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Home My WebLink AboutPROSPECT HEIGHTS #1 BLK 5 LT 15 MUNICIPALITY OF ANCHORAGE Departmen~'~f Health and Environmenta~rotection 825 . Street, Anchorage, AK. ~501 Permit 9 ~D~ Applicant: Location: 264-4720 * * * HANDWRITTEN PERMIT * * * W'~:~FW~-~'~ON-SITE SEWER PERMIT~CC~J~ ~/~3(2- Mailing Address: Phone Number: Legal-Description: L/~-~S- /~c,~ ~k Type of Soil Absorption System Is: Trench: // Drainfield: Seepage Bed: Maximum Number of Bedrooms: .. ~ Lot Size: Holding Tank: Soil Rating(sq.ft/br) ~ The Required Size of the Soil ~Absorption System Is: ' DEPTH /~/[ LENGTH GRAVEL DEPTH &-.~e WIDTH 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 = /~ ~ 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) ~NSPECTIONS 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. Minimun~ 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 8 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 enlargement if the resi~/ce~ r~odeled to include more that 3 bedrooms. Signe~: , /-I~ _~/// Issued by: Appllcan~ Date: e/! ~ I (~MUNICIPA LITY O F ANCHORAGE DEPARTMENTOFHEALTH&ENVIRONMENT \"~ 0k, AL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION k~' ~ ~ " 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME iPHONE ~ UPGRADE LEGAL DESCRIPTION NO. OF BEDROOMS J Well J Absorption area Dwelling PERMIT NO. ~ ~ Manufacturer ~ ~ ~ Material ~ N°' of compartments Liq. capacity~ ~_~in gallons iF HOME~DE:/ inside length ~t] ~ ~ Width ~]~ Liquid depth 0 ~ ~ Manufacturer ·--~ Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO, ~ ~ ~ No. of lines Length of each lin Total length of line Trench width Distance between lines ~ N Top of tile to finish grade ~ I O t i Material beneath tile Total effective absorption area Length Width Depth PERMIT NO, ~ ~ Type of crib Crib dia r Crib depth Total effective absorption area ~ DISTANCE TO: Well Building foundation Nearest lot line ~ Class ~ Depth Driller Distance to ~ot line PERMIT NO, ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PiPE MATERIALS~. . / ~ SOIL TEST RATING ~ / / INSTALLER ~__ . , ~/J ~ ~ ~ REMARKS ~ ~ S F ~ APP ~ATE LEGAL ..Certified Well /, ~or ............ ~'.':~:~..~.. . -~ ' ......... : .......... :,:~ ............................................................. '-'--z.~ Date comnleted. ' ............................... ~p~h o~wei~ · ' ' '~" ~ '- .: ' " ..' . ' . Size of ~sln=... Distance to water ............ : ............... ~2~2 & .: ...................................... ~.~tance to water while pumping ............. ;_.:.. ............ ~...~2 ................. at rate I certify the abovetrue and correct. . : DOTTEN DRILLING CO. John's Road SPENA'RD, ALASKA We advise you to attach this certificate to your deed. PERMIT NO. FIPF'LICRNT .8,RL,T,~C BUILDERS P. 0. Bo,.., .t ii;~, RNCH. 99509 LOCATION BU[:,[:, ..r' Pibl~:r-ib K LEGAL L:L' .~ E,.J'= PF..E=,FEL. T' r- ' ~ HEIGHTS S,.'"D #± LOT SIZE :L4:?'95:L SQURRE FEET TYPE OF "'~ =,LIL FIBSORBTION 'q'"- ' IS: - ~ .=,'f EM TRENCH MAXIMUM NUflBER OF E,E[.ROUM_, = 4 .....q,]T! RATING '.."',Q FT."BR): ,_,'='='..., THE 'F.'EQ IRED .=,I,=E OF THE '-" ' "-F F ,-. · .- _-,_lIL MB=,JRFTI.~N SY--';TEM I:':,. THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF' R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). PERMIT AF'PLICRNT HAS THE RESF'ONSIEILITY TO INFORM THIS DEPRR'Ff'IENT DURING THE INSTRLLRTIAN IN'-]PEC:TIONS OF' ANY WELLS ME. JRLENT' ' * TO 1HI=.' '- PROF'ERT'¢ AND THE NIIME:ER_ . OF RESIDENCES THRT THE WELL WILL C_.EF..,¢E., T'~.~L--i ¢-: 2 ::,, I II'--JSF'EI.~:T I Eil"-.IS RI;::E F-:E~_--I... IJ I RE:E:. BFtC:KFILLING OF RN'¢ "--'"- -. .=,'r=,TEH WITHOLIT FINAL INSPECTION RNE:, APPRZ',/RL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR R PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF' THE WELL COMPLETION· OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE[ AVAILABLE TO INSURE PROPER INSTRLLATION. F'E-EF-:I'4 I -r E;=<F" I F::E:-_q E:,F-:£:EP-1E:ER. Zc::L.. :.1_ L--,:" '-- ~,, '--" I CERTIFY THAT i: I BM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTRND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF ]'HE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. RPPLIL:RNT BALTIC: BLIILDERS ~ ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-950, Anchorage, Alaska 99502 276.222'~ SOILS LOG- PERCOLATION TEST ~SOI LS LOG [] PERCOLATION TEST LEGAL DESCRIPT'ON: ~"~f /~' Z.'.-~ ~%~' 1 2 3 4 § 6 7 8 9 10 11 12 13 14 15- 16 17 18 19 2O SLOPE 7~' WAS GROUND WA'rER S j i 1 DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) z~ ,,4 ,~/1 ,, · uJe~s,4s ]o sneers pue X~!le6el e~l~ o~ :3/ON ~{ue3 bu!plOH e3ls-uo lenp!^!pul :'IVSOdSIQ IJ~IJ.V/A~IJ. SV~A dO ~dAJ. pug Xl!leOel eLI~ o] ~u! -7$e~e OgQV e~e~ ~uo.~j uo!~e~uJguoo ua~!.~4 ap!AOJd '~ua,~sA'$ Ile/~ X~!un~u~uoo Jl :3/ON Je~eM o!lqnd Ile/~ ~!unwwoo Ile~a lenp!Alpul :AlddrlS IJ~iiVM JO :ldA£ ~. /~ :swooaoaado aaewnN · dn~lo!d ~o~ pleq aq II!/~ VVH 'pel$enbaJ e$!/vue4]o SSelun o,I,;~L;.£Z.~ Ou. oqd AeO ¢~-~¢y-~4¢' / '¢3-,,.~,, ~r'j~,~ sse~pp¥ ~y~'=~ ]~-,~ ~¢~'o/) / r,~,,~.~rl X~i,~I 3ueSv sseJppe auoqd XeC] o/~;~/..- £,,~ ,~ euoqdXe(3 ~oue6e §u!pue'l sseJppe 6u !Ii'IAI Jeu~o X1JedoJd 'C (suo!$oeJ!p Jo sseJppe e~!s) uop, eoo-1 uop, dposep lel~el aleldwoo NoImVIAiI:I OJNI qvl:lqN:] 9 '1. DNIqq3Ma Aql~¥~ 3qDNIS ¥ UO:I -IVAOl:Jdd¥ ^±IaOH~-RV H£qV~H -I0 ~/VOI~I/U30 oggg-6lg66 D~ISelV '~)I~eJoqouv 099961. xo8 'O'd uo!loeS seo!/ues el!s-uo S~OlAa~S NV~RH ~ H/3V~H ~O # 'Q'I leOJed STATEMENT OF INSPECTION BY ENGINEER As certified by my sea~ affixee 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 structu re indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves_ti_gation 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. Phone _ :~ "/,5"- 13 5-5~ Address I Eng'ineer's signature ,6: D. HH.S SIGNATURE :~' ; '" : rev for ';-- '- -' Disapproved· Date ~ % cE- 358?, .' ~¢. bedrooms· lee Y Conditional approval for bedrooms, with the following stipulations: By: Additional Comments Zt State and Municipal Codes'. There are nitrates present. continued suitability- Nitrate concentration is 6.41 mg/1. EPA 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 engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes professional institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not and their lending 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y/N) Total depth Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed '7 / 7 8 Driller Cased to ? I' Casing height Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed Nitrate ; On adjacent lots Public sewer manhole/cleanout Petroleum tank "// r,,P/~ Other bacteria Collected by: F/~f/-O? ?-~c4 Tank size I ~-5'~ ,~'¢~/ Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y' High water alarm (Y/N) N./J-. Alarm tested (Y/N) Date of pumping ~ //! / 9-7 Pumper f{'o/-~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Depression (Y/N) N Well(s) on lot'* 9') ~ _¢:;'-or, c, o. On adjacent lots ~ ~oo, To property line ;~ ~-o' Absorption field ~ ?-3' Surface water/drainage ~ ~ oo, 72-026 (3/93)* Front ~' [A~ I ~'~'/" ? r¢~/) /'"~='(' .-~/'~* ~ Foundation ~ y' _,A~ c. o, Water main/service line ;> ~,5" CONTINUED ON BACK PAGE Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Sanitary seal (Y/N) 'r' Wires properly protected FROM WELL LOG AT INSPECTION Date of test 7/76~ Static water level I¢,O' .__ / Well flow ______~__~ .__ .g.p.m. Pump level1 ~. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot~ 99 ' ~ o ~ ; On adjacent lots~" C. LIFT STATION N.h. Date installed Size in gallons Vent (Y/N). "Pump on" level at. High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer _ Manhole/Access (Y/N) "Pump off" Level at _Cycles tested Sudace water D. ABSORPTION FIELD DATA Date installed 7 / ~6-/7 ~ Length '-~'7' Width Total absorption area_ ~'7<9 c~' Date of adequacy test ~ ! ~8 / 9 y Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) g'5' Gravel thickness ..Cleanout present (Y/N) .Results (pass/fail) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot II o' To building foundation On adjacent lots_ ~ b-O' Sudace water > toO' Curtain drain Oi/~'Mrr~ .System type _ 'T'f-~P c4 7' Total depth / ~/' y Depression over field (Y/N) _ N f',~.u- for '/ Bedrooms After test 5' ~,.¢" of If yes, give date. ~, A, .On adjacent lots 7~ too' Property line To existing or abandoned system on lot_ N, ,~. Cutbank /V, 4. ..Water main/service line -> Driveway, parking/vehicle storage area 3'~-' E. ENGINEER'S CERTIFICATION Sig.at.re Engineer's Name Oate HAA Fee $ Date of Payment ......... .~Z'::~:i:!- i:~~ . :~:~!:". ::::"::'::;':': .... ........... ~" ~ 'IHEODO;::,] F. ~'~OOR~ ,,." ~ /-"fo ~,'l~ ~...: ......... ~ 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 1. GENERAL INFORMATION Complete legal description HAA # ~ ~'~ q ~ L,t ~,L~, LOT 15'~ ~ZK 5- '?WoS?£CT FITS. Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent J~ E LL'( Address Soo ~(iEL U~ATUN COn 9~ol BubD7 ~£~N£R ?, o. 8ox /5'- Day phone '3q~,- 32,37 Day phone C Day phone ~'(~2.- G~&q Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing td ~he legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site ~ 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 'm, eQ m, uewwoQ I~uo!I!PPV :suo!lelndp, s §U!MOIIOJ eLli ql!M 'SWOOJpoq JoJ leAoJdde I'eUO!l-!pu°O -- .peAoJdde9!O JoJ poAo.,ddV ~ :II::lnJ.VN~IS Si-iNa . ~-T.,,~V- eleC] ouoqd · uop, oedsu! S!Ul3 jo m,~p eq~ uo ~,3ojjo u! suop, eln~m pu~ 'soou9u!P~o 'sopoo o~m,S pu~ led!o!unlAl lie q~,!~ ooue!ldwo3 u! s! wo3sXs lesOds!p ]o~o~se~ lo/puc Xlddns ]re, eM m,!S-UO OUp, 'UOp, Oadsu! pu~ uo),e6qSO^U! Xw LUO]J pue SOI!,t o~moqouv Jo XLled!munl/~ woJJ pou!elqo UO!leWJ°lU! oql uo poseq leq~, AJpO^ Joqlan,t I :U!Ojoq P°leO!pu! oJnlonJ),s ,to odA1 pue sLuoo~poq 10 ~oqLUnU Oql JOt el~nbepe pue leUO!lOun~ 'o,ms s! LUre, SAS Igsods!p ]e),e~elseM ~o/pue Alddns ~eleM el!s-uo oql ll~LI1 s~OLIS uop, eo!ldd~ le^°JddV Alpoqln~' qlleOH s!q~, ,to ALU lOLl1 Al!Jo^ I 'MOlOq UMOqS Olep UO.),ePHe^ OCp, ,tO Se pug OlOlOq pax!lte leOS ALU Aq pe!l!laeo s¥ EFI=INI~gN:I Alt NOIJ.O~idSNI 40 £N:IVI:I.LYJ.S '9 '9 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: La'r IE~ ~LI~ .5 PRos?EoT ~T5 BI Parcel I.D. A. WELL DATA Well type Log present (Y/N) Y Total depth 2 5'o Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Date completed Cased to c~ I ¥ FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot c/~/~ To (~.0. Absorption field on lot Public sewer main Sewer service line ~ ADEC water system number '7/78 Driller ~oTT£N Casing height Wires properly protected (Y/N) g.p.m. AT INSPECTION ; On adjacent lots ~1~o ; On adjacent lots ~. /oo Public sewer manhole/cleanout WATER SAMPLE RESULTS: Petroleum tank Coliform C~ co( {4c, o~.~ Nitrate 5"7. h'~- ~,.~ /'.~ Other bacteria Date of sample: ~/Ifo/cl3 Collected by: ~/,4T-rOP B. SEPTIC/HOLDING TANK DATA Date installed '7(2-~ Cleanouts (Y/N) ~/ High water alarm (Y/N) Date of pumping Tank size J2 5'0 ~,~/. Compartments ?- Foundation cleanout (Y/N) "{ Depression (Y/N) ,/~, Alarm tested (Y/N) N ,~. -~ Pumper Ro~ ~'o o ,'Lo~ N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot c~ FR0~ C,O. On adjacent lots ~100 To propertyline ~- ~'o Absorption field Surface water/drainage > Foundation 3~ F~o~ ¢.0. Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) ."Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested ~ Surface water D. ABSORPTION FIELD DATA Date installed 7/25/7~ Length 27 ' Width _' "~(p ravel thickness 7 Total absorption area ,37'8 ~ ¢ Cleanouts present (Y/N) Depression over field (Y/N) N Date of adequacy test Results (pass/fail) ¢'c~$..¢ . for H/cd-~r t~,~t '~ ~.ro,'l~h'o'~ ~-~-~c4 b~r~ /'~k = ~-~"~ Peroxide treatment (past 12 months) (Y/N) t40¢~- [4¢0~¢N Soil rating_¢~5 ~/8~¢,~ .System type Total depth Y /p~¢r ¢-~.~ -- ,.4'?, 8.S'" If yes, give date ~J ,A - bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot_ To building foundation On adjacent lots _ ~ 5'0 Surface water '~ Ioo _On adjacent lots ~./oo Property line To existing or abandoned system on lot .Cutbank. N. ,A, .Water main/service line_ _ Driveway, parking/vehicle storage area Curtain drain_'NoNE 0'¢,$g,~ VE~ _ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and BAA guidelines i~,¢¢(f~~e of this inspection. bngineer s Rame -,, ~ ~ THEODORE r. A~' ' r,~ ~ ¢ , HAA Fee $ Date of Payment ~r,¢inf I~llmhRr Waiver Fee: $ Date of Payment Receipt Number During a recent Health Authority Approval on-site inspection and test pf the po~ab%e Rater supply well on Lot /_~. Block ~ of /v~O&~P6~ ~/z~,~ ~/ Subdivision, the well's productivity was det~rm{ne~ ~o be O,~ gallons per minute. The minimum well productivity required by this department (AMC 15.55) is 150 gallons per day per bedroom. On this basis, the minimum well flow requirement for a + bedroom residence is(J)~_~__, gallons per minute. Although the subject well currently meets the minimum well production requirements, all parties concerned are advised that the production capacity of..the.well may fluctuate and that water conservation measures may be required during periods of low production capacity. Measures which can be taken to minimize the impact of a low production well are: Installation of a storage tank (300 to 500. gallon) to serve as a reserve source during times.of maximum water usage. Restriction of noncritical water uses such as, washing cars, lawn and garden watering, etc. Installation of water saving devices on faucets, showers and toilets. 4. Conservative use of laundry facilities and dishwssherso This advisory must be attached to all copies of the subject Health Authority Approval. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description HAA# ~O};~ O\ ~ V Location (site address or directions) .. Property owner %3er& ?o~rd Mailing address c~ ?.o, ~o~ Iq Lending agency C'd,y Cie, r- Mailing address. Day phone Day phone Agent Address Non ¢ · Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ x~ TYPE OF WATER SUPPLY: Individual well ~ Oommunity well Publio water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm _~/~, {-/c-,~-~ ~ ~ (~ / .~'~r~ [' ,'~' Phone _ Address ~/y~-~_~_~Ao ~-/:.~~_~¢r~_~ A-~ engineer's signature ~ ¢'~/-~'~"~ Date ~/~-7 /~]~- DHHS SIGNATURE .~_ Approved for _ ¢ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 3~)J~weD I .-Eoac_ t]::~_s prop-e32tY-met-ts ez4-i s~ It is State an~ Municipal codes. There are nitrates present. ~h=~s sugg~~ ~io~ic t~in~ b- . ' ~ ..... continued suitability. Nitrate concentration zs 5.1 mg/1. EPA ~Zmbm ~e~¢L~Zs ['¢' ~' Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of 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. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 15'/8- J~r'~.r~.~c/' /~/3 ¢~' '/ Parcel I.D. A. WELL DATA Well type ?r't ~' ¢( f~ If A, B, or C, attach ADEC letter. ADEC water system number /',h 6, Log present (Y/N) ~ Date completed ~'~ ly., /¢ ?~' Driller Oo/"/'¢n Total depth 8.5-0 ' Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Cased to ~/' Casing height Wires properly protected (Y/N) FROM WELL LOG I~0 ~ g.p.m. ¥ MUNICIPALITY OF ANCHORAGE AT INSPECTIJJ~IIRONMENTAL SERVICES DIVISION RECEIVED g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot II o' Public sewer main I\l, Public sewer service line ^1. A-, WATER SAMPLE RESULTS: Coliform 0 cot /too m.~ Nitrate Dateofsample: ~/It/~,, ~/17/~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank 3-. I ~'/-~ Other bacteria Collected by: ~ F-. /'-~c,o,-~ B. SEPTIC/HOLDING TANK DATA Date installed 7 1~5'/ 7~ Tanksize 1~5"0 ~e~l Compartments Cleanouts (Y/N) Y' Foundation cleanout (Y/N) Y' Depression (Y/N) High water alarm (Y/N) ~/.4. Alarm tested (Y/N) h/. Dateofpumping 11 / I / ]0 r{~ l~r~ ~..~v ~o / ~ ~e~ ~/~c~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: I~ ~ ~ ' ' Well(s) on lot ~ ff~ c.c. Onadjacentlots ~ ~oo, Foundation ~V Topropertyline ~ C'O~ Surface water/drainage Absorption field ~, I00' Water main/service line 72-0~6 (Rev. 3/91)Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION ikh/~. Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LiFT STATION TO: Well on lot On adjacent lots Manufacturer. Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed 7/2-5-/ 78 Length ~7 ' .Width Total absorption area ~'Tg Depression over field (Y/N) Results (pass/fail) i Peroxide treatment (past 12 months) (Y/N) Soil rating ~'$~ c~'/b'M,'~, System type 7' Gravel thickness , Total depth Cleanouts present (Y/N) Y' Date of adequacy test j~/f/~¢'/ for ¢/ bedrooms No If yes, give date /~, ,4 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~i0' ~. To building foundation On adjacent lots ~ $ o' Surface water ~. Ioo ' On adjacent lots ~ To existing or abandoned system on lot Cutbank hi./I. Water main/service line Driveway, parking/vehicle storage area Property line Curtain drain Date E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. t~ % 'i;-i~o~o:t~ i:, ~.~oo~ o~ , .:/ HAA Fee $ / ?~) 0..,¢' Date of Payment ,~,- Waiver Fee: $ Date of Payment Receipt Number Tom Fink Mayor unicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 March 24, 1992 Ted Moore, P. E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 15 Block 5 Prospect Heights Waiver Request #WR920010, PID #015-091-37, HA920130 Dear Mr. Moore: from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services Your request for waiver of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance is 97 feet from the well to the septic tank. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval ConcurS: // On-site Services ljm:#6 ;,I ~O0 lA,' 7-3 [ii 2.? CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. PH: (907) 345-1355 February 26, 1992 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 14530 ECHO ST. ANCHORAGE, ALASKA 99516 Dear Sirs: By means of this letter we are requesting issuance of a waiver allowing the existing septic' tank to be 97--, feet from the existing private well on Lot 15, Block 5, Prospect Heights Subdivision, Addition #1. Copies of a property as-built survey which I have marked up to depict additional well and septic features and slope information, plus the well log, septic system inspection report, and a cUrrent HAA request. package are enclosed for your review. Based on a discussion with John Smith, I understand that even though the shortfall from criteria is slight and the responsibility for avoiding this mistake lay with the Municipal inspector, you are still requiring a full-blown waiver analysis and payment of the $410 fee. According to the driller's log (the copy from your files is very hard to read) the well was completed in July of 1978 by Dotten Drilling and has a total depth of 250 feet, of which the depth below 91 feet is an open hole in bedrock. On the date of our test the static water level stood at 144 feet below the top of the casing. We tested the yield of the well by running the pump to cause the water level inside the casing to be drawn down to the pump intake at 199' below the top of the casing. We then measured the rate at which the water level recovered inside the well over the next two hours, and then measured the additional gallons which could be pumped out, and then measured the recovery rate again. Based on our test data, we determined that the yield of the well was 0.49 gpm on the date of our test which is adequate for this 4 bedroom residence. Water samples collected on 2/11/92 and 2/17/92 were satisfactory, showing 0 coliform or other bacteria per 100 ml., and 5.1 mg/l of nitrate-N. While relatively high, this nitrate level is 'lower than the 6.5 mg/1 which was last reported in November of 1990. According to the Municipal as-built inspection report, the wastewater disposal system was installed on July 25,4978 and consists of a 1250 gallon steel septic tank followed by a 27 foot long soil absorption trench containing 7 feet of sewer gravel. On February 17 we measured the fluid depth in each cleanout of. the septic tank to be 48", on the basis of which we concluded that the tank is not leaking. The tank was last pumped on November 1, 1990, however since the house was unoccupied after that until January of this year, and we observed no scum buildup in the tank, there should be no need to have the tank pumped again at this time. Adequacy tests of the soil absorption trench in November of !990 and on 2/24/92 both indicate that the system continues to accept water at an adequate rate for a 4 bedroom residence. During the course of our adequacy test we measured the distance between the center of the well casing and the center of the cleanout in the first compartment of the septic tank to be 99.3 feet. The waiver · request distance of 97 feet is being made to allow for the underground projection of the tank closer to the well. Several factors contribute to the unlikelihood of their being any public health risk in granting this waiver. The house sits directly between the well and the septic tank, resulting in the shortest surface flow path between the well and the tank being 109'. Secondly the house sits on top of a knoll, with the topography sloping down in ail directions, causing the surface flow path from the septic tank to be directly away from the well. The following is a breakdown of how the waiver evaluation points could be assigned using the "Separation Distance Waiver Guidelines for SCRO" Categ0r¥ Points Distance to water table (144' - 1' stickup - 9' to bottom of septic tank = 134') 7.17 Soil sorption ((81' till (silt) @ 3.5 + 53' bedrock @ 6.0)/134) = 4.48 Permeability ((81' till (silt) @ 2.0 + 53' bedrock@ 3.0)/134) = 2.39 Water table gradient (assume same as overall level topography = 2.9 Horizontal separation (97") = 2.88 Total 19.8 This point assignment conf'u'ms the above assessment that the waiver can be safely granted without concern as to potential contamination of the well by the septic tank. Please give me a call if you have any questions on this analysis. Sincerely, Ted Moore, P.E. cc: Neil and Robin Umatum 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. # ~/.~'-J 6~]./~ 3~ HAA# -/"~"~' 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing Address (c) Lending Institution /'/, Telephone: (home) ,'7¢~-2r7I' 'Business.27¢- '¢q¢~- ?es'-// Telephone. Mailing Address (d) Real Estate Company and Agent Address Telephone ~7~ ~ (e) Mail the HAAto the following address: (or check here)~, if hold for pick up,) List contact person and day phone number below: 2. TYPE OF RESIDENCE Singte-Family,[~ Number of bedrooms 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 woll sy=tem, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72q)25 (Rev. 7/88) Page 1 of 2 5. 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 - (~ ~'~-- ~'-_/,/~//./~'/'¢/.,y'~ Telephone----~'~¢'-- '~¢r7/'/ Date ~ c/ ~' O 6. DHHS APPROVAL Approved for~ ~/~_ bedrooms by Approved _/~ . Disapproved Terms of Conditional Approval Date Conditional Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the well's continued suitability. Nitrate concentration is 6.5 mg/1. EPA maximum concentration is 10.0 mg/1. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 insp~ct!ons 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 ~O~'~.O,~'~ MUNICIPALITY OF ANCHORAGE (MOA) ~ .~O',.~ ,.~.~.~_.~,~....,'~,,V Legal Description: A. WELL D~' ?' ' Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Well Classification Well Log Present ON) /V Date Completed Total Depth ~5-~9 Cased to . Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) 1c2 ?';~' Yield 3:~ ~"~c~z4., Static Water Level /¢.~--~ Casing Height Above Ground Electrical Wiring in Conduit ~)N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by ! Pump Set At / ~'J~----~ Sanitary Seal on Casing(~N) Depression Around Wellhead (Y/~ Water Sample Test Results ~'~/-7'7/$~-~c~-¢,,~' (__~,~z~'~',~- ¢'~ Comments C~/~ ~/~ i.~ ~/~ ~ ~ ~ I~ '~¢~ B. SEPTIC/HOLDING TANK DATA Date Installed ~,Ly /¢2E-'Size StandpipesCN) Y Depression over Tank (Y6)~ t ; On Adjoining Lots ft-/'//~x /15- r ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ~/o ~. ; Date / ~ 1;~-¢ No. of Compartments Air-tight Caps CN) /v' Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /~. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: ! To Water-Supply Well To Property Line '~ "~"~- To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course /~, . Foundation cleanou~N) /v Date Last Pumped / /./ou, 7'''/'/y ' :for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field .2 Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed _ Width of Field Type of System Design Length of Field ~,~Depth of Field _ Gravel Bed Thickness Statndpipes Present ~/N). Date of Last Adequacy Test Square Feet of Absortion Area Depression over Field (Y~ 1"¢' · Results of Last Adequacy Test /k/, SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~//'/(z.¢ To Building Foundation To Property Line ~;~ ~ To Existing or Abandoned System on Lot _ ,f"/- ~' ;On Adjoining Lots ~' 1¢¢ 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 Comments ~ D. LIFT STATION Date Installed_ Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) . "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Comments _ **Check Permitted Bedroom Rating Against HAA Reques¢* I certify that I have checked, verified, or conformed to all MOA and HAA.§uld~lin;es~.i0 effect on the date of this ~j w ..., .:% o~ o~... ~ ~n ineer'sbeal MOA No. ~ ~- Receipt No. Receipt No. //~/~ ~ ~ Waiver Fee: Date of Payment Amount: $ ~._ ~) Date of Payment 72-02s (R.v. 7/a~) a~ok Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPT. OF HEA.~H & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECI~RONMENTAL "~ROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION NOV ~_ 6 1978 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAClLITI DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. I PHONE 1. PROPERTY OWNER ~'~ ~q~L (I MAILING ADDRESS · PROPERTY RESIDENT (If different from above) BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION MAILING ADDRESS REALTOR/AGENT MAILING ADDRESS 5, LEGAL DESCRIPTION PHONE PHONE STREET LOCATION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] ' MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five [~ Three [] Six [] Other~ 7. WATER SUPPLY [~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [~ I NDIVI DUAL/ON-SITE~* [] PUBLIC UTILITY **If individual/on-site, give installation date If system is over two {2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78)