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HomeMy WebLinkAboutGLEASON TR B Municipality of Anchorage Page 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: %k,,/qqOq~J PIDNumber: OI55'O~ N~: Wastewater System: D New ~Upgrade Address: ABSORPTION FIELD Phone: ~ ~ No. of Bedrooms:~ ~DeepTrench Q Shallow Trench BBed BMound ~Other~ LEGAL BESCRIPTION Soil Rating: Total Depth from original grade: ~, ~ GPD/Sq, Ft. ~ [ ' __ u ,~ Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Lot: ~ACT ~ ~LEASOM ~ Ft. ~ Ft~ Township: Range: Section: Fill added above original grade: Gravel length: .... · 5 Ft. 6 S FI~ ~ Upgra~~ Gravel width: ~ Ft, Number of lines:l I Distance between lines:~ Ft_ WELL:~,s-r,~Q New Classification (Private, A,B,C): ~ Cased To: Total absorption area: Pipe material: ~ Ft. ~t. 15 ~ SO. Ft. ~OS~/f-G~O _ Driller: ~ Date Drilled: Static Water Level: Installer: Date installed: Pump Set at: Casing Height Above Ground: TAN K GPM F. Ft. __ SEPARATION DISTANCES ~.tio u Holding ~ S.T.E.P. To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines A~(~O~A~ Materisl: Number of Compartments: waR' ~o' ~o~ ...... ;~'4. %T'~L urf,o ~ot ~ t S~ze in ~allons: Manufacturer: Line ~ ~1 '~ ~ ~"~ : I / -- Of ~ ;"Pump on" level at: ~~el at: High water alarm at: Foundation Curtain ~ump Make &~Electrical Inspections performed by: Drain ~- ~0~/~ ~[O~ ~ Remarks: ~C~(TIV~ ~k ~ L~e~. BENCH MARK Location and Description: Assumed Elevation: ~ Lo~ A~O ~ ~FFr~CTIV~ E~GI~8 SEAL Inspections performed ~¢~ River, Alas~a 99577 ~ , ~; ..... Department of Health_and Human Services approval ~,">., .... ,: ,', ~eviewe¢ and approved by Date: ~ ~2 -~',',~, .~', ...... ' 72-013 (Rev. 9/91) MOA 25 Permit No, sw940419 Page 2 of 2 Municipality of Anchorage DEPAR'rMENT 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 GLEASON S/D TRACT B PID No.: ST1 ST~ Legal Descri orion: NEW 1000 GAL SEPTIC TANK GRADE MTco 01550122 86.4' (co3&co4) 80.4~ · '76.1' NO WATER :.FOUND · N'EW'"'TI~ENCH i ~ ! ~-EX.I~T; ~RENCH .Ii...A-..I....B....I ...... /~/ ~ ~ ~ ST1 1~35' I 20'1 c04~ I, :: ST21~38,124'} r :. co~ 1::40' [ 28'1 ~ EXIt% 1000 GAL C02 :~41' I 30'1 ~ .S.E~..~i.C.....~ ~ co~ [~7~ I....aa:..I : ABANDDNED COMPL~TLY co4/~86',l 66'I MT1 /::74 I 79'J NEW 1000~GAL SEPTIC TANK 3 BDRM SCALE t" = 40' DEGK TRACT B ~WELL ROBERT C, COWAN CE - 8801 72-013 A (1/93) 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:SW940419 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DATTAN D SCOTT & CAROL L OWNER ADDRESS:10446 DAISY CIR ~NCHORAGE, ALASKA 99516 PARCEL ID:01550122 LEGAL DESCRIPTION: GLEASON TR B DATE ISSUED:il/01/94 EXPIRATION DATE:il/01/95 LOT SIZE: 76979 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC 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 (18AACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVI:O~{'S: RECEIVED BY: .,1""~~vq'~ [I II~Q-'tk-~i~'b~j~ DATE:II--I-- ROBERTSHAFER, P.E. October 14, 1994 OIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTHAUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPOR'rS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage¢ Alaska 99519-6650 REFERENCE: Tract B; Gleason Subdivison Request you issue a permit to replace the septic system serving the 3 bedroomhouseo~ the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. The monitoring tube within the test hole has been check and found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. There are no points of contamination within the proposed well radius which can be seen on the attached site plan. If you have any questions, or require additional information for your review, please contact us. Sincerely, ROBERT C. COWAN, P.E. RCC/gk ENCLOSURES 17034 NORTH EAGLE RIVER LOOP . SUITE 204 o EAGLE RIVER, ALASKA 99577 o Z 3(]V~DdFI ,09 = ,,[. ROBERT SHAFER, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES MAT~LIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORIT~ APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRDCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN REFERENCE: Tract B; Gleason Subdivision 1. The scope of this project includes the installation of a 1000 gallon septic tank and an absorption trench to serve the three bedroom residence located on the referenced property. The existing trench is to be abandoned in place. The existing septic tank has collapsed. It is to be excavated, pumped, crushed completely and abandoned. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. $~ICTANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Tract B; Gleason Subdivision October 14, 1994 4. Septic tanks installed with less than 4' of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10' from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENC~/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (roughed-up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced do~lward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MA'£~IAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. Page Three Tract Bi Gleason Subdivision October 14, 1994 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: o o 7o Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2o The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. Page Four Tract B; Gleason Subdivision October 14, 1994 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Ii~. -9 ~.' ..... ' .',-.-'",' ~.ri;,' *,,~ ',~i?~-~' ~'~ -- LEGAL DESCRIPTION:~¢-~ ~; ~&~O~ ~/P Township, Range, Section: SLOPE OL-/I~L - FI~, SIC.TS D~p'FH 10 WASGROUND WATER ENCOUNTERED? 11 12 13 14- 15- 16- 18 19- 20- SITE PLAN S IF YES, AT WHAT DEPTH? E Depth to Water Alter Monitoring? /~/~[_ Dote: /O/~'/e~- Reading Date Gross Net Depth to Net Time Time Water ~/~J Drop ~lz~l,~,~ / ,,~-&,,.~ ____ tmmutes/mch) PERC HOLE DIAMETER ~F .5oI~ ~/c'l'/~7'E'~ /d~- L,~yer~ ,5'Hou~D /~ ,~,~T'&~ A~oCd 72-008 (Rev. 4/85) H/~HE~T/t/~ //JD~C,~7-~-b /~f ?~-~-_ /~£Suc~5,// 5~/~ E~/~a = O,G ~Pb/~z PERFORMED BY:~-~~ I ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECTON THIS DATE, DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTFI & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl_ INSPECTION REPORT NAM E~j~, MAI LING ADDRESS .... L~,~ ,3 ~-2/c~(~ J ~ UPGRADE LEGAL DESCRIPTION ~-~ DISTANCE TO: [~ ,~ ~tJon , ~Dwelling , PERMITNO, IF HOMEMADE: Inside length ~ Liqmd deptl~ Well - DISTANCE TO: Dwelling PERMIT NO. _ :~-- ~yr,al /We~ ' Foundation ~ = DISTANCE TO: ~ ff / 00 *~O ~ ~/O PERMITNO. No. of tines ~ 1~]~'~ ~ ~/' Total length of lines 7' Trer~ ~ic,~ ..... Distance between lines Top of t,le '0 fin]'sh grade ~Jal beneatlt/ V ~ "~ .~inches tile OTHER PIPE MATERIALS SOIL TEST RATING DATE LEGAL /% REMARKS ~-~'Ro~-ED ~ 72 013 (R~Cv,/3/78) ,/~- T'gF:'E Cfi:' SCI:II... FIDSOF~:F:'T]:Cff.,I S'.r'STEH IS: 'I"RENC:H I'"tFtF~; ! HUH F,II..li"IE~E:f;i: OF: E~[i':DFi:OOHS ~: THE F~:EL.:!IJ:[F:ED SI;:_':E OF; THE': SOIL [:::~ !E: P' -'1]'- tF...'II FIF'F'L Z[ C:FIN'I" I::'FITF: I C I FI FI. L.. I [i:E~E/F[:I"'If:If-,I ':L5'9 E~URTOiq :B'T[q'.E/ET '.'-)S~50d. /) [,4[~'J .t:[ :~..E. 7,.~LT,.:iI ;:"i::l L. 0 CFIT '[ 9N IJ:d:l ]: S;h.' E '[ F' ZZ LE L. EEif~L TF?F~C:T D GLEF:I[SON SLIE:C,~',,,'~ S Im3N LOT TI-lIE LE:I'.,IC~TFI I.':, :[ t"IEI'.~E~ :[ ON I L:; THE LENCJ'I'H ,:.' :[ i'.,I FEET ::, OF THE 'T'Fi:ENCH C'IR: C, RffI:[ NF ]: EEL. E:,. TI-.II:S DEPTH CIF F:I TD. ENC:H OR F']:T :[5; THE E:, :i: STF:INCE E,'ET[,.IISEN THE SL.IF. iFF.'.IC:E!: Cfi:: THE GF~:OLINE:, FIN[::, THE BO'T-f'CU'"I OF THE E',:.:;C:FI'v'FIT~ON ,::II'.,I FEET). I"Flli~F~:E ]: :.S I'.,10 SET !.,.t ~ [::,TH F'OF.' I'f~:ENCHE.':5. THE: EJF:FI',,,'[-EL. E:,EF'TH ]: :E; THE M ]: I'-,I ~ I"'lI.Jl',l [::,EF'TH OF CiF..'Ft',,,'EL E:ETHEE:I'.,I THE OUTF:rFIL. L. F'i F'E: FIND THE E~OT'TC.U't OF' 'THE ENCFI',,,'FI'T I ON ,:: I N F'E:E:T ). F'EF:H :11 '1" Fff:'F'I... ]: CFIhrr HF:r.:.!; THE f~:E:~;F'ON.[5 t D I L ]:. T¥ l'O :[ NFOF.'.I'I TH 1 5; [:,EF'FIRTMEI'-,I-F E:,L.tF.: I NG THE ]: NSTFILL. F~T :[ O1'.,t I I'.,tS:;F'ECTI ONS.'; OF FII",I'T' 14E:LL.:.E; Fi_F:,,.TFICENT TO TH I S F'~?.OF-"E:[,~W'9 FIND THE: Iqt...IHE:E:R O1:::' RE:'_:~;IDENCE?_:i; THFIT THE HE:LL HIL. L SERVE:. DI::ICI<:F ]: LL I f',lG OF: Ftfm,I'T' .?.!;'T'5;TEP't I.,.I I TI~IOI...IT F I NFIL I N'E,F'EC:T 113f',t FIN[::, I:"I[:'F'RCI',,,'F't[.. E~'T' TH ]: :.T:; [::,EI:::'F~F:THENT I.,.tZLL. E:E: SLtD.~E.::C'T TO F'F.:O'.'SE:.'C:U'FICIN. i"Iliq]:MUH [:,IS;'I"FINC:E E:E/T[,.IEE:N F~ I.dELL. FIN[.', FIN'9 CIN-.L:-.:ITE SEP.IFIGE :I..E~E~ FEIET FOR FI F'R:[',,,'F]'I"[£ I.,.IEiLL. OF..: ±50 TO 2.00 flEET FRCff'I FI F'LIDI_IC I.,.ffiLL E:,EiF'ENI)INC~ UF'ON 'THE-: T'gF-"E: OF F'L.IE~L ]1 C: P.IEiL. L. MII'm4IF'tLIt'"I [)IS;"FFINC:E F'FtOH FI F'F?.]Z',,,'FITE HELl_ '['11~ FI F'DmlVFITE: ]SEI-,.IE]F?. LINE[ ILE; .:.'~:~i FEE::T FIN[:, TO FI COHHUNIT'9 SEP.tEFi: L. i I'.~E ]:S; 755 F'[EET. HEL. L I_CIOS; FIF.:E RE:('::!I..tIF:E:D FIN[:, MLtST DE I:;i'.ETURi'.,IE:D TO THE [:,EF'FI[,:':THENT I,.t :[ TH :[ N ]ii:O [:,FI'gS 01:: THE HELL COi'"IPL. ET]: OTHE[~: RDZ.:.!LI ]1REME:F, ITS i'"tFt"r' F:IPF:'L'T'. SF::'[:'):~: I F I C:FtT I OI",tS FI~'it[) C:OI",t'.S]"Fi:I.JCT I ON D 11: FIGF:tF:ff'I'ii; FIRE: FI',,,'FI ]: L.FIE',L.E -I'C'l I NSI...IFi:E: PROF'tEI~: :[ P,I:STFILLFIT I ON. CERT ]: F'"r' THFIT FtH FFII"I]ZL. ZFI[~'. I.'.I]:TH THE REQIj:[RE~.HENT~; F'Cff~'. ON--:SITE SEI.,IEF.:S r~f',!.[Z:, HE"JL.I...E; Ft:'S, sE:mT D'T' THE i'dI.Jhl HILL. iN'JSTFII....L. THE' '.E;'~"S~I'Ei'"I l~',l F~C:COI'~t.[."Fff',ICE: t.'.tl'FH THE: C:OE:'[E~;. IJN[i:'['ZR:ii;TFIND THF]T THE ON-SIT[£ [SD.I.'.IEF[: :~"r'~TI'E:H PtFI'9 I~ffSL:~UIR.Fi E"EhlI...FIRC~E:ME:NT IF THE: RES:;IDE:NCE ]:5-'; IREHOE:'EL. ED TO INCL. LII)[E I"IOF?.E THFIN 2~: E',E[)ROOHS':. ......................................................................................... ................ MUNICIPALITY OF ANCHORAGE Department : Health and Environmental rotection 825 ~ Street, Anchorage, AK. 99501 264-4720 HANDWRITTEN PERMIT * * WELL AND/OR ON-SITE SEWER PERMIT Location: .. btr~/~i ~-~!I~- Phone Number: i~'~>'?--~_ / Legal Description: ~?--~ ~ ~ ~.~/~L~ ~.C~ Lot Size: 27 Type of Soil Absorption System Is: Trench: ~__~r~Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: _~-~ Soil Rating(sq.ft/br) / The Required Size of the Soil Absorption System Is: LENGTH / I GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). · * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~C~)CJ GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 8 1 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include mor~ that 3~bedrooms. Applicant Date: SWP/024(1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-B50, Anchorage, Alaska 99502 276-2221' SOILS LOG- PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: UAVI ~ LEGAL DESCRIPTION: ~-'r' 1 2 3 4 5 6 7 8 9- 10- 11 12 13 14 15 16 17 18 19 2O DEPTH (FEET) DATE PERFORMED: '~//~/~ I S'ITE PLAN ' )1 I~c,,,,J,-,,I ~, G~>/~ ) '~?) /,,,,c:,,, 5'7-' ~,,.,.,.,.,.,.,~uJ,,k.I ! ~l/'(,,~y ~IL:~- WASENcOUNTERED.,)GROUND WATER ~E.o,vv'~l I ~P~ ~:~) IV~C,,~T1F YES, AT WHAT /(,:::, S L 0 P El Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE 4- '~.,~ {minutes/'inch) TEST RUN BETWEEN FT AND 4 ~ / ~ , FT COMMENTS CERTIFIED BY: 72-008 (7/76) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRO'FECTION Pouch 6-650, Anchorage, Alaska 99502 276-222.'[ SOILS LOG- PERCOLATION TEST [] SOILS LOG PERCOLATION TEST PERFORMED FOR: DAVID A. LIEBERMAN DATE PERFORMED: 3/25/81 LEGAL DESCRIPTION: 1 2 3 5 6 7 8 9 10 12 13 14 15 16 17 18 19 20 TRACT B, GLEASON SUBDIVISION~ Frost to 1.25' __ Dark Brown Organic Topsoil, roots Brown SANDY GRAVELLY SILT (ML) moist Gravelly @ 4.0' Br~wn,SANDY SILT (ML) moist w/random gravels SE~ SECTION 15, T12N, R3W, S.M. SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED, IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop Brown SILTY SAND(S~ moist w/silt seam~ Brown SANDY GRAVELL' SILT, (ML) moist TOTAL DEPTH OF BORING - 25.0' No Free Water Ob- served. PERCOLATION RATE /,,,~ Jminutes/inch) TEST RUN BETWEEN J~- ~ FT AND J'~ ~ FT * ADDED 18½" OF WATER TO DRY HOLE, 72-008 (7/76) COMMENTS ** ADDED WATER TO 130~z"~.~,.~,~/.~,, · PERFORMED BY: ~,~-~'~(_~,. J4~L CERTIFIED BY:~¢~/ ,-~],,'~Z DATE: '/ Date oo=p~eted ......... / Depth of well ............ ~ o~ ~ ......... .~ ..... (~ ...... ' ........................ :'~ .... ~'~ ........ Dist~ce to water wb~e pmm~ ~-/' - a ....................................... :: ............... at rate ................................ J ZO __ Sec. D~2J!er r DELTA DRILLING CO,~PANy Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015.501-22 GENERAL INFORMATION Complete legal description Location (site address or directions) Tract B Gleason SID HAA# Expiration Date: 0_9 oo .. '.._c/o 10443 Daisy Circle, Anchora.qe, AK 99507 Current Property owner(s) Charles & April Jensen Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requesled, HAA will be held by DHHS for pickup. HAA picked up by; NUMBER OF BEDROOMS: 3 Day phone 346~967 10443 Daisy Circle, Anchoraqe, AK 99507 Day phone Day phone 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well [] [] [] [] TYPE OF WASTEWATER DISPOSAL: Individual On-site · [] Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Depadment (DSD) 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. DSD 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 water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. (Rev. 11~J9) 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 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Enq. Svc. Phone 272.8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Pdnted Name Steven R. Pannone, P.E. Date .~//c Engifi'eers Comment's: In conducting an adequacy test, [ attempt to provide a thorough, conscientious engmeenng analys,s of the system m accordance with MOA DSD Guldehnes & Regular,ohs. The reported results describe the performance of the system under the cond~tlons encountered at the t~me of ~r the test, and separation distances measured to readily identifiable features. The operational life of all m .... m wells and sephc systems depend on the local soft cond,non, ground water levels that may fluctuate m ~ 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 system. All systems eventually fail and satisfactory test results ~'"",~~ do not guarantee future performance ofthe system, nor do they guarantee that there are no hidden defects ~..'~...~-.X.; .................. or encroachments. PES can therefore not provide any warranty for future performance nor give any ~ ~P,~ ~$le,/e~ estimate of how long the system will continue to meet the operational requirements of the ADEC or ~ C./~'.... No CE MOA DSD. The content ofthis report is for the sole benefit ofthe owner listed above. Any reliance upon }~?/x~o... ...... v. or use of thts report by any other person or party ~s not authorized nor will ~t confer any legal right ~- 6. DSD SIGNATURE Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Expiration Date: (Rev. 11~9) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: --~ Reissue Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak,us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Tract B Gleason SID If A, B, or C provide PWSID # Sanitary seal Y Cased to. 80 ft A. WELL DATA Well type P Date completed 513tf1~81 Total depth 83 ft Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/lO0 mi Date of sample: 316/200~ B. SEPTIC/HOLDING TANK DATA FROM WELL LOG 51311191~1 58 fl 10 g.p.m Parcel I.D.: 015-501.22 Well Log Y Wires property protected Y Casing height (above ground) 20 AT INSPECTION . , 31612003 59 fl 4,5+ g.p.m iR. Fluid depth in absorption field before test pry in Water added450 gal. Elapsed Time: t440 min Final fluid depth [Dry in Any rejuvenation treatment (past 12 mo.) (Y/N & type), N (Rev. 11/99) New depth-l~ in, Absorption rate >= 450+ g.p.d. If yes, give date, Tank Type/Material · Anchoraae Tank Sl~eel Date installed 4122/1995 Tank size . 1000 gal Number of Compartments 2 Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm Nt~, Date of pumping 31512003 Pumper ,,A+ Homp,Servlces C. ABSORPTION FIELD DATA Date installed ,412211995 Soil rating (g.p.d./ft2 or ftZ/bdrm) 250 System type Deep Trench Length 63 ft Width 4 ft Gravel below pipe 6 ft Total dept~ 11' ft Effective absorption area ?{i{i ftz Monitoring tube .~ Depression over field Date of adequacy test 31612003 Results (Pass/Fail) p For.3. bedrooms Nitrate , 2,71 mg/I Other bacteria 0 coloniesll00 mi Collected by: Laura Pannon, e D. LIFT STATION Date installed. "Pump on" level at Datum E. SEPARATION DISTANCES Size in gallons, in'Pump off level at ~ Cycles tested Property line 10'+ Water Service line 10'+ Curtain drain None Known COMMENTS Manhole/Access High water alarm level at in Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout !00+ Holding tank 100+ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 150+ Absorption field on lot 150+ Public sewer main 75'+ ' Sewer/septic service line. 25'+' ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Suilding foundation 13' - P~'operty line 52' Water main 10'+ - Water service line 10'+ Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 60' · Surface water 100+ Wells on adjacent lots 100'+ Absorption field 50' Surface water t00+ Water main 10'+ Driveway, parking/vehicle storage 4'+ , . ' .~,~.. ........... G. ENGINEERS CERTIFICATION .- · , . . I ~d~ that l heve dete~m~ through field ~nspe~ions and review of Municipal records that the a~ve systems am in ~'""~"~~ .......... ~'""~ confo~ance w~h MOA H~ guidelines in effe~ on this da~e · , * Enameer s Pnnt~ Name Steven R. Pannone~ P.E. H~Foo $ ,~75, ~ Waiver Fee $__ _ Date of Pa~ent .~ - Date of Pa~ent , R~eip, Number ~ ~ ~ R~eipt Number (Rev. 11/~) ' ' ~14~ ~-..~~ .. I . ' ,::' : · I~' ~i~"' ~" ~ L ,i SURkE~ CER~FICA~ON -~t- ' Prepored b~ .~ Robert E. Johns, r. & Assoc. , ~.~ ~, ~.~ ~ Professionol Lend Surveyors AN~A~, A~A ggS01 ~~~mx ~ ~ ' '~ 1 f~ " Rec. Lot S.F. Rec. Pier ~le No. F~N~A~ ~B~LT ~ Oro~ ~ ~ecked b~ Parcel I.D. # 01550122 1. GENERAL INFORMATION Complete legal description 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 ~HAA# . HA950057 ._ ?. :!~4~.'.:~, ~. ,,,.., .. Tract "B"~ Gl~ason S~bdi~ision · ::,.,~,'"' Location (site address or directions), ' '" ':.'_ -i~?r~'Pe'.,rtY~ o~vfier'-~ · ; ::-:~;- Malhng address . :'~.:?;:? Lendi'ng ageficy ' . -..?-~; Mailing address_ ~. Agent J~nn~ Bie~n/ VISTA REAL ESTATE ' Address .42~:~ ';B" S~g~ Anchoraqe~ AK 99503 10443 Daisy Cire. lg Anchoraq~,' AK Day phone 10445 Do~y O~J~¢ Anchorage, AK 99516 Day phone 346-2242 _ Day'phone. 562-6464 _ ,Unless otherwise requested, HAA will be held for r)ickup. 2. NUMBER OF BEDROOMS: e TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: .. r lng tO the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site If community well system, provide written confirmation from State ADEC attest- ,., , ~:!; Ill/, , ;-\ I,,::h' Holding tank ':~ ', ~;~ Community on-site ~2" %' " ' '/L?/i,"' l~\~,~ ~i', ,,,' Public sewer , , NOTE: If community wastewater system, provide Written confirmation from State attesting to the legality and status of system. 72-025 (Rev, 1/91} Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validatiOn date shown :below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my inves.ti, gation 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. Nameof Firm* S&SENGI~m=~!NG Phone L~,.J .. Address - ~,~.~~7/_~ Engineer's signature ,fc~./,~_/f c_-- /~! ,.,-~-- Date DHHS SIGNATURE · -Approved for ' ,~ Disapproved. Conditional approval for A ¢ond~on~-H~Ith Authority Approval was' issued on F6bruary 21~ 1995. P£e~u~ b~ adv~,d ~ work r~q~d for ~ Con~o~ H.A.A. ~ b~n c~.m~d. ~. ~.- ~OBERT C, COWAN" ROBERT C. COWAN " CE-8801 bedrooms.- .' .':- bedrooms, with the following stipulations: Additional Comments ~. ,' · ~1 '~'~'~. ~ ' -):.The MdniC~pali~ of',A~chorage Depa~ment of Health and Human Se~ices (DHHS) issues Health AuthoriW . .Approval',Oe~ificates' based only upon the representations given in paragraph 5 above by an independent ' :> ~ ' ' f S · profesmonal e~m~r registered m the State of Alaska. The DHHS does th~s as a courtesy to purchasem o home , - ,0,Xq . . . · and the~ end ng mst tubons n order to ~t~s~ cena n feaeral and state requirements. Employes of DHHS do not conduct inspections or anal~e data before a certificate is issued. The MunicipaliW of Anchorage is not responsible for errom or omissions in the profe~ional engin~fs work~ 72-025 (R~¢. 1/91) Beck MOA ~ Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: [--~Ac-r "~L~" ' ~LEA_$O¢ G/r~ Parcel I.D. A. Well Data Well type ~.\',/A"rE If A, B, or C, attach ADEC letter. ADEC water system number I"-//~A Log present~4) V~ Date completed '~ - Gl Driller '"O~LT¢~ "DC,~L~-I~, Total depth ~ % ~ Cased to ~ O ~ Casing height t. '~ I Sanitary seal t~N) kT/E- % Wires properly protected (~N) k/E.E> FROM WELL LOG AT INSPECTION Date of test Static water level ~ ~' ' ~ c} ' Well flow I o g.p.m. '-I Pump level1 MAY 0 19'35 g~.ic~)alll - ' ,.,- t... y ct Anchora¢~e ~ealttl & Humeri Ser~ces SEPARATION DISTANCES FROM WELL TO: Septic/h~l(tk~J~tank on lot I~ o~ Absorption field on lot ~ ~ o i Public sewer main '-'/~ "~' Sewer service line ;~¢o' ~- ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Icc'-t Petroleum tank ~ IA WATER SAMPLE RESULTS: Coliform ¢ Co~.o~-,,~S~/~oo Date of sample: ~-- ~} - q Nitrate .¢,,~] / ~_ Other bacteria Collected by: % ¢% E-~c~a'~e./rcC~ B. SEPTIC/HCoLD~N~i TANK DATA Date installed '~/ Cleanouts ~/N) High water alarm (Y{~ Date of pumping A,///A Tank size /OOO ~- Compartments ~ Foundation cleanout (~N) ~/ES Depression (Y~) M//~ Alarm tested (YLFN~ ~O A J/',4 /,./E-co '7'~/,,/{< Pumper /",/,,//I SEPARATION DISTANCES FROM SEPTIC/bl~gE~¢¢'~..~ TANK TO: Well(s) on lot ~o To property line Surface water/drainage On adjacent lots Absorption field /OO ¢-/- ! I I00 4. Foundation /'5 Water main/service line /@ / '~ 72-026 (a/aa)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N). "Pump on" level at High water alarm level ~ C/-~ycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LI. BT-'~TION TO: Well on lot //.../"/'" On adjacent lots D. ABSORPTION FIELD DATA Manufacturer j Manh01e/^c~__ J "Pump off" Level at Surface water Date installed H - ~'~ - q ~ Length f~ '5 Width Total absorption area '7'5~, ¢ Soil rating (GPD/Ft2) O, Gravel thickness Cleanout present (~N) Date of adequacy test r,.z/,5 tw~uJ $'-/s~:~ Results (pass/fail) ~ for Water level in absorption field before test .................~../'""'"'~ After test Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: System type Total depth t \ Depression over field (Y(~ Bedrooms Well on lot '~. To building foundation On adjacent lots Sudace water too On adjacent lots ~,©©~ Property line To existing or abandoned system on lot Cutbank ~-O' + Water main/service line Driveway, parking/vehicle storage area ~ Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA gu/de~es in eff~e~~e, of this inspection. ~;,,,~, . ' .. Engineers Name ~O ¢ ¢,.~c (L ~ '~ ~ '. .~ ~ Date ~ / ,~ ? / ~ ~ ~, ~. % .,-'l.~ 5. , ,?,.~: .................. ::, HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number .,,,.._ (~ DEPARTMENT OF HEALTH & HUMAN SERVICES ~ '.:'.- ' -'- '::'-'[,' ~ Division of Environmental Se~ices P.O, Box 1~650 Anchorage, Alaska 9951~6~0 ~:~;.,.-: , :, - ..... CERTIFICATE OF HEALTH AUTHORI~ APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I,D. # 1, GENERAL INFORMATION ", '.-. Complete legal description Trae.~ Bt Glcason Subdivision' Location (site address or directions) Property owner Scott and Carol Dattan ,Mailing address 10443 Dais~ Ci~c~{ Anchorage. AK 99516 Lending agency Day phone ' 10443 DAZSg Anehoraqe, AK '_Day phone 346-2242 ' - . Mailing address .... ._~ NOTE: If communi~ well system, provide written confirmation from State ADEC a~estr NOTE: If commum~ Wastowator system, prowde wr,.en co~f!~{fi~{~: ~.~.~DEC a~esting to the/egali~ and status of system. ' ,.- .. [Rw, 1~1) Fmnl MOA~I STATEMENT OF INSPECTION BY ENGINEER :~ As certified oy my seai affixed hereto and as of the'Validation date shown below, I verif,/that my investigation of this Health'Authority Approval ~ipplication shows that the on-site water supply and/or wastewater disposal system is safe, functional and ade(~ uate 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 invest, i. gation and inspection, the on-site water supply and/or wastewater dis posal system is n compliance With all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 · ,5 ENGINEERING Phone i ? 03qE~.le River Leop Road Ne. Iq34 Address ~e~t~ ~,u,,,., A~.~.~5~ ~ ~ ~ Engin.ffssignatu~e- ~~~ "~ ~ Date REQUEST YOU ISSUE A CONDITIONAL HEALTH AUTHORITY APPROVAL...SE_PT, Ij~J~BE UPGRADED PER M.0.A. PERMIT #SW940419 AND S ~ S ENGINEERING D.F~'~-~~[~0/14/94, -.SYSTEM TO BE UPGRADED.NO LATER THAN 15, JUNE 1995 ~~~,~%. :$, ,,~ :~f~ ~.' ~ .-~ ~" Approv~ for '- , ' bedrooms..' ~ ..... " '~~- ,~ . .- .(, ,:,-, .,~;., - Disapproved. - ........ '.'" .......... "~'-? ......Tt'"f-~.:. ', '; ,-'.,: :':,'Y., ~ Conditional approval for ~" ' b~rooms, with the following st~pu ations: ~ ~'.",~ - , .,'"-:- , :-,.:~_ · .---',, '; ,.;.... :.':....'y-'. . :'-' Additional comments H~r ~/v~ Flint : ~ ~L ....... .,_.' l., ~. ~:. ~: - ' ' .' ?.," r ? : ...... ... L: ipality o}.¢;nc"horage Department of Health and Human Sewmes (DHHS) issues Health Authority _ 'v'.Approval?,Certifica, te~ based only upon the representabons g~ven ~n. paragraph 5 above by an independent ;' ; L . '-- ,, ~.'~ ,' , . · ' . ' · profess,onal er~g~,6, i)er registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes "~ ~ ..... :'~: " .... ' ' ' ' H and tl~e~ lending mst~tut~ons m order to sahsfy certmn federal and state requirements. Employees of D .HS do not conduct..inspectlons or analyze data before a certifi,cate is issued, The Municipality of Anchorage is not espon [bie for errors or omissions in the'~Ofe~idnal ~ngine~'s wo~'kJ ' "' ';" ':''''; "':' ~'' . 72-025 [Rev. 1/91) Bac~ MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. ~3/~,5'<¢/22. A. Well Data Well type Log present Y~N) Total depth ?-~ ~ Sanitary seal (~)/N) ~ ~ v,~q'E If A. B, or C, attach ADEC letter. ADEC water system number . ~"~ ,~' Date completed ,¢-./~1 Driller __ Cased to Casing height /,~ Date of test Static water level Well flow Pump level1 2d' Wires properly protected ¢~N) FROM WELL LOG AT INSPECTION /O g.p.m, q g.p.n~ SEPARATION DISTANCES FROM WELL TO: Septic/hoMing tank on lot Absorption field on lot /(¢9' ~ Public sewer main 7~' ~ t- Sewer service line 2-E Lp /27~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~ C O WATER SAMPLE RESULTS: Coliform .~ ~',~/a4,~'//Cd ,~/ Date of sample: __~- C} .~3~ Nitrate 2.11 ,~-//__ Other bacteria Collected by: B. SEPTIC/H~4-=DfN6 TANK DATA Date installed ~,//5'/~' Cleanouts(~N) YE'~' High water alarm (Yt~) Date of pumping Tank size /dOd ¢~c Compartments Foundation cleanout ~N) ~/~-~' Depression ('¢;~ /,J 0 /t///h Alarm tested (Y(~ /L)O /U//'~- /t,/EW 7',4A)/~ Pumper SEPARATION DISTANCES FROM SEPTIC/H~ TANK TO: Well(s) on lot (2_7 ' On adjacent lots To property line ;¢(~ ~ Absorption field .~/ Surface water/drainage /OO Foundation Water main/service line 72-o26 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer ~ Size in gallons Manhole/Acces~ Vent (Y/N) "Pump on" level at ~ "Pump off" Level at High water alarm level _,~"~'Cycles tested Meets MOA electrical codes (Y/N) ~ SEPARATION DISTANCE FF~FT STATION TO: Well on lot ~ On adjacent lots Surface water D. ABSORPTION FIELD DATA /~0 ~TEA Date installed ~¢/1~/q~ Length ~' ~1 ~ Width Total absorption area 7SL~ ~ Cleanout present (~) Date of adequacy test ,,9/A k)EvO '~%'TErkResults (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N).~_.~'''''''~ Soil rating (GPD/Ft2) Gravel thickness SEPARATION DISTANCE FROM ABSORPTION FIELD TO: System type /~E~ Total depth 1 / Depression over field (~ -~-~'---~ for /~Bedrooms After test If yes, give date Well on lot /(.¢¢/' To building foundation On adjacent lots Surface water On adjacent lots /¢~¢2 Property line ~'~' ' To existing or abandoned system on lot /O ' ¢- Cutbank ~-O ' +' Water main/service line /0 0 -/- Driveway, parking/vehicle storage area ,Z0 Curtain drain /O' E. ENGINEER'S CERTIFICATION I certify that I have checked verified, or conformed to all MOA and HAA guidelines in effect ~a~4b~,~late%C..,t.his inspection. Signature H~ Fee $ ~ ~ ~ Waiver Fee $ Date of Payment ~ - /3~ -- ¢~'~ Date of Payment Receipt Number ~ ~ ~ ~'~ ~ ~ Receipt Number CT&E Ref.~ Client Sample ID Hatrix CT&E Environmental Services Inc, Laboratory Division 5.055,_1 ly · ~ ~ ~so~ s/~Laboratory A~a sis Report WATER Client Name S & S ENGINEERING WORK Order 12562 Ordered By RAY Printed Date 02/13/95 ~ 17:53 hrs. Project Name Collected Date 02/09/95 ~ 09:30 hrs. Project~ Received Date 02/09/95 ~ i0:00 hrs. PWSID UA Technical Director STEPHEN C. EDE Sample Remarks: ROUTINE SAMPLE COLLECTED BY: BOB C. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 2.11 mg/L EPA 353.2 10. 02/10/'95 CMR See Special Instructions Above UA = Unavailable ** See Sample Remarks ~Joove NA = Not A21alyzed U~ = Undetected, Reported value is the practical quantification limit. LT = Less Than D>= Secondary dilution. GT = Greater Than 200 W. P0tte~ Drive, Ancho~a§e, AK 9951 8-1 605 -- Iek (907) 562-2343 Fax: (907) 561 -5301 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 WA'rEP FACILITY 264-4720 Application Date (~/~ ~/'f4~' GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name'--~-~Jl//f):.~/(;.~¢,~mA,'~_ Telephone: Home -~zJ'(o-,)-C-~'Z- Business Applicant'Address ~/¢¢40 ~'~. ,,q/S'(~' ~-~l r'~, (c) Applicant is (check one): Lending Institution E~'¢~,"Owner/buitder E]'~Buyer I-]; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company an¢ Agent" ,k,///~ Address ..... _ Telephone Telephone (f) Mail the HAA to the following address: A,,:. , TYPE OF RESIDENCE Single-Family iTI'~- Multi-Family [] Other Number of Bedrooms -T'H ¢Z'~EL ~ ~ ) WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ,~ Public [] Community [] Holding Tank [] Note: Il community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 z2-025 ENGINEERING FIRM PROVID...~ INSPECTIONS, TESTS, FILE SEARCH, [~,-.,'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 Anchorage files and from my investigation and inspectioo, 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 I-'~-/C/G/-/ ~[~1~/~ Telephone Address .SGO~ /~; ~/~ ~ ¢~ ¢ Ap proved for ~/-,m~ (,.'¢.~"? bed rooms by d( [)ate_ Approved ~//'~_ Disapproved Conditiohal Terms 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 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 lor errors or omissions in the professional engineer's work, Page 2 of 2 72-025 {11/84) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION "" o 'i. 1086 A. ED MUNICIPALITY OF ANCHORAGE (MO~,~ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~'~/~-F'- ~'~2 Well Classification _ pt"lU, Well Log Present (Y/N) Total Depth ~'-~ _ Cased Static Water Level _ _-~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N.) Separation Distances from Well: l~'l('J(l~ ' If A, B, C, D.E.C. Approved (Y/N) Date Completed ~' / ~( Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot /,¢' --~ ~--' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~-~ ~-¢' ; On Adjoining Lots To Nearest Pub'lic Sewer Line. ~-2 ¢~ To Nearest Public Sewer Cleanout/Manhole ,r~ To Nearest Sewer Service Line on Lot _ Water Sample Collected by --~%'~' /~/~-~. · Date Water Sample Test Results -"5/4¢'15 ~,4~,¢~r ~ ~J&,~ Comments B. SEPTIC/HOLDING 'rANK DA'T'A Date Installed Size Standpipes (Y/N) _ Y __ Air-tight Caps (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 (~ (J No. of Compartments Y Foundation Cleanout (Y/N) Date Last Pumped (¢/(~ [ ~'~' To Water Main/Service Line ; for Temporary Holding Tank Permit (Y/N) )'J.,//¢ To Building Foundation _ /L~-( To Disposal Field /~ t To Stream, Pond, Lake~ or Major Drainage Course Comments Page 1 g! 2 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 (Y/N) Results of Last Adequacy Test '--r~/~ Separation Distance from Absorption Field: To Water-Supply Well /~O To Building Foundation ~ 4 r Lot /':,~J~'~', L)o To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~'*(~-~r'(_./) Type of System Design Length of Field Depth of Field Gravel Bed Thickness /~~og~) Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots /~c') ( To Cutbank (if present) Comments D, LIFT STATION Date Installed Size in Gallons a"'""'"~ .........~t ~ "Pump On" Level 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 during Adequacy Test, Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t~hecked_c~crifJ~d, or conformed to all MOA and HAA guidelines in effect on Signed ~.~ ..,(~¢2 Date ¢..~//~¢ the date of this inspection. Company "~' tq~c'/-¢~/'/~c,/-- MOA No, Receipt No, ¢_.~ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84} TO SUBJECT tr · IVIESSAGE DATE_ REPI.Y SIGNED SIGNED SEND PARTS 1 AND 3 INTACT - PART 3 WILL BE RETURNED WITH RI:PI Y