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Home My WebLink AboutJODIE ESTATES LT 3Jodie Estates Lot 3 #015-143-03 Jul 14 19 02:099 .g! �v1a,-1c Begrch Mayor AnchcragtD Well & Pump S` -r .,072430742 DeEreiaprnPnt 5ervices Oepartme?lt Buildiq safety Division Or;-Sa•te Weater. c& Wastewater Program 4700. Rncre kocd P.O. Box I966-1-50 krc�orcye, AR ?95C'7 �'„y_'E'rn__.`rn Uri, prcJ�hsite (907 343.794 Pump Installa#ion Loci Feil Drilling Permit�;tiat�er: ti� r'arcei Ir;;e zti cati3» tcr'rr��ez:.� 15 Date of issue: ----~-----�-. -a ... �. Legal i I)escr>iption PUMP lrstallatior] Date, €'temp Intake• Oepth Beloti�, Top :rl'welF feet Puf-LP Manufacturer's Name: 4,Y J` , �. �• f, 1'ucnp _mad el: f�,/j: PUMP .Size ! •w hp Pifless Adaptor Burial Depth: l i fee: Piffess E#dapter Mariuf'actut-e2•'s lame• CIL— I'iOM adapter Insfalier: Well Disinfected Li pon CirrnpitYiufi ��!'�•ec �.� No Nhrl'Od of Disinfection: COMIneuts: 1)elzet PUMP Ieastailer Name: J , IT 10 d An/, �� 4 n SueMIrrAL Inspection Report_1-1-12.doc Municipality of Anchorage 51-6 1 Community Development Department Page 1 of 4 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131175 PID Number: 015-143-03 ❑ New ❑✓ Upgrade Name: Calvin & Margaret Hay ABSORPTION FIELD ❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 5520 E. 112th Avenue ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.45 GPD/SF 12.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6.0 Ft. Gravel depth beneath pipe 6.019. Subdivision Block Lot Jodie Estates 3 Fill added above original grade 0 Ft. Gravel length 90.0 Ft. Township - Range Section Gravel width 3.OFt. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES TO Septic_ Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 1080 FP 2 27Ft. well 119.8 130.4 N/A N/A 106 TANK EI Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1 1250Gal. Surface Water 100+ 100+ NIA N/A Material Number of compartments Lot Line 63.3 44.9 N/A N/A Steel I 2 NA Foundation 12.8 28.4 N/A N/A LIFT STATION Manufacturer Capacity - Curtain Drain N/A r N/A N/A I N/A Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL Housetotank 3034 drain Tnfield eldkto 3034 A+ Home Services Drainfield 3034 C01MT 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 100ft Inspection „ dates: 1 8/1/13 2- 8/1/13 Location and description Sri 8/2/13 4" 8/2/13 1 Corner of House Trim COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OF7 Conditional Approval: Date 4 } �RIt'- � >wr TH=ik 41. Steven F#' annorae� CE 8 s �litry�O'fpiisa� Approved Date I IY ly Inspection Report_1-1-12.doc | T1 15.7 29.6 T2 22.3 36.9 DV 24.8 39.9 mi 41.1 59.8 C2 80.6 88.5 M2 2 87.9 C3 33.5 37.5 M3 33.6 36.9 C4 76.1 72.8 M4 76.8 73.6 INSTALLED DOUBLE CLEAN OUT, | 130.4 3 BR NEW 1250g SEPTIC TANK *'HOUSE (E) INSTALLED DOUBLE CLEAN OUT, 2p\ DIVERTER VALVE, AND FLOW SPLITTER. A 44 F CO SEPTIC AREA (E) 44.9 M 111.5 NEW DRAIN FIELD TH-1 (1985) REUSE AS RESERVE 2 UWP (E) NOTES: PAMONE fNG SVC, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 00 TH teven R.. annone CALVIN & MARGARET HAY 5520 E. 112th AVENUE CE 81 9 P7 ERMIT NO OSPI31175 PLAN ANCHORAGE, AK 99516 Sheet SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 3. SCOPE OF WORK: REPLACED 1250g SEPTIC TANK. INSTALLED DRAIN FIELD. 4. GROUNDWATER WAS NOT ENCOUNTERED AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 19 FEET BELOW EXISTING GRADE. FILTER FABRIC TH-1 (PES) FM ML ML/ GM /4" 0 DRAIN PIPE DRAIN ROCK 6" ABOVE PIPE INV -1.0 PT TH-1 -20 OL (1985) GM (W) -6.0 ML - -81 6'3 (W) GM "III IIY— GM 3.0 12.0 2.5 1-8 93.8 (E) 7.8 (E) 3.0 H- NEW 12509 SEPTIC TANK PROFILE LEGEND —w—w— WATER LINE/ WELL RADIUS ss NOTES: RECORD DRAWING NEW SEPTIC DESIGN DETAILS DESIGN PARAMETERS UPGRADED SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1250g PERC RATE = 22 MPI SOIL RATING: 0.45 GPD/SF AREA ROD: 1000 SF SYS. TYPE: DEEP TRENCH 6.0' E.D MIN LENGTH: 83.3 LF USED: (2EA) 45 LF X 3.0' WIDE, 6.0' E.D., 12.0' TO TOTAL AREA: 1080 SF PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 JODIE ESTATES, LOT 3 CALVIN & MARGARET HAY 5520 E. 112th AVENUE ANCHORAGE, AK 99516 92.3 (W) 93.8 (E) —DRAIN ROCK -,90LJL Scale NTS -87.8 (E) ABBREVIATIONS CU COPPER SECTION DUCTILE IRON PIPE TH J FC W T# TANK CLEAN OUT NO. C# O� - > R. 1. k DCO m m Q0 < ?W 0 0 w w J0 z �� a 0 ¢ FILTER FABRIC ¢ p oW Jj w w 0 0 0 z'2 J z0 1 z 4 0 DRAIN PIPE z0 rrr-DRAIN 0 W p�p n n ROCK 6" ABOVE PIPE INV � 0, NEW 12509 SEPTIC TANK PROFILE LEGEND —w—w— WATER LINE/ WELL RADIUS ss NOTES: RECORD DRAWING NEW SEPTIC DESIGN DETAILS DESIGN PARAMETERS UPGRADED SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1250g PERC RATE = 22 MPI SOIL RATING: 0.45 GPD/SF AREA ROD: 1000 SF SYS. TYPE: DEEP TRENCH 6.0' E.D MIN LENGTH: 83.3 LF USED: (2EA) 45 LF X 3.0' WIDE, 6.0' E.D., 12.0' TO TOTAL AREA: 1080 SF PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 JODIE ESTATES, LOT 3 CALVIN & MARGARET HAY 5520 E. 112th AVENUE ANCHORAGE, AK 99516 92.3 (W) 93.8 (E) —DRAIN ROCK —,`. G?r !.... ►'`Q;•••� �� 86.3 (W) Scale NTS -87.8 (E) ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL & VEGETATE —,`. G?r !.... ►'`Q;•••� �� 1/3/2014 Scale NTS .... .. . .. ....:.. P.I.D. NO 143-03 PERMIT N0. OSP131175 ........... ... ...... Steven R. Pannone / IP�•J.CE 8149 •.� +'�`t1-AROFESSIO<SP�'�� Sheet 3 OF 4 TEST HOLE 1 OR ORGANICS 2 3 GM SILTYGRAVEL 4 5 6 7 SILT/ S ML VERY FINE SAND 9 10 11 12 13 SOILS LOG - PERCOLATION TEST SLOPE X TH 14 WATER NET TIME LEVEL NETDROP READING SILT WITH VVAO UKVUINU VVA I tK 2 SOME FINE ENCOUNTERED? N 4 ML SAND AND SILTY 15 GRAVEL IF YES, AT WHAT DEPTH? 15 17 DEPTH TO WATER AFTER MONITORING? DRY 18 DATE: 8/8/2013 19 BOH 20 DATE PERFORMED: 611/13 3 BR HOUSE (E) 3�W W Wim_ W- aTHF WE —1 (1985) SLOPE TH X CLOCK READING DATE TIME WATER NET TIME LEVEL NETDROP READING NO PERC 2 3 4 5 6 PEROLATION RATE N/A (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN - FT AND - FT COMMENTS: Test hole excavated by JR's SEPTIC PUMPING. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS NOTES: RECORD DRAWING SOILS LOG :IPAL GUIDLINES IN EFFECT ON THE DATE O PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 JODIE ESTATES, LOT 3 CALVIN & MARGARET HAY 5520 E. 112th AVENUE ANCHORAGE, AK 99516 TEST. .. 1 J Steve, R �GI IIP CE 8149 2/2/2013 ScaNTS P.I.D. NO 015-143-03 e � PERMIT NO eet 3 OF On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131175 Tax Code Number: 01514303000 Work Type: Septic Permit Effective Dates: July 10, 2013 to July 10, 2014 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: JODIE ESTATES Site Legal Address: JODIE ESTATES LT 3 G:2637 Owner/Address: HAY MARGARET D & CALVIN C 5520 E 112TH AVENUE ANCHORAGE AK 995161721 Site Mailing Address: 5520 E 112TH AVE, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank All construction must be in accordance with: Lot Size in Sq Ft: 49370 Total Bedrooms: 3 N Privy N Private Well N Water Storage 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: Additional test holes and groundwater monitoring shall be completed prior to or during construction to verify the design. If the test results do not support the permitted design, an approved change order shall be acquired. The test results shall be submitted with the final inspection report. Recei% Issued MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-143-03 Property owner(s) Calvin & Margaret Hay Day phone Mailing address 5520 E. 112th Avenue, Anchorage, AK 99516 Site address 5520 E. 112th Avenue Legal description (Sub'd., Block & Lot) Jodie Estates, Lot 3 Legal description (Township, Range & Section) Lot Size 49,370 So. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade [ADuplex (D) F1Holding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized Permit/Rush Fees: Sao Date of Payment: 11 a ] l3 L% -,C -a. Receipt Number: C) ia`Jb G Permit No. 0".LN101'51115 Permit App_::- : - : Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@paneneak.com June 30, 2013 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. 0. Box 196650 Anchorage, Alaska 99519 Subject: Jodie Estates, Lot 3 Septic System Permit Request Ladies and Gentlemen: 1 am writing to request a permit to install a septic system be issued for this property. The proposed systems will serve an existing three (3) bedroom house. Currently the lot is developed, and the existing field will be re -used as a reserve. The integrity of the existing 1250g septic tank will be verified and the tank will be replaced if found to be leaking. This lot is served by a private well that is over 100 feet from the existing and proposed system. The surrounding developed lots are also served by private wells. There are no wells within 100 feet of this system. 1. Soils. One test hole was excavated by AECS Alan Wien in October of 1985, and groundwater was not encountered. Bedrock was not encountered in the test hole. I request that as a condition of the permit PES be allowed to log a verification test hole and perform groundwater monitoring at the time of installation. A test hole was also performed on this lot in August of 1982 by Leroy Reid. That test hole found very similar soils and the same perc rate as the 1985 test hole for the installation of the original system and also found no groundwater. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 0.45 gallons/day/square feet should be used for a conventional wastewater system. 2. Soil Absorption System Design. a. See Sheet 2 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography slopes from west to east at approximately 10% in the area of the proposed drain field. There are no steep slopes in the vicinity of the drain field. • w t Page 2 of 2 S. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments -Soils Log -Septic System Design Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 'Al E 112TH AVENUE 3' R.O.W. ESMT WELL (E) WELL E 120. 1250g SEPTIC TANK (E) VERIFY INTEGRITY AND REPLACE 146.0 IF FOUND TO BE LEAKING, 3 BR INSTALL DOUBLE CLEAN OUT, HOUSE (E) FLOW SPUTTER. 101.4 vv� wl DRAIN FIELD (P) (2EA) 45LF x SW x 6.0'ED x 12.0'TD, WELL (E) TH-1 (1985) SEPTIC AREA (E 26.8 12.0 12.0 j 10' T&E ESMT NOTES: PAMONE ENG SVC, LLC Da7.— 7/9/2013 FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 Scale PHONE (907) 272-8218 FAX (907) 272-8211 1"=50 JODIE ESTATES, LOT 3 0 5-143-03 CALVIN & MARGARET HAY 5520 E. 112th AVENUE ANCHORAGE, AK 99516 n R. anno..n 149 PERMIT NO. OSP1 31175 Sheet PL AN 1 OF 2 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 3. SCOPE OF WORK: VERIFY SEPTIC TANK AND REPLACE IF NECESSARY. INSTALL DRAIN FIELD. 4. GROUNDWATER WAS NOT ENCOUNTERED AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 18 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. FILTER FABRIC 4'' 0 DRAIN PIPE TH-1DRAIN ROCK 6" (19851 ABOVE PIPE INV GM DRAIN ROCK ML/ GM 6 0 3.0 12.0--{ 3.0 12509 SEPTIC TANK (P) PROFILE LEGEND —w—w— WATER LINE/ WELL RADIUS ss NOTES: FOR CONSTRUCTION NEW SEPTIC DESIGN DETAILS DESIGN PARAMETERS UPGRADE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1250g (E) PERC RATE = 22 MPI SOIL RATING: 0.45 GPD/SF AREA ROD: 1000 SF SYS. TYPE: DEEP TRENCH 6.0' E.D MIN LENGTH: 83.3 LF USE: (2EA) 45 LF X 3.0' WIDE, 6.0' E.D., 12.0' TO TOTAL AREA: 1080 SF PANNONE ING SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 ROCK ABBREVIATIONS CU COPPER DIP -'°"— TH TEST HOLE SECTION FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG W OJ 0 J 0 7 W WW o TOPSOIL & VEGETATE FABRIC FFILTER ? i 6 m w w o. 4" 0 DRAIN PIPE OJ J J OJ J z Irf z n rDRAIN ROCK 6" ABOVE PIPE INV BU n B O n n 0 12509 SEPTIC TANK (P) PROFILE LEGEND —w—w— WATER LINE/ WELL RADIUS ss NOTES: FOR CONSTRUCTION NEW SEPTIC DESIGN DETAILS DESIGN PARAMETERS UPGRADE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1250g (E) PERC RATE = 22 MPI SOIL RATING: 0.45 GPD/SF AREA ROD: 1000 SF SYS. TYPE: DEEP TRENCH 6.0' E.D MIN LENGTH: 83.3 LF USE: (2EA) 45 LF X 3.0' WIDE, 6.0' E.D., 12.0' TO TOTAL AREA: 1080 SF PANNONE ING SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 ROCK ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL & VEGETATE JODIE ESTATES, LOT 3 Steven ,R. P a I CALVIN & MARGARET HAY CE 8149 OE. t ANCHORAGE, AK 99516&N ttltiKinaP Date 7/9/2013 Scale *�I NTS rPin NO 015-143-03 ine/ PERMIT N0. L$/ OSP131175 2 OF IVILJIVN✓IL'l1Ll I r VI- iilVe.+l1eJ Y'1Pll]4_ ?'tl lViIHMT CAE i 4 Ai,` VA ANMD HUMAN 3FFIF S rvivo� rt i Hrialth Divedon 825 "1" Street, Anchorage, Alaska 99502, Telephone 264-4720 'S[,,`VM' G ; VIKER OSA.L NSYS f �[Afl f,\lKI �/0FIeft ft �:,(<., ��`MTECTfIK N RIEP(DRY --- _ \ NameD�� Address Phones) s Permit No. No of Bedrooms LFGAL DFSGflIPTION , Lot .. Block Subdivision Township, Range, Section c STI ❑ H011-DIVR MannlectWer Capacity in gallons Material No. of Compartments XTRENC&8 I_� C �a Cl Fit(. V)NAlN ❑ C)grmn _ — Depth to pipe bottom from -- —-- Intal depth horn original go, de original grtde FI / ✓ f'7 Fill added above original grade Gravel depth beneath pipe � 67 FI - 6 - Grd-vP.11enyth -- Gravel width � Total absorption area Distance between fines SQ_ET� _ Number of Imes oil eating so 1T f iprmatch vl � Installer" p/� -Pj Date Installed Ci'�i' C It.E .Lv PF11VATF. F] OTHFilll Ottontifv) Classlhcatior/((A�,-BC-)^ o� 1 117 — tot tl De/p`1h�y, Cased to�pAP,=$' Installer Date Installed. REMARKS ,TSH /tT ��c�_�1�if ., d�+,il 7itadi ts3e s�ii 4.1 % �yY fit= ✓ i�(r 9LC:i'e� i Ali e>6 i�l�i it0 r� �1lr FHOI LOT LINE--- FOUNDATION A a-k3UILIF Eft, dnveway. water WELL — r A�IX 0 VI (Show location of well, septic system, property Imes, foundation, etc:.) Inspections Performed by Date. certify that this inspection vias performed according to all j w6� Municipal an1l,State guidelines m eflert on this date: 'i //P7 Health Department dEptsroval: ...__, .. ..__. . _ ..._.- - Date.._ 72-013 (3/85) /c F. NGINEER'S SEAL a _. .a _s ,,.. ✓„„..awl ... �,.� \J_; A ac, r� January 10, 1986 TO: Permit Applicant P. C. B{JX 66 0 A,'CHORAGE, ALASKA )9u02-0850 (907)264-4111 T!' JI <N011LES, �1 Y(IR DEPARTMENT OF HEALTH & HUMAN SERVICES Subject: Permit # 850727 Lot 3 Jodie Estates Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as -built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit PERMIT NO: UATE ISSUED: APPLICANTI; ADDRESS: CUNTAC7 PHONE: 850727 12/02/85 SOLAR PLUS INC. 1132 E 74TH AVE, #201 ANCHORAGE,` AK 99508 344~5214 LESAL 1E001IP: SU8DIVISION: JOT) IE ESTATES LOT: 3 SECTION: 22 TOWNSHlP: 12N RANGE: 3W LO|SJZE: 49500 (SQ"FT. OR ACRES) MAX 8EDROOMS: 3 / 8LOW: NA Listed below are the options available to you in designing your septjc DEFARTMENT OF HEALTH AND 1:l:.! N' AL PROTECTION 825 L STREET� ANCHORAGE, 264-4720 AK 995O1 q J ivy —00 11 0 W 1 A H2 TAT HH�:: F� Th W W: A.. iL.. 1 �N STR7 N 41 by 1 9, PERMIT NO: UATE ISSUED: APPLICANTI; ADDRESS: CUNTAC7 PHONE: 850727 12/02/85 SOLAR PLUS INC. 1132 E 74TH AVE, #201 ANCHORAGE,` AK 99508 344~5214 LESAL 1E001IP: SU8DIVISION: JOT) IE ESTATES LOT: 3 SECTION: 22 TOWNSHlP: 12N RANGE: 3W LO|SJZE: 49500 (SQ"FT. OR ACRES) MAX 8EDROOMS: 3 / 8LOW: NA Listed below are the options available to you in designing your septjc system. Choose the option that best 1 10 your site, DEPT|t 1 FlPE DOTTOM GRAVEL D[PTH (FT.) TOTAL 1+13 PH (FT.) GRAoEL WIDTH (FT") 2"5 23.0 5.0 GRAVEL LENGTH (FT"> 178.0 ** 44.0 125"0 ** G�:AVEL VOLUME (CU.YDS,) 41.3 37.5 34,O TANK SIZE (GALS) 1,CPU) '0 ** 1,000.0 * 1,01 )0.0 ** SOIL RATING (SQ^FT./8R) 237 220 SKY ** GRAVEL LENGTH > 75 FT, REQUIRES M�LTIPLE RUNS (NOT £XCEEDING 75 FT^ EACH) ** TANK MUSl HAVE Al LEAST TWO COMPARTMENTS I certi�y that: 1. I am familiar with the requirements for on`site sewers and wells as set forth by the MunicipWity of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria o/ this permit. 3. I will adhere to all MOA and State of Alaska requiremenLl; |or 1 te set back distances 1rom any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot- 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will recluire an additional permit. [F A LIFT IVY ATlO0-1 lS INSTALLED IN AN AREA COVERED DY MOA 8UKN. DING CODES, T|EN (1) AN ELECTRICAL PERMIT AND INSPECTION 1, 1143 BE 081-0INE1) 2 AS-WALTS WILL NOT BE APPROVED 1,01THOU1 AN ELECTRICAL INSPECTION REPORT AND (3) THE ELECTRICAL WORK MUST BE DONE BY A) LICENSED ELECTRlCIAN" Go! NX. UA7E: ..... ... �-�'~�~��~-r--�-^~~ PHA LICANl: SOLAR PLUS JNC. lSSUED ~----w—^�-�-----~�~-�~--�-~-��~�..... ... ..... ... ...~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVlgkS 825 "L" Street, AnctWtd pPAWT, 'r9.� SOILS LOG m Pllk�� f ALT, PERFORMED FOR: = COMK '71V5 Lu2 o 19B6 LEGAL DESCRIPTION: PTH 2 ; I_, I IL y ; s r 5 I 6 �j 7 8 9 10 + I� 11 72 I 13 41516 14- 15- 16 17 18 19 `7j/j 20 COMMENTS I // 39d � -77 0W -r M V*Afs HL10 n SLOPE (ENGINES SEAL) \s DATE PERFORMED: SITE PLAN WAS GROUND WATER ENCOUNTERED? Ak S IF YES, AT WHAT t - DEPTH? O P E Depth to Water After Monitoring? Date: Reading Date Gross Time Net Time Depth to Water Net Drop .77 V J�. PERCOLATION RATE_G�� r mutes/incjh)) PERC HOLE DIXXJ ER 52! 0y .,T ST RUN BETWEEN .._ FT AND FT '736 ✓° PERFORMED BY: '�°' � M r� _ 4f41 C+0AA- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) :Permit 4- 820248 January 31, 1.983 TO - Perm it Applicant Subject;_ 'I'12M IOW Section 22 f,ot 34 NE; A permit issu(--,d by this department for an individual well arid/or on-site sewer system bas expired as of December 31, 1982. Permit -.s are -issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. if you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. I'L a private engineer inspected the installation of the on. -site _-ewer system, please 11 -lave them send us the as--builts for our files and documentation. If there are any further questions, please call this office at 264--4720. n c e r o..1. y., Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/Ijw enc.* Copy of Permit sWP/057 TYPE 3F S�IL H85SRPTION SYST�M IS TREN�H K MDIQO�S 50IL RHlI45G (SQ FT/BA 27] THE �EOUTRA" SlZ2 OF THE SOIL RBABC lIGH SYSTEM IS THE LEClH DIMENSlOH I5 TE LENGTH (lN FEET) OF vHE TREpiCH OR D"HlNFIELD ME E6 CH THE SARFSCE OF TA SROUN0 "WD THE 600811 D: THE EXCHYRTI9N (IN FEET) Tf ERE N3 SET WIDTH PAR TREMCI-ES. TM GRRYEL DEPM IS THE M|N001 DEPM OF GRHVEL EXIT WA: M TAE OUTFHLL PIPE HND THE B3TTO� O� THE EXC�YHTIO� (IN FEET) 7 T PAMW{ 4� 'J Vi..�.�� P�V14IT WIN LlCHOT too; THE REV PONSlGILITY T8 INoSRM T4IS rEPHRlmoT 3URI$S THE INSTHLLMI0H IMSPECTIGHS OF HHY WELLS HDJSCENT TQ TH[S M8PERTY row THE �||MBER C 'rF RESIDEMCES Tbill T THE WELL !flLL 9001E. -��! i!ti �� - �i oh��o bv� V p - 4 c C" I � R n& Qw M TV I & 0 W J 1 F 1 A. 14 "A Q ?MKzlLL(Pill OF 94Y OSTEM PIITHOUT F[NHL IMAECMAI Wo HPM�MHL 8Y THlS cEP9W ANT NILL BE SUBJECT TO 1 R3SEC!1TI;H. MUNICIPALITY OF ANCHORAGE m ,�\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION I TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR:,_ J{zL__ _ ---�� Plrf�v�-Sir's ___ DATE PERFORMED:_(Z - 2 G c9a LEGAL DESCRIPTION:1710 /r_ DEPTH SITE PLAN 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: WAS GROUND WATER ENCOUNTERED? __ 0 _ � IF YES, AT WHAT , DEPTH? Reading Date Gross Time Net Time Depth to Water Not Drop d 1 ( 3 V 7 is =_3.'(9V /0 PERCOLATION HATE______. _ ��l'migtes/inch) TEST RUN BETWEEN Np 251 72-0 8 (6/79) ` F a 9 ALASKA HUIR0I101CnTAL COMROL KRUIRS, InC. Engineerinq & Enuironmental Studies CLIENT ADDRESS I—o ZIP CODE LEGAL LOCATION l TOTAL DEPTH OF HOLE ZONE TESTED /-_311— PERCOLATION TEST DATA SHEET 1 DATE i f, ft. ft TO — _. i .__'_ v_—__._ft READING { CLOCK TIME NEI' TIME DEPTH TO i NET DROP RATE: (min/in) DATUM 41 P.L I {l 3 FINAL PERCOLATION RATE PERFORMED 6Y 5i_/, c1c, / z d�,z_. 1220 &1 25th Auenue - Anchorage, Alaska 99503 o (907) 276-1361 CONTROL rd Ave ` �, INC. ( . 1200 West 33rd Avenu.:, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO OF CALCULATED BY �%< DATE -12 /311F -W.__ CHECKED BY 0111 L Cf SCALE DATE 14Q°�1 � Q s -n picuon CUZ 91 WW -6'V( 06) auoild roue a5'carceza ��. uOneAa13 El sejy '5czoyJuv ZOc66 e�a adcd uoTI P�o3 uTyaa pImOI O �aaiaS poorueT19 ONq �e7. v gnll PLmo3 ❑ mad �aS n SE-MmN3 O"Ij.ljvdj 1� '2uo, wcyj Po�3 ® CW I • . .•'Y�',( %` 'c''��' 30 /iep Toe STLP 'eysE?TV 'a�zo4^ud ui paaq �cjd uoisv ipgnS papzooas alp uo ze-adda :ICU op IPTui guoloJ;cnsai y "' • e gmDo•w �•`�!J'r�• •e"`� "�" .'.: �'�N. -70 'SaUF—U3A00 'S7luocz Sea XUL, }O aouaasua aLp o'.Iill:�a7ap 07 P::? 'S'10 =77oi:.:aJ e•n.m�Yom••e°see a•wa w•m•� cID saiatii-in pur opriS pacls.tuZ3 01 ant7e1a1 apes3 p•.se uD:orool &npjinq paso-aTd [azanol 'uOtaJnzasuoJ o7 soTad 'iapjinq io Ioumo Dip 3o fiijiq:suasas eLp St JI goo AV wG•C�s ° se•w �k7v 30 �•uoa.xay uMogs se a.Te pue sluauraAaldrr pasodwd aip juip pue 1._Lb_1_r _} :.3iadoid pagis_Szp auurojjoj @Lp PDfaAMS aneq I :JeLp j 7Tao �C zsaq I L�col2 Cl t� �J d'b=,1 31b;7S i5:�u � lii I @1a�� 01 7 M.,6109a6a N 11919 1.vv� rn'o'�l,s w 0 _ _ DnNDAV Ott 2 1 1 �j MA1V'y�MMU I/ ' ANCHORAGEv AEASKA 344-'71714 SIX INCH WATER WELL DRILLED __.__-__. --- OUT TO THE DEPTI'..OF _ DRILLED AT THE RATE OF (1'i)0 PER FOOT. Cay"tn.g ca�r. tecl.a 178 � PROPERTY OWNER LOCATION OF WELL SITE o2cl e,4.ed hi Str h. l3eaal i.e Gtatr4 of DRILLER WELL LOG: 0----1 jr S.t,%tr. ilaufi. 4J ,u G-CrtI. lrin,c,e,'r. 15 --- 49t Come gAP-ue--. 1 S;'� cLau, ntntp',i.rr.C, S.oaa"c. T.lar'4 9nc. q__-yl r 11cyu(ltc�n._il cea uaecf. .(row-de;t,6. 1_1-`11800cl urnteli drecytutq g�ut.vel. ;t.t 1?.ci �,#.h.e urate -L purrs/zed cCea/t. a4 tuet,,U aA .the vel good r/.ama ty_(Ten gaAtor1j pe.2 m uut te. ur.l tlz pTat JL necoveny. 1iac� up to 80 dee off./ bottom.) 1/2. llo4An Sttbrae o4+ rt -e pump. 4how-d be, 4n4,tAVed f'Lye .to -ten. �ee.t 0", MUNICI`)ALITY OFF ANOHOMGE r[Pr. of HEALTH & N\•k;it); ; NTAL PROTECTI®RI ,SAN "r i9g-1 L C04 -1.o0 pe/t ft x 1z8 ft: ,92t688.00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO. RAMPART DRILLING WORKS FOR THE SUM OF $21688.00 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART D LLING WORKS DATE_Ak 7,01 1980 iln it1 ___._.—�---=----- SERVICE CHARGE OF 1'/:% PER 'MONTH WILL BE ASSESSEb ON PAST DUE 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 I.D. # D 1 Lf 3- d 3 HAA # 1. GENERAL INFORMATION Complete legal description DT C) Location (site address or directions) S n))_0 1:—: 119 - Property owner t �&- l L` ®� Day phone 3LI6" U77 Mailing address o L I t )-1-L, Lending agency Day phone Mailing address Agent %v%oli e Cr; 5"w elyDay phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: -7:;, 3. TYPE OF WATER SUPPLY: Individual welly 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 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(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 h h e- it LU r � 1a V ee , E Phone �_-7q-306 Address 2 v ?> I,f/ ! ti J -Z -a H a a Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments LOW I bedrooms. Date 7-1t, bedrooms, with the following stipulations: Date /Z 3 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: 1--6d 7� i Gv ; �i� Parcel I.D : A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Pi r Log present (YIN) Date completed Total depth j p2 Cased to cis Sanitary seal (Y/N) FROM WELL LOG Date of test �-A?C-b ,r Static water levels% Well production f �y d Casing height (above ground) Wires properly protected (YIN) � 5 d AT INSPECTION g.p.m. I, _// g.p.m. WATER SAMPLE RESULTS: Coliform / Nitrate a Other bacteria 4 V 2� t Date of sample: L� `l �- Collected by: B. SEPTICIHOLDING TANK DATA 12 Date installed '/A Tank size � ��' Number of Compartments Cleanouts (Y/N) Foundation cleanout (YIN) _ Depression (Y/N) 1 High water alarm (Y/N) N Date of Pumping '(�' , • Pumper A ilt e&i C. ABSORPTION FIELD DATA Date installed /G/ D Soil rating (g p d ffiz or ftZ/bdrm) d '' System type 1y bt i Length 27 C; Width ` Gravel thickness below pipe f P Total depth Effective absorption area 76C-> Monitoring Tube present(Y/N)_Y-- Depression over field (YfN) p95 Date of adequacy test Results (Pass/Fail) For_ bedrooms 11 Fluid depth in absorption field before test (in.); j(y Immediately afterV�13gal. water added (in.): l 1 Fluid depth (ins.) Minutes later: L/4' ± Absorption rate _g.p.d. Peroxide treatment (past 12 months) (Y/N) 1140 If yes, give date 1). LIVI' STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Sire in gallons "Pump on" level at* * Dalrml "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: 1 Septic/holding tank on lot On adjacent lots i O Absorption field on lot _ i h _; On adjacent lots > Public sewer main F1�� Public sewer manhole/cleanout Sewer /septic service line Lift station l ej SEPARATION DIS'T'ANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation � Property Linc Absorption field_ Water main/service line ),7 Surface water/drainage rICY_ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation )O / Water main/service line Surface water _ �, 1 L? – Driveway, parking/vehicle storage area _ _ ! v L) / Curtain drain Wells on adjacent lots _ � � tom' _ Property line F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that the above systems are in conformance with NIDA 1L1A �Yu/idehnes in effect on this date. Signatureu Engineer's Name l e%v,4�, I tl 113 AV -<j ' tt- & EngineAring Seal Here Date -----11ti ` rcca – 06 HAA Fee $ :3 C) o ` ' Date of Payment Receipt Number _ - o� .� �✓ C3 % R- { Rev. 8/95 OSS: haa.wk.doe Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc. CT&E Ref.# 966444001 Client Name Tobben Spurkland P.E. Project Name/# Lot 3 Jodie Client Sample ID Lot 5 Jodie Nfatris Drinking `Vater Ordered By PWSID 0 Sample Client PO# Printed Date/Time 12/09/96 11:25 Collected Date/Time 12/06/96 12:50 Received Date/Time 12/06/96 13:00 Technical Director: Stephen C. Ede Released By Allowable Prep Parameter Results PQL Units Method Limits Date Nitrate -N 0.194 0.100 mg/L SM18 4500-03F 10 max Total Coliform 0 0 col/100mL SM18 92226 Analysis Date Init 12/06/96 EMS 12/06/96 TMU MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL I _ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 'Jorife )u✓ 5cc z2 - Location (address or directions) E 112[-� Ar�� (b) Applicant Name Telephone: Home �r /Business Applicant Address 1VFZ _�1V � r 1XCn` (c) Applicant is (check one): Lending Institution ❑ ; Owner/builderX; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family o Multi -Family ❑ Other Number of Bedrooms 3, WATER SUPPLY Individual Well Community ❑ Public ❑ Telephone 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` 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 72-02® (11,84 5. ENGINEERING FIRM PROVIDING ,ASPECTIDNS, TESTS, FILE SEARCH, DA). _ 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 regulations in effect on the date of this inspection. ' u � –0 Name of Firm Telephone 5f/S ?_H/ TX Address 5 / Date A'A oOi4@LL�'i�p1..{gry 0 ��n o ` eo• o e••c •oo oc� %ecsol. e' •o•e eccocc c • • •e•c. (Y� C. 1 r 6. DHEP APPROVAL �� Approved for ' bedrooms by /� Date / Approved ��Gx�— Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) A. WELL DA � Well Classification PR M I c If A, B, C, D.E.C. Approved (Y/N) Well Log Present ILY Date Completed > Z deo Yield \ P� "t r ' Total Depth ! ?" Cased to r� Depth of Grouting / 47 Static Water Level qS Pump Set At alllRfUF_ (4 -vv Casing Height Above Ground — 2, 3 ' .r,. Sanitary Seal on Casing 6N) Electrical Wiring in Conduit N) Depression Around Wellhead (YA Separation Distances from Well: To Septic/Holding Tank on Lot 2 c On Adjoining Lots loo To Nearest Edge of Absorption Field on Lot ; On Adjoining LotsE To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by J, KF>' / Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA r �� Date Installed Size No. of Com partments Standpipes 6fN) Depression over Tank (Yl Air -tight Caps ((qN) Foundation Cleanout( /N) Date Last Pumped 41111 Pumping/Maintenance Contract on File (Y/N) I ; for Holding Tank High -Water Alarm (Y/N) AXTemporary Holding Tank Permit (Y/N) -- Separation Distances from Septic/Holding Tank: l To Water -Supply Well `��-' To Building Foundation /2 To Property Line To Disposal Field To Water Main/Service Line —� To Stream, Pond, Lake, or Major Drainage Course ) r) 6) 4 Comments &5 OF 121 -3 YX /40[15, IAI r-1411t?1Z -5 r46,—__S; Page 1 of 2 72-026(11/84) MUNICIPALITY OF ANCHORAGE (MOA) �P AttCHORaG" �Uti1G1PA�1iY NE�vSFt & HEALTH AUTHORITY APPROVAL (HAA) pEPZ• NTA VQ�tEC[1c� CHECKLIST - FEBRUARY 1994 264-4720 E1dV1R(j1�� Legal Description: v a 7 -12 -IV R,--5 t2% A. WELL DA � Well Classification PR M I c If A, B, C, D.E.C. Approved (Y/N) Well Log Present ILY Date Completed > Z deo Yield \ P� "t r ' Total Depth ! ?" Cased to r� Depth of Grouting / 47 Static Water Level qS Pump Set At alllRfUF_ (4 -vv Casing Height Above Ground — 2, 3 ' .r,. Sanitary Seal on Casing 6N) Electrical Wiring in Conduit N) Depression Around Wellhead (YA Separation Distances from Well: To Septic/Holding Tank on Lot 2 c On Adjoining Lots loo To Nearest Edge of Absorption Field on Lot ; On Adjoining LotsE To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by J, KF>' / Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA r �� Date Installed Size No. of Com partments Standpipes 6fN) Depression over Tank (Yl Air -tight Caps ((qN) Foundation Cleanout( /N) Date Last Pumped 41111 Pumping/Maintenance Contract on File (Y/N) I ; for Holding Tank High -Water Alarm (Y/N) AXTemporary Holding Tank Permit (Y/N) -- Separation Distances from Septic/Holding Tank: l To Water -Supply Well `��-' To Building Foundation /2 To Property Line To Disposal Field To Water Main/Service Line —� To Stream, Pond, Lake, or Major Drainage Course ) r) 6) 4 Comments &5 OF 121 -3 YX /40[15, IAI r-1411t?1Z -5 r46,—__S; Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata _ 2, 7__7_Type of System Design T Date Installed— �� y�`_-� _ Length of Field Width of Field Depth of Field Square Feet of Absorption Area I Gravel Bed Thickness ___Y Standpipes Present (YN) Depression over Field (Y'/�1y _ Date of Last Adequacy Test 10 - Results of Last Adequacy Test Separation Distance from Absorption Field: 1 , y To Water -Supply Well — /, To Property Line _ L_ , To Building Foundationr1 To Existing or Abandoned System on Lot A//A On Adjoining Lots To Water Main/Service Line IV To Cutbank (if present) 14 i To Stream/Pond/Lake/or Major Drainage Course loo To Driveway, Parking Are�gor Vehicle Stora Area Comments —t�eC al--- + ��Ii��L•IIiil. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for _- Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) ___ _ 'Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that hav i ed, ver /i�fied, or conformed to all MQA an HAA guidelines in effect on the date of this inspection. Signed —` Date Company MOA No. 6 �< , _ ��a�a, ,,,XL�i Vit; Receipt No. AV Date of Payment _. ___f_� AV 1 vN 111a t% Amount: $ __ _ __ _ ___ __ ��C ® g+ s.Seal .yam � �1�°AAglry4 � 03br^1 f} ,.1 •1104• "l l�,`�ff/V�Fi'tl�S i� 1 1//N/EGl_ 10c v1 ILER r C. rtiD1R Page 2 of 2 ipr4 1`1 4AI 12-026 (11/84) Im • • LAU 11UKT L.D. # #A -a Ci 7227 OLD SEWARD HIGF. ,AY ANCHORAGE, ALASKA 99518 (907)344-8551 BACTERIOLOGICAL WATER ANALYSIS TO BE COM DATE COLLECTED MONTH DAY YEAR.. C 4. � "5,' '._ I.D. NO. (PUBLIC SYSTEMS) NAME OF SYSTEM ADDRESS CITY ETED BY WATER S TIME COLLECT�E1DI TYPE OF TEM PAM M ❑ PUBLDTYIDUAL CTRCLE CLASS — 1. J A B C Residenti'af"� TELEPHONE NUMBER STATE LOCATION WHERE SAMPLE WAS COLLECTED COLLECTED BY:(SIGNATURE TYPE OF SAMPLE / (CHECK ONLY ONE THIS COLUMN) DRINKING WATER %/CHECK TREATMENT ZIP CODE v n ❑ CHLORINATED ❑ FILTERED TREATED OR OTHER ❑ RAW SOURCE WATER ❑ NEW CONSTRUCTION OR REPAIRS ❑ OTHER(Specify) IS THIS SAMPLE A CHECK SAMPLE TO A PREVIOUS NON -CONFORMING SAMPLE? ❑ YES RNO PREVIOUS COLLECTION DATE ANALYSIS 4ZEQftSTED (IF OTHER THAN TOTAL COLIFORM) SEND REPORT TO:(PRINT FULL NAME,ADDRESS AND ZIP CODE NAME , c ADDRESS CITY STATE ZIP BACTERIOLOGICAL WATER ANALYSIS RECORD FOR LAB USE ONLY ❑ RESUBMIT SAMPLE Sample rejected because: CHECK ONE OR MORE ❑ Sample too long in transit. Sample should not be over 30 hours. ❑ Sample received too late in week ❑ Not in proper container ❑ Leaked out ❑ Insufficient information provided. Please read instructions on form. ❑ Other (Specify) RECEIVED FROM Jr 9 LL // RECEIVED BY J/)L DATE (s1 -23- v G TIME ANALYTICAL METHOD: Z'OMEMSRANE FILTER ❑ FERMENTATION TUBE Date & Time Started 12- R3 -$6, '-/; P C I Date & Time Completed "VI Yf t- #�'.If I LABORATORY RESULTS Analf!'czi(rt ri LJ Other Bacteria s ❑ Test unsuitable because: ❑ Confluent Growth ❑ TNTC SATISFACTORY Z UNSATISFACTORY ❑ TOTAL COLIFORMS Membrane filter: Direct Count Coliform/100ml Verification: LTB BGB FECAL COLIFORMS final Membrane Filter Results Coliform/100ml OTHER Reported By Date AJ4. R.'M. REAM ;"l E 'COLLECTIONINSTRUCTIONS ON BACK OF FORM j' s � � REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) "2. Name of person requesting approval 2. Name of property owner 3. Legal description 4. Number of bedrooms in house 5. Water Analysis: a. Bacterial (��( b. Detergent 6. Well data: a. Type b. Depth^,•, c. Casing Size d. Distance from well to closest existing or proposed: 1. Sewer, line 2. Septic tank 3. Seepage Area 4. Cesspool' 5. Property Line 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainate ditch, etc. 7. Sewage disposal system. a. Age of system h. Septic tank capacity in gallons( c. Name of septic tank manufacturer 1. If "home made" show diagram on reverse side of this form. d; Disposal field or seepage pit size and type 1, Liatance to property line to house i Y, e. Percolation, Test 'results f. Percolation Test performed by 0 Use the reverse.side of this form to show diavram. Diagram should include the following information: property lines, well location, house location, Coptic tank location, disposal area Location, location of percolation test, and direction of ground slope. 9. The inforuation on this form is true and correct to the best of my knowledge. Si€ -nature of Applicant Date Signed TO BE PILLED OUT BY HEALTH DEPARTMENT PERSONNEL 'The above described sanitary facilities are hereby approved, subject to the. - llowin�, conditions: Conditions: The above described sanitary facilities are disapproved for the following reasons: X11��Z Z. Sign tune of Officra-.- Date Approval is valid :For one year following; the date of approval. CPJ : cw LIC n11Y141Y1 VI rrsrsra rr rsr�sr •�dm r.r DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS DATE PUBLIC SEMI-PUBLIC NAME ADDRESS CITY ADDRESS OF SOURCE SAMPLE COLLECTED BY am DATE COLLECTED __ TIME COLLECTED pff Sample Collected From ❑ Kitchen Top ❑ Bothraom Tap ❑ Basement Top ❑ Other (List) LLIEIM�FIII INDIVIDUAL F1 OTHER TORT RESULTS TC— I occ O Well - ❑ Dug ❑ Driven ❑ Drilled ❑ Bored SOURCE: ❑ Spring ❑ Cistern ❑ Other Dug Well or Cistern Construction: Brick or Walls - ❑ Wood ❑ Concrete ❑ Metol ❑ Tile ❑ Concrete Top ❑ Wood ❑ Concrete ❑ Metal ❑ Open Top LOCATION: ❑ In Basement ❑ Basement Offset ❑ Under House ❑ In Yard ❑ Other – Beilding Sewer Septic DISTANCE TO: or Other Drainage Pipe Feel. Tank Feet. Tile Seepage Cess - Field Feel. Pit_ Feet. Pool Feet. Privy Feet. Other Possible Sources of Contamination MATERIAL: Building Sewer ❑ cos ❑ Wood El Tile El Fibre ❑ Asbestos Cement ❑ Plastic Joint Material - Type — – GENERAL: Does Water Become Muddy or Discolored? ❑ Yes ❑ No When? Diameter of Well--- Depth Feet. Well Casing Material Diameter Depth – Length of Water Depth Drop Pipe From Bottom Feet. Offset In PUMP LOCATION: ❑ In Well ❑ Basement ❑ In Basement ❑ In Utility Room On Top El OfWell ❑ Other_ PURPOSE OF EXAMINATION: Illness Suspected? Cl Yes ❑ No New Source of Supply? ❑ Yes ❑ No Repairs to System? ❑ Yes ❑ No Lab. OFFICE Records in this office indicate this WATER SUPPLY to be oF: ❑ Satisfactory ❑ Questionable ❑ Unsatisfactory Sanitary Status. Analysis shows this Water SAMPLE to be: ❑ Satisfactory ❑ Questionable ❑ Unsatisfactory. If an "Unsatisfactory" or "Questionable" status is indicated above you should take immediate action as recommended below. 1. Notify consumers water is polluted. Boil or chemically treat this water as outlined in the enclosed leaflet "Drink If Pure." 2. Increase chlorination sufficiently to meet recommended residual standards. Determine source of contamination and take action necessary to maintain a safe water supply at all limes. 3. Check chlorination and other mechanical equipment. Make certain i1 is functioning properly. 4. If after checking equipment a disinfecting residual is not obtained, please. wire this office for emergency assistance or advisory services. 5. This is o surface water source and subject to pollution by man and animals. An approved water supply source should be developed. 6. Improve your ❑ spring ❑ dug well ❑ driven well ❑ drilled well ❑ cistern. 7. Relocate your well to a sale location in relationship to your sewage disposal system. ❑ see enclosure 8. Sample too long in transit: sample should not be over 48 hours old at .examination to indicate reliable results, please send new sample. ❑ Bottle Broken in transit, please send new sample. 9. Contact your nearest ❑ local Health Department or ❑ Alaska Division of Public•Heolth, sanitation office for bulletins, consultation and assistance. SANITARIAN'S REMARKS Signatu READ INSTRUCTIONS am Date Received— Time Received pan Lab. No. ONLactose Broth IOcc lore lore 1Occ IOcc "® 24 hours 48 hours REVERSE SIDE EMB B G B Lactose Broth, 24 hrs.----48 hrs.—Gram'! BEFORE Coliform Density —IM MF result Reported by .—Dat COLLECTING SAMPLE This analysis indicates C,ailorm Organisms to be: Absent Present. Lore 1 O.1 cc stain est probable No. per 100ce.I CvI' 11011 iIV �� ..._.. I I :1 '= I �.II11 :1'.'. II! III'.' I ITvi 1'', �n ul.:.;.f 1,•, „I :a; r.: � Iur. 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