HomeMy WebLinkAboutT12N R3W SEC 15 LT 40TI2N R3W
c 15
Lo1' 40
#015-052-08
Jun 30 11 05:00p Beau Maxim 19073391985
Mark Begich
Mayor
Development Services bepar?ment
Building Safety Division
On-Site Water & Wostewater Program
4700 Elmore ~ead
P.O. Box ::[96650
Anchorage, A K 99507
www.muni,orq/ons/?~
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW
Date of Issue:
Parcel Identification Number:
Legal Description
TI2N R3W SEC 15 LT40
Pump Installation Date: 6fl5~11
Pump Intake Depth Below Top of Well Casing: 135 feet
Pump Manufacturer's Name: ~RUNV~OS
Pump Model: 15 SQE 07
Pump Size 3t4 hp
Pitless Adapter Burial Depth: 6 feet
Pifless Adapter Manufacturer's Name: C^MBEL
Pifless Adapter lustaller:
Well Disinfected Upon Completion? [] Yes [] No
Method of Disinfection: RECIRCULATED USING CHLORINE PELLETS
Comments:
Property Owner Name
BILJL BURRIS
] 9Z11ELMORERD
ANCHORAGE' AK
& Address:
Pump Installer Name: B~J~U MAXIM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl. INSPECTION REPORT
fl~l ~ ~l~y I<om~r DISTANCES
A~d~" TANK RELD WELL
L~*~.~SC.'.T'ON '"~ LOT LINE
~ ~ FOU~DATI0~
Township, R~nge, Section AS-~UILT DIAGRAM (Show ~ocahon of well, septic system, property hnes, foundatmn~
.SEC I~ ~ T 12 N ~ ~ ~ ~ __ drlVeW.~ wa~er bOdmS, elc)
- I N
Manulac~urer Capacdy m galJons ~ ~ ~ J ~[~
~chor~e T~n ~ ~oo
MateriaL'' ~ No o~ Compadmenls
.... g~ ~ / I _ - -
nT.ENCH B.E~ U W. ORAm UO'rHER /
.epJhtoplpebollOmlrom ,ot.ldepJh omo ginalgraOe -- /
~veJ Jenglh Gravel width /
Numberolhnes Soil rahng Pipe m~terial ~ll ~ ~0 ~g~ ~'
~ PRIVATE ~ OTHER ddentifv) .~ ".
~assifical~on (A,B,C) Total Deptll FI Cased ~o ~ } ~
~EMARKS:~ ~e~ II/l~ /90 ~C ~
~ lop I,~e ~aw~r ~ ~gt~om ~,~ Sca~e: 1" :: ~O'
/
Municipal and State guidelinea in elleclon thisbe: . ".tI ~ / .~
72-013 (3/85)
Tom Fink,
Mayor
Municipality Anchorage
Department of Health and Human Services
825 %" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
November 19, 1990
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject: Waiver
Waiver
Dear Mr. Moore:
Request for T12N R3W Section 15 Lot 40
Request ttWR90009~, PID #015-052-08, SW#900210
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved.
waived distance is 2 feet.
The
This approval applies
separation only. Any
require all separations
department.
Daniel N. Bolles
On-site Services
to the existing sep'tic system lot line
future upgrade to the septic system will
be met or another approval from this
Concur~,[~ / ~
Jpyn Smit~/ P.E.
DNB/ljm
~ ".Q~ ~'zv4'x~x
PH: (9(17) 345-1355 ANCHORAGE, ALASI(A 99516
Anct:orage.., ~k 9951 <3
~5': me:ires of this letter we are requesting a lot line waiver dOWil from the norrnally
:~,4uire,:i 10 foot separation distance to 2 feet, with respect to tim soil absorption bed on
BLM Lot 40 Section 1~, T I2N, R3W, S M. rile s.~-l)mlt inspection report, is enclosed for
your review and approw, l.
The soil absorption bed is entirely on the subject lot, and was constructed in basic
:.-'-."c, rdance with tile approve<_!- plans and specifications. The rectangular e:-:ension to the
u--~uth of the main b_}dy of the bed was constructed t) coi~_lpensate for tile elimination of a
p,;['tion of tile bed which would ottlerwise have protrllded into :txe 50~ R.O.W fei- Abbott
L,,u,[., Road. The total area c,f tile soil absorption bed is I 13'7 square feet., whictl is m
~:.'..:e:os or l~te requn'ed 1013 sq~mre feet.
f. ince. tile requested waiver is bi_: a property line abutting a dedicated right-of-way,
o-r :+, tree' ,' ~ ~,in :.:,:liver will not have ail adverse impact on the ability to develop on-sit~
_taclhtleS <:m any adjoining lots, nor will it have any effect on future utilization of the road
rigt:t-or -way.
During tile course of construction, tile existing septic tank was e:~osed to verify it's
condition. The tank is a 2 compart:nent steel septic tank of 1500 gallon capacity, and was
installed level. It appears to be in excellent condition. Our inspection as-built indicates
t!l¢ locations of ttie cleanouts between tile house and the tank, and tt:e assumed
alignment oI the waste line.
Sincerely,
Ted Moore, P.E.
0
ALASKA enuIROFIllleFITAL COFITROL SeRUICe$, 113C.
· {~nqincerin~ ~, ~nuironm~nld SKrclics
SPECIFICATIONS FOR BI'iD WASTEI~ATER TREATMENT SYSTEM
LEGAl. DESCRIPTION: Lot 40. Sec 15, T12N,
GENERAL
1.1
The Drawings, sbeets 1 tt~rough 3, shall be part of
this specification.
1,2
All materials and workmanship shall meet the
requirements of the Municipality of Auchorage,
Department of l.Iealtb & ltuman Services (DIflIS), the
conditions of tile permit, and all applicuble rules and
regulations currently in effect.
1.3
All excavations and depths are advisory, and are
to be verified or modified in the field by the
Engineer or inspecting agency.
1.4
it is [:be responsibility of the property owner or
installer to adhere to approved design for the
installation, to maintuln the specified separation
distances and to have the appropriate inspections
1.5
It is tlle responsibility of the property o~,ner nr
installer to report to the engineer any observed
conditions t~hicb would put tile system in violatlon
of state or Municipal regulations.
1.6
If the insLallution is not inspected by an AECS
engineer, AECS wilt not be responsible for the
installed system. An engineer at AECS should be
eollStllted priop to constrlletioll, to determille the
number of inspections that will be re, quired and to
explain what these inspections will involve.
2,0 SEPTIC TANK
2.1
If there is an existing septic tank it may be nsed
if it meets the capacity requirement fer the
residence. The structural integrity of the tank
must be verified.
2.2
The septic tank sha] 1 be a IJPC approved
two-compartment tank, constructed of 12 gauge
steel with bitumastic coating and set level on
undisturbed soil . If the tank is buried at a
dep[h of 4 feet or less, it mus~ be insulated
an overlying layer of 2 inch burial type
polystyrene rigid board insulation.
2.3
The septic tank shall be a minimam of 5 feet from
the house foandation, slid a minimum of ,5 feet from
the absorption area,
2.4 Tile septic tank and bed shall be a mini,mm of 100
feet fr'on~ any private well o2' body of water, 150
feet front Class "C' wells, and ~00 feet from Class
"A" or "B" ~ells, an/ess othem~ise specified.
Less than the reqnired separation distance must
haw~ prior approw~l or waiver by DtI[IS or Alaska
Department of Environmental Conservation (ADEC) .
2.,5
2.6
2,7
Piping shall be fitted with a a~echanicai
watertight calder coupling on the outlet and inlet
of the septic tank. Piping shall be 4 inch solid
PVC AST~4 D 3034 or cast iron, sloped a minimum of
1/4 inch per lineal foot on the inlet side sad 1/8
inch per foot on the outlet side. If the piping
is bat'ied at a depth of 4 feet: or less, it must be
insa]ated with an ove~'lying layer of 2 inch burial
type polystyrene rigid bnard insulation.
Cleanouts shall be installed as designated sad
capped with ail' tight rain caps (,l:in~ Caps or
equivalent) , and extend a mininlum of 1 foot above
ground lew~l .
If a lift station is required it shall be a
combJnatioe llft station septic task per Anchorage
Task and ~¢e]ding, Inc. design. Specifications and
design drawings are on file with the mtnieipulity
and the engineer.
3,0 SEEPAGE BED
3,1
The gravel for the bed shal I be 0 . 5 to 2 . 5 int:h,
screened rock with less :ban 3 pel'cent passing the
No. 200 sic. ye. All snbs~'[tutes must have prior
DHHS approval.
3.2
Tile ho:tom of the excavation shal! bc lcw~.] and
raked with the backhoe blade to ensure that tile
bet:em has not been romper, ted during excavatioa.
3.3
Sand, for leveling, shall have a size distribution
which ~eets the requlrenmnts of MOA code
15.65.077.
3.4 The distribution pipe shall be perfol'ated 4 inch
rigid PVC with a minimum crush strength of 1500
3.5
3.6
3.7
3.8
poonds und sba'k1 meek the approval of D}IItS for ese
as drainfield pipe. All pipes shall he laid
level, and spaced according to thc drawings.
Monitor standpipes shall he placed as shown in the
drawings. They shall be 4 inch rigid PVC ASTM
B~3034, or cast iron. The section shown with
holes may he either drilled 0.5 inch ho/es on 6
inch centers on opposing sides of the pipe, or a
section of regular perforated sewer pipe may be
clamped to ~he solid section with a no hub
conpling or selveat joint. Thc perforaked section
of the monitor tube shall be located in gravel
only. The portion of pipe above the se~qer ~'o(:k
shall be solid. A rubber raincap (Jim Cap nr
equivalenk) shrill be placed over the top of the
pipe.
Filter fabric Js required.
Tile side slope of the mound shall he slope 1 foot
vertical ko 3 feet harizontal ,
The bed shall be planted with a wbite clover and
red fescue mix, or with Kentucky bluegrass.
4.0 INSPECTIONS
4 . 1
This bed will require a minimum of three
inspections. The first inspection will be of tile
opera excavation, ko assure ti)ak the system is
installed iii the proper soil strata, correct depth
and meet mJuill/llll/ specified deslga parameters.
4.2
The second inspection will be after placement
gravel, inonitor standpipes, aad distribution
to verify proper lnstallatinn and position of
pipes prior to backfill .
of
pipe,
4.3
The thJ. rd inspection will he after final backfill
grading and seeding to ensure that adeqaaLe sci ]
cover has been provided over the bed.
4.4
The inspection of the septic teak or lift station
installation can be incorporated with any one of
klm above listed inspections.
4.5
The lift station will require eil:her an MOA
electrical inspection or certification by a
licensed electrician deponding on whet;her tile
building c'ode applies to this part of the city.
ALASKA ENVIRONMENTAL
CONTROl. SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
CHECKE° BY DATE.
SCALE
ALA~RA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
CALCULATED BY
CHECKED ~Y DATE
Municipality of Anchorage
DEPARTMENT OF HEAL'rH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION 'rEST
Township, ~an~e, Section:
SLOPE
SiTE P LA N/~.
L)
1
2
3
4
5-
6-
7
8
9
10
11
12
13
14
15-
16-
17-
18
19
20
'
WAS GROUND WATER
ENCOUNTERED? /JO
IF YES, AT WHAT
DEPTH?
Depth to Water Afler
Moniloring? /Pr~__ Date,
Reading Date
TEST RUN BETWEEN
COMMENTS
Net
Time
Depth to
Water
Net
Drop
O,/5
PERCOLATION RATE ~ (m~nutes/inch) PERC HOLE DIAMETER
· FT AND ~7/ ¢' FT
PERFORMED aY: /' /~ /C),
I CERTIFY THAT THIS TEST WAS PERFORMED iN
ACCORDANCE WITH ALL STATE AND MUNiCiPAL GUiDELiNES iN EFFECT ON THiS DATE. DATE:
72-008 (Rev. 4/85)
QGRE
'ER ANCHORAGE AREA BOF "UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ('ii, /,~ .' ( z '"" ~') MAILING ADDRESS (~ OK/~: /~t]:'gz, /~/ PHONE
LOCATION /i~x'~)/' ~) /,,<~/ID/;&c;'/ /('~,~ LEGAL DESCRIPTION /(~2 ///2/ ~ / ~_~ /,,>~,/~
SEPTIC TANK:
DISTANCE /t I/ [ 7t. I,~¢,/
' · NUMBER OF
FROMWELL /0¢, MANUFACTURER ~?/:~,¢~ --MATERIAL ~'/~ c COMPARTMENTS
INSIDE LENGTH
_ INSIDE WIDTH
LIQUID DEPTH
LIQUID CAPACITY / %( (' _GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER --
LINING MATERIAL__ / CRIB SIZE:
BUILDING FOUNDATION z~ ~ /-t'
OR WIDTH /~
DIAMETER
NEAREST LOT LINE 2¢~ /
ADDITIONAL ABSORPTION
LENG] H / ~ / DEPTH ~¢" / ~ /
DEPTH F? / DISTANCE FROM: WELL ~:~/ /
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~'~ (~' (; .SQ. FT.
WELL:
TYPE ~ /'//)~ t.,/
BUILDING , ~
FOUNDATION ·
CI--SSPOO L
APPROVED ~
CONSTRUCTION
NEAREST
LOT LINE__ ~ '-" /
OTHER SOURCES
_ DISAPPROVED
DEPTH DISTANCE FROM:
SEPTIC /~, /¢ SEEPAGE ~, ,
TANK SYSTEM '/9' /
REMARKS
DISTANCES:
INSTALLED BY: _/" ,'t/'/?~ ]~:'~/E ·
PIPE MATERIAL:_
LOT SLOPE:
REMARKS:- ('7/"; ~/Z
I' ~/ 7 t/~ //¢
Form No, EQ-031
/\// ---
DIAGRAM OF SYSTEM
DATE /
_ APPROVED
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 IICI' STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
INSTALLATION OF: SEPTIC TANK
FINANCED THROUGH
. SEEPAGE PIT DRAIN FIELD . OTHER
_ h
TO BE INSTALLED ~Y
NOTE~ THIS PERMIT IS NOT VAL,ID WITHOUT SOil TeST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKEILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TD PROSECUTION.
SEPTIC TANK SIZE --/ '~ ¢~(~ TYPE
MINIMUM DISTANCES, REQUIREMENTB
FOUNDATION TO SEPTIC TANK __
FOUNDATION TO seePAGe PIT (~.(~) t _, DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK ,~1 , SEEPAGE PIT ~ I , DRAIN FIELD
WELL TO SEPTIC TANK I ~'~ ¢"){
WATER MAIN TO SEPTIC TANK / ~{
SEPTIC TANK, f {~(~1 SEEPAGE PIT { ~3(')[
, SEEPAGE P[-r
ALSO CONSIDER AREA WELLS,
, SEEPAGE PIT /
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETer CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
DIAGRAM OIF SYSTEM
GRAVEL BACKFILL
CONFORM TO BOR~_~B REGULATIONS REga: INSTallation.
I CERTIFY THAT [ AM FAMILIA~ WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DEpA~<lFMLN[ OF ENVIRONMFttlAL QU~
3330 "C" Street
ANCHORAGE, ALASKA 99503
Case
Perfo~¢~d For
Legal Description:
This Form Reports
Soil
Depth
Feet
P e r f o r m e d
Cand_~yConstructionCo.~---.--Dated
........ - .... Percolation Test.
System
Soils Log ...... ~_x
~est Must Be Louqed To 4' Below Proposed Seepage
Soil Characteristic_S____
PT
Roots and organics .
S-~ty~ r e s idual"~°--~' lig~tDe ll°w '
3-- low moisture content
6 ~ Sandy gravel to gravelly sands
light gray, low moisture content,
random cobble size material.
Trace to minor amount of silt.
SM
13--
GW - SW
Was Ground Water Encountered?__No ._ ~e~O~'
If Yes, At What Depth?
Reading
Date
Gross Time
Net Time
Depth to H20
Net Dro
p~ r c o-~-a~t i o~ Rate Mi n u 'ce
Proposed Ins'~-]-l~'on: Seepage Pit Drain Field
Depth of Inlet Depth to -B~-SIal-f-Pit or Trenc~'14~'~.
C 0 M M E N I S: In view of tb_~A;~a-ti°n conditions in the lower 10.5 feet at the test
we~wwoul__~d r__e_co_~m_m_e_.n_d__u..s_ing_.l_25_ s_R, ft. ~bedroom.
Test Per formed BY
ALASKA MINERAL & MATERIALS LAB
Date
Certified BY: ...............
Date:
Parcel I,D.
t.
Municipality of Anchorage
Development Services Department
Building Safety Division --
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.munl.orcj/onsite
(907) 343-7904
CERTIFICATE OF 0N-SITE SYSTEHS APPROVAL
FOR A SINGLE FAHILY DWELLING
GENERAL INFORMATION Expiration Date: /
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
· Mailing address
Real Estate Agent
Mailing address
T12N, R3W, SECTION 15, LOT 40,
9211 ABOTT LOOP ROAD * ANCHORAGE~ AK 99507
COUNTRYWIDE HOME LOANS
Day phone
· C/O SHAY ERNISSE w~ PRUDENTIAL ~S?A
Dayphone
SHAY ERNISSE w/ PRUDEN~AL ~STA Day phone
3801 'C' STREET * ANCHORAGE, AK 99503
273-731~
Unlessotherwise requeste~ COSA willbeheldbyDSD~rp~kup.
2. NUMBER OFBEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Ser,/icas Department_(DSD) Issues Certificates of_On,Site_Systems
Approval (COSA} based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
STATEMENT OF INSPECTION BY ENGINEER
ms 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,
s~o~s that the'on-sit~ water supply and/or wastewater disposal syslem 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.
Name of Firm CARNESS ENGINEERING GROUP. Ltd.
Address 3701E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone
Date
337-6179
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of tho system in ecoordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the fime of the test, end separation
distances maasured to readily identifiable features. The (~oerafional life of alt wells and
septic systems depend on the local soils condition, groundwater 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this reper~ 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.
5. DSD SIGNATURE
L,//' Approved for ~
Disapproved.
Conditional approval for __
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
bedrooms.
bedrooms, with the fllowing stipulations:
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
Odglnal Certificate Date:
Municipality of Anchorage
Development Services Department
Bulkling Safety Division
Or~,-Slte Water & Wastewater Program
4700 Bmg~w Street
P.O. Box 196650
Andmmge. AK 99519-665O
www.muni.org/on~te
(90?)
CERTIFICATE OF ON-SITE SYSTEHS APPROVAL CHECKLIST
Legal Description:
T12N, R3W, SECTION 15~ LOT 40,
Parce 0 i 5--- 0 5".2. *- 0
A. WELL DATA
WeU type PRrVAT[
Date completed ~ 1965
Total depttt 116+ fl.
If A, B, or C provide PWSID# N/A
Sanitary seal (Y/N) YES
Cased to 40+ ft.
Weft Log (Y/N) NO
Wires propedy protected (Y/N) YES
Casing height (above ground) 12 + in.
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
ATINSPECTION
9/12/2006
114
4.74
g.p.m.
Coliform O cofoniesJl00 mi.
Amenic: ND ug./L.
SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
1 soo/
Tank size 500 gal. Number of Compsrtments 2/1
Foundation deanout (Y/N) YES
Date of pumping 9/11/2006
ABSORPTION FIELD DATA
Nib'ate 5.7.~ mgJL. Other bacteria 9 colonledl00 mi.
Date of sample: 9/7/2006 Collected by: GE(;, Ltd.
Depression over tank (Y/N) NO
Pumper
10/14/1974
Date installed 1 1/15/1990
Cteanoute (Y/N) YES
High water alarm (Y/N) YES
McDonald's Pumpincj
Dm installed 11/15/logo Soil rating (g.p.d./ff~Or~"~'-~ 135 System type BED
Length SEE INSP. ft. Width SEE INSP. .fl. Gravel below pipe 0.5 ft.
Toteldepth *5.se ft. Eff. absorpUonema 1137 fl= Monltodngtube YES Depression over fleld NO
Date of edequacy test 9/12/2006 Result~(Pase/Fall) PASS For 5 bedrooms
Fluid depUi in absorption field before test 1 in. Water added .75. g gal. New depth 4 in.
Elapsed 'r"mle: 150 min. Final fluid depth 3.5 in. Abemption rate >= 750+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
DRNNFIELD PRESOAKED WITH 1600 GALLONS OF WATER ON 9/11/2006
D. LIFT STATION
Data installed 11/15/1990
"Pump on" level at 28 in.
Datum TOP OF BASKET
E. SEPARATION DISTANCES
Size in gallons 500
"Pump off" level at
Cycles tasted.
*REPNRS MADE BY A+ HOME SE:RMCES ON 9/20/2006
Manhole/Access (Y/N) YES
28 in. High water alarm level at 19
" Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
100'+
Septic tank/lift station on lot
Absoq~tion field on lot 100'+
Public sewer main N/A
Sewer/septic sen/ice line 25'+
Animal containment areas 50'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excreta storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation $'+ Property line $'+ Absorption field
Water main N/A Water service line 10'+ Surface water
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
property line *2' Building foundation 10'+ Water main
Water sewice line 10'+ Sudace water 100'+
Curtain drain NONE: KNOWN Wells on adjacent lots 100'+
5'+
100'+
N/^
Driveway, parking/vehicle storage
F. COMMENTS
*WRg00056
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspec~3ns end
ravisw of Municipal records that the above systems ara in
conformence with MOA CO,SA guideflnes in effect on this
date.
Engineer's Printed Name Je.I.I-~<EY A. GARNESS
Data
Waiver Fee $
Data of Payment
Receipt Number
in.
YES
10'+
SGS Re£#
Client Name
Project Name/#
Client Sample ID
Matrix
1065311001
Gamess Engineering Group, Ltd.
TI2N R3W Sec 15 Lot 40
TI2N R 3W Sec 15 Lot 40
Drinking Water
All Date~JTime~ are Alaska Standard Time
PHnted Dateffime 09/19/2006 13:28
Collected Date/Time 09/07/2006 14:08
Received Datefrime 09/07/2006 14:40
Technical Director Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Paramctcr Results PQL Units l'.tclhod Conuincr ID Limits Datc Date Init
Net:a[, l:~ 'rep/MS
Arsenic
5.73 5.00 ug/L EP200.8 C (<10) 09/08/06 09/14/06 Mil
.Waters De,ar tmen~
Nit~te.N
ND 0.100 mg/L EPA 353.2 B (<10) 09/07/06 ALR
Microb:Lolocjy Laboratory
Total Coliform 9 OB, No Coil col/100mL SM20 9222B A (<1) 09/07/06 TLF
S~P-26-~06 14:08
PRUDENTIAL VISTA REAL EST
· '|ii! ill[! ,'~.~,.[~:~',,.~..r., ,~
i "' I~' I ..... ?'t
· ~*'~-~'t ~'r*~ b~'t'~ ~/
..~.,.: .... Q~ , .. ~. ~.~
~.0 -
.... ~']" ~.~
907 562 5485 P.02/02
I THOSE 5H~V~ ON THE RE~dMO ' //~.'1~ / ......
I A - P~T, AREINOT SHOWN H~E~)N.
I -.. '
~. :::.. . t~;:~--~;-~
I "~'' '%~~
TOT~ P.
CUSTOMER
7501 E. ]40th Avenue
Anchorage, Alaska 99.516
345- i 890
Aim: ~hay Etrisse
TO: 3383246
INVOICE It 3113 9
Block Lot
DATE DESCRIPTION
Ordered by: 5n.-a~ O~-alt with C~ess E~inee~mg Group
REMAFJKS
:
~ Gallons ~ Septic ~ Leach Area Holding Tank Standpipes ~ Time
E] PROBLEM AREA ~CALL FOR MORE INFORMATiON
[] NEEDSTO BE DONE AGAIN IN 6 MONTHS
[] Good Shape [] sludge buildup on bottom [] Floater on top
D Jim cap missing or D Cut standpipe to 1' above ground [] Needs Septictrlno
needs replacing
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
Parcel I.D. #
1. GENERAL INFORMATION
Complete legal description ~ '-F(Z'I"30~2¢?'k'~J-¢-~'G-c'TIO'~'[ IS--
Location (site address or directions)
Property owner ¢~5G~_
Mailing address
Lending agency
Mailing address ....
Agent _
Address_
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF: BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
Day phone ~/~'
Day phone
Day phone
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.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection. .
Firm ~ bq~ ~ &u¢~~-- Phone
Name of -~- 7 ~ ~
Engineer's signature ~--~¢/~~ Date
DHHS SIGNATURE
X Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By: 7~'~'~ ~'-~- 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.
72~25 (Rev ~/91} Back MOA
Municipality of Anchorage /~
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHFCKLISI'
Legal Description: Co'i-4¢~"C~ZI, J:~ ¢.~,¢J;~ .~c. 15- Parcel I.D.
A. WELL DATA
Well type ~-12'tV/'~
Log present (Y/N)
Total depth
Sanitary seal (Y/N) '~4~
If A, B, or C, attach ADEC letter. ADEC water system p~mber
Date completed tJcJ~¢u"eJ Driller
Cased to ,~) / L.,,=_m-i--EPiD asi n g h eig h t
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM
CELL LOG
g.p.m.
SEPARATION DISTANCES FROM WELL,~:
Septic/holding tank on lot
Absorption field on lot
Public sewer main N~,~,
Sewer service line
WATER SAMPLE R.~ULTS:
Coliform __ --'~L~'-~ Nitrate _
Date of sample'.
AT INSPECTION
_
; On adjacent lots
; On adjacent lots
_ Public sewer manhole/cleanout
Petroleum tank
~ ~ ~A Other bacteria _~
B. SEPTIC/HOLDING TANK DATA '? ~¢~n~k
Date installed ~?.-~j~/¢~'l'/'~¢ size ~) Compartments
Cleanouts (Y/N) ~-t-~c~ Foundation cleanout (Y/N) k~l~-~ Depression
High water alarm (Y/N) % ~E~E=~ '~ L. tF-';- ¢'F'~:~-'10~ ~ Alarm tested (Y/N)
Date of pumping ~/~.¢~'/¢L~ Pumper /
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot On adjaaent lots ~ y'~O
To property li'n~e L -~'~- ~ ' (~ Absorption field ~ ~
Surface water/dra nage ~O~ O~~v~
Foundation '~(~"
_Water main/service line
72 026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
Size in gallons
Vent (Y/N) ~F---..~
High water alarm level _
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N) ~H~-,~
"Pump off" level at
Cycles tested
SEPARATION DISTANC.~F~FROM LIFT STATION TO:
Well on lot ~ (O / 'z(,.~ On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed Itl 1'~'/c~O
Length Width
Total absorption area
Depression over field (Y/N)
Soil rating ~ "~ ~'
"-'-"----~, G ravel thickness
{ L~"-J ~ Cleanouts present (Y/N)
Results (pass/fail) '~-~
Peroxide treatment (past 12 months) (Y/N) ,/~/A~
7'
SEPARATION DISTANC/?.,,~,~,QM ABSORPTION FIELD TO:
Well on lot I10 On adjacent lots ["~*~/ (~
To building foundation
Date of adequacy test
for ,t~
System type
Total depth ~ ~,
On adjacent lots_ .
80 ~'~*_ Cutban k
If yes. give date
Property line
To existing or abandoned system op lot
Water main/service line
bedrooms
Surface water ~o~¢_ t~¢~Cd~¢~-~ Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
sigRature~certifythat~have;:e~ked~:~:v:~n~rmedt~a~M~AandHAAguide~inesineffe~t~thedate~fthisinspe~ti~n.`~
HAA Fee $
Date of Payment
Receipt Number
72 028 (Rev 3191) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
Alaska Water & Wastewater Services
"Preserving tire Last Frontier"
MuniciPality of Anchorage.
Divisiop nf Environmental Services
Box 196650
Re'fi: I/eal[',h Authority Aooroval for _.o~ 40, T12N, RSk, Sec 15
Seward Meridian.
-o whom it may ~;anoa~rn:
Co~lents cegardin¢~ hl]e sLIbjoc~ HAA ar(~ a~'~ follows."
1. Well Adequacy: 'l-h(,~ well ~as tested ['or adequacy by
Dumping 3.~3 9Pm 'PoP a to,al of 20~ minut;es (750 9allons).
The stable lave1 in tho ~el] ~as ].07 f'ae~ below ~na ~Op
the we/1. casirg, Fha wa~ar' .maya]. al; bh8 eno (]f ~r~ test
J. 14 faa~l', ba].e)~ bha top of bha we].] casing. Oonaa(~uanl::ly,
[mere was only a drawdown of 7 feat during the entire
LJpon completion of ;ha 'basE, bhe we.l,l recover'e(~ ~;o ~08 fmeb
irq I .5 hours. Basted Llpc~r/ bhis inforl~a~:m, on, the wail was
qeen'l~d aaeouata 'Fo~ a 5 bedroom hOUSe (750 gpd).
2. Septic Systel~l: Fha aaDbic system was te~tac Dy pumping
wace, n inbo it; a~ a re'ua of 5_75 9pm Con a ~o~;a]. of 201
minubea (750 9a.l. lons)~ at the paginnin9 an<~ an(~ of bha 'best
bo~h raorlitorin9 su~e}s ~era oomoloto].y ory, indioaking l;hat
waT;ar was being absorbeo into bl](~ soil as Fas~ as ib was
being introduced. 3sand upon bhis information, the septic
~;,yatam was deama(] ts(:) be~ a(]oquage for a 5 bedroom nousa (750
gpd) -
3. No Well Log on File: Dur'inn my sits visit I did not
']¢,}a~' any wa'Ear' trickling into cna well tinder static
(:;:onditior]a_ Th~S observation will [;ypically detect; any
wa~e~ migrabing through oepforated casing aoove the static
I;ha ac]aquacy ~esc, I shineo a light down ti~e ~ell to
visually obaenve bhe casing and ~aa able ~o see casing as
'Par as [;no ],ighk would sraval. [3asea upon ishia limib(~d
ii]formation, ib appc~ars ~r~ar. th(~ we],] is cased to a~ ].east
Telephone - Fax ~$8-3246 · 8471 Brookridge [)rive · Anchorage~ Alaska 99504
.'5. Separation Distances to Adjacent Wells and Septic
Systems: Beo~tJse of t;he large lot sizes, I only vetS'fi, ed
]:'f you have any questS, on, pi, ease call me
Sir'~o'e rely,
(]w rCeCr 6su ], i;ant;
kommer2.WPS
