HomeMy WebLinkAboutSANDHILL LT 7Sandhi /I
0570
Lot 7
-saa - 09
Municipality of Anchorage Page Z_ _ 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 �� GB��j� _ PID Number:
Name-
Wastewater System: New ❑ Upgrade
v vYl vy
Address
ABSORPTION FIELD
Phone:
No. f Bedrooms:
O Deep Trench Shallow Trench O Bed O Mound O Other
LEGAL DESCRIPTION
Soil Rating /
D.
Total Depth from origi algraade:
3•
tP GPD/S Fl
�•
Lot. Block- Sub iv ion:
Depth to pipe bottom from original rade:
Gravel depth beneath pipe
f 5,
0."? Fl.
3. Ft.
Township:
Range: Section:
Fill added above original grade:h aqz.
a/
Gravel le/� In
- ('2
t/ 2, D -Z• 6 .2.2 - y/ffI.
ea. e_k Ft.
WELL: New El Upgrade
Gravel width C
dreh.c�f-
Number lines
Distance between lines.
d
ea- J Fr
�--
Classification (Private. A,B,C):
Total Depth:
Cased To:
Total absorption area:
Total
Pipe material: P �3 10
l V ��
`7CJ S Ft.
gJ Ft:
SO- Ft
-3
Driller: ,
Date Drill
Static Water evel.
Installer:
Na,,A
Dale installed:
7-Z - �8
I
zo
3 Fl.
Yield: Pump Set a&/
asing HeightAbove Ground:
rf
TANK
GPM Fl:
htt Fl.
8
SEPARATION DISTANCES
Kseptic O Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
-HoldingPublic/Private
Manut lurer:
ra
Capacity in gallons: ��%%"" LL
//_
From
Tank
Field
Station
Tank
Sewer Lines
v_k
�/)
Well-1
f
_
Material: J
Number of Compartments:
1,90f
DO --
Surface
I
LIFT STATION
Water
!00 4
00 *
—
—
—
Lot
/
/
Size in gallons:
Manufacturer:
Line
/Q f
104
—
—
—
Foundation
t
f
"Pump on" level at:"
Pu ' level at:
High water alarm at:
Curtain
r
l
Pump Make d M
Electrical Inspections performed by:
Drain
`�'
Remarks: over-
BENCH MARK
Location and Description: n
-0 7" t
DO
Assumed Elevation: D
DFI-
ENGINEER'S SEAL
OF
E 126 40
:�'*�t►
49 Di
Inspections performed by- /D Dates: 1st
2nd 29 4d
%.....:...
..
/U 27- B
Department Health Human Services ap ro a9 l
..........:....
f' KENNETH M. DU c ,
♦ c� '•
♦ ��
of and
: c to
Reviewed and approved by: �%. Date:
0A. '
4%�ROFESS\
/i 013 (Rey 9/91) MOA 2S
AS -BUILT SYSTEM DETAILS/SITE PLAN
LOT 7, SANDHILL S/D
... .... : i Q5_ '133 )S
33TY'W l•. _34 6. 1 2k
d
a
WELL
K
1'
A—C=24.9' " Z
A—G=117.2'
B—G=104.4'
A—H=123.7'
B—H=149.5'
� CLEANWT
B— C= 32.2' � CYEANWT
A—D=29.9' o
B—D=40.4' �o
� N 1250 -GAL
A—E=64.1' !f
WELL
4 BDRM
SFD
aQ
z
o
I
PROPO D PR
o a
TH #98—
1250 S. T
CO
D
Y SYSTEM
A�/TT
A FR
co
a
G
FINAL GRADE
FILLER FABRIC \ /
SEWER ROCK
TRENCH 1
62'
FINAL GRADE
INSVLA110N
FILLER FABRIC \ /
SEWER ROCK
TRENCH 2
62 —
PREPARED FOR.
CHARLES E. HOMAN II
HOMAN INC.
P.O. BOX 111969
ANCHORAGE, ALASKA
99511
FIELD BOOKS COMPUTED:
BOUNDARY: LANG DRAW
B—E=92.9'
STAKING: LANG CHECKED:
SEPTIC
°ate
ASBUILT: LANG DATE.
11/4/1
TANK
A—F=74.8'
B—F=141.2'
103.64 10�
WELL
4 BDRM
SFD
aQ
z
o
I
PROPO D PR
o a
TH #98—
1250 S. T
CO
D
Y SYSTEM
A�/TT
A FR
co
a
G
FINAL GRADE
FILLER FABRIC \ /
SEWER ROCK
TRENCH 1
62'
FINAL GRADE
INSVLA110N
FILLER FABRIC \ /
SEWER ROCK
TRENCH 2
62 —
PREPARED FOR.
CHARLES E. HOMAN II
HOMAN INC.
P.O. BOX 111969
ANCHORAGE, ALASKA
99511
FIELD BOOKS COMPUTED:
BOUNDARY: LANG DRAW
KMD
STAKING: LANG CHECKED:
KMD
ASBUILT: LANG DATE.
11/4/1
DWG. FILE: GRID:
SW262
ACAD FILE: 98022.DWGI JOB No.: 98022
M
Permit SW980056
PID#050-522-09
L
rMT
CO
MT
MONITOR
LOT 7
VE SYSTEM
#98-2 j
(rte
43y
8 1 SEP
SCALE: 1" = 50'
VARIES
0.5T 98.83
95.73
MONITOR TUBE J CLEANWT
VARIES
0
T
3,0'
1
SCI 5
L 1\
(907)696-611
OF oil
Ar
KND ENGINEERING ` *:: ''•;.,� i
20441 PTARMIGAN BLVD. �.... ' 49 ,................. ...
EAGLE RIVER, AK 99577-8736 ,�„„,;,;,,, ,,,/}L�
KENNETH M. D Se
♦ i� CE 7116 �.'�� i
SOILS LOG - PERCOLATION TEST ♦♦♦♦ ts/ ,.•••'':
♦,,1
Performed for: Ldp! /?Cii/YIG/LGA/_ Date Performed: 7��8 14>•� 5����••
Legal Description: �Gir/�/%/G� %�� TEST HOLE #
Depth
(Feet) O/g�� tGS SEE ATTACHED SITE PLAN
V FOR HOLE LOCATION
1-
2 -
Ca
Was Groundwater encountered? Iblo What depth?
3 -
Depth to water after monitoring? Date
4-
5- G M1 i✓l
6-
7-
8- ��l S e--
9-
--9-
12-
12-
13-
14-
15-
13-
14-15-
16-
17-
18-
19-
20-
16-
17-
18-
19-
20-
Reading
Reading Date Gross Net Depth to Net
Time Time Water Drop
Percolation Rate (min/in) Perc Hole Diameter
Test Run Between feet and feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date:
Percolation Rate (min/in) Perc Hole Diameter
Test Run Between feet and feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date:
From ALPINE DRILL 907 345 0202 Oct.27.1998
STAT E;OF ALASKA
DEPARTMENT OF NATURAL RESOURCES:
DIVISION'OF MINING & WATER MGMT,
WATER WELL RECORD
„ A
Lfl� TION of wlall
BOROUGH SUBDIVISION LOT BLOCK SECTION OTRS 86CTION TOWNSHIP RANOE ',WRIDIAN .!! <
ON CIE.
r
07 IDS ❑W
'LOCATION/SKETCH: WELL OWNER:
DEPTHS MEASURED FROMOVsing top Oground surface WELL DEPTH: ,. DATE OF COMPLETION
Depth of hole: ft ,
"BOREHOLE DATA: Depth Depth of casing, ��,�;" ft _l42 �1
tylOterial Type and Color From To
I
DEPTH T TATIC WATER LEVEL:
.4
10
ft below Ktop of casing ❑ ground surface
Date: /-1 1
J�
Or
METHOD OF DRILLING: mal[ rotary ❑ cable 19ol
.
❑ other
USE OF WELL: 19 domestic ❑ irrigation C]' monitor
iv
❑ public supply ❑ other
CASING STICK-UP:. ft. Diem: n. to
Casing type: In. to,
WELL INTAKE OPENING TYPE: ❑ open end CJ-,sOreenea
❑ perforated open hole
Depths of openings: to ft .
SCREEN TYPE: Diam: In. :.
Slot/Mesh Size; Length: ft...
,.,
GRAVEL PACK TYPE:'
Volume used: Depth to t p:
GROUT TYPE:
E
Depth: from to ft
rrft
DEVELOPMENT METHOD:
9 19°
Duration:
Municipality of lar.'
t-Drac:
PUMPIN EVEL AND YIEL :
ft after firs pumping • gpm
t
F)OpPUMP
erv;ce,
INTAKE DEPTH: ft Horsepower:
WELL DISINFECTED UPON COMPLETION? YES ' ❑ NO
CONTRACTOR INFORMATION:
REMARKS:
r/l 1' r �"
R609 fledliness Name
7A �,0+.� .y PLEASE MAIL WHITE COPY OF LOG TO::
tom""" T rte_ ��+��' �'___ . �L DNRIDIVISION OF MINING & WATER MGMT .
510na ure of�Aut Authorized espresa ative Uate 36010 St, Suite 800
ANCHORAGE- AK 99603-5935
Phone 19071269.8639, Fox 19071662.1394
M
co�
Y `
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE �"� x'58 '9s 5 -Pm
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650 �_��1,<� U
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW980056
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:HERNANDEZ FLOYD & ALICIA G
OWNER ADDRESS:C/O CHARLES HOMAN PO BOX 111969
ANCHORAGE, AK 99511
PARCEL ID:05052209
LEGAL DESCRIPTION:
SANDHILL LT 7
LOT SIZE: 59481 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED: 4/09/98
EXPIRATION DATE: 4/09/99
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:
RECEIVED B
ISSUED BY:
DATE • LB
DATE: q 'q -7 o
14 DENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
11/FAX (907)696-8111
March 25, 1998
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: New sewer/well permit - Sandhill S/D, Lot 7
Gentlemen:
On March 14, 1998, we excavated two testholes for the subject property. The results
of these tests and water monitoring are attached.
We propose to install a 5' wide shallow trench. The depth to water is 9.5' therefore
we have designed the system in the upper top three feet of the gravel layer.
Additional fill will be placed over the system to provide a minimum of 3' of cover
when complete. This lot slopes from north to south at approximately 5-10% which
is away from the proposed house and any surrounding wells.
We propose to drill; the well west of the house and septic area. There are no public
or private wells within 100' of our proposed system location. There is neither
surface water within 100' nor any known curtain drains within 50'. We do not
expect that there will be any adverse effect on adjacent lots by the development of
this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
KBD Engineering
enneth M. Duffus, . .
attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WAS I EWATER DISPOSAL SYSTEM/SITE PLAN
LOT 7, SANDHILL S/D _
LOT 4 LOT 5 6a
LOT 6
'Sg s
NT
lo
HiC/f �^�73
Vv F S 39.77 `P
R il
�sQ qQ w !
rS• � �8S ' � ` � � R�50 1 N87'58'33"W 436.12
Fsmf ^Jp N� `—`"'—•---^-
PROPOSED WELL
4 DORM
660.66 BLM
® WELL PROPOSED PRIMA SYSTEMCl
CO
N r
ey4' �Y PROPOSED RESERVE
OR, i
LOT 9 k�Oes TH #98
8
o •
1 "=100'
OF..AZ4
KENNFTH M. DU
CE-- 711fi 4
4J
t
Ar
ARasstot�Av
SEPTIC
z' LOT 7 &
• AO
COMPUTED:
DRAWN:
250 GAL. S.T. N
STAKING: LANG
Fl Ipa_.2
KMD
N
DATE:
T e3
LLJ
Gym
R
(L
p
ro
Gy
U
SEP":C
DESIGN CRITERIA
1. 4 BEDROOMS X 150 GAL./DAY/BEDROOM = 600 GPD
2. SOILS RATING: 16 MIN/INCH = APPL. RATE 0.6 GPD/SF
3. 600 GPD/0.6 GPD/SF = 1000 SF
4. (1000 SF /(5')) x 0.58(RF) = 116'L
5. MIN. DESIGN SIZE = 2 TRENCH'S - 58' LONG x 5' WIDE x 3' DEEP
6. DEPTH OF GRAVEL BELOW PIPE IS 3'.
7. TOTAL DEPTH OF SYSTEM IS 4' FROM ORIGINAL GRADE.
NOTES:
1. TIE INTO TRENCH AT MIDPOINT.
2. INSTALL 1250 GALLON SEPTIC TANK. INSULATE TANK IF <4' COVER.
3. INSULATE TRENCH WITH 2" HD BURIAL FOAM IF <3' COVER.
4. CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK.
PREPARED FOR:
CHARLES E. HOMAN II NO SEPTIC SYSTEMS WITHIN 200' OF
HOMAN INC. PROPOSED WELL, EXCEPT AS NOTED.
P.O. BOX 111969 NO PRIVATE OR PUBLIC WELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED.
ANCHORAGE, ALASKA 99511
FIELD BOOKS
BOUNDARY: LANG
COMPUTED:
DRAWN:
KMD
STAKING: LANG
CHECKED:
KMD
ASBUILT: _
DATE:
3/24/
DWG. FILE:
GRID:
SW262
ACAD FILE; 98022.DWGI JOB NO.: 98022
�Jlv IJ ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
1.9
11
e Municipality of Anchorage . "R% •••••• ••••••�••
T DEPARTMENT OF HEALTH & HUMAN SERVICES �•• ••_•;,r
825 "U' Street, Anchorage, Alaska 99502-0650 9� � Kennet rl. vu /
SOILS LOG — PERCOLATION TEST ►►4%T.9
9•••a E 71�• • �'���
4 OfESS1S_r+
�/r/IILi�� DATE PERFORMED: ,
PERFORMED FOR: fle� 3
'IClC'{
LEGAL DESCRIPTION: �"' "•// L� T Township, Range, Section.
ci r)PF SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMM
PERFORMED BY:I yehrl "'m � 1, UL CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL ST T=UNI =GUIDE'LINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev, 4/85)
Municipality of Anchorage •,a' ao.,nawn•„ o►,w •:••
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650 9 �� Kenre!ii
SOILS LOG — PERCOLATION TEST �e s, CE 71 i
PERFORMED FOR: Lei%�z7) %%G�e DATE PERFORMED:
S,..„ ,,/Lj�`� 7 Township, Range, Section:
LEGAL DESCRIPTION: J,
DEPTH SLOPE SITE PLAN
(
N --
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMM yn,
PERFORMED BY: N ti I L���P +� � 'PJ'^'SCERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL ST TE AND MUNI AL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage
Development Services Department
s+*4` tr4f{d
{ 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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
ErM511158,10 i i •
1. GENERAL INFORMATION
FOR A SINGLE FAMILY DWELLING
• � .s u
HAA# 0 3 03/(�
Expiration Date: ! - a- - O 4
Complete legal description Sandhill Lot 7
1
Location (site address or directions) 24941 Hamann Rd., Fagle River, AK 99577
Current Property owner(s) Floyd Hernandt-_7 Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
Barbara Crittenden -Prudential Vista Day phone 6 8 9 -1 8 02_
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional
civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the
transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal
and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health
Authority. Approval are valid for 90 days from the date of issue for properties served by a private or Class C well
and may be reissued with, new water sample results. (Certificates may be reissued for a period of up to one
year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or
a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this
application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional
and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all
applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm KND ENGINFERING, Inc- Phone (q07) 69 6-6111
Engineer's Printed Name Kenneth M_ Duffus Date 10/20/03
Engineer's Comments:
This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the
condition of the well and septic applies only to the
conditions as of the day tested. The flow and absorption
rates may change due to subsurface conditions that
may not be observed from the surface, changes in
land use, local soil characteristics, groundwater levels
that may fluctuate during the year and the water usage
of the family being served by the system. The operational
life of all well and septic systems are subject to these -
various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system.
Therefore, KND can not give any estimate of how long a
system will function satisfactory for current or future .
occupants or can KND guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Kenn
1 �,•.• Cr 7115
�@ 9 •.. ..''�z XV
\01a0't►®Q'�idra
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
WS1TE ; G�
`X: WATER AND
WASTEWATER
PROGRAM:
1
X Maintenance Agreements
NTSENN
Supplemental Engineer's Report �X/►,.,...,0)N.
Other
By: Original Certificate Date:/ 0 `
Municipality of Anchorage
• Development Services Department r°
Y Y
i
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: SANDHILL LOT 7 Parcel ID: 050-522-09
A. WELL DATA
Well type private If A, B, or C provide PWSID #
Well Log (Y/N) Y
Date completed 4/20/1998 Sanitary seal (Y/N)-Y— Wires property protected (Y/N) i—
Total depth _30_ft. Cased to 185 ft. Casing height (above ground) 18"
FROM WELL LOG
Date of test 4/20/1998
Static water level 234 ft.
Well production 1 g.p.m
WATER SAMPLE RESULTS:
AT INSPECTION
6/17/2003
270 ft.
1.1 g.p.m.
Coliform _ 0 _,._colonies/100 ml.Nitrate 0.1 mg./I.Other bacteria --D—colonies/100 ml.
Arsenic: _..K► mg./I. Date of samnle:6/19/2003 & 10/13/03Collected by: KND Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 7 / 2 8 / 9 8 Tank size 12-50 gal.
Number of Compartments 2 Cleanouts (Y/N).Y
Foundation cleanout (Y/N) Y_pepression over tank (Y/N).bL__High water alarm (Y/N) IM
Date of pumping 6/17/2003 Pumper SANITARY
C. ABSORPTION FIELD DATA
Date installed 7ZZ9/98 Soil rating (g.p.d./fe or ftz/bdrm).Q,i System type TRENCH
Length 124 (2 X-62') ft. Width 5 ft. Gravel below pipe 3.0 ft.
Total depth 7 ft. Eff. absorption area01 00+ fe Monitoring tube Y Depression over field N_
Date of adequacy test 6117/Q3 Results (Pass/Fail) PASS For A__ bedrooms
Fluid depth in absorption field before test 8.5 & 3 in. Water added, 000 gal. New depth15.5 & 11 in.
Elapsed Time: 1440 min. Final fluid depth 9.5 & 8 in. Absorption rate >= 679 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) if yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at in.High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 10 0' +
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
i
Sewer /septic service line 25'+ Holding tank 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5 ' + Absorption field 5 '+
Water main 10'+ Water service line 10 P + Surface water 10 0'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 10 0'+ Driveway, parkinglyehicle storage 10'+
Curtain drain 50'+ Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through held inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.. •�••+ ,,a
•' Kanne: �s
Engineer's Printed Name Kenneth M. Duffus I�j�9 •�� CE 7116 ••�.•��'
Date 0/20/2003 4nbe7
10FE S ''�A"r
HAA Fee $375.00 Waiver Fee $
Date of Payment
Date of Payment
Receipt Number Receipt Number
(Rev. 12/01)
a
-- 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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel LD. 050-522-09 HAA#` 0042 �
Expiration Date: in - U - O
1. GENERAL INFORMATION
Complete legal description SandhllLLot 7
Location (site address or directions) 24941 Hamann Rd., Eagle River, AK 99577
Current Property owner(s) Floyd Hernandez Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
Barbara Crittenden -Prudential Vista Day phone 6 8 9 -1 8 0 2
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 4 by an Independent professional
civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the
transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal
and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health
Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well
and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one
year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or
a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the
professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this
application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional
and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance with all
applicable Municipal and State codes, ordinances, and regulations in effect at the time of Insta:lation.
"I, 17-1775W. M -101111:11n. rM0.117-TWA
Engineer's Printed Name_ Kenneth M. Duffus Date 6/27/03 �`
Engineer's Comments:
This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the
condition of the well and septic applies only to the
conditions as of the day tested. The flow and absorption
rates may change due to subsurface conditions that
may not be observed from the surface, changes in
land use, local soil characteristics, groundwater levels
that may fluctuate during the year and the water usage
of the family being served by the system. The operational
life of all well and septic systems are subject to these
various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system.
Therefore, KND can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can KND guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
5. DSD SIGNATURE
_1Z Approved for _14- bedrooms.
Disapproved.
i A�OF At
vINJEoL,3 no.
CE 71
?ROFESSIO�?P4
Conditional approval for bedrooms, with the following stipulations:
zv
J ON-SITE •'•��i
1�e?F�D : m:
: WASTEWATER
PRO ,RAM
Attachments: '���`` • • • . . •' • ,����
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: p Original Certificate Date:? 0 3
Municipality of Anchorage
Development Services Department
Building Safety Division •
On -Site Water & Wastewater Program .. •TT
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: SANDHILL LOT 7 Parcel ID: 050-522-09
A. WELL DATA
Well typeprivate If A. B, or C provide PWSID #
Date completed_ 4/20/1998 Sanitary seal (Y/NL„Y_
Total depth 385 ft. Cased to 185 ft
FROM WELL LOG
Date of test 4/2011998
Static water level 234 ft.
Well production 1 g.p.m
WATER SAMPLE RESULTS:
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 1 8 "_
AT INSPECTION
6/17/2003
— 2 Z o ft.
1.1 9—
p.m-
Coliform _Q--.golonles/100 mi.Nitrate 0.1 mg.A.Other bacteria _D—colonies/100 ml.
Arsenic: -M mg.A. Date of sample: 6/19/2003 Collected by: KNR Engineg fig
B. SEPTICIHOLDING TANK DATA
Tank Type/Materlal SEPTIC/.Date installed 7 / 2 819 8 Tank size 1250 gal.
Number of Compartments$ Cleanouts (Y/N) Y
Foundation cleanout (Y/N) I—Depression over tank (Y/N)-N--High water alarm (Y/N) b
Date of pumping_ 611712003— Pumper SANITARY
C. ABSORPTION FIELD DATA
Date installed 7/29198 Soil rating (9.p.d./112 or ft'/bdrm)_M System type _TR( jdH
Length 124 (,2 X 62') ft. Width 6 ft. Gravel below pipe 3 - 0 ft.
Total depth Z ft. Eff, absorption area 1000+ ft2 Monitoring tube Y Depression over field N
Date of adequacy telt 6/17/03 Results (Pass/Fall) SASS Forte bedrooms
Fluid depth in absorption field before tet 8.5 & 3 in. Water added 1000 gal. New depth15.5 & 11 in.
Elapsed Time: 1440 min. Final fluid depth 9.5 & 8 in. Absorption rate >= 679 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level aL_ in. "Pump ofr level at__ in.Hlgh water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main 75'+
Sewer /septic service line 25'+
On adjacent lots 10 0 ' +
On adjacent lots 10 0 +
Public sewer manhole/cleanout 100'+
Holding tank 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5 ' + Absorption fields ' +
Water main 10'+ Water service line 10 ' + Surface water 10 0 ' +
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10 ' + Water main 10 ' +
Water Service line 10'+ Surface water 10 0 ' + Driveway, parking/vehicle storage 10 ' +
Curtain drain 50'+ Wells on adjacent lots 10 0 ' +
F. COMMENTS
OF
G. ENGINEER'S CERTIFICATION 8-01� -z `� 't
I certify that I have determined through field inspections and f�'i' N�•'
review of Municipal records that the above systems are in • . .«
conformance with MOA HAA guidelines in effect on this date. i+
��� 7Y16 Hvs
Engineer's Printed Name Kenneth M. Duffus •��l9'+.:;??,«..•����\
Date 6/27/2003
HAA Fee $375.0
Date of Payment
Receipt Number &iNSLI
(Rev. Viol)
Waiver Fee $
Date of Payment
Receipt Number
6-26-03; 9:56AM;
SGS
SCS Ref.# 103361800I
Client Name KND Engineering
Project Name/# Sand Hill Lot 7
Client Sample 11) Sand Hill Lot 7
Matrix Drinking Water
;907 5615301
All Dates/times are Alaska Standard Time
Printed Date/time 06/25/2003 15:11
Collected DatNTime 06/19/2003 15:30
Received DateMme 06/19/2003 16:55
Technical Director �Stephen C. E
Released
0 2/ 3
I
Sample Remarks:
Allo I,, Analysis
Parameter Qualifiers Results PQL Units Method container ID Limits pate pate /nit
Waters Department
Nitrate -N 0.100 U 0.100 mg/L EPA 300.0 D (<a10) 06/19/03 )S
Microbiology Laboratory
Total Coliform 0
coV100mL SM189222D A (<=1)
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services 44
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. #
HAA # A " 1 F L L -I i121
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) - L/11/I flarr/alJ1-9 leoaall
6?44 Ales
U
Property owner aw Day phone
Mailing address
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: `r
3. TYPE OF WATER SUPPLY:
Individual well _
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of FirmKND Engineering Phone
arm(gan Blvd,
Address Eagle River, AK qP577--87W
Engineer's signature
6. DHHS SIGNATURE
� Approved for
Disapproved.
D U/� bedrooms.
Conditional approval for
Additional Comments
By:
aUTIC
Date
�E
OF
A-4
W��
•.
•%
eth WC
CE 7116
bedrooms, with the following stipulations:
Date //_5__ 1 k
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA •21
M
Municipality of Anchorage
0* DEPARTMENT OF HEALTH & HUMAN SERVICESOCr
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (98` %)f4tfVICEs Divi.
Health Authority Approval Checklist
Legal Description: LO / 7 cL i 'Z/ Parcel I.D.: 650 — r a IF
A. WELL DATA
Well type In If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Y Date completed�Z� f9g
Total depth Cased to lcg5 / Casing height (above ground) 145
Sanitary seal (Y/N)
Date of test
Static water level
Well production
FROM WELL LOG
WATER SAMPLE RESULTS:
9—
p.m-
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
Coliform (,U Nitrate d Other bacteria
Date of. sample: — 1011IL98 Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed '28' Tanksize 5 Number of Compartments Z Cleanouts (Y/N)—Y—
Foundation cleanout (Y/N) V— Depression (YIN) /// High water alarm (Y/N) AIA
Date of Pumping Pumper
C. ABSORPTION FIELD DATA
Date installed %- 29-98 Soil rating (g.p.d./W or ft2/bdrm) 4:7 System type S`!!c w
-2c0- !�ZI
Length /��i' Width s Gravel thickness below pipe • O Total depth
Effective absorption area v f Monitoring Tube present (Y/N)Depression over field (Y/N)
Date of adequacy test
Results (Pass/Fail)
Fluid depth =(ins)
before test (in.);
Fluid depthMinutes later:_
Peroxide
72-026 (Rev. 3/96)'
(past 12 months) (YIN)
For
gal. water added
rate = -� —c.p.d.
If yes, give date
D. LIFT STATION
Date installed
Manhole/Access (Y/N) _
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
11�— Size in gallons
on" level at* 7"Pff" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot On adjacent lots
Absorption field on lot /00 '4 -
On adjacent lots /DO '4
Public sewer main /DO �� Public sewer manhole/cleanout
/00
Sewer /septic service line 2� i Lift station /V 4
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation /b F Property line /0 �� Absorption field /O f
Water main/service line Z 5 -E Surface water/drainage 100 Wells on adjacent lots /60-1--
SEPARATION
)D�
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /U f Building foundation /(5 f Water main/service line z✓�
Surface water / / 00 -f- Driveway, parking/vehicle storage area
Curtain drain /OCA Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal
in conformance with MOA HAA guidelines in effect on this date.
Signatur
Engineer's Name a
Date�r�'
ego
HAA Fee $ 3 0 0 ^ Waiver Fee $
Date of Payment�0,,��
�\\—/Z CP
�/
Receipt Number.
0 44'
o � (
/�/�
D b
72-026 (Rev. 3/96)*
Date of Payment
Receipt Number
25,4
rtglaoy�vee ems are
CE 7j I6�6�./'�
NORTHERN TESTING LABORATORIES, INC.
F--Aj 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125
8005 SCHOON STREET ANCHORAGE, ALASKA 99518 (907) 349-1000 • FAX 349-1016
POUCH 340043 PRUDHOE BAY, ALASKA 99734 (907) 659-2145 • FAX 659-2146
DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA
KND Engineering
20441 Ptarmigan Blvd.
Eagle River, AK 99577-3736
Phone Number: ( )696-6111
Fax Number: ( )696-8111
Collected by: KELLY
Sample Type: Private water Systems
Method of Analysis: Membrane Filtration (SM 9222
B)
Date Received: 10/7/98
Date Analyzed: 10/8/98
Date Reported: 10/13/98
Next Sample Due:
Comments
Time Received:
16:20
Time Analyzed:
12:00
Time Reported:
08:06
S = Satisfactory
U = Unsatisfactory
POS = Positive Test Result
ND = None Detected
TNTC = Too Numerous To Count (>200 Colonies)
CG = Confluent Growth
HSM = Heavy Sediment Masking, Results May Not Be Reliable
SA = Sample Age >30 Hours But <48 Hours, Results May
Not Be Reliable
Old = Sample Age >48 Hours, Too Old For Analysis
Comments: R = Resample Required
NT = No Test
* # Colonies/100 ml # Colonies/ml
Sample Sample Total* Fecal Other* HPC**
Date Time Coliform Coliform Bacteria Result Lab# Location Comments
10/7/98 10:00 0 ND 1 NT AC10217 SANDHILL L7
Sherri L. Trask Environmental Analyst 10/13/98
Northern Testing Laboratories, Inc Anchorage, AK
Satisfactory
NORTHERN
TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE
FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125
8005 SCHOON STREET
ANCHORAGE, ALASKA 99518 (907) 349-1000 • FAX 349-1016
POUCH 340043
PRUDHOE BAY, ALASKA 99734 (907) 659-2145 • FAX 659-2146
KND Engineering
20441 Ptarmigan Blvd.
Eagle River, AK 99577-3736
Attn:
Client ID: Sandhill Lot 7
Client Project #:
Source:
NTL Lab#: A158531
Sample Matrix: Water
Comments:
Report Date: 10/8/98
Date Arrived: 10/6/98
Sample Date: 10/4/98
Sample Time: 14:00
Collected By:
** Legend **
MRL = Method Report Level
MCL = Max. Contaminant Level
B = Present In Method Blank
E = Estimated Value
M = Matrix Interference
H = Above MCL
D = Lost To Dilution
Date Date
Method Parameter Units Result MRL Prepared Analyzed
SM 4500 NO3
Nitrate -N
By: Jorma K. Kuusisto
y Supervisor
mg/L <MRL 0.10
10/6/98
ii. Vu, i+.2..1,15�1 111 �JN�rAA 7v.ihytl
FIKS1 AbERICAN
HUMAN INCORPORATED
r ; 1
la' unwry m"(SpAd%br,
19"-[' 66-1-.
MA4AK%"4wt4T Na►+WmJ43
4AApe".,. $ub--
PAGE
10002
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PLOT PLAN ` ASBUILT SCALE 1".x20 GRID 5w N.z. Pro(eof No.
Kenneth G. L01isj 1731 �uarye Boll Circle, Anchorage, Alaska 99519
Rseistered Land Surveyor M7i.3 s --46M Phone
OF q
I hersr oertlty that 1 have our"7W the fell ovinp,p�4 irr"d ptajpe ` ��............
L. Orr
?�:31rNcNAt�. �tlli3'adlelO +lioti4r.`"'im �•_(lnton en5o► a � ; P4?� �*
7GwehereQe Reeor4lne Dlektor, Aleow pte+e Cr?
thel Iwo are ""bin the prop" 11neo end de not oneresoh onto the properly
adl000rd th rate, %at no In+prorerrrertls ort the prop". lrino adleagd thents}........
one 04 It on the go- Per pr+nreele and Mlef then are no roadwaap, lraen+bolen �-•{�-,
Ilene or other e1Hble eaeemonte on fold prop" emoepl an Indleslod hereon.
— :KENNETH
parted Ihle the !I!—f- Day of C263TANIM- ii �;. at Mahora0e. Alaeke c� •., l t/—�2pZ .1177,{x.
N b the roeponetblltty of the owner to dehrmino 1ho ewidenoe of onr ........... S�
eoeanente, oewnenle, or reetrteNone whlah do net appear an the reoerded FA LAND
wldrdelon plot. -