HomeMy WebLinkAboutELMORE #2 BLK 10 LT 4 MUNICIPALITY OF ANCHORAGE ~)/~),-. /7~)" DEPARTMENT OF HEALTH AND HUMAN SERVICES Envlronmenlal Health Division 825 'L' Street, AnchoraGe, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT TANK'S ,,,J~EPTIC I-3 HOLDING TYPE OF SYSTEM ,~ED f"l W. DRAIN I'-I OTHER 0,~ F1 WELLS [] TRENCH OFT ~ FT ~'~'RIVATE REMARKS: [-] OTHER (IdenUfv) DISTANCES SEPTIC TANK ABSORPTION FIELD WELL FOUNDATION 72-013 (3/85) erIifiei Drilling SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 * TELEPHONE 6~8.275g OWNEr OF LAND ADDRESS LEGAL DESCRIPTIONL- 4 I~t' /o ~"/,'O:~/c-- JJ[.~ ~c~,. DATE - Started. Ended ~/'~'7' PERMIT NUMBER STATI(' LEVEl OF 1,rATER I)RA~,V I)O~,¥N FT. GALS. PEr Itt Tco KInl) OF cAsInG (, fO<:) KIND OF FORMATION: From ~ FI. to From ~, Ft. to.~ From 3 Ft. to '77 From ~ '7 Ft. to From__.FI. lo From Ft. to Ft. From FI. to Ft._ From Ft. to Ft. From Ft. to FI, From Ft. to Ft. From Ft. to FI. From FI. to FI From Ft. to Ft._ From Ft. to FI From __ Ft. to Ft._ From __ Ft. to Ft. From FI. to Ft. FI. to Fl. FI, to FI. Ft. to Ft. Frmo FI, lo FI, From.~Ft. Frcm~ Fl. lo FI. From FI. h) FI. From Ft. to Ft. From Fl. to Ft. From Fl. to Ft. From Ft. From Ft. to Ft. From Ft. to From Ft. lo Ft From~Ft. to From~Ft. to From Ft. to FI. Ft..__ Ft .,,/ MISCL. INFORMATION: M U N I C I P A L I T Y 0 F A N C H 0 R A G E Department of Health & Human Services 825 L Street~ Anchorage, Alaska 99501 545-4720 0 Permit Number: Date Issued: Owner Name~ Owner Address: H-S I T E SEWER & WELL 0S/50/89 Engineer Designed A H F C 520 E 54TH ANCHORAGE, AK 99505 PERMIT Day Phone: Parcel Id: Lot Legal: Lot Size Max Bedrooms: 018-175-10 Subdivision: ~LMORE ~2-'~ot: 4 Block: 1~ Section: 54 ~oWnship: 12N Range: 5W 40280 (sq. ft. or acres) This Permit: ~ Total Capacity: 5 SEPTIC TANK: Minimum total septic tank capacity: 1,000 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0 feet requires insulation over tank(s). WELL: Log must be submitted to Municipality of Anchorage Department of Health and Human Services within 50 days of well completion. PERMIT EXPIRES DECEMBER 51~ 1989. NOTIFY DHHS OF INSPECTIONS AT 545-4744 OIR 545-5681. OLD SEWER SYSTEM AND WELL MUST BE ABANDONED; ENGINEER MUST CERTIFY PROPER PROCEDURES HAVE BEEN FOLLOWED. I CERIlFY THAl: 1. I am familiar with the requirements For on-site sewers and wells as set forth by the Municipality oF Anchorage (MOA) and the State o~ Alaska. ~. I will install the system in accordance with all MOA codes and regulations, arid iF) compliance with the design critePia of this permit. 5. I will adhere to all MOA and State oF Alaska requirements Eot the set back distances From any exist.ing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I undepstand that this permit is valid fop a maximum o~ 5 bedPooms. I understand~he capacity oF the total system is ~ bedPooms and any enlapggme~l~equipe an additional permit. SHT. Municlp~llty o! Anchor. ge ~~'.~°'*'~--~: I DEPARTMENT OF HEALTH & HUMAN SERVICES ,//~~-.-.(;~','"?~. I .~ .~. ~,r.e,. ~nc~o,a.e, ~,a.,..~0~.~ ~~~-~. SOILS LOG -- PEROO~TION TEST ~~ ..~'~" I 1 2 3 4 5 6- 7 8 9- 10 11 13- 14- 15- 16- 17- 18- 19- 20- SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? Reading Date Gross Net DePth to Net Time Time Water Drop --~.. PERCOLATION RATE /~ (m~nutes/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN __ FT AND FT PERFORMED B~C_~ =_-;._- .o.!¥_,,~-. L_ _~ -~c=E .~g. ~ ~ //~ CERTIFY THA~THIS TEST WAS PERFORMED IN 72~ (R~. 4/~) ~ / / GI~--~TER ANCHORAGE AREA BOROt~-~H f ~ HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 27;?-251 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELl .,~..-~ I,,.~_ LIQUID CAPACITY MAILING ADDRESS PHONE. .LEGAL DESCRIPTION ~-~7"' X; /~'~://('/O,.. ~/'~tC/~"- MATERIAL GALLONS. INSIDE LENGTH NUMBER OF COMPARTMENTS. -- INSIDE WIDTH. -- .DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL /,,,.~ ~',,._~.~'m NEAREST LOT LINE '~'"'~."~ OUTSIDE DIAME/ER~OR WIDTH .D.STANCE FROM WEL, /~'~' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) / LENGTH /'/o , DEPTH -~-"' /. BUILDING FOUNDATION "'Z~ / ~ ~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION ., NEAREST LOT LINE NUMBER OF ~INES H ABSORPTiON~A A~j~/~t SQ.F[. LENGTH OF EACH UNE DEPlH: TOP OF TILE IO FINISH GRADE. DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH OF LINES ~EFFECTIVE IN. ABOVE TILE DISTANCE FROM ~/, / WATER WELL: TYPFT~/~7"/AJ */)~F"' DEPTH ~ . BUILDING FOUNDATION. / ('''' tc'' SAMPLE j's,.~, NEAREST LOT LINE .,//0 ~ NEAREST / SEPTIC / SEEPAGE ~, /,~ OTHER , SEWER LINE ~ "f" TANK ~ ~ SYSTEM r,/~ CESSPOOL '~' . SOURCES DIAGRAM OF SYSTEM DATE GREATEI 'ANCHORAGE AREA ;' OROUGH C. No. IIEALTH DEPARTMENT 327 Eagle St. Anchorage, Alad~ 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION 8, PERMIT NAME OF APPLICANT. , RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH .~.e ,r{ PERCOLATION TEST RESULTS MAILING ADDRESS PHONE NO. LOCATION OF INSTALLATION '/ SEEPAGE PIT " , DRAIN FIELD ,OTHER TO BE INSTALLED BY ,'"'"~ ....... '' "' ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT "'~ '~ ~ " , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE O.F NI,T/~O BE SERVED · SEPTIC TANK SIZE. -/'2'~ .TYPE ~ ~'[zS/ SEEPAGE AREA A' ./ t' "TYPE DIAGRAM OF SYSTEM DISTANCES: I certify that I 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 APPLICANTS SIGNATURE (""~'~GR£ATER ANCHORAGE AREA BOROUG!/''~ itEALTH D£PARTt!ENT 327 EAGLE STREET ANCHORAGE, ALASKA 99501 CASE Performed ror~L,~.,k CF,~6d(, Date Performed 2~ /7~ 1470 Legal Description, Lot_.~._._~lo~k /0 Subdivision /'~{~,)~6 ~'f~ ~/ This Form Re~orts a: Soils Log ,, ,/./· · -Percolation Tes: Depth Feet - Soil Characteristics Was Ground Water Encountered? If Yes, At What Depth "'{ Location Sketch I I Reading Date Gross Time Net Time Depth To H20 Net Drop Proposed Instal~Seepage Pit_. ~ Drain Field Depth Of Inlet ~ To Bottom Of Pit Or Trench~.~.~.~ COMMENTS: Test Performed · Data Certified Date~/Q 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) Lo,~ 4~ 8~.oc~. I0~ Eft. moor. Location (address or directiqns) 4800 Ec..~t 145.t.h Avc~z¢ (b) Property owner Mailing Address A.H.F.C.# 30795 Telephone :'(home) A.¢ho~aq¢~' ~t.a.61z. a. 99505 Business (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address 2600 ~eJ~cf-~ ~ena~.J. Tou~¢~.6, Ancho~taqct A~z. 99503 Telephone (e) Mail the HAA to tho following address: (or check here~ if hold for'pic~ ~p.) List contact pemon.and day phone number b~low: · ' 17034 5001 REALTY 'ATTN~ N~c~ 8¢~qh-Po~oc~ 2. TYPE OF RESIDENCE Single-Family 8~. Number of bedrooms ,T '~ 3. WATER SUPPLY Individual Well {3~x. Community r-I Public I"'I 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 r'l Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ~.~(...t~ Page I of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify ~hat my investigation of th is Health Authority Approval shows that the on-site water supply and/or wastewate~r disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated h~reirt. I further verify that based on the information obtained from the Municipality of Anchorage files and from myJ.nvestigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance w. ith albMu~nicipal and State codes, ordinances, and regulations in effect on the date of this inspection. Telephone ~:~'~ '~-~'~ ~' ......... --RING 17034 Eagle River Loop Roac~ No. 204 Name of Firm Address Date 6. DHHS APPROVAL Approved for ~ bedrooms by Approved /~ Disapproved Terms of Conditional Approval Conditional Date /'c-~ o/'7 c The Municipality of Anchorage Department of H~alth 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 oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. n~s (..,,.~'~) e.c.~ Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) ' CHECKLIST- FEBRUARY 1984 343.4744 Legal Description: /~',"/" ~/'. ~ ~!,.,~.k" ! ~ j "If, A, B, C, D.E.C. Approved (Y/N) Yield ' ~C:j). ~ Well ClasSification ..~;~ I~ ~"'~ Well Log Present (Y/N) ~ Date completed TotalDepth !o/"Casedto 1¢31° Depth o! Grouting Static Water Level z~ ~ Casing Height Abo{/e Ground ( Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELl': To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Pump Set At LP Sanitary Seal on Casing (~'/N) Depression Around Wellhead (Y/N) · ~ On Adjoining Lots ! LDo './- ( I 0 ' ; On Adjoining Lots ( Igo '¥' To Nearest Public Sewer Cleanout/Manhole "d//9 ---~ 5/- -% ~C'~uce~¢~'~VS~ ;Date ~' ~ -~'0 Water, Sample Collected by . . -- -'" . . . -- .,~ Water Sample Test Results I Comments -' B. SEPTIC/HOLDING TANK DATA Date Installed /_,~ -II- .TDSize_./_~ZCZCZ__No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression Over Tank (Y/N) Pumping/Mainte,nan,ce Contact on Fi!e (Y/N) Holding Tank High-Water Alarm (Y/N) Foundation Cleanout (Y/N) c~ Date Last Pumped I J - 2. - ~ c/ ;~or "~/V:{ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: I To Water-Supply Well ( P .~ To Property Line ! o ' ~' To Water Main/Se~ice Li~e To Stream, Pond, Lake or Major Drainage Course Comments ~-~, 'h'~ ~0 t~_~ 0 ~4 /_.~ To Building Foundation To Disposal Field (oc~ T Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) ~ f~ Type of System Design .' © >' !./- -'~ - ~' ' Length of Field ~'.~ * (,''; - "::,. ~' Depth of Field Gravel Bed Thickness '" ~'''~ ' '" ~ ~ Statndpipes Present (Y/N) ,- Results. of L~stAdequacy,Te..st ' /~_b,J :-~.~."~A~' ~_~_'_O~.~- ,?~'C,~'~ SEPARATION DISTANCE FFIOM ABSORPTI'O~q FIELD: Date of Last Adequacy Test i,p/Ft ' TO Wa't~r~Sbpply Well / I {~" To Building Foundation ~_.C) ' ' ' Lot ' _2 ~ ! ~- "' To Water Main/Service Line : ''1 C) To Stream. Pond. Lake. or Major Drainage Course To Driveway; Park. lng Area, or Vehicle Storage Area Comments To Property Line [ ~P ~" " T(~ Existing or Aband0n~d System on ; On Adjoining Lots _~, * 1- " TO Cutback (if present) D. LIFT STATION Date Installed '- I -I -' ~ - ~'c/ Size in Gallons· ' ' - - "Pump On" Level at ~ ~>" · High Water Alarm Level at ;~ ~" Meets MOA Electrical Codes (Y/N) Comments ' Dim~n$ion~ '~/ 'X '/'1/ }O" i~ ,'J~ Manhole/AcCess (Y~Ni ~[ ' "Pump Off" Level at ~_. I~" Vent (Y/N) ~ Pumping Cycles during Adequacy Test. **Check Pe~'mitted Bedroom Rating/~,gainst HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in, inspection Signed ,5 ~, S ENGINEERING 17034 Eagle River L~p koa{J INo. 204 Company ........ ~..~. e9~77 Date MOA No. Receipt No., Date of Payment Amount: $ Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 Date hepo[t P~tnted: OCT I 90 ! 12:56 Client Sample ID:L4; BIO; ELMORE PI~ID :UA Collected SEP 26 90 ~ 15:50 ~ecel~ed SEP 27 90 ( 15:00 Presezved ~ith :AS REQUIRED Client ~ame Client Jcct P.O.! NONE Analysis Completed :SIP 28 90 SeM ~eporte to: Laboratory SuperviSor .:STEPHEN C. 8DE Z)S & S DN~INEERIN~ Special ]netruct: Chemlab kef 8:903920 Lab Dapl ID: 3 , Hatzix: ~ATEE Allo,able Pasameter Tested ~esult Units Method Limits NITIATE-N NDCO.iO) ~g/1 EPA 353.2 10 Sample ROUTINE SABLE. ~emarks: SAMPLE C0ELEC:~D BI Tests Performed ' See Spectal Irut:uctiona Above UA-Unavailable None Detected "See Sample [emarke Above Not Anal~ed LT-[ess Than. GT-G~eate~ Than Parcel I.D. #  MUNICIP'ALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES · .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) Lot 4: B~ock 10; E~o~, #~ Location (address or directions) 4800 E~:~ 145~h 4m,~n~,, (b) Property owner A.i!. F. C. # 30'795 Mailing Address 55,0 Er~6t $4th Au~.mz~ Telephone: (home) Ar[cho¢~zqe~, A.~z6h~:t 99505 Business (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent ~00! REALTV ATFN~ ~a~¢q Be~qh-Po.t~oe~ Address 1~45 ff~ 9th Aue~u~ A~cho~a~¢. ALa6ka 99501 Telephone ~76'~001 (e) Mail the HAA to the following address: (or check here~, if hold for pick up.) List contact person and day phone number below: $ & S ENGINEERING Eagle River, Alaska ~9577 2. TYPE OF RESIDENCE Single-Family ~,K Number of bedrooms 3. WATER SUPPLY Individual Well I~X Community I-I Public · Note: If c~mmunity well system, must have written confirmation from the State Departmen. t of Environmental Conservat on attest ng to th ega ty and status.' ' 4. SEWAGE DISPOSAL', On-site,~J: Public I"1 Community [] Holding Tank [] · 'Nolo: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailt~ and status. Page I of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ' AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from m.y 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 t/~'~ ~' ~'~' ~ ~ Address S & S ENGIt,IEERING 17U34 E3~e tcj¥~r ~-~ 6. DHHS APPROVAL Approved for - .~ App~:ove~' ~' Disapproved Terms of Conditi0n~ Approval /~c~A_~"~ Conditional 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 insti]utions 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 (MOA) ": (,e~.~. Health Authority Approval (HAA) ·" *,.~,.~ CHECKLIST - FEBRUARY 1984 ~' ":"?'" ~ 3.~ 343-4744 ' ' ~',.?,' . ...\,,~%~~.., ~ ·.. Legal Description: We, Log P,e ent N) y C;mp eted Total Depth ~ ~ ~ / If.A, B, C, D.E.C. ~pproved (Y/N) Yield Cased to' ~~c>tl Depth of Grouting "'"-' Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~N) Pump Set At t.~V.--.. Sanitary Seal on casin~.q~. ) ~-/ Depressi(~n Around Wellhead (~ ~ SEPARATION DISTANCES FROM WELL: TO Septic/Holding Tank on Lot- ~ c.~''z''~ ; On Adjoining Lots t. ~ t ,To Nearest Edge of Absorption Fiel~o/~,,,Lot ~ ~ ~;~' ; On Adjoining Lots *~ To Nearest Public Sewer Line , -/,*r- TO NeQrest Public Sewer Cleanout/Manhole I~/~ To Nearest Sewer Service Line on Lot '~ Wate. r Sample Collected by '~ ~ ~'~ ~"~' ; Date Water Sample Test Results '~. ~'~ "' Comments - B. SEPTIC/HOLDING TANK DATA v/ Date Installed {~'-I~-~OSize I ~ Standpipesd:~) ¥ Air-tight CapstaN) Depression over Tank (Y/~t~ '1'~ Pumping/Maintenance ContactAlarmOn File (Y/.i~ / Holding Tank High-Water (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: .~ :'~ . '..~. ~ o~'~~ .:~ W~ter-Su~'p!y. Well: To Building Foundation ....,'. ;;To Property Line ' To Disposal Field 'To Water Main/Service Line ~ ~*~* ~ -' To St'ream, P;:)n~, Lake or Major Drainage Course ~ ~ I,~ --- No. of Compartments "-/ Foundation Cleanout::T:~TN) , y pate Last Pumped ; for Temporary Holding Tank Permit (Y/N) 72~2e (.,,.7~) F~,~ Page 1 of 2 Soils Rating in Absorption Strata ~/' -'-" Type of System Design Date Installed I~._,~_ ~c:~ ~ 'Length of Field ,,.~I _ Width of Field "Z~' ~ Depth of Field (Jr' Gravel Bed Thickness Square Feet of Absortion Area ~:ff7.~ ~ Statndpipes Present (~N) .Depression over Field (Y(t~ t'~.. Date of Last Adequacy Test r,~ Results of Last Adequacy Test ~ ~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ ~ ~ '=:=' To Property Line' To Building Foundation "~--,~>~ To Existing or Abandoned System on Lot .~.~.- I..~ ; On Adjoining Lots' "~ To Water Main/Service Line ~ ~ ~' ~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ~, ~ ~ ~ To Driveway, Parking Area, or Vehicle Storage Area ' '-~ ~ ~ Comments D. LIFT STATION Date Installed ' High Water Alarm Level at Tested for !"5o .l~,~)ff.A~, Meets MOA Electrical Codes {~/N) Comments Dimensions '~ '~. Ma~hole/Access~i~TN) .. "Pump Off" Level at Vent {~1) _t:~'~;b' Pumping Cycles during Adequacy Test. **Check Permitted B'ed{oom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines In effect on the date of this inspection.' Signed ,~ & s ENGINEERING 17034 Eagle River L~ Road No. 2~, OA.o. ,' Receipt No, Date of Payment Amount: $ 72-026 (Rev. 7.'88) IB~Ck Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF, LASKA, INC. Date Seport Printed: DIC 21 89 I 17:08 Client ~a~ple ID:L4 BIO ELNORE 82 PW$ID :UA Collected DEC 20 89 8 14:00 Received D[C 20 89 I 16:30 h~l. P~eserve~ vith :15 Client MaM: S ~ S lR~ Client Icct : SSSENSP P.O.I I10~ R~CEIWD lnalysis Conplated :DEC 20 89 Send Reports to: Labozatozy Supezvtsoz,:STlPHEH C. EDE 1)5 & $ Special SOLD UPOH CO~PLETIO~ fO~ PICK UP. Irmt~uct: Chemlab lei l: 8985 Lab Sapl lO: I Jhtzix: #ATEE lllowabla PataMte~ Tested Hssult Unite Method Limits MITIITE-H O.IE ng/l IPA 353.2 10 ~a~ple SIMPLE COLLECTED BI B.P. Tests PeEEormed ° 5oo Special IrdtEuctions Above UA-Unavailable Pone Detecto~ °' Soo ~anpla ReMrks Above ' ' ~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME ~-~-~ ~,~.,( MUN~CIPALt]Y MUNICIPALITY OF ANCHORAGE DEPT. OF H~ALTH & ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~E~AL  825 L Strut * Anchora~, AI~e ~1 ' ~.WnO.~.TAL SA.~rAT~O" D~WS~O. 3¢~ 2 3'1981. REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE DIRECTIONS: Complete all pa~s o,t page 1. I~o~[ete r~u~ will not ~ pr~d. Please allow ten {I0} days for pr~sing. MAILING ADDRESS PROPERTY RESIDENT (If different from ebon) PHONE PRONE MAILING ADDRESS ~ LENDING INSTITUTION PHONE ¢. REALTOR/AGENT ~ PHON~ I MAILING ADDRESS TREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [~' SINGLE FAMILY [~ Two [~ Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY [] INDIVIDUAL· [] COMMUNITY [] PUBLIC UTILITY [] Other · ATTACH WELL LOG, A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY ,YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. . THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS I-'1 SINGLE FAMILY I--I ONE I--I THREE I--1 FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR I--I SIX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE . DATE INSTALLED Connection Verified INSTALLER •SepticTank or r-lHold[ngTank Size: ! ~(~) If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK I MAN U PACTU R E R ,~t~ ~'"~LI" TOTAL ABSORPTION AREA MATERIAL · 4. DISTANCES Sept*c/Holchng Tank Absorption Area JSewer Line j Nearest Lot Line WELLTO: I I Absorption Area to nearest Lot Line 5. COMMENTS D APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) ~.~"'OISAPP ROY E D 72,010 (Rev. 6/79I MAT[RIALS TF~TI~.~ · QUALITY CON"I'RO. SOILS [N.$1H[[ RING _ ~-204 Clevelond Ave. =.0. Boi 10-112G ~.nc~oroge~AK. 99511 ~T7-OZ~l 710 Third Ave P.O. Box 2540 Folrboflks, AK. D9707 S"' T I C SYSTEM ADEQUACY REPORT JOB NO. 81-1582 DATE OF REPORT July 8, 1981 DATE OF TEST July 29, 1981 LEGAL DESCRIPTION 2 LOT 4 , BLOCK 10 , OR. SECTION Elmore ~2 , T N, R W, SUBDIVISION , ALASKA PERFORMED FOR: lqorman Flothe PHONE NO REOUESTED BY: Jean Sm[th Box 1928 AnchoraRe, Alaska 99510 PHONE NO..277-6013 TYPE OF SYSTEM : ~ SEPTIC TANK - SIZE 1TO00 GALLONS ~ CRIB OR SEEPAGE PIT ;'" ' ~ LEACH FIELD SEPTIC TA~K WAS PUMPED D YES O NO ABSORPTION RATE: AVERAGE 24 HOURS 450 GALLONS. SURGE RATE; 360 GALLONS IN 36 MINUTES. NOTES a OBSERVATIONS' Day # 1 # 2 # 2 TANK CRIB TANK CRIB TANK CRIB Initial 4_0_~5~ Z~25" 360 g~ 1,~_-~-,~ 1LD" ~20_su=ge /+0 ~" 79.5" -39.-5" TEST PERFORMED BY: T.B. REPORT PREPAhED , unicip lityo Anckor' ge 825 "L" STREET ANCHORAGE, ALASKA 99501 (007) 2t34-4111 GEORGE M. SULLIVAN I%~A¥OR July 17, 1981 Norman Flothe % Jean Smith Jean Smith Realtor 746 F Street Anchorage, Alaska 99501 Subject: Lot 4 Block 10 Elmore Subdivision #2 The sewer system on the subject property has been tested and shows the system is functioning properly for a three(3) bedroom single family residence. The water was sampled and is satifactory. Ho~zever, the well is not an approved type construction because it is hand dug and appears to be shallow. This letter does not constitute a full health authority approval. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist CC: Spokane Mortgage 3201 C Street, Suite 250 99503