HomeMy WebLinkAboutATELIER BLK 2 LT 8
~~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAM E 1PHON E J~NEw
Fl, /vlAIRLObUI Z~'7-- J~ ~UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION ' NO. OF BEDROOMS
DISTANCE TO:
~ ~ ~ Z Manufacturer ~C ~O~~ Mat3~ ~ No. of c~rtments
Li~.,c~acJty~ ~oin gallons IF HOMEMADE: Inside length Width Liquid depth
~O ~ DISTANCE TO: Well Dwelling PERMIT NO.
~ ~ ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation Nearest lot line PERMIT NO.
~ Z DISTANCE TO:
~ ~ ~ No. of lines Length of each line Total length of lines Trench width Distance between lines
~ inches
~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area
~ inches
Length 3 ~' 'Width j ~ ' Depth ~ I PE~
~ Type of cri~ Crib diamete~ Crib dept~ ~Tota} effective absorption area
Well Building~tion Nearest lot line j j 1
DISTANCE TO: J J 7 l
~ Clas~ ~ ~ Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line ~ Septic tank ~ Absorption area(s)
OTHER
PiPE MATERIALS ~ __~ I
REMARKS ' _ ,~ t
72-013 (Rev. 3/78)
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological & Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL (Please complete either Io, lb or lc.) A.D.L. NO.
~.JBorough Subdivision Lot Block ~l ~/4qttl. Section No. TownehiPND Range EF-~ Meridian
WELL LOG . Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLETION
Material Type Top Bottom
~ I"~/~ ~. ~ J~/~,I~A~ F)~/~ ~t~ ~ ~1' ~ ~ Irrigation ~ Recharge ~Commerlcal
diam. ~ In. to 7~ ft, Depth Weight ~lbs./ft.
diam. in, to__ft. Depth Stickup
9. FINISH OF WELL:
__ Type: Diameter:
Slot/Math Size: Length
Set between ft, and ft.
Backfilling Gravel pack
......... ~ Above or ~ Below land lurface
--' Equipment used; ~1~/~
..... DEPT. O~ m~
.... ,,¢~tr~l p~O~C'JO~ II. PUMPING LEVEL below land lurface and YIELD
I~.GROUTING Well Grouted: ~ Yel ~ No
_. .m
I&~ ~ I~.PUMP: (if available) HP
~ Length of Drop Pipe ft. ~apacity g.p,m.
14. REMARKS:
16, WATER WELL CONTRACTOR'S CERTIFICATION:
15. Water Temperature ~e ~ F ~ C
This well was d~lled under my jur~sdictlon end this report is true to the best of my knowledge and belief;
Recj~s~e~ed Business Nome Contract License Number
Authorlzea Represenfolive
I~'Orm O~-WWR (11/81) COpy Distributions: WHITE-S~ofe DGGS, PINK-Driller,
.?2;; E: il..-..ii r:"::'
:'2: ,::i. 0 e '1.7.
0 2 ,.'" :t. E: ,.." :iii: q-
I',tF:ll:;[:r" Ft Ht:':IF;;:L. OH
:1.0 0:1. E; 0 N i F:' F:i E. E]
FI N C i...I., t'::t i.:( :9 9 5 C~ q.
;2 7 7 ..... ::L 6 9 4
E L (3 I"':I.:' ..... '
?,!::?'T'H TO F:' ! F'E EOTTC!H (F:'"'!'. ':'-
GF~'.F:I',,,'EI.... E:,EPTF'! ,:'F"T. ':,
To"r'F~L. DEPTH (F'T ::,
GRFI'v'EI_ !4IDTH (F.."'T. ::,
GF.:R'v'EL L..EI'.,tGTH ,:: F::'T.
GF..:R',,,'EL. 'v'OLLIHE; ,:: ('.;.i...I. '.r'E.,'..:.:;. )
TFII",II'::.' :51 ZIiE ,:: LEd::IL.S Z:,
S 01 L... !:;;:F:!T ]: I'-,iG ,:: :!'.:;(:".!. FT. ,.'"BF.: .':,
:+::'!': TI:::'It",II'::: [,I1...1:!:"..;"1" l".lt::l'v'E FIT I....EFtST TH(] I .... i'"It::'I:::IF.'"FMEJI'.,ITL::i
I CERT I F"r' TI'"IFIT:
t. I Ftl'd F'"RI'dlI_IRF.': I.,.tI'T'H THE REQUIt:;'::EHE]'.,fTS F(]Iq: ON-SI1.'E SEI.,.tERS Rt',tD 1.4ELLS FIS SEET
F.-ORTH E?.r' THE i,'iUN I C: I PF. ILI T"r' OF' FINC:HOF;?.F:IGE: ,:: MOFI ;:, FINE:, THE STFITE OF FIL. FISKFI.
;:T.':i I.'.tILL IHSTFiL. L. THE: S'¢STEM IN FICCORE:,FINE:E Hi't"Fi FIL. L I"10Ft CO[;'ES FIN[;, REGULFITIONS.,
FIND IN COHPLtFII",ICE HIT'H THE DE:SIGN C:F4:ITE;F.:IFI OF THIS F:'EF. ff'1IT.
3: t I.,.II'LL RE)HERE TO FILL F1OF! F:IN[:, STFtTE:. OF FtL. FISk;F:I REQUIF.'.EMENTS FOR THE SET E:FICI<;
D i :STF:INCES FF.:OH FIt'g"r' E'~::": I':_"::'t" I NG HEL. L., 14FtSTEHFFFE'F:: B' I SPOSFIL. S'¢STEM OR PUE:L I C
E;EHERFtGEE S'?L'."ii;TEH ON 'T'HI:i~: OF.: Fil",l"r' FI [;, .~r FI C: E: N T OF.: I'.,IEFIRE','?' L..OT.
4-. I UI'.,I[:,EF.:STFtNI:) 'T'HFiT TH I S F'ERH i 1'' I S VFtL. I B, F'OR FI MFI',,-:: I I',/LIM OF 4 E:EE:,RF,;]HS FII'.,I[:,
F'IN'¢ EI'.,tL.F-hr.;b:iiii.EHE:NT 1.41 LL REQU I F..'E: F:IN FI[:,E:, I TI ONRL. PERr,11 T.
IF Ft I...IF"T' ::-.', "i" Fi T :I: O N IS INSTFII._I_E:[:, i1'-,I FIN FIRE:FI -':',,,'EF.'E'D B'?' MOFI 8.1IL[:,ING F:nE:,ES.,
THEN ,:'I ....... ", FIN E:t....E]i:1.'Fi:IE:FtL. F:'EF;.:M!T FIN[;, INSF'!i.2CTION hlUST E',E OBTFtINE[;,.~ ,::::.", H'"'=-""E, UIL.¥_,' '':'
t.,.!It....L. !'.,!OT BE: FtF'PF;..:O',,,'E:[:, 14ITHr" J1.' FIN EL..E:(:::TI;E':IE:FIL. INE;F'ECTIEH'.4 F.tE.F':R"I'.; FIND ,::"~', THE
:.-T, I (.~it'.,fEE:, [;,FI-r'E · ~
1:5 E L FI.":, B'¢ E:'F!']" E '
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOl LS LOG
[] PERCOLATION
TEST
PERFORMED ~OR: ,,T;m ~' Vi ~k ;~T'~.~l~
3
4
5
~'6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DATE PERFORMED:
S SITE PLAN
WAS GROUND WATER j/~) t
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
COMMENTS
TEST RUN BETWEEN FT AND FT
CERTIFIED BY: ~O~
PERFORMED BY: ~.o~L
72-008 (6/79)
DATE:
· .~, r,t ~ t,n- Lot 8
amp
Lest ho] e.
2 0
"- J : r, ~ ?, ! 0
F.r~-.7':,r'~ T.~te grr,_~.s Tir;,e r~t T;
I
' .....
' ! . .i. iii'L] ................... i';...;I]_'..'."f]-i-.' i'' !~'i ....
' ' :~ir, ute ~ Field
~er-ol~t;r~n F, ~_ t. e
- ' a ~i[,~: S~ en~. a,~ Pit
. . . - r,:~F,,th Fo
Cr~,:,~h;~- 150 s~.jua]:e fgot l'equ.ired.per t.)edroc, m (rom m~nus 1'
-.. ~ r ~ f-:~ r ~ -Y DavJ..d Paul
i
?er(or~,ed
Lecal
Th~s
F r, r_ _ _T?~._ T_~.~}~r .................................. Date ~'erformed 7-30-77
5escrimtion' Lot 8 ~i oc.k2 S u b d i v i s i o n___Ate_i~er. Subdiu5 sion-:
Form Ret, otis Soils Loa____~.~ .................... Percolation Test ..... = ...........
nenth
- Soil Characte.ristics
Feet
.......... Red-dz-sh-'Si'l't
/
4 .... Slightly Silty Sandy Gravel
-Damp
Bottom of test hole.
20
Idas ground
l~ Yes, At ~,.,'-~at Denth?
t
Pit Drain Field
i
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
~/'" ~).~] ~ ~'~ HAA # ,..~\ ~.~ c[.~ ~_~,.~ ~\
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) ¢~z//~ ~./-~,~'/~,/- /_,,~.
Property owner
Mailing address
Lending agency
Mailing address
Day phone
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: F ¼
TYPE OF WATER SUPPLY:
Individual well
Community well
X
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: 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.
KND Engineering
Name of Firm o~A~ ~,~._~ ........ Phone ~/~'~ -~/////
Address Eagle River, AK 99577.8736
Engineer's signature
DHHS SIGNATURE
/~' Approved for
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date /~ -/~Z- ¢7'>...,~-
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
Legal Description:
A. WELL DATA
Well type ~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744
Health Authority Approval Checklist
~Za/~ ~3/~:~ ,,2 Parcel I.D.:
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to 7~ Casing height (above ground)
Wires properly protected (Y/N)
Date of test
Static water level
Well production
FROM WELL LOG
AT INSPECTION
/7' t~l~
/~ g.p.m. 3.
WATER SAMPLE RESULTS:
Coliform ~
Date of sample: /,~//~ff-
B. SEPTIC/HOLDING TANK DATA
Date installed ~/~Z,/~4 Tank size
Ce
Nitrate
/' ~7/,~'t2/~ Other bacteria
Collected by: ff/[/.~ ~-(~ .
Foundation cleanout (Y/N)
Date of Pumping
! /
ABSORPTION FIELD DATA
Date installed q3~/t~' /
Length ~'~// Width
Effective absorption area ~' 7~
Date of adequacy test
/~Y,ffO Number of Compartments a2
Depression (Y/N) /P/ High water alarm (Y/N)
Pumper g~da'~'a~Ot ~/qff,~.~06//ff~/~
Cleanouts (Y/N)
Fluid depth in absorption field before test (in.); 2~ ' Immediately after~/gal, water added (in.):
Fluid depth jS/4/t~ Minutes later: ~ tjx,' (in.) ~,D-~O 4- g.p.d.
Absorption rate =
If yes, give date
Peroxide treatment (past 12 months) (Y/N) /9/
Soil rating (~:~[4ft3 o~ ~' System type ,~v//
!
Gravel thickness below pipe ~ t, Total depth ~, /
Monitoring Tube present(Y/N) ~/ Depression over field (Y/N) At/
Results (Pass/Fail) f For z// bedrooms
LI~T STATION
Date installed ~ / Size in gallons
Manhole/Access~'~'~ ~u~Pump on ' level at*'' e~"Ptlmp off'" level at*
High w ra~alarm level at* / *Datum /
Cycles tested ~/
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
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:
Foundation /t9 t 4- Property line /0 '"*' Absorption field :5' ' 4-
Water main/service line Z~ '4- Surface water/drainage /tgZ9/4-- Wells on adjacent lots /tgt0 ~ -/'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation //9 ~ "/'
Surface water
HAA Fee $
Date of Payment /fi_)/'5 ~'~--
Receipt Number / '~::~':'~¢9,~
Rev. 8/95 OSS: haa.wk.doc
Water main/service line &frs t ~
Driveway, parking/vehicle storage area .~t~ t 4
Curtain drain gt~) t ~ Wells on adjacent lots
ENG~EWS CERTI~CATION
conformance with MOA H~ guidelines in effect on this
Signature
~, ~ Waiver Fee $
Date of Payment
Receipt Number
OCT 05 '95 10:20~H HTL ~HCHOR~GE P.1
NORTHERN TESTING LABORATORIES, INC.
INDUSTRIAL AVENUE FAIR6ANKS, ALASKA $9701 (907) 456-3115, FAX 456-31P.$
FArRBANKS S?RI[B"r ANGHORAGE, ALASKA 9950:3 (907) 277-8378. FAX 274-9645
LE'I'I'ER OF TRANSMITTAL
Date: lCt/0~g5 , Job~
Time; From:
TO:KNDENGINIIIIIRINI~
From: [ ] Fairbanks
IX] Ancho~'~e
Attn: Thrs Is Page 1 of
Subject Matter:
N[t~te result for Iongtien Atelier La B2 ia 1.4re_n/L_ ._Enclosed ia re~ulf~ far Tetal Coliform_,,
Comments'.
Copies to:
Fairbanks Fax#
Anchorage Fax#
(907) 456-312S
(907) ;?40645
Date Faxed~ 13y ~
Tranunit via:
[ ] Facsimile:
[] Mall via:
[ ] Offier:
please indicate =artier
If Transmission error occurs call
at' (907) 277-8378
Julie
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 AT t~ L;~¢'~ ~2~ D1¥15 I01'J j
Location (site address or directions) c~ ~,~0 ,~-~-. /..t~_,~.
Property owner
Mailing address
Lending agency
~LOL~J Day phone '~ '3 3 -15'4'7
Day phone
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4 X,
Day phone
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: 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
o
Si
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.
Nameof Firm /3r(.A~id.A- 5'v'C~pl~one ~'~8 '~.4~,/.~.¢'~'"~/7/
Address ~'~-"7 1
Engineer's signature
DHHS SIGNATURE
/~ Approved for
Disapproved.
Conditional approval for
bed rooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-O25 (Rev. 1/91) Back MOA #21
Legal Description:
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Parcel I.D.
RECEIVED
~~i~ MAY 9 1991
f¢,u:~ c i)~,~v ot Anchorage
Dept. Flealth & Human Services
A. WELL DATA
Well type ?P-,t~/~TE:
Log present (Y/N) "~F_-~
/
Total depth ~ ~
Sanitary seal (Y/N) YE---. S
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed -7/~-.~'/~ Driller ~J' I~
/ I/''' Il'
Cased to ---j c~ Casing height
Wires properly protected (Y/N) ~----~
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
g.p.m.
AT INSPECTION
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot | I "/
Public sewer main I~
Public sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
!
/
WATER SAMPLE RESULTS:
Coliform
Date of sample: ~,/2,/.cj I
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
N it rate
Tank size
Foundation cleanout (Y/N)
Collected by:
Other bacteria
Compartments
~/F---~ Depression (Y/N)
Alarm tested (Y/N) ~/A
NONF--.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
/
Well(s) on lot l O ~" On adjacent lots ~'~ ~O(~ Foundation '~'~' /
To property line '~1'~ ! Absorption field [ (o / Water main/service line
Surface water/drainage Iq[pr >'> lO0t
72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
~e~i i '.__._~__ Manufacturer
Size in gallo~s-'~'""~ ,, Manhole/Access (Y/N~J
Vent (Y/N) ---- ~at~- __~p off" level at
High water alarm level~~Cycles tested
Meets MOA electrical ~J~
j~mt On adjacent lots Surface water~"'--.~..~
D. ABSORPTION FIELD DATA
Length 3(o !
Width ['7 I
Gravel thickness I ~..// Total depth
Total absorption area C:~"7 ~)
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N) NO
Cleanouts present (Y/N)
Date of adequacy test
for
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
/
Well on lot ( J'7
!
On adjacent lots ~'~' IO~ Propertyline
To building foundation '~"7 / To existing or abandoned system on lot N
Onadjacentlots ~"~ t~I~ /
Cutbank ~ ~ Water main/service line
Surface water ~ ~ ICG / Driveway, parking/vehicle storage area ~ ~
Curtain drain ~~ ~ ~v~ ~~ -- ~ -
E. ENGINEERS CERTIFICATION ~ ~ ,~ /
I certify that I have checked, ve~if~d, or conformed to all MOA and HAA guidelines in,,~ffec~n the date of this inspection.
Date
¢. ~ROFEss~O%
HAAFee$ /~ (~ 0 U
~ ~-~ Waiver Fee: $
Date of Payment ~,,.~ ~Or,~ ( ~ Ck.~___~~ Date of Payment
Receipt Number ..... Receipt Number
72-026 (Rev. 3/91) Back MOA 21
CHEMICAL & GEOLOGICAL,'LAB O TORY
5633 B STREET ANCHORAGE, ALASKA 99518" ~I'i:[.EpHoNE (907) 562-2343 FA{(: (907) 561-5301
ANALYSIS REPORT BY SA.t~LE for ~RKo~dert 32968
Cllant Sample'ID:TA? WATER 9340 ATELIER DR Client Name :AK ~ATER & WASTEWATER SERVICES
PWSID :UA Cliant ~cct :AK~WS
Collected APR 2 91 ~ '20~00 ~s, BPO t PO ~ NONE RECEIVED
Received APR.3 91
Preserved With :AS REQUIRED O~dered By :3EFFRB? A, OARNESS, P.E
Analysis Completed :APR 3 91 Send Reports to:
Laboratory Super,visor,:STEPHEN C. EDE I)AK WATER & WASTEWATER SERVICES
· ... . . _ '/ ...... >:' .,~¥_,:~/.. ........................... 2)
Chemlab Ref #: 911205 Lab 3mpl ID: 1 Matxlx: WATE~ ~
lllowabl,
Parametez Te~ted ~esult U~t~ ~ethod / Ll~t~
NITRATE-N 1.2 ~/1 EPA 353.2 10
Sample ROUTINE SAMPLE COLLECTED BY: JEFF GARNESS, P.E,
Remarks:
1 Tests Performed ' See Special Instructions Above UA-Unavailable
ND- None Detected "S~e Sample Remarks Above
NA- Not Analyzed LT-Lass Than, OT-~rea%er Than
Alaska Water & Wastewater
"Preserving the Last Frontier"
May 31, 1991
Services
ECEIVED
MAY 3 1 19- I
ealth & Human Services
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section
P.O Box 196650
Anchorage, Alaska 99519-6650
Ref:
Curtain Drain Site Plan; Atelier Subdivision,
Lot 8, Block 2.
Attn: Susan Oswalt
[)ear Susan:
Attached is a site plan for the curtain drain on the subject
lot. I "shot" the elevation of the leachfield and the
curtain drain and found the curtain drain to be 42" higher
than the bottom of the leachfield. In short, it is not
possible for wastewater to migrate from the leachfield to
the curtain drain. Currently, the curtain drain is
approximately 50 feet down slope from the leachfield. For
the reasons stated above, I am requesting that the 50 foot
separation requirement be waived for this particular case.
According to the home owner, the curtain drain was installed
in the fall of 1990,
If you have any questions and/or comments please feel free
to contact me. Assuming all goes well, please hold the HAA
for pick-up.
Sincerely, //~
ness, P · E.
O~er/Consultant
JAG/jag
ma rioS. ups
Telephone - Fax 338-3246 · 8471 Brookridge Drive · Anchorage, Alaska 99504
¢.uoF'~ .' -' .
I II~t CE.7953 .o .~
I '... .."';~
Alaska
May 6, 1991
Water & Wastewater
"Preserving the Last Frontier"
Services
RECEIVFD
MAY 9 1931
Dept. HeJlth & Human Serv'ces
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section
P.O Box 196650
Anchorage, Alaska 99519-6650
Ref:
Health Authority Approval (HAA); Atelier Subdivision,
Lot 8, Block 2.
To whom it may concern :
Attached is the HAA application for the well and septic
system located at Atelier subdivision, Lot 8, Block 2. The
following is genera] information regarding this application.
1. The well and septic system were both tested for
adequacy. Water was pumped from the well to the septic
system at an average rate of 2.7 GPM for six hours. The
total volume of water pumped was 972 gallons. The septic
system was able to absorb the entire volume without filling
the drain pipe. The well was pumped at a rate of ~.25 gpm
for 2 hours. The drawdown ranged from 4 to 7 feet between
pumping cycles and stabilized after the initial 10 minutes.
Consequently, the well test was discontinued after 2 hours.
2. There is a curtain drain installed approximately ],5 'feet
(downhill) away from the absorption bed. The bottom of the
curtain drain is approximately 6 feet below grade according
to the home owner. The bottom of the absorption bed is 6
feet below grade according to the original inspection
report; however, it appeared to be several feet deeper thai]
that when I placed my test float into the monitoring tube
during the adequacy test. In short, I don't believe that it
i's possible for "water' in the absorption bed to migrate to
the curtain drain.
Due to the large lot sizes in this particular
subdivision, the separation distances from adjacent wells
Telephone - Fax 338-3246 · 8471 Brookridge Drive · Anchorage, Alaska 99504
and septic systems was much greater than 100
Consequently, those distances were only verified
greater than 100 feet.
feet.
to be
Please mail the HAA to the home owner.
If you have any questions and/or comments please feel free
'to contact me.
Sincerely, /~
~9~W~e~Co nsu 1 rant
JAG/jag
marlo2.wps
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicants Name /Vier c' ~-/~,~ Telephone - Home Business
Applicants Address ~ ~--"~ E- ~C"~ ~ c~.~( /r~ ~'Z 1~ f
(c) Appliqant is (check one) LeMing Institution ~ ; ~er/builder ~
Buyer ~ ; Other ~ (~plain);
(d) Lending Institution~ Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f)
Mail the HAA to the following address:
2. T~pe of Residence
Single-Family~
Number of Bedrooms
3. Nater Su~pl~
Individual Well~-~
Multi-Family ~--~
Community ~--~
Other (describe)
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 Di,sposal'
Onsite ~ 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]
En~ineerin~ Firm Providin~ Inspections~ Tests; File Search~ Data and Informatf. on i?:?
As certified by my seal affixed hereto and as of the validation date shown below, !
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 Manicipality 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 regula-
tions in effect on the date of this inspection.
Name of Firm
Address / Z o ~*., ~ 3 "~ ''& /Jr,~ ~/i, ./~ ~..
(ENGINEER SEAL)
Date
DHEP Approval
Approved for t'r3(~ ~ bedrooms
Approved ~ Disapproved
Terms of Conditional Approval
Telephone
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 REQUIRE-
MENTS. 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.
(DHEP SEAL)
RR4/eJ/D18
[Page 2 of 2]
7 -19-84
ao
MUNICIPALITY OF ANCHORAGE (MOA)
A mO TY (mm)
CHECKLIST - FEBRUARY 1984
Well Classification
Well Log P~esent ~/~)
Total Depth ~ ! ~ Cased to
Static Water Level ~ o
Casing Height Above Ground ~- /~3- '
Ele~t~.ical.Wiring in Conduit _~) ~
Separation Distances f~cm Well:
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
MAR
If A, B, c~ C, D.E.C. App=oved(Y/N)
Date Ccm~leted Jvly ~_~-/~ Yield /~ ??~..-
Sanitary ~al on ~sing ~)
~essi~ ~nd ~l~ead (Y~
To Septic/Holding Tank on Lot /o. y 4~ ; On ~djeining Lots ./v-~ (160' 4)
To Neamest Edge of Absc=ption Field on Lot ~ ; On Adjoining Lots A/ ~ ~10d%')
TO Nearest Public Se~sr Line . . A/.A To Nearest Public Se~r
Cleanout/Manhole ~t/~ To Nearest Sewer Se=vice Line on Lot /.J,4..
Water Sample Collected By . ~ ~ ..~ ; Date. ~v/~ / ?5- .
Water Sample Test Results ~ . , :! . ,, .
B. S,,,EI~[,C/HOLDTNG TANK DATA
Date Installed f-m2-~. ~ Size /2_ 5-0 NO. of Ccmpazrtments
.,
Cleanou~
Dep=ession over Tank ('Y/~ Date Last Pumped
Pumping/Maintenance Contract on File (.Y/N) ;v~-; for
Holding Tank High-Water Alarm (Y/N) . x/~ Tempo=ary Holding Tank Permit (..Y/N)
Separation Distances f=cm SePtic/Holding Tank.'
To Water-Supply Well / 0 c~ . .~
To gToperty Line , ,
To Water Main/Se=vice Line ,,{.0'--~
course /00
To Building Foundation ~-/3- ~
To Disposal Field ._ /~' ~
TO St=earn, Pond, Lake, c~ Major D=aina~e
Receipt % .%3~ q~~
Date Paid: _,%_Q,o~_ ~%-.--
Amount: k~%~, OO.
[Page 1 of 2]
2-15-84
Ce
ABSORPTION FIE~D DATA
Soils Rating in Absorption Strata
Date .Installe~
Width of Field:
Square Feet o~ Absorption A=ea
Depression over Field (YQ
Results of LaSt Adequacy Test
~J'/~.. Type of System Design
Length of Field ~ ~
Depth of Field ~ ' ~
Gr, avel Bed Thickness-- /!~ L
~$ ~ Standpipes P=esent'6~//N)
Date of Last Adequacy Test
Separation Distance f~cm A~sCrption Field:
To Water-Supply Well
To Building FOUndation
Lot
' '
To Water Main~.:iService Line
TO Stream/Pond/Lake/c= Majo= Drainage Course
To D~iveway, Parking Area, c= Vehicle Storage Area
//~ ' To P=operty Line / [ '
~ ~.t ~ TO Existing or' Abandoned System
; On Adjoining Lots ~ d~o'~ /o~. To Cutbank(if present)
De
LIFT STATION
Date Installed
Size in Gallo~s
"Pure9 On" LeVel at
High Water A1arm Level at
Tested for
Electrical Co~s (Y/N)..
Cc~ents..
Dimensions
Manhole/access (Y/N) ~/%
"Pump Off" Level at .....
Vent (Y/N)
Bm~ping Cycles du~ing Adequacy Test.
Meets MOA
** Check Permitted Bedroom Rating A~ainst HAA Request
I certify that I ~ave checked, verified, Or conformed to all MOA HAA Guidelines in effect
on the date of this inspection. [ _~__~~--~
' .... -' -"°~.'~I ~
I
·
,;..
2-15-84