HomeMy WebLinkAboutCALKINS LT 7 ,,"'"' MUNICIPALITY OF ANCHORAGE
' DE !:ITMENT OF HEALTH AND HUMAN SER E.S
· '~" Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
Adclfess
Township. Range. Sec ~on
TANKS
~: SEPTIC/z./F7' [] HOLDING
TYPE OF SYSTEM
~TRENCH ~ BED ~ W. DRAIN ~ OTHER
~ FT & FT
FT
/ J ~" :~SO FT
rT
WELLS
~j~ PRIVATE [] OTHER {Identilvl
REMARKS: ~'~ ~/~'~"
FT
DISTANCES
FR 0 M"~'"'"'~ SEPTIC ABSORPTION
TANK FIELD WELL
WELL
LOT LINE /0 ~- // ------'
FOUNDATION
W/
AS-BUILT DIAGRAM (,Show location of v. eLI. sephc system, properly hnes. IounOat~on.
Scale:
Inspecbons Pedormed I~y: / .,'
cedify Ihat Ibis inspection was performed according to all
IYiunicipal and State guidelines in effect on this dale:
Health Depadment Approval:
Date; 7~/-~7
72-013 (3/85)
:~U~I I ~3 I F'AI_ I 'I'Y Of= AI~CI-~O~AGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET~ ANCHORAGE. AK 99501
264-4720
SEWER P EI~ I~i I
PERM I T 1'40:
DATE ISSUED:
870001 UPGRADE
01/02/87
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
SHEL HENSLEY
'121 WEST FIREWEED, SUITE 208
ANCHORAGE., Al'{ 99505
276-0000
S(!BDIVISION:~ CALKINS SUBDIVISION~ LOT: 7 , £LOCK:~ ~ , ~,!
'SECTION: 7 TOWNSHIP: T14N RANGE: R~W .......
16902 (SQ. FT. OR ACRES)
I certify'that:
1. 'I am familiar with the requirements for on-site sewers and wells as set.
fo~th by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
'and in compliance with the design criteria o~ this permit.
3. I will adhere to all MOA and State o~ Alaska requirements ,~or the set back
distances from any existing well, wastewater disposal system or ~publie
sewerage system on this or any adjacent or nearby lot.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICA~ERMIT AND INSPECTION MUST BE OBTAIN, ED~ (2) ~AS-BUILTS
WILL NOT BE APF'~OVED~WI]]~OUT AN ELECTRICAL INSPECTION REPORT~'AND (~,) THE
A,F'FLI CA, :~S t~Et~_ ~'HE~L~''~'~ '~'~-~ .......................
ISSUED BY ~~ /. ~~ DATE:
unicip litYo¥
nchor e
P.O. BOX 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 2, 1987
Leroy C. Reid, Jr.,P.E.
Alaska Environmental Control Services, Inc.
1200 West 33rd. Avenue, Suite B
Anchorage, Alaska 99503
Subject: Lot 7 Calkins Subdivision waiver request
Waiver No. WR87-003
Dear Mr. Reid:
The request for waiver of distance from the well on the subject
lot to the septic system on the.neighboring lot 8 has been
approved. The required separation distance from a private well
to a septic system of 100 feet has been waived to 96 feet.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Services
ALASKA .,,UIROI ITI nTAL CONTROL Seh,JIC[ $, II'lC.
~nclintcrinq I~ ~nuir0nmental Sludics
November 3, 1986
Department of Health & Human Services
825 L Street
Anchorage, Alaska 99501
Attn: Steve Morris
MUNICIPAi. ITy, OF
"'VIAL pRO T~r~Tio
NOV 2 1988
P'EC£1vED
Re: Waiver request, Lot 7, Block O, Calktns Subdivision
T14N, RIW, Section ?
Dear Steve:
While performing a llealth Authority inspection on the subject property, we
discovered the distance from the private well on the subject lot to the
neighbors septic standpipe on Lot 8, was only 96 feet. The septic system was
installed 3/1/76 and the well was drilled 3/3/78. We surmise that snow might
have covered the standpipe when the well was drilled In March 1978, as It is
barely above ground.
The separation distance waiver guidelines issued in a memorandum from Bruce
Erlckson, District Office Coordinator, State of Alaska, Department of
Environmental Conservation, dated January 3, 1985, suggests that the
geological conditions be addressed separately.
The water table ts greater than 5 feet below the absorption system.
Point Value 0.5
Soil Type:
Sandy Gravel
Rated 150 sq.ft./bedroom
Soil Sorbtlon
Point Value
Permeability Point Value
4.5
3.0
The Water table gradient is a negative 19% slope.
Point Value
Horizontal Separation
Absorption field to well 96 feet
Point Value
2.84
Total Point Value 11.54
According to guidelines, a total point value of 11.54 indicates contamination
ts unlikely from bacteria. Water samples taken 10/21/80 and 10/13/86 were
satisfactory. The general slope of the area is from the well to the
standpipe, with an elevation difference of at least 10 feet between the two.
Any contamination surfacing would have a tendency to flow away from the well.
We feel that the reduced separation distance does not constitute a health
1200 ~Ue$i 33rd Aucnue. Suite B * Anch0ruq¢. Alaska 99503 *1907) 561-5040
hazard. Therefore we request a written ~alver for the separation distance of
96 feet from the well to absorption trench standpipe be granted. If you have
any questions, please feel free to contact me at 561-5040.
Sincerely,
Dennis Roe
Soil Scientist
Approved by:
ALASKA 5,m',OIROIqlTIEFITAL COFITROL Sl holCl S. IRC.
(~n~in¢¢rinq I~ ~nuironmcntal $luclics
SPECIFICATIONS FOR A TRENCtI-TYPE WASTE WATER TREATMENT,
LOT ?, BLOCK O, CALKINS SUBDIVISION
l.O GENERAL
1.1 TIlE DRAWING SIIEETS I THROUGH 5, SHALL BE A PART OF
THIS SPECIFICATION.
1.2 ALL MATERIALS AND WORKMANSHIP StIALL MEET TIlE
REQUIREMENTS OF THE STATE OF ALASKA, DEPARTMENT OF
ENVIRONMENTAL CONSERVATION (ADEC). TIIE CONDITIONS
OF THE PERMIT, AND ALL APPLICABLE RULES AND
REGULATIONS CURRENTLY IN EFFECT.
1.3 ALL ELEVATIONS AND DEPTHS ARE ADVISORY, AND ARE TO
BE VERIFIED OR MODIFIED IN THE FIELD BY THE
ENGINEER, OR INSPECTING AGENCY.
i.4 IT IS TIlE RESPONSIBILITY OF THE OWNER OR INSTALLER
TO ADttERE TO APPROVED DESIGNS FOR INSTALLATION,
MAINTAIN TIIE SPECIFIED SEPARATION DISTANCES, AND TO
HAVE APPROPRIATE INSPECTIONS BY ADEC'S APPROVED
AGENCY.
1.5 IF TIlE INSTALLATION IS NOT INSPECTED BY AN AECS
ENGINEER, AECS WILL NOT BE RESPONSIBLE FOR THE
INSTALLATION. AN ENGINEER AT AECS SItOULD BE
CONSULTED PRIOR TO CONSTRUCTION, TO DETERMINE THE
NUMBER OF INSPECTIONS TI~T WILL BE REQUIRED AND
TO EXPLAIN WHAT THESE INSPECTIONS REQUIRE.
2.0 SEPTIC SYSTEM
2.1 THE SEPTIC TANK SI~LL BE A UPC APPROVED TWO
COMPARTMENT TANK, SET LEVEL, AND INSULATED WITH AN
OVERLYING LAYER OF 2 INCtl BURIAL TYPE POLYSTYRENE.
THE SEPTIC TANK SHALL REST ON UNDISTURBED SOIL.
2.2 INLET AND OUTLET PIPING StlALL BE FITTED WITH WATER-
TIGHT CALDER COUPLINGS. PIPING SHALL BE 4 INCH
SOLID PVC, SLOPED A MINIMUM OF 1/4 INCll PER FOOT,
WITH A MINIMUM OF 4 FEET OF COVER. IF LESS THAN
4 FEET, USE 1 INCll OF DOW EXTRUDED BLUE POLYSTYRENE
FOR EACH FOOT OF COVER LESS THAN 4 FEET (INCLUDED
IN 3.S).
2.3 CLEANOUTS SI~LL BE INSTALLED WITtl CALDER COUPLINGS,
CAPPED WITH AIR-TIGHT JIM-CAPS (OR EQUIVALENT), ~D
EXTEND A MINIMUM OF 0.5 FEET ABOVE GROUND LEVEL.
2.4 THE SEPTIC TANK SHALL BE A MINIMUM OF 5 FEET FROM
THE HOUSE FOUNDATION, AND A MINIMUM OF 5 FEET FROM
THE DRAINFIELD.
2.5 CLEANOUTS SHALL BE INSTALLED AS DESIGNATED, CAPPED
WITH AIR-TIGHT RAIN CAPS (JIM CAPS OR EQUIVILANT),
AND EXTEND A MINIMUM OF 2 FEET ABOVE GROUND LEVEL.
2.6 RECOS~END USING AN ANCHORAGE TANK COMBINATION
SEPTIC TANK/LIFT STATION, MINIMUM SIZE SO0 GALLONS.
1200 LUest 33rd/~uenu¢. Suil~. B, ,~nchoreq¢. ~l(~s~,a 99503,.(907) 561-5040
3.0 SEEPAGE TRENCH
3.1 THE GRAVEL FOR TIlE TRENCtl St~LL BE SCREENED TO TIlE
SIZES OF 0.5 TO 2.5 INCHES AND FREE FROM SILT OR
SAND (OR ADEC APPROVED EQUIVALENT).
3.2 THE BOTTOM AND SIDES OF THE EXCAVATION SI~LL BE
RAKED WITII Tile BACKHOE BLADE TO INSURE THAT IT
NOT BEEN COMPACTED DURING EXCAVATION. TIlE BOTTOM
ELEVATION St~LL BE */-2 INCHES.
3.3 A MONITOR PIPE SHALL BE PLACED AS SHOWN IN THE
DRAWINGS. IT SI~LL BE RIGID PVC., ASTM 3033D, OR
3034. THE SECTION SHOWN WITH HOLES, MAY BE DRILLED
0.5 INCIt IIOLES ON TIIE 6-INCH CENTERS ON OPPOSITE
SIDES OF TIlE PIPE OR ANOTHER OPTION IS A REGULAR
SECTION OF PERFORATED SEWER PIPE ~YBE CLAMPED TO
THE SOLID SECTIONS WITH A NO HUB COUPLING OR A
SOLVENT JOINT. A RUBBER RAIN CAP (JIM CAP) StlALL
BE PLACED OVER THE TOP OF THE PIPE.
3.4 THE DISTRIBUTION PIPE StlALL BE 4 INCH RIGID PVC OR
PE. ALL PIPES SHALL BE LAID LEVEL.
3.5 IF TIlE FINAL GRADE OVER THE TRENCIt IS LESS THAN 4
FEET ABOVE THE ORAVEL, INSULATION IS REQUIRED.
INSULATION SI~LL BE DOW EXTRUDED BLUE STYROFOAM
BOARD OF A REQUIRED THICKNESS OF 1" PER FOOT OF
SOIL LESS THAN 4 FEET, OVERLAYING THE TRENCtl. TIlE
SOLID PIPE EXTENDING FROM THE SEPTIC TANK TO DRAIN-
FIELD SHALL ALSO HAVE 4 FEET OF COVER OR AN EQUIVA-
LENT LAYER OF INSULATION TO PREVENT FREEZING OF THE
LINE.
3.6 IF INSULATION IS NOT NEEDED, A COVERING OF TYPAR,
MYRAFAI, FIBERTEX, UNTREATED BUILDING CONSTRUCTION
PAPER, OR EQUIVALENT WILL BE USED TO COVER THE
ENTIRE TRENCH OVER THE TOP OF THE GRAVEL.
3.7 TItE AREA EXCAVATED IN THE VICINITY OF THE TRENCll
SHOULD BE PLANTED WITH A WHITE COVER, RED FESCUE
MIX, AND KENTUCKY BLUE GRASS.
4.0 INSPECTIONS
4.1 A MINIMUI~ OF TWO INSPECTIONS ARE REQUIRED FOR THE
INSTALLATION OF THE TRENCH. TIlE FIRST INSPECTION
WILL BE OF THE EXCAVATION TO VERIFY TIIAT
INSTALLATION WILL BE IN THE PROPER SOIL.
4.2 TIIE SECOND INSPECTION WILL BE AFTER PLACEMENT OF
TIIE GRAVEL, MONITOR STANDPIPE AND DISTRIBUTION
PIPE TO VERIFY PROPER INSTALLATION BEFORE BACKFILL.
5.0 LIFT STATION
5.1 SEE ATTACItED SPECIFICATIONS BY ANGtlORAGE TANK AND
WELDING, INC.
Anchorage Tank & Welding, Inc.
2700 Porcupine Dr.
Anchorage. Alaska 99501
(907) 272-3543
TANK FOR LIFT SYSTEMS
SEPTIC TANK SHALL BE A MODIFIED ANCHORAGE TANK
STEEL TANK. THE DESIGN OR ANALYSIS SHALL BE IN
ACCORBANCE WITH ACCEPiED ENGINEERING PRACTICE
AND LOCAL REGUI.ATORY AGENCIES.
TIlE TANKS SHALL BE DESIGNED FOR LOADING'
CONDITIONS AS REQUIRED BY HUNICIPAL AND STATE
REGULATIONS.
C. ALI. WELDING SHALL BE IN ACCORDANCE WITH
APPLICABLE CODES AND STANDARDS.
D. COATING SHALL BE TNEMEC ~6-t~65 HI-BUILD
TANK COATING AND APPLIED AS FOLJ.OWS:
'l.
SURFACE PREPARATION.- ALL SURFACES MUST BE
DRY, CLEAN, AND REASONABLY FREE OF RUST AND
MILL SCALE EXCESS RUST, HILL SCALE AND
WELDING SLAG SHALL BE FEMOVED BY WIRE BRUSH
OR OTHER MEANS AS NECESSARY.
2. APPLICATION SHALL BE AIRLESS SPRAY TOUCH UP
WITH BRUSH OR ROLI..ER.
TH]iNNING SHALL BE ACCOMPLISHED WITH
APPROVED MATERIAL AND WILL NOT EXCEED 5%.
SURFACE TEMPERATGRE SHALL NOT BE BELOW 40F
OR 5 BELOW DEW POINT W~ICH EVER IS LOWER.
INTERIOR SHALL BE COATED TWO TIHES AND SHALL
BE A MINIMUM OF 20 DRY MILLS EXTERIOR SHALL
BE COATEB ONE TIHE AND SHALL BE A HINIHUM
OF 10 DRY MILLS.
RISER
Anchorage Tank & Welding. Inc.
~700 I~r~plne Dr.
Anchorage. Alaska ~gsot
(907) 272-3543
OUTLET RISERS SHALL BE GALVANIZED STEEL CULVERT,
AND SHALL BE 5~ INCHES (MINIMUM), HIGH, SHALL
HAVE A MINIMUM NOMIMAL DIAHETER OF 2~ INCHES,
AND SHALL BE CAPABLE OF BEING EQUIPPED WITH THE
FOLLOWING:
A. A JUNCTION (NEMA ~X) BOX OR EQUAl,, BONDED
OR ATTACHED TO THE RISER.
B. UL LISTED ELECTRICAL CORD GRIPS, INSTALLED .
IN THE J-BOX.
A bi[' - SHALL BE FURNISHED WITH THE RISER, IT
SHALL BE CONSTRUCTED OF FIBERGLASS OR EQUIVALENT
AGGREGATE FINISH.
C'. · RISER INSTALLATION - EACH RISER SHALL'BE SEA~EB
OR WELDED TO THE TOP OF THE TANK IN SUCH A MANNER
AS TO PREVENT INFILTRATION OF GROUND WATER
WHERE PRESENT.
II,
INSULATION - 2" RIGID EXTRUDED POLYSTYRENE
SHALL BE PLACED IN THE RISER DIRECTLY BELOW THE
LIB.
E. INSULATION - 2" SPRAYED URETHANE ON
CIRCUMFERENCE OF RISER.
Anchorage Tank & Welding. Inc.
2700 PorcupIne Dr.
Anchorage. Alaska 9950i
(gO*',') 272-3S43
EFFLUENT PUHPING ASSEMBLY
A, EFFLUENT PUMPING ASSEMBLY SHALL BE ORENCO
SYSTEMS (TM) MODEL OSI WE 1000 SERIES CONSISTING
OF FOLLOWING:
1. 1/3 H.P. MYERS SSM25 115 VOLT OR EQUAL
SCREENED PUMP VAULT (U.S. PATENT #L~37323)
59" DEEP, 3/16" THICK HIGH-DENSITY PVC
CYCLIHBER HOUSES THE PUMP, LEVEL CONTROLS
AND SCREEN AND SERVES AS A BAFFLE TO PREVENT
THE SCREEN FROM CLOGGING.
THE FIFTEEN 1-1/2" DIA. HOLES ARE DRILl,ED IN
THE VAULT AT A LEVEL THAT PLACES THEM AT
ABOUT THE MIDWAY POINT IN THE DEPTH OF THE
SEPTIC.
FLAP CHECK: ALLOWS Tile VAULT TO DRAIN WHEN
REMOVING FROM TANK,
SCREEN: 15" DIA. CYLINDER OF HIGH-DENSITY
POLYETHYLENE 1/8" MESH CAST INTO FIBERGLASS
BOTTOM.
3, ALL PLUMBING SHALL BE PVC OR OTHER NON-
CORRODING MATERIAL.
PUMP CONTROLS AND ALARM SYSTEM -
CONTROL SHALL BE ORENCO SYSTEMS (TM) ML-3F
CONSISTING OF:
1, AUDIBLE ALARM PANEL MOUNT.WITH A MINIMUM OF'
80 DB SOUND PRESSURE AT 2q-INCHES, OP~RATINO
TEMPERATURE -30AC TO 65AC, CONTINOUS SOUND.
orage Tank & Welding, Inc.
2700 Porcupine Dr.
Anchorage, Alaska 0oS0{
[9o7) 272-3543
OIL-TIGHT VISUAL ALARM WITH PUSH-TO-SILENCE
FEATURE. AUTOMATIC AUEIIO-ALARM RESET.
15 AMP MOTOR RATED TOGGLE SWITCH, SINGLE
POLE, DOUBLE-THROW WITH THREE POSITIONS;
MANUAL'(MAN), AUTOMATIC (AUTO), AND CENTER
(OFF) (H.O.A.).
NEMA 4. X-RATED, FIBERGLASS, OR EQUAL,
ENCLO~;URE WITH HINGED COVER.
LEVEL CONTROL FLOATS SHALL BE ORENCO.SYSTEMS (TM)
MF2 CONSISTING OF 2 MERCURY FLOATS ON ADJUSTABLE
PVC STEM WHICH ATTACHES TO VAULT. ONE FLOAT
SIGNALS ALARM; THE OTHER SWITCHES PUMP ON'OFF.
INSTALLATION~ ALL PUMPING SYSTEMS SHALL BE
INSTALLED IN ACCORDANCE WITH THE MANUFACTURER'S
RECOMMENDATIONS AND STANDARDS.
. :ALASKA ENVIRONMENTAL
..... CONTROL SERVlC"'~ INC~
* ~ ' 1200 West 33rd Aven~, Suite B
" ,,' ' ANCHORAGE, ALASKA 99503
.'.. : ~ , .~ .:(gu/)~iiz-~u4o
· SHEET NO, ' ' OF
c'~c~o ~v , .WT~._ ' .'
SCALE
. .~ ....~ ' --r - -'T'--~"--'~ "-~- ................ ? '-'~ t ........ .' .... T .........~ ............................................. 7 ....... ~ ........ --'~ .....
-'-~ ......... ' ............. f ....... f'-'-~ ............ ~ ............. t ...... ~ .... t ...... t ...... f ....... I ...... ~ ........ ~'"";"; ...... ~ ......................... r ........ ~--'d ................ ; ........ ~----
.... :. I ._:._!.Zd~.~.::_.] ...... lh~t~P, i-.u~ ~ b~.._.!.._ ~r~r~L_~ Y~r~_:....~4.:.~,~ ~...:~o....~.J ...... :....:.:
~ t ! t ~ ' ~ ' ' ~ x ' '
,
..... 4 ..... ~ ............... ~ ..... ~ i '
i i i
I
. ! '!' ~ ~ t ' 'i i .I
i
.... I..~ .~ ~ ,
" ' ' I ' i '
.._~ ...... ~ ................. ,..._..~.~..c,~...~_=__~ ....................... . ........ ~_.._~ ...... ~__+ ........
't .I I ' ' I ' ' ~ ..... ~ " ; i i i
. , , I , · . t . , , , . , · ! _ I · , .
........ T ....... ~-.--v-% ......... r--.-.~ .......~ .... t-"-3m~ ................................... ~ ~
....... ~--~TI ........... ~ ........ 1. "* .... 1~ .... ~ .............. ~ .......... 7'f~ .......... ; ........ r ........................ t ¢---'-t ....... . ~, .... *--'~ ......
'~'--'~'--~"~--t~-i ..... r ....t ...... r'--l"-"~ ........ ~ ...... 7-'r-'''' r~-~ '--: .... :'~i ..... r-.~ ~--.~ ..... r .....
.... ~ ' ~ '~ ~ ~ ~ "r
--,-~.---~--~ ....... ~ ......... ~ ...... ~--~ .... ~ .......... ~ .......................... ~.. -.-.~ ...... L.---~ ................ ~---:*.-----~ : --
~ · , . ~ ~ ~ ! , , · .
't ~ . -~ ,
: I ~ ~ I. · · u / .....
"':l,t'-t 'i'r /''i LI 't. ! 'tt. ! I z ~: ! II t :': 'i ~'~ :~ ~ I:
-'-!w-q- i =F-t-:i-,T!-'F-iq' T"T:, .... ...... F'-F-r'--i ...... I ':i ....... q .... i'
r , · i I I ;i. i i I I . ! ' i t I 'i I i I I ' ! I I ! ' I ' ~ ';
~ ........ 4-'---'~'~ ................ ~ . ~'"~"~-. - "~ .......... ~ .......... ~ ~ ..... +'--w .......... I +~ .......... r"--~ .... ! ..... ~ ................. l ~, .... i-~ "~
,, t.~ I, t~, i ,./ ,.,, l, ~., I,.~ , 1"I-, , , , ,
q , 1 r '~
,. ........... ................... , ;
................................. ~ .................. ~ .... i ......... ~ ...... , "I ..................- ~ .......... ; ................ ; .................................................. ~ ..... L--.& ........ ;
ALASKA ENVIRONMENTAL
CONTROL SERVIO",, INC;
1200 West 33rd Aven'~., Suite B
' ANCHORAGE. ALASKA 99503
. (907) 561-5040
SHEET NO,
C~LCU~A~;'D.¥ ' -hiP'-
CHECKED BY
oF
DATE
i I
ALASKA ENVIRONMENTAL
CONTROL SERVIC"~. INC, * .....
1200 West 33rd Aven~c, Suite B
' ANCHORAGE, ALASKA 99503
(907) 561-5040
ALASKA ENVIRONMENTAL
CONTROL SERVIO'"', INC.
1200 West 33rd Avenue, Suite B
· ANCHORAGE, ALASKA 99503
(907) 561.5040
CHECKED BYii# DATE
f
0
Z
0
o
H
> Don.
o
bj[O § o
0
_.1 ~ ,,' o
\
O ',~H
~J H
lu 0
0 ..J
~ Z
Z
0
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
1
2
3,
4
5
6
7
8,
9
10
11
13
15
16
17
18,
19-
20
~?
(ENGINEER'S~EAL)
DATE PERFORMED:
/
Township, Range, Section: '7'/~/~, ~/~//
SLOPE ' S~E -PLAN'
WAS GROUND WATER
ENCOUNTERED?
DEPTH? _ pO
-- E
Deplh Io Watecf~fler~,..i ./,-.-, /~t
Moniloring? ~ Dale; I1~
S
IF YES, AT WHAT L
Reading Date Gross Net Depth to
Net
Time Time Water q Drop
,, ,- ,.,, ~?q l
~ .,~ i .
~ /i
~oql 50
PERCOLATION RATE ~[,~'~ ¢-~(m,nutes/inchj PERC HOLE DIAMETER
/3 /'__ /' TEST RUN BETWEEN ~,0 FTAND ~./~" FT
PERFORMED ¥ . , CER" 'T"ATT"'S'ESTWASPER ORMEO,N
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~//~ ~"" ~
72-008 (Rev. 4/85)
ALASKA I dlROlllTIE IqTAL COI1TROL
~nqincerinq
December 18, 1986
Municipality of Anchorage
Department of Health and Human Services
825 L Street, Suite
Anchorage, Alaska 99501
Attn: Steve Morris
Re: Lot 7, Block 0, Calklns Subdivision
Dear Steve:
Some questions have been brought up by your,,department concerning the upgrade
for the above referenced lot. The existing'system ts for 3 bedroom capacity.
The house has been upgraded to 5 bedrooms so:~he sewer system must also be
upgraded. Referlng to the site plan dl~gram,'there'ls approximately 4,500
square feet of area on the lot, including the existing system, that Is outside
the 100 foot radius of the well. since this is'an upgrade, the requirement to
show 15,000 square feet of reserve area does n6t.abply.
In reviewing our design for the additional lift:station septtc tank, we are
changing our design to show a minimum 1,000 gallon additional tank. This will
give a 2,000 gallon tank capacity which Includes adequate reserve capacity.
Also, attached is a diagram showing our proposal for even flow distribution to.
the two separate trenches.
If you have any questions, please feel free to call.
Sincerely,
Alan C. ~ien
Engineering Technician
Approved by:
1200 ~e~t 33rcl ~uenue, SuJle ~ · Anchorcqe. /~losh 99503 ,[907) 561-5040
ALASKA ENVIRONIv,,~NTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue. Suite B
ANCHORAGE, ALASKA 99503
(907) 561.5040
SHEET NO.
CALCULATED BY /'
CHECKED BY
OF
CATE
...... ~ ........... ~ ...... .. ..... !".i.i:~o~'...r,~....~r~_...o~_....! ........ ! .........
A-~'~',~ '7"X~K ~ : ' ' · ,E'*x/3~',,.4/& i M.V'~' 'T~':. 7~,J~-.//~
! , ; , ~i .................... 1 . : .......... ~" '-"" .: , ......... : ............... :: ........................... . ! ..............................
...................................................................................... ~ ............. ; ~ - .................. : ...............................
...... ~'~/-~,,~c- F'/.,,J 3n~'~'~,7~.,~' ............................. · .! ...... : ............................................. : ................................
......................... ."7~ ~.~E'~' ........ : ................. ' ........................................................................ ; ......... ~ ....... i ......
-x~,,~ ....... -~ ~'~..~; .... ! ................ L. ! ................. :_......j ........ J ........................
... .................................... ,,/-r-.-..., , ........................... : ..................
.................................... , , /. ~,m~,/,~.. ~,T&~..i.~,~...~....~...~
......... . ...... ~. ,c~ ,~"r.~'r ~.,W ~ //~v£ F~
· "~/~1~ ......................... r,~/.. ~ r,~.~ :.'r~,~,i ......... ! .........................
............... .,. ........... , ....... ~.....~.. :~ r~/.u~.n ~....~,~( .......
.....I _ · ........ ~ ...... ......... . ....... ,..........~ ........ , ......
' C, REID, Jg.. ? '~' .... i ; .......: ....... [ ..... : ........................ ; ............................. ; .................. : ......
,- - Y.:Zb~ ............................................ . .....................................................................................................................................
Z./YT' : "'"'t ......................... ; ......................................
f~'-MUNICIPALITY~ OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PRoTECT'iON
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME IPHONE ,~NEW
~AILING ADDRESS
LEGAL DESCRIPTIO~
LOOATION ~0, OF BEDROOMS
Absorption area D~llin~,
~ ~,~.c~To: I~'' I0~' 7'
~ Manufacturer ~O.~r P~*~'~ ~,4~*~Material
Liq. capacity In gallons Inside length Width Liquid depth
/ O~ IF HOME,DE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O Z < Manufacturer Material Liquid capacity in gallons
Q Well Foundati~ / Nearest /~l°t line
--~ / ~ ~ r~ inches
~/~
~ ~ Top of tile tO finish grade Material beneath tile ~ /t Total eff~ve absorption area
Length Width Depth PEHMtT NO.
< ~ Type of crib Crib diameter Crib depth Total effecti~ absorption area
m Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS ~ ~
INSTALLER
REMARKS
~....,..~...~,.-,.... ~
....... .
APPHOVED DATE LEGAL
PERMIT HO.
RPF'L I CRNT
LOCRTION
LEGRL
Of4--SITE
( 780129 )
fdLIt4 Z I-TM '[ P¢~'~.. '[ T'T' OF
DEPRRTMENT OF h.'RLTH RND EN","IRONHENTRL PRG,-':CTION
825 'L' STREET, RNCHORRGE, RI(. 9950'1
264-4728
SEIiEE: F'ERfd I T
LRRY DELRHOUSSRYE
CRESTVIEW DR
L? CRLKINS
230'1F'RXSON ST
LOT SIZE
3~? 11~0
0 SQURRE FEET
TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH
MRXIMUM NUMBER OF BEDROOMS
SOIL RRTIHG (SQ FT?BR)= 1~5
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
DEF'TH= :1.2 LEI'-tBTH= 6:_=: 6 F-: R',.-' E L B,F'PT! I= _3:
THE LENGTH DIr'IENSIOM IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE E×CRVRTION (IN FEET>.
THERE IS HO SET WIDTH FOR TRENCHES.
THE ORRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEH THE OUTFRLL PIPE
RND THE BOTTOM OF THE ENCRVRTION (IN FEET>.
F~ EL--iLl I F.'E[:, SEPT I C T R I'-I I-'-f. S I ZE= i0 ~-~ £-~ GRLLI31'-.IS
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF ANY WELLS RDJRCENT TO THIS PROPERTY AND THE
NUME:EF.'. OF RESIDENCES THRT THE WELL WILL SERVE.
TI-4m~ < 2 >' I f4SPEL.']:T I 014S RRE FiEE!IJ I REC,
BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND flPPROVRL BY THIS
DEPflRTMENT WILL BE SUBJECT TO PROSECUTION.
MIHIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
i00 FEET FOR A PRIVATE WELL~ OR
· 150 TO 20A FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS ARE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
PERM I T E.~-~.F' I RES DFCE£'IE:ER
I CERTIFY THRT
l: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND HELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
_~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE. IS REMODELED TO INCLUDE MORE THRN 2 BEDROOMS.
F~'LI CRNT LPJ~Y DELRHOUS~IYE
ISSUED B~ ~
V-~. 0
O ~ E GEOTF'~,.HNICAL Et- DEVELO-'MENT CO.
Russell Oyster
694.2774
Soils b Foundations
Performed for: Name: ~/?~
Hall trig Address:
Legal Description: Zoo' ~7t
Depth (feet)
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
SO~L LOG
Tel. No.
Sotl Characteristics
Eaff ,fi/is
688-2280
Land Development
lO
11
12
~5
Ground Water Encountered: Yes~
Proposed Installation: Seepage Pit
Comments: /-/DOF~ /5 £~JT~
,o /
If yes, what depth
Drain Field ,
~/ ~7" ~,'~,N--
Date:
by
A & L DRILLING COMPANY' -
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION ~ 7 ~ Z:~C ~"'t/t,/,?
DATE- Started ~////7 ~" Ended --~/~/~ ~
' ~
/
DEPTH OF WELL '~/r~
STATIC LEVEL OF WATER FT.
/
DRAW DOWN FT. /~
GALS. PER HR 7,,,'7~
KIND OF CASING
/!
,-97'7
KIND OF FORMATION:
From 0 Ft. tn c~9
From ~. Ft. to /c~
From /& Ft.~o~
From ~c~ Ft. to ~
From ~ Ft.t,d-o
From.
From . . .
Ft. 00~'~ ~U,~,%~ From
Ft..q'-/;~,9 (~ e~< .~ ~
~t. e~r ~, ~'~m__
Ft.. ~ ~ ~5~ From
. .. Ft. .~O From
_ . F,.
Fro m
From .
From
From
From
From
From
'r~o 5"'Ft. to:~/~' ~Ft.
Ft. to Ft, ' From
__Ft. to Ft. ." 'From'
__Ft. to F't, From
Ft. to_ .Ft. From
From
From
Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
Ft. to.
Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
Ft. to.
Ft. to
Ft. to
Ft. to
Ft. to
Ft
Ft.
Ft.
Ft.
Ft
Ft.
Ft.
Ft.
Ft.
Ft,
Ft.
Ft.
Ft.
Ft.
Ft,
MISCL INFORMATION:
k
PERMIT NO.
r-lUN I Ch i'lL I T'T' OF
_
DEPRRTMENT OF HERLTH RND EHVIRONMENTRL PROTECTION
825 'L' STREET~ 8NCHORRGE, ~K. 99501
264-4728
P4ECL F"EF~r4 I T
78~42 >
RPPLICANT
LOCATION
LEGRL
LEE SULLIVRN
CRESTVIEH
L? CAULLINS
BOX i97 EAGLE RIVER
LOT SIZE
694 2588
28725 SQUARE FEET
MINIMUI4 DISTRNCE BETWEEN A WELL RND RNY ON-SITE SEHRGE DISPOSRL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
WELL LOGS 8RE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT HITHIN ~0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIAGRRMS ARE
RVAILRBLE TO INSURE PROPER INSTRLLATION.
PERI'"I I T E,':-':P I t~.ES DFOFI¥1BFR _-2::1.., '1978
I CERTIFY THRT
l: I AM FRI~ILIRR 14ITH THE REQUIREMENTS FOR ON-SITE SEWERS RND HELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I HILL~NSTALL THE SYSTEM IN RCCORDANCE WITH THE CODES.
V-~. 0
Parcel I.D, if
1, GENERAL INFORMATION ..........
Complete legal description Lo~, 7;
MUNICIPALI'PI' 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
Location (site address or directions) ,.."'*'*""~','~'--. - , . .
~'Property owner "-
,:.,Mailing address ' : 9
.-, .'. ..... .: ......... ~:-~
,', .Lending agency ...........
~.Malllng aooress -' -,. ~' ,
10459 C~e.6ZvZe~
A~
Day phone
AK 99577
Agent ..... :: ,., t.'..~
Day phone
~94-0444
. ,:,v.,:. ~ ~,, .. .,*,' .' ** .. ,.: :', L; , ,..,..-.'**..:.~-~:*. ,.,~:::.T:~,~ff,.:r~:',,..**,'~, , ...';., : . '".' :. .*." .' .' . - . '. .;' ,,:..';,:...,,~,~_,~,'.~,:~,,~,:*~ :~..:.
'. -.,.1~ :.'..¥" ...... . ~ ~ . .... , ................ ~'"*'~:'.'" .......... ,'~ .....''"" ": '.' '." ~ .......... ....!,'.~:L.;'.x'~'~'~'.~,Y ~?.:'~',.~:~; ~;.":Z.
;::.' ::.' :, '. Unless otherwise requested, HAA will b~?eld forpickup. ': .-.: .~ ~ .~*' ...; ;,??'. ,r '~i'-.':.":~".; '~:~".~ ~.-7-
'--3.-:'" TYPE OF WATER : -:-':
*: : ... i ; '
· , · ..~'.:...-. ~ ',"..';' ..~ ::.
.................................... Indi~/Idual well ~-;'-'~-.--. ----~'.~:'XXX .................................... :-' :!":"~ '~ ::-'~.?'";:?"':
,.,,,m,,,,,n,,z.--,,, .,,.... :., ....... . . ..... <; ..~....,::~...~?...
.:i: ...... ' ............. '...:..._Publicwater;._.:.'...~;~::__.!::; .' " '; ' _. ::"-~ ":'~ :'.:-.?,'~.::~'~.'..',c;:.'..'.'..
NOTE: --/f communi~ well system, provi~e written confirmation trom State AD~ attest-.. "'
lng to the legality and status of system. . ~ 12,.:
;. ................................................... ~ ; '-~" ~ . ~ -': .
'lndividualon-s~te -.' :.... ~OC~ ·., ,. , · 1 - , ?.~
· . . ' ~. ' ,, ~,, , ~ ,~ . ;..' :~..
· .. . ... · Holding tank .... ,' c~.~r, ~ .... : .....· ..... , .... , . . .~..,,l ~....,~-.~ ·
-. , :, .,,, ... .., .., .... -- ~ ..... .'. · ,...~:, ,. ~. '..:.,~,~...~..; -. :,, · =. ..; . . , ~ ·.~ .~.
Community on-site .,..-: .: :-..: .... ~:.- !,,~ '-
__..._,- , :...,.~.-: ~ .., ..... , ,,.,:-.. .~
Public
.. .. .... , "".'? ~i: ? ~,
NOTE: If community wastewater system, provide written confirmation trom State
attesting to the legality'and status of system.
~2-02~(Rev. 1/'gl) Front MOAI~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 fu. rther verifythat 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 S & s ENGINEERING
17~ 7..~:. ~;,.~ :,,~ ;,~.& ;;~ iG4 Phone
Add~'ess Z~le River, Alaska 99.5'77
Engineer's signature ~ Date G /~2(,/7 ~--
: Additional Comments .... · ' '
.. -',".-"--/?
· - ~ f. , ~ . ~.. ~ '..:~ ... .,,, ...... ; :~ ....
"~ _~ I
-Jhe ~umcipah~ of.~nchomge ~nt of H~lth a~ Human ~ (DHH8) i~u~ Health ~hor~
Approval Ce~ifi~ ba~ only upon the mpr~nmbons given in ~mgmph 5 a~ve by an inde~ndent
prof~al eng~n~r r~ister~ In the S~te of Al~ka. The DHHS d~ this ~ a ~u~y to put, harm of ho~
and their I~ndin~ in~titutiona in order to ~ti~ ~ln [~ and ~to r~uimmnB. ~mplOy~ o~ DHH8 do not
eondu~ in~tion~ or anal~o data ~[or~ a co~ifimt~ i~ i~u~. Th~ Munleipali~ o[ ~nehora~o ~, not
Municipality of Anchorage ...... PAt~-- ~
DEPARTMENT OF HEALTH & HUMAN SE~~sa~v,c~ vr~ '~
. . Environmental Se~i~s Division ~J~
,0o so=. 6 1996
Legal Dc~ription:
A. WELL DATA
Health Authority Approval Checklist
~ t,g.,,,[ ~ Parcel I.D.:
Well lype ~ If A, 13. or C. attach ADEC letter. ADEC water .system number
Lo8 p~sent {~N) .~ Date completed
Total depth "~ I"'L. ~" Cased to . ~. I '~, ~
Date of ~
Slatic water level
RECEIVED
FROM WELL LO0
I '"'~. 'o F-p.m.
O$O -All -t¥
Casing height (above ground)
Wires properly protected (~)
AT INSPECTION
Well production
g.p.m.
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B.~OLDING TANK DATA
Co
Date installed %~q,~ - l'~87 Tank s~ltx,,
Depression (Yd~J ~ High water a!~rm (Y/N) ~ J~.
Fo~dation clCan°ui (~N)
Date of Pumping
ABSORPTION i~I'I~LD DATA
Soil rating (ii.p.d./it= or it:/lxlrm)/'t4'?t~7'Systnn .type :~-.4:,ff~ff'
t~,n t~,' ff ,/r'. Width p~ 4~.r" O~,~lni=~t~l~pip, :~'t S' Ton~aepn r-}s' t/t'-/~,~-'
Effective absorption area ~S ~ 40 Mouitoring Tube pmsent~)/N) ~ Depression ow, nad (Y~) ~
Dateorade~uacyt~ /,.-d.~"'~t, Rcsa~,~l~'F~) /',('~'~ For ~' ~trooms
Fluid depth in absorption field befor~ test (in.).; O TM
Fluid depth ~ (ins.) Minutes later:
Peroxide treatment (past 12 months) (Y~ ...,bP/...
immediately a-~r//.~, gal. water added (in.):
'~bSorption rate 7 ~'o 4-
=~ g.p.d.
./
D. Lll~r STATION
Date instalkxl
High water alarm level al* ~ ~. s.
Siz~ in gallons
"Pump on" level at* 4?--*
*Datum
Cycles tested
· 'Pump off' level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WF.I .i. ON LOT TO:
~-'~holding lank on lot
Absorption field on lot
Public sewer main
Sew. er/septic service line
: On adjacent lots
; On adjacent lots
Public sewer nmnho[c/cleanout
Lift station
SEPARATION DISTANCES FRO~OLDING TANK ON LOT TO:
Building foundation ~" s +' Propenlt line t t~ W Absorption field [,.~. '
Water main/service linc ~ c~ ~' 4- Surface water/drainage I Wells on adjacem lots i ~:~ x 4-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
S~face water
Cunain drain
Water main/service line I o ~ ~
Driveway, parking/vehicle storage area ~'~ ~'~
Wells on adjacent lots ~ c?. ~ ~'¥' Property. line I o~'
F. ENGINEER'S CERTIFICATION
in conformance with,¥[O,4 HAA gu~ ct on this date.
HAA F~ $
Date of Paymem
Receipt Number
Waiver Fee $
Date of Payment
Po:s:eipt Number
Rev. 8195 OSS: haa.wk.doc
. 05x25/96 1~:10 CT~E ESI ANCHORAGE
CT&E Environmental Services Inc.
Laboratory Division Imee, ~-,aame',~,a-,,~--_~__ "'
Laboratory Analysis Report
CT&E
Cl;ent Sample ID
Matrix
962485.962485001
Lnt7 CaulkiI~ Sub
Dfin~ngWaer
PWSID 0
Sample Rcm;u'~:
Collected Date 0~/19196
Technical Director: Slephen. C. Ede
Total
Results QC PQL Units Hotbed Alto~bte Prep
QuaL L{m{ts Oate
0,176 0.100 eg/L EPA
0 0 coL/100mL SM18
analysis Init
Date
'06/g~/96 ELizabeth
06/g0/96 TAV
U - Undetected
LT ' Le~s than
GT - Greater than
0 - Secordar¥ DILution
J - BeLo~ the cetlbratlon range
200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: {907) 582-2343 Fax: (907) 561.5301
3180 Pager Road. Falrbank~. AK 99709-$471 ~ Tel; (907} 474-8656 Fax: {907! 474-9685
ENV1BONMCNTAL FACtLITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND. MICHIGAN. MISSOURI, NEW JERSEY., OHIO WEST VIRGINIA
MuNIcIPALITY OF ANC~0RAGE
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. # O~')- ~- Id
1. GENERAL INFORMATION
Complete legal description
Lot 7~
Location (site address or directions)
Property owner
Mailing address
10439 Cr~6t View Lan~
E~qte RZ.v~, AK
Anc/zo.~ge.,
Day phone 563-1912
AK 99508
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
e
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 5
TYPE OF WATER SUPPLY:
Individual well XY, 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:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
?2-025 (Rev. 1/91) F~'ont MOA4121
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 $ · ~ ~ N~.~~~ Phone .. ~,~..E ~,7;~:
Address E~~
Engin~fs signature . Date
DHHS SIGNATURE
Dt"~_ Approved for /~, (r',.q.~ 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 o~ 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 et 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. ·
Municipality of Anchorage
Department of Health & Human Services ,"
HEALTH AUTHORITY APPROVAL CHECKLIST
A. WELL DATA
Well type ~¢-~t t,4'~__
Log present (~VN) ~
Totaldepth .zp~,.p ,~' t
Sanitary seal (~N)
If A, B, or C, attach ADEC letter, ADEC water system number
Date completed ~ ''~ '"/~ Driller ~- ~ L... [~,~..,~
cased to "5 ~, l..5- ~
Casing height ~
~'[ .-~' Wires properly protected (~TN) y --"
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG AT INSPECTION
¢11 ' '7---'/'~r-
[ "/..-. O g.p.m. ~"~ ~- ~
~J V---
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption .field on lot
Public sewer main 'J I ~
Sewer service line ,?,,~. ~4r
WATER SAMPLE RESULTS:
Coliform
Date of sample:
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout ,~'
Petroleum tank
~'~ I~ ~ Other bacteria
Collected by:
~ ~ Nitrate~'~ 0 A, o
B SEPTIC/HOLDING TANK DATA /~ --
· _ ·
DateinstalledJ'}~/~ '1 1'~¢7 Tanksize /¢c~ '~
Cleanouts finN)
High water alarm (Y~
Date of pumping
S & S ENGINEERING
17034 Eagle Rh'er Leep Read Ne. 204
Eagle River, Ala~k, 99577
Compartments ¢¢' ~,'~-
arm;ir~t~l*~'/ , Dep.res,s!o,n,,,(Y,,~ ,,~}~/~ ,..,, ~
' ' .~ .' :. '.x, ,~ ,~',,,.,~..,~C;;~ ~
Pumper ~. ~5~' ' ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I O'Z2 On adjacent lots
To property line . /¢~ ~' Absorption field
Surface water/drainage ' / ,3o
Foundation ~'-~"
14'
Waterma n/serviceline , /o
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date ir~stalled
Size in gallons
Vent {~N) ~
High water alarm level
1 ~ ~) ? Manufacturer
~ 7-- ~ , Manhole/Access (~/N)
"Pump on" level at ' '"Pump off" level at
~(~' Cycles tested
Meets MOA electrical codes ~/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot I o Z, On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed /'7 7 ~5 ~1
Length ~' ~' Width ._A ' 1/ /~.~"
Total absorption area ~]'6 z/ ~ j
Depression over field (Y~) ' ' 'J
Results.(.{~fail)
Peroxide :treatment (past 12 months) (YJ~ I~ ~¢''' ~"~J '~
Soil rating
Gravel thickness
Cleanouts prese~t~/N)
Date of adequacy test
~ 2. (,$' ~/~Syste m type
Total depth
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellonlot ! ~1 ~ Onadjacentlots ,~ ~ & ~c,-- Prope.rtyline
To building foundation - '"~'~ ' To existing or abandoned sYstem on lot
On adjacent lots / = ' Cutbank ~/~ /
~Watermain se~iceline .
Sudace water I ~ ~ ~ ~ Driveway, parking/vehicle storage area
Cu~ain drain ~/~/
E. ENGINEER'S 'CERTIFICATION
~~ date of this inspection.'
I ce~ify that I have checked, verified, or con OA and HAA guidelines in effect on the
HAA Fee $
Dateof P,.yme,t
Receir, t Number 0 qI C40'b
Waiver Fee: $
Date of Payment
Receipt Number
72q326 (Rev, 3/91) 8ack MOA 21
COMMERCIAL TESTING & ENGINEERING CO.
ENVIRONMENTAL LABOR~ATORY~ SERVICES
Chemlab Ref.~ :93.2277-1
Client Sample ID :L7 CALKINS S/D
Matrix :WATER
Client Name :S & S ENGIt~r~TRING
Ordered By :RAY
Project Name :
ProJect~ :
PWSID :UA
REPORT of ANALYSIS
5633 B STREET
ANCHORAGE, AK 99518
TE~.'. (g07) 562-2343
FAX: (907) 561-5301
WORK Order ~66233
Report Completed :05/24/93
Collected :05/18/93 @ 16:00 hrs.
Received :05/19/93 @ i5:00 hrs.
TechnicalReleasedDirectorBy :STEP3~-~:.~.~,..~.~C. EBZ .
Sample Remarks: ROUTINE SAMP[.~ COLt~CTED BY: RAY.
Parameter ~ Results Qual.. .Units
Allowable Ext. Anal
Method Ltmits Date Date Init
Nitrate-N 0.10 U mg/L £~A 353.2/300.0 10 05/2! LLH
* See Special Instructions Akx~ve
** See Sample Remarks Akx)ve
U = Undetected, Reported value is the practical quantification limit.
D = Secondary dilution.
~.~,~=,~ Member of the SGS Group (SociOt0 G~n~rale de Surveillance)
UA = Unavailable
NA = Not Analyzed
LT = Less Than
GT = Greater Than
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO. MARYLAND. WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-S,TE SEWER AND WATER FAC,',TV
264-4744
,.,
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal, Des~i'~.'tio~,(include lot, block, subdivision, section, township, range)
~T..;Lo'c[ti0 ~,[ad dress 6r'd~ections)
(~)...p;roperty. Owner~_~F/-z-,c./~/,;z~ / ~/fZ',iz~J$ Telephone:Home
'.,. · ;Majhng Address · :'
(c) Lending Institution" Telephone
Mailing. A. ddr~ ' ~''
Business
(d)
Real Estate Company and Agent ~"~,~'
Address /~/ ~J" ~'~
Telephone ~7~
(e)
Mail the HAA to the followino address: or; Check here r-I, if hold for pick up.
List contact persoj3 and day phone number below.
TYPE OF RESIDENCE
Single-Family'S,.
Number of Bedrooms
WATER SUPPLY
Individual Well~.. Community [] 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 r'l Holding Tank []
Note: If community well system, must have written confirmation from the State Departmer!t of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72.025 fnev 8/86t From
· z-7 ~'r'A~a)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 an.d/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 Fi,m ~/'~'5 Telephone ~ / '~ ~
Address /~ 1~ ~ ~/~ r~/~ ~ ~ ~ ~
Date
Approved for ~ bedrooms by Date 7- ?- 8 7
Approved ,,~ Disapproved Conditional
Terms of Conditional Approval
CAUTION
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. '
Page 2 of 2 72.o~$ (Rev 8,'86t Back
MUNICIPALITY OF ANCHO~AOE
ENVIRONMENTAL SERVICES DIVISION
JUN 0 1987
WELL DATA
RECEIVE
Well Classification
MUNICIPALITY OF ANCHORAGE (MO~,t
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: Z.~'~'"'
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present~N)"~ Date Completed .3-.~ -? o~ Yield
Total Depth .~/]'-'~'~"' ' Cased to --~/~'~' Depth of Groutina ,~//,~ ,
Static Water Le vel ~--.77' ' · Pm ~PseSta,,j: At --~)~
Casing Height Abov~Gro~L_~.~it:ry ~on Casin ._
Electrical W~nn in Condui~e''f F~R (~1~ ~ei~_~l~1~g,~ 1,~ ~.. ~
· ' ' g , i,~,~,~,- - - .... uepression Around Wellhead (Y/N}.]
,Separation Distances from WelT:
/
To Septic/Holding Tank on Lot /~)~- ; On Adjoining Lots
·
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by ~ ,~'
Water Sample Test Results
Comments ~ Aj~.Z ,~' ~..~'r'
/o/
; On Adjo'ining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date ~ -/~ '~
~-3-7g
Date Installed ~, -/,~r7
Standpipes~N)
Depression over Tank (Yi~
SEPTIC/HOLDING TANK DATA
Size /7"~ No. of Compartments ~*- ~-"~',4/
Air-tight Caps~N) Foundation Cleanout(~)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances Irom Septic/Holding Tank:
To Water-Supply Well
To Property Line /c~
To Water Main/Se~ice Line
Course ' ~Z~ ~/~
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-o26(11/84)
Co
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date
Installed
Square Feet of Absorption Area
Depression over Field (Y~)).
Results of Last Adequacy Test
Type of System Design
Length of Field o'~/& G ~' /
Depth of Field ~/& ~ ~/~' '
/
Gravel Bed Thickness '~'/~/'& ~
Standpipes Present ~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, or Vehicle Storage Area
/
To Property Line ,/~)
To ~isting or Abandoned System on
; On Adjoining Lots /4~
To Cutbank (if present)
//?j/~ '
Comments
D. LIFT STATION
Date Installed ~ -/~"-~' 7
Size in Gallons /,~"~"'~
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
Manhole/Access~)
"Pump Off" Level at
Vent (WN)
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Code~N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I hav,.e~ec_J~d, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~'/' ~'~'~' / ~'/'~'"'"-~ Date ~' -/~'- ~'~'~
Company ,/~'~.~ MOA No.
Receipt No. ~- ~ ~ 0 ~0 ~.)CJ ~
Date of Payment ('~ -- "~ ~:) '" ~3 7
Amount:$ ~ ~ ~
Page 2 of 2
72-026 (11/84)
ALASKA I OlI Olqm llTAL COIqTROL S RuiC S, II1C.
~nqimrin~ ~ ~nuironmcnlaJ SlucliCS
July 1, 1987
Municipality of Anchorage
Department of tlealth & tIuman Services
825 L Street
Anchorage, Alaska 99501
Attn: Dan Roth
Re: Caulklns Subdivision, Lot 7
Dear Dan:
Alaska Environmental Control Services. Inc. (AECS) checked the electrical wires
for the well located on the above mentioned lot. Repairs have been made and the
~vlres are now in conduit.
If you have any questions piease feel free to contact our offices.
Sincerely,
Cindy L. Lovelace
Office Manager
MUNICIPALITY OF ANCHOI~AGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
~JUL 0 i 1987
RECEIVED
NOILgJ,LO~d\IVJ.N ]WNO~IAN~
'~ HZ3V~ ~O '~d3a
1200 ~¢sl 33rd Ru(nue. Suil¢ ~ · Rnc~oraqe. Alaska 99503e(907) 561 5040 ~
< '
FEDERAL TAX ID" 92-0040440
A~L~LYSIS R~ORT BY SAMPLE
CI len'~ ?C,~ : VERBAL Feq ~:
CI lent ~.ul ID: L2 CALKINS S/D O/S TAP
Samplet~ec'O : JUII 16 87
Orrlere~l By :
i~POfTS ADbR~SS ~1
AECS
Work Otter )1o. ; llli
Client Account :
bate ieport Prlnteo: JUN 1~
keieasec~y : SCE-
12UO W 33RD AVE. 5%E B
ANC~OR~$E,A~. 99503
Special
instruct:
ChemlabRe~ ~: 6581 Lab Smpl ID: I Matrix: Water
Al Iowaule
Parameter ?est eO Resui t/Unt ts he~hoc L~m~ ts
TO?AL COLtEO!I~ 0 col/lOOml
Simple
~e~,r~s:
ROUTIME
ASALYSISCOLLEC~ED: 6-18-87
LAOO~ATOR¥SUPERVISOR:STEPflUI CEDE
1 Tests FeriormeO
ND=Hone Cetected
NA: Not Analyzed
See Special lnstructlonsAl>ove
See S~¢le Remarks AUove
LT=Less T~an. b~=GreaterTnan
GEOLOGICAL LAB OF ALA.~KA, INC.
FEDERAL T~X ID if 92-0040440
~AL'f$IS P. EPOICr Bf SAP2L[
CI len~, $.':~ I ;~D: L7 CAL[II[S S/t20,'S TAP
A!iALY$1S COLL~b'£LD: b-lU-87
LABOPAIOEYSUPEEVISOE: 5~HE}I CEDE ~' ~' ~
'iests~eriormeo - SeeSpe:lal InstructionsAb~ve
liene De tecteO *~ See S~vle?em~r~cove .
Not An ~ I yzed L't =Less !'nan. ~=~ce ~ tec 'ih a~,
To
Alaska Enviromental Services
12DD W.55rd. Ave
Suite B
Anchorage,Ak. 995D5
June 24,1987
Attn. Mr. Alan Wien
Ref. Lt.7,Calkins Subdiv.
Please be hereby advised that the control station and
assembly unit for a on site sewer lift station was in-
stalled and wired by this firm. All work has been done
in accordance with the National Electrical Code. The
pump and alarm system has been tested in the presence of
Mr. Chuck Mowrer, CCC Construction Co.
HALMAR £LECTR;C
£1ectrlcz~ & GeneraJ Contractor
P. O. Bo~ 771745
'Eagle RI~ A~ 99~77
!; '"~:'i '~,; .:.' , ,:, ~'~!.CERT FiCATE OF INSPECTION FOR HEALTH AUTHORITY AP,,PRO,V.A~ ',::~. .-";.':"',.'--. ; :
'." ~a~ '.'Leoa Description ( nc ude lot bock, subd wsmn, sect on township range).: , ,; ~,. ~.. :, ~ ,. _ · . ,,. · . ; -
(b) Applicant Name~ ~~~elephone: Horn;
'. ';~'~':"tc~"~o~ cantis'(checkonel:Lendng nsttuton~;Owner/budder~;Buyer~;Other~(~xplaa),'
'(d) Lending Institution
Address -
(e) Real Estate Company and Agent
Address -
(f) Mail the HAA to the following add.tess:
2. ,TYPE OF RESIDENCE
:!!, .Single-Family~ Multi-Family[:] 'Other '"'
~,' Numbed'of Bedrooms · , ,', ,'..,.i ' '.' . ~' . .... '
3 WATER SUPPLY . ..
Noie:'lf communitY, well system, musi have writte'n ~(~nfi~natio~ from the State Departmeni ~f Eny. ir0nmental Conservation
{o
the legahty and status. '. :'
4.' SEWAGE DISPOSAL; ,. -
:' Onste,,.~ Pub cE:] Communtyr'l'' HodngTankl-I' : ~": .... ' ;',' ~ "
J ~)te"lf commun t :we s stem must have wr tten confirmation from the State Department of Eqvironmental ,Conservation
5. ENGINEERING FIRM PROVIDIt,.~ INSPECTIONS, TESTS, FILE SEARCH, D*., 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 suppiy 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. · ·
Address ~ ~ ~7~ ~ 7~ ~/~/~ ~ ~'
....
; Ap~rov~b fo~ ~ edrooms by
Approved ~. , - ' Disapproved " ' " ' :?' Co~it~'onal
T~rms o~ Cc ndit ona Approval ' · '
CAUTION
Th~ Muncipality of:A'nchor&ge Depadment 'of Health and Environmental Protection (DHEP) issues Health Authori~
'Approval cedific&tes' b~sed solely upon the re pre{ehtations given In paragraph 5 above by an Ind~pendent'professional
engineer registered ih'the State of Alaska. The DHEP does this as a coudesy to purchasers of homes and their lending
Institutions in order to satisfy cedain federal and state requirements. Employees of DHEP do not conduct inspections or
anal~e data before a ce~ificate Is Issued, The Municipality of Anchorage Is not responsible for errors or omissions In the
A, WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
MUNJCI?ALITY OF ANCHOP. AG."
DEPT. OF HF. ALTH &
ENVIRONMENTAL PROTECTION
JUN 3 0'J98~,
Well Classification _Z~.~,z~,.'w.'wz::~J~.~-4-. If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) ~ Date Completed -~/~7~'~ Yi.eld
Total Depth ~/ .Z , ~" ' ~
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
~paration Distances from Well:
To Septic/Holding Tank on Lot , , /~. / ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /~// ; On Adjoining Lots
Depth of Grouting' ,,"t/'/'~z* "~
Pump Set At
Sanitary Seal on Casing (Y/N)
. Depression Around Wellhead (Y/N) .
To Nearest Public sawer Line
Cleanout/Manhole ~,/',v~",~t To Nearest Sewer Service Line on Lot .
Water sample Collected by ~'~"~
Water Sample Test Results
Comments ~/~ ,~
Date Installed /YT~ Size /~ No. of Compa~ments ~
Standpi~s (Y/N) ~ Air-tight Caps (Y/N) ~ Foundation CI;anout (Y/N)
Depre~ion over Tank {Y/N) Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ~ ; for
Holding Tank High-Water Alarm (Y/N) ~ Tempora~ Holding.Tank Permit (Y/N) ,
~paration Distances lrom ~ptic/Holding Tank:
To Water-Supply Well /~ / /O~~To Building Foundation
To Pro.ny Line /~/. To Dispo~l Field
To Water Main/~ice Line ~ To Stream, Pond, Lake, or Major Drainage
Cour~
72-026(11/84)
ABSORPTION FIELD DATA * ·
Soils Rating in Absorption Strata .~ ,~;/~ ~'-~"~pe of System Design
Date Installed /~ Length of FielU ~
Width of Field ~ ~ ~ Depth of Field~
Gravel B~ Thickne~ ~
~uare F~t of Absorption Area ~ Standpip~ Print (WN)
Depression over Field (Y/N) ~ Date of Last Ad~uacy Test
Results of L~t Ad~uacy Test ~ ~ ~~~
Separation Distance from Absorption Field: ~
To Water-Supply Well /~ / / To Prope~y Line
To Building Foundation ~ / To ~isting or Abandoned System on
To Water Main/~ice Line ~/~ To Cutbank (if print)
To Stream/Pond/Lake/or Major Drainage Course
TO Driveway. Parking Area. or Vehicle Storage Area /~ / ~
Comments .~~ /.5 ~z,~ ~ ~~~
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at .,~/'/~"'
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify th~ ha¥.e chec k~cL,v, erified, or conformed to all MOA and H~,A g.Fidelines in effect on the date of this inspection.
Signed/'~'C'~c'~//"/"Z'C'df--~--~"~'c~'~''~_ Date __
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11~84)
Engineer's Seal
M31T-SU TEST LAB, INC.
Soils - Concrete - Water
Field and Laboratory Testing Services
P.O. Box 871868 * Wasilla, Alaska 99687: ($07J 376-3005
DR'INKInG WATER'ANALYSIS FOR TOTAL COLIFORM BACTERIA
APPLICANT INFORMATION:
S or~ol~ Information:
'Date Collected:
Sample Type:
m Roucine
Time Collected:
C]Check Sample ~']Treaced
Stole L D. No."
Collected By:
[] Uncreated
TIIIS SECTION TO BE COMPLETED BY LAB
ANALYSIS RESULTS'
~ Satisfactory
~ Unsatisfactory
~] Sample Rejected:l--lOver 30 Ho~sln Tronsit~-'~TNTC:C~o~es ~o Numerous To Cmnt
~'--] Confluent G r~,~.th RECOMMEND RESAMPLE
Final Hembrane Filter R~sults: U Cot0nies/l?~ml ,
No. of Positive Tubes f~om five 10 ml Portlons;/0/l~:HPN:/~J//~ Der
Date Analysis Compteted.¢ Reported By: (~ '~" ~
HICROBIOLOGY LABORATORY RECORD-COLIFORM ANALYSIS
.TEST METIIOD TEST RESULTS I~ATE/TIHE/ANALYST
Membrane Filter Direct Count: ~-~Cclonies/lO0 ml ~'-~Q-O-~?~z~ /~OO ~_.~_O
(HF) Verification: LTB ~,BGB __
Presumptive Tube #
(LTB) 24 lit.
48 itt.
Confirmatory Tube #
(BOB) 24 ~{r.
48 lit.
Completed Place #
Tested EMB 24 Ilr.
Tube #
LTB 48 lit.
REFER TO BACK SIDE FOR INSTRUCTIONS
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR I NSPECTOF~-~
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~I~O~ENT~ P~OTE~ION
825 L Strut - A~or~, Al~ka ~501
ENVIRONMENTAL SANITATION DIVISIONOCT Z 5 1980
Telephone 2~720
:,
REQUEST FOR APPROVAL OF h,DIVIDUAL AT N I
DIRECTIONS: Complete ell parts o, pa~ 1. I~omple~ r~u~ will not ~ pr~. Please allow ten (10) deys for proc~sing.
1. PROPERTY OWNER ~ PHONE
MAI LING ADD,SS
PROPERTY RESIDENT (If different lrom ahoy) PHONE
;2. BUYER PHONE
MAILINGAD~ESS ~. . ,
3. LENDING IN~ITUTION ~ ~ . ~ PHONE
~ MAILING ADDRESS
4. REALTO~IAGENT
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One I--'1 Four
[::~--~SI NG LE FAMILY [] Two [] Five
[] MULTIPLE FAMILY .. ~ Three [] Six
[] Other
7. WATER SUN~LY
[]~3- INDIVIDUAL*
,FI 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.)
8. SEWAGE DISPOSAL SYSTEM
~--. INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) ~
..- THIS SIDE FOR OFFICIAL USE ONLY ' --
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
r-'] SINGLE FAMILY. [] ONE [] THREE [-'1 FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
I-q' INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
•PUBLIC[]INDIVIDUAL/ON'SITE UTiLiTY DATE INSTALLED ~'--- ~.~ ~
Connection Verified ' iNSTALLER
[]Septic Tank or [] Holding Tank
Size: ]_/')(~7(~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area ISewer Line I Nearest Lot Line
WELL TO: 70 ~ ! C)'2~-I I '
Absorption Area to nearest Lot Line ·
5. COMMENTS
[] CONDITIONAL APPI~OVAL (letter must acco. a~certificate)
72-010 (Rev. 6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH 8, ENVIRONMENTAL PROTECTION
825 L Street · Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Teleph0ne 264A720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete request~ will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER
MAILING ~DI~R ESS-
~ROPERTY RESIOENT Iii ~iflerent from above)
2. BUYER
MAILING ADDRESS
PHONE
/~ c:/ /./ ..3 70 '7
PHONE
PHONE
MAILING ADDRESS
..... . . '' ".~:""_ - ' ,,' , . ....... ~:':: :,..~-".;'T'o '~ .... , : ·
S....__LEGAL DESCRIPTION ~.:'. T ·: · · . I' ., ., - . .:
............................................ C.'AI/¥"' :" ............
:' ~" :' (n-S . :'~"~:: ..... :"~'"'" ...... ' ' :"' ' ...... ' .... :'"': ' "
STREET LOCATION : "'~-'.:"*'" ,- ',',~ ' . : ' ' ' ""~-"J .............. : .................. ',,~' : - : ". I
· , ...... :~ .' ...... ~'.:-:.',--:,~:.:.f~,.~',c r--,,~+'.,c)~'e'"-u~,'~,:.~,~;~-~':..~:.~.~.-~ ~ .- ...................... '"
6. TYPE OF'RESIDENCE,~"': .... ' NUMBER OF BEDROOMS
' '- ' ' '~, · -- E]m'.':'~:d~':~['::: ', .I-'1 ' F~'r . ~ I'-I ,~ Other'; ''','-c--
:!".. ~:: SINGLE FAMILY,' '- '
....... :., [] ':':T~' .[]' Five
..... : [] MULTIPI:'EFAMIL'Y':.:;: ......... -:'~.T':~:TF"'T'li~-'Ti~'~*;::"'-r"'l"'si~ ............... -:"-:,' '-:'-i.*"'~.
7, WATER SUPPLY
..... [] iNDiVIDUAL°~ ..............
..... E~'~--COMMUNITY
~;.~ ....... []" PUBLiC'UTILITY
SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE"
'- [] PUBLIC UTILITY
- ' ATTACH WEI:[.:'L:~G'?A-~ell Io'~ is r~luir~ed for alt wells drilled ' '
si n ce-Ju ne 1 975.-F o r -welts-d alii ed -p t~ oTt 0-th~a t-d ~t~l
:': ........
*' If individuallo~--~ite~'gi~'~ installation date'S.
If system is over two [2) years old an adequacy test is ~equired
by this Department.
~IOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
~ THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR I NSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
I-'1 SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
2. WATER SUPPLY:, '"' ' ..... I PERMIT NUMBER ...... .
, [] INDIVIDUAL .... DEPTH OF WELL ........
' [:::] COMMUNITY DATE DRILLED
Connection Verified LOG RECEIVED ': , · ' ; ,i. - ,-
3. SEWAGE DISPOSAL SYSTEM .. PERMIT NUMBER
............. '[:]iNDIVIDUAL/ON ;~ITET.-- -; .... DATE INSTALLED. -,., '~"
[]pUBLIC UTILITY" ~'~';''~- - "'-- ~ -- ......... T::',-',~ '' ?' ..... ~
: ", Connection Verified : j ' ~ ' NSTALLER
Size:l. If Tank is homemade SOILS RATING-".;,.
4.' DISTANCES j:' :' :'" ;;,:~.._£-!_.. Sept'c/H°ldingTanklAbs°rpti°nArea ' ISewerL'ne "INearest L°t Line :
Absorption Area to nearest Lot Line.
5. COMMENT,5'~''~ '.'"~ , ~ . . ,'~ ' '~,') , · ' ....
'*:*'"""'"' .... "*'m'-'- ,- ·
'[--I CONDITIONAL APPROVAL (letter must accompany certificate) ' '
12~BiSAPPROVED '
DATE BY (Title)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)