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HomeMy WebLinkAboutWILLIAMSON #1 BLK 1 LT 12 Municipality of Anchorage Pa,.le / 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: ~l/.-I ~'~,.¢~(.2(~,. PID Number: Name: ~ ~pgrade ~:LTO~ ~ ~ ~~ Wastewater System: ~ New A~/ ~. q~ ~¢~ ~e~/~ ABSORPTION FIELD Phone: ~No ofl~oms: ~eepTrench ~ Shallow Trench [~Bed ~Mound ~Other LEGAL DESCRIPTION S°dRatia9: ~' ~PD/Sq. Ft. Tota, Depth from original grade: ¢ Lot: Subdivision: Ft. Ft. / ¢ Block: / ~/L~/~~ ~epth to pipe bogota frorn origin~rCe: Gravel depth beneath pipe¢ / Township: Range: I Section: Fill added above original grade~Ft' Gravel tength: WELL: B New ~ Upgrade Gravel width: ~ (F t Number of lines:/ ] ~7~Disl~ncebel een]ines:.Ft  Pipe materi~l: Classification~l ~(PrJv~te' A,B~/~C): Total Depth: Ft Cased TO: Ft. Total absorption area:~ ~SQ. Ft ~ ~- Yiold: I Pump Set at: I Casing Height Above Gm.nd: SEPARATION DISTANCES u s..tic ~ ~o~din~ ~.T.~.~.~¢~ TO Sephc Absorption Lift Holdin9 ~ublic/PrivatcManufscturer: Capacityin gallons: Surface w~t~ /~ /¢~% /¢/% ~ ~ LIFT STATION Size in gallons: ~ Manufacturer: / / "Pump on" level at: "Pump off" Ievel at: High water alarm at: Remarks: BENCH MARK Location and Description: Assumed Elevation: / , ENGI~AL S & S ENGINEERING ~'~~ Department of Hea~l and, Human Services approval :" ' Reviewed and approved by: ."/~ Date: ~ -/~ - Permit No.Sw930106 Page 2 of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIFIONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Descript}CVo~.LIAMSON SUBDIVISION //1, BLOCK 1, LOT 12piD No.: 01507329 2 COt 94.2' WELL RADIUS CO MH :1250 GAL ;~.T.E.P. ~YS'i'EM J[~TION GRADE LOT 12~ LOT 15~ NO HSB ON LOT~ 3 BDRM HOUSE c~ ~REA~ INS1 83.6!N0 WATER FOUND · A FCO 50.0 C01 66,0 ~ co2 8o o CO3 66.0 MT TRENCH GAL iLOT 4 UTiL ~ ACCESS ~/~iP'l'IC REA/ MT C04 89i6' 27.0 1-94 TUE 14 :~1 · #.~·,~e.e POST INACONSPICUOU~PLACE e e~ 24 HOUR NOTICE IS REQUIRED FOR INSPECTION SERVICE ELECTRICAL. ~PPLICATION AND PERMIT Municipel;~70~ Anchorag~ Building 8alety Division FE~l'r EXPffiES IN :J~0 DAYS WORK I~ NOT COMMENrJED 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 PERMIT NUMBER:SW930106 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MORRIS ELDON & RUTH OWNER ADDRESS:5131 E 98TH AVE ANCHORAGE, AK 99516 DATE ISSUED: 5/i[4/93 EXPIRATION DATE: 5/14/94 PARCEL ID:01507329 LEGAL DESCRIPTION: WILLIAMSON #1 BLK 1 LT 12 1 LOT SIZE: 12320 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION 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 343-4329 OR 343-4681 AFTER BUSINESS HOURS 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: ~,, Q ~.,~- DATE: Torn Fink, Mayor Muni pality of Anckorage Department of Health and Human Services ~__~ 825 "L" Street P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 May 14, 1993 Robert A. Shafer, P. E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 12 Block 1 Williamson Waiver Request ~WR930024, PID 9015-073-29, SW930106 Dear Mr. Shafer: Your request for waiver of the required 10 foot separation between a septic system and a lot lJ. ne has been approved. The waived distance is 5 feet from the proposed leachfield to the property line. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Robert W. Robinson Civil Engineer On-site Services c. RWR/ljm MUNICIPALITY OF ANCHORAGE Departmen~ of Hea]th and Human Services On-site Services Section Waiver Review Worksheet WRa WR930024 PID= 015-073-29 HA= Date Received: May 11, 1993 Legal Description: Lot 12 Block 1 williamson ~1 Engineer: Robert A. Shafer, P. E.t S & S Enqineerlnq Applicant: Permit 17034 Eagle River Loop Road, Eldon Morris Suite 204, Eacile River, Alaska 99577 Waiver Requested: of 5 fee%. Lot line waiver proposed leachfisld to property _ line Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: ~ Waiver ~.s NOT Granted: / R~asons for above: List vCond~t;ions or ,4/ j - ' ..... /~ame of Reviewer ROBERT SHAFER, P.E, ROGER SHAFER, P.E. CIVIL ENGINEERS August 4, 1993 (907)6942979 FAX 694-121I RECEIVED HEALTH AUTHORI F¢ APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS Municipality of Anchorage DEPART~4ENT OF HEALTH AND HUMAN SERVICES 825 L. Street Anchorage, Alaska 99501 AUG 9 199; iViunicipality of Anchorage Dept. 14ealth & Human Services REFERENCE: Lot 12, Block 1, Williamson Subdivision, Request you re-issue permit ~:SW930106 to upgrade the septic system serving the referenced property. The referenced permit was issued on May 14, 1993, with a 5 foot property line waiver. At the time the permit was requested the as-built survey relied upon failed to show a ].5 foot utility easement. The system therefore requires redesign outside the utility easement and utilizes all available space. A D.E.C. waiver was issued which permits the septic system to exist within a 75' radius of the well. We propose to install 22' of new trench as shown on the attached site plan, which will be 11' deep with 9' effective. The existing trench which has a waiver to the well will be reconstructed; excavating to a depth of 11', removing the existing gravel and piping, installing 9' of gravel (of which 6' will be considered the active effective depth). We do not anticipate any adverse effects on the neighboring properties by the installation of the proposed system. If you require any additional information please contact us at 694-2979. ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. May 1, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SI] E PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST S]RUCTURAL & MECHANICAL INSPECTIONS Municl')ality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L. Street Anchorage, Alaska 99501 REFERENCE: Lot 12, Block 1, Williamson Subdivision Request you issue a permit to upgrade the septic system serving the referenced property and grant a waiver for the separation distance between the proposed leachfield trench and the property llne to 5 ft. An adequacy test performed on the existing system in March, 1993 for Health Authority Approval purposes found the existing system to be in a state of failure. A soils test was performed on the property and the attached design developed. As can be seen, there is limited room on the property for an upgrade. Thus, a property line waiver is necessary. There currently exists a waiver for the separation distance between the well on the property and the septic system on this and the neighboring property at a distance of 75 ft. If you have any questions or require additional information for your review, please contact us. · SHAFER, P.E. ON SITE WASTE WATER D)S POSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Municipality o! Anchorage [)EPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~J \~"~A LEGA' DESCRI.T,ON: L I~-ID \ 1 3- HL- 4- 5- 6- 7 8 9 10 11 13 14 15 16 18 19 2O COMMFNTS Township, Range, Section: SLOPE SiTE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTFI? p E Depth to Water Alter ~aaiterill0? '~J:~"/~'~/ Oale: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE Im~nutes/inch) PERC HOLE DIAMETER S & S £NGINEERING PERFORMED BY: i70~4 E.gie~"~vc." Loop AGCORDANCE W,TH~¢e~kV~.',A~t~N'~A~ ~U,DEL,NES ,N EFFECTION TH,S DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: "=~AME 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 ©fEW MAILING ADDRESS LOCATION ~ Liq ciW,in gallons ~ DISTANCE TO: Well~ ~ Manu,acturer ~; DISTANCE TO: ~ ~~~ No.o~lines Lengtl of,~a ~ * Type ~ ~i ~ DISTANCE TO: Well ~ J~~class Depth I Absorpt~n ~rea Inside ~,~gt~.~ )we ng )e3 J NO. OF BEDROOMS Dwelling 7 ~ Material ~% ~"LI_ [Width --- No. of ~.~mpar~ments Liquid depth PERMIT NO. Material ltv in gallons Foundation Nearest lot lir UPGRADE Material be ~ Depth Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line Septic tank MATERIALS OTHER g &OL ~(,/ LEGAL 72 013 (Rev, 3/7B) 9 kl* C; z .3 Z LU 9 z 0 kl* Z z 0 HCCCC cc' uj 913 LLO IJ6 U. 116 W og U. 916 U. U. CAn I -As 7/30 R& Ess) LL. Cd 916 ce. L16 cc U6 cc SJ6 cc LA. 0 ad U. 0 c1c U. it I& I z 0 HCCCC cc' uj 913 LLO IJ6 U. 116 W og U. 916 U. U. CAn I -As 7/30 R& Ess) z 0 HUNIClPALIT't~ OF iFINCF'nRFIGE DEPFIRTMENT C HEFILTH FIND ENVIRONMENTAL . OTECTION 825 L STREET., ANCHORAGE., RK 5~9D0~ 264-4728 PERMIT NO: 840432 DFITE ISSUED: RPPL 10ANT: ADDRESS: CONTACT PHONE': S M CONTRACTING ~605 FIRTIC ,~ 547 FINCHORBGE, RK 99503 344-0182 LEGFIL DESCRIP: SUB[:,IVISION: HILLIFIMSON LOT: SECTION: :1.5 TONNSHIF': i2N RANGE: ]:1.4 LOT ¢-;IZE: 2.2320 (SQ. FT. OR BCF.:ES) MFIX BEDROOMS: BLOCK LISTED BELO[4 FIRE ]'HE OPTIONS RVFI!L. RBL. E TO 't'OU IN [:,ESIGNIN8 YOUR SEPTIC S~.%TEi"I. CHOOSE THE OPTION 'fliRT BEST FITS '-¢OUR SITE. 'TRE'NC:H / E: E [:, DEPTH TO PIPE BOTTSM <FT. ', 7. 0 ~,~.~/ 6. GRFI'¢EL DEPTH (FT.) ~. 8 ~'~ 8. TOTAL DEPTH (F'r. > ie. e 7. GRAVEL HIDTH (FT.) 2. 5 14. GRAVEL LENGTH (FT. > 43. 0 28. GRAVEL VOLUME (CO. b'DS. ) i~. ~ i4. TI=INK SIZE (GALS) l., 000, 0 ~,:+, i., 000. SOIL RATING <S~. FT. /AR) 85 85 7.0 ';I..0 8.0 5.0 45. 0 ';I. 2. 5 000. 0 '*::~: TFINI< MUST HFIVE FIT LEAST TMO COMPARTMENTS BERT IF'¢ THAT: · .1.. I FIM FFIMILIFIR NITH THE RE(;!UIREMENTS FOR ON-SITE SEI4ERS AND WELLS its SET FORTH B'¢ THE i'`IUNICIPRLITt¢ OF F'INCHORAGE (MOA) ANB, THE STFITE OF FIL. RSKA. 2. I HILL INSTALL THE S'¢STEM IN ACCORDANCE HITH ALL. DiOR CODES FIND F,'.EGULFITIONS., FIND IN COI`IPL'IFINCE HITH THE DESIGN CR. ITERIR OF: THIS PERMIT. 3. I !.4ILL FIDHERE TO FILL MOB AND STATE OF FILRSK. A REG!UIREi'`IENTS FOR. ]''HIE SET BACI< DISTANCES FROM FIN"r' EXISTING WEEL... 1.4RSTEWRTER DISPOL=.,RL S't'STEM OR PUBLIC SENERRGE :":;'¢STEM ON'THIS OR ANY RD..TRCENT OR NE[ARB't' LOT. 4. I UNDERSTFIND THAT THIS PERMIT IS VALID FOR R MAXIMUM OF 2: BEDROOMS AND AN'¢ ENLRROEMENT WILL REG!UIRE RN ADDITIONAL PERMIT. IF: R ].'NEN P JILL ELECTRICAL WORK. MUST BE DONE B~d A LICENSED ELEC:TRICIRN. LIFT STATION IS INSTALLED IN AN AREA COVER. ED BY MOFI BUILDING CODES., (:L) AN EL['-CTRICFIL PERI'lIT AND INSPECTION MUST BE OBTFIINE[.b (2) RS-BUILTS NOT BE APPROVED WITHOU].' RN EI;EC]"RICRL INSPECTION REPORT.~ FIND (3) THE & ENGINEERS, INC. s 1125 OLD SEWARD HIGHWAY ANCHORAGE, ALASKA 99502 (907) 349-6591 PERFORMED FOR: SOIL L. OG ~ 'E,OOLA.ON TEST PERCOLATION TEST .7 BED.OOM~ 4 5 6 ? 8 9 SLOPE SITE PLAN ~¢ LI It I~ W E ENCOUNTERED? ~- ~ .~ 18 L PERCOLAT,O'.ATE ¢~$(/,",--~.d, vJ DEPTH .... (minuleslJnch) PERFORMED BY: ~ B~S~.~ CERTIFIED BY: . DATE: 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 CERTIFICATEOI= HEALTH AUTHORITY APPROVAL;FO FI A SINGLE FAMILY DWELLING NERAL INFORMATION '--.. :Complete legal descriptlo~ Location (site address or directionsl 5131E. ~8th Anchorage; AK Property owner .:'Mailing address Eldon ~ Ruth Morris Day phone Lending agency Mailing address Agent Barbara Erniss¢,/VISTA REAL.ES,TATE Day phone Address 3000 C Stre. e~, Suite'101 Anchorage., Day phone. 562-6464 AK Unless othe'rwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ,~ 3.. TYPE OF WATER SUPPLY: Individual well XXX NO'rE: Community well Public water If community well system, provide written confirmation from State ADEC attest- TYPE OF WASTEWATER DISPOSAl.: ndividual on-site ~olding tank Community on,site Public sewer lng to the legality and status of system. XXX 'NOTE: If community wastewater sy.;ste~,',.prov(de'wntten confirmation attesting to the legality a'nd.'statUs:of s'ystemJ from State ADEC Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAl.. CHECKLIST Legal Description: [~.~ll'--I---//~r~/5(~,"./ A. WellData 7-~/~¢)C_.//~. ] / Well type ~ ¢~ IfA, e, ~ or C, attach ADEC letter. AEC water system number Log presen~N) ~ Date completed Total depth ¢~(/ ~ Cased to Casing height Sanitary sea'N) __ / Wires properly protected~,/N) / FROM WELL LOG AT INSPECTION Date of test ¢//q/~/-¢- ~//'/~ Static water level ~-~ / ~-~ / Well flow ~ g.p.m. ~, ~ Pump level1 ~/~ ~/~ MUNICIPALI 1/' LcF AN~HU;,,*~t- ~NVIRONMENTAL SERVICES DIVISION : .L,'-. 0 2 1994 g,p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO; Septic/holding tank on lot ~/~' / ~ Absorption field on lot ~ ~. I ~_ Public sewer main t.~ 01-~.~ Sewer service line ~ f ~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (~ Nitrate _ Dateofsample: '?~. /'Z....¢' { '~ L~ El. SEPTIC/HOLDING TANK DATA Date installed ~/I Cleanouts(~N) High water alarm~)N) / ? Date of pumping (~, /~¢:¢ /~¢,~/~-- Other bacteria _ / S EHGINEERING Collected by: -17034 .~agJe i~ivur Luup ~a~ Eagle l~tver, Alaska 995?7 Tank size / 2 ~) ~" ,,A~L_ Compartments ~. Foundation cleanout (~N) y Depression (Yc¥~)? A Alarm tested~N) ~ Pumper ~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~._1 To property line 1 ~ Surface water/drainage Foundation Water main/service line CONTINUED ON BACK PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl. TH AND ENVIRONMENTAL PROTECI'ION DIVISION OF I-'NVlRONMENTAL HEALTH CERTIFICATE[ OF INSP[:.CTION FOR HFALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMA'IrlON (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) - (b) Applicaot ~ame ~, I~n ~10[~,5 ~ ~/ ~/I ~' . ~ Telephone: Home -. Business (c) A~p'licant is ~ck o~e):'Lending Institution ~; Owner/builder; Buyer D; Other D (explain); (d) Le.nding InstitutJon Telephone Address (e) Real Estate Con'party and Agent Address Teleehone (f) Mail the HAA to tile following address: TYPE OF RESIDENCE Single-Famil~ Multi-Family [] Number of Bedrooms. ~' Other 3. WATER SUPPLY Individual Well,~ 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 confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 7~-o25 {11/84) my invest m'~lII d on the i ;;;~r~ ~/ on-site ,~l~_.l.~,:: ::.~I ' , and/c,~f '~I ,s, and re ~l Telephone ENGINEERING FIRM PROVIDING ,,',ISPECTION$, TESTS, FILE SEARCH, DA"I,. AND As certified by my seal affixed hereto and as of the validation date shown below, t verify that my investigation of this Iii Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adc for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtalr'Ccdl from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply 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 __ Address /Zoo c/J .~3 DHEP APPROVAb ~... Approved ~ DisapprovZ ' _ Conditional. Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and E;nvironmental Protection (DHEP) issues Health 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 DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or ()missions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WFLL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPRC)VAL (HAA) CHECKLIST- FEBBUARY 1984 264-472g MUNICIPALITY OF ANCHORAGE DEPT. OE EIEALTH & ENVIRONMENTAL PROTECTION 1985 LegalDescript,on: [.%/,'/J,~.."45o/7 ~C/!!I~V~ED/ Z-c,',~/~-- Wel Classification ~/omes'h'~ Wel Log Present N) ~ es Total Depth / ' Cased to _;~ ~ / ' Static Water Level Casing Height Above Ground ;~ / Electrical Wiring in Conduit 'Y/N) Separation Distances from Well: ~To Sepbc/Holding Tank on Lot "~ o Nearest ~dge of Absorodon FielO on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Samole Collected by _ Water Sample Test Results If A. B C. D.E.C. Approvea (WN) /v Date Completed '¢/- /5' ' ~'~ Yield Depth of Grouting Pump Set At 5-' oi¢' _ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining LOtS ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lei B SEPTIC/HOLDING TANK DATA Datelnstalled ¢A-15- 84 _Size ~OOO ,403 4, · No. of Compartments Standpipe N) Air-tight Cap ) Foundation over Tank (Y,/~I~) ~,o Date Last Pumped Deeresslon Pumping/Maintenance Contract on File (Y/N) r-] ~, : for Holding Tank High-Water Alarm (Y/N) Separation Distances from Seotic/Holding Tank: v~ ~,'.,~.~,,,~&.~. o Water-Supply Well ~' (~ To Property Line To Water Male/Service Line I0' - Temporary Holding Tank Permit (Y/N) rv~, To Building Foundation To Disposal Fiela $' To Stream Poric LaKe. or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ? - I >' - ~.~-I '~' Width of Field tt & ~' Square Feet of Absorption Area/ Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ,V A To Water Main/Service Line re)O ' G '/z. ' Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present'N) Date of Last Adequacy Test 'T,'-e,*.c l., cH To Property Line I ~/ To Existing or Abandoned System on ; On Adjoining Lots 3 o + To Cutbank (if present) 7 ~ ' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments -¥ · 14~ on~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions _ ' Pump Off" Level ** 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 '~:~¢'~ Company Receipt NO. '~-,~J Date of Payment Amount: $ Page 2 of 2 Date 5'/~2~/~,5 MOA No. 5"~' ~s'- o'-z'~ D~P~ O~ ~NVIIRON]MENT~ki~ CONS~tV~T[[O~ BII. L SHEFFIELD, GOVERNOR ANCHOI~AGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHOP~GE, ALASIfA 99501 274-2533 May 16, 1985 Ms. Darcy Bevens Alaska Environmental Control Services, Inc. 1200 West 33rd Avenue Suite B Anchorage, Alaska 99503 SUBJEOr: Horizontal Separation Waiver Between Well and Septic TaM~, Lot 12, Block 1, Willia~on Subdivision 8521-WA-158 Dear Ms. Bevens: The department has revi~ved thes ubject waiver request and hereby waives the horizontal separation between 'the well and septic systems to 75 feet on the subject property for a 3 bedroom single family residence only. Sincerely, SE/dd District Engineer 12OO West 33r(~ Aven~e ",~ite B ANCHORAGE, 'ALASKA ,03 6HECKED BY . DATE (~07) 561.5040