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HomeMy WebLinkAboutT12N R3W SEC 33 LT 32Bion 33 Lot 32B #018-181-19 Municipality of Anchorage Development Services Depadment Building Safety Division On-Site Water end Wast~afer Pr~ram, 4700 S. Bragaw SL P.O. Box S~650 Anchorage, ~ 99519-6650 Page ~.d.an~orage.ak.us (907) ~3.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INsPEcTION REPORT Permit Uumbec 5~OIO~11 PID Number: O1~-I~--I ~ "-Helv;~ ~.~v;~k WastewaterSystem: ~.ew ~Upgrade W~'~t E~ Iq~ ~v~.¢ J,~a~e,~& ~5~U~/ABSORPT~ON FIELD Well: ~New ~ Upgrade e~ ~" -~+ /i IO SEPARATION DISTANCES D sepllc ~ HoMing ~S.T,E,P. ~ Othe~ Septic Absorplion LI~Holding ,-- ~' ~7' ~' /~ '-"-'~ .'-'*'". "~" BENCH MARK Inspections pedormed DY'~~7 . Dates. 2~ JO-- I~-01 ~..~.-, .......... Develbpme~t Se~lces Department Approval ~,'~ ,,. ,,., //// '~,-~.'., . ,.,..-,.'" P£R~T NO S~O ~ 05~ 1 PA~E 2 OF Municipo~H~c_y_oF .A.n_c h.o F c~.e' DEPARTMENT OF HEALTHAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 mAnchop~ge, AIosko 99519-6650 m Telephone= 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT L£CAL LOT $2B, SECTION 55, T12N, RSW Pig. No. 018-181-19 / 3aA _----_ \ ~ ~ NEW 2000 GALLON ~r~\,-~ ~ i E~f~fL__ J i~ ~,~.r~I ,mm' ~m ~A~IUS I ~l ,ABANDONED FOR m ~ ~ /UU w~ '"'~ m ~ ~UT2 N~W TRENCH I FUTURE USE r'''~ ~ ~ -r J i J  ~~ ~';~ ~'"'~;~' ~ , 4,. ... ............ .,~ P£R~rr NO SW010311 PAGE 5 OF 5 Municip. oAi~c oF .A.n c h.o.r'g g?. DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ,Anchor'age, Atasko. 99519-6650,Tetephone~ 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL iNSPECTION REPORT L£C^L LOT 32B, SECTION 33, T12N, RSW P.I.D. NO. 018--181--19 FINAL GRADE: 94.1 ,,/" ST1 ST2 100.0' _, NEW 2000 '"'"'93.9' GALLON S.T.E.P. SYSTEM MT3 MT3 MT2 ~-101.5' _ / ~,,/-FINAL GRADE I S--~ .q'-- DISTRIBUTION Iii 99.2' 98.6' 95,7''-/ 'X'"-MT2 = 95.7' · MT1 WATER FOUND ® ~O.2' 8 ?.:;[ B.O.H. = 95.1 PRESSURE DISTRIBUTION SYSTEM: PUMP = 20 OSI 05HH - 5 STAGE (~30 GPM) 2 LATERALS ~ 62' & 16' LONG 30 HOLES (2.5' O.C.) 3/16"o HOLES FACED DOWNWARD 1 1/4% LATERALS A 8 FCO 11.0' 21.0' ST1 14.0' $2.5' ST2 25.0' $8.0' MH 29.0' 40.0' MT1 72.0' 53.0' MT2 97.,5' 72.5' MT3 132.0' 113.0' MT1 10/25/2001 07:34 FA][ 9078686770 NAME: E~'S FJ~EC ADDRESS: 4101 E 142ND AVE era~ar~z~e 01-9154 i:,Ar'£: 10/23/01 272~$91 I'IIOA~E #2: LOT:. 3213 BLOCK: SUBDII.7,.VIOiV.. SEC 33 COMMEN'Rq C?Ji. 1ST TO 'IYPE OF ~ #2; ~,,~: ~. IAWPEC?IO~: E!:.c~. 1::2 FLnz! ~:.f_, .... ._ ...~- ~.~ --?-~ _ -_....~.~.~... ' No aOa~o~ipli~ m~d. ~ ~ not ~ncg~ mLfil r~-~c~d, - , RcjJoAglvml~; . MIEN CORRECTIONS ZtRE .~L'~DF., PI, FA.gE CALL FOR INSPEC-I~OIV DO JVOTRE!,IOI~ Tills NOTIC~ MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 I b lot ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 10, 2001 Expiration Date: Aug 10, 2002 Permit Number: SW010311 Legal Description: T12N R3W SEC 33 LT 32B Design Engineer: 0003 S & S Engineering Owner Name: Helvie Sanvick Owner Address: 4101 E 142ND AVENUE ANCHORAGE, AK 99516-4021 Total Bedrooms: 5 Parcel ID: 018-181-19 Site Address: 004101 142ND AVE E Lot Size: 39250 SQ. FT. Permit Bedrooms: 5 This permit is for the construction of: [] Disposal Field [] Septic Tank [] 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 DSD at least 2 hours prior to each inspect[on. Provide notification by calling (907) 343-7904 ( 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: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWEPJ~VELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Permit Number SW 0 10 3! I Property owner(s) Mailing address (1) ~o~ F..~$'t- Iq.~N_~°.:?.v~ · Mailing address (2) ~,.~c'~o-~.~(~- · ~,~ ~-~.-~,~ Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size 0 ,c~ THIS APPLICATION IS FO/~- Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Day phone Zip Code Number of Bedrooms ~1 ~. [~ Well Only [] · [] Water Storage [] Jacuzzi Water Softening Unit [] I certify that the above information is correct. I further cer[ify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. ~Z *///~,~---'"'-"~' S & S ENGINEERING 17034 Eagle River Loop Road, No. 204 (Signature of property owner or authorized agent) Eagle River, Alaska 99577 Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: ROAD DESIGH TEST ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 69442t 1 July 25, 2001 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 32b, Sec. 33, TI2N, R3W, S.M. It is requested that you issue a permit to install a septic system with a drainfield . _ and lift station to serve the existing five bedroom (four bedroom, adding one more) dwelling on the referenced property. A test hole was excavated and a percolation test was performed on 7/20/01. The approximate location of the test hole is located on the attached site plan. Ground water was monitored as shown on the attached soils logs & water was found at 10.5 feet. After seven days of monitoring water was still found at 10.5 feet. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, RCC nm Enclosure 17034 NORTH EAGLE RNER LOOP ',' SUITE 204 · EAGLE RIVER, A.L,'~ KA 99577 J.H.M. R,C.C. ~: '7-30-01 1 OF 2  DESIGN CRITERIA: ~U~UR~. E~SE,~,'rS. OR £~CRO^C,.~)CrS .._[//'/,~,/.:.~:;.--:.,.,.~! ~F[~ 5 BDRM = 750 GPD SHOWN ON THIS SITB P~N AR~ ~ SHOWN ON 5' DEEP DI~ANC~. AND PROPER~ UN~ PRIOR TO 3.5' EFFE~IVE CO~RU~ION. r~X~ (e0776~4-1311 (R = 0.~) I I CONT~OR DISTRIBUTION SYSTEM: I 3o Ho~ (e 3.~' o.c.) il ~ I ~EX~STING SEPTC T~K ~ -- ~ I/ a U~ STATION (TO SE X 31 ' _..,~.,,~/~ ..s.~.~w ~ , ~-' - / ~ 1500 ~LON e I ,~ t / / N WITH LI~ STATION ~, ~:~.- tN'~' X ::z:~ ' [ g ~ ' X-EXISTING L~CHFIELE 0 ' ~ ~ X°~ ~,.- .~ ~ ~ 33 t I ALL PORTIONS OF SYSTEM ~ , WITH LESS THAN ~.5' OF COVER REOUIRF INSULATION  ~'~" LOT 32B, SEC. 33, T12N, R3W, S.M. sol~ - ~.~ GPD/SQ.~. THOMAS H. DREYER ~ ~,~ ...... ,, ~, ~, TO VE~ ~EUEN~. REQUIRED SEPA~TION TRENCh OaIT~IA: o:~,acm. AND PROP~ UN~ PmOR TO ,,o~ ~ ,~,, ~, ~ ~.s~s~xvs ' ~ -~, ...-. :-"/~>'-- ......... · ::.%%; ~.o,~ ~,o,~.,-,,,, !_.wl~_ ~ EXISTING SEPTIC TANK ~ ,,,,~,o,),,,-,,,, (~-%~4) /& LIFT STATION (TO BE ~ ~ -EXISTING INSTALL NEW o ,,~ ~co / ~ ~oo OA~LOa : ~ / / 5 SEPTIC TANK ~~ F~T~ / / ~INSTALL PUMP BASIN ~~" / / / ~ WITH Ll~ STATION 0usE ' '.i.~'~ ~ ~ALTERNATE~ SITE ' :" [ ~,~' ~ '~,k ~x,s~,~e,l aa YELL / 'SEPT] _ __ 100' WELL RADIUS ~ J' -- 'J~'Q ~EACHFIE~ ~ITHIN 100'+ ~ ~ ' I FLATi MIN. 10' 'MT ~ X / :' ~ ~ DISCONNECT ~ z ~ O / - ~-- EXISTING LEACHFIELD ALL PORTIONS OF SYSTEM ~ WIT" LESS T~ ~.S' OF 5 o ~FORFUTURE USE COVER RFOUIR[ INSULATION ~ ~ Municipality of Anchorage ~'4~tII~WG'INEER'~ Development Services Depa~ent On~ite Water and W~ter P~=m 4700 S~ B=gaw SL P.O. Box 1~ ~ge. ~ ~519~6~ Sods Log - Percolation Test ' Pe,o~ed Fo~ ~' ~ G A ce ~ Date.Pe~: Legal Des~p~on: ~ ~ ~ ~ T~ship, ~nge, ~e~: SIo~ Site Plan 2- 3- 4- 0.o.#. 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water A~er Monitoring? Reading Date Gross Time Net Time Depth to Water Net Drop ,, ,' ~ Y;" ~o ~¥" 3" ,, " /o5' vo z :3 PERCOLATION RATE ;3. ~' (mmute*Yw~o~) PERC HOLE DIAMETER TEST RUN BETWEEN ~ Fi' AND .~ ~/~. Fl' $ & S ENGINEERING PERFORMED N A(~r.r..~ V~i~'~;,~L"L"~'~A-I~"'I~N~I..3:~IPAL GUI'~ELINES IN EFFECT ON THIS DATE DATE' , ,'UasKa Y95~7 ' ' SO~.TEST ROBERT C. COWAN. P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CML ENGINEERS (907) 694-2979 FAX [907) 694-121 REFERENCE: Lot 32B, Sec. 33, T12N, R3W, S.M. August 9, 2001 GENERAL: The scope of this project includes the installation of a 1500 gallon septic, tank and leachfield trench for the existing five bedroom house located on the referenced property. Construction shall be in accordance with the approved site plan and 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 any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP * SUITE 204 · EAGLE RNER, ALASKA 99577 Page 2 Lot 32B, aec 33, T12N, R3W, $.M. Augu.t 9, 2001 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. fxom the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (rafted-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Grovel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the grovel shall be perforated from the bottom of the trench to the invert ofthe distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 32B~ Sec 33, Tt2N, R3W, 8.M. Augult g, 2001 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM FSI0 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically them will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot 32B, Sec 33, T12N, R3W, $.M. August 9, 2001 The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. Them will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owners representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER 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 PHONE '~Z ~'-~ [] NEW LEGAL DESCRIPTION I- ~ Material No, of lines Length of eacl~ tine Total length of lines Trench width Distance between lines iLiq. capacity in gallons DISTANCE TO: Type of crib DISTANCE TO: Crib diameter Depth Crib d e4~ IL Sewer line NO. OF SEDROOMS ,~ PERMIT NO. No, Df compartments Liquid depth PER IT NO. Total effective absorption area Well Building foundation Nearest lot line Building foundation OTHER PIPE MATERIALS SOIL TEST RATING /oo ~'/~ INSTALLER REMARKS i ,'~, ,,,~-/~,/ ' 1.¢'~ ,J~4,~ ~'~'~. t PERMIT~NO. 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JENG'/'I'I (1:::]'.) ~:]:;8,, () / 34.0 .qB,, () GRAVEl_ V[~I,.UME: (CLh. ],/DS. ) ~ 19., 4 / 21 ,, 5 26,, 'Tf~tlxll<: S]:ZI: ([']ALS) ~v/S~z,t/¢~:)~.;~-'~_~o ~000~E~'~' ,(~0:1:1., RA]'):NG (S[;~,, ,:::'T. /)3F() ~ 125 ~-.~ TAI',IK MU'3T HAVI!!!: Al' I,.EAST TWO C!]MI:::'AR'f]qlii]qTS (:::el"L :i. fy thai:.: :t.,, ]: L:ull '[~:.uftJ.]:i. al' w:i. tll 'U-If.:! i'equ:i, p6mlelq'k.:; I'(::m cnl'"'i~i:i.t.(~ :SL!t,~¢,H"!:i ~'(::)rl:,h by M"t,:,) Mt.u'~:i. cipat:ity oF Anchc)ra(]e (MOA) ,'.~n~} 't'..h(:~ 2. :[ ,/,]i]:] :i. nsta:l, 1 t:.he syst:.em .i.l'~ ac:c:(::md,':u'~cc~ w:i,'{h ail , 3,, I ~.:1.]. acJl'n:2r'e 't..(::) ail I'I[)A arn::I SLa't:.~.) ct.[' A],a:,l::a r~:,qu:ir~,>m(:.::~'t'.s ¢(::n' the s()'t, back se)~JeH'age ~';,'/~'t:,~.:)g] cn~ th:i.s ~::~1' any adjacen"v[ c)r lltF)i'~['l:~y ]: und(/)rs[a~d i:.l]ai:. [his i::)0:H'm:i.t :is va].J.d ~'(:)r' a m.'~x:i, mum cof' 3 I::}~,.~c:h"[3oms and cdp/ ('~n],ar'q(.:~merv(: w:i,].], r'(:;H]tJ:i. PE) al'l ~'?d:h::l:i, ticlna]. ]: F:' A 'I"FIIEN W:[I,.L NO'f' BE APF:'ROVI:!~D W I'l'l IOtJ'f' AIq E:L..li:CTR]:CAI.. ELECTF,:]:C, AI.. WOF;:K MI.IST BIE DONE BY A I.]:[',IEI',ISE'O I.. :1: F:T ST(-TI" Z (:)iq ]; S I I'.I,S:;]'AI..I .E:D I Ix! fin AF;%A [;OVIEF;:E:D [.",Y I'1OA ~':' ~ 'r , ¢' ..... :' ( J ) AN IEI..I:.L, I F,,.I...AI I::'I~:I:~M ]: 'T (]lqD ]:f',lSf:'li:[:'l"]]]l',l I"IIJST E',I: (]BTA]]',IE:(}', (;:;i'.) ,.. ,~ ,. ill I,i A F:'PI. ]: C AIq'l': SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl. PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4- 7- 8 9 lO 11 12 13 14 15 16 17 18 19 2O F~' t~ ('Th,'cY,~ on ~.) SLOPE DATE PERFORMED:_ (~)~' ~- ~"~'~ / SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net , Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN __ FT AND __~ FT ~72-oo~ (6179) ANCHORAGE, ALA. -~ 99503 Phone 561.5040 DHEDKED BY .... - DATE LIFT STAT/ON DETAIL NEMA 4 ENCLOSURE GALVANIZED OR PAINTED METAL COVER 2" URETHANE FOAM GLUED TO COVER POWER AND PUMP CONTROL LINES I~Xd" DIA PULL- PIPE CONNECT~'D TO PITI_ E'SS ADAPTER FOR PUMP REMOVAL GROUND LEVEL I ~ DIA STEEL PIPE PUMP PUMP POWER FILLET WELD AROUND RIPE ~"i o "DIA SOLID PVC PIPEi M SEPTIC TANK .CALDER COUPLING DIFFERENTIAL MERCURY FLOAT SWITCH ALARM CORD ADAPTER I ~"~" COUPL lNG 2"SOLIDPE ORAB 4' MIN / . TO ABSORPTION A REA ~HEAT TAPE GALVANIZED STEEL A-~444-76) OR ALUMINUM CULVERT ALARM LEVEL · PUMt /NS/DE OF PIT SHALL | BE COATED WITH BITUMINOUS PAINT ORTAR ~'"~,',,',,~'~.~, d~,~tl., ,-,f' ~.../ ~ ~?" ~,,'~, PUMP "OFF" LEVEL GALVANIZED OR PAINTED STEEL PLATZ MUNICIPALITY OF ANCHORAGE DEPARTMENTOFHEALTH&ENVIRONMENTALPROTECTION (-/-0 (T C/ [ ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, A~aska 99501 'relephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAI LI N~G ADDRESS LOCATIO~c/,3~ .¢J ~ DISTANCE TO: Liq, capacity in 9aliens DISTANCE TO: IF HOMEMADE: Inside length Liquid depth Well DweNing PERMIT NO. DISTANCE TO: / Well No. of lines Top of tile to finish grade Width Foundation / Total len~ :,~es Material beneath tile Depth ]Wd~ ~ Near~st~'~ot Jine / Trench. ic~t h// [Tren ~)v/;~= inches Liquid capacity in gallons PE I NO. / Distance between lines Total eff0cdve absorption area PERMIT NO. Type of crib Crib diameter Crib depth Total effoelive absorption area Well Buitding foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot tine L~._~_/_~¢,~ / Building foundation Sewer line Septic tank I Absorptio~ a~aea(s~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) 1:;, E F" I:::11:;;i t" H E 1".! i [ i:)(:::l::l I :1' I' t",l t-.IE (131::1L I"IFIV,:!:HIII"I H I"l[i[i:'l:;' OF' I:',E[:,f;i:CICd'I:!:: ...... 1. liE: L [~:[lql:!i'l"H l):!: lll[i:~',l~ii: ]: (:)l"lt ]i i-i; TI I1_: I [::I",IG t-I I ( '[ tl,l I:'[:F:'!' .:' OF: "1'[ Iii: 'II'I:'i:IZI",!E:I I Ii]Il';: [::'t;~:1:1:1: t".tl::' :[ [::1 I.;' III1.: Dt::t:::II[ll (I)F t:::1 'II:;:E:I",IE:II EII;;i [::I:I:T ];S I'tlE[ l::']:}~;l"l:::lt'lll:~:fi; E:Iii'I'H[:::{::I",I t'I'][-:: i~i;I. II:;:l::'l:::l~::[: OF: ]111: I:il:;i:CILtt:,ll:)' I:::INI) '11'11}_ l;'i:Ci"l']Ollll Cfi: 'Illl[i: Ei:i:.:iE;I'::I',,,'I:::I'I ]:Otl':l (:i:I'.,I I:Ef:!:I). 'ItlE[;;'I:::: I '5 t'40 SEI' t,I ;1: Ii)TI II:::E6:'. 'll;i[[~l.,ll::;tlt~:!ii;. IIIE GI,;:I:::I',,,'[::I I)[~:l:!'Iq ;I.::; I'/11: H(I",I[I'IlJ['I I:)IEP"II"I l::lt:::' (:il:;~:l:::l"ll:E:l_ IiiIE:TH[i:IEI",I I'IIIE EIt.I'tFI:I!.I. [:':!:t::'E FIl"d::, ['H[i: B()I I'EIH O1:: 'f'11[!: I:V,I::t:I'v'I::IT;!:CII",t (]:i",1 I::E:I~i'::I. :1: I: :: l: i l ;: l ' ]: I::: h' I t'IFI [ :1.: :!: I:::11't F: f:ll"l :[ L. :[ I::1t:~: I.q ]: I'H i-HI!!: [;:'.[!~1~:!1. Ii: 1'4'.[:H[(I',I"i'S I:Of~: Of',l-":i:, ;i: I'f:: :!;[J;I,.tI:!:[;::S I::[N[) 141:1.1. S I::CII:;;:IH [3? Ill[: I'tl..Iht]:I:::[I::'F:II.]:T'¢ Cfi:: f:IIqC:tlCIi:;:FI(~iE: ::: ]: I'1:1: [.l :1: N:::t't:::IL.t ['tie ?'¢~:'1%1'I I: H FI(::COI:~:I)f:II",IC:[:: I'1 :[ TI'I TI-II: :~:;:: [ t..INf)EI:;i:?II:::II".f[) THI:::IT I IIE l:lhl'"'~:;:[]'l:( :~:;E. I4[::I;~: ?¢::;'1'1:1'1 t'"IF:I"Q [,~:1~:~1:;!1.):1:1:;~'.f~: l::hll..l:::l[;:Fi[il'l[X,l'l [[: file F;'.I/~::Ei):I;'IEIq(;:E :1:~.; I;;:E:I'ICd)EI ED TO :[1",1(::1 LI[:'[~ fflCIf~'.[~: IIIFIH ":1. :1: :::::::::J::::::) [:" , ~ ,.~,-.~..--':'~-'- "-[:: :::'' ::: ............. '"":::' SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222'~ SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5- 6- 7- 8 9 DATE PERFORMED: ~ ~''/'5 -7o~ C o lo b /,e 5 ~ SLOPE SITE PLAN 10 11 12 13 14 15 16- 17- 18- 19- 2O COMMENTS WASGROUN"WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEE '/Om 5', 5; ~ -- FT AND (minutes/inch) FT 72-008 (7/76) b /~ That we~l i$ producing v,~all'' ,MOON DRILLING .. IJOX 3370 PA[MI R, ALASKA 9%45 1 [LI:PttONE 74:S-4071 BIk.~ Sub,~ I/ WELL LOG ItLEA$1~ PAY FROM THIS INVOICE /.__~/ I MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) fi/o/ (b) Property owner ~::¢~'e Mailing Address (c) Lending Institution ~f~/ ~ o~ ~[~/=~ Telephone Mailing Address (d) Real Estate Company and Agent /"Ce /~¢.¢. Address S ~'O O Go r ~:~'o v~x ~-~,,' Telephone Z76'- Telephone: (home)'~¥-5-'~''z'~'? Business 5"d'/~ 303'3'- (e) Mail the HAA to the following address: (or check here [], if hold for pick up.) List contact person and day phone number below: '7-ec.~ ~o~ re ~ ~'5'- / ~.¢'..¢ 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 3. WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev 7/8§) Page 1 of 2 ')pOM s,Jaeu!eua ISUO!SSajoJd aql u! suo!ss!uJo Jo s JO J J@ JoI elq!suodsaJ lou s! e6sJoqouv jo,q!lsdfo!unR eq/'panss! s! also!t!lJeo s aJoteq elsp eZXlSUS Jo suop, oadsu! lonpuoo lou op SHHC] jo saa,~OldUJa 'siueuJa]!nbaJ ale,s pue IsJepaj u!s),Jeo ,~JsRss oh ~ap~o u! suo!~n~!~su! 8u!pual ~!aLtl pus SeLUOq JO sJessMoJnd oi Xsa~Jnoo s ss s!q~ saop SHHC] aqj_ 'e)tSSlV to a~m,$ eq~ u! pa~a~s!6a~ ~eeu!eue Isuo!ssajoJd luapuadapu! us/~q a^oqe ~ qdeJesJed u! ua^!6 suo!~e!uasaJde~ aLl~ uodn ,quo peseq pe~eo!jpao le^oJdd¥ Alpoq),n¥ qtleaH senss! (SHHC]) sao!^~eS ueLunH pus M~leeH jo ~UaLU~]sdac] aeeJOMOu¥ to X),!led!3!un[q aM.i. leUO!~!puoo / ISAoJddv ISUO!j!puoO jo SLUJa/ paAoJddss!O ~ paAoJdd¥ Xq sLuooJpaq ~ JO,[ paAoJddv q'¢AO~dd'¢ SHHO '9 lees MUNICIPALITY ~F ANCHORAGE (MOA) Approval (HAA) 343-4744 RECEIVED A. WELL DATA Well Classification t Well Log Present (Y/N) )" Date Completed TotalDepth ~o3' Casedto (~'~' Static Water Level _ 6'7' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot II E' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line N,.4. Legal Description: £ ec~o~ 3.7 If A, B, C, D.E.C. Approved (Y/N) N, 4-. 8/~ /' 7¢' Yield Depth of Grouting Pump Set At ~> 8 '7 ' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Y N ; On Adjoining Lots ;:> fcc ' / '7 3' ; On Adjoining Lots _ ;> ~.,o ' To Nearest Public Sewer Cleanout/Manhole N, 4. To Nearest Sewer Service Line on Lot __ Water Sample Collec!ed by Water Sample Test Results Comments D,X,'"~n..~ ~1/ ~(o~ ~ SEPTIC/HOLDING TANK DATA Date Installed~¢~7~ _Size /~/ No. of Compartments Standpipes (Y/N) .... ~ .... Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) N, Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well I I ~" To Property Line ~¢ ' To Water Main/Service Line ~ ~ ' To Stream, Pond, Lake or Major Drainage Course ~ (~o ' Comments ;Date 1/31 /90 ,,/ Foundation Cleanout (Y/N) 'r' Date Last Pumped I~'1~'[ ; for N, ,4, Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field 72-026 (Rev 7/88) From Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Datelnstalled H //~" /,~ Width of Field ..-¢.-8-r- I ~ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot ~ fo ' To Water Main/Service Line '/L~'~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line /5- ' To Existing or Abandoned System on ; On Adjoining Lots ..~ 3'o ' To Cutback (if present) /~,/t. To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments i'1¢¢~t¢,~c¢' ¢,cc~/'~;e~ /¢~'~o~' D. LIFT STATION Date Installed (I lid- ,"<~' Size in Gallons 5-g~' ~/ ;~: ~c~H /~ ~'/~ "Pump On" Level at '~ Y ~' High Water Alarm Level at /¢~ ~' Tested for /~y Meets MOA Electrical Codes (Y/N) Y' Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA ~.u~jQg~jn effect on the date of this inspection. Signed ~~ ~ Company F{~ ~g~)¢~/ ~ ~'~ ~ ...................... ~...~ Engineer's Seal MOA No. ~ - /~ Receipt No. ~/~¢ ~¢ D Receipt No. ate of . ment P*/ Waiver Amount: $ / ~J' ~ Date of Payment 72 026[Rev 7/88) Back Page 2 of 2 OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907)5'63-2343 ~'$~J~.L~// ANALYSIS REPORT BY SAMPLE for Work Order I i9610 '~/- Date Report P~lntod: FZ~ 6 90 ~ 12:47 Client Sample ID:L32E, SEC 33, TL2N. R30 S~ HOSE PWSID :UA Collected JAN 31 90 ~ 14:45 hrs. Received JAN 31 90 @ 16:45 hrs. Preserved with :AS REQUIRED Client Name : FLATTOP TECHNICAL SRV Client Rcct: FLATTOT P,O.~ NONE RECEIVED Req ~ O~dered By : TED ~OORE Analysis Completed :FEB 2 90 Send Reports to: Laboratory Supsr/~i~_j~TEPHEN C. ZDE lJFLATTOP TECHNICAL SRV Special Instruct: Chemlab Re£ ~: 9398 Lab Smpl ID: I ~at~lx; WATER Allowabl. Parameter Tested ReCult Units ~ethod Limit, NITRATE-N 0.85 mg/l EPA 353.2 lO Sample ROUTINE SA~PI, R Hemarke: SAMPLE COLLECTED BY T.F.~. I Test, Performed See Special Instructions Above UA-Unavailable ND- None Detected "See Sample Remarks Ahow Nh= Hot Analyzed LT=tesm Than. GT-G[eatez Than I/~UN',Ci%"BTY', OF ANL.HOt~A~[ MUNICIPALITY OF ANCHORAGE I:EP[, Of DEPARTMENT OF HEALTH AND ENVIRONMENTAl. PROTECTIONE~%~;~''~'' ' mwS ON OF ENWRO.UENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL RISC Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, renge) Location (address or dire~ions) (b) Applicant Name ~~'~¢"/~f~., Telephone: Home ~¢~" '/¢.~'?' Bus,ness (c) Applicant is;[c~eck one},j B~¢¢¢]h~.l9~t~ ~; Owner/builder~; Buyer B; Other ~ (explain); (d) Lending ns~tuid~., kl,tl .?"Lr'"~ Telephone Address _ ~ (e) Real Estate Com~ny,,~pd Address Telephone (f) Mail the HAA to tire following address: 2. TYPE OF RESIDENCE Single-Family'~ Multi-Fa2y [] Other Number ol Bedrooms L_ WATER SUPPLY Individual Well~ CommunityD Public[] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4, SEWAGE'DISPOSAL Onsite~.. Public [] Community [] Holding Tank [] Note: If corrr munity well system, must have written confirmation from tire State Department of Environmental Conservation attesting to the legality and status, Page 1 of 2 72 025 (11~84) ENGINEERING FIRM PROVIDIF. ~NSPECTIONS, TESTS, FILE SEARCIf, D,' , AND INFORMATION As certified by my seal alfixed hereto arrd 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 indicaLed herein. I further verily that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm //¢'~'~ Telephone DHEP APPROVAL Approved for Approved Disapproved Conditional .. Terms of Conditional Approval Date CAUTION The Muneipality of Anchorage Department of Health end EnvJronmentaJ 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 Alaske. The DHEP does this as a coudesy to purchasers of homes and their lending Jnstifutione in order to setiafy certain federal and stere requirements. Employees of DHEP do not conduct inspections or analyze dete before a eertificate is issued. The MunicipaJity of Anchorage is nor responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA ...... DEPT. OF HEALlH &" ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOAI HEAl. TH AUTHORITY APPROVAL (HAA) J U N 0 (~ 1986 CHECKLIST ~ FEBRUARY 1984 264-4720 Legal Description: /._ , RECEIVED Well Classification Well Log Present'N) Total Depth / ~""~ Static Water Level ~'~,)~'/t'//~7'~¢''' If A, B, C, D.E.C. Approved (Y/N) Date Completed ~r-/~'~-?~' Yield ~'"~,./'-') ~'~ Cased t9_ /0/ / Depth of Grouting _ ~ 73-~ - Pump Set At ~_ /, ~ / Sanitary Seal on Casing~N) Depression Around Wellhead (Y~ Casing Height Above Ground Electrical Wiring in Co~nduit~.)N) Separation Distances from Well: To Septic/Holding Tank on Lot ! / ; On Adjoining Lots /~ To Nearest Edge of Absorption Field on Lot _ ? ~-~ / ; On Adjoining Lots To Nearest Public Sewer Lir;e ~ To Nearest Public Sewer Cleanout/Manhole ,~/,,4 To Nearest Sewer Service Line on Lot Water Sample Collected by /'¢'~¢~'~' /¢, /V/Z"/ ; Date ~-~-3 '?~ Water Sample Test Results Comments ¢ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes~N) Air-tight Caps (~N) Depression over Tank Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) - Separation Distances from Septic/Holdin/g Tank: Size /Z'-'-'-5~'¢ . No. of Compartmeets ~"" ItO /eo Foundation Cleanout(~N) Date Last Pumped __7 /[/fl ;for ,'~J/~ , Temporary Helding Tank Permit (Y/N) / To Building Foundation To Disposal Field ¢'~ / To Stream, Pond, Lake, or Major Drainage To Water-Supply Well To Property Line To Water Main/Service Line Oe ~qf2 Pa 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ,/~'0 Date Installed //-/0 -~¢ Width of Field ,~"~" ~'~)~ .f~ . / Square Feet of Absorption Area ~/~ Cf" Depression over Field (Y~ Results of Last Adequacy Test /~"'~b'//r'¢'''~'''' -- 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 Presen~N) Date of Last Adequacy Test ~ ~-~ ~¢'~ To Property Line ,/~"" / To Existing or Abandoned System on ; On Adjoining Lots ~"~ To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at 4 High Water Alarm Level at 4 )~-ested for Electrical Codes ~N) Dimensions Manhole/Access~N} "Pump Off" Level at Vent(Y/N) t/ Pumping Cycles during Adequacy Test. Meets MOA Comments .~,&"~ /~/~/~/~' /,~d/? ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h~ch~ed, v~rifi~d, or conformed to all M~ and HAA guidelines in effect on the date of this inspection. Signed ~L'~~ Date No. Company Receipt No. Date of Payment · Amount: $ Page 2 of 2 72-026 (11/84) ALASKA 8 dlF oIlmel]TAL COI TI OL $Sr uIC $, IFIC. ~nqineerin§ 8 ~nuironmntd Studies MARY & JAMES REBENACE 4](I] EAST 142ND ANCHORAGE ALASNA 99516 SELLER-SAME .JUNE 5 t936 MARY & JAMES REBENACI< 4101 EAST 142NU ANCItORAGE ALASKA 99516 60257 LEDAL:T12N R3W SECTION 33 LOT 3215 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST [)ATE .JUNE 3 1986 THE TYPE OF ADSORPTION SYSTEM IS A BED WITII AN AREA OF 612 SQFT TItE SYSTEM iS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF TIlE SYSTEM IS 603 GALLONS, BASEI) UPON TIIE TEST DATA TIlE SYSTEM IS'ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANI( ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR TItlS 4 BEDROOM HOUSE. TIlE SEPTIC TANK/PACIiAGE PI,ANT WAS PUblPED ON ,JULY 25 1985 . THIS REPORT DOES NOT VERIFY 2'lie INTEGRITY OF TIlE PIPING I,'OR TIlE WATER SUPPLY OR WASTEWATER SYSTEbl. FLOW TEST ON WELL WELL FLOW DATE JUNE 3 1986 A FLOW TEST WAS PERFORMED ON TIlE WELL. 603 GALLONS OF WATER WAS PUMPED Al' A RATE OF 8.6 i GPM OVER A DURATION OF 2.7 HOURS. TIlE DRAWDOWN WAS 8.4 ' WITH A RECOVERY TIME OF 80 MINUTES .5 ~ · AND THE STATIC WATER LEVEL WAS 98.6 FEET. THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME, 200 ~esl 33rd hucnu¢, Suite B · Anchorage Alaska 995030(907) bCdNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEAl,TM DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block~ subdivision, section, township, range) Location (address or directions) , (b) Applicants Nam Applicants Address C~ ([/_~_~.L..6 /c4 ~.~c~ ~(c) Appl~iea.h)_i~ (check one) Lending Institution .... Bu~ar ~ ':;i'; Other F--~ (explain); (d) Lending' Institution TeIephone Address (e) ileal Estats CO, & Agent ~~7 Address 'c~ ~ O_~J__A)~ C%6-~4'[~t~tg~ Telephone .. ~-q J - ZIO ~ (f) Mail the I~ to the following 2¥ '~of Reszoenc. Single-Family~ Number of Bedrooms ~ate___~.' SUPP!.H Individual Well~-----[. Multi-Family Other (describe) Community ~ Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewag~.O__isposal. 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 21 5. En in~i_ng 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 ny 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 ~th all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Fir~_ ~C5 Address IL ~ O ~ (ENGINEER SEAL) DHEP .kppr_oval Approved for /~,'x' /~)bedrooms Approved _--~. Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE ILEPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAl, ENGINEER REGISTERED IN T~ STATE OF ALAS~%. THE DHEP DOES THIS AS A COURTESY TO ~PURCHASERS OF HOMES AND TMEIR I~NDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HFJkLTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: I,,~UNICIPAI.ii'Y OF ANCHORAO,~ DEPF. Ok ilEALiH & I .u ~E L PRCidCI'iON R i:! (] E!V D Well Classification ~%p If A, B, Or C, D.E.C. Approved(Y/N) Well Log P~esent ..~N) 7e ~ Date Completed ~'~ - ~ f'Q~ Yield Total Depth ~/O%' Cased to ~ /~ ! ' Depth of Grouting Static Wa~r. Level q 7, ~ ~ Pump Set At ~/' ~_!9 I ~asing Height Above Ground /, Electrical Wiring in Conduit ~/N) Separation Distan~ss f~om Well: To Septic/~t~Pi~x~ Tank On Lot ~-/0 Sanitary Seal on Casing Depression Around Wellhead (_Y~ _; On Adjoining Lots To Nearest Edge of Absorption Field on Lot~L I / To Nearest Public Sewer Line ~3 ~ Cleancut/Manhole ~/~ Water Sample Collected By Water Sample Test P~sults ~ ; On Adjoining Lots~T/O To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date fo-ii~ B. SEPTIC/HOLDING TANK DATA Date Installed{/~//~ Size~_~L ?O '.'-~ __. NO. of Compartments Standpims~) ~5 Air-tight Caps ~) 9~5__ Foundation Cleanout~~ ~p~ession ove~ Tank (X~O Date Last Pt~d /~ Pu~ing~aintenan~ Contract on File (~) ~- ; fo~ Holding Ta~ High-Wate~ Ala~ (Y/N) ~ ~m~ra~y Holding Tank Permit Separation Distan~s ~ ~ptie~ Tank: To Water-Supply ~11~..{0~.9' To ~ilding Foundation ~ To ~o~rty Li~ ~O ~ To Dis~sal Field. ~ To ~ter Main/Se~vi~ Line ~ TO S~e~, Pond, ~ke, or Major ~ainage Cour se ~'~ ,' O0 ' [Pa~e 1 of 2] Receipt ~ Date Paid. Anlount: . 1f.-~:i~'.- 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~- ~-11-9% Width of Field ~%'¢ Square Feet of Absorption Area Depression over Field (.Y~ ~uO Date of Last Adsquacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~-) t{; To PEoDerty Line Length of Field Depth of Field Gravel Bed Thick~ess Standpipes To Building Foundation Lot ~3 ~- ; On Adjoining Lots fr?/6~! To Water Main/Service Line ~- To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course C~ 7 ~ o ~ ' To Driveway, Pa~king Area, oE Vehicle Storage Area 71 I ~'~' P--g,q/ To Existing or Abandoned System on D. LIFT STATION Da~led Size in Ga/l~ "Pump C~" Level High Water Alarm Level at Tested foe Electrical Codes(Y/N) C~ments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ~ Vent (Y/N) ** C~eck Permitted Bedrcx~m Rating Against HAA Request ** I certify that I have checked, verified, oE conformed to all MOA HAA Guicl~lines in effect on the date of this i~.s~pection. Company KB1/d5/s Date MOA No. [Page 2 of 2] 2-15-84 ..lx~4~d~.~ON FIE[iD Ila Soils ~:tir. g in Absorpti°n Strata DaLe Installed Width of Field, .... Square Feet of ~pti~ ~ea ~press~on over ~i~l~ (Y~) Results cf ~st Type of System E~sign Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of L~st Adequacy Test To Water-Supplyi..~WsllPi -h~, >: To Property Line To Buildings. Foundation '. ~ TO Existi~ or ~ndo~d Sys~m Lot - ; ~ ~joining TO ','~at,.m Main/~vi~ Li~ To ~t~(if pre~nt)__ To otream~ond~ke/~.~]~ ~ai~ ~ To ~iveway, Parki~ :~ea, ~ Vehicle St~a~ · Date Installed Dirge ns ions Si~e in Gallons b~w_~l at. i'esLed for ' .... ~.::...'':' Electrical Co~s (Y~)' Manhole/Access (Y/N) "Pump Off" level at /~ ~/~ Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Con~n~ nts ' ' c'i~,~et i%z:'mJ I:ted Becl~oc~n RatinG AGainst ~ ~q~st ** i (~r'tifv ~at I ha~ ~ed, ~rified, ~ ~f~d to all b~3A ~ ~i~li~s in effect 2~15-84 ALASKA F1UII OFlm FITAL CO[1TROL SeRUICe5, IrIC, ~r, qiue~rin~ $ ~nuironmenlol $ludies OCT 19 1984 ADAM JOBNSTON 4100 E 142ND AVENUE ANCHORAGE AK 99507 SELLER - VICK VAILEY BUYER - SUBDIVISION - T12N R3W SECTION 33 BLOCK - LOT - J2B ADE~dACY TEST FOR SE~4~R SYSTEM FLOW TEST ON WELL THE WELL FLOW RATE WAS 2,368 GPM FOR J HOURS. THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 550 S~JZT. THE SYSTEM IS CAPABLE OF ACCEPTING ldo GALLONS OF WATER PER DAY, THE 5URGE CAPACITY OF THE SYSTEM Z5 290 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A HONE OF 4 BEDROOMS. THE SEPTIC TANK WAS PUMPED ON OCT 19 1984 '1 ~ SEPTIC TANK ADE~JACY THE EXISTING SEPTIC TAN{ VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE, 1200 L[lesl 33fa Auenue. Suile [~,, Auchoraqe. Al~sko 99503e(907) 561-.5040 --D ,~T~ RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME -~ATE DATE DATE INSPECTOR INSPECTOR INSPECTOR ,-. MUNICIPALITY ©F ANCNO~AGE MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~IVIROb~.,,[[,~,~L , . ~ LCTION  825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Teleph.n. 264-4720 , R~C~Iv~D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DI RECTION8: Complete all parts on page 1, Incomplete requests will not be processed. Please ~llow ten (10) days for processing. MAILING ADDRESS-- PROPERT~ RESIDENT (l~differee~from abo~~ PHONE 2~ BUYER ' MAI LI~G A D D~R~ - '~ -- MAILING ADDRESS y ' ' 4. RBALTOR/~GE~T - PHONE MAILING ADDRESS ' -- ~--. ~E-~'~. DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER O F ,B E D~,~_~ M S [] One '~ Four [] Two E3 Five [] Three [] Six [] Other 7. WATER SUPPLY ~, INDIVIDUAL~ [] COMMUNITY [] PUBLIC UTI LITY 8, SEWAGE DISPOSAL SYSTEM "'~;~ INDIVIDUAL/ON-SiTE*' [] PUBLIC UTILITY ATTACH WELL LOG. A well Icg Is reaulrecl for all wells drilled since June 1975. For wells dri led prior to that date, give well depth (attach Icg if available.) YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BI.-' FORE PROCESSING CAN BE INITIATED, ;¢,' "x~qq MUN,O,PAL,,M OE ~.~.O.~ ~V,~O~.~.. ~ ~.. ~,O~  ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 R E C E i ~ E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on paae 1, Incomplete requests will not be proc0ssed, Please allow ten (10) davs for orocessing, 1. P PERTY OWNE~R PR O¥~ERT~I~R E~' DENT (l~f dllOh~o~t from 2 BUYER MAILING ADDRESS MAILING ADDRESS 4, REALTOR/AGENT PHONE PHONE P~'N E PHONE MAILING ADDRESS E, LEGAL DESCRIPTION STREET LOCATION 6--TYPE OF RESIDENCE NUMBER OF BEDROOMS ,,,~ SING LE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY [] One ..~J~'Four [] Two El Five [Z] Three [] Six [] Other ~,~ I'qDIVIDUAL* COMMUNITY [] PUBLIC UTILITY S. SEWAGE DISPOSAL SYSTEM 4~' INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY + ATTACH WELL LOG. A wall log is required for all walls drilled since JuDe 1975. :or walls drilled prior to that date, give well depth (attach log if available.) '*If individual/on-site, give insta lation d to , If system is over Two (2) years old an adequacy test is required NOTE: THE NSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSP ECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILy [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED~ .~_~ 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED(..~ E~PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: )o~~''~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACT~ TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nea'rest Lot Line Absorption Area to nearest Lot Line '~. COMMENTS ~ APPROVED FOR ~.~-- BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev, 3/7B) CON'rROL SERVIC' INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 JOB -- ' SHEET NO OF DATE~ l / t ,/