v 7/~) Bao~ Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907)562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE foz Work Order $ 22227 Date Report Printed: JUN L$ 90 @ 13:05 Client Sample ID:L12 B2 TALUS ~EST S/D BOILER ROOM H.B. PWSID :UA Collected JUN 5 90 @ 09:45 bxs. NeceiYed JUN S 90 ~ 13:30 h~e. Pxese~ved with :AS REQUIRED Client Name : FLATTOP TECHNICAL SRV Client Acct : FLATYOT P.O.S NONE RECEIVED Req { Ordered By : Analysis Completed :JUN 11 90 Bend Reports to: EDE 1)FLATTOP TECHNICAL SRV Laboratory Superviso~ :STEPHEN C. Released By : ~___~. ~ 2) Special Instruct: Chemlab Ref #: 901706 Lab Smpl ID: 1 Matrix: WA~BR Allowable Parameter Tested Result Units Method Limits NITRATE-N 0.31 n~U/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY C~IS. I Tests Performed * See Special Instructions Above UA=Unavailable ND~ None Detected '* See Sample Remarks Above NA= Not Analyzed LT-Less Than, GT=Greate~ Than 'd~.l¥1J. INI ~l N¥3 9NISS]3Okld ~]aO-I:~]/S:II-1O:ItJ HO'Ca AN~d~OO3¥ .LSNIAI ~ta.4 NOI.IO~]dSNI aH.1 :~.lON ,,~/11 IJ-n Ol-1~Ncl 'O:rl'IVJ_$NI SVA~ ~±$A$ ~±I$-NO ~JV~.,', ~ **q±I$-NO/qVNOI^IONI ]lam a^!t~ 'a3ep ~eqq. o:~ JOlJd PalIYP SllaM Jo4 '9L6!, aunf aauis A/INrIiNIAIO3 [] Pall!Jp sllaM IIe JoJ paJ!nbaJ si §Ol IlaM ¥ '90-I -1-13N/HOVZ I¥. .-IYNQIAI(]NI [] ~oq~o [] x!s I~q aaJ4/ U~ A-11~VH 3-1dl/-I NIAI [] o~!~J [] oMI [] ' mo-I ~ ou0 [] THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUIVIBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT HUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Conoection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holdiug Taok Size: /~_~O O If Tank is homemade SOILS RATING give dimensions; TYPE OF TANK MANUFACTURER 4. DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS I;~-"/AP P R OV El) FOR ~' BEDROOMS E] CONDITIONAL APPROVAL (letter must acco/~p~y certificate) E3 DISAPPROVED // DATE BY -/ GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: C. Septic Tank: 1. D. Seepage Pit: 1. E. Disposal Field: ~ Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF fNDIVIDUAL SEWER & WATER FACILITIES Phone: 4. Location: 5. Type of facility to be inspected / 6. Well Data: A. Type C. Construction D. Bacterial Analysis 7. Sewage Disposal System:~. Size /'~J 2. Manufacturer~C-~z~?/b/~L~ Absorption Area Total length of lines Distances: / A. Well to: Septic tank 7~ , Absorption area /~ . Nearest lot line ~-- , Other contamination - B. Foundation to septic tank /~/ .._, Absorption area C. Absorption area to nearest lot line _~2-~2/ Sewer Lines EQ-034 (1/74) Page 1 of two pages Pag~ 2 of two pages - Req~.ast for Approval of Individual ~l~er & Water Facilities Comments Approved Disapproved Approval Valid for one year from date signed Greater Anchorage Area 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. Date SIGNED E0-034 (l/74)