HomeMy WebLinkAboutSKY RANCH ESTATES #1 BLK 5 LT 13Sky Ranch
Estates #1
Block 5
Lot 13
#015-301-25
5 0 30 \
GRAPHIC SCALE CHAIN LINK FENCE
1"=30' \\
189.00' --
S86 -20'21"W 189.02' (C) `
100.1'
1�
10.0'
\ y WOOD SHED
NOT ON FOUNDATION
!OT 13
18,274 S.F.
0.420 AC.
CHIMNEY -
,z
DECORATIVE ROCK
RETAINING WALL
LOT 14
12.3'
/ CANTILIVER
\� s o�
0 3.4
WOOD~` 2.3'
DECK
w /
STAIRS
(TYP)
ROOF OVERHANG
/ of hoz �o
LOT 12
��ooR
28 �PN0
38.1
9.4'
YPC LEANS EASTERLY
SIGNIFICANTLY. YPC BEARS
1- APPROXIMATELY 1.3'
• • •'
S88'18'46" E
COTES
,`Q�,•'' •, t�
FROM RECORD POSITION.
8.7'
PLAT (71-166) 1. EASEMENTS OF RECORD,
® FOUND YPC
Ct/
�� +fi .' • • •FRANK .R. •BELL • • .q
A ;4l
t •. NO. 3252-S
4:
r p l
%,
l �F�D . Aug. 14 2018 , •' �J@r/
ON THE
�\ A o"E5s I ON m-
th �
COMPUTED
.
LOT 18
FOLLOWING DESCRIBED PROPERTY;
25'
SKY RANCH ESTATES UNIT NO.1 BLK 5 LOT 13 WAS MADE ON
®
WELL
o ® SEPTIC VENT
BELL
L
F.R. ELo ASEDUATES
!OT 13
18,274 S.F.
0.420 AC.
CHIMNEY -
,z
DECORATIVE ROCK
RETAINING WALL
LOT 14
12.3'
/ CANTILIVER
\� s o�
0 3.4
WOOD~` 2.3'
DECK
w /
STAIRS
(TYP)
ROOF OVERHANG
/ of hoz �o
LOT 12
��ooR
28 �PN0
38.1
9.4'
YPC LEANS EASTERLY
SIGNIFICANTLY. YPC BEARS
1- APPROXIMATELY 1.3'
• • •'
S88'18'46" E
COTES
,`Q�,•'' •, t�
FROM RECORD POSITION.
,r
PLAT (71-166) 1. EASEMENTS OF RECORD,
® FOUND YPC
Ct/
�� +fi .' • • •FRANK .R. •BELL • • .q
A ;4l
t •. NO. 3252-S
4:
r p l
%,
l �F�D . Aug. 14 2018 , •' �J@r/
ON THE
�\ A o"E5s I ON m-
C�
COMPUTED
.
I HEREBY CERTIFY THAT AN ACCURATE SURVEY OF THE
FOLLOWING DESCRIBED PROPERTY;
25'
SKY RANCH ESTATES UNIT NO.1 BLK 5 LOT 13 WAS MADE ON
LEGEND
COTES
0 FOUND REBAR
(R)
RECORD PER
PLAT (71-166) 1. EASEMENTS OF RECORD,
® FOUND YPC
(M)
MEASURED
OTHER THAN THOSESHOWN
ON THE
A GAS METER
(C)
COMPUTED
RECORDED PLAT, ARE
NOT SHOWN HEREON.
A ELECTRIC METER
®
WELL
o ® SEPTIC VENT
BELL
L
F.R. ELo ASEDUATES
® AUGUST 08, 2018
AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND DO NOT OVERLAP OR ENCROACH ON
THE PROPERTY LYING ADJACENT TO THE PREMISES IN
QUESTION AND THAT THERE ARE NO ROADWAYS, TRANSMISSION
LINES OR OTHER VISIBLE EASEMENTS ON SAID PROPERTY
EXCEPT AS INDICATED HEREON.
THIS DRAWING REPRESENTS A MORTGAGE LOCATION SURVEY PREPARED IN ACCORDANCE WITH
THE ASPLS MORTGAGE LOCATION SURVEY STANDARDS.
THIS MORTGAGE LOCATION (AS -BUILT) SURVEY IS A REPRESENTATION OF THE CONDITIONS THAT
WERE FOUND AT THE TIME THE LOCATION SURVEY WAS PERFORMED AND DOES NOT CONSTITUTE
A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY
SURVEY MAY DISCLOSE.
INFORMATION CONTAINED HEREON SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE,
OR OTHER IMPROVEMENTS.
UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE
LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT.
engineers L13 135 SKY RANCH ESTATES UNIT NO. I
surveyors AS -BUILT SURVEY
PREPARED FOR:
Bell LEMAY HUPP
DRAWN BY: WEM
CHECKED BY: VFS
801 W. FIREWEED LN. #201 JOB NO.: 2018-2535
ANCHORAGE, AK 99503
(907)274-5257 SCALE: AS SHOWN
FIELD BOOK: FRBA18-02
GRID MAP#:
SW 2737
DATE: 08/14/2018
Municipa!ity of Anchorage Page / of /
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343:4744
On-Site Wastewater Disposal System and/or Well Inspection Report
N~ ~~, ~ ~~~ WastewaterSystem: BNew ~pgrade
;~'~¢~~~~/~ ~¢~/¢ . ¢ASSORPT~ON F~ELD
Phone:~_ ~ [No, of Bedrooms~ ~epTrench ~ Shallow Trench ~Bed ~Mound ~Other
LEGAL DESCRIPTION ~N so~,.~,.~:~. ~ GPD/Sq. Ft. Total Depth from original grade:
Township:~¢w Range:~ Section: ~ Fill added above originai grade: Graveliength:~ i Ft.
WELL:~/~ ~ New ~pgrade G~a~, width: ~ Numbe~fli.es: Distan~eenlJnes:
Fi, ~ Ft.
~lassification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Driller: Date Drilled: Static Water Level:Ft. ~t;e~o~ ~¢~
Yield: GPM Pump Set at: Ft. Casing Height Aboye Ground',Ft. ~ TANK
SEPARATION DISTANCES ~t~o u Holding Q S.T.E.P.
To Septic Absorption Lift Holding =ublic/Private Manufacturer: Capacity iR ga[Ioas:
Welf~ /~/ /~ ~ ~ ~ Material~~ Number of Compadments:
s.,.O.w.t., ~ ~ ~N A/A ~A UFT STATION
Lot
Cudain Drain ~ ~ ~ ~ ~ Pump Make & Model Electrical Inspections pedormed by:
Remarks: BENCH MARK
ENGINEER'S SEAl.
Department of Hea~, and'Human ~ervices appTova, ~e~..~~..2~ ~
Reviewed and approved by: ,<"/¢~ ~/ 7'¢,~ Date:/~ -2~-¢¢_ ",~(~?or~ss~o~ '~* ............... -' '
72-013 (Rev. 9/91) MOA 25
Permit No. SW940442 Page 1 or 2
Municipolity of Anchoroge
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchoroge, Alosko 99519-,6650 Telephone: 54-5-4744.
On-Site Wostewoter Disposol System ond/or Well Inspection Report
Legol Description: Lot 13, Block 5, Skyronch Es~. N~o. 1, T12N, R3W, Sec. 22 PlO No.: 015-301-25-000
See Sheet~2/2 for Ele~otio~_ ~ ~~. '~ ~.~ ~
............... ~ ............. ~..~,~..:.~..;........:..~.~.L..~.~.L~ .... ~ ........ ~..~.~..~..~ ~ : .. ~ .~
............. ('~ ' ~u~e' ~'q ............ :~L ...... ~ ............ q..... ,. ~ ......... ~... '~k.N~ .....
.~ ....... ~: .... V .................. q :...~ ........... :% ..... ~. ~..~..,~ ...... ~...
Existing
3 Bdrm
House
System Plan
Not to Sco e
;ystem
~wing Tt~es
JOB #: 94027 FILE:94027SYS PLOT SCALE:I"=IO'
28.1
17.7
~ ~RO~ER~ W. WR,O~
~ ~ ee CE 8156
DATE: 11/18194
Permit No, SW940442
Page 2 of 2
JOB #: 94027 FILE:g4027A$2 PLOT SCALE:l"=10' 0ATE: 12/I 9/94
Municipolity of Anchoroge
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchoroge, Alosko 99519-6650 Telephone: 54.3-4744
On-Site Wastewater Disposal System ond/or Well Inspection Report
Legol Description: Lot 1,3, Block 5, Skyronch Est. No. 1, T12N, R3W, Sec. 22 PID No.: 015-.301-25-000
PAGE 1 OF 1
~CHO~GE
~ICIPALITY
OF
/
DEPONENT OF HEALTH ~ H~ SERVICES
P.O. BOX 196650, 825 "m" STREET, ROOM 502
~CHORAGE, ALASKA 99519- 6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPG~E) PERMIT
PERMIT NUMBER:SW940442
DESIGN ENGINEER:ROBERT W. WRIGHT, P.E.
OWNER NAME:LAMBERT DONALD S & BEVERLY H
OWNER ADDRESS:il920 STEEPLE CHASE CIR
ANCHORAGE, ALASKA 99516
PARCEL ID:01530125
DATE ISSUED:12/02/94
EXPIRATION DATE:12/02/95
LEGAL DESCRIPTION: SKY RANCH ESTATES #1 BLK
T 13
5 L
LOT SIZE: 18202 (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 ANCHOP~AGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) 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
DATE: /~/~/~
'Vright-Alaska Engineering Services · 6004 Glenkerry Dr. · Anchorage, AK 99504
November 22, 1994
W.O. 94027
Municipality of Anchorage
Department of Health & Human Services
On-Site Services Division
P.O. Box 196650
Anchorage, Ak 99519-6650
Re:
Lot 13, Blk. 5, Skyranch Est. No. 1
Health Authority Approval &
Upgrade Septic System Design
Dear Sirs,
With the submittal of the following HAA paperwork, new system design package and the
payment of $620.00 for Municipal Fees, Mr. & Mrs. Don Lambert request the review of
the information provided for the granting of a Health Authority Approval and an On-Site
Wastewater Disposal System Upgrade Permit for the above noted lot.
The available lot area for situation of this replacement system is extremely tight. To
conform to the requirements for Lot Line and Well separation distances, the proposed
upgrade system has been placed through the existing deep trench drainfield. The
existing perforated piping supplying the existing system will be cut and plugged.
The proposed deep trench system is 54 ft. long. We have elected to enter the trench
with a service pipe from the septic tank in the proximal end. We feel that, although the
trench is over 50 ft. long, supplying the trench by middle entry will lead to differential
effluent supply to one side, effectively reducing the system to 1/2 its design length. With
the difficult design constraints on this lot, we request that we be allowed to utilize end-of
trench entry, for the benefit of the system.
Should you have any questions or require additional information, please feel free to
contact me at the numbers listed.
Sincerely,
Wright-Alaska Engin~eer~n,,,g Service, s
Robert W. Wright, P.E.
Telephone (907) 338-6230 · Fax (907) 337-5182
Wright-Alaska Engineering Services
6004 Glenkerry Dr. · Anchorage, AK 99504 · Telephone: (907) 338-6230 Fax: (907) 337-51§2
Percolation Log Repod/ Soils Log
Performed for: Mr. Don Lambert Hole No:l Dote: 11/15/94-
Legal Description: Lot 1.3 Block. 5 Tract NA Subdivision' Skyranch Est. 1
Township, Ronqe, Section: T12N, RSW, Sec. 22 Sheet1 of 1
Groundwater Gross ~ Net Depth ~o Net Adjusted
Encountered?NoReading Date Time Time (min.) Water(in.) Drop (in.) Rate (min./in./
At what depth?~'~ I 1 11/15/94. 10:50 10 3,563 NA
Water level a~r ?egln ,~ H'our'Pre,,ook Period
11/15/94 15:20 30 5 3,063 14,99
Monitorin g?~_ 2 11715/94 15:52 30 5 2,75 16,69
11/22/94 3 11'/15/94 16:23 30 5 2,688 17,08
Date:
4 11/15/94 16:53 30 5 2.,75 16,69
Percolation Rote
17.08 mln/in.
Comments:
Performed by: BOb Wright I,
Certify that this test was performed in accordance with all State & Municipal guidelines in
effect on this date. Date:
2 SM ' ' & ' ' ' ' ' ' ' ' ' ' '~' '
~ If': "' "' [ ] [ [ [ ] [ [ [ [ [ ] [
4 -.':ML:: Dry, Loose. , , .~ , , , , , , , , , , , ,
.,, .":'.. Silt= 20% ' [ ' [ [ [ ' [ [ [ ' [ [ [ [ [ [ [
8~Mt~'k ~l' ' I I I I I I I I I I I I [ I I I I I
9 '" ' to 7 Slope Site Plan
10 .. .. I ~--~---~, ,-,"--+t~----- , ' ~j*--- . .......~,-- ~J*--~---~--', ,
11 .'.'":.'"' P ' ' ' ' ' ' ' ' ' ' ' ' '
-.~ e ,__,___,__,__,___,__,__,___,__,__,___,__J
14 .'.,IS;. Sand> 95%
Silt< 2% ~'· e·ee.eeee eeo
~ ~ % ROBERT W WRIGHT · ~- ~"
17 16 End Hole " "
Gross Net Depth ~o Net Adiusted
Reading Dote Time Time (min.) Water,in.) Drop (in.) Ro(e (min./in./
1 11/15/94 10:40 NA
1 11/15/94 10:50 10 3.563 NA
?egln Hour' Pre.. oak Period
11/15/94 15:20 30 5 3.063 14.99
2 11/15/94 15:52 30 5 2.75 16.69
3 11/15794 16:25 50 5 2.688 17.08
4 11/15/94 16:53 30 5 2.,75 16,69
Percolation Test Rate Adjustment
All percolation tests conducted for this project have been completed using a 4"
diameter tube in a 6" diameter hole. The annular space between the tube and the
hole walls is filled with 3/8" pea gravel.
The following adjustment has been made to all readings to account for the volume
occupied by the annular gravel pack.
h:=8
d := 5.25
h d
- 0.344
h
P :: 0.344
The porosity of the gravel has been determined using two
identical 64 oz. containers. One filled with water, the other with
gravel. The depth of water (h) was measured. Water was
poured into the gravel container. The depth of the remaining
water was measured. P= (h-d)/h.
The correction factor 'R' was calculated using the formula from page 76 of Dr. O.
Benjamin Kaplan's book "Septic Systems Handbook":
r1 : 2
r2 ::3
1
r2.~ = 1.5
radius of 4" diameter perc tube
radius of 6" diameter perc hole
C :- 1.5
I t p.¢2_ 1~ =0.636
C2
R: 0.64
R= V1/V2 where Vl is the total water vol. in the hole, and V2 is water volume with no
gravel.
Example:
6" water drop in 2:13 min.
2.22
- 0.37
6
0.37 min/in with gravel pack.
0.37
- 0.578
0.64
0.57 min/in without gravel pack in 6" hole.
November 19, 1994
W.O. 94O27
Lot 13, Block 5, Skyranch Estates No.1, T12N, R3W, Sec. 22
Absorption Area Calculations:
Soil percolation rate is 17.08 min./in., see percolation logs.
Application rate for design purposes= 0.6 GPD/s.f.
Number of bedrooms= 3
Gallons of septic effluent/bedroom/day= 150
3.150 = 450 gals/day
450
0.6' = 750 s.f. required absorption area
Assume a deep trench where depth= 7 ft.
750
- 53.5711.f.
7.2
Therefore, assuming side absorption only, trench= 7 I.f X 54 I.f
94022CAL.MCD
Permit No. Poge 1 of 7
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska g9519-.6650 Telephone: 545-4744
On-Site Wastewater Disposal System ond/or Well Inspection Report
Legol Description: Lot 13, Block 5, Skyronch Est. No. 1, T12N, R3W, Sec. 22 PID No.: 015-301-25-000
Existing Trench
System :
ProP:.o~i~d' ' sys
i.....'.: f i4
Deck
L..'.:: t 15
3 Bdrm,
Frame .......
/ General site Plan
Scale: 1"-- 30'
/
.................. : Ground· El;
i@ Well= 84.4'
JOB ~: 94027 FILE:94027GSP PLOT $CAL£:1"~30'
Steeplechase iCir.
)fox, Edge Rood
Rebor
· A~eum'ed' El;=" 100; 0
IOQ
Permit No.
Page 2 or 7
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:
On-Site Wostewater Disposal System and/or Well Inspection
343-4744
Report
Legal Description: Lot 1..x, Block 5, Skyronch Es~. N~o. 1, T12N, R3W, Sec. 22 PlO No,: 015-.301-25-000
95x ~ :
'x.
'~,'-- '~
~ 189.00 :
: ~ Trench
Droinfisld, ~Notes
~...
.....
on~rlng .... .~
Tu~e ~.)
Exlstim
'See'
System Plan
Scale: 17= 10' i
Existing
3 Bdrm
House
;ystem
.ocatio
JOB ~: 94027 FILE:g4027SYS PLOT SCALE:I"=IO' OATE: 11/18/94
Permit No. Page ,.~ of 7
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-,6650 Telephone: 545-4744
On-Site Wostewater Disposal System and/or Well Inspection Report
Legal DescripUon: Lo'( 1.t, Block 5, Skyranch Est, No. 1, T12N, R3W, Sec. 22 PID No.: 015-.t01-25-000
9i:'['6 [='13 'AUl ed!d Wed ,
qoua~ dee0 ~pu3 gg'gz+0t 'p~S /~
9~'¢6 ='13 'AUl Je~oq o
PlalJ qoua~l dang ulSea '~ la~qS
--dOdO OAd L~ IlOlSUl gg'L~+OL
000[ UlOe8 LB'gO+O[ 'ols ~
,JOB #: 94.027 FILE: 94'027PRO PLaT SCALE:l"=1 O' DATE; 11/19/94
Permit No.
Page 4- of 7
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:
On-Site Wostewater Disposal System and/or Well Inspection
343-4744
Report
Legal Description: Lot 13. Block 5, Skyronch Est. No, 1, T12N, RSW, Sec. 22 PID No,: 015-501-25-000
'g .I.33HS
.............................................................. I. ..................... ~ ............... ~, .............o ~ ..........
< 'NIR::
"' ,o',i I'1
,0 T
ROBERT W. WRIGHT
CE 8156
JOB #: 94027 FILE: 94027TNK PLOT SCALE:I"= 3' DATE: 11/19/94
Permit No,
Poge 5 of 7
Municipolity of Anchoroge
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O, Box 1966,50 Anchorage, Alaska 99519-6650 Telephone:
On-Site Wostewoter Disposol System ond/or Well Inspection
345-4744
Report
Legol Description: Lot 13, Block 5, Skyronch Est. No. 1, T12N, R3W, Sec. 22 PID No.: 015-301-25-000
II
II :
E
0
IZ. '1-
,~0B ~: 9~,027 FILE:9'tO270ET PLOT SCALE:l"=2' DATE: 11/19/94
Permit No. ~~'~/~/~7~ ~ W.O. u~uz/
Legal Description: Lot 15, Block 5, Skyranch Est. ~,~(~'~ee?~ ~/ n.,. 11/1g/94
ALL CONSTRUCTION SHALL BE IN ACCORDANCE ~TH CHAPTER 15.65. WA~T~R DISPOSAL REGULATIONS
OF THE MUNICIPAL CODE AS CURRENTLY AMENDED.
2 INSTALL NEW 1000 GAL SEPTIC TANK AS SHOWN ON THE DRAWINGS. RECORD INLET AND OUTLET
ELEVATIONS OF THE TANK. TANK SHALL BE PLACED ON UNDISTURBEO NATIVE SOIL,
SITE TOPOGRAPHIC SURVEY CONDUCTED ON 11/11/94, EXISTING STRUCTURES, WELLS, SEPTIC SYSTEMS
OBSERVED ARE SHOWN ON DESIGN DRAWINGS.
4 ANY DEVIATION FROM THE DESIGN MUST BE AUTHORIZED BY THE ENGINEER PRIOR TO ITS INCORPORATION
INTO THE SYSTEM.
CONTRACTOR TO LOCATE ALL UNDERGROUND UTILITIES, PROPERTY LINES, EXISTING WELLS. WATERWAYS,
SURFACE AND SUBSURFACE DRAINAGE FACILITIES, LAKES, PONDS, AND OTHER FACILITIES REQUIRING
SEPARATION DISTANCES FROM THE PROPOSED SEPTIC SYSTEM. CONTRACTOR TO STAKE PROPOSED SYSTEM
PRIOR TO CONSTRUCTION. NOTIFY THE ENGINEER OF ANY OBSERVED CONFLICTS PRIOR TO CONSTRUCTION.
CONTRACTOR TO NOTIFY THE ENGINEER AND DHHS 24 HOURS PRIOR TO COMMENCING WITH CONSTRUCTION.
A MINIMUM OF THREE INSPECTIONS ARE REQUIRED. THE FIRST INSPECTION SHALL BE OF THE SUBGRADE
PRIOR TO PLACING THE SEWER ROCK. THE SECOND INSPECTION SHALL BE AFTER THE PLACEMENT OF
GRAVEL, DISTRIBUTION PIPING. STANDPIPES, TANK, AND OTHER COMPONENTS AS SPECIFIED. THE THIRD
INSPECTION SHALL BE AFTER THE WORK IS COMPLETED.
CONTRACTOR SHALL DELIVER TO THE ENGINEER A SET OF RED-LINED. AS-BUILT DRAWINGS SHOWING ALL DATA
AS SPECIFIED IN SEC. 15,65.150.F.2, `3, 4, 5, 6 OF MUNICIPAL WASTEWATER DISPOSAL REGULATIONS WITHIN FIVE
DAYS OF THE FINAL INSPECTION. INVERTS SHALL BE MEASURED TO THE NEAREST HUNDREDTH OF A FOOT.
SWING TIE LOCATES SHALL BE MEASURED TO THE NEAREST TENTH OF A FOOT.
THESE AS-BUILTS SHALL BE USED BY THE ENGINEER TO PREPARE AND SUBMIT RECORD DRAWINGS TO DHHS.
10
11
12
15
14
15
16
ALL EXCAVATION DEPTHS ARE ADVISORY, THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE
ENGINEER IF ACTUAL FIELD CONDITIONS VARY FROM THOSE USED TO PREPARE THE DESIGN.
EXCAVATE THE ABSORPTION FIELD. BOTTOM OF EXCAVATION SHALL BE LEVEL AND SCARIFIED. RECORD
ELEVATIONS AT BEGINNING, MIDDLE, AND END OF TRENCH BOTTOM. CONSTRUCTION EQUIPMENT SHALL
NOT OPERATE ON THE FLOOR OF THE EXCAVATION. ANY MATERIAL COMPACTED BY THE OPERATION OF
THE CONSTRUCTION EQUIPMENT SHALL BE REMOVED AND REPLACED WITH UNCOMPACTED MATERIAL.
PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS, DO NOT CONTAMINATE SEWER ROCK WITH NATIVE MATERIAL
OR SPOIL FROM EXCAVATION. LEVEL ROCK SURFACE TO + 1" PRIOR TO INSTALLING THE PERFORATED PIPE.
ALL PIPE SHALL BE PVC CONFORMING TO ASTM D3034, FBIO OR ENGINEER-APPROVED EQUAL. MINIMUM SOIL
COVER SHALL BE .3 FEET OVER THE PIPE AND 4 FEET OVER THE SEPTIC TANK. ONE INCH OF INSULATION MAY
BE SUBSTITUTED FOR 1 FOOT OF SOIL COVER. (SEE NOTE 12)
ALL INSULATION BOARD SHALL BE 2" THICK DOW H1-35 INSULBOARD OR ENGINEER-APPROVED EQUAL.
CENTER INSULBOARD WIDTH OVER SEPTIC TANK.
GEOTEXTILE SHALL BE MIRAFI 140S, PLYFELT OR ENGINEER-APPROVED EQUAL, LAP ALL JOINTS 2' MIN,
COVER THE DISTRIBUTION PIPE WITH A MIN. OF 2" OF SEWER ROCK, AND COVER ~TH GEOTEXTILE BEFORE
PLACING INSULATION AND BACKFILL.
MATERIAL USEO AS FILL SHALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS,
SLOPE ALL FILL MATERIAL TO DRAIN AT 2% MIN. SLOPE, AND 3:1 MAX SLOPE, AND IN SUCH A MANNER THAT
PONDING AT OR NEAR THE DRAIN FIELD DOES NOT OCCUR. THE FILL SHALL BE LEFT AT 6" HIGHER THAN
SHOWN TO ALLOW FOR SETTLEMENT. SEED SURFACE AFTER COMPLETING INSTALLATION AS PER MUNI. SPECS.
17 RECORD THE FINISH GROUND ELEVATION OVER THE BEGINNING, MIDDLE, AND END OF SYSTEM.
Permit No.
Legal Description:
Page 7 of 7
W.O. 94027
Lot 15, Block 5, Skyranch Est. 1, T12N, R3W, Sec. 22 Dote 11/19/94
NOTES:
18 CONTRACTOR SHALL PUMP EXISTING TANK AND TRENCH PRIOR TO BEGINNING INSTALLATION OF NEW DEEP
TRENCH.
19 EXPOSE EXISTING TRENCH WHERE IT CROSSES PROPOSED DEEP TRENCH FIELD. CUT EXISTING PERF. PIPE
AND PLUG EACH END.
20 BUILDING CLEANOUT NOT LOCATED DURING INSPECTION OF SYSTEM. CONTRACTOR SHALL LOCATE BUILDING
CLEANOUT AT TIME NEW TANK IS PLUMBED IN TO EXISTING SYSTEM.
21
CONTRACTOR SHALL EXCAVATE EXISTING DEEP TRENCH DISPOSAL FIELD TO 10' MIN. EACH SIDE OF NEW DEEP
TRENCH. REMOVE EXISTING CONTAMINATED SEWER ROCK, DISPOSE OF SEWER ROCK IN ACCORDANCE WITH
ALL STATE & MUNICIPAL LAWS, REGULATIONS & GUIDELINES. BACKFILL EXISTING DEEP TRENCH WITH PIT RUN
SAND.
AS-BUILT REQUIREMENTS
RECORD INLET AND OUTLET INVERT ELEVATIONS OF SEPTIC TANK
RECORD BEGINNING AND END INVERT ELEVATIONS OF ALL RUNS OF SERVICE PIPING
rECORD BEGINNING, MID-POINT AND END ELEVATIONS AT THE DRAINFIELD FOR THE BOTTOM OF TRENCH.
DRAINFIELD PIPING INVERT AND FINISH GRADE
FROM AT LEAST ONE TANK STANDPIPE AND AT LEAST ONE DRAINFIELS STANDPIPE, RECORD DISTANCES TO 1/101
FOOT TO AT LEAST TWO POINTS READILY LOCATABLE UNDER WINTER CONDITIONS
RECORD FINISH GRADE ELEVATIONS AT EACH POINT WHERE SERVICE PIPING CHANGES DIRECTION OR GRADE
Wright-Alaska Engineering Services · 6004 Glenkerry Dr. · Anchorage, AK 99504
December 19, 1994
W.O. 94O27
Municipality of Anchorage
Department of Health & Human Services
On-Site Services Division
P.O. Box 196650
Anchorage, Ak 99519-6650
Re:
Lot 13, BIk. 5, Skyranch Est. No. 1
Health Authority Approval &
Septic System Upgrade Record Drawings
RECEIVED
DEC 1 9 1994
Dept. Heaith ~ Human
Dear Sirs,
With the submittal of the following HAA paperwork, system upgrade record drawing
package and the payment of $300.00 for Municipal Review Fees, Mr. & Mrs. Don Lambert
request the review of the information provided for the granting of a Health Authority
Approval for the above noted lot.
Please note that the verification of fees received is on the first yellow sheet in this
package, which reflects the old system information. Fees for both Design Review and
HAA Review were paid at the time the Design Review was requested for an Upgrade
Perm it.
A new yellow sheet has been submitted to reflect the minor adjustments to the location
and separation distances made by the installation of the upgraded system.
The existing septic tank was abandoned in place in accordance with Municipal
requirements, being pumped & filled with soil.
Should you have any questions or require additional information, please feel free to
contact me at the numbers listed.
Sincerely,
Wright-Alaska Engineering Services
Robert W. Wright, P.E.
Telephone (907) 338-6230 · Fax (907) 337-5162
t(~~ 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 INSPECTIQN REPORT
NAME PHONE ~ NEW
M. Edward Shumway 344-3980 E~]UPGRADE
MAILING ADDRESS
Box 10024 South Station Anchorage~ AK
LEGAL DESCRIPTION
Lot 13 Blk 5 Sky Ranch Estates
LOCATION NO. OF SEDROOMS
Steeple Chase Drive 3
-- Well Absorption area Dwelling PERMIT NO.
DISTANCE TO: ~ 7 7 0 7_2--
_or 135 5' 8.8'
t- ~ Manufacturer Materiel No. of compartments
~< Greer S t e~e 1 2
~ I- Liq. capacity in gallons IF HOMEMADE: Inside length Width -I Liquid depth
~ '¢ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ < Manufacturer Material Liquid capacity in gallons
-- D Well Foundation Nearest lot line PERMIT NO.
,~,.% DISTANCE TO: 148! 21.8' 23' 77072
u~
~ No. of lines Lenathof each line Total length of lines Trench width Distance between lines
32 ' 38" inches ......
I-.~. Top of ~1
cc e~ to finish grade Material beneath tile Total effective absorption area
m 132" inches 484 S.F.
-- Length Width Depth PERMIT NO.
u~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(si
~ DISTANCE TO:
'--PIPE MATERIALi~ast iroI1 & plastic perforated
SOl L TEST RATING
~'r
112 S.F./B.R.
INSTALLER
RCJ Enterprizes
REMARKS --
Permit has expired '$'~-
--APPR~ /¢ //' ~.j;tAT E / LEGAL f
72-01~ (Rev. 3/78)
I::'IERI"I ]i T i',,I
I::1F'I::' L.. I C F:I I",l T
L~ :'ICI:::I T I 0 N
L. E G I:::1 I._
I'"II:::I?,IMUM I'.~!LtMI!F::IEI:;~: IDl:::' E:E[:,I:;b]OM'-:!!; =
THE MEI'.,IGTI'.~ [:, ]: I'"IE:I'.,t'.:.:.'; I O1'.,I I :iii; "I"HIE LEi'.,tG'T'I"~ ,.i I N I:::'EET ::, Ell::;' THE 'T'I:;~:E:i'.,ICH O1:;?. t}I:;i:F:I :[ I'.,IF:' I liEl....l:).
'T'HI:E [::,EI:::'TH Cfi:.:' I:::1 'T'I:;.".EI'.,ICH OR I:::'tT I'.E, THE'. DI':'!;"I"F:II',If.'::IE IF.::E;"I"I.,.II~:.:':[:~:t",I THE EilJI:;i:I:::'I:::ICEi O1:::' 'T'HIE
GI:;i'.OLJN[) f:ll',l[:, "I'HIE E:O'T'TOM OF THE EXE:F:IVI::fT' I CII'.,I ,:: I I",I I:::'EET ).
TI4ERE :(E; NO SET 14I[:,TH F:'OR TREI'.,ICHES.
'T'HIE GI:~:I:::I',,,'IEI... [:,IEPTH :1:9.'; "['HIE MI i',I]:MIJM DE:PTH OF: GRI:::fVlii:.'I.... I~iE.ETI.,.II~ii:I:EI'.,t THti:.:: OI..JTF:'FILL_ I:::' :I: I:::'E:
I:::II'.,ID THE I?,OTTEiM 01:::' THE EXCFIYI:::ITIEII',I (II'.,I I::'IEIET::,.
I;::1 I::'I:::II'.::KI:::II]E: I:::'I....I::II'.,I'T' MF'IY BE IN%"t]::tL..LIEI:) FI"I" "['HE I:::'EI:;i:MI'T"T'E:IE:"".:ii; OPTION :E'iLIB..ZfI!!!:C'T' '1'0 "I"I..dE
I:::OI...L..OI.,.I I NG COI'.,I[)I TI ONS:;:
% EI'T'Hli~:I:;?. FI CLI:::ISE; :1: OF.". :1: I IqSl:::' FII::'F:'RC¢,,,'IE[::, I::'LI:::II'.,I'T' Mt:::IY E',E I I',ISTI:::ILI.~EiE;,.
;2.. I::1 CC[NT I I'.,ll...IOl...l'.i~; MI::I I N'T'IE':I'.,tI::II'.,ICE I::IEiI:;?.EIEMEI',IT t E; t';:'.l_;.".l]:!lJ ]: REt}. ! I:::' I"::t hlR I NTE:I'.,II::INCE!
I:::tGI:;UZIEMEI",IT :l:Ei; I'.,IOT I<IEPT CI...IRI:;?.IEI'.,tT YOIJ HI::IY BE F?.E:X;:!IjII:;?.E[:, 'T'CI EI'.,II...I:::II:,?.GE 'T'Hlii: ':".i;O;l_.
I:::IE','.iii;C[RI:::'TIOI",I ':'~;"r":'~;"I'EM F:II",I[:',.'"OI:;~'. "r'OU MI::IY BI:E SlJlE',,:rI!!.::(]T 'T'O I:::'I:;;'.OE;ECIj'T'IF.)I'.,I.
]] i]:lii;R'l" I F:'Y 'T'HI:::I'T'
;I..; !' I:::IM FRM:I:I...II::II:;?. I.,.I:rTH THE I:;?.E(;!IJZI:;?.EMENTS FOR ON-SITIE E;li!i:!.,.tlEl:;?.'.:.3; I:::I1'.,I[:, I.,.II!~(I...LE; FIS '.iii;IE"l-
I:::'OI.;~:'I"H E:Y THE MIJI',I I C I F'FIL :1: 'I"Y O1-::' I::II'.,~CF.IOF;?.f:IGEL
;~;::: :!: I,.I :1: I....I... :1: I'.,l:ii;Tl::ll._L 'T'HIE '.:~i;YSTE]"I :1'. N I:::ICC:OI:;?.E:,I:::INCIE 14 Z TH THE C(')I}ES.
:.!i:: :f: LII'.,I[)EI:;?.S]"FIND THI:::I'f' 'T'HI:~: ON.-..'.E;ITIE E;EI.,.IIEI:;~: '.i!;YSTIEM MI:::IY I:;i:E:(;!I.J]:Fd~E EI'.,ILFII:;b]iE:MIEI'.,tT :f:1:::' THE!
RIE'.iii;]:DE:NCE IS:; I:~'.IEMODEI_ED TC[ :[l'-,Ir_::LI...l[:,li.:.: i"1Oi:;?.E THI:::iN ]!:
I:::IF::'I::'L I CI::III'~T i"1 IE[:,!.,.II:::II:~'.[) SHIJMt,.II:::IY
, , ':: :'. "'
i r::.
". % L$ON WELL I)RILtlh.3
1305 W. 45TH STREET
ANCHORAGE, ALASKA 99503
, I)EI~ING LOG
Location (address of: Township, Range, Section if ~own ;r'd stance ~ain'
Siz~ of casing. ~(' DePth of Hole_~ q Z ~eet Cased to ~/
Static water level--I .~14 ft.
Screen ( ); Perforated ( ).
(above) ~ !and surface. Finish of well (check one) opgn end ( t"~'); .
/%. Describe screen or perforation --...!~ --- · ' '-
" ' ~ /o,~ ~o
Well pumping test at__-.~ gallons per (hour) for [9 _hours with_
of drawdown from static level
Date of completion
WELL LOG
Depth in feet from
ground surface
Give details of formations penetrated, size of material, color m~d, hardness
.TO
.TO__-
TO
TO__.
TO
TO--
TO_
March 2, 1977
R & M No. 751117
Edward Shumway
Box 10024 South Station
Anchorage, Alaska 99502
RE: Test Hole and Soil Log Report for Sanitary System
Lot 13, Block 5, Sky Ranch Estates, SE 1/4, Sec 22-12N-3W, S.M.,
Anchorage, Alaska
Dear Mr. Shumway:
We are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This in-
vestigation was performed in accordance with your request of February
23, 1977, and those procedures outlined in a letter dated July 15, 1975,
by Mr. Rolf Strickland of the Municipality of Anchorage Department of
Environmental Quality.
A single test hole was put down within the subject site area for the
purpose of defining general subsurface soil conditions for the proposed
sanitary system. Excavation was accomplished with an auger type drilling
rig, and the test hole was extended to a total depth of 20 feet below
ground surface. The final log prepared for the test hole has been
included in Drawing A-01.
Groundwater was not encountered in the test hole while drilling.
A percolation test was performed from a depth indicated and reflects
average infiltration from that depth to the bottom of the hole.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very truly yours,
R & M CONSULTANTS, INC.
James W. Rooney
Vice President
JWR/ddp
xc: Municipality of Anchorage
T.H.1
3-1-77
ORGANIC SILTY SAND
3.07
GRAVELLY SAND W/SOME
SILT, BRO%'R~
5.0'
WHISPERING SPRUCE DRIVE
T.tt.1
Lot 13
Note: Test hole locations are
approximate and have not been
located by Survey methods.
SILTY SAND W/SOME GRAVEL
BROWN, MOIST
1Io0'
SAND W/SO}.~ SILT
TRACE GRAVEL, BROI~I
HOIST
SAND W/SOME SILT
BROWN, MOIST
SILTY SAMD
BROWN, MOIST
NO WATER TABLE
16.0'
18.0'
20..0'T.D
This log represents subsurface
soil conditions within Lot 13,
Block 5, sky Ranch Estates, S.E.
~, Sec. 22-12~4-3W, S.I~.,
Anchorage, Alaska
C.D.~A~OW ~"[:
: JMA
E: _3-2-77
__] ~~& ~ ~ ONSULTANT S, INC,
Sanitary Sewer .est Hole
Edward Shumway
Anchorage, Alaska
TIME
3:14
3:15
3:16
3:17
3:18
3:19
3:20
3:21
3:22
3:23
3:24
3:29
3:34
3:39
3:44
3:54
4:04
4:14
ELAPSED
TIME
1
2
3
4
5
6
7
8
9
10
15
2O
25
30
4O
5O
6O
PERCOLATION TEST
EDWARD SHUMWAY
R & M NO. 751117
TEST HOLE 1
MARCH 2, 1977
INCHES
9.5
10.0
10.5
11.0
11.5
12.0
12.0
12.5
13.0
13.5
14.0
16.0
17.5
18.5
19.5
21.5
23.5
25.5
DROP IN
INCHES
0.5
0.5
0.5
0.5
0.5
0.0
0.5
0.5
0.5
0.5
2.0
1.5
1.0
1.0
2.0
2.0
2.0
16 inches total deep
3.75 min/inch
03-07-~0 Z2:22 FEOM-CTE ENVIRONMENTAL 5616301 T-387 P.03/03 F-171
CT&E Environmental Services Inc.
200 W. PoTter Dr,ye
Drinking Water Analysis Report for Total Coliform Bacteria Anchor.,, AK 998~8-1605
Tel: (907) 562-2343
READ INSTRUCTIONS ON REVERSE.SIDE IIEFORE COLLECTING SAMPLE Far 1907) 56!-S3{M
" MUST BE COMPLETI~D BY WATER SUPPLIER T~O BE COMPLI~TED BY L^ItOIL~TORY
rl PtJIILIC WATER SYSTEM LD." L_t_L_ll'll
~[~ PRIVATE WATER SYSTI,'-M
~nchora§o, AK 995t~4
Month Day Year
SAMPLE TYPE:
Routine ~ Treated Water
Repeat Sample (for routine sample r~ Untreated Water
witl! lab ret', no. ~ )
~ Special Purpose
Tlma Collected
SAMPLE L~ATION COlI~ By
lysls shows this Wat*r SAMPLE 1o be:
Unaa~sfacmry
$~nple ov~ 30 hou~ o1~ ~sul~ ~y
~le t~ I~g in ~sil; s~ple should
not ~ ov~ 48 houm 014 ~ cx~ma~on
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG ~tllt~ Total Coliform,
Membrane Fll~c, Dlree~ Coum
Verffieatlon: LTH ~l
Fecal CoUform Confl~flon
Final Membrane ~lter ReaultS
Colonies/100 mi
COLIFIRM,
- CoMform/100 mi
Time _._.._~.=.~__. h~
ENVIRONMENTAL FACIUTIES IN ALASKa. CALIFORNIA. FLGRIOA. ll44NOffi. MARYLAND. MICHIGAN. MISSOURI. NEW JERSEY. OHIO. WEST VIRGINIA
03'07-00 22:2) FROM'CT£ ENVIRONMENTAL
,~l~m~ CT&E Environmental 8arvicaa Inc.
5615301
T-387 P.02/03 F-I?I
CT&E Ref.~
Client Name
Project Nameda
Client sam@le ltd
Matrix
Ordered By
PW$1D
Sample P~marks:
10110866001
AK Water & Was~owatar Consultants Inc.
Sky Ranch Log 13 Bk 5
Sky Ranch Lot 13 Bk 5
Drinking Water
Client PO#
Printed Date/Time 03/07/2000 12:41
Collected OaIe/rimc 02/29?2000 18:d0
lt~ceived Date/Time 03/01/2000 13:40
Technical llireeJ~r~ S.t,ephen C. Ede
~TERS DEPT
Un~t~ Method
0,500 U 0.500 mll/L EPA 30~,0 ¢c10) 02/01/00
coill00mL $N18 92228
0~/01/00 ~AP
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
HAA ~
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
, comPlete lega~ description ~.-~::2~' /,_~/,
i~roperty owner'/f///~, /~¢),A/~~T , Day phone~
Mailing address ~~ '"'
Lending agency ~O¢~/¢ /~/¢
Mailing address ~-/ / /
Unless othe~ise requested, H~ w~l be held for PickUp..
~PE OF WATER SUPPLY:
Individual well /'--
Community well
Public water
' ":-':':-NO~E: "' If cOmmunity well system, provide written confirmation :' ' ' lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL: I ndivi'dual on-site
.:/~;::':~- NOTE::~, Ifcommumtywastewate Y P .... : ,,
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify tha:t my
investigation of tl~is 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.
Address (~'E~ '~ ~__~/~'~'/~/~'~V' /:::;~/"~,
DHHS SIGNATURE
X ' '
Approved for~. ' :'bedro°ms.
Disapproved. , ; ;::;: ;:: :: ',
Conditional approval for:
~,, ..~.~
bedrooms, with the following stipulations:;::
Additional Comments
· ",'The Muni~,!'palityJ le Department of Health and Human Services (DHHS) issues Health Authority
;~ .based only upon the representations given n paragraph 5 above by an independent
istered in the State of Alaska. The D H HS does this as a courtesy to p u rchasers of homes
and the i' end ng nst tubons 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
responsib_ e for errors or omissions Jn th~ professional engineer's work.,
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:~' ,¢-~/~D//E~./~
E ~ TA T~ S 1
Well ~pe ~/~A ~
Log present (Y/N). ~
Tota dep .
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
_Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number
.Date completed Ch//?? (~ Dr ler~./~.~C/Y'//¢/~'~ /~"~*'~--~-~
(~) Cased to ~2~', ~-,~ (~ Casing height 2,-~ ,~F, (~
y (~ Wires properly protected (Y/N). Y (~)
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ~ / (~) /'~ /
FROM WELL LOG AT INSPECTION
Absorption field on lot _
Public sewer main
Sewer service line
; On adjacent lots
/ z¢~_/ ('~ ..; On adjacent lots
/~/,~ Public sewer manhole/cleanout
/,~//~ Petroleum tank
WATER SAMPLE RESULTS:
Coliform (:~ (~ Nitrate
Date of sample:_
B. SEPTIC/HOLDING TANK DATA
~),///22~.~/~.- (~ Other bacteria
Collected by: ~'~ ~'f~/~/~7/~'
Date installed ///,//O/q ~ Tanksize //~0 ~A£ (~ Compartments
Cleanouts (Y/N) _ Y Foundation cleanout (Y/N) _Y Depression (Y/N)
High water alarm (Y/N) ,//V'/~ Alarm tested (Y/N)
Date of pumping /A~/,,Z(:' (A/'~-~//(//,_~y'~T¢/V~_) Pumper ,/~/'/-"I
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /,~ / (~) On adjacent lots __~.~¢
To property line ~?-7~/ (~ Absorption field ~-~ //~
Suflace water/drainage
72-026 (~)' Fret ~ ~¢M P~
Foundation
Water main/service line.
CONTINUED ON BACK PAGE
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N).
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Sudace water
D. ABSORPTION FIELD DATA
Date installed ~/J//~,/~'~ (~ Soil rating (GPD/FF) (~;) ' ~' Systemtype ~,¢:~'/~ ,"~/~/~'//
Length ~'~_¢,/~-T'~-d~Width ,.~'7~ (~ Gravelthickness 7 / O Totaldepth
Total absorption area L -7 (;~-.~-~' Ld~ Cleanout present (Y/N) Y Depression over field (Y/N) _~__
Date of adequacy test_ /k¢/~
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N).
Results (pass/fail) /%///~ for /&,//ti Bedrooms
/"CA After test /
/k/'/~ I! yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot / .~ ~::~ 5 /~) On adjacent lots ,/' ~ '~' ~ Property line
To building foundation / / / ~ To existing or abandoned system on lot
On adjacent lots
Sudace water
~_~ ,.~ / (2) Cutbank
Curtain drain /k,//~
///
~. ~ / (~2 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 guideli~les in effect on the date of this inspection.
HAA Fee $
Date of Payment
Receipt Number
· .........::..,. '..
Waiver Fee.S:
Date of Payme~
Receipt Number
72-026 (3/93)' B~ck
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:~-/-~/~--~-~,, ~'/~' ]/'/'~'~/Y' ~-'¢' T ,/_Parcel I.D.
A. Well Data
Well type [::~{J
Log present (Y/N) Y
Total depth _ ~ 2 '¢¢', Z.~ ~'"77, (~ Cased to ~ ~ '~r -~ ~7'~, (~__Casing height
Sanitary seal (Y/N) y (~ Wires properly protected (Y/N)_
.If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~7 7('~ Driller ~___~.~<'D/V//"~/~-~-&~ /"//~'~'~
g.p.m.
AT INSPECTION
FROM WELL LOG
Date of test ~,/~//77
Static water level / (~).__~ 0
Well flow
Pump level1 -
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot / ~ -~/ (~
Absorption field on lot _
Public sewer main __
Sewer service line
.; On adjacent lots
.; On adjacent lots _
Public sewer manhole/cleanout_
Petroleum tank
WATER SAMPLE RESULTS:
Coliform _ ~ .Nitrate
Date of sample:_ "/
Date/nstalled _ __Tanksize
¢2, / ,,?.~//--- Other bacteria
Collected by: ,¢~/¢~
/ ~_.~__~ Compartments_
Cleanouts (Y/N) _ Y Foundation cleanout (Y/N) . /k,/ ~ Depression (Y/N) .~
High water alarm (Y/N)_ /,~///¢1~ __Alarm tested (Y/N) _ /~/dj
Date Of pumping ,/.~¢/q.,¢ Pumper //~) ~ ~~
SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK TO:
Well(s) on lot /~/~ ~ On adjacent lots .~ ~ Foundation ¢,~[:T ~
TO properly line ¢~ ~ Absorption field ~, ¢~¢ ~ .Water main/se~ice line ~
Sudace water/drainage ~
~¢¢~¢ ¢~/~ CONTINUED ON BACK PAGE
72-026 (~)' Front ~ ~¢ ~ ~ ~/~ ~
C. LIFT STATION (/V/,~)
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Manufacturer
Manhole/Access (Y/N)
"Pump off' Level at
Cycles tested
Sudace water
D. ABSORPTION FIELD DATA
Date installed '~/7~ ~ Soil rating (GPD/FF) _ /, 2- (~ System type z¢;,~/~
Length ~_.~ ~'~ Width 5<:~:)//(~ Gravelthickness G / ~ Total depth G
Total absorption area _~. ~ ~ ,-~ F(~Cleanout present (Y/N) __ Y (~ Depression over field (Y/N) .
Dateofadequacytest_////q/G,Resu,s (pess fail)f zZ--for .~ Bedrooms
Water level in absorption field before test ,.~'~)// After test 70//
Peroxide treatment (past 12 months) (Y/N) ,,~ (~ If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellonlot /~:~.~ ~-7~ (~) Onadjacentlots /~'~'
To building foundation ~-- / ,'c- 7"
On adjacent lots
Sur/ace water
Curtain drain
Property line
To existing or abandoned system on lot /~['/~
Cutbank / ('~, -.~ / (~) Water main/service line /X,/,'~
Driveway, parking/vehicle storage area / (~' '~
E. ENGINEER'S CERTIFICATION
p E ,d - & o'/ /.- 7" ,cop ,PE PL C EMI E/v T- ,P Y s TE
to all MOA and HAA guidelines in effec_~~o~ f this inspect/on.
l oerfify that l have checked, verified, or conformed
'
Engineer's Name
Date
Waiver Fee $.
Date of Payment
Receipt Number_
HAA Fee $
Date of Payment
Receipt Number
72-026 (3~93)* Back
MUNICIPALITY OF ANCHORAGE
DEPARTIVtENT OF HEALTH AND ENVIRONMENTAL PRO'rECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR FIEALTH AUTHORITY APPROVAL
OF ON-SI'rE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, r~ange)
Location (address or directions)
Applicant Address ~~ ~ er ~
(c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buy ; Other ~ (explain); -
___ TCephone
(d) Lending institution
Real Estate Company and A
(e)
Address
(t) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family ~/'Multi-Family E-.~ Other
Number of Bedrooms ~
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.
SEWAGE D/JcSP OSAL
Onsite [~ Public El Community [] 14olding Tank []
Note: If community well system, must have written confirmation from the State Department ol Environmental Conservation
attesting to the legality and status.
Page 1 ol 2
the date of this inspection.
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SFARCH, DA'I A 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 fu~lher 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
DHEP APPROVAL /) /'~ / '
6, J ' f,i s Date
A p p r ova d f oT._~f;~- ~ ~b..e d r o o m sj~.~...~....~._~/~_~_(''
Approved b/'/' _ Disapproved'~ %_~__ Conditional
· Terms of Conditional Approval -~-
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72*025 (11/84)
WELL DATA
Well Classification pCJ ~///~r"~'/'"~ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) _ y Date Completed ~_U~,] ~.~ J9 77' Yield
Total Depth ~Z4 I Cased to. '~_~z:~.. -- Depth of Grouting
Static Water Level _ /~'~/1~
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MUNIciPALITY OF ANCHOI~GE
264-4720
DEPT. ~ HEAI.?H &
Legal Description: .
1985
RECE,I_ ED'
Pump Set At
Sanitary Seal on Casing (Y/N) T
Depression Around Wellhead (Y/N)
Casing Height Above Ground ___
Electrical Wiring in Conduit (Y/N) Y
Separation Distances from Well:
To Septic/Holding Tank on Lot _
To Nearest Edge of Absorption Field or) Lot
To Nearest Public Sewer Line ~(./f'/'
Cleanout/Manhole -
WaterSampJeOollectedby- _;l Nlq
i3¢ / ¥
14,¢ /E)O
TO Nearest Sewer Service Line on Lot
; On Adjoining Lots
_; On Adjoining Lots _
To Nearest Public Sewer
Water Sample Test Results
Comments
SEPTIC/HOLDING TANK DATA
Date Installed - 7'~ 7~ _ Size _//200 NO. o! Compartments '~'
Standpipes (Y/N) Y Air-tight Caps (Y/N)_ Y Foundation Cleanout (Y/N) Y
^//~ '-¢ ? ' ~/,'~
Depression over Tank (Y/N) ~ Date Last Pumped /V//~. ~ '~" ~ 'i
Pumping/Maintenance Contract on File (Y/N) __ //k]//~" ;for /k////~' - '
Holding Tank High-Water Alarm (Y/N) .,~/~f" . Temporary Holding Tank permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well / ~ '~ ¢
To Property Line Z¢ /
To Water Main/Service .~/~.~
Course
To Building Foundation
To Disposal FieLd
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 7-- 70°
Width of Field .~/'~ /!
Square Feet of Absorption Area
Depression over Field (Y/N)
'~'('~/(~P Type of System Design Length of Field
Gravel Bed Thickness
Resultsof Last Adequacy Test · /'
Separation Distance from Absorption Field:
Standpipes Present (Y/N)
Date of Last Adequacy 'Fest
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line ~ ;~'
To Existing or Abandoned System on
I
; On Adjoining Lots
To Cutbank (if present)
D, LIFT STATION
D'""~a~ Dimensions ......
Size in Gallons-~"~.~ Manhole/Access (Y/N) J~- .----~ .....
Pump On Level at "-~_ Pump Off Level @t~.~.~..-~
High Water Alarm Level at %~ % , ~Vent (Y/N) ~ ~_
Tested for _~.~~~ ~ng CYcles during Adequacy Test, Meets MOA
Co~-Electrical~ Codes (Y/N) ~' ~-~._ .....~
** Check P~(¢itted Bed¢~m Rating Against HAA Request
/
I certify thCt ~ Chec~erified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
FIELD PUMP[.NG TEST
DATA SHEET
t~ 'cl
J~J T~me
.LOCATION OF WELl] (LeQal Description):
· ' ' WELL DEPTH: %~(~ FT. CASING:
DATE DRJLkJtlG COt. IPLETED:_,)U~ /~77
STATIC WATER LEVEL (Top of Casing):
Pumping Started/ LDepth to Drawdm.m/
lqin. ?'ater, ft. Recovery
· 0 0
DATE OF TEST:
FT SCREEH:
DRILLER: C4]I ~,~J
FT
Pumping
Ral;e, GPM
0 Start
Remarks
25
! hours
'--~ J 210
i': · RECOVERY
15
25
3~
· '35 I
40 I
45 J
,: 60 (J hour)
tz(J (~ hOUrs)
(suol~e9) paqzosq¥ za:~et4