HomeMy WebLinkAboutLONGVIEW LT 2Longview
Lot 2
#015-472-26
Pdiay 28 19 08:12@ kicoot-age'aVe;i & Pump Set- 30724:10742 N.'
bevelapmenf Services Upartrr;ent
Building Safety i�ivision
L7n- Site t Qtcr & 1 GStewOter Program
< 4700 Elmore Road r'
P.G. fox 196650
Mayor.ayor.
< n
i s?�1:B8. Archaroge, AK 9950%
\�
(907)343.7904
Pump installation Log
Well Drilliug Permit Number: Ste!
Date of iSSlte:
Parzol Tdeettilicari ri 4`tsrnb� 15� y72- 2(o
Legal Dript-iov P"Terty O_wle" Mame & Ad_dr,e
;s:
Lotid 1i lld 0
srq.at� �r
PUMP Iristallatiors late: 5"
P'uMP i male Deptb l3ejow -r-op c:f ti�'cil i asi . : //O feet
lump :4iateufacturer's Name:
Pump -Model: a S 1-2,
Pump Size /2— hp
Pitless.S.dapter Rariai Dvp4h: L 0 feet
Pit -less Adapter liiarlufacturc�'s ?Natne:e,' ?
trw
PRIM, Adapter tnstailer:
Well Disinfected Lrpon rComptetian7 s L7 No
Method ofDisinfecdon;
Comments: i 4(/ ffff ,
Uxrap Installer Dame:
I LL
ArCerttZO?k: r'ia(- Bump instarler S lei p!'oV.1Cle a r' :21 .n5#ili.idtlrijj 10- to Che "sV C3y5 of pUlllp �Y1S.2ii4t:^3x,
GREP'" )ANCHORAGE AREA BOV"(
�f Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
1/ INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
✓C%GA( 6PW 17—d MAILING ADDRESS �`' $� E7�! PHONE
LOCATION aJl�LlJL-i/J� �y LEGAL DESCRIPTION 4-077 �r✓�7refE�Zi �/o
SEPTIC TANK:
DISTANCEc r21� NUMBER OF
FROM WELL MANUFACTURER QST MATERIAL / r��fi�r%� COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/y-SG' GALLONS.
TILE Dom:
le' ez zo TOTAL LENGTH
DISTANCE FROM WELL %0-0'/ FOUNDATION NEAREST LOT LINE Z�? OF LINES 3
NUMBER OF LINES DISTANCE BETWEEN LINES Af/7' TRENCH WIDTH •3l'IN¢ TOTAL EFFECTIVE
ABSORPTION AREA ' SQ. FT. LENGTH OF EACH LINE
rAICW,ts-/. 494fff+7-N �i'r DEPTH OF FILTER ,',//
DEPTH: TOP OF TILE TO FINISH GRADE (bid 3V MATERIAL BENEATH TILE—6-0 IN. ABOVE TILE '7" IN.
mut-r pjge�&i'• 6/`F�+/3 5�ri3.»i7' �fJ�ZC_ LI�f7
WELL: W,�r{:,�( 3,� i�,•�ys i=vc_utJrrfCi cC�lio&-c 7z�.✓ c).� arJczz ,
TYPE .t.1Qr r%' CONSTRUCTION — ��.�N� YIJ� DEPTH 14617 -
DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC Kt�°''1G5EEPAGE Pf �-0
FOUNDATION , LOT LINE . , SEWER LINE , TANK /"/ , SYSTEM (D -C
CESSPOOL
APPROVED
DISTANCES:
OTHER SOURCES
DISAPPROVED
INSTALLED BY: C7C1qC'i0Z k�CV,
SEWER LINE DEPTH:
PIPE MATERIAL: l ✓fSi's�
11 Ot-i� i-rC
LOT SLOPE::
REMARKS(�jL r��'✓Gu
REMARKS SO/L //6 tJ/
DIAGRAM OF SYSTEM
a
ii
- o aJ Qi
DATE r 3 .7,P APPROVED. �� 1
G.A.A.B.
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
PERMIT NO.
,3
L �
NAME OF APPLICANT ��yMAILING ADDRESS PHONE INSTALLATION LOCATION
LEGAL DESCRIPTION ���/ P/-/�`��2� ��✓�
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
SEEPAGE PIT
FINANCED THROUGH TO BE INSTALLED BY
DRAIN FIELD OTHER
solL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
�/Y'L��1L-c D/?7 ice✓ igli/,» �/C� /L//j ���� ,
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED.. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE `��G'`� TYPE '1,���/�•��/' SEEPAGE AREA SIZE TYPE
� �/a�'�I!%fig %�✓f �L�C�
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT DRAIN FIELD
/
SEPTIC TANK TO SEEPAGE PIT WALI
SEPTIC TANK S SEEPAGE PIT �� DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANKf% l SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK �� / SEEPAGE PIT
DRAIN FIELD -J
SEPTIC TANK, /�L, SEEPAGE PIT DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
C � e-
-T JCIC_
G.A.A.B.
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER AN RAGE AREEEA,B�- OROUGH OR7NCE NO.
28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. �i���
F
f
1
�-
1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER AN RAGE AREEEA,B�- OROUGH OR7NCE NO.
28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. �i���
WATER WELL LOG
FOSS DRILLING
1336 Ingra Street
Anchorage, Alaska 99501
WELL OWNER Ye- r' +) IV . S� v�� USE OF WELL a ri
LOCATION
U
SIZE OF CASINGL'" DEP'T`H OF HOLEiLL&T, CASED TO C��41 FT•
STATIC WATER LEVEL % FT. YIELD �,DOGAL.PER." . WITH
I���oti✓ SW��
FEET OF DRAWDOWN.
REMARKS Pe-r-�',rccvte J 8 J �D IV D A
DATE COMPLETED r �o�- % c'�' PUMP TO BE SET AT
0 to-L,f)
�LDtojb
,j 0— )I (,5AMe, At
w1�)
RII / //��
esrl���il7 t') r4.,,.
t o_
_t o_
to_
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to`
t 0-
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Development Services Department `\\
Building Scfety Division
On -Site Weter WStreeter proornm
g
S70G l?ragawStreet
P.O. Boy 1966500
-/
Mark Segich Anchoraae• AK 99519-6650
Mayor wvw mpn• ora/nnpr�
(907}343.7904
Pump Installation Log
Well Drilling Permit Number: SW_ Date of Issue:
Parcel Identification Number:
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
'Legalagger
weer liame & Address:
1:1(10 &U,a►lw
G t 2
Pump Installation Date:
Pump Intake Depth Welow Top of Well Casing: //C feet
Pump Manufacturer's Name:
Pump Model:
0j ".2 l3
Pump Size by
Pitless Adapter Burial Depth: /0 feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer.
sr
Well Disinfected Upon Completion VYes ❑ No
Method of Disinfectiop:
Comments:
Pump Installer Name:
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
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. # Ci1�) - ITI� ) - ado HAA # U R)'1 )LOU
1. GENERAL INFORMATION
Complete legal description
Lot 2; Longview Subctiv.L3ion
Anchorage, AK
Location (site address or directions) 11to 0 Snowx ne
Property owner David FRii,5 Day phone
Mailinn gr4r1racc 153 Meadow Look Lane
Boutde_n, Cotonado
Lending agency Day phone
Mailing address
Agent Joanie Freeman/CENTURY 21 Paci. jic North Day phone
orar♦rAe� 1120 Hu66man Anchorage, AK 99515
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
345-1444
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 XXX
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.
]9.095 [P.. 1A11 9,nm MnA M91
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 furtherverify 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 5 8, 5 ENGIP
17034 Eagle
Address
Eagle River-
Engine&s signatu
Ne. 204
6. DHHS SIGNATURE
Approved for �- bedrooms.
Disapproved.
M
Conditional approval for
Additional Comments
Phone—/ Z/-��
r-
, ) It
r fs
bedrooms, with the following stipulations:
�t`ITC
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 orderto 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 fol errors or omissions in the professional engineer's work.
5v
bedrooms, with the following stipulations:
�t`ITC
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 orderto 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 fol errors or omissions in the professional engineer's work.
Municipality of Anchorage
Department of Health & Human Services'
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L L�'i r / UW U F__� S/p Parcel I.D.
A. WELL DATA
Well type If A, B or C, attach ADEC letter. ADEC water system number
Log present (Y/toDate completed ' /�� ? Driller AK
Total depth + Cased tor Casing height A
Sanitary seal ON)yeS / Wires properly protected (6/N) yds
���
FROM WELL LOG AT (INSPECTION
MUN
( 1, �p,IT� nF 4DrN( 2AGE
Date of test IAN(AQ8IL. 3-/8-0JJNVIkGNME,\TJ"ER I�`S.�IVISION
Static water level
Well flow
Pump level
53 r 'A" 1 9 1993
g.p.m. tttlVED
T WEI,� �Ztut.Ea tro j��� �cR �i2FVIovS
SEPARATION DISTANCES FROM WELL TO: N a A j�q 7�D g -15-8y by f`�q� lap 7Eco 45Adit
Septic/hbfd•iftg tank on lot 5l) r} ; On adjacent lots
r f
Absorption field on lot f 6� ; On adjacent lots �O(J
Public sewer main " Public sewer manhole/cleanout IA
I/N
Sewer service line 10'/
Petroleum tank r VUN� /` 6-W
WATER SAMPLE RESULTS:
Coliform Nitrate �{,,Z4 �� Other bacteria
Date of sample:
N -�3
B. SEPTIC/HOLDING TANK DATA
Collected by: S , S FrvG�ntF-82rnx
U
Date installed r-�Z-> Tank size 1a50 Compartments
Cleanouts (®/N) QNf' Foundation cleanout ON)_. Depression (Y/mj /UO
-�- --r r
High water alarm (Y/6� NU Alarm tested
� nn
Date of pumping `,- L8'R3 Pumper ttfFSF-R�tct=S
SEPARATION DISTANCES FROM SEPTIC/ TANK TO:
Well(s) on lot j So +On adjacent lots /40 Foundation a0
To property line SC fi Absorption field -Water main/service line
Surface water/drainage %bd
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFTS TION
Date installed
Size in gallons
Vent (Y/N) "Pump
High water alarm level
Meets MOA electrical codes (Y/,W
Manufacturer
Manhole/Acces
at
SEPARATION D481`ANCE FROM LIFT STATION TO:
of
D. ABSORPTION FIELD DATA
Date installed
Length 3S r Width
On adjacent lots
g`"
"Pump off" level at
Cycles tested
Soil rating 80 SF113A System type jtZENCA
r r
—Gravel thickness 5 Total depth 00
Total absorption area 35o Sl- Cleanouts presente?/N) 6NE Q f3r=F: OF TRF_.-qc*
Depression over field (Y/V9
Date of adequacy test Z -18-f`13
Results (Os/fail) FABS for a bedrooms
Peroxide treatment (past 12 months) (Y/I) N07 07 Krikr' If yes, give date NlA-
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 160,-1- On adjacent lots �d r� Property line
To building foundation To existing or abandoned system on lot NA
On adjacent lots a 5 Cutbank N/A Water main/service line
Surface water 10o. �-
Curtain drain NoNF_ KNOWN
E. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect onthey
S & S ENGINEERING
Signature 17034 Eagle River Loop Road No. 204
age ,
9
Engineer's Name
Date
HAA Fee $ �/ " / V
Date of Payment - .S
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
r
a
of this inspection.
t y '
�C iN1
HEALTH AUTHORITY
APPROVALS
`,
YW U
Uo(,
SEWER & WATER
MAIN EXTENSIONS
SEWER& WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
OISPOSALSYSTEM
WELL FLOW TEST DATA
ROBERT SHAFER. P.E.
ROGER SHAFER. P.E.
CIVILENGINEERS
(907)694-2979
FAX 694-1211
/
CLIENT: o�� cJatgfvlr- ? DATE OF TES/T: 3 c/3
LOCATION OF WELL (Legal Description): L - 2, �CYVG F_w
WELL DEPTH: ta,�I- CASING DEPTH: ¢b TESTED BY: &.
DATE DRILLING COMPLETED: i DRILLER: (XK
TEST DATA: (_'I Pk_—Vrow, (l.R,(} I Do-7EA $-15-c4'-( by Fes( ?oP
CLOCK
TINE
DEPTH TO
WATER
DRAWDOWN
PUMPING
RATE(GPM)
REMARKS
Swl
UO i -P -Q69 (9-
:12
`
-I `
S•S
7SIDE OB
im FCow off Fucc,
asTq-
y': -yz'
GIs
RAM 12 C
log
0
116
-►o` = -65
r\jw r.1,Ap SRF
3 S
I I?'
+( = -6Y`
IIS
Lf 0
.06
3:
�f
-1` � -6Y`
6:15
rr3l
f1• : -sy'
I
MISC. DATA: CASING HEIGHT: IL{1SANITARY SEAL?: —S �1i193
WIRES IN CONDUIT?:�_ GRADING O.K.?: V
BACTERIA & NITRATE SAMPLES COLLECTED:�/�� Ya air -S?
RESULTS: WELL CURRENTLY PRODUCES GPM WITH A DRAWDOWN
FLOW RATS NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR!
S. t U09
ueoww�onr
L ;t
VVl
COMMS, CIAL TESTING & ENGINEERING CO. AK DIV
CHEMICAL & GEOLOGICAL LABORATORY
TELEPHONE (907) 562-2343
6633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED'.$Y WATER SUPPLIER
❑ PUBLIC WATER SYSTEM I.D. #
,J RIVATE WATER SYSTEM
rnain nu.
l�U3K �'�fC-tz )�tv� %aP 2d1
Mailing Address _
�L
State
SAMPLE DATE:
Mo. Day Year
SAMPLE TYPE:
19 Routine
❑ Check Sample (for routine sample
with lab ref. no. ) ❑ Treated Water
❑ Special Purpose ❑ Untreated Water
SAMPLE Time Collected
No. LOCATION Collected Ilected � B
2
3
4
5
A.D,E.C. -3-') ai
READ INSTRUCTIONS
TO BE COMPLETED BY LABORATORY
Analysis sh4 ws this Water SAMPLE to be:
A♦ Z Satisfacfory
❑ Unsatisfactory
i
❑ Sample oo long in transit; sample should
not be o or 30 hours old at examination
to indic a reliable results. Please send
new sa pie via special delivery mail.
Date Received Z Z
I
Time Received -14�2�
Analytical Method: Membrane Filter
No. of colonies/100 mi.
Lab Ref. No. Result` Analyst
F -T lob
93.0767 —Z m
m
lug m
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter: Direct Count
BEFORE Verification: LSB BGB
Fecal Collform Confirmation
COLLECTING SAMPLE FI I M b
TNTC =
0 Collform/100 ml
na em rane Filte ass//ults q Coliform/1100 ml
Reported By "C� Date Z"2�"/ 3
Too Numerous To Count Time; /5?in a.m.
OB = Other Bacteria
OWN S13S Member of the SGS Group
4111010,
PART ONE OF TWO
REMAINDER TO FOLLOW
CHEMICAL & GEOLOGICAL LABORATORY
=cog A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
LAeowAronr 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
REPORT of ANALYSIS
Chemlab Ref.
# 93.0767 1
Client Sample ID :L2 LONGVIEW S/D
Matrix : WATER
Client Name :S & S ENGINEERING
Ordered By
Project Name
Project#
PWSID :UA
Sample ROUTINE SAMPLE COLLECTED BY: J.W.
Remarks:
QC
Parameter Results Qual. Units Method
---------------------------------------------------------------------------------
NITRATE-N 4.24 mg/l EPA 353.2/300.0
Collected :02/24/93 @ 15:00 hrs.
Received :02/25/93 •@ 14:00 hrs.
WORE Order :63472
Report Completed :02/26/93
Technical Director :STEPHEN . EDE
Released By
Allowable Extract Analysis
Limits Date Date Init
-----------------------------------------------------
10 02/26/93 LLH
' See Special Instructions Above UA - Unavailable
" See Sample Remarks Above NA - Not Analyzed
U - Undetected, Reported value is the practical quantification limit. LT - Less Than
D - Secondary dilution. �±�+ GT - Greater Than
��NSE3S Member of the SGS Group (Soci6t6 Generale de Surveillance)
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date�f / _
(a) Legal Description (include lot, block, subdivision, section, township, range)
t-oi 2 6 -on view SuS
Location (address or directions)
3'FL-
(b) Applicants Name \/ter o lei Sm; f Telephone -- Home/,s-/SL Business
Applicants Address 11160 &. k" ALI,-hova-q 4K 995/
(c) Applicant is (check one) Lending Institution ; Owner/builder ;
Buyer ; Other [:::I (explain); _
(d) Lending Institution
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
zlj f
Erb% it 4-4-i"r",��.�,�..
2. Type of Residence
Telephone
Single-FamilyMulti-Family F�j Other (describe)
Number of Bedrooms
3. Water Supply
Individual Well Community El e-
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: I£ community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the 'legality and status.
[Page 1 of 2]
5. Engineering Firm 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 files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of
Firm r1e44k,0
%c4nicc !
Telephone _3y_,/--- /35�
Address
S R Box `73c9a
-M A:nc-4ofoclf AL 991`16'Lj
°�
Date /�iuy
l l F9 /
9
-
r °°•
er �� ,• °� �®
.°.°°°°°.........jo
(ENGINEER SEAL)
.00.Yi�e..®
0 �_ $1 1
000.0.°,. e....s0o0oo000000°�
wo THEODORE F. MOORE
�•.�
6. DHEP Approval
%)
c� CE - 3589 °°` mow`' AW
�A rE�f� `O°.s...•°�°
J
��
v�
r fess!
Approved
for
bedrooms By L�
ate
Approved—
Disapproved Conditional
Terms of
Conditional
Approval
CAUTION
THE 14UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO •SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2] 7-19-84
-1
0
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH &
HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION,,
CHECKLIST - FEBRUARY 1984 SEP 7 1984
A. WELL DATA —ver',
Description: L ? r Su,!
e Ellen .5'MIM
Well Classification Pn(/aIf A, B. or C. D.E.C. Approved(Y/N) N.h.
Well Log Present (Y/N) Y Date Completed 19 79 Yield I.
Total Depth 12,8 Cased to Un k Depth of Grouting u„ 1-
Static Water Level 55' Pump Set At Un rT
Casing Height Above Ground /�" Sanitary Seal on Casing (Y/N) Co e
Electrical Wiring in Conduit (Y/N) '( Depression Around Wellhead (Y/N) M
Separation Distances from DLe11:
To Septic/Holding Tank on Lot 168' ; On Adjoining Lots 12,,5"'
To Nearest Edge of Absorption Field on Lot 18a ; On Adjoining Lots 130
To Nearest Public Sewer Line N.A. To Nearest Public Sewer
Cleancut/Manhole N.A. To Nearest Sewer Service Line on Lot N•A,
Water Sample Collected By % r/oorc Date 7130 !& y
Water Sample Test Results sal-tsi'C`��rf d cofifor'D
Comcents 2/Qµ well On %o7 ccnnneCl-oa �uriny Wdl-Cr Somole
Asooew ec4c-( a"w;ny 11re& JT $O' + &Ve P"gel M// S�Cer riper Gr'((^2v'[ci
qP (410tWe yirlol front v/Jer «,eu .
B. SEZIC/HOLDING TANK DATA
Date Installed 7/23 /7„5 Size 1250 a21 No. of Ccmpartments U41-
Standpipes
nkStandpipes (Y/N) y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y
Depression over Tank (Y/N) N Date Last Pumped 7/2y/8Y
Purrping/Maintenance Contract on File (Y/N) fl -A ; for N•A
Holding Tank High -Water Alarm (Y/N) pl-A. Temporary Holding Tank Permit (Y/N) N-11,
Separation Distances from Septic/Holding Tank:
To Water -Supply 4Jbll 16uA To Building Foundation r8�
To Property Line 7 20' To Disposal Field r2'
To Water Main/Service Line N•4. To Stream, Pond, Lake, Cr Major Drainage
Course > loo
Comments -
R:, acA<9 av:�
�
Tq 1-7 (�C,e
[Page 1 of 21
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata [to 0 Type of System Designr�enclr
Date Installed 7/ 23 17y Length of Field 31
Width of Field .3017" Depth of Field 18911- 36"
Gravel Bed Thickness 60"
Square Feet of Absorption Area J So no Standpipes Present (YM) f
Depression over Field (YM) K Date of Last Adequacy Test none- v/) "caro(
Results of Last Adequacy 'Lest N.b.
Separation Distance from Absorption Field:
To Water -Supply Wbll Ibia To Property Line 7 2o'
To Building Foundation �?Y' To Existing or Abandoned System on
Lot NA ; On Adjoining Lots N.6,
To Water Main/Service Line 11J. 4. To Cutbank(if present) N•4-,
To Stream/Pond/Lake/or Major Drainage Course 7 loo,
To Driveway, Parking Area, or Vehicle Storage Area > Ko'
Commnts PerArg/n/ IgrJ'e c 4oar"/ z 1HJ441toy w',% l,e% �h i6n
S`rGiP wry /sral� taut
14 V24 �,/1 lL. ,e�vt ulsn / rrs�rn.ePie'u y
J
D. LIFT STATION N.A.
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Dinensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (YM)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed c %rld e+C Date 811Y1,9Y
0
y t�•O�•A
t 66 •• I
Company F(Q)t7_ectin1co ( Sr�Vrcof MOA No. By oS z * 5 ••'fy
KBl/d5/s 0+.� 0000. ......Y:........
:THEODORE F. MOORE ; At
% CE -3589
(Page 2 of 21
`
2-I5-84
i TM1CkOCaGt AYFe
i `^goo
OLILO
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
treet, Anchorage, Alaska 99503 274-4561
Date Received May 5, 1976
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF.
NDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
1. Approval requested by: First National Bank of Anchorage — Southcenter Branch
Mailing Address: Post Office Box 4-2090, 99509 Phone:
2. Property Owner: Vern N. Smith Phone: 276-2363/344-0076
Mailing Address: Star Route A Box 425, 99502
3. Legal Description: Lot 2 Longview Subdivision
4. Location: Snowline Trail — Upper O'Malley
5. Type of facility to be inspected_ F, No. of bedrooms
6. Well Data: Individual — serving one
A. Type B. Depth 160'
C. Construction D. Bacterial Analysis
7. Sewage Disposal System: On—site system
A. Installed B. Installer
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Absorption Area Z. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank Absorption area Sewer Lines ,
Nearest lot line , Other contamination
B. Foundation to septic tank , Absorption area
C. Absorption area to nearest lot line
Fn -0"d (1/74) Pana 1 of twn nanac
Page 2 of two pages - Rer' st for Approval of Individual �r & Water Facilities
Legal._Description — Lot 2 Longview Subdivision
f -
Comments
Approved Disapproved Date
62 ald e year from date signed
4r�aer An,:horage Are br ug partment of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
EQ -034 (1/74)
Date
,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION— • i
i fI W.;R
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
Type of Inspection
2. Property Owner:
,, vjA
CMRO VA FHA �i%'�=�� CONVinvd��,�(n�,�a
1v nQ22, 7�
Mailing Address: n� Day Phone:
3. Name of Buyer:
Mailing Address:
Day P
4. Name of Lending Institution:
Mailing Address:, Phone:
5. Name of Realtor or Agent:
Mailing Address:
6. Legal Description:
Location:
I
7. Type of Facility to be Inspected:
No. Bd
8. Water Supply
Type of Supply: Public Utility Individual ✓��
If Individual, number of dwellings presently served
If Individual, depth of well 167 !1
9. Sewage Disposal System
Type of System:
If Individual, data
72-003(3/76)
M.Win ) ItHiry Individual (on-site)