HomeMy WebLinkAboutMOORE LT 43B-1
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~°cO 0 ~' -C' PID Number: (~'~ ~ ~ -- ~'~--
Name: Wastewater System: [] New ~' Upgrade
Address:
/~ z~ ~~L ~w~, ~ ~ ~ ABSORPTION FIELD
Phone: ~ ~/~ . No. or,Bedrooms: ~Deep Trench D Shallow Trench D Bed ~ Mound D Other
Soil Rating: Totsl Depth from original grade:
LEGAL DESCRIPTION ~. ~ ~s~. ~. //, ~
Lot: Block: Subdiv~ion: Depth to pipe boEom from original grade: Gravel depth beneath pipe
Township: Range: Section: Fill added above original grade: Gravel length:
WELL:~ New ~ U~ Gravel width:~{ Ft. Number of[ lines: Distance.be~een lines:Ft.
Classification (Private. A.B.C): ~th: Cased To: Total absorption area: Pipe mate/iai:
~ Ft. Ft. /0~'~ SO. Ft. ~lO /3~
Driller: _. //%~ I~ Date DriUed: StaticWater Level: installer: Date in.ailed:
Ft. ~ ~%~ ~//~/~
~ GPMIPump Set at: Ft. ~ Casing Height Ab°ye Gr°u~: TANK
SEPARATION DISTANCES ~Septic B Holding ~ S.T.E.P.
To Septic Absorption Lift Holding 3ublic/Pdvate Manufacturer: Capscity in gallons:
From Tank Field Station Tank Sewer Lines ~ ~ ~
SudaCewaterWel~ ~'~/~ ~LineL°t /~ ~ /OO~ J ~ ~ ~~I Material: Size in gallons:Manufacturer~ ~/~LIFT, STATION, Number of Compa~ments:
Foundation ~l ~1~ ~ "~ump on" I~vel at: ~~1 at: ~i~h wator alarm at:
CudainDrain ~/~ ~I~ . ~ I~ct~ I~ti~sped°rmedby:
BENCH MARK
Remarks: ~r~ ~ ¢~¢~¢~~
Location and Description:
I Elevation:
Assume~ ~
ENGI~.~ SEAL
Inspections pedormed by: ~-~A~¢~,p.~ Dates: 1st ~¢/~ ~~,~ .... ..................
Department of Hep th an Iint;l~l Se~ices approval %°~2%¢~
~ ~' -%~o~ss~o~%~
Reviewed and approved by: ~[ ~ ~q~ Date: ~g/go~'~ ~.'~e~,..,.",
72-013 (Rev. 9/91) MOA 25
R-BUILT
WASTEWA ABSORPTION SYSTEM
EX:~T, j
~/E L
~z NEW
~'~-- ~- ~ 74,3[
SWING-T]
134,5' 66,8'
i 42,4' 72,2'
i 68,0' 100,8'
93,9' 120,3'
136,6' 155,5'
o u p~§
98,7' _-~ NrlTES~
1) EXISTING BE]) WAS
0,9' HIGHER THAN TANK,
T~,_~_ r~--C~T~T.[r~,, ~'I[';~TEM A]~ANI]ONE]] IN PLACE,
HT
~-' ~11~ ]~raJn Pipe ~
97,5
MUNICIPALITY OF ANCHORAGE ~- ~
DEPARTMENT Or EA TN NUT SE IC
P.O. BOX 196650, 825 "L" STREET, ROOM ANCHORAGE, ALAS BLA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW970095
DESIGN ENGINEER:STEVEN R. PANNONE
OWNER NA_ME:EGGERT JOHN THOMAS &
OWNER ADDRESS:14251 BRANDL ST
ANCHORAGE, AK. 99516
DATE ISSUED: 5/16/97
EXPIRATION DATE: 5/16/98
PARCEL ID:01819241
LEGAL DESCRIPTION:
MOORE LT 43B
LOT SIZE: 49326 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18/LAC72) AND DRINKING WATER REGULATIONS {18/LAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) {NOT REQUIRED FOR WELL ONLY PERMIT
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SA24E DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY
DATE:
Steven R. Pannone, P.E.
Consulting Engineer
(907) 272-8218
P.O. Box 142025
Anchorage, Alaska, 99514
(907)272-8218 Fax
May ll, 1997
ATTN: James Cross, P.E.
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Subject:
Lot 43B Moore Subd.
Septic Upgrade Permit
FAILED SYSTEM
RECEIVED
MAY 1 2 1997
Municipality of Anchorage
Dept. Health & Human
Dear Mr. Cross:
My finn was contacted to conduct an investigation of a failed system on this lot. The existing system on this lot is in
failure. The bed has 12 inches of standing water, and the liquid level in the tank is 70 inches deep. There are signs that
the liquid levels have been higher in the stand pipes. I performed a single test hole on May 9, 1997. The soils report and
percolation test result is attached. Ground water is currently being monitored. Lot 43B has water monitoring data from
I983. There was no water encountered to a depth of sixteen feet nor after seven days of monitoring. Lot 43A soils
information indicates there is no water at a depth of sixteen feet also (it was monitored in 1991). No bedrock was
encountered in the test hole. I request the water monitoring requirement be waived due to the eminent health concern
affecting this property and the close proximity of existing water data indicating adequate separation to ground water.
There was no water in the monitor robe on Sunday May 11, 1997. The' water monitor tube will remain to verify that no
water exists.
The lot is approximately 1.15 acres in size. Lot 43B slopes to the south at a rate of approximately 1 percent. The
proposed installation will be located on the southwestern portion of the lot. The existing field and tank will be reused. A
diverter valve will be installed directly after the tank. The existing tank is located inside this lots 100 foot well radius.
An existing waiver is m place for the separation distance to 98 feet. If a new tank is required, it will be installed out-side
the 100 foot well radius on this and surrounding lots. Double clean-outs will be installed down stream from the diverter
valve on both post-tank lines. The proposed location is greater than 100 feet away from the existing well serving this
property and 25 feet from the water service lines. The surrounding wells are located greater than 100 feet from the
proposed installation. The proposcd installation shall not impact the future development of the surrounding lots. Seethe
attached design.
If you have any questions about the proposed installation, please contact me at 272-8218
Sincerely,
~nnone, P.~.
Attachments:
C:\WORK\43MOOR.001
MUNICIPALITY
RECEIVED
I}ESIGN
WASTEWATER A]~SBRPTIBN SYSTEM
Lo~c 433 Moore Subd,
NOTES,
l) EXISTING ]~E]] SYSTEM HAS FAILE]I
SEWAF, E LEVEL IN THE TANK WAS
NEASUREI) AT 70' ]~EEP ¢4E' BELOW
Tnp OF C,D,),
2) VERIFY INTEGRITY BF EXIST,
EAST 14end 1850g SEPTIC TANK, REPLACE
.................................................... IANK/]L~T&T~F~ _TJ~$ _lQOi _ W E L L
RADIUS IF FDUN~ LEAKING,
3) TEST PIT 3 WAS EXCAVATE9
ON 5/~1/83, ORIGINALS ARE ON
FILE AT ~; ',', ',~.
.......... EXIST,
/
~ELL
EXIST.
SEPTIC TANK ~
~ INSTALL ~IVERTER
VALVE & ~DUBLE
CLEANBUTS,
PRDP[
EXIST. BE~
FIEL~ EFF, SYSTEM
Drawing C,\~/ork\43MDDR,I]WG
75 LF
C:>TP3
TPI
¸42'
HnUSE
ND WELLS DR SEPTIC
WITHIN EOO' BF PRDPDSE~
INSTALLATIaN 7,~~75'
EXIST,
~x.~_
4 tledroom House
1000 SF Rqd
DESIGN; 7' E??ec~clve
11' To'cai Depth
2' Wide, 75' Long
Total Absorption = 1050
PREPARED FDR~
Hr, Tom Egger~
14251Brandt Drive
Anchorage, AK 99516
(907) 265-1663
Pannone Eng, Svc,
P, D, BOX 142025
ANCHORAGE, ALASKA 99514
272-8218, PHONE & FAX
0ATE, 5-11-97 ~ DESIGN
~C/~LE, 1'=60'
/
DESIGN DETAILS
WASTEWATER ABSORPTION SYSTEM
Lot 43]3 Moope Sulod,
RECEIVED
MAY 1 2 1997
~ Mlmioipality of Anchorage
el)t, Health & Human Service,,
Z
[23
W
il'ID NV393
~r~ ~OmINaW
lflD NV]13
Z
_J
b_
O_
D~wlng C,\Wo~'k\43MDDR,lWG
lno NV31D
NV]lO
£RDNV393
NOlIV~lflOJ
PREPARED FDR~
Mr, Tom Eggert
14851Br~n~l Drive
Anchorage, AK 99516
(907) 265-1663
P~mnone Eng, Svc,
P, D, BOX 142025
ANCHORAGE, ALASKA 99514
878-8818~ PHDNE ~ FAX
IDATE 5-11-97
INDT TO SCALE DESIGN
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
9
10
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED?
Township, Range, Section:
SLOPE
SITE PLAN
S
IF YES, AT WHAT ~)
DEPTH? ~ p
E
Depth lo Water A~fter. _
Monitoring? '~'~" Dale:
COMMENTS
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE '~ ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND ~ FT
PERFORMED BY: '.-'~'~'~"'~,'~j/U'O'~/t~'t~'~ I ~'"r~L~-'~),~,,u.,,~J~.,,~,/.~.~: 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)
i~ ,,_~/ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME '~ IPHONE EW
IMAILING A _D,D R F~SS
LZAL DESCRIPTION
LOCATION NO, OF BEDROOMS
DISTANCE TO: J Weg ~,¢ / Absorption7 Dwelling¢0 PERX~O.
~ kiq. c~it~ ~jlons Inside length Width Liquid depth
~ ~ IF HOMEMADE:
~ ~ ~ Well Dwelling PERMIT
DISTANCE
TO:
O ~ ~ Manufacturer Material L~quid capacity in gallons
~ Well Foundation Nearest lot line PERMIT
~ ~ DISTANCE TO:
~ ~ ~ No. of IMes Length of each line Total length of lines Trench width Distance between lines
~~ ~ inches
~ ~ Top of tile to finish grade Material beneath tile Total effective
absorption
area
~ inches
~ ~ Length ~/~ Width ~ 7 ~ Depth ~ / PERM~N~
~ ~ T~e of cr,~ Crib diamete~ Crib depth ~ Total effectiue absorption area~ ~
~ell
~ DISTANCE TO: t~0 / Building ,~/~ion Nearest lot line /~
~ Class Depth Driller Distance to lot line PERMIT NO,
Building foundation Sewe~ line Septio tank Absorption area(s)
~ DISTANCE TO:
OTHER O
PIPE ~ATERIALS t
SOIL TEST RATING
72-01~
rv~-~/ DRILLING, Inc.
P.O. Box 10-378 * 10300 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner CHUC~ FDORE Use of Well Dormstic
Location (address of: Tow. nship, Range, Section, if known; or distance main road Lot 43-B M~ore Subdivision
11
Size of casing.
Static water level
Screen ( );
Describe screen or perforation None
Well pumping test at 10 gallons per (I~;~
of drawdown from static level.
Date of completion Animist 2; 1983
_Depth of Hole ]130 feet Cased to 129 feet
90 ft. (~ (below) land surface. Finish of well (check one) open end ( xx );
Perforated ( ).
(minute) for 1 hours with 100%
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated size of material, color and hardness
0 TO_ 2 Casing stickup
2 TO_ 30
30 TO 8O
80 To_~llD_
__i!0_TO ] 27
127 .TO. 130
TO.
TO_
TO_
TO_
TO
TO
TO
TO_
TO_
Br~n clay and gravel
Brown cia.v and gravel ('d~p)
GTav silty ~ava_l
CCr~y hard ?m
Waterbearing gravel
NWWA Certified Canli',~cLur
Certificate No's. 814 & 973
1 -- CUSTOMER
~ ~ ~ HANDWRiTTeN PERMIT
- ~he bottom of ~he excavation(in leek). There i~ nO
,. ~e graVek depth is the m~ depth of gravel between the outfali
. P~it ap~lican~ ha8 the ~pon~_b~l~y ~o info~ thi~ depar~nh
~ ~ *.TWO(2) INSPECTIONS ARE R~U[R~O
:will be subject to prosecution.
:~n4 ~x~t be ~etu~n~ to this dapa~en~ within 30
(:Other remitments ~y appZy. ~p~ifica~ions and
- ~ o~rkify that:
set fo~kh by ~he ~icipaii~y of .~chorage.
MUNICIPALITY OF ANCHORAGE
Department ~ Health and Environmenta] ~rotectiont~_t
825 \~ Street, ~_qchorage, AK. '~501 - ~
.... ~ ~ 264-4720
~' * * * HANDWRITTEN PERMIT * * * ~:~. '
Permit %~ WELL AND~ ON-SITE SEWER PERMIT C/
~,~Z' /
~pplicant:c~,~/( /~~- Mailing Address: ,_p~
Legal Description: ~m ~L¢ ~.:'~ :T/2"-X~~" Lot Size:
Type of Soil ~sorption SyStem Is:
/
Trench: . Drainfield: Seepage Bed: ~ Holding Tank
e rooms:
DEPTH
The Required Size of the Soil Absorption System Is: '
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~,~-L3 GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 o° 3 * * * ·
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlar/~ement if
the residence is remodeled to include more tha~3 bedrooms~./
Signer: Issued by :~~(~/~-~u~.~ .............
Applicant /x :/./,~
Date: _ . ·
SWP/024(i/81)
J 5~e('~ t o'~ 3 S[-,cetS ] ~/ SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION .,~ PERCOLATION
. ' TEST
.825 L,'. Street; Anchorage, Alaska 99501 ,.264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DATE PERFORMED:
SLOPE SITE PLAN
1
2
3
4
~0~
11
12
13
15-
16-
17
18
19-
20-
C. Reid, Jr.
No. 2251-E
WAS GROUND WATER L
ENCOUNTERED? ~',~o
o
P
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
[~zq 50 .Sq · oH
8q5 ~ '8z5 .o~5
65ot ,t~ ,81 .ol5
PERCOLATION RATE > (~O (minutes/inch)
':' ~! ~TEST:RUN:BETVVEEN .... '-% · ,.:;F~T,AND ~ '/~- FT
'~ 5' ~dL5 ,~,.~ ~a ® 8su'/I,~o,. s~,-~ ~ 5-'% q' o.~. ,-,~,wb. bt~
-~,- n,q -. ,~; 4-e.
PERFORMED BY:
CERTI FI ED BY: DATE:
72-~08 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED: 5 /~-'~ / ~
LEGAL DESCRIPTION:
4'
6
7
Lo't-
9
SLOPE
SITE PLAN
10
11
12
13
14
15
16
17
18
19
20
COMMENTS Se;~ '~
L,~- net L'oq¥;,~oo~s-- q~t '~c
PERFORMED BY: ~e',/eqS
WAS GROUND WATER S
ENCOUNTERED? 1~o L
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE minutes/inch)
TEST RUN BETWEEN FT AND ~ FT
CERTI FI ED BY: DATE:
,,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRO.NMENT,AL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~' SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION:
5
6
7
8
SLOPE
SITE PLAN
10
11
12
13
14
15
16
17
18
20-
COMMENTS
WAS GROUND WATER S
ENCOUNTERED? ~ L
0
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
o,z~ - ,~O --
~15'~ '5o .3o . zo
~[57.. ~ ,50 --
PERCOLATION RATE 2-~ (minutes/inch)
TEST RUN BETWEEN "~ ¥2- FT AND ¢.5f FT
PERFORMED BY: ~-,It~ ~, 3,
72-008 (6/79)
CERTIFIED BY:
DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
~'7-- ~ z.{~ ,./'/ NAA# ////~
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Day phone
A I/-- ~5
Day phone
Agent ~-4~.
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: ~
3. TYPE OF WATER SUPPLY:
"~: ' Individual well
Community well
RECEIVED
MAY ? 1 1997
Municipality of Anoh~Orra~ece
Dept. Health & Human ~e
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
Holding tsnk
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA#21
STATEMENT OF INSPECTION BY ENGINEER.
As certifiedby 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 waste~vater 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~--'~A,o,d~r~¢ oeruAocm,.,u~ CfoC,.
Address
EngineeYs signatu r~~:::~~
Phone
Date
· ~, Approved for ~;fd/'L ,.
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska, The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA fY21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental
Se~Jces
Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3
Health Authority Approval Checklist
Legal Description::/- ~3~E, t'-~oc~.- '5/-~ Parcel I.D.:
A. WELL DATA
Well
Log present (WN)
Total depth I~Jot
Sanitary seal (Y/N)
IfA, B, or C, attach ADEC letter. ADEC water system number
Date completed ~'/~/~'._~
Cased to ~o'P Casing height (above ground)
I. Wires properly protected (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
FROM WELL LOG AT INSPECTION
~l'zl~
/ b g.p.m. .~.
g.p.m.
Coliform -- ~ ~" Nitrate ~) ~ tC~ ~) Other bacteria
Date of sample: .~/1'~[ q=F Collected by: --~ ' F2'~A~ c~,,u~
B. SEPTIC/HOLDING TANK DATA
Date installed /c)/~"~ Tank size /~,.~o . Number of Compartments
Foundation cleanout (Y/N) "~
Date of Pumping '.5'//&/~'~
C. ABSORPTION FIELD DATA
Date installed -~-//"~'~/~ =7-
Length '~'~(-'~ Width
Effective absorption area
Date of adequacy test ,4J~.
Depression (Y/N) ,,,c/c)
Pumper ~ ~o,,~ ~Vc~-
~-- Cleanouts (Y/N)_
High water alarm (Y/N)
Soil rating (g.p.d./ft~ or fF/bdrm)
Gravel thiCkness below pipe
Monitoring Tube present (Y/N)
Results (Pass/Fail) ~A
Fluid depth in absorption field before test (in.); ~
Fluid depth ~ (ins) Minutes later: ---'
Peroxide treatment (past 12 months) (Y/N) - -
72-026 (Rev. 3/96)*
O · ~ System type -t'-~2~..~,.~C/~
-~' ~ Total depth ~ /~-~,~'
Depression over field (Y/N) ,,~
For z~ bedrooms
Immediately after '""-- gal. water added (in.): ~
Absorption rate = -'--' .g.p.d.
If yes, give date ~
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at* ~
E. SEPARATION DISTANCES
Size in gallons
"Pum~ "Pump off level at*
*Datum RECEIVED,
SEPARATION DISTANCES FROM WELL ON LOT TO'
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
Septic/holding tank on lot
Absorption field on lot
Public sewer main ¢t~'[¢~
Sewer/septic service line
MAY ? 1 1997
Municipality of Anchorage
Dept. Health & Human Services
SEPAR'ATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~ q ~ Property line /'/~ Absorption field
Water main/service line
Surface water/drainage ! c~c~'4- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Sudace water
Curtain drain
Building foundation ~, ~ ~ Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots / .~¢¢,
F.
ENGINEER'S CERTIFICATION
~c~rt~y~ha~havede~erm~ed~hruf~e~d~s~ec~nsand~ev~Mu~c~a~r~c~rc~st~~:/~
in conformance w/th MOA HAA gu/de//nes /n effect on th/s date.
Signatur6~ ~
Engineer's Name ~~ ~~~'~
HAA Fee $ ~ 6
Rece,pt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
,~ ,MA¥-22-1997 16:49 CT&E ESI
.~t~_-~, ~CT&EEnv[r°nmen~alServiceslne'
ANCHORAGE
90?5615301
P.02/03
CT&E REA'.#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
972489001
Pa~none Eh§
4SB Moore S/D
Fronthoae Bib
Client PO#
Printed Date/Time 05t22/9'7 11:16
Collected Date/Time 05/18/97 14:00
Received Date/Time 05/19/97 10:20
Technlca! Director: Stephen C. Ede
Released B~ ~'
S--afiiple Remarlc~:
CT&E Microbiology Drinking Water Program certification status is provisional as of 4/8/97.
Parameter Results .._ p~tL Unlta , ,, Matho¢~
Nitrate-N 0.100 U 0,100 mg/L SM18 4500-N03~
Total coliform 0 eol/tOOmL $M18 92~2B
10 m~x 05/20/97 ~
05It9/97 RMV
MUN C PAUTY ^NCHOR^GE
DEPARTMENt' HEALTN AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a)
(b)
(c)
Legal Description (include lot, block, subdivision, section, towns_h, ip, range)
Location (address or direction, s~
Applicant Name ('~C~'~.-?~ ~_,--~. Telephone: Home...~.~//-~ ~ 5,~/..,2-,, Business
Applicant Address ,/¢/~_.~.-'/ /_..~/_.~~,~'_ ~__~_~_~--/,
Applicant is (check one): Lending Institution []; Owner/builder,~; Buyer []; Other [] (explain);
(d)
(e)
(f)
Lending Institution ~,/~?~¢_~/_-'~.-¢~/'~</~-~/~¢--Telephone
Address'
Real Estate Company and,Agent ~/ ~~, ~~.
Address
Telephone
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family~ Multi-Family []
Number of Bedrooms Y
Other
WATER SUPPLY
Individual Well~ Community [] Public [] '
Note: If corn munity well system, must have written confirmation from the State Department of Environ mental 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
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
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.
Name of Firm S ~ S ENGINEERING Telephone ~' ~"'~-~¢~ ~ ~
Address 5[~ B "~95X
Date
· EAGLE RIVEP,, AK 9957~'
D.E. APP.OV^L
Approved for,-~'~"- bedrooms by ~ ~' ~¢-~"~> Date
,,Approved ~ ', Disapproved Conditional
Terms of Conditi6nal APp~oyal
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)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
· .H.~..A..L.T~..AUTHORITY APPROVAL (HAA)
MUNICIPALITY OF
DEPT. OF HEALTH & CHECKLIST- FEBRUARY 1984
ENVIRONMENTAL PROTECTION 264-4720
,SEP 41986
RECEIVED
Well Classification
Well Log Present ~i~YN)
Total Depth ~,"Z~ c> t Cased to
Static Water Level '¢~ O ~
Casing Height Above Ground J "L. ~
Electrical Wiring in Conduit (~N)
Separation Distances from Well:
To Septic/~ Tank on Lot ~ '~ ~ ~
To Nearest Edge of Absorption Field on Lot \ ~:~ ! 4r
To Nearest Public Sewer Line Cleanout/Manhole '"'
Water Sample Collected by
Water Sample Test Results
Legal Description:
I
IfA, B, C, D.E.C. Approved (Y/N)
Date Gompleted ~,''J-~ ~'~ Yield ~,~
~'7.~ ~ Depth of Grouting
Pump Set At
Sanitary Seal on Casing (~N)
Depression Around Wellhead (Y/~)
; On Adjoining Lots
; On Adjoining Lots
¢ I/~ To Nearest Public Sewer
,r~/~ To Nearest Sewer Service Line on Lot
B. SEPTIC/14~L-DtN~ TANK DATA
To Property Line
To Water Main/Service Line
Course
Date Installed
Standpipes~/N) Air-tight Caps (~I/N)
Depression over Tank (Y/~
Pumping/Maintenance Contract on File (Y/N),41
Holding Tank High-Water Alarm (Y/N) I~
Separation Distances from Septic/l~ank:
To Water-Supply Well ~ t
No. of Compartments
Foundation Cleanout (Y~.
Date Last Pumpe¢
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation "~'~ ~
!
To Disposal Field ~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72 026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed \[~'~ ~ ~ ~"~'~
Width of Field "~'"~ !
Square Feet of Absorption Area
Depression over Field (Y/~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
~l~Gravel Bed Thickness
Standpipes Present (~N)
Date of Last Adequacy Test ~:~,-""Z.,[o- ~L~
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~
To Cutback (if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify tha~ I~ ~'~[~1~,,~,,' or conformed to all MO~ and~A~uidelines in effect on the date of this inspection.
Signeds"~ ''6x .Date ~/~
Company~6LE RIVER, AK 995~ MOA No. ~ ~
Receipt No. /~O[ OO~ ~
Date of Payment ~- ~' ~
Amount: $ ~, O~
Page 2 of 2
72-026 (11/84)
Anchor e
P.O. BOX 196650
ANCHORAGE, ALASKA 99519-6650
(90?) 264-4111
TONY KNOWL£S,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
September 9, 1986
Robert A. Shafer, P.E.
S & S Engineering
SRB 196X
Eagle River, Alaska 99577
Subject: Lot 43B Moore Subdivision
Waiver Request, WR86-128
Dear Mr. Shafer:
Your request for a waiver of the 100 foot separation required between the
septic tank and well on the subject property has been granted. This
distance has been waived to 98 feet.
This waiver is valid for the existing four bedroom single family dwelling
only.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
SSM/ljw
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SiTE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
ROBERTA. SHAFER
September 4, 1986
CIVIL ENGINEER
694-2979
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, Alaska 99501
ATTENTION: Steve Morris
MuNICIPALI'[Y OF ANCHORAGE
DEP'[. OF HEALI'H &
Ei~vIRONMENTAL PROTECTION
REFERENCE: Lot 43B; Moore Subdivision
Request you approve thc attached Health Authority Approval and issue
a waiver for thc horizontal separation distances between the well and
septic tank.
The on-site inspection report performed by the Municipality of Anchorage,
on October, 1983 indicated a horizontal separation distance between
the well and septic tank of 99 feet, however, our field measurements
indicate a distance of 98 feet, therefore, request the waiver be issued
at 98 feet. Attached for your review in addition to the material provided
with the HAA application are the following documents:
A. Site plan showing the relationship between thc well and the
septic system.
B. Waiver review worksheet.
It is our opinion that the horizontal separation distance prescribed
by 18AAC72.021 are not required in this
If we ma~?b~of further service, please contact us.
SRB 196X EAGLE RIVER, ALASKA 99577
D,\TE RECEIVED:
!!NG I NEER:
MUNICIPALFi'¥ ,77
DEPARTMENT OF l{['lAl, l'fi A~X'D HUMAN 5i']RV' ":"
WAIVER REV®..,~ %~G.~IKSttEE]'
CRITERIA:
1) Geology: Votnt~:
2)
3)
A. Water Table
B. Soil Sorption
C. Permeabll£~y
D. Water Table Gradient
E. ~lorizontal Separation
ro-i'^l.: tq ,g
WAIVER
graated, with conditions listed below:
not granted fo~ reasons lis~:ed below:
DAI'g: ·
APPLIC, .__.NT FILLS OUT UPPER HAL._i. ONLY
Address
Zip Code
Lending Institution i !,/_) i\At ~. -~ A (J ~ ~J ~.J ~
Address
Type of Residence
~"~in g le Family
[] Multiple Family No. of Bedrooms
[] Other
Zip Code
Zip Code
Phone
Water Supply
~-4ndividual
[] Community
[] Public Utility
ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975.
For welds drilled prior to that date, give well depth (attach Icg if available).
Sewer Disposal
¢'.~ndividual
· [] Public Utility
[] Holding Tank
Year Individual Installed: ~ -~
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE iNITIATED.
Time Time Time Tim~
°ate °ate Date
Inspector Inspector Inspector Inspector
Field Notes:
~I~F~~rj::P:~%ROOMS 'CONDIT'ONS OF APPROVAL
( ) CONditIONAL APPRCVAL*
Soils R~ting Date ~wer Installed Well To Absorption Are~ /~ ¢ Well Log Received
~% g /C ' 7--rS WelltoTank ~ ¢' SepticT~kSiz.
72-023 (3/82)