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Home My WebLink AboutTALUS WEST #2 BLK 5 LT 22Talus West #2 Biock 5 Lot 22 #015-202-52 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 195650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: -Pa v ; ,4 A I b,, ,' Numar of B~ms: LEGAL DESCRIPTION Block: Lot: SubdivisioN: T~ship: Ra~e' Well: [] New [] Upgrade Classification (Private, A. B, C): I Total Dep~: Ft. I Cased to: GPM Ft.I FL To Septic Absorption Lift Holding Tank Field Station Tank / ,~e,, I i1~ ~ I Surface Water J Page of Wastewater System: [] New [~l'Upgrade ABSORPTION FIELD ~d~'DeepTrend't r'] Shallow Trench I'~ Bed i'l Mound 1'11 Othor~ Soil Rating:. Depth Io pipe Ix~ttom from original grade: q Fill added above c~ginal glade; Gravel widt~ Total absorplioN area: Installer:. Total Depth from ongi~l grade: Gravel dep~ beneat~ pipe: ~ Ft. ~avel Numb~ of I~es: Oistan~ between lines: i Pipe Mated~: Oala I~ta~ed: TANK [~l'~Septic [] Holding [] S.T.E.P. [] Other: Manufacture~. Number of Compartments' r,u.da,o, : '70 Curtain Drain Remarks: Sewer Line · Pump on' level at: Pump Make & Model High v.'ater alarm at LIFT STA/TION / IEIocth~l Inspections pedormed by:. BENCH MARK .oca[~oN and OescdpUon: igo"TTo ~ Assumed Eieva',~on: Inspections performed by: W Spt./rkl~ Dates: 1st Development Services Department Approval Reviewed and approved by: . d ..,.~///.,~/, ,~.~ Date: -//// -. . ~so ~t smr~ r,~' / \ -- -- ~ ~. / ........ ~...~ ,_, , , 203 ANCH. AK. 99501 DAVID AND NARY ALBORN DATE: ~AY 19, 2004 (~07)~27~_39~ ~21 FIRNUNE ORI~ SH[~: 2/~ GRIO: 27~ O Monlfor Cleon DuE S tondord Trenches, 2' Vide 60' Lon9 10' Deep 6' Sewer rock 4' Cover Cleon Our 0 Monlfor NO SCALE C(eon Oq C(eon Ou / ~LOP/SPUH~ 75~ 'NO SCALE 1250 SEPTIC TANK AS BUILT MARK: BOI~OM $1011~ ASSUMED ELEV. 100.00 TDBBEN SPURKLAND P,E. E03 ~15.h Ave Anchop~ge Ak 99501 LOT 22 BK 5 TALUS WEST#] DAVID & MARY ALBORN 11621 FIRNLINE DRIVE SEPTIC SYSTEM SCHEMATIC DATE, MAY18, 2004 SHEET, 4/4 GRID, 2740 PERMIT # SV030498 PID # 815-202-52 TAVO5223.DVG MUNICIPALITY OF ANCHORAGE Deve/opment Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Dec 04, 2003 Expiration Date: Dec 03, 2004 Permit Number: SW030498 Legal Description: J'TAI"0S-iWEST. #2 BLK ."5'LT Design Engineer: 0007 Tobben Spurkland, PE Owner Name: David & Mary Alborn Owner Address: P.O. Box 13552 Amber Lake, AK 99683- Parcel ID: 015-202-52 Site Address: 010550 OUR RD Lot Size: 53333 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field r~ Septic Tank ~] Holding Tank [~ Privy Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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: Date: / Z,/O B Municipality of Anchorage Development Services Department Building SafetY Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Permit Number Property owner(s) Mailing address (1) ~',. O, Mailing address (2) Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size ~"-/"21,'~'~'z'~-z~ Acres~. ;,... ~/k-'e_2'~ /~ t._ ~, On.t-.~ Day phone Zip Code L~T ~-~. TSV- 5, TA-Lu5 I I Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only I--1 Well Only r'-I Sewer and Well r'-I Water Storage l-'1 Sewer Upgrade ~ THIS PROPERTY CONTAINS: Hot Tub r'-I Jacuzzi [] Swimming Pool I--~ Water Softening Unit [] Therapy Pool ~--] I certify that the above information is correct. I fudher certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of '~' ' property ow~ Permit Fees: ~ V~'''~ Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: LOT 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN 22 BLOCK 5 TALUS WEST 31 DAVID ALBORN Municipality of Anchorage Delopment Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519-6650 November 24, 2003 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (Sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable test holes are also enclosed. The septic system design is based on the following: No Ground Water or Impervious Layer to 16 fi. Use Standard Trench Soil Rating. From Test holes 11/19/03 60 rain/in = 0.45 gal per sq.tVday No. of Bedrooms 4 Required Area per Bedroom: 150/0.45 = 333.3 SCl.~ Total area required: 333.3 x 4 = 1333 sqft Testhole depth 16 feet Bottom Rock At 10 feet Top Rock At 4 feet Rock Depth 6 feet Minimum Trench Length 1333 / 12 = 111 fi. Use two trenches. Each 60 ft SYSTEM CONFIGURATION STANDARD TRENC~S TOTAL LENGTH 100 FT TOTAL WIDTH 2 FT TOTAL DEPTH 10 FT ROCK DEPTH 6 FT COVER 4 FT SEPTIC TANK 1250 GAL The installation of this septic system will not prevent wells and sePtic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoffwill not result from this installation. ../: - ,,~ --~_-.~ . ,. ,~ ~ ~ ~~'-/ ~CALD ~' = Z~ F~ rOeeE~ SPURK~ND P.E. ~OT 22 BLOCK 5 TALUS ~ST SEPtiC SYSTEg DESIGN ANCH. AK, 99501 DAVID AND gARY ALBORN DATE: NOK 21, 200~ (907) 279'~916 ' 11621 FIRNLINE DRIVE SHE~' I/Z GRID: 27Z6 PERNIT ~SVO3OXXX PI~ ~ xx TAVO5221.~VG Clean Dui '-1 Stondorcl Trenches, 2' V/de 60' Long I8' Deep 6' Sewer rock 4' Cover C(eon Ou Clean Our 0 Monlfor NO SCALE vALVE eeee eee Rl'eeeOe oeeeeee eeee NO SCALE li3ii, !I 1500 SEPTIC TANK 8ENClt NARK: 80170~ $101N~ ASSUMED ELE~ 100.00 TDBBEN SPURKLAND P.E, Il 203 ~15~h Ave II Anchorage Ak 99501 ~79-~916 LOT 22 BK 5 TALUS WEST#i DAVID & MARY ALBORN 11621 FIRNLINE DRIVE J J SEPTIC SYSTEH SCHEHATIC 9ATE, NOV. 25, 2003 SHEET, 4/4 GRID, 2740 PERMIT # SVOSOXXX PID # XX 12324MCCASB£DVG ~erformed For: Description: 1 2 3- 4. 5- 6- 7- 8- cu. 10- 11- 12- 13- 14- 15- i i9- 20- Municipality of Anchorage Development Services Department Building Safety Division On-Site Waler and Waslewaler Program 4700 South Bragaw St, P,O, Box 1~6650 Anchorage, AK 99519-6650 www.ci.anchoraqe.ak.us (907) 343-7904 COMMENTS Soils Log - Percolation Test Date Pe Slope "~-A-LU'¢ ~¥~nship, Range, Section: Site Plan WAS GROUND MIATER E,':CCU;:T~.RED? L ~,-- YES. AT V.~T OEP,m? C~ ¢'"1 .. o Depth to Wa:er After Monitoring? E Re-*ding D~te J GrossTime J NetTime jDe;)thtoWater F E RCCL~TIOI'I RATE I I Net Drcp I~Jz. TEST RUN BF. TWEEI'I ~, Fi' AND "~ FT PERFO~MEO BY: '~. ~j, I ~ t-), CERTIFY THAT T~JS ;[ST ',';,'"S PERFORMED IH ACCORDANCE WITH ALL STATE AND MU, ,,CIPAL GUID_LI, ES h I .. FECT O~1 TH.S DATE. DATE: ~ % J ~,¢ I O.~ Perfcrmed For: Legal Oescripticn: 2 7- 12- 13- t~ u ~ 14- 16- ;7- I 20- COMM=NTS Municipality of Anchorage Development Services Department Building Safety Div{sion On-Site Water and Wastew'ater P~ogram 4700 South Bragaw SL P,O. Box 1-e6650 Anchorage, AK 99519-6650 www.ci.anchoraqe.ak.us (907) 343.7904 Soils Log - Percolation Test Slope Ill Township, Range, Section: Site Plan I I WAS GROUND VVATER E,";C,~U:'ITER-'- D ? IF YES. AT WHAT DEPTH? Depth to Water After Monitoring? Date: Reading Date I Gross Time Net Time I ' FERCOLAilO,"I PATE ~ ~:~ .~',.n~tes.',~.c,) FERC HOLE Oi4.;.IETEA lEST RU,"~ BETWEEN ~,) Fi' AND --7' Fl' Depth to Water Her Orc~ PEAFOR,MEO BY: '~. ~ I I, ,~, CERTIFY THAT THiS TEST WAS PERFORMED IM ACCORDANCE WITH ALL STATE AND MU,MICIPAL GUIDELINES IN EFF-7..CT OH THIS DATE. DATE: I t 'Z,cJ '~ 5 ~ ARTMENT OF HEALTH AND HUMAN SE%.~ ? Environmental Health Division ~' 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ' '"J ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Na,~,~J~ / /~.~ DISTANCES ~d~ TANK FiELD WELL Phone(s) Parred No. No of Bed s Manulactu¢er TYPE OF SYSTEM ~TRENCH ~ BED ~ W. DRAIN ~ OTHER FdJ added above orig,nal grade Gravel depth beneath pipe ~O FT ~, ~ FT ~ ~ I~' L~ Number ol Imnes SOU ratmng Pmpe material / WELLS ~PRIVATE ~ OTHER (Identilv) // cma~auon {A,B,O) lomm Depth FTCased to m REMARKS: , . E., ;] ~r..~ ~J~(~ ~edily Ihat this inspec[ion was pedormed acc~rdin~ lo all / Health Depadment Approval: Date:/~ ¢/~ -- ~ 72;013 (3/85) DEF:'ARTMEI~IT 01:::' HEALTH AND ENV~RONMEiNTAL PROTECTION 825 I- STREET, ANCHORAGEx AK 9950i 264.-472() hE.RI, .~ T I;)ATIE ISSUED: 8,50660 UPGRADE I.../(. 7z8o ,~FI--L. ZI.AI I1 . ADDRESS: CONTA[]T F'HONE ~ JOHN HATHAWAY S&S EENGINEERING EAGLE I:;:IVER, AK 694"-2979 99577 Lb, GAL.. LE.~:L,~ IF. LO'F : t ~..,:. ~ ,.~UED.[VI,rd, ON. 1AL.J,.'5 WEST ...... ' LOT: 22 SEC'T I ON ~ "~ ~'' ' ' - - '" .*a,=: TOWNSHIF': 12N RANGE.. :,W ,_ ..:..,;...,...;, (oL. I' 1 . OR ACRES ) E LO ~r .... 5 t. ify that: I 6~/iil f'¢tftii ). iap with t, he r'equir'ement, s for' oink-site sewers and wells as set. for'th by the Municipality of Anchopage (ME)A) and the St.o. te oF Alas~l<a, I will :i. nst. all t. he system in accopdance with all MOA c:odes and Pegulat. ions, and in compliance wit. h the desigo criteria of t. his per'mit. I will adhere ~.o all MOA and State of .Alaska pequipements for the set. back dist. arHze~s F~'om any existing well, wastewatep disposal system or' public sewepage syst. em on t. his or any adjacent or nearby lot.. IF A L..IFT STATION I,S tN,.~TAL[..ED IN AN AREA CLVE. RED BY MOA BU.[I_D].IIG CODES% 'THEI',I (1) AN L. LECIRICAL PERMIT AND 1NoFEC]IOII MUST BE OB]"AINED; (2) A,='-EU1LT,a WItJI... NOT BE AFI"IxO~ED WI"FI'~OUT AN EL. EC1F~I~AL ].Nol E.C]ION RIz. FORI, AND (3) THE EZ!_EC"I'RICAL._ WOlO.. MUST BE DONE BY A LICENSED ELE. CII,ICI¢'":' '*N. S!GNIED ~d-.F. LIt.,ANI., JOH tA 1 ,_~SUI::.D BY Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: ~0-~J¢- ~' q-°wnship' Range, Section: ~'-~'Z-/--~ , SLOPE SITE IJLAN I WAS GROUND WATER ENCOUNTERED? 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O IF YES, AT WHAT DEPTH? Deplh to Water After Monitoring? Date: S PERCOLATION RA'IE TEST RUN BETWEEN r~ FT AND 8 FT COMMENTS PERFORMED BY; .. ~ ~ ~/ ~ / CERTIFY THAT THIS TEST WAS PERFORMED JN ACCORDANCE WITH ALL S~ICIPAL GUIDE~E~N EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Gross Net Depth to Net Reading Date Time Time Water Drop ) MUNICIPALITY OF~^~'WnRAGE · ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE [] UPGRADE MARLING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS JWell I Absorption area Dweging / Liq. capacity in gallons Inside length i W~dth Liquid depth /~S~ I F HOME.DE: ~ , ~ Well Dwelling PERMIT NO, ~_~O Z ~ Manufacturer Material Liquid capacity in galJons ~ Well Foundation Nearest lot line PERMIT NO, ~ ~ ~ No. of lines Length of each line Total length of lines Trench width Distance between lines ~ ~ ~ Top of tile to Enish grade Material beneath tiJe Total eff ption area Length Width Depth PERMIT NO. ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: Building foundation Sewer line Septic tank ~ Absorption area(s) OTHER PIPE MATERIALS ~ SOl L T EST RATING REMARKS APPROVED DATE LEGAL Applicant Departmen~ -' Health and Environment6~ '~rotection 825 ~ Street, Anchorage, AK. ¥-4501 264-4720 * * * HANDWRITTEN PERMIT * * * W~/OR ON-SITE SEWER PERMIT ,/~>~{.~.~ , / '~'.,~% Mailing Add=ess: Location: Phone Number:, ,~'/'~- / ..1/~?,~, /' "' , Lot Size: Type of Soil Absorption System IS: Trench: ~/~ _ Drainfield: Seepage Be~l Holding Tank: Max~ N~ber of Bedrooms: ~ Soil Rating(sq.ft/br) '> c .~ The Required Size of the Soil Absorption System Is:' DEPTH // .LENGTH ~/-~ 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 = /~)'F) 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 departmen~ 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 available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 2 * * * I certify that: (1) I am familiar with the requirements for on-site sewers set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site the r.e~idence~i-s remodeled .to pplicant are and wells as sewer system may require enlargement if include more that 3 bedrooms. issued by. ~3~&~..t ~, (~" ~/ t', ~%,' ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, A{aska 99501 264-4720 SOILS LOG -- PERCOLATION TEST SOILS LOG PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: OL 1 2 9 10 .11 12 13 ~% L~ .'~ ko'ff' SLOPE J SITE PLAN WASGROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 14 15 16 17 18 19 2O ..r t '2, Gross Net Depth to Net Reading Date Time Time ~bJ Water ~[.~- . Drop PERCOLATION RATE ~ ~ (minutes/inch) TEST RUN BETWEEN =~= FT AND~ FT CERTI FI ED BY: DATE:.//~/~ '-.~'~'~ 72-008 (6/79) 5.) (90.7) 243-7893 KEN JOHNSON WATER WELL DRILLING PUMP SALES 8: SERVICE 3163 LINDEN DRIVE ANCHORAGE, ALASKA 99502 FEBUARY 28, 1978 ,.z~e & Cathy ](rupa 1930 Stongate Circle Anchorage, Alaska 99502 RE: Water well Lot 22 Blk. Talus West # 2 Subd. WATER '//EL!, LOG 1,5 ft -to 23 ft 23 ft zo 3~ ft 35 ft to 49 ft 49 ft to 57 £t Prozen brown silt Brown silt and gravel Same with 60~ Brown silt Hardpan ( course gravel and gray silt ) Clean Water.bearing Sand & gravel ( loose ) Left 18" of material in hole to check heave. Test bailed at 10 GPM No drawdovm 12 ft. head Total casing 57 ft. Municipality of Anchorage Development Services Department Building Safety DMsion On-Site Water and Wastewater Program 4700 South Bragaw St. 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. GENERAL INFORMATION Complete legal description LoT Location (site address or directions) HAA# 0 ~0 (~ ~' Expiration Date: Current Property owner(s) Mailing address Lending agency Day phone. ~'~_;3- "/<~¢*'¢-~ Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested,.HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: i~/ / 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 r"'l [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4' 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) for properties served by a single-family on-site wastewater disposal and/or water · supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for propedies served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for propedies 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., STATEMENT OF INSPECTION BY ENGINEER ~ As certified by my seal affixed hereto and as of the validation date sh6wn below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- sitewater supply and/or wastewater disposal system is(are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address Engineer's Printed Name /'~ bedrooms. DSD SIGNATURE Approved for Disapproved. Conditional approval for Phone bedrooms, with the following stipulations: Additional Comments .By: Attachments: HAA Checklist Septic System Advisory well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 01/02) Legal .Descri pfion: i Municipalityof AnChorage DeVelopment Services Department ~ Building Safety Division On-SiteWater & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 .www.ci.anchorage.ak.us : (907) 343-7904 HEALTH AUYHORITYAPPROVAL GHECKt!IS¥. A. WELL DATA Date complete,d 1¢]7oe' .: Total de pth ~ft. Date~f~test i:": ]} Stati~ v~ter level ,., i Olt~-2.o2.- ~Z.... ' ' ' ' ' I ~ ~ '~ AT INSPECTION Any rejuvenation ft. Well production ,,~:~ g.p.m: Other bacteria B. SEPTIClHOEDING TANK DATA '; " . ' ~ ' '~ Tank~i~e /~ ~ gal. , .: . Numbe~of Compadments ~] · Cleanouts (Y/Ny , Founda[ion cleanoUt (Y/N): ~ ~ ~Depression over t~nk (YIN) :i~ ': H~gh ware[ alarm (Y/N) Date inst~lled ?/~/o ~' :: Soii rating" {g.p.d./ff' Or ft~/~drm) ~5 ' SYs~e~m :~YPe~ I~¢ Total'depth J~ ~ft , Eft absorption area ~t~ Momtormg tube ~" Depresmon over field Date of adequacy test :,~/~, I ~ Results (Pass/Fad):; '~' ~ . I, ,:' For ~bedrooms Fluiddep~h i~bs6?ptionfield befor~te~i'~' ~'i~. ~ ~ : Wate?added ~a~.~ ~ [ ~,~' Newdepth ~ in. Elap~edTime~ '~jmin.,~' ~ . :;Final fluid depth ~: in. ~. Absorption ~ate ~>= ~ g.p.d. treatment ~past12.... ~ ' ~ ' ~ : ~ .....i mo.) (WN &;type) ~ : : If.y~, give date FROM WELL LOG IfA. B, or C Provid~ pWSID # ~ , i' · i' !:i ' · ' "' h///~ ' Well ~og (Y/N) y .". 'Sani{arY:seai (WN) ~// ":. : : :: ,!' .iii: : ~ wires properly, pr0tected (Y/N). t-'/' : - . . ;! . Oasing height (abov~ ground) ' ~ in. LIFT STATION / ~/' Date installed ' ,,,'/ Size in gallons ss (Y/N) "PumPon" level at ,,,~n. "Pump off' level at in,,/ High water alarm level at Datum / Cycles tested ,/' Meets alarm & circuit requirements? SEPARATION DISTANCES ; SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line .'.'.:'! ! 0 - On ~djacent lots '~ :i~:~:) I'-'~O On adjacent lots ~'/~'-~:' t',[/,~ Public sewer manhole/cleanout t~//~ I ~O ~' - Holding tank · t-4//,,~ ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property" line Water service line ,,.,~O ,"/", Curtain' ~rain COMMENTS Property line '70 'Water service line J~ '/- Building foundation Surface water t"~//.,~. Wells on adjacent lots 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. Enginee~:'s Printed Name Absorption field Surface water IO Water main Driveway. parking/vehicl(~ s!orage in. Date HAA Fee $ Date of Pay~eqt,' Receipt Number (Rev. 12/0;I) Waiver Fee $ Date of Payment Receipt Number (,~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Descriptioe (include lot. block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~¢~"-~-~ ~L'~'-r!-~.~Telephone: Home ~-~ -~Lcc~'~ Business ApplicantAddress / I ~, ~Z..¢ r~/4/cz.//.JT~. ,D~.. -- ~ ~J4.. / ,,¢~K, '=/ gG"/ I~ (c) Applicant is (check one): Lending Institution []; Owner/builder j~'; Buyer []; Other [] (explain); (d) Lending Institution AI~/~,~I'~ ~;;;',,¢,-(_..~,,~1 4. Telephone Address (e) Real Estate Company and Agent Address Telephone (f) the HAA to the following address: 2. TYPE OF RESIDENCE ;i~ gml;:~aor~ ~Ye d~r o o Mm~ It i- F~a m il ~O t~_ WATER SUPPLY individual Well[:~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environme[~tal Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72 025 hi/84) EN(~INEERING FIRM PROVIDIN~,'~SPECTIOHS, TESTS, FILE SEARCH, DAT~'~ND INFOR~qATION As cedified by my seal affixed hereto and as of the validatio~ date shown below, I verify that my investiga Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional a~d adoquate for the number of bedrooms and type of structure indicated herein. ~ further verify that based on the information ob[ained from the Municipality of Anchorage flies and fro~ 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 the date of this inspection. Name of Firm Address '~,~[~ ~IV~ A~[~ _ Telephone DHEP APPROVAl,. ~~_.~..~ Approved for _~c~',,~ bedrooms by Approved ~ Disapproved _ . Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health end Environmental Protection (DHEP) issues Health Authority Approval c(~.rtificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does fhis 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 Aachorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (1 ~/84) WELL DATA MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~. ENVIRONMENTAL PROTECTION Well Classification ~ ,~ / C.,",~ ~ if A, B, C, D.E.C. Approved (Y/N) Well Log Presen["~l~) Date Completed /'*""'~--~ / ~ 7,¢~ ~Yield Total Depth. ~ ~ Cased to ~ Depth of Grouting Static Water Level ~ ~ ~ ¢f Pump Set At Casing Height Above Ground _ ~ t t ~ Sanitary Seal on Casing~N) Electrical Wiring in Conduit/N) Depression Around Wellhead Separation Distances from Well: To Septic/l~':G;~-Tank on Lot /00 ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /~ t ~ ; On Adjoining Lots To Nearest Public Sewer Line ~/~ To Nearest Public Sewer Cleanout/Manhole ~ ~ To Nearest Sewer Service Line on Lot Water Sample Test Results Comments B. SEPTIC/N~=DI~G TANK DATA Date Installed ~ ¢-. Standpipe~)N)..~-, Air-tight Capsl~N) Tank ('~N0 ~ ~ Depression over Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) - Separation Distances from Septic/~ Tank: Size ~.-'~ No. of Compartments Foundation Cleanou (~.Y N) __ Date Last Pumped ~-'~4) .75J~_.,_~"' __ ~ ; for /0 To Water-Supply Well ~ To Property Line /<¢) /"/ To Water-M.~,~Gervice Line Course Temporary Holding Tank Permit (Y/N) / To Building Foundation To Disposal Field __ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11184) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~/"(:~ 2-- /%,~"" Width of Field 2. · ~ Square Feet of Absorption Area Depression over Field (Y~"~)..) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /005 To Building Foundation Lot To Water'M~i:rr/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments /t.., o ~J/....~- Type of System Design 74'/'-E:'.~- /¢ Length of Field r"/7 / ~'-~ ! Depth of Field ~// Gravel Bed Thickness ~_o / Standpipes Present ~,~N) Date of Last Adequacy Test /~///,~:~,-ff~' To Property Line /<3 t~ To Existing or ~h~F, de~t¢ System on ; On Adjoining Lots __ To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) _ "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Receipt No:' .,.~..~:~,4s~,,..~ Date of Payment Amount: $ Page 2 of 2 72~026 (11/84) APPLI '~NT FILLS OUT UPPER HA ~ ONLY Address Zip Code Address Zip Code Address Zip Code Type of Resi~nce Water Supply Community For wells drilled p~r to that date, give wel~ depth (attach log if available). ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Field Notes: ~ APR A i~8'3 RECEIVED ( ~ ) OONDITIONAL APPROVAL* O~j 72.023 (3182) CHEMICAL & GJ~LOGICAL LABORATORIES~F ALASKA, INC. TELEPHONE (907)-279,4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 6633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO SE COMPLETED BY WATER SUPPLIER WATER SYSTEM: Water System Name J.D. NO. Phc[ne No, Mailing Address City SAMPLE DATE: ~Mo. ~ SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose State Zip Code Year [] Treated Water [] Untreated Water SAMPLE NO. LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to De: ~ Satisfactory [] Unsatisfactory [] San' 3~e too long in [rans~t; sample should not De over 48 hours oJd a[ examination to indma[e rehable results. Please seno new sample. Date Received Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter LabrRef. No. 'Result* Analyst r · ~NO of colonies/lO0 mi el No of Po$11~ve peri,OhS READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev, 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD 24 Hours 48 Hours CHEMICAL & GL~LOGICAL LABORATORIES,~F ALASKA, INC. ~ Orinkir~;Wam~'A ,;Sis RePo t fo T ,a Colif rm cteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. )Phone No. Mailing Address City State Zip Code Mo. Day Year SAMPLE TYPE: [] Routine [] Chock Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water E; Untreated Water SAMPLE NO. LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analvs~s snows this Water SAMPLE to De: [] Satisfactorv [] Unsatisfactory [] Sample too long ~n transit: sample should no'~ De over 48 hours old au examination To indmate reliabre results. Please send new sample, Date Received Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No. Result* Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Date Corlecte~ Source 24 HOURS · . f_,EMICAL & 'G,_~'LOGICAL LABORATORIES-....F ALASKA, INC. ,~. '~- TELEPHONE (g07)-279.4014 ANCHORAGE INDIISTRIAL CENTER Drinking tot AnalYSiS ie~ort f0r Tota C°lif rm Bacteria TO BE COMPLETED BY WATER SUPPLIER ~ ~ ,I.D. NO. " ~Phone No. Water System Name Mailing Address City State Zip Code Mo. Day ' Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. 2 I LOCATION Time Collected Collected By READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE COMPLETED BY LABORATORY .~oalysis shows this Water SAMPLE to be: [] Satisfactory )'~] Unsatisfactory :' [] Sample too long in transit; sample should qot be over 48 hours old at examination to indicate reliable results. Please send hew sample. Date Received " · Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No. Result* Analyst 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 24 Hours 49 Hours .~onflrmatory April 7~ 1983 Approval fer the individual sewer and water7 tacititi~ cannot be :jt~a~]ted until the ~,]11o~1 ~g ~te~as have~, ~,~Di~'' ~e~' "~ A We, ll lo%~ submitted to this office for otlr ~iles and ~b~' ~' ~ P~ ........ ' ' pit around the well casin9 needs to filled with liNe,vis, u,., type soil, oo ~.na~; it slopesa o '2he water anaiy;~is reOOL'% ~eeds to oe oo.h~J to office t~?om the (,~ ~,~c:~J~ ,}63s ~5 Street~ ~or our review. Please notify this Deparhale~t for a ~la~,}gct;~or, ,~.l~n the noted,;l~,~r_t. all~.leS~ - ~' ~' have been corrected, l~ there ar~ arty ple~,,~,. ~11 u~lle, office a'k q"~-,~' Sincerely~ RPg/ej/Et Robert /' ~. Pratt Aa~eclatc Ehvironr,~ental dOO 7