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Home My WebLink AboutCLEARVIEW LT 11Cl rvi 11 #015-242-50 Municipality of Anchorage Development Services Department .= = .'- ~-'_-- = '= -._o Building Safety Division ,-~-~'- '-" On-Site Water & Wastewater Program, 4700 South Bragaw St. "I~:~IE i~ P.O. Box 196650 Anchorage, AK 99519-6650 ~ ~ www.ci.anchorage.ak.us (907) :343-7904 Page 1 of On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number:. SW020490 PI• Number:. 015-242-50 Name: WILLIAM DAVIDSON Wastewater System: E] New lB Upgrade ~i~tdrese: 1164-1 SNOWLINE DRIVE * ANCHORAGE, AK 99516 ABSORPTION FIELD Phone:' No. of Bedrooms: (907) 345-4167 4 II Deep Trench ri Shallow Trench I-1 Red ri Mound [] Other LEGAL DESCRIPTION '" "~"': 1.2 o,o,,~ ,- .~, ,~,. ,r.. 0~.~8.5_9.5 Block: Lot: Sub~Zvision: De,th b p~pe bottom fr~,n e~l~inal grade: I Gravel del~l~ beneath pipe: - 11 CLEARVIEW 2.43-5.43 ~. 6.07 TownshSp: Range: Section: re ~4 atx~ e,-~lnal e~ade: Cea~el length: - - - SEE DWG. ~ 45 WELL: [] New [] Upgrede 2.5 r~ 1 _,,.~r~ ....- n. n. 5404' s~.~ D 3034/ F-810 ~ OrllNd: Stetro Watee Le~e~: inet=~ Date inltalled: r,. A+ HOME SERVICES 3/4-5/2003 G,, ,, ~ TANK SEPARATION DISTANCES =s,pt~c []Holding [] S.T.£,P. •Other ~mm~~.l SepUc AbsorpUon Uft Holding Public/Private Manuf~ct~mn Capa~it~ in ~lorm: Tank Field StaUon Tank .~,,~ U,,, ANCHORAGE TANK 1250 Well 100'+ 100'+ - - 25'+ STEEL 2 S~o¢. Wa~e, W0'+ 100'+ - - -- LIFT STATION ~emarks: BENCH MARK -EXISTING SEPTIC TANK AND DRAINFIELD BOTTOM OF SIDING NEAR FOUNDATION CLEANOUT COMPLETELY ABANDONED. J~.m.~ ~ 120.50 4i t' Inspections performed by:. AKWWC, INC. Dates: 2ndlS' 3/4/20033/4/2003 ~: ':'~ '~",;;;'~"-':::[:-- 3rd 3/5/2003 . Development Servi¢~s Department Approval q ?Z" !.. ..."_,-,~,~ R~v~e~ed and approved by:~~clte: ~-~-~3- I~I3;'"" ' "-~'~?.,:~ot'ee,,o~..~,=~'=== SW020490 015-242-50 ,,-\~ . ,.~-~ ~ . . ~. . ....... 6ONSULTANTS, INO.- ......... WILLIAM DAVIDSON (907) 545-4167 2 OF 5 ~¢ :.~,ffl~y~CCness.: ~ AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE -~~ ~ERM~ NOM~E~: AS BUILT DRAWING ~0~ '~ ~UM~: SW020490 -- 015-242-50 SOUTH END OF r-FINAL GRN)E - 101.71-103.39 AT IN~ - g7,80~ ~ - / - --~P OF T~K AT IN~ - 97.21~ SEPTIC TANK , I ~ oF eUNG I ~ - 94.78 EI~ ~ sowou or ~CH C.J.G. " ~SI~ WATER & ~VASTE&~TER ~ , CONSULTANTS, tNC.,, , ....: .... ,.~ ~.~ ...... ~:.r..~ 6q01 DEBA~R ROAD, SUITE 2B * ANCHORAGE. AK 9qSOG · PHONE (q07)537-6179 ' FAX (q07)538-5?G6 N.T.S, PREPPED FOR: PHONE NUMBS: P~E NUMBER: WILLIAM DAVIDSON (907) 545-4167 ~ OF 5 ~E OF WORK: PROFILE AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE MUNICIPA~.I~'Y OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Dec 24, 2002 Expiration Date: Dec 24, 2003 Permit Number: SW020490 Design Engineer: 0041 AK Water & Wastewater Consultan' Owner Name: WILLIAM DAVIDSON Owner Address: 11641 SNOWLINE CIR Total Bedrooms: 4 ANCHORAGE, AK 99516-1168 Parcel ID: 015-242-50 Site Address: 011641 SNOWI_INE ClR Lot Size: 100506 SQ. FT. Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either:. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By': Issued By: Date: Date: / ~-/~-,~/~.. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERHIT APPLICATION FOR A SINGLE FAHILY DWELLING Parcel I.D. 01,5-242~,50 Permit Number 5'~,[/O,Z 42 ~ ~'O Property owner(s) WILLIAM DAVIDSON Mailing address (1) 111~41 SNOWLINE CIRCLE * ANCHORAGE, AK Mailing address (2) Legal description (Lot, Block & Sub'd.) LOT 11: CLEARVI-EW SUBDIVISION Legal description (Section, Township & Range) Lot Size / I0! ,7Z'06 Acre~ THIS APPLICATION IS FOR: Sewer Only [] Sewer and Well [] Sewer Upgrade · THIS PROPERTY CONTAINS: Hot Tub ~r~ Swimming Pool Therapy Pool [] Number of Bedrooms Day phone 345-4167 Zip Code 99516 Well Only Water Storage Jacuzzi Water Softening Unit I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Permit Fee! Date of Payment: Receipt Number: Waiver Fees: Date of Payment: Receipt Number: ALASKA WATER 8,- WASTEWATF:R December 9, 2002 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Septic System Upgrade for Lot 11; Clearview Subdivision To whom it may concem: The existing 4 bedroom house is served by a private well and septic system. The septic system consists of a 1250 gallon septic tank and a deep trench type drainfield that is completely surcharged and must be upgraded. A test hole was excavated west of the existing septic system. The new system will be designed around the 30 foot radius of this test hole. We are proposing that a new 1250 gallon septic tank and also a deep trench type drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 1.2 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 1.5 minutes/inch b. Proposed Application Rate: 1.2 gallons/day/ft2 c. Number ofBedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 500 ft2 f. Total Depth: 12 feet (maximum) g. Effective Depth: 6 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 45 feet total length k. Effective absorption area = 540 ft2 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwe.com 3. SURFACE WATERS: Campbell Creek runs parallel with the south/southwest property line. The 100 feet setback from the creek is to be flagged by a registered land surveyor in order to insure that the separation distance is met. 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average topography in the area of the proposed drainfield is a 15% to 25% slope running from approximately northeast to southwest. There is a steep slope 50+ feet below the proposed drainfield which should not be a concem. systems. If you assistance. Jellr0.lr ~ ~mes I am unaware of any adverse impacts this installation would have on adjacent wells or septic ave any questions, please contact us at 337-6179. Thank you for your NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, a soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: ak~s~'c.eom / / // · /i /,, / ,' / / CLr..'~EW S/D; LOT , ~ , ~_ ~~~-.. '' ---- · ~,~.__ ~ ~' ~~ '- ~ I ~-. 'x ', / "~' ~.~._ ..--- ~L -"-~~. III ! ,xX III./ - ' CONSULTANTS, INC,, CLEARVIEW SUBDIVISION~ LOT ~ ~ SITE P~N FOR SEPTIC SYSTEM UPGRADE ~-~ ~ ~ . ~ , .... ..~. .~. ~ ~ ~ I . ~:'.:":. ;.' ' ."Z.' ?. :,;:~" "'. ".. - · ' ~ "' ':' 1'~ i' ~ "~'::~'~;, "¥'"'. '~:':':" .... ~;.? '.~" ,~': ..... ~:' .~ '. ":' ': 'e' '~ ?;;'~':' "~',': ' ,"':' ~: ?'.c~', 'c ': ' .':=*" ~~.(?~.;~.~..:., ,",' ..*, '. '.' %.}~:"~'.: :.'/;:' i:":'. "'. ......... "' '.. '~? '. ~ '~.~ / 'x / CC[~RVI[W SUB~IV]SION; COT 11 ~;'..,.[ ~ ....'~ DESION Of SEPTIC SYST[~ UPGRADE ALASKA WATER & '~VASTEWATER ?~"~;'4~ ~[~ '".?. - , , CONSULTANTS, INC.~ · , ,, - ,,. ',":'s',', c,...,,.., P~'RFORMED FoR: w,~,~ o,~Dso. DATE: 1~/~/~00~ '<"~'"-. :"~..."..~ ~,;i ITEST HOLE #1l 1~==~ ORO~CS : .... ~: .: GP ML , ~,, ~ SW MH ~-.--~--~,,. i ~ ,':', sc /./..-~ ,,.,,: ,.:.,. ,, ? .::. ~,:,-,-,-,-,-o -/{.....~. ~ ~.___. '., 'GROUNDWATER DATE ~,, GM TO I DRY 12/2/02 -... 9 ':' CM/S~ I DRY 12/5/02-... , , DRY 12/9/02 lO T~E (~NUTES) ~EAD~NG ONCHES) 12 ':' 12/5/02 1 12:15 - 6- _ --I1~1[ ' ' 2 12:2,3 8 o- 6- 15 I, 3 12:25 _ 6. _ J!lt' ' 4 12:,34 9 o- 6- 14 I, 5 12:35 - 6- _ Jtlt I~ 6 12:44 9 O" 6" 15 7 12:46 - 6- .,; 8 12:55 9 O' 6" 16 il. 9 12:56 - 6- _ 17---J ! 10 1:05 9 O' 6' /' 11 1:06 - 6- _ 18d 12 1:15 9 6" O" 19~[ PERCOLATION RATE 1.5 (HIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5.0 FT. AND 6.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORHED: [] YES [] NO SOILS LOGGED BY: ~IODY MAUS PERCOLATION TEST PERFORMED BY: MATI' FISHER COHHENTS: PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WA.~ PERFORMED IN ACCORDANCE WFFH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: DEPTH TO GROUNDWATER DATE DRY 12/2/02 DRY 12/5/02 DRY 12/9/02 -- MUNICIPALITY OF ANCHORAGE D~ .RTMENT OF HEALTH AND HUMAN SER...;ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Address LEGAL DESCRIPTION Lot J j Block J Subdivls,on Township, Range, Section TANKS SEPTIC [] HOLDING WELL DISTANCES SEPTIC TANK ABSORPTION FIELD WELL LOT LINE t J b-- ~ ~ ~4 FOUNDATION ,.~ ~ ~' ~ ~li ~ AS-BUILT DIAGRAM (Show location of well, septic system, property hnes. foundabon. driveway, water bodies, etcj Manulacturer J Capacity In gallons Material No. of Compartments TYPE OF SYSTEM ~(,,~RENCH [] BED [] W. DRAIN [] OTHER Depth to p~pe bottom from or,gJnal grade ~ 2 -~' FT Fdl added above ongmal grade Total depth lrom original grade Gravel depth beneath p~pe Gravel width O ....I lengm 4~ FI ~'~ FT Total absorption area j Distance between lines 3 ~ ~ SO FT N A FT Number of lines J Sod rating Pipe material SQFTJ C~ Fe~o Installer J J J Date installed . WELLS [] PRIVATE [] OTHER ¢ldentifv) Class$cat~on (A.B.C) Total Depth J Cased to FTJ FI Inslallel JDate Installed: REMARKS: Inspections Performed by: /ir E~:_~ ~'~-- ,~ :,'-~ "~L Date: ~nicipal and State g~ in effect on this dale: Health Departmenl Approval: certify that lhis inspection was performed according to all E'II~NEER'S SEAL 72-013 (3/85} ) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological I] Geophysical Surveys Drilling Permll No. LOCATION OF WELL (Pleoee complete either Io, lb or lc.) A.D.L. No. la.JJBorough Subdivision Lot Block ~ I/4qtre. Section No. TownshiP N r"] Range EI--i~ Meridian ~ // ~' _.,_o,_o,_ .o ,,,.., Address end Arco of Well Location ~ ~. ~' 2. WELL LOG /~ ,,. ~ -~ __- ~t~rl~l TIP. Tot ~otto~ .. o,,,,..,,-o,..,.,,. ~ ~ ~ diam.~in.~ ,o ~ ft. Depth Weight /~ lbs./ft. · . ~,,,~,.o~.,~:.~ Backfilling Gravel pack I0. STATIC WATER LEVEL:~ ft. ~ Above or ~w land .ur~ce Date Equipment ueed: II. PUMPING LEVEL below land surface and YIELD ft. after hrs. pumping . g-P.m- I~.GROUTING ~lll Groutld: ~ Yll ~ NO Material: ~ Neat Cement ~ Other: I~. PUMP: (If available) HP Length ef Drop Pipe ft. capocily ~g.p.m. ~ Subm. ~ Jet ~ Centrlfical ~ Other 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Wnfer Temperature o ~ F ~ C This ..il .as drill.dAnd.r .y~risdlction*nd this report Is true tothe~f ~;n~.dg. and b.lief; MUN ICI AL I-~-Y OF ANCI-~ ~RAGE DEF'ARTMENT bF HEALTH AND ENVIRONMENTAL F'ROTECTION 825 L STREET.~ ANCHORAGE., AK 99501 ~64-472C~ (]N---'S I "rE SE~JER 8~ L~IELL F'ERM I T F'ERMIT NO: DATE ISSUED: 850566 06/27/85 APPLICANT: ADDRESS: CONTACT PHONE: BILL DAVIDSON % GEOLAB~1151 E.76TH AVE ANCHOHRAGE, AK: 9~502 544-8042 LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS: SUBDIVISION: CLEt~V IEW SECTION: 24 TOWNSHI F': ~-. 5A (SQ. FT. OR ACRES) 4 LOT~ 11 RANGE: 3W Listed below are the options available to you in designing your septic system. Choose the option that best ~its your site,. DEPTH TO PIPE-BOTTOM (FT.) GRAVEL DEPTH (FT.) TOTAL DEPTH (FT.) GRAVEL. WIDTH (FT.) GRAVEL LENGTH (FT.) GRAVEL VOLUME (CU. YDS.) TANK SIZE (GALS> SOIL RATING (SQ. FT./BR) TRENCH BED W. DRA IN 2.0 ** 2.0 ** 2.0 ** 4.0 0.5 5.0 6.0 2.5 5.0 2.5 16.0 5.0 45.0 52.0 40.0 18.0 19.0 26.0 1.,250.0 ** 1..250.0 ** 1.,250.0 ** 85 85 85 ** DEPTH TO PIPE BOTTOM < 5.5 FT. REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM (~ 4.0 FT. MAY REQUIRE A LIFT STATION ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set ~orth by the Municipality o~ Anchorage (MOA) and the State o~ 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. 5. I will adhere.to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4 bedrooms and 4. I understand that this permit is valid ~or a maximum any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES~ THEN (1> AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE ELECTRICAL WOR~ MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED ~~_ ~~~__,___ DATE: __~_~_~~_,, · AF'F'L I CANT: ~~I ~_. _~__~_~__ ISSUED BY ............. DATE: _ ~ELL ~'~[~' PERMIT NO. ( 8~059~ ) 8PPLiCBNT WILLIBM M. DI~ON LOCBTION LEGBL LOT ii CLEBRVIEW SUB i,"iljt'-,,I Z C: I i---'RL 1" T"T' m--mF RI'-,,IC:H--~!~"l=lm'''~E DEPRF.:TMENT OF HERLTH RNr:, ENViF.:ONbtENTRL PROTECTION '=":'.~ '" L" STREET.. 1-~NC:HOF.:RGE, RK. ,_-.¢.,_-.¢.._ ~.:'~-1 264-4-720 ~ Cml--.i--S I Ti SEI--.IEF:;~-: F-EF;?.I'4 I f 9_.7:"-:7t K:RMPBELL TERR. :.-'4-,-,' o,. 5 LAT SIZE 999999 SQURF.:E FEET TYPE OF SOIL 8BSORPTION SYSTEM IS: DRRINFIELD i4RXIHUM NUMBER OF BEDROOMS = 5: SOIL RRTING (SQ FT?BR)= 85 THE REQUIRED SIZE OF THE SOIL 8BSORPTION SYSTEM IS: [:.EF'TH= :E: LE[-~GTH= 3:6 iSE:R%-'EL [:,EF'TH= 2 THE LENGTH DiMENSiON IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF ~ TF.:ENCH OR PIT IS THE DiSTRNC:E E:ETWEEN THE SURFBCE OF THE GRDUN[:, 8N[:, THE E:OTTOM OF THE EXCRVRTION (I~ T~ THE TE:Ef'~E:H ~4 I D' TH I S ~~EI~I FEE THE GRRVEL DEPTH IS THE MiNiMLtM DEF'TH OF GRRCEL '-E'~,--!EEN T~F OL~L PIPE RND THE BOTTO~ OF THE EXCRVRTION (IN FEET). E:EI;!I_iI E:E[:, SEF'TI C: T RPI~=:: SIZE= t~3~3Et GRLLCmr4S PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TI-lC, (2) I /-iSF-EE:TICmt-IS RE:E E:EG!iJ IRE[:, BRCKFILLING OF RNY SYSTEM HITHOUT FINRL INSPECTION RND RPPROVRL BY THIS DEF'RRTMENT HILL BE SUBJECT TO PROSECUTION. idINiMUM DISTRNCE BETWEEN R HELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS ±00 FEET FOR R PRiVRTE HELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC: HELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 30 DRYS OF THE HELL COMPLETION. OTHER REQUIREMENTS P1RY RPPL¥. SF'ECIFICRTIONS 8ND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. F'EE:t-1 IT E;-=;F'I E:ES [:,EC:EI"IBEE: 3:t. t96:2; i C:ERTIFY THFtT ::L' i 8f'1 FBMILIRR WITH THE REQUIREMENTS FOF.: ON-SITE SEWEF.:S RN[.', WELLS RS SET FOF.:TH BY THE MI_INIC IPFILITY OF FINCHORRGE. UU[ E_,. 2' I WILL INSTRLL THE SYSTEM IN I=ICCOF':E:'RNCE WtTH THE 3:' i UNDEF.'.STRN[:, THFIT THE ON-SITE SEWER SYSTEM MI=I¥ F.:EQLIIRE._.~LI=IRGEMENT IF THE RESiDENE:E iS REMODELED TO iNCLUDE M,DF.:E THRN-< BE[:,F.'O,Z,f'I~~..~ ! S l GNE[:, ' i SSI_lED RF'PL l CENT W ILL I Rl'l M. [:, I :;-,;ON ~ "'" V4. 0 ~Cf~NT H.%LL]~H 14. DIXON ~! ON i. . ~Rl~mN'~ OF b~LIH ~N~) ENVIRONM~NIBL PROjlION sTr-dgE'I', RNC:HOI~RGE, IRK. L-tN--_c. ! TE 5Et.-,IEE LOT SIZE LO7 li C:.LER~'VIEt, I SUE:. .~**~-~SL~ SQUFIRE FEET : OF -COIL RE::50~F"I'ION SV~cTEH 35: [ak-~IlNF'IELD ~UFI NL~:~EF~ OF BED~:OOFL% = ~E~UIRE~ _¢.12E OF THE -C. OlL ~ ~'TH= ~'- LEI,lOTH"-' ~E LENGTH DI~NSION I5 T~ LENGTH (IN FEET) OF THE TRENCH OR DEfl]NFZELD. t Z- TH :~ G~L ~P~H ]~ ~HE H~HJH~.I:DEPIH (,F ~RVE PE ~ILII~ED- ~EPTIC TRt~K 512E: ~O~O '6RLLON~ ~T ~PLIC~47 ~R 7~ RE~I~IL-]3Y TO ~_LRTION ]~/CIJO~ OF RNY ~LL~ flE,JRCENT :~ ~ ~S]~NCE~ 3HR7 THE ~LL HILL E~EVE, :.g4 DI~TR~E ~T~EN R ~LL R~ :,:~T F~ R P~I~TE ~LL ~ ~ TO ~e FEET F~O{.1 R PL~:L~C ~LL DEPE~]~ J~,J DJ~1~CE FROH R PE]V~E ~LL TO R :~LR4IT~' ~NER L]~ ]~ 75 FEET. -: ~LL .~RE~NTS ~V RPPLY. ~EC]FIC.RTION~ fiN[> CC~UCT/ON DIRG~I~ RRE ~LE ~0 ]~L~ PRIER ]N~TRLLRTiON. 'RfdI T E~F' 3 EE~ DEC:E 1'-IEEE ~H FRMILIRR NITH 1HE REOUIEEMEN'I5 FOR ON-SITE E. EWERS; RND NELL~. RS SET E,¥ THE PII,~.,1C]Pf'ik]T¥ OF RNC.*HOK'RGE. !JILL ]NSTrlLL"-'~-~V~"TEM--~IN- RCCORD;RNCE* H]TH }flDER.'2-,TRNr~ IHFtT 'fHE 0N-SI'T/ E, ENER -c. VgTEM I~OUIEE NL. REGEI, I~E'NT IF' THE :NC-E IE, E:EHO[~LED 1'0 iNCLUDE HOR:E THRN flPP'L]GflN'[ HILL]tiM fl [')]XCel ~" ~ ,/ V4. 8 r~ ~'~ ~ / SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: )SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O N.o. 1814-E WAS GROUND WATER ENCOUNTERED? O P E. IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) COMMENTS TEST RUN BETWEEN FT AND FT PERFORMED CERTIFIED BY: ~ ~ t/ (~' .~ ~"',~-.- f~.~ DATE: 72-008 (6/79) GEOLAB, Inc. 1131 E. 76th Ave. Anchorage, Alaska (907) 344-8042 Suite 101 99502 SOILS LOG - PEF~COLATION TEST PERCOLATION TEST LEGAL DESCRIPTION: 8 10 SLOPE 11 12 13 14 15 16 17 THOIvfA$ iR'. $ 2248-E 19 20 SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S L 0 P E Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~,0 TEST RUN BETWEEN 2. ,~"" FT AND DATE: MUnicipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage,AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAI"llLY DWELLING Parcel I.D. 015-242-50 1. GENERAL INFORMATION ~# I-/~ 0.~; o I o -7 Expiration Date: 7 -" ~ - 0 .~ Complete legal description CLEARWIEW SUBDIVISION; LOT 11 Location (site address or directions) 11641 SNOWLINE CIRCLE * ANCHORAOE~ AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address WILLIAM DAVIDSON Day phone 345-4167 11641 SNOWLINE CIRCLE '~ ANCHORAGE, AK 99516 Day phone CORA CARLSON Day phone ,373-7660 851 WESTPOINT DRIVE STE 101 * WASILLA, AK 99654 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF wASTEWATER DISPOSAL: ~r~ Individual On-site ~ Individual Holding tank B 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 4 by an independent professional civil engineer registered in the State of Alaska, Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served 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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or pfior to closing for the engineering services provided. o STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the vafidation date shown below, I verify that my investigation, based on procedures outlined in the Health Authofity Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) 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 t'des and from my investigatidn and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all ',applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phonb Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. CARNESS. P.E. Date 537-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results descfibed the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate dufing the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects er encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. ,Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal fight whatsoever. Approved for L.~ Disapproved. Conditional approval for DSD SIGNATURE bedrooms. bedrooms, with the fllowing stipulations': i ~: WATERAND : ~ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory (Rev, 12/01) I~ Manitenance Agreements ! 1 Supplemental Engineer's Reor~ utner Original Ce~ificate gate: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 $oul~t 8ragaw St. P.O, Box 196650 Anchorage, AK 99519-6650 ~nNw.cLanchorage.ak.us (god 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type PRIVA'II~ Date completed 8/19/1985 Sanitary seal (Y/N)~ Total depth ,, ,,105 ,fl. 87 CLEARVIEW, S/Di LOT 11 ,. If A, B, or C provide PWSID~ N/A , fl. ,, g.p.m. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: N/A mg./L. SEPTIC/HOLDING TANK DATA Tank Type/Matartal , , STEEL.. Cased to FROM WELL LOG . 8/19/,1985 35 13 Parcel ID: 015-24-2-50 Well Log (Y/N) YES Wires propedy protected (Y/N) YES Casing height (above ground) ,. 12+ AT INSPECTION /2002 46 .fl. 6.5+ g.p.m. in. Nitrate , 2.06 mgJl.. Other bacteria 0 colonies/100 mi. Date of sample: ! 1/11/2002 Collected by; AKWWC, INC. Tank size 1250, gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 11/'! !/2002 Pumper ABSORPTION'FIELD DATA ~,@£ww EXlSllNG ,~RN)EI Date installed tO~'!$/,lgSS Soil rating (g.p.d./ft~o~ ..85 Length . 46 ,, It, Width 3 fl. Total depth , *a, ff. Eft. absorption area .368 fi= Monitoring tube YES Date of adequacy test 11/11/2002 Results (Pass/Fail) FNLED, Fluid depth in absorption field before test *59 in, Water added - gal. Elapsed Time: ,-, min. Final fluid depth - in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (YIN & type.) L .NONE KNOWN If yes, give date *FI~ C0MP)~TEL¥ SURCHARGED 6U~t' 'NOT OVERFLOWING OR BACKING-UP. Date installed. 1 O/t 5/1985 Cleanouts (Y/N) YES High water alarm (Y/N) N/A McDONALDS PUMPING System {ype SHALLOW TRENCH Gravel below pipe ,. 4 f. DepressiOn over field NO For. 4 bedrooms New depth - in. - g.p.d. D. LIFT STATION Size in gallons Date installed "Pump on" level at in. ~ ~ ~ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot100'+ Absorption field on lot. 100'+ Public sewer main N/A Sewer/septic service line 25'+ High water alarm level at Meets alarm & circuit requirements?. On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/'A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N//A Water service line, 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field Surface water, Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN COMMENTS 5'+ 100'+ G. ENGINEER'S CERTIFICATION .in. Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 100'+ Water main N~/A Driveway, parking/vehicle storage 10'+ I certify that I have determined through field inspections and review of Municipa) records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Nan~ Date l ! ~1/03 JEFFREY A. GARNESS Fee $ 45- 150 = 625-'- Date of Payment Receipt Number ~._~__~0 0 (Rev. 12/01) Waiver Fee $. Date of Payment Receipt Number FP.X NO. I that the iml~tovements situated thereon ara within Ihe property lines and do not overlap or encroach on Ihe property lying adjacent thereto, that no |mprovemenls on property lying adjacent thereto encroach on the premises In question and that there are no roadways. ItansmisSion lines or other visible easamenls on said property except as Indicaled rmreon. It is the responsibility Of the owner 1o aetermine the existence of any easements, co,,'enants, or restrictions which do not appear on Ihe recorded subdlvlsJ0n plat. Under no clrcumslances should any data hereon bo used Ior consltuction or for establishing boundary or fence lines. Dated al Anchorage, Alaska. Ibis 1.7 day of ~.1~_ .~l~- 19_~ 9~0f Buddy Warner Dr. Anchorage, Alaeka ' CT&E Environmental Services Inc. 90?5615301 1-806 P.OZ/OZ --315 C]'&£ Ref.# 1027778001 All Date~Time~ ar~ Aluka S~n~ Time Client N~ ~ Water & Wute~ter ~ltan~ Inc. P~nt~ Dat~ ] 1/15~002 15:14 Prsl~tEnm~ ~e~Lot Il Coll~Dat~l~ 11/11~002 15:05 Client ~mpfe Alloxv~blc hep Results P~L Units Medmd Limits Detc Da~c Init Watern Depar t:m~nt: Nitrate-N 2.0~ 0.600 mg/L F. PA 300.0. (<,-10~ 11/l 3/02 t~J. ctol~J, ology ~a. boz-sst: o z-,Z Total Coliform 0 cot/10OmL SMI8 92221~ 1/12/02 ]CAP MuniCipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Prcgram 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www,ci,anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROV ~j~ 'U S ~"~ FOR A SINGLE FAHILY DWELLING Parcel I.D. 015-242-50 HAA# 1. GENERAL INFORMATION Expiration Date: '~,/7i lc Complete legal description Location (site address or directions) Current Property owner(s) WILLIAM Mailing address 11641 Lending agency Mailing address Real Estate Agent Mailing address CLEARWIEW SUBDIVISION; LOT 11 11641 SNOWL1NE CIRCLE * ANCHORAGE, AK DAVIDSON Day phone 345-4167 SNOWLINE CIRCLE * ANCHORAGE, AK 99516 Day phone CORA CARLSON Day phone 373-7660 851 WESTPOINT DRIVE STE 101 * WASILLA, AK 99654 Unlessothe~e~quested, HAA wNbeheldbyDSD ~rpick~. 2. NUMBER OFBEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] 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 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Cedificates are valid for one year for properties served 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. Note:Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior I to closing for the engineering services provided.. I STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 537-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations, The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of ali wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the eva/uator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments, AKWWC, /nc, can therefore not provide any warranty or future estimate of how long the system wi//continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other per~on or party is not authorized, nor wi//it confer any legal right whatsoever. Approved for bedrooms. ~'! ON-SITE ' [=~: WATERAND Disapproved. ~ ;. WASTEWATER .: XX C ~ ~ 4 ~ FROGRAM ' __ ond'tiona approval for _ bedrooms, with the fllowing stipulations: '~ ~'°-. Money in the cmount of 1.5 times the high bid of cz mimmum of three bids from c~.;~Ve.~' ~,' contrcctors shcll be put in escrow to construct cz new wastewczter disposal system p~J6'~i' ~?, :'' "' to permit number 5W0204~0 czttcched. Money in escrow shnll not be rele~ed until this oirF;c~, hus ~;wr,/;n-I upp,'uv,,l. Construction sh(~ii be compieTed no iarer Then June eS, Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other ~;z.~, 't- -- ~ ~.-'C~C~,'~ C Original Certificate Date: Municipality of Anchorage Development Sentices Department Building 6aMy Division On-Site Water & Wastewater program 4700 Sout~ 8ragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.cl.anchorage.ak.us (907) 343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: , A, WELL DATA I Well t~'pe pRIVATE. CLEARViEW ,SUBDIVISION; LOT 11 IfA, 8, orC provide PWSID# N/A Oats completed 8/~19/lg85 Sanitary seal (Y/N) .YES Total depth 105 ,fL 87 ft. Date of test Statio water level Well production WATER SAMPLE RESULTS: Coliform _~.J~! colonies/100 mi. Arsenic.: N/A mgA.. B. SEPTIC/HOLDING TANK DATA Cased to FROM WELL LOG ,8/, 9/1985 35 ft. .... 13 g.p.m. Nitrate 2.06 .~Aj. Date of sample: Tank Type/Material , , , STEEL Tank size,,,!250 gal. Number of Compartments 2 Foundation cleanout (Y/N) ,,YES, Depression over tank (Y/N) NO Date of pumping C. ABSORPTION FIELD DATA Date installed ,, Length 45, ,, fL .... Pumper .... I, eJ[LOW nNAL ORADe Sob rating (g.p.d./ft~or(~ 1.2 Width 2.5 ff. Parcel ID: _ 015-242-50 Well Log (Y/N) YES ,,, Wires properly protected (Y/N) YES,, Casing height (above ground) ,, 12+ in. AT INSPECTION 11//71/2002, ....... 46 ..... fi. · ... 6.5+ g.p.m. Other bacteria , ,O. ,, colonies/100 mi. Collected by: AKWWC, INC. Date installed 3/4.-5/2005 ,, Cleanouts (Y/N) YES High water alarm (Y/N) N/A Total depth~lo.a'~fL Eft. absorPUon area 540 fl= Monitoring tube ,YES Date of adequacy test: , NEW, Results (Pass/Fall) -, Fluid depth in absorption field before test 'T in. Water added '-. gat. Elapsed Time: - rain. Final fluid depth - in. Absorption rate >= Any rejuvenation.ffeatment (past 12 mo.) (Y/N & type) System type .,, DEL~, TRENCH Gravel, below pipe .... 6.07 ff. Depression over field NO For , T bedrooms New depth - in. - g.p.d. - , If yes. give date ~ _ - D. LIFT STATION Date installed Size in gallons "Pump on" level at in. ~ ~ ~ Cycles tested E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot. 100'+ Absorption field on lot 100'+ Public sewer main N//A Sewer/septic service line 25'+ High water alarm level at Meets alarm & cimuit requirements? On adjacent lots 100'+ On adjacent lots 100.'+ Public sewer manhole/cleanout Holding tank N//A. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N//A Water service line 10'+. Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 100'+ N/A Absorption field 5'+ Surface water. 100'+ Property line 10°+ Water service line 10'+ Curtain drain NONE KNOWN F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. JEFFREY A. GARNESS Engineer's Prin}ed N~'~e Date Waiver Fee $ Date of Payment Receipt Number Water main N~/A Driveway, parking/vehicle storage 1 HAA Fee $ Data of Payment ~ -,,,~ ,1:::~- 0. ~ Receipt Number (Rev. 12/ol) in. 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 ~/// Ox~V'/,OLSO,~/ Telephone: Home ~-~- Applicant Address ~'~/.5 (c) Applicant is (check one): Lending Institution []; Owner/builder ~; Buyer []; Other [] Business (explain); (d) Lendinglnstitution ~-~'"-L}l~_l'.i-.l(_',.,~p~_.l~.,.~-- Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following addresS: ~' i::~,..> '" .. .- " 80/5 ._%,"_ H co ~,l ,: " TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms Other 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 OnsiteA 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 I of 2 72-025 (11,84) 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 (~L),~} P-~ ~--~(,; t/k)(~'~',~PJ C Address ~0 / ~, ~~ ~ ~ Date ~/Z7/8~ Telephone ~--,1~ "' ,~ 770 Engineer's Seal Approved for /~--~/.,~'. bedrooms b Approved /,~ Disapproved Terms of Conditional Approval · ~-t/~(~ ~ate Conditional 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 WELL DATA MUNICIPALITY OF ANCHORAGE (MO,~i HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: Well Classification /o,~,/~/.4 ~-~' Well Log Present (Y/N) /V 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 If A, B, C, D.E.C. Approved (Y/N) Date Completed 8/~//'~'5' Yield Depth of Grouting Pump Set At W'~ 7",z~,~g~-~/,~e'z Sanitary Seal on Casing (Y/N) y Depression Around Wellhead (Y/N) · On Adjoining Lots /I,.~ · ' On Adjoining Lots To Nearest Public Sewer Line .uo~- /,v A ~'E A Cleanout/Manhole /V'/,~ Water Sample Collected by /'~,'~',~ Water Sample Test Results Comments CoELL 15 To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) N Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: Size I Z ~c:::~ ?,~. Air-tight Caps (Y/N) No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) ,4'.//-'2 To Water-Supply Well To Property Line //~ To Water Main/Service Line Course To Building Foundation .5' ?' To Disposal Field ~ · To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ,,~&'" Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Y Separation Distance from Absorption Field: CCC)' To Water-Supply Well To Building Foundation Lot W<)4"£ 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 Existing or Abandoned System on · On Adjoining Lots /o~' TO Cutbank (if present) ' Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M~)A arid HAA guidelines in effect on the date of this inspection· Signed . ,~4~~, ~-~ ~,~~ Company /~,J~O~J/~.4~~'~. . __ __ ~'"~'/~J, MOA No. Receipt NO, ~'~')~)Q?. ,~ Date of Payment (._~ -~-~,(,c, Amount: $ ~ ~--""~ Page 2 of 2 72-026 (11/84) Engineer's Seal