HomeMy WebLinkAboutSEQUOIA ESTATES BLK 1 LT 1054C 6
Al" 0 1 qmwl - I D owaw to
Municipality of Anchora98 Page of
DEPARTMENT OF HEALTH AND. HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 o Anchorage, Alaska 99519-6660 e Telephone: 343-4744
On-Slte Wastewater Disposal System and/or Well Inpoection Report
PermitNumber 5LJ96OL33 PID Number. Q/ 7 / 5*7- /0
Name: JVhw
Wastewater System: 0 Now PKUpglrade
Addfe=
&1730 scovoiA Gfi.GLC�
ABSORPTION FIELD
phone.
No. of Bedrooms.
P(DwTrench oftallowTrench 08ed ElMound 00ther
LEGAL DESCRIPTION
Sall Plating:
45'
Total Depth from graft
;dtm Izi
CIFID/So. Ft.
Lot slock: Subdivision:
Depth to pipe bottom Imm criginal Waft
Gravel deP6 beneath Pipe
!�Gj2voiA
5.0 Ft.
-5j, F t,
Township:
Section:
Fill added above original graft
Gravel length:
134'
Ft.
Ft.
...... 0�
WELL , _ Ale OOLA_ WtMrr�
e)4j!,_rjAjj _7;10
Gravel wfdft
3 .5 ' Fl.
Numberaffiffils:
Doulce ww
Ft.
Classification (Pnvate. A.S.Q.
Total Depth:
Cased TO:
Total rption area:
Pipe material:
45rM b3OX4
Ft.
Ft.
.,,340 SO, Ft.
Driller
Date Drilled:
state Water Level:
installer
Date installaW �
9A - /'5 /it,
FL
A'1 V '4C-JhQD4
Yie=
Pump Set at
I
Casing Heigh I Abe" Gmund:
TANK
r,pM
I Ft.
Ft.
SEPARATION
DISTANCES
0 Septic Alo Oojw�L- -T�oks rca-�rr-
To
sepdc
Absorpbon-
un
"Oldsoll
pubhellhwate
Manufacturer
Capacity in gallOnE
From
Taf*
Field
stsuen
Tank
Sewer Unes
I
material:
Number Of Compartments:
won
>)00 I
r
�>
Surface
TION
I
Water
>101;
> Z.S
—
Lot
1
>10
)P/O
0
')10
ifteingallons:
1
Line
opumpon"levelat: "Pump air level arm at:
leve a
on_�
p:
Foundation
I
;
Curtain
Pwnp Make & Model
Ellaecwtficaal innspecefions performie"d blyr.
Drain
AIOAJC
V.'j
0"r
RemarkS: S9PT% -7;�Jll- C -005A A4,16 ValflzliEli
BENCH MARK
5DVpjp 1=0(L- Cb"-rltjVn- kjSe. A/0 WOP-V,
Location and Description:
�'irprc� -TZ4il- OrL Lor-ic r–po t^
Assumed Elevation:
qN%jq1TWS--SEAL
V11
.1P
I f'h4
0. vr
Inspections PeArmed by! Jq - AOULA Data! ist It"N
lAiclict.4 F.. Aaa6rsoll lo
Department of Health and Human Services approval
A,
A /:Z -12-
Ma%Azawari and nnnmvprf hv- Date:
I
PermltNo. SV)9401-33
Page 7- of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 9 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Zew 10. gtaca_ I 5cotviA E-'_4rAT-05 PIDNo.: 01715;7,10
11
tli� - 6-1
(A)
0
Ul. g
# �130'
jV00,
& WAI
PermitNo. 24""433
Page 3 Of .3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 e Anchorage, Alaska 99519-6650 9 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: /0, i3toto, f, 5covotA ES-rWrCb PID No.: 017161-10
v
air, Tylk
a
W
IgN
Y
I
IT
PAGE 1 OF
I -A 0 ��A
MUNICIPALITY OF ANCHORAGE L
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM
PERMIT NUMBER:SW960233
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:JOHN LEWIS
OWNER ADDRESS:6930 SEQUOIA CIR
ANCHORAGE, ALASKA 99516
PARCEL TD:01715210
LEGAL DESCRIPTION:
SEQUOIA ESTATES BLK I LT 10
LOT SIZE: 48936 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
(UPGRADE) PERMIT
DATE ISSUED: 8/06/9
EXPIRATION DATE: 8/06/97
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 BY: nj'-o-t't 6: DATE: g - -1, 96
ISSUED BY:
DATE: 4y W/ ��
July 28, 1996
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot 10, Block 1, Sequoia Estates Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
The absorption trench serving the four bedroom home on Lot 10, Block 1, Sequoia
Estates Subdivision will not pass an adequacy test and the owner wishes to
upgrade the system. Unfortunately, very little area is available on the lot for the
new trench so it will be necessary to rouse the existing trench. We attempted to
place testholes upslope from the existing trench and found an old burial area
where old stumps had been deposited during lot clearing operations. The only
feasible location for the system is in the current location.
A testhole placed near the existing system revealed a much slower percolation
rate than that used to design the first system. Sixty feet of trench in addition to
the existing trench will be required to meet the design criteria specified for the
slower percolation rate. The attached site plan indicates the area where the new
system is to be placed.
The location is further complicated by the presence of a steep slope near th e
north end of the existing trench. This trench has been in operation, however, for
more than 10 years and no effluent has ever percolated out of the slope face.
There is no reason to believe it will in the future either. The ground slope over
the trench for the most part slopes at a less than 15% grade from east to west.
There are areas, however, where the slope exceeds 25%. A cross section of the
slope is attached which shows the area where the slope is the greatest.
The existing septic tank will be uncovered and inspected for apparent leaks or
areas of corrosion. A new tank will be installed if the existing tank cannot be
verified satisfactory for continued use. If the system is constructed as designed
the followina statements can be made:
Lot 10, Block 1, Sequoia Estates
July 28, 1996
Page Two
1 The system, if constructed as designed, will have no adverse impact on the
wells in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on
existing septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on
reserved space, either surface or subsurface, on any lots located in the
area.
4. The system, if constructed as designed, will have no adverse impact on
drainage patterns in the area. The current drainage pattern will be
maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
THIS PROJECT
1-4 SCHEBEN DR. -LL�UPIN I
DE ARMOUN T300
0! Tfl. A
z
2 116241
2 >
6731 6741 — z
5 PRISM PINECONE
IR 30 IR. 6900 13301
w
4
7 5 �j 4
00 <�- *4-4:
6T2I 4 6820 00.
6 6720 6731 TA 5 5 4
M401
6601 6621 6801 6841 11 41 \01VI '2
SEQUOIA CIR 13501
6630 6700 6740 684*0
16 z 14 Z 12 n /0 13541
-----------
77?. A T20D
6 5 716000
cr
6621 6701 9K 6w 7100
Y. a:
6m
166M -mm 7040
I vun - 7000
660D 6700 .6740 6800 68Q 690D 6940
7 6 5 6
CREEK
4— --.3 3011 7311
/0 4
F?/ i
L6!21 6!5 6701
_. _f _ 2 t
CRESTUNE RD.. 2
6720-�,,\ TR A w
-3 2 RAA 7
0
8 L611
4 5 6
6NO 7001 7101 E. 140 AVE.
LOCATI.ON MAr
%10
NO WELLS WITHIN 10 ol
OF NEW SYSTEM.
z
fA*l
S A
9
1 0
NOTE:
1 VERIFY INTEGRITY OF EXISTING SEPTIC TANK.
2. PROVIDE FLOW SPLITTER VALVE AT THE
LOCATION SHOWN.
3. REMOVE ALL CONTAMINATED MATERIAL
FROM EXISTING TRENCH AND BURY ON SITE OR
DISPOSE OFF SITE IN AN APPROVED MANNER.
156,10401'26'
5c
SITE PLAN.
son
-a
SCALE I" = 50'
CLEANOUT
NOTE:
VERIFY THE INTEGRITY OF THE EXISTING
SEPTIC TANK. REPLACE IF NECESSARY.
SPLITTER VALVE
no
MONITOR TUBE
0.4�z
SySTF.M FLAN.
SCALE 1" = 20'
EXISTING PAVED
PARKING AREA
LOT 10, BLOCK 1, SEQUOIA EST. SUB.
DESIGN FACTORS:
Four Bedroom Home
Perc. Rate: 39 Min./inch
Application Rate: .45 GPD/SF
SYSTEM REQUIREMENTS:
Deep Trench System
1,250 Gallon Septic Tank
Verify Integrity of Ex. Tank
4 Bedrooms X 150 GPD = 600 Gallons Per Day
600 GPD/.45 GPD/SF = 1,334 SF / 10 LF/LF = 134 LF Total Length
Therefore: Construct a Deep Trench System With One Lateral a Total
Length of 134'. Split the Flow From the Tank and Enter the Trench at
Two Locations. Contaminated Material in Existing Trench to Be Completely
Removed and Buried On Site or Properly Disposed off Site, Distribution
Piping to Be Placed 5' Below Existing Ground.
57-0 6
1\1A-rVaA'L
BAULErILL.
61A 14
6E0-r-CVX1 L -C
FA-uiiit�
J> T? -A I rJ F1 CLb
TYPICAL DEEP TRE 4CH 3ECTION
(NO WALL)
NOTE: Bottom of Trench to be 4' Above Groundwater.
Minimum 3' Cover Over Trench.
P,;&acl E And,WWII
4381 -E
0\1
gp\
71,
T"
uj 71
IIENGINEER'S SEAL)
Municipality of Anchorage ? C�'
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG PERCOLATION TEST
PERFORMED FOR: 47-�4)J DATE PERF - - - - -
LEGAL DESCRIPTION:L-�/D 4-!5/. &5�Township, Range, Section:
r —E=PT 1 4� SLOPE SITE PLAN
—D H
10FE I
2
3-
4 -L-
rr
5 1 4�"' I - C—)Ar'
6
9-Z
10 -
12
13
14
��MMCN�a
'0�-Zr/-/
WAS GROUND WATER
Net
Time
ENCOUNTERED?
A/
7//
IF YES, AT WHAT
DEPTH?
Depth to Water After
7, 7";
Monitoring?
Date:
I
L
3
3
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
7//
7, 7";
/a,
tjo I d L-�
764,
too 1.46
4% g;
rgP'0/!D
4. 1&+-
44 -
PERCOLATION RATE (minuteVinch) PERC HOLE DIAMETER
TEST RUN BETWEEN FTAND FT
'A
PERFORMED X�- I ly"J." �--- �CEIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL G61DELINES IN EFFECT ON THIS DATE. DATE: z L14Li
72-008 (Rev. 4/85)
g SOILS LOG
MUNICIPALITY OF ANCHORAGE 0 PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
Pouch "50, Anchorage, Alaska 99502 276-2221
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: &/,f W WORLD �AIYD C�0, DATE PERFORMED' 91271e7-_
LEGAL DESCRIPTION:
SLOPE SITE PLAN
Pff
2
3-
5
6 ZW
7-
8-
9 -
5L1&l-,TLY �51L.Txl
10-
WASGROUNDWATER /yo
ENCOUNTERED?
SAIVPY L'�A)IJF)4
12-' IF YES, AT WHAT
/ A DEPTH?
13-
14-
Date
G ross
Time
Net
Time
Depth to
Water
Net
Drop
16 --
or A
17 -
got Y, go. ��P
18-
0
ell
71) 1
,;Z,00
ZZ
lornord
Ead R. I r a
Reading
Date
G ross
Time
Net
Time
Depth to
Water
Net
Drop
20- 75
(minuteslinch)
AV PERCOLATION RATE
TEST RUN BETWEEN FT AND � FT
COMMENTS
PERFORMED BY: z?, H, /,-, CERTIFIED BY:
, � � / � Z41 A,;,
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: Lot 10, Block 1, Sequoia Estates Subdivision
GENERAL:
The scope of this project includes the excavation,
verification of integrity and possible replacement of a
1,250 gallon Septic Tank and the construction of a deep
absorption trench with 5' of effective depth and a total
length of 134 L.F. Approximately 75 L.F. of the trench is in
the existing absorption trench area. The contaminated
material in this trench must be totally removed and either
buried on site or properly disposed off site.
2. Construction shall be in accordance with the approved site
plan, design drawings, Municipal Permit with any special
provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regulations.
3. The Contractor shall be
responsible
for
obtaining all
underground utility locates
and for the
layout
of the septic
system and verification of
the location
of all
lot lines.
4. Unless specifically agreed otherwise, the contractor shall
be responsible for final grading areas subsequently
depressed from soil settling. Property owner shall be
responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must
be certified by the Municipal Department of Health and
Human Services for system installations. Owners installing
their own systems must receive prior approval from D.H.H.S.
before beginning system installation.
SEPTIC TANK INSTALLATION
A new 1,250 gallon septic tank, if required, must be procured
from an approved source and installed at the location shown
vii Mv %�Itv Min,
Lot 10, Block 1, Sequoia Estates Subdivision
July 28, 1996
Page Two
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts
for pumping access.
3. The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of
12 inches above final grade.
5. Tanks installed without 4' of cover shall have a minimum of
2" of direct burial insulation.
6. A foundation cleanout shall be installed one to four feet
from the building foundation. Two cleanouts are required
between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive
slope exists away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown
on the design. The bottom of the trench shall be within 2"
of level.
2. Distribution piping
must
be placed
level with perforations
down atop a level
bed of
drainfield
rock. Rock should then
be placed over the
pipe
to provide
a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between
the drainfield rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the
locations shown on the design. The portion below ground
must be perforated.
Lot 10, Block 1, Sequoia Estates Subdivision
July 28, 1996
Page Three
5. Contractor shall verify the septic tank and drainfield are a
minimum 100' away from any private water wells in the
area, 150' from a Class "C" Well or 200' from any community
well.
6. Direct bury insulation must be placed over the distribution
system if less than 3' of backfill depth is available. Finish
grade over the trench must be mounded to prevent
settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the
drainfield rock. Contractor shall verify this condition prior
to placement of the rock. All pockets of unacceptable
materials must be removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C.
(perforated and solid), ASTM F810 or H.D.P.E. (perforated, but
not solid) and ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial
polystyrene (Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must
be installed between the final drain rock layer and the
native soil layer.
Lot 10, Block 1, Sequoia Estates Subdivision
July 28, 1996
Page Four
6. All drain rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 sieve.
INSPECTIONS:
A minimum of two inspections are required by Municipal
Ordinance. These inspections must be conducted under the
supervision of a professional engineer registered in the State
of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation
of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement
of the geotextile fabric, gravel, distribution piping,
standpipes, cleanouts and insulation. No backfill should be in
place at the time of inspection.
Contractor shall provide a copy of all field survey layout and
construction notes for use in preparing the certified as -built
of the completed system.
72-013 (3/85)
MUNICIPALITY OF ANCHORAGE
DIL ATMENT OF HEALTH AND HUMAN SER, 12S
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
DISTANCES
� !�"41' "E; ze's'live
SEPTIC
TANK
ABSORPTION
FIELD
WELL
Add r �ess
3
Phone(s) Permit No. No. of Bedrooms
3-7 rf,
WELL
��
IR50 4
LOT LINE
LEGAL DESCRIPTION
Lot
AQ 1
Block
Subdivision
1, ��_IOL2'9 /,a, x5- 5 7,4 Z-)e�
FOUNDATION
Township, Range, Section
AS -BUILT DIAGRAM (Show location of well.
septic system, property lines,
foundation,
ZZ:_
driveway, water bodies, etc.)
TANKS
IM. SEPTIC [I HOLDING
Manufacturer
Capacity in gallons
Materra I
No. of Compartments
r)
C_77Ar;.A�- /�
1?1
TYPE OF SYSTEM
1
XTRENCH El BED Ll W. DRAIN Ll OTHER
Depth to pipe bottom from
Total depth from original grade
original grade FT
J- i_ If
FT
I I
I,--
I? If
Fill added above original grade
Gravel depth beneath pipe
FT
�:;' t __ - 0 F T
12 1 5
Gravel length
Gravel width
7D FT
S FT
14
�r
F
1�ra'kl
_Ilfr�
Total absorption area
Distance between lines
&--e;; �o SO FT
I — IT
1 1: A
7`4
's-_
I
Number of lines
Soil rating
Pipe material
� rj S 0 F T
5X ""6 14 -e?7111-4 �D
Installer
Date Installed
Y5 Z16E
19 N_!7�
W ELLS
PRIVATE F] OTHER (Identifv)
Classification (A,B.C)
Total Depth
Cased to
FTJ
FT
Installer
Date Installed:
REMARKS:
_11ENGIN EWSSIML:�
n_ Z,,,o s.P�®rd by.
I sae c
. I , I I
.,- , , ; :
Date.jv"e. Z0 Z17, /W-
J
LtAYL )!,�AVIAIFD tMily 1hig ingoulion W mod nurdimo ID A
Municipal and State guidelines in effect If n this date: 44 -Z -AC
AVate: 2 170-41
Health Department Approval: - 7-----J-
72-013 (3/85)
M 1[_J 1�4 I �I F���1 ��� �F� �����4 e::% r=-
DEPARTMEN�
~ ' T /—��EALTH AND ENVIRONMENTAi' `nTECl�ION �
825 t- STREET, ANCHDRAGE� AK 99bo1 �� m
264-4720
0 Irq I _F_ [=� �FEE �I—.- F;� LIJ I ��$- F, -Z 9-1 1 -11- *
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS -
CO
NTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
MAX BEDROOMS -
850'350
06/24/85
SOLOR INVESTMENT INC
3751 E. 67TH.
ANCHORAGE, AK 99507
349~5233
SUBDIVISION: ^
SECTION: 26` TOWNSHIP. 121\1
1.25A (SQ"FT° OR ACRES)
4
LOT. 10 ' ` BLOCK: 1
RANGE: 3W
Listed below are the options available to
you in designing
your septic
system. Choose the option
that best fits
your site.
��F_� IE__ P4!E:��~.l
F3 I=—
W BD FZ ][8^J
DEPTH TO PIPE BOTTOM (FT")
4 0
5^0
4.0
GRAVEL DEPTH (FT.)
5.0 `
- 0.5
3.5
TOTAL DEPTH (FT.)
9,0 '
5.5
7.5
GRAVEL WIDTH (FT.)
2"5
20.0
5"0
GRAVEL LENGTH (FT.)
5d.0
38.O
54.0
GRAVEL VOLUME, (CU.YDS. )
25"5
28"2
40.0
TANK SIZE (GALS)
1,250°0 **
1,250°0 **
1,250.0 **
SOIL RATING (SQ.FT"/BR)
125
125
125
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
`
I certify that:
1. I am familiar, with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install 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 State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of' 4 bedrooms and
any enlargement will require an additional permit.
IF 9 LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (Z) THE
ELECTRICAL WORK MUST BE DONE BY A. LICENSED ELECTRICIAN, .
SIGNED DATE-
434
ATE:
������������������������
.l� /
APPLICANT: SO4mr\INVESTMENT INC '
ISSUED BY
DATE:
_-A
_0
lz�
P.O. BOX 6-050
ANCHORAGE, ALA63KA 991502-0650,
.10, 1
�907) 264-4111
T
, -:-"Ily P""'CWLES'
�11� V -P
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 10, 1986
TO: Permit Applicant
Subj ect: Permit # 850350
Lot 10 Block 1 Sequoia Estates Subdivision
A permit issued by this Department for an individual well and/or on -S4 te
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and to close the permit.
If'a private engineer inspected the installation of the on-site sewer system
the original as -built inspection report(three part form) must be sent to
this'office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
24'.'_� 6Ltr�
Susan E. Oswalt
Program Manager
On-site Services
SEO/ljw
enc: Copy of Permit
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-2221
SOILS LOG - PERCOLATION TEST
YL SOILS LOG
El PERCOLATION
TEST
PERFORMED FOR: ME W W09LD �-AIYD �:0, DATE PERFORMED: 91271d'2 -
LEGAL DESCRIPTION:_L6)7 &I / -
SLOPE SITE PLAN
DEPTH
(FEET)
2-
3- A
4-1
5-.
6
7-
8-
9-
Reading
Date
/Z 0(-/) 1
10 -
- 0'-,
(�:LAY&Y-3-1/�TCM
S
WAS GROUND WATER
L
ENCOUNTERED? 0
12
P
�AIVPY --Z-A�1,W E
16
IF YES, AT WHAT
17-
DEPTH?
vv
Reading
Date
/Z 0(-/) 1
14
- 0'-,
(�:LAY&Y-3-1/�TCM
-IL7 Y -5A 1)16
16
OF '0.t�
17-
'5
vv
18
-
Earl R. Barnard
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
20— 754-E
1;:� PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND - FT
A.
COMMENTS lj-ev-- "I
49Y LZ I DATE:
PERFORMED BY: CERTIFIED BY:
72-008 (7/76)
UNICIPALITY OF ANCHORAGE,,,
Department' -i Health and Environmenta.' �)rotection
825 Street, Anchorage, AK. -79501
264-4720
Permit # HANDWRITTEN PERMIT
WELL AND* ON-SITE SEWER PERMIT
Applicant: (L- Mailing Address: lo=j
Location: Phone Number: S
2
Legal Description: 0 %I—Lot Size:
Type of Soil Absorption System Is: 61
Trench: Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br) 1,50
The Required Size of the soil Absorption System Is:
DEPTH Q LENGTH &0 - GRAVEL DEPTH f-- .. WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall Pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve. I
* *.* TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection -and approval by this department.
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100,feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3
I certify that:
(1) 1 am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) 1 will install the system in accordance with codes..
(3) 1 understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that b d ooms.
e f
Signe'a: '4/"" 1 Issued by:
r1i" arK
App c
Date:
PERFORMED FOR
LEGAL
DESCRIPTION:_
SIL7-,v -5AI)IO
15-
Depth to
DEPTH
16 -
IF E ET)
0 IF
17 -
Water
Drop
2
18
-
3-
19-0
14
5
Earl R. arnard
20-
6
74
75
7
av
8-
'J'ROFES 111P
9-
-rm'
ef
10-
Iq
Earl R
ba:
Barnard
7
4-E
12 -
AV.-
13-
14-
I -� '��L 6011-0 LUO
MUNICIPALITY OF ANCHORAGE 11 PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
Pouch 6.650, Anchorage, Alaska 99602 276-2221
SOILS LOG — PERCOLATION TEST
Mf W MORZ�D ZA"-0
Z -Z)710
N)
DATE PERFORMED: 912 711 -g' -L
7// 7-4
SLOPE SITE PLAN
--- ------- I
5LIcAiinl%r
WAS GROUND WATER
ENCOUNTERED?
-5A IV -I,) Y 6 Z -A Y IF YES, AT WHAT
DEPTH?
cnmw
/yo
w
SIL7-,v -5AI)IO
15-
Depth to
Z,4 Y
16 -
Date
0 IF
17 -
Water
Drop
18
-
-, lv"
19-0
14
Earl R. arnard
20-
74
75
av
lit
'J'ROFES 111P
cnmw
/yo
w
- %% -- '-�w
PERCOLATION RATE (minutes/in6h)%%v%%q11'1
TEST RUN BETWEEN FT AND � FT
PERFORMED BY: 21�1 CERTIFIED BY:4���--t-
Z5�ld I�K
72-008 (7/76)
01
DA
Ok
11*41IK30
Gross
Net
Depth to
Net
Reading
Date
Time
Time
Water
Drop
-, lv"
14
lit
-rm'
ef
Iq
Earl R
ba:
Barnard
7
4-E
AV.-
- %% -- '-�w
PERCOLATION RATE (minutes/in6h)%%v%%q11'1
TEST RUN BETWEEN FT AND � FT
PERFORMED BY: 21�1 CERTIFIED BY:4���--t-
Z5�ld I�K
72-008 (7/76)
01
DA
Ok
11*41IK30
WELL LCG
Date Drilleds 7-10-85
Static Water Level 240 feet
Draw Down N/A feet
TyDe Material Drilled:
0 feet to 20 Silty Gravel
20 feet to 90 Clay w/sand
90 feet to 105 Clay, Gravel
105 feet to 115 Gravel
Lot ) Blk. I
Sequoia Estates
Gallons Per Minute 15 �
Total Feet of Lasi & 269
115 feet to 250 Clay w/gravel MUNICJPALITY nx
11 1
DEPT. OF HEAUT!,40"S.
ENViRONMENTAL PPOTECTION
750 feet to 264 Clay
00
Hefty Drilling
S.R.A. Box 1553 H
Anchorage,Alaska-
99507
HEPY DRILLING
3540 AKULA DRIVE
ANCHORAGE, AX 99516
, ;*L
, 5'— dP,9'9_5
(2 "-,//#
."EIVED
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
oil— 1,5z- —ja HAA# "W'Un()QYq
1. GENERAL INFORMATION
Complete legal description r 10 13 t t? u4- '!�Cavolk 1-:S7-647i�-s
Location (site address or directions) . 67-36 '5r -,Q u� o 1A
Property owner Y,4,rj1 V tj a -I -LS Day phone
Mailing address �q3O
Lending agency Day phone
Mailing address
Agent C -W rj Day phone
Address C/O TAC�L_ PC-YJL EST -*F C- 3zc 1
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: F-6 L) jL,,
MUNICIPALITY OF ANCHORAGE
3. TYPE OF WATFIR SUPPLY: ENVIRONMENTAL SERVICES DIVISION
Individual well X X -j- JUN 12 1996
Community well
Public water RECEIVED
NOTE: If community well system, provide written confirmation from State ADEC attest -
I . ng 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 confirmationfrom9tate 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 Firm
U k__ I Ij 61 6A-_1 INU Phone �Z to I I _')
Address F: -T 1� 0 Y� 740 -7 1 br Q e) S 7,4
Engineer's signature Date (f It 4q(D
6. DHHS SIGNATURE
1Y Approved for bedrooms.
— Disapproved.
— Conditional approval for
By:
Additional Comments
t
bedrooms, with the following stipulations:
M
ItITIC
Date,Z2 -12 -�Z
The Mur0cipplity 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 engine&'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 DHHSdonot
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
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICE6
Environmental Services Division RECEIVED
825"L" Street, Room 502 0 Anchorage, Alaska 995010 (907) 343-4744
NOV 1 1996
Municipality of Anchorage
Health Authority Approval Checklist Dept. Health & Human Services
Legal Description: to 6coati, 5LrovolA 6'�-,wT-Lf--5 Parcel I.D.
A. WELL DATA
01715-Z-10
Well type Pa i \f,4 -7-C-- If A, B, or C, attach ADEC letter. ADEC water system number
Log present (YIN) Y Date completed -7 / , F, G—
Total depth Z-b?q Cased to Z- III Casing height (above ground)
Sanitary seal (Y"
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0
j �; — 9 -p -m -
Wires properly protected (YIN)
AT INSPECTION
c,/G-/qt,
g -p -m -
Nitrate /I- Other bacteria
I
N
Date of sample: f. Collected by: A, J4A-P-41.4-
X- L4JA-r67Z- QIAL-Yr� -t-l-rc-0 7-pitcc. 1 'j -r*-c
B. SEPTICIHOLDING TANK DATA C -4 -s -r �-:' /)C, 1A 0 urp tzCSUV-S 4cxk-P71H3X-
Date installed (9 1 Z-?, / AS- Tanksize 1, ZT0 Number of Compartments Z- Cleanouts (YN Y
Foundation cleanout (Y/N) Y Depression (Y/N) /�J Mgh water alarm (Y/N) 14
Date of Pumping qk'7!qS- Pumper
C. ABSORPTION FEELD DATA
'T5 A A C -'s
Date installed _C1111 -Is lq� Soil rating (g.p.d./ft2 or ft2lbdrm) , System type DL --v -7a—t9,4cA
Length 13 4' Width .3' -FO 9 - Gravel thickness below pipe Total depth '7
Effective absorption area � 34V F-77 Monitoring Tube present(Y/N) Y Depression over field (Y/N)
Date of adequacy test IJCW (� rJS7� Results (Pass/Fail) TW.5 S For T;0 IL- bedrooms
T71..;d d�rtl' i. f;AA t�.t 6- ): 1.�diately after gal water added (in-)- 0
Fluid depth Minutes later: (in.) Absorption rate = g-p.d.
Peroxide treatment (past 12 months) (YIN) ^1 — If yes, give date AIJA
ATION IJOtJc
Date installed
Manliole/Access (YIN)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
0r,J 1,61-
Size in gallons
*Datuni
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/liolding tank on lot >/Do —� On adjacent lots
Absorption field on lot �� /0 0 —; On adjacent lots
"Pump off' level at*
> /0 to /
Public sewer main tc--�5 Public sewer manliole/cleanout M ILCS
Sewer /septic service line > Ze5 I Lift station /,J 0 t -i C- - o J
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation Property line Absorption field
Water main/service line Z-5 Surface water/drainage I �/00 ( Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation )/01 Water main/service line
Surface water - > /0 0, Driveway, parking/vehicle storage area
Curtain drain /J00C 01-J 1,07- Wells on adjacent lots
,> /0 1
F. ENGINEER'S CERTIFICATION Pi2rOF-L-a"y Llic /0
I certify that I have determined thru field inspections and review ofMunicipal records that the,,.above sy, ; �teiws are
in conjin-niance with 110/1 I -111A gindelines in effect on this date.
Signature
Engineer's Name ---4-
Date L/, Iq
---------------------------
HAA Fee
Date of Payment
Receipt Number
Rev. 8/95 OSS: liaa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
CT&E Environmental Services Inc.
Laboratory Division
Laboratory Analysis Report
CT&E Ref.# 962421.962421001 Collected Date 06/18/96
Client Sarnple ID Private Well Water
Matrix Drinking Water Technical Director: Stephen C. Ede
Released By - 4::� et/�
Parameter
Results QC POL Units
method
Allowable Prep Analysis
Init
Qual.
Limits Date Date
Nitrate -N
0.928 0.100 mg/L
EPA 353.2
76'/21/96
FL—izabeth
Nitrite -N
0.100 U 0.100 mg/L
EPA 353.2
06/21/96
Elizabeth
Total CoLiform
0 0 cot/100ml.
SM18 92228
06/18/96
TAV
U - Undetected
LT - Less than
GT - Greater than
D - Secondary Dilution
J - Below the calibration range
0)
200 W. Potter Drive, Anchorage, AK 99518-1605 — Tel: (907) 562-2343 Fax: (907) 561-5301
3180 Pager Road, Fairbanks, AK 99709-5471 — Tel: (907) 474-8656 Fax: (907) 474-9685
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 0 Anchorage, Alaska 995010 (907) 343-4744
Health Authority Approval Checklist
Legal Description: "T- to, 13LOUIJ Si:--QY01A C -:ST-. Parcell.D.: 01'7 - 15 Z- - 10
A. WELL DATA
Welltype PfZ1\/4T_C-' If A, B, orC, attachADEC letter.
ADEC water system number
Log present (Y/N) Y — Date completed
7 Ig g -
Total depth g (�q Cased to
Casing height (above ground) 3
Sanitary seal (Y/N) 'Y
Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECT10N
Date of test 7&1b�-
1,15 Iq 1,
Static water level Z40,
z 14 q'i
Well production JG7 9 -p -m-
4-65 - g.p.m.
WATER SAMPLE RESULTS:
Coliform Nitrate Oq /%A9 /L— Other bacteria
Date of sample:_ Collected by: 15" � OIL- I\A rw yo k -%l
B. SEPTIC/HOLDING TANK DATA
Dateinstalled 6LZ f�IA5 Tank size IZqb Number of Compartments Z— Cleanouts(Y/N)—Y—
Foundation cleanout (Y/N) Depression (Y/N)
DateofPumping_ c�lz_71q5- er J_s AA c_5
C. ABSORPTION FIELD DATA
14 High water alarm (Y/N) tj
Date installed lb5 Soil rating (g.p.d./e or e/bdnn) 5�/-fr- -(System type
Length -70 Width Gravel thickness below pipe Total depth
* �;Lv Fr Z'
Effective absorption area Monitoring Tube prcscnt(Y/N)__�C Depression over.field (Y/N)
Date of adequacy test 1� Results (Pass/Fail) PA SS For ok)IL bedrooms
afterl/ gal- water added (in-):
Fluid depth_;�b, 5� tat &00
/* (iris.) Minutes n rate = g.p.d.
Peroxide treatment (past 12 months) (Y/N) PIJ If yes, give date /A
\/j CG- vtu tj6
1). LEff STATiON -`>- Al 0 KJ ��- Otj /IV --r
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum
"Pump off' level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot �> /00 On adjacent lots 1> /0 0
Absorption field on lot >100 On adjacent lots >/00 I
Public sewer main /A I t� �- Public sewer manhole/cleanout M , "f�j
Sewer /septic service line ),/0, Lift station /JC7 tj tf�- 0 pJ 1-0'r'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
I I
Building foundation Property line /0 Absorption field
Water main/service line 0 Surface water/drainage � 10 0 Wells on adjacent lots > /0 0
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation > /V PropertyLine >J(3 Water main/service line
Surface water 1 )1/00 f
f
Driveway, parking/vehicle storage area Is
Curtain drain -1iJ0A11F vtd 6) T- Wells on adjacent lots >/O 0
F. ENGINEER'S CERTMCATION
Icertify that1have determined thru field inspections and review ofMunicipal records. that ihe,6bove:s))§tems are
in conformance with MOA HAA guidelines in effect on this date.
Signature
7y�
Engineer's Name 'U -M L---7- A -7-i t9Z-S 0 0J
Date /tz-
HAA Fee $ C$�) -
Date of Payment
rQ
Receipt Number./
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
VON SCHEBEN DR.
4LUPINE I 4FOSTER SAUNDERS
DE ARMOUN ER
M111111 FARK
C� TR. A 73110 13210
15241
Cr 2
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1 741 6851 6901
6731 6 z
PRISM PIN
IR. I R Go
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6720\ 6820
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6601 6801 6841 1
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75011 7311
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66W 6646 67io--\
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4 5 6 8
6740 7001 7101
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GR. 2939
255 254 256 DeArmoun Area Reference Map—P14
y
@ COPYRIGHT 1985 JMR 265
41
41
44
V4(V (-,7 10114V
YL en /?
FlopIN,
, W10
NORTHERN
TESTING [ABORATOBIES, INC.
3330 INDUSTRIAL AVENUE
FAIRBANKS, ALASKA 99701 (907) 456-3116 - FAX 456-3125
2605 FAIRBANKS STREET
ANCHORAGE, ALASKA 99503 (907) 277-8378 - FAX 274-9645
Haas & Associates
3900 E 112th Avenue
Anchorage AK 99518
Attn: Sandor
Our Lab #:
Location/Project:
Your Sample ID:
Sample Matrix:
Comments:
F159213
Blk I Lot 1-0 Sego-Ja Est
Lot 10 Blk 1 Segoia Est
Water
Report Date: 03/29/96
Date Arrived: 03/27/96
Date Sampled: 03/26/96
Time Sampled: 0930
Collected By: -
MDL = Method Detection
Limit
* Flag Definitions
R = Below Regulatory Min.
H = Above Regulatory Max.
Date Date
Lab# Method Parameter Units Results MDL Prepared Analyzed
---------------------------------------------------------------------------------------------
F159213 EPA 300.0 Nitrate -N mg/L 0.89 0.03 03/27/96
Reported By: Patric oody
Senior Chemist ci
NORTHERN TESTING LABOHATORIES, INC.
f. 0 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 - FAX 456-3126
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 - FAX 274-9645
DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA
Haas and Assoc. Public Water System I.D.#
3900 E. 112th Ave.
Anchorage, AK 99516 Date Received: 03/26/96 Time Received: 12:25
Date Analyzed: 03/26/96 Time Analyzed: 14:30
Date Reported: 03/28/96 Time Reported: 09:23
Next Sample Due:
Comments:
* # Colonies/100 ml ** # Colonies/ml
Sample Sample Total* Fecal* Other* HPC**
Date Time Coliform Coliform Bacteria Result Lab# Location Comments
-----------------------------------------------------------------------------------------------
1 03/26/96 09:30 ND NO NT NT AB6968 Blk Lot 10 Segoia Est. Satisfactory
o� . vu
J01 O'Schaefer
E v nmental Analyst
S
= Satisfactory
Phone No.
U
= Unsatisfactory
Purchase Order No.
POS
= Positive Test Result
NO
= None Detected
Collected by: SM
TNTC
= Too Numerous To Count (>200 Colonies)
Sample Type:
CG
= Confluent Growth
Routine Untreated
HSM
= Heavy Sediment Masking, Results May
Not Be Reliable
SA
= Sample Age >30 Hours But <48 Hours,
Method of Analysis:
Results May Not Be Reliable
MMO-MUG (Colilert)
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
-----------------------------------------------------------------------------------------------
1 03/26/96 09:30 ND NO NT NT AB6968 Blk Lot 10 Segoia Est. Satisfactory
o� . vu
J01 O'Schaefer
E v nmental Analyst
.06/07/96 09:12 FAX 907 243 5112 JASON BONNER lao0i
ADEQUACY TEST REPORT
LOCAT ION: 10 7- /0 DATE:
L f -T L; 0 1 L -7-S 77
I NSPECTOR
TYPE OF DWELLING:- PROJECT
NO. OF BEDROOMS: 4 SEPTIC TANK SIZE!
PEAK LOAD CALCULATION: TYPE OF
Time
Flat
Raia
(gpm)
Vol.
(901)
cumu I
Vol.
(go 1)
T.
S. T.
Li id
�. �V'I I
S-A�S.
MT� I
Comments
Liquid
Level
?, i4o
37 9;
4�1
—C3-
Al
—7
1A,
117, 2
43,4-
iL�-
310
-7
t,-
d -t -k -d /Vt
t37
f
q V I Csr
Y?A"j
0
T�ST
REVIEWED
KSULT9:
BY:
DATE
06/07/96 09:12 FAX 907 243 5112 JASON BONNER 0002
WELL FLOW TEST
Do t e
L ocot ion: 1/0-T- i. 0 C-/, U 0 r 1-144
Inspector
We I I Dep t h f I Costing Above Ground 3,0 1 f t
Static Water Level : ( f t Project
(MeasursJ from top of cutting)
Time
Wo ter
Level
f t
Vo I ume
(gal I
n
VaNme
(gal I
Me t er
R..J i .q
Flow
(gpm)
Comments
3 j, U q.
r -
71h:
74;
".
V.r,
30
7 b3, 0
3- 2 7 4�-
3 3S it,
11 41�.
-4, 7
if 0,
+;, 4-
* I clip
7-
Z
RECOVER't
COMMrzNTS
I
AVERAGE FLOW RATE:�—�,� (Spm)
REVIEWED BY:
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 t /4,0V , / 904
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
.0 gp r /,,� gL 0�r a ;5&;S9 1A If 70 Z -Al -I ZW
Location (address or directions)
(b) Applicant Nam IeA�J� "1-46 Telephone: HomeAf—
L9 Business
Applicant Address 10 0V,0,'A ejC, — A0y'e_46P&A
(c) Applicant is (check one): Lending Institution 0 ; Owner/builder 14 ; Buyer[] Other El (explain);
1!,24ZJf7-Xk1e-,7-10A1 VA:th
(d) Lending Institution
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
Telephone
2. TYPE OF RESIDENCE
Single-FamilyA Multi -Family Other
Number of Bedrooms 4!
3. WATER SUPPLY
Individual WeIIA Community 11 Public El
Note: If community well system, must havewritten confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
. . Onsite;O Public 11 Community Holding Tank
Note: If community well system, m . ust 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
1.1
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm 2�M,4,C�0 eAl&,IMA�Al Telephone
Address . _,2,0 14!� ICrAe A 11,t4W 04,oV I- Z
t, VVj4M4e*-A .4.e 9 9; o:p
Date
DHEP APPROVAL (�)
Approved for jF0 bedrooms by
Approved Disapproved
Terms of Conditional Approval
Conditional
CAUTION
-wit%
.w. OF
Earl Parnze
4--
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Appr�vnl nortificates based aniely upon the repregentations aiven in paraaranh 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 ANCHORAG�
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA) L,B 0 3
CHECKLIST - FEBRUARY 1984
264-4720 W�IVED
Legal Description: /'Pr /to
,5',X:rAqVe1,4_ '�� 2-ArAff-5
A. WELL DATA
Well Classification AMVk L-1 1,0VA 4- If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) �� Date Completed �� 1,t* , Af Cr Yield 1��10A-1
Total Depth Zle �! Cased to Depth of Grouting A&A -t ocr
Static Water Level Z4L* t* Pump Set At z ee �r
Casing Height Above Ground — Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) _)!fg.4 Depression Around Wellhead (Y/N) - /ovz)
Separation Distances from Well:
To Septic/WekI4"n-T-drrK--un Lot ; On Adjoining Lots / P'p ""4 -
To Nearest Edge of Absorption Field on Lot On Adjoining Lots AV do
To Nearest Public Sewer Line N104- To Nearest Public Sewer
Cl eanout/Man hole A104 To Nearest Sewer Service Line on Lot
Water Sample Collected by AKZA(O�AE —;Date /_zr5_JfW0
Water Sample Test Results :074-r-1 6A--A-e__77&Av, e
Comments W_4rAz- "^rI4 k9,r=AA:;1 AeV&f AZELx. oZ,,Peot.
B. SEPTIC/HOLDING TANK DATA
Date Installed 4 zg�tcrSize oe,94-4 P No. of Compartments It
Standpipes (Y/N) k�525 Air -tight Caps (Y/N) Z Ao6 0:6.1 Foundation Cleanout (Y/N) V-16 :r?
Depression over Tank (Y/N)
Date Last Pumped Al&"'a
Pumping/Maintenance Contract on File (Y/N) Uk I ; for
Holding Tank High -Water Alarm (Y/N) o" - Temporary Holding Tank Permit (Y/N) IVA
Separation Distances from Septic/Holding Tank:
To Water -Supply Well — /P,6* To Building Foundation
x S. It EZ
To Property Line To Disposal Field 4 -
To Water Main/Service Line IVA To Stream, Pond, Lake, or Major Drainage
Course 6ZffA7-.,5R_ Ape
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design err
Date Installed Length of Field
4
Width of Field Depth of Field n=MtA�
Gravel Bed Thickness J7 7,-o S
Square Feet of Absorption Area 5.eAl — Standpipes Present (Y/N) k�e
Depression over Field (Y/N) A& i Date of Last Adequacy Test 12!�,&,o A AZe.r A&Clg�
Results of Last Adequacy Test N—RAzoE
Separation Distance from Absorption Field:
To Water -Supply Well 111X� To Property Line
To Building Foundation To Existing or Abandoned System on
Lot /VA On Adjoining Lots ^/,g ,
To Water Main/Service Line A44 To Cutbank (it present) A��A/,E
To Stream/Wond/Lake/or Major Drainage Course 71 -
To Driveway, Parking Area, or Vehicle Storage Area 210
Comments
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)
"Pump Off" Level at
— Vent (Y/N)
. Pumping Cycles during Adequacy Test. Meets MOA
Check Permitted Bedroom Rating Against HAA Request
I certify . that I have checked, vjified, orcon ormed to all MOA and HAAguidelines in effect on thedaM'�RftVipection.
-P�e OF A� tjh
Signed 44,Z"44,4.a"2Date t,4e 2,05 1996 .my Af V�
r
Company AAU44" 45;� MOA No. -57-04- —�74104r- 0
Receipt No. 00�� 0 �10 *14
Date of Payment
KI R. Barn d
JJpS,)ejs%eaI-
Amount:$ �7b(o3j
Page 2 of 2
72-026 (11184)