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HomeMy WebLinkAboutFORELAND VIEW BLK 2 LT 1Foreland View Block 2 Lot 1 #017-401-48 • 72-01391 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 0* ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME (� PHONE EW QS.v ❑UPGRADE MAILING AiD'DRESS `l LEGAL DESCRIPTION b� 2 LOCATION NO. OF BEDROOMS Q Well Absorptio area Dwelling PERMIT NO. u DISTANCE TO: s' Y 1 ry / _ m C Manufacturer Material of co No. mp rtments wF w Liq. capacit in gallons IF HOMEMADE: Inside length Width Liquid dept Y DISTANCE TO: Well Dwelling PERMIT NO. J 0z i Z H Manufacturer Material Liquid capacity in gallons 0 = DISTANCE TO: Well ���/ F�ndation Nearest lot ling PERMIT NO. W � v. z No. of lines Length of each line Total length f lines Trench idth Distance between lines 1=?W inches F Top of rile to finish grade i e Material ben Wath rile Total effective absorption area 0^ inches Length Width Depth - PERMIT NO. W 0 i H �y a Type of crib Crib diameter Crib depth Total effective absorption area h DISTANCE TO: Well Building foundation Nearest lot line J Class Depth I Driller Distance to lof line PERMIT NO. J4W W DISTANCE TO:. Building fou dapon , Sewer line Septic t k2 Absorption area(s) N ti n OTHER PIPE MATERIALS 0—AS i I U4 W M e— 4z: --L-14 SOI L TEST RATING ♦ s S INSTALLER UIZOORAD-TC- '� 1041 i REMARKS - i \\ O L 1A C0 e. l o0.1,%CO P .x®.; nFai1 tN ®usIrpe ° °• pq°° SEI. TA o�TN ee�e uwue a rnq Si E. O ppel • r APPRODATE LEGAL - G 30-Z-LOT 1Rev. 3/78) - 17 rl t_J r_4 I c_ IOt=1 i_ I T °-r 0 F= F:� N ti; A Fc Ft Ca E -'� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 F-FEF_F'EWER F- l=F;R.M I T PERMIT NO. is 8_70512 [NATE OF ISSUE 66983 ,= E, F=' V »: WARNING DUE TO CHANGING REQUIREMENTS THIS PRINTOUT MAY NOT BE AN EXACT COPY OF THE ORIGIONAL PERMIT APPLICANT RIORDAN J. DAUGHERTY 1412 RICHARDSON DRIVE 163-4463 LOCATION LEGAL LOT 1 BLK 2 FORELAND VIEW 'SUB LOT SIZE 999999 SQUARE FEET TYPE OF SOIL AB_ORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = X* 1,Wt- SOIL RATING (SQ FT/BR)= :125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C°EF= TFC= ��3_ 1_ErAGTF-F= 40 ciF�F�Ik�EL r'F=F- -F"= *E- _ 5a THE LENGTH [DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH 15 THE MINIMUM DEPTH OF GRAVEL BET14EEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION {IN FEET). /A;lo FRE,ALJ I EcErD S~EF='T I I- -F F=j1 .4FC" �75 I =- E_ larlI I c.)"S --- FLJ C, R: .a I r !1P 1 f T I r 1-. F9R_'E FREC-2F_' I fR°EC* --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL.; OR 150 TO 200 FEET FOR A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY - SPECIFIC:ATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION F=^EF:Cr°7 I T E: ;P I FRES C-�EE=Er^1E=EF:! :!—L, I CERTIFY THAT 1: I All FAMILIAR 14ITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNIC:IPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. s: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODE ED T- IN E MORE T AN `: BEDROOMS. SIGNED: --=---- f(( APP'LIffiNT R:I Oii� DRUG ERTY -----/ ISSUED BY-�d INSPECT T0 WELL INSP HISTORY - SEWER 1 0 SEWER 2 0 0 WELL LOG DATE 0 DRILLER / Orr 1oa/ 14117- z� .•i !-®LP@ � I �- I•F�L I T T@. ^._.F= f-!N1Z. 4kTC Hg -:1 E= "L 's DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION � 825 'L' STREET, ANCHORAGE, AFC. 99501 264-4720 l '3 U WELL FiNC.- o_iF 1—=.ITE ! F=L4E=F? F EZF_'M T PERMIT NO. ( 830512 ) Ia� �3 APPLICANT RIORDAN J. DAUGHERTY 1412 RICHARDSON DRIVE 163-44E3a.�U LOCATION man 10-a`7-83 LEGAL LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM I=: TRENCH MAXIMUM !'DUMBER OF BEDROOMS = _ SOIL RATING (SQ FT/ER)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: CtiEF _r"1 1e_i. w—=; L E:"13TF1= �:D l F-_1- VE:L CaEF'-r"F #-:=;- c THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE FIND THE BOTTOM OF THE EXCAVATION CIN FEET). FRE=iDU I FREES EEF= -r I 1= TF l"F< E I ZE= ::L0IDO QnL-L-C--jN•E PERMIT APPLICANT HAS 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. --- T'WID < 22 > I N!S5F=^EC7r I ID "!E3 F=l F,�E F-tEQU I Fc EG BACFCFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I5 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 A PRIVATE WELL TO A PRIVATE SEWER LINE IS• 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F•EFR1-1 I T EXF• I FSE GaEC=EME4EF?' _29: 1 - -sp:a: I CERTIFY THAT 1: 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 CODE_. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. S I G N E D i / f.'_"c__'0'"_ -- ---- -- APPLICV9Q ORDRN .J. DRUG RTY ISSUED B�_V------------ - ----DATE _�-4_T/_,C_ V4. 0 -�-'a43 )-)t8 0 • ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE ` DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION �f PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: '/ `"�-+�'e� �/�D/ATyE PERFORMED:— ew LEGAL DESCRIPTION: L/y? C,y � � u? / /7 ' " 3 DEPTH SLOPE SITE PLAN (FEET) 2 3 SiL/ Y �$e7✓ lM 4- PEP—C— 5 6 7 8 9 10 7_,E� 11 WAS GROUND WATER S ENCOUNTERED? All L 0 12 P IF YES, AT WHAT E 13 DEPTH? 7 14 Date Gross Time Net Time Depth to Water 1 %I Q't�°©F 45 ro s r .A4.. 1 :* r4gld 7- �0os a o^. ao�e r�ae H oia•• 3.6i JOHN T. LDVETT No. 3512.E .• G� •'�+a 19. 3'- 8 .• Reading Date Gross Time Net Time Depth to Water Net Drop 6-2-5z 24 i 6-3-97- S:S® 3.6i 3'- 8 / z �. 3' G.%S Zoe,,; 20 PERCOLATION RATE ��//q //9 (minutes/inch) / TEST RUN BETWEEN 4 FT AND 11— FT COMMENTS / !JT k�i%E.� hgxS fIJ 6!�:r4z�l PERFORMED BY: ✓' T Z'0�- CERTIFIED BY: --767A/ 77 Z- �yG�/ DATE: 72-006 (6/79) _ 26 ii, Y A 1I .' ANCHORAGE, A>r.AsxA 99 502 344-7714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 20 Tee* DRILLED AT THE RATE OF "24.00 PER FOOT. 0$$04 Rack. PROPERTY OWNER rz. c'. ii'>A. DanDa en5.r r �,, 263-/463 11337-0754 1410 'Zch .txiAan Dt, LOCATION OF WELL SITE Lt. 1 3tic. - Sub. fbre- A Vie,a DRILLER ',, eltnz CLau,4 oP .'ame U .pa&t DPVJ,fnaAA4. WELL LOG: 0-----1$' SLLur_ eVtave,L. ITT cfa k bdndet. 19----37' Can2.ee bot,-uvti. 20` c tttu. 37---205' °ee.zack. 0 6e L—nat n -,j tock. 11A) WA aP natatti E nhanu. (rate-&, a.La shower 6are of watch. no aaod 6hau,,n.n unit a depth of 18$ ;veo 1/n �.P".'. 1/9 UP at 9$ Peet. 'etep �t ptaducttan IA a otom ,tocl 4-tcttecl ahawina. ol: 200 ;oeet. 9t arae mui dec 4lon .to at •tea4t r7a ; etre, mate veal VA 4 �7rn. l2.4 0 C(!i7 17M °hon. 200 to ruma,it 6000 potmtta) ZrL a 24 houbt tLne PJume.. ALdo ovet 180 .fe-et of uy tet ztaadtmain. ca4-tru7,. 1.6 as A Wz foot. ; most 300 aaUo" to te4etve. 3/4 ?fat7e Su,Gme v. rte Pma 4hautd be t"tatted 10 to 15 Peet ag- bottom. Ca.6t of D&- V-n,o.: .124.00 peri ?aat X 20$ Peet: 149,210. 00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF 94920.00 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE ;tme 18th, 19 3 SERVICE CHARGE OF I Va% PER MONTH WILL DE ASSESS O ACCOUNTS. 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 Parcel 1. D. # L A-1 - Lr^I - q HAA # 1. GENERAL INFORMATION Complete legal description Lott 1; Block 2; Fon.eeand View Subd i.v.Ls.i.on Location (site address or directions) _ 6520 Snend?ove D,,Live Ancho7a.ge, AK Property owner David Cokt Day phone Mailing address 8520 Spe.nd2ove. D.Y.£ve Anchoaaoe AK 99516 345-4062 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 9 4. TYPE OF WATER SUPPLY: Individual well KXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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. 72-025 (%. 1/91) Front MOA 11 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 Phone G q y - °l ag a River Loop Road No. 204 Address Eagle River Alaska 99577 Engineer's signature Date 7 �� /°-JG ti vV"r•JJ„�.. a- ROBERT C. C0'JW-;1 +`c' Cc -8801 ,• 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 0 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-0 (RW. 1,91) Back MOA x21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 3444744 Health Authority Approval Checklist ,/�C Legal tion: Lor ! ll�oc<c ! oRe«I�n v,e4 S�, ��%,9 g P Parcel I.D.: 9� A. WELL DATA �l/CD Well type N ' v a r E If A, B, or C, attach ADEC letter. ADEC water system number Log present 6" Y i -f Date completed 6 /r S/ 0 Total depth o Cased to fli�- 7 oz K 3-4- P Casing height (above ground) I Sanitary seal Y S Wires properly protected I9" Y ¢ S pFROM WELL LOG AT INSPECTION Date of test G, l [ tr 3 g q Static water level 4s- ci G Well production y g.p,m. y- -7 g.p.m. WATER SAMPLE RESULTS: Coliform O Date of sample: b // 1 /') L B.SEPTIC OLDING TANK DATA Nitrate S. 7 Y Other bacteria 0 Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Date installed 6 / 30/ $r 3 Tank size 1)- 5- a Number of Compartments a Cleanouts YE S Foundation cleanout (ON Y jlk- 5 Depression (Y4 N c High water alarm (Y6` Al J Date of Pumping C I` 8 /'I L Pumper A t Non f (#,AV .s J C. ABSORPTION FIELD DATA Date installed 6 / 3 c / $ 3 Length o Width 3 Soil rating (g.p.d./W or /bdrm 1 d $ Gravel thickness below pipe 7 `! System type T-4 c � c & Total depth q Effective absorption area 9`0 6 Monitoring Tube present&-" YDS Depression over field (Y/ N P6Po.n.T SHo wJ 2 Jvh Pi —c-wW o, 4� Date of adequacy test Co 71 9 / 9 b Results (Pass/Fail) p s S For bedrooms Fluid depth in absorption field before test (in.); Immediately after7gc gal, water added (in.): 3 t I Fluid depth 3 n (ins.) Minutes later: 1 b Absorption rate = 6 r'v -r g,p.d. Peroxide treatment (past 12 months) (Y/N) wo., k KG Own/ If yes, give date — D. LIFT STATION Date Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: at* LS—e- tr olding tank on lot / 0 t ; On adjacent lots "Pump off' level at* Absorption field on lot /00 f ; On adjacent lots Public sewer main N /A Public sewer manhole/cleanout Sewer /septic service line /oo ff- X 1.¢ Lift station u /,# SEPARATION DISTANCES FROM EPTI OLDING TANK ON LOT TO: Building foundation P O r } Property line /0 /+- Absorption field S Water main/service line a 5- rf Surface water/drainage t o o '4- Wells on adjacent lots 200 r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 3 ° + Property Line / p + Water main/service line O Surface water % D o r} Curtain drain NON 6 '<mOW N F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area Wells on adjacent lots j 0 o '�- C v r /S A,,, K * NO SV&44c1,v(r F.KiLJC1- 0994AV4,0, I certify that I have determined thru field inspections and review ofMunicipal in conformance with A1QA HAA guidelines in effect on this date. Signaturez nn Engineer's Name r ` 0 y E'4 C- cc) t, 94 J Date -7/ 1 / 9( - HAA (e HAA Fee $ e_ k), Date of Payment �� /9/,�, Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment _ Receipt Number _ are ROBERT C. COWAN CE -8801 is%r i E MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY �7 264-4744 d/ 7— Application Date Apti2 12, 1988 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1; 8kock 2; View Heights FOREIgND Location (address or directions) 8520 Snendtove (b) Property Owner At" ka Houb.ing Telephone: Home Business Mailing Address (c) .Lending Institution - Telephone Mailing Address (d) Real Estate Company and Agent 2001 REALTY/Nina Mann Address. 1345 We,6t Ninth Avenue Telephone 276-2001 (e) - Mail the HAA to the followina address: or: Check here In, if hold for pick up. List contact person and day phone number below. S 9 S ENGINEERING1694-2979 17034 EagQe Riven Loop Road, Suite 204 Eagte Riven, A2ahka 99577 ondeaed by Nina Mann 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms _ 3. WATER SUPPLY Individual Well In Community D Public D 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 P Public D Community D Holding Tank D 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 rae, B18M Font q�,aac�rrj�, A HEALTH AUTHORITY APPROVALS SEWER 8 WA ER WAIN EXTENSIONS SEWER d WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION d FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION LIST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL. SYSTEM DESIGN • ROBERT A. SHAFER CIVIL ENGINEER Apr,.$. 29, kiilbPAM OFAK� 694-2979 DEPT, OF HEALTH t EWIRONMENTAL 06Md �IIQ i *R 21 1988 Ma. Nancy Berg-Poetock 2001 REALTY RECEIVED 7345 Wmt 9th Ave.nuc Anchorage, Ata6ka 99501 REFERENCE: Lori 1; Block 2; Fore.ta.nd Uicw SubdJV�Aton Dear Nancy, In .the process ob obtaining a H( aeth Author ty ApprovaX. (NAA) gor the residence Located on .the negenenced pnopvtty, we we)ce &,,qu.ined to 6amp e, water bnom the private well to determine. the nitrate tevetA. A sampte. was .taken on Ap4%2 8, 7998 with an a.nakys.i.6 report ob 9.1 mg/t. Since th 4 teve.t was very nea./L the ae2owabte tim.it o� 10 mgg the Municipattty o6 Anehon.age (MOA), Department otl Health and Human Senvi(-.e (DHHS) tcequ.ined a second sampting be4O)Le iAAud.ng .the HAA. A Aeeond 6ampte was taken on Ap)Lie 15, 1988 with an anaty6.i6 report 06 10.8 mg/t. ThiA e.xeeed6 .the at2owaVe t�mit. We ane in .the p400u6 o6 tLedeve2opi,ng a ween .in the, adjoining Aubdivis on (Mountain Shadow,). Thi6 wet2 also had niPLate 2evU2 which exceeded a2P_owabte t,muts. Ater .the work %6 eompteted and Lejampting o6 thiz went i6 pen�onmed, is suceezA(1,, you might cu sh to con6tder the Game pnocedune on yocut weUl. Vowevetr., .in the, meantime, unV..2 something uoA ive can be done to neduee the niPtate. 2evol4, the occupants should be alerted to the heaXth hazard usoe.iate_d with these cone .entra ionA o6 nit;Late in the water suppty. rh.is in�orrnati.on iA avaiUbk_e through .the DNNS at 825 L Street, 343-4744. It 4,4 aur opinion that ate dndnking watn shoued be ebt(L ned {horn a duniatpat watea suppty and hand eatvc,ied to the home. In addition, Men bathing swain ch,i &i.en 2n wate.)t 6uppUed by the weet, cane shoutd )e .taken to be sure the Ji Uuften do not Awattow the bath water. 1e wi.22 keep you tn6ormed ob the progn.ess in th,A area. incercc2g OBURT A. SHAFER, P. E. AS /6A 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 NUNI�TWIRAt4t# 'ANCHORAGE (MOA) Er1VVRU ALTH AUTHORITY APPROVAL (HAA) ;Crcggr - FEBRUARY 1984 264-4744 RL C � J\J Je'al Description: T XRuL• Z A. WELL DATA V011tfi Well Classification tJ D\\J 1 12J.6-1_- If A, B, C, D.E.C. Approved (Y/N) Well Log PresenttV?N) X__ Date Completed Yield 64ft-1 Total Depth ' Cased to -X Depth of Grouting Static Water Level Pump Set At J� N Casing Height Above Ground Sanitary Seal on Casing ( 1) i Electrical Wiring in Conduit a/N) y Depression Around Wellhead (Y/M Separation Distances from Well: To Septic/FTof 44ag Tank on Lot ty ; On Adjoining Lots -F To Nearest Edge of Absorption Field on of 1 ; On Adjoining Lots '\'�� I -t` To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole P' To Nearest Sewer Service Line on Lot Water Sample Collected -by � � xlr i+�1 Date1 - is - 8e, Water Sample Test Results O G� �M�. = �i.1/ Comments vz- B. SEPTIC/Htlt9MG TANK DATA Date Installed Size No. of Compartments Standpipeso/N) Air -tight CapsQ&V) Foundation Cleanout (YZN) Depression over Tank (Yo t__J Date Last Pumped Pumping/Maintenance Contract on File (Y/N) � for — Holding Tank High -Water Alarm (Y/N) /A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Hatdigg Tank: To Water -Supply Well \y To Property Line To Water Main/Service Line 1 I l Course \ �� r Comments A+ Page 1 of 2 72-026 (Re, 8166) Front To Building Foundation i To Disposal Field 1 To Stream, Pond, Lake, or Major Drainage 0 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �/4r'-rt--- Type of System Designlx{t ��� Date Installed � - �- Length of Field ¢� Width of Field Depth of Field Gravel Bed Thickness n Square Feet of Absorption Area `��� Standpipes Present") y Depression over Field (YO Date of Last Adequacy Test 4 - l 2- - Bg Results of Last Adequacy Test �/�T is rpt zz �/ — !!!± T -a_ Separation Distance from Absorption Field:` To Water -Supply Well ( To Building Foundation Lot �P To Water Main/Service Line i o To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION I3/ Date Installed Sizein Ga "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Property Line ; On Adjoining Lots To Cutbank (if present) I -'Q V -Cl kc ( h 'COV try To Existing or Abandoned System on 3� �4- Ih Dimensions Manhole/Access (Y/N) "Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping ty6es_furing Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA andkHAA guidelines in effect on the date of this inspection. Signe & S ENGINEERING Date Compo Eagie River Loop Road No. 210jA No. Eagle River, Alaska 99577 Receipt No. r) 0 artDate of Pay ment Amount: $ En Se Page 2 of 2 72-026 (Rev 8/881 Back •Property APPLIC&T FILLS OUT UPPER HA ONLY OwnerPhon .. Date t; t- Mailing Ad,4efs Ifv , ..�(' =G'.., f - Zip Code (` `: Buye? Inspector Inspector Inspect���pp�//))��j�� � Address Zip Code MUNICIPALITYOF ANCHORAGE Lending Institution 1 / /-/ / �; ���Ci 4-1k Phone r'J / L / �/ ��;L✓ct � ,!-. t`n�c, f ENVIRON'vLjVTAL PROTECTION Address Zip Code DEC I ' 'I z,+: Realty Co. & Agent } -. Phone Address Zip Code Legal Description 10, ( ) DISAPPROVED Street Location5�6 mini all ( ) CONDITIONAL APPROVAL' Type of Residence -- zl r mgle Family DATE ❑ Multiple Family No. of Bedrooms BY: ❑ Other Soils RRating(� Wpply Uividual Well To Absorption Area - �� / J Well Log Received Septic Tank Size SO - ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community - For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility - Sewer Disposal Q,,rndivldual Year Individual Installed: /9 E 3 ❑ 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 Time Date Date Date Date Inspector Inspector Inspector Inspect���pp�//))��j�� � - Field Notes: MUNICIPALITYOF ANCHORAGE CEPT. OF I'Si:!T!i tj r'J / L ENVIRON'vLjVTAL PROTECTION DEC I ' 'I z,+: RECEIVED / ( �) APPROVED BEDROOMS - 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' zl r DATE BY: Soils RRating(� Date /Sewer Installetl n Well To Absorption Area - �� / J Well Log Received Septic Tank Size SO Well to Tank S''