HomeMy WebLinkAboutPARADISE VALLEY BLK 4 LT 18ULC 212018 Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181293 PID Number: 020-411-26 ❑ New ❑✓ Upgrade Name: KEN YAZAKI ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 6501 ITALY CIRCLE ✓❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 6 GPD/SF 1.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 0.5 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot PARADISE VALLEY 4 18 Fill added above original grade 3.0 Ft. Gravel length 20 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 100 Ft2 1 Ft. Well 100.5 106.7 109.5 N/A 69.2 TANK ❑ Septic ❑' S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1500Gal. Surface Water 100+ 100+ 100+ N/A Material Number of compartments Lot Line 29.2 12.5 25.6 N/A STEEL 2 NA Foundation 38.2 47.9 46.9 N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ 50+ 50+ N/A ORENCO 500 Gal. Remarks Pump on level at TIMED in. Pump off level at in. High water alarm at 45in. Pump make and model P2005 Electrical Inspections performed by MOA BUILDING SAETY Installer PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 A+ HOME SERVICES Drainfield 3034 CO/MT 3034 Inspector PANNONE ENGINEERING SERVICES BENCH MARK (Assumed elevation) 104.0 ft Inspection si dates: 11/1/18 2nd 11/2/18 Location and description p 3'd 11/2/18 4"' 12/18/18 NW BOTTOM TRIM COMMUNITY DEVELOOMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: DatN. e `:. :'.`.yj teven "06W6ne . CE 81496 �.W-fiJAZo Approved�® Pp Date °o� % � � t�'���s�•" 7Gt io i s in cl Uan 7e Aw W -r S DESIGN PARAMETERS t PRIMARY/RESERVE SEPTIC SYSTEM / NO. BEDROOM: 3 (450 gpd) 4 / TANK SIZE: 1,500g ADVANTEX / / W/ AX20 POD &AUX PUMP VAULT 13 PERC RATE: <1 MPI SOIL RATING: 6 GPD/ SF 20LF x INSTALLED DRAIN FIELD \N 5.0'W x 0.5 ED x 1.OTD ,/'"� AREA ROD: 75 SF INSTALLED MONITOR TUBE AT EACH END / LIMIT OF MO/UND FILL SYS. TYPE: WIDE TRENCH — 0.5'ED INSTALLED 1.25"0 DISTRIBUTION PIPE VJ/ a HOLES DRILLED 18" O.C. M MIN LENGTH: 15 LF USED:20 TOTAL AREA: 500. DF 1 ' TD jX EPS U CO W I � TH-1 NO TRACE OF BED WAS FOUND IN THE TEST HOLE. IF ANY PART IS FOUND IT SHALL BE REMOVED R MOV D EXISTING f W/I 10' OF THE DRAIN FIELD HOLDING TANK PER MOA C / INSTALLED 1500 ADVAN W/ AX 20 POD AND AUXILLARY PUMP { VAULT / 19/ \� Ov O O WELL E LOT UNDEVELOPED / NO WELLS OR SEPTICS LOCATED fIt ! t 1 c> A B CO 32.8 54.6 T1 42.1 61.0 T2 48.0 65.5 LS 49.2 66.3 AUX PUMP 53.8 69.6 M1 50.2 81.9 M2 67.0 86.9 U CO W I � TH-1 NO TRACE OF BED WAS FOUND IN THE TEST HOLE. IF ANY PART IS FOUND IT SHALL BE REMOVED R MOV D EXISTING f W/I 10' OF THE DRAIN FIELD HOLDING TANK PER MOA C / INSTALLED 1500 ADVAN W/ AX 20 POD AND AUXILLARY PUMP { VAULT / 19/ \� Ov O O WELL E LOT UNDEVELOPED / NO WELLS OR SEPTICS LOCATED fIt ! t 1 c> 1500g ADVANTEX I "PROFILE TANK SCALE: NTS NOTES: PAMONE ENG WC, C, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 DRAWN: ACP PARADISE VALLEY, BLOCK 4, LOT 18 KEN YAZAKI 6501 ITALY CIRCLE PLAN ANCHORAGE, AK 99516 AXE S 3BR HOUSE LOT 18 (0 �0) SAUNAI W m W m O 0 z� H z J O O FIT FAB H O- F 0 0 z o > O AIN R ao t t 3.0 o - 3 o z z w t z w N M t o OR EL Ow E U O O.G. F.C. O 0 SP to�o.X2 a 5 IF TF0 01878010 6 OAPD TOR -IR -"51/188018 1500g ADVANTEX I "PROFILE TANK SCALE: NTS NOTES: PAMONE ENG WC, C, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 DRAWN: ACP PARADISE VALLEY, BLOCK 4, LOT 18 KEN YAZAKI 6501 ITALY CIRCLE PLAN ANCHORAGE, AK 99516 AXE S 3BR HOUSE LOT 18 (0 �0) SAUNAI W m O 0 H z O F.G. t t 3.0 3 t o.C. TH4 t OR Z 1 0 SP 4 5 iG30 01878010 6 TOR -IR -"51/188018 DATE PERFORMED. 0I11EfXHe OF ALgsl�t 'c- ' •Steven 'f2. •F'annorie• �F CE 8149 F�/ �tcsTF�: ��1FNPROFESSMO' .� Dote 12/19/18 Scole 1 40' 2+-0. NO 020-411-26 PERMIT NO. OSP181293 Sheet 2 OF 2 0 w ,o ASBUILT SEED & ASSOCIATES LAND SURVEYING 694-0828 I HEREBY CERTIFY -THAT 1 HAVE SURVEYED THE SCALE:�� FOLLOWING DESCRIBED PROPERTY= QF A 4�n DATE ­ Ar AND THAT NO FNCROACHMEIM EXIST CEPT As INDICATED. IT IS THE RESPONSIBILITY OF THE � �= H OWNER TO DETERMINE THE E)OSTENCE OF ANY GRIT?: EASEMENTS COVENANTS., OR REe3-RICTIONS WHICH DO NOT APPEAR ON THE RECORDS? SUBDI®FS, �4� � o e Metz S�. VISION PLAT UNDER NO CIRCUMSTANCES SiOI.IIeO / yy 'I- LS - 5,913 , ANY DATA HEREON BE USED FOR CMN rR JC f'I ON OF FENCE LIKES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN: I MUNICIPALITY OF ANCHORAGE ment ^~` On-Site Water&Wastewater Program Allic\o 'PO Box 196650 4700 Elmore Road . Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.orgionsite • nctmynt fHppP� On-Site Wastewater Disposal System Permit Permit Number: OSP181293 Effective Date: 9/21/2018 Work Type: Septic Upgrade Expiration Date: 9/21/2019 Tax Code Number: 02041126000 Site Legal Address: PARADISE VALLEY BLK 4 LT 18 G:3538 Site Mailing Address: 6501 ITALY CIR, Anchorage Owner: YAZAKI KEN & Lot Size in Sq Ft: 16302 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3 This permit is for the construction of: El Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well 0 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 • 1 Received By: —;��ili - ...a.,,411111NENIL Date: Q t9 9 Issued By: J � (N Date: q Ar EPLh&4 MUNICIPALITY OF ANCHORAGE Community Development Department \. Phone: 907-343-7904 Development Services Division ` Fax: 907-343-7997 On-Site Water&Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-411-26 Property owner(s) Ken Yazaki & Miyuki Sato-Yazaki Day phone Mailing address 6501 Italy Circle, Anchorage, AK 99516 Site address 6501 Italy Circle Legal description (Sub'd., Block & Lot) Paradise Valley, Block 4, Lot 18 Legal description (Township, Range & Section) Lot Size 16,302 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field 0 Initial ❑ Single Family(SF) 0 (w/wo ADU) Septic Tank Q Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. lg ture of ppe ivaMer or authorized agent) Permit/Rush Fees: �j�9 Waiver Fees: Date of Payment: •g/g3h2 i2 Date of Payment: Receipt Number: 0.//25 7-.7 Receipt Number: Permit No. 63P12 I 943 Waiver No. Permit App_2- c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181293, Deb Wockenfuss, 09/21/18 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181293, Deb Wockenfuss, 09/21/18 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181293, Deb Wockenfuss, 09/21/18 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181293, Deb Wockenfuss, 09/21/18 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181293, Deb Wockenfuss, 09/21/18 T W UNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGRE EMENT !*HIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREE-Xi4ENT" made and entered into as of this "A Day of Sukk�,J/!�''of 20 by and between _kAL re he' in the"OWNER,"aid the Municipality of 1 U " Anchorage, herein the "MUNWIPALITY7- in accordance writh Anchorage Municipal Code (AMC) 15.065.365. In consideration of the mutual covenants contained herein, the parties to this Aent ageasfollows: ,-m 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the 0xvner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as A 4 YA_-7AK' located at (legal description) e- � j T -c- Vr,4 (C, y, 6l . �, K �) L- - l I F (Owner is required to read. understandand Initial each section' �_ks Throughout the term of this Agreement. the Owner shall enter into a service agreement ,Mth an AWAVTS sere -ice and maintenance provider appro-ved by the Nfunicipality or the manuf acturerls representative. TheAWIATTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. <; It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs., and inspection costs. This includes an annual maintenance fee (typically $4GO to $1600). 0t,vnlr agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to time system. I Owner acknowledges that regular maintenance of an AWWTS reduces the potential Z:� failure of the system, which could include sewage backup and costly repairs or drainfield replacennent. (rev. 05/18/2018) Page 1 of 3 (YN Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be Z:) assessed in accordance with AMC 14.60-0310. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS_ The -.Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS, vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred_ 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality- Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severabilitv. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 (signature) Uli Z Cprint name) STATE OF AAS ) ) ss. THIRD JUDICIAL DISTRICT } Bate: The foregoing instrument was acknowledged beffore me this Li4'" play of 20bySt,-\,3 M �(,\ NOTARY PUBLIC FOR ALASKA My Commission expires: ?YMI ICIPALITY- By: (sibnatnre) Oe b aJoca ,e e75 (print name) J (rev. 05/18/2018) 00���191dBBB`i do U1300 N' OF lBlB 1111 t� Date: g pzg Title: Page 3 of 3 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Name; ~-~cu~,,~(~~ ¢ '~~.~¢~/*-/3~ ' ' Wastewater System: D New ~Upgrade Address: ~ ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION ~o~, Rating: Total Depth from original grade: GPD/Sq. WELL: ~ New D Upgrade Grsvel depth: Number of lines: ~ Distance between lines: Classification [Private, A,8,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. SQ, FL Driller: Cate Drilled: StadcWater Level: Installer: Date installed: Ft. Yield: Pump Set at: Ft. Casing Height Above Ground: SEPARATION DISTANCES Septic ~olding ~ S.T.E.P. TO Seplic Absorption Lift Holding Uublic/Pdvat~ Manufacturer: ~rom Tank Field S,,,ion Tank Sewer Lines AR~.~ '~FA.~ t ~ , Material: 7 ' Co~padments: Surface , Water LIFT STATION Lot Size in gallons: Manufacturer: Line Foundation 'Pump on" level at: "Pump off" level at: High water alarm at: CurtainDrain >ump Make & Model Electrical Inspections performed by: Remarks: BENCH MARK ~ ~ / ~ ~j~ Assumed Eld ation: Department of Health~Hu~erv~ces approval '~:,:?,~ , (1/91) MOA 25 HE1LJgI/V TANK [XI£T 3Ez9 0 NDTES SCALD 1' = SO FT, TDBBEN SPURKLAND P.E, 203 ld 15TH, AVENUE ANCH, AK, 99501 (9117) R79-1~916 SEC II TIiN R3F/ ~,$01 ITALY £f1~£1F SUPFACED~ 1, PUMP A3SD/~PTIQN 3ED 2. BE P/CEPANEz9 ?O PUMP EXCA VA T]DN FD~ HDL~ZN5 TANK 3, MINIMUM S FT, DF CDVE~ DVER [~N~ SEPTIC SYSTEH AS~U~LT 9ATE, N~ ~ 19~1 SHEET, 2/3 ~R~,3538 IN L / 1' X 10' CflN~UIT RAIN CAP TYPICA 1' GAL VANIZED LB - PUMP ACCESS / ~--- 5 ~T, Z7F COVER OVER TANK ,,,,,,,,,,, ,,, ,, ,,,..,,, ,,, ~,~_,,,~ ,,E?;, ~ -~--...~,,,~,,,~ ~ ~ ~ ~ ...... ~ ~1 I ~Z ~ CAULgER CDUPLIN, ~TYPiCAL FD ALARM PANEL ~GH ~TER ALARM MERC~Y S~TCH ~ T ~-- DIRECT £U~IAL ~/I~E l' PVC CUNDUIT 5.33 1£, 17 £TANDA£9 ?000 6AL, HOL~]Nd TANK ANCHORAGE TANK TDBBEN SPURKLAND P.E. 203 W JSTH P, VE ANCH. AK, 99501 LOT 18 9LDCK 4 PARASISE VALLEY SECTION 11 TllN RSW NED GRUB£ ])ATE, NOV, 6 1991 _ SHEET, 3/3 GRID ~530 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910335 DESIGN ENGINEER:TOBBEN SPURKLAND, OWNER NAME:GRUBB EDWARD B OWNER ADDRESS:6501 ITALY CIR. ANCHORAGE, AK 99516 PoE. DATE ISSUED:10/22/91 EXPIRATION DATE:10/22/92 PARCEL ID:02041126 LEGAL DESCRIPTION: PARADISE VALLEY BLK 4 LT 18 SEC 11, T12N, R3W, SM LOT SIZE: 16302 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: HOLDING TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ELECTRICAL INSPECTION MAY BE NECESSARY, BUILDING SAFETY PRIOR TO INSTALLATION. RECEIVED BY: VARIFY WITH (907) 27~-~916 LIlT SEPTIC S¥.SFFE~I DESIGN 1~ BLOCt( 4 P~q~R6~} I S E V~LLE¥ NED GRUBB L.J~;~:9 Hell d :i. I]1..] T,-'TH"I k MUNICIPALITY OF ANCHORAGF. ENVIRONMENTAL SERVICES DIVISION oct 1 1991 RECEIVED Sc~p'l:.j.c tank Out;:le'L: 4' be].o~,~ gr't~und bal,'.:ulce up]:l.Ft: Use 110 h= 62.4x6/].~0 = 3.5 ~t Numbof c)'F ~)E)drc;)c)llH:4 450 gal 466 gall. SYSTEH I: [! I~1F Z I] U R/i T ] Il l~t 2000 GAL. HSLDING TANK LEAVE E×ISTING TANK AND LIFT STATION IN PLACE The ins'/a:Llatil:)n c:rF this holding tank :Ls necess:Lta'ked by the 'FL~:i. lLIr'~, O~ the ex:i.s'LJ, ng absc3rp'l:.ic:~rl system ancJ caused by tlqe imperv:i(::~usness o.F thcs, sc)J. ].~ at thJ. s lcH:.,, Ext~nsive sc]i :L ~ nvesti- g~':cl::;i, c:,11!.~ J]~Av(.E, '{: f'~:J, ]. ~,d '?,c] -F ;L iqd sc:ii ]. s 5LLJ. '~:~/[;):[ ~2 '~ CH'" ~?lz~'~l'ld~ir"d ~BiDJ. ]. abs~grp'kicu'-, systems. J-.loll. ding t~'::tf'lk Cil" a ~r3f]c;lv~]tiv(:~ !~ystc~ffl~ il]t~?l ..... ITiJ,'[t'~]f:)l]'J] s*':ti]d 'F :i, ]. 'l:'. el"' ~ at"l? the C)l"l].y prac'lz:i, ca} sciiutions a'l:, th:i.s t :i, m e ,, Sc!ptic: System Des:L~;In l..c~t lO, Bll::)ck 4 F'ar'ad:[se Valley I:i g q \ 13 2~ .50 0 50 100 150 200 £50 SO0 0 27 26 TnBBEN SPURKLANI] P,F. R03 b/ 15TH, AVENUE ANCH, AK, 99501 .(9o7) R79-5~916 SEC Ii TUN 6501 ITALY £IREI SEPTIC SYS1TM DESIGN BATE~ DC[, ~°0~ 199! 0 ~ 0 0 ~..,~-~- EX]ST. SURFACE N SO 0 SUP SURVACE DBAIN SCALEr F = 4et~FL C~-2225 i. PUMP ABSQRPTIflN DED ~ z?E PREPAREfl Tfl PUMP EXCA VA TI£N FDA HflLDING TANK 3. MINIMUM S FT. DF CDVE~ £VER TANK. TBBBEN SPURKLAND P.E, 203 ~/ 15TH, AVENUE ANCH, AK, 99501 SEC Il TIJN f~3h/ t~Sfll fTAI Y SEPTIC SYSTEM DESIGN DATE, BC~ ~ I991 SHEET,~/2 GRID, 3538 1N RAIN CAP TYPICAL PUMP ACCESS GAL VANIZED LB, S FT. DF CDVER DVE, e lANK CAULDE£ CDUPLING TYPICAL TD ALABM PANEL DIRECT £URIAL ~/IRE ]" PVC CDMgU]T 1~,17 £[ANY?A~y? ~000 ~AL, Hi]L~?IN~ TANK 5.33 GREE£ DR ANCHDRAGE TANK T~]BBEN SPURKLAND P,E, 203 W 15TH AVE ANCH, AK, 99501 LDT 18 z2L£CK 4 PARADISE VALLEY $£CTION 11 [lin 1~3~t NED G£U~B SEPTIC SYSTEM DESIGN DATE, D£~, ~ I~91 SHEET, -'~3/3 GP4D,35~q8 NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alasl(a 99501 Telephone 204-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS /~ 14o LEGAL DESCRIPTION LOCATION ILk. capacity in ga OhS /000 IF HOMEMADE: OISTANCE TO: Well ~8 '~-~ [] UPGRADE DISTANCE TO: I Well No, of lines Le 9th ofeacl line NO, OF BEDROOMS Absorption area Inside length Width Dwelling Dwelling ~O PERMIT NO. ~,.~6 3~ J Material No. of compartments Liquid depth PERMIT NO. Manufacturer Material Liquid capacity in gallons Foundation3~z ,~re~ ~2,0. Nearest lot line/O PERMIT NO~ ,~O ~ ~' Total length of lines I Trench width ~ ~ ] ~' ~ inches Material beneath tile inches Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) Distance b e t we e n~,L~/~,2._ Total effective abs6rption area OTHER PIPE MATERIALS C ~ SOIL TEST RATING lool;1 ' INSTALLER ~'t ~--~,169 /-I,ils,'~ db,~.'~.,'/,,~, £7. ~,J-' 287. REMARKS APPROVED DATE 8 72 013 (Rev. 3/78) Date Drllled~ Static Water Level 220 Draw Down N/A Tyne Material Drilled: feet feet WELL LOG Gallons Per Minute Total Feet of Casin~ .0., feet to to tN f~-hrn~n rl~F ~ur~vP1 ,3q ft ?_m 140 ft. to 330bed rock fractures fro~ 285~-330 ,, to Hefty Drilling Anchorage ,Alaska AF:'I::'t. I CAN 1:: COIfl'I'ACT I::'l-JOIql!: I.I!:GAI. /)t..,:N:.L ,, I.J]T ,~.I ;2, t · [l:l..]).llb ]..L(. ~ ,, I Afd~]l.)t,:~l:: VAI,Jl..EY 1...[}"['.'.' 18 :il (~(:~ (::)' (")[ I Il II=F'' OR Al'bb.':: ) E L.OCI<',", Zl :1: c c'~, p 'I: :i. f' y t Ii a'L: £1:)r'tl'l k)y 'Ll'16_~ I~lL~ri:i.l::j.l::la~J. ty I:)f Al'lc:hol',agl') (J',ll](~,) arid '(:.~"~.;) Sta'L¢} c)f A].aska. 2~. :1~ w:i.:l. 1 :install 'Lh~ sys'[x.:~m :i.n acccH,danc~:~ wi'Ll~ all MOA c:od~s and atll(::J :ilq C:[:)[~JZ)].J. aFIIX6') I~J:i.'J:,h tlllc'~ I:]I=~'S:J.(.~I] (:::r':i. Ler~:Ja C)f I:,J'l:[~:~ :][;,, I [:JJ.]/I adh~.')l,i) 'l:(:~ a].]. M(]A and Sta'Le~ ~::~.[' Alaska I'JlOquir'(~)merllLS fen, '{:lb(Il) (l:: A I..II::']' STATZON :IS INS]ALIJ::D IN AN AREA COVERED BY MOA [U.JILDING (Z)DES, Ifil:lq ( :1 ) AN I::I.I:CTRICAL. F:'[;I-~I~II T' AND :I: IxlSI::'I~:CT ]: [IN HLJS'I' BI~: OBTAI NED ~ (2.) AS-Bt.III 'I'S Ifl:l:[I Nf.)'l BI:: AI::'I::'ROVI~:D WZI'I. tl]UT AN I:I.J~:C]"I::~ICAI.. ZNSPE:CT]:[)N RE]::'CiF(]'~ hlxl]) (.:~;) 'IHE I:I..I:CI'F~IC:hl. 19(:)1:~1::: MIJS'I BIS: BY ~,I.:[CI:NSE~) I:LI~:C'IRICIAN,, S :[ GNED DA'I'E: ' AI:::'F:'t. :t.( :AN I ~', ~1 Zl: S SI JE:)~ ' ": ALASKA ei UIRODIlleDTAL CO[1TROL SeRuICeS, IDC. ~ngi~¢~inq 8 ~nuJi'onm~nl~l Slu~Jics SPECIFICATIONS FOR BED WASTEWATER TREATMENT SYSTEM - PARADISE VALLEY BLOCK 4, LOT 18 1.0 GENERAL 1.1 THE DRAWINGS SHEETS 1 THRU 8, SHALL BE PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF DEPARTMENT OF HEALTH AND HUMAN SERVICES. 1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE VERIFIED IN THE FIELD BY THE CONTRACTOR. 1.4 IT IS THE RESPONSIBILITY OF THE OWNER OR CONTRACTOR TO ADHERE TO APPROVED DESIGNS FOR INSTALLATION, MAINTAIN THE SPECIFIED SEPARATION DISTANCES, AND TO HAVE APPROPRIATE INSPECTIONS BY ADEC~S APPROVED AGENCY. 2.0 SEPTIC SYSTEM 2.1 2.2 THE SEPTIC TANK SHALL BE A UPS APPROVED TWO COMPARTMENT TANK, SET LEVEL, AND INSULATED WITH AN OVERLYING LAYER OF 2 INCH BURIAL TYPE POLYSTYRENE. THE SEPTIC TANK SHALL REST ON UNDISTURBED SOIL. INLET AND OUTLET PIPING SHALL BE FITTED WITH WATER- TIGHT CAULDER OR FERNCO COUPLINGS. PIPING SHALL BE 4 INCH SOLID PVC ASTM 3034, SLOPED A MINIMUM OF 1/4 INCH PER FOOT, WITH A MINIMUM OF 4 FEET OF COVER. IF LESS THAN 4 FEET, USE 1 INCH OF DOW EXTRUDED BLUE POLYSTYRENE FOR EACH FOOT OF COVER LESS THAN 4 FEET. 2.3 CLEANOUTS SHALL BE INSTALLED WITH CAULDER COUPLINGS, CAPPED WITH AIR-TIGHT JIM-CAPS (OR EQUIVALENT), AND EXTEND A MINIMUM OF 0.5 FEET ABOVE GROUND LEVEL. 2.4 THE SEPTIC TANK SHALL BE A MINIMUM OF 5 FEET FROM THE BUILDING FOUNDATION, AND A MINIMUM OF 5 FEET FROM THE DRAINFIELD. 2.5 THE ENTIRE SEPTIC SYSTEM MUST BE 100 FEET OR MORE AWAY FROM ALL PRIVATE WELLS AND YEAR-ROUND WATER SOURCES, NATURAL OR MAN MADE, AND 150 FEET FROM CLASS C WELLS, AND 200 FEET FROM CLASS A WELLS. 3.0 SEEPAGE BED 3.1 THE GRAVEL FOR THE BED SHALL BE SCREENED TO THE SIZES INDICATED; 0.75 TO 2.5 INCHES (OR ADEC EQUIVALENT). ? 3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. 3.3 TWO OBSERVATION PIPES SHALL BE PLACED AS SHOWN IN THE DRAWINGS. THEY SHALL BE RIGID PVC, ASTM 30303 D-3034. THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5" HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE 1200 LUesl 33rJ J~ucnu¢, Suil¢ E~ · ~nchorctq¢, J~lesko 99503,[907) 561-5080 OR A SECTION OF REGULAR PERFORATED SEWER PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP OF THE PIPE. 3.4 INSULATION, SHALL BE DOW EXTRUDED BLUE STYROFOAM BOARD OR EQUIVALENT (1" PER FOOT OF SOIL LESS THAN 5 FEET OVERLYING THE BED.) 3.5 THE TOP AND SIDES OF ~fHE BED SHALL BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX OR BLUE GRASS. 3.6 THE SEPTIC TANK OR BED MUST NOT BE CLOSER THAN 100 FT. TO ANY EXISTING PRIVATE WELL OR BODY OF WATER AND SHALL BE NOT CLOSER THAN 150 FEET FROM EXISTING CLASS C WELLS OR 200 FEET FROM CLASS A OR B WELLS UNLESS OTHERWISE SPECIFIED. 3.7 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC ASTM D 2729 OR EQUAL OR POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL. 4.0 THE LIFT STATION 4.1 THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER GALVANIZED STEEL (ASTM A-4444-76), OR ALUMINUM CULVERT, CAPABLE OF BURIAL TO 10 FT. 4.2 THE 36" DIAMETER PIPE FOR THE LIFT STATION SHALL HAVE A WELDED WATER TIGHT BOTTOM OF THE SAME THICKNESS AND COMPOSITION AS THE CULVERT. 4.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED AND WATER TIGHT. ALL WELDS SHALL BE CLEANED OF SLAG. WELDS ON GALVANIZED STEEL WILL BE SPRAYED WITH ZINC RICH PAINT OR COATED WITH BITUMASTIC. 4.4 THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED WITH SCREWS. A TWO INCH LAYER OF POLYURETHANE FOAM SHALL BE BOLTED TO THE INSIDE OF THE TOP CAP. 4.5 ALL ELECTRICAL FITTINGS AND CONNECTIONS IN ~{E LIFT STATION SHALL MEET THE REQUIREMENTS FOR A WATER TIGHT SERVICE. 4.6 THERE SHALL BE A HIGH LEVEL ALARM, PEABODY BARNES 6147 OR EQUAL SET AT ~{E LEVEL OF THE SOIL PIPE FROM THE SEPTIC TANK. THE BUZZER SHALL BE LOCATED NEAR THE ELECTRICAL CONTROL PANEL OR IN A LOCATION DESIGNATED BY THE HOMEOWNER. 4.7 THE SUMP PUMP SHALL BE CAPABLE OF DELIVERING 10 GPM AT A HEAD OF 20 FEET. 4.8 PROVIDE A CALDER COUPLING AT THE CONNECTION OF THE 4" SOLID PVC INFLUENT PIPE AND 4" STEEL NIPPLE. 4.9 THE PUMP SHALL BE CONTROLLED BY A DIFFERENTIAL MERCURY FLOAT SWITCH, ADJUSTED TO ALLOW A TWO FOOT SPAN BETWEEN 'ON' AND 'OFFI, AS SHOWN IN THE DRAWING. ALL RELAYS AND ELECTRICAL CONTACTS SHOULD BE LOCATED OUTSIDE THE CHAMBER TO PROTECT THEM FROM CORROSION, PREFERRABLY IN A DRY LOCATION WITHIN THE HOME. 4.10 COAT THE INTERIOR OF THE CHAMBER WITH BITUMASIC PAINT OR TAR TO APROXIMATELY 3.5 FEET ABOVE THE BOTTOM. 4.11 THE SYSTEM SHALL BE INSPECTED BY A LICENSED ELECTRICIAN TO INSURE THAT THE ELECTRICAL INSTALLATION IS IN ACCORDANCE WITH APPLICABLE CODES AND REGULATIONS. 4.i2 AT LEAST TWO INSPECTIONS WILL BE NEEDED OF THE SEPTIC SYSTEM--FIRST, OF THE EXCAVATED BED; SECOND, OF THE SEWER ROCK AND PIPE AND INSULATION, AND THE TANK. IF AECS DOES NOT PERFORM THESE INSPECTIONS AECS WILL NOT BE RESPONSIBLE FOR THE DESIGN. ALASKA ENVIRON"'~NTAL CONTROL SERVIC , INC. 1200 Wes~ 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) §61-§040 JOB ~Z)~.~/~.(, U~//('~ ,~,/~'¢~' ~ ~ SHEET NO OF CALCULATED BY ~r~ DATE CHECKED BY DATE 2.O \ ALASKA ENVIRONMENTAL CONTROL SERVIC' ', INC. 1200 West 33rd Avert Suite B ANCHORAGE. ALASKA {}9503 (907) 561-5040 ALASKA ENVIRONMENTAL CONTROL SERVICe% INC. 1200 West 33rd Aver Suite B ANCHORAGE, ALASK~ 99503 (907) 561-5040 ALASKA ENVIRON'"ENTAL CONTROL SERVK ,, INC. 1200 West 33rd Avenue. Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JOD P,~d,.<~ t/,~l~ l~l,~f q SHEET NO. ~' CALCULATED BY ~' ~ DATE_, ALASKA ENVIRONlUI~NTAL CONTROL SERVIC INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 56~..5040 I': 2.5' ' OF DATE DATE ALASKA ENVIROI~ !NTAL CONTROL SERVIC=5, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 Joe 8HEETNO CALCULATED BY CHECKED BY DATE ALASKA ENVIRON~'-NTAL CONTROL SERVIC, INC. 1200 Wes:~ 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 8HEST NO CALCULATED BY D~-' ~Y DATF CHECKED BY DATE SCALE 1200 West 33rd Avenue Suite B ANCHORAGE, AL/ ~, 99503 Phone 561, ~,0 SHEET NO (~[f OF ~;~' V/S~-~ D Y .-----~'~0~:~)~ DATE CHECKED BY DATE - L/FT STAT/ON DE'7'A/L NEMA 4 ENCLOSURE GALVANIZED OR PAINTED METAL COVER ' ~ ~" URETHANE FOAM :GLUED TO COVER I~'DIA PU/L'PIPE CONNECTED TO ADAPTER FOR PUMP REMOVAL GROUND LEVEL POWER AND PUMP CONTROL lINES I ~ DIA STEEL PIPE ~ " CONDUIT FIL£ET WELD AROUND PIPE 4'DIA SOLID PVC PIPE FROM SEPTIC TANK COUPLING DIFFERENTIAL MERcuhY FLOAT SWlTCH /NS/DE OF PIT SHAL BE COATED WITH BITUMINOUS PAINT OH TAR PUMP PUMP .POWER ALARM CORD · PUM/ CLAMP /T/ESS ADAPTER · '/' '2" SOLID P MIN /.. . TO ABSORPTION AREA ~HE4T TAPE GAl_VAN}ZED STEEL A-4444-?6) -- PUMP "OFF" LEVEL GALVANIZED OR PAINTED STEEl- PLAT~ Leroy C. No. 2251-I~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~SOILS LOG [] PERCOLATION TEST PERFORMED FOR: ~"~M'-,..~ .~'~ I,' $'F DATE PERFORMED: SLOPE 4 6 9 10¸ 11 13- SrTE PLAN WAS GROUND WATER ENCOUNTERED? ~t IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop 14- 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: 72-008 (6/79) PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) FT AND -- FT 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 1. GENERAL INFORMATION - Cum plete legal description Location (site address or directions) ~J-O~ _~'~l,v C,r¢l~ Property owner Mailing address Lending agency Mailing address Agent /Vo,~ Address 711/ T~I/ ~/'p~'~-~- ?~,,¢,'~ ,¢'/~-,/¢~ mo,-~-~-,¢¢4 Dayphone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well t~- Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-325 (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 veri~y 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. Name of Firm ~'/,..¢.6p 7',, ¢.~ ., , 'c ,. / $~fv~ Phone Address Engineer's signature DHHS SIGNATURE ~ Approved for '-r'/-/',~ E'~' 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 cpu rtesy to pu mhssers 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. Legal Description: A, WELL DATA Well type Log present (Y/N) Municipality of Anchorage AU6 SE-'RVICES DEPARTMENT OF HEALTH & HUMAN MUNICIPALiTy OF Environmental Services Division 825 L Street, Room 502 · Anchorage, ALaska 99501 · (907) Health Authority Approval Checklist If A, B, or C, attach ADEC letter. ADEC water system number '/" Date completed Total depth Sanitary seal (Y/N) Y Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 col ~/roo ,,~.~ Date of sample: ,~'/~- / ? 9 B. ~E~'tHOLDING TANK DATA Cased to I '-/¢' FROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION ~-/.~- / ?¢ Nitrate g.p.m. 5-;. E. g.p.m. /, '/~- r~,.,? /-¢- Other bacteria /',/o,"¢ Collected by: ,~'/~/'/~,~ '~'~'c& .Cc, ~ Date installed tl /,5- ,/? / Foundation cleanout (Y/N) Date of Pumping 7/2.-~/?? C, ABSORPTION FIELD DATA Date installed .r,/. A. Length Width Effective absorption area Date of adequacy test Fluid depth in absorption field before test (in.); Tank size '~ aO0,_7~_ Number of Compartments ~ Cleanouts (Y/N) Depression (Y/N) ^/ High water alarm (Y/N) Pumper ,4 -~ Soil rating (g,p,d./ff~or ft~/bdrm) __ __ Gravel thickness below pipe Monitoring Tube present (y/N) . Results (Pass/Fail) Fluid depth (ins) Minutes ater: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* System type Total depth Depression over field (Y/N) __ For Immediately after___ gal. water added (in.): Absorption rate = If yes, give date g.p.d. .bedrooms D. LIFT STATION N. ~. Date installed Manhole/Access (Y/N) High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~/holding tank on lot Absorption field on lot ~J. Public sewer main ~. Sewer/septic service line --.....> Property line Surface water Curtain drain F. ENGINEER'S CERTIFICATION Size in gallons "Pump on" level at* "Pump off" level at* HAA Fee $. Date of Payment Receipt Number in conformance with MOA HAA ,~uidelines in effect on this date. ~ ,,.. ~, , ~ ~, ,~ Engineer's Name ] ~¢¢ ~o~ ~ )~o ~ ~ ¢ ~~.~ ,~~ Date ~ ~ ~ ~ /¢9~ :?.;~% CE-3589 ..~ ,~,~ Waiver Fee $. Date of Payment Receipt Number 72-026 (Rev. 3/96)* SEPARATION DISTANCES FROM ~:;~;C/HOLDING TANK ON LOT TO: Foundation ,¢o' :~ Property line ~> ! o' Absorption field /~. ,4. Water main/service line '-~ lo' Surface water/drainage '~ /oc,, Wells on adjacent lots -~ ~ o,~ , SEPARATION DISTANCE FROMABSORPTION FIELD ON LOTTO: h/./). ( I-)ol~(/,~,Z 7"-c~n ~,) Building foundation Water main/service line Driveway, parking/vehicle storage area. Wells on adjacent lots On adjacent lots I~¢' '/~ _,,'z-¢P ~,~4o/~ On adjacent lots ~>/¢~' Public sewer manhole/cleanout Lift station N. ,~., 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 Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~21 5. STATEMENT OF INSPECTION BY ENGINEE~ 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. NameofFirm %~-'~,/,.¢.5¢.¢? ~,,¢'k~,,~.¢~/??~ Phone Address ¢~ % ~ i4 Engineer's signature ~ ~.c66-~~ Date / DHHS SIGNATURE ~ Approved for _..._~ __ Disapproved. bedrooms. __ Conditional approval for bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage ~, Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST J- et.4~'~(~ .(~z Parcel t.D. Legal Description: ~o ~ ~(~, fi)i( ~g3_L)-- ~J ~'~ A. WELL DATA Well type 1 Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Date completed Cased to i L~-~ FROM WELL LOG Date of test Static water level ~- Well flow Pump level SEPARATION DISTANCES FROM WELL TO: _~ptic/holding tank on lot Absorption field on lot Public sewer main I~/~ Sewer service line ~'}-/~k ADEC water system number "-/3' ~w-[~-- Driller Casing height Wires properly protected (Y/N) AT INSPECTION -~ ~' 7' q~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SBI~TIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) Tank size ~- (-¢~*-~2 Compartments (~) Foundation cleanout (Y/N) ~ Depression (Y/N) ~" Alarm tested (Y/N) t'~///& Pumper /'h///~,- High water alarm (Y/N) Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I ~ To property line ' Surface water/drainage On adjacent lots Absorption field ,/- Foundation Water main/service line, 72-026 (Rev, 7/91) F¢ont CONTINUED ON BACK PAGE C. LIFT STATION ~/-~ Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Soil rating Gravel thickness SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed Length Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Surface water Well on lot To building foundation On adjacent lots Surface water Curtain drain System type Total depth Cleanouts present (Y/N) Date of adequacy test for · rf yes, give date On adjacent lots Property line To existing or abandoned system on lot Cutbank Water main/service line Driveway, parking/vehicle storage area bedrooms 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. HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91 ) Back MOA 21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions Property owner Mailing address Lending agency Mailing address Day phone ~¥.~- (~; 4/~/~/ Day phone Address .... Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: 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. 4. · .T-YPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, ~ 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. Name of Firm "~ ~'-~ ~ u v'~J c~,L~ Phone I Address ,~O'~ be' Engineer's signature _~--~j_, ~ Date 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. 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. 72~25(Rev. 1/91) Back MO^~21 Legal Description: A, WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. If A, B, or C, attach ADEC letter. ?/ Date completed .~ 90 Cased to I ADEC water system number Casing height . ~2/~/I Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level ~,~ O Well flow Pump level g.p.m. AT INSPECTION .MII1NICIPALtTY OF ANCHORAGE ~P ' V' ~ } ~:~,!v!prjNMENTAL SERVICES DIVISION 1991 SEPARATION DISTANCES FROM WELL TO: Septic/l:mldir~-tank on lot J Absorption field on lot Public sewer main ~///~ Sewer service line r'Z/A ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank I¢,O 'f WATER SAMPLE RESULTS: Coliform ~ Date of sample: ~'/tl/ d B. SEPTIC/HOLDING TANK DATA Date installed ~', 7' &.~ Cleanouts (Y/N) X High water alarm (Y/N) Date of pumping . ~ ~ Other bacteria Tank size / 1~4.~ Compartments Foundation oleanout (Y/N) ,~,/ Depression (Y/N) Alarm tested (Y/N) J~ 'Z~-- ' '~1 Pumper '~ Nitrate Collected by: SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot tO ~ To propertyline J Surface water/drainage On adjacent lots Absorption field w/,~ Foundation Water main/service line 72-026 (Rev. 7/gl) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) ~'/ Manufacturer /~ ' ~.~a Manhole/Access (Y/N) ~// '~ Cz. "Pump off" level at /~. Fz Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot I } 0 ~ On adjacent lots Surface water /",//,~ D. ABSORPTION FIELD DATA Width Soil rating 104~ System type Gravel thickness ~ ~/ Total depth Cleanouts present (Y/N) /"h/ Date of adequacy test ~/7*'/¢/ Date installed Length '~'¢ /'7 Total absorption area Depression over field;(Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) for bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots l ~¢ o/ Property line To existing or abandoned system on lot Cutbank t'..d,~ m e_ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect'on the da'ti ~f this inspection. Engineer s Name '~ ~.u~ ~..(~ Date HAA Fee $ /,/~) ¢3.~ Date of Payment Receipt Number 72-O28 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 203 N£Sl 15¥N, AVENUE StlITE 206 (~07) S__EF'~.~C ~YSTEM ADEQUAOy ~ES]' LEGAl-: L..crb. 1~3,¢ B].c:~c:I.,: 4 par'~&di~e Vall6~y LOCATION: 650% Irately Cir. OWNER: RESIDENCE: WELl-: SEPTIC SYSTEM: Ecl El u..bb Single) Fam:L:Ly~ ..:, 13el:h" tit)ms pr'ivate~ On Site MLIN]][.'IF'AL RE[][]RDS: 3 Bedr'c~c)m System TANK: Greet' Steel. 1000 (3al,, "Fwc) (]c~mparts. ABEH]RF)TION SYSTEM: Bed AB~iC]F~F"I"]:ON AREA: 4.76 ~Cl. I:';'t,, SCI ]; b RAT I NG: ~. O0 :1: N E~'I" (.~ L.L Al' ]; [)N DA'T'E: DATE OF LAST PUMPING: ]:.csa,'ac:cs Au.tgui~'b ~;~:-2 1.9c71 DATE OF TEST: Au¢. '7 1991 TEST PROCEDURE: S}y~(~t:.em ~as inspet:t, ed arid mea,;~ur6~d. Tanl< .Found w:i. th '~' ':~ ~.:~,~:.~'E o+ (::over and wi'tih a l~.C:luid ].e:.>v~]. (:]~: 50 :Lr~c:h .... TEST RESULT: TI"JJ.~ ssysvbem 1'fl6~e:r[';~s 't.l"lce c:c:~de r..6)quir'~rl~c~lt:~s c~...., .' -.¢~,~ ~)~[:)¢'&i,-t':f~69~]'b. (].F thee i:h6:' I.-lec*lth and S(~c:ial .~=r Ant q~)raqe. EXCEPT HIGH NATER ALARM NOTE 'Thee c)pe:~r-'~a't:ic)natl :l.i.¢e o.F ,~].:1. ssep'b, ir: sy~terr,~:; c:le~pe)ndf~, c)n 'U. he;, c~vaz].ua['.(::)r o~ 't'.h:i.s~ ~:i;Ecp'[:.:i.(::: f~yst.~:rfl. NE (::&~rl 'Eh(:)l"6,~cir'¢~ WEST 15'IH, A~ENUE ~UITE A~CHORABE~ ALA~KAg9502-~904 (~07) 279-~918 RESIDENTIAL WEL~ INSPECTION LEGAL: Lot. 18~ Block 4 Parad:Lse Va].ley LOCATION: 65'- 1 it. aly Cir. OWNER: led Grubb TYPE OF WELL.: Privat. e~ Single F:'ami. iy WELL LOG AVAILABLE: Yes INSTALLATION REQUIREMENTS ME]':Ye!~s WELL YIELD FROM WELL LOG: PUMP YIELD FROM TEST: DATE OF INSPECTION: TEST PROCEDURE: We]. 1 4. Gallons per Minute'- 5 Ga].],ons per Minute August 7~ 1991 was pumped at a c:;ons]FJ:ar]t rat'.e whi ]. e 'JZI]E9 ~:~ pE~riod pre)be. At. the ])(~qliFH]inc=l 0'~ t.J]e test water' level was -Found at .,~,z. 8 ,J:c~et be].c]t~J t. op c)~ cas:Lng,, At a p ml:]in(]) ra~]e O'E ~ gailol]s I/I~,I'H.i'~'.E~ th(D water' ].eve1 dr'c:)pped to 3C)1 a.ft. er" 65 mil]utes o-I: ]"h~-,~ we].l rec:overy was monitored .for 90 minutes,, During this time [".hf~ ~elI recovered to 22S .fo:et. TEST FOR E.COL]] AND TOTAL NITROGEN: Water was test. ed .for E.Coli and '~:c)ta]. nitr'ogen on August 14 1991. EE. []OIi O. To'~.aI Ni'L'.roge;"l O. 6S lag/].. TEST RESULTS: ThJ. s we].I meets the MLIni(::J. pal i ty o'~ Afl: ~ or'a(:lc~, THIS.. WELt~ WILL, PRODUCE.. MOR_E_ THAN. ~ GALLON~_ ~PER ~INUTE THAN F_QUR. NOU_R~ FOR .MORE asqes s ~ 'r~ o'¢ the cof]d i {'.:J. Ol"t o'J: thE, we}I ]. .'~ppI i 6)~ ol-i], y to;) the c:omqdi'L:LOl"~s as of 't'.'.lie day test. ccd,, 'l'hc~ f:Low 1" 6&'J; 6.;¢ ~lay cqang¢~ due to aqui fc.)m"' -f~.x~:d:i. ng t. he wel i, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date June 8, 1988 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) 6501 Italy Circle (b) Property Owner Alliance Bank Telephone: Home Denali Br., 440 E. 36th Avenue Mailing Address Business 786-6324 (c) Lending Institution A] 1 '~ ~n~: Bank Mailing Address Telephone 786-6324 (d) Real Estate Company and Agent R~ma× ~ Carl Rmi t-.h Address _ 2600 Cordova Telephone 2?6-2?6]. (e) Mail the HAA to the followino address: or: Check here [], if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family l[~( Number of Bedrooms 3 WATER SUPPLY Individual Well F~X Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ~X Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 ENGINEERING FIRM PROVIDING ImSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, [ 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 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. NameofFirm q~.' ,~purklRnr~: P_ R. Telephone 279-3916 Address 203 W. 15th Date May 'R1 ; 1ORR Engineer's original stamp and signature on file with D.H.H.S. Engineer's Seal DHHS APPROVAL Approved for "Ph~¢¢ ( '4)bedrooms by Approved ×× Disapproved Conditional Date 06-28-88 Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-025 IRev 8/86} Back ALASKA el/UIROnmellTAL CONTROL SeBUICeS, InC. o ~nqineerinq 6 {~nuironmenlol Studies Jtlne 28, 1988 Department of Ilealth & Iluman Services 825 Y, Street Anchorage, AK. 99501 Attn: Susan Oswalt Let: 18, Block 4, Pul'adise Valley Subd:iv:ision As of June 27, ]988 the illegal curtain drain on the ]or was disconnected, It is no ]onge]? funel::Lena] as the pari: of Lhe drain along [tim wesL side of the house has been removed and 'blue clay" has been packed back into the trench. The crawl space drain :is still OOlllleci;ed Lo ~ha'k porkion of the dl'aJll Lhak extends fpom the SW corl~ep of the house to the outfa].l. See the attached sketch. MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION JUN 2 8 t988 RECEIVED {200 LUes{ 3Srd Auenu¢, $ui1¢ ~eAnc{mroqe. Ahsko 99503,(907] 551-5040 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Properly Owner &~ ~ Telephone: Home Mailing Address ~ (C) Lending Institution ~[[~ Mailing Address Y ~O ~ ~ ~ ~-¢ (d) Real Estate Company and Agent Address Telephone ~7~ (e) Mail the HAA to the followin~ address: or; Cheek here~ if hold for pick up, List contact ~erson and day phone number below. TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL onsite~L, Public [] Community [] Holding Tank [] / Note: I~ community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025/Rev 8/861 Fronl 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND 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 in effect on the date of this in~ /~ Name of Firm ~a. J' · .... f/ Telephone ~"7 ~" ~ ~ / ~ Address / ~ ~ l~--~ Engineer's Seal 6. DHHS APPROV.~ 'Xx~pproved f o'r"~ '" proved /% / ppr( CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does th is 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. Page 2 of 2 72-025 IRev 8/86) Back PAU'f¥ OF ANCt4(bR^G~: MuNICi ...... ~1~,1~,~ ~LITY OF ANCHORAGE (MOA) ENTAL ~w~o ~,--~ ~NvI~ON~ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 JUN C 198B 264-4720 WELL DATA Well Classification Well Log Present (Y/N) Total Depth ~ '"~(~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/b4+,,~,,~g Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments 'Y' '~ If A, B, C, D.E.C. Approved (Y/N) 7' ~' ~'"' Yield Date Completed Depth of Grouting ~ O ~.~ ~_.. Pump Set At ~,, .fl/~.z Sanitary Seal on Casing (Y/N) '~ Depression Around Wellhead (Y/N) ~f O V ; On Adjoining Lots /~ ~4,. ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Size /O.~¢.',~ No. of Compartments "'~-~'~*~ Air-tight Caps (Y/N) X Foundation Cleanout (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Comments Date Last Pumpe~-"~'Z ; or Temporary Holding Tank Permit (Y/N) ~ __ To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage ,, ' · :. --/, Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field ' Gravel Bed Thickness Standpipes Present (Y/N) Date of. La. st Adequacy Test Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons To Property Line I C~ To Existing or Abandoned System on ; On Adjoining Lots ~'~o-C~! present) ~ O u/ ,~ "Pump On" Level at IltI High Water Alarm Level at ~,~) Tested for Electrical Codes (Y/N) y Comments Dimensions /"7/~ ~)'~ Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Bating Against HAA Request ** I certify that I have checked, verified,~or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '~-~ Date '~/i~/~ Company MOA No. Receipt No. / Date of Payment Amount: $ Page 2 of 2 Engineer's Seal 72-026 nl/84) CONSULTING ENGINEER TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: ~ ' : LOCATION: -. ' OWNER: RESIDENCE .- WELL: SEPTIC SYSTEM: Lot 18, Block 4, Paradise Valley ~ OF ~,,~..' ~,, .. 6.501 Italy Circle ,¢%. Single Family, Three Bedrooms ¢~~7~' O~ Site, Single Family ~% FROM MUNICIPAL RECORDS: TANK: Greer Steel, 1000 gal. Two Comp. ABSORPTION SYSTEM: Bed ABSORPTION AREA: 476 SOIL RATING: 100 INSTALLATION DATE: August 1985 DATE OF LAST PUMPING: May 21, 1988. Marx DATE OF TEST: May 19, 1988 TEST PROCEDURE: System was inspected and measured. Tank was found with three feet of cover and a liquid depth of 55 inches. Two monitor tubes in bed were found 2.5 feet deep with no standing water. Lift station was found 77" deep and with 8 inches of water. Lift station lid was not bolted down. 730 gallons of clean water were added to the lift station at a constant ra~e of 5 gallons per minute. Pump turned on at 11 inches and off a5 6 inches. Approximately 50 ~allons were pumped per cycle. Adding 730 gallons to tAe bed caused 3.5 inches of water ~op be m%asured in the monitor tubes. 12 hours later the tubes were dry, indicating that the volume of water had been absorbed ky the sO~ ............................ ---~ ........ /0~ May<-~ the tank was exposed and it was discovered that t~ // pipe between the septic tank and the lift station had separated [at the lift station. The tank wa's found 6 inches lower than the ~inlet to the !lft. Tank was raised, bedded in pitrun material ~und_~reconnected to the liftstat~n. TEST RESULT: This system meeus the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore~ not give any estimate of how long this system will function satisfactory for currenu or future occupants. 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) Location (address (b) Applicant Nam, Applicant Add~' (c) Applicant is ~phone: Home 15Z~ % S ~ -3- ~5 Business ; Owner/builder%~; Buyer []; Other [] (explain); (d) Lending Address (e) Telephone Real Estate Company and Agent Address (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Familyi,~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY' Individual Well'~ Community [] Public [] Note: If corn m unity well system, must have written confirmation from the State Department of Environmental Conservauon attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 {11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, D~,,,A AND 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 Anchora9e files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm _ /~ Eo~ Telephone ~ I ~o~,0 Address Iz~oo t,O :~ .~ ~z.r~ ~c~ ~ c~ ~(,9 °~ Date /,~ "/," '~ ~ Seal DHEP APPROVAL Approved for -¢',,.,~c. C"~2 bedrooms by ~ '~)'' "~-t~,~ Approved / Dis~ved Cond~al 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 $ above by an independe.nt 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-o25 (11;84) MUNICIPALITY OF ANCHORAGE (MO~, HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION ,JAN 5 lg86' WELL DATA Well Classification (C/ ~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present~_~N)~ Date Completed '7-~ ~;~'~5- Yield Total Depth ~ ' Cased to /¢0'~ Static Water Level ,'~¢'~ Casing Height Above'Ground Electrical Wiring in Conduit~N) Separation Distances from Well:- To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments Depth of Grouting (~/~.h'~Z.¢~-~.% Pump Set At of~:~¢(4/~-t Sanitary Seal on CasingS4) Depression Around Wellhead (Y/~ ; On Adjoining Lots ~ OZ~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot · ~T~O- t ¢-"( ; Date -6' ,-. 2. 5 SEPTIC/HOLDING TANK DATA Date Installed Standpipes Depression over Tank (Y/I~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ',,O To Propert~ Line ,~;W~t~r ~q n~ce Line Size too o No. of Compartments Air-tight Caps~N) Foundation Cleanout Date Last Pumped ; for '---- Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage 72-026(11/84) C. ABSORPTION FIELD DATA · Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well J O~ To Building Foundation 5 2- Lot - To Water Main/Service Line \ (.3 -~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness J Standpipes Present ~N) Date of Last Adequacy Test To Property Line 1 o To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at ,/~'~- Dimensions Manhole/Access~N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Tested for Electrical Codes~N)~'~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify tha~l have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Receipt No. Date of Payment J Amount: $ ( Page 2 of 2 72-026 (11/84) December 9, 1985 WATT ELECTRIC 2907 W. 33rd Anchorage, AK 248-7557 99517 To Whom It May Concern: This is to confirm that Doug Mandevill inspected the electrical hook ups on the lift station at Lot 18, Block 4, Paradise Valley Subdivision. Mr. Mandevill is an Alaska licensed journeyman elec- trician. He stated that the connections, splices, etc., appeared to conform to the National Electrical Code, and any applicable local codes. Very truly yours, JW:cw