HomeMy WebLinkAboutT12N R3W SEC 24 W2W2SW4SE4SW4 M PTNT12N R3W
Section 24
W2 W2 SW4 SE4 SW4 M PTN
#015-242-09
Development Services Department
Building 5cf&y Division
On -Site Weer & Wastewater program
4700Street
p.0..O. Sox ax 19 196650
Mark Segich Anchorage. AK 99519-6650
Mayor waw num a,a/nr5it._
(907) :43.7904
Pump Installation Log
Well Drilling Permit Number: SW_ Date of Issue:
Parcel Identification Number:Lla-C` Llgzq
Legal Descriptionp-,
T�a� t�.�ttiJ �Zl
I,�Z lvZ ->04 SCS wq %ll,pN
Property Owner Name & Address:
�/Yllhnfc t�t►L
12. Z'{5 L, J^dl ctscic�
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing:0— feet .
Pump Manufacturer's Name:
Pump Model: 50 31 t 64V-5 12 Vb
Pump Size, ,) hp
Pitless Adapter Burial Depth: /
ca
Pitless Adapter bIanufacturer's
Pitless Adapter Installer.
Well Disinfected Upon Completio)
�
Method of Disinfection: —,__----
Comments:
Pump Installer Name: b11L�f�vstA+tNt„3� ��
Attention: The pump install= shall provide a pump irstallation log to the DSD within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE O//~'~- Z~'/~-'"
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street. Anchorage. Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Address
LEGAL DESCRIPTION
I S U bdivisio..~,.~
TAN~(S
[] HOLDING
No. o Comp~,~s
TYPE OF SYSTEM
'~"~S E PTIC
Manulac~urer
Material
[] TRENCH ,~,~ED [] W. DRAIN [] OTHER
eepth ~o pipe bottom from Total depth from original grade
original grade ~- t~' FT "~,0 FT'
~-~'~gJ"~i~..~,~)g.... FT graveldepthheneathplpe O"~""FT
Gravel'lengJh ~ FT Grsvel width ~ __
WELLS
.~"~RIVATE
[] OTHER (Identify)
Total Depth FT Cased to
Date Installe~:
Classification (A,B,C)
DISTANCES
FROM'~ SEPTIC ABSORPTION
WELL
TANK FIELD
I
WELL
LOT LINE
FOUNDATION
AS-BUILT DIAGRAM (Show location of well, septic system, properly lines, foundation,
driveway, water bodies, etc.)
REMARKS:
$ & S ENGINEERING
~ , cedily th. at this inT~ection was pedormed according Io all
17034 Eagle ~Lver [,oep Kc~aci N¢~. ~ /~ //~ /~
Municip~R~e~a~ ~ , ,/~// ~ / a )~.
Health Depadment Approval: /~C~~ __~~
72-013 (3/85)
F'ar' c:e i ]: d: () :l. 5-242-09
I...o',.',. [...~,;.ic~].: Subdivisic)r'i: !_..or:
Sect :[ ora ~, 24 To~,,~nsh :i. p: 1 [:,~Ixl Ran ge:
BLId LOT :1.7
Max Ba, dr'.oc:ims: This Pamrn:i.t= 5 To'La! Capac:ity:
SEF:'T'iC rANK:,, Minimum tl;:ta] septic ~..,:,l 1.. -~ -' ..... . ,ja....c)n ....
'~:.atrll.:: i£tLI!~F~, halV~:9.:¢.-"',.. .,.' easu" 2 compar"Lmertt!~h, Depth to r.o. of sep'L:i.c
f i:.:.) e .I:. r. e c:tu :i. r' e~ i n ss u ]. a t i (]n o v e r' 'L a n I-:: ( s ) =
Iii[ach septic
tank (s) < 4.()
]:N,C.~TAi..! t:::'Ei:R I~[NGINEERS ATTACHE:D AF'PROVED DESIGIxI~ NO'T'IFY DHHS
F:'RZOR TO lEACH ]: IqSPEEFT' ]: ON ,, EXCAVAT:[ON iS 'TO BE: EiI:'IEIqE;D AND CL.OSED
[:)N THE SAME. DAY ]:1::' NOT I..IEA'F[::D. ]'HIS PEIRMZT :IS ];SSUIE:D F'OF;'. ]'HE
E:X:I;SrIIq(~) 5 Ed~:DRE)OM SINGL..E F:'AM]:LY DWE[.L..ING C)NLY AND E XF:']:RES ON
J. 2 / 3 i /El 9 ,,
I CIERTIF:Y 'Il'iAI
:t.,, ]: El~li far~i:i,].:[ar' ~,~:i,'t:.h thE! p~l;;lL(iPigriiE!nt~"~ fop i:;H"i'-'~i~itE) S~:.H,,I~i:H"!a al!d ~,le].],Ei
{OF"I_I'i I]y the Mun:i. cipai.:i, ty of Anchoi'a~](-~ (MOA) arid tile SCa'Lc oF Ala!~dca,,
~:'.,,I ¥.d. 1] j.n,~Ft:.a].l 'Lh6~ .ii~ys'Lc:ml in ac:c:oPcJanc:e with a].l M[]A ,::::[:des and
.~f]CJ ii"l l](3fl]p].:J~.l-I?.;~} ~;J.'[.h ?..h(((, clesJ, gn izP:i.'Lep:J.a of Chis per'mit,
3,, ): ~,~:i. ll adher'a t.(:) a].]. MOA and Sta'Le o~ Alaska r'aquir'em~:~rlts fop the set bac:k
!~ewe:r'.age syst.~:3m on 't'.l'~:i.s c)p any adjacant c:m neapby lc:it,,
4. :[ ,...u'lder's'l:.ar'~d 'Lha'L thi. s peF. mJ.t is val:Lcl fop a maximum (:){' 5 bedl"c:)om~.
aisc) LU"!d~:~Pstai'iEI '[hat thE) capaci'Ly of t. he 'Lint, al system :i.s 5 bedr'c;x::)ms and
a n y~e n 1 a i- g ~e n '[: ~ :i, 11 r' e c] u J.~) a n a d d i 't. i i::~n a ]. p a, i* m :i. i:,.
.......... ~..__....: .................................. . .......... .. ......................
' I
).
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
Township, Range, Section:
(O/P)- F g//
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DATE PER FOR~/ED.~~
SLOPE SITE PLAN
WASGROUND WATER
ENCOUNTERED?
s
IF YES, AT WHAT J OL
DEPTH?
P
E
Dale: X~--- ~-~
Deplh lo Water After
TEST RUN BETWEEN ND __ FT
COMMENTS ~'~° ~ ~/*/-~" ~;~"/~ ~-~, ~. E' ~ '~ / ~
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUID~~T ON
THIS
DATE.
72-008 (Rev. 4/85) ~
D^~[?TIFV T~/~ T/~ Ty~S.~RP°RME°'N
Gross Net Depth to Net
Reading Date Time Time Water Drop
MUNICIPALITY OF ANCHORAGE
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
[] NEW
~ UPGRADE
NAME
LEGAL DESCRIPTION I
DISTANCE TO: /~)~ I Absorption area
/~)~ Igwelling
Manufacturer
DISTANCE TO:
Manufacturer
Dwelling
NO. OF BEDROOMS
PERMIT NO.
.artments
Liquid depth
Well Foundat~.~
DISTANCE TO: / ~) ~'"'
No, of lines~ of each line ngt,~of lines
Top of tile to ~ni~.~rade
Depth
PERMIT NO.
Liquid capacity in gallons
Nearest lot line PERMIT NO.
Trench width Distance between lines
inches
Total effective absorption area
,e of crib
depth
Well
DISTANCE TO:
OTHER
Driller
Distance to lot line PERMIT NO.
Septic tank Absorption area(s)
SOl L TEST
INSTALLER
REMARKS
DATE LEGAL
DEPARTMENT OF HEALTH AND ENVIROPlMENTAL PROTECTION
$25 L STREET, ANCHORAGE, AK 9950i
2.'64-4720
PERMIT NO: 850590 LIF'GRADE
DA]"E ISSUED: ()9/13/S5
APPL I CANT:
ADDRESG:
CGNTACT PHSNE:
ME:LV IN MGNSON
UPPER I=IUEFMAN/WINDY CIRCLE
ANCHORAGE, AK 99511
345-2808
LEGAl_. DESCRIP:
LOT SIZE:
SUBDIV]:SION: NA LOT: P 17G
SECTION: 24 TOWNSNIF': 12N RANGE: 3W
1.OA (GQ.FT. GR ACRES)
BLOCk:: NA
ce~*t i ~'y t h a'l.'.: ,
I am £amiliar- with 'the Pequirements for on-sf, te sewers arid wells as set
Eot'th by the Municipality o£ Anchorage (MOA) and the State of Alaska.
I' will insta].l tine eystem in accordance with all MOA codes and ~-eguiations,
and in tempi, lance with the design criteria o£ this per'mit.
I wilI adher'e :t:e all MOA and State of Alaska r'equir'ements ~'~3P the set back
distances ~'r'om any existing well, wastewater' dispesal system of pub].ic
s~;~wer'age system'oi"~ this or' any adjacent or nea~*by.lot,.
~:f:' A L. IFT STATIGN IS INSTALLED IN AN ARE:A CGVERED BY MGA BUILDING CODES.,
TGEN (1) AN EL.ECTRICAL PERMIT AND INSPECTISN MUST BEE OBTAINED; (2) AS-BUIL.-I-S
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK IdLIST BE .DONE BY A LICENE}ED ELECTRICIAN.
o 1GNI::D DATE:
~',.MUNICIPALITY OF ANCHORAGF~
Department of Health and Environmenta~ ~Protection
Pouch 6-650, Anchorage, AK 99502
264-4720
Permit No:
Date Issued:
Applicant:
On-site Sewer/Water Permit
HANDWRITTEN
Address:
Legal Description: S/D:
Lot Size:
Lot: Block:
Section: ~ Township:
(Sqo Fto or Acres)
Range
Lot Location:
Max Bedrooms:
Listed below are the options available to you in designing your septic
system. Choose the option that best fits your site.
TRENCH BED W. DRAIN
Depth to pipe bottom(fto)
Gravel depth (ft.)
Total depth (ft.)
Gravel width (ft.)
Gravel length (ft.) ~ I[~ol
Tank size (gal.)
Soil rating (sq. ft./br)
** Gravel length 75 feet requires multiple runs (not exceeding 75 feet each)
** Tank must have at least two compartments
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage(MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and
regulations, and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set
back distances from any existing well, wastewater disposal system or
public sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for the maximum number of bedrooms
stated above, and any enlargement or modification will require an
additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN
(1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; '(2) AS-BUILTS WILL
NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUm BE DONE BY A LICENSED ELECTRICIAN.
SIGNED: ~ ~L.~I ~ ~( J~/'~d~J~.__~ DATE:
Applicant L
ISSUED BY:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] SOILS LOG
PERCOLATION
TEST
PERFORMED FOR: M ~L~J~
LEGAL DESCRIPTION:
1
2
3-
4-
5-
· EEc
8-
9-
10-
11
GP- L4-
13-
14-
15-
16-
17-
18 - D. aarler
19-
20-
COMMENTS
DATE PERFORMED:
SLOPE
WASGROUNDWATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SITE PLAN
S
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~o ~ (minutes/inch)
PERFORMED BY: ~~
72-008 (6/79)
~GREi~ ER ANCHORAGE AREA B0F UGH
~.q~),~/ Department of Environmental Quality
'~ 3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL
MANUFACTURER
MAILING ADDRESS -/(")(')~:5'(/r' /~'-//?-// '~-/' PHONE~ 7Ct'-~'~ ~
-( ~])(~ //c. LEGAL D~SCR PT ON //~i~ ,/~'~/~ ~'(/:(~*¢ ~'{('~/'
MATERIAL
NUMBER OF
COMPARTMENTS
INSIDE LENGTH
II'SI DE WIDTH
LIQUID DEPTH
LIQUID CAPACITY /O~ ~) GALLONS.
SEEPAGE PIT:
NUMBER OF PITS ? DIAMETER __
MATERIAL/C (/~ CRIB SIZE:
LINING
BUILDING FOUNDATION ~,/~, NEAREST LOT LINE ~::
DIAMETER F~2, ~DEPTH '~) / DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) .SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPe ("/(~g?(/~ /~ CONSTRUCTION
BUILDING NEAREST
FOUNDATION_ LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
/
DEPTH ~/~c:~ DISTANCE FROM:
NEAREST ~ SEPTIC,~ .. ,~ SEEPAGE ~ /
SEWER LINE TANK ('(# F'/,~ , SYSTEM ~
REMARKS
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY: ./~Z~/~2,*-
PIPE MATERIAL:
Form NO, EQ-031
-~ i-:: :~ q '~;~'""~ --'
DATE /~//(~/-/:' APPROVED / / ....
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERM]T NO,
INSTALLATION OF SEEPAGE PIT , DRAIN FIELD _, OTHER
FINANCED THROUGH TO BE iNSTALLED BY
SO{L TEST RESULTS .~i$ PERMIT IS NOT VALID WITHOUT $OIL~
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
FOUNDATION TO SEEPAGE PIT
S XIC TANK TO S E PIT WALL
~EEPagE Pit //GO I DRAIN field
TANK , SEEPAge P t ,/~ t
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, , SEEPAGE p~T/~ , DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CR}B CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
CONFORM TO BOROUGH REG LATIONS REGARDING INSTALLATION.
I CERTIFY THAT I AM FAMILIAR '~/[TH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROU (~RDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE,
DAT £ ~C:~//-:~//~> APPLICANTS SIGNATURE
R&M
Civil Engineers
ENC,..qEERING & GEOLOGIC,kL CONSULTANTS
229 EAST 51st. AVE. - P.O. 90X 6087 - ANCHORAGE, ALASKA 99503
TELEPHONE 907-279-0483 TELEX 090-35419
Geologists Land Sun/eyors
JAMES W. ROONEY, P. E.
MALCOLM A. MENZIES, P.E., L.S.
JAMES H. WELLMAN, P.E.
RALPH R. MIGLIACCIO
Engineering Geologist
October 12, 1973
R & M No. 36682
Mr. Melvin Monson
Box 100-36
tClatt Road Station
Anchorage, Alaska
Re:
~ECEkv~D
00'[ 5 1973
P~PT. OF,NVI~!ONM~NTAL~UAMTY
Test Hole and Soil Log Report for Sanitary System, S.W. 1/4
of Section 24, T12N, R3W, S.M.
Dear Mr. MonSon:
We are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This investi-
gation was performed in accordance with your request of October 5, 1973,
and those procedures outlined in a letter dated September 13, 1971 by
Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of
Environmental Quality.
A single test hole was put down within the Section 24 area for the purpose
of defining general subsurface soil conditions for the proposed sanitary
system. Excavation was accomplished with a tractor-mounted backhoe and
the test hole was extemded to a total depth of 14 feet below ground surface.
The final log prepared for the test hole has been included in Drawing A-O1.
Ground water was not encountered in the test hole.
We appreciate being given this opportunity to be of service to you. Should
you have any questions with regard to the above, please do not hesitate
to contact us.
Very truly yours,
R & M ENGINEERING & GEOLOGICAL CONSULTANTS
~R:ph
xc: GAAB/
ANCHORAGE FAIRBANKS JUNEAU
T.H. 1
10-5-73
Organics
Sandy Silt
Gravelly Sand (SW)
0.0:'
0.5'
Sandy Silt w/some Gravel
(SW-OM)
4.0'
6.07
Silty Sands w/some ~ravel
(S~O
No Water Table
14.0' T.D.
NOTE: Test hole excavated with tractor-mounted backhoe~
Engineering ~ Geologica I Consultants
~'re 10-5-73 s~"=2' ~w~__BY JRS
MELVIN MONSON PROPERTY
LOG OF TEST HOLE
Anchorage Alaska
WED A-01
MUNICIPALITY OF ANCHORAGE ~ '
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SiTE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel LB. # /"~,/--~- 2 ./?/'~'~ ~ (~.c/ HAA#
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Parcel 17G, S.W.I/4; Sc..(: 24; T12N; R3W; S.M. ~k./~,.'t4/~.
/
Location (address or directions)
'NHN Windy Cir~6e
(b) Property owner Melvin Monson
Mailing Address P.0.Br~ 1
(c) Lending Institution
Telephone: (home) $45-2~08
Telephone
Business
Mailing Address
(d) Real Estate Company and Agent
Address 3201 0 Street suit6 ¢100 Anchorage, Alaska 99503
Telephone 563-5500
(e) Mail the HAA to the following address: (or check here,{~ if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
Ea~le River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family'S( Number of bedrooms 5 ~
3. WATER SUPPLY
Individual Well ~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site B:K 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.
724)25 (Rev. 7/88) Page 1 of 2
5, ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ·
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional .and adequate for the number of bedrooms and type of structure indicated herein, I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Telephone
$ & $ ENGINEERING
Address 17034 Ea~le Bi,'er Loop Road No 3 ~
Date .
6. DHHS APPROVAL
Ap?ovod for ,,0''7~ bedrooms by
/
App"eyed /~(~_. __ Disapproved
Terms o¢ Conditional Approval
Conditional
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88} eack Page 2 of 2
,,,~------~ MUNICIPALITY OF ANCHORAGE (MOA)
(~*~[~'-~/ Health Authority Approval (HAA)
,,_, ~.,~.~.~.,/ CHECKLIST - FEBRUARY 1984
~,~'~?~" :' <~'~ Legal Description: '~~
A. WELL DATA
Well Classification I~ ~ ~O ~
Well Log Present (Y/~ ~ Date Completed
Total Depth ~ Cased to ~ Depth of Grouting
Static Water Level ~ Pump Set At
Casing Height Above Ground
Electrical Wiring in Conduit t~N) '
If A, B, C, D.E.C. Approved (Y/N)
Yield '~ '~ ~2't"1
I'~" ~ Sanitary Seal on Casing ~) y
~ Depression Around Wellhead (Y/~.
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ~
; On Adjoining Lots
; On Adjoining Lots
To Nearest Edge of Absorption Field qn Lot
To Nearest Public Sewer Line i'~/~/'
To Nearest Sewer Service Line on LOt
Water Sample Collected by %
Water Sample Test Results
Comments
; Date
To Nearest Public Sewer Cleanout/Manhole
B. SEPTIC/HOLDING TANK DATA
Date Installed ~:~ ~--°"~"Size
Standpipes t~;~'N) ~ Air-tight Caps
Deeression over Tank IY/~
Pumpir~g(Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) I~/
To Water-Supply Wel
To Property Line
To Water Main/Service dine
No. of Compartments
¥
/ Date
Foundation Cleanout
Last Pumped I'[ '-I ~-- ~:~'1
; for "-"-'--
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM S EPTIC/HOLDING TANK:
To Stream, Pon_a, Lake or Major Drainage Course
To Building Foundation
To Disposal Field
Y
72-026 (Rev. 7/88) Front Page 1 of 2
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~ '7_....~ ")"~/~v'~---- Type of System Design
Date Installed /'2- ~ ~ to, -- ~ Length of Field
Width of Field ~-.~-.-~' Depth of Field
Gravel Bed Thickness O, '~'
Square Feet of Absortion Area '¢~ z:~¢c:~ ~'
Statnd pipes Present I~N)~/~.
Depression over Field (Y/~ r-¢~ . Date of Last Adequacy Test
Results of Last Adequacy Test ~ ~:~l'~::;rLj~ ,
SEPARATION DISTANCE FROM ABSORPTION FIEIrD' ~.~.~ ,'_.,
To Water-Supply Well '~ ~'5 (,.) ~ To Property Line I
To Building Foundation ~ I.-~ To Existing or Abandoned System on
Lot "~ ~ ~ ; On Adjoining Lots ~
To Water Main/Service Line ~ c:=,t 4- To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course I ~:,Ot''~
To Driveway, Parking Area, or Vehicle Storage Area \ ,s:~
D. LIFT STATION
"Pump On" LeveT"¢c-----~ %~
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments.
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
~ ~Pumping Cycles during Adequacy Test,
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec.!~-
inspection. ,~ ~..,.~.,- ,~.~_..~.~ .
S & S ENGINEERING
Signed ~n~4 ~..I. ~;~n~ Loan ~n=~ . ~,~
Company Eagle River, Al~sk~ 99572 ~
MOA No.
Receipt No. ~l~gY Receipt No.
Date of Payment /~ ~ ~ Waiver Fee: $
Amount: $ /?~ o~
Date of Payment
72-026 (Rev 7/88)Back Page 2 of 2
~ CHEMICAL
& GEOLOGICAL LABORATORIES OFALASKA, INC.
FEDERAL TAX ID # 92-0040440
ANALYSIS REPORT BY S~J~PLE £or Work Order $ 18919
Date Report Printed: DEC 19 89 e 17:27
Client Sample ID:PArCEL 17G, SEC 24, T12N, R3W
PWSlD :UA
Collected DEC 18 89 ~ 14~OO his.
Received DEC 18 89 @ 16:00 his.
Presezved with :AS REQUIRED
Client Name : S & $ ENGR
Client Acct: SNSEHGF
P.O.I NONE RECEIVED
Ordezed By : EOB SI{A~ER
Analysis Completed :DEC 19 89 Send Reports to:
Laberatozy SupeFvi~or :STEPHEN C. EDE i)S & S ENGR
R.l.ased By: ~~. ~ 2)
Special HOLD UPON COMPLETION FOR PICK-UP.
Instruct:
Chemlab Ref S: 8952 Lab Smpl ID: 3 Matrix: WATER
Allowable
Pazameter Tested Result Units Method Limits
NITRATE-N 3.0 ~/1 EPA 353.2 10
Sample ROUTINE S/OiPLE. SA~PLZ COLLECTED BY BOB $IL~EER.
Remarks:
I Tests Perfolmed ' See Special Instructions Above UA=Unavailable
ND= None Detected *' See Sample Remarks Above
NA= Not Analyzed LT-Lese Than, GT-G~eatee Than
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SiTE SEWER A XID WATER FACILITY
264-4720
Application Date (~',-'~=~O -'~'
GENERAL INFORMATION
(a)
(b)
(c)
(d)
Legal Description (include lot, block, subdivision, section, township, range)
Location(addre,ssjor ~di,rections)l ,.\ ~..~ /~., _/i_
Apphc'a~t Name/~,hl ~J~/~o~ ~Telephone:Home,~.~_~_O~L Business
Applicant Address ~.~. ~0~ II~)(~a~ ~)~-~o ro~,, a ~/o~3_
Applicant is (check one): Lending institution []; Owner/builder []; Buyer []; Other~ (explain);
Ler~aing' I~stit~tior~ '-~"'~,~.~.~ ,~,~Mx:t~. ~/~ Telephone
Address
(e) Real Estate¢ompany.and ~gent
Address
(f)
Telephone ·
Ma the H~,A t~he following address:
!
TYPE OF RESIDENCE
Single-Family J~ Multi-Family []
Nu tuber of Bedrooms J~'!/J~=
Other
WATER SUPPLY
individual Well ~ Community
Public
Note: If community werl 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: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-025 {11/84)
Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
AS certified by my seal affixed hereto and as of the validation date shown berow, I verify that my investigation of this Health
Authority Approva} shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms anc~ type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this ir~spection.
Address
DHEP APPROVAL ~
Approved for ~'-"-~'~'~------' bedrooms by
Approved X Disapprovec~
Terms of Conditional Approval
Engineer's Seal
CAUTION
The MuncipalJty 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 for errors or omissions in the
~ ~aJ~.~..~ ne er's work.
· Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
WELL DATA
WeJl Classification ~-I U ,~~-
Well Log Present (Y/N) ~/
Total Depth ~"~-~A'~ Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Ii A, B, C, D.E.C. Approved (Y/N)
Date Completed ~/- ~/~'/~-"~,~ Yield
.~-~1~' Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
¥
IO,~ ; On Adjoining Lots Jf-J~ ~
.~* ; On Adjoining Lots ~/~ ¢'
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line -
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results ~..~,,1~.~---~.
Comments ,V. ~'~ .~,~-¢J'~.~
B. SEPTIC/HOLDING TANK DATA
Date Installed ~ Size
Standpipes (Y/N) ~/ 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:
No. of Compartments "-/"'E~O
¥
Foundation Cleanout (Y/N)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N) '-'
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72~026(11/84)
C, ABSORPTION FIELD DATA
Soils Rating in AbsoJ~ption Strata
Date Installed
Width of Field ,,,~
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /~'-
To Building Foundation /'~
To Water Main/Service Line ~ -
/~,.~_ Type of System Design
Length of Field 11,~"~
Depth of Field I~ .~
Gravel Bed Thickness ~ "~
~,~ Standpipes Present (Y/N) Y
~/ Date of Last Adequacy Test
TO Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course --
To Driveway, Parking Area, or Vehicle Storage Area -
Comments
D. LIFT STATION
Date Installed ~ Dimensions
,,S, ize in Gal,:ons ~ Manhqle/Access(Y/N)/
Pump On Level at
High Water Alarm Level at ~ Vent(Y/N) __ _
Tested for / ~ Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
Check Permitted Bedroom Rating Against HAA Request
I certi fy t, ha~l._h a.ve,~.c~erified, or confor mod t o all MOA and HAA guidelines in effect on the date of this inspection.
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (~ ~184)
Engineer's Seal
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date ~
GENERAL INFORMATION
(a) Legal Description (include lot, block, sabdivision, section, township, range)
Location (address or directions)
' ~
{ d! c2¢
(b) Applicant Name {'ejU¢~*, Ct, ~tS~:O:. Telephone: Home ~¢;~;~ Z. eOe Business
(c) Applicant is (check one): Lending institution ~; Owner/builder~; Buyer ~; Other ~ (explain);
(d) Lending Institution
Address
Telephone
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family ~ Multi-Family
Number of Bedrooms
Other
WATER SUPPLY
individual Well .0~ Community [] Public ~]
Note: If community well system, must have written confirmation from the State Department of EnvironmentaJ C~n~r'¢afJo.~ '
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite~ Public [] Community E] Holding
Tank
Note: If corn munity well system, must have written confirmation from the State Department of Environmental Ccr~rvat~o~
attesting to the legality and status.
Page 1 of 2 :~¢~ ~
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFOR~IATION
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 hereto. 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 Munici ~al and State codes, ordinances, and regulations in effect on
the date of this inspection,
Address !'~ 4&_t
Telephone ___ ~2,~/~;~ t,t~}_
Engineer's Seal
DHEP APPROVAL .
Approved for~~'~/~/~-~'*' bedrooms by/~---/ --~%7._~¥
' Conditional
Approved :_ Disapprgved --
· ., ,, ..-
Terms of Conditional Approval ~~~
CAUTION
The Muncipality of Anchorage Depadment 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 DIdEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
/ MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHOBAGE (MOA) DEPI'. OF HEALTH &
ENVIRONMENTAL PROTI~CTION
HEALTH AUTHOBITY APPBOVAL (HAA)
CHECKLIST- FEBRUARY 1984 ~\UJ] 2 9 ~
264-4720
Legal Description: D ~' ~' ~ J ~/J~ r~
WELL DATA
Well Classification ~(~! U~c.. If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) ~ Date Completed ~ Yield
Total Depth '~ ~',~ Cased to ,~,-t- Depth o_f Grouting
Static Water Level Pump Set At
Casing Height Above Ground ~'_ tn'--[-'z-~,, Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) )/ Depression Around Wellhead (Y/N)
Separation Distances from Well:..,~.,5~ ~ ~, ~ ~
To Septic/Holding Tank on Lot /~,7~ O~to'~' ;'On Adjoining Lots
To I~earest E~ge of Absorption Field on Lot J~""~ ; On Adjoining Lots
To Nearest Public Sewer Line ~ To Nearest Public Sewer
Cleanout/Manhole ...... To Nearest Sewer Service Line on Lot
Water Sample Collected by ~[rl ; Date
Water Sample Test Results
SEPTIC/HOLDING TANK DATA
Date Installed ~ Size t ~8~ No. of Compartments
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 J ~'~ "J--
To Property Line ,~ ~"'J¢'
To Water Main/Service Line --
Foundation Cleanout (Y/N)
Date Last Pumped ~
; for
Temporary Holding Tank Permit (Y/N) _
To Building Foundation J ~) ~
To Disposal Field JO ~
To Stream, Pond, Lake, or Major Drainage
Course '-~'-"-'
Comments
Page 1 of 2
72-026(11/84)
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N) ~'~
Type of System Design '~,-~¢-~-- ¢-'~L'~¢~c1~'
Length of Field ~
Depth of Field ~
Gravel Bed Thickness ~
Standpipes Present (Y/N) ~
Results of Last Adequacy Test
Separation Distance from Absorption Field: 0
To Water-Supply Well I/_~*'~ ~
To Building Foundation
Lot '~_ ~t~ ~~
I
To Water Main/Service Line '"'""' --
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Date of Last Ade,qtcacy Test
To Property Line C:;~ ~-'
To Existing or Abandoned System on
; On Adjoining Lots ~
To Cutbank (if present)
Comments
D. LIFT STATION
Date Installed ~ Dimensions
Size in Gal,l, ons ~~_ Manhole/Access (Y/N)
"Pump On Level at '~'~ "Pump Off" Level at
High Water Alarm Level at
Tested for ~"'"~P~rnp~ing Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments____ _ ,~,,_~_. ~
r
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to~ll MOA and HAA guidelines in effect on the date of this inspection,
Signe~~ Date ~-<:~ ~,
Company MOA No..
Receipt No.
Date of Payment
Amount: $ '~ Engineer's Seal
Page 2 of 2
72-026 (11/84)
August 6, 1985
To: Ms. Cindy Lindeman
~irst National Bank
Reference: SW~ Sec. 24 T12N
R3W Parcel 17G
Dear Ms. Lindeman:
At the request of ~r. Scott Torrison, representing Mr. Melvin
Monson, I performed an adequacy test on the septic system for
the subject property. The test was accomplished on July 27, 1985,
and the following is my report.
On the date mentioned approximately 750 gallons was introduced to
the septic system. The water levels were periodically monitored
with respect to time for the filling and subsequent absorbing
period. The absorption rate was extrapolated according to I~.
Leroy Reids paper, "In Situ Testing of On-Site Sewer Systems,"
September 1982. On the date tested this system would accept
approximately 700 gallons of effulent for a 24 hour period and
does not meet the requirements for a five bedroom residence.
Therefore, the following items will have to be corrected before
an application for health certificate may be submitted.
1. Install a new approved 1500 gallon tank at a distance greater
than 100 feet from the well.
^ Make all ~lumbing connections to the trench and lead line
~' from the ~ouse as necessary to obtain an operating system.
2. Break open existing concrete esponosa tank and splice in a
new pipe of similar material between the inlet and outlet
with watertight couplings. '
A. Backfill the tank with sand or gravel.
B. Install a cleanout at the foundation ·
Abandon the old crib.
A. Cut off and cap the lead line.
B. Pump the liquid from within.
C. Break open and backfill with gravel or sand.
Extend trench. A. Dig a test hole 14 £eet deep or to watertable to log soils.
B. The soil log will be used to size the trench addition
C. Provide a dike 5' to 6' long at the north end of trench
for the extension. It is expected to be between 10' to 15'
long with 6 foot of gravel depth.
page 2 of 2
5. Extend all standpipes as necessary for 12 inches
above ground and provide Jim type caps.
of extension
These requirements have been presented to three independent
excavators for bids to accomplish this work. It is my
understanding that you have those bids in hand and this report
will support the work required. If I can be of further
assistance, please give me a call at 346-1170.
S incer e~
To'ny D. Barter, ~P.E.
Barter and Associates
10461 Hampton Ilrive
Anchorage, Alaska 99516
cc: Municipality of Anchorage
TDB/kb
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quelity
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Received /
-/
3.
4.
5.
Time of Inspection
Date of
REQUEST FOR APPROVAL OF
INDIVIDUAl. S£WER & ~;~ATER FACILITIES
FOR -'
6. Well Data:
A. Type
C. Construction
Depth
Bacterial Analysis'
7. Sewage Disoosal Svstem:
A. Installed
B. Installer
C. Septic Tank: 1. Size
D. Seepage Pit: t. Size
2. Manufacturer
E. Disposal Field: Total Length of Lines
Se
Distances:
A. Well To:
Septic Tank
Nearest Lot Line
, Absorption Area , Sewer Lines
· Other Contamination
B. Foundation to Septic Tank__
"> AbSorption Area
Absorption Area to Nearest Lot Line
Rec~e~t for Approval of Individual Sewer & Water Facilities
Pag~ Two
Date
Approval Valid for One Year From Date Signed
Greater Anchorage Area Borouqh, De~rtment of Hnvironmenta] Quality
.
I certify t
and accurat
DIAGRA~ OF SYSTE~
//
]at the information contained iH this request for approva] to be true
; representation of the subiect sewer and water facilities locate at:
/.) ....