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HomeMy WebLinkAboutRABBIT CREEK VIEW & HEIGHTS BLK 5V LT 6ARabbit Creek View &Heights Block 5V Lot 6A #020-541-53 Municipality of Anchorage Page of -:3- 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 >t Permit Number: 2,rZ PID Number: "� - A') Name: Wastewater System: ❑ New ❑ Upgrade Address: ABSORPTION FIELD Phone: No. edtooms� JJ El Deep Trench &Shallow Trench El Bed El Mound 11 Other LEGAL DESCRIPTION Soil Rating:�n 6 Total Depth fro original grade: GPD/Sq.Ft, Lot: Block: f �S,/ubbdiivkisio% y 15 Rd(sj-+"'c''1 D Depth to pipe bottom from.original grade: ./P .rc. � _ Ft. Gravel depth beneath pipe L ,j Ft. Township: Range: Section: Fill added above original grade: Gravel lengt� r Ft. Ft. WELL: ONlew ❑ Upgrade Gravel width: Number of lines: Z_ Distance between lines: 6 Ft. Ft. Classification (Private, A,B,C): D V Gs 1t � T9tal Depth: I Ft. Cased To: / ✓� Ft. Total absorption area: Z, SQ. Ft. Pipe material: Z � 4 riiall:G"L J J� Driller -, — G rdl Date1D,rille/d C'r?b. Static Water Level:Inst Ft. Il Date installed: C, Yield: Pump Set at: Casing Heerii9ght Above Ground: TANK 10 GPM Ft. G- .,n Ft. SEPARATION DISTANCES JXSeptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: � <s:> Capacity in gallons:/ Capacity From Tank Field Station Tank Sewer Lines �/ 5-' G Well f I 4JIA I Material: 6—� Number of Compartments: Surface 'q LIFT STATION Water Lot / 5 5! /r /IA W < IA Size in gallons: Manufacturer: Line (� ��c GV Foundation 1 2� t, / LJD "Pump on" level at: _. -Pum f' level at: High water alarm at: Curtain Pump Make & Model ctrical Inspections performed by-_� Drain BENCH MARK Remarks: ._ Location and Description:, - - Assumed Elevation: 0 cf::10 FL ENGINEER'S SEAL a 5 �ae A E.F. t T Inspections byA r Dates: 1st �R ° �a,.,u� �� •� performed C Gt`Z�✓ q5 r 2nd reb Y9 2 Department of Health and Human Services approval t rt� t Reviewed and approved by:t`r Date: 72-013 (Rev. 9/91) MOA 25 A/ti7e:Of'igfrlCyI i, Xe(-vnj Wm , fS�Dued 'lar 2'1<'�K, G7vivPW'+ i. Permit No. Svc ® 5 3 3 Page IVof 3 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:P IDN o.: v Epr,c.. sY5,- A5 DUiL 72-013 A (2/911 MOA 25 Lq N 73 - P e> 7 COT, I 72-013 A (2/911 MOA 25 Lq N Permit No. �) W 75 ®a 3 Page 3 of 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: �- �5 Ra66;+ GPID No.: lie) /c' V) r AIS! L° N P�®�= fee pp :5? TO A pA L�GR ml l er Fadi �yy�l l t� C=�� Gt ?rj /qgF3 Flow aiU� der © T0z-� V G,r\Ti...... ENGINEER'S SEAL s��3 �Wo ®rJSPpd m �y S�h�.F7 !k y Fm�M. %. 8` Y7 a erra `Qbp ,w Ile _._. _.. i% � + lam• 'e°,�8� 72-013 A (2/91) MOA 25 I P01 R,�mor- St. 90,51 5 AaerC�®RA�1� AL�B'� ®7719 SIX INCH WATER WELL. DRILLED----------OUT TO THE DEPTH OF 130 feet. DRILLED AT THE RATE OF------------ PER FOOT. Steel. c,n.s ng -e,-.,ted nut to 38 ft. PROPERTY OWNER Mlnrk Schultz 345-1347 16310 Fings 'tiny A..nch. 99516' LOCATION OF WELL SITE Lt. rik, 5 `pub: T'' bbit 'reek 1.71-IT. Bernie Cl- u o n-:nrl--rt Dri..11, ng 'Vorkc-,. DRILLER WELL LOO: 0 - 16' Si.l_t,y sandy fine g.r^vel_ with )0%) c].-ly reateri.r+l. 16 - 38° Co.-rye gr^,vel c^n� _neer-toy ^, .',rn th^ret' bedrock (e^rl.y) broken u.r enough to drive c-rin;s i.n j.t to 38 feet 38 -- 130' Bedrock. .5eci_rr.nnt r.°y bec'rnck, No -t-^r sh.o, n-g until 85 to 90 feet, wi-th. "bout ? g,yin "ll.n,? ut of 7_; ;Ur^c _n I — roc)-. Tut Cnir 130 feljtf Production incrPB,nr' cnriir mit ^f rOr011" `rP:. fr'Cm 115 to 123 feet, The cru: ;_ty ?� q.ua_ntity of tbir, very ,good? Mob urn R, back, no ch rme, No ch^rme for set -u, . p: id in fill, _ by Mprk Schultz, October 27, 1995° Jan. 26, 1999 Ms. Donna C. Means Municipality of Anchorage Department of Health and Human Services On -Site Services Section Reference: Septic System As Built for Lot 6, BI. 5 Rabbit Creek View Subd. Dear Ms. Means: As requested on the transmittal sheet when you originally reviewed the submittal for the subject As -Built, I am writing this letter with the re -submittal. As you can see on the As -Built form the system was installed on Oct. 23, 1995. It began snowing concurrently with excavation of the first trench. Due to the access problems with the site, the contractor elected to keep working until both trenches were complete and backfilled. It was about 10:30 P. M. when the second trench was completed. The owner of the lot was living in a trailer, and no house was built on the lot at that time. A foundation was poured later that fall. Due to the slope of the lot, my plan was to measure the swing ties from the foundation the next summer. My filing system failed me and I never made the measurements until Mr. Shultz contacted me in 1997. After I obtained the comments on my first submittal to you, I bought them home to my office and then became lost. The As Built I am submitting shows the system as built on the lot. The system was constructed in accordance with the MOA Permit and the approved design. Sincerely, y James F. Sizemore P.E. Mumeipality of Anchorage Department of Health and Human Services 825 "L" Street Rick Mystrorn, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor 343-4744 October 10, 1996 Mark G Schultz Heather L Johnson 16301 Genevieve Street Anchorage, Alaska 99516 5238 Subject: Lot 6 Block 5 Rabbit Creek View Subdivision Permit #SW950333, PID X1020-032-28 The subject permit, issued October 10, 1995 by this office for a single family well and/or on-site wastewater system, has expired as of October 10, 1996. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as -built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sinc rely, ,.,�--,,res,, Ja es Cross, P. . P ogram Manager On-site Services enc: Copy of Permit cc: Theta Environmental Engineering MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950333 DESIGN ENGINEER:THETA ENVIRONMENTAL ENGINEERING OWNER NAME:SCHULTZ MARK G & OWNER ADDRESS:16301 GENEVIEVE ST ANCHORAGE, ALASKA 99516 PARCEL ID:02003228 LEGAL DESCRIPTION: RABBIT CREEK VIEW BLK 5 LT 6 LOT SIZE: 35625 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED:10/10/95 EXPIRATION DATE:10/10/96 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: P. RECEIVED B ISSUED BY: t, I , DATE: II 0 DATE: OE THETA ENVIRONMENTAL ENGINEERING 905 Jayme Court Anchorage, Alaska 99518-2444 (907) 344-1928 Fax: (907) 349-2363 Mr. Dan Roth On -Site Services Department of Health & Human Services Municipality of Anchorage 825 L St Anchorage Alaska, 99501 Dear Mr. Roth. October 2, 1995 MUNICIPALITY OF ANCHORA(:iE ENVIRONMENTAL SERVICES DIVISION 0(,T (;13 1995 RECEIVED Re: Lot 6, Block 5, Rabbit Creek View On -Site Sewer Permit Application Attached is a corrected copy of my original submittal, The following changes were made: a. Soil test #2 contained a typographic error. It read Lot 6, Block 6 and should have read Lot 6, Block 5. The copy was corrected. b. All drawings have been xeroxed. Xerox copies are submitted. c. A cross section drawing of the wastewater system has been prepared and is attached as drawing 2/2. d. A flow splittind device, Zabel Z200 Flow Divider is now specified. I have retained the two 44 foot legs. This keeps some separation between the legs and ensures that if the flow is not equal in each leg, the additonal 5 feet of absorption area at each end can absorb the effuluent. I see no harm in this and it could add to the service life of the system. d. A post tank two way cleanout has been added to the design. e. The topographic information contained direction of slope, but the percent was not indicated. Percent slope was added to drawing 1/2. If you have any additonal comments or desire any additonal changes, please contact me at 344-1928. Sincerely, Ronald E. Godden, P.E. OE2 THETA ENVIRONMENTAL ENGINEERING 905 Jayme Court Anchorage, Alaska 99518-2444 (907) 344-1928 Fax: (907) 349-2363 LOT 6, BLOCK 5, RABBIT CREEK VIEW SUBDIVISION SITE NARRATIVE Lot 6, Block 5, Rabbit Creek View Subdivision is bounded by Lot 5, Block 5 to the North, Lot 7, Block 5 to the South, Lot 9, Block 5 to the East, and Genevieve St to the West. There is a home on Lot 7 with a water and wastewater system. This system is recorded with the Municipality. Lots 5 and 9 are vacant. Lot 10, Block 4 is directly across Genevieve St to the west and is vacant. There is a home on lot 12, Block 3 of Cinerama Terrace, but both the well and wastewater system on this lot is in excess of 200 feet from the proposed wastewater for Lot 6. A small structure is located on the extreme NE corner of the lot. This structure is not service by an on-site wastewater system and the lot currently does not have a well. The owner, Mr. Dave D'Amato proposes to remove the existing structure and construct a two story, three bedroom home of about 3,000 sq ft. The home will be near the location of the existing structure which will be removed. Access will be from an existing lane that crosses Lot 9, Block 5. A right of way through the lot is required. If the right of way is not obtained, access will be directly from Genevieve St. The lot slopes from the east to the west with some slopes exceeding 40%. The area of the proposed structure and waste water system slopes from 20-30% The southern third of the lot has slopes in excess of 40% and slopes to the southwest corner. There is a 6 foot drop(cutbank) from the lot to the drainage ditch on the east side of Genevieve St. The ditch was not holding water, despite the heavy rains that occurred the 5 days prior to the perc tests. The layers in the test holes are fairly steeply sloped and slope to the west, parallel to the surface. The material exposed in the cutbank along Genevieve St is quite silty and appears to be a different material from the receiving material exposed in the test holes accomplished for the wastewater system. The proposed system is located over 50 feet upslope from the cutbank. Based upon these observations, it is my professional opinion that a 5 foot wide wastewater system, installed parallel to the slope of the lot, in the location proposed will operate correctly and not impact the surface water below the system. Lot 6, Block 5, Rabbit Creek View Subdivision, Continued. WELLS No impact to the wells on the adjacent lots is anticipated from this system. There is sufficient room on adjacent lots to locate a well and wastewater system. Page 1 of 2 WASTEWATER SYSTEMS No impact to wastewater systems on adjacent lots is anticipated from this system. RESERVED SPACE. Sufficient room to the south of the proposed system exists to place a replacement system. The proposed system is above the test holes, and the replacement system can be placed 10 feet to the west of the proposed system which will be at least 5 feet from the test holes. This system would still be in excess of 50 feet from the cutbank on Genevieve St. DRAINAGE No impact on the drainage of the lot is anticipated from the proposed wastewater system. All fills will be sloped to drain in the direction of existing drainage. The system will receive topsoil and seeding to prevent erosion. It is strongly recommended that the contour above the system be graded in such a manner that the upper portion of the lot to the east not drain over the proposed and replacement systems location. WASTEWATER SYSTEM DESIGN Percolation Rate: Test Hole #1 = 10.4 min/in. Test hole #2 = 13.9 min/in. Per Table 1, A 90-48(S-1) Page 16, Loading Rate = 0.8 gpd/sq ft = 188 sq ft/bedroom. Suggested System = Wide Drainfield. 3 bedrooms x 188 sq ft/bedroom = 564 sq ft. System to be installed in the strata which was percolated. Bottom of the system will be 18 inches into the strata which will be 6 feet from the bottom of the hole. Depth of gravel = 18 inches, trench width = 5 feet, reduction factor = 0.78. 564 sq ft x 0.78 = 440 sq ft/ 5 ft = 88 feet of trench. Suggest two length of Drainfield, 44 feet long connected in the middle by a distribution pipe. The distribution pipe should consist of a Zabel Z200 Flow Divider or equivalent with two legs, two feet long connected to the short legs of the flow divider. This pipe should be laid level on native soil between the 44 feet legs. The long leg of the flow divider should accept the effluent from the dwelling. See attached data sheet and drawing 2/2. Note: the native soil gives an additional 10 feet of absorption area on the ends, and, ensures separation of the legs, should one receive more effluent than the other. This contributes to longer service life. The Drainfield should be constructed to the Municipality of Anchorage Typical Wide Drainfield Requirements and SMQQ(gations(AMC 15.65). OF 1-04 f�o Page 2 of 2 ooBeC� a,,e�oee aeaoo ...... e� itr®�p��►��,r"o�1A� THETA ENVIRONMENTAL ENGINEHiINU oE2 905 Jayme Court Anchorage, Alaska 99518-2444 (907) 344-1928 Fax: (907) 349-2363 JOB i2R(;z I T CiZEt�. V 3EW Z Z SHEET NO. OF G4r�Dru 913 UI�/S� CALCULATED DY_ `G^ DATE � GVD7�� 91301 CHECKEDBY DATE_ SCALE THETA ENVIRONMENTAL ENGINEERING OEC 9, 05 Jayme Court Anchorage, Alaska 99518-2444 (907) 344-1928 Fax: (907) 349-2363 JOB y.OT C 6LOG tC s 846811 CM16C ' V-atFW SHEET NO. OF Z CALCULATED BY �l DATE R CSU�jDt`N 81�1a� CHECKED OY DATE_1 z c1.1 c __ / ` Jy s Et U PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST Dave D'Amato TH#2 DATE PER IZE it Lot 6, Block `� LEGAL DESCRIPTION: INTO hh' + h 1 Township, Range, Section: T11N, R3W, DEPTH I T — SLOPE + SITE PLAN �p.Tty 1 2 3 4 5 6 7 8 9 10 11 OL, Organics GM, Silty Gravel, some cobbles, tan/dark tan GM, Silty Gravel, tan, lots of fines, cobbles, larger cobbles, layers of loose material, gravel/sa 12 BOH 13 14 { 151 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? Mn S 't IF YES, AT WHAT L O DEPTH? NSA P �. E Depth to Water Atter Monitoring? Nr lq PP Date: 8/10,195 ®®®® •Drop MENNEN MINE IMMEMEMEMIN MMMIEMMMMMIM MENNEN WAS GROUND WATER ENCOUNTERED? Mn S 't IF YES, AT WHAT L O DEPTH? NSA P �. E Depth to Water Atter Monitoring? Nr lq PP Date: 8/10,195 ®®®® •Drop PERCOLATION RATE .12Q (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 6_ FT COMMENTS PPrr hnl P sl lrf fPri rlirri nq PrO 1301 P nrP cnakr H A n hncirs Hole Was npPn Pd and rPmainind npPn diirinn very hPairjr rainy fnr S riacrc No water acc,,rr»lated in the hole. R.Godden PERFORMED BY. CERTIFY THAT THIS TEST WAS PERFORMED IN R. Godden ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/28/99 72-008 (Rev. 4/85( �.., . Municipality of Anchorage •j A DEPARTMENT CIF HEALTH & HUMAN SERVICES ��'•• � 825 "L" Street. Anchorage, Alaska 99502-0650 Q �T SOILS LOG —PERCOLATION TEST ,,.,,•, ��.� .,x PERFORMED FOR: DAVE D I AMATO TH#1 DATE PERFOR �C,b•7� / v' T,nt.6 - R1 nck 5 LEGAL DESCRIPTION: Rabbit Cree '? i' - 1 -DIOL, Organics 2 �Is�'• SM, Gravelly, 3 i•'' Dark Tan, Well s Y i Sandy Silt Compacted Township, Range, Section: T 11 N, R3 W, *IIGM, Silty, Sandy Gravel oi Few Cobbles, Loose-Sluffing - °'Tan +D i i • 8 GM, Silty 9 Fractured Tan t0 11 i I 12 BOH I 13 — 4 15 — 16 17 18 19 20 1 Gravel, Coarse Cobbles, Dark SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? nrn S L IF YES, AT WHAT O DEPTH? NSA P E Depth to Water After Monitoring? None Date: 8 / 10 / 9 5 PERCOLATION RATE --IA.-4- (minutesnncn) PERC HOLE DIAMETER D • 5 Net Drop f TEST RUN BETWEEN —A 5 FT AND c� n FT COMMEN-S Perc hole sluffed duri ncr perc Hole nrP 'Snaked 4.0 hni�ra Hole was opened and remained open during very heavy rains for 5 davG, no water accumulated in hole. PERFORMED BY: I Gedd CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 72-008 (Rev 4,85) EN SEMEN MEER .��E R■■■ MMIMMMMMIMI ■.�EHIMMEN .■■■E■I S L IF YES, AT WHAT O DEPTH? NSA P E Depth to Water After Monitoring? None Date: 8 / 10 / 9 5 PERCOLATION RATE --IA.-4- (minutesnncn) PERC HOLE DIAMETER D • 5 Net Drop f TEST RUN BETWEEN —A 5 FT AND c� n FT COMMEN-S Perc hole sluffed duri ncr perc Hole nrP 'Snaked 4.0 hni�ra Hole was opened and remained open during very heavy rains for 5 davG, no water accumulated in hole. PERFORMED BY: I Gedd CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 72-008 (Rev 4,85) V ,��`��. Municipality of Anchorage .ea • .. 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 Parcell.D. 0 T a -032.?.vfHAA# Qti(�`J9q Expiration Date: 1. GENERAL INFORMATION Complete legal description Lg fl flecks' qu s k; p Cr -«6e v, ic✓ Sip Location (site address or directions) l d 3 l0 ki A y1 4,C AV Current Property owner(s) Murk S c h u /f s Day phone 711r- SZ3� Mailing address Lending agency Mailing address Real Estate Agent Mailing Address i}larka uS� _ Day phone FS 3a Day phone Unless otherwise requested, HAA will be held by DSD for pickup. pl e4vc CAt, ham Scti `/� 3 rs-StTc 2. NUMBER OF BEDROOMS: _� "' +h74 '0-� A- /oec4-,y 3.. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of We (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. (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 ls(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 F la h6e Phone Address l ltS30 Ectio I/ , hAe,14oc.0521 � A4 9159,161 Engineer's Printed Name Date /Vow eM4 #r j 2C -.&V 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for be( Additional Comments Note: The well for this property meets existing State and Municipals Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wens continued suitability. Current nitrate concen a on is 7.32 m maximum concentration is 10.0 m ore informatt= on nitrates 119 available from Me un -Site services Program, at 343-15FU4. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: A ��. Original Certificate Date: i — /s": d -T (Rev. 01102) Municipality of Anchorage • ''` Development Services Department ; Building Safety Division ` On -Site Water & Wastewater Program 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: Lof 6, 41cac lc E Rub io-, f Creek 0'f cc) Parcel ID: O ZO --032 - z8 r A. WELL DATA Well type ' nvf If A, B, or C provide PWSID # N• ? Well Log (YIN) Y Date completed 16 127 / 9S Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth i 3 O ft. Cased to 3 6 ft. Casing height (above ground) in. /x ljadmc k FROM WELL LOG AT INSPECTION' Date of test 16/27/9S` fb /2- /m!/ Static water level Alai shocyn ft. SO ft. Well production E g.p.m. S' y g.p.m. a WATER SAMPLE RESULTS: Coliform _colonies/100 ml. Nitrate 7.3 Z mg./I. Other bacteria ' 0 colonies/100 ml. Arsenic: -- mg./L Date of sample: 140 27/ oY Collected by: F /a H -P 7TrcA 5,.c B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sen /-i c / S,lre f Date Installed tO / T-3/ 9s - Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) A)• A. Date of pumping 1I / 4( f 49 Pumper j4 y" Fl6...e Servtc� C. ABSORPTION FIELD DATA bate installed ly /z3/9S Soil rating (g.p.d./ft' or ft'/bdrm) O --v c4 System type d �-.wee �� r� Fte%( Length 156 ft. Width S ft. Gravel below pipe 1, 5 ft. Total depth _6/ ft. Eff. absorption area tL1 2 ft' Monitoring tube 'r Depression over field N Date of adequacy test 1a / 27/0V Results (Pass/Fail) Pc+r For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 149zgal. New depths in. Elapsed Time: 15" min. Final fluid depth o_S in. Absorption rate >= I ca g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) A/ If yes, give date Al. A. W Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off level at _ in Cycles tested Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ICY On adjacent lots '�> t oma' Absorption field on lot I On adjacent lots -> IGr>' Public sewer main N• A• Public sewer manhole/cleanout Al. A. Sewer /septic service line > 7x, Holding tank N• A: SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 35 Property line 6'5- Absorption field 5 - Water Water main M.A. Water service line > t°r Surface water > rcp Wells on adjacent lots > rca7' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 12 Building foundation Yo Water main Al. A. Water Service line > tO Surface water > tcic�' Driveway, parking/vehicle storage 66 ' Curtain drain N. k. Wells on adjacent lots >10c,' 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 Ttieoel&-e- P : /L+c re Date - NCJWfM Ser- 4 2GUy HAA Fee $ Y30=g- Date of Payment Na v B �aY Receipt Number 0 (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number ............. MORE F. AdOORE CE -3589 in. wI w LJ W z w u 30' 0 0 � s m m D D N N LOT 5 N 89'42' E N 89'28'03" E ®® LOT 6 190.00'(REC) 188.71'(MEAS) EXISTING HOUSE 3 X02, LOT 8 30' z i o z � 0 0 2' 27.8, Z ti 'i tt j i 44.9 p / a � � L m s GRAVEL DRIVE ; _ i INERAM i IN R TE RACER SUBDIVISION _ ..w. >:IZ-M: .607 5616301 c mat -Su Test Lab of Alaska Water Quality Testing-' ntsray. � .. m x Mile 3.2 Palmer•Wasilla Hwy. P.O. Box 2749 Midtown Community Business Park Palmer, Ak. 99645 Phone: (907) 745.3005 Email: pat-sutestlabOroeerShsa.com Fax: (907) 745.1010 Client: SGS Enviromentai Date Arrived: 10/28/04 200 W. Potter Report Date: 10/29/04 Anchorage, Ak. 99518 Sample Date: 10/27/04 Attn.: Forest Taylor Sample Time: 1145 Client ID' Lot 6 Block 5 Rabil Ck. View S/D-1047180001 Collected By: PWSID #: Source: M.S.T.L.#: 20041058 Sample Matrix Comments: Method Parameter Units Results MDL Date Prepared Date Analyzed MCL SM 4500-NO3-E Total NO3/NO2 mg/L 7.32 Legend. MRL = Method Report Level MCL = Max. Contaminate Level B • Present In Method Blank E = Estimated Value H =Above MCL D = Lost to Dilution Re&bed Ay Jon Paul Campbell Lab Supervisor 0.50 10/29/04 10/29/04 10.0