HomeMy WebLinkAboutTHAYERMOORE HEIGHTS BLK 3 LT 1 Municipality of Anchorage Page _ I 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: $~/q Name: ~O ~C~-~ ~ ~--i o ~ _ Wastewater System: ~ New ~Upgrade Address: ~¢01 ~t)s~k~L C~¢~ ABSORPTION FIELD ~ . Deep Trench ~ Shallow Trench ID Bed ~Mound BOther LEGAL DESCRIPTION so,..~i.~: Total Depth from original grade: Lot: Block: Subdivision: Depth to pipe boltorn from original grade: Grovel depth beneath p~pe Township: ) Range: Section: Fill added above original grade: Gravel length: m W~L~: El New ~ Upgrade Gravel width: /~ Ft Number of gnes:/,I0istance between I;nes:~ ' Ft. Classihcation (Private, A.8.C): Total Depth: Cased TO: Total absorption area: Pipe material: Driller: Date Drilled: ,tatic Water Level: l lnstaller: [eln Date i stalled: SEPARATION DISTANCES ~eptic U Holding n S.T.E.P. To Seplic Absorplion Lilt Holding Cublic/Privale Manufacturer: Capacityin gallons: SurfaCewater ~'///~ ff/A LIFT STATION LiRe[°t ~ (~ ~ ~ Size in gallons:II Manufacturer: "Pump oh"level at: I"Pump off' level at: I High water alarm at: Foundation ~ ~ 0 I I Remarks: BENCH MARK t Assumed Elevation: Inspections performed by:__ Department of Heal.and Human S~rvic~¢ approval Reviewed and approved by: 72~013 (Rev 9/91) MOA 25 ~ o BUL~_ RUN b ~-S 50 7S~ lO0 185 150 SCALD' 1~ = 50 FT, \ I ITDBBEN SPURKLAND P.E, 203 \4 15TH, AVENUE ANCH, AK, 99501 (9~17) 279-3916 LOT ~ 8LDCK 3 THAYERM~I~IRE HEIGHTS ?£0] NUSSEL CIRCLE MARION Kg~/ACKi SEPTIC SYSTEM AS BUILT I)ATEi FEb 28, 1994 .%HEEl, 1/3 GRID. ~°439 INSULA ?E UN/9£7¢ DN I VE ICA Y 7 £'~ o£ ,CJep~:ic t?ock Under Pipe tTBBBEN SPURKLAND P,E, 203 ~/15'th Ave Anchorage Ak 99501 77~-271fl i)IVERfER VALVE BULL RUN 12~-0 gal Septic toni< Anchorage Tonk Stondord [renc'h ,' ~' F//de 7~' Long 14' Oeep 7' Sewer rock 7' Cover SCALE Cleonou~s Mo~i'~o~ 7' Cover E~[SHN5 T£ENCH 97.:~ ~3,5 gal, sep'~ic 'fonk ND SCALE 7£01 RI/SS£-L L CIRCLE MARII]N KD~/ACKI SEPTIC :SYSTEM A,SBUILI' DATE, FE2~ coq .SHEEI: 2/3 GRID, £'459 PAGE 1 OF 1 MUNICIPALITY OF ANCBORAGE 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 PERMIT NUMBER:SW940016 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:KOWACKI MARIAN C OWNER ADDRESS:7201 RUSSELL CIR ANCHORAGE, AK 99516-5682 DATE ISSUED: 1/28/94 EXPIRATION DATE: 1/28/95 PARCEL ID:01508114 LEGAL DESCRIPTION: THAYERMOORE HEIGHTS BLK 1 3 LT LOT SIZE: 24750 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALI. CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. 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). THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 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 THE FOLLOWING SPECIAL PROVISIONS. RECEIVED BY: ISSUED BY: SPECIAL PROVISIONS: ANCHORAGE, ALASKA 99501 (907) 279-1916 Fax SEPTIC S¥STEH DESIGN HARION KDWACKI No Ground Water or Impervious Layer to 17.5 ft. Use ,~tandard Trench Soil Rating. From test January 13~ 1994 40 rain/in .45 gal/sq. -Ft. Required Area per Bedroom: 150/.45 = 333 Finished Floor Elevation Lewest Floor 100~00 Septic Tank outlet 91+- Ground Surface at Testhele 97 invert I)istributio~-~ Pipe 90.5 Testhole Total Depth 17.5 Have space for 70 feet trench Needed Rock Depth 333 x 3 / 2 x 70 = 7 Teet Number eT Bedrooms 3 Required Absorption Area 1000 sq. ft. Length of Trench 1000 / 14 = 72 feet SYSTE~ C~)NF I GUR~tT · 0~ STANDARD TRENCH TOTAL LENGTH 72 FT. TOTAL WIDTH 2 FT. TOTAL DEPTH lq ET. ROCK DEPTH 7 FT. COVER 7 FT. SEPTIC TANK Check integrity existing tank. Replace if neces-- EXISTING S¥STEH Install Diversion ing trench valve to ex i st-- i oL J ).'Ol)ch: ::!: Iltay(:-rnicx::n"~.:, He:ii;]hts j]q ,, I The ius'Latlation caf this septic system will not prevent from be installed ~n ~he adjacent lots.. There are no dew, loped or- natural surface / sub surface drainage courses on ~his or the adjacent lots. The proposed septic system will not change the general slepe o~ the ar'ea. Pending and/or concentration of ~,surface runeff will net result .From this installation. There is a drop of'f along the west property ].ine. Fop of siepe is :30 Ye[.~t more or less away ~rom the pr[~posed location o~ the trench. The elevation o~ the road ditch is 88 ~eet~ the bettom o[ the prOl)osed 'l:rel~ch is at eleva~ior~ 83 and the Iiip o+ r'oc~:: at 90. Sur~ac:ing o~ e.Ffluent is highly unlil(ely. We. il :tog shows no bedrock ~.o a depth of 125 -Feet. During con-- struction it will be verified that no impervioos layers OCCLIF w~thin 6 ~ee'~ o~ the botL~]m o~ the trench. 1::1 ct ,, 2 LOT I THA YEf~ ILDT t-LDT 2 I I LOT ] I I I ~ar ~ ..... ~I,I LOT 3 LOT ~ 5O O 50 'ILDT 4 LOT 3 I LOT 5 150 ~00 250 300 SCALD l' = 100 FL TBBBEN SPURKLAND P,E. 203 ~ ISTH, AVENUE ANCFI, AK, 99501 SEPTIC SYSTEH DESIGN DATEI JA~ 15 SHE£T~ &/3 GRID' '2#39 ]~ULL RUN I, TRENCH TrlBBEN SPURKLAND P,E, 203 V/ 15TH, AVENUE ANCH, AK, 99501 + ~elll / SCALE~ I' = 50 FT, 7,201 RU$$EL OIROL[ ~ I ~)^T~,,JAN, 11, 1994 MARION KDWACKI JJ l SHEET 1/.9 GRID, P439 · CLEAN ,OUT£-m ])IVERrER VALVE I~~ULLRUN Sfand~rd Trench 7' Se~er rock 7' Cover -~ EXISTING ?RENCfl ND SCALE Miro£1 I40 7 £t o£ Septic Rock Under Pipe CleonouSs /-- Monitor / //-- 4' Topsoi~ ./., i/-- z' Cover _ __/ NO SCALE 12S0 9ol. septic TUBBEN SPURKLAND P,E, 803 ~15th Ave Anchor~oe Ak 99501 ??~-I~1~ ~ 7801 RUSSELL CIRCLE ~)ATE, JAN £5, 1994 MARION KgVACKI SHEET, 3/3 (~' £439, PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST . . (ENGINEER'S SEAL) PERFORMEO: ':e,q DATE 't '"~~; LEGAL DESCRIPTION: LCJ~ I1~'/~;~ 'T~.~,.~,c,,.-~,~.,-.-TOwnship' Range, Section: SLOPE 4- 5- 6- 7 8 9 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth lo Waler After , Monitoring? ~ Dote: SITE PLAN Gross Net Oepth to Net Reading Gate Time Time Water Drop PERCOLATION RATE '///~) (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN _C~,5_ FTAND. q __FT COMMENTS PERFORMED BY: ~ I ~¢' '~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON TRIS DATE 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OP 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 TPHONE LEGAL DESCRIPTION Liq. cai Fn]~ ~'! .-4~'Abso DISTANCE TO: ]~1~ I ~e.~ Manufacturer DISTANCE TO: Manufacturer IF ROMEMADE: Well DISTANCE TO: W~{~)~. /,~. No. oflines / ILengthofea$ine~ Top of tile~'~inish grade ~ / '~,~ ~ '7' Inside length Dwelling Dwelling Total length of li~es I Trench width ~vr ........ L-- _~.~ ~ inches Length Width Type of crib lib diameter Well Crib depth Building foundation NO. OFBEDROOMS PERMIT NO, Liquid depth PERMIT NO. ~iquid capacity in gallons PERMIT NO. Distance between Ih~es Total ef fective(~:~.p~tion aroa PERMIT NO. DISTANCE TO: Depth Driller PERMIT NO. Building foundation Sewer line Absorption area(si DISTANCE TO: OTHER PIPE MAT E R I A LS[~¢.~¢. ~_/~. SOIL TEST RATING INSTALLER REMARKS APPROVED~ DATE LEGAL FIPPL I LOC:RT I ON I...EC~RL [:.C L. L. 8.1.0302 SIZE C,,.~::E: GEf',I. INC:. P. 0. C~RO',/ER ,~: RUSSELL LOT 1. BLK :Z: THFI"r'E.R['IOO~:E SUB d.O --t:~.:4.9 LOT T'T'PE OF SOIL FIE:SOF[!F:"I"IOF~ '::'.';?STE;M I'=;: TRENCH MFI',,<IMLIhl NUf~IE:E~: OF E:EDROOMS = ~: SOIL_ RRTtNt3 ,.'.SQ F'F,.'BE:,= 225 THE REC!LIIRE[:, SIZE OF:' THE SOIL RE:SOf~'.F'TION S"/S'FEM I[) E: F:" ]'- F-ii =: ,',:3 IL_ E: !'4 [.~ 'T FI =: S~ '7 (.:i R F! ",,/[:: IL.. [:, E: ~::~ 'T' F~ :== 3:. ~3 THE I...Eh4gFH B, IMEi",ISICIN IS TFIE L. Ei'4GTH '.'.'IN FEET) OF THE TRENCH OR DI:4:FIINF'IEL. D. ']"FIE I-")EF'TH OF F1 "['F'.Ef'~C:H OR PIT I'.E; THE E:,ISTRNCE BE'1"[,.IEEf,I TI']E SORFRCE OF 'TI4E GROLII"4E:, FI['~E) THE BOTTOI"I OF THE E~'::CR',,,'RT]CON '.'.'I~4 FEET). TFIEF:'.E :ES NO SET I,.IIDTH FO~: Tf~:ENC:HES. THE QRFI',,{L B'EPTH IS THE f'lZ[.~:[f'lLIt'l [:'EPI'H OF' GfE:FI',,,'EL BET[4EE:N THE OUTFFILI_ PIPE RND THE BOT'f'Offl OF 'T'HE E',,':',CFI',,,'Ft'T'ION (:If'~ FEE"r). PERf'I I 1' FIPPL I C~3NT f-lB'_=; TI{if: RESFONS I B I L I 'F'-r' 'FID I I'.,tFOF.:M I['.,!Ff'FILLFI'FIOf.,I INSF'EC:uf'IOf4S OF FIN"r' !-4ELLS FIr_.',.TR(]ENT TO f.,IUfdE{R OF rESIDENCES THF;IT THE bELL I.,.lILL TH I S I)EPIaF.'.THENT I)UR I i'.,tG THE THIS F'ROPERI"-/ FINE)THE .......... T' 114 C~ ,:: BFIC:KFILLINC~ OF FIN'./ S'.r'STEI'i [4ITl-lOUT f:'INISL. IN:i~,f:'ECTZON IBf.~D RPF'F...'OVI31._ B'.r' THIS F.:,EPRf~!TP'IE[.ff [,JILL BE 'S, UB.TEE:I' TO Pi~:OSEr:UTION. MINIr,IUI"I [)ISTRNCE BE'T'[,.IEE~.~ FI I,.IELL Rh,ID RNY ON--SITE SEFIRGE DISF'OSFIL. S'¢s;'rEP1 IS :1.00 FEE-f' FO[~: F~ F'F:tlVRTE ~,~E;LL OR :i.50 TO ':200 FEET FROH R PUBLIC: I.,~ELL [.".,EF'Ef.,IC, II'41:3 UF'ON THE T'¢PE OF PUBLIC: I.,.IE:t...[... MI[.,IIMLIM DIS;TFIf.4L':E FROf,1 FI PRI',,,'RTE [,~EL.L TO I~ F'RI',/laTE SE[4EF.: LINE ]:S 25 F'EET ~:tND TO FI 00Mf,iU[.~IT'./ SE]ER I..I[.E :ES 75 FEET. [,.IELL LOGS FIRE RECIUII:41ED R[4D MUST BE RETURNEE:, TO ]"HE: E:,EPFII:~!Tf, IENT I.,i:[THIN ~:0 [)R'¢S; OF "ri{ [,.IELL COI'dF'LETION. OTHER RE:!L.IIREMENTS f'tR"r' RPPI3". SPEC]:FICFITIO['~:"¢, FINE:, C:ONSTRLICTION [)IFIGF~'.FIf"I':~; RRE FI',,/RZLFIBLE 'FO INSURE F'ROF'ER IE:;TF~LLFrFIOf.,I. F' EE F: ~'"'] :[ T F: ::4 F" IF. liE: [:_'..-E :S [> E'~ C: E:: [r"'l E: [.-E.: R 3::1 .... t. S" :..:3 I CEFI'IF"/ "FF'IRT i: I Rf'I F'FIMILIFIR [,.IITH TI-IE I;:EQUIREMEf'~TS FOF~! Of'4--SII'E: SEI.4ERS I:~I',ID 14E:L_L.S FIS SET FOF?.TH B"r' THE f'ILJf'~ICtPFILIT"r' OF f~P',ICFIORR(SE. 2': I I.,.lIL. L INSTF-~LL THE S'¢STEf"I If,I FiCCOF~'.E)FINC:E [,~I'T'H THE C:ODES. 2;: t Uf'~[)ERSTRN[:' THf:IT THE ON-SITE SEI.qEF: S',?STEr't f'tFI'T' REC!IJIF'.E ENL[~[~:C{I"IENT IF:' THE RESIE:,E."NCE IS; [~'.Ef,IODELED TO INCLLIC, E PIOF:F THFIN Z-': E:EE:,F. iOOMS. 21; 113P.,IE E:,: ........ ISSUED E:"r'. V4. 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVlRONIVlEN'rAL PROTECTION 825 L. Street, AnchoraBe, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST SOILS LOG PERCOLATION TEST DATE PERFORMED: 4 5 6 7 ~ 8 9 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS IO - WAS GROUND WATER ENCOUNTERED? /N/'0 ~ 0 P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop 2. I ',3'~ I1 ~ ,0/, 0 ,~t 7 '~.~, /0 ~.~,~¢ o, od PERCOLATION RATE TEST RUN BETWEEN 72-008 (6/79) SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF ___ ,;,. 1.00 [DRILLED AT THE RATE OF PER FOOT, PROPERTY OWNER LOCATION OF WELL SITE ?,e. cm.L6. DRILLER WELL LOG; R F b L) Co.~ L off ' ~.'d.L :~e ~zd_.: COST INCLUDES ALL LAB. OR AND MATERIAL FOR COMPLETION OF SAIl:) DRILLING, WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ,,~ . ~.()0 THANK YOU VERY MUCH. BERNIE. CLAUS OF RAMPART DRILLING WORKS ',/'t~' 'I '~/' /?,1 DATE__ ,/ ' '~ '~ ~ x~_~t ~ ....... SERVICE CHARGBOF 1F,% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS, PERHI'I' NO, < PIPFLI .f N r 1'Iii,GE MEGFIERFI ,Z42~. JI_INEFII_I ('2-t q CC:) ~ L. OC:tTF I ON LEGlaL LT:L 8LK]: THFI't'ERP'IOORE E;,."D LOT 'S~ZE ~0000 2?6=5888 S~]~UARE FEET MINIMUM DiSTFINCE BETI, IEEN FI b. IELL IqND F]N',r' ON-SITE SEWF4GE [)ISF'OSRL S¥S]"EM IS :1.00 FE:ET FOR ~q PRI',,,'FITE NELL OR J.E¢8 TO 200 FEEl' FROM ~ PUBLIC I,~ELL DEI:EN[:,ING UPON TFIE 'I"¥PE OF F'UBLIC I'.IEL. L MIIqIMIJH D'IS;TFINCE FROM FI F'RI',/FITE I,.IELL TO FI PRIVP]TE SEP.IER LINE IS 25 FEET F~N[:, l'O FI COMMUNITY SEt.,.IER L. INE IE; 75 FEET. NELL. LOGS F~RE R[B]]LIIRED K~N[:, MUST DE RETURNEE:' TO THE [:,EPFIRTMENT HI]"HIN 2[:0 DFI¥S OF THE MEL. L COMF'LETION. OI'In'IER. REI~I.JIREMEN]":5 MFI¥ ¢~F'P[..~'. SF'ECII:IC~aTIONS FIND COI",ISTRUC'TION DIFIGRF~MS ARE FI',,,'FIILFIDL. E TO INSURE F'ROPER INSTF]LL.FtTION. I CER'FIF"r' THFtT ~L: I F~M FFIMILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEI,]ERS F~NE.', t.,.IEL. L..S: ~aS SET I::'OI:~]TH B"r~ ]'HE MLINIC:IPFILIT~' OF BNCHORBGE. 2: I ,,.lIt_L INE;T~t_L.. THE S","STEf",~4,3CCOI~'.DFINC:E WITH THE CO[:'EE;. ............. ........................... ........... . .......... ',,,' 4. 0 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 SINGLF FAMILY'DWELLING Parcel hD.# _~1~- HAA # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) , Property owner Mailing address Lending agency Day phone Mailing address Agent ~cl-4~¢ Address ~,C¢.,/,,L~ (~.v-~ '"~,-.,,~--(.~"1L . Day phone. Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Community on-site If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Public sewer NOTE: If community wastewater system,~provide written confirmation from State ADEC attesting to the legality and status of system..' STATEMENT OF INSPECTION BY ENGINEER As certified by my,seal affixed here,t.o and as of the'validation date shown below I verify that my- investigation of tt~s Health Authont~ Apprbval application shows that the on-site water supply' and/or wastewater disposal systerd is safe'!funcbona 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-s te 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. NameofFirm '"~/~J~-~ ~ ~) '~- ~ Phone ~.'7~'~,~ F~ Address bO ~ t,¢" /~,/--~/ /=' ~Lm :~ Engineer's signature ~-~'~ -~ Date ~"/~//~)!~ DHHS SIGNATURE ~ Approved for 3 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage D~partm~ni ~ H~lth ~nd Human ServiCes (DHHs)issues Health Auth0ii~ Approval Certificates based only UPon thei'i:ePrese'ntafl°ns gi~,en in paragraph 5 above by an independent professional engineer registered in the stAte~Alaskai The DHHS d0es this as a courtesYto purchasers of homeS and their lending institutions in order t° satisfy Cert~lr{ fedemi and state requirements. Employees of DHHS do nOt ~oriduct inspections or analYZe;da{aib~0r~:A:~cer~ificate is,issUed. The Municipality of Anch0'rage is responsible for errors or omissions in the profess onal engineer's work. Municipality of Anchorage Department of Health and Human Services HEAl.TH AUTHORITY APPROVAl.. CHECKLIST Legal Description: A. Well Data Well type ~ Log present (Y/N) y Total depth /~-~ Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number Date completed "-z//A./u¢~ ! Driller Cased to l ~ ~ Casing height Wires properly protected (Y/N) ENVIRONMENTAL SERVICES DIVISION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot _ J,..-'[ Absorption field on lot /,~ Public sewer main ~//:¥ Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: / ¢~-'/~ ,'5/'~ Nitrate ,.~'? Other bacteria _ (Y Collected by: "~""'~- ~> B. SEPTIC/HOLDING TANK DATA Date installed :~//~J~/-"/~/ Tank size Cleanouts (Y/N) "/ High water alarm (Y/N) Date of pumping Compartments ~.~ Foundation cleanout (Y/N) i~ Depression (Y/N) h'///-~ Alarm tested (Y/N) ?"!/~q- ~-/~Z-\ Pumper t"//~,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot [pO../_) On adjacent lots To property line :=~C) Absorption field Sudace water/drainage Foundation Water main/service line 72-026 (3/93)° Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manhole/Access (Y/N). "Pump off" Level at .Cycles tested SEPARATION DISTANCE FROM LiFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length '7 ,..~ Width Total absorption area Date of adequacy test Water level in absorption field before test ~ ,/~-'~ Peroxide treatment (past 12 months) (Y/N) '~"~1 Soil rating (GPD/FF) Gravel thickness Cleanout present (Y/N) '"// / Results (pass/fail) .System type -~-'/~-~/ Total depth Depression over field (Y/N) for '~-'~-~ Bedrooms After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ! I.~ I~ To building foundation On adjacent lots ~ l- Sudace water ~'~o ~' Curtain drain On adjacent lots "~ /~-(~J Property line To existing or abandoned system on lot Cutbank ;¥© Water main/service line Driveway, parking/vehicle storage area ~/ E. ENGINEER'S CERTIFICATION I ceA'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ ~0o ~'~ Date of Payment Receipt Number 72-026 (3/g3)' Back Waiver Fee $ Date of Payment Receipt Number CT&.E Ref.# Clieut Sainple 1D Matrix Commercial Testing & [:ngineering Co. Environmental Laboratory Services ~.-/~/7/7~/7/~7×?/~.~./~./7/?~/~?w~/?~/~~ LABORATORY ANALYSIS REPORT 94.0808-3 L1 B3 TIqAYE1LMOOiLE WATER Client Nmne TOBBEN SPLrRIKLAND, P.E. WORK Order 76053 Ordered By TOBBEN SPUP, KLAND Printed Date 02/28/94 c~ 13:24 lu's. Prq}ect Name Collected Date 02/23/94 ~ 15:40 lu's. Prqiect# Received Date 02/23/94 @16:50 hrs. PWSID UA Technical l)irector STEPI IEN C. EDE 8ample R.emarks: ROUTINE SAMPLE COLLECTED BY: T.S. QC Allowable Exl. Anal Parameter Results Qual Units Method Limits Date Date hilt Nilrate-N 3.9 rog/I, EPA 353.2/300.0 10 02/25/94 RLE * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA- Not Aualyzed [J = Undetected, Repoded value is the practical qt~mtification limit. I:F- Less 'Ihau D = Secondary dilctioc. GF- C~-eat er'lhan 5633 B Street, Anchorage, AK 99518-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA 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) Lot 1 Block 3 Thayerstore Subdivision Location (address or directions) 7201 Russel Circle (b) Applicant Name Marion Kowackt Telephone: Home Business 264-4811 Applicant Address 7201 Russel Circle, Anchorage 99507 (c) Applicant is (check one): Lending institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution City Mort~a~g_e Address Telephone 243-4373 (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family E~:xMulti-Family [] Number of ~edrooms three(3) Other WATER SUPPLY Individual Well [~x Community [] Public [~] Note; If corn munity well system, must bare written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite E,-,-,-~x Public [] Community [] Holding -rank [] 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 z2-o~5 (11/84) ENGINEERING FIRM PROVIDING iNSPECTIONS, TESTS, FILE SI-'ARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the val[da,on 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 i[rdicated herein. I further verify that based on the information obtained from the Municipality of Anchorage tiles and from my investigation and inspection, tile on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect orr the date of this inspection. Name of Firm Telephone Address Date Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of February 11, 1986. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal standards and is now approved. (Corwin Engineering) Approved for ThraeJcTl~L bedrooms by u~n_e Approved __XXX¥×××× Disapproved -v Conditional. Terms of Conditional Approwd CAUTION The Muncipality of Anchorage Department of Health and Environmeutal Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in tile State of Alaska. lhe DHEP does this as a courtesy to purchasers ut 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, lhe Municipality of Anchorage is not responsible for errors or omissioes in the professional engineer's work. Page 2 of 2 72-025 (11/84) & associates,inc. consulting Engineers 4790 Business Park Blvd. · Bldg. D · Suite One * Anchorage. Alaska 99503 ° (907) 561-6151 June 3, 1986 Municipality of Anchorage Dept. of Health and Human Services 825 "L" Street Anchorage, Alaska 99502-0650 Attn: Mr. Robert Robinson Dear Mr. Robinson: On January 30, 1986, Corwin & Associates, Inc. performed a Health Authority Approval inspection on Lot 1, Block 3, Thayermore Subdivison for Mr. Marion Kowacki, the Owner of this property. Conditional approval was granted by your office pending installation or location of the end standpipe to the field. On June 2, 1986, a field inspection was performed and the end standpipe has been installed and is accessible. Based on this verification, we now request that the "conditional" be lifted and the property be given full approval. If you have any questions, please let us know. Very truly ours, C'Q~WIN & AS )~IATES, INC. Vuruce J! Corwin, P.E. Pres ~ht BJC/. 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 1. GENERAL INFORMATION Application Date / ~' .~'C) '~ 8 ,~ (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name~O~ ~O~ Telephone: Home Business ~ ¢~// Applicant Address _~ _~J_~_¢~~&~ ~ ~; ~?~ (c) Applicant is (check one): Lending Institution D; Owner/builder,~ Buyer ~; Other D (explain); (d) Lendinglnstitution E~I ~0~~ Telephone ~b/- ~ t Address (e) Real Estate Company and Agent Address Telephone / (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family/~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual WellX Community [] Public [] Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written conlirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72 025 (11/84) 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 ~(D/'~uLJ//~' ,~' /~'-.~,~-, /,,~'~, Telephone ~[' ~:~{,~"/ Address ~ 7 c/ 0 I~ O,.51~',Y P~J~. p,~I~"~_~D E~ D ,E (..~ I"Y-Y~5 ~_ /~//~C// ,~l~, c~'~'O.~ Date ] ' ~ ~er's Seal A rv ppoed for~./_J2...3~ bedrooms b~"(~ Approved Disapproved Conditional CAUTION The MLmcipality of Anchorage Department of Health and Environmenlal Protection (DHEP) issues Fiealth Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of [)HEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible lor errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL [HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal DescriPuon: L ~_ ~" _./ MUNICIPALITY OF ANCHORAG~ DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION / We Classification If A B. C. D.E.C. Approvea (Y/N) J~'~/','~ We Log Present (Y/N) '~¢~..~.~.~.~.~.~_ Date Completed ~" /,'~- ",~ ! . Yield Static Water Level 7'~' Casing Height Above Grouna Electrical Wiring ~n Conduit (Y/N) Separation Distances from Well: To Septic/Holding 'rank on Lot J To Nearest Edge of Absorpuon Field on Lot J~,..'~) FT; On Adjoining Lots To Nearest Public Sewer Line _~,L~/'//~ To Nearest Public Sewer Cleanout/Manhole ,,~/ Water Sample Collocted Dy Depth of Grouting _~N Pump Set At / ,,~¢:~ Sanitary Seal on Casing (Y/N) _ Depression Around Wellhead (Y/N) : On Adjoining LO'IS ~'(~O *'~ ,,'do .-/, To Nearest Sewer Service Line on Lot ~ ,,~j./_~.j~ ~'~/~/k,/ ; Date Water Samole Test Results Comments /~/J~/%/,~' B. SEPTIC/HOLDING TANK DATA Date Installed ~,'~"2.,,~ "~ [_ Size /"0¢~:~ No. of Compartments _ Stand3ipes (Y/N) ~ _ Air-tight Caps (Y/N} ~/'~-,~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) _4/"~?_ Date Last Pumpea Punlplng/Maintenance Cont-act on File fY/N) A/",¢~ . for __ Holdmc~ Tank High-Water Alarm tY/NI . /A,)'/j4~- __ Temporary Holding Tank Permit [Y/N) _ Separauon Distances from Septic/Holding Tank: To Water-Supply Well _ To Property Line To Water 'vlain/Service Line Course _¢ To Building Foundat on /,~ F -o Disposal Field _ To Stream. Pond. Lake. or Major Drainage Comments Page 1 of 2 72 026( $ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata~~' ~' ,~, ~ J~r~ Type of System Design Date Installed ,~ '~ * ¢] ~ Length of Field _ Gravel Bed Thickness Square Feet of Absorption Area ~ ~. F~ Standpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Results of Last Adequacy Test ~ ~/~~ ~ Y ~ Separation Distance from Absorption Field: To Water-Supply Well _/~ ¢~ To Building Foundation ~ O ~ ~ Lot To Water Main/Service Line ~ To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway. Parking Area, or Vehicle Storage Area ~ To Property Line / O "~ To Existing or Abandoned System on ; On Adjoining Lots LIFT STATION ~/dO 'T /,25; ~'~D') Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electricai Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Oft" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check P~"~itted BedrOom Rating Against HAA Request ** I certify t h~t J~have chec, y~, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Receipt No. Date of Payment Amount: $ ~gineer's Seal Page 2 of 2 72-026 o 1/041 & associates,inc. Consulting Engineers MUNICIPALITY OF ANQIoRA~ 4790 Business Park Blvd. · Bldg. D · Suite One · Anchorage Alaska 99503 · (907) 5~)b~j-1, 5~F HrAiT~-i '& ' ~; [NVIRONMI~NTAL PROF[~CTION February 3, 1986 Municipality of Anchorage D.H.E.P. 825 "L" Street Anchorage, Alaska 99502-0650 , ECEIVEI) Attn: Mr. Robert Robinson Dear Mr. Robinson: On January 30, 1986, Corwin & Associates, Inc. performed a Health Subdivision Authority Approval on Lot 1, Block 3, Thayermore ' ' ' for Mr. Marion Kowacki; the Owner of this property. The stand pipe at the end of the trench for the septic system is missing, we were informed by the Owner that he obtained prior verbal permission from D.H.E.P. to perform the adequacy test using the two standpipes on the septic tank. This in fact is how the test was performed. A total of 900 gallons, of the required 675 required gallons, was introduced into the system with no apparent rise in the septic tank fluid level. It is our opinion that this system is adequate for a three bedroom home. The Owner informed us that: he would work out an agreement with you to obtain conditional approval for financing until Spring when construction of a standpipe at the end of the trench would be more economical. The well on this property averaged 3.75 GPM over a four hour period which is greater than the required 0.51 GPM average. It is our opinion that this well is adequate to serve this dwelling. Please find prior records, H.A.A. forms, and accompanying data (attached). T/L/ROBINSON D.H.E.Po February 3, 1986 Page Two Should you have any at your convenience. Very truly yours, CORWIN & ASSOCIATES, INC. Tod W. Sherman Civil Engineer questions please fee]. free to give us a call As Approved By: TWS/rc Attachment t ~ruce~.// Corwin, ]?.E. T/L/ROBINSON FIELD PUHPING TEST DATA SHEET Time ' PROJECT: ;,UygR./OA/ ~O<4...Y~ ~ ,LOCATIQJ OF ~IELm' (Legal Descriptton):_~._Q_~_, / WELL DEPTH: 1~' _ FT. CASING: DATE DRILLING CONPLETED:_~.F/~. ~[ STATIC WATER LEVEL (Top Q¢ Casing): Pumping Started/ Stopped, )din. Depth to ___ ?later, ft. Drawdm,m/ Recovery DATE OF TEST:_/',2{0 FT SCREEDI: ET Remarks 2O Pumping~ Rate, ~0 l ~Star~ I 35 7~ 4O 90 210 RECOVERY MUNICIPALITY OF ANCHORAGU 15 I 25 '30 '35 I 45- 50 (1 our) .},~.U (Z hours)./