HomeMy WebLinkAboutREED LT 8Reed
Lot 8
#051-102-19
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-0720
\
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
NEW
DRM 0 r---
fg-5[j'SS'
❑UPGRADE
MAILING ADDRESS
V,VDIX- q
LEGAL DESCRIPTION
L 0-r I -
LOCATION
O
NO. OF BEDROOMS
C= o ov"
ow
DISTANCE TO:
Well
/
Absorption area
/ /
Owelling
PRtJAOSE
PERMIT NO.
f 2
o a
W I.,
rn
Manufacturer
-
Material
No. of Com artments
Liq. capacity in allons
9
ODt?
IF HOMEMADE:
Inside length
Width
Liquid depth
DISTANCE TO:
Well
Dwelling
PERMIT NO.
-10Z
Manulac[urer
Material
Liquid rapacity in gallons
W =
DISTANCE TO:
Well /
Foundation
Nearest lot line `
PERMIT NO. 14 O ��
� W Z
2 W/
No. of lines
Length of each line
Total lenJth of I�es-
Trench witlih
Distance between lines
h
r
��thes
2 Fes-
Top of the to finish grade /
Material beneath we /
Total effective ab on area
prpti
O4
es�
Q/
W
Length
Width
Depth
PERMIT O. �
n F-
W d
Type of crib
Crib diameter
Crib depth
Total effective absorption area
w
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class M
Depth
Driller
Distance to lot line
PERMIT NO.
.Ji
W
DISTANCE TO:
Building foundation
Sewer line
Septic t�k
Absorption ,rea(s)
OTHER
PIPE MATERIALS
a'U ' L
SOIL TEST RATING /
INSTALLER
J+
-o
REMARKS
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-TANK, Et16T.NEc Rz.Nlr
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APPROVED D TE LEGAL /
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�t81, R d� ia£d T M f1 w <Grc 19
72-013 (Rev. 3/78) V����-� /E <�— 1—y—&�
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MLJFJ I C I F' iL_ I TY OF' FiMCHC_ ,2t-71GE
• DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET. ANCHORAGE, AK 99501
264-4720
01rJ-SITE SEWEF;Z F'EFZtlI -V
'PERMIT NO: 840472
DATE ISSUED: 06/18/84
APPLICANT: JOHN MOORE
:ADDRESS: BOX 4-604
ANCHORAGE, AK 99509
!CONTACT PHONE: 688-4555
:LEGAL DESCRIP: SUBDIVISION: REED LOT: 8 BLOCK: NA
SECTION: 9 TOWNSHIP: 15N RANGE: 1W
iLOT SIZE: 16625 (SQ.FT. OR ACRES)
,MAX BEDROOMS: 3
!LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC
,SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE.
**--GRRVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
** TAW MUST HAVE AT LEAST TWO COMPARTMENTS
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I CERTIFY THAT:
1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOR) 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 OF THIS PERMIT.
3. 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. I.UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 3 BEDROOMS AND
ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.
iIF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY V10A 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 (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED
APPLICANT
;ISSUED BY
i L?OH Ni
f,.-
��/�
TFZErJCH
BED>
W. E>FiF1ItJ
DEPTH TO PIPE BOTTOM (FT.)
4.0
4.0
4.0
GRAVEL DEPTH <FT. >
5.0
0.5
3.5
'TOTAL DEPTH (FT.)
9.0-
4.5
7.5
'GRAVEL WIDTH (FT.)
2.5
26.0
5.0
GRAVEL LENGTH (FT.)
109.0 ** -
51.0
117.0 **
GRAVEL VOLUME (CU. YDS. )
55.5
49.1
86.6
.TANK SIZE (GALS>
1,000.0 **
10000.0 **
1, 000.0 **
:SOIL RATING (SQ. FT. /BR)
362
290
362
**--GRRVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
** TAW MUST HAVE AT LEAST TWO COMPARTMENTS
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I CERTIFY THAT:
1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOR) 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 OF THIS PERMIT.
3. 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. I.UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 3 BEDROOMS AND
ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.
iIF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY V10A 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 (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED
APPLICANT
;ISSUED BY
i L?OH Ni
f,.-
��/�
I;/ SOILS LOG
MUNICIPALITY OF ANCHORAGE
j,� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
'ERFORMED FOR: Achy -)
5
DATE PERFORMED:
Gross
Time
Net -
Time
LEGAL DESCRIPTION:
A16
t rrp
{]]
cc
SLOPE
II��Y��f
(o'
- • e
�
(o
e
L4,--
4
•
5
6
7
8
9
10
11
12
13
14
15
171 I ��k.L%C4 i
18
19
20
ENCOUNTERED?
WATER Ko
ENCOUNTERED? 1V
IF YES, AT WHAT
DEPTH?
T'1tav,nslc✓ — Init
I
Reading
Date
Gross
Time
Net -
Time
Depth to
Water
Net
Drop
t rrp
s
z:8
•�
(o'
'5.. 0 g
(o
I
•
I�Z-o
a; 0
d
7
fd.0lo
3
3'•30to
•-77
0
PERCOLATION RATE (minutes/inch)
4n - S (i --
72008 (6/79)
ALASKA EIIUIR nmewl, COIITROL SERUM, Inc.
Enginrcrinq 6 Enuironmental Studies
PERCOLATION TEST DATA SHEET
CLIENT tTo Ah Moore, DATE
ZIP CODE r // //
LEGAL LOCATION _ e- s51(I l V15 -h
TOTAL DEPTH OF HOLE1 3 ft.
ZONE TESTED .S ft TO (I, -f ft
D=$
READING
CLOCK TIME
NET TIME
DEPTH TO
DATUM
NET DROP
RATE (min/in)
azo
2:Z.o
�0
!,'f?
1.91
19.06
40
_
!, 3S 9415
o
3
3;Oz
�v
i:�
p,04
iHLC
�;, 07
o
e�L
B4O�
, LZ
/o
e7
6
IR 44
0.03
u
FINAL PERCOLATION RATE z (min/in)
PERFORMED BY 61-6gh
Ra tel a t 2 80 -�t2/betel f'r-o m 1 f o 13 �eef.
West 33rd Aoenue. Suis•.P• Anlmge. Alaska 99503 0 (907) 2761361
ALASKA MBOflmOU COnTROL SNIUS, InC.
Enqineerinq E Environmental Studies
December 21, 1984
Department of Health and
Environmental Protection
825 L Street
Anchorage, Alaska 99501
Subject: on -Site Sewage Disposal and/or Well Inspection
Report
During 1984, a number of septic systems have been installed and
inspected, prior to the establishment of the foundation(s). AECS has
contacted (or attempted to contact) the applicants concerning the
installation of foundation clean-out and pipe from the foundation to
the septic tank inlet. In many cases, construction will not resume
till in the spring; therefore, precluding any further inspections.
Since the end of the year is near, with the expiration of permits,
AECS is forwarding the inspection reports without a foundation
cleanouts to your office. We understand that this will not eliminate
this situation; nonetheless, the reports reflect the actual inspected
installation at this time. We recommend you accept these as is. The
Health Authority, site evaluation for these properties can confirm the
installation of the cleanout. Conditional approval, based on required
installation in the spring, may be required during the interim.
If this office can be of further assistance, please contact us at v
561-5040.
Sincerely,
,,eZ-1.2rx��'
L. D. Montgomery
Supervisor,
Environmental Department
Approved By:
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALI- 5
EWIRONMENTAL PROTECTION
DEC 2 61984
RECEivLD
1200 West 33rd Avenue. Suite B • Anchorage, Alasla 99503 • (9071 561.50x0
Municipality of Anchorage
Development Services Departmen*
Building Safety Division
On -Silo Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. D51' 102-1c) COSA#CIO �i,"
1. GENERAL INFORMATION Expiration Date:
Complete legal description
Location (site address)
Current Property owners)
Mailing address
Lending agency
Mailing address
REED SUBDMSION: LOT 8.
23009 ROSEBUD ROW • CHUGIAK. AK 99567
JENNIFER DAVIS Day phone 229-6955
23009 ROSEBUD ROW • CHUGIAK. AK 99567
Day phone
Real Estate Agent Day phone es_?�
Mailing address !is W. 38TH Nc-olwc
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems
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.
4. 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, based on procedures ouHined in the Certificate of On -Site Systems 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 ofAnchorage riles 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 GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 1D1 * ANCHORAGE, AK 99507
Engineers Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
In conducting this evaluation, GEG, VD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines d 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 Identifmable features. The operational life of all wells and
septic systems depend on the local sells 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 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 or encroachments. GEG, LTD. 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 right whatsoever.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
337-6179
Date It t o&
Conditional approval for bedrooms, with the tllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Reort
Other
�o Y'OFtiff
,'r.,��
• o-
ON-SITE • •
WATER AND ; m-
WASTEWATER
PROGRAM
By: 0 ��0 Original Certificate Date: I —
(Rw. I IM)
i
I
i
Municipality of Anchorage ,
• Development Services Department
Building Safety Division
On -Site Water d Wastewater Program
4700 Bragew Street
P.O. Box 196650
Anchorage, AK 99519$6W
www.muni.orgionsite
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: REED SUBDIVISION; LOT 8, Parcel ID: D S/ - / 0 2-19
A. WELL DATA
We9 type K A, B, or C provide PWSIDN _ Well Log (YM)
Date completed Sanitary seal s property protected (YIN)
Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate-mg./L,
Date of sample: Collected by:
B. SEPTICIHOLDING TANK DATA
Tank Type/Material STEEL Date installed 12/1984
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression over tank (YM) NO High water alarm (YM) N/A
Date of pumping 10 2006 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Data installed 12/1984 Soil rating (g.p.dAt2or4j!E�D 362 System type TRENCH
Length 111 ft. Width 3 ft. Gravel below pipe 5 ft.
Total depth 010.0 ft. Eff. absorption area 1110 ft' Monitoring tube YES Depression over field NO
Date of adequacy test '3/15/2005 Results (Pass/Fall) PASS For 3 bedrooms
Fluid depth in absorption field before test 13 in. Water added 489 gal. New depth 20 in.
Elapsed Tana: 1440 min. Final fluid depth 13 In. Absorption rate >= 450+ g.p.d.
Arty rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
'TESTED BY EAGLE RIVER ENGINEERING.
DRAINFIELD HAD 12 INCHES OF LIQUID ON 9/29/2006.
D. LIFT STATION
Date installed
"Pump on" level at _in.
Datum ---------
E.
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (Y/N
'Pump ofr leve High water alar level at in.
Cycles tested Meets alar 8 circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
areas
PUBLIC WATER
On adjacent
On adjacent lots
sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 50+ Absorption field 5'+
Water main 10,+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line $8.5' Building foundation 10'+ Water main 10,+
Water service line 6*81 Surface water 100'+ Driveway, parkmgivehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
•WR010027 **SEE LETTER DATED 6/11/1996
G. ENGINEER'S CERTIFICATION
I oertNy that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guideffnes in effect on Ihfs
date.
Engineers Printed Name JEFFREY A. GARNESS
Date I I I I /0,,
COSAFee$
Date of Payment /I IOG
Receipt Number. G. 3 ? S
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
�a .0 '6NJAV^
Municipality"of Anchorage
-. Development Services Department -
Building Safety Division '
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel l.D. OSI- lot -I `(
HAA # b5 n l l9
Expiration Date: 3 —
.3 O
1. GEN,ERALINFORMATIO' N
Colnplelele6pfdescription69b
1-07
�
L6cati0.n (site address or directions)
2300"7
ROS 'iiut, "E-
-dt.Current
CurrentProperE owners) ReEAIAA
K. T44,6K
Day phone
f�laifin g address33001
IZoSEguD
POW "t:- LH -44r.4
.414 j %U2
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address .
Unless otherwise requested, HAA will be
held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑l
Community On-site
❑
Public Water System
(}K
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 sample results. (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.
4. 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,
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 Eagle River Engineering Services Phone _691 -5/9C -
Suite 20 1
S
Address Ea -de River. AK99577
Engineer's Printed Name 6H2XSroPftQ P, tJooD Date 3/22/4 S
5. DSD SIGNATURE
—jZ. Approved. for 3 bedrooms.
Disapproved.
Conditional approval for --- —bedrooms, -with the following stipulations: -
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: � Original Certificate Date: 3 " 3 O — 0„6�
(Rw. oiroz)
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.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: loz ED Lr9i 4 Parcel ID: 05'1^102-19
A. WELL DATA
Well type RADIX(-
Date
CL
Date completed _
Total depth ft.
Date of test
Static water level
Well production
WATER SAMPLE
Cofrform L
If A, B, or C provide PWSID # _
Sanitary seal (Y/N) _
Cased to ft.
Well Log (Y/N)
Wires properly
Casing hgjghtTabove ground) in.
FROM WELL LOG h jJNSPECTION
00 ml. Nitrate mg./l.
ft.
Other bacteria colonies/100 ml.
mg./l. Date of sample: _ Collected by:
B. SEPTICI14G68I116 TANK DATA
Tank TypelMaterial ST&EL Date installed
Tank size J41= gal. Number of Compartments Z Cleanouts &N) Yt S
Foundation cleanout &N) ]jam Depression over tank (Y/IV NFA High water alarm (Y/tV VQ
Date of pumping 3h5 /d_C Pumper TR' S
C. ABSORPTION FIELD DATA
Date installed 12 Soil rating (9#_."2 or ft=/bdrm) �Z System type 7RE7l1(N
Length III ft. Width 3 ft. Gravel below pipe S ft.
Total depth '� ft. Eff. absorption area 1 I f Oft' Monitoring tube � Depression over field _&JQ
Date of adequacy test 3 / S/ fpm Results (Pass/FO) P4PS For 3 bedrooms
Fluid depth in absorption field before lest _L3 in. Water addedWgal. New depth_Z_e in.
Elapsed Time: -Lq4Qmin. Final fluid depth 133 in. Absorption rate >= 4 SO g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y6)& type) No If yes, give date /[,
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
`Pump on" level at _ in. "Pump 0
1vel at)6,-1)--',1n igh water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
) V
Absorption field on lot 7 bn adjacent lots
tJ'
Public sewer main Public sewer manhole/cleanout
Sewe service line Holding tank
SEPARATION DISTANCES FROM SEPTIC/1-191:4)" TANK ON LOT TO:
Building foundation +/0 Property line t ID f Absorption field t S
Water main 4110 / Water service line +10 1 Surface water i t00 r
Wells on adjacent lots +160
I
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
t
Property line X 4b. S Building foundation 4 I r Water main 1-10" 10 1
Water Service line _& Surface water d- ttM r Driveway, parkingivehicle storage 7*10 1
Curtain drain A"Mi; r.A)b l Wells on adjacent lots f /oo t
F. COMMENTS
I
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.
Engineer's Printed Name 6dTP970Pff6V-
i2. b,Jd01�
Date 3/24/0.5
HAA Fee $ Q :JY1 00 Waiver Fee $ _
Date of Payment��iCr Date of Payment
Receipt Number 1_IFS'2I LIES =.%M Receipt Number
(Rev. 12/01) `
3-L'J-•S
L, 1400 03
RasE e per
uD (2ow AS -BUILT
I hereby certify that 1 have surveyed the following described
property LOT- S t (LE.EU SuRb.1 A I/?- I/AE Iii .
PlE%��NE'!61 . sEc.9�' . 1sh�
��c�M�
Anchorage Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the Property lines'and do not
overlap or encroach on the property lying adjacent thereto, that
no improvements on property lying adjacent thereto encroact-
on the premises in question and that -there are ndroadways,
transmission lines or other visible easements on Bald property
except as indicated hereon.
Dated at Ogle River, Alaska
this'qday of���
ROBERT C. JOHNSOMmay
SCALE: r Registered Land Surveyor No. 8"O -LS
1•• - ZO - Box 77.0456, Eagle River, Alaska 9957,
Phone (907) 694-2543 1
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I hereby certify that 1 have surveyed the following described
property LOT- S t (LE.EU SuRb.1 A I/?- I/AE Iii .
PlE%��NE'!61 . sEc.9�' . 1sh�
��c�M�
Anchorage Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the Property lines'and do not
overlap or encroach on the property lying adjacent thereto, that
no improvements on property lying adjacent thereto encroact-
on the premises in question and that -there are ndroadways,
transmission lines or other visible easements on Bald property
except as indicated hereon.
Dated at Ogle River, Alaska
this'qday of���
ROBERT C. JOHNSOMmay
SCALE: r Registered Land Surveyor No. 8"O -LS
1•• - ZO - Box 77.0456, Eagle River, Alaska 9957,
Phone (907) 694-2543 1
Municipality of Anchorage ••
1-15
Development Services Department
��. Building Safety Division .. ..
Onsite Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.d.enchorageek.us
(907)3437904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 051-102-19 HAA# HA 6'1 O7 -a3
1. GENERAL INFORMATION Expiration Date: O off_
Complete legal description REED SUBDIVISION: LOT B.
Location (site address or directions) 23009 ROSEBUD ROW AVENUE • CHUGIAK. AK 99567
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
WILLIAM ROBINSON Day phone 688-0303
Day phone
RENEE BIANCO w/ DYNAMIC PROPERTIES Day phone 261-7650
3111 "C* STREET • ANCHORAGE. AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
®
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil
engineer registered in the State of 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 sample results less than 30 days old. (Certificates may be reissued for a period of
up to one year with valid water samples.) Certificates are valid for one year for properties 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 $700.00 at, or prior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat afrixed hereto and as of the validation date shown below, I verify that my
Investigation, based on procedures outlined In the Health AuthorityApproval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system ls(are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated heroin. I further verify that based on the
Information obtained from the Municipality of Anchorage tiles and from my Investigation and inspection, the
on-site water supplyandlor wastewater disposal system Is(are) In compliance with all applicable Municipal
and State codes, ordinances, and regulations In effect at the time oflnstallatlon.
Name of Finn
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SUITE 213 • ANCHORAGE, AK 99504
Engineer's Printed Name
Engineer's Comments:
JEFFREY A. GARNESS. P.E.
In conducting this evaluation, AWWC, Inc. attempted to provfdo a thorough,
conscientious engineering analysts of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the peftmanco of the
system under the conditions encountered at the time of the test and separation
distances measured to readily identifiable features. The opera tional life of all wells and
soptic 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 evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do May guarantee that
there are no hlddon defects or encroachments. AK=, Ina can therefore not provfde
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 solo bonefit 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 right whatsoever.
5. DSD SIGNATURE
✓ Approved for. 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the flowing
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Phone 337-6179
Date 0� "
Manitenance Agreements
Supplemental Engineer's Reort
Other
ON-SITE
WATER AND •:
WASTEWATER
• PROGRAM
By: � Original Certificate Date: S ''
OW. izcol
Municipality of Anchorage
Development Services Department
Budding Safety Division
OnSlte Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 19WW Anchorage, AK 995196050
www.ci.anchorage.ek.us
(907) 3437904
HEALTH AUTHORITY APPROVAL CHECKLIST
ee'9eeo
Legal Description: REED SUBDIVISION; LOT 8, Parcel ID: 051-102-19
A. WELL DATA
Well type If A, B, or C provide PWSID#
Date completed Sanitary seal (YM
Total de Cased to ft.
FROM WELL LOG
Date of test
Static water level ft.
uction g.p.m.
WATER SAMPLE RESULTS:
Coliform ooloniesM00 ml. Nitrate mgA.
ON
e. SEPTIC/HOLDING TANK DATA
Well Log
property protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
ft.
g.p.m.
Tank TypelMaterlal STEEL Data installed 12/84
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (YM) NO High water alarm (YM) N/A
Date of pumping )_ j"KL2=i PumperSoA r Lq Pum o x%
C. ABSORPTION FIELD DATA I -BELOW FINAL GRADE
ml.
Date Installed 12/84 Soil rating (g.p.d./fe0roj5j� 362 System We TRENCH
Length
ill ft. Width 3 ft. Gravel below pipe 5 ft.
Total depth 10 ft. ER. absorption area 1110 fe Monitoring tube YES Depression over Heid NO
Date of adequacy test 5/3/01 Results (Pass/Fall) PASS For 3 bedrooms
Fluid depth in absorption field before test 4/15 in. Water added695 gal. New depth' 4 291n.
Elapsed Time: 1123 min. Final fluid depth4/'7 in. Absorption rate>= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
D. UFT STATION
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot
Absorption field on lot
Public sewer main
line
PUBLIC WATER
On adjacent lots
On
Public sewer manhola/deanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+
Property line 5'+
Absorption field
5'+
Water main 10'+
Water service One 10'+
Surface water
100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
"8.5'
Building foundation 10'+
Water main 10'+
Water service line
8'+�-
Surface water 1000+
Driveway, parking/vehide storage 40'+
Curtain drain NONE KNOWN
Wells on adjacent lots 100'+
*PER AS—BUILT SURVEY
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I ceAHy that I have determined through field inspections and We review of Munidpa/ records that the above systems are in conformance with MOA HAA guidelines in effect on this date.
0 . ness,
Engineers Pri Name JEFFREY A. GARNESS ADate° 4
�P�o les6b�do�
HAA Fee $ 3c� . "
Date of Payment �5 — /4,', -o /
Receipt Number `-lqz-tg
Waiver Fee $ 116 , o 0
Date of Payment
Receipt Number y�8�
Municipality of Anchorage
George P. ll'uereh. Mayor Department or
Public Works
Bttildin(I Safety Division
I'.O. Bos 190650 a 4700 S. Bragaw Street
Anchorage, Alaska 99519.61650 • (907) 343.8301
h ltp://)titiv.cl.anchorige.ak.us
AK Water & Wastewater Consultants, Inc.
ATTN: Jeffrey Gamess, PE
6901 De Barr Road, Suite 2B
Anchorage, AK 99504 -
May 24, 2001
Subject: Waiver Request forREED LT 8
Waiver # WR010027 Lot Line Request for Parcel ID 051-102-19
Dear Engineer:
Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater
disposal system to the lot line has been approved. The approved separation distance is 8.5 feet.
This waiver approval applies to the current on-site wastewater disposal system and lot line
separation only. Any future upgrade to the on-site wastewater disposal system and lot line will
require all separation distances to be met or another waiver approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office at
343-4744.
Sincerely'/
Jeff Jeff P et
Engineering Technician III
On -Site Water Quality Program
ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
May 23, 2001
Municipality of Anchorage
Department of Development Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Lot Line Waiver for Reed Subdivision, Lot 8.
To whom it may concern:
The septic system on the subject property was installed in 1984. It has a trench type drainfield
that, per MOA records, is 3 feet wide and is 13 feet from the lot line. According to the as -built
survey (Robert Johnson, L.S.), one of the trench clean -outs is only 10 feet from the south lot line.
Given the fact that the trench is 3 feet wide, it is assumed that the drainfield (subsurface) is
approximately 8.5 feet from the property line.
This separation distance was noted on the last MOA health certificate that was approved in June
of 1996. Regardless, it is our understanding that a lot line waiver will be required at this time in
order to receive a current Health Authority Approval.
The subject lot line parallels a road right-of-way, consequently, there are no septic systems to
encroach upon. In short, there does not appear to be any adverse impact associated with this
encroachment. We request that your department waive the required separation distance from the
drainfield to the line to 8.5 feet.
If you have any queyUons, please contact me at 337-6179.
M.S.
6901 Debarr Road, Suite 2-B * Anchorage, Alaska 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
Onsite Services
Waiver Review Worksheet
WR#: 010027 PID#: 051-102.19 HAM 010223 Permit#:
Date Received: 052401
Legal Description: Reed Subdivision: Lot II
Engineer.
6 'Iil61-1;T iL'L•ZSIEnirV1i;jw_MI -=-T-3 i:1:4'kl•:1L
Applicant: William Robinson
Waiver Requested: Absorption Field to Lot line of 8.5 feet
Criteria: 1. Geology Points:
A. Water Table
B. Sal Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
2. Special Conditions:
3. Other.
..........
Waiver Is Granted:
List Conditions or Reasons for above:
Total:
Waiver is not Granted:
Date: _57n2Y — O I By: �
..........
Rec#: 05-24-01 Amount Date Paid: 05.24-01
MUNICIPALITY OF ANCHORAGE AlAk
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services ME
On -Site Services Section
P.O. Box 196650 Anchorage. Alaska 99519-6650
343-4744 '�
"✓/C/••
CERTIFICATE OF HEALTH AUTHORITY '�
APPROVAL FOR A SINGLE FAMILY DWELLING 4 a
s�.
Parcel l.D. # 051-10 2 -117- 000 HAA # 9121
1. GENERAL INFORMATION /p+
Complete legal description L -or 6, Mao QIt>
Location (site address or directions) 7-2,009 2o&54jup r2 ov1 p✓E
P'i171e25;. C,PS64--1 , D-• 94Sb�
Property owner L -Au fzp�E.-r EA F2 �T' —� Day phone B 8 -/293
Mailing address
5v r6—z" =-- "�.. c Q. o go -c 6'7 19 47 0 gg st
Lending agency Day phone 'j 14
Mailing address
Agent �''P021`�"�~G Day phone 694-9e3S'
Address N 1A 696-7628
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3 �'
3. TYPE OF WATER SUPPLY: S
Individual well —V 10
Community well l 1 0
Public water _X— '^
0; �•' t�,
NOTE: If community well system, provide written confirmation from State ADEC attest=
Ing to the legality and status of system. `i . t•�
4. 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.
72-025 (R«.1Ai) FWt MOA 121
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 1°AeO" Uj4TC'¢ t � '` ' Phone 3?7-6/72
Address `$`f, t �' P4 OR c<r 4�. r19SO4
Engineer's signature Date i% 9
G GLVSiJL— 4pa� 1t4Vo1c8 -
Stf�r-+�rrF� -m Bog Baowj>
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
, I
i
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 courtesyto 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.
nan Mft IM) B. MOA W
Municipality of Anchorage N
DEPARTMENT OF HEALTH & HUMAN SERVICES 'Q?{
Environmental Services Division
(*0)) 825"L" Street, Room 502 0 Anchorage, Alaska 995010 (907) 343-4744
s
1� 9
Health Authority Approval Checklist
Legal Description: L a r, 9, FES.D S h> Parcel I.D.:
A.'%MLL DATA C -k" W A-- r—
Well type
Log present (YM) _
Total depth
Sanitary seal (YIN) -
Date of test
Static water level
Well production
WATER SAMPLE
If A. B. or C. attach ADEC letter. ADEC water system number
Date completed
Cased to
FROM WELL
Coliform / Nitrate
sample:
& SEPTICRIOLDING TANK DATA
Casing heighijAlfovc ground)
Wires pW*iy protected (YM)
2—
p.m-
Collected by:
AT INSPECTION
Other bacteria
9—
p.m-
Date installed � Tank size 1000 Number of Compartments 2— Cleanouts (Y/M-Lo.S
Foundation cleanout (Y/N) �*eW� Depression (YIN) Ao High water alarm (Y/N) �
Date of Pumping S t y 9S Pumper .S IR's
C. ABSORPTION FIELD DATA
Date installed 1464- Soil rating (g.p:dleor ft=lbdrm) System type 'ii^)cu
r i i
Length _1 11 Width 3 Gravel thickness below pipe 5 Total depth 10
Effective absorption area 19 10 Monitoring Tube present(Y"Y Depression over field (Y/N) -0J O
Date of adequacy test 6 0 j9t Results (Pass/Fail) UFSS For 3 bedrooms
Fluid depth 69/t I 628 Zz-'
dcp absorption Geld before test (in.); �_ Immediately after_ gal. water added (ia.): 8
Fluid depth ZO (ins.) Minutes later: 180 Absorption rate = Z8 •ie to pAh = 686 600
G
Peroxide treatment (past 12 months) (YIN) k^lw.+--J If yes, give darn nJ � H0AP
STATION
Date installe
t
Manhole/Access (Y/N) —
High-water alarm level at*
,.1 Ito
Size in gallons
on" le N'
*Datum
E. `SEPARATION DISTANCES N'p.
DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on
Absorption field on lot
Public sewer
service line
On adjacent lots _
Public sewer
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
"Pump oft" level at*
Building foundation 4
1 Property line 3O tr Absorption field 16 r=
i
Water main/service line > to Surface water/drainage �19 Kb ' Wells on adjacent lots 7 ton r
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
i
Building foundation 30 Water maintservice line $ts
Surface water NONE o&ffi2wW)-- lcV:1nvewey, parking/vehicle storage area 40 e+
Curtain drain NoNF °g�R Wells on adjacent lots 10 Zoo Propem• line 8.5a PQ0-
SvR�'
F. ENGINEER'SCERTUICATION
1 certijv that 1 have th mons end review ofMunfcipd re C me
in conjormaace i r M ti Ines n effect on this date. i '�..7
r �
Signature % » . N. .
Engineer's Name/ I/� (yn/2�yd� w/ T
�I ti� M7953
Date (o/ter//'►G t♦
yf' t'�\ AOfE5 tS��
HAA Fee S 0V • ";I
Date of Payment 64�P;?/2 j
Receipt Number1� 1)
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee S
Date of Payment
Receipt Number
,-J
Iry :5,Z.W
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t j�,11 6i o�,.:•t C. lc:nnw� . .
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1
AS -BUILT -
7 hereby certify that 1 have surveyed the
property: LOY- P. , 17
described I
- rA,
Anchorage Recording Precinct, Alaska, and that the improve;
mems situated thereon are within the property lines and do.not ; • '
overlap or encroach on the property lying adjacent thereto, that;
no improvements on property lying adjacent thereto encroach
un the premises in question and IFtat there are no roadways,,
transmission lines or other visible easements on said)iroperty
except as indicated hereon.
Dated at Eagle River, Alaska
this—L ria. day of `
ROBERT C. JOHNSON a
SCALL: Registered Land Surveyor . LS
?OBox 77.0456, Eagle River, Alaska 99577 .
Phone (907) 694.2513 '
.\
IV
4_.
ti.
Y
YO
Yt rlllsv��y,�.
t j�,11 6i o�,.:•t C. lc:nnw� . .
it
MJ.
1
AS -BUILT -
7 hereby certify that 1 have surveyed the
property: LOY- P. , 17
described I
- rA,
Anchorage Recording Precinct, Alaska, and that the improve;
mems situated thereon are within the property lines and do.not ; • '
overlap or encroach on the property lying adjacent thereto, that;
no improvements on property lying adjacent thereto encroach
un the premises in question and IFtat there are no roadways,,
transmission lines or other visible easements on said)iroperty
except as indicated hereon.
Dated at Eagle River, Alaska
this—L ria. day of `
ROBERT C. JOHNSON a
SCALL: Registered Land Surveyor . LS
?OBox 77.0456, Eagle River, Alaska 99577 .
Phone (907) 694.2513 '
r
Alaska Water & Wastewater
8471 Brookridge Drive — Anchorage — Alaska 99504
Phone (907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
June 11, 1996
Municipality of Anchorage
Dept. Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O Box 196650
Anchorage, Alaska 99519-6650
�Gy �1((sFOlt
��'o
F�F�l� X96 "OV
Fp
Ref: HAA for Lot 8, Reed S/D. 23009 Rosebud Row Ave., Chugiak, Ak.
To whom it may concern:
The subject lot is served by a private septic system, and city water. I inspected the septic system
on 6/10/96. Comments are as follows:
SEPTIC SYSTEM ADEQUACY TEST: The existing trench system is 111 feet long, with an
effective depth of 60 inches. The initial water level in the trench was 6.56 inches. Water was
introduced at a rate of 7.9 gpm for a total of 79 minutes (628 gallons). The liquid level in the
trench rose 15.56 inches to a total depth of 22.1 inches (37% of the effective depth). This
corresponds to 40.35 gallonsrnch. The recovery was monitored for 3 hours during which time
the level dropped 2.1 inches (86 gallons). Based upon this data, given constant head conditions
(at o* 22.1 inches of head), the trench will absorb approximately 28.6 gallons/hour, or 686
gallwu'day.
The recovery of the trench was monitored 23 hours later (the two occupants restricted their water
usage overnight to an estimated 25 gallons) and the liquid level had dropped to 14.5 inches (7.5
inch total drop), which is equivalent to an absorption rate of 13.2 gallonsthour, or 317 gallons per
day. Including the 25 gallons that was used by the occupants, the absorption rate, given falling
.} head conditions, was approximately 340 gallonstday. I am confident that if the trench was filled
to a greater depth, it would absorb more than 450 gallons/day, even under falling head conditions.
Based upon the data (constant head conditions), the septic system is deemed to be adequate for a
3 bedroom house (450 gallonvday).
NOTE. The adequacy of a septic system is in j7uenced by numerous factors, including, but not
limited to, seasonal surface water infiltration, grouralwater variations, septic system
maintenance (frequency of septic tank pumping, usage of biological additives), condition of
drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age),
type of substances deposited in septic system (cigarette butts, sanitary napkins, mise. objects),
and the amount of water being introduced on a contimial basis. Consequently, the results of this
adequacy test are only valid for the specific day ofthe lest Furthermore, because of the limited
nature of this investigation, it is possible that there are hidden defects which may not have been
detected No warrantee is made regarding the future performance of this uclpor septic system
WATER SERVICE LINE 8 FEET FROM TRENCH: The lot was connected to city water
within the last year. The contractor that installed the water main also installed the water service
lines. The key box is located approximately 10 feet from the south sump. According to the
homeowner, the water fine runs straight from the key box towards the hose bibb by the front
door. Given this, the water line must run only about 8 feet from the trench. I don't see this as
being a serious health concern, but thought it should be noted for record.
If you have any questions, please contact me at 337-6179, or on my pager at 1-800481-1162.
Thank you foryour assistance.
c.c Bob Brown, Agent for Ms. Fritter.
Laurretta Fritterl.wps
ka
.O-1 laz /9
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH b HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES • IIpp
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744 .
Application Date July 15, 1988
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 8: Reed Subdivision
Location (address or directions)
(b) Property Owner HUD Telephone: Home Business
Mailing Address #025748
(c) Lending Institution City Mortgage Telephone
Mailing Address ATTENTION: Carol Nesbeth
(d) Real Estate Company and Agent Lou Campbell/ASSCCIATED BROKERS
Address. 640 West 36th Avenue, Suite One, Anchorage, Alaska 99503
Telephone' ' 563-3333
(e) Mail the HAA to the following address: or: Check here 9 if hold for pick up.
List contact person and day phone number below.
S & S ENGINEERING/694-2979
17034 Eagle River Loop Road Suite 204
ra91e River Alaska 99577
ordered by Lou Campbell
2. TYPE OF RESIDENCE
Single-FamilyiR
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well ❑ Community)U 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 E% 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 72-075 (Rw 8 W Front
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leuolssalad ayl u, suo!sslwo jo sjaja jol alg!suodsaj lou s! 96=43uy to Alpedlo!unyy ayl •panssi sl eleoippao a aiolaq
elep azAleue jo suolloadsui lonpuoo lou op SHHO to saaAoldw3 •sluawaiinbai alels pue lejapa) u!eUao Amies of �ap�o
u! suo!lnl!isu! 6ulpual rayl pue sawoy to siaseyoind of (saUnoo a se s!141 saop SH HO 041 •e�lselV to ale1S a41 u! pajalsi6ai
Jaaul6ua leuo!ssalad luapuadapu! ue Aq anoge S ydei6eied w u9n16 Su013e1uasOjdal ay1 uodn Aluo paseq saleo!pPao
lenaddy tluoylny ylleaH sanss! (SHH(3) sao!niaS uewnH pue yileM to luawlyedaO 06ejo14ouy to (llledlolunyy ayl
NOI1nV0
lenaaddy leuop!puoO to swial
leuoll!puoO panaddes!O �— panaddy
_ ele0 �n, ,,,, i � dq swowpaq ---y— sol panaddy
�
C!(�/J/L IVAOtlddV SHHO
r mrt fit
A"*y►"
oleo
ajppV
-"a ...... I....3G •l�3 PEOLl
auoydalal ON11133NION3 S I S wnd l0 OWEN
uoyoadsu! s!4i to alep eyl
uo loalla ul suo!leln6ai pue'saoueu!pjo'sapoo OmS pue ledlo!unyy Ile yllm aoue!ldwoo u! s! wals.ts lesods!p jalemalsem
jo/pue (lddns Salem ells-uo ay1 'uogoadsui pue uo!le6!lsanu! Aw wal pue sapl a6ejoyouV to AplediotunVy ayl wal
pau!elgo uo!lewJolu! 9141 uo paseq leyl A1!Jan jaglm) I u!aiay paleolput ainlonils to adA1 pue swoapaq to jagwnu ayl jo;
alenbapepueleuo!iounl'aless!walsAslesodslpialemalsemio/puetlddnsiaiemei!s-uoaylleyismogslenaddyAluoylny
411eaH s!yl to uo!le6llsanu! dw leyi Al!Jan l'molaq umo14s alep uogep!len aql to se pue olaiay paxyle leas Aw Aq pa!l!uao sV
E
NOIIVWHOjNI ONV VIVO'HOHV3S 311d'S1S31'SN01103dSNl E)NIOIAOHd WFlId ONIV33NION3 'S
n r,
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES IVISICIN
UNICIPALITY OF ANCHORAGE (MOA)
EALTH AUTHORITY APPROVAL (HAA)
J U L 2 2 1984 CHECKLIST - FEBRUARY 1984
264-4744
RECEIVED Legal Descriptio e
S_
A. WELL DATA
Well Classification G If A. 8, C. D.EC. Approved (5li )
Well Log Present (Y/N) Date Completed
Total Depth Cased to
Static Water Level
Casing Height Above Ground _
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N) —
_ Depression Around Wellhead (Y/N)
To Septic/Holding Tank on Lot 2'M4 ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot 11110 ; On Adjoining Lots —
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Ll(�CIhSG4=R-Irby ;Date
SDT1S5a�a�
B. SEPTIC/KOtV" TANK DATA
Date Installed 17iSize I 521125> No. of Compartments '%
Standpipes&9N) Air -tight Caps4PN) Foundation Cleanout CJ7N) _
Depression over Tank (Yo Date Last Pumped17-1
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/tfokkag Tank:
r '
To Water -Supply Well 2'� `4 To Building Foundation " �S
To Property Line 4o To Disposal Field
1
To Water Main/Service Line o To Stream, Pond, Lake, or Major Drainage
Course
Comments
Pagel of 2 .
72-M IPw 8 $61 FM -1
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata l.Z��k Type of System Design
Date Installed - r
Length of Field
Width of FieldDepth of Field
3 f
�
t
Gravel Bed Thickness S
Square Feet of Absorption Area OStandpipes PresentiWN)
Depression over Field (Y& t. -I Date of Last Adequacy Test Z -) $7
Results of Last Adequacy Test G��ISPDz�-fl��?�ti1�r1 f� psgsr�
Separation Distance from Absorption Field:
r i
To Water -Supply Well To Property Line �3
To Building Foundation .3 o I To Exiting or Abandoned System on
Lot On Adjoining Lots 30 -V-
To Water Main/Service Line c A" To Cutbank (ii present) r-1 A
To Stream/Pond/Lake/or Major Drainage Course !+
To Driwvay.Parking Area, or Vehicle Storage Area
D. LIFT STATION rJ
Date-( ailed
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 _
!:�ent (Y/N)
•. Check Permitted Bedroom Rating Against HAA Request ..
I certify that I have checked, verified, or conformed to all M Aar
Signe` S ENGINEERING ate % 2
170�Rtvs►tooP-R*81 N6�
Como"16 Riva Alsshs "577 MOA No.
Receipt No. cX_11e`
'-3 (% 6 S .201T -.Z6
Al
Date of Payment -Aa- -,PIP
Amount: $ %40 , a -e— &4R -C,
Page 2 of 2
72-026 (Ft" 81861 Back
Pumping Cyc ring Adequacy Test. Meets MOA
guidelines in effect on the date of this inspection.
so li 9 E e .eal • t�
I •• A. u„b aw
19Fn� ••.»..r••.�`LAF.
!~ ^ STEVE COWPER, GOVERNOR
uo F RUM
DEPT. OF ENVIIIONMENTrAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775
3601 C STREET. SUITE 1334
ANCHORAGE, ALASKA 99503
DATE: July 21, 1988
PWSID: Class C Well
To Whom It May Concern:
According to the records on file in this office, the Lot 6. 7. 8.
9 REED SUBDIVISION Water System is in compliance uith the State
of Alaska Drinking Water Regulations.
Sincerely.
i
Ronald S. Klein
Environmental Field Officer
MUNICIPALITY OF ANCHORAGE S i
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION , 1 O -7,/
DIVISION OF ENVIRONMENTAL HEALTH 0_
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY FLS
264-4720
Application Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
1.4 Z- B BLk —0 PsE� n 9(1 e 1n
Location (address or directions)
(b) Applicant Name Nn1/41 R2tr.egrifeI _ Telephone: Home Business 661-6680
Applicant Address 107C.7 tj Sn -f , ) &/' P-1 Anr Z A r- 99�77 9
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other (explain); f
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
klint/A PPb/Je.-fres 9,1tfiu: cci SAA10elef
S's -1 PN /mn• n
AAic 99SIs
2. TYPE OF RESIDENCE
Single -Family Multi-Faamily ❑ Other
Number of Bedrooms J
3. WATERr9UPPLY
Individual Well ❑ Communityx 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.
72-025 (11,64)
Page 1 of 2
5. ENGINEERING FIRM PROVIDING ,NSPECTIONS, TESTS, FILE SEARCH, DA... AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verity 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 in�%ection. p�
Name of Firm -CTelephone
Address 0G' ° ' Ct!c� C n
Date 17-1171W-7
' = c' Engineer's Seal
6. DHEP APPROVAL
Approved for bedrooms by Date
Approved Disapproved Conditional
Terms of Conditional Approval
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) .
i,MUNICIPALITY CF ANCHORAGE
cNVIRONMENTAL SERVICES DIVISION
MUNICIPALITY OF ANCHORAGE (MOA) DEC 1 V0 1987
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984 RECEIVED 2644744
Legal Description: n T 8 g! C Jd
e1=F_�N
A. WELL DATA
Well Classification rnm� If A,. C�.EC. Approved (Y/N) �V
Well Log Present (Y/N) Date Completed Yield
Total Depth Cased to Depth of Grouting
Static Water Level Pump Set At
Casing Height Above Ground Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot ZZ ¢ 1 : On Adjoining Lots
t
To Nearest Edge of Absorption Field on Lot 7-7-0 : On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by % nt}/ �s°F. ; Date / L�-7
Water Sample Test Results /
Ade 77
B. SEPTIC/HOLDING TANK DATA
Date Installed le hg184 Size/=`K / No. of Compartments e --"-
Standpipes
Standpipes (Y/N) Air -tight Caps (Y/N) —,� Foundation Cleanout (Y/N) —�
Depression over Tank (Y/N) A/ / Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) N /t� ; for iu /fl
Holding Tank High -Water Alarm (Y/N) N1 Temporary Holding Tank Permit (YIN) �
Separation Distances from Septic/Holding Tank:
r
To Water -Supply Well Z K4 t To Building Foundation �S
To Property Line 46 To Disposal Field K r
To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage
Course IJ
Comments
Page 1 of 2
72-0M (S" 8 861 Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 'K 6Z ST -(4 /&I,Type of System Design ' _r Z&1 C l-1
Date Installed /Z- o/v le d Length of Field III,
t
Width of Field 3 Depth of Field q
Gravel Bed Thickness
Square Feet of Absorption Area 1_116 0144 Standpipes Present (Y/N) Y
Depression over Field (Y/N) Date of Last Adequacy Test (C /L 4 7
Results of Last Adequacy Test 5ATI1 FNS-rQ#0V
Separation Distance from Absorption Field:
To Water -Supply Well ZZO To Property Line /3)
To Building Foundation QU t To Existing or Abandoned System on
Lot -- -lA ; On Adjoining Lots CO f
To Water Main/Service Line To Cutbank (if present) M.M
To Stream/Pond/Lake/or Major Drainage Course K M
To Driveway, Parking Area, or Vehicle Storage Area
Comments vf,,4,/ ayr r 7-0/) r c 7-x- /^ a C e Ft e
D. LIFT STATION ► / !
11
Date Inst led
Dimensions
Size in Gallo
Manhole/Access (Y/N)
"Pump On" Lev at
"Pump Off' Level at
High Water Alarm L el at
Vent (Y/N)
Tested for
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
•• Chec9Y9 m
Rating Against HAA Request ••
Icertifyverified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed
Dte /1,,44 -Z
Compa
/ •MOA No. SZ -67-e716'
Receipt No.
Date of Payment /I —
S;- 7
Amount: $ / O O
c7 r ` ` Engineer's Seal
Page 2 of 2
'
72-M IRev 9'N1 Sxk
- - -
-
• � � OF HUM STEVE COWPfR, GOVfRNOR
�
DEPT. OF ENVIRONMENTAI, CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775
3601 "C" STREET. SUITE 1334
ANCHORAGE. ALASKA 99503
DATE: _ 12-17-87 ----------
PUSID
2_17_87---
PWSID #: Class C R'ell_—_
Peters Creek
To Whom It May Concern:
Accordinq to the records on file in this office. the REID_SUBDIVISION
Lots 6,_7Z 8,_f, 9 Class C Water System is in compliance uith the
State of Alaska Drinkinq Water Requlations.
Sincerely.
Ronald S. Klein
Environmental Field Officer
Per verification of Jim Hayden, ADEC, Anchorage
CHEMICAL & GEOLOGICAL LABORATORIES OFALASKA, INC.
t 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
FEDERAL TAX ID N 92-0040440
ANALYSIS REPORT BY SAMPLE
Client POI : VERBAL ' Req 1:
Cl lent Smpl ID: LOTS 6, 7, 8, 9 REED S/D PETER'S CREEK
Sample Rec'd : DEC 21 87
Ordered By : THOM FISCNER
Send
Reports To: CORWIN S ASSOC
1200 INDUSTRY WAY, BLDG B, 1111
ANCHORAGE, AL. 99515
Special COLLECTED 12-21-87 BY T. FISCHER
Instruct:
Chemlab Ref 1: 0670 Lab Smpl ID: 1 Matrix: Water
Parameter Tested Result/Units
----------------------------------------------------------------
NITRATE-N 2.0 WI
Sample ROUTINE SAMPLE
Remarks: ANALYSIS COMPLETED: 12-21-87
LABORATORY SUPERVISOR: STEPBFM C. EDE
1 Tests Performed
ND= None Detected
RA= Not Analyzed
3
:t See Special Instructions Above
iM See Sample Remarks Above
LT=Less Than, CT=Greater Than
Work Order No.
: 4436
Client Account
: CORWIMP
Date Report Printed: DEC 30 87 9 11:17
Released By
: 20c-�
Reports Address 12
Method
Allowable
Limps
10
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIROICENIAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRO:MENTAL PROTECTION
APPLICATION FOF. HEALTH AUTHOFiTY APPROVAL CERTIFICATE
1. General Information Application Date
(a) Legal Description (include lot, block, "subdivision, section, township, range)
Location (address or directions)
/!LL o *_l iL*fc 'DJOI £ r
(b) Applicants Name `105 S11U4!J Telephone
Applicants Address �0. Lak 49-/087 e,4f6W lit �i9S�7
(c) Applicant is (check one) Lending Institution Owner/builder ;
Buyer E:7 ; Other F�' (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co. b Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. Type of Residence
Single—Family
Multi—Family Other (describe
Number of Bedrooms
3. Water Supply
Individual Well Cor,.mrnity Public
Note: If community well system, must have written confir...ation.from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite r7._7T Public Community E=1 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]
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 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 infoimation 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 regula-
tions in effect on the date of this inspection.
Name of Firm
Address /7 -el
/Td
Telephone
AIX
Date % 30' (l :�Q'.•' C� a•
r 3bt Lam;
�{�iTL�/ J1Lw.JC/G�6� .Q / ✓'„ r. • ...! Hia 1....
�� (ENGINEER SEAL) B (_
//
/ �9... •. •�.
i
c � Lc�y C. Reid, Jr.
N0.2:51•E
6. DEEP Approval �� •..
Approved for bedrooms By Date'^
Approved Disapproved Conditional
h
THE MUNICIPALITY OF ANCHORAGE DEPARMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIO&I.L ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE MEP DOES THIS AS A COURTESY TO PURCHASERS OF = ES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. E:`SPLOYEES 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 21
7-19-84
I 1 :ISI `.LITf C' A .HOI'.C[
L' , T. 07 1 I' ALTH
• - C"":Ir...,..=VV� F.'.CTCCT:OiI
i KUNICIPALITY OF ANCHORAGE (MDA)
HEALTH AUTHORITY APPROVAL (HAA) FEL =
CHECRLISr - FEBRUARY 1984
RECEIVED
A. WELT. DM Legal Description: 40r f AUB`
affil SNdb,✓'V nJ Ts -AI A?fGO S,ec_
Well Classification dl ftk.7T If A, B. or C D.E.C. ApprovedA)
Well Log Present (Y 9) A A Date Completed d�/0 Yield d
Total Depth A11A Cased to _ Depth of Grouting,
Static Water Level /t PumpSetAt A�i)
Casing Height Above Ground Sanitary Seal on Casing (Y )
Electrical Wiring in cmduit (y/N) ASA Depression Around Wellhead (Y/N)
Separation Distances from Wells
To Septic/Bolding Tank on Lot Z31�S _t On Adjoining Lots A
To Nearest Edge of Absorption Field on Lot Z�� t on Adjoining Lots��A
To Nearest Public Sewer Line AIfA To Nearest Public Sewer
Cleancut/Manhole AA 'To Nearest Sewer Servii ine on Lot
Water Sample Collected By Add (Dt Date Al
Water Sample Test Results
FAM
Date Installed t - -f size /00 BAL No. of Ccapartments
Standpipes MN) Air -tight Capsj `L. ) Foundation Cleanout ) `
Depression over Tank Y ) Date Last Pumped XA
Pumping/Maintenancs Contract on File Y )A) i for A)
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y )Ai/i
Separation Distances from Septic/Holding Tanks
To Water -Supply Weil Z3 4.f ' . ® To Building Foundation
To Property Lira 40f To Disposal Field
To Water Mairvtervice Line AIIA To Stream, Pond. Lake, or Major Drainage
Receipt t 3D3-JL1:)_
Date Paid: --fit
Amount: VS.Oc>
[Page 1 of 21 2-15-84
AOT T $a or ,tui
Soils Rat /
ing in Absorption Strata 3GL O Type of System Design 7bJCd
Date Installed Length of Field /// '
Width of Field S ' Depth of Field 9 If
Gravel Had Thickness
Square Feet of Absorption Area ///0 Standpipes Present AN)
Depression over Field (YA Date of Last Adequacy Test A/
Results of Last Adequacy lest A
Separation Distance from Absorption Field:
To Water -supply Well ' To Property Line /3 OF
To Building Foundation 40"(2)To Existing or Abandoned System on
Lot 2A s Cn Adjoining Lots SO' t
To Water Main/Servics Line dA To Cutbank(if present) tl A
To StreanVPo:d/[ake/or Major Drainage Carse -g A
To Driveway, Parking Area, or Vehicle Storage Area G'
D. LIFT STATION
Sias in Ga
"Ramp On" Level at
High Water Alarm Level at
Tested for
Electrical
Manhole/Access (Y/N) _
"Ptatp Off" Level at
Vent (Y/N)
ing Adequacy test. Meets MOA
Check Permitted Bedroom Rating Against HAA Request *'
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this
ctian.
of
Signed w`—t Date 1 ja-95�
Campany MOA No. ,0
(Page 2 of 21
L • • ALASKA ENVIRONM,FNTAL
CONTROL SERVICE INC.
1200 West 33rd Avenue Suite B
ANCHORAGE, ALASKA 99503
Phone 561.5040
JOB 4 _0
SHEET NO. a G/ OF
CALCULATED BY /' • -• /F DATE-��•��
CHECKED
DATE
Fmonl nor 4w �., p.••
n�n S K n BILL SHEFFIELD, GOVERNOR
W w
DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: J907)
Addm
ANCHORAGE/WESTERN DISTRICT OFFICE ,
437 "E" STREET, SUITE 303 274-2533
ANCHORAGE, ALASKA 99501
DATE:,
PWS I.O.k
To Whom it May Concern:
Accord'ng to records on file in this office the i�l,!�1ih (ltl7ut�'1��
Water System is in compliance -with the State Drinking
Water Regulations
Sincerely,