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HomeMy WebLinkAboutRONS LT 201514Z $ l o00 ► �1�11L O t`) Lam/ Municipality of Anchorage .,�° ter`•• Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: b o N PID Number. Name: Wastewater System: ❑ New 03,upgrade Address: ny NC ABSORPTION FIELD Phone: Number of Bedrooms. -7 9 E3 Deep Trench Shallow Trench [3 Bed Q Mound l7 Other. LEGAL DESCRIPTION Soo Rating: Total Depth from original grade: p >F Ft, Block: Lot:Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: Q ( is Ft. Ft. Township: Range: Section Fill added above original grade: Gravel Length: Ft. Ft. Well: E3 New ❑ Upgrade Gravel width Number of lines: Distance between lines: Ft. FL Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area Pipe Material: Ft. FL FO Driller. Date Drilled: \ Static Water Level: Installer. Date kutatled: �7 I t'i '� d FL / '� Yield: Pump Set at: Casing Height Above Ground: TANK GPM Fl. FL SEPARATION DISTANCES 15/septic ❑ Holding p S.T.E.P. ❑ Other. To Septic Absorption Lift Holding PubriclPrivat Manufacturer. -FA Capacity: From Tank Field Station Tank Sewer line X L N V, 1 e e OGal. Well 10-7 Material: 54-4— 1 Number of Compartments: Z Surface Water Ni b LIFT STATION L Size: Manufacturer. Lot Line 76 7 Gal. Foundation 'Pump on' level at 'Pump off level aL High water alarm at: 3' In. in. in. Curtain Drain Pump Make d Model Electrical Inspections performed by. 0 Remarks: BENCH MARK Location and Description Old 4-gkLi V Y Assumed Elevation: t' rn / NV.,x oes+eeoemo � o .. C2 e Inspections performed by: a. 5 Dates: tat )0-)"7—VN CMN NONafaalMM��e 2nd 9� T spum"d e Development Services Department ApprovalQ�s Reviewed and approved by: Date: !o ems.• P,pE�P;�� (Rev. 12/00) la 49th ...mfnvni...... t • ..................... ..� .� . IIN Sp LAND o. CE -2225 r 25 0 25 50 75 100 125 150 SCALD 1' = 50 FT. 1000 GAL. SEPTIC TANK BENCH MARK: TOO DECK ASSUMED ELEVATION: 100.00 FT 1UHMN JYUKKLANU F.L. LOT 2 ROWS SID SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE CAROLYN HANS DATE: OCT. 20, 2003 ANCH. AK. 99501 11041 GAMACHE SHEET- 1 1 GRID: 907 279-3916 2637 PERMIT # SWO30442 PID # 015-521-35 RON00022.DWG V MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030442 Legal Description: Eton`s. Lot"2., Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Carolyn Hans Owner Address: 11041 Gamache Anchorage , AK 99516 - /O_/?'03 �9 1:2oa Date Issued: Oct 16, 2003 Expiration Date: Oct 15, 2004 Parcel ID: 015-521-35 Site Address: Unknown Lot Size: 49443 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Date: /1 6 03 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 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 01� J7 —� Permit Number SWO3044-z Property owners) L'%Q 0 Lyl\l I -i/4, N s Day phone Mailing address (1) It gu I C, A tiuAC � I q_q I 0 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) L 0 i 2 . W's Legal description (Section, Township & Range) Lot Size C L Acres/ q.Ft. THIS APPLICATION IS FOR: Number of Bedrooms _1_3 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade V THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized ag4nt) e Permit Fees: Yad '�- Waiver Fees: Date of Payment: J(� %3 Date of Payment: Receipt Number: y 3[ 4 5 C Receipt Number: (Rev. 12/00) T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Development Services Department On Site Water and Wastewater Program 4700 South Bragaw St. Anchorage, Alaska 99519 Gentlemen; October 15, 2003 We are applying for a permit to replace the existing septic tank on Lot 2 Ron's subdivision. The tank was installed in 1975, and is probably perforated and in groundwater. The tank was pumped last Friday and again yesterday. The proposed replacement will have no effects on this property or the adjoining lots. Yours T—q-t�� T. Sp land P.E. -(- Well — —1 --'t— — — — — I i —1 •�E�— AV ir A.� tt �.......F....� ra kilt,VIA # 8b 25 0 25 50 75 100 SCALEr 1' = 50 FT. REPLACE 1000 GAL. SEPTIC TANK -�- Well 9th !�v •••i'�a I EN SPURKLAND No. CE -2225 125 ISO IUHI&N SPUMKLANU P.L' LOT 2 RON'S SID SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE CAROLYN HANS DATE: OCT. 15, 2003 ANCH. AK. 99501 11041 GAMACHE SHEET.• 1/1 GRID: 2637 907 279-3916 PERMIT # SW030XXX PID # XXX RON00022.DWG MUNICIPALITY OF ANCHORAGE DE 1TMENT OF HEALTH AND HUMAN SER\ S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name /�vna SvM� viz c c: DISTANCES Depth to pipe bottom from Cl TO SEPTIC ABSORPTION WELL FT Address FROM TANK FIELD Gravel depth beneath pipe / v t FT Phone(s) Permit No. No. of Bedrooms WELL Gravel length � Gravel width 5¢d! 141M FT flat LOT LINE Total absorption area Iv _SrtCr Distance between lines LEGAL DESCRIPTION /496) SO FT Lot Block Subdivision 1 eelvS FOUNDATION ✓ Pipe material Township, Range, Section AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, �Lnveway, water bodies, eta) Date Installed TANKSiif'j 11 (SEPTIC �CY/57/NC� ❑ HOLDING N. Manufacturer Capacity in gallons 1^ U Material No. of Compartments X72 OF SYSTEM /TYPE ❑ TRENCH L� BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Cl Total depth from original grade /� i 0 $'�+ original grade { 4 177111 FT FT Fill added above original grade Gravel depth beneath pipe / v t FT /Z ";.1;f7S5et-f l%� FT Gravel length � Gravel width 5¢d! 141M FT flat FT Total absorption area Iv _SrtCr Distance between lines /496) SO FT FT Number of lines Soil rating ✓ Pipe material C ZY0 SO FT iIAW60,9g Installer rop 5770 Date Installed WELLS [> PRIVATE ❑ OTHER (Identifv) / ClasDiication (A,B,C) Total Depth Cased to NIA f//✓K FT Z/Wk FT Installer Date Installed: Z//V/< "/< REMARKS: Weelel/tiG earl W&_71- 5 + /5 1/6ZE/FlCA172fAl t1,641 ea -5f 11rW I M Sf'4i4!;�k/ 7,'141,t 77 IVVIe7 - Scale: IVr 1(� 0 ` _ 4' Inspections Performed by: d 4444- Date: certify that this inspection was performed according to all Municipar4nd Stale gut lines in effect on this date: // Health Department Approval: Date. �� >1-7 T ' ENGINEER'S SEAL ��� ���w ^ DEPARTMENT HEALTH AND ENVIRONMENTAL .ROTECTION ` . 825 L STREET� ANCHORAGE, AK 99501 264�4720 PERMIT NO: 860416 UPGRADE DATI SUED: 11/07/86 APPLICANT: RON SOMERVILLE '��E� ADDRESS: 26O0 CORDOVA �~^-I--'� ANCHORAGE, AK 99501 CONTACT PHONE: 276-2761 LEGAL DESCRIP: SUBDIVISION: RON,S SUBDIVISION LOT: 2 BLOCK: 0 SECTION: 22 TOWNSHIP: 12 RANGE: 3W LO9200 (SQ"FT, OR ACREG) 1 certi1, y that: 1. I am {amiliar with the requirements �or on~site sewers and wells as set �orth by the Municipality of Anchorage (M)A) and the State o[ Alaska" 2, I will insta1l 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 Alaska requirements �or the set back distance(D III any existing wwastewater disposal sysm or public sewerage system on this or any adjacnt eor, nearby lot. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS�BUIL�S WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICA ENSED ELECTRICIAN" GIGNE0 � DATE: �p—` � -- -~.... APPLICANT: R LLE � /^ ~^' ISSUED BY ��~l���______~'_-. ~ �����..�I-���^.~- _-�~� � / (ON017-10AI FOR AA1 4PPI?8uk0 �����1LJ~ ����� ������� ��� ^������ ����� �����*~ PERC4Aip W47FR MOA117-of? OE 4T rHE EJ�-T Emp or 7-1-1,E VAiqlFe THE 2 FOOr 14,11ni OF ^9C(EI07-Iu16��a"�� ly �m'*xxJ2,^�.��- /�fr Pep, ^~ ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 JOB --- SHEET NO. OF CALCULATED BY DP\ DATE /0 - 3L- CHECKED BY DATE .�or✓eAlaM F=c�au- S�vr �e�����e ,C2 p10 iu� s� i• ��dNs acs RONS SUBDIVISION 113-s� LOT 2 Y C. RID, JR. E-2251 4�ti..a LYYY �C ,:� d� _57 . ISA 5510 le v5c3-5V 0TES= IO'p iw.ev,�iioY•�i SL,owh o" bo%)r40.vy c�ti-t Feco1-d Ir{-o•w�44''�o.n fro.,,. Y1�� No• 74-245. ♦� Oz Fovv\4 '4� 0 rebar a,f gll lot' corkAe:r5. ;"i BUILT PREPARED BY. JEFF A. 9ASTALDI, R.L.S. 9011 BETTLE9 BAY LOOP ANCHORAGE, ALASKA 9960E TEL. 344- 427E A � CHECKED BY% GRID: '26.37 FIELD BOOK: I° J P� % O Y C. RID, JR. E-2251 4�ti..a LYYY �C ,:� d� _57 . ISA 5510 le v5c3-5V 0TES= IO'p iw.ev,�iioY•�i SL,owh o" bo%)r40.vy c�ti-t Feco1-d Ir{-o•w�44''�o.n fro.,,. Y1�� No• 74-245. ♦� Oz Fovv\4 '4� 0 rebar a,f gll lot' corkAe:r5. ;"i BUILT PREPARED BY. JEFF A. 9ASTALDI, R.L.S. 9011 BETTLE9 BAY LOOP ANCHORAGE, ALASKA 9960E TEL. 344- 427E DRAWN BY: J.A.B. DATE', 1D-29-86 CHECKED BY% GRID: '26.37 FIELD BOOK: JOB NO. I HEREBY CERTIFY THAT I HAVE SURVEYED THE J FOLLOWING DESCRIBED PROPERTY: AV As shown hereon s0 AND THAT NO ENCROACHMENTS EXIST EXCE AS INDICATEDAT IS THE RESPONSIBILITY THE OWNER TO DETERMINE THE EXISTENCE ANY EASEMENTS, COVENANTS, OR RESTRICTI WHICH DO NOT APPEAR ON THE RECORDED SUB ; DIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CON- STRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT,AK. 15 Nr� ALASKA bUIROWnTAL COnTROL SNUIRS, InC. Sngineerinq & 6nuironmental Studies SPECIFICATIONS FOR BED WASTEWATER TREATMENT SYSTEM — RON'S SUBDIVISION, LOT 2 1.0 GENERAL 1.1 THE DRAWINGS, SHEETS 1 THRU 5, SHALL BE PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE, DEPARTMENT OF HEALTH & HUMAN SERVICES (DHHS), THE CONDITIONS OF THE PERMIT, AND ALL APPLICABLE RULES AND REGULATIONS CURRENTLY IN EFFECT. 1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY, AND ARE TO BE VERIFIED OR MODIFIED IN THE FIELD BY A DHHS APPROVED INSPECTOR. 1.4 IT IS THE RESPONSIBILITY OF THE INSTALLER TO ADHERE TO APPROVED DESIGNS FOR INSTALLATION, TO MAINTAIN THE SPECIFIED SEPARATION DISTANCES, AND TO HAVE THE APPROPRIATE INSPECTIONS. 1.5 IF THE INSTALLATION IS NOT INSPECTED BY AN AECS ENGINEER, AECS WILL NOT BE RESPONSIBLE FOR THE DESIGN. AN ENGINEER AT AECS SHOULD BE CONSULTED PRIOR TO CONSTRUCTION, TO DETERMINE THE NUMBER OF INSPECTIONS THAT WILL BE REQUIRED AND TO EXPLAIN WHAT THESE INSPECTIONS WILL INVOLVE. 2.0 SEPTIC SYSTEM 2.1 THE SEPTIC TANK SHALL BE A UPC—APPROVED TWO COMPARTMENT TANK, CONSTRUCTED OF 12—GAUGE STEEL WITH BITUMASTIC COATING, SET LEVEL ON UNDISTURBED SOIL, AND INSULATED WITH AN OVERLYING LAYER OF 2 INCH BURIAL TYPE POLYSTYRENE. 2.2 THE SEPTIC TANK SHALL BE A MINIMUM OF 5 FEET FROM THE HOUSE FOUNDATION, AND A MINIMUM OF 5 FEET FROM THE ABSORPTION AREA. 2.3 THE SEPTIC TANK AND BED SHALL BE A MINIMUM OF 100 FT. FROM ANY PRIVATE WELL OR BODY OF WATER, 150 FEET FROM CLASS C WELLS, AND 200 FEET FROM CLASS A OR B WELLS, UNLESS OTHERWISE SPECIFIED. LESS THAN THE REQUIRED SEPARATION DISTANCE MUST HAVE PRIOR APPROVAL OR WAIVER BY ALASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES 2.4 PIPING SHALL BE FITTED WITH A MECHANICAL WATERTIGHT CALDER COUPLING ON THE OUTLET AND INLET OF THE t�nn iiiet zzrd Qionnn 4iiito �i..�inrinrnnr �iine�rn QQ�ift�.�Af17) �iR1-.rifl(!f1 SEPTIC TANK. PIPING SHALL BE 4 -INCH SOLID PVC ASTM D3034 OR CAST IRON, SLOPED A MINIMUM OF 1/4" PER FOOT WITH A MINIMUM OF 4 FEET OF COVER. 2.5 CLEANOUTS SHALL BE INSTALLED AS DESIGNATED AND CAPPED WITH AIR -TIGHT RAIN CAPS (.JIM CAPS OR EQUIVALENT), AND EXTEND A MINIMUM OF 2 FEET ABOVE GROUND LEVEL. 3.0 SEEPAGE BED 3.1 THE SAND FILTER SHALL MEET THE FOLLOWING M.O.A. CRITERIA: SIEVE SIZE (MM) PERCENT FINER BY WEIGHT #4 (4.75) 100 #10 (2) 75 - 100 #60 (0.25) 5 - 75 #200 (0.074) 0 - 15 3.2 THE GRAVEL FOR THE BED SHALL BE 0.5 TO 2.5 INCH, SCREENED ROCK WITH LESS THAN 3% PASSING #200 SIEVE RESIDUAL. ALL SUBSTITUTES MUST HAVE PRIOR DHHS APPROVAL. 3.3 THE BOTTOM OF THE EXCAVATION SHALL BE LEVEL AND RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. 3.4 THE DISTRIBUTION PIPE SHALL BE 4 -INCH RIGID PVC WITH A MINIMUM CRUSH STRENGTH OF 1500 LBS. ALL PIPES SHALL BE LAID LEVEL, AND SPACED ACCORDING TO THE DRAWINGS. 3.5 MONITOR STANDPIPES SHALL BE PLACED AS SHOWN IN THE DRAWINGS. THEY SHALL BE RIGID PVC ASTM D-3034, OR OR 4 INCH DIAMETER CAST IRON. THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5 INCH HOLES ON THE 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE, OR A SECTION OF REGULAR PERFORATED SEWER PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO -HUB COUPLING OR SOLVENT JOINT. A RUBBER RAINCAP (JIM CAP OR EQUIVALENT) SHALL BE PLACED OVER THE TOP OF THE PIPE. 3.6 IF THE FINAL GRADE OVER THE BED IS LESS THAN 4 FEET ABOVE THE GRAVEL, INSULATION IS REQUIRED, USING DOW EXTRUDED BLUE STYROFOAM BOARD, THERE SHALL BE 1 INCH OF INSULATION FOR EVERY FOOT OF SOIL LESS THAN THE REQUIRED 4 FEET OF COVER, BUT THERE MUST BE AT LEAST 18 INCHES OF SOIL EVEN THOUGH INSULATION IS USED. THE SOLID PIPE EXTENDING FROM THE SEPTIC TANK TO THE DRAINFIELD SHALL ALSO HAVE 4 FEET OF COVER OR AN EQUIVALENT LAYER OF INSULATION COMBINED WITH SOIL TO PREVENT FREEZING OF THE LINE. 3.7 IF INSULATION IS NOT NECESSARY, THEN THE GRAVEL MUST BE COVERED WITH A LAYER OF A NONWOVEN FABRIC (SUCH AS MIRAFAI, FIBRETEX 200 GRADE, POLY -FILTER X, OR EQUIVALENT). 3.8 THE TOP AND SIDES OF THE BED SHALL BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX OR BLUE GRASS. 4.0 INSPECTIONS 4.1 THIS BED WILI, REQUIRE THREE INSPECTIONS. THE FIRST INSPECTION WILL BE OF THE OPEN EXCAVATION, TO ASSURE THAT THE SYSTEM IS INSTALLED IN PROPER STRATA AND DEPTH. 4.2 THE SECOND INSPECTION WILL BE PERFORMED AFTER SAND FILL IS INSTALLED, BUT PRIOR TO PLACEMENT OF GRAVEL AND DISTRIBUTION PIPES. THIS INSPECTION WILL VERIFY THAT THE FILLER IS PROPERLY INSTALLED, THAT IT MEETS SPECIFICATIONS AND THAT IT FULFILLS THE INTENTION OF THE DESIGN. 4.3 THE THIRD INSPECTION WILL BE PRIOR TO BACKFILL AND VERIFY THAT DISTRIBUTION PIPES ARE POSITIONED PROPERLY, SUFFICIENT GRAVEL IS PLACED, AND THE SPECIFICATIONS OF THE DESIGN ARE MET. QST S2' 11. -7 E 299-x' ("=50' AS BUILT ,PREPARED 1Y: JEFF A. "STALDI, R.L1. ..1011 1ETTLEi BAY LOOP 'ANCMORAtE. ALASKA 11609 TEL. 144- 4E7E -1`54.74' - DAT61 10-29-66 CHECKED BY* N FIELD BOOK: 409 N0. N d j TEM -°- 5STT 1 G 4Y ye,1+ Pees 274 156 -ST tl"9° /SAY t9.5 •' w,,jvovd 4tmr. 0 1i' IS Wil�tB GRAVELS l c•eir, `WALK a s Z%^ r --� EXISTS NG 0 [+t8 'aZ' It .7" Z J9.SZ' i NOTES ©'D iw.tv+�aio�^'i gtmev g% a„ b0%jv%44'6.Y 9Avjc Kecord Z NTo�N14 T••�O+t1. �WWn 1 'Q 11'i' iJD•. !Y' Z"i7 . 10 VovaA4 111 rcbar wt qll 10+ corncry. i j' .►SOFA/ AS BUILT ,PREPARED 1Y: JEFF A. "STALDI, R.L1. ..1011 1ETTLEi BAY LOOP 'ANCMORAtE. ALASKA 11609 TEL. 144- 4E7E DRAIN BY: J.A.I. DAT61 10-29-66 CHECKED BY* GRIM 2637 FIELD BOOK: 409 N0. I HEREBY CERTIFY THAT I HAVE SURVEYED THE ,`�,��....,• •9s P4 FOLLOWING DESCRIBED PROPERTY �- As shown hereon ih:• TH g. AND THAT NO ENCROACHMENTS EXIST EXCE 009 ago* 0: 49" '. 00 AS INDICATEDAT IS THE RESPONSIBILITY THE OWNER TO DETERMINE THE EXISTENCE v • •••••• °• ANY EASEMENTS/ COVENANTS9 OR RESTR{CTI G's%kl A WHICH DO NOT APPEAR ON THE RECORDED SUB , =SI g DIVISION PLAT. UNDER NO CIRCUMSTANCES �/�,�'•..,.�..•'• + SHOULD ANY DATA HEREON BE USED FOR CON— STRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT,AK. I e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 ly� SOILS LOG — PERCOLATION TEST t�i PERFORMED FOR: )Qci" sbme�vi`l/P DATE PERFORMED: 12- /V'oy• ?d LEGAL DESCRIPTION: on Suddiv/siw, . L6'f Z Township, Range, Section: S e, 2 z r' f2 3 i--- . SLOPE SITE PLAN I / r � 2 Gm //� s`n�y yrH✓ot 3 4 5 6 j11 1111 ML1s114 7 8 9 10 11 12 13 s4pPk- 14 m not. Sc� tS 15- 16 5 16 Moa p4r�k 17 18 19 ^krsira /' Ar'X v / l ■■UMEM■N■■ ■■■UMM■N■ Date Gross Time Net Time Depth to Water Net Drop /2Nuv. ✓z .ry z--- y. 60 .®NEU■MMMMENNENOMEN, As- ovaj �w� c '7O e/)f u. -e 7-ka� •Ap 3� Zy Cs Boas L ' a.� .1 u cam,= /c %f �.7l�f ■O■■■M11■■■ ■AMENtttt - 2 (j 30 Y5 { GUIDELINES IN EFFECTTHIS DATE. DATE: xolr. ft/� n �,� MMENf - 3 25 f 3 C.1 MEMMMEMMEN 1......... ......... .......... WAS GROUND WATER -54'10 ENCOUNTERED? ;7,o S IF YES, AT WHAT L L -- _ DEPTH? P E Depth to Water After sfi rldry 13 /�o� g6 ./..y ..--7 Monitoring? Date: Reading Date Gross Time Net Time Depth to Water Net Drop /2Nuv. ✓z .ry z--- y. 60 COMMENTS 7A 3< As- ovaj �w� c '7O e/)f u. -e 7-ka� •Ap 3� Zy Cs Boas '- a.� .1 u cam,= /c %f �.7l�f q/ 60 - 2 (j 30 Y5 { GUIDELINES IN EFFECTTHIS DATE. DATE: xolr. ft/� n �,� - _ <11.e - 3 25 f 3 C.1 20 G PERCOLATION RATE / Y` � (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN jz rL FT AND 11 FT COMMENTS 7A 3< As- ovaj �w� c '7O e/)f u. -e 7-ka� •Ap �//�� J u,f 7C, -7r fern base of led Cs Boas '- a.� .1 u cam,= /c %f �.7l�f fC7f r7r7 oLJT. / �.0 /✓Lq 1 PERFORMED BY: �'cc Rel IFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECTTHIS DATE. DATE: xolr. ft/� n �,� - _ <11.e 6:ov of 7Jtiinov 1Psi- Gvf ref /�urse.r a perza Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: g'4. A.Bf%1 Ae DATE PER LEGAL DESCRIPTION: 5"L. Township, Range, Section: T /,;t'u PT �— SLOPE SITE PLAN` p�- oR&�lJ1G 1 to FA 4 5 6- 7 7 Ip®tee $ t 'Xq0 Sr�z by 17 seeps 9 ml- sA�vijL( sitar lo-1.WAS GROUND WATER ENCOUNTERED? 11 r s L IF YES, AT WHAT O DEPTH? 12P E 13 Depth to Water Aftersf 1 Monitoring? —tlL Date:/ (X/ 14 15 16 17 18 19 20 ii PERCOLATION RATE ` �'F1 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ,r/ FT AND 6.1�— FT COMMENTS' (, •j'7"�%a 4 / PERFORMED BY: it/ "(/Aw I & %k- - -7 4.4r� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: f©" a� 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 ❑ NEW Donald. Somerville 789_34.50 aUPGRADE MAI LING ADDRESS R.R6 Box 68077, Juneau, Alaska LEGAL DESCRIPTION Loti:2i- :Ron's Sub -Division LOCATION NO. OF BEDROOMS 0' iUialley�Birch Ivrea 3 Well Absorption area Dwelling PERMIT NO. Uy DISTANCE TO: F z Manufacturer Material No. of compartments aQ wf N Liq. capacity in gallons Inside length Width Liquid depth IF HOMEMADE: o o z DISTANCE TO: Well Dwelling PERMIT NO. 0 Z Q Manufacturer - Material Liquid capacity in gallons 2—F- 0 DISTANCE TO: Well 125' Foundation 75' Nearest lot line 36' PERMIT NO. 790101 w= Lu LL U _jFL No. of lines Length of a ch line g �! Total length �}f1 es g ' Trench wi t �j� Distance between lines F —¢ 1 ' ^r inches ;I A. G finish Material beneath the Total effectiv absorption area F Top of tile to grade 60 X70 N.F. p 4 F+' - t, inches Length Width Depth PERMIT NO. Lu 0 Q F- Type of crib Crib diameter Crib depth Total effective absorption area w ° LU rn Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J Lu � Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER ° PIPE MATERIALS Ductile Iron & P.V.C. SOIL TEST RATING ,on ' L iJl� 155 "C Ft INSTALLER Schachle Excavati i S-^ 11 REMARKS '-11111 t 491H • ,r¢T! �� w✓w•w es.•s•• •. � �®spew.® 9 1. Flnrman f 4C oG t� s • NO. 1198-E a® �® .� ------------------ APPROVED DATE LEGAL i'1/1- .s/� /73 Lot 2, eon's Sub -Division �W Q 141 Q 1A C T� �0EPHRTMENT ^l HEALTH AND ENVIwONMENTHL PW[ECTION STREET, HNCHORHQE, �K. 99501 ^ ° 264~4720 01 J­� F=w: Fit rwi x» PERMIT W1.1 HPPLICANT RQNHLD SOMERYILLE RRC, BOX 68077 JUNEHU 789 ]450 LOCATION SORRELS DRIVE LEGHL L2 RON'S S/D LOT SIZE 55000 �QUARE FEET TYPE OF SOIL HBSORBTION SY�TEM I�� TR�NCH MHXIMU� NUMBE� OF QEDROOMS SOIL RHTING (SQ FT/BR)� 155 THE 8F THE SOIL HBSORPTION SYSTEM IS: K> FE.: -F- F. -1 == `E--49 P_... FEE 1441 (as -V F I == e. -F ������ ���F­ I� � THE LENGTH DIMENACN IS; THE LENGTH (I61 FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFHCE 01: THE 8R{X/ND AND THE BOTTOM OF THE EXCHYHTION (IN FEET). TI IS NO SET WIDTH FOR TRENCHES THE GRAVEL DEPTH 15 THE MINIMUM DEPTH OF GRAVEL BETWEE.N THE OUTFHLL PIPE AND THE BOTTOM OF TI � EXCAVATION (IN FEET). PERMIT APPLICANT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE IN5THLLHTIQN INSP�CTIONS OF HN9 WELLS HDJHCENT TO 70I5 PROPERT\/ HND THE NUMF"ER OF, RESIDENCE15) THHT THE WELL WILL SER\��. ��� _*Ir, 11".1 CA ��� :1, VA F`4 E"', C:.':: -*IF' I C3 PA �.-E-i. E" �� BHCMILLING OF ANY SYcSTEM WITHOUT FINAL INSPECTION AND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION MINIMUM DISTANCE BETWEEN H WELL HND ANY 80-4~SITE SEWRGE DIHL 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC WELL CTHER MHY APPLV. HND CONSTRUCTION [>IHGRHMS HRE HVHILFIB[ E TO INSURE PROPER u.iSTHLLHTIQN. Fol K Fit M 1: 4, ���������� c"", P1 FEE" F`�'? I CERTIFY THAT 1: I HM FHMILIFIR WITH THE REQUIREMENTS FOFI ON-SITE HND WELLS HS SET FORTH BY THE MUNICIPAL ]TY 8F HNCHORAGE. W I WILL INSTALL THE IN ACCORDANCE WITH THE CODES ]� I UNDERSTR S�TEM MHY HRGEMENT IF TEON�E RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNE):-�~0 : - IF r 11� ISSUED ' ��/~,n��/°~�'' —' ^" - ~ GREER ANCHORAGE AREA BO""`UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME 9061 -'iVrnn1e/LV14Le MAILING ADDRESS 1"o '73 PHONE 341'/- S737 LOCATION OPE ©U-2 LEGAL DESCRIPTION 4"12- 40r 2-7, 'SCC- 22-, _722A/' 7777SEPTIC TANK: ' DISTANCE!4- NUMBER OF FROM WELL 70� MANUFACTURER 614EE2• MATERIAL -57 COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /0 Z" GALLONS. SEEPAGE PIT:/ / / ! 14,></9 x2/ xz! NUMBER OF PITS DIAMETER OR WIDTH—, LENGTH_, DEPTH a/ LINING MATERIALC72e CR BSI E: DIAMETER—DEPTH & "DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION—, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE -LNO [ IJ CONSTRUCTION !! IZ R SIA14 DEPTH DISTANCE FROM: BUILDING �0 �� NEAREST 20 �f NEAREST ao SEPTIC �� / f SEEPAGE v �; FOUNDATION LOT LINE SEWER LINE TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED �� REMARKS ^/STAZL Sfh✓! Se'04- OA/ U)EL., DISTANCES: DIAGRAM OF SYSTEM SOIL. /S:[ -Q/ INSTALLED BY: INC M �$ PIPE MATERIAL: LlfJST =2OA� �..�� �0 LOT SLOPEa �� . V qQ� REMARKS:SO `�C n/'/r-c r 1 -.'Ale- TD Q-�9r/o�r oM7rsLoE ,coonnlF ©-57iyiV0 C L�.B,ilau T Gt-D an/ 7"; -IVAC. DATE 23- 74- APPROVED G.A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT V., o )"/'/l, 71-kJ17 Ot- PERMIT NO. NAME OF APPLICANT(/�//G'�✓�� MAILING ADDRESS ¢(6?(�/^' 6 PHONE J-Xlk� INSTALLATION LOCATION /sSzGL-ETJ'r LEGAL DESCRIPTION C INSTALLATION OF: SEPTIC TANK f.� eSEEPA E PIT_ , DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED��/�� FINANCED THROUGH TO BE INSTALLED BY ����ee_/ SOIL TEST RESULTS GZL-lop—"-el / --- THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. /may / (j / SEPTIC TANK SIZE / TYPE '�i�CZ�'v�' SEEPAGE AREA SIZE L / l_rz TYPE /✓G�N�f �/�� MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD _ SEPTIC TANK TO SEEPAGE PIT WALL J - SEPTIC TANK ✓ SEEPAGE PIT DRAIN FIELD TO NEARESTLOT LINE. WELL TO SEPTIC TANK / �j SEEPAGE PIT DRAIN FIELD - ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK / / SEEPAGE PIT DRAIN FIELD �rJ SEPTIC TANK, /SEEPAGE PIT. RAIN FIELD - TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY Case # 3330 "C" Street ANCHORAGE, ALASKA 99503 92_ LOT 27 Performed For Ron Summerville Dated Performed April 2, 1974 Legal Description: Loth` ock Subdivision Sec. 22, T12N, R3W, SM, This Form Reports Soils Log xx Percolation Test - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics .- Organics (Pt) 2i_ Gravelly sand (GW - SW), light brown to i_ buff, gravel to. 1.5", well rounded; trace of silt, low moisture 1— Gradational change to coarse sandy gravel 6:_ (GW - SW) with trace to minor amount of silt; low moisture 8­ 0214 ilty Silty gravel (GM), light gray, low moisture Coarse sandy gravel (SW), light gray, low moisture content Bottom of boring 12.5' Was Ground.Water Encountered? No S� 0,0 If Yes, At What Depth? F �i% W/���".�i/��M M mwm�� Reading Date Gross Time Net Time Depth to H2O Net Drop Percolation Rate, Minute Proposed Installation: Seepage Pit xx Drain Field Depth of Inlet Depth to Bottom of—Pit or Trencfi T— COMMENTS: Based upon GRAB requirements, we recommend 155 sq. ft. per bedroom. Test Performed BY Howard J. Grey/ John Jameson Date Certified BY: ALASKA"MNERA "& 'MATERIAL -S 1;A]B Date 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 �a 1. GENERAL INFORMATION (a) Legal Description (include Location (address or subdivision, section, township; range) 5-1,A . <lC 2z 7,10/1, (b) Applicant Namer�S�l%%.�3%��LLl �-�ephone: H�o�mjelk Busine/s+s Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builderod., Buyer ❑ ; Other ❑ (explain); (d) Lending Institution .° Telephone Address' " ?,��� a r (e) Real Estate Company and /Agent —A Address �Ia 4: �ln Telephone —� ) c2 Zz (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family b� Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well L( Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ,n 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 Addre Date OF A4 A. G?i'fC�LgLil� _!meq �Q'`V •..... .�' vp of 2) ` � HHe• � sewe•a.n•c••e• aF. REID, JR. ` I �����G��� � °.• CE - 2251 or 6. DHEP APPROVAL Approved for "fl,r�bedrooms by./X" Date Approved �'� Disapproved (/ Conditional Terms of ,Conditional Approval CAUTION / 2- - 2—a& 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 MUNICIPALITY OF ANCHORAGE r1 " 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 //12/A��' 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 12, a � f�Ortl.S s1113,9, 5'!52'- 22$ Tie /V ,C ZW - Location (address or directions) (b) Applicant Name OON SaMNI€KV Telephone: Home Business�� 7� Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer ❑ ; Other ❑ (explain); (d) Lending Institution IVOM Telephone iLbN Address (e) Real Estate Company and Agent Address Telephon (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family 2/'Multi-Family ❑ Other Number of Bedrooms 3. WATER SUPPLY/ Individual Well Community ❑ Public ❑ " Note: If community well system, must have written confirmation from the State Department df Environmental Conservation ell attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Lf 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 (11184) Page 1 of 2 5, ENGINEERING FIRM PROVIDIN..-ASPECTIONS, TESTS, FILE SEARCH, DA 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 Authorrty 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 AECS hie Telephone Address /ZOd yl/, " ,�b�� LLL- B /�/IICfdO�r�`. Ale 9 50 3 Date wAr i e ofais �trs�� d/.ee le ,/a- farvvi; Z� e' f� T1//1S 6. DHEP APPROVAL�' ZX Approved for Approved toff A P TH , • {✓nee g���oeoeoo� LEROY C. REI ; JR. �• i cE - 2251 ® : C A' r% bedrooms by —=� _ Date Disapproved Conditional ix— Terms of Conditional Approval as 0 U 7'1he-el elly /��eS 4 44,9 , -?,) f'sou�Gle f'S T�.s ��la`Tlsis,Grr Lrliy'1i p<�vt 7'L�'i' i1e a�ou.e cov�a�%tions a deeH eT ho facer y�i�� �%u /l8� f � ♦ 1 t � CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) Alpine Drilling & Enterprises INVOICE Domestic — Commercial N° 2 Pump & Water Systems 077 Box las 4,Job Na e / Location n Anchorage, Alaska. 99511 ))(907) 3445-02200`2 TO. /� T AlaG_&,q S(AJLC-�f% rte/ i • 1 DATE DESCRIPTION AO FAW _ " , ! ® 1. 4111 1 V,- I o Vd r_ &A PAY THIS AMOUNT Thank You SIGNATURE - (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. - SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. p- MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) NOV 2 4'N° CHECKLIST - FEBRUARY 1984 264_4720 RECEIVED Legal Description: ZZ1 4411� SC6f31P ,5r_ rizN, RH W, _5�, A& A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) NIA LINK 7 Well Log Present _ Date Completed Yield�m Total Depth Z//✓k Cased to UNK Depth of Grouting ULlfk Static Water Level &4, / // Pump Set At ��✓�` Casing Height Above Ground 40" Sanitary Seal on Casing (qN) Electrical Wiring in Condu''(Y/� /Y ,° Depression Around Wellhea ®/N) Separation Distances from Well: To Septic/Holding Tank on Lot l'�� On Adjoining Lots v To Nearest Edge of Absorption Field on Lot f'¢� ; On Adjoining Lots /00 To Nearest Public Sewer Line &A To Nearest Public Sewer Cleanout/Manhole N'1A To Nearest Sewer Service Line on Lot /y�A Water Sample Collected by A. 1N/�N 4 0e� 4• ; Date Water Sample Test Results 50�- Comments (A!5"XL5ri N66_ 0/r. GLS VO A'/L5Z 7r _W144 .S&PPGY 77V6 PVC411VL-Wr B. SEPTIC/HOLDING TANK DATA -7/Z-31.7 Date Installed Size (000 No. of Compartments Standpipes (Y/N) Air -tight Caps V) Y Foundation Cleanout ON) Depression over Tank (Y49 ty Date Last Pumped Gly' ���2c-✓ �G ex,.Q Pumping/Maintenance Contract on File (Y/N) NSA for N1r4 44-6 «l r Holding Tank High -Water Alarm (Y/N) 1Y1, Temporary Holding Tank Permit (Y/N) �01 Separation Distances from Septic/Holding Tank: i i o� To Water -Supply Well lo`� To Building Foundation 410 To Property Line To Disposal Field To Water Main/Service Line N`,4 To Stream, Pond, Lake, or Major Drainage Course > /®© Comments Page 1 of 2 L z, F,.Zr 26N5 5'C/`3D. .SSG Z2, T/ZN, /Z3tiY C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �9® �B�' `� Type of System Design Date Installed ///�9k6 Length of Field Width of Field !/cl�•d Depth of Field AS�%h- Gravel Bed Thickness /Z Square Feet of Absorption Area ����Standpipes Present &/N) Depression over Field (Y/t I Date of Last Adequacy Test IVIA i Results of Last Adequacy Test A Separation Distance from Absorption Field To Water -Supply Well N9 / To Property Line /l /al� To Building Foundation To Existing or Abandoned System on Lot 20 ; On Adjoining Lots *? To Water Main/Service Line NIA To Cutbank (if present) ^11A To Stream/Pond/Lake/or Major Drainage Course/Ob To Driveway, Parking Area, or Vehicle Storage Area Comments '0k,4cW g& -P apmew,57 `� D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N _ Comments — Dimensions Manhole/Access (Y/N — "Pum evel at Vent(Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that I h ve checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed < C ie:9 Date Company 'Q rsy //�/���' a MOA No. Receipt No. h 0 0 1 ` U CO3/ l Date of Payment X4 Z Amount: $ (�c�- od Page 2 of 2 72-026 (11/84) A C s ALASKA RUIROMPTAL C011TR0L RUM, Inc. Engineering & EnuironmMUNent I CpPIAIJ#bF AN(7!HORAGE, NVIR%MFNITAL PROTECTION 1200 West 33rd Auenue, Suite BoAnC0 raqe, laska 99503*(907) 561-5040 TO R E C E ...... .. ...... . . .... ...... V ED DATE — SUBJECT..... 60550 ALASKA �, JIROn RTAL COnTROL Seiw'US, IN. enywrinq & 6nuironmental JtudleS DIXIE DIXON/REMAX 2600 CORDOVA ANCHORAGE ALASKA 99501 11/24/86 SELLER—RON & JANET SOMERVILLE DIXIE DIXON/REMAX 2600 CORDOVA ANCHORAGE ALASKA 99501 LEGAL:RON'S SUBDIVISION BLOCK 0 LOT 2 FLOW TEST ON WELL WELL FLOW DATE -11/13/86 A FLOW TEST WAS PERFORMED ON THE WELL. 680 GALLONS OF WATER WAS PUMPED AT A RATE OF 5.66 GPM OVER A DURATION OF 2.15 HOURS. THE DRAWDOWN WAS 18.3 ' WITH A RECOVERY TIME OF 10 MINUTES AND THE STATIC WATER LEVEL WAS 64.1 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. i • ••. TH * . a•.. LER C. REID, JR. - 14 .-14 Pr'OiCSS ,nnn iiia, ".., Q, ­ %.;tom R.A,Ai ,n AkAm oorn-2o(W71 W-FNtA .,i�Bc `J�► LAWCORY I.0. # x'127 I.D "SEWAROMN �Y AN1.MORAC1r, ALASKA` 99518 -. 007)344=8551 BACTERIOLOGICAL WATER -ANALYSIS — TO BE COMPLETED BY VATER SUPPLIER 11" FnR I AR 110 ANI r BACTERIOLOGICAL WATER ANALYSIS RECORD FOR LAB USE ONLY TOTAL COLIFORMS Membrane Filter: Direct Count Coliform/100ml Verification: LTB BGB FECAL COLIFORMS Finaf Membrane Filter Results Coliform/100m1 OTHER Reported By Date Time A.M. P.M. y READ SAMPLE COLLECTION INSTRICTIONS ON BACK OF FORM DATE COLLECTED MONTH DAY, YE R TIME COLLECTED TYPE Of YSTEM 0PUBLIC INDIVIDUAL ❑ RESUBMIT SAMPLE Sample rejected because: CHECK ONE OR MORE . I.D. N0. (PUBLIC SYSTEMS). CTRCLE CLASS A B C NAME.OPeSYSTEM TELEPHONE NUMBER 1d dAiS 8�/✓! fY+ ❑ Sample too long in transit. Sample should not'be over 30 hours ❑Sample received too late in week ❑ Not in proper container SYSTEM ADDRESS ❑ Leaked out ❑ Insufficient information provided. CITY STATE ZIP CODE Please read instructionsonform. ❑ Other (Specify) i LOCATION WHERE.SAMPLE WAS COLLECTED "� s j, COLLECTED BY:(SIGNATURE) RECEIVED FROM TYPE OF SAMPLE RECEIVED BY �r (CHECK ONLY ONE THIS COLUMN) { (� DRINKING WATER ❑ CHLORINATED; ✓CHECK TREATMENT 0 FILTERED DATE // ,q0 V TIME a0 ANALYTIC METHOD: taUNTREATED OR OTHER ❑ RAW SOURCE WATER EMBRANE FILTER ❑ FERMENTATION TUBE ❑ NEW CONSTRUCTION OR REPAIRS OTHER(Specify) Date & Time Started Date & Time Completed It -1/46 4;35:H«L { IS THIS SAMPLE A CHECK SAMPLE TO A PREVIOUS NON -CONFORMING SAMPLE? YES; ONO PREVIOUS: COLLECTION DATE { LABORA RY RESULTS AnalR�r ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM) ❑ Other Bacteria SEND REPORT TO:(PRINT FULL NAME,ADDRESS AND ZIP CODE NAME S ADDRESS /L 17 4� �3 /�iY6,iTd" ❑ Test unsuitable because: ❑17 Confluent Growth ❑ TNTC 3 I CITY /N61 STATE ZIP qQs 4j SATISFACTORY ® UNSATISFACTORY ❑ BACTERIOLOGICAL WATER ANALYSIS RECORD FOR LAB USE ONLY TOTAL COLIFORMS Membrane Filter: Direct Count Coliform/100ml Verification: LTB BGB FECAL COLIFORMS Finaf Membrane Filter Results Coliform/100m1 OTHER Reported By Date Time A.M. P.M. y READ SAMPLE COLLECTION INSTRICTIONS ON BACK OF FORM 00 m I - m °n w,:oiaz- _ E O � n 3 V rc u r �av_ f _ I rO I I A {a II E e G Q 11 E < E E e v n > r c n T �� m0 co ss°oc cpm Iii N F s -¢:oc �v n a 7 m I s V eveae n.ulo el Aon reae I III - m - N III a J n e 3A HO m �,y �"s SIawOS �oRd zo �m E pp A0 - 4