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HomeMy WebLinkAboutSKYLINE VIEW BLK 1 LT 13  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ,/ NAME 1PHONE I[~N MAILING ADDRESS O / o ~ NO. OF BEDROOMS I WeI, Absorp~n area Dwelling , PERMIT NO. DISTANCE TO: . ~ ~ Manufacturer Material No. of compartments Liq. capacity in gallonsx ~.~ IF HOMEMADE'. Insidelength ~ l" Width 0 ~ ~ Manufacturer · Material kiquid capaciW in ~allons  DISTANCE TO: ,We1, Foundation ~ Nearestl~tHne ~O PERMITNO. ~l.'q ~ ~ ~ ~ No. of lines ~ Length of each line.~ ~ Total length of lines.~ ~ Trench wid~h~, O ~ ~ Top of tile to finish grade ~, ~ II Material beneath tile Total effectiveabsor~i%n~ea ~ ~ ~ ~ inches Length Width Depth P~MIT NO. ~ ~ [ter Crib Oeoth Totol effective absorption area  Type of crib Crib di m Well I ~ I ~ ~ Building foundation Nearest lot line ~ DISTANCE TO: ~ qlass Depth Driller Distance to lot line PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER ~,PE MATERIALS , ~ ." C'EE ~.~ $ ~ -" SOIL TEST RATING ~00 INSTALLER - 72-013 (Rev. 3/78) FII:::'F'L 1 L. [)Iii:I:;;I'T' ]i (] I",1 I,,,.l!iiXiii FII .... 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[)I:~:I::'I:;Ii'~:'TI"'ItEt',tT I.'.1];1_.1... liii:E '.i:;I..l[?,.J'E(:Y/" TO 0 Er E GE£ Russell Oyster 694-2774 Soils ~ Foundations Performed for: Legal Description: ~epth (feet) o ECHNI CAL ~ DEVEL JPMENT Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Name: ~.~-~/V/oA/D Mai 1 ing Address :~ CO. Earl EIb~ 688.2280 Land Development So__~t]_~harecteristic~ 5~ 6~ 8~ 9 ~ 10~ 11~ Ground Water Encountered: Yes Proposed Installation: Seepage Pit____ Comments: No ~ If yes, what depth___ Drain Field 0 0 O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 © 0 0 0 0 0 ~ : ~D 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ~O ~c 0 .H 0 0 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING C~'~ I - \ c-~ ...3.,, - Lt ~ HAA # \~.~ 1. GENERAL INFORMATION Complete legal description Lot 13; Block I; Skylin~ View Subdivisron Location (site address or directions) 19309 Lupine Property owner Mailing address Lending agency Mailing address Agent Address Dana Kurtz Day phone 688-4162 P. 0. Boz 672188 Chugiak, Alaska 99567-2188 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. $ NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well X× Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XX 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 ~, ~ ~ !:~NGiNEE~JNG Address '17034 Eagle River Loop Road No. 204 ~t;ic ¢i¥m' ~Jaska 99577 Engineer's signature DHHS SIGNATURE Phone Approved for~/~¢-~/'~) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to 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. 72~25 (Rev. 1/91) Bsck MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Parcel I.D. Well type Log present (~FN) ~ Total depth -¢---o~ ~ Sanitary seal ~_.~N) Date completed Lc ¢ ~/~ - ¢~- Driller Cased to I ~ [ ~ ~r Casing height Wires properly proteoted(~N) '-/ If A, B, or C, attach ADEC letter. ADEC water system number Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ o,~ \4- Absorption field on lot ~ ~ o Public sewer main Sewer service lin~_~/ WATER SAMPLE RESULTS: Coliform ~ (~'~/~ ~£ Nitrate Date of sample: ¢"~ 1~, Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~ ~ ~" ''/'~ Cleanouts C~/N) High water alarm (Yr~ Date of pumping Tank size /~ ~'c.~ Compartments Foundation cleanout ~/N) y Depression (Y/~ ~ . Alarm tested (Y/N) "5 ..-~ "b' Pumper 7~'.¢'~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line .l~Su rface water/drainage 72-026 (Rev. 7/91) Front On adjacent lots ~c[(¢ ~ Foundation ~/. l Absorption field ~ ' Water main/service line /o ¢'/' CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level f Meets MOA electr~ SEPARATIO.._N..BdSTANCE FROM LIFT STATION TO: W..e ol-I~n lot On adjacent tots Manhole/Access (Y/N) ~ 2~un~'~ level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed ~ ' ~¢~ ~' Length '5 ~ ' Width ~i' ~ Total absorption area Depression over field (Y/d~ /-J Result~fail) ('2/k'~ ~¢ Peroxide treatment (past 12 months) (Y~) pU'~/U~ Soil rating_ Gravel thickness Cleanouts present ~/N) Date of adequacy test /Z~ ~(/-( If yes, give date _ System type _ "~'¢'¢ Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot [¢~ /~' To building foundation On adjacent lots ~ Surface water Curtain drain On adjacent lots /¢~ Property line ~%' ~ To existing or abandoned system on lot Cutbank tJ///P Water main/service line___ Driveway, parking/vehicle storage area ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this insp~ijon. Engineer's Name Date ~ ~-~ ~ ~ '~~ HAAFee$ /~ ' ~ Waiver Fee:$ Oate of P~yment ~ ~' ~ ~ Date of Paymeot Receip~ Number ~/~ ~/~ ) Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE ~ 58960 Chemlab ROE.{ 92.5338 Sample # 7 Matxix: WATER Client Sample ID PWSID Collected Received ?reserved with L13 Bi SKYLINE VIEW S/D Client Name :S & S ENGINEERING UA Client Acct :SNSENGP SEP 28 92 @ 14:45 hrs. BPO~ : SEP 29 92 @ 15:45 hrs. Req~ : AS REQUIRED Ordered By :R. SHAFER PO8 :}{ONE RECEIVED Analysis Completed : SEP 30 92 Send Reports i)S & S ENGINEERING Parameter Results Units Method Allowable Limits NITRATE-N 2.9 mg/1 EPA 353.2/300.0 10 Sample ROUTINE SA~IPLE COLLECTED BT; R.J.S. Remarks: 1 Tests Performed ' See Spaeial Inst~uction~ Above UA-Unavailable ND~ None Detected *' See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT~G~eater Than ~ SSS Member of the SGS Group (SociOt~ GOn(~rale de Surveillance) 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) LOT 13, BLOCK ] SKYLINE VIEW Location (address or directions) NHN SKYLINE DRIVE //,~,.~ Mrs. Kurtz (b) Property owner Mailing Address 19309 Lupin Eagle River. AK (c) lending Institution ALASKA USA F.C.U. Attn:Ron McA.~phone Mailing Address P.O.BO~ 196613 (d) Real Estate Company and Agent ACTIVE REALTY Address Telephone: (home)688-4162 Business 786-2750 An~h.o~ag~.~ Alaska 99519-6613 Linda Mo~.p~s s¢~in9 agent for Telephone 563-4872 (e) Mail the HAA to the following address: (or check here,~, if hold for pick up.) List contact person and day phone number below: test ordered bq Ron MeAlpin S & S ENGINEERING 17034 Eagle River Leop Read Ne, 204 Eagle River, Alaska 786-2750 2. TYPE OF RESIDENCE Single-FamilyY~ Number of bedrooms 3. WATER SUPPLY Individual Well ~ 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-siteJ;~X 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. 72-o25 (Rev. 7/88) Page 1 of 2 le^oJddV leUOl~!puoo Jo swJe£ leUOB!puoo pe^oJddes!Q ~ pe5oJdd¥ ~ Joj pe^o~ddv qV^Ol~dd¥ SHHa '9 ~qO~\(~4~UNICIPALITY OF ANCHORAGE (MOA) .~ &~l~'~,¥ Health Authorily Approval (NAA) ~,'~'~ ,~g:'~./ CHECKLIST- FEBRUARY 1984 ~ ,xk~, ' ,~ Legal Descript on: X. WELL DATA ~0~%~ Well Classification ¢'~/C, ~l/1 Well Log Present (Y/N)_~ Date Completed_ ~ - TotaIDepth_~¢_Casedto_~ CO Depth of Grouting Static Water Level ,/ ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Y SEPARATION DISTANCES FROM WELL: 'To Septic/Holding Tank on Lot ;/~DO / '/- To Nearest Edge of Absorption Field on Lot 'Fo 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 Pump Set At _ L,)['~" Sanitary Seal on Casing (Y/N) _ Depression Around Wellhead (Y/N) ; On Adjoining Lots '/- ; On Adjoining Lots / O(2 To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Standpipes (Y/N) Y Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /')/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: [~-O No. of Compartments Air-tight Caps (Y/N) y -/- Foundation Cleanout (Y/N) F Date Last Pumped ..--,2 ~ ~-J ~)¢,) d? ~ ~ ; for Temporary Holding Tank Permit (Y/N) ~/'~ To Building Foundation To Disposal Field To Water-Supply Well ,/ / To Property Line To Water Main/Service Line ,/ To Stream, Pond, Lake or Major Drainage Course Comments_ .~()~ I 72-026 (Rev. 7/88) Fro.l Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorpt'~ ~,~aT~)O Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field / Gravel Bed Thickness Statndpipes Present (Y/N) .. Date 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, o'r Vehicle Storage Area .. Comments / To Property Line ,.~ To Existing or Abandoned System on ; On Adjoining Lots / /'("2 '-~- TO Cutback (if present) D. LIFT STATION Date Installed ~ ,~ I /,-. Dimensions Size in Gallons ~'""~-"~'---~/~_~//~ Manhole/Access (Y/N) "Pump On" Level at ' '"""~ "Pump Off" Level at High Water Alarm Level at ~'~'~'"'"--,_. Vent (Y/N) Tested for -"~-"'~--P-~.rnping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments '""~-~ **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effecton',th, inspection. Signed $ ~. ~ ENGINEERING 17034 Eagle Ri'/er Loop Road No, 204 Company Eagle ~.lv..~ A[~.~.b-= 99577 MOA No, Receipt No. ~/¢'~¢-~ U ~ ~ ~- ) Receipt No. Date of Payment Waiver Fee: $ Amount: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 Tom Fink, Mayor / unicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 19, 1989 Robert A Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 13 Block 1 Skyline View S/D Waiver Request #WR890035, HA890258, PID#051-192-42 Dear Mr. Shafer: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is between private well on Lot 13 to the leaching field on Lot 14 Block 1 Skyline View Subdivision is 96 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Daniel J. Roth Civil Engineer On-site Services DJR/ljw#6 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 13; Block I; Skyline View ~989 ROBERTSHAFER, P.E, ROGERSHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Request you issue the attached Health Authority Approval (HAA) and grant a waiver for the horizontal separation distance between the private well located on the referenced property and the leachfield located on the adjacent Lot 14; Block I; Skyline View at a distance of 96 feet. The septic system for Lot 14 was installed and inspected by the MOA on October 13, 1982. The well for the referenced property was drilled on December 9, ~982 and then deepsncd on June 12, 1984. From the well logs we can see there are several layers of poor to impermeable soil. These layers include clay form 78 ft. to 95 ft.; hardpan from 95 ft.to 128 ft.; and silt/clay from 128 ft. to 149 ft. Because of these layers of soil it is very improbable the septic system effluent will even reach the aquifer supplying the referenced well. A risk analysis has been performed and it appears that no baceterialogical pollution is possible from this source. Attached for your review are the following documents: A. A plot plan showing the relative distance between the well and the septic system. B. Risk analysis waiver review worksheet. C. Satisfactory coliform and nitrate water analysis taken from the by referenced well. D. A flow test report for thc referenced well. E. Well logs for the referenced well. F. On-site sewage disposal system inspection report for Lot 14. It is our opinion the horizontal separation distance prescribed 18AAC72. 021 is not required in this case. ~~_ additional information, please contact us. R,P. E. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 F~om FIo~ t = 2.8 ,CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~¢~"--~,.'o;,~,;.',~':k~ FEDERAL TAX ID # 92-0040440 Client Sample ID:L13 Bi SKYLINE VIEW PWSID :UA Collected JUN 28 89 @ 14:00 hrs. Received JUN 29 89 @ 16:30 hrs. Preserved with :AS REQUIRED Analyeis Completed :JUN 30 89 Laboratory Supervisor :STEPHEN C. EDE ANALYSIS REPORT BY SAMPLE for }tork Order { 14443 Date Report Printed: JUL 2 89 @ 13:20 Client Name : S & S ENGR Client Acct: SNSENGP P.O.~ NONE REC'D Req # Ordered By : RJS Send Reports to: Instruct: Chemlab Ref #: 6025 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tested Result/Unite Method Limits NITRATE-N 2.4 mR/1 EPA 353,2 10 Sample SA~IPLE COLLECTED BY RJS Remarks: Teets Performed · See '' .......................................... Speczal Instructions Above UA=Unavailable None Detected "* See Sample Remarks Above Not Analyzed LT~Less Than, GT=Greater Than MUNICIPALITY OF ANCHORAGE DIVISION OF [~ViRONMENTAL HEArl[%I DEPARIMENT OF HF~jf.~{ AND EVB;IRONMENTAL RO1ECTION APPLICATION FOR H~_J~LTH A[Y~HORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, b].o~k, subdivision, ~mction, tcvmship, range Lot i~.~_/3j, ock 1___~ Sk'lline View Subdivision Location (add~ess o~' directions) _~u_pine Stree-~ & S :~l~ne Dri.y~_~ChHg:iak~__AK (b) Applicants Nar~ Desmond Du.f£y %~elephone 688~-4559 I°.0. Box 670183 Applicants Address General Delivery, Chugiak~ AK 99567 (c) Applicant is (check one) Lending Institution Owner/firelight (d) r~nding Institution Alaska USA Federal. Credit Unio~j?elephone 563~567 Ad,ess 4000 Credit Union Drive~ Anchorage~ AK 99503 (e) Real Estate Co. & Agent Address Te le phone 2. Type of Residence Single-Family Number of Bedrooms 3. Wate~ Individual Well Mult i-F~nily ~--1 Other (describe) Note: If con~a]nity %911 system, must haw ~].tten c. onfi~maticn from the State ~p~nt of ~v].ron~ntal Conservation attesting to t)m legality and status. IS ~e ~].1 adequate for the nun~r of ~'~ns s~cified in this HAA Is hhe was~ewaher dis~sal syseem adequate fi~ the nLim~ off ~xedroms (Y/N) [Page 1 of 2] 2-.].5~ 84 5. ~n_0jLFirm Providin_~q_~tions, Tests, Data and Information I certify that I have checked, verified, or conforn~d to all MOA HAA ~]ide].ines in effect on the. date of this inspecti?n~/// // / Signed ~dckess 15 Le~ou~_Ea_gl_e River~__~AjL_..99577 Sigr~d b~ Vernon ~. Roel.fs ])ate April 14, 1984__ ( ENGINEER SEAL) 6 .~oval Approved fo~___;~ he dr oc~ Approved ~. Disap.pl, oved ~_~ Terms of Ccnditional App~ova! Conditicnal ~ Date '1 / / The Municipality of Anchorage Departn~.nt of ~ba].th and Envirom~ental Iq-otection not guarantee the continued satisfactory Derfo~nance of the water supply and/or the wastewate~ disposal system. This approval indicates that, as of the w~lidation date shc~n above, h~sed on the data and infornmtion furnished by an engirmer registered in the State of klaska, the water supply and wastewater disposal system is safe and func tional for the number of ~drc~ns and ty~ of structure indicated. (~]EP SE~J'~ ) 7. Mail the HAA to the following address: KB2/d5/S [Page 2 of 2] 2--15-84 ae WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLI~ - FEBRUARY 1984 Legal Description: Lot 1 - ~ '.. - ... 3, Blk 1. o~y.iine View Sub~iv~i~n-- Well Classification Private Well Log P~esent (Y/N) Yes Total Depth 181 ' Cased to Static Water Level 161 ' Casing Height Above Ground 20" Elec~ical Wiring in Conduit _{Y/N) Yes SepaFation Distances from Well: To Septic/Holding Tank on Lot 100'+ To Nearest Edge of Absorption Field on Lot 100'+ To Nearest Public Sewer Line N/~ If A, B, o~ C, D.E.C. Approved(Y/N) N/A Date Completed 12-9-82 Yield 4 gpm * 181' Depth of Grouting.,,. Unknown Pump Set At 171' Sanitary Seal on Casing (Y/N)Yes Depression Around Wellhead (_y/N) No ; On Adjoining Lots 100 ' ; On Adjoining Lots 100'+ To Nearest Public Sewer Cleanout/Manhole N./A To Nearest Sewer Service Line on LOt ~00'+ Water Sample Collected By Mike Ha~an _~ ; Date-- ~-11-84 WateF Sample Test R~sults . 0/100 ml ; Negative Cm~,~nts '1 Es-~imate from well log. B. SEPTIC/HOLDING TANK DATA Date Installed 8-1-78 Size 1250 Gal No. of Compartments 2 Standpipes (y/N) Yes Air-tight Caps (Y/N)Yes Foundation Cleanout (_Y~/N) Yes Depression over Tank .(Y/N) No Date Last Pumped 4-11-84 Pumping/Maintenance Contract on File (Y/N)N/A ; for N/A Holding Tank High-Wate~ Alarm (Y/N) N/A ~ Temporary Holding Tank Permit (Y/N) N/A Separation Distances f~n Septic/Holding Tank: To Water-Supply Well 100 ' + To P~operty Line 40' To Water Main/Service Line 15 ' + Course ,,. N/A To Building Foundation 1 '7.5 ' To Disposal Fi'eld 7' To Stream, Pond, Lake, o~.Major Drainage Conments [Page 1 of 2] 2-15-84 C0 ABSORPTION FIELD DATA Soils Rating in Absorption Strata 100 sg£~/bdrm Type of System Design Date Installed Width of Field 8-1 -78 Square Feet of Absorption A~ea Depression over Field (Y/N) No Length of Field 31 ' Depth of Field 10 ' + Gravel Bed Thickness 5 ' 310 sq£~ Standpipes P~esent (Y/N) Date of Last Adequacy Test Yes 4-1 '1-84 Trench Results of Last Adequacy Test Adequate Separation Distance from Abso~pticn Field: To Water-Supply ~11 100'+ To P~operty Line _ ?0' To Building Foundation 27' . To Existing or Abandoned System on Lot N/A '; On Adjoining Lots ,75 ' To Water Main/Service Line 15'+ ~To Cutbank(if present) N/A To Stream/Pond/Lake/or Maj°~ Drainage Course lq/~ To D~iveway, Parking Area, o~ Vehicle Storage Area 16' Co~mants D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested fo~ Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off'" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy_ Test. Meets ..MOA Coi~nts ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, oF confo~wed to all MOA HAA Guidelines in effect on the date of this inspection. Company Entech Engineer~, Inc. ~IOA ~o. [Pa~ 2 of 2] TECH ENGINEERS INC. CIVIL · SANITARY April 14, 1 84 Municipality of Anchorage Department of Health & Environmental Protection 825 "L" Street Anchorage, AK 99501 Re: Desmond Puffy, Health Authority Approval (HAA Application; Lot 13, Blk 1, Skyline View Subdivision Dear Sir, During the period from April 11 to April 13, 1984, we performed research, investigations and testing persuant to Health Authority Approval on the above referenced lot. We performed a flow test on the well and found the output to be adequate for a 3 bedroom house. (Refer to Water Yield Test, attached). We also took a water sample for bacteriological analysis and results were negative (Refer to Chemical & Geological Laboratory Analytical Report, attached). ~,~ We performed an adequacy test on the septic_..~f~S~em ~,~ ...... ~ found that it absorbs at a rate greater thanfi'3 [~> .... The v '~) test was run by discharging 1000 gallons of clerK:water into the absorption trench and measuring the rate of drop. As part of the test, the septic tank was pumped. During our initial inspection we found that one of the septic system clean-outs was clogged with rocks and dirt. The pipe was dug up and cleaned out by the owner. We have reinspected this deficiency and found it to be corrected. 13LEDOUXLANE · EAGLE RIVER,ALASKA 99577 · TELEPHONE (907) 694-3574 To our knowledge, we have assembled all available information on the HAA Checklist and Application Form. We offer this information for your review. Please call if you have any questions. Sincerely, cc Desmond Duffy Attachments HAA Application HAA Checklist Water Yield Test Sewer As-Built Well Log Chemical & Geological Testing Lab, Total Coliform Analysis