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MUNICIPALITY OF ANCHORAGE l
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
T4AME PHONE I ~NEW
VAILING ADDRESS
LOCATION NO, OF BEDROOMS
DISTANCE TO:
Manufacturer ~_~__~
Width
IF HOMEMADE:
Well ~_ Dwelling
Manufacturer Material
No. of co~l~a~rtments
Insidelength Liquid depth
PERMIT NO.
/-'4 ~
Liquid capacity in gallons
Well li~
DISTANCE TO: ~ ~,.~.~"~ /
Length Trcnch wid,~ h ~
Top of tile to finish~.~ Material b~Ln'e~[~.z ~ ~V'~', t'~ inches Total effective absor
Length ~ Width Depth ~ PERMIT NO. ·
Type of crib Crib diameter Crib depth Torsi effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO: ~ -- --
Distance to lot Jlne PERMIT NO.
DISTANCE TO: Building -- Sewer line~ Septic tan~_ Abso~rption area(s)
OTHER
PIPE MATERIALS
REMARKS
APPROVED
DATE
LEGAL
72-013 {Rev. 3/78)
DEPARTMENT OF' HERLTH AND ENV~ONh'IENTAL PROTECTION
825 L STREET, RNCHORRGE, AK 9950±
264-4720
F'ERMIT
[:,ETE ISSUE[:,:
:4E0]'2 ENGINEEF:E[:, [ E_.,~ alq
.:l_...,.. El._,, : 4
FIF'PLICFINT: DFI'¢ID RN[.', [:,ONNFI MCCFIRRE*/
FIDDRESS: 12.740 F:I TFINFI[:,FI LEiOP
RNCHORREiE, RK 995±5
CONTRCT F'HONI,E: ]:45-5807 ·
i...EGFIL DESCRIP: SUDDIVI_c;ION: STEVRHN
'SECTION: 25 TOHNSHIP:
LOT SIZE: :].5600 (SQ. FT. OF;'. RCRES)
LOT:
RRNGE:
E:LOCK ~~¢///4
CERTIFY THRT:
:t.. I FIM FRMI!_IRR Hi-f'H THE F:EQUIREfqENT5]. FOR ON-SITE SEI,IERS RND HELLS RS SET
FORTH B'T' TFIE PilJNICiPFILIT'¥' OF FINCHORFIGE (i'tOFI) FIND THE S'I'RTE OF RLRSKR.
2. t .[,.iIL. I... tNSTRLL THE SYD;TEPI IN FIC:C:ORDRNCE HITH FILl.. I'"IOR CODES RN[:' REGULRTIONS,
RND IN CC$]F'I_IRNCE HI'TI'"I ]"FIE DESIGN CRITERIFI OF THIS PE~;E'IIT.
_'3.._i HILL R[:,HEF..'E TO RLL. MOR RND STRTE OF' FILRSKR REQUZR'EMENTS FOR T'HE SET BRCK
[:,I';E;TRi'ICES FROM FIN"r' E;:':',tSTING HELL, PJRSTEHRTER DTSPOSRL S?S]'EH OR PUBLIC
L'-:qEI.qEF.'FIGE SYSTEM ON THIS OF..' RN'¢ RD..TRCENT OF'. NERF..'B'¢ LOT.
IF Fi LIFT STFITiOi'",i iS INSTRLLED IN FiN FtREF! COVERED 8"r' MOR DUILDING CODES.,
THEN (:L) FiN ELECTRICFIL. PERMIT RND INSPECTION MUST BE O8]"FIINE[:'.~ (2) FIS-BUILTS
HILL. NOT BE RF'PRO"/ED HITHOUT RN EL. ECTRICRL INSPECTION REPORT.~ FIND (33' THE
EL. EC:TRIC:FIL I.'.IORK MUST DE DONE B'T' FI LICENSED EL. ECTRICIFtN
.:, I bi ~[.'.[ DRTE:
FIF'F'L. I ClZli",IT: [)i.:1',,,' I [:' F~i'-,l[::, [:~Oi"JNI::I
ISSUED D"/. DRTE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
SLOPE
DATE PERFORMED:
SITE PLAN
10
11
12
13
14
15
16-
17
18
19-
20-
COMMENTS
PERFORMED
72-008 (6/79)
WAS GROUND WATER S
ENCOUNTERED? ~//~ .~ L
Gross Net Depth to Net
Reading Date Time Time Water Drop
¢',¢~ ~/~/ /~ .'o¢ /,~,/
~ /~: /~ i~
~ /~',~o lO /,~7 .D~
PERCOLATION RATE ~ ~/__"OO i/inch) '
TEST RUN BETWEEN
CERTIFIED BY:
ALASKA eI UIROIlmeI1TAL COI1TROL $eRuI'Ce$,
~n§inecrin9 6 ~nuironmcnl~l Sludies
InC.
SPECIFICATIONS FOR ELEVATED BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM-
LOT 3, STEVAHN SUBDIVISION
1.0 GENERAL
1.1 THE DRAWINGS, SHEETS 1 THRU 3, SHALL BE A PART OF THIS
SPECIFICATION.
1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE
REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND
ENVIRONMENTAL PROTECTION PERMIT.
1.3 IT IS THE RESPONSIBILITY OF THE OWNER TO OBTAIN ALL
NECESSARY PERMITS OR EASEMENTS.
2.0 THE LIFT STATION
2.1 THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER
GALVANIZED STEEL (ASTM A-4444-76), OR ALUMINUM CULVERT,
CAPABLE OF BURIAL TO 10 FT.
2.2 THE 24" PIPE FOR THE LIFT STATION SHALL HAVE A WELDED
WATER TIGHT BOTTOM OF THE SAME THICKNESS AND
COMPOSITION AS THE CULVERT.
2.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED
AND WATER TIGHT.. ALL WELDS SHALL BE CLEANED OF SLAG.
WELDS ON GALVANIZED STEEL WILL BE SPRAYED WITH ZINC
RICH PAINT OR COATED WITH BITUMASTIC.
2.4 THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED
WITH SCREWS.
2.5 ALL ELECTRICAL FITTINGS AND CONNECTIONS IN THE LIFT
STATION SHALL MEET THE REQUIREMENTS FOR A WATER TIGHT
SERVICE.
2.6 THERE SHALL BE A HIGH LEVEL ALARM,PEABODY BARNES 6147
OR EQUAL SET AT THE LEVEL OF THE SOIL PIPE FROM THE
SEPTIC TANK. THE BUZZER SHALL BE LOCATED NEAR THE
ELECTRICAL CONTROL PANEL OR IN A LOCATION DESIGNATED BY
THE HOMEOWNER.
2.7 THE SUMP PUMP SHALL BE CAPABLE OF DELIVERING 10 GPM AT
A HEAD OF 20 FEET.
2.8 THE SUMP PUMP SHALL BE SUSPENDED NOT LESS THAN 6 INCHES
OFF THE BOTTOM OF THE LIFT STATION WITH A CHAIN OR
NYLON LINE.
2.9 THE ELECTRICAL CONNECTIONS OF THE LIFT STATION SHALL
MEET THE MUNICIPALITY OF ANCHORAGE BUILDING CODES AND
SHALL BE IN COMPLIANCE WITH APPLICABLE ELECTRIC CODES.
3.0 SEEPAGE BED
3.1 THE GRAVEL FOR THE BED SHALL BE SIZED BETWEEN 0.5 TO
2.5 INCH AND RELATIVELY FREE FROM SILT OR SAND.
3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE
BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN
COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL
BE PLUS OR MINUS 2".
3.3 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR
POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL.
3.4 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE
DRAWINGS. IT SHALL BE RIGID PVC, ASTM 3033 q-3034. THE
SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED' 0.5"
HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE
OR A REGULAR SECTION OF REGULAR PERFORATED
1200 J]Jesl 33rd Aucnue, SuiJe B · AncJmracl¢, Alaska 99503 · (907) 276-1361
DISTRIBUTION PIPE MAY BE CLAMPED TO THE SOLID SEGTION
WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN-
CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP THE
PIPE.
3.5 THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM
BOARD OR ARCO GEOFOAM EMBANKMENT INSULATION BOARD OF
THE THICKNESS SHOWN ON THE DRAWINGS.
ALASKA ENVIRONMENTAL
CONTROL SERVlCE/~!NC.
1.200 West' 33rd Avenu~ ouite B
ANCHORAGE, ALASKA 99503
Phone 276-1361
SHEET NO. ' OF ~
CALCULATED BY ~/' ~7~
CHECKED BY
DATE
DATE
SCAL~ Y~r4, /"= Z' h~r,~. I"= ~'
)
So;Is' /?~/,',~. 2Z5
(/,
ALASKA ENVIRONMENTAL
CONTROL SERVICE,~'~NC.
1200 West'33rd Avenue' .,uite B
ANCHORAGE, ALASKA 99503
· 'Phone 276-1361
SHEETNO, if~ OF
CALGULATEO BY t~f- Z ~ DATE
CHECKED BY DATE
SCALE
CONTROL SERVICES, INC. S.EE~ NO
1200 WEST 33RD AVE., ?-~!TE B I
ANCHORAGE ,' ALASKA 9:, - J3 I CALCULATED BY
. . PHONE 276-1361 CHECKED BY.
SCALE
1, URETHANE FOAM
BELOW GROUND
2,..COAT BOTTOM 2
3, USE .~ OR
~ ~ FLEXtB~.E
~..S£E SPECIFICATIONS FOB,
DATE
DATE
. :NOTE S
SHOULD BE APPLIED TO A. DEPTH OF 4
SURFACE AT A THICKNESS OF ] INCH,
FEET INSIDE WITH_BITUMASTtC PAINT.
HOSE TO FIT .PUMP.
IV:, AT EP, IALS.
FEET
.. - .GROUND
.LIFT :STAT tON
SCREMS..
NEMA 4 BOX-
F!LLET WE-LD ~
ALL AROUND>
CHAIN OR NYLON ROBE-
-PUMP POWER CE
No;
~'METAL CAP WITH
~/2" URETHAI:,~E FOAM
LLET WmL.
AROUND
TO 4" COUPLING
L~INPT NIPPLE
~.:
i_] ~F.~x ~OSE.
'
~¼ C~ECX VA.L.V.E
' suMP- 'pUHp .'
-ALARM CORD -] ....
':.4 ':'j STEEL' N:IPPLE"~___J~) (tt
PIPE ~ i .. I . __ 1___'_~'
~ METAL :PLATE~ ~ 24* .4
I~OX 1869, STArt I{OI~TE A ANCHOIIAGI!I, ALASKA 9950~
~.oo
DRILLED AT THE RATE OF PER FOOT.
.PROPERTY OWNER ~.
LOCATION OF WELL SITF
DRILLER B~ ~
WELL LOG:
0 .... 16' Sand~ 9.za~e.L ~i.td~ 45~ o~e.t cZa4F.
16---34 ~ Ra. rdpzuz. A c. ea~ ¢.~wed.. Se~e. zaZ 4mad. L ~oudde.~.
34---49' Corw..Lome.za,t~. a L,,ro£e~ ~,ed.,toc~ ma. te~. ~ ~ ~o ~ ~ 49 ~.
49--255' B~o~. a ~ ~ ~~ ~. g~ ~ o~ ~o~ I 1/2 ~2~
~ 188 ~ 194 ~ ~ a ~ ~ ~ ~ ~
242 .to 248 ,fd:, ~a,t.e,,r p,,~r~ aL Lou. z gPi?Z ,hz {z
,f..o.t.a,L p,to&Lc~on..~a 5 1/2 ~?~?l. Th,,~ ~LL .oeem.~ ;Lo
Th~ /~ed.L wa~ pa. Ld. -foe Zn. 7u~L be ,th.e /flc. Ca~eu~ ,O~
1984
COST INCLUDES ALL LABOR AND, MATERIAL FOR COMPL~'~ION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF
THANK YOU VeRY MucH.
BERNIE CLAUS OF RAMPART DRILLING WORKS
DATfS~l~L~2Od~,1984 <~~
SERVICE CHARGE 0 F 1~a% PER MONTH WILL BE: ASSESSED ON PAST DUE ACCOUNT$.
~ ~n On
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Data -~/ ~ ~ /
(a) Legal Description (include lot~ block, subdivision, saction, township, ranga)
Location (address or directions)
(b) Applicants Name
Applicants ~dress
Telephone - Home 5WU' ~-~fi~iness
(c) Applicant is (check one) Lending Institution
Buyer ~-~; 0ther~__~ (explain);
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
Other (describe)
Multi-Family~
2. Type of Residence
Single-Family~
Number of Bedrooms
3. Water Supply
Individual Well~
Telephone'p~?-1~5%
Note: If community well system~ must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Sewag~ Disposal
Note: If community well system~ must have written confirmation from the State
Departmeut of Environmental Conservation attesting to the legality and status.
[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~ 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 ~mter 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.
Name of Firm
Address ;z
Date
6o DHEP Approval
Telephone
Approved for~__~.~ bedrooms
Approved~__~.._~ Disapproved
Terms of Cond±tional Approval
CAUTION
THE ~JNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY ~PPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 REQULRE-
MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE Ffu-NICIPALITY 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
HE~ilCAL & G~'OLOGICAL LABORATORIES OF ALASKA, INC.
5633 B Street
Drinking Water Analysis Repo~ for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
LD. NO.
(*) See h on back
Water System Name
City State
Mo. Day Year
Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no,
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
I
I
LOCATION
Time Collected
Collected By
//~' ~"~
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
Sadsfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination to
indicate reliable results. Please send new
sample via special delivery mail.
Time Received
Analytical Method:
[] Fermentation Tube
,[~embrane Filter
Lab Ref,~ No.Result* Analyst
I?~-~ ~ r-Fq ~
I ~
I ~-1
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter. Direct Count
Collformll00ml
Verification: LTB BGB
Final Membrane Filter De,~ulls
ReporledSy '~ ~~L..-' Date
//
?line:
!
INIC = Too Numerous To Count
/ ~CollformllOOml
A. WELL DATA
r"-'"~ · "~ MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MOA) ENVIROIqMENYAL P?Off-CTION
~EALTH AU't'~OR.[TY APPROVAL (HAA)
I,i/ i? 5 1985
Well Classification
Well Log P~esent ~) Date Completed
Total Depth ~%~' Cased to
Static Water Level r ~.~ Puff Set At
Casing Height Above Ground /,
Electrical Wit-lng in Conduit ~/N)
Separation Distances f~c~ Well:
To Se~tic/ll01ding Tank on Lot
; On Adjoining Lots
TO Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~J A
Cleanout/Manhole
Wate~ Sample Collected By
Water Sample Test P~sults
Cc~aYents ~ F,-~-o
~ TO Nearest Public Sewer
Nearest Sewer Service Line on Lot
Date 3/t Z./~ 5
; On Adjoining Lots
B. SEPTIC/HOLDING TANK DATA
Date Installed 8/i~ /0~1 Size I~oo ¢~,~%\un3 No. of CQ~ga~tm~nts ~
Standpipes ~/N) Ai~-ti~t Caps ~) Foun~tion Cleanout ~)
~ession o~ Ta~ (Y~ ~te ~st P~d N A C~ l~
P~ing~intenan~ ~n~a~ ~ File (Y~)~ ; fo~ ~ ~
Holding Ta~ High-Wate~ ~a~ (Y~) ~ A ~ Holdi~'Ta~ Pe~t (Y~)
~p~ation Distan~s ~ ~ptic~olding Ta~:
To Water-Supply W~
To P~ope~ty Line
To Weter Main/Se~vic~
CoUrse iOd ? ¥
To Building Foundation ~
To Disposal Field ~' ~
To Stream, Pond, Lake, car Major D~ainag~
Comments ~', ~'rot'.
Receipt ~ q~q~?
Date Paid: q-i%-~b~
Araoun t: z~_~' ¢30
[Page 1 of 2] 2-15-84
C. ABSOBPTION FIEIZ) DATA
Soils Bating in Absorption
Date .Installed 9/
Width of Field
Square Feet of Absorption A~ea
Depression over Field (Y/~
Results of Last Adequacy Test
[2~/~ ~Typ~ of System Design
Length of Field 5
Depth of Field ~'~
Grail ~d Thick,ss (z"
Stan~i~s ~esent ~)
~te of ~st A~a~ Test
To Water-Supply Wall
TO Building Foundation
Lot ~ ~
To Wate~ Main/~.~vice Line
To Stream/Pond/Lake/o~ Major D~ainage CoL~se
To D~iveway, P~:king A~ea, o~ Vehicle Sto~age A~ea
Separation Distance from A~sc~ption Field:
To P~ope~ty Line I~' ~
I ~. %~ TO Existing or' ~ndo~d System
i~~ .+ To ~t~(if p~e~nt) ~ A
bell .w
D. LIFT STATION
Date Installed
Size in Gallons
"].~ On" Level at
High Water Ala~n Level
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Tested for
Electrical Codes(Y/N)
Comments
Dime ns ions kJ J%
Pumping Cycles du~ing Adequacy Test.
Msets MOA
** Check Permitted Bedroom Rating Against HAA Bequest
I c~tify that I have checked, verified, o~ oonfc~med to all MOA HAA Guidel
on the date of this inspection.
Signed /~7 ~"~ Date
Company /~ { 5 J~ MOA No. 67
KB1/d5/s
[Page 2 of 2]
2-15-84
DTIO01?02 i