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HomeMy WebLinkAboutREED LT 9 MUNICIPAI.ITY el:: ANCI4ORAGE DEPARTMENT OF 14EAI_TH & ENVIRONMENTAl. PROTECTION ENVIRONMENYAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telel]hone264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS LEGAL DESC~IPIIO~ ~-~ ..... ~ Wml ~ i'Abso,ption a .... ] Dwelling · D STANCE TO' ~' ] 13' ~ Lkl. capacity in gallons ........... Inside lengtIT ~dth ; ,~-- I D~STANCE TO: t_ength Width Depth <( I - ryp¢ of cl ib Crib diamete~ Glib depth ~ Well u) ~L- DISTANCE TO: r--' ~ ,c,~a- ....... 5~'- Driller :~ / Buildin9 ..... ~;.~ DISTANCE TO: foundation OTHER PIPE MA-FERIALS SOIL TES'F RATING INSTALLER REMARKS Building fotmdation Sewer line Fota] effective abSolption Nearest lot Line Distance to lot line j_Septic :,ON ~ F ,~rEw .. ~-,~ -~'~ [~ UPGRADE NO. OF B%ROOMS PERMIT NO. ~o z, '~o Liquid depth PERMI'F NO. [iquid capacity in gallons iota/ effective abso~l~ are8 ~/.~o~, PERMIT NO, PERMIT NO. PERMIT NO: DRTE ISSUED: 8404?0 06/:L:'~/84 RPPLICRNT: RD[:,RESS: CONTACT PHONE: · ]'CIHN i'IUL RE RHCFIORRGE., 6884555 RK 9~509 LEGRL. [:,ESCRIP: SUBDIVISION: REED LOT: SECTION: 9 TOWNSHIP: tSN RRNGE: LOT SIZE: ±6625 ('Z. it.]. FT. OR RCRES) MRF:', BEDROOMS: .~: BLOCK: LISTED SCL. OW ARE THE OPTION'=;/,'R'v'RILRBLE TO 'T'OIJ IN DE_-,IGNIH.~ 'T'OJF.' _-,EPTI_. S'¢STEI'"I. F:H-~nSE THE OPTION TvHRT BEST FITS '¢OUR _ITC. DEPTH TO PIPE BOTTOM ,::FT. ) GRRVEL DEPTH <FT. ) TOTRL DEPTH (FT. ::, 6RR',,,'EL 14IDTH (FT.) GRRVEL LENGTH ,.'.'FT. ) GRR',/EL ',,,'OLUME (CU. '~'B,S. ) TRNK :SIZE (GRLS) SOIl. RRTING (SC!. FT. ,."BR) 4.0 4.0 4.0 6.0 .~ 0.5 ]:.5 ±0.0~ 4.5 7.5 2.5 i8.0 5.0 ~5. 0" ~5. 0 45. 0 2i. 0 2]:. ]: Z.'.:~. ]: 000. 0 :~:+: :~4, 00¢% 0 m:-I-: , ::L., 000. 0 :'~.:+: i~8 t3:8 13'E: ,+::+: TRNK MUST HRVE RT LERST TWO COMPRRTMEHTS I CERTIFM THFIT: i. I FIM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS Bf.,ID WELLS RS SET FORTH B'¢ THE MUNICIPRLIT'¢ OF 8NCHORRGE (MOB) RND THE STRTE OF RL.R~C;KFI. 2. I WILL INSTRLL THE S'¢STEM IH RCCORDRNCE WITH 8LL I'10F~ CODES RND REGULFITIONS., FIND IN COMF'LIRNCE WITH THE DESIGN C:RITERI~ OF ]'HIS PERMIT. ]:. I WILL RDHERE TO RLL MOB RND STRTE OF FtLRSK8 REC.!UIREMENTS FOR THE SET BRCK DISTRHCES FROM RN'¢ E',,,.:ISTING WELL., WBSTEHRTER DISPOSBL S'¢STEM OR PUBLIC: SEWERFtGE S'¢STEM ON THIS OR FIN9 RDJRCENT OR NERRBb' LOT. 4. I UNDERSTRND THFIT THIS F'ERMIT IS VRLID FOR R MFt,~4II"IUM OF' 2,' BE[:,ROOM$ RND FIN'¢ ENLRRGEMENT WILL REQUIRE RN RDDITIONRL PERMIT. IF. Fl THEN HILL ELECTRICRL WORK MUST BE DONE E:k' F~ LICENSED ELECTRICIRN. SIGNED .................... DFiTE: RF'F'L I CR~.~HN~]RE ISSUE[:, [:2¢ _-___ [)RTE: LIFT STRTION IS INSTFILLED IN RN RRER COVERED E:'¢ MOR BUILDING CODES., (~:.', RN ELECTRICFIL PERMIT RND INSPECTION MUST BE OBTFIiNED.: (2) FIS-BUILTS NOT BE I=IPF'RO'v'ED 14ITHOUT RN ELECTRICRL INSPECTION REPORT; RN['., (]'.) THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST DATE PERFORMED: [0'" ~ LI - ~'~ ~:/' LEGAL DESCRIPTION: 3 4 5 6 7 8 9 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER S ENCOUNTERED? . ~,)C~) ~ P E IF YES, AT WHAT DEPTH? '3) :: ~ Reading Date Gross Net Depth to Net Time Time Wate~ Drop ~ q ~:~ )o ~',~. 'fib ' ~ PERFORMED BY: 72-008 (6/7cJ) TEST RUN BETWEEN CERTIFIED BY: FT AND FT '-r-o / ALASKA eFIUtROilITIEFITAL COFITROL S RUIC S, IFIC. ~nqirl¢¢rinq $ ~,ui~'onmenlol $1uclies 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). A_ECS 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 recon~end 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 c r s n aC 561-5040. Sincerely, L. D. Montgomery Supervisor, Environmental Department Approved By: MUNICIPALITY OF ANCt-I©PAQI~ DEPT. OF HE;'~L7 ~ ~ [NVIRONMENTAL PROI8CTt©N EIE C 2 6 lqn4 1900 UJest 33rd J~u~nue Sutle [1 · Anchar~qe Alas[a 9':3503 ,~[gOT) 5Gi-50110 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lo 9; R¢~d Subdivision Jun~ 8, 1988 Location (address or directions) (b) (c) Property Owner Mailing Address HUD Telephone: Home ATTENTION: Vivian Gaqton Business Lending Institution City Mort,qag¢ Telephone Mailing Address· ..405 W~..St $&th Av6rcz¢., Anchoraq6, A£as~za (d) Real Estate Company and ~,gent Address Telephone (e) Mail the HAA to the followinq address: or: Check here ~, if hold for pick up. List contact person and day phone number below. _q ~ _q ~NP~INFF~INC~/~9#-¢979 ! 7gg4 Fagg~a ~2u~.~ I ~p ~nad; _qn~. ~04 Fagga ~Uo~; Afasba 9q~77 TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms WATER SUPPLY Individual Well [] Community ~ Public [] (Class C) Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8,861 Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm $ 8, $ ENGIN£ERING Telephone 17034 Eagle Rb/er Loop Road No. 204 Address ...... ^~..b., .ag.. Rt~.., ...... Date DHHS APPROVAL APproved for ~"~ _~)bedrooms by Approved X Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph § 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. Page 2 of 2 72-025 ¢Rev 8/861 Back MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: L,-~"1- ~"~ WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~'"_~¢:- If A, B, C, D.E.C. Approved ~.,~N) Date Completed Yield Cased to Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ,/ ~--~c:;~ ~-' ; On Adjoining Lots To Nearest Edge of Absorption ,Field on Lot '~'-~ ~:) J ; 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 * % '~--'~?,L~'~.-~ t ~.[Z~,~ ,--..3E_,~ ; Date ~-~:~ '~ (~ Water Sample Test Results ~1¢-¢~ '~ ~ ~'~¢~ : ~9,~5 ~ Comments ~'~O ~,t ~ ~ " B. SEPTIC./'I'-I'OEDII~ TANK DATA Date Installed 4c~-~.~-) '¢~-"~' Size Standpipe~(~?N) x./ Air-tight Ca ps(C~-2N) Depression over Tank (Y/~i'~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Fteld[r~g Tank: To Water-Supply Well .~Z.-L¢ To Property Line "~ '~, '~ To Water Main/Service Line Course \ '(?E::;' I~ t3//~ate ..~_.-.---~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation "-'~' To Disposal Field ~ ~') ~ To Stream, Pond, Lake, or Major Drainage No. of Compartments Foundation Last Pumped Comments Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'~ -- Width of Field Square Feet of Absorption Area Depression over Field (Y/~)~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To B~i~ing Foundat,ol.~ To Water Main/Service Line Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~) Date of Last Adequacy Test To Stream/Pond/Lake/or Major Drainage Course To DrivewayI Parking Area, or Vehicle Storage Area C o m m e n t s "~ ~:,.h"~..),.~ .~ .~. ~ ~/ .'*~-..~;,-¢" D, LIFT STATION / To Property Line ! ~ ~ To Existin9 or Abandoned System on ; On Adjoining Lots To Cutbank (if present) "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 Vent (Y/N) uring Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & Compaq034 Eagle Ri~er L~p Road No~ No. Eagle River, Alaska 995~ Date of Payment Amount: $ ~,~ Page 2 of 2 72-026 fRev 8~861Back DEPT. OF ENVIRONMENTAL CONSERVATION ~NCHORAGE. ALASKA ~503 STEVE COWPER, GOVERNOR 563-6775 To Whom It May Concern: 0 A T E: _ _J_u_n_e_6_ ~ _1_9_8_8- ...... PWSID ~: __C_L_A_S_S__C__W~_~_L_ .... Accordinq to the records on file in this of?ice, the SUBDIVISION on Lots 6, 7, 8, 9 REED Water System is in compliance with the Stat'e o? Alaska Drinking Water Regulations. RSK:sa Sincerely. For Ronald~pS. Klein Environmental Field Officer Per Verification with Jim Hayden, DEC, 563-6529 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name MC I//4-¢ j'~t*~¢¢,"-./-/e ~,' Telephone: Home Business (c) Applicant is (check one): Lending Institution U.; Owner/builder ~; Buyer U; Other~explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [~ Multi-Family [] Number of Bedrooms '~ Other WATER SUPPLY Individual Well [] Community,~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, 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 (11,84) Page 1 of 2 ENGINEERING FIRM PROVIDINL. ,SPECTIONS, TESTS, FILE SEARCH, DA'~ .~ND INFORM.,~HON 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 theinform~tion 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 ins~pcection. / ./A/a~~ Nameof Firm ~¢~¢~ ~,/ Telephone Date Engineer's Seal Approved for/~'~___~&edrooms by, _-~/"~'~/ ~,-~~ Date Approved ~_ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11184) MUNiCiPALiTY OF ANCHORAGE ENVIRONMENTAL SE, RVICES DIVISION JUN 7 1988 WELL DATA RECEIVED Well Classification C¢¢~ Well Log Present (Y/N) Total Depth MUNICIPALITY OF I~[".~CI ENVIRONMEN1AL e -:, ,,- ,.:_~ . , oE,,,V,~.-o DI,/IS ON ~UNIOIPALITY OF ANCHORAGE (~OA) HEALTH AUTHORITY APPROVAL (HAA) Di:C .'I. 0 CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: L, .'r ~ I~ ~;..~t If A, B~).E.C. Approved (Y/N) Date Completed Cased to Depth of Grouting Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot _ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Man hole Water Sample Collected by ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot J~'~,"¥~3' ; Date J~/J/(;~ -I Y Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Air-tight Gaps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well _~:'-~ ~ '~ To Property Line E_~ ,~' '~ To Water Main/Service Line Course ~//~ Size J,~d)CJC-) ~tF/,L- No. of Compartments Foundation Cleanout,(Y/N) y Date Last Pumped ;for Ill /~' Temporary HoLding Tank Permit (Y/N) To Building Foundation To Disposal Field J To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-0261Rev 886/Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata l,~~¢'¢ .¢~""~-+ ,/~'~',~, Type of System Design Date Installed ~/'//'0/~ Length of Field ~ 0 i Width of Field '~ '~ Depth of Field l (-.) ~ Gravel Bed Thickness ~-~ '~ Square Feet of Absorption Area 4:tO~O ~'.¢4.~..~ Standpipes Present (Y/N) Depression over Field (Y/N) ~-~ Date of Last Adequacy Test Results of Last Adequacy Test ~'~'Ti,~ Separation Distance from Absorption Field: To Water-Supply Well ~...,,~ ~ i To Property Line / zig t To Building Foundation I J ~ To Existing or Abandoned System on Lot ~'~/~ ; On Adjoining Lots -.-~-(_..) ' To Water Main/Service Line To Cutbank (if present) !~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~ ~ Comments LIFT STATION Date Installed ~'~- Dimensions __ __ Tested for Level~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) NN \ Comments / ** Check P~t:).~ted Be~r~___~Rating Ag'~st HAA Request ** I certify thC I~¢,}¢/¢hec. rco,~erified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ,~//~- _/-/~?,~,/~-- Date L/ / ''' ReceiptNo. ,~,~ ~ 0 Engineer's Seal ~EFT. OIF ENVIIIIIONMIENTAL CONSIERV~TIION Ar.I,iHORA~E/UESTERN DISTRICT OFFICE / 34~')1 "C" STREET. SUITE 1334 / Ar'.ICHORAGE, ALASKA 99503 STEVE COWPER, GOV~:RNOR 563-6775 DATE: PUSIO ~: To Uhorn It May Concern: 12-17-87 Class C Well Peters Creek Accordinq to the records on ¢ile in this o¢¢ice, the ............. REED SUBDB~ISION .LO~s_6,_~i_~,._~__~_as_~_C_ ...... Water SYstem is in compliance with ~ he qtate o¢ Alaska Deinkinq Water Requlations. Sincerel Y , Ronald S. Klein Environmental Field Of'¢icer Per verification of JSn Hayden, ADEC, Anchorage ~fO'NICIPALITY OF ANCHORA~['] DIVISION OF ENVIRONMENTAL IU~ALTH ])EP;HCL~4ENT OF HEALTH AND ENVIRONMENTAl, PROTECTION A!?PLICATION FOR I~iALTH AUTHORITY APPROVAL CERTIFICATE ! o General Info~mnation Application Date (a) Leg. EL Description (include lot, block, subdivis]~on, section, township, range) Location (address or directions) , (b) Applicants Name ~/,'~'f _~//~u,v~ Tele~lo~}~__Z_~.o~_~ Business - ,' .,.,~ o5:?o (C) Applicant is (check one) Lending Institution (d) Lending Institution 1' e 1 e p~k~O n~:e_ ............................. Address (e) Real Estate Coo & Agent Address Telapho ne (f) 2o ~y~e of Residence Single--Family ~[ N~mber of Bedrooms Multi=Family Note: If community well system~ must have %.~'itten confirmation from the State Department of Envizon~ental Conservation attesting to the legality and status° 4. Sewage Disposal Note: If community well system~ GUSt have , ,-I- , .... ,.~_tten cot~i~ation from the S.,ata Department of Enviror~ental Conse~atlon attesting to the legality and status~ [Page 1 of 2] ~,_~v~.zneer~'nz~ ~,'~.~,~. ...... ~rovfd[n~ In.,~pections~ Tests~ File Search~_ Data and Infoznnation As ce:tilled by my seal affixed hereto and as of the validation date shown below, verify that my investigation of this HesJ. th Authority Approval shows that the ware? 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 info[nnation obtained from the Municipality of Anchorage: files and from ~'y investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance ~.zith all Municipal and State codes~ ordie~ances~ and regula.= tions in effect on the date of this inspection. Telephone (..,NG].NEER SEAJ, ) Approved for ~ bedrooms Approw;d ~./' Disapproved Terms of Conditiona;. Approval CAUTION Tt~ ~fONICIPALiTY OF z~MCHOIhkGE DEPAR%MENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES R~ALTH ALF£tIORITY APPROVAl, 6%RTIFICATES BASk.~D SOLELY UPON THE P~EPRESENJk= ATiONS GIVEN IN PARAGRAPH 5 ABOVE BY AM INDEPENDENT PROFESSIONAL ENGII~ER iN %~,LE STATE OF ALASKA° TH[z, DI1EP DOES THIS A,S A. COURTESY TO PURCtlASERS OF HOMES AND T~EXR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN I~%DERAL AND STATE REQUIRE~ MENTS~ RMPLOYEES OF DREP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED, TIiE MUNICIPALITY OF _A~YCHORACqE IS NOT RESPONSIBIg FOR ERRORS OR OMISSIONS IN T~)E PROFESSIONAL ENGINEER'S WORK° (DHEP SEAL) [Page 2 of 2] A. ~LL DATA Well Log P~esent (Y/N) Total Depth ~./~ Static Water Level Well Classification Cased to Casing Height Above Grcund 4//4 Electrical Wiring in Conduit (Y/N) ~.//~ Separation Distances f~c~ Well: To Septic/Holding Tank on Lot ?~&F~ To Near. st Edge of AbSorption Field on Lot To Nearest Public Sewer Line MUNICZPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) Legal Description: Date Completed ~,//~ Yield ~// /J~ Depth of G~outing Sanitary Seal on Casing (Y/N)~ Dep~tession Around Wellhead (Y/N)',~/~ ; On Adjoining Lots ~f~' ~j3 ; On Adjoining Lots C leancut/Manhole Water Sample Collected By Wate= sample Test Rssults C~tn~nts TO Nearest Public Sewer To Nearest Sewe= Service Line on Lot Be SEPTIC/HOLDING TANK DATA Date Installed ~/-t~- ~/ Size /~7~ ~,~ Standpipes (~/N) Ai~-tight Caps ~/N) No. of Ca't~artments ~- Foundation Cleanout ~Y~N) Holding Tank High-Wate~ Alarm (Y/N) L//~ Temporary Holding Tank Permit (Y/N)~ , Separation Distances f~om Septic/Holding Tank: To Wate~-Supp!y We 11 To Property Line _ To Water Main/Service Line Course ~//~ To Building Foundaticn ~' ~ TO Disposal Field /~' To Stream, Pond, t~ke, c~t Major D~ainage Receipt Date Paid: Amount: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD I~%TA Soils Rating in Absorption Strata Date .Installed ~ ~/~ ~ Width of Field _~' Square Feet of Absorption A~ea ~ Depression over Field (Y~ Date of Lest Adequacy Test Results of Last Adequacy Test Separation Distano~ frcm Absorption Field: To Water-SupDly Well ~f3~ To P~operty Line To Building Foundation //' ~JO To Existing or' Abandoned System cn Lot A//~ ; O~ Adjoining Lots To Water Main/Service Line ~//~ To Cutbank(~if p~esent) To Stream/Pond/Lake/or Major D~ainage Course .~/~ T~ Parking Area, o~ VerSicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes P~esent _~N) D. LIFT STATION ed Dir~ ns ions Size in GaIl-c~ High Water Alarm Level at Tested for Electrical Codes (Y/N) Cc~ents · Manhole/Access (Y/N___! ~ ,/ / ~"PumpOff'' Level at, ~n~quacy Test. Meets MOA ** Check Permitted Bedrcc~ Rating AGainst HAA Request I certify that I have checked, verified, or confolnred to all MOA HAA Guidelines in effect on t~ clare of this ir~pec~ion. Signed Date _ Company KB1 /d5/s [Page 2 of 2] ~ -u --~ ,..'~.~,.:~.:.~':-' : 2-15-84 ALASKA I:PIVIt~UMIVi~:PI m ~L CONTROL SERVIC INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561-5040 SHEET NO. OF CALCULATED BY ~' ~J~/~'"J DATE CHECKED BY DATE SCA~.E /J 7'5 ANCHORAGE/WESTERN DISTRICT OFF[CE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA gg501 BILL SHEFFIELD, T~lephone: (907) Address: 274-2533 PWS To Whom it May Concern: Water System is in ~omp,iance-wi~h the State Drinking Water Regulations Sincerely,