HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 7 LT 2
~ MUNICIPALITY OF ANCHORAGE
/ DEPARTMENT OF FIEAL'I'H & ENVIRONMENTAL PROTECTION
i ~ ~/,-- ~T. ,,, ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchora§e, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT
-~-AME PHON~
MAILING ADDRESS
~GAL DESCRIPTION /
LOCATION NO. OF BEDROOMS
DISTANCE TO: ~Wel, /~¢ , [Absorpti~rea. Dwellings./ PERMITNO.~_OL,~ O
F- ~ Manufacturer Material No. of compartments
Uq. capacity in gallons Inside length Width Liquid depth
/f~.~'O IF HOMEMADE;
~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ~ Manufacturer Material Liquid capacity in gallons
~ Well Poundotion Nearest lot lin PERMIT NO,
No. of lines Lengt~f each line Total length of lines Trench w dt ~ Distance be~ lines
Top of tile to finish grade _/ Material beneath tile Total effective absorption area
Length Width Depth P~RMIT NO.
~ ~ Type of crib Crib diameter Crib depth ~otal effective absorption area
m ~ ~ell Suilding foundation Nearest lot line
~ DISTANCE TO:
~ Clas Depth Ddll , c Distance to lot line PERMIT NO'~OLI~Q~
~m D I STANCE TO: ~ ~uilding foundation Sewer I~;,~ ' Septic ~tankl OD z Absorption area(s)
OTHER
PIPE MATERIALS z~ tdPJ
SOIL TEST RATING ---- S~
REMARKS ~
/
72-013 (Rev. 3/78) ~-
MUNICIPALITY OF ANCHORAGE
Department ~ Health and Environmenta.~ 'rotection f):l~/ .'~-~'~
825 ~ Street, Anchorage, AK. ~9501
264-4720
* * * HANDWRITTEN PERMIT * * *
Permit ~ ~S~L~ ~,ELL AND~-ON-SITE SEWER PERMIT
Applicant: ~/ A'~~/~ Mailing Address: /~/"~ ~/ ~ ~ ._
Location: ~ Phene Nu~er: ~f- ~4
/
Type of Soil ~sorption System Is:
Trench: ~-Drainfield: Seepage Bed: Holding Tank:
~ax~mum ~umber of Bedrooms: _ 8o~1 Ra~n~(s~.~/br) /~ ,
The Required Size of the Soil ~sorption System Is:
DEPTH ./~ LENGTH /~d ,~ GRAVE_ DEPTH _~< WIDTH
renc or
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet), There is no set width for trenches,
The gravel depth ls the mlnlm~ depth of gravel, between the outfall plpe and
the bottom of the excavation(in feet),
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = ./~2 GALLONS * *
Permlt applicant has the responsibility to lnform thls department durlng %he
installation inspections of any wells adjacent to thls property and the number
of residences that %he well will serve,
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system wlthout flnal inspection and approval by thls department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a co~nunity sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
are
Other requirements may apply. Specifications and construction diagrams
available to insure proper installation.
* * * PERMII' EXPIRES DECEMBER 31, 1 9 8 3 * * *
I certify that:
(1) I am f~miliar with the requirements for on-site sewers and wells as
set forth by 'the Municipality of Anchorage.
I will install the system in accordance with codes.
(2)
(3)
Signe~:
I understand that the on-site
the residence is remodeled to
Applicant
SWP/024 (1/8].)
sewer system may require enl~gement if
include more th~// bedrroo~/~
Date: ~//,~
: ,.. ,:~ * ~ ~ I~ANDWRITT~N PERMIT ~. ~ e
eb, a Re. ired ~izo of the 8o1~ Absorpbion system
d,:~p~h off a t. renoh o~' pit ? ~he d~s~ance between ~;lm ~u~'fac~ o~ ~h~
~ ~ RG~U[RED SEP~IG(HOLDING) TANK SIZS ~ ~J¢~ .__ GALLONS
~ ~ * ~lqO(2) INSPECTION8 ARE R(SQUtRED ~ a .~
Backfil~Dq o~.aDy_~t~I~ withouE final in~De~tloD_aDd approval by ~hi~
O~l~er ~equi~en~ may apply. ~p~ezf~.oak].on~ and construction dLaq~'af~
~va~l, able ~o ~B~ur~ prope~ ins~al, latlon.
· e "" PEHMIT EXPIRES DECEMBER ~i, 1 9 8 3 ~ ~
~ ce~tLffy that:
I ~ f¢~illar wit;h the requirement9 Sot on**9ite sewers and
s~t~ ~orth by the M~c).pa~zEy of ~lc:horage.
(2) ~ will ima~aT.l ~ha system in aocordanc~ wleh oodom.
(3) E~e~sba~hat: ~he ofl-~J.{;o ~ewoc ~ystem may ~equtce
dwP/024 (1/81)
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH, AND ENVIRONMENTAL PROTECTION
'' 825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LC)G - PERCOLATION TEST
,r_] PERCOLATION
TESF
6
7
8
9-
.... I0 -
11
ML
Sift /~..
SITE PLAN
II I' t
13
14
15
16
17
18
''19
20-
COMMENTS
72-008 [6 '79)
Readin9 Date G~oss Net Il Depth Io I Nel
I I
,'Static Water Level_ 48
_ feet
of Haney & J' ~.e Romero
Lot 2 Bk. 7 Skyway Park Sub.
Anch. Ak.
Gallons Per Minute
-- feet
Total Feet of Umsing_65 F~p~
r
feet
.. to .~5 feet Boulder and Crav~,l
35 feet
tO 50 feet Sand
, tO 65 fmet Sand and Gravel
-- tO
Hefty Drlllin6
B.R.A. Box 1553 H
A nchora6e .Alaska
99507
MUNICIPALITy OF ANCHORAoI:
DEPT. OF H~ALTH ~
ENVIRONMENTAL PROTECTION
,JUN 2 0; ~
. ECEIVED
Haney & Judie Romero
1231 A West 47th
Anchorage, Alaska 99503
May 28, :[978
Mr. Jesse Rich
8208 Peck Ave.
Anchorage, AK 99504
Subject: Soils investigation for sanitary sewer system; Lot 2, Block 7,
Skyway Park Estates Subdivision, Anchorage, Alaska
At your request of May 25, 1978, I conducted a soils investigation at the
proposed location of a sanitary sewer system on the subject lot.
This investigation, which was accomplished on May 27, 1978, consisted of the
inspection of soils removed during drilling of a 4 inch diameter test hole,
using solid flight augers and a Mobile B-34 drill rig. The test hole had a
total depth of 16 feet. After completion of drilling the test hole was filled
with water and a percolation test performed. The results of the percolation
test are tabulated on an accompanying sheet.
The topography of the area where the soils test was conducted, is level
~ith no discernible J~ainages. Vegetation consists of small birch and
~;pruce trees to 10~-J 12 feet tall, with a ground cover of grasses and
some moss. The subject lot was originally a homesteaders potato field.
This accounts for the uniformity of the height of the trees.
The soils encountered are graphically shown on the accompanying test hole
boring log. The soils consisted of a 1.5 foot layer of Silt with a trace
of sand, gravel and organics overlying essentially a Silty Gravel with some
sand, and occasional cobbles to a total depth of 16 feet.
No water table was encountered.
An accompanying sketch shows the subject lot with the approximate location of
the test hole and proposed house in relation to the property lines.
I appreciate the opportunity to be of service to you. Please contact me if you
have any questions regarding this soils investigation.
Very truly yours,
Box 191, Star Route A
Anchorage, Alaska 99502
(907) 344-9150
Attachments: Drawing of test hole boring log with location sketch, and tabulation
of percolation test results.
xc: Department of Health and Environmental Protection
50I .
Proposed
Home
Location
85
T.H. No. 1
102 '
Jesse Rich Property
Lot 2, Block 7,
Skyway Park Estates Subd.
Anchorage, Alaska
S69°40'E
202.43'
WOO BLVD.
NOT TO SCALE
Distances are approximate and have
not been measured by surveying
methods as to location of test
hole
Proposed home location is approximate
and may vary slightly from location
shown on sketch.
Michael B. Bergmann
Consulting Geologist
~]chorage, Alaska
T.H. No. 1
5-27-78
0.0'
Silt:w/trc sand & gravel,
loose, vy moist, bm, some
~ganics in top 3".
~ (ML)
~--- -- --- 1.5'
3ravelly Silt: w/som~ sand,
occ cobbles, dense, sl moist,
.~rybrn.
~'-- 4 5'
Silty Gravel: w/some sand,
scattered cobbles, dense,
sl moist, gray.
(GM)
Gravel: w/some silt & sand,
n~nerous cobbles & boulders,
vy dense, dry, gray.
(GM)
NO WATER TABLE ENCOUNTERED
16.0'
Test Hole Boring Log represents soils
encountered on Lot 2, Block 7, Skyway
Park Estates Subdivision, Anchorage,
Alaska.
Jesse Rich Property
NOTE: Property was origJ, nally a
homesteaders potato field
and had been cleared of
natural vegetation in the
past.
May 28, 1978
Jesse Rich Property
Lot 2, Block 7, Skyway Park Estates Subdivision,
Anchorage, Alaska
Percolation test performed May 27, 197B, by filling a 4 inch diameter, 16 foot
deep drilled test hole(T.H. NO. 1) with water, and measuring the water level
drop periodically for one hour.
TABULATION OF PERCOLATION TEST PJ~SULTS
TIME INCHES ET (min) DROP
17:10 4.0" start start start
17: 20 5.5" 10 1.5" 6.7
17:30 6.25" 10 0.75" 13.3
17:40 6.75" 10 0.5" 20.0
17: 50 7.25" 10 0.5" 20.0
18:00 7.5" 10 0.25" 40.0
18: 10 8.0" 10 0.5" 20.0
RATE (mill per inch)
Average percolation rate for entire hour = 15.0 min per inch
Average percolation rate for last one half hour = 24.0 min per inch
Michael B. Bergmann
Consulting Geologist
Anchorage, Alaska
Municipality of Anchorage
t - On-Site Water and Wastewater Program :,
(907) 343-7904 S"' "Y
Certificate of On-Site Systems Approval
Parcel I.D. 019-102-02 Expiration Date: I - 1 Z -1 7
1. GENERAL INFORMATION
Complete legal description SKYWAY PARK ESTATES LOT 2 BLOCK 7
Location (site address)
1601 WOO BLVD
Current Property owner(s)
JOHN HOFF Day phone 744-2502
Mailing address
1401 SHORE
Real Estate Agent Day pho
4, 089 /07i
43 �
,,, 'fi A
2. TYPE OF DWELLING: N ',i,I ti'' "`
❑ Single Family (w/wo ADU) a • ��
❑ Duplex �v "��
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
68
4 �� �[ � 9c.
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual Q
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System E1 Public Sewer ❑
WaiverNariance request for: Distance:
_
G i/�
Received by: LDate: /0) I/I5
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ ��o Waiver Fee $
Date of Payment // /t ' Date of Payment
Receipt Number D Receipt Number
COSA# .O CJW I #0. g. 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 C&M ENGINEERING Phone 907-854-5558
Address 30840 PRUDHOE BAY AVE
Engineer's Printed Name Charles Balzarini Date 01/18/18
6. DSD SIGNATURE * 9TH
System #1 Approved for T bedrooms
System #2 Approved for bedrooms HARLES G BALZARI 0
r �' CE-13854
Disapproved f pis•.,
9FQ •• •
Conditional approval for bedrooms, with the following sztp pR, ''�
440&-
I f\, isA4A,k 06(1/C Ci—Cd
_ ao -^JPCI VC; C9/
,t,.
ON-SITE t.),,
WATER AND
m WASTEWATER cs
fp PROGRAM _t165
O,p'`6%/1
17
.G v\tP
By: • Vvt, 1 C �^ Original Certificate Date: / ‘-/ 'I
The Municipality of Anchorage Development 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 r •
If more than 1 septic system is on the lot:
COSA Checklist# 1 of1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: SKYWAY PARK ESTATES LOT 2 BLOCK 7 Parcel ID:019-102-02
A. WELL DATA
Well type public water If A, B, or C provide PWSID# -- Well Log (YIN) --
Date completed -- Sanitary seal (YIN) -- Wires properly protected (Y/N)--
Total depth -- ft. Cased to -- ft. Casing height (above ground) -- in.
FROM WELL LOG AT INSPECTION
Date of test -- --
Static water level -- ft. -- ft.
Well production -- g.p.m. -- g.p.m.
WATER SAMPLE RESULTS:
Coliform -- colonies/100 mL Nitrate -- mg/L
Arsenic -- ug/L Date of sample: -- Collected by: --
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC / STEEL Date installed 7/29/1983**
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) NO
Date of pumping 1/12/18 PumperONE STOP PUMPING
C. ABSORPTION FIELD DATA
Date installed 7/29/193 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 System typeTRENCH
Length 100 ft. Width 3 ft. Gravel below pipe 3 ft.
Total depth 8 ft. Eff. absorption area 600 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 1/16/18 Results (Pass/Fail)PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 10 in.
Elapsed Time: 20 min. Final fluid depth 0 in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed -- Size in gallons -- Manhole/Access (Y/N) --
"Pump on" level at-- in. "Pump off' level at -- in. High water alarm level at -- in.
Datum -- Cycles tested -- Meets alarm&circuit requirements?--
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot -- On adjacent lots --
Absorption field on lot -- On adjacent lots --
Public sewer main-- Public sewer manhole/cleanout --
Sewer/septic service line -- Holding tank --
Animal containment areas -- Manure/animal excrete storage areas --
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation +5 Property line +5 Absorption field +5
Water main +10 Water service line +10 Surface water +100
Wells on adjacent lots+100
ABSORPTION FIELD ON LOT TO:
Property line +10 Building foundation +10 Water main +10
Water Service line+10 Surface water +100 Driveway, parking/vehicle storage +10
Curtain drain +50 Wells on adjacent lots +100
F. COMMENTS
** TANK APPEARS TO BE FUNCTIONAL BUT SHOULD BE REPLACED SOON
DUE TO AGE, OR CONNECT TO CITY SEWER.
wilt- 4p PEARS-7o {-tAvt pctov '49 17c�12T4/6 t49 S p,i/.✓C c T.1c,.v ece 7(42 Lxc-
Wd;EA :.fib y -cR, t t c L1 E9 5,'NL Oiv,T .,��1 ."� k
t.
G. ENGINEER'S CERTIFICATION ‹ OF At.,:ikkk
I certify that I have determined through field inspections and ,e ;. , ' Wt÷
review of Municipal records that the above systems are in ,,/C; 57
conformance with MOA COSA guidelines in effect on this date. * T
Engineer's Printed Name CHARLES BALZARINI ,:011*:
�"
. . .. • ' ' }° • •
Date 1/18/18
H LES G BALZARINI
fa F,. qtr
AMP'
: .
PR�OFESSt4 r -.:'
-COSA canary sheet 2-6-15.doc "�N
NOTES:
1) THE LOT IS SERVED BY A PUBLIC WATER SYSTEM.
2) THE LOT AS DESCRIBED ON THE PLAT OF SKYWAY PARK
ESTATES SUBDIVISION (PLAT P-632), NOTED AS (R1), HAS A
MISCLOSURE OF 8.99'.
3) THE DIMENSIONS HELD ARE FROM AN AS—BUILT FROM
1983 BY ALASKA LAND DEVELOPMENT SERVICES, INC., NOTED AS
(R2). THAT SURVEY RECOVERED ALL FOUR PROPERTY CORNERS. Tract B1
4) NO LOT BOUNDARY SURVEY WAS PERFORMED FOR THIS
AS—BUILT.
CHAIN—LINK FENCE 10' UTILITY
11.8'x12.0' GREENHOUSE N 89'59'30"E 213.90' (R1) EASEMENT
N 89'59'30"E 2 4.05' R2 _ — — —.
/ / — -- -
12.0'x8.0' GREENHOUSE1a' 8.3'x30.5' DECK
cn
N SEPTIC PIPES
l^ N 67.5.
1 ngomi
0 54.3' 8.4'x8.0' SHED
/,`,;) ", / J TRi— 12.0'x23.8' �\---
2.0',
r\''
\ ca SEPTIC LEVEL
Lot 3 PIPE 0.04'RESIDENCE o SHED „`nj
lr�rCa/ / 54.3' O
/ � � S LA ... . . NN
� ^/ CONCRETE :,
Nin PAVERS • p8.6o co Lot 1
/,Z 2^/ 7.7'x7.7' DECK ,
co co
10' UTILITY o ASPHALT DRIVEWAY
EASEMENTS /
- - - - - - _ � Lot 2 J. l
41,338 s.f.
,"202.36,- 3' s. R�
(R1] 3j13 67.
woo �`
li/ _�U`EVAR p _
PLOT PLAN AS BUILT _X SCALE 1" = 50' GRID SW 2728 Project No. 18-005/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & AssociatesInc . (907) 522-6476 Phone 000p00�,
' ' keOnOlangsurvey com522-4625 ax v� OF A �0�%
Professional Land Surveyors
jonathanOlangsurvey.com �s�o0o
OOP. ' `�, '//
I hereby certify that I have surveyed the following described property: * 49TH /\ .,37 U
LOT 2, BLOCK 7, SKYWAY PARK ESTATES SUBDIVISION (PLAT P-632)
Anchorage Recording District, Alaska, and that the improvements situated thereon that
re
within the property lines and do not encroach onto the property adjacent thereto, O
no improvements on the property lying adjacent thereto encroach on the surveyed DO'S ' KENN N : ��
premises and that there are no roadways, transmission lines or other visible °O�"% l _ r`� . 9
easements on said property except as indicated hereon. 04 �F ' .,LS-5202
Dated this the IZ�\ Day of T,o� >a 1 _, — at Anchorage, Alaska �04ORpSSIONA��
It is the responsibility of the owner to determine the existence of any easements, �040000"'•�
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
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
CERTIFICATE OF REALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. Cf
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address _ !
Lending agency
Mailing address '~'~ ~-
Agent ~'¢ ~
Address
~"~ ~'~¢ ~,,f .E_*¢'O Day phone
/,(,,~.z4 ~ ~ .~ Day phone
0'700
~OOl
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual 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.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site F
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State AD£C
attesting to the legality and status of system.
72-025 (Rev, 1/91) F¢ont 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 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 '~/)Ja.-c_~4d ~oc~L~,_]ev~ i'~-~ Ph0ne.277~o~/~'
Address ~OX ~ /~
Engineer's signature ~ ~- Date
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms,
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: / ~
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The 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. 1/91) Back MOA
--~ Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL. CHECKLIST
Lega, Description: 4/7 Parce, .D.
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B. or C. attach ADEC letter. ADEC water system number
Y . Date completed ~' 7'~'~ ~ Driller
(°-~ Cased to ~2 '-~ Oasing height
y Wires properly protected (Y/N) __
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level ~>~
g.p.m.
AT INSPECTION
_('?/ ' / 7 ' ¢/ 7__ MUNICIPALf[¥ OF ANCHORAGE
ENVIRONMENTAL SE,VICES DIVISION
JAN 21 1992
g,p.m.
RECEIVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot /~.~2 '/''
Absorption field on lot
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots
_ Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ¢
Date of sample: ¢'7/'?,Z
Nitrate _
Other bacteria ~k~lD
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed ~ ¢/,'¢ ~ _ Tank size /
Cleanouts (Y/N) ~ _ Foundation cleanout (Y/N).
High water alarm (Y/N) ,
Date of pumping ////_ 7/? 2~
Compartments _ ,-LC--
. Depression (Y/N)
Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I ~O
To property line o~,.¢
Surface water/drainage
Foundation
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION ~,~//
Date installed
Manufacturer
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed ~ q /~ '~
Length J' b~) Width
Total absorption area ~
Depression over field (Y/N)
Results (pass/fail) "-~
Peroxide treatment (past 12 months)
Soil rating
Gravel thickness
Cleanouts present (Y/N)
Date of adequacy test
for
System type
Total depth
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain I'h/,/~-~
On adjacent lots I '% ~ Property line ~3 '--~
To existing or abandoned system on lot
Cutbank t'~//~. Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
HAA Fee $
Date of Payment
Receipt
Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
203 ~ES'f 15¥H, hVENUE ~UITE 20&
~NDHOR~GE~ ~L~SK~ ~9502-3~04
1~07) 27~-~916
SEPTIC SYSTEM ADEQUACY TEST
LEGAL:
LOCAT I ON:
(]WNER:
(lES I DENCE:
WELL:
,SEPTIC SYSTEM:
2, Bloc::l.:: 7 Sl.::yway Par'l:: Estate
FROM MUNICIF'AI... RECORD,S: zl Bedroom System
ABS[)RPTI[]N SYS'T'EM~ Tr'enc:h
ABSORI='TION AREA: 600 Sq,, Ft.
SO 1 I.. RAT i IxlE~: 150
I NS]'AI...L..AT Z ON DA"I"E ~ 07/29/83
DATE: OF LAST PUMPINS: Anch. (];ess F'ool January 17, 1992
DATE OF TEST."
JaJn_lary 17, 1992
TEST PROCEDURE: Syst. em was ~nspected and ineasured. Tank was
-found w:i. th 4 'f:eet o'I: cover and with a l:i. quid level o'f 49 inc:hes.
]'r'er~cl"l mord. to~ .... t:ube was 9.5 deep w:i.N'l 34 inches o'F ~'~'F'.
65() gallons o'f c:lean watc~r was added to the '~r-er'ich while the
J~'~'~:er :Level iii th~? talqk did Ilot c:hal'lge~ while the ].J:~vel in the
mc)rd, tor r'ose 16.5 incl)es. Dur:J. ng 'L:he nc~x'l: 90 m:i. nut. es the wa'l:e~r'
'TEST RESULT:
Depart merr~i o'F
-l'h:i.r~; system meets the code r'equ:i, remerrb, s o.F
the Health and Soc:ial Services
the ML.II')i C:i I:)~l i ty O'F Anchorage.
NOTE "['he op0:~r"a{'.iorlal l:L~:e o'E all sep'~::i.c:: syst. ems clE!per~c:Js
:Lc)c:~], ~i(3il c:cindi'~.'.ic)f]s~ gl'"OL,tFtcJv~ter levels that
dur':i.r~g 'k:hce yeal'", ar'Jd the water usage c:)'~ the ~:ami].y be:J. rig
by Khe system. 'these (: (:)rl cl :L t :L or] s E31"e oLIt~icJe '[:,hE~ c:olltl'"Ol o~:
[:~Va].l..t~:~]:l::)l" (::)~ '~hJ. iB septic system. We can there.t:or'[:~ not giv[~ any
es~t:i, mate i:)~ how Zc]/'~g tl'~i~J ~ayst~.:am will '/urlc:tior~ satis'~actar"y ~:of
203 ~ESI 151H. AVE~HE SUITE 206
(907) 279-3916
RESIDENTIAl_ WELL INSPECTION
LEGAl_:
LOCATION:
OWNER:
TYPE OF WELL:
I._o'(~ 2 Blc:)(:::k '7 Skyway Park
:l. 60] Woo B]vd
Jucly Romer'o
F'rivatE,~ fJ~il"lgie Family
WELL. LOG AVAILABLE: Yes
INSTALLATION REQUIREMENTS MET:Yes
WELL YIELD FROM WELL LOG: 20 Gallons per
PUMP YIELD FROM 'FEB]-:
DATE OF INSPECTION:
TEST PROCEDURE: Wel 1
M :i. n u t e
8 Gal ].c, ns per )'linu'[:(:,
January 17,~ 1992
~as pumped at a constant fate while t. he
probe, h'b. the beg:Lnn:Lng o~ the test water ].[,:zv(,e]. wa~ ~ound at *q.[~
· Feet b~::.~low top (:)f c::as:LrJg. At a pumping rate o.f [] gE~l].6)l']f~ per
Wel ]l. recow::~r'ed immedi at.e].y after puml:) sbu'l:, dc:)t,~n.
TEST FOR E.COLI AND TOTAL NITROGEN: Water' was t(~.~sted ~:c:)r" E.CoIJ
E. (]ol :L 0. Tot:al Ni'l:.r'oger) ND (Norie D~,:rL'.ec:{'.~ad) .
Max. allowable Total. Ni~'.r"ogen :1.0 rog/1.
'rEST RESULTS: This well meets ti'ira r"eqLcir'emerrbc~ o.f tho
Murl:i c: ;i. l::) a l :Lty o.1:
THIS WELL WII-L PRODUCE MORE THAN 3 GALLONS PiER MINUTE FOR MORE
]tHAN FOUR HOUF(S
]'lie ML.Ir~J. cipa], reclLd, remer~t ~:c')r e~e].l ~c].(:)~ is 150 ga].lons c)~ water'
per I:)edroom per clay,, "rTu[s well exceed this re)qu:[rement. 'T'he
6:/!~Se)~Slll(f~m]L (]'F 'J'.he cc)ndit:kc)r] o'f the ~e:ll app]:ies c:)ri].y t(::) the
(::c)r)ditior)s as o.F the day E(:z, sted. The FI. ow rate may (::hange dl_~e t(.)
allcJ changes ~1-1 thE? ].~/mqd LISle and o'L']'~er' ~:a(ztors thai: may
aqu:L.Fer .Feedi~;i L:he well.
Property. Owner
Mailing Address
APPLIC FILLS OUT UPPER HAL ONLY
~, ~ ~. ~ ~ , , , ~ ~ k _ ( . ;; , Zip Code
Address ~. -~
Street Locati~ ~ { C,E' ~ ' ' ~' ~ .
Type of esldence
~ Multiple Family NO. of Bedroo~_
~ Other
Water Supply
[] Community
[] Public Utility
Sewer Disposal
C] Public Utility
[g Holding Tank
Phone
Zip Code
ATTACH WELL LOG. A weg log is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attech log if available).
Year Individual Installed:
When Connecled to Public Utility:
NOTE: THE INSPECTION PEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Inspector Inspector Inspector Inspector
Field Notes:
./-i 2/ 0
MUNiCIpALITY OF ^NCHOR^GE
D[PT. OF H~/~,L¥1'l 8:
ENVIRONM~NYAL pROTeCTION
RECF. W ED
APPROVED BEDROOMS
DISAPPROVE[)
OONDITIONAI. APPROVAL'
*CONDITIONS OF APPROVAL
Well To Absorption Area / '~- c/ _ _ Well Log Received /~"/,;'9 (.,/~-
Well Io Tank £ ~) ,, ~[ Septic Tank Size /) ~. ~) · LO
Soils Rating Date Sewer Installed
z--L.?--
123~-A %.L~st 47th Ave~me
Anchot-ago, ~i{ 99503
Subject,' Lot 2, B].oclT. 7, f~).[y%/ay 1?ark [$ubdt. vi:$ion
the in¢]J, vid~.~a], se\.;olc and water f[~cilitJ, e,9 cannot
Che to? of the v;o].l casing shotl].d be: sea]cci ~;o tll~t it i%~
water tight;.
Exposed e].~ctrica] ,,;ires to the we].] l~ead are in vioJ.~t:i, on
liOltOd di. sc~:epancJ, es have been correcked. Iii[ there are any
fulfiL]lillY questions, please call it)lis Of:ti.ce at 264-~4720.
,<;incerely,