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HomeMy WebLinkAboutPANORAMA TERRACE BLK 2 LT 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES /Y-,,"/~ 0 Z L ("ov~ o ~ ,~T'Am~:~ ~ TO SEPTIC ABSORPTION WELL AddressFROM ~"~-~.~.~ TANK FIELD Phone(s) J Permit No. No. of Bedrooms WELL // Township, Range, Seclion AJ-~UILT DIAGRAM (Show location of well, septic system, properly lines, foundation, TANKS ¢ SEPTIC ~ HOLDING Manufacturer Capacity in gallons ~/~, Material No. of Compadments % TYPE OF SYSTEM ~ BED ~ W. DRAIN ~ OTHER / TRENCH Depth to pipe bottom from/Total depth from original grade :ill added above original grade Gravel depth beneath pipe ~ , - - Gravel length Gravel width I WELLS -~ _ . - ~ PRIVATE ~ OTHER Ildentifv) Clarification (A,B.C) Total Depth ~ Cased to L REMARKS: f~ ......... I ~/~ ~ a ~[J'O~ cedily that this i.spe~ion was peHormed accordinD Lo all Health p PP : : : · 72-013 (3/85) Notes Da te GO-95 (10/89) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744 HAND WRITTEN PERMIT' Permit Number: SW90~ Date Issued: ~//~/f¢ , Design Engineer: /~-~&~/~F, Owner Name. Z~$~ Owner Address: ~ ~/~7~/~ Parcel ID: Lot Legal: Subdivision:/~m~ ~-F- Lot: ~ Section: /~ Township: /~/ Range: Lot Size: Max Bedrooms: This Permit: 3 Total Capacity:_~ Permit Type: ~/rr~/L . Expiration Date: Day Phone: Block:~ SEPTIC TANK: Minimum septic tank capacity:~ gallons· Each septic tank must have at least 2 compartments, insulation is required if depth to top of septic tank(s) is less than 4.0' Lift stations require an appropriate electrical inspection. WELL LOG: A copy of the well log must be sent to DHHS within 30 days of the well's completion. CERTIFY THAT: 1. I will install the on-site sewer system and/or well in accordance with all codes and regulations of the Municipality of Anchorage (MOA) and State of Alaska , and in compliance with the design criteria of this permit. 2. I will adhere to all MOA and State of Alaska requirements for separation distances from any existing well, septic system, or surface water on this or any adjacent or nearby lot. 3. I understand that this permit is valid for a single family dwelling with a maximum of ~ bedrooms. I also understand that any enlargement will require an additional permit. 4. I understand this permit is issued for the calendar year and expires on December 31 of the year issued. 5. I will notify DHHS prior to all inspections by the engineer or well dril/. ISSUED BY: DATE: DATE:~ db/ll5 M o" oE. 'vv f57. oo ~ O o.~7 1o. Li, I""iL.. i-ry 5 o'"o"z' ~ E5'"7.0o' ANDERSON ENGINEERING P. O, B°x 240773 Anchora~I.e Alaska 99524 90~ 33?-836? Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL OESCRiFTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15- I6- 17- 18- 19- 20 COMMENTS Township, Range. S~fion: ~/~ ~/~ ¢ ~ ¢3 SLOPE SITE P~N WAS GROUND WATER ENCOUNTER ED? S IF YES. AT WHAT ~ DEPTH? /~'~ / P Ei Ii Gro~ Net / Deoth to Net R~cli~J Date Time Time Wate¢ Oro~ I ~-~ ¢~ ~ ~ ~ /~ ,, _ ~ ,, y ¢ //" i,, z ,, ¢ ~ -/¢" /" ¢ ,. /f : · ¢., /,, ¢ ,, -1¢ ¢ ~', /,/ PERCOLATION RATE ~ {mmu[e~mC~l PERC HOLE DIAMETER TEST RUN BE'C'~VEEN '~'~ FT ANO ~ FT II 0 ~ 10'. UWiL ITY AC. 6. .... ~_~' HO.~7_ _._ '~. MUNICIPALITY OF ANCHORAGE ~-,>/ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS PHONE [] UPGRADE LEGAL DESCRIPTION LOCATION I DISTANCE TO: { /00,/~ IMa,,ufacturer ' v, ILq capact¥ riga onsI ~-- ~ DISTANCE TO' IWell ~ ~z IDISTANCE TO: I /~O P ~ ~ ~ No. of lines, Length of each line ~ ~ Length Width ~ ~ ~ Type of crib Crib diameter ~ DISTANCE TO: Well ~ JClass Depth ~ ~ Building foundation DISTANCE TO I Absorption area/ I nside length Dwellin~ Material ~/.¢_~¢¢ / Width Dwelling Foundation Material Nearest lot, I i,q e.= Total length of li~es [ Trench width ~ c) I ,:¢6 Material beneath tile Depth inches inches Crib depth Building foundation Driller Sewer line OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER R EMAR KS / NO. OF BEDROOMS PERMIT NO. No, of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines Total effective absorptio~rea PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Septic tank PERMIT NO, Absorption area(s) APPROVED DATE LEGAL 72-013 (Rev. 3/78) CD ,.H- O c+ ~D © c+ 0 © ~b : : :,~. ~-~ ~-~ ! ~:o !co ~o 0 0 © 0 0 © © 0 0 0 © PERMIT NO. DEPRRTMENT 0 '~EFtLTH RND ~N',/IRONMENTRL F '~TECTION ,.,--',.~" = "L%'''STREET., RNCHORRGE., ~-...§F'L~_ l-~-~[:, ,]~-~--S I "T'E SEL.IEE." F'EE."~-I I T 800405 ) APPLICANT LOCATION LEGAL JIM BUMGRRDNER SRA BOX 474E NEDLETON DR. LOT 2 BLK2 PRNORRMR TERRACE LOT SIZE t7000 SQU~RE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT/BR)= 150 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:. E F" T ~--~ = 1 ~-Z", LE ~-~i3 T F-I= gE: ,_3~:R %.'E L [:,EF'TH= 6 ~ i i~ THE LENGTH DIMENSION t'=_, THE LENGTH ,.IN FEET), OF THE TREN_.H 0R DRRINFIELD. THE 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 IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFBLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F-:E,g."L, I F'.'E~--, '--=.EF"T I ,2: TR~-~::." S ][ ZE= -1.. ~]',,-Z',L---~ L~l::tL! C,l"-,tS PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T~L] (2) I ~-~SPE,]TIC,~-~S F~RE ~:F,~LiIREg, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R HELL AND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS t00 FEET FOR A PRIVATE WELL OR t50 TO 200 FEET FROM A PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM B PRIVATE WELL TO B PRIVATE SEWER LINE IS 25 FEET TO B COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS 8RE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THRT 1: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIP8LITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORD8NCE WITH THE CODES. g: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENL8RGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: ..... RPPLICRNT JIM BUMGRRDNER ISSUED E:Y __[:'RTE-~-T.-~.-L]..:~..~.. .... "/4. 0 DEPARTMEN( .'IF HEFtLTH RN[:,'ENVIRCtNMENTF /F'ROTECTION 825"~:/L' STF'.EET.. RNCHORRGE, RK. ~5E~1 ~ 2E. 4-472E1 ' 2/ I.,IELL F-:! r--liS:, L--~I"-J--S I TE LS[CI.--IER F'ERI~'I RPPLICRNT ,.~ I TF/ "-~ u ¢Y~ dA LOCRI'ION G~A~% LEGAL L~C ~ ~L~ & ~D~A ~ [~FFam~ LOT SIZE [~ moo S~I_IARE FEET TYPE OF SOIL RBSORPTIEIN SYSTEM IS: MRXIMIJM NIJMBER OF BEDROOMS = ~ SOIL RRI'ING ~S~2 FT,.*BR)= /~ ,- .-, _ . ,,-]-, c, ,- IS' THE REQUIRED .:.Iz_E FJF THE SOIL. RE,.:,LRPTION _,¢.:,TEM £:, E F' T I-4 = I0 L E !"-4 G-r H ~ E-", E P T !-t =: THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF Ft TRENCH OR PIT IS 'THE-~]~¢STRHCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRT!ON (IN FEET). THERE IS NO SET HIDTH FOR TRENCHES. THE GRR',/EL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETNEEN THE OUTFRLL PIPE RN[, THE BOTTOM C,F THE EXCRVRTION (IN FEET). PERMIT RPPLICRNT HRS THE RESPONSIBILIT'¢ l'O INFORM THIS DEPRRTMENT [)URIHG THE ~NSTRLLRTION INSPECTIONS OF RN~r' WELLS RDJRCENT TO THIS PROPERTY RNC' THE NUME:ER OF RESIDENCES THFtT THE HELL HILL SERVE. ]-I.-.IC' ( 2 .':, I r4_c-PEC:T I 01'-.I':-_] F-iRE F~:E~.:'?__ L! I F-~:I:£ [-', BRCKFILLING OF RN'¢ SYSTEM WITHOUT FINRL INSPECTION RND RPF'ROVRL B'¢ THIS [:,EPRRI'MENT NILL BE _~I_IBJE_.T TO PROSECUTION. MINIMUM DISTRNCE BETWEEN A WELL RND RNY ON-SITE SEHRGE [:,ISPOSRL SYSTEM IS 18E~ FEET FOR R F'RIVRTE HELL OR 15¢~ TO 2E~8 FEET FROM R F'LIE:LIC WELL DEPENDING UPON THE TYPE OF PUBLIC NELL. MINIMLIM DISTRNCE FROM R F'RIVRTE HELL TO R F'RIVRTE SEHER LINE IS 25 FEET FINE:, TO R COMHLINIT9 SEWER LINE IS 75 FEET. WELL LOGS BRE REQUIRED RND MUST BE RETURNED TO THE [:,EF'RRTMENT HI'FHIN ]:E~ DRYS OF THE WELL CCIMPLETION. OTHER REQUIREMENTS [dRY RPPLY. SF'EC:IFICRTIOHS RND CC~NS'rRUCTION DIHGRRMS RRE RVRILRBLE Ti] INSLIRE F'ROPER INs'rRLLRTION. PEF-:r-11 T E,'--~:P Z F.:E:S DEL--:EF'IE:ER _~t.. J_.. 19-'~-3 I C:ERTIF'¢ THRT 1' I RM FRMILIFIR NITH THE REQUIREMENTS FOE: ON-SITE SENERS RND WELLS RS SET FORTH B'¢ THE HUNICIF'RLIT'¢ OF RNCHORRGE. ~'- I HILL INSTRLL THE _,Y:,TEM IN R]~IqRDRNRE .WITH THE CODES. ~: I UNDER$I'RND THHT THE FIN-SITE :.E,4ER SY:,TEM MRY REQLIIRE ENLRRGEMENT IF THE RESIDENCE IS REMO[:,ELED~TO INCLI_IDE MORE THRN ~ E:EDROOMS. / '._,~"'o'~ICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-522! SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: 1 3 4 5 6 7 8 g 10 11 I ~ SLOPE SITE PLAN 12 IF YES, AT WHAT DEPTH;) 13 Gross Net Depth to Net Reading Date Time Time Water Drop 14 15 16 17 18- 19- 20- PERCOLATION RATE J (mlnules/inch} TEST RUN BETWEEN ~ - FT AND Il , FT ~'. t 32-008 (7176) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~ \ %- ~--'~01 ~ ~ z-'~ ~ HAA# '~ ~ ~ ~\1'% ,~ ~,~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) /Z E~- /~A~JO~/~,4 'r'-~rz~A~ .S /.5 7"/~./,,J Location (address or directions) q.szI ~ ~TT~-~ T~d (b) Property owner ~.E'%/_/~-_ /'d I C, o L.L. Telephone: (home) Business Mailing Address (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address '":' ~' Telephone Mail the HAA to the following address: (or check here if hold for pick up.) . List contact person and day phone number below: (e) 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms 3. WATER SUPPLY Individual Well ~Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISP~OSAL On-site E~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72 025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, Iverifythatmyinvestigation 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. Name of Firm 4/,J~,;~,SQ J ~,~o//.~.. Telephone Address '~O ~'3,~ ~-,N/O 71~ ~ ~I. Date ~//~/5~ ~ '~~°~° -.~.,:~TN ..... ~ ~.~ .~:~. ~ ~. Engineer's Seal ¢,~ ;Michael E. Anderson , Approved for -~ ___ bedrooms by ~_ . . Date Approved .~ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdo 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. ?/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: WELL DATA Well Classification ,,4~,~? MA) 'r-~' Well Log Present (Y/N) y Date Completed TotalDepth )~' Casedto /Z~)/ Depth of Grouting Static Water Level q¢/' 7" Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot //~-' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water SampleCollected by /gJ )~CF'AI3DEt'J Water Sample Test Results ¢/¢TI 5 F'Ac--FO¢'~' Comments /-A,I~L-L I$ Pump Set At Sanitary Seal on Casing (Y/N) )/ Depression Around Wellhead (Y/N) If A, B, C. D.E.C. Approved (Y/N) . Yield -q w d~',~,'~ ILO~ ; On Adjoining Lots /¢ 5' ' ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ;Date SEPTIC/HOLDING TANK DATA Date lnstalled /'~>,'~,/~ Size Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contacton File (Y/N) Holding Tank High-Water Alarm (Y/N) ~'/-~ No. of Compartments ~ Foundation Cleanout (Y/N) /V Date Last Pumped (,,- ; for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: //~' / To Building Foundation .2. ~'/ To Disposal Field L,O~ kLOT ~E.t~_a,C~_D A.~ /7' /4/A5 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ~ ?/ Depth of Field x/'- ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot ¢4 D,.1-A c. ~' ~J T To Water Main/Service Line Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) ToStream, Pond, Lake, or Major Drainage Course MO~J¢' I~ ,AI~',A To ~ Parking Area, or Vehicle Storage Area Comments I D.~~ION Date I nstall'ed--. Size in Gallons ~ "Pump On" Level at ~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HA/ inspection. Signed ~t~, Company Date MOA No. Receipt No. Date of Payment Amount: $ I~, ~('~ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 in effect on the date of this Engineer's Seal CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE fez Wozk Ozdez # 22503 Date Repozt P~lnted: JUN 19 90 @ 15:57 Client Sample ID:WELL WATER, 9321 NETTLETON PWSID :UA Collected JUN 13 90 Received 3UN 14 90 Pzeeezyed with :AS REQUIRED Client Name : MCFADDEN, WAYNE Client Acct : MCFAWC P.O.$ NONE RECEIVED Req # O~de~ed By : Analysis Completed :JUN 15 90 Send Repezts to: Labozatozy Supezvisoz :~_EPHEN C. EDE I)MCFADDEN, WAYNE Released By: ~~.~4~ 2) Special Instruct: Chemlab Ref #: 901866 Lab Smpl ID: 1 Matrix: WATER Allowable Pazamete~ Tested Result Units Method Limits NITRATE-N 2.5 mc/1 EPA 353,2 10 MUNICIPALITY OF ANCHORAGE OEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 'JUN 2 2 1990 RECEIVED Sample SAMPLE COLLECTED BY W. MCFADDEN. ROUTINE SAMPLE. Remazks: 1 Tests Pezfozmed * See Special Instzuctlons Above UA=Unavailable ND- None Detected ** See Sample Remarks Above NA= Not Analyzed LT=Less Than, CT=Greater Than MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I,D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING I~ ~ L~ ~ - L~'L/ HAA # ~--1 ~- ;C'~.t'~% i-'"! 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner /.~.5[~¢ Mailing Address ¢ 3 21 IV.~/'//g (c) Lending Institution ~-e~-/-'/~' Mailing Address (d) Real Estate Company and Agent Telephone: (home) Business Telephone ---~°~' Address '~ 702 ~--~./n &sl(' Telephone ~78 - E'77~ (e) Mail the HAA to the following address: (or check here [~, if hold for pick up.) List contact person and day phone number below: '7-¢¢_-Z /'-fo~ ,',~ ~ '¢6-- 2. TYPE OF RESIDENCE Single-Family [~ Number of bedrooms ~ '~ 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site r~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 , ©~: ~.~,~$~.~.~,,~ MUNICIPALITY OF ANCHORAGE (MOA) ,..~' ~otY (~) Health Authority Approval (HAA)  CHECKLIST - FEBRUARY 1984 ,~::~ . --343-4744 ~'~ ,-0' ~ .~-t'~' ,,4~, ~ ~ v ~ ' ,.:~.? ~ Legal Description: ~ ~ ~ ~4o~ A. WELL DATA Well Classification ~ Well Log Present (Y/N) ~ Date Completed I~ / 8~/~o Yield ~ Total Depth 18~ Cased to / 8~~ Depth of Grouting Static Water Level ~Y' PumpSetAt ~ I1~' Casing Height Above Ground I~' Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot I1~' ~e~ ~-~lf~ ; On Adjoining Lots ~ ~oo~ To Nearest Edge of Absorption Fieldon Lot !0~'~~ ~7 /Y~ ; On Adjoining Lots To Nearest Public Sewer Line N, ~ To Nearest Public SeWer Cleanout/Manhole N, To Nearest Sewer Service Line on Lot ~ ~-' Water Sample Collected by ~ ~ ~¢~ ; Date ~/~ Water Sample Test Results ~k~c~. ~ ~(~ /1~ ~ ~,~ ~-1~ B. 5~PTIC/HOLDING TANK DATA Date Installed (o/~/~a Size I~l No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~ Date Last Pumped ~/~/~ GZ ~c~ Pumping/Maintenance Contact on File (Y/N) ~1, ~, ; for Holding Tank High-Water Alarm (Y/N) ~t, ~. Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well [1~' ~ C.o. To Building Foundation (o ' To Property Line I~~ To Disposal Field 5- To Water Main/Service Line ~ ~ ~ To Stream, Pond, Lake or Major Drainage Course ~ ~o ~ If A, B, C, D.E.C. Approved (Y/N) Comments 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test /t.bror-?./-to~o SEPARATION DISTANCE FROM ABSORPTION FIELD: per To Water-Supply Well To Building Foundation Lot To Water Main/Service Line //~c:~¢','~ Type of System Design Length of Field qO ' Depth of Field (O t Gravel Bed Thickness 6' t Stayndpipes Present (Y/N) Date of Last Adequacy Test To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments t= l D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments To Property Line /6> / To Existing or Abandoned System on ; On Adjoining Lots ;> ~o t To Cutback (if present) p/, nt. ~ ,'Oo r Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA g.~[d~.l~i.n effect on the date of this inspection. Signed ~"~/~ ~ ~ Company F{~ ~ec~n~c~ ~e~c~ ,,.. ......................... ¢ Engineer's Seal Date F~ ~ /2~0 MOA No. ~o - ~1¢ Receipt No. ~ / / ~ ~ %~ ¢~ o//Receipt No. / Dateof Payment ~ / / Waiver Fee: $ Amount: $ ~ ~ ~._ d~ Date of Payment 72-026 (Rev. 7/88) 8ack Page 2 of 2 Tom Fink, Mayor 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 March 15, 1990, Theodore F. Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Health Authority Approval Certificate For Lot 2 Block 2 Panarama Terrace Subdivision, HA900077, PIN 015-092-44 Dear Mr. Moore: The subject Health Authority Approval Certificate has been denied. This denial is based upon the data supplied with the Health Authority Approval Certificate application. Our office files indicate the absorption field serving this lot is a total of ten (10) feet deep with six (6) feet of gravel beneath the perforated pipe and three and one-half (3 1/2) feet of topsoil cover over the perforated pipe. On the day you arrived at the site to perform the adequacy test on the absorption field, the water level in the standpipe at the end of the absorption field Was at 18'inches below the ground surface. This means that the perforated pipe is under the water in this absorption field by approximately two (2)'feet. This would indicate that the absorption field is either encroachihg into the ground water table or the absorption field is not operating as designed and is in a state of failure. In either case, it would appear that an upgrade of the absorption field is warranted. If you have questions, please call me at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-Site Services Program cc: John Smith P.E., Manager, On-Site Services Program CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. /~v~ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ,~,~LY~I~ ~};POR~ }~Y SM,~LF, f. oz Work Oz,lo~ ~ 20023 Da~e Report ?tinted: t'gB 27 90 ~ 12:13 Co].i~t~d i!ZB 23 90 ~ 12:~S g~ce±ved ?~B 2~ 90 ~ i2:$i! Sp~eia! Chonlab i~.f ¢: 900211 Lab fi~'O1 !I): 1 l~atxJx: ~llo~abi~ Par ar, e';;er Te~t~d l~esult Ilmts ~,let, hod Li~,'{i t S i{I'iM~)?~"}! 2.4 ng/i gP~, 353.2 J Ys;~ts Per~o~:i~*ed See Speclal Instructions llD~ None D~t~cted ~ See S~mpte gm,~rks ibove MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ' DIVISION OF ENVIRONMENTAL HI~LTH-~::': : ~ ~!;~ ~' l~/'~'"~'''~-~:~ : '?~:¢~ CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ,4/¢ v:'- GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) .Applicant Name ,4/¢/:,'~- ¢//¢/-~,4u/~ I,~///~o/,/ Telephone: Home Business 'ApplicantAddress 8qO0 14A~'rz.~'LL- A~VcRO/~A~,f~; AK-. ¢t~t~07- (c) Applicant is (check one): Lending Institution [~ ._.C)wner/builde. i'li;~; Buyer []; Other [] (explain); (d) Address ~.-.~,.:(e) Real Estate Company and Agent - Address ~z~O0 - : ...- Telephone ?J ¢4/- ~ Lending Institution ~,,¢"~t~./bf,,'~--'//-~-~ //4,0 ~r~, Telephone ;;: :?¢;f';(f)',':'Mail the HAA to the followin9 address: ·-,'-:~:;~:.:~;¢~;!!., E ~ A ~ ~ ,~ c'W ,.. '- -' ' '. -.-:~ ~ulti-Family ~ .; Other: 3.:-~::WATER SUPPLY ..:': '. ~.~ai Well ~ '~ Commun ty _-:~;~;~¢,,~¢~;~;~;~¢f~;h ;?:'h: ?- -,;: ;-,::':?-., .':' '-7-'' .' '.:>:- :';;? ,:,-.--' . .- . --' ~ ''~ - ': 7".:', . Conservatlo~ '..SEwAaE'~SPOSA~ '.. .:::_:,.~ "-: _ ~.-; - .:.- .. . ~ ":-_. .... ? ' -.. -~.-. .... -:. ..... Onsite~ Public ~ Community ~ Holding Tank g ~ote: I~ community well system, must have written confirmation from the State Depa~ment of Environmental Conse~ation attesting to the ~egality and status. Page 1 of 2 72-025 (i 1/84) ~-~J 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. Name of Firm ([~)1"'4~)'Q'14' ~.~G~Je.'-E'~-~G Telephone ~.7/,, - ~770 Address /EE7 ~ ~~ ~'¢./¢~ / ~c~ II/1 DHEP APPROVAL ~ ApprOved for ~ ~edrooms by .'Terms of Conditiona! A, ppro, val CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval ce~ificates based solely upon the representations g yen in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy ce~ain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a cedificate 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 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: LOT' MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION 1987 RECEIVED WELL DATA Well Classification /~,,~/ Well Log Present (Y/N) -)/ Total Depth /Z¢-/~ Cased to Static Water Level ~'7 Casing Height Above Ground Electrical Wiring in Conduit (Y/N) y Separation Distances from Well: To Septic/Holding Tank on Lot 103' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole IfA, B, C, D.E.C. Approved (Y/N) Date Completed /O./~.//,~ ~:~ Yield /Z_O' Depth' of Grouting /t/O/ff~.,. Pump Set At /~, ~:::~ ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Y Water Sample Collected by [,,4',4_¢~,~' ¢~/Ic~',4J)Z~,,~"~J ; Date Water Sample Test' ResMts Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Atarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /O To Property Line ~ :~-~ To Water Main/Service Line Course /~)¢~) ¢ '/' Size IZ~5'0 No. of Compartments ~. Air-tight Caps (Y/N) ,J/ Foundation Cleanout (Y/N) Date Last Pumped /!/~0/~ Y y ; for /?~ ? Temporary Holding Tank Permit (Y/N) To Building Foundation '7' To Disposal Field ~' ' To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date In'stalled Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test PA ~F_. f~ Type of System Design Length of Field Depth of Field _ Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Y Separation Distance from Absorption Field: To Water-Supply Well /¢~ ' 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 To Property Line ,~ ' To Existing or Abandoned System on ; On Adjoining Lots ~ ~/ To Cutbank (if present) AJo~¢ f'~',6'.~"/.47' /000' -h- D,~/V~IW,4y 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 M OAand HAA guidelines in effect on the date of this inspection. Sig ned 7/~"~~~ Date Compan;~''A~ ~¢/ ~'~'¢'¢" MOA No. Receipt No. ~ O /-- ~O ~ -- OF 4~ "t~ ' Date of Payment /~ --/-- ~ ? Amount: $ / ¢~ ¢~ /~.."' ~'" s Seal Page 2 of 2 72-026 (11/84) CHEMICAL & GEOLOGICAL LABORATORIES OF A__LASKA, INC. ~"~&;;,;2-k FloE.^. :Ax .D # 02-004044° .... 2.. ~'"~ ' h'etetor 'i'~st~d ResuJt/gnit~ Het, hoc~ TOTAl', CO[,:FORH 0 coi/iOOnfi PROJECT /. ~_~jz~j~ ~ JOB NO. SHEET / CALCULATED BY f~\r'- ~-~ ~' '~ DATE CHECKED BY DATE SUBJECT OF / JR_ ' /~ ~ . ' . _¥ ~:; .'.',c79o I DEPAF~TMENT OF HEALTH 8, ENVIRONMENTAL PROT~Ii~qMENTAL 825 L Street-Anchorage, Alaska 99501 MUNICIPALITY OF ANCHOKAG MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH MAR 1_ 9 1981 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 "~ LLb'L~I~ RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND St:WEIR FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PHONE 1, PROPERTY OWNER /g -% 7-- MAILING ADDR E~ ...... CROPERTY RESIDENT (If different fro ~ PHONE PHONE JPH. QNE , ~ 2. BUYER MAI LING ADDRESS MAILING ADDRESS MAILING ADDRESS 5. LEGAL DESCRIPTION ;TREET LOCATION 6, TYPE OF RESIDENCE ~: ~_~NGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [~ One [] Four [] Two [] Five ,y..~ ree [] Six 7. WATER SUPPLY I~..----f~D I VI O UA L* [] COMMUNITY [] PUBLIC UTILITY '*'ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM j~.-q~-01ViDuAL/oN~SiTE** "*If individuat/oo-si~e, give installation date / ~__<~)'~' . If system_is over two (2) years old an adequacy test is required [] PUBLIC UTILITY by this' D'epartment. NOTE: THE,INSPECTION FE,E~'MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USEONL' ....... DATE'RECEIVED '' ' INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WE~ ~ COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified, LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER FJINDIVIDUAL/ON -SITE DATE INSTALLED Connection Verified ~NSTALLER E]Septic Tank or [~]HoldingTank Size: __l ~.~)- .~"L~ If Tanl< is homemade; SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAl_ 4. E~ISTANCES Septic/Holding Tank Absorption Area Sewe'r Line I Nearest Lot Line WELL TO: : .... [~'~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) I~;~'" DISAPPROV ED EEGALDESCRIPTION 72-010 iRev, 3~,~)