HomeMy WebLinkAboutT12N R3W SEC 33 LT 114ATom Fink,
Mayor
un cip H y of Anchor ¢
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
October 22, 1992
Alonzo J. Lyford
14711 Lake Otis Pkwy.
Anchorage, AK 99516
Subject: Lot 114, Sec. 33, T12N, R3W, SM; PID #018-252-37
Dear Mr. Lyford:
Please be advised the shop building under construction on the
subject lot is in violation of the separation requirements
specified by AMC 15.65.060. The required separation between an
absorption trench and building foundation is 10'
As the system is not now in a state of failure no immediate
action will be taken. However, prior to receiving departmental
approval for refinancing the septic system must be brought into
compliance with AMC 15.65.060.
Please contact my office if you wish to discuss the matter
further. My telephone number is 343-4744.
Sincerely,
Daniel N. Belles
On-Site Services
cc: John Smith P.E., Program Manager, On-Site Services
Public Works, Building Safety
db/194
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OI-- HEALTH & ENVIRONMENI'A[ PROTECTION
ENVIRONMENTAl. ENGINEERING DIVISION
825 [_ Street - Anchora,qe, Alaska 99501 TelePllone 264-4720
ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WEI.L INSPECTION REPORT
GARY DRAHOSlt
MAIMNGADDRESS
2721 Porcupine Trail, Anchorage, AK 99516
F~ NEW
L] UPGRADE
I.EGAL DESCRIPTION
Portion of West ~ lot 114,~1 -~"~-T ........ ]FZ''
LOCATION NO. OF BEDROOMS
4
PERMIT NO.870243
Section 33 T12N R3W
OISTANCETO' I over 100'
__ V~n~horage2q.ank' [ ~ 90'
Manufacturer · ~'1 Stee 1
I 1500 [ IF HOMEMADE: [W,dth
No, of coml)arlments 2
t Liquid clepth
DISTANCE TO: ITMLeli
Dwelling
DISTANCE ¥O: 64 ' over 100 ' PERMIT NO. 870243
NA
40 inches
Length
of crib
Matmia[
Foundation over T(~%e's~'i~t Ii,,,, j'-~,
Material beneath tile 30 inchos
Class Pr ivata Depth Distan¢l~Jq lot line
~O
DISTANCE TO:
St, ilcjisg~ foundation
Sewe, ire 34'
PERMIT NO.
Liquid capaciW in gallons
PERMIT NO.
Fotal effective absorption ~iTea
Septic tank
over 100'
PERMIT NO.870243
OTHER
PIPE MATERIALS D266~I{ouso to S.~.
F810 Perf,, D3034 Unperf. Outlet of S.T.
SOILTESTRATING
125 Sq Ft per BR
INSTALLER
Gary Drahosh~ Owner
REMARKS ~
See attached sheet for location dimensio
APPROVED
DATE LEGAL
1/t6/88 Portion GE w~ tot
BRUST & ASSOCIATES
Engineers. Planners - Surveyors
1610 Dimond Drive MUNiCIPALITy OF
Anchorage, Alaska 99507 DEPT. OF HEALTH
(907) 562-7878 I~NVIRONMENTAL PROTECTt~N
April ]1, 19S8
RECEIVED
Anchorage Department of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Attn: Susan E. Oswalt
Subject: As-built for' T12N R3W Section 33 Lot 114
Dear Ms. Oswalt,
Enclosed is an attachment sheet for the As-built for the subject
property, as requested in your recent letter. These reference
distances should also serve to describe swing ties to two points.
An As-built survey is scheduled in the near future. Elevations of
the septic system will be taken at that time and forwarded to
your office.
Sincerely,
Stanley Brust
cc Mr. Gary Drahosh
NOR~
SYSTEM,_ · DISTANCE IN FEET
PART[!SW CORNER SE CORNER NE CORNER FOUNDATION
WELL I 33.4 14,8
FOUNDATION ] FRAME NOUSE
CLEANOUT 21.0[ 2.4
CLEANOUT 53.7 34.O
CLEANOUT 72 . 7 62.9 6) C.O.
S.T.C.O. 99.0 92.0
S.T.C.O. 108.1 102.1 ~ C.O.
CLEANOUT 109.2 103.6
CLEANOUT 112.8 107.6 LQ! S.T.
C.O.s
CLEANOUT 173.0 169.0
MONITORING
STANDPIPE 165.2 164.5
monitoring ~O
~AWN BY; s b
~""~0"*, 8 ASSOCIATES PORTION OF WEST ~, LOT 114
DAT[i..I/16/88 ~ ENGINEE~-~N~-SU~O~ Rabbit Creel< Small Tra~ts
SCAL~, P'=50' 1616 DIMOND D~IVM ~C~AOEA~sRA ~EFERENcE"D~STANCES' .......... [~
JO~ NUU~m 87-3 i ~90~)$B~-~07~ .... 90~ Ior
SYSTEM DISTANCE IN FEET FRO~_
PART !SW CORNER SE CORNER NE CORNER FOUNDATION
WELL 33.4 14.8
FOUNDATION
CLEANOUT 21.0 2.4
CLEANOUT 53.7 34.O
CLEANOUT 72 . 7 62.9
S.T.C.O. 99.0 92.0
S.T.C.O. 108.1 102.1
CLEANOUT 109.2 103.6
CLEANOUT 112.8 107.6
CLEANOUT 173.0 169.0
MONITORING
STANDPIRE 165.2 164.5
,? 0
Tom Fink,
Mayor
Municipality Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
March 9, 1988
Mr. Stan Brust, P.E.
Brust and Associates
16].0 Dimond Drive
Anchorage, Alaska 99507
Subject: As-built for T12N R3W Section 33 Lot 114
Dear Mr. Brust:
We recently obtained your final inspection report on the above
property from the owner, Mr. Gary Drahosh. However, we did not
receive the attachment as noted under the "Remarks" section.
Please forward a copy of the "location dimensions".
In addition, we request that you provide us with a drawing
depicting elevations on the system from the house to the septic
~ank outfall. It is most unclear as to grade on this line as
it appears to be installed on a rather substantJ_al slope.
Finally, the inspection drawing must include swing ties to at
least two points.
Please remember in the future to send inspection reports directly
to the department within ten (10) days of the final inspection.
This will help eliminate confusion and loss of records.
If there are any further questions, please Oall this office
at 343-4744.
Sincerely,
Susan E. Oswalt
On-site Services
SEO/ljw#6
Anchorage
P.O. B~.,, 196650
ANCHORAGE, ALASKA 99519-6650
(907) 343-4200
r~R~Y~kq~ Tom Fink
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 12, 1988
Gary A. Drahosh
2721 Porcupine Trail
Anchorage, Alaska 99516
Subject: T12N R3W Section 33 Lot 114
Permit #870243, Tax #018-252-26 ~/ ' S-~.
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1987.
Permits are issued on a calendar year basis by authority of
Municipal Ordinance. A new permit must be obtained from this
Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of the on-site
sewer system, the original as2built inspection report (three-part
form) must be sent to this office for review and approval, and
for documentation.
Effective January 1, 1988/ a new fee schedule is in effect.
When re-applying for a new permit, the new fees are; $90.00 for
an on-site sewer permit; $50.00 for a well permit; $140.00 for
a combined sewer and well permit.
If there are any further questions, please call this office at
343-4744.
~ly, r ~/~
Program Manager
On-site Services
RWR/ljw
eric: Copy of Permit
!~< ¥PT~ C.o.
CHECKED
BRUST 8~ ASSOCIATES
ENGINEERS-PLANNERS - suRVEYoRI
1610 DIMOND DRIVE ANCHORAGE
ALASKA
907)5~27678 ,, 9~gLsq~
ANCHORAGE WATER & WASTEWATER UTILITY
Engineering & Planning Division
401 W. International Airport Road
Anchorag e, Alaska 99518-1104
Tony Knowles,
Mayor August 10, 1987
Owned by tile
Municipality of Anchorage
Stan Brust
Brust & Associates
1610 Dimond Drive
Anchorage, AK 99507
RE: LOT 114, RABBIT CREEK SMALL TRACT
SANITARY SEWER SERVICE
Dear Mr. Brust:
The purpose of this letter is to con'firm our telephone
conversation of August 4, 1987. In 1982, the Anchorage Municipal
Assembly approved an ordinance called Hillside Wastewater Manage-
ment Plan. within this plan, boundaries are defined establishing
areas for public sewerage and private systems. The above
referenced lot is outside of AWWU's service area and within the
Hillside Wastewater Management area to have private sewer.
I recommend you contact the Municipal Health and Human Services
Department at 825 "L" Street for requirement of on-site septic
systems.
Sincerely,
R. WAYNE BENNETT
Private Development Supervisor
Engineering & Planning Division
Anchorage Water & Wastewater Utility
RWB/dw
[wpe.wp.privatedev]19
] :I~-~"F.~:.,.~. CD ~T-~ ~_] ~)(~ I ~--ES --. SOILS LOG
ENL~INEERS PLANNERS - SURVE._,RS
1610 DIMOND DRIVE
ANCHORAGE, ALASKA 9x~507 ~ PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9-
SOILS LOG - PERCOLATION TEST
SLOPE SITE PLAN
10-
11
12
13
14
15
16
17
18
19-
20-
ENCOUNTERED?
Gross Net De p~_~t~,~,~_~ , Net
Reading Date Time Time
....
.... ~.-.~
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND -- FT
F- ~-- f ,'~, ,~- l, ' , /4~ ~.7~ 77., ,.. , /., ~ ~'-l/~.'
PERFORMED BY:
CERTIFIED BY:
72 008 (G/79)
7-7?
~-~GINEERS - PLANNERS - SURV~ ORS
1610 DIMOND DRIVE
ANCHORAGE, ALASKA 99507
[~/-SOl LS LOG
[] PERCOLATION
TEST
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
SLOPE
IF YES, ATWHAT :/~Z /¢I¢ P
E
DEPTN? ¢,//0 //£
DATE PERFORMED:
SITE PLAN
Gross Net Depth to Net
Reading Date
Time Time W ~,~' Drop
PERCOLATION RATE
{minutes/inch}
TEST RUN BETWEEN FT AND FT
72-008 (6179)
~ELL LOG
Date Drilled: 9-26-87
Static Water Level
feet
Gallons Per Minute ' 15
Draw Down N/A feet
Total Feet of Casing 147
T_ype Material Drilled:
0 feet to 8 Gravel
8 feet to 25 Sandy
25 feet to 38 Cemented clay w/rock
feet to _R_O_J~I ay
40 feet
4L-JSe-~t
120 feet
to~ w/lgpm
to 120 Cemented clay ~/sandy.streaks
to 145 clay
145 feet to 147 Gravel w/water
to
HEFTY DRILLING
3540 AKULA DRIVE
ANCHORAGE, AK 99516
(907) 345-0593
RECEIVED
Municipality of Anchorage
Development Services Department
Building Safety Divlslon
On-Site Water & Wastewater Program'
4700 South Bragaw SL
P.O. Box 196650 A~chorage, AK 99519--665(3
www.cl.anchorage.ak.us
(907) 343-7904
-CERTIFI'CA E OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING' "
Parcel I.D. 018-252-37
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Expiration Date: _~ . ~ tT/L'~) !
T12N, R3W, SECTION33; LOT 114A,
14711
LAKE OTIS PARKWAY * ANCHORAGE, AK' 99516
Current Property owner(s)
Mailing address
Lending agency
ALONZO LYFORD
Day phone · 250-2635
Day phone ' . ....
Mailing address
Real EstataAgent
LEANNE COATES w,/ PRUDENTIAL JACK WHITE Day phone ' 227--3773
Mailing address
3201 'C" STREET SUITE 200 * ANCHORAGE, AK 99503.
Unless otherwise requested, HAA will be held by DSD forplckup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-slta
Individual Holding tank
Community On-site
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 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) for properties served by a single family on-site wasteWatar 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 properties served by a pdvata or Class C well and may
be reissued with new water sample results less than 30 days eld. (Certificates may be reissued for a period of
up to one year with valid water samples.) Ce~ficates ere 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.
4. STATEMENT OF INSPECTION BY ENGINEER *
As cerb'fied by'my sea/affixed hereto and as o~ the velidab'on date shown below, I vedfy that my
Investigation, based on procedums~outlined In the Health Authod~y Approval Guidelines for this application,
shows that the on-site water supp¥ and/or wsstewater disposal system Is(am) safe, functional and ad. equate
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/gat/on and Inspection, the
on-site water supply and/or wastawater disposal system Is(am) In compliance with all applicable Municipal
Name'ofFIrm ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, surrE 2B * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. (;ARNESS, -P.E.
Phone 357-~179
Engineer's Comments: - '
· · · In conducting ~hls evelualion~ AWWC, Inc. attempted to pmvfde a thorough, .'.
conscientious engineering analysis of the ~ystem In acoo/dance ~gl ADEC and MOA
DSD Guidelines & Regulations. The reported results desonT~d the performance of the
system under the conditions encountered at the time of the test, and separalion
distances measured to resdl~y Identifiable features. The operelional life of all wells and
septic systems depend on the Iocal sotls condition, greundwatsr levels that may .
fluctuate dudng the year, and the v, at~' usage of the faml~, being served by the system.
These condigons are Outs/de the contrg of the eve]uae'of the system. Salisfactozy test
results do not guarantee future pedormanee of the system, nor do they guarantee that
there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide
any warranty or future eslimate of how long the system wlil conlinue to ment the
operattonal requfrements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the ov~er listed above. Any reliance upon or use of this repc~t by any
other person or pan'y ls not authodzed, nor wt~l lt confer any legal flght whatsoever.
5. DSD SIGNATURE
[,"'/ Approved for ~ bedrooms.
Disapproved.
Conditional approval for ~
bedrooms, with the tilowtng stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manltenance Agreements
Supplemental Engineer's Reort
Other
OriCn Cern,ere Oete: 5z - o /
Municipality of Anchorage
Development Services Department
' Building Safety Dl~slon
On-~lte Water & Wastewater program
4700 Soultt Bmgaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
wwv,ci.anctm:~age,ak.us
(gO7) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescril~lon: T12N, RSW, SECTION 3,5; LOT 114A, ParcellO: 018-252-57
WELL DATA
Wall type P~^~E IfA, B, or C provide PWSID~ N/A Wall I. J3g (Y/N) YES
Data completed 9/26/87 Sanitary seal (Y/N) YES Wime properly pmtactad (Y/N) YES
Total depth 147 lt. Cased to 147 lt. Casing height (above ground) 12"+ in.
FROM WELL LOG AT INSPECTION
Data of test 9/26/87 5/5/01
Stafic water level UNKNOWN lt. 117' ff.
,5.68 g.p,m.
Wall production 15 g.p.m.
WATER SAMPLE RESULTS:
Ce
Coliform ~ colonies/100 mi.
Data of sample: 5/`5/ot
SEPTIC/HOLDING TANK DATA
Ntimte _~:_~ mg.lL.
Collected by:
Other bacteria.._~colonies/100 mi.
AWWC, INC.
Tank Type/Mataflal
Tank size 1500, gal.
Foundation cleanout (Y/N) YES
Data of pumping 5/3/01
ABSORPTION FIELD DATA
Data installed ~/~5/e8
Length 64 fl.
STEEL
Number of Compartments 2 .
Depression over tank (Y/N) NO
Pumper
Soil rating (g.p.dJlt~o~--~) 125
Width 5 It.
Data installed 1 / 16/88
Cteanouta (Y/N) YES
High watar alarm (Y/N) N/A
NORTHLAND PUMPING
Total depth 7.0 ff. Eft. 8psoq3fion ama 500 fl~ Monitoring ~be YES
Data of adequacy test 5/3/01 Results (Pass/Fail) PASS
Fluiddepthlnabeorptionfleldbefomtast 17 in. Wateradded 629 gal.
Elapsed Time: 18 min. Final fluid depthlS.25in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
System type TRENCH
Gravel below pipe 2.5 lt.
Depression over field NO
For 4 bedrooms
New depth 19 in.
600 + g.p.d.
NONE KNOWN If yes, give date -
D. UFT STATION
Date installed Size in gallons ~ _
'Pump ~ High water alarm level at __ in.
~ Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WI~LL ON LOT TO:
Septic tenk/li~ station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 2.5' +
On adjacent lots. 100'+
On adjacent lots. 100'+
Public sewer manhole/deanout
Holding tank N//A
N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5' + Property line 5' +
Water main 10' + Water sewice line. 10' +
Wells on adjacent lots. 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation. <.4'+
Water service line I o'+ Surface water 1 oo'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
Absorption field
Surface water
5'+
100'+
Water main 10'+
.Driveway, parldngNehicie storage
FROM C/O TO SHOP BUILDINGJ
G. ENGINEER'S CERTIFICATION
I cerJEy that I have determined through field inspections end
rm4ew of Municipal records that the above systems em in
conformance wfth MOA HAA guidelines in effect on this date.
Engineer's Printed/Name
JEFFREY A. GARNESS
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12.m0)
Waiver Fee $
Date of Payment
Receipt Number
T-T09 P.02/09 F-992
ClEat PO~t
Printed Date/Time 05/16/2001 9:11
ColEcted Dale/Time 05103/2001 9:38
Received Date/Tlme 05/04/2001 8:42
Technical Director Stephen C.~Ede
Rclea~'d B ~'~
Allowable P~p Anal}sis
Limits Dale Dam Init
Hiuntc-N
0.$00 U 0.500 mg/L EPA 300.0 {<10) 05/04/01
SCL
~crob~olo~ LaBor&~oz7
Total Coliform 0
0 col/lOOmL SMI89222B
05/04/01 KAP
ALASKA WATER ~' WASTEWATER
CONSULTANTS INC
FACSIMILE TRANSMITTAL
DATE:
MAY 2 4
NUMBER OF PAGES:
(INCLUDING COVER)
. 6
Alaska Water hnd Wastewater Consultants, Inc.
Jeffrey A. Garness, P.E., M.S.
COMMENTS:
T~ .c~ar,'gi~ di~r~e., &_~4~o~ Cat. ~r~~
6901 Debarr Road, Suite 2-B * Anchorage, AK 99504
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 ~t
'1,
GENERAL INFORMATION
Complete legal description
/.o'F IIq A SEC 33 TI~.~I, ~3k/
Location (site address or directions) I ur]Il
Property owner
Mailing address
Lending agency
Mailing address
GARY ~RAHoSH Day phone ,3~5-
Agent '~aNt4E Hu~Te~, CE~fTu~Y ~1 ~C. N8ffff~ Day phone
Address fl~O ~n R~,; ~nc~r~; ~ ~¢~1~'
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~ ~
TYPE OF WATER SUPPLY:
NOTE:
Individual well /
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system. .
TYPE OF WASTEWA'rER DISPOSAL:
· ; Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm F/-,~TToP T£cH s~/c5 Phone_3q, g'- 13,~,~-
Address IH530
Engineer's signature "-~~ '~.
DHHS SIGNATURE
Approved for
Disapproved.
Date
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By:
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their fending 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.
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L eT ItU,4, SE(:: 3~, ~'IzN, ~$k/ Parcel I.D.
A. WELL DATA
Well type PRIW~T~'
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter.
Date completed
Cased to [ ~'/~
ADEC water system number
~/2~//~'7 Driller I~EFT¥
Casing height
Wires properly protected (Y/N) ~
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
g.p.m,
AT INSPECTION
MUNICIPALITY OF ANCHORAGE
ENV~ONMENTAL SERVICES DIVISION
g.p.m.
RECEIVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 1 2. t4
Absorption field on lot ~ IqO
Public sewer main '~ /oO
Sewer service line ~ ~5 ~
; On adjacent lots IO~
; On adjacent lots '~ /o3
Public sewer manhole/cleanout ~./oo
Petroleum tank t4e~4 ~ ~5/;~'Z~ b
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
~. ~', ! m, ~'/.~ Other bacteria
Collected by: FLATTOP
B. SEPTIC/HOLDING TANK DATA
Date installed l[! IGI 8~
Cleanouts (Y/N) _ '¥'
High water alarm (Y/N)
Date of pumping
Tank size I Soo Cfi L, __ Compartments '2,
Foundation cleanout (Y/N) ~' Depression (Y/N)
Alarm tested (Y/N) ~ ./~ .
Pumper
SEPARA¥1ON DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I 2 ~
To property line ~1o
Surface water/drainage
O0 adjacent lots ~ leo' Foundation c~2.
Absorption field (~,* i.~?. ,'~?,Watermain/serviceline ~ 12o
~./oD '
72-026 (Rev 7/9t) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length ~ q ' Width
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
Soil rating ]2,5'
,,
Gravel thickness 30 Total depth
Cleanouts present (Y/N)
Date of adequacy test
for
No~4E K~,lo~l oF If yes, give date. N./~.
System type ,5 ~/~bE b~,4/NF/ELD
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot Iqo On adjacent lots > ICc'
To building foundation Io8
f
Propertyline_l~' ?~¢ I~$P, ~'p.
On adjacent lots :> 2o ~
Surface water :> Ioo
Curtain drain
To existing or abandoned system on lot
Cutbank 14.~, -Water main/serviceline '~' //o '
Driveway, parking/vehicle storage area I lo '
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Engineer's Name
HAA Fees _/~:7~ ¢O
Date of Payment ~¢ ~/¢~ ~¢-~'
Receipt Number ,~,~),,~-~
72-026 (Rev 3/91) 8ack MOA 21
Waiver Fee: $
.. Date of Payment
~'~/~) Receipt Number
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING& ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
ChOh~lab kof.'i 92.~89! 2a~,pil, ~ 3 1,i'Zr:tx
FAX: (907) 561-5301
])t'L/'t/f0P .~rZllff C,, 1, 2PJI
Member O' the SGS Group (Soci~t~ G(}n(}rale de Surveillance)