HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 4 LT 21 Municipality of Anchorage Page I of--~--~
DEPARTMENT OF HEALTH AND HUMAN SERVICES
· ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
PermitNumber: ~ c,~ c) ~,. O I ~ 6'" PID Number: Of
Name:A r~ ~ ~O ~ E~ (+e I~ ~ Wastewater System: ~ New ~ Upgrade
Address:/Z~/. ~p/~( R~ )f~/~ ABSORPTION FIELD
No. of Bedrooms:
Phone: ~-- 17~ ~ ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other
LEGAL DESCRIPTION sog Rating: ~ ~t~y¢le ~, Total Depth from originalgrade:
GPD/Sq. Ft.
Lot: Block: Subdiv~ion: Depth to pipe botlom from odginal grade: Gravel depth beneath pipe
Township: Range: m section: Fill added above original grade: Gravellength:
~. O Ft. ~ ~ ~ Ft.
WELL: E~SF ~ New ~ Upgrade Gravel width: J~' Ft. Number3of lines: Distance~be~eenlines:Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Ft. Ft. ~ SQ. Ft.
Driller: Date Drilled: Static Water Level: Installer: Date installed:
Yield: GPM IPump Sot at: Ft. ICasing HeightAb°v° Gr0und:Ft. TANK
SEPARATION DISTANCES ~ septic D Holding
To Septic Absorpt[on Lift Holding Public/Erivat6 Manufacturer: Capacityi6 gallons:
From Tank Fietd Station Tank Sewer Lines ~ ~ IOC~¢[~ '
Material: Number of Compa~ments:
we,. , ~ 17 ' i EO ' l t 9 ~ _ ~ Z~-~ Ft&e~IayY
Sudace
Water >~OO' >t~' >~' -- - LIFT STATION
Lot Size in gallons: Manufacturer: ~
Foundation ~ ~ ~ ~. ~ ~ t -- -- "Pump on' level at: "Pump off" level at: J High water alarm at:
Curtain Pump Make & Model Electrical Inspections performed by:
Drain ..... ~o-~ ~eA~ ) ~.~'~.
~ . BENCH MARK
Remarks: ~o¢yC~~ $yX~e~ ~l/e~
- Location and Descdpti~:
I Assumed Elevation:
Inspections pedormed by: ~/nh~ ~e~ ~C Dates: Ist E/t~ I~ ~,?.: ........................
Department of d rvices approval
Reviewed and approved Date: /
72-013 (Rev. 9/91) MOA 25
PERMIT NO: SW 960186 PAGE 2 OF 2
PID NO: 01702321
WELL
RISER RIM
ELEV. 99.9
LOT 21
BLK. 4
3 BDRM ,,
HOUSE , ,
;,,
ALARM , ,,
BOX ~',
SWING TIES:
FROM: COR. "A" COR. "B"
TO:
UNIT "C" 32.5' 47.5'
M.T. "D" 84' 67.5'
M.T. "E" 85' 60.5'
PLAN VIEW
SCA L ~: 1~,', =~'30~ .-0"
2" INSULATION
+ 2' SOIL COVER
TOP FILTER SAND
ELEV. 103.8
1500 GAL.
"BIOCYOLE"
AEROBIC
TREATMENT
UNIT
SCHED. 40 PVC
15'x 20'
RESIDUAL
DISPOSAL
BED
"LAKE OTIS GRAVEL" FILTER SAND
NATIVE SANDY GRAVEL
INV.
94.8
DIST. PIPE
104.3'
(ALL ENDS)
BOTTOM T.H. #1 M.T.
ELEV. 104.0'
WATER @ 98.0' 4/96
CROSS-SECTION
NOT TO SCALE
2" RIGID INS. (30 PSI)
UNDER "BIOCYCLE"
LOT 21, BLK. 4, MTN. PARK EST. #2
SEPTIC SYSTEM UPGRADE
AS-BUILT INSPECTION REPORT
FLAri'FOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, ALASKA 99516
SCALE: AS NOTED
DRAWN BY TFM
SEPTEMBER, 1996
iNSPECTION REPORT
MUWi'CIPALtTY OF ANCHORAGE, BUILDING SAFETY
3500 EAST TUDOR ROAD
CO&I~4ENT~: (FOR INSPECTOR USE, ONLY)
IN,SPi~CTOR
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW960186
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:HELMUTH ARTHUR C & ROBERTA P
OWNER ADDRESS:12901 LUPINE RD
ANCHORAGE, ALASKA 99516
DATE ISSUED: 7/11/96
EXPIRATION DATE: 7/11/97
PARCEL ID:01702321
LEGAL DESCRIPTION:
MOUNTAIN PARK ESTATES #2 BLK
4 LT 21
LOT SIZE: 20130 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THE EXISTING SEPTIC TANK, LIFT STATION, AND
ABSORPTION FIELD MUST BE PROPERLY ABANDONED.
RECEIVED BY, :~~~ ~:j/~..
ISSUED BY: ,~/ _ _.6~!.~'
DATE: 7f/! /~
OP CHNICAL .. ER
CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 June 28, 1996 ANCHORAGE, ALASKA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design nmTative in support of our application for a
pe~Tnit to install a "Biocycle" aerobic treatment unit and residual disposal bed on Lot 21, Block 4,
Mountain Park Estates, Unit #2, located at 12901 Lupine Road. The existing soil absorption trench is
periodically no longer able to accept the effluent flow generated by the residence. Soils logs, perc test
results, a site plan, design drawings and specifications are enclosed for your review.
The proposed residual soil absorption bed will be constructed in the vicinity of test hole # 1. As can be
seen from the soil log, the native material between 1.5' and 6' below ground level is a somewhat silty
sandy gravel with a measured perc rate of 2 minute~ per inch. The horizontal extent of this excellent
r6ceiving material is limited to a small area comprising a natural knoll in the back yard of this lot. The size
of the proposed absorption area was derived by first calculating the required absorption area for a
conventional mound type system in this type of soil, which would be (3 x 150)/0.8 = 563 square feet, and
then reducing this by a factor of 50% in consideration of the far cleaner effluent emanating fl'om the
proposed "Biocycle" unit, for a total required area of 282 square feet. The proposed 15' x 19' soil
absorption bed will have an effective absorption area of 285 square feet.
The topography of the lot in the vicinity of the proposed construction is generally level with the
exception of the aforementioned low knoll upon which the residual disposal bed is to be constructed.
Additional filtration and separation from seasonal high groundwater will be provided by the placement of 2
feet of filter sand underneath the bed.
The proposed project will have no significant impact on present or future water supply and wastewater
disposal systems, serving adjacent properties, nor will it have any significant impact on reserved space-
surface and subsurface, or on drainage.
Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
", o SEPTIC SYSTEM o ',
\ ' ' 0 LOT 3
HOUSE ,
', LOT 22 ', I l SEPTIC
, ' ' SYSTEM
, INSTALL , ,
'-, ~UNIT , ,
~HOUSE -- ~/~~ .... ~SOIL ABS : SEPTIC
~Tg~ ~ .... [,,, S.~. 15' x 19'-' SYSTEM ', SYSTEM HSE
,- ' D SPOSAL ,
--... ~ : , , ,
kOT 20 ,, ,
, ' LOT 5
"
' , SEPTIC , ,
HOUSE ,' , , SEPTIO
~ SYSTEM " ', SYSTEM
WELL - '
.... ' ~.,:-z-~? ~, ~ ~ WELL AND SEPTIC SYSTEM
.c:~. · J~9 "'~" ''~':~ ANCHO~GE, ~AS~ 99516 MAY, 1996
~ .:~,'~ .¥ ~.: ~ NOTE: THIS IS NOT A SURVEYED P~T.
~".~ ~, ~Y ~""~': ~,;;;~' ALL LOCATIONS SHOWN ARE APPROXIMATE.
"BIOOYCLE
AEROBIC X II
TREATMENT
UNIT
INFLOW REOM
RESIDENCE
DISCHARGE LINE --
1.25" DIA SCHED 40 PVO /
.... 5 ,'2.5
5,' 5" ·
GRADE TO PROVIDE
SURFACE DRAINAGE
AWAY FROM UNIT
"BLOC COLE"
_ _A_E B(. )BiO
TREA] MENT ·
Ui~ IT
RESIDUAL
DISPOSAL BED
1.25" DIA. SCHED 40 PVC
W. 3/16" DIA. HOLES IN
BOTTOM, SPACED 2' C.C.
PLAN VIEW
SCALE: 1" = 10' - 0"
2' SOIL COVER --
FILTER FABRIC
2" RIGID
9" SEWER GVL,--~
1.25" DIA
SCHED 4O PVC
W 3/16" HOLES
SPACED 2 FT.
2' FILTER
ORIGINAL
GROUND
BAOKFILLAROUND
"BIOCYCLE"WITH
CLEAN SAND
2" RIGID INS. (30 PSI)
UNDER "BIOCYCLE"
-- LEVEL EXCAVATION
W. CLEAN SAND
NATIVE GRAVEL SOIL
SECTION "A - A"
SCALE: 1" = 5'- 0"
LOT 21, BLK. 4, MTN. PARK EST. #2
SEPTIC SYSTEM UPGRADE
PLAN AND CROSS-SECTION
FLATTOP TECHNICAL SERVICES SCALE: AS SHOWN
14530 ECHO STREET DRAWN BY: TFM
ANCHORAGE, AK, 99516 MAY, 1996
TEST HOLE # 1
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
DEPTH
(feet)
COMMENTS:
FLA'I-rOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
Lot 21, Block 4, Mountain Park Estates, Unit #2
AprU 10, 1996
Arthur and Roberta Helmuth
Pt.
SM Reddish gravelly loam
GP/GM Somewhat silty sandy gravel
dry, hard digging
many rounded cobbles
becomes clean sandy gravel below 5'
SM/IVlL Very silty sand
SLOPE
SITE PLAN
ML Gray silt
Boulders near bot.
Depth to Groundwater Date
No groundwater 4/10/96
Groundwater (~ 6' - 0" 4/29/96
Groundwater @ 8' - 0" 5/28/96
Clock Net Time Pemometer Net Drop
Date Reading Time (minutes) Reading (inches)
4/10 12" Presoak
Add water & start 12:13 23 3/8
#1 12:18 5 20 7/8 2 1/2
Add water 12:18:30 23 7/16
#2 12:23:30 5 21 2 7/16
Add water 12:24 23 3/8
#3 12:29 5 20 15/16 2 7/16
PERCOLATION RATE 2 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BE'rWEEN 4.25 FTAND 4.75 FT
PERFORMED BY FLATTOP TECHNICAL SERVICES. I ~'~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: O'"f 2.-~/~ ~
TEST HOLE # 2,
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
Lot 21, Block 4~ Mountain Park Estates, Unit #2
April 10, 1996
Arthur and Roberta Helmuth
DEPTH Pt
(feet) SM
GP/GM Somewhat silty, sandy gravel
Brown, many cobbles
SLOPE
ML Silt (frozen)
B.H.
~ / EXISTING
~ ~ ~ / SOILABS
~x ~J., ~ / SYSTEM
71.
"~:--T.H. #2
COMMENTS:
lower at T.H. #2 than at T.H. #1.
Depth to Groundwater Date
No groundwater 4/10/96
Clock Net Time Percometer Net Drop
Date Reading Time (minutes) Reading (inches)
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
This T.H. dug to assess contiauity of gravel stratum encountered in T.H. #1. No monitor tube set. Ground elevation approx. 2 feet
I ,~~ CERTIFY THAT THIS TEST WAS PERFORMED IN
PERFORMED
BY
FLATTOP
TECHNICAL
SERVICES.
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: O'""'/' ~...~' ~'O'~
Flattop TechnicaI Services
14530 Echo Street, Anchorage, AK99516
Phone (907) 345-1355
Lot 21, Block 4, Mountain Park Estates, Unit //2
12901 Lupine Road
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of abandonment of an existing septic tank, lift station, and soil
absorption trench and installation of a"Biocycle" aerobic treatment tank which discharges effluent into a
15' x 19' soil absorption bed constructed over 2 feet of filter sand.
1.2 Construction shall be as depicted on the approved site plan and design drawings, as supplemented
by the "Biocycle" unit manufacturers specifications. Minor deviations from these drawings may be
allowed or required by the engineer conducting the inspections. All construction procedures and material
specifications shall conform with Municipal and State requirements. All separation distances shall be in
conformance with Municipal requirements, unless specifically waived.
1.3 The property owner shall enter into an on-going periodic maintenance agreement with the
"Biocycle" supplier which is acceptable to the M.O.A. Health Department.
1.4 The property owner shall enter into an analytical testing agreement with the "Biocycle" supplier
which may be required by the M.O.A. Health Department.
1.5 The contractor shall be responsible to obtain any necessm3~ utility locates, and to work around any
buried utilities.
t.6 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.7 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after
the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction.
2.0 Existing wastewater disposal system:
2.1 The existing 1250 gallon steel septic tank and separate lift station tank must be properly
abandoned by thoroughly pumping, removing the tops and backfilling with soil.
2.2 The existing soil absorption trench shall be abandoned in place with any standpipes removed.
3.0 "Biocycle" aerobic treatment tank:
3.1 The new 1500 gallon "Biocycle" aerobic treatment tank shall be manufactured, furnished and
equipped by Pegasus Engineering in accordance with the M.O.A. approved design.
3.2 The contractor shall prepare a suitable site for the "Biocycle' unit and install it as follows: The
location of the unit shall be chosen to maintain a minimum separation distance of 100 feet from all private
wells. The depth of the excavation shall be sufficient to allow connection to the 4" wasteline leaving the
house at a minimum slope of 1/4" per foot. The bottom of the excavation shall be carefully leveled and
smoothed by the placement of a layer of clean sand. Two inches of rigid, burial type, insulation with a
minimum compressive strength of 30 psi shall be placed on the sand leveling course prior to installation of
the "Biocycle" unit. The space between the sidewalls of the excavation and the "Biocycle" unit shall be
backfilled with sand. The top of the "Biocycle" treatment unit shall be buried no deeper than specified by
the manufacturer, with the manhole riser extending above finish grade. The final ground surface shall be
graded as necessary to provide drainage away from the "Biocycle" unit.
3.3 The contractor shall be responsible to obtain the necessatT Municipal electric permit and
inspection, and shall provide a copy of the electrical inspector's report to the engineer overseeing the
construction of the wastewater disposal system.
3.4 The on, off, and alm~n floats shall be set at the elevations specified by the manufacturer, and theh'
proper operations shall be verified by the contractor. The alarm box shall be mounted inside the
residence.
3.5 The discharge line from the "Biocycle" aerobic treatment unit to the soil absorption bed shall be
1.25" dia. Sched 40 PVC.
4.0 Soil absorption system:
4.1 The residual soil absorption bed shall be constructed by excavating a 15' x 19' area to a depth of
2' below original ground surface in the area shown on the site plan.
4.2 The bottom of the excavation shall be level. Appropriate sidewalls shall be consn'ucted as needed
to contain the filter sand and sewer gravel. A total of 2 feet of"Lake Otis Gravel" filter sand shall be
placed in the bottom of the excavation. Sand serving as filter material shall comply with Municipal
specifications.
4.3 A total of 0.75 feet of approved sewer gravel shall be placed on top of the filter sand with the
perforated distribution pipes laid level such that the pipe inverts are no less than 0.5 feet above the bottom
of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the
//200 sieve.
4.4 The distribution pipe network shall consist of a non-perforated 1.25" dia. Sched. 40 PVC
manifold feeding 3 distribution laterals consisting of 1.25" dia. Sched. 40 PVC with 3/16" diameter holes
drilled in the bottoms spaced 2.0' O.C. All pipe connections in the distribution system shall be glued, and
the ends of all pipes capped. Monitor tubes shall be of 4" diameter and installed in the locations shown
on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be
perforated.
4.5 Approved filter fabric shall be placed over the entire top sm'face of the sewer gravel. A minimum
of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet,
two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in
addition to the filter fabric.
4.6 The top surface of the cover material shall be graded to smooth contours. Fill slopes shall be no
steeper than 3:1.
4.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the
site finish graded after the backfdl material has stabilized, and for placement of adequate topsoil and seed
to promote rapid revegetation of ail areas disturbed by the construction.
5.0 Inspections:
5.1 A minimum of 5 engineering inspections will be requh'ed during the course of the project: (1)
initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the
infiltrative stwface to ensure that it is level and at the right elevation, and conforms with the soil test
information, (3) after the sand leveling and/or filter material has been placed, (4) after the sewer gravel is
in place and the disnSbution pipes have been laid and connected up to the "Biocycle" aerobic treatment
tank, but prior to placement of insulation or,,filter fabric, and (5) after rough backfill and grading is
complete. The installation of the "Biocycle aerobic treatment tank requh'es two inspections - immediately
prior to placement in the prepared excavation and after it is set level and the piping connected, but prior to
backfill. These inspections may be inco~l>orated with any of the above inspections, if feasible.
5.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
c)
001'= Si
008 = 9 ·
U--
LI-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
NAME
MAILING AD,~ESS
LEGAL DESCRIPTION
LOCATION
Absorption area.4.._
Inside length
Dwelling
Well
DISTANCE TO: ~ 6~:~'d
ILe. r~qi. hlof e~gh line
Top of tile to finish grade
Foundation
Total length ofli~
Materiat beneath tile
Depth
Width
Dwelling~
Ma~;e~ial
Width
PHONE L ~"N EW
NO. OF BEDROOM~/..~
PERMIT NO. -
'7 ?O P ci'
NO. of c~Dartments
Liquid depth
PERMIT NO.
Material Liquid capacity in gallons
Nearest ,otline /
Trench W dth~.gOinches Distan~b[~n lines
Total eff~v~orption area
Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
Driller Distance to lot line
Sewer line
DISTANCE TO: Building foundation
Absorption area s
Septic tank
OTHER
PIPE MATERIALS
SOIL TEST RATING
APPROVED DATE LEGAL
72-013 (Rev, 3/78}
PERMI-r NO. ( ,.,.,... ..... )
FIF'F'L I ClINT
LOC:RT I ON
LEGRL
I'-IUN Z C: I F"RL_ .'[ T'T' ,::,F I-III'-.IC:FIC.-,F;J:R,3E iD,~%.
' DEPRRTMENT OF HERLTH RND ENVIRL-INMENTRL F'ROTECTIGN G-~/'~'~ ~-~;O~L ^
2E;4-47~0 . . /
I-4E-_.'L_L. RI'-.~[:, C,l'-,i--.S I -FE SEL4EF( F EF-."t.1 I T 1
,=,-, . ,, . ~,~-,~-
_.RR 80,:.:, i ....... H 3:44.-42:L4
L. OT SITE 20000 SQURRE FEET
_, ~ _,TEtl DRR I I".1F I ELD
]""r'PE OF '-C - -,,- ". " ,:', ,c' -
:,_ilL HE.:,ORBI ION IS
MR>::IHUM NUMBER 19F BEDROOMS = -1-
SOIL RRTING ,"SI.'-.! FT.'BR.- ±~..
THE REQUIRED SIZE OF' THE SOIL RBSORPTION S'T'STEM IS:
aZ:,EF'T, , 4 I EI'-~GTH= '-"-" ,3F-:Ft%¢EL [>EF"TH= :~
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRE:E OF ]"HE
GROUND 8ND THE BOTTOM OF THE E>(CRV8TION (IN FEET).
THE TREf-.iBZ:H L--~ I [:,T~--I I S 5. ~='-~_~r;Z'~ F-EET
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL. PIPE
RND THE BOT"rOM OF THE E;.:',CRVRTION (IN FEET:).
PERMIT FIF'PLIr':RNT HRS THE RE_FUN_,IBILITT TO INFORM THIS DEPFIRTMENT DURING THE
INSTRLLFITION IN=,FECTILN~ nF RNY WELLS RDJFICENT TO THIS PRAPERTY RN[) THE
NUflE, ER OF F..E=.I[EN_.E_~ THRT THE WELL WILL SERVE.
I i'-,I:.~-;PE C:'f' I ,31'-,!:-7; flF-."EE F.: E L--:."L! I
BR~:KF'ILL~NG OF RN'T' Sg-'STEM WITHOUT FINRL IN=,FECTIJN fiND RPPRO',/RL B"r' THIS
DEF'RRTMENT WILL BE _-,UBJEL. T TL9 PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND RNtt ON-SITE SEWRGE DISPOSRL S~¢STEM IS
±00 FEET FOR R PRIVRTE NELL; OR
i5E~ TO 20G FEET FROM R PUBLIC NELL DEPENDING LIPON THE TYPE OF PUBLIC WELL
WELL LOGS FIRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ':.':E~
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MR'¢ RPPL'¢. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
I CERTIFY I'HRT
l: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH B'¢ THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE S'T'STEM IN RCCORDRNCE WITH THE CODES,
2~: I UNDERSTRND, THRT THE ON-SITE SEWER SYSTEM MR'¢ REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED, TO INCLUDE MORE THRN 4 BEDROOMS.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-2224
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED:
[~"~'~SO ILS LOG
[] PERCOLATION
TEST
1
2
3
4-
5-
6-
7
8
9-
SLOPE SITE PLAN
III /i
-- 'J~--- ] --~'-'- ,~
10-
11
12
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
CERTIFIED BY:
(minutes/inch)
PERFO,MED BY:
FT AND
FT
72-008 (7/76)
Lo cation:
De scription:
Mat eri al s: -
Well Lo g
Lot 21, Block 4, Mt. Park Est.
6" well cased to 85'
topsoil
-21' gravel, clay
-22'-25' boulders, surface water
-26'-34' silt and gravel
-35'- 64' sand and gravel
(small amount of water)
-65'- 80' silt (water bearing)
-81 '-85' gravel (water bearing)
Yield: 11 gal. per min.
Static sater level:. 19'
Drilled by: Thomas Drilling Company
P.O. 10-516
Anchorage, Alaska 99511
License #WD 78020
Completed: September 25, 1978
PAGE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM UPGRADE) PERMIT
PERMIT NUMBER:SW970239
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:HELMUTH ARTHUR C & ROBERTA P
OWNER ADDRESS:12901 LUPINE RD
ANCHORAGE, AK. 99516
DATE ISSUED: 8/05/97
EXPIRATION DATE:
PARCEL ID:01702321
LEGAL DESCRIPTION:
MOUNTAIN PARK ESTATES #2 BLK 4 LT 21
LOT SIZE: 18000 (SQ. FT.)
NUMBER OF BEDROOMS: 2 THIS PERMIT: 2
THIS PERMIT IS FOR THE CONSTRUCTION OF:
WELL SYSTEM
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 (iSAAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 { 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
1 OF
8/o5/98
SPECIAL PROVISIONS:
RECEIVED BY: ~~
DATE:
ISSUED BY:
'PERMIT NO: SW 960186
PAGE 2 OF 2
PID NO: 01702321
WELL
RISER RIM
ELEV. 99.9
LOT 21
BLK. 4
3 BDRM ,,
HOUSE
ALARM - - ~,
BOX --
SWING TIES:
FROM: COR. "A" COR. "B"
TO:
UNIT "C" 32.5' 47.5'
M.T. "D" 84' 67.5'
M.T. "E" 85' 60.5'
15o0 GAL.
"BIOCYCLE"
AEROBIC
TREATMENT
UNIT
40 PVC
15'x 20'
RESIDUAL
DISPOSAL
BED
: PLAN VIEW
SCALE: ~-~3~. ~.0"
2" INSULATION
+ 2' SOIL COVER
TOP FILTER SAND
ELEV. 103.8
"LAKE OTIS GRAVEL" FILTER SAND
NATIVE SANDY GRAVEL
INV.
94.8
DIST. PIPE
-- -- ~, 104.3'
(ALL ENDS)
BOTTOM T.H. #1 M.T.
ELEV. 104.0' %
WATER @ 98.0~ 4/96
CROSS-SECTION
NOT TO SCALE
__ 2" RIGID INS. (30 PSI)
UNDER "BIOCYCLE"
LOT 21, BLK. 4, MTN. PARK EST. #2
SEPTIC SYSTEM UPGRADE
AS-BUILT INSPECTION REPORT
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, ALASKA 99516
SCALE: AS NOTED
DRAWN BY TFM
SEPTEMBER, 1996
, '. o SEPTIC SYSTEM o ', ',
' ~ ' LOT 3
HOUSE , ' '
' LOT ;J2 ' ,
J ' ,
r~ / WELL ; ' ' ' o
~ ~ 100, ~ INSTALL ', ',
.' -' ~]) ''-.. ~ ,' . AEROBIC I ',
." L Il_ ~ ~ TREATMENT , ,
'. ~ UNIT , , , '
~~L~. '~ EXISTING ,
[ [HOUSE '-~~ .... ~SOILABS : :
/n~*~ ~ i ." S.~. 15' X19' '-' ~ ~SYSTEM : ,HSE
i ~v.~/ / l. ' ' ES UAL ' ~' ' '
~/~ ~ ~'~ , R ID :'-._, , o o ~
. , BED ] . :::~:~:~:~:~:~: .~:~ ,,
',' ~~L .....L / ~ .2 , ', ::::::::::::::::::::: , , : , , , , LOT4
_ T.H. ~3 ~ ~T-H' ~4 :
..I ~ , ', '
I ' '
I LOT 20 ' " '
· ,' , ' LOT 5
~ ",,' ~ ', ,
HOUSE ,, , SEPTIC , , SEPTIC
. ', SYSTEM " ', SYSTEM
~ WELL .; - ' ' ', ' '
""'--.__ ~ ..... -- ,, ',
I ,
~ ...............................,~ .................... ,' ~ ....
LOT 21, BLK. 4, MTN. PARK EST ~2
WELL AND SEPTIC SYSTEM
SITE PLAN
~A~OP ~C~C~ S~V~C~S I INCH = 40 FEET
14530 ~C~O S~T' DRAWN BY TFM
ANC~O~O~, ~AS~A 995~6 MAY, 1996
NOTE: TFIIS IS NOT A SURVEYED P~T.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
04/82/1~98 10;16 9~73571781 ARTHUR HELMUTH PAGE 02
....... I~ Y: ,, ;~-~; ,"..
/ I . .
do not overlap or encroach on the Ofo~Y lying adjacefll lhe~elo, thai no -
imDrov.~n,, on p,oper,y lying .jacefll th.,eto e.cfoach O~ ,h~ Pr.'i'e'
covenants, or r~irictions which do nol appea~ on the recorded su~ivlslon
plat, under no c ir cu.,t ante, ~uld any dale he,eon bo used for
construclton or lot asr ablishing ~unda~ O~ fence fines. '~ "': '"'
~RU~ING ENGINEERS, ~.
04/24/1SS~ 08:~ S07S571781 ~RTHU~ HELMUT~ P~GE 01
W.D. Dotten & Sons
Art& RobeC~aHelmuth
12901LupineRoad
Anch.,Ak. 99516
11/29/97
Mr. & Mrs. Helmuth,
Following is a log of drilled depths on the well under construction on your property.
Please note that the existing well is 'under construction' and as such must be completed as a
fip. i~hed, producing well or properly abandoned as per Municipal Code. In the event the well
is not completed and another well is begun the existing weal must be abandoned, If you have.
any questions on this call M.O.A. Dept. of Health and Hum~ Services, On-Site Services
( ph. 343-4744 ),
Based on your te~afination of our agreement to drill a well on your property we will move all
of our equipment upon receipt of the remaining charges due ( see attached ).
I apologize for any inconvenience this situation has caused you.
Well Log:
0-
84-87
87-116
116-122
122-138
tan silty till
tan silt w/cen~ented boulders
tan silty till
tan silt w/cemented boulders
tan ~ilty till
Total depth: 138' Total cased depth: 122' Total Pipe Left: 124' 1~/~''
Please call if you have any questions.
Sincerely,
Earl Dotten
/]537 Hartzell Road · Anchorage, AK 99507 · Phone: [907] 344-1514
84/24/1998 09:32 9873571781 ARTHUR HELMUTH PAGE 81
Roberta & Arthur Helmuth
631 Stamper Drive
Wasilla, AK 99654
Formerly:
12901 Lupine Rd
Anchorage, AK 99516
April 24, 1998
To Whom It May Concern:
Re: Abandonment of old water well
Employees o! Mike Anderson, P.E. abandoned the old well at 12901 Lupine
Road, Anchorage, AK, on or about March 2, 1998 per municipal code. The
bentonite chips used were obtained from M/W Drilling and the top of the
casing was sealed with 0.25 + inch steel plate welded to the top of the
casing. The site was then covered with soil.
Arthur Helmuth
Date
Roberta Helmuth Date
STATg 0t'
DEPMIT{~'T OF NATUP, M,
12901
~RAV~L: ERO~N, ~g, BgT~, CLARY, DAHP
DEPTH TO STATIC ~JA'~ER LEVEL:
156 t~ Eft, OM IX] TOP OF CA~0 [j ~ROUHD SDRERGE
DATE: 02../B /1~8
~.RS: ~TY, COARSE, GEMEI~ER
.~,TSTOR
~TSTOt~ ~qOJ~
_4 kt~ J~o ~
APR ~_0 199~
Municipali~
, Serv}ces
DFI~E O~ OP~GE: 14~'__. TO ~
~C
ELOT/~4Eff S~: 4'X~ $ PER ~0~, ~: 1~
VOLUI~ USER:.
DEPTH: ~OM
DURA~: 1 itOUR
~ TO TOP:
__HO~E ~U~PISO 7 +/- OPti
DATE
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
~'/ 70 ~-{ HAA# '~,(c"~ ....
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) /
Property owner
Mailing address
Lending agency
Mailing address ~%~0 Penal;) .~¢~ I~O~
Agent Do~
Address
Unless otherwise requested, HAA will be held for pickup.
Day phone
L~ a~'~//~., .4-~
Day phone
Day phone
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
Public water
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
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1191) Front MOA#21
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/orwastewaterdisposalsystem issafe, functional and adequate for the number of bedrooms
and type of structure indicated herein, lfurtherverifythat 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.
NameofFirm ~' l~ t-/-~? 'T-~c~,o [¢~;f ~-,,'~'~ ~-.J
Address I V,5-,F o /~ 0 6 o ...¢'/.... /~-~ c 4 ¢, ro~, ~ ,
Engineer's signature ~~ ~ '2¢7,¢,..~.(_
Phone 3
Date 5' //E/,¢~
o .
DHHS SIGNATURE
'v/ Approved for \~-~,~
Disapproved.
Conditional approval for
bedrooms.
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~)25 (Rev, 1/91) Back MOAI~21
Legal Description:
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
RECEIVED
Municipality of Anchorage APR 2 0 1998
DEPARTMENT OF HEALTH & HUMAN SF_/~:i~, OF ANCHOP, AGI:
Environmental Services' DivisioJRVIRONMENTAL SERVICES DIVISION
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority ApprOval Checklist
].of ~/~ )~/oc/<' ~ /ff~o Pa~'/<'Ec/'-Cf~'ParcelI.D.: 0170'~3P-I
If A, B, or C, attach ADEC letter. ADEC water system number
Datecompleted P~.?e,~;~ '~1~-<"/,~ I~
Cased to ~edr~ c ~
FROM WELL LOG
<~ /y '7,j- '
Date of test
Static water level I ~'~' '
Well production '7 .-~
WATER SAMPLE RESULTS:
Coliform O¢o[/too m .~ Nitrate
Date of sample: /'[ / I /
B. SEPTIC/HOLDING TANK DATA
Date installed b~/I? / ? ~ -Tank size
Foundation cleanout (Y/N)
Date of Pumping ~//I.~
C. ABSORPTION FIELD DATA
Date installed ~/2-~ / ?6'
Length 19 ~ Width
Casing height (above ground) "& '
Wires properly protected (Y/N) 'r'
AT INSPECTION
g.p.m, g.p.m.
/ ,.,~d Other bacteria
COllected by:
Number of Compa~ments'
Depression (Y/N) ~ High water alarm (Y/N)
Soil rating (g.p.d./fF or ft~/bdrm) I, b~vR/~c~.,z System type /Io
/~-' Gravelthickness below pipe 0,6~ Totaldepth ~', O
Effective absorption area '~ g'5- 0t Monitoring Tube present (Y/N).
Date of adequacy test ~/.~. (_KT-yrz'c'lg)Results (Pass/Fail)
Immediately after
Absorption rate =
If yes, give date
Fluid depth in absorption field before test (in.);
Fluid depth (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
__ Depression over field (Y/N) __
For -~
__ gal. water added (in.):
.g.p.d.
bedrooms
72-026 (Rev. 3/96)*
D. LIFT STATION (~/0C)/¢[¢ ~(/~;/~
Date installed ~ / /~ / ~'
Manhole/Access (Y/N)
High water alarm level at* ~ ~ '/z"
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
F.
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
Size in gallons
"Pump on" level at* 8 ~' '('¢" "Pump off" level at* 5- '/8"
*Datum /'~o/-1~, o/ P'~,~ A'
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ¢ ~ ' Property line ~ O' Absorption field 3¢ '
Water main/service line ~> 2--~-¢ Surface water/drainage ~> ¢o~, ' Wells on adjacent lots ~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
~ ~' ' Building foundation ,5-,~'~ Water main/service line
Property line
Surface water ~ too'
Curtain drain h/onE ¢~
ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area > 5-¢ '
Wells on adjacent lots ~> ~ oo,
I certify that I have determined thru field inspections and review of Municipal records that the above systems are
in conformance with MOA HAA guidelines in effect on this date. ~
Signature .~~ ~ ~¢t¢.~ ~L
Engineer's Name ~'/1¢,:,~.~'o¢z¢ F. ~oo~d
Date A~;/ /~ /~¢~ ..... :z :.. '..,.~.~- "
HAA Fee $ .~¢-'0 ~.4¢
Date of Payment ~//.~3 /: 2
Receipt N u mber ~::~ / ,,~
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125
8005 SCHOON STREET ANCHORAGE, ALASKA 99518 {907) 349 1000 · FAX 349-1016
POUCH 340043 PRUDHOE BAY, ALASKA 99734 (907) 659-2145 · FAX 659 2146
Flattop Technical Services
14530 Echo St.
Anchorage, AK 99516
Attn: Ted Moore
Client 1D:
Client Project #:
Source:
NTL Lab#:
Sample Matrix:
Comments:
L21 Blk 4 Mtn. Park Est. #2
Drinking Water
Helmuth Residence
A154725
Wastewater
Method Parameter Units Result
Report Date: 4/6/98
Date Arrived: 4/1/98
Sample Date: 4/I/98
Sample Time: 14:50
Collected By: T.M.
** Legend **
MRL = Method Report Level
MCL = Max. Conlaminant Level
B - Present In Method Blank
E - Estimated Value
M = Matrix Interference
H = Above MCL
D Lost To Dilution
Date Date ]
MRL Prepared Analyzed
SM 4500 E
Nitrate-N mg/L 1.56
1.25 4/3/98
Rcp e& B}: Jo;ma Ku sisYo
Ch6~nistry Supervisor
NORTHERN TESTING LABORATORIES, INC,
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125
8005 SCHQON STREET ANCHORAGE, ALASKA 99518 (907) 349-1000 · FAX 349-1016
POUCH 340043 PRUDHOE BAY, ALASKA 99734 (907) 659-2145 · FAX 659-2146
DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA
Flattop Technical Services
14530 Echo Street
Anchorage, AK 99516
Phone Number: ( )345-1355
Fax Number: ( )345-1355
Collected by: TFM
Sample Type: Private water Systems
Method of Analysis: Membrane Filtration (SM 9222
B)
Comments:
Date Received:
Date Analyzed:
Date Reported:
Next Sample Due:
Comments
S =
U =
POS =
ND =
TNTC =
CG =
HSM =
SA =
4/1/98 Time Received: 15:30
4/2/98 Time Analyzed: 16:30
4/6/98 Time Reported: 10:04
Satisfactory
Unsatisfactorv
Positive Test Result
None Detected
Too Numerous To Count (>200 Colonies)
Confluent Growth
Heavy Sediment Masking, Results Mav Not Be Reliable
Sample Age >30 Hours But <48 Hours, Results May
Not Be Reliable
Sample Age >48 Hours, Too Old For Analysis
Resample Required
Old =
R =
NT = No Test
* # Colonies/100 mi ** # Colonies/mi
Sample Sample Total* Fecal Other* HPC**
Date Time Coliform Coliform Bacteria Result Lab~ Location Comments
4/1/98 14:50 0 ND 0 NT AC8307 Mtn Park Estates L21 B4, Satisfactory
#2
Sherri L. Trask Environmental Analyst
Northern Testing Laboratories, Inc Anchorage, AK
4/6/g8
CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 ANCHORAGE, ALASKA 99516
April 24, 1998
M.O.A. DHHS, On-Site Services
Attn: Donna Mears
P.O. Box 196650
Anchorage, AK 99519
Dear Ms. Mears:
The purpose of this letter is to provide assurance to DHHS that I have agreed to collect samples of
the effluent from the Biocycle unit serving the residence on Lot 21, Block 4, Mountain Park Estates #2
within 30 - 60 days. The samples will be tested for BODs, TSS, TKN, NO3-N, and FC, and the results
provided to your office as soon as they are available.
Sincerely,
Ted Moore, P.E.
Cc: Arthur and Roberta Helmuth
907~4~1~55 P.02
CT&E Ref,#
~ ~,Jec~ Nam~
CU~ S~mph m
CU~ ~
Pt~mbgl l~t~'ime 06/25/98 08:21t
Coll~"t~l DezelTlme 06/18,98 10:40
li~ceive4 I~t~l'lm~ 0fi/18/98 1 l
Tedmlml Dfl',~,,,=. Stephm C, Edt
~lcers Pc1~rtm~t
Fecot colif~ ~ ~F
g-~ Z.OO
3.BP O.~O ~IL
19.1 T.OO m~/L
AL Lo,,k~bt e Prep Armly~t~
I. infi ~_~ ~a. te O~te
EPA I,t,O.Z 06/19198 TI~
EPA '~'OO.O 06/Z='/~ 06t2Z/9~ ~
RECEIVED
JUN 2 9 1998
MunJctpahty o! Apcnorage
Dept. Health & Human Services
TOTR~ P, 02
....... 8tOCYCLE ALASKA
......... ] QU ARTEL~L~_~.,~M~A,.IN ,T. ENANC_..E REPORT
S~i~ ~s~ct~ons: Name of Se~iee l'¢chnioi~n: ~-
Municipality: ~lr~l~lr~r_... ..... System$iz~: ~ Numb,:rofOccup,,nts: ~ NumberofT~nks:
All Diffuse r,a Operaling?
ANAEROBIC CI'IAMBER
mm ${udge})¢pthAeecptablc? ~
__ mm Square Junctions tn Pla~ & CleanT(~
Overflow ]unctions Clem-? ~x~" {
AEI~, ,T,!ON CI-IAMBER
Sufficient Air Supply?
/urpump Filter Cteaned:
pipcworkIntac~,?~ LiqUid EolourAe~cplabl¢? ¢Datk Brown)
CLARIFICATION ,TANK
Arc thc Ovc~ow Junctions Cleatr7 ~ AnyUnacc~plnblcOdour0? [~]~)
Pipework ~n~¢t? ~
Chlorinator Fmc fi'om Fomi§n Mattcr'l ~ Number of Chlorine Tablct~ Added: ~ Chlo~ator Inlac! aid Op~:ratiog Wnll? ~
Am thc ehlofine Cannistcrs Clean and lnta¢l? ~ ArctheChlorineCannis'terLid$On? ~
IIs~hc Tsnk Cl~n7 ~
IRRIGATION TANK
ZLZCT Cm SyI MS
Vnual H~sh Wate~ ~n~ ~? AUtO Hi8h Wa~r ~a~ O~afi~?
Vi,~ ~r ~ O~,ins, ~ ' ~
~ ~e-EImM~ B~ In.ct? ~ ~l ~bles OK? ~ Audio Air~. O.mfi.7 ~ Backup
IRRIGATION 8y,,,STEM
pH R~ading: __
Dissolved Oxygen Reading:
OVERALL SYSTEM ~ ~ Acceptable ['~
PERFORMANCE Ver~ ~,x. ~
I~tr~o~
poor ~ S=rvio¢ T~-hnicisn's Signature: ~-
b)st~Jlafinn Address:
Special t.nstruclions:
r,~-~,..,~,-,~,,.~ t'"') J BtOCYCLE ALASKA
" ':'' ' ~)UARTE,,RLY MAINTENANCE REPORT
ANAli;ROBIC C, ,,,,HAMBER
$cumD cpthAcc~ptnblc? ~ ~. mm Sludgnl~plhAc,'..cpl~bleq ~ ...... mm Squ.r~.Zunotio"sinPlac~& Clca~
AERATION` CHAMBER
Overflow Junctions Clem,?
~ Temperature: E-'-] {
Su~cicnt Air Supply? ~ pipework Intact? ~ Liquid CoDut Aeec~)~blc? (Dark Brown)
M~ump Filter Cl~n~:
CLA~CATION TANK
' IRRIGAT!ON
bthoT~nkClcea? ~ l~theLiquidColourC~am'~--~--] Cerc, m~at~: CL;~'~/~
I~he?ipcworkbomligPumpOK? ~ Areth¢$PmYs°rgprinkeraW°rldnswell? -F'~T~ ' ]
~GAT,I, ON SYSTEM
OVERALL SYSTEM,
~o~
DateofThisServict: 6;~ /~("~n
Sy~.em Sm: ~ Number of Occupants: ~ Number of Tanks:
Time: ~ Temperature:
ANAEROB!,.C CHAMBER
mm $1'ud$~ Dvpth A~p~able7 ~
mm Square JunctJon~ inPlace
AEKA.TION CHA. MBE. R
CLARIFICATIOI~ TANK
Ate lh~ Ovcdlow/un,efforts Cl~r? .any Unacc~teble Odour$? ~
Chlorinator Free from Foreign Mailer? ~
NumlmofChlorineTablclsAdd~: ~ Chlorinatorln~ctandOIz~tiugW~ll7 ~
thc Chlofinn Cannisters Clean and Intact?
CHLORINATORL''' MOl"
Are thc Chlorine Cannister Lids Ors?
IRRIGATION TANK
la thc IA~id COtour Chain?
IRRIGATION Sy$TEM
ANALYSES
pl-[ Reading: __ Dissolvett Oxygen R~,~d~ng: , ~ F~ Chlo~ R<ading: ~
Lrt., BlOC Y CLE ALASKA
..... ~.,oic, ~. ~J OUARTEI~Y MAINTENANCE REPORT
S~c~ ~ctions:
Name of Scrvic~ Technician: ('_"~. alt~YiF~
SySt,mSiZ~;/~ NuvaberofOccuparlt,: ~ Num~erof'fanks:
ANAEROBIC CHAMBER
__ mm Squ~r~ SunclJons in Pla~ & Cl~n?~
AEI~ TION CHAMBER
Stlflicienl Air Supply'/ ~ Pipewmk InS,ct? ~ Liquid Col0ur Acccp~blc? ~ark Br~n)
~ump Filt~ Cl~ncd: ~
Ovcrll°w Jurteti°n s Clear'/' ~
Temperature: L_~
CLARIFICATION TA, NK
A~ thc Ovcdlow Junctions Clear? ~ Anyt)'nacccptableOdom'e? ~v
Pipcwork ln~t? ~
AsclhcChlorincCaanister~Cl~nandl. ntact? ~ Are~hcChlofineCanrtislerLidsOn? ~
thc Tsak Clczn? ~
IRRIGATION TANK
Imgafoa Pump Ol~tatmg? ~
~is~ Air AM, m O~rstins?
Is lib-Electric, ti Box lnt~et?
_ELECTS, ~AL SYSTEMS
pH Rem:ling: __
Dissolved O~gcn Rrading:. ,
CHI: __.
~amc of Service Tcchmcian: tt'~S"~
,,A, NAEROBIC CHAM~ER
Scum DcpLh Acceptable? ~ , . mm $Iud$¢ Dq['lh Aor~ptabl~? ~
~ mm Square: Jun,lions in plmc¢ & Clean? ~
AERA,TION CHAMBER
All Diffu.~rr, Opcna6ng? ~ Any Odou~? ~ Bio-mass Growth Accep~a~:,le? ~ Ovcffi0w Junctions Clear? ~
Suffi,icntAirSupply'! ~ Pipewoi'klntaet? ~ LiquidColomAc¢cputbl¢? (Dm'kBrown) ~ Tumperatu~'e:[-~--~
Airpump Filter Clcan~: ~J-~ + ~~. _
CLARI, FICATION TANK
Any tJnaex~ptabk: Odoura? ~
Arc thc Ovcrftow Junchons Cie'ar?
CHLORINATOR 2--- AJ/,t,n
Chlonnator Free from Fotcisn Matler? ~ Numar ofChlo~ TabJe~ Ad~: ~ Chlofinatar In.ct ~d'O~mting Well?
~eChlofiucCannislmCl~and~ct? ~ ~lhcChlofifl~C~nist~LidaOn? ~
!, ,RRIGATION TANK
SYSTEMS
pH Rt. ading: , ~ Dissolved Oxygen Reading:
ANALYSES c~., ~.~..,4~: ;
1A,~vt,~ua Mot~r.lm,~,~ll~ . -- l
~i. Frm Chlorine R~ding: ~ ~ wv~ ',~,~,: J
OVERALL SYSTEM
Scum Depth Acc~tabl¢? ~ ~
A. NAEROBIC CHAMBER
mm $ludg~ Dcplh Acc~plab[¢? ~
__ mm Squ~rc Junctions in Pl~cc & Clan? ~
~ARIF,ICATIO, N, ,TANK.
Pipcw0~k IJdact? ~
Al'ctheChlorin¢Canni$lersCl~tnandlnlael? ~ Arcth¢Chlodn¢CannisicrLids'O~? ~
thc Tat*~ Clca~? ~
I ,RRIGATION TANK
IRRI, GATION SYSTEM
pH Rca.ding: _
Di~olve4 Oxygen Re&ding' _ .
Fr~c Chledne Readins: __
PERFORMANCE Very
DEPT. C?
MUNICIPALITY OF ANCHORAGE ENVIRON;d;NTAt_ ;,'.~ ~ ;CTION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
~/~ 825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720 RECEJVFD
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
PROPERTY RESID~:NT (If different from above) ' PHONE
2. BUYER~/~'.x~.~t~' '~~ PHONE
MAILING ADDRESS
3, L'ENDING INSTITUTION /) 1 PHONE
MAILING ADDRESS
,..EA',O.,AGENT
MAILING ADDRESS
5. LEGAL DESCRIPTION
I 6. TYPE C/~ RESIDENCE
~ SINGLE FAMILY
· [] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One ,[~ Four
[] Two [] Five
[] Three [] Six
[] Other
7. WATER SUPPLY
J~ INDIVIDUAL* ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[~ PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
,[~ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date ~zz~. /Tt'~ .
If system is over two (2) years old an adequacy~est is required
[] PUBLIC UTI LITY by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
F-ISepti,c~ank or [] Holding Tank
Size:__l O~'~'''(~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
~ APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY(Title)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)