HomeMy WebLinkAboutT15N R1W SEC 18 LT 106BTI5N RIV /
· 18
Lot 106B
#051-172-53
Municipality of Anchorage Page / of .5"
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: .~ J.4/(:~)C)O ./~ ~_:2_ PID Number: 0.5'/- / '7 ;~_ - ~"~
Name:/f.~/¢/-~'.'~--/-- .4~'3~x"'¢~'~ Wastewaler System: [] New E3'"Upgrade
/~' ~'~ '~'.<~-/,~' ~'~ .,~/~ '~7 7 ABSORPTION FIELD
;'hone: ~ ~_/~ INo. of B~r~,s: DD,pTrench ~hallowTrench DBed DMound DOther
LEGAL DESCRIPTION so, R,,,~;: /' ~ OPD~q
WELL: ~v,~w m Upgrade Gra,lwidth: O-- Ft Num,rofline,:/ {D~/~Ii,Ft
~'~ ~P~l ~~'-{ ~'=~'. TANK
SEPARATION DISTANCES ~.pt~ u Holding ~ S.T.E.P.
w~t~, /~ ~ ~/~' ~/~ ~/~ /~'~ LI~ STATION
Lot I
Remarks: BENCH MARK
Inspections pedormed bT: ~~ ~-~ Dates:lst'~/~ /.;~
Depadment of Health and Human Se~ices approval
Reviewed and approved bT: ~ ~ ~ ~Date. /- e~ -~/
................ .-
Permi~ No.
of 5
On-Site
Legal Description:
Poge 2
Municipolity of Anchoroge
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650. Anchoroge, Alosko 99519-6650. Telephone .343-4744
Wesfeweter Disposel Sysfem end/or Well Inspecfion
Repod
LOT 106B, TRACT 15N, RANGE lW, SECTION 18 PID No.:
! /
Permit No. ~' lc/o O O /-'/~.-
Page 3 of 5
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 1966,50 · Anchorage, Alaska 99519-6650-Telephone 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LOT 106B, TRACT 15N, RANOE lW, SECTION 18 PID No.:
MUNICIPALITY OF ANCHORAGE
Department of Health end Human Sen, ices
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Nov 15, 2000
Expiration Date: Nov 15, 2001
Permit Number: SW000482
Legal Description: T15N RIWSEC 18 LT 106B
Design Engineer: 0069 Douglas T. Kenley, PE
Owner Name: Michael Dexter
Owner Address: 18915 Trudy St.
Chugiak, AK 99567-2022
Total Bedrooms: 4
Parcel ID: 051-172-53
Site Address: 018915 TRUDY ST
Lot Size: 44030 SQ. FT.
Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
Ail construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection, Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. 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.
Date:
Douglas T. Kenley. P.E.
9960 E. Puffin Drive. Palmer, Alaska 99645
(907) 746-1073
November 15, 2000
Mr. Michael Dexter, O~er
Lot 106B, Tract 15N, Range IW, Section 18
Chugiak, Alaska
PERCOLATION TEST RESULTS
AND
GENERAL SITE INVESTIGATION REPORT
On October 1 !, 2000, an adequacy test xvas conducted on the well and septic system. The well passed, but the
septic system x~s found to be in a failed condition. The above-referenced I acre+ site was inspected in
support of this application for approval to upgmda the on-site xvastcavater disposal system. The inspection
consisted of soils percolation tests and an overall conditions survey of the property.
Thc site is located on 18915 Trudy Street. Thc immediate area that has been selected for thc replacement
waste~vater disposal system has an average slope of I to 2%. The site is sparsely treed with birch and spruce.
On-site observation and physical survey show that there are no xvater wells nor private x~stcwatcr disposal
systems within a 100' radius of the proposed system A small amount of surface x~tcr ~vas observed during a
second inspection, after conversing with the property m~cr. Also, surface water ~x~s located on Lot 106A,
adjacent to the subject property. The present system falls ~fithin the 100' radius of the surface ~vater.
On October 14, 2000, one test hole xvas dug to a depth of 1 I'. A subsequent test hole was dug on October 26
to a depth of 13'. Both percolation rates were greater than I minute and less than 5 minutes per inch. The
results of these tests are attached to this report.
On October 21, 2000, thc reading for ~=ter level on perk test # 1 revealed that a nc~v system would have to be
installed at a higher elevation. Test hole #2 revealed the same results, and because of the surface xvater and 4'
ground ~vater separation, the ne~v septic system and tank will have to be installed at approximately a 1.3'
higher elevation than the existing system. In all likelihood, a new tank will have to be installed. The house is
on a cra~'l space and there is adequate distance to accommodate the rise in elevation of the tank and nmv leach
field without a lift station. At that time a foundation clean-out can be installed.
On November 14, 2000, two mom pere tests were performed in thc an= ortho first t~vo test holes. Pcrc test
#3 was performed at the 6-1/2' to 7' level of test hole #1 ~vith a pcrc rate or'2 minutes per inch. Perc test #4
xx=s performed at the 5' to 5-1/2' level of test hole #2 xx4th a perc rate of 7 minutes per inch.
Thc proposed system will have no measurable impact on additional reserve space, surface or sub-surface
drainage or on drainage from adjacent lots. It appears that there is no potential for contamination of adjacent
xvater wells or streams from knoxx~ sources.
Lot 106B, Tract 15N, Range 1W, Section 18
Page -2-
11 / i 5/00
Attached please find proposed design drawings for the replacement system. If there should be any questions
concerning the percolation rate or characteristics of the site, please call me at (907) 746-1073 or 243-5372.
Sincerely,
PE#8176
Douglas T. Kenley, P.E.
99E0 E, Puffin Ddve, Palmer, AJaska 99645
(907) 746-1073
October 31, 2000
Mr. Michael Dexter, Owner
Lot 106B, Tract 15N, Range IW, Section 18
Chugiak, Alaska
PERCOLATION TEST RESULTS
AND
GENERAL SITE INVESTIGATION REPORT
On October I 1, 2000, an adequacy test was conducted on the well and septic system. The well passed,
but the septic system was found to be in a failed condition. The above-referenced I acre+ site was
inspected in support of this application for approval to upgrade the on-site wastewater disposal system.
The inspection consisted of soils percolation tests and an overall conditions survey of the property.
The site is located on 18915 Trudy Street. The immediate area that has been selected for the replacement
wastewater disposal system has an average slope of I to 2%. The site is sparsely treed with birch and
spruce.
On-site observation and physical survey show that there are no water wells nor private wastewater
disposal systems within a I00' radius of the proposed system. A small amount of surface water was
observed during a second inspection, after conversing with the property owner. Also, surface water was
located on Lot 106A, adjacent to the subject property. The present system falls within the I00' radius of
the surface water.
On October 14, 2000, one test hole was dug to a depth of 11'. A subsequent test hole was dug on
October 26 to a depth of 13'. Both percolation rates were greater than 1 minute and less than 5 minutes
per inch. The results of these tests are attached to this report.
On October 21, 2000, the reading for water level on perk test #1 revealed that a new system would have
to be installed 1' above the level of the existing system. Test hole #2 revealed the same results, and
because of the surface water and 4' ground water separation, the existing tank will have to be
repositioned to accommodate proper separation distances. In all likelihood, a new tank will have to be
installed. The house is on a crawl space and there is adequate distance to accommodate the rise in
elevation of the tank and new leach field without a lift station. At that time a foundation clean-out can be
installed.
The proposed system will have no measurable impact on additional reserve space, surface or sub-surface
drainage or on drainage from adjacent lots. It appears that there is no potential for contamination of
adjacent water wells or streams from known sources.
Attached please find proposed design drawings for the replacement system. If there should be any
questions concerning the percolation rate or characteristics of the site, please call me at (907) 746-1073
or 243-5372.
Sincerely,
PE#8176
II I
\
\
\
\
~1. NOLLO~ '~Attl 'NgU. 'gg0t .I.O1
I:l=J I X3(] 'I~VHOIIN
~.00 ./cj .6BN
I
I
/
/ /
/ /
4: ~ot 3d09S
\
LM
z ~
I
/
/
/
/
I
PERFORMED FOR
MuniCipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION. Z~ ~',O&~ ~"~O-"~K./I ~/Z/-//~*~;"~ /,~Townsh,p. Range, Sect,on:
~.,~.. SLOPE
I
2
3
4
5
6-
7-
8-
9-
SITE "PLAN
,/
A
10-
It
12
t3
14
l$
t6.
19-
20-
WASGROUNOWATER
ENCOUNTERED~ ~'~S
$
IF YES, AT WHAT ,4S ,~' · (~
DEPTH? "" , P
TEST RUN eF. TW£EN ~ FT AND '~' F T
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 %" SI~,I. Anchorage. Alaska ~502-~
OATE PERFORMEO:
LEGAl. 0ESCRIPTION
2
3
4
$
6
7
8
9
10-
12
13
14
15
16
17
18
19
20¸
Townsh,p. Range. Sect,on: ~*~..~",c~/ ,~'/,4J/ ~,'"'/~',c~ /~
SI-OPE SITE PtAN
WAS GROUNO WATER
ENCOUNTEREO~
YES. AT WHAT
OEPTH~
,,,c",~
PERCOLATtON RATE /~"' ~b--"tmmumt.,mChl PERC t-tO~.E OIAMETER ~ .
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
Township, Range, Section:
SLOPE
SITE PLAN
2-
3-
4-
5
6
~7
10~
11
14
15
16
17,
18-
19-
20-
COMMENTS.
~..// WAS GROUNDWATER
· ' ENCOUNTERED?
PERCOLATION RATE -'~' -~
(mmuteshnch) PERC HOLE DIAMETER
TEST RUN BETWEEN · /~ FT AND ~'/~/~'~' FT
· -- (.,.,) L ' ~ /~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DAT~. DATE* ~ ~--j ~
72-008 (Rev. 4/85)
PERFORMED FOR
Municipilily of Anchor&ge
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street. Anchorage. Alaska g9502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION
I
2
3
4
5
6
7'
9-
I0-
12
~3
14.
17
t8
Ig
Townsh,p. Range. Sect,on: 7'7'/.5'",,t~ ~/,¢.)/ ,~'~-~-~,~ /~
I
WAS GROUND WATER
ENCOUNTERED)
SITE PLAN
If YES, AT wHAT
DEPTH)
~ ~ ~ ~S TEST WAS pEn~On~(D'N
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
HE PHONE ~NEW
M~ING ADDRESS
LEGAL DESCRIPTION
Absorption area
"' DISTANCE TO: I /~ ~' I /0~' Dwelling -- PERMIT NO.
~ Z Manuf er Mater'al No. of compartments
Liq. capacity in gallons ~ Inside length Width ~ Liqui~ depth
~ IF HOME,DE:
~ -- ~ Manufacturer -- Material Liquid capacity in gallons
Foundation ~ Nearest lot line PERMIT O.
Length of each Ii e Total ~ength of lines Trench width Distance between Hnes
~ No. ofllnes/ ~ Y~. ~ ~d, __ ~ inches
Top of tile to fi is grade Material ~neath tile Total eff ctive abso tion area
Length Width Depth PE .
~ Type of crib Crib diameter Crib depth Total effective absorption,.area
m Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
m Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS ,,,~, ~ -~
SOl L TEST RATING
INSTALLER
..x
APP MED DATE LEGAL
72-013¢ er. 3178) /¢
'~~~~
000000000000
000000000000
I)EPFIRTHENT' OF HERr_TH FIN[.':, ENVIRONHENTF:IL F'RO]"ECT!ON
o-:':,~: "L '" '-' '" .... I' ........
..':, f'REE f., HN...H[IRfqt: E., F:tK. c~,::)p I~ :.t -~J- /- '2 "
!-*.! EC b. I F::, P..I [;'~ CI f¢.4 ,,...,.... E~?; :1[: 'T' Ib~:;; ~S.T, EE: l.,,.l! IE: IF<;: F" EE ~:;;: ~"-1i :1(:
< '78OE;77 )
f:lF:'Pt.. I CRNT
LOC'.'FFf' I ON
t...EEiFIL
CRLI< I N"2; ENTERPRISES
RE)R :[ I:~N Lf:~i'.,IE
BO',.'.', 68~: ERGL..E RI';,'ER
S1/'2 Lt~ZI¢~ TiSN RiW SI'"I S:&8
TYPE OF L:,OIL RBSORBTION S"r":STEM IS: DRFtINFIELD
MRXIFIUM NUMBER OF BEDROOMS; = 4
GOIL Rf::ITING ,::Sg! FT,.'"BR)=
THE REQUIRE[) SIZE OF THE SOIL RBSORF:"rION S"r'S:;TEM ISr,:
[::::, [E:Z F' qf' b-t .... ~2]; L.. [FZ P.ql (~ 'T" t-.11 ....... ~'S t.':.E~ (:'i F;: !=4 '.,? E: 1 ..... [}:. E.']' F' T' IF.~ .......
THE L. ENGTH DIMENGION IS; THE LENGTH (IN FEET) OF THE TRENCH OR [)Rf:IIt'.,IF'IE::t.D.
THE DEPTH OF R TRENCH OF..'.' PIT IS THE DISTFINCE BETHEEN THE ':St.IRFFICE Of::' TH[::
GROUND FIND THE BOTTOM OF "f'l.4E EF':CFA,'FITION (IN FEE]").
'T' ~'-'~ E:£ 'T' ~L' [CF.: ["-.I C: F,al !t,..~ ][ IE::. -1F' ff'"t ][ 2.:E;; ~'~':;~. ,;]:~ ¢:':':.~ ~:;::.!~ F" E:E IE ~T'"
THE GRFtVEL,. DEPTH IS THE MINI. HUM £:'EPTH OF (3RFP,,'EI,,. [3ETI.4fEEN 'THE OUTFFIL,L. F:'!F:'E:
FIN[) 'THE BC)TTOM OF' THE E:>:',CFI',,,'FITION (IN FEET).
I::'ERH l T F:IPPL I CI']NT I-IF:IS THE: RE:SPONS I
INS'T'FILLFITION INSPECTIONS OF RN"r' 1.4EL.Lr.Ci; f:IDJRC:ENT 'TO THIS PROPEF:'.T'T' Fq'.,ID THE
NUMBER OF:' RESI[.:,ENCES THRT THE WEL..L. !..tILL
'FHE
E':FICKFIL. L. ING OF FINer' S"r'STEH !,/ITHOUT FINF~L IN':SPECTZON RN[:, FIPPRO'v'RI.. F.,"T' THZ:E;
DEF'I:::IR"f'I~IENT 1.4ILL BE SUB.T[.:.:CT TO PROSECUTION.
I'IINIMUH [:'ISTFINCE BE"FNEEN R .t4ELL RND RNY ON-S:[TE SENf:IGE f-':,ISf::'O::.'~;Rt..
J. eIO i:::EET FOR R F'RIVRTE WELL; OR
±Se~ TO ~:00 FEET FROM FI PUBL. IC HELL [:,EPEN[:,ING UPON THE T'~"PE 0F:' F'UBL. IC HI=L[..
WELL L.OCiS FIRE REQUIRED RND HU':ST BE RETURNED TO THE DEPF:IRTMf!!NT HITHIN
OF Tt4E NELL. C'OMPL..ETION.
OTHER I:r.':EQIJIREMENTS MFI'T' FII='PLY'. SPECIF'IC:FITION% FIND CCINS'T'F]:UCTZON [:,!FIGRF:Ii'dS; F'tRE
F:I',,,'RILf=IBLE TO INSURE PROPER IN:T.',TF:ILL. FITION.
I C:ERTIF'T~ TFIRT
::L: :1: Ri'"l FRMILIFIR I.,.II'TH THE REQUIREMENTS FOR ON"<E;ITE
I='ORTH BY THE MUNIC:IPFILIT'¢ OF F'INCHORFIGE.
2: I 1,4II,,.L IN':STF:ILL THE S~"STEM IN RC:CORDf=INCE WITH "FHE CODES.
:]!:: I UNDERSTRND THFIT THE ON-:'SITE SE.t4ER SYSTEM HR"r' REQLJIRE ENL.FIR[:i[i!}tENT .[F Tl"ffi:.
RESIDENCE IS:; REMODEI._ED TO INCLUDE HORE THI=IN 4
SIGNED:. 2
F~PPL. I CRNT Cf:1LK I NS ENTERPR I SES
:[ '..('~:LIE[. EfT' _ ............. [:,F:t]"E .........
[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-6B0, Anchorage, Alaska 99502 276-2221
SOILS LOG -- PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION:
1
3
4
5
6
7
8
9
10
11
13-
14-
15-
16
17
18
19
2O
SLOPE ' SITE PLAN
- /
WAS GROUND WATER
ENCOUNTERED? ~/~'-,-~
IF YES, AT WHAT
DEPTH? ~' ~..
Gross Net Depth to Net
Reading Date Time Time Water Drop
COMMENTS
PERFORMED BY: /~0~ ~ ~IZ~y CERTIFIED BY: ~4~/~IM~-- ~Z~Y
PERCOLATION RATE minutes/inch)
TEST RUN BETWEEN ,. FT AND FT
DATE:
72-008 {7/76}
· ,. . : ., .:. , .,. .. ::,..On_Site,ServcesS,.ecton.. ~,.,.:... ..,1,~ ,... .~_.. .
· CERTI ICATE OF HEALTH AUTHORITY ... · ' ' · ' ~ - : -
.... · "":' '~ ;' ' 'APPROVAL'FOR A SINGLE FAMILY -'"-;'-'--':':- ' ' ' ' '
UW~'LLIN~i
........ ' .................... "' ............ . . ". ""
- ~,,~,. ¢,~,~ .... .. .-,... ..... ...... ;.. ~ . .. .: . .. .... . .
Locabon. ,(s~te address or d~recbons)
',~,~ .,,~",' ~..,~_,' · .. ,: .. - , .... .. ,.. :,.,,,... , /,-,· ...... .. / - . ; ._
,-, · · · ~, -~"'~ ' , ,', ' , * ".
· ,- · I_ondmg 8aenc¥ ................... "DaY r~hon~. ...... · ,~ ....
' :: M,adm.~ address .......... ~-: ..... "~- .: :'"-'- ' -' ' -:.-. - ': ·
Agent_ _ : ,' ' ' ' " '. -.Da~;nhone '. --
Address ..... ' .- - ': .', .' - .
J "' """ ' ~h~ld'forpi I~up: '
Un ess otherwise requested, HAA will be c : ' .. ' :. ·
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Community well
Public water -
NOTE: If communi~ well system, provide wri~en confirmation from State ADEC a~est-
· i'ng tO th'e legality and s}at~s ~ s~/~tem.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site ~
Holding tank
Community on-site .,.
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.~
5.* STA~EME~T,~OFjI~SPECTION~B~/ENGINEER.~*;:i::~ '*''~ '. ,i ,.i',~,,:~,,.?~.;~'/..: 4 .i ":; ~ *.
' ' ' A~ C~rfifi~d by m.Y ~e~l Afli~ ~eret° ahd a~ 0t t,~e.v~li~qn ~t~,~)9~ ~!q~,,,!,~erj,~t p~' .:, { ·
,:. - - .- ... ~._;.:-2 ~';'.~ _~'~_~ ;d'al.;~x.~;~d~ova a~.li~t on'sh6~ thatthe On;s te Wat6r supply, ; ' '
,.~ and W~.of structure ind ~t~ ~erem.:l fu~h~r vey;.,tha~_, as~ ~t~. ; -~..-,~ -'~- ~*=- -n-~. ,~* .?. ;; ,
. ' . ,~= ~,,ni~innli~ nf Anchnra~e ffl~ and from mY nv~tlgatlon and Ins~tlon the on .site wa~r., ,,.
· ' '~.~v'~na/~r wa~t~ter d s~ s~tem s n comphance w~th al Mumc~l and State c~
. . . .......... _ ......... ~ ..
Eng n~fs s~gnature, · Date [[ .
........ ~: - ~ . ~. .
The Municipality of Anchorage Department of'l-:lealth and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given In paragraph 5 above by an independent
professlohal engineer registered in the State of Alaska. The DH HS 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 Anch~.ra. ge is not,
responsible for errors or omissions In the professional engin .e~r's work. ~ .. . ~
Municipality of Anchor.ge
DEPARTMENT OF HEALTH & HU..M~.N SERVICES
Environmental Services D~vislon
825 L Street. Room 502 · Anchorage. Alaska 99501 - (907) 3~:~-~'/~4~
Health Authority Approval Checkll~,,~..C~._Nj~y o~c~:)~
L~I O~n: ~,~/~ ~-~/~ ~/~.l~el I.E[
A. WELL DATA
Log presem (Y/N)
Total depth
Sanitary seal (~/N)
Date of test
Statio water level
Well production /,~'. G'
WATER SAMPLE RESULTS:
If A, B, or G, attach ADEC lelter. ADEC water system number
Date completed
Cased to '~','~ ,~ 'Casing helgm (above ground)
/./' Wires properly protected (Y/N)
AT INSPECTION
FROM WELL LOG
O.P.m.
g.p.m.
~.~-
Date of sample: ?;,~,,-..,,~,.
GE~O~ING T~K DATA
Foundation cieanout
oate of eum
C. ABSORPTION FIELD DATA
Other bacteria -~-
Tank$1ze I~-~?,,l Number of Compartment$ ,.~ Cleanouts(Y/N) .
Depression (Y/N). ~/' High water alaml (Y/N) /~/~
~oXl ratlng ~r tF/'ndrm) ,~' .~ System type ~',~ o/~,~,~,~,~/~
72-026 (Rev. 3~96)*
D. UFT STATION
Date installed
Manhole/Access (Y/N)
High water atarm tevst at*
Size in gallons
'Pump on' level at'
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic, molding tank on lot
Absoq~ion field on lot / ~ ?
Pul3ilc sewer main
On adjacent lots. /~' ,'
On adjacent lots
Public sewer manhole/cleanout
Sewer/septic servlna line ~J-'~- ' lift station /f/.~
SEPARATION DISTANCES FROM SEPTIC/HOLDINGTANK ON LOTTO:
Foundation ,~ / Property line .,~ ' Absorption field
Water malmsenace line e?o",' Sudace water/drainage /a/
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line / ;~ Building foundation
Smtace water '/~ ,~
Curtain drain
Wells on adjacent lots
Water main/sewlce llne ,,~-$"'~
Driveway, paWJng/~ehlcle storage area ..7,.~- /
Wells on adjacent lots /~' ~'
ENGINEER'S CERTIFICATION
inconformancewlthMOAHAAguldellnesmeffectonm~saate. ~-~; OF
....
'1 :~/~.~, ~ oho
HAA Fee $ ,.-'z~(:::). Og> Waiver Fee $
Date of Paymem
Receipt Number
72-026 (Rev. 3/96)'
Date of Payment
Receipt Number
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Lot I06B~ Sect~on 18, TI5N, RIW, S.M,
Location (site add'ress or directions)
18915 Trudy Street
Property owner Robert W. Dr~ves Day phone 688-0822
Mailing address
Lending agency Day phone
Mailing address
Agent Klm Stringer PHH/HOMEOUITY Day phone 51~-246-6545
?. 0. Box 4039
Address Co~cord;, Ccc¢~fo~cJ.a 94524-4039
Unless otherwise requested, HAA will be held for pickup. "..
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
×X
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
individual on-site
XX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72~25 (Rev. 1/91) Front MOA ~21
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 inspection.
Name of Firm s & S ENGINEERING
Address Eagle River, AlasJ(a ~)9577
Engineer's signature
DHHS SIGNATURE
~ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisf7 certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued; The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91 ) Back MOA ~21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~ \DL~ '~ ,.c-~ -~c~. ~. D :"C' ~"~. ~ ~Y,~ Parcel I.D.
~,~.
A. WELL DATA
Well type
Log present (~/N) "~
Total depth
Sanitary seal ~N)
If A, B. or C, attach ADEC letter.
Date completed
Cased to L~ E)~
FROM WELL LOG
Date of test
Static water level ~::)~
Well flow
Pump level
ADEC water system number
~-~'~5 Driller 2-'-'-'-'-'-'-'-'-~ ~
Casing height
Wires properly protected ~N) ~
AT INSPECTI~tQpALIW OF ANCHO~GE
~ ~ ~ ~]~oNMENTAL SERVICES D~VIS[ON
JAN 0 2 1992
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
/o~ ; On adjacent lots \~C) t'~''
/I~ ; On adjacent lots \/~ ~-~
Public sewer manhole/cleanout ~'&lJ~-
Petroleum tank "~ \ ~
Sewer service line
WATER SAMPLE RESULTS:
Coliform
Nitrate
Date of sample: [ 7.- ~7-- L~ --% \
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed
Clean0uts (~N
Tank size ~."~...~5'-C:,"
Foundation cleanout I~N)
Other bacteria ~ O ~ ~
S & S ENGINEERING
17034 Eagle River Leep Road No. 20~
Eagle River, Alaska 99577
Compartments "Z--
X/ ~ ..... Depression (Y,~
Alarm tested (Y/N) '~/"~
High water alarm (Y,~
Date of pumping ~"~ i, .%\ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot \oo\'~'
To property line
Surface water/drainage \
Foundation I~~'~ ~?'
Water main/service line \ ~ \ ~-
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
__ Manufacturer
High water alarm level
Meets MOA electrical codes ~
SEPA~ROM LIFT STATION TO:
Weft'On lot On adjacent lots
Manhole/Access (Y/N) ~
"Pump on" level at ~vel at
,/"~Cycles tested
Surface water
D. ABSORPTION FIELD DATA
Date installed ~-:~;C, ~'~ ~>
Length I,.OC~ Width ~'
Total absorption area --z~:~ A~
Depression over field (Y/~) ~
Results~ail) /~?,A~<J
Peroxide treatment (past 12 months) (Y~
Soil rating ':~- ~/1% ¢.- System type
Gravel thickness Total depth
Cleanouts present ~'/N) "J
Date of adequacy test /
for ~-~r~-- (/~ bedrooms
/~£ ]"/~'~/~J If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
On adjacent lots \o~ ~ ~ I.¢~'~' Property line
To existing or abandoned system on lot
Wellon lot ~r~t~
To building foundation
On adjacent lots .~
Surface water \c~----------------~ ~ ~
Curtain drain /J/~
E. ENGINEER's CERTIFICATION
Cutbank ¢l.~- Water main/service line
Driveway, parking/vehicle storage area
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ~..i~e~.~{of this inspection.
S & S ENGINEERING ~;* ~,~ '.~ I
~g.~,~,~' .~+, ,~ 17034 Eagle River L~p Road Ne. 2~. ~ ;4~[! ~ "~
Eagle River, Alaska 99577 ~ . ,,~ .~ ,.. ~, · * ' [
Engineer's Name __ __ ~ , · .
Date [~__~ ~:..__ .~
Waiver Fee: $
Date of Payment /- ~- ~ ~ Date of Payment
Receipt Number ~ ~ / (~/~]. Receipt N~mbor
72-026 (Rev, 3/91) Back MOA 21
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date '"'~'~'~//~ 7
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property Owner ../~.~-~c--) Telephone: Home
(c) Lending Institution '~'~-, -,~ Telephone
Mailing Address
(d) Real Estate Company and Agent
Telephone ' '~ ? ,~/~
(e) Mail the HAA to the followina address: or: Check here.,~, if hold for pick up,
List contact person and day phone number below.
Business
S & S ENGINEERING
i ~'~a4 =agie i*lYer Loop Road
Ea~le River: Al~,~k~ 9957"~
TYPE OF RESIDENCE
Single-Family ~
Number of Bedrooms
WATER SUPPLY
Individual Wellx Communityl-i Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 trey 8/861 Front
leUO!SSe~o~d @ql u! suo!ss!uJo Jo s~oJJe Col 81q!suodseJ ~OU S! e[~eJoqouv JO ~l!led!o!unv~ eqJ. 'penss! s! e~eo!Ji~Jeo e eJoj@q
~ep eZHleUe Jo suo!~oedsu! lonpuo3 !au ap SHHQ jo see/~OldLUB 's~uaLuaJ!nbaJ e~ls pus IS~epeJ u!~pa~ ~sp, es ol ~ap~o
u! suoRn~!lsu! 6u!puel ~!eq) pus sauJoq to s~aseqo~nd o~ ~selJnoa e se s!q~ seop SH HQ sql '~Sel¥ to a~e~S @q~ u! peJe~s!Oe~
Jesu!Sue leUO!SSa~o~d ~uepuedepu! ue ~q a^oqe ~ qde~l~e~ed u! ua^!8 suo!~e~ues@~deJ eq~ uodn Aluo pas~q sa~eo!J!pea
le^oJdd¥/qpoqin¥ q~le@H senss! (SHHQ) sea!^JaS u~LunH pu~ q~le@H ~o ~UeLUpedeQ eSe~oqou¥ lo ~iled!~!un~l eq.L
NOIJ. nVo
IBUOil!puoo
le^oJddv leUO!1!puoo Jo sLuJel
pe^oJddes!Q ~,)~,~ pa^oJdd¥
,~q StuooJpeq ~ JO~ pa^oJdd¥
'lVAO~ddV SHHQ
'9
euoqdale±
ua loella u] suoilelnSeJ pus 'saoueu!pJo 'sepo3 elelS pus ied!a!un~ lie ql!M eoueildLuoo u! s! Luels,~s lesOds!p JeleMejSeM
Jo/pus Xlddns JejeM el!s-ua sql 'um~oedsu! pus uo~leS!~saAu! ~m moji pus Sel!~ e~Joqouv jo Xl!led!o!unw eq~ moji
peule~qo uo!je~Joju~ sql ua peseq jeq~ ~iJeA Jeq~nj I 'u!eJeq pe~eo~pu! eJnlonJls jo adX~ pus s~ooJpeq jo Jaq~nu eq~ Jo~
elenbepe pus leUO!~ounj 'ales s! ~els~s lesods~p Je~eMe~SeM Jo/pus ~lddns JeieM el!s-ua aql leq~ SMOqS leAoJddV ~l!Joqlnv
qlleeH s!q~ ~o uo!leb!~seAu! X~ leql ~HJOA I 'MOleq UMOqS elep uo!lep!l~A sql Jo se pus o~eJeq pex!l~e leas ~ ~q peff~peo sv
NOI~V~OdNI aNY ~va 'HO~V3S ~ld 'S&S~& 'SNOI~O~dSNI ONIQIAOMd ~ld ONI~NI~N~
'S
MuNtCIpAL~TY OP ANCHORMC~,JNICIPALITY OF ANCHORAGE (MOA)
6NvlRONMENTAL SF_RVICF-S oH~_~rH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MAY 2 8 1987
Legal Description: ~?
RECEIVED
WELL DATA
Well Classification
Well Log Present(~/N)
Total Depth
Static Water Level
-~', ~ If A, B, C, D.E.C. Approved (Y/N)
Date Completed ,¢' ' ( 7- - ~'~ Yield
Cased to bO Depth of Grouting
,~Z_' Pump Set At
Sanitary Seal on Casing ,~N)
Depression Around Wellhead (Y/g
; On Adjoining Lots
/ ~ ~ ' ; On Adjoining Lots
Casing Height Above Ground
Electrical Wiring in ConduitS/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
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/Holding Tank:
Size /~- >*'~ No. of Compartments
Foundation Cleanout (~N)
Date Last Pumped 5~' (~5,-,~'T ~: ~-~'~
; for
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well f c~ $ '
To Property Line /~
To Water Main/Service Line Course ~/~
To Building Foundation ~'Z'
To Disposal Field ,/r.~¢
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026 (Rev 81861 Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ,9/~
Width of Field ~
Square Feet of Absorption Ares
Depression over Field (Y/~.~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ! Z~ /
To Building Foundation (P~ ~
Lot '""~/'~'
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness /
Standpipes Present t~/N)
Date of Last Adequacy Test
To Water Main/Service Line ~'~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line ~5~ '
To Existing or Abandoned System on
; On Adjoining Lots -~")
To Cutbank (if present)
,-/{/-)
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certi~h~i~(~l~[~e(~, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Eagle River, Alaska 99577
Company MOA No.
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72 026 IRev 8/86) Back
· MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date ~~7~
(a) Legal Pescgl~t%pn ~include~_l.,ot._block, subdivision, section, township, range)
5"~z. /._. / c, 0 ,,3' ~'/ ~J 7-/,5- x~ M ~ ~u
(b)
(c)
(d)
(e)
Location (.a~dress,gr dir,ectlo,,ns)
Applicants Name (~1~ ~0 5~elephone - Nome Business
Applicants ~dress ... ~L~ ~:"~ .... ~'-
,--. ~9~ - . ~ar/bnilder~
Applicant is (cheek one)-h~d-i~stltut~on ~ ; ;
Suye~ ~; ot~e= ~
Lending Institution
/~' ~ ?'-J'~:"' Telephoue
Address
Real Estate Co. & Agent_
Address
(f)
Telephone
the HAA to the following address:
2. Type of Residence
Single-Family~
Number of Bedrooms
3. Water Suppll
Individual Welt~
Multi-Family ~-~
Other (describe)
Commnni ty ~-~ Public
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
pewage Disposal
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
5. Engineering Firm Providin~ Inspections~ Tests~ File Search~ Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein. I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm.
Date
Telephone
(ENGINEER SEAL)
D._HEP Approval
Approved for ~ bedrooms By
Approved ~ Disapproved
Conditional
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF IiEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HF~%LTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 ~ND
THEIR LENDING 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
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPRDVAL (HAA)
CHECKLIST - FEBRUARY 1984
Well C lass i f icati~ ~/~/~/~
Well Log P=esent (Y~)
O ~
Total Depth ~ O , Cased to
Static k~te= Level 2~) '
Casing Height Above Ground /F. t~_/
Wiring in Conduit ~
Electrical
Sepa=ation Distances f=cm Well.'
To Septic~Tank c~ Lot ../O~~ '
To Nearest EdGe of Abso~-ption Field on Lot
Nearest Public Sewer Line AY,/F~
To
; On Adjoining Lots..../~L9
/~9 ! ; On Adjoining Lots
To Nearest Public Sewer
watar S le results
B.. S. EPTIC/HOLDING TANK DATA
To Property Line /O
To Water MsX~/Service Line
Co~
Cowue~
TO Disposal Field /O !
To St=earn, Pond, Lake, c~ Major D~ainaGe
[Page 1 of 2]
Receipt #
Date Paid:
Amount: ~ ~- ~_~
2-15-84
Ce
ABSORPTION FIELD DATA
Soils Paring in Absc~ption Strata
Date Installed ~/_~O~
Width of Field ~ ·
Length of Field ~
Depth of Field ~'-
Gravel Bed Thickness
Square Feet of Ab.sc~ption A=ea h ~,~- Standpipes ~esent ~)
~sults of ~st ~a~ ~st ~/~'~~
,/
Sensation Distan~ ~ ~s~tio~ ~isld:
To ~te~Supply ~11 / ~ ' To ~o~ty Li~ /~ ~
To Building F~n~tion ~D ' To Existing ~ ~ndo~d System
Lot ~ ~ ; ~ ~joining ~ts ~ ~
To Ware= ~/~=vi~ Line FO ~ To ~t~(if ~e~nt) ~ /~
To St~e~nd~ke/~ ~jo~ ~ai~ C~se ~ / ~
TO ~i~way, P~ki~ ~ea, ~ Vehicle St~a~ ~ea FO ~
D. LIFT STATION
Date Installed
Size in Gallons
"Punl~ 0~" Level at
High Water Alarm Level at v~'w
Tested for
Electrical Codes(Y/N)
Cc~snts
Dime ns ions
IManhole/Access (Y/N)
~ ~ "Pum~ Off" Level at
Vent (Y/N)
Pumping Cycles du=ing Adequacy Test.
Meets MDA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, cr confc~ed to all MOA HAA Guidelines in effect
on the date, of this inspection.
Signed Date /
it7 ........
C~any MOA No.
KB1/d5/s
[Page 2 of 2]
2-15-84
I . APPLI' IT FILLS OUT UPPER, HAL 3NLY
~ . , ' .. , ,, ~/ ~. , Phone
Mailing Addre~ _.~ ~ ~.. Zip Code
Buyer ~ ~ t~
,~'~D' ~ '~ A ",- - -. 'L~'
.~ ~ultlple F~m~~ ~--No. of Bed~)o~
~ Other ] (~ ~
Water Supply ~
~ Community~~ ¢( ~/ / For wells drilled prior to that date, give well depth (attach log if available).
~ Public Ugllty '~ ~
Sewer Disposal
~ Individual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
Date ~ Date
Inspector Inspector Inspector Inspecto/
~ ~ *CONDITIONS OF APPROVAL
{ ) APPROVED BEDROOMS .
( ~ ) DISAPPROVED -~
( ) CONDITIONAL APPROVAL' .~ ~ [m o ~
Soils Rating Dat~wer I~stalled Well To Absorption A a ~11 Log Received
Well to Tank Septic T~k Size
72.023 (31~)
Phone
APPLIC ,T FILLS OUT UPPER HA~ )NLY
Property Owner . ~' ,/
Legal Description
Zip Code
Type of esidence
[] Multiple Family No. of Bedrooms
[] Other
.~T Individual ATTACH WELL LOG. A well Icg Js required for all wells drilled since June 1975.
[] Community For wells drilled prior to that date, give well depth (attach Icg if available).
[] Public Utility
Sewer~iisposal
_,~~ndlvidual Year Individual Installed: /
[] Public Utility When Connected to Public Utility:
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time I Time
Date Date Date Date
Inspector Inspector Inspector Inspector
( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ~ DISAPPROVE~
( ) CONDITIONAL APPROVAL*
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
Well to Tank Septic T~k Size
ADEQUACY TEST
WATER AND SEWER INSPECT)ON
WELL INSPEDTiGN$ AND
~LOW ~ EST
D'SPOSAL SYS rEM DESIGN
Re/Max Realty
ATTENTION: Darlene Nicolaysen
P.O. Box 848
~a~lo Rivor, hlaska 99577
ROBERTA. SHAFER
December 19, ].983
CIVILENGINEER
694-2979
Dear Ms. Nicolaysen,
Reference: Lot 106; Section 18; T15N; R1W
A sewer system adequacy test was performed on the system located
on the referenced property as you requested. The septic tank was
pumped and verified to have a capacity of 1250 gallons. The
absorption trench was tested by a continuous flow of water over
a period of 48 hours without any adverse effect on the system.
It can be concluded from this test that the waste water disposal
system serving the four bedroom residence located on this property
is currently functioning adequately. However, the system cannot
be guaranteed against subsequent failure.
]if we may be of further service, please do not hesitate to
contact us.
Sincerely?
.-" .:.4.;://-
?"?As/ss /'
cc: Hunicipality of Anchorage
Departraent of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA 99577
MUNICIPAI.VI'Y OF ANCHORAGE
ENVIRONMENTAL EN(;fi~IEEtllNG DIVISION
Telephone 26/l-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WA'TER AND SEWE~ FACILITIES
~ SINGLE FAMILY ~] One ~ Four 1.7} Other.
~ INDIVIDUAL~ "AT'FACH~,,~A 'LL LC)G. A well l{}g ~s required for all wells drilled
] COMMUNITY since June 1975. Fm w(dls drilled p,[ol 1o that date, give welt
~ INDIVll}UAI../ON-SFrE"" *"If h,dividua~,on-~,m~, ¢,ve rnst,dlado,, dau~ ~g~/
,; ..... THE INSPEC'rlON FEE MUST ACCOMPANY EACH REQUEST I~EFORE PROCESSING CAN BE iNITIATED.