HomeMy WebLinkAboutBIRCH HILLS TERRACE #2 BLK 1 LT 3Birch Hills
Terrace #2
Block 1
Lot 3
#050-141-26
ibpecuun rcepun_ I - I-y4.aoq-,,
Municipality of Anchorage
Community Development Department Page 1 of 1
On-Site Water and Wastewater Program
4700 Elmore St. • P.O.
Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: SW 930046
PID Number: 050-141-26 ❑ New ❑ Upgrade
Name:
Stephen & Mandi Constantine
ABSORPTION FIELD
❑ Deep Trench ❑✓ Shallow Trench ❑ Bed ❑ Mound
Address
17827 Lacey Drive
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
1.0GPD/SF
8-15 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
9-13 Ft.
Gravel depth beneath pipe
0.5Ft.
Subdivision
Block Lot
Birch Hills Terrace'
1 3
Fill added above original grade
2-5 Ft.
Gravel length
2X60.0 Ft.
Township
Range Section
T14N
R2W 12
Gravel width
5.DFt.
Beds: Number of Lines
2
Distance between lines
10.0 Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lib Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
600 Fel
2
Ft.
Well
N/A
N/A
N/A
N/A
N/A
TANKr❑ Septic ❑ S.T.E.P. ❑ Holding []Other
Manufacturer
Anchorage Tank
Capacity
I 1,250Gal.
Surface water
100+
100+
N/A
N/A
Material
Number of compartments
Lot Line
65
66
N/A
N/A
Steel
2
NA
Foundation
5
30
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
NIA
N/A
N/A
N/A
N/A
Gal.
Remarks
Pump on level at
Pump off level at
High water alar at
Information found from record drawing and field
in.
in
in.
measurements.
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL Housetotank Tank to
drainfield
Walker Construction
Drainfield CO/MT
Inspector Pannone Engineering
Services
BENCHMARK (Assumed elevation) 1008
Inspection si
dates: 5/3/13
2„d 7/11/13
Location and descri tion
p
3b
41h
Garage Floor
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval:
Date
.r �(F. • • •A4� ;Q
Steven fi• ♦3anrior�e'r
f `�4.r�',�F�e' SS �i►'.�i
Approved
,�
Date
ibpecuun rcepun_ I - I-y4.aoq-,,
Municipality of Anchorage Page —of ^'
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: '5*W X13PID Number: 0_5D -/,94/ - z--�-
Name
Wastewater System: ❑ New LlUpgrade
LCG-j 3✓L
Address e
wer
ABSORPTION FIELD
Phone
bq _� 3
No of Bedrooms:
C7 Deep Trench jShallow Trench O Bed EI Mound El Other
LEGAL DESCRIPTION
Soil Rating: S,,-� PIli-416
Total Depth from original grade:
, O GPD/S Ft.
0i= So orw J 3,J Mo4
Lot Block: Subdivision
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
p A
l- 00�L
3 grf A}tt4.STFi�rt
9 .S3 /'J,TN Ft.
OrS— Ft.
Township
Range.
Section:
Fill added above original grade
Gravel length:
Z S 4 A) Ft
z 'x- foo Ft.
WELL: 11 New El Upgrade
Gravel width:
Number of lines:
Distance between
S Ft.
Z--
Ft.
Classification (Private, A,B,C)
Total Depth:
Cased To:
Total absorption area.
Pipe material:
4 -Lu v "4TH-
Ft
Ft.
Co O SQ. FL
3 d OJ L
Driller:
Date Drilled.
Static Water Level:
Installer:
Date installed.
Ft,
6J L --4 � ON i.r h
Mg/. 9
Yield:
Pump Set at.
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
Kseptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
IrOlj
I L �;"O
Material:
Number of Compartments:
Well
ic.
L
Surface
LIFT STATION
Water"—
Lot
Size in gallons:
Manufacturer:
Line
bS"
`�-
__
_
"Pump on" level at:
"Pump off' level at
High water alarm at:
Foundation
dc -1
3v'
--^
_
Curtain
Pump Make & Model
Electrical Inspections performed by:
Drain
BENCH MARK
Remarks:
Location and Description.
Assumed Elevation:
@r�) O
ENGINEER'S SEAL
Inspections performed by: Dates: 1st
2nd --9/W9.- _—
Department of Health and Human Services approval
Reviewed and approved by: - - - --- - ---- Date:
72-013 (Rev. 9/91) MOA 25
Z
Permit No. S �`� 3 UOQ Page 2 of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
72-013 A (2/91) MOA 25
Municipality of Anchorage
_ Department of Health and Human Services dln)_
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
April 5, 1994
Gerald J. Graham, Jr.
Kathy J. Graham
17827 Lacey Drive
Eagle River, Alaska 99577
Subject: Lot 3 BLock 1 Birch Hills Terrace Subdivision #2
Permit #SW930046, PID #050-141-26
The subject permit, issued April 5, 1993 by this office for a
single family well and/or on-site wastewater system, has;
expired as of April 5, 1994.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
I
If you have drilled the well, a well log must be sent to
this office fbr documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as -built inspection report must be sent to this office for
review, approval and documentation. All inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Sinc rely,
J ?nm i P.
ogram Manager
On-site Services
enc: Copy of Permit
cc: David R. Dayton, P.E.
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930046 DATE ISSUED: 4/05/93
DESIGN ENGINEER:PU qM;6 Gempm�Y c I, EXPIRATION DATE: 4/05/94
OWNER NAME:KAISER, KATHLEEN F.
OWNER ADDRESS:17739 CHILKAT COURT
EAGLE RIVER, ALASKA 99577
PARCEL ID:05014126
LEGAL DESCRIPTION: BIRCH HILLS TERRACE #2 BLK 1
LT 3
LOT SIZE: 39156 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
6S Z�-AZ
v
DATE:
DATE: ��
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Pero
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David R. Myt6n P•B.
20210 Dente St.
Ch4ok, Aloka "W
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650 '
SOILS LOG - PERCOLATION TEST' • �i o. 2
-6l�5-7- //OZ-zr-
PERFORMED FOR: 6-rilao— DATE PERFORMED:
% `fy,P1iY /�iu5 7�jr,,r.�ecc
LEGAL DESCRIPTION: Awa 6c.'l #w -0 Z Township, Range, Section: ie. /Z, ?Zt /i Ai�/uf
DEPTH {S—LOPE SITE PLAN
(FEET) -1D04p�� �6�LSrT*r><4^J 1I 1 17
1
2
x.s
3-
4
5+al►I�+�
6-
7
7
8
9
10
11
12
13
M
15
16
17
18
•
19
}4VLS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
MR,
Depth to Water After
Monitoring? &*OVO Date: 460j—
S
L
O
P
E
Gross
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
�� 7.�
� A►1/w/
� 'r
G r
20 a 9 s � -t— / �/�+r�
lul PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN '� FT AND FT
COMMENTS
PERFORMED BY: `�`"''O �' � I A 4ERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 3�Z S�9 a-
72-008 (Rev. 4/85)
K SIM
e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street Anchorage, Alaska 99502-0650... l«� i
povidIL�� ; �
SOILS LOGS-- ERrC�OLAT ON TESTV44Ae
RS��."e'
PERFORMED FOR: 1C T/`ll�J � /'�/��S �� DATE PERFORMED: 0 E
3t Pc.+1 Neu s 7�
LEGAL DESCRIPTION: /tcr3 mac' I App st L Township, Range, Section:% r, T/SG,�j
DEPTH ,I SLOPE SITE PLAN
(FEET)
1 --
3
4
5
SLA'r' 0Tf,") S / Ury
6 t G P
7 (�c�/De4h5ccvu L6",CVS
8
9
10 WAS GROUND WATER
ENCOUNTERED?
11 S
L
IF YES, AT WHAT
O
DEPTH? P
12 E
Depth to Water After'' //
13 Monitoring? "V,AO Bate:
15 -i I �3o�S7�i0-rW
16
17
18
19
Reading D to Gross
Time
Net
Time
Depth to
Water
Net
Drop
2lo/
60
20J_�j
r $' �,,�t;- & a
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN A(— FT AND 4 FT
COMMENTS
PERFORMED BY: )91F 1 w—'w CERTIFY THATTHS TES WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:� 9 3
72-008 (Rev. 4/85)
Parcel I.D. 050-141-26
r!t a�L
Municipality of Anchorage x= x
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Expiration Date: _4.
Complete legal description Birch Hills Terrace #2, B1, L3
Location (site address) 17827 Lacey Dr.
Current Property owner(s) Stephen & Mandl Constantine Day phone
Mailing address 17827 Lacey Dr.
Real Estate Agent Day phone
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
i]
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
u
Public Sewer
❑
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 641 L) Waiver Fee $
Date of Payment Date of Payment
Receipt Number 09;A ( G Receipt Number
COSA# o50 1312-'11 Waiver#
5. 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,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services LLC
Address P.O. Box 100217, Anchorage Alk. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIG
System #1 Approved for —4- bedrooms
System #2 Approved for _ bedrooms
Disapproved
Conditional approval for
Phone (907)272-8218
Date 5/3/13
bedrooms, with the following stipulations:
By: Original Certificate Date: 7J y L
The nZ'alj ,o chorage Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only
upon the reprYYesentations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSA blue sheetf s
Nitrate Advisory, ,
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # -L_of r
Structure served by this system +
Certificate of On -Site Systems Approval Checklist
Legal Description: Birch Hills Terrace #2, B1, L3
A. WELL DATA
Well type AWWU If A, B, or C provide PWSID # _
Date completed Sanitary seal (Y/N)_
Total depth ft. Cased to ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1250 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping 5/9/13 Pumper JR'S Pumping
Parcel ID: 050-141-26
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
ft.
g.p.m.
Collected by:
Date installed 9/8/93
Cleanouts (Y/N) Y
High water alarm (Y/N) N
C. ABSORPTION FIELD DATA
Date installed 9/8/93 Soil rating (g.p.d./ft' or ft2/bdrm) 1.0 GPD/SF System type Shallow Trench
Length 2X60 ft. Width 5 ft. Gravel below pipe 0.5 ft.
Total depth 7.4 ft. Eff. absorption area 600 ftz Monitoring tube Y Depression over field N
Date of adequacy test 5/3/13 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 614 gal. New depth 0 in.
Elapsed Time: 100 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NO If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons _
in. "Pump off' level at
Cycles tested _
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Manhole/Access (Y/N)
in. High water alarm level
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Sewer /septic service line 25+ Holding tank 100+
Animal containment areas 100+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that / have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone
Date 5/3113
COSA brown sheet 10-10-12.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 110+
4,Loe�Fi �AC'rt-lr �.IVL(L L� RLAO
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'so S19Y." o [1A hart
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LoT' 3
39
1'5,5 sf.
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e ""��7EPTtc. GLts•r.,ovt3.._.
•
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t t Cn3= �2'•t�0 W 1-M 46
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N-IVMG TNIs rpmwtu q 6`(A PUPaLtC Wart - 5 {Sttuni. ��/i �J
PLOT PLAN — AS BUILT _mac_ SCALE'11:4-o_ GRID NW t53 Project No. W-Ztn"1
Xtane j.f�i 'UL
TT am& L,34
Q 3 a 1731 George Bell Circle
tLt�l �4J t!_f-t � LC�t ta`J Anchorage, Alaska 99515 (907) 345-6476
I Hereby certify that t have surveyed the following described property: 57Z Z -4-117
Lot 3 ,BlockOF
_, Slt4,k4 F4ru.S T tu�.e;?0.ax� r_ 2 ,il,+aa*
1+5}59LZ4C_ Recording District, Alaska, nd that the improvements situated �'�* A.f`,QS
thereon are within the property lines and do not encroach onto the property AV •.' . -
adjacent thereto, that no improvements on the property lying adjacent thereto / v3 •"$% r
transmission 1
encroach on the surveyed premises and that there are no roadways, .e.•..+• .... ....L,;,
lines or other visible easements on said property execat as indicated hereon. 01
Dated this the Da of • {�'a
` Kenneth G. an` • �`
Y _lC-'i9. 1t- t9 `�4,, at Anchorage, Alaska ;i �•,, 15-52D2 .' t
�, 4I
It is the responsibility of the owner to determine the existence ofany easements,� �''• •.++•' �
covenants, or restrictions which do not appear nn the recorded subdivision plat.
��;'SSIt7rifilt.0
p Iotii'v.a��
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. # HAA # '
1. GENERAL INFORMATION
Complete legal description �07 -3
B t ��N I -J ► S T� A-ee-+�Z
Location (site address or directions)
Property owner A-T*i - a + s 2 Day phone Cp9 ¢ - S (e (.3
Mailing address IG -739 (24/1-xA-7- e!�O_ J,z-- G-f1Zt_s- e.ev `-,c 4k- 99-S77
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4-
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water x
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site Y,
cog
Holding tank?
Community on-site
r_ 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 021
S. 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.
David R. Dayton P.E.
Name of Firm — 20210 Donalar St. Phone
Chugiak, Alaska 99567
Address
Engineer's signature ``- Date /Z IiZAF3
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
0
Ng
bedrooms, with the following stipulations:
Date
�ni!1" _ D
¢ �_S.fu'—c��w... 7Lp Jt.L L"Lik"•
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 (Rev. 1/81) Back MOA M
Municipality of Anchorage
Department of Health and Human Services `-
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: !_.. T -> ( Parcel I.D.
f5e 2 e, e v _T--41ZA-c_ �
A. Well Data A-7—
Well type /0 GU Lk If A, B, or C, attach ADEC letter. ADEC water system number
W �vT S S ysn�J
Log present (Y/N) Date completed Driller
Total depth Cased to Casing height
Sanitary seal (Y/N) I Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Pump levell
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 4,1,4-
Absorption
,1,J -
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform Nitrate
Date of sample:
B. SEPTIC/HOLDING TANK DATA
AT INSPECTION
_; On adjacent lots
; On adjacent lots _
Public sewer manhole/cleanout
Petroleum tank
Other bacteria
_Collected by:
Date installedV 9f9 5
3 Tank size 12a Compartments Z
Cleanouts (Y/N) Y Foundation cleanout (Y/N) y Depression (Y/N) Al
High water alarm (Y/N) _!✓�- Alarm tested (Y/N)
Date of pumping—�Vc!crJ SYS TLyyJ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot On adjacent lots /00 i --
To property line _� Absorption field /m
Surface water/drainage 1 pC>—F—
Foundation
Water main/service line
72-026 (3/93)• Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed N /4 Manufacturer
Size in gallons
Vent (Y/N) "Pump one level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
Manhole/Access (Y/N)
"Pump off" Level at
_Cycles tested
Surface water
,O
Date installed %���% 3 Soil rating (GPD/Ft2) �h..o ��.c System type
Length 2x60: / t -o
Width 5` Gravel thickness
Total absorption area _ 690054 Cleanout present (Y/N)
Date of adequacy test AhIEW SYS rr�t Results (pass/fail)
Water level in absorption field before test
Total depth in z s "&
Depression over field (Y/N) Al
for
After test
Peroxide treatment (past 12 months) (Y/N) 61 If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot _ �✓ On adjacent lots _ m o t- Property line
To building foundation :3,9 To existing or abandoned system on lot
G CP
A,A —,(:Y--
On adjacent lots .;5Z.> 1- Cutbank 'U1,4 Water main/service line 7'
Surface water / ov Driveway, parking/vehicle storage area
Curtain drain /long
E. ENGINEER'S CERTIFICATION
Bedrooms
I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on.Wee-d ofd ,In§ vection.
0.0
David R. Dayton P.E. �ir-.
20210 Donalar St. n
d
Chugiak, Alaska 99567 �o.•: ' """''�° °
io
Signature
• Q ��..�' D_44 IL Dayton f tv
Engineer's Name
2205-E
Date
IMPP
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number
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DATE
MESSAGE
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4S 468
POLY PAK (50 SETS) 4P468F-1
rarba"Iess
NO REPLY NECESSARY
SIGNED
—1 REPLY REQUESTED USE REVERSE SIDE
I
RECEIVED
FEB 18 1998
munipality ()f Anchorage
1060. Health & Human Services
TO
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SUBJECT
MESSAGE
FROM
DATE
SIGNED
FFDIRM _FO • 4S 468
POLY PAK (50 SETS) 0468❑ NO REPLY NECESSARY F�
REPLY REQUESTED USE REVERSE SIDE
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hereby certify that 1 hove surveyed the following described ,� L,,..•M"'•a�,•��� 5�r
property: Gar kTzr y ••-;TSq,
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Anchorage Recording Precinct,Alaska,an 0 the Improve- 9�•••4•�•�Q•°o•• ++•+••'^•-•
ments situated thereon ore within the property lines and do 4�q,
not overlap or encroach on the property lyln adjacent thereto,
that no Improvements on. property lying ad?scent thereto 'r % NO. "�� •f c• .w
encroach on the premise In question and that there are no �* °• "•�`��'
roadways, transmission lines or other visible easements on �F s�°> ror•�' �� J
said property except as indicated hereon.. `��,'"`��e,:�: `0,.
.Dated at Chuglok , Alaska
this ¢ day of /,%2�t. , 19
PREPARED BY: RESIDENCE OF:
D. R. Dayton R.L.S.
20210 DONALAR SL fi
CHUGIAK, ALASKA 99567 Phone (907) 696-2417 r
DRAWN BY:���� DATE: ¢ 1 1 ¢ 1 9 3 W.O. N0. DRAWING NO. FIELD BOOK No.
1 9z 1 9
CHECKED BY, SCALE: PLAT FILING, NO. SECTION, TOWNSHIP, RANGE GRID NO.
T>e��-Z95 sz Ti9ti, Q 2w A, kV 53
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I hereby certify that I have surveyed the following described
,Cor 3 BGOG,C l F .'
property
Anchorage Recording Precinct,Alaska,an that he Improve-
ments situated thereon are within the property lines and do
not overlap or encroach on the property lylnadjacent thereto, „a.
that no improvements on. property lying adjgacent thereto '
encroach on the premise In question and that there are no
roadways, transmission lines or other visible easements on
sold property except as indicated hereon.
Dated at Chuglok , Alaskan
this I L day of , i9
PREPARED BY: RESIDENCE OF:
.0. R Dayton R.L.S.
20210 DONALAR ST.
CHUGIAK, ALASKA 99567 Phone (907) 696-2417
DRAWN BY: DATE. W.O. NO. DRAWING NO. FIELD BOOK NO.
71:> ► 2a r $'� 9 3 5p - /, 4.3.7
CHECKED BY, SCALE: PLAT FILING, NO. SECTION, TOWNSHIP, RANGE GRID NO.