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HomeMy WebLinkAboutMARTENS LT 1AOnsite File Martens L1A Lot 1A PID# 017-441-65 (Formerly Christensens's Eqestrian Acres) —, Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 Parcel I.D. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 0 11-1-10 Hal i 1. GENERAL INFORMATION COSA #a C l ada33 Expiration Date: `1 ` 12— Complete Z Complete legal description Christen questrian Acres Subdivision, Lot 3 Location (site address) 5830 Huffman Road Anchorage, AK 99511 Current Property owner(s) Gayle D. Christensen Day phone Mailing address 5830 Huffman Road Anchorage, AK 99511 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: Individual Well ❑✓ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑✓ Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 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 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 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Phone 522-7773 Date 81612OV,;,v ,(04� Ot n s•m� i e• .A.9J,4i'•r 40, MOM L ANDOWN 5. DS�)� Apprtoved for bedrooms. ,�� jifs f d ESS10 Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By. / o Original Certificate Date: O " Rea 11105) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Christensens Equestrian Acres Subdivision, Lot 3 Parcel ID: 017-441-03 A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 12/16183 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 201 ft. Cased to 201 ft. Casing height (above ground) >13 in. FROM WELL LOG AT INSPECTION Date of test 12116/83 7/26/2012 Static water level 169 ft. 176.2 ft. Well production 25 9-p m. 7.2 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 2.40 mg/L Arsenic: N/D mg/I Date of sample: 7/19/12 Collected by: JKB B. SEPTIC/HOLDING TANK DATA Tank Type/Material septiclsteel Date installed 7131/84 Tank size 2.000 gal. Number of Compartmentswn Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 8/7/2012 Pumper Around the Clock Pumping C. ABSORPTION FIELD DATA Date installed 71311B4 Soil rating (g.p.d./ft2 or ft2/bdrm)1251150 sFBDRM System type Deep Trench Length 48 ft. Width 4 ft. Gravel below pipe 6 ft. Total depth 11-15 ft. Eff. absorption area 576 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7126/12 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 8 in. Water added 600 gal. New depth 14 in. Elapsed Time: 1.440 min. Final fluid depth 8 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Size in gallons "Pump off' level at —in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main N/A Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5 Absorption field >5' Water main N/A Water service line >10' Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10, Building foundation >10' Water main >19 Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS: A section of the absorption trench is under the edge of the driveway. The soils log utilized in the design of the absorption trench indicates 4' of the absorption area is classified as 125 SF/BDRM. The remaining T was classified as 150 SF/BDRM. The trench meets requirements for 4.35 bedrooms. 4i (r:V -q wP.•• -- G. ENGINEER'S CERTIFICATION fi); 4918 •ya l certify that I have determined through field inspections and '0 ! L review of Municipal records that the above systems are in s, •••.•.».......� conformance with MOA COSA guidelines in effect on this date.L AM m ; Engineer's Printed Name Michael E. Anderson, P.E. ��'•�"� Date 8/6/2012 COSA Fee $ � � Waiver Fee $ _ O Date of Payment O// a Date of Payment Receipt Number t ) 0 ZU 4 Receipt Number (Rev. 11/05) OHE Lot 1 Lot 2 0 M x —` Conc Gate Post M Q Huffman Road 3' Section Line Reservation � N89'55'05"W 199.31, x FT&tEE x °P Cone.----ai- �C77 ..�._w_� 'Gate Post ement_._ Shed 7yp, �- Light Post o Typ- �t Conc. Wei; P Planter O Q 75.3' ---- Typ. Conc- planter Lot 3 'Re, �ry 0 �ry- ry Lot 4 1F- 1 10' T & E Easement �.."�..- x .— v ooao� S89'49'29"E 98.43' OF A4 ;4 4 S89'49'290E L,vQ• qs�a� Lot 5 Mountain Park Estates Lot 6 o°O 49� �Qd P.... ............... .°. 4 NOTES: This drawing is not to be modified for use as. o plot plan Without the (j p, My P. Hoffman, �op0 !� expressed written consent of Lantech. V "e LS -9020 �"fy(, 2) Snow and ice may conceal minor surface features- a S° s�ret�."V�l+ 3) Per Christen�'s Equestrian Acres plot note number 7, a 15' Temporary Qf°raseronat�°eek' iV Goa Easement (not shown) is dedicoted centersd on the existing service line through Lots i and 3. This easement is to be 4utomaticotiy wcated upon removal or abandonment of said seNce line, � at;a,r. As -BUILT' $ 6ayte Christensen legend avrhoad Do, Pile Lot 3, Poem Fees .3 Sepuc Starulpip� r' V .r. Christensen's Equestrian Acres xater wi+ t' {� �.r - wa m.�pyri S)RWY f OMICAT"; LANTt'CH hm aonduetsd a Phy'poat v y of the = ZZ". o this *V~lr9 and outhu* that the "Yn enn the P"Peety IFws a no endeatlimy,te asfat LAND & CONSTRUCTION SURVEYOtY$-p s'-EIVGINEERS EXCLUesweec< A on a�nw the a,ers ` 4+0 west Benson BouON Sl Suite 200 Phone: 562-5291 "p0A6tion to r*t1o„ the Y 0s a the tS restrictions subdK aright—ai_e'e, Anchoru e, Alasko 99503 Zo Circ M6t do "sh �•O a" to her,,, b +Usedf , arae urea F•--- 561--6626 ter �Qst°M1�• e� y li any data hvson be uncal for eansu-uetion. Plat: 2005-112 -- �"� a`OPdtY cess, ur lar got—van Daryaws aid SW2838 oacc January 23, 2012 an.a sy PL ""� aroer: 2012-L-008 Rei. Zoos -s -as seae: 1-=40' ch•cxad By JM7 I / MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE I CKINEW �--�7 ❑UPGRADE MAILING ADDRESS E_hA.O h�( (cS 'o LEGAL DESCRIPTION Pnket ZZ IT 72x.1 I CL3,-�4 Z6 LOCATION N t� NO. OF BEDROOMS DISTANCE TO: Well �w ^�- Absorption area 15� Dwelling � PERMIT NO. U y i Q Manufacturer n Material No. of compartments F7 w Liq. capacitygallo s IF HOMEMADE: Inside length Width Liquid depth i' DISTANCE TO: Well Dwelling PERMIT NO. J t�Z I Z 4 Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well 1S& 7 Foundation esS 7 Nearest lot line %s0 r PERMIT NO. = Z No. of lines ` Length of each 'n / Total length f line Trench idth Distance between Ijn s^ F W inches s� F Top of tile to finish grade Material beneath tile. -t Total effective abso area �i inches t q`IL Length Width Depth PERMIT NO. W O i F W C_ Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line lejas!s Depth,7 oft Driller^� Distance to lot line PERMIT NO, ��� W DISTANCE TO: Building foundatio ��% Sewer line Septic tank 1'y(,% Absorption area(s) 1r—'�- - OTHER t PIPE MATERIALS SOIL TEST RATING INSTALLE REMARKS moo+ 1 P_`x ar.1 %1Ei D44 AR¢n� t3 tas34— . ir.1`5{YitL ` 8 gpopyp�+ [� A �.� V• �• a••oo. o.••• ao.. - � 6nYD J6. 11e WNF1ELDo APPROVED DATE LEGAL lei 72-013 (Rev. 3/78) 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME omy ZI NEW 31 64 a✓ ❑ UPGRADE MAILING ADDRESS . O1114162 9.57! LEGAL D (CRIPTION �ff�J A� XF�� LOCATIOfy.�A4CrL Z Z T{ rI //DISTANCE Z N R 3 W` //v O. OF BEDROOMS ' TO: Well I tO r Absorption area I Dwelling '? t PERMIT NO. UY t5-*3 3 wF Manufacturer /` n MateriaS No. of compartments KCL •7 w Liq. apacity in gallonsr` ,fid V IF HOMEMADE: Inside length Width Liquid depth d Y DISTANCE TO: - Well Dwelling PERMIT NO. JGZ = Z F Manufacturer Material Liquid capacity in gallons - DISTANCE TO: Well 1 (Z U Foundation Nearest lot line I r PERMIT. NO. O a w= O � u. z No. of lines Length of each line I Total length of lines I' Trench widt Distance between lines H Z w qf inches F Top of tile to finish grade I Material beneath tile j ?_ Total effective�absgrp�tion area O inches C=Jri Length Width Depth PERMIT NO. w C7 a F Type of crib Crib diameter Crib depth Total effective absorption area wa rn DISTANCE TO: Well Building foundation Nearest lot line _ Class Depth Driller Distance to lot line PERMIT NO. J w �+ DISTANCE TO: Building foundation Sewer line Septic tank - Absorption areas) OTHER PIPE MATERIALS o r SOIL TEST RATING - t5U INSTALLER N C-[JnJ£ ✓Jv I2• REMARKS IN 4t_OF A4® •Oa IIP • !!f!! !�`a� \ 1 J JZ. !!a!•••a••!!! 'tl!0, J. J. 8esp R :BOYO Nf16�Oa • 895 E = `m APPROVED -DATE LEGAL 72-013 (Rev. 3/78) UNICIPALITY OF ANCHORAGE Department Health and Environment '. 825 Street, Anchorage, AK. 501 (� 264-4720 10)400 # # HANDWRITTEN PERMIT # # # Permit # WELL ANDA�R__9-N-SITE SEWER PERMIT Applicant: Location: Q� �ti ��(yt Vtn1A►� Mailing Address: 1 G I 7 A r,l a �'T 1 a PJ R 3\,)3 Sec) -`'hone Number: Legal Description Type of Soil Absorption System Is: Trench: ✓ Drainfield: Seepage Bed: Size: 6- A , c4a-24 - I Holding Tank: Maximum Number of Bedrooms: 3_ Soil Rating(sq.ft/br) 1 S 0_ I The Required Size of the Soil Absorption System Is: I '_4 I C- I DEPTH I LENGTH �t 5 GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is 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). . * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ 10 00 GALLONS # # 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. * * * TWO(Z) INSPECTIONS ARE REQUIRED # # # 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 fee for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 S certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if A; esidence iss r d to include more that 3 bedrooms. n,� Signed %!�_� Issued by: i 1 � A is t Date: ;s 3, a q SWP/024(1/81) • . 5d SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: J Nr m d - DATE PERFORMED: 10414/93 II 11 � LEGAL DESCRIPTION: Po r c e! d T J eZ N. R 3 b4 S e f Q 6 SLOPE SITE PLAN a OL 1 Si 1 + gray, dry, (/'l L) 16 17 18 19 20 S;1+y Sand ray, damp. (5;-13 Sand welt graded. (S w) WAS GROUND WATER S �t ENCOUNTERED? , I L O P E IF YES, AT WHAT DEPTH? Sowd ,Poor ly graded, (S -P) ■■MERNM■■■ Date Gross Time Net Time Depth to Water Net Drop ■IrNSUNNI■■M e•'■■■■■'Q'12■ epi■■■■■��■■�� ■i■■■■■■■■il in Reading Date Gross Time Net Time Depth to Water Net Drop End PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT a4 Jas �/bedrnom be4,,ea 3 nd 13' ' an.4 ' e r PERFORMEDBY: l_n. fcan CERTIFIED 72-008 (6/79)' DATE: 101;1419, • 1/3O/gq (Parcel 22, Sec 26, T12N, R3W - Harmon) ADDITIONAL REMARKS: The original test pit was located in excess of the ten feet required maximum distance from the final absorption field (actual distance of about 30 feet). While the distance is in excess of the allowable limit there are essentially three holes triangling the area which substantially verify the predominant soils in the area: The original test pit; the water well log; and the absorption trench which, itself, is 15 feet deep. The soils log (test pit) and the first inspection of the trench revealed a fine grey silty layer (ML) down to about 7 feet with the underlying soils consisting of a variation of sand from silty, well graded, to poorly graded deposits, all of which can be classified visually as meeting the 150 feet/bedroom criteria except for the upper grey silty layer. The water well log generally substantiates these findings and verifies that the depth of the variable sandy material to be as much as 63 feet. The dimensions of the absorption field exceed the design requirements for a three bedroom home (actually meeting and exceeding a four bedroom home) and the septic tank has a capacity which far exceeds the three bedroom requirements having theoretically a 7 bedroom capacity. The absorption field is immediately adjacent to and under a portion of the driveway. This is some cause for concern, however, either cast iron pipe or PRC pipe having a crushing strength equal to or exceeding ASTM 3034 is in place. The use of this pipe and the fact that the tile drain is 9 feet below the surface minimizes any effect of traffic immediately over or adjacent to the field. I would, however, recommend caution be used by restricting only light vehicles to that portion of the driveway. Note the Soils Log dated 10/24/83 lacks a PE stamp. I consider this, however, of little to no consequence at this time. The major question here is the location of the original test pit to the final location of the absorption field. In my opinion, there exists other valid evidence which supports the conclusion that the test pit does, in fact, represent the true soils characteristics of the area. I further conclude that the septic system meets and exceeds the municipality standards for an on-site 3 bedroom system. For the above reasons I recommend that the original test pit results be accepted as a valid representation and the system be approved, as built, with a note of caution that only light traffic use the driveway adjacent to and over the absorption field. 0 MUA80#,k 6d 19 8 4 De artment of Health and Environmental Protection DEPT. A10* GL Environmental Engineering Division EINVIRONMENALPRLO/& 825 L Street IEC Anchorage, Alaska 99501 'JUL 30M4 Reference: Parcel 22, Sec 26, T12N, R3W - Harmon R Y r n , ..., Attn: Susan Oswalt Susan: I am in receipt of your message regarding the referenced lot and opologize for the delay in response. Your observation of the test pit being too far away is correct and since the system is in and grass planted we are trying to find another way to verify the soil conditions which is acceptable to the State and Municipality yet does not require digging up the area. In this regard I have asked DEC for a variance based upon what I feel is very strong evidence that, while the test pit was some thirty feet away from the existing absorption pit, it is, nonetheless, representitive of the prevailing conditions. Note, our observations of the absorption trench, itself, during the first inspection supports the findings of the original pit. Further, the Well Log generally substantiates the conditions to exist as deep as 63 feet from the surface. I am enclosing an updated Inspection Report for your consideration with the added information you've requested regarding well location plus a more definitive sketch. I will inform you of any further developments as they occur. Lescrace screeaa or yeraur Well pumping test at --2-59i of drawdown from static Date of completion December Depth in feet from ground surface ' G oTo _2 - 2 TO 27 (h D=) (minute) for l hours with 100% ft. WELL LOG OF iations penetrated, size of material 8Uhr lig s ANCH ORAGe OTECT) 1984 TO TO 3—CONTRACTOR "ECE I VLA 27 Tp 63 &endv GraveF D 63 TO 78 S11ty Hardpan 78 TO 84 Silty Gravel. 84 Tp 123 Si3ty�sand vel I23 TO 135 Silty Gravel NWWA Certified Contractor 135 To 155 Stie,W/Silty Clay Certificate No's 894 R, 978 155 TO 172 Silr_v crave, - .tic'._. 172 TO 192 Silty Sand 192_T0 201 Natarbe-ar_n Gavel_ TO TO 3—CONTRACTOR 0 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1: General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) n (address or (b) Applicants Name .'orr)( Mmon Telephone - Home3yg.i,t,sBusiness Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer r__1 ; Other [� (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: � A S �3r��� �� .•J t r k 9�S-i E+ 2. Type of Residence Single -Family Multi -Family Other (describe) Number of Bedrooms 3. Water Supply Individual Well 59 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 Ez 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] 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the rdate of this inspection. Name of Firm r v 1� P1�J �j�r1`_3 Telephone:30 J `7-4011 Address Date ir(ul4.. j �J << f SC z itioQ=� Q�-r7,'R1�S (ENGINEER SEAL) 6. DHEP Approval Approved for 3 bedrooms By Approved A Disapproved _ Terms of Conditional Approval CAUTION eovo • annwwrm�c . O° 895-E r �, Er Conditional THE 14MICIPALITY OF ANCHORAGE DEPARTMENT 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 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 v • 8 Z 9Qgj MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) NOU331M WJKWMMJAta V (4097H 10 •aaa CHECKLIST - FEBRUARY 1984 v AID A1nWL-ANAW A. MEL DATA "Legal -Description: QPQc.6L,ZZ. -n �o 2 3-..( S�z 2� 1-� T Well Classification_t.LeT[�VEtLlgC[ f A, B, or C, D.E.C. Approved(YM) Well Log Present (Y/N) Y Date Completed I�C. t(o JCL3 Yield Total Depth 2-o t . �' ` Cased to Z®1. Depth of Grouting Static water level 16q I Pump Set At 9 Casing Height Above Ground �� Sanitary Seal on Casing (Y N) Y Electrical Wiring .in Conduit (YM) Y Depression Around Wellhead (YIN) hA Separation Distances from Well: 16. To Septic/Holding Tank on Lot � / ; On Adjoining Lots 00 To Nearest Edge of Absorption Field on Lot S6' On Adjoining Lots > Joe" To Nearest Public Sewer Line , 1 I0oI To Nearest Public Sewer > t00/ Cleancut/Manhole > 100 / To Nearest Sewer Service Line on Lot ? l CO / water Sample Collected By —0v. /r,t F u CL D Date Water Sample Test Results/i�JE Comments 40 c u�- S e- �4� 1 N PKI EA •-) B. SEPTIC/HOLDING TANK DATA Date Installed 4WAL- ►3i� Size 2- o00 eW—. No. of Compartments Z Standpipes (YM) - Air -tight Caps (Y ) Foundation Cleanout (YIN) Depression over Tank (Y/N) Date Last Pumped roe- i) Pumping/Maintenance Contract on File (YM) 0 for Holding Tank High -Water Alarm (YM) 014 Temporary Holding Tank Permit (Y ) 0 Separation Distances from Septic/Holding Tank: To Water -Supply Well 126 To Building Foundation 6 To Property Line s To Disposal Field �S To water Main/Service Line h( �_ To Stream, Pond, Lake, or Major Drainage Course > 1 CXD Comments pf 4J IS-, a u V f o^-kti I _ttc, a 9,k 19 3 [Page 1 of 21 - 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed ftVa-,°> 94- Length of Field 4-U Width' of Field Depth of Field S Gravel Aad Thickness Square Feet of Absorption Area 62y SF, Standpipes Present (YIN) Y Depression over Field (Y/N) Date of Last Adequacy Test rit---4 � © Results of Last Adequacy Test of Separation Distance from Absorption Field - To Water -Supply Abll 1E:E�, 6 / To Property Line 2-0/ To Building Foundation 4S To Existing or Abandoned System on Lot t-jotX� ; On Adjoining Lots KS- OtA To Water Main/Service Line To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course 7 t 00 To Driveway, Parking Area, cr Vehicle Storage Area Comaents DEE7 D. LIFT STATION t�J /A Date Installed Dimensions Si2a in Gallons Manhole/Access (YM) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (YM) Tested for _ Pumping Cycles ging Adequacy T@st. Meets MDA Electrical Codes(YM) ** Check Permit I tify t- I on date t Signed Conpany RBl/d5/s [Page 2 of 21 Rating Against HAA Request ** or conforned to all I No. 031 2-15-84 A