HomeMy WebLinkAboutT&T LT 3
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite r
l�elr�rtmcnt
On -Site Wastewater Disposal System Permit
Permit Number: OSP231126 Effective Date: 6/9/2023
Work Type: SepticTank Upgrade Expiration Date: 6/8/2024
Tax Code Number: 01516366000
Site Legal Address: T&T LT 3 G:2640
Site Mailing Address: 11560 HIDEAWAY TRL, Anchorage
Owner: HABERMANN MARKS Lot Size in Sq Ft: 49469
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 5
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
_ a. Opened and_Closed__on the same day, or
b. Covered, sealed, and heated to prevent freezing
_S �rS
Received By: Date:
Issued By: ' Date: 'Z J 2
M a¢ar ; �� ANCHOR,
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ra:��-a.,�.^carta�•aa�w��r a ^�--�,� me,�:�as,za.'�a, �h��..'� __ -n.�as-cs�.asB.�r..�.�rr �3'�r.�.��.;x,�.,�.::�
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WI=LL PERMIT APPLICATION
Parcel l.D. 15-163-66
Property owner(s) Mark Steven Habermann
Mailing address
Site address 11560 Hideaway Trail Anchorage, AK 99507
Legal description (Sub'd., Block & Lot) I &T Lot 3
Legal description (Township, Range & Section)
Lot Size 49,469 Sri. Ft. Number of Bedrooms
Day phone
APPLICATION IS FOR:
(Z all that apply)
Absorption Field ❑
Septic Tank 0
Holding Tank ❑
Privy ❑
Private Well ❑
Water Storage ❑
5
APPLICATION IS AN: TYPE OF DWELLING:
Initial ❑ Single Family (SF) 0
Upgrade
(w/wo AD U)
0
Renewal
Duplex (D) E]❑
Multiple Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
ignature of property owner or authorized agent)
Permit/Rush Fees: 225 Waiver Fees:
Date of Payment: ( rr l 20 Z Date of Payment:
Receipt Number: () h Receipt Number:
Permit No. 05P2-3 / I % Waiver No.
Permit App_-'- : ,_...:c
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
Mailing: P.O. Box 1807 Palmer, AK 99645
Telephone: (907) 745-8200 FAX: (907) 745-8201
30 May 2023
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road
P. O. Box 196650
Anchorage, Alaska 99519
Subject: T&T Lot 3
Septic System Upgrade Permit Request
This is a design narrative for a permit to install a 1500-gallon septic tank to replace an existing 1500-gallon septic
tank to be issued for this property. The existing tank is 42 years old and is likely perforated and leaking, it will be
removed per code. Currently the lot is developed. The proposed replacement will be connected to the existing drain
field. This lot and the surrounding lots are served by private wells. There are currently no wells within 100’ of this
upgrade.
1. Upgrade Tank Design.
A foundation clean out installed if needed.
The tank will be located: 5’+ from any property line.
5’+ from any deck/stair support.
10’+ from building foundation.
10’+ from any water line.
100’+ from any surface water.
100’+ from any private wells.
200’+ from any public wells.
The proposed installation will not affect the future development of this or the surrounding lots.
If you have any questions or concerns, pleas e contact me at (907) 745-8200.
Sincerely,
SRP
Steven R. Pannone, PE, F. ASCE
Owner/Civil Engineer
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231126, Curtis Townsend, 06/09/23
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PANNONE ENG SVC LLC (C.1. 1088)
P.O. BOX 1807 PALMER, AK 99645
PHONE (907) 745-8200 FAX (907) 745-8201SCALE
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T&T LOT 3
MARK STEVEN HABERMANN
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ANCHORAGE, AK 99507
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NOTES:
PANNONE ENG SVC LLC (C.1. 1088)
P.O. BOX 1807 PALMER, AK 99645
PHONE (907) 745-8200 FAX (907) 745-8201SCALE
.
"fi�even annoys
CE 8149 ;
REVISIONS
DATE
05/26/2023
for construction
T&T LOT 3
MARK STEVEN HABERMANN
SITE: 11560 HIDEAWAY TRAIL
ANCHORAGE, AK 99507
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P.I.D. NO
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DRAWN LJC
CHECKED ACP
SOIL LOG/NOTES
PANNONE ENG SVC, LLC (C.1. 1088)
P.O. BOX 102954 ANCHORAGE, AKK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
T&T LOT 3
MARK STEVEN HABERMANN
SITE: 11560 HIDEAWAY TRAIL
ANCHORAGE, AK 99507
CE 8149
N
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REVISIONS UAIG
05/26/2023
NTS
1 015-163-66 1
2OF2
~._/
~.j 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
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
Liq. c; Well DISTANCE TO:
Manufacturer
IF HOMEMADE:
I Absorption area Dwelling
Insidelength Width
Dwelling
PHONE ~EW
E~UPGRADE
NO, OFBEDROOMS
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
DISTANCE TO:
Manufacturer Liquid capacity in gallons
Foundation
Materia~),~/n~
Nearest lot Ii e
Trench width
DISTANCE TO: I
No. of ~inest ] Length of each, ~::~ ~line
Top of tile to finish grade
Width
Length
Total length of Ii es
Material beneath tile
Depth
PERMIT NO:~/ ¢-~ (~'7 ~,
Total effective absorption
700 ~
PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Weft Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO.
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOl L TEST RATI N G
17o.
INSTALLER
REMARKS
72-0 lSC~Rev. 3~'8J - (~
DATE LEGAL
RF'F'L. I 2RNT
L 0 C F!" I 0 N
LE'3RL
CF!RLESON I...Utk ::, T.
HIDE .Fl I,.IFl'?' TRRIL
LOT 3 E,_i.. ! 'lV;:.-r _,L,E,.
[ .. [':.. OF ~OIL HE,..LI-..FT!Lf4 ::,T.:,I_II TRENCH
s, .- , , .......... ._ c,f-t I i
P1FIHIMUH NUflEEF.. OF E:FF,R-'-H':; = f'q ..... RRTIHG ,'SS! FT,-."E:R)=
THE REQUIRE[:, S'.(ZE OF 'THE S-IL RB:E,.iRF'TH~h~ .... ]EH ~..:
THE LENG-FH DIMENSION I.'.:.; THE LENGTH (IN FEET:) OF ]'PIE TRENCH OR DRP, iNF!EL[:,.
'THE DEPTH OF' R TRENCN GR PIT iS THE D)]STRNCE BETHEEN THE SURFRCE OF THE
GROUND FINE:, THE BO'TTOH OF THE EHCR'v'RT!ON (IN FEET).
THERE IS NE) SET HIDTH FOR TRENCHES.
'THE GRR',/EL. DEPTH IS THE HINIHUH DEPTH OF GRFI',,,'EL.. 8E'FHEE:N 'THE OUTFRt_L. PIPE
RND TNE BOTTOM OF THE E:?.','CFt',/FITtON (IN FEET::,.
F'ERHtT F:IPF'__!iI=INT HSS THE RESF'ONSIE:!LTTb' 'TO iNFORH THIS [:,EF:'RRTHENT E)LIRZNC'[ THE
!NSTRLLFFf'!GN :[NSF'ECTtONS OF RN"r' !-,!E..L'S R[i:..iRCENT TO THIS F'ROPERT'¥' RND THE
NI_I.I_EI~ OF RES!E:ENC:ES THRT THE HELL I,.iI!_L bER¥'E.
MINIMUM [:,ISTRNCE BETHEEN R HELL FIND ANY ON-SITE SE!.4FIGE D!SPOSRL SYSTEM
:!00 FEET FOR R PRIYR"f'E P.!ELL OR :250 TO 200 F'EET FROM R PUBLIC HELL ClEF'ENDING
UPON THE TYPE OF' PUBLIC HELL.
MINIMUM DIE:TF~NC:E FROM R PRiVRTE HELL TO ~ F'RI',/RTE SENER L. INE IS 25 FEET F~ND
TO R COMMUNIT'¢ SE!.qER LINE IS 75 FEET.
HELL LOGS RRE REQUIRED RND HUST E:E RETLIRNED TO THE DEPRR'FMENT NITH!N 30 [:,W.?S
OF THE HELL COMPLETION.
OTHER REQUIREMENTS h'IR'W BF'PL¥. SPECiFICRTIONS RND CONSTRUCTION DZRGRRMS RRE
RVR!LBBL.E TO INSLIRE F'ROF'ER ZNSTRL. LWFION.
! CERTIFY THRT
±: I RM FFIM!LIRR HITH TNE RE6!U!REMENTS FOR ON-S.!TE SEHERS FINE) HEL..L.S FIS SET'
FORTH E:'¢ THE MLtNICtF'F!L!]"'¢ OF RNC:HORRGE.
2: I t4ILL. IN:F_,TFILL THE 'S'¢STEM Il'-,! RCE:ORDRNCE H:[TFI THE CODES.
3: I UNDERSTRN£) THFI]" THE ON-SITE SEHER E;'T'STEH i',lFff¢ REQUIRE E?4. LFIRGEMENT IF :"FIE
RESIDENCE IS REHODELE[) 'T'O INCLUDE HORE TFIRN 5 8E[:,F;:OOHS.
~,21. OG OF TEST PIT C
Equipment Backhoe - Drott 40
Elevation -' Date Drilled 4-9-81
BROWN-GREEN MOSS & ORGANICS (Pt)
BROWN SILT (ML)
medium stiff, moist
with some gravel @ 2.0'
BROWN SILTY GRAVEL (GP)
dense, moist
increase in silt content @ 7.5'
3" thick lense of silty sand (SM)
medium dense, wet ko moist @ 8.7'
BROWN SILTY SANDY GRAVEL (GM)
dense, moist
no free water encountered
LOG OF TEST PIT D
Equipmen~ Backhoe - Drott 40
Elevation -' Date Drilled 4-9-81
ROWN-GREEN MOSS & ORGANICS (Pt)
BROWN SILT (ML)
with some gravel size particles
BROWN SILTY GRAVEL (GM)
medium dense, moist
GRAY SANDY GRAVEL (GP)
dense, moist to dry
Minus #200 Sieve = 2.8%
FBROWN-GRAY SANDY SILT (ML)
medium stiff, wet to moist
BROWN SILYY GRAVEL (GM)
dense,.moist
some seepage @ 12.0',less than
1/4 gallon/minimum
no free water encountered
LOG OF TEST PITS C & D,
HILL DRIVE IHPROVEMENTS
Anchorage, Alaska
PLATE
'- ~" WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological 8~ Geophysical Surveys
Drilling Permit No.
or lc.) A.D.L. No.
,. ~ -/-~..?' .~ ..........
/'~/:/i ~, .., I _ o~-'~ of-- sm wE]
/.,~/:~/?~:.~. :~/:/,/t.X ~,,,, ~.._..,, .
,: "' .~'-' /x
:' x , /:.. ,- >-, /Y... ,i ~. -.... ~
' MUNICIPALITY OF ANCHORAGE :'
DEPARTMENT OF HEALTH & HUMAN SERVICEs-
Division of Environmental Serv ces :
On-Site Services Section ~
P.O. Box 196650 Anchorage'Alaska 99519-6650
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION ~ ........... ~ "-'
deScription Lot $~T ¢, T SubdZv,b~io~
v[v
Location (site address or directions)
11560 Hideaway Trail
Anchorage, AK
Pro~e~y owner Mr. & Mrs. G~..tzenaur Day phone 546-2380
Mailing address 11560 Hid~wa~ Trail Anchoraqe, AK 99516
Lending'agency Day phone
Mailing address.
Age~nt P~e K~ma~Zde.~ (2001
Address -'- 2600 De.n~,~, StA6e. t Su.,~6 400
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
'- Day phone 276-2001
AnchOrage, AK 99503
NOTE:
ndividual well ~0( ......
Community well
Public Water- "~' ' -
TYPE OF WASTEWATER DISPOSAL:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system. - -
NOTE:
Individual on-site
- Holding tank ~.
Community on-site
· ..- - Public sewer
XXX
If community wastewater system, provide written confirmation from state ADEC
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I w.~rify 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 ef bedrooms
and type of structure indicated herein. I furthei; verifythat based on the information obtained from
the Municipality of Anchorage flies 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 17034 ~.,,w~ ~,..., ........... Phone G~z/
Eagle River, Al~ka ~95~.
Address ~ // ~ ~
EngineeFs signature ~~.~ Date_
DHHS SIGNATURE
Approved for
Disapproved.
__ Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By:
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 , ~. , ' ~' ,
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
Parcel I.D.
A, Well Data
Well type /~/~ (('/~ ?'~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (~)
Total depth
Date completed
Cased to
Sanitary seal(~) ~-'~ Wires properly protected {~1)
FROM WELL LOG AT INSPECTION
Date of test '~/'J'~-
Static water level
w.,,
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/hc!d!ng tank on lot
Absorption field on lot
Public sewer main
; On adjacent lots
; On adjacent lots
Driller
Casing height
Sewer service line
Public sewer manhole/cleanout
Petroleum tank
g.p.m.
,/r...)k3
WATER SAMPLE RESULTS:
Coliform
Date of sample: <~//~ / ~'<~---
Nitrate
Collected by: ---~:~--~' (~'JGff~J~")~/~J~
B. SEPTIC/H~L-~NG-TANK DATA
Date installed ¢/~'~,/~//
Cleanout (~N)
High water alarm (YN~
Date of pumping '~//~Z_/
Tank size /'__k'--~X) (::,,¢¢ C___ Compartments
Foundation cleanout~l) ~}" Depression (Y/~.)
Alarm tested (Y/N)
Pumper /~ ,~/~//~"
SEPARATION DISTANCES FROM SEPTIC~ANK TO:
Well(s) on lot /~'q'~ r.~ On adjacent lots /' ~ ~''~
To property line /~ r_~ Absorption field
Surface water/drainage ~/d~C3
Foundation
Water main/service line
7a-026 (3/93)* Front CONTINUED ON SACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Manufacturer ~~
.Manho~
"Pump on" level at ~ "Pump off" Level at
~ Cycles tested
Surface water
Cleanout presen~,l)
Date of adequacy test ~'I~'(.-L-/ 4) ~7~ Result~il)
Water level in absorption field before test ,~..~
Peroxide treatment (past 12 months) (Y/N) ,,~.,~,,d~'
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Meets MOA electrical codes (~.~__
SEPARATIO~.S.T-A~CE FROM LIFT STATION TO:
~...W..~,~ot On adjacent lots
D. ABSORPTION FIELD DATA
Date installed ~'/2~/~:~/ Soil rating (GPD/Ft2)
Length ~'(~ r
Total absorption area
Width ,.~ / ~ Gravelthickness
System type __ ~"~
Total depth
~/'~-~ Depression over field (Y~
?~_~ for :/y~ ~Bedrooms
After test Z
If yes, give date
Driveway, parking/vehicle storage area ,.~
Well on lot /~-~O
To building foundation //O /-~ To existing or abandoned system on lot
On adjacent lots ~(~ f'z~- Cutbank ..~O ¢¢- Water main/service line
Surface water /"00 t..~__
Cur[ain drain
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA ~
ection.
Engineer's Name
Date
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
Commercial Testing & Engineering Co."
Environmental Laboratory Services ~~"~'¢~'~'"~'~'~JJ~'~'~'~'~'~'
LABORATORY ANALYSIS REPORT
Client ¢:*.mpl~:
Matrix
ClientNmne
Ordered By
Prttjeot Name
Pro joel#
pWSID
94.4684-3
LO"[' 3 T&T
WATER
S & $ I~NGINEERENG wORK (kdcr 81221
Printed Date 09/16/94 ~10:00 hrm
R. S~:ER CollectcdDale 09/12/94 O 18r35 hrs.
Rcccigt~l D~te 09/13/94 ~ 13:00 l~s.
UA %chni~al ~r¢Ctor STBP~N C, EDE
__= ....:2 ...................... ~%~;E'~%;
Sample llemm'k~: ROIo~ffN S SAMPLE COLLECTED BY; SS,
Qc Allowable l,;xt. Anal
Pat'ameter Re.quits Qtml Unit~ M~thod Lb'nits. ~_ Date. Date hlit
......................................... ~5 .......... ;~C .... ~F~T~Sfi~7¢ ..... ~3 ............
Nitrate-~
NA = ~ot ~alyz~d
See 8mmple Remarks Ab o v e ltl'= }~ lhan
oNed vahe !~ tho practical ~t~dification limit,
('fi'= Ckeater ~Ian
D = Sccon&~y ~hltion.
5633 B Street, Anchorage, AK 99518-1600 -- Teh (907} 562-2343 Fax: (807) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORAOO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
/"2'~ MUNICIPALITY OF ANCHORAGE
(~.~i~:¢.~ Dr:pARI'MENT OF HEALTH & HUMAN SERVICES
'~. ~:~=' '. Division of Environmental Services
On-Site Services Section
P.O. E4ox 196650 Anchorage, Aiaska 99519-6650
343-4744
Psrcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
015-163--66 HAA#
1, GE;'4ERAL INFORMATION
Comp~u e legal description
T & T Subd., Lot 3
Loca(ion (site address or directions)
11560 Hideaway Trail, Anchorage
Property owner __A3 an & Ann Maki
211 Lake Vista,
Mailing address
Day phone msq 694-5195
~2F, Wallis, TX 77378
Len, ding agency __ N_/A
Maili~g address
Day phone.
Agent
Gean Hohnstein/Marston
Address 2804 w. Northern Liqhts, Anchorage, AK
Unless otherwise requested, HAA will be held for pickup.
NUI~,I~JE,~;~ OF BEDROOMS: 5
TYPE OF WATER SUPPLY:
Individual well ×
Community well
Public water
NOTE:
Day phone 248-2804
99517
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:
X
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
fun UY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm _ Ea~LLe_ R]~serv~ces Phone 694-5195
Address P.O. Box 773294, Eagle River, AK 99577
Engineer's signature ~ _ Date ~
DHHS SIGNATURE
~ Approved for ~
-- Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By: --~OW N- ~'Uf I'¥J-} Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Cert*ificates 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.
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
If A, B, or C, attach ADEC letter.
Date completed
(~ ~ , ,~ Cased to , ?~ /
Legal Description: 7~ '~'
A. WELL DATA
Well type ??/~',~-r/~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Parcel I.D.
ADEC water system number
0~//~.//~ ~-~' Driller ,,~£ ,o///~
Casing height
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/,he~ing tcnk on lot //~ x
Absorption field on lot ?/ ~ '
,~ubHc sewer main
Sewer service line
g.p.m.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank /V~ WE-
k
WATER SAMPLE RESULTS;
~ /¢ O.~////'~/
uoliform/P// ,,9//15/¢
Date of sample: ~ ~,//",/'~/
B. SEPTIC/H~L-t~NG TANK DATA
Date installed ~// ~' '/ Tank size / ~'(3~ Compartments
Cleanouts (Y/N). ,Y~ Foundation cleanout (Y/N) )/~ Depression (Y/N)
High water alarm (Y/N) ,/~///'~ Alarm tested (Y/N) /~/'/~
Date of pumping ~////~/~- Pumper ~-~ .¢*¢/~¢-/~
SEPARATION DISTANCES FROM SEPTIC/HCLDING TANK TO:
Well(s) on lot //~ On adjacent lots ¢'/~¢
To proPertyline CZ~ / Absorption field ¢ ? '
Surface Water/drainage '"~//~
72-026 (Rev. 7/91) Front
Foundation
Water main/service line
CONTINUED ON BACK PAGE
SEPARATION DIST..ANO'~E FROM LIFT STATION TO:
Well on / On adjacent lots
D. ABSORPTION FIELD DATA
C. LIFT STATION
Date installed Manufacturer
Size in gallons Manhole/A~s~s (Y/N)
Vent (Y/N) . "Pump on" level a~t /1~....../ "Pump off" level at
High water alarm level ..,~r/ Cycles tested
Meets MOA electrical codes (Y/~,).--~
Surface water
Date installed ¢ ?/~" /
Length ~-t2 / Width ~-.,.r,, ..,~ .~ /
Total absorption area
Depression over field (Y/N)
Results (pass/fail) /~"¢
Peroxide treatment (past 12 months) (Y/N)
Soil rating ///O System type ~-,'~c*'A/£
Gravel thickness ~ / Total depth ~//
Cleanouts present (Y/N) )/~- ~
Date of adequacy test ,¢~/?"/~/
for ~ bedrooms
If yes, give date ,A/.//~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot //~
To building foundation
On adjacent lots
Surface water
On adjacent lots ~/¢ p / Property line /6-
'¢' '~ / To existing or abandoned system on lot .A/
Cutbank ~//-,¢ Water ma,h~/service line
Curtain drain
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 co thedate, ¢f this inspection.
Engineer's Name ~¢'~,'}' ,,~¢~-,
ate /
HAA Fee $ / ?
Date of Payment /
Receipt Number
72 026 IRev 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
NORTHERN TESTING LABORATORIES,
Eagle River Engineering Report Dates 01/17/92
P.O, Box 773294 Date Arrivedt 01/1~/92
Eagle River AK 99577 Date sampled: 01/15/9~
collected ~yt L~
Attn~ Louis Butera
Definitions
MD~ ~ Method
Limit
Our Lab #5 Al16014 B = Below
H ~ Above Regulatory
Loeation/PrOJeet~ Lot 3
Your Sample ID: T & T Subdivision. E = ~elow Detection Li~l~
Estimated Valu~
Sample Matrlx~ Water
Units Result Flag ~DL Analyzed
Method Paramete~
EPA 353.3 Nitrate-N mg/1 0.9 0.1 09/1~/92
Reported Byt William E. Buehan
Anchorage Operations Manager
3330 INDUSTRIAL WAY
2505 FAIRBANKS STREET
TESTING LABOitATOItlE$, INC.
FAIRBANKS, ALASKA 99701
ANCNOBAGE, ALASKA 99503
(907) 456-3116 · FAX 456-3125
(907) 277-8378 · FAX 274~9645
Eagle River Engineering
PO. Box 773294
Eagle River AK 99577
Attn: Louis Butera
Report Date:
03/13/91
Date Arrived: 03/11/91
Date Sampled: 03/11/91
Time Sampled: 1342
Collected By: Stuart
Our Lab ~: A108786
Location/Project:
Your Sample ID: T & T Subd. ~3
Sample Matrix: Water
Comments:
Flag Definitions
U = Below Detection Limit
DL Stated in Result
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Below Detection Limit
Estimated Value
Date
Method Parameter Units Result Flag Analyzed
EPA 300.0 Nitrate-N mg/1 0.8 03/12/91
Reported By: William E. Buchan
Anchorage Operations Manager
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HY~ALT~
DEPARTMENT OF h~ALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR ttEALTH AUTHORITY APPROVAL C~RTIFICATE
1. General Information
(a) Legal Description (include lot, block,
Location (address or directions)
(b) Applicants Name ~x~iO ~l~o~
Application Date ~O -~-~%
subdivision, section, township,
Telephone - Home Business
range)
Applicants Address
(c) Applicant is (check one) Lending Institution
Buyer ~-~; Other~_~ (explain);
(d) Lending Institution N//~
~--~ ; Owner/build~r~ ;
Telephone
Address
(e)
(f)
Real Estate Co. & Agent
Address
Telephone
Mail the HAA to the following address:
2o Type of Residence
Single-Family~-~
Number of Bedrooms
Multi-Family~--~
Other (describe)
3. Water Supply~
Individual Well~ 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]
Address
Date
Engineering Firm Providin8 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 ~ater supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
o~ b~d~ooms a ~
Approved,:~. ',,, Disapproved ~ ~~_ ,,
Te~s of Conditional Approval
CAUTION
TH~ I~ONICIPALITY OF ANCHORAGE DEPARTMENT OF REALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY ~PPROVAL CERTIFICATES BASED SOLELY UPON TH~ REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN TH]~ STATE OF ALASKA° THiE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF NOMES AND
THEIR LENDING INSTITUTIONS ~IN ORDER TO SATISFY CER~IAIN FEDERAL AND STATE REQUIRE-
MBNTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE M~lqICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
A. ~,,ELL DATA
MUNICIPALITY OF A/gCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST. - FEBRUARY 1984
Legal Description:
D.2J"' ~ aNCHORAGE
c~. OF HEALTH &
ENVIRONMENTAL PROT£CTIO~
9
RECEIVED
Well Classification [P~o ATC
Well Log P~esent (Y/N) ~
Total Depth 9~' Cased to
Static Water Level ~ 5i
Date Completed
If A, B, or C, D.E.C. Appz, oved(Y/N)
~-~ ?.-~?- Yield
Depth of Grouting. ~J ~
Pump Set At
Casing HeightAboveGround
Electrical Wiring in Conduit (Y/N) y
Separation Distances from~ell:
To Septic/Holding Tank on Lot JiO~ ~'
Sanitary Seal on Casing (Y/N) ~_
Dep~essionA~ound Wellhead (Y/N) bJ
; On Adjoining Lots
To ~NeaEest Edge of Absorption Field on Lot
To Nearest Publie Sewe~ Line g4~
Cleancut/Manhole ~4~
Wate~ Sample Collected By
Water S~mple Test Results
Comments C~-I~ 'Te~ 7-
I~O'~F ; On Adjoining Lots
To Neazest Public Sewer
To Nearest Se~ Service Line on Lot
C~-L ; Date ~ o- Z~ f~3 ' '
B. SEPTIC/HOLDING TkNK DATA
Date Installed ~- Z3-~) Size 150~_fii' No. of Cc~partments.
Standpipes (Y/N) ~/ Air-tight Caps (Y/N) ¥ Foundation Cieanout (Y/N)
Depression ove~ Tank (Y/N) bJ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N)P4~ ; fo~
Holding Tank High-Wate~ Alarm (Y/N) .fq~ . Temporary Holding Tank Permit (Y/~)
Separation Distances f~om Septic/Holding Tank:
To Water-Supply ~11 itO'+ ' To Building Foundaticn
TO Property Line ~O~ ~ To Disposal Field ~'~
To Water Main/Se~vioe Line
"~o~4- To Stream, Pond, Lake, c~ Major Drainage
Course
Comments
Receipt ~ l~_~---,C~
Date Paid:'
Amount: ______~_~o~iJ
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~-7-5-~
Width of Field ~ ~
Square Feet of Absorption Area
Depression over Field (Y/N)
Type of System Design
Length of Field ~
Depth of Field Il'
Gravel Bed Thickness -?l
Standpipes Present (Y/N)
Date of Last Adequacy Test ~o-- L5
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well IlO' '~' ~' To Property Line ~'~-
To Building Foundation ~' + To Existing or Abandoned System on
Lot AT~ ; On Adjoining Lots
To Water Main/Service Line ~O~+ To Cutbank(if present)
To Stream/Pond/Lake/or Majo~ Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Corm~ents I ~ {~.'lez~ i; ~Le~
D. LIFT STATION
Date Installed ~ ~
Size in Gallons ~
"Pump On" ~evel at
High Water Alarm I~vel at
Tested fo~
Electrical Codes(Y/N)
Conments
Din~nsions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Cycles during Adequacy Test.
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, o~ eonforn~d to all MOA
on the date of this inspection.
Signed ~_~<~-~-~)o~<t~ Date
Company ~6,~'~oc~'~ ~,~,~)%~, MOA NO.
KB1/dS/s
[Page 2 of 2]
Meets MOA
in effect
2-15-84
.~ _.r APPLY ' NT FILLS OUT UPPER H.A...~ ONLY
PropertyOwndr ~,~O~r~..~.~ ~. ~ e_~o~ Phone
Buyer
Address Zip Code
Real~y CO, & A~nt
Address Zip Code
Type of Resi~nce (~
~ingle Family
~ Multiple Family NO. of Bedroo~s ,'~
~ Other
Water Supply
~lndividual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975.
~ Community For wells drilled prier to that date, give well depth (attach Icg if available).
~ Public Utility
~ndividual Year IndivMual Installed: [ ~ ~ ~
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE iNITIATED.
Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
( ) CONDITIONAL APPROVAL'
DATE ~--~:~/--// ~ ~
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
~-- ~} [ Well to Tank Septic T~k Size
72-023