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Home My WebLink AboutALPINE TERRACE BLK 4 LT 7 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: PID Number: Name: ~"~1~.. ~V~{:~.o~ Wastewater System: ~New ~ Upgrade Address: tt~O~ ~~ ~~.~ ~ ~k ABSORPTION FIELD Phone: ~__ ~ ~ ~No. of~rooms: ~ Deep Trench ~ Shallow Trench ~Bed ~ Mound ~ Other Total Depth fr~m original grade: Lot: ~ Block: ~ ~)~Subdivisi°n:~~ Depth to pipe bottom from origipal~l ~grade: Ft. Gravel depth beneath~ ~pipe Ft. Township: ~ Range: ~ Section: Fill added above original grade: :Gravel length: Number of lines: Distance between lines: WELL: ~New ~ Upgrade Gravel depth: I Ft. ~ ~ ~ Ft. Class~cation~~(Private, A,B,C): Total~Depth:~ Ft. Cased~o~ Ft. Total absorption ~area: SQ. Ft. Pipe~ll~material: Driller:. Date Drilled: Static Water Level: Ins~ller: % Date installed: Yield: I Pump Set at: [Casing Height Above Ground: SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: Well j~ ~ / / / , Materia,~~ Number of~mpartments: Surface Water ~ - -- LIFT STATION LineL°t ~O ~ / / / Size in gallons: Manufacturer: ~ 'p off" Iovol at: "~ump on" : ~ ~i~h wator alarm at: CurtainDrain ~ ~ ~ Pub&Model I Electrical Inspections peHormed by: Remarks: BENCH MARK Location and Description: Assumed Elevatio~ ENGINEER'S SEAL Inspections performed by: ~ Dates: 1st ~ w_t ~A~K W PEA.SON ~,~ Department of Hea d Hum ervices a I/ %~.% Reviewed and approved by: Date: .~. ~ 72-013 (1/91) MOA 25 Permit No. Page 'Z-- of ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ~t'L.~l t~ TI~I~/~-/~ ) ~ '~! Iz~~ L-iL PID No.: IODI Swing Ties Fixture IBM !1 BM 12 CO il 33.6 55,1 CO 12 20.6 37.4 CO 13 20,6 36,9 CO 14 9.5 27,0 CO 15 32,5 28.0 MT ~11 21,9 6.8 MT 12 29,1 40,6 ST 111 23,1 43.2 ST 12 20,9 38,g DRIVEWAY 100 FT Well 72-013 A (2/91) MOA 25 Clrcle Drive LOCATION OF WELL STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD SECTION QTRS SECTION TOWNSHIP i-iN Os RANGE []E I'-Iw MERIDIAN LOCATION/SKETCH: DEPTHS MEASURED FROM:l-]casing top r-]ground surface BOREHULE DATA: Depth Frcm Tc ,JUL 2 B 1995 D eMp ,u. ~ceia~ tehI' ~ ~ fu Am~h~ ravgieces WELL OWNER: WELL DEPTH: __~--/ DATE OF COMPLETION Depth of hole: ?~ ft Depth of casing: DEPTH TO STATIC WATER LEVEL: / ~' .... ft below [] top of casing Date: ~Z' / .-¥, / '>"-L' [] ground surface METHOD OF DRILLING: [] air rotary [] cable tool [] other USE OF WELL: []'domestic [] irrigation [] monitor [] public supply [] other CASING STICK-UP: '"~--'~'- ft. Diam: ' '~ in. to <"'~/, /" in. to ft Casing type: _;.. , __ __ WELL INTAKE OPENING TYPE: [] open end ~] perforated [] open hole Depths of openings: [] screened ft SCREEN TYPE: Diam: in. Slot/Mesh Size: Length: ft GRAVEL ~'ACK TYPE: Volume used: Depth to top: GROUT TYPE: Volume: Depth: from ft to ft DEVELOPMENT METHOD: Duration: ~ ~-,¥-~, PUMPING LEVEL AND YIELD: ~ r~-. ft after ,~/ hrs pumping PUMP INTAKE DEPTH: ....... ft Horsepower: WELL DISINFECTED UPON COMPLETION? [] YES gpm [] NO CONTRACTOR INFORMATION: Regis.t,e~ed Business Name , ~ ' Signature of Authorized Resprese~n~ative Date REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: DNR/DIVISlON OF WATER PO BOX 772116 EAGLE RIVER AK 99577-2116 Municipality of Anchorage Department of Health and Human Services Torn Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 May 20, 1993 Sam R. & Lana K Moad 11805 Circle Drive Anchorage, Alaska 99516-2533 Subject: Lot 7 Block 4 Alpine Terrace Subdivision Permit #SW920092, PID #015-243-21 The subject permit, issued May 20, 1992 by this office for a single family well and/or on-site wastewater system, has expired as of May 20, 1993. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by .the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $200.00 for an on-site wastewater permit; $75.00 for a well permit and $275.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sinc. erely, ~ ~rogram 'Manager On-site Services enc: Copy of Permit cc: Flattop Technical Services PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920092 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:MOAD SAM R & OWNER ADDRESS:7517 BASEL ST. ANCHORAGE AK 99507 DATE ISSUED: 5/20/92 /~/d~ EXPIRATION DATE: 5/20/93 PARCEL ID:01524321 LEGAL DESCRIPTION: ALPINE TERRACE BLK 4 LT 7 LOT SIZE: 46900 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. ENGINEER MUST PROVIDE GRAIN SIZE ANALYSIS OF FILTER SAND MATERIA~ RECEIVED BY:~~ ISSUED BY: ~.~ DATE: DATE: c/z /q FI A Y-- 2 8 -- 9 2 T H I_1 ?. : 0._'9. T'E ]3 I) 0 0 I"1 .. C F' R P . 0';' EXPRE SS PAGE , 003 MAY ~8 '92 8:14 fROM POSTAL CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 May 19, 1992 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to construct wastewater disposal facilities on Lot 7, Block,4, Alpine Terrace S/D, located at the ' intersection of Soldotna and Circle Drives. Soils logs, perc test results, a site plan, design drawings and . specifications are enclosed for your review.: The proposed system will be constructed in the vicinity of test hole #3. As can be seen from the soil log, the native material between 2' and 9' below grade is a slightly silty sandy gravel with a measured perc rate of less than 1 minute per inch. Using the soft application rate of 0.7 gpd/sq, ft. specified in the wastewater ordinance for filter sand which is required when perc rates are faster than 1 minute per inch, this 3 bedroom residence requires a total absorption area of 643 square feet. The proposed 25' x 26' bed design has a total absorption area of 648 square feet. The topography of the lot in the vicinity of the proposed bed slopes towards the west at 3% - 5%. The site of the proposed replacement system has comparable soils and slopes. The proposed project will have no impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any impact on reserved space/surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. h/EL L LOT ~ LOT ur LOT LOT/o VA, c^N T L o'~ '7 · '1'01' ,' SLOPE I:~oPosED PROPo$£ b iooo ~RoPoSEb CIRCLE DRIVE LOT' PIT 20' LoT (o WELL ~tt6--~ T6chfilcal Servicee ' 14530 Echo Street Anchorage, Alaska · 995~ LOT 1,6L~ ~ LOT "7, BLK H.,.ALPINE TERRACE SEPTIC. $',/5TEI"1 DESigN SITE PLAN SCALE: I"= 50 t DA'rE: $ /~i :2 btOT~=', TIllS 15 NoT ,4, SuRV£"I£1~ PLAT. ALL LoCATIoNS ARE A,?PRoX t I~ATE. :;25' m ~LAN VIEW ~"--,o' DOUBLE C LE~Nou'I'~ IOOO ~; E PT I c °1 tqohl- PElF TA~qk t)-3o 3u~ FILTEr, SECTION ! A-A Platto~ Technlcal Services 14530 Echo Street Anchorage, Alaska 99516 LoT 7, BLK ~, ALPINE TEP, AAC£ SEPTIC_ SYS TE~4 PLAN ¢ CRoss SECT ION SCALE' AS SHo~vN 'DATE : ,S'/92. PERFORMED FOR:, f 14530 Echo Street Anchorage, Alaska 99516 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCQLATION TEST LANA LE~A~.DESCR~,T,ON: L7, Bt. ALP/NE T£RR. 1 51'~ REDDISt-/ 5/JND¥ LoAM 2 3 4 ,5 6 7 10 11 12 13 14 15 16 17 18 19 20 GW / GP SLIGHTLY SILTY SANbY ~I~AVE L GRAY, ',;LOPE WAS GROUND W^T~R E.COUN'r~_R~D~ ..... ~_~ COMMENTS T 12. N IF YES, AT WlIAT DEPTH? Oeplh lo Waler Alter Monitoring? ~3'9" Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RA1E ............. Immules/u~ch) PERC HOLE DIAMETER . TEST IRUN [}E'IWELH ......... I '1 AND ........... F1 PERFORMED BY: ...~FL ~ TTOp _..'r£ct-/._._El,,'¢ ~. i CE~'{I[ I FY 1 HA'! 3HIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEC'I ON J~II813A]E. DA!E: ._~.._~_ /~ /~ ~ 72'008 (Rev. 4/851 ..... ~ttS'~ T~'~l~fii~'8! S~[vlce~ ,,,- .... 14530 EchoStreet Anchorage, Alaska 9951~ Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN ~EHVICE~ 825 "L" Street, Anchorage, Alaska 99502-0650 SO,LS LOG --p~-,. ~'C~AT, Oi,~ TEST MOAD ~ .ERPORM~D ~O.,, LA N A LEGAL DESCRIPTION:, LT~ PT 5W ....................................... IJ/\l L I'EI (1' f.)IiMED;~ 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS ALP/NE i'4L REbDISH SAND',/ 5LIGHTL"! 5lL'r"/ SA/qb'./ (:;RAVEL Townshi[.,, Range. Section: SEC.. 2./'1I' 'T 12.. N ~..~ tV' SLOPE /,/.,,r' WAS GRqUND WATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? ~ O E Oeplh ID Water Alter. ..,.,~/~/~/7. Monitoring? .. ~$ ~,G.L. Dale: j Reading Date Gross Net Depth to Net Time Time Water Drop PE,qCOLAIlON F{A-] [: ........... (nunutos/,nch) PE,~tC HOLE DIAMETER ]EST RUN [~,[':¥WEEI,~ ................I I AND ....... F'I PERFORMED BY: _F'/-ATTop _ 'rE c/4~ SV¢~. _ , ~~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEC'I ON N. tIS [)ALE. 72-008 (Rev, 4/85) (3EH IIFY , HA'! 'IHIS ]EST WAS PERFORMED IN PERFORMED FOR: "" 14530 :Echo Street · 'pa ily of Anchorage DEPARTMENT OF HEALTH & HUMAN SEHVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST .,.,...... P El:l I' C)I'IM ED: LEGAL OESCR,PT,ON:_.L7i BI+, ALP/NE T, Ei~R. Township, ~ang~, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O GP/6M ~ILT¥ -.~Nby GRAI/EL GW//GP SL] 61-/TL',/ SILTY S~Nby G~AVEL COMMENTS SI_OPE ~"/ CO~SE WAS GROUND WATER ENCOUNTERED? -SANDY ¢li~Avg L DEPTH? _T~ .............. Depth Io Waler Alte~r , _ _ / ~_ Gross Net Depth to Net Time Time Water Drop 12:H3 'oo --__ 2&, 12:~q:~o 22 Y2. - ~: s~: ~...... ~ ...... ~l ~/~ I ?/g Reading Date · (s + tiaO PERGOLA'lION FIA]E _4._.1 _._ Ul,,)u:es/mt:h} I'EHC HOLE DIAMETER ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEC'I ()hi 'FHIS 1'3AT E. 72-008 (Rev, 4/85) CElt'IIFY 'l HA'f ]HIS "lEST WAS PERFORMED IN Flattop Technical Services 14530 Echo Street, Anchorage, AK99516 Phone (907) 345-1355 Lot 7, Block 4, Alpine Terrace NE Corner of Inter~ection of Soldotna and Circle Drives Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of installation of a 1000 gallon septic tank followed by a 25' x 26' soil absorption bed with a 2' thick sand filter. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and seeding all areas disturbed by the construction, 2.0 Septic Tank: 2.1 The 1000 gallon septic tank shall be Municipally approved with a two compartments, and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.2 All pipe.connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 ' Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating the 25' x 26' bed area into the ative s. Landy gray.el at a depth of 7' below the original ground level. The bottom of the excavation shall be evel.. 'lne exact Oepth of the excavation is to be determined in the field based on the waste line elevation reqmrements from the proposed house. 3.2 A total of 2' of coarse pit run NFS sand shall be placed in the bottom of the excavation, and the top surface leveled within +/- 0.1 feet. This filter sand shall comply with Municipal specifications. 3.3 A total of 1.0 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 6 inches above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel before backfill. The top surface of the soil cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. 3.6 All areas disturbed by the construction are to be covered with 4 inches of topsoil by the owner and seeded with an approved grass seed to promote rapid revegetation. 4.0 Inspections: 4.1 A total of 5 engineering inspections will be required during the course of the prOject: '(1)initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative ' surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) · after the filter sand has been placed and leveled, (4) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of filter fabric, and (5) after final backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. 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 01 5-243-'21 HAA# GENERAL INFORMATION Complete legal description Lot 7; Block 4; Alpine RECEIVED JUL 0 8 1998 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Terrace Location (site address or directions) Property owner Mailing address Lending agency Mailing address Tina Backen 11805 11805 Circle Drive Anchoraqe, AK Day phone Circle Drive Anchoraqe, AK Day phone 345-9805 99516 Agent Dan Wolfe/Remax Properties Address Day phone 257-0114 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: , 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. TYPE OF'WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XX 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 Address Engineer's signature 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 l~is inspection. Name of Firm o Phone ~'~ 7 '"~-! '~ (/_ 7~[q*' ,.,.._j _ Date , DHHS SIGNATURE L//' Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration iF 5. !7 mg/!. EPA ma×imum concentration i_= !0_0 mg,/l_ More information on nitrates is available from the On-site Services Program, Additional Comments By': //0~/~/ ~?. ~:~'~-'~ 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 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/421 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: Health Authority Approval Checklist T~:~~ L'"'~'l~t'( Parcell.D.: A. WELL DATA Well type Log present~/N) Total depth Sanitary seal ~__~N) If A, B, or C, attach ADEC letter. ADEC water system number Date complected ~"_~_c~ ~ Cased to ~-~ ~1¥J~ ~(,f~'Casing height (above ground) Wires properly protected ~N) FROM WELL LOG AT INSPECTION Date of test (~ _ .~_ c~ ~ ~- o'~ Static water level I~-"~ ~ I Well production ~O g.p.m. ~, WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: '-~/~--/~ B. SEPTIC/HOLDING TANK DATA Date installed ~/~-[~- Tanksize [~C.Y-~ Foundation cleanout (~N) ~Ect¢ Depression (¥~). ~o C= g.p.m. ~' ° ~ "7 rt4~,,-/'~/ Other bacteria ~ Collected by: ~J~,~J ' Number of Compartments '~. Clea~outs (~I/N) -~ High water alarm (Y/I~) /d~/~- ABSORPTION FIELD DATA Date installed ~-~-~',2 Soil ratingl (g.p.d.~ or ff~/bdrm)(~ ,;'~c System type~ ,~.0 Length~l,~~C, Width ~ ~. Gravel~hickness below pipe O,~ Totaldepth ~,~ ~ ~T - ~ ~- ~ ...... Effective absorption area ~ ~ '~nitoring Tube present ~) ~ Depression over field (Y/~ ~ Date of adequacy test ~-~ ~-?~ Results ~s/Fail) For ' ' ~~ bedrooms Fluid depth in absorption field before test (in.); w" -~ Immediately affer~ gal. water added (in.): W"- 5ou~ F~uid d~pth ~/~ (~n,) Minute, ~t~r: ~/~ Absorption r~t~ = ?~ + g.p.d. P~roxidetr~t~nt(p~,tl~onth,)(Y~ ~ ~Y lfy,~,~iv~d,t~ , ~/~ 72-026 (Rev. 3/96)* D. LIFT~ Date installed ' /" ~ Size in gallons Manhole/Access (Y/N) ~Pump~__ Pump off" level at* High water aid el at* *Datum *Datum . Cycles tested i - - _ E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot JO~ "+ Public sewer main Sewer/septic service line On adjacent lots ! On adjacent lots / Public sewer manhole/cteanout /,J/A Lift station /~/,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation' /0 "f'- Property line Absorption field .~S?': Water main/service line ./0 ~ Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain [0 ~.~ Building foundation l~ ',~ Water main/service line \(--~' ~' Driveway, parking/vehicle storage area I O ~ ~:~J~,-,,,- Wells on adjacent lots /'o(j ~-/- ENGINEER'S CERTIFICATION__ ~- ' ceRify ,hail ~ d~mi~u ~.,d inspections and ,view of Municiea~ ~~ ~tems are Signature ~f r- 1- ~ I Engineer's Name HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ANCHORAGE 90756~5~02 P.03/05 CT&E ReL# 983344002 Client Name AX Water & Wasiewa~et Pro, i~ct Nsme/~ N/A Client $~ple ~ L7 ~ Alpin~ Terr~ Matr~ Dri~g Water Ordered By ~S~ Client PO# Printed Date/Time 07/07/98 12 Colkcted Date/Time 07/02/9g I6:10 R~¢ivcd Date/Time 07/03/9S I3:00 Techni~ ~rector: Step~ C. Ede Total CoLiform PCIL Units coL/iOOmL mg/L ALLowable Prep ^naly~i~ Ne~hod Limits D~te ~ate [nit SMl~ 92~2B 07/03/98 TMW ~i 300,0 qO ma~ 07/06/98 0710i,,~A ~Mv 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. # CERTI FI CATE OF HEALTH AUTHORITY A'PPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description L. o~- Location (site address or directions) Property owner Mailing address Lending agency Day phone Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ,~ TYPE OF WATER SUPPLY: Individual well NOTE: Community well ~ ~ Public water ~ If community well system, provide written confirmation from State ADEC a~j~t- lng 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, t verify that my investigatio, n of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from 'my 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. DHHS SIGNATURE /~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 2 - 7- ~'~' The Municipality of Hnchorage 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 leqding 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 Legal Description: A. WELL DATA Date of test Log present (Y/N) y Total depth ~'ct Cased to ~ '4' ! Sanitary seal (Y/N) y · FROM WELL LOG Static water level ~5~ ,, g.p.m. Municipality of Anchorage DEPARTMENT OF HEALTH &-HUMAN SERVICES Environmental Services Divi ion San, ~/C'/~.~ s 825"L" Street, Room 502 * Anchorage, Alaska 99501 Health Authority Approval Oheokli~t If A, B, or C, at.ch ~EC le~er. ~EC water ~stem number Date completed ~ -- ~ ~ 9~ Casing height (above ground) ~-' Wires properly protected (Y/N) . Y · AT INSPECTION g.p.m. Well production WATER SAMPLE RESULTS: Coliforn~e~ . , Nitrate Date of sample: ~" ~-~ '~ ~(o B. SEPTIC/HOLDING TANK DATA ~'~4 ~,5(L'', Otherbacter~ Collected by: l~t.~--[-- p. Date installed Foundation cleanout (Y/N) ~/ Depression (Y/N) ~ Date of Pumping 9""99, r Pumper ~ -"'~ C. ABSORPTION FIELDDATA Tank size I;m:~-~At. Number of Compartments ~ Cleanouts (Y/N) '~,, High water alarm (Y/N) ~ Date installed ~:~--9'~'~ '- Soil ratin~orft2/bdrm) O' q System type ~ Length ~ / Width,,~"/ Gravetthickness below pipe~ jt Total depth Effective absorption area~ 9.~. Monitoring Tube present(Y/N) x(t Depression over field (Y/N) Date of adequacy test J'~ .~"' ~.~ Results (Pass/Fail) FA-(---------------~ For ~ bedrooms Fluid depth in absorption field before test (in.); -~ Immediately afte~ gal. water added (in.): Absorption rate = '~, ~q,p.W~. -g.~.d. If yes, give date .N,/06 ~ Fluid depth ~ (ins.) Minutes later: Peroxide treatment (past 12 months) (Y/N) D. LIFT STATION Size in gallons Manhole/Acce~~mp off' level at* High water alarm level at* ~ *Datum~~ SEPARATION DISTANCES ~ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot ~ I ~ ,.~ ! Public sewer main Sewer/septic service line , On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ,n., Water main/service line .n~ ~O Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ ~0 t Water main/service line Surface water Curtain drain Driveway, parking/vehicle storage area Wells on adjacent lots ~'~ { ~ !Property. line F. ENGINEER'S CERTIFICATION I certify that Id~ve deter,~4;tedld/rt~field inspections and review of Municipal rec~q~e'a~ ~?~s are ,. ~o.fo.,,..~ ~,th '.effect on this date. ~' Signature~~ ~ ' HAA Fee $ ~ ' ~ W~ver Fee $ Date of Payment //O~ ~ ~/~ Date of Payment Receipt Number /f.~9/t~ ( ,~ ,~~ Receipt Number Rev. 8/95 OSS: haa.wk.doc CT&E Ref.# Matrix Client Sample ID Client Name Ordered By Project Name Project# PWSID CT&E Environmental Services Inc. Laboratory Division .o255-1 Laboratory Analysis Report WATER 11805 CIRCLE CIRCLE EATON, BRENT UA RUSH Order 20821 Printed Date 01/25/96 $ 11:14 hrs. Collected Date 01/23/96 $ 15:45 hrs. Received Date 01/23/96 $ 16:00 hrs. Technical Director STEPHEN C. EDE Sample Remarks: SAMPLE COLLECTED BY: B.E. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 3.94 mg/L EPA 300.0 ION 10 01/24/96 MCE ============== === = = = ===== = = ========= === =============== = ==== == = === ====== ~ = == =========== = =============== ===== * See Special Instructions A]0ove UA = Unavailable *~ See Sample Remarks D. bove NA = Not Analyzed ~ = Undetected, Reported value is the practical quantification limit. LT = Less Than = Secondary GT = Greater Than dilution. 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA 11:01 CT~E ESI ANCHORAGE -~ 98~434786 NO. 192 ~1 CT&E Environmental Services Inc. Laboratory Divioion ~_~ Drinking Water Analysis Report for Total Coliform Bacteria 200 w. Potter Delve Anchorage, AK 99518.1605 READ INSTRfJCTION$ ON REVERSE SIDE BEFORE COLLECTING SAMPLE Tel: (907) $62-2343 Fax: (907) 561-~301 TO BE'COI~LE'I4ED BY ~BORATORY Analysis shows this Water SAMPLE to he: Satisfhotory Unsntisfinotory S~mpl~ over ~0 hours old, renults m~y be unreliable Sampl~ too long in transit; samplc should not be over 48 hour~ old ~t ex~lnation to ~ndl~ate reliable r~ul~. Please send n~w sample*via sp~ial delive~ mail. Time Received Mon~:h ! Day SAMPLE TYPE: · '~'%~ ' o Routine , '"~','-'. ~ ~ Repeat Sample (for routine sampl~ With lab ret. no, ) [ n Sp~ial P~rpos~ '; Time C~i~ed SABLE LOCATION i Collected By D ~ ~nt BACTE~O,LOGICAL WA~R ~YSIS ~CO~ Analytical Method: ~ Membran~ Filter o MMO-MUG * Number ofoolonie~JI00 mi, !ab Ref. No. R~uit* Analyst J#lt Client notified of unsatisfactory results: Spoke with Tim~; MMO-MUG Re, nit: Total Coliform Membrane Filter: Direet Count Verification: LTB ,~ / ~/~ a~ ~o/o c~ &_'_,, co~o.l~t00 m~ ( BGB ~ COLfflRM Comments: Fecal Coliform Confirmation Final Membrane Filter Reported By' P"~ ~, C~) Coliformll00 mi D.. i', ~.to,'zc Tim, rz-~,O h. [] irax~i [] r,~. - r. ,v.,.~ r, ca,,, 011 n f)t~ .~et~q~ I~~ Member of the SG5 Group (8colOr6 Ginb¢ale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MiS.SOURI, NEW JERSEY, OHIO, WEST VIRGINIA 16:16 CT&E ES! RNCHORRGE -> 90?3493386 N0.290 D02 CT&E Environmental Sewices Inc. L ~, DrirLkin_ Water Analysis Report for Total Coliform Bacteria ~ Anchorage, AK 99518,1 605 R£.4D [.VSTRUCTIO.V$ 0."; t~EP'Et~E SIDE BEFORE COLLECTI,VG $.4.111~L£ Tel: (207) $62,2343 .',FjST BE CO.X, LPLET~D BY WATEK SD'?PLL~K PUBLIC WATER SYSTEM LD.# < PF, IVATE WATF~R SYST£3I ~_ $~nat g~.sulr$ "Z _ge.nd Int'ol¢~ $.~\ [FLE DATE: 31onrh S.-X3I?L.E. ~ t:4outin,, ,2 Repeat Sample (for routlne ~nmple wi~h lab ref. no. ) /~ Sp~ial SA3~LE LOCATION Treated Water Time CoLlected Collected By' ?.ax: {907) 5,31.5301 TO BP, CO,MPLst~D BY U~BOK,.\TO,~Y A~_~l>'sjs shows ;~[~ Wa:~: S,~MPL~ ;o be'. O ~ SumpD over 30 ho~:s Samule ~oo long in ::~si;', ~ampl~ should no[ ~¢ over ¢8 hour~ oie a~ ~xamina~lon n~w s~r~p[e via ~p~:ia[ d~livem Da;a Received Tim~ R~c~ived Analytical 5:[mthod: egl..~-2;, m b fane Fill.~r O. M.MO-.M UO Number oF:olon{e~,"100 mi, Lab Ret'. ,','o. Result / 5vn~ ti) A,D,E.C, Anch Fb~ Jun __ Tim--; ~ Ciie.~ .otifiecl or uns~d~f-~c:or?' results: Pho,,~d SpOL,~ ,,, im Dat.*: TJm~: Fu~cd Fa~c~t BACTERIOLOGICAl, WATER .~N.A_LYSIS RECORD .'q.xiO..ML'G Result: Total Coliform Membrane Filter: Direc: Court( Verification: LTB {"coal Coliform Confirmation Final 31em0tane Filter ResuJts £, Coil C) Colonies/100 COLIFtR){, ColiDrm/100 mi Date "Z- ' ~' C~ Tim hfs Oil · (lth,~r Itu¢ter(~t - Member of t~e $G$ Group ($oei(~ O-.'n,J_rale de $urveiUancel