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Home My WebLink AboutT15N R1W SEC 16 LT 19 W2S132'TISN RIW ction 16 Lot Ic) W2 S132' #051-212-37 Municipality of Anchorage " Development Services Department : .....L.-~r~I' Building Safety Division ~" On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of w'.~v.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTE~NATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW020477 PID Number: 051-212-37 ROI~ VITT Wastewater System: [] New [] Upgrade Address: PO BOX 671884. CHU$1AK. AK 99567 ABSORPTION FIELD 688-6288 3 I~ Dee~Trel~ch I'1 Shallow Trench [] Bed [] Mound GPO/Ft~ Ft. ToWnship: Range; Section: Fdl added at~ove o~gioal grade: ,~_ Gravet Length: Cia ssif~catJO~Private(PmnRe. A. B. c): To~al,,~,.,,~Oep~,~,,,,.,~Fi. Cased to: FI. '[o~al abso~p~[ F~ Pipe Matenah SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:. Septic Absorption Lift Holding Public/Private Manulactu~'ei'; Capacity; Tank Field Station Tank Sewer Line Anchorage Tank 1000 w., 100' 100'+ NA NA 25'+ Steel 2 su,,:,w,,e, 100'+ 100'+ NA NA '~ / LIFT STATION ~ I *none known. Old tank removed and properly abandoned. Hew BENCH MARK ' · tank placed in same location as old tank-added insulation and an Porch additional post-tank cleanout inlins to existing system. 100 rt. Engineer's Stamp Inspections performed by: KND EnRineering, Inc. Dates: 1St 12/71200.._~2 g ~.4~9_ Z~. Development Services Department Appro~;al - l,?,&'~,,,"--,---~:..' AS-BUILT SYSTEM DETAILS/SITE PLAN LOT 19, SEC16, T15N, RI~, 8.~. PID# 051-818-37 ~ 100' WEL~ G ' ~ I - ~ SCALD 1' = 50' B-C= E7.5' A-D= ~0.9' B-~= ~5,5' ~ r ORIGINAL GRAgE ~ B-E=NA ~ ~tOOO ~ m ~ - '' "~ ~ :. O0 '-~--'"'- "~:~'"" -.~-~:" '"'~,~. S-F=NA ' '~"~ - . ........ , RACK--'"::": ='~ "- ' CHUG~AK, AK 99567 ~ '... ......... ..~ "~= STAKINQ ~=~ KMD 20441 PT~MIGAN BL~. MUNICIPALITY OF ANCHORAGE Development Sen/ices Depadment On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Dec 05, 2002 Expiration Date: Dec 05, 2003 Permit Number: SW020477 [Legal D~s-c~i~{'i~?Ti'~i~i**R'~ ~*~ ~ ~ (~"i~T'II'.1'9' w2s132' Design Engineer: 0070 KND Engineering Owner Name: RODNEY W. VI'IT Owner Address: PO BOX 671884 CHUGIAK, AK 99567-1884 Parcel ID: 051-212-37 Site Address: 018404 AMONSON RD Lot Size: 21780 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~ Issued By: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.a nchorage.ak.us (907) 343-7904 ON-SITE SEWEPJVVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 05t.212-37 .Permit Number SW O~O~.7 7 Property owner(s) Rod Vitt Mailing address (1) P.O Box 671884 Chu.qiak, AK 99567 Mailing address (2). Day phone 688-6288 .Zip Code Legal description (Lot, Block & Sub d.) TI5N RlW SEC 16, Lot 19 W2S132' Legal description (Section, Township & Range) Lot Size 21,780 Acres S~.Ft.~ THIS APPLICATION IS FOR: Sewer Only [] Sewer and Well [] Sewer Upgrade [] THIS PROPERTY CONTAINS: Hot Tub [] Swimming Pool [] Therapy Pool [] Number of Bedrooms 3 Well Only [] Water Storage [] Jacuzzi [] Water Softening Unit [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (~i~ p p y owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev, 12/00) Waiver Fees: Date of Payment: Receipt Number: (907)696-6111/FAX (907)696-8111 December 3, 2002 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Septic Tank Upgrade - T15N R1W SEC 16 LOT 19 Gentlemen: The owner has requested we proceed forward to obtain a septic permit on the subject lot to replace the existing septic tank. The existing septic tank has been identified to be in failure and will be properly abandoned. We propose to install a 1,000-gallon septic tank. There are no public or private wells within 200' of our proposed system location except' as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, II~I~2) Engineering, Inc. Attachments: On-Site Well and Sewer Application Wastewater Absorption System Details/Site Plan ~ELL K ~/ASTE~/ATER DISPBSAL SYSTEM ]DETAILS/SITE LOT 19, ~/2 :S 132', SEC 16, T15N, Rl~, S.M. D 8 PLAN DESIGN DETAILS CONNECT Tn EXISTING SEPTIC FIEL]] USE EXISTING sySTEM NOTES, ~<~ .. ......... . ~,.,,~,~ PREPARED FORm PO ~OX 671884 (907) 688-6888 ~ BO~S ~ SEWARD · ..-'~ ~~ .... ......... ~ ~ ~ ~ 02083.DWG 12/5/02 NW1058 02085 c~c:x~. KMD Scckle, 1'= 100' PAGE 1 DF 8 ENGINEEi~ING 20441 PTARMIGAI~ BLVD. EAGT.F. I~IYE]~, AK 99577-8736 (oo?)8.8-Bxxx/~',A.x USE 1000 GAL SEPTIC TANK, INSULATE IF 44' OF COVER. INSULATE TRENCHES ~/ITH e' HD ]~URIAL FOAM. CONTRACTOR VILL ENSURE MINIMUM EX SLOPE INTO SEPTIC TANK. A]]]]ITInNAL FILL ~/ILL I~E A]]]]ED OVER SYSTEM TD ACHIEVE MIN. 3' COVER IF REQUIRE]]. CONTRACTOR ~/ILL ENSURE ALL SEPARATIONS TD A]]JACENT VELLS, SEPTICS, LOT LINES, FDUN]]ATIBNS AN]] ALL OTHER SET]]ACKS. WASTEWATER DISPBSAL SYSTEM DETAILS LOT 19, W8 S 138', SEC 16, T15N, RIW, S,M, . ~ T' EXISTING TANK ~ ~ \ IN FAILURE m) ~ ,~ X PROPOSED 1Om GAL //~ ~ ~' XX ~ ~ SEPTIC ~ANK ~/~//~ o ~~~~ 5 co - ~~~0 ~ ~'~¢0 EXlSTINGSYSTEN 5 · "" '".~ PB 3aX 671884 Sc~(e~ 1'= 20' ~~ <9o7) 6ee-6eeB PAGE~ ore ~'q. ~~~~~ ~...' ~e ~ KMD 20441 PTARMIG~ BL~. ~ ~ ~ N~ 058 '~ MUNICIPALITY OF ANCHORAGE ,~ f, ~ 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 NAME IP~HONE ~"N EW AbsorPtion area Dwellin~ ~ PE IT ~ ~ Manufacture~e~ ~¢ / No. of core.merits Lp~i¢l/ons IF HOMEMADE: Inside length Width Liquid depth , ~ Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons ., Length~li,e Totalleng~e, Trencmh . Dista.cebe e I' es ~, ~ Top of tile to finish graOe q , . Material beneath tile 4~ g/inches Tot narea Length Width Depth P~RMIT NO, ( ~ Type of crib Crib diameter i pth Total effective absorption area Well foundation Nearest lot line DISTANCE TO: ~ CIo~/~a,~ -- DeUx/~7/~h Driller Distance to lot line PERMIT NO. ~ ~DISTANC~ TO'. Building foundation Sewer Hne Septic tank Absorption area(s) OTHER INSTALLER 72-013 (Rev. 3/78) II'"g LII ~',dl ][ ~[=: :.E IF::::" ,~::~ L- ][ IF' ~"' CD F~' ~:~ INI C3 fl-II C.} IF:~',: ~?.:~ IEE~ EE'.; DEF:'ARTI~EIxlT OF HIEIAI_TH AND ENVIF:~ONMENTAI.. F:'ROTE[.TI':IDN 82.5 L ~TF~EET~ AIxICHOR~GE~ AK 99501 264-4720 PEFIM I T' NE)." DATE I SSLIED ~ 840846 ],0104/84 APF'L.. I CAIxFT' ," ADDRESS: CON?i':ACT PHONE ~ []/0 S & S ENG'G. SF(B :L96X EAGI....E R I VER !~ AP:: 694"'"2979 GARY F'ERKI NS 99577 I..EGAL. DIE:S[',R I.P: L. OT SI ZE: MAX BIi~:DROOME~: SLIBDIVISION~ NA LILT,", 19 SE[.'T'ION: 16 TOWNSHI F:': :L5N RANGE: ].W 1.25A (SQ.F'T,, OR ACRES) Listed below ar, e the options available 'Lo you in desigr'~:Lr~g sy~M',.t.b.m. []I'IOC)s[~) t. he c)p'L.~.c)r'l that ~jest £i'Ls your' site. ""If' F~ E: ~"4 C]; 11...,41 Ib.dl., :1[> F;;':. ~t::~ ]] Ih41 DE:F::'TFI '1"0 F:'IF'E BOTTOIq (F"I".) 4.0 4.0 GRAVEl... DEF:'"FI..J (F'T',,) 4,, 0 3,, 5 T'DTAL. DEF'TH (F'I".) 8.0 7.5 GRAVEl.,,' WIDTH (I=T,,) 2., 5 5,, 0 GRAVEL L. ENGTFI (FT.) 46., () 4 1,. 0 GRAVIEL, VOI.AJI~IE (CU. YDS. ) :1.9.2 30.4 ]"ANI< ~31 ZE (,GAl.,.,:)) 1,0()0.0 '~"~' 1,0C)0.0 '~'~' SOIl,.. RA'I"ING (SQ. F:'I". /BR) 122 125 · ~,~- 'T'ANI< MUST 1,4AVE: A"r I..,EAST TWO E;OMPART'ME.".I'4TS BL. OCK: NA I cer't.i~y t, hat.~" :1.. I am i'ami].:i, ar, wi/Lb the r'equir'ements t'cH" c}n-site sew(~rs arid wel],s as set fot"Lh by the Murl:Lcil:~alit. y o{' Anchol-age (MOA) anti the Sta't.,e (::)~' Alaska. 2. I will J,r'n~t.z~tl], the system in accol'dance 'w:i.'Lh all MOA c:c)des and ~'egu],a'L:i.c~ns, .arid irl c:c)mp].:Lance with 'Lhe design c:piter'ia af 'LI]:Ls peruni't.. 3,. i will adhel~e ta alI MOA and Sta'Le cH' Alaska r, equir, emen'Ls few the set back distances t'r'om any exis'Lir~g well, wastewa'Ler' d:~sposa], sys'Lem c~r' public sewePage system 01'] 'Lh:Ls of any adjacerrL c:}r, i]ear, by ],ot,. 4., I Uilhd~ps'Lalhd 't. ha'lL 'this per'mit is valid fop a max:i, mum c~f 3 bedr'ooms and any enlar'gemer'rL wi].], r'equil'e an adcl:i,'t.:i.(~nal per'mit. IF: A L..IFT STATION tS .[NSTALJ..,I::D IN AN AREA COVERED BY MOA BLJIL. DINB [~ODE:.ch, THEN (1) &N ELECTI~AL F:'IERHIT AND IIxlSPEE'/I~ION MLJST BE OBTAII~IED~ (2) AS-BUIL. TS NII....L. NOT BE ~F¢'I::~VE~ W~'TH~LJT ~N EL.EL~TR~CAL INSI'~ECT~ON REPORT~ ~IxlD (3) "H4E APF":'I '[CAN'I" S ~, S F'NG'G. GARY PErRI<"[NFI ...... ~~N[::] ' ........ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRiPTiON: 1 3 4 ~6 7 _8 9 ~ lb SLOPE 125 DATE PERFORMED: SITE PLAN -~10 11 12 13 14- 15 16 17 18 19- 20- COMMENTS PERFORMED BY: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 72-008 (6/79) Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE /~¢/'~- (minutes/inch) TEST RUI~ BETWEEN FT AND -- FT SRB 196~ 694-2979 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) W½ of S132', Lot 19, T15N, R1W, Sec. 16 Location (address or directions) 1'Cern Admonson D~. (b) Property owner H.U.D. Telephone: (home) Business271-4342 Mailing Address 222 W. 8th Ave. (Box N-64), Anchorage, Ak. 99513 (c) Lending Institution Mailing Address N/A Telephone (d) Real Estate Company and Agent Address N/A Telephone (e) Mail the HAA to the following address: (or check here [], if hold for pick up.) List contact person and day phone number below: Pickup by engineer 2. TYPE OF RESIDENCE Number of bedrooms Single-Family'Z9 3. WATER SUPPLY Individual Well ;l~ Community [] Public [] Note: If community well system; must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site;~: Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 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 flies 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 Eagle River Engineering Services Telephone (907) 694-5195 Address P.O. Box 773294, Eagle River, Ak. 99577 Date 6. DHHS APPROVAL Approved for Approved __bedrooms by _ Disapproved Terms of Conditional Approval 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 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 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: /.~//~',F A. WELL DATA Well Classification ,,"~/'/'~' ~ Well Log Present (Y/N) ,Y Da~.e~?ompleted °~- "'~':~- ~ ~ Total Depth --~-~ Cased to S~ '~'~'~pth of Grouting /,4 Static Water Level 5-~ ~'~. '""~- ~ '~ ..... "~ ,~, ~....,..~. ..:,,,~.,.a.....~ Pump Set At Casing Height Above 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 Water Sample Collected by ~¢'~'~','"¢~'-~' Water Sample Test Results ~-~-'~"-~'~ Comments If A, B, C, D.E.C. Approved (Y/N) ~'/~ Yield ~, ./.r- d.~',*.-. ~/~'/~¢ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ,;~-/~o ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole SEPTIC/HOLDING TANK DATA Date lnstalled /~'~'J'¢'¥ Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ,~' /~"~'~ No. of Compartments Air-tight Caps (Y/N) ,~' Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: TO Water-Supply Well To Property Line ,2,~- To Water Main/Service Line ~-/~ To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field Comments 72-026 {Rev 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /'¢/~/g'¢/ Width of Field '~¢/~ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /~ '~-- / To Building Foundation "~"~ / Lot ~ ,/~' To Water Main/Service Line ~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field /'~;~ / Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ¢'~ o / /'¢%~) To Cutback (if present) Comments D. LIFT STATION /'~/z~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Eagle flfver Englaeerin~n R~rvfce~ P. 0, Box 773294 MOA No, ,~"~- ¥ 894-5195 Receipt No. Date of Payment Amount: $ 72~026 (Rev, 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Seal NORTHERN TESTING LABORATORIES, INC. 2505 FAIRBANKS STREET 3330 INDUSTRIAL WAY ANCHORAGE, ALASKA 99503 FAIRBANKS, ALASKA n9701 907-277-837B · FAX 2.74.9645 907.456-3116 · FAX 456-3125 PRELIMINARY RESULTS REPORT September g0, 19~0 Custu~er Name Lai~ Cu~t~r ID Method Par&~eter Units Result Eagle River Engineering A105125 U165' of s132, EPA 300,0 Eagle River Engineering A105126 Eagle River Engineerinn A105127 Eagle River Engineering A10S$28 Lot 1~ Chunlak EPA $00,0 Nttrate-R #ethodist Camp Oebore Lot EPA 300,0 #ttrate-N 18/8Lk B Rntetn Valley EPA 300.0 #ttrate-N Est. Lot 14 mall 2.2 0.5 U 1.4 0.SU 11940 ~usiness Blvd, Suite ~205 Eagle River, Ak. 99577 Fax 694-3297 Owner: ~ ~.o, Date: Type of test: [] Well Flow Tesl E3 Septic 1-esl Only ~ WeU &: Septic 7esi [] Other: Meter Time Reading /,'? ?,~¥ Monitor Level Well Level Tonk OPM Level PSI Remork5' 11940 Bus~ness Blvd, Suite ~'205 P,O. Box 773294 694-5195 Eegle River, Ak. 99577 Fex 694-3297 Owner: /-¢~, ~ Dete: ~/¢¢ - y~,x Type of test: E1 Well Flow Test 1] S~ptic Test Only 1~ Well & Septic Test [] Other: Meter Time Reoding Monitor I Well Level Level Tonk Level GPM PSI Remorks' MUNICIPALITY OF ANCHORAGE DIVISION OF E~IRO~AL ~TH DE~NT OF [~TH ~D E~IRO~NTAL ~OTECTION ~ICATION FOR t~TH A~HORI~ ~PROV~ ~RTIFICA~ :~eral Info.etlon Application Da~ (a) Legal Description~inclu~e.lot, .bloc~t s~division, section, to.ship, ra~?) d~ ~- ~ ~c ~..~..,~ ~ ' ' Tele ho~ - Home Business (~) Applicant is (check one) ~ending Inetitu~ion ~ ; ~er/bu~lder ~ Buyer ~ ; O~her ~ (~plain); = (e) Real Estate Co. & Agent ~ Address Telephone.~ (f) 2~I the ~ to the following address: TTpe of Residence Single-Family ~ Multi-Family Number of Bedrooms '-.:~ Other (describe) S. Water Supply Individual Well~ Community~ Public~--~ Note: If community well system, must have written confirmation from the Stats Department of Environmental Conservation attesting to the legality and status. Sewal~e 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 statue. [Page 1 of 2] , As certified by my seal affixed hereto and as of the validation date shown below, 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 hereino~ I further verify that, be,ed on the information obtained from the Manicipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewate~' disposal system is in compliance with all Municipal and State codas, ordinances, and regula- tions in effect on the date of this inspection° Name of Firm Telephone Address Date Approved for ~ ~i~ X-~bed rooms By Approved ~__ Dimapproved .~ Te~s of Condi~ion~ Approva~ Conditional CAUTION THE Mb~ICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HF~ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENUENT PROFESSIONAL ENGINEER REGISTEtLED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF It0MES AND THEIR LENDING INSTITL~flONS 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 A. ~LL DATA MUNICIPALITY OF kNCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (~AA) MuNiC~pALF¥ OF ^NCF DRAOE DEPT. OF 14EALTH ~, ENVI~ONMEN'I'AL ~)I~U'I'L(~I ION hlAi I I 1985 Legal Desori~tion: L/g ~/~ Well Classification ~)/~/&/~ If A, B, c~ C, D.E.C. Approved(Y/N) ~ / Total Depth 7_ ' Cased to ~b-- ' / " ., Degth of G~outing -- Sanitary Seal on Castn¢(Y~_.___ Depression A~ound Wellhead~ Static Water L~vel $O~ ~ Pum~ Set At Casing Height Above Ground /g-/I 7(' Electrical Wiring in Conduit~l~ Sepa~ation Distances f=cm Well.' To Septic/He--Tank on Lot /~ ~ To Nearest Edge of Absc~ption Field on Lot /~; ~, ' ~ on Adjoining Lots /O0 ; On Adjoining Lots To Nearest Public Sewer Line /%3 /F~ ,, To Nearest Public Sewer Cleanout/Manhole A3 / ~ , TO N,e, arest Sewer Service Line on LOt Wate~ Sample Test Rssults ~/~?~-.--~AT~( J ~c ~ ~ SE~IC~ T~ ~TA ~ Date Installed /6) /6~ ~ Size //~3 ~ No. of C~,~a~U~nts ~- Standpipes ~) ' Aid-tight CaDs~ F~n~tion Clean~t~ ~esslon o~ Ta~ (~ ~te ~st P~d ~ ~ P~ing~inte~n~ ~n~a~ ~ File ~/~ ,; f~ ---- . Holdlng Ta~ High-Water ~a~ (Y~)~/~ ~=~ Holdi~ Ta~ ~t {Y~/~ ~p~ation Distan~s ~ ~ptic~Ta~: To Water-Supply Well ./O~ To Property Line /D To Water Main/Se=vice Line COUrse Com~nts To Building Foundation /~ To Disposal Field O'- r (-/-- TO Stream, Pond, Lake, c~ Major D~ainage 1,.30 ,.~ ,~ Receipt ~ Date Paid: Amount: [Page 1 of 2] 2-15-84 C. ABSO.RPTION FIELD DATA Soils Rating in Absorption St=ara Date .Installed / 0 / g ~ Width of Field ~o ~' Gravel Bed Thickness Squa=e Feet of Absorption A~ea ~ 7~'-- . . . Standpipes P~esent( Depression over Field (Y~ .. Date of Last Adequacy Test Results of Last Adequacy Test /-~--~ ~ Separation Distance fTcm A~sc~ption Field: · To Water-Supply Well /D ~ ~ To Pmoperty Line /0 ~ To Building Foundation ~ ~ r To Existing c=' Abandoned System cn Lot /0 ~ ~/~ .; On Adjoining Lots 30. ( ~- To Water Malt,'Be=vice Line /~ ¢~ To Cutback( if ~esent) To Stream/Pond/Lake/c= Majo= Drainage Course lJ o ~ ~ To D=iveway, Parking A=ea, c~ Vehicle Stc~age A=ea ~ '~ Length of Field ~, ! Depth o~ Field D. LIFT STATION Date Installed Size in Gallons "Pump On" Lavel at High ~ter A18rm Level at Tested for Electrical Codes(Y/N) Contasnts Dimensions Manhole/access Level at Meets MOA ** Check Pem~itted Bedrocm Rating A£3ainst HAA ~squest I certify that I have checked, verified, c~ confc~ed to all MOA HAA Guidelines ~n effect on the date of this inspectiom Signed ~ ~ C~any p~. 6B~297~ KB1/d5/s [Page 2 of 2] - , No. 1~7,E / ~ 2-15-84