HomeMy WebLinkAboutSKYHILLS PH 2 BLK 3 LT 13Sky Hills Pha,
Block 3
Lot 13
#011 - 122- 39
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage. AK 99519-6650 Page I of
www.ci.anchorage.ak.us (907) 343 4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW990252 PID Number: 011-122-39
Jnhn Haom~_ic_r Ch_ Wastewater System: [] New [] Upgrade
2204 Cleveland Av~. Suit~ 208. ~17 ABSORPTION FIELD
248-6789 ~ ~ DeepTrench ~ ShallewTrench ~ Bed ~ Me,nd ~ Other:
LEGAL DESCRIPTION so~*~t~.~: To'al ~pth from ofioina, grade:
0.8 ~* 10-12'
Block: Lin: SubdMsiom ;;~ ~ DeCh to pip, boffom from original grade: Gravel depth beneath pipe:
3 13 Sky Hills 3-5 F,. 7
T~'mship: Range: Section: Fill added above original grade: Gravel Length:
0 ~. 75
Well: ~ New ~ Upgrade o,~.¢,~th: Number of lines: I D[s~ncebebveenJines:
3 ! 0
Classification (Private, A, B, C): Total Depth: Cased to: Tota~ absorption area: Pipe
A~U ~. ~ 1030 ~ I F810/3034
Driller: Date Drilled: StaPcWater Level: In~aller: ~ Date Installed
~. Haqemeier Co.~ 8/23/2000
'B~,0: I Pump Se~ at: t Casing Hefgh~ Above Ground:
~*~l ~.1 ~, TAN K
SEPARATION DISTANCES :~ septic ~ Holding ~ S,T.E.P. ~ Other:
T~ To Septic Absorption L[A Holding Public/Priv~e Manufacturer: capac[~:
From~ Tank Field Station Tank 8ewer Line A~oh. Tank
wo, N/A N/A n/a Steel 2
su~,~.~,o, 100+ 100+ ~ / LIFT STATION
~/a
,~m,,~,: BENCH MARK
Side Door Threshold
i 100.0
Engineer's Stamp
Inspections performed by: Pannone Enfl. Svc Dates: 1~t8/23/2000 .~ *;-:.
, ....... .............
Depa~ment of Health and Human Se~ices approval ~~
Reviewed and approved by: ~_ ~. ~ Date: ~-~-~O ~-: ~
PERMIT NB~ SW990252
aS-3UZLT
WASTEWATER ABSORPTION SYSTEM
LOT 13 BLOCK 3 SKYHILLS S/D
i NOTE~
P,LD, NB, 011-122-39
1) SUB]], IS SERVED BY AWWU, THERE
ARE ND WELLB WZTHZN 200 FEET DF
WATER ................. X'
NEW i .................. ~ ~ "
5 ]~ HOUSE ~
~ /
co\ A B
T1 \ 31,0 8,8
T2 ~ 2~,5 14,0
I5,5
C~\Work\12- ?SKYH,DWG
SEPTIC TANK ~ MT~ ~ ~" ~ ;.' . . t~,. 75LFx7 EFF,DRglNi2m TD
~~ .' ~REgERVE ,
IELD
/
AS-BUlLY, /
PERC RATE~ i2,5 MIN/INCH
SOIL RATING: 0,8 GPD/SF
188 SF/BEDRDDM, 5 BEDROOM
938 SF REQUIRED, 1DO0D SEPTIC TANK
DEEP TRENCH, 7' EFFECTIVE
10-12' TOTAL ]]EPTH, 75 LF
2-3' WIDE, 1050 BF TOTAL
PREPARED FOR~
JoNm Hmgmelem Co,
220~ CLeve[mm~ Ave, Suite 20~
Anchorage, AK 99517
(907> 248-6789
PANNONE ENG, SVC, LLC
P, O, BOX 102954
ANCHORAGE, ALASKA 99510
272-8218 Phone & F~x
DATE, 8-30-00 I AS-BUILT
SCALE, 1'=50'
/
WASTEWATER ABSORPTION SYSTEM
LOT !3 BLOCK 3 SKYH!LLS
C,\Work\13-3SKYH,DWG
Z
PREPARED FDR~
John H~gmelep
John H~gmeJer Co,
2204 Cleveland Ave, ~;ui~;e 204
Anchorage, AK 99517
(907) 248-6789
lnON¥393
PANNONE ENG, SVC,,LLC
P, D, BOX 102954
ANCHORAGE, ALASKA 99510
272-8218 PHONE & FAX
DATE~ 8-30-00
NOT TD SCALE AS-~UILT
PERFORMED FOR:
LEGAL DESCRIPTION:
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3
4
5
6
7
8
9-
10-
12
13
14
15
16
18-
2O
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE
Township, Range, Section:
SLOPE SiTE PLAN
WAS GROUND WATER
ENCOUNTERED?
Depth te Water After ~. ,.~ ~
Reading
Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE __
TEST RUN BETWEEN
(minutes/inch) PERC HOLE DIAMETER I
FT AND FT
PERFORMED BY: '~', ~'- "~ ,A~A./(~OP-/' L~ I CERTIFY THAT THIS TEST WAS PERFORMED tN
ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 995¢9-6650
¢O7) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Renewal
Date Issued: Jul 17, 2000
Expiration Date: Jul 17, 2001
Permit Number: SW000238
Legal Description: SKYHILLS PHASE 2 BLK 3 LT 13
Design Engineer: 0062 Pannone Engineering Services
Owner Name: John Hagmeier Co
Owner Address: 2204 Cleveland Avenue Suite 200
Anchorage, AK 99517-
Parcel ID: 011-122-39
Site Address: 008306 HEAVENLY ClR
Lot Size: 40438 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
[] Disposal Field [] 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 ) a nd Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calving
(907) 343-4744 ( 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:
Issued By:
Date:
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Aug 05, 1999
Expiration Date: Aug 04, 2000
Permit Number: SW990252
Legal Description: SKYHILLS PHASE 2 BLK 3 LT 13
Design Engineer: 0062 Pannone Engineering Services
Owner Name: John Hagmeier Co
Owner Address: 2204 Cleveland Avenue Suite 200
Anchorage, AK 99517-
ParcellD: 011-122-39
Site Address:
Lot Size: 40438 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
[] Disposal Field [] 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 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.
Date: ~/'/U~/f~'
Oate:
Steven R. Pannone, P.E.
Consulting Engineer
(907) 272-8218
P.O. Box 142025
Anchorage, Alaska, 99514
(907)272-8218 Fax
July 25, 1999
Municipality of Anchorage
Dept. of Health & Humm~ Services
On-Sim Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Subject:
Lot 13, Block 3 Sky Hills Snbdivision,
Septic System Permit
Gentlemen:
My fi~m was contacted to design and fi~stall a new septic system for the referenced lot. We conducted a field
investigation to locate existing wells and septic system before designing the proposed system. A single test hole was
excavated on August 6, 1998 for the system design, which is on file with your department. No ground water was
encountered. No bech'ock was encountered in the test hole.
The lot is approximately 0.93 acres in size. Lot s 13 slopes to tt~e northeast at a rate of approximately 10-15 percent.
The souflmastem pmtion of the lot is flatter (approxi~nately 10-11%). The proposed installation will be located on fl~e
eastern portiun of the lot. Double clean-outs will be installed after the tank and diverter valve. The proposed location
is greater tban 200 feet away from any wells. This lot is served by AWWU water service. The proposed system will be
greater than 10 feet from the water service lines. The proposed installation will not affect the fi~ture development of
the sma'oundh~g or existh~g lots. See the attached design.
Please contact me at 272-8218 or 227-3522 if you have any questions about the proposed installation.
Sin cerely,
Steven R. Pannone, P.E.
Attachments:
PERMIT NO, S~ DESIGN
WASTEWATER ABSORPTION SYSTEM
LOT 13 3LOCK 3 SKYHILLS
NOTE'
1) SUBD, IS SERVED ~Y A~WU. THERE
ARE ND WELLS WITHIN 200 FEET DF
THE PROPOSED INSTALLATION,
PROPOSED · ~ .....~
~ ........
i~1D.5 ~ TD
PROPOSED 1500n ~ i ; ~ /
SEPTIC TANK '~ : :::~ "~'~'~
PREPARED FOR~
DESIGN.
PERC RATE~ 12,5 MIN/INCH
SOIL RATING~ 0.8 GPD/SF
lee SF/~EDRDDM, 5 3EDRDDM
938 SF REQUIRED, 1500g SEPTIC TANK
DEEP TRENCH, 7' EFFECTIVE
11-12' TOTAL DEPTH, 67 LF EACH
2-3' WIDE, 938 SF TOTAL
Johm Hagmeler
Johm H~gmeler Co,
2204 Clevet~md Ave, Suite 204
AmcHor~ge, AK 99517
(907) 248-6789
DRAIN FIELD
/
/
/
/
PANNDNE ENG, SVC
P, 0, 3OX 102954
ANCHORAGE, ALASKA 99510
27~-8218 Phone & F:x
DATE, 7-25-99 IDESIGN
SCALE, 1'=50'
PERMIT NFl,
DESIGN DETAILS
~/ASTEWATER ABSORPTION SYSTEM
LOT 13 ]]LOCK 3 SKYHILLS
Z
C:\~/ork\iS-3SKYH,DWG
PREPARED FUR~
John H~gmeler
John Hcgmeier Co.
2204 Clevel~nc~ Ave, Suite 204
^nchor~ge0 AK 99517
(907) 248-6789
P,I,D, ND,
PANNDNE ENG, SVC,
P, D, BOX 102954
ANCHORAGE, ALASKA 99510
878-88t8 PHONE & FAX
I]ATE, 7-25-99 J
NIT ~ ~LE/ DESIGN
Municipality of ARchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
2
3
4-
5
6
7
8,
9
10
11
12 ':'
13-
14
15
PERFORMED
LEGAL DESCRIPTION:
,,~ Township, Range, Section:
~'g. SLOPE
WAS GROUND WATER
OATE PEREORMEO:~ -~,-.~.~,
IF YES, AT WHAT
DEPTH~
Reading
SITE PLAN
PERCOLATION RATE / ~
TEST RUN 8ETWEEN~_ ~'
COMMENTS ?ere c~vlty ~'as P~"esoaked ?~'ior t.o
PERFORMED ~
FT ANO -- '~ FT
testing'.
CERTIFY THAT THIS TEST WAS PERPORMEO iN
, :'iichael S. And. e~son
ACCORDANCE WITH ALL STATE ANO MUNiCiPAL GLJIDEL,NES jN EFFECT ON THIS OATE OATE
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG ~ PERCOLATION TEST
PERFORMED FOR: I~ E Construction, Inc.
LEGAL DESCRiPTiON:~nship, Range, Section:
SLOPE
1
2
3
4
5
6-
7
8
9
10-
11
12
13
14-
15
COMMENTS [3 e r e
WAS GROUND WATER
ENCOUNTERED?
DATE PERFORMED:
S
IF YES, AT WHAT / L
DEPTH? O
SITE PLAN
Reading Date Gros~ Net Depth to Net
Time Time Water Drop
PERCO TIC. RATE
Im,nule~'mchj PERC HOLE DIAMETER
TEST RUN EETW;:EN .--' ~" FT AND -- ~ FT
PERFORMED
I CERTIFY THAT THIS TEST WAS PERFORMED IN
Michael E. Anderson
ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825"L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak, us
(9O7) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 011-122~39
1. GENERAL INFORMATION
Complete legal description
Expiration Date:
Lot 13, Block 3 Sky Hills S/D
Location (site address or directions) 8306 Heavenly Circle, Anchora.qe, AK 99516
Current Property owner(s) Cendant Mobility
Day phone
Mailing address
Lending agency
Day phone
Mailing address
Real Estate Agent
Mailing Address
CB Fortune/Brian Burnett
~ C Street~ Anchorage, AK 99503
Day phone 242-9363
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS: 5
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] individual On-site
[] Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health
Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska, Certificates of Health Authority Approval are required
for the transfer of title (except between spouses) on properties served by a single family on-site wastewater
disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of
Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C
well and may be reissued with new water sample results less than 30 days old. Certificates 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.
5. STATE~/IENT OF INSPECTION BY ENGINEER
As cerlified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation
based on procedures outlined in the Health Authority Approval Guidelines for this 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 furlher 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Enq. Svc.
Address P.O. Box 102954, Anch, AK 99510
Engineer's Pdnted Name Steven R. Pannone, P.E.
Phone 272-8218
Date 12/1712001
6. DHHS SIGNATURE
Approved for ,pr-'
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Expiration Date:
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Reissue Date:
Legal Description:
A, WELL DATA
Well type AWWU
Date completed __
Total depth
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L' Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak, us
(907) 343-4744
HEALTH AUTHORITY APPROVAL CHECKLIST
Lot 13, Block 3 Sky Hills S/D Phase II
ft
IfA, B, or C provide PWSID # __
Sanitary seal __
Cased to ft
FROM WELL LOG
Parcel I.D.: 011-122-39
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 mi
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
ft
gpm
Well Log
Wires properly protected
Casing height (above ground)
AT INSPECTION
in.
Nitrate mg/I
Collected by:.
ft
g.p.m
Date installed 8/23/2000 Tank size
Cleanouts _Y Foundation cleanout _Y
Date of pumping 12/18/2001 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed 8/231200q Soil rating (g.p.d.lfl2 or ft2/bdrm) 0.._~8
Length 75 ft Width 3 ft
Other bacteria
coloniesl100 mi
1500 gal Number of Compartments 2
Depression over tank N High water alarm N/A
System type DT
Gravel below pipe 7_Z_ ft
Total depth 10-12 fi Effective absorption area 1030 ft2
Date of adequacy test~'C- ~'o ~f'~f~'¢~uults (Pass/Fail) Pass
Fluid depth in absorption field before test __ in Water added
Elapsed Time: rain Final fluid depth in
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No
(Rev. 11/99)
Monitoring tube Y
For 5 bedrooms
__ gal. New depth.__
Absorption rate >=
If yes, give date
Depression over field N___
in.
g.p.d.
D. LIFT STATION
Date installed %*~'"~-..~ze in gallons
"Pump on" level at __ in"Pump off"~P~l at __ in
Datum Cycles teste¢'--...
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 6 Property line 45
Water main 100 Water service line 50
Drainage 100+ Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 12
Surface water 100+
Wells on adjacent lots 100+
Property line 28
Water Service line 25+
Curtain drain 100+
F. COMMENTS
Manhole/Access
High water alarm level at __ in
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Absorption field 6
Surface water 100+
Water main 25+
Driveway, parking/vehicle storage 5
This is a Recertiflcation for chan,qe of ownership. System was inspected & is in~t~'~c~l~/lOA ReRs.
ENGINEER'S CERTIFICATION ~ ~.." ~ '-..~**
t cedify that I have determined through field inspections and ~ ~ ,.,,~ ............. ~,,,,.~
conforman~ with MOA HAA guidelines in effect on this date. ~,.~.~,.,~,~,~,~
Engineer's Printed Name Steven R. Pannone, P.E. -*,, ,,-~- ~, , .. ->~ ~..,~,...,~H ¢l~¢...~~
Date ~ 1Z/I :/'~ 'e.'<O,. ,9> ................. ~-, ~.-', ~"~ ~
Date of Payment
Receipt Number
(Rev.
Waiver Fee $
Date of Payment
Receipt Number
: ~-. ~,~. , Municipality of Anchorage
/~) Department of Health and Human Services
Division of Envirohmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak, us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 011-122-39 HAA# /~'~(~(~-r/~. _~-
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lot 13, Block 3 Sky Hills SID
Location (site address or directions)
Current Property owner(s) John Ha,qmeier Co. Day phone 248-6789
Mailing address 2204 Cleveland Drive, Suite 200, 99517
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Un/ess otherwise requested, HAA ~v/I/ be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site
[] Individual Holding tank
[] Community On-site
[] Public Sewer
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Heaith
Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required
for the transfer of title (except between spouses) on properties sen,ed by a single family on-site wastewater
disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of
Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C
well and may be reissued with new water sample results less than 30 days old, Certificates are valid for one year
for properties served lay 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.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation
based on procedures outlined in the Health Authority Approval Guidelines for this 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 fudher 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Eh.q. Svc.
Address P.O. Box 102954, Anch, AK 99510
Engineer's Printed Name Steven R. Pannone, P.E.
Phone 272-82t8
Date 8/31/2000
DHHS SIGNATURE
~ Approved for _~
Disapproved,
Conditional approval for
Additional Comments
Attachments: HAA Checklist
Septic System Advisory
Well Flow Advisory
Expinstion Date: ~- ~-..,ff-
Maintenance Agreements
Supplemental Engineer's Report.
Other
Original Certificate Date: d:~. ¢. ~,. 490
Reissue Date:
Legal Description:
A. WELL DATA
Well type AWWU
Date completed __
Total depth
Municipality of Anchorage
Department of Health and Human
Division of Environmental Services E ! V E
On-Site Services Section 825 %" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak, us
(907) 343-4744
MUNICIPALITY OF ANCHORAGE
HEALTH AUTHORITY APPROVAL CH[-:q..~iVTENTAL SERVICESDIVI$10fl
Lot 13, Block 3 Sky Hills S/D
Parcel I.D.: 011-122-39
IfA, B, otC provide PWSiD #__ Well Log
Sanitary seal __ Wires properly protected
ft Cased to ff Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
tt ft
gpm g.p.m
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 mi
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Nitrate mg/I Other bacteria
Collected by: S.R.PANNONE
colonies/100 mi
Date installed 8/23/2000 Tank size
Cleanouts Y Foundation cleanout Y
Date of pumping ~ "¢'?'1~ Pumper NEW
C. ABSORPTION FIELD DATA
Date installed 8/23/2000 Soil rating (g p d./ff2 or ft2/bdrm) 0.~8
Length 75 ft Width 3 ft
Total depth 10-12 ft Effective absorption area 1030 ft2
Date of adequacy test ~ Results (Pass/Fail) __
Fluid depth in absorption field before test __ in
Elapsed Time: __ min Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
(Rev. 11/99)
1500 gal Number of Compartments _2
Depression over tank N High water alarm N/A
Monitoring tube _Y
N EW.-5'r~ F'~ ',4 For
Water added
in
System type DT
Gravel below pipe 7 fl
Depression over field N~
bedrooms
gal. New depth___ in.
Absorption rate >= __ g p.d
If yes, give date
LIFT STATION
Date in~f~ll¢¢l
"Pump on" level at __
Datum
in"Pump off" level at
Cycles tested
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N!A
Absorptien field on let
Public sewer main
Sewer ./septic s~c. rvi¢:~ lin~
Manhole/Access
High water alarm level at __ in
Meets alarm & circuit requirements?
On adjacent lots
On adiacent lets
Public sewer manhole/cieanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 6
Water main 100
Drainage 100+
Property line 45
Water service line 50
Wells on adjacent lots !00+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 28
Water Semice line 25+
Curtain drain !00+
F. COMMENTS
Building foundation 12
Surface water 100+
Wells on adjacent Pets 100+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through fie/d 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 Name Steven R. Pannone, P.E.
Date 8-31-00
Ahnnrntinn finlrt R
Surface water !00+
Water main 25+
HAA Fee $
Date of Payment
Receipt Number
(Rev. 11/99)
Waiver Fee $
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