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HomeMy WebLinkAboutPARADISE VALLEY BLK 4 LT 8 Municipality of Anchoroge pog. 1 of. 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchoroge, Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW990084 PIP Number: 020--411--16 ~°me:MICHAEL DAVIDSON Wastewater System: [] New · Upgrode Address: 807 HERDSMAN DR,, HOUSTON, TX 77079 ABSORPTION FIELD Phone: (281 )-684-0063 No. of Bedrooms: 3 BDeep Trench [:3Shallow Trench E]Bed r'lMound [2Other LEGAL DESCRIPTION 0.8 GPo/s.. r~ B.8 - 10.8 8 4 PARADISE VALLEY 1.75 - 3.75 pt. 7.06 Ft, -- -- -- 2.0'_+ rt. 42 rt, WELL: [] New [] Upgrade 2 Ft. 1 -- Pt pt, G & G EQUIPMENT 29/99-7/1/99 Yle~'/'''"'''/ GPM Pump Set At: Ft. Coslng Height Above Oroun,fFt. TANK SEPARATION DISTANCES u Septic [3 Holding · S.T.E.P. Tonk Field Station Trmk sow.r Un.. ANCHORAGE TANK 2000 Well 100'+ 100% 100'+ - 25'+ STEEL 2 Surfoce 100'+ 100'+ 100'+ - - LIFT STATION Woter Line -- 2000. ANCHORAGE TANK Found(3tion ,5'+ 10'+ 5'+ - - 39" Drain NONE KNOWN 20 OSl 05 HHF M.O.A. ~ I Remarks:THE SEWER SERVICE LINE FROM THE EDGE BENCH MARK OF THE DECK TO THE NEW STEP TANK WAS NOT THRESHOLD OF DOOR IN REAR INSPECTED BY AWWC~ INC. GAG EQUIPMENT iS FULLY RESPONSIBLE FOR CONSTRUCTION AND 100.00 rt. Inspections performed by: AWWC, INC. Dates: 1st 6/29/99 ....... .... 2nd 7/1/99 '-~ ~ ~ /...N.....~..: , 3rd 7/7/99 /~ ,,~ ,~ ff .< y A, "6e~ess Health and Human Services approval ~%['1, i/;E-7953 ,'"~ Department of ,[~'¢...~; ........ ....~ Reviewed and approved byu~.~c~C~:~C-Dote:~ -~,~.~ro~ fe~o~' e~ PERMIT NUMBER: AS BUILT D~[~WING PARCEL ID NUMBER SW990084 ' 020-411-16 'Db~L' OUTL~S X NEW DRAINFIELD ~ ~ ~ /'k ~ ~ORIGINAL LOCATION n~ ~ ~ ~ on n DRAINPIPE TO TOE OF THIS .~¢ %% ~ ~ Sl 11.5 55.1 SLOPE IS LESS THAN 25%, ~ %q~ / /~ ~ ~ ~ S2 21.7 40.5 ~ ¢% % % -- ~ MT1 28,5 35.7 ALAS~ WATER AND WASTEWATER CONS~TANTS, INC. PHONE: (907) 337-6179/F~: (907) 338-3246 WPE OF WORK: AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ........... :....~ DATE:7/1 2/99 D~WN BY: SCALE: I PACE: A.C.G. 1 = 30' 2 OF 3 A B D1 16.7 28.8 D2 15.6 29.9 Sl 11.5 ..35.1 S2 21.7 40.5 MH 24-.2 42,5 MT1 28.5 55.7 MT2 62.0 51.1 PER.,. MUM*R: AS BUILT DRAWING P^.oEL ,o MUM*R: SW990084 = 020-411-16 / ~w ~ooo ~o, ~ ~ ~7,~ ALAS~ WA~R AND WASTEWA~R CONSULTANTS, INC. 6901 DE~RR ROAD, SUITE 2B. ANCHO~GE, AK. 99504 PARADISE VALLEY SUBDIVISION, LOT 8, BLOCK 4 ~PE OF WORK: PROFILE AS-BUILT OF SEPTIC SYSTEM UPGRADE =R[P~ED FOR= PHONE MUMBER= 684--0065 MICHAEL DAVIDSON (281) 'qb~e~ .......... A.C.O. N.I.S. 3 OF 3 '~~ 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 (9O7) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 06, 1999 Expiration Date: May 05, 2000 Permit Number: SW990084 Legal Description: PARADISE VALLEY BLK 4 LT 8 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Michael Davidson Owner Address: 807 Herdsman Drive Houston , TX 77079-5203 Parcel ID: 020-411-16 Site Address: Lot Size: 27323 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] SepticTank [] 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. Received By: Issued By: Alaska Water & Wastewater Consultants, Inc. Snite 2B Anchorage Alaska 99504 6901 Debarr Road, N ~ (907) 33%6179 N Fax (907) $38-3246 Consulting Engineers March 15, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Upgrade Design for Lot 8, Block 4, Paradise Valley Subdivision To whom it may concern: The existing 3 bedroom house is served by a private septic system and private well. The existing septic system is surcharged and must be upgraded prior to the sale of the house. We are requesting a permit to install a pressurized conventional drainfield and a 1250 gallon S.T.E.P. tank. Comments regarding the design are summarized as follows: 1. SOILS: Attached is a log which shows the soil profile, and the percolation tests results. The soil below the orgmfics is SW/GW material to a depth of 7 feet and than transitions to a SM/SP material to a depth of 17 feet (bottom of test hole). No groundwater was encountered during the excavation. A percolation test was performed at a depth of 7.0 to 7.5 feet and found the rate to be 15 minutes/inch. The SW/GW material was visually rated to be less than 1 minute/inch. We will be using a 0.8 application rate for our design. 2. TRENCH DESIGN: a. Percolation Rate: 15 minutes/inch b. Allowable Application Rate: 0.8 gallons/day/fi2 e. Nmnber of Bedrooms: 3 d. Design Flow: 450 gallons per day_ e. Minimum Absorption Area: 563 ft2 f. Total Depth: 11 feet maximum (at any point) g. Effective Depth: 7 feet h. Width: 2 feet i. Minimum Length: 42 feet j. Effective absorption area = 588 fi2 (>563 fi2 OK) k. Reduction Factor = N/A The distribution line shall be 1.25 inch schedule 40 PVC. The pressurized lateral shall be 40 feet long with 1/4 inch holes spaced 16 inches on center with the holes facing down. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the design, topography site plan, and digital photos, there is a slope that is greater than 25 percent southwest of the proposed drainfield. The closest point from the proposed trench to the top of the slope is approximately 25 feet. We request that your department issue a 35 foot separation distance waiver to a slope greater than 25 percent. Elevation shots have been taken and it appears that a 25 percent slope from the top of the proposed d~smbutton line elevation wdl no daylight 35 feet away. The existing drainfield has been in place for approximately 16 years, and there has been no problems with daylighting. In short, there appears to be minimal risk associated with the proposed eneroachmant. CLOSING: I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If~ you have any questions, please contact me at 33%6179, or 244-9612. Thank you for your ~Iistanee. ~relyA~~ Jet~¢ ~..~a~l~s, P.E., M.S. Prest :nt kJ Note: Attached is a site plan, design, soil log, topography site plan, digital photos, and a 4 page specification letter which are all part of this design package. I --*'"'-'*--*-~ I, '~ v.~,~'~ '~, ¢~...',, ~ ~ ..~ PARADISE ~ALLEY SUBDIVISION; LOT 8, BLOCK 4, ~,~ ..... ..... ~n~ (~n~) nn~-oo6~ '~"... '~ --- / .,*~ MIKE DAVID.-,. s/~s/o. J J.L.U. J 1 = 100 J \\ 6901 DEBAR ROA~ SU~ 2B, ~CHO~OE, AK 0050~ PARADISE VALLEY SUBDIVISION; LOT 8, BLOCK 4, PHONE NUMBS: PREPAREO FOR: MIKE DAVIDSON (281) 6B4-0063 ,'"" ALASKA WATER, & WASTEWATEB, CONSULTANTS, INC. 7320 E. CHi~Gt~-~ HTS. CIRCLE * ANCHOP, AGE, AK. 99504- PHONE (go7) 337-6179 * FAX (907) ;338-3246 SOIL LOG - PERCOLATION TESTJ LEGAL DESCRIPTION: PARADISE VALLEY SUBDiViSION; LOT B, BLOCK PERFORMED FOR: MiKE DAVIDSON DATE PERFORMED: 3/4/99 )RGANICS 3W/GW I TEST HOLE #1 I SOIL CLASSIFICATIONS ORG ML CL OL MH CH OH SC DEPTH TO DATE GROUNDWATER DRY 3/4/99 DRY COHMENTS: SH/SP B.O.H. DATE ~'~ ~1-"--~ 2 2:45 30 MIN. - ~-' ~:~- 30 MiN. IREADING I CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) PERC CAVi~' PRESOAKED FOR 4-+ HOURS 6" 6" 2 1/2" 2II PERCOLATION RATE 15 (MIN./INCH) PREC. HOLE DIA, _- TEST RUN BETWEEN 7,0 FT. AND 7.5 FT. SW/GW SOILS WERE VISUALLY RATED TO BE LESS THAN 1 MINUTE/INCH. §" (INCHES) PERFOMED BY ALASKA WATER & WASTEWATER I, , CERTIFY THAT THiS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EH-ECT ON THiS DATE. DATE: DEPARTIVIENT OF HEALTH & ENVIRONMENTAL PROT'~CTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT SCRIPTION LOCATION DISTANCE TO: DISTANCE TO: / :72 / -/_2' IF HOMEMADE: Absorption area Inside length Well DISTANCE TO: No. of lines / Length of-ea.~.l3 lille./ Dwelling Material Total I~ngti~..~f]~,nes/ I Trench,~id½h Material beneath tile ~//'~ inches Depth PHONE NO, OF BEDROOMS Liquid depth PERMIT NO. Liquid capacitV in gallons PERMIT NO Total effecti,~?~ area Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. DISTANCE TO: Sewer line Septic tank Absorption area(s) OTHER PIPE MATERI S SOIL TEST RATING DATE APPROVED 72-013 (Rev, 3/78) PERMIT NE). [.',EPRRTMENT (..,, HEFILTH FIND EN',,,'IRCd'.,IMEI'.,ITFIL ~,.:OTECTION 825 'L'" STF~:E[ST'., I:::INC:HORI:~C. iE., FII<. 9950:'L it....Jt EE L_ IL IF-:~I kql IE:. ,2~ IP.~ --- :'~: DE -IF- [:?.. ~2~; EEL'_ IL.J] E] F-." F" lEE] F~." 11".11 DE '-IF' ( :3SOZ'.":52. ) RPPL i C FIIq'l" L. OCFIT i ON LEGFIL RKtLPH H. R. OFIHER SRFI 802:172::L--0 LOT 8 [:]LK 4 PFIRFIE:,ISE VFILLE¥ SLI LOT SIZE T~¢PE OF SOIL FIBSORP'FION S'¢S]'EM IS: TRENCH E1'97:1995~ SQUF:tRE FEET idFI:,.,iIf"ILIM NUMBER OF' E:EDROOi"IS = S SOIL RFITING (SQ F'T/BR)= t;25 THE LLI,IbFN [:,IMENSION I:.', THE LENGTH (IN FEET'::, OF TFIE TREI,I..FI _iF.'. [:'RFIINFIELE:,. TFIE [.EFTH OF iC:l~'E. Ett~.FI CiE: PIT I=,'- THE [:'IS]"FINC:E E, ETI4EEN:' :" , ' THE ':: '.. _,URFI' ..E OF THE C'iROIJNE:, FINE:, THE E, U F'] UII OF THE E.~.,...F, M'l I LN (IN FEET). THERE IS NO SET HII}TH F'OR TRENC:HES. ...... aRH EL E, EI[IEE. N THE OUTFI::ILL PIPE THE GRFIVEL [:'EF']"H iS THE MINIMIJM I. EFT[I OF' F'"""U" ', RND THE BOTTOf'I OF THE EXE:RVRTION (IN FEET). F'ERHIT RPPLIC:RN-I" HI:tS THE RE'_=,POI",ISIBILIT'¢ TO II",IFORM THIS B'EPFIRTMEN]" DUE'.tNG Ii'.,ISTFII_LFFf'ZON INSF'EC"FtONS OF FIN"r' I.,IEt_l_.'~; FIDJFHBENT TO THIS PROPERT'?' FINE:' THE i",!UMBER OF I,"?.ESIE)ENCES THFIT TFIE NELL NILE SERVE. THE ............. -T N-.~ C~ ,;: F~2: ::, Z ~"-~ £~; D:' E: C: T' :[ C, P-,I ~-2; P~ R E g--: ~-] la~ ~_~ ~ F..~ l-~ E::~ ............. E=EIE:KFII_I_ING OF:' RN'T' S'T'STEM HITHOUT FIt",IRL. INSF'ECTION RI",IE:' RPF'RO',,"RL.. B'T' 'rHIS DEF'RRTI,IENT WILL BE SUE,'¢EE:T TO PROSECLFI'ION. HINIMUM DISTRNC:E BETWEEN Fl NELL RNB, F41',l'.r' ON-SITE SE:HRGE DISPOSRL S:,'¢STEH :l:S :.l. C10 FEET' FOE: R F:'RI',,,'R]-E HELL OR t50 TO 200 FEET FROM R PUBLIC: HELL. DEF'EN[;,ING UPON ]'HE:' "I"T'F'E OF PUBLIC NELL. HINiNUM E:,ISTRNCE FROM R F'RIVRTE HELL 'FO R PRIVRTE SEHER LINE TS 25 FEET RND TO FI COI'dMUNIT'¢ SEP.IER LINE IS '75 FEET. HELL LOGS RRE REQUIREE:, FIND MUST BE RETURNEE:, TO THE DEPRR'FI"tEN'F 1.4iTNZN :SO E:,R'¢S OF TI4E WELL CE)t'IPLE'I"iOI',I. O]'HER REQUIREMENTS f"lFl'T' RPF'L'T'. SF'ECIFICFITIONS RNE:' CONSTRUCTION C"II:'tGRRMS RRE R","RILRBLE TO II",ISLIRE F'ROF'ER. INSTRL. LRTION. I CEE:TIF'¢ THRT J..: I RM FRMILtRR WITH THE REQUIRENENTS FOE: ON-SITE BEFIERS F'ORTN 8'¢ THE I',IUNICIF'I::ILIT¥ OF FINE:HORFIGE. 2: I HILL II'.,ISTFILL THE S'¢S"FEN tN RCCOE:DFiNCE I-,lI]"l-I TEIE CODES. 3:: I UNDERSTFIND TtqI::tT THE CtN-SITE E;EP.IEE: S'¢STEf, I I','IFI'¢ REQUIRE RESIDENCE IS REMODELED TO INCLUC, E MOE:E THRN 3: BEDROOMS. =,I aN[::[../~_-- FIF'F'L Z4]:,SI'.,I T F:FIL~dI'II,.IER laNE) HELLS RS SET ENLRRGEMENT IF TFIE PERFORMED FOR: LEGAL DESCRIPTtON: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST 1 2 3 5 6 7 9 10 11 12 13- 14- 15- 16 17 18 19 20 Reid, Jr. 2251.E COMMENTS SLOPE SITE PLAN ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? ~, PERFORMED BY: ~<~kk ~'~ '~Z~ Gross Net Depth to Net Reading Date Time Time Water Drop 72-008 (6/79) CERTIFIED BY: WATER WELL RECORD STATE OF ALASKA OEPAETMENT OF NATURAL RESOURES Division of GeoIogicoI a Geophysicol Surveys Drilling Pecmlt .o. 860230 · LOCATION OF WELL (Pleole complete either Io, lb or lc,) A.O,L* NO, ~,JDorough Subdivision Lof SIoak ~ I/4qtrl. ~lcflon No. TownlhlPN[~ Range [F-~ Mlrldlen ~OtSTANCE AND DIRECTION FROM ROAD INTERSECTIONS ~. OWNER OF WELt: Ralph Rohwer Addr,,,: 10845 Our Road Anch.,.A[ 99516. Street Address end Are~ of Well Loceflo~ Feet Below 4. WELl. DEPTH: (final) 5. D~TE ~F CSM LETIOH 2. WELL LOG Surface ' 1U5 fl, 2~ - ~6 Top soil 0 4 ~. ~c~,~ ,~, ~,~,, Brown clay & gravel 4 57 ~.~ ~.,,. Gray clay & rocks 57 ~'1 7. USE: ~ corneille ~ Public Suppl~ Water~ sand & .gravel ( 1 ga3 87 88. ~.,,.,,.. ~,.,~,~.. pm. 2 ft 'static level ) ~,,,w., Brown clay &.rock. 88 .151 e. cAs,,~,' ~T,....~ ~W.,,. . Bedrock, pipe set at 152 ft. 151 185 ,z,.: 6 ~.. ,, 152 ,,.o,p,, ~OC~ ~ 16~ ~; 9.~NmHO~WELU Type: Open m.mm,, 6 in ,o.s~v,c w,~z, ~wu 105 ,,. 7 /2~ ' ' ~ Above 6r ~ B~ow land ~urface Date Equipment used: '}~]~ ~ ~ rc~' .175.. ~.. 4 MUNICIPALI~ OF ANCHO~G~ I2.GROUTING Will ~rouled: O~PT. OF HEALTH & Ualetlal: ~Neat Ca'ant ~ Other: ~ ~ ~ ~ ~7 Length of Drop Pipe ft. capacity ~ O.P.m, RECE.!VF.O I~. WATER WELL CONTRACTOR'S CERTIFICATION~ 15. Wal~r Temperotu~e ,° ~ F ~ C Polar Drive, ~.,.~: 11140 · . ' Anchorage. e. Alaska 99516 ...... 2. 6.'I...4 ? i~' () Fi I i ,,~'1.t1. 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 Complete legal description L~ ~- ~ P~'~ q Location (site address or directions) Property 'owner Mailing address Lending agency Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well NOTE: Community well Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYpE'OFWASTEWATER DISPOSAL: · .:~ ~,~ . Individual on-site · ,;.~,i~, .... :H01din g 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 · qJO~ s,Jaau!6ue leUO!SSejoJd aql u! suo!ss!uJO JO sJoJJe JOj elq!suodsaJ lou s! e6eJoqouv ~o ~!led!o!un~ sql 'penss~ s! ol~ouI~eo e eJo~eq elsp eZ~leUe jo'suo.loedsum lonpuoo lou op SHHO ~o s~Xoldm~ sluemm!n~ elels pus leJe~ u!epeo ~Sll~ ol~ep~o u suo.lnll~u. 6u puc ~eql pus semoq ~o ~eseqomd ol ~pnoo e se s!q~ s~p SHHO eq~'e~SelV jo elelS eql u! pe~els!~u!6ue leUO!~e~°~d ~. luapusdepu! us Aq eAoqe g qde~6eJed u{ ueA{6 suolleluese~de~ eql uodn AlUO peseq seleoUi~eO leAodddv, ~uoqlnv qlleeH sensm (SHHO) sera.as uemnH pus qlleeH ~o luem~edeo e6eJoqouv Io ~1 led~mun~ eqi. s~uew~uoo leUO!l!PP¥ suo lelnd~ls 6Ul~OllOJ eql ql!~ 's,,,ooJpeq 'swooJpsq ,~? ~ pu~.~d~u~qo~ 5 ' · UOliOedsul sJqJ jo elep eql uo loewe u! suo!jeJn~eJ pub 'ssgueujpJo 'sepoo eleiS pue Igd~mun~ lie qilM eoUe~ld~OO u~ s~ ~eis~s lesodmp JeJeMelSeM Jo/pue ~lddns Jel~M elJ~-UO eqJ 'uolloadsul pue UOge~Ii~eAUI ~ moji pue saul e~EJOUOUV JO ~j.led~olun~ eqi moji peulelqo uoJle~JOJUl eqj uo peseq l~ql~lJeA Jeqpn~ I -uleJeU peleolpul eJnjonJls jo ed~ pue smooJp~q jo Jeq~nu eql Joj elenbepe puE leuojlounj 'ejes si ~els~s leSOdS~p JeleMelSeM Jo/pue ~lddns JeJeM ajlS-UO eqJ Jeqj SMOq~ UO JeOI dde JeAoJddV ~llJoqlnv qlleeN sJqJ jo UO.Je~IJSBAUI ' ' M~NI~N~ Aa NOI~O3dSNI dO Jo~ le^oJdde ISUOR!puoo · pe^oJddes!o ..... Jo~ pa^oJdd¥ gI~nI~fNIDIS SHHO '9 eJnjsu6!s s,Jeeu!6u=~ ~. Q.~ sseJppv ,g Legal Description: A. WELL DATA Well type '~ Log present (Y/N) Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST if A, B, or C, attach ADEC letter. Date completed Total depth ] ,~,b'"' Cased to Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow "7 Pump level Parcel I.D. ~Z-O ,-- ~/I- [,Jo ADEC water system number ~'~//-~- I~.-~ ~ Casing height Wires properly protected (Y/N) y g.p.m. AT INSPECTION MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Septic/holding tank on lot Absorption field on lot Public sewer main SEPARATION DISTANCES FROM WELL TO: Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: 1~/3/q 'L- Nitrate ~ ~-- Other bacteria Collected by: ~'¢'~-44,.?cb 'c'~L B. SEPTIC/HOLDING TANK DATA Date installed (~/,~"/,~-~ Tank size /(-~ Compartments Cleanouts (Y/N) F Foundation cleanout (Y/N) ~,/ Depression (Y/N) High water alarm (Y/N) b'//A- Alarm tested (Y/N) 57;~'-/~ ~ Pumper /~ Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~///~ On adjacent lots ~ /~'" O Foundation To property line _~ ¢¢~.~5~ Absorption field --~ Water main/service line Surface water/drainage r -,//~2 72-026 (Rev. 7/9~) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at - "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/~¢/'~ Length ~:'~--~ Width To'tal absorption area Depression over field (Y/N) Results (pass/fail) ~'~ Peroxide treatment (past 12 months) (Y/N) Soil rating /~-'~ System type Gravel thickness y Total depth Cleanouts present (Y/N) Date of adequacy test 1 for If yes, give date bedrooms To building foundation On adjacent lots ~> .~0 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot ~ //'3~' On adjacent lots ~ /2~C;> Propertyline 7 ~t;;) To existing or abandoned system on lot Cutbank ~',1¢ H ~ Water main/serviceline Surface water Curtain drain Driveway, parking/vehicle storage area 0/0 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ~"~ ~~~'~ Engineer's Name'. J ,~'~ ~ --~t ~--~L~.P,~ '~') ~-~ Date j "Z../¢ ~ /~_- HAA Fee $ Date of Payment Receipt Number ~z/~ 0_¢) (~/.~ 72-026 (Rev, 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION~) DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) --l--l/bi (b) (c) Location (address or directions) - Applicant is (check one): Lending Institution D; Owner/builder~; Buyer ~; Other ~ (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent /~//¢" Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [~Multi-Family [] Other Number oi Bedrooms '-T'H~ 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. 4. 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. 72-025 [11/84) Page 1 of 2 ENGINEERING FIRM PROVIDING ,,~SPECTIONS, TESTS, FILE SEARCH, DA'I'. .*ND INFORMATION AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations [n effect on the date of this inspection. Name of Firm Address Telephone ~7-71/1 Engineer's Seal DHEP APPROVAL Approved bedrooms by ~' Conditional Approved Disapproved Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental 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 omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) I'~UNtQPALiTy OF ANCHoi~,G~iEALTH AUTHORITY APPROVAL (HAA) ENVII~ONMENTALSEI~ViCESDivi$10N CHECKLIST- FEBRUARY 1984 · )UJ~ ~ ~9~ 264.4720 Legal Description: ~,~ RECEIVED WELL DATA Well Classification · ~'~:l Well Log Present (Y/N) ~' Total Depth !~Z, ,G~ Cased to Static Water Level Casing Height Above Ground ~¢ Electrical Wiring in Conduit (Y/N) ~I/ Separation Distances from Well: To Septic/Holding Tank on Lot Date Completed ¢1/~'~ / 8~¢ Yield Depth of Grouting tOt~l? Pump Set At /~Z!; ~ ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) If A, B, C. D.E.C. Approved (Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ! ~Z z ® ; On Adjoining Lots To Nearest Public Sewer Line ¢v'/it To Nearest Public Sewer Cleanout/Manhole ~W/>~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~/' 7,7";~-~-"'-//¢/z~',~ ;Date Water Sample Test Results ,~""]'r/*'~ F;/.! ~'~1'/¥~ ~'~' Comments (~2 /V,r:~': ,'.<.:'~':,"/~ C>, !~r~ c,,-~..~,~d' ~)~z~:~;,,~x:,~, /y' ,~/~' /V/t B. SEPTIC/HOLDING TANK DATA Date Installed (;~/'¢/ ¢-~) Size ,,'~E;'L) ,~,~/~ '~" ~ No. of Compartments ~*- Standpipes (Y/N) ~' ~ Air-tight Caps (Y/N) ~ ~ Foundation Cleanout (Y/N) ~ ~:~ Depression over Tank (YIN) ~ ~ Date Last Pumped ~'/~b/ Pumping/Maintenance Contract on File (Y/N) ~ ; for Holding Tank High-Water Alarm (Y/N) &¢~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic./~Holding Tank: /..,/ To Water-Supply Well /c., To Property Line ~" (L~) To Water Main/Service Line Course To Building Foundation To Disposal Field /0,~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 4',~/~/ ~:~ ~;'~ Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ~'~ ~ Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~'~'/;7/2~¢/ ~ Type of System Design "7""~?~'c&.;/ ~'~'~ Length of Field .~'5 ~ ~) Depth of Field '?~-~ Gravel Bed Thickness /~ / ~ Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line /// © To Existing or Abandoned System on ; On Adjoining Lots '4-c5 ~ ~Z'~ To Cutbank (if present) /WfJ D. LIFT STATION Date Installed % Dimensions ,.S, ize in Gall, ohs %~ Manhole/Access (Y/N) 'H::~aOt:: :,e:relm Level aat t '%_ "Pump ;;eS;;r~cf: rCa d es '~%. Pumping Cycles during Adequacy Test. Meets MOA (Y/N) Comments ~ . . ** Check Permitted Bedroom Rating Against HA.A. Re.!7:~t~ I certif t~hat I h~ve ch~e¢l~e~, verifJ(ia or conformed to all MOA a~¢~A guidelines in effect on the date of this inspection Company // MOA No. . Page 2 of 2 72-026 (11/84) ZB~- KOT Lot ~ , Block LOT SURVEY CERTIFICATION I hereby certify thor I hove.surveyed the property shown end described he, eon,end th~ the Improvements situated thereon ere within the prol5- erty lines end do ~ot over ~3p o~ encrooch on odiocenf property end thor no improvemen/s on edjocent property ever ep o~ encronch on the premises in question end thor there tire no rondwoye, utility lines o~ other visible eosemente on soid properly except oe indlcoted hereon. Date LEGEND , ~1 ~Sross copped monument recovere o = Iron pipe end/o c~ = ;'x2 hub 8~ rock recovered · = 5/'8"x~O"reb~r ~etthlseurvey Prepared by: R. L. BUTTON Registered (and Surveyor 519 W, E/ghfh Ave. Anchorege~ ~losko 9~501 EB. NO, ., ~PLEASE PAY FROM THIS INVOICE-- . . . .. . ~ ~ ~ ~ ~ . ~C~:r* ~ ~'.Ggllons~r,~':'~',Septld, ~? :CessPool:· : '" ~HoIdlngTank( ," '- S~andplpes ' ":·'Time' ., [~. ,;:'-: ~ phOB~EM(AREA~cA[L FOR'MORE INFORMATION r . . =" ~:~;'.;.} D' Jim oap mlssih~ o~..r .'::.r;' , ' :~Ut standpipe to 1 above ground ~-, ' . ~ Needs. Septlctflne ~, .~'; r '" . ' .... ' . ,; ~r.. ':, "'. r , . · . . · ~ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 Client Sample ID:LO, E PARADISE VALLEY PWSID :UA Collected I~Y 16 SD @ 14:00 h~s. Received ~Y 16 88 @ 16:00 hfs, Preserved with :4 deg C Client Name : COLD REGIONS LABORATORY, Client Acet : COLDRETA P.O.# NONE RgC'D geq ~ Analysis Comploted :M~Y l@ 86 Send Reports to: Laboratorr Suporv~sor ;STEPHEN C. EDE I)COLD REGIONS LABORATORY, INC. Released By: M~ ~-~,g~-~ 2) Special In~truct: Che~ab Ref [: 1051 Lab Smpl ID: i Matrix: Water Allowable Parameter Tested Result/Units Nethod LiNts NITNATB-N 3.3 mg/l EPA 353,2 10 Sample ROUTINE SABLE. Remarks: SABLE COLLECTED BY NENE MCKINNBY. Tests Performed ' See Special Instructions Above UA-Unavailable None Detected "See Sample Re~rke Above Not Analyzed L~=Less Than, GT-Greater Than APPLIC ,~TtFILLS OUT UPPER HA! ONLY Address Zip Code Realty Co. & Agent Phone Address Zip Code Type of Residence ~Multlple Family No. of Bedroon~ ,~ Water Supply ~ Individual ATTACH WELL LOG. A well Icg Is required for all wells drilled since June 1975. ~ Community For wells drilled prior lo that date, give well depth (attach Icg if available). Public Utility Sewer Disposal ) ¢.? ¢~ Time Time Time Time Inspector Inspector Inspector If~@ector ~ ~ield tee: MUNICIPALITY OF ANCftORAO~ RECEIYED ( )DISAPPROVED ( ) COND,TIONALAPPROVAL'