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Home My WebLink AboutFREEMAN LT 8tnc n Lot 8 #016-112-15 ~ MUNICIPALITY OF ANCHORAGE ' i ~e,~ ~-'~ 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 PHONE [--I NEW MAILING ADDRESS LEGAL DESCRIPTION ~c~.~-~ ~'e' LOCATION ~ ~ NO. OFBEDROOMS j Well J Absorption area D~lling PERMIT NO. DISTANCE TO: I I ~ Manuf~turer Material No. of compartments Liq. capacity in gallons I F HOME,DE: Inside length Width Liquid depth ~ ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. -o Z < Manufacturer Material Liquid ca,city in ~Uons Q Well Foundation Nearest lot line PERMIT No. of lines / ~a ~ ~ ~ inches ~ ~ ~ ~ Total eff~ti~ absorption area DISTANCE TO: :~. ~ DISTANCE TO: ~ . ~e~'~, ~ ~ ...... OTHER x ~'~ ** PiPE MATERIA~ SOIL TEST RATING ~w~ ~d ~ I \, Z~___~I 3 IRev. 3,78~ 'DEPRRTMENT r. HE;qLTH RN[:. Ei".I',.,'IRCIN.MENTRL .JTECTION ..... 825 'L' STREET, P..,NCHL-~,:RGE, RI",.' -q35~3]. 2E4-4729 C,t-~--S I TE SEI.-IEF: E'ER['1 I T PEF:MIT NO. < E'2¢53± ) RPF'LIC~NT CRRON PEPF'ER-DRLE JOHH:L-O/J=":F:R BO.Z.-. i780 LOCRTION ¢ ~~____,~¢ LEGRL 'z-=-~.---"!. ~- LOT SIZE TYPE OF SOIL RBSORPTIOH S',r'STEr'I IS: TRENCH l, lR>:lr,llJl,1 NUME:ER OF E:EDROOMS = 5 999?29 SOLRRE FEET / SOIL RRTING <S.O. FT/BR)= ~.70 c c ' IS THE RE.qUIRED SIZE OF THE SOIL FtBSORF'TION _,Y_,TEM : DEPTH-- 2-1 LE[-.IGTH= 6'1 GF:R%-'EL DEF'TH= 7 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH. OF R TRENCH OR PIT IS THE DISTRNCE BETHEEN THE SURFRCE OF THE GROUHD RND THE BOTTOM OF THE E×CRVRTIOH (IN FEET). THERE IS NO SET HIDTH FOR TRENCHES. THE GF'.RVEL DEPTH IS THE MIHIIMUM DEPTH OF GRRVEL BETI4EEN THE OUTFRLL PIPE RN[', THE E'.OTTOM OF THE EXCRVRTION (IH FEET). ' F:EC:I_I I F:ED SEPT I C TFI~W~::: S I SE= -150r_-~ 6FILLF, fWS PERMIT RPPLICRNT HAS THE RESPOHISIBILITY TO INFORH THIS DEPARTMENT DURING THE -INS~,RLLATIONI INSPECTIOHS OF RNY HELLS HDJRCENT TO THIS PROPERTY 8NO THE NUHSER OF RESIDENCES THAT THE NELL HILL · TI*lO < 2 > I/-~SPE,2T I I:'[-~S RF:E RECII_I I F:ED ~RCKFILLING OF RNY SYSTEM HITHOUT FINRL ]NSPECTION RHD RPPROVRL BY THIS DEPRRTMENT.HILL BE SUBJECT'TO'PROSECUTIOH.' MINIMUM DISTRNCE BETHEEN R HELL AND~ Rf'IY'Of-f~ITE SEI,f~GE ,DISPOSRL SYSTEM 1~0 FEET FOR ~ PRIVATE NELL,OR 150 TO.2~E/FEET FROM A FUE:LIC HELL DEPENDING LIF'ON THE TYF'E OF F'UBLIC 14ELL. MINIMUM DI~TRNCE FROM R PRIVRTE NELL TO R PRIVRTE TO R COMf'IUNIT~ SEHER LINE' IS 75 FEET. OTHER REOUIREHENTS MRY RPPLY. ~PECIFICRTIONS RND CONSTRUCTIOH DIRGRRMS RRE RVRILRBLE TO INSURE PROPER IN$TRLLRTION. PERf'I I T E:*::!i' I RES [:'ECEr~IBER 3-1~ I CERTIFV TH8T , i: I Rf'l FRMILIRR HITH THE REO..UIREMENTS FOR ON-SITE SEI.IERS RND HELLS RS SET FORTH E.Y THE NUNICIPRLITY OF RNCHORRGE. 2: ~ HILL INSTELL THE SYSTEM IN RE:CORDRNCE HITH THE CODES. ~: I UNE:,ERSTBND THRT THE OH-SITE 5EHER ?¢STEM MRY REOUIRE ENLRRGEMENT IF THE RE~E:'EN,~ REr. IODELED TO INCLUDE MOP. E THRN 5 BEDROOMS. .......... RPPL]CRNT CRRE~PEF'REF:-DRLE JOHNSOH M of Date ,, ~ - ~-~'~-/~ Time WHILE YOU WERE OUT Phone MUNICIPALITY OF ANCHORAGE I~ PERCOLATION ·%...-DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST \~-~ 825 L. Street, Anchorage. Alaska 99501 264-472O SOILS LOG - PERCOLATION TEST '" PE.FO.MEO POR: 'pALE ~'Ot-1~4SO~ DATEPERFORMED: ~'~'g~'"' LEGAL DESCRIPTION: 6- ?- 10- I~__ %11 13- 18- ~0- SLOPE ENCOUNTERED? IF YES, AT WHAT SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN / (minutes/inch} CE.T,,,ED..: /"----"V/ .DATE:~"'¢ K~: 72.008 (6/79) · /~ ~UNICIPALITY OF ANCHORAGE ( .~. , . ~. DEPARTMENTOFHEALTH&ENVIRON~IENTALPROT'=~,mmON · I ENVIRONMENTAl. ENGINEERING DIVISION 825 L Street o Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE_ ~] NEW LEGAL DESCRIPTION NO. OF BEDROOMS Mature No. of compartments TO: ~ DISTANCE TO: m Building foundation Se~r line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS · ) PERMIT NO. ' ~PLICRNT PAT LARUE i -)OATIO~I REEDER RD ,EGAL LB FREEMAN f ;/'rYF'E OF SOIL ABSORBTIO~I SYSTEM [MAXIMUM MUMBER OF BEDROOMS = 4 r-l.U[~ I C I Pi--iL I T'T" OF RNCHORRGE 'DEPRRTMENT OF HEALTH AND ENVIRONMEHTRL PROTECTION 825 264-472~ 014--~ I TE 5Ei~ER LIPGRRDE PERt~ ( 78~646 ) ~780 R SRA 344 8323 LOT SIZE 28880 SQURRE FEET TREHCH SOIL RRTING (SO FT?BR)= 200 ',THE REQUIRED SIZE OF THE SOIL RBSORPTIOH SYSTEM IS: DEPTH= ~ LE I'-,I ~_~TH = 0 G R R',.-' EL DEPTH= 0 THE LEMGTH DIMENSIOH IS THE LEi-IGTH (IH FEET) OF THE TREHCH OR DRRIMFIELD. THE DEPTH OF A TRE~ICH OR PIT 'IS THE DISTANCE BETNEEN THE SURFACE OF THE GROUND AND THE BOTT0r'I OF THE EXCAVATIOH (IN FEET). THERE IS rio SET WIDTH FOR TRENCHES. : THE GRAVEL DEPTH IS THE MI~iIMUM DEPTH OF GRAVEL BETNEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE E~CAVATION (IN FEET). PERMIT APPLICRHT HAS THE RESPONSIBILITY TO INFORM THIS DEPRRTMEtIT DURING THE INSTRLLRTION INSPECTIO[iS OF RNY WELLS 8DJRCEHT TO THIS PROPERTY RND THE NUME:ER OF RESIDE[ICES THRT THE ~IELL I,IILL SERVE. BOCKFILLING OF 8NY S~STEM NITHOUT FINOL INSPECTIOH 8ND 8PPROVOL BY THIS DEP~RTMENT ~IILL BE SUBJECT TO PROSECUTION. MIHIMUM DISTONCE BETWEEN A NELL 8ND AHY OH-SITE SEHRGE DISPOSRL SYSTEM IS l~O FEET FOR R PRIVRTE HELL~ OR 15~ TO 2~ FEET FROM R PUBLIC ~IELL DEPENDING UPON THE TYPE OF PUBLIC WELL OTHER REQUIREMEMTS MRY RPPLY. SPECIFICRTIONS RHD COHSTRUCTION DIRGRRMS PRE RVRILRBLE TO I[ISURE PROPER INSTRLLRTION. I CERTIFY THAT ±: I Ar,1 FAMILIAR WITH THE REOU~REME[ITS FOR OH-SITE SEHERS AND ~IELLS RS SET FORTH BY THE MUNICIPALITY OF' ANCHORAGE. 2: I MILL IHSTRLL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~:: I UNDERSTBND THBT THE ON-SITE SE[,IER SYSTEM MAY REOUIRE ENLRRGEMENT IF IHE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. ............. RPPL I CRNT P~RUE ISSUED E:~- .... -%-~-'='- '-:-"- ........... ~' .... \ G~I~TER ANCHORAGE AREA HEALTH DEPARTMENT r ~ .~TO. 24? 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: ADDRESS PHONE~ LEGAL DESCRIPtiON NUMBER OF DISTANCE FROM WELL .~'..~"/ ~"'~..,~'"~. MATERIAl ..s"~ COMPARTMENTS LIQUID CAPACITY ~,/~)~7 z~ GALLONS. INSIDE LENGTH ~ INSIDE WIDTH ~ DEPTH' SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF FITS / OUTSIDE DIAMETER LINING MATERIAL NEAREST LOT LINE '~ , LENGTH . DEFTH , DISTANCE FROM WELLJ~./ ~,"~",*~-'~*- , BUILDING FOUNDATION ~. . TOTAL EFFECIIVE ABSORPIION AREA ~ALL AREA) ~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL ~ON ~, NEAREST tOT UNE NUMBEROFLINE/~ DiSlANCE gETWEEN LINES CH LiNE '~ TRENCH WIDTH// IN. JOTALEFFECIIVE A~S~, SQ. FL LENOIH OF EA __ D~[H: TOP OF ~LE TO FINISH GRAD~ DEPTH OF FILTER ~TERIAL BENEATH TILE INA. BOY TILF WELL: ~,,s,.~,/~,./.::~4,~,.. J ,,~,,~.,.~'.r.:c-~- / DISTANCE FROM ~PE ~ DEPIH . BUILDING FOUNDATION LOT LINE / NEAREST / , SYST~ , SEWER LINF /TANKSEPTIC SEEPAGE WATER SAMPLE ./-''''''''''''----, NEAREST ., A.-.-"'"CESSPOO[ ~ , SOURCES DISTANCES: DIAGRAM OF SYSTEM GREATEI~tNCHORAGE.AREA.~ROUGH tI£ALTII D E,P~RTr, t £NT 327 Eagle St, Anchorage, Alaska 99501 279-2511 Case No. RESIDENCE ADDRESS LEGAL OESCRIPT~ON /~'"t APPLICATION TO INSTALL: SEPTIC TANK '~' SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT MAILING ADDRESS /~-~.~ [f./&-~-~ PHONE NO. LOCATION OF INSTALLATION , SEEPAGE PIT ~ , DRAIN FIELD ,OTHER TO SERVE THE FOLLOWING FACILITY ~ ~'-~/~gL~,~'-'~.t ~/~' FINANCED THROUGH ~ ,[ TO BE INSTALLED BY BELOWT0 BE FILLED OUT BY HEALTH DEPARTMENT T,,S ,S TO SERVE AS ~/~ F~,,g,.. .PERM,T TO ,NSTALL A ~'"' As OESCR~eED .ELOW. S~ZE O~ U.~ ~ . SE"lC TANK SIZE /~ TYPE ~('~ S DIAGRAM OF SYSTEM DISTANCES: · I certify that [ am familiar with the requ~ements of Greater Anchorage Area Borough Ordnance No. 28-68 and that thc above des~ibed system is in accordance with ~id code. ~ ~ - ~UC~UTSSmU~TU~E ~(U,' ~ ~F'"~EATER ANCHORAGE AREA BOROUGH~ HEALTH DEPARTMENT CASE 327 EAaLE STREET CHOR^GE, 9 sot vu.o. PWr£ormed For ff'~. ~5. ~.Z ,~/~ Date Performed Legal Descrlption= Lot ._~lock -- 5~dxvi~ ~fff~.O This Fc~ Reports a: Sozls Log ~. ~ . ~ercozatzon iest 1 Z Depth Feet Soil Characteristics Was Ground Water Encountered? ~/6 If Yes, At What Depth Lo:atton Sketch Proposed Instal~Seepage Pit ~ Drain field? .Depth Of Inlet ? Depth To Bottom Of Pit Or T~ench ? , Readlng, ! Date Gross Time [ Net T/me Depth 1~ H20 Net Drop ePco£acxon kate' 'i,,/ /.lxnute _ Data Certified ~y,'~l.;, ~J{~.~.~ , Municipality of Anchorage Development Services Department Building Safer'/Division ..... On*Site Water & Wastewater Pn~gram ..... · 4700 South Bragaw St. P.O. Box 196650 ~chorage. AK 99519-6650 www.cLanchorage.ak.us .... · (907] 343-?~04 ' CERTIFICATE OF HEALTH HORI'T APPROVAl= FOR A SINGL.E FAHIL.Y.'DWELLING Parcel I.D~ 1. GENERAL INFORMATION .... Expiration Date: Complete legal description '" FREEMAN S/D LOT 8 LecaUon (site address or directions) 11400 READER RD. Current Property owner(s) JERRY ST~OBLE Dayph0ne* 786-3555 Mailing address Lending agen,cy Mailing address 11440 READER RD. - Day phone Real Estate Agent DEBBIE PLESSlNGER Day phone 257-0139 Mailing address Unless otherwise requested, HAA will be held by DSD for pickup. 2. HUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTE'WATER DISPOSAL: Individual Well ...... Individual Water Storage _ Community Class Well Public Water System Individual On-sita Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered in the State of AJaska. Certificetes of Health Authority Approval are required for the transfer of UUe (except between spouses) for properties served by a single family on-sita wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties sewed by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. '4.* *STATEMENT OF INSPECTION BY ENGINEER · AS certified by my ~ affixedbemto.and.as Of ~lm va/ida fion date shown below, I varify that my investigation, based on procedures outlined in the Health Authod~y Approval Guidelines for this application, shows that the on-si~e water supp~' and/or waste~ater disposal ~'ystem Is(am) safe, fun~'onal 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 Inspec~on, the on-site water Supp~/ and/or Wastev;'ater disposal system is(am) in compliance wfth ail applicable Municipal and State codes, ordinances; and mgula~ons In eff~t at the time of installatfon. NameofFirm · ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone 357-6179 Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE,.AK 99504 Engineer's Pdnted Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments:**~* - ............. ' In conducting this evaluation, AWWC, Inc. attempted to proWde a thoreugh, . consdentious engineering ana~/~/s of the system In accordance with ADEC and MOA DSD Guidelines & R~gulations. The reported results described the performance of the system under the conditions encountered at the time of tho test, and separation distances measured to readily Identifiable features. The opomtional /ifs of ali wells and septic systems depend on the Iocal se#s condWon, groundwater levels that may fluctuate during the yea6 and the water usage of the famtiy being sewed by the system. These cc~diEons are ¢~fside ~he control of the evaluate' of the system. Satisfactoo/ ~est results do not guarantee future perto~ of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provfde any werran[y or future estimate of how long the system will continue to meet the opera#onal requirements of the ADEC or MOA DSD. The contsnt of this report Is for the sole benefit of the owner listed above. Any re~iance upon or use of thts report by any other person or party is not authedzed, nor will It confer any I~gal right whatsoever. 5. DSD SIGNATURE ~ Approved for ~ bedrooms. Disapproved. Conditional approval for __ .,-~.~: ON-S~TE '-. ~. bedrooms, with the fllowing s~pulation~ ..... .. A[tachments: HAA Checldist Septic System Advisory Well Flow Advisory ManItenance Agreements Supplemental Engineer's Reort Other Oflglnal Certificate Date: Municipality of Anchorage Development Services Department Building 8a;u~y OIv~on On. Ire Warm & Wastwmter Program 4700 South Bmgaw SL p,o. Box 196650 Ancixxage. AK g9519-6650 Legal Desct~on: A. WELL DATA WlBll t~:g). PRNAI~ If A, B, or C provide PWSiD~ N/A Date completed PRE 1971' Sanltmy~eid(Y/N)YES Total depth 58'+ ft. Dateoftest Stetro water level Well production HEALTH AUTHORITY APPROVAL CHECKLIST FREEMAN LOT 8 Pan,el ID: Cased to 40+ ft. FROM WELL LOG ~/^ N/A It. N/A g.p.m. well Log ~/N) Wlr8~ prope~ protected (Y/N) Casing height (a~:we ground) AT INSPECTION 6/26/01 55 It. 6.8 g.p.m. 016-112-15 N 20" .~. WATER SAMPLE RESULTS: / Date of eample: 6/26/01 Collected by:. AWWC, INC. SEPTIC/HOlDING TANK DATA Tank 'Typ(dMaterlal ~ ~...~1~_~--~ Tanks= gal. Nu~.. Founda~~P~_ ~ aver ~nk (Y/N) I"flgh water Alarm (Y/N). pumping Pumper C. USO;ON REID DATA poD_ow n~e. 0RA0[I ~ Total depth lt. Eft. ~n ~ ~~ ' D~l. on ~r ne~ I Da~ ~,d~ ~(~,")~' '. , ~ ~ mJ~u~ ~ent ~ 12 ~.) ~ & ~) E ~, g~ ~. D. UFT 8'rATION Date Installed. Size In gallons 'Pump on' level et In. 'Pump n. High water alarm level et ~ In. ~ Cycles tested Meets alarm & drcult requirements? Se~c lank/lift station on lot A~fion field on lot Public sewer main Sewer IsepUc service line E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 75'+ 2§'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots 100'+ On adjacent lots. 100'+ Pubilc sewer menhole/cteanout Holding tank N/A 100'+ Building foundation Property ilne ~ ~:ter maln__~ Surf-ce water SEPARATION OISTANCE FROM ABSORPTION FIELD ON L~ Property line B~n~---.---'~'- Water mal~__ Water sendce line ~------~b"--urface water Driveway, paddng/vehicte storage ~ Wells on adjacent lots. F. COMMENTS G. ENGINEER'~ CERTIFICATION I certify that I have determined through field in~a and mvfew of Municipal recotrls that the above aT, ems em In conformance with MOA HAA guidelines in eflt~t on this date. Englnem's Pdn~ed N~me Date JEFFREY A. GARNESS Receipt Number (Rev, Waiver Fee $ Oats of Payment Receipt Number / -L <~ / C/r) 'ZW$3 3~L .OL JUt.-0Z-Ot 23:09 FI~U-CT&E ENVI~'OM~f(TAf $R¥ ,~TK CT&E Environmental 5ervlcH Inc. 907561530! T°504 P.02/03 F-572 CT&£ Ref.# 101369S00! Client PO# Client Name A]~ ~atcr & WagtewMer Co]lsuhant~ htc. Printed Date/Time 07~001 Pro]~t Namd~ ~eman ~t S Coll~ed Dat~Jme 06~6~001 14:40 Matflz ~nk~g W~er Technlc.t Dlr~tor Stephen C. Ede Ordered By . ~ PWS~ O ~ka~ By Samplc RemS: Parameter P~lts Nilrate-N 0.500 U /,JIo',~able Pr'~p Analysis P(~L Units Mcthod limits DJ= Date Init 0.500 m~'~. EPA 300.0 (<10) 06/~7/01 SCL Total Coliform 0 0 co]/lOOmL SMISO~n (<1) o6/27/Ol YAP MUNICIP~ALITY 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) (b) Property owner Mailing Address Location (address or directions) J'~, ~..~l'~h-~ "~Ej:~ Telephone: (home) (c) Lending Institution Mailing Address ~/ Telephone (d) Real Estate Company and Agent Address Telephone ~ I I~ (e) Mail the HAA to the following address: (or check here ,[~if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family,~ Number of bedrooms 4 3. WATER SUPPLY Individual Well ~:~3/ Community n Public [] Note: If commuqity well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. ' " 4. SEWAGE DISPOSAL On-site,,~ Public [] Community 0 Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. Page I 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 regulations in effect on the date of this inspection. Name of Firm Date "7/~ ~ Approved for '~ bedrooms by Approved /~(' Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) ANCHORv~OF.~KLIST - FEBRUARY 1984 ~,,[V.t~Qi,~SEI[VTC-~S DIVISI, · 343-4744 ~ ' Legal Description: A. WELL DATA Well Classification Well Log Present (Y/N) ~ Date Completed RECEIVED Total Depth Cased~ Depth 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 If A. B. C, D.E.C. APpr'o~ed (Y/N) ' ¥'~/)~. 'Yield ~'~ ~3~;V't ~ of Grouting' t,~ ~ Pump Set At ~J ~ Sanita~ Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) ~ To Nearest Public Sewer Line ~'~ t ~3_ To Nearest Public Sewer CleanouVManhole To Nearest Sewer Service Line on Lot ~ / ~//- Water Sample Collected by ,ICa Ch/ ~C ~'~/r¢¢?-~ ; Date "7/~-~//,,-~ Water Sample Test Results ,-~"¢7"/.5,zr'~7"~"~i/ ; On Adjoining Lots 1 ~0 ; On Adjoining Lots Comments B. SEPTIC/HOLDING TANK DATA Date Installed/P/~/TM '--Size-~- I"*"'"' No. of Compartments Y Standpipes (Y/N) ~' Air-tight Caps (Y/N) Depression over Tank (Y/N) ~ Date Last Pumped Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarr~ {Y/N) 'H ] ,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Sen/ice Line '~/'~ / . ;for Temporary Holding Tank Permit (Y/N) ¥- Foundation Cleanout (Y/N) Y To Building Foundation To Disposal Field ~"7 I /Z>/ To Stream. Pond. Lake or Major Drainage Course ~//~ Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ~-'~./".) , Type of System Design ~//'~/~ ~' Length of Field ~'~") ' Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test 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 Depth of Field Gravel Bed Thickness SEPARATION DISTANCE FROM ABSORPTION FIELD: la5 ' Statndpipes Present (Y/N) '~ ~' Date of Lest Adequacy Test ~ (:~ To Cutback (if present) /.~/'/~ . To Property Line ,~,~- I To Existing or Abandoned System on ,' On Adjoining Lots Check Permitte( I certify that I~ inspection. Date MOA No. Receipt No. Date of Payment Amount: $ D. LIFT STATION Date Installed Dimensions S, izein Gallons Manhole/Access (Y/N) ii!!!:!sA Electrical Co..~)~~~~'~ Pumping Cycles during Adequacy Test ~edroom Against HAA Request** and HAA ~..]le)c I..,y~r'di~d, or conformed to all MOA J~i.~l[r~s in effect on the date of this J- Engineer's Seal · ~ ~z~ O~a.~ /~ ~-~ ~ Receipt No. CC" ~'~--/~(~ Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE. ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 Client ~emgla ID:rlE6~ LOT lq~ID :Ua Collact~ JUL 26 90 ! 15:45 ~acetved 3~ 26 90 I 17:00 Client hue: COtWIl t 13S0C. Client lcct: CO~MIFP ~.O.E IIOIIE inalyets Co~leto~ :JUL 27 90 Send Repozt8 to: Special lrmt~uct: Chomlab 1eL ~: 902662 L&b Smpl ID: I Ihtztx: WaTEg lllouable h~amtoE Tested lotult Units bthod Ltmtte MII~t!S-I I~(O.tO) m~/1 EPA 3S3.2 10 ~*~le ~O~IIIE SAMPLE. -~AMPLK COLLECTED BT Jo$. I ~eete fez~oru*~ ' See $~ctal Instzuctlom lbova ~A-~rm~allebla liD- lone Detected "See S~mgle lmzks i~ve Date Date Date InspectorInspector Inspector C_~.s & ~- ~" ~,~. .... , , -~.~ ~ ~-~_ .. ~- '~ ~ ~ 1952 ~ ~ ~ ) ~:z:':'onal Approval Date Sewer Install~ ~ ~ Pe~it No. ~ptic Tank Size /O ~ ~ Holding Tank Size ~lls Rating Well To Abso~tion Area / ~ / Well L~ R~eiv~ APPLICANT FILLS OUT LOWER HALF ONLY Prope~y ~ner ~1~ J oj~o~ ~ ~ 14~ H*p~*r Phone Mailing Address 17~ ~ ~r ~ Buyer ~ ~ ~u~l,'~ ~ Lending Institution ~J~i~ ~ ~l~(t~&~ Phone Address Tu~ ~,~ ~/~ Realty~.&Agent~?r~R~ ~V~ ~Z~u~ ~l r~'Jr~t~l'/or~ Phona Legal~scrlption /~f ~ ~F~ ~ Street Locatlon /7~ ~(~ Typ~qf Residence ~ Single Family ~ Multiple Family No. of Bedrooms ~ Other Wat~r,Suppty ~ Individual A~ACH WELL LOG, A well log Is r~ulr~ lor all wells drlll~ since June ~ ~mmunlty 1975, For wetls drilled prior to that date, give well depth (attach ~g If ~ Public Utility available.) Sew~e Disposal ~E_ ~ ~ Individual Year Individual Installed: ~ Public Utility When ~nnected to Public Utility' ~ Holdin~ Tank NOT~ THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INmATED. Municipalityof Anchorage POUCH 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLE$, MA YOR DEPARTMENT OF HEALT~ AND ENVIRONMENTAl. PROTECTION Anchorage, AK 99507 Subject= Lot 8 Freeman Sub. Approval for the individual sewer and water facilities cannot be granted until the following items have been completed= "~3e adequacy test ~erformed on your sewer system reveals the system is not functioning properly. Therefore, an upgrade will be necessary. Prior to the upgrade you will need to obtain a soil test so that a permit can be issued by this department. Final approval to the bank cannot be granted until the following have been completed= 1. The sewer system upgraded 2. The well head sealed so that it is water tight 3. A satisfactory water result submitted to this office Please notify this department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, ~ Associate Environmental Specialist RP82/p/EH ALASKA I FIUIROI]I]]I I]TAL COFITROL SI RUICI S, I~nclinctrin~I ~, ~nuJronmenlal $~u~{its InC. APRIL 3 1982 DALE JOHNSON 1780 READER RD ANCHORAGE AK 99507 SELLER - DALE JOHNSON BUYER-ERT'-qCHECK SUBDIV~SIO N-FREEM AN BLOCK- LOT-8 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM ~ A PIT WITH AN AREA OF 864 SQFT. THE SYSTEM ~ CAPABLE OF ACCEPTING 150 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM ~ 230 GALLONS. BASED UPON THE TEST DATA THE SYSTEM ~ NOT ACCEPTABLE FOR A HOME OF 4 BEDROOMS. SEPTIC TANK ADEQUACY THE EX~STING SEPTIC TANK VOLUME OF TH~ 4 BEDROOM HOUSE. 1500 l~q ADEQUATE FOR 1220 UJts! 25dl Aucnu¢ · Anc~oro~e, Alos~ 99503 · [907) 276-1361 MUNI CI PA_~,~ DEPARTI~IENT.,~2~LTH ENVIRONMENTAL ENGINEERING DIVIsIoN '' ' ' '~ ; Telephone 2644720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES 1. PROPERTY OWNER PHONE MAILING AODRESS PHONE PROPERTY RESIDENT (if dlff~rent from ~o~e) '2. BUYER ,cho, d L, PHONE PHONE ~-~ ~_-/~',/./ MAILING ADDRESS I~. LENDING IN~ITUTION MAILING ADORESS 4. REALTOR/AGENT LEGAL DESCRIPTION STREET LOCATION B. TYPEOF RESIDENCE NUMBER OF BEDROOIdS [] One ~. Four [] Other__ ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATEI~ ~, INDIVIDUAL· [] COMMUNITY [] PUBLIC UTILITY ' · ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE'* [] PUBLIC UTILITY **lfindivlduel/o~-site, give instellation date /¢~/ (?) If system is over two (2) years old an adequacy te~t is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCE~ING CAN BE INITIATED. 724)10(3/78) _ . ,,., ,, ,,,,~,f~,~, · ,.~ ~_ ,. THIS SIDE FOR OFFICIAL USE ONL'~ .. ~.,, -: D~.I~E RECEIVED' INSPECTION APPOINTMENTS ~ ' · TIME TIME rIME DATE DATE DATE INSPECTOR INSPECT OR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ~.-SINGLE FAMILY I--I ONE [] THREE [] FIVE I-'1 OTHER [] MULTIPLE FAMILY I-'1 TWO [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER [~INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED I--I PUBLIC UTILITY ' Connection Verif[e~ LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER i'--IINOIVIDUAL/ON -SITE DATE INSTALLED Connection Verified INSTALLER [~.Septic Tank or []Holding Tank Size: / (~OO If Tank is homemade SOILS RATING give dimensions: TOTAL ABSORPTION AREA M^TER,AL 4. DISTANCES Sept;c/Holding Tank IAl~orptio~ A~'ee ISe~er Li~e I Nmr~t Lot Line I '~ COMMENTS [~] APPROVED FOR BEDROOMS "~ CONDITIONAL APPROVAL (tetter must accompany certificate) [] DISAPPROVED LEGAL DESCRIPTION 72-010 (Rev. 3/78) July 17, 1978 R&M NO. 851554 Mr. Pat Larue c/o Polar Realty 101 East International Airport Road Anchorage, Alaska 99503 Attention: Dennis O'Day Be: Adequacy Test on Existing Sanitary Sewer System; Lot 8, Freeman Subdivision, Anchorage, Alaska Dear Mr. Larue: Per your request of July 10, 1978, we conducted a test of the sanitary sewer system on the above described property. The septic tank had been pumped prior to the test. During the test the liquid level in the crib was measured before and after the addition of 600 gallons of water. The total depth of the crib was 13.3 feet. All liquid levels were measured below the top of the standpipe and are s~nmarized in the following table: Liquid Level Before Water Added Liquid Level After Water Added Total Rise in Liquid Level 6.6' 5.0' 1.6' The water level rose 14.2 inches with the addition of 600 gallons of water, indicating an acceptance rate of 31.25 gallons per inch. Twenty- four hours later the liquid level was again measured and found to be 7.2 feet. It had dropped 2.2 feet or 26.4 inches. This indicates an average effluent acceptance rate of 825 gallons per day for the surrounding soils. If the 4 bedroom residence on the property is to house 8 people, the average load on the system can be expected to be 600 gallons per day. We can therefore conclude that the system is disposing of effluent at an adequate rate for a 4 bedroom residence. July 17, 1978 Mr. Pat Larue Page -2- We appreciate this opportunity to be of service to you. Please contact us if you have any questions regarding this letter or we can be of additional service to you. Very truly yours, R&M CONSULTANTS, INC. Lynne Kosikowski Staff Geologist 7. ~Gar~. Smith //-"Project Manager GS: ~K/kah /..~ HOT LINE HOUSING PUBLIC FACILITIES NOISE '--'~SEWER & COMPLAINTANT: G!~TER ANCHORAGE AREA BOROUG"~'"'~ .Depa .... ent of Envirynmeptal Qual,.y Complaint and Action Form AIR POLLUTION CA)E~ JUNK AUTOS NUISANCE ~HER DATE INVEST: ADDRESS: NATURE OF COM,LAINT :' r~e~ '.~.~~-~ /-~./~,./~~ LOCATION OF CO"PLAINT: RESPONSIBLE PARTY ADDRESS PHONE NUMBER RECORD OF CONTACTS AND CORRESPONDENCE DATE TIME '0 COMMENTS / TIME & DATE COMPLAINTANT CALLED BACK USE REVERSE ~__~__~Q-045 (9-?4) ~ SIDE OF FORM FOR FURTHER COMMENTS: