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Home My WebLink AboutLOMA ESTATES BLK 3 LT 1 ,~ MUNICIPALITY OF ANCHORAGE -- D, .RTMENT OF HEALTH AND HUMAN SEI- .;ES e. "~' Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCES Address /~O ~/~.~, ~y_/~ TANK FIELD WELL Phone(s)~ r ¢~ J--~ Permit~2oN°' ~ ~ No. oi Bedrooms~ LoTWELLLINE /~ / Township, Range, Section AS-BUILT DIAGRAM (Show Iocauon ol well, septic system, properly hnes, foundahon, T//~ ~,X~ ,~,~ ,S~ ' drweway, water bodies, etc.) TANKS ~ SEPTIC ~ ~ . Manufacturer ~ ~y ~n 9allons ~], Material ~ No. ol Compadmems TYPE OF SYSTEM or,g,na~grade O,~~ FT ~,5' '~ ¢o~ o~2 ~_ . FiD added above original grade Grovel depth beneath p~pe '~~'%~ ~ , Oravellength Gravelwldth ~ ~ Total absorpt,on area Distance between enes ~ "~ ~ Number of enos So*l raung P~pe material ~ PRIVATE ~ OT~ X'~ Class,ficauon {A,B,OJ ~~" ¢ ~¢ FT Cased to ~ ~, J~~ Date Installed: REMARKS: Scale: lire ¢~ t ENGINEER'SSEAL j Z - '~ ceflily that Ibis inspection was pedormed according Io all Municipal and State guidelines in e[iect on mis date ~ Heallh Depa~menl Approval: .... ~ Date: -, I/ ALASKA e, LIIROFlmI F1TAL COFITI'NOL Sel, ulCeS, IF1C. ~.§i.¢erin§ ~- ~nuiroFime.taJ St~clies SPECIFICATIONS FOR ELEVATED BED WASTEWATER TREATMENT SYSTEM LEGAL DESCRIPTION: LOT 1, BLOCK 3, LOMA ESTATES SUBDIVISION 1.0 1.i 1.2 1.3 1.4 1.5 2.0 3.0 3.1 3.2 3.3 3.4 3.5 GENERAL The drawings, sheets 1 through 2, shall be part of this specification. All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & Human Services (DHHS), the conditions of the permit, and all applicable rules and regulations currently in effect. All excavations and depths are advisory, and are to be verified or modified in the field by the Engineer or inspecting agency. It is the responsibility of the owner or installer to adhere to approved design for the installation, to maintain the specified separation distances and to have the appropriate inspections. If the installation is not inspected by an AECS engineer, AECS will not be responsible for the installed system. An engineer at AECS should be consulted prior to construct{on, to determine the number of inspections that will be required and to explain what these inspections will involve. SEPTIC TANK - NOT USED SEEPAGE BED The sand, if specified, shall have a size distribution which meets the requirements of MOA c~de 15.65.077. The gravel for the bed shall be 0.5 to 2.5 inch, screened rock with less than 3% passing #200 sieve residual. Ail substitutes must have prior DHHS approval. The bottom of the excavation shall be level and raked with the backhoe blade to insure that the bottom has not been compacted during excavation. The distribution pipe shall be perforated 4-inch rigid PVC with a minimum crush strength of 1500 pounds and shall meet the approval of DHHS for use as drainfield pipe. Ail pipes shall be laid level, and spaced according to the drawings. Monitor standpipes shall be placed as shown in the drawings. They shall be 4-inch rigid PVC ASTM D-3034, or cast iron. The section shown with holes may be either drilled 0.5 inch holes on 6 inch centers on opposing sides of the pipe, or a section of regular perforated sewer pipe may be clamped to the solid section with a no-hub coupling or solvent joint. Perforated section shall be located in gravel only. Th~ portion of pipe ~,nn Ill~.~t ~'~rA A,,~.n,,e .~,i]~' [~ · Anchoraaa Alaslm 99503 .,{907l 561-50z10 3.6 3.7 3.8 4.0 4.1 4.2 4.3 4.4 above the sewer rock shall be solid. A rubber raincap (Jim Cap or equivalent) shall be placed over the top of the pipe. Insulation ts required, using burial type polystyrene rigid board insulation. There shall be 1 inch of insulation for every foot of soil less than the required 4 feet of cover, but there must be at least 24 inches of soil even though ~nsulation is used. The solid pipe extending from the septic tank to the drainfield shall also have 4 feet of cover or an equivalent layer of insulation combined with soil. T~e side slope of the mound shall be sloped 1 foot vertical to 3 foot horizontal. The top and sides of the bed shall be planted with a white clover and red fescue mix or blue grass. INSPECTIONS This bed will require a minimum of four inspections. The first inspection will be of the open excavation, to assure that the system is installed in the proper soil strata, ~orrect depth and meet minimum specified design parameters. The second inspection will be performed after sand fill is installed, but prior to placement of gravel and distribution pipes. This inspection will verify that the fill is properly installed, that it meets specifications and that it fulfills the intention of the design. The third inspection will be after placement of gravel, monitor standpipes, and distribution pipe, to verify proper installation and position of pipes prior to backfill. The fourth inspection will be after final backfill and grading to ensure that adequate soil cover has been provided over the bed. ALASKA ENVIRONMENTAL CONTROL SERVIC"'~' INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JO0 SHEET NO. OF OA~C~A~D S¥ /' ~_.4 DATE CHECKED BY DATE SCALE ALASKA ENVIRONMENTAL CONTROL SERVI(?~", INC. 1200 West 33rd Avenum Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO. OF CALCULATED BY ~, t~ (C~ DATE CHECKED BY DATE /'% SCALE ~ 1~///~'~'/~/ /'~- ¥ CERTIFICATE OF SURVEY hereb~ cetllf/that I have surveyed the foil.owing desc~bed property=__ LOT I ~SLOCK :5 LOt,4A E~TATE~ 5U~,D, Anchorage Recording Dletricl, Alaska, end that the Improvements situated thereo~ are lithin the ~oper~ Ilna and do n~ ~erlap or encroaCh ~ f~ p~ lying adjacent thereto, that no improvements on the ~operty lying adjacent thereto encroach on ~l premltel on said proper~ exce~ es indicated hereon. Doted at Anchorage, Aiolko, this o,,n*r WAL-JH~ C..oNG'rF. UCTION Jobno. ~1- Bookno. ~J-I~ Dravm by ~ F,~ Checked by I~ K4 · ." '..j,....+ '/ LEGEND s~rv. t~tle AG - tSIJI L-T ALASKA TECH ~03 We~t 15th Ave. Anchorage, Alaska 9_9501 Tel. 275- 821~ Iecol. 1'~.50 e City grid Fnd. Set Bross or AL Monument , - ". - :'-' "%"~ "~ /' ' Iron Pipe · ;.~ : ~,'~ - :. -~ -~ ~ / Rebar · o Nell ' :' I Municipality of Anchorage 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST '~.~.~225} ./~ PERFORMED FOR: ~ ]'~ LEGAL DESCRIPTION: ,,i. ~ Township, Range, Section~T // /U ~ ~ %'.~ SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19- 20- WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~ DEPTH? /~J'J,~ p E Depth to Woter After , Monitoring? .'.'~,~' Dote: .~,/~,/~? Gross Net Depth to Net Reading Date Time Time Water Drop / ~/a~ Ila~ o ~. ~ ~ t?~t.~~ i~ ~ , v~ ~. / ~ I~/~ /~ o ,~ 0,/~ PERCOLATION BATE '~/q (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '7/ FT AND ~"$'" FT PERFORMED BY: ~' /~ z~/ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEI~INES IN EFFECT ON THIS DATE. DATE: SUPPLEMENTAL SOILS INFORMATION LOT, / ~LOCK ~ 1 2 3-- 4 5 6 7 8 9 10 11 12 13 14- 16 17 18 19 20 1 2 3 4 5 6 7 8 9 10 11 12 13 14- 15- 16 17 18 19 20- 1 2 3 4 5 6 7 8 9 10- 11 12 13 14 15 16 17 18 19 20 1 2 3- 4 5 6 7 8 9 10 12 13 14- 15- 16 17 18 19 20 dAME 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 LL~F 0~ L LS&/')& LEGAL DESCRIPTION LOCATION '--j~ ~.. I DISTANCE TO'. , ~J r~ j [~ :~) ! J Absorption~d(area ~Z I Manufacturer~. ~ JLiq. cap ~t in allons IF HOME,DE DISTANCE TO: i ~ J No. of lines / J Length o~ ~h ~e ~ ~ ~ Top of tile to finish grade ~ J Length Width ~ ~ J Type of crib Crib diameter ~ TO: Well IC, Depth ~ I Building foundation DISTANCE TO: I Inside length Crib depth Driller Sewer line OTHER PI PE, tMATER I,A LS ~..~ SOIL TEST RATING REMARKS Dwelling c1~. Dwelling MateriaJ Foundation ~} Nearest lot lin2~ Total lengtJ~of,,nCs. I Tre~_--~ff. dth. . inches Material beneath tile 3~. inches Depth NO. OF BEDROOMS No. of compart~ Liquid depth PERMIT NO. ~ Liquid capacity in gallons Total e f f e c t i~J:~ s~Jj~ t i~;~e rea PERMIT NO. Total effective absorption area Building foundation Nearest lot line Distance to lot line PERMIT NO. Septic tank Absorption area(s} DATE ~ LEGAL i'"ii::D,: ;!: !','ll..!f,1 I'..!l.)l"'l!ii:Fi:F-;: OF: DEf::,Fi:OOf'I:!~; = ::i!: ::T:;O :[ L FiFtT' Z NG ,:::~;g! F'T,.."I~:~:fR ::, ..... ::l..;;~:f.5 I'!. lie I:;~:E~):;:¢...1:1: !:;~:[:E!:::, ';.: '( ;:::'E' OF THE: :E;O :[ t .......... i~' ':,~ ~':'.'.."'. 7:~" F>. ""ir.," IF.'~ ::%. i,::::::~.. ,. ........... ,i...... t!"..,,~ C'!)i THE L..F:I",!GTH !5::, Z !'"!E~1".!:55; ): ON :[:5 '['Hf:}: LENGTH < ]: N FEET ::, OF 'lq'lE "I"Fi:ENCH (:)R !:)i:;i:Ft:!:I",!F :i: EL.C,. THE 1::,[5:F"T'H OF" FI T!q:E:!",IE:H Of;i: F']:T ~::5; THE: E:,Z:5'TF:tNCE E=IET!.,.!!:~!:Ehl THE ~Ei;I. ll:;;:f::'l:::!l:::t:~S: O!::: "FH!E GFi:OIJN[) I:::ff',lD 'T'H!:5:: E:OTTOH OF THE: E:?,C:F!',,,'F!'1'~Ed'-~ (: ZN FEE'F::,. "f'HERE Z::5 bio :~i;ET !.,.!:II)TH FOR T!RENCHE~;. 'THE GI:;'.R',,,'I:~i:L. [::,E~ZF'"I"I'I :!;~a; THE: F!NI:::, T'HE DOT T'OH OF:' "I'I-I[E !E::'::I:::F¢,,,'F:IT ]: EIt'.,~ ':: 7~: !",! I:::'EIF:T ::,. r, .~.l.,l..~¢Jl! DZ::~;T'F:!F,!C:E: Dr.i!:'f'i.,.tEEi'.,[ F:I !.,.ItEI....L I'::it'-.[[::, !:::1i'.,!'.¢' Oi'.,F...::5:['I'iE rlSi!~:!,.ff::IGE [:,I!!i;F'Cdii;F:il... ?./:ii.:,'l'E!',1 'r,::; :~Jii:.iC:i I:::'[!:E"i" FOR ::i.:::5¢::.~ "I"E! :;;i:(.:'nil) I'::'E[i:TF F'Fi:!Z.)H F:! I::'LI[~i.. ]: (:: I.,.![!!:!...[... i:,[~:P.f..:~:H[::,'['kl!'_~i Pr'ff.,! 'T'HI:E 'T".¢l:::'llii: OF' I:::'I.J[!!',L.:[C ..,[E:LI ME!..L.I...OEiF!: 'F ~ "' t .... ': I::: 'l"l-..![i~ F.IEI..L. r': F r,'iF:'t F:'i" :i: :': 1.1 OTI'II::::F;: I:':E":!.. :I:I:;:f~:HENT:!il H!:::I? I::.F:'F'I."r'. ';SF:'[!::CZI::-:!:CF:I'!':IZCd",!:5 FIN[::' "':'i'.I':::TI:;i:!JC"I" ON t:::, :I: t:::l!::!iF:F:!i"'i:!!!; .?.I:. ..... I:: ""l::l T I ::: J::: t::: "J'O :t: i",I::!!;i..[I;;'.[E F:'F:OPI!~:tF.: '" :' ' ". ..... I I '~V £~,~ 7 =' Y ~'ZO£ £9 1 ~o98N vV/g07~ gl'9Z 9go ,I ,98'g8 _o 0 vV~i0 '1= ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JOE /~ / SHEET NO. CALCULATED BY CHECKED BY SCALE OF DATE WELL CONSTRUCTION LOG ¥orn ~ ~ o~lltlng & Ent~rises Orilli.g 0o ¥ornon L. Nowell Type of rig C&~,le tOOJ- DrilLer Well owner Well location: (address & legal description) Lot Oepth of well°?;;F Static water level USGS no. 82 {- 6 ~ ft. Casing: depth' - ft. diam. in. ! 51 'A' ft. (above. H:m~ow) land surface. Date 6'"7-79 Finish of well: (ogen~ed~tl, screen, perforated, open-hole, other) Date woll completed. 6-7-79 Nearest community. Location sketch or remarks MUNICIPALITY OF ANCHORAGE DEPT. OF ;!AU.TH & ENVIRONMENTAL P~Oi£CTION Describe intervals and size' Well yield tested by ,(.¢,u~. bailing, air) at 7 for 1 hours with 1~ ft. of drawdown from static level. ,gal/min. JUN 1 8 ~7~,.,. RECEJE.E DRILLER'S MATERIAL LOS Depth below land surface in feet 0 15 --to --to ,~to 80 ~t 0 ~to ~t 0 ~to. ~t~ ~to. ~tO ~to to ~to ~to Give description of strata penetrated (size of material, color, hardness of drilling, and water content) bro','a~ t±!! with cobbles ,i.Lcy brown ~cmll bou~dors ~i} 33* and 40~ hard bro¥:n silt wit![ gravol 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 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 ,~-'~Z.lC~ .~7~.~7-~ Mailing Address ~,~/~ (o) Lending Institution ~',~t~ Mailing Address ~'~f~- Telephone: (home)-~¢- ~ (r!'~ ~ Business , Telephbne (d) Real Estate Company and Agent Address ~/~ Telephone (e) Mail the HAA to the following address: (or check here ,!~ hold for pick up.) List contact person and day phone number below: TYPE OF RESIDENCE Single-Family/~/'/ Number of bedrooms -~J 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. SEWAGE DISPOSAL On-site)i~¢ 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 · ')tJOt~ s,Jeeu!bue leUO!SSe,toJd eH~, u! suo!ss! LUO JO sJo¢Je Jo,t elq!SuodseJ lou s! ebeJOLlOuV ~o Xl!led!o! unR eli/'penss! s! eleo!jBJeo e eJoJeq elep eZAleUe Jo suo!loedsu! ~oRpuoo ),ou op SHHG jo see,~OldUU3 's~ueLueJ!nbeJ el~1s pue leJepe,t u!elJe3 X~s!les o~ JepJo u! suoBn~Rsu! bu!puel J!eLt~ pue SeLUOq JO sJaseqoJnd o~ ~se~Jnoo e se s!q1 seop SHHC] eLIJ. 'e>tSel¥ jo e~e~S eLl~ U! peJe~s!beJ jaeu!bue leUOiSSe~oJd ~uepuedapu! ua ,~q e^oqe ~ ~de~§eJed u! ua^lb suoRelueseJdeJ eql uodn ~luo peseq pe~eo!~!Je3 le^oJddV ,q!JOLp, nv q~leeH senss! (SHHO) seo!^JeS ueLunH pue Ll~leeH ,to ~ueLu~JedeG e6eJOLIOUV jo/4!ledp!unlA] eq/ leAOJddV leuoR!puoo Jo 9guJe/ leuo!l!puoO pe^oJddeslQ ~ pe^oJddv ~ Jo,t pe^oJddv TVAOl:ldd'V SHHG '9 leas s,Jeeu!Su3 A. WELL DATA Well Classification Well Log Present (Y/N) y Date Completed Total Depth'~, '~ ~ Cased to ¢~,¢ Static Water Level. ~,~ I Casing Height Above Ground Electrical Wiring in Conduit (Y/N) "~ MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Depth of Grouting 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 If A, B, C, D.E.C. Approved (Y/N) Yield '-/00 S'¢('q Pump Set At ~]~ Sanitary Seal on Casing (Y/N) "~, Depression Around Wellhead (Y/N) ; On Adjoining Lots ~ I Ge/ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole q/A SEPTIC/HOLDING TANK DATA Date Installed '*¢/~ ~¢'~P¢~ Size Standpipes (Y/N) T Air-tight Caps (Y/N) Depression over Tank (Y/N) q Pumping/Maintenance Contact on File (Y/N) ~/~ Holding Tank High-Water Alarm (Y/N) ~"'~l A' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: 2_ ? ,~.20~/ NO~ of Compartments Foundation Cleanout (Y/N) Date Last Pumped /'¥~¢f~'~ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Water-Supply Well 10 ~ ' To Property Line ~- To Water Main/Service Line '~ t f~' To Stream, Pond, Lake or Major Drainage Course Comments '~ \~O?-Pq~'~ ~ ?~:~f"l 72-026 (Rev, 7/88) Front Page 1 of 2 C. AB,~;ORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~0 / ~ ''~ ~'"~ ~ Width of Field ' Type of System Design Length of Field Depth of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well I To Building Foundation Lot ~/ To Water Main/Service Line ~ / To otream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line ID To Existing or Abandoned System on ; On Adjoining Lots ~(,) '~ To Cutback (if present) D, L I F~" s~r"A~LO_..N Date I nstalled"'""~. Dimensions Size in Gallons ~ "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Manhole/Access (Y/N) "Pump Off" Level at I '~'~.Vent (Y/N) ~"~t'~":~'/~ L:::: -ing Cycles during Adequacy Test. **Check Permit~// I certify that inspection. //// Signed Company / Date MOA No. Bedroom Cting Against HAA Request** ~,checked~verified, or conformed to all MOA and HAA Receipt NO. Date of Payment Amount: $ 72~026 (Rev. 7t88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 on the date of this Engineer's Seal CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-23,43 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT EY SJ~i~LE for Work Order t 25301 Date Report P~inted; JUL 16 90 6 20:14 Client Sample ID:LI B3 LO)dA EST. PWSID :UA Collected JUL 11 90 ~ 14:30 Received JUL iI 90 ~ 16:00 Pzesezved with :AS REQUIRED Client Name : COR~IN ~ ASSOC. Client Acct : CORWINP ?.0.$ NONE RECEIVED Req $ Oxde~ed By : BRUCE COR~IN Analysis Completed :JUL 13 90 Send Repo=ts to: Labo~ato=y Sups=vis?, :SE~.~_HEN C. EDE IJCOR~IN ~ ASSOC. ReleasedBy : ~~~ 2) Special lnstxuct: Che~ab Ref t: 902387 Lab Smpl ID: I )datrix: WATER Allowable Pa~amete~ Tested Result Units Method Limits NITBATE-N 0.71 ~/1 EPA 353.2 10 S~ple ROUTINE SA}dPLE. Remarks: SABLE COLLECTED BY BJC. Tests Pexfozmed * See Special In~t~uctions Above UA-Unavailable None Detected ** See Sample Rem~ks Above Not Analyzed LT-Less Than, 6T-G~eate~ Than 'MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~" ~/~ '-~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (adc~ress or directions) (b) Ap piicant N a me '~/~-~/~ .Applicant Address Telephone: Home (c) Business Applicant is (check oh,e);;,'L(~nding Institution []; Owner/builder~; Buyer B; Other D (explain); (d) Lending Institution "':' Telephone Address (e) Real Estate Company and Agent Address Telephone (f) M ai~.t~AA t ° t h e ~d d~¢c.7~¢~/ TYPE OF RESIDENCE Single-Family'~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. P,age 1 of 2 SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If Community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. ,, 'i; 72-025 (11/1~4) the date of this inspection. Name of Firm -- _/'~-'C Address ~ -~/Z~cJ Date ;.¢~u,~ :.; :.'.' ' . . ........ -~ -o of the vahdatlon date sho .... ;. ,~f~ functional and adequat ~:.';:';, ~*~ ~ ~a bvmv sea amxed nere~-u -~ --~, ...... stewater disposa ~.~tum, ...... . ..... ~tained "' A rove showsmattne~ ....... -. '.-J,~t~ ~erein fudher verily ~'~ ....... ' and/or AuthoritY PP . __~ ..... f structure mu~u ...... · ........ the on-site water supplY forthenumber°fbedr°°msanu'y~ m investigabon and inspeuu~ ..... -~-~nulationsineflecton from the Municipality of Anchorage f'~.;f,~ MYunicioai and State codes, orainancest is osal system is m compllanu~ w,, ........ ~ ~ Telephone ~ '~ '- /~H Er%vAe~rO ~b ed roo m s by ' ~ pp . . Approved ~ · '- Disappr°vl~ Terms of Conditibnal Approval - CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given 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 nstitutlons in order to satisfy certain federal and state requirementS, Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not respOnSible for errors or omissions in the professional engineer's work. - Page 2 of 2 . 72-025111/84) ...., -. . ..... -*-: .....~-. ~ ..... ~ .........~7,~ " ' MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAGe: DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED WELL DATA Well Classification ~'~-1~'//¢'~' If A, B, C, D.E.C. Approved (Y/N) Well Log Present'N) Date Completed ~ ~ ~'-7¢ Yield Total Depth ~'Z-..'¢' Cased to ~¢~-, ¢'' ' Depth of Grouting Static Water Level ~;~) ¢¢f¢,~-*' Pump Set At Casing Height Above Ground Electrical Wiring in Conduit(~N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot /,~,~'~ ~ Sanitary Seal on Casing ~.~N) Depression Around Wellhead (Y~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line ~¢/~ To Nearest Public Sewer Cleanout/Manhole ~,y~ To Nearest Sewer Service Line on Lot Water Sample Collected by ,/¢'~'~ ~¢' ~/~'-/¢/ ; Date Water Sample Test Results Comments (_~) ¢¢~./~ B. SEPTIC/HOLDING TANK DATA Date Installed ¢ ';5¢7'~' ?¢ Standpipes~tN~ ) Depression over Tank (YO Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well J To Property Line /~ To Water Main/Service Line Course Size /¢'~ ~"'d'¢¢ No. of Compartments ,¢~ Air-tight Caps CN) Foundation Cleanout CN) Date Last Pumped o~"~$ '~ ,,4'y,,~- ; for Temporary Holding Tank Permit (Y/N) To Building Foundation /'~"/ To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ¢~ ~ ~¢ / Widtt~ of Field ~'~ Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line '~¢/,~IZ/-/ Type of System Design Length of Field ~'~ Depth of Field Gravel Bed Thickness Standpipes Present N) Date of Last Adequacy Test 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) Comments LIFT STATION Manhole/Access (Y/N) "Pump On" Level at ~~ "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for ~ycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have. CheWed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~¢~< //~'z'"~"'~ Date Company //~'¢ -'~ MOA No. Receipt No. q .! Date of Payment ~' } ~ ~ Amount: $ ~ ~ ¢ Page 2 of 2 72-026 (11/84) 60060 ALASKA E dlROnmEFITAL COF1TROL S6 uICES, lB(;. ~n§ineerinq ~- ~nuironmenl~l Stuclies PATRICKHARINGS 16800 BETTIJEAN ANCHORAGE ALASKA 99516 SELLER-SAME LEGAL:LOMA ESTATES SUBD/BLOCK 3/LOT 1 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-FEB 11 1986 FEB 13 1986 WILL PICK UP FROM OUR OFFICE MUNICIPALITY OF ANCHORAGE DEPL OF HEALTH & ENVIRONMENTAL PROTECTION F E 8 i 4 1986 RECEIVED THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 378 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 150 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 0 GALLONS. THE SYSTEM IS UNACCEPTABLE BECAUSE THE SURGE CAPACITY IS LESS THAN 75 GALLONS. THE SYSTEM IS NOT CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON AUGUST 5 1985 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE-FEB 11 1986 A FLOW TEST WAS PERFORMED ON THE WELL. 433 GALLONS OF WATER WAS PUMPED AT A RATE OF 3.5 GPM OVER A DURATION OF 2 HOURS. THE DRAWDOWN WAS 27.5 ' WITH A RECOVERY TIME OF 40 MINUTES AND THE STATIC WATER LEVEL WAS 40.6 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. INVOICE EWER AND DRAIN ",'~'~,<~/.f ~. ~ CLEANING SERVICE ~.0. ~OX 4-2841 ~HO~[ 345-25~3 Job Address ROTOR ROOTER SERVICE CALL HRS. ~,, STEAM THAWING HRS. TRIP CHARGE HRS. (~, OVERTIME CHARGE HRS. ADDITIONAL LABOR CHARGE HRS. (~, HRS @ ANCHORAGE, ALASKA 99509 PLUMBING REPAIR CHARGE / r-'l JOB NOT GUARANT~ED FOR FOLLOWING REASON WORK ACCEPTED BY MUNICIPALITy OF ANCHOR .: '~u~"IMENTAL PROT£CTIoN RECEIVED ~ DA~ RECEIVED " ~ INSPECTION APPOINTMENTS '~IME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR_ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P2OTECT[ON ENVIRONMENTAL SANITATION DIVISION 0~ { ~ 9 Telephone 264-4720 REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. MAILING ADDRESS PROPERTY RESIDENT {If different from above) PHONE PHONE MAI LING ADDRESS ~ , PHONE 3. LENDING INSTITUTION , .' MAILING ADDRESS ' q / -'~ / 4, REALTOR/AGENT ~ . ] PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION / STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four ,~E~.: '[~" Two Five SINGLE FAMILY [] MULTIPLE FAMILY [] Three [] Six [] Other 7, WATER/SUPPLY ~] INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM -[~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS_ INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 {Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY' 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified iNSTALLER []Septic Tank or []HoldingTank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [~ DISAPPROVED DATE BY 2.,;_~; DATE RECEIVED · INSPECTION APPOINTMENTS / ,T, ME T,ME T,ME // At~UINIC:IPALITY (Df: ANCHONA~ MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~ONMENTAL PROTECTION JUN 2 3 1981 ENVl RONMENTAL SANITATION DIVISION Telephone 264-4720 ..... D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete aH parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. 1. PR~r~,TY OWNE~ ..... ~., . PHONE PROPERTY RESIDENT (If different from above) ' PHONE PHONE ~AILING ADDRESS 3. LENDINGI~TITUTIO~ J ~HONE PHONE 4. REALTOR/AGENT ~TREET LO_~z-~ION , . 6. TYPE OP RESIDENCE ~> NUMBEROF~BEDROOMS ~. ~ [~] One [] Four .~]~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY )~]~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM )[~3~!N DI V I DUAL/ON-SITE** [] PUBLIC UTILITY [] Other * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 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 WELL [] COMMUNITY DATE DRILLED Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I NDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septig Tank or [] Holding Tank . Size: / (.~ ,~9 ~) I f Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Are Sewer Line I Nearest Lot Line WELL TO: ,.i,: ./ /,~ Absorption Area to nearest Lot Line 5. COMMENTS [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY C\ M-W DRILLING INC. P.O, BOX IO-378 ANCHORAGE. ALASKA 99511 PHONE 344-0526 INVOICE N°_ 1615 MATERIALS TOTAL MATERIALS AMOUNT NAME LEGAL DESCRIPTION SANK OR LENDING INSTITUTIONS CURRENTLY HOLDING DEED OF TRUST ROME PHONE WORK PHONE WELL NUMBER DIAMETER DEPTH SETTING STATIC LEVEL SERIAL NUMBER : MODEL SCREEN LENGTH BLOT SIZE LI~ER/$CREEN VOLTS PHASE DESCRIPTION OF WORK DATES All charges shall be paid in full w/thin ten days unless other arrange?ents are mede prior to drilling. The customer shall pay in- terest at the rate of I ~ % per month on any amount not paid within ten days. Failure to pay may result in a lien against the property, WORKMAN DATE IN -OUT HOURS I RATE ~¢-D U~C.~ MATERIALS IFROM ASOVE~ '~t~ OTHER CHA"GEB