HomeMy WebLinkAboutCONIFER HEIGHTS BLK 1 LT 11
Municipality of Anchorage Page
· DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O, Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ..~6~_) c~'7~)0~i PID Number: ~/~-Oc~ ~'~
Name: ~A~ ~Om~5 Wastewater System: ~ New ~Upgrade
Address: ABSORPTION FIELD
'Ph°ne: ~U~-JS~5 No. of Bedrooms:5 ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION so,,~,,g: j.~ ~sq.~.
~ Subdiv~ion: Depth t~ pipe bott~ from original grade: Gravel depth ~e?h pipe
Township: I Range: I Section: Fill added above original grade: Gravel length:
~ ~- ~ ~. j I Ft. Ft.
WELL: ~.=ANew ~ Up~ Gravel width: ~ , Number of lines: J Distance between lines:
Ft. / Ft.
Classification (Private, A,B,C): ~~ Cased To: Total absorption a~ Pipe material:
Driller: / Date Drilled: Static Water Level: Ins~: Date installed:
~t. ~ ~. ~-d-~7
I..m.S.,.,: J Casing Height Above Ground: TANK
': GPM Ft. Ft.
SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P.
From Tank Field Station Tank Sewer Lines
Surface t~
Water J00 JO01~ ~ ~ LIFT STATION
Lot JOl~ ]0~ Size in gallons: IManufacturer'.
Line ~ ~
Foundation ~/~ JO~ ~ -- -- "~u~. on" ,~v~, ~~, ~t: J Hig~ water ~,~r~ at:
CunainDrain ~--~O~1~ ~ ~o~. ~ Pummel J Electrical Inspections performed by:
~ Remarks: BENCH MARK
~ Location and Description:
J As~u~
Elevation:
~ ~"
~5~ -;-... ~¢.~,
Inspections performed by:s ~, s ~c~.:~.~" ~ Q~s: 1st~'~'w' ~~
~ Eagle Rive~, Alaska ~ ~' ~' ~ ~ I~ ~ ...~'
J Department of Heal~ and Human Services approval
Reviewed and approved by: Date: 7-/7- F 7
,
72~013 (Rev. 9/91) MOA 25
PERMIT NO. SW970061 PAGE 2 OF 2
PlunlcipaLity oF AnchoPa9e
DEPARTHENT OF HEALTH AND HUMAN SERVOCES
ENVIRONMENTAL SERVICES DOVlSION
p,FI, Box 1966500 Anchorage, ALasko 99519-6650 O TeLephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 11, BLOCK 1, CONIFER HEIGHTS S/D P.I.D. NO. 015--093--47
\\ INSTALLED
DIVERTER VALVE (¥D)-
\
MT ~
10' UTILITY EASEMENT
38' PATENT RESERVE
NEW TRENCH
NEW 1500 GAL.
SEPTIC TANK
EXISTING
TRENCHES
ST1 / 64.0'
ST2/ 64.5'
DBL1/ 64.5'
DBL2I 64.5'
FD J 64.5'
/ -
MT1 / -
c02/ 89.0'
MT2/ 84.0'
B C
7.5' 23.0'
30.5' `32.0'
,39.0' -
41.0' -
41.5' -
42.0' -
,35.5' 44.5'
,37.5' 44.0'
84.5' -
76.5'
ST 1 ST2
94 O' ~
N.T,S.
\
\ &
\
\
GRADE
\
\
\
MT CO CO1 = 99.3'
,~CO1 = 93.7'
C02 = 93.6'
MT1 = 88.6
MT2 = 88.5'
·
NO WATER FOUND
81.5' B.0.H.
LOT 1 1
SCALE 1" = 40'
EN£
PAGE 1 OF
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW970061
DESIGN ENGINEER:S & S ENGINEERING
OWNER NA_ME:HOTES RICHARD WILLING
OWNER ADDRESS:7765 PORT ORFORD DR
ANCHORAGE, ALASKA 99516
PARCEL ID:01509347
LEGAL DESCRIPTION:
CONIFER HEIGHTS BLK
1 LT 11
DATE ISSUED: 4/15/97
EXPIRATION DATE: 4/15/98
LOT SIZE: 40887 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 ~ND 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 BY: j~~
DATE:
DATE:
ROBERT C. COWAN, RE.
ROBERT A. SHAFER, RE.
March 27, 1997
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 11, Block 1, Conifer Heights Subdivision
Request you issue a permit to upgrade the septic system
serving the five bedroom house on the referenced property.
A test hole was excavated and a percolation test performed.
The approximate location of the test hole is located on the
attached site plan.
The monitoring tube within the test hole has been checked
and found to be dry.
We do not anticipate any adverse effects on neighboring
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/mg
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
60' SITE-PLAN DESIGN
~0x
~/ _~ / / / /~~ I
._~ ~ ~x, / / / ~ ~ i ~
~ m I ~
/
~=~ / k / ~ /~ ~__~ ~~
~ ~ ' ~ ~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRiPTiON: J-O 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
s
IF YES, AT WHAT ~
o
DEPTH? p
E
Depth lo Water After ~/~, y
Monitoring? Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
3',,~(,, i '",,,, ~" /"
3' ~7 " ~" "
:.z 3¥ ,,- ~=,. -
3;,¢o ,, c~?,.~ ,,
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN -~ FT AND ~:~ FT
$ & S ENGINEERING "-'~//('~7~'~' --
PERFORMED BY; 17G$4. F. agjU ~,Jvur Lo~p ~oa~ No. 2~ I CERTIFY THA~THIS ~ST WAS PERFORMED IN
ACCORDANCE W~g~b~AL GUIDELINES IN EFFECT ON THiS DATE. DATE: 3/~ ~ / ~ 7
72-008 (Rev. 4/85)
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, P.E.
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
REFERENCE: Lot 11, Block 1, Conifer Heights Subdivision
March 27, 1997
GENERALs
1.
The scope of this project includes the installation of
a 1500 gallon septic tank and a leachfield trench to
serve the five bedroom residence located on
the referenced property.
Construction shall be in accordance with the approved
site plan and design drawings, Municipal permit with
any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal
Regulations.
The contractor shall be responsible for obtaining any
necessary underground utility locates.
Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
subsequently depressed from soil settling.
Contractors installing wastewater disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
Ail standpipes on the septic tank shall extend a
minimum of 12 inches above final grade.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
Page Two
Lot 11, Block 1, Conifer Heights Subdivision
March 27, 1997
Septic tanks installed with less than 4 ft. of cover shall
be insulated.
A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the tank
and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed
soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed-up) before
gravel (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
®
A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on
the design.
Page Three
Lot 11, Block 1, Conifer Heights Subdivision
March 2'?~ 1997
Se
Backfill over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent
the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Type of Pipe
Perforated Solid
Cast Iron
ASTM D3034 (PVC)
ASTM F810 (HDPE)
ASTM D2662 (ABS)
Yes Yes
Yes Yes
Yes No
Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
e
Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N,
or equal) must be installed between the final leachfield
gravel layer and the native soil backfill.
Ail leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the %200 sieve.
When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements, which ever requirement applies.
Page Four
Lot 11, Block 1, Conifer Heights Subdivision
March 27~ 1997
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
me
The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic tank
may be set in place, but may not be backfilled before
this inspection.
The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
®
The final inspection is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and in accordance
with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S
Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
Page Five
Lot 11, Block 1, Conifer Heights Subdivision
March 27, 1997
S & S Engineering shall have no liability to the owner or to
others for acts or omissions of the contractor or any other
persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR/INSTALLER
Rick Mystrom,
Mayor
Municip of Anch6rage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
June 18, 1997
Robert C. Cowan, P.E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 11 Block 1 Conifer Heights Subdivision
Waiver Request #WR970027, PID #015-093-47, SW970061
Dear Mr. Cowan:
Your request for a waiver of the required 10 foot separation
between an on-site wastewater disposal system and a lot line has
been approved. The waived distance is 1 foot from the existing
trench to the west property line.
This approval applies to the existing on-site wastewater disposal
system lot line separation only. Any future upgrade to the on-site
wastewater disposal system will require all separations be met or
another approval from this department.
If there any further questions or concerns regarding this waiver,
please call our office at 343-4744.
Sincerely,
Daniel J. Roth
On-site Services
ljw #7
Hotes
0F ANcHoRAG~:
Waiver Review Worksheet
WR9 WR970027 . PtD~ O15-093-47 HA#- Permi~
Date ' Received: -4-!-97 '
Le
Engmneer.
' ' a · Richard H0tes
Apptl¢ nt.
Waiver Req%
Criteria: 1. Geology: Points:
A. Water Table
B. Soil -Sorption ' ,
D. Water Table Gradient
E. Horizontal Separati.on
2. sPecial Conditions:
'List
Date:
Rec 9: 02807/6347 Amount: $ t15.00 Date Paid:
ROBERT C. COWAN, P.E.
ROBERT A. SHAFER, P.E.
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
March 28, 1997
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
RECEIVED
Anchorage, AK 99519
REFERENCE: Lot 11; Block 1; Conifer Heights
Request you issue a Conditional Health Authority Approval on the
refercnced_propert~v due to winter conditions.
Upon completion of our site evaluation, we found the septic system
to be saturated. There is no eminent health hazard and there will
be no adverse effects as a result of granting the conditional approval.
The septic system will be upgraded no later than 15 June, 1997.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/gk
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL ,SERVICES DIVISION
APR 0 1 19B1
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
GREA.. R ANCHORAGE AREA BORL
Department of Environmem:al Quality
3330 C Street
Anchorage, Alaska gg§03
,GH
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE NUMBER OF
INSIDE WIDTH
INSIDE LENGTH
LIQUID DEPTH
LIQUID CAPACITY A~OGALLON$.
DISTANCE FROM WELL /~7~ / 7"-'-
FOUNDATION ~'_~
NUMBER OF LINES 2 DISTANCE BETWEEN LINES
ABSORPTION AREA 7~'---~Y SQ. FT.
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
NEAREST LOT LINE_ _~g.~ OF LINES
~' ~' / TRENCH WIDTH :~'~:~IN. TOTAL EFFECTIVE
LENGTH OF EACH LINE F,~, "/" 3/~/ DEPTH OF FILTER
MATERIAL BENEATH TILE (~..~u IN. ABOVE TILE ~ IN.
WELL:
CONSTRUCTION
DEPTH DISTANCE FROM:
BUILDING
FOUNDATION__
NEAREST
LOT LINE_
NEAREST SEPTIC SEEPAGE
, SEWER LINE , TANK SYSTEM
CESSPOOL
APPROVED
OTHER SOURCES
DISAPPROVED
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE: Z
REMARKS:
DIAGRAM OF SYSTEM
DATE/t/-//,~d:;:_ 7~APPROVED ~
G.A.A.B. ~
Form EQ-032
lEE tt::;;~::
":~h;p::~-... 4. ~
'i'HE Diiiil:::"T't'"! O1::: t:::1 "Ir'F;i:EI",I(:::H Ol:;;: t:::':1:'[' :[:!ii; "f'HIE [::,:I;:~TT'F:It'.4E:IE !!ii:lE'T'14E.~liii3'.,! "!"l...fliii; :i!i;i...J!:;;:t:::'l:::l(ii:i!!il Ill)i:::' 'T'HE
(Zii J:;]: (:ii.. i i'.,li;::, i:::ll'.,lf:) "i" H tEE', O T T O r"l (3 t::: 'T' H E E ::.:: C I:::1',,,'t:::t "J" ]; O1'.,I ( :i: I'.,I FIE E'T' ::,.
'i"HE!:;;:iiL :i; :iil; NO :!i!;JiiTT' t.,.t :[ DTH F(.';d:;i: TREt'.,ICHE:!5.
i" H ii!i: (] {:;1: J:::i VEi .... D EiL J:::' T' I...! :1: :iii; T H lii!i H :1: I",I i!: H l..j H D Iii!: I:::"T' H O I:::' (3 I:;;: I:::1 ',,,' Jiii: L Jiii', !ii!: "J" J.,.~ J!ii; J!!!: I'.,t T H E O U "J' i:::' t:::l J... J .... J:;:' ]: J:::' l!ii
i:::il'.,iD 'Ti...iiE i!!!',O'l' 'T'()H OF THE E:::.::(}t:::IVI:.:I'T' ;1: O1'.,t ( :1: N I:::'IEET ).
2516E. iudorRoad
Anehorai~e, Alaska 99507
276-2221
,~()11,,% 1,()(; I'liI~()I,A'I'I()N 'I'J,:,~'l'
Pc rfo rllimd For
· . ..... Mr,. P~)~er. I~,. J~o_b.§gD_ .............. ;!,~ to Perforlu:.-j 8/~0/76
Legal Ue,scr~ pLi on: · a ................................
lhis ~orm reporu~, bolls Iog ~( __ Percolation ~est
De p t h
Feet
i- ----~~- ......
2 - a~ (ee~)
6 - ~ (~)
7 - ~ (~o)
~ - ~ (~o)
9 - s~ (~5o)
10 - s? (175)
11 - sP (175)
12 ~ (17~) Boulde~
13 -
14 -
Fi~ ~?°P0
Was ground water encountered? _~ ......... if yes, at w;~a~ depth?
........................ f ................ f ................. I ...................
· Proposed ins tal la't]~}-F~ '~9e Pi t Drain Fie Id
l)eptl~ of Inlet Dept[F~"b~'~t~'"b'F~'l)it or tre~,ci, ..........................
.,,
I'//
//
// /
12
Hidden Lake Area Reference Map-P12
160
167 ¥
172
161
..Veil Owner___
Location (address of:
M-~V DRILLING, Inc.
P. O. Box 4-1728 · 2811 Dawson
A C 90%279-1741
ANCHORAGE, ALASKA 99509
DRILLING LOG
_Roger Jacobson
Use of Well-- Dom
Toxvnship, Range, Section, if known; or distance main road
of casing 6
ic water level
Screen (
Lll, Blk 1, Conifer Heights, P7tP~lgO
Depth of Hole__426 feet Cased to 24~ feet
2~_0__ ft. (~t~) (below) land surface. Finish of well (check one)
); Perforated (
Describe screen or perforation
None
pumping test at_ 4-~ gallons per (~
of drawdown from static level.
of completion___12 lqar 74
open end (
x );
(minute) for 1 hours with 100~
WELL LOG
:~.~pth in feet from
c~x.~nfl surface Give details of formations penetrated, size of ma~terial, color and hardness
Loose Medium Gravel
Sand
Jagos M a __
_Sand - -
Loose Cobble Gravel ,'
Small Gravel: silty/sandy
" " with oaaal~'lon~l ~e~mm o~ m~dium
Silty Sand~ ceca.to, al ~mal l gravel
1 -- CUSTOMER
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 015-093-47
HAA# ~
1. GENERAL INFORMATION
Complete legal description
Lot 11: Block 1: Conifer Heights
Location (site address or directions)
7765 Port Orford
Anchorage, AK
Prope~9'6wrler. Richard Hotes
.? Mailing address :' ;9024 Vanquard
· g
? ~'Lendin agency
Mailing address :
~ Agent
'Address
Suite !01
Day phone
Anchorage, AK
Day phone
Day phone
344-1565
99507
J
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
XXX
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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.
S & $ ENGINEERING ~
Name of Firm ........ ,- p.!.::.- _.:_:- ,-,.-.~ -- ,ma Phone. ~ ' ~ ci 7
Address Eagle River, Alaska 99577
Engineer's signature /~v~--ft~/'~' Date
REQUEST YOU ISSUE A FULL HEALTH AUTHORITY APPROVAL.
CONDITIONAL H.A.A. DATED 3/28/97 HAS BEEN COMPLETED.
SYSTEM HAS BEEN UPGRADED IN ACCORDANCE WITH PERMIT
Si
DHHS SIGNATURE
X Approved for ~
Disapproved.
Conditional approval for
bedrooms.
ALL WORK REQUIRED ON THE
THE WASTEWATER DISPOSAL ,.:
SW 970061
cE-880]
- ---
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025(Rev. 1/91) Back MOA~,~I
Municipality of Anchorage DE
DEPARTMENT OFHEALTH & HUMAN SERVIO'~S C E IV E D
Environmental Services Division (90 1 J 3.147 97
825 L Street, Room 502 · Anchorage, Alaska 99501 ·
_ Municipality ct Ancl~orage
Health Authority Approval Checkli~pt. Health & Human Services
Legal Description:
A. WELL DATA
Parcel I.D.:
Ol ~--o'~ 3-¥ 7
Well type j9,~ ~ ,./4 )~ ~_ If A, B, or C, attach ADEC letter. ADEC water system number
Log present(~) ¥ ~-$ Date completed
I
Total depth ~ ;)'~ Cased to 2 ~4 g"
Sanitary seal {~YN) ~' ~-- ~'
Casing height (above ground)
Wires properly protected (~)/N)
Date of test
Static water level
Well production
FROM WELL LOG
3 /
!
g.p.m.
AT INSPECTION
/
1.1
g.p.m.
WATER SAMPLE RESULTS:
Coliform O Nitrate
Date of sample: ;~ //'t/¢~ '7
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed i~ / (-*/~) ? Tank size / ~"o 0
Foundabon cie ~//~-J e
';.' ' ~~N¢ D press,on (Y/~ ~ O
Date of ~P~*~/~ -~,.. ;~ Pumper .
C. ABSOhff~0~FIELD DATA"",.*~5
Datoqnst~lled ~ /` / ~ 7 .;-.~*,~ Soil rating ~or ff'/bdrm) )-
. / - .~
Length....'~ ~ ~,' Width '? ~ 6ravel thi~kn~88 belCw pipe
ENGINEERING
i~,~4 ~agle River Loop ROaCl No. 204
River, Alaska 99577
Number of Compartments ~ Cleanouts (~N) ¥,';_5-
High water alarm (Y~ ,~ o
System type 7',4'~~ c ~
,.5' Total depth ~' '/~- - / o ~
Effective absorption area ~o' ~-~ ~'; ~ Monitoring Tube present ~/N) Y~;-,~ Depression over field (Y~) /v 0
Date of adequacy test ~/~. _-/v~,~. Results (Pass/Fai~. ~..bedrooms
Fluid depth in absorption field before test (in.); ~ely after gal. water added (in.): _.
Fluid depth Absorption rate -- g.p.d.
Pero '~ment (past 12 months) (Y/N) If Yes, give date
72-026 (Rev. 3/96)*
D=
LIFT STATION
Date installed
Manhole/Access (WN)
High water alarm level at*
E. SEPARATION DISTANCES
Size in
..~~ "Pump off" level at*
F.
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM WELL ON LOT TO:
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
[ !
Foundation ~- -/- Property line [,- -t- Absorption field
t
Water main/service line / 0 -~- Su dace water/drainage /oo -.+- Wells on adjacent lots
/00
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line )o ~,- (,,~ ' _ w.,~ w?o~-~. ~Building foundation ~ o Water main/service line
Surface water - ) 9 a ~ Driveway, parking/vehicle storage area
Cu~ain drain ~ ~ ~ ~ ~ o ~ ~ Wells on adjacent lots
ENGINEER'S CERTIFICATION
I ce,i~ that l have determined thru field inspections and review of Municipal rec~~--~~ms
,nconformance ~5~72~ i2~ff[ct on this date.
Da,. 7 A~/e 7 V~
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, P.E.
July 16, 1997
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 11; Block 1; Conifer Heights
RECEIVED
JUL 17 1997
Municipality of Anchorage
Dept. Health & Human Services
A Conditional Health Authority Approval (HAA) was issued March 28,
1997 for the referenced property. All work required for the
Conditional HAA has been completed. The wastewater disposal system
has been upgraded in accordance with Permit #SW 970061.
Please issue a full Health Authority Approval at this time.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/gk
17034 NORTH F_AGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
;!i-::i: ';'? :[~'~'~) ,' DEPARTMENT OF HEALTH & HUMAN SERVICES--~:?~
;/;'' '.: - ~,"'/ ....Division bfEnvironmental Services '
~ ">' ':, :'. ~ '. "-. ~'.::'~r~:on;siteSe~ices section · ' ' "~'"
'.:LL,, ,_~ ;. · ~p:O. Bo~-.~6650 AnCh0~ag~,:Aiaska--.99519:6650
::":~ ~ 343-4744:'
CERTIFICATE OF HEALTH AUTHORITY
A~ROVAL FOR A SINGLE FAMILY DWELLING
p?te legal description "'~°~ ~; ~]ock ~; Oon~e~
(site address or directions)
......... Property owner
7765 Port Orford
Anchorage, AK
Richard Hotes ~. Day phone 344-1565
9024 vanquard suite 101 Anchoraqe, AK 99507
- Lending agency
.... :_.~ ...... Mailing addreSs
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual well
..TYPE OF WASTEWATER DISPOSAL:.
'" Individual on
commun
INSPECTION BY ENGINEER -.: ,.~:,~ ~r d
AScertified by mY seal affixed hereto and as of thevalidation 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 a'dequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anc.h.orage files and frOm mY.investigation and inspection, the on-site water
supply and/or wastewater disposal system' isin c0mPli'an~e 'With all MuniCipal and State codes,
ordinances, and regulations in effect on the date of this inspection. ? .: ~'
S & S ENGINEERING
Name of Firm
Address
Engineer's signature
17034 Eagle River Loop. Read
Eagle River, Alaska 99577
Date
REQUEST YOU ISSUE A CONDITIONAL HEALTH AUTHORITY A~PROVAL.
NO LATER THAN 15 June 1997.
6. DHHS SIGNATURE
Approved for
Disapproved.
bedrooms.
SYSTEM TO BE UPGRADED
× Conditional approval for 5
bedrooms, with the following stipulations:
Money shall be put in escrow to upgrade the wastewater disposal
system servinK this lot pursuant to Permit #SW970061 (attached).
Construction to be completed by notlAterr than June 15, 1997.
Additiona~ oomments Mo~ey in escrow shall not be released until this office
haS*given final approval.
Date. ~-- ! 7- ~' 7'
Back MOA
Of 'H~b'it*i~~ a~(d' ~Li'~a'n-se~ices (DH'HS) 'i~s~es Health Authority
the repres&htati°n~."{liven in Paragraphj 5?bpve by an independent
~f Alaska. The DHHS does this as a courtesy to purchasers of homes
~irem~nt~: Employees of DHHS do not
is not
Municipality-of'Anchorage ,~
Environrnentaj ~r{/jce~"Division ~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4~!~ 0 1 1997
Health Authority Approval Checklist RFCE IV£13
Legal Description: Z-(~7' II 8LK I C~4,.~ //~/4#~-J' Parcel I.D.: OI 5~ -09 ,~-~?
A. WELL DATA
Well type
Log present ~)/N)
Total depth ~ ~ (o '
Sanitary seal (~) 'Y
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~ /j ~ / 7 ~
!
Cased to "~ Lj ,.S'"' Casing height (above ground)
Wires properly protected (~/N)
Date of test
Static water level
Well production
FROM WELL LOG
AT INSPECTION
g.p.m.
WATER SAMPLE RESULTS:
Coliform (2 Nitrate (2 · I * Other bacteria.
Date of sample: - 3'~//0/~7 '
Collected by: *' :$& s ENGINEERING
B. ~HOLDING TANK DATA EaSe RIv~ N~ 995?7
Date installed ~/;~/~G Tanksize ~ 5-0 o Number of Compa~ments ~ Cleanouts~N)
Foundation cleanout (Y/N) Depression (Y~. ~ o High water alarm (Y/~
Date of Pumping ~/~/ ~ 7 Pumper ) ~cc ~
C. ABSORPTION FIELD DATA
Date installed II /I ~ / '7
'
Length ~t ~ ~ Width
Soil rating (g.p.d./fF or~~ ~5"o System type
Gravel thickness below pipe ~ Total depth
Effective absorption area '75-0 /~ ~' Monitoring Tube present {~/N) I ~ 2. Depression over field (Y~) __
Date of adequacy test '3 J / ~-/ol '7 Results (Pas~ ,~,f- ~/...'"~ For
.-i / .7~'
Fluid depth in absorption field before test (in.);
Fluid depth (ins) Minutes later:
72-026 (Rev. 3/g6)*
bedrooms
Immediately after 0 gaLwate~
Abanrp~ g.p.d.
If yes. give date
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Size in gallons
"Pump on" level at* ~at*
...._~'-
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
~[[~holding tank on lot J o o
Absorption field on lot
On adjacent lots
On adjacent lots
!
)06 ~
/oo ''~
Public sewer main ~//4 Public sewer manhole/cleanout
!
Sewer/septic service line '7 5- + Lift station
SEPARATION DISTANCES FRO~HOLDING TANK ON LOT TO:
Foundation ~- -/-- Property line ~ ''/- Absorption field
Water main/service line /O -+ Surface water/drainage ?oo ~ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
line I Building foundation ) 0 -/- Water main/service line ! 0 -j'
Property
Surface water / o o ~ Driveway, parking/vehicle storage area /o ~
Curtain drain ~ ~ ~ ~ ~o ~ ~ Wells on adjacent lots / ~ o ~
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal recorc
Signature -~ ~- ;~!
Engineer's Name ~:~13Z~,,¢ 7 ~- ~0~ ~'~
Date ~/~ ~/~ 7
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $ ~ //,,,~,- 0'~
Date of.Payment ~- t -~/7
Receipt Number
72-026 (Rev. 3/96)*
~t~. CT&E Environmental Services Inc.
CT&E Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
971370001
S & S Engineering
Lot 11 Blk 1 Conifer Hgts
Drinking Water
Drinking Water
Sample Remarks:
Sample collected by: Bob C.
Client PO#
Printed Date/Time 03/21/97 22:07
Collected Date/Time 03/19/97 16:00,
Received Date/Time 03/20/97 10:05
Technical Director: Stephen C. Ede
Parameter
Results
PQL Units Method
Allowable Prep Analysis
Limits Date Date Init
Nitrate-N
Total Coliform
0.100 u
0
0.100 mg/L SM18 4500-NO3F 10 max
col/lOOmL SM18 9222B
03/20/97 JBL
03/20/97 RAM
CT&E Environmental. Services Inc.
Drinking Water Analysis Report for Total Coliform Bacteria 200 w. Potter Dr~ve
Anchorage, AK 9951 8-1 605
READ [NSTRUCTIO:VS O:V REVERSES/DE BEFORE COLLECTI~VG SAMPLE Tel: (907) 562-2343
Fax: (907) 561-5301
tn PUBLIC WATER SYSTEM I.D. # I IIIlll
WAT . sYs-n ,
"~ Send Results ~ Send Invoice
Phone .Number l'~t ,~ u raber
C3 Send Results E3 Send Invoice
Month Da.,,' Year
SAMPLE TYPE:
~:~ Routine [] Treated Water
121 Repeat Sample (for routine sample ~ Untreated Water
with lab ref. no. )
a Special Purpose
Time Collected
SAMPLE LOCATION Collected By
Low It ~L~ I co~l~;L ~r~ 'U.'O~ P.~ ~U,-~ C.
Plca~ Pnnt
TO BE COMPLETED BY LABOP~ATORY
Analysis shows this Water SAMPLE to be:
V~-~ Satisfactory
a Unsatisfactory
Sample over 30 hours old, results may
be unreliable
a Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
3/~ o
Date Received
Time Received
Analysis Began
AnalvticalMethod:~ Membrane Filter
/el MMO-MUG
Number of colonies/100 mi.
Result'~
@7.~370
Anch Fhks
Analyst
.Jun
Date: Time:
Client notified of unsatisfactory results:
Phoned Spoke with
Date: Time:
I:axed
Faxed
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Result: Total Colifor.m
Membrane Filter: Direct Count~ ~''-~)'
Verification: LTB
Fecal Coliform Confirmation
BGB
E. Coil
Colonies/100 mi
COLIFIRM
Comments:
Final Membrane Filter R suits
ONE
Coliform/100 mi
~ ~ '.Ob hrs
Member of the SGS Group (Soci~t6 G6nbrale de Surveillance)
ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA, FLORIOA. ILLINOIS, MARYLAND. MICHIGAN, MISSOURI, NEW JERSEY, OHIO. wEST VIRGINIA
Time Time ~e
Date Date Data
Inspector Inspector Inspector
Comments ~1~~~ Conditional Approval
Date Sewer Installed ~_.f. ~,~_.~..~, ~--~ Permit No. Septic Tank Size
]//_ '~ ~:~ Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner Phone
Mailing Address
Address
~ t
.'~."~ Phone
Lending Institution .-%'¢ ~ ~ .~-,..~, 7'~/~"~-'~/
Address
Realty Co. & Agent ~ ~?,~'-~' ~'-~ ~' ,~'~' ~'~ Phone
Legal Description ~---~, // -.~ / ~,)-~.~ ¢~/'~ · ..
Street L°cati°n ~c~ ~___~~~...,.~ , "
Type.~pf Residence
~'~ Single Family
[] Multiple Family No. of Bedrooms
[] Other
Wet.e5 Supply
~ IndiVidual ATTACH WELL LOG. A well log is required for all wells drilled since June
[] Community 1975. For wells drilled prior to that date, give well depth (attach log if
[] pUblic Utility available.)
Sewage Disposal
~1~ Individual Year Individual Installed:
[] Public Utility When Connected to Public Utility:.
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANy EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
ALASKA E FIUIROFImI FITAL COFITROL SE RUIC $, IrlC.
I~n§in¢¢rinc1 I~ {~nuironmcntd Studies
6/7/82
RECEIVED
CURT CARLY
2702 GAMBEL
ANCHORAGE
AK 99503
SELLER - HERB ROSS BUYER-
SUBDIVISION-CONIFER HEIGHTS
BLOCK-1 LOT-11
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 750 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 1125 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 750 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
5 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON 6/7/82 .
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF
THIS 5 BEDROOM HOUSE.
1500
IS ADEQUATE FOR
1220 LUcst 25th Augnu¢ * Anchora§¢,/~laska 99503 · [907) 276-1361
~rmt
2702 Gambel 1
Anchorage, AK
99503
June 7, 1982
Subject: Lot 11 Block 1 Conifer tits.
Approval for the individual sewer and water facilities cannot
be granted until ~'%e following items have been completed:
Exposed electrical wires to the well head are in violation
of the [-iunicipality of Anchorage codes and must be encased
in conduit.
The water analysis report needs to be subraitted to this
office from the Chem Lab, 5633 B Street, for our review.
The septic tank pumped with a receipt submitted to this
Department.
An adequacy test needs to be performed on the existing
leaching area~. This test will determine if the system i~
adequate according to National Standards. A listing of
private firms performing the test is enclose~. .This report
needs to be submitted to this office for our review.
Please notify ~%is Department for a reinspection when the
note(] discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerels~
~',.i ~. .~ .A ~,ir/
RObert d' Pratt
A~sociate Environmental Specialist
Enclosure
.... /' {' "" ' ' / DATE/~ECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~uN~C~pALiT¥
825 L Street - Anchorage, Alaska 99501 DEPT. OF
ENVIRONMENTAL SANITATION DIVISION ENVI~o~'~AL
Telephone 264-4720 ~C)" ~
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER ~ILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed. Please allow ten (10) days for processing.
MAILING ADDRESS ~ '
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAI LING ADDRESS
3'. LENDING INSTITUTION
PHONE
MAILING ADDRESS
PHONE
MAILING ADDRESS
5. LEGAL DESCRIPT'ION
STREET LOC,~,TI ON
6. TYPE OF RESIDENCE
NUMBER OF~BEDROOMs
~ SINGLE FAMILY
[] MULTIPLE FAMILY
[] One [] Four
[] Two ~ Five
[] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to th~ d/~te, give well
depth (attach log if available.) t~--}~ '/~L_~ ·
8. SEWAGE DISPOSAL SYSTEM
~. INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
/
~:;25 "[_" STREET
ANCHORAGE, AIASI<A 99501
(907) 264-411!
(il ()titS[ M. StJt I
[.~1 i)ARTM, ENI C)[ IlEAl IH AN{) tN\,'lt~()F!~vif NI/;,I P~I(')TECTION
Buyer: Steve Nathanson
November 5, 1981
Paul Palmer
Star Route A Box 35-S
Anchorage, Alaska 99502
Subject: Lot 11 Block 1 Conifer Heights Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
(1)
The water analysis report needs to be submitted~to
this office from the Chem Lab, 5633 B Street,
for our review.
(2)
The septic tank pumped with a receipt submitted to
this office.
(3)
An adequacy test needs to be performed on the existing
leaching,area. This test will determine if the system
is adequate according to National Standards. A listing
of private firms performing the test is enclosed. This
report needs to be submitted to this office for our
review.
(4) Statement of 'date of occupancy of the residence.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Alaska Mutual Savings Bank
1503 West 31 Avenue 99503
i., ,- , , . SEP,q. 8 1978
' ~¢4~) ENVIRONMENTAL ENGINEERING DIVISION
~ Telephone 264-4720
' RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) davs for processing.
1. PROP~.,RTYOWNER , ~ I PHONE
MAILING AD~R E$8
PROPERTY RESIDENT(Ifdifferentfro ab e) ~ ' PHONE
2. BUYER PHONE
~AI~IN~
3 ~ENDINGINSTITUTION ~ n~ PHONE.
MAILING ADDRESS--
4. REALTOR/AGENT J PHONE'
I
MAI LING ADDRESS
I 5.
L'EGAL DESCRIPTION .
' YPE
· T OF E D
[] SINGLE FAMILY
[] MULTIPLE FAMILY
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
NUMBER OF BEDROOMS
[] One [] Four
[] Two [] Five
[] Three [] Six
[] Other
* ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells drilled p. rior to that date, give well
depth (atta~:h Icg if available.) 'q~
**If individual/on-site, give installation date //-- ! °~- /~(~
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED·
72-010(3~78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOI NTM ENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
NUMBER OF BEDROOMS
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] I NDIVI DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade
give dimensions:
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SlX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
[] OTHER
Septic/Holding Tank
IAbsorption Area
Sewer Line
INearest Lot Line
5. COMMENTS
~APPROVED FOR ...~'" BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
CHEMICAL
TEI_EPHONE (907) 279- 4014
Analysis(Facility)
Collected: 3-14-77
& IOLOGICAL LABORATC'" tS OF ALASKA, INC.
P.O. BOX 4- 1276 4649 BUSINESS PARK BLV[),
ANCHORAGE, ALASKA 99509
ANALYTICAL RECPORT
Roger Jacobson
Time Collected:
, .,/
By: Sonia Jacobson
> <f Sample:
Potable water; Lot ll, Block 1, Conifer Heights Subdivision
Observations, Remarks: Meets American Public Health Specifications for Human]____
Consumption
Copper
Chromium-Total
Chromium-Tri
Chromi um-Hex
Iron-Total
Iron-Dissolved
Lead
Magnesium
Manganese
............ _~_~/]_Mercury
Nickel
Potassium
Selenium
Sodium
............ n~xL/_l' S i 1 v e r
.......... __m.~g_/_l. Zi nc
[)~ 230 mmhos' Conductivity B] 67 mg/l_ Hardness as
CaCO3 .
[~ ..... ~.6 units pH B] llO mg/_/l_Alkalinity as
CaCO3
[] mq/1 Ammonia [] ..... _mgm_/1_Acidity-T as
NitrogenJN CaCO3
[] mg/]. Kjedahl [] .~mg/._l_ Acidity Free
Nitrogen-N as CaCO~
Col i for~-T
[] mg/1 Organic [] /lOOml
Nitrogen-N
[] mg/1 Nitrate(N) I~]__~l /].OOml Coliform-F
[] mg/1 Nitrite(N) [] /lOOml Strep-F
[] mg/1. Phosphorus []__
(Ortho)-P
[] m ~/_1_ Phosphorus []
(Total)-P
IX]_ ? ~ mg/1 Chloride []
[] mq/1 -F-luo~ide
[] mq/1 Cyani. de
[X] 20 mq/1 Sulfate
[] . mq/1 Phenol
[] mg/1. MBSA
[] mg/i BOD
[] mg/1 COD
~] 142 mg/1TD Solids
[] m~tZ]_TV Solids
[] mg/1 Suspended
Solids
[] m~/1SV Solids
[] JTU Turbidity
units Color
Transported by:
Received by;.
Transported by:
Received by:
FOR LAB USE ONLY
Lab# 5552
Rec'd by: Se
Date
Date
Date
Signed:
Date:
sample rec'd: 3-14-77
analysis completed: 3-1.5-77
results reported: 3-16-77
March 16, 1977