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HomeMy WebLinkAboutSEQUOIA ESTATES BLK 1 LT 16Sequoia Estates Lot 16 alock 1 #017-152-16 Jun 30 11 05:04p Beau Maxim 19073391985 Mark Begich Mayor Development Services bepar*ment Building Safety Division On-Site Water & Wastewater Program 4700 Elmoce P.O. 8.ox 196650 Anchorage, AK 99507 www. muni.orq/onsi?¢ (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: Legal Description SEQUOIA ESTATES BLK 1 LT 16 Pump Installation Date: 0/02/11 Properly Owner Name & Address: ROBERT A. VALANTAS '6630 GUNN[SON DR ANCHORAGE, AK; 99516 Pump Intake Depth Below Top of Well Casing: z'm. feet Pump Manufacturer's Name: GOULDS Pump Model: 05SBOZ4-12CL Pump Size 3/4 bp Pitless Adapter Burial Depth: t0 feet Pitless Adapter Manufacturer's Name: CAMBEL Pitless Adapter Installer: Well Disinfected Upon Completion? [] Yes [] No Method of Disinfection: RECIRCULATED USING CHLORINE PELLETS Comments: Pump Installer Name: BEAU MAXIM Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES BIVlSION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000256 PIDNumber: 017-152-16 N~r.e: Wastewater System: [] New Z3 Upgrade Robert Valantas Add~e~s~0 Gunnison Dr. Anch., AK 99516 ABSORPTION FIELD IND. of Bedrooms: Phone: 345--7065 . Four ( 4 ) [] DeepTrench [] Shallow Trench [] Bed E] Mound E] Other Soil Rabng: Total Depth from origlnal grade: LEGAL· DESCRIPTION GFD/Sq. Pt. Su bdivkslon: Deplh to pipe bottom from original 9fade; Gravel depth beneath pipe Lot: 1 6 Bl~k: 1 Sequoia Estates Pt. Ft. Township: J Range: J Section: Fill added above original grade: Gravel length: I Ft. Ft. WELL: [] New · E] Upgrade Gravelwidth; Number of {ines: IDistancebeiweenlines: Ft. Ft. ClasSification (Private. A,B.C): Total Depth: Cased TO: Total absorption area: Pipe material; Existing Ft. Ft. SO. Ft Driller: Date Drilled: Static Water Le~ek Installen 7 / 2 6 / GPMIPump set at: Ft.I F~ TANK SEPARATION DISTANCES ~Septic E] Holding [] S.T_E.P. From Tank Field Station Ta.k Sew~rLines ! Anchorage Tank t ? 250 Wel~ > 100 ' Steel Two Surface > 100' ' ' LIFT STATION - N/A Remarks: Septic Tank Only Placed BENCH MARK Under This Permit. Concrete Landinq at Bottom of · . Front · Stairway. Inspections pedormed by: MEA Dates: 1st 7/26/00,~,,~¢ '**,~-~;¢,¢'~*.',-,¢, ~,.~ ,o~%~ .¢.~, Depadment of Health and Human Se~ices a reval .¢. Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Page 2 of 3 Permit Number SW000256 PID No. 017-152-16 GUNNISON DRIVE Existing Well [istin( / Jocati( Bedroom House ~i- J Not Exact) NOTE: Locations Not Surveyed. May. Not Be Exact. A B S1 10.9 15.0 S2 19.2 21.4 C2 24.7 22.7 C3 26.3 22.9 PLAN AS-BUILT SCALE1"=40' Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW000256 Page 3 of 3 PID No. 017-152-16 90.26 96.1 1 , 250 ~Gal Sep. Tank ~ 90,06 To Existing Absorption Bed 7' 6.9' NOTE: Septic Tank and Post Tank Cleanouts Placed Un~er This Permit. Existing Absorption Bed Remains in Place. PROFILE AS-BUILT 1" = 10' '~£z.L i] N. 8D %:5'0 '. OC)"P'v: /~G. ?o ' WEST BENSON BLVD. 272-9231 "HORAGE, ALASKA 99503 582-5291 .AL DESCRIPTION: · .43 PLEASE NOTE; It Il Ihl contrect LEGEND: SET FOUND El8" REBAR · O HUB & TACK I~ ~ MONUMENT ~ ~) At-CAP ~ ~) PK NAIL X MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 25, 2000 Expiration Date: Jul 25, 2001 Permit Number: SW000256 Legal Description: SEQUOIA ESTATES BLK 1 LT 16 Design Engineer: 0014 Anderson Engineering Owner Name: Robert Valantas Owner Address: 6630 Gunnison Dr. Anchorage, AK 99516-3716 Parcel ID: 017-152-16 Site Address: 006630 GUNNISON DR Lot Size: 49460 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [~ Septic Tank [] Holding Tank ~] Privy [] Private Well [] Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. July 25, 2000 Municipality of Anchorage Department of Health and Human Services 825 ~'L" Street Anchorage, AK 99502-0650 Subject: Lot 16 Block 1 Sequoia Estates Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The septic tank serving the four bedroom home on Lot 16, Block 1, Sequoia Estates Subdivision has failed and must be replaced immediately to prevent a potential health hazard and damage to private property We are therefore app y ng for a permit to olace a new septic tank at the same location as the old tank to serve the new house. The attached Site Plan and backup documentaticn identify the location and configuration of the existing septic system and the location of the new tank. It also shows the location of the oroposed well and its proximity to the septic system on this lot. The configuration of the septic system will not change and all separation distances currently in place will be maintained. The ground surface on the lot slopes in all directions from the house location. The new septic tank will be ptaced in a fairly flat area. The existing tank will be pumped, crushed and either removee from the site or buried in place. If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, wilt have no adverse im pact on drainage patterns in the area. The current drainage pattern will be Sincerely, Michael E. Anderson, P.E. Attachments LOT 16, BLOCK 1, SEQUOIA ESTATES SUBDIVSION Existing Well GUNNISON DRIVE Bedroom House Existin ~Absorpt Trench New 1,250 Gall, Septic Tank Tank sCOpE OF W 1. Remove 2. Place Ne 3. Place Tw 4. Reconne 5. Regrade 6. Revegeta RK: nd Dispose Existing Septic Tank. 1,250 Gallon Septic Tank. New Post Tank Cleanouts. Existing-Absorption Trench. ,11 Disturbed Areas. a Area As Required. SITE PLAN SCALE 1" = 40' ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 16, BLOCK 1, SEQUOIA ESTATES SUBDIVISION GENERAL: The scope of this project includes the pumping, crushing and removal or burial in place of the existing 1,250 gallon septic tanks and the procurement and placement of a new 1,250 gallon septic tank at the location shown on the Site Plan. It also includes the construction of two new post tank cleanouts. All disturbed areas must then be regarded. A minimum of 4' of cover is required over the septic tank or 2" of insulation and 2' of cover. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. Unless specifically agreed otherwise, the Contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. The new 1,250 gallon septic tank must be procured from an approved source and installed at the location shown on the plans. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. Alt standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. Lot 16, Block 1, Sequoia Estates July 25, 2000 Page 2 of 3 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION (NOT THIS PROJECT): 1. The drainfietd shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. A silt barrier or geotextile fabric must be placed between the drainfieid rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings ~ Caulder, Fernco, or equal). ' Lot 16, Block 1, Sequoia Estates July 25, 2000 Page 3 of 3 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleaneuts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. 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 ~AME VIAl LING ADDRESS LEGAL DESCRIPTION LOCATION ¢' DISTANCE TO: I/Vt + Manufacturer [..iq. IF HOMEMADE: DISTANCE TO: Manufacturer IAbsorption area ~L~ ~ / Inside length 13 I D,w~lling Material NO. OFBEDROOMS PERMIT NO. No. of compartments Liquid depth Well Dwelling PERMIT NO. Liquid capacity in gallons F/~d at ion~.. Total length of I)nes Material beneath tile Depth Crib depth II , DISTANCE TO: 1~71~ ¢, ~_en th of Ch line No. of,,.es O' Top of tile to finish grade Length Width Crib diameter I Material Nearest lot Ii b - ! Trenct) width ' C'~)' inches Type of crib Well Building foundation DISTANCE TO: Class Depth Driller DISTANCE TO: Building foundation Sewer line OTHER PIPE MATERIALS SOl L TE"~T~ RATING INSTALLER REMX~KS / ~'NEW [] UPGRADE P~E~.~)T NO.. . Distance between lines _~..! Total ~ffe~ti~ve.~sorp~.ion ~r. ea Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Sept c tank Absorption area(s) APPROVED DATE LEGAL 72-013 (Rev. 3/78} 'DEF'RR. TNEN'F OF HERLTH RND EN',,,'IR-NMENTRL F'F.'_-TEI-:TION 825 '"L'" STREET, RNCHORRGE, RK '..--~95~.'-11. 254-472F_~ : FINCHORAGE 5'_--.~4-2i]:i : EF~GLE RIVER PERMIT NO. 8S±0]:4 APPLICFINT: NEW i.,.tOR. LD INC PHONE: ]:45-~:854 R[:,[:,F.:ESS: PO BO.N :Li±]:±4 FINCHORAGE.. RI.::: S~95±:L LE.~H,_ [:,ES,-.RiF'TI]N - SUB[:,IVISION: SEQUOIA BLOCK: - LOT LOT SIZE 0 SQ. FT. TOWNSHIP: - RANGE - SECTION: - I'tRXIMLIM NUMBER OF BEDROOMS = 4 SOIL RRTING= '.i?,-" .±,.'?,--' ±?? ,::SQ. FT. ,.."DR) LISTED BEL. OW RF.:E THE OPTIONS AYFiILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THRT BEST FITS YOUR SITE. I.,.Ii[.,TH = 2. 5 FT. LENGTH = ±±8. 0 FT. NOTE ' - _-:."7'5 FT. REQUIRES TWO TRENCHES 5 FT. NOTE ~ - REQUIRES INSULRTION 0 FT. NOTE ' - MFIY REQUIRE LIFT STRTION 2 CU. YDS. 0 GFtLLONS ,::"FRO COHPAF.:TMENT TRNK) TOTRL DEPTH = 5. GRRVEL DEPTH = ]-':. GRR',,,'Et_ ',,,'OLUMF: = ]:8. TFtNK SIZE = ±., ~5L'.~. W I [:,TH = 24. LENGTH = 48. TOTAL DEPTH = . 4. GRFI',,,'EL DEPTH = 0. GRAVEL VOLUME = 42. TANK S i -.'-'E = ±., 250. 0 WIDTH = 5. 0 LENGTH = ±24.0 TOTAL DEPTH = 4.5 GRAVEL DEPTH = ±. GRAVEL VOLUME = 24. TANK SIZE = ±,250. I CERTIFY TFiFtT: FT.. FT. FT. C'U. YDS. GALLONS ,::TWO COMPFIRTMENT TANK) ][ E L [:, [:, E S ][ "3 FT. FT. NOTE - }-?5 FT. REQUIRES TWO TRENCHES FT. FT. t'-,IOTE .- MAY REQLIIRE LIFT STATION CIJ. YDS. GRLLONS ,:.'TP.IF~ Cc~MPARTMENT TRNK) ±. i A!'"t Ft~MILIAR WI]'FI THE REQLtlREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPFtLIT!~.' OF FINCHORAGE AN[:, THE STATE OF ALASK8. 2. I WILL INSTF~LL THE SYSTEM IN BCCORE:,RNCE WiTH THE CODES AND HAVE RECEI',,,'ED FI COPY OF TFIE CODE SUMMARY AND [:,IRGRRM ATTACHMENTS HHICH IS PART OF THIS PERM I T. 3:. I UN[)ERSTRND THBT THE ON-SiTE SEWER SYSTEM I"IBY REQLIIRE ENLARGEMENT IF THE RESIDENCE iS REMODELE[:, TO INCLUDE MORE THAN 4 BEDROOMS.' PERMIT AF'F'LIE:FINT N~qS THE RESPONSIBILITY TO INFORM PERSONNEL DURING THE INSTFILLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AN[:, THE NLIMBER OF' RESIDENCES THFIT THE WELL WILL SERVE. IF' ~ LIFT STATION i~ INSTALLED., B~.,I ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED. i::IS-BUIL]'S CANNOT BE 8PPRO',,,'ED WITHOUT 8N ELECTRIC8L tNSPEE:TION REPORT~ THE ELECTRiE:BL WORK MUST DE DONE BY 8 LICENSED ELECTRIE:IBN. S I GNE[:,: ~~'~~~ SOILS dbG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST LEGAL DESCRIPTION: ~"~' ~:~'~'" ~ ~:~ 2 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS -'~-~C'~ '~,,,..~.) (~o.~::~ WASg~ROUNDWATER ~'~,,l~ (~.,".~ (~'4~.~ ENCOUNTERED? DEPTH? SLOPE SITE PLAN r_.~~ s L O P E Gross Net Depth to Net Reading Date Time Time Water Drop · z '.q~ o , ~b PERCOLATION RATE ~J ~ ~ (minutes/i CERTIFIED BY: ~t - ~ DATE: 72-O08 (6/79) Alaska F~p. viron, mentat Con. trol k~er_ vice, Inc. 12(i)0 h'est 33rd Avenue, Suite A r~ci%oraqe, Alaska 99503 Subject: As-Ruilt, Lot ' ~ Se,it c)qa Subdivision f',.ear ~4ro Reid: The er, giDoer"s as-buitts ~:hic.h }lave beep, submitted to tbi~= offic~ are Dot wit},il~ tho p~ra!-~otors of the oD-site iD~tslla~.iol~ permit issued by thi~ depsrtr~oDt, The discrepancy tigteO below will n~ed to be addressed before this depart~-~o~t cad ~ccop';- the sub- mitred engir, eer's as-buitts, ,.% request foF 6 ~oo{'~ waiver betweot% ~=~.. ~-')~n~'~, bed and lot line ,'-~ior to septic syster,~ iDstal]atioD, ALASKA b, UIROrlmeF1TAL COI TROL SI hulC{!S, InC. I~nclineePJncI 8 ~nuironmenlal Studies June 28, 1984 Department of Health & Environmental Protection 825 L. Street Anchorage, Alaska 99501 Attn: John Kennedy MUNICIPALITY OF ANCHORA(31~ DEPT. OF HEALTH & ENVIRONMENTAl. PROTECTION J U N 9, 9 1984 .RECEIVED Dear John: Reference my phone call of the June 27, 1984 for Sequoia Estates Lot 16. The inspection form dated 12/5/83 shows the distance to the edge of the bed to the lot line of 6 feet which is 4 feet closer than the 10 foot minimum requir~nt. In early December of last year we contacted the Health Department and asked if this would be acceptable and we were told that it would be. However, at that time you and I beth know that documentations of waivers were not being done but it was on a word basis. We have looked at the situation and have found that there are no on-site sewer systems located adjacent to this lot and we doubt that this will create a problem in the future. The soils were 177 sqft/bedroom and the soils are such that the ground water flow curve would be such that one would not expect it to cross that lot line under these circumstances. We there by request that you waive the 10 foot distance. If you have any questions please let me know. Sincerely yours, PE 1200 UJest 33rd Aucnu¢. Suite [~. Anchora§¢. Alaska 99503.(907) 561-50/10 ALASKA iUll OI Ill F TAL COF1TI OL I~nqineeHnq 6 I~nuironmenlol Studies May 9, 1984 Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 Attn: John Kennedy RE: Lot 16 Sequoia Subdivision iVlUNICIPALITY OF ANCHORAGI~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIOI~ 1984 C) c) .RECEIVED' John: I have reviewed the information available in our office concerning this property, and do not know if this matter has ever been resolved. From speaking with Jim Green, the inspector, it appears that this took place during the transition period in which information concerning the necessity of clearing waivers during the inspection was just reaching our office. Up to this time, it was fairly routine to obtain a waiver of 5 feet to the lot line in property with space restrictions. Overall, I believe that this matter is tied to communication problems between our office and yours, and would like to clear up any questions which you may have. The placement of the system within 6 feet of the property line does not pose any health problem, and is situated within the clearly defined property lines, ensuring that no disputes will arise over its placement. I am aware that prior approval by the DHEP should have been obtained, but considering the circumstances and general confusion over procedures, it would appear that this matter can be best resolved by obtaining a written waiver via DHEP. Should you have any further questions, please contact my office. / Sincerely, (~/~ (. /~ [ Harald R. g~hlers Environmental Engineer 1200 LUgsl 33rd Aucnu¢. $ui1¢ B, Anchoro§e. Alosko 99503'[907) 56~-5040 A'LASKA ENVIRONI~r-'TAL Jo.. /-~ CONTROL A.-,..~,~lr.l~Vl~l:.~., INC. SHEET NO* OF 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 CALCULATED BY ~ OD DATE Phone 276-:136]. CHECKED BY DATE .... Ma~ch ~5,84 Static Water Level 198 f~et Gallons Per Minute 6 Draw Down N/A feet Total Feet of ~asing 2i8 Type Material Drilled: feet to '10 feet Silty clay feet to. 40 feet fine sand 40 feet tO 1,13 feet Clay 113 feet tO 117 feet Gravel/clay , 117 f~et tO 145 feet Clay eravel w/i mnm water 145 foot to 120 foot C]a~ I ?r~vol 155) to 218 gravel w/ water Hefty Drilling S.R.A. Box 1553 H Anchorage ,Alaska 995O7 (b) Applicants Nam~ L,~c_~u2~)o~[Q ~o~e~ ~. ~uC_ Applicants Add~e~s,s ~ tO 5-C)~NQU$7~ UJ~ (c) Applicant is (Che'ck one) Lending Institution muye~ F----}; Othe~ ~ (explain); (d) Lending Institution Telephone % ~ ~'- '~'~_"/ ~-~; Owner/builder ~; Telephone P. ';G, - 19 I I Address ~qS' ~ % ~z~-~-~ T (e) Real Estate Co. & Agent Telephone 2. T_~oe of Residence Single-Family ~ Number of Bedrooms Multi-Fancily ~ Other (describe) 3. Water Supply Note: If cc~[~.~nity well system, must have w~itten confitn~ation f~cm the State Department of Environmental Conservation attesting to the legality and status. · Is the well adequate fo~ the number of bedrccms specified in this HAA ) ~ 4. _Sewage Disposal Onsite ~ Public ~-~ Coi~uP, ity E~ Holding Tank ~-~ Is the wastewater disposal system adequate fc~ the numbe~ of bedrocks ~;~N) 2-15-84 Engineering Firm P~oviding Inspections, Tests, Data and Information I certify that I have checked, verified, oF conformed to all ~DA HAA Guidelines in Nam~ of Firm ~¢-5 Telephone ~-~[-5-OYO Address s gned by Date I oo u (ENGINEER SEAL) 6. DHEP Approval Approved for Approved ~ ~- kedroc~s Disapproved Te~s of Conditional Approval Conditional Date The Municipality of Anchorage Depaz, tment of Health and Environmental P~otection dces not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer ~egistered in the State of Alaska, the water supply and wastewate~ disposal system is safe and func- tional for the number of badrccms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: ' KB2/d5/s [gage 2 oE 2] 2-15-84 MUNICIPALI?f OF ANCHORAGE (MOA) HEALTH AU~qO~ APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Wgll .Classification ~ Well Log p~eSent~N) ~O > ~.~N'IC~*Ln"¢ 9F ANC"WO.I~k~I~ O.EFF. OF HEALTH ENVIRONMENTAL PROT~"I'IO~ i JUL 9, '1984 Legal Description: ~T/EI ~£ 5~4o~A Total Depth~ 2J~' Static Water Level-~ Casing Height Above Ground ~' Electrical Wiring in Conduit~_(~N) ~ ~ Separation Distances f~c~ Well: To Septic/Holding Tank on Lot /~-~, ~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~J J/~.- Cased to ~- ,~l~" /9' '2' At If A, B, c:~ C, D.E,C. Approved(Y/N) ~/~ Date Completed ~-I..S- -- ~ y Yie~ ~//~,i~~ Depth of G~outing sanitary seal on Casing ~)~5 Depression Around Wellhead (Y~ ; On Adjoining Lots ~-~ ; On Adjoining Lots G-T To Nearest Public Sewer Cleanout/Manhole ~ To Nearest sewer Service Lir~ on Lot ;~/f~- Water Sample Collected By ~0~ C-oOQ~ ; Date -~s-~ FY /3:~o~ Water S~le ~st ~sults ~ ~ ~ ~te Installed~ I~-~-~ Si~ I~O NO. ~ C~nts ~ ~' Cleanout ~) Sta~pi~s~) ~ Air-tight ~ps ~) ~3 Foundation ~pression o~r Ta~ (Y~ ~O ~te ~st P~d ~ ~ P~ing~intenan~ ~n~a~ ~ File (Y~) ~ ; for Holding Ta~ High-Wate~ Ala~ (Y~) ~ ~ ~~ Holdi~ Tank ~t (Y~) ~[~ Sep~ation Distance ~ ~ptic~olding Ta~: To Water-sUpply ~11 /5'q.q ~ To ~ilding F~ndati~ /O. ~' To ~o~ty Li~ ~, 0~ To Dis~sal Field ~ ~ ~ I To~t~~ ~_ ~ ~vi~ Li~ ~ ~ To S~e~, Pond, ~e, ~ ~3or ~alna~ cou~~: &[~ ?~ . '",: .... :; '..,':2,,~% · ..... [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed $' IP--5--q--~ Length of Field Width of Field ~ ~.~t! Square Feet of Absorption Area Depression over Field (Y~_$~ 6dO Results of Last Adequacy Test Type of System Design Gravel Bed Thickness ~- ~]~- Standpipes P~.esent ~N) Date of last Adequacy Test Separation Distanc~ f~om Absorption Field: To Water-Supply Well /~ ~ To P~operty Line ~, q To Existing or Abandonsd System cn ; On Adjoining Lots ~_ , 17 ~- To Cutbank(if present) ~- To Building Foundation ~P Lot ~ % To Water Main/Service Line To Stream/Pond/Take/c~ Major D~ainage Course ~//~ To D~iveway, Parking Area, o~ Vehicle Storage Area Comments .~--fn4(~ ~,~ ~ %~]~ ~1~'. De Date Installed Size in Gallons "Pump O~" ]level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dirge ns ions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Combatants ** Check Permitted Bedroom Rating Against HAA I~mquest I certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect on the date of this i~pe~ ction. S igne d . 7£C5 KB1/d5/s [Page 2 of 2] ai 2-15-84 ALASKA ellOIROrlmerITAL COI1TBOL ~nclincerinq $ ~nuironmcnlal Studies InC. July 12, 1984 Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 Attn: Keith Bandt Legal: Lot 16 Block 1 Dear Keith: Sequoia Estates On July 3, 1984 I inspected the well on the above property. The well wires were in conduit which was attached to the well seal. This complies with the conditional approval granted by your department. If you have any questions please contact me at 561-5040. Approved: Sincerely, urner (Environmental Scientist 1200 LUest 33rd Aucnue. Suite ~ o Anchoraqe. Alaska 99503 ,/907) 561-50~J0