HomeMy WebLinkAboutSTUCKAGAIN MANOR BLK 2 LT 2Stuckogain Manor
Lot 2
Block 2
#041-023-02
MUNICIPALITY OF ANCHORAGE
ilzcnt
On -Site Water & Wastewater Program 10 - s',
PO Box 196650 4700 Elmore Road i
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite v
tiCl)81'hilCllt
On -Site Wastewater Disposal System Permit
Permit Number: OSP221404 Effective Date: 11/30/2022
Work Type: Septic Initial Expiration Date: 11/30/2023
Tax Code Number: 04102302000
Site Legal Address: STUCKAGAIN MANOR BLK 2 LT 2 G:2043
Site Mailing Address: 10001 FARPOINT CIR, Anchorage
Owner: WOJCIEHOWSKI JAMES M & JOYCE Lot Size in Sq Ft: 48276
Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 5
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: SS T`3 1vb dila- IZ (�
Issued By: (Q��
Date:
Date: Z
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 04102302000
Property owner(s) WOJCIEHOWSKI JAMES
Mailing address 10001 FARPOINT CIR
Site address same
Day phone 230-3409
Legal description (Sub'd., Block & Lot) STUCKAGAINMANORBLK 2 LT 2
Legal description (Township, Range & Section)
Lot Size 48,276 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR:
APPLICATION IS AN:
(® all that apply)
Absorption Field
0
Initial El
Septic Tank
0
Upgrade ❑
Holding Tank
❑
Renewal ❑
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
TYPE OF DWELLING:
Single Family (SF) El
(w/wo ADU)
Duplex (D) ❑
Multiple Dwellings ❑
(SF and/or D)
Distance:
1 certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: G J
Date of Payment: nU o2
Receipt Number:
Permit No. S P 2/
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
SteveEng.com Stuckagain Manor B2 L2
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is an existing 3-bedroom, single family home. This is a
developed subdivision. An ADU is planned; the septic system is oversized to
accommodate a future 4-bedroom house connection. A new trench is planned + new 1500
gallon Septic Tank. Slope at the new trench site is level and falling away to the west as
indicated. No adverse conflicts to the other lots will take place by this septic system
construction. A new soil test reveals SW w/gravel. An application rate of 1.2 GPD/FT².
Trench Length = 625 FT²/(6 x 2) = 53 long trench, 6 effective, bucket width. Easements
depicted in the Plan view, private water wells serve these lots. Add double cleanouts prior
to Septic tank for future location connection for house. 10 trench depth requested due to
recent soil test.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
Two compartment, new 1500 gallon septic tank. Install Double Cleanouts both sides
of tank. MOA-Spec Material Under Tank.
10 minimum between the tank to house, property lines, 5 between tank & trench.
3 of cover or insulation is required for trench; 2 Minimum thickness for insulation
can substitute for 1 cover.
Tank & solid pipe must be set on well compacted, stable soil.
4 inch diameter cleanouts with airtight caps are required 1 to 4 from foundation
wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two
adjacent opposing cleanouts between the tank and the absorption field, not more than
10 from the tank positioned to provide cleanout access towards the tank and towards
the absorption field.
All cleanouts must extend to at least ground level.
In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
Trench to be placed level, minimum of 4 to groundwater, 6 to bedrock from drain-
rock.
Drain rock to be ½ to 2 screened, distributed uniformly throughout the trench.
Perforated pipe to be installed level with perforations down.
Silt barrier (filter fabric) to be installed above the drain rock.
Smeared trench sides must be raked or scarified before drain rock placement.
The finish grade must be mounded to promote drainage away from trench.
Insulation must be placed over any pipe installed under driveways or parking areas.
Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
Sewer Service Line is minimum 2% slope.
Septic Tank to be pumped every two years or when required.
Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221404, Curtis Townsend, 11/30/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221404, Curtis Townsend, 11/30/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221404, Curtis Townsend, 11/30/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221404, Curtis Townsend, 11/30/22
w
U
W
0
W
D
OD
D
1n
z
D
0
I
r
0
O
v
N 00.03'17'W 257.49'
z
O Q
O o
O
09
11 1
�t
ao+
o
v
0
N
m e m
J
W
O
wa
a�
SII
w0
O W
�wh0
N330
111
I�
v
,Z'bZ
0.2
O 0 L>
W
a¢
p J
�<
N
w
I
Of
J°
Q
=
10.411
.Z'bZ.
1 w
Iz
z
�
W
oW
w
Z 3
I
16-2Q
SHED
m
ONO C C
0
O
f °
�W
am f
0
u°1 p 0
O ap E+ j� 0
o1n
�z
0
0 L
v OL n o
Z
o
>tt
O W
O+ N
oa
w
N �
�
�I
I
Eo
O O O U
��
-0o
w a
v+
a v
/
J
o
I
0
O
v
N 00.03'17'W 257.49'
z
O Q
O o
O
09
Q z
�t
ao+
�I
v
0
N
m e m
J
W
O
wa
a�
SII
w0
O W
�wh0
O
^
:J
J
0.2
O 0 L>
N
a¢
p J
30.0
w
I
Of
I
°
a
O
u
W
W O
M
oW
l �
0
'O.-.Eo0 0O
m
ONO C C
0
O
f °
am f
0
u°1 p 0
O ap E+ j� 0
0
0 L
v OL n o
�+
L
TO
O+ N
I
0 0
.2�oto2
gLUo+v
�I
I
Eo
O O O U
��
-0o
w a
v+
a v
/
'a 0
C
o
I
mm
001; O
O
T
I
+p
O M, a O
S 04'03'21"E /235 57'
0 0
0 0e
<vma°x
°
o
O
\
U
0. 0
0 Q :,a 0 0
T
v
O L
OYp O cO S teO
0 «
O] 0 0 O
LN
I
O
O C°
�
0) CL d
I
.Z'V
ori c£o -0
t 0
0
�d
0
0
m m�p•Eco
0
°
o p o c
:E 00
\
OO
,Z'9f
/
<3a0ao
0
Se
Sn�Obb)
01
N
.6*f1
)3M 3�/1J31p00,
b
w
I
,L'9L
Q N
c1 IN
^1
N N
3
O�
>1030
J 00
W I
J
M2:
nm
i
Cp
S�
\
0
O
44.0'
00
/
a II
Q
o
co
/
�M
a<w
of
LL w
4. .
cr UL
RAP
0
0
4
44.0
m
15.0
'n
arn0
a
4j
N
U
Z
1
0
O
° aC
�'•\\ ~y
O VO
I � t
IQ
0
z m
rn
m o
0
a` c °
c
o x
aI 0 0 C4
VI < 10
�I NN
C-4 14
Ln in
O n n
C 1! v00
O ^ v
ri
0
v
m
t
I
MI U i
T
^I �
w (n L
Q
UU) t V)
'0 J
7 N
M V) _
a Q a
c
O
xl 8d"V)
I to
o C O
a J CL
v
N 00.03'17'W 257.49'
z
O Q
O o
O
09
Q z
�t
ao+
�I
v
0
N
m e m
J
W
O
wa
a�
SII
w0
O W
�wh0
O
^
:J
J
0.2
O 0 L>
N
a¢
p J
30.0
w
I
Of
I
°
a
O
u
W
W O
M
oW
l �
0
'O.-.Eo0 0O
m
° aC
�'•\\ ~y
O VO
I � t
IQ
0
z m
rn
m o
0
a` c °
c
o x
aI 0 0 C4
VI < 10
�I NN
C-4 14
Ln in
O n n
C 1! v00
O ^ v
ri
0
v
m
t
I
MI U i
T
^I �
w (n L
Q
UU) t V)
'0 J
7 N
M V) _
a Q a
c
O
xl 8d"V)
I to
o C O
a J CL
v
z
O Q
O o
O
09
Q z
�t
ao+
1
v
0
J O
m e m
J
W
O
W
O W
�wh0
O
N 4
U
<
0.2
O 0 L>
N
O O
30.0
w
I
Of
I
°
Cz OD
O
W
W O
O
I
I
�nI
O V
t�l
0
'O.-.Eo0 0O
J
ONO C C
° aC
�'•\\ ~y
O VO
I � t
IQ
0
z m
rn
m o
0
a` c °
c
o x
aI 0 0 C4
VI < 10
�I NN
C-4 14
Ln in
O n n
C 1! v00
O ^ v
ri
0
v
m
t
I
MI U i
T
^I �
w (n L
Q
UU) t V)
'0 J
7 N
M V) _
a Q a
c
O
xl 8d"V)
I to
o C O
a J CL
v
s
O o
0
�t
ao+
v
0
m e m
o
O o
O
o
Ea
�wh0
N
U
<
0.2
O 0 L>
U +
>
=M os
°
oa
0 v O
wN
ea. f0o
I
I
�nI
O V
t�l
0
'O.-.Eo0 0O
0
C�
ONO C C
f °
am f
0
u°1 p 0
O ap E+ j� 0
0
0 L
v OL n o
�+
L
TO
O+ N
I
0 0
.2�oto2
gLUo+v
�I
I
Eo
O O O U
��
-0o
w a
v+
a v
'a 0
C
o
I
001; O
O
T
+p
O M, a O
0 0
0 0e
<vma°x
°
of
U
0. 0
0 Q :,a 0 0
T
v
O L
OYp O cO S teO
0 «
O] 0 0 O
LN
I
O
O C°
�
0) CL d
I
.Z'V
ori c£o -0
t 0
0
L) a 0 C
O a 0
0
0
m m�p•Eco
0
00
°
o p o c
:E 00
O
OO
L
-0
<3a0ao
0
c I C, 1 C4 a r,r {;. 73V I i & p u a r ,-:0794_-0712 P, 1
be'v21cpmert Scvvces bepartment
90 Building Safety Divisiwi
7 On -Site Water WaStmoter .Programs
470C Elmore RCC
-
29,6650
116k lil
mae,304'ch AK. 3P9507 A F c T.Y�
ME YC 411.11-1 1_111 M,
Pump Installation Log
Well Dtiffing Permit Nuua�ev;
Parcel ldcutification Nit mber:_o L� 0 2 3 - o2 -
Legal
cc,'kn Cylo-nor �)� L2
Pump T11stalIndon Date:
Pump Intpke Pq)tb Relow l.,)p oi'M'01 C2sing'. feet
Pump Model:
PL111111 SiZL ��Jlp
Phless Adapter Burial Deptlit feet
Pitless Adapter
Wel! DiS Sinfelcted Upon Compiefion?,
- Yes No
N1 e thod o f D ishqft c tj un -
(
. orlimie tits:
Pump histaRLr _Naxe:
Datc. of is me.
I'; - t. () ` n e 1. IN, a I f ic &, Address:
Atteution. Thea e i,,jsta ler 3J all plovtdc -1 pump insmIuioy.,, log to the DSD Nvichin A days ofnu.mn iwtallat;,Y,
~ 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
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
AbsorlJtion area Dwelling
DISTANCE TO'.
Manufacturer Material
Liq, capacity in gallons ' Width
Well
DISTANCE TO:
PHONE J~EW
~/~ z//~ -~ ~)~yc~ [] UPGRADE
NO. OF BEDROOMS
PERMIT NO.
Liquid depth
Dwelling PERMIT NO.
Manufacturer Liquid capacity in gallons
Material~/ 0 /
Nearestlotline
Trench width
~ ~ ~inches
inches
we~. ~
DISTANCE TO: JJ~o (~')~¢~.
/ Length of~ac,~,~'- ':-- ,.
Top of tile to finish grade
Length Width
Foundation
.Material beneath tile
Depth
Distance between lines
Total eff~¢~b?;~ption area
PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot llne
DISTANCE TO:
Depth Driller Distance to lot llne
foundation Sewer tine Septic tank
DISTANCE
OTHER
PIPE MATERIALS
b, o 4
SOIL TEST RATING
NSTALLER
REMARKS
~- /,
LEGAL
APPROVED DATE
DEPARTMENT OF ~A'TURAL RESOU~E$ ,,:.
Division of Geolo~ic~'l ~t"G~hysl~ol~Sdrve~ '
.'~' ~"~;~'.'- " .' ' ~ ~ ~o ~of ~ ' S w '
~ '~-.:' ~. . ~ ~_ _~ , ~ ~ .; .
~;~ ~~RECTION FROM ROAD INTERSECT~NS ~ OWNER ~F "*¢
~J~=~"l~aB~dv--~.~,~-,.,~ .' ~-. , [~ ' ' '" · ~: ' ' - - :'. ~ ~ -
~ ~a~a. a~ ......... - ..... , .... . ...... . ....
.. ~..~ . . -. , .
6 ¢~$%~.;'~ · :";.~ '-. '- ' .- ,,' ~. ~ ~ ...... . .
;~;J~[WATER?~LL~'CONfRAOY0~ CERT F CAT ' ' '
· ,~:~j~..~}~ ~:~(~: Reglsf~red Busmess N~e Cg?ro t License Number
-'.~'c,F~RTf,IENT OF HEFIL, TH RND EN~IF_NHENTHL F'ROTECTIOI'~
F- '- ' T RNL HuF..MbE FtK. 995EI::L
:~.:;, '"L" =,TREE :
PERMIT NO.
RPPLICRNT 1.4ILLIRH 9TRUTZ
LOCRTION
LEGRL L2 B2 STUCKRGRIN MRNOR
±£~E~E~± FFIR POINT CIRCLE
LOT :,I ~.E
9'9.507 -m:44-28:-::5
4a.c, 4... :.,I=~LIHRE FEET
T' ' ' '- ] c' ''= TRENCH
.'¢FE OF =,LIL FIE:SZt']'F'TION _,-r_,TEI'I IL:;:
, · -, ,--,,:' - .:,EIL RRTING
MR;:'::IMIJf'I NLIHBER. OF E, EE. RuUil- = -:': '-t
THE REL.]UIRE[:' :,I,'-E OF THE '-]OIL FIBSORF'TtON =,'r:.,TEi'l IS:
[:.E P-f'H = 9 L E[c-~STI4= ¢__~. .
THE LENGTH [:,iMENSiON IS THE LENGTH (tN FEET) OF THE TRENCH 3R [)RRINFIEL[:'.
THE [)EF'TH OF R TRENCFI OR PIT IS THE [:,ISTRNE:E BETHEEN THE =.LINFR_.E OF THE
.- - ~', ENCRVRTION ,'IN FEET:.".
GRZI_I~'~D RN[) THE E, uTtCI1 OF THE
,- ,= F]F' TRENL. H~-. P~PE
THERE l.:, NO _,ET WIDTH -' -'=
THE mRH EL DEPTH IS THE MINIMUM DEPTH OF GRR'¢EL. BETFtEEN THE OUTFRLL
RN[:, THE BOTTOf'I OF THE EXCR'¢RTtON ,::IN FEET).
PERMIT HFFLI_.HNT- '' C-. HRS THE RESPONSIE:ILiT'¢ TO INFORH THIS [:,EF'RRTMENT [:,URING THE
INSTRLLRTiON IN=,FEL. t ~UN: OF RN'T' 1.4ELLb RDJRCENT TO 'THIS FR.FER] T RN[:, THE
RE_,IDENI_.E- THRT THE WELL WILL
NLIMBER OF : ' ' ': ': '"'
,-'": '," 1.4ITHOUT FINRL INSPECTION RN[:, HFPF- HL THI_,
BRCKFILLZNG OF BN:T' :,T_,TEI - ' '-"- B'T'
[:,EPRRTMENT 1.4ILL BE 'BIjBJECT TO F'ROSEE:UTION.
i'tiNIMLIH [:,ISTRNCE 8ETHEEN R HELL RN[:' RN'T' :N-SITE SEN~GE [)ISF'OSRL S'¢STEf"I ILq
~.~ FEET FOR R F'RI'¢RTE HELL OR 15~ TO 2,.'~¢~ FEET FROH ~ PUE:L. IC WELL [:,EPENDING
UF'ON THE T'T'F'E OF FUE, LI-. WELL
MINIMUM [:,ISTRNCE FROH R PRI',,,'RTE ~4ELL TO R PRIVRTE :,EHER LINE IS ';'R FEET RN[:'
TO R COMMUNIT'¢ _EHER LINE IS 75 FEET.
I.,IELL LUU_,-'"= FIRE REQUIRE[:' RND i'"!UqT_ E:E RETLIRNE[' ' ' ) TO THE [:,EPRRTMENT HITHIN Z;C4 DR'T'S
OF THE NELL COHF'LETiON. . ..... =.
OTHER REQUIREMENTS MR'¢ RPPL'T'. SPECIFtCRTIONS BN[:' CONSTRLICTION [IHaFRH_ FIRE
R'¢RILRE:L.E TO IN=,URE F'ROF'ER INSTRLLRTION.
F'ER[""~ % T E;:~F" Z F.E_. [:,EC:E["']E:ER
I _.ERTIF~r TI-IRT
:1.: I RI',1 FRMILtFIR WITH THE REQIJiREi'"tENTS FL]R Ltlq-_,ITE .:,EHER_, Ri't[:, klELLL-] RS SET
FI3RTH E~'TI THE MLINICIF'RLIT'¢ OF RNE:H]RFIGE
.... :' ....... ' ' - ¢'" TRE UL DE:.,.
~"~' I ktILL INS'fRLL THE :,-~_TEII IN IdbL. UF..[HN~.E HITH -']' '-
.... ENLH, " ·
m- I JN[)ERSTFIN[:' THRT THE ON-L-]iTE SEHER q"r'S~EH MFI'¢ RELqUIRE -~3EI'tEiqT IF THE
'TESiDENCE IS REMO[:'ELE[:' TO INCLU[)E FIORE THRN 3: E:E[:,F.:OEMS
' EE:, BY. ......... E.i-~TE ............... ;S.~',~¢'¢-c e,~:~, ,,,4.. O
H [l.L I]RH SYRU TZ
~pPI~ D~NT
U]GFIT i~
LEG~-1L
LOT
9950?
DEPTH~ '-~ LE~dDTH~ 26 GRR%-'ECL E~EF'T~t~
· :~:'-4-_~H~ LENGTH D~DIENDION ~'~ THE LENGTH fin FE~) OF THE FNEN~H OR OR~[NFI~D,
THE DEPTH OF A TREHCH OR PIT [5 I'HE D[STSN~E 8ETHEEN THE SU~RCE OF THE
THEF:E I5 NO 5E~ i,I[DTH FOR TRENCHES-
THE ,~RAVEL DEPTH [~ THE HINIHUM DEPTH OF qR~VEL 8ETPlEEN TNE QUFF~L P[~
~ -- L UPON THE TYPE OF PUBLIC HELL
.' O~ FH~ [,ELI_
_- F'ERi,11 T E>-=;P I REg C~EC;EI~i~E~: ]~-' -J. 982:
[ CERTIFY THBT
~ 2: [ HELL [N~T~LL THE 5YSTEH tN ~CCO~D~HCE H[TH THE COOE~. .
~ ~: [ IJNOERSf~NO THaT THE 0N-SIf~ SEHER ~'PSYED1 PI~Y R~QUIRE ENL~]EI'IEHT IF I'~
~ R~S~O~NCE ES R~HODELED TO IHG~UDE DtO~ fH~N · D~DROOPI~.
RPPL~C~NF HILL~I ~FRIJF~ -- I
MUNICIPALITY OF ANCHORAGE
[] PERCOLATION
DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION TEST
82§ L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PEREORMEO EOR:
· E~ALOESC"'PT'O": ~'T :2:
1
2
4
5
6
7
SLOPE SITE PLAN
10
11
12
13
14
15
16
17
18
19
20-
No, 2225-E
JUNE
WASC.O'.OWA'ER
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Cross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
FT AND
minutes/inch)
FT
COMMENTS
PERFORMED BY: W-~
72-008 (6/79)
ParcelI.D.#
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P,O. Box 196650 Anchorage, Alaska 99519-8650
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
0~1-025-02
1. GENERAL INFORMATION
Complete legal description STUCKAOAIN MANOR SUBDIVISION: LOT 2. BLOCK 2
Location (site address or directions) lOOOl FARPOINT CIRCLE
Property owner
Mailing address
Lending agency.
Mailing address
DAVID & ELLEN RECHENTHIN Day phone
10001 FARPOINT CIRCLE. ANCHORAGE. AK 99507
Day phone
(907) 332-1055
Agent GREGG BRODERICK Day phone (907) 727-9627
Address c/o PRUDENTIAL VISTA. 4241 "B" STREET. ANCHORAGE. AK 99505
Unless otherwise requested, HAA will be held for pickup.
2, NUMBER OF BEDROOMS: 5
3, TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE: If community well system, provide written confirmation fram State ADEC attest-
ing to the legality 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
lng to the legafity and status of system.
72-O25 (Rev. 1/91 ) Front MOA #21 Computer Version
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $550.00 at,
or prior to, closing for the engineering services provided.
5. STATEMENT OF INSPECTION BY ENGINEER
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 application 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 inspec~on, the on-site water supply and/or wastewater
disposal system is in compliance with all Municipal .a~¢ State codes, ordinances, and regulations in effect
on the date of this inspection. ./~/--
Name of Firm ALASKA WAT~& ¢/S'fE~/TEF~ CONSULTANTS, INC. Phone (907)337-6179
Address 6901DEBARRR~AD,~SL/I'I~= 2/B/(A/NOHdRAGE, ALASKA 99504 . /
Engineer's Signature ~_ .//~ ~ ~]' Date
In conducting this evaluation, AWWC, In~, a~e~ tted to prowde a thorough, conscientious engineering analysis of the
system in accordance with ADEC and MOA DHI- S 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 sen/ed 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 3
Disapproved
Conditional approval for
bedrooms
bedrooms, with the following stipulations:
Additional Comments
By: ~/~///~ ~// ~/J.~/. ~¢~'-- Date ~ ' ~L ~ - d
The Municipali~ of Anchorage Depadment of Health and Human Se~ices (DHHS) issues Health Authod~
Approval Ce~[ficates 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 couAesy to purchasers of
homes and their lending institutions in order to satis~ ce~ain federal and state requirements. Employees of
DHHS do not conduct inspections or analyze data before a ce~ificate is issued. The Municipali~ of
Anchorage is not responsible for e~ors or omissions in the professional enginee¢s work.
72-025 (Rev. 1191) Back MOA #21 Computer Version
Health Authority Approval Checklist
Legal Description: STUCKAGAIN MANOR S/D; LOT 2, BLOCK 2 Parcel I.D.:
A. WELL DATA
Well Type_ PRIVATE
Log present (Y/N)
Total depth 150
Sanita~J seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0
,ECEIVED
AUG 24 RO00
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVI~,ES~^ui~
.... Environmental Services Division ~q. ONMENTAL
825 L Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744
N/A
041-023-02
Nitrate
Date of sample: 7/28/2000
B. SEPTIC/HOLDING TANK DATA
Date installed 8/83 Tank size
Foundation cleanout (Y/N) YES
Date of Pumping 8/25/2000
C. ABSORPTION FIELD DATA
Date installed 8/83
Length 28 Width
Effective absorption area 280
Date of adequacy test 6/3/99
Fluid depth in absorption field before test (in.);
Fluid depth DRY (ins)Minutes later:
Peroxide treatment (past '12 months) (Y/N)
72026 (Rev. 3/96)* Computer Version
75' 82'
7 g.p.m. 3.9+ g.p.m.
ATINSPECTION
6/3/99
0.5 mg/L Other bacteria 0
Collected by: A.W.W,C., INC,
1000 Number of Compartments 2 Cleanouts (Y/N) YES
Depression (Y/N) NO High water alarm (Y/N) N/A
Pumper McDONALD'S PUMPING
Soil rating (g.p.d./ft2. or fl2/bdrm) 85
2.5 Gravel thickness below pipe
System type TRENCH
5' Total depth 6.7'
Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO
3 Bedrooms
gal. water added (in.):15 3/8"
450+ GPD
Results (Pass/Fail) PASS For
DRY Immediately after 740
18 H RS Absorption rate =
NONE KNOWN If yes, give date
LIQUID LEVEL @ 11" ON 7-28-2000
FROM WELL LOG
8/83
If A, B, or C, attach ADEC letter. ADEC water system number
YES Date completed
Cased to 150
YES
8/83
casing height (above ground) 12"+
Wires propedy protected (Y/N) YES
D. LIFT STATION ~
Date installed
Manhole/Access (Y/N) ~evel at* "Pump off' level at*,
High water alarm leve?~ *Datum
E, SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
100'+
IO0'-F
On adjacent lots
On adjacent lots
N/A
100'+
100'+
Public sewer manhole/cleanout N/A _
Sewer/septic service line
25'+
Liffstation N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation . 5'+ Property line 5'+
Water main/service line 10'+ Surface water/drainage 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Building foundation
Surface water
100'+
Curtain drain
F. ENGINEER'S CERTIFI
I certify that I
of Municipal r~cordrs
with MOA H~A gui~e,
Signature \-i/~
Engineer's Nam~p
Date
NONE KNOWN
~ld inspections and review
fstems are in conformance
this date.
JEFFREY A. GARNESS
Absorption field 5'+
Wells on adjacent lots 100%
*UNDER DRIVEWAY
AS ON LAST HAh
10% Water main/service line 10'+
Driveway, parking/vehicle storage area *.~'0'+
Wells on adjacent lots 1 oo%
HAA Fee $
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
ComlS¢ete legal description
Lot 2; Block 2; Stuckagain Manor Subdivision
Location (site address or directions)
10001
Farpoint Circle
AK
Anchorage,
Prope~y owner Aric Cunningham Day phone
Mailing address c/o Dynamic Properties 3111 "C" St. Anchorage, AK
tending agency Day phone
M~ilin. g address
^g'ent Stacie Herr±nq/Dynamic Day phone 261 -?600
Address
99503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Xx
Individual well
Community well
Public water
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:
XX
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
5. STATEMENT OF INSPECTION BY ENGINEER
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 application 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
Name of Firm
Address
Engineer's signature
ALASKA WA'r~
/f~NCHOR~(
ATERh is inspection.
Phone
-'28
S? 7-~/7~
Date
Wastewater Consultant~,
Shall be PAID ~$ //-2~~ at,
or prior to, closing for the
Engineering Services Provided.
DHHS SIGNATURE
~ Approved for "r'/~/~F~¢ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
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 DH HS 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.
Municipality of Anchorage JUN ]
DEPARTMENT OF HEALTH & HUMAN SER¥46E~Y o~
Environmental Services Division~NVIRONMENrAL s~RV~CES e~V~S~o
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Legal Description:
A. WELL DATA
Well type ~r~-,
Log present (WN)
Total depth
Sanitary seal (Y/N)
Health Authority Approval Checklist
~ ~-- R"~/~-'~. -.~ ~'"~:~"t~O{~--' Parcel I.D.:
IfA, B, or C, a~ach ADEC leEer. A~E~ water system number
~1~ Date completed ~b~/e~
Cased to /~ Casing height (above ground) /~ //~
~,~ Wires properly protected ~/N)
~. FROM WELL LOG AT INSPECTION,
/
Date of test
Static water level -7~'- f ~ ~ /
Well production
g.p,m.
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
' /~/ /Y/~//-- Other bacteria
Coliected by: ~ ,.~)~.,O ~ j I ,O C-.
Number of Compartments 'Z- Cleanouts (Y/N)
Depression (Y/N) nO High water alarm (Y/N)
B. SEPTIC/HOLDING TANK DATA
Date installed ~/~Tanksize
Foundation cleanout (Y/N) ~'
Date of Pump,ng umper
C. ABSORPTION FIELD DATA
/
Date installed ~3/(~
Length ~-'~ Width
'~/ Depression over field (Y/N) __
Effective absorption area ~--~ 0 Monitoring Tube present (Y/N) ~
Date of adequacy test ~/~/~ Results(Pass/Fail) /P~¢'~-~ For
Fluid depth in absorption field before test (in.); [~(2-J-¢"/k' Immediately after"7~'Ogal, water added (in.):
A-¢$ I ~ ' Absorption rate ~ 4-
Fluid depth ID¢-~. (ins) ~s later: = .g.p.d.
Peroxide treatment (past 12 months) (Y/N) j~s, Jo ~,A,/ If yes, give date
72-026 (Rev. 3/96)*
Soil rating (g.p.d./fF or fF/bdrm)¢'-r"-O.~ System type,~'-o~ .~/ /
~--- '~' Gravel thickness below pipe ~:~ Ai¢ Total depth
No
bedrooms
~ STATION
Date installed
Size in gallons ~
Manhole/Access (Y/N) "Pum~ "Pur~p off" level at*
High water alarm level at* ~ ~
*Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot [00 I-(-
Absorption field on lot I (DO/'~'
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~f'~ Property line ~" 1''~ Absorption field
Water main/service line JO/+ Surface wateddrainage 1o0 ~4- Wells on adjacent lots
E
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
!
Property line /0 'f' Building foundation /O/'f- Water main/service line IO"/-
water IOO/ ~ Driveway. parking/vehicle storage area
Surface
Curtain drain _~',J_~ ,,,4 ~---- ~ o ~ Wells on adjacent lots I D O/4-
ENGINEER'S CERTIFICATIOI*
I certify that/bffa-~ ¢/er~ff/~ , are
'nconform~nceTit~,~./~A~A, ,Jidelinesineffectonthisdate.
Signature~ ~ ~ -
ru field inspections and review of Municipal reco. rj~,,ibeCt4b~,/~.~JCel~s a
~.": ~ ~
~';.,' %
HAA Fee $ ~-.-..-~)~'¢~'
..teof,.,m.nt
Receipt Number
72-026 (Rev. 3/96)*
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
Parcel I.D. #
CERTIFICATE OF HEALTH.AUTHORITY
APPROVAL FOR A S NGLE FAMILY DWELLING
1. GENERAL INFORMATION
Corn plete legal description
Lot 2; B!ock~'2; Stuckagain Manor
Location (site address or directions)
10001 Farpolnt Circle
Anchorage, AK
,Prol,erty owner - .~ric Cugnir~gham
-10001 Farpoigt Circle
MAiling address
Lending agenc~
-: Mailing address
Jack Blair/ Rerdax Propertzes
Agent
Address
Day phone 337-9497
Anchorage, AK 99507
Day phone
Day phone 257-0159
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3 ~'
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
#
TYPE' OF wAsTEWATER DISPOSAL: '
XXX
Individual on-site ~_ ~ ._
Holding tank .~ r- :
Community on-site " :': -~
Public sewer , t\ ~
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72~25 (Rev. 1/91) Front MOA~21
STATEMENT OF INSPECTION BY ENGINEER.
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 application 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 flies 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.
S & $ ENGINEERING Phc'ne ~ ~ ~ ' ~ '7 ~
Name of Firm :70,1'4 =-tJ[~ ~;ver Loop Road No. 204 '
Address Eagle River, Alaska 99577
Engineer's signature '?~/~'~ ~'-----~ Date 3/1¥/~7
DHHS SIGNATURE
· /~ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
';,The Mun ci~al ty of~nchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certifi,.'.cct~' based only upon the representations given in paragraph 5 above by an ~ndependent
I5'¢o'~s~ bnal er~ji'~'~: registered in the State of Alaska. The DHHS does this as a courtesY to purchasers of homes
and t~lr lending institutions in order to sabsfy certmn 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.
MUNICIPALITY OF ANCHORAGI:
ENVIRONMENTAL SERVICES DIV~ION
Municipality of Anchorage MAR 14
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division R ~ ~' ~ I V
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority ApprOval Checklist
Legal Description: ~T .~. 8~.~0 ,< 2 3')-uc~-~)(~,.~ /4~,-~ Parcel I.D.:
A. WELL DATA
Well type 0.~
Log present
Total depth __
Sanitary seal
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to I S- 0 Casing height (above ground)
Wires properly protected (l~/N) Y g J'
Date of test
Static water level
FROM WELL LOG
AT INSPECTION
Well production ~7 g.p.m.
g.p.m.
WATER SAMPLE RESULTS:
Coliform o Nitrate
Date of sample:
B /~HOLD N6 'rANK DATA
Date installed ?/',~-/~'~ Tanksize Joo O
Foundation oleanout~/N) ¥
Date of Pul:nping _~-
Other bacteria O
Collected by:
5 & S ENGINEERING
17034 Eagle River Loop Road No. 204
~;agJe River, Alaske 99577
Number of Compartments ,~ Cleanouts(~/N) Yg $
Depression (Y/~ ,~ 0 High water alarm (Y,~'~ /v o
C. ABSORPTION FIFI.D DATA
D~teinstalled ?]i.Y/~3 Soilrating (g.p.d./fFo~rm~ (~,~ Systemtype '7 .4,/. ¢, c AI
Length ~ f¢ _ Width ~' '/~- / '
. Gravel thickness below pipe $' Total depth ~
Effective absorption area '~' '~O rr Monitoring Tube present {~/N) yr~j Depression over field (Y~ ~ O
Date of adequacy test '3, / ~ '~ / ~ '? Results (~¢Fail) /~/~ :~ J . For ~ bedrooms
Fluid depth in absorption field before test (in.); '3 ,o ~. Immediately after~3~t gal. water added (in,): $ /o
Fluid depth /~/4 . (ins) Minutes later: ~'/~ Absorption rate = ~'5`0 J'- g.p.d.
Peroxide treatment (past 12 months) (Y/N) /~'~,v/¢ ¢c ~,0 ~,, ,,, If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed Size in gallons .-------'------
Manhole/Access (Y/N) ~evel
at*
High water alarm le~._ ~ *Datum
Cycl_d~d
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
~holding tank on lot _ /o0
Absorption field on lot ?
Public sewer main
Sewer/septic service line / o O W Lift station ,~/
FROM~HOLDING TANK ON LOTTO:
SEPARATION
DISTANCES
Foundation ~C'
Water main/service line /0 .-~ Surface water/drainage.
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line
Surface water
Curtain drain
Building foundation 3, ~ +- Water main/service line ! O 4-
~ Driveway, parking/vehicle storage area o~,-~,~y .- ~ ,~,-~(.
~,,, o~ ,,~ Wells on adjacent lots / ~ o ~
F. ENGINEER'S CERTIFICATION
I certify that I ha
inconformance~th~72uideline-sineffecton
Engineer's Name
Date
ve determined thru field inspections and review of Municipal records th~~?s are
~ HAA gUi, sii, es in e,ect on this date. ~"~:'":i....¢~
;7'" / ~ ~ ~ '".~ ~
HAA Fee $ ~ ~'~' ~
Date of Payment ~
Receipt Number
72,026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
Mailing Address /~)/' ~¢/['~ h W~
(C) Lending Institution ~ Telephone
Mailing Address
(d) Real Estate Company and Agent ~.~
*ddres,
Telephone ~'~
(e) Mail the HAA to the following address: (or check here for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDEN/J~E
Single-Family E3' Number of bedrooms
WATER SUPPLY ~
Individual Well ___________________~ Community [] Public []
Note: f community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DIS~P~L
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
~ J~o ~ e6ed
'~Jo~ s,Jeeu!~ue leuo!ss@joJd re.Ii u!
SUO]SS!LUO JO sJoJJe JoJ elq!suodseJ leu s! ebeJoqouv Jo ,'~3!led!o!u nlAI eq..L 'penss] s! eleo!J!lJeO e eJod. eq m, ep ez,qeue Jo
suo!~.oedsu] ~onpuo,')leu ap SHHQ jo see,~old~:3 's~.ueuJeJ]n beJ m,9~.s pue leJep@j u!epee ,~js!~.~s o], .lepJ o u] suo!,~.nl !~.su!
I~u]puel J!eq~ pue SeLUOq JO sJeseqoJnd o~ /,sepnoo e se s!q~, seep SHHQ eqJ. 'miselV ,~o e~e3S eqi u! peje3s!eeJ
.Jeeu!6ue leUO!SSeJoJd luepuedepu! ue/~q e^oqe S qde~§e~ed u! ue^[l~ suo!le~ueseJdeJ eq~. uodn ~lUO peseq
le^oJddv,q!Joq)nv q~,leeH sanss! (SHHQ) seo!^JeS UeLUnH pue q~leeH Jo ~.UeLU~.JedeQ e6~Joqeuv,to,q!led!o!unhl
le^oJdd¥ leUOp,!puoo jo suJJei
leUO!~.!puoc) pe^oJddes!G ~ pa^oJdd¥
/,~..).j~/~ , ~' *q SLUOOJpeq ¢ JOi peAo, ddv
lees s,Jeeu!eu3
· ua loedsu sql 1o elep eql ua ~oeJ~e ul suo!~e n6eJ pub seoueu!pJo sapoo e~B~S
pue lediolun~ lie ql!M aoue!ldmOo u! s! ~eisAs lesods!p ~eleMelSeM ~o/pue ~lddns JeleM el!s-ua eqi 'uo!loedsul
pue uo!le6!lSeAUi ~m ~o~J pue Seli¢ e6eJoqouv jo Xl!led!o!unR eq~ ~oJj peuielqo uo!lemJoju! eql ua pesuq
leq~ XJpaA Jeq~Jn~ I 'uleJaq pa~eo!pu! eJn~onJ~s ~o edXi pue smooJpaq ~o Jaq~nu aqi Jo~ e~enbepe pue leUO!lounj
'e~es s! mels~s lesods!p .JeieMelSeM Jo/puc ~lddns Je~eM e~!s-uo eql leqi s~oqs leAoJddv ~ipoqlnv qlleeH
s!q~ ~o uo!lebllSeAU! X~ ~eqi XJpeA I 'MOleq UMOqS elep uo!lep!leA eq~ jo se pue oleJeq paxlite lees ~ Xq pa!j!lJao sV
NOI&~8OJNI aN~ ~a 'HOMV~S tllJ 'SZSiZ 'SNOI~O~eSNI 9NlalA088 ~MIJ 9NIB~NIeN~ 'g
MUNICIPALITY OF ANCHORAGE (MOA)
,H, ealth Authority Approval (HAA)
>,No Io,~HECKLIST - FEBRUARY 1984
,.,-~,,,,r :~ ~V~S[OH 343-4744
Legal Description:
/
Well Classification ..... ,~/'7~'¢'¢ '//(~· £. _.~_., ¢-_~..,~ A, B, C, D.E.C. Approved (Y/N) '/~//,/,/
Well bog Present (Y/N) /(-'/ DateCompleted~/~ft:~t,¢/~) Yield .~..~:/~,~?-/L.
Total Depth./?-~p/~:Cased to .~¢?¢' Depth of Grouting /'~;~?Z/~/::://¢~/
Static Water Level '-/~'
Casing Height Above Ground -~ /
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot //.¢~-O/-~-
Pump Set At ///¢/..~. ~'~¢¢p¢4/,'
Sanitary Seal on Casing (Y/N) ,.~
Depression Around Wellhead (Y/N) ~
; On Adjoining Lots ~/~':'20 /
To Nearest Edge of Absorption Field on Lot //~'~,¢~ /'/- ; On Adjoining Lots
To Nearest Public Sewer Line ./~./.~' To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot -~>/d~> /
Water Sample Collected by ,/~/~r'~'~ .¢ ~'~//¢4~¼ ; Date //~/.-~.//~
Water Sample Test Results
Comments
SEPTIC/HOLDING TANK DATA
Standpipes (Y/N) /-~
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well //'¢'~¢ I
/
To Property Line
/
To Water Main/Service Line ~ /,5:2
TO Stream, Pond, Lake or Major Drainage Course
/'¢¢'¢¢¢ No. of Compartments
Air-tight Caps (Y/N) ~'~ Foundation Cleanout (Y/N)
~ Date Last Pumped '/'~/~/~¢?
'L"////~¢ ;for /t'///,//- _
/C//,~ Temporary Flolding Tank Permit (Y/N)
To Building Foundation
To Disposal Field (¢~ /
Comments
72-026 (Rev 7~88) Front
P~.ge 1 of 2
C. ABSORPTION FIELD DATA ~
Soils Rating in Absorption Strata ;~ Type of System Design
Date Installed ~;>',,/~'/,J~'3 Length of Field *~ /
Width of Field -~ ,-~O /~1~/~-~' Depth of Field ~ ~ ~'1 /~'
Gravel Bed Thickness ~4- ~,,~
Square Feet of Absortion Area ~ ~¢2~,,'~ /27 / Statndpipes Present (Y/N)
Depression over Field (Y/N) /¢~/ Date of Last Adequacy Test
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot //L/~,/~-
To Water Main/Service Line ~/4/~ /
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
/
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutback (if present)
D. LIFT STATION
Date Installed Dimensions /
Size in Gallons Manhole/Access (~_~~
"Pump On" Level at /F ~j~ff" Level at_
High Water Alarm Level at ,/ t/ ~.._,~- Vent (Y/N) __
C~leeS!~!!i!; Elec~/Nt/'~,) ¢,-~"~'~/ Pumpinrg Cycles during Adequacy Test.
I certify that I/~¢¢v/C~¢~ecke~./~eri.f~i~d, or conformed to all MOA and H,~
inspection. ///////,/ //
MOA NO.
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
effect on the date of this
Engineer's Seal
CORWIN & ASSOCIATES, INC.
1000 E. Dimond Blvd. Suite 205
ANCHORAGE, ALASKA 99518
(907) 522-1311
CALCULATED BY DATF
CHECKED BY DATE
~:A" DEQUACy TEST
-LOCATIQ;I OF HELC (Legal Oescription): ~,,7~oZ-~ ~:~-/~'
· STATIC HATER LEVEL (Top of Casing): '7~ FT
Cloc~
Tine
2,:3o
Elapsed Time Since
pumping'StatE,d/
SEopped. llin.
10
15
2U
25
3O
3S
40
50
55
60 (t hour,
.120 (2 hoursI
t50
180 (3 hours.)j
210
240 (4 hours
RECOVERY
5
10
15
2Q
25
40
45
SO
$5
60 ([ hour)
9U
140 (Z hours
Depth to
,Ua ter fL.
Orawdown/
Recovery
5
~o
Pumping
Ra~e, GPH
Start