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Home My WebLink AboutLILAC PARK BLK 1 LT 6Lilac Park Block 1 Lot 6 #015-211-21 Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage. Alaska 99519-6650 Telephone: ,545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number:. SW000450 PID Number:. 015--211--21 Name:RICHARD AND JUDY ANSHCHU~.IZ WastewaterSystem: I-I New' · Upgrade 12150 ULAC DRIVE ANCHORAGE, AK 99516 ABSORPTION FIELD Ph°ne:(907) 345--9089 4 · Deep Trench f-i Shallow Trench r-i Red [] Mound 13 Other LEGAL DESCRIPTION '~ "~ 0.6 ~/~ RI ,~ o.~~, ,~ 8.2-9.0 6 1 LILAC 2.2-5.0 rc 6.0 - - - 0.5-1.5 rc (2 WELL:D New [] Upgrade 5 ~ 2 ... r~ p~ 1008 so. n. ASTM D-3034/F-810 .. EAGLE MTN, EXC. 11/10/2000 SEPARATION DISTANC ES o S.pUa [].o~,, Well 100'+ 100'+ -- -- 25'+ ~ N~,,,b~ ,~ ~ Surface - - - LIFT STATION 100'+ 100'+ Water Une 5'+ 10'+ -- -- -- 5'+ 10'+ - -- - "P""P ~"' ~ o~ -l~-~ ~ ~ .d~m Foundation Curta;n ~.,..~_.,~,~e~ rr~.u~ ~ ~ ~ Drain N~NE KNOW; ~emor~: BENCH MARK TOP OF DECK NEAR POINT I~'~ ~ 112.54 ~/,,,x... ; '.-~--, '..'r'y~ Department of Health and Human Services,approval q~ o.... .. by.~Date: //.~6.O<'"' "-- ~;,e,. ~,=~-- · ........... R~vtewed and approved '""" """"": AS-BUILT DRAWING SW000450 015-211-21 A B C FCO 8.50 18.30 ST1 16.80 23.30 -- ST2 26.80 31.40 -- DBL1 30,90 34,10 - D~NF1B.~S DBL2 32.00 34.40 -- FD 32.60 .34.30 - co, I~,~ I // C01 124.95 - 138.82 I I1~1~ ill, miI MT1 124.44 -- 139.15 I CO5 136.45 - 142.39 I MT2 157.59 - 142.94 I C04 142.65 - 170.34 · ...... MT3 142 61 - 170 66 pco~ .~ r O~RTr~ fro) C05 150.89 -- 171.25 ,,,,,; ~-..,,.,j~,~ .~c MT4 149.55 - 169.67 X.,.,,,,._,// / x. \ ~- '" 7;.:?.:"; ¢""' ~ "" % k / 1.'..?.,:1 --'"-\/ AI~S~ B~TER & 5~STE~TER ~ ,' ~ D~R~N: ~j ',. (:i --7953 ,, .~ "...~ ....' ~-~ LInC PARK SUBDIVISION; LOT 6, BLOCK 1 AS-BUILT OF SEPTI~ SYSTEM UPGRADE '~""' "~""-: ASL ,BUILT DRAWING SW000450 015-21 - ~.~ (AV~ 11/29/2000 CONSULTANT~, .o, ~.~ ~..~.. ~.~. ~.~. ~ ~,,,.~,,..~ ~.,,,,,-,,,. ..~.s. ~P':"'~ .............. JUDY ANSHCHUETZ (907) 345-90~9 2 OF ~ LInC PARK SUBDIVISION; LOT 6, BLOCK 1, ~ o~ ~o.~ ~o~,,,~o~ PROFIL~ AS-BUILT DRAWING O~ SEPTIC SYSTE~ UPGRAD~ 11-1o-o6 MUNICIPALITY OF ANCHORAGE Department of Health end Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 23, 2000 Expiration Date: Oct 23, 2001 Permit Number: SW000450 Legal Description: LILAC PARK BLK 1 LT 6 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Judy Anshshuetz Owner Address: 12130 Lilac Dr. Total Bedrooms: 4 Anchorage, AK 99516- Parcel ID: 015-211-21 Site Address: 012130 LILAC DR Lot Size: 90870 SQ. FT. Permit Bedrooms: 4 This permit is for the consh-uction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ), 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: CONSULTANTS, INC, I October 12, 2000 Municipality of Anchorage Department ofHealth & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref.' Well and Septic Design for Lilac Park Subdivision; Lot 6, Block I To whom it may concern: The existing 4 bedroom house is currently served by a private well and septic system. The existing drainfields are in a state of failure and in need of an upgrade. One test hole was excavated on the property. The proposed septic system will be designed within the 30 foot radius of this test hole. We are proposing the installation of a dual deep trench type drainfield. We will use the existing 1250 gallon septic tank. Comments regarding the proposed design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 0.6 gallons/day/ft2 should be used. 2. TRENCtl DESIGN: a. Percolation Rate: 7.5 minutes/inch b. Allowable application rate: 0.8 gal./day/ft2. Visually appeared to be 0.6 gal./day/ft2 c. NumberofBedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 1000 ft2 f. Total Depth: 9 feet (max.) g. Effective Depth: 6 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 84 feet long (2 ~ 42 feet each) k. Effective absorption area = 1008 ft~ 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akxvwc.com 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average topography of this property is a 13 to 21 percent running from approximately southeast to northwest; in short, there are no slope concerns. The trench is to be installed parallel to slope contours. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179. Thank you for your assistance. Jeffre .¥ l[tlam';23'~, P.E., M.S. Presk :n! ~ NOTE: ,~ttached is a site plan drawing, a design drawing, a topography site plan, one soil log, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwxvc.com / \ \ TAUS~S/D / ~ -../ ~ \ T~us WmT S/D ~ LOT e, e~ 2. / ~ /~'~ '~ TALUS DRIVE ~ ~'"~ ~ / ~ ..... X ...... ,', ~ ~T4,BK 2. ~ /'/ i /'//~ % ~ ~ ./// ,¢' ~ -,..__....- ...... ~ .......... M Y z ~ ......... ::~ : ..... : ........... ~ ~ ~PROPOSm X X // ~/~%-" ",% ~ ~~ ~.~-~-2' /// ,,'-'~ '/~, .-' ~ 10/i 2/2000 D~WN ~: ~ONSULTANTS. m~. ,. .,o. ~--~, ~.. ~.~,. ~ .,~- ~ ~o,~,,~.,,. ,~ ~,om,.4,,, 1"=100' PR~ ~R P~NE NUMBS: P~E NUMBS: JUDY ANSHCHU~Z (907) 345-9089 1 OF 2 U~C PARK S/D; LOT 6, BK 1, ~E OF WOR~: SITE P~N FOR DESIGN OF SEPTIC UPGRADE CL~, WASHED SEWER DRNNROCIC INSTAJ.~ TR~NCHF. S pARALLLrL TO SLOPE CONTOURS. ~ ·" ._____ x K.D.W. ALASKA WATER & WASTE~%~.TER co.suL'r^.TS.,.o. "~':t~D~"-i .......... ..~..,,,o.o.: ..o.~.~,,,,,~ "~"~""~": , .'-':f~.'~:'.~"'2 ....... :'"': JUDY ANSHCHUETZ (907) ~45-9089 2 OF 2 UL*C PA.K SUBDIViSiON= LOT S..~OCK ~ ..'""~ ~.~ o~ .o.~ DESIGN OF SEPTIC SYSTEM UPGRADE ALASKA WATER & WASTEWATER CONSULTANTS, INC. ,~' 6901 OEBA~R ROAD. SUITE 28 · ANCHORAGE. AK. 99504 ~,(~ , .]~.o.j~,[lj ~ ~t [SOIL LO0 - PERCOLATION TEST] ~/ 4~1I~/~ ~.~ ~..t.=..fN~.y~ ........... LEGAL DESCRIPTION: ULAC PARK SUBDMSlON; LOT 6, BLOCK 1 PERFORMED FOR: ,UDY ANSHCHU~,, ,.L~. ~.k .... I ........... DATE PE.FORMEO: 10/2/2000 I,. ~]~{{-?~a ...' [ I ....... TEST HOLE # 1 ,~,~._~,~o....,..~ ~EP~ ~ feet) OR~ICS I I AT N GC OL sw .H / SH OH SC DEPTH TO 3ROUNDWATER DATE SM/GM ~NS~ D~ 10/2/00 ~ [[[[[[ D~ 10/10/00 / // 11 DATE RE.lNG CLOCK NET TINE WATER LEVEL NET DROP TINE (MIN~ES) RE. lNG (INCHES) 12 10/5/00 PERC. HO~ W~ PRESO~ED 4+ HOURS PRIOR TO 1~ I 2:51 -- 6' 2 5:21 30 I 1/4' 4 ~/4' 14 5 5:21 ~ 6" 4 ~:51 50 2' 4' 15 5 5:51 ~ 6' 16 6 4:21 50 2' 4' 17 18 19 PERCO~TION ~TE 7.5 ,(H~N./INCH) PERC. HOLE DIA, 6 (iNCHES) 20 TEST R~ BETWEEN 6.5 FT, ~D. 7.0 FT. COHHENTS: SOl!_ ~SU~LY ~P~RED TO BE A 0,6 GPD/~= PERFORMED BY A~ WATER · W~ATER, I, JEFFR~ A. GARNESS, CERTI~ T~T W~ PERFORMED IN ACCORDANCE WffH ~ ~ATE ~D UUNIClP~ GUIDEUNES IN EF~ ON DATD DEPTH TO ~ROUNDWATER DATE DRY 10/2/00 DRY 10/10/00 w~r s/o LOT ~, BK 2, TALUS WEST LOT 6. BK L s W~T S/O r 4, BK 2, LOT 7, ULAC LOT PARK 2 / / Municipality of Anchorage Page / of 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 P'ermit Number: '.~ D,2.1J PID Number: ~:)~.~ '- ~L.I --I.2,I Name: A,N, Sr..-14¢ ~Tz. ~.tC~-¥/4,~_~ Wastewater System: [] New [] Upgrade Address:[~,.~."~O [..--[~.--,~C '~-_,~,V'~- ABSOFiPTION FIELD Phone: No. of Bqrooms: [] Deep Trench [] Shallow Trench [] Bed [] Mound [] Other L E G A L D E S C R I P TI 0 N Soil Rating: Total Depth from original grade: GPD/Sq. Ft. Lot: Block: Subdivision: Derh to pipe boltom Item original grade: Gravel depth beneath pipe Township: Range: I Section: Fill added above original grade Gravel length: FI. Ft. WELL: [] New [] Upgrade Gmvetw,dtb Number of hnes: D,slancebetweealines: FI. Ft. Classitication (Privale. A.B.C): Tolal Deplh: Cased To Tolal absorption area. P~pe mater~al' Ft. FI. SQ. Ft. Driller: Date Drilled: Stalic Water Level: Installer: Date in tal d: Yield: Pump Set at: Ft. Casing Helghl Above Ground: ~PM Ft. TANK SEPARATION DISTANCES ~(Septic [] Holding [] S.T,E.P. TO Septic Absorption Lill Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Stabon Tank Sewer Lines A~,t.--I~JlL ~'-~'~'~ J~ I ~ ~ ~ Well N//~,. Material: .~ ~_~.~ Number of Compartments: Surface Water l~'//'~.~t LIFT STATION Lot Size in gallons: Manufacturer: Line ~'~) ~ Foundation ~ ,~ "Pump on" level at: "Pump off" level at: High water alarm at: Curtain 1'~/. Pomp Make & Model Electrical Inspections performed by: Drain Remarks: BENCH MARK E ~,,~ L',,¢, ~..~ ~¢ l~. ~..~. Location and Description: J Assumed Elevation: ENGINEER'S SEAL , Inspections performed by: '"~-['~,,__C_~ Dates: 1st. '~/u/ *V !,, 7 Department o[ Health fmJl Humal~er¥ices approval ~,,~ ' R, eviewed and approved by: / ~ Date: 72-013 (Rev. 9/9t) MOA 25 ELEV. ~.5-~ ~37~ ~ 1250 GAL ANCHORAGE TANK \ \ EXI$7'IN5 $:£TUBE \ TOBBEN SPURKLAND P.E, II II 205 W 15TH. AVENUE ANCH, AK. 99501 2907'1 Z79-~916 LOT 6 BLOCK 1 LILAC PARK S/D R/CHARD AND JUDY ANSCHUETZ 12150 LILAC DMVE J J SEPTIC SYSTEM ASBUILT DATE: AUGUST 27, 1994 SHEET: 1/1 GRID: 2736 PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE NASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940211 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:ANSCHUETZ RICHARD A & JUDY A O~NER ADDRESS:12130 LILAC DR ANCHORAGE, AK PARCEL ID:01521121 1 OF DATE ISSUED: 6/28/94 EXPIRATION DATE: 6/28/95 LEGAL DESCRIPTION: LILAC PARK BLK 1 LT 6 LOT SIZE: 90870 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: 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 (18AAC80). 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 PROVISIONS RECEIVED By: ~..~/.~.~?~ DATE: DATE: N \ \ P£EIPZTSEz9 APgITILTN \ EXIS?IIV6 SxT~C?U£E 125 15~ TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE ANCH. AK, 99501 (9o7/ 279-3~1§ LOT 6 BLOCK 1 LILAC PARK S/D N/CHARD AND JUDY ANSCNUETZ 12130 L/LAC D£1VE SEPTIC SYSTEM DESIGN DATE: JUNE 22, 1994 SHEET: I/1 GRID: 2736 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AN[) HUMAN SERVICES Environmental Health Division 0/-'4'- - ~ / ,/ - ~- / 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name /¢/¢~']'¢1~7~ / ~__./t,4/'~,~1 ~_/¢/~/~ DISTANCES Address ~0 SEPTIC ABSORPTION ~ ~x ~-~¢? ~. ~ ¢~? ~ 'r~,~~L, WELL Phone(s)__ -- -- J Permit No, No. ofBeams WELL Lot ~p ~ Bl°ck / Subdivisi°n~/~ ~ FOUNDATiO. /~,~' / '~ ~J ~ ~ AS-"UILT DJAG.AM (Show ,.caUon of well, septic system, property I,nes. ,oundatior Manufacturer Capacily in gallons TYPE OF SYSTEM - / ¢ ,T --Total absorption area G~/ S~ F~ Dislance between lines Ins[aller . & ~ ~--~ Date _ WELLS ~PRIVATE ~ OTHER ddentifv) -- Inspections Pedo~ed ~).~ Municipal and State guidelines in ellect on this [late: _ ?~ Health Depa.ment Approval: ~~ /¢ 72-013 (3/85) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ Geophysi¢olSurveys Orilling Permll No. LOCATION OF WELL (Please complete either Io, lb or lc.) = / ! y..i' ~ /;., /: , EL~ Merldien ,. --of--et__of __ sE] wE] I~./ DISTANCE ANO DIRECTION FROM ROAO INTERSECTIONS ~. OWNER OF WELL: WELL LOG Feet Below Surface 4. WELL DEPTH: (f hal) 5. DATE OF COM~LET ON , ¢' I , ,, ,¢ =.c 6, ~Coble tool /7 ,,' - ~ .': "' , ,:~. ..... / .¢ 7. USE: ~'Domeotlc ~ Public Supply ~ Industry , ,, , :; :~t~'~-'" ~.:'~:~ :' . ~¢ / ~ ~ Te~f Well ~ Other: ........ , /"¢- "~ ~ ~ ~<~: b / 8, CASIHG: ~ Threaded ~ Welded ~ "} /J' 9. FINISH OF WELL; Backfilling Gravel pack _. 10, STATIC WATER LEVEL;. / .+-: "'~ ~ Above or ~ Below land surface Oate / / } Equipment used: r'~ , t I~. PUMPING LEVEL below land surface end YIELD ~. ~-, . " ~;~,~.+ fi, oTter ~ hrs, pumping. ~ - g,p.m, ft. otter hrs. pumping g.p,m. 0 Subm, El ~,t ~ Cenlrifical ~ Other 14, REMARKS: 15. Water TemperaTure ~o ~ F ~ C ~,- ..... ~ v ~ .t.~ ~..,f k..~/U /:., ~, .... ¢ E~gistered Bus(ness N~e Signed: .'~4%.- ' '"' t' , ' - ' :" AuthoriZed Represenlotive D~par'~m~er'vL oF I'.~e:,a].t. ln ~ Human 1... ~:~ t' r' ~.:.~t:. ~ Ar'~ c: ho r ag ~:.~, A ]. a~H.:: a 99501 ..::,zh::,..-.~O OIq"~"S:[TI~: E~ENEIR ~ SEF'T]:C "I"ANI.( ~ NELL F'I~:F~M :I: ']' L,. o t. I.,~ [.~)(: ~ ]. ~ c' . -. . ,;:~ .. b I . v :~. ~ ~. on ~, L. :t:I....(~C F"AI:~I<: Lot. :: E~ B 1 oc: k, :1. I"lax B~-~:,dr. oom~:~ 7'hi~ F'~.~r'mi't'..:~ 4. 'l"ot.a~ Capac:i.t.y~ 4 . , ,: .... ~h'~ I :l. or'Hs ,, I~:ac:l'"~ ~:.:.~I::)'L i c: 'Lar'll.:: rm..t¢~'f hav(e al'. ].e)a,:~vL ;~{ ~: )mF)aPt:.m(:.)n'(si,, Depth 'Lo tOD (::)F [5(.~[:)'L:i.c: t. artk(s~) .::: z[,,O 14E]..I,.,.I~ Log mu.~'L be: ~ul:)rr~it'Led t',.o IVlLu'~J. cipali,Ly of' ~-~ncl-tor'ag~.~ D~z,)par'.l:,me)rl'L oF He)a].'Lh an d Fh4mar'l S(~.:, r v i c: ~!i~ w :i, 'L h J, r'l :~() (::1 ay!ill o -f w(.~:,~ ]. ]. c:omp 1 lsd:. :i, or'l ,, ]: IxI~J~'T'F~I....L F:'ER I~:lq(3 Z BIE:[~RS DE[El ]: [{)lxt (~ ~ ]: DEEDR~ Z N TVF'E ~)3C~(]R[::'T N :1: 't"H A :1. 250 !3[EF:"F I C 'T(~NI.(. 'l'Tq~]qC:l-I LE~Iqi3'T'H ~ i3~ ' ( 2 ..... Zl.:? ' I"'II]UIqD OVER N:I:"['I,..I SC):I:I 'TH]:S I:::'E]:;Rlfl:[T :IS F:'DI::I h 13 ]: NI:]L.E t:::'~MZI....Y ONL, Y RI',ID I~[:XF:':[I::IliE~ :I. 2/:5:t/13D,, F'HC)NIE DI.,.IHS F'I:IZOF~ "1"O (~L.L.. II',ISI:::'E~CT:I:DIqS,, C I:!~:R'T :1: F:' Y "I'HAT' ~ ]: ar:till {am:i.].~.ar'. w:i.'Lh '~.l"i~ r'~'.;-)qL~J.r'(.)~)m~:~r~'L[~ .For'. on.-..~s:i.'Lu) ~caw[.)p~ an(::l Fo]"'Lh bV 'l:.h(~.:, HL~rt~c::i. pa].j.'Ly oF (.~r'il::l-lc:)l~at~(e~ (M[)F.~) and th~:, ~J'La'L~:.~, :5,, :1: w:i.:l.:l adh~.':.H"~] t.o a].:l. M[](.~ anct ~H'..a'l:..e) o/ A:l.a~il<a r,[.:.)(:lL~ip~)m~:.:~n.L~~ For' 'Lb(.;.) ~s~.:;.~t.. I:::,ac:l.:: zl',, :[ LU"ll:Jer'~i~'~:.a~l"id 'Lha'L 'Lh:i,~ t::~;~mmit. :i,~ va].~d For ~ rnax:[l[iLu~ ar'ly ~)l'l].ar'g~.~m(.~-rl:. w~.]:[ PI~::~['~:[I'~¢.:) afl ~u:h:lJ.t. iot'';, D¢~.:,n~n:it~'.,, D~T'F'" ...... ......................................................... ., . .... ALASKA ENVIRONMENTAL CONTROl. SERVICES, INC, 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561.-5040 SCALE C~ H~ H~ O~ 70 ~ r O< ~q 03r' C.<~ ,> . ~0 X < 0 0 0 Z 'n · q ~ X D Z 0 < C. REID, JR. - 2251 LEGEND LOT CORNER DRAINAGE A.ROW SPOT ELEVATION SCALE 1" = 50' ,t~= 430.~0' ,'.' I7~00' L /LAC "~ .~ LOT ~, , BLOCK ! L/LAC (P 85 -4fl4 ) 0// PERFORMED FOR: LEGAL DESCRIPTION: · ~, eeee SEAL) SOILS LOG -- PERCOLATION TEST ~, ~'.~)'t~?~.-~-6r~'~,...'/' j Township, Range, Section: ~/~ ~ j~ ¢ ~ ~ 1 2 3 4 5 6 7 8 9, 10 11 12 13 14 15 16, 17 18 19 2O O f~'~.~.~. ,¢_ SLOPE WAS GROUND WATER ENCOUNTERED? SITE PLAN S IF YES, AT WHAT L DEPTH? O P Depth Io Waler After Monitoring? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __.. (minules/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN / FT PERFORMED BY: . ~'' ~-'~r CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~'~//.//~ .~ 72-008 (Rev. 4/85) ' ALASKA I FIUIROFImfflTAL COFITROL SeRUICE!$, Inc. ~n§in~rinq ~ ~nuironm~nlal ~ludics G E,",'I~R AT. The draw:ings, shee[:,s ] thPoug 4, s]m]] be a pm, k oF this sped f'J. c8 kJ. on, ~,l.lnlCipa]Jty cf ABchora~e, Dopartl[!ei!t o~ II~li2b & Iltlmat! SeNvJces, (DIIHS), klm conditions of klm pf~i'BIi[, ~)lli] all appl .i cable -u!es ~md re~ruiutfons c ))'t'~ittly ill ef~ ~cL ~;!evatiolhs ulld depths ep(? adv:lsot, y and uPe Lo be v(~.P[[jod oF the fie_id by a J]flffS approved Jnsp(;etor. IL ~s thc Pe.qpon.';:[bil[i:y o[ the i~;ta]ler [o adhet-e to appPoved dS. stances, and have [l~e appropr:Jake :hmpeck.ions. If the insta]latJ, on is not U~speci:ed by an ),ECS en~J~eer, AECS wJ!] not be responsible fur the fnstul]od t4y~-;kem. An en~ineeP at AECS should bo consult, ed pFiof tie OOllSEl't/ct5ol~, tO d(tgePll!~!le tile tltttltl)oP of inspections will invoJve. o qepq, TC ') 2.5 The existing sepk:ic Lank muy be s,~'d :if :['k meeks ~he capacJ ky roquiPemenks for tho ' - tesJuem.;e and the appPova] of DHTIS, Olde. 2,2 thPough 2.6 apply. The scptio Lank slit<_] be a UPC appPoved i:wo--compartntent tan]:, c~ :stp ~ :ted of i2 gauge stee], with )J [!_!lllasti ] COatJIl~[, SOt on tu diskupbod soil alid insu].a'ked with ovet'Jy:[ ~2 htyel' (F 2 burial type po].ystyrene, 'r]}o sep'kic tank 8ha!] be a nih;mum of:' 5 F,p' (, ,L ?fO]Il the }lOll!se [Ottlld[ttJO!l, and a minimum of 5 feet fl'Olll the abso!'ptioll aPea. The septic Lank und tire, infield shall be a minimum of I00 Cee¢ [rom any private we]] oP body of water., ~50 {lock Cl'Olll C].aS8 C W(~JiS, and 200 feel fi'om (Llass A et' B we]is, unless ether'wise spec:if led. Less khan the r'equiPed sepal'alien distance taus2 have prior 8. ppt'nva] oP waive!, by A]aska Department of Environmenh~l Conservation (ADEC). Piping shal] be fitted with a mechanical watertight ca!dep couplJug of the iule[ and ouLlet oF [he sep~:ic tauk. Piping' .shall be 4 i. nc]i AST~ D3084 or cast .iron, sloped a IllJlsJllllIIII of i/4 JDch pe~' foot £m)m i:he house [:o t:he tank and ~/8 :inch per ['oot: ]"POIIt thc L~H]k ho tiN.) 1200 [Ucsl 33rd ~uenue. $ui1¢ B oAnch0r0q¢, gl0ska 99503"(907) 561-5040 · 3.0 )RAINF!EI,D SYSTEM ° :I w.ith less ti.an 3% passJllg the ~200 s~eve, All subsi:Jtu~es must have p~'ior D]I]IS apppova]. The boLtoln and side of the excavak[on shall be pal<ed w:ith [he l:~,ckho. blade to ensupe that: J.t has not been compactad during excavati, on. The bottom e](¢v[[[:[Oll ~h~t]J. }3~) !OV(?]. 3.3 Monitor standpipe(,~) shall be placed as ,~dmwn in tile dpawJngs, and shall be rlgJd PVC AS'F)~ I)3034, or 4 inch ca~¢ iron. The '..:ecL]on shown wi~h holes may I)e drilled 0.5 inch holes on ~he 6 inoh centeps on opposiLc sides o[ tile pipe, or a p(?gula~: sect:',on e[ perT[ora<ed sewer pips, e].amped ho a solid section, with either a tm .hub coup].in2 opa ~;o]vent joink. A pubbe]' pai]l cup (.Ji[)l/ cap or equ:tvalenl:) sba[1 be placed over 2he top of the pipe. · q.d The dist~'ibutJon pipe shall be 4-inch pigid PVC with a m[nimtun cru,,;h strength of 1500 ihs o].' equa]. Al! distpibutJon pipes shal] be laid i eve i. 3.5 [I~ the fins] grade of the dra:tnF:[(e]d i.'~ les:~ than 4 fee~ above the g-pavel, insulation is requiped using Dow extrudad bJue t~typofoam board op equal. There shall be ] [nob of insulation fop evepy fool of so~l ]ess than the pequired d feet of uovep, but thepe must: be ~t least 18 i. nches oF soil covep even though insulation is used. The solid pipe exteendin~ frOII! the septic tank or' iJft stittJon to Lhe dpainfield shall aJso have 4 fee[ of cover oF all equivaleni_ lay(u' of insu!atJon Lo prevent freezing of tho line. 3.6 If insulation [~a not necessapiz, the gravel sha]] be covered ~,zJ l.h a layer of nonwoven engineeL-Jng fabpic, 4.0 ]NSPECT T ON':; · _~'.37(.(? i~spe(;'t]olh,:; a~'u Pe I lit-ed fop ]]~sl:a!J. attio~ of the ts'erich. The fipst insl)ec:l Jan will he of th~ ~excavation to vet-ig~, that the JusLa]Jat:ion wJ].] be itl the ppopcr :mil. s~ancil,)ipe(s) and dJst~.'Jbut'[on pipe bero:?o l)a.c]c?JZ[j . Izhe g'round MUNICIPALITY OF ANGHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmenta! Sewtces On-Site Services Sec'don P,O, Box 196650 Anchorage, AJaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLIt,,~:;:~ Parcel I.D. # 015-~11-~I 1. GENERAL INFORMATION ~.Y'~'~ Complete legal description LILAC~SUBDIVSIoN: LOT 6. BLOCK 1, Location (site address or directions) 12130 LILAC DRIVE ANCHORAGE. AK 99516 Property owner RICHARD AND JUDY ANSHCHUE'TZ Mailing address 12130 LILAC DRIVE ANCHORAGE. AK Lending agency Mailing address Dayphone (go7) 345-gc)B9 gg51§ Day phone Agent JACKI-~ DANL-DANNER w/ DYNAMIC PROPERTIF~Dayphone Address 3111 C STREET ANCHORAGe. AK 99503 Un/ess otherwise requested, HAA will be held for pickup. 2, NUMBER OF BEDROOMS: 4 (907~ 261-7600 Indivi( Community Public water NOTE: 4. TYPE OF WASTEWATER DI: Individual ~ Holding Tank Public sewer NOTE: If communit) ing to the legality and status of system. State ADEC 72-025 (Rev. I/I)I) Front MOA ~21 Computer Vemion Note: Alaska Water and Wastewater Consultants, In.c.. shall be paid ~ at, or prior to, closing for the engineering services pro.eec;. 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 nvestigat on and inspection the on-site water supply and/or wastewater disposal system is in compliance with all Munici.,dat, and State codes, ordinances, and regulations in effect on the date of this inspection. '~ Name of Firnl ALASKA WA'I'E~ & CA~TEWAT~R CONSULTANTS, INC. Phone (907) 337-6179 Address 6901 DEBAR~ R(~AD. ~J1LE~ 2/B ~NO~ORAGE. ALASKA 99504 · / /~ Engineer's Signature [.~. ~.~',~ ¢~-'~ I Date /~/2.~./c'P ~_¢/~1.. system in accordance with ADEC and MO~. .pRHt~uldellnes & Regulations. The reporled results described the ped~rmance ~f the system under the c~nditi~ns en~untered at the ti~rne ~f the test~ and separati~n distance$ measured to readi~y identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate 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 the system. Satisfactory test results do not guarantee future pedormance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not pro~fde any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will It confer any legal right whateoever. 6. DHHS SIGNATURE ~ Approved for - ' bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments . By: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authodfy 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 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. 1~91) Back MOA f~21 Computer Vers[on 825L Street, Rm 602 Nlchorage, Alaska 99501 (907) Health Authority Approval Checklist Legal A. WELL DATA Well Type PRNATE Log present (Y/N) Total depl~ 1 ULAC SUBDIVISION; LOT 6f BLOCK I f Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number 015-211-~1 Date completed Casedto 170' FROM ~ LOG 8/28/1988 g.p.m. Date of test Staltc water level 1 Well preduc~on 9 WATER SAMPLE RESULTS: Coliform 0 Date of sample: 11/3/2000 B. 8EPTIC/HOLDING TANK DATA Date iostelled 7/11/1994 Tenk eize Foundation deanout (Y/N) Date of Puroplng 9/19/2000 ¢. ABSORPTION FIELD DATA Date Installed 11 / 10/2000 8/28/1988 Casing balght (above ground) Wires properly protected (Y/N) AT INSPECTION 9/1, /2ooo 120' 4..2 Nil]ate 0.500 mq/L Other bacteria 0 Collected by:. A.W.W.C, INC. YI~s 12.50 Number of Compartments 2 Cleanouts (Y/N) Depression (Y/N) NO High water alarm (Y/N) N/A Pumper NORI'H~AND PUMPING Effective absorption area 1008 SQ.FT. Monlterlng Tuba present (Y/N) YES Depression over field (Y/N) Date of adequacy test NEW Results (Pass/Fall) - For 4 g.p.m. YES 'FROM FINAL_ GRADE rafing (i~r fl2/barm) O.6 System type TRm~NCH 2.~' Gravel INdmess below pipe §' Total depth '9,35-10.62 NO Bedrooms Ruld dep~ In absoq~on field bafom test (In.); - Immediately after - Fluid depl~ - (Ins) Minutes letec - Abso~tlon rote =. Peroxide treatment (past 12 months) (Y/N) - . If yes, give date gal. water added (in.): __ D. UF'rSTA O... ,. Date ~.i~ailed ~SIze In gailon~ ~ ManhOle/Access (Y/N) ~/~~t· "Pump off" level at* ..---'~- *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM ~ ON LOT TO: Sepfic/holding tank on lot. 100'+ Absorption field on lot Public sewer main Sewarlsepl]o eervlce ilne 100'+ N/A 25'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property ilne 5'+ Water main/sentf~e ilne 10'+ Stnface water/drainage 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Pmpe~y line 10'+ Building foundafion 10'+ Surface water ' On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cteanout N//A Ut~ etefion 100'+ Absorption field 5'+ Wells on adjacent lots 100'+ · 100'+ Water main/service line 10'+ Driveway, parldng/vehlcle storage area 50'+ Curtain drain. NONE KNOWN Wells on adjacent lots 100'+ I corlJfy that I h~Xe d~e/ml/fe/J/thr~ field inspe~ons and review of Mun/c/pal /O'co~s ~h/~t ~he~fl_bo~ sys~_ . me am in conformance -7953 ... ~- m. o2s (Rev. 3m~)' c~m~x~t~ v.mm Waiver Fee $ Date of Payment Receipt Number Zt~__- CT&E Environmental Servlces Inc. CT&E Ref.# Client Name Project Name/g Client Sample ID Matrix Ordered By PWSID 1006976001 AK Water & Wastewatcr Consultants Inc. Lilac Park L6 Lilac Park L6 Drinking Water Client PO# PHnted Date/Time 11/07/2000 13:56 Collected DatedTIme 11/03/2000 10:20 Received Date/Time 11/03/2000 10:40 Technical Director Stephen C. Ede Released B~ ~ Sample Remarks: Allowable Pr~p Analysis Parnme~ Resolts PQL Units Method Limits Date Date Init Wa~ers Department Nitrate-N 0.500 U 0.500 mg/L EPA 300.0 10 max 11/03/00 SCL Microbiology Labor&=ory ToulColi~rm 0 col/100mL SMI8 9222B 11/03/00 KAP ParCel-I.D. # ~ENERAL INFORMATION Complete legal description (~12N ~3N ~C 22) MUNICIPALITY OF ANCHORAGE, DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P;O;.Box 196650; Anchoragej:Alaska 99519-6650 343-4744 '., CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING '-:";':- """ ' Location (site address'or directions') t2%3'0' LilAc Drive off HOffman:Road ' ' ' ' ' :Property owner Holt,, ('~__fh~_ '~ ~(~J,~o..' Dayphone(~_07) 345-6874 g address 12130 L±la¢ I)r.,,Anchorage, AK 99516 · Lending agenc~ ' ':-Maiiinq address -;;".',Agent ,' -Address Day phone. otherwise requested, HAA will be;hel'd fS~:piakuP: .2., NUMBER OF BEDROOMS= 4 )F WATER SUPPLY: ..,~,, .... , , Individual well _ .. ... · .?, ' - Community well Public water -NOTE: , -Yk/,h, If Community well system, provider written confirmation from State ADEC attest- ing to the legality and status of system. ,'4..' TYPE OF WAsTEWATER DISPOSAL: ndividual on-site : .... "' Holding tank Community on-site Public sewer If community Wastewater system, provide written 'confirmation from State ADEC attesting to the legality and status of System. "' '. 72.O25 (Rev, l/91) Front MOA#21 STATEMENT OF INSPECTION BY'ENGiNEER' ' ' ' ' As certified by my seal affixed hereto and a'S'of the validation date shown below, I verify that my .:.: investigation of this Health Authority ApprdVal application shows'that th'e on-s te water supp!y and/or wastewater dis posal 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,.... i and. regulations. . in effect on the date//~..:,this inspection,. · Name of Firm EnvJ-rd~'~;a& ..tcjar~a~ement;'LI/in¢, Phone 272-9,336 Address 206:East' F~:~c~ed~2. Su~'Cd;2D'/'l, A~chbrap;~, AK 99503 Engineer's signature //~-'L~r .~,~'~'''-' Date ~-¢'-/-7 ~ 6. DHHS SIGNATURE ,~" Approved for " Disapproved. bedrooms. ;' Conditional approval for bedrooms, ....,..__ ........ ..~ ~.;.,. .... ~,~a. ?. , . -. . · - ...f"... /.. ,... ... i.. ?;'. ; [_% i By _ ~ __ .¢ Date , 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 A aska, The DHHS does th s asa Courtesyto purchasers of homes and:their lending institutions in order to sat sfy Certa n federal and state'requ rements; Emp oYees of DHHSd° ndt i' ic°nduct' inspections or analyze, data befbre a cert fC~te s iSs(~ed: The Municipality of Anchorage is,:n~t resPonSible for errors or omissions in the ProfeSSional engineer's Work,:. .... 72'025 (R~'~1,'91) Back MOA#21 . Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. Well Data Well type Private if A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ¥ Total depth 170 ft. Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 Date completed Aug. 28, 1988 Driller Alpine Drilling and EEt. Casedto 170 ft. Casing height 1 ft. Wires properly protected (Y/N) Y g.p.m. FROM WELL LOG August 12, 1988 121 ft. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 130 ft. Absorption field on lot 173 ft. Public sewer main N/A Sewer service line N/A AT INSPECTION M~rch 22, 1994 120.5 5-7 ; On adjacent lots ; On adjacent lots 100 ft. + 100 ft. + Public sewer manhole/cleanout N/A Petroleum tank N/A WATER SAMPLE RESULTS: Coliform 0 Coliform/100ml Date of sample: March 22, 1994 Nitrate 0.13 rog/1 Other bacteria Collected by: Simon Schroeder 8 colonieS/100ml B, SEPTIC/HOLDING TANK DATA Date installed Sept. Cleanouts (Y/N) Y High water alarm (Y/N) Date of pumping 28, 1988 Tank size 1250 Foundation cleanout (Y/N) N Compartments 2 Y Depression (Y/N) none observed Alarm tested (Y/N) N/A Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 130 ft. On adjacent lots 100 ft. + To property line 20 ft. + Absorption field 34 ft. Surface water/drainage none observed Foundation 14.5 Ft. Water main/service line 10 ft. + 72-026 {3/93)° Front CONTINUED ON BACK PAGE C. LIFT STATION Not Applicable Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D, ABSORPTION FIELD DATA Soil rating (GPD/FF) 150 f~, Gravel thickness Date installed Sept. 28, 1988 Length 87 ft; Width Total absorption.area 621 Cleanout present (Y/N) Y Date of adequacy test March 20, 1994 Results (pass/fail) Pass Water level in absorption field before test 30" belo~ G.L. Peroxide treatment (past 12 months) (Y/N) N System type shallow trench 2 ft, Totaldepth 3 ft. Depression over field (Y/N) N for 4 Bedrooms Aftertest 24" below G.L. If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 173 ft. To building foundation /~ ft. On adjacent lots 10 f~:, + Surface water none observed Curtain drain none obse~-,zed On adjacent lots 150 ft. + Property line 10 ft. + To existing or abandoned system on lot N/A Cutbank N/A Water main/service line ] N fr. + Driveway, parking/vehicle storage area 10 ft, + E, ENGINEER'S CERTIFICATION I certify that I have checked, ver~ed, or conformed to afl MOA and HAA guidelines in S~gnature ,-// Engineer's N~me ~: ~ ~ ~~ Date/' /'~-/'~ Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number EI3.."25/'94 :tE,:05 CT:;_.',E EI.IUIROI.IHENTAL LAB SEF.!L.JICES --, 91372'7'2415Lq 1.10. :tiE, g02 CT&E .gel.# Climl t S amp I e Matrix Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT 9q.1233-1 WATER .FROM SINK TP, P 1'21301.11 .A C DRIVE WA'I ClientN,'une F,N~vTRONM~NTAI_.M(fMT INC (E~'~) \V()l{l'~ Order 76846 Ordered By SI MON SC~OEDER Prjn.ted Date 03/25/94 ((~ 15:40 hrs. p,'ojecl Name Collected [~te 03/17/9,1 (~ 12:30 lu's. Prcject~ Received I~te 03/23/94 (~} bi:10 hrs. I'WS~ UA Itc eased By: ~ ~ ' --~nl~-~-~i-(~-l~-:' SAMI:'I 1". CO~,~;FED BY: .SHMON SCHROEDL,:I',, W FffNESSED BY (;].,F,N HOLT. QC :\lbm'~ hie Ext. Anal Para~lleter I?,esulls Qtltd thfits M. elhod Limits Dab:: Date Init .......................................................... 7~8./~,- ....... EPA 353.2/300.0 l J) 03/25/94 LLH Nitrate-N o. 13 . ' Sec Special Instn]ctim~s Above UA = Unavailable ** Sec Sanlple .Remark~ Abovc NA = Not Analyzed U = IJ~tdet eutcd, l(q')orted v ah~ is th.e practica! ¢~ntification limit. T,T= Less Than 13--Secombry dilution. Gl'= Gt'eatet '[hun 5623 B Street, Anchorage. AK 9951 8.1600 --Tel: (907) 562-2343 Fax: (907) 561-5301 ....... EN~;~';NM-E~'FATF~CH~;TIES iN ALASKA, COLORADO, FLORIDA, ILLINOIS. MARYLAND, NEW ,JERSEY, OHIO, uTAH, WEST vIRGINIA I SEPTIC SYSTEM FILL Tilde ~TIME DEPTH ~ D Z D 102.0 :: : ~yo -- I ' - ,' / SAMPLE DATA SHEET (use continuation sheet for Class A & B) L~ATION ~ I~LL (Legal kscrlptton): WELL DEPTH: FT, CASING: FT SCREEN: DATE DRILLING CO~4PLETED: DRZLLER: STATIC WATER LEVEL (Top of Casing): FT DATE: .. . Elapsed Time Since Cl.~¢k .i Pumping Started/ Oepth to Orawd~n/ P~ptng Renmrks Time : Stopped, Min. - I(ater, ft~ 15 35 45 55 180 (3 hour~) ~.~ 240 (4 hours)' RECOVERY C~nt5: '\, Separation Distances Static water level '~'-//~- Well flow Pump level I ' ~'"~'i .................................... 100 ft. (class A&B-=~150 ft.) ~din_g._g~ank on adjacent ~ -- I'~ Absor,otion field ~n T~ 1-~ ~. - ~ ~ '/' Absor t~n on adjacent lot (B) Public sewer line Public sewer manhole/cleanout Sewer service line 100 ft. Petroleum tank Well(s) on lot (A) - Wells on adjacent lots Foundation 5 ft. Property Line 5 ft. ..A. bsorption Field ' 5 ft. Water main/service line -' 10 ft. ~-' ~'/ ~'/ Surface water/drainage 100 ft. Well on lot (B) ' ¢"'""'"'""'- Well on lot Well on a__djacent lots _P_roperty line 10 ft. Building foundation 10 ft. c,,-" -'~'~'1 -~'~' _Existing or abandoned system on lot Existing or abandoned system on adjacent lot Cutbank ~Vater main/service line 10 ft. /~) ~urface water 100 ft. _Driveway, parking/vehicle storage area 10 ft. Page1 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 0/. !! 2- / HAA# '-' 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Telephone: (home) (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: (or check here~, if hold for pick up.) List contact person and day phone number below: (e) 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms. 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)ii~ 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. 72-025 (Rev. 7/88) Page 1 of 2 8 jo ~ ebBd '~JOM s,Jeeu!eue leUO!SSejoJd eq~, u! suo!ss!uJo Jo sJoJJe Joj elq!suodseJ ~,ou s! e~BJOqOU¥ Jo ~!lBd!o!unlAI eq/'penes! s! m, Bo!J!~,Jeo B eJojeq e~ep ez,{iBuB Jo suop, oedsu! ~,on puoo ~ou op SHHa jo see,~oldUJ3 's~ueuJeJ!nbeJ e~B~s pub leJepej u!elJeo ,~j. sp, es o~ JepJo u! suo!~m,!~su! 5u!puel J!eq~, pub seuJoq Jo SJesBqoJnd o~, ~se~Jnoo e sB s!q~ seop SHHQ eq.L 'B~SelV ~o m,B~S eq~, u! pejm, s!13eJ Jeeu!bue iBuo!ssejoJd ~,uepuedepu! uB ~q e^oqB ~ qde~Be~Bd u! ue^!13 suop, B~,ueseJdeJ eq~, uodn ~lUO peseq pm, Bo!;!Jeo IB^oJddv ~l!Joq~n¥ q~lBeH sense! (SHHQ) seo!^JeS UBLUnH pus q~lBeH Jo ~UeLUlJBdeo e6eJoqouv Jo ~!lBd!o!unp~ eqJ. 'uoRoedsu! s!q~ jo e~Bp eq~ uo ~oe¢~e u! suoRelnDeJ pub 'seoueu!pJo 'sepoo e~B1S pub IBd!o!unp~ I1~ ql!M eouB!lduJoo u! s! Lue~s~S lesOds!p ~e~eMe~s~ Jo/puB ,qddns ~ele~ e~!s-uo eq~ 'uo!~oedsu! pub uo!~BeRse^u! ,~LU LUOJ¢ pUS sel!¢ eeeJoqou¥ Jo ,{l!lBd!o!unpl eq~ uJOJ~ peu!mqo uo!~eLuJo~u! eq~ uo peseq ~eq~,~pe^ Jeq~Jn; I 'u!e~eq pe~Bo!pu! eJnlonqs jo ed/~ pub sLuooJpeq JO ~eqLunu eql ~o¢ e~Bnbepe pue'lBUO!~oun~ 'e~Bs s! u~els~s iBsods!p ~e~e~else~ ~o/puB ~lddns ~e~eM e~!s-uo eq~ leq~ s~oqs leAo~dd¥ ,~uJoq~nv M~leeH s!q~ jo uo!~8!~se^u! ~LU ~BMI,~;Pe^ I '~oleq u~oqs e~Bp uoRBp!Ie^ eq~ jo BB pUB o~eJeq pex!~B IBes,~uJ ,~q pe!~!~Jeo s¥ NOI£Vi~I~O4NI aNY ~£¥~ 'HO~t¥t$ tllJ '~.LSt.L '$NOI£O~dSNI 9NIdl^Ol~ INI~I4 eNIl~ttNl~Nt '9 . :. ~'"'""' MUNICIPALITY OF ANCHORAGE (MOA) :'"' ";/::'~t~t'~" \t~,4~if.,,~l Health Authorily Approval (HAA) V~,~.;~'"'..;.,-;.. ' \~-~l~,r,~/CHECKLIST - FEBRUARY 1984 ~ '!~ ~ ~--~-/'"'"' 343-4744 A. WELL DATA Well Classification Well Log Present'N) Date Completed Total Depth ?70 Cased to_/~ Depth of Grouting Static Water Level __ Casing Height Above Ground Wiring in Conduit (~N) Electrical SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot / To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by ,/~,/'/~/.~ Water Sample Test Results ~ Legal Description: Zd)7'~¢' ~/~' / If A, B, C, D.E.C. Approved (Y/N) Yield Pump 8et At Sanitary Seal on Casing~'~N) Depression Around Wellhead (Y(~ f /,~ ; On Adjoining Lots r /7.~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ;Date ,//"~ ,~/~'~¢/¢¢~ ¢, / Comments B, SEPTIC/HOLDING TANK DATA Date Installed ~L~.¢-~ Size Standpipes (~N) Depression over Tank (Y/fN~ Pumping/Maintenance Contact on File (Y/N) Holding Tank Hi'gh-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Wa(er-S~ppl~ Well '" ,-',, ,/~) ~ To Building Foundation To Property Line .... i~ ;~O/~P~ To Disposal Field To Wb. ter MainTService Line ....../o ,y · / To Stream, Pond, Lake or Majo¢ Drainage Course ?~'5''~ No. of Compartments Air-tight Caps(~/N) Foundation Cleanout(~N) Date Last Pumped "('J'/'-"¢,¢~ , ,for ¢/,¢ Temporary Holding Tank Permit (Y/N) Comments 72~026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/~ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line /73' Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present~)N) Date of Last Adequacy Test To Stream, Pond, Lake, or Major Drainage Course /cz) To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots /~ To Cutback (if present) / Comments D. LIFT STATION D a'~'6~'l.c~.a I I e d ///~ Dimensions Size in G~ / Manhole/Access (Y/N) "Pump On" Level at ~'""""'"'~~ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for ~ 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 Signed Company Date MOA No. Receipt No Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 10630 Date Report Printed: NOV 30 88 @ 15:19 Client Sample ID:LILAC L6, B2 PWSID :UA Collected NOV 28 88 @ 12:15 Es. Received NOV 28 88 @ i2:30 h~e. P~eee~ved with :NONE Client Name :AECS Client Acct: ANECSR? P.O,# NONE REC'D Req { Ordered By : Analysis Completed :NOV 28 88 Send Repo~te to: Laboratory Super¥igor~:STEPHEN C, EDE 1)ARCS Releaeed By : ~ ~/~..---~ 2) Special Inetruet: Chemlab Ref #: 3561 [,ab Smpl ID: 1 ){at~ix: WATER Allowable Parameter Teeted Reeult/Units Method Limite NITRATE-N O.lO mg/1 EPA 353.2 lO Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY DLH. 1 To,ts Performed * See Special Instructions Above UA=Unavailable ND- None Detected "' See Sample Remazke Above Nh- Not Analyzed LT-Les~ Than, GT-Greate~ Than