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HomeMy WebLinkAboutSPRING HILLS ESTATES BLK 1 LT 3Lot 3 Municipality of Anchorage Page Of a DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: �� � a,5o5a9 PID Number: O I S O 5 1 9( Name: M'ES '�t� SA/. Ea` I Ccs R*E7L .) Wastewater System: El New 1T Upgrade Address: A ANG!{oRA(��� �, aiyot S �tN� �ItL� -DR. ggstw C ABSORPTION FIELD IGL® Phone: No. of Bedrooms: -39 (0 Lf ❑Deep Trench 1�Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: f I GPD/Sq. Ft. I O Lot: Block: t Subdivision: fJ:P21hNo ylLL.S i sl Depth to pipe bottom from original grade: t Gravel depth beneath pipe, . (o .S Ft. �.5 Ft. Township: Range: Section: �— Fill added above original grade: ' Gravel length: t . 0.5' – 1. `a FL 6G Ft. WELL•�xls71N�❑ New El Upgrade Gravel width: 5 I Number if lines: DistancebetweenlinFt Ft Classification (Private, A,B,C): Total Depth: Cased T • Total absorption area: Pipe material: ASTm -i II-1VAT» t. Ft. 1# SO. Ft. V-010/1>3034 Driller: ate Drilled: Static Water Level: Installer:_ Date installed: Ft. I WL -t > o - i0t-cL5 Yield: Pump Set at: Casing Height Above Ground: w� K 9 AN N� TANK GPM Ft. Ft. X15?! SEPARATION DISTANCES aseptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: (a� From Tank Field Station Tank Sewer Lines GQ�' Well- (Iq ! ('� I — — as + Material: STZ Number of Compartments: o2 Surface I oo'� t + --- — — LIFT STATION LotS r r I01 — '- Size in gallons: Manufacturer: Line _ Foundation r (o a? 1 ,____ ..._- _ 'Pump on" level at: "Pump o •• vel at: High water alarm at: Curtain N Pump Mak el Electrical Inspections performed by: Drain Remarks: 'C�IvE' -r-o BENCH MARK St_OvC�()tD- &. of V�IA�'�lAt_ — Location and Description: '-5c) of 6ARAG4-- GLAB if `G 9. AAi),£o r C %0 „ S'ffa?1'� Assumed Elevation: tG0.�.@ Ft EN' L �r( 0': S S ENGINEERING . �' � �,�. M,. ...... .......:.�,.+ Inspections performed g934 Eagle River Loop Read, No.2 ates: 1st 5, r? Eagle River, Alaska 577�, 2nd )Q ' 19 - of �'• •, `"' ;•:.:, f -n g ROBERT C. COWAN rc Department of Health -end Hum{a/rn,,Services approval st. CE -8801 .. r�Y tip, / 77 Reviewed and approved by/.Date: `/, 72-013 (Rev. 9/91) MOA 25 \ WELL Permit No. SW950329 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ® Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 3, BLOCK 1, SPRING HILLS ESTATES 01505141 PID No.. S 1 99.4' ST2 99'5 FINAL GRADE FINAL GRADE MT1 CO3 �� EXIST. 92.3'- 1250 GAL 2.1' SR EPTIC TAN 91 5' 8.0' ♦'82.0' NO WATER FOUND .9-30-95 EXISTING TRENCH ABANDON D SUCH THAT IT MAY A B 6' -- FCO LOT 3 �Mrt; ST1 10' 43' 34' i NEW ABSORPTION ST2 19' T/ TREN H C01 21 45 CO2 2 2'1, 46' lr `J C04 DV z CO3 32' 51' C04 73' 83' t 00 CO3 i MT1 63' 69' . Cot CO2 '-- _ _ 79 103° T2 __J'MTI ° STI TIN�-G 12IC 50 AL �EXI .FCO A... (VERIFIED �tA1� IN RfTY 921`\9 V B V 0 ROOM �pR E L �,� t� F 01 00 A �s. aaa :ae..•.xe�enc: `• k -o ROBERT C. COWAN t �- SCALE 1" = 40' . CE - 8801 a' ��+ry,+� A•� 72-013 A (Rev. 9/91) MOA 25 \ 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 NUMBER:SW950329 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:PETTIGREW JAMES W OWNER ADDRESS:9401 SPRING HILL DR ANCHORAGE, AK 99516 PARCEL ID:01505141 LEGAL DESCRIPTION: SPRING HILLS ESTATES BLK 1 LT 3 LOT SIZE: 51051 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 (UPGRADE) PERMIT DATE ISSUED:10/07/95 EXPIRATION DATE:10/07/96 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 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 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. �14y el DATE: 16 /4 115�- ISSUED BY : A��1!'.yl/ C�✓//,��Y�--� DATE : OZ�l HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN September 28, 1995 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, A.K. 99519 REFERENCE: Lot 3, Block 1, Spring Hill Est. S/D ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Request you issue a permit to upgrade the septic system serving the four bedroom house on the referenced property. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole and after seven day ground water monitoring, the monitoring tube was found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, P Robert C. Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1", = 50, SITE PLAN UPGRADE SCALE r t r [yam '`/-7`�% t- C�`•'�" --I N) 41 no fir`' 7� �o < M c � v r r O I �� O p > P G) D OF Z r Ln o r Oi— �� OCA W p�pp---q Ln l I N- 1\ 000 Z=- — 0 �� �� CA --j Lf) +� u) I p 'lam W C �CU Z C m m C Z m — 0� Gtl� D > Mtn-�'- I �UZ � �� � Z 0 M op. N(- O rT1 O ---------- z w < (m -Di Ui I � ---�------�, �I O--1Ea J--iK m D o 00 �; o -am- -Cm7 w I o 1 M m <�;0 r- W � M oZ -mN �OOU�ZO I 1 00 j m mD -� 1_ C ri�Z D X (p o = ���- -0 Lo DC z I I z o m m m (x. O (/� 0. -----------------------------------(n(A------___-_----------=n=-----'n��� 0_ 10' ELEC. & TELECOM. ESMT. m- z D m -1 c y iTl O -1 Z Z DC7 D m�0 Zp O� M .Z7 Z o--iN 0 OZO 0 0�g000 �ODZcot Z>i oco rTl a� Z xr� ;,, Cl R' � 00m �{ -' m -tea '1 V >>O O z,mn G 00 O 0O .� z Apo t Z C'J �' • •'�.� (ENGINEER'S SEAL) OF ' ® Municipality of Anchorage�..a"� .' DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 n� SOILS LOG — PERCOLATION TEST4.�.� PERFORMED FOR: C A `� L'4 )o f 7) Ir I` ' /CE $ Q , DATE PERFORME���� '•J -'kr �� ,r E S' tai ' .'•..... LEGAL DESCRIPTION: Lo 1� 3 nL°L � 5.���iNc A"r i Township, Range, Section: a�"a "`•�` �,;�� DEPTH SLOPE SITE PLAN ZFE i' �26-ANi C f 1 2- 3- 4- 3 4 it ML Sig/ �� R')C"CJ 5 6 7 8 a �P� 9 rT WAS GROUND WATER 0 -- ENCOUNTERED? 11 LL= S IF YES, AT WHAT -- L 12 % S I } t vt� DEPTH? O E 13 - �4x 7D Depth to Water After FSR � y 3e '� Monitoring? Date: 14 15 16 r , 17 18- 19 8 19 �'. N• N Qui Reading Date Gross Net Time Time Depth to Water Net Drop 0 A X b 31" G -o G 3Z/ z 7 34 , :.s 3 20 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER b TEST RUN BETWEEN G� FT AND FT COMMENTS )' Y W4 L4 (:��fN�E�fN� / / CERTIFY THATTHISTEST WAS PERFORMED IN 17034 PERFORMED BY: I r Eagle River Loop Road No. 2Q$ q / 30 ACCORDANCE Wf "1eLRWbf,JA M"PAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE �. fi 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 � d �J C 1� E� � Q 1� PHONE � EW ❑UPGRADE MAILING ADDRESS Jr� LEGAL DESCRIPTION i_ LOCATION NO. OF BEDROOMS U Y DISTANCE TO: Well �C % ® Q Absorption area Dwelling ,� PERMIT NO. a Z Manufacturer �s Material No. of compartment U~ l LZi�c� S� Liq. capacity in gallons IF HOMEMADE: � ZSb Inside length Width Liquid depth �oZ DISTANCE TO: Well Dwelling PERMIT NO. = z Manufacturer Material Liquid capacity in gallons = T DISTANCE TO: Well ��b_ � Foundation ,J�— e`► Nearest lot line C' PERMIT NO. tl�+�+�W�i�—T� IV J LL z No. of lines Length of each line Total length of lines Trench width Distance between lines E- Z w ✓L ti ( to Q� (�, p inches Q H Top of tile to finish grade Material beneath ti\` Total lJe _ 7 effective absorption area inches (�o ./ W Length Width Depth \ PERMIT NO. C7 Q I— Lu °• Type of crib Crib diameter Crib depth Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER Car I ZLt, V PIPE MATERIALS _ CoSkt/C. �TB+..� O1JI— s 1 0 SOIL TEST RATING y�0.1 INSTALLER I LE REMARKS REMARKS 1 (;� \\ 1 C,,� 0 o JT APPROVED DATE LEGAL 1 p /z -u 13 Inev. 3/ /ti) r j M _� DRILLING, Inc. E4-109 P.O. Box 10-378 • 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner P.ou-, Malin Use of Well Do,:,est is Location (address of: Township, Range, Section, if known; or distance main road Lot 3 Block 1 Spring Hills Estates Size of Static water Screen 242 feet Cased to 241.50 feet bove) (below) land surface. Finish of well (check one) open end ad ( }. Describe screen or perforation "lone Well pumping test at 5 gallons per ('NWY) (minute) for---j------hours with 100% ' of drawdown from static level. Date of completion Sanuary 26 1i34 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness .-q-TO 2 Casing stickup 2 TO 100 Brown sante clan *with rravel 100 TO 110 Brown clay & gravel ---1-'—OTO US 118 TO 17v 170 TO 220 220 TO 235 235 TO 242 —TO- O -TO- -TO- -TO- -TO— TOTOTOTO TO- TO Brown Brown silty gravel Brogan silty gravel (damp) Brom silty gravel Brown silty gravel (damp) Waterbearingrg avel 1V w W A uerimieca contractor Certificate No's 814 & 97.1 3 — CONTRACTOR ,_.MUNICIPALITY OF ANCHORAGE,-- Department( NCHORAGE; Department( Health and Environmenta( -rotection 825 L Street, Anchorage, AK. v9501 264-4720 # # HANDWRITTEN PERMIT # # # Permit # WE L AND/,", ON-SITE SEWER PERMIT Applicant: �p-t �Cx Mailing Address: ::2-96-z Location: Phone Number: C'S Legal Description : L13 3 Q 2a�/A! o Sol Lot Size: -- Type of Soil Absorption System is: Trench: , I Drainf ield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) -L�L-2 / (�/:-D AJ) The Required Size of the Soil Absorption System Is: DEPTH LENGTH 7 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(HO-tD-"G) TANK SIZE _ /2SO. 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 M INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection.and approval by this departmer will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee 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 3 3 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 reskdence is remodeled to include more that bedrooms. Signed: X Issued by: Applicant >> s "a Date: SWP/024 (1/81) \/1 SOILS LOG O, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION %GJ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Doyo me -n DATE PERFORMED: (DCt Z 1 (c 2"!' LEGAL DESCRIPTION:S MO A Sl S-,3 O "7 <<� SLOPE SITE PLAN Fj$ I ---n — - - --- - IT OL— 1 2 3 4 5 6 7 ,8 9 11 12 13 14 15 16 17 18 19 20 COMMENTS Sc vr.y S.-a� c.II Y .: OF A L • a J `•..•...... •.. R i Leroy C Reid No. 2251 �t Fy •. WAS GROUND WATER e� S ENCOUNTERED? L O P IF YES, AT WHAT 1C� E DEPTH? Reading Date Gross Net Depth to Net ■E■■■M®MIN Time Time Water Drop MENEENAMENE t-L Oct ■EMEMMEEMEM MINEEMEMENE MMM.■E■■■E ONE NEMEMMENNIN EMENEEMENE EMENEEMENE WAS GROUND WATER e� S ENCOUNTERED? L O P IF YES, AT WHAT 1C� E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop t-L Oct s,t 00 •�,•r� 4FESSl4r'� o � N\.Z' .%��A 3COLATION RATE / TEST RUN BETWEEN 3 //L FT AN A,? 3'17- -7b /q! ;:s r, q w C--` 18 9 Lr ll (minutes/inch) FT PERFORMED BY: wo CERTIFIED BY: DATE: C d No p _ 0 .� / q o,) I��� v e,Y� b( 72-008 (6/79) �/ .._: inaiviauai weir n_ .... _ Community well NOTE:. If community wastewater system, provide written confirmation fromState ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #t21 r 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 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 invest!qation 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. S & S ENGINEERING Phone Name of Firm River LOOP Road Na. 204 Eagle River, Alaska 995 Address Engineer's signature Date Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 995010 (907) 343-4744 Health Authority Approval Checklist rM � c Legal Description: Lor 3, 6L_CcK 1, SFQINeNi, 5 CsT. Parcel I.D.: C�tSX51 }{ I Z rn `= Z r A. WELL DATA _ r j Cn C rn T Well type `P2 tvAT" If A. B. or C, attach ADEC letter. ADEC water system number <_ z (n C.n Cn S Log present (PN) ���5 Date completed I - a gC <i 5j IC TT Total depth a y a ' Cased to a `i t Casing height (above ground) 114- Z Sanitary seal (VN) `/Es Wires properly protected (DN) (-/1E-S FROM WELL LOG AT INSPECTION Date of test I - � Ic - M i Static water level NoT S?ATc+D a I a Well production g.p.m. 5 I g.p.m. -X- Re-sr1c=c:; j1, n y I°Vr,jo S, pNc- WATER SAMPLE RESULTS: Coliform O Nitrate ®• Other bacteria 11 4� q S` S & S ENGINEERING Date of sample: Collected bv: ant] No. 204 17034 Eagle-Rt+fer�-Loop R B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed I I - S - S -5 Tank size I --5-D Number of Compartments a Cleanouts (m 1/8-5 Foundation cleanout (IPN) y157S Depression (YS) 00 High water alarm (Y// ) Date of Pumping 9 - I B -qs Pumper est Ho wt e -m 5�2v tc�S C. ABSORPTION FIELD DATA Date installed 1 ° - 19 - q S Length (,(, Width —Soil rating (g.p.d./ft` or ft''/bdrm) I. 0- System type S- HAL-Loc,-3-rR4zr­c.1-i S r Gravel thickness below pipe S-5 Total depth H-5 ' Effective absorption area GI l '� Monitoring Tube presentOM yr--� Depression over field (Y© +Je, Date of adequacy test N�A ss &Ev— Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.): Immediately after — gal. water added (in.): — Fluid depth (ins.) Minutes later: Absorption rate = I g.p.d. Peroxide treatment (past 12 months) (YIN) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off' level at* High water alarm level at* *Datum Cycles to E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: eptic holding tank on lot 11l ; On adjacent lots )y" t -4 - Absorption field on lot I ; On adjacent lots IUv '-.4- Public sewer main —7S + Public sewer manhole/cleanout lac) ,+ Sewer /septic service line Q6 -I- Lift station J /A SEPARATION DISTANCES FROM(§E�OLDING TANK ON LOT TO: Building foundation (O Property line 1� 5 Absorption field Water main/service line Surface water/drainage foo '4 Wells on adjacent lots 100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation C� 7 Water main/service line I v �- Surface water Driveway, parking/vehicle storage area 3 r Curtain drain "-wS: KNoWQ Wells on adjacent lots I Property line F. ENGINEER'S CERTIFICATION 1 certify that I have determined thru field inspections and review ofAIunicipal records that -t,' are in conformance withpAIIOyA/I/ 4A uidelin s in effect on this date. Signature Engineer's Name 43 6 •:. i Date i 1 I ! l q S— �r ? �UEER7 C. CGINry ?� Ci; - 3201 HAA Fee $ 3 �� Waiver Fee $ Date of Payment l( —(� S^ !. \ Date of Payment Receipt Number -' ( / r \ 7, y I Receipt Number Rev. 8/95 OSS: haa.wk.doc 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. # 11 \1-, - - L\ \ HAA # 1A o'1 211'�) Complete legal description 610c -k / L4 3 's�p-i"'9 /k/5 t S Location (site address or directions) Property owner Dewls 2114UY Day phone 3lk, )/(Pt Mailing address Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. )O%e-AS c C,9 -L,- t4. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Individual on-site Holding tank Community on-site 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 #21 tZnbow X388 (L6/t'Heli)9Z0-ZL •�aom s,aaauibua ►euoisselo,(d ayI ul suolsslwo ao sao.)ja aol a►gpsuodsai }ou sl a6eaoL40uy jo A111edlolunV�1 ayl •panssl s► aleolgpeo a aaolaq epep azo leuao suolloadsul lonpuoo s�uawaalnbai avels pue ►e�apaI u►eljao A4s1}es OIJapao u► suol}njllsul bulpual alayl pue IOU op SHHQ Io saa�(o►dw3 sawoy to saaseyoand of �(sal(noo e se slyl saop SHHQ ayl'e�lselV 1•o alels 914, ul paaalsl6aa aaaul6ua leuolssa}oad anl6 suoijuluesaidaa all uodn �(luo paseq saleoilpeo ienoiddy luapuadapul ue 1(q anoge g ydei6eaed ul u /,luo(llny. y11eaH sanssl (SHHQ) soolAieS uewnH pue UlleaH jo juawliedao a6e.(oyouy jo Aliledlolun►N ayl s}uawwo0 leuoilippy suoi}elndils 6ulMollo, ay, L4,!m swooapaq aol lenoidde leu0lllpu00 � -7))-7 =� area ME •panoaddesla •swooapaq aol. panoaddy 3unjL`dNJIS sHH® '9 aT y' srti y aan}eu61s s,a9aul6u3 ssei ppy Q wall 10 aweN OL!l- 0)h auoyd •uolloadsul sly, 10 a}ep ayl uo 10911a u► suollelnBei pue `seoueulpao `sapoo alels pue ledlolunVll Ile L41!m eouelidwoo ul sl waIsAs lesodslp jolumalsem ao/pue Alddns amen ails-uo 9141 `uolloadsulpue uol}e6l�sanul ALU LU04 pue sails a6eaoyouy jo AllledlolunW ay} woaj paulelgo uollewaolul E)141 uo paseq leyj � j!JE)n aaylanl. I •ulaaay paleolpul aanjonajs to edAj pue swooapaq jo aagwnu ayl aol alenbape pue ieuoljounj `apes sl wa}sAs lesodsip aawmalsem jo/pue l�iddns aa�enn ails-uo 9141 }ey} snnoys uolleolidde lenoaddy � l!joglny y1lBeH slyl 10 uollebllsanul AW leyl A}uan i molaq unnoys aIep uollepllen ayl to se pue olaaay paxljle leas Aw Aq paipliao sy U33NI0N3 AS N01103dSNl 40 LN3W3J.VJLS 'S nF*�- Municipality of Anchorage Department of Health and Human Services tlhhs HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: //S ZS44� Parcel I.D. m= M m A. Well Data n Well type Peru AA--- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) y Date completed -84- Driller Total depth 2`IL Cased to 25//• SU Casing height 1� -,Y-¢ Sanitary seal (Y/N) y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level "104 '444-=D Well flow g.p.m. Pump levell SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main 14 /k Sewer service line -4A- WATER SAMPLE RESULTS: FA U I-ZIA ho ex v,/ On adjacent lots /66 f g.p.m. A4- A- 64 'I.S9prv. e �.1CcE'SS o�o�I fes wWkour/ �Sl�e�+(�ZI7/S t ; On adjacent lots / e) t Public sewer manhole/cleanout 14 A - Petroleum tank !4/C Coliform SA TtS !-'A-c7nZY Nitrate Other bacteria �� r7sFA cam , Date of sample: 0 (. - o-7- R3 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Tank size Cleanouts (Y/N) Foundation cleanout (Y/N) Compartments Depression (Y/N) 14 High water alarm (Y/N)! (� Alarm tested (Y/N) /,�A- Date of pumping Pumper 7i4'L6t+A SDS SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /(76-+ On adjacent lots 16-0 f Foundation /0 To property line >,5-/ Absorption field S± Water main/service line 11414 Surface water/drainage Or 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STA' Date installed Size in gallons Vent (Y/N) "Pet High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE Well on lot D. ABSORPTION FIELD DATA Date installed //-,e -83 Length is g Width rer Manhole/Access (Y/N) "Pump off" Level at Cycles tested LIFT STATION On adjacent lots Surface water Soil rating (GPD/Ft2) /90 System type O Gravel thickness 17.1a, Total absorption area Cleanout present (Y/N) Date of adequacy test �2-9 3 Results (pass/fail) Total depth /Of Y Depression over field (Y/N) /q PhSS for Water level in absorption field before test &1 4 After test Peroxide treatment (past 12 months) (Y/N) N A If yes, give date 4 - SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1On adjacent lots /fit Property line To building foundation 7t To existing or abandoned system on lot _ On adjacent lots -7 30 Cutbank 14A- Water main/service line 14Ar Surface water t-4 A Curtain drain //A E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area /ate Bedrooms I certify that I have checked, verified, or conformed to all MOA and HAA guidelines jq,efect on the date of this inspection. ,��i ivy da>?GPif�V 4•�9 c1�^ 17 V Signature Engineer's Name (oma C r 4, a1y'•� 6v: Date - ! I ~' HAA Fee $ / 70 , Cr0 Date of Payment Receipt Number 7 %% ( g�Fol 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number a az U O ti = E- Z a O — Z Yo 3 xo3° Za N a w o Oy O W 0 2 ~ N H � W y - Z Qom` !;'l�Gz fi�t`an >a oI--� Foo ow a -1z0 ►- o 1"F > Ww2 1 -co 00 _ CZ wmxw ZQN W ,69 292 0o a wZ x ozo lQ ~ L o. W p F i U Lt . 61 W _jV J IA 3 ON > ~NO 0wMwaY 1 J> =<w w 0 Q CO mm ~ aF0 m39 LN 0 1 71 E' I S m w OaW w�IL J , Q 41- , x 0 a gni ►x -w LQ ,n atnQ 1() ILQ = - BOXca OF -W J a/,• Y' �\3,- 5i1' t e t o m' -1 i; -ow= t wWW 41 n! o .� yy% .� ;, <) N F w w cw o N LL= F ! T J wO C9 q ra 2q� Y y \ ( I 0 J WF a N 2 F w U afl LTi N _ c a� mg w_ aosz WN Y) gib- o s �= Y� U) NZ oy wa, ° YNw }_ U) WZ Q zo # F}- ►x- a" w Q W J U a 1 1 I a mo �� WiLm �3oi J �r m Q w Z Z w— Zn wow- Zpzo 72 \ a -�4g . s� `a> izs i ( W !- a x=- as aIL oa 0 -�4 y I 0 0 a wo WW ~Yh v t yN }I J U. m-iU cr FW0 �Joz f1' Q «. -inz wl- axoa oocz O \ �t aoZ tx-w ILJ XL = z4 FF m Yj` g)_• / �l I CD O ui NJC qN y0-- Ww4w :r f 2 YJ'%�OZ ( LO w LO J Z Fmmo ~z �ux.CL FxNao ax O e t w1" f`1"•V• 0 1- 0 W O Q W `\ I �e -N • •'iib ,�yW ~ > y W_ ® • x w a CL ti �1 7� ei L `O a ®/ ®V YS�S Y /••A _in FNN `� ��C t r. .•''�{'���®gym✓ Lr w O Z O to m¢> 0 y om ki 00. J MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND EWIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATI 1. General Information (a) Legal Description (include lot, block, Application Date 6X'zr&1 vision, section, township, range) (b) Applicants Nar 1b le hone 57Z, 2 - Applicants Address (c) Applicant id'ched,-. one) Lending Institution Owrer/builc3erF7T; Buyer r:::l ; other f:::j (explain); (d) Lending Institution TeleRhor... Address (e) Real Estate Co. & Agent Address Telephom 2. Type of Rasidence Single -Family Cm Number of Bedrooms 3® Water Supply Multi --Family Individual 'Kbll �- Community Other (describe) Public Note: If ccmmunity vzill system, must have written conf irnaticn from the State Departmnt of Environ.. ental Conservation attesting to the legality and status. Is the yell adequate for the number of bedrooms specified in this HAA L) 4. Sewage Disposal Onsite Public community 1'-' 4 Holding Tank Is the wastewater disposal system adequate fcr the rumber of bedrooms RIN) [Page 1 of 21 5® Engineering Firm Providinq Inspections, Tests, Data and Information I certify that I have checked, verified, or conformed to all MOA RAA Guidelines in effect on the date of this inspection. am Name of Firm Address S igned by Date ME a Ki We WIT" 2 Date (00-2okv Teleohore MW Go % to a V*dV&Q5P6G* ua ct W. 22$1 Approved for bedrooms BY Date Approved Disapproved Conditional Terms of Conditional Approval I The Municipality of Anchorage Department of Health and Environmental Protection does not guarantee the continued 'satisfactory perfcxrn:-ince of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedroom and type of structure indicated® (DREP SEAL) 7. Mail the HAA to the following address: 0—'Yll (- � 5 &� - L/ 90 0 Fvie-l--, d 4 A =Hn I -J 7W XJ (Page 2 of 21 2-15-84 S4U1N1C1PALIi OF ANCHORAGE . DEPT. OF HEALTH & ENS/IRO1!' E�:T \L PROTECTION MUNICIPALITY OF ANCHORAGE ( MOA) U I� HEALTH AUTHORITY APPROVAL (HAA) r , ^ s CHECKLIST - FEBRUARY 1984 �, E !F_ _t A. WELL DATA Legal Description: Well Classification If A, B, cr C, D.`E.C. Approved(Y/N) Well Log Present fiz/!) Date Completed Yield Total Depth pZ Cased to a Depth of Grouting,2v 7c--. cu F lig Static Water Level Pump Set AtAjr�7�/u Casing Height Above Ground �,3/ Sanitary Seal on Casing Electrical Wiring in Conduit glN) Depression Around Wellhead (Y Separation Distances from Well: To Septic/Holding. Tank on Lot ,p, ©� On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots }/UD/ To Nearest Public Sewer Line "-'IA- To Nearest Public Sewer �" Cleanout/Manhole <✓/� To Nearest Sewer Service Line on Lot /U% Water Sample Collected By '� ��� Dade g%i,/ Water Sample Test Results - Cents B. SEPTIC/HOLDING TANK DATA Date Installed 83 Size / as v No. of Ccupartments 2 - Standpipes Standpipes Y _) Air -tight Capsy�) Foundation Cleanout &M �( Depression over Tank (Y Date Last Pu /mped A)//t Pumping/Maintenanee Contract on File (Y/N) V/A, for Holding Tank High -Water Alarm (Y/d) 04 Temporary Holding Tank Permit (YM) N//f Separation Distances from Septic/Holding Tank: To Water -Supply Wzll 7/4)61)� To Building Foundation /y To Property Lire >67J To Disposal Field S 1 To Water „MaiWService Lire VtA To Stream, Pond, Lake, cr Major Drainage �l Course Mom [Page 1 of 2 ] , 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 19D Type of System Design 7eFinaA Date Installed 111,93 Length of Field Width of Field S` Depth of, Field /v ` Gravel Bed Thickness (or Square Feet of Absorption Area �'j(�� Standpipes Present 61N) Depression over Field (YA Date of Last Adequacy Test `vl14 Results of Last Adequacy Tbst AJ114- Separation Distance from Absorption Field: To Water -Supply Well } j n 7 ` To Building Foundation -Jo ` Lot V ( /�- ; To Property Line %/ To Existing or Abandoned System cn On Adjoining Lots To Water Main/Service Line /U/,,9 To Cutbank(if present) To Stream/Pond/Lake/cr Major Drainage Course A11A To Driveway, Parking Area, or Vehicle Storage Area WA_ D. LIFT STATION Date Installed Dir ensions 0177 Size in Gallons Manhole/Access (YIN) `L)14 "Pump On" Level at ,U j2+ "Pump Off" Level at High Water Alarm Level at Vent (Y/N) N%f� Tested for '`11A Pumping Cycles during Adequacy Test. Lets MDA Electrical Codes(Y/N) A -)IA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or, confcrmd to all MOA HAA Guidelines in effect on the date of this inspection., % ..•es OF 41��9� Signed v Date 466004,0 Company ���� MOA No. _D 2p� S * a• ERS % a A ••N.0 as ameemae 'm KB1 /d5/s '•�• �. a i e My � C. Reid, in e [Page 2 of 21 w_ 2-15-84