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Home My WebLink AboutMARIANN LT 73A Municipality of Anchorage Page J of 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: ¢'~00~15003-5 PID Number: ~t o~1 Name: ~'~r~y ~ L~4 ~V~5 Wastewater System: D New ~Upgrade Address:~.O.%O~ ~ I~o~ qq~u~ ABSORPTION FIELD Phone: ~~ No. of Bedrooms:~ ~eepTrench ~ Shallow Trench ~Bed ~Mound ~Other LEGAL DESCRIPTION so, Rating: O.~ GPD/Sq. Ft. Total Depth from~ original, grade: Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: ~ IRange: iSection: Fill added above original grade:o -- · ~' Ft. Gravellength: [O ~q', I'G~',le~' WELL: ~sT/~ New ~ Upgrade Gravel width: Number of lines: Distance between lines: ;'~ Ft. ~ [ I ~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total ~bsorption area: Pipe material: ~T~ ~ 1~T~ Ft. Ft. ~l~~ SQ. Ft. Driller: Cate Drilled: StaticWater Level: Instal[er: Date installed: Ft. ~ }~T~ EL ~-- Yield: [ Pump Set at: Casing Height Above Ground: TAN K GPM] Ft. Ft. SEPARATION DISTANCES ~Septi~ ~ Ho~di,g ~ S.T.E.P. To Septic Absorption Lift Holding ~ub][c/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~O~~ ~ Well- ~O~ I iD t ~ ~ ~ ~ ~ Material:~ L Number of Compadments: Sudace w~t~ ~o'+ ~o'+ ~ ~ ~ LIFT STATION LineL°t ~ ' ~ I ~ ~ ~ ~ Size in gallons: Manufacturer:~ Foundation ~ ~ ~ ~ t ~ ~ ~ "Pump on" level at: ~t: High water alarm at: Gu~ain . ~ ~ ~ ~ ~ ~ump~ ~loctdcal Inspoctions porformed ~rain Remarks: o~ ~*~ (~o~ ~,/~.o.Z BENCH MARK Location and Description: ,,~ "~ ] Assumed Elevation: ~o~ IOO. ~ F~, EN~ .... Inspections performed~4 Eagle .iv, r Le.p .earl, Ne.'" Dates: 1st ~-~-~ Eagl; River, Alaska 995~ ~_X ~o~T c · ~_ ~%_ .-'~ Department of Health and Human Se~ices approval ~, ~.~ ......... Reviewed and approved by: Z/~¢¢ ~~ Date: 72-013 (Rev. 9/91) MOA 25 2 Permit No. SW950025 Page 2 of 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 LOT 75A, MARIANN SUBDIVISION 05108159 Legal Description: PID No.: I STI NEW ~oqo TIC ST2 FINAL GRAD% MT1 ~T2 99.7' 102.6' MT3 87~9' 88.0' 88.0' ..................................................................................... i! ............................................................................... ~:"~'~'g ;'"'fi;5 '"~:;(:(fi~'~'iYS~;~i~ I ~! WELL N NEW 200~ SEPTIC iA B FCO 141' -- ST1 i1I' 22' ST2 i20' 20' .... G.O..1....~.. 2...... .2.1.~. C02 i23' 22' FD 124' 25' C05i24' 51' C04 i77' 75' C05 !.55' 44' C06 182' 81' C07 47' 57' C08 i90' 92' MT1 !25' 52' MT2 177' 74' MT3 35' 45' MT4 85' 81 ' "f~T5'"~8'"' 58'"' MT6 191' 92' FLOW DIVEt EXIST. SYSIEMw/'''?' / / / / / NEWi TRENCHES iLOT 73A SCALE 1" = 40' i 72-013 A (1/93) ' CLASS C--~ WELL Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 2 3 4 5 6 7 8 9 10- 11 12 13, 14 15- 16- 17- 18- 19- 20- Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT L DEPTH? pO E Depth to Water After Moniloring? ~.[~ Dale: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE J~C~ (minutes/tach) PERC HOLE DIAMETER L~ TEST RUN BETWEEN ~ FT AND ~'~ FT COMMENTS S & S ENGINEERING · ~ ~. t~...J M~ 19t"t~~V~'"-'","~"J~ CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: ~'~ ~.~,~ ,~.;VCT ..-~ ............ ACCORDANCE WITH AL~q~,q'~'~'E~ ~l~'~l~AqL~'~lO ELIN ES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) 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 PAGE 1 OF 1 b-2q-q~ PERMIT PERMIT NUMBER:SW950023 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:STEVENS RONALD A & OWNER ADDRESS:21511 TORKELSON CIR CHUGIAK, ALASKA 99567 DATE ISSUED: 2/28/95 EXPIRATION DATE: 2/28/96 PARCEL ID:05108139 LEGAL DESCRIPTION: MARIANN LT 73A LOT SIZE: 50339 (SQ. FT.) NUMBER OF BEDROOMS: 6 THIS PERMIT: 6 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE: HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN ED(TENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER OISPOSALSYSTEM DESIGN ROBERTC. COWAN, P.E. ROBERTA. SHAFER, EE. Fzbruary 15, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of H~z~th and Human S~rvic~s P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 73A; Mariann Subdivision Re4u. e.,at ~o~ isau~ a peJunDt, to upgrade .Ore. 6e.p,t, te a~a,te.m propo6a, d ~ 6ecl, coom hou,,6~ on .th~ r~f~r~ne~ p~ope,~t~. An adequacy t~st p~rformed on the existing system for H~th Authority Approva~ purposes found the absorption capacity of the system to be inadequate. T~st hol~s w~re excavated and p~rcolation t~sts performed. The approximate locations of the t~st holes are located on the attached s~te plan. At the time of excavation, water was not encountered in test hole #I and in test hole #2 and after seven day ground water monitoring water was found at 14 fe~tand dry respectively. This property has enough ar~a for a future septic upgrade which can be seen on the attached sx~e plan. We do not anticipate any adverse effects on n~ighboring properties by the instigation of the proposed septic system. The proposed 1750 gallon septic tank is to be placed out~ide the w~ protective radius. Attached is a site plan which depicts the location of the proposed tank. There are no points of contamination within the proposed wzllradius which can be seen on the attached site plan. If you have any questions or require additional information please contact us. Sincerely, ~ ROBERT C. COWAN RCC/gk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 I m tCELL RADIUS SflIGV~[ ~I~Ialt. ,OOI o 3civaoclrl z II F1 Ii Ii ii Ii II ~11 II u U :r'1¥0~ ('d,~,) 0,--3. 0 ]I¥i~O/NOIIO3S-X 'S'I'N PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 c~'.,., J>,_....,, ~ ~ ROBERT C, COWAN tt~ ~( DATE PERFORMED~q}~~':~ ~ Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT t_~1 OL DEPTH? '~ p E Depth to Water After Monitoring? \~ Date: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch} PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~' FT COMMENTS $ & S ENGINEERING PERFORMED BY: .... ~, v.-.A --~""t~ ...... DluAr /O~3t~. Road No. 204 ~/~-~ o~1> CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITI~.~I~S~X~.'/~S~N~IP/A/L GUIDELINES I. EFFECT ON THIS DATE. DATE: ~ -- ~---c~'~ 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2 3 4 Township, Range, Section: SLOPE WAS GROUND WATER .t ENCOUNTERED? ~5¢1~ IF YES, AT WHAT ¢-~L ~ DEPTH? p E Depth to Water After Monitoring? . Date: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE '~O~ tminutes/inch) PERC HOLE DIAMETER ,V~' TEST RUN .ETWEEN A F, AND ¢- FT COMMENTS S & S ENGINEERING ¢1~ PERFORMED BY: 17034 ~-~fd~6 ,~.~VC.;' ~--~'~ ~-"-~ H-~.1204 ~'~J~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH AL~,~"~'~E)'~r~Ii~A~TG'TUIDELINES IN EFFECT ON THIS DATE. DATE: '~-- ~ ~"-01'¢"" 72-008 (Rev. 4/85) nq nee , nq 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 WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. ON-SITE. OlASTE~IATEI~ PISPOSAL S¥STEU CONSTRUCTION PIZA, CTICE~ ~ATERIAL SPECIFICATION~ CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFEI~ENCE: Lot 73A; Mariann Subdivision GENERA L '. The scope of this project includes the installa~on of a 1750 gallon septic tank and $ l~achfi~ld trench~s to s~rve the proposed six bedroom r~sidence located on the referenced property. The existing septic tank is to be excavated, pumped, crushed, and abandoned in place. The ex, ting leachfi~Id is to be abandoned in place such that it may be used again in the future through the installation of a div~rt~r valve. ConstructJ. on sh~J~ be in accordance with the approved site plan and d~sign drawings, Municipal p~rmit with any special provisions or conditions, and all applicable State and Muni~pal Wast~wat~r Disposal Regulations. 3. The contractor shall be r~sponsible for obtaining any necessary underground ~ity locates. Unless specifically agreed otherwise, the property owner shall be r~sponsible for final grading areas subsequently depressed from so~l s~ng. On all l~achfi~ld mound systems, the property owner shall be r~sponsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastawat~r disposal systems must be e~ttified by the Municipal H~th Department for system installations. 0whirs installing their own systems must also receive prior approval from the Municipal H~th Department. SEPTIC. TANK INSTALLATION: I. A septic tank is to be eonstru~ed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent s~ng or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 73A; Mariann Subdivision February 15, 1995 All standpipes on the septic tank shall extend a minimum of 12 inch~s above final grade. Septic tanks installed with less than 4' of cov~r shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line b~twe~n the tank and the leachfield there shall be two adjacent cl~anouts (unless an efflu¢~tpumping syste~ exists with~ the septic tank). Th~se eleanouts shall be located on undisturbed soil not more than 10' from the tank. The first cl~anout, in line, shall be to clean toward the leachfield. The second cleanout shall be to ~ean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/PRAINFIELP INSTA£LATION: Excavate the proposed trenches to the dimensions shown on the design. The bottom of the excavation shall be within 2 inch~s of level. If the sidewa~ of the excavation become smeared, they must be raked or scratched (roughed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the p~rforations faced downward.-Grav~ is then to be placed over the distribution pipe to provide a minimum of 2 inches of cove~ over the pipe. A silt barrier must be installed b~tween the final gravel layer and the native soil backfill. Ensure the silt barri~ covers the en£ire grav~ sarface before placing backfill. Monitor tub~s shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the grav~ shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gr~v~ as noted on the design. Backfill ove~ the final gravel layer must not be less than twenty-four (24) inch~s. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish 9fade over the t~eneh must be mound~ to prevent the formation of a depression after settling. Page Three Lot 73A; Mariann Subdivision February 15, 1995 MINIMUM I. UATERIAL SPECIFICATIOHS: Any septic tank proposed for instal~tion must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for ~se in septic system installations in the Municipality of Anchorage: e Type of Pipe Perforated Solid Cast Iron Y~s Y~s ASTM D3034 (PVC) Y~s Y~s ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Y~s Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall beat least 2" t~ck extruded direct burial polystyrene (Dow Chcmica£ Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Cauld~r, F~rnco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be instated b~tween the final leachficld gravel layer and the native soil backfill. All leachfield gravel (s~w~r rock) shall be 0.5"-2.5" screened gravel with l~ss than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 73A; Mariann Subdivision February 15, 1995 Typically there will be a minimum of three (3) inspections required during the installation of the wast~wat~r disposal system. These inspections will occur as follows: I. The first inspection m~st be conducted after the excavation of ditch~s, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, grav~l, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, ~tc. Thus, the inspecting engineer ~s to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction me~ing will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these spe~fications and plans and in accordance with the at~achcd M~0.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work r~sts with the owner and the M.O.A. S g S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on th~ project or the fa~ure of the contractor to carry out the work in accordance with these constr~e~on documcnt~. S & S En~ine~in~'s inspce~n~ engineer w~ not be responsible for the construction means, m~thods, technique, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER r · , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I' ENVIRONMENTAl ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ]PHONE J~EW MAILING ADDRESS LEGAL DESCRIPTION LOCATION ~ NO. OF BEDROOMS J Well Absorption are~ Dwelling ~. PERMIT NO. ~ ~ DISTANCE TO: ~ ~t ~ - k ~ ~ ~ ~ Manufacturer Material~~:. N°' of comp~ments ~ ~ Liq. capacity in gallons Inside length Width ' Liquid ~ '~ IF HOMEMADE: _ ~ ~ ~ DISTANCE TO: Well ~ ~ ~ Dwelling PERMITNO, O ~ ~ Manufacturer~// ~ Material Liquid capacity in gallons Well t ~ Foundation ~ Nearest lot li~e PERMIT NO. i ~ DISTANCE TO: ~ t ~ ~ ~ ~ ~ ~ Top of tile to finish grade ~ Material beneath tile Total effe~ve abso~ti~n area Length Width · Depth PERMITNO. ( ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Cla~ Depth ~ Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Bu~ldmg foundat~on~.~,~ ~r~ li~ ~* Septic tank Absorption area(s) PIPE MATERIALS ~ ~/~.~ $ ' SOILTESTRATING ~~~ "" , ' ''] ~ ~ REMARKS ~ 0~E$5 ~ / ~ ~: ~..~tt~.~l~ DATE LEGAL 72-~13 (Rm/ 3/7R~ r ; N ~.*~ ~.~ ~'~ AS-BUILT . :. , I hereby certify that I ha'ce ~ur,zeyed Anchorage ~cbr~ng Pr~in~ Al~a, and ments dtuated ~ereon are within not overlap or encroach on the prop~t~ to,,that no improvements on encr~ on the ~remhes in question roadways, ~m~sion l~es ~r o~er visible ~aid pro~ty except as i~icated hereon. Dated at Eagle River, Alaska this ~1 ~ __day ot ,~:s~- ROBOT SCAL~: g~ q ~t~ed U' =.~o~ ~ ,~ ~.~gle ~iver~ A~ ~"~ ~ Phone (~07) 6~-2~3. Larry D. Call Excavator OWNER OF LAND ADDRESS d'~,'¢ LEGAL DESCRIPTION DATE - Started PERMIT NUMBER Drilltng og by DOC Co. dba SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 ' ~ DEPTH OF WELL ~. ,/, '~/,4' ~. Ended -/ ~'~" ~ ~' STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR / ~;"(9 ~'~, KIND OF CASING .-- ? KIND OF FORMATION: From ,' ~ Ft. to ~ Ft. From "[' Ft. to .. , ,, Ft, From Ft. to___.Ft. From/~,} Ft. to [ ~? Ft.. From / ''/ Ft. to ': ~ '~' Ft. From __ Ft. to . From - :d 'i'-' Ft. to '~?;' From '~"~ .Ft to 7 From__Ft. to From )':' '? Ft. to ii: O From__Ft. to-- From Ft. to__Ft. From Ft. to Ft. From__Ft. to Ft. From__Ft. to Ft. From__Ft. to Ft. From Ft. to Ft. ,Ft. Ft. 7Ft, Ft. Ft Ft. From From From From-- From From From __ From__ From From-- From From From From From From Ft. to Ft. to Ft. to_____ __.Ft. to Ft. to-- Ft. to Ft. to .Ft. to Ft. to __Ft. to__ Ft. to Ft. to . Ft. to-- Ft. to Ft. to Ft. to Ft. to Ft. Ft. Ft. Ft. Ft. Ft. Ft Ft Ft.\ ~ ~ Ft. Ft. __ Ft.. Ft. Ft. MISCL. INFORMATION: DRILLER'S NAME MUNICIPALITY OF ANCHORAGE ~,,, DEPT. OF HEALTH ~ ~"/;~Or~,"4ENTAL PROTE~ZTION JUL 2, 9 g85 uly 198 RECEIVED HEALTH AUTHORITY APPROVALS Municipality of Anchorage Department of Health and Environmental Protection 825 L Street SEWER&WATER Anchorage, Alaska 99501 MAIN EXTENSIONS ATTENTION: Susan Oswalt REFERENCE: Lot 73A; Section 5; T15N; R1W~ SM SEWER & WATER INSPECTION Dear Susan, In response to your telephone request to Mike Gray we have searched our files and find that we performed SYSTEMDES'GN a soil test on Lot 73 in October 1983 prior to it being subdivided into Lot 73A and B. The actual test hole would be located on what is now on Lot 73B. The soil log indicated GM soil with a percolation WELL,NSPECT~ON rate of approximately-.-197--SF per bedroom equiv~I~-~ &ELOWTEST with no visible' ~"~ns of water to a depth of 13 fe_e~.t.- It is our opinion that this soil log is representative of the soils in the surrounding area and that a soil SITEPLANS test on Lot 73A, if taken, would produce similar results. If we may be of further service, please notify us. ROAD DESIGN PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN SRB 196X EAGLE RIVER, ALASKA 99577 ROBERTA. SHAFER CIVIL ENGINEEH 694-2979 ATTN: Susan Oswald MUNICIPALITY OF ANCHORAC~I~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION~ JUL 9 lg85 RECEIVED The septic system put in on Lot 73, sec 5, T~,,~P15bT, R1W, SM was done in the summber of 1982. To the best of my knowledge, the system is as attached and there was no water present at the test hole, nor during the excavation of the trench.. Excavator Michae~ A. ~fcay ~ Own e r/ ~_~z STATE OF ALASKA ) ) THIRD JUDICIAL DISTRICT) SS. THIS IS TO CERTIFY that on this 29th day of July 1985, before me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn, personally appeared Larry D. Call and Michael A. Gray, to me known and known to be the identical individual described in and who executed the within and foregoing attachment. SUBSCRIBED, SWORN AND ACKNOWLEDGED the day and year last above written. and for the State of Alaska My commission expires: ~:;~ ~'t:-[~h ".-~- DEPARTMEm OF H~LTH & HUMAN SERVICES ,.:~ " :?-' ~?~,"~ ~J : _ D v~s~on of Environmental Se~lces ~..~-z~-:.z:-.~':?'.t '.~..;~.;~';.:_:.-.~-:: -' ~,~ ..... . , .. _ , ~ . ' .... ~,;,. -, .:;'~, ~-,- ~ _, . . . .. :. :" '4":' ~ ~,~¥~{.: .-../::- .: , .-. ..:-,. :: -/. ,. ~:. ,- . , .. :.. ,, . ~ ,. ~'-_ ...: ,'_.,....' .... ~;.~_.... '. .;;~: ........ CERTIFICATE OF H~LTH AUTHORI~ .- - , ' v. -. - '~2~:[:~3 :~r:: ' ~PPROVAL'FOR A SINGLE FAMILY DWE[LING - L ---: :- ~A_ ~ ..'~:...~* _L.~g~.:Z:C~:,L~5,~+~-~,. .. ',,'~...,-:~:~-~ .......... ~.~.-.~:.~L:*~-~.:--~,~ ..... ".~,~-~ ~:.--~/sr~ - ' ~' ' ~te"' ...... address - Tork~on ........ -.....-, .... : ...~ .... · ' ' ' :'""-' -~ ' "' Da~"phone .' ;~:.-~gg-'&943 -.,-.'.' .:--.:.,;.:4'::.. . '~0~ ~?,~'~:: ': 9~'s~'-' ::':-:-': '"" - v -~ ....... 71 STATEMENT OF INSPECTION BY :ENGINEER;.c,?:-~-~;,-': :::-: :-..' ,..'.'-.-:*"_ :--~..--~'~'~'~"~-?--- ' as of the validation ~late shown below; I v~nfy that my As ce~ified by my seal affixed hereto a~d :~ ' ....... ~ ';" *;" ~'~':~ ...... .... '~" * investigation of this Health Authori~ Approva application:shows that the ~n-~i~:'~ater supply and/or wastewater disposal system is ~fe, functional and adequate for the number of bedrooms and ~pe of structure indicated herein. I fu~her ~eri~ that based on the information ~btaine~ from the Municipaii~ of Anchorage files and from my inves~ation 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 eff~t on the date of this insp~tion,~::~: "~:. ~ Nameof Firm .......... ~"-'Phone (~'~/z./. ~.c~7ff ~'-conduct nsp~t ons or aha yze dat8 before a,ce~ffmate ~s ~u~. The .Mun~c~pah~.of Anchomg s not ': 'r~suonsible for errom or omissions n the profe~ional Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT ~-A , l~t.~tA~J~ ~/=~ Parcel I.D. A. Well Data Well type Log present ~N) ~:~ Total depth ~o "7 Sanitary seal ~N) If A, B, or C, attach ADEC letter. ADEC water system number G~ ] "J - ~; ~ Driller Ho + ' Casing height Wires properly protected ~1) AT INSPECTION ; On adjacent lots ; On adjacent lots /oo -~ Date completed Cased to FROM WELL LOG Date of test (~ ~ I~ ~ ~ ~- Static water level ~ ;3 ' Well flow ~ Pump level1 L) I~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /o ~ f Absorption field on lot /o ! Public sewer main '7 ~ ~ +- .g.p.m. Public sewer manhole/cleanout 700 % Petroleum tank = S ~ Sewer service line WATER SAMPLE RESULTS: Coliform /~ Date of sample: /- -~ o - ~/ Nitrate o. Collected by: Other bacteria ~._._~ ~ ~'I,../GI/,J~//,J~ B. SEPTIC/I~I~t!~G TANK DATA · ,;, ,~-~ ? ~'¥ ~,~ Date installed, .:' ,/~ ~'~ ? 7 ~. ~ Tank size Cleanout$~N)., ~. ~:~ , ~ . '~Foundation cleanout ) ~/~.J .... '--. ',.. High water alarm ";'''~''' )%/o ,~Z,//~ Alarm tested (YJ~) Date of pumping f-//',~-- ~ ~ ~/~.w-~-~ Pumper ~ - SEPARATIoN DISTANcEs Fi~qM~SEPTIC/HOLDING TANK TO: Well(s) on lot .- I.o,~'~. ',.i,,~ On adjacent lots To property line Compartments Depression (Y/~ Sudace water/drainage Absorption field Foundation ? Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Manhole/Access (Y/N) Size in gallons ff ~'~~Levet'~ Vent (Y/N) "Pump on" level at "Pump o High water alarm level C~.~estCd~ Meets MOA electrical codes (Y/N) ~ SEPARATION DISTA. J~[~-~ LIFT STATION TO: ..~,~"0'~"- On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed "7- Length /¢o ~o~-.~<_ Width Total absorption area Soil rating (GPD/Ft Gravel thickness Cleanout present (~N) Date of adequacy test ~,,~,/',4 ~/,.,a~.,d sy$?,t¢~ Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) / System type q)~"~ T~'~// Total depth /.~. 5"- Depression over field (Y/~) /,,/0 for ,/ Bedrooms After test / / If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water / / On adjacent lots /c,o ,/- Property line To existing or abandoned system on lot / Cutbank 5'0 + Water main/service line /'~ Driveway, parking/vehicle storage area - Curtain drain ~'~/"'~- K~°~"/ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in e~f this inspection. H~ Fee $ Waiver Fee $ -: Date of Payme~ Date of Payme~ Recei~ Numar Recei~ Number 72-026 (3/93)' Back . .. ',-~.~;-;:- -, Divisi6n 0f Envimh~ental'se~ice~'~::;'?~?'~ -'~;: '~.}~L~-;.'; ~.;:~-:-: :*:.- n S te Se~mes Sect on ......... P.O. Box 1~0 'Anchorage,-Alaska -:.' .', -'~">~;~..g;?' .~-~-- ',",-~;:.;-~.;%75',.~;.~ :~;.'..; ..... .,;":..~;~ .. ~-.L ~ ~i~;~. - '~; ---':;-- ' -'- ApP~O~L',FOR.A SINGLE FAMILY .......... INFORMATION ........ . .......... ,, .................. , .~ .......... .~. ~:... . --' .; .;, ...~: ;. Locatlon~lte address or directions)~:~-'- 215/1 Tork~on .......... , p rty Da h n ~.(7 21 263-2471-~-~.~ ...NOTE: ::;:: lf community well system, p~ide.:v~r, ittep~.~nfirmation from"'"Sta te ~:~':_ '! ~;.'~ ~ ~~- "-'v' - ,:~,.v~ . ~ng to the legah~ and status of system. ~ "'~:'r~. '-~.-.~' ....... -.~Ol~lng tank ~.~...~.~..~,~_.:. :~ ~ ,. ,,~ ~--~:..-~. ~ ._, ..~ ,~-. ,- ~.?¥,~:t~:;~.~-:~:~-._..:~-~ · .... -~ - ~5.:~?-~' ~-~o~munl~ on-~ ~ . =: - It commum~ wastewater · ~: . .'-t -- , . . ;-~: ';.':~/:'-:,.-.: ' ~. :.'' · "~-" ,?" -'; "':---- ~Lt :::;?'-: t:~:~ =~=(,-.,~,,) ,~ ~o,~ '--. ': " -As certiflt on: yof this y' Hea' tn Aumonty'~ '-,- -',.-. ~,p.,~.Q,*: ..... .~ ..~niication shows and ~pe of structure indicated herein. I fu~her ven~ that oase~ on the I~iOrlll~[lUH uu~u~u .. · -, ~,..- --MuniciDaiiW of Anchorage fines and from my inveSt~ation and msp~t on, th~ pn-~lt~ wat~, lance W~th all Municipal and ~t~te codes, the wastewa{~r:.~'isP~sa system n comp supply and/or r~ulLti~eg . u.o in eff~t on the date of this insP~ti0n: ordinan~es~ and · .,...,.. ~,::' ..:, , - ,- - ," :, . ~-- ~ [ ~ ~<~'/ ~ ~:' Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~..~¢--r -] -~ ~ V'-'~,~(~,~5 ~1~ Parcel I.D. A. Well Data Well type ~'~-(q Log present {~1) ',~ Total depth ~ ~ ' 7 Sanitary seal (~N) If A, B, or C, attach ADEC letter. ADEC water system number r~/~x Date completed (,, - !'-/~,5 2- Driller .__F~,,.~ ,/~ Cased to "-/o / ~' Casing height Wires properly protected {;~N) AT INSPECTION g.p.m. ~, J~ ~- g.p.m. Date of test Static water level Well flow Pump level1 ; On adjacent lots ; On adjacent lots / FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot \ Public sewer main Sewer service line Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed Nitrate 0, Collected by: Other bacteria ~ ~ & $ ENGINEEEING 17034 Eagle Rivet' Loop Road No. ~ Eagle Eiver, Alaska 99577 Tank size [ ?,.-~-o Compartments Cleanouts~N) 7 Foundation cleanout~l) '7' Depression (Y~ High water alarm (Y~j)_ ~ Alarm tested (Y/N) Date of pumping ~ --'7..-'1 .--~1 5-- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line /~ Surface water/drainage 72-026 (3/93)* Front (~ /~/$ On adjacent lots ~ co Foundation Absorption field 5-~/ Water main/service line /o ~ z- ~ ~S~ ~~ ~. CONTINUED ON BACK PAGE (9. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" ~ High water alarm level C~ Meets MOA electrical codes (Y~....~ ~ SEPARATION DISTc.AblGEI~OM LIFT STATION TO: We'lf~'n lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length "'J ti Width Total absorption area '7/,.~ Date of adequacy test ~ "'5/~ Water level in absorption field before test Peroxide treatment (past 12 months) (YL4~. Soil rating (GPD/Ft2) ',_5¢--- System type '~ ~ Gravel thickness ~ ' '~'/~ Total depth Cleanout present..~N) t/ Depression over field (Y/lOp Results (pas~ ~-A~ ~-- for 4 Bedrooms 8~- After test /~' If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: /4- Well on lot /o 0 On adjacent lots To building foundation To existing or abandoned system on lot / On adjacent lots .¢,o Surface water /o Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidefines in effect o~g,.~c/T&t:; of this inspection. Signature ~., Engineer's Name / H~ Fee $ ~ ¢ ~ Waiver Fee $ Date of Payment 2 ~6 -- ~3~'- Date of Payment Receipt Number ~ ~ ~ Receipt Number 72-026 (3/93)* Back ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. July 13, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUT H ORI'i'Y APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITEPLANS ROAD DESIGN SOILTES~ PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE W.~TEWATER DISPOSALSYSTEM O£SIGN MUNICIPALITY OF ANCHORAGE Department of H~lth and H~man Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 73A; Mariann Subdivision RECEIVED JUL 1 ? 1995 De~t??!ci~a!ity of Anchorage ~ealth & Human Services A Conditional H~alth Authority Approval (HAA) was issued on 2/28/95 for the referenced property. All work required for the Conditional HAA has been completed. Please issue a full H~alth Authority Approval at this time. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk 17034 NORTH EAGLE RIVER LOOP ° SUITE 204 · EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # L/-~'-~) I- ~'~)'C' ] -~°~ c~ HAA# ~'~ ~L~ c~c~ 1, GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) LOT 73A; Mariann Subdivision Location (addreS'§.°r ~ireCti:ons) NHN Glacier Ro~d~" "~'' (b) Property Owner ~{Z~z-~'~- ~,',Mar~anne Gray Telephone: (home) Business Mailing Address. .844~'~E~ ~a..a o~,o~ g~nt~da~. A~?on~ ¢5257 (c) Lending Institution NORT~/AND Mr)~T~A~F Telephone 694-7872 Mailing AddresS A~.TN~ Sue/T~ 11421 01d Glenn Hig~y, Eagle RZv¢.r,AK. (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here I~xif hold for pick up.) List contact person and day phone number below: $ & S ENGINEERING 17034 Eaale R~ve~' Eagle River, Alaska 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms .~ 3. WATER SUPPLY Individual Well [~X Community [] Public [] Note: If community well system, must have written.confirmation from the State Department of Environmental Conservation attesting to th legality and status. '~ 4. SEWAGE DISPOSAL On-siteY.~ 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 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, Iverifythatmyinvestigationofthis 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 Address Date S 8, S ENGINEERING 17034 Eagle Rive. ! hop Eagle River/Alaska 9~5~ Telephone 6. DHHS APPROVAL for-¢ Approved_ /'""'"'~---D'isapproved Conditional Terms of Conditional Approval Date /' //~'~'~' The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval 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 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. 72~025 (Rev. 7/88) Ba. ck Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) ........ ,He, a, lth Authority Approval (HAA) ;~.,~.~.~ ,~ I~.~1~ - I'-EBR'UARY 1--4t~U ~,~OV ~- 2 ]~89 Legal Description: L A. WELL DATA R E 6 E J V E D Well Classification -~, ~- Well Log Present (Y/,/[~) ~. Date.,,C'°mpleted Total Depth ~0' ~ Cased to /--/6>"/' Depth of Grouting Static Water Level {~ [ ~ Pump Set At ~. ~, ~ Casing Height Above Ground ~ O" '--' Sanitary Seal on Casing (Y/N) ~ 'if A, B, C D.E.C. Approved (Y/N) '~"/~ Depression Around Wellhead (Y/N) /~ '-' / Electrical Wiringin Conduit (Y/N) / SEPARATION DISTANCES FROM WELL: To Septib/Holding Tank on Lot /' OO To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /J/~ To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ,~' ; On Adjoining Lots [ O / ( O ¢ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date Installed ~,~/£~.z Size ~ No. of Compartments Standpipes (Y/N) / Air-tight Caps (Y/N) F Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Foundation Cleanout (Y/N) . Date Last Pumped /] ~ ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line / /oo ! To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course t0/~ "-- Comments _~_~-t-;c.. '~r~x/ ~ ~ ,D¢_Oj /¢~4 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ,~ of ; ~. ~' ~ Width. of Field ~ (¢ /~ Square Feet of Absortion Area Depression over Field (Y/N) "" Type of System Design Length of Field "~ t ' Depth of Field ( Gravel Bed Thickness [.o Statndpipes Present (Y/N) Date of Last Adequacy Test Resultsof Last Adequacy Test __~¢, -/~, ?C~q ~.~t~ -- ~ ~.~ ~-0o~, t~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ! / O To Property Line To Building Foundation c2 o - To Existing or Abandoned System on Lot t'J/~-- ..-- -; On Adjoining Lots ~'~o/ To Water Main/Service Line / O /~-- To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ~- f'J/~ To Driveway, Parking Area, or Vehicle Storage Area ---~>~ ' -¢- ~ Comments D. LIFT STATION 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 guidelines in effect on the date of this inspection. Signed Company Date MOA No. 17034 Eagle RiYer Loop Road No. 204 Receipt No. Waiver Fee: $ Date of Payment Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Page 2 of 2 It~IUNICIPALITY OF ANCHORAGE DEPARTIVtENT OF HEALTH AND ENVIRONNIENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORI~IATION (a) Application Date_ t"~ -' Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) CC'~I- '1%,¢~ ¢~A,~ ~-~ (b) Applicant Name l~,lA,~, d~p_/,~ ' Telephone: Home ~q¢,- -- '2-q~r7 Business __ Applicant Address f~. ~ F%~--,~z.~ ~lq 0 ?%Lc~zl' ~_-/~'.L~ ¢--~V~--- ~ (c) Applicant is (check one): Lending Institution []; Owner/builder.,CE~, Buyer []; Other [] (explain); (d) Lending Institution ~¢ ,'~ ~" Telephone Address (e) Real Estate Company and Agent Address Telephone (f) 4~4a~1 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 welt system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCN, DATA AND INFORIVIATION / 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 inspectior~ ,~~.,~ ~(~E~(:~, , .. 8RB ~96M Name of Firm t~, ,h~ ~ ~w~ ~ .~-,, _ Telephone Address Date DHEP APPROVAL . ' ApproveO for '-~,~, ;'-~.~ (, ~''' o~ bedrooms by ~pproveO ~ ~ DisapproveO __ Terms of Conditional Approval Conditional 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) MUNICIPALITY OF ANCJ AGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAl. PROTECTION HEALTH AUTHORITY APpROvAL (HAA) JUL 2 2 CHECKUST- FE.RUARY 984 264-4720 RECEIVED WELL DATA Legal Description: [_.~_ ~.c~ 1 ~.¢._~_~j , Well Classification Well Log Present:2~YN) Total Depth ~,c'~ ¢ Static Water Level Casing Height Above Ground ~ ~ Electrical Wiring in Conduit4~¢4)" Separation Distances from Well: To Septic/l~Tank on Lot ~ ~ To Nearest Edge of Absorption Field on Lot ~ t 'E~ To Nearest Public Sewer Line ~-~/'~ IfA, B, C, D.E.C. Approved (Y/N) ,'O//~. Date Completed (~ - i cA;- ~'?--. Yield Depth of Grouting Pump Set At Sanitary Seal on Casing~N)-'4 Depression Around Wellhead (Y,~j[~'~ Cased to ; On Adjoining Lots ! ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole "°~JA To Nearest Sewer Service Line on Lot I. ~ t ~_ Water Sample Collected by <'~ '~Z ~ ~(~¢._.~(_-~---~ t,.~¢'_ ; Date ~ -- ~ ~ ~ Water Sample Test Results ~ ~~~ ~ Comments ~ k~ ~'~ ~ ~~ ~ ~~ B. SEPTIC/I'Cct~I=~i'Nt~TANK DATA Date Installed Standpipes(~N) TM Air-tight Capsc'C~/N) ~ Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~"-~//'~' Separation Distances from Septic/~' !o',d~ng~,ank: To Water-Supply Well To Property Line To Water Main/Service Line Course No. of Compartments Foundation Cleanout (Y,(~ Date Last Pumped "7 ~ I. (,.0 · for Temporary Holding Tank Permit (Y/N) To Building Foundation 'L-'~ ( ~ To DisPosal Field ~' To Stream, Pond, Lake, or Major Drai'nage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata (._.J ~ I~, Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y~fJ~ Results of Last Adequacy Test Separation Distance from Absorption Field: f To Water-Supply Well ~ ~. 1Z~ To Building Foundation ~ Lot ~'~ //,~' Type of System Design Length of Field Depth of Field Gravel Bed Thickness r~ l ~"'~ Standpipes Present~/N) Date of Last Adequacy Test To Water Main/Service Line (c'~ (; ¥ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, Or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots "~-~ c.O To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** 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 -~ & 8 16NGINE~RIN~ Date / Com~an,, .. 8'RB 196~ MOA No. Receipt No ........... :~, ' L___ _ Date of Payment r! ~ Z' ~ Amount:* Page 2 of 2 72-026 (11/84)