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Home My WebLink AboutT15N R1W SEC 9 LT 142 MUNICIPALITY OF ANCHORAGE D£ ,RTMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name ~"~ ~/'~ ~?~. ~r (~ ~"~ -'~,J---~- ~ D~STANCES ~ SEPTIC ABSORPTION ~ ~ ~. ~ L[ ~[~ ~ TANK FIELD WELL 7 LOT LINE I + 7 LEGAL DESCRIPTION ' FOUNDATION ~l ~ Townsgip. Range, Section AS-BUILT DIAGRAM (Show Iocabon ol Well septic system, p~opedy hnes, loundahon, TANKS N Capacity m gallons Material N~ of Compartments TYPE OF SYSTEM ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER ~eptg tO p~pe bottom Irom ~otal depth lrom original grade original grade ~ FT ~, ~ FT FJa added above original grade Grovel deptg benemh pipe Gravel lel~ggl Gravel wldtg Total ab~rptl~n~rea .......... Distance between lines ,2 ~J WELLS +'~ ~ PRIVATE OTHER fldentifvI Cla~ ~f~-~t~o~{~,B,~'~'~ lotal Depth Cased Io ~ ~ ' ET ~0~ q~ ~ FT ~ I~ - ~ ~' J ( ~ ~ cedify Ihat tills inspection was pedormed according to all ~ % R~d D, ~llllflg Mugicipal and Slate BuidelJnes ie ellect 0n this date: ~~~~v.~¢~.,,~.:~,%% CE' 1411 72 013 (3/85) E125 L SFF:EET, ANC['K)RA[~E~ AK 995():1 t..l::.l..I.tl I tq[]l~ 86"4( 8 UI I:l ADI:. DA]'E I SSUIED~ .I..I., ....... I~ I...E[.:}AL. DESK:',I::t J: I::':S.~E D :1: V I S I (:Iix{: NA I...[)T = BEN oI::.L, I1UN~ TOWNSHIP: 15N RANGE: 1W ........ A (SQ,,I='T, OR ACRES) I-.. 0 T' ,..~ .I. ~..I ...... " LI-L)L,I .... NA 1,, I am fam:il:i, ar w:PLh the r'(0qu:Lr'er~er'rlLs for' for'th by t. he MLu'J:J.c:il:)ality c:)f Arn=hor'age (MOA) arid the State of' Alaska.. ?., ]: v~J.].], ir'l!i~it~'a].] 'k.h(::.) ~i~;ys'k.(~:~iil Jr1 acc:or'dance wiLh all I'"'I[]A codes arid pegu].a'Lioi~s, and in compliar~c~z.s, w:iLh the dc..~s:kgn c:r'iter':i.a of this per'mit. 3,. I wi:I.l adher'e t.c, all MC)A ar]c] ~}!;'t.a't.(~-} c:)t ~].;:tsl{~:~t r'equir'emer'~ts for' the ~ie'k. back ~ewc,.u"ag0:, system on 'Lhis or arw adjacent of near'by lot. I1= A I....II=-T S'IAI':I:OI,,t IS INS'TALLIED IN AN AF:tEA C;OVIE]:~ED BY I"tOA BU:£LDINIB CC)DIEiS!, f't'IEN ( :}. ) AN I!ii:L.I!SiC.t'T R ]: CAL PERM :l: "1' AND I NSPEC I" '.}: []l',l MUST' EIE OB'T'A I 1",IISE:D; (,?) AS-BU I L.]'S NIL.L I".IOT BIS APPROVE:.D N:t:THOU]" AN I'!!:LECTI::;:ICAL INSI='ECTI[]N REPORT!I AND (3) 'I'HF!!: Ii~LIECTRIC:AL.. WOI::i:I<: MUST BE DOI",I!:i}: :~)Y A LI[:;lili:I',I!:iilZD EL.IJ~]]TRICIAN. AF'I::'L I CANT': ROEIEF;:T' SCH I L.L I NG ;549-5552 (Office) AREA ENGINEERING 1207 E. T4thAve. Suite 20.% Anchorages Alaska 99518 562-2161 Ext. 58:5 (Message) October 31, 1986 Subject: Septic System Inspection, BLM Lot 142, Located In Sec 9, T15N, R1W, S.M. (North Birchwood) On October 25, 1986, I inspected the septic system located on the subject property to ascertain its condition and to determine what, if any, remedial measures would be required. The existing dwelling is a 4-bedroom log house in relatively good condition and undergoing some corrective foundation repairs and drainage improvements to the lot. The existing septic facilities consist of 4" cast iron house drain into a lift station located about 20' from the NE corner of the house. The invert of the house drain is about 9' below the ground surface and discharges into a 24" CMP-tyoe lift station. The bottom of the lift station was about 4' below the drain line invert but it was not possible to determine the nature o¢ the bottom due to a dense layer of sludge. The lift station discharge line is a 2" line buried at about 4' depth and connected by reducer to a 1250-gallon, 2-compartment, steel septic tank, which had recently been pumped. The tank had been exposed to determine its condition. The tank was found to be in good condition, and is equipped with a capped standpipe on each access cover. The tank outlet is connected to about lO' of 4" PVC pioe which then connects to the 4" perf. PVC drainoiDe of the absorption field. The drainfield is a bed of about 40' by 40', with a standpipe located at each outside corner. An adequacy flow test of the drainfield was conducted by introducing approximately 0.75 gum of water into the cleanout located about 2' downflow of the septic tank. After about 2 hours, there was no evidence of backflow into the tank, and it was concluded that the drain- field is in adequate condition for normal usage by a 4-BR dwelling. CONCLUSIONS AND RECOMMENDATIONS: 1. The existing drainfield is adequate for a 4-BR dwelling. 2 o The drainfield was noted to have only about 3' cover over its western half and it is recommended that additional cover be added to give a minimum of 4' cover. Tbe lift station is located about 89' from the well and also does not. aopear to be equipped with a grinder. It is recommended that the lift station and septic tank be removed and replaced with a 1500-gallon combination tank-lift station and located -1- 549-5552 (Office) AREA ENGINEERING 1207 E. 74th Ave. Suite 20:5 Anchorage, Alaska 99518 56Z-2161 Ext. 583 (Message) about where the existing septic tank is in order to assure the required 100' separation from the well. The existing seotic tank is salvageable and with some cleanun and coating repairs, could be re-used. Another option would be to re-locate the existing tank to a lower elevation and then install a new lift station of current standard design downflow of the tank. Either of these options would work and the choice could be based on cost com- oarision. A quick check with Anchorage Tank & Welding shows that the integral tank-lift station option would be cheaper by about $700 when considering the salvage value of the existing septic tank. There could also be some savings realized when considering this option's lesser excavation and line fittings. The DHEP records on the existing system were not available at the time of this report and thus the adequacy of the well is not known. If a well log and yield are not available, a flow test and water quality test will have to be done prior to HAA submittal. If there are any questions concerning these findings and recommenda- tions, please contact me at your convenience at 349-5552. Robert D. Schilling, P.E. -2- 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 N'AME PHONE MAILING ADDRESS U I LEGAL DESCRIPTION ~ LOCATION NO, OF BEDROOMS Manufacturer Material No. of compartments Liq. capacity in gallons I F HOMEMADE: Inside length Width Liquid depth ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO, ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO. ~ ~ No. of lines Length of each line Total length of lines Trench width Distance between lines ~ inches ~ -- Top of tile to finish grade Material beneath tile Total effective absorption area ~ ~V~c cf ;.~b C~t.r C~b d~mh Total .ffective ~bsomtion area m Well ~uilding foundation Nearest lot line ~ DISTANCE TO: ~[0' ~[0 t ~ Class Depth Driller Distance to lot line PERMIT NO, ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARK~ ~ APPROVED DATE LEGAL PERMIT NO. I ¢; I F-~tL I T'~' OF FIN~SH "',RFtGE DEF'BRTMENT L HEBLTH 8ND ENVIRONMENTBL . ..OTECTION 825 '"L' STREET, 8NCHORBGE.. BK. ~9501 264-4720 C~--S I TE SE~ER PER,'1 I T 82~19G ) E,O~-, D CHUGIRK RK. LOT SIZE ' ' C' - - '= P' HPFLI_.HNT STEVENS ~KBG3S CoN_.T. 0. LOC~TION LEGflL LOT i42., =,EC 9, TiSN., RtW TYPE OF SOIL HB_,uRFTIuN SYSTEM IS MRF',IMUM NUMBER OF BEDROOMS = ]: SOIL RRTING (SQ FT?BR)= _?..~LO THE REQUIRED _IZE OF THE SOIL flBSO - SY- ~Z~2~,~_~ g. EPTH= e~ LENGTH= 112 GRBVEL ~EPTH= 4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET;' OF THE TRENCH OR DR~INFIELD. THE DEPTH OF ~ TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFACE OF THE GROUND ~ND THE BOTTOM OF THE EXCAVATION (IN FEET). THE TREr~mgH ~4I[)I'H IS 5. ~300 FEET, THE ~VEL DEPTH I~ THE MINIMUM DEPTH OF bR~VEL BETWEEN THE OUTF~LL PIPE 8N[:, T~ BOTTOM O[/~HE.,E?~CRVRTION (IN FEET:>. REQ~ ~¢F:ED SEPTIC T~NK SIZE= 1088 G~LLON:q PERMIT ~PPLIC~NT H~S THE RESPONSIBILITY TO INFORM THIS DEP~RTMENT DURING THE INST~LL~TION INSPECTIONS OF ~NV WELLS ~D..T~CENT TO THIS PROPERTY ~ND THE NUMBER OF RESIDENCES THaT THE HELL WILL SERVE. T~IC~ .C 23~ I NSPE~3T I O~-~S 8RE REQL~ I RED 8~CKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND ~PPROV~L B~ THIS DEP~RTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS ±00 FEET FOR 8 PRIVRTE WELL OR t50 TO 200 FEET FROM R PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC HELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO 8 COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS WRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS 8RE RVRILRBLE TO INSURE PROPER INSTRLLRTION. ~.~ ~ ~' ~82 PER~'IlT E.-.PIRE--. [~EE:EMBER ~-. I _.ERTIF¢ THRT _,EHER_ RND WELLS R--, SET l: I RM FRMILIRR HITH THE REQUIREMENTS FOR ON-SITE '= ' "-~ " FORTH BY THE MUNICIPRLITY OF RNCHORR~E. >'.: I WILL INSTILL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ]~: I UNDERST~N[:' THRT THE ON-SITE SEWER SYSTEM WRY REQUIRE ENLRRGEMENT RESI[:,ENCE I~ ~EMODE~ TO INCLUDE MORE THRN 3 BE[:,R. OOMS.~ , ~ , ~F~I~NT STE~'SK~GGS CONST. ~ __' ~/ ISSUED B' ' / V4. 0 O & E ENG,NEERING & DEVELO, ~VlENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: SOIL LOG Name:.'~'T~--~//~'=/¥' /~, '~/~/qo_~.~.~' Tel. No, Earl Ellis 688-2280 LegalDescription: LoT' /z~. / ~a, ~x 7-/-~-,&// /~/~-/, '~ '///~' Depth (feet) Soil Characteristic8 0 3__ 4__ 5__ 7__ 8__ 9__ 10 11__ 12__ 13__ 14__ 15__ 16__ Ground Water Encountered: Yes ~, --...?,,,:1, No~ If yes, what depth PLOT PLAN PERC. TEST Proposed Installation: Seepage Pit Drain Field Comments: p~/Z.c¥ '~-~-7- V',q~./z3 ,~9/Z. o/,.% H Date: GRFATER ANCHORAGE AREA BOROP"~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: NUMBER OF COMPARTMENTS DISTANCE FROM WELL ~'Or MATERIAl LIQUID CAPACITY i/ ~ GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PllS J OUTSIDE DIAMETER OR WIDTH ~'~ LENGTH .~1 , DEPTH LINING MATERIA[ ~ ~z~ . DISTANCE PROM WELl /O~;~ ! BUILD;NG FOUNDATION-- NEAREST LOT LiNF //VoF C/.-.O~,~ TOTAL EFFECTIVE ABSORPilON AREA (WALL AREA) ~'--v. ~'~7,~ SQ. FT. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL , FOUNDATION_ NEAREST LOI LI , OF LINES - NUMBE IST ABSORP~ AREA ~u~. rh L~u~n ur ~t~b .... DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATER AL BENEATH TILE IN. ABOVE TILE-- O,B, ANCEEROM Zr' WA,ER WELL: TYPE , DEPTH ,BUILDING FOUNDATION. SAMPLE , NEAREST '? NEAREST ? SEPTIC ~ SEEPAGE /~0# OTHER LOT LINE " , SEWER LINE ~ ,TANK , SYSTEM , CESSPOOL '~ , SOURCES DISTANCES: DATE DIAGRAM OF SYSTEM P ,% H EAL]H AUIHORIIY · GAAB-H D-2 GREATEL ANCHORAGE AREA , {)ROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case No. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT RESIDENCE ADDRES~, ~D~'I [~1, (.['l ~,,,~e)~ LOCATION OF INSTALLATION APPLICATION TO INSTALL: SEPTIC TANK ~,/ , SEEPAGE PIT / , DRAIN FIELD , OTHER TO SERVE THE FOLLOWIN6 FACILITY ,~ b~ ~,~-) ~) ,~ TEST RESULTS~///~ANTICIPATED DATE OF COMPLETION ,'2 BEL~~ TO BE FILLED OUT BY HEALTH DEPAHTMENT THIS IS TO SERVE AS /~ F, -.. r C , PERMIT TO INSTALL A ~'~&c2~.~ DISTANCES: Health Authority AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ,'~ '~ ~/~A · SEPTIC TANK SIZE/~-/?~C) r/" fl/TYPE'~'' "" ,~/~'. L~-/. SEEPAGE AREA ~- [~ ~? TYPE - / DIAGRAM OF SYSTEM I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE APPLICANTS SIGNATU RE ./,~/~ f~. 7). F./~t x.~. ? r.~il ~ (tREATER ANCHORAGE AREA BOROUGH HEALTH DEPAkTMENT 327 EAGLE STREET ANCHORAGE, ALASKA 99501 CAS~ # Depth Feet Was Ground Watev Encountered? If Yes, At Wha~ Depth Date GPoss Time Net Time Location Sketch Reading Depth To HsO Net Drop P~oposed Instal~Seepage Pit ~ Drain Field Depth Of Inlet ~v'~-x ,._ ~. ~ , ~-/-.~ uep~n ro Bottom 0f'~it Or TPenc~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES D ViSlO. OF E.V, RO.ME.TA' SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL /~Jg"~- ,("~) ~ OF ON-SITE SEWER AND WATER FACILITY 264-4744 · . .... Apphcat~on Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner ~,~.~_/~-.~.~,.~eJephone. Home Mailing Address Business (c) Lending Institution ~-"~'~"~f-"'~-~' Telephone (d) Address /¢~ Telephone (e) Mail the HAA to the followina address: or: Check here ~, if hold for pick up. List contact person and day phone number below. 17034 Eagle River Loop Road Rag · River, Alesks 99577 TYPE OF RESIDENCE Single-Family []' Number of Bedrooms WATER SUPPLY Individual Weli/~ Community [] Public [] .. ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legaJity and status. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 77-025 IRev 8/86/Fronl 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 S & S ENGINEERING 17034 Eagle RIYer Loop Read No. 2U4 Date 6. DHHS APPROVAL Approved for Terms of Conditional ApCroval bedrooms by Date Disapproved Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev 8/861 Back ~¥'Vell Classifi,~L_'~ __ Well Log Present (Y/~ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: Total Depth c¢O ~'¢ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit(~4) Separation Distances from Well: To Septic/H~Mfng Tank on Lot Cased to ¢~, If A, B, C, D.E.C. Approved (Y/N) Date Completed /4r..c,~/~o~( /~'=/-c~ Yield Depth of Grouting Pump Set At C~ I~--- Sanitary Seal on Casing ~)/N) Depression Around Wellhead (Y~ To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line f'~//¢ To Nearest Public Sewer Cleanout/Manhole '~J/z~ To Nearest Sewer Service Line on Lot ~-~ /'f' Water Sample Collected by ~ ,4---.~ ,~_,,.~i.~,,,,,'~-.'"'.-'",'Z~,~t..~ ; Date ///10/~ Water Sample Test Results ,~'~Y~r~'-;"~,~'~J'z~/y ~ A-~II~'F'~-~.¢"~ ~ ~,,~¢-,. Comments \,,~/-~.~c_ ~//z~_,~ /"~--'~/'"~.~,e.~4~.~ I[~1[_.~-~ IC'-O~.- ~-~H~>. SEPTIC/HOLDING TANK DATA Date Installed/~:~:~ /z.-&~-~8~.Size Standpipes ((.~, N) Air-tight Cap§ ~'~VN) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) '~"/f~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course / ~o ,=, No. of Compartments Foundation Cleanout ~'/N) Date Last Pumped // /~//'~-- ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ~'~ To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026 IRev 8/861 Fronl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~- ' Width of Field Square Feet of Absorption Area Depression over Field (Y,~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~O To Building Foundation ~$ ~ Lot [0/4 To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design 5~"~-~1~"~bc~ Length of Field ~1 Depth of Field '~' ' Gravel Bed Thickness c, Standpipes Present ~'N) Date of Last Adequacy Test / / -/o - ~ ~- To Property Line /D To Existing or Abandoned System on ; On Adjoining Lots ~O/~ To Cutbank (if present) ~-f/~ Comments D. LIFT STATION Date Installed %~,'-* ,~'n*4 -~ ,~=~"¢~ Size in Gallons ~ ~ I "Pump On" Level at ~-JZ,' High Water Alarm Level at L/~,. Tested for L~ Electrical Codes (Y/N) '%J//~ Dimensions ,4~.~c~/¢4~.~E. ~',~.~- /~.5-'12, ~,~g. Manhole/Access (:~N) "Pump Off" Level at ~ '~ ' Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments /~J~-/~' z~Jz~. /~'C,~L ** Check Permitted Bedroom Bating 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. Com~ River, Alask. ~577 MOA No.- Receipt No. /~ ~ / O d 0~ Date of Payment Amount: $ ~¢ ~ Page 2 of 2 72 026 fRev 8/R6) Back GEOLOGICAL LABORATORIES OF ALASKA, INC. ~~?~ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 ~..~..~ FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE C{ient PO~ : VERBAL Req ~: Client ~npl lot LId2, SEC 9 TISH R.W, 11-10-87 Ordered By : Send Reports To: 17034 EAGLE RIVER LOOP RD., ~204 EAGLE RIVER, AK. 99577 Work Order No, : 3865 Client Account : SNSENOP Date Report Printed: ~OV 12 87 9 16:2~ Released ~y : 2 Reports Address ~2 Special Instruct: Samp].ed by JPI' ]].-1 )-~' 7 (!llg~O hou'r'$o Chemtab Ref (h 0303 Lab 8mpI iD: I ~atri×~ Water AilowaDle Paralne~er Te~ed Reuult/Unit~ Hethod Limit~ Remarks: A~AL¥SIS COMPLETED: 1i-il-87 LABORATORY SUPeRViSOR: STEPII~t C. gDE g, gZ~ (5' ~[<-~- i'rests Ber/ormed . See Special Instructions Above ~IU= Hone {)erected ,* See Sample Remarks Above HA= Hnt Analyzed LT=Less Thao. OT=Oreater Than 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/~ ~'~ Telephone: Home ~- Applicant Address ~ ~ ~ ~ ~[* (c) Applicant is (check one): Lending Institutionj~'; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address (f) Telephone Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Well~]~ Community [] Public [] Individual 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 (11/84) 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 F rm,.,~.cc'-~ ~--~'~.~ ~ ~ ~'~-~w ~ Telephone Address ~'~O ~--~,.~ '~_'~l ~ ~-/~--J /'~'~-~-,-- ~ Date / / ~ ~' ~ '-'~ ~ DHEP APPROVAL Approved ~ '~"~ Disapproved Conditional ~-_ , . ~ ~.~ ~ ?:;_-__-- ,..*=.,,,' ...,,,- Terms of Conditional Approval ~'"~ -, -'*- ~.-..---.~- F..'~-,- /.- ,~_~:_..,~. ~_.¢,...-,,.- Engineer's Seal ,,. oF AL Date /~-~--~ zr ~ CAUTION / , The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval cedificates 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 72-025 (11/84) WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1964 264-4720 Legal Description: t"4~L l~t !..off ~¥t~i~l~,lr~.ll¥ OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ,/~ Date Completed /~,'~' - /??.)~- Yield Total Depth '¢'""- Cased to ,,~ ,5- Depth of Grouting Static Water Level ~z.,z:~ Pump Set At '~-'-' Sanitary Seal on Casing (Y/N) ~._~% ~/&"~'~"~, Depression Around Wellhead (Y/N) ; On Adjoining Lots / ~ ~'- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by '"'-' To Nearest Public Sewer ~ To Nearest Sewer Service Line on Lot '"- /~ I~ ("-'.~"''~i,~'.",- ;Date Il Water Sample Test Results Comments :2F't-'~ 'J¢-~"/- S. SEPTIC/HOLDING TANK DATA Size Date Installed Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) "-~' Separation Distances from Septic/Holding Tank: To Water-Supply Well ./,~. To Property Line To Water Main/Service Line No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation -~'/ To Disposal Field / ~ To Stream, Pond, Lake, or MajOr Drainage Course Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'Z-- ~ ~ .- ¢'-'~-- Width of Field '~ I 3?,= Square Feet of Absorpuon Area / ~q-'~( Depression over Field (Y/N) ~ Results of Last Adequacy Test Separation Distance from Absorpuon Field: To Water-Supply Well ,/"~'-~'-- To Building Foundation Lot ,/o,-- To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parkin§ Area, or Vehicle Storage Area Type of System Design Length of Field .~ Depth of Field ~ ' ~- Gravel Bed Thickness ~, 3 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) ~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level Tested for Electrical Codes (Y/N) Dimens(ons Manhole/Access fY/N) Pump Off" Level at Vent (Y/N) Pumping Cycles eurlng Adequacy Test. Meets MOA Signed / ."~/.~~ Date Company?~CZ2~"~JL'~?'. "~r~'~"'"~j MOA NO. Receipt No. ,~c~:)/ 4¢~'~/~ Date of Payment /~//Zg Amount: $ ~ ~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines m effect on the date of this i nspecuor Page 2 of 2 72r026 (11/84) Engineer s Seal [ I APPLIC NT FILLS OUT UPPER HAL' ONLY Property Owner /.~I ''~" ~ ' Phone Lending Institution ~Z~ E/~ ~, ~: ~, Phone TIpe of Resi~nce ~Multlple Family No. of Bedroom~ ~ Community For Wells drilled prior to that date, give well depth (attach log I, available)./ ~lndivldual Year Indlv~ual Installed: Time Time Time Date Date Date Inspector Inspector Inspector ) DISAPPROV~D CONDITIONAL APPROVAL* Inspector II~)m, oJd lelu~muOJ~A~ ,,~u¥ lo fqffedlOlUfl~l,, £g6l ~0 *CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well To Absorption Ares Well Log Received Septic Tank Size P.O, BOX 754 E/\GL.E RIVER, ALASKA 99577 (907) 694-2131 April 8, 1983 Darrel Daley P.O. Box 108 Chugiak, Alaska 99577 Subject: Lot 142 Sec. 9 T15N, R2W Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: Exposed electrical wires to the well head are in violation of the Municipality of Anchorage codes' and must be encased in conduit. The septic tank p~nped with a receipt submitted to this department. The total number of gallons, pm~oed need to be on the receipt and verified by a registered engineer as to the actual number of gallons p~ped. This is to verify the size of the septic tank. Please notify this department for a reinspection when the noted descrepancies have been corrected. If there are any further questions, please call this office at 694-2131. Les Buchholz, ~ E~vironmental Division~ Eagle River Office EVEN L. Ii(AGGS NSTRUCTION Darel Daley December 27, 1982 Soils Test Inspection and Permit Fee O & E Engineering Inspection Fee 24" CMP Lift Pump Sump 1250 Gal. 2 Compartment Greer Septic Tank 50 Yards Sewer Rock Lift Pump, Float Controller & HiFh Level 300 Ft. Perforated Pipe 70 Ft. 3034 Solid Pipe 5U.'Ft. 2" ABS Pipe 6 Calder Couplings 6 Bushings For Calder Couplings 4 90° PVC Elbows 7 PVC,Tees 1 4" No-Hub Connector 2 22-1/2c PVC Fittings 2 2" 90° ABS Elbows 1 1 Single Gang Single Gang Single Gang Outdoor Boxes Outlet Switch With Covers 110 Pt. 12-2 Underground Romex 1 Outdoor Light Fixture 1 Male Plug For Pump Styrofoam Insulation For Pump Outfall Pipe 2000 Sq. Ft. Visqueen 3 Slip Caps 18 Hours 880 Backhoe 8 Hours JD450 Dozer 18 Hours Labor Alarm Float $ 250.00 30.00 50.00 175.00 857.28 65( 00 422 00 270 00 119 00 56 50 36 00 11.40 11o80 26°25 4.62 5.80 1.44 10.30 1.25 5.40 39.60 3.90 2.28 34.12 63.00 '1.75 1,800o00 600.00 54O.OO P.O. Box D / Chuglak, Alaska 99567 Phone(907) 688-2831 0 ~ E El. 'INEERING ,~ DEVELO, ,,CENT CO. Russell Oyster 694-2774 Civil Engineering Soils B- Foundations Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 333 5240 Earl Ellis 333-5240 Surveying Land Development