HomeMy WebLinkAboutAUDUBON HILLS BLK 2 LT 8Onsite File
supposed1983 deep trench i's
disabled with concrete plug. Based on
1999 THI 1983 Trench 'I's ion Ground water
and cannot be used
Municipality of Anchorage Poge 1 of 5
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: SW990235 PJD Number: 015-251-58
Name:
CAL AND FRAN DUNHAM Wastewater System: [] New · Upgrade
Address:
12301 AUDUBON DRIVE, ANCHORAGE, AK 99516 ABSORPTION FIELD
No. of Bedrooms:
Ph°ne:(907) 545--2471 3 rlDeep Trench ·Shallow Trench i-IBed rlMound DOther
LEGAL DESCRIPTION o.s o,D/,,. ~
8 2 AUDUBON HILLS 2 F~ 2
- - - 0 - 1 F~ (~-0 & 4~-) 84' TOTAL F~
WELL:
5 ~ 2
[]
New
[]
Upgrade
cl ~ ~ Ft. 600 ,W. F~ ASTM D-5054/F-810
Driller: tC.'~\'~ ~ Drfll.d: O[ofl= Wo'mr Lev. I
· C~,~"S EYE EXCAVATING 7~0/99 - 8/2/99
~ .. TANK
,~SEPARATION DISTANCES · ~.~c [],olding [] S.T.E.P.
-rom Tank Reid SteUon Tonk s.w.~ u.o. ANCHORAGE TANK 1000
Well 100'+ 10O% - 25'+ STEEL 2
~oo'+ ~oo'+ - - LIFT STATION
Surface
Water
Foundation 5'+ 10'+ -- -- --
I
Drain = NONE KNOWN
I
Remorks: BENCH MARK
; TOP FRONT CORNER OF LOWER RETAINING WALL
(RAILROAD TIES)
IAumed E3eveUon: 108.82
.
Inspections performed by:. AWWC, INC. Dates: 1st 7/50/99
3rd 8/4/99 L~ XJ ~ fr~A_'_~;
Department of Health and Human Services approval uh;,% ... . ..
Reviewed
and
approved
PERMIT NUMBER; AS BUILT D~WING PARCEL ID NUMBER
SWg90235 ' 015-231-58
ST1 36,3 28.4-
ST2 41.9 55,1
A~S~ WATER AND WAS~WATER CONS~TANTS, ~C.
sam ~[m~ ~o~. suiT[ 2~. ~c.oma[. ~.
AHDCBON HILLS, LOl 8, BLOCK 2 ,... ..... ~,~ ~ ........
AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE .....
PRePAReD FOR: PHONE NUMBE.:
345--2471 q~ ..... "~
CAL AND FRAN DUNHAU (907)
BUILT DIL~WING pARCEL ID NUMBER:
PERMIT NUMBER= AS 015--231 --58
SW990255
~(OM ~ ~ (A~)
(A~)
ALAS~ WA~R AND WAS~WA~R CONS~TANTS, INC.
AUDUBON HILLS SUBDIVISION, LOT 8, BLOCK 2
AS-BUILT Or SEPTIO SYSTEM UPGRADE "
OAL AND rRAN DUNHA~
DATE:8/5/g9 ID~wN BY: IscA~:
Depa~lment of Health and Human Services
On-Site Services Program
825 L Street, Roam 502
P.O. Box 496650, Anchorage, AK 99549-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jul 29, 1999
Expiration Date: Jul 28, 2000
Permit Number: SW990235
Legal Description: AUDUBON HILLS BLK 2 LT 8
Design Engineer: 0041 AK Water & Wastewater Consulta
Owner Name: Cai & Fran Dunham
Owner Address: 12301 Audubon Drive
Anchorage, AK 99516-2424
Parcel ID: 015-231-58
Site Address: 012301 AUDUBON DR
Lot Size: 58095 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.
Date:
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B ~ Anchorage ~ Alaska 99504
(907) 337-6179 -Fax (907) 338-3246
Consulting Engineers
July 19, 1999
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic Upgrade Design for Lot 8, Block 2, Audubon Hills Subdivision
To whom it may concern:
The existing 3 bedroom house is served by a private septic system and a private well. The
existing septic system consists ora 1000 gallon septic tank and a deep trench type drainfield. The
existing drainfield will not pass an adequacy test and must be upgraded prior to the sale of the
house. One test hole was excavated on the property. Comments regarding the proposed design
are summarized as follows:
1. SOILS: Attached is a log which shows the soil profile, and the percolation test results. The
soils below the organic layers are a ML/SM material to a depth of 8.5 feet to 12.5 feet (bottom of
test hole). Between 8.5 feet to 12.5 feet, the soils also transitions to a SP material. Groundwater
was encountered during the excavation of the test hole at 12.5 feet and seven day later,
groundwater was found to be at 9.7 feet. Two percolation tests were performed in the test hole,
one between the depth of 4.0 feet to 4.5 feet which had a percolation rate of 4.2 minute/inch; and
one between the depth of 7.0 feet to 7.5 feet which had a percolation rate of 10 minute/inch.
2. TRENCH DESIGN:
a. Percolation Rate: 4.2 & 10 minutes/inch
b. Allowable Application Rate: 0.8 gallons/day/ff2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 563 ft2
f. Total Depth: 4 feet (max.)
g. Effective Depth: 2 feet
h. Width: 5 feet minimum
i. Reduction Factor: 0.70
i. Minimum Length: 80 feet total length (2 ~ 40 feet long each)
j Effective absorption area = 571 f~2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHy: As can be seen on the attached topography site plan, the average
topography in the area of the proposed upgrade is approximately a 15 percent slope running from
east/southeast to west/northwest; in short, there are no slope concerns.
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, or 244-9612. Thank you
for your assistance.
Sincerely, ~
Jeffrek/q. Gp]mess, P.E., M.S.
Presic~ent [J
NOTE: Attached is a site plan drawing, a design drawing, two soils logs, a topography site plan,
and a 4 page construction specification letter which are all part of the design package for this
septic system.
~,~ ~ J BEDROOM HOUSE ~ -- / --
HUFFMAN ROAD ~ ~ / /
~AS~ WA~R ~ WASTEWATER CONS~T~TS, ~C. ~ OF I~
AUDUBON HILLS SUBDIVISION; LOT 8, B~OGK 2
CAL AND ~RAN DUNHAM (907) 345-247~ .'"
~.~. ' · ........ .-'
GALLON SEPT1C TANK
/-~ .__ ~.//
ALASKA WA'I'I~R AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD, $UI1£ 2B. ANCNORAOE, AK. 99504
P.oNB: ~907~ 557-B.9/FAK; (907> .8-~246 .~¢...?'"~
AUDUBON HILLS SUBDIVISION; LOT 8, BLOCK 2
~E oP WOR~= 'r-';~ I/ '-~-" _2 .........
PREPARED FOR: PHONE NUMBER:
CAL AND FRAE DUNHAM (907)345-2471
DATE:7/'9/99 IB~AwN B¥:K.D.w. I,c~[B:' = 30' IPA°E: 2 OF 2
ALASKA WATER & WASTI~WATER CONSULTANTS, INC.
6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK. 99504
I SOIL LOG - PERCOLATION TESTI F~..'..'.t~/~'~, '.....~-T~O~
L CA. DESOR,PT, O.: AUDUBON .,LLB SU D,V, ,ON; LOT 8. 'OOK 2 .......
PERFORMED FOE: CAL AND F~N DUNHAM
DATE PERFORMED: 7/9/99
"~,, ".2......"~
ORGANICS
2 ~ SOIL C~SSIFICAIIONS
IH ML/S~ W~TH GH ~ CL
~{I SOME SMALL GC OL
~OCKS ~ ~ ~ HH
~ ~~ OH
~ sc
DEPTH TO
[~1 sM/ML GROUNDWATER DATE
~l HARDER 8.25'-SEEPING 7/9/99
DIGGING 12.5' 7/9/99
9.7' 7/~ 6/99
10'-~-' ~ I I
11 DATE READING CLOCK NET T~HE WATER LEVEL NET DROP
..% TIME (MINUTES) READING (INCHES)
12 ~*~ 7/12/99 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING
13 __ ~ 3:09 6"
14 ___ 2 _3:39 30 2 7/8" 3 1/8"
3 __3:39 ~ 6"
15 ~ _ _ 4 4:09 3~ 3.0" 3.0"
__ 5 4:09 6"
16 --__ _ 6 4:39 30 5.0" 3.0"
17
19 PERCOLATION ~TE 10 (HIN./~NCH) PERC. HOLE DI~. 6 (INCHES)
20 TEST RUN BETWEEN 7.0 FT. ~ND 7.5 FT.
CO~ENTS: PERCO~TION DATA ON THIS PAGE FOR UPPER BENCH PERC. HOLE ONLY.
PERFORMED BY A~SKA WATER & WASTEWATEE. ~, JEFFE~ A. GAENESS, CEETI~ THAT THIS
WAS PE~FO~ME~ JN ACCOSDANCE
DATE: 7//~/~ WITH ALL STATE AND MUNICIPAL GUIDEUNES ~N EFFECT ON
DEPTH TO
GROUNDWATER DATE
8.25'-SEEPING 7/9/99
12.5' 7/9/99
9.7' 7/16/99
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
6901 DEB,ARE ROAD, SUITE: 2B * ANCHORAGE, ~m 9~504
I SOIL
LOG-
LEGAL DESCRIPTION: AUDUBON HILLS SUBDIVISION; LOT B~ BLOCK 2~"~IFIJ-I"'~:'~'~.,/.....r,r.~..~.~?~r~ ................
2-- SOIL C~SSIFICATIONS
I~ GM CL
~ GC OL
SW NH
5~ ~ SP CH
SM 'OH
6-- · SC
7-- ~ DEPTH TO
3ROUNDWATER DATE
0
11 -- ~ DATE READING CLOCK NET TIME WATER LEVEL NET DROP
~ TIME (MINUTES) READING (INCHES)
12~ 7/12/99 PERC, HOLE WAS PRESOAKED ~+ HOURS PRIOR TO TESTING
o 1 3:08 ~ 6-
~ ~ ~:28 10 2 3/8" 5 5/B"
15 -- ~ 5 3:28 6"
17~ 3 5:4~ ~ 6-
4 3:58 10 3 5/8" 2 5/8"
18~
5 3:58 6"
19 ~ 6 4:08 10 5 5/8" 2 5/8"
PERCOLATION RATE 4.2 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
20 ~ ~
TEST RUN BETWEEN 4.0 FT. AND 4.5 FT.
COMMENTS: PERCO~TION DATA ON THIS PAGE FOR LOWER BENCH PERC. HOLE ONLY.
PERFORMED By A~SKA WATER & WASTEWATER. I. JEFFR~ A. GARNESS, CERTI~ THAT THIS
WAS PERF~M~ IN ACCORDANCE
DATE: ?/fq/q~ WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON
l~ 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
NAME IPHONE ~EW
MAILING ADDRESS
LEGAL DESCRIPTION
:LOCATION ~ NO. OF BEDrOOmS
Well / I Absorplti~a~a Dwe)ling :Z~' PERMIT NO~
DISTANCE TO: [ ~I /W ~ ~ ....~ ~O~
~ ........
~Z Manufacturer ~ ~,~~ Matorial~~ ,o. ofc~partmonts
kiq. ca~ac~tg m ~allons H~moe: [ Inside length ~idth kiquid deoth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~_~O Z < Manufacturer ~ Material Liquid capacity in gallons
~= DISTANCE TO: Well [ ~7 ' Foundation~. Nearest~llne/ PERM ITNO. *~4
Z~_J,~O ~ '~O ~ ~ * inches
O~ ~ TOPLengthOf tile to~i~ ~sh gradeWidth MateriaIDepth~*X ~~beneath tile ~~mches T°taIpERMiTeffective abs°rpti°n area~
Type of crib Crib di~~ Crib depth Total effective absorption area
~ DISTANCE TO: Wel~ Building foundation Nearest lot line
~ ~ Depth ~ / ~ Driller~~ Distance to~lot line,. PERMIT NO.
Building foundS' Sewer line ~" Septic[~ / Absorp~i~s)
~ DISTANCE TO: ~ .~ r .....
--~ ~ r ITM
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER ~</
REMARKS ~ ~ '
.
. " '/
· : ~ICip~¢Ty OF ANCHORAGE
"~ ENvIRONM~NiAL
APPROVED gtC[l~¢' LEGAL
72-013 (Rev. 3/78)
PERMIT NO.
II'.ILiI'-.I I C: I F;RL I T'T" ']JF RI'-.IE:HC-4F-:RGE
[:,EF'RRTMENT I HERLTH RN[:, ENVlRONMENTRL FITECTION ~///,/)
:E:25 '"L"' STREET., RNC:HOF.'.RGE, AK. 99501
264-4720
I..-..IELL RI'-.I[:, C,l"-.i--'=~ I TE 5EL...IEF;;_' F'EF-."I'-I I T
( L::]'.0-'=.'04 )
RF'F'L I CANT
LOC:BT I ON
LEGAL
DANIEL ¢'¢f'Nf~: ~a~r
LOT 8 BLK 2 RUDOBON SUB
C:,.-"O THOM FISCHER: F'. 0. BOX ]:-40
LOT SIZE '9'B. 9'..~ SQUARE FEET
T'¢PE OF SOIL ABSORF'TION SYSTEhl IS' TRENC:H
r,IR:~-.':IMI_IM NUHBER OF BEDROOMS = _=-':
SO I L RAT I NG (S_-4 FT,.-"BR ) = 125
THE REQUIRED SIZE ElF THE SOIL ABSORPTION SYSTEM IS'
E:,EF"TH= 11 L EI'-.,I G TH = '==- '7 I-~ E: R'-..' E L E:,EF'TH= 7
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE iS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
PERMIT APPLICANT HAS THE RESPONSIBILIT'¢ TO INFORM THIS DEF'RRTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS RE:,JRCENT TO THIS FR_FEF..T¢ RN[:, THE
NUME:ER OF RESZ[:,ENCES THAT THE WELL WILL SEF.:',,,'E.
TI. ICI (: -2 ) I I'-,ISF'EC:T I CII'-,IS RE:E I:;:E~]:!LI I F-:EE:,
BRCKFILLING OF RNY S'f'STEM WITHOUT FINRL II",ISF'EC:TIOI",I RN[:, RPF'ROVRL BY THIS
[:,EF'RRTMENT W I EL E:E SIJBJEC:T TO PRFiSE ,:_ T I OI'-,L
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR R PRIVATE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMLIM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMidUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEF'RRTMENT WITHIN 2-:0 DRYS
OF THE WELL COMPLETION.
OTHER REC!UIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
A'v'AILABLE TO INSURE PROPER INSTALLATION.
P E ~-: t-1 I T E ::-:: F' I ~-: E S [:, E C: E £'1 E: E ~-: ~---: 1 .. t L="- :------: "~-::
t CERTIFY THAT
t: I AM FAIdlLIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIE:EN=: IS E.'E..LE[: TO INCLUDE MORE THFIN 3: E:EE:,F.:OOMS.
S I GNEDS ~-'"~¢ ~,~_~_~_f~___
~F'F'L I CR~T.~ [:,RN I EL F.'. 'r NRR
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
3
5
6
7
8
SLOPE
SITE PLAN
10
~11
12
13
14
15
16
17
18
19-
2O
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
.~,
TEST RUN BETWEEN FT AND FT
COMMENTS
(
Box 1369, STAR ROISTI~ A ASCRORAOE, ALASKA 9950~
844-7714
SlX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF
DRILLED AT THE RATE OF
9/,.or:'
PER FOOT.
PROPERTY OWNER
r+. ~'. S~},'.
LOCATION OF WELL SITE ....
""a'n." a CL:'u.'~ r~,'~ '?a.r?,',,-.?.L 9,~;.LI~..;n~, ~o ".l~ ~.
DRILLER
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF i'Ll~AiA'~
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART DRILLING WORKS
SERVICE CHARGE 0 F 1Yz% PER MONTH WILL BE ASSESSED ON P
MUNICIPALITY OF ANCHORAGE
Department--'f Health and Environmenta~Protection
825 .~ Street, Anchorage, AK. ~9501
.- 264-4720
* * * HANDWRITTEN PERMIT * * *
Permit #
WELL AN~~., ~..f-~5~R PERMIT
Applicant: ~t,~"> ~) -~ L. ~ ~ ~ Mailing Address:
Location: PhoNe Number: ~ ~ -
Legal Description: ~ ~ ~. ~.-~.~, c~d'D4. ~.~ Size:
Type of Soil Absorption System Is:
Trench: --- Drainfield: - Seepage Bed: - Holding Tank-
Maximum Number of Bedrooms: ~2__. Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH .... LENGTH GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no .set width for trenches.
The gravel depth is .the minimum depth of gravel between the outfall Pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE - GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this departmen-
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee-
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of'the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
Z certify that:
(1) I am familiar with the ~equirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bed~oms. .
Signe~: Issued by: ~~ ~~~
Applicant ~ . ~'
Date: ~ ~ -~-C~ '
SWP/024 (1/81)
~ e~ 264-4720
',-__ HANDWRITTEN P£RHIT
WELL A~~~~R PERmiT
Trench~ -~ Dratnfield: - ~eepage ~d ~ Hold~g Ta~k; , __
I~ N~r Of ~e~o~S; ~ / Soil ~t/ng(sq.ft~r) iYl; ........
~e ~q~ir~ SizG' of the Soil ~sorptton
{PTH '- . LENGTH _ '- SRAVEL DEPTH .... _ WIDTH
te length dJ_.-~mnslon t5 t/~e length(in ~eet) GE Ihs L~en~h o= d=ainE~el~. ~he
~th of a trench or pit tS the distance ~tween the surface of the ground and
m b~t~ of th~ excavation(In feet). There is no sGt width for trenches.
~ gravel dapth is t~e m~~ de~h of 9ravel ~tween th~ outfall ~i~ and
~ ~tt~ of t~ excavation(in feet), · ~ ~"'~
· * REqUiRED SEPTIC(HO~I~) TANK SIZE =-~:'' _ eALL~S · .
~:11attO~ ~s~=ti~S of a~y wells ag~ac~nt tO this pro~rty and the nu~
' ' "Two(2) INSPECTI~S ARE REQUIRED · * *
~$ll~g of any syst~ without f~al he~otion and approval by this departed
~ ~ubject tO ~OSee~ r .............. ~
m~ distance ~t~ a well ~d ~ny on-site s~wage die.sa1 system i~ 100 fee.
~ private well or 150 to 200 feet fr~ a ~bllc well de.haling u~n the
~biio well. gin~ distance fr~ a private well ~o a private se~ line
~5 f~et ~ to a ~~ity s~er line t~ 75 feet Nell logs are requir~
mu~t ~ ~~ %o ~his de~~e wlthi~ 30 ~ays of the well
-~f r~quir~e~ts ~Y apply. ~iflcations and uonstruction dtagr~s are
{table to insure p=o~r ilstallation.
,. · e · PE~IT EXPIRES DECE~ER 31, 1 9 8 3 * * *
i':(1) I ~ ~liar with t~e requ~e~nts for on-site sewers and wells
] ' set~ort~ by t~ M~lCipality of ~ohorage. .
~'(2) I~ill i~siall~the syst~ tn accordance with o~es., _ .
(3) y~er~a~d ~~ on-site sewer syst~ may require ~lazqemen~
(1/81)
Parcel I.D. 015-231-58
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Expiration Date: i,,k(A
Complete legal description Audubon Hills Block 2 Lot 8
Location (site address) 12301 Audubon Drive
Current Property owner(s) Evelyn Haley Day phone
Mailing address 615 E. 82nd Ave. #100 Anchorage, AK 99508
Real Estate Agent Day phone
2. TYPE OF DWELLING:
FF] Single Family (w/wo ADU)
❑ Duplex
F1 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
rX_1
Individual
ED
Individual Water Storage
❑
Holding Tank
0
Community Class Well
El
Community
❑
Public Water System
R
Public Sewer
❑
Waiver/Variance request for:
Received by:XD X - Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Distance:
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at
the time of installation.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
Date 3/12/2018
OF- („ lk
: _tri •.
6. DSD SIGNATURE ....... .
-J System #1 Approved for bedrooms Seven R. F56nnone
CE -8149
System #2 Approved for bedrooms s
Disapproved �')' SSIiNt'
Conditional approval for bedrooms, with the following stipulations:
\-A v1
WATER AND
o
IASTEVVA I tmpppr.RA�A PJo
By: 'PJJ UO �' t out, -Lk) Ejk, f (.,h J Original Certificate Date: 01)1Jj
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory r
Septic System Advisory Arsenic Advisory t
Well Flow Advisory Other
i
COSA blue sheet f c
Audubon Hills Legal DemnhPhon� ~ ~~' '° '~~^^- �~^ ~
A.WELL DATA
PrivateVVeU�pe |fA.B.orCprovide PVVS|D#
5/12/1983 Sanitary N^
��becomp|ebadharymea| �YN)��_
Total depth 300 40'+ft. Cased to'ft�
FROM WELL LOG
DDat�J1�/1���
ate �''~'~~~
Static water level UDknOVVO ft
Well production qon ~ g-/zm_
WATER SAMPLE RESULTS:
Coliform NEG oo|onies/1O0mL Nitrate �6.89
0[l ��
Arsenic ���__ ug/L Date nfsample: 01A
~'/�~/�~'`
B. SEPTIC/HOLDING TANK DATA
���n�r��f��|
TonkType/Mahaha| `^ r^'`~^~ '
Tonkoiza�_1,000gal. Number ofCompartments 2
Ifmore than 1septic system hsonthelot
COSACheck|iet#1o�__
Structure served bythis system 1____
Parcel ID: 015-231-5R
WellWellLog (Y?N)\/
Wires properly protected (YYN)_'_______
Casing height (above ground) _, 1A+ _n.
AT INSPECTION
10/30/2017
A
~-�. �
0.7�+
- �— 9 -P.M.
Collected by: PIES
Date installed 7/30/1999
Foundation cleanout (YYN)Y Depression over tank 0 N 9N) High water alarm (YNDate of pumping YN)
3y2/2018 Pumper A+ Home Se[V'CeS
Date installed ""��~"=� Soil rating (g.p.d,/ftzorft2 lbdnn) °=~="~u5 S°IBIR System type "=l—~=^'0 -p"-0
40/44/30 ��/�/��� 2/2/7
Length 40 Width~' ' ~ �� Grave be�wp�e~_._�_,_'___fL
�''= m «a `� KJ
Tota depth �'�� E�ebaorpUonarea*�^ [Nonhohnghube____ �epr*ooionover�e|d��__
1�/��/��17 Pass3
Date ufadequacy 0ao RaouKa(Pemu0FaiU_�����_ Forbedroome
Fluid depth inabsorption field before test 0/0/74`~ in. VVaka 480 gal. c/o/rr N�wdepth_._.__in.
160 0/0/74 �1�0+
E|apnedTime�min� Fine|8uiddepth_in� Abno��innreb*^= '~~ g.p.d.
yJO
Any n�uvenedontreatment (past 12mo.)(Y/N&type) '` |fyes, give date _________
D. LIFT STATION
Date install"Pump on" level at
Datum
ed
_ Size ingallons __
in. "Pump off' level at
14m&*I;xzriii Zf-1T4V L031211111 91 &1 r-110 WWI
WELL ONLOT TO:
Cycles tested
Septic tank/lift station onlot 100+
Absorption field onlot 100+
+�
Public sewer main 75+
Sewer /septic service line 25+Animal containment areas
50+
_ Manhole/Access (Y/N)_
in. High water alarm level st
Meets alarm & circuit requirements?
On adjacent lots � '~~
Onadjacent |ot10Df
� '~~
Public sewer manhole/cleanout 100+
f
Holding tank '~~ 100
Manure/animal excrete storage eraon100+
SEPTIC/HOLDING TANK DNLOT TO:
Building foundation 5+ on Property line 5+Water main
1O+ Water service line 1O -F
Wells unadjacent lots 100f
ABSORPTION FIELD ONLOT TO:
1Of
Property line '~ Building foundation 10f
Water Service line 10+ Surf1OO+
Surface '~~
Cud5Of VV
Curtain ~ eUoonadjacent lots 100+
Absorption field 5f-
e|d.^.__
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 10+
in.
F. COMMENTS
*Well cap does not create @ sanitary seal. There iSDo gasket between casing and cap.
**Old drain field appears to be tied into new field with a flow splitter and in use.
G. ENGINEER'S CERTIFICATION
/ certify that /have determined through field inspections and
review of Municipal records that the above systems are /n
conformance with MOA COSA guidelines ineffect onthis date.
Engineer's Printed !�tBV8n Pannonenh*dNume ~
Date"' ~^-~'~
�U1�/�01�
oos*canary nhevt-u-6-1smm
Engineer:
Legal Description
Parcel ID:
Permit:
Report Type:
Municipality of Anchorage
On -Site Water and Wastewater Program
P.O. Box 196550 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http:llwww.muni.org/onsite
�<ee_e
`It1 5c
Review Comments
PANNONE ENGINEERING SERVICES
AUDUBON HILLS BLK 2 LT 8
01523158000
OSC181083 WellSeptic
COSA
�-\1 C 11 j'
f
llC:l)81'tCI1C.ilt
4/5/2018
Completed By: T.Ecklund
The application has been reviewed and the following comments have been generated. These are to be satisfactorily
addressed prior to MOA approval:
After meeting with Ross, Jeff, Steve, and myself the conclusion to the previous comments were.
1. Document and note on checklist all stand pipers per IR found or update survey
2. The diverter valve to 1983 Trench to be adjusted so all flow is directed to the 1999 trenches. The diverter is then to be
disabled with a concrete plug
3. Note to be placed on COSA that 1999 trench appears to be in ground water and not for future use
.Retesting not necessary on 1999 trench
Municipality of Anchorage
.... .........
Development Services Department
Building Safety Division Ks F
Nv
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
w,,vw.muni.org/onsite
(907) 343-7904
Certificate of On -Site Systems Approval 9 OSC 18108' )
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 8 of
Audubon Hills subdivision. This inspection revealed a nitrate concentration
of 6.89 milligrams per liter (mg/L) was reported for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 mg/L for public drinking
water systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Frons Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby' disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical"
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
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To
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. # 01 5-231 -58 HAA#
1. GENERAL INFORMATION
Complete'legal description Audubon Hills; T.ot 8, Block
Location(siteaddressordirections) 12301 Audubon Drive,
An~horage~ Alaska 99516
Prope~y owner cai and Vran Dunham Day phone 345-2471
Mailing address
Lending agency
Mailing address
Day phone
Agent .Day phone
Address
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well ~
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site xX
Holding tank
Community on-site
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
o
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
AI.ASKA WATER & WASTEI
Name of Firm CONI ~U,LT~
Address 6{~ ~
Engineer's signature (~7~ ~
7l/
Alaska Water &
W. tewater Co.su ta
DHHS SIGNATURE
I// Approved for ~ bedrooms.
· h.j&~spection.
Phone
E21~
Disapproved.
Conditional approval for
bedrooms, with th-e 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 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.
Municipality of Anchorage J~ E C E i V E D ~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division AUG 1 9 1999
825 L Street, Room 502 · Anchorage, Alaska 9950~1~d~@i7p~rtt~;~A7,~Z~orage
uept. Health & Human Services
Health Authority Approval Checklist
Legal Description:
A. WELL DATA
Well type PRIVATE
Log present (Y/N)
Total depth 500
Sanitary seal (Y/N)
AUDUBON HILLS; LOT 8, BLOCK 2 Parcel I.D.:.
If A, B, or C, attach ADEC letter. ADEC water system number
YES Date completed 5/12/83
015-231-58
Date of test
Static water level -
Well production
WATER SAMPLE RESULTS:
Coliform 0
Date of. sample: 7/19/99
B. SEPTIC/HOLDING TANK DATA
Date installed 7/30/99
Foundation cleanout (Y/N)
Date of Pumping NEW
C. ABSORPTION FIELD DATA
Date installed 8/2/99
Length 44' & 40' Width
N/A
Cased to 40'+ Casing height (above ground) 12"+
YES Wires properly protected (y/N) YES
FROM WELL LOG AT INSPECTION
5/12/83 7/1/99 ('TED MORE, P.E.)
32
5 g.p.m. 5 g.p.m.
Nitrate 3.49 mq/L Other bacteria 0
Collected by: A.W.W.C.~ INC.
Tank size 1000 Number of Compartments 2 Cleanouts (y/N)__
YES Depression (Y/N) NO High water alarm (Y/N) NO
Pumper N/A
Soil rating (g.p.d./fF or ~/bdrm) 0.8
5' Gravel thickness below pipe
Effective absorption area 600 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N) __
Date of adequacy test NEW Results (Pass/Fail) - For ;~
YES
System type SHALLOW TRENCH
2'Total depth ~*' MAX.
NO
Fluid depth in absorption field before test (in.);
Fluid depth - (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
Immediately after gal. water added (in.):
Absorption rate = -
If yes, give date -
g.p.d.
.bedrooms
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N) .....
·, vel at* *Datum
H~gh water alarm le _ ~ *Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 100'+
Absorption field on lot 100%
Public sewer main N/A
Sewer/septic service line 25'+
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation 5'+ Property line 10'+ Absorption field
"Pump off" level at*
100'+
100%
N/A
N/A
5'+
Water main/service line 10'+ Surface water/drainage 100%
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+
Wells on adjacent lots 1 oo'+
Water main/service line 10'+
Surface water 100'+ Driveway, parking/vehicle storage area 35'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
ENGINEER'S CERTIFICATION ///
F.
I ce~i~ that l h~ter~ f~ld inspections and review of Municipal re~~~ems are
in conformance with ~/~id~lines in effect on this date.
Signature ~, ~J~l V ~
HAA Fee $
Date of Payment.
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OFANCHORAGE
DEPARTMENT OF HEALTH'& HUMAN, SERVICES -
Division of Environmental Services: -
On-Site Services Section
P.O. Box196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE. FAMILY DWELLING
~, , . . ., ~-: . . - ....... , :. --..¢- ·
Parcel I.D.# ~F'~\g-~-:~-~\ -~ ': "' ....' ':?.'?.;.:~' ' NAA#
1~ GENERAL INFoRMATIoN ":;: :'? '~:~ ;': '"' :'"';':;-:;~;~':=;'", ~ ..... '
..... Complete legaldescription ~~ ~'~ ~'~ ~~' "
. Location (site address or directions) '~--- -~ '} '
: c ': ~1 r~--
, .......... i,.~,-:~ -- "":'
. ,.-: _. '. :~ '.. ~ ' ., ::...-,. : :'~':-',:
· :,: , ~::_,~ - ... :- ~:,. i:!, ::. .,
........ .... .'-
"~:":':: '. ProPe~y oWner...:
: . , 'i-...Mailing address
:,: : , ,-',,,, ~:':!':;i: Lending agency ~_
: '" -': '"add ress ""
[..: "" ' ont"
· ':' '" '.- ing to the leoalit~'andstatU'Sofs¥~tem.
" ' ' 'OFWASTEWATER" DISPOSAL.'
4. ~ TYPE
: :'. ..... ~.~,.~. . .,, .... ,-
-'- ' ,. ' :~': :':,-.¢~: Indwldual on-site:, ::-,t.,,;;~ :.
': .~., :' ~ .... . ,':,:.~' Holding
, , , Pubhcsewe . · . -.
confirmation, from
NOTE: If community wastewater
;'::::i,,'..,~ .? ...... . ' attesting to the legality ahd sta~b~"Ef,'s':Ystem.
72-025 (Rev. 1/91) Front MOA it21"
· .:.~. ;: .. ::..:,,,,,.. .-," ": ' -:-,.~
written confirmation from State ADEC ,, ,,:
5. STATEMENT "OF INSPECTION BY' ENGINEER
As certified b'y my seal affi:x~d hereto and as of the validation date shown below,
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate fo r 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..J~'~ .~,~ '~~FoJ~//~.~ Phone
Address '~_ '/~ ~c~,~//¢./~. ~::~/'~,~,~7/'//~/"~.//
Engineer, SSignature ~~~ ./~:2__.~~p Date ~%? /
verify that m y
James
?';'. i':--- ;? "-/' ".;2~,;:':. ~; ...;'.-, .': .:-!' 7:,': ...... ;"-. ';"
..... .~ ¢3':~;': C app'ro~l for' '-';'''''; bedrooms, with the following stipulations:
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 ~o 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 engineers work.
:~,
.T:
T2-O25(Rev. 1/91) Bac~ MOAit21
?
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~-~J ~ ~'%'~c',~- ~ ~'~-~ ~:/~ ~////~-~ Parcel I.D.
A. Well Data
Well type /~?? i('?c~ ~'; ~
Log present (Y/N) ~'~
Total depth ~ d--/~ ~
If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~x/;? .~ ! Z~' Y :~ Driller
Cased to ~ ~ ' ~,,~ ~)
. Casing height ~'~-- ~-"- ~'
Sanitary seal (Y/N) "~
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
Wires properly protected (Y/N)
g.p.m.
AT INSPECTION
;On adjacent lots
;On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform /;~ Nitrate
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date insta,ed / :>
~/O ~ Tank size
Cleanouts (Y/N) ~ Foundation cleanout (Y/N)
High water alarm (Y/N) /~/~
Date of pumPing ~ ~ ~/~ .~ Pumper
Well(s) on lot i On adjacent lots j ,~ J'~ - Foundation
To property line Absorption field ,~ Water main/service line ~/~'/''~
Surface water/drainage /'X//'~ ~/i ~
/
72-026 (3/g3)' Fro~t
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
..._ "Pump off" Level at
High water alarm level '""'-, ,.-~Cycles tested
Meets MOA electrical codes (Y/N)
Well on lot ~ On adjacent lots
D. ABSORPTION FIELD DATA
/
Date installed ~..¥'?~-- ~'~) Soil rating (GPO/Et2)
Length ~ ~ Width
Total absorption area
Date of adequacy test
Water level in absorl:~ion field before test
Peroxide treatment (past 12 months) (Y/N)
~_~' '~' Gravel thickness
Cleanout present (Y/N)
"~--- ~'~---d?- ? c~_.-~ Results (pass/fail)
Surface water
' Z
Totaldepth I [
'~/" Depression over field (Y/N)
!-~,? ~.~'-'~ for ~ ,/Bedr°°ms
After test
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots "~
Suflace water ~x,v~
Curtain drain
On adjacent lots '~'-/(.}L'? ' Property line
To existing or abandoned system on lot
C~bank /~' ~ ~ Water mai~sew~ line
D~ay, ~in~ehicle storage area ~
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 inspect'on.
.,,, ,. 01' 41
, i ~ '--~;'~",~, ~ '- '~'a ;~L ~, James F. $tzemore ,~ ,.~d~
HAA Fee $ . ~ c~ ,d__,r~ Waiver Fee $
Date of Payment ,~ '- '~ - ~;g~-' Date of Payment
Receipt Number //~--~ ~ ~'~D ,~7~ Receipt Number
72-02S (3~J3)' Back
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
264-4720
Application Date ~'"'-/I._..~"~/~,~:
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions) ., ,.: ~ ~' ,, ~
(b)
Applicant
Name
Home
~-~. ~~elepb~ne: ~ ''~ '~ ~ ~j ~siness
(c) Applicant is (chock OHO): kondin~ Institution ~; ~wn ~uyor ~ ' Other ~ (explain);
-' · ~ Tolephone
(d) kenOin~ Institution
Address ' .?..~ ~..
(e) Real Estate Company and Agent
Address
l'elephone
address:
(f) Mail the H,~A to the following ~
TYPE OF RESIDENCE
Single-Family,,'~~ Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual WelJ~ 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~ 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 ~ ¥~ ~"~,~,'Y1~-- (~'~'fL. ~--__~ct, c~1~elephone ._~_z"~.~__~'--"7 C'('~ ~
-Ct) : . ' : h l
Address
Date
Engineer's Seal
DHEP APPR~~k-~ ~'~ate
Approved for (~L(/_.I~__~ bedrooms b
Approved Disapproved Conditional
Terms of Conditional Approval
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
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 4/"Z e/Ze
Width of Field ~ ~/
¢/~¢-v~- Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
,_./
Square Feet of Absorption Area ~1 '~,~..~ ~
Depression over Field (Y/N) ~ O
Standpipes Present (Y/N)
Date of Last Adequacy Test
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot '¢
TO Water Main~' 55
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 ~, I~C;) I....~
To Cutbank (if present)
Comments
· ,.T S;A ,O. J"J
Date Installed ~ Dimensions ~
"S~jemi~ %~l'l'°LneSvel at .~,J'/' / Ma'~:/PA~)fcf'e'S~vYeiNa)t~~
Hig h Wate r Ale r m, J,~Cv-~el at ~ Vent~~____ ~______
Tested for ./'/ ~ ~,,/p~ping Cycles during Adequacy Test. Meets MOA
Electrical/es (Y/N)
Comme,~. s -
** Check Permitted Bedroom Rating Against HAA Request
I certify that l ha~e checked,~i-0;'conformed to all MCiA and. HAA guidelines
Signed /'~"~'~- ~, ~'k~%_,~_. Date
Company ~ ¢rt~ ~ (~1~o.
Receipt No. 3~ ~ ~ ~
Date of Payment ~"- \Co-
Amount: $ ~
Page 2 of 2
72-026 (11/84)
in effect on the date of this inspection.
APPLIC,-,NT FILLS OUT UPPER HAL, ONLY
, Phone
Prol:,erty Owne-,
Zip Code ~/~; ~.i',~ ,-~ ~ ~. _, .-, ·
Mailing Address
~u~e~ , .;-' ';:-" ,:~ /
Address ~ . ~' ~ ,. : .. , /~,. ~ , Zip Code -.; ....
' Phone
Lending Institution
Address Zip Code
Phone
Realty Co. & A~nt
Address Zip Code
Street Locati~ , ~
Type of Resi~nce
~ Single Family
~ Multiple Family No. of Bedroo~.
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach Icg if available).
~ Public Utility
Sewer Disposal
~ Individual Year Individual Installed: - '~ ?";
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Inspector Inspector Inspector Insp~
Field Notes: J~UNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
,4. ~ ~ ..-'~'~""~ ~ ENVIRONMENTAL PROTECTION
/~,.> ,~
AUG 4. '§"3
RECEIVED
(,'~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
< I CONDITIONA~ APPROVAL'
Soils Rating Date Sewer Installed Well To Absorption Area / ~ 7 ~' Well Log Received
? --- / ~. - ~' ~ we, to Tank / Z~ '~ ' Septic Ta.k Si~e
72-023
