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Home My WebLink AboutELMORE #2 BLK 7 LT 9 ~'t MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMF P~IONE LEGAL DESCRIPTION LOCATION [~ NO. O~OROOMS ~ ~ DISTANeC~n' Well Oweiling PERMIT NO. ~ Liquid camcity in OTHER SOIL IISI RATING 72-013 {Rev~ 78) PER~IT NO. APPLICANT LOCATION LEGAL HUt4 I C I PAL I T~r' OF A~4CHORAGE DEPARTMEN, T P~-HEALTH AND ENVIRONMENTAL/'~OTECTION 8--05 '~ STREET, RNCHORRGE, AK. 264-472~ tdELL Ar4~ ON--~ I TE SEWER ( 810~1~ ) PO 10-2157 JOHN HENSLEY 145TH LOT ~ BLK ~ ELMORE SUB 345-~.084 LOT SIZE 43000 SQURRE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MRXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 7 LEI'4GTH= '100 I~iRR~..'EL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD, THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO 5ET WIDTH FOR TRENCHES. THE QRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REQU I RED SEPT I C TRr-.I~,-. S I ::~E: I 2.50 i~RLLOI'-.IS PERMIT RPPLICRNT HR$ 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. TL,IO ( 2 ~" I t4SPECT I Or4S ARE REQU I RED BACKFILLING OF ANY SYSTEM WITHOUT FINRL INSPECTION AND APPROVRL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R 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 R PRIVATE WELL TO A PRIVATE SEWER LINE IS ~5 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEAr-11 T E×P I RES DECEMBER ;~:::!_, -1 ~'~8~L I CERTIFY THRT 4: 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 THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. ~ ~v"~UNICIPALITY OF ANCHORAGE f'~ DEPARTMENT. OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 09501 2644720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST SLOPE 11 13 14 15 16 17 18 19- 20- COMMENTS DATEPERFORMED: ~' ~ SITE PLAN WAS GROUND WATER ENCOUNTERED, y'~ I~ O P g E IF YES. AT WHAT Reading Date Gross Net Depth to Net Time Time Water DroD J J PERCOLATION RATE .(minutes/inch) TEST RUN BETWEEN FT AND FTr PERFORMED EY:~~ CERTIFIED B Y: ~E~~i~,.~.D AT E ::~ ~- 0 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 1. GENERAL INFORMATION Complete legal description £ot 9; 8~oc~z 7; E~z~o~;. #~ Location (siteaddressordirectlons) 4401 E. 145~tk Ave~,,,( A~cho~,,g¢, AK Property owner Mailing address Lending agency Mailing address Agent Gcc~/ V~z~tou~ / Address 1101 'E 7&,tit. 4401 E. 145.t. tt Aue. tzu. e Day phone $45-06Zf~ Ancho,,~tge, AK Day phone POLAR REALTY Day phone $45-06~ 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well. Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on.site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 Insp .e~tion. S & S ENGINEERING 17034 Eagle River Loop Road No, 204 Eaqle River, Alaska 99577 Name of Firm Address Engineer's signature Se DHHS SIGNATURE ~ Approved for ~-~.,>. (z./.) Disapproved. Conditional approval for Date Phone bedrooms. bedrooms, with the following stipulations: By: Additional Comments Date The Municipality of Anchorage Department of Health and Human Servlces (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by a,, 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. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: L-OT=/ /~(--~ EZ.~c~' $/'D ~'~, ParcelI.D. 4'/(~-//2~-'F? A. WELL DATA Well type Log present. N) Total depth Sanitary seal ~N) Date of test Static water level Well flow Pump level If A. B. or C, attach ADEC letter. Date completed FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot //-~ · Public sewer main Sewer service line ~--~' ADEC water system number ,4.~/',~ 4, {z-~Jgl ' Driller S~'~ ~'~o$. ~l~.clt.~ , Cased to ~ ~' Casing height I Wires properly protected~) '~--~ g.p.m. AT INSPECTION ... g.p.rm--- ; On adjacent lots ; On adjacent lots, P~blic sewer manhole/cleanout, A.]o/J~ ~5~'~.'~" Petroleum tank ~b/j,~' WATER SAMPLE RESULTS: Coliform ' Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed Cleanouts (~i High water alarm (Y,~ Date of pumping ' Nitrate ~/C:'. [~)/~// Collected by: Other bacteria Tank size / ~ Compartments ~ Foundation cleanout(~N) T"~S'~ Depression (Y~___~ ~ Alarm tested (Y,~ ~//~ Pumper A~ HOlVJc~ ,~EY~t/IC.E'S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line SuHace water/drainage On adjacent lots Abs,.,rption field Foundation Water main/service line 72-026 {Rev. 7.91) Front CONTINUED ON BACK PAGE C. LIFT STATION ,c~,~,uE' /o~E/~q'- · ' Manufacturer *' ~_ ' Manhole/Access (y/N)_ ~..----'-''/~ High water alarm level ~ ~ ~..~es tested Meets MOA ele~i~~ . . . ~ ~t ~. ' ~ adj~ent lots - ' S~ace water D. ABSORPTION FIELD DATA Date installed ~' //~ ! ~'1 ~--'l Length IO-~'- Width T0tal,absorption area ~ .~ ~ Peroxide treatment (pest 12 months) (Y/N) Soil rating /..-~0 ~"/,~Z~,.~ System type Gravel thickness ~ / ~" Total depth Cleanouts present ~/N) ~/~"~ ~ Date of adequacy test for ~ /~'~./c3c.J,,.J If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: . Well on lot /[~.e On adjacent Iots.l.O O~'f' Property line To building foundation ,~.~-~)1 To existing or abandoned system on lot Wo~ Onadjacentlots ~ /~ Cutbank ~o~ ~Watermain/se~iceline Sudacewater ~o~ ~~ Driveway, p~[king/vehicle storage area ~ E. ENGINEER'S CERTIFICATION ~- ' ' ' ' " I ce~i~ that I have checked, verified, or conformed to all MOA and HAA guidelines i~~ate of this inspection. Signature 1~0~ Eagle River L~p Roaa Ne. ~ ~ ~ ~ j~ Engineer's Name -,* HAA Fee $ / Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY 5633B STREET ANCHORAGE, ALASKA99518 TELEPHONE (90~ 562-2343 FAX:(90~ 561-530! Cha,.leb lei.! :93.1500-1 ~EPOR! of AR&[ISIS Client Sample ID :L9 17 ILNORE $/D 12 Collected :04/09/93 ! 16:$0 hzs. Recetve~ :04/09/93 I 17:10 hzl. Repozt Completed =04/13/93 Sample COLLECTED ~C Allowable Extzact inalysts Per~te: Results ~al. Units Netho~ Limits Date Date Init NIIlIH-M O.10 U Iq/l EPA 353.2/300.0 10 04/12/93 LLH Bee Special In~tzuctions Above UA - Unavailable " See ~ample Remarks Above ~l - Jot AnalFze~ U - Cn~otected, Reported value ll the pzactlcal quantification limit. L! - Less Than D - Seco~ary ~llutlon. ~T - Gzeater ~han ~E~~m~-~ Member of the SGS Group (Social. G~n.rale de Survei,lance) ParcelI.D. # MUNICIPALITY OF ANCHORAGE ~ D3partment Of Health & Human Services DIVISION OF ENVIRONMENTAL ~ERVlCES 343-4744 / 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) A.,-/ .... }',!; ,'. Telephone: (home),~;~';-~2~O~'/- Business (b) Property owner- Mailing Address (C) Lending Institution ~/~ Mailing Address (d) Real Estate Company and Agent Address ~ ~ / Telephone Telephone ~ /.~ (e) Mail the HAA Io the following address: (or check here,~. If hold for pick up.) List contact person and day phone number below: 27.- I 11 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 lo th legality and status. 4. SEWAGE DISPOSAL On-site ~' Public I-I Community [3 Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legallty and status. Page 1 of 2 5. ENGINEERIN~ FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORI~ATION 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. NameofFirm d",~r~.,~ ~/ /ler~x-. Telephone _~?~-I~11 Address I~0 ~ PI.~IO< ~ O ~I.?o~ ~ ~c ~ ~ ~ Date ~/Zg/~ 6. DHHS APPROVAL Approved for 'Z/// bedrooms by Approved ~--- Disapproved ~/~~~Date Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval cerificated 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 ~?~.gc~ ,~0~ Heallh Authority Approval (HAA) ~.~.v .~'¥ ~J ' CHECKLIST - FEBRUARY 1984 ~' ~- ~ ~3~744 ' · L ~~ Legal Description: A. WELL DATA Well Classification .'Pr~lc4'tTi'' Well Log Present (Y/N) }/ Date Completed TotaIDepth ~4-~ Casedto Static Water L. evel ~ Casing Height Above.Ground · ,2 ' 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 To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved (Y/N) Yield Depth. of Grouting //,, [.-.., Pump Set At Sanitary Seal on Casing (Y/N) ~/ Depression Around Wellhead (Y/N) . ~ lOC, ~ To Nearest Public Sewer CleanouVManhole A,h ' ~.~. ; Date ~/ ' ; On Adjoining Lots ./~0 ; On Adjoining Lots B. SEPTIC/HOLDING TANK DAT,,~ Standpipes (Y/N) ~/ · Air-tight Caps (Y/N) Depression over Tank (Y/N) ~,~_ pumping/Maintenance Cont,.ct on File (Y/N) /k//~l Holding Tank High-Water Alarm (Y/N) ~_ /~1 ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: No. of Compartments ~/ Foundation Cleanout (Y/N) Date Last Pumped , ~'/z ; for kt /,,~ Temporary Holdir~g Tank Permit (Y/N) .Lt /.~ .To Wate,r-Supply Well ! lb'- ' To Property Line ,~o' To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation To Disposal Field 72-o~{.,,,. 7~) F,~t Page 1 of 2 Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test C. ABSORPTION FIELD DATA ' * * t/-~-~'&~ Soils Rating in Absorption Strata /.~"0 ~:? -~4-/~,~ Type of ~ystem Design Date Insta ed ~1 ' ' ~/~/~ ' Length of Field J~ ~ '~ Width of Field .~ ~ . Depth of Field ~ ~ Gravel Bed Thickness ~ ~ ~ ~ ~'~ Statndpipes Present (Y/N) ~ Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ JcO' To Property Line To Building Foundation >' '~¢)~ Lot Al /f~ ' To Water Main/Service Line ;' Z 5- ~ To Stream, Pond, Lake, or Ma, jor Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Existing or Abandoned System on ; On Adjoining Lots Jo ' .4- . To Cutback (if present) ~¢ J/~ ! D. LIFT STATION ~ Datelnstalled \ N /4. Size in Gallons "Pump On" Level at High Water Alarm Level at ~,. Tested for Meets MOA Electrical Codes (Y/N)"~',.~ Comments Dimensions Manhole/Access (WN) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check PermUted Bedroo~ I certify that Yh~Je checl~ inspection. Signed Company Date MOA No. Rating Against HAA Request** or conformed to all MOA and HAA._qu~ljnes in effect on the'date of this . ~ "J/.'7 '"'g-.(l".'.?', ~- I~ ~'/z'~'~ ~:~/tC'/' 't .' ~ Engineer's Seal Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 / .ff CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. /~T~,~:~',\ 5633 B STREET ANCHORAGE. ALASKAg9518 TELEPHONE (907)562-2343 FEDERAL TAX ID # 92-0040440 ~W$I9 :gA Collected ¥~ 24 89 8 13:30 h~=. Client Wame : C08WIW G ~380C Client Acct : CORWIWP P,O.I MOWE ~EC'D Special Instruct: Chemlab 8e~ l: 4658 Lab im~l ID: I I~trix: NAT8~ Allovoble Pozemete~ Teste~ Result/Units M.thod Limits Sample RO~INE Remark{: SAMPLE COLLECTED leers Pelformed See Special l,'mtluctions Above Uk-Unavellible Mone ~etecte~ "~ee Sample 8emalks Above Analyzed LT-~eas Than, GT-Gzeate~ THan ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~//~/;~'~", GENERAL INFORMATION (a) Legal Description (include lot. block, subdivision, section, township, range) Locatioo (addtess or'd feet ons) (b) ,~l~ljc~.r~t~ Nat'ne"t ~/~- '.~/~ Telephone: Home ~- G~K~ Business ~pplj~gt~ddress ~6o~ ~ ~ ~, ~ (c) ~pp~cant' s teheck ohe): Lendipg Institution ~; Ownor/builder~; Buyer ~; Other ~ (explain)i Id) Lend,ng In~t,t~t,~ ,,~. ~ ~ O ~ ~ ~ Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the follo~j~g a~dress: l cL Lk,, TYPE OF RESIDENCE Single-Family'S[, Multi-Family D Number of Bedrooms Other WATER SUPPLY Individual Well'~ Community ri Public n Note: I! community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~l~. Public 1-1 Community f'] Holding Tank r'l Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-o=5 tit/s,,) 5. ENGINEERING FIRM PROVIDIN,.~ INSPECTIONS, TESTS, FILE SEARCH, D~.,,A AND INFORMATION As certified by my seal aftixed 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 Suj~ply 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 '"~-~*'~., Telephone .'~' / Date A~proved Ior _7~., ,.~,.~-~ bedrooms by Approved ~ Disapproved Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority' Approval certificates based aolely 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. The Municipality of Anchorage is not responsible for errors or omissions in Ihe professional engineer's work. ,~ Page 2 of 2 WELL DATA Well Classification Well Log Present{~N~) Total Depth Static Water Level MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 2644720 Legal Description: "[AL PROTECTION JUN '~t g86 Casing Height Above Ground Electrical Wiring in Conduit~N) Separation Distances from Well: To Septic/Holding Tank on Lot "~,~1~,4'~.'"' If A, B, C, D. EC. Approved (Y/N) Date Completed ~' ' ;~'-~'/ Yield Cased to .5'"'~--" Depth of Grouting ,'~//f F~''~' Pump Set At ~./,~' Sanitary Seal on Casingi~N) Depression Around Wellhead (YI~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /~:~Z~ -~' ; On Adjoining Lots To Nearest Public Sewer Line 14/'/~ To Nearest Public Sewer CleanouVManhole ///// To Nearest Sewer Service Line on Lot o~' Water Sample Collected by ,,,~rg~ '~' ~J"~"~/ ; Date Water Sample Test Results -3"/)"~"~,~/' B. SEPTIC/HOLDINGTANK DATA Date Installed Standpipes~N) Air-tight Caps~N) Depression over Tank (Y~,)) 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 ~ Size /~..5"'4) No. of Compartments Foundation Cleanout {~) Date Last Pumped ~' -/.'~'~'(~ '4'//~ ;for '~//'~ Temporary Holding Tank Permit (Y/N) To Building Foundation .- To Disposal Field To Stream, Pond, Lake, or Major Drainage 72-026{11J84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Fi /53 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,'~f To Water Main/Service Line ~-~'<" Type of System Design Length of Field Depth of Field Gravel Bed Thickness _~ ·~,..,. Standpipes Present (~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots /O To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area;~'Z Comments LIFT STATION "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (WN) Comments Dimensions Manhole/Access (Y/N) "Pump Off'* ,eve, at Vent (Y/N) s during Adequacy Test. Meets MOA Page 2 of 2 72-026 (11/84) *° Check Permitted Bedroom Rating Against HAA Request ** I certify that I h.~v~ che.~ked, y~_ rified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~---'~'~/'~"'-' Date Company ~ MOA No. ~'~ ~ R~ceipt No. ~ ~ ~ ~ ~..''"...~. Date of Payment (~- I ~--~ Amount: $ ~ ~ ,. ALASKA 81 UIROFImI I TAL COFITROL St ItuICI S, IRC. (~n(jin~rincj $ (~n~ironmcnlol Sluclics DAVID WILLIAMS 3605 ARCTIC #672 ANCHORAGE ALASKA 99503 SELLER-SAME DAVID WILLIAMS 3605 ARCTIC #6?2 ANCHORAGE ALASKA 99503 JUNE 17 1986 60291 LEGAL:ELMORE ADD 82 BLOCK ? LOT 9 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-JUNE 12 1986 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 630 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 1106 GALLONS. BASED UPON THE TEST DATA TttE SYSTEM IS ACCEPTADLE FOR A 3 BEDROOM ROME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLL~E OF 1250 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PL~iPED ON JUNE 13 1986 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE-JUNE 12 1986 A FLOW TEST WAS PERFORMED ON THE WELL. ll0G GALLONS OF WATER WAS PUMPED AT A RATE OF 4.8 GPM OVER A DURATION OF 3 HOURS. THE DRAWDOWX WAS .9 ' WITH A RECOVERY TIME OF 10 MINUTES AXD THE STATIC WATER LEVEL WAS 45.8 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. ALASKA ENVIRONM. F,.NTAL CONTROL SERVICr 'INC, 12oo West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 DAlE RECEIVED ..... INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE MUNICIPALITY OF ANCHORAGE MUNICIPAU~ OF ANCHO~GE ) DEPARTMENT OF HEAETH & ENVIRONMENTAL PROTECTION D~PT. OF I~[;L~it & · 825 L Strut · ENVIRONMENTAL SANITATION DIVISION Tele~one~47~ SEP 1 ? 1981 MAILING A~DRESS ' PROPERTY RESIDENT {If different from abo~) PHONE 2. BUYER PHONE MAILING ADDRESS 4. REALTOR/AGENT I PHONE I LEGAL DESCRIPTION 7 STREET LOCATION 6. TYRE ~ RgDENCE NUMBER OF,BEDR~OM~' L.(J~ SINGLE FAMILY I"-I One [~ Four r-I Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SU~LY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY [] Other ATTACH WE LL LOG. A well log is required for all wells dHUed since June 1975. For wells drilled prior to that date, give well depth (attach fog if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) .... ~ THIS SIDE FOR OFFICIAL USE ONLY !. ~ 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS I--1 SINGLE FAMILY I-'1 ONE [] THREE I-1 FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL )EPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE :)ATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: SepticlHo,dmg Tank IAbsorption ISewer Line Area I Nearest Lot Line I Absorption Area to nearest Lot Line 5. COMMENTS f; ; .PROVEDFOR EOROOMS [] CONDIIIONAL APPROVAL ~letter must accompany eertifieate} [] DISAPPROVED 72.010 (Rev. 6/79)