HomeMy WebLinkAboutGRANITE VIEW #1 BLK 10 LT 1J
Granite View
#1
Block 10
Lot 1
#014-302-42
`UGH
_
.�,,,„ D,£.G, GRE*" ER ANCHORAGE AREA BOf
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME F,�A/Y.E-l'/r /'y'9/0/y,0MAILING ADDRESS 1315 (:l/e/TOT PHONE *x/78
LOCATION A613 OTT LEGAL DESCRIPTION
SEPTIC TANK: ,/S. T
CSMATERIAL
DISTANCE �'/ Svase% A1�AS1tC-- COMPARTMENTS
NUMBER OF
FROM WELLB���� _� MANUFACTURER
INSIDE LENGTH INSIDE WIDTH — LIQUID DEPTH — IQUID CAPACITY 1000 GALLONS.
SEEPAGE PIT:
NUMBER OF PITS I DIAMETER OR WIDTHLL, LENGTHLL, DEPTH
LINING MATERIALfty-CDR CRIB SIZE: DIAMETER9--DEPTH—ILDISTANCE FROM: WELL %
n�
,,,,>� TOWL EFFECTIVE
BUILDING FOUNDATION.2 NEAREST LOT LINE rz_. ABSORPTION AREA (WALL AREA)?C^ SQ. FT.
ADDITIONAL ABSORPTION
WELL -
TYPE
TYPE DRAW CONSTRUCTION DEPTH � DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LINE , SEWER LINE , TANK , SYSTEM
CESSPOOL , OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES: DIAGRAM OF SYSTEM
INSTALLEDBY: Sr/,r
PIPE MATERIAL: C45 2:er/✓
LOT SLOPE: A44
REMARKS: -Co. / CRF 7- �� N
oti /y io Pl Ps r //, s-' /9,5
C/1 /s klow M,s S7x-474
r, %o Jv i Srz E t4e.
S.P7.c. %.avk- ""d n/v Ga
pl4cEe T.ir. /Oo'/leyvr,va�rrnT
Wdl' ox y,ivn / o
pa�zn,iTitS�E� T
,rev /9L
E
DATE
G.A.A.B.
Form No. EQ -031
GREATER ANCHORAGE AREA BOROUGH
OlGlil
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT No.
3330"C"STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4361
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT l L MAILING ADDRESS J J I PHONE
INSTALLATION LOCATION
LEGAL DESCRIPTION J JP7
INSTALLATION OF: SEPTIC TANK Lei SEEPAGE PIT l'� DRAIN FIELD OTHER
~ :.
TYPE AND SIZE OF FACILITY TO BE SERVED -��.�
FINANCED THROUGH
TO BE INSTALLED BY
SOIL TEST RESULTS "' NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED V / I )41,
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE ' J TYPE ' ' SEEPAGE AREA SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM
FOUNDATION TO SEEPAGE PIT )(j , DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE PIT J DRAIN FIELD
TO NEAREST LOT LINE.
i
WELL TO SEPTIC TANK /' ', SEEPAGE PIT
DRAIN FIELD ':1 ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK—,L11 / SEEPAGE PIT
DRAIN FIELD I r,'
SEPTIC TANK, �', SEEPAGE PIT ' DRAIN FIELD
Ji
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION
G.A A.B.
OR
LICENSED DESIGNER
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE
FORM NO.EO-0t6
APPLICANT'S SIGNATURE
GREATER ANCHORAGE AREA BOROUGH
.i.: Depa,:,Tent of Environmental Quality
/- 3330 "C" Street
Anchorage, Alaska 99503
Perfor-.2d for Mr. Frank Malone Date performed Sept. 13, 1974
� k 10 C it Vi Subdivision
Legal Descrlpt on: Lot 1 Bloc rana Vie
Reading I Date Gross Time I Net Time I Depth to H2O Net Drop
Percolation rate minute
Proposed installation: Seepage Pit— ' ... Drain Field ...
Depth of Inlet 1' Dept to bottom of pit or trent An oro 51
COMMENTS:( Per ciient s tair, w/ Boro, and'to avaoid exceccive denth.can tiro tn, St
(' 4.5' x 150 = 0 c. o£ surface ar a of pit reconmenr uer bedroom.
Performed By: / Certified 6y:Date:
J�, Ps_
.
'this
form reports::
of s
log x
erco atior. test
Depth
Feet
—
— y
— 275 Org. silt
2
3 :.
4.51 Sp
'. Sand
with some silt
— 150.
4—--
1.01 Sm
Organic
Silt'in Sand
250
1-51- Ch
clay
350
7—
8 —
1.0l Sp
Sand
150
9 —
'Sand
.0
10 —
2.0 E
and Gravel
125
12 _...
%
13 —
14 —
Has'ground
water
encountered?
ITO
If yes,
at what depth?
Reading I Date Gross Time I Net Time I Depth to H2O Net Drop
Percolation rate minute
Proposed installation: Seepage Pit— ' ... Drain Field ...
Depth of Inlet 1' Dept to bottom of pit or trent An oro 51
COMMENTS:( Per ciient s tair, w/ Boro, and'to avaoid exceccive denth.can tiro tn, St
(' 4.5' x 150 = 0 c. o£ surface ar a of pit reconmenr uer bedroom.
Performed By: / Certified 6y:Date:
J�, Ps_
n
DEPT. OF ENVIRONMENTAL CONSERVATION
SOUTNC£NTRAL REGIONAL OFFICE
September 27, 1974.
Mr. Les Bucholz
Dept. of Environmental Quality
Greater Anchorage Area Borough
3330 C Street
Anchorage, Alaska 99503
r
WILLIAMA EGAN. GOVERNOR
3380ENALISTREEr
MACW BUILDING-ROOMB50
ANCHOR4G£B0501
SUBJECT: Lot I, Blk 10 -Granite View Subdivision (Franklin Malone)
Dear Mr. Bucholz:
This department has no objection to the placement of the septic
tank and seepage pit as indicated on the "Inspection Report on On -Site
Sewage Disposal System" covering the subject installation.
Yours truly,
VKyI Cherr P.E.
Y
Regional Environmental Engineer
^�b/D GREATEL ANCHORAGE AREA :~JROUGH
1' HEALTH DEPARTDIENT
327 Eagle St. Anchorage, Alaska 99501
279.2511
SEWAGE DISPOSAL SYSTEM - APPLICATION A PERMIT
Case No. -LL
C del d"�/'V9
NAME OF APPLICANT /fro �rC'-'F, '^' / �' I^ "'" MAILING ADDRESS ��� �/� ^ PHONE NO.
RESIDENCE ADDRESS �f`'"•r. LOCATION OF INSTALLATION �T}"^ 1 �' �•<���� IJIJi�:
LEGAL DESCRIPTION ��
APPLICATION TO INSTALL: SEPTIC TANK SEEPAGE PIT '� , DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY ' '/^ ^ ""1'
FINANCED THROUGH �� TO BE INSTALLED BY
PERCOLATION TEST RESULTS /' %f ANTICIPATED DATE OF
COMPLETION
—
0
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT ` ' / /`
;1,1it>/' ,PERMITTOINSTALLAi� i
THIS IS TO SERVE AS ,
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
SEPTIC TANK SIZE TYPE SEEPAGE AREA nr TYPE
DIAGRAM OF SYSTEM Iry
DISTANCES: P"IItj
7- 10c,11
,Health Authority
■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
I ( j
DATE
Z5 /1D/f^ APPLICANTS SIGNATURE 4-
/I/-°/''�'^
Municipality of Anchorage
�` ••�•��pp}���yry--°, Development Services Department
Building Safety Division
on -Site Water & Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.anchorage.ek.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING I��/i��I
Parcel I.D. 014-302-42 HAA# oqc
1. GENERAL INFORMATION Expiration Date:
Complete legal description GRANITE VIEW
SUBDIVISION N1 •
LOT 1 BLOCK
10
0
Individual On-site
❑
❑❑
Location (site address or directions) 3106
SOUTH CIRCLE
• ANCHORAGE
AK • 99507
Community Class Well
13
Community On-site
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
ALLEN dr SHARON BRITTNER Day phone c/o AGENT
c/o AGENT
Day phone
JANET BORDERIEUX w/ DYNAMIC PROPERTIES Day phone 244-5436
3111 'C' STREET • ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
❑
❑❑
Individual Water Storage
❑
Individual Holding tank
Community Class Well
13
Community On-site
0
Public Water System
❑
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water samples. (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 AuthodtyApproval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system ls(aro) 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 Finn GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 6 Regulations. The reported results described the performance of the
System under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational lire of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions ere outside the control of the evaluator of the system. Satisfactory test
results do not guarantee lutum performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit or the ownerlisted above. Any reliance upon or use of this report by any
otherperson orparty Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
�SL Approved for� bedrooms.
Disapproved.
Conditional approval for
Attachments:
bedrooms, with the
Phone 337-6179
Date tI Zg v
1�ttnlY OF
•,
W11
V IY-JI 1 t -
WATER AND
PROGRAM
HAA Checklist �_ Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
Original Certificate Date:
IR«. 1zvil
Municipality of Anchorage
Development Services Department
BuildYp Safety DNbbn
On -M water & Wastewater Program
4700 South Bragaw SL
P.O. Box 198850 Anchorage. AK 9951945SW
www.clAnc orageA k.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: GRANITE VIEW SUBDIVISION it: LOT 1. BLACK 10 Parcel ID: 014-302-42
A. WELL DATA
Well" MWAX If A, B, or C provide PWSIO# N/A
Date completed UNKNOWN Sanitary Gael MINI) .YE .
Total depth 47+ ft. Cased to 40+ ft.
FROM WELL LOO
Date of test
Stats water level ft,
Well production g•P•m•
WATER SAMPLE RESULTS:
Cctiform �_ colonleaH00 ml.
Arsenic: N/A mgA.
B. SEPTICfHOLDING TANK DATA
Nitrate i t+3 mgJL.
Well Log (YM) NO
Wires pmpeM protected (YIN) YES
Casing height (above ground) 12+ in.
AT INSPECTION
3/29/2004
43 ft.
7.03 g.p.m.
Other bacterie.'&_colontesl100 ml.
Date of sample: 11/08/200 Collected by: GEG LtD.
Tank TyWMeterlsl
Tank Giza gal. Number of Compartments —
Foundation cleanout (YIN) _ Depression over tank (YIN) —,.,_
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date Installed Sall rating (g.p.dAa
Length ft. Width
Total depth ft. ER.
Date of adequacy test
Fluid depth in
Elapsed Tpeo�_ min.
Date Installed
Cleanouts (YM)
High water alar
System type
Gravel below pipe ft•
fe Monitoring tube Depression over field
„e—,o' Results (PSUMSH)
before test — In. Water added —gel.
For bedrooms
New depth —in.
Final fluid depth — In. Absorption rate s. g.p.d.
treatment (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed
"Pump on' level at in.
E. SEPARATION DISTANCES
Size in gallons Manhole/
RSP High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAdt station on lot N/A
Absorption field on lot N/A
Public sewer main •52'
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 070'
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Budding foundation Property tine Absorption
Water main Water service line Surface
Wella on adjacent lots CwER
SEPARATION DISTANCE FROM �` `Q`�G S`Vv
Property tine B oundadon Water mein
Water service lines Surface water Driveway, parkinghrehicle storage
Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have detemrined through field kWed/ons and
review of MunldPal recolds Chet the above systems are in
conformance with MOW HAA gulde0nes in effed on this date.
Engineer's Printed Name JEFFREY A GARNESS
DateWit-
��11
HAA Fee S -1 Waiver Fee S
Date of Payment Date of Payment
Receipt Number Receipt Number,
(ebv. ruoo)
0' ( S l 3„00,/-O.A S
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I
Municipality of Anchorage a •.
• j, Development Services Department
Building Safety Division ,. .
- On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519650
Uww.ci.anchorage.ok.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel IA. 014=302-42 HAA# C7 T �-
1. GENERALINFORMATION Expiration Date: 7-- Go — Q 4
Complete legal description GRANITE VIEW
SU6bKn I6N P:
LOT 1. BLOCK
10
Individual Water Storage
❑
Individual Holding tank
Location (site address or directions) 3106
SOUTH CIRCLE
• ANCHORAGE.
Ak • 99507
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
SHARON & bALE SHAW Day phone
310.6 SOUTH CIRCLE * ANCH012AGE. AK 99567
Day phone
JlWEr boR66IEUX w/ DYNAMIC PROPERTIES 'Day phone
3111 V STREET • ANCHORAGE, AK 99503
Unless otherwise iequested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
276-6407
261-7614
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
N
Individual On-site
❑
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
ElPublic
Sewer
'ii
The Municipality of Anchorage Development Services Departmdn( (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single -(amity 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 samples. (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 cerb'fied by my seal affixed hereto and as of the validation date shown below, 1 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(am) safe, functional and adequate
for the number of bedrooms and typo 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
onsite 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 GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS. P.E.
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system to accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
Iluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee Arturo performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for _ 3 bedrooms.
Disapproved.
337-6179
Date _3 t3C
4 4-
v,
i
7 .. ...............
of a A. G ess:
Q� o -7 3 d�
h:�n_ •� •••e04�
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments: /
HAA Checklisty
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
ON-SITE •;
�0-
WASTEWATER
PROGRAM...-
By:
ROGRAM.
By: Original Certificate Date: - 4-6-05
(R". 17101)
Municipality of Anchorage
Development Services Department �.> '
Building Safety Division Jo.." 's . . � ,
On -Site Water R Wastewater Program
47W South Bragaw St.
P.O. Box 196650 Anchorage, AK 995196650
www.d.enchorage.ak.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: GRANITE VIEW' SUBONISION #l1: LOT 1. BLOCK 10 Parcel ID: 014-302-42
A. WE).L DATA
Well type PRIVAlt If A, B, or C provide PWSID> N A Well Log (YM) NO
Data completed UNKNOWN Sanitary seal (YA) YES Wires piopetty protected (YM) YES
Total depth 47+ ft. Cased to 40+ ft. Casing height (above ground) 12+ In.
FROM WELL LOG AT INSPECTION
Date of test 3/29/2004
Static water level ft. 43 ft.
Well production g.p.m. 7.05 g.p.m.
WATER SAMPLE RESULTS:
Collfomi 0 c6lonies/100 ml. Nitrate ,Q_n19A. Other bacteria _ 0 colonies/100 ml.
Arsenic: N/A mbjL. Date of sample: 3 29/2604, Collected by: CEG UD.
13. SEPTICIHGLDiko f Nk LATA
Tank Type/Material
Tank size gat. Number of Compartments
Foundation cleanout (YIN) _ Oepiession over tank (Y/N) _
Dam of pumping
G ABSORPTION FIELD DATA
Date installed
Length ft.
Total depth ft. Eff.
Date of adequa6i test
Fluid depth1n abBek
Elapsed Ti mm.
Pumper
Data installed
Cleanouts (YIN)
High water alann_D dK
Soil rating (g.p.dJft''1 �G System type
WIdFl9 P Vv� ft. Gravel below pipe ft.
absorptlon ' _ ft'
Monitoring tube Depression over field
Results (Pass/Fall) For bedrooms
before test _ in. Water added _gal. New depth _in.
Final fluid depth _ in. Absorption rata x g.p.d.
treatment (past 12 mo.) (YM 6 type)
If yes, give date
D. LIFT STATION
Date installed
"Pump on' level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot N/A
Public sewer main '52'
Sewer /septic service line 25'+
On adjacent lets 100'+
On adjacent Lots 100'+
Public sewer manhole/cleanout e70'
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property Ilne Absorption field
Water main
Wells on adjacent lots
SEPARATION DISTANCE FROM
Property line
Water service line
F. COMMENTS
G. ENGINEER'S
Water service line
Surface
PuB�"\c
WER
SE
Water main
Surface water Driveway, parkingfvehide storage
Wells on adjacent lots
I certify that I have determined through field inspections and -4 "-7*
review of Munidpal records that the above systems ere in .... • .... . . """"'
conformance wRh MOA NAA guidelines in effect on this date.
Engineer's Print d N ie JEFFREY A GARNESS —7953
Date 3I3 04 Qp„'i, ro.
e�.
HAA Fee $ 14 Waiver Fee $
Date of Payment i �a �U4 Date of Payment
Receipt Number Receipt Number
(Rev. 12101)
Municipality of Anchorage .
• Development Services Department : • ■ ►�
j% Building Safety water
-- On -Site Water &Wastewater Program
4710 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.d.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 014-302-42 HAA# Ll 0 `q O r! 71G
1. GENERAL INFORMATION Expiration Date: 0'3_
Complete legal description GRANITE VIEW SUBDMSION #1: LOT 1. BLOCK 10
Location (site address or directions) 3106 SOUTH CIRCLE • ANCHORAGE,' AK
Current Property owner(s) LORRAINE SHOWALTER Day phone
Mailing address 3106 SOUTH CIRCLE • ANCHORAGE. AK 99507
Lending agency.
Mailing address
Real Estate Agent
Mailing address
Day phone
JANEr BORDERIEUx w/ DYNAMIC PROPERnES Day phone
3111 'C' STREET • ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
261-7614
TYPE OF WASTEWATER DISPOSAL:
Individual Well
IS
Individual On-site
❑
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
■
r
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (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.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1 Ico.= at, or prior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below, I verify that my
Investigation, based on procedures outlined in the Health AuthorityApproval 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 ofAnchorage riles and from my Investigation and inspection, the
on-site we ter supply and/or wastewater disposal system is(aro) in compliance with all applicable Municipal
and State codes, ordinances, and regulations In effect at the time of installation.
Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC.
I�
Address 6901 DEBARR ROAD. SUITE 2B • ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AKWWa Inc. attempted to protide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. fie operational fife of all wefts and
septic systems depend on the local softs condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AKW WC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
Me sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person orparty Is not authorized, nor will N confer any legal right whatsoever.
5. DSD SIGNATURE
Phone 337-6179
Date .
4'
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the filowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
(Rw. 1807)
AND
Manitenance Agreements '���r/��� EMS
Supplemental Engineers Reort
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On•Ska Water 6 Wastewater Program
4700 South Gragaw St.
P.O. Box 196850 Anchorage. AK 99519-6850
www.d.anchorsge.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Desaiption: GRANITE VIEW SUBDIVISION #I1: LAT 1. BLOCK 10 Parcel ID: 014-302-42
A. WELL DATA
Well type PItIVATE If A, 8, or C provide PWSIDN N/A
Date completed UNKNOWN Sanitary seal (YIN) YES
Total depth 47+ ft. Cased to 40+ ft.
FROM WELL LOG
Date of test
Static water levelft.
Well production g•p•m-
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml.
Arsenic: N/A mg./L.
B. SEPTICIHOLDING TANK DATA
Tank TypelMateriat
Nitrate 0.1 WQA..
Well Log (YM) NO
Wires property protected (YM) YES
Casing height (above ground) 27 in.
AT INSPECTION
4/25/2003
43 ft.
4.1 + g.p.m.
other bacteria 0 colordesl100 ml.
Data of sample: 4/25/2003 Coneded by: AKWWC. INC.
PUBLIC SEWER
Date installed
Tank size gal. Number of Compartments _ CI poWe
Foundation deanout (YIN) _^ _DeLess ank (YIN) _ High water alarm (YM)
C. ABSORPTION FIELD DATA
Date installed
Length ft.
Pumper
Son rating (g.p.dA br ft%dnn) _ System type
Total depth ft. Eff. absorption area _ fe Monitoring
Date of adequacy test
Results P 1)
Gravel below
over field
For bedrooms
Fluid depth in absorption field before t-^�kr• Water added gal. New depth _in.
Elapsed Time: Final fluid depth _ in. Absorption rate >= g.p.d.
venation treatment (past 12 mo.) (YM 8 type) If yes, give date
D. UFT STATION
Date Installed
'Pump on' level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot N/A
Absorption held on lot N/A
Public sewer main •52'
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 170'
Holding tank NLA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER
Building foundation Property line Absorption field
Water main
Water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water
Water service line
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Surface water
Wells on adjacent kits
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Naa JEFFREY A. GARNESS
Date &la -703
HAA Fee $ - -525. � Waiver Fee $
Date of Paymd
ent '1 '31D Date of Payment
Receipt Number 346 2A Receipt Number
(Rev. 12M)
storage
•7953
13%07/67 RED 19: 9J F.AS
i
VISTA FE.AL ESTATE INC
t
2002
VI
n v'
A189• :'E ISo,00 I
'EASi;AENT3 OF RECORD, O7HrR TKAN
I 71105C ;ItO11'N OD! TRZ
M.r FLAT, ARE NOT SHOWN tiEA:ON•
A/
1 bweby cew'/y *00 1 h..•e ,wr�nd the (ello.lna do'#'444 praperry, la/ L Batt
Ad'4tien—%:. 11 rt VKr• n at ^ r•N ra.
naordlnp Fmcind, Ala,ko, and Nat the ,•��•. �'�� 44 �d
Imn•awmenn dtuoted Ih.raen are wiNln the Property Y•N and do mar overlap at .ncrooeh ✓��,.'•• p 1tis
on the h on I lylnp adjwent Nerve, that ne i.dn.emom, on preperry /yMp adjeeent thororo r y •' t.+.}•) •. •;! ,
en:roech an the Premhn u. Ow,tba and that thoe are as roedwam lrenemLdan Ikw w ✓ tigf y t (�Lq
ether ahikle ea,emenn an cold Prop,ry eecopc n IndlWad! hereea. re•) R•r.�17S�.,,�„�'...1.•i..•
' , � � N••.'.•..1YY Y.YIYM
e►R•.: Renu Mad*," �faz.
Anchorope, Alaska- 7 Jr/R/Zr /g yt/ �, sifq •� No. U0t-S •.r'
,S l C CK r I—Or _v f j,i ✓t/A/e /93 y.1iLJI.,..� �' �o�•••• Y•.•'•'�q ',�
1 �� dGrfL:-,rat ��yti
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH i£ HUMAN SERVICESaim
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTH ITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 6 14 -' 3 o z'— 4 z- ' HAA N
1. GENERAL INFORMATION "
Complete legal description C oT- ' l0 6r2n..,1 V16,Aj S%O
Location (site address or directions) :� 106 Sot -T14 Cr C -CLE
Property owner No24 sN+r77-4 Day phone 52Z -x/338
Mailing' address SAME A3 A160 VE
Leriding agency N Day phone 1-J14
Mailing address'
Agent N2VOeJ0 `lp'i�GG } 11rc tL. Day phone ZLZ3
Address cc.J7-acs �C2)a JL
unless otherwise requested, HAA will be held for pickup.
" 3 `/
2. NU161BER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:,,�SS
J�
Individual well x
_ piUz--u? e9—
Community well
337- 6t 7'
Public water
NOTE: If community.well system, provide written confirmation from State ADEC attest -
Ing to the legality and status of system.
OF WASTEWATER DISPOSAL:
RECEIVED
4.. .TYPE
Individual on-site
APR 1 1997:=
Holding tank
- 1...
Municipali{y of Anchorage
Community on-siteDeptHealthBHumanSarvicer
-
Public sewer X
X",
NOTE: If community, wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system."'
):{25)Rw.t/V) Fwl MOA021
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 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 thi inspection.
Name of Firm Q�S� t'vc�Phone 5 �7— 6/79;
Address 84'lI 13(Lo 6E AV 4AJG4-1 7�iSo4-
�
Cl.osi.11� �+J.rCiL.E S�3r+�T-tip -Tp _.
6. DHHS SIGNATURE
x Approved for 3 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By,
ey A. Gomm
+:1.0CE-7957 _
bedrooms, with the following stipulations:
.. DateS'2'g7-
y
i CAUTION
The Municipality of q. chorage 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 e661neer iegistered in the State of Alaska The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto 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. '
r207 F( ANI)- B. MW M
Municipality of Ancborage
pPR 2 � �g97
DEPARTMENT OF HEALTH & HUMAN SERVICES R�CEI�j
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: LAT I; IBV- Ifl 62d41 -res Parcel I.D.: O 14 — 30 2-4Z
viP�AJ SIP
A. WELL DATA
Well type N t � If A, B, or C, attach ADEC letter.
Log present YM) No Date completed
Total depth i )�+ tip r'
ADEC water system number t4.0 to
Cased to Casing height (above ground)
>21
Sanitary seal (YM) � Wires properly pied (Y/N) y64
FROM WELL LOG
Date of test N l�
Static water level
AT INSPECTION
4i IZ/9$-
541
Well production 9 -P.M. �J �(�•33 1 g p.m.
TV� t3v Mw' S 6-"0
WATER SAMPLE RESULTS:/ Igo f • DR/� �Ocwv �0 62"
'4�" J1i Nitrate i e L4- � Other bacteria
Coliform ,V 0. J3 r4/0 6/1t)
Date of sample: ��4jr6l9f— Collected by:��SS
TANK DATA
Date In ed
Foundation dean /N) _
Date of Pumping
C. ABSORPTION FIELD DATA
Date installed
Length Width
Eftective absorption area
Tank size Number of Compartments _
Depression (YM) High water
Pumper
Soil
Monitoring Tube
or ft=/bdnn) System We
below pipe Total depth
Depression over field (YM)
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in orption field before test (in.); Immediately atter_ water added (in J:
Fluid depth (ins) Minutes later: Absorption rate =
treatment (past 12 months) (YIN)
72-026 (Rev. 31913)'
If yes, give date
D.
Date installed Size in
Manhole/Access (Y/N) "Pum BtTI at' _
High water alar level at- 'Datu
e
E. SEPARATION DISTANCES
`Pump air level at'
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot N /b On adjacent lots > too
Absorption field on lot NJq On adjacent lots > t oo
SIS A ('two . �el� ) Sar-4T•MGo►6>
Public sewer main i 00 Public sewer manholeJdeanout 100 dw w u 0"Arl
Sewer /septic service line 3o"+ Lift station N
DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation
Water mairdservice line
SEPARATION DISTANCE FROM
Property line
Surface water
!!nriT r1'fPi
F. ENGINEER'S CERTIFICATION
1 certify that I have dete ned t
in confbrr 7a e
Signature
Engineer's Name
Data
Property line
iurface water/drainage _
'SO
FIELD ON L
rild tion
Driveway.
HAA Fee
Date of Payment `f �� / 7
Receipt Number 71 -
72-026 (Rev. 9/gB)"
Absorption ?old
Wells on adjace ets�
_ Water mairdservice line
Ivehi a area
Wella on adjacent bts
spectlons and review of Municipal n
in effect on this data
• irwv i' Y
Waiver Fee $
Date of Payment
Receipt Number
aorQ�.(�gf � �m3 Bre
. . .p• .•
• CE -7959 �'•r
a
gat Ei a
9'. W
r
Y
f1
YF1
.�� Municipahty of Anchorage
Department of Health and Human Services
825 "L" Street
Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor
343-4744
September 19, 1997
Dean A. Karcz, P.E.
Professional and Technical Services, Inc.
4155 Tudor Centre Drive, Suite 103
Anchorage, Alaska 99508
Re: Waiver Request For Lot 1 Block 10 Granite View Subdivision, Waiver
Request Number WR970029, P.I.N. 014-302-42
Dear Mr. Karcz:
Your request for waiver of the required 75 feet and 100 feet separation from a
private well serving the subject lot to a proposed public sewer main and public
sewer manhole has been approved. The approved separations are 52 feet and
70 feet respectively.
As a condition of this approval, the attached specifications for the construction of
the sewer main and manhole shall be a part of the design package for this sewer
line extension project for any part of the collection system proposed to be within
the setback requirements of the private well on the subject lot.
This waiver approval applies to existing well and proposed sewer line separation
only. Any future upgrade to either item will require all separation distances be
met or another approval from this department.
If you have any questions of the above, please feel free to call me at 343-4761.
Sincerely,
X CW�Xa
Daniel J. Roth
Civil Engineer
On -Site Services
MUNICIPALITY OF ANCHORAGE
• Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR#t f�i�Q-1bL��i PID# 0111- SD--kja HA# Permit #
Date Received: CA , n mss. i5on
Legal Description: Lot 1 Block 10 Granite View Stbdiv;sign
Engineer: Professional and Technical Services, Tnc.. Dean A. Karel
4155 Tudor Centre Drive, Suite 103, Anchorage, AK 99508
Applicant: Granite View Group, Bill Miller, Attorney -in -Fact
Waiver Requested: Existine, well to proposed public, sewer line
(less than 1001)
Criteria: 1. Geology: Points:
A. Water Table (541) 5.3
B. Soil Sorption 3.0
C. Permeability 2.5
D. Water Table Gradient 2.9
E. Horizontal Separation 1.0
TOTAL: 14.7
2. Special Conditions: Special manholes per MASS standard.
DTLS 50-22 & 50-23 shall be used wit' -in the 1001 well rnrljus
3. Other:
Waiver is Granted: l_ Waiver is NOT Granted:
List Conditions or Reasons for above: SEE onnyc y6D
Date: /L- %7 By: Pf4AJ
Name of Reviewer
Rec #: 6x213 Amount: $ Date Paid:
Following are minimum standards typically used to protect a residential well when the
sanitary sewer encroaches into the well radius. The referenced brand name materials should
be considered as "typical" and any "or equal" product may be used upon approval of the
design Engineer. Approval to use the materials shall be by the governing body with the
delegated authority to approve sanitary sewer main encroachment into a protective well
radius. It is the responsibility of the design Engineer to prepare mitigating measures to protect
the well and submit a written request to the governing authority for consideration to issue a
well waiver.
• Manholes shall be constructed in accordance with MASS Details No. 50-22, 50-23, and
50-34 as appropriate. Pickholes shall be mortared inside an out, coat exterior with
foundation waterproofing, and wrap exterior with 8 -mil polyethylene to top of cone. All
manholes in a protective well radius shall have sealed lids.
• Sewer mains and services shall be ductile iron pipe, class 50. Pipe joints shall be
restrained with US Pipe Field LOK Gasket Systems, or equal and sealed with a shrink wrap
(Raychem 6013, or equal) to one foot minimum beyond joints. All sanitary sewer mains
and services shall be double wrapped with an 8 -mil polyethylene encasement.
rwb::r.\windows\temp\wells.da
w,+/VER R647UE5T FOR LOT / III -Ir /O 61fo lrt- VIEW Su
PER REQLAEST NUMBER W R 97002 %
IVEIq R6QuFST Fol? OW -GOT L,,ea TO )vOfVPOSEP SEWER UNE OF SO
IVEtt DArn -
7-14FRE 13 NO wFLc Loi FvR ThlE 5140TEcr t,lFLL HPwkv6R THEirr
tCW �'F SEVERnL l.F_LL LoG1 FOR ADTh<CE.vT LOTS THRT /A-�7CATB (�S�S7EA•T
isx
noo L.4eeK7 OF SOIL IC/ TAfE gREA TI{yT /,.OHLD 1pes7wICT k q?-&R,qL
�a
_nd OVEl4EA/T
or- SERT7C rAt* EPFLLLEA•T TO 7 -Ht PP)1104E s-ArER SN/Pops,
ava
rrr Tkf t.,IELL IA- Q,C6SAOn 7r A ,PE(6w7- filMf TEST IvNS ORAhAi Sri.. -A.
GWnPEA AT A RATE OF S• 33 G . P. Q . TNE,v 771E vjeo-,vp - �
%)-A 0/Ll21!I' 7Lktj Allo,/F&x SuPPL✓IAi6 TNF 1-MTE/C TU Ti+is ' "ACL
APPEARS TO FUA-fTIOA- A7 A lOAIF.*&,GP AQ"lAtT uA'OCK "4rr �P,e
lvI9rER sA7uPLE3 OF THE WELL wr9TER IAP/«7E NO PACr&RIA loe'rreloT
A,vO AVv N/TR7gTEi DE TEtTEO.
w
r
COMAMHN7Tr 5eI-EL L/ASE I A7X -
THF St'wER LltlE If dpROfoSEO T» L3E SO 7if�AY. S/Fl AAL
C"VST,futT70w 1-714L DE PCPfoRw.Ep en. T7Y£ SFw-�,p LI,,,� TO K�Tf4�}TE
50FILT7tA770^✓ OF fgwH(�E PROM TiL(E SFr,,•,Fffl LIAl E.
l^�
Pi
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p0lvr5
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AW7.3
t
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aaa
2.2
r ri r
rnllH
lvfirrR 7A cF .T oir�vr
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0 Al C L a sic.v
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4 r/Vnu
,, R,IA,C 7-07,14 &.,6'
z/
r
Wk vE c- amLe Vt Foe- Lir 1, t,ocv- 10 , G ?,t?J'Tt View �✓ P,
Po%,..t< VALVC = Z•9
b x kE ;Z.r-i Pz,-illx .b Q upi E Exls% IJELL = r
Tb.L-
X
433x
Ss' _ 'JlaK VWt SD + (/ YFq
. j5,
Weis"-
cr'eY,ii
w„ ro
�aaat/
FAaa�A
77777
B --V44 .14 ��T I�iDlC�rrEs src.�`f �1D
is l5.
TEST P: 00 La' t-W*?£S CCA`41 5074b-, (cZAIX-1
-rt) S•S
PJ1F-lT , YkWE = 3.D
JII
Fog- S l i`{ f J _ Po«c VALVE = ZS
Cr tXU- b►n! 0�0 "i
TnLr- &i4tb l CfJ - r=,)S tri A AJOi *OCST
N WC,77091
i.e. _. &JAI . FF�►1 __. 1,)F rck sw�-C r, _..
-
APrR�xt+►�!F_ C&
5-700
Po%,..t< VALVC = Z•9
b x kE ;Z.r-i Pz,-illx .b Q upi E Exls% IJELL = r
Tb.L-
X
1JIN Pfofessiona/andTechnica/setwees, INC.
4155 Tudor Centre Drive, Suite 103, Anchorage Alaska 99508 (907) 561.6237 fax: (907) 563.3813
July 10, 1997
Dan Roth
On Site Services
Municipality of Anchorage
Department of Health & Iluman Services
825 L Street
Anchorage, AK 99501
Re: Granite View Subdivision
Additional Information for Waivers
Dear Mr. Roth:
As discussed in our conversation today, enclosed please find the information necessary to
complete the criteria for Waiver Points sheet. Please note that at the time the Granite
View Group picked up the Waiver Request Worksheet they were told by Health
Department staff that the information needed to be completed by an engineer, which is
different than what you explained to me today on the telephone - that Health Department
staff needed to complete the waiver criteria.
The original Waiver Request was submitted on June 18, 1997 approximately 3 weeks
ago. This waiver is the last item necessary to obtain AWWU approval of this project.
Time is of the essence as a contractor has been selected.
PTS appreciates your prompt attention to the completion of the Waiver Request. If you
have any additional questions, please call me at 561-6266.
Sincerely,
Professional and Technical Services, Inc.
a
r E lJ
Dean A. Ka ez, P.E.
Senior Engineer
DAK:dal
Enclosures
ALASKA PROPERTYDEVELOP.IIENTSPECIALISTS
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026.001
November 6, 1996
Professional and Technical Services, Inc.
4155 Tudor Center Drive, Suite 103
Anchorage, Alaska 99508
Attention: Mr. Dean A. Karcz, P.E.
Geotechnical Investigation
Granite View Subdivision
Anchorage, Alaska
This report presents the results of the geotechnical in-
vestigation performed for the Granite View Subdivision
in Anchorage, Alaska The subdivision is on each side
of Claridge Place and north of Abbot Road as shown on
the Site Plan, Plate 1. Both a sewerline and waterline,
which will be buried about 10 feet below the surface,
are planned improvements for the subdivision.
The investigation has been performed in accordance
with our verbal agreement of October 25, 1996. The
scope of services provided has consisted of:
• exploring subsurface conditions by drilling four bor-
ings 16 feet deep in the subdivision's roads,
• performing laboratory tests on selected soil samples
obtained from the borings, and
• preparing a report that presents results of the
investigation.
INVESTIGATION
We investigated subsurface conditions in the subdivi-
sion by drilling four borings at the locations shown on
Plate 1. The borings were drilled to a 16 foot depth
with a CME 55 drill rig using hollow stem auger equip-
ment. Our engineer was on site to log soil and ground-
water conditions encountered. Logs of the borings are
presented on Plates 2 and 3. The soil has been classi-
fied in accordance to the Soil Classification System
presented on Plate 4.
CR001THFR ASSOCIATES. INC
Soil samples were obtained either by grabbing material
augured to the surface or with a 3 -inch OD split -spoon
sampler. The sampler was driven with a 350 pound
hammer falling 30 inches. The number of blows re-
quired to advance the sampler the final 12 inches of an
18 inch drive are presented on the boring logs.
Soil samples were delivered to our laboratory where
they were reexamined to verify field classifications.
Laboratory tests were performed on selected samples to
measure moisture content, percent passing the number
200 sieve size, and particle size distribution. Results of
the particle size distribution tests are presented on
Plates 5 and 6. Results of the other laboratory tests are
presented on the boring logs opposite the depth that
each sample was obtained
SITE CONDITIONS
Granite View Subdivision is on the east side of Anchor-
age at the foot of the Chugach Mountains. The ground
surface gently slopes downward towards the southwest.
The subdivision has single family residential lots
accessed by unsurfaced, two lane streets.
A glacial till deposit was encountered at all of the four
borings. It consists of a medium dense to dense, silty
gravelly sand Static groundwater was not encountered
in any of the borings.
RECOMMENDATIONS
Trench Slooes
Temporary trench slopes for the sewerline and water-
line excavations should be cut at 1: 1 (horizontal:
vertical) or flatter. This temporary slope recommenda-
tion is based on guidelines set forth in the Occupational
Safety And Health Administration (OSHA) excavation
requirements published October 31, 1989.
Sloughing may occur if the slopes are steeper that rec-
ommended. If slopes must be steeper, excavation brac-
ing or a shield can be used during pipe installation to
protect workers. The safety and maintenance of tempo-
rary trench excavation slopes should be the responsibil-
ity of the contractor.
Page I
P. O. Box 110854 /Anchorage, Alaska 99511-0854
Telephone (907) 349-2198 /Telecopy (907) 522-3885
016.001
Bedding Material
Both the sewerline and waterline should be surrounded
by bedding material, which will act as a bearing sur-
face. Bedding should extend at least 6 inches above,
below and outward of the pipe. Bedding should meet
the Municipality of Anchorage standard specification
for class C material. Bedding material below the pipes
should be compacted to at least 95 percent relative com-
paction
• Relative compaction refers to the in place dry
density of soil expressed as a percentage of its
maximum dry density established by ASTM D
1557-78 (modified proctor test)
LIMUATIONS
The subsurface conditions described in this report are
based on data obtained form the four borings drilled at
locations shown on Plate 1. Subsurface conditions en-
countered in the borings may not be representative of
soil and groundwater through out the subdivision.
We taut this provides the information you require.
Please call if you have any questions.
Yours very truly
'Sr..'Loa 6&0t�i
G. Scott Crowther, P.E.
Attachments
Plate 1 Boring Location Plan
Plates 2 and 3 Boring Logs
Plate 4 Soil Classification System
Plates 5 and 6 Particle Size Distribution
CROWTHER ASSOCIATES, INC.
Page 2
P. O. Box 110834 /Anchorage, Alaska 99511-0854
Telephone (907) 349-2198 /Telecopy (907) 512-3885
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Boring Location
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SCALE IN FEET
Refference: Site Plan by Professional and Technical Services, Inc.
Crowther Associates
Boring Location Plan
Plate
Geotechnical Engineering Services
Cranite Yew Subdivision
Anchorage, Alaska
Job No. 026.001
File No. 026001P1
Date Nov.
1996
PSA I 0
—1200=12R 0 4.8
—1200=30% G 10.6
SS 17
SS 22
SS 38
G
SS 31
PSA SS 60
—J200=395
5
17.2
10
5.7
15
8.5
6.3
7.1
6.8
5
10
BROWN SILTY GRAVELLY SAND SP—SM)
v
a
BROWN SILTY GRAVELLY SANG SM)
LOG OF BORING 1
bonded, seasonally frozen to 3.0 feet
medium dense to dense, moist below 3.0 feet
glacial till
static groundwater not encountered
Equipment
Hallow Stem Augers
Laboratory
o d
o
r iu
o o
v
o
g
z
o
Elevation
-- Date Drilled 11-1-96
Tests
N M
m
N N
c.)
v v
o
vi
PSA I 0
—1200=12R 0 4.8
—1200=30% G 10.6
SS 17
SS 22
SS 38
G
SS 31
PSA SS 60
—J200=395
5
17.2
10
5.7
15
8.5
6.3
7.1
6.8
5
10
LOG OF BORING 2
Equipment Hollow Stem Augers
Elevation -- Dote Drilled 11-1-96
BROWN SILTY GRAVELLY SAND SP—SM)
BROWN SILTY GRAVELLY SANG SM)
bonded, seasonally frozen to 3.0 feet
medium dense to dense, moist below 3.0 feet
glacial till
static groundwater not encountered
LOG OF BORING 2
Equipment Hollow Stem Augers
Elevation -- Dote Drilled 11-1-96
SS 46 3.2 I I g
Crowther Associates Log of Boring
Geotechnical Engineering Services Granite Yew Subdivision
Anchorage, Alaska
Job No. 026.001 File No. 026001P2 Date Nov. 1996
Plate
2
BROWN SILTY GRAVELLY SANG SP—SM)
BROWN SILTY GRAVELLY SAND JSP—SM)
bonded, seasonally frozen to 3.0 feet
medium dense to dense, moist below 3.0 feet
glacial till
staticroundwater not encountered
SS 46 3.2 I I g
Crowther Associates Log of Boring
Geotechnical Engineering Services Granite Yew Subdivision
Anchorage, Alaska
Job No. 026.001 File No. 026001P2 Date Nov. 1996
Plate
2
SS 47 11.4
SS 49 6.5
PSA
—1200=35% SS 50
C
5.6
5.8
PSA SS 43 6.8
—1200=32%
SS 60 7.1
5
10
15
5
10
BROWN SILTY GRAVELLY SAND SP—SM)
BROWN SILTY GRAVELLY SAND SM)
BROWN SILTY GRAVELLY SAND SM)
LOG OF BORING 3
bonded, seasonally frozen to 3.0 feet
glacial till
medium dense to dense, moist below 3.0 feet
Equipment Hollow Stem Augers
Laboratory
o
g g
s o
z^
g d
o
--
Elevation Date Drilled 11-1-96
Tests
N
m
N N
=8
'=o-
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11.3
0
1
BROWN SILTY GRAVELLY SAND SP—SM)
SS 47 11.4
SS 49 6.5
PSA
—1200=35% SS 50
C
5.6
5.8
PSA SS 43 6.8
—1200=32%
SS 60 7.1
5
10
15
5
10
LOG OF BORING 4
Equipment Hollow Stem Augers
Elevation -- Date Drilled 1-1-96
BROWN SILTY GRAVELLY SAND SP—SM)
BROWN SILTY GRAVELLY SAND SM)
BROWN SILTY GRAVELLY SAND SM)
bonded, seasonally frozen to 3.0 feet
bonded, seasonally frozen to 3.0 feet
glacial till
medium dense to dense, moist below 3.0 feet
staticroundwater not encountered
glacial till
seam of medium grained sand
static groundwater not encountered
LOG OF BORING 4
Equipment Hollow Stem Augers
Elevation -- Date Drilled 1-1-96
15
SS 61 5.2 g
Crowther Associates Log of Boring
Geotechnical Engineering Services Granite Yew Subdivision
Anchorage, Alaska
Jab No. 026.001 File No. 026001P3 I Dote Nov. 1996
BROWN SILTY GRAVELLY SAND SP—SM)
BROWN SILTY GRAVELLY SAND SM)
bonded, seasonally frozen to 3.0 feet
medium dense to dense, moist below 3.0 feet
glacial till
staticroundwater not encountered
15
SS 61 5.2 g
Crowther Associates Log of Boring
Geotechnical Engineering Services Granite Yew Subdivision
Anchorage, Alaska
Jab No. 026.001 File No. 026001P3 I Dote Nov. 1996
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES �t
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 l.D.# (III -3(-)A— L) HAA# 1���1'1Clta'1
1. GENERAL INFORMATION r!
Complete legal description )'I C' Gratt.i �
Location (site address or directions) �Pl0 b < 011 ' n
Property owner Z11-0yj 21,1:' 4 Dayphone 3 305
Mailing address
3100
Lending agency �a<<k�s�— n ' d04j °.,%_ Day phone
Mailing address—
Agent
ddress
Agent 4'ays.
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
.'Attesting to the legality and status of system.
?2-025(A..1/91) Front 1AOA N21
S. STATEMENT OF INSPECTION BY ENGINEER
in
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 re�c 0tions in effec`on the date of this inspection.
Name of Firm /dua.Z4-1
Address 40 .�> w /.1
Engineer's signature
DH SIGNATURE
Approved fo
Disapproved.
r,,3_ bedrooms.
Phone
Date Hyl % Z
f
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 orderto 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.
i
72-M(1«. 1N1) 6¢k MOA 021
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
/
Legal Description: f 11 o �� `�a L,-, .i �� Gcei Parcel I.D.
A. WELL DATA
Well type If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed
Driller
Total depth > Cased to .> 0 Casing height
Sanitary seal (Y/N) Wires properly protected (Y/N) %
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
ATI SPECTION
.Z O qoL
iM
oe
�2
n
n
co
g
41 G
M
r,,:-
g.p.m.
g.p.
G1
m 0
M
_
ao
ao
Q
ro
00
z0
G 0'
O m
Z
Septic/holding tank on lot N/A ; On adjacent lots
Absorption field on lot NSA ; On adjacent lots > ��
Public sewer main > y&0 Public sewer manhole/cleanout �> /O tJ
Sewer service line ;;, 50 Petroleum tank
WATER SAMPLE RESULTS:
Coliform Nitrate 1\1 0 Other bacteria
Date of sample: 2/� /9'2 Collected by: S � z c
B. SEPTIC/HOLDING TANK DATA/
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Tank size
Foundation cleanout (Y/N)
Compartments
Depression (Y/N)
Alarm tested (Y/N)
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot On adjacent lots Foundation
To property line Absorption field Water main/service
Surface water/drainage
72-026 (Rev. 7191) Ronk `. �.. '-' '. 'CONTINUED ON BACK PAGE
C. LIFT STATION
Date Installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
Date Installed
Length' Width
Total absorption area
Depression over field (Y/N) _
Results (pass/ fail)
On adjacent lots
I?�
Peroxide treatment (past 12 months) (Y/N)
"Pump off" level at
Cycles tested
Surface water
Soil rating System type
Gravel thickness Total depth
Cieanouts present(Y/N)
Date of adequacy test
for
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
If yes, give date
Well on lot On adjacent lots Property line_
To building foundation To existing or abandoned system on lot
On adjacent lots Cutbank Water main/service line
Surface water
Curtain drain
E. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area
i
bedrooms
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signa
Engin
Date
HAA Fee $ -� ��� _ Waiver Fee: $
Date of Payment Date of Payment
Receipt Number 3 4�B'D � 4g> Receipt Number
72 -MMR.. SNI)S�k MOA 21
�uGQ
T - SF—U FI FCILAN13 F' _ E
203 VEST 15TH. AVENUE SUITE 206
ANCHORAGE, ALASKA 99502-3904
(907) 279-3916
RESIDENTIAL WELL INSPECTION
LEGAL: Lot 1, Block 10, Granit View
LOCATION: 3106 South Circle
OWNER: Robert Smith
TYPE OF WELL: Private, Single Family
WELL LOG AVAILABLE:
No
INSTALLATION REQUIREMENTS MET:Yes
WELL YIELD FROM WELL LOG:
PUMP YIELD FROM TEST:
DATE OF INSPECTION:
Gallons per Minute
4.6 Gallons per Minute
February 20, 1992
TEST PROCEDURE: Well was pumped at a constant rate while the
drawdown was monitored with an acoustic
probe. At the beginning of the test water level was found at 42
feet below top of casing. At a pumping rate of 4.6 gallons per
minute the water cycled between 44 feet and 49 feet. A total of
800 gallons were pumped.
TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli
and total nitrogen on 2/21/92
E.Coli O. Total Nitrogen None Detected.
Max. allowable Total Nitrogen 10 mg/1.
TEST RESULTS: This well meets the requirements of the
Municipality of Anchorage.
THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE
THAN FOUR HOURS
The Municipal requirement for well flow is 150 gallons of water
per bedroom per day. This well exceed this requirement. The,
assessment of the condition of the well applies only to the
conditions as of the day tested. The flow rate may change due to
subsurface conditions that may not be observed from the surface,
and changes in the land use and other factors that may impact the
aquifer feeding the well.
O MUNICIPALITY Department
fHealth
F ANCHORAGE
• Department of Health &Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D.#- 21Yn-1-10 HAA# 6\Q29C)2LL
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, rage`)
Location (address or directions)
(b) Property owner u -yam
MoZS��— yl--JS6i
Telephone: (home)
10 Business
Mailing Address
A� cr 1 nc—
'I'losbl
(c) Lending Institution 12r1^Tµ t'l,—rZti. Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here: if hold for pick up.)
List contact person and day phone number below: .
•S'& S ENGINEERING
17n34 Eagle River Loop Road Ne 2t1vt
Eagle River, Alaska 99577,
2. TYPE OF RESIDENCE
Single -Family '� Number of bedrooms _!2
3. WATER SUPPLY
Individual Well4<' Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ❑ Public; Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Ft". 71N) Page 1 of 2
5. 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 —17& 5 ENGINEERING + 7
Telephone
Address Eagle River, Alaska 99577
Date
-V
6. DHHS APPROVAL
Approved for_ b3drooms b4Z Dat%/2
e a 9
Approved Disdpproved Conditional
Terms of Conditional Approval ILAOn7/[g-
, CAUTION • I. I.
The Municipalityof Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible forerrors oromissions
In the professional engineer's work.
72-025 (RM. 7/BB( Back Page 2 of 2
• �o�G�\off
,S
dFP,\��5� MUNICIPALITY OF ANCHORAGE (MOA)
\St 5�a • -• Health Authority Approval (HAA)
J�\L\��ey �,o� _ `.�( CHECKLIS343F4744UARY 1984
Legal Description: �-
A. WELL DATA
Well Classification If A, B, C, D.E.C. Approved (Y/N)/
Well Log Present (Ydl? `S Date Cor pleted ��1L• Yield �5_ Q EM ✓
t
Total Depth aK•✓ Cased to Depth of Grouting 7 - IZ-2F1
Static Water Level S �✓ Pump Set At J �^
N
Casing Height Above Ground 12- "4" Sanitary Seal on Casing ®N)
Electrical Wiring in ConduitON) `t Depression Around Wellhead (YM
SEPARATION DISTANCES FROM WELL:
t
To Septic/Holding Tank on Lot otic ;On Adjoining Lots
To Nearest Edge of Absorption Field on Lot —;On On Adjoining Lots L l�
To Nearest Public Sewer Line -15" To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot 21
Water Sample Collected by S �t S 1%v�G (rlfa`�'L�_ ; Date -up - 619
Water Sample Test Results'��ns—
Comments
P -r -T�1-F�s -% Mt✓ .
B. SEPTIC/HOLDING TANK DATA r(/A-
Installed Size No. of Compartments
fpip Air -tight Caps (Y/N)
Depression over Tank
Pumping/Maintenance Contact on File
Foundation Cleanout (Y/N)
Date Last Pumped
Holding Tank High -Water Alarm (Y/N) Temp
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well
'To Property Line
To Water Main/Service Line
;for
Tank Permit (Y/N) _
To Building Foundation
To Disposal Field
To Stream, Pond, Lake or Major Drainage Course
Comments �J�VtL r4l-
72- M(Rf'.7/68)Front Pagel of 2
C. ABSORPTION FIELD DATA /
Rating in Absorption Strata Type of System Design
trkstalled Length of Field
Width of
Square Feet of Absortion-Re
Depression over Field (Y/N)
Depth of Field
Gravel Bed Thickness
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well _
To Building Foundation
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
_ Statndpipes Present(Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Aban-tofued System on
On Adjoining Lots
To Cutback (if present)
To Driveway, Parking Ar a,,.or-Vehicle Storage Area
Comments 1p1v�tL
D. LIFT STATION
Datestalled
Size in G ns
"Pump On" Level a
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions —
Manhole/Access (Y/N) .
"Pump Off' Level at
Vent(Y/N) _
Pumping Cycles during Adequacy Test.
"Check Permitted Bedroom Rating Against HAA Request"
I certify that t have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
Inspection. a
Signed 5 & c SbIG(NEERING
Company 17034 Eagle River Loop Road No. 204
Hage ry , 9T
Date ? �I X
MOA No. —�c/ G73
Receipt No. c;21
Date of Payment
Amount: $
Receipt No.
Waiver Fee: e
Date of Payment
72-M (Ray.7/88) Back Page 2 of 2
ST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request:
United Bank Alaska
Mailing Address: 645 G Street
2. Property Owner:
Mailing Address:
3. Legal D•-�scription:
Franklin Malone
Phone: 276-1911/12
Phone:
Lot 1 Block 10 Granite View Subdivision
4: Single Family Residence: (XA
Multiple Family Residence: ( )
Number of Bedrooms: three
Number of Bedrooms:
5. Well System: Individual 19011 (Xi Community/Public System ( )
Permit $
Construction
Depth of Well Well Log on File ( )
Bacterial Analysis`
6. Sewage Disposal System: On-site System boo Public Utility ( )
Permit k
Septic Tank Size
Absorption Area
Installed Installer
Manufacturer
Soils Rate
7. Distances: Well to Septic Tank
to Sewer Line
to Nearest Lot Line
Nearest Lot line
Material
to Absorption Area
Absorption Area
n n �
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r-rr. C
MUNICIPALITY OF ANCHORAGE-
,� +.r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276.2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES i
i
1. Type of Inspection: \�CMRO VA FHA CONY 1
2. Property Owner: �a�Ll�4,y �::�tzs
Mailing Address: ^ \ Day
3. Name of Buyer: c� ��� • \ �L;Q4p a
Mailing Address: Day
4. .Name of Lending Institution:
Mailing Address: ;5nz7_-'�5 Pho
5. Name of Realtor or Agent:
I
6. Legal
Phone:.p77— 59 3 (MOO
v
7. Type of Facility to be Inspected: No. Bdrms.
8. Water Supply
Type of Supply: Public Utility Individual ✓
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility Individual (on-site)
If Individual, date of installation
72003(3/76)/ ✓�D
Fane Wa
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 1 Block 10 Granite view Subdivision
Comments:
0
V
Affadavit Attached: ( )
Approved:
Letter Attached: ( )
Date: 71
Department Worksheet:o
7117-
ARCA, Oj /000 2
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PLEASE REPLY TO �.1 �}l`�-( SIGNED wu-^^^
poli PM 150.w 1 4F469
DATE
SIGNED
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4S 4169 SEND PAM 1 AND 3 WITH CAPON INTACT. i
PANT] Witt NE AttURNED WITH 11101Y.
poli PM 150.w 1 4F469
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• ` ' M .,,icipality of Anchorage
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
•
PRE -INSPECTION CHECK SHEET
279-2511
4" CAST IRON SIPHON
SEPTIC PIPE WITH AIRTIGHT
HOUSE TANK CAPS❑ Crib or Log
n n �n
4— 5' •--►
MINIMUM
❑
CAST IRON REQUIRED WHENEVER LINE
CROSSES UNDER DRIVEWAY ❑
MINIMUM WELL DISTANCES:
INDIVIDUAL
TO TANK 100' ❑
TO PIT 100' ❑
NO SEWER LINE 10' ❑
PUBLIC - Under 25
Service or Less
Than 15 Connects
TO TANK 100' ( )
TO PIT 150'
75'-100' ONLY CAST
IRON SEWER LINE
PUBLIC - Over 25
Service or More
Than 15 Connects
TO TANK 200' ( )
TO PIT 200' ( )
100'-200' ONLY
CAST IRON SEWER
LINE
100' NO SOURCE OF
CONTAMINATION
NOTE: 100'MINIMUM
FROM TANK AND PIT
RIVER, LAKE OR
STREAM ( )
72-004 (4/76)
GRAVEL BACKFILL O
CRIB 4' MINIMUM ABOVE WATER TABLE ❑
6' MINIMUM ABOVE BEDROCK ❑
Individual Wel
4"
SEWER LINE ❑
CONSIDER DISTANCE TO AREA WELLS 8, SEWER SYSTEMS ❑
PIT EXCAVATION BASED ON SOIL TEST ❑
SEPTIC TANK MUNICIPALITY APPROVED O
HOUSE
INLET OUTLET MUST 5'
BE WATERTIGHT GRADE: 2' PER 100' OR
SEPTIC moo %" PER FOOT EXCEPT 10'
TANK PRECEEDING TANK AND THAT
SHOULD NOT EXCEED 215 O
H 6" PER 100' ON FLAT
TERRAINS ❑
y. SEEPAGE PIT
SEEPAGE
.
PIT �7; 0 CRIB
SCREENED GRAVEL
V - 2Y„
20' MINIMUh1 TO NEAREST LOT LINE O
1
O
O
'.
LEVEL W CASTIRONINTO
1 O
O
O
•'
UNDISTURBED SOIL
�' o
15' MINIMUM TO EDGE OF
'
O
O
O
EXCAVATION ❑
e
o
CAST IRON REQUIRED WHENEVER LINE
CROSSES UNDER DRIVEWAY ❑
MINIMUM WELL DISTANCES:
INDIVIDUAL
TO TANK 100' ❑
TO PIT 100' ❑
NO SEWER LINE 10' ❑
PUBLIC - Under 25
Service or Less
Than 15 Connects
TO TANK 100' ( )
TO PIT 150'
75'-100' ONLY CAST
IRON SEWER LINE
PUBLIC - Over 25
Service or More
Than 15 Connects
TO TANK 200' ( )
TO PIT 200' ( )
100'-200' ONLY
CAST IRON SEWER
LINE
100' NO SOURCE OF
CONTAMINATION
NOTE: 100'MINIMUM
FROM TANK AND PIT
RIVER, LAKE OR
STREAM ( )
72-004 (4/76)
GRAVEL BACKFILL O
CRIB 4' MINIMUM ABOVE WATER TABLE ❑
6' MINIMUM ABOVE BEDROCK ❑
Individual Wel
4"
SEWER LINE ❑
CONSIDER DISTANCE TO AREA WELLS 8, SEWER SYSTEMS ❑
PIT EXCAVATION BASED ON SOIL TEST ❑
SEPTIC TANK MUNICIPALITY APPROVED O
HOUSE
INLET OUTLET MUST 5'
BE WATERTIGHT GRADE: 2' PER 100' OR
SEPTIC moo %" PER FOOT EXCEPT 10'
TANK PRECEEDING TANK AND THAT
SHOULD NOT EXCEED 215 O
H 6" PER 100' ON FLAT
TERRAINS ❑
y. SEEPAGE PIT
SEEPAGE
.
PIT �7; 0 CRIB
SCREENED GRAVEL
V - 2Y„
20' MINIMUh1 TO NEAREST LOT LINE O
1
n
