Loading...
HomeMy WebLinkAboutBERGGREN LT 4Berggren Lot 4 #017-092-37 e 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 1PHONE ~ ,~EW MAILING ADDRE88 LEGAL DESCRIPTION LOCATION~~ ~ ~ ~~ NO. OF BEOROOMS~ DISTANCE TO: I Well Dwelling PERMIT NO~ ~ ~ Manufacturer ~ ~e~- ~ Materi~ ~ e ~ No. of compartmen~ Liq. capacity in gallons, ~ IF HOMEMADE: Inside~,~ ~,~ DISTANCE TO: Well ~ ~ Dwelling Material ~ / Liquid capaci n ns t~ Manufacturer --A( ~ ~ Well Foundation Nearesttot line PERMIT NO~ ~ No. of lines Length of ~h ~e Total lengt% %es Trench %ohes Distance between4n~s~ ~' Top of tile to O I' ~nish -md¢~_ Material beneath tile ~i Total . Length b~ Width mC Depth ~, ~ ~ Typeofcri Cribdia Cribdepth~ ,~ Total effective ab ~ Well Building found ion Nearest lot line ~ DISTANCE TO: ~ ~ Class Depth Driller ( Distance to lot line PERMIT NO. ~ DISTANCE TO: ~ ~ ~ Building fovnda~n Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ~OIL TE~T R~IN6/ INSTALLER REMARKS . APPROV~ ~ , DATE LEGAL 72-013 (Rev. 3 ) F'ERtllT NO. APF'L I CANT LOCRT I ON LEGAL TOM BF..E::,L I N F' I C K E'F T S T L.4 E, ERa aEEN S,..'D T"r'F'E OF :,UIL HE,=,I_F4. E, TIFIN MR',:.:',IMIJM NUI1E, EF.. OF BEDROOMS SF.:R 17-..':6 ',/ :.r.::49 42E:S LOT S I ZE ,~8.5E:6 L--.,I"..:!UFIF. IE F'E.:E:'~)~ IS' TRENCH ~r'4Jc"~q~'~. =,LIL'-q RRTING ,::SLT.! FT,."'E,'R)= ~.~.5 ~--' ' -- / 'THE RE6!LIIRED SIZE nF THE SOIL HB---,CF. FTI_N S~'STErl IS [:, E: F"I'H = ::L ;='~: L E I"-.l~S T H = ~'~ ~%..~ F;:.' R ".,." EZ L / E:' [£ F" "F Fll ==-_.-':=' THE LENGTH [:, I MENS I ON IS THE LENGTH (IN FEET', i]F THE TRENCH CF.' [:,RRINFIELD. THE DEPTH OF Fi TREN..H I_,F.. F'IT I'= THE DISTRNCE BETWEEN THE '=,,IIF.'FRCE OF TFIE GRC'UN[:, RN[:, THE BOI'TOM OF THE; E~<C:FI'v'RTION (IN FEET',. 1-HEF.:E IS NO SET NI[:,TH FOF.: TF..ENL. HE_,. THE GF.:RVEL DEPTH IE; THE MINIMUH [:,EF'TFt OF GF.':F¢/EL BETWEEN THE nUTFRLL PIPE RND THE BO'rTOH OF THE E).~CR'v'RTION (IN FEET). F'ERMIT RF'PLICRNT FIRS THE F.:ESF'ONSIE:ILIT'.r' 1'0 INFORM THIS [:,EF'RF.:I'MEN'f' [:,LIRING THE '" ....... I '-- '--' I' - ' '1- ' "'' IN.:,FHL. LHTII_N IN_-,FEUTIJN_-, OF FIN'¢ WELLS R[:,..TRI_-:ENT TO THIS FF,_FEF..Fr RN[:, THEi NUMBER JIF RESIDENCES THFtT THE WELL WILL SEF.:',,,'E. - ......... l"' L..I i~i .:"..=_"-:" .':, I r-I .'=:-; F" E: i.'~. T I i]! ~-J '.El. R F-: E: [~' E ,:-T-,,. IJ I F~:'~ E'. BRCKFILLING OF RN'T' =,T.-.TEH WITHOUT FINRL INz, FEL. TION RN[:, RPF'RIDVRL. E"T'., THIS DEF'RR"rMENT N IL. L BE :,UB..TEL. T TO FRO:,EL. LIT~JN. .=,FI.I_,HL .::,m::, ,:., I MINIMUM [:'I'=.TRNCE BETNEEN R WELL RN[:' RN'¢ FIN-SITE '_=;EHROE [:'I'-'-~'--' '-'"-Tr'"'H ':: :~¢3() FEET FnF.' R PF.:IVRTE WELL.~ 2%¢'.~ TO 2¢.4E~ FEET' FF.'FIM R PJE, LIC HELL DEPENDING UPON THE T'¢PE OF PUBI_IC WELL. WELL LnG% RF.'.E F.:EC..!UIRED RN[:, MU=,T E:E F.'.ETURNE[:, TEl THE [:,EF'FIRTMENT WITHIN ~.~..:.~ [:,FI'CS OF THE WEL_L. CCIMF'LETI,.ON. OI'HER F..E.F.!UIF..EflENT::, '~lFl"r' RF'PL"r'. ::,FE..IFIC:RTION.::, RN[:' C:ONSTRUI'-':TIf"IN [:,IRGRRMS RF:'.E '" I , .... , ' H,,,FIIL. HE, LE TL"'I INSURE FF....FEE INSTRLL. RTION. E. ,-..-, F' ] Fl E "---~ [:, E C: E !"1 E: E F-." ~: :1... :1..:.:.. ,- .::, F' E F-.'t I'-1 I T ',, ..... ":" --"" "-:" I CERI'IFY THRT i: I RM FRMILIRR WITH 'F.HE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET F'ORTH BY THE MUNICIPRLIT"r"OF RNCHORRGE. ' 2: I WILL INSTRI-L THE $'~'STEM IN RCCORDRNC:E WITH THE CODES. '"~:: I LINDERSTRND THRT THE ON-SITE SEWER SYSTEM f'IR'¢ RE(.:!UIRE ENLRRGEMENT IF' THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDF.'.OOML--.,. =, :l: ..,r,lEl:. · -._,, ............... RPPLICFINT TOM E:RESL. II'.,I t'.'.-.';E;UED E:"r' }~' ' .... I-:,RTE .... ~ '¢' . ~., N I C I PP'- I T¥ OF t:~NCHOR~:~GE ' ¢RRTMENT C _~LTH AND ENVIRONMENTAL 825 'L STREET, ANCHORAGE; 264-4?28 F804Oi ) I BRESLIN KETT STREET BERGOREN SUBD SAR i7~6 V LOT SIZE ~4~-4286 40586 SQUARE FEET ,L ABSORBTION SYSTEM IS: TRENCH .JMBER OF BEDROOMS =~?~SOIL RATING (SQ FT?BR>= ,RED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= ~E DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE ~OUND AND THE BOTTOM OF THE EXCAVATION (IN FEET>. HERE IS NO SET WIDTH FOR TRENCHES. FHE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE .L PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET>. TANK S I ZE== PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEP[ INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ~T DURING THE AND THE TWO ( 2 ~> INSPECT ION$ REC-~.LI I BACKFILLING OF ANY SYSTEM' WITHOUT FINAL INSPE~ION' ND APPROVAL DEPARTMENT WILL BE SUBJECT TO PROSECUTION. ~ D IlS MINIMUM DISTANCE BETWEEN R WELL AND ANY i00 FEET FOR R PRIVATE WELL~ OR 150 TO 200 FEET FROM R PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECI AVAILABLE TO INSURE PROPER IN~TRLLRTIONi'~'~ TO AND EXP I RES DEC~ER ;EWRGE DI r :~E OF ONS] I CERTIFY THAT l: I RM FAMILIAR WITH THE REGUIREMENTS FO C'RTH BY THE MUNICIPALITY OF ANCHORAGE. : I WILL INSTALL THE SYSTEM IN ACCORDANCE 5: ! UNDERSTAND THAT THE ON-SITE SEWER RESIDENCE IS REMODELED TO INCLUDE MORE THAN S I GNED: -~-~¢J~-~.--L~~v~;.~'~. ~,~P~CRNTTOHBRESLIN TEM IS WELL. W I TH 30 [:,AYS DIAGRAMS ARE lEAS 8t~T E~'~ THE V~. 2 Municipality of Anchorage POUCH 6-650 ANCHORAGE, ALASKA 99502 (907) 279-2511 GEORGE M. SULLIVAN, MA YOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (825 "L" Street) January 3, 1978 John Berggren 5941 Arctic Boulevard Anchorage, Alaska 99502 Subject: Lot 1 Berggren Subdivision, Permit 977655 Lot 3 Berggren Subdivision, Permit 977657 Lot 4 Berggren Subdivision, Permit ~77658 A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, ~icialist LNB/ljh F'ERMIT NO. r.lUN Z IZ: JL ~--'HL-- I I *ir-" i_ih. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PPOTECT~ON 825 '"t STREET, ANCHORAGE, AK. 9S 2~-25ti ~D[-I--S,I TE SEFIEE: F'ERr.1 [ T RPPL I CANT LnCAT I ON LEGAL J_C.'H_,N' BERGGRE~. P I CKETT LT. 4 BERGGREN .;,,. C 594:t RRC:TIIS: BLVD. LOT_, ¢IZE .:.1.2:5~"~0 SC,!UARE FEET TYF'E OF SOIL ABSORBTION SYSTEM IS' TRENCH -'' I MH~..',IMLM NUMBER OF BEDROOMS = 4 SOIL RATING "-- THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS' [)EF"TH= i2 L. ENGiTH= 42 (3 R I----I'-/E L C. EF"TH= 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). F.."EL-.~!Li IRE[:* SEPT I F'F-IC:K:I~I]E PLFINT OPTION A PACKAGE PLANT MAY BE INSTALLED 8T THE PERMITTEE"S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1. EITHER 8 CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2. 8 CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF A MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM AND/OR YOU MAY BE SUBJECT TO PROSECUTION. TWCm ( 2 ) I NSF"EI_-:T IONS Fll;:E I~:EC-!I_I I '- -' ." F..' -' '~ BHL. k:.FILLINa OF ANY 5~-TEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEF'ARTMENT WILL BE SUB..TECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL. AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR 8 PRIVATE WELL OR 200 FEET FOR 8 PUBLIC WELl.. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'EI~:rl I T E:-<P I F-'ES C-EIE.:Er'IBER 3::1_. I CERTIFY THAT 1: I 8M FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. AF PL I CANT JOHN 8ERGGREN 4040 "B" STREET, ANCHORAGE, ALASKA 99503 PHONE: c)07-270-2581 4040 "B" STREET, ANCHORAGE, ALASKA 99503 PHONE: 907-279-2581 July 13, 1977 W.O.. #D-10093 MUNICIPALITY OF ANCHORAOI~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION, Mr. John Berggren 7301 Chad Street Anchorage, AK 99502 JUl.. 1 4 197'7' RECEIVED Subject: Suitability of Berggren Subdivision for On-Site Sewerage Disposal Systems Dear Mr. Berggren: After carefully examining the report of our parent firm, DOWL Engineers, dated November 3, 1975, on the above referenced project, we decided to expand the scope of that investigation for the suitability of the property to receive on-site sewerage disposal systems. ~A ~ Initially, a visit was made to the site and test pits 1, 2, ~ 3, and~ were located. The test pits were on, respectively Lot 4, Lot 3, ]Jot 2, and Lot 1. We were unable to located test pit #5. Those approximate test pit locations are shown on the enclosed Figure 1. From the logs of the test pits from the original report, it appeared that the area of test pits 2, 3, and 4 would be adequate for on-site sewerage d~sposal.systems with the area near test pit 1 being marginal. This opinion was further reinforced by the inclusion of gradations, rather than a simple visual analysis in that report. We decided at this time that additional exploration at the site would be appropriate. We placed one test hole adjacent to test pit ~1 to a depth of 20'. The log of that test hole is included as Table A. The test hole showed to have the same basic soil type of that indicated in the test pit. Tke hole was cased with slotted, 3/4" PVC pipe and a percolation test run by saturating the test hole, returning the next day and filling the hole again, and monitoring the water level drop over the period of an hour. Minimum percolation rate for this lot was 10 minutes/inch. We feel that the soil conditions for Lots 2, 3, and 4, as reflected by the data collected in test pit 1, 2, 3, and the test hole drilled on Lot 4, show the soils in this area to be qui~e un~Lform. We ~eei that the 10 minu~es/inch percola- tion rate can b~ con. servatiw~ly applied to all three of those lots, and that those lots are adequate for on-site sewerage dispesal systems. Mr. John Berggr~ July 13, 1977 Page 2 The test pit #4 on Lot 1 was a different matter. The test pit from the previous report showed the material to be a sandy silt with relatively low percolation characteristics. We decided to see if we could find a better location for placement of an on-site sewerage disposal system on the lot, so two test holes were drilled. ,The first one was drilled on the SW corner of the lot and the second one in the NW corner of the lot. The logs of both of those test holes are included in this report. The first one drilled showed similar silt for the full depth to 15'. The second test hole in the NW corner was substantially better with silty sand and silty gravelly sand layers. A 3/4" PVC pipe was set in both these holes, and percolation tests run in this manner similar to that performed on Lot 94. The results of these percolation tests showed a minimum percolation rate of 20 minutes/inch in the SW corner of the lot in the silt, and 10 minutes/inch in the NW corner of the lot. We therefore recommend the placing of the system in the NW corner of the lot, and the use of a design percolation rating of 10 minutes/inch. It should be noted that no water table was detected in any of the test holes or test'pits that were logged. If you have any further questions or if we can be of further service, please do not hesitate to contact us. Very sincerely, ALASKA TESTLAB Melvin R. Nichols, P.E. Laboratory Manager MRN:rb Enclosures U N ,S U B q) AP?P_o× I i',A ~T' t~ 8 8 o WES" 55~' ~ 142 nd AVE. ;._J.~' (;iA ~P~ TF,,.~,~PH.~.._~ EI~.=. .... --i 190th 5 4 IO~' UTILI T Y. EASEMENT '5 AVE. UNSU (140th) NW Corner Lot 1 Date: July 6, 1977 Logged By: Jim Mack W.O. #D-10093 'Depth in Feet From To 0.0' - 1.0' 1.0' - 8.0' 8.0' - 12.0' 12.0' - 20.0' Soil, Description Topsoil. Gravelly. Sandy. Silt, ML, and Silty Sand, SM. Sandy Silt, ~. Silty Gravelly Sand, SM. Bottom of Test Hole: Frost Line: Free Water Level: 20.0' None Observed None Observed SW Corner Lot 1 Depth in Feet From To 0.0' - 1.0' 1.5' - 15.0' Date: July 6, 1977 Logged By: Jim Mack W.O. #D-10093 Soil~Description Topsoil. Silt, ML, with gravel content, PL±. Bottom of Test Hole: Frost Line: Free Water Level: 15.0' None Observed None Observed DaCe: July 6, 1977 Logged By: Jim Mack W.O. 9D-10093 Depth in Feet From To 0.0' - 1 .5' I .5' - 4.0' 4.0' - 12.0' 12.0' - 20.0' Soil Description Topsoil.. Gravelly Silt, ML, damp. Layered Gravelly Silty. Sand, SM, and Silty Sandy Gravels, GM. NFS, Sandy Gravels, GP/GM. Bottom of Test Hole: Frost Line: Free Water Level: 20.0' None Observed None Observed Test Hole Log - Description Guide The soil descriptions shown on the logs are the best estimate of the soil's characteristics at the time of field examination and as such do not achieve the precision of a laboratory testing procedure. If the log includes soils samples, those samples receive an independent textural classification in the laboratory to verify the field examination. The logs often include the following items: Depth interval - usually shown to 0.1 foot, within that zone no significant change in soil type was observed through drill action, direct observation or sampling. Frost Classification - NFS, FI, F2, F3, F4, see "Soil Classification Texture of Soil - An engineering classification of tile soils by particle size and proportion, see "Soil Classification Chart", note the proportions are approximate and modifications to the soil group due to stratification, inclusions and khanges in properties are included. Moisture Content - this is a qualitative measure: dr_Lz, no or little apparent surface moisture, damp, moisture forms portion of color, less than plastic limit, wet, no free water, oftet~ soft, il' cohesive soil, satoratcd, free water may be squeezed out, if a free draining soil; dilatcnt at natural moisture content, if a non-plastic silt or fine sand. (The moisture content is further definedby reference to PI, LW, NP, M% or dilatency.) Density - refers to more-or.less non-cohesive soils, such as sand gravel mixttu'es with or without a fine fraction, derived from drilling action and/or sample data; usually described as: very loose, loose, medium dense, very dense. General intent is to portray earthwork characteristics. Stiffness - refers to more-or-less cohesive soils and fine grained silts of ~ clay-silt groups. Derived from drill action and/or sample data. Very soft, soft, stiff, very stiff and hard are commonly used terms. Particle size -- Thc largest particle recovered by the split spoon is 1-3/8", Shelby tube 3", auger flights (minute.man) 2", Auger flights (B-50 hollow stem) 6"-8", Larger particles are described indirectly by action of tile drilling and are referred to as cobbles, 3" to 8", or boulders 8"+. Therefore when reviewing the gradation sheets, if any, the description on the hole log must be considered for an:indication of larger particles. Unified Soil Classification - This is a two letter code, See Unified ~tYeation sheet for fu~:ther definition. In some cases AASHO and/or FAA soil classifications may be shown as well as the unified. Atterberg Limits - useful for fine grained and other plastic soils. P1; natural moisture content believed to be less than plastic limit PI+; natural moisture content believed to be between plastic and liquid Lw.__+; natural moisture content believed to be greater than liquid limit · NP; non-plastic, useful as a modifying description of some silty materials, Dilatency - is the ability of water to migrate to the surface of a saturated or nearly saturated soil sample when vibrated or jolted - used as an aid to determine if a fine grained soil is a slightly or non-plastic silt or a volcanic ash. Rock flour - finely ground soil that is not plastic but otherwise appears ~ clayey silt. Organic Content - usually described as Peat, PT, sometimes includes discrete particles such as wood, coal, etc. as a modifier to an inorganic soil. Quantity described as; trace, or an estimate of volume, or, in ca~e of all organic, - as Peat. This may include tundra, muskeg and bog material. Muck - a modifier used to describe very soft, semi.organic deposits usury occuring belo~v a peat deposit. Amorphus peat - organic particles nearly or fully disintegrated. Fibrous Peat - organic particles more-or-less intact. Bottom of Testhole - includes last sample interval. Frost Line - seasonal frost depth as described by drilling action and/or samples at the time of drilling. Frozen Ground - other than-frost line, described by samples, usually includes description of ice content, often will include modified Unified Classification for frozen soils - this is a special case related to permafrost studies. Free Water Level - The free water level noted during drilling. This is not necessarily the static water table at :he time of drillingor at other seasons. Static water table determination in other than very permeable soils requires observation wells or piezometer installations, used only in special cases. Blow/6." - The number of blows of a 140 weight free falling 30" to advance a 2" split spoon 6"; the number of blows for a 12" advance is. by definition, tile standard penetration. natural moisture content of the soil sample, usually not p~rformed on clean sands or gravels below the water table. Type of Sample-- SP, refers to 2" split spoon driven into the soil by 140 pound weight, a disturbed sample, S, thin wall tube, "Shelby" used to obtain undisturbed samples of fine grained soil, .G., "grab" disturbed sample from auger flights or wall of trench, .~., cut sample, undisturbed sample from wall of trench. Dry..S.trengt}? - a useful indicator of a soil's clayey fraction, N=None, L--Low, M=Medium, H=High - Tile samples are placed into apparently similar groups based or and texture and ar~ arbitrarily assigned a group !et)er. Further disturbed tests including Atterberg Limits, grain size, moisture-density relationship, etc. may be performed on the group and are assumed to reflect the general dis)tubed characteristics of the soils assigned to the group. This is an important phase of the soil analysis and is used to standardize the various qualitative determinations and to reduce the number of quantitative tests necessary to describe the soil mass. SOIL CLASSIFICATION CHART CLAYEY OR SILTY SAND CLAYEY CLAYEY SILTY SILTY GRAVELLY SAND SANDY GRAVEL CLAYEY SI LTY GRAVEL SAND GRAVELLY SAND SANDY GRAVEL GRAVEL \ x \ o 0 1 0 20 30 40 50 60 70 80 90 ! 00 GRAVEL (+#4 SCREEN) % BY WEIGHT NONFROST SUSCEPTIBLE SOILS ARE INORGANIC SOILS CONTAINING LESS THAN 3% FINER THAN 0.02 mm. GROUPS OF FROST-SUSCEPTIBLE SOILS: F1 GRAVELLY SOILS CONTAINING BETWEEN 3 AND 20% FINER THAN 0.02 mm. F2 SANDY SOILS CONTAINING BETWEEN 3 AND 15% FINER THAN 0.02 mm. F3 a. GRAVELLY SOILS CONTAINING MORE THAN 20% FINER THAN 0.02 mm. AND SANDY SOILS (EXCEPT FINE SILTY, SANDS) CONTAINING MORE THAN 15% FINER THAN 0.02 mm. b. CLAY5 WITH PLASTICITY INDEXES OF MORE THAN ]2. EXCEPT VARVED CLAYS. F4 a. ALL SILTS INCLUDING SANDY SILTS. b. FINE SILTY SANDS CONTAINING MORE THAN 15% FINER THAN 0.02 mm. c. LEAN CLAYS WITH PLASTICITY INDEXES OF LESS THAN 12. d. VARVED CLAYS. ,~- ,LSON WELL DRILIf ,G 1305 W. 45TH STREET ANCHORAGE, ALASKA 99503 PHONE 272'9343 Well Owner , DRILLING LOG Location (address of: Township, Range, Section, if known; or distance main road Size of casing_ b t. ~ ~ 01 lO I' ....... Depth of Hole I t,~ /O _..feet Cased to_[t~ feet Static water level {O~ ft. (above) ) land surface. Finish of well (cheek one) Screen ( ); Perforated ( ). Describe screen or perforation Well pumping test at ~47~- gallons per (hour) open end ( ~ of drawdown from static level. ..i~:' :', :: "':?~:'. Date of completion t ~;;;.:::-" WELL LOG '?('. Depth in feet from ':i!~ii~.' ground surface ,.~.~ .... - .t,~l ,,~ I :.;~. ,:'.. · ft. ); Give details of formations penetrated, size of material, color and hardness .:,.., ..... ~ ~ '-- '- ~ I .' ,.,~+.. , J ' '.:5::';,' ' / "~:' ",,,TO '::"?:._:~,,~,., ~o . , ~o~ : ~. -- ---_. _-: :-: ___:,-, _- ,,~,->.<- ,- . . ..-,' ... . ,,4~)!~.:, · ,.-:~' ..... ," ~i:.,~. ,........,,::.... , ~-.~.,,,- .:..¢~... ~.~g~:.: ...,. Municipality of Anchorage Department of Health and Human Services ' Division of Environmental Services ~ E C E I V On-Site Services Section 825 "U' Street Room 502 P.O. BOX 196650 Anchorage, AK 99519-6650 dUN 07 ~000 www. ci.anohorage.ak.us (907) 343-4744 ' MUNICIPALII¥ OF ANCHOEAGE 'VIRONMENTAL.~ERVICES DIVISI HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT 4 BERGGREN S/D Parcel I.D.: 017-092-37 A, WELL DATA Well type PRIVATE Date completed 7/8/1978 Total depth 140.8 ft If A, B, or C provide PWSID # Sanitary seal _Y Cased to 140.8 ft FROM WELL LOG Date of test 718/t978 Static water level 100 ft Well production 4.5 g.p.m WATER SAMPLE RESULTS: Coliform .~-d~ colonies/100 mi Date of sample: ~' il( I ~ SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 7/6/1978_ 'Tanksize 1250 Cleanouts Y_ Foundation cleanout Y Well Log Y_ Wires propedy protected _Y Casing height (above ground) 15 .in. AT INSPECTION 3/11/2000 9O ft 1.1 g.p.m Nitrate ~,.~x~, mg/I Other bacteria .'--O ~ colonies/100 mi Collected by: S.R.PANNONE gal Depression over tank N Number of Compartments _2 High water alarm N/A . Date of pumping 3/1012000 Pumper_A+ HOME SERVICES ABSORPTION FIELD DATA Date installed 7/6/1978 Soil rating (g.p.d.tft2 or ft2/bdrm) 85 System type D.T. Length 23 ft Width 3 ff Gravel below pipe 7.8 Total depth 13..~4 ft Effective absorption area 36.~8 ft2 Monitoring tube Y_ Depression over field Date of adequacy test 3/11/200q Results (Pass/Fail) PASS, For _4 bedrooms Fluid depth in absorption field before test DRY in Water added70.~0 gal. Elapsed Time: 1._~5 min Final fluid depth DRY~ in Any rejuvenation treatment (past 12 mo.) (YIN & type) NO New depth2.._~9 in. Absorption rate >= 700. g.p.d. · If yes, give date (Rev. 11/99) D. LIFT STATION Date installed ~ "Pump on" level at Datum Size in gallons in"Pump off" level at Cycles tested Manhole/Access High water alarm level at . in Meets alarm & circuit requirements? On adjacent lots 106 On adjacent lots _100~. Public sewer manhole/cleanout Holding tank 75+ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septictanldliff station on lot 105 Absorption field on lot 120 PubLic sewer main N/A Sewer/septic service line 25+ _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 15 Property line 40 Water main 25+ Water service line ~25+ Drainage 100+ Wells on adjacent lots 127 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 60 Surface water 100+ Wells on adjacent lots 107 Property line 25 Water Service line 25+ Curtain drain 100+ N/A Absorption field 5 Surface water 100+ Water main 25+ Driveway, parking/vehicle storage 50 F, COMMENTS G, ENGINEER'S CERTIFICATION ~ ~,¢,, *~ ~ h~z~ H¢t~ i~ed through field inspections 'r;;;;' ;~'~unicipal records that th~ above ~?tcms.fre ~ conformance with MOA HAA guidelines m effect on roes oa~u. ~ ~ · one P.E ineeCs Pr nted Name Steven R. Pann H~ Fee $ ~, ~ Waiver Fee $ Date of Payment _ ~- ~- CO Date of Payment Receipt Number (3 G~ ~ ~ ~ ~O~O~ Receipt Number (Rev. 11199) Pannone Engineering Services, LLC Consulting Engineer Legal: Owner: Residence: No. of Bedrooms: Septic System: SEPTIC SYSTEM ADEQUACY TEST Lot 8, Berggr~n S/D Dennis & Verne McCrohan 14150 Pickett Street, Ad,ch. AK 99516 Four (4) Tank Size: _1250 gallons. Absorotion System Type: De~geAzTrench P.O. Box 102954 Anchorage, Alaska 99510 (907) 272-8218 Absorption System Size: 23'x 3'x 94" Absorption Area: 368 s.£ ~nstaU,~ion Date: 7/6/78 Soil Rating: 85 sffbr Date of Pumping: 3-10-00 By: A+ Home Services Date of Test: 3-i i-00 Test Procedure: System was inspected visually and measured. The tank was found to have 4 feet of cover, k,lqUlo deptn was measureu to be >v lncne, the dram held was found to have ~6 ~nches oi cover and a total depth of 130 inches. There was no liquid measured in the field's monitor tube (one monitor tube ...... - ' ' the post tank clean-out over a 25 was found.) Water was added from me A+ nome ~e~v~ces pump truc~ ~nto minute period. Liquid depths were measured in the monitor tubes. The liquid levels rose 29 inches in the monitor tube with the induction of 700 gallons of water into the drain field. After the water was turned oft; the liquid level returned to the original level within 15 minutes. Tins system is able to aosorb greater tha 700 gallons per day. The well was tested separately from the septic system. I was informed that the well feeds a 50 gallon storage tank lns~oe the nouse. ~he water ~evm lB toe storage tank aetenmnes when the wen turns on. The static water level in the well was measured to be 90 feet below the top of the casing. The water level in the well was drawn down to the pmnp level, i40 feet below the top of the casing. The recovery was measured over a 90 minute period the water level returned to the original level over this period. From this information, it was determined that the wall has a capacity of I. 1 gallons per minute, which is acceptable. TEST RESULTS: This system meets the code and operational requirements of Municipality of Anchorage, Department of Health and Social Services r%r a 4 bedroom house. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA D~S Guidelines & 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 PES can therer%re not the syste , nor do they guarantee that there are no hidden defects or encroachments. provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 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. # ~)~'-'t -~.-~'-~ 1, GENERAL INFORMATION Complete legal description Lot 4i HAA # B ,~rggren Subdivision Location (site address or directions) 14150 Pickett Anchoraqe~ AK Property owner Mailing address Jam~s and Susan Wirth es£at~ Day phone C/O Kay EIZison-FORTUNE PROPERTIES 2525 "C" Street Suite 100 Lending agency Anchorage, AK 99503 Day phone Mailing address. Agent Kay EIlison/ FORTUNE PROPERTIES Day phone Address 2525 "C" Street Anchorage, AK 99503 265-9137 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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: XXX 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 1t21 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 inves_t~ation 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 S & $ ENGINEERING 17034 Address Eagle River, Engineer's signature __ DHHS SIGNATURE /~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ;Z~-<~__. ~r.~- Date ~- The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Z.oT' ~- ~E,"4~_~.F.~J ~//~ Parcel I.D. A. Well Data Well type Log present(~N) Total depth J,~' Sanitary seal(~) ~'~ If A, B, or C, attach ADEC letter. ADEC water system number ~'* Date completed ~/~/~ ~" Driller Cased to ! ,~-.r__.3 t lC) ~ Casing height Wires properly protected(~_J~i) ~"'-~' FROM WELL LOG Date of test Static water level We,.ow Pump level1 AT INSPECTION g.p.m. 4-/-/- (-~/~/"/ /'/-G' SEPARATION DISTANCES FROM WELL TO: Septic/hc,'.d'.;;.g tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots [(..O(D fM- ; On adjacent lots //O 0 ('/-- Public sewer manhole/cleanout ,,~/,-~E' Petroleum tank ./fJ¢cJE' /~'AJ~c,J/,J WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/I.fI~-DtNe-TANK DATA Date installed Cleanouts (~N) High water alarm (Y~) Date of pumping Nitrate O'/0/'~/~ Other bacteria /f../ Collected by: ,~'~-,~ ~--~'-/~//"J~-~'~'~//(~(-'~ Tank size /' ~ FO Foundation cleanout(~) '~¢' ~ Compartments c//d.~,~ Depression (~_~ Alarm tested (Y/N) Pumper A -~ /-[O/vlg' SEPARATION DISTANCES FROM SEPTIC/~TANK TO: Well(s) on lot /'d:~'~ c/- On adjacent lots //~(::::2 r'7'- To property line (~-~ /'/'~ Absorption field Surface water/drainage /~/7~ Foundation <~(:~ Water main/service line 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTAN.CE-FI~M LIFT STATION TO: Wel[.ol~'''''~ On adjacent lots -~ ~ .~L~ Sudace water D. ABSORPTION FIELD DATA ~'X~3//,,,¢~'~ J:.~ Date installed ~/ 8oil rating (GPD/FF) System type Length ~.~ ! Width ¢.~ / Gravel thickness Total absorption area ~ z~' Cleanout present (~1) Date of adequacy test ~//h,5~' Results ~/fail)/E~/~,..~,~, Water level in absorption field before test /(? ,t Peroxide treatment (past 12 months) (Y/N) ~/o,,~E' SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /'O© r_,~ To building foundation /C~/¢ On adjacent lots .~(~ ~ Sudace water //~ r-F-- Manufacturer ~ ' Manhole/A~-Y7~) ~ "Pump off" Level at .~~Cycles tested On adjacent lots /©0 r./. Property line To existing or abandoned system on lot Cutbank .~C.~ ~ water main/service line Driveway, parking/vehicle storage area Totaldepth /~/- // Depression over field (Y~./c,',~ for '-~ C'~'~ E'~'_} ~rooms After test 5&' ~ If yes, give date .~)/~ Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, ve~onformed to all MOA and HAA guidelines in effect,~ ,¢*°n'"(h"¢~C~°f.. :' ~ .~: ',,, this inspection. Date HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Slb Pfk. $. ':' [] vd,sa [],hbu,qi [] ~ NmOI, IMI,JIOOt) A.V,tALYm O,.,nd ArS. M ~w O~M OoM,. iXln~ ~ .. ArN Sq. Pt s 'Fh~M ' W.n." Avl. ~t P~ ;' : ~O 0 0,0 ,, O,i _J~- for ~ of ~iec-e~ uualttu MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744' Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 4; Berggren Subdivision; Location (site address or directions) 14150 Pick~ttStre~t e Property owner Mailing address Day phone Lending agency Mailing address Day phone Agent .~u.~. Duo~ak FORTUNE PROPERTIES,INC. Day phone 562-7653 Address $000 A Street #101 Anchorage, Alaska 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well XX 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 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 S;tructure 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 Engineer's signature DHHS SIGNATURE Approved for Disapproved. Phone Conditional approval for bed rooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 1/91) Back MOA ~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-~J/-,q; ~o.¢-c~ ,~ ~/'~_.~,.,~ C-'~. ~ A. WELL DATA Well type~ If A, B, or C, attach ADEC letter. Log present (Y/N) ~ / ~ Total depth //~/O [ c) Sanitary seal (Y/N) ~ Parcel I.D. ADEC water system number Date completed --~ - ~) - '~,c~ Driller / Cased to / ~ D [ ~ Casing height Wires properly protected (Y/N) h FROM WELL LOG Date of test -~' - Static water level Well flow '/"~. Pump level AT INSPECTION /o- 51-?o I g.p.m. ~--~ ?~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot / Public sewer main -/ Public sewer service line AJ/~A / 7~- ; On adjacent lots ,/ '//- ;On adjacent lots ./ CC) -/' Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: 4- /- Nitrate -~ ~t ~L~ 5 (,~ c--fo ¢ ~ Other bacteria Z_. ¢--~¢'0 B. SEPTIC/HOLDING TANK DATA Date installed "~ - ~- '"~. ~ Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pumping / 0 - Tank size (.~--~-'O ,~ ~ ( Compartments Foundation cleanout (Y/N) ~ Depression tY/N) /~/A Alarm tested (Y/N) ~//~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: / ! Well(s) on lot / O0 ~ Onadjacentlots I O0 '~ Topropertyline [ 6) "f Absorption field ..~ /./. Surface water/drainage [ O<:D ~ Foundation Water main/service line ! /o 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed ,,"= ~, Manufacturer Size in g,a,.Ue/~s _,, ~ Manhole/Access (Y/N) '~t (Y/N) - ~, . ~'~ "Pum[x'Cm" leV'~',at "Pump off" level at %~"~ ig h w~t~?a~a r~'~e~~ ~) ~ [ ''~ Cycles tested __ __ Meets Ml~%l~e 'c~ttrical c°des (Y/N) ~ Well on lot On adjacent lots ',,. Surface water D. ABSORPTION FIELD DATA Date installed ~ - /o - '-~ ¢ Soil rating ~ ~ r~'System type / ~^J¢ h Length ~ ~ / Width ,~ ~ ~ ~ Gravel thickness ~'/'//' ~ Totaldepth Total absorption area ~ ~ _r_F') ~:t Cleanouts present (Y/N) fl Depression over field (Y/N) ~ Date of adequacy test ! O -- ~ ! - ~ ~ Results (pass/fail) /3~, _~-, .~-~ for ~ bedrooms ~ ' , Peroxide treatment (past 12 months) (Y/N) .~/./A If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ./ E)O To building foundation On adjacent lots Surface water Curtain drain /~ On adjacent lots ,/ O0 ~- Property line ! I 0 '/' To existing or abandoned system on lot Cutbank ~C~ '~ Water main/service line Driveway, parking/vehicle 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 inspection. o,y ~°:~na'ure ........:'~'~ .... ~' Engineer's Name~;.a9te CNer, Alaska 99577 Date ~- / ~- ~t HAA Fee $ / Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS REPORT BY SAMPLE fox WORKorder% 32964 Date Report Printed: APR 3 91 ~ 17:23 FAX: (907) 561-5301 Client Sample ID:L4 BERGGREN S/D Client Name :S & S ENGINEERING PWSID :UA Client Acct :SNSENGP Collected APR 1 91 e 15:30 h~s. BPO ~ PO # NONE RECEIVED Received APR 2 91 ~ 12:40 hrs. Req ! Preserved with :AS REOUIRED Ordered By :R. SH~FER Analysis Completed :APR 3 91 Send Reports to: Laboratory Supe~v.ior~TEPHEN C. EDE lis & S ENGINEERING Chemlab Ref ~: 911186 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N 0.21 m~/1 EPA 353,2 lO Sample ROUTINE SAMPLE COLLECTED BY: RDJ. Remarks: I Tests Perfozmed * See Special Instructions Above UA=Unavailable ND- None Detected ** See Sample Remarks Above NA- Not Analyzed LT-Less Then, GT-Greater Than ' CHEMICAL & (il5o~,~.,,,..~-~. .......... ~ Drinking Water Analysis Report for Total Coliform Bacteria · ___-z----" ~ ..... ~ 'TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY [] PUBLIC WATER SYSTEM I.D.# d( PRIVATE WATER SYSTEM Phone No, S & S ENGINEERING . "lY034 Re!lis'River Re!lie River, Alaska City 8tate Mo, Day' Year Zip Coda SAMPLE TYPE: }~ Routine Check Sample (for routine sample with lab tel, no, ~ ID Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. t 2 3 4 5 LOCATION [ ,. Time Collected Collected By , 1' I ! I shows thls Water SAMPLE to be: factory [] Unsatisfactory r-] sample too long in transit; sample should not be over 30 hours old et examination to indicate reliable results, Please send new sample via special delivery mail, Date Received ~/~../ ~J,I _ Time Received .... /~/~ .... Analytical Method: Membrane Filter. * No, of colonies/lO0 mi. Lab Ref, No. L 1 Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filler, Direct Count Colltorm/100 mi Verlllcetlon: LTB __BGB..~ Final Membren, Repoded TNTC = Too Numerous To Count OB = Other Bacteria PART ONE OF TWO REFIAINDER TO FOLLOW MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY. DWELLING Parcel I.D. # (-"~'-'l - C'~ol ~ -~-'~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) L~t 4; B~rggr~n Sub~uision; Location (address or directions) 14150 Pickett Street (b) Property owner Mailing Address Diane Bennett Telephone'(home) Business (c) Lending Institution KEY BANK ATTN: Kay Murphy Telephone Mailing Address (d) Real Estate Company and Agent MARSTON REAL ESTATE ATTN: Address 2804 West Northern Lights Blvd., Anchorage, Telephone 248-2804 Sheri Marston Alaska 99503 (e) Mail the HAA to the following address: (or check here ~;Y~ if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eaqle Ri~r 1.9¢p R~a~l N~. 2n,.~~ Eagle River, Alaska 99577 TYPE OF RESIDENCE Number of bedrooms Single-Family aX WATER SUPPLY Individual Well E~x Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site ~x. 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. 72-025 (Rev. 7/88) Page 1 of 2 '){JOM %JG~)U!§U{) leUO!SSetoJd eql u! suo!ss!uJo Jo sJoJJe Jot'elq!suodseJ iou s! el~ejoqou¥ to ,q!led!o!unlAI eq.L 'penss! s! eleo!l!lJao e eJoleq elep ez,qeue Jo suo!loedsu! lonpuoo lou op SHHC] ~o see,~oldLu3 'slueLu~J!nbeJ ~lels pue leJepel u!elJeo ~ls!les ol JepJo u! suo!lnl!lsu! §u!puel J!eql pue sewoq ~o sJes~qoJnd ol ,{se~Jnoo ~ se s!ql seop SHHQ eq.L 'e)lSelV ~o elelS eql u! peJels!SeJ Jeeu!§ue I~UO!SSeloJd luepuedepu! ue ~q e^oqe S qdeJ6eJed u! ue^!§ suo!lelueseJdej eql uodn,{lUO peseq peleo!l!Jeo le^oJdd¥ Xl!Joqln¥ qlleeH senss! (SHHQ) seo!^JeS UeLUnH pu~ qll~e,H ~o 1ueLulJedeQ e§eJoqou¥ ~o ll!led!o!unlAI eq.L leUO!l!puoo pe^oJddes!C] elea Z;Zg66 easel¥ 'aaA!Ii el6e:l t~0: 'ON peo~l dool .mA!Ii ej6~ v~;OZt sseJpp¥ MUNICIPALITY OF ANCHORAGE (MOA) Health Authority ApprOval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: /-o"~ /.?L, If A, B, C, D.E.C. Approved (Y/N) M/IA Yield Sanitary Seal on Casing (Y/N) ~ Well Classification Well Log Present (Y/N) 1 Date Completed ~;~\,~///~ -'~ ~ Total Depth {/--/b /o Cased to /dO (o Depth of Grouting -- Static Water Level ~ ~ Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Depression Around Wellhead (Y/N) A,) / I -I- ; On Adjoining Lots ; On Adjoining Lots (' O0 /'lc To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date Installed "~'~(~--~ Size ~No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: Date Last Pumped Ag//,A ;for ~l/ Temporary Holding Tank Permit (Y/N) Foundation Cleanout (Y/N) ~ TO Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course / Comments .~ ~o'~/C J~M p~_ To Building Foundation To Disposal Field 72-026 (Rev, 7/88) Front Page 1 of 2 Soils Rating in Absorption Strata ~ ~'- ~/~:) ~'~' Type of System Design Date Installed ~ -- ~ - ? ~/ Length of Field .~ Width of Field ,~ ~," Depth of Field G.~vel Bed Thickness ~- Square Feet of Absortion Area ~ Logo Statndpipes Present (Y/N) Depression over Field (Y/N) fO Date of Last Adequacy Test Results of Last Adequacy Test ~.~'~/_%,~_~-d- '~OV'~ -- 4- SEPARATION DISTANCE FROM ABSORPTION FIELD: To Property Line To Water-Supply Well To Building Foundation .~ O / 'f- Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA RequestS* conformedM"OA and HAA guidelines in effect on the date of this I certify that I have checked, verified, or to all 17034 Eagle River Loop Road No. 204 Eagle River, Alaska ~5~7 inspection. Signed Company Date MOA No, Receipt No. Date of Payment //--~ ~ ~ Amount: $ /.7 ~.. E:~5) d Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 56,.33 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 29793 Date Report Printed: NOV 5 90 @ 17:47 Client Sample ID:L4 BERGREN PWSID :UA Collected OCT 30 90 @ 13:55 Received OCT 31 90 @ 14:20 Preserved with :AS REQUIRED hr s . hrs. Client Name : S & S ENGINEERING Client Acct: SNSENGP P.O.# NONE RECEIVED Beq # Ordered By : R. SHAFER Analysis Completed :NOV 2 90 Send Reports to: Laboratory Supe~o~ :STEPHEN C, EDE 1)S & S ENGINEERING Released By : ~~"~.~F/ Special Instruct: Chemlab Ref #: 904585 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N ND(O.iO) mg/1 EPA 353.2 lO Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY B.J.S. 1 Tests Performed * See Special Instructions Above UA-Unavailable ND= None Detected ** See Sample Remarks Above NA= Not Analyzed nT.ness Than, GT-Greater Than CHEMICAL &.GEOLOGICAL LABORATORIES OI~4LASKA, INC. TELEPHONE (907) 562-2343 5633 B Stre~ ,.'~ Anchorage, Alask! g9518 Drinking W<ater Analysis Report for Total Colifor~n Bacteria TO BE COMPLETELY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D.# ~' P.~VATE WATER SYSTEM r Name )~-~ Phone No. $ & $ FJ~GINEERINO Mailing Add~e River, Alaska ~5~ City 2, State Mo. Day ~; Year Zip Code SAMPLE TYPE: []~-Routlne [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water TO BE[COMPLETED BY LABORATORY · ~ysiS shows this Water SAMPLE to be: ~ Satisfactory [] Unlatisfactory [] Sanjple to° long in transit; sample should notre over 30 hours old at examination to I~dicate reliable results. Please send nev~sample via special delivery mall. o,t, R~c,~v,d Time .~c*lved - ~/'~(~ / Analytllal Method: Membrane Filter * No. of colonies/100 mi. SAMPLE -~¥~, NO. ~ LOCATION " 21 31 41 · Time Collected Collected By I I I I Lab Ref. No. Result* I I-~ I ~ I I-~ Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS ; Membrane Filtec Dlract Count BEFORE ~ ! Ve~flcatlon: LTB ~?, Final Membrane Filter Results COLLECTING. SAMPLE TNTC = Too Numberous~T~° Count OB = Other Bacteria BGB CollformM00 mi Coliform/100 mi · DATE RECEIVED INSPECTOR I NSPECT(~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE t DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF ]~r',"~L.~it ~ 825 L Street - Anchorage, Alaska 99501 ENVIRONMEN1AL; ,'.O [ECTION ENVIRONMENTAL SANITATION DI VISION Telephone 264-4720 J'~'~ ~' 0 ~8'1 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~FEI~EIL¥1J~0 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ Pz~jONE PROPERTY RESIDENT (Ir different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAI LING ADDR ESS 4. REAJ.,TOR//~GENT n ~ I PHONE' MAI LI N---G ADDRESS ~) ~ 5. LEGAL DESCRIPTION ¥ STREET LOCATION 6. TYPE OF RESIDENCE /~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One .~ Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON'SITE** [] PUBLIC UTILITY /~'~7,~*''/' YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-OLO (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank. or [] Holding Tank Size: I "~ ~ If Tank is homemade give dimensions: [] ONE [~] TWO PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER NUMBER OF BEDROOMS [] THREE [] FIVE [] FOUR [] SlX DATE INSTALLED iNSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] OTHER Septic/Holding Tank IAbsorption Area ISewer Line INearest Lot Line 5. COMMENTS DATE [~-/'ApPROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED1BY 72-010 (Rev. 6/79) SINGLE FAMILY - ,~IU ~.TI PLE FAM:L. INDIV!DUAL'~ * T A TACI't WE~.L LOG. A wet1 (2) TIME DATE CTO R DIRECTIONS: THIS SIDE FOR OFFICIAL USE ONLY INSPECT ION APPOINTMENTS TIME -- b-ATE [)ATE - INSPECt' 1, TYPE OF RESIDENCE [] SINGLE FAMILY E] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Veri fled 3. SEWAGE DISPOSAL SYSTEM ~ IN DIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified [--}Septi'c Tank or F-tHolding Tank give dimensions: If Tank is homemade -- TYPE OF TANK TOTAL, ABSORPT ON AR EA NUMBER OF BEDROOMS [] ONE [~ TWO 'PErMiT E-2 THREE F-I FIVE [] FOUR [] '-' SIX [] OTHER DEPTH OF WELL DATE DRILLED LOG ~-~,' ~' PERMIT NUMBER DATE INSTALLED INST~ALLER SOILS RATING JSewer Line Nearest MATERIAL 4, DISTANCES $~l~'tic/ILIolding "~an2bsorption Area ....... WELL TO: Absorption Area [o nearest Lot Lhm 5. COMMENTS ¢ .OR ,E ROOMS [] CONDITIONAL APPROVAL {letter must accompany certificate 72-0t0 (Rev. 3/78) riovember 3, 1975 W.O. ~!8721 Nr. Gerald 1,U. etcher Star Route A, Box 342 A Anchorgge, A],.a ska 99507 Re: 5 ACres E.-i/2, N.E.-1/4, Sec. 35 Sir: At the request of Hr. Bob Bell of Be].l & ]~errJ.ng & Associates an e:.:am.ir~af:J.on of the soils of the above refe.rred property was made on Wednesday, October 22, 1975 Five test pits were excavatdd usJ. ng an owner furnished backhoe and operai'.or to maximum depths rangi~]g from 11' to 14' Grab samples were taken 'in each pit to ~- - de ~e~.m].ne the general'soil ~- ~ ~ ~]pes for eva~.uatlon as to the suitability for or limitafiio]]s of development of the property. No specific structural data was collected other than. the estimated re].Shive'densiLy of the soils and frost classifications. As a. genera], coheir]sion, it is. the opinion o{ the writer t]tat sal':isfactory sanJ.{tary absorption areas mal, be found on this sJ ue. ]lcwever, data co].lectipd J. ndicates w.i. th the (~xc(2pE:J.o]l of Tost ]]o].Q 1 that permeable materials are below 5' %O 8' to the dept]] of exp].o.rating. In that zone the soils are layered with about 1/2 of tho mdtoria].s beJ. ng op(m qraded J.n ,.lie SP cia ......'F'ca . .,.>_L...I hi. Oil i'.]]O }' ' "' ' ' r OS . Cl,,d ll~(](-!r ~ro]~ c'~ · 1 1111.3 I .~,,~ rio I~I, as.do the soils above '" ~ for vx}rcolation ca].culatJ, ons 1/2'of the dc~pl:h J.n the NFS/N--]. or NNS/F--2 zone may bo /.).'-(_,:f_ed," ' as an SP. The ut?or so.il_b" are highly frost snscopt.i, bl.o and c:a~e shou].d bo o:,:(grcisod J.n foul~daLt.ion :l .... ' and cons 'r",-'- ~ .... .~grl . .Iht upper soils are gcn(.ra sy:~Lcr.n;. '.['he variations of soil typ' o; m,'t.,~.'e J.t esso~tJ, al to oxam.i, ne :;p,,c.if.ic N~.'()i>o:;t}d on site st:weraUe syst(:m sj.L:e:; for soil suit-ab.i.]..iLy, · )1t 1'.'x , V(-.'-ry truly yours, TN)I; ) ,.'.: :; Test Pit ~I1 l)optJ~ in Feet From To 0.0' 4..0' 4.0' 14.0' Frost Line: Free Water Level: Test Pit [!2 0.0' 3.0' 3.0' 6.0' 6.0' 11.0' Frost Line: Free Wa%er Lextel: Test Pit ~!3 0.0' 8.0' 8.0' 12.0' Frost Line: Free Water I,c\'e].: 'Post Pit ]i'1 0.0' 5.0" * 5.0' ].2.0' Soil Description F-3 & F-4 tan gravelly Silt dam,o, medium density/ stiff, non plastic With occasional c~3obles and "boulders, ~.U~ F-4 tan silt; damp, stiff, NP. ML None None F-3 & F-4 tan gravelly silt; damp, medium density/ s%J_ff NP with occasional cobbles and boulders, ML F-4 tan .s.i.!.t; d~mp,, stiff, NP, ML NFS & F-2 tan sand; damp, medium density with minor si'l, layers, SP/SM None None '" .- F-4 tan .9_(fi_X_e:.!.!:._y_ .s_5_~_ll_:; damp to wet, medium density with ]aye. rs of silt ~m. NFS/F-2 tan sand with thin scant of 9cavelly sand @ 9' ± . c.g? l'~Ofle ~op.e F--4 1)rown--t:an Uravelly silt medium stiff, FL- with occa:;.i.o~al cobbles Ni.'S/i.'-I. gray, silLy gravc]l.y :;n'~d/:;,~.ht gravel.; damp m,,,lium d,':n:;i, tv wi.t.h r;il;: & (~r,~v,~l.].y sand:; itt: 7' S ~t: 9' ., ' .... ~ v / /1//,...-,'.. , '.:'"'::'--m' . .' ' , .,'.,<._., ~;,..._' .7 . " ' ].P, 1:'(': e t From To Fros'~ Line: Free Water Level: F.-oj. 1 l)e':cr~l>tion' * Sample t)l None None GM Test * 0.0' 5.0' 5.0' 8.0' ** 8.0' 11.0' Frost Line: F~ee Water Level: F-3 tan gravelly sJndy silt/gravelly silty sand damp, me~i[~-c~,~]{sity~-silts NP, with occasional cobbles and boulders ~.~L/SFi F-4 silt, damp stiff NP with occasional' silty : sand layers, F~ f NFS & F-4 fine & medium silty sands with sandy silts & s['lh~--da--mp, SLI -i.~L * Sample ~1, F-4 SM ** Sample ~,2, F-4 ML ~one No n e o O. {Il lllr.,l |'~, ti) 1l ~lttl , , t',) ltl,I I i r j ( ¢)