The URL can be used to link to this page

Home My WebLink AboutSUMMIT ESTATES BLK 2 LT 13/ Bloc, F-- MUNICIPALITY OF ANCHORAGE DE~.)TMENT OF HEALTH AND HUMAN SER~, / "' Environmental Health Division v - ~. 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES O/~r'eJ' oc ~t~ ~o~ ~ SEPIIC ABSORPT~O~ A..,.~ TANK FIELD WELL WELL Phone(st Permit NO NO. of Bedrooms ~.~ OESC.,"T'ON LOT LINE L°' ,~ J "'°~k~ J S"bT~;~, ~ ~ FOUNDATION Township, Range. SecUon AS-BUILT DIAGRAM (Show location of well, seplic system, property hnea, foundaUon. TANKS ~ff U ~ SEPTIC ~riN~ O HOLDING Manulacturer Capacity in gaffons TYPE OF SYSTEM J ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER ~ ~Ti ~ Grave, length Graver w,dth Number of hnes Soil ~ahng Pipe material p~ 'F-~l~ WELLS ~Z I H~ ~S = J ~ PRIVATE ~ OTHER (Idenlifv) C~assflication~A,B,C] Total Depth ET Cased to i9 7~ Scale: ENGINEER'S SEAL ~, ~ ~ ~r~P p ¢ ~ ~J[~ Inspections Pedormed by: ' ' Municipal and Stale guidelines in effect 0n Ihis date: ~f ~1 72 013 13185) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 2- 3- 4- !5- 7- F.~-I 9- 13 14 17, 20- DATE PERFORMED: GROUND WATER SLOPE SITE PLAN ENCOUNTERED? J~/ O E IF YES, AT WHAT ~E~t~t~ ¢/~,- DEPTH? ~THEODORE F. MOORE CE 3589 Gross Net Depth to Net Reading Date Time Time Water Drop ,MUNICIPALITyI El' VIRONMENTAL ~F~ANCHoRAG~ 'c~VlCE$ DIVISh )N /4PR 2 ~ 1988 . RECEi /ED I'~ERCOLATION RATE T~T RUN BETWEEN COMMENTS PERFORMED BY: (minutes/inch) FT AND FT DATE: 72-008 (6/79) ENVIRONMENTAL SERVICEs DIVISION aP~ 2 5 1988 RECEIVED LOT 13, BLOCK 2, SUMMIT ESTATES SEPTIC SYSTEM UPGRADE SPECIFICATIONS 1. Lot line waiver needed (no fee per DHHS agreement) to allow construction within 5 feet of easement and east property line. 2. Contractor shall arrange to pump septic tank and existing seepage pit prior to commencing work. 3. Contractor shall temporarily remove portions of existing chain link dog pen as necessary for construction, and restore to original configuration upon completion of work. 4. Contractor shall dig down to existing line between the septic tank and the seepage pit to allow determination of the necessary depth for the distribution pipe in the trench. 5. Contractor shall install a NDS Diverter Valve (or equai) in the line leading from the septic tank. These valves are available from Western Utilities. The valve shall be Set to direct all flow into the new absorption trench at this time, but shall allow future diversion back to the seepage pit. Each valve outlet shall be 9onnected to the solid pipe with solvent glue and/or Fernco couplings (or equal). The unused outlet shall be capped. The valve riser shall extend 1 foot above ground level. The contractor shall clearly identify the open and closed positions of the valve, and shall provide for both operation and removal of the valve mechanism from the top of the riser. 6. The absorption trench shall be located as shown on the plan, and shall be 32 feet long containing 6 feet of sewer rock beneath the distribution pipe (6.5 feet total), unless field adjustments are necessary. 7. Ail construction techniques and materials shall comply with -M.O.A. requirements. A cleanout pipe shall be installed at each end of the distribution pipe, and a monitor tube with perforated pipe extending to the bottom of the sewer rock shall be separately installed near the middle of the trench. Filter fabric shall be placed over the top of the gravel before backfill. 8. Approximately 20 cubic yards of sewer rock are theoretically required to fill a 6.5 foot deep x 32 foot long x 2.5 foot wide trench. However it should be noted that some sloughing of the test hole sidewalls occurred between 8.5 feet and 12 feet in depth, which may indicate that additional gravel will be needed. FLATTOP TECHNICAL SERVICEs 14530 Echo St., Anchorage, AK 99516 Ph. (907) 345-1355 ADEQUACY TEST DATA SHEET Legal.'Description: £o~ I~. ~[o¢~ Street Address: £5¥! ~ 98 ~ /~, Client Name:, C~ri~ ~ ~e Test Date:, 3/~/~ Initial Conditions: Tested By: Float #1 in~c a~ set G~" b.t.o. ~£ "pipe w. 70" fluid Floa~ #2 in~ ~ c,~. set *~" b.t.o. ~ "pipe w. ~" fluid Float #3.in ' ~ set__" b.t.o.; "pipe w. "flu'id Float #4 in set "b.t.o. "pipe w. "fluid Water added through: £~¢ 7~ ~ ~ · r~mf ~a~e =~/: ~ Z~fm Adequate for ~ + Bdrms Measured W=II ~ .so~,, ' Unit Absorption Capacity = Surge Capacity Average Absorption Rate = ~/~/--O~?fl,"Adequate for Co~I ~/,~,~ o~,, ~ ~ o~ ~-.~ ~.?, ~_ icipality of Ancho e MEMORANDUM DATE: March 15, 1988 TO: File FROM: Susan Oswalt~. SUBJECT: Lot 13 Block 2 Summit Estates Subdivision Mr. and Mrs. Christopher Young, current owners of the above property, met with me today regarding the HAA on their house. Records in file reflect an original two bedroom design and installation, but both two and three bedroom HAA's have been written. At the time the Youngs purchased the house it was actually a three bedroom and this department signed a three bedroom HAA based on adequacy test results. Prior to that DHHS had signed another three bedroom approval, ignoring both the design capability and an original HAA approval for only two bedrooms. Under the circumstances it seemed appropriate prior to processing a new HAA for the following agreement to be made: 1. An adequacy test on the existing field must verify two bedroom function. 2. DHHS will waive the requirement for a reserved disposal area and allow an upgrade of the field to three bedrooms (addition of one bedroom). 3. DHHS will waive the fee for a separation distance to lot line waiver application, should it be necessary. Permit fees will not be waived. 4. The existing 1,000 gallon tank may remain at its present location provided the engineer verifies the integrity of the tank. We will require a site plan drawn by the engineer and a copy of the adequacy test prior to permit issuance. In addition, there may be no further expansion beyond three bedrooms. SO/ljw~5 GAAB-HD I GRr ~,TER ANCHORAGE AREA BOROU:~-H HEALTH DEP/~RTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM c SEPTIC TANK: LEGAL DESCR,PT ONZ' ' /'?.., DISTANCE FROM WELl "7~ / .~- LIQUID CAPACITY /2 [~'~) GALLONS. SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER NEAREST LOT LINP ~'> (~ NUMBER OF MATERIAL r'~'~"ff~,Z- / COMPARTMENTS INSIDE LENGTH // /' INSIDE WIDIH-- OR'WIDTH /O , LENGTH TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LIQUID DEPTH____ DEPTH sQ. PT. TILE DRAIN FIELD: ~./DISTAN TR EN W~l..~.g.]~l DTh DISTANCE F~DMWELL NUMBER O~'~. ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH OF _ NES IN. TOTAL EFFECTIVE~'~' DEPTH: T OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE N ABOVE TILE FROM WATER WELL E ~J')/~//'L'/--~-/'7~ DEPTH ,BUILDING FOUNDATION, /~ t SAMPLE/,. . / NEAREST '~O / SEPTIC -~ I SEEPAGE / ~ OTHER LOT LINE /~ ~t- , SEWER LINF , TANK ~ t- . SYSTEM /~?-'~ . CESSPOOL '~- . SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE ~^~-~= . GREATEI~,_ANCHORAGE AREA L .)ROUGH · ~ 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT R ESIOENCEADORESS ~//~ ~' .~~FcA~'c~'LOCATI0" OF I,~LL~TI0" APPLICATION T0 INSTALL: SEPTIC TANK~PAGE PiT. ~ , D~AIN FIELD. , OTHER ~'~ fly 4 BELOW TO BE FILL~T BY HEALTH DEPARTMENT THIS IS TO SERVE AS ~JL, ~)~. , PERMIT TO INSTALL A AS DESCRIBED BELOW, SIZE OF UNiT TO BE SERVED ~ ~'~ .. SEPTIC TANK SIZE '~'~ TYPE ~-~SEEPAGE AREA TYPE DIAGRAM OF SYSTEM DISTANCES: I certify that ! am familiar with the requirements of Greater Anchorage Area Borough OM~nance No. 25-65 and that the CAS~ # ;REATER ANCHORAG~ AREA BOROUGH HEALTH DEPARTMENT 32? EAGLE STREET ANCHORAGE, ALASKA 99501 Performed For Donald Dahl Date Performed 4/16/70 Legal Descrlp~~°n Summit Estate This Form Reports a: 6-- 8__ Depth Feet Soil Characteristics ML - Brown Sandy Silt GW-Weli graded fine to mediumgravel and sand SW - Well graded sand and fine gravel Was Ground Water Encountered?,.,,~ No If Yes, At What Depths_ Gross Time Net Time Location Sketch nue Pit _ ~eplm Depth To H20 Net Drop Proposed Instal~Seepage Pit xx Drain Field Depth Of Inlet Depth To Bottom Of Pit Or Trench COMMENTS: This test indicates a drainag~ surface area oI 210 so. ft. for tO~ , ,bedroom home , ~, ~ ,, / Test Performed By: .... R: E. Carlisle Natio~l T~stir~ S~rYices', Inc. Date: 4~/16/70 ..... Anchoral~e, ,~laska 9.<)50I 5Uii. l~CT: ~',atm' '3upp!y and C,m~tr~tion by 1)cnmid Dahl~ Lot 13, ~tlock 2, ~u~nit Estates; Serial No. II1~010160~23 gives tcmporar/ approval 2673 will ^d~inistrative 'hrecgor cc; Donald bdhl -~"~ D~TE RECEIVED INSPECTION APPOINTMENTS ~:;~_c~.~.~' ~IME TIME TIME ~UNICIPALITY OF ANCHORAGE MUNICIPAB~ OF ANCHO,AGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~EPT' OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION ( ENVIRONMENTAL SANITATION DIVISION FEB A A i981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND ) 5, LEGAL DESCRIPTION TREET LOCATION 6, TYPE OF RESIDENCE z /NUMBER OF~BEDROOMS [] One [] Four [] Other__ J2~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six 7. WATER SUPPLY 'J~ INDIVIDUAL*~',~-~~* * ATTACH WELL LOG. A well log is required for all wells drilled E] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~L INDIVIDUAL/ON-SITE** //~'~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [~] SINGLE FAMILY I;~ ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [~] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [~ Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AR EA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [3~ ~PPROVED FOR ~'~<~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev, 6/79) ANCHORAGE, ALASKA 9950..1~.~ (907) 264-4111 GEOROEM. SULL!VAN, MAYOR February 27, 1981 Albert C. Ryan, III Post Office Box 10-,1318 ~chorage, Alaska 99511 Subject: Lot 13 Block 2 Summit Estates Subdivision Approval for your individual sewer and water facilities cannot be granted until the following items have been completed: (1) The wa~er analysis report needs to be delivered to this office from the Chem Lab, 5633 B Street, for our review. (2) The septic tank pumped with a receipt submitted to this office. (3) A four(4) inch cast iron cleanout needs to be installed to the seepage area and reinspected by this department. Please call this office for a reinspection when hhJ_s is completed. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw CC: Alaska Statebank 310 East Northern Lights Boulevard 99503 Bob Stanton Real Estate 2509 Eide Street - Suite 6 99503 CHEMICAL & G~.~£OGICAL LABORATORIES ~' ALASKA, INC. TELEPHONE (9071-279,4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: Mailing Address I.D. NO. Phone City SAMPLE DATE: ~ MO. State Day Year Zip Code SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. ) Special Purpose Treated Water Untreated Water SAMPLE NO, 1 I LOCATION /' .: Time Collected Collected By TO BE COMPLETED BY LABORATORY Analys~s shows this Water SAMPLE to be: I~ Satisfactory [] ~nsatisfactory [] Sample too ong in transit; sampmshould no[ De over 48 hours old at examination ro indmate reliable results. Please send new sample Date Received ,-. , Time Received "; '" ( ;~ Analytical Method: [] Fermentation Tube [;:]"Membrane Filter Lab Ref. No. Result* Analyst Rev. 1978 BACTERIOLOGICALWATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Date Cotlect ecl Source 24 Hours 3onflrmatory 24 Houri 48 Hours Date MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENV RONMENTAL PROTE~T~,,NO~?~ 82~ L Street - Anchorage, Alaska gg~01 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE Merrill Lynch Relocation Management MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE VIAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT Elliot Lawson % Jack White Company JPHONE 277-1553 MAI LING ADDR ESS 3201 C Street 99503 5. LEGAL DESCRIPTION Lot 13 Block 2 Summit Estates Subdivision TREET LOCATION 6, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [] Other ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six 7. WATER SUPPLY [~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attaCh log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTI LITY If ~nd~wdual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TiME TiME TIME DATE DATE DATE I NSPECTO R INSPECTOR I NSP ECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER E3 MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIViDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: ]00~ If Tank is homemade SOILS RATING give dimensions: __ /~) .~/ TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer L~ne Nearest Lot Line Absorption Area to nearest Lot Line [~APPROVED FOR ~-~-~ BEDROOMS [] CONDITIONAL APPROVAL (letter must acco~fipa~¥ cert~oate) DATE '-- / ~'-~ L J [ BY (Title) 72-010 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO. 2. Property Owner: Mailing Address: 3. Name of Buyer: , Mailing Address: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: FHA CONV Day Phone: Mailing Address: ~, ~-(5 \ Legal Description: Location: Type of Facility to be Inspected: Day Phone: Phone: No. Bdrms. Water Supply Type of Supply: Public Utility_~lndividual If Individual, number of dwellings presently served \ If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) 72-003(3/76) C~ & gEOLOGICAL LABORATORIES OF ALAS~ IN · P.O. BOX 4-1276 4649 BUSINESS PARK BLVD. ANCHORAGE, ALASKA99509 Drinking Water Analysis Report for Total Coliform Bacteria TELEPHONE (907) 279-4014 TO BE COMPLETED BY WATER SUPPLIER ,UBL,O, ATER SYSTEM= I I I Ir II //J , I.D. NO. /~ Public Water Sys{em Name ~J /~ ~ City ~// State Mo. Day Year Zip Coda SAMPLE TYPE: [] Routine [] Check Sample (for routine with lab ref. no, [] Special Purpose sample [] Treated Water [] Untreated Water SAMPLE Time Collected NO. LOCATION Collected By TO BE COMPLETED BY LABORATORY LABORATORY: NAME ADDRESS CiTY Date Received Time Received Analytical Method: [] Fermentation Tube /}x~M em bran e Filter Lab Ref. No. Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) 06-1220 Rev, 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD July 9, 1979 Jack ~ite Company 3201 'C' Street Anchorage, Alaska 99503 R~I No. 951223 /MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION JUL. 1.. 1979 ..' RECEIVED Attention: Elliot Lawson Re: Adequacy Test on Existing Sanitary Sewer System; Lot 13, Block 2, Summit Estates Subdivision, Anchorage, Alaska Dear Mr. Lawson: Per your request of July 2, 1979, we conducted a test of the sanitary sewer system on the above described property. During this test the liquid level in the septic tank was monitored as water was added to the system. The measurements are summarized in the following table: Liquid Level Below Top Total Gallons Time of Standpipe Added 11:09 a.m. 6.2 0 11:18 6.0 42.0 11:29 5.9 67.6 .11:36 5.7 92.6 11:43 5.7 116.0 11:51 5.5 141.0 12:00 5.5 166.6 The meter used during the test was a Rockwell 5/8" standard water meter which had previously been calibrated by RS~! Consultants, Inc. If the 3 bedroom residence on the property is to h~use 6 people, the average load on the system can be expected to be 450 gallons per day or 0.31 gallons per minute. During the test, the system accepted 166.6 gallons in 51 minutes. This indicates an average effluent acceptance rate of approximately 3.3 gallons per minute at the time of the test. We can therefore conclude that the system is disposing of effluent at an adequate rate for a 3 bedroom residence. July 9, 1979 J~ck White Company Page -2- We appreciate this opportunity to be of service to you. Please contact us if you have any questions concerning this test or if we can be of additional service. Very truly yours, R&M ~NSULTANTS .^ I.NC. Proj~o% Manager GAS/rm/AT&SI-T .~'-~-~::'~x, ' MUNI~TY OF ANCit0RAU:...' , '-¢ ,--'~'~r7 A DEPAPIT~~~ND ~ Re~MEN~/ ?ROTECTtON L[~? ~ ~ Anch61~oe, Alaska 99501 ~1: Time 11:00 a.m. ~,2: Time Date 12-20-77 Tuesday Date In sp Buchholz Insp 1977 Time REQUEmT FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Leonard Realty, Beth Holland Mailing Address: 530 East 4th Avenue 99501 Phone: 344-6150 2. Property Owner: Mailing Address: David/Elise Troutman Phone: 349-1037 Legal Description: Lot 13 Block 2 Su~it Estates Subdivision 5531 East 98th Avenue Single Family Residence: (x) Nnmber of Bedrooms: Two/unfinished basement Multiple Family Residence: ( ) Number of Bedrooms: ~_ Well System: Individual well (x) Community/Public System ( ) Permit # Depth of Well kO(} Well Log on File Construction Bacteria]_ Analysis 6, Sewage Disposal System: On-site System (x) Public utility ( ) Permit # Installed 1970 Installer Septic Tank Size 1,000 gallons Manufacture~r ~",-, .~_¢~x~:>, ~ Absorption Area _~.(9 Soils Rate ~___0_~_~__ Mat~ri.al ~_ ~¢C~% Distances: Well to Septic Tank "~ to Sewer LJ_ne [ ~z~ Nearest Lot liue to Nearest Lot Line ~ to Absorption Area ~__ Absorption Area ~ ANCHORAG Ek~J . k~MUNIC I PALITY OF Department of Health and Environmental ProteCtion 825 L Street, Anchorage, Alaska ,99501' . 264-4720 uest for Approval of Individual Sewer and Wate~ ~FaCi31itfes Property Owner:. Mailing Address: Phone: Name of Buyer: Mailing Address: Phone: 3. Lending Institution: Mailing Address: Phone: Realtor/Agent: Mailing Address: Phone: Street Location: ~l ~.., ~/~'/~ 6. Single Family Residence: (~f~Number of Bedrooms: ~ ~ ~_~ Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: *Individual Well (~ Public/Co~nunity System If Individual Well, well depth If Community System, name of system ( ) o Sewage Disposal System: *~n-site System (~ Public System ( ) If On-site System, date of installation: iC{~> *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 Bage '~£w~ Department of Health and Environmental Protection Request for' Approval of Individual Sewer and Water Facilities Legal Description: Lot 13 BlOck 2 Summit Estates Subdivision Comments: Affadavit Attached: '(i ) Letter Attached: ( Approved~ Disapproved: Da re: /a~/~'~7 / Date: Department Worksheet: 06-1220(a) Rev. 1973 DATE AL~ DEPARTMENT OF HEALTH AND SOCIAL S'b~ICES DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI,.PUBLIC BACTERIOLOGICAL WATER ANALYSIS SEMI-PUBLIC [] CHLORINE RESIDUAL PPM INDIVIDUAL [] REPORT RESULTS TO COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY Sample Collected From [] Kilchen Tap [~Bathroom I/ / ' ' ' E]ln Yard [] Other GENERAL: Does Water Become Muddy or DJscolore~l? [] Yes [] No OFFICE Analysis shows this Water SAMPLE to be: []. SaHsfactory [] Unsatlsfaclory [] Questionable [] Sample too long ifi. translt; sample should not be over 48 hours old af examination to indicate reliable results. Please send new sample· [] Bottle broken in transff, please send new sample. SANITARIAN'S REMARKS Diameter of Well Depth Feet. Well Casing Material Diameter Depth : Length of Water Depth [] OE w., :n O~her ::~-. PURPOSE OF EXAMINATION: Illness Suspected? [] Yes [] No READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Bev. ]973 A- ~' . ~'/"// -~ .- ~ - Date Received J ~' /:: (? ?~me ReCeived pm Lab. No. Lactose Bralh 10cc 10cc 10cc 10cc 10cc 1.0ce 1.0cc 24 Hours EMB AGAR Laclose Broth, 24 hrs. 48 hrs. Gram's stain Reported by ;~/ · ~ This analy~J~ indicates ColiEorm Org~hJsms to be~ 1. Approval Requested By: GREATER ANCHORAGE AREA BOROUGH Department of Environmental queltty 3500 Tudor ROad, Anchorage, Alaska 99507 279-8686 Date Recetve~ Time of Inspection Date of Inspection REQUEST FOR APPROVAL'OF INDIVIDUAL SEWER & WATER FACILITIES 3. 4. 5. , Address: Phone ocat-:on Type of Facility to be Inspected:_ Number of Bedrooms: 6., Well Data.' , ! C. Construction ff-~ .- D. Bacterial AnalMsis Size /D '~/0 To%al Length of Lines ...... , A. Installed C. Septic Tank: D. Seepage Pit: 1. E. Disposal Field: A. Well To: Septic Tank /~ ~ , Nearest Lot Line Foundation to Septic Tank ' Absorption Area , Sewer Lines ~/--- , Other Contamination "> AbSorption Area ,, · C. Absorption Area to Nearest Lot Line i~quest, for Approval of~divldu~l Sewer & Water Faoilit~g Page Two 9. Comments; Approva] Valid for One Year From Date Signed Greater Anchorage Area Borouoh, Department of Environmenta! Quality DIAGRAM OF SYSTS~ I certify that the information contained in this request for approval to 5e a true and accurate representation of the subject sewer and wa~er facilities located at: Signed Date REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATE. R FACILIT,IE$ person requesting a~roval , b, Depth,, ...... c, Casinf Size Distance from well to closest existing or proposed: 1. Sewer line , 2. Septic tank ,'P~[7~ 3. Seepage Area/zg~f7~. q. Cesspooli_ 5. Property Line 6. Other sources of possible contamination, i,e.~ creeks~ lakes, houses~ barn~ drainage ditch, etc. Sewage disposal system, a. Age of system , / ~:~ 9~J]) b. Septic tank capacity in gallons / ~ 1. If "home made" show diagram on reverse side of this form. d.' Disposal field or seepage pit size and type,.¢.~t.~(~~ . 1, Distance to pr~pe~ty,~ne ~_¢--/-, : house fo'undation Z~/ i -e, Perco~atio~ Te%~t '~e.sults f. 'Percolation Test performed by ~~.~ Use th$ reverse.side of this form to show dla£ram. Diagram should inclUde he following information: p~operty lines;.well location, house location, ~t~pelc tank location, disposa~ area location, location of percolation test, a~ direction of g~ound slope. 9. The lnf-o~mation on this form is true and correct to the best of my knowledge. ..... Applkcant ' ' $~gnature of ,T,,O, BE FILLED OUT BY HEALTH DEPARTMENT PERSONNEl Date $ifned ~ke above described sanitary facilities are hereby approved, ~ubject tq,~he ......... ~l~owing con~lions: Conditions: The above described sanitary facilities are disapproved for the following ~easons: 'Signature of ¢.i"&'.%~ .... ate '~' --Apln'oval is valid for one year following the date of approval. - CPJ: cw FHA F°rm~2573 , ~'~ ff FEDERAL H~USING ~DMINISTRATION '~ ~/ Forrn Approved , IN~)IVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART L--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. Files'{; Nationa~ Bank of J~.nohorag~ AnchorageB Alaska P.O. ~ox 7205 Anchorage, Ala.~ka 111-0~0160-203 MORTGAGOR OR SPONSOR PROPERTY ADDRESS Donald Rah1 90th Avermes Anchorage, Alaska SUBDIVISION NAME BLOCK NO. LOT NO. Su~,~ t Est~-~es 2 ]3 TOTAL NUMBER: 1 2 1 WATER SUPPLY BY: [] Public system BASEMENT [] New installation r~Yes [~No [--]Community system Can attic or other area be made into additional bedrooms? (If Yes, how many?) NO. SYSTEM DESIGNED FOR ['~-'] Individual 2 [] Yes [] No SEWAGE DISPOSAL BY: --]Public system -']Community system [] Individual PART II.raTa BE COMPLETED BY HEALTH DEPARTMENT 4EALTH DEPARTMENT INSPECTOR'S SKETCH IIIIllll J Ill IIII IIl[lllllllll 'i !!I' ~1,,,~, ,,,, '"il""""l,,,,,,,[ ,,,, Il ,{iii Iliilll'{illitllI II '"" II1'"" IIII IIIII IIIIIIllillll[l IIII '"Ii lill 1 I'""lll Illlll[lll IIII III II III1~11 Ililil IIII I [[I Il I IIII I Illl IIIll I I I I iii '"'"':'"""'" ,,,, ,,,,,,ii,, ,,,, Jill Illlll!]llll Il I IIII ; !!!!',,,,,,: ,,,,,, i, IIII ,,,iii,,,, ,,,,,, iI,,"""l ,,,,'"' , ,,,,,,, ,,,,,,il, ~,,, i ,,,,,, ,,~, II III,, ,~,,,,,, ,,,Ill ,,,, " '"1'""IIIIIII "~',,, ,,, ,,, ,,, IIII1,,,,~,~ IIIl,,, ,,,, III ~,,,,,,~ ii,,,,,,, ,,,, 'll,,I,,,~,l i~,,,,, ,,,, ill' III It is the opinion of the [] State [] County [] Local Department of Health that this individual water-supply system [] is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [] State [] County [] Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: ~ Can be expected to function satisfactorily, and [] Cannot be expected to function satisfactorily is not likely to create an insanitary condition DATE SIGNATURE , ~ ./t' ~t TITLE ' NOTE. The health authori~ s~'~ld complete the appropriate opinion statement above and a~x date, signature and title in the PART III.~FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER~ I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that'the Individual water-supply system be considered [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM [~[~ CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form 2573 Rev. July 1958 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) (c) Lending Institution ~e .~'c~..m~,~ ~/--~ ' Telephone Mailing Address /~'c~ ! ~--~:. (d) Real Estate Company and Agent Address ~0"O ~' ('~ ~-,::~o~.'~ Telephone ~ ~' ' ~- ~'~'1 Properly Owner ~'h~*~'/"J,¢ }"'o~,,~,/~ Telephone: Home ~'¢~-.~*',>'"7 Business ~'~' Mailing Address '~'-'~ ~/ ~:. ~<:~ ''~ (e) Mail the HAA to the followina address: or: Check here [~, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single~Family [] Number of Bedrooms WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] 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. Page 1 of 2 72-025 (Rev 8/861 Front 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. Nameof Firm Ff~'{~/~ 7-'~c.~/~;'¢~w" _~'¢~'~'~¢,~' Telephone 3 ~- t~-- Address /~ ~C~ ~ ~ ~C~O~, ~ ~1~ Date ~ ~ /~ DHHS APPROVAL Approved for ..~ Approved bedrooms by ~',~/ .~.~t e Disapproved Conditional Terms of Conditional Approval f- 12 CAUTION 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 engineer's work. Page 2 of 2 72-025 fRev 8/86) Back ~uM~c~PAU'Ty 0[: ANcHORAG~ ~.~¥1~ONIC~-N~AL sCRVtCe~II;~I~i¥CALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (NAA) [9~B CHECKLIST- FEBRUARY 1984 9 264-4744 R~C~ LegalDescription: ~o~ (~.. ~/~C{~ ~, WELL DATA W(~ll Classification" : ~r~'vcz~ If A, B, C, D.E.C. Appro'~d (Y/N) Well Log Present (Y/N) ~/ D~ed ' I ~ ?~¢2 Yield Total Depth ~ Cased ty ~-7~f~;.) Depth of Grouting -f'f'~/~ -- Static Water Level ;~o" · {.~.,.,~ . Pump Set A ;~ ~'o' Casing Height Above Ground ! Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ~' Depression Around Welll~ad (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 7.~ . ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot xe~- ~' ~,~,,cA; On Adjoining Lots -:~ too ' To Nearest Public Sewer Line N,~.. To Nearest Public Sewer Cleanout/Manhole N,/I-. To Nearest Sewer Service Line on Lot Water Sample Collected by "T'/~f'/ ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~//17 Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ?~" ..¢:r~ ¢, To Property Line To Water Main/Service Line N, ·. Course ~ Size I-~°o(~'~( No. of Compartments Air-tight Caps (Y/N) ~' Foundation Cleanout (Y/N) N Date Last Pumped 5"'/5'1,~'~ Ch ,,~. ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026 fRev 81861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ~ ~' ¢ Depth of Field I ?- ~ Gravel Bed Thickness ¢* J Standpipes Present (Y/N) Date of Last Adequacy Test ~ Separation Distance from Absorption Field: To Water-Supply Well 10,.¢ ' To Building Foundation Lot TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments 1~70' ¢o~ cr¢~ ~'~, To Property Line fl~ TO Existing or Abandoned System on ; On Adjoining Lots ~..~0 To Cutbank (if present) lO0~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~"~-'~ ~ ~ Date '.~-'/~/~'~ Company ~"~['~ 7"~_.~ ~ MOA No. Receipt No. /,¢/ ~ , Date of Payment ~/~/~ Amount: $ Z~'OO~ Engineer's Seal Page 2 of 2 72 026 IRev 8/86) Back