HomeMy WebLinkAboutTONJESS ESTATES BLK 3 LT 5Tonjess-
Estates.
Block 3
Lot 5
#051-831-06
f
MUNICIPALITY OF ANCHORAGE
s DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264A720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE NEW
PGRADE
MAILING ADDRES //) �,\' / �/ /� ��%�� ♦ f-'
LEGAL DESCRIPTION ,, ✓✓
LOCATION
%AW,SSjC. L Q ` NO. OF BEDROOMS
O>r
Well (
DISTANCE TO: rQQ
AbSorpll � a
e�,�
Dwellin
PERM f N
P:
W,
Manufacturer
M P_✓D,�
No. of arTrtpartments
to
c p. city in gallons
Z�l AmIF
HOMEMADE:
Inside length
Width
Liquid depth
_102!
DISTANCE TO:
Well
Dwelling
PERMIT NO.
SF
Manufacturer
Material
Liquid capacity in gallons
J=
DISTANCE TO:
Well
OQ �%�
Foundation L
Nearest to li t
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liuW
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{
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l
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inches
Distance nes
f
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Top of tile to finishr le
_
Material beneath tile ns.1.rZ
Total a fect;ya absorption area
o
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U
Length i
Width
Depth
PERMIT NO.
Qa o~—.
W
Type of crib
Crib diameter
Crib depth
Total el lective absorption area
W
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATE LS 3
SOIL TEST RTING
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INSTAIJUji
REMARKS �/
A
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mut r-4 I C It^tiL- I TY OF= fqt�ICF-~iRFAGE
DEPARTMENT lur HEALTH AND ENVIRONMENTAL PROTECTION
825 'L' STREET, ANCHORAGE, AK. 44501 �b
264-4720 kJoi �ca
IJELL I�rJG� CI'1—SITE '= E4JEF: PEF�7I T .$�
PERMIT NO. C 820240 )
APPLICANT SAL AIELLO P.O. BOX 2071 EAGLE RIVER 644-4163
LOCATION JESSIE LEE COURT
LEGAL LOT 5 BLJ' 3 TONGESS'EST. LOT SIZE 43560 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH Q•Dv
Q-)1.49
MAXIMUM NUMBER. OF BEDROOMS = 4 SOIL RATING CSO FTlBF:)= 125
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
C�EF'TH= 1- LE"GTH= 2�2 rF:F-fk•FE: L L�EF'TH= E_:
THE LENGTH DIMENSION IS THE LENGTH CIN 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 CIM FEET).
THERE IS FJO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIM FEET).
F:EG!U I F:EC� SEF}TIC TFiI aFP c I cE= 12!Z:; C GFiL_L_jD ,S
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 !JILL SERVE.
--- TWO c 2 I t4SF ECT I ciNE; FiF E f E:iD I REO
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 FOP. A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC IJELL.
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 THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION. \�-�
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F ERt'1 I T E: -;F' I FRIES C•ECEME3ER = 1 15+82
I CERTIFY THAT
1: 1 AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWEP:S AND I•JELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I !JILL INSTALL THE SYSTEM IPJ ACCORDANCE WITH THE CODES.
_: I UNDERSTAND THAT THE ON-SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED
AP'P'LICANT SAL AIELLO
ISSUED Bl
ao
� 7G6o
V4. 0
Mr. .Jesse L. Prince Jr. and
Mr. Tony Schaff
P.O. Box 467
Girdwood, AK 99587
4040 "B" STREET
ANCHORAGE, ALASKA 99503
(907) 278-1551
September 13, 1978
W.O. $D10766
Subject: Subsurface Information for Tonjess Acres
Gentlemen:
The recommendations which indicate the suitability of each lot
in the above subdivision•for individual waste water treatment
systems, are organized as follows:
Lot and Block
Report
Color
Numbers
Date
Code
Block 1 - All
9-11-78
White '
Block 3 - Lots 1-5
9-11-78
White
Block.2 - All
7-5-78
Blue
Block 3 - Lots 6-24
•7-5-78
Blue
Test..hole logs with accompanying reports are color coded
..'as follows:
Test Hole Report ..Color
Numbers' Date Code
26-39 9-1.1-78 White
14-25 6-28-78 Gold
1-13 5-2-78 Green
Idealized soil profiles are near the back of the 6-28-78
(gold) r01p rt. Test holes locations are shown on the
accompanying preliminary plat.
i Very sincerely,
ALASKA TESTLAB
. Mark Hansen
RMH:rb
Enclosures
APPROVED
�T-CIJIW �. ot Cn% �AS
Melvin R. Nichols, P.E.
Laboratory Manager,
I
qThe soil most generally encountered was a silty sandy gravel.
This material was quite dense and contained occasional
cobbles. Thus, it offered considerable resistance to drilling.
C Test Holes #32 and #34 did not have percolation tests run
because the holes caved in after withdrawing the auger.
i
n
cu
:u•. Jc;s�c .� Pro�'ice, Jr. and
..
Mr. Tony Schaff
,..
September 11, 1978'
Page 2
BLOCK 1
Z,f
Recommended Design
Lot # Test Hole #
Percolation Rate
1 17; 18, 260 27
28
'Not Recommended
j'
I
2 221 231 291 30
10.0 minutes/inch
3 24, 25, 31
5.0 minutes/inch
4 32
15.0 minutes/inch*
5 33
27.0 minutes/inch*
6 34
15.0 minutes/inch*'
f
7
20, 21
5.0 minutes /inch
j
BLOCK 3
f.t
1 8, 35
5.0 minutes/inch i
2 Be 36
5.0 minutes/inch
f
4
3 371 38
5.7 minutes/inch
4 38, 39
5.0 minutes/inch
539
5.0 minutes /inch
'
* We expect these values to be conservative. After the
j
absorption trench is excavated,
we recommend inspection
of the trench walls and a possible
reduction of the area
dependinq.on the soil type encountered.
Subsurface investigation was conducted on August 24-29, 1978
xt
and consisted of 14 test holes.
A Nodwell mounted Mobile
Drill B-50 rig equi¢ped with a solid flight auger was used
for the exploration: Test holes
were logged and located in
the field by Mr. T.L. Barber, geologist
with Alaska Testlab.
w
Percolation tests were performed
by Mr. Barber and Mr. T.A.
Sexton, geologists with Alaska Testlab.
qThe soil most generally encountered was a silty sandy gravel.
This material was quite dense and contained occasional
cobbles. Thus, it offered considerable resistance to drilling.
C Test Holes #32 and #34 did not have percolation tests run
because the holes caved in after withdrawing the auger.
i
of;atil
September 11, 1978
{y! Page 3
When drilling was completed a 3/4" slotted PVC pipe was
-� inserted in the hole to aid in determining the water level.
The hole was filled with water and left overnight to saturated.
..jj On returning the next day the hole was refilled with water
:d and the water level in the hole carefully monitored for the
next 60 minutes. The observed minimum percolation rates are
tabulated above.
We trust the above meets your present requirements. If you
have any questions or if we may be of further assistance,
please do not hesitate to contact us.
Very sincerely,
ALASKA TESTLAB
�Et. Mark Hans
'7 RMH: rb
�j Enclosures
APPROVED
Lw � 1 V (LivLt1LS
Melvin R. Nacho s, P.E.
ti Laboratory Manager
6�
1
I
'
,
1, • i 1,
4040 "B" STREET
ANCHORAGE, ALASKA 99503
A fT D (907) 278-1551 -
September 11, 1978
W.O. ID10766
Yl
Mr. Jesse L. Prince Jr. and
Mr. Tony Schaff ;
P.O..Box 467
+
Girdwood, AK 99587
Subject: Subsurface Investigation for Proposed '
Tonjess Acres Subdivision (formerly
ti proposed as Prince Acres Subdivision)
..Located within the SW 1/4, Section 2,
T.15N., R.1W., Seward Meridian, Alaska
Gentlemen:
j We have now completed the additional testing in Area B of,
1, the proposed project as outlined in our report of July 5,
1.978. Included with this transmittal are the following:
ITest Hole Logs Table A.:
Standard Explanatory Information Sheets 1-3
'Preliminary Plat with Test Hole
Locations Drawing 121-28
Each lot in the area investigated with the exception of
I Lot 1, Block 1, is suitable for an on-site sewage treatment
system .
One or more test holes were placed on each lot in Block 1,
(with the exception of Lot 7 which already had a suitable
test hole) and on Lots 1-5, Block 3. Six percolation tests
were performed. .The results of percolation tests are as
I follows: �+(:
Test Hole No. Minimum Percolation Rate
29 + 5 minutes/inch
31 4.4 minutes/inch
33 27 minutes/inch
'35 5.0 minutes/inch
36 3.1 minutes/inch
38 5.7 minutes/inch
Our recommendations for septic tank absorption system design
i
-values, along with the test holes upon which these values
~ , Test hole 939 Table A . WO AD10766
' Logged By: T.L. Barber
Date: 8-28-78
Depth in Feet
From To Soil Description
0.0' - 0.5' Brown Peat and Silty Sand (Pt), damp, soft.
0.5 - 16.0' NFS, brown slightly Silty Gravelly Sand (SP
to SP -SM), damp, fine and medium gra ni ed,
medium density, subrounded and rounded
particles to 3/4".
Bottom of Test Hole: 16.0'
Frost Line: None Observed•
Free Water Level: None Observed
Type of Dry
Sample Depth M8 Sample Strength Group Unified
1 5.0' G
2 10.0' G
3 15.0' G
Remarks: 1: Type of Sample, G=Grab,'SP = Standard Penetration,
U = Undisturbed.
2. Dry Strength, N=None, L=Low, M=Medium, H=High.
3. Group refers to similar material, this study only.
4. General Information, see Sheet 1.
5... Frost and Textural Classification, see Sheet 2.
6. Unified Classification, see Sheet 3.
-T
41- _
G �
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lis X57` ..2 7 OF -/-K arc
Municipality of Anchorage
-• Development Services Department
Building Safety Division
/ On -Site Water and Wastewater Program s t
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 I.D. 051-831.06 HAA # W2
2
Expiration Date: 2/ ,2/ a ��j
1. GENERAL INFORMATION
Complete legal description Lot 5, Block 3. Tonless Estates Subdivision
Location (site address or directions) 25040 Schaff Drive
Current Property owners) Chester R. Milton & Kathervn Roselle Day phone 694.8521
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
P.O. Box 770716 Eagle River, AK 99577
Day phone
Rolf Milton, Partners Real Estate Day phone 694-4994
11940 Business Blvd., Suite 202 Eagle River, AK 9
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Four(4)
TYPE OF WASTEWATER DISPOSAL:
®
Individual On-site
❑
Individual Holding tank
❑
❑
Community On-site
❑
❑
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 5 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 less than 30 days old. (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 Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 51412005
5. DSD SIGNATURE
Approved for _ 4 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other�`�tl�;�
By: �L����-r'C�L jh. 0-- 0-_ Original Certificate Date:
(Rm. 12M)
Municipality of Anchorage
• Development Services Department
Building Safety Division'
On -Site Water & Wastewater Program
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: Lot 5. Block 3. Toniess Estates Subdivision Parcel ID: 051.831.06
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 51181 982 Sanitary seal (YIN)!
Total depth _4PS ft. Cased to A0 ft.
FROM WELL LOG
Date of test 5MSH982
Static water level 320 ft.
Well production 1.04 g.p.m.
WATER SAMPLE RESULTS:
Well Log (YIN)
Wires properly protected (YIN) Y
Casing height (above ground) 24 in
AT INSPECTION
77.3 ft.
.0 g.p.m.
Coliform _k_ooioniesl100 ml. Nitrate 7.98 mg.A. Other bacteria 0 colonies/100 ml.
Date of sample: 4112005 Collected by: Stuart Gilbert
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SeotldStsel
Tank size 1,250 gal. Number of,Compartments j
Foundation cleanout (Y/N) N Depression over tank (YIN) N
Date of pumping 1211012004 Pumper J rs Pumoina
C. ABSORPTION FIELD DATA
Date installed &4811982
Cieanouts (YM) Y
High water alarm (YIN) N
Date installed SMBH982 Soil rating (g.p.dJft or ftAxfrm)125 SFA3drm, System type Deep Trench
Length 32 ft. Width 3 ft. Gravel below pipe 8 ft.
Total depth J2 ft. Ell. absorption area ;eft' Monitoring tube Y Depression over field N
Date of adequacy test _313012005 Results (Pass/Fall) Pass For 4 bedrooms
Fluid depth in absorption field before test 5�7 in. Water, addedM gal. New depth92 in.
Elapsed Time: 1.440 min. Final fluid depth L0 in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
'Pump on' level at _ in. 'Pump ofr level at _ in. High water alarm level at in.
Datum Cycles tested Meats 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'
Public sewer main WA
Sewer /septic service line >25'
On adjacent lots >100'
Public sewer manhole/cleanout WA
Holding tank WA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >S Absorption field >5
Water main WA Water service line >10' • Surface water MW
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 >110' Surface water >1W Driveway, parking/vehicle storage >2S
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION'
I certify that I have determined through field inspections and 4th
review of Municipal records that the above systems are in --
conformance with MOA NAA guidelines in effect on this date.
Engineer's Printed Name Michael E Anderson. Re
Date 51412005 4e. •.,4.' :. �i
r
HAA Fee $ Waiver Fee $
Date of Payment _ lr— rf O S' Date of Payment
.Receipt Numbers/ Receipt Number
(Rev. 12/DO)' .
Municipality of Anchorage
• Development Services Department
Building Safety Division
—� On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Health Authority Approval # HA050182
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block 3, Lot 5 of Tonjess Estates subdivision,
the well's productivity was determined to be 0.97 gallons per minute. The
minimum well productivity required by this Department (AMC 15.55) for a
4 -bedroom residence is 0.42 gallons per minute. Although the subject well
currently exceeds this minimum requirement, all parties concerned are
advised that the production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering lawns and
gardens may be required.
This advisory must be attached to all copies of the subject Health Authority
Approval.
Municipality of Anchorage
• Development Services Department
Building Safety Division
—� On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Nitrate Advisory
Health Authority Approval # HA050182
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block 3, Lot 5 of Tonjess Estates subdivision,
a nitrate concentration of 7.98 milligrams per liter (mg/L) was reported for
the property's water well sample. The Environmental Protection Agency
(EPA) maximum contaminant level (MCL) is 10.0 mg/L. Although the
subject water well sample is less than the MCL, it is suggested that periodic
testing be performed to insure the wells continued suitability. More
information on nitrates is available from the On -Site Water and Wastewater
Program, at 343-7904.
This advisory must be attached to all copies of the subject Health Authority
Approval.
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ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX
MEMORANDUM
DATE: May 12, 2005
TO: Julie Makela, P.E.
FROM: Mike Anderson, P.E.
SUBJECT: Lot 5; Block 3, Tonjess Estates Subdivision
Certificate of Health Authority Approval
We have reviewed the file for the septic system on the subject lot and have found that
at least 4 times in the past information has been submitted to the City stating that no
foundation cleanout is in place. In all cases the documentation was reviewed and
approved by the City. It is therefore unfair to expect the current homeowner to bear
the cost of a new foundation cleanout since the Certificate of Health Authority Approval
upon which he based his purchase of the lot in 1993 indicated no foundation cleanout
was in place at that time.
The septic system construction permit issued for this lot requires 32' of absorption
trench. Mr. John Kennedy in his initial inspection stated the first 27' of trench was in
place and he needed to check for the 5 additional feet on his second inspection. His
inspection report states 27' of trench, but also indicates a total absorption area of 500
square feet. Three Certificates of Health Authority Approval completed since that time
indicate the same information or 27' of trench and 500 square feet of absorption area.
The 27' length with 8' of rock equates to an absorption area of 432 square feet
insufficient for a four bedroom home based on an application rate of 125 square feet
per bedroom.
Our inspection and probing led us to believe the additional 5' of trench had been placed
and a total of 32' is currently in use. The total absorption area then becomes 512
square feet and meets the requirements of.the initial construction permit. We are
confident the system is currently capable of absorbing a minimum of 600 gallons of
water per day and is eligible for a Certificate of Health Authority Approval.
Municipality of Anchorage
Development Services Department
• +e Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Anderson Engineeri►g
Legal description: Tonjess Estates, Block 3. Lot 5
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design. _
❑ Additional soils Information needed.
❑ Water monitoring results Inadequate.
® Discrepancy in information submitted. Total length of absorption field different than 1982
inspection report.
❑ Topographic information missing or inadequate.
® Incomplete; missing foundation cleonout
❑ Incomplete; missing _
❑ Additional adequacy test information needed. _
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing. _
❑ Locations of all soils, percolation and water monitoring tests not shown. _
❑ Proposed system too deep for soils information submitted.
❑ Well log required.
❑ Omission in narrative.
❑ Insufficient fill over tank or field._
❑ Other.
Name of reviewer. Julie Mokelo. P.E.
Date: 5/9/2005
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
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
Parcel I.D. #
1. GENERAL INFORMATION
Complete legal description
HAA# 0QCO,C)aa1
ss
Location (site address or directions) "?S'z) �/o Sc m.4=- �02
Property owner
f� �
N2�o
Day phone bfr- G2�/
Mailing address
�5�yo
� �� /�2
``,Jtcain c Ae- 9%j -Z7
Lending agency
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: N
3. TYPE OF WATER SUPPLY:
Individual well X
Community well
Public water
Day phone
Day phone
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-M(R".1/91) Front MOA121
S. 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 furtherverify 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 regulation�a�ie�f -6t on %date of this inspection.
Name of Firm 20210 Donalar St. phone
Chugille,
Address
Engineer's signature
6. DHHS SIGNATURE
X Approved for
Disapproved.
Conditional approval for
Additional Comments
0
��✓ Date
%t.p b
4.
ep�C. i C6Yt�1 C. L ]'JKII • 1y 1[
bedrooms.
bedrooms, with the following stipulations:
•
Date S- 2 ¢ - 9?
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 thei r lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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.
7M5 (Ra . 191) Back MOA n1
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: lar 5-6Z 3 Parcel I.D.
�NJLr55 EST
A. WELL DATA
Well type NIVILL If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) y Date completed Driller Ll1 u in+n s
Total depth � Cased to ` P 7�Casing height r
Sanitary seal (Y/N) Wires properly protected (Y/N)y ;G
2
FROM WELL LOG AT INSPECTION b
r
Date of test o
320 ,7 2- T
Static water level �
Well flow /Sb0 �/lcf`i g.p.m. Q. Z g.p.m. rtt "' a V
C Q tn^ m
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot /o S ; On adjacent lots /007-
Absorption
007'Absorption field on lot / 05 r ; On adjacent lots
/oe7'
Public sewer main WIL Public sewer manhole/cleanout
Sewer service line /os Petroleum tank .tgAu� /ouNO
WATER SAMPLE!NZ
TS: � j 3r9�
.vrew.wi�rir+
Coliform ' 0 ^' Nitrate 3015` at�9s Other bacteria 2 a r31
Date of sample: 0, 1 -- Collected by: ----------- ---- 7_
B. SEPTIC/HOLDING TANK DATA
Date installed 01942- Tank size 1 2_SV Compartments
Cleanouts (Y/N) Y Foundation cleanout (Y/N) Depression'(Y/N)
High water alarm (Y/N) W-/," Alarm Jested (Y/N')
Date of pumping 5�/�9 Pumper SW'n+<r Aut,14txS
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
?A
Well(s) on lot /o 5- On adja�,3ntlots 1004 Foundation
To property line jo-1- Absorption fie.J 15 Water main/service line 30+
Surface water/drainage /°y+`-
A-1
72026 (Rev. 7191) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed /`'/�i Manufacturer
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (YIN)
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
"Pump off" level at
Cycles tested
Surface water
D. ABSORPTION FIELD DATA
Date installed //. - Soil rating 1153%10— System type
Length 2! Width _Gravel thickness 8 Total depth �Z
'A 3'L
Total absorption area "142 <.•4r) Cleanouts present (Y/N) Y
Depression over field (Y/N) ' A( Date of adequacy test �a3
Results (pass/fail) FA for bedrooms
Peroxide treatment (past 12 months) (Y/N) A( If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot lest Onadjacentlots lc>Oe Propertyline /,0/ -
To building foundation To existing or abandoned system on lot tib
On adjacent lots loot Cutbank� 21st Water main/service line 2»
Surface water moo s— Driveway, parking/vehicle storage area Z
Curtain drain ��ar= Kao.u,J `"
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
.:,vid R. Dayton P.E. ; ' Je A y
t•�?10 Donalar St.
Signature
Engineer's Name.
Date 1
6cvfd C CaykA, ?,u
AO. Zcs-e
HAA Fee $ 170 rCrO
Date of Payment 5 `ZO - '73
Receipt Number LIZ76!q C•7 & LT_
72-026 (Rev, 3/91) 8"k MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
D. R. DAYTON, P.E., R.L.S.
HOMEWIM2H Chugiak, Alaska 99567 (907)MVxM7
20210 Donalar 696-2417
WELL FLOW TEST
Legal Description: Lot 5, Block 3, Tonjess Estates
Date of Test: May 3, 1993
Depth of Well: 405 ft.
Static Water Level: 72'
Driller: Jay Williams Drilling Co,
Test:
The well was pumped for 274 minutes at 2.2 gallons per minute.
Total water pumped was 603 gallons.
Drawdown at 120 minutes was 1431. Measurements after 120 min.
were not possible as the depth probe wire tangles with the pump
wires and drop pipe at this point.
Results:
The well is currently producing adequately for a 4 bedroom home.
C314i � is wili'• : , :�I
D. R. DAYTON, P.E., R.L.S.
H0.171KORM29 Chugiak, Alaska 99567
20210 Donalar
ADEQUACY TEST
Legal Description: Lot 5, Blcok 3, Tonjess Estates
Date of Test: May 3, 1993
Septic Tank: 1250 gallon, 2 compartment, steel tank
(907) EMMU
696-2417
(DHHS Records)
Absorbtion System: 3' wide x 27' long x B' effective depth trench (DHHS Records)
Soils Rating: 125 sq. ft, per bedroom (DHHS Records)
Requirements: 4 bedroom - 600 gallons per day
Test:
600 gallons of water were injected into the absorbtion trench
with a rise in the liqiud level of 0.30'. After injection was stopped,
the liquid level dropped to the original level within 10 minutes.
Results:
The absorbtion system is currently functioning adequately for
a 3 bedroom home.
vi` A
fIf'r y dpi
Ccykl Il Cara
Na =a.t
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES a
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
Parcel I.D. # C)L — (Mlk — IC n HAA # Q QS 1 r1,'4 %A Q
1. GENERAL INFORMATION
Complete legal description Lot 5• Stock 3• Tonjee6 Es#atee
Location (site address or directions) 25040 SchaAA D i.ve
Property owner Sat Uaf fa Day phone
Lending agency Day phone
Mailing address
Agent Loxi Cnowden JACK WHITE COhIPANY Day phone
Address 10923 Eante Riven Road EagCe R.iveA Ah 99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well Xx
Community well
694-5500
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 XX
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.
1
72-025 (Rw. t/91) Front MOA 121
S. 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 furtherverify 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 s & 5 ENGINEERING
— _ 01..' -
Engineer's signatufa9le River, Alaska 99577
6. DHHS SIGNATURE n (T'-
� Approved for bedrooms.
0
Disapproved.
Conditional approval for
Additional Comments
Phone 10� Z97�
A
Date (o/ZZ/Gl
Nu. 1151s
...........
..tt
bedrooms, with the following stipulations:
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.
?1-025 (R•v. L91) ex• Moi n1
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: IAT S 1�,LAZ-3 '>prlsass I~sr Parcel I.D.
A. WELL DATA
Well type VP -IJ h&6._ If A, B, or C, attach ADEC letter. ADEC water system number �`IA
Log present(3N) V Datecompleted 5'tR-SZ Driller
�, Casedto A } —Casing IZ'r
Total depth � 9 heiht 9
Sanitary seal CSN) `/ Wires properly protected (DN) �
FROM WELL LOG
Date of test
Static water level 3Zo�
Well flow Ear. 1Soo g•p.9.
Pump level ' JK -
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 1 ac+ ; On adjacent lots \on
Absorption field on lot \'o a , Y ; On adjacent lots 1 00
Public sewer main IN Public sewer manhole/cleanout
Public sewer service line � r'" Petroleum tank •
25
WATER SAMPLE RESULTS:
Coliform d 4'~X%02•J^ Nitrate 4-L A"D�-Q Other bacteria. �� E
Date of sample: L' 13 - `► I Collected by: 5 `• S 6.Ja/.J E SG...I y
B. SEPTIC/HOLDING TANK DATA
Date Installed Tank size I ZS° Compartments 2
Cleanouts (AXI Foundation cleanout 0:9) � Depression p(®j
High water alarm oz) N Alarm tested (* #r
Dateofpumping L'1a'�il 5y— LFss?60� por+P14"
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlot 1oa 4- Onadjacentlots 1 ofl�-*_ Foundation
To property line Ir> �t- Absorption field 'S1 Watermain/service line 1t7� t
Surface water/drainage 10 d ` r
72-026 (R«.3191) From MOA 21 CONTINUED ON BACK PAGE
AT INSPECTION
V -IS -91
rn
c
��
Z
z�
73'
m
tv
I.b.r
g.p.m.'C
co
m
_
o'
Z
WATER SAMPLE RESULTS:
Coliform d 4'~X%02•J^ Nitrate 4-L A"D�-Q Other bacteria. �� E
Date of sample: L' 13 - `► I Collected by: 5 `• S 6.Ja/.J E SG...I y
B. SEPTIC/HOLDING TANK DATA
Date Installed Tank size I ZS° Compartments 2
Cleanouts (AXI Foundation cleanout 0:9) � Depression p(®j
High water alarm oz) N Alarm tested (* #r
Dateofpumping L'1a'�il 5y— LFss?60� por+P14"
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlot 1oa 4- Onadjacentlots 1 ofl�-*_ Foundation
To property line Ir> �t- Absorption field 'S1 Watermain/service line 1t7� t
Surface water/drainage 10 d ` r
72-026 (R«.3191) From MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed .
Size in gallons
Vent(Y/N) _
High water alarm level
Meets MOA electrical
Well on lot
Manufacturer
Manhole/Access (Y/N)
—"Pump on" levet at
FROM LIFT STATION TO:,
D. ABSORPTION FIELD DATA
On adjacent lots
Cycles tested
off" levet at
Surface water
Date installed' Soil rating (ZS �a c- System type nreo-Irlie-/
Length '27( Width 3• Gravel thickness B Total depth 7-
Total
Total absorption area Sao �Cleanouts presentd9N V
Depression over field (Y/C4 ^J Date of adequacy test 18 -9 /
ResultsdUEei PASS for 60 F;ur
bedrooms
Peroxide treatment (past 12 months) (Xj� U!L If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot tc�01+ On adjacent lots look; Propertyline- 1ok
To building foundatiori1�1 To existing or abandoned system on lot
On adjacent lots 30k� Cutbank 2�k - Water main/service line t b�+
Surface water 1 0C> Driveway, parking/vehicle storage area l b�
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
S e. 5 ENGINEERING . 1 � �
Signature 17034 Eagle River Loop Road No. 204
Eagle River, Alaska
Engineer's Name
Date A Z_ A? /
�E OF 'N
i ctP x �'•v �S,f� �i
L'`�
/• ... caw«Iu•
� � w
`•: •.: .............•pC
f,• No. 14S7•E �F
-•..wwa.�
HAA Fee $ Waiver Fee: $
Date of Payment ( Date of Payment
Receipt Number %/ 8 �� Receipt Number
72-M (Rw. 191) Back MOA 21
f^ 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
2644720 �%'p�S• i
Application Date -f
1. GENERAL INFORMATION
(a) Legal DeVription (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name.2 //!e� - Telephone: Home As!Z4 APIf BBu§T- ess BOG ZSJ
Applicant Address �o /�� n 7-7 "� �4-'�6�1 "
(c) Applicant is (check one): Lending Institution O ; Owner/builder; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution
Address
(e) Real Estate Company and Agent
Address
Telephone
Telephone
(f) .Mail the HAA to the following address:
5 & S Engineering
SBB 196x
,2' !75= -
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
Number of Bedrooms
3. WATER SUPPLY
Individual Well Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
I Onsite Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-025(11,84)
Page 1 of 2
5. ENGINEERING FIRM PROVIDINU INSPECTIONS, TESTS, FILE SEARCH, DAn AND INFORMATION '
AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulat11 ions in effect on
the date of this inspection.
Name of Firm C e, F alneerinn Telephone
SRB 196x
Address age �v 9 r
Date i Z �'� — B v
A1 -4
i*
....r:
4obeA A. Shafer y
No. 1457
F�PROFESSt�aP�!
6. DHEP edforAPPROVAL(
Approved for bedrooms by
Approved Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given In paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
Institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 p 118.1
n r)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
MUNI PAUTYDEPT.
O A�LIST - FEBRUARY 1984
DEPT. N L PR 284-4720
YNVIROIJMENTK PROTECTION
Legal Description: j ..... r
hpC1
UEC 2 3 4W
A. WELL DATA RECEIVED
Well Classification S' F If A. B. C. D.E.C. Approved (Y/N)
Well Log Present®N) Date Completed <-1ig- 82 Yield
Total Depth q -c19 ' Cased to 4,x21.4- Depth of Grouting _
Static Water Level s7-0 - Pump Set At
L) IL
Casing Height Above Ground 30 Sanitary Seal on Casing (2)N)
Electrical Wiring in Conduit (YIN)
Depression Around Wellhead (Y(®
Separation Distances from Well:
To Septic/Hakli" Tank on Lot t oc�1 ; On Adjoining Lots
To Nearest Edge of Absorption Field o Lot I L �1 a" ;On Adjoining Lots
To Nearest Public Sewer Line a 1 r. To Nearest Public Sewer )
CleanouVManhole To Nearest Sewer Service Line on Lot ZS '4 -
Water Sample Collected by 5 i S &%tetbf t-+• Date 17- -\q - BS
Water Sampl
Comments
B. SEPTIC/G TANK DATA
Date Installed 13 ^ la- S?-6ize (ZSo No. of Compartments 7 -
Standpipes
Standpipes CVN) Air -tight Caps CDN) Foundation Cleanout (Y&
Depression over Tank (Y® Date Last Pumped 7-c>-
Pumping/Maintenance Contract on File (Y/N) 1A for
a A
Holding Tank High -Water Alarm (Y/N) a A Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/I folding Tank: t
To Water -Supply Well t may-^ Imo- To Building Foundation
To Property Line lC' t'F' To Disposal Field
5 r
�}
To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page t of 2
72-026(11164)
a0.
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 12.5 _1IFsti Type of System Design -150-0= ,3 a a
Date Installed e - l P6 82I
Length of Field 'L�
Width of Field .3Depth of Field 12. I
/
Gravel Bed Thickness 13
Square Feet of Absorption Area 45C04- Standpipes Present(ION)
Depression over Field (10) Date of Last Adequacy Test t - 7 - - R
Results of Last Adequacy Test S/S t'1S:�O .
Separation Distance from Absorption Field:
To Water -Supply Well ( `L01y To Property Line
To Building Foundation
Lot a
On Adjoining Lots
— To Existing or Abandoned System on
3 o ra'
To Water Main/Service Line 1 o I -I,- Tp Cutbank (if present) 20 r -t
To Stream/Pond/Lake/or Major Drainage Course �A
7
To Driveway, Parking Area, or Vehicle Storage Area _ 10
Comments
D. LIFT STATION
Date Installed
Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at .,Pump Off" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Check Permitted Bedroom Rating Against HAA Request ••
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed S A s I: �ip�j� Date
Company6 19Qx I a MOA No.
Receipt No. ? (o -113
Date of Payment %a -
Amount:$ tbs%oo
Page 2 of 2
72-026 (1144)
OF qh at e
WMn A. ShAw w.
(le. 14574 r�
/1Rn e.n e�nll• ..