Loading...
HomeMy WebLinkAboutBOREALIS #1 LT 11 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 NAMEbi~) IPHONE ~'UPGRADE MAI LI%G ADDRESS LEGAL DESCRIPTION ~ ~ I Manufacturer Material No, of compartments ~ ~Liq. capacity in gallons IF HOMEMADE Inside length Width Liquid depth ~ ,-~ DISTANCE TO' ~Wetl Dwelling PERMIT NO. ~Z I ' I ~ ~ ~ Manufacturer Material Liquid capacity in ~atlons ~= DISTANCE TO: ~"' If'V Foundation / Nearest ot ine j~l P~MIT~O. ~ ~ Z ~ No. of lines ~ I Length of each li~.~ ~' Total length of line~.~/' Trench wid~ _ Dist~n~e~ween lines~ ~ ~ I ~ Z ~ inches TotaLeffe,tive absorpti~ar~ ~ ~ Top of tile to finish grade ~ Length Width Depth PER~T NO. ( ~ I Type of crib Crib diameter Crib depth Total effective absorption area ~ DISTANCE TO: Well Building foundation Nearest lot line ~ ~Class Depth Driller Distance to lot line PERMIT NO.  ~ DISTANCE TO Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS P SOl L TEST F~ATING INSTALLER RE~ARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE Department ~ Health and Environmental "~rotection 825 _ Street, Anchorage, AK. _ /501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit'~~ W~/OR ON-SITE SEWER PERMIT C~C~.~/~ LOcation: ~tl~/~~0~_/ Phone Number: Legal Description: ~-I ! Type of Soil Absorption System Is: Trench: ~/~.r Drainfield: Maximum Number of Bedrooms: Lot Size: Seepage Bed: Holding Tank: Soil Rating (sq. ft/br) c~ff~ The Required Size of the Soil Absorption System Is: DEPTH I~ ,LENGTH __,5~ GRAVEL DEPTH /r9 WIDTH~O~CT- The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall Pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = ~~ALLONS * * Permit applicant has the responsibility to inform~ Athis department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling~of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of!public well. Minimum distance from a private well to a private sewer line i's 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are a~ailable to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 8 2 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the ~eside~ce i~/remodeled S igne~: Applicant to SWP/024 (1/81) include more that 3 bedrooms. Date: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOl LS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 2 3 5 6 7 8 9 10 12 ~3 1§ 17 2O COMMENTS PERFORMED BY: DATE PERFORMED: SLOPE~ SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time ~ Water Drop +l..I.,_O/1 q-~,B~ 3,.z~/~:~z.. '.-~ / ~,~,n ,fi2./,'&O ,.~ / .~ ~zO ~:~- '~.~ q :o5 l 0 0 , O? .~ZO q:~l ~ ~,03 · ~ 0 ,minutes/inch) BETWEEN ~'~ , FT AND q,(;~'"' FT CERTIFIED BY: DATE: PERCOLATION RATE TEST RUN 72-008 (6/79) GRE 'R ANCHORAGE AREA BOr Department of Environmental Quality 3330 C Street Anchorage, Alaska gg503 'GH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION , MAILING ADDRESS LEGAL DESCRIPTION PHONE SEPTIC TANK: DISTANCE FROM WELL ~O INSIDE LENGTH MANUFACTURER~-~-E~ MATERIAL NUMBER OF COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /~J-~ .GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER LINING MATERIAL~-~ ~2 CR~B' SIZE: BUILDING FOUNDATION__, fj'C / ?/ OR WIDTH , LENGTH , DEPTH DIAMETER DEPTH ~/ DISTANCE FROM: WELL /~ /~ NEAREST LOT LINE ~ /'/' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ O SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE BUILDING FOUNDATION -- CESSPOOL /~PPROVED CONSTRUCTION NEAREST LOT LINE ~&~ DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE , SEWER LINE , TANK __, SYSTEM , OTHER SOURCES DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: ~ /~/~ Form No. EQ-031 DATE APPROVED ~ G.A.AoB. '" C? /, ')Pi.I¢;~,.N'r .~ ..' . ..................... MAll. ~-!G Af_'I.~IIE%S .... - ........._' '~ ./_'!_._ :.. :' -:~:'_-.~._ PHOi',IF. .:_. ..,.: ,:.~ ,.:, ,.-,-,o, ..... ::::.2].~:...:L._: .....' .:__::_._:._~_:::..:._:- ............... :. -.' ................................................................... .. I_1A/II~H C)[;'; S[:'P'FiC 'rANK ............. ~ .......... SEEPAGE PIT. ......................... 'i ,.~ ri~OUGH .............................................. '[O i;E IN:'TAI Et'l) SEEPAGI~ PIT_ ....... ]'.'. ........ DRAIF.~ [-'IEI..D l,~:l'i~i ,-,LI.[) ................................ AI_[)O CONSIDi-:R AREA ~'[-I_L5 MAIH Tr) ~'EPTIC -I'i'NI~ ....... --: .............. ~EEPAGE PIT . .................. l .... /:h~l:. ' " SEEPAGE PIT ' ' . DttAIN FI~.LD ........ F(:: ~,;V'[:~, !.AI(E. STREAM <~-::'N N-F© AHL) OUT OF S£PTIC T/:,f',It; AND INTO Cf'lIB CROSSING GAP OF ~,': ,'-,' ~,'r~ol~ :: Fk:rL'r H'q'ro LINDIS1-UR!3EI)SOIL t:[i'.i,,',L-TEI? C/',,?,'l IRON SIPHON PIPES ON SI':P?IC 'f'Al41'( AND SEFPAGI? PI't' AIR'fIGHT H~ MOVABLE CAPS 'FO t?,O~:'~OLV-:,FI |:~EGULATIONS REGARD|HG INSTALLATION. OF~ LIC [~N SIZI) GF Depa 'eR /~.NCHORAGE AREA BOROUGH ,t of Environ,~e!~tal Oua!ity 3330 "C" c .... ~ : .) c~ eet Anchorage, Alaska 99503 i~,?scriF.~tion: ~off ~! 'i5~ l form m-.,ports: Soils log ~ Perm~l'a'Cion test Lepth 12- ',,~<: s flroLInd water encountered? rio If yes, at what depth? fs, e~dine Date Gross Time Net Time Depth to I ' ;. ~.~;> ~.~ ,.1 ~i ~.~ on :,...~,~'~.F~ ~4,:.;...,~ ~.. .... . ....~...- .... bra t:~ .~, ~ e'i d · .. ..... .'..'....... ,.., ~""t"' i~ii}'{' " " ........... ............... ; ............ ':' ' '"' ................... ' ' 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 015-203-23 HAA# ~ ~ .~ ~C' k'i © GENERAL INFORMATION Complete legal description Lot 11; Borealis Subdivision~l Location (site address or directions) 4930 Omega ,,~.,,~..r..~* ~..~. "''~ Anchorage, AK ~,~i,~,' '~, ..k. ,.DavJd Woodward M~ilin' .,~dress4 .L;4.930'~ Omega C~rcle Anchoraget Circle Day phone AK Day phone 264-0234 99516 Agent ~-' · " Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 '-,, TYPE OF WATER SUPPLY: Individual well Community well xx 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 MOAtf21 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, Address Engineer's signature ordinances, and regulations in effect on the date of this inspection. ~laska Water & Wastewater Name of Firm 7320 E~st Chester Hts. Circle Anchor~e, Alaska 99504 Phone Date DHHS SIGNATURE Approved for T'/---I/~'E 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, 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage ~0¥ 0~ ~ DEPARTMENT OF HEALTH & HUMAN SERVICE,.~u~.,,,.,~^u4 ~ ~ Environmental Services Division NVtRONMENTAL S[~RVICE~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist A. WELL DATA We~t~e ~b/4~/~1'~' I~B, or C, attach ADEC letter. ADEC water system number Log pi~sent~'~¥N~( ' Date completed Total'depth ' '~"~_ Cased to ~ __ n~r~g height (above ground) Sanitary seal (Y/N) ~"-.._ ~es properly protected (Y/N) FROM~ AT INSPECTION Date of test ..-"- ~ . · Static wate~~ Well p~tion g.p.m. ~ g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: Collected by: B. SEPTIC/I~ TANK DATA Date installed /ol;;)'5 I~ L-[ Tank size I~SC) Number of Compartments . . Foundation cle~n6ut '~N)*,(~.I~::A ~ ~ .... . Depression Date of ,~mp!ng "7-~'~ Pumper /, Cleanouts(~N) I High water alarm(~N) "r-'E.s--/~ OK. ,~l[c~l':/~' C. ABSO~PTIONE!ELD DATA .. Date i~ta',ed '/O/,t[~. ~ so, ratin~ orffe~d~) ~ System ~pe ~p~o~,,~ Length ~ ~ Wid~ ~ Gravel thickn~ below pipe, lAC'~ Total depth ~.~' Effective ~sb~O area [~O ~ Monitoring Tube present ~) ~ Depression over field ~ Date of adequacy test 'O1~[~ Results ~Fai,)~S For T~F_ bedrooms Fluid depth in abso~tion field before test (in.); ~,5 Immediately affe~~ gal. water added (in.): Fluid depth ~" (ins) Minutes later: ?~,N Absomtion =te = ~ + q.p.d. Peroxide treatment (past 12 months) ~ ~X ~ ~c~ if y~, giv, d~t* 72-026 (Rev. 3/96)* LIFT STATION Date installed lOlo~-/~ ~- Manhole/Access (~N) High water alarm level at* ~r~ -T_L~_%-~ -~-'r Size in gallons ~2 I,,31~--~O~a r-J FE:.~ "Pump on" level at* /~ '~ ¢/ "Pump off" level at* I z~- "'] I~ *Datum T~p, ~,~ OF-/VI.~. E. SEPARATION DISTANCES . Septic/hold'rog tank on 10t ~~ ~jacent ~ots Absorption field on lot On adjacent lots Public sewer main~ J Pu~ Sewer/se.p_.JJc.-se~ce line Lift station E~'~RATION DISTANCES FROM SEPTIC/I:~B~IIRG TANK ON LOT TO: Foundation .~ ~ ~ Property line ~ '~- Absorption field. ~/0 ~,Z Water main/service line lO fJ- .Surface water/drainage I0~ ''+- Wells on adjacent lots c~O0 ~.h SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /0 ~ Building foundation ! 0 f-/- Water main/service line /(~ Surface water 100''~ Driveway, parking/vehicle storage area /o Curtain drain (~0~,~"-- ~'-~'~ Wells on adjacent lots c~.O0 R ENGINEER'S CERTIFICATION~ /~ I certify ,hail h~et~in~ fi~_!d inspections ,,nd review in confo~aye w~p~~~s in effect on ~is date. S~gnature ~ Engineer's Name d'~ ~' ~~J j ~/T/S are HAA Fee $ ~:> gr~, ~ Receipt Number .Z~'~/~ WaiVer Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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 GENERAL INFORMATION Complete legal description '~B0r~ SUbdivision #I Location (site address or directions) 4930 0me,~a Circle Anchorage, AK Property owner Mailing address Julia Steele 4930 Ome,~a Circle Anchorage, AK Day phone 345-4403 267-1229 99516 Lending agency Mailing address Day phone .: ' ' Agent John B~zine - Col~. &znker ': -" ' Address 4105 Tudor Cen.~e D~ve Anchorage, AK · Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 '~ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water XXX Day ph~n~' NOTE: (h) 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 s)uewwoo leUOp,!PPV :suop,~lnd!)s 6U!MOIIO~. eq3 ql!M 'sLuooJpeq Joj le^oJdde leUO!l!puoo . 'pe^o~ddes!O 'SLUOOJpeq ~ JOJ': peao~ddv,.: ~ :aun~¥NglS SHHa ? · uop, oedsu! s!ql jo e),ep eql uo loe,ye u! suo!leln6ej pue 'seoueu!pJo 'sepoo el~lS pu~ led!olUnlAi I1~ ql!M eOUe!IdLUOO u! S! Luels~S I~sods!p Je),~MelSeM Jo/pue ~lddns Jel~M el!s-uo eql 'uo!loedsu! pus UO!lS6!lSeAU! ~LU LUO&t peu!slqo UO!lSLUJOiU! eql uo pessq 1sql/qpen JeqlJni I 'u!eJeq pel~o!pu! eJnTonJ),s jo ed/q pus SLUOOJpeq ~O JeqLunu eql Jot e)~nbep~ pus leUO!loun~ 'ej~s s! LuelstS Issods!p JelSMm, S~M Jo/pus '~lddns JelSM el!s-uo eql 1~q1 SMOqS uo!leo!ldd~ leAoJddv/q!Joqlnv qllSeH s!ql jo uo!le6!lSeAU! ,~LU ),sql/ypen I '~oleq u~oqs elep UO!leP!ISA I:I~I~INIDN~! AG NOIIOgdSNI dO 1NgflglYIS 'g Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /-. o7- / ~ ~ / /~E'Zt(.-/~' 5.j~ Parcel I.D. A. wo. Well type ~'/_.~ ~..~ ~ If A, B, or C, attach ADE¢ letter. ADE¢ water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Driller Cased to FROM WELL LOG Casing~ Wires properly protecte~ ..~~SPECTION Date of test Static water level Well flow ~ Pun3pleVell .g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot "~...(~ ( '¢'- ; On adjacent lots Absorption field on lot ~ ~"/'- ; On adjacent lots ~ Public sewer main Public sewe~t Sewer service line P..eImte~ tank WATER SAMPLE RESULTS~ Coliform ~ Nitrate Other bacteria Date of s ,'~8mpt~ B. SEPTIC/HOLDING TANK DATA Date installed ~ t Cleanouts(~N) High water alarm (Y/~) Date of pumping Collected by: Tank size Foundation cleanout (~) /~.~-(~ ~ ~-- Compartments ?~' ~' Depression (Y/~.,~ Alarm tested (Y/N) Pumper /~o7--0 ~'- SEPARATION DISTANCES FROM SEPTIC/~TANK TO: Well(s) on lot /LkJ~ On adjacent lots ~O,,U6'"'"" ,/o0"¢---- Foundation ~/'"~- To property line /C~ ~'~ Absorption field /0"""~ Water main/service line Surface water/drainage { O C~ r../._ 72-026 (3/93)° Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed / Size in gallons~_~ -- Vent (Y/N) /--/3 ~3T AIr47'l(_~d'"Pump on" level at High water alarm level Meets MOA electrical code~N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot /2.' ~ I, ~ "Pump off" Level at /~r'~-" e~' Cycles tested ~ Sudacewater /<~<:D ~ Date installed /O/7_ / ~ Length ~.~'~ r Total absorption ama Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Width ] <~0 ~ Cleanout present(~/N) ~'/~' / ~f ~- Results((.p~ail) ~,~/-~' ~ Soil rating (GPD/Ft Gravel thickness System type '"'~/J Total depth Depression over field (Y~_)~ for 4 /~(~'Y- Bedrooms After test '~F~ ~" I, yes, give date /'~/~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: we, on ot/Ycvuc To building foundation //(') On adjacent lots Z.C) Surface water /'~ O ~ Curtain drain /LJO On adjacent lots ~©r.~ Property line To existing or abandoned system on lot Cutbank /LiO/,J~-~Y.E.g~'~J~ Water main/service line Driveway, parking/vehicle storage area /O ~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or con MOA and HAA guidelines in effect on t~ of this inspection. Signature S & $ ENGINFI=~!HG 17034 Eagle RiYer L~R~ Ne. 204 "=~=~:~" HAA Fee $ "~, ~ .... Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY - 264-4720 Application Date //-' '~'~'- ,~ ~: GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name '"~',q ~.~'~'/'~ u~ Telephone: Home ..~'.5':- Applicant Address /,~Z~/ ~A~i'-~.. ~,~.~ / (c) Applicant is (check One): Lending Institution []; Owner/l~i/eler~[]; Buyer []; Other [] (explain); Business (d) Lending Institution ,,~'~.-~'".~. ' ,~,,~--/~'/~' ,,~~_~-t Telephone Address /~/ ,. (e) Real Estate company and Agent ~'~~ Address ~, ~~ Telephone ~ - ~/ (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,,~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well [] Community,J~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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 72-025 (11/84) ENGINEERING FIRM PROVIDINU INSPECTIONS, TESTS, FILE SEARCH, DA'I A 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. Name of Firm'/~~ ,~'v','~ Address Date DHEPAPPROVAL J/(~~-~ /' '~/~----Date /~. -.~--"~' Approved for 3 bedrooms by .... Approved ~/~. Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality 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) WELL DATA MUNICIPALITY OF ANCHORAG;: DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4744 Legal Description: _ ~'~ Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results RECEIVED ~'~"¢~/~¢~"¢';~"~/ If A, B, C, D.E.C. Approved (Y/N)'//z Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) /U' Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~'~ ~ To Property Line '¢¢'~ / To Water Main/Se~,~ib'~tbine -4~ ,6ourse . . . .-~, Size /'L'~'.~ No. of Compartments / Air-tight Caps (Y/N) /V' Foundation Cleanout (Y/N) ,)'/ Date Last Pumped /~--"'¢- ,~'~ ;for Temporary Holding Tank Permit (Y/N) ~v',~ To Building Foundation /'¢~ / To Disposal Field ~'~'-¢~ / To Stream, Pond, Lake, or Major Drainage Comments - Page 1 of 2 72-026 fRee' 8fS~¢¢i'ont( . , i' ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'~'~"'~- ~' Width of Field ~-~'4;¢' ''/ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~'?~:~ "';"~ To Building Foundation ~ Lot ~'~',~' / To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field '=¢"¢~' /' Depth of Field /,¢""? 4;~,,'~ cc Gravel Bed Thickness /~" Standpipes Present (Y/N) /V' Date of Last Adequacy Test To Property Line ~¢ To Existing or Abandoned System on ; On Adjoining Lots -,~ / To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at ,~ High Water Alarm Level Tested for ,~ ~- -~""'~'- ~'Z Dimensions ~.¢,./ t~/,,~. _~ / ~ ~¢~/~ J~ ~ ~ Manhole/Access (Y/N) ~ "Pump Off" Level at ~' ~ ~ .~/ ~ Vent (Y/N) ~ ~~ ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) .~/ Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I haye checkejA verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed/,,~--~.,,~~~ Date ///'-~'o~ Company/~,'C/,~c'..~h/~ ~ MOA No. ~-~',,'~ ~/---¢' ' ~,o ¢ Receipt No, Date of Payment Amount: Page 2 of 2 72-026 (Rev 8/86) Back BEVAN ENGINEERING Approved Well & Septic Engineers November '28, 1986 Municipality of Anchorage Department of Health & Environmental Protection 825 "L" Street Anchorage., Alasl...:a 995~1 P.O. Box 112852 Anchorage, AK 99511 (907) 522-1383 MUNICIPALITY OF ANCHORAGE (907) 258-0584 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED Re '.' Don Bigelow, Health Authorit. y Approval (HAA) Appl:Lcation Lot 11 Borealis Subd.~l. Gentlemen During t. he periocl from November ).~; to November 26, lq86 we per¥ormed resear'ch.~ site investigations., lift station testing and absorption field 'testing pur'suant t.o Health Authority Approval on t. he above referenced lot. We per'fc~rmed an adequacy test on the septic system and determined that it absorbed at a rat. e of 475 gallons per day (gpd). This exceeds the 450 gp('l required for a 3 bedroom home. The septic: tank was pumped and the volume veri.f:i, ed to be 125E~ gallons. To our' knowle(::lge all of tFle in.for'marion requested on the HAA Chec:klist and Applicat. ion has been assembled. We ar'e submitting th:is data to you far your' review. Please c:ontact us ii we can provide any additional in¥ormation. nc:er"e], y .. ~R. Bmvan P.E. Attaclnments : HAA Application HAA Checkist Sewer' as-built Upgrade soils investigation Septic: tank pump:lng receipt Lift' station diagram c:c: Don Bigelow Lok iL Boreolls Subdivision #! Top wekwell Groundline Elev. Dlsc¼=rge Elev. 95.5 94.2 91.2 83.2 Alarm Elev. Pump On Elev. 82.? Pump OFF Elev no SC~l[ e B! .3 I Ground 1 lne 24 ' ~mp < 84.5 InFluent Elev. 80.5 Bose Elev. Job No.86203-s LIFT STATION ELEVATIONS Dn£e ' tl-26-86 Bevon Engineering GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received ./o- /~/-79/ · REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval requested by: ./w~..~. //~.~;2.~ Mailing Address: Time of Inspection Date of Inspection Phone: 2. Property Owner: Phone: 4. 5. 6. Mailing Address: Legal Description: Lo f // ~o~,:~-~'., ~ ./yO Location: gZ~.., ~_ Type of facility to be inspected Well Data: No. of bedrooms~P~Z7 A Type .~x~ ~'~7 C. Construction B. Depth D. Bacterial Analysis e Sewage Disposal System: A. Instal 1 ed ~ at P ~/' C. Septic Tank: 1. Size B. Installer ~),¥~. / ~ ~o 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. 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 LQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re Legal~ Description for Approval of Individual Water Facilities Comments Approved r ~, ~h~-~D_isa pproved Date /'~ - / d~ 7C/ Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 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 Date EQ-034 (1/74) Department of Environmental Quality Water and Sewer Questionnaire Date/~--~/~Z~iime ~fw~4 Subdivision Owner's Name: Mailing Address: questions: 1. How many bedrooms are now in your house? 2. How many bedrooms were in the house at the time of purchase? 3. Were the base?~nt bedroom walls "roughed in" at the time of purchase? 4. Was the basemer~t bathroom plumbing "roughed in" at the time of purchase? X/~-~ 5. Did the realtor or builder inform you that you would have to enlarge the existing sewer system if you finished the basement bedroom? ~ 6. If on a public water supply, do~y~ou always have an adequate supply of water? 7. Is the pressure always adequate? .~/~ OTHER COMMENTS: