HomeMy WebLinkAboutDRAKE BLK 2 LT 5B
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
Permit Number: l[,l'~(~ 4..\(~O~ RID Number: ~'-~ - ~
Name: DA~ ~O ~bT~ CT/~ ~ Wastewater System: ~New ~ Upgrade
~ar.~s: ABSORPTION FIELD
Phone: ~ No. of Bedrooms:
, 3~ ~ /~ ~I ~ ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~Other
LEGAL DESCRIPTION soi, Rating: Total Depth from original grade:
/, % G~/s~. ~. ~. '~ '
Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe
Township: ~ Range: ~ Section: Fill added above original grade: Gravel length:
. ~ - Ft, Ft.
WELL: ~ New ~ Upgrade Gravel width: , Number of lines: Distance between lines:
~ Ft. I ~ ~ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Ft. Ft. ~ ) ~ SQ. Ft.
Driller: Date Drilled: Static Water Level: Installer: Date install~:~
Yield: GPM[[ Pump Set at: Ft.[[ Casing Height Above Ground:Ft. ~ :: . TANK
SEPARATION DISTANCES [ ~Se~tic: OHotding O S.T.E.P.
To Septic Absorption Lift Holding, Pq~lic/Private Manufacturer: ' / Capacity in gallons:
From Tank Field Station Tank · Sewer Li8~s ~ ~¢~ ~ >
Material'. ~ ~ Number of Compartments:
Surface ..... LIFT STATION
Water
Lot ~ Size in gallons: "~ Manufacturer:
Line ~. 0 / 0 ~ ~ -
I
-- "Pump on" level at: J "Pump off" level at: J High water alarm at:
Foundation / % / ~
I
I
Gu rtain Pump Make & Model ~ Electrical Inspections performed by:
Drain ~
I
Remarks: BENCH MARK
Location and Description:
~o~ iV(= .~ bc
Assumed Elevation:
Inspections performed by: ~ ~)~ Dates:lst ?/~ ~~~"'"
2nd '7/~/~ V
'"~ "' /" ¢~~~''~i~;. ~ ' CE · 7892' PUT~{,,...~:~.~,~,
Department ct Heallb~ Hum~ervices approval '1,~1,.
Reviewed and approved by - Date:/ ~
72-013 (Rev. 9/91) MOA 25
Permit No,
Municipality of Anc. horage~
DEPARTMENT OF HEALTH AND HUMAN 'SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650' Anchorage, AK 99§~9.~6650' Tel: 343-4744
On-Site Wastewater Disposal S'ystem~Well Inspection Report
Legal Description: LOT 5B BLOCK 2 DRAKE SUBDIVISION PID No.
Page,~ of.~
W.O. 94116
Dale 9-22-94
5' WIDE TRENCH
SOLID MANIFOLD PiPE
FROM SEPTIC TANK.
CLEANOUTS AT
l-- :~~NNING AND END OF TRENCHES
] ~--~-. MONITORING TUBE
~ CAPPED - PERFORATED IN
~ .. SEWER ROCK, SOLID ABOVE, ?
5' I "---4" PERFORTATED PIPE
3/4" TO 2.5"\
c~
PLAN VIEWNTs
CLEANOUTS - CAPPED
1000 GAL
SEPTIC
TANK
MONITOR TUBE
PERFORATED IN
ROCK. SOLID ABOVE.
~ FINISH GRADE '~r[ ~ SILT
SEWER ROCK
PROFILE (TYP)
NTS
DESIGN REQUIREMENTS
1. THREE (5) BEDROOMS
2. PERCOLATION TEST PERFORMED BY FLATTOP TECH. SERVICES
ON 11-7-91. RESULTS: 2 MINUTES/INCH (SEE ATTACHED)
3. WASTEWATER APPLICATION RATING:
1.2 GPD/SQ.FT.
4. NO GROUND WATER AS OF 6-1-94
INSTALLATION:
1. 1000 GALLON SEPTIC TANK
2. ABSORBTION AREA: 575 SQ. FT.
5. 58.5' LONG BY 5' WIDE TRENCH WITH 18" GRAVEL
72-01.t A (2/gl) MOA 25
WATER
CONTOUR BACKFILL
TO SLOPE AWAY
MONITOR TUBE - CAPPED.
FROM DRAIN FIELD
o PERFORATED IN SEWER
LID ABOVE,
I 12-, I Ill-'--4" PERFORATED PIPE
I I~ l ill LAID LEaL WITH
'.. ~ I:11 HOLES DOWN ANP
I I-c l il~ SIDEWALL OF
~ ~ III ~ 3/4" - 2.5"
5.0'
TABLE
IMPERMEABLE
LAYER
TYP. CROSS
SECTION NTS
IcWN: ekb
KD: gmp
ISCALE: '~ N~DJ
1 201 Ramona St. 9951 5 ANCHOI~AGE~ ~,LA~KA
SIX INCH WATER WELL DRILLED
DRILLED AT THE RATE OF
PROPERTY OWNER Mr. ~on
OUT TO THE DEPTH OF ..,76 ft.
PER FOOT. Steel casing seated out to 76 ft.
3;.~4-21 84
LOCATION OF WELL SITE
DRILLER
WELL LOG:
0 - 16'
16 -
49 -
Lt. 5B B4k. ~ Drake Sub.
Bernie Claus of Ramoart Drilling Works
Silty sand.y c].ay with 1~% fine ~rsvel.
35% gravel in clay material.
Hardpan. A cemented, grave.
79 - 76' Fine sandy water bearing fine grave]_ going into a good coarse water
bearing gravel. Thi. s water we.l.[ is oroducing 1() g~m with good quality water.
Water recovery is back up to within 3.-) ft. ,of surface. 1/2 horsepower sub.
pump should be instal. 1..ed within about 3 to 4 feet of bottom.
Water well. paid in full by Don Da.hi.
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PaYabLE TO RAMPART ~DRILLING WORKS FOR_ThE SUM OF
Thamk you, Don. :',~o way we couldB~$~Eg~[j~~ ~r~A~]~T~[t?~ ~~t the T-4
DATE ~]g~at. 3): 199/~
SERVICE CHARGE OF 1Y~% PER MONTH WILL BE ASSESSED ON PAST DUEACCOUNT~.
PAGE
1 OF
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALAS KA 995 %.9 -~ 6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW940181 .....
DESIGN ENGINEER:LANTECH
OWNER NAME:H S PARTNERS
OWNER ADDRESS:DIMOND TOWER #3-300
ANCHORAGE, AK 99515-2043
DATE ISSUED: 6/20/94
EXPIRATION DATE: 6/20/95
PARCEL ID:01746112
LEGAL DESCRIPTION: DRAKE BLK 2 LT
LOT SIZE: 18000 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT:
5B
THIS PERMIT IS FOR THE CONTRUCTION 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)
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 BY:
DATE:
Permif No.__
On-Site
Legal
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, AK 99519-6650° Tel: :348-4744
Wastewater Disposal System/Well Inspection
Description: LOT 5B BLOCK ~ DRAKE SUBDIVISION PID No.
Page
Date
of
94116
6-1~'-94
Report
Narrative
Lot 5B Block 2 Drake Subdivision is bordered by Lot 5A (undeveloped) to the north,
Merganser Ave. to the south, LOt 5C (under construction) to the east, and Lot 6
(residential) to the west.
The lot topography is general characterized by flat to sloping 5% in a south westerly
direction. There was no apparent open water on Lot 5B or is neighboring lots. Lots 6,
5A, and lots to the south of Merganser Ave. have no wells within a 100 foot radius.
The well servicing LOt 5D is located at the proposed well location shown on the Site
Plan prepared by Flattop Technical Services. The existing well on Lot 5C was not
abandoned (on 6-3-94) and redrilled at the proposed location, and it is my
understanding the existing well will service Lot 5C. The well servicing Lot 5B will be
drilled at the proposed location. Lot 5B and C do not currently have a septic system.
Lot 5B is approximately 18,000 square feet and the proposed development is a 1500
square foot ranch style house with 3 bedrooms.
On 10/28/91 Flattop Technical Services performed 2 percolation tests on Lot 5B
resulting in 7 minutes/inch and 2 minutes/inch. Both test pits are characterized by 1'0"
of organic material and SP/SM to approximately 13 feet below the existing ground
surface. The ground water monitering tubes installed at that time are still in place and
were dry on 6-3-94.
Based on these percolation tests, the plot plan (performed by R&M), and a site
investigation, Lot 5B can accommodate a septic system and well even with Lot 5C's
utilizing of the existing well.
//
Permit No.
~[JN ~9~90t~ Municipality of Anchorage
ba,.i~.ioa~it¥oiA~~MENT OF HEALTH AND HUMAN SERVICES
Dept. Health& ENVIRONMENTAL SERVICES DIVISION
P.0. Box 196650 Anch~age, AK 99519-6650' Tel: 343-4744
On-Site Wastewater Disposal System/Well Inspection Report
Page__of __
W.O. 94116
Date 6-5-94
Legal Description:
LOT 5B BLOCK 2 DRAKE SUBDIVISION
PID No.
LOT 5A - VACANT LOT / /
SITE PLAN
. N 90'00'00" E 100.00: /
10' UTILITY EASEMENT / FOUND 5/8" REBAR
+ rococo' ~- ~o~
~ ~ .~o. os~/~' ~" ..o.os~o/
I ~ ~LL ~v .~ ~ ~ _ ~LL J
~ · ~NT ~ ~ ~ ~ ~ /
Dj
LOT6 ~~
~ ~ ~ ~000~L ,k ~ ~ ,'
· ~ J TANK , ~ m ~'~ '
0 ~ t --+'
0 = .~. ~ J x' 0 / NO~S
' u J ; I ....... J - / 1. Sl~ PLAN DEVELOPED FROM PLOT
~ ~__ I~.UUU ~.~. ~ / PLAN PERFORMED BY R & M
~ ~ ~ST PIT ~ - 1~ o' - ~ ~ / CONSULTANTS 5-20-9~
~!I ~ ~ ~ ~ .... ,~ ,oo.~ + / 2. ALL L0T D~MENS~ONS ARE RECORd
~ J ' ~ ~ ~ / AS SHO~ ON PLAT NO, 69-206
~ I -~, PROPOSED 58.5' ~ ~ - ~ DRAKE SUBDI~StON.
~ J j ~ (TOTAL LENG~) ~ ~ ~SEPTIC ~ ~ / 3. mE ELEVA~ONS ARE BASED ON
< ' 5' ~OE ~ENCH ~ ~ CLEANOUT~ ' ~ ~ A~HMFn B~THM
I I ~ W/18" GRAVEL. ~ ~ ~ -- ~ ...................
~- 10' t ~ BASIS OF ELEVATION ~ ~%~ ~ 'e~
rOUND 1/2" REBAR J N ~U UU UU Tw i uu.uu FOUND 5/8' REBAR ~ ~ ~,--~
-- ~ee~e~e~e~eeeeeee4
OVE~
J 'v "~v~ '~. ~GREGO~ M. PUTNAM
o CLEANOUTS t ...... ~
9 SPOT ELEVA~ON I ~3 2553 ~ cress
SCALE' 1" - 30' G~'~ ~ ~ J DWG a. 1 of ~ ~
+. ' , ~' . , '"' . - DATE
Permit No.
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, AK 99519-6650 * Tel: 343-4744
Page__of __
W.O. 94116
Date 6-.3-94
On-Site Wastewater Disposal System/Well Inspection Report
Legal Description: LOT 5B BLOCK 2 DRAKE SUBDIVISION PID No.
/ LOT 5A - VACANT LOT / /
FOUND 5/8,, REBAR +'~0'~'~ / SITE PLAN
/
10' UTILITY EASEMENT / FOUND 5/8" REBAR
+~'~ moo. Go'
~ ~ ~LL ~
· VENT ~ u ~ ~ /
~ ~.oo'[ ' ~.o' ~d~ /
b 9 ~ ~3 RIO0.O0'
< X?'°°' FOUNOA~N ~ " /
~ 'X I='°°' // .o, sc
LOT
6
-- b b /
NO WELLS ~
RADIUS ~ ~ I I
~ ~ ~ ~O00~L ~X ~ ~ ,'
~ ~ I x o "
0 ~ --+ 0
0 ~ ~ / NO~S
~ L~ ' ' ' X / PLAN PERFORMED BY R ~ M
~ ] I ~ST Pit ~ -- / CONSULTANTS 5-20-9~
~ +
~ ~ / I ~2 ~ ..... ,X ,oo.~ / ~, ALL LOT O,MENS,ONS ARE REOORD
~ I ~~ % / AS SHO~ ON PLAT NO. 69-206
~ I ~m , PROPOSED 58.5' ~ _ , ~ DRAKE SUBDI~SION.
~ I ;j/ (TOTAL LENOX) ~ ~ ~SEPTIC ~% / 5. ~E ELEVADONS ARE BASED ON
< 5' ~DE ~ENCH C EANOUT~ '
~1 w-~" G.AVEL ~ ~ ~ ~ ~ ASSU~ED DATU.
-~ PIT ~ ~
FOUNO1/2"REBAR I N 900000 ~W 100.00 FOUNDS/8-RrBAR ~e_~--~
LEGEND ~ mo' MERGANSER AVENUE ~
- ~ / Tn W~,,
/ .... ~.~GREGO~ M. PUTNAM
o CLEANOUTS t .... ~-'
DWN: ekb E~ ENTE~P~[5~5 CLIENT~: - ' ~A~: ee
¢- DATE' 6 2 94 1~II~2~om~. ~'(~) / ~Ri~ ' ' ~--
+' ~ ' ' ' ' DAlE
72-013 A (2/91) MOA 25 EBE COMP F~le: 116eite,OWG
Permit • No. Page of
Municipality of Anchorage W.O. 94116
DEPARTMENT OF HEALTH AND HUMAN SERVICES Date 6-3-94
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ° Anchorage, AK 99519-6650 • Tel: 343-4744
On—Site Wastewater Disposal System/Well Inspection Report
Legal Description: LOT 5B BLOCK 2 DRAKE SUBDIVISION PID No.
Affiv�r 1
DESIGN REQUIREMENTS
1. THREE (3) BEDROOMS
2. PERCOLATION TEST PERFORMED BY FLATTOP TECH. SERVICES
ON 11-7-91. RESULTS: 2 MINUTES/INCH (SEE ATTACHED)
3. WASTEWATER APPLICATION RATING:
1.2 GPD/SQ.FT.
4. NO GROUND WATER AS OF 6-1-94
INSTALLATION: DWN: ekb
1. 1000 GALLON SEPTIC TANK CKD: 9MP
2. ABSORBTION AREA: 375 SQ. FT. DATE: 6-2-94
3. 58.5' LONG BY 5' WIDE TRENCH WITH 18" GRAVEL SCALE: AS NOTED
72-013 A (2/91) MOA 25
®E COMP file: 1176611E.OWu'
CONTOUR BACKFILL
® SOLID MANIFOLD PIPE
TO SLOPE AWAY MONITOR TUBE — CAPPED.
FROM DRAIN FIELD
FROM SEPTIC TANK.
PERFORATED IN SEWER
CLEANOUTS AT
ROCK, SOLID ABOVE.
— BEGINNING AND END OF TRENCHES
I
MONITORING TUBE
CAPPED — PERFORATED IN
SEWER ROCK, SOLID ABOVE.
NATIVVE BACKFILL
20.0' I �4" PERFORTATED PIPE
36" MIN
PERF DOWN LAID LEVEL
3/4'" TO
I SEWER ROCK
0
m SILT BARRIER
— L------------------- 5.0'
T 6" GRAVEL
4" PERFORATED PIPE
LAID LEVEL WITH
HOLES DOWN AND
38.5'
18" I CAPPED ON END.
SIDEWALL OF
5 I TRENCH
PLAN� /
VIEW
NTS
� 3/4" — 2.5"
SEWER ROCK
5.0'
T41�
MONITOR TUBE
PERFORATED IN
CLEANOUTS — CAPPED ROCK. SOLID ABOVE.
�6+'
WATER
TABLE
FINISH GRADE SILT
�—
IMPERMEABLE
LAYER
SOLID
BARRIER
PIPE PERF PIPE 36" MIN.
TYP CROSS
HOLES DOWN
1000 GAL
END CAP
.
SECTION
SEPTIC -------------
NTS
TANK AS
18"
REQUIRED (BOTTOM LEVEL)
3/4" — 1.5"
SEWER ROCK
EB ENTERPRISES
PROFILE(TYP)
Site Planning 4 Pngineeriny Support Services
Mlle 2 Crow Geek Hwy. ft ne a (W'T)
NTS
�g3-233-f
GP0.8ox213
irdwood, .GK 99581
DESIGN REQUIREMENTS
1. THREE (3) BEDROOMS
2. PERCOLATION TEST PERFORMED BY FLATTOP TECH. SERVICES
ON 11-7-91. RESULTS: 2 MINUTES/INCH (SEE ATTACHED)
3. WASTEWATER APPLICATION RATING:
1.2 GPD/SQ.FT.
4. NO GROUND WATER AS OF 6-1-94
INSTALLATION: DWN: ekb
1. 1000 GALLON SEPTIC TANK CKD: 9MP
2. ABSORBTION AREA: 375 SQ. FT. DATE: 6-2-94
3. 58.5' LONG BY 5' WIDE TRENCH WITH 18" GRAVEL SCALE: AS NOTED
72-013 A (2/91) MOA 25
®E COMP file: 1176611E.OWu'
Permit No,
On-Site
Legal
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, AK 99519-6650 ° Tel: 348-4744
Wastewater Disposal System/Well Inspection
Description: LOT 5B BLOCK 2 DRAKE SUBDIVISION PlO No.
Page __
W.O.
Date
of
94116
6-5-94
Report
NOTES:
10
ALL CONSTRUCTION SHALL BE IN ACCORDANCE WITH ON-SITE WASTEWATER TREATMENT AND
DISPOSAL REGULATIONS OF THE EPA DESIGN MANUAL.
INSTALL NEW 1000 GAL SEPTIC TANK AS SHOWN ON THE DRAWINGS. RECORD INLET AND OUTLET
ELEVATIONS OF THE TANK. TANK SHALL BE PLACED ON UNDISTURBED NATIVE SOIL. PLACE OUTSIDE
PROTECTIVE WELL RADIUS.
ANY DEVIATION FROM THE DESIGN MUST BE AUTHORIZED BY THE ENGINEER PRIOR TO ITS INCORPORATION
INTO THE SYSTEM.
CONTRACTOR TO LOCATE ALL UNDERGROUND UTILITIES, PROPERTY LINES, EXISTING WELLS, WATER WAYS,
SURFACE AND SUBSURFACE DRAINAGE FACILITIES, LAKES, PONDS, AND OTHER FACILITIES REQUIRING
SEPARATION DISTANCES FROM THE PROPOSED SEPTIC SYSTEM. NOTIFY THE ENGINEER OF ANY OBSERVED
CONFLICTS PRIOR TO CONSTRUCTION.
NOTIFY THE ENGINEER 24 HOURS PRIOR TO COMMENCING WITH CONSTRUCTION. A MINIMUM OF TWO
INSPECTIONS ARE REQUIRED. THE FIRST INSPECTION SHALL BE OF THE SUBGRADE, PRIOR TO PLACING
SAND FILETER. THE SECOND INSPECTION SHALL BE AFTER THE PLACEMENT OF GRAVEL, DISTRIBUTION
PIPING, STANDPIPES, TANK, AND OTHER COMPONENTS AS SPECIFIED.
CONTRACTOR SHALL DELIVER TO THE ENGINEER A SET OF RED-LINED, AS-BUILT DRAWINGS SHOWING ALL DATA
AS SPECIFIED IN THE ON-SITE WASTEWATER TREATMENT AND DISPOSAL REGULATIONS WITHIN 50 DAYS OF
THE FINAL INSPECTION. INVERTS AND SWING TIE LOCATES SHALL BE TO THE NEAREST TENTH OF A FOOT. THESE
AS-BUILTS SHALL BE USED TO DOUBLE-CHECK THE ENGINEER'S INFORMATION PRIOR TO SUBMITTAL TO DHHS.
STAKE ALIGNMENT OF SYSTEM WITH MARKERS SHOWING THE PROTECTIVE DISTANCES FROM WELLS AND
OTHER BODIES OF WATER PRIOR TO BEGINNING INSTALLATION.
A SOILS LOG MUST BE PROVIDED OF THE TRENCH WALLS AND BED OF SUBSURFACE DISPOSAL FIELD IF THE SOILS
DIFFER FROM CONDITIONS UPON WHICH THE PERMIT WAS BASED.
ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE, TO BE VERIFIED AND MAY BE MODIFIED BY THE
ENGINEER.
SLOPE ALL FILL MATERIAL TO DRAIN AT 270 MIN. SLOPE, AND 3:1 MAX SLOPE, AND IN SUCH A MANNER THAT
PONDING AT OR NEAR THE DRAIN FIELD DOES NOT OCCUR. THE FILL SHALL BE LEFT AT 6" HIGHER THAN
SHOWN TO ALLOW FOR SETTLEMENT. SEED SURFACE AFTER COMPLETING INSTALLATION.
11 ALL PIPE SHALL BE PVC CONFORMING TO ASTM D3034 OR
ENGINEER-APPROVED EQUAL.
12 MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS,
TRASH AND CONSTRUCTION DEBRIS.
15 RECORD THE FINISH GROUND ELEVATION OVER TOP OF BED.
~. ~ ~ ~o~. ~UT~A~
%?2'........'%*?
DATE
COMP File: IO§O.DWG
(~ ~ Ir~OX~ / 1~7..'-
PERFORMED FOR:~
']4530 Echo Street
Anchcra e, Al,=ska 995]q
Municipality et Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
IJATE I'EHFOFIMED: l~' J ~--b /~ ~/
LEGAL DESCRIPTION: /-- 0 'r' ,,,~_~
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
Ol~A /~c~=Township, Range, Section: S~c. ~b. 'T'I~.IV/ I~'~ S./"'I.
SLOPE SITE P~AN
14oSe. r of bl/..
WAS GROUND WATER
ENCOUNTERED?
$
L
IF YES, AT WHAT ~ O
DEPTH? p
E
Oepll~ lo Wau Aller J~.'E
Moniloring? Date: 11/'.5'/~/
Gross Net Depth to Net
Reading Date
IO { g<9 'rime Time Cm~'~ Were, Drop
~y ~ .'~7:~ 7 ~Z 'lt~ / '~
PERCOLATION RAT E 7 Immutes~mch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~'- P.d' FT AND o~. 7.3' FT.
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE; I t // 7/9/
PERFORMEE) FOR:
LEGAL DESCF¢IPTION:
(FEETI
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
~4530 Echo Street
A_c..o:cg',., ~...-.-...a 9,.5~ ~
~ Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG ~ PERCOLATION TEST
I'1 I,.. ~C;II rnaf' I)
K~=Townsl~ip, Range,Seclion: S~'c ~c~. 7'/~./V, /~ S',/%
SLOPE SITE P~AN
7:. t/. #3
WAS GROUND WATEI]
KNCOUNTE~ ED?
'
,,~
"~
$
' L
IF YES. AT WHAT , O
DEPTH? . p
E
M.
Oeplh to Water After IPr/
Monitoring? Date: ti/5'!9 1
5P/SM
Gross Net Depth to J Net
PERFORMEDBY. F[~x~/.zg.,~ ?¢~ _~0'¢ , ~'~"'~' ~ CEHI IFY ?HAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE.
72-008 (Rev. 4/85l
GAAB-HD-I
GP'6.TER ANCHORAGE AREA BORO;"~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
i.rl !l.,,,,~.~J'~.., ADDRESS
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
MATERIAL ~4~lJ~/~'~ ~'~'~' NUMBER OF /
COMPARTMENTS
GALLONS. INSIDE LENGTH INSIDE WIDTH __DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH f~/i/ i
-- LENGTH { ~ ~/ ~ j
, , DEPTH ,
LINING MATERIAL ~1~'/~/~'~ /~'~"",~" DISTANCE FROM WELL /'~""~) !
. . BUILDING FOUNDATION. ~"'~------~
NEAREST LOT LINE ~-~ . TOTAL EFFECTIVE ABSORPTION AREA (WALL ARE~,) ~ '~ & SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
FOUNDATION ~LOT LINE
DISTANCE BETWEE~NE~ TRENCH WIDTH
LENGTH OF EACH LINE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL:
TYPE t/'"')'~//-"6.~":,~ , DEPTH
NEAREST
LOT LINE ~ , SEWER LINE ~'
SEPTIC
, TANK
DISTANCE FROM
, BUILDING FOUNDATION
J SEEPAGE
SYSTEM
WATER
SAMPLE
, CESSPOOL
NEAREST
OTHER
SOURCES__
DISTANCES:
DATE
DIAGRAM OF SYSTEM
' HEALTH AUTHORIT~ -- /
GAAB-HD-~ Case No. ~
GREATEi,
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, AlaSka 99501
OROUGH
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS,
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ~
~'~-8~TEST R ESU LTS
SEEPAGE PIT
MAILING ADDRESS ,~)~2-/~ ~%~)~/3'~7~:::PHONE NO.~)
LOCATION OF INSTALLATION
, DRAIN FIELD , OTHER
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
THIS IS TO SERVE AS ~-'~ T-T~I,--' , PERMIT TO INSTALL A
.. SEPTIC TANK SIZE /~- ~ TYPE ~.4r'l~ SEEPAGE AREA
DIAGRAM OF SYSTEM
DISTANCES:I/Y/Jr/J
TYPE
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code. . ' '~
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 017-461-12
1. GENERAL INFORMATION
Complete legal description Drake Block 2 Lot 513
Location (site address) 3301 Merganser Ave, Anchorage
Expiration Date: f 0 x.'7'2 C)
Current Property owner(s) Janice Spray Day phone
Mailing address
Real Estate Agent
3301 Merganser Ave, Anchorage, AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class _ Well
❑
Public Water System
❑
Waiver/Variance request for:
Received by:
3
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
❑
Community
❑
Public Sewer
❑
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ �I I �� 5U ( Co UI 6` 1� Waiver Fee $
Date of Payment Date of Payment
Receipt Number CQ2(,2 (p. Receipt Number
COSA # SC 3 y y Waiver #
Distance:
5. STATEMENT OF INSPECTION BY EN:GiNEER
As certifted by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. i further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING INC. Phone 696-6111
Address 20441 PTARMIGAN BLVD. EAGLE RIVER,AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date I L? Zv
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen r
encroachments, deficiencies or discrepancies exist. OF4���A
L
10,
6. DSD SIGNATURE
System #1 Approved for bedrooms.
System #2 Approved for bedrooms.
Disapproved.
N mss.,+ -4►
Conditional approval for bedrooms, with the following stipulations:
ON-SITE G
1,7VV ER z =
PROGRAM 6
Original Certificate Date: c�11 Vl
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other TC
rnica hb,a h—t �r�trLt� r
COSA Checklist
Legal Description: Drake Block 2 Lot 513 Parcel ID: 017-461-12
If more than 9 septic system on lot: COSA Checklist # of Structure served by this system 1
A. WELL DATA
Well log is filed with Onsite (or attached) Well production at time of test 5.1 gpm
Date drilled 8/30/94 Water storage tank volume gallons
Total depth 76 ft Well disinfected for coliform test? El Yes Nc
Cased to 76 ft Coliform bacteria is Negative
3*
Sanitary seal is functioning correctly Nitrate 13.mg/L ❑ Nitrate less than MRL (ND)
01 Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) . 12 in. Collected by AreTerra Consulting
Date of flour test for COSA 5/19/20 Date of Sample 7/9/20
Static water level at beginning of test 36 ft.
Comments *Well scoped 10/1 A 8 by e ty Drilling in MOA file
B. TANK DATA
Age of tank(s) 26 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank 49"
, Standpipes/foundation cleanout per record drawing
Date of pumping 7/24/20
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/8/94
ALL standpipes present per record drawing
Total measured depth from grade 7 ft (max)
Measured depth to pipe invert from grade 4 ft (min)
❑ N/A pressurized field
01 Monitor tubes go to bottom of effective. If nof, smote
depth into effective
10 Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 5/19/20
Results D Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 450 cal
New depth 0 in
Elapsed time 10 min
Final fluid depth 0 in
Absorption rate 450+ gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
I- SEPARATION DISTANCES
From Private Welf on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Yes
if No
Community Sewer Manhole/Cleanout > 100'
Yes
if No
ft
Yes
if No ft
Neighboring Tank > 100' Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No ft
Absorption Field on Lot > 100' Yes
if No
ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No ft
�j Yes
if No
ft
ft
If septic tank is under driveway comment below
ManurelAnimal Excreta Storage> 100'
Community Sewer Main > 75' Yes
if No
ft
® Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Yes
if No
ft
Surface Water> 100'
®Yes if No ft
Property Line > 51j
Yes
if No
ft
Wells on Adjacent Lots:
Yes
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
Yes
if No
ft
Community Wells > 200'
Yes if No ft
Water Service Line > 10'
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' Yes if No ft
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' 0 Yes if No ft
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that t have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on -this date.
COSA Checklist yellow sheet
fuly 23, 2020
CONSULTING, INC
20441 Ptarmigan Bld, Eagle River, AK 99577
Office (907) 696-6111, Fax (907) 865-3793
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: COSA Drake Blk 2 Lot 5B- Arsenic Sample
SGS sample # 1203295 taken 7/8/20
Per our telephone conversation today I am informing you the SGS Laboratories
has not reported on. the arsenic levels for the well water sampling on this
property. Their direction to us on 7/22/20 stated that they will not be able to
provide that report for another week due to testing proceedures.
I have reviewed MOA files in the area and found no evidence to suggest this
property will have an abnormal arsenic level. The reported arsenic levels on this
proerty in 2018 was non -detect. We will provide the report for your files once it
is received.
Respectfully submitted,
ArcTerra Consulting, Inc.
Dea L Duffcis G'
20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 d PH (907) 868-3791 • FAX (907) 868-3793
Septic Tank .Advisory
Certificate of On -Site Systems Approval #OSC 201344
Subdivision: Drake Block 2 lot 5B
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 26 years old. Typical replacement costs range from $8,000 to $11,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 201344
Subdivision: Drake Blk 2 Lot 5B
A water sample revealed a nitrate concentration of 13.3 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
0,070 2m' ggu
�� , Mailing Address P O £Box 196650 *Anchorage, Alaska 99519 6650 www muni org
•
r(.
•
•
Municipality of Anchorage
On-Site Water and Wastewater Program . Lin 11
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 017-461-12 Expiration Date: ' "f3
1. GENERAL INFORMATION
Complete legal description DRAKE BLOCK 2, LOT 5B
Location (site address) 3301 MERGANSER AVE,ANCHORAGE,AK 99516
Current Property owner(s) DONALD&CAROL DAHL Day phone
Mailing address 3301 MERGANSER AVE,ANCHORAGE, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
El Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well ® Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class _Well ❑ Public Sewer ❑
Public Water System ❑
WaiverNariance request for: Distance:
Received by: A/,/la i1 . 4L� Date: 0 3 i
COSA to be released to the engineer,unless oth, s •uested by the engineer.
COSA Fee $ 5-210 Waiver Fee $
Date of Payment 9/2-14 rg Date of Payment
Receipt Number CS 129-ip Receipt Number
COSA# 61Y /509 Waiver#
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,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD.,EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS -_ Date 9/17/2018
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING.SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with
• ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use,
local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the
system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the
. control of the.evaluator of the well and septic system Therefore, ArcTerra can not give any estimate of how long a system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen \Nak
encroachments,deficiencies or discrepancies exist. i- OL'
Air
14<
SN" tyl
6. DSD SIGNATURE / ✓ Til /\
System #1 Approved for bedrooms. - IIII /�t
Y pP s.:. KENNETH M. -Sr /
System #2 Approved for bedrooms. ``>.. ? Bei
Disapproved. X b
411P-
Conditional approval for _ bedrooms, with the following stipulations:
\G\Qp,�CI Y OF AC'
�O
°N-StxE
C3 WATER AT_VVAisrsivND
171
PRO
oo GR4-M-.Q40 -=
By:
Original Certificate Date: /0—S—/
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist#
Structure served by this system ,
Certificate of On-Site Systems Approval Checklist
Legal Description: DRAKE BLOCK 2, LOT 5B Parcel ID: 017-46142
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 1994 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y
Total depth 76 ft. Cased to 76 ft. Casing height (above ground) 12 in.
FROM WELL LOG AT INSPECTION
Date of test 8/30/1994 9/5/2018
Static water level 30 ft. 39 ft.
Well production 10 g.p.m. 5.6 g.p.m.
WATER SAMPLE RESULTS: Z p.
Coliform NEG colonies/100 mL Nitrate J• l mg/L
Arsenic: _ ND ug/L Date of sample: 9/13/2018 Collected by: ARCTERRA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC I STEEL Date installed 7/8/1994
Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 9/5/2018 Pumper A+
C. ABSORPTION FIELD DATA
Date installed 7/8/1994 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type SHALLOW TRENCH
Length 77 ft. Width 5 ft. Gravel below pipe 1.5 _ft.
Total depth 7+ft. (Measured 9/5/2018) Eff. absorption area 385 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 9/5/2018 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 650 gal. New depth 6 in.
Elapsed Time: 1140 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum _--_ Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+_ _ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 100'+
Animal containment areas 50'+ _ Manure/animal excrete storage areas 100'+__
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots _100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation _ 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ _
Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date. -""\>„-- OF j
Air
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r
Engineer's Printed Name KENNETH M.DUFFUS /�Q c�
Date 911712018 4 9
COSA canary sheet_2-6-15.doc /�
^rn KENNETH M. Di,F' : /
71 16 .E•�./
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r s• E. �o�a�.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 1• '"�. 907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC181509
Subdivision: Drake, Block: 2, Lot: 5B
A water sample revealed a nitrate concentration of 13.9 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org
I
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*a 49,........",._yri..• -
Oc. • MICHAEL J. HORNE g) /
•• s'� No. S-5318 .•4,4. .
44 'OrEssla•IN` •4. �
LEGEND:
A; : ° 3NTCInc .
' UTILITY POLE- (71.3
WELL-
LAND SURVEYING * MAPPING * PLANNING SURVEY CERTIFICATION:SENTEC Inc.has conducted
2102 CLEVELAND AVE. TEL.#(907)243-9966 a physical survey of this property as shown on this drawing SEPTIC VENTS- 0
ANCHORAGE,AK 99517 FAX. #(907)243-9967 and that the improvements situated thereon are within the DECK- t_
property lines and no encroachments exist other than noted.
ASBUILT OF: LEGAL DESCRIPTION:
LOT 5B,BLOCK 2 EXCLUSION NOTES:It is the owners responsibility
DRAKE SUBDIVISION to determine the existence of any easements,
covenants,or restrictions which do not appear on the
WORK ORDER NUMBER: DAZE: SCALE: E-MAIL: recorded subdivision plat.NOTE:Under no
July 24. 2001 1"=40' sentec@gci.net circumstances should any data hereon be used for the
n1 — 0 9 8 DRAWN BY:CHECKED BY.GRID NUMBER: BOOK/PAGE:
VTD MJH 2834 — construction or for the establishing of property lines.
DATE
ICefty Ord-ling, Inc.
345-0593
P.O. Box 112130 Email: heftydrilling@aol.com
Anchorage, AK 99511 www.heftydrilling.com
Customer JobSite
3301 � {�G�, 5
WELL DEPTH SWL PITLESS DEPTH PUMP DEPTH
(TY. DESCRIPTION UNIT PJRICE AMOUNT)
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(Labor Hours Rate Amount Total Material:
Total Labor:
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Received By TOTAL `
1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERV!CE$
: DiVision ~of Environmental Services
· ' ~" .... ~ ' '" On-Site Se~ices Section
P,O, Box 1~0 Anchorage, Alaska 9951~0
Parcel I.D. #
: CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. ::GENERAL INFORMATION
- ~;~i Complete legal description z. o 7'
· _ :!%~.:.: . .
...... ::'r;:' LoCatio h' (site ada ress o r d i rect io ns)
Day phone
NUMBER OF BEDROOMS: " :' ' :5 ; ,.....
X.,*.~~.~ ~,~,~,..~ .........
, , !~r, ', ::~: 3.':.~;:..TY PE OF..WATERsUI~pLY..,,~.;
":::::;-~'~;::.::,r'..::':::.:..-: .'.::: Individual well -
STATEMENT OF INSPECTION BY ENGINEER :'.~i',
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigati°n 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 inves.t~ation 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 T ~- c _7/./C Phone 3 3.~ 'g (~ <~ '.!
Address 7~;O /
Engineer,s sig nature
........ DI-IHS SIGNATURE "
Conditional approval for
Date
Additional Comments Note. The ~e'll ~or th~.s 'property meets '"exzst~.na
State and Municipal Codes. There are nitrates, present. It is
.'d that a
.,,,.,~.~.~/,~ suita] . Nitrate concentration is 7.13 mg/1. EPA
Date
'of Anchorage Department of Health and Human se~tce~''' (D~i~i$) issues Haslth'Auih~3ritY
based only upon the representations given in paragraph 5 above by an independent
] istered in the State of Alaska, The DHHS does th!a as a courtesy to purchasers of homes
ng institutions in order t° setisfy certain federal and state re~j~n~h~s:'Employees of DHH$ do not
or analyze data before, a certificate, issued, Municipality of is not
"i~isSi0ns in'the'
Municipality of Anchorage ~i~
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: J-' -~ /~ ~-/~ ~ ~,/~4- Pamel I.D.
A. Well Data
Well type
Log present (Y/N)
~ ~ / V ~ i-~ If A, B, or C, attach ADEC letter. ADEC water system number
~//~ o / ~ "/ Driller j~/~
Date
~mpleted
~ ~? Cased to ~ ~ ~ Casing height
Total depth ~
Sanitary seal (Y/N)
~ Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot / / ..~ "*
Absorption field on lot
Public sewer main --
Sewer service line
g.p.m. ~~
Z
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~ ~:~ - Nitrate
Date of sample: / ~/~ ~5/~ '~
'~, / ~ Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed '?/
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Tank size ? ~o ~ ~
Foundation cleanout (Y/N)
~ ~ ~- Compartments ~
~ Depression (Y/N)
Alarm tested (Y/N)
Pumper -' ~ ,~ ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
?
Well(s) on lot /) ! .~ On adjacent lots / ~/0 Foundation
To property line ,~ ~ Absorption field ? o Water main/service line
Sudace water/drainage ~"~ ~> o ~ ?~1 ~ ~ $ T" ~_- % ~
72-028 (3/g3)' Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed ---
Manufacturer
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed .'7//~'//~ ~
Length 7 2 / Width
Total absorption area ~ ~ ~;
Date of adequacy test ~ ~
Water level in absorption field before test -
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF) /,
Gravel thickness
Cleanout present (Y/N)
.i~) Results (pass/fail)
System type
Total depth
Depression over field (Y/N)
for
Aftertest
If yes. give date
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ? /
To building foundation
On adjacent lots
Surface water -
Curtain drain ~
On adjacent lots / ~-/ ~ Property line
To existing or abandoned system on lot -
Cutbank - ~ ~ Water main/service line
Driveway, parking/vehicle storage area A ?
t
E. ENGINEER'S CERTIFICATION
I cerb'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effe~..~?_t~q[te~ of this inspect'on.
Signature /~/~/~ ~.~~~. ~
Engine,s N~e /~ ~ ~_ ~ -~/~ ~4 I~_
Date /~ / ~ /,/~ ~ -~l~;% CE · 7892 ..~
H~ Fee $ ~ . ~ Waiver Fee $
Date of Payme. [O~ ~/~ ~ Date of Payme.
Recei. Num~r ~ ~ ~C ~ ~ Recei~ Num~r
/
72-026 (3/g3)* Back