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Home My WebLink AboutASPEN HIGHLANDS #3 BLK 3 LT 11Aspen Highlands #3 Block 3 Lot 11 #017-013-75 Municipality of Anchorage ;~! .�., Development Services Department • ° Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-8850 Page /of www d.anchorage.sk.us (907)343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW050378 PID Number. 017-013-75 k. Scott Irvin & Susan Heverling Wastewater System: ❑ New B Upgrade Aadteae 13141 Midori Dr., Anchorage 99516 ABSORPTION FIELD Plies N,~ofBedo 3 17DmpTrwd MSnNb«`fwdhoBed ❑Maaq 1300— LEGAL DESCRIPTION Sod Rabg 0.8 Total Depth dam aged! Fade GpO/Fir N=4.4/M=4.5/S=4.5 Fl. ens 3 La 11 am�aprt Hihlands#3 Aspeng Depth, b ppe 1,ottmmn*V"gede G," depth benaadl ppe N=2.4,1=2.5/S=2.3 F,. N•2.00a=2.015.2.16 Ft Toeehp Range sec9at Fe addad eewe o ginN grade Gr" Lerath: N=2/M=O/S=O Ft. N-201M-20/Sa40 Ft Well: [INew E]Upgrade OmN wam 5.0 NumMr D=Desna beg tNre FL 3 10'+ FL G4W came Wmale. A, B, h T" De{e ceeed b Total eppo« e«a . Pp MaWel Fe. Ft 4� N 1.25'PVC c,,W Dete DnW supe Water WN Install«: Miller Services DetelrutalW 10/11/05 Ft v.a"Seta ca«rg1NgMAe GMM 6)(D/p_45D'8 TANK GPM FL Ft SEPARATION DISTANCES ❑ septic []Holding EI S.T.E.P. ❑ Other. 'ro Septic Absorption Lm Holding lublicPrOvate a *, p«Ar From Tank Field Station Tank Sewer Line Anchorage Tank 1250 GN VM 113 107 122 NA 88 Steel N«2.Nc«p• •waw 100+ 100+ 100+ NA LIFT STATION La Um 20 1 20 NA 100 G,, Anchorage Tank & Welding F«xMemn 19 14 27 NA �p W r N. 32 •Pump p r at. 22 Hgh vest« alarm a 36 b b e. C~ Dian NA NA NA NA Pimp Mab a ModN I OS120 Elect," Itepacmee Wx by MOA Curt Burgoyne Fee a V Lot line waiver to the east property line. BENCH MARK Old tank removed. Tank, all flowlines, and Loaua,ad Daaa�ppn. Top of Manhole . drainfields insulated.� t 102.099 Ft Engineer's Stamp .py. U-1 Inspections performed by: Cindy W. Ellis, P.E. Dates: 1° 10/5/05 , ' 49M 9 •d 10/6/05 Development Services Department Approval Reviewed and approved by: Date: I 'L 0'� (Raw 12No) Cin y W. E�Ilis%~ r c�•. CE•loan �D q, ssioi+is o r. ZE AS -BUILT Aspen Highlands #3 Blk 3 Lot 11 Record Drawing of Septic Upgrade Scott Irwin & Susan Heverling Parcel ID. 017-013-75 Permit No. SW050378 Cindy W. Ellis, RE February 2, 2006 Scale 1 Inch - 30 ft DEARMOUN ROAD Based upon a survey by Shane A. Holt. LS -6914 October 19, 2005 Watkins Engineering, Inc P.O. Box 110443 Anchorage, Alaska 99511-0443 Phone: (907) 349-1851, Fax (907) 349-1934 ►A A I D I C D FCO 22.5 13.4 STI 40.4 19.9 33.0 ST2 46.7 26.4 35.9 MH 48.7 28.4 37.5 MTl 1 24.8 19.3 MT2 1 1 64.1 44.0 MT3 1 1 60.6 58.7 MT4 71,1 73.6 MT5 44.8 44.4 44.1 COI 33.5 18.5 18.5 CO2 58.9 62.0 73.7 AS -BUILT Aspen Highlands #3 Blk 3 Lot 11 Record Drawing of Septic Upgrade Scott Irwin & Susan Heverling Parcel ID. 017-013-75 Permit No. SW050378 Cindy W. Ellis, RE February 2, 2006 Scale 1 Inch - 30 ft DEARMOUN ROAD Based upon a survey by Shane A. Holt. LS -6914 October 19, 2005 Watkins Engineering, Inc P.O. Box 110443 Anchorage, Alaska 99511-0443 Phone: (907) 349-1851, Fax (907) 349-1934 ►A STI FCO Dim of SEPTIC SECTIO\ N.T.S. AS -BUILT ST2 M11 1250 Gallon S.T.E.P. Tank Bim of of Aspen Highlands #3 Blk 3 Lot 11 Septic Upgrade Record Drawing Scott Irwin & Susan Heveding Parcel ID: 017-013-75 Permit No. SWO50378 Cindy W. Ellis, P.E. January 19, 2006 Not to Scale MTI old drainfield Final Grade = 99.22 - 99.7 FILTER FABRIC & 2" RIGID FOAM Top of Sewer Rock 125"0 PIPE nverl 97.01 South rent 40' Long Note: Test flole Relative Depth: 85.15 Water at: 90.85 MT3 Final Grade = 101.39 FILTER FABRIC & 2" RIGID FOAM 99.2OTop of Pipe h Sewer Rock \kKUL 1.2510 PIPE F113ER 20' Long Note: Test hole Relative Depth: 87.35 Water at: 93.05 MT4 Final Grade = tn't nit o Sewer Rock op of Pipe 1.25"0 PIPE 20' Long Note: Test Hole Relative Depth: 88.71 Water at: 94.41 Watkins Engineering, Inc P.O. Box 110443 Anchorage, Alaska 99511-0443 Phone: (907) 349-1851, Fax (907) 349-1934 1IT2 NOTE inal Grade = .61 - 99.35 mu NOTE al Grade = i - 101.55 97.91 NOTE Original Grade = d 102.21 - 102.91 9m.oL MT4 98.74 .�� OF...A.,....1 0 ?' 49111 ' CINPV W. ELLIS ' CE • 10577 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO50378 Legal Description: ASPEN HIGHLANDS #3 BLK 3 LT 11 Design Engineer: 0844 Watkins Engineering, Inc Owner Name: SCOTT IRWIN & SUSAN HEVERLING Owner Address: 13141 MIDORI DRIVE ANCHORAGE. AK 99516-3306 Date Issued: Oct 03, 2005 Expiration Date: Oct 03, 2006 Parcel ID: 017-013-75 Site Address: 013141 MIDORI DR Lot Size: 28792 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑Q Disposal Field E Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. C11-1 Date: Issued By: _f _ I rt'� Date: to b4 �Alm--Acipality of Anchorage o :71 I!I). ILI.0 I!MIIAII) • AlIfI111nIF1', (,I11tiIQ10!MI9'fiG�(1 •Telephone (!N17) 743-8701 •rat (!M17) SiafG'011 4700 nrngme Strect • Mchurnge, (llaslu, 7.4M xtTtc.munLorg Mayor Mark Bcyich Iluilding Safety Di-Osion October 3, 2005 Cindy Ellis Watkins Engineering P.O. Box 110443 Anchorage, Alaska 99511 Subject: Waiver Request for Aspen Ilighlands #3 Block 3 Lot 11 Waiver Request WR#: 050080 Parcel ID # 017-013-75 PERMIT # SWO50378 Dear Cindy Ellis: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 1.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there arc any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, tgo�all ineer On -Site Water & Wastewater Program Community, Security, Prosperity 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.anchoragc.ak.us (907)343-7904 Waiver Review Worksheet WR#: 050080 PID#: 017-013-75 HA/Permit# PERMIT # SW050378 Date Received: October 3, 2005 Legal Description: Aspen Highlands #3 Block 3 Lot 11 Engineer. Cindy Ellis Watkins Engineering P.O. Bos 110443 Anchorage, Alaska 99511 Applicant: Scott Irwin & Susan Heverling Waiver Requested: 1 FOOT LOT LINE WAIVER TO EAST PROPERTY LINE Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: X Waiver is not Granted. List Conditions or Reasons for above: ZD Date: 10/3/05 By: Joe Goodall Name of Reviewer r................e........................................ neewee.......... Rec#: 74666 Amount: $175 Date Paid: 10/3/2005 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 99519650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-013-75 Permit Number SW Property owner(s) Scott Irwin & Susan Heverling Day phone Mailing address (1) 13141 Midori Dr. Mailing address (2) Anchorage, AK Zip Code 99516 Legal description (Lot, Block & Sub'd.) Aspen Highlands, Addn.#3, Blk 3, Lot 11 Legal description (Section, Township & Range) Lot Size 28,792 Acre /Sq.Ft THIS APPLICATION IS FOR: Number of Bedrooms 3 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade (] THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. M4�1 (Signature of property ownerVor authorized agent) �l Permit Fees: Z/&o Waiver Fees: f S Cr7l Date of Payment: 9yy,,aO.S Date of Payment: Receipt Number. Receipt Number. t" 61 (Rev. 12/00) Watkins Engineering, Inc. P.0 Box 110443, Anchorage, AK 99511 (907)349-1851 cwellis@gci.net September 29, 2005 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: Aspen Highlands #3, Blk 3, Lot 11 Proposed Septic System Upgrade To Whom It May Concern: Attached please find the application and supporting documentation to upgrade the septic system for the referenced 3 bedroom house. The existing drainfield was installed in 1982 and is now surcharged. It is proposed to install a new 1250 gal STEP tank and 80 ft of 5 -wide drainfield. The existing drainfield will be retained for future use. A one - foot waiver is requested to the east lot line. The proposed design is based upon a test hole dug on September 20, 2005. There was groundwater influx at 10 ft when the hole was dug, and it was determined to be 8.5 ft below grade after 7 days of monitoring. The test hole was dug to a total depth of 14.2 ft and encountered silty sand and gravel. A percolation test conducted at 4.5 ft resulted in a rate of 6.7 minutes per inch. An application rate of 0.8 gpdV is used in the design. The soil log is attached. Proposed Soil Absorption System: 3 Bedrooms x 150 GPD/BR = Drainfield Type: Application rate: 450 GPD / 0.8 gpd/ft' _ Groundwater Level: Maximum Depth: Effective Depth: Reduction factor: Length Required: 450 GPD 5 -wide 0.8 gpd/ ft' 563 ft' required 8.5 ft on 9-28-05 4.5 ft 2.0 ft 0.70 79 ft Sewer Upgrade Permit Application for Aspen Highlands 113, Blk 3, lot 11 Watkins Engineering, Inc.; September 29, 2005; page 2 A one foot lot line waiver is requested to the east property line. In order to achieve the 4 ft separation distance to groundwater with 2 ft of effective depth, the trenches must be positioned with very little variation in original grade. A small knoll in the area of the drainfields presents a problem with maintaining a similar grade, so the trenches must be positioned to the east side of the lot. There is surface water along Upper DeArmoun Rd, 9 ft south of the lot line. Therefore, the drainfield must be at least 91 ft from the south property line. I do not believe that approval of this waiver will adversely affect the adjacent lot's wastewater needs. There are no private wells within 100 ft of the proposed septic system. I am not aware of any adverse effect that this upgrade would have on any adjacent properties' water and wastewater treatment needs. Thank you for consideration of this permit application. If you have any questions or need further information, please call me at 349-1851. Yours truly, Cindy Ellis, P.E. President \10A 4 8 I s 10 Aspen Highlapd S/D Block \ /8 �6 \ g I / / /Existing septic Sy em Aspen Highlands #3, lock 3 L-- --- / �--- iilyy�sem�nt— ---- — — — Proposed septi�y \ \ 14 na ' xisbng 3 Existing sept system Als" °Holumo \ 13ell \ 12 I UPPER�EARMOUN III \ \ limberly Mz nor S/D Plock 1 13 10 1112 II II Aspen Highlands #3, Bik 3, Lot 11 Proposed 0�OF q � 444 Septic Upgrade - Site Plan Watkins Engineering, Inc o4 _''' "''qS+�O Scott Irwin & Susan Heverling Q1 o �' Op : O q TH Parcel Il} 017-013-75 p ,C : 49 y 0 �'>f�D .............. • . 'ci r w. ELLIS : p OQ : '•. E - 10577 P.O. Box 110443 Cindy W. Ellis P.E.0 Anchorage, September 29, 2005 AK 99511-0443 ��p Scale 1• - 100' Phone: (907) 349-1851 Fax: (907) 349-1934 •,�; •.......•• '� 4o �4 •,...,...O� _moo Existing septic tank to be removed 3 drainfields proposed: and hauled away for disposal. 2@20 ft long, 1@40 R; New 1250 gal STEP tank Tees must 2 It effective, max depth 4.5. to be installed w/two outlets. be leve Use 1.25' PVC wr0.25'holes, 24.0C. INSULATED N 8905749'w 160.00' 17 Druny EASEMENT -------------------------- /1------ > - — — f M O L982 bed - to be retained Small b+ R — — _0 Knoll MT 1If lot line O waiver O requested TH#10 -30:. DECK \ 00• I \ MT 1 well radius \\ cy W PHALTDRNEw4y \\ Existing 3 BR House 1 \ n \ \ MT 10'+ to of Lu of foundation o G Lu o o � \ o 0 to Test Hole #1 Proposed 920/2005 Trenches Insulated, it F Z Organics 0.5' '2'soil°°ver Trock s Pvc ML 1.5' pe wl0.25' les, N oc I 0• sewer45, f SMI s GP la.tr 3 water �0�� DESIGN DETAILS @ 8.5' S5`apP\ 3 BR, 450 GPD a GA� O �O 0.6 gpdM ' o BOH 14.2 '40 Requires 563 ft2 + Shallow Trench S 8905749"E 160.00' 2.0 ft effective g RF = 0.70 Septic System 79 ft required Surface water to be installed per Max 5.5 ft dee2 in ditch MOA code. ------------------------- UPPER DE ARMOUN ROAD taken from Shane Hoft survey LS-6914; Sept 19, 2005 00o VV Aspen Highlands #3, Bik 3, Lot 11 Proposed Septic Upgrade Watkins Engineering, Inc. vo�Q"�'. �t 00 Scott Irwin & Susan Heverling C1 Parcel ID No 017-013-75 o.`? 49TqqH......�9•.p4 `1l.LG .......... p CindyW. Ellis, RE 4 • Nor W. ELLIS ; v P.O. Box 110443 0 •; CE . 10577 v September 29, 2005 Anchorage, Alaska 99511-0443 ODp'•.;'•.......... Scale 1 Inch - 30 ft Phone: (907) 349-1851, Fax (907) 349-1934 Municipality of Anchorage Development Services Department Building Safety Division y� OnSlte Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www. munl.org/onsite (907) 343.7904 Soils Log - Percolation Test Performed For. .Scott Irwin Date Performed: 9/20/05 Legal Description: Aspen Highlands #3 Blk 3 Lot 11 Township, Range, Section: Depth 1-I AIL- 2- 3- 4- L 2- 3- 4- 5x11/ 5- 6- 7.1 -6- 7- 8- 9- 10- 11- 12- 13- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19-1 WAS 4-15-16- 17- 18- 19- o p r34n icy - 0, 5 1115 SA UO kJA WAS GROUND WATER ENCOUNTERED? yes e IF YES, AT WHAT DEPTH? 10' L Depth to Water After 0 Monitoring? 915 E Dote: �Zto Site Plan Reading Date Gross Time Net Time Depth to Water Net Drop 1 9/20/05 2:52-3:22 30 min 6-1.0 5.0" 2 3:233:53 30 min 6-1.5 4.5" 3 3:54-4:24 30 min 6-1.5 4.5" PERCOLATION RATE 61 (minxseh"n) PERC HOLE DIAMETER a kwlee TESTRUNBETWEEN 4.5 FT AND 5.0 FT COMMENTS pesoak prior to lost. PERFORMED BY: Rocky Trainor / Cindy EllisI (�•/ uGi' if/G�-� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDE ES /I1(IN EFFECT ON THIS DATE. DATE: q,Z 8-05 MUNICIPALITY OF ANCHORAGE D[ RTMENT OF HEALTH AND HUMAN SER ,;ES ~) / '7 ~) / Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Address / ~ 3 ~ Z~' ~ ~ ~ ~/~ ~ TANK FIELD WELL Phone(s, ]Permit No. IND. of Bedrooms WELL LEGAL DESCRIPTION -- // ~ ~'~/e,~ ~, ?i/~,~ FOUNDATION Township, Range, Section AS-BUILT DIAGRAM (Show Iocabon of well, septic system, property lines, foundation, TI~ ~ ~]~ ~Z~ dr,veway, water bodies, etc.) TANKS N ' ' I Manufacturer Capacity m gallons Material No, of Compa~ments ~ ~L' TYPE OF SYSTEM ~, Depth to p,pe bottom from ~otal depth from orig,nal grade ~~~t~ original grade · Fill added ab~a original grada Gra~¢ aapth banaath plp~ Gravel length Gravel w,dth , ,~ ~ - Total absorption area Distance between lines 'Number ol ,,nesz J Sod rat,ng/z~-S8 FT P,pe materialF'/~ ~' ~ ~ ~']) '~ ~ ~ ~ ~~__ ~-' Installer Date Installed ' · ' ' , ~,¢ ~ PRIVATE ~ OTHER ~ldentifv) Classd~cat~on {A,B,C> ~ed t° / FT InstaHe~ ~ ~ Date Installed: REMARKS: ¢ Scale: ENGINEER'S SEAL , /, :~-~' cedily that this inspection was pedormed according t0 all Mumcipal and State guidelines in effect on this date: ~/~ ~/¢ ? ' Health De~admenl Approval: ~ Date: ~ (3/85) PERFORMED FOR: ,unicipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage. Alaska 99502.-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION;~-4)'7~// ~ 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (FEET) mmm m ~ COMMENTS /'"~ ~J'"/' '" ~' { ~'ERFORMED B¥~ /~5~F_,V///~&~/~,,eTownship. Range, Section: SLOPE WAS GROUND WATER ./'~ ENCOUNTERED? ., SITE PLAN S L IF YES, AT WHAT O DEPTH? p E Reading Date Gross Net Depth to Net Time Time Water Drop /~ ~ ~ /o I. /¢ ,'~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. PERCOLATION RATE /~-- , tmmuteshnchJ PERC HOLE DIAMETER , ~ ?' TEST RUN BETWEEN ~?' ~- FT AND z~, c") FT / I 6ER31FY ~HAT THIS TEST WAS PERFORMED IN DA~E: 72--008 (Rev, 4/85) 12OO West 33rd Avenue, Suite B ANCHORAGE, ALASKk, ~503 (907) 561-504(, SCALE NOIUAId S]DIA~FJS 'IVIN]~NOWAN] ]OVfJOHDNV 40 Xlt'IVdlDINN~ I ,/7g IGINEERS ANNERS JRVE¥ORS ' 'C:" S'f~"IEET. SUITE NO, 3 iiL~RAGE. ALASKA 99S03 , NE {90'7i 272.92~11 ..................... LEGAL"DE$CRIPTION~ ......... L 'r- /I SURVEY CERTIFICATION: I hereby. certily tiler I havl , rveyed P P IT II!awn' ~lld~dll'Cdbed hereon .nd tm~ovementl litualod I'hereon ecl w thin the p~'operty lines and no encroochmontl'i~Jtt. '>,~ q~lr..,, l~l~'~t~.. ~,:'-'.-+. NOTE: It is the contractor's responsibility to ch~k top of Ioundndon In rllqi~p lq ~tqlll (~1~,. lfld, building .lbq;~l.. in ;CAL.,/"= 30 3ATei __ i~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION , ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT 1PH°NE I .EW MAILING ADDRESS LEGAL DESCRIPTION I Well~.¢ .~ Absorption area Dwelling PERMIT NO. DISTANCE TO: ~ ' ~/0 ~ Manufacturor~ ~ Mater~ ~ ~o. ofcompartme~ ~ ~iq. caOacitg in ~llons Inside length ~i~h Eiquid d~th / ~)-~ IF HOMEMADE: ~ Welt Dwelling PERMIT NO. DISTANCE TO: Z ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO. ~ DISTANCE TO: ~_~ ~ No, of lines ~ Length of each~ ~line Total len~ ~°~nes Trench width~o inches Distance between lines ~ ~ ~ Top of tile tu~inish grade~/~ ~/ Material beneath tile Total effective absorption area Length Width Depth PERMIT N~. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER ' ' ' PIPE MATERIALS SOIL TEST RATING INSTALLER / R EMAR KS I ..... I APPROVED DATE LEGAL 72-013 (Rev. 3/78) M�JPJ I C PEEL I TY OF nr-4 oRF�C3E�f DEPARTMENT � HEALTH AND ENVIRONMENTAL :OTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 WL; !V EL- - FlV4E> CDr4-SITE SEWER PERt�1 I T PERMIT NO( 810734 ) APPLICANT WILLIAM H. DWIGGINS 926 W 26TH #308 265-8331 LOCATION MIDORI/DEARMOND DR. LEGAL LOT 11 ELK 3 ASPEN HIGHLANDS LOT SIZE 27792 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL EATING CSO FT/BP.)= 165 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: D>EPTF-L= 12 LE"13-r"= 42 GRFik'EL E>EF}TH= ;D -- THE 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 CIN 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). REZlDU I REE? 'SEPTIC TF=ir4F< GRELLLG7t-4S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. C 2 > I r4F>ECT 14PJS nFZERE�IJ I RELti --- 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 THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERMIT El<P I RES OECEMEER 31, 1'?S1 I CERTIFY THAT 1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IFI ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCEIS P.E ELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED:-_ IGNED:----�------- w --- _._�_✓ LICAFJT WILLIAM H. DWIGGINS ISSUED BY --- LT-J_ll -1516,00-11' -DATE--./n1&&/�K-2- V4. 0 (1 -�a Alaska Testlab ;010 "a" Street Anchorage. AIuYe !9501 % Phone (907) 2761SS1 ( Telecopicr (907) 272.5742 ) June 9, 1981 W.O. #A19800 „ Grid #2840 Mr. Hugh Gellert 406 'G' Street, Suite 2 Anchorage, Alaska 99501 Subject: Subsurface Investigation for Suitability of On -Site Sewage Disposal, Lot 11 Unit No. 3, Aspen Highland Subdivision Dear Mr. Gellert: Transmitted herein is the percolation test result and soil log for the test hole placed on the subject lot. A location sketch for the test hole is attached. The test hole was drilled on the subject lot on May 27, 1981. The test hole was located in the field and its approximate location is shown on the attached location sketch. The dril- ling was done using a Nodwell mounted, Mobile B-50 drill fitted with a solid flight auger. The drill rig is owned and operated by Denali Drilling, Inc. The drilling was.supervised and the test holes logged by Mr. O.M. Hatch, geologist with Alaska Testlab. Grab samples were obtained at five foot intervals, were visually classified, and were sealed in plas- tic bags to preserve the natural moisture content. The test hole: was drilled to a inch,. perforated PVC pipe was hole for running the perc test No groundwater was encountered on later dates. depth of 16 feet, and a 3/4 inserted to maintain an open and monitoring water levels. while drilling or when checked The percolation test was performed by filling the holes with water and allowing them to soak for 24 hours, then refilling the holes, and recording the water level at 10 minute inter- vals over a one 'hour period. The measured percolation cater based on the slowest drop over a 20 -minute period," was minutes/inch. However, we recommend a more conservative value of 10 minutes/inch, due to the silty nature of the soils en- countered. ed The system should be placed in the area of the test hole, as shallow water was observed near the front of the lot. Also, n Mr: Hugh Gellert June 9, 1981 Page 2 the system should be kept as shallow as possible. If you have any questions regarding this investigation, please feel free to call. CAB:mbldd Very truly yours, ALASKA TEST--L--A/B..__ &GALA Carl A. Bassler Geotechnical Engineer A�ppQoveed by: ) , Melvin R. Nichols, P. E. Manager - a Meldm R. Nichols No. 4113-E - e rAl R UPPER DE ARMOUN 1 TNCHz-50 FEET TEST HOLE LOCAT=ON APPROXIMATE LOCA7ION FIGURE I r� t^ Test Hole #11-3 Lot 11, Block 3 Depth in Feet From To 0.0 1.0 1.0 2.5 2.5 7.5 7.5 14.0 n TABLE A f"% W.O. ##A19800 Date: 5/27/81 Logged by: OMH Soil Description Brown Peat, (Pt), soft F-1, brown Sandy Silt (ML), trace gravel, moist, stiff, nonplastic F-4, brown Gravelly Sandy Silty (ML), moist, stiff, Np, 311+ F-4, brown Silt, moist, stiff, NP 14.0 16.0 F-4, brown Gravelly Sandy Silt, (ML), moist, stiff, NP, 311+ Set 3/4" perforated PVC pipe to run pert test and monitor water table elevation. Perc rate = 6.7 minutes/inch Recommended design pert rate = 10.0 minutes/inch. Bottom of Test Hole: 16.0 Feet Frost Line: None observed re Water Level: None observed 5/28/81 -None observed 6/8/81 -None observed Sa. Type of Dry Temp. No. Depth Blows/6" M% Sample Strength Group Unified OF 1 5, V ML 2 10" V ML 3 15" V ML Remarks: 1. Type of Sample, G=Grab, SPT = 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. 2X -1' n HELL LOG Date Drilleds-- Static Hater Level a feet Draw Down feet Tyre Material Drilled: 0 feet to S75 0 5's to 95 San 95 to 1,3 5 rock 135 to 16c) c) sa i -I to to Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 Gallons Per Minute J r Total Feet of Casing A50 ave MUNICIPALITY OF ANCHORAGE C'0T r" I,�... _.4 EWIS 1! A -/-:.UF �1M u J 1962 RECEIVED Time .. - Time "~ate :r Date Date Inspector Inspector Inspector m s jJ Conditional Approval . Co ment~ DateSewer Installed ~~ Permit No, Septic Tank Size )'~ _~ ~ · Holding Tank Size 'Soils Rating Well ~o Absorption Area Well Log Received Well to Tank ' ' APPLICANT FILLS OUT LOWER HALF ONLY Mailing. Address. ~ ~ ~ ~, ~ ~ ~c, ~ Buyer , , Address ~ ~ Lending Institution ' ' ' Phone . ( - Legal Description~ / f ~ . ~C~ ~ Typ~ pf~sld~nc~ ESlngl~ Family ~o. of ~edrooms ~ Multlpl~ Family D Other .... Wat~pply ' ~ Individual A~A~H WELL LOG. A w~ll log is required for all w~lls drilled since June D gommunlty lg75. For w~lls drilled prior to that dat~ glw w~!l depth (attach log If D Publl~ Utlllt~ ~ . available.} ~ Indlvlaual Y~ar Indivld~at Installed: · D Publlo Utility " When Oonn~ct~d to Public Utlllty; B Holdtng Tank NOTE: TH~ INSPECTION F~ ~UST ACCOMPANY ~CH ~U~ST ~EFO~ ~OC~SSlN~ CAN ~E INITI~TEO. ALASKA B,,dlROFIm[ FITAL CO[1TROL IFIC. ~nqineerincI 6 [~nuironmental Studies November 20, 1986 Department of Health & Human Services 825 L Street Anchorage, Alaska 99501 Attn: Steve Morris Re: Aspen Highland Subdivision, Block 3, Lot 11 Dear Steve: On November 19, 1986 we did an adequacy test on the subject lot. The system failed. However, there is no indication of overflowing sewage on the lot. In 1981 when the system was installed, the permit used 250 square foot per bedroom which is based on a DOWL soil test. When I inspected it I felt that the soils were slightly under rated in certain spots, so I had them increase the length of the field by 17 feet. Midori Street slopes slightly to the south and it appears with the high rain fall this year there may have been some surface drainage getting into the system. The system is still working. It takes approximate]y 55 gallons of water per day and with two people in the home it seems to be adequate for now. Our plans are to drill several testholes above the system, to run a percolation test and then to monitor for groundwater. From the use of these testholes we can probably determine if there is a hydraulic gradient. The ultimate solution of this system will either be an elevated bed system or a curtain drain to divert water away from the system or adjust an enlargment of the system. At this time I can not estimate the cost of upgrading the system. However, by the time the testing is over, within the next few months, we should have a good indication of how large the replacement system should be or what it would cost to put 'the curtain drain in around the lot. If you have any questions please let me know. Sincerely, Leroy c~ Reid Jr. ,~d~D, Civil E~gineer P.E. 1200 LUesl 33rd Auenue, Suite E~, Anchora§e, Alaska 99503,(907) 561-50/40 ALASKA B,,UIROFImeFITAL COFITIgOL Sel dlCE$, I C. I~n§ineerinq 6 I~nuironmenlol Sluaies MARIE ERCOLANO 1237 E 66TH AVENUE ANCHORAGE ALASKA 99518 SELLER-MARIE ERCOLANO 11/20/86 MARIE ERCOLANO 1237 E 66TH AVENUE ANCHORAGE ALASKA 99518 60610 LEGAL:ASPEN HIGHLAND SUBDIVISION BLOCK 3 LOT 11 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-II/19/86 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 1040 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 55 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 36 GALLONS. THE SYSTEM IS UNACCEPTABLE BECAUSE THE SURGE CAPACITY IS LESS THAN 75 GALLONS. THE SYSTEM IS NOT CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 11/14/86 THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE-ii/Il/86 A FLOW TEST WAS PERFORMED ON THE WELL. 881 GALLONS 0F WATER WAS PUMPED AT A RATE OF 4.3 GPM OVER A DURATION OF 8.25 HOURS. THE DRAWDOWN WAS 12 ' WITH A RECOVERY TIME OF 30 MINUTES AND THE STATIC WATER LEVEL WAS 128.7 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. a,.~ .-' .'- A~ '..- ':~',, ~ ..... ~', 1200 ~eSl 33~ Auenue, Suile B · Anchorage, AI~sE~ 99503 e{907) 561-5040 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION NOV 20 ~ RECEIVED 3 TOF R O M i SUBJECT Gof // p,/� a� DATE MESSAGE � SIfS�C�. OK fGG 'j461GGf IOf N -re M c� "I'kC R �L- 1 v (l/ v OtNu r_� o� ve o -7D 44VG V U n [.✓ �' J' O �ca..I •.. V c� b. -a..' �'- �b r0.fY Q.• 'l<L.1.c S.� c- � S`F ��.... f 11 p-- .. _..,_.. .. / RA�►Y Ir CG /T C. Y,s� Q� e Iv/PsP�a7 i17^rND� �NNc APs y -moo. 1 u 7 h' .._. __..,..: ... ,SIGNED DATE I/ /2o/glo REDIFOW. IS 471 SEND PARTS'I AND S INTACT - PAcarboMeos POLY PAK (50 SETS) 4P172 RT 7 WILL RE'RETURNED WITH REPLY. DETACH AND FILE FOR FOLLOW-UP 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent "'~..~ Address Day phone Day phone Day phone o Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ w 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. 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 Firm ~ ~ ~ ~,p r' ~ ~-~,~ -'~. ~-. Phone ~"7~- ~,~ !/o Address ~O ...% ~ '/~' ~ '~ 2.~ ~ Engineer's signature DHHS SIGNATURE /~' Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date ¢- -~ -¢ 7 . 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 DH HS 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. 72~25(Rev. 1/91) Back MOA~'ZI ~uN~c~^uvt ov ^NCHO~,G~ ~;,~vI~ON~N'~At S~VtC~S ~tVlS~ON Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICES ~U~ ~ 0 ~7 Environmental Se~ices Division 825"L" Street, Room 502 · Anohorage, Alaska ggS01 · (g07) 348-41 Health Authority Approval Checklist Legal Description: A. WELL DATA Parcel I.D.: o!7- Well type ~. If A. B, or C. attach ADEC letter. ADEC water system number ~/~ lO/ Log present (Y/N) , ~ Date completed I$o , ~ ~ Total depth I _~o Cased to J ,~ Casing height (above ground) ~,~' ~ Sanitary seal (Y/N) FROM WELL LOG Wires properly protected (Y/N) AT INSPECTION Date of test i0. '~O. ~'1 Static water level Well production · g.p.m. g.p,m. WATER SAMPLE RESULTS: Coliform ~ Date of sample: ~-./~, ~ Nitrate Collected by: Other bacteria N.D SEPTIC/HOLDING TANK DATA Date installed ~/~7/$"/ Tanksize /~9,,G't.2 Number of Compartments ,g.. Cleanouts(Y/N) y Foundation cleanout (Y/N) ~l~bepression (Y/N) .~ High water alarm (Y/N) ~] Date of Pumping 8/r~]q'l Pumper I/~6 '~, ABSORPTION FIELD DATA Date installed Length ~'~ Width Soil rating (g.p.d./fl2 or fte/bdrm) / 7~' System type a / ~ Gravel thickness below pipe ~ Total depth Effective absorption area a~,~ Monitoring Tube present(Y/N) ~'/ Depressionoverfield(Y/N) /~ Date of adequacy test ~'/qA '~ Results(Pass/Fall) ,7 For ,~ bedrooms Fluid depth in absorption field before test (in,); ~. ~" Immediately after~'lDgal, water added (in.): ! ~. ~ Fluiddepth ~ (ins.)Mi~n~ later: q Absorption rate = ? 4/,~ff'~ g.p.d. Peroxide treatment (past 12 months) (Y/N), ~ If yes, give date D. LIFt STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I O ~ ; On adjacent lots Absorption field on lot ~ I ~ I ; On adjacent lots Public sewer main I~/,~, Public sewer manhole/cleanout Sewer/septic service line '~' ~q-~ ' Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~-~.. ~ Property line ~' ~ ~ Absorption field Water main/service line ~.,~ Surface water/drainage ~1 I1> Wells on adjacent lots- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain / Water main/service line '> .,q. ~ Driveway, parking/vehicle storage area ~ 2 Wells on adjacent lots '~ t ~ ' Property line Fe ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal rec~c ~qi~ dt~v~tt~gts are in conformance with MOA H~ guidelines in effect on this date ~' :~ ~:' ~ ~' ~' ~ ' ~'~ Si~ature ~ ~~ Engineer's Nmn ~ ~ ~ HAA Fee $ ~'~ fro ' ~ Waiver Fee $ Date of Payment ~r/'~'c~ /'=~7 Date of Payment Receipt Number ~ 7/ ~ / ~ Receipt Number Rev. 8/95 OSS: haa.wk.doc FROM : ALASKA WATER & WASTEWATER PHONE NO. : 9073383246 Aug. 22 1997 03:45PM P1 '"'-',', ,--,,i, ~41i~'~ ............ ,,,,.,.,..,~ ,.,., ~,. SEPTIC SY//TEM ADEQUACY TEST ~PT/C SY~EM: FROM M~CIP~ ~C0~s- ~ ~ ..... :~'..," , ~ ~,. 80~ ~T~O: 175 / .... ~ ~' ~p ~ ~ o.~ ~os olliquid, ~ ' 510 salons of cle~ ~r ~rs added to ~e b~ wM]~ th~ llcui~ re,-'- :- ,' ....... '"~' - indi~l~ ~a~ the ~yst~ ~ operatl~ s~s~eto~, . TEST ~,ULT: ~,,,.m m.,, ~ ~= ~.~ of ~e H.i~ .d $~ia, ~p~enl of~ M~lcipal[~ O~otage, l~ls ~ may ~ue~s~ d~ ~ y~, ~d t~ ~ us~e at ~ f~i~ ~i ~r~d by eyS~. ~e ~ondl~ons ~e ou~ide ~c ~n~ol o~ t~ ~vg~tor of ~s ~ptic ~s~cm. We ~ not give ~y ~te ofhow l~g th{~ ~s~m will ~UoA ~aU~etorfly ~ ~m o~u~. ~1 ~e~c ~$ ~ly ~I. go~ s~s last 13-20 y~'s, othen f~it 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description LeT tl~ Location (site address or directions) e Property owner Mailing address Lending agency Mailing address Day phone Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Day phone ~ 5 - ~1~'~ 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: NOTE: Individual on-site Holding tank Community on-site Public sewer 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, Phone ,27¢-~, ?/Jo ordinances, and regulations in effect on the date of this inspection. NameofFirm -I ~/o~o-~,d Address ~..o ~ Engineer's signature bedrooms. DHHS SIGNATURE /~/ Approved for Date Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 1121 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L_~ ~ II, ~ ~ 5, ~)~, l-[;~ltl~,~./~ Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ o/~)/~ i Driller Cased to I .~O Casing height A. Well Data Wires properly protected (Y/N) Well type Log present (Y/N) '-/ / Total depth I Sanitary seal (Y/N) ~-/ FROM WELL LOG Date of test Static water level I Z- o Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot J I Public sewer main Sewer service line g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots m ~/u'-'-O Public sewer manhole/cleanout Petroleum tank ~'~ WATER SAMPLE RESULTS: Coliform ~;~ Date of sample: <~/...% / ~ Nitrate Other bacteria Collected by: "~ ~ L B. SEPTIC/HOLDING TANK DATA Date installed ~J ~/~ "7 Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size /' p'~__~ Foundation cleanout (Y/N) ]"///--¥ Alarm tested (Y/N) (~/~)/~ ~/ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Compartments '~- Depression (Y/N) Well(s) on lot ,/~0 ~ To property line ~ Z. CO Surface water/drainage On adjacent lots Absorption field ~' --/~-~ Foundation ~-~-- Water main/service line 72-026 (3/93)° Front CONTINUED ON BACK PAGE C. LIFT STATION ~//^ Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/'/~' '~/'~ 7 Length ~ ~' Width Total absorption area ~ c5 '~ Date of adequacy test ~(/~//~ Y' Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) Gravel thickness Cleanout present (Y/N) ~.,/ Results (pass/fail) //'~ for ~;~ After test ~X~ If yes, give date System type /~ ~'-J---~ Total depth //'-'--~ Depression over field (Y/N) Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1 To building foundation On adjacent lots Surface water Curtain drain On adjacent lots ~/C~ ~ Property line To existing or abandoned system on lot Cutbank d ~ vt E_ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect~o~_n the date of this inspec~on. Engineer's Name' I ~ -~ ~ ~ ~ .~ ~ u ,/~/~Lc~ ~'~ ~- L~ Date HM Fee $,,~<:~d;~ '---- Dateof Payment <~"'/~ '-~'4/ Receipt Number / I Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back 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. # O~'7- O!'~- 7~"' 1. GENERAL INFORMATION Complete legal description HAA # t I v Location (site address or directions) Property owner Mail!ng address Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: _'~ 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site v/ 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, Address Engineer's signature ordinances, and regulations in effect on the date of this inspection. NameofFirm i~'~,/ ~o,r~L.~:~.u~~ '"~L=."'- Phone St DHHS SIGNATURE Approved for /~.~;~.-/--~/~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 ( Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST I'l l]~ l~ ~ ~ IJ~; ~14 ~,~,~ Parcel I.D. Legal Description: A. WELL DATA Well type ~ Log present (Y/N) Total depth I ~C> Sanitary seal (Y/N) Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. Date completed Cased to t ~C:) FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /O ~ Absorption field on lot /1.~' +- Public sewer main N/~ Sewer service line ), 5 O ADEC water system number ' ~]3o ],~] Driller Casing height Wires properly protected (Y/N) AT INSPECTION I/. g.p.m. ~ ~ -~ ; On adjacent lots ; On adjacent lots '~ ! u-.o Public sewer manhole/cleanout Petroleum tank I'~ WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~/~ Y/f' ? Cleanouts (Y/N) y High water alarm (Y/N) Tank size /~.-O- O Compartments Foundation cleanout (Y/N) 7 '~- Depression (Y/N) I~///~. Alarm tested (Y/N) -~'/2-/~ ~- ~- Pumper Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot i ~b _~, On adjacent lots /%/t,~ Topropertyline '), ~O Absorption field ~ 10 Surface water/drainage I~ ! O Foundation Water main/service line 72-026 (Rev. 7/91) Fronl CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~///~/~ Length ~'~'"' Width Total absorption area DepresSion over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating ! 7 ~'"' System type Gravel thickness .~, I _- Total depth Cleanouts present (Y/N) Date of adequacy test ! I J t for W jf~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I ! ~-' On adjacent lots ~ /U-¢_~ Pr0pertyline To building foundation } '7 To existing or abandoned system on lot On adjacent lots ~/C~::~ Cutbank ~ O~t ,~_ Water main/service line Surface water J~ J 'O Driveway, parking/vehicle storage area Curtain drain t"l l ~ ¢fi; k'T/~>~ ~/~/~/ 6'1'¢~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effecton_thedate of this inspection. Engineer's Name ]"-~ ~i,"Z I'b~'v' ~,,.[~.,~'. "['['~1::~-- I Date N0~/ l¥, L'~'~ HAA Fee $ / ;7/:) Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION DIVISION OF ENVIRONMENTAL SERVICES 'CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL (,,)~]' 2 :~ 1987 OF ON-SITE SEWER AND WATER FACILITY REC, E IVED Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) , ..~ ~, ~ .., Locatlo~ (address .or,'~!r~tlons) (b) '~r~peny Ow. ne,' ~.,~ ':.~~' ~ Telephone: Home ~ ' ~/~ ~,i:;g' Address- "":,~ ::':~d- (d) Real Estate Companyand Agent Address ~~ - Iolophono (e) Mail the HAA to the followino address: or' Check here Id for pick up. List co~n and~~~d~one number below.~,// . · Business TYPE OF RESIDENCE Single-Family)~[ Number of Bedrooms 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. ' SEWAGE DISPOSAL Onsite~,, Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ' ' · .; -.' Page 1 of 2 72-025 (Rev 8/86~ Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, 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 Date ,/~ -,Z-/-" DHHS APPROVAL Approved for ~bedrooms by Approved ~ Disapproved Terms of Condi~ional~pproval Conditional CAUTION 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. Page 2 of 2 72-025 IRev 8/86) Back MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: uCf 2 3 1987 RECFiVED WELL DATA Well Classification Well Log Present~q) Total Depth /,5~O Cased to Static Water Level ~ /,Z,~",'7' ' Casing Height Above Ground fr ~" / Electrical Wiring in Conduit~N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot '~/I'//~'~'~¢~' If A, B, C, D.E.C. Approved (Y/N) Date Completed /O --3~'O- ~'/ Yield /~" Depth of Grouting Pump Set At Sanitary Seal on Casing(~) Depression Around Wellhead (Y{~) · On Adjoining Lots · On Adjoining Lots TO Nearest Public SeweK Lin(~ /u../_rr To. Nearest Public Sewer Cleanout/Manhole '"'J/~.. To Nearest Sewer Service Line on Lot ~'~' Water Sample Collected by /~ ~ '/Jl&'~u/ ;Date Water Sample Test Results ~/~-- '7" ~ ,~.//~;~,r'~r-,j' O, '~" Comments {J~ ~ /~J '"~'~ //-///-~' B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes~NF~'-~'? Depression over Tank (Y~_~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding, Tank: To Water-Suppl,y_Well To Property Line 'FO ,Water Ma n/Service Llne~:~ Course ~m ' /~ Comments Size Air-tight Caps,) /,~'~'~ No. of Compartments Foundation Cleanout~N) Date Last Pumped ~,'~J//~ . /~j/,~l- ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 ' 72-026 fRev 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Stratax/J Date Installed ¢~'~ ~J~"'"~' ~ ,~ __ Width of Field ~' /~"'~ Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation //~?/ Lot 7 To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course Type of System Design Length of Field ~'"5..~ Depth of Field / ~ ..-~'-~ Gravel Bed Thickness ~:~' ~'' Standpipes Presentl~) Date of Last Adequacy Test ,'~)//~ To Property Line //~ To Existing or Abandoned System on · On Adjoining Lots /0 To Cutbank (if present) To Driveway, Parking Area, or Vehicle S~$ra_ge Area --/'O'"~ Commen ;ommen D. LIFT STATION 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) Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha~ecJ~d, yerifjed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~~ ~'"~---" Date Company ,/~5 MOA NO. Receipt No. Date of Payment t b - ~ .~ ~ ~ Amount: $ I t,_'3b Page 2 of 2 72-026 fRev 8/861 Back