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HomeMy WebLinkAboutMOSLEY LT 73A Municipality of Anchorage Page \ of '7--- 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: '~ C:::~,~:~'~ PID Number: ~~ Name:~ Wastewater System: ~ New ~pgrade Address:. ~oo ~~ ~. ~l~ ABSORPTION FIELD Phone: JNo. of~rooms: D Deep Trench ~ Shallow Trench ~ Bed ~ound ~ Other LEGAL DESCRIPTION SoilRating: ~'~ GPD/Sq. Ft. Total Depth from origJnal g~de: Block:~ Subdi~is~n: Depth to pipe bottom from original grade: Gravel depth beneath pipe Tow~j~ Ran~ Se~ ~ Pill added ab~e~rigina~ra,e:_ Ft. 'Gravel length: ~ ' Ft. Numbe~ lines: JDistance betweenlines: WELL: ~ New D Upgrade Gr~w,~ ~* Ft. J ~ Et, C~sification (~ivate. A.B.g): . Total Depth: Cased To: Total absorption area: Pipe material: ~t Driller: Date Drilled: Static Water Lev;;:. ~~ ~ Yield: GPM J Pump Set at: Ft. Casing Height Above Ground:Ft. TAN K SEPARATION DISTANCES ~ Septic ~ Holding ~.T.E.P. To Septic Absorption Lift Holding 'ublio/Privat. ~%~:~~ Ca pa~s: From Tank Field Station Tank Sewer Lines Well ~ ~' ~, / / Ma~ Number o~mpadments: Sudace w~t~ ~ ~ L~k / ~ LIFT STATION Lot t ~ Size in ~l[ons: [Ma~f~cturer: I "Pump on" level at: Foundation ~ ~'~ ~+t ~ ~ ~" I,,~um. o,,,,,~, ~t: High w~ at: u.a,n .,ect.,R, Drain ~ ~Z ~ ~ ~o pedormed by: Remarks: BENCH MARK J Assumed Elevation~ ~ E~SEAL S & S ENGINEERING ~ ~~ Inspections performed by'17034 Eagle Ri~er L~p RoadNe.~es. 1st ~-~ "¢~~ 'Eagle River, Alaska ~7Z - ' ~-~ ~ I :' 2nd. Department of H d H ervices approval Reviewed and approved b~~:'''~:~ :' Date: ':/:~)0 J'"~~:~ 72-013 (1/91) MOA 25 "Permit No. ? of ~ SQ)c)IOI&c) Page Municipality of Anchorage 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 Legal Description: MOSLEY SUBDIVISION LOT 73A PID No.: 01825125 SCALE I"=10~ · ?/L co~~ ~r~ ' .... ~ ' p' P/L ~L NEW BED~,~ ,i I : ' ,T2~ i250 ~L ~B~N~ ~EPTi¢ TAN~ SHALE I"=50' 72-013 A (2/91) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SWg10169 D~$IGN ENGINEER:S & S ENGINEERS OWNER NAME:KILLPAT~RICK DWIGHT G & OWNER ADDRE$$:14400 SNOWSHOE LN ANCHORAGE, AK 99516 DATE ISSUED: 6/25/91 EXPIRATION DATE: 6/25/92 PAR~L ID:01825123 DESCRIPTION: MOSLEY LT 73A SEC 33, T12N, R3W LOT ~: 29988 (SQ. FT.) ~'~R ©F BEDROOMS: 3 THIS PERMIT: 3 T~:%8 ~ERMIT IS FOR THE CONTRUCTION OF: DI;~OSA~ Fi'EbD SYSTEM A~ ~:ONSTRUCTION MUST BE IN ACCORDANCE WITH: !, TM~ ATTACHED APPROVED DESIGN. AbL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS ~5.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL R~GULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS PERMIT REPLACES PERMIT #SW900362. ISSUED BY: ....... DATE: DATE: Tom Fink, Mayor unicipalit¥ of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 January 8, 1991 G.M.A.C. 460 West Tudor Road Building A Anchorage, Alaska 99503 Subject: Lot 73A Mosley Subdivision Permit #900362, PID #018-251-23 The subject permit, issued by this office for a single family well and/or on-site wastewater system has expired as of December 31, 1990. A new permit must be obtained from this office for a well and/or on-site wastewater system not installed by the expiration date° If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built inspection report (three-part form) must be sent to this office for review, approval and documentation. All inspection reports'must be submitted within 30 days of constructio~ completion. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site waskewater and well permit° If you have any, questions, Pr~g.r.am Manager On-site Services please call this office at 343-4744° JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 5.19g0 November 5, 1990 RECEIVED ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 73A; Mosley Subdivision PERUIT REQUEST NARRATIVE Request you issue a permit to upgrade the septic system located on the referenced property. A conditional Health Certificate was issued on the property January 15, 1990. Subsequently, groundwater monitoring performed has found the existing system within groundwater during various times of the year. We have performed two soils tests on the property for purposes of upgrading the leachfield and have monitored a water table at 7 ft. below the surface. However, suspecting higher seasonal groundwater levels we have designed a shallow bed system to be excavated no more than 2 ft. with a 2 ft. sand filter installed. Due to large lot size and th& two roadways which are adjacent to the corner of the property of which the upgrade is proposed, we see no probable impacts on neighboring properties b~ the installation of the proposed septic upgrade. As can be seen from the design, we proposed the addition of a 500 gallon lift station. However, w~ suspect the existing septic tank to be of poor integrity and in need of replacement. If this is the case, a new 1250 gallon S.T.E.P. system will be installed in place of the proposed 50~0 gallon lift station. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 2 4 5 8 10 '12 14 1§ ~8 19 2O DATE PERFORMED: Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? L IF YES, AT WHAT O DEPTH? p E to Water Alter,~I Deplh Monitoring? c.-' Date: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~o (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN "~ FT AND Z~ FT COMMENTS ~ ~,v~r Alaska 99,~77 TEST WAS PERFORMED IN PERFORMED BY: . ' .* ~ I ///'/ ~ CERTIFY THAT THIS Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 6 7 8 9, 10- 11 12 13- 14- 15- 16- 17- 18- 19- Township, Range, Section: SLOPE PERCOLATION RATE (minutes/inch) PERC HOLE DtAMETER COMMENTS S 8. $ ENGINEERING TEST RUN BETWEEN/..~T AND -~"'~' FT PERFORMED BY: RTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAl- GUIDELINI~S I~FFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ~" S L IF YES, AT WHAT O DEPTH? P E Depth te Water Alter "7 ¢ MonitorinD? Date: ~d~"")'~O Gross Net Depth to Net Reading Date Time Time Water Drop ENCOUNTERED? SITE PLAN ALASKA ErlUIROllmEFtTAL COEITROL SERUICES, lilt. ~nclineeri,cI g ~.uironmentol Studies P. 0. Box 240668 Anchorage. AK 99524-0668 (907) 279-5553 *** FAX (907) 276-8706 September 5, 1990 Municipality of Anchorage Department of Health & Human Services 825 L Street. 5th Floor Anchorage, AK 99501 ATTN: Dan Holies RE: Lot 73A, Mosley Snbdivision Dear Dan: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 'SEP 6 RECEIVED Somewhere my reporl was lost in i:he sys-tem. Here is a copy of the report on tile septic system on this lot. There are drainage problems, if corrected, that will no longer lrouble this lot. It took awhile to discern it. On April 14, !990, the well pit was abandoned. The casing was extended to above ground. A pitless adapter was ins-tailed by Sullivan Drilling and Dean Construc'tion. Sincerely yours, Leroy C. Reid, ,Ir. 1412 West. 331~b gvenue · 3.ncho~aqe, 3.laska 99503 · (907) 279-5553 ALASKA ellUlROnmel TAL COI1TROL SeRUICeS, Inc. ~n§in~erJn~ ~ ~n~Jronmental Studies P. 0. Box 240668 Anchorage. AK 99524-0668 (907) 279-5553 *** FAX (907) 276-8706 July 31, 1990 Robert Dean Dean Construction SR Box 9352 Eagle River, AK 99577 RE: Lot 73A, Mosley SubdiviSion, Remax Properties Dear Bob: Finally, here js my report on the findings at this lot. When we first looked at this property breakup was in full swing. Water was running over the east part of the lot and the 'surface water had flooded into the trees. See attached site plan. The first test hole was in the driveway near the crib. It was a good gravel below 2 feet, but had sewage water at 5 feet. The second test hole was in the edge of the trees, but it was abandoned because flooding had wetted that area and made the ground very wet. The third test hole was just north of the paved driveway. Water was at 6 feet below the ground. It looked like septage and as you noted, it smelled like septage. A monitor tube was installed. I checked the area around the bank west of the paved driveway for surfacing septage, but could not find any seeps. I continued to watch the drainage over 144th Avenue. The northeast part of the lot stayed wet. On July 7, 1990, the water in TH2 was at 6.8 feet. It is obvious that this is part of the drainage pattern from the crib. The test hole in April shows a silty soil alongside the sandy gravel. See soils tests. On July 19, 1990, we again dug a new test hole near TH2. This hole was slightly over 4 feet below the crib bottom. We found groundwater that was not septage, or at least it could not be detected as septage. The water level was at 84.2 feet, relative elevation using the top of the crib standpipe as elevation 100. It is slightly over 4 feet deeper than the system bottom. On July 26, 1990, the water in the TH had disappeared. The soils on this lot consist of several varied types. There are large cobbles, clean sandy gravel, and silty gravel all within a 80 foot by 50 foot area. The soils logs are attached. It was difficult to determine whether or not groundwater was a problem. The water in TH1 and TH2 was definitely sewage and not groundwater. The sandy gravel looked like pit' run gravel. It was not until a fourth test hole was dug that the gravel was found that closely approximated the soils in TH1 and TH2. It was then that the 4 foot separation was determined. SUMMARY I don't believe that the system is normally within 4 feet of the groundwater table. However, there are serious drainage problems which at times could cause surface waters to be within 100 feet of the system. This water could also percolate downward and raise the waterlevels in the gravels. A culvert needs to be placed under East 144th Avenue at the low point of the road to drain surface runoff for the land north of this lot. The road service district or the homeowners' association may be reponsible for this work. A drainage ditch needs to be dug along the lot boundary to divert the water away from the low area which was flooded. It should continue along Snowshoe Road to the south. If these drainage problems are not corrected, then it is possible under certain conditions for water to run into the gravel in which the system is built, thereby temporarily causing the watertable to rise. If you have any questions, please do not hesitate to call. Sincerely yours, d . Ph~, PE, DEE LCR/sr 00'001 -~ .~0 ~0 '3 ._1 O0 '0ol. ~ ,~-0 o0 ~ I~''~ ,'t, S3IZ,~,3dO~Jd XUFI3;3 ZP:P; 06, £T ~d~J ~ , ALASKA E[1UIRO[lmEI1TAL CO[1TROL $~RUIC.~$, I~1C. LOT TH 1 2 3 4- 5 6 7 8 9 10 11 12 13 14- 15- 16- 17- 18 19 20 Subdivision Supplemen%al Soils Information. 8lock -- ~7~ 7Jx~ LO~ ~/~q~o LO~ %~/~'° LOT ~/~/~° TH "~ TH ,~, TH ~ q,~/ 1 2 3 4 5 6 7 8 9 10 11 12 13 14- 15- 16- 17- 18- ,19 20 14- 15- 16- 17- 18- 19 20 ? q,F' Tom Fink, Mayor ]V[uniCzPality of AnchOrage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 June 5, 1990 GMAC Mortgage 460 West Tudor Rd. Anchorage, AK 99503 Re: Lot 73A, Mosley Subdivision, PID 018-251-23. To whom it may concern, On January 15, 1990, this department issued a conditional health approval for the subject'property. The conditions were .t.o bring the well in to compliance with AMC 15.55 and ko provide soils data, percolation testing, and water monitoring necessary to ensure that the existing septic system was adequate. The conditional approval was granted with the stipulation that all work would be completed, and a report made to the department, no later than June 1, 1990. As of this date our office has yet to receive any notification of compliance. We are, therefore, obliged to revoke the conditional approval at this time and render the certificate as disapproved. If these conditions have been met or are in the process of being completed an extension may be granted. Please contact this office as to the disposition of the well and septic system as soon as possible. Our telephone number is 343-4744. Daniel N. Bolles On-site Services cc: John Smith, P.E., On-site Services Manager Ted Moore, P.E., Flattop Technical Services db/ll8 Parcel I.D. # 1o MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, AJaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Se.c, 53~ T12N, R3W. S.M. Lot 7~A; Mosle,y Sub,vision; Location (site address or directions) 14400 Snowshoe. Lane Property owner Mailing address Lending agency Mailing address Killpa~ick 14400 Snowshoe Lane, 460 West Tudor Road, Day phone AnchoraCe,, Ak. 99516 Day phone Anchorage,, Ak. 99503 562-2181 Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: X× Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 compl!ance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ........ .-_~o~,m, $ & 5 ~t,,,- ...... Add ress 17034 ~.~1,.~dv~r, _,.~L°~P.~R°a~ No. 204 Engineer's signature Phone / ~ondi~ons of Health Authority Approval issued 1-15-90 ~~.~ Approved for F Disapproved. Conditional approval for DHHS SIGNATURE bedrooms. bedrooms, with the following stipulations: Additional Comments By: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~325 (Rev. 1/91) Back MOA ~1 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 34:3-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF' ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) L.o,-' 7..%4, f'-~fe? ;,"/) (?oehoo o£ ,Lo/7Y. Location (address or directions) /y yoc, ~' / 5'Y ~ (b) Property owner-~ o~ D~/~ /¥~e~b- /1 Telephone: (horn. e);3 ¥9 -~_?)~Business.'~g'..C-.~'/~_ qd'o ~J. '7-~Jo ," ~ ¢,4 Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here F~, if hold for pick up.) List contact person and day phone number below: 'T-~r~ r-~oor~ - ~ q~-- t~ ~o 2. TYPE OF RESIDENCE Number of bedrooms Single-Family I~ 3. WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State DePartment of Environmental Conservation attesting to'th iegality and status. 4. SEWAGE DISPOSAL On-site [~ 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 (Rev. 7/88) 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, lverifythat 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 m.y 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. > NameofFirm ~"/ct/'~/'¢/¢ 7'Ao/Tn't¢¢~/ .~'uc_r' Telephone Date ~ ~Y ~, /~ Engineer's Seal 6. DHHS APPRO/VAL Approved for-- ,-~ D~ Conditional Terms of Conditional Approval ~,~,u- . _ _ .;~'.~ The Municipality of Anchorage Department of Health and Human Services(DHHS) issuesHealthAuthorityApproval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdonotconductinspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageisnot responsible for errors or omissions in the professional engineer's work, 72-025 (Rev. 7/88) Sack Page 2 of 2 · .~--"~, 5~'~'~ Health Authority Approval (HAA) ,j~',O<~ ~ CHECKLIST- FEBRUARY 1984 ~;d~ ~5~ ~ 343-4744 A. Well Classific~ion~ ~ v ~¢ ' If A, B, C, D.E.C. Approved (Y/N) ~{, Well Log Present (Y/N) ~Dat~Completed ~ ~W ~ Yield ~, Tota Depth~ 77 Casedto~ 77 Depth of Grouting Static Water Level ~O ' Pump Set At 7 7 ~ Casing Height Above Ground ~' ~e~ ff~/ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ~ ~ ~a~ Depression ArOund Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~/.~' ~ c,o. ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot II1.~' ~ c.o. ; On Adjoining Lots To Nearest Public Sewer Line (00 ~ (00 / ~. too' To Nearest Public Sewer Cleanout/Manhole :=- too ' To Nearest Sewer Service Line on Lot Water Sample Collected by 7%. I~ l'--(c~or~ ; Date I WaterSampleTestResults ~'ce/~cJYetc /~r'~/ - ~ Co(~ / roo ~ Comments bio ~;u~r n~e~e~ ~ ~((-~e~c ~~o~ /~( ~/ ~,~ ~. SEPTIC/HOLDING TANK DATA p ~ b [~ - ~[I ~ ~ ;~ ~ Qn~ Datelnstalled ~ 1¢~ Size /~D~a/ No. of Compartments Standpipes (Y/N) ~ (~) Air-tight Caps (Y/N) P Foundation Cleanout (Y/N) /~¢~ Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~/. E' ~C~,m ¢, o. To Property Line T~ to' To Water Main/Service Line ,~ ~-¢'f To Stream, Pond, Lake or Major Drainage Course Comments /\fc~ cua(~,¢r n~,ea~e¢o~ ~ ~./~ c¢ Date Last pUmped !/3-/?O ; for ~,~. Temporary Holding Tank Permit (Y/N) ~'~ To Building Foundation To Disposal Field ~ I00 ' 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ I¢~' Width of Field (.X.n Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test (~<,,,,~'~.r¢.,,~/) Type of System Design Length of Field 6Ln Depth of Field Gravel Bed Thickness ¢¢~.c'~/2' Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot N, A-. 111,6"' To Water Main/Service Line ,T~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments _~rom c, o. To Property Line / ~' /¢-~¢ /9 ¢'9 ~/)-,A ~r~,~ C. o To Existing or Abandoned System on ; On Adjoining Lots ~ ~O / ~' es~ ' To Cutback (if present) N,A. D. LIFT STATION /q,,4. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA g.u,i~L~!2nes in effect on the date of this inspection. 4, ¢ t3~' ~q( ~ ~. Signed ~7'-~ .~. ~ ,~,.K,~',..; t~a' 'k ~ , ¢ ...................... ;., .';;~ Engineer s Seal MOA NO. _ o0¢ - 0.5'8 ~ · V~ %'. %%i;,, °.. · Receipt No. Date of Payment ./--/E) ~ ~- (~ Waiver Fee: $ Amount: $ i~. ,/~d:9' ¢ o . . Date of Payment 72-026 (Rev. 7/88} Back Page 2 of 2 CHEMICAL & GEOL GICAL LABORATORIES OF ALASKA, INC. ~~'~,~ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ~,~ ~_~~,,~ FEDERAL TAX ID # 92-0040440 M{~L~SI,~ R~,?O~[~ df S~['I,F, fez ~,!ork Orde~ ~ 19170 Pat,~ gepox~ ?x~.r,[ed: JM~ 10 90 ~q !1:17 Client Ba~aple ID:~73A Col!coted JAN S Re~e~ved Jl:~ S 90 ~ 16:30 hrs. F tnalysia Compi~ted :JAN 6 90 P.O.~ NOIIE RECeIVeD R~q ~ Orde×ed By : Send Repoxt~ to: kilo~able hi See Spec5ai inotruct~.one lbo'tn Ll'=f, ea~ )]hen, G_~,rea~e Uh~Una~:~dlabl ~ CD ,,--I FHA Form 2573 Rev. July 1958 U. S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT FEDERAL HOUSING ADMINISTRATION HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM iNSURING OFFICE Anchora~ :t~L~eka PART I.--TO BE COMPLETED BY FHA MORTGAGOR OR SPONSOR SUBDIVISION NAME MORTGAGEE F~.rst ~L,tional Bank of SERIAL NO. 111-00936.%203 TOTAL h l__._____~:~'~' 'GI /'~F BASEMENT ~ New installation / ]. r~ ~ ~Yes ~No WA~R SUPPLY BY: Public system ~ ~mmuniW system PROPERTY ADDRESS BLOCK NO. LOT NO. DATE SEWAGE DISPOSAL BY: [~ Public system Can attic or other area be made into additional bedrooms? (if Yes, how mony~) [] es iYSTEM DESIGNED FOR [~]~. Individual No. of $DRMS. GARBAGE DISPOSAL [] Corfimunity system ~ Individual [~ Yes [] No PART ,,.--TO ,E COMPL.,D BY .E^LT. DEPARTME.T HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [] State [--] County [~ Local Department of Health that this individual water-supply .system [~ is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [] State [] County tem with proper maintenance: [~Can be expected to function satisfactorily, and is not likely to create an insanitary condition [~ Local Department of Health that this individual sewage-disposal sys- --]Cannot be expected to function satisfactorily DATE ]SIGNATURE/? NOTE: The health authority should-complete the appropriate opinion statement above and afllx date, signature and title in the spaces provided. Use of the above grid 'for Health Department Inspector's sketch as well as use of the back of this form is at the option of the~ health authority. PART Ill.--FOR USE OF FHA OFFICE - TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the Individual water-supply system be considered [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [--] Not Acceptable. SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM _] CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form 2S7~ Rev. July 1958 Form Approved Sudge: Bureau No. 63-R296.8 Rocky Read Anchoz~ge~ ~,l ~ ~'~ ~/ ~ REQUE~,T FOR APPROVAL OF ~,t~ ~,~_~, ~ ~ ~ ~NDfVIDUAL SEWAGE AND WATER FACILITieS d, D~s~anc~ fro~ ~e~ ~o c2os~s~ ~x~s~n~ o~ p~opose~t 4, Cesspool~_ ~ . 5. Property Line ~'/ 6. Othem sources of possible contamination, i.e., creeks, lakes~ houses~ bamn~ drainage ditch, etc. ~ . Sewage disposal system. a. ~Se of system ~ **/~,¢. . ,.'b' Sebtlc. tank capacity in gallons. /~~ · .... 1. If "home made" show d~agram on reverse ~ide of this form. d.' Disposal field or seepage pit size and t~e~¢~ ~ 1. Distance to proper~cj.. 3-ine /~ ! _~7 ....... · to house Percolat£ork T~st ~results . , f. Percolation Test performed by Use the reverse .side of this form to show diagram. Diagram should include -x~%he foilowing information: p~operty llnes~.well location, house location, m~ptlc tank location, disposal area location, location of percolation test, a~d direction of ground slope. 9. The ¼~-~>~t~on on this form is true and correct to the best of my knowledge. Signature 'of Applicant Date Si~ned ~ TO.__ BE FILLED OUT BY HEALTH DEPART~-~ENT PERSONNEL above described sanitary facilities are hereby approved, .subject to the ~l~owing cond~ions: . Conditiona:~ _----- The above described sanitary facilities are disspproved for the following reasons: ".Approval is valid for one year following the date of approval. .-- CPJ:cw OWNERSHIP AFFIDAVIT hereon. We her@by request epprovel o~ tMs pb% sho~ing such L. ~rlesY -- D~ol~ [ ~riesl 8-237 NOTARY'S ACKNOWLEDGMENT PLAT APPROVAL ENGINEER'S CERTIFICATE OTlO0~10g8 MOSLEY SUBDIVISION BLM LOT 7,~,SEC. SJ , TI~N, RSW~ S~. $~. I/4, ~ 1/4, SEC ~ . TI~N, R$~ SM.