HomeMy WebLinkAboutOUR MOUNTAIN BLK 1 TR 3
': Municipality of Anchorage Page I of ~
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~ G0i%7-- PID Number: O,~l-
=
Name: d.H~'r ~v~-r¢~ Wastewater System: I~' New D Upgrade
Address: ~ ~ ~
¢.0, ~t ~o, ¢~ ABSORPTION FIELD
Phone: ~G --~ ~o~ Nc. of BeSeems: D Deep Trench D Shallow Trench ~Bed ~ Mound D Other
LEGAL DESCRI PTI O N ~o,, Rating: Total Depth from~orioinalr ,~7grade'~l
0.7 GPD/~q. Ft ....
Lot: Block: Subdiv~ion: Depth to pipe botlom from original grade: Gravel depth beneath pipe
Township: Range: Section: Fill added above original grade: Gravel length:
.... ~,~ ~ I,~ Ft. ~ Ft.
WELL: ~ New ~ Upgrade ~rav~ width: Number of lines: Distance belween lines:
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: &~ ~ -~
~1~ ~*~ Ft. ~ ~ Ft. j 0 ~0 SQ. Ft.
Date Drilled: StaticWater Level: installer: Date installed:
Pump Set at: Casing Height Above Ground:
=,e,~: G ~ ~ ~0 ~,. m' ~,. TANK
SEPARATION DISTANCES ~ Septic D Holding D S.T.E,P.
TO Septic Absorption Lift Holding Public/Privat~ Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~¢~ ~ ~ J ~ O O
Well- ~ O O~¢ /CO I ~ ~ ~ ~ 1+ Material: ~ Number of C~mpadments:
Water -- ~ LIFT STATION
LineL°t J o0 1 + ~oo[ ~ Size in gallons: Manufacturer:
Foundation /ell ~ "Pump on" level at: ~ High water alarm at:
Cu~ainDrain ~~0} 0 ~ Electrical Inspect~ns pedormed by:
Remarks: BENCH MARK
Location and Description:
Assumed Elevation:
& $ ENGINEERING . '/ol~ - 'f(,
Inspections performed be_. .... - ....... Dates. 1st
17034 Eagle River Loop Road, No. 204
Eagle River, Alaska 99577 2nd -7-I~ -'~&
Department of Healt~ Huma~rvices approval ~
Reviewed and approved ~~(~~- Date: ~ ¢/~ ._
72-013 (Rev. 9/91) MOA 25
ROBERT C. COWAN
CE - 8801
Permi'~ No.
SW960'142 2 2
Page _ of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LOT 3, BLOCK 1, OUR MOUNTAIN S/D PIDNo.' 051-111-69
A B__
:CO_ 15.0' 36.0'
ST1 20.5' 41.0'
~T2 27.5_'_ 4,7,5'
)BL1 51.0' 50,0'
)BL2 52,0' 51.5'
:01 .37,0' 79,0'
302 64.5~- 52.0'
qT1 47.0' 85.0' ~~~ ,LT.
~T2 58.0~ 40.5' ~LL
sf~ sf2 ~
// ~T~~ 002
NEW 1500 GAL~
SEP[IC TANK blEW
· moo (~ __
~.~.s vJT~ = 90.3'-- '
54.3' B.O.H. ''-
72-013 A (Rev. 9/91) MOA 25
~' KUlYl ~U I I bK L;UI~ I KUL; I I UI~J t', U U ~
LOCATIDN OF WELL
~OnOUOI4 SU ~IDI¥II,~O~ ~.oT
. .. I I
LOCATION/SKETCH:
OEPTH~ MEA~UR~rD FROM:L-'JCaSing top ~]gr0und sudace
BOREHOLE DATA:
Muteri~[ Type and Color
Depth
From Tn
STATE OF AL~SK,~
DEPARTN1ENT OF NATURAL RESOURCE~
Oi'v'l~lON OF MINING & WATER MGMT
WATER WELL RECORD
E]N l
WELL OWNER:
WELL DEPTH: ~ ~ DATE OF COMPL~'TII3N
O~pth O! t~Ole; *J~,
DEPTH TO STATIC WATER LEVEL:
/ ~',.~' It below ~[ top of casing ~ 9round surface
METHOD OF DRILLING: ~-air rotary [] cable tool
E] other
USE OF WELL: (~'domestic [] irdoation [] monitor
[] public supply [] other
CASING STICK,~'[ ft, Diem: ~ in. I;o__
Casing typ~: ~ '~---'~. to __
WELL INTAKE OPENING TYPE: (~ open end [] screened
~'~ per~orated J~open hole
Depths of openings: to ft
CONTRACTOR INFORMATION:
~9nature of Authorized Respr. p~'entative Date
SCREEN TYPE; O/am; in.
Slot/Mesh Size: Length; It
GRAVEL PACK TYPE:
Volume used'.
D0pth tO top:
GROUT TYPE: Volume:
Depth: from tt to ft
DEVELOPMENT ME'TH,pO:
Duration: ~:~
PUMPING LEVEL AND YIELD:
_~__ ~t afte~ ~
~MP INTAKE DEPTH: .~ ft Horsepower: __
WELL DISINFECTED UPON COMPLETION(? YES
REMARKS; ~
hrs pumping ,~ gpm
[] NO
PLEA$'E MAIL WHITE COPY OF LOG TO:
DNR/DIVISION OF MINING & WATER MGMT
3601 C St, Suite 800
ANCHORAGE AK 99503,593Pu
Phone 19071269-8639,
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
Date: '7 - 2.~-4 ~
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER &WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING SIUDIES
AND REPORTS
WELL INSPECTION
& FLOWTEST
SITE pLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
1EST
STRUCTURAL &
MECHANICAL
iNSPECTiONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
JUL 29 1996
Municipality of Anchorage
Dept. Health & Human Services
REFERENCE: LoW .~.;
The septic inspections for the referenced property were
performed on 7-J~-q~ and ~-I%-fl~ · Prior to submitting
the On-site Wastewater Disposal System and/or Well Inspection
Report we are wa:Lting for the i~.6~,u~ ~ /~,. to be
completed. ~ / ~..~;.~
If we may be of further service please contact us.
Sincerely,
Robert C. Cowan, P.E.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASI<A 99577
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW960142
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:CHET SUITER
OWNER ADDRESS:P.O. BOX 701
PALMERf ALASKA 99645
DATE ISSUED: 6/25/96
EXPIRATION DATE: 6/25/97
PARCEL ID:05111169
LEGAL DESCRIPTION:
OUR MOUNTAIN BLK
1 TR 3
LOT SIZE: 330185 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THE SAND USED IN THE FILTER LAYER MUST BE A CLEAN COURSE
SAND WITH 4% OR LESS PASSING THE #100 SIEVE AND 2% OR LESS
PASSING THE #200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED
ON THE SAND USED/z~R) 2B.~INED FROM A~ APPR~.VED SOURCE.
ISSUED BY:~~/ :· ~
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSrONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
ROBERT C. COWAN, RE.
ROBERT A. SFIAFER, RE.
June 7, 1996
CIVIL ENGINEFRS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Tract 3, Block 1, Our Mountain Subdivision
Request you issue a permit %o drill a well and ins%all a
septic system 'ko serve %he proposed five bedroom house on
referenced property.
A test hole was excavated and percolation test performed.
The approximate location of the test hole is located on the
attached site plan.
At the time of excavation no water was encountered in the
test hole. The monitoring tube within the test hole has
been checked and found to be dry.
This property has enough area for a future septic upgrade
which can be seen on the attached site plan.
We do not anticipate any adverse effects on neighboring
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
If you require additional information, please contact us.
Sincerely,
~bert:~. Cowan, P.E.
RCC/gk
Enclosure
17034 NORTH EAGLE RIVER LOOP ° SUITE 204 · EAGLE RIVER, ALASKA 99577
T
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAl_ DESCRIPTION:
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
Township, Range, Section:
~/~ ~-i~ SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth Io Water Alter
Monitoring? _~ Date:
SITE PLAN
Gross Net Depth to Net
Reading Date
Time Time Water Drop
TEST RUN BETWEEN FT AND __
PERCOLATION RATE__~' \ (m~nutesl~nch) PERC HOLE DIAMETER
F7
//,./
PERFORMED BY: $ & $ ENGINEERING
17'034 Eagle River Loop Road No, 2u~ I = . CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WE~8-R~'~I~?'i~P, IbC,4]~{~AL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev, 4/85)
ROBERTC. COWAN, RE.
ROBERT A. SHAFER, RE.
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER&WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WElL INSPECTION
& F LOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERDOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
REFERENCE: Tract 3, Block 1, ()ur Mountain Subdivision
June 7, 1996
GENER/~L:
1.
The scope of this project includes the installation of
a 1500 gallon septic 'tank and absorption bed to serve
the proposed five bedroom residence located on the
referenced property.
Construction shall be in accordance with the approved
site plan and design drawings, Municipal permit with
any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal
Regulations.
The contractor shall be responsible for obtaining any
necessary underground utility locates.
Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
subsequently depressed from soil settling. On all
leachfield mound systems, the property owner shall be
responsible for ensuring a satisfactory vegetation
growth over the mounded area.
Contractors installing wastewater disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Departmen't.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
30
Ail standpipes on 'the septic tank shall extend a
minimum of 12 inches above final grade.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
Page Two
Tract 3, Block 1, Our Mountain Subdivision
June 7, 1996
Septic tanks installed with less than 4 ft. of cover shall
be insulated.
A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the tank
and 'the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed
soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
LEACHFIELD BED INSTALLATION:
Excavate the proposed Bed Area to the depth shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the bottom of the excavation becomes
smeared, it must be raked or scratched (ruffed-up) before
gravel or sand placement.
If a sand layer is required, place sand over entire
excavation to the required depth shown on the design. The
top of the sand layer must be within 2 inches of level.
Sewer rock shall be placed uniformly throughout the entire
bed. Perforated distribution pipe must be installed level
with perforations down. Gravel depth below the perforated
pipe shall be a minimum of six (6) inches. Gravel depth
above the perforated pipe shall be a minimum of two (2)
inches. The total gravel depth throughout the entire bed
shall be a minimum of twelve (12) inches.
The perforated distribution pipes must be no more than six
feet apart. The distance between the outermost perforated
distribution pipes and the sidewall of the absorption bed
must be no more than three feet.
Page Three
Tract 3, Block 1, Our Mountain Subdivision
June 7, ].996
Silt barrier material must be installed between the final
gravel layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
Monitor tubes shall be of four (4) inch diameter, installed
at the locations shown on the design, and extend a minimum
of 12 inches above final grade. The portion of the
monitoring tube extending through the gravel depth shall be
perforated six (6) inches below the bottom of the
horizontal distribution lines. The monitoring tube should
not extend below the bottom of the gravel surface.
BackfJ_ll over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty-six (36) inches.
The finished grade over the bed must be mounded to prevent
the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Type of Pipe
Perforated Solid
Cast Iron
ASTM D3034 (PVC)
ASTM F810 (HDPE)
ASTM D2662 (ABS)
Yes Yes
Yes Yes
Yes No
Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
Page Four
Tract 3, Block 1, Our Mountain Subdivision
June 7, 1996
A ]permeable nontoxic silt barrier (Typar 3401, Mirafi 140N,
or equal) must be installed between the final leachfield
gravel layer and the native soil backfill.
Ail leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the ~200 sieve.
When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic tank
may be set in place, but may not be backfilled before
this inspection.
The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
The final inspection is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple 'trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction° If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities°
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and in accordance
with the attached M.O.A. permit. There will ]De no contractual
arrangement existing between the contractor and S & S
Engineering.
Page Five
Tract 3, Block 1, Our Mountain Subdivision
June 7, 1996
S & S Engineering shall be the owner's representative and
will inspect the work as stated above to document the
contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to
others for acts or omissions of the contractor or any other
persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR/INSTALLER
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE ~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section ~ALII'.~ Ui'-,k!'~LH~JxAU~.
~N¥1RQN~ENTAL ,~E~YlC[~8 DJ~I~
P.O. Box 196650 Anchorage, Alaska 99519-6650
CERTIFICATE OF HEAl_TH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING R~6[JV[p
1, GENERAL INFORMATION
Complete legal description
Tract 3; Block 1; Ou~ Mountain Subdivision
Location (site address or directions)
24275 Ski Road
Chugiak¢ AK
Property owner
Mailing address
Chat Suiter
P.O. Box 701
Day phone 746-7804
Palmate AK 99645
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 5
TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
xxx
If community wastewater system, provide written confirmation from State AD£C
attesting to the legality and status of system.
72-025(Rev. 1/91) Fronl MOA #21
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.
Name of Firm
Address
Engineer's signature
S & S ENGINEERING
170~4 ~-,~l~ ......... ~. ............
Eagle River, Alaska 99577 / ,u~"
Phone
Date /o /~/~-C-
DHHS SIGNATURE
]/
Approved for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The 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.
72~25 (Re~. 1/91) Back MOA #'21
Legal Description:
A. WELL DATA
Well type
Log prese"t (..~N)
Total depth
Sanitary seal ~N)
MUNICIPALITY OF ANCHONAGE/,~.~
Municipality of Anchorage ENVIRONMENTAL ,SERVICES
DEPARTMENT OF HEALTH & HUMAN SERVICESocT ;~ C) 1.996
Environmental Services Division
825L Street, Room 502. Anchorage, Alaska 99501 · (907~;8~t4j~.l~ [ D
Health Authority ApproYal Checklist
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed '~' - 'Z~ -¢7~
Cased to J851 Casing height (above ground)
I
Wires properly protectedl~N) 'CE;_5
FROM WELL LOG
AT INSPECTION
Date of test
Static water level
Well production
g.p.m.
WATER SAMPLE RESULTS:
Coliform
Nitrate ~, o ~l Other bacteria
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed ~
Foundation cleanout(~N)
Date of Pumping
Tanksize )~oD NumberofComaartments Z_ Cleanouts~'~N).
Depression (YIn) /~e High water alarm (Y~[~
Pumper ....
C. ABSORPTION FIELD DATA
Date installed
Length '"/7- Width
Effective absorption area l~
Date of adequacy test ~
Soil rating ~or ft2/bdrm) O, ~7 ._ System type
Gravel thickness below pipe CL G ITotal depth
Monitoring Tube present ((~N) ~E_¢' Depression ever field (Y,~
Results (Pass/Fail) ~ For .-~-- bedrooms
Fluid depth in absorption field before test (in.); ~ Immediately after ~ gal. water'added (in.):
Fluid depth ~ (ins) Minutes later: ~ Absorption rate = -' g.p.d.
Peroxide treatment (past 12 months) (Y/N) """--
If yes, give date
72-026 (Rev, 3/96)*
LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Size in gallons
"Pump on"~~"'~"'~"""~i'Pump off" level at*
_ ~/~""~ Datum
E. SEPARATION DISTANCES
F.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
Publicsewermanhole/cleanout ~/A
Liftstation
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation tq' Property line tO I+
Water main/service line jo1 4' Surface water/drainage 1 oo ! '~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~O f+ Building foundation ,,,~, q I
Surface water
Curtain drain
Absorption field
Wells on adjacent lots
Water main/service line
Driveway, parking/vehicle storage area ~75'
Wells on adjacent lots ~ooI +
ENGINEER'S CERTIFICATION
I certi~ that I have determined thru field inspections and reffew of Mumctpal rec¢~af the a~ ~,~s are
in conformance with ~OA HAA~uideli~ in effect on this date.
Signature ~;}"¢ ~ %/ '
Engineer's Name /~ ~ ~-¢~T
/
/
'{,.'-.- .', :;%".t....",..- .,~
HAA Fee $ ~ ~
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev, 3/96)*
11/04/96 17:26 CT&E ESI RNCHORRGE * 9876941211 N0.251 Q03
,~ CT&E Environrnent~l Servioes Inc.
CT&E Ref.#
Client Name
Project Name/#
Clteat Sample Il)
Matrix
Ordered By
965797002
S & S Bngine~ring
N/A
Tract 3 B1 Our Mouuulin S/D
Smlple Remarlcs:
Client PO#
Printed Date/Time 11/04/96 08:29
CollectedDate/Time 10/29196 09:50
Received Date/Time 10/29/96 13:o,5
Technical Director: Stephen C, Ede
2.09
0
Method Limits O~te O.te Init
0,500 InB/k SMIO 4500-NOSF I0 maz
0 co[/lOOmL $M1~ 9222B
~0129/96 TAV
4rcx..t.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL HEALTH CASE RFVIEW WORK SHEET
PLATTING BOARD [~ PLANNING & ZONING
NUMBER
S-5289
-~iAT E RECEIVED
October 31, 1979
COMMENTTO PLANNING BY
November ~, 1979
FOR MEETING OF
NAME
Tract 3 Our Moun-tain Subdivision, VAC.
CASE OF
[~PUBLIC WATER NO___T~AVAILABLE TO PETITION AREA
I~{JBLIC SEWER NOT AVAILABLE TO PETITION AREA
REVIEWER'S COMMENTS:
71-014 (Rev. 2/78)
