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HomeMy WebLinkAboutLAMPERT ESTATES BLK 2 LT 12Alm" IIS Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 APR f V2018 of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171138 PID Number: 051-791-20 Dwelling:* Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New 0 Upgrade Name: Craig J. McCracken ABSORPTION FIELD ❑ Deep Trench ❑Shallow Trench El Bed El Mound Address 22534 Lampert Cr. Chugiak AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Lampert Estates 2 12A Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line FtZ Ft. Well >100' >100' N/A N/A >25' TANK ❑� Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 11500 Gal. Surface Water >100' >100' N/A N/A Material Steel Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation >5' >10' N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain None Noted Remarks Pump on level at Pump off level at High water alarm at in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034 Tank drainfield D3034 Installer Sanders & Sanders Drainfield CO/MT Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspdection 15c $/22/17 ndLocation and description 2 Bottom of siding 3rd 4th COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OF A4 ari, �:q`5��. Conditional Approval: Date �,`P°• j� ca ��p ............ ..�. i.... �� ° .� Y ..................................r4 ,-.MICHAEL E. ANDERSON e roved �^•....••°••�'� �(n _ �J' A � Date �i�cn 19 1 9 Approved 4 J,°. CE - 4381 lb . 4�440FESSII'' WW I�%L Inspection Report_9-1-12.doc Municipality of Ancyhorage Page 2 of 3 On—Site Water and Wastewater Program — (907) 343-7904 ON—SITE WASTEWATER INSPECTION REPORT Permit No. OSP171 138 PID No. 051-791-20 0 O 6 N N W O cV O O O O PIA NOTE: Subdivision is served by a Community Water System. No conflicts with adjacent wells or septic systems. .•PSE OF `• 49th ..... a ........................ ......... ••• MICHAEL E. ANDERSON =i �� ; •• NO. CE -4381 •• �� AN 4V '♦���� i R0FESSVeZ4.• LAMPERT CIRCLE N 89'58'50" W 90.00' 53.00' NOTE: Existing Septic Tank Decommissioned in Accordance with Municipal Code. Drawing not Completed from Surveyor As Built. Locations are not Exact. SITE PLAN SCALE 1' = 40' LEGEND MT — Monitor Tube FCO — Foundation Clean Out TH — Test Hole CO — Clean Out MH — Man Hole LAMPERT ESTATES BLOCK 2 LOT 12A PERMIT # OSP171138 PID # 051-791-20 VJ.V NOTE: Septic Tank Only Replaced Under This Permit. PROFILE AS -BUILT (NO SCALE) of V. i�'•'•'000 49 R1 �• Michael E. Anderson j �� �Fc�s • • . SCE 4381. i i1F�F� PROFESSI0�'��� N "T` MUNICIPALITY OF ANCHORAGE _ _ On-Site Water& Wastewater Program •,° PO Box 196650 4700 Elmore Road 4,444 ewer Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite 1)(l).irtnicn On-Site Wastewater Disposal System Permit Permit Number: OSP171138 Effective Date: 6/15/2017 Work Type: SepticTank Upgrade Expiration Date: 6/1512018 Tax Code Number: 05179120000 Site Legal Address: LAMPERT ESTATES BLK 2 LT 12A G:1459 Site Mailing Address: 22534 LAMPERT CIR, Chugiak Owner: MCCRACKEN CRAIG J & Lot Size in Sq Ft: 40242 Design Engineer: ANDERSON ENGINEERING Total Bedrooms: 4 This permit is for the construction of: El Disposal Field Q Septic Tank El Holding Tank ❑ Privy ❑ Private Well El Water Storage All construction shall 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 (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: 12.eit /J/Ii j9(4 / Date: e _/ Issued By: ReiteCe_52 I / Date: 6A1r0201 1 v<0 � 6 � � 8 9 1Q � A MUNICIPALITY OF ANCHORAGE + �. N R1413* i I i� Community Development Department 16 Phone: 907 a,- 3-7904 ti Development Services Division Fax: 907 -7997 w On-Site Water& Wastewater Program c < y ! 0:\a 68L9 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-791-20 Property owner(s) Craig McCracken & Marilyn Fine Day phone Mailing address 22534 Lampert Circle Chugiak, AK 99567 Site address Same Legal description (Sub'd., Block & Lot) Lampert Estates, Block 2, Lot 12A Legal description (Township, Range & Section) Lot Size 40,242 Sq. Ft. Number of Bedrooms Four APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑x Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. -7').ii,L1, E 6.4.,4L' ....--, (Signature of property owner or authorized agent) Permit/Rush Fees: pZ 1 6- — Waiver Fees: Date of Payment: (,--13-i 1 Date of Payment: Receipt Number: otSol GI Receipt Number: Permit No. O5Q 11 \13$ Waiver No. Permit App_2-:• :_..c ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) June 10, 2017 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 12A, Block 2, Lampert Estates Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The Septic Tank on Lot 12A, Block 2, Lampert Estates Subdivision has failed and must be replaced. We are proposing to replace the tank with a new 1,500-gallon septic tank to serve the four-bedroom home on the lot. The house may be remodeled in the future to five-bedrooms at which time the absorption trench will also be reconstr4ucted. The Municipal files indicate there is an existing 1,000 gallon steel septic tank on the lot. Previous explorations indicate it may be no more than a culvert contained at each end. At any rate the tank will be decommissioned in accordance with Municipal Code. We are therefore requesting a permit be issued for the construction of a new tank to serve the home. The attached Site Plan and backup documentation identify the location and configuration of the existing septic system and the location of the new septic tank. The subdivision is served by a community water system with the well much more than 200' away. No conflicts exist between the well and septic system on this lot and those on adjacent lots. The drainage patterns on the property will be maintained after construction. The ground surface on the lot is basically flat in the area of the new tank. The tank will be placed near the same location as the existing tank at nearly the same elevation. It will then be tied in to the existing service line. The tank will be constructed in conformance with Municipal requirements. If the tank is constructed in accordance with our design the following statements apply: 1. The tank, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. Lot 12A, Block 2, Lampert Estates June 10, 2017 Page 2 of 2 2. The tank, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The tank, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The tank, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, v44_,Ljj, (24-^-12----7 Michael E. Anderson, P.E. Attachments *******. • • S MICHAEL E. ANDERSON <v� ���f•.• N0. CE-4381 •�.�f�••..(-l0.e.�•'' 4) LAMPERT ESTATES BLOCK 2, LOT 12A 29,354 S.F. LAMPERT CIRCLE N 89'58'50" W 90.00' 90.00' 1111- s' : 1 Four Bedroom z Home o FCO L'': O 0 �{ N ci i CarOrt • SV New 1,500 Gallon Or. 3 c P ,V Septic Tank. 2C0 W Existing O Absorption Trench CO N (.J1 O W O U! O LOT 12A z7 77 NOTE: 7 Subdivision is served by a Community Water System. 7/ No conflicts with adjacent _ wells or septic systems. 10' UTILITY EASEMENT 90.00' 53.00' ��vi++aiiiiIii,� SCOPE OF WORK �..�E OF ^,* Decommission Existing Septic Tank n Accordance KP :................,�' 1+ with Municipal Code. Place New Foundation Clean ® C7:' ,_ ' . Out and 1,500 Gallon Septic Tank. Place 2 post i 'I 49th i� 21,t : tank Clean Outs and tie In Existing Absorption Bed. 5441.- 1 �� LEGEND •�:MICHAEL E. ANDERSON sITE P [_ A \ 0,-" MT — Monitor Tube • sr I•r��.. No. CE-4381 . NI" FCO — Foundation Clean Out **F,4'•..{. ,10-,7•,•.'C4 - TH — Test Hole ..��PROFESSI�Pi••� SCALE 1" = 40' CO — Clean Out tl"1",�w"��4MH — Man Hole GREA, ER ANCHORAGE AREA BORgJGI-I O Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH · //¢~ NUMBER OF INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY__/0'~0"~ GALLONS. SEEPAGE Pit: NUMBER OF PITS / DIAMETER__ · ,N,NG MATER,A 4 /_ CR,B S,ZE: BUILDING FOUNDATION__ OR WIDTH '~ LENGTH ''~['~ DEPTH 7 DIAMETER__DEPTH ?/ r' DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE__ ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK __ SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIA[· LOt SLOPE: __ REMARKS: Form No. EQ-031 DIAGRAM OF SYSTEM PERMIT NO. DEF'RRTMENT OF HEALTH FIND ENVIRONMENTAL F'R.0TECTION 251.0 E. TUf}OR RD.., ANCHORAGE, FIK. ( 76i7D ) APPL I CAN'[' LOCATI ON LE'"GFIL · 3IM TREESH blRN-O-WRR RD Li2 B2 LAMF'ERT EST BO:.q 4.0 - E. R. LOI' SIZE 694-9±99 2:1..000 SQUARE F'EET ~F'¢F'E OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL, RATING (SQ. FT/BR):= ±05 'T'HE REQUIRED SIZE OF THE S.0IL RE:SORPTION SgSI'EM IS: THE LENGTH DIMENSION IX THE LENGTH (IN FEET) OF' THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IX THE DISTANCE BETWEEN THE SURFACE OF ]'HE r3ROUND AND THE BOI'TOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE I]RRVEL DEPTH IX THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). RED SEF'T BFICKFILLING OF ANY S~r'STEM WITHOUT FINAL INSF'ECTION AND APPROVAL DS.' ]'HIS [:,EPRRTMENT WILl_ BE SUBJECT TO PROSECUTION. MINIMLIM DISTANCE BETWEEN R NELL AND RN'¢ ON-SITE SEWAGE DI=,PC:,RL'= r- S'¢S"FEM ±.0.0 FEET FOE'. R F'RIVFtTE WELL OR 20r.¢ FEET FOR A PUBt. IC WELL. SF:'ECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER I NSTFILLAT ION. F" [ZE;~." I'"i I T '..mt:IL I [.". F~]R ~YJlqE ~'EF~F~ IF=R~Dr.1 .~ S;SKJIE~. I CERTIFY THAT ±: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS A'%, SET FORTH BY THE MUNICIPALI]"¢ OF ANCHORAGE. 2: I WILL INSTALL THE: S~r'STEM IN FICCORDANC. E WITH THE (.]:ODES. g: I UNDERSTFtND THAT ]"HE ON-SITE SEWER S~'STEM I"IR'? REQUIRE ENLARGEMENT IF' THE RE:]SIC;,ENC'E IS REMODELE[) TO INCLtJDE MORE THAN :~: 8E:DROOD1S. ( S I GNE:D: ....... · ,:.~,' ...... ,AF'PL.//} O 8 E GEO, CHNI(~A~. ,~ DEVIsaL. .... ?!VJENT ~u. Russell Oyster 694-2774 Soils ~t Foundations Performed for: Box 90, Davi',; St,, Eagle River, Ak~ska 995'77 694-2774 or 688-2280 L:url Ellis Lend Development '/ 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. # (i'-'/~i-' -'¥';! ~' ~¢f'~)' 1. GENERAL INFORMATION Complete legal description Lot 12, Block 2, Lam.Deft Estates Location (site address or directions) 22534 Lampert Property owner Mailing address Chuck ¥oehl Day phone 688-5673 PO Box 671310, Chugiak, AK 99567 Lending agency Mailing address Agent Address Greatland Mortqage/Jannette Caron Day phone 563-3923 3201C Street, Suite 406, Anchorage, AK 99503 Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well xxx 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: XXX 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 s & s ENGINEERING 17034 Eagle River Loop Road No. 204 Address ~,,gb ~v¢,. Al~mtrn 99~77 _ Phone Date DHHS SIGNATURE "w// 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 cou rteey to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~1 Municipality of Anchorage .~ ~ , .; ,r ~ DEPARTMENT OF HEALTH & FIUMAN SERVICES FF_R 2 6 1999 Environmental Services Division MUNICIPALII¥ OF ANCH(,~=~I~--I~--? 825 L Street, Room 502 · Anchorage, Alaska 99501 · (9 . )/i t 4SERVlC S DW SION Health Authority Approval Checklist Legal Description: L-.c~-r' /7.- ~-¢- '2- L-~,,w~p¢-~¢.:~~- Parcel I.D.: A. WELL DATA Well type Log present (Y/N) If A, S, or C, attach ADEC letter. ADEC water system number Date completed Total depth Cased to Sanitary seal (Y/N) Date of test FROM W~~~'~ ight'(~ve ground) .~W~'es properly protected (Y/N) AT INSPECTION g.p.m, g.p.m. Nitrate Other bacteria Static water level Well production ~ Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~/'~(~ Tank size Collected by: Number of Compartments ~ Cleanouts ~N) ~ Foundation cleanout ~N) Date of Pumping II- ~[' C. ABSORPTION FIELD DATA Date installed ~/~ Length oA'--~ Width Effective absorption area Date of adequacy test ]/¢ Depression (Y~D ~ _ Pumper ,J~_/Z. Pd4,/?r,,,J ,~, High water alarm (Y/N) Soil rating (g.p.d./fF or f¢/bdrm) /o,S~- ~/~",¢ System type Gravel thickness below pipe //" Monitoring Tube present~*IN) ~/ Result~-/Fail) /?,'rS'O' Total depth '? / . Depression over field (Y~ ~ For ~ Fluid depth in absorption field before test (in.); ~ ~'" Immediately after© gal. water added (in.): __ Fluid depth cC%/- F (ins) Minutes later: \ i ~ Absorption rate = q~.4- g,p.d. Peroxide treatment (past 12 months) (Y/~) vO~ ~ ¢-/¢0~._¢ .O If yes, give date ¢-~ bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* C3Lcle~ed E. SEPARATION DISTANCES Size in gallons "Pump on" level at* ~-~'~evel at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main /septi~ Lift station Sewer SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /<~ ~'~' Property line 1 ~ v-~ Absorption field Water main/service line On adjacent lots .~--~'-P-~blic sewer manhole/cleanout Wells on adjacent lots Surface wateddrainage ~' bO \ .t-' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Building foundation \o tk- Water main/service line Driveway, parking/vehicle storage area ~'~ ¥>,~O~l~ Wells on adjacent lots .1,-~o ~-F ENGINEER'S CERTIFICATION . I certify that I have determined thru field inspections and review of Mumc~pal recor,,~Yh~t, ft~e above ~.~t¢_.~. are in conformance with MOA HA~ guidelines in effect on this date. Signature Date ~/a ~ / ¢i ~ .,',, :, ,,< '-, HAA Fee $ ~b'~- Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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 10t, block, subdivision, section, township, range) Lot 12; Block 2; Lampert Estates Location (address or directions) 22534 Lampert Circle (b) Property owner Ken & Debra Blue Mailing Address 22534 Lampert Circle~ (c) Lending Institution Telephone :(home) 688-9931 Business Chugiak~ Alaska 99567 Telephone Mailing Address (d) Real Estate Company and Agent Re/Max of Eagle River ATTN: Don McKenzie Address 16600 Centerfield Drive Suite 201 Eaqle River,Ak. 99577 Telephone (e) Mail the HAA to the following address: (or check here 1~4f hold for pick up.) List contact person and day phone number below: S & S ENGINEERING . . i7o34 Eagle Riryer Loop Road No_ '~q4 dagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family,~ Number of bedrooms WATER SUPPLY Individual Well [] Community P~X 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 E~x 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, Iverifythat 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 Telephone ~'¢2¢,~,, ~.~¢',~, ~ $ & $ ~NGINEF. RING Address 17034 ~agle River Loop Road No. 204 Date EagJe River, Alaska 99577 6. DHHS APPROVAL Approved for ~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval ,~//~//~. ~/~/Date Conditional The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5abovebyan 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 DHHSdonotconductinspections 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. 7/88)Sack Page 2 of 2  MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 MUNICIPAI.IIY OF ANCHORAGk 343-4744 ENVIRONMENTAL SERVICES DIVISlOht Legal Description: ~ A. WELL DATA Well Classification R Date Completed Well Log Present (Y/N) If A, B, C, D.E.C. Approved ~),l) _7~____ Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~'~,4:;;;~:~[-'~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot "~/-.~¢:~"~ ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK ~A Date Installed (-¢2/? (-2 ~/~',~ Standpipesd~N) '~ Air-tight Caps,) Depression over Tank (Y/C/'q'j~ Pumping/Maintenance Contact on File (Y/N),4 / Holding Tank High-Water Alarm (Y/N) . SFPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line /~:~ To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~ No. of Compartments ~ Foundation Cleanout Date Last Pumped ~'~'~LO ; for Temporary Holding Tank Permit (Y/N) ~/~ To Building Foundation 'Fo Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~' ~ '7 Width of Field ..~/ Type of System Design Length of Field ~-~ Depth of Field '7 ( Gravel Bed Thickness Square Feet of Absortion Area ~:;::~ '~ Statndpipes Present(~N) /~' Depression over Field (Y~ W Date of Last Adequacy Test Results of Last Adequacy Test .~,~-~ ~ ~ '- ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ (Jr~ To Property Line To Building Foundati ~ ot~j/~ ~ To Existing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line I ~ f Jr' TO Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course 1. ~ (,A-- To Driveway, Parking Area, or Vehicle Storage Area ,~,-~-~ C::)I- Comments D. LIFT STATION Date~.~d '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 HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. S & S ENGINEERING Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 APPLIC FILLS OUT UPPER HAL ONLY Property Ow~ar -,/ ()...:/ /.,,..?,,~? ~__~: (~,,::;', )~ /( /-~ Phone Mailing Addre~ -' Zip Code .~"~?'~ Lending InstitUtion ..~/-c~:/t/~.~ /~/)~Z~ /~;~ ~c~.~"/ Phone Slreet Locali~ Type of Resl~nce ~glo Family ~ Multiple Family No. of Bedroo~ ~ Other Wafer Supply ~ Individual A~ACH WELL LOG, A wall log ts required for all wells drilled since June 1975, mmunity For wells drilled prior to that date, give well depth (attach log If available). blic Utility Sewer Disposal ~dividual Year Indiv~ual Installed: ~,z ~ Public Utility When Connected lo Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Tirre Time Date Date Date Date Inspector Inspector Inspector Inspector _ Field Notes: MUNICIPALITY OF ANCHORAGE RECEIVED ~)~A~PROVED BEDROOMS *CONDITIONS OF APPROVAL ( ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' Soils Rating Date ~wer Installe~ Well To Absorption Area Well Log ~eceived Well to Tank Septic T~k Size '3/82) EXCAVATION ROBERT A. SHAFER CIVIL ENGINEER 694-2979 1982 ~UNICIPALITY OF ANCHORAG~ RECEIVED WORK June 6, Mrs. Leiberman P.O. Box 365 Anchorage, Alaska 995,Z0 Dear Mrs. Leiberman, Reference: Lot 12; Block ~2; Lampert Estates Subdivision A sewer system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The absorption trench was tested by a continuous flow of water over a period of 48 hours without any adverse effect on the system. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is currently functioning adequately. However, the system cannot be guaranteed against subsequent failures. It should also be noted that the cleanout pip~) at the end of the trench was full of rock and other debris. All this foreign material should be removed from the pipe. If we may be of further service, please do not: hesitate to cc: Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA QGREA ANCHORAGE AREA B0R SH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION · MAILING ADDRESS LEGAL DESCRIPTION PHONE SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER ~"r ~ C.t~. INSIDE WIDTH CTg~ L- MATERIAL C-r~' ~'- I~ NUMBER OF COMPARTMENTS 2~ · LIQUID DEPTH LIQUID CAPACITY /000 GALLONS. SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL BUILDING FOUNDATION___ DIAMETER '6~P" OR WIDTH"~"'~¢ LENGTH Iii, DEPTH /0! CRIB SIZE; DIAMETER_(~! DEPTH~ '~ DISTANCE FROM: WELL TOTAL EFFECTIVE ., NEAREST LOT LINE ABSORPTION AREA (WALL AREA) Y~:~ .SQ. FT. ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION CFSSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED NEAREST SEWER LINE REMARKS · DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK. SYSTEM. .. DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: ff'~' ~ <'(-- c~,'~ Form No. EO-031 DIAGRAM OF SYSTEM APPLIC. IT FILLS OUT UPPER HAL' 3NLY Properly Owner ~.~J//-,.'..d/~ /? (?, o~ /,~Z.'.-~'fL/¢ /~ , .~.¢/)/¢.;l/~ Phone Maillng Addre~ Zip Code Buyer ~17~ ,/ ~ ///:-~/ ' ,~ ~/ Address Zip Code Lending Institution ~-t)~L~ ~/)/~1~1~;~3 /-~, ~', ~/d~ Phone Address Zip Code Legal Description L¢~..l~ t f~ J t-)L,:)Cr-- --' / '~ Type of Residence ~ingle Family - ~ Multiple Family ~: ~/ No. of Bedrooms ~ Other W~ler Supply ~ Individual ATTACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. ~Communily For wells drilled prior to [hal date, give well depth (allach Icg if available). ~ Public UIHiIy Sewer Disposal ~lndlvidual Year IndMdual Installed: ~ Public UHliIy When Conneoled lo Public ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST ~EFORE ~OOESSING CAN BE INITIATED. Time Time Tirne I~sp~tor Insp~tor Insp~tor Insp~tor Field Notes: MUNICIPAUTY OF ANCHO~Gg DEPT. ENVIRONM[NTAL PRC)~ECTIO~ ( ~ ) APPROVED BEDROOMS 'CONDITIONS OF APPR~ ( } DISAPPROVED { ) CONDiTiONAL APP_~OVAL' Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received Well Io Tank Septic T~k Size 72.023 (3182) Time Date Time Date Date Inspector Inspector Inspector Comments Date Sewer Installed Conditional Approval Permit No. Septic Tank Size Heldlng Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner ~;r//-/~-',k,, Buyer ~,//~b ,~Phone Phone Phone ~ 7b ~/9/P Type, cf Residence 4~ Single Family [] Multiple Family No. of Bedrooms [] Other Water Supply ~ individual Community [] Public Utilit~/ Sew~,ge Disposal · '1~ Individual [] Public Utility [] Holding Tank ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to 1hat date, give well depth (attach Icg if available.) Year Individual Installed: When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCFSSING CAN BE INITIATE[).