Loading...
HomeMy WebLinkAboutALPINE TERRACE BLK 2 LT 2ticx_JlL 11O tA - aq S.., C)c, bevelopment Services Department O Building Sa;"ety Divisicn , `+ on -Site Weer & Westewcter procrcn , .� 4700 Braccw Street = P.O. 6ax 196650 r--�1 •• Mark 8egich Anchorage. AK 99719-6650 Maycr --- n•Vnan^/nn�i�+ (9C7'j 343-7904 - Pump Installation Log Wen Drilline Per mit Number. SW_ Date of Issue: o parcel Identification Number:_ Legal Description pro er Name & Address: 7erre, ce pz L2 II` b lvebe5,�c� �i. pip Installation Date: G.S-p9 pump Intake Depth Below Top of Wen Casing: asi feet pump Maaufacturer's Name: pump Model: .S0r-'3/1CA6 1130 P=P Size I/� hP pitless Adapter Burial Depth: /47 feet Pitless Adapter hlanafacturer's Name: /FQ*x94, pitiess Adapr_r IBSmller: N1 Well Disinfected Upan Compledonn.($ Yes C Yo L\,hod of isi=ectign Comments: pump Installer Name; 'g;fsvx Attention: The pump k=ue: shall provide a pu=p i =Wlat:oa log to tw- DSD wits 30 days of pt --p ir:•tallatioa- 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: SW990201 PID Number: o1 5-243-06 _ Name: Richard C. Skvarch Wastewater System: 0 New XXUpgrade Y Address: P.O. Box 112022 Anch. , AK 99511 ABSORPTION FIELD Phone: 244-6758 No. of Bedrooms: Three ❑Deep Trench XXShallow Trench C3 Bed C3 Mound ❑Other LEGAL DESCRIPTION Soil Rating: 1 Total Depth from original grade: 4 5 ' ' .2 GPD/Sa. Ft. Lot: Block: Subdiv ion: 2 Alpine 'verrace Depth to pipe bottom from original grade: Gravel depth beneath pipe 2' 2 2.5' - 3.5' Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: .5' Ft. 70 Ft. EXl sting I n WELL: g Gravel width: 5' Number of lines: 1 Oistance between lines 1 - Ft. Ft. Classification (Private. A.B.C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. 500 So. Ft. ASTM D3034. PV Driller. Date Drilled: Static water Level: Installer: Acreage Systems Date installed: 7/19-20/99 Ft. Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES iXSeptic Existing Verified Sound To Septic Absorption Lift Holding Public/Private Manufacturer. Capacity in gallons: From Tank Field Station Tank Sewer Lines 65' > 10 0' 751 N/A N/A Material: Number of Compartments: Well Surface > 100' > 100' > 100 N/A N/A LIFT STATION Water Lot > 5 1 61 > 10 ' N / A N / A Size in gallons: Manufacturer: Existing Verified Sound Line > 5 ' > 10 ' > 10 ' N / A N / A Pump on" level at: "Pump off' level at: High water alarm at: Foundation Curtain Pump Make &Model Electrical Inspections performed by: Drain r7None on L t BENCH MARK Remarks: New Absorption Trench Placed Under This Permit. Existing Tank Location and Description: Bottom Sill Back Door. and Lift Station Placed in 1970. Assumed Elevation: Separation Distance From Well at 100.0 Ft ENGINEER'S SEAL t� That Time Was 50' T 'tl� ° Line From Lift Station and Absorption Trench n��tl 1# Insulated With 2" Direct Burial Insulation. 0 Inspections performed by: A. xaralaDates: 1 st 7 / 19 / 99 e °r.° °° • �4° � 2nd 7/20/99 °o •°�, o© ef9N P°. ape o Department of Health and Human Services approval 435114 • ° •® Reviewed and approved by: ux Date: 7'� 2' ! 09 •' • • • ° „�� r 72-011 iAev 9/911 `MOA 25 ig a Municipality of Anchorage Page 2 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-665.0 - 343-4744 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW990201 PID No. 015-243-06 PLAN AS -BUILT SCALE 1" = 40' U Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW990201 N W Ei PID No. 015-243-06 Inti r, E1 z 106.5 N U I �- r ..,: PROFILE AS -BUILT SCALE 1" = 10' MEMORANDUM DATE: July 22, 1999 TO: Jeff Poet y4Ea FROM: Mike Anderson, P.E. SUBJECT: Lot 2, Block 2, Alpine Terrace Subdivision Septic System As -Built Certificate of Health Authority Approval The design for the septic system upgrade for Lot 2, Block 2, Alpine Terrace Subdivision was based on a plot plan furnished by the owner of the property. Unfortunately, the house is not situated on the lot in the manner shown on the plot plan but is actually 15' to 20' further south. The as -built of the upgrade is shown in its actual location which is also 15' to 20' further south than shown on the design. The location of the testhole shown on the design is in near proximity to the existing absorption crib. It is shown at the same proximity to the crib on the as -built. The location of the new absorption trench did not change from the design site plan to the as -built site plan. The house location was moved 15' to 20' further south to its actual location on the lot. Both the existing septic tank and the lift station were uncovered and inspected and verified for continued use. The baffle in the septic tank was corroded and was replaced. The line to the existing absorption crib was left in service. A ball valve and valve box was placed near the pit to activate the line at a future date. All effluent currently flows to the new absorption trench. The absorption trench was increased in length by 15' due to the quality of the soils encountered during construction. The majority of the trench is in the same layer found in the testhole, but not to the consistency expected during design. The trench should be much more effective in its final configuration. Rick Mystrom. Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us Anderson Engineering ATTN: Michael E. Anderson, PE PO Box 240773 Anchorage, AK 99524-0000 July 22, 1999 Subject: Waiver Request for ALPINE TERRACE BLK 2 LT 2 Waiver # WR990045 Lot Line Request for Parcel ID 015-243-06 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the lot line has been approved. The approved separation distance is 6 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Qr� Jeff Poet Engineering Technician III On -Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human 'Services On-site Services Section Waiver Review Worksheet PID# 015-243-06 HA# Permit # SW990201 Date Received: July 22, 1999 Legal Description: Lot 2 Block 2 Alpine Terrace Engineer: Michael E Anderson, PE PO Box 240773, Anchorage, Alaska 99524 Applicant: Richard C Skvarch Waiver Requested: Lot line Waiver of 6' to the sourth property line Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: By: Name of Reviewer Rec #: 05092/6939 Amount: $ 115.00 Date Paid: July 22, 1999 July 21, 1999 RFCFI Municipality of Anchorage VFI Department of Heath & Human Services Jud 2 825 "L" Street pep ;p�l`I 2 7999 Anchorage, AK 99502-0650 yea�th 0U.'% /JC S"e9e Subject: Lot 2, Block 2, Alpine Terrace erv'ces Separation Distance Waiver Absorption Trench to Lot Line Dear On Site Services Engineer: The absorption trench on Lot 2, Block 2, Alpine Terrace Subdivision was constructed within 6' of the south lot line to remain outside the 100' protective well radius. Soils in this area were the most effective on the lot for the absorption of septic effluent and no other area was available which was outside the radius and more than 100' from surface water to the east. We are therefore requesting a waiver be issued allowing the placement of the trench in its present location 6' from the lot line. The new trench is more than 100' from wells to the south or on adjacent lots. It is also more than 50' from the septic system to the south and does not conflict with any easements. We therefore recommend that a waiver be issued allowing the trench to be located 6' from the south property line. Sincerely, Michael E. Anderson, P.E. MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 16, 1999 Expiration Date: Jul 15, 2000 Permit Number: SW990201 Parcel ID: 015-243-06 Legal Description: ALPINE TERRACE BLK 2 LT 2 Design Engineer: 0014 Anderson Engineering Site Address: 011866 NEBESNA DR Owner Name: Richard C Skvarch Lot Size: 51900 SQ. FT. Owner Address: PO BOX 112022 Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE, AK 99511-0000 This permit is for the construction of: 0 Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. If the tank needs to be replaced, DHHS shall be informed of the location of the new lift station. Received By: Issued By: e Date: ° 1'( 2 92 Date: 7_116 99 July 11, 1999 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 2, Block 2, Alpine Terrace Subdivision Septic System Design Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption crib on Lot 2, Block 2, Alpine Terrace Subdivision has failed and must be replaced. We are therefore requesting a permit be issued to construct a new absorption trench on the lot to serve the home. Records indicate the existing system was constructed in 1970. Both the septic tank and the lift station fall within the protective 100' well radius. Since the construction was prior to 1973 they have grandfather rights in their present location. We intend to verify the integrity of both the septic tank and lift station. If they are found suitable for continued use they will remain in their present location. If they have corroded and are leaking a new 1,250 gallon STEP tank will be placed outside the well radius. The attached site plan and backup documentation describe the proposed location for the new absorption trench. It also shows the location of the existing well and absorption crib. The testholes placed on the lot revealed well graded gravel with a percolation rate of 1 minutes per inch to 6' below the surface. Silty sand was then found to extend to the bottom of the testhole at 13'. This material percolates at 40 minutes per inch. We are therefore proposing to construct a 5' wide shallow absorption trench with 2' of gravel beneath the distribution line. The pipe will be placed at 2' below the surface. Total depth of the system will be 4'. The existing distribution line from the lift station will be matched in size and type with hole sizes and spacing to be determined once the lift station has been tested for continued use. Lot 2, Block 2, Alpine July 11, 1999 Page Two Terrace Subdivision The ground surface of the lot has very little slope in any direction with the maximum being approximately 1%. The new trench will be constructed a minimum of 10' from the existing crib. The crib will be pumped, crushed, backfilled and abandoned once the new trench has been put in service. If the system is constructed as designed the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern w i I I be maintained. Sincerely, ,A� E OtA-� Michael E. Anderson, P.E. Attachments Existing Sep is Tank & Lif S ati Three Bedro Existing Home/ Well Exist Crib Tt2 55' LONG 2' EFFEC ABSORPT ALL WELLS IN THE AREA ARE MORE THAN 100' FROM THE PROPOSED UPGRADE if f TE: Verify Suitabilityof Existing Septic Tank � T°° and Lift Station or Continued Use. Replace if Necessary. A! MW , o' Pump, Crush and Backfill Existing Absorption Crib. a c o ?oa 0000c�' ( R, n a Tn u Sin, < SITE PLAN SCALE 1" 40' 5' WIDE X E DEPTH TRENCH i� I ;w 01 1 .. Exist Crib Tt2 55' LONG 2' EFFEC ABSORPT ALL WELLS IN THE AREA ARE MORE THAN 100' FROM THE PROPOSED UPGRADE if f TE: Verify Suitabilityof Existing Septic Tank � T°° and Lift Station or Continued Use. Replace if Necessary. A! MW , o' Pump, Crush and Backfill Existing Absorption Crib. a c o ?oa 0000c�' ( R, n a Tn u Sin, < SITE PLAN SCALE 1" 40' 5' WIDE X E DEPTH TRENCH LOT 2, BLOCK 2, ALPINE TERRACE DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom Home 5' Wide Trench System Perc. Rate: 1 Min./Inch Exist. Septic Tank/Lift Station Application Rate: 1.2 GPD/SF 2' Drainfield Rock Pressure Distribution 3 Bedrooms X 150 GPD / 1.2 GPD/SF = 3755 SF of Absorption Area 375 SF/5 LF (Width) X .7 (Red. Factor) = 52.5 LF Trench Length Therefore: Construct a 5' Wide By 55' Long Absorption Trench System With One Lateral As Shown on the Site Plan with 2' of Drainfield Rock Beneath the Lateral. Distribution Pipe in Trench Placed at 2.0' Below Original Ground Surface. Mound Over Trench to Provide Cover and Positive Drainage Away From Area. Natural Backfill Mound to Provide Minimum 3' Cover Over Pipe.,.,., 1 1611 eotextile Fabri ll C:6 Intercept Existing Pressure 2' Line and Match Size and Type .std Drainfield Rock diw TYPICAL WIDE TRENCH SECTIO OW; o / (NO SCALE) n NOTE: Grade Area Over Trench to Drain Away. iKM, Minimum 3' of Cover over Septic System. r Minimum 10' Separation From Lot Line. Minimum 4' Separation From Groundwater. yLL�'°x�.°�Lw�a®°� dolow y.: 0 P_RFORm=0 FOR: Municipality of Anchorage DEPART MENT Of HEALTH & HUMAN SERVICES E25 -L7 Street, Anchorage, Alaska 99502-DE50 SOILS LOG — PERCOLATION TEST a49 o` �� o p�Ypyg�µ• r' y.. ,lpe gee enb A 01 DAT E P=_RFOit�i LEGAL DESCRIPTION:Lot 2, Block 2, Alpine Terrace SLOPE SITE PLAN I -M 0L D=Th to Water I Net DreC '• I — I 2" I — i i I !Ni l 3v ' 1" I I I 1 30 2 I I i I I i TESTHOLE NO. 1 I I I I I I I i AJ fir' S� i I I I I I I I I I I � I I I I I I i I �•'' I I I I , 7 8 '��:' I I I I I I I I I A I• Ii WAS GROUND WATER i-------- 70 , L ENCOUNTERED? I I I S I I i I 11 a M o r= IF YES. AT WHAT /� ! O I I I 1 + I I I DOTH? _ P 12 E Tcs-rta-o t..e- 13 14 15 16 17 78 19 DepimW= off Reading Date G! T ime Nm I Time D=Th to Water I Net DreC t►tJ I 73 1 /D: 30 I — I 2" I — I nv l 3v 1 23 1" 1 30 I .7 I I i I I i P-=RCpLAT10N RAT=_ � (minuusutch) PsAC KOLE DtAM=TER _ TEST RUN BETWEEN 1 AND s FT COMMENTS Perc. Cavity presoaked prior to testing. PE RFORMED BY: /' I ER FY TKAT THIS TEST WAS PERFORMED 1 Michael E. Anderson /x 1, ACCORDANC_ WITH ALL S -,AT- AND MUNICIPAL GUID=.LIN=S IN EFFFC i ON 7HIS DATE. DA7j = Muni.;ipai-qty of AnChonge • DEPARTMENT OF HEALTH S HUMAN SERVICES E25 "L" Street, Anchorage, AlasKa °O 02-DE50 SOILS LOG — PERCOLATION TEST AOR /01 et �+®� • ems: d �� DATB P_R PERFORMED FOR LEGAL DESCRIPTION; Lot 2, Block 2 Alpine Terrace SLOPE SITE PLAN D E P-li_ OL i 3_ I 16 17 18 19 TESTHOLE NO. 2 GW SM Bottom of Testhole WAS GROUNDWATER No ENcouNTER=D? __ IF YES. AT WHAT N/A D I—"-}—=- DEPTH? —_ P E gym W= Ate 1Ap? Reading I Dm Gross T,me Nei Time Death to Water I N- Droa 4 Z, I l /1 u> I I DQr I 5" 1 if I ( i1 2G I I 6av i I ,h Z-7 I 1 Z,, i 20 J PERCOLATION RAT: t�L (mmw rch) PERC HO's DIAMETER _ TEST RUN BE i V6 --=N 7 F-1 AND 1 F7 COMMENTS Perc. Cavity presoaked prior to testing. PERFORMED BY: AM* 1 � FY THAT THIS TEST WAS PERFORMED Michael E. Anderson i�lG 99 ACCORDANCE WITH AL S-,;,-, =- AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DAT; 1 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 2, BLOCK 2, ALPINE TERRACE SUBDIVISION GENERAL: 1. The scope of this project includes the exposing and verification for continued use of the exisitng 1,000 gallon septic tank and lift station. It also includes the construction of a new 55' long x 5' wide x 2' effective depth absorption trench at the location shown on the attached Site Plan. Total depth of the trench is 4' with the distribution pipe placed at 2' below the surface. Mounding will be required over the trench to provide a minimum cover of 3'. If the septic tank or lift station are found unsuitable for continued use a new combination 1,250 gallon STEP tank will be required for placement outside the 100' protective well radius. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining a I I underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. Lot 2, Block 2, Alpine Terrace July 11, 1999 Page 2 SEPTIC TANK AND LIFT STATION INSTALLATION 1. The exisitng 1,000 gallon septic tank and lift station are to be reused if found in suitable condition. If not anew 1,250 gallon STEP tank must be procured from an approved source and installed outside the 100' protective well radius. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. Lot 2, Block 2, Alpine Terrace July 11, 1999 Page 3 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. insulation shall beat least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Lot 2, Block 2, Alpine Terrace July 11, 1999 Page 4 5. A permeable geotextile be installed between native soil layer. fabric (Typar, Mirafi or equal) must the final drain rock layer and the 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be i n place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. GAAB-HD-I GV VER ANCHORAGE AREA BOROV TH HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILIN �7 NAME /j45Z4—/ �i _ - ADDRESS./.''� ��,, PHONE_— LOCAT I© e1 �w E G A L DESCRIPTIO SEPTIC TANK: / OF DISTANCE l DISTANCE FROM WELL 7 '� MATERIAL /� �' NUMPARTMEN (e ^�D LIQUID LIQUID CAPACITY GALLONS. INSIDE LENGTH INSIDE WIDTH ////// DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS O LININ(b MATERI NEAREST LOT LINE OR WIDTH WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) , LENGTH , BUILDING FO , DEPTH , SQ. FT. TILE DRAIN FIELD: r l / TOTAL LENGTH//;2 DISTANCE FROM WELL FOUNDATION '?D4 NEAREST LOT LINE OF LINES- NUMBER INE NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINA O� I DEPTH: TOP OF TILE TO FINISH GRADE -DEPTH OF FILTER MATERIAL BENEATH TILE; IN. ABOVE TILE W ELL:� 1 DISTANCE FROM / WATER TYPEIJWIG44 `" , DEPTH -,BUILDING FgUNDATION. 6 t SAMPLE U, NEAREST LOT LINE d SEWERSLINE Z-19 �, TANKC j SYS EM—, ESSPOO ��' OURC GRE ..'ER ANCHORAGE AREA BOI,JUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. -- 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279.8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME OF APPLICANT dC" - MAILING ADDRESS , ` �X .�D - 3yg O, PHONE INSTALLATION LOCATION LEGAL DESCRIPTION �i A?4/0- INSTALLATION OF; SEPTIC TANK ' SEEPAGE PIT DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED������/�6LE FINANCED THROUGH TO BE INSTALLED BY Zt/ SOIL TEST RESULTS -� PES/iO/20®/J') �iieo%%�% N TEs THIS PERMIT 1S NOT VALID WITHOUT SOIL TEST SOT �L BGea COMPLETION DATE ANTICIPATED FINAL INSPECTIONS 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE v' ^ TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PITS DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK, SEEPAGE PIT / DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT /D DRAIN FIELD SEPTIC TANK, SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO ANO OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 9 FEET INTO UNDISTURBED SOIL 4 INCH DIAMETER CAST IRON SIPHON PtPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. ' GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH AUTHORITY OR LICENSED DESIGNER I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE -7^ /,3— 7. P,, APOLICANT'S SIGNATURE I'Li ^ 2 ty �ji(.4.1 DIAGRAM OF SYSTEM P AP 3 5 P. 0 TUDOR R(,AtT.! ANCHORAGE, ALASKA 99502 Performed For Ve 11 n _L a" -,Date Performed 7 15-72 Leaal Oescrintion: L o t — Z_Plock. 2- _Subdivision___A'p� ._' n T. rrace This Form Renorts Soils Loq_ Percolation Test Oenth Feet Soil Charactori-,tics I — p'_'+ (c> - 1'r') 031� 3— n- — A- !3 0. C_' r � OCL -7) cw S 'S (7- q"-) Gnu- S 1' ­JA -- Was Ground Water Encountered? 7 0 4 If Yes, At what Denth? Obs e rv,.d over 71f JofbK M, I GAAB-14D-2 GREATEF kNCHORAGE AREA " 9ROUGH Case No. HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska .99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT 2.2 )i# MAILING ADDRESS ' PHONE NE N0. RESIDENCE ADDRESS d �^'' LOCATION OF INSTALLATION LEGAL DESCRIPTION— APPLICATION ESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE PIT , DRAIN FIELD � , OTHER TO SERVE THE FOLLOWING FACILITY - Epe/?? /- FINANCED THROUGH �- TO BE INSTALLED BY PERCOLATION TEST RESULT ANTICIPATED DATE OF COMPLETION Dieu M sot t Tess- aN BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS N I iZ V 1 5 , PERMIT TO INSTALL A �_Ir AS DESCRIBED BELOW. SIZE OF UN TTO B SERVED SEPTIC TANK SIZE 000 TYPE Cpr�P.vr SEEPAGE AREAL a�fl TYPE .�S�a,Iw�.,rG' DISTANCES: C �P--M GK 'iLL- nn EALTH AUTHORITY OR LICENSED DESIGNER I certify that I am familiar with the requiremen above described system i in accordance with said DATE APPLI 2 DIAGRAM OF SYSTEM /i A) "".A, v C Greater Anchorage Area Borough Ordinance No. 28-68 and that the code. rf , CANTS SIGNATURE �� D P%�RT ���.i`j i!f f.�`i�; I�t i1(`� i ASE 3500 TUDOR. ROAD ANCHORAGE, ALASKA 99502 Performed For )z E it AL--kJ__S-C-A_ Date Performed Legal Descri nti on : Lot 1Z BI ock. 2 Subdivision A -,p; - Tkr-re«_.__ i This Form Renorts Soils Log )C Percolation Denth Feet I Soil Characteristics Gross Time I— Net Time ilenth to H2O I Net Dron; -- - --- -- ---- - - - _ XR j o n0'. 5 �v Sow+e �ar�e S4v-,v+ks *Cse,%j M 6 .� 7 0 S(k%*%4 10 Coa,rs a era h— 447 Ground Water Encountered?__Y-e-s If Yes, At what Dernth?/E)1/Z T • d 4s0416%1c I Reading Date Gross Time I— Net Time ilenth to H2O I Net Dron; -- - --- -- ---- - - - _ j j o i • d 4s0416%1c Percolation Rate Prorrosed Instal1ati n r-) P -it Depth of Inlet Denth To Borten; i t 0r .0 -Tench . COMMENTS ; Test Performed Reading Date Gross Time I— Net Time ilenth to H2O I Net Dron; -- - --- -- ---- - - - _ - - ---- — a — -.---------_ ------ j Percolation Rate Prorrosed Instal1ati n r-) P -it Depth of Inlet Denth To Borten; i t 0r .0 -Tench . COMMENTS ; Test Performed October 19, 1972 Mr. James Curley Executive Vice President Alaska Mutual Savings Bank 5th and "F" Street Anchorage, Alaska 99501 Subject: Lift Station and On Lot 2, Block Dear Mr. Curley: Seepage Pit For A Private Residency 2, Alpine Terrace Subdivision The Greater Anchorage Area Borough, Department of Environmental Quality today received the as -built engineering plans for the subject improvements to this property. After review of this facility with the engineer who designed and oversaw the con- struction of it, we are in agreement that this facility will function satisfactorily provided it is given proper maintenance until public sewer becomes available. Our approval, of course, does not guarantee the operation of the lift station or the possibility that the seepage pit may fail sometime in the future. Our approval, however, does guarantee that with proper maintenance the sewer system will not cause problems by discharging sewage to the surfacig of the ground or contaminating wells in the immediate area. Sincerely, Rolf Strickland, R.S. Chief Sanitarian bb cc: Mr. Warren Culver August 16, 1912 Mr. Larry Mathis 645 "G" Street Anchorage, Alaska Subject: Lot 2, Block 2, Alpine Terrace Subdivision Dear Mr. Mathis: I have reviewed the plans for the sewage lift station for the subject property and have no disagreement with the construction standards. The seepage pit size will have to be based on a soils test, however, and the distance between the seepage pit and the existing underground drain should be increased. This distance would be relative to a soils analysis. Please contact us after the soil test has been taken to determine the seepage pit size and the proper distance between the seepage pit and underground drain. Your "as-builts" will serve as the final inspection on the system. If you have any questions regarding the above information, please contact the undersigned. Sincerely, John R. Lee, R.S. Environmental Services Supervisor July 26, 1972 Mr. Vernon nisch P.O. Box 4-2093 Anchorage, Alaska 99501 subject: Single family residence on Lot 2, clock 2, Alpine Terrace. Dear Mr. Risch. This letter is in regard to the recent difficulty you gave experienced with repair to the on-site sewer system on the subject lot. Uur discussion revealed that recently the system failed and was In need of repair. Field inspections made bY this department and a soils test perforNed by Mr. Tom Sexton indicaW that uoder the present conditions it is not possible to repair tht cxsirtin; septic tank -drain field system and he in compliance with borough ordinances. Accordinsly, the permit issued to you On July 13, 1972 was changed to shuw the installation of a sewaye holding tdnk. Under the conditions where an on-site systew cannot be 4dequately repairea and if repaired, will lead to early failure again or, contawination of the water table, a sewage holding tank is approved. We sympathize with you in this position but one of our responsibili- ties is to prevent contamination of ground water and sewage discharge to the grouni surface. We must advise you that this sewer holiIng tank is to be installed ionediately to prevent a serious health hazard of raw sewage being exposed to the people in the area. July Z6, 1972 Page 2 Mr, Vernon Risch We are holuin,,t your pem-At for this installation anwill expect to hear froi.,, you within one week to cof.iplete toc final inspection. sincerely, Aolf Strickland, k.S. Assistant Director rib CC,. Mr. John Lee Mr. "arren Gal ver PAN ARCHITECTURAL, CIVIL, ELECTRICAL, MECHANICAL, & STRUCTURAL ENGINEERING AMERICAN 645 "G" STREET, SUITE 201 ANCHORAGE, ALASKA 99501 Mr. John R. Lee, R.S. Department of Environmental Quality 3330 C Street Anchorage, Alaska Dear Mr. Lee: CONSULTING ENGINEERS October 18, 1972 Attached please find Sheet 1, "Lift Stat&on & Seepage Pit, Residence, Lot 2, Block 2, Alpine Terrace" which reflects the As Built condition of the disposal system. At the present time, the system is operating satisfactorily. Sincerely yours, /(2 L. 0. Mathis, P.E. Pan American Consulting Engineers k; C14.eUF-8- 01% ; 12 , Revolutionary Fiberglass -a Sump Basins 4 The easy way to installump pumps and sewage pumps. One man can install it -A ' in two sizes for single or duplex pump syste4 Row you can get both pump and fiberglass sump from one sopp ier, Penberthy. • Lightweight, any to handle • Low cost • Incredibly durable • Exceptionally strong • Highest quality • Immediately available e Fits all popular sump pumps VENT 1 3 V 1 lex y 5 t 6" 1 D. HUS INLET INLET r ' 4" DIA MIN ,, FE { 1. X� is 4a , MATERIALS r Basin - Fiberglass reinforced plastic ' Hubs — Cut iron Carer .- Hot rolled steel. Equipped with cord grommet, tubber 4 ; ' lid gasket; and gastight flanged 2" or 3" discharge opening and 2" vent opening. e b /-✓ v /" Est. Basin Size Discharge Siie . shipping Weight *Part No, 18" x 3C" (singlenump,,two hubs) 2" dia 60 125981120 18" x 3Q". (single pump, two hubs) 3" die 60 1259g-030 30" x 3"u" (double pump, two h*) 2" dia 125 .. 12 ao 30';,� 30" (double pump, two hubs) 3" dia 115 120190,10 i' .�u.swrrl it �Irru.r��iri .r�krr_�r� �rlrt�r %) fi 'NQTE:'does not Includepump(s) f� ► Penberthy division, HeuSipe Industries, lnr', Prophetstown, Illinois 61277 '. .� J,.-...�+4f .. r .. - - 5�+,,vT�lIIlro4fMY'•••.•.^•Rr^Y!T'NYIa'tr ! JMf 1 3 V 1 lex y Ot,l��-� F�PPr.u�c, �.oc(a���zti.��TyPf C 7:-1NcxV6 SP — Sg.m, Nq)-,C. OSEW E2 Sy5'C6v✓�� RF'Q��RGt) Rf3sbRPT,D�J t-OVATIO-J, NO i i t A ry Tb 0/5,r :+ t A : : Municipality of Anchorage Development Services Department ' Building Safety Division On -Site Water 8 Wastewater Program ' • ' 4700 South S P.O. Box 196650 Anchorage, L AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-243-06 HAA#off/• 1 6 1. GENERAL INFORMATION Expiration Date: _7— •% $ — o Complete legal description ALPINE TERRACE SUBDMSION• LOT 2 BLOCK 2 Location (site address or directions) 11860 NABESNA DRNE 0 ANCHORAGE AK 99516 Current Property cwner(s) • LENARD & SONJA CULSTROM Day phone 348-7897 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 11860 NABESNA DRIVE * ANCHORAGE AK 99516 Unless otherwise requested, HAA will be held by DSD forpickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Day phone Day phone ' TYPE OF WASTEWATER DISPOSAL: Individual Well X Individual On-site e 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 tho State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (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 engineers work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality ofAnchorago tiles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with 8/1 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS. INC. Address 6901 DEBARR ROAD. SUITE 29 • ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, AKW WC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of Me system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKW WC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for Me sole benefit of the ownerfisted above. Any reliance upon or use of this report by any other person orparty Is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE tllGN Approved for bedrooms. Disapproved. Phone 337-6179 Date Akf 14,/16 Conditional approval for bedrooms, with the flowing stipulations: Attachments: HAA Checklist L/ Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other a A� WATERAND ; r^: MIASTEWqER- PROGRAM i�O��VT SEN�S` By: It-), e Original Certificate Date: ' 4 C702 3 (Rw. IZ91) Municipality of Anchorage Development Services Department • Building Safety Division 0(, On -Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ALPINE TERRACE SUBDIVISION; LOT 2, BLOCK 2 Parcel ID: 015-243-06 A. WELL DATA Well type PRIVATE if A, B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed 1970 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth 92+ ft. Cased to 40+ ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 3/21/2003 Static water level 1 ft. 41 ft• Well production g.p.m. 1.86 g•p•m, WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate D•1 mg./L. Other bacteria _0 colonies/100 mi. Arsenic: N A mg./L. Date of sample: 3/25/2003 Collected by: AKWWC, INC. B. SEPTIC/HOLDING TANK DATA *FOUNDATION CLEANOUT INSIDE HOUSE Tank Type/Material CONCRETE Date installed 9/1/1970 Tank size 1000 gal. Number of Compartments 1 Cleanouts (Y/N) YES l Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) NO I , Date of pumping 3/18/2003 Pumper A+ HOME SERVICES f I i C. ABSORPTION FIELD DATA013ELOW EXISTING CRAOE Date installed _7/19-20/1999 Soil rating .p.d./t r 0bdrm) 1_2 System type TRENCH i Length 70 ft. Width 5 ft. Gravel below pipe 2 ft. Total depth 05.67 ft. Eff. absorption area 500 W Monitoring tube YES ' Depression over field NO Date of adequacy test 3/21/2003 Results (Pass/Fail) PASS For 3 bedrooms I Fluid depth in absorption field before test 18 in. Water added 610 gal. New depth"25.5in. Elapsed Time: 970 I p min. Final fluid depth 20 in. Absorption rate >= 450+ g.p•d• Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - •00.5 INCH BELOW INVERT OF DISTRIBUTION LINE D. LIFT STATION Date installed "10/1972 Size in gallons 30 Manhole/Access (Y/N) YES "Pump on" level at* -18 in. "Pump off" level at*'15 in. High water alarm level at i`24 in. Datum BOTTOM OF TANK Cycles tested 3 Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES *PER PREVIOUS 1994 do 1999 HAA SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot **650+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service tine 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line***B' Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS **INSTALLED PRIOR TO OCTOBER 1973 ***SEE WAIVER #WR990045 IJA G. ENGINEER'S CERTIFICATION%•.'•% ••., �Op 1 certify that I 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. • • , • • • • • • • .. • • •. . y A. Ga ss: v Engineer's Printed Yame JEFFREY A. GARNESS �Q49 7953 Date HAA Fee $ 375• Waiver Fee $ Date of Payment .4-15-03 Date of Payment Receipt NumberJ�J�,—L— Receipt Number (Rev. 12/01) FROM : WHY USA SOOUET REALTY FAX NO. 907 563 6202 Apr. 04 2003 01:37PM P2 ..ray,, .. i y Q. \ :. c\ T"� I' ► Sir er , c9�• �yr4' .�,,' t• 5 = OF AC .'� 4 ` art✓Y ivy (� / 649TH •.:. � `, . 3 . ��x da ,� p a' :,� : l�.e Karl Dowllnp . ---. ti.::.•: .r:. AlB9'Saoo•w..4- `0000 I SIONA=r`' •,( 5'. r.It u Na tespomlbl0 at the owner to dcicmline dm :ezistetiee or my to 'iImts, covenants o. resvlcdons pua n the raeorded sued vaion plat Nmri "Undnorcorireumionor.forshould any dauh'ercoabe /� (7�r7'j'�'" - tued for eotiThe sur or. for estier responsi boundary a 11—�11S U 1L OFRLCORD, O (NL•R THAN THOSC . farce lines Tnc s wcyor uties rcsponsibiliu for the SHOWN ON M. RECORDED PLAT. ARL• NOT. .. anitW immudon only. . . StIOWN HGREON. - LOT _BLOCK 2. m DRASS CAP MONUMENT. ANCHORAGE RECORDING DIST Cr (PLAT NO.: `� 0• IRON rim 0 RFBAtt CORNER FOUND 13 HUB AND TACK ' PREPARED BY: DOWLING & ASSOCIATES 1126 Hyder. Street. Anchorage, Alaska 99501 REVISIONSDATE DA'f ^ r _ BY SCALE • WORK ORDER FIELD BOOK: GR1D 140„`_-'- .. MUNICIPALITY OF ANCHORAGE AAL • DEPARTMENT OF HEALTH & HUMAN SERVICES AM 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. # 015-243-06 HAA # 14 1. GENERAL INFORMATION Complete legal description Lot 2, Block 2, Alpine Terrace Subdivision Location (site address or directions) 11860 Nebesna Drive Property owner Richard C_ Skvarch . Day phone 244-6758 Mailing address P.O. Box 112022 Anchorage, AK 99511 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Three (3 ) 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx 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 021 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. Name of Firm Anderson Engineering Phone 522-7773 Address 2.0— Engineer's - o - -- Engineer's signature 6. DHHS SIGNATURE Approved for 1._Ctf� bedrooms. Disapproved. Conditional approval for Date 7/21/99 bedrooms, with the following stipulations: Additional Comments By: /��= / �. Date aUTW The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M (Rev. 1/91) Beek MOA k21 0- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIC t CCI `' c Environmental Services Division IRt C D V C t! 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907 343-4_744 �UL 2Z 1999 Health Authority Approval CheckllsWunicipality of Anchorage Oept. Health & Human Services Legal Description: Lot 2. Block 2, Alpine Terrac&arcei I.D.: 015-243-06 A. WELL DATA Well type Private 1f A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) N Date completed 1970 Total -depth >1251 Cased to >4o, Casing height (above ground) 21 " Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test 6/30/99 Static water level 42.5 Well production g.p.m. 1 .52 g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate h S2 mg f r. Other bacteria 0 Date of sample 7/16/99 - Collected by: MPA 13 SEPTIC/HOLDING TANK DATA Date installed - 9 / 7 0 Tank size 1 f n o o Number of Compartments 1 Cleanouts (Y/N)_ y__ Foundation cleanout (Y/N) N Depression (Y/N) N High water alarm (Y/N) N Date of Pumping 7 / 20 / 99 Pumper Isaac's C. ABSORPTION FIELD DATA Date Installed 7 12 0 -21 / 99 _ Soil rating (g.p.d./ft2 or it2/bdrm) 1 2 System type s w; r3p Trench Length 70' Width 5' Gravel thickness below pipe 2 Total depth a 5 1 Effective absorption area 5:00 SF Monitoring Tube present (Y/N) Y Depression over field (Y/N) N Date of adequacy test New Const.. Results (Pass/Fail) Pass For Three bedrooms Fluid depth 1n absorption (field before test (in.); - Immediately after gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = a.p.d. Peroxide treatment (past 12 months) (Y/N) ry If yes, give date N/ A 72-026 (Rev. 3/96)" D. LIFT STATION Date installed 10/77 Size in gallons ?n Gallons Manhole/Access (Y/N) Y "Pump on" level at' 18 "Pump off" level at* 15" High water alarm level at* 6" *Datum Bottom of Tank Cycles tested Several E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 6 s, ** On adjacent lots 00, Absorption field on lot >100, On adjacent lots >100' Public sewer main NSA Public sewer manhole/cleanout N/A Sewer /septic service line >251 Lift station 71; 1 ** Separation Distances to Well and Lift Station Met Criteria at Time SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: of Installation. Foundation >51 Property line >5, Absorption field > s Water main/service line _L2 Surface water/drainage > 100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 6' * Building foundation 510, Water main/service line ),-)51 Surface water >1001 Driveway, parking/vehicle storage area > 4 0 ' Curtain drain None Noted on Lot Wells on adjacent lots > 1 oo' * See Lot Line Waiver F ENGINEER'S CERTIFICATION 1 certify that / have determined thru field inspections and review of Municipal r t ltJ4 systems are in conformance with MOA HAA guidelines in effect on this date. low Signature. Engineer's Name Michael E. Anderson. P.E. Date ?/Z x HAA Fee $ Zr' n . rr) Date of Payment Receipt Number nti�CtQ 74Z Z 72-026 (Rev. 3/96)* Waiver Fee $. Date of Payment Receipt Number n OL JUL-20-99 15:22 FROM -CTE ENVIRONMENTAL 5615301 T-027 P.02/03 F-673 AkCT&F Environmental Services Inc. �rwriwrrrrrr�rwiiwr� CT&E Ref.# Client Name Ptwject Name/# Client Sample in Matrix Ordered By PWSID 993463001 Anderson Enginccnag Lot 2 Block 2, Alpme Tc race Lot 2 Block 2, Alpine Terrace Drinking Water 0 Client POn printed Date/Tithe 07/20/99 14:23 Collected Date/Time 07/16/99 14:00 Received Date/Time 07/16/99 15:10 Technical Director: Stephen C. Ede Released By AIIowW a Prep Analysis Parameter Results PQL units Method Limits Oete Date lnit Total Coliform 0 col/100mL SN18 92228 07/16/99 GCP Nitrate -N 0.652 0.500 m9/L EPA 300.0 10 max 07/19/99 07/16/99 SCS Received Time Ju1,20, 2:23PM 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 — aq'3-Oh HAA # UA 94o 6q-( 1. GENERAL INFORMATION Complete legal description �.ai 2 6//r 2 ,9-/n��¢ T-rr-«c c Location (site address or directions) 116610 NQ.; es.,ce- Sl-. Property owner kee. SA#r 1.fy Ora kc -6 er Day phone 3 YS- -Y,:510& Mailing address —_T30 7 Slgeo7aroC Ted �y� chor 4e Ak 99S03 Lending agency (f I`'tor'�!4122i, Day phone Mailing address Zr W. F1 reaieecC Xa'oe A/1e"40r 14-4< 99�GJ' Agent Diu/! 6691 .zrlakc pay phone 2 ?G-' 1033 Address SSS W Alee fi ern llw4lr 011noe Unless otherwise requested, HAA will be held for pickup 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well . Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm EIcu F% Teti 4' "` S'er"` "s Phone AS Address /tilS 3 �c do -S1� 4-1 c -4o A t -r 996 /� Date 199 y Engineer's signature 1�1 U� 2 /, ,* •4 9-- • 0000 09 6 DHHS SIGNATURE Aj f ME CE- 3589 cR�"�At .,rAr ODO Approved for bedrooms. o Disapproved. ,:►�,.' Conditional approval for bedrooms, with the following stipulations: Additional Comments Date By: CAUTION 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 a 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 ono • con uct';inspect�ons or analyze data before a certificate is issued The Murncipal�ty of Anchorage is not Aconal engineer's work xr r responsible for errors or omissions in the profess Y ,� � tf -., S� a­_p °+.y%�F. r [A "T h . ,�� y r'�•,.'�ms °� "+ �; t 1 {'^ s r�"`rr�'F' „.(�`` e� " 1161 � •t'Y 72-05 (� tea - - .,ate .{.'zad:...`r:..`"•., . ,... ...,i,.,,.vx,.. - . Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo f-2; !3/k 2�A1,12me Tcrrac� Parcel LD. A. Well Data Well type Pri iva Ve— if A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) N Date completed 1970 Driller (�(n Gcnacvr� Total depth I es, Cased to > yo, Casing height 21" Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y 1 mg / -e Other bacteria 4ao a Cegcr f r-( Date of sample: 10/2,7/9f, )i//7/9y FROM WELL LOG AT INSPECTION S c r of test I a / 27 19'1 m xz DDate Static water level 27 Z Well flow g.p.m. g.p.m. .._ N m a Pump levels les, M N � v_G SEPARATION DISTANCES FROM WELL TO: ti c 0 Septic/holding tank on lot G 7' 4V C. G. ; On adjacent lots 5 100 ' z Absorption field on lot 106, �v c.a. ; On adjacent lots > 16,0 ' Public sewer main N. A. Public sewer manhole/cleanout N. A. Sewer service line > ZS' Petroleum tank Noe e- See,-) Ceea.rafwn Glvlance waf le qa/ of fir+P of ins%t/�cfir<ran WATER SAMPLE RESULTS: �' Coliform 0 car / 10 G m Nitrate O. 1 mg / -e Other bacteria 4ao a Cegcr f r-( Date of sample: 10/2,7/9f, )i//7/9y Collected by: plo T-ecA S c B. SEPTIC/HOLDING TANK DATA Date installed 9/70 Tank size 1000 qcc r Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) N Depression (Y/N) N High water alarm (Y/N) N.A. Alarm tested (Y/N) r\I. A. Date of pumping P / Z C' 9 Y Pumper RGA - Roo AGS' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 6*"7' --rem Co, On adjacent lots > 1G0' Foundation � 5'' To property line > / o ` Absorption field 98' fv co, Water main/service line Zs Surface water/drainage No* 72.026 (3W)• Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed I o / 7 2 Manufacturer Pen ber- fA Size in gallons 30 Manhole/Access (Y/N) Y Vent (Y/N) Y "Pump on" level at 16 to "Pump off" Level at Is--, High water alarm level + 6' I + Cycles tested Mei Meets MOA electrical codes (Y/N) /Q�ryveel at tiro e of orT*^u 1 i^r11* 11M1i&1. SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot * `'7S l On adjacent lots > 100' Surface water iE Sepor«noo 'olilJ*nce ex ov le 41 of f►me clFr /nSki//af7r» D. ABSORPTION FIELD DATA V Date installed to / 7 Z Soil rating (GPD/Ft2) 65 Q' �l3Gfvr+ System type Se�p�c P�f Length 11' Width III Gravel thickness 6 Total depth Total absorption area 2 6 `/ g' Cleanout present (Y/N) Y D Depression over field (Y/N) N Date of adequacy test I o / Z7 / 91 Results (pass/fail) Pa.(.( for 3 Bedrooms Water level in absorption field before test 29" After test sy " Peroxide treatment (past 12 months) (Y/N) Na A e- known o .� If yes, give date /V. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 10 &' S�rvn' C. a. On adjacent lots > 16, 0 Property line > 1U' To building foundation SH' _To existing or abandoned system on lot On adjacent lots > 30' Cutbank N. A Water main/service line > Zr' Surface water > too' Driveway, parking/vehicle storage area > 5-0 ' Curtain drain Npli e s e Ph E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on tt it specti /�,w TI!!!ill0lr r!!r1!!!• il1�tC 6� Signature Th eo orra �^G:'::'��►+�::*:r*�:'�'�:«*+**r•i�t�rlrr�ua�. Engineers Name F. MGG re o'tH�t7Di;7,� . M00R� ;J f rZ •�,,, r 54. o C -35u� , Date Iq Z! 199y 4s �'•rar.r<�• �s4 HAA Fee $ 300 Date of Payment ReceiptNumber 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number Commercial Testing & Engineering Co. L IL Environmental Laboratory Services SINCE 1908 CT&E Ref.# 94.5527-1 LABORATORY ANALYSIS REPORT Client Sample ID L2,BLK2, ALPINE TERRACE, EAST HOSE BIB Matrix WATER Client Name FLATTOP TECHNICAL SRV WORK Order 10454 Allowable Ext. Ordered By TED MOORE Printed Date 10/31/94 @ 13:33 hrs. Project Name Collected Date 10/27/94 @ 02:30 hrs. Project# Received Date 10/27/94 @ 13:00 hrs. PWSID UA Technical Director STEPHEN C. EDE Released By�..,,� Sample Remarks: SAMPLE COLLECTED BY: T F MOORE QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init -------------------------------------------------------------------------------------------------------------------- Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 10/28/94 MICE * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed ALT = Undetected, Reported value is the practical quantification limit. LT = Less Than Err ;:�,D = Secondary dilution. GT = Greater Than ri 5633 B Street, Anchorage, AK 99618-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA