HomeMy WebLinkAboutBEAR VALLEY BLK 4 LT 1Bear Valley
Lot 1
Block 4
#020-431-24
Municipality of Anchorage Page 1 of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW990454 PJD Number: 020--453--24
JOHN TRAWICKI Wastewater System: [] New · Upgrade
Address:
941~ SNOW BE~R DR~VE ABSORPTION FIELD
No. of Bedrooms:
Ph°ne:~907/( ~ 786--5474 ,3 [3Deep Trench [3 Shallow Trench ·Bed []Mound IOther*
LEGAL DESCRIPTION so,, ,.,,,, 2 c,e/e,. FL ,o~, ~.,~ ,rom o,,,.o,2.8
1 4 BEAR VALLEY 0,55 - 5.15 ~,. 0,25 FL
-- -- -- 0.8 -- 5.1 FL 30 FL
~. F~ 560 S~. F~ ASTM D-3054/SCH. 40
FL EAGLE MTN. EXC. 3/15/2000
FL FL TANK
SEPARATION DISTANCES [3 septic [] Holding ·
-rom Tank Field Station : Tank Sewer U.., ANCHORAGE TANK 1250
Well 100'+ 100'+ 100'+ 25'+ STEEL 2
Water 100'+ 100'+ 100'+ - - LIFT STATION
Line 5'+ 10',~- 5'+ -- -- 1250I ANCHORAGE TANK/ORENCO PRODUCTS
Foundation 5'+ 10'+ 5'+ - - -- TIMER ACTIVATED -~ 45"
Drain NqNE KNOW~ 20 OSI 05 HHF M.O.A.
Remarks: *3'HIS IS AN ,NTERM~TENT BOTi-OMLESS SAND FILTER. BENCH MARK
TOP OF MANHOLE LID.
97.68 FL
.:a'7"~,
Inspections performed by: AWWC, INC. Dates: 1st 3/15/2ooo ~.~.~: !//~/:~;~. · "/~'~/'
2nd 3/15/2000 '~': ....
3rd
5/20/2000
Department of Health and Human Services approval ~h t~ '".. . ."
Reviewed and approved by: ~Z~..~./ /Z/, ~ Date: ~-/~-~0 -~ e~ ''
~ ro f ess~O~
PERMIT NUMBER:
sw99o43,, AS-BUILT DRAWING PARoEL,u NUM.E,:
020-451-24
-- -- _ DRAINAGE DITCH__ ...... DRAINAGE DITCH
10' UTILITY EASEMENT
I( ........................
i 20' UTIIJ1Y EASEMENT
DBL1 110.78 78.55
ST1 ~ 5g.~7 133.2~
MT1 176.61 151.51
MT2 171.59 194.21
MT5 202.05 179.59
j MT4 197.58 177.63
A B
DBL1 10.78 78.55
DBL2 11.43 79.72
ST1 158.47 13,3.26
ST2 163.90 139.1
MT1 176.61 151.51
MT2 171.59 194.21
MT3 202.0~ 179.59
MT4 197,58 177.65
ALASKA WATER & WASTEWATER K.~.W.
'" *'~" :'~'~*': ~',~- ~'~,,,;, CONSULTANTS, INC,~-~;;:~.~,.~. ~ ..... ~ SCALE:
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
JOHN TRAWICKI (907) 786-3474 2 OF'
LEGAL DESCRIPTION:
BEAR VALLEY SUBDIVISION; LOT 1, BLOCK 4
tYPE OF WORK:
AS-BUILT OF SEPTIC SYSTEM UPGRADE
PERMIT NUMBER:
~wggo,,3,, AS-BUILT DRAWING ,,,~OE, ,,, NUMBER:
020-4,51-24
blN~5 94.8¢ ;~,~,, Cf ?PA ~'¢¢b ~ 94,60 (AVS.)
' ' 3/22/2000
....... ..~ ..... ......... ~: ~ ~ CONSULTANTS, INC. ~:: ...... ,~=.~ ,~ ....... SEAL[:
690 DEBfiRR ROAO, SUITE gB '* ANCHORAGE, AK 99SOA. * PHONE (907)337-6179 * FAX (907)33B-32&~ N.T.S.
JOHN TRAWICKI (907) 786-5474
LEGAL DESCRIPTION: /O/~F.~ 'f..J CFI '795~ o° ~.~
B£AR VALLEY SUBDiViSION; LOT ~..LOCK ,* %~'V""-:.i ...... '";¢~
BOTTOMLESS SAND FILTER (ISF) AS-BUILT
MUNICIPALITY OF ANCHORA GE
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: Dec 29, 1999
Expiration Date: Dec 28, 2000
Permit Number: SW990434
Legal Description: BEAR VALLEY BLK 4 LT 1
Design Engineer: 0062 Pannone Engineering Services
Owner Name: Fred Surd
Owner Address: PO Box 110546
Anchorage, AK 9951%0546
Parcel ID: 020-431-24
Site Address:
Lot Size: 46235 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field ~ SepticTank [~ 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.
This permit is issued in conjunction with the conditional Certificate of Health Authority Approval #HA990610.
Received ~ Issued By: /
Date:
Steven R. Pannone, P.E.
Consulting Engineer
(907) 272-8218
December 20, 1999
P.O. Box 102954
Anchorage, Alaska, 99510
(907)272-8218 Fax
Mmficipality of Auchorage
Dept. ofHeaith & Hnman Services
On-Site Services Section
IP. O. Box i96650
Anchorage, Alaska 99519
Subject:
Lot 1, Block 4 Bear Valley S/D
Conditional Health Authority Approval
Septic System Upgrade Permit Request
Ladies and Gentlemen:
i mn writing to request a Coudifioual Health Authority Approval be issued for the above referenced lot, as well as a
pel~mit to construct a replacement septic system. My film was contacted to perform a health authority investigation at
the referenced lot for an upco~ning sale. The system was lhll of water and backed-up into file septic tank with the
induction of 20 gallons of water, I was requested to conduct a soils iuvestigation and design fora systein upgrade. A
single test hole was excavated on Novetnber 19, 1999 to verify the soils. See the attached soils repml, percolation test
results, and upgrade design. Water seepage was noted at ten feet below ground smTace. This will be used as the design
elevation of the water table. No other water was noted. No bedrock was encountered in/he test bole.
The lot is approximately 45,000 square feet in size. Lot 1 slopes to the northwest at a rate of approximately 10 to 35%
perceut. The proposed upgrade installation will be located in the northwestern portion of the lot on a relatively flat
area. The proposed location is greater than 100 f~et away from any existi~g or proposed wells. The proposed system
will be greater than 10 feet from the water service lines. The new sewer service line will be located greater than 25 feet
fi'om the existing well. The proposed installation will not affect the future development of the sun'ounding or existing
lots.
I request a Conditional Health Approval be granted m~til the new septic system can be installed. Due to the adverse
weather, the system will be installed this spring, before July 1, 2000. The new owner is a single person, and in not
expected to produce significant sewage flows. I do not expect any health hazard to exist by granting this intenn
approval. Money is being escrowed to cover the cost of this installation.
Please contact me at 272-8218 or 227-3522 if yon have any questions about the proposed installation.
Sincerely,
Aaachments: ~.....h ................................... ~.....~
cswo~ ET 'ERS~ -4BEgJ{V~LEY.DOC ~9~'% ~t~ ,** ~ ~
PERMIT
P~
~DPDSED
SEPTIC
hF SiGN NO, 020-4m-_ 4
WASTEV/ATER ABSORPTION SYSTEM
LOT 1, BLOCK 3 BEAR VALLEY
i UNDEVELOPEd], NO WELL nR SEPTICS
x,~WITHIN 200 ~EET OF PROPOSED
INSTALLATION,
PROPOSED REPLACEMENT ~Y~TEM,
EACH 5-~IDE TRENCHE~ 4' EFF,
1 AT 46LF, 1 AT 54LF~ 500 ~F TOTAL,
C,\Work\]]RAWI~G\5OAJANET ~
ED
86' ME
?
/
?/
~-IN FAILURE, T~ BE
~- L6 ....................... ~..,
! Lb.- /,
3BR
WELL
3 BEDROOM HOUSE
PERC RATE 45 MIN/IN
SOIL RATING, 333 SF/BR
1000 SF RQD
5-~IDE TRENCH, 4' EFF,
RF= 0,50, i00' LONG
TOTAL AREA: 1000 SF
PREPARED FDR~
Mr, Fred Sur:
9111 Snow }~e~r Drive
Anchor~Qe, AK 99516
(907) 345-8463
PANNONE ENG, SVC
P, 0, BOX 102954
ANCHORAGE, ALASKA 99510
272-8218 Phone ~ F~x
DATE, 11-24-99 I DESIGN
SCALEI l'=lOO'
PERMIT
DESIGN DETAILS
~/ASTE~/ATER A]]SDRPTIDN SYSTEN
LDT 1, ]]LDCK 3 ]]EAR VALLEY S/D
P,I,]), ND~ 020-431-24
Z
o ~
?
C'\Wor k\I)RAWING\3-1SLAKE,)]~/G
PREPARED FDR:
Mr, Fred Sur~
9111 Snow Be~r Drive
Anchorage, AK ggS1G
¢907> 345-8453
PANNDNE ENG, SVC,
P, D, ]]DX 108954
ANCHDRAGE, ALASKA 99510
878-8818 PHDNE & FAX
~)ATD 11-1-99
NOT TO SCALE DESIGN
PEP, FOPSAED FOR:
LEGAL DESCRIPTION:
OR
BOH
~3/~_~3 ~ - ~RCOLATXON TEgI'
PANNONE ENGINEERING SERVICES
P.O. BOX 102954
ANCHORAGE, AK 99510
(907) 272-8218
Mr. ~ Sura
Lot I~ Block 4 Bear Vall ,ey S/D
Ora~ic-
Tcpso~
DATE PERFORMED: 11-19-99
Brown Silts w/
WAS GROUND WATER
ENCOUNTERED? Seep (~ -10'
IF YES, AT WHAT
DEPTH? - 10'
DEPTH TO WATER AFTER
MONITORING? -14'
DATE: 11-26-99
6130 ....
PEROLATION RATE 45 (rain/inch) PERC HOLE DIAMETER 6 inches
TEST RUN BEWTEEN 4 FP and 5 Fr
COMMENTS: Test hole excavated by A+. Test Hole was presoaked before perc test.
PERFORMED BY: Steven R, Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
ALASKA WATER & WASTEWATER
January 24, 2000
Municipality of Anchorage
Department of Health & Human Services
Division of Enviromnental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic System Upgrade for Lot 1, Block 4, Bear Valley Subdivision
(Bottomless Intermittent Sand Filter - ISF)
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. The existing septic
system consists ora 1000 gallon septic tank and a trench type drainfield. The existing system is
surcharged and must be upgraded. A design was previously submitted by Steve Panonne, P.E.,
and pelanitted by your department. The buyers of the property have retained AWWC. Inc to
redesign the system. We are proposing that a 1250 gallon S.T.E.P. tm~k and a bottomless
Intermittent Sand Filter (ISF) system be installed. Comments regarding the proposed upgrade are
summarized as follows:
1. GENERAL: A test hole was excavated on the west end of the lot by Steve Panonne, P.E.
and the origial stamped soil log is in the DHHS files. Due to the slow percolation rate of the
soils and the limited space available, it is our opinion that a Bottomless ISF system is the most
viable option, and will provide a long term solution to our clients wastewater treatment needs.
2. SOILS: Attached is a copy of Steve Panonne, P.E.'s soil log which shows the soil
classifications, groundwater monitoring, and the percolation test results. The soil below the
organic layer is primarily a ML/GM material to a depth of 14 feet (bottom of test hole). Seeping
groundwater was encountered during the excavation of the test holes at a depth of 10 feet and
after 7 days it was measured at a depth of 14 feet. A percolation test was performed between the
depth of 4 feet to 5 feet and the rate was 45 minute/inch.
3. DRAINFIELD DESIGN: Bottomless Intermittent Sand Filter (ISF)
a. Percolation Rate: 45 minutes/inch
b. Allowable Application Rate for ISF: 2 gallons/day/ft2
6901 Debarr Road, Suite 2B - Anchorage, AK 99504 ~ Ph: (907)337-6179 - Fax: (907)338-3246
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 225 ft2
f. Effective Depth below pressure pipes: 3 inches
g. Width: 12 feet
h. Length: 30 feet.
i. Effective absorption area = 360 fl2
j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank".
k. Air Supply Line: "Wasteftow" emitterline, 1/2 inch I.D, "Anchorage Tank".
1. Sand Material: In accordance with M.O.A. latest standards
m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and
less than 1% passing the #8 sieve.
We are proposing to excavate down to a depth of 4 feet (maximum), place a minimum of 6
inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On top of the sand,
we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We
will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so
that flow can be intermittently dosed to the ISF.
4. SURFACE WATERS: There is a streem that runs in the ditch along the north lot line. The
test hole was excavated 86 feet from the surface water.
5. TOPOGRAPHY: As seen on the site plan.
6. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the
construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation &
Maintenance Manual". The contractor should read this document prior to construction. Copies
are available at the Municipal Onsite Services office (5th floor, 9th & L St.).
7. CLOSING: I am open to any suggestions from your department, which would be an
improvement to the proposed design. I am unaware of any adverse impacts this installation
would have on adjacent wells or septic systems. If you have any questions, please contact me at
337-6179. Thank~ for your assistance.
J etFp~ ~. jGa~ss,j'P.E., M.S.
pr~idbnv --
6901 Debarr Road, Suite 2B ~ Anchorage, AK 99504 ~ Pr: (907)337-6179 - Fax: (907)338-3246
NOTE: THERE IS A 7 PAGE SPECIFICATION
t PACKAGE THAT ACCOMPANIES THESE DESIGN DRAWINGS.
CE. ARK SUBDIVISION~
~-- LOT 1, BLOCK 1
(.0
/ (SEE PAGE 2 OF 3) ~~'' (
~AS~ WATER ~ WASTEWATER CONS~T~TS, ~C.
BEAR VALLEY SUBDIVISION, LOT 1, BLOCK 4 J '
SITE P~N
J.W.M. 1 = 100' 1 OF 1
NOTES:
t THE mR COMPRESSOR SHALL Be LOCATED WITHIN THE BASEMENT OR THE GARAGE. THE CONTRACTOR SHALL
PROVIDE A 0-10 PSI PRESSURE GAUGE AT A LOCATION WHICH IS READILY ACCESSIBLE FROM WITHIN THE HOUSE .
NOTE: A 30 PSi GAUGE WILL NOT WORK.
THE AIR COMPRESSOR SHALL BE A THOMAS INDUSTRIES MODEL 5070. AS SUPPLIED BY ANCHORAGe TAND. THE
AiR UNE SHALL BE 1/2 INCH DIA. HDPE (1 PIECE). INSrDE A 2 INCH SCH.40 PVC dACNET. THE LINE SHALL BE BURIED
TO A MINIMUM DEPTH OF 3 FEET.
THE CONTROL PANEL FOR THE STEP TANK SHALL BE INSTALLED OUTSIDE THE RESIDENCE WITH AN
AUDIBLE/VISUAL INDICATOR INSIDE THE HOUSE.
J GENERAL LOCATION CONTRACTOR: SEE SPECIFICATIONS FOR
_ W~%~FbBA~W,i~(~ WDA~i~HR. "~ I SURVEYING REQUIREMENTS.
IF ........................
BE COMPLETELY ABANDONED EXISTING SEPTIC TANK
I [ BE COMPLETELY ABANDONED ,
100' SETBACK ~-- PROPOSEO NEW 1250 / ~'~'~''
/
~ .... ~ ,/_
, i ~%- ,.s..~o AIR.LI.E--/ ( EX,STING THREE ~ (SEE NO~).
~_ m I Z ' o --'' ~ (SEE NOTE) \ BEDROOM HOUSE ' / , /
/ ,111
iI FILTER. ~CA¥^TE A BED THA'~ IS '~ FEET DEEP , ~ /I
MAXIMUM BY 12 FEET WIDE BY 50 FEET LONG. \
DEE A~^CHEB DETAIL AND PRO.ER (.AGE 5 ~
OF 3) FOR CONSTRUCTION DETAILS AND
A~A$[c~A WA~nE~]~ A_ND WAS~E~WA~EE CO~Sfj~AtX~TS, ~TC.
990, DEBABR RO , ,B. ANOHOBAGE, AK. 99B0,
PHONE: (907) 357-6179/F.~X: (907) 338-3246 ·
BEAR VALLEY SUBIDVISION; LOT 1, BLOCK 4 ,
D~S'~N 0r SEPT~C SYSTEM U P~"ADE
=REPAREO FOR: PHONE NUMBER: ~h.'~e,.~ ..., i,~E_795.3 ....
JOHN TRAWICKI (907) 786-,.3474
)ATE:l/21/O0 JDRAWN BY: ISCALE: PAGE:
,~,W?R [.IN~ COIL. ~AC~Ig Al' ~/4,, PlA ~,"H 4c) r,v,'- LA'~A] ~ ~12' x~O' ~T0~55 I~
PROX. 2,~. ~NCO ('H&~,' ~l'~p' ~'~iN" ~
I '1
I-
PI~ blN~ FROM I~, (PRILD l/~ I~ P~
PLAN VIEW
/
M(
(~L ~F~ PIP~ ~ ~'~m) ~
~¢~'¢g~ PROFILE VIEW
PHONE: (907) 337-6179/F~: (907) 338-3248 "' ....
BEAR VALLEY SUBDIVISION, LOT 1, BLOCK 4
BOTTOMLESS SAND FILTER (ISF) DETAIL ..... . ....
~REP~ED FOR; PHONE NUMBER:
5~ ....'
786-~474
JOHN TRAWICKI (907)
1/21/00 J.W.M. N.T.S. 3 OF 5
S~nt By: Alaska WateF & WastewateP Consu; 907 338 3246;
~lar-l-o0 13:20; Page 4/4
-' RECEIVED
MAF~ 05 2000
~,~Utlictpahl r
~ F ' ~v, ces
FOE~~~ 0 ~ ~ '
Anchorage Dep~uen~ of Health ~,~,~ Human $¢rvic~ (DHHS) and ~lm property
This a~cmm~ is ma~e for ~hc purpose of m~in~dning an on-si~e was~ew~er disposal
syr, em on the subjec~ property.
'Z~e prolMr~ owners a~ee m ~e Following:
Submit to the Municip~Uv/of Anchorage, on an ,.nual basis, ~u i~pecQon and
opera~ion statement f~om a registered professional engineer. Thh k~pecQon and ,
operation ~a~ement ,h~! verify that ~ha eneineer.ha.s i~pec~ed all ¢ffiuenl .~ air
pumps, Qmcrs, and alarms, and that any deficiencies have been repaired and ~h~ the
sy~em is func~io~-2 as designed./
(s~e) (si~a~)
St:a~e of
~ Nan.) (Pdntcd N~)
........ NoCa~ize Hera ................. '-''' .... ~
persOna~ly appaared before ae,
~who ~a personally ~o~ to me
whose idenc~Cy I proved on the basis of ~
vhoo6 idenciCy I p~ovdd on che bach/affl~Ciou of
, a c~edible vituesa
to be ~he s~er of abo~documeng, ac~l~ed
Nota~ ~blic
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
IP'°NE O 6S I
NAME
I 3 ~ ~-'/' E~ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
lWell ~ Absorption area Dwelling PERMIT NO.
DISTANCE TO: J~O ~5 ~'~
~ Z Manufacturer Material No. of co~¢artments
Liq. c~p~city in gallans Inside length ~idth Liquid depth
[ O OO IF HOMEMADE:
. ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO,
~ -- ~ Manufacturer Material Liquid capacity in gallons
~ DISTANCE TO: Well I ~ Foundation ~1 Nearest lot line ~ O ~ PERMI~N~
Length of each line Total length of lines Trench width Distance between lines
~ N°'°flines / ~8 ~-8 ~O inches
-- Total effective absorption area
~ Top of tile to finish grade ~ Material beneath tile ~O inches
Length Width Depth PERMIT NO.
( ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
¢ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
PV C c I
SOIL TEST RATING r
INSTALLER
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
IHS WELL DRILLING
ANCHORAGE, AK 99501
. PHONE 34,,-3792
D R I L LER'S WELL L'OG
CASING DEPm
YIELD / ~- c~ ~ STATIC WATER LEVEL //
PUMP INSTALLED ~ TYPE
TO
FORMATIONS ENCOUNTERED AND APPROPRIATE DEPTHS
7-~:? ~_~ L ~. ~. ,,~-~..C,
! ,
MUNICIPALITY ur AiqC;
................. ~ .0 ECTION
F'ERM ! !" NO.
DEF'RRTMENT HERLTH RN[:, ENV I RONME:N]"PIL ~'.OTE:CT ! 0t",t
825 '"L.'" STREET., RNCHORRGE:., PIK.
264-4728
,:: 82e6t2 )
FIF'F'L Z C:RNT
L C C FI T Z 0 N
t_.EGRI..~
H R R R ~.' T E [:, S 0 N
Lt E:4 BEPIR ,- "'- '
,HLLET =,t.B
.3:EtE '9 [:,ENN I NGTON I::,R I ',,,'E
LO]" SIZE
,=,= ~-,=,= ,= E;C,~URRE F'EET
'f~'FE OF ':.~;OIL PIE,:,t.F. F tIOI",I S"r'STEM IS' I REN_.H
MFI;:'::.1:I'"IUM NUME:EF.: OF E:EE:,ROC~MS = :3:
SOIL RFITING ,::SI;:! F'I",."'E:R)= 2":.":~;
THE RE~]:!L.iI RED E;IZE OF THE SOILHE.:,' ""-]. F.'.PI"'" I ON.:,'-'~"'-:,TErl' I S '
E::, E.~ F' 'T 1.4 == :]_ "E'~ b. E[ I"',t iS 'T ~-t == -"J~ ;E; ,3 F;-': Ft %." E: L.. [::, E F' ]" t-4 == E;
THE LENGTH DIMENE;ION IS THE LENGTH (IN FEET) OF' THE ]"RENCH OR DRRINFIELD.
'T'HE DEF"T'H OF' Fi TRENCH OR PIT IS THE DISTRNCE BE'THEEN THE SURFFICE OF:' THE
GROUND RND THE BOTTOM OF THE EXCRVRTION <IN FEE]").
THERE IS NO SET I.,.!~[.',TH FOR TRENCHES.
THE GRIRVEL DEPTH IS THE MINIMIJM DEPTH OF' GRF!VEL BETb~EEN THE OUTFRL. L PIPE
F~NE:, THE 80TTOM OF THE EXCPI',,,'RTION (IN FEET).
FEF..,IIT FtF'PL..ICFIN"t" FIPIS THE RESPONSIE. I_I TO INFC~RM THIS [:,EPRRTMEN"t" [,_F.'IN6 THE
....'[ NSTFILLRT I ON :[ N =,F E _.T I cd'.,l'=; OF Rt'.,t'-r' HELLS FtE:,JFICENT TO 'TH I :=, r-~""'¢r,. _ r'""'r~"~"r_r,..~ ~" FIND 'THE
i".!UME:ER OF RESIDENCES THFIT THE; F.IEL. L .t4ILL E";ERVE.
-f"
BRCKF:' Z LL I
El- HR11 tENT
MINIMUM [.',ISTPINCE BETI.,.IEEN R HELL PINE) PINY ON-SITE SEHRGE DISPOSPIL. E";YSTEM IS
::LETO FEET FOF..' FI PRIVR'TE HELL. OR 150 TO 200 FEE¥ FROM Ft PUBLTC HELL DEPENDING
UPL")I'.,t THE T'¢F'E OF" PUBLIC t.,.tELt...
MINIMt.IM B"ZSTFflNCE FROM PI F'F.:T',,,'FtTE HELL TO PI PR I ',,,'RTE SEI4ER L. INE ZS 25 FEET RND
"FO R COMMUNIT',? SEHER L. INE IS 75 FEET.
HELL L. OGS FIRE RE('::!UIRED FINE:, r'lUST E:E RETURNEE:, TO 'THE DEF'F~RTMENT WITHIN 3~:..~.~ DFYT'S
OF THE WELL COMF'LETION.
OTHE:R REQUIREMENT':=; I'"lR"r' PIPPL'¢. SPECIFICRTIONS FIND CONSTRUCTION DIF:tGRRMS RRE
PIVFtILPIBLE TO INSURE PROPER INSTRLL. RTION.
F::" E If;: IPl~ ]E -f' E'; ?.-=: F' Z IF;:: E: ::E; [:. E: C: lEE It"1 E: E F-: -_-?: ::L ,., ± :E~ EE;
I CERTIF"¢ THRT
:L: I RM FRMIL!RR HITH THE REQUIREMENTS FOR ON--SITE SENERS RND HELLS RS SET
FORTH B"r' THE MUNICIPRLIT'¢ OF RNCHORRGE.
2: I HILL ;[Ns'r'RLL THE SYSTEM IN PICCORE:,RNCE 1.4I]"H TFIE CODES.
:.".-i:: I UNE:,ERSTRN[:, THRT 'THE ON-SITE SEI4ER S"r'STEM MR'¢ REQUIRE: ENLRRGEMENT IF:' 'THE
RESIDENCE IS REMO[:,ELE[:, TO INCLUDE MORE THRN 2 BEE:,ROOMS.
',,,'4. Eli
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
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lO
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WAS GROUND WATER
~.COU.~RED~
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time r~, Water Drop
· H~O ~ ~ ;~' ~ ,C~q
TEST RUN BETWEEN
..
COMMENTS '~-3~"') ~:]" 0~/4v~ j~-I-b~j~,~/,v¢ ( z~
PE.FORMEDBV: Oqa F Rtan /aSl . o. CERT,.,ED.V:
PERCOLATION RATE 2d, ~"' (minutes/inch)
~ ' ' DATE:
72-008 (6/79)
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.# ~- ~.~1 ---~.z~
1. GENERAL INFORMATION
Complete legal description Lo-¢ / ~-~ Lc ¢1~. ~-/
Location (siteaddress ordirections) ~1/I £.~ ~.~_~,~ %Or2,u~
Property owner
Mailing address
Lending agency
Mailing address
Day phone ~/~-¢4~
Day phone.
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. 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.
4. 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.
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
Address ~-~ ~o~
Engineer's signature~-~
6. DHHS SIGNATURE
Approved for
bedrooms.
X~LX
Disapproved.
Conditional approval for 3 bedrooms, with the following stipulations:
The septic system on this lot shall be upgraded pursuant to the attached
escrow for 1.5 times the high bid from a minimum of 3 bids. The balance of the
=..__~ ~L~11 ___1 .... ~ _¢ ..... ~ ...... Authority
escrow ............ bc ........... ~- apprcvcd Ccrtificatc ~ Ha~
Approval has been issued by the Department.
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 DHHS does this as a courtesy to purchasers of homes
and th~eir 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.
Legal Description:
Municipality of Anchorage /:...
DEPARTMENT OF HEALTH & HUMAN SERVr0~'S,.
Environmental Services DivisJccr~¢,~....
825 L Street, Room 502 · Anchorage, Alaska 9950"~/~.~ ~4~3-~4'7~4
Health Authority Approval Checklist
Parcel I.D.:_ (:~O- ~,"~/-~(
A, WELL DATA
Well type ~P
Log present (Y/N)
Total depth C~,,~
Sanitary seal (Y/N) ~"~
Date of test
Static water level
Well production
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~ ¢'~'~. -- ~,,¢~,¢c,c¢,t..,
WATER SAMPLE RESULTS:
Coliform '~¢~"~- ,--C~ --
Date of sample: ////~
Cased to /--/¢ '-~
FROM WELL LOG
g.p.m.
Nitrate
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
/,~/
~. '~-;.;~ Other bacteria
Collected by: .~' ["~:::~'
g.p.m.
B. SEPTIC/HOLDING TANK DATA
Date installed
Foundation cleanout (Y/N)
Date of PumPing
C, ABSORPTION FIELD DATA
Date installed ~/'f'2 / ~;~_
Lengt~ -~--_~ Width
Tank size
Pumper
¢/4::"~7~ Number of Compartments ~ Cleanouts (Y/N)
Depression (Y/N) ~ High water alarm (Y/N)
Soil rating (g.p.d./ft2 or fF/bdrm) _ ~%
~ C~ Gravel thickness below pipe
Effective absorption area ~:~ -~ '~ Monitoring Tube present (Y/N) Y
Date of adequacy test ~ f J ] I~/~'~ _ Results (Pass/Fail) '~'/'A fL_
Fluid depth in absorption field before test (in.);
Fluid depth ~2 '' (ins) Minutes later:_ ~- [~-~.-&
Peroxide treatment (past 12 months) (Y/N) .,,"L/¢-~
System type "Tr2C. CJ ¢(/--
~O" Total depth /
Depression over field (Y/N) ~
For ~ bedrooms
Immediately after ~ gal. water added (in.):
Absorption rate = /--T ~ G-f~Dg.p.d. .
If yes, give date ~ -
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N) ~ "Pump off" level at*
H'~~ *Datum
~sted
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot / C~ ~ ~ On adjacent lots
Absorption field on lot ~ ~ ~ ~v~ ,~"~,~k~n adjacent lots
Public sewer main /t/(~
Sewer/septic service line
Public sewer manhole/cleanout ,,t~
Lift station ./C~ ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation /--f: O'
Water main/service line
Property line
.~"-O Surface wateddrainage
Absorption field / ~' ¢
Wells on adjacent lots ~' c~ ~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
/
Building foundation ~'~ Water main/service line ,~--'c~
Driveway, parking/vehicle storage area ,.~-c.) ~
Wells on adjacent lots
"-'~ ~_.c ,.,.,~. '~z ~ c ~ t ~ ~' ,~ ~-
Engineer's Name
Date
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records
inconformancew~~guidelinesineffectonthisdate,
Signature_~_ ~'-'%,. ~-- ~ __
HAA Fee $. '--
Receipt Number ~
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
CT&E Environmental Services Inc.
CT&E Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
996294002
Parmone Eng. Srv.
N/A
L1 B4 Bear Valley W. Hose Bib
Drinking Water
0
Client PO#
Printed Date/Time 11/30/99 09:03
CollectedDate/Time 11/14/99 i0:00
Received Date/Time 11/15/99 11:45
Technical Director: Stephen C. Ede
Sample Remarks:
Parameter
Results PQL Units Method
Attowabte Prep Anatysis
Limits Date Date In~t
N]trate-N
Totat Cotiform
6.27 0.500 mg/L
TNTC~[i, No Fecal/lO0 ML
EPA 300.0 10 max 11/15/99 11/15/99 SCL
SM18 9222B 11/18/99 YAP