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HomeMy WebLinkAboutKASILOF HILLS BLK 8 LT 13 Municipality of Anchorage Page _ / 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 Permit Number: ~¢"J ~'~ o~ ~z PIDNumber: O/5'- N,,~:~,~ ,5'-~'/,;~'/~.00 ~.. Wastewater System: Ei'lqew [] Upgrade ~d,e,,: ABSORPTION FIELD ~:~ 75~/ ' ~pTr~h DShallowT~nch aB~ aMou~ ~Ot~r LEGAL D ESCRI PT IO N ~ ~: ' To., ~,~,.,~ 1~ 8~ ~-~ _ . ~t.. ~ WEL~ ~ew D Upgrade G~ ~ ~um~oUn~: ' ~dll~ I Date ~1~: ;~W~ I~ Date ~11~: SEPARATION DISTANCES ~ O Holding  Mattel: Numar of CompaA~nts: s~,~c~ LIFT STATION Water ~/0 0 ~/0 0 ~ ~ '- Lot ~0 ~/0 -- ~ ~ ~elngal~: ~M~nufa~m~ Line "~mp ~" ~ at: I"~mp o~ ~ a~ ]~igh wat~ ala Foundation / o I - Drain Remarks: ~~.. ~ /~/~g BENCH MARK L~tl~ a~ ~ptlon: " [ ~su~ ~e~tion: / /0~, 0 ENGINEER'S S~L Inspections pedormed by: . Dates: 1st ~- 7 ,~:~~~ ,. ~,,~,~,.. Department of Health and Human Se~ices approval '~¢,~.',-'~'~' ~" ~' Reviewed and approved by: 2'~:., ~,~ )-". 7i:-/.,--'-:~bate: 7~/('-?~ ~'~Y~AL Il:lev 9/91) MOA25 Permit No. SW950094 2 2 Page _ of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN $£RVlCE$ ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report LegalDescription: LOT 15, BLOCK 8, KASILOF HILLS S/D PIDNo.: 01,515202 SECTION A-~, 100' W~LL RADIUS WELL~ ~- I I /' I I H )USE I I , co n~co co ~ 72-013 A (Rev. 9/91) MOA 25 PermitNo. ,.)"t,,~ ~'OO?~' Pago ~' o! ~ Municipality of Anchorage 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 Legal Description: I I ! ! ! / A 72-013 A (2/91)MOA 25 ENGINEER'S SEAL · PermitNo. ~%'/-.,L) ~O0~ ~ Page '~ of ~3. Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIFIONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-66§0 · Telephone: :343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PID No.: f, o 0 72-013 A (2/91) MOA25 ENGINEER'S SEAL 1201 Ramona St. 0q51 .= ,~ki'~O~..~k.~]B~, ~kX,~ I 14-7714 SIX INCH WATER WELL DRILLED DRILLED AT THE RATE OF PROPERTY OWNER ~ernL e LOCATION OF WELL SlTF DRILLER BernLe Claus OUt TO THE DEPTH Of 3.=.5 ft. PER FOOT. Steel casing seated out to L:3 ft. Claus of Ra~oart Drilling Works kL IVFL) JUN 2 2 1995 WELL LOG: Munimpah~y ,¢. ,. ............ ) - 16' ~ne ~ravel w%t~ 19% clay .naterial. Dry J~:~l~'~l-t'~.&Huma''~'~''~:ces 16 - 38' Coarse gravel with 1=% clay. Dry ,aterial. 38 - ~3' A broken con~!omerate of bedrock. _]..3 - 3~ Bedrock. A sedimentary tyoe bedrock. No water ,yield until 26~ ft. About one gore coming out of ~ranulated rock. _From ~ly to 3z/ ft there are several fissures of oorous rock? & in the last 15 ft. oroduction increased t~ & $.~ (2~3 gallons oer hour) coming ou~ of a oorous area. Test oumoed f~r .~ ~purs with full draw down at Water recovery comes back uo to within 35 ft. of surface. A one horse sub~ersible oumo should be' use~ in this well & installed about 23 feet off botto.~. The water quality of this well is exceotional, giw;n that all the wells in this immediate area are exceptional...Medium hardness & no contaminates. All above information is certified by Ber~_ie Claus of Ra..~oart Drilling. This Water Well has been oaid for in full. C'-O~T INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ............ BERNIE KS DATF October 2"~ 13q~ ROBERT C. COWAN, RE. ROBERT A. SHAFER, P.E. August 14, 1996 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECNANIOAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALI57 OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 13; Block 8; Kasilof Hills REEF,"' ..... ' AUG 1 6 1996 Mtm;cipality of Anchorage Oept. Health & Human Sentices We have been requested to resolve and provide documentation for the five items listed by the D.H.H.S. dated 12/20/95 and the conditions of approval of the H.A.A. dated 1/16/96 for the subject property. Additional site work and grading was completed just prior to our inspection on 8/8/96. Each item is addressed respectively below: 1) Elevation shots were taken uphill and downhill of the trenches at points that appeared to be at or near original ground surface elevations. We found an elevation change of 13.2 ft. in 70 ft. of run. This would be about a 19% slope. 2) Additional grading has been done to create a minimum 25% slope between a point at the northwest cleanout 2 ft. above the distribution pipe and a point at the toe of the slope downhill from the trench. (see attached drawing) A waiver to AMC 15.65.050.1-B is requested. 3) There is no way to determine if part of the effective depth was installed in organics without digging up the system. We noted about 6% ft. of cover at the northwest cleanout. 4) Perforated drain pipe has been replaced with solid pipe-from the structure to the outfall. 5) A replacement site is located along side of the septic tank. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 MUNIUPAUTY OF ANCHORAGE Development Services Department �v'. Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I. D. 015-132-02 IN Certificate of On -Site Systems Approval GENERAL INFORMATION Complete legal description Kasilof Hills 138 L13 Location (site address) 10741 Glazanof Drive Expiration Date: l7_�2_9 L—e-0 Current property owner(s) Jonathan & Jennifer Casurella Day phone Mailing address Real estate agent same 2. TYPE OF DWELLING: F-1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee Date of Payment g a 0,0 D 7 Receipt Number �(�,.3 Cn COSA# ©SC,20 'N l� Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MCA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water 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. this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Narne Steven R. Pannone P.E. Date OF Aqkk� . 49 TH 6. DSD SIGNATURE s; • • • • •r`r-S��7 l/ System #1 Approved for H bedrooms an CE -0149 System #2 Approved for bedrooms Disapproved �For%?o'�ssic�>i`�° Conditional approval for bedrooms, with the following stipulations: `o�-\1,� OF A*S6,, I ssLZ nKI_qITE r.) g WATER AND 1 SEi1R111`� \l By= v Original Certificate Date:�Zy The Municipality of Anchorge Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory_ Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Kasilof Hills B8 L13 Parcel ID: 015-132-02 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled lalel-)l 0 Total depth 355 ft Cased to 43 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12"+ in. Date of flow test for COSA 8!9'2020 Static water level at beginning of test 45.5 ft. .i �. 411 17 Well production at time of test 3.0 gp Water storage tank volume n/a gallons Well disinfected for coliform test? El Yes ❑✓ No ❑ Coliform bacteria is Negative Nitrate , �,_�. mg/L Nitrate less than MRL (ND) Arsenic ug/L R3 Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample 8119/2020 Comments s, VV1"7 ld_V B. TANK DATA Age of tank(s) 25 years Tank type/material se "Slee' Measured operating fluid level in septic tank On Standpipes/foundation cleanout per record drawing Date of pumping 7/7/2020 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 1995 C;) ❑ ALL standpipes present per record drawi8.8/10.5 Total measured depth from grade ft Measured depth to pipe invert from grade 3.3/5.3 ft (min) ❑ N/A – pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: `H\.P_ U1rAt—r r,, jn r COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 8/'9/2020 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 0/28 in Water added 600 gal New depth 0/39 in Elapsed time 220 min Final fluid depth 0/28 in Absorption rate >600 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date WA,,, {-urs 5 c, - --o tCar?`k -Af-(ds WoAcr- Farces n%s r . d ?c ss"yy ` k' -Vv k lvc�o t Si es 64 "t'c SPIa • ': rIWAC) E. SEPARATION DISTANCES From Private Well onLot to: (Please enter distances if less than required mif community well) Septic Tank/Lift Station on Lot >100' L�]Yea ifNoft Community SewerManhole/Cleanout >100' Q,/ Yes �� �N « � �� — `�'Yen ifNo# Neighboring Tank >�1OO' MYea ifNoft �lYea Private Sewer/Septic Line 25'[7lYes ifNoft Absorption Field onLot 10O' ��Yeo ifNoft MV Holding Tank 1OU' FqYas ifNoft Neighboring Absorption Fields >�10O' Yea ifNoft Animal Containment >5O' FqYon if ft ��Yes ifNoft — -- ---- �Wanure/Anima/ExcnabaStonage�1UO' (�ommunitySewer PWoin>�75' E] Yes ifNoft — Yeo ifNoft FromSeptic/Holding Tank ooLot to: (Please enter distances ifless than required) Building Foundations >10' f-VIYoa ifNoft Surface VVeter>�10U' 0Yes ifNoft PropertyLine 5I L�]Yea ifNoft ifNnft Wells onAdjacent Lots: AbsorptionField > 5' MV Yes ifNoft Yea Private Wells >1OO' Yes if No. Water Main >�1O' �lYea ifNoft Community Wells >�2OO' Yom if No. Water Service Line 10' MV ifNnft Surface VVaher>�180' |fseptic tank iounder driveway comment below From AbsorptionField onLot to: (Please enter distances if less than required) Building Foundation > 10' El Yes if No ft If absorption field is under driveway comment below Property Line >�1[[ F71 Yes ifNnft Wells on Adjacent Lots: Water Main >1U' Yea ifNoft Private Wells >1OU' Yea if No Water Service Line >1O' Yes ifNoft Community Wells 2U0' UYaa if No Surface VVaher>�180' Yea ifNoft F'ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION /oarbfy that /have determined through field inspections and review of Municipal records that the above systems are /nconformance with MOA CO3Aguidelines /neffect onthis date. COSA Checklist yellow sheet '—�R~^P 'nnoo ' CE 8149 ' ft ft ft ft MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Nitrate Advisory Certificate of On-Site Systems Approval # OSC201472 Subdivision: Kasilof Hills, Block: 8, Lot: 13 A water sample revealed a nitrate concentration of 7.9 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached “Nitrate Fact Sheet” for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. "We Keep Alaska's Water Flowing" 907-230-1868 9/10/2020 In regards to property 10741 Glazanof Dr. Said well on this property after inspection and review has the following findings. Total casing depth 41 ft. First water encountered at 45 ft. First major water source was found to be 71 ft. During the inspection no cracks, breaks or perforations were found. Well cap was found to be intact. No signs of construction flaws. No signs of environmental contamination were found. If there are any further questions please feel free to contact me directly. John Netherton 907 Water Well Services 907-230-1868 907waterwells@gmail.com 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 1. GENERAL INFORMATION Complete legal description Lot 13; B~ock 8; Kasilof Hills Location (site address or directions) 10741Glazano~ Drive Anchoraqe, AK Property owner Tom SmalZwood Mailing address P.O. Bo× 240005 Anchorage, Day phone 786-5221 AK Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: xxx If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Name of Firm 17.'3~4 E:¢: ~!v:.- L~p ~_*_*.~ 'A=. 2~ Phone ~q Address E~g[e River, Alaska 99577. Engineer's signature ' /: ~_~¢--zJ~_ .. Date DHHS SIGNATURE /~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ~-~' - . / ~ Date ~'- ~'-~' 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 DH HS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 1/91) Back MOA #21 MuNICIPALIIY ~F ANCI-IL~ru~L~e t[NVIRONMENTAL SERVICES DIVISION Municipality of Anchorage~;.~'" ~ g 1996 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" St,'eet, Room 502 $ Anchorage, Alaska ggs01. (g07) ~4~3~,C4[~ 1V ~ [3 Legal Descril)tion: A, WELL DATA Health Authority Approval Checklist Well type. Log preseut (Y/N) Total depth Sauitary seal (Y/N) Z o Z If A, B, or C, attach ADEC letter. ADEC water system namber 2/ Date completed Cased to /_?/,fi / Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform /'d f'~ Y FROM WELL LOG . g.p.m, Nitrate Date of sample: / ~ - 7- 9,...~- B. SEPTIC/HOLDING TANK DATA Date installed Foundatiou cleanout (Y/N) _ Date of Pumping c. A so PTION toLD DAXA Date ir, stalled Casing height (above ground) Wires properly protected (Y/N) _ AT INSpEcTION ~., '2 ~, Other bacteria Collected by: ' /'./?,,,c/ ~ ,,c" ~-';~,'~ g.p.m. Soil rating (g.p.d./ft2 or--g~dr_-_:) /5 ~ System type # Gravel tldCkness below pipe ~'" Total depth . Monitoring Tube present(Y/N) fi'/_ Depression over field (Y/N) Number of ConrPartments ~ Cleanouts (Y/N) __ High water alarm (Y/N) Length ~'~ Width Effective absorption area Date of adequacy test Results (Pass/Fail) ~ For ~ bedrooms Fluid depth in absorption field before test (in.); Fluid depth ~ (ins.) Milmtes later: Peroxide treatment (past 12 months) (Y/N) hmnediately ~ffter ~ gal. water added (in.): Absorption rate = ~ g.p.d, If yes, give date ~ Tank size / ~5'() Depression (Y/N) /X~d Pntnper ~ LIFT STATION /L/0 ~' /-~ .5 ~ Zee) Date installed Size iu gallons Manhole/Access (Y/N) -- ~'Pump ou' level at* ~ ~Tump off" level at* ~ Ifigh water alarm level at* -- *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding rank on lot %/Ot::9" Absorption field on lot -~/F_~O r Pablic sewer mare ~ /d'~O" Sewer/septic service line fi- ~t55~ ; On adjacent lots .; On adjacent lots Public sewer lnanhole/cleanout Lffi station SEPARATION DISTANCES FROM SEFFIC/~Ui~4~I~k~ "rANK ON LOT TO: Building foundation 4- /~ Property line 4- ~ 6> Absorption field Water maivJservice line /- 56> Surface water/drainage '~/~ O Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT 'FO: Building foundation /' ~ 0 Water ~nai~ffservice line Surface water '//Ot9 ' Driveway, parkin~vebicle storage area Curare dram Wells on adjacent lots Prope~ line F. ENG~EER~S CERTIFICATION 1 certify that I have determined thrufield inspections and review of Municipal records that the above systems are inconformancewithMOA1L4Aguidelinesineffectonthisdate. ~.~e' /¢~ t~t~r~~¢ ~ Date of Payment / ~g- 9~ Oat~ of Payment ReceiptNumber /~5-7~' (;/'/C:~) ReceiptNumber Rev. 8/95 OSS: haa.wk.doc MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Z~ 7' Z-/ ~ ,~ ,,~ $ ~ ~ /3 Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Dayphone ?~¢ 52'Z/(°) Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State AD£C attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 {Rev. 1/91) Front MOA #21 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 ~hat 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 o.n-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and rec]ulations in effect on the date of this inspection. J" Name of Firm c"'a,~ J';~ (~,c, q,,ZS' Phone Address ~,o/ ~Je// ~/~ ~ ~/~ ~?~/~ Engineer's signature ;~f'/'~'/~ ~'-- Date /' ~'~/~ CONDITIONS OF APPROVAL: 1. Abandon west(downhill) trench and replace with a new trench to the east of existing system 2. Perform additional so~l testing as required and design a replacement system and show replacemen~~ site on final as-built drawings ~~ 3. ~elocase Qralntl~e originating [rom rounQatlon to a m~nlmum d~stance of 50 feet from the septic~}i~{% system or replace dra~nt~le wzth solzd p~pe. (Show on fznal as-bumlt.) 4. Engineer shall inspect septic system for dayllghtlng ~~ent on a 6. DHHS SIGNATURE monthly basis & report monthly findings to this dept. Approved for bedrooms. Disapproved. Conditional approvalfor four (4) bedrooms, with the following stipulations: 5. Perform well flow test on the well and submit the results of this test to this department. AdditionalComments ALL WORK MUST BE COMPLETED BY JULY 1, 1996. MONIES SHALL REMAIN IN ESCROW UNTIL FINAL APPROVAL IS GRANTED FROM THIS DEPARTMENT. '--- '" The Mur~}cipality 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 er~gineer 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 omission8 in the professional engineer's work. 724)25(Rev. 1/91) 8ack MOA ~21 9~1 8UDf'~ ~R~4~'R Og.: (~r~) ]46.2000 .:. Constru ,~i!i,.i3g:E n gi neers .... ~ ,,,w.~ ~ ~ f~B f4,q.~ Construc~,i .'.n§. Engineers E n§i ne~,~i.i.~urveyo rs ..~i~,,~.,,,,": .... ... . ,;~.;,. ~,, ', H~-N RY WI,~ON ~1 ~IDL'?/',,'VERNER DI~.~ Constru~fi.~i' En~lnee~ · -~ ~: ~in~;Surve¥ors RECEIVED ~ MU~dcipali~y of Anchorage g~ept, Health & Human 8e~ices 7"/,f/.,< HENRY BUDDY WERNER DRa AN~Ht",IL~I:. AK ~51h 9,5 -- O .5 - ? 0 .ri, . :,~t.~:~ ,,,:::.:. g ..... EnBin"~},g ~eyors; ""~'~ '"'~!'5 ~1 ~_.o to Dt T I o tos ~DER$ON BRO$, CONST TE[.:i-go?-694-32a4 Jan 08,06 i8~04 No.OOS P,Ol ~.0. BOX 770~9 ~A~ ~V~R, A~ASKA 99577 PHON~l 694-3~? FAMt 694-3244 / hereby lebor- complete Ir~ a¢¢orda.co with IWove spinificntlOnt, tot the $~Jl~ w~thcl~ewn bi P~ il hal accepttd p u, ............. . ....... ;:;;.. ' , . ,_.~ ..... : ":__ ~_. "" ~ig~lur~ ~~..~. } := ~....~ ................ ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SJ=,RVlCES On-Site Services Transmittal Shee_t The attached paperwork has been reviewed and is being returned for the following reason(s): Discrepancy in legal description and/or owner name. Discrepancy in number of bedrooms. Signature and/or stamp missing on Show measured distances to sewers/wells, curtain drains and streams within 200 feet of preposed system./ Replacement disposal site not ' Calculation error in design. / Show locations of all soils, percolation or water table tests. Proposed system too deep for soil test submitted. Topographic information missing or inadequate. Narrative missing or inadequate. __ Additional soil/perc test needed.~OZ Sand filter requirements not satisfied. Water monitoring results missing or inadequate because X Incomplete; missing O/V ~5-~UlCT Well log required. Water sample unacceptable because ~/_ Other Please supp] request. Ye Reviewer f y the necessary information and re-submit your ur cooperation is. ~ppreciated. ,%[~l~,~.h_ ~, ~~(~ Date !~q~? ~!?~ LEA VE THIS FORM ATTACHED TO PAPERWORK /203-rev. 4/93 Municipality of Anchorage . 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 1 I ./ 72-O13 A (2/91) MOA 25 ENGINEER'S SEAL ~'~ ~. '~.-- ~- ~ b','~' 72-013 A {2/gl) k A25 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES On-Site Services Transmittal Sheet TO: ~,~, WlC.<~>/~ LEGAL: The attached paperwork has been reviewed and is being returned for the following reason(s): Discrepancy in legal description and/or owner name. Discrepancy in number of bedrooms. Signature and/or stamp missing on Show measured distances to sewers/wells, curtain drains and streams within 200 feet of proposed system. Replacement disposal site not shown and/or tested. Calculation error tn design. Show locations of all soils, percolation or water table tests. Proposed system too deep for soil test submitted. __. Topographic information missing or inadequate. __. Narrative missing or inadequate. ~1%c Additional soil/perc test needed. satisfied. Sand filter requirements not; Water monitoring results missing or inadeq~te because ~ Incomplete; missin ~/~LCT~-<>, ©~ ~$p~/C~a Well log required. Water sample unacceptable because Please suppl~ ~he necessa~ ~nforma~on and re-subm~ ~our request. ~our coope~t~on ~s ppprec~ated. t, EA VE THIS FORM A~ACHED TO PAPERWORK /203-rev. 4/93 Municipality of Anchorage Page, / 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 Permit Number: c,~¢~..) ~ 5 ~ ? ~ PID Number: ~m~:~ Wastewater System: ~ew D Upgrade · ~'~": ' ABSORPTION FIELD LEGAL DESCRIPTI ON so,,...~: 'ro~., /' ~ GPD/Sq. Lot: Bl~k: Subdlv~ion: Depth I0 ¢~tto~ from original gra~: Gravel depth ~neath pipe Township:%,~ ~ I Range: ~ Section: _~ Fi[~ Gravel length: ~ >~>~~~~' Numar of lines: Dists~ ~ li~: WELL:~pgrade e.v~ ~ Ft. ~. / ~ Et, Driller: ~ I Date Dd{l~ Sta~Level: Installer: Date installed: Yield: ~u~t at: ~ I ~ing H~ove Ground: ~t Holdl~ =ubllFPrivate Manufacturer: Capaci~ in gallons: TO Septic Abso~lion ~ LI~ From Tank Field i~ Tan ~ewer Lines ~O~, %~ ~/< / Number of Compadments: Su.ac. ~ % LIFT STATION ~/~ Water ~/~0 ~/0 o - Lot ~ein gallons: Manufacturer: Line ~0 ~/~ -- ~~ FoundatiO. */¢ * ZO _ _ ~ "Pump~e, at: "Pump o~'~evel at: High water~larm at: Ou.einDrain +~-o +~ _ _ ~% Pump Make&M--~~____e, I Electrical Inspections podormod by: Remarks: /) I¢~ ~¢: /¢~ '¢ ~z ~BENCH MARK % l ~sum. Elevation:  ENG~EER'S SEAL Inspections pedormed by: "'__ _~ Dates: 1st - Department of Health and Huma ~ices approval Reviewed and approved by: _ ~ Date: 72q)13 (Rev 9/91) MOA 25 Permit No. ,.FO ¢5'oo2'y' Page Municipality of Anchorage 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 LegalDescription: L.I~ 'l~ /~,/~3[LOF F~I~,L$ PID~.: <D 72-013 A (1/93) · HENRY WILSON 9601 BUDDY WERNER DR.: ANCHORAGE, AK 99516 1907) 34~-2000 Constru¢fi' g. ; : .__ Engineers En g i rveyors Mr. James Cross, P.E. Program Manager, On-Site Services DHHS P.O. Box 196650 Anchorage, AK 99519 December 5, 1995 R.e: Lot 13, Block 8, KasilofHills Discussion of slopes per AMC 15.65.030(G) and AMC 15.65.060(A.2.a) Dear Mr. Cross: In 1994 the writer was retained to design a septic system for subject lot. Although constrained by an existing well on the lot, an area adequate for a conventional system existed as shown on the design. Constraints regarding grades and location of proposed improvements were discussed with the client. Subsequently, the lot was sold. In 1995 the writer was called by an excavator to inspect subject system installation. On arrival we observed a completed foundation. The grade of the foundation was higher than expected. A pioneer driveway impacted the replacement site. I contacted the new owner and discussed the situation. Owner advised tie preferred the area southeast of the foundation for a replacement even if pumping is required, as the drive location called for on the septic design would not work with the existing foundation. We dug a test hole SE of the foundation before installing the septic per the design. Finishing the drive and final grading has created slopes greater than 25% that are less than 50 feet from the system. The E.P.A. Design Manual briefly discussed slope criteria for trenches on page 212. The only limit cited is for safe operation of equipment. The Manual further states that slopes in excess of 25% can be utilized and refers to a paper by J.T. Winneberger and J.W. Klock for further guidance. Rather than retyping page 140 of Winneberger and Klock, I am attaching a copy of their steep slope discussion. The essence of Winneberger and Klock research is "...slopes as steep as 70% or even more can serve as a site for a disposal field..." and "...steep slopes are avoided for fear that effluent will find daylight. Slopes as such do not result in such an occurrence." This writer's 25 years of experience agrees. I have seen a number of old systems on very steep slopes that are working well. I am confident that subject system will also work well, and request its approval. Very Truly Yours, Constructing Engineers H. H. Wilson, P.E. Steep Slopes Steep slopes are difficult for equipment constructing disposal fields. 20% slope is almost the upper limit at which a backhoe can work safely. Sometimes a terrace can be cut for operations, but this requires deep soils and tends to ruin landscapes. Sometimes it is practical to dig a disposal field in steep terrain with handtools. Constructed carefully, in appropriate places, slopes as steep as 70% or even more can serve as a site for a disposal field. sOmetimes steep slopes are avoided for fear that effluent will find daylight.. Slopes as such do not result in such an occurrence. Effluent finding day- light is caused by a disruptioh of the soil mantle in the immediate path of percolation. Such occurrences (roadcuts, rock outcrops, or the like) are not matters of slope but rather they are matters of misjudgment of on-site conditions. NK/NICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950094 DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC. OWNER NAME:SMALLWOOD THOMAS H & KAREN M OWNER ADDRESS:10741 STROGANOF DR ANCHORAGE, ALASKA 99516 PARCEL ID:01513202 LEGAL DESCRIPTION: KASILOF HILLS BLK 8 LT 13 LOT SIZE: 28500 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 PAGE 1 OF DATE ]iSSUED: 5/30/95 EXPIRATION DATE: 5/30/96 THIS PERMIT IS FOR THE CONTRUCTION 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 (iSAACS0) . 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: P~O~,APc/_E, IMPAGT8 TO AD-TAGENT ~-OTg: Ag gHOWN ON THE ~IT~ Pl_AN, DEVELOPMENT TH~ Wg&& AND 8~PTIG ~YgTEM9 FO~ THI~ ~OT WI&~ HAV~ NO ~I~NtFtOAN'r ADVE~8~ THE AD,AGeNT A, W~LL~ 0. ~V~D ~PAO~ / ~U~FAO~ AND AND D, D~AINA~B ANOHO~A~, AgA~KA LBT S PLAN WASTBWATER ASSISRPTTBN SYSTEH 13 BLOCK 8 KASILBF HILLS SUBDIVISIBN VACANT VACAN'F [250 GAL SEPTI NK SEPTIC WELL RADII, HOUSE FOBTPRINT TOTAL AREA AVAILA}}LE FBR SEPTIC SYSTEM EXISTING WELL ON LOT N0 ENCROACHMENTS ON THIS LOT OTHER THAN SHOWN, THIS PROPOSED SEPTIC SYSTEM HAS NO ADVERSE IMPACT ON ANY LOTS AS SHOWN BN DRAWING 19,350 SF 8,150 SF PREPARED FBR: BERNIE KLAUS HENRY H, WILSBN, P,E, 9601 BU1) gY WERNER DR ANCHBRAGE, AK, 99516 348-2000 DATE: 6/1/94 IDRAWING ~ 1 SCALE: 1' : lOg' L~7- WASTEWATER ABSORPTION SYSTEM 13 ]}LOCK 8 KASILOF HILLS SUBDIVISION PROPOSED FRAME HOUSE ~= 5 co 14' SEPARATION O0 dq / ~250 GAL SEPT~ TA~IK CO CO BOTTOM OF TEST HO~E DESIGN CRITERIA l, SOILS RATING 1,2 GP]]/SF 2. 4 BEDROOM HOUSE = 4 x 150 GPD/BEDROOM = 600 GPO 3. 600 GPO ~ 1.2 GPD/SF = 500 SF ABSORPTION AREA 4, 500 SF :- (8)(5'D) = 50 L_F TRENCH (M]NIHUM) 5. 8' HD INSULATION REQUIRED OVER TRENCH IF < 4' GROUND COVER 6, 8' HD [NSULATInN OVER TANK IF < 4' COVER 7. INSTALL 1850 GAL STEEL SEPTIC TANK PREPARED FBR: BERNIE KLAUS HENRY H, WILSON, P.E, 9601 BUDDY WERNER DR ANCHORAGE, AK, 99516 346-2000 6/1/94 ] NOT TO SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION 'TEST PERFORMED FOR: LEGAL DESCRIPTION: 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O ~/~/'clr., ,',P,_~ DATE PERFORMED: /.3~c~' /'~%~,//~2~' /~'~/~.cTownship, Range, Section: ~"/2'/,.J /~..~t2 c~ /~.,~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? --- C u.~e:l L, N S IF YES, AT WHAT DEPTH? P E Depth Io Water After .,~..~,~ Monitoring? - Dale: _ Reading Date Gross Net Depth to Net Time Time Water Drop / 5--Z.5---- o o- /~ ,, Z $,~ :~ -,,; ?" /" $ ~,~ ,3,~ ~'" /" y' ?,, .S,.~ ?" /" ~ /~ ~ ~ ~ ,, / ,, PERCOLATION RATE ~ (minutes/tach) PERC HOLE DIAMETER ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4185) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~' /~ ,/¢~ /~'~-.L,$//~/"/,CC'~/~wnship, Range, Section: ~""/EA./ /~¢-(J ,~/,..~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS {,) ~'~-!~¢ ~¢['~' ~"~h SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~ ~) DEPTH? p E Oopth to Waler After Monitoring? ~ 0ale: ~'~" ~ ~ ' Reading Date Gross Net Depth to Net Time Time Water Drop ~ 5'- ~,5' ~ o {o" ~ Z',. ~ ~'" ,3" ~ /~ Zm I ~" ~" PERCOLATION RATE /~ ~ (m~nutes/inch) PERC HOLE DIAME]ER ~ '~ o.~ ~¢¢? ~s 5,~,...(/ .~o~. c.oo/d d~..5. PF-RFORMED BY: /"'~ ~ /'~//~0,~,.. I ~"/¢~" '~/'/~'~ CERTIFY THAT TRIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: '~"'~; ' ~''''~' 72-008 (Rev. 4/85) 'i201 Ramona St. 0951 SIX INCH WATER WELL DRILLED ......... OUT TO THE DEPTH Of 355 ft. DRILLED AT THE RATE OF PROPERTY OWNEr ~ernt e Claus PEr FOOT. Steel casing seated out to b3 ft. of Ranoart Drilling W,or!~s LOCATION OF WELL $1T~ DrillEr BernLe Claus RE(blVFD JUN 2 2 1995 WELL LOG: Mur'liclpai~iy ) - 16' ~t. ne 5ravel wit~ 10% clay 'naterial_.__ Dry ~16 - 38' Coarse gravel with 1.=% clay. Dry naterial. 38 - &3' A broken cong!_o,nerate of bedrock. 43 - 3~ Bedrock. A sedimentary tyoe bedroc!{. No water yield until 26~ ft. About one gore coming out of glranulated rock. = to 35~ ft there are several fissures of oorous rock~ & in the From 31 ~ · last 15 ft. oroduction increased to /4 g..o~ (2L,'3 ~allons oer hour) comin~ o~ of a ,oorous area. Test oumoed f~r .$~_~u_rs wit_h f~u.ll draw ~own at 4gPm. Water recovery comes back uo to within 35 ft. of surface. A one horse subaersible oumo should be' used in this well & installed about 2~ feet off bott%~. The water quality .of this well is e×ceotional, given that all the wells in tkis immediate area are exceptional. Medium hardness & no contaminates. All above information is certified by Bernie Claus of l%.',oart Drilling. Tkis Water Well has been oaid for in full. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ..... BERNIE KS DAT~, October 2',~ SERVICE CHARGEOM lv/,% PER MONTH WILL BE ASSE.~SED ON PAST DUE ACCOUNTS. CT&E Ref.# Client Sample ID Matrix Client Name Ordered By Project Name Pro,ject# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services ~-~.~-~-.~.e-.~.~.e-.e-~-.e,.~-.~-~-.~-.e-.~r~ LABORATORY ANALYSIS REPORT 94.1762-1 GLAZNOFF LT. UPPER O'MALLEY WATER Lt 13 Blk 8 Kasilof Hills RAMPART DR1LLINGWORKS BERNIE CLAUS UA WORK Order 77658 Printed Date 04/30/94 608:53 lu:s. Collected Date 04/21/94 ~ 13:30 hrs. Received Date 04/21/94 ~ 14:30 hrs. Teclmical Director STEPHEN C. EDE Released By: ~ ................ Sample Rmnarks: SAMPLE COLLECTED BY: BERNIE CLAUS. IRON EXCEEDS THE RECOMMENDED DRINKING LIMIT. QC Parameter Results Qual Units Method Allowable Limits Ext. Date Anal Date Private Individual 1t20 EPA/SM Alumh~um 0.24 mg/L EPA 200.7 ICP Arsenic 0.050 U mg/L EPA 200.7 ICP Barium 0.041 mg/L EPA 200.7 ICP Cadmimn 0.025 U mg/L EPA 200.7 ICP Calcium 34 mg/L EPA 200.7 ICP Chromium 0.025 U mg/L EPA 200.7 ICP Copper 0.025 U mg/L EPA 200.7 ICP Iron 0.55 ~ng/L EPA 200.7 ICP Lead 0.050 U mg/L EPA 200.7 ICP Magnesium 4.8 mg/L EPA 200.7 ICP Manganese 0.025 mg/L EPA 200.7 ICP Phosphorus 0.10 U mg/L EPA 200.7 ICP Potassium 2.5 U mg/L EPA 200.7 ICP Silicon 5.0 ~ng/L EPA 200.7 ICP Silver 0.025 U mg/L EPA 200.7 ICP Sodium 7.3 mg/L : EPA200.7 ICP Zinc 0.025 U mg/L EPA 200.7 ICP Nitrate-N 2.42 mg/L EPA 353.2/300.0 Chloride 7.44 mg/L EPA 325.3/300.0 Sulfate 23.7 mg/L EPA 375.4/300.0 Residue,Filterable(TDS) 130 mg/L EPA 160.1 Hardness as CaCO3 100 mg/L SM 309A Alkalinity as CaCO3 71.6 mg/L EPA 310. l Conductivity 218 umhos/cm EPA 120.1 pH 7.51 units EPA 150.1 Total Coliform 0 #/100 mi SM 908 1.3 max 10 04/26/94 04/26/94 04/26/94 04/26/94 04/26/94 04/26/94 04/26/94 04/26/94 04/26/94 04/26/94 04/26/94 04/26/94 04/26/94 04/26/94 04/26/94 04/26/94 04/26/94 04/22/94 04/26/94 04/21/94 04/27/94 04/27/94 04/27/94 04/27/94 04/27/94 04/27/94 04/27/94 04/27/94 04/27/94 04/27/94 04/27/94 04/27/94 04/27/94 04/27/94 04/27/94 04/27/94 04/27/94 04/28/94 04/27/94 04/28/94 04/25/94 04/27/94 04/21/94 04/21/94 04/21/94 04/22/94 DFL DFL DFL DFL DFL DFL DFL DFL DFL DFL DFL DFL DFL DFL DFL DFL DFL MCE MCE MCE lEK DFL IEK lEK GPP * See Special Instructions Above ** See Smnple Remarks Above U = Uudetected, Reported value is the practical quantification limit. D = Secondary dilution. UA = lhtavailable NA = Not Amalyzed LT= Less Thau Gl'= (h'eater 'Ihan 5633 B Street, Anchorage, Al( 99518-1600 --Tel: (907) 562-2343 Fax: (907) 561-5301 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~-/~g-i.-/~ '--.2 ~.*.~ HAA Ct ..~ ~-,~C:~ ( ~..¢? r',\ 1, GENERAL INFORMATION Complete legal description Lot. Location (site address or directions) Property owner Mailing address Tom Smallwood P.O. Box 240005 10741Glazanof Drive Anchoraq~, AK Anchorag e, Day phone 786-5221 AK Lending agency Mailing address. Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site , Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. XXX 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. 4. S&$ENGINEEEING (.~¢j ~ '-.-~ ¢17 ~ Name of Firm 17034 E:-~!: .mvsr L*-=F P.=:d N=. 2~ Phone Eagle River, Alaaka 99577 Address Engineer's signature '~7/~//~/~ ~- ~-----zJ~ ~ Date ~') /~" / ¢7~ DHHS SIGNATURE /~ Approved for J Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~ Legal Description: Municipality of Anchorage /~ DEPARTMENT OF HEALTH & HUMAN SERVICEi$!~ J~! C E!IV E D Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 304~474~ 1996 Municipality of Anchorage Health Authority Approval ChecklistDept. Health & Human Semites h/~ [ 5 ~ /~ Parcel I.D.:~ I ~"" - / ~ - O :~ A. WELL DATA Well type PR Log present Total depth Sanitary seal If A, B, or C, attach ADEC letter. ADEC water system number Date completed )'~ / ~ o Cased to z¢ ~ Casing height (above ground) Wires properly protected ~)/N) I Date of test Static water level FROM WELL LOG AT INSPECTION /'-/- ~ g.p.m. Well production g,p.m, WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: ~ 7/~ Other bacteria Collected by: B: S~P~_.~_~HOLOING TANK DATA Date installed ~ / c~'(J-' Tank size Foundation cleanout ~'~/N) ~[ J Depression (Y,~) Date of pLlrnping'~ I"//_ ~ /'/~ C~Pumper C. ABSORPTION FIELD DATA Date installed Length ~ ~ Wid, th Number of Compartments L~. Cleanouts ¢~/N). ~' E J' ,Ax 0 High water alarm (Y/~)) ~v o Soil rating ~r fF/bdrm) ). Gravel thickness below pipe System type Total depth ¢'') "' ~ )'A Effecti've abSor, ption area 5~,~0 ¢'r Monitoring Tube present (~N) Y~J Depression over field (Y/¢ Date of adequacy test/v ~/¢ ~ ~ ~ cJ Results (Pass/Fail) For Fluid depth in absorption field before test (in.); Immediat_~~. gal. water added (in.): Fluid depth (ins) Min_.u..~~ Absorption rate = .g.p.d. Peroxid~s~12 months) (Y/N) If yes, give date bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) "P u m~_.p~~ water alarm~ *Datum High Cycle'ed Size in gallons "Pump off" level at* E, SEPARATION DISTANCES ~holding tank on lot Absorption field on lot Public sewer main SEPARATION DISTANCES FROM WELL ON LOT TO: 100 -/--- ),~o '.v- ¢o0 Sewer/septic service line ~ ~' ~ Lift station /v / SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO: Foundation ~- ~- Property line ~ ~ Absorption field Water main/service line I ~ '~ Sudace water/drainage / 0o '~ Wells on adjacent lots On adjacent tots On adjacent lots Public sewer manhole/cleanout SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ! O -/- Building foundation ~o -/- Water main/service line Surface water ? ¢ ~ '¢- Driveway, parking/vehicle storage area / Curtain drain .~, 0 ~ re. ~;/,, ~ ~v~ Wells on adjacent lots O o ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records in conformance with,MOA HAA .cluidel~es in effect on this date. Signature jJ~~~~ Engineer's Name //~0zc~'4~'r ( ' ~0 ~ HAA Fee $. Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)*