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HomeMy WebLinkAboutSKY RANCH ESTATES #1 BLK 4 LT 35 ky Ranch Estates #1 Block 4 Lot 3 #015-301-09 C q.. GR TER ANCHORAGE AREA H( ©UGH �Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM c��./a (VZ'A! DON })1t . PHONE--- NAME�l.:�' �,}t�jf,,�Jjt/ MAILING ADDRESS LOCATION f>12� N l�Cr LEGAL DESCRIPTION ZO% }G•K.> �''>Y.yF F}lU(�l! Z"S'Z/}TC' a SEPTIC TANK: DISTANCE �2 FROM WELL NUMBER OF l MANUFACTURER ST( -j: `Sffe`C �30. MATERIAL-�r�L ?�Zf� 7'7E�G'7= COMPARTMENTS — INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH_ LIQUID CAPACITY J'F''' GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER— ---OR WIDTH LENGTH.—, DEPTH tD �7� LINING MATERIAL, ff� �a". GRaB SIZE: DIAMETER 1I-_DEPTH�' DISTANCE FROM: WELL el/ ri1XI, ! TOTAL EFFECTIVE BUILDING FOUNDATION AL!, , NEAREST LOT LINE— • ABSORPTION AREA (WALL AREA) ? SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE !�i i�/U4tCONSTRUCTIONf� (1� DEPTH _ DISTANCE FROM: BUILDING NEAREST !� NEAREST SEPTIC SEEPAGE FOUNDATION / LOT LINE_! ---, SEWER LINE i TANK SYSTEM OTHER SOURCES ZIJ "i ,t:? F: {1%Z7 r/ `r,•� CESSPOOL �'`�`%�l 1 7-- , • APPROVED �" DISAPPROVED REMARKS— DISTANCES: — EMARKS DISTANCES:_ _ DIAGRAM OF SYST o , �M �rtj f'�om INSTALLED BY: I lc PIPE MATERIAL: A l j Ofu LOT SLOPE: a.. PiTREMARKS: `� (y . >C _ F�ii"YF ILS u5' DATE OCLIf)Z�I 7l APPROVED Form PW -026 G.A.A.B. GREAT' R ANCHORAGE ARCA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 2500 TU[l C`R ROAD POUCH 6.650 AKCHORAG@.ALASKA 99502 TH-Cvt,otiE 279.BFBC SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT!:' -AJ �'LL �SJyC'%!✓ __-__________ MAILING ADDRESS INSTALLATION LOCATION PERMIT NO. — -- - Dr _L2-- - LrPHONE -- a LEGAL DESCRIPTION (,.L DRAIN FIELD ., OTHER INSTALLATION OF: SEPTIC TANK SEEPAGE PIT —__ TYPE AND SIZE OF FACILITY TO BE SERVED / / I !� TO BE INSTALLED BY L� Gt (1 �ji]i�F�l NOTEI THIS PERMIT IS NOT VALID WITHOUT SOIL. "MST SOIL TEST RESULTS / % 1 COMPLETION DATE ANTICIPATED pFRMiT yAl I[l 0NF YEAR ---- FINAL. INSPIECTIONr 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPgGT10N By THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. p" ty i y. r,� S.�,[ /]wy:X� TYPE -,Di,. f'i-� TYPESC'�DOOX—Cni1 - ,, �vSEEPAGE AREA SIZE SEPTIC TANK SIZE DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS 5 IC + FOUNDATION TO SEPTIC TANK t FOUNDATION TO SEEPAGE PIT 20 its DRAIN FIELD 1'0 1t" SEPTIC TANK TO SEEPAGE PIT WALL 6/ , "I }10 f t.._ SEPTIC TANK 5 '�3----. SEEPAGE PIT 20 ft, DRAIN FIELD ,TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK 10 ft° SEEPAGE PIT DRAIN FIELD 10 ft" — SEPTIC TANK. 25 ft*, SEEPAGE PIT 100 ft" . DRAIN FIELD 50 ft" A" CAST IRON SIPHON SEPTIC PIPE K'ITII AIRTIGHT\ CRIB LACI: /% CAPS y � lever \ CAST IRON INTO UNDISTOPBED SOIL TO RIVER, LAKE, STREAM. I'lalss�li v[I.L 'i Si f.(Ilf'-- AND INTO CRIB CROSSING GAF' OF I:.I I I:I Ito: I II I t11 HUti EXCAVATION S FEET INTO UNDISTURBED SOIL. IU -PIT- SO III PIT- 1LI A. C I required whenever line CrDASea (CRIB FITTED WITH AIRTIGHT REMOVABLE CAPS. TABLE( unJcr Jriveuay. T^ I'I1- 120' TO RIVER, LAKE, STREAM. I'lalss�li v[I.L 'i Si f.(Ilf'-- AND INTO CRIB CROSSING GAF' OF CAST IRON INTO AND OUT OF SEPTIC TANK II,;.1_eluU•1L EXCAVATION S FEET INTO UNDISTURBED SOIL. IU -PIT- SO III PIT- 1LI 1,0 Si1:LR LINE- 10' A INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE. PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. 10 TAI:K,- P.O'" T^ I'I1- 120' ho :[R IIflf- An AH' -ia' mILT GRAVRL BACKFILL (A,.. )Roll SEVER I. I I: r. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I_IIM If D 200' in IIT zoo' ].Fri S[s:[11 :.-,,X ,6,,.._ •_.._l I I, I.50IIPEL DE - LTH AUTHORITY / OR LICENSED DESIGNER A local Gr$CR LIME. CONSINIt AKE!. I!ELIS, SL[PtXt Pil EXCAVATION BASED ON SOIL TEST. CAST ]roN, .I SrT [rr IC vin R:rn uv1. --- in 'IPP.. SOIL ; i 20' HIHINUtI 0.AYEL FA(KFILL gOUB CR 8. A' I1IHINU.'1 ABOVE- HATER Grade: V.per 1L0'. or 1/4' p r foo' except 10' prccr Aing tank 6 the. should I not exceed 2S. 6' per 100 on flat terrains. 4 INCH CAST IRON SIPHON PIPE SEEPAGE PIT .CRIB GRAVEL OACKFILL I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUG14 ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE — � e "'y ,�-' ` APPLICANT'S SIGNATURE�. P3REATER ANC"ORAGF AREA BOROUGH CASE 11 HEALTH DEPARTMENT 327 EAGLE STREET ANCHORAGE. ALASKA 99501 Performed For r�`��f/f ` .� E 1 Date Performed ,�l<'? 12�A1Gi rST Legal Description: LotBlock Subdisv� on Perco al tion 'restf This Form Reports a: Sois Log #J Depth Feet Soil Char.acteris_ics &f,/0 6(lJ GINr V W,fli �a*j ? WIN DY[C�YXvJti 1V1^�t•i1�. � � 2, ,� .S I� oVtG'`l hn't'- o rwi .f )1-ry St1140 r•7- /Snit j,)vtf'`N- 6,110 hlvavc- tcl Slt,TL1 Sawa )r--I-/,Srt W !?USE, F%fS 4r f�itWV Was Ground Water Encountered? A/0 If Yes, At W; at Depth Location Sketch I 1561 MM MM »MMr Reading 1 _e Gross ;ilee Net Time Depth To H2O Net Drop a �.�.. .un..vs� �a-.��.rr•�'vr.rv. ��� Iercu. rqli ic'r`"i GREATER ANCHORAGE AREA BOROUGH DEP^^.TMENT OF ENVIRONMENTAL QUI' -(TY CAST: # 3500 TUDOR ROAD =� ANCHORAGE, ALASKA 99502 6909 Perf timed For Ken JacksonDate Performed 8-30-72_ t,egal Description: Lot 3 Block 4 Subd vision SkyrauchSubdivision this Form Reports Soils�g--_X �_��ereolai%� —t— Depth Depth Feet_ Soil Characteristics Orange -reddish silt (ML)�s I 2 Silty Gravel 1t w/small quantities of gravel. (ML,) tlas Ground Water Encountered? No if Yes, At What Depth? Reading Date Gross Time Net limeFD pth to H2O Net Dr® FE, lisn Grrntin _.'-'Tfi: a_. - - .�_. � -E- 2H Proposed Insta atll- on.- Seepage Pit _______Drain Field Depth Of Inlet. _ Depth To Bottom Of Pit 7rncPi C0F1M1_NTS:we s not :recommend this site for a seepaAenit due to requiring ovex 275 sq, ft, Yc�1'h��roo� which exceeds GAA,B specifications,_.v_��_- �� T �, _.p0 r10rme d BT—JEaxpcajL(Lk �_— ...D; 1a Tier y: National Te,ta�x Date: - -- f • '� Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 .. .. Parcel I.D. 015 301 09 Certificate of On -Site Systems Approval Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 3, Block 4, Sky Ranch Estates #1 Location (site address) 5511 Whispering Spruce Dr., Anchorage, 99516 Current Property owner(s) Unk Day phone Mailing address Real Estate Agent Wayne Nelson 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 357-1770 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public VVater System ❑ Public Sewer ❑ WaiverNariance request for:. Received by:h i ec to be releasedt jM-� Date: COS to the engineer, unless otherwise requested by the engineer. t - Call Wayne Nelson @ 3554485 for Pick up C4 �e COSA Fee $ `% O Date of Payment 9-12-13 c4 K ,2 / 3/ L' Receipt Number f (, C, S COSA # I ©moi Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm AK Rim Engineering, Inc. Address 9131 E. Frontage Rd, Palmer, AK 99645 Engineer's Printed Name Chuck Leet 6. DSD SIG System #1 Approved for System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms Phone 745-0222 Date 7/26/13 bedrooms, with the following • C adn A. Leet `v ;••• CEt 0400 BYW,,hrg�e ✓ Original Certificate Date: " 15`1 -3 Th nDevelopment Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet! - . c If more than 1 septic system is on the lot: COSA Checklist # + of 2 Structure served by this system + Certificate of On -Site Systems Approval Checklist Legal Description: Lot 3, Block 4, Sky Ranch Estates #1 Parcel ID: 015 301 09 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) N Date completed Pre 1972 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth <165ft. Cased to >40 ft. Casing height (above ground) 18 in. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: In AT INSPECTION 7-18-13 156.9 ft. g.p.m. 5.27 g.p.m. Coliform 0 colonies/100 mL Nitrateo,-ny mg/L Arsenic RD ug/L Dateofsample: % t$I2,oi3 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Tank size 1000 gal. Number of Compartments Foundation cleanout (Y/N) Y Date of pumping 8/15/2013 C. ABSORPTION FIELD DATA Collected by: &_ v\doy1 Ac' ne5 Date installed 10-18-1972 1 Cleanouts (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) _ Pumper Northland Pumping Services NA Date installed 10-18-72 Soil rating (g.p.d./ft2 or ft2/bdrm) 250 System type Seepage Pit Length 24 ft: Width 25 ft. Gravel below pipe 6 ft. Total depth 6 ft. Eff. absorption area 588 ft2 Monitoring tube Y Depression over field N Date.of adequacy test 7-1.8.13 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 66.5 in. Water added 727 gal. New depth 69 in. Elapsed Time: 168 min. Final fluid depth 66.5 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed NA Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at Datum E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tankAift station on lot 86' ** Absorption field on lot 108' Public sewer main NA Sewer /septic service line >25 Animal containment areas >50' Meets alarm & circuit requirements? On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas >100 SEPTIC/HOLDING TANK ON LOT TO: Building foundation 22' Property line >20' Water main Water service line >1 Wells on adjacent lots >86' ABSORPTION FIELD ON LOT TO: Property line 16' Building foundation 46' Water Service line >10' Surface water >100' Curtain drain NA Wells on adjacent lots > 100' F. COMMENTS ** 50' required in 1972 G. ENGINEER'S CERTIFICATION 1 certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSSIU A\ rguidelines in effect on this date. Engineer's Printed Name l u _QRl'-�� W • L,�A Date 'S - iS-2o1 �2 COSA brown sheet 10-10-12.doc Absorption field 18' Surface water >100' Water main 100 1 Driveway, parking/vehicle storage >40' ❑ 0 E N m CD C < a CD 0 N Q N CD �_ fD N O_ <n CCL C O m n C W O � # N C] W m 0 m 0 p el3 d a 3 a 0 ❑ 0 E N C r C C C 9 0 N Q N CD �_ N O N N �a co m r D o N - <n CCL C O m n O<� A � m O O � # A A W W 0 N 0 p N d a 3 a 0 CD J .1) ❑ 0 E N DDm 30 D qK 0)z� G DD N — m Zl jDDv_> m Z m IIco nno-2 _ C7 r D D<Om -mr-n n O m n O<� A � m O O � # A A W W W N N N d 0 00 r O NOOf co 0 tdO O � L j W SOA CD co W N. 3 U2N w �D ❑ O p1 O N N N J N J N " 3 CD M un�nFP rt su ,v P N 0 N s -+ �" CD W W W W 3 fD `i i) N W M W fJO cVO W N. O CJ 6N i V w A 0 0. CD to C WCD r N W CO NA 7 N cn i Cn O� O) W O) O) O) O O1 01 V CO V V V V J J W !M < �p O7 A W W 4J 4JN�A O n= D S N N A A A p� A A N r O< V7 .OP A C� = CD O. CO 1 D n D cn O�O)0)0)mmm W �,60in < C V O f0 (O (O (O S fD — pQ g Q. DD o F (n r r g X c0i N D n D 0 r 3 r - 1,450. CD (D C cn D :01 D 3 (n r r X s —Q M 0+ cn cn cn cn Cn W W W N" W W O N COW N N V N V O_ (D M J A. O W O) CO ' • (p V 0 A M M W U n O o o 3 M CD 0 � N N DDm 30 D qK 0)z� G DD N — m Zl jDDv_> m Z m IIco nno-2 _ C7 r D D<Om -mr-n n O m n O<� A � m O O � # . O r w ❑ W C p 0 00 r O N co 0 3 O � L j -n CD co W 3 U2N w �D ❑ 0 y N x 3 CD M Z 0 rt su 3 " a m W m 0 mm r D m 0 n O m n 0 o D O � # .< On ❑ Cl) G O 0 IA O O O 0 3 O � L j -n CD 3 U2N w �D CD y CD rt ❑ N s CD CD rt O f O z a W m 0 mm r D m 0 n O m n 0 o D O � .< On r Cl) w `< O A IA O O O O O O � L j U2N w y TRACT A RECOVERED _ 5/8" REBAR BASIS OF BEARING 7.5' WALKWAY _ N89'59'33"W 90.00'(R) 89.86'(M) — —0 10' UTILITY EASEMENT -----------� TRAN� r------------------ I POLE w c I w o I BLOCK 4 Iw I In FI z I LOT 1 in wl C AIN -LINK 0 LOT 3 FENCE (TYP.)— ZI <1 13,472 &F. IS I LU �I SEPTI �o FI /®(ISE) O.H.( EC. I x =)I ,; Q/ HEED"! LIFT LOT 2 RECOVERED 5/8" REBAR 15.6' I —J `C.O. O.H. ELEC. Dowl4G olte— — — — — xI `5/8" RE BAR 4.5'x10.5 COVERED AREA 8't x ONI N 74 DECI® WELL K /STEPS (TYP.) Ls�g23 � E 5 NG NOTES: 1" - 30' 1. EXCEPTING FOR GROSS NEGLIGENCE, THE LIABILITY FOR THIS SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY. 2. THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY. 3. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY & IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. 4. THIS SURVEY SUBSTANTIALLY COMPLIES WITH ASPLS MORTGAGE STANDARDS. 5. TIES TO PARTIALLY MONUMENTED OR UNMONUMENTED PROPERTY LINES ARE ±1 FT. 6. THIS SURVEY PERFORMED FOR GERALDINE EKVALL, IT SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. REUSE OF THIS DRAWING FOR ANY PURPOSE NOT STATED ABOVE WITHOUT THE EXPRESS WRITTEN CONSENT OF ALASKA RIM ENGINEERING, INC. IS A VIOLATION OF FEDERAL COPYRIGHT LAW ��� LEGEND: (C)=CALCULATED DATA (M)=MEASURED DATA (R)=RECORD DATA PER O.H.=OVERHEAD ELEC.=ELECTRIC (TYP.)=TYPICAL w 0 EXCLUSION NOTE IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. Robprt J. Farmer ' o 10615-S AS—BU I HEREBY UNDER M' LOT 3, BI PLAT No. ' SURVEYED ALASKA RIM ENGINEERING, INC. 9131 E. FRONTAGE RD., SUITE 1 PALMER, ALASKA 99645 PH: (907)745-0222 : FAX: (907)746-0222 EMAIL: akrim®alaskarim.com : WEB: www.alaskarim.com 1 of 1 1" = 30' 1 FILE: A MORTGAGE I THE FOLLO' V I..,V„ 2013. FB: 13-06 PERFORMED PROPERTY: IORAGE, ALASKA. ©2013 MUNICIPALITY OF ANCHORAGE GE"PARTM€NT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472f1 Application Date ._'W, 3 i 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) � � 11 l%l� Ing (b) Applicant Name . PIvt� t 141 e- , t%eXTelephone: Horne —?> � _'-_` % Business _ 6 1�m Y 79' Applicant AddressV----------- (c) Applicant is (check one): tending Institution El ; Owner/builder Pl�; Buyer 1-1 ; Other 0 (explain); ----- -------------------------- (d) 1 -ending Institutionr�__.__�'- Address J-� lY✓— to G(-- -- -- ---- n --- — p -- (e) Real Estate Company and Agent --_ off,•_.—_,1 �' ctJ c��l _ 12 c�, %/1 Address Telephone — -----— 1 % ���-� �o i --- — -- -- — ----- ----- -- — (f) Mail the HAA to the following address: 2. TYRE OF RESI©ENCF Single -Family Multi -Family EI Other Number of Bedrooms 3. WATER SUPPLY Individual Well Community C_7 Public III Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [ Public 0 Community n Holding Tank B Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 0 ani 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INF0.9MATION As certified by my seal affixed hereto and as of the validation date shown below, hverify that my in�lestigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,9functional 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 --- y Date ..--- -r- -- oc pt-vt,,•E=ngineer's Seal tJll. r 6. DHEP APPROVAL Approved for f�i_r_ bedrooms b ` / 2 ��.G _Date - Approved -__---- `_ — Disappro4 d ---------- Conditional ------ Terms of Conditional Approval CAUTION The Muncipahty of Anchorage Departrnent of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer regis+.,ed in the ;tate 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 requirements. Employees 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. Page 2 of MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALITY OF AN('HORAGE DEPT, OF HEALTH & ENVIRONMENTAL P OTECIION (.t' 13 W5 Legal Description: L.—��,_T3KM•pap]'` A. WELL DATA Well Classification R k5S If A, B, C, D.E.C. Approved (Y/N) N/A Well Log Present (Y/N) may— Date Completed -•"7-4 /77Z _ Yield _5!W" Total Depth > Y G -G Cased to O Depth of Grouting N a N L _ Static Water Level / &p Pump Set At - ;_1 &6 y Casing Height Above Ground `ZQ Sanitary Seal on Casing(Y/N) — Electrical Wiring in Conduit (Y/N) -- l Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot �6 _ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot f g On Adjoining Lots — To Nearest Public Sewer Line L -)N P_ To Nearest Public Sewer Cleanout/Manhole Noma To Nearest Sewer Service Line on Lot 'l i 0 Water Sample Collected by Date S -_S Water Sample Test Resultse+tc� Comments 4' SO �C-g 1A9 1?Tri - B. SEPTIC/HOLDING TANK DATA Date Installed to45fiA Size /000 No. of Compartments Standpipes (Y/N) --i! Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contract on File (Y/N) N`4 ; for �/A Holding Tank High -Water Alarm (Y/N) N/A Temporary Holding Tank Permit (Y/N) t'4fA Separation Distances from Septic/Holding Tank: To Water -Supply Well _ 26 To Property Line _L To Water Main/Service Line Course IN v fid P Comments Ir Page 1 of 2 72-026(11/84) To Building Foundation GCS To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /, :2,; Type of System Design S e epo� Date Installed 10lea ?vt Length of Field W/A Width of Field Jy . Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 1598 Standpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test — $ S Separation Distance from Absorption Field: To Water -Supply Well /005 To Property Line To Building Foundation 41& To E=xisting or Abandoned System on Lot /Vy E ; On Adjoining Lots _3 o To Water Main/Service Line To Cutbank (if present) NON E To Stream/Pond/Lake/or Major Drainage Course ND N i�i To Driveway, Parking Area, or Vehicle Storage Area > Wo Comments D. LIFT STATION N Dry( 6 Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) -- Comments Dimensions ManhofeF,P,ccess (Y/N) _ "Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, %conformed to all MOA and HAA guidelines in effect on the date of this inspection. ItSigned ���"��u `"'^" Date q 111--!/ R i Company S0� MOA No. SG S i –O l l Receipt No. Date of Payment /p pT1 Amount: $ Page 2 of 2 72-026 (11/84) ' Engineer's Seal a, J i4'r- 7 o o I M t Ri nmumv mu 2 � ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: )907) 279-3916 R E S I D E N T I A L W E L L I N S P E C T I O N LEGAL: LOT 3, BLOCK 4, SKYRANCH ESTATE LOCATION: 5511 WISPERING SPRUCE OWNER: GERALDINE EKVALL TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: NO INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: UNKNOWN PUMP YIELD: MORE THAN 5 GALLONS PER MINUTE DATE OF INSPECTION: SEPTEMBER 12, 1985 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 5 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. THE STATOC WATER LEVEL WAS FOUND AT 162 FEET. AFTER THREE HOURS OF PUMPING AT 5 GPM THE WATER LEVEL WAS 167 FEET. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON SEPTEMBER 12, 1985. TEST__WAS- NEGATIVE. TEST RESULT: e• n • o a n- - e s•�� e 2225 -E JUNY 25, ,1971 �•yi inn �Onc �.e wo (._y1` �'s. VA •:.l THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. 03 W. 15th AV"C" SUITE 203 vb g ® 2n �G�( IAmuhbv I, Q' r Q z A CHORAGEEALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 S E P T I C S Y S T E M A D E Q U A C Y T E S T — — — — — — — — — — — — — — — — — — — — — — — — LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: LOT 3, BLOCK 4, SKYRANCH ESTATE 5511 WISPERING SPRUCE GERALDINE EKVALL SINGLE FAMLIY, THREE BEDROOMS ON SITE WELL FROM MUNICIPAL RECORDS: TANK: STACK STEEL, 1000 GALLONS ABSORPTION SYSTEM: ABSORPTION AREA: SOIL RATING: INSTALLATION DATE: SEPTEMBER 16, 1985 SEPTEMBER 12, 1985 ONE COMPARTMENT, CONCRETE CRIB 588 SQ. FT. 250 OCTOBER 1972 TEST PROCEDURE: CRIB WAS FOUND WITH 4 INCHES OF LIQUID, TANK WITH 34 INCHES. WATER WAS ADDED TO THE CRIB .�- AT A CONSTANT RATE OF 5 GALLONS PER MINUTE. S�,$d WATER LEVEL IN TANK AND CRIB WAS MONITORED.EVERY 100 GALLONS CAUSED A 7 INCH •'��r. RISE IN THE CRIB UNTILL THE LEVEL WAS 59 •• ;A INCHES. AT THIS LEVEL THE RATE OF RISE z25_ �fe DECREASED TO 4 INCHES PER 100 GALLONS. A TOTAL OF 900 GALLONS WERE ADDED. AFTER 6 HOURS THE WATER LEVEL WAS CHECKED. IT HAD DROPPED 8 INCHES. TEST,, RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. IT WILL ABSORB MORE THAN 450 GALLONS PER DAY. The operational life of all 1-septic—systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received , Time of Inspection / S 2 Date of Inspection 1 -�,Zc)_� 7— REgUEST FOR APPROVAL OF INDTVIDUAL SEWER & INATF.R FACILITIES FOR • Vii: �o�e 1. Approval Requested By: �� : ��^ �•� C> Addr. ess :Phone��_��� 2 . Property Owner —Phone 3. Legal. Description:_/ 4. Location: 5. Type of Facility to be Inspected: Number of Bedrooms: _ 6. Nell Data:i��, A. Type B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disnosal Svst A. Installed l' - B. Installer C. Septic Tank: 1. Size 2. Manufacturer--- IF Seed q Pitl�lj Size 2• Material 5( Disposal Field: total Length of Lines S. Distances: A. Well To: Septic Tank-- , Absorption Area---, Sewer Lines Nearest Lot Line Other Contamination B, Foundation to Septic Tankp Absorption Area C. Absorption Area to Nearest Lot Line— ___ _ 4 RequeEt for Approval of T Page Two 9, Comments: vidual Sewer & 'Nater Facilitie Annroved s ,. \ SGC r. dAisapproved Date Apnrova] 'Ialid for One Year From Date Signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM T certify that the information contained in this request for approval to be a true and accurate representation of the subiect sewer and water facilities located at: Signed Date