HomeMy WebLinkAboutSOUTH HILLS BLK 1 LT 3
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
LEGAL DESCRIPTION
L
DISTANCE TO:
Manufacturer .~
' ~ I 'cT~tY~-~alJ°ns IF HOMEMADE:
DISTANCE TO: We
Absorption area
Inside length
Dwelling
Manufacturer
Well
DISTANCE TO:
No. of lin? Length of eac~._~
Top of tile to finish grade ~,,.(~ !
Length Width
Crib diameter
DISTANCE TO:
Depth
Building foundation
Type of crib
Foundation
Total len gt h~l:~c~-
Material beneath tile
Depth
Crib depth
Dwelling
W dth
IMaterial
Nearest lot line
Trench width
inches
inches
NO. OF BEDROOMS
PERMIT NO, ,
No, of corr~rtments
Liquid depth
PERMIT NO,
Liquid capacity in gallons
PERMIT NO.
Distance between lines
Total effect~a~.~ption area
PERMIT NO.
Total effective absorption area
Building foundation Nearest lot line
Class Driller Distance to lot line PERMIT NQ,
Sewer line Septic tank Absorpt on area(s)
DISTANCE TO:
OTHER
MATERIALS
SOIL TEST RATING
INSTALLER
R EMAR KS
h,
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
F ._.F..H I 1 NI:L
FtPPLICFINT SCHREC:K CCI. 13UILDERS
!_OCRT ION HILLSIDE: I.,.IFI'¢
LEGFIL L 1~: B ± SOUTH HILLS S,-"[:, LOT SIZE
TYPE OF SOIL RDSORF'TION S'T'STEH IS: DRRINF'IELD
HRXIh'IUH 1'.4UHE:ER OF BED, ROOHS = 3: SOIL RRTING (SQ F'T/BR>=
THE REQUIRE[:' SIZE OF THE E;(:)IL. RB2;ORPTION %'T'STEH IS:
4625'? SC.:!UF!RE FEET
THE LENGTH E:, ~ HENS Z ON :IS 'T'HE LENGTH ,'IN FEET::, OF THE TRENCH OR E:,RFI~NFZELE:,.
. T'" ','' .... ' ~ ...... !'HE S JRFFfl"2:E r]F THE
THE DEF'TH OF R TRE:NCH OR PIT IE; .hE D.[:.IPI.4_.E E',ETHEE:N -
GROLIND FIND THE E:OTTOH OF THE EXCF!',,,'Ft'FZON ,' IN FEET::,.
THE L~.~.n,.:.~ DEF'TH ZS 'THE hlZNZHLIH E:,EF'TH FIF .... F'-' ~" E:ETHEEN THE OUTFRLL F:'IF'E
FIN[:, TFIE E:OTTOH OF THE EXE:R',/FtTZON ,'Zt'-4 FEET::,.
PERHZT RF'F'LICRNT HFIS THE R[:.=,F..h!:,ZE, ZLZTT TZm ZNF'ORH 'I"HZS DEPI::IRTHENT [:,URZNG THE
ZNSTFILLRTZON ZI'.4%F'E::TZDt'.,I::5 OF FtN'T' HELLS R[:,Jf~CENT TO THZS F'R:PERT'T' FIND, THE
NUHE:ER EmF RE2;ZDENCES THFIT THE 1.4EL. L HZLI_
EF4EFF'ZLLtNG OF FIN"? S'¢STEII HZTH:.IT F'ZNRL ZH'~;P[:':TZE~N FIN[:, F.F'F'R:mVRL
DEF'F1RTHENT b.l:[LL BE SI_IE:..]'ECT TO F'F'ZSEZ:I_FF ZON.
MZNIHm_IH E:,ZE;TFtNCE E:ETHEEN R 1.4ELL. F~f.,I[:, FIN'¢ m:mN-.SZTE !SEHFIGE DZSF'E~SRL %Y:E;TEh'I ZS
t00 FEET FOR FI FF.Z,HIE HELL .F 'l~lm::~ TO ;'F~F~ FEET FRmDH R F'UE:LZC HELL D, EF'ENE:,ZNG
LIpmZmN THE T'¢F'E 3F PJE:LZC HELL.
f'IZf.,IZPII_II'"I .:,Z'STFINCE FREmH R FF._ ,P 1E HELL. 'TO FI F'RZ'¢RTE ':;~=[4ER LZNF ZS ';'~ FEET RN[:,
TCm F1 CEHH~INZT'¢ :SEI.,.IER L. Zf-IE ZS 75 FEET.
HEL. L LOG:5 FIRE REQUZRE:[:, RND f'ILIST E:E RETURNED TO THE DEPFtR'THENT NZ'FHZN 3~Z.~ DR'T'S
OF THE HELL COHPLETZON.
OTHER REQL.mZREMENTS HFI'¢ FtPPL?. SF'ECZFICRTZON'E; FIND, -:H'STRJCTZiN E:,ZRGRF~HS RRE
; F E F'~'-F'F'~'
Ff,,,'RIL. FIE:L.E TO Zt4b. E E r' ........ ZNSTRL. LRTZON.
F' FZ F: ~'1 Z 'T E ::"~: F~ Z F: EE :~E; [... EE, L., E~: f'l E:. E: F. 2J: J- .....................
I CERTIF"T' THFIT
:1.: I BM FRHIL. IRR HITH THE REQUIREMENTL:., FOR ON-SITE .'==,El.tiERS RN[:, b. IEL. L.S RS SET
FORTH B"r' THE HUNIE:IPRLI]"'¢ OF' RNCHORRGE.
2: I HILL- INSTRL.!._ THE S'¢STEH IN RE:CORDRNCE HI'TH THE CO[:,ES.
3: I UNDEF.'.STRN[:' THRT THE ON-SITE SEHER S"r'STEM HFW REQLtlRE ENL. P, R0~EI"IENT IF TFIE
RESIDENCE IL:.; REMO[:,ELED TO INCLUDE HORE ]'HRN 3: BEDF::OOHS.
S I Gi',,fE [:,: ............................................................................................
FIF'F'L IE:FfNT 2";EHRECK CO. E:I. ILE. ERS
ISSUE[:, E:"r'- ................................................................................. [:,FFf'E_~.:..'-~.'~=-2~-J ..........
MUNICIPALITY OF ANCHORAGE
Departmen)f Health and Environment, :Protection
' ~ 825~L Street, Anchorage, AK.~'~9501 '
~,' ~ 264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND,~ ON-SITE SEWER PERMIT
Applicant: %f_~,cea~ :~ ~,~il~*r£ Mailing Address:
Legal Description: L 3 (~ ~ 1 :OOtL~ //~ ~,'~ Lot Size:
Type of Soil Absorption System ts:
Trench: Drainfield: ~_ Seepage Bed: __ Holding Tank: ~ /.
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
LE.GTH Fe . R^VELDEPTH
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('I~jN~G) TANK SIZE = /000 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 1 9 8 1 * * *
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 r~si~enc~?is rempd¢'~d to~lude more that 3 bedrooms.
Date::~//.~/
SWP/024(1/81)
PERFORMED FOR:
LEGAL DESCRIPTION:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
DATE PERFORMED:
~'~SO ILS LOG
PERCOLATION
TEST
1
2
3
~4
5
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
SLOPE
SITE PLAN ,~/- /([,),a .
WAS GROUND WATER
ENCOUNTERED? /~.t~ I~
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
Z ,2 ,~.,,z Io o. t,7
q ,7. ~ ~ /o O ,~ 7 F~, ~ 'Z
~ 7,/y o O ,s-o
PERCOLATION RATE 3 ' '~ (minutes/inch)
TEST RUN BETWEEN /7L' ~'-FT AND : ~'f FT
PERFORMED BY: ~L '~- J~/* ~/"~-~ -
72-008 (6/79)
CERTIFIED BY:
DATE:
?- / ?-2/
( WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geologicol ~ Geophysicol Surveys
Oril(ing Permit No.
LOCATION OF WELL (Please camplefe either la, lb or lc.) A.D.L. No.
la.llBorough Subdivision Lot Block I~.I I/4qtrs. Section No. Township N[~ Range EEl Meridian
Ic.)JDISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 5. OWNER OF WELL:
Street Ad.re~s and Area of Well Location A~l~J / ~ ~q~lb
Feet Below ~. WELL DEPTH: [final) 5. DATE OF COMPLETION
2. WELL LOS Surface ~ ft. }~ -- 5&*PT- ~
Matsrlal Type Top Bottom
~ DJ~Id!IfitAI~ ~ItlE$L ~ ~AS~N&I e. ~Cable tool ~Rotary ~Oriven ~Oug
I~C'p7 H --- -- ~' ~ Auger ~detied ~ ~ored ~ Other:
7. US~: ~ Domestic ~ Public Supply ~ industry
~ N~ZmL t~-~l~J~ F~~ l~' ~ mrriaatlon ~ Recharge ~ Commericol
~ Test Well ~ Other:
)~[Pf~(~: ~EFT. ~17~ '( t~D ~ ~0 8. CASING= ~ Threaded ~ Welded
' HAlZDE~ )~ I ~ dJam.~in, to~ ft. Depth Weight ~lbs./ft.
~)~T ~-'?j J~J~ H~I~.~~ ~ ~ ~9 diam. in. to ft. Depth Stickup~ft.
Type: Diameter:
~ Above or ~Below I~nd surface Date
I, PUMPING LEVEL below I~nd surface ~nd YIELD
E~tROHiA~NT~ pRC ~z.e. OUT NG Well Grouted: ~ Yes ~ No
~ ~-~? ~}7~[~ , )~U~J~ ~ ~ ~ Material: ~ Ne~f Cement ~ Other:
[~gih of Drop Pipe ~ fL copocilye g.p.m.
14. REMARKS:
16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Water Temperature ~o ~ F ~ C
This well was drilled under my jurisdiction and this report is true to the best of my k~owledge and belief;
Registered Business Name Contract License Number
Add .... : l~i ~tlLLT~;P I)IZ AN4H ~,~ ~'~1~
~uthorlze~ ~epresentative
Form O~-WWH (11/81) Oopy Distribution: WHITE-Stole DGGS~ PINK-Driller, OANA~Y-Oustom~r
Log
Date completed ...... .//. ' .~. ·../././~{/.'.
Depth of well ........ ./.?..~Z.. ..........................................................................................
Size of casing ......... ~.Y~'. ..... .?f./'.?. ........ .~..z..../.'f./...'...~....i ..........................................
Distance to water .......... ~..Y..~..d..~. ......... ~ ........ ~"..~i-~.../. ...................................
Distance to water while pumping ............ ~_~ ................................. at rate
fl'om
d)
to
4¥
of ................................ ~ ............... gallons per hour.
"Formation
MUNICIPALIT] OF ANCHORAGE
DELTA DRILLING COMPANY
SRA BOX 394 B
ANCHORAGE. ALASKA 99507
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
· 343-4744
CERTIFICATE OF INSPECTION FOR ~IEALTH AUTHORITY APPROVAL OF
OI~'-SlTE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # [~'~JL"-~ -/;~l~ ~-~°t HAA #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, s'ection, township, range)
Locabon (add~ess,~:d~ect I~ ~ '
Telephone: (home) ]F'J~-~ ~'.¢/, Business
Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
T--elephone .... ' -" :' ' '
(e) Mail the HAA to the following address: (or chbck here r'-l, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family/1~'_. Number of bedroo~s ~ '~
3. WATER SUPPLY
Individual Wel/t(~ Community [] Public []
' : Note: If commun ty we system,., must have wr?ten confirmation.from.the State Department;of Environmental
'. dohs~'~atiod'a[t~sting 'th ~h le~'Jit~/'~"s';~'~ti~.<*'~'~''?:;':~: '?.-"::'"~.'~";?~;' ?~'~:~ ':;' ~" "'::"-'~'"'~ ............. - ....... ...... "-'- .......... ' ' -:
4. sEwaGE DISPOSAL."
-', On-site~-. v, Public U -'.: ':.Community U~;.;.~'~' Holding.T~?k
.
72425 (Rev. 7/88) Page 1 of 2 - .: . ; -
~ to ~ e~ed
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suo!ss!uJo Jo s Jo J J@ JOj @lq!suodseJ lou s! e6eJOLIOUV Jo/%!led!o!unl/~ eq.L ;penss! S! e~,e,3!i p,J eo e eJojeq e~ep eZ/,leUe Jo
suo!loedsu! lonpuoo lou op SH HQ ~o see~oldLU3 'm, ueuJeJ!nbeJ elels pue leJepej u!e]~J~)O ~J.$!)~eS 0), Jap JO U!
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. -. . . · .~,~¢a-,C~_.f'~/ ' ~'~,,'¢/~'~¢/ ..~¢.¢a~ ~ ~ 0~ sseJppv
~~¢Z~ euoqdelez · ~ ~ ~!~ ~oameN
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pue led!o!unR lie ql!~ eo~e!ldmeo u! s! ~e~sXs leSOds!p 4eie~e~se~ ~o/pue Xlddns ~ele~ el!s-uo eq3 'uo!loedsu!
~ue uo!iee!isenu! A~ ~oJj pue sel!J eeeJoqouv jo X~iledlo!unR eq~ ~o4~ pau!e3qo uolie~4oju! eql uo peseq
leq~ X~pen Jeql~n~ I';u!eJeq pe~eo!pu! eJnlon43s jo adA1 pue s~oo~peq ~o ~eq~nu eql 4o~ e~enbepe pue'leUOgOunt
'ales s! ~els~s esodsip ~ele~else~:~o/pue Xlddns ~e3e~ ei!$-uo eql leH~ s~oqs.le6o~ddv Xlpoq~nv qlleaH
s!q~ ~o uoBeeRsenu! X~ 3eqi4~pen I '~oleq u~oqs elep uo!~ep!len eql ~o se puc ole~eq pex!~je legs X~ Aq pe!jRJeo sv
~Ol~VflMOdNI ONV V&VO 'HOSVgS ~11~ '5~S3~ 'SNOI~O3dSNI 9NIOIAO~d ~81J 9NIM3gNIONg
.g
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
MUNICIPALITY OF ANCHORAG~
ENVIRONMENTAL SERVICES DIVISION Legal Description'.
2 5 990
A. WELL DATA
Well Classification
Well Log Present CN)
Total Depth ,?_n ,'? Cased to
Static Water Level .5--¢' '
Casing Height Above Ground
Electrical Wiring in ConduitS)
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
Water Sample Collected by J-' (~/~/
Water Sample Test Results ~e~7~.' ¢
Comments ~.~Jer ~.
Date Completed/~//¢///~) ~/ ~,~¢7~¢ Yield
Depth of Grouting lie ~,~,~,~.
Pump Set At
If A, B, C, D.E.C. Approved (Y/N)
Sanitary Seal on Casing ~;~N)
Depression Around Wellhead (Y/~¢)
; On Adjoining Lots .~?~
//¢' ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
;Date ~ ~'"'~.~'~
B. SEPTIC/HOLDING TANK DATA
Date Installed ¢A¢//'~'/ Size /'E)C)¢ No. of Compartments
Standpipes(¢~;~l) Air-tight Caps~N) Foundation Cleanout ~N)
Depression over Tank (Yin) Date Last Pumped
Pumping/MainteD~nc~.6~ntact on File (Y/N) ~ ; for
Holding Tan~.~~. (Y/N) ~ Temporary Holding Tank Permit (Y/N)
SEPAR~i.d;¢'D~CES"~ SEPTIC/HOLDING TANK:
To W~er-S:e,,ty~--.~&: :..:; To Building Foundation
To Pr~B¢¢t~Li~e'~*~,,¢,,~.:~. :' To Disposal Field
To Water ~B~/¢e'¢~TeCbine?*
To Stream,'Behd, Bake ptr~Maj~r Drainage Course
Comments ' ': ~' ¢';''
72-026 (Rev. 7/88) Front
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area --%¢-/~ '
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Present ~/N)
Date of Last Adequacy Test
Depression over Field (Y~
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation ~-f'" /
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line "¢2~
To Existing or Abandoned System on
; On Adjoining Lots ,-:> ~
To Cutback (if present)
Comments
D. LIFT STATION ~
Date Installed Dimensions
Size in Gallons Manhole/Access~Cf~
"Pump On" Level at __~.~g,ml~Off" Level at
High Water Alarm Level at ~ / Vent (Y/N)
Tested for /Y~ ' Pumping Cycles during Adequacy Test.
Meets MOA Electrical Cod~.y..zN)' _
Comm~~..~~
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidel
inspection. ~,~¢'~.,/,,, ,~/
Signed
Company
Date
MOA Ng?
Receipt No.
Date of Payment _
Amount: $
72-026 (Rev. 7/88) Back
delir~,~ffj~F~ the date of this
~'r~T~er's Seal
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343
FEDERAL TAX I.D. #92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order g 21791
Date Report Printed: MAY 19 90 ~ 11:49
Client Sample ID:L3 B1 SOUTH HILLS S/D TAP WATER
PWSID :UA
Collected ){AY i7 90 @ 10:30
Received ~AY 17 90 ~ 14:00 h~s.
Preserved with :AS REQUIRED
Analysis Completed :MAY 18 90
Client Name : A E C S
Client Acct : AKECSBP
P.O.$ NONE RECEIVED
Ordered By : L. REID
Send geports to:
Supervisor:~TSR]{gN C. EDE 1)A E C S
Laboratoxy
Released By : ~~r~--~-z~ ~ 2)
Special
Instruct:
Chemlab Ref ~: 901406 Lab Smpl ID: 1 Matrix: WATER
Allowable
Parametex Tested Result Units Method Limits
NITRATE-N 1.2 n~/1 EPA 353.2 10
Sample ROUYINE SAMPL~
Remarks: SAMPLE COLLECTED BY L. REID.
Tests Performed ' See Special Instructions Above UA-Unavailable
Wone Detected "See Sample Remarks Above
Not Analyzed LT-Less Than, GT-Greater Than
Tom Fink,
Mayor
N unicipality o3 Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
October 31, 1990
Chuck & Nancy Davis
6300 O'Malley Road
Anchorage, Alaska 99516
Re: Lot 3, Block 1, South Lakewood Hills Subdivision
Dear Mr. & Mrs. DaviS:
Please be advised that the on site well' and wastewater disposal
system serving the subject lot has not been approved by this
office. It is our understanding that these systems serve a
single family house and a detached apartment. In accordance
with Anchorage Municipal Code 15.65, this office does not have
authority to approve the installation or use of a well or
wastewater disposal system which serves more than a single
family residence.
Approval for your Class "C" well and multi-family wastewater
disposal system can only be provided by the Alaska Department of
Environmental Conservation. They can be reached at 563-6775.
If we can be of any assistance to you, please contact our office
at 343-4744.
Sincerely, A/ /
j/~ ~mith, P/~.
pi/ogram Manager, On-site Services
cc: Mike Lewis, P.E., Alaska Department of Environmental
Conservation
Kids Are Our Future
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 (address or directions)
(b) Applicant Name ~/~ ~A~K~ Telephone: Home B¢~-~G?¢ Business
Applicant Address 7~ & / ~/~ S/¢~ ~A ~
(c) Applicant is (check one): Lending Institution ~; Owner/builder~; Buyer ~; Other ~ (explain);
(d) Lending Institution
Address
Telephone
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
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 Environ mental Conservation
attesting to the legality and status.
4. 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.
72~025 (~ 1/84)
Page 1 of 2
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
Address
Date
DHEP APPROVA_/J.7~' ~
Approved for ~-/~ZC-~¢- bedrooms b
Approved .,~ Disapproved
Conditional
Terms of Conditional 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
institutions 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
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
Q :J AI 3 :J ,ECKL,,T-264.4720FEBRUARY 1984
996[.3 ~, ~11~t'I~· Legal Description: ~ ~/ ~¢~
Ho~zo~ ~vt~oa~
~ ~vaH ~0 '~
~/~ If A, B, C, D.E.C. Approved (Y/N)
~ Date Completed //~'/~/ Yield
Cased to ¢~ / /" Depth of Grouting
,¢2¢', %'-~> ' Pump Set At
/ ~/ Sanitary Seal on Casing (Y/N)
~/' Depression Around Wellhead (Y/N)
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot /./,¢¢/(~) ; On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer
/~'/~) ; On Adjoining Lots
Cleanout/Manhole ~ To Nearest Sewer Service Line on
Water Sample Collected b~ ~ ~, ~ ~, ; Date ~~
Water Sample Test Results ~//~/~
B. SEPTIC/HOLDING TANK DATA
Size
Date Installed
Standpipes (Y/N) ~' Air-tight Caps (Y/N)
Depression over Tank (Y/N) /4./
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) A///~
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
TO Property Line
To Water Main/Service Line
Course ~'/,¢[')
No. of Compartments
~/ Foundation Cleanout (Y/N)
Date Last Pumped -~/~'/~'
/~/~ ;for ' /V//~
Temporary Holding Tank Permit (Y/N)
To Building FoundatiCn
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Page 1 Of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /0-~-~'
Date Installed
Width of Field ~:?~
Square Feet of Absorption Area .-~Z'/
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
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
Comments
Type of System Design
Length of Field
Depth of Field ,~,
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present) /4//4
~/¢)~ '
D, LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for /
Electrical Codes (Y/N) ~
Comments ~-
Dimensions ~/
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Page 2 of 2
72-026 (11/84)
** 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 / -~/¢'-/¢/, % :,¢'7(~ Date
Company7 /~-C"'"/~/ //CC. MOANo.
Date of Payment G- ) ~ -~
Amou.t:
ALASKA W UIROFlmEF1TAL COF1TROL SEhdlCES, IF1C.
ERIC WAL RER
7261 HILLSIDE WAY
ANCHORAGE ALAS KA
99516
SELLER-ERIC WALRER
03/12/86
ERIC WALRER
7261 HILLSIDE WAY
ANCHORAGE ALASKA 99516
60106
LEGAL:SOUTH HILLS BLOCK 1 LOT 3
ADEQUACY TEST FOR SEWER SYSTEM
ADEQUACY TEST DATE-3/7/86
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 321 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 696 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 696 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
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 3/7/86 .
THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER
SUPPLY OR WASTEWATER SYSTEM.
FLOW TEST ON WELL
WELL FLOW DATE-3/7/86
A FLOW TEST WAS PERFORMED ON THE WELL. 196 GALLONS OF WATER WAS
PUMPED AT A RATE OF 2.8 GPM OVER A DURATION OF 1.2 HOURS.
THE DRAWDOWN WAS 32.75 ' WITH A RECOVERY TIME OF 360 MINUTES
AND THE STATIC WATER LEVEL WAS 48.5 FEET.
THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME.
1200 ~Uest 33rci J~ucnue, $uil¢ [~' Anchorc~q¢, Alaska 99503 '(907) 561-50/40
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) ssz-5o4o
JOB.
~ ~ ~ / :5ou7'1-1 /-//cc ~ g//,D - ~-.
SHEET NO.. OF-
CALCULATED BY "--~ ~'~:~ OATE
CHECKED BY DATE
Date Date Date
Inspector Inspector Inspector
Comments Conditional Approval
Date Sewer Installed Permit No. Septic Tank Size
Holding Tank Size
So~ls Rsting Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY .
ProPe~y Owner ~ ~ ~ ~~ Phone
Buyer
Address
L~nding Institution ~ ~ ~~ ~ ~ Phone
Address
Street Location
Typ~ ~f Residence
~ Single Family
~ Multiple Family No. of Bedrooms
D Other
Wat~r~upply
~lndividual A~ACH WELL LOG. A well log is required for all wells drilled since June
D Community 1975. For wells drilled prior to that date, give well depth (attach log if
~ Public Utility available.)
Sew~ Disposal
~lndividual Year Individual Installed: ~-
D Public Utility When Connected to Public Utility:
D Holding Tank
NOTE; THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
ALASKA 6nuIRoIlm6rlTAL CONTROL $ RUIC $, I[1C.
MUNICIPALI OF ANCHORAGE
(~ncli~eerin§ 8- ~nuironmenlal Studies DEPT. OF H.'ZALTH
ENVIRONMENTAL
December 21, 1981
Department of Health & Environmental Protection
825 L. Street
Anchorage, Ak. 99503
Attn: Les Bucholtz
RECEIVED
Dear Les:
On December 21, 1981 I inspected the well and took a water
sample for loan approval for L3 B1 South Hills Subdivision.
The results of the bacterial test for the water is attached.
It was satisfactory. The well has a seal and is approximately
1 ft above the ground level.
The sewer system has caps on all standpipes.
S z~,~ rs~y~ ~%~
1220 West 25th Auenue · Anchora% Alaska 99503 * (907) 276-1361