HomeMy WebLinkAboutBONNIE VIEW LT 7
MUNICIPALITY OF ANCHORAGE
4, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE I ..[~1 EW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION~~ ~/O ~ NO' OF BEDROOMS
lw.,, I Ab.o~r~a -- Dwelling __ PERMIT NO.
DISTANCE TO', ~O ~ Zd ~O'~/~
~ ~ Manufacturer '~ Material No. of compartments
I Liq. capacity i n~all~s Inside length Width Liquid depth
/~ ~ IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~Z
O Z ~ Manufacturer Material Liquid capacity in gallons
Q Well Foundation Nearest lot line /(~ PERMI~N~
~ ~ Z No. of lines / Le~qth of.ach line Total length of lines Trench width Distance between lines
~ ~ Top of tile to finish grade ~j Material beneath the Total effective absorption~rea~
~~ - ~' inches / ~ ~
Length Width Depth PERMIT NO, ' /
< ~ Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
I~ ~t of " '
APPR OV ED DATE LEGAL
72-013 (Rev. 3/78)
L'.',EEPFIRTHEI'.4]" OF HE:FIL.'TH BNI..D ENVIRONI'"IENTSL PROTEC:TION
E~;:_"5 L STREET, RNCHORFIGE.. RK 9950±
26,'4-47::20
PERM I"F 1",10:
.F.:,I::I T E ISSUED:
RI':'PL I CRI'.,Fr':
RE:',DRESS:
CONTRCT PHOI'.,IE:
:F.:40:1.70 HAI'.,ID 1.4R I TTEN
O 4,.." :1.. ;:i:,.." :E:,4
FF.:EE:, B FI R ~.': F.:
'..7::.1..t ELL. EN C: I Fz.'.CL.E
FINCHOF..:RGE., FII.::: 995:t. 5
522"- L:~:879
L. EGFIL. [:, E: S C: F.: I P i
I....OT' Ei; :[ ZE ·
SLIB[:, 1 ',,,' I S I O1",1: BONN I E 'v' I EH
SECT I01"4: 25 TOHNSHIP: :.E2N
34:~::1..2 ,::S:;C:L F'T. OR FIE:RES>
LOT:
RFINGE: 31.,.I
BLOCK: 1"t8
I CEF..:T I F:'Y "I':HRT:
:1.. I FIM FRI'dlL. IFI'F.': 1.4:[TH THE F.:EC.!UIF=:EMEI'4TS FOR OH-SITE SEI.,.tEF.:S RNE:, 1.4ELLL=; RS :':;ET
FOF.:TH E:"r' THE' MU1",IICIPFIL..IT'¢ OF FINCHORflGE ':: MOFI .':' FIND THE STFITE OF FIL. FISKFI.
;;'.'?.. I 1.4IL. L. INSTFIL. L. THE :SY'"STEH IN RC. COF.:[:,FINCE H ITH RLL. MOFI CODES FINE:, F.:EGUI._FITIONS.,.
FII",iD IN COMF'L. iFINCE: I.,.II'TI"'I THE DESIGN CRITERIFt OF THIS PERHIT.
Z'.':. I 1.4ILL FI[:,HEF.:E 'T'O FH....L MOFI FINE:, STRTE OF FI[.RSI'.'::R F.:EQUIREMENTS FOR THE: SET BRC:K
[:' i:.STFINCES FRFd"I F:IN"r' lEX I ST Z NG 1.4ELL, HFISTEI.qFITER E:, I SFuqSFIL S"r'STEM OR PLIBL lC
-' SEHERFIGE Sh"STE;I"t ON TH I:F.; OR FIN"r' t'RD...TF.H.ZENT OF.: NEFIRB"r' LOT.
IF:' R L. IF'T :."7,1" FI T I. O1".1 IS II",i:"":;"Ft":ILL. E:[:' 11"4 FIN FIREFI COVERED B"r' MOFI BUILE:'ING COE:'ES.,
'T'HEN (t::, FIN IEL. EC:TF.:I C:RL 'PERMIT R1'qD INSPECT ION MUST BE OE:TFII 1"E[:'.~ (2) RS-BUILTS
¢
HIL. I.... I'.;iO]' BE: FIPPRO',,,'E[:, HITHOUT FIN ELE:CTRIC:FIL INSPECTION REPORT.~ laND (Z.:) THE
ELEC:TRICI::IL P.ICIRK MusT BE [:,ONE ['3'¢ 1"":1 LICENSED EL. ECTF.:ICIFIN.
............................
FI F::' F:' L. I CI::It",IT: F'I$:'.E[:, t:3FIRF3E:R
Permit # ~C/ O /7 L~
Applicant: ~-. ~
MUNICIPALITY Of ANCHORAGE
Department e¢ Health and Environmental ~rotection
825' Street, Anchorage, AK. 301
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
~z_~ Mailing Address:
Location: Phone Number:
Legal Description: :~ 7 ~-~ ~~ Lot Size: ~ //~
Type of Soil Absorption System Is:
Trench: Drainfield: ~ Seepage Bed: ~ Holding Tank:
Maximum Number of Bedrooms: ¢~ Soil Rating(sq.ft/br) ~ /
The Required Size of the Soil Absorption System Is:
/-~? LENGTH ._~o GRAVEL DEPTH ~ // 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 the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~-~D GALLONS * *
Permit applicant has 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. '
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
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.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 * *
I 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 residence.is remodeled to include more that 3 bedrooms.
Signe~: Issued by: /,~.~_.(j3.
ApplicantDate: M//~/~'5//
ST/~LW BRUST/~D ASSOCIATFZ
E~IGINERS SURVEYORS PLJ:~Ii~
1610 Dimond Drive, Anchorage, Alaska 99507
PERFORMED FOR:
Phone ~ % [] SOILS LOG
LEGAL DESCRIPTION:
1
2
3
4
5
7
8
'7--/~ ,'t,// z //~'-~' L~ TEST
· -SOILS LOG - PERCOLATION TEST
DATE PERFORMED:
SLOPE SITE PLAN
10
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED? _ ~'-~ SL
b' o
P
IF YES, AT WHAT ,/"~ /-- 0 oM' e
DEPTH?
/.,.//~.~, ~'.,~ /,,,~., ~_,~.~ )
Reading Date Gross Net Depth to Net
Time Time Water Orop
/
PERCOLATION RATE /~"~ -..~-" (minutes/inch)
TEST RUN BETWEEN FT AND ~'~ / FT
12-008 {6/79)
STMIEY BRUST ~D ASSOCIATF
Phone 344- .4
SOILS LOG
FrlGI[~FFRS SURVEYORS
1610 Dimond Drive,
P~i4ERS
Anchorage, Alaska 99507
--SO~LS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
e
SLOPE
DATE PERFORMED:
SITE PLAN
f,d \
' 1
!
11
12
13
14
15
16
17
18
19
20
COMMENTS
Reading Date Gross Net Depth to Net
Time Time W~te~3':";," ,:} ~ Drop
?..;,...;,.-'.., ; ,,
;~ , 7.~,; ~ ,~t~ ~0~ · ;,~ ' ' ".A
', ',o ',,,, ,~ '. , ',
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND FT
PERFORMED BY:
DATE:
72-008 (6/79)
~UNI(~ PALl:FY o.t: AN.~HO .P, AGJ~!
~EPT. iOF ~EALTH &!
;NVImNM,ENTAL PRCSTEC~OI~
:
:
_.
:
o o o c5 o o o o o c5 o ¢
0 0 0 0 0 0 0 0
|
0 0 0 0 0 ~ 0 0 0 0 0 0
O
(b
o
o
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL INFORMATION (MUST BE~ COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
/d
(b) Property Owner /~f~ _~,T lephone: Home
Mailing Address~/~':~_Z ' '~¢/'/,/'~'~
(c) Lending Institution ~'~~~
Mailing Address ~/~
(d) Real E~tate Companyand Agent
Add res, ¢/4~
Telephone ~¢- /I/~
(e) Mail the HAA to the followina address: or: Check here ~ hold for pick up.
List dontac~r~day phon~ ~mber
Business
TYPE OF RESIDENCE
Single-Family~
.!
Number of Bedrooms
WATER SUPPLY
Well~ ~
Community [] Public b
Individual
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
sEWAGE DISPOSAL
Onsite~, 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.
Page 1 of 2 72-025 fRev 8/86~ Front
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e~ep @ZAleUe ~o suo!~oadsu! ~onpuoo ~ou op SHHQ jo saaAold,,,B 's~ua,,,a4nba~ a;els pue leJgP@J u!e~aJ A;s!~es o~ ~ap~o
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NOIJ. n~:3
'9
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JO/pU~ ~lddns J9J~M ~1!$-U0 eql 'uo!lo~dsu! pue UO!JB6!iS~AU! ~LU UJOJJ pUB SSI!j e6~JOqOUV JO Xl!l~d!o!unv~ ~ql uJoJj ,,
peu!8lqo uo!18~Jo~u! eql uo p~ssq 1~ql ~J!J~A J9q~nJ I 'u!~J~q pel~o!pu! eJnlonJ1s 1o ~d~l pu8 suJooJpeq 1o j~qtunu eql Jo~
~lenb~p8 pu8 I~UO!loun/'aj~s s! tuelsts I~SOds!p JgiBMgi~M Jo/pu~ ~lddns J~J8M el!$-UO aql l~q1SMOqS J8AoJddV tlpoqlnv
qlteeH $!ql JO uo!le6!lseAu! ~uJ leql XJ!JgA [ 'MOleq UMOqB elep uo!leP!leA eql Jo se pue oleJeq pgx!JJe lees/~LU/,q pe!J!:Peo sV
NOI/V~OdNI aNY v/va 'HO~VgS glld 'SISal 'SNOI/O~dSNI ONIQIAO~d ~ld ONI~ggNION~
.g
MUNICIPALITY OF ANCHORAGE (MOLl
ENVIRONM CHECKLIST- FEBRUARY 1984
APR 2 ! ]988264'4720
Legal Description: ZL,O'~"'
RECEIVED
WELL DATA
Well Classification '~/~/V//~7'-~" If A, B, C, D.E.C. Approved (Y/N) ~'/,~
Well Log Prese. nt (y/!~, Da, te Compl(~ted ~f~d~j~'d'c) Yield
'*'/:"~[ '"'/' /?? /,4
Total Depth .~7~ Cased to~- - B~ Depth of Grouting
Static Water Level z~,4-~
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
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Pump Set At
Sanitary Seal on Casim[~N)
Depression Around Wellhead (Y~)
Comments
/ /
/0~ ' On Adjoining Lots //~-')
!
/~0 ,'~ · On Adjoining Lots
W///~C' TO Nearest Public Sewer /
~///~ TO Nearest Sewer Service Line on Lot ~"~'
~' /~' ~J/~'~'J 'Date '~/-
~','~'7'"'- ~ · ,4/T~-~ o. :~
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes ~/N)
Depression over Tank (Y(~
Size
Air-tight Caps~N)
Pumping/Maintenance Contract on File (Y/N) ·
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /O 7
To Property Line
To Water Main/Service Line ,/~
Course
No. of Compartments
Foundation Clea~.o ~_o~)
Date Last Pumped
· 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
.;
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/~
Results of Last Adequacy Test
Type of System Design
Length of Field
Depth of Field ,/.
Gravel Bed Thickness O,,~"
Standpipes Present~l)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
/o 4-
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 /d
To Cutbank (if present)
Comments
D. LIFT STATION
~ Dimensions
Size in Gallons ~-- Manhole/Access (Y/N)
"Pump On" Level at "pump Off" Level at
High Water Alarm Level at ~ (Y/N)
Tested for Pumpi~OA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that l ~hec~, ~,.eri~ie~, or conformed to all MOA and HAA guidelines in effect on the date of this inspection·
Signed ~-'~.-.----L-~"~../~..-.----~' Date
'"~ ¢'"'~ MOA No.
Company
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
M-W Drilling, Inc.
P.O. Box 110378, Anchorage, Alaska 99511 (907) 349-8535
April 1, 1988
Alaska Enviromental Control Services
1200 West 33rd Avenue
Suite B
Anchorage, Alaska 99503
Attn: Alan Wien
Re: Lot 7 Bonney View - Water Well Descriptions
]2701Nehr Road, HUD No.11-029-958-203
Gentlemen;
As you ~now, the subject property has two water wells which were
drilled%~Syren Brothers Drilling. We have never seen the logs and
do not know when the wells were drilled. The original owners
asked us to work on them beginning about a year ago. The
southernmost well (Well #2), is approximately 400' deep and,
typical of bedrock wells in the area, has a very high static
level (10 to 20 feet below ground) when left for long periods.
On 13 July 1987, we tested this well while setting the adjustment
on a coyote pump controller. The results were 0.2 GPM. On 16
July 1987, we did another flow test because we wanted to verify
the results of the previous test. These tests were done by
pumping the water level in the well down to the pump intake and
then measuring the recovery (after a 15 minute rest period) by
pumping the water level back down to the pump intake while
measuring the actual volume of water pumped. This process/test
was repeated 9 times -- the results were 0.37 GPM.
From 4 to 13 March 1988, we worked on Well #1 (the northernmost)
which we had previously explofracked. We cleaned it out and ran
a steel liner down to 177'. During this time the well was left
pumping (on a timer) from 09 to 13 March as part of the
development and cleanout process. On each development cycle the
well was pumped down to the intake. Several tests were conducted
similar to that described above. The results were 0.88 GPM. We
have hooked this system together with a coyote pump
controller/timer so that Well #1 and Well #2 will run together on
demand. The coyote is wired to the Well #2 pump so that when, or
if, the water level is pumped down to the pump intake the pump
will automatically shut off and not be allowed to cycle again for
4 hours. The only other thing~ which needs to be stated is the
fact that the system was drained and winterized last fall. There
's are our business,t
is a water filter which needs to be replumbed since the bowl was
taken off. This must be done before the system can become
operational.
ayne E. Westberg ~
President
WEW/klr
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
ANALYSIS REPORT BY SAMPLE for Work Order # 5999
Date Report Printed: APR 12 88 @ 09:01
Client Sample ID:LT, BONNIE VIEW Client Name : AECS
PWSID :UA Client Acct : AKECSRP
Collected APR 7 88 @ 14:10 hrs. P.O.# NONE REC'D
Received APR 7 88 @ 15:00 h~s. Req #
Preserved with :H2804 AND REFRIGERATION Ordered By :
Analysis Completed :APR 8 88 Send Reports to:
Laboratory Superviso~:_.STEPHEN C. EDE 1)AECS
Released By :~ ~~----~/-(/' 2)
Special
Instruct:
Chemlab Re£ #: 9605 Lab Smpl ID: I Matrix: Water
Allowable
Parameter Tested Result/Units Method Limits
NITRATE-N 0.36 mg/1 EPA 353.2 10
Sample ROUTINE SAMPLE
Remarks:
1 Tests Performed ' See Special Instructions Above UA-Unavailable
ND- None Detected "See Sample Remarks Above
NA~ Not Analyzed LT~Less Than, GT-Greatez Than
MU. C .A,m' OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date /' ~";~ - ~.~
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 ,"~'~//:~<~/" Telephone: Home ...,¢,¢/.5-~.;¢~'.~' Business
Mailing Address ";'''~ -'~ .
(c) Lending Institutio'r~' : ;~' Telephone
Mailing' Address
(d) Real Estate Compa,~y a.nd~Agent..,~?~ '~ _/~'~'¢'~z/'~'2~'''~
Address
(e)
Mail the HAA'to t't~e fc~liowina address: or: Check here I-I, if hold for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-Famil~
Number of Bedrooms
WATER SUPPLY
Individual Wel. I/~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite/~ Public [] Community [] Holding Tank []
Not. If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 fRev 8/86~ Front
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm ~-'x;,'~..o ~"~'~.~'./.-".'.'.'.'.'.'.'.~'~-f..-~ Telephone
Address '~ //~~ ~/~~ ~
DHHS APPROVAL
Approved for ,,~';'?--~./.~ bedrooms by
Approved .AZ' Disapproved
V ~
Terms of Conditional Approval
Conditional
Date
CAUTION
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.
Page 2 of 2 72-025 fRev 8/86) Back
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4744
Legal Description:
Well Classification /./~'~:_.~ If A. B. C. D.E.C. Approved (Y/N)
Well Log Present (Y/N)('"'~' ; Date Completed /"J~J"~ Yield
Total Depth --~-.:~> ~- Cased to ~'¢ ~'¢'/:::.'~ Depth of Grouting
Static Water Level ,/-,~/- ,~ ,~'--~,~,'
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N) ./Y
Separation Distances from Well:
To Septic/Holding Tank on Lot ,/~'/'
To Nearest Edge of Absorption Field on Lot _~'~.;"~' ~'~
Pump Set At -'~-~ --~
Sanitary Seal on Casing (Y/N) ~t/'
Depression Around Wellhead (Y/N)
· On Adjoining Lots ~'/~ '/
; 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 Z~_d_~_ ,///..~.~ ..¢_ ,~.,,- ~/_)y~_ J~'J/~. .... ~5 _ ,~'"~'~/~'7 ~ _
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line ,~.,,'~
Course , ,
Size /~'->'~ No. of Compartments
Air-tight Caps (Y/N)
Foundation Cleanout (Y/N)
Date Last Pumped ~/- Z~'- ~"~ z~..-
, for "'-
Temporary Holding Tank Permit (Y/N) ~
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Com'ments
Page t .of 2 ..
72-026 Rev. 8/86~ Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~/"~" ~' ~
Width of Field ~"~ / ~'
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ,,//pc, ''~
To Building Foundation ~'~
Lot
To Water Main/Service Line /~'.~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field "=¢-'~/ "~
Depth of Field ,=~ '" ~__..~, c~ , ??~
Gravel Bed Thickness ~ /~
Standpipes Present (Y/N) ./V'
Date of Last Adequacy Test -~-~--~Z- ~? ~'
To Property Line ,,'~' ¢
To Existing or Abandoned System on
; On Adjoining Lots .-,~'~¢ ~
To Cutbank (if present) /~/.,,-~
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that Ih.ave che~,,~ked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed~~ Date
Company ~"~/~-,~ ~.:~/': MOA No. ~.~
Receipt No. // ~ O/~¢/~/
Date of Payment
Amount: $ / ~ ~
Page 2 of 2
72~026 (Rev 8/86~ Back
BEVAN ENGINEERING
P,O, Box 112852
Anchorage, AK 99511
(907) 522.1383
M u n :i. (::: i p a 1 i t y o.F A n c h r.) r a g e
Department. cH: Healt. h & I:.Environmental I::'rc)'t:ec::t:~on
825 "1..." St':r"ee'h
.Af'lc:hc:II'-a(~e.~ Alast.::a 995¢1
I.".:,'e :: F::'re:d & Anne'ht.e Bari<er., Health Au'P. hor:L t.y Appl :i. cat:t on
t...c)'h 7 Bonnie View
Dur":i. ng '[:he peri od .~:r'(:~m Apr":i. 1 13 'l:'.c) Apr:i. 1.~.~:.'""~", 1987 I per.Formed r'esearch, si t.e
:i. i'.1 v (..'~.:. ?; '~:. :i. (~l .~.~ '~': i ~zH"l ~.!~:, .~ i,~e ]. 1 .~: ]. ~:)~..~ eR. n a ]. ys i .c.~ ~, af]d
l..~eal'hh Au'hhc)r':i. ty Appr"oval c)r'; the ab(~ve r'e.Fer'enced
I per.Formed a we].]. .Flow tes'E and ~:ourld '['.he well. produc'h:ion to be 2,g~ gallons
pe.r m:i. nute (gpm), Th:i.s ¢..,:xcee. dst. he. [~.~,,4167 gjpm rE..~qU:Lred -¢(:]r a 4 beclrcm}m home, I
too!.:: a water samp:l.e .For col:i..Fc)rm arlalys.~.s arid '[:.he lab resu].ts were
s a t :i. s.F a c t c} r" y ,,
I p e r .~: o r' m e d a n al::) s c~r" p t :i c) n t e s t o n t h e s e p t i c s y s'~: e m a in d d e t e r" in :1. n e d t h a'h :i. t.
absc)r-I::)ed a't'.' a rate (::),f 6¢g~..I.. t:~al],or'ls per" day (gl::)d). This exceeds 't':he 6C~,~.>.'.~
rec]u:i.r"ed ..Fc}r a 4. I:)edr"c~c)m he)me. The sept.:Lc: tank ~as pumped and 'Ehe. vc}lume
r"emoved was ].25¢~ ga!ohS.
'Tc) my I.::nc)wledcle I have a ..... emb.l, ed al 1 (:)~ the :i.n.Format:i.(:~l"~ r'equest::ed c)n th,:...".: HAA
App!i(:::a'f:ic~l") and Checkl:i. st. I .:':':tm sL.tl:l)~f~:i, tt':i, rlg th:i.r~, data t.o y63Lt .{:c)r yC)Ltr rev:i, ew.
F:'lease ,::::c}n~:act me i.F I car'l prov:Lde any addit.:i, onalL in.Fcw"'matic}n. (ph ........... 1383)
S :i. n c e r e 1 y,
~l::~'.. Bevan F' ,, E.
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date ~~t~(i(
(a) Legal Description (include lot, block, subdivision, section, township, range)
Locatio31 (address or directio~) ~ ~ '
(b) Applicants Name F¢(~ ¢,- ~e_~+~ ~C~?~4? Telephone- Home BusiF~ss,Z~k,-~5~I
,
(c) Applicant_is (check one) Lending Institution ~ ; ~er/builaer ~ ;
~uyer ~ ; other ~ (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate CO. & Agent
Address
(f)
Telephone
Mail the HAA to the following address:
2. Type of Residence
~ingle-Family
Number of Bedrooms
3. Water Su_~
Individual
Multi-Family
Other (describe)
Community ~ Public ~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. ~ispo$_a~.
Onsite ~ 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.
[Page 1 of 2]
5. E~ineerin~ Firm Providin~ Inspections, Tests~ File Search~ Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein. I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
bedrooms
Disapproved
DHEP Approval
Approved fo r/L~3Z/~
Approved ~N
._, ..... ,..,
Con6itional
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ~NCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASgak. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION~
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AD~fHO~ APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
OCT 9 1984
RECEIVED
Well Classification ~w~%~, _
Well Log P=esent (.~)
Total Depth ~o ~. ~ ~d ~
S~tic ~ter ~1 U
Casing ~ight ~ Gr~nd
Elec~i~l Wiring in ~n~it
~p~ation Distan~s ~ ~11:
To ~ptic~olding Ta~ ~ ~t
If A, B, c~ C, D.E.C. Approved(Y/N)
Date
'Zo ~+_ ~ Depth of Grouting N / ~
PU~ ~t At ON~n~n
Sanit~ ~al on ~sing (~)
I ol, f.
Depression Around Wellhead (y~
I
; On Adjoining Lots > lOG
To Nearest Edge of Absorption Field on Lot I%0~[ ~-t-.
To Nearest Public Se~r Line ~ ~t~. To Nearest Public Sewer
Cleanout/Manhole ~o% Ao~%;~ . To Nearest Sewer Service Line on Lot
Ware= Sample Collected By [_. Oaac. ;4. d~{~- ; Date %0- $ - 99
O '
Wate= Sample Test Results ~So--~~rM
; On Adjoining Lots ~ ~,~,
B. SEPTIC/HOLDING TANK ~I~TA
Date Installed G - tB- ~4 ~ Size J %$0 ~ .% No. of Ccmpartm~nts
Stan~i~s ~) Ai~-tight ~ps ~) . Foun~tion Clean~t
~ession o~ Ta~ (Y~ ~te ~st P~d ~
P~ing~intenan~ ~n~a~ ~ File (Y~) ~[~f~
Holding Ta~ High-Wate~ ma~ (Y~) ~ Te~a~ Holdi~ Tank
~p~ation Distan~s ~ ~ptic~oldin~ Tank: .
TO Wate=-Supply W~ll
To P~operty Line
To Water Main/Se=vice Line
To Building Foundation.. ~O~-'
To Disposal Field Z.~.~+.
TO Stream, Pond, Lake, c~ Major D~ainage
[Page 1 of 2]
MUNi~,AuTY OF ANCH~
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
0OT 81984
RECEIVED
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ZO~
Date Installed ~-t~- 8~ ~
Width of Field ~ ~, ~
Squa=e Feet of Absc=ption A~ea ~ ~ ~ ~
Depression over Field (..Y~ Date of Last Adequacy Test
Results of Last Adequacy Test ~ IR
Separation Distanc~ f~cm Absc~ption Field:
TO Water-Supply Well ~ o ~. To P=operty Line ~0 ~.~.
~.~%/~n~Type of System Design
/
Length of Field $~
Gravel Bed Thickness
Standpipes P=esent ~N)
To Building Foundation ~'
,, ~ /~ ; On Adjoining
Lot
To Water Main/Service Line ~C) To Cutbank(if present)
To Stream/Pond/Lake/c= Major Drainage Course
To Driveway, Parking A=ea, c~ Vehicle Sto~age A=ea
To Existing or Abandoned System cn
H/g
D. LIFT STATION
Date Installed Dimensions
Size in Gallons ~ Manhole/Access (Y/N)
"Pump On" Least ~ "Pump Off" Level at
High Water/~arm Level at ~ Vent (Y/N)
Elect~i/al Codes(Y/N)
Cc~m~n~s
Meets MOA
**
** Check Permitted Bedroc~ Rating Against HAA R~quest
I certify that I have checked, verified, c~ confcmTed to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed /;~.'~ /)/('~//~z_~
/
Ccmpany t~o,-~ ,',, ~- .~o~,, ~/-~
Date
KB1/d5/s
[Page 2 of 2]
2-15-84