HomeMy WebLinkAboutSEACLIFF BLK 3 LT 15Seocliff
Lot 15
Block 3
#011-221-42
~ 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
PHONE
[~UPGRADE
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
W,~ll Absorption area
DISTANCE TO: I I
Manufacturer ~ . .~
Lq capacty n~ga onsl ^ Aside ength
· /f'~'-O! -- F HuMEMADE
DISTANCE TO' /Well Dwelhng
· /
Manufacturer
DISTANCE TO:
No. of,,nev I
Top of tile to finish gr~d~.¢/~, /,
Dwelling
Material
Width
Material
Foundation Nea rosSI ~_~e
Total leng~:~ of I~es Trench
inches
Material beneath tile ¢~:~ ' ~'~ inches
Depth
NO, OF BEDROOMS ~
PERMITNO. 5¢11 %
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO,
Distance between lines
Total effective absorption area
PERMIT'No.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
CJass Depth Driller Distance to lot line
Sewer line
Building foundation
DISTANCE TO:
Septic tank
OTHER
PIPE MATERIALS 5"T-'~ e / ~nJ' 7~2Jn
RATING
INSTALLER
REMARKS
APPROVED
DATE
LEGAL
PERMIT NO,
Absorpt on area(s)
72-013 (Rev. 3/78)
LEGF!L
T:?'F'E C'F ::30!L. FiECi;Cif~:F'TT:tFt ?¢'ETE:i'I i::~:'
TNE !...ENEf'FH [> i ME]',!S i ON i S THE LENGTH ,:.' llq FEET > OF' TNE TF.:ENC.,'--i OR E:¢i:Fi i NFi EL[::,.
THE DEP'T'H OF A ]"RENCH OR F'ZT Z:E; 'THE DISTANCE BE"i'HEEN THE :~.;tJRF:F~CE OF' 'THE:
GROUNE:, R?.4[.'.', 'THE: E:OT"FOH OF THE: E;;.:.:C:F!VI::YfION ,::tN FEE]">.
TFIEF::E ii:'; NO 'SET Hif>TH FOR TF.:ENCHES.
THE GRF!VEL DEPTH IE; THE MIN!MLi?I DEPTH (:IF:' GF.:fa',,,'EL. !E',ETb.iEE]',! THE OUTF:'RLL P Zi='E:
FIND THE E',OTTOM OF' THE E;:-:;Cf:iVFITION < !f',! FEEET>.
PEI:-::M:£T F. PPL.'ZCFINT I'"IFIE; 'THE: F.:E':.';';:'iNt:ST:~I._T.'."h.'-r'] ]:NFORM TH IE; E:,EF:'FiF:':'T'MENT E:, f;"!i'..'~. THE
l N:!;!;TFiLL.FI'T' I Eib! I '~- ,::.c,c.,--.~. .... N'::; 0F' F!N? i,.iF' t ':: p...r.> CI:. ] E:b!T TO "Fbi I '=, . ,- ........... ,
.... : .............................. ::: ~ -,c ::',',"r'*. f:d"l[> THE;
NUMEE:=.R C F' RE:=:, ! E:'ENCEX:!; "FHRT 'T'HE i !F.<L.~ ...... !I .... E;E:RVE.
!'"ii N i MUH [> ! %TF!NE:E E~ETNE:Ei'.J F! NELL. FIND Fif',l"~.' ,'.')N-S ! TE :~:ENFK3E D I SPO"_'-';RL ?¢::7, TE:M
~.e!E} F:'EET FOR f:i F'R!'VRTE NELL OR :i. DE~ TO ;2:G.E~ FEET FROi'i ia, PUEC..!C NELL
UPON THE T?PE OF PUBLIC: NELL.
MINIMUM E:,ISTRNC:E FF:or,t Fi PF.'.IV!~TE: HELL ]"O R Pi:E:!Vf:,'"f'E :ii;E].,.!ER L. iNE iS 25 F'E(ET
'T'O R C:OHP'II...tN!T'.~' SEI.,.IER LINE l'S 75 FEET.
OTHER .RE(;:!L.I!REiME;',FFS i"!Fi'?' FiPF'L'¢. S.r='EXi:!FIC!~TIOi',IS RNL':, COi',,'-'STRLiC':T~Oi'-~ DiRCJRI::iNS RRE
Wv'F!I LFiE.'L.E TO i F,!'Z, LIRE F"ROPER ! NSTF!L.LY-I'r' I OF,t.
i CERT :I: F"P "FHfiT
:£: ! Fff"l FF:!H!!...!FiF:: NITH 'THE F:EQUIREME:NT':';!; FOR ON-.SITE: E;E,k!ERE; FIND klEL.L.S
F'OR"i"H EW 3'FIE:_" MUN!CIF'FILIT'¢ OF FINCHORF[GE.
2: i NiLL !i'.,!:i!;TF!LL. THE': S'./STE]"t !N fzlCCOF~:C,f~NC':E: b.!!'T'H 'T'HE:
]:: Z Ui'.,!E)ERSTFINE) THFFf' TNE: 0i"',I-SZTE SENE]=..: S'.~'E;TEM H.P,'-? ..':~!EE'!U!RE ENL. F!RGEMENT' iF 'T'NE
RE'E; I E:,ENCE I !~; F::EI"IEIE:,EL.E[:, TO ! Nt/::L. UE:,E ,~'tORF_' 'i'I-'!RI",/ 3: E[EE:,ROOM:::3. ~-' ¢ ,. '-=-. _ , '
,, /~"J (1 .-~ ~.~..~ /¢.¢ f~'~l~ ..~,)
~ / k, 4_, D :: ':¢ Z~ =' ,r.', ,¢.'~
V,::!..
i SSUEE:, E:'¢ _. !=~]"E' ..........
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR: ~""~(,~ ~'~'~7~'~,$< ~.-
LEGAL DESCRIPTION: ZO"/ /,~"~ ~,,//~ '~
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16--
17,
18-
19-
2o
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
O
p.
IF YES, AT WHAT E
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
(minutes/inch}
COM,,ENTS
PERFORMED BY:
TEST RUN BETWEEN
CERTIFIED BY:
FT AND ~. FT
DATE:
72-008 (6/79)
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
011-221-42
/
HAA #
1, GENERAL INFORMATION
Completelegaldescription SEACLIFF SUBDIVISION: LOT 15. BLOCK
Location (site address or directions) 9220 SHORECREST
Property owner dUNE FRESWlCK Day phone (907) 274-2992
Mailing address 9220 SHORECREST DR, ANCHORAGE. AK 99515
Lending agency. Day phone
Mailing address
Agent MARK SOQUET
Address
Day phone (907) 561-728,3
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: `3
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
XXX
If community well system, provide written confirmation from State ADEC attest-
ing to the legafity and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding Tank
Community on-site
Public sewer
NOTE:
XXX
If community wastewater system, provide written confirmation from State ADEC
ing to the legality and status of system.
72q)25 (Rev. 1/91) Front MOA #21 Computer Version
[ Note: Alaska Water. and Wastewater Consultants, Inc. shall be p~id $700. O0 at,
[or prior to, closing for the engineering services provided. J
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that rny
investigation of this Health Authority Approval application shews 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 fudher vedfy that based on the information obtained from the Municipality of
Anchorage files and from my investigation and inspe, ctien, the on-site water supply and/or waetewater
disposal system is in compliance with all Municipal ~nS' State codes, ordinances, and regulations in effect
on the date of th~s ~nspecbon.
/-/ / ~
Name of Firm ALASKAWA~'ER!& WAS'~EWATER CONSULTANTS INC. Phone (9071 337-617,}
I ii/!/(///
Address 6901 DEBARR ROAD, SUJTE42B "ANCHORAGE, ALASKA 99504 ,
Engineer's Signature (_/t , '/, ~(/¢ ~,/~x,'~ ~ Date
In conducting this evaluation, AWI/VC, Inc~/attCmt;/tCd to prow~te a thorough, conscientious engineering analysis of the
system in accordance with ADEC and MGA I~Ht-I~ Guidelines & Regulations, The reported results described the
performance of the system under the conditions encountered at the time of the test, and separation distances
measured to readily identifiable features. The operational life of all wells and septic systems depend
on the local soils condition, ground water levels that may fluctuate during the year, and the water
usage of the family being served by the system, These conditions are outside the control of
the evaluator of the system. Satisfactory test results do not guarantee future performance
of the system, nor do they guarantee that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not provide any warranty for future estimate of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
The content of this report is for the sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or party is not authorized,
nor will it confer any legal right whatsoever.
6. DHHS SIGNATURE
~ Approved for '~ bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
CE-7953 ." ?~
Additional Comments
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.
72-025 (Rev. 1/91) Back MOA #21 Computer Version
Municipality of Anchorage R E £ ol
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Sewices Division
825 'L" Street, Rm 502 Anchorage, AJeska 99501 (907) 343-4744 '"" '
MUNICIPALiI~¥ O? ANCHORAGE
~ '~ !VI£ONMENTAL SEEVICE$ DIVISIC
Health Authority Approval Checklist
Legal Description: SEACLIFF SUBDIVISION; LOT 15, BLOCK 5 Parcel I.D.:
011-221-42
A. WELL DATA
Well Type' CLASS "A"
Log present (Y/N) N/A Date completed
Total depth N/A Cased to N/A
8anitmy seal (Y/N) N/A
IfA, B, OrC, attach ADEC letter. ADEC water systam number
210485
: N/A
Casing height (above ground) N/A
Wires properly pmtacted (Y/N) N/A
Date of test
Static water level
Well production
FROM WELL LOG
g.p.m.
AT INSPECTION
WATER SAMPLE RESULTS:
Coliform
Nitrate'
2 Clesnouls (Y/N)
High water alarm (y/N) N/A
~ Collected by:
B. SEPTIC/HOLDING TANK DATA .~?.:~ IJ''5
Data installed 10/21/81 Tank size. ~ Number of Comparlments
Foundation clesnout (Y/N) YES Deprasslon (Y/N) NO
Date of Pumping 8/8/2000 Pumper DENALI
Yes
C. ABSORPTION FIELD DATA
Data installed 10/2/81
Length ,30 Width
Effec~ve absoq)§on area 278
Data of adequacy test 8/7/2000
Fluid depth in absorption field before test (In.);
Fluid depth 16 (ins) Minutes later.
Pem~dde treatment (past 12 months) (Y/N)
72.028 (Rev. 3/96)* Computar Vmalan
Soil rating (g.p.d./ff2 or fl2/Ixlrm) 85 System type TRENCH
5 Gravel thickness below pipe 42" Total depth 7.3' +/-
MonitorlngTubepraesnt(Y/N) YES Depraeslonoverfleld(y/N) NO
Results (Pass/Fail) PASS For
1,3 Immediately alter 799
74 Absorption rote =
NONE KNOWN If yes, glvedate
Bedrooms
gal. water added (in.): 18
450+ GPD
Manhole/Access (Y/N) /~m'4~6~ level at* ~ 'Pump off" level at*.__
High wa:~ *Datum
E, SEPARATION DISTANCE8
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
O~
adjacent lots
Public sewer main ~ Public sewer manhole/cleenout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+
Water main/service line 10% Surlase watar/dralnage 100'+
Absorption field ' 5'
Wells on adjacent lots__. 200%
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation. 1
.Water main/service line._
Surface water 100'+ Driveway, paddng/vehlcle storage area..
Curtain drain NON.~ KNOWN Wells on adjacent lots 200'+
Engineers Nam~ f ! ~ JEFFREY A. GARNESS 7953 ..." &~
Date
IO'-P
10'+
Fee $
Date of Payment
Receipt Number
72.026 (Rev. 3/96)* Computer Vaslon
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # OIl -- 'Z?---I -4-5
1. GENERAL INFORMATION
Complete legal description
ENVII~ONMENTA~ SERvICE~ DIVI31oi.,
HAA # ~p'~
Location (site address or directions)
'4.
Rroperty owner
,Mailing address
Lending agency
Mailing address
Day phone
Agent t~_.~-/~ ~L.. ~:~c~ ~V-~'~ ' Day phone
Address -~_~-~OO CO¢'t-D~-JA- ~-¢" , %-~ r-pE: ?04D
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~
~S-7- 011~o
TYPE OF WATER SUPPLY:
Individual'well
Community well
Public water
F-cc- PI u'?
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
Municipality of Anchorage e,~WRONMmTAL
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825L Street, Room 502° Anchorage, Alaska 99501. (907)343~7i~
Health Authority Approval Checklist
Legal Description: Lo'T- ~,5 (~/-~) %F.,~:~CL.~i~r-I~' Parcel I.D.:
A. WELL DATA
Well type ¢_O/'1t-'/ I ~..~,, or C, attach ADEC letter. ADEC water system number
.Lpg present (Y/N) Date
T~ Cased to completed ~ /
__ casing heigh~ound) _
Sanitary seal (Y/N) ~ Wires~rotected (Y/N) _ _
Date of test FR~ /AT INSPECTION
Static water level
Well production /
WATER SAMPLE RES~.'
Coliform /
[~at~ sample:
~ g.p.m.
Collected by:
B. SEPTIC/HOLDING TAI~K DATA
Date installed ~C)/?--~J~ Tanksize ~OOO Number of Compartments ~ Cleanouts(Y/N) .
Foundation cleanout (Y/N) ~ Depression (Y/N)
Date of Pumping ~--~/l~/~/~ Pumper
C. ABSORPTION FIELD DATA
Date installed I0/'z-./(~l'
Length '~O Width
Effective absorption area ~_~"7~,
Date of adequacy test '~-/'Z~/~'
Fluid depth in absorption field before test (in.);
Gravel thickness below pipe
Monitoring Tube present (Y/N) V
Soil rating (g.p.d./fF or fF/bdrm) ~ ~' System type
Total depth
_ Depression over field (Y/N)
For ~ bedrooms
Immediately affer~OOgal, water added (in.):
Fluid depth t~z~r ~' (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
Absorption rate = ~'-'~-) -i~- g.p.d.
If yes, give date
TOTAL P, 8F~
7320 East Chester Heights Circle - Anchorage - Alaska 99504
February 22, 1998
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
R[C[IVFn
. L?
Subject: HAA for Private Septic System. Lot 15, Bk 3, Seacliff S/D.
To whom it may concern:
The subject lot has a 3 bedroom house on it which is served by a private septic system and a
community well. The results of the field investigation and adequacy test are summarized as
follows:
A] SEPTIC TANK: According to the M.O.A records the septic tank was installed in October
of 1981 (approx. 16.5 years old). The tank is made of steel, has two compartments, and a
capacity of 1000 gallons. Steel tanks typically have a structural life of 20-25 years.
B. SEPTIC SYSTEM ADEQUACY TEST: The drainfield is a 5 foot wide trench, which is 30
feet long, and has an effective depth of 3.5 feet. Prior to starting the adequacy test, the M.T.
had 7.5 inches of liquid in it. The first 184 gallons of water introduced rose the liquid level 10
inches (to 17.5 inches). The next 416 gallons only caused a rise of 2.75 inches (151
gallons/inch). Upon stopping the flow, the level dropped 2 inches in 11 minutes, which
corresponds to an absorption of 302 gallons. Based upon this data, it was determined that the
absorption rate of the trench exceeds 450 gallons per day, as required for a 3 bedroom house.
NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not
limited to, seasonal surface water infiltration, groundwater variations, septic system
maintenance (frequency of septic tank pumping, usage of biological additives), condition of
drainpipe and pipe joints (which can be damaged by seismic activity and deteriorate with age),
type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects),
and the amount of water being introduced on a conlinual basis. Consequently, the results of this
adequacy test are only valid for the specific day of the test. Furthermore, because of the limited
nature of this investigation, it is possibIe that there are hidden defects which may not have been
detected. No warrantee is made regarding the future performance of this septic system
If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your
assistance. /~
Sincerely~/? ,/ '
.., M.S.
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D.# ('-~1 \- ;-~- L[,~ HAA# ~ ~°~c~ F'~-~'-~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Location (address or directions)
qZZO ,~ HO ? F('-
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address J'J
(d) Real Estate Company and Agent
Address
r) i.~- [ Telephone: (home)
.< HO? FC?F 'T' kJC'_H ,,
Telephone k!/f~
Business .,~'d- 1:- ~i 7.~f
Telephone ~,1
/
(e) Mail the HAA to the following address: (or check here~, if hold for pick up.)
List contact person and day phone number below:
2Z- i I
2, TYPE OF RESIDENCE
Single-Family~' Number of bedrooms
3. WATER SUPPLY
Individual Well []
Community j~d' Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
ConservatiOn attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site,~ 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 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of thevalidation date shown below, Iverifythat 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 (~0 ~_.~ ! N ,~- ,,~.%.g'O(' Telephone .'.~7- J -~ J ]
Date C7~ ~.~. /~?
/ /
Engineer's Seal
6. DHHS APPROVAL
Approved for~ _bedrooms by
Approved ~___Disapproved
Terms of Conditional Approval
Conditional
Date
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph S 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 DHHSdo not conduct inspections
or analyze data before a certificate is issued. The MunicipalityofAnchorageisnot responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: ~_r:'F
-- EA CLI FF-
.ALE ,--5'
WELL DATA
Well Classification ._(~'~¢)~1,4A0,4) I?~ ~.L
Well Log Present (Y/N) Date Completed
IL~B, C, D.E.C. Approved (Y/N) /
Yield
Total Depth Cased to
Depth of Grouting
Stat c Water Level
Pump Set At
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by
; Date
Water Sample Test Results
Comments
SEPTIC/HOLDING TANK DATA
Standpipes (Y/N) ~ Air-tight Caps (Y/N)
Depression over Tank (Y/N) ~
Pumping/Maintenance Contact on File (Y/N) ~,~/J-~
Holding Tank High-Water Alarm (Y/N) ~/
Foundation Cleanout (Y/N) 7
Date Last Pumped ~ //_Z27/¢r~
;for kl/ ,
Temporary Holding Tank Permit (Y/N) ~/~/[
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well -;~2()(~ ' To Building Foundation
To Disposal Field ?~- '
To Property Line z:~(~' '~'
To Water Main/Service Line '> 4-..~ t
To Stream, Pond, Lake or Major Drainage Course
-!
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed Id':)/¢ j ¢ ~
Width of Field 70> ~)
Square Feet of Absortion Area ¢;~'7 g~
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ~(.
To Building Foundation
Lot '~/~
ToWater Main/Service Line ~
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, ~arking Area, or Vehicle Storage Area
/ / ~ ,
Comments ~ ~,~'~ ~,'?~/
/ _/'¢_ 'c4/r,'~ Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutback (if present)
/
Date Installed \
Size in Gallons
"Pump On" Level at %.
Water Alarm Level at
High
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permit.t/' Bedroo !p~g Against HAA Request**
I certify that I,ha~V"echecked'; Ve¢i'fied, or conformed to all MOA and
inspection. /F///////////~/'
Signed ?////¢/'6/~'////~" - .¢
Company' (~ ~/I~¢U/ ¢ ~.~gOd "~
;ffect on the date of this
MOA No.
Receipt No. c~//7/_
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No
Waiver Fee: $
Date of Payment
Page 2 of 2
ANCHORAGE/WESTERN DISTRICT OFFICE
3601 C STREET,,SUITE 322
ANCHORAGE, ALASKA 99503
563-6775
DATE: Sept. 21, 1989
PWSID: 210485
Requested By: Corwin & Assoc.
According to the records on file in this office, the Seacliff
S/D Water System is in compliance with
State of Alaska Drinkihg Water Regulations.
the
Sincerely,
Cindy Thomas
Environmental Engineer
~ Time
Time .. ~ .
Date Date Date
Inspector Inspector Inspector
Comments Conditional Approval
Date Sewer Installed F,~^ ~,..j,~.i~ Permit No. Septio Tank Size
l0 --0 --~ ~ Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
~ ~ Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner ~. ~ ~;~'~ ~ "~- ~'~C~ I~ ~ Phone
Buyer
Address ~/~)
" Phone
Realty Co. & Agent
Address I') )
Street Location ::~ _,
TyP~ ~f Residence
~Single Family
~ Multiple Family No. of Bedrooms
~ Other
Water Supply
Individual A~ACH WELL LOG, A well log is required for all wells drilled since June
Community 1975. For wells drilled prior to that date, give well depth (Attach log if
~ Public UtilitX available,)
Sew0pe Disposal
~ Individual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSpEcTION FEE MUST ACCOMPANy EACH REQUEST BEFORE PROCESSINB CAN BE INITIATED.