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HomeMy WebLinkAboutMANN BLK 4 LT 1BMann Lot 1 B Block 4 #020-04i-i 4 '-' " Municipality of Anchorage Page I el 3 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~rmit Number. SW000156 PiD Numbe~ 020~041 21 ~E"~rl Becker Wastewater Sys{em: n New ;3[:3 Upgrade ~,~ ..... : '. ABSORPTION FIELD 16236 Luna Street Anch., AK 99516 ,~o.~: .. ' I"°~°fsi'°°"'': " ODeepTr~nch OShall~)wTrench 345-.72~6, Four (4) ' '. :' " DESCRIPTION ' LEGAL- . . ~,~: ~. T~,~,~,,~i~- .' 1'~:. ' .'" ..'".'4 ' 'Mann" ' :' ":""" ~'.: ' '"' ' "' " .... . . .... . ~,,,~:'. · . . .. , : ! ..,.~ ': . :~,. WI=Il'".'..'..".:': ~New' " I-IUpgrade ....'.. ::. . . :.' .' :.'.'' ~,. . :' ' "' " '" · ' · · · ~, ...... '" :~/'hlnn ............ · . '::.' '-'"~ '~SEPARATION DISTANCES '/.' .':-,.~ ~x~?~....?'; '"S'Ho'di~" .. ::,~.i ~ S:~.~,. ' '"' .. ;. · -.'1 r.250" ! ": · ' -: :: :'! ..Wel~"· .~;I ' '.':.1 ' : ! ;" .-.'":" ·:>'25' Steel · '-' '.- :..-,' Two' .... .: -- . s.,~, .. ~100 .:'~'. '. · .':', '.... ".'-. - .'"" . .':.': "': .-"'.';.'LIFT'STATION': ~i/A' ::::':,.". v'.' LOt .:.'.' >51'' ' :'." .... "' S~zein93~°~''lM'a~.~.ct~,'P~'-' "' '' "' "'::./' '"':'..'~."' · 'u,~' · '.. .' ..... : ' " ' "'' ': '" '"' :'""'":' "'" ..... ' · ' ....... BENCH MARK'.::'"'. ""'-';"~'"..' ' :'" ' "' ..... "~ ;~ 6~;~,;": ':' '"'""": ';'":;':' : : - Remarks:. :A Me~ .1 i2"~0'Ga o · · ' ~n]~ ..'~nd':2 ::Pos't 'Tank: C'l~h66t~:'.Wer6' ".. Landing .From Stairway .Leadinq. From ?'Placed 'Under. Th'i~ Pe'rmi~"" ExiSt~h'g' . 'Upper :Deck.' :.:-':.' '-."..:. ": ':.:' '::~ "-" :" :' ':'[' %bsorption"~Trench.:'Remains':tn Service. :,!..::: ...,....,....-..!.. .~. -......, .... .~. .' ' . ............. :' ' ..... · .... ' ."~ .... ".. ' · .'::.. ' .. :""*'~'-.- ~. '£ ,.. . ...,....,.:...... ...... -........... ... ...... ., · ' '2"' Insulatzon..Over 'Tank. '.' ..... . ..... ... ........ ... ,.:. ..........,.,........ ~. .. ; ..............,:q.."....'::.' .... f~,:~I~i~:,,..".;:.~, ' ' '"""'": .... "' "'" "'" "' ' "" '" ' ' ' /o6 .'.;,'~..,,...,.,,..~,7~:-:. . . . . . . · "De artment of Health and Human Serv,ces approvm :..- Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW000156 Page 2 of 3 PID No. 020-041-14 10' Utility Easement Exis~ing Absorption Tr( . Local%on Approx ate '.Cl 'TBM Three'~ "..Bedroom . · llome "i '.' ' (D'Exis tine '"' Well' · LUNA DRIVE PLAN AS-BUILT SCALE 1" = 40' 51.7 . S2.. 29.2 I 52.8 C2 ' 31.5 157'3 (;3 31.9 58.8 ' Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW000156 Page3 of 3 PID No. 020-041-14. . Note:' Existing ' sorp~on ..,Trench Only the.Tank and Post.Tank Cleanouts Were Placed Under This-Permi.%. Existing Absorption Trench Remains in Service. PROFILE AS-BUILT · '' SCALE'I' = 10' 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 too ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT ~ ~'/~ F_/~ ~_ Upgrade Date Issued: Jun 09, 2000 Expiration Date: Jun 09, 2001 Permit Number: SW000156 Legal Description: MANN BLK 4 LT lB Design Engineer: 0014 Anderson Engineering Owner Name: EARL BECKER OwnerAddrass: 16236 LUNASTREET ANCHORAGE , AK 99516-5044 Parcel ID: 020-041-14 Total Bedrooms: 3 Site Address: 016236 LUNA ST Lot Size: 44961 SQ. FT. Permit Bedrooms: 3 Thi~ permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of AJaska 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. Fram 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. Date: ANDERSON: ENGINEERING- P.O. BOX 240773- , . :. ANCHORAGE, AK 99524 ~ 522-7773 522-6779 (FAX) .] ,June 9, 2000 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, AK 99502-0650 "Subject: Lot lB, Block 4, Mann Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite'Services Engineer: The existing 1,000 gallon septic tank on Lot lB, Block 4, Mann Subdivision has failed and must be replaced immediately. Sewage cannot currently-pass the tank to the absorption field and is backing into the house. It is imperative a new tank be placed as soon as possible to prevent damage to private property and to resolve a possible health problem. The location of the new tank is shown on the attached Site Plan. The existing well location is also shown along with the 100' protective radius. No conflicts exist between the new tank and other wells in the area. ' The ground surface on the lot slopes from east to west at gradual and varying slopes.- The new tank will be constructed in close proximity to the old tank in a fairly level area.' Two new post tank cleanouts will also be constructed. '. Surface grading and relandscaping will be accomplished to assure drainage is.away from the new tank location. · Sufficient distance from the existing .well on the lot is available to assure the 100' protective radius is not violated. In addition, other wells in the area are more than 100' from the location of the new septic tank. - ,~ If.the system is' constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constr~cted as designed, will have no adverse impact on existing '. septic systems in the area or those to be constructed in the future. · 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. LcJt lB, Block 4, Mann June 9, 2000 Page Two . Sincerely, pattems in the area."The current drainage pattern will The system, if constructed as designed, will have no adverse impact on drainage be maintained. Michael E. Anderson P.E: Attachments 10' utility Easement Existing Absorption Trer SCOPE OF WORK: 1. Remove and Dispose Existing Tank. 2. Place New 1,250 Gallol Septic Tank. 3. Place 2 Post Tank Cle~ 4. Regrade~.~rea. ~outs. Tank Cleanouts New !,2~ G~llpn ~ep~lc ~anK Three Bedroom Home (~'Existin¢ Well LUNA DRIVE SITE PLAN SCALE 1" = 40' ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT lB, BLOCK 4, MANN SUBDIVISION GENERAL: The scope of this project includes the removal and disposal of the existing 1,000 gallon septic tank. It also includes the procurement and placement of a new 1,250 gallon septic tank at the location shown on the Site Plan. Two new post tank cleanouts must also be placed. Once construction is completed the disturbed area must be regarded to pre construction condition. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise, Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. The new 1,250 gallon septic tank must be procured from an approved source and installed at the location shown on the plans. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. Lot lB, Block 4, Mann Subdivision' June 9, 2000 Page 2 of 3 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION (Not This Project): 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. A silt barder or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfi~ld are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall vedfy this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). · Lot lB, Block 4, Mann Subdivision June 9, 2000 Page 3 of 3 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfllled. The second inspection must be conducted after the placement of the geotextile fabdc, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. 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 NAME PHONE [] NEW [] UPGRADE LEGAL DESCRIPTION Wel~__ ,O. v DISTANCE TO: ~.~'~ F- ~ Manufacturer Liq. e .al,ons I ~ IF HOME.DE; ~ ~ ~ Manufacturer ~ Top of tile to finish ,fade ~ ~ Length Width ~ ~ ~ Type of crib Crib diameter  Class Depth ~ D STANCE TO: Building foundation Abs°rptii~,r~a Inside length Dwe ng Foundation q ~7 1 Total len g.~ ~Sir]es Material beneath tile Depth Crib depth Building foundation M a t e~,~,~_~ Width Material Nearest lot line /0x ITrenc~h width, inches inches Total effective absorption Nearest lot line NO, QF BEDROOMS No, of compartm~_.: Liquid depth PERMIT NO. Liquid capacity in gallons ! PERMIT NO.II ~ Ho,~J LOft'l-I-~fx Distance between li~ I Total effective a~,~.~12re~, PERMIT NO. ~ area Driller Distance to lot line PERMIT NO, Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOli TEST ~.ATI NG REMARKS 72-013 (Rev. 3/78) LEGAL Department 825 264-4720 * * * HANDWRITTEN PERMIT * * * Permit # ~'7~( WELL AND/OR ON-SITE SEWER PERMIT Applicant: ~O~"~'" .~K~f._~d.., Mailing Address: MUNICIPALITY OF ANCHORAGE ~ Health and Environmental ~rotection Street, Anchorage, AK. _3501 Location: Legal Description: A~)~ Type of Soil Absorption System Is: Trench: Drainfield: Maximum Number of Bedrooms: .~ Phone Number: ,5'7'-.._. / --! ~ [-~ 3 ! Seepage Bed: ~ Holding Tank: Soil Rating (sq. ft/br) /~ The Required Size of the Soil Absorption System Is: DEPTH ~! LENGTH ~,5 GRAVE'_ DEPTH ~ ! WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~]~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may~guire enlargement if tke residence is uemodeled to include more tha~ 3~bedrooms. Signe~: ~-c_ -- Issued Applfcant Date: (~/8~) SWP/024 MUNICIPALITY OF ANCHORAGE DEPART/V1ENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Straot, Anchor~a, Alaska 99501 264-4720 SOILS LOG - PERCC)LATION "['EST ,~- (~' SOILS LOG [] PERCOLATION TES'[ SLOPL'- P'~Y~ F SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- IF YES, A'F WHAT /c~ ' COMMENTS 72-008 (6/79) Date Gross Time Reading Net Time Water ALASKA eF,.;ROFImeFITAL COF1TROL SeRL em, IFIC. ~nqin~rln§ 6 ~ulronmcnlol S~u~i~s SPECIFICATIONS FOR ELEVATED BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM- LOT lB, BLOCK 4 M~N #1 SUBDIVISION 1.0 GENE~LAL 1.1 THE DRAWING, SHEET 1, SHALL BE A PART OF THIS SPECIFICATION. 1.2 ALL M~ERIALS AND WORKMANSHIP SH~L MEET THE REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERMIT. 2.0 SEEPAGE BED 2.1 THE GRAVEl, FOR THE BED SHALL BE SCREENED TO THE SIZES INDICATED. 2.2 THE SAND SHALL HAVE AN EFFECTIVE SIZE OF 0.4 TO 0.6 MM AND A UNIFORMITY COEFFICIENT OF NOT MORE THAN 4. 2.3 THE BERM AROUND THE SEEPAGE BED SHALL BE CONSTRUCTED OF IMPERMEABLE MATERIAL, AND ON A SLOPE OF 1 FOOT VERTICAL PER 2.5 FOOT HORIZONTAL. 2.4 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN CO~PACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL BE PLUS OR MINUS 2". 2.5 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL BE RIGID PVC, ASTM 3033 D-3034. THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5" HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A REGULAR SECTION OF REGULAR PERFORATED SEWER MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP OF THE PIPE. 2.6 IF INSULATION IS REQUIRED THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM BOARD OR ARCO GEOFOAM EMBANKMENT INSULATION BOARD OF THE THICKNESS SHOWN ON THE'DRAWINGS. 2.7 THE TOP AND SIDES OF THE BED SHALL BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX. 1200 II]esl 33rcJ Aucnu~. Sui1~ J~., Anchoro§e. Alask~ 99503 · [907) 276-1361 ALASKA ENVIRONMENTAL CONTROL SERVICr INC. 1220 West 25th Avenue Suite B ANCHORAGE, ALASKA 99503 276-1361 279.2917 SHEET NO CHECKED BY DATE Municipality of Anchorage D~, .rtment of Health and Environmental Protech~., 825 L Street, Anchorage, Alaska 99501 264-4720 BED REQUIREMENTS Install Bed Per Permit Specifications Cast IronCleanoul - 1' to 4' from foundation TWO INSPECTIONS REQUIRED: FIrsl: Absorption trench excavated Second: Septic system ready for backfill SEPTIC TANK: Must be insulated with 2" high density burial type styrofoam or equivalent Two Compartment, Municipal Approved, Set level 5' Minimum undisturbed earlh between tank and trench, and tank and foundation. Tank must be level. Tank and solid pipe laio on well-compacted earth Cleanout required prior f¢ 90° bends before tank inlet Cleanout required 2' from foundation wall Inlet and outlet with water-fl6ht mechanical couplings Two cleanouts on tank with air-fight caps All cleanouts must come to at least ground level ASTM D3034 may be used in place ol cast iron DRAINFIELD AND PIPE: Minimum dlslance between drainfield on adjacent lots 30' Excavation to lot line minimum 10' Bed installed across slope V~" to 2%" screened gravel PeHorated pipe set level, holes down. Pipe must be level. Bottom of bed level 2" gravel over perforated pipe Gravel extends to edges of drainfleld Minimum 3-6' between distribution pipes The outer distribution pipe shall be 3' from the bed sidewall Solid pipe under driveway, insulated (see insulation) 100' from tank or dralnfield to river, lake or stream Barrier material between gravel and backfill when insulalion not used Cast Iron Standpipes INSULATION: 2" high density burial type polystyrene or equal over lines and bed when earth backfill is less than 3'; over any line (s) installed under a driveway and/or parking area; over all septic tanks. DISTANCE REQUIREMENTS OF WELLS FROM TANK AND TRENCH: Individual, single family - 100' Class C - Under 25 service - 150' Class A, B - Over 25 service - 200' Further design and installation information is available upon request. solid pipe Two Comparlment Municipal Approved, set level, must be insulated pipe dislribution box or connection must be set on compacted earth and must be level bottom must be level peHorated distribution pipe holes down must be level stand pipe perforated in bed, solid above bed, with top cap 3' - 6' ~1. 3'- 6' ft. 72-024 (2/83) ]Box lao9w swAim HourrN E�77��.�� nn r�.Er��NCnomAGEv ALASKA 90502 3 ireI 714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT THE RATE OF _ -'13. nnPER FOOT. f �lL e PROPERTY OWNER — LOCATION OF WELL SITEAL�), n !17 / 77e Pte 772247 99577 DRILLERG7a^�?I.,; WELL LOG: 0-----Ipl LOw:i_i-� lPn-o SPL"PiL(.LL 4L7C' CIU sPi:!Ae _ 79---37' 2 U a%on :Lcc!, ,'_a•'rLaJr ar a, can. �afLP✓L!L`L 62'2 r ( l.. 31--9-70' 2 9/2 �i �'� f./Z d n,'LCn.Lt(.^✓L •t..t�!`C %Lac'. lU 700 ,to 200 ?;�� nlLa C!LLc%Lan •i.ILG'LPCl/eC� ,ta 2 3/4 �i 4''� V out a -P jl?.tl?. CL'LP.GLO a;� po,L,o A f,% e /nc!.i�terL nUI;L(�(.rLf! ,i'_alt 30 ILUL.LteAr ptacluc Um—L �'laJ:.�nC to ane aaLC.an SLC 7 :" ,'tCL'".P, T'an rnoiLe •PG,t o-, d& U✓f.n-7. brand ena1LC+,h to /7,�Lery/., rnl.a (road ca^✓LJP ua tQ✓L be-a"I'l-aq gait om o f . tcF J L.x- C!CLL'a;?,6 ^e't. tUILI `P !!Y -f X11 brate✓L A,2.cauP✓L" !;CLC,! tjZ.L ,;o. `_P!L pe'C Y`, o P �tllL;°PCP., 3/4h o/r�P �u !rr PLS.+ �r Le Qw 3hau,(,d be- ,%n d' c (,!_e_d 70 .t0 75 P✓: 30r� 2P1L 0"-- '483n 0,n COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS -` SERVICE CHARGE O F 1Y,% PER MONTH WILL BE ASSESSED ON PAST DUE AC.C^,�'vir'Y —_�` PERHIT i'.JO. [:,Iii]='IqI:;.':THENT , HIEFILTH FIN[:, EN',,,'I F.:Oi",IHIEI",I]'I:rjI .... .]:O'T'EC:T I 01'.,I 8;.25 '" L. "' '.!.:;"I"I';.:EIET., FiI'..IE:HORFIGIE., FIK. 26~-4}720 It..~-~ E: b. It._ 1i::::~ E'Z IF;?' I] "ii :ii:: -IF' IqP F'L. I CFINT L. 0 CFIT I Oht L. EGFIL. FtLMON[:, I I'.,IC. LO"I' ::LE: BI....K 4 MFII'.,II'.,I SUE: BOX :.1.. ::L - ;Fu.: ;.]:: 4 ? I,,,.0'1" E.': I ;.?.E: ~:45-2:82::L r~;,'.F,'.'~S,:F.E+:, SQIJRRIE FEET H t i'.,t I HUH I} t '~,"I'I:tlqCE 8ETHEEI'.,I FI HELL FIN[:, J..OE~ FEET I='OF:: FI F:'I-"4:Z',,,'R"I"E HELl... OR :I..50 ]r'O ;..?.'F~O FEET FROH FI F'UE,'LIC HELL DEF'IENDI'I",iG i...IF'Oi"4 'T'HE T"r'F'IE OF PI...IE',L. iC I*IELL. i'IiNIHLII't [:'tSTI::II",ICE FI:;.:OM F:I F'Ri'v'FFI"E HELL TO R PRIVR'TE :~;EI.,.IEF.: LINE ]:S; 25 FEET FIN[i' 'T'O R COHHUNIT'¢ :E;EHER L. INE :I:S 75 FEET. HEI...L. I_OCi'.'ii; FII:;.'.E REQUIRtE[:' FIN[:' MUST E:E RETUF4:I",IE[:, TO ]"HE [:'EI::'FIRTMEI",IT I.'.lI"f'HIi",l OF" THE HELL. C[)HPLETIOI".!, OTHEF.: REQU I RE]'"IIENT:b] I'"IR'T' FII::'PI_"r'. SPEC I F I CFIT ION$ FINE:' CON'.'='qTFi:UE:T 101"4 D :[ FIGRI=IH:i.:.; I=IRf. E F:t',,,'F'I I L.FIBL. E 'T'O I t",tSLIRE PROPEl;it I I",I:~',TRL..L. FI"I"I ON. :1:. CEF.:'T':t: F"¢ THFIT :i..: I FIH FFIHII_IFII:;~: HITH THE I:;.'.EQU.'I:REI"IENTS F'OF.': OI'.,I-':?.;:[TE '=Z, EI.,~EI-?.':S Iql'.,l[:, I.,.IEI....L.S I:lli~, FOF.:TH B'T' THE HUi",ItE:IF'RLIT'¢ OF FINCHORFIGE. 2: :1: HIL. L. INSTFIL. L THE '..:.:;"r'STEH ~1",1 f::ICCOF::[:,FIi",ICE HITH THE E:EI!}I.E:5. V4. E) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) LgCation',(address or .directions) ? ,i,: ' .' .: . .'..'; '.,, ~' Owr~er./~/~'~-'(/ , ~¢~J~ ~ Telephone: Home -~;:z/¢'~'~ ?~_.4..,¢' Business Address Telephone Telephone · (e) Mail the HAA to the followina address: or: Check hereL~ if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family{~ Number of Bedrooms WATER SUPPLY Individual Well~~ Community [] Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/861 Fronf '~tJot~ s,~eeu!Sue leUOiSSejoJd eql u! suo!ss!~uo JO sJo~Je ~oj elq!suodsaJ leu s! eee~oqouv jo/~l!led!olunR eq.L 'penss! s! eleo!,qpeo e a~ojaq eiep ez/~leue Jo suogoedsu! ~onpuo3 ~ou op SHHQ jo se@,~Oldmq 's~uaLueJ!nbe~ e~e~s pue leJepe~ u!el~eo/~Jsiles o~ ~ep~o u! suo!~nl!lsu! 5u!puel deq~ pue seuuoq jo s~eseqomd el Ase]moo e se s!q~ seep SHHQ eq.L 'e~selV jo e~e~S eq~ u! peJe~s!SeJ Jeeu!Sue leUO!SSajmd ~,uepuedepu! ue/~q @^oqe ~ qde~l~e~ed uf ua^!5 suo!le~ues@Jde~ aq~ uodn ~tuo peseq se~eo!~i~@9 leAmddv/~!~oqlnv q~leeH senss! (SHHQJ Sep!A~eS ueLunH pue qlleeH jo ~,ueuupedeCl eee~oqouv jo A~!led!e!unlhl eqJ. NOlin¥o leUO!~!puoo le^oJddV leUO!i!puoo jo stuJe± pe^oJddes!Q -"~¢ pe^oJddv /~q smooJpeq (,~ A~"~ JOJ pe^oldd¥ 'lVAOI~ddV SHHQ ~ ~.//~,/2/ /,2/ WELL DATA Well Classification Well Log Present .~_/N) Total Depth /:~-0 Cased to Static Water Level Casing Height Above Ground Electrical Wiring in ConduitL~:~) Separation Distances from Well: MUNICIPALITY OF ANCHORAGE (MO~-v HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: If A, B, C, D.E.C. Approved (Y/N) Date Completed _ 5-;-/'~-~¢~ Yield ¢~)/ Depth of Grouting /-?//~', Pump Set At Sanitary Seal on Casing~_X~N) To Septic/Holding Tank on Lot /.~ ~/' / To Nearest Edge of Absorption Field on/J_ot /F(¢' / To Nearest Public Sewer Line /6//:4- To Nearest Public Sewer Cleanout/Manhole /u///~- To N/~arest Sewer Service Line on Lot Water Sample Collected by /¢g'?"¢-~ ..~_ /.dl/¢7/ ; Date ~,/" (' ' 'Y~) Water Sample Test Results -¢<~'Y//~YX~/?~;u'~'/: Depression Around Wellhead (Y~_? ; On Adjoining Lots /~';~d ; On Adjoining Lots /O~ B. SEPTIC/HOLDING TANK DATA Date Installed ~'¢'~ ,/- '~: Stand pipes://~) Depression over Tank (Y~)~ Size Air-tight Caps:~q) To Water-Supply Well To Property Line To Water Main/Service Line Course Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /¢//1 Separation Distances from Septic/Holding Tank: No. of Compartments Foundation Cleanout ~¥/~N) Date Last Pumped ¢L/~? 4//¢ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field .j / To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~" Width of Field Square Feet of Absorption Area Depression over Field (Y(~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot 4//~L- To Water Main/Service Line f To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~) 2"-~:Z: //'N'/c]d//~'k-~ ~.O. ~/fid'2~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Pr ese nt L~'.~/.-'N ) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) LIFT STATION Size in Gallons ~"'"'"""~_ Manhole/Access (Y/N) "Pump On" Level at ~ "Pump Off" Level at High Water Alarm Level at ~t~cfa~rco~es ~ Pumpin~dequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h .a..~.ohep~ed, ve,tified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. " Signed -~¢ ~ / Date Company /~ ~ MOA No. ,~ ~C)Z~ oP ANCHORAGE Receipt No.~/~-- ~0 ~ ~NV~ONMEN~AL ~,.. t -'"~ Date of Payment ~/~ '~ JElL 1 6 1987 ,, Amount: $ ~~ Page 2 of 2 72-026 (11/84) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~'\ 5633BSTREET ANCHORAGE, ALASKA 99516 TELEPHONE (907)562-2343 FEDERAL TAX iD # 92-0040440 /~NCI~ORA(]g, i~i, 99503 ~pecial ROU~'~gSAHPLF, COLI,~C~D7%,-07 CHEMICAL & GEOLOGICAL I~, ORATORIES OF ALASKA, INC. ,~/~'~.~.'o~r~)~',~:~,~ FEDERAL TAX ID # 92-0040440 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562.2343 5633 B Street Anchorage, Alaska 99518 Drinl~ing Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER '~PRIVATE WATER SYSTEM Name e/?~., Phone No. Mailing Address City State Zip Code Mo. Day Year SAMPLE TYPE: ~ Routine [] Check Sample (for routine sample with lab ref, no. [] Special Purpose ) [] Treated Water "JS~ Untreated Water SAMPLE NO, LOCATION 3 I 4 I Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~ Satisfactory [] Unsatisfactory [] Sampletoolong in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. f' j~ x~ ~...~ Date Received Time Received Analytical Method: Membrane Filter * No, of colonies/100 mi. Lab Ref. No. Result* I 7-71 I 771 I 7Tq I Yl-I Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE D Membrane Filter: Direct Count -- Verification: LTB BGB Final Membrane Filter Results ~') Time: TNTC = Too Numberous To Count Coilformll00ml Coilform/100ml OB = Other Bacteria. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRON~ClENTAL PROTECTION DIVISION OF ENVIRONi~,~ENTAL HEALTH CERTIFICATE OF INSPECTION FOI-] HEALTH AUTHORFFY APPROVAL OF ON-SITE SEWEI~I AND WATER FACILITY 264-,t720 Application Date ...... GENERAL ~NFORMA'I'ION Le§ai ©escription (include lot, block, subdivision, section, township, range) f.ocat~on (address or directions) ~,./~," AcJp .... icant is (check one): Lending Institution ~7, Owner/buildo Buyer (d) Lending institution ............................... Telephone Address (e) Re~t Estate Company and Agent Addre3s Telephone ............................... : , r,~,Lt,,e ,tiAA .g the following add~e~o. , TYPE OF RESIDENCE $ing!e-Famdy,~F Multi-Family ETJ Other .Number of Bedrooms _.__ ..~ WATER SIJPPLY individua; V,"oi?_'~-, Community F] Public ~ Note: If con- mmnity well system, must have written confirmation from the State Department of Environmental Conservation attesting to ~he legality and status. SEWAGE DISPOSAl. Onsite?.-~'~ Pubic E] Colnmunity [:] Holding Tank ~ l'!ote: I1 c~m- rr, nndy weil system, must have written confirmation from the State Department of Environ mental (.;ol~ser,,'atiol ~ a',testing to tho iegnhty and status. ENGINEERING FI(tM PROVIDING INSPECTIONS, TESTS, FILl.-'. SEARCH, DATA AND INFOI. iMATION As cedified by my sea~ affixed hereto and as of the validation date sl~own below, I verify that rny investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, fa nctional aad adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Munidpality of Anchorage files and from my investigotion 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 Rrm __~C~(,~.:,,~(~- ~::'~z?/~'~<~z~ Telephone .... Address Date _~ ./~._.p~mT~f~ Engineer's Seal /~pproved ~--:*T' ..... DisapproveE~ ................... Conditional Terms of Conditional Approval ............................................................ CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. Tho Municipality of Anchol'ago is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11184) M, UNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Well Classification Pi~J~' ~ ~J~r~ If A, Ii, C,,.D.E.C. Approved (Y/N) Well Log Present (Y/N)~I¢ ,~.~te Completed ~'- _~f. J ~"~l Yield Total Depth v'/ Cased to" Depth of Grouting Static Water L~vel Pump Set At Casing Height Above Ground ~*.~' ~ Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding 'rank on Lot j J~lJ~J~ To Nearest Edge of Absorption Field on Lot I'~ Sanitary Seal on Casing (Y/N) ~'~ Depression Around Wellhead (Y/N) ;On Adjoining Lots ;On'Adjoining Lots ~J~' To Nearest Public Sewer~Line ~J~J'r... To Nearest Public Sewer Cleanout/Manhole _~,--o Nearest Sewer Service Line on Lo.__ ~b~~ Water Sample Collectedby __ I',~0 AJ' ; Date __ Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA 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 lJ~ To Property Line _ Date Installed 1 9 ~j~_~ll~ Size I j:j~) O No. of Compartments Standpipes (Y/N) __y~l~ Air-tight Caps (Y/N) _ ~'~ ~1~, Foundation CleanoL~t (Y/N) Date Last Pumped ~ ~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation _ To Disposal Field ~ To Water Main/Service Line ~O~ ~ ~¢~1~ To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026{11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~4~ ~1,~ Width of Field I"~I fO Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Date of Last Adequacy Test __ Type of System Design~~ Length of Field ~ O~' ~g~ ~ Depth of Field ~, ~ ~ Gravel Bed Thickness - I~ ~"~ Standpipes Present (Y/N) ~1~,'~ Separation Distance from Absorption Field: TO Water-Supply Well [, ~'~ ~11 ~ To Property Line I To Building Foundation ~1~ ~ # To Existin,g/or Abandoned System on Lot NO~. . · ;On Adjoining Lots To Water Main/Service Line ~To Cutbank (if pres.ent) To Stream/Pond/Lake/or Major Drainage Course ~ ~,f To Driveway, Parking Area, or Vehicle Storage Area ~ ~ d' Comments __ ~ ~l ~' . . ' " D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at .~ Vent (Y/N) Pumping Cycl.es during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date MOA No. Company Receipt No. Date of Payment Amount: $ Z~.~ Page 2 of 2 72-026 (11/84) 440 W. Benson Blvd. Suite 2O6 PENINSULA ENGINEERING Anchorage, Alaska 99503 (907) 561-5107 ADEQUACY TEST RESULTS DATE 7/24/85 TIME SEPTIC C.0. #1 C.O. #2 MIN. TANK START END BED BED WATER ADDED(gals) 0 7 " 0 " 0 " 0 10 7 0 0 60 30 7 1 0 180 50 7 1 0 300 70 7 1 0 420 75 7 1 0 450 7/25/85 0 13 " 0 " 0 " 0 10 13 0 0 60 30 13 1 0 180 50 13 1 0 300 70 13 1 0 420 75 13 1 0 450 80 13 0 0 450 HEMICAL & GEOLOGICAL LABORATOt~IES Or ALASKA, INC. ~-~'~, TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER ~'~,~7~.[; ,./'~,/,:. 5633 B Street ~,~/ Drink ng Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I I I I I Ij (~)See h °n back' I.D. NO, er System Name Phone No. Mailing Address / City (~ State MO. Day Year Zip Code SAMPLE TYPE: ,~Routlne Check Sample (for routine sample with lab ref. no [3 Special Purpose IZ] Treated Water [] Untreated Water SAMPLE NO, LOCATION Time Collected Collected By I I TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ,~ Satisfactory [] Unsatisfactory' [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Time Received , Analytical Method: [] Fermentation Tube ~ Membrane Filter Lab Reft No. Result* Analyst 06-1220 (b) Ray. 1983 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE Membrane FIIten Direct Count Verification: LTB BGB. Final Membrane Filter Results ~"~.-.,.~ Time: Collformll00ml Co il ~orml100mi COLLECTING SAMPLE TNTC = Too Numerous To Count ISAACS PUMPING SE!.:tVICE (Norm Tibbetts, Owne;') 6218 Quinhagak Strect ANCHORAGE, ALASKA 99507 Phone 563-3300 TAX TOTAL 2782 All claims and returned goods MUST be e, ccompe, nled by this bill, MUNICIPALITY OF ANCHORAGE ('~ DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 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 ~/;~ ~fj..~l~f'~ Telephone: Home Mailing Address (c) Lending Institution ~O/2-~F'NJ~/~ND Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followinq address: or: Check here ~,' if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family'[~ Number of Bedrooms WATER SUPPLY Individual Well'~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite/~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72 025 fRev 8/861 Front 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 this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and 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 %~.,,~/,~/~¢4,,t.,¢/~ Telephone Address ,,~0 Engineer's Seal BHHS APPROVAL Approved for~-/'A"'~--d'~"'~bedr°°ms by ~4~'' -' "~)' '~'¢/"-~'~ Approved Disapproved Conditional Terms of Conditional Approval Date CAUTION 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 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. Page 2 of 2 72-025 IRPv 8,'86~ Back r ~ r ~ '~ -~'-~[~' '~"~t'~ ~!Z!'~ ) ~ ,,.~ i~ i , ~"~r~ 203W 15th AVE "C" SUITE 203 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: LOT lB, BLOCK4, MANN SUBDIVISION LOCATION: 16236 LUNA STREET OWNER: DAN MILLER TYPE OF WELL.' SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 5 GALLONS PER MINUTE PUMP YIELD: 8 GALLONS PER MINUTE DATE OF INSPECTION: SEPTEMBER 16, 1987 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 8.25 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. AT THE START OF THE TEST WATER LEVEL WAS LESS THAN 24 FEET BELOW TOP OF CASING. AFTER 90 MINUTES OF PUMPING WATER LEVEL WAS AT 82 FEET. WELL RECOVERED 40 % IN 15 MINUTES. TOTAL WATER AMOUNT DELIVERED IN 90 MINUTES: 700 GALLONS. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA AND NITRATES ON SEPTEMBER 17, 1987. E.COLI 0, NITRATES ND TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE AND FBA AND AHFC. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to 'the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. ,,, ,. ,t ...?. WELL DATA .~ O~ ~.> ~DNIClPALITY OF ANCHORAGE (MOA) ~'~ .,,:.~?'HEA~TH AUTHORITY APPROVAL (HAA) :, ","~ '.,: ,, Legal Description: Lc, T .l~'i £-~LC~ LC; Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Cased to ~ED~o¢...;~ If A, B, C, D.E.C. Approved (Y/N) _ Date Completed O CT 2 ~ I q. _,~'~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~' ~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date o, /,/ N.D Comments B. SEPTIC/HOLDING TANK DATA Date Installed /O, ¢,~,....~ Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Size Io¢~::~ No. of Compartments Air-tight Caps (Y/N) Foundation Cleanput (,Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field / O To Stream, Pond. Lake, or Major Drainage Comments Page 1 of 2 72-026 fRev 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ,,¢~i/"'/ Date Installed /O o ~/Z, ~.~ 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 Lot To Water Main/Service Line ~/~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ,~, To Cutbank (if present) Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments Company Receipt No. Date of Payment ¢,/~ ~///~ Amount: $ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '~- ~~ Date I MOA No. Page 2 of 2 72 026 fRev 8/861 Back Engineer's Seal CONSULTING ENGINEER 203 W. 151h AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL .' LOT lB, BLOCK 4, MANN SUBDIVISION LOCATION: 16236 LUNA STREET OWNER: DAN MILLER RESIDENCE: SINGLE FAMILY, THREE BEDROOMS WELL: PRIVATE, ON SITE SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. 1000 GAL. ABSORPTION SYSTEM: BED ABSORPTION AREA: 1302 SQ. FT. SOIL RATING: 214 (NOT ADJUSTED) INSTALLATION DATE: OCTOBER 1983 DATE OF PUMPING: DATE OF TEST: SEPTEMBER 16, 1987 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH 2.5 FEET OF COVER AT ONE END AND 3.5 FEET AT THE OTHER. LIQUID LEVEL IN TANK WAS 47 INCHES. BED HAD 2 FEET + WITH COVER. NO WATER OBSERVED IN CLEAN OUTS. 700 GALLONS WERE ADDED TO THE BED CLEANOUT. NO WATER WAS OBSERVED AT THE FAR END. NO BACKUP OBSERVED AT THE FILL POINT. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater 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 this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State~ APPLI( NT FILLS OUT UPPER HAI ONLY Property Owner /~/' · / "' / , Phone Beyer Address Zip Code Address Zip Code I .) ~ ~ ~-v)-~ Street Locali~ Type of Residence ~Slngle Family B Olher Waler Bupply ~ Individual A~ACH WELL LO~. A well log Is required for all wells drilled sinc~ June 1975. ': Community For wells drilled prior to that date, give well d~plh (attach log if available). : Public Utility ~Oivl~ual Yoar Individual Installed: ~ Public Utility Whsn Connected 1o Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Date lespector Field Notes: Time Date Inspector Time Date Inspector Time Date Inspector I~vIUIPALiTy'~' OF ~NcH , PEPT, Ot. , - , ORAOE RECEIVED APPROVED BEDROOMS DISAPPROVED CONDITIONA~L APPROVAL' 'CONDITIONS OF APPROVAL Soils Rating 72-023 (3182) Date Sewer Installed Well to Tank -7 Septic Tenk Size xCHEMICAL & Gl. LOGICAL LABORATORIES . ' ALASKA, INC.~_ TELEPHONE (907) 562-2343 ANCHORAGE5633iNDUSTRIALB Street CENTER Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYST~/~'I1 I.o. NO. W~tor $¥$tom Name Phone No Mailing Address City State SAMPLE DATE: Mo. Day Year Zip Code SAMPLE TYPE: ;~-.Routlne [] Check Sample (for routine sample with lab ref. no. ) [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION I I Time Collected Collected By TO BE COMPLETED BY LABORATORY " .Analys~s snows this Water SAMPLE to be: Satisfactory [] Unsatisfactory [] Samole too long m transit: sample should not ee over 48 hours old al examination to inOicato reliable results. Please send ,. ..... new,so,~P~O. . . - Date Received -'~ I h ~ ~'(., "' Time Received / <:/0 Analytical Method: [] Fermentation Tube ~l~Membrane Filter Lab Ref. No., Result* I FTq I M-iq Analyst,? READINSTRUCTIONS BEFORE COLLECTING SAMPLE 064.220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source Date Received .Time Received p,m. Lib. No. Presumptive 3.0mi 3.0mi 3.0mi 3.0mi 3Oml 1.0mi 0,Zml ~4 Hours 48 Hours Confirmatory 24 Hours ,48 Hours EMB BTOth 24 hours: Multiple Tube Report= Membrane Filter; Dlre~t Count Verification: LTB Flnll Membrane FlJteY.Results , , '(' ~ R.po,,, .y ::._ / Broth 48 houri: 10mi Tubes Positive/TOtal 1Omi Portions Collform/100ml BGB