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HomeMy WebLinkAboutSAND LAKE #1 LT 5 & 6Municipality of Anchorage Page 1 of z DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S W 4I D 1`d @ PID Number: O 11-11 — 11-L Name: rrS 0"Wastewater 1�J i LL i U..r.��. p >y�/a..'t' System: El New Upgrade Address: l.G, ABSORPTION FIELD � tai &0 Phone: _ 53sz, No. of Bedrooms: 1 O Deep Trench ❑ Shallow Trench 1$t Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from origin al grade: (05 GPD/Sq. Ft. Lot: Block: Subdivision: PP4//.VS"c caGAka,4t_3. Depth to pipe bottom from original grade: 5 Ft. Gravel depth beneath pipe . 5 Ft. Township: Range:� �/ Section: 10 Fill added above original grade: Gravel length: �J � I A N1 �, W 0 Ft. Ft. WELL'' ❑New ❑Upgrade Gravel ilk: bv/r' ? Number of lines: Distance between lines: O Ft. qFt. Classification (Private, A,B,C): Total Depth: I Cased To: Total absorption area: 600 Pipe material: i(O P✓ C— Ft. Ft. SQ. Ft. S Driller: Date Drilled: Static Water Level: Installer: Q OC Date installed: �S''' Z m 21 1 q/ aO Ft. i f -t c4 E Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Well /00 _ /C) 71 //0 Material: Number of Compartments: SurfaceLIFT y �(p0 r l - � . STATION Water Lot�y F f- / 1� Size in gallons: Manufacturer: ._... ,` AK k, Line V 7 &4 Foundation ' / { (�j v �'-' 9 "Pump on" level at: 4 "Pump off 41 level at: 4 rm at: High water alarm Curtain (��// 'r �% // �[ F? 1 T Pump Make & Model Electrical Inspecctio,Ins performed by: Drain �o Y"`%A. Remarks: BENCH MARK T "-" O(„ ewt O !? 010Ln Location and Description ',' f �� Assumed Elevation: O v tos, ENGINEER:S.SEAL f' E Inspections performed by: Dates: 1st 8 s8 ej �r S i9 hkf 2nd 6l 2G y C Department of Heal d Hu art vices app ova Reviewed and approved by: u a- Date: s u 72-013 (1/91) MOA 25 a e e Well Q W e ti 0 I Q ° o� j ,yea 0 o 12 l e v. 100 0 0 I U I � El e v, 100 I I lQj Qj L I U Ls ° 43 (4.- w j rnul I R ° u E( e v. 10 I o J c ting 0 Gal, T nk� o ti Icl� I i 50 Tan I I L with i �t S a tion + ° C21 L� Q Q) I I�T Iu ° I I o �u I 0.0f I a M 0 5,0 tP — — — — — — — — j E(e v, 102 Testho e (L v, 102 #5 Rebar I #5 Rebar TOPPEN SPURKLAND P,E. LOT S, SAND LAKE tt 1 6751 W. DIMOND BLVD, SEPTIC SYSTEM ASBUILT 6751 AK. MDND99502-3S04 4951 W BOTH, AVE DATE: MAY 22, 1992 ANCHGLADYS AND RUSSEL HALL SHEET: 2 GRID, 2224 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE g a,plt DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT NUMBER:SW910148 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:WATSON WILLIAM D OWNER ADDRESS:4951 W 80TH AVE ANCHORAGE, AK 99502 PARCEL ID:01111112 LEGAL DESCRIPTION: SAND LAKE #1 LT 5 LOT SIZE: 15700 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 -D (UPGRADE) PERMIT (),C;k� DATE ISSUED: 6/11/91 EXPIRATION DATE: 6/11/92 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. ENGINEER MUST VERIFY INTEGRITY OF SEPTIC TANK. IF TANK IS FOUND TO BE IN UNSATISFACTORY CONDITION A NEW TANK MUST BE INSTALLED. ENGINEER MUST NOTIFY DHHS PRIOR TO BACKFILLING LIFT STATION. DHHS I9PECTOR MUST OBSERVE BACKFILLING OF LIFT 0"L' T ON. ( J DATE:. 6z /1 ' RECEIVED BY: ISSUED BY: J Rt,4 `Srq) rH DATE::1 k) �YLtA 2c vL� 6131N.0MOWDBLVD. ANCHORAGE, ALASKA Y9502~3704 (907) 248-5095 SPECIFICATIONS FOR SEPTIC SYSTEM INSTALLATION LOT 5, SAND LAKE *1 SEC 107 T12N R4W 1.0 GENERAL 1.1 Owner is Gladys and Russel Hall, 5405 Chena Ave, 99,508 Anchorage, Ak. Phone 333-6850. William Watson resides at 4951 W 80th. He is the owner of the property, 1.2 �m��m��a�r is the person or entity hired by the Owner- to inspect this project. The Engineer must be recognized by the Municipality of Anchorage, Department of Health and Human Services. 1.3 Contractor is the person or entity hired by the Owner to install this project. The Contractor must be recognized by the Municipality of Anchorage, Department of Health and 1.4 The Drawingsv sheets k through part of this specification. 1.5 All materials and workmanship shall meet the require^ ments of the Municipality of Anchorage, Department of Health and Human Services, the conditions of the permitand all applicable rules and regulations currently in effect, 1.6 All excavation depths are advisory, and are to be verified and may be modified in the field by the Engineer. 1.7 It J.s the responsibility of the Owner or the Contractor to adhere to the approved design, to verify that the speci� fied separation distances are met, and that the required inspections are performed. 1.B The �o��r���c»r or the Qw�er shall report to the Emgi- neer any observed condition which would put the septic system in violation of State or Municipal regulations. 2.0 SEPTIC TANK 2,1 If there is an existing septic tank� it may be used if it meets the capacity requirement for the residence. The tank shall be inspected by the Engineer, and its water tightness and structural integrity shall be verified. Specifications for septic system installation Lot 51 Sand Lake 11 pg. 1 ^ ^ 2"2 A new septic tank shall be one fabricated by ejther Anchorage Tank and Welding or by Grear Tank The septic tank shall be a UPC- -approved two~compartment tank� constructed of 12 gauge, or bettery steel with bitu mastic coating" The tank shall be set level on undisturbed soil.The tank shall be covered with the equivalent of four feet, or more' of soil. 2.3 The septic tank shall be installed a minimum of five feet from the house foundation and a minimum of five feet from the absorption area. 2"4 The septic tank shall be a minimum of 100 feet from any well serving a single residence; 100 feet from any, body of water, creeks or drainage ditches with flowing water; 15O feet from Class oC» wells, and 200 feet from Class A or C1ass B wells. 2^5 All pipe connections to the tank shall be mechanical watertight calder couplings" Cleanouts shall be inctalled as designated and capped with air -tight rain caps" Clean~ outs shall extend a minimum of 12 inches above final ground elevation. Provisions shall be made for landscaping and importation if topsoil, 2.6 Lift station shall be as manufactured by Anchor -age Tank .and Melding, ORENCO SYSTEMS. m~' A124*_A6e ^-SYSTC-M 3.0 ABSORPTION FIELD 3.1 Gravel used in the absorption field shall be 0"5 to 2"5 inch screened and washed rock9 with less than 3% passing Lite No. 200 sieve. 3.2 Sand, used for leveling or for filtering, shall have an effective grain size between No" 40 sieve and No" 18 sieve" Uniformity coefficient shall be less than 4" Not more than 57 by weight shall pass the No. 200 sieve. 3.3 Perforated pipe shall be Schedule 40 PVC or ABS. 3.4 Solid 4 -inch pipe shall be Cast Iron or ASTM D3034. 3"5 Monitor standpipes shall be installed as shown. That section of the pipe penetrating the gravel shall be pca. rfo^ rated, either by drilling O.5/' holes on 6~inc1-i centers or by joining a section of F810 perforated pile to a solid section of pipe. 3.6 Geotextile shall be Mirafi 140, 3"7 Insulation shall be extruded direct burial polystyrene~ Dow Chemical Styrofoam HI 40. Specifications for septic system installation Lot 5� Sand Lake 21 rig. 2 3"8 Topsoil shall be a mixture of organic materials, 20~30% sand and 20% or more Silt. All measured by volume. 3,9 Grass seed shall be Kentucky bluegrass" 4.0 INSTALLATION 4"1 Locate all underground utilities, property lines, future driveways' existing or proposed water wells, water ways, surface and sub surface drainage facilities, lakes, ponds, and all other facilities requiring separation dis- tances from the proposed septic system. Notify Owner or Engineer of any, observed possible conflict. 4.2 Stake alignment of system with markers showing the protective distances from wells and water bodies" 4"3 Establish an elevation benchmark. This BM shall be easily ident ifiall leq stable and permanent" An arbitrary elevation of 100 can be assigned. 4.4 Install the tank as shown on the drawings. Record the inlet and outlet elevations of the tank" Tank shall be placed on undisturbed native soil" 4"5 Excavate the absorption field" Bottom of excavation shall be level and scarified. Record elevation of each corner and center point of bed" Construction equipment shall not operate on the floor of the excavation. Any material compacted by the operation of the construction equipment shall removed and replaced with uncompacted materials. 4,6 Place the rock to the depth specified. Do not contami... nate rock with native materials or spoils from the excava� tion. Level the rock surface (+~ 1"> before installing the perforated pipe. 4"7 Install the distribution pipe. Record the elevation of each joint. For pressure system solvent weld the joints. 4.8 Cover the distribution pipe with rock, and cover the excavation with geotextile before backfilling. Grade the surface to provide drainage. 4.9 Record the finish ground elevation at each corner and at the midpoint of the bed. 4.10 Place topsoil -CO a total uncompacted depth of 4 inches. Rake and roll topsoil. Spread seeds and water as needed. 4.11 Furnish a copy of all survey notes to the Engineer. Specifications for septic system installation Lot 5, Sand Lake 31 13g.3 - (`,tC1Vl]IIV CCl1J JLh1Lf e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES P 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR:-.G 1L10// V5 Cusse_n 14O 1 al —DATE PERFORMED: \�t41S��{O` -� I , LEGAL DESCRIPTION: �o� J Sw�.ttOC L..ac.4tp Township, Range, Section: i 1. ,N, 'R4 V1 eL c- l o f-dX I hP CAl I SLOPE SITE PLAN 1 s i c -I- Loa.,," 2 R -e-4 is k 3 4 6 7 ot_ t44 8- 91011 9- 10- 11 21314 12- 13- 14 15Dt 1 DIM of D t_ I:-: 16- 17 18 19 20 COMMENTS WAS GROUND WATER y jO Depth • ENCOUNTERED? S IF YES, AT WHAT / L 0 DEPTH? P E Depth to Water After t i121 % O Monitoring? t4 0 Date: ®®®® Depth • .. PERCOLATION RATE I t 1 (minutes/inch) PERC HOLE DIAMETER B t TEST RUN BETWEEN 2 FT AND FT e_), .1:5 g tee./rte — PERFORMED BY: I _ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: K0 J CONSULTING ENGINEER Sr--PTLc SYSTEM t>PC 24D'= l -D -r 5 SACND I AKC a j 14q S I w 63© L4 Ave, Sys�ewt �es��kedlo r c=- �►o�l, 21� L44o LI 15t C e. e_r T\l o Ivi a.IC�� LLl o2X l50 b i Y3 Tobben Spurkland P.E. 91_Piic sZosTL= I -L Lq PGp.Ate LOT 5 SA rND LAKIZ W J 4q:51 0`/ 8&+4 Ar,.e— �_t Cf —C, V S E A M644 i L i fc' sT*4r-rt ow . Nov 2!1!490 ;t'' 11 n NO �. y � n a 1 99 lM�►� ASS eaaa �rE. �• •.:r. &/0 31 wr G 90 � .20orw e P dK Tobben Spurkland P.E. SC'Pi is SYST��-t Lo i 5 SArND LAV-t:E � 1 4q 5 1 VOaoU,. Arv.e, 3/3 °' � "''a° It � � I (s-�4� c� a.�'l �,.,ti,c t Go•,,,.� w�.X" ,te�wG� c,-r�t� Gl 2e,p u�L vet c� LIC4 Lie LA� VLOJ 4c -;t C 1/� cc,AltM Olt _ �+'r%eli 100 f S N f .3 4 EAtVD LAKE L A K WES> T EIGP TIE TP A Et .fS ce,� F � y i.i � �i • j 1 �g 0A LOP -1., � yfCCppa ntyn�eo a e c o e ®aY ® P' T�aF.en S,:u'rl�ac3� ..v - V YPu"rLSS�t�`F�'. `� La l',t D' I L -RL L7CK 1 0 t�0 75 110 150 —' Scaler 1` = 50✓ TOBBEN SPURY,LAND P.E. L J T 5 SAND LAKE #1 SEPTIC SYSTEM DESIGN 6751 W. DIMOND BLVD, 4?51 W C-'OTP. -AVE DATE, NOV 15 1990 (907) AK. 99502-3904 GLADYS AND RU.SS€L PALL SHEET 1 GRIDS t''t''Z4 I ". A r� Wei! Vl f•Y , Vii- �q� _ �' 1� •"w.�-d� `� / I,�l L / ^y --<' Fe tip. 1017 ply I c I tuOL t� i f > , ra_ f �+ f t r _ 1 h E'fi s t n 1000 Gal. T J, �' �u with i t rr% ' e I t - Q tion I q �? 4A Q I .n 7t7Li I G} •--i f I COY T�S'ti v 5p r- 3 ' r. j�"./. 1�(fl/ � � �•1 ![GXJ�.i V TOBYEN SPIIRKLAND F.E. ' LL',T 5 },4tVD. f ��� #t� � � SEPTIC SYSTEM DESIGN 6751 W, DIMOND BLVD, j r 4T 1 t,f, „S1�T.H, � ,r .�4VE DATE, NOV 1.5,. 199pti ANCH. m6K. 9950'2'-3904 a-;1 �T?YC AAMPH-G`^l-1 PAI I SHEET- e GRID,LL4 J/ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 `L' STREET, ANCHORAGE, AK. 99501 264-4720 I -rF= fE; NE t4 r=- F:;.* F E: R. M I -r PERMIT NO. < 781056 ) APPLICANT SCHACHLE EXCAVATING 3126 E 72ND 344-2911 LOCATION WEST 82ND AVE LEGAL-L4A&--E&--SANE*-LW-E #2 LOT SIZE 6750 SQUARE FEET L,:5' I-AV6 TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 95 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �L;2 L_5=r4o3-r"— _10-D G_iFeF4Vl=lL_ ENE:F:8-r"� wD THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT 15 THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION -(IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). FR 1= G� L-1 31 FR ECA m -=--F=1= -r 310 _r F:V " K :E; l :�lE= JL ID 01 C--1 13 F1 L_ L_ Cl r -4:F. PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL. OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING.UPON THE TYPE OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PRn_PER INSTALLATION. Fl8l=F;l.'Ml-U L-nB[-=lZE:MEDE:F:;z 354:1-, ::L S=8 � �0 I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE 'SXWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDEWRE THAN 3 BEDROOMS. SIGNED APPLICONT SCHACHLE EXCAVATING ISSUED V3. 2 ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE s +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST Pouch 6.650, Anchorage, Alaska 99502 276.2221 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Raphl Sutphin DATE PERFORMED: 11-23-78 LEGAL DESCRIPTION: Lot t6-, B Sand_ Lake No. * Subd . 11 Gravel UI/CObbleS WAS GROUND WATER NO ENCOUNTERED? 12 USCS GT7 ` IF YES, AT WHAT DEPTH? _ 13- 14- 15- 16- 17 314151617 18 19 20 S L O P E SITE PLAN DEPTH Gross Time 1 (FEET) Top Soil w/Organics i i US CS am 2 3 Sandy Gravel USCS Sw �4 5- 6- 67 7- Light Brown Sand W/ Traces of Silt 8 TTSCS SW -SP 9 10 11 Gravel UI/CObbleS WAS GROUND WATER NO ENCOUNTERED? 12 USCS GT7 ` IF YES, AT WHAT DEPTH? _ 13- 14- 15- 16- 17 314151617 18 19 20 S L O P E SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop i i z I Reading Date Gross Time Net Time Depth to Water Net Drop i i Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) u TEST RUN BETWEEN FT AND FT COMMENTS Lot has good natural drainage and has several large trees. Soils meet Specification for 95 sq. ft./bdrm. ;7A ,e/ PERFORMED BY: rT.5/SG 72-008 (7/76) CERTIFIED BY David 0"�/ DATE: 12-7-78 P.r. JLJL-29-50 SUIN 7 35 P 0 1 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & KNIEFEL ENGINEERING ENVIRONMENTAL PROTECTION 8441 Miles Ct., Anchorage AK. 99504 4(11 3119190 I(E (907) 3371121 • Fax (907) 338-1874 HEALTH AUTHORITY RESULTS AND ANALYSIS Date of Testing: June 8, 1990 Legal Description: Lot 5, Sandlake Subdivision Street Address: 4951 West 80th. Avenue Number of Bedrooms: Three (3) ------------------------------_----------------_--------------- - Results of Well Flow Test: Passed Average Flow Rate: > 4 spm --------------------------------------------------- -- ----------- Results of Water Quality Analysis: Passed. Total Coliform -- 0 colonies Nitrate --N -- C 0.1 mg/,l•, (.10 mg/1 allowable) Testing Laboratory: Northern Testing Laboratory -------------------------- .._---------------------_------�-- Results of Septic System Adequacy Test; Failed --------------------------------------------------------------- Comments: The we11 system passed the flow test and water quality analysis. The septic system failed the system adequacy test. This occurred because the water level in the foundation clean-out and the field cleanouts was above the field level at and during the test period. The water induced into the field only raised these levels with no relief found for the high level. The field can be affected by a high ground water level or the field has reached the end of its useful life. In either case, the system needs to be replaced. The system was tested in accordance with MOA policy and regulations in force at the time of this test. CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSTS THEODORE F. MOORE, P.E. July 10. 1990 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 Russell and Gladys Hall P.O. Box 140295 Anchorage, AK 99514 Dear Mr. and Mrs. Hall: ��- Per your request, on July 9 we conducted an adequacy test of the waste ater dais Sposal� system serving the house on Lot 5 of Sand Lake S/D # 1, located at 4951 W. 80th Ave., The house was unoccupied at the time, and the system had been treated approximately two weeks earlier with hydrogen peroxide by Isaacs Pumping Service. The only records on file at the Municipality indicate that the present system was installed in 1979 and consists of a 1000 gallon septic tank followed by 18 lineal feet of soil absorption trench containing 8 feet of sewer gravel. As Mr. Hall pointed out, an old seepage pit adjacent to the septic tank had recently collapsed. The contractor who you had fill the hole and repair the septic tank standpipe did not leave the standpipe in good condition. There is a constriction/displacement 5 feet below ground level which would make it difficult, if not impossible, to do the necessary pumping of the septic tank. I recommend that you ask the contractor to go back and fix that standpipe. At the start of our test there was no fluid in the trench to the maximum depth we could get a float into the monitor tube - approximately 14 feet below ground level. During the test we added 1388 gallons of water to the system at'the maximum pump output of 4.6 gpm through the cleanout after the septic tank. This amount of water caused the float to rise 7.5 feet, and after the flow of water was stopped the fluid level receded at a rate indicating that the system was performing adequately for at least a three bedroom residence. You should be aware that an adequacy test only measures the performance of the system on the date of the test, and that subsequent tests under different conditions may produce different results. Also the longevity of improvement due to hydrogen peroxide treatment is unknown. Give me a call if you have questions on this report. Sincerely, Ted Moore, P.E. 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 al OF 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 5. Sand Lake Subd. Addn. #1, Sec. 10, T. 12N. R. 3W. S.M. Location (address or directions) 4951 West 80th Ave. Anchorage, Alaska 99502 (b) Applicant Name Russell B. Hall Telephone: Home 333-6850 Business 333-6850 Applicant Address Box 140295 Anchorage, Ak. 99514 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ff; Buyer ❑ ; Other ❑ (explain); We are refinancing our current mortgage. (d) Lending Institution Rainier Mortgage Services Telephone 561-1744 Address 560 East 34th Ave , Suite 102, Anchorage, Ak. (e) Real Estate Company and Agent None Address Telephone (f) Mail the HAA to the following address: Rainier Mortgage Services, Attn: Kathy Miller P.O. Box 101200, Anchorage, Alaska 99510 2. TYPE OF RESIDENCE Single -Family C2 Multi -Family ❑ Other Number of Bedr6oms Two 3. WATER SUPPLY Individual Well EX Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite IZ Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11184) 5. ENGINEERING FIRM PROVIDINti INSPECTIONS, TESTS, FILE SEARCH, DA i A AND INFORMATION 91 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 ealls/ <= Telephone 3 Z� � Address � 6!5° 01 Date Ocr/— 30 1784 DHEP APPROVAL (A) Approved for bedroom Approved Disapp Terms of Conditional Approval 4 s by t ate r rove 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 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEA DEPT.PT. OF HEALTH &TH AUTHORITY APPROVAL (HAA) MUNICIPALITY of AN & CHECKLIST - FEBRUARY 1984 O ENVIRONMENTAL PROTECTION 264-4720 Legal Description: % of # 5- J fZ3ry A. WELL DATA Well Classification OCT 3 01986 RECEIVED F If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) %J Date Completed / 1&6p Yield .3,5�p,29 Total Depth -7Zr Cased to 7 r Depth of Grouting Static Water Level S-54, Pump Set At Z r Casing Height Above Ground �/ Electrical Wiring in Conduit (Y/N) J Depression Around Wellhead (Y/N) 'Z'22JJ Sanitary Seal on Casing (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot /O.3 / On Adjoining Lots To Nearest Edge of Absorption Field on Lot /�S ; On Adjoining Lots 4 'IU 0 To Nearest Public Sewer Line 4 /00 To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot O ` Water Sample Collected by ���; Date Water Sample Test Results 0�� �/ —14C Comments �iGGs' .1-160 J B. SEPTIC/HOLDING TANK DATA Date Installed Size� No. of Compartments Standpipes (Y/N) —y� Air -tight Caps (Y/N) Foundation Cleanout (Y/N) / Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /03 / To Property Line '/0 To Water Main/Service Line Course "A/D O Comments Page 1 of 2 72-026(11/84) -(-5`0 /t/ for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field `t/ %q To Stream, Pond, Lake, or Major Drainage MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION 0G7 q.a 1�6 RECEIVED n C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed f 9 7,7 Width of Field 3 q 5- Square Feet of Absorption Area 7- e? Depression over Field (Y/N) A-) Results of Last Adequacy Test 4,leI%yC, At Separation Distance from Absorption Field: To Water -Supply Well 11,5- To Building Foundation -E Sy ( nT '362' To Water Main/Service Line 30 To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION — /l% /q� Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Type of System Design 1`e -/7c'/'' Length of Field �� r Depth of Field / Z Gravel Bed Thickness Standpipes Present(Y/N) y Date of Last Adequacy Test v 2 9/c To Property Line To Existing or Abandoned System on On Adjoining Lots f 30 z To Cutbank (if present) N 4 -*/00 / 'lL Z_,91 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 that I have checked, verified, orconformed to all MOA and HAA guidelines in effect on the date of this inspectior Signed I Date Company LfwfS IS�S--7.r/c-�MOA No. Receipt No. ZDD� ,�®DOp�, �• "' Date of Payment Amount: $ r9S 077-- 24 ?-` d q 1 Ste'' _a`, Page 2 of 2 72-026 (11/84) f r, CHEMICAL & 6,LOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 AL- Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIERI TO BE COMPLETED BY LABORATORY 11 PUBLIC WATER SYSTEM LDA �� VP VATE WATER SYSTEM Na /meee --:24 phone No. Mailing Address %2r City - State Zip Code SAMPLE DATE: © F—M g Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample -/ with lab ref. no. ) ❑ treated Water [t�" Special Purpose [�' Untreated Water SAMPLE Time Collected NO. LOCATIONZ� �� Collected By 1 1 9 ,;� L� 7" R -,)1A 2 3 4 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to Indicate reliable results. Please send new sample via special delivery mail. Date Received 4 Time Received Analytical Meth s! _-lftM. rane Filter ' No. of colonies/100 ml. Lab Ref. No. Result' Analyst F-1-01 DLC U m I m U m U -I m BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LTB Final Membrane Reported By TNTC = Too Numberous To Count OB = Other Bacteria Coliforml100ml BGB -- -- _w. Coo orml100ml j Qs 9 to __::Zdate l �{/ P.M. LVV�I I/ ' 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 K.-''2 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ` CAnJE Telephone: Home 2 q-3— YS�2_Business Applicant Address) O0'tk' 4tiGp�l (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer ❑ ; Other ❑ (explain); (d) Lending Institution G G Telephone � ? 2420 Address q B,! 1 63 i Na. (e) Real Estate Company and Agent &D�� Address Telephone (f) Mail the HAA to the following address: ef / % Y 14 77A) •` � iL'� l 2. TYPE OF RESIDENCE Single-Family,o(_Multi-Family❑ Other Number of Bedrooms _2=, 3. WATER SUPPLY Individual WelliilQ Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 )11/84) r. 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, l 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 eft /1�l' TIC (::dAr/^, Address X06 G+✓. -7/� b�x Telephone ��y (" 41 Y Sidngv E. CE - 6. DHEP APPROVAL S Qy Approved for bedrooms b/rk- �"'"`�' � � Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPAUTY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECT10,,4 MUNICIPALITY OF ANCHORAGE (MOA) �. HEALTH AUTHORITY APPROVAL (HAA) `. J: CHECKLIST - FEBRUARY 1984 264-4720 / E C RED Legal. Description: LOT �� fln/t�A �' /o . -r/2 A. WELL DATA Well Classification _//JFK/yID(JAL If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y�/N) � Date Completed 4PPCOX IL? 61 --6 Yield g�QL "/ Total Depth —/__� Cased to "v72 Depth of Grouting Static Water Level `, Pump Set At 2 Casing Height Above Ground 2 Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) / Depression Around Wellhead (Y/N) /N Separation Distances from Well: To Septic/Holding Tank on Lot 0"g ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot % j ; On Adjoining Lots To Nearest Public Sewer Line A)ZA To Nearest Public Sewer Cleanout/Manhole A To Nearest Sewer Service Line on Lot so -o' -I- I Water Sample Collected by T AZA wC,C` ''r ; Date 2 3 – 9 Water Sample Test Results EA / T/ S F'ALTGiL Y Comments t!<(%EGC J ! re_6 Ls? B. SEPTIC/HOLDING TANK DATA Date Installed — I_q 1 . Size 4&WalX ( No. of Compartments I– Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) �y Date Last Pumped' 2 3 $ Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N)A'M Temporary Holding Tank Permit (Y/N) 62114 Separation Distances from Septic/Holding Tank: To Water -Supply Well f lis To Building Foundation Q To Property Line ©�F To Disposal Field % 2 r To Water Main/Service Line 'f To Stream, Pond, Lake, or Major Drainage Course 2 cy Comments Page 1 of 2 72-026(11/84) '-1 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed � q 7 q Length of Field / Width of Field t9dC KE'r r(%/OTN Depth of Field 12 Gravel Bed Thickness Square Feet of Absorption Area ? g� �F 2 Standpipes Present-(Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test 2Dt7�a SU%' Separation Distance from Absorption Field: To Water -Supply Well v� To Property Line D !rg To Building Foundation 2 'r To Existing or Abandoned System on Lot 3 D On Adjoining Lots q 'r" To Water Main/Service Line / To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course 1,4 To Driveway, Parking Area, or Vehicle Storage Area 2 0x'14 Comments D. LIFT STATION Date Installed — Size in Gallons — "Pump On" Level at /\,/ /.A. 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 that I have checked, ve ifi , or nformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date 5��5 Company �/ S MOANo. Receipt No. 3q I 3� Date of Payment 5' V 6 - 5 Amount: $ yss-= Page 2 of 2 72-026 (11/84) - DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME - TIME DATE DATE - DATE SINGLE FAMILY ❑ One ❑ Four ❑ Other C II II ❑/ Two ❑ Five ❑ MULTIPLE FAMILY E�7 Three ❑ Six INSPECTOR INSPECTOR INSPECTOI/1� �J a `, Q l�S * ATTACH WELL LOG. A well log is required for all wells drilled MUNICIPALITY 01" MUNICIPALITY OF ANCHORAGE DEPT. GF I �.-LTH & DEPT. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTO"RONMENTAL P-OTECTION 825 L Street - Anchorage, Alaska 99501 VIDUAL/ON-SITE**/.e,. • SLP 3 981 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 REQUEST FOR APPROVAL OF INDIVIDUAL �A I V E WATER AND SEW LITI S DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please alto ten 1101 day__ spa processing. 1. PROPERTY OWNER PHONE An4au1j, 54(4 1 _r MAILING ADDRESS PROPERTY RESIDENT (If differentfromabove) - PHONE 2. BUYER q_�, - PH1ONE MAI LING ADDRESS q /aC 3. LENDI G INSTITUTION PHONE P-5 -l5 MAILING ADDRESS 4. REALTOR/AGENT PHONE MAI LING ADDRESS 5. LEGAL DESCRIPTION , `� d r i --) _ - STREET LOCATION 6. TYPE OFRESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑/ Two ❑ Five ❑ MULTIPLE FAMILY E�7 Three ❑ Six 7. WATER S PPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) POSAL SYSTEM B. SEWA7INDI VIDUAL/ON-SITE**/.e,. YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) f/ -G,JJj�__.y11 I Ot�17SI D e 12 yl 1 1' MUNICIPALITY OF ANCHORAGE ��TIAICIPPT ONEpI H & ` / DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTOIDEPT• DEAL pROTE j 825 L Street - Anchorage, Alaska 99501 @1YIR0 • ENVIRONMENTAL ENGINEERING DIVISION 191978 6. TYPE OF RESIDENCE . Telephone 264-4720 k� llvV r D REQUEST FOR ec��, APPROVAL OF INDIVIDUAL WATER AND SEW&�RU�LITIES ' Tp DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. JA0 1. PROPERTYOWNE//R. % - PHONE z %- 4�� ❑ INDIVIDUAL* MAI LTNG ADDRSS - - - - since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY PROPERTY RESIDENT (If different from above) PHONE 2. BUYER F7 INDIVIDUAL/ON-SITE** - PHONE G?� If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. i MAILING ADDRESS' �o I� I 3. LENDING INSTITUTION PHONE t'�' *6-� -), r V /9 MAILING ADDRESS 4. - REALTOR/AGENT - PHONE MAILING ADDRESS ! C -//- /7 (//&/ - /2/0,,— is !i 5. LEGAL DESCRIPTION A C7 2" .moi ' 7 /2 ed 4 G / 1'i e • �CZz 6J STREET LOCATION - 6. TYPE OF RESIDENCE . NUMBER OF BEDROOMS ❑ One ❑ Four ❑ Other l SINGLE FAMILY ® Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled CK COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM F7 INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) L,D+ U y IL tieaQO'^ u ends ' Wlu t,t� lT (96 LDCJ 'I A. jam_ THIS SIDE FOR OFFICIAL USE ONLY c 3 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: -Septic/Holding Tank bs Aorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line - 5. COMMENTS ti- APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE ( BY 72-010 (Rev. 6/79)