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Home My WebLink AboutT15N R1W SEC 5 LT 100 Municipality of Anchorage Page / of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ,.~'~,) 9/~ 000°/'¢ PID Number: ~'/- D2~ ~/~ N~.~/~ Wastewater System: D New ~Upgrade Address: Phone~,, ~/~ ~ ]No. of B~oms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION soi, Rating: ~, ~ GPO/Sq. Ft. Lot: Block: Subdiv~ion: Depth to pipe boffom from original grade: Gravel depth beneath pipe Township: /5'~ IRange: /]~ IS~iOn: ~ Fill added above original g.de: Gravel length: N From Tan, Reid Station Tank ~wer Lin~ ~9N D/~ Water f/p~ ~ LIFT STATION Lot Size in gallons: ~ Foundation /~' ~0' ~/~ 'Pump on' level at: I'~ IHigh water alarm at: Cu~ainDrain ~/~ ~. ~u~t ~cal Inspections peddled Remarks: BENCH MARK Location and Description: I A~umed Elevation: ENGIN~ SEAL Inspections pedormed by: ~ Dates: 1st 05//?/]~ ¢,"*',"~"""""'~ 72-013 (Rev. 9/91) MOA 25 Permit No. SW960084 Page 2 of 2 Municipolity of AnchoroDe DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box ]96650 · AnchoraDe, Alosko 99519-6650 · Telephone: 5~3-~7zd On-Site Wastewater Disposal System and/or Well Inspection Report LeDal DescriplJon: LOT 100, T15N RIW SEC.5 E PID No.: 051-082-15 LE]T 100 ELL 330,00 N S~/ING TIES: A - C = 81.4 ]3 - C = 92.0 A - D = 97.3 B - D = 90.0 SCALE i' = 60' 50' ROW EASEMENT PIONEER DRIVE ELEVATIONS (NOT TB SCALE) ~-~ ~ssuM£~ £L£v = t0o.0 @ 87,7 MONITOR TUBE SEWER CLEANOUT WELL EASEMENT LEACHFIELD 6/3/96 ENGINEER'S SEAL ,~..".4-DTH ~ '".?~, · .... ~',. LOUIS A. BUTERA ,"~ 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 (UPGRADE) PERMIT PAGE 1 OF 1 PERMIT NUMBER:SW960084 DESIGN ENGINEER:EAGLE RIVER ENGINEERING OWNER NAME:KIMBALL DAVID D & PAMELA J OWNER ADDRESS:P.O. BOX 670893 CHUGIAK,AK. 99567 SERVICES DATE ISSUED: 5/21/96 EXPIRATION DATE: 5/21/97 PARCEL ID:05108215 LEGAL DESCRIPTION: T15N R1W SEC 5 LT 100 LOT SIZE: 108900 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 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 iSSUED By: ~/~ i~/Y~ ~ DATE: O /Z Ea le River En ineerin Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax May 8, 1996 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 100, T15N R1W Section 5 SM Narrative & Permit Application Dear Mr. Cross: The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity and large lot size. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. 1996\96-025A-NAR.DOC WELJ +100' E 1 330.00 I I I LOT 101 ~ LET t00 I VACANT I I ' I I ~ I ~ ,START TRENCH EAST DF I ~ I ~,~. -, /EXCAVATED AREA o ~ I EXISTING TRENCH ~ S~ ', SHALL BE ABANDONED ~ /// /// ~ LOCATIDN OF NE~ / ~ / .~% / ~ &Oz. ~ X 1000 GALLON SEPTIC ~ c~/~(~ .......... ' ~------~--~----~ .............. ~ - TEST HOLE ~ ~ · - MONITOR TUBE LOT 111 X '~X W~L ~oo' iD;2ZZ~ o - SEWER CLEANOUT ~ ~ ...... I + - WELL NO SURFACE WATER ~ 2 :- $~%%%%%TD LEACHFIELD NO KNOWN C~T~N DRAINS N ~ I- EXISTING LEACHFIELD SEPTIC UPGRADE SITE PLAN LEGAL: LOT ~00, T~SN R~W gEC.5 ~... EAGLE ~JV~ ~NGJNEE~ING SE~VJCES ¥~ '.. c[-~73~ ..'~ P.O. ~ox 773294 EAGtE NJVE~, A~. 99577 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST CATE PERFORMED: LEGAL DESCRIPTION: Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 tl 12 IND WATER ELOPE SITE PLAN E L P 13 - Water A~er ~ / Readl PERCOL 14- 15- 16- 17- 18- 19- 20- PERCOLATION RATE I.O(?¢~mrl'(mmnutes/~nch] PERC HOLE DIAMETER -- ¢' $'~, ,, TEST RUN BETWEEN . FT AND FT COMMENTS PBRFORMEDBY: ~ K F~ ~c I ~~~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. CATE; '~ ~5~- ~( 72-008 (Rev. 4/85) EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 96-025 Calculated By: LB Date: 5/8/96 Legal: Lot 100, T15N R1W Sec. 5 Single Family 3 Bedroom Dwelling TEST HOLE Bed Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 450 gallons Percolation rate = 1.1 minutes per inch Wastewater application rate = 0.8 gallons per day per square foot Required absorption area = 563 square feet Bed width (W) = 6 feet Gravel depth (D) = 1 feet Required length = Required absorption area / Bed width Required length = 563 / 6 Required length = 94 feet Total Excavation Depth = 5.0 feet SINGLE FAMILY ON-SITE WORKSHEET ERES PROJECT NUMBER: 96-025 CALCULATED BY: LEGAL DESCRIPTION: Lot 100, T15N R1W Sec. 5 LB NUMBER OF BEDROOMS: 3 WATER USE PER BEDROOM: 150 GALLONS PERCOLATION RATE: 1.1 MINUTES PER INCH DEPTH TO GROUNDWATER: 8.5 FEET DEPTH TO IMPERMEABLE LAYER: 12 FEET USABLE SOIL STRATA ANTICIPATED DEPTH OF COVER: 3 FEET TOTAL USABLE DEPTH: MOUND OR BED SYSTEM USABLE SOIL STRATA DEPTH: 0.8 GAL/SQ.FT 563 SQ.FT WASTEWATER APPLICATION RATE: ABSORPTION AREA REQUIREMENT: MINIMUM BED LENGTH 12 FEET WIDE BED I5 FEET WIDE BED TRENCH SYSTEM WASTEWATER APPLICATION RATE: ABSORPTION AREA REQUIREMENT: SHALLOW TRENCH OPTIONS 5 FEET WIDE TRENCH 4.5 1.5 47 FEET 38 FEET 1.2 GAL/SQ.FT 375 SQ.FT DEEP TRENCH OPTIONS 3 FEET WIDE TRENCH EFFECTIVE REQUIRED TRENCH EFFECTIVE REQUIRED TRENCH DEPTH (FT) ENGTH (FT) DEPTH (FT) ENGTH (FT) 1 66 4 NA 2 NA 4.5 NA 2.5 NA 5 NA 3 NA 5.5 NA 3.5 NA 6 NA 4 NA 7 NA 8 NA 9 NA DESIGN SPECIFICS FIELD SYSTEM: GRAVEL DEPTH: TRENCH OR BED WIDTH: LENGTH: B (B=BED, S=SHALLOWTRENCH & D=DEEP TRENCH) FEET 6 FEET 94 FEET G:~XLSDOCS\1996\96-025.xls SPECIFICATIONS FOR ON-SITE SYSTEM LEGAL: Lot 100, T15N R1W Section 5 05/08/96 A. GENERAL 1. The septic plan is for a single family residence only. 2. The drawing and/or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health (MOA- DHHS requirements. 4. All soil tests are advisory to the design and are to verified or modified in the field by the Engineer. 5. All excavations and depths are advisory and are to be verified in the field by the Contractor to meet MOA-DHHS requirements. 6. It is the responsibility of the Owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7. It is the responsibility of the Contractor to secure all utility locates prior to construction. 8. The excavation is to be exactly in the area shown on the site plan, any deviation requires Engineer approval. 9. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 10. Any remaining open test hole excavations shall be filled. B. SEPTIC TANK 1. Septic tank shall be uncovered and the lid removed to allow inspection of tank integrity and baffle condition. 2. Tank shall be repaired or replaced as per the engineer's instruction. 3. If tank is replaced, current separation distances shall be observed, and tank placed as shown on site plan. C. LEACHFIELD 1. The leachfield is to follow the natural contour to maintain uniform total depth of the bed bottom. 2. The bottom of the leachfield shall be level, plus or minus 1.5". 3. The total depth of the leachfield excavation is not to exceed 5' at any point. 4. The sewer line is to replace the existing sewer line that leads to the existing leaching system. 5. The leach gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the bed is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200' to any conm~unity well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 5' GRAVEL DEPTH = 6"' under pipe, 2" over pipe GRAVEL LENGTH = 100' GRAVEL WIDTH -- 6' SOIL RATING - 0.8 gpd/ft~ BEDROOM CAPACITY = 3 SEPTIC TANK SIZE - 1,000 gallons if required Twenty-four (24) hours notice required for all inspections \1996\96-025a-spc.doc ANCHORAGE AREA BORr"!GH Departmen3t5;f0 ~nuV~roOr n~oeand~ Quality Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION ,/~"2;-'11 ~¢/J,. Z~¢?./A 2~>. LEGAL DESCRIPTION'~-'Tz /~)~'~ .-~"~' .~' ~? Y~. /~.~?ZJ,I '~'/~?. SEPTIC TANK: DISTANCE FROM WELL ~' (~~ MANUFACTURER NUMBER OF COMPARTMENTS / INSIDE LENGTH INSIDE WIDTH -- LIQUID DEPTH LI(~UID CAPACITY/, ~'2~) GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL TOTAL LENGTH FOUNDATION ~-~ NEAREST LOT LINE _-~'-~ OF LINES ~'~ NUMBER OF LINES -~ DISTANCE BETWEEN LINES -- .TRENCH WIDTH '~/~'~ IN. TOTAL EFFECTIVE ABSORPTION AREA ~'~%'-',~;~ SQ. FT. LENGTH OF EACH LINE /¢~ DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE ~ MATERIAL BENEATH TILE .'~ IN. ABOVE TILE WELL: TYPE CONSTRUCTION DEPTH BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE , SEWER LINE TANK , SYSTEM. CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: /~'~.-5'~ .-~ INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL' LOT SLOPE: REMARKS: Form PW*027 DIAGRAM OF SYSTEM U- G]A.A.~. GREA,,-~R ANCHORAGE AREA BOR. JGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT TYPE AND SIZE OF FACtLITY TO SE SERVED NOTE, THI,,~ F~RMIT I$ .NOT VALID WITHOUT ~OIL T~BT PFRMIT VAI Iff 0NF YFAR FINAL INSPEGTION~ 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOL~T FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. · / 6/ MINIMUM DIBTANCE$, REQUIREMENTS 5 ~. FOUNDATION TO SEEPAGE FIT 20 f'~ , DRAIN FIELD -- ].0 DIAGRAM OF BYS'r~M i SEPTIC TAN]'( TO SEEPAGE PIT WALl- 15 SEPT.c TA.K 5 ,f~. SEEP^CE PIT 20 ~t WATER MAIN TO SEPTIC TANK 10 DRA]N ~IELD 10 ft. · DRAIN ~IELD .10 ALSO CONSIDER AREA WE~S. SEPTIC TANK, 25 fie SEEPAGE PIT 100 f%e , DRAIN FIELD _50 ft. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANE Abed SE_EPAGE PiT GRAVEL. BACKFILL I CERTIFY HAT I AM FAMILIAR WITH THE REQUIREMENTS OF (~EEATER CHORAGE AREA ~OROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE L DRILLING COMPANY OF ............................................. DRA~, "OW" ~ ....................... ZD~ ~s. ~ ~ ..................... ~ b ~ IND OF FORMATION: .................... ~ FROM ......................... FT. ,~o~ ........... ~ ......... FT. TO..../.~ ......... 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FT ......................................... FROM ........................ FT. 'ROM ........................ FT. TO .......................... FT ........................................ FROM .......................... FT. :ROM .......................... FT. TO ......................... FT ......................................... FROM .......................... FT. TO ......................... FT ............................ TO .......................... FT .............................. TO .......................... FT ............................. TO .......................... FT ................................. TO .......................... FT ....................... TO ....................... FT .................................. TO .......................... F'I' ................................... TO .......................... FT ............................... TO ......................... FT .................... TO .......................... FT ................................ TO ......................... FT ........................... TO .......................... FT ................................ MUNICIPALITY OF ANCHOI~Ot] DEPT. OF HEALTH & ENVIRONMENTAl- PROTECTION MAY 2 8 1985 RECEIVED ,~!msg NOTE: ndividual ~.,on-site Holding tank ' Oommunit¥ on-site Public sewer 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 STATEMENT OF INSPECTION. BY ENGINEER .... As certified by my seal affixed hereto and as of the validation date shown below, I verify that my invest gat on Of this Health Authority Approval application shows that the on-site water suppl~ 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.~. _ . Municipal anc 'supply and/or ~ =astewater d~isposal system is in compliance with all State codes, '. Ordinances, apd regulati~-~'in ~ffec:~ O~ ~he date of ihi~ inspection. 'i' ':' " ~,!¢. ~' '. :.,'~;.~;:¢,?/" ?"':i.'~;.':':~'!..:": ';;-'-. ' '.".' -.: ." '"' ~ ', ~,,~ .=~,,= :" Name of Firrd'Eagle River' Ez~gzz~eerJ.~g Se~clces Phone Address ',P.o. Eox.773294. Eac~le'Rlver, ~ 99577 / 6 DHHS sIGNATuRE '~':,: · ''"': - -'.?~: ~ ,~- Approved fort....- .-" ..bedrooms. : '. :..' . ~ · -.~ -.': '.." ~.i..'.C0nd~t~onal approval for ..... bedrooms, w~th the following sbpulahons: :, Date 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 th~s as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspectionsi or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engine,¢-~'s work. Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICES R E C E IV E Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744dUN 5 1991 Municipality of Anchorage Dept. Health & Human Services Health Authority Approval Checklist 051- Legal Description: A. WELL DATA Well type Log pres·ut (Y/N) Total depth // Saaitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform sample: 0 Date of If A, B. or C. attach ADEC letter. ADEC water system mtmber Date completed ~,.~.//z// Cased to / Z~ {~v ' Casing height (above ground) ~'~5 Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION /'~ g.p.m, q, 3~'' g.p.m. Nitrate 0, / ~&//"- Other bacteria Collected by: B. SEPTIC/HOLD~qG TANK DATA Date installed ~/7~/~- Tank size Foundation cleanout (Y/N) ~ ti * ~' s~,, Depression (Y/N) Date of Pumping ~¢~//~ ~ Pumper C. ABSORPTION FIELD DATA Date installed Length /~O / Width Number of Compartments / Cleanouts (Y/N) ~///~ High water alarm (Y/N) Soil rating 2 ~ (g.p.d./fi c ....... m) t~, ~ System type ~,~ / Gravel thickness below pipe t/~ // Total depth Effective absorption area &fro/~ Monitoring Tube present(Y/N)_ fib'-% Depression over field (Y/N) /'lin - Date of adequacy test .A/~ Results (Pass/Fail) /9~ For .~ bedrooms F~re test (in.); Immediately afte~ gaI. water added (in.): Peroxide treatment (past 12 months) (Y/N) If yes, give date' LIFT STATION Date installed Manhole/Access (Y/N) "Pujup4ylI level at* High water alarm level at*_,~~'~ *Datum Cycle,.sJested~ Size in gallon_s ~ "Pump off' level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic3hok~g tauk ou lot ~ / Absorption field ou lot /~ tO ' Public sewer maill /~///~ 8~/septic se~ice liue ~G /HxzTq£z-f): On adjacent lots ; On adjacent lots '~/~0 / Public sewer manhole/cleauout ~//~ Li~ statiou /~/~ SEPARATION DISTANCES FROM SEPTIC/f-fOLDInG TANK ON LOT TO: Building foundation / ~" Property line 7* ~ ~ / Absorption field Water-maflffservice line ,Z] 0 ~ Surface water/drainage ?~/DO / Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Buildiug foundation [pt9 / Water maiWservice line Surface water ~/69 O Curtaiu drain // P l~/~ £t~ h/'7- Drive~w~y, parking/vehicle storage area ~) Wells on adjacent lots /-/00 Property line F. ENGINEER'S CERTIFICATION I certify t/tat 1 have detemnined thrufield inspections and review o in conformance with MOA HAA guidelines in effect on this date. Signature ~< -. ~+~> Engineer's Name Date HAA Fee $ ~. t,4) Waiver Fee $ Date of Payment b/~"---'/Y,,~ Date of Paymeut Receipt Nunlber / ?t/' 0 ~/~,.~,~'~) Receipt Number Rev. 8/95 OSS: haa.wk.doc A. WELL DATA Well Classification Well Log Present{~) · Total Depth / '¢"~' MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL ~'HA~{tUNI¢IPAUTY OF ANCHOP.~GE · '~J DEPT. OF H~L~ & CHECKLIST - FEBRUARY 1984 E~I~ONMENT~ PROTE~I~. 264-4720 LegalDescription: ~,~ /~ 2~ ~, ' C i_v.c , ~"/~, IfA, B, C, D.E.C. Approved (Y/N) Date Com ~pleted .~. i,,¢F . t~ _~ Yield Cased to /'/~L''5~ Depth of Grouting Static Water Level Z?i¢ ¢ Pump Set At Casing Height Above Ground / ~ ¢' Sanitary Seal on CasingS) Electrical Wiring in Conduit(~N) Depression Around Wellhead (Y~ Separation Distances from Well: To Septic/Mold=.~,G Tank on Lot f~(~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /E)O ¢ ; On Adjoining Lots To Nearest Public Sewer Line "¢//~ To Nearest Public Sewer Cleanout/Manhole ¢'J~. To Nearest Sewer Service Line on Lot Water Sample Collected by ~ ¢¢' ~ '~/L~)~--=~"~-/AJ4 ; Date Water Sample Test Results Comments /& '~/~ /~:~/~£~'v,./ '7-~--~ ~'¢¢l~J~__.P~ "7'7-~¢ B. SEPTIC/IICLD;;,;G-TANK DATA Date Installed ~" Standpipesl~N) ~ Depression over Tank (YO Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~/~' Size Air-tight Cap,~N) No. of Compartments · ' / Foundation cieanout (Y~. Date Last Pumped ~-~ ~-~'-- '~'.i~ · ; for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/14el~4:u~Tank: To Water-Supply Well To Property Line To Water Main/Service Lii~e '"~ ~ I'~ Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 9f 2 72 026(11/84} ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/ ~ ~C) ~ '"~ Width of Field : ,::~(x.~ ~ Square Feet of Ab. sorpfion Area Depression over Field (Y~'~) Results of Last Adequacy Test Separation Distance from Absorption Field: TO Water-Supply Well /Oft,-3 / TO Building Foundation ' '~"~ ~'~ Lot Type of System Design Length of Field ~¢~'~ Depth of Field ~¢' / Gravel Bed Thickness ,.~¢, 6, Standpipes Present (Y,(~. Date of Last Adequacy Test To Water ~/Service Line ~...%. I.~ 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 '"~ L~ 14- TO Cu/tbank (if present) '~'-'~/fl/ 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 I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed __ Date ':~' /~" ~"/~:~ ~ Company ~ ~),~:~l~ MOA No. 0~2 ~ Date of Payment ~-~%-%~ Amount: $ ~ ,~ . Page 2 of 2 ,~,,, 72-026(11/84) =0, 6~4 ~297 biO. 0~0~/~6 15:05 CT~E ESi ANO~CRAGE -~ ~ o C T&E Environmental Services In c, Laboratory Division :~'~'~'.ar.e'.,~.~'~r.e;ar.e;er~.~a-.~..~t.~jfi~j~jj~jj~jj~ Drinking Water Analysis Report for Total Coliform Bacteria ~oo w. ~o.~ o.~ Anchorage, AK 99~18-1605 READ IIV37TRUCTIO!VS ON ~'~E 31DE REFO~ COLLECThVG ~PL~ Tel: (~O7} 562-2343 Ntonth Day Year RouE TYPE: tine 121 Treated ~,¥a to r Time CoUected S.A&IPLE LOCATION Collected By [or/go Fax: (9071 561-~30~ TO BE COMPLETED BY LABORATORY A~lalys/s shows Ibis Water SA~MPLE to ~i Sa~ia ~cto~ o Un~tisfacwry O Sample over 30 hours old, resulu ma7 be uneetiab[e Sample too long in ~ait; sample should not be over 48 hou~ old at examlnat{on to indicate reliable r~auJls. Please send n~w $a~p[~ via special delivery ~ail. Date Received ~ S/~ ~me Received ~. ~ J An~l)'si~ Beg~n I A.al?~ienl Method: ..~/Men'lbrane Fikcr [3 MMO-MUG * Number ole colonies/100 Client no/ifle~ of un~n/isE~cto~ results: BACTEP, ffOLOGICAL WATER ANALYSIS RECORD Total Coliform £, Colt 3[embrane Filter: Direct Count '¢eriflcation: LTB Fecal Coliform Confirmation BGB ~'~ ._ Coloni,l{tIO0 mi COLIFIROt · -- ON~, ~. 06,"0~/96 tS;~ CTEE ESI PNCH~R~~ 90? 694 329? N~.~'~! g03 CT&E Environmental Services Inc. Laboratory Division ' Laboratory Analysis Report Collec/ed Date 0~131196 Tech~ca| Director; Stephen C. Ede 200 W. Potter Drive, Anchorage, AK 99518-1EOB -- Teh (907) 5§2-23~3 Fax: (907) 561-5301 :)180 Pager Road, F~irbanks, AK 99709-5471 -- Tel: {007) 474-8856 Fax: (907} 474-9005 ENVIRONMENTAL ~^CIiJTIE$ IN ALAgKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND. MICHIGAN. MIS$O[JRI. NEW JERSEY, OHIO. WEST MUNICIPALITY OF ANCHORAGE /-''~ DIVISION 0P ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE General Information Application Date (a) LeEal Description (include lot, block, subdivision, section, township, ra~e) Location, (~ddress or direc~io~) ~ ~r (c> Applicant is (chec~ one) Le~ing Institution ~; ~er/b~lde%~ i Buyer ~ ; Other ~ (=plalu); ' ' (d) Lending Institution Address (e) Reel Estate Co. & Agent Address el pbone 6 ? Telephone 2. Type of Residence N~ber of Bedrooms Other (describe) 3. Water Supply Individual Well~ CommuniTy Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality au~ status. 4. Sewage Disposal 0nsite,~ Public ~ Community ~--~ Holding Tank ~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. En$ineerin~ Firm Providin~ Ins~ections~ Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shpwn below, I verify that my investigat~on of' this Health Authority Approval shows that the on-si~e water supply amd/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and ~ype of structure indicated herein.- I further verify that, based on the information obtained from the Muni~ipality of Anchorage files and from my investigation.and inspection, the on-site water supply and/or ~rastewater disposal system is in cempliance with all ~untcipel and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Telephone Address Date ............. :------~ /L~/~ ~ Agproved ~ Disapproved -- Ta~s of Co~i~ou~ Approv~ CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF I~ALTH AND ENVIRONMENTAL PROTECTION (Dill[P) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN P/ERAGI~ 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN '£u~ STATE OF ALASKA. TU/I DHEP DOES THIS AS A COURTESY TO PURCHASERs OF HOMES AND '£it~rR DENDING LNSTITUTIONS 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 ~ PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) KR4/e3/D18 [Page 2 of 2] 7-19-84 HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER . . 5633 B Street , . "~':.~ Drinking Water Analysis Report for Total Coliform~Bacteria ' TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: (*) See h on back I.D. NO. Water System Name . . - Phone No. SAMPLE TYPE: ~Routlne I-I Check Sample (for murine sample with lab ref. no. I-I Special Purpose 'zip Code ' ' Treated Water ..~treated .Water SAMPLE NO. LOCATION r' Time Collected Collected J 1 ] TO BE COMPLETED BY,LABORATORY Analysis shows this Water SAMPLE.Fo be: ~Satisfactory [] 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. ',Date Received :Time Received Analytical Method: [] Fermentation Tube ' A~Membrane Filter Lab Ref. No. · :Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE .BACTERIOLOGICA1 WATER ANALYSIS RECORD Membrane Filter. Direct Count Verification: LTB Final Membrane Filter Results Reported By ~" Collformll00ml BGB__ Collformll00ml Time: / (;"-0 C) a.m. TNTC= Too Numerous To Count