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HomeMy WebLinkAboutSAND LAKE #2 BLK 2 LT 11 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl_TH & ENVIRONMENTAl. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl- INSPECTION REPORT ' PHONE ~ NEW NAME A,L,NG ADDRESS EGAL DESCRIPTION LOCATION ~.. ~,~ ,~ If) ,~/.,~ , [Liq. c~apa~city in gallons [ -- --- Inside length ~ ~ ~) ~ IF HOMEMADE: DISTANCE TO: ] Well Dwelhng OISTANCE TO: Well -- k~ng~h o~ach Top of die to finish;~7.~ Dwell ng [Width NO, OF REDROOMS PERMIT NO. Liquid depth PERMIT NO. Liquid capacity in gallons ,Foundatio , PERMIT NO. inches Total effective bsorption area inches ~ g;- ~ . To al le~n~ of Depth Length Width Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation DISTANCE TO: Depth Driller Building foundation DIST OTHER PIPE MATERIALS NSTALLER PERMIT NO. Sewer line Nearest lot line Distance to lot line ]PERMIT NO. Se~tic t~n% --- 1X~i°~ aarea(s) APPROVE[) [)ATE LEGAL 72 013 (Rev. 3/78) F'EITH I T I-Ft. I .'F,I L.. O C:I::I T '[ 'Z I".1 I [: L F I I I: ~'ff:II::'F'I!E/I:::ff::IF'F'E' [:.,.'.,L.. E, .. ,.., ±1:3--.~;2 ~ r: 2 S E f:114 E f_"~ [:'::,' ...... 1. EfT :l.:t. E,I...F ..... ..... Mt,J[.. L.F::II<:E[ :[~;.:.:: L O T ,: :, I ,:: I"!I::IF;: ]: MLII"I i' iLIt IE L[-.. OF F!:EI:)R:OOM'S~ ~:: ? 'THE: L.E:hl(]"I"I-I D]:MENE, ZON I5; "['HE; LEN(]TH '::Il",! FEET::, Of::' THE Tf4:ENC:I"I OR [:,ITFIIIqF':I:E:L.I::,. THE DE:P"I-H OF' I::1 TITENC:H OIR F:'IT IE:; 'I'H[E DZ::T,I"FINC:E: E~[ETP.IEEI'.,I 'T'HIE '~;LI[;!F:FIC:E: CIF' "fT.IE: G[:~:Cfl. JN[) FIN[::, THE EJO'f'TOi',l OF THE E('?:;CFY,,,'I::ITZ Oh,J ,:; I J",l FEET ;:,. TI...IEFi:[E !'.S h!CJ :SITT 14I[)'TI-4 FOR 'T[;;:EF,IC:H[EE;. -FHF C~[~'.I::IVEL DEPTH IS, THE: MINIMLIM E:,LSF'TH CIF' C~I:;:FI',/EL.. E~F~TI.,.IE;[£N 'THE OUTFFILL FIND TI.lIE [~JO'TTOi',I CiF' 'I"HE.~ [~:h','C:Fl',,,'Fl-I"IOIq (:[i'.,I FIIF,III',ll...IP1 DI::i~:I"FINC:E [~)ET[q[.::liEhl FI [,.tELL. RF,ID F:IN¥ Oiq--SITE S:.-EklF:ll3E :1.(30 F:'EETI" f::'OR: F:I F:'I:~:I',,,'FITE t.,.IEL.L. Ci[;~: ::[.~C~ TO :.;i:l;~l:~l FEET FROM I:1 LIPOi'.,I 'I"HE: 'I'?PE OF' PI. JE,'LIC HELL. MIh!ZI,'IUF! DI::STF:II'..IC:~ F:'F~OM FI F'R:I',/F:ITL:: I.,.IELL TO [:1 PR'.IVFITE 5:EI.,.IEFi: I...iP,IE IE; ;2:~5 FEET FIb,ID 'l-O F:I C:Ol','li','lLll'.,lI-f'k' .'-2:J:EI,.IF:Fi: LINE ?5 ?!5 F'E[ET. HE~L.L. LOL'!iE: FIf4:E I::~:EI:~IUZI:~::Elrr.':, I:::li'.,t[:, MI.J.'.ST E:E R:ECTLII~U'.,IED TO ]"hie DEI::'F:IITTI'"IEi'.,IT I,.IITHiF~I OF THE: NE~L..L. COI'"IPLETIOIq. OTHER [~'.liEiT!l.J I F?.EFIE:i'qTE: fql:l't' FII::'F:'L.'~.'. E;F'EC: I F I C:FTI" :[ Of.,l~l J::llr.,l[:, C:Cd",I'~;TI~'.LJCT I:::IJ,,,'i::~IL.FIBLE TO ZhIS;LIF;?.E: F'R:OF'E~: II",I!STFILLFq'I'ICJF~L :[ C:ERTIF:'.? THFI'T '_1..: I FIM FF:IFIiL.IFff;~ P.I!TH THE I:~'.EL::!I...IIFi:E:MENTE~ F'OR: Oi'.,I..-.~'SITE ~[:~P.t[£F~:~S F:II'.,I[) I,JEEL. LS: FIE:: F'OR'TH E!:'~' THE J'"IUi'*,IIE:IF'FILIT'.~.' O1:-': ;?.: ]: !-,.III..L. ZIqS:TFILL THE: ~S'-~"'E:"I"EM ]:lq i::IOC:CJF~IDI::INC:Ei: HI'T'H "['HE 2:: I I...INI)F31bS'TFIND 'T'HFIT THE OF,I'"-S:I'I"E :SI:TLbJ[:~R: Sh"STEM I"II::I"P RE(i]UIR'.E E~h!LI:::IF?.C~E:I"IEI'qT ~[1:::' THE I:~IE?SIDENCE ):S REPIODE:L. ED '1"O INC:L.Ur::,E: I'dCJ[~:E 'I"HI:aN :~: 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 4 5 .11 12 13 SLOPE ENCOUNTERED? P IF YES, AT WHAT E DEPTH?. DATE PERFORMED: SITE PLAN Readin9 Date Gross Net Depth to Net Time Time Water Drop 14 15. 16 17 18- 19- 20- PERCOLATION RATE ['/('~ (minutes/inch) T STRUN BETWEEN "~"0 FTAND "~'~----- FT PERFORMEDB': ~A & ,~' CERTIFIED B,: % ' DATE: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVlCFS 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 Complete legal description Location (site address or directions) ¢ / h'/ .g~,,~ ~/¢ ~rc.~ £/-. Property owner Mailing address Lending agency Mailing address b'~ D¢,~ ~Jc4 Day phone Day phone Agent _L-/, 6-4 Address 3' Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual welt Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank. Community on-site Public sewer NOTE: If community wel.l_ system, provide written confirmation from State ADEC attest- ing to the legality and status of system. If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOAt¢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 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. EngineeCs signature DHHS SIGNATURE Approved for 'TH bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 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 DH HS 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. < CEIVEb M,,nMpality o, Anchorage dUL 09 1999 DFPARTMENT OF HEALTH & HUMAN SERVICES ' ~- MUNICIPALI~ OF ANCHO~GE Environmental Se~iceo Division 825 L Street, Room 502, Anchorage, Alaska gg501 · (go7) 343-474~ Health Authority Approval Checklist Legal Description: _L.o / //.~ ~/oc~' ~ A. WELL DATA Well type ¢. 1~.~.¢ '~:" Log present (Y/N) Total depth Sanitary seal (Y/N). .~n~' &~/c¢ ~2 ParcelI.D,:. ~'// -/S3 If A, B, or C, attach ADEC letter, ADEC water system number ~ / ¢/-¢'~ _ Date completed Cased to Date of test Static water level Well production WATER SAMPLE F{ESULTS: Coliform 0 Ec,( /(c~o ~ Date ofsample:_ 7/ g/?? B, SEPTIC/HOLDING TANK DATA FROM WELL LOG g.p.m. Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Nitrate _ z, ~..,5'" .~,'n~, / -~- C~ollected by:__ T. F, J"~oo ~'~ Other bacteria _ g.p,m, Number of Compartments ~ Cleanouts (Y/N) ~' Date installed ? / g-~/g / _ Tank size _Looo cr Foundation cleanout (Y/N). ~ Depression (Y/N) tV . High water alarm (Y/N) ~,/f, Date of Pumping 5~/~! / ? ~ . _ Pumper ..~.~'~,~ C. ABSORPTION FIELD DATA Date installed ~ / ~ ,~/,~/ Soil rating (.q,p.d./ff~ or ff~/bdrm). I ~'d'_ ~.._ System type Length ~' 7' .Width '~ ' . Grevel thickness below pipe ~ _Total depth _ I Effectiw} absorption area ~ ~' c~' MonitOring TUbe present (Y/N) Y' _ Depression over field (Y/N) Date of adequacy test 7/~ / ? ? Results (Pass/Fail) ?~rj For Fluid depth irt absorption field before test (in.); _3 ~ _ Immediately after'YC~? gal. water added (irt.): Fluiddepth~-~,~JT.5- (ins) Minutes later: ~'¥ Absorption rate = .'~ ¢/,¢'d"J __g,p.d. Peroxide treatment (past 12 months) (Y/N) _ ~/¢ ^~- ~.:n ~ ~,~ If yes, give date /V, 72,026 (Rev. 3/96)* bedrooms gz.37a- D. LIFT STATION h/./¢. Date installed Manhole/Access (Y/N) High water alarm level at* *Datum Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Size in gallons "Pump on" level at* On adjacent lots On adjacent lots "Pump off" level at* Public sewer main Public sewer manhole/cleanout Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ ~ 'z' Property line '~. 5"' Absorption field ~ 5,~ ' Water main/service line ",>/o ' Surface water/drainage ~>/co ' Wells on adjacent lots .'-,-,-,> /~' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~' /~¢~' ~f. Building foundation ~ ~5'~ Water main/service line Surface water ~ ~ oo ' ~ .~-o Curtain drain ,~¢ ENGINEER'S CERTIFICATION I certify that I have determined t~ in conformance with MOA HAA guidelines in effect on this date. Signature ~.- -~. ~ Engineer's Name "~/~ ,~o ~o ~,¢ ~ ~'c,o ~ Date ~7-~/,y ~ /¢¢¢ Driveway, parking/vehicle storage area Wells on adjacent lots ~ f¢~ ' 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN S!:iRVICES 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 HAA#_ 1. GENERAL INFORMATION Complete legal description Lot ii; Block 2; Sand Lake. Sub~i, vision #2 Location (site address or directions) ~141 S~vi~ Property owner Mailing address Lending agency Mailing address Kristi Parr Day phone (503) 726-8477 1914 N. 5th Street Sprin~a/ie~d, OR 97477 Day phone Agent Larry Su,Ct~t/Re¢~ Estate, Co. Day phone 563-4858 Address 4155 Tudor Centre, D~ve #204 Anchorage, AK 99508 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 ~ TYPE OF WATER SUPPLY: Individual well Community well , Public'water NOTE: XXX If community well system, provide written confirmation from State ADEC attest-. lng to the legality and status of system. TYPE OF WASTEWA'rER 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. xxx o 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 of this inspection. Name of Firm Address Engineer's signature S & S ENGINEEEING i/u34 Eagle River Loop Koad No, ;zu4 Eagle Riv~)r, Alaska 9.~9577 ~/// Phone DHHS SIGNATURE X Approved for bedrooms. Date Disapproved. __ Conditional approval for bedrooms, with the following stipulations: Additional Comments Date / 2 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 federaland 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 Municipality of Anchorage DEPARTMENT OF HEALTH & HUVIAN SERVICES Environmental Services Division 825 L" Street. Room 502 · Anchorage Alaska 99,501· (907) 343-4744 Health Authority Approval Legal Description:~. ]5' ~ ~gj .¢a.v: c/ Z a ,~'e. ~ ~ ~Parcel A. ~LL DATA Well type c/~o~ ~ Log present (Y~) ~o If A B. or C. attach ADEC letter ADEC water systent number Date completed ~--/..5'- 00.,7.. Total depth --' Cased to Casing beigbt (above ground) Sanitary sca] (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Dale oftcst Static water level Well production _ g,p.nt. ---' g,p,m. WATER SAMPLE RESULTS: Coliform ~ ~ Nitrate Other bacteria Date of santple: Collected by; IL SEPTIC/HOLDING TANK DATA Date installed q~'~/ Tank s:ze / ~ O O Number of Compartn/ents ~ _ Cleanouts (Y/N))/e~. Foundation cleanou! fY~ ~e~ Depression (Y~) ~o High water alarm (Y~) ~ DateofPtnnping 11/13 /q~ Pamper~ ~o~ ~'~v,(:~ C. ABSORPTION FIELD DATA Date installed ~'/~/ Soil raung I.g.p.d./fl2 or f¢/bdrm2 / Lcngtb. 3 7 / Widtlt 2 q '/ Gravel tltickacss below pipe Effective absorptmn area ~' ~ Monitonng Tube present(YfiXg System type 7-~e*~ Total depth Depression over field (Y/N) Date ofadequac3 test //' c] - ~3- Results fPass/Fail) JOo..,e...q' For 3 bedrooms .~,qiaO FIoid dcplb in absorption field before test (ia.); O hnmediately after gal. water added (ill.): q ~. ~// Fhfid depth ~$ .(ms.) Minutes later ~ ~ Absorpmm rate = q~O + g.p.d. Peroxide tmatomnt {past 12 months~ (Y~) ~*v ~ ~ ~ If yes, give date '~ o D. LIVY STATION Date iostalled Manhole/Access (Y/N) High water alarm level at* Size in gallons ,/ "Pamp on' leve~ level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ; On adjacent lots Absorption field on lot : On adjacent lets Public sower main Poblic sewer manhole/clcanout Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ..~ / '/- Property line 5' /'~ Absorption field 5 /"-I- Water mai~ffscrvice lice /0 Surface water/drainage /t> 0 Wells on adjaccot lots /.~"0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Boilding foundation / 6) t.._/.. Sorface water /Or9 ' _/t_ Curtain drain Water main/service line / 0" "'/L Driveway, parking/vehicle storage area ..~ 0 Wells on adjacent lots / .5-~0 Q../L Property line F. ENGINEER'S CERTIFICATION I certify that 1 hm,e determined thrufield inspections and review o in conJbrmance u ith ~10~ HA~guideli~s in effbct on this date. Signatnre Engineer's Nalne ~O~T C, IAA Foe *, Oa . Dat¢ofPay,nont ///~-~71q~-'-" Waiver Fee $ Date of Payment Receipt Number ROBERT C, COWAN CE-8801 Rev. 8/95 OSS: haa.wk.doc IMonth Day YeaP a, MPLE T'¥-p~: ROut/ne Q Treotad Water Repeal Sampl~ (for routln~ santpl¢ ~' Untreafe~ Special Purpose SA3~LE LOCATION' Time Collected Collected Sat{~fae 0 CIn~ati~fac~o~ be unr~lisble . Not bc over 48 ~oue$ old ~( Cx~minaaon Ioind ea~ re ,b - resu s P new sampl~ via speci!~live~ mail Date R,ceiv¢d -- ,~~ Time Received Analytical 3felflod: Lnb R?..0'~. R~su/I* Client nodded of u~sati~faeto~, results: BACTERIOLOG[C:4& WATER MS'A.LYS][S RECORD ¢[~fO-,xrg'C Result: Total Coliform ,Membrane ~ilter: Direct Count ..... Vtrificarion: LTB ~ Coloni~sllO0 " ~ , ~ COLIFIRM ,CT&E Environmental Servioas Inc, ~le Remarks: ~34Ph~ C05I, ECTED BY: BoB C. OC ~ MUNICIPAL. ITY OF ANCHORAGE ~ ' [~] Department of Health & Human Se~ices ~ ~ DIVISION OF ENVIRONMENTAL SERVICES ~ ~ 343-4744 ~ C~ATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF SEWER AND WATER FACIUTY FOR SINGLE FAMILY DWELLING ~ ---.-:% HAA~_ ~( ~,~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Descriptign Cnclude lot block, subdivision, section, township, range) Lo c~ioh', (ad d r~,~,-directions) Telephone: (home) Business (c) Lending Institution ' '" Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here]~.if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Community~[. Public [] Note: If community well system, must have written confirmation frorn the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE I:)ISPOSAL On-site,S.. Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmatioe from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATIOI~ ' ' 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 inspection. Name of Firm /d~"'~ ~' Telephone Address / J/~"' ~) ''~'~ ~ x~/ /'~ 6. DHHS APPROVAL Approved for ~ bedrooms by ApProved j~_. Disapproved Terms of Conditional Approval Conditional Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 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. 7/88) Back Page 2 of 2 A. WELL D~C~ MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ,¢.o7'" Well Classification ~¢'¢)"/ If A, B, C, D,E,C. Approved (Y/N) og Present (Y/N) Date Completed Yield ~;~.....__Cased to ____ Depth of Grouting __ Static Water L~eL........~ ...... Pump Set At __ Casing Height Ab. ov_e ~ .... Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y"/~....___ Depression Around Wellhead (Y/N) SEPARATION OIST_ANCESFROM' To Septic/Holding Tank on Lot ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~ ; On Adjoining Lots _ To Nearest Public Sewer Line To Neare-"~4s ~r Cleanout/Manhole To Nearest Sewer Service Line on Lot _ Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~-Z$"Y/ Size StandpipesbN) _Air-tight Caps(~N) Depression over Tank (Y~(I..~ Pumping/Maintenance Contact on File (Y/N) . .~/'/,~1 ; for h Holding Tank High:Wate'[ A'l'h~r,(Y/N) Temporary Holding Tank Permit (Y/N) D'IST'A'NC~S*FROM~'SEPTIC/HOLDr4~ NB TANK: SEPARATION To Water-SuPp,ly~Well ';-,~ ~,~,~:~ To Building Foundation To Property,,~ne .~ ¢ ' ' To Disposal Field o water Maln/Serwc~l~e, ~'c'"/~ lo ~tream. [ o~e~:,kak~ or Majo[~u~ge Course _ Comments '. ,,', .-:'~:¢~.' No, of Compartments ~ Foundation Cleanou~N) Date Last Pumped J3¢Z~-'¢~"¢ /~'~4,~c5 72-026 (Rev. 7/88) r¢ont Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ~'~ Square Feet of Absortion Area Depression over Field (Y~) Results of Last Adeguacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation To Water Main/Service Line /o ~-~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field _ /~' Gravel Bed Thickness Statndpipes Present~.~N) Date of Last Adequacy Test To Property Line ~' To Existing Or Abandoned System on ; On Adjoining Lots /¢ ¢' To Cutback (if present) ~/~ /d,~ 4- JO/.~ Comments D. LIFT STATION Installed "Pump On" Le~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, **Check Permitted Bedroom Rating 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 ~--'-~ Company Date MOA No. Receipt No. Date of Payment Amount: $ /~. 72-026 (Rev. 7/88) Back Engineer's Seal Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCH©~GE WESTERN DISTRICT ©FFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: June 22, 1989 PWSID: CLASS C To Whom It May Concern: According to the records on file in this office, the Sand Lake #2 S/D, Lot fill, Blk tt2 Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VEC: gd C_'.HEM1CAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. AI~M,¥$I~ P,F, PO?,T BY SAI,~PL~, ~o~ Work Ord~ ,~ ~39~7 I)ato P, epozt Prtnted: .JIJ[] 12 ~9 ~ J~:59 CDont Sa,apl~ II):L]i, i;2 SMfD AA~F~ Col]scted Jg}l 9 89 ~ 14:00 hrs. llocelved J[II~ 9 89 ~ 14:$0 hrs. Preserved with his RI~QUIR~iD knalysis Cou~p].et~d :lU}i 9 89 Send Reports to: Laboratory Supervisor :STF, PIIF, II C, F~DI! .L)A E C S keleauod ~;y : /~ 2 ')) Special Chol,llaD Rof ~: 5671 Lab Stop] Il): J_ !.{otzix: Allowable Paralastor Tested Rosuit/Unlt s ).let hod gilal t s IIlTRATE.-}I ~ID(R.IO) mt~g/] EPA 353.2 8alap/e ROU'r PI~ SAI.IPL F,. Rolna~ks: SM.IPLI; COI, I,F, CTF, D BY A. ;'~ig}l. I fasts Pe~formad Sec Special Instrnc~tons Above Uk~DnavaiJab]e IIR,. }lone Detected "Soo 3a~hplc Bmo~rk;~ Al)ove M[~NICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH IDEPA~I~M3~r OF HEALTH AND ENVIRONMENTAL PRU£ECI'ION APPLICATION FOR HEALTH ~3THORI~Yf APPROVAL CERTIFICJ%TE 1. Ge~e~al Inforrm~tion (a) Ix~gal Desc~tiption (include lot, Lot 11, Block 2, Sand Lake t~2 Application Date _ 4-~ 9-84 block, subdivision, section, township, range) Location (addm~ss or directions) 814] SeavJ.ew (b) Applicants Nan~ Craig & Karen Ra~ppe Applicants Adrift'ess 8141. ~.eav___~e_w_ A__n. cho.__r.a_~ (c) Applicant is (check one) Iending Institution BuFer L--~-' Othe~ ~ (explain), (d) Lending Institution Alaska Pacific Bank Address 101 W. Benson Blvd. P.O. Box ].00420 (e) I~al Estate Co. & A0ent _iRed Ca.¥p..e_t Redoubt Rea]tX Tamera Kell% Add~ess 611 W. Tudor Rd Anchorage, Alaska 99503 Telephone 248-4479 A 1 a s k a Telephone 564-0209 Anchorage ,._Alaska__. 99510 99510 Telephone _T2~!~._ of Residence Single-Family [ ..... [ Numbe~ of [~drocms 6 562-3335 3 Othe~r ( descr.,ibe ) Individual Well _~]: Cor~unity ~__x] Public Note~' If. cxm~mmity ~sll system, must have ~:[tten ccnfirmation f~an the State Depaz, t~mnt of D~vironmsntal Conservation attesting to the legality and status. Is the ~11 adefluate fo~. the ntm~er of hedrco~s specified in this HAA (Y/N) y _ __wa_gA.,pi Onsite ~-]I Public L~-------I C~Dm~anity ~-~ Holding Tank Is the wastewater disposal system adequate for the tmm~e~ of b~drcx:ms (Y/N) [Pa~e 1 of 2] 2-15-84 5. Eng~.neer`~nq Firm Pcoviding Inspectzons, ' ~o '< .___j.__.._' ..................... ' iL.,t,~, Dmza and Inforn~tion I cmrtify that I have checked, %grified, 0~' confom~d to all MOA HAA Guidelines in effect on the date of this inspection° Signed ,~ /~ ~ ' ~.,, Date / ~ ~ ~ Adc~ess 1506 West 36th A_l~.x_~_t~Ol ~--~ Signed by Duane ManeX Date 4-19-84 (ENGINEER SEAL) 6. DHEP ~pprov_91- Approved for. Disapl~ox~ad Cond[tional L--I Ternm of Conditional App..oval %he Municipality of Anchor.age Depa~i~mnt of Health and Enviror~ental Protecticn dces not guarantee tl~ continued satisfactory p~..forraance of the water` supply and/cr, the wastevrater dis[~osal system. %his approval indicates that, as of the.. validation shcwrl above., based on the data and information furnished bj an engir79er registered in the State o~ Alaska, tJ~e water supply and Wastewater disposal system is safe.and I[unc ticnal for the num[x~r, of h.~dr`¢x~as a~d type. of str`uct~n~e indicated. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 WELL E~kTA Well Classification __CJuaaa_?____ Well Log l~esent (Y/N) N Total D~pth. --.-~- Card to --- Static Water Level ...... Casing Height Above Ground 12" ~ Electrical Wi~ing in Conduit (Y/N) Y Separation Distances frcm Well: To Septic/Holding Tank on Lot 150' + To Nea~.est Edge of Absorption Field on Lot__ To Nea~:est Public Sewer Line . N/A Cle a~.cut/Ma pJno le N/A Water Sample Collected By Water Sample Test Results Cc~Tn~nts I UNICIPAUI'Y OF ANCHO 'eI ENVIRONMENTAL pRO'¥ECTIO RECEIVED LEGAL DESCRIPTION: Lot 11, Blk 2, Sand Lake Subdivision #2 If A, B, O~ C, D.E.C. Approved(Y/N) y [)ate Ccmpleted 6-15-82 Yield --~ Depth of Grouting ~_~rJ~=- __ Pump Set At ~ ..... Sanitary Seal on Casing (Y_/N) y Depression A~ound Wellhead (Y_~_j_ N, ; On Adjoining Lots 100' + 150, + _; On Adjoining Lots__]oo, + To Nearest Public Sewer · To Nearest Sewer Service Line on Lot __ 150' + D. Maney ; Date 4-18-84 Satisfact. ory for Total Coliform No well log available. Wells in general area yield. 30-.50 .qlom B. SEPTIC/HOLDING TANK DATA Date Installed 9/81 Size 1000 gal. Standpipes (Y/N) y Air-tight Caps (__Y/N) Depression over Tank (Y/N) ii_ Date Last Pumped Punt~ing/Maintenanos Contract cn File (Y/N) No. of Ccmpartn~nts 2 _ Foundation Cleanout .(Y/N) unknown for ___RZA Holding Tank High-Water Alarm (Y/N) N/A Temporary Holding Tank Permit .(Y/N) Separation Distances f~om Septic/Holding Tank: To Water-Supply W~ll 1~0'+ To P~operty Line 18' To Water Main/Service Line COL~Se None Noted To Building Foundation 12' To Disposal Field 5'+ N/A 10' + TO Stream, Pond, Lake, or Major Drainage ColNr~nts___.Septic Tank Pumped 4-18-84 [Page i of 2] 2-15--84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 9/81 Width of Field 24" Square Feet of Absorption Amea Depression over Field (Y/N) N Results of Last Adequacy Test 165 Type of System Design Trench Length of Field 37' Depth of Field 9' Gravel Bed Thickness 108" 666 Standpipes P~esent (Y/N) y Date of Last Adequacy Test none none Separation Distance from~Absorption Field: To Water-Supply Well 150' + To Building Foundation Lot none TO Water Main/Service Line To P~operty Line 6' 2D' + To Existing or Abandoned System on ; On Adjoining Lots 56' 10'+ To Cutbank(if present) none To St~eam/Pond/Lake/c~ Major Drainage Course None Noted TO Driveway, Parking A~ea, or Vehicle Storage Area N/A Com~nts Adequacy Test performed 4-18-84 indicating absorption in excess of 1400 gallons per day. D. LIFT STATION N/A Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Con~n~nts ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect Date MOA No. ST84-O01 on the date of/~his inspection. Company Arctic Engineers, Inc. KB1/d5/s [Page 2 of 2] APPLK NT FILLS OUT UPPER HAl ONLY Property ow"er ~> 'i! '~' ~ ~3 ~3 ~:' Suyer ~ t{~ ~ ~ Address Realty Co.&Agent ~\~ Zip Code Zip Code Address Zip Code Type of Residence E] Multiple Family Water Supply t~ Individual No. of Bedrooms Phone ):?6 ~,.300 Phone q-7 ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that dale, give well depth (attach log if available). Sewer Disposal [~ Public Utility E3 Holding Tank Year Individual Installed: When Connected to Public tJtility: NOTE: TRE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEPORE PROCESSING CAN SE INITIATED. Time Time Time [)ate Date Date Inspector Inspector Pield Notes: ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' [)ATE ,~ ~/~ 7'-(C~ ~-~. Inspector Time Date Inspector MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTil & I~NVIRONMENTAL PROTECTION ' ONDITIONSOF APPROVAL Well TO Absorption Are& Well Log Reoeived Well to Tank Septic Tank Size Soils Rating Date Sewer Installed