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Home My WebLink AboutALPINE TERRACE BLK 4 LT 1 Municipality of Anchorage Development Services Department Building Safety Division On.Site Water and Wastewater Program. 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page www.ci.anchorage.ak, us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ,, -.~ ~Y.x' O "5~O clc~ NATi- "PAu L- I Number of Bedrooms' LEGAL DESCRIPTION Lot RanGe Section. Well: [] New [] Upgrade C~a$ $,f, ca',,o~ (Private, A. 8, C) kTotal Depth: J Cased Io' I o....e, .,.f.,.D ' ' io ""1 ate Drilled. Slah¢ Water Level: Y'e'd '~" I Pun"pSelat I Cas,n~ He,obi A~ove C,,ou~d. GPM FI. FI. SEPARATION DISTANCES Lift Station Holding Tank Seotic Absorption Tank Field ilo PublicJPrivate Sewer Line PIDNumber:, Ol~- ~--q3- WastewaterSystem: [] New [] Upgrade ABSORPTION FIELD of [] Deep Trench [] Shaf~ Trench 1"3 Bed Fill added above o¢ig,nal g~ade' Gravel w,~dth i Number of Fines TANK I[~eptic [] Holding [] S.T.E.P. A-wc H TA N~-. Material: LIFT STATION •Other: Caoacdy I. ASO a' II~umber Of Cl~..can'~e'~Is Size J Manufacturer 'Pump On' level at.. I 'Pump off' level al i H,g'-t wa!e, alarm a! Pump Make g Model I Electrical InsDechons pedormed by BENCH MARK Location and Inspections performed by:. 2nd Developme_n[ ~e.~es Department Approval Reviewed and approved by: ~3 BE 71 49i;h TOn SPURKLAND No. C£-~e5 50 75 SCALD I' = 58 FI'. BDICX MMCK: ~I~GE SlAB A$$tlJ~D ELEVATIOX. 100.00 rOBBER SPURK/_AND P.E. 203 Pt' 15TH. AVENUE ANCH. AK. 99501 LOT 1 BLOCK 4 ALPINE TERRACEV[ 11945 CIRCLE SEPTIC SYSTEM AS BULT DATE: JULY 13, £003 SHEET: 2/3 GRID: PERMIT II $1d030099 PIB # 015-£43-15 AL TO4OI£.BVD MUniciPality of Anchorage Development Services Department " Build ing Safety Division on'Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 - www. ci.anchorage.ak.us (907) 343,7904 ON-SITE SEWER/VVELL SUBMITTAL COMMENT SHEET To: tobb:en 'SPurkland Legal deS(~ription: alpine terrace' bl6ck 4 lot t The attach~l.., ~, paperwork, has. 'bee'n. reviewed,, and is being returned for the following reasons: J'-J rig!ri, al signature or stamp missing on ['-I Calculation error in design, ,. r-'-I;Ad'(~i~i~al soils information ~needed. : ' r-] Water monitoring results inadequate.~, Lhscrep~ancy in information submitted; ' :'i'oj~bg'r~'phic information missing or Inadequate Inc?mplete; missing -. ~: , ,. , ' Incomplete; missing ,* !:'i 'i !, ' r, : ~ 4 I' J'-J Addl~io~lal adequacy test mformahon needed. Water,,sample unacceptable.' '" · ' !;I ~J' .'! , : '' Mea'sufed/proposed distances/dimenSions missing. 'i;t i·ll' : · · , i :o: i. I ; · LoCati?ns~ , of all sods, percolabon and water momtonng' ' ' "':tests ''' ' not shown. , reposed,,. ~ r' ,system too deep, for,, soils, information submitted". Well !(Jg required.' ', .'! ,~! i . r, .,. LJmlSSlOn In narrative.: = ' : ,.t~,1 ~.rl~, . Insufficient fill over tank or field, i [~ 0th'[Lr i'!i"~ii!':"" '.;: '~ed~!,~ !!,:.: to fill. in the. sepa!atJ~n.:: , ':i distances'on, as-built,. Name of reviewer: ioe_~oodall, · 'Date: 4/7~2004 P/ease supply the necessary information and re-submit your request. ii'.:, ,ji '~. LEAVE·THIS FORM ATTACHED ~ ~r,O... ;THE PAPERWORK j:, ,* ,,: ; MUNICIPALITY OF ANCHORA GE Development Services Department On-Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Apr 28, 2003 Expiration Date: Apr 27, 2004 Permit Number: SW030099 Legal Descri~3tion'~AI"P. INEi,TERRA'CEBLK _-41LT.~I' Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Matt Pauli Owner Address: 11945 CIRCLE DRIVE ANCHORAGE, AK 99507-0000 Parcel ID: 015-243-15 Site Address: 011945 CIRCLE DR Lot Size: 42863 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: E~ Disposal Field [~] Septic Tank [] Holding Tank E~ 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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. Issued By: _ _ _ . . ~ Date: Y-Zc~- c3 '-~ Date: ~__~_..~:;~..~ · .Municipality'. o.f.Anchorage Development serv~Ceis'Depa'rtment · ' Building safety'DiViSion . On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 ·Anchorage, AK 99519-6650- www,ci.anChorage;ak.us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE 'FAMILY DWELLING Parcel I.D. Permit N u m b e r S W...~..0_,~.i2~ Property owner(s) Mailing address (1) Mailing address (2) Day phone Zip Code Legal description (Lot, Block & Sub'd,). Legal description (Section, Township & Range) LotSize ~,-~R~ ^cres/q~.. THIS APPLiCATiON IS FOR:' Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS; Hot Tub r-1 Swimming Pool D, Therapy Pool ['-] LoT' 1, B k q,~ A k p/N~ r-1 Number of Bedrooms Well Only. D Water. Storage D Jacuzzi [] · Water Softening Unit [] Permit Fees: Date of Payment:, Receipt Number: (Rev. 12/00) I cedify that the above information is correct. I fudher certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municil:/al Codes. (Signature of property owner..,0r authorized a3 ' g~- ~ Waiver Fees: ~/~- ~'/D ~, Date of Payment: ~L['~ W '~ .'~' Receipt Num~;r: T. SPURKLAND P.E. 203 WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907) 276-6013 April 23, 2003 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage AK. 995169-6650 Subject: Septic System Upgrade Alpine Terrace, Block 4, Lot 1 PID 015-243-15 Gentlemen; We request a permit to replace existing 1000 gal septic tank on this property. A recent HAA inspection indicated that the tank is severely corroded. The replacement of this tank will not have any adverse affect on the adjoining property. Drainage patterns will not be changed. There are no wells within 100 feet of the tank location. Yours truly, Tobbe~ L~5 -~ LOT I BLOCK 4 ALPINE TERRA C~ 11945 CIRCLE SEPTIC SYSTEM DESIC, N DATE: APRIL £3, 2003 SI-IEET: 2/3 C,£1D: TOBBEN SPURKLANO P.E. 203 I~' ISTN. AVENUE IANCH. AK. 99501 GREA' ,, ANCHORAGE AREA BORe Department of Environmental Quality 3330 C Street Anchorage, Alaska 99,503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION MAILING ADDRESS PHONE LEGAL DESCRIPTION///:~ /'~//~"#£ SEPTIC TANK: DISTANCE ~y/~/ fROM WELL INSIDE LENGTH MANUFACTURER .,~:l~:: ,~' MATERIAL INSIDE WIDTH -- LIQUID DEPTH NUMBER OF / COMPARTMENTS LIQUID CAPAC iTY/~-~'~::~ GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL~-//¥ FOUNDATION /O NUMBER OF LINES / DISTANCE BETWEEN LINES ABSORPTION AREA t_~'''"(~)C~ SQ. FT. LENGTH Of EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE--,--~ MATERIAL BENEATH TILE~/_~ NEAREST LOT LINE TOTAL LENGTH OF LINES /,~0 ~"~/'/~ iTRENCH WIDTH /'/~IN. TOTAL EFFECTIVE _ . .IN. ABOVE TILE ~ IN. WELL: TYPE BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST SEPTIC , LOT LINE __, SEWER LINE__, TANK__ OTHER SOURCES DISAPPROVED REMARKS DEPTH SEEPAGE SYSTEM DISTANCE FROM: DISTANCES: INSTALLED BY:.$'~t/ I SEWER LINE DEPTH: --~- PIPE MATERIAL: LOT SLOPE: REMARKS: ~M¢'/ /~/ /~ Form EQ-032 DIAGRAM OF SYSTEM DATE GREaTEr AnChORaGE AREa BOROUGh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456! SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION PHONE INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT TYPE AND SIZE OF FACILITY TO BE SERVED 4 , DRAIN FIELD OTHER FINANCED THROUGH SOIL TEST RESULTS TO BE INSTALLED BY (L~T- ,,~ ~,~ /~ ~-O~ NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~E' FOUNDATION TO SEEPAGE PIT ~) SEPTIC TANK TO SEEPAGe PiT WALL t SEPTIC tank ~ I TO NEAREST LOT LINE. DRAIN FIELD SEEPAGE PIT ~0 I . DRAIN FIELD WELL TO SEPTIC TANK DRAIN FIELD /~)(3 ( /o WATER MAIN TO SEPTIC TA/NK DRAIN FIELD / 0 SEPTIC TANK, /~)~) . SEEPAGE PIT TO RIVER, LAKE, STREAM, ! / /~)0 SEEPAGE PIT ALSO CONSIDER AREA WELLS. ! SEEPAGE PIT DRAIN FIELD CAST irON iNTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FeET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G,A.A .B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILiar WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDinance ~O. 28-68 AND THAT THe ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WiTH SAiD CODE. ~/~ ~/~ ~/rl~/ FORM NO. EQ-OI 6 GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case # Performed For }F~ t~~., Dated Performed ~__~/~3//2~ _ Legal Description: Lo ~ Subdivision This Form Reports Soils Log ~ Percolation Test - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet 4w 7m 10w 12-- 13~ Soil Characteristics Was Ground Water Encountered? If Yes, At What Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop' Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom of Pit or Trench COMMENTS: ~-~/~~ ~ /~ ~ ~ ~ ~ c.~//~ ~~. /c~o~_ ~__~t~_ Test Performed BY /~, .S'~"'~-~~ Date Certified BY: Date: ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 ,SHEET NO. OF CALCULATED BY /"~"' ~")/~/ DATE C,EC,~ED BY DATE sC^,E / ;30 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot I; Bloc~ 4; Alpine T~rrace Subdivision; Location (site address or directions) 11945 Circle Drive Property owner Mailing address Lending agency Mailing address Scott P~t~rson /Klm Morrison P.0.Box 230272 Anchorage, Day phone 345-2600 Alaska 99523-0272 Day phone Agent Krz,¢l~J. ?nbnz~nn '/AC,/(' WHITE ¢.r)MP~.NV Day phone Address 3501 C Street ~I00 Anchorage: Alaska 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well XX NOTE: 762-3123 Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer 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 I ;'G~4 E~.9;. ~iver Loop Roa~/NO~ .2.04 Phone Address Eagle River, Alaska 99577 Engineer's signature DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS 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 #21 ( Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /.--C)-[ '!1 ~/..tr.. L.~ -[.F.j~...E' £/OParcel I.D. A. WELL DATA Well type Log present(~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed c~//1/'~-4'/ Driller ~Wv/P-/~,~ f Total depth ~ Cased to ~.~.~0 ' Casing height Sanitary seal (~N) ~V~_.~ Wires properly protected(~/N) ~/~--~ FROM WELL LOG AT INSPECTION I %o /0 g.p.m. 5.1 ; On adjacent lots ; On adjacent lots /00 ~ Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: / Septic/holding tank on lot Absorption field on lot lO0 Public sewer main Public sewer manhole/cleanout Petroleum tank Sewer service line /'-~ ' WATER SAMPLE RESULTS: Coliform ~ Date of sample: Nitrate ~ ,'~r- n'~(~'--/~.~. Other bacteria /~ Collected by: q'~ ~' ~ B. SEPTIC/HOLDING TANK DATA Date installed . ~'~T"~ L~ Tank size Cleanouts (~N) '¥~5 'Foundation cleanout --- High water alarm (Y/N) h,.)' -~ Date of pumping Compartments Y~ ' Depression (Y/(~). Alarm tested (Y/N) ~J//~ '--- Pumper /~ '/- ~:3A4~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~OOt '{" On adjacent lots To property line I(~ 4- Absorption'field Surface water/drainage I00 t- Foundation Water main/service line 72-026 (Rev, 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons ~.' Manhole/Access (Y/N) (Y/N) "Pump~~ / ~evel at Vent High water alarm level ~~-v~ested Meets MOA electrical codes (Y/N) SEPARATION DIS~TION TO: ' Well on lot ~..--"- On adjacent lots Surface~ --.~. D. ABSORPTION FIELD DATA Date installed °~-r-~-~-I Soil rating /&5 '~,g'~. System type Length Width ~ Gravel thickness /2 Total depth Total absorption area ,~O ~,~ Cleanouts present (Y/~) Depression over field (Y~J,~ )'~-~e Date of adequacy test //P- ~/~,?-- Results (~s/fail) ~A'~ for Peroxide treatment (past 12 months) (Y/(~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot l O0 To building foundation On adjacent lots ( ( '~ On adjacent lots /00 50' Surface water Curtain drain If yes, give date / /00' Property line To existing or abandoned system on lot Cutbank ~o*J~- Water main/service line Driveway, parking/vehicle storage area bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Eagle River, Alaska 99577 :ngmneersName ~ Date HAA Fee $ I ~~ Waiver Fee: $ Date of Payment ~ '"',~D ~ ~-~ Date of Payment Receipt Number f--~)/'~.// Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS RESETS for IN~0ICE ! 50600 Chemlab Ref.t 92.0301 Sample t 3 Matrix: FAX: (907) 561-5301 Client Sample ID : DRINKING WATER L1 B4 ALPINE TERRACE S/D PWSID : UA Collected : JAN 23 92 t 18:00 hrs. Received : JAN 24 92 ~ 14:20 h~s. Preserved .ith : AS REQUIRED Client Name :S & S ENGINEERING Client lcct :SNSENGP BPO$ : Reqt : O~dered By :UA POt :NONE RECEIVED Analysis Completed : JAN 27 92 Send Reports to: lis & S ENGINEERING 2) Parametez Results Units Method Allowable NITP~TE-N 2.7 mg/1 EPA 353.2 10 Sample SAMPLE COLLECTED BY: J.W. Remarks: I Tests Performed * See Special Instructions Above UA-Unavailable ND- None Detected "' See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT-Greater Than Member of the SGS Group (Soci~t(~ G~n~rale de Surveillance) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. Cf CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING /~/~' "~ ~ '-~ / ~'" HAA Cf /~Z/P',.. ~'~ o o ~'-~[ GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Location.(ad, dre~s or d rect'ions) (b) Property ovjner Mailing AddreSs Telephone · (home) Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone ~"'¢~-~3~ (e) Mail the HAA to the following address: (or check here"~ if hold for pick up.) List contact person and day phone number below: TYPE OF RESIDENCE Single-Family'~ Number of bedrooms WATER SUPPLY Individual Well'~ Community [] Public [] Note: If community well system, must have.written confirmation from the State Department of Environmental Conservation attesting to th legality'and status.' SEWAGE DISPOSAL On-site'S, Public [] Community [] Holding Tank CI Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-02s (Rev. 7/88} Page 1 of 2 '~JOM s,Jaeu!§ue leUOlSSejoJd eqi u! SUO!SS!LUO JOSJOJJS JOJ elq!SuodseJ 3OU S! e~eJoqouv jo Xi!led!olun~ eqi 'penss! s! eleo!~!iJeo ~ eJojeq ~leP ez~18ue Jo suo!loedsu! ionpuoo lou op SHHQ ~o saaXoldcU3 'slueLueJ!nbeJ ~ls pue I~J~peJ u!elJeo ~Js!les ol JepJo u! suo!~nl!isu! §u!puel J!~ql pu~ seuJoq jo sJes~qoJnd ol ~sepnoo e s~ s!ql seop SHHQ eq~ 'e~SelV jo ~lelS eq3 u! peJeis!§eJ Jeeu!~ue I~UO!SSejoJd ~u~puedepu! u~ ~q e^oqe ~ qde~e~ed u! ue^!§ suo!3elueseJdeJ eql uodn XlUO peseq pe~o!j!Jeo le^oJdd¥ Rl!Joqln¥ qlleeH s~nss! (SHHQ) seo!AJeS ueuJnH pue qileeH jo lueuulJ~dea e6eJoqou¥ jo R~!led!o!un~ le^oJdd¥ leUO!l!puoo ~o SLUJe/ I~UO!3!puoo peAoJddes!Q ~ ' peAoJdd¥ lVAOI:IddV SHHa '9 sseJpp¥ MUNICIPALITY Of ANCHORAGE (MOA) A. WELL D.~TA Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: /- ! Well Classification ~-./v"~' Well Log Present(~. N) Date Completed / Total Depth ~' Cased to .-~ Depth of Grouting Static Water Leve /'/// / ! Casing Height Above Ground Electrical Wiring in Conduit~_~N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot TO Nearest Public Sewer Line ~//~ To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ,¢4"~.Z.. If A, B, C, D.E.C. Approved (Y/N) Yield / Pump Set At Sanitary Seal on Casing(~N) Depression Around Wellhead (Y6 ;On Adjoining Lots ,/¢~-') ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole /~r-. /,'J/~'~/f//~,?. ;Date ~-- ~ ~'''? SEPTIC/HOLDING TA? DATA Date Installed ~,...~C?/..SiZe StandpipesON) Depression over Tank (Y~ Pumping/Maintenance Contact on File (WN) /Z.-~"~ No. of Compartments / Air-tight Caps(~)N) Foundation Cleanou[~N) Date Last Pumped Z--/-'~-~)' ;for ,~J/~l- Holding Tank High-Water. AlarmlY/N) ,x)//¢) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM,~I~'lq~C/HOLDING TANK: To Property Line :: · "'": ¢'~'¢' .... To Water Main/Servi'ce ~ine To Stream, Pond, Lake'or ~ajor D:rainag'e~'~°urse Comments " To Building Foundation ~'~ / To Disposal Field /d ' 72-026 (Rev, 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ?-5-L ?~[ Width of Field c/[. ! Square Feet of Absortion Area Depression over Field (Y(~ Results of Last Adequacy Test Type of System Design Length of Field ? ~o Depth of Field Gravel Bed Thickness Statndpipes Present (Y~) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot ~/~r To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on / ; On Adjoining Lots ~ v ' "/- To Cutback (if present) / Comments STATION Date~s~ Dimensions ,Size in Gallons -'"---.~ Manhole/Access (Y/N) Pump On" Level at ~-~ "Pump Off" Level at ' High Water Alarm Level at -"'---..~ Vent (Y/N) _ ~ Pumping Cycles during Adequacy Tested for Test. Meets MOA Electrical Codes (Y/N) ~_ Comments ~"~~ **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signed Company Date ~ -/~' -~' MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev, 7/88) Back Waiver Fee: $ Date of Payment Engineer's Seal Page 2 of 2 CHEMICAL '& GEOLOGICAL LABORATORIES OF ALASKA, INC. Client Sanpl~ ID:Li, ER, ALPINE Spec i al Instruct: Chemlab ~ef ~: ~167 Lab Smpl tD: i Matrix: WATER Allowable ?arameter Tested ~,esul~/Jmts M~,t. hod }I!'I'~h?E-~l ND(O,iO) mE/1 EPA 353,2 Samp].~: BOUTINE SAMPLE. ltemazf~,~: S.CMPI, E COLLECTED See Special instructions S~e Samplo Renark. s Above MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION, DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472O Application Date /O GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address oi: directions) (b) (c) Applicant Name, ~'~,J-~l''t/~ ~-~'//b'"~; Telephone: Home ~'¢-~- ~ ~/ Business Applicant Address '//~ C/~e~ M- ~ld~,, ~, Applicant is (c~eck oge}: Ebnding Institution ~ Owner/builder~; Buyer B; Other ~ (explain); (d) Lending Institution' Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,~ Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~i~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 ~") Telephone Address /~,~, /4,/ Date ~-t~ Approved for /__Y'/./~ ¢ ~ ) bedrooms b Approved /~'" Disapproved Conditional Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) WELL DATA Well Classification Well Log PresentlY)N) Total Depth t Cased to Static Water Level ~ ~/, 5/.' Casing Height Above Ground Electrical Wiring in Conduit~l) Separation Distances from Well: To Septic/Holding Tank on Lot ,/,~ To Nearest Edge of Absorption Field on Lot ,/~ "/" To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Corn ments {~) ~/~.) ' ~.kt.tlY Ot: ·~,1~~iALITY OF ANCHORAGE (MOA) I~Ut'ttCt-pT OF H~'LI~I~'~I~'TH.AUTHORITY APPROVAL (HAA) EtqVt~D~Ni~i~I,,fl'AL PROT~;;~;CKLIS2T;4.F4E7B20RUARY 1984 ~i~ ~ ~'~ ~Oj~,, Legal Description: /-~.'~'/ .~'Z~,~-v~ ¢ ~7.~,4/~¢' "~'~/~'4-¢ If A, B, O, D.E.O. Approved (Y/N) ~ ~ Depth of Grouting ~I~ ~ Pump Set At ~' ~/ Sanitary Seal on Casing~N) Depression Around Wellhead (Y~ · On Adjoining Lots ; On Adjoining Lots /(/'//~,~1 To Nearest Public Sewer To Nearest Sewer Service Line on Lot /~ ~ /~' /~/t~'Z/ ;Date ~',-/? -~1~ /~'~ ¢ ;/ B. SEPTIC/HOLDING TANK DATA Date Installed ~-~' ¢¢ Standpipes(~N) Depression over Tank (Ye Pum ping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~'//~ Size /~'-'~ ~'"~ No. of Compartments Air-tight Caps(~N) Foundation Cleanout~N) Date Last Pumped 4~ 'for ./~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Su pply Well To Property Line To Water Main/Service Line Course Comments .% To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA / Soils Rating in Absorption Strata f Date Installed ~-,.~ 4 Width of Field Square Feet of Absorption Area Depression over Field ('~) Results of Last Adequacy Test Type of System Design Length of Field /~'O / Depth of Field ! Gravel Bed Thickness Standpipes Present (Y{~ Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~¢~--) To Building Foundation Lot ,'~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments~) ,,I/2"/~¢~)/~r' ~/(~" To Property Line ; On Adjoining Lots To Cutbank (if present) To Existing or Abandoned System on LIFT STATION Date ~ Z/A ' Dimensions ' Size in Gallons ~ Manhole/Access (Y/N) "Pump On" Level at ~ "Pump Off" Level at _ High Water Alarm Level--at '~- Vent (Y/N) , _ i . ~_ ,- ..... ~yCles during Adequacy Test. Meets MOA Tested for Electrical Codes (Y/N) ~omments ,. Check Permitted Bedroom Rating Against HAA Request I certify that I ha~y~he~ed, vej. ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~/~'" ~'~//~' Date :~'-/0 Company /~'~' MOA No. -- O~. ~ t Receipt No. ~ ~ ~ D3~ Date of Payment Amount: ~ ~ ~ .~ Page 2 of 2 72-026 (11/84) ALASKA I I1UIROllmi FITAL COFITROL Si RuICi S, IIIC. ~ncjincerincI g- J~nuironmenloJ Slu(Jics KELLY & GORDON REEVES 11945 CIRCLE DRIVE ANCHORAGE ALASKA 99501 n3/10/86 SELLER-KELLY & GORDON REEVES RELLY & GORDON REEVES 11945 CIRCLE DRIVE ANCHORAGE ALASKA 99501 60054 LEGAL:ALPINE TERRACE BLOCK 4 LOT 1 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-2/17/86 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 604 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 898 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 2/10/86 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE 'WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE-2/17/86 AND THE STATIC WATER LEVEL WAS THE WELL IS ADEQUATE FOR THIS 3 A FLOW TEST WAS PERFORMED ON THE WELL. 1198 PUMPED AT A RATE OF 5 GPM OVER A DURATION OF 4 THE DRAWDOWN WAS 16.8 ' WITH A RECOVERY TIME OF 41.4 FEET. BEDROOM HOME. GALLONS OF WATER WAS HOURS. 20 MINUTES 1200 UJcsl 33cci J~ucnu~, Suil¢ B. J~nchoroq¢, J~loska 99503 .[907) 561-5040 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 , ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 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. MAI LING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER ~~ ~' PHONE MAILING ADDRESS MAIkI~G STREET LOCATION 6. TYPE O~F~~E L~ SINGLE FAMILY [] M~,Jc'TI P LE FAMILY 7. WATER SI.~P~LY [~' INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] ,,,,Twv o [] Five ~ Three [] Six [] Other * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAG~E ~SAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **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. 72-01 O(3/78) THIS SIDE FOR OFFICIAL USE ONL TIME DATE I NSP ECTOR~ DI R ECTIOIXTs: - INSPECTION APPOINTMENTS TIME DATE INSPECTOR DATE RECEIVED TIME DATE INSPECTOR 1. TYPE OF RESIDENCE ~/SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY I~' INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM E~INDIVIDUAL/ON -SITE [:3PUBLIC UTILITY Co.~ection Verified [~eptic Tank or [] Holding Tank Size: ¢~ If Tank is homemade give dimensions: TYPE OF~ TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] ONE E: TWO ~?BER OF BEDROOMS L~ THREE [] FIVE [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER ~~. SOILS RATING MANUFA~ r MATERIAL Sept~l~i..~Tan k 1 Absor~ iA.~ [] OTHER Sewer Line I Nearest Lot Line 5. COMMENTS EE~ APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate [] DISAPPROVED DATE BY (Title) 72-010 (Rev. 3/78) June 13, 1978 R&M No. 851535 Mr. Art Dorsey SRA Box 396-F Ancorage, Alaska 99507 Subject: Adequacy Test on Existing Sanitary Sewer System; Lot 1, Block 4, Alpine Terrace Subdivision, Anchorage, Alaska Dear Mr. Dorsey: At your request of June 6, 1978, we conducted a test of the septic system on the above described property. During the test the liquid level in the septic tank was monitored as water was added td the system. table: The measurements are summarized in the following Liquid Level Below Top Total Gallons Time of Standpipe Added 10:15 8.3 25 10:20 8.3 50 10:25 8.2 100 10:37 8.0 150 10:45 8.0 150 11:00 8.1 150 11:30 8.3 150 The meter used during the test was a Rockwell 5/8" standard water meter which had previously been calibrated by R&M Consultants, Inc. If the 3 bedroom residence on the property is to house 6 people, the average load on the system can be expected to be 450 gallons per day or .31 gallons per minute. During the test, the system accepted 150 gallons in 75 minutes. This indicates an average effluent acceptance rate of approximately 2.0 gallons per minute at the time of the test. Because the house on the lot is occupied, we assume that the leach field was at its normal degree of saturation. We can therefore conclude that the system is disposing of effluent at an adequate rate for a 3 bedroom resi- dence. ANCHORAGE FAIRI~ANKS JUNEAU June 13, 1978 Mr. Art Dorsey Page -2- We appreciate this opportunity to be of service to you. Please contact us if you have any questions concerning this test or if we can be of additional service. Very truly yours, R&M CONSULTANTS, INC. l~ynne Kosikowski Staff Geologist JMB/kah