HomeMy WebLinkAboutT12N R3W SEC 33 LT 60Rick Mystrom.
Mayor
Municipali of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
May 26, 1995
Nancy E Brew
Timothy H Silbaugh
14201 Ida Road
Anchorage, Alaska
99516
Subject: T12N R3W Section 33 Lot 60
Permit ~SW940146, PID #018-182-14
The subject permit, issued May 26, 1994 by this office for a
single family well and/or on-site wastewater system, has
expired as of May 26, 1995.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well
this office for documentation of the
close the permit.
log must be sent to
installation and to
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as-built inspection report must be sent to this office for
review, approval and documentation. Ail inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this
Sigcerely,
tProgram Manager
On-site Services
enc:
Copy of Permit
cc: Flattop Technical Services
office at 343-4744.
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW940146
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:BREW NANCY E &
OWNER ADDRESS:14301 IDA RD
ANCHORAGE, AK 99616
DATE ISSUED: 5/26/94
EXPIRATION DATE: 5/26/95
PARCEL ID:01818214
LEGAL DESCRIPTION: T12N R3W SEC 33 LT 60
LOT SIZE: 108900 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC?2) AND DRINKING WATER REGULATIONS (iSAAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
/
THE MAXIMUM WIDTH OF THE BED MUST NOT EXCEED 15.0 FEET IN
ACCORDANCE WITH THE REVISED ENGINEERING DESIGN DATED 5/20/94
WAIVER WR930075 DATED 5/26/94 GRANTS A TWO FOOT LOT LINE
WAIVED.
DATE:
Tom Fink,
MayOr
MaY ~ ' 1994
3. Ot
Waiver is 6
List Condit.
~t~v~ ~ ~tree~ 9W940146
· t' waiver itWR930u~ ~ '
sub3ec ' waiver RequeSt
oOt separatiOn
MoOre: required %0 ~been aPPr.°v~ed' The
Dear Mr. --iver o£ the%ot l. ine ~a~roperty %kn~.
-t ~or w~ ~m and a ~ north F ,
~aived dis~ ~'~s to ~ ~rade ~ ~mroVaz
-'s aPpr°~ ~" AnY ~ ~e met o~ ~
sepa~at~ ~yy separa
requare ~% · ~
departme /~
~iviY Enq ineer
On-site Services
RECEIVED
NIAY ~ 0 1994.
Health & Human Services
0.75" DIA. / ~ : / I
SC~ED4O~VC ~\ ,.m.o ~ I
W. 1/8" HOLES
2'O.C.,NBO=OMS /''x~.~.. L
EDGE OF
SCHED 40 PVC
~~ '~ 1250 GALLON
- v 'STEP TANK
PLAN VIEW
SCALE: 1" = 10'
2' SOIL COVER j~M.T.
~ ~ -2" RIGID INSULATION & FILTER FABRIC
~'~--~---~q ~./ ~.75"DIA. LATERALSW. 1/8"HOLES2'O.C.
0.5' MIN. SAND
~;~.~:z.~ -- GRAVEL
NATIVE SANDY GRAVEL
RECI!IVED
SECTION "A - A"
SCALE: 1" = 5'
~.~:, g~ A,~ :~.
MAY 2 0 1994
Oept, I- ealth & Human Ser¥i¢,
BLM LOT 60, SEC 33, T12N, R3W
PROPOSED SEPTIC SYSTEM
PLAN AND CROSS-SECTION
SCALE: AS-SHOWN
DRAWN BY: TFM
NOVEMBER, 1993
MUNICIPALII¥
;,; , ENVI~OiqMENTAL SERVIO:S DIVISION
4 1993
TECHNICAL
CIVIl, & ENVIRONMENTAl, I~N(;INI~I'~RIN(; · ENI'~RGY CONSERVATION & ANALYSIS
14530 ECHO ST.
TItEODORE F. MOORE, P.E. November ,.,.
1993
PH: (907) 345-1355 ANCHORAGE, ALASKA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design nma'ative in support of our application for a
permit to consn'uct wastewater disposal facilities on BLM Lot 60, Section 33, T12N, R3W, S.M., located
at 14301 Ida Road. Soils logs, peru test results, a site plan, design ch'awings and specifications are
enclosed for your review.
The proposed system will be constructed in the vicinity of test hole # 3. As can be seen from the soil
log, the native material between 1.5' and 4' is a sandy gravel with a measured peru rate of less than 1
minutes per inch. This material is underlain by a silty gravel with a measured perc rate (in T.H. #1) of 32
minutes per inch. The presence of this silty gravel eliminates the need for filter sand. The proposed
design concept, however, does incorporate a minimum 6" thick leveling course of com'se gravelly sand
which is intended to provide filu'ation to inhibit premature formation of an impermeable clogging mat.
Using the soil application rate of 0.8 gpd/sq, ft. specified in the wastewater ordinance for soils with a
percolation rate of between 1 and 5 mhmtes per inch, this 3 bech'oom residence requh'es a total absorption
area of 562.5 squm'e feet. The proposed design has a total absorption area of 600 squm'e feet.
The topography of the lot in the area of the proposed construction slopes towards the south and west at
approximately 5 %. Beyond the area in the NW corner of the lot delineated on the site plan, the
topography slopes downwards towards the south at 25 - 30%. Despite the lin'ge lot size, most of the m'ea
is unusable for on-site wastewater disposal because of poorly drained soils and subsidim3, streamlets
flowing down towards Rabbit Creek.
A lot line waiver allowing the soil absorption bed to be within 2 feet of the north property line is
requested. This waiver is necessary to allow the proposed system to be constructed outside the 100 foot
raclius fi'om the existing well serving the lot, and it should not adversely impact the ability to consla'uct a
replacement system on Lot 37A, at such time as that becomes necessm,d.
Since the present failing system on this lot was sized for a 1 bech'oom cabin only, we have designated a
site for a replacement system on the site plan. At such time as this is constructed, it will be necessary to
abandon the existing well aud drill a new one in the general m'ea shown on the site plan. There should be
no mason to relocate the well until such time as the replacement soil absorption system is needed.
The proposed project will have no impact on present or future water supply and wastewater disposal
systems selwing adjacent properties, nor will it have any impact on reserved space/surface and subsurface,
or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
LOT
38
EXISTING LOT 37A
~.: SOIL ABS
SYSTEM
SITE FOR '- ..
REPLACEMENT ' ..
ABSORPTION BED
(AFTER WELL MOVED
._ ~ _.S} lEDS
EXIST.
SEPTIC C.O
WELL
PROP.
3 BDRM
HOUSE
NO WELLS WITHIN 100'
PROPOSED
600 SQ. FT.
SOIL ABS. BED
-.H.
PROPOSED
1250 GALLON
STEP TANK
LOT 37B
FUTURE
REPLACEMENT
WELL SITE
, .. TOP OF 30% SLOPE DOWN
TO POORLY DRAINED AREA
LOT 60
::/,,,.., :ha..:: '/o '" '
U°¢,' .... .'!t :' ;. :., ',¢,, ¢.,,.,/
.' CZ. ~.,:/
' i~,/ "'/ '"
20 0 20 40 60 80 100
FEET
BLM LOT 60, SEC. 33, T12N, R3W
WELL AND SEPTIC SYSTEM
SITE PLAN
FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET
14530 ECI{O STREET DRAWN BY TFM
ANCHORAGE, ALASKA 99516 NOVEMBER, 1993
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
0,75" DIA.
SCHED 40 PVC
W. 1/8" HOLES
2'O.C. IN BO~FOMS
OUTER EDGE OF
SOIL ABS. BED
PLAN VIEW
SCALE: 1" = 10'
N
1,5" DIA.
SCHED 40 PVC
1250 GALLON
STEPTANK
~ 2' SOIL COVER [1.T.
~ ...... ~" RIGID I-NSULA:rlON & FILTER FA~I~R'IC-
...... ~- ~'-~0 75" DIA LATERALSW 1/8"HOLES2'OC
2' ~AX. CUT ..... ~::~?:~m::~::~;::~::~:: ~::~::~:.::~::~::~::~~~~-~.
0.5 MIN. SAND ~':~ ..... L~:L-::~:_~AVELLY SAND LEVELING ,75' SEWER
................ ~ ..... ~ ~ ~RAVEL
SECTION "A - A"
SCALE: 1" = 5'
BLM LOT 60, SEC 33, T12N, R3W
PROPOSED SEPTIC SYSTEM
PLAN AND CROSS-SECTION
SCALE: AS-SHOWN
DRAWN BY: TFM
NOVEMBER, 1993
Fb~ttop Technic;al Services
14530 Echo Street, A~tchorage, AK99516
Phone (907)345-1355
BLM Lot 60, Section 33, TI2N, R3W, S.M.
14301 Ida Road
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of abandonment of a existing septic tank and seepage pit and
installation of a new 1250 gallon STEP tank which pumps efflnent into a 600 squm'e foot soil absorption
bed.
1.2 Consn'uction shall be as depicted on the al)proved site plan and design drawiugs. Minor
deviations fi'om these di'awings may be allowed or requited by the engineer couducting the inspections.
All construction procedures and material specifications shall coufonn with Municipal and State
requirements. All separation distances shall be iu conformance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any
buffed ntilities.
1.4 The contractor shall provide adequate cover material aud rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agtecd otherwise, the homeowner shall be responsible for finish grading after
the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction.
2.0 Septic Tank:
2.i The existing septic tank and seepage pit ate to be abandoned in place by thoroughly pumping.
removing their tops and backfilling with clean soil.
2.2 The uew 1250 gallon Municipally approvext STEP tauk shall be set level on undisturbed soil.
Each compartment shall be equipped with a watertight manhole cover aud a 4" cleanout. If the tank is
buried less than 4 feet, it shall be insulated with 2 inches of approved bm'ial type, rigid insulation.
2.3 All pipe connections to the tank shall be eqnipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot. A cleanout
shall be installed within 5 feet of the building foundation.
3.0 Lift station:
3.1 The lift statioa shall be installed in thc second compartmeat of the STEP tank which has an
additional 250 gallon capacity and shall be an "Orenco" system as supplied by Anchorage Tank. the
discharge pipe from the lift station to the soil absorption bed shall be 1.5" dia. Sched 40 PVC.
3.2 The contractor shall be tesponsible to obtain the nc,cessary Municipal electric permit and
iuspectio~), and to provide a copy of the electrical inspector s report to the engineer overseeing the
const~'uct~on of the wastewater disposal system.
3.3 The on, off, and alm'm floats shall he set at the elevations specified by the lift station supplier, and
their proper operations shall be verified by tile contractor.
4.0 Soil absorption system:
4.1 The soil absorption bcd shall be constructed by stripping the peat and sandy loam material off tile
proposed 600 square foot bed area to expose a clean saudy gravel material with many cobbles and
boulders. Tile maximum depth of excavation shall be 2 feet. The north edge of the bed shall be no closer
than 2 feet fi'om the north property line, and the trapezoidal shape depicted on the drawings may be field
adjusted to conform with optimum coil conditions encountered.
4.2 The bottom of tile excavation need ,lot be level. A level base for the sewer gravel is to be created
by placing a minimum 6" thickness of coarse gravelly sand (Lake Otis gravel) in the excavation.
4.3 A total of 0.75 feet of approved sewer gravel shall be placed in the bottom of tile excavation with
the perforated distribution pipes laid level such that the pipe inverts am no less than 6 inches above the
bottom of the sewer gravel. The pressm'ized distribution pipes shall be 0.75" dia. Sched 40 PVC with
1/*" dia. holes drilled in tile bottoms on 2' centers. The ends of all the distribution laterals shall be
capped and ail pipe joints securely glued. Sewer grave! shall }~ (/.5" - 2.5" screened gravel, with less than
3% passing the #200 sieve.
4.4 Monitor tubes shall be of 4" diameter and installed ia the locations shown on the design di'awings.
The portion of the monitor tnbe extending through the sewer gravel shall be perforated.
4.5 Two inches of rigid, burial type, insulation and approved filter fabric shall be placed over the
entire top surface of the sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter
fabric.
4.7 The top snrface of tile cover material shall be raised a minimmn of 6 inches higher than the
sm'rouuding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
4.8 The propmly owner shall be responsible fol' ensaring that all areas disturbed by the construction,
with particulm- emphasis on thc bed top and side slopes, are covered with topsoil and reseeded to promote
rapid revegetation.
5.0 Inspections:
5.1 A total of 5 engineering inspections will be required during tile course of the project: (1) initial
stakeout with the corm'actor to establisb the location of the system and to discuss the plans, specifications
and construction procedures, (2) after the native material has been excavated to expose the infiltrative
surface to ensure that it coufo,'ms with the soil test information, (3) after the sand leveling filter material
bas been placed, (4) after tile sewer gravel is ill place and the distribution pipes have been laid and
connected up to the septic tank, but prior to placement of insulation or filter fabric, and (5) after final
backfill and grading is complete. The STEP rank requires one inspectiou after it is set level and the piping
connected, but prior to backfill. This inspection may be incorporated with any of the above inspections.
5.2 The installer shall coordinate tile timing of tile inspections with tile engineer sufficiently far in
advance to ensure the availabilily of the engineer.
TEST HOLE#3 ]
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
t EOAL DESCRIPTION: B[,M LOT 60, SI';CTION 33, TI2N, R3W, S.M.
DATE PERFORMED: OCTOBER 28, 1993
PERFORMED FOR: NANCY BI~.EW & TIM SILBAUGH
DEPTH,
(foot) I Pt
SM reddish sandy loam
4
12-.
GP Brown/Gray
Cle.qn sandy gravel
Many cobbies and boulders
GM Gray sandy silty g~avel
Shnilar to t.h. #1
water seep
B.H.
SLOPE
[.
Depth to Groundwater Date
SITE PLAN
EXIST.
'.H. #1
TOP OF
SLOPE
T.H. #2
18
19
20
COMMENTS:
Clock
Time
Readin9 i
0/2-8{ :galTii,esoak ~ 3:01
{ }1i 77 ~ 3:02:30
Net Time Percometer
(minutes) __ Reading
1 1/~2 dry
PERCOLATION RATE <1 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 2.5 FT AND 3.0 FT
5 gallons of water poured into perc hole were corn )letcly gone within 2 minums after pouring was cotnplete,
Net Drop
(inches)
6
PERFORMED BY FLATTOP TECHNICAL SERVICES. I_ %:~ ._. CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: (! / ~ ~. / ~
FLA'KroP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: BLM LOT 6g, SECTION 33, TI 2N, R3W, ,'-; M
DATE PERFORMED: OCTOBER 28, 1993
PERFORMED FOR: NANCY BREW & TIM SILI~AUGfl
DEPTH SLOPE
(feet) Pt
3
13-
14-
17.
19-
20
SM Reddish sandy loam
GP Brown sandy gravel
many cobbles
Gray sandy silly gravel
similar to lest hole fl I
hard digging
Ilear bottom
water seep
Depth to Groundwater
Reading
12;' presoak
Date
SITE PLAN
EXIST.
C.O.
.H. #2
'.H. #1
TOP OF
SLOPE
Clock Net Time Percometer Net Drop
Time (minutes) Reading (incl~es)
3:17
3:34 5 ~ __
add water 3:40 -- _. 23 3/8
113 5
PERCOLA] ION RATE 2 (minutes/inch)
TEST RUN BETWEEN 275 FTAND 3.25
COMMENTS:
PERC HOLE DIAMETER
FT
PERFORMED BY FLATTOP TECHNICAL SERVICES. ~,~ '~?'~¢,v& . CERTIFY THAT TH S TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ]l/ ~ / c~
ER ANCHORAGE AREA B0r' 'JGH
Department of EnvJronmentaJ Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
N A M E ~/~/"'~ ~;~O'~.'~
-- MAILING ADDRESS_~/~// ~]~/~' z~2~// -- PHONE --
LOCATION ~.////~A////d~LZ//U' ~.~..Z//~'~/LEGAL OESCR IPTION ~:~gf/" ~'.~' ~-//~/(//~2g/~./ ~ ~..~
SEPTIC TANK:
DISTANCE
INSIDE LENGTH__
SEEPAGE PIT:
MANUFACTURER
HUMBER OF
_IN~ID~WIDTI~ ~ _LI~UI~ DEPTH ~LIQUlD CAPACITY ~ GALLONS,
DIAMETER/ OR WIDTH
NUMBER OF PITS /
LINING MATERIAL ,~2{~S' : CRIB SIZE: DIAMETER
BUILDING FOUNDATiON~/ ~
, NEAREST LOT LINE /~/
ADDITIONAL ABSORPTION
WELL:
DEPTH~"'~_ DISTANCE FROM: WELL ~'.~ /
TOTAL EFEECTIVE
ABSORPTION AREA (WALL AREA) ~ .SQ, FT.
BUILDING NEAREST //j//~ NEAREST
FOUNDATION ~2.~.~~x LOT LINEX~' SEWER LINE~/~
CESSPOOL
OTHER SOURCES
SEPTIC
TANK
OISTANCE FROM:
SEEPAGE /4 ~ /
SYSTEM ~2
APPROVED ~'--
- DISAPPROVED ~'
!
DISTANCES~_/~~-~ ~ ~' ~-/
INSTALLED BY: /z~/~ .?r~/~/X)g//~
PIPe MATERIAL: ~/~ ~/~/~
LOT SLOPE: /~D
REMARKS:
Form No, EQ-031
DIAGRAM OF SYSTEM
G,A.A,B.
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL. QUALITY
3330 "C" STREET ANCHORAGEi ALASKA 99503
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
FfNANOED TH.OUGH .... TO BE INSTALLED ~y fft'~__ff(A *~
- --' /~~ - NOTE, YHI~"E".Iym NO, VALID WlfHOUT
FINAL INSPECTION: 24 HOUR NOTICE ~EQUIRED. BAGliFILt. ING OF ANY SYSTEM WlTNOUT FINAL INSPECTION BY THE
DEPARTMENT OF' ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION,
SEPTIC TA.I, SIZE ~--~ TYPE~ ~ ~SEEPAGE AREA SIZE ~.~ ~
WELL TO SEPTIC TANK
DRAIN FI ELL)
- - TYPE
FOUNDATION TO SEEPAGE pIT I~-~
SEPTIC TANK ,rD SEEPAGE PtT WALL __
ALSO CONSIDER AREA WELLS
SEEPAGE PIT ___
DRAIN FIELD_
GRAVEL BA(;~(FI LL
CONFORM TO [:~OROUGH REGUL IONS REGARDING INSTALLATION·
/
LICENSED DESIGNER
u .,b 'lo~ For '.-. Ida Larson. ): w'lll be unabl¢, ',~ apprew~ ,,h,.
i' would ,=~[ re 'm~e ,/uur assistance i~i ~h'is ,idt ,~1 as soon
ml d
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
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
-~O ,-,,,..g ~ b ~ ~ E Day phone
Day phone
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well )~.
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify th, at 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 /'~,.J t3 E77-50 ,J ~',,,j ~, ,,J ~c%-fu~,,J O Phone
Address ~>.O. ~4'3 × Z ¢0 7 ~' :'~ /~ C4~ ~¢~ d~
Engineer's signature ~/~,t..z~,L~,, ~, L~&~'--.- Date
'z 8 9//0
DHHS SIGNATURE
,,~' Approved for ~/,./~_
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The 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. 1/91) 8ac)~ MOA
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
. ~,~' ~'~/~-PT(c-,~Parcel I.D.
Legal Description: TI?×I~I. ¢ ,~.¢w/
A. WELL DATA
we, type ~!~r)t~L.. If A, B, or C, attach ADEC ~etter.
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
ADEC water system number
Date completed q ~t l~" Driller
t' ~r ii
Casedto ~ ~'~0 Casing height .
Wires properly protected (Y/N)
FROM WELL LOG AT' INSPECTION
g.p,m. ~'~
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/L',;d,~ tank on lot
Absorption field on lot
Public sewer main
Public sewer service line ~/~
g.p.m.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform /~'~MZ~ ~/~'~'
Date of sample: ~//~ ~/~/
Nitrate
/J "~) ' Other bacteria
Collected by: F ~/'t¢t'7¢/~~
B. SEPTIC~ TANK DATA
Date installed ? '7~
Cleanouts (Y/N) ~
High water alarm (Y/N)
Date of pumping
Tank size 7F~O (~i'A~,~. Compartments
Foundation cleanout (Y/N) ~' Depression (Y/N)
Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/~ TANK TO:
Well(s) on lot ~0'
I
To property line ~;~
Surface water/drainage
On adjacent lots
Absorption field /*/'
~O'
Foundation
Water main/service line
72-O26 (Rev 3/91)Front MOA21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date-Lnstalled I~/'//~ Manufacturer
Size in Manhole/Access (Y/N) .~-
Vent (Y/N' ~oa evel at "
~ P ~ P~.u~p-off 'level at
High water alarm level '~' ~'"~. ~.-.~e;'tes'-~'~O __
Meets MOA electrical codes (Y/N) ~-~"~'f ~
V~::~fYSn lot On adjacent lots Surface water '~,
D, ABSORPTION FIELD DATA
Date installed 7 l'7:'~ Soil rating [/oO ~X~,,,. System type .~?~'}~/ ~I'~
Length 1{2' Width I'~I't Gravelthickness )~¢,~' '~ ~'~-' Totaldepth '~'
Total absorption area Z~-/O ~ ~ Cleanouts present (Y/N) ~
Depression overfield (Y/N) kl Date of adequacy test ¢,ll " iPl
Results(pass/fail) ~'/~ for O~¢ ~l~ bedrooms
Peroxide treatment (past 12 months)(Y/N) ~ If yes, give date ~/~,
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot IO~-
To buildingfoundation7'7' To existing or abandoned system on lot ~/~
Onadjacentlots ~I/A Cutbank ~'~1001 Water main/service line /k.}//~
Surface water q//~, Driveway, parking/vehicle storage area
Curtain drain
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.
Engineer's Name /'~'6''~f'4''0~''~ ~ ,,'~.~C"¢/'Z~0¢)
Date ~/'~*'~/~ /
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72 026 (Rev. 3191) Back MOA 21