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Home My WebLink AboutMARIE ESTATES LT 12B '" MUNICIPALITY OF ANCHORAGE .... DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO'~ =~'TION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT N A M E ~'""~/ ~' PHONE , ~IEW NO. ~bsorption ers~ Dwellin. Manufact~>e ~ ~1~ / No. ofcomrtments kiq.~ap~W ~n~llons Insida length ~idth Liquid dapth Manufacturer ~aterial Liquid capacity in gallons We200 Fo Nearest2dine DISTANCE TO: ~ inches Type of crib Crib diamet epth Total effective absorption area Well Building foundation Nearest lot Hne DISTANCE TO: Cla~¢~' ~ ~'~~ Driller Distance ,o Io, line PERMIT NOl Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER SOl L TEST RATI~?~OX ~. ~ 1 ,I (Rev. 3~78) MUNICIPALITY OF ANCHORAGE Department ~r~'~Health and Environmental,:~.rotection 825 .. Street, Anchorage, AK. ~01 264-4720 * * * HANDWRITTEN PERMIT * * * 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 community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Otherl requirements may apply. · Specifications and construction diagrams are available to insure proper installation. · * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * Ii certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the~/zi~nce~ ~o,,deled to include more that 3 bedrooms. Permit Location: Phone Number: Legal Description: ~/~ ~~ ~~ Lot Size: TYpe~of Soil Absorption System Is: Trench: ~ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~,~- ?¢~oil Rating(sq.ft/br) /~ The Required Size of the Soil Absorp$ion System Is: DEPTH //~" LENGTH GRAVEL DEPTH c, WIDTH' The length dimension is the length(in feet) of the trench or drainfield. 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 thee outfall p~pe and the. bottom of the excavation(in feet). ~ I~ * * REQUIRED SEPTIC(HOLDING) TANK SIzE =~ GALLONS * * Permit applicant has the responsibility to inform~his department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TW0(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection.and approval by this department will. be subject to prosecution. 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION December 31', 1980 Stephen Whaley Post Office Box 1025 Eagle River, Alaska 99577 Permit # 800546 Subject: Lot 12 Marie Estates Subdivision A permit issued by this department for well and/or sewer system has expired as of this date. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, / / /~ Senior Environmental ~p~cialist LNB/ljw enc: Copy of Permit SWP/057 DEPARTMENT .'~-~' HEBLTH AND ENVIRONMENTAL '~'~IOTECTION ~ 825 '. STREET, BNCHORRGE.. RK. "'~ "' ' ' ~64-4720 PERMIT NO. ( 888546 ) APPLICANT LOCRTION LEGAL STEPHEN NHRLEY SKI RORD LOT t2 MARIE ESTATES PO BOX i825 99577 LOT SIZE 688-298i 45568 SQUARE FEET TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH /1H.hi.M_M NUMBER OF BE[:,ROFM'-] ..... = .=.C IL RATING ,.'. FT/BR.)= 2F4F'_i THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: C, EF'TH== 12 LE [-~,:~ TH = 4L=~ G;:R%."EL [:,EF'TH= 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E×CBVBTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE E~'::C:RVATION (IN FEET:'. PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. BACKFILLING OF AN9 SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL 89 THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS · 88 FEET FOR R PRIVATE WELL OR ~58 TO 288 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM A PRIVATE HELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAV APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE RVRILRBLE TO INSURE PROPER INSTALLATION. PERI"1 'f T E:=--:F' ][ RES [:,EIZ:Ef-IE:EF-: _~.=:-1 .. I CERTIFY THAT t: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND HELLS AS SE]' FORTH BY THE MUNICIPALITY OF RNCHORRGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MR9 REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 5 BEDROOMS. SIGNED: APPLICANT ISSUED BY__ STEPHEN WHRLEY PERHI T NO. ( ) [-TGF~L LOT SIZE ~'F'E OF SOIL £~BSOF:F'TION SYSTEM IS' ~.~ ~):..:/II'll..l~'l NUME:ER OF E:EDROOMS =~ SOIl_ R~T!NG '::SO ET,.'"E:R)= ~ 4E F:EOUIREC' :5IZE OF THE SOIL .FIBSORPTION ~'r'STEM IS: pEF'TH=: f~ LE~-I,JiTH:= ¢¢ ,3~:I~'-.-'E:L [:,EF'T'H=:: THE t_ENGTtl [:,IMENSION !S THE LENGTH (IN FEET) OF THE TREf'IC:H OR DRRIHFIEL[:'. THE [:,EPIH OF Ft TRENCH OR PIT IS THE D[~;;'RNC:E [:ETHEEN THE SURFflCE OF THE GROLIHD FIND THE E:OTTOM OF THE E:,::C:fl',,,'flTION (IN FEET.'.". THERE ES NO SET HIDTH FOR TRENOHE~ THE GRfl',/EL DEPTH IS THE MINIMUM DEF'TH OF 6RSVEL E',ETHEEN THE OUTFFqLL PIPE BND THE BOTTE}M. OF THE EXCfl'v'flT~ON (IN FEET;'. :Rt'IIT RPPLICFff~T HRS THE RESPONSIBILITY TO INF'ORM THIS DEF'F]RTMENT DUE'Ir~G DqE ~STF~LLBTION IN'.gPECTION~ OF BN'¢ HELLS BC, JflC:ENT TO THIS PF'.OF'ERTY Btt[:, THE JME:ER OF RESIDEHCES THST THE HELL HILL SERVE. I"1 IJ I'-1 I C: I F' F! L I T '.r' . ~3 F: f-:l i'll C: H C} F~: F:113 E [:,EF'FIRTHENT F~'-, HERL TH FIND EN'./I RONt'1ENT~L..r-'['n,.._ TD2_ T I ON -I'- I...1 ~'~J ,-'. ':.~:' ::, I I'-t :E, F' E C: T I s3 !'-.i F_; ta F:~: L-Z F::: E L---! LI I F~: E~ [_-:. -iC. KFILLING OF FIHh.' ??STEM HITHOLtT F'[N£IL IHSPECTION RN£:, FdF'F'ROVFIL E',',r' THI'_:: -_'F'F~RTMENT HILL E',E SLE.J'EC:T TO F'ROC_':ECUTION, FEET HI,HUM [:,ISTF~rlCE E:ETL,IEEN R WELL ~h,ND 1-3N'¢ ONoSITE SEHFtGE [:,ISPOSFtL SYSTEM IS )0 FEET FOR F~ F'RIVRTE HELL OR ±50 TO 2ElO FEET FROP1 £4 F'UE:LIC HELL [:,EPEN[:,IHG -'OH THE TYPE OF F'LISLIC HELL HIMUM DISTFff.iC:E FROM R F'RI',/RTE HELL TO R F'RI'v'F~TE SEHER LINE IS 25 FEET Bt-l[, Ft E:OMMLINIT'?' SEHER LINE IS 75 FEET. ~!_L LEH]S F~RE ErEC!LilF. iE[) FIND MUST E'.E RE-'TLIRNE[) TO THE [:,EF'F]RTMENT HITHIH THE HELL C:OMF'LETION. -HEF: F:EL';!I.IIREMENTS MFM'¢ FIF'F'LS'. ;SPEE:IFICRTIONS RN[) C:C~N%TRI..ICTIEIt.I DIFtGRF-IMS FtF:E ,'RILRBLE TO INSURE F'ROF'EI~: ~N%TFfl_LFtTICd'.L C:EF:T IF'¢ THRT I Rt'I FRr'IlLIFff;: NITH THE REOUIRtEMEN'rs FOR ON-SITE SEHERS ~)N[:, WELLS RS SET ~RTH B'¢ THE MUNIC:IF'F]LIT'¢ OF RflC:HORF4GE. I HIt_L INSTRt_L THE ?¢STEM IM RC:COF:[)RNCE HID-t THE CODES. I IJtl[',EF:STRN[', THRT file ON-SITE %EHER ?¢STEM MR'¢ FTEOIJIRE ENLRRGEI'IENT IF THE ~SI[:,ENCE TS F:EI'll3E:,ELEC, TO INC:LLI[:,E HORE THRH ~E:EC, ROOMS. ........................... IV]UNICIPALITY OF ANCHORAGE 'DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 9950q Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS [~e Absorption area Dwelling PERMIT NO. __ ~ Ma~lu~c~TO [~ ~ ~ Matera ~,O No. ofcompartm~'O~ ~ e Liq. capacity in ga OhS Inside length _ ~ _ Width . ~ _ Liquid depth _. ~ .~ ~O~ IFHOME~DE: ~ I ~ IR N IH ~ ~ ~ DISTANCE TO ]Well Dwelling PERMIT NO. ~ ~,'~ ~, - . . . ~ '~ISTA~C[ TO Buildin~ foundation Sewer line Septic tank ABsorpdon aroa{s OTHER ERIALS SOIL TEST RATING INSTAF LER \ 4o rot DATE 72-013 (Rev,/ 3/78) LEGAL . DEPRRTi'tENT [ HEHL] H HND EN,,, ZRONMENTRL .'n-Ec:"r ZnN "'~' ' '""t..,~EL.I" 0:~5 "L", STREET., 264--,:$720FINC:FIORRGE" PERMIT NO. ,:' 7:~%1:~;';~ :, ' FIF'F'LtCRNT STEPHEN E WHRLEY PinE:13::-:;_ ._ '~:~... LOCRTION 8FF SKI RORD PETERS CREEK LEGRL L 1;Et MRRIE ESTRTES LOT SIZE 7'9065 SQUARE F'EE-I~ TYPE OF SOIL ~E:DORE, TION o ¢ , ~ · _, -:,TErl Z:,: TRENCH. f'l~q,.,]bl.lfl NUMBER OF EEDR'IaFIMq = 3: SO~L RRTING ,:SQ FT. E,E. = t40 THE REQUIRED SIZE OF THE SOIL RBSORP~¢4~M THE LENGTN [:,IHENSION IS THE LENGTH ,::IN F'E[T::, OF THE TRENCH ER' DRAINFIE[.D. THE DEPTH OF Ft TRBNCH OR PIT IS THE DISTANCE BET[,.I[EN TFI[ SUR. FFIC~ OF TFIE GROUND' AND THE BOTTOM OF THE EXC~VFITION (IN FEET.'.',. 'THERE IS NO SET WIDTH FOR TRENCHE~. THE GRFIVEL DEPTH IS THE MINIMUM DEPTH OF GRFI',,,'EL BETWEEN THE OUTFRLL PIPE ~ND THE BOTTOM OF THE [::.:;CFIV~TION (lf.,I FEET). F'ERHIT RFF'LIC:FINT HRS THE RE::,F_N:,IBILI]" '- 'Fi '- ' "T' TFI INFORM THIS DEF'FIRTMENT DURING THE INSTFILLRTION INSPECTIONS OF RNY !.,.IELLS RD.TRCENT TO THIS PROPERTY RND TNE NUME:EF.: OF RESIDENCES THRT THE WELL WILL SEF.'.',,,'E. ........ '"~- [-,-~ ~Z! ,:'.. ,=:.'""" .-:, ]t; !I'-~ '.::~, F:' E Ii: T :[ i_-'} ~'-.t '--..:-:, RF::E F: E~ ~;.-"~ LIt .f,. BRIZ:KFiL. LING OF FIN"r' SYSTEFI WITHOUT FtNRL INSPECTION FIND HFFR_- ' F HL"' E:'T' THIS DEPFIRTHENT HILL. BE SI_ID.'rECT TO PROZ';EC:LITION. MINIMUM DISI"FINCE BETWEEN R HELL FIND RNY ON-SITE SEHRGE DISPOSRL. SYSTEM !00 FEET FOR R PRI',,,'FITE !.,.IEI,,.L.~ OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBL:[C HELl .... WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPFIRTMENT WITHIN Z.':O DFI"r% OF THE WELL CONPL.ETION. OTHER REQLIIREMENTS MI::W FIPPLY. SPECIFICRTtONS RI",IE." CONSTRUCTION DIRGRFIHS RVFIILFIBLE "FO INSURE PROPER INSTRLLRTION. I CERTIF'Y TNRT ::[: I FII'"I F'I:IMILIFIF.: WITH THE RE;~UIREMENTS FLF."' ' ON-SITE SEWERS FII"~[:, HELLS AS SE]" :'ERTH BY THE HUNI]:IPFILITY OF FINEHERFt3E. 2: I WILL INSTRLL THE SYSTEM IN FICCOR[:'RNCE WITH THE .'":]['EF " ~:: I UNDERSTFIND THRT THE ON-SITE SEI.,.IER :.,'-,FEH hlRY F'EC, IR'E: ENL.FIRGEHENT IF THE ;..:E:SIDENCE IS F¢~MODELE[:, TO INCLUDE MOF.:E THRN 3: BEDROOHS. -4/T '-";TEPHEN E I-,IHFILE~. Parcel I.D. # 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 HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete'legal description~; /__cD-[--' /~,~ Location (site address or directions) Properly ow~er Maili'ng address L~nding agency, Mailing address Day phone Day phone Agent Address '~-5- 7=~rA~r4 ~4~ ~u~ ~A~ ~A Unless othe~ise requested, HAA will be held for pickup. NUMBER °F BEDROOMS: Day phone t'~¢~ ~z~'-- TYPE OF WATER SUPPLY: Individual well -. CommUnity well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: "~" ;' Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 {Rev, 1/91) Front 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 Si ~ n at u r~-=-~'--~:~~ Phone Date DHHS SIGNATURE Approved for F! I,/E 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. 72-025 (Re~. 1/91) Back MOA ~1 Municipality of Anchorage' R F C E iV E D//'~--~ : DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MAY 1 0 1999 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907 343-4744 n hora e ~unimpal ty ct A c g Dept. Health & Human Serv ces Health Authority Approval Checklist Legal Description: L A. WELL DATA L~ ~£c ~'$ e~' ~'-(-I'~.~C-. Well type Log present (Y/N) Y Total depth Sanitary seal (Y/N) ~'~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed I'~ ~/?-~ [3z ~ Cased to ~ ~ ~ Casing height (above ground) Wires ~)roperly protected (Y/N) Date of test FROM WELL LOG AT INSPECTION Static water level Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform '-- C~ · Date of sample: --~/-~//~' ?' Nitrate ' ~. '~ Collected by: Other bacteria -- ~ ~-- B. SEPTIC/HOLDING TANK DATA Date installed ~/!/~/~- Tank size Foundation cleanout (Y/N) Date of pumping C. ABSORPTION FIELD DATA Date installed Number of Compartments __ ~ Cleanouts (Y/N) ~r~ Depression (Y/N) ~ High wateralarm (Y/N) ~ Pumper ~A,,"J I"c'¢¢¥'~P~---~¢-~ Soil rating (g.p.d./fF or~---ff-'~)- Length ~ 6' Wi'dth ,~' Effective absorption area Date of adequacy test ,5--,//~' ~ ? ? Fluid depth in absorption field before test (in.); Fluid depth ~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Gravel thickness below pipe Monitoring Tube present (Y/N) Results (Pass/Fail)<~' ~ For Immediately after~.P gal. water added (in.): Absorption rate = ~z,S- c~ .g.p.d. If yes, give date '----- System type ,_>~-- cO ~% ~ Total depth -~-~' Depression over field (Y/N) xt~/ bedrooms /5- 72-026 (Rev. 3/96)* RECEIVED D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested Size in gallons "Pump on" level at* /~-¢ ~ *Datum MAY 10 1999 MUNICIPALITY OF ANCHURAGE EI~ITAk SERVICES DIVISION "Pump off" level at* 1,.~? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~ e_c_. t. oA~j~'z_ o,,d ~'/¢, Septic/holding tank on lot Absorption field on lot Public sewer main On adjacent lots On adjacent lots Public sewer manhole/cleanout Sewer/septic service line Lift station Water main/service line '~0t Surface wateddrainage /Cc)d- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /-~? ~ Property line ,::~5' ¢ i Absorption field ,/~"-- ! Wells on adjacent lots ~ t~e_.. Building foundation ~--S'-t Water main/service line Driveway, parking/vehicle storage area /~'- Wells on adjacent lots-- Property line Surface water Curtain drain F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records th,,c~L~,.~s~cms are in conformance with MOA HAA guidefines in effect on this date. ~p,:~ ~,~,,,,,,,,-,.,,,;,;. ; .. Engineer's Name ~¢¢~ Date ~/~ ¢ HAA Fee $ ' Date of Payment '~///.~~¢ Receipt Number Z~'z'//~ ¢/_../Z C~.~7,~--& ) 72-026 (Rev. 3/96)* Waiver Fee $ Date of Pay~nent Receipt Number ¥-~?Z P. OZ/03 F-4gg ~a~p]e'Ren:~-k~: Client PO// l~nied Datel~h~e 05t06t99 16:15 Coli~Date!T~me 05/02/99 13:00 R~iv~ Date/Time 0~/~/99 12:15 T~h~ Dir~: Stephen C, Ede 3.72 o max g6Y30/99 05/03/99 SCL 05/03/99 gAP RECEIVED MAY lO 1999 Muii~C~pah~y Ol Anchorage Oept. Health & Human Services 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 HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# O,-~-'/ J// ~/ 1. GENERAL INFORMATION Complete legal description HAA # Location (site~address or directions) ,,c~.~,4/. .¢.,~ ~. ~,,--~.---r',~c; Property owner Mailing address Day phone Lending agency Mailing address Day phone Agent ,,~,,¢~"/'~ '~ ~ Address ,,~.~-/,z-/,~..~- ¢,~- Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ,~' TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone ,~'~'- ¢'~ 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: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front 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 /¢~',,4/~,C/,¢¢"E~ ~",¢,'~/.,,¢.,'.~7'~,,¢__./'/f./'~ Phone ...~/?z Address ~"¢~ j--o ~'/_.~I~-//~ ~' /d,, . ~ ,,v~./-/~,,,.'~.~ ~ __ Engineer's signature ..... ~ate 6. DHHS SIGNATURE By: Approved for bedrooms. Disapproved. Conditional~approval for, /~ Additional Comments ,, f', ,f' C/~, ~ c~~ate ,,. : '~ , '. oms, with the following stipulations: 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services ' ' HEALTH AUTHORITY APPROVAL.CHECKLIST. Legal Description: A. WELL DATA Well type ~--~ Log present (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number ~/~'~',¢,5-' )z' Date completed / z./~¢'/~' Driller ~ ¢' /-~ '~"~//-'~/'¢'"~ ~" Totaldepth ~ Cz"o,~ Sanitary seal (Y/N) - Y Cased to FROM WELL LOG Date of test / z./;~. Static water level -z¢'~ ~ ' - Well flow / Pump level ('¢~-,~' ~ .¢'z-,~' Casing height Wires properly protected (¥/~) g.p.m. AT INSPECTION MUNICIPALITY OF ANCHORAGE ~ ~,/~_~/¢/ENVIEoNMENTAL SERVICES DIVISION ~ 7'. ~ SEP I ? 1991 g.R CEIVED SEPARATION DISTANCES FROM WELL TO: Septic/hOds.tank on lot /~-,~' ; On adjacent lots. /,¢'~ / Absorption field on lot /,5",~ '("~.,-~ ~'¢ r c, ¢ ,~ ; On adjacent lots Public sewer main /'¢/,/~ Public sewer manhole/cleanout Public sewer service line "r-//~ Petroleum tank .,'¢--/,~ WATER SAMPLE RESULTS: Coliform ~4::~ - Nitrate Date of sample: ~/~/~/ Collected by: Other bacteria B. SEPTIC/MOt. DING-TANK DATA Date installed ,/'¢P,~¢'--~ Cleanout? (Y/N) ~>/ High water alarm (y/N) Date of pumping Tank size //5--¢c:~. Compartments Foundation cleanout (Y/N) k//- Depression (Y/N) . Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/14OLD:iqG TANK TO: Well(s) on lot To property line Surface water/drainage -'~'~ 72-026 (Rev. 3/91) Front MOA 21 On adjacent lots ~ /~'-~ Foundation Absorption field /.5-' / Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed / ~'~"~ Manufacturer ? /~"~. Size in gallons mo ~c~ ~. Manhole/Access(Y/N) Vent (Y/N) ~ ~z~',,p mp on" ~z~, u level at ~/~ d~) "Pump off" level at ~/~~ High water alarm level ~ ~ ~/~~ Cycles tested ~ Meets MOA electribal codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot ~ ~- ~.') /~P On adjacent lots ~/~:P Surface water ./(.//~ I0. ABSORPTION FIELD DATA Date installed /~'3 Soil rating /GO -¢,~-~.//Go/~4,System type Length ~7'~ / Width ~/'' Gravel thickness Total depth Total absorption area 7 Depression over field (Y/N) . Results~pass/fail) ,~.,4 Cleanouts present (Y/N) Date of adequacy test for ~ Y bedrooms Peroxide treatment (past 12 months) (Y/N) /~/ If yes.give date.. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot _/'/z- c-._~ To building foundation On adjacent lots Surface water Curtain drain On adjacent lots ~/~2'~ Property line To existing or abandoned system .on lot Cutbank ~> ~'O' 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 $ /70 Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number T ENERGY . , ARNARD ..AN MAC.,NE .ROOUCT D~ · MATERIAL ~ DESIGN [] CONSTRUCTION [] RESOURCE DEVELOPMENT ~~X~XX~ "' ANCHORAGE, ALASKA ~ · TEL~PHON~ 907-~ 9050 CLaridge Place 99507 349-8748 September 3, 1991 ADEC Anchorage & Western District Office 3601 'C' St., Suite 322 Anchorage, AK 99503 Attn: Eeven Kleweno, Environmental Engineer Re: PUS No. 213865 Serving Lots 12B & 12C Marie Estates Subd. Dear Keven, He are requesting on behalf of our client and the lending institution an updated approval of the referenced water The water and wastewater systems have been inspected and teated (where applicable). Attached please find copiee of supporting data for this report. ~ATER SYSTEM The existing..well was drilled to a depth of 242.3' and produced 72e gph (12 gpm). Preseure tanks should provide the 60 gallons o~ storage required to meet 20 minute demand requirements. The well was flow tested for 4 hours ~ 8.1 gpm {maximum flow through the one outlet available) for test output of 1944 gallons (12~0 gpd required to serve a total of 8 bedrooms). Static level was at 203.6' with a draw down of 6.7' and 99~ recovery in 15 minutes verifying that the well is capable o~ producing (at least) the 12 gpm recorded by the well driller. ~eCer sampled on August 3~,1991 passed with no coliform or other bacteria end s Nitrete-N content o£ 2.0 mg/1. Separation distancee to surrounding °neite'septic systems met or exceeded the 1~0' protective radius with the except of ~ot which wes granted a waiver by the ADEC on September 19, This waiver covered the septic tank at 128' and the lift station (which measures 140'+). The closest drain~ield cleanout on Lo~ 12B measures st 153'. ~ithout an "Aabuil.t" of the underground system it is impoesible to verify that it does not encroach into the 150' protective radius. However we are assuming it doesn't because SAS Engineering ~ho inspected the system and applied for the waiver did not include it. SEWER SYSTEM The ae~,t~= tank and the lift station were leak teated for 32 ~ours ~ithout an~ mesaurebl~ ~osa. An adequacy test . was l~rform,ed on the absorption field which passed: for a · bedrooe dwelling. ~ater was applied to the field aC a' rate o{ 8.1 gpm for 2 hours-and 30 minutes £or a total application of 121~ gallons (7~0 gpd required). The water level rose approximately e.~' in the distribution pipe at the end of each pump cycle but was absorbed while the 1irt station was re~illing. Please note that the weter/wastewster system on Lot 12C has not been used because the owner has not completed construction of the dwelling. If there ere any questions please call Harry Bates o£ Bates Technical Services at 688-~69. Upon your update approval of the subject water system please notify Mr. Bates and hold for pickup. Thankyou. sincerely, .. Earl R. Bernard P.E. i 260. 4~' GNIO I / .:4 D~PARTMENT OF ~NVIRONM~NTAL OON~ERVATION CONSTRUCTION AND OPERATION CERTIFICATE f~ PUSLIC WATER SYSTEMS APPROVED CHANGE ORDERS Apl:roved by Date The "APP~VAL TO OPERATE" ~tlon must be oom~lete~ and signed by the De~artmeflt before any water i~ ~e ~vailable to the pub/Se. As.built plans submitted during the i~t~rirn spt3roval period, or an inN~e¢~lon by the DeDsrtment, has confirmed th. s~stem was gonstru~ted ~rdlng to ~he a~proved pl~. Yhe system 1~ hereby granted final approval to CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA99518 TELEPHONE (907)~562-2343 ~L~SI$ ~E~O~T ~! ~i~PLE £o= ~O~[o~de~! 37809 Date Report ~zlnted: SE~ ~ 91 e' 09:02 FAX:(907) 561-5301 Client ,~le ID:U~REATBD ~LL WATER LI2B ~U~IE B~fATE$ P~SID :213865 Collected AUG 30 91 e 1~:35 h~s. Recelved ~U6 30 91 ~ 15;55 ~s. Chemlab Re~ t: 91~494 Lab Sapl ID: I )(atxlx: WATER MJo~able P~aMteE Tomtmd Rosu/t ~ntts )bthod L/a/ts NITRATE-H 2.0 mq/l EPA 353.2 ,/ ~ample ~OI)TIHE ~&14~Lg COLLECTED BY: B. BALES. ! m imm ! ! ! m ! m mmm mmmm mmmmmm mm ! ! m ~B-' Hone Detocted~ ** See S~le ~en~kt Above HA- Not Arml!~od" 5T-Lose lhn, GT-Greator T~n ~ S~S Member of tho SGS Group (Soci~tO GOnora,. de Surveillance) · / ' ' MUNICIPALITY OF ANCHORAGE (MOA) · Heallh Aulhorlty Approval (HAA) CHECKLIST. FEBRUARY 1984 343-4744 ~-, ,, Legal Description.; ~ A.. WELL DATA .... ,' -~~ Well Classification Well Log Present (Y/N) ~___ Date Completed ~ Il' A, B, C, D.E.C. ApProved ('Y/N) Total Depth_~_..~ Cased to ~ Depth of Grouting ~ -"--"' Yield ~ -- Static. Wate. r Level ~ i ..... Casing Height Above Ground ~ '~------ Pump Set At ~ · - ~-~ ' Sanitary Seal on Casing (Y/N) Electrical W/ring in Conduit (Y/N) ~ ~Depression ' ' SEPARATION DISTANCES FROM WELL: -- Around Wellhead (~/N) ..~ T°Septic/H°ldingTank°nL°t~-"Y-~T-;O,,~nA~joiningLots___.~5_d.~' To Nearest· Edge of Absorption Field on Loi ~.__ .; On Adjoining Lots TO Neare~, Pub,i~ Sewer Line ~ TO Neare,, PUblic Sewer cleanouFManhole To'Nearest Sewer Se~ice Line on Lot /~ ~ Water Sample Collected b ~ ~ ' - B. 8EPTIC/HOLD]N~ TANK DATA Depression over Ta - '- ~ ~n~ Ua~ (Y/N) ~ . ~ - Da~e Last Pumped ~ Pumping/Maintenance Gomact on F~]e (Y/NJ ~ . . ' F~OM ~ ~ Tempora~ Holding Tank Permi~ (Y/N) SEPARATION DiSTANCEs SEPT[O/HOLDiN~ TANK: .. To Water-~upp]y We, ~ ~ " To Prope~y Line ~ ~ ~ . . To BUilding Fouhdatio~ ~ ~ ~ To Water Main/Se~ice Line ~ ' ~ ~ TO Disposal Field ~ ~ To Stream, Pond, Lake or Major Draina '" ~. ge Coum Comment= ,C_ / ;-' Page 1 of 2 · ". C. ABSORPTION FIELD DATA Soils Re!lng in Absorption Strata Date Installed /ct~'~' Width 0! Field ~'G ') Square Feet of Absortion Area _~00 ~¥' ~7-h ' Depression over Field (y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ' To Building Foundation Lot ~'~ Z.~' ' ; On Adjoining Lots To Water Main/Servic~ Eine To Cutback (if present) To Stream, Pond, Lake,. or Major Drainage Course ~,!//"~ To Driveway, Parking Area, or Vehicle Storage A,rea ' Comments ..~yY-r~.~' I~ ,/?J. ,~,,, Type of System Design Length of Field ~.Z ~ Depth of Field .5' '--~ ' Gravel Bed Thickness '~) Statndpipes Present (WN) Date of Last Adequacy Test To ProPerty Line ' ~=~Z ~ To Existing or Abandoned 'System on D. LIFT STATION Date Installed . /?r~'~ Dimensions ~-~? ~..~/~,,,.-~.4 )~/~_./Z~7~&c,¢.z~ Size In Gallons .:5"C'3~,~/ Manhole/Access (Y/N)' :Y .- / "Pump On" Le,~el at /~ "-~4~ '~'Y7 /////-'///~.~ "Pump Off" Level at ////~,'~ "~/3 ///~/'{ .//~/' '/ ' 7,~/~, t ' High Water Alarm Level at ~c¢ ~(//4 ~ '/ /"~/~ -'~ Vent (Y/N) .~/ Tested for --~ Meets MOA Electrical Codes (Y/N) Comments. :~c d~'~:~Z.~/_~/ /,7~)7z " / y- Pumping Cycles during Adequacy Test. *'Check Perrn/it ~d Bedroom/Rating Against HAA Request** I certify tha~) lv.e,, qhecke.~l,...v~rified, or conformed to all MOA and HAA,,,..a~_~h ~jn effe Inspection.//~ ~/~//,~/ ///-/ - S gned ///, - r~ Receipt No. Receipt No. Date of Payment Amount: $ 72-o26 (fl~,. ~ISB! 8ack Waiver Fee: $ effect on the date of this Engineer's Seal Date of Payment Page 2 of 2 l)~to ~epo~t Printed.' OCT LO 88 ! t3:a,2 1)COa~]~ a ~ Special , ~-' ' Inftruat: '~ Chemlab P~e~ t: 2915 Lab Smpl ID: 3 ]~trlx: WATER Pa£anetec Tested lesult/Untte 1.3 hq/1 EPA 353.2 =' '10 Hone Detected '* See ~ample Immzb bye ~ot Amlyzid~ LT-Lits thn. ~-Otutec T~ ? · ' ffiU/'41LIIqALIi Y MUNICIPALITY OF ANCHORAGE DEPT. O~i ~ .~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~'~-Y~[j~Ni'V,/--NT,~L i~;,~.~ ZCTION 825 L street - Anchorage, Alaska 99501 JUN 8 Telephone 264-4720 .R E C E I E D REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DI REDTIONS: Complete all parts on page 1. Inaompld{~ requests will not be processed. Please allow ten (10) days for proaessing. ~1. PROPERTY OWNER I PHONE MAILING ADDRESS i l PROPERTY RESIDEN~ (If different'from above) ( PHONE 2, BUYER PHONE MAI LING ADDRESS 3. LENDING INSTITUTION ~,~ ~ T~ PHONE ~AI [I NG ADDR ESS / % 4. REALTOR/AGENT [ PHONE I MAI LING ADDRESS 5. LEGAL DESCRIPTION I*' *YPE~F "ESlDENOE / NUMBER OF~BEDROOMS [] One [] Four [] Other__ /~'_ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six 7' WATE;~].UP~% i Vi DUAL* ~l ,_~-~M~[..~ t~J*~ATLTTACH WE L L LOG. A well icg is required for all wells d tilled / [] COMMUNITY E~_~t/-J .({~? since June 1975. For wells drilled prior tothat date, giveweli [] PUBLIC UTILITY ~ ~/~_~.F~- depth (attach log'i~favailable.} B. SEWAGE O,SPOSAL SYSTEM I NDIVI DUAL/ON-SITE** **If individual/on-site, give installation date · If system is over two (2) years an adequacy test old is required PUB LIC UTI LITY by this Department. 72-010 (3/78) NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME I 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 [] INDIVI DUAL 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~T~nk or []Holding Tank Size: /~,)~__,)c) If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER 4. DISTANCES Septic/Holding Tank Absorption Area ISewer Line Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS ~]//'APPROVED FOR ~,2~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) ~ LEGAL DESORIPTION 72-010 (Rev. 3/78)