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HomeMy WebLinkAboutSIEFKER TR 12ASiefker 'Tract 12A #015-281-89 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · 'Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000077 PID Number: 01 5-281 -89 Jam°: Wastewater System: [] New ~ Upgrade Robert & Krystal Hubbard ,,dd,.ss: ABSORPTION FIELD 12140 Avion Street Anchoraqe, AK 9951 Phone: 345-- 2407 Three [] Oeep Trench ~ Shallow Trench E} Bed E] Mound [] Other LEGAL DESCRIPTION s~,~,.g: .6 ~o~s~.~,. 10' · ract 12A Siefker 5 Ft. 4 Ft. Township: ~ Range: Fill added above original grade: Gravel length: WELL: Q New ~ Upgrade G/avel width: 5 Ft. > 1 0 ~ Fh Existing ~. ~t. 811 SO. Ft. AS~M D3034 PVC Ft. Acreage Systems 5/10~ 11/00 SEPARATION DISTANCES = Septic a Holding a S.T.~,P. From Tank Field Slalion Tsnk/ SewerLines Anchorage Tank 1 r 000 Well '100' >100' N/A N/A >25' Steel Two su~f~. LIFT STATION - N/A Water ~100' >100' N/A N/A N/A ,5, U1 0 ' N/A N/A N/A Sizein gall°ns: IManulacturer: LOt Line Foundation >5' >10' N/A N/A N/A "Pump on" level at: I i ,,Pump o,f,, level at:I ~ High water alarm at: Cu~ai~Drain None Noted onLotI. PumPMa~e&M°del JEtectricallnspectionsperformedbY: Remarks: BENCH MARK 100.0 Fh Inspections pe,ormed by: H~A 0ares: 1st 5/! 0,/0~ ~Z~,~ Department of Health and Human Se~ices approval ~(~,. ,,,~.~, ~ 0 o30 // AVION STREET Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 Anchorage, AK 99519-6650 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW000077 PID No, 015-281-89 15' 48' 91.44 12' 91 .30 4.5I ~ ~ 96.0 o Drainf±eld Rock 19.2~ 20.4~ t 79.4 p5.7 / \91 .3 NORTH LATERAL 12' o/ 91 .2 14' I GeotextJ  Drainfield RoG 35.3' PROFILE AS-BUiLT SCALE 1" = 10' J SOUTH LATERAL 0 lid z zz MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Apr 26, 2000 Expiration Date: Apr 26, 2001 Permit Number: SW000077 Legal Description: SIFFKERTR 12A Design Engineer: 0014 Anderson Engineering Owner Name: Williwaw Realty Owner Address: 3340 Arctic Blvd., Suite 101 Anchorage , AK 99503- Parcel ID: 015-281-89 Site Address: 012140 AVION ST Lot Size: 44999 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ~./~. Disposal Field [¢~ SepticTank Ei 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 ( t 8AAC72 ) 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: Date: ~ 2 -00 April 21, 2000 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Tract 12, Siefker Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing septic system on Tract 12, Siefker Subdivision has failed and must be upgraded. Unfortunately, the well on the lot is centrally located and reduces the amount of area available for the upgrade. We have determined, however, that soil conditions will allow placement in the northwest corner of the lot. The attached Site Plan and backup documentation shows the location and configuration of the new septic system and the location of the existing well. The 100' protective radius for the well and neighboring wells is also shown on the Site Plan. Several testholes were placed on the lot late last year to determine the extent of the existing absorption trench and to find an acceptable location for the upgrade. All of the holes revealed silty sand material which percola'ted between 8 and 20 minutes per inch. No groundwater was noted during excavation nor was any found during the monitoring period. We have therefore designed a 5' wide shallow absorption trench with 4' of gravel beneath the distribution line. The total depth of the trench will be 8' below existing ground. The trench was designed for a percolation rate of 30 minutes per inch to allow for extra capacity and is a total of 75' in length. A new septic tank will be placed and the old tank will be pumped, crushed and backfilled on site. The existing absorption trench will be abandoned in place. The lot surface is basically flat with shallow slopes from southeast to northwest at approximately 1%. Due to the constraints caused by the 100' protective radius from the well the trench will not be exactly perpendicular to the slope. We do not anticipate this as being a problem in this instance. Sheds, cars and other debris will be moved to facilitate the construction of the new septic system. If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing Tract 12, Siefker Subdivision April 2'1, 2000 Page Two septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments Tract 6 Tract 11 ~ k THIS \,,Tract 5 / L 4 \ ) . ~ AREA MAP SCALE 1" = 100' I'!1 Z AvION STREET TRACT 12, SIEFKER SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom Home Perc. Rate: 30 Min./Inch Application Rate: .6 GPD/SF 5' Wide Trench System 1,000 Gallon Septic Tank 4' Drainfield Rock Bedrooms X 150 GPD / .6 GPD/SF = 750 SF of Absorption Area 750 SF/5 LF (Width) X .5 (Red. Factor) = 75 LF Trench Length Therefore: Construct a 5' Wide By 75' Long Absorption Trench System With One Lateral As Shown on the Site Plan with 4' of Drainfield Rock Beneath the Lateral. Distribution Pipe in Trench PLaced at 4.0' Below Original Ground Surface. Mound Over Trench to Provide Cover and Positive Drainage Away From Area. NOTE: 3.5' .5' 4.0' Natural Backfill Geotextile Fabric · 4" PVC (Holes Down) · Drainfield Rock TYPICAL WIDE TRENCH SECTION (NO SCALE) Grade Area Over 'rrench to Drain Away. Minimum 3' of Cover over Septic System. Minimum 10' Separation From Lot Line. Minimum 4' Separation From Groundwater. Municipality of Anchorage Department of Health & Human Services 825 L Street, Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION TEST Performed For: Williwaw Realty Legal Description: ~28ct 12. Siefker Subdivision 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21 OG/OL SM' 15% Silt Bottom of Hole TESTHOLE NO. 1 SLOPE North Was Groundwater Encountered? If Yes, What Depth? Depth to Water After Monitoring Date: Date Performed: SITE PLAN South No See Site Plan None 4/21/00 1%-2% ~,eading Date Gross Net Depth To Net Time Time Water Drop 1 12/6/99 2:27 4.375" 2 2:57 30 8.125 3.75" 3 3:17 3.5" 4 3:47 30 6.75" 3.25" 5 3:48 3.5" 6 4:18 30 6.75" 3.25" Perc. Rate: 9.2 Min./Inch Perc. Hole Diameter: 8" Test Run Setween 5 Ft. and 6 Ft. Comments: Testhole Presoaked Prior to Percolation Test, Design System for 30 Min,/Inch. Performed By: Mike Anderson. I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 4/21/00 ON-SITE WASTEWA'rER DISPOSAL SYSTEM CONSTP. UCTION AND IVIATERIAL SPECIFICATIONS SUBJECT: TRACT 12, SIEI-'KER SUBDIVISION GENERAL: The scope of this project includes the procurement and placement of a new 1,000 gallon septic tank. It also includes the construction of one new 75' long x 5' wide x 4' effective depth absorption trench at the location shown on the attached Site Plan. The total depth from original ground of the trenches will be 8' below ground. The existing septic tank must be pumped, crushed and backfilled in place. The existing absorption trench will be abandoned in place. A minimum of 100' separation must be maintained from the existing well on the lot to all components of the new septic system and the reserve system. Please note a shed, several cars and other debris must be moved to facilitate the construction of the new septic system. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. The new 1,000 gallon septic tank must be procured from an approved source and installed at the location shown on the plans. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a m~nimum of 12 inches above final grade. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. Tract 12, Siefker Subdivision April 21, 2000 Page 2 of 3 A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. A Silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Tract 12, Siefker Subdivision April 21, 2000 Page 3 of 3 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. 05qB-O0 17:02 FRO~-CTE ENVIRON~NTAL CT&E Environmental Services T-075 P.02%03 F-557 CT&£ Rgf.# Client Namu Project Name/# Client Sample ID Matrix Ordered By PWSLB 100220S001 Anderson Engineering Tracl 12A, Si~fkcr Tract I2A, Sie~er Drinking Water 0 Client PO. Printed Date/Time 05/15/2000 13:35 Cullected Date/Time 05/I 1/2_000 11:45 Received Date/Time 05/11/2000 13:50 Sample Rmnarks; Attowabte Prap Analysis WATERS DEPT 2.84 0,500 mfl/L EPA 3mo.o 10 max 05/11/00 cot/lOOmL sM18 9222~ 05/11/00 JDT Received Time May,15, 4:04PV, MEMORANDUM DATE: May 17, 2000 TO: FROM: SUBJECT: On Site Services Engineer Mike Anderson, P.E. ~ Tract 12A, Siefker Subdivision Septic System As-Built Certificate of Health Authority Approval Attached is the septic system as-built and application for a Health Authority Approval for Tract 12A, Siefker Subdivision. The configuration of the absorption trench is different than the original design due to lack of space outside the 100' protective well radius. We constructed 2 - 5' wide shallow trenches a total of 81.1' in length instead of the single trench 75' long as originally designed. A flow splitter valve was placed between the two laterals to evenly divide the effluent from the septic tank. In addition, a minimum of 10' separation was maintained from the existing absorption trench that was abandoned in place. Fine sand was encountered in the trenches which percolated much faster than the 30 minutes per inch used to design the system. The trenches are therefore overdesigned and provide much more capacity than 450 gallons per day. RECEIVED MUNICIPALITY OF ANCHORAGE [ RTMENT OF HEALTH AND HUMAN SER ES Environmenlal Heallh Division .- / / ON-SITE S~EWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Address LEGAL DESCRIPTION ~ I Block Subdmslon TA~KS I . ,¢4 I~ I /~ ,, OTHER FIJI addOd above orlglfla~ grade Gravel lenggJ Installm-- ..... Dat~ Iii $ ha [l~p----- -?l WELLS FT FT FT ~/¢RIVA'rE 63 OTHER fldentifv) REMARKS: DISTANCES WELL ~ SEPTIC ABSORPTION TANK FIELD WELL FOUNDATION ~8*BUJLT DIAGRA~ (Show Iocaho~l DJ well, septic sysJem, rmed by: ENGINEER'S SEAL Heallh Deparlment Approval: 72-013 (3/85) cerlily IIl~t this inspection was pedormed accordinB I~ all .()('i: l: ! '.: ;:;i )i i)a 0:':,' ! :i::' PERFORMED FOR: LEGAt_ DESCRIPTION: 1 2 3 4 5 6 7 8 9- 10- 11 13- 14- 15- 16- 17~ 18- 19- 20- COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE SITE PLAN WAS GRODND WATER ENCOUNTERED? ~ IF YES, AT WHAT DEPTH? ~ pO ,epth lo Water After~ ~ Monitoring? ~ Date: _ Readin9 Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RAIE __ (m~nutes/mCh) PERC HOLE DIAMETER TES~ RUN ~EEWEEN ET AND ET ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEUNES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev 4/85) ALASKA BiIUIROI Ill8F1TAL COf/TROL $ 14dlCe$, linC. ~qine~rin~ & ~nuironmcnlal $1udies HERB CLARK 12140 AVION STREET ANCHORAGE ALASKA 99516 SELLER-HERB CLARK 03/03/86 HERB CLARK 12140 AVION STREET ANCHORAGE ALASKA 99516 60094 LEGAL:SIEFRER SUBDIVISION LOT i2 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-02/27/86 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN UNRNOWN AREA. THE SYSTEM IS CAPABLE OF ACCEPTING 325 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 80 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A HOME OF 3 BEDROOMS.! SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT HAS NOT BEEN PUMPED WITHIN THE PAST YEAR. THIS REPORT DOES NOT VERIFY THE-INT~TYZ0~'~E PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. 1200 UJ~sl 33rd Aucnu¢, Suil¢ [~ · Anchoraq¢, Alaska 99503 ,[907) 561-50zl0 ~unicip~.t~of ~ ~nchora~e P.O. L .X 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES QGRE~ ANCHORAGE AREA B0R Deparlment of F. nvironment I~uality 3500 Tudor Road Anchorage, Alasl<~ 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~0/~- /{M /2 7-~/~/~/~ MAILING ADDRESS ~R~ LOCATION_~JOa// ~ LEGAL DESCRIPTION PHONE SEPT,: TANK: /~% .../"'---~I~ ~ ~'~} '' ~"~'~ ~ ~fi o~S~A~C~ / . _ k / ~ or MATER~ COmPARTMENtS ~/ FROM ,~L_ ~A~F~R~ ~ INSIDE LE~TH_~ ~SIDE WIDTH ~ LIQUID DEPTH . LIQUID CAPACITY _ GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES J'J"'_ FOU N DA'F IO N /~ DISTANCE BETWEEN LINES NEAREST LOT LINE__2-~ ! TOTAL LENGTH OF LINES /O /-~ I ABSORPTION AREA 1!'~:~ SQ. F'T. LENGTH OF EACH LINE ~ DEPTH OF FILl'ER DFPTH: TOP OF TILE TO FINISH GRADE_~g)~IIMATERIAL BENEATH TILE .TRENCH WIDTH ~) IN. TOTAL EFFECTIVE IN. ABOVE TILE ~ IN. WELL: TYPE DISTANCE FROM: BUILDING t NEAREST j./~. NEAREST SEPTIC FOUNDATION ~0 t LOT LINE ~)'/) SEWER LINE TANK /'~/' SEEPA6 E SYSTEM CESSPOOL OTHER SOURCES APPROVED //~ DISAPPROVED REMARKS -- DISTANCES: INSTALLED BY: ~/~*/ ~-~_.:/7-~," SEWER LINE DEPTH: PIPE MATERI/~E: LOT SI_OPE: REMARKS: DIAGRAM OF SYSTEM /.l~lt/ DATE ~1-" /~'-~¢APPROVED¢~¢~,~' ~'' ~.~ G.A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUAL!TY PERMIT NO.. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION ~"~)~/ / ~ /~/ ~/~ ' MAILING ADDRESS ~/"~ /~)~ / 3~--~ LEGAL DE$CEIPTION "7---/~,~ (1~ 7~ INSTALLATION OF: SEPTIC TANK - TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED ~ SEEPAGE PIT --, DRAIN FIELD ., OTHER W~TH{~UT SOIL TSST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION bY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE TYPE DIAGRAM Or-" SYSTEM MINIMUM DISTANCES, RI"QUIR£MENTS / FOUNDATION TO SEPTIC TANK 20 / /o/ FOUNDATION tO SEEPAGE PIT , DRAIN FIELD SEPTIC TANK TO SEEPAGE Pit Wall 2- Io/ SEPTIC TANK ~ / ~ ~) j , SEEPAGE PIT ., DRAIN FIELD TO NEAREST LOT LINE. / / WELL TO SEPTIC TANK _ t ~--~ . SEEPAGE PIT WATER MAIN TO SEPTIC TANK DRAIN FIELD_ SEPTIC TANK, --- / /J~( SEEPAGE PIT TO RIVER, LAKE, STREAM. , SEEPAGE PIT / / / DRAIN FIELD / CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT ~ITTED WITH AIRTIGHT REMOVABLE CAPS. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I CERTIFY THAT ] AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA ROROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. GREATER ANOIORAGE AREA BORO[' Department of Environmental Qu. 3330 "C" Street Anchorage, Alaska 99503 80ILS LOG - PEROI,ATION TEST This form reports: Soi]s lo9 ~ , ty Date Performed Percolation test Depth Feet Was ground water encountered? _.}_~7.c9~ ....... If yes, at what depth? Reading Date Gross l'ime Net Time _!~_p_~;_h_t_~atev Net Drop Proposed installaC]on: Seepage Pit Drain Field Uepth of Inlet ................... · COI,IHENTS: EQ -040 (d/74) Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 01 5-281 -89 1. GENERAL INFORMATION Complete legal description Expiration Date: Tract 12A, Siefker Subdivision Location (site address or directions) 1 21 40 Avion Street Current Property owner(s) Robert & Krystal Hubbard Dayphone 345-2407 Mailing address 12140 Avion Street Anchorage, AK 99516 Lending agency Mailing address Day phone Real Estate Agent Mailing Address Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: TYPE OF WATEFI SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Three Well (3) TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new wate~ sample results less than 30 days cid. Cedificates are valid for one year for properties served by Class A or 8 wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address Anderson Enqineerinq Phone 522-7773 P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name DHHS SIGNATURE /.//' Approved for __ Michael E. Andenson, P.E. Date 5/16/00 !*, ~,~' *. ' ~:~ ", ~) ENGINEER S ~ bedrooms. -~'~"N: :,. Conditional approva~ for ~ bedrooms, w~th the following Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: ~' -~-_ -© 0 Original Certificate Date: Reissue Date: .2_ '-2 -o o Legal Description: Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 %" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us RECEIVED klA¥ 17 2000 (907) 343-4744 MuNICIPAUTY OF ANCHOI~,C~E , .~ViI~ONMENTAL SEI~VICES DJVJSI(' HEALTH AUTHORITY APPROVAL CHECKLIST Tract 12A, Siefker Subdivision If A, B, or C provide PWSID Cf Sanitary seal ¥ Cased to 66 ft FROM WELL LOG A. WELL DATA Well type Private Date cempleted 1960~s. Total depth 66 ' ft Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi Date of sample: 5/11/00 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel 5/lO/OO ft g.p.m Parcel I.D.: 015-281-89 Well Log None Wires properly protected Y Casing height (above ground) 1.5 AT INSPECTION 5/13/00 29.5 ft 5.9 , g,p.m Nitrate 2.84 mg/I Other bacteria 0 colonies/100 mi Cellected by: MEA Date installed Cleanouts ¥ Date of pumping Tank size 1,000 gal Number of Compartments 2 Depression over tank N High water alarm N/A Pumper N/A Foundation cleanout Y New Construction C. ABSORPTION FIELD DATA Date installed 5/1 1 / 00 Soil rating (g.p.d./ft2 or ft2/bdrm) ,6 Length 81.1 ft Width 5 ft Gravel below pipe Total depth 10 ft F. ffective absorption area 811 fF Monitoring tube Date of adequacy test N/A Results (Pass/Fail) bTew Const. System type ft Fluid depth in absorption field before test __ in Water added__ Elapsed Time: mtn Final fluid depth __ in Any rejuvenation treatment (past 12 mo.) (Y/N & type) N in. Shallow Trench 5' Wide ¥ Depression over field N For bedrooms . gal. New depth_ in. Absorption rate >= __ g.p.d. If yes, give date 72:026 (Rev. 01/00)* LIFT STATION - N/A Date installed "Pump on" level at .__ Datum in E. SEPARATION DISTANCES Size in gallons __ "Pump off" level at Cycles tested in Manhole/Access High water alarm level at in Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot> 100 ' Absorption field on lot > 100 ' PubLic sewer main N/A On adjacent lots > 100 ' >100' On adjacent lots Public sewer manhole/cleanout tq/A Sewer/septic service line > 25 ' Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation > 5 ' Property line > 5 ' Water main t~/A Water service line > 10 ' Absorption field Surface water Drainage > 100 ' Wells on adjacent lots. > 1 00 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Water Service line > 10 ' Curtain drain None Noted Building foundation > 1 0 ' Surface water > 100' Wells on adjacent lots > 100 ' Water main N/A Driveway, parking/vehicle storage > 50 ' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 5/16/00 HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 01/00)* 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 GENERAl_ INFORMATION (a) (e) Legal Description (include lot, block, subdivision, section, township, range) ~- :' ' Location (address or ¢irections) Applicaet Name_/t~', ¢~*'~ Telephone: Homo Applicant Address '~/¢0 ~¢]¢~ ~'~' ¢¢~/¢ Applicaul is (check one): bending Institulion ~; Owner/builder~%Buyer D; Other ~ (explain); (d) Lending Institution . Telephone Addmss (e) Real Estate Company and Agent Address Telephone (f) Mail tile I IAA to tile Iollowing address: TYPE OF RESIDI--NCE Si n gte- Fa mily~,~g'" MultFFamily Number ol Bedrooms Other WATER SUPPLY Individual Well..J~-1/ Community [-I Public [] Note: I1 commonity well system, must have written conlirmation from the State Department of Environmental Conservation attesting to the legality aad 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. [:FI(~INEI;:'R!RG FIRM PROVIDING INSPECTIONS, TESTS, FILE SEAl:ICH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify thai my investigalion of this Health ^ulhority ^pproval shows that the on-sile water supply and/or wastewater disposal system is safe, funclional and adequale for the number ol bedrooms and type of structure indicated herein. I furlher verify that based on the information obtained from tire 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. Address _~ ~f-.,/- Telephone Approved ___ 7~' Disapproved Conditiona~ Teinls of Conditional Approval 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 lhe State of Alaska. Tbe DHEP does this as a coertesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP d~o not conduct inspections or analyze data before a cerlificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICiPALiC. H.E~CI~LST - FEBRUARY 1984 u=Pr. OF HEALTH & MAR 2 0 WELL DATA If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/~ Date. Colcpleted ~ /7C~ * Yield Total Depth ~¢ ~ Cased to ~ _ Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~N) Separation Distances from Well: To Septic/Holding Tank on Lot Pump Set At _ Sanitary Seal on CasinggN) Depression Around Wellhead ('~) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~/¢f/ r ~ ,_.~:~.; On Adjoining Lots __ /¢"¢' To Nearest Public Sewer Line /¢//~//If To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ..~ Water Sample Collected by ,~¢g62 ~)¢, [/r,-,-,.~ ; Date ~.~"o.~ Water Sample Test Res,Its ~,~-'~:~¢~'%~"i~/~ , Comments ~/~ L'__/o~//~','¢~'/ ,¢¢T/' '¢~/~-g ¢~ B. SEPTIC/HOLDING TANK DATA Date Installed ~ ._ /'~'¢o ~ Size Standpipes (~4) __ Air-tight Caps~/~N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well _'~-~:~L:~z ' Jpo To Property Line ____/~ To Water Main/Service Line ,-~' Course '~7- ,[OCD No. of Compartments Foundation Cleanout (Yi~ Date Last Pumped /(...//t~ ;for ---4/4 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 / ~-'? (~5) Type of System Design Date Installed ~/,/~¢~'-,~,~-e- ~-¢?-~'~; \ ~X'/~/~ (~ Length of Field /~'/ Width of Field ~.~1 ~-5- Depth of Field Square Feet of Absorption Area d~ /¢~ ~ ~.~ Standp pes Present ~N) /¢ Depression over Field (Y/¢ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot /q [ To Water Main/Service Line Date of Last Adequacy Test To Property Line ; On Adjoining Lots To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments (-~ ~.~/~.¢r~¢. ~"~?~~, To Existing or Abandoned System on To Cutban,~ (if present) /00 '¢ ,06 D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions ~ Pumping Cycles during Adequacy Test, Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have ch ecxked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~ ~ Date Company ~r~C'~'~ ~ ~ I MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) ALASKA ,,UIRO[I [1TAL COI1TROL SE,,ulC $, I lC. ~nqinecrinq ~, Enuironmenlol Slurli~s HERB CLARK 12140 AVION STREET ANCHORAGE ALAS IfA 99516 SELLER-HERB CLARK 03/03/86 HERB CLARK 12140 AVION STREET ANCHORAGE ALASKA 99516 60094 LEGAL:SIEFRER SUBDIVISION LOT 12 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-02/27/86 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN UNKNOWN AREA. THE SYSTEM IS CAPABLE OF ACCEPTING 325 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 80 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A HOME OF 3 BEDROOMS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE, ~'~ z' THE SEPTIC TANK/PACKAGE PLANT HAS BEEN PUMPED WITHIN THE PAST YEAR. THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. 1200 [lies, 33rc{ Aucnue Suile B ,. Anchoro~ Alcs~:~ 99503.(907/56~-50a0 WATE..WEI. L - TEST PUMP t. JPORT Sheet.___ f Da,.: ~ ~ ( Owne¢ Address Casing Size~____Screen Oiam _Screen Slot Remarks Pump Information: Intake Oepth_~'O" Pump Size & Mo~del .¢/,~/~'~ Pump On: TO. Static Water Level ~-/, Time ~¢~¢J. ~-~ -J- Date --- ~ ~,~ ~__ Pump Off: Time GPM, Max, Drawdown WATER PIEZO- FLOW WATER PIEZO- FLOW TIME LEVEL TUBE GPM BEMARKS TIME LEVEL TUBE GPM REMARKS INVOICE R AND DRAIN ",,4!'~<~.f ~ '7,a~c~,ge4, CLFANING SERVICE P.O. BOX 4-2041 PHONE 345-2510 ANCHORAGE, ALASKA 99509 I Job Address YERMS--30DAY~ CUSTOM£RORDER# ROTOR ROOTER SERVICE CALL HRS. STEAM THAWING HRS. TRIP CHARGE HRS. OVERTIME CHARGE HRS. ~.. ADDITIONAL LABOR CHARGE -, , HRS. PUMPING SERVICI: ", (GAL) HRS PLUMBING REPAIR CHARGE HRS ~,, PLEASE PAY FROM THIS INVOICE TOTAL TOTAL FOO'i'AG E CLEANED OR THAWED__ BLADES US ED PROBABLE CAUSE OF STOPPAGE C~' P~ ~ - ~P~ ~ LINE CLEANED .G~-I~'F[ ~. ,7'R /U/,~ OE'~'C .G"~O 0 {_ [] JOB NOT GUARANTEED FOR FOLLO~WING REASOI~,, ir I- ~ro.y /'¢7. / I hereby codify ~at I ha~ ~ fl~ ~l~wlng de~rl~ pm~, ~t_: ~ ~/~ ~, ~/~, recording Prednct, Ma~a, end Ihat Improve~en~ fl~at~ ~er~n me wl~ln ~e p~pe~ I~ne~ and ~ ~f overlap o~ ~c~och e~ ~e ~ ~ing adJcKent t~re~, ~at no Improvemenh an ~opl~ lying odJa~ ~ere~ enc~ on ~ p~em~ ~ q~t~ ~d ~at there me na mo~a~ ffanunl~ ~¢~ r/ ¢/¢D /o ,4u~. /pz52..4''~' GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received February 28 ~ 1977 Time of Inspection ;)i~D~ Date of Inspection '~-~-77 /l ~om/ REQUEST FOR APPROVAL OE ~0~ INDIVIDUAL SEWER & WATER FACILITIES FOR I. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: Lomas and Nettleton Company 4449 Busines Park Boulevard Phone: James Miller Phone: 1551 Avion Street 3. Legal Description: 4. Location: 1551 Avion Street 349-5429 N150 of Tract~,~12 Siefker Subdivision Type of facility to be inspected' Well Data: A. Type Individual Single Family Depth C. Construction ~ 7. Sewage Disposal System: O~-Site ~stem A. Installed B. Installer C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank No. of bedrooms D.~Bacterial Analysis 2. Manufacturer , AbsorptioD area , Other contamination Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line ., Absorption area , Sewer Lines ___ 2. Material EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - R~ st for Approval of Individual~ ~r & Water Facilities [egal Descrip~ N150' of Tract 12 Siefker Subdivision Comments Approval ~Valid for one year from (late signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) 3330 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality "C" St., Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Type of Inspection: CMRO VA Property Owner: _~(~.k/k~ Mailing Address: Name of Buyer: FHA CONV D_.~a y Phone 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: ~II)V~9.-~ Mailing Address: Phone 6. Legal Description: Location: I~1 e Type of Facility Water Supply 'Type of Supply: If Individual: If Individual, to be inspected: Public Utility number of dwellings depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation EQ-037 (1/74) No. Bdrms. ~)--- Individual presently served Individual (on-site) ~UNICIPALIT¥ OF ANCH L'NVIRoN~'f,r ~A[TH & '~" r~TAL PROTECTION i:E~ oo 8 I9-/7 RECEIVED March 17, .1977 R & M No. 751507 Mr. Jim Mille~ SRA Box 1551 Anchorage, Alaska 99507 Re: Percolation Test on Existing Disposal System; Tract 12, Seifker Subdivision, Anchorage, Alaska. Dear Mr. Miller: On March 17, 1977, at your request, our office conducted a percolation . test on 'the existing sewage disposal system located on the above describ- ed lot. The following table represents the level of the liquid in the tank. The depth of liquid in the tank was initially 7.1 feet below the top of the stand pipe. The tank was assumed to be full or at the outlet level. For the test, the liquid level was measured from the top of the stand pipe. Summary of Measurements Level of Liquid Meter Reading Time In Septic Tank In Gallons Remarks 0:00 7.12' 3,334. (Initial) As Arrived 0:22 6.99' 3,459. 0:48 7.15' 3,484. 150 gallons in 48 minutes (3.13 gpm) The meter used during the test was a Rockwell 5/8" standard water meter. The meter had previously been calibrated by R & M Consultants, Inc. The septic tank had not been pumped prior to the percolation test. Since the house on the lot concerned was occupied, it can be assumed that the leach field in question was at its normal degree of saturation. If it is assumed that the existing three bedroom house will house six people, the average daily load on the disposal system can be expected to be 450 gallons per day, or 0.3]. gpm. Mr. Ji~n Miller March 17, 1977 page 2 Since the existing disposal system accepted 3.13 gpm, we would conclude that the leach field is presently performing in a satisfactory manner for the attached private residence. If you have any questions concerning this test or this letter, please do not hesitate to call. Very truly yours, R & M CONSULTANTS, INC. Edward Yarmak, Jr. Geotechnical Engineer EY:mh March 4~ 1977 1551 Avion Street A~lchorage, Alaska 99502 Subjeot: !I[50 of Traot 12 Slefker Subdivision );)ear Mr. Miller State and local health codes ruquire a one-h~mdred foot separation between a well and any ~ewer symtem. Your well is eighty-three (83) feet away from your seepage area, therefore, this departmleut can not give any approval until the seepage area is moved one-hundred (100) f¢~et away from your well. B~.~fore any construction begins, you will need t:o obtain a permit fx:o~% 'this office. there are any questions, please ~ontact this offies at 279-2~11~ extension 224 or 225. Sincer~ly, Robe~ C,o Pratt, Sa~l ~.aE ian RCP/lJh GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received %-- ,5!~j Time of Inspection Date of Inspection 1. Approval requested by: Mailing Address: 2, Property Owner: Mailing Address: 3. Legal Description: 4. Location: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Phone: Phone: Type of facility to be inspected c)/O,~-. ...... No. of bedrooms Well Data: A. Type .~: - C. Construction Sewage Disposal System: A. Instail6d? B. Depth D. Bacterial Analysis "" ' B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Se~pag~B.i~: 1. Absorption Area ~, ?~, 2. Material E. Disposal Field: Total length of lines /,?~/" Distances: A. Well to: Septic tank Nearest lot line '~'~ , Absorption area // ., Other contamination B. Foundation to septic tank , Absorpti.on area C. Absorption area to nearest lot line Sewer Lines EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re¥,~st for Approval of Individual '~ .,er & Water Facilities Legal Description c . x ' )' x,.rz ~: /~/ Comments Approved Date '?--:~& '_/~// Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection 1. Approval requested by: Mailing Address: 2. Property Owner: ~ · , · ~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES ?. Mailing Address: Type o'F facility to be inspected No. of bedrooms--~ --/,'-~ 3. Legal Description: 4. Location: 5. 6. Well Data: ? ' ' : ( A A. Type .... /. ,, ~, ,.';' ~ ~ .... ~-.-~. C. Construction B. Depth D. Bacterial Analysis Sewage Disposal System: A. Installed / ~' ~ '~ C. Septic Tank: 1. Size D. Seepage Pit: 1. B. Installer 2. Manufacturer Absorption Area 2. Material E. Disposal Field: Total length of lines 4 Distances: A. Well to: Septic tan Nearest lot line , Absorption area __ Other contamination , Sewer Lines B. Foundation to septic tank I , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Puge 2 of two pages - Req.~st for Approval of Individual v er & Water Facilities Legal Description Comments Approved Disapproved ,:-'""' Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of 'the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (]/74) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274--4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: 4. 5. 6. _ Phone: Phone: Legal Description: Location: / Type of facility to be inspected Well Data: A. T ,pe C, Construction Sewage Disposal System: A. Installed~'~d~/ ~ No. of bedrooms t//B. Depth. ~. ;~Z ~/~7, D. Bacterial Analys~s Installer ~4~-4~k C. Septic Tank: ,/D. Seepage Pit: E. Disposal Field: Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line __ 1. V/Absorption Area/~ Total length of lines , Absorption area , Other contamination , Absorption area , Sewer Lines , EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re~,__st for Approval of Individual ~. Jr & Water Facilities Legal Description Comments Approved Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of 'the subject sewer and water facilities and these facilities are operating satisfactorily. ~SIGNED _ (~~/~ ~(_~~<~ Date ~c~ 1~/1~ ~/ EQ-034 (1/7~) GREATER ANCHORAGB AREA BORQUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Receive~ //- Time of Inspection. Date of Inspection // RHQUEST FOR APPROVAL· OF INDIVIDUAl. SHWER & WATER FACILITIHS FOR Number of Bedrooms: 7. Sewage Disooaal Syatem: A. Installed ~ /~6]~' 8. Depth ....... Bacteria] Analysis' Installer <Cp Septic Tank: 1. ~D; Seepage Pit: 1. E. Disposal. Field: 8. Distances: A, Well Tot Septic Tank__ , Nearest Lot i,in~ B. Foundation to Septic Tenk Size 2, Manufacturer Size 2. ~aterial Total Length of Lines · , Absorption Area ~J , Sewer tines , Other Contamination AbSorption Area C. Absorption Area to Mearest Lot Line ........... · ft.:PLY iVI[: AO,?rote of At, silo MESSAGE REPLY ) PYELLOW COPY. 2. SEND WHILE AND pINK COPIES WITH CARLSON INTACT. SIGNED I. WRIT£ REPLY. 2. DETACH SJ'Ull, KEEP PINK COPY. RETURN WHITE COPY TO SENDER. Rbc~'~est.for Appz'oval of ~,,dtvtdual Sewer & Water Faeflitlu,' Paf, e T~o Comments :~ -~'~ .~Z(/'~-~'~ .... .Disapproved x~z~, ~. c/~J~__ z. /,, / 97 .~ ~- --' Approval Valid for One Year From Date Signed Greater Anchorage Area Borough, geFartmeut of ~nvfronmenta] quattty DIAGRAM OF SYSTEM Z certify that the information contained in this request for appreval to be a true and accurake repraCentation of the subject sewer and water facilities located at: Signed Date 'l'hl s of Pice LIust :..;~:i ] 1 di Sa!)provu l;'.)e sewer a,id wa U~r r ylu.:z:l; on the area. ! soil '.'e L,mFId r~ccrmt ~ copy o¢ an ~scrow .agre,2ment i:o C(wep ~:ho co~ of aisle,, to cranta te~;~por~Py ilpprova], Sanitarian Voi:er,~n~*, Administration Kylo Cherry ~u!;di vi si on~