HomeMy WebLinkAboutPARADISE VALLEY BLK 6 LT 9MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
GREY-'ER ANCHORAGE AREA BO~'"JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL qq
INSIDE LENGTH
, 4'¢ , /_¢ NUM, ER OF /
MANUFACTURER /~'~ MATERIAL C82~1 C_~/~ COMPARTMENTS
INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /~:~:~(~ GALLONS·
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER__OR WIDTH /~, LENGTH/Z. DEPTH / 0
LINING MATERIAL~-~)~:~ CRIB SIZE: DIAMETER DEPTH /$2 DISTANCE FROM: WELL /
TOTAL EFFECTIVE
BUILDING FOUNDATION ~ NEAREST LOT LINE ~/. ABSORPTION AREA (WALL AREA)~ SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE ?J/i JqC¢- CONSTRUCTION
DUI LDI NG NEAREST
FOUNDATION- LOT LINE
NEAREST
SEWER LINE
De~u ~ ~ ~~'~r ' DISTANCE FROM:
S~.PT lC ................ SEEPAGE
TANK SYSTEM
CESSPOOL
APPROVED
OTHER SOURCES
DISAPPROVED
REMARKS
DISTANCES:/~z"qE~/', 2~FC ~' I Z~-¢
DIAGRAM OF SYSTEM
INSTALLED BY:
pi pE MATE R IA L:~¢- ~¢~/~ ~ ¢"OF~
LOT SLOPE: .
REMARKS: g::~- 7~l~ ¢ ~ q d / ,'C /t, t l/~ ~
Form No. EQ-031
DATE ~¢~ ~ 3 - 7~'
Ap p R 0 V E J/~---~A~//~
M-W DRILLING, Inc.
P. O. Box 4-1728 · 2811 Dawson
A C 907-279-1741
ANcHoRAGE, ALASKA 99509
DRILLING LOG
l~r. Sam F~yee Use of Well Dom
Well Owner :
Location (address of: Township, Range, Section, if known; or distance main road
Lg, Blk 6, Par~diee Valley
6
Size of casing
Static water level
Screen ( );
Describe screen or perforation
Well pumping test at J-=~/~allons per of drawdown from static level.
Depth of Hole 577 feet Cased to_24 feet
ft. (above) (below) land surface. Finish of well (check one)
Perforated ( ).
(minute) for ~ hours with
Date of completion 2L ~!~y 7}
WELL LOG
Depth in feet from ~'
ground surface Give details of formations penetrated, size of material, color and hardness
0 TO. ~'9 Silty ~r~vet
f~ TO ~
TO
T~
~2~ ~77
~ -~' TO
~O
~O.
TO
~O
TO.
__
open end ( X );
ft.
fractur.s--lees than [{ GPM w/ 127 Static Level.
A/A~ ~i~ed u:~ more water in thtc are~,
~UNIcIPALiT¥ ,~. 'AIwCHo~ -
'wmC)NMENTAL PROTECTioN
rrr,vE
3 -- Contractor
SEWAGE
GREATEr ANCHORAGE ArEa BOROUgh
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-456!
DISPOSAL SYSTEM m APPLICATION AND PERMIT
PERMit NO..
MA,L'NG ADDRESS >~¥ '¢?P / *¢¢~'r P"GNE
INSTALLATION LOCATION
LEGAL DESOR,PT,ON r.-. '~ ¢'¢
INSTALLATION OF: SEPTIC TANK
TYPE AND BIZE Of FACILITY TO BE SERVED
FINANCED THROUGH
SO,L T EBT .ESULTB /0 O
SEEPAGE PIT DRAIN FIELD OTHER
TO BE INSTALLED BY
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM
FOUNDATION TO SEPTIC TANK ~ /
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
£
FOUNDATION TO SEEPAGE PIT ~ ~/ , DRAIN FIELD
SEPTIC TANK TO SEEPAGE Pit WALL ( ~-
£
SEPTIC TANK , SEEPAGE PIT ~ ~ , DRAIN FIELD
TO NEAREST LOT LINE~ ~//~ /
WELL TO SEPTIC TANK , SEEPAGE PIT ~
DRAIN FIELD . , ALSO CONSIDER AREA WELLS.
WATER MAIN tO SEPTIC TANK , SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK. /f'O (~ ~ SEEPAGE PIT '/~) ~' DRAIN FIELD /'~ "~ /
TO RIVER, LAKE, STREAM.
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
OR
CERTIFY THAT I Al~i~ii'lAR WITH THE REQUIREMENTS Of GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCr bED BYST~:M S N ACCORDANCE W th SAiD CODe
Depth
Feet Soll Characteristics
ANCH.JRA._~E AREA BOROUGH
GREATER
HEALTH DEPARTMENT ' ~"'~
327 EAGLE STREET
': ~ ~ ~ ~ ANCHORAGE, ALASKA 99501
~er~oD~e~ fo ~ ~ I , ....... ,
L ~e al Descrlption:""~'o~Biock ~
This FoDm RepoDts a: So~ls LoK ~ ....Pemcolation
Was Ground Water Encountered?
If Yes, At What Depth _ ~ ....
Location Sketch
f i i_ i' L_-i ii
! I I_l" 1'i-I. J ,I
I !, J I,]'3....! J I
I I I !'.[21 I !
1 .... I t, t,, ,'1'['~,1, ,,I .... t,
Reading Date Gross Time Net Time Depth To H20 Net Drop
l
~rcolation (ate 1"/ M'~,,~' .... , ..... ~-~1 ......
Proposed Instal-l'a~ion: Seepage Pit L/ Drain Field
De~pth Of_Inlet ..... Dept'h 'To' Bottom Of P~t Or 'french ......
Data Certified
Parcel I.D. 020-412-16
Municipality of Anchorage
On-Site Water and Wastewater Program 4i6k
(907) 343-7904 �p A F 1_Y�K
Certificate of On -Site Systems Approval
9-(
_50_10
Expiration Date: (4�D_
Complete legal description PAF*DISE VALLEY: BLOCK 6, LOT 9
Location (site address) 6425 Switzerland Drive *Anchorage 99516
Current Property owner(s) Michael Parker Day phone 406-0790
Mailing address
Real Estate Agent
Day phone
2. TYPE OF DWELLING:
Z Single Family (w/wo ADU)
F-1 Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage 0
Community Class Well F1
Public Water System 0
WaiverNariance
Received by:
iffirizKols . 8 so ,
Individual
N
Holding Tank
F-1
Community
El
Public Sewer
0
COSA to be released to the erilgipeer, unless otherwise requested by the engineer.
Date:
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.
Name of Firm: Gayness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: 5� ��g
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE gmc,
System #1 Approved for bedrooms
'* : 9 T
. .... .... t .. ....... .......
CE 795 .0. •'
1%;R P,0 f essiO1flll��
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
BY: Original Certificate Date:
The Municipality of Anchorage 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.
film TNIM 9NITME4,11101
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: PAFflDISE VALLEY; BLOCK 6, LOT 9 Parcel ID: 020-412-16
*ALL TEST DATA IS FROM 9/16/16 INSPECTION DONE BY BENJAMIN SCHILLER, P.E. ON FILE AT MOA
A. WELL DATA GEG PERFORMED NO ASSESMENT OF THE WELL PRODUCTION **WITH 100% DRAWDOWN
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 5/24/73 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 377 ft. Cased to 24 ft. Casing height (above ground) 12+ in.
FROM WELL LOG
Date of test 5/24/73
Static water level
Well production
UNKNOWN
**2-3
AT INSPECTION
*9/8/16
ft. *253 ft.
g.p.m. *2.75 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate r g -./L. Collected by: GEG, Ltd.
Arsenic! N"O ug./L. Date of sample: 5/9/18 l
B. SEPTIC/HOLDING TANK DATA 'PER PHOTO PROVIDED BY PROPERTY OWNER ATS GDJ
Tank Type/Material SEPTIC/STEEL Date installed 3/22/14
Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N)
Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N)
Date of pumping 5/16/18 Pumper ISSAC'S PUMPING SERVICE
C. ABSORPTION FIELD DATA
Date installed 3/22/14 Soil rating p.d./ Zor ftZ/bdrm) 1.2 System type DEEP TRENCH
Length 43 ft. Width 2 ft. Gravel below pipe 7.5 ft.
Total depth *13 ft. Eff. absorption area 645 ftZ Monitoring tube YES Depression over field NO
5-1Prn� pec- 6-E.G
Date of adequacy test 6/6/16 Results (Pass/Fail) PASS For •-)t bedrooms
Fluid depth in absorption field before test *0 in. Water added *1125 gal. New depth *0 in.
*'1501 - %,L, e` GEG
Elapsed Time: *0 min. Final fluid depth *0 in. Absorption rate >= * g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date -
*ALL DATA IS FROM 9/16/16 INSPECTION DONE BY BENJAMIN SCHILLER, P.E. ON FILE AT MOA
MONITORING TUBE APEARS TO EXTEND 104 INCHES BELOW THE INVERT
MONITORING TUBE DRY ON 5/10/18 DURING GEG INSPECTION
GEG PERFORMED NO ASSESSMENT OF THE SEPTIC SYSTEM ABSORBTION CAPACITY
YES
N/A
D. LIFT STATION
Date installed
"Pump on" level at in
Size in gallons Manhole/Access (Y/N)
"Pump off"level at wa er alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer /septic service line `*25'+ ( WITH CAVEAT) Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
"101' FROM ST1 TO EDGE OF WELL
100'+
10'+
**NOT VERIFIED DURING GEG INSPECTION - 251+ PER 4/22/14 INSPECTION REPORT DONE BY MIKE ANDERSON P.E.
G. ENGINEER'S CERTIFICATION
1 certify that / have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date 4 f q3/ //
(Rev. 10/12/12)
�r,&'%1k1k%
Otto
C-) . S
AF
1 /
49
..........
..... . io
............. �....:..
0
0�. �•: of r A. Garne s:•_�
�AV
��.pROFESS\���:�•.
LICENSE %„`**
#AECC884
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Prcgmm
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ak, us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
1.
GENERAL INFORMATION
Complete legal description /.-o b 9/
Location (site address or directions)
Expiration Date:
Current Property owner(s)
Mailing address
Lending agency
Day phnne
Day phone
Mailing address
Real Estate Agent
Mailing Address
Un/ess otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER'OF BEDROOMS: ~
3. TYPE OF WATER SUPPLY: '
Individual Well []
Individual Water Storage []
Community Class ~ Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues CertLq~tes of Health Authodt,/
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required fcr the transfer of
title (except between spouses) for properties served by a single-family on-site ',¥astewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Cer'dficates may be reissued for a pedod of up to one year w~th valid water samples.)
Certificates are valid for one year for properties served by Class Acr B wells or a public water system. Ti~e
Municipality of Anchcrage is not responsible for errors or omissions in the t:rofessional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As ce~fied by my seal affixed hereto and as cf the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information ol3tained from the
Municipality of Anchorage files and from my investigation and inspection, the Ch-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 installafion.
Name of Firm F::/~ H¢,/~ '7~h~;c~../ $~ ,"~;~¢~.,.
Address I ~.5-3 ~, ~_¢_A ~,
Engineer's Pdnted Name
Phone ~ '-/._c-- I ~' 5"5"
Date ~c ~,~/. Z Y, ~.oc/~.
DSD SIGNATURE
Approved for .~'
Disapproved.
Conditional approval for __
-'
bedrooms. " '~' ', " ~ ~
,~ -~, . _.~,,~
bedrooms, ~th the following ~tipuiations:
Additional Comments
· ~.~-".. ' ' .."O~-.
~ .' %-- ~
~'~:. O~-S~ ~ ~'
By:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Odginal Certificate Date:
Municipnlity of Anchorage ,__o
Development Services Department
Building Safety Division (~'
On-Site Water & Wastewater Program ~
4700 South Brag'aw SL
P.O. Box 196650 Anchmage, AK 99519-6650
www.ci.anchorage.ak, ue
(9O7) 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
If A, B, or C provide PWSID # A/. 4.
Nitrate 1,73 mg./I.
Date 0fsampla; )/¥/~ 2.
Foundation cleanout (Y/N)
Date ofpumping 9/~t /o ~..
C. ABSORPTION FIELD DATA"
A. WELL DATA
Well type P~,,/'.
Date completed ~'lz¥/~..~. Sanltap/seal (Y/N)
Totaldepth '377 ft. Casedfo ~-~' ft.
FROM WELL LOG
Date of test 5'/2.¥ / '~?
Static water level No/' $~t,t. on fi,
Well production 2::11~,~, o)le. g.p.m.
WATER SAMPLE RESULTS:
Coliform O .colonies/100 mi.
Arsenic: A/,~. mg./l.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material .Se/~ ~'~
Tank$ize tOO,g gal. Number of Compartrnents
Depression over lank (Y/N)
Pumper
Date installed ~'/3/?¥ Soilrating (g.p.d./lt2
Length I Z
Total depth '7 fi.
Date of adequacy test
Wall Log (y/N)
Wres properly protec~ (YIN)
Casing height (above ground)
AT INSPECTION
J '?* in.
._~9/l~/0 ~. ~,y b'f.tl/. Dr,/h,~,~
"& ¥,~(~ g.p.m
Other bacteria I coionies/100 mi.
Collected by:
Date installed ~' / .3 / '? ¥
Cleanoute (y/N)
High water alarm (Y/N) AJ. 4.
Width t ?- fi, Gravel below pipe e/ ft.
Eft. absorption area'f-~t ~ Monitoring tube Y Depression over field /v
) / ¥/o 2. Results (Pass/Fall) P~a,t*( For ~ bedrooms
Fluid depth in absorption field before test O in. Water added 3~ I gal. New depth b'$~: in.
Elapsed Time: IO.Crrfm. Final lluld depth O in. Abeorptionrate >= Y.t"~, g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) AJ~,~d ~<~ ~'~-~','~ If yes, give date /~'. ~.
D. UFT STATION
Date installed
"Pump on" level at in.
Datum
E. SEPARATION OISTANCES
Size in gallons
'Pump off' level at
Cyc~s tested
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & cimuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septtctanldliffstatlononlot log' ~ ¢.o.
Absorption field on lot 130' ~, ~;
Public sewer main /~./I-.
Sewer/septic service line ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO;
Building foundation i ?.o' Property line
Water main . /~J.,4.. Water sewice line ~'
Wells on adjacent lots l~5"' ~'~,' c.~,.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
On adjacent lots I oO' '
On adjacent lots ~. I ~o,
Public sewer manhole/cleanout
Holding tank /~.,4..
Absorption field
Surtace water
ir1.
Date of Payment
Receipt Number
HAA Fee $ '3
Date of Payment
Receipt Number
(Rev. ~2/o~)
Properb/line ff~' Building foundation ! ~*¢~' Water main
Water Senfice line ~ to' Su~facewater · too' '. Dffveway, parkingNehiclestofage
Curtain drain .~o,,( 5,'~','* Wells on adjacent lots. Io~" ~,,=,,~ c.c.
F. COMMENTS I~¢(I A,/c,(r'O- )C,'~c/**~.J~
~a~ ~ MOA ~ gu~el~es
Engineers P~n~ Name
'Il
I l,,I / ' ·
'~l:t ' '
~,~ --. -x:..L ~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
O vision of Environmental Se~ ceE .
~i~;~r~:'''~ ...... "~;""'~-- ~ '~ ~ ..... ~ ~"~ ~'q"'~ ~; ~ ,~: ~
O. Box 196650., Anchorage A aska., 9951~6650
CERTIFICATE OF HEALT~ AUTHORIT~
'A~PROVAL FOR A SINGLE FAMIL~ DWELLING
Parcelr I.D. #
' GENERAL1NFORMATION
Complete legal description '" '~£~** ~.,
Location (site address o r directions) '
~'~ gE"
Property 0wner:~i,~
· ':'~,~'; : !, Z:~" :~i~:~, "~"' ..... ;
Mailing ad~JreS~
Le~ing agency
Mailing address
Day phone,
Day phone
HAA will be held for
.; ~::,.;:: :;-,NOTE:-,~;:If communtt)syste , prOvide writtenr confirmation
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. .-_.. -
Name of Firm
Address
Engineer's signature
Phone ~f~-t~ ~
Date ~//~/~-,"'
6. ' DHHS SIGNATURE ;~_~i -'~ ~ .....
.... )? , _.. 'Conditional approval" for :'-~ ..... ~"': b~rooms ~th-the following st[pulations:;~::::::t~:~
Date - -.
The i~umcipality of Anchorage Department of Health and Human Services [DHHS) issues Health Authority
, ~ Approval Certificates based onl;y upon the rep~:esentations 'given in paragraph 5 aboVe by 'an ind~pend~i;it
..,:~ professional engineer registered in the State °~A'i~S~:'The DILIHS does this as ~-cou rtesy to purchasers of homes '"" ':
,,~ and ~heir, !.,ending institutions in order to satisfy ~ertai',n.~federal and s. tate r~ef:lU rements. Employees of DHHS do not ,-
:,~;F:: ': conduct ,nspect ons or analyze data before a certiflcate~ s ssued. ~The Munic pa ty of Anchora e s not :'
,:,:.~:~t:?::?,,. responsible for errors or omissions in the professional"engineer's work.- ............. ,-
MunicipalitY of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) '343-4744
Legal Description:
A. WELL DATA
Well type F~,~,
Health Authority Approval Checklist
Bh, ctc ~ Faracl,¢e, Va/It, r ParcelI.D.:
If A, B? or C, attach ADEC letter. ADEC water system number
Log present (Y/N) ~
Total depth ~ 7 7'
Sanitary seal (Y/N)
Date of test
Static water level
Well production
Date completed
Cased to "~ ¥'
FROM WELL LOG
WATER SAMPLE RESULTS:
5-/ El'/ '-r~7
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
?17/95-
qg'
g.p.m. O. ,5'"/ g.p.m.
Coliform 0 co/ /roo r~ Z Nitrate
Date of sample: 9' / '7 / 95'
B. SEPTIC/HOLDING TANK DATA
Date installed ~/~/?¥ Tank size
Foundation cleanout (Y/N) ~'
Date of Pumping 7/t9 / ?3-
C. ABSORPTION FIELD DATA
Date installed 6' /.Y/7~/
Length I ~' Width
~.5'.7 m~?/Z Other bacteria None
Collected by: FIo ~.A~.p 7-ec,4 _Cc, c
Depression (Y/N)
Pumper A -t-
Number of Compartments / Cleanouts (Y/N) ~
ty High water alarm (Y/N) N. 4.
Soil rating (g.p.d./f~2 or ft2/bdrm) Ib'~'
t E' Gravel thickness below pipe
Effective absorption area ~ ~oa Monitoring Tube present(Y/N)
Date of adequa~ test ~ / 7 /~ Results ~ass~l)
Fluid depth in absorption field before test (in.); E ~/ Immediately afterYY/ gal. water added (in.):
System type
Total depth IO' ?~r ,~.~?. r~d
Depression over field (Y/N) N
For ..~ bedrooms
Peroxide treatment (past 12 months) (Y/N) Mope bcnooa~ If yes, give date At, /~.
Fluiddepth IlO Minutes later: E~9 Vy (in.) Absorption rate = ~ 5/50 g.p.d.
D. LIFI' STATION tN. ,4.
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump ou' level at*
*Datum
Fo
"Pump off' level at*
Rev. 8/95 OSS: haa.wk.doc
HAA Fee $
Date of Payment
Receipt Nmnber
Lifistation too' .lo I,f-t £/~,bo,* o,~ od~ Iot
(_cee
Engineer's Name
Date 9 / I~
Water mai~ffservice line > ~ .6- '
Driveway, parking/vehicle storage area
Wells on adjacent lots I O3' ' J2r'o t,, c, o
ProperS? I',,"< ~1~-' :fro,,,, C.o
1 certify that ........................ field mspecttons and review of Municipal records :;;a: the above systems a;'*
in conformance with MOA I-[AA guidelines in effect on this date.
Signature ~--~ ~.~
Building foundation t 3-O '
Surface water
Curtain drain N o~ e r e et,
ENGINEER'S CERTIFICATION
105' ' .,i~ro~ c.o.
Waiver Fee $
Date of Payment
~ THEODOM~ F. t,5OOR~ .. ~
Receipt Number
SEPARATION DISTANCES FROM WELL ON LOT TO: 9~' i?~r ,hSlO. re?or!
Septic/holding tank on lot lO $ '* t~, c lec~oou~ ; On adjacent lots I OO '
Abso~tion field on lot /Jo' ~ C. o ; On adjacent lots ~ (oo '
Public sewer main N. ~, Public sewer manhole/cleanout N./~.
Sewer/septic semce line ~
SEP~A~ON DISTANCES FROM SE~C~OLDING TANK ON LOT TO:
Foundation / EOt Prope~ line 7~' ~ 60. Abso~tion field
Water maiWse~ice line ) ~f' Surface wateffdminage ~ too' Wells on adjacent lots
SEP~ON DISTANCE ~OM ABSOR~ON ~ELD ON LOT TO:
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
WATER WELL ADVISORY
HEALTH AUTHORITY APPROVAL NO. HA950405
During a recent Health Authority Approval on-site inspection
and test of tl~e potable Water supply well on Lot 9
Block 6 of Paradise Valley Subdivision, the well's
productivity was determined to be .51 gallons per minute.
The minimum well productivity required by this Department
(AMC 15.55) for a 3 bedroom residence is .31 gallons
per minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This advisory must be attached to all copies of the subject
Health Authority Approval.
CIVIL & ENVIRONMENTAL ENGINEERING" ENERGY CONSERVATION & ANALYSIS
TttEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 ANCHORAGE, ALASKA 99516
October 6, 1995
Jim Williams
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
RECEIVED
OCT 9 1995
Mul~ic~pality o! Anchorage
Del~t, Health & Human Services
Dear Mr. Williams:
Per our discussion I am submitting a copy of our well test data and a new HAA checklist
for Lot 9, Block 6, Pat'adise Valley S/D. The well test data sheet shows our field measurements
of gallons of water pumped, water level drawdown inside the casing and recovery upon which we
based our determination that the yield of the well is slightly in excess of 0.5 gpm.
I am also providing the following explanatory comments with regard to the separation
distances between the well and nearby septic tanks. The 1974 inspection report which
documented and approved the construction of the septic system on this lot has a sketch showing
that the standpipe is located neat' the middle of the tank and states that the distance between the well
and the septic tank is 99 feet. Our field measurements show that the standpipe of the septic tank is
actually slightly over 106 feet from the well. A normal 1000 gallon concrete septic tank has
dimensions of approximately 4.5' wide by 8 feet long and a fluid depth of 4 feet. Assuming this
is the configuration of a tank and that the standpipe is in the middle, it appears that the actual
separation distance between the well and the septic tank is approximately 102 feet, so no waiver
should be necessary.
We haVe also remeasured the separation distance between the well and the 1500 gallon
STEP tank on Lot 10. With the tape measure strong as straight as possible between the center of
the wellhead and the center of the STEP tank standpipes we measured a slope distance of 103 feet.
An elevation differential of approximately 10 feet between the ground surface at the well and the
STEP tank, means that the horizontal distance is approximately 102.5 feet. Since a typical STEP
tank has a diameter of 58 inches with the standpipes located in the middle, it appears that the
sepat'ation distance between the well and the closest part of the septic tank is 100 feet, assuming a
normal configuration. Thus, a separation distance waiver should not be necessary for this tank
either.
Please feel free to give me a call or make yom' own confh~ning measurements if you have
any questions.
Sincerely,
Ted Moore, P.E.
FLATTOP TECHNICAL SERVICES
14530 Echo St., Anchorage, 'AK 99516
Ph. (907) 345-1355
ADEQUACY TEST DATA SHEET
Legal Description:
Street Address: , ~-
Client Name: Dmrl~ C)%.~r
Test Date:. 9/7/~3' Tested By: ~.~. m*~
Initial Conditions:
Float #1 ln~?~¢ 7-~& C. 6. set "b.t.o. ~3 "pipe w. ~7 "fluid
Float ~2 in'~a~a~ P~ ~,~set "' b.t.o.'Z3' TM pipe w. %~" fluid
Float ~3 tn ' ~ set "b.t.o.'--'" pipe w.'"' "fluid~
Float ~4 in set "b.t.o. -"". pi, 99.~::w* "fluid
Water added through: ~.~ff ~ - ~:'::~:~'*.,,~a~'.~'
ACTION TIME H20 METER NET. GAL WELL '" FgUID LEVEL
TAKEN LEVEL
~I~rb Iz :~ Zz3
i :~r 3gz * o
7 _.
Measured Well Yield ='~PY'-3ZI'O,,h~f.~/F/.)..O,~-~ Adequate for 3 Bdrms
%:i 0 ,~
:~l°P~ Adequate .for ~ Bdrms
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description: ]. c/~ {~ll~' 6'/ IPor',n e:,(u¢ I/'~ II,y Parcel I.D.:
A. WELL DATA
Well type p~,
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Y
If A, B, or C. attach ADEC letter. ADEC water system number
Date completed
Cased to 'Z '/'
FROM WELL LOG
Casing height (above ground)
Wires properly protected (YfN)
AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 Cot
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed ~'/.3
Foundation cleanout (Y/N)
Date of Pumping '7/
s'/z¥ / 73
g.p.m, t9, ,,c' ! g.p.m.
Nitrate ~.5'3 ,-,,,~ /--ct Other bacteria xtone r, etoor /-e ,,f
Collected by: fxto/~of 'T'.,erA _Ct/e
Tank size IOOO~lqat! Number of Compartments I Cleanouts (Y/N).__
~( Depression (Y/N) /V High water alarm (Y/N) /4, At,
Pumper
C. ABSORPTION FIELD DATA
Date installed ~/~ /7~/ Soilrating (g.p.d./fl2orfi2Podrm) lO0
Length t ~-' Width ! ~-~ Gravel thickness below pipe d' '
Effective absorption area ~ &~ ct' Monitoring Tube present(Y/N) ¥
Date of adequacy test 9 / 3' / 9.q' Results (Pass/Fail) Pa.el For
Fluid depth in absorption field before test (in.); '~ ¥ Immediately after ff 3' Igal. water added (in.):
Fluid depth ti O Minutes later: ~_~ ~/ (in.) Absorption rate = > ~'~o g.p.d.
Peroxide treatment (past 12 months) (Y/N) t~lt,~, l.o~t~,, If yes, give date A/. ~q.
System type ~,~
Total depth
Depression over field (YfN) N
bedrooms
D. LIFt STATION ~l,/~.
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Puinp on" level at*
Fo
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
9P' t?¢r ~ppr~ve~ '.,xp. re~'o
Septic/holding tank on lot t O G ' ~ ¢.o0 ' On adjacent lots
"Pump off' level at*
Absorption field on lot
Public sewer main
Sewer/septic service line
laO' ~ c.o.
; On adjacent lots .'> tOO '
Public sewer manhole/cleanout /~/.
Lift station
adj.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation I E O' Property line 70' ~Crom e, o, Absorption field
Water main/service line ~ ~$" Surface water/drainage ~, too' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation I ~0 '
Surface water > too '
Curtain drain ^lon~
ENGINEER'S CERTIFICATION
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots t o,
pr.eF~rt.7 Im~
baX~t an rn~ . e~p~ear
I certify that !/:a;'c --~:zr:.~.i::a~t :/::-:: field inspections and review of Municipal records :l;a: the aoove systems
in conformance with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name
Date
HAAFee $ ~OO ~
Receipt Number //~-~2e~/~'~/ ~ 'x)
Rev, 8/95 OSS: haa.wk.doc /
Waiver Fee $
Date of Payment
Receipt Number
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
020-412-16 HAA# HA910287 '
. 1. .GENERAL INFORMATION
COmplete legal description
Lot 9 Bl~ck 6 ParadiSe Valley Subdivision
~ (~it6 address or directions)
6425 Switzerland Drive
-: ~ ~i ,,,i~ ~:~-" ·; .....
;:Michael K. Walker · -
address' 6425 ~Switzerland Drive
ng?gency Day phone
Mailing~hddress
Agent Kay ~lia~n % Fortune -"~ ~ayphone
3000 A Street
Address
Unless otherwise requested, HAA will be held for pickup.
:'-'~'Day phone 261-7732
Anchoraqe, Alaska' '99516
2. NUMBER OF BEDROOMS: three (3)
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well xxx
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site xxxx
Holding tank
Community on-site
Public sewer
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
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'9
I:I=m=mNION=m Aa NOI.LO=~dSNI dO J. Ngi~lglV.LS '9
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. # o2.o - ~//p.- I~,
1. GENERAL INFORMATION
Complete legal description
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Location(site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Day phone
Day phone
Agent /'-'~ ~- L~,:~4 '
Address .~0~¢--~
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ._~
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Day phone
Public water
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individua on-site
Holding tank
Community on-site
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
7~-025 IRev. 1/91) Front MOA #21
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JoJ leAoJdde leUOR!puoo
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LUO~ peu!e~,qo UO!~eLU~OJU! eq~ uo pes~q ~eq~,~Jpe^ Jeqpnj I 'u!eJeq pe~eo!pu! e~n~on~s jo ed,~ pu~
swooJpaq jo Jeqwnu eq~ Joj @~,enbap~ pue 18uo!~ounj 'ejes s! LUa~S/~S lesods!p Je~,e~e~,s~ ~o/pue
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Xw ~eq~/~jpe^ I 'N~Oleq u~oqs elep uo!~ep!le^.eql jo se pu~ o~e~eq pexwe leas/~uJ ,~q pe!j!~ao sv
'9
B:I=INION:I A8 NOIJ. O3dSNI dO J.N=IIN=IlVJ. S '~
Attachment to
Health Authority Approval
HA910290
During a recent Health Authority Approval on-site inspection
of the well and septic system on Lot 9 Block 6 Paradise Valley
Subdivision~the well flow and recovery test showed the well's
sustained productivity to be 0.38 gallons per minute. The
minimum well productivity required by this department to
satisfy the requirements of municipal codes (AMC 15.55) and
Health Authority Approval guidelines;is 150 gallons per day
per bedroom. This equates to 0.1042 gallons per minute per
bedroom or 0.313 gallons per minute for a 3 bedroom
residence. The recently determined productivity of 0.38
gallons per minute marginally satisfies this requirement. The
financing entity and prospective buyers should be made aware
of the marginal productivity of the well, and recognize the
probability of an inadequate water supply during certai'n times
of the year. There are measures which can be taken .to
minimize the adverse impact of the low well.productivity suc'h
as (1) a water storage tank serving as a supplemental reserve
reservoir, (2) curtailment of all non-critical water uses
(washing cars, lawn and garden watering, etc.) (3)
installation of water saving devices on showers and toilets,
(4) restricted or controlled use of laundry facilities and
dishwashers, and (5) self imposed water conservation practices.
While the subject well meets the minimum MOA requirements, the
comments herein contained should be attached to the Health
Authority Approval Certification and all copies thereof.
RWR/ljm: 386
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type ~
Log present (Y/N) y
Totaldepth 377
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter.
ADEC water system number
Date completed '~/~/. Y'z'~ Driller
Cased to ~--~;Y' Casing height
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
WELL LOG AT ,.SPECT,O"
7~" g.p.m.
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Public sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~
Date of sample: ~/P-?/~/
Nitrate
~. ~ Other bacteria
Collected by: ~/ · ~ '
B. SEPTIC/HOLDING TANK DATA
Date installed ~ ..~. 7y'
Tank size /d~-..~C~ Compartments
Cleanouts (Y/N) Y' Foundation cleanout (Y/N) Y' Depression (Y/N)
High water alarm (Y/N) 7Y'/A- Alarm tested (Y/N)
Date of pumping '~'/~//f~! A 1~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I0 "? On adjacent lots t ID
To property line I O ~A Absorption field ~-~
Surface water/drainage
Foundation
Water main/service line
72-076 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION ~//~
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Gravel thickness
System type /-.o-~,~
Cleanouts present (Y/N)
Date of adequacy test
for __
Total depth
Date installed ~'" ~ ' 7t'// Soil rating
Length I ~- Width ~ ~
Total absorption area ~,~u,~t
Depression over field (Y/N) ~
Results (pass/fail) ~- ~.~,.~
Peroxide treatment (past 12 months) (Y/N)
t"l If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot J'5 ) On adjacent lots j e j + Property line
To building foundation I ~ To existing or abandoned system on lot
On adjacent lots ~Go f' Cutbank ~'/,~, Water main/service line
Surface water /"///~, Driveway, parking/vehicle storage area
Curtain drain ~/~-¥
E. ENGINEER'S CERTIFICATION
Z
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the da!e of this insl~_ction.
Engineer's Name-~'"~ ~,~ ~..o v'~-~P
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/91)Sack MOA21
Waiver Fee: $
Date of Payment
Receipt Number
(907) 2~-5095
RESIDENTIAL WELL INSPECTION
LEGAL:
L,.cxL ?~ Blc:,cl.:: 6 F:'ar"adise Valley
LOCATION:
6q:]!;5 Sh,,':J. 't.:z er' ;I. and
OWNER:
M:i.c:hael K. Wa].ker
TYPE OF WELL: F'r":i. vate.~ S:kng;I.e Fam:i. ly
WELL LOG AVAILABLE:
Yes
INSTALLATION REQUIREMENTS MET:Yes
WELL YIELD FROM WELL LOG:
12-314 Gallons per' I¥linute
PUMP YIELD FROM TEST:
6 Gal;I.c~ns per M:i. nute
DATE OF INSPECTION:
June 27~ 199:t
TEST PROCEDURE: Well was pumped at a constar'rt: ra't:e wh:i.]e 't:he
prt::)l::)e. A't:'. 'k:he beg:k nn:k ng (::).f: 'khe 'kest wa'tier level was ~:our'~d at. 5:L
,f:eet [::)e].(::)~,¢ top (::?f: casing,, At a pLtmpil]g rate O'f: 6 (;];:).l].orls per
m:Lnute i':hca wa't:'.er :l.~;:;.vel drc)pped t':c)346 .Feet a~i:,er 9C) minutes
pumping. A i::. c) t .~'l ]. o.f: zl. 5() (;:jaZl(:)ns v,~er"e pumped.
-l'l"~e v..,el], r~:::x:::c)ver"~?ct at a r" a'E (:.:;, (::)./,': ,,6 ,gal. per m:i,r'u..t't:(a.
TEST FOR E.COLI AND TOTAL NITROGEN: War. er was tested ..For E,Cc~li
and '(':c)'l:.al r~it. rc)ger't (:~!"~ J,',..u'~e 28~ i':79t
Max,, a].].owab].e 'T'otai Nitrc)gen 1() rog/1.
TEST RESULTS: 'T' h :i. s ~,,*e .'1. 1 meet s t h e r' eq u :i. r" emen 't: s c:).F t h e
F'h..u"~i c:L pal. :i. [:.y c:,-F
p 6))1'" J::)cecJrc]cgf~] j:;) 8~'- day,, This ~E-:,~L ]. Eex (::(~(.~2d thJ. s I'"eC:jLti r-ement ,, 'T'he
assessmer'yi:: o.{: 't::l"~,:, cc:)ncl:i, t:i. c)t'", o.F the wel ]. appl i es c:)nl y t':o the
(:::or'u:]:i. ti(::)ns as (::)'F t. he clay '[:'.es'E:ecl. ]"he .F:Low rate may c:hange due to
s~d::u;~;ur'.Fa(:::? c:c)r'mJ:L'l::ic)ns i::hat may r]c)t b(-::~, c)bs((.:~r"vEgd '¢r"c)~'l t. he sur.Fac::e~
.,
~751 ~. DIMONO
ANCHORAGE, ALASKA 99502-3~04
LEGAL:
LOCATION:
OWNER:
RESIDENCE:
WELL:
SEPTIC SYSTEM:
SEPTIC SYSTEM ADEQUACY TEST
Lo~[: 9 Block 6 F'aradise Val)ey
6425 Swit~zerland
Michael K. Walker
Single Fam:i. lyv 3 Bedr~:~oms
F'r:Lva't~e~ Or] S:i.'t~e
F:ROM MUNICIF:'AI.,. RECOF;,'DS: .]: Bedroom Sys'Eem
"FAIqI<: Espir'~c)Ta :[000 Ga:L. One Cc)mpart..
ABSORF:']":[ OIq SYS"I"IEM: Log Cr"i b'
ABSORP'[' ION AREA: Unknown
SO]:L. RATING: 10()
'I: NS"I"hL..I..AT I ON DATE[: :1. 974
DATE OF LAST PUMPING: May :i, v 1991 A+
DATE OF TEST:
TEST PROCEDURE: Sys'tem was :[nspec:ted and measured. 'l"ank was
.Found with 4 ~eet o.F (::over and with a ].iquid level o-F 46 .inches,,
Cr :i. b was -[: [:)Ltnd '?. 3 -f: ~::-:,e'[,: (::l~:eep al'Id ~.,~i th a 1 :i, clui d dE, p'[:.h c:).~: 36 i r'~(:::h ....
(,E,%.
450 (~jlallc)ns (::).~ clean wa'['.er ~as added to 'hhe crib wh'i].e the wa~zer
].evels in 'hl't~a '[':arlk and crib w(,:~l'"e mc~r~J, tc:H'"ecl. ]"he ,Firs'[ :1.0() gallo)ns
~er'e ch..~mp(~;.~d :i. ri th[:e .~: c)uF~(::!a'[::[ c)l"~ c:l 6:.:,ar'~ c)u'[:. 'T'hJ. ~; cau?.E,d 'l:',l']E, water
].eve] :[.l'] the '[:ar'~l.:: 'k.(::) i'":i, se :~; J. Ft(::hes whJ.][e I]o I'"J. s6~ was
'h ["~ (.:.::, c:r i I::). The nE:.:t 3[71~C) gall, 1 ohs ~el."'e dumped :[ ri'ho the cr:[ b. 'T'he
water ].ew.:.~l :in t.h(.~:, tank rema:[ned +.3 :[nc:hes while the ].evel ~.1] the
cr':i.b r'c)s(~e :[() :[r'u::h~:~.?s. Dur:i.n(:.:; '[',hE, 1")6.?x'E ].:[0 ll~J,l"H.l'l':,6:)!i[~ 'Ehe wa'her level
:i.r~ '[:he tar'~[-:: ,.:Jr(::)p!:)(~)d [},:::tc:[:: '[(:) r')(:)rma], while the ].ev~:.)l :in '~:he c:r"ib
(::h'c)pped .~ :[ v~(:::h(es,, "l"h(:):, next:', day t.h(~, wa'her 1 ev~:~,l :[ ]'"~ '[:he c:r:i,
c::l-~(~.)c:kE~c[,, ['he water ],ev():,i ha(:J dr(::,pp~:ed to the :[r~i'['.J.a]. level
:i.r',c:l:i.c:a'h:[r":q:l tha'L a].l (::)..f: th(.:e voa'Et(m'" had I::)(aer'~
TEST RESULT: 'T'h:i.s system meets t. he code requ:i.r'emer'lt.'~; (:::,.{:
the Heal th and Soc :i. al Set v:i. (::es-:.
D(ape. rtm~.::¢r'v?: c:,.',:: 'l:h~:e id~u"~:i c :i pal :i ty o.¢ A.r't,::::h(:)rage~..
NOTE The oper'¢:~d':ional 1 :i.-F(e o.{: al 1 sep't'.:i.(::: systems depends or'~ 't:he
]. (::;(::a:l. so:i. :[ c:c;nd:i, t i c3ns ~ gr(:)ur~clwater l eve]. s tha'[: may; ~: I uc:t. ua't:e
cit..u,' J. r'~g 't:.hE¢ ';,,ear ~ ar'u::l t. he wa?ct:er usage (::).f '[the .f: ami ], y be:i. ng served
[:)y '[: !"t (~-:~ ~;¥'st(~:.)m. ']'he:~e c:(::;r'td:i, t J.c]r'ls are c)t.,v[:side the
(;::,:,valuatc)r o.{: 't:.his s6:.:,[:)'[: :[ (:: !aF),~;'[:6:,[~. [~J6~ car] th6:,r(~:.?¢c)rE,
es'['::i, mate o.¢ hc)w tong this system w&11 .~:ur'l(::t.:[on sat:i.s<:act(:~ry .¢(::~r
c:ur're:,n'h or" .~u't'.:ur'l.;? c~cc:upar'rhs.
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # E~.~C)-Lll.~-I~-<> HAA# ~___~ ~',~ ~ ~ ~:r~ ~ ~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
/_ ? (¢ V,¢//¢'? 5/1 7-11 /¢.%W.
(b)
(c)
Location (address or directions)
Property owner/~f"~, g/~ f~.~- -5'~/~ .,~.,"~YC--<.P Telephone: (home) ~ Business
Mailing Address
Lending' Institution~ ~¢ ¢~ /,, ~ _. ,
Mailing AddreSs
(d) Rea. I Estate Company and Agent /~(~)'~--~' -- O~L')~'"~ :~:~ /?'~"~
Address
Telephone
(e)
Mail the HAA to the following address: (or check here/~., if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms 3
3. WATER SUPPLY
Individual Well ~, Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ~, Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
(Rev. 7/88) Page 1 of 2
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NOI.LVlNIdO:INI ONY vJ. Ya 'F101~¥~!$ 311.-I '$j.$:lj. 'SNOIJ. C)~idSNI ONlalAOEId INl:lld 9NII~:~]NIgN~! 'g
~ MUNICIPALITY OF ANCHORAGE (MOA)
(,'~,1 Health Authority Approval (HAA)
ALtT~-,~-4ORAGE CHECKLIST. FEBRUARy 1984
~UNICIP _~ DIVlStON 343-4744
~NVIp, oHMENIAt' ~r.~
Legal Description:/--- ~ ~_~-~
.{ljN 1 3 !989
A. WE'L DATA r C I::_lV D
Well Classification ~_2 [ V4~-~'~---~ If A, B, C, D.E.C. Approved
Well Log Present (Y/N) ,Y Date Completed /V~¥ ~.~/.~7'7,,;~ Yield ~.
Total Depth ~ 7 ~1 Cased to ~ Depth of Grouting
Static Water Level . ~ [ Pump Set At ~ ~ /
Casing Height Above Ground / ~ll ~ Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit(Y/N) ~ Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL: / ~
To Septic/Holding Tank on Lot /~ 7 _~ ;On Adjoining Lots / ~ C¢)
To Nearest Edge of Absorption Field, on Lot / ~ ' ; On Adjoining Lots
To Nearest Public Sewer L ne ~/~ To Nearest Public Sewer Cleanout/Man;ole
To Nearest Sewer Service Line on Lot
Water Sample Collected by ~ ~¢¢ ~ ;Date ~/¢/~¢_ .
Water Sample Test Results ~ ~ ~/,~
Comm n ,
B. SEPTIC/HOLDING TANK.RATA ~
Date Installed ~/~/~'~Size ~%c of Compartments
Standpipes (Y/N) ~¥ Ab-tight Caps (Y/N) ~/
Depression over Tank (Y/N) .,~
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) //~r/~
Foundation Cleanout (Y/N)
Date Last Pumped ~.~.~x-. ~ ~
for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM ,e-,FPTIC/HOLDING TANK'
~_~ · ._
To Water-Supply Well / O_7 To Building Foundation /
TO Property Line ~ To Disposal Field
To Water Main/Service Line ~~ ~~
To S{ream Pond, Lake or Major Drainage Course ~~ ~~ ~
Comments~ F~/~
7
72-026 IRev. 7/88~ Front Page I of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /~:~O ;~/~, Type of System Desi~-q)
Date Installed -~ J ~ ~ ~ Length of Field / ~
Width of Field Depth of Field /~ ~
Grav~ed Thickness ~
Square Feet of Absortion Area ~~ ~ Statndpipes Present (Y/N)
Depression over Field (Y/N) ~ Date of Last Adequacy Test
Results of Last Adequacy Test ~ ~ ~ ~ ~ ~ ~ ~
SEPARATION DISTANCE FROM A~PTION FIELD:
TO Water-Supply Well / ~ ~- ~ ~ TO Property Line
To Building Foundation / ~ / ~ To Existin~ qr ~doned System on
Lot ~ ¢ ~ ~ ; On Adjoining Lots /~/
To Water Main/Service Line ~ ~ ~ ~ To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course ~¢~~~
To Driveway, Parking Area, or Vehicle Storage Area ~ / ~
/
D. LIFT STATION
Date Installed (7~ .~. Dimensions
Size in Gallons -~'~ Manhole/Access ~
"Pump On" Level at ~'"----.~~e~el'~t~__~
High Water Alarm Level at ~ ~~
Tested for ~ Pumping ~cl'es-du i~g~Adequacy Test.
~l~ernt~ eMrOtsA Elect rica~s~Y/N)
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, ve. rified, or conformed to all MOA and HAA guidelines
inspection.//
Signed. _~..~-~¢,,~_ ~k,..~.~-~'-~ ~%.~_~ .
MOA No.
~n effect on the date of this
~eal
Receipt No. (~
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4726
Application Date l/(~)J( ./Y?_'?~ /~'~ &
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, towns,hip, range)
Location (address or directions)
(b) ApPlicant Name /~/¢'~ ~,,¢3 H~ Telephone: Home ,-~/~"'"'! ~/~'~'~ Business
Applicant Address
(c) Applicant is (check one): Lending Institution []; Owner/builder I~.; Buyer []; Other [] (explain);
(d) Lending Institution .~'{~.~.> 5"¢~¢C"
Address ~0,' W~
(e) Real Estate Company anO Agent
Address
Telephone
Telephone.
(f)
Mail the HAA to'the following address:
TYPE OF RESIDENCE
Single-Family~2r% Multi-Family []
Number of Bedrooms
Other
WATER SUPPLY
Individual Well J~CX, 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. SEWAGE DISPOSAL
Onsite~[,,, Public [] Community [] Holding Tank []
Note: If Community well system, must have written confirmation from the State Department of Environmental Conservation
attestingto the legality and status.
72-025 ~11/84)
Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Nameof Firm.~/")"~.-~ ,..~~/'~;~/ 4~-~C-~"~Telephone .'~. /,~,~
AD~:vAe:~oRr~ ~ed room s by ~_~
Approved ~.~ Disapproved
Terms of Conditional Approval
.~--.~ ~.4.~ Date
Conditiona~
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements, Employees of 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.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY '1984
264-4720
MUNICIPALITY OF ANCHORAGE
DEPT, OF HEALTH &
ENVIRONMENTAL PROTECTION
,JUN 1 0 i98 '
WELL DATA
Well Classification .~ ~ ~'[,/"O~ 7~--- If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) Y Date Completed /V~.t~. Y ~-.~'~ /1~, ~ ~ Yield
Total Depth "~ 77 t as,.d to f Depth of Grouting
Static Water Level _-~ _
Casing Height Above Ground /
Electrical Wiring n Conduit (Y/N)
Separation Distances from Well:
Pump Set At ~) ~.~ .~ -, *r~ /
Sanitary Seal on Casing (Y/N) Y
Depresmon Around Wellhead (Y/N) /~y/
To Septic/Holding Tank on Lot -] ~) 7 ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /'-~ ~'/' ~
; On Adjoining Lots
Line ./~,tO/w') ~. To Nearest Public Sewer
To Nearest Public Sewer /~ ~ ~ ~
Cleanout/Manhole To Nearest Sewer Service Line on
Water Sample Collected by -~ t: ~/~(~f~ ; Date ~ /
Water Sample Test Results ~ ~"["
Commems ~ I'lfJ ,~aS, ' 14,'ell C3. : C.,
SEPTIC/HOLDING TANK DATA
Date Installed ~¢2/b /-~4Size''j ~__~'~_~ Nc. of Compartments /
Standpipes (Y/N) F Air-tight Caps (Y/N) ~/' Foundation Cleanout (Y/N)
Depression over Tank (Y/N) ~ Date Last Pumped
Pumping/Maintenance Contract on File (Y~//~. '/~ ; for
Holding Tank High-Water Alarm (Y/N)
Course
Temporary Holding Tank Permit (Y/N) //J~.X~j
,CZ)
To Building Foundation ~
To Disposal Field ~ (~ !
Separation Distances from Septic/Holdj~tg~Tank:
To Water-Su pply Well
TO Property Line
To Water Main/Service Line /~O/~t~' To Stream. Pond. Lake. or Major Drainage
.-[-o /o/"
Page 1 of 2
72-026,11/84)
C. ABSORPTION FIELD DATA
SOils Rating in Absorption Strata
Date Installed
Width of Field /~_...,
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field,;,.~
To Water-Supply Well --- -"' ,~'~-" t
TO Building Foundation / ~/~'-? ! ~
Lot /4~(~/,~ ~
TO Water Main/Service Line ~ ~ ~ ~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
;
) ~-?~"' (~ Length of Field }
T..~ Depth of Field /~
G(~el Bed Thickness
~c~e~--~'~C, Standpipes Present (Y/N)
'A// Date of Last Adequacy Test
To Property Line --~'~:~ /
To Existing or Abaj;~l~ined System on
; On Adjoining Lots J ~:::)~ /
TO Cutbank (if present) ~_~..///, ~.
D. LIFT STATION
Date Installed Dimensions ,/"~
Size in Gallons Manhole/Acce~ (Y/N)
"Pump O"fi'~'E'm/eha{-._ ~ ~-~- l--~ump Off" Level at
High Water Alarm Level at '""'"'~.~ Vent (Y/N)
Tested for
'------..P~ing Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)..
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have chec, J~d,~er. ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed~~~'"'~ Date ~' J~/~'~ /(~/I~' ~
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11t84)
JAMES SIZEMORE & ASSOCIATES
CONSULTING ENGINEERS & SURVEYORS
6410 Switzerland Drive
Anchorage, Alaska 99516
Ph. 907-345-1572
Mr. Sam Hayes
6425 Switzerland Drive
Anchorage, Alaska 99516
Dear Mr. Hayes:
On June 9,
system for
results.
1986 I performed an inspection of the well and septic
your home. The following briefly summarizes the
WELL: A flow test was performed on the well over a 6 1/2 hour
period. The maximum drawdown was 173 ft. During this test period
a total of 451 gallons were pumped from the well. The static
water level had returned to 39 ft. at 8:30 P. M. My test
indicates that the well is producing approximately 0.7 Gal. per
Min. and is adequate for the three bedroom home.
SEPTIC SYSTEM: Four hundred and fifty gallons of water were
pumped into the seepage pit during the test. The pit handled the
water satisfactorily and is adequate for a three bedroom home.
Sincerely lours~
v James F. Sizemore P. E.
