HomeMy WebLinkAboutPTARMIGAN LT 4Onsite File
Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: Sc'j 7C6(Jov,- PID Number: (-),so- 3c � -
kWastewater
Name: L /-1 L
I
System: NCNew ❑ Upgrade
Address:
-7-010 [- O C fl 7
ABSORPTION FIELD
Phone: _
No. of Bedrooms:
Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating: p
Oi
Total Depth from original grade:
I
d GPD/Sq. Ft.
/,q
Lot: Block: —p Subdivision:`
j
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
�9
/� /- x� b// �f�/Y
oZ Ft.
a Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
Ft.
4/7 Ft.
WELL: U
I� New ❑ Upgrade
Gravel width:
-,3
Number of lines:
Distance between lines:
^J%i
Ft.
Ft.
Classification (Private, A,B,C): -
Totaa Depth:
Tota.
Cased To:
/
Total absorption area:
710
Pipe material:
2014t,15714
PR I XAI e
Ft.
O Ft.
SQ. Ft.
Driller: /
Date Drilled:
Static Water Level:
Installer: y /
Date installed:��
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
6 GPM
Ft.
(/ Ft.
SEPARATION
DISTANCES
Septic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
uhiic/Private
Manufacturer.-
-rA,A11<
Capacity in gallons:
/
From
Tank
Field
Station
Tank
Sewer Lines
I%Ale_l/
-5Lgo
Well-
��% /
/DLI
/t//A
1,11A
7o,9/
Material: S%EEL
Number of Compartments:
�i
Surface
�
1\//A LIFT STATION
water
/CC
-
Lotr
/ / /
j
Size in gallons:
Manufacturer:
Line
3S
Foundation
?
/ 2 j
NIA
Pump on" level at:
"Pu p oifrlevel at:
High water alarm at:
Curtain
!,I%
Pump l
Electrical Inspections performed by:
Drain
/r
Remarks:
BENCH MARK
Location and Description:
jam/ /IySUL/'FT/O/V-Qf/LiJ2
w r., p�f fes.... c.r 17� of Re bn�
/�/' ,1
0 /' g5I—D UE-1-10"s'c F"'isl,
Assumed Elevation:
724L
/,DO
ENGINEERS SEAL
�5
FIZFS �� ��'-,
a= e0•soeboafus d7
Inspections performed by: Dates:ls
FA•ev�§s•
2nd �� /DF
ee %e Veao es evueeeeweoe•
-
$
t• : Louis A. Butero
'•
Department of He and Hu ices approval
cl.t�ae
Reviewed by: Date: aL
'.�,
and approved
Y
Permit No. SW 9& &OOS'li Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: PTARMIGAN LOT 4 PID No.: 0S S& Z 3
PTARMIGAN BLVILD\\
M
e 241.1 SWING TIES
A -C = 102.6
100, o B -C = 72.63
00,
RgD,5s- L� 100' WELL B -D = 82.3
US y< .. WELL. RADIUS
1500 GAL \
PROP
SEPTIC TANK
00 0C
HSE ]O�
I\
0 3X47' TRENCH Vol-
VACANT LOT
RESERGV-� Q�O�, SVOQ
VACANT LOT
PQ
A 82.5' -
W
-L❑T 4
0
ZO
ZO
63,338.25SF
bN
01
®
- TEST HOLE
VACANT LOT (U
o
•
- MONITOR TUBE
0
0
- SEWER CLEANOUT
z
- WELL
— —
- EASEMENT
- LEACHFIELD
0
0
0
0
N
SCALE 1'=60' O
rT
8/9/96
15 9, 4 ENGINEER'S SEAL
a00000p�o4
0
ELEVATIONS SOUTH VEST PROP CUR. (PT A)
�- o �F'• �F'q� 9S�p
(NOT TO SCALE) ASSURED ELEV = 9345 � O4:-,�P .•• j 00
ORIGINAL _ 49TH O
GROUNU o �+D
LEVEL AT. m Q....... .. ..........0
1' MOm FlLL 99A2.5 V
' 33PSI INSIAATI@I NO GVT
83A . LOUIS A. BUTERA : t�T D
TANK
97.3 7.2 7.0 97.0 Q S % . CE -6736
BB.] 044�� � pROF E....
`
LOCATION OF WELL
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING & WATER MGMT
WATER WELL RECORD
BOROUGH
-SUBDIVISION
-LOT
BLOCK
-
SECTION QTRS -
SECTION
TOWNSHIP
RANGE
.- MERIDIAN -
f
❑N
❑E
i
❑S
0
LOCATION/SKETCH:
WELL OWNER:
DEPTHS MEASURED FROM:❑casing top ❑ground surface
WELL DEP ' DATE OF COMPLETION
Depth of hole:F1'� ft
BOREHOLE DATA: Depth
Depth of casing�ft % l t G / w
Material Type and Color From To
DEPTH TO STATIC WATER LEVEL:
ft below lktop of casing ❑ ground surface
Date:
METHOD OF DRILLING: (fair rotary ❑ cable tool
❑ other
USE OF WELL: domestic ❑ irrigation ❑ monitor
El public supply ❑ other
`
CASING STICK-UP: ft. Diam: in. to_21ft
Casing type: in. to ft
WELL INTAKE OPENING TYPE: Xopen end ❑ screened
❑ perforated ❑ open hole
AV
Depths of openings: to ft
SCREEN TYPE: Diam: in.
Slot/Mesh Size: - Length: ft
GRAVEL PACK TYPE:
Volume used: Depth to top:
GROUT TYPE: Volume:
Depth: from ft to ft
DEVELOPMENT METHOD:
Duration:
v�
PUMPMG LEVEL AND YIELD:
ft after hrs pumping gpm
PUMP INTAKE DEPTH: ft Horsepower:
WELL DISINFECTED UPON COMPLETION? SZYES ❑ NO
CONTRACTOR INFORMATION: REMARKS:
RECEIVED E G I E D
` Y
2Registdusiness N?aamme AUG 12 1996
PLEASE MAIL WHITEY OFLOG T0:
Signature of Authorized Resprese ative Date DNR/DIVISION OF MIN'S V NR#1dF7'cnorage
3601 C St, R r th &Human Services
ANCHORAGE AK 99503-5935
Phone (907)269-8639, Fax (907)562-1384
P
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES �-
P.O. BOX 196650, 825 "L" STREET, ROOM 502 L
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW960086 DATE ISSUED: 5/23/96
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 5/23/97
OWNER NAME:KIEHL CYRIL & LOIS
OWNER ADDRESS:2020 MULDOON #225
ANCHORAGE, ALASKA 99504
PARCEL ID:05036237
LEGAL DESCRIPTION:
PTARMIGAN LT 4
LOT SIZE: 64033 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS.PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED P
ISSUED BY:
DATE:
.�--.27 76
DATE: -05 -o� 3 -?6 6
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 •'L' Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: (001-c `IY Bv/LpEA�S DATE PERFORMED:
(O -Ir q
LEGAL DESCRIPTION: ^f%)r42R1 b41k1 Township, Range, Section:
T, -DOTH SLOPE SITE PLAN
H 3 A EET�
t /" To,03or l
6
7
a-
10 10
17
18
19
Ak
-f7emJtr-%%/j' ifra HNN
WAS GROUND WATER
ENCOUNTERED? Nd
IF YES, AT WHAT i
DEPTH?
I
Depth to Water After
Monitoring? ASA to 1N.J 0211: S—io_56
11
Reading Date
to i. lc s/s/sc
Gross
Time
Net
Time
Depth to
Water
Net
Drop
57571Z
8:3�
(ENGINEER'S SE�AIi
�Yf"
G'
4
f�
3 %k
3
6 3 Imo'
6f b�,i
P N'l14
n!m Oy�4�yOry ob
YI,
t:'V:S
A. 'ut rn
G
8' 63 yo
h: 7
toG G/G
PERFORMED FOR: (001-c `IY Bv/LpEA�S DATE PERFORMED:
(O -Ir q
LEGAL DESCRIPTION: ^f%)r42R1 b41k1 Township, Range, Section:
T, -DOTH SLOPE SITE PLAN
H 3 A EET�
t /" To,03or l
6
7
a-
10 10
17
18
19
Ak
-f7emJtr-%%/j' ifra HNN
WAS GROUND WATER
ENCOUNTERED? Nd
IF YES, AT WHAT i
DEPTH?
I
Depth to Water After
Monitoring? ASA to 1N.J 0211: S—io_56
11
Reading Date
to i. lc s/s/sc
Gross
Time
Net
Time
Depth to
Water
Net
Drop
57571Z
8:3�
3 %k
3
6 3 Imo'
ti
YI,
G
8' 63 yo
h: 7
toG G/G
a 14„
to
a'• % ,
5:00”
(y /,�"
01 'A(
20
PERCOLATION RATE 2� 3 (minutesimch) PERC HOLE DIAMETER
TEST RUN BETWEEN 5 FT AND i FT
COMMENTS �Pcc L//-, /. ziti{ Sz.l d -G >-.-�5 %Sr
Eagle River Engineering S ervices
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
May 10, 1996
Jim Cross, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Ptarmigan Lot 4
Narrative & Permit Application
Dear Mr. Cross:
The proposed well and septic system will have very limited impact on adjacent properties for
the following reasons:
1. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, due to absorption capacity.
4. Drainage will not be affected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\1996\96 -024A -NAR
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: Ptarmigan Lot 4
05/10/96
A. GENERAL
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi -family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
9. Any remaining open test hole excavations shall be filled.
B. SEPTIC TANK/LIFT STATION
1. Septic tank and lift station shall be 1,500 gallon Orenco/Anchorage Tank model
OSI 05-20-HHF.
2. Receipt from licensed electrician stating the lift station was wired to applicable
codes to be supplied to Engineer.
C. TRENCH
1. The trench is to follow the natural land contour to maintain uniform total depth
of the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 10' at any point.
4. The effluent line within the trench shall be 1-1/4" PVC with 1/8" holes drilled
9-1/2" on center with orifice shields installed, holes facing up. One 1/8" hole
on bottom of pipe at each end.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface
water runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing
private well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH= 10' GRAVEL DEPTH = 8' under pipe, 2" over pipe
TRENCH LENGTH = 47' TRENCH WIDTH = 3'
SOIL RATING= 0.8 GPD/ft2 BEDROOM CAPACITY = 4
SEPTIC TANK = 1,500 gallon with lift
Twenty-four (24) hours notice required for all inspections.
\1996\96-024a-spc
0
VACANT LOT
GAL
82.5'
VACANT LOT
NO SURFACE WATER
NO KNOWN CURTAIN DRAINS
PTARMIGAN BLVD
241.1
PROP.
WELL n
THl��oo,
PROP
HSE
/per
Li
LOT 4 ip
v
p
� c :0 63,338.25SF
v
159.4
VACANT LOT
T
0
c
0
ri
m
0 — TEST HOLE
• — MONITOR TUBE
0 — SEWER CLEANOUT
9 - WELL
— - EASEMENT
— PROPOSED LEACHFIELD
WELL SEPTIC SITE PLAINOF 44 �.•��••���
LEGAL: 'TARIUIGAN LOT 4Q�•.•• 9Ss1�
OWNER: COLONY BUILDERS AF
CONTRACTOR: N/A * :49TH
JOB# 016-02ADATE: 05/20/96 SCALE 1" 00' i 0
0 :,. ...�
EAGLE RIVER ENGINEERING SERVICES �I .Lours A BUTERA
P.O. Box 773294 �,-J}F CE -6736 �g_A,
A EAGLE #, ' e6 �
907 8.94-nsK�a 95/ n7) R-9Q—g9g7 1��h::Ess����''�
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 96-024
Calculated By: LB
Date: 5/10/96
Legal: PTARMIGAN LOT 4
Single Family 4 Bedroom Dwelling
Deep Trench Subsurface Wastewater Disposal Field
TEST HOLE 3
Water use at 150 gallons per bedroom = 600 gallons
Percolation rate = 2.3 minutes per inch
Wastewater application rate = 0.8 gallons per day per square foot
Required absorption area = 750 square feet (adjusted up)
Trench width (W) = 3 feet
Gravel depth (D) = 8 feet
Required length = Required absorption area / 2 / D
Required length = 750 1 2 / 8
Required length = 47 feet
Total Excavation Depth = 10.0 feet
Pressure effluent lateral:
Assume 5' head at orrice
25 GPM flow rate
.42 GPM per orfice
25 /.42= 60 orfices
Spacing = 47'/ 60 orfices =
78' or 9.4" o `� •• OF' g
49—
C S�4
OD��P T
p
�
............. :. ".,...
LOUIS A. BUTERA,
0 'n CE -6736 �G
0���4 ° PROFEss�oNP����o
SINGLE FAMILY ON-SITE WORKSHEET
ERES PROJECT NUMBER: 96-024 CALCULATED BY: LB
LEGAL DESCRIPTION: PTARMIGAN LOT 4
NUMBER OF BEDROOMS: 4
WATER USE PER BEDROOM: 150 GALLONS
PERCOLATION RATE: 2.3 MINUTES PER INCH
DEPTH TO GROUNDWATER: 16 FEET
DEPTH TO IMPERMEABLE LAYER: 16 FEET USABLE SOIL STRATA
ANTICIPATED DEPTH OF COVER: 2 FEET TOTAL USABLE DEPTH: 10
MOUND OR BED SYSTEM USABLE SOIL STRATA DEPTH: 8
WASTEWATER APPLICATION RATE: 0.8 GAUSQ.FT
ABSORPTION AREA REQUIREMENT: 750 SQ.FT
MINIMUM BED LENGTH
12 FEET WIDE BED 63 FEET
15 FEET WIDE BED 50 FEET
TRENCH SYSTEM
WASTEWATER APPLICATION RATE:
ABSORPTION AREA REQUIREMENT:
SHALLOW TRENCH OPTIONS
5 FEET WIDE TRENCH
EFFECTIVE REQUIRED TRENCH
DEPTH (FT) ENGTH (FT)
1 131
2 105
2.5 95
3 88
3.5 81
4 75
DESIGN SPECIFICS
FIELD SYSTEM:
D
GRAVEL DEPTH:
8
TRENCH OR BED WIDTH:
3
LENGTH:
47
TOTAL
83
EXCAVATION
75
DEPTH:
68
0.8 GAUSQ.FT
750 SQ.FT
DEEP TRENCH OPTIONS
3 FEET WIDE TRENCH
EFFECTIVE
REQUIRED TRENCH
DEPTH (FT)
ENGTH (FT)
4
94
4.5
83
5
75
5.5
68
6
63
7
54
8
47
9
NA
(B=BED, S=SHALLOW TRENCH & D=DEEP TRENCH)
FEET
FEET
FEET
10.0 FEET
0
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 '`L" Street. Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
� vL;��5D 9^dy4
ICI v cg a,acn c7 V-
A. Aviera
C€•4F.ib �c
{a
PERFORMED FOR: C.o%ny 13y�LaerS DATE PERFORMED: 6 4� 3 - % S
r2 Lary
LEGAL DESCRIPTION: lgTaTownship, Range, Section: 7-y. '0 t✓ t__
10 t ✓ 1` e j-7— t4 WAS GROUND WATER
i30r=ow
O' Ole ENCOUNTERED?
11
IF YES, AT WHAT
12 DEPTH?
13
41516 14-
15-
16
71819 17-
is -
19
20
COMMENTS 7 4
SLOP
LAN
S
L
elf' P I s < <
E
Oepth to Water After /
Manllaringll-
Reading
D P H
F E
r
Te(a5O1 I , �(-9«HSG Mal
1
Net
Drop
v
C>il 4-J
�. D'j�
3
(57
a
v J
-
6
/
�m.A.i ai S I Rt Fol �Vyt1�
4
.
7
8
If IV
z
/
10 t ✓ 1` e j-7— t4 WAS GROUND WATER
i30r=ow
O' Ole ENCOUNTERED?
11
IF YES, AT WHAT
12 DEPTH?
13
41516 14-
15-
16
71819 17-
is -
19
20
COMMENTS 7 4
SLOP
LAN
S
L
elf' P I s < <
E
Oepth to Water After /
Manllaringll-
Reading
Date
Gross
'rime
Net Depth to
Time Water
Net
Drop
n
10..� t Z 1 'v ,4
4
z
S, If
PERCOLATION RATE 00 Immutesnncht PERC HOLE DIAMETER G
TESTRUNSETWEEN 3 5 FT AND 4•C FT
PERFORMED 8Y: c('' cI' Uj,-r '—+ u: ✓rI- { •! ,._ � CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE.
p,a
PERFORMED FOR: Co%Y 3v�Y�cls '1
GATE PERFORMED::
T4 , Lor Z/
LEGAL DESCRIPTION: /PT a -wri a „ Township, Range, Section: Tiy,,,- Q
aEPyH SLOPE SITE PLAN
F Se Tid10 PLOVIA
" -
1 pf�a',•'_ rbtal
. r
Me el ��„S o^ 4,(,
Y
3
^ -r
4 6,2 to pa%T0In S o}
$ Ci s•
14- co✓ -Iievr� 5mv,rlue 5 , 6"wo
6 �), 010"S4,, M4Y,y 1wrJe rack,,
f rJ,(,'
12
13
14
1$
16
17
18
19
20
L7 'f
COMMENTS 41- — C f fj
WAS GROUND WATER
ENCOUNTERED? AJ,7
S I I I S`o
IF YES. AT WHAT /v A_ L II
DEPTH? P Ste. /tet
E
gepth to Wafer After
Monitoring? dr; palt
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
Saa 'C
ENGrriEE°
y, Municipallty of Anchorage
.�•`,+es = air. •xaevoaso�e.•-
DEPARTMENT OF HEALTH &HUMAN SERVICES
``"""'""`'°'°"`""'1'a`
825 "L* Street= Anchorage, Alaska 99502-0650
�; R? , , <
Li,
SOILS LOG — PERCOLATION TEST
1
t� '
!� 4J4AOQ \e
p,a
PERFORMED FOR: Co%Y 3v�Y�cls '1
GATE PERFORMED::
T4 , Lor Z/
LEGAL DESCRIPTION: /PT a -wri a „ Township, Range, Section: Tiy,,,- Q
aEPyH SLOPE SITE PLAN
F Se Tid10 PLOVIA
" -
1 pf�a',•'_ rbtal
. r
Me el ��„S o^ 4,(,
Y
3
^ -r
4 6,2 to pa%T0In S o}
$ Ci s•
14- co✓ -Iievr� 5mv,rlue 5 , 6"wo
6 �), 010"S4,, M4Y,y 1wrJe rack,,
f rJ,(,'
12
13
14
1$
16
17
18
19
20
L7 'f
COMMENTS 41- — C f fj
WAS GROUND WATER
ENCOUNTERED? AJ,7
S I I I S`o
IF YES. AT WHAT /v A_ L II
DEPTH? P Ste. /tet
E
gepth to Wafer After
Monitoring? dr; palt
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
Saa 'C
�'S•°i'
2: 33
y'
Li,
4 Z
1
t� '
.-
I Z- S u
1 t7 ,u'
N u 6/
9ir6
PERCOLATION RATE r�() (minutesrinch) PERC HOLE DIAMETER b
TEST RUN BETWEEN FT AND 5 FT
PERFORMED BY: C".iF Vof �r'a:�vpr. =� � • r I - - CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCCROANCE WITH ALL STATF Antn A.0 1d1r"tQA1 n1:In Cl 3XIec Int eeeenT nwi rU.e nnTC nnre ? . /
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
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. LonGJD X102_-3%
1. GENERAL INFORMATION
HAA #_P A D! D 2 2 S
Expiration Date: _ 3 — d
Complete legal description L-crT 4 f �'-DAV Mlc- {Ltj Sib
Location (site address or directions) ;W`5/
Current Property owner(s) AK'T 4 �c lyl 43F-- 0J1J Day phone 2- —4&&
Mailing address
Lending agency
Mailing address
90,7-& el-Al?na(e:-,ta-*c +3vU)
Day phone
Real Estate Agent f\k'�E_ ��sr3o� Day phone
Mailing Address
Unless otherwise requested, NRA 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 Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater 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 less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the 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 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 -[:,;) V�tJ J'T Q• P. e_ --
Address
Address x&7c j3l�pV_5('e5,QE p'
Engineer's Printed Name ?5P2,Ct`T P. EiI �
5. DSD SIGNATURE
Approved for 4 bedrooms.
Disapproved.
Phone 2Z9 - 377
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: C(/, �a-[iI Original Certificate Date: S 2 3 - d i
(Rev. 1? 00)
Municipality of Anchorage
• Development Services Department
Building Safety Division `
On -Site Water & Wastewater Program a T'
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: �� `t f�Tf�2PA IG A�►1 Parcel ID: 050-2%
A. WELL DATA
Well type INP. If A, B, or C provide PWSID # _ Well Log (Y/N) es
Date completed 7J��/%p
Total depth jaL_ft.
Date of test
Static water level
Well production
Sanitary seal (Y/N)
Cased to 3i—ft.
FROM WELL LOG
Z—& iq (p
6�
WATER SAMPLE RESULTS:
9—
p.m-
Wires properly protected (Y/N)
Casing height (above ground) �✓� in.
AT INSPECTION
5(ooI
5g) ft. ea-T&P
5
9 -
p.m -
Coliform C colonies/100 ml. Nitrate 4 •r,Z mg./I. Other bacteria 6:�> colonies/100 ml.
1
Date of sample: % l 5 111 01 Collected by: pazol'r �4-1lJ
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material 1x%00 e0t,iL Dateinstalled O(Oho
Tank size 15� gal. Number of Compartments 2 Cleanouts (Y/N)
Foundation cleanout (Y/N) 05 Depression over tank (Y/N) K10 High water alarm (Y/N)
Date of pumping �J O Pumper --M's / G f d�tTiiGb D� _
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ftz ortt4h ria) System type VgFT 1f2;67"
Length 47 ft. Width 5 ft. Gravel below pipe `8 ft.
Total depth �= ft. Eff. absorption area 5�0 ft' Monitoring tube Depression over Feld "o
Date of adequacy test 54(p 1 Results (Pass/Fail)�S For 4 bedrooms
Fluid depth in absorption field before test � in. Water addedW gal. New depth : in.
Elapsed Time: if min. Final fluid depth 40 in. Absorption rate >= PW g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) 00 If yes, give date
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at _ in. ___EuwvVff level at _ in.
Cycles tested
E. SEPARATION DISTANCES
(Y/N)
High water alarm level at
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot 10% 1 On adjacent lots
f �
Absorption field on lot I P 4 On adjacent lots -I UO
Public sewer main _ 1A Public sewer manhole/cleanout 1\1
/
Sewer /septic service line + Holding tank
SEPARATION DISTANCES FROM SEPTICµ49kDWGrTANK ON LOTTO:
Building foundation (�J Property line 59 Absorption field
1 4 1. 1
Water main 'hl � Water service line ^' �� Surface water ��
1
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Water main
c�pr
Driveway, parking/vehicle storage _
Property line i � Building foundation _�z
Water Service line 'i D Surface water 4- 100
Curtain drain 11atitE AQp(Lt.iiWelis on adjacent lots + j
Db
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name�jP��
Date
in.
HAA Fee $ 3 v 0 a 0 Waiver Fee $
Date of Payment 5-- .11- Q/
Receipt Number 14 (0!6 7
(Rev. 12/D0)
Date of Payment
Receipt Number
iBINNF$P �.............
N Or
�FljMP ��
QROFESS7BC=
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 AUTHOR ITEE
APPROVAL FOR A SINGLE FAMILY DWEA6
Parcel I. D. # 050-362-37 HAA #
1. GENERAL INFORMATION
Complete legal description
Ptarmigan Lot 4
Location (site address or directions)
NHN Ptarmigan Blvd., Eagle River
Property owner Colony Builders, Inc. Day phone 244-6233
Mailing address 2340 T,nrPn Ci -mlP. An -m age AK 99516
Lending agency
Mailing address.
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well X
Community well
Public water
Day phone
Day phone
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 x
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 N21
5. STATEMENT OF INSPECTION BY ENGINEER
- -As certified by my seal affixed hereto and as of the validation date shown.below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Phone
Name of Firm
Eagle River Engineering Services 694-5195
Address P.O. Box 773294, Eagle River, AK 99577
Engineer's signature -� Date
• 6. DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
Additional Comments
V
M
bedrooms.
auTlc
bedrooms, with the following stipulations:
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 orderto 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 e21
Municipality of Anchorage a
DEPARTMENT OF HEALTH & HUMAN SERVICES r'Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343 -f.44l 4 1996
Health Authority Approval Checklist Municipality of A,c,ctn� Elie
Dept. Health & 4-iUM21-1 S� ry ces
Legal Description: Z- Parcel I.D.: 050-13&Z-31;?
A. WELL DATA
Well type If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Yta Date completed 6?AU
Total depth -9/ Cased to ?/ Casing height (above ground)
yes flz
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
5�7
g.p.m.
Wires properly protected (Y/N)yrS
Coliform '49- Nitrate /-/, %/ m bi 1-4=- Other bacteria
Date of sample: /0�1�go Collected by:
B. SEPTICfHeMNG TANK DATA
9 -
p.m -
Date installed%t1D Tank size /5CV Number of Compartments /— Cleanouts (Y/N) l�
Foundation cleanout (Y/N) Y" Depression (Y/N) /Ya High water alarm (Y/N) lyl,4
Date of Pumping AX -11d Pumper
C. ABSORPTION FIELD DATA
Date installed r%& 960 Soil rating (g.p.d./ft2 Vii) 01 ly
D4�6p
System type 7�4/11C-/l
Length / Width Gravel thickness below pipe Total depth
Effective absorption area �' 00 Monitoring Tube present (Y/N) � Depression over field (Y/N) /V4
Date of adequacy test Ivy Results (Pass/Fail) RII5 S For 4 bedrooms
Fluid depth in absorption field before test (in.);
/�/ 14
Immediately after= gal. water added
(in.):
Fluid depth NIA (ins) Minutes later:
I
Absorption rate =
g.p.d.
Peroxide treatment (past 12 months) (Y/N) /IJ 1A If yes, give date
72-026 (Rev. 3/96)"
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at* _
Cycles teste
E. SEPARATION DISTANCES
Size in
"Puma el at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/fielding tank on lot
M /
"Pump off" level at`
On adjacent lots f/00 /
I J
Absorption field on lot /01/ On adjacent lots
�,,vv0
Public sewer main 141A Public sewer manhole/cleanout 1114
rr�� I
r/septic service line � i,y Lift station N14
SEPARATION DISTANCES FROM SEPTIC/WG4=B NG TANK ON LOT TO:
Foundation Property line
SCJ /
Absorption field 5 /
Water main/service line Surface water/drainage f-/00 / Wells on adjacent lots /00
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
e / �
Property line %/ Building foundation WatersaWn/service line f $�
Surface water /-/00
Driveway, parking/vehicle storage area
Curtain drain / ON6/ A?PA4W 7'
Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
/certify that/ have determined thru field inspections and review of Municipal records fl l.a ��k.44 re
° a�°:.�
in conformance with MOA HAA guidelines in effect on this date. �� �,•'q@meq+.
Signature
P,4
0v¢�•A,.,,»«,3x.4@•�;,a
Engineers Name41
Date
� ef%t�f 4°4e�`.ee®sad@P•��j'fl
HAA Fee
Waiver Fee $
Date of Payment �1 �l —tel (�
Date of Payment
Receipt Number (DQ 3 U a \
Receipt Number
72-026 (Rev. 3/96)*