HomeMy WebLinkAboutPARK HILLS #1 BLK 2 LT 2il
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Municipality of Anchorage Page of --3—
DEPARTMENT OF HEAL.TH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: S V1 910:4 PID Number: 0 0 — i 4.V-- - 15
Name:
Wastewater System: 0 New D Upgrade
ioLk,
A cc�-�401
Address: I, L4 1, -31
[1=1 Dy-
ABSORPTION FIELD
Phone: '�, !L S- — -,22
ODeepTrench OShallowTrench Dead XMound ElOther
LEGAL DESCRIPTION
Soil Rating:
Total Depth from orminal grade:
GPD/Sq. Ft.
Lot: Block: Subdivision
ti,ob )_ a- _P014-6-
epth to pipe bottom from original grade:
Gravel depth beneath pipe
9 v,
1 -4,6- Ft.
Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
V
Ft.
Ft.
WELL: L1 New Ll Upgrade
Gravel Aelp". k9li'
umber of lines:
Distance between lines
S 0 Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
Ft.
Ft.
6'0-0 SQ. Ft.
P to' id,
Driller:
Date Drilled:
I d
StaticWater Level:
_/
Installer:
1.)
Date installed:
Ft.
A,
Yield:
I
Casing Height Above Ground:
TANK
Ft.
Ft.
SEPARATION
DISTANCES
0 Septic El Holding XS. T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
acity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
Well
Material:
Number of Compartments:
Surface
N/A
1_//At
N11
LIFT STATION
Water
Lot
Line
q0
Siz rus:
0;
anu romper
L
>j u
10'F
14 &17
Foundation
E3 -,]E
6
"Pump on" level at: Pump off" level at:
11
Ll
Highwateralar at
1
�
Curtain
NA
imp Make & Model
Electrical Inspecti.r;s verformed by:
.
Drain
P X-1
Remarks:
BENCH MARK
Location and Description.
Asa ed Elevation
3-ra
ENGINEER'S SEAL
Inspections performed by: Dates:1st
2nd 11)
Department of Hea and Human oprvices approval
S
Reviewed and approved by7w Date:
72-013 (1/91) MCA 25
1%00
WO
i-
GVm
Top 17f Bed Efev. 1045
Bottm 17 Bad Dev. JWM
Ant) J40
6- 0 Septic rock
Sond Leveling Course
SCAW I' � 15 FT.
Ak 3 Ff oP Cover
�VC TO STEP rANK
rom.
Jw rw TTFP Tfird
IIUBBLN Nt-UNKLAND 1.L. SEPTIC SYSTEM AS BUILT
203 W15th. Avenue Lar R BLOCK 2 PARK HILLS SID DATEi JAWARY 9 J992
ANCH, AK 99501 J" CAETON
1-11 — 11— 11 14631 PARK HILL DRIVE SHEET, 313 GR
7— T'
INSPECTION REPORT
�AOTY OF AN&HoRAGE, BUILDING SAFETY DIVISION.
MUNICIP
3500 EAST TUDOR ROAD
INSPECTIONS (907) 563-3464 e INFORMATION (907) 71ill!1-8211
NAMEU-e-14 13_�.
STREET� AD 01
REIS
A
LOT BLOCK SUED IV. DATE
FOOTING 0 ELEC. TEMP. El PL13G. UNDGR, El
FOUNDATION 0 ELEC. SERVICE D PLBG. ROUGH D
BONDBEAM El ELEC. ROUGV) El GAS TEMP. El
FRAMING - -7 E)
El ELEC. FIN*V.0 GAS
INSULATION E) OTHEI C MECHANICAL El
SHEETROCK —�J MECH. FINAL 0�
STRUCT. FINAL FIRE FINAL — I-] PLBG, FINAL El
OTHER 0 ZONING — EJ OTHER
pg�NO NONCOMPLIANCE OBSERVED 000RRECTIONSESSENTIALAS
EXPLAINED BELOW
0 WILL REEXAMINE AT NEXT INSPECTION 0 DO NOT CONCEAL UNTIL REINSPECTED
COMMENTS
INSPECTOR 'DATE
"EN�CORRECTIONS ARE MADE, PLEASE CALL FOR INSPECTION
DO NOT REMOV THIS NOTICE
84-002 IRev 11187)�
PAGE 1 OF
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650 JPIIA 010
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910288
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:CAETON A JOHN &
OWNER ADDRESS:14631 PARK HILLS DR
ANCHORAGE AK. 99516
PARCEL ID:01714215
LEGAL DESCRIPTION: PARK HILLS #1 BLK 2 LT
LOT SIZE: 56686 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
2
DATE ISSUED: 9/12/91
EXPIRATION DATE: 9/12/92
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
FOLLOWING THE REMOVAL OF THE PEAT AND/OR TOPSOIL,
SAND MUST BE ADDED IN SUFFICIENT DEPTH TO ASSURE A
MINIMUM OF 4 FEET SEPARATION ABOVE THE UNDERLYING
GROUNDWATER WHJ_CH_,,�ES-,4 FEET BEL03q GROUND SURFACE.
RECEIVED BY:
ISSUED BY:
) - 16-1 a 01 JtLA L) �d 4C� EA6 U
DATE: '�za /I (
DATE: 'x,
203 �l 15th. Avenue, Suite 206
ANCHORNE, ALASKA 99501
(907) 179-3916
SEPTIC SYSTEM DESIGN
EDT 2 DEOCK 2 PARK HIEES S/D
JOHN CAETON
Gir oi.m d N a h c2 r- �, A t 4 F t �. E I r� wa t i c) i 1 9
f� F:']' Ent; S U r j. z c.? cl Be)d
7 / :1. 0 9 '1 �..4 B / 2 J. / 9 A.
Sw�i 1. rz cik L j. I I g F r a (1) L. c. T�.i t
16 mil)/ill
per
(!".-5o/.,4 = :..l-7'5
N �..i ni h o i, of B(-!cJrcjc)fy'S 4
T
f'.w?d Ar p.a 4 x -IT-5 1 "4510 0 1-1 cl t
SYSTEM CONF-ISURATION
MOUND
TOTAL
LENGTH
50
FT.
TOTAL
WIDTH
30
FT.
TOTAL
DEPTH
0
FT.
ROCK
DEPTH
.5
FT -
COVER
3
FT.
SEPTIC TANK EXISTING.
LIFT STATION 500 SAL STEP
ABANDON EXISTING SYSTEM
fhc� :i I V -al .1 a t -i aii o F (�hit; sc)fAic-, MYStefil Will 1'10t� C01-1-flict VAH-F th(?
ol."istAlig orl thea acljacc�'rlt lot..s.
-1 ? drairlagc.4
f hc� r t--, a], ric.) d *Vol or)(��d or I I i., Lt.kra I, st.kr f; ac t�. / st..tb f.5utr f
c:(:)L.tr ric?s ori Hiis or U-ic, iad.ja.ccml� I a t t5 �
I ha pr c)pc)G(-'cj �:.;qpt. i c sm�y�'i IAJ:i. I I I lot c-Tiarig(.2 Ulo gc�r)or a.1 !�';l C) p (I c) F
1:. 1-1 C.� al, I cl j. I I cl �arl d / or c cirl c: oll t r a ol-i c) f m� L.tr fa (-.: c-� r'L.tf 1 of f w :i .1 1 1") Ot
r L-�SU 1 t f: (" MCI [-� 1-1 i V3 :i 1-1 �A a I I ��tlA 011 -
Soptic Syst.tem 1)c�tigri
I.. . a t '2. f-.3 .1 c) ( � I � V:'a V k. 1-1 j. 11 1
pg� 1.
ell
\V
IV
100
%
CF -1225
0 50 foo 150
200
?50
300 350
S'CALE:
I' =
J00FT,
TOBBEN SPURKLAND P ,
LOT
2,
BLOCK 2 PARK HILLS
S/D
SEPTIC SYSTEM DESIGN
6751 W. DIMOND B LV�'E
11
JDHN CAET17N
DATE, AUGUST 19, 1991
ANCH. AK. 99502-3904
14631 PARff 1411 /.� nR[VF
SHEET: 113 GRID -3037
A s
'o
FBN 100,00
518 REWILOT MRNERG
................
...............
.........
k�DRIVE WA Y
JAISLIL A TE Ll
....... ..
......... ..... . ...
4
. ........
....................
.........
.............
TALL 500 GAL STEP
..........
....
PUMP S TA TIEN
............
... ..... .....
0
............ . .
..............
0
.. . ..... . ...
...........
EXIST. TANK
... . ..........
................ ..
...............
4-.gCpg,,,g
v f,b
CE.^225
0
15 30 45
60 Z5
90 105
SC& E., I'
3OF T.
TOBBEN SPURKLAND P.E.
L17T 2,
BLOCK 2 PARK HILLS
S/0
SEPTIC SYSTEM DESIGN
6751 W.
DIMOND BLVD,
JUHN C4[TDN
DATE, AUGUST 19, 1991
AMC . H. AK - .
-- 99502-3904
IA41V pApw wil �, npwr
SHEETi Pl? GRID, 3037
50.00
0 F 1-114 PVC 1/8' Holes at 6' ;?1 PVC TO STEP TAW
600
3U0 99
Nowtor rube so 0
Hin, 3 Ft of Cover
Top IN'Bool Elev. 104.5
F910 I I.. I I IA I I—_
Bottol ll 00.00
lAr 140
6� of Septic rock
Levell Coupse L
500 6al STEP Tank
2
2
C."
TOBBEN SPURKLAND P.E. LOT 2 BLOCK PARK HILLS S/D SEPTIC SYSTEM DESIGN
P-03 W15th. Avenue FDATE: 4LIGLIST Pi? 1991
ANCH. AK � JUHAI CAETHN
14631 PARK HILL BRIVF SHEET, 313 GRID, 3037
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 1" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: '104N CALETON1 —DATE PERFORM
�(ENGINEER'8 SEA4
i C'
LEGAL DESCRIPTION: LOT a. BI-oc-K Z, Township, Range, Section:
F/ si�`Ili
'YT-�
.& _pL IpAe:V 1.4 1 L_j_ C. S SLOPE
� .3
4
5
6
7
8
9
10
GO-KA6 1�1 (4-
V) Y 0 L4�"
S �0.� - I -
I ;3 -e -co
WAS GROUND WATER
ENCOUNTERED?
0 P
r
I IF YES, AT WHAT
12 DEPTH?
13 0opth In Water After t I Algale:
Monitoring?
14
15
16
17
18
19
1.1" 1
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
11, 61
57M.
0
14 1-
tj W//
L ( I qLlt.
Iz?
15 7-
1
11146
—'0
la,
20 PERCOLATION RATE I (� (minutes/inch) PERC HOLE DIAMETER
TESTRUNBETWEEN 024 FTAND 13 FT
COMMENTS
PERFORMED BY: — I — CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: q,
72-008 (Rev. 4/85)
PERFORMED FOR:—
LEGAL DESCRIPTION:
DEPTH
(FEET)
2
3
4
6
7
8
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
191 20
COMMENTS
C
MUnICIPFIlItY of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
, 11A T
tE��GiNrER'.$'�tAL)
7.
—DATE PERFORM
nship, Range, Section: I L'
SLOPE SITE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring? — Date:
L
0
P
E
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
_41 —wa
V�)
—
to
1 0
q 1(,
171/1.
2�0
jo
11 /1"
10
10/16
a
j L3
:& 17-
6
I CD
u
PERCOLATION RATE (M1nLgeS1mCh) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND –OV—FT
PERFORMED BY: I — CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4185)
71e� h(,3
A + 9 D j
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: -�o" eae-� DATE PER
q
LEGAL DESCRIPTION: �/z 7i�e4k 974 Township, Range, Section: Cleo,
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT L
0
DEPTH? P
E
Depth to Water After
MunhDring? — Date:
SITE
Reading Date
G ross
Time
Net
Time
Depth to
Water
Net
Drop
7 4-0 Jq
/X� 0
'11
10
3 "/1
IC)
4b
A, 3.q
-3
0 A
PERCOLATION RATE 2VQ-- (mmutes/mCh) PERG HOLE DIAMETER
TEST RUN BETWEEN 01 YZ— FT AND 3 — FT
PERFORMED BY: — I — CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
'r C_ 3
A) `(E�GINEEIFVS SEXL),
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
p,
PERFORMED FOR: C�ia a" —DATE /7
LEGAL DESCRIPTION: Township. Range, Section: N f2'3 UL
SLOPE SITE PLAN
FD E P—T 7H
I (FrET) I
1
2
3
4
5
6
7
8
9
10
11
12
13
14
16
16
17
18
19
20
11111100111TAVIUM
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT L
0
DEPTH? P
E
Depth to Water After
Monitoring? __ Date:
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
H1 2,2-.q I _10 Li 8
—
D
I IA
-6 C)
112.— loll
T_
IV//I,
L4 P,
qIII,
7 to J0
12 IV//,,
12, oi?7
PERCOLATION RATE la — (minutes/inch) PERC HOLE DIAMETER
TEST RUN 13ETWEEN /7 " FTAND 123'/FT
PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
0 I_, &':t� 0 NJ 11
Q5\N,D|MUNDBLVD,
SPECIFICATIONS FOR SEPTIC SYSTEM INSTALLATION
LOT 2 BLOCK 2 PARK HILLS SEC 34 T12N R3W
1.0 GENERAL
1.1 Owner is John Caetnn. 14631 Fark Hills Drivc, Anchor-
age, Alaska 99516. Phone 345-3153
1,2 Engineer is the person or entity hired by the Owner to
inspect this project. The Engineer must be recognized by the
Municipality of Anchorage, Department of Health and Human
Services.
1.3 Contractor is the person or entity hired by the. Owner-
to
wnerto install thin The Contractor must be recognized
by the Mun:[cipality of Anchorage, Department of Health and
Human Services
1,4 The Drawings, sheets 1 through �, shall be part of this
specification"
1.5 Al.] materials and workmanship shall meet the require-
ments of the Municipality of Anchorage, Department of Health
and Human Services, the con(Jitions of tke permit, and all
applicable rules and regulations currently in effect.
1"6 All excavation depths are advisory, and are to be
verified and may be mpdified in the field by the Engineer,
1.7 It is the responsibility of the Owner or the Contractor-
to
omtractorto adhere to the approved design, to verify that the speci
-
fied separation distances are met, and that the required
inspections arc performed.
1,R The Contractor or the Owner sha]l report to the Engi-
neer any ohserved condition which would put the septic
system in violation of State or Municipal regulations"
2"0 SEPTIC TANK
2�1 If is an sept1c tank, 1t may used 1f
it meets the capacity re4uirement for the residence. The
tank shall b� insperted by the Eng ineer- , and its water
tightness and structural integrity shall be verified.
2.2 A new septic tank shall be one fabricated by either
Anchorage Tank and Welding nr by Greer Tank
Specifications for septic system installation
Lot 2 Block 2 Park Hills C.3 /I)
p g . 1.
The septic tank shall be a UPC -approved two-compartment
tank, constructed of 12 gauge, or better, steel with bitu
mastic coating. The tank shall be not level an undisturbed
soil.The tank shall be covered with the equivalent of four
feet of soil.
2^3
The septic tank shall be installed a minimum of
five
feet
from the house foundation and a minimum of
five
feet
from
the absorption area.
penetrating
the
2"4
The septic tank shall be a minimum of 100 feet
from
any
well
serving a single residence; 100 feet from
any body
of
water,
creeks or drainage ditches with flowing
water;
150
feet
from Class »C'/ wells, and 200 feet from
Class A
or
Class
B wells"
2,5 All pipe connections to
watertight calder couplings.
as designated and capped with
outs shall extend a minimum of
elevation" Provisions shall
importation if topsoil.
the tank shall be mechanical
Cleanouts shall he installed
air -tight rain caps" Clean -
12 inches above final ground
be made for landscaping and
2.6 Lift station shall be as manufactured by Anchorage Tank
and Welding or as provided by Acreage Systems, Inc.
3°0 ABSORPTION FIELD
3.1 Gravel used in the absorption field shall he 0,5 to 2.5
inch screened rock, with less than 3% passing the No, 200
sieve.
3^2 Sand, used for leveling or for filtering, shall have an
effective grain size between No. 40 sieve and No, 18 sieve.
Uniformity coefficient shall be less than 4^ Not more than
5% by weight shall pass the No, 200 sieve.
3.3 4 -inch perforated pipe shall be ASTM FR10" For pres-
sure distribution, pipe shall be Schedule 40 PVC or ABS.
3.4 Solid 4 -inch pipe shall he
Cast
Iran or
HGTM D3034^
3.5 Monitor standpipes
shall
he installed
as shown" That
section of the pipe
penetrating
the
gravel
shall be perfo-
rated, either by drilling
0.5"
holes
on 6 -inch
centers or by
joining a section of
F810 perforated
pile to
a solid section
of pipe.
3.6 Geotextile shall be Mirafi 140^
3.7 Insulation shall be extruded direct burial polystyrene.
Dn,/ Chemical Styrofoam HI 40"
3.8 Topsoil shall he a mixture of 40-60% organic matter,
Specifications for septic system installation
Lot 2 Block 2 Park Hills S/D
pg.2
20-30% sand and more that 20% silt" All quantities are
measured by volume.
3^9 Grass seed shall be Kentucky bluegrass.
4^0 INSTALLATION
4.1 Locate all underground utilities, property lines,
future driveways, existing or proposed water wells, water
ways, surface and sub surface drainage facilities, lakes,
ponds, and all other facilities requiring separation dis~
tances from the proposed septic system. Notify Owner or
Engineer of any observed possible conflict.,
4,2 Stake alignment of system with markers showing the
protective distances from wells and water bodies.
Absorption field shall be located as field staked by the
Engineer. Use rebar at North West property corner as TBM^
Elevation assumed at 100.00 ft.
4^3 Establish an elevation benchmark. This RM shall be
easily identifiable, stable and permanent. Use property
corner rebar or transfer control"
4.4 Install the lift station tank as shown on the drawings.,
Record the inlet and outlet elevations of the tank. Tank
shall be placed on undisturbed native soil"
4.5 Excavate the absorption field by removing all organic
material" Bottom of excavation shall he level and scarified.
Design elevation = 100.50 Filter sand may be used as level-
ing course
Record elevation of each corner and center point of bed.
Construction equipment shall not operate on the floor of the
excavation unless equipment operates on low pressure pads.
Any material compacted by the operation of the construction
equipment shall removed and replaced with uncompacted mate-
rials.
4"6 Place the rock to the depth specified. Do not contami-
nate rock with native materials or spoils from the excava-
tion" Level the rock surface (+- 1«) before installing the
perforated pipe.
4^7 Install the distribution pipe. Record the elevation of
each joint. For pressure system solvent weld the joints"
4.8 Cover the distribution pipe with rock, and cover the
excavation with geotextile before backfilling and placing
insulation, if required. Slope the top of the bed to provide
positive drainage. Design elevation of top of bed is 104.5
Side slopes of bud shall be ma: 3:1"
4.9 Record the finished ground elevation at the beginning,
Specifications for septic system installation
Cot 2 Block 2 Park Hills S/D
pg"3
middle and end of trench. Record the finish ground eleva-
tion at each corner and at the midpoint of the bed.
4"10 Furnish a copy of all survey notes to the Engineer.
5,0 INSPECTIONS
5.1 A minimum of three inspections are required" The
first inspection will be of the open excavation" At this
time the soil conditions will be observed and compared to
the design assumptions. Ground water conditions or presence
of bedrock will be verified.
The second inspection will he after placement of gravel,
standpipes, distribution piping, tank(s) and other compo-
nents as specified,,
The third inspection will be after completion of the work.
Any deficiencies will he noted and the Contractor notified.
Such deficiencies shall be corrected within ten days.
5"2 All electrical work requires either an MOA electrical
inspection or certification by an licensed electrician"
Submit proof of inspection or certification to the Engineer.
5^3 Submit catalog data of all mechanical equipment.
5"4 Notify Engineer at least 24 hours in advance of begin-
ning any work.
Specifications for septic system installation
Lot 2 Block 2 Park Hills S/D
pg./',
I
1 72-013 (Rev. 3178)
MUNICIPALITY OF ANCHORAGE DEPT (D;-
ENVE"U'\""J"'
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION t �T,L
ENVIRONMENTAL ENGINEERING DIVISION
oe'.T'
825 L. Street - Anchorage, Alaska 99501 Telephone 264-4720
1984
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION F,�Ep!:�RT
NAME PILIME L t, 11 1mFW
- -6 UPGRADE
CA Ok L L '� C) ju 6 Ai �j /U < I i P
_J
MAILING ADDRESS
—P-6 A0"x j I C l C' "s 11-E& m 1—, 9 "'A
LEGAL DESCRIPTION
L
L o) - v --7 A r, -
LOCATION NO. OF BEDROOMS
Well )sorntionarea Dwelling PERM;T NO.
DISTANCE TO: 13 �No 4-
I_ 2 Manufacturer Material No. of comp5rtments
o.< C� L -L L
it] I- - - —_ I ..
Q) Uq. —capacity in gallons Inside length Width Liquid depth
IF HOMEMADE:
Well Dwelling
DISTANCE ro
PERMIT NO.
JUA—
Liquid capacity in gallons
<
ma nLJ f act u i e r
_j
ta.T
IS
D LAI� CE TO..
Tv�_
No. Length of each ine
Foundation Nearest lot line
Tual length of lines I Trench width
PERNILT NO.
R
Distance between lines
LL 2
;1 an
of)ines 111
i IV z�
inches
4yjA
7x fr.
---
_�C.
Total
Ir. T-
I an of tile to finish grade e )
Material beneath tile
effectr aq),sq _qphpi� apa'
C1
Length
Width
Depth
PERMI.
< f-
Type -of crib
Crib dianneter
Crib depth
Total effective absorption area
in
Well
Building foundation
Nearest lot line
DISTANCE 10:
1
Class
[Tepth
Driller
Distance
T NO.
_Aj^�_L ',�' -------
__INA
u
Building foundation
Sewer line
Septic tank
Absorption area(s)
DISTANCE TO:
OTHER
Smormir
1"'I�
PIPE MATERIALS
I
40,6
SOILTESTRATING
INSTALLER
/V z to 1-4) &J, i�A i�� 4 - e"
L
REMARKS
�41
_IAA)_� UZ L�_ti( IA/0 f\ J-ikJ I
_I 4's f -i
L — -- ----
Jf -
6
3_1
_71
11 A/ "i
APPROVED DATE
LEGAL
7
`7_7
I-) /Y
L , -4-
A
'2
S. Pm�
w
k
I
1 72-013 (Rev. 3178)
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENTOF NATURAL RESOURES
Division of Geologicai a Geophy4lapal Surveys
Drilling Permit No.
LOCATION OF WE _L (Planes complete either 10, lb or lc.) A. 0. L, No,
-I Borougl� S: bdivis7ionLot Block] Ila. '/4 qf,s Section No, Township Range Meridian
E E)
—of— Wo
JDI�TANCE A IN D 0121E C T I�X RA' tTfE'P'E 1 3. OWNER OF WELL!
�',t r I - 110 ri�.
Address!
Street Address said Area of Well Location
9. WELL 1_00 set Belo. 4 WELL DEPTH: (final) 5 DATE OF tOMPLETI
Material
16, WATER WELL CONfRACTOR'S CERTIFICATION:
u
foe
5 -�-
ON
Top
Bottom
2
6. tCfiblis tool C) Rotary Driven Dug
11 Auger 0 Jetted 0 Bored. C3 Other
�.z
0
7. USE -'ODomellic C] Public'Suppit, Industry
Irrigation C] Recharge Commerical
Test Ill Other;
S. CASING' C] Thraqded 'xWelds ft� 4
cl (_�7 In. to f I. Depth Weight 1) ;;;, Iles./ft.
dicam.-in. to ft. Depth- Statute ft.
9. FINISH OF WELL:
Type. Diameter% 6
slot/M fish Size: Length: -
Set between ft. and ft.
Backfilling - Groval pack __
10, STATIC WATER LEVEL: � ?) f I. /,'.N
Above of ff'Balow land surAolod, Date
�'/�
Equipment used:
11 . PUMP[" LEVEL below land surface and YIELD
ft. after hirs. pumping/ D 9 -P -M
It, after _ hrs. pumping _ il.p.m�
12,GROUTINO Well Grouted: [I Yes R No
Material: [] Neat Cement Ej Other
13. PUMP: (if available) HIP
Length of Drop Pipe ft, capacity 9-1) M.
0 Subm. C3 Jet E] Centrifical Other
14.REMARKS
1 15. Water Temperature .0 0 F
ThiS �c 1 ,a s d )I ad diCtioli and lhis�report is true to the P�aall of my knowledge and belief;
Ba�ialll No a
contract 0pnso, Number
L
'e".
5 19
<
Dole: /4'
,a
A otho,lz,
F-11 02-WWR ropy Distribution. WHITE- Stale DGGS, PINK -Driller, CANARY -Customer
C,
as
0
z
l_ry #_-Np nr4cA-AlDr_wFA17317=
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
f__l P-4 1 -F 1= U U� I F� 1:;.' 6�. U-4 EE L_ L_ F:="F= F.."I'l 1 '7
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE
LEGAL DESCRIP
LOT SIZE:
MAX BEDROOMS
840352
05/17/84
CARLESON CONST
P.O. BOX 110905
ANCHORAGE, AK 99511
346-2786
SUBDIVISION: PARK HILLS
SECTION: 34 TOWNSHIP: 12N
566. :6 (SQ. FT. OR ACRES)
4
rL-Oi-T-:___?
RANGE: 3W
LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU
IN DESIGNING
SYSTEM. CHOOSE THE OPTION
THAT BEST FITS YOUR
SITE.
- - - - - - - - - - - - -
- - -- -- -- -- -- -- - -
-r FT En P4 CD I
- - - - - -
E-3 F= U.,
DEPTH TO PIPE BOTTOM <FT.)
4v0'
4.0
GRAVEL DEPTH (FT.)
12�k�
0. 5
TOTAL DEPTH 0T.)
16.0
4.5
GRAVEL WIDTH (FT.)
2. 5
25. 0
GRAVEL LENGTH (FT.
23.0
47.0
GRAVEL VOLUME (CU.YDS.)
38.1
43.5
TANK SIZE (GALS)
1.- 2150. 0
A.., 250. 0
SOIL RATING (SQ.FT.?BR)
cl"J�-p
-
BLOCK: 2
YOUR SEPTIC
- - - - - - - - - - --
14. r.'s f� n Ir.
4. 0
3. 5
7. 5
5.0
84.0
62.2
1� 250. 0
194,
G -RAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
TANK MUST HAVE AT LEAST TWO COMPARTMENTS
- - - - - - - - - - - - - - - -- -- -- -- -- -- - - - - - - - - - - - - - - - - - - -
I CERTIFY THAT:
1. 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA.
2. 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS,
AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
3. 1 WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK
DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
4. 1 UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 4 BEDROOMS AND
ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES.,
THEN (i) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINEDj (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICALINSPECTION REPORT; AND <3> THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED
APPLICANT
ISSUED BY
DATE: s_/
---------------
DATE: c ;nVon-
I
MUNICIPALITY OF ANCHORAGL
E)
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
SOILS LOG 6
"/C—
PERCOLATION
TEST
PERFORMED FOR: PoNrK Wt"% —DATE PERFORMED: 3 - 2 3 - 8 2.
LEGAL DESCRIPTION: -T";! -3 -r W o -7 A
FDFPTH SLOPE SITE PLAN
(or' 44LimW5
T--R-Otew +0 Z'
2 - 5(t rt., SA#JO
ge - brc,,�tj
3-
HArd W,6,,,g
-
5 �j ra o c, I-
6 1� SILgh-irity rvtoi5r ,
-�kn�,rC qr4uFt_
7
9
10
11
12
13 14�rj DZILI-ln
14
15
1--16
17
181 54,10',
rA')CL
'T.A iq
WAS GROUND WATER S
ENCOUNTERED? 0 L
U
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
q, / %
J
2 2-
'75 'Ile, A I
J
4/
q `43
'7 0
20 -[�� I -, \
PERCOLATION RATE (minutes/inch)
FT
TEST RUN BETWEEN — FT AND
COMMENTS of,.,Qrw 00� 'nerr'l Q,.Pp -15 314 31 41 6000gf
PERFORMED BY:
72-008 (6/79)
CERTIFIED BY:
DATE:
26
Parcel 1. D. 0 17-142-15
Municipality of Anc
On -Site Water and Wastewater
(907) 343-7904
�0_ 16 jz�� IL
Certificate of On -Site Systems Approval
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Park Hills #1, Block 2, Lot 2
Location (site address)
14631 Park Hills Dr.
Current Property owner(s) Steve Lloyd & Julie Drake Dav phone
Mailing address
Real Estate Agent
14631 Park Hills Dr. Anchorage, AK 99516
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
Duplex
Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
WaiverNariance request for:
Received by:
COSA to be released to the engineer, unless
Day phone
TYPE OF WASTEWATER DISPOSAL:
requested by the engineer.
Date:
COSA Fee $ -5;t (0 Waiver Fee $
Date of Payment ?4191kl Date of Payment
Receipt Number Receipt Number
COSA# Waiver #
Individual
El
Holding Tank
0
El
CommuNty
11
Public Sewer
requested by the engineer.
Date:
COSA Fee $ -5;t (0 Waiver Fee $
Date of Payment ?4191kl Date of Payment
Receipt Number Receipt Number
COSA# Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my sea] 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 ls(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 MoA COSA
guidelines and regulations. The reported results describeft$erformance 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.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510.
Engineer's Printed Name Steven R Pannone Date 6/18/2016
6.. DSD SIGNATURE
X_ System #1 Approved for 4 bedrooms
0
System #2 Approved for _ bedrooms
Disapproved
Conditional approval for
bedrooms, with the following stipulations:
Original Certificate Date:
The Municipality of/�nchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 6 by an independent professional civil engineer registered in the State of Naska. The Municipality
of Anchorage is not responsible for errors or omissions in the professionalangineer's work.
ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSA blue sheetj - , c
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checkhst# 1 of I
Structure served by this sy�tem
Certificate of On -Site Systems Approval Checklist -
Legal Description: Park Hills #1, Block 2, Lot 2 Parcel ID: 0 17-142-15
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (Y/N-) Y
Date completed 10/15/1984 Sanitary,seal (YIN) Y Y
Wires properly protected (Y/N)
Total depth 53 ft. Cased to �3 ft. Casing height (above ground) in.
FROM -WELL LOG AT INSPECTION
Date of test 10/15/1984 6/13/2016
Static water level 28 .26
5.0+
Well prod'��tion .10 9 -P -M 9 -p -m.
WATER SAMPLE. RESULTS:
Coliform A)e lonies/100 mL Nit.rate mg/L
Arsenic A -)h ug/L Date of sample: 7141 lo -401 Collected by: Pl�',
B. SEPTIC/HOLDING TANK DATA
Tan I k Tyl:)6/Material Septic/Steel Date installed 9/14/1984'
Tanksize li250 2
gal. Number of Compartments — Qleanouts (Y/N) Y
Foundation cleanout (Y/N) _�L Depression over tank (YIN) N High water alarm (-Y/N) N
el
Date of pumping 7 12-5 1,44 16? PumperA+ Ao� :5 e4t;j
C. ABSORPTION FIELD DATA
Date installed 10/6/1991 Soil rating (g.p.d./ft2or ft�bdrm) 6.4 GPD/SF Red
System typo
Length 50 , ft. Width 30 ft. Gravel below pipe 0.5
Total -depth4,1 6 L,500it2l
ftw Eff. absorption rea Monitoring tube Y. Depression over field N
Date of adequacytest 6/1312016 Results (Pass/Fail)'PagO 4
For bedrooms
Fluid depth.(n absorption field before test 0 in. Water added 614 gal. New depth in.
Elapsed Time: 120 - min. Final fluid d - epth 0 in. Absorption rate 600+ g.p.d-
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give da I to
D., LIFT STATION
10/6/1991 5100 Y
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at 28 in. 'Pump off'level at 24 in. High Water alarm level itt 34 in.
Daturn Bottom of Tarik Cycles tested 5 . Meets alarm & circuit requirements? Yes
E. SEPARAT IONDISTANCES
WELL, ON LOT TO:
septic tankilift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
75+ 100+
Public sewer main Public sewer manhole/cleanout
100+
Sewer Iseptic service line 25+ Holding tank
Animal containment areas 50+ 100+
Manure/animal excrete storage areas
SEPTIC/HOLDING TkNK6N LOT -rb:
Building foundation Property line 5+ Absorptio I n field 5+
10+
Water main Water service liq 101+ 100+
Surface water
Wells on adjacenklots 100+
ABSORPTION FILD ON LOT TO:
Property line 10+ Building foundation 10+ Water mair,1 10+
10+ S iface water 100+ - -10+
Water Service line p Driveway,-parkingl,�ehicle-sto'
-rage -
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. EkGINEItR`S CERTIFICATION,
I certify that / hig.ve determined through fiel d inspections and
review of Municipal -recor.ds-that,.theabove systems�'are in
conformance with MOA COSA guidelines in effed on this date.
Engineer's Printed Name0l.even Pinnone
Date 6/18/2016,
COSA canary sheet-2-6-15.doe
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisor
Certificate of On -Site Systems Approval # OSC 161316
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 2 of
Park Hills #1 subdivision. This inspection revealed a nitrate concentration of
9.38 milligrams per liter (mg/L) was reported for the property's well water
sample. 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. 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.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream, There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical"
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
C:)
ce)
Septi, vel7fs
Shed\
W�
TITI I
C CD k
D
0 0
LOT 3
8200H
0 "0
Tank
57
sr
Sept/c
I'efjtS
4(1
19
0
0
c ,
�0
Wej,�7 0
LOT 2
\\I CO'Creek Maint. Easernent
e
SCALE: 1"= 50'
EASEMENTS OF RECORD, OTHER THAN LOT 8
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. CEA
c�� LOT 1
N't
OF
';!�;*'49th
CID
J ipro
CO 10
00
�k*.Fred Wcilatka:p ow
3255 - S
�'CSSIONA - - - - - -
RECERTIFIED 6-18-16Y
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed I Mortgagee s inspection
of the following described property: LOT 2, BL�CK 2,
PARK HILLS, SU BDIYISION. ADDITION No. I
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the pigmises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 1 5th day of JUNE INg
FRED WALATKA & ASSOCIATES
BE 1 (907-248-166�) Engineers and Surveyors
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.C. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # C�� - \LA _-) - \ -4-., HAA # 0 1�� (�,O\ n :��n
1. GENERAL INFORMATION 1�
Complete legal description
Location (site address or directions) 14631 Park Hills Drive
Anchorage, AK
Propertyowner _john Caeton Day phone
Lending agency
Day phone
Mailing address
Agent Mary Cox/ Remax Properties Day phone 257-0112
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: — 4
3. TYPE OF WATER SUPPLY:
Individual well XX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written con firmation from State A DEC
attesting to the legality and status of system.
72-025(Rov.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 effeAf89k&4i61*Athis inspection.
Name of Firm Wsgawat!r Cana�lt�nfs, km 7-617�
Phone
Address /4444"44
Engineer's signature ZZ �=Z, Date
Alaska Water&
Wastewater Consultants, lm
Shall be PAID $
or prior to, doslhg for the
11-tigineoring
6. DHHS SIGNATURE
Approved for E-0 �14
Disapproved.
Conditional approval for
Additional Comments
-0
bedrooms.
rljal"�
11171r.
bedrooms, with the following stipulations:
Date L _30-11
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 theStateof Alaska.The DHHS does this as a courtesy to purchasersof homes
andtheirlending institutions in order to satisfy certain federalandstate requirements. Employeesof DHHSdo 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 engineers work.
72-025(Rw.1M) Sock MOA#21
� I - ( , F. I V , I-,
Municipality of Anchorage JUN 30 1999
DEPARTMENT OF HEALTH & HUMAN SERVLQ�..5ALIIY OF ANCHURAGE
Environmental Services Division ENVIRONMENTAL SERVICES DIVISICA
825 L Street, Room 502 * Anchorage, Alaska 99501 * (907) 343-4744
Health Authority Approval Checklist
Legal Description: !"o ) j & :2- A�- //6 Parcel 1. D.: j 6,
A. WELL DATA
Well type �rp I d
Log present (Y/N)
Total depth '53
Sanitary seal (Y/N)
Date of test
If A, B, or C, attach ADEC letter. ADEC water system number 0
Date completed
Cased to 6- �� f Casing height (above ground) / q �j
FROM WELL LOG
Static water level A �6
Well production
WATER SAMPLE RESULTS:
/0
Wires properly protected (Y/N)
AT INSPECTION
9 -P.M.
Coliform. Nitrate Z11 99 ^11Z. Other bacteria
'/1
Date of sample: 10 Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed Ia- 1* -'7 / Tank size / ?_ 6-0 Number of Compartments 2�' Cleanouts (Y/N)
Foundation cleanout (Y/N) —Y Depression (Y/N) NJ _ High water alarm (Y/N) dh
Date of Pumping Pumper 4, llome-,
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft' or ftl/bdrm) 69, �/ System type
9 -P.M.
M'o ;-114
r 0,5 t / Bg_Lo�
Length ---Width Gravel thickness below pipe Total depth 3 Fi,�xv-
Effective absorption area _L4�___04 �Monitoring Tube present (Y/N) Depression over field (Y/N) N L -D
Date of adequacy test 4- 6 - I I Results (Pass/Fall) For 41 --bedroorns
Fluid depth in absorp , tion field before test (in.); - �� Immediately after?AVgal, water added (in.): 1-6-11
Fluid depth 0- (ins) Minutes later: 0 �� Absorption rate g.p.d.
Peroxide treatment (past 12 months) (Y/N) A-)_ If yes, give date _4
72-026 (Rev. 3/96)*
JUN 30 1999
D. LIFT STATION
mUNICIPALITY OF ANCHORAGE
Date installed AV Size in gallons 60MVIRONMENTAL SERVICES DIVISION
Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at*
High water alarm level at* *Datum 90—%—M�A 70�,44
Cycles tested LAxejc-�p l-,0Lr-- I, ea--r-sgaul-
L.. r -r-D A-9PAf2F---r,—
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot J(Do
Absorption field on lot / V-0 / V -
Public sewer main A,10
Sewer /septic service line
On adjacent lots
/v W I -,"
On adjacent lots / 00
Public sewer manhole/cleanout A14
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 3/ Property line /0) Absorption field
Water main/service line V-�� 14- Surface water/drainage 'fWells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line � 0 Building foundation —5-e)
Surface water
1 0-017,
Curtain drain A10 61 e� e+tgwl "l
Water main/service line 1 -45 -
Driveway, parking/vehicle storage area
— Wells on adjacent lots / R-"7
011 e
F. ENGINEER'S CERTIFICATION w%,%1
A4
certify that ve a t fi d inspections and review of Municipal T,0�1 rA
wit ,,i1,r,,A Uidel nes in effect on this date.
t I
in conforma =ced �Yuldfel r
Signature
Engineer's Name
Date 06Zu
HAA Fee
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
Wf-t
Alaska Water & Wastewater Consultants� Inc*
6901 Debarr Roadt Suite 2-11 — Anchorage — Alaska 99504
Phone (907) 337-6179 — Fax (907) 338-3246
May 17,1999
John Cacton
CIO Remax Properties
Attn: Mary Cox
2600 Cordova St.
Anchorage, AK 99503
REFERENCE; Lot 2; Block 2; Park Hills Subdivision
Dear Mr. Cacton,
RECEIVED
JUN '�o 1999
MUrliciPality ot Anchorage
DOM Health & Human Services
Per the request of your realtor, Mary Cox, we performed a well and septic test at the
referenced property on June 5, 1999. It is our understanding the house was vacant
during the month preceding the testing. Our findings are summarized as follows:
WELL TEST: Prior to starting the test, the static water level was measured at 27 feet
below the top of the well casing, A moter was connected to the outside hose bib and the
valve turned on full. The maximum drawdown attained was 41 feet below the top of the
casing during the test. Based on our data, the average well production over a 370 minute
period was 3.52 gallons per minute. This exceeds the M.O.A. minimum flow
requirements for a four bedroom dwelling .
Water samples were taken and tested for coUform, nitrates and other bacteria. The results
were satisfactory, (see attached).
SEPTIC SYSTEM ADEQUACY TEST: Per MOA inspection report, the drainfield is a
bed type systernthat is 30 fixt wide and 50 ket long.. Itshould be noted that we could
not see sand, only drain rock at the bottom of the monitoring tubes, which cast some
doubt as to whether the pipes are set at the correct elevation, Short of excavation and
physically inspecting them, we can only assume they are correct. Prior to the start of the
test, the monitoring tubes were dry. Over a period of 370 minutes, 923 gallons was
introduced into the bed, causing a rise of 1.75 inches in the deepest monitoring tube.
Twenty hours later, the level had dropped 1.5 inches. Based upon this data, it was
determined that the absorption rate of the trench exceeds 600 gallons per day, as required
for a 4 bedroom house.
Page Two
Lot 2; Block 2; Park Hills Subdivision
NOTE: The adequacy of a septic system is influenced by numerous factors, including,
but not limited to, seasonal surface water infiltration, groundwater variations, septic
system maintenance (frequency of septic tank pumping, usage of biological additives),
condition of drain pipe and pipe joints (which can be damaged by seismic activity and
deteriorate with age), type of substances deposited in septic system (cigarette butts,
sanitary napkins, misc. objects) and the amount of water being introduced on a
continual basis. Consequently, the results of this adequacy test are only validfor the
specific day of the test. Furthermore, because of the limited nature of this investigation,
it is possible that there are hidden defects which may not have been detected No
warrantee is made regarding thefuture performance of this septic system
Prior to meeting MOA requirements for Health Authority Approval, the following repairs
will need to be completed and verified:
o There is only one to two feet of cover over the drainfield. There needs to be a
minimum of three &e.
e The pump screen in the lift station needs to be pressure washed/cleaned (not
mandatory, but recommended.)
9 The sanitary seal on the well head is broken and needs to be replaced.
the repairs are made, we will submit the necessary paperwork to the MOA to obtain
Ith Authority Approval (HAA). The MOA will charge $300.00 to process the HAA.
If you have any questioRs, please contact us at 337-6179. Thank you for your business.
Sincerely,
P.L. M.S.
JAF/gd
06/21/11999 �2:37 2581300 MAPV COX REIMAX FROP PA6E 01
C-Rr I
Vci�T-,
F T 79-T71
5,clne cr
A.,
-4-
Ilk
N I
TAS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I haVQ perfoned a Mortgagee's IrispeCtion
7: Z
40 of the followIng dagerlbed property:
A 9
tt
I '�A 1', &
EASEMENTS OF RECO110, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON, U. A
V F -
Anchorage R000rcling Precinct, Alaska, and that rho
improvements situated thereon are within the property 11., g and
do not overlap or encroach on the property lying adjacent tl orolo,
tiler no improvements On properly lying adjacent thOrOtO
OAC�oach on the promises in cuestion and Met there I re no
roadwi3o. transmIssion lines or other visible oassmen" o I Salo
properly except as indicated hereon
Dated at Anchorage, Alruil�a
day Of
FRED WALATKA A ASSOCIATES
(907) 246-1660 Engineers and Surveyors __
M
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date 7
(a) Legal Description (include lot, block, subdivision, section, township, range)
L 2_ 6 -Y -- /�/4 /Z i< /-/ /,, /_ , S 'S',?- V, 7" / 2- IU A�' ekJ �'. /",
(address or directions)
/-/ / //�'j -D k' I '-� C.
(b) Applicants Name Y-6 Z -7Y:7
ele Business
Applicants Address _9
(c) Applicant is (check one) Lending Institution Owner/builderk�_
Buyer [�_ ; Other 1::�l (explain);
(d) Lending Institution Telephone_--_
A 'a
d IL
jkps
(a) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. -aidence
pe oLRL ____
Single—Family 1771 V1ulti--Fam1ly1::'_T Other (describe)
Number of Bedrooms
3. Water Sui)ply
Individual Well Community Public
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Lewat DiUo,�al
Public E___j Community Holding Tank
Onsite FZ2 1=
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page I of 2]
5. EnIllneering Firm ProvIdLim_1risj�ec t ions, Tests. File Search. Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein.. I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm �)-S ('-4 Telephone
Address
Date
Vdp�d as 0 13
(ENGINEER SEAL)
6. DIU
Apj 1,�� bedrooms By b�- ee
Approved Co i nA1
Terms of Conditional Approval_
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DREP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PRoyrS—sR6—NA—L ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF H014ES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES Or DHEP 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.
(DHEP SEAL)
RR4/ej/DlB
[Page 2 of 21 7-19-84
MUNICIPALITY OF ANCI-10i
DEPT. OF HEALTH & MUNICIPALITY OF ANCHCIRAGE (MOA)
ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA)
,"A 16M CHECKLIST - FEBRUARY 1984
A. wELLmRECEIVED
Description: L 'L 'S Z_ eP.A r Al-
- 'S z y J -F- 7T —AY -12, ---� CZ) '
Well Classification "Ptr If A, B, or C
TATell Log Present (Y/N) � Date Completed
Total Depth -5-31 - Cased to 5-31
Static Water Level 61 PumD Set At
D.E.C. Approved(Y/N)
1,0'-1S_- gt�� Yield /0�'5PM_
Depth of Groutinq AJ114
vs -
Casing Height Above Ground Sanitary Seal on Casing QL/`N)
Electxical Wiring in Conduit -(Y/N) Depressim Around Wellhead (YM)
Separation Distances from 'Abll:
To Septic/Holding Tank on Lot 4- ID6 On Adjoining Lots 4- /00
To Nearest Edge of Absorption Field on Lot 4106 On Adjoining Lots
To Nearest Public Sewer Line A) /f To Nearest Public Sewer
Cleanout/Manhole A-1 4 To Nearest Sewer Service Lira on Lot 269
Water Sample Collected By IIA-) ; Date z S- -
Water Sample Test Results "3 6 7 15 ro /--' 'Y�'
Comments e_'q e4-�'
-'2r
Iq rl� c- lre�_ a,
B. SEPTIC/HOLDING TANK DATA
Date Installed Size Z C-6 No. of Ccmpartments Z�
Standpipas (YZN) -tight Caps (Y/N Foundation Cleanout (I
Depression over Tank IYZN) X) Date Last Pumpe�
Pumping/Maintenance Contract on File (Y/N) A-) ; for
Holding Tank High -Water Alarm (YIN) �_A Timporary Holding Tank Permit (Y/N)X�14
Separation Distances from Septic/Holding Tank:
To Water -Supply 1,4ell To Building Foundation
To Property Lim 4- 5-e) To Disposal. Field '?, 5 e
To Water Main/Service Line To Strewn, Pond, Laker or Major Drainage
Course 1-1114 -
Comments
Receipt #
Date Paid:
Amount: 5
(Page 1 of 21 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design
Date Installed Length of Field S -Z
Width of Field Depth of Field /6'
Gravel Bed Thickness
Square Feet of Absorption Area Standpipes Present (YM)
Depression over Field (Y/N) A.) Date of Last Acbquacy Test
Results of Last Adequacy 'Ibst
Separation Distance from Absorption Field:
To Water -Supply Well To Property Line
To Building Foundation 4- To Existing or Abandoned System cn
Lot 1(14 On Adjoining Lots
To Water Main/SqYvi ce Line AW '?d 1 To Cutbank(if present) /A
To Stream/Pond/Lake/cr Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area 7",?4)
Convents )-) 4_�- a-) :5, 5 rlc- 4-f
D. LIFT STATION - A.)IIA
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical
Convents
(Y/N)
Off" Level at
Vent (Y/N)
Cycles during Adequacy Tbst. Meets MCA
** Check Permitted Bedrocm Rating Against HAA Request **
I certify that I have checked, verified, or conformad to all MOAI,HAA,-
on the date of this inspection.
Signed Date
Conpany. eo4jl, C-05,-6 L%-, MCA No. �L�_dL_3_
KB1/d5/s _P, 1732-E
'ON
'NN 7ONALC
[Page 2 of 21 iEaiiY82
2-15-84