HomeMy WebLinkAboutDAV-DOR LT 2I
*���s-aha-31
�u GRE' -TER ANCHORAGE AREA BO►"'UGH
%121P1
u Department of Environmental Quality
N G�3330 C Street
-f Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME lN LL ICri Cr,2 2f'-- MAILING ADDRESS /PCS % f 'S �''y'( PHONE
LOCATION/' 'a. L11600 T+� � UA\\ l�
LEGAL DESCRIPTION /•
-✓' Cf ���'�•
SEPTIC TANK:
DISTANCE OM WELLr�'r C.S<<�MANUFACTURE /1 NUMBER M /
F�- ^ S MATERIAL L� ���� l COMPARTMENTS
INSIDE LENGTH 1� INSIDE WIDTH '— LIQUID DEPTH — I IQUID CAPACITY X06 C) GALLONS.
SEEPAGE PIT: /
NUMBER OF PITS DIAMETER 193 OR WIDTH=, LENGTH_, DEPTH /
LINING MATERIAL, h" CRIB SIZE: DIAMETER`.t-DEPTH 6 DISTANCE FROM: WELL
/ TOTAL EFFECTIVE
BUILDING FOUNDATION iL2, NEAREST LOT LINE . ABSORPTION AREA (WALL AREA) 1/33 SQ. FT.
ADDITIONAL ABSORPTION
WELL: S t 4, f'-Uc# rA/ Z lCla-�n�ic�
TYPE —CONSTRUCTION
BUILDING NEAREST
FOUNDATION LOT LINE
DEPTH
DISTANCE FROM:
NEAREST SEPTIC SEEPAGE
SEWER LINE , TANK SYSTEM.
CESSPOOL . OTHER SOURCES
APPROVED DISAPPROVED
REMARKS
DISTANCES:' /-I��T+�"'
DIAGRAM OF SYSTEM
INSTALLED BY: ^�.al f�
,
(alkt.ti�l��
�
Sapp.
PIPE MATERIAL:
LOT SLOPE'
REMARKS:C 92'7t<<P .S'S
`r
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529hi b'I'l, t i
vwco�, ti� rcc/C4
DATE(e/^93
d7l
APPROVED 7"Uo�- LRnhl
G.A.A.B.
Form No. EG -031
NAME OF APPLICANT
INSTALLATION LOCATION
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
1530 •'C'• STREET ANCHORAGE. ALASKA 99507
TELEPHONE 274-4561 • /
NG L/J
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
PERMIT NO.
& AIJ7-.
MAILING ADDRESS 100 E. S3'¢� PHON~T_o6
OFF /O 4z T/?'
LEGAL DESCRIPTION LOT Z DAV— Zb/L SID
INSTALLATION OF: SEPTIC TANK �� SEEPAGE PIT DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS 3' /O �.��dFM NOTE HIS PERMIT 13 NOT VALID WITHOUT 8 IL TEST
COMPLETION DATE ANTICIPATED
19711 4 / BctouJ BoT/o/n 0 'R/d
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
L
SEPTIC TANK SIZE
MINIMUM DISTANCES. REQUIREMENTS
FOUNDATION TO SEPTIC TANK J /
FOUNDATION TO SEEPAGE PIT 2c DRAIN FIELD
SEEPAGE AREA SIZE TYPE
SEPTIC TANK TO SEEPAGE PIT WALL /' /
/
SEPTIC TANK S SEEPAGE PIT 26 DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK. / SEEPAGE PIT /e'v / DRAIN FIELD / L ,
TO RIVER. LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION B FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
G.A.A.B.
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE I- 11-74Z — APPLICANT'S SIGNATURE
FORM NO. EO -01 6
1 .'CLIENT Pederson ,;;; 'BY 'KorYntk.a
z PROJEC 'Dav-Dor..Subdi.vision` i'r: �:';,'ti:';'.'. DATE z
►- s :. • r,; :: ;.. `4 , :' '6
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6V-�DRILLING, Inc.v. Box 4
rt Road d.1224 • 1310C International Ai
! ' ' (907) 274.4611
ANCHORAGE. ALASKA 99509 '
SE 67-3-/5 ARQIJ
��3pp3-S/
Newowner; $q,,,uel M.7gfurr� DRILLING LOG
Well Owner Pederson Construction Use of Well Dom
Location (addrAc of: Township, Range, Section, if known; or distanced acro' road
TO cve(/ ecf
TO -- %, /7e. 4.
To
TO
TO
TO
TO
TO
LAS 14-23)
Ccrtificttc Nos. 614 6- 973
cc: Mu.1 o-ic nCeye cc; DGGS 1/86
2 —STATE
L2. al, Dave Tbr
Subliv
.�
l
Size of casing 6 nepth of Hoje ' 62 /
feet Cased to 41 feet
Static water level 25 ft• (siiov�) (below) land surface. Finish of well (check one) open end ( x )
Screen (
); Perforated ( J•
..: J
Describe screen or perforation None
Well pumping test
a It 5 gallons per (li,Rfif•)
(minute) for 1 hours with 1002 Ht,
of drawdown from static level
Gell w/i h SI" SE Nh. S� 4 '
Date of completion
21 X;\Tch 1975
Sec /5*,7'12ty; Raw SM
N21— 06)0'7329
WELL LOG w2y- IV) 46So.'t-
Depth in feet from
ground surface
Give details of formations
penetrated, size of HM;T# WPF&ess
O TO__:5_
rill
ENVIRONMENTAL PROTECTION
5 To 25
Clayey ilarepron 'APR 81986
25 TO 30
_'Small Gravel
RECEIVED
30 TO 41
Silty crixvel
41 TO --
Water Gravel
TO cve(/ ecf
TO -- %, /7e. 4.
To
TO
TO
TO
TO
TO
LAS 14-23)
Ccrtificttc Nos. 614 6- 973
cc: Mu.1 o-ic nCeye cc; DGGS 1/86
2 —STATE
Municipality of Anchorage
• -rl Development Services Department
Building Safety Division ,.
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.O. 015-292-37 COSA# 0S C 16 % UO2r11
1. GENERAL INFORMATION Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
DAV—DOR LOT 2
5301 E 104TH AVENUE 'ANCHORAGE, AK 99507
PAUL do TAMARA BURTON Day phone 346-1688
5301 E. 104TH AVENUE *ANCHORAGE, AK 99507
Day phone
KEVIN ELFRINK W/ GLOBE REAL ESTATE Day phone 727-2150
3300 C STREET SUITE 102 "ANCHORAGE, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are 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 certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the
information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the
on-site water supply andlor wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineers Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the lost, and separation
distances measured to readily Identiriable features. The operational life of all wells and
septic systems depend on the local soils condition, 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTO. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. 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 whatsoever.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
337-6179
Date 5-19-110
Conditional approval for bedrooms, with the flowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Report
Other
By: AJ Original Certificate Date: a
(Rev. 11m)
Municipality of Anchorage,
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.munl orglonsite
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: DAV—DOR LOT 2 Parcel ID: 015-292-37
A. WELL DATA
Well type MOTE If A, B, or C provide PWSID# N/A
Date completed 3/21/75 Sanitary seal (YIN) YES
Total depth 62 ft. Cased to 41 ft.
FROM WELL LOG
Date of test 3/21/75
Well Log (YIN) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
4/20/10
Static water level 25 ft. 29 ft.
Wellr
p oduction 15 _ . g.p.m. 4.96... g.p.m.
WATER SAMPLE RESULTS:
Coliform O colonies/100 ml. NitrateZ-21mg./L. Other bacteria _n colonies/100 ml.
Arsenic.< 0ug./L. Date of sample: 4/20/10 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
SEPTIC/STEEL
Date Installed
10/23/74
Tank size 1000 gal.
Number of Compartments 1
Cleanouts (YIN)
YES
Foundation cleanout (Y/N) YES Depression over
tank (Y1/N) NO High water alarm (Y/N) N/A
Date of pumping g e�V01 PumperA1aSKCA '�Cwe/ s"QLAirL
C. ABSORPTION FIELD DATA 0BELOW EXISTING GRADE
Date installed 10/23/74 Soil rating (g.p.d./ft'o /bd e5 System type SEEPAGE PIT
Length N/A ft. Width 23 DIAMETER ft. Gravel below pipe 6 ft.
Total depth • 10 ft. Eff. absorption area 433 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 4/20/10 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 26 in. Water added 450 gal. New depth 36 in.
Elapsed Time: 135 min. Final fluid depth 28 In. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump off" leve High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'
On adjacent lots 100'+
Public sewer main N/A Public sewer manhole/cleanout N/A
.i
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 50+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage
0'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Prin ed /Name JEFFREY A. GARNESS
Date �5 //O
J�e f A. Car ess.
CE77 d�
Vie_+�15.�•l3,
COSA Fee $ 41%0 Waiver Fee $
Date of Payment !J 5 I I Date of Payment
Receipt Number 0 9 0 Receipt Number
(Rev. 11105)
SGS RcEM
1101640001
Client Name
Gamcss Engineering Group, Ltd
Project Name/W
Dav-Dor L2
Client Sample ID
Dav-Dor L2
htatrie
Drinking Water
Printed Date rime
Collected Date rime
Received Date rime
Technical Director
04262010 15:25
04202010 14:30
04202010 15:05
Stephen C. Ede
Sample Remarks:
4500NO3 - Column Efrciency sample showing Nitrate recovery docs not meet QC criteria. LCS Nitrate recovery is within QC limits.
Allowable Prep Analysis
Parameter Rewhs Lex) Units Method Container ID Limits Date Dau Init
Metals by ICP/MS
Arsenic
5.00 U
5.00 ug/L EP200.8
C
(<IO)
Waters Department
Total Nitrate/Nitrite-N
3.71
0.100 mg/L SM204500NO3-F
D
(<I0)
Microbiology Laboratory
Colony Count
0
co1/100mL SM20 9222D
A
(<200)
Total Coliform
0
coUl00mL SM209222R
A
(<I)
Fecal Coliform
0
coVIOOmL SM209222O
A
(<I)
0421/10 0423/10 SCL
0421/10 AYC
0420110 SDP
0420110 SDP
0420/10 SDP
05/04/2010 18:03
9073453338
KEVIN ELFRINC
,. _J24 HOUR EMERGENCY SERVICE
A 10
ASK -DSA
PAGE .02/02
# 44430
Anchorage. Eagle River Mat Su
248-9557 694-9557 376-4600
PO Bo: 221914 • Anc'16orage, AK 99522-1914 + Office 248-9551 • Fax 248-9552.
YOUR FROF=SIONAL SEWER & DRAIN CL LhNING'SERVICE ,/,f
LICENSED L,I ,C. INSURED
Date Phone
Customer Name
Address I_. ' i ay Tv �vF • 1�1JG.l oi1r r
N� �I=DJN2aro.J i't_�tAr .L7JI- r�N�-S'»°n.r��,P� o,v -/1.,r TAn/✓
N� r rc 6?" ?^h3' o 1 ✓ l.G.Ir liAi' 1/il',. "WI Vr-j r�,-� / ��,,, „e,. A,
f
11
t
Technician No Warranty
Customer Sign ture
:SPONSIBLE FOR CRACKED OR BROKtfN PORCELAIN FIXTURES OR LOST OR BROKEN CABLES IN DRAIN LINES.
MER AGREES TO PAY FOR DAMAGED OR BROKEN CABLES, JET HOSES ETC. DUE TO FAULTY PLUMBING, AS
,S ANY AND ALL OTHER FEES INCURRED ATTHE TIME OF SERVICE, -
There will be a 530.00 charge on all NSF checks. A collection fee of 40% will be added It sent to collectlons..
PAYMENT DUE ON RECEIPT '
Finance charge of 0.075% oer month. Or annual rate of 10.5% is aoolled to oast due balances. -
Power Snake
0 Camera Inspection
❑ Install Clean 'Out
❑ Hydro -Jetting
❑ Vacuum Truck
❑ Steam Thawing
❑ Excavation
❑ Install New Toilet
PO#
Steam Thawing
Hydro Jet Cleaning
Sewer Line.Camera
-Service Call
Vac Truck
/
Septic Pumping
Extra Man
Parts/Tax
.,.._.TOTAL
N� �I=DJN2aro.J i't_�tAr .L7JI- r�N�-S'»°n.r��,P� o,v -/1.,r TAn/✓
N� r rc 6?" ?^h3' o 1 ✓ l.G.Ir liAi' 1/il',. "WI Vr-j r�,-� / ��,,, „e,. A,
f
11
t
Technician No Warranty
Customer Sign ture
:SPONSIBLE FOR CRACKED OR BROKtfN PORCELAIN FIXTURES OR LOST OR BROKEN CABLES IN DRAIN LINES.
MER AGREES TO PAY FOR DAMAGED OR BROKEN CABLES, JET HOSES ETC. DUE TO FAULTY PLUMBING, AS
,S ANY AND ALL OTHER FEES INCURRED ATTHE TIME OF SERVICE, -
There will be a 530.00 charge on all NSF checks. A collection fee of 40% will be added It sent to collectlons..
PAYMENT DUE ON RECEIPT '
Finance charge of 0.075% oer month. Or annual rate of 10.5% is aoolled to oast due balances. -
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No Cerin, bt TAM Wt• I
( Mreoy eerutY thet I twe euryryed dte helMwln3 dwrlbed PmPsM. Lot p_Nlook
.DAV-DOS! _euwn,
the krprwvvwwM Ift"s d tArwn wk witNmtlr prepertep y9llift" end Procinct,
noott'~Wp or
eneroeeh tin the proprry tW, &oleo", ttweto, ttrt no kWowrhrhte on proprty
lylrp edieoent thwow n"or"th On the pranlew In "tion end ,het then re no roodwoyt,
UVmrrJrlon lkue Or O[hr y161ON eewnwlte on wkl proprty rtCept w kldWM$d hrgn,
AnWww, Akwke M, Ara -'•-•--
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bok Ne. Fey No.
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NO. In"
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
Parcell.D.# n1�,_ aq�_'�"1 HAA# 0Qg0r%Sa3
1. GENERAL INFORMATION
Complete legal description LoT 2 DAV DOR
Location (site address or directions) 53o 1 E. IOLI {L
Property owner SAMUEL M. •TATVM Day phone •346-3819
Mailing address 5301 E 10414 mce 995/6
Lending agency HAT1oNAL BANk of ALASKA Day phone 2c;'7 -3201V
Mailing address MINNESOTA lRFNSc7
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
, Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site V-11
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.
72-025 (R". 1/91) Front MOA 071
S. 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 furtherverify 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 FLATTOP TECH SVCS. Phone ?4,T -135T
Address 14530 ECHo ST ANCIj. A/c 995/6
Engineer's signature �- �%*- Date V 2s
6� OF A4+`
dr
AV
ar
Cy=
* :4
9TH .•�9��
r .........................
.................... t+ y�
THFODOn^E i. MOOP.E
�i r0?vp••u.L..s.s..�.•' vl
6. DHHS SIGNATURE
_ Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
bedrooms,' with the following stipulations:
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 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(R« A/91) 8uk MW m
t
Municipality of.Anchorage
Department of Health Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: loT 2 UAV DOt; S& Parcel I.D.
A. WELL DATA
Well type PR t ✓ATE If A, B, or C, attach ADEC letter. ADEC water system number .. N.A.
Logpresent(Y/N) y Datecompleted 3121175 '7 .Driller M -%V DRILLING
Total depth `{2 Cased to 4 t Casing height 16 N
Sanitary seal (Y/N) % Wires properly protected (Y/N)
Date of test
Static water levet
Well flow
Pump level
FROM WELL LOG
.3 121 /7S
2-T
I -T g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 120' : On adjacent lots
Absorption field on lot 139 : On adjacent lots '>/Go'
Public sewer main > / 00, Public sewer manhole/cleanout > /o 0
Sewer service line 110 Petroleum tank t(okE OSSFR✓Ee
WATER SAMPLE RESULTS:
� r
Coliform 0 cot 1100y" Nitrate 1,9yI-e Otherbacteria O ca///oonA.2
Date of sample: 5/21 A2 Collected by: FLATTOP 160/ S✓cS
B. SEPTIC/HOLDING TANK DATA
r
Date installed to123171f `- Tank size IDOO 6G Compartments 2
Cleanouts (Y/N)Y Foundation cleanout (Y/N) y Depression (Y/N) N
High water alarm (Y/N) N.A.
•A, Alarm tested (Y/N) N •A -
Date ofpumping Pumper ROTO- ROOTER
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot t 20I 177 ' On adjacent lots > f °O Foundation R Fawn C.D.
Topropertyline — 35 -- 'Absorptionfield 2A' C-0 4* C.o. 'Water main/service line - SO'
Surface water/drainage
72-026 (Rev. 7M)FOM CONTINUED ON BACK PAGE
�c
AT INSPECTION
S•/22/92
m
n
28
/rn
ry
g•p<
;Z
pz
-
> 30
i
m
N
H4
00
N ,n
O "'
z
Septic/holding tank on lot 120' : On adjacent lots
Absorption field on lot 139 : On adjacent lots '>/Go'
Public sewer main > / 00, Public sewer manhole/cleanout > /o 0
Sewer service line 110 Petroleum tank t(okE OSSFR✓Ee
WATER SAMPLE RESULTS:
� r
Coliform 0 cot 1100y" Nitrate 1,9yI-e Otherbacteria O ca///oonA.2
Date of sample: 5/21 A2 Collected by: FLATTOP 160/ S✓cS
B. SEPTIC/HOLDING TANK DATA
r
Date installed to123171f `- Tank size IDOO 6G Compartments 2
Cleanouts (Y/N)Y Foundation cleanout (Y/N) y Depression (Y/N) N
High water alarm (Y/N) N.A.
•A, Alarm tested (Y/N) N •A -
Date ofpumping Pumper ROTO- ROOTER
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot t 20I 177 ' On adjacent lots > f °O Foundation R Fawn C.D.
Topropertyline — 35 -- 'Absorptionfield 2A' C-0 4* C.o. 'Water main/service line - SO'
Surface water/drainage
72-026 (Rev. 7M)FOM CONTINUED ON BACK PAGE
C. LIFT STATION
Date Installed
Size In gallons
Vent(Y/N)
High water alarm levet
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off" levet at
Cycles tested
Surface water
Date installed _ 0 hZ3 /7Soil rating R5 p,/BDRn S stem SEEVAGE wr
Y tYPe -
LengthDtAnETER '23 ( Width — Gravel thickness Total depth 9
Total absorption'area 433 Cleanouts present (Y/N) i
Depression over field (Y/N) tJ Date of adequacy test 522/42
Results (pass/fail) PASS for 3
bedrooms
Peroxide treatment (Past 12 months) (Y/N) No.If KrfowN If yes, give date N. /-
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 139 On adjacent lots > /oo � Property line 20' Feats C.O.
To building foundation - 21 Leah C.o. To existing or abandoned system on lot N.A.
Onadjacentlots 720r Cutbank Arco• Water main/service line � 70r
Surface water > loo' Driveway, parking/vehicle storage area 12 • FRon C.D.
Curtain drain NoKE ORSE(eVeo -
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, orconformed to all MOA and HAA guidelines in effect on the date of this inspection. y
Signature
Engineer's Name - TSS ie7oCo •e l=. MbO. e
Datef-1 y /992
P
03 }rrTH •: j' }
0.*
4j
�THEOOORE F. -MOORED• 0
d, :y •.
CE -3509 �,
Y 4r
HAA Fee $ I70 Waiver Fee: S
Date of Payment Jr'�Z�� Z- Date of Payment
Receipt Number 2-37 0 ZZ Receipt Number
72-M (Rw. "I) 8• k MOA 21
APPLIC'NT FILLS OUT UPPER HAI^`ONLY
Property Owner O/ • f �j/�J �p G
Phone
q!,
Melling Address 5-5C71— e:!,�i, �i �• Zip Code / /,j0%
%� �7c�•
Buyer 5.09 //1 kf L 7-4 74-1-11
Time
1
Address zip Code
Lending Institution
Phone
Address zip Code
Date
3
P>
Realty Co. d Agenl��e ,[� !vj/1/-✓ F/ 1Z'Vi 4.1OZ
Phone
?
Address 3 2.b/— & • 5 T• '4•!/L� // • zip Code �j"SOJ
%%• /,:Fs3
Legal Description LO y— S/ p,cu Da/G S/ub
Inspector
/
Street Location p /— - �� ��i �7 • �.11!/ f . /4�'
Inspecto 11
Type of Residence
Insp r 11
Single Family
Multiple Family No. of Bedrooms
❑ Other
Water Supply
Individual
ATTACH WELL LOG. A well log Is required for all wells drilled
since June 1975.
Community
For wells drilled prior to that date, give well depth (attach log
If available).
O Public Utility
Sewer Disposal 74/
Field Notes:
Individual Year Individual Installed:
0 Public Utility When Connected to Public Utility:
NCHORAGE
DEPT. OF HEALTH L
0 Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
1
Date
Date
Date
3
Date �n
IY`
Inspector
Inspector
Inspecto 11
Insp r 11
Field Notes:
NCHORAGE
DEPT. OF HEALTH L
f%y r7
Ef 4VIRONV 1_NTAL PROTECTION
OCT q 3 idrs�
RECEIVED
o ..
( 3 -APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ))ISAPPR VED
( ) CONDIT
AL'
DATE
BY: _
Solis Patina
Date Sewer Installed
Well To Absorption Area /per
Well Log Received
Septic Tank Size O v
V S
/ 1 ''f
Well to Tank &.g
?2W3 CM
Time Time
Date
Date
Date
k�
veg
Inspector
Inspector •
-
Inspecor
Comments
�
Conditional Approval
Cµ ut,r,9w
roomsproval,A'R-C.1�'
=Bedroo�
CPO
Date Sewer Installed
Permit No.
Septic Tank Size )0(!D0
/0--7((
Holding Tank Size
Solis Rating
Well To Absorption Area
Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner do non
Phone
Mailing Address R �..�,/ 1717 -C
Z3 76
Buyer
Address /�-/�Ih S.,�t v✓�, �T7`�'i
Lending Institution
Phone
Address
Realty Co. 3 Agent
Phone
27i-/SS3
Address 3201 'rCr. St`. AX.
%�7J-03
Legal Description r 3U' o Sk
Street Location E. 1 0q 1 t ((� hd i,i)
��!! "
Type o.}jiesidence -
G Single Family
0Multiple Family No. of Bedrooms
❑ Other
Water $apply
Ind lvidual ATTACH WELL LOG. A well log Is required for all wells drilled since June
❑ Community 1975. For
wells drilled prior to that date, give well depth (attach log If
❑ Public Utility available.
SewaeDisposal /!/+ 7
G Individual Year Individual Installed:
EIPublic Utility When Connected
to Public Utility
❑ Holding Tank
NOTE THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
w
�1
61UNICIPAUTy OfANC]10RAGE
QEPT. OF HEALTH
ENVIRONMENTAL PROTECI TI°�ALASKA SUIR011M611TAL conTR0L SCRUICES, Inc.
SAAR 3 01982 Engineering 6 Enuironmental $mdics
RECEIVED
3/26/82
JACK WHITE
3201 C. STREET
ANCHORAGE AK 99501
a a• r a• i 111 04
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 433 SQET.
THE SYSTEM IS CAPABLE OF ACCEP'T'ING 675 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 450 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON 3/26/82 .
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR
THIS 3 BEDROOM EDUSE.
OF .%%
Q %
°vt .•4�T%• 7 it
C. •Nd.
"��,'•, o. 2251E
�Zr. q��FA0fES510N�..�"
1220 Wcst 25th Auenuc • Anchorage, Alaska 99503 0 (907) 276-1361
March 11, 1962
tir. Robert Cannon
SRA Pox 1717-C
Anchorage, AI: 99507
Subject: Lot 2 Dau -Dor Subdivision
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
• The depression or pit around the well casing needs to be
filled with impervious type soil so that it slopes away
from the well casing.
• Exposed electrical wires to the well head are in violation
of the Municipality of Anchorage codes and must be encased
in conduit.
��� The water analysis report needs to be submitted to this
office from the Chem Lab, 5633 D Street, for our review.
The septic tank pumped with a receipt submitted to this
department.
• Locate and expose the standpipe to the seepage pit for our
inspection. This is to insure the minimum distance
requirements are met between the well and sewer system.
An adequacy test needs to be performed on the existing
leaching area. This test will determine if the system is
adequate according to National Standards. A listing of
private firms performing the test is enclosed. This report
needs to be submitted to this office for our review.
Please notify this department'for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this of at 264-4720.
/ Sincve rrly,
P.obert C. Pratt
`'' Associate Environmental Specialist','