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Home My WebLink AboutNETTLETON ACRES #2 LT 13 Municipality 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 Permit Number: ..¢1,4/ 97'0 I 't~' PIDNumber:_Ol,~17 Name: A/e~ ~ ~ ~ ~ 6 ~, ~ Wastewater System: ~ New ~ Upgrade Address: d~ P~,{~ PI'~ ~ No. of ~9~-/¢ ABSORPTIONFIELD 64¢~ ~ch U Shallow Trench UBed UMound~ Phone: ~¢, ~¢¢~ B~rooms: LEGAL DESCRIPTION SoilRating: ~Sq. Ft. TotalDopth~grade: Lot: Block: Subdivision: Depth to pipe bottom from original gr~ ~ benealh pipe Township: I Range: Section: Fill added above original gra~ Gravel ~ / Ft. ~ Ft. WELL: ~x~f D New U Upgrade Gravelwidth: ~ Number of lines: Distal: Classification (Private. A,B,C): Total Depth Cased To: Total ~tion area: Pipe material: FL FI./ SQ, Ft, D--~3 y : Driller: Date Drilled:- Stalic Waler Level:Installer: Date installed: ~. C~I~ ~ ~e~,, Yield: Pump Set at: Casing Heigh~ Above Ground: ~ ~. ~,. TANK SEPARATION DISTANCES ~septic D Holding ~ S.T.E.P. TO Seplic Absorplion Lig Holding Public/Private~ Manu[acturer: Capacity in gallons: ' Material'. -- Number o~Compartmenls: we, I 0 ~ ~ P~e l Surface w~t~ >~¢~' ~~ LIFT STATION Lot Size in gallons: Manufacturer: Line ~ ~ Foun0ation ~ t ~ "~ump on" level a~: "~ump off" Iovol al: High water alarm at: Curtain Drain -- / '~ Pump Make & Model Electrical Inspections performed by: Remarks: ¢¢~ . ~ ~,~ ~.. ¢~ ,~ty BE~OH ~ARK : Location and Description: Assumed Elevation: ENGINEER'S SEAL Inspections performed by: ¢/~)~ ~c& ~q Dates: lst_7/¢/~7 ~ .... '"" ...... ~ ~ . . 2nO Department of Health~~ervices_ approval ~,~.,? x c~= ~s~":- "? ' ._ '%, % - ,,-. ~.~ Reviewed and approved by:' Date: 97 -~',~'~:,,., ..... ~2-o~a m.~. wgn MOA ~ PERMIT NO: SW970173 PID NO: 01506217 SWING TIES: FROM: WELL~ COR."A" COR"B" PAGE 2 OF 2 GAR. · "i " · ~ ~/ SOILABS. ~ //'~"C" -~T.B,M. TRENCHES /~ ~ .NEW1250 GALLON / [ SCALE: 1" = 30' ~e~.~/ ' -DOUBLE ~O. ELEV. 99.2 _~ 1250 GALLON ~INV. SEPTIC TANK ¢94,9 PROFILE VIEW NOT TO SCALE HOUSE LOT 13, NETTLETON AC. #2 SEPTIC TANK UPGRADE AS-BUILT INSP. REPORT FLA~I-I*OP TECIt-NICAL SERVICES 14530 ECHO STREET ANCHORAGE, ALASKA 99516 SCALE: AS NOTED DRAWN BY TFM JULY, 1997 PAGE 1 OF 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:SW970173 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NANE:ZERBINOS ALEXANDER H & OWNER ADDRESS:6746 PAULA PL ANCHORAGE, ALASKA 99516 DATE ISSUED: 7/08/97 EXPIRATION DATE: 7/08/98 PARCEL ID:01506217 LEGAL DESCRIPTION: NETTLETON ACRES #2 LT 13 LOT SIZE: 43563 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: 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 (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 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 SA_ME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: ~ DATE: DATE: CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS TttEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 July 2, 1997 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 narrative in support of our application for a permit to replace an existing 1000 gallon septic tank serving the residence on Lot 13, Nettleton Acres #2, located at 6746 Paula Place. The Municipal inspector's measurements made at the time of installation notwithstanding, more recent measurements indicate that the present tank is only 95 feet from the private well serving this residence. Since the existing tank is now 20 years old, it does not make sense to go through a formal waiver procedure at this time, so we propose to simply install a new tank located outside the 100 foot protective radius sun'ounding the well. The topography of the lot is generally level. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have aay significant 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 7 WELL ,R 100' GAR. ExIsTING 1000 GAL. I /C~T 1 SEPTIC TANK - ~ 10% ..... (TO BE.A,BANDONED ~- I ' ~ EXISTING 500 GAL. ~ ~ HOUSE SEPTIC TANK -- ~ ~ \ ~, (TO BE RETAINED) '-.. % % ~ / EXISTING S01L~BS. ~ ~ 1000 GALLON · ~NCH~~ ~ s~,c ~AN~ , ', - .~.~ / t INSTALL ~ ,, ,, ,, ~ ~ ~~55~0.o. ~ , _ ~ ', ~ LOT 14 o ""',,~ '"",, o SEPTIC SYST o ', SEPTIC SYSTEM ', ~ ', LOT 13, NETTLETON ACRES #2 SEPTIC TANK UPGRADE SITE PLAN FLA?TOP TECH~riCAL SE:R. VJCE$ 1 INCH = 50 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 JULY, 1997 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. NOTE: AN ALTERNATIVE CONFIGURATION WHICH COULD ALSO BE INSTALLED 49TM UNDER THIS PERMIT WOULD BE TO ABANDON BOTH EXISTING SEPTIC TANKS "., THEODOREF. MOOR AND REPLACE THEM WITH CE-3589 A NEW 1250 GALLON ""....."" SEPTIC TANK Flattop Technical Services 14530 Echo Street, Anchorage, AK 99515 Phone (907) 345.1355 Lot 13, Nettleton Acres #2 6746 Paula Place Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of abandonment of an existing 1000 gallon septic tank and installation of a new 1000 gallon septic tank on the south side of the present tank. 1.2 Construction shall be as depicted on the approved site plan. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requirements. All separation distances shall be in 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 buried utilities. 1.4 The contractor shall provide adequate cover material and 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 agreed 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. 1.6 At the homeowner's option the scope of work may be modified to abandon both existing septic tanks and install a new 1250 gallon septic tank in their stead. 2.0 Septic Tank: 2.1 The new 1000 gallon, 2 compartment septic tank shall be Municipally approved mid shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplfl~gs. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tm~k. The contractor shall verify that the waste lines connecting the tank to the house and the soil absorption trenches are unobstructed. 3.0 Inspections: 3.1 A total of 2 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the septic tank has been set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 3.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. --'~ MUNICIPALITY OF ANCHORAGE / DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTF. CTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPFCTION REPORT -~AME PHONE [] NEW ~GAL DESCRIPTION ..... 'OCATI~ / ] ~e[I ~ Absorptio~ are~ ~wellin~ ~ERMIT ~0. r DISTANCE TO: ~ ~ /~ ' ~ ~ O ~ I [ ~ ~ Manufacturer · Liq. capetians IF HOMEMADE; Inside length Width Liquid depth ~ ~ Well Dwelling PERMIT NO. DISTANCE TO: ~"~ Manufacturer Material Liquid capacity in gallons No. lines Length of each line Total length of lines Trench width Distance between lines ; ~ ~ Top of tile to finish grade - Material'be,eath tile Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS INSTALLER t), ~ ~ F'IERM I T t'.IO: 85()411 DATE: I AF::'F'I... I CAN'T': A D D R E S S: E;ON'T'AEq" F'I-40NE: LEGAL DESCRIP: I....D T SI I....O"F I..J]CA'/" 101',1 MAX BEDRI]OMS: J OSEI::'H AND DEN.C ~t::. GAI...BRA ]: TFrl 6746 I:::'AULA F'I...A[~,F;: ANCFtC)RAL".)IS, Al< 995 :L6 346--. 1 636 SUBDIVISII:IIXh~ NETTI..ETON ACRES ~R LOT: 13 SECTION: 14 TOWNSHIP: 12N RANGE: 3W (SQ ,, FT ,, OR ADRES '"~ ....... 1 RAIL.. HOMEo IE. AD" BLI]CI<: I....isi',,ed b(:?:t, ow are tine ap't:,:i, clns available to you :i.n de.hsit::JF~:i.f'ig yot,.tr s[,:.~ptic system,, Choose the option thai'- best fits ¥(,~uP siT. ce. DI~F:"TH 'I"C) P I I:::'E BCI'I"TDIfl (l:r]'' ,, BRAVF~:L. DEF:'TH (F'T.) 'TI]TAL DEF'TH (FT.) GR(:WEL. N.I:D]'H (I::'T.) GR~VEI... L. IENB]"H (F']',,) GRAVli~].... VOL.UME (cU. YD,S,,') TANK SIZE (GALS) SO:I:t.,. RAT ]: N(,:.~ (SG!. F:'T. /BR) 4 ,, 0 4.0 4 ,, () 8.0 0 ,, 5 :}.i ,, 5 12.0 ¢' 4.5 '7 ,, 5 2 ,, 5 ;2, 3 ,, () 5 ,, 0 56.0 44,, 0 96.0 .~..~ 44 ,, 1 :37.5 7 1 ,, :;~ 1,000. () ~.*/ 1 ~ 0()0. () .~.~ 1 .. ()00 ,, 0 ,~,,~, 445 8~ 330 445 .~,.,,~. GIRAVEL I...ENG"t]fl > 75 FT. REC;!I.,IIRES [IUL, 1 1FLE FIt. INS (NOT EX[:EEDIIIC~ 75 FT,, EACH) '~"~' TANK MUST HAVE AT L.IEAST TWO I..OMPAk]ME.NF.~ ]: c:~.sr'tify t.l'~at,", , 1,, I am famil:i, ar w:i.'Lh i:.he r, equ:i, remen'L!.-:~ for on.--si.re sewers and wells as set forth by tl"~e Municipality of Anchorage (MOA) ..and the State of' Alaska,, 2. I will ir'~ta].I the system in accordance ~i{h a].l lflOA ccides and regulat:i, ons~ and in c:omp].iar~c~,~ wiit, h the des:i, gn triter:La of 'this 3. I wi].1 adhere J:.o al, I, MOA and Stai:e of Alaska r'equipements fop the set back dis'Lances ¢r'l:irll any existing well, wastewatet' disposal system of 'l:)ublic SEW~ePa:~g(;;i syster~. 6in th:i.s [)r' any .adjacent oP rleal-by lo't:.. 4. I under'stand that th:i.~ per'mit J.s val:i.d for' a maximum of 2 bedr'ooms arid any er~lar'<~emerlt will PeqLtiPe an addit:i.c)nal penm:i,'L. Il:::' A I..,.IF'T STA]"IOIq IS INS'TALLIED IN AN AREA CDVERED BY MOA BUII.,.DIIqGI.UDl:::.c'o, THEN (3.) AN EL..IECTFIICAI... F:'ERMIT AND IIqSI::'ECT:I:[IN MI. IST BE OBTAINED; (2.) AS-EUI:I...'T'S WILl.,, NC)'T' BE AF'F'FtOVED WITHOI, IT AN EI..EIS"I'RIC~I..., ZIqSF'IEC'r'ION REF;'ORT~ AND (3) TFIE S I GNED I SSit.,IED BY MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 6 7 8 9 10 11 --12 -13 C~'/kU C4,_Q A I'?'F-~ MUNIcIPALiTy OF ANCH ~,. DEPT. OF HEA' cNVIRoN^.~ ._ ~.TH & ,v,~-IX~lAL PROTECTION i,j U l. WAS GROUND WATER .R_ECEiV °u'TERED? IF YES, AT WHAT DEPTH? SLOPE DATE PERFORMED: SITE PLAN O P E -15 16-- ~o H 17 18 19 20 Gross Net Depth to Net Reading Date Time Time Water Drop PERCO LA'rlON RATE (minutes/inch) TEST RUN BETWEEN -- F~4~I~ O~*~[[~ 72-008 (6/79) '~'~ %e ~'~ GRE~,ER ANCHORAGI: AREA BOR~,JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 II)ISPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM LOCATION ./~_, ~/'/) ¢-~'T-C/~[ ~) SEPTIC TANK: DISTANCE '/' /<~O .~ ~U.~j NUMBER OF FROM WELl ---- MANUFACTURER ..~z-.~ MATERIAL COMPARTMENTS INSIDE WIDTH INSIDE LENGTH LIQUID DEPTH LIQUID CAPACITY/~i~) GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL"//"/( NUMBER OF LINES ABSORPTION AREA '-~' DEPTH: FOUNDATION DISTANCE BETWEEN LINES NEAREST LOT LINE / (~ TOTALoF LINEsLENGTHc~,~}-, I TRENCH WIDTH (/~'~' IN. TOTAL EFFECTIVE TOP OF TILE TO FINISH GRADE SO, FT. LENGTH OF EACH LINE DEPTH OF' FILTER MATERIAL BENEATH IN. WELL: TYPE BUILDING FOUNDATION__ CESSPOOl APPROVED _CONSTRUCTION NEAREST LOT LINE .... , OTHER SOURCES DISAPPROVED NEAREST SEWER UNE____ .REMARKS DEPTH SEPTIC SEEPAGE TANK , SYSTEM DISTANCE FROM: DISTANCES; __. INSTALLED BY: t~-f-~ SEWER LINE DEPTH: PIPE MATERIAL' ~-~"3~':5'~ LOT SLOPE: REMARKS: Form Lq-032 ~~ DIAGRAM OF SYST_EM / / G.A.A,B. June 6~ !977 Steve Syverson Star Route A Box 15B1B ~nchoraga, Alaska 99507 Subject: Permit Expiration Dear ~,~. S!;verson: A permit issued by this department for well ~nd/or on-sit~ sewer installation on Lot 12 and Lot 13 N_~et__t..ke~Q~¢~Subdivision has e::pired since the issue a~.~ ~xceeds one (1) y~r. In the event you still plan to install the well and/or on-site sewer system, a new permmt is required. The ori lznal soil test may be used to obtain a current permit. If ~hs well has been drilled, a ?~e!! log should be sent to this department to document the installation date. If you have any ~lestions regarding the above matter, please do not hesitate to contact this office i~n~diately at 279-2511, extension 224 or .~5. Sincerely, Les N. Buchholz, R.S. oanm%arzan I'J'"ll~; i,.IEH(;!i'T't't I;::' ;J; i'"il!::;i",l:iii; ;i; Ol",I ;( 'i'l"'lliii; [;:'IEI::'Fhl OF:' t:::l 'I'I:;i:IiEH(;;:I.J GI:;~:OI..II'.,i[;:, f:tl",i[;:, "t'J-II~; li~?,OF"~'OJ"l 't'l"II~;;l:a:E ;l;~;i; HO ?~;liiJ'l' !.,.I):1%1"t'1 "i'hll~; I;;~il:~:l;:l',,,'l~:~;I.. [;:'EI:::"I'H ;1; ?~i; '1"1"11~ I"1 I:::lt",li;::' 'FHE E=O~I I"Eihl Ed;:' THE FERh~I] F:'EPARTMENT OF HEALTH AN[:, ENVIRONHENI'I~L PRO]'EC:T.~ON 2,=.;±~ E. TLII)OR RI':,.., RNCFIORtaC~E., AK. 995C17' ( '?~t76 :.', f~F'PL. ][ C:ANT LEft]AT I ON L.EGFIL .=, 'r ~, EF..=,ON 5RA BL,:~:,....'L:58:LP. "!, t40MI-ZSTEAD 'rRA Z L LiS: NETI"LETON ACRES; UNZT LOT SZZE: 'i'"r'PE OF SOIL AE:SOF.:BTION S~r'STEM I=,:~' IREN_.H' ' r-. 1,1FtXIMUM NUMBEF.'. OF' BE[:,ROOM5 = ..'..< SOiL RAT'rNG ": ' .', ..~Q FT,, E,R':,= THE REI],~LI]:F.:E[) .~;;IZE OF THE SOIL FIBSORPTION =,tr=,TEl-1~' 'c ", %.=,¢~'~,., THE LENC'iTH [:' ~ I'IENS ;I: ON ~$ THE LENGTH ','IN FEET~ [:.i~ THE TRENCH THE E.~EPTH OF FI TRENCH OP, PIT ZS THE D'rSTRNCB BE~;I.4EEN lHE 2;UF..'FFIC:E OF THE GROUI'JE:, RI'.,IE:, THE BOTTOM OF THE EXCAVATION ,::ZI'.,I THERE ;IS NO SET FI~E:,T'H FOR TRENCHES. ' THE EiRFI',,,'EL DEPTH ZS THE r'lZNZI',IUFI DEPTH ~f-'" GRAV~'L BE'TFIEEN THE OLI]"FAL.L.. F'~F'E AND THE F,.,'OT'FOM OF THE EXCR',,,'RTION <IN FEI, ET),' "-,] ' [~FICKF'ZLLING OF RN"r' :,'¢_,Tl:r,1 14.TTHOUT FZI',IAL zN?,.PECT~rON AND F:IPPF.:OVRL [:,EPRRTf,IISNT 14IL. L BE SUBJECT TO PROSECUTION. '~ i"I:[NIf,IUM DZS;TflNE:E BE'TI4EEN A I.,.IELL AND RN"r' ON?~S;,I'I"E 5EI-,JAGE I)]:.SF:'OSFIL. '~"""" .... , :LO0 FEET FOR Fl PRIVATE NELL OR 200 'FEET FOR A PUE:LIC P.IELL t4ELL bL..~b AF.~E RE¢4U:[RED AND MUST BE RETURNEE TEl THE DEPFIRTI',IEN'f' HITH!N OF' 'rile NELl.. COI',IPLETION. ..,FEt.,.(FI ..HTZ3N.? AND CONSTRUCTION [/IAI3RAI',~S ARE FIVAILREfL. E TO INS;UAE FF...]PEF.. I IqS;TFILLAT ! ON. I CERTIFY THAT i: I Aid F'AI4ILT. RR ['IITH THE REC.4UIREMEN'rS FOR ON-S, ITE 5EI,IEF..'S AND HF. LLS [-~::; S;tET Fr F.'Tt - ... 4 BN.' THE MUNICIPALIT'¢ OF' ANCHORAGE. 2: I [,JILl_ INSTFIL. L TH[-" S'¢S]"Ef'l IN ACCORDANCE HITH THE CODES. :g: I UNDERSTAND THAT THE ON-.SITE 5Et-,.I[:.'R S'.r'S;*I'EI~I MR'-r' REQUIRE ENLRRGEMEI'.,IT .TF THE RIS."::';:(DENCE I_C; REMODELED TO INCLU[:,E MOl:BE 'I'HFIN ~ BEDROOMS. FtF PL ICFINT S;, T IE/¢ E -q'¢VEF.'.~;ON . WATER WELL LOG FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 qdo% USE OF WELL_~~-~ r~e,r{,e ~ , FEET OF D~AWOOWN. REMARKS .... DATE COMPLETED.~- J ~- ? ~ PUMP TO BE SET AT FT. tom ~to ~to~ Parcel I.D. # MUNIOIPALITY OF ANCHORAGE ~;~ DEPARTMENT OF HEALTH & HUMAN SERVICES. ' Division of Environmental Services On-Site Services Section LITY OF ANCHO~b~,GE P.O. BOX 196650 Anchorage, Alaska 99519-665F0NVIRONMENTALSERvlCE$ON]$1ON 343-4'744 JUL 15 1997 CERTIFICATE OF HEALTH AUTHORITY GENERAL INFORMATION Complete legal description Location (site address or directions) ~ '7 '/' 6' Pcxu/~ ?/~ ¢ ¢. Property owner Mailing address Lending agency Day phone. Mailing address Agent ,,~ro,--~ ~¢ ~ Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my 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. NameofFirm ~ l,~¢-/~f' 2-¢cA,~ ~ ¢c,[ ..~'r¢,,'o~r Address Engineer's signature Phone Date ~-¢//v /~, /9¢7 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-O25 (Rev. 1/91} Back MOA ~¢21 MuNIcIPALITY OF ANCHORA(3i~ ENVIRONMENTAL SERVICES DIVI.SlON Municipality of Anchorage JUL 1 $ 1997 DEPARTMENT OF HEALTH & HUMAN SERVIC~:a Environmental Services Division RECEIVED 825"L" Street, Room 502 · Anchorage, AJaska g9501 · (907) 343-4'744 - Legal Description: /.-,o P t3 A. WELL DATA Well type Ft/{' Log present (Y/N) Y Total depth I ? O ' Sanitary seal (Y/N) Health Authority Approval Checklist IfA, B, or C, attach ADEC letter. ADEC water system number Date completed 7 / !~9 ! ? 7 Cased to 170' Casing height (above ground) Y' Wires properly protected (Y/N) Date of test Static water level PROM WELL LOG 7/ 1,9t 77 AT INSPECTION 71i ~¢'7 Well production ~' ~9 g.p.m. ~.t9 ~ g.p.m. WATER SAMPLE RESULTS: Coliform Date ofsample: 7/ ~ / ~ '7 B. SEPTIC/HOLDING TANK DATA Nitrate ~. o, I ~/-.~ Other bacteria tVc~e repo~-be,~f Collected by: ~'[c~/-A~r~ 7"~cA .f ~c Date installed 7 / ~ / ? 7 Tank size t ~ ~-~/~ Number of Compartments _ ~ Cleanouts (Y/N) Foundation cleanout (Y/N) ¥ Depression (Y/N) /X/ High water alarm (Y/N) tv'. DateofPumping M.,4. (,Oem) Pumper N'. C. ABSORPTION FIELD DATA Date installed 7/~,5- Soil rating (g.p.d./ft2orfl:/bdrm) ,~_<' 6'd-~- System type -j-reoc/~ Length I ~" Width $' Gravel thickness below pipe 6" Total depth ~' - 7" Effective absorption area. t ,90 Monitoring Tube present(Y/N) y Depression over field (Y/N) Date of adequacy test '7 / ~ / ~ 7 Results (Pass/Fall) ['c.c.,' For 5/ bedrooms 7~/' ~,~] ,, ,, Fluid depth in absorption field before test (in.); t ~'" Immediately ~erT~ g~. water added (in.): ~ ~, ~' ~, Z~ Fluid dep~ 2~,3~'" (ins.) Minutes later: ~ 7 Abso~fion rate = _~ ~O g.p.d. Peroxide treatment (past 12 months) (Y/N) /,/an,~ 0c,~,, If yes, give date_ tv'. ,4, LIFt STATION b/. A. Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot t O E ' ~> tto' Absorpti'on field on lot Public sewer main Sewer/septic service line Size in gallons "Pump on" level at* *Datum ; On adjacent lots ~> tOO ' ; On adjacent lots '> t oca ' Public sewer manhole/cleanout Lift station /V, A. "Pump off' level at* SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '7 ' Propertyline ~O' Absorpfionfield ~ tO ' Water main/service line ~> ~0' Surfacewater/drainage '> too' Wells on adjacent lots ;> SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property Line t O' Water main/service line Driveway, parking/vehicle storage area ~> SO' Wells on adjacent lots '> loc,' Building foundation 5tO ' Surface water ~ t OO ' Curtain drain hJo~g F. ENGINEER'S CERTIFICATION ,i,f,:~*' ;;~;g~ ~ ;~ :'~.~. I certify that I h~e determined that field mspecttons and review ofMumctpal record~.th~[~e abov~t~tk are~ mconformancewtthMOA~gutdehnesmeffectonthmdate. ~,, ~'{'~. ;:::,. , ~-~- Engineer'sName "7-h ~ do~ /:z. i~t o o r-~ Date ~J".t? ts'3 tP97 HAA Fee $ ~ ~aO o¢ Date 0fPayment ~d/~OY~ 7 Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number ~-~_.Z~ CT&E Environmental Services Inc. CT&E Ref.# 973504001 Client Name Flattop Technical Srv. Project Name/// N/A Client Sample ID Lot 13 Nettleton Acres #2 Matrix Drinking Water Ordered By PWSID 0 Smnple Remarks: Client PO# Printed Date/Time 07/02/97 16:43 Collected Date/Time 07/01/97 14:30 Received Date/Time 07/01/97 16:00 Technical Director: Stephen C. Ede Parameter Results PQL Units A[louable Prep Analysis Hethod Limits Date Date Init Nitrate-N 0.100 U 0.100 mg/L SM18 4500-NO3F 10 max 07~02/97 JBL Total coliform 0 col/lOOmL SM18 9222B 07/01/97 RAM MUNICIPALITY OF ~;CHORAGE DIVISION OF ENVIRONME~NTAL HEALTH DEPARTMENT OF I~ALTH AND ENVIRONmeNTAL MtOTECTION APPLICATION FOR 1- ~RLALTH AUTHORITY APPROVAL CERTIFICATE 1o General Information Application Date ~ ~J2JJ_q~'~ (a) Legal Description (include lot, b. lock, subdivis~,ion, section, township, range) Location (address or directi. Qns) . ' (b) Applicants Name~f~~Q~ honnon~~_Bus i~es S,____L~_ .~% (¢) Applicant is (check one) Lending Institution ~ j Owner/builderf~; (d) Lending Institution ~_~Q_O )C25/~__ Telephone (e) Telephone ......... (f) Mail the }{AA to the following address: ~y~e of Residence Number of Bedrooms Water Mnlti-Family ~] Other (describe) 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 states. S!.~wase Di~ o~ 0nsite ~ Public ~_~_~ Community ~. Holding Tank ~I Note: If community well system, must have writ'ten confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. E.~n~P~ro_.v~idi~n~In~sp~ct__J_o_n_~/ Testst File Sear~d~.at___a. apJ Information As certified by my seal affixed hereto and ae of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-mite water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and t~Tpe of structure indicated herein°- I further verify that, bamed on the information obtained from the M~nicipality of Anchorage file~ and from my investigation and inspection, the on-mite w'a:er supply and/or ~rastewater disposal system is in compliance with all. Municipal and State codes, ordinances~ and regula~ ~ions in effect on the date of thia inspection. Name of Fi ~. ~_. Telephon ' ' ~ Approved ~-_ Disapproved ~ Co~i:ion~ ~ Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH ~ND ENVIRO~4ENTA3~ HIOTEGTiON (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BAS~) SOLELY UPON THE REPRESE!~- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY ~N INDEPENDENT PROFESSIONAL' ENGINEER REGIS%~YRED IN THE STATE OF ALASKA° THE DHEP DOES THIS AS A COURg~SY TO PURCHASERS OF [{(R~S ~N~) THEIR LENDING INSTIT]YflONS IN ORDER TO SATISFY CERTAIN FEDER_4L_ AND STATE REQHIRJZ- MJ~NTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED° l]tE MUNICIPALITY OF ANCHORAG% IS NOT RESPONSIBLE FOR KRRORS OR OMISSIONS IN I~{E PROFESSIONAL ENGINEER'S WORK. (DHEP SFAL ) P~R4/eJ/D18 [P~ge 2 of 2] MUNICIPALITY OF ANCHOR~GE~ DIVISION OF ENVIRONMENTAL HEALTH DEPAR%~4ENT OF b!gALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HF~LTH AUTHORITY APPROVAL CERTIFICATE 1o General Information Application Date 7/~1~/85 (a) Legal Description (include lot, block, subdivision, section, to~mship, rarq;e) Lot 13 Nettleton Acres #2 Section 14, township 12N~ Range 3W Location (address or directions) 346-!636 (b) Applicants Name Joe Galbraith ~.e_l~.phone ~ Home Applicants (c) Applicant is (check one) Lending Institution (d) Lending Instttu~tom NO~E 263~4256 Business Telephone (e) Real Estate Coo & Agent Fcrtune Properties Sue Dvorak Address 3000 A Street, Suite 101 AnchoraKe~ AK 99503 Telephone 562-7653 Mail the HAA to the following address: To be picked ~u~ _T~e__9of Residence Single-.Fa~d. ly ~5=x~ Number of Bedrooms Other (describe) Note: If community well sy~tem~ must have ~itten confi~ation from the State Department of Enviro~antal Co~e~ation attesting to the legality a~ status~ Sewage Disposal Note: If community well system, must have ~-:Ltten co~trmation from the Sta~e Department of Environmental Conse~ation attesting to the legality and statu~. [Page 1 of 2] 5. ~E~ineerin~.~,~Firm Providin.~In_3~R~ctions, T~sts~ File Searc__.h~u. Data and Information As certified by my seal affixed hereto and as of the validation date shown belm;~ I verify that my investigation of this Health Authority Approval sho~r~ that ~he or. site water supply and/or ~astewater disposal system is safe.~ ftunctional and adequate for the number of bedroomm and type of structure indicated herein°. I further verify that, based on the information obtained from the ~nicipality of Anchorage file~ and from my investigation and inspaction~ the on=site water supply and/or wastewater disposal system is in compliance %zith all Municipal and State codes~ ordinancea~ and regula- ~ions in effect on the date of this inspection° Name of Firm ARCTIC ENGINEERS~ INC. ~;-~>~%%~ Telephone 561-!345 Address ]506 Wo 36th Anchorage~f~tY[~c395031'°%i~i]~..~b · Approved for q~ ~,Z~.'-. ,~_~-,.bedrooms By Approved ~ Disapproved ~ Condigion~l Te~s of Condition~ Approval ~, ,~ CAUTION THE MUNICIPALITY OF ANCHORAGE. DEPARTMENT OF ID'/ALTH AND ENV!RObR,1E~LAL PROTECT%ON (DHEP) ISSDqZS HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOlidLY UPON TI[F, Pd~PRESEI~f- ATIONS GIVEN IN PAtL~GRAPH 5 ABOVE BY Ai~ INDEPENqPENT PROFESSIONAL ENGII~ER ~EGISTER~) IN THE STATE OF AbASKAo THE DHEP DOES THIS ~$ A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE Pd~QUIRE- MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS 011 ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED° THE MUNICIPALITY OF ANCHOKAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK~ (DHEP SE&L ) RRd/ej/D18 [Page 2 of 2] 7-19~84 MUNiCiPAi'ITY OF ~NCI-{ORAGI~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION SUL 9 RECEIVED A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Lot 13 Nettleton Acres #2 S14, T12N, R3W Well Classification individual Well Log P~esent (Y/N) Y Total Depth 170' Cased to Static Water Level 57' Casing Height Above Ground 12' + Electrical Wiring in Conduit (Y/N)Y Separation Distances frcm Well: To Septic/Holding Tank on Lot 100' + To Nearest Edge of Absorption Field on Lot 100' + To Nearest Public Sewer Line N/A C leancut/Manhole N/A Water Sample Collected By Wate= Sample Test Results C~af~nts If A, B, or C, DoEoC. Approved(Y/N) N/A ~ Date Completed 7/18/77 Yield 5.6 8pm~ 170' .... Depth 9~ Grouting N/A ~'~ Pump Set 'At 168' ~,~ ' ~ Sanitary ~al on Casing (.Y~) Y __ ~pression ~nd ~l~ead JY~) N ; On Adjoining Lots t00"+ ; On Adjoining Lots 100'-+___ To Nearest Public Sewer To Nearest Sewer Service Line on Lot 25' + Duane Man~y ; Date 7/3/85 Satisfactory · .__ SEPTIC/HOLDING TANK DATA Date Installed 7-77 Size 1,000 gal. Standpipes (Y/N) Y ~ Air-tight Caps (Y/N) y Depression ove= Tank .(Y/N) N Date Last Pumpe~ Pumping/Maintenanc~ Contract on 'File _(Y/N) .N/A~'_ .. for Holding Tank High-Water Alarm (Y/N) N/A . . Temporary Holdir~ Tank Permit (Y/N) Separation Distances f~om Septic/Holding Tank: To Water-Supply Well · 100' + TO Property Line 5' + To Water Main/Se~yice Line 10' + Course N/A ~A~~ To Building Foundation 24' To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments 7/19/85 Upgrade - 500 gal. tank added to system u,,~, ........ DJ!PT, OF HI~ALTH & Ri E! ED [Page 1 of 2] 2-15~84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 85 Type of System D~sign Trench Date Installed 7-77 ~Up~rade 7/85).. Length of Field 22' Width of Field 48" D~pth of Field 70.5" Square Fest of Absorption Area 245 (7/85 180 ft~tandpipes Present (Y/N) ¥ 'Depression over Field (Y/N) N Date of Last Adequacy Test 7/3/85 Results of Last Adequacy Test Adequate Separation Distance from Absorption Field: To Water-Supply Well 100' + To Property Line 10' + To Building Foundation 36' To Existing or Abandoned System cn Lot None ; O~ Adjoining Lots 30' + To Water Main/Service Line i0' To Cutbank_(if yesent) None Present To Stream/Pond/Lake/or Major Drainage Course N/A ~t~ TO Driveway, Parking Area, or Vehicle Storage Area 10' + Co~nents 7/19/8~5 Upgrade . added 6'D x 15'L trench D. LIFT STATION N/A Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Com~mnts ** Check Permitted Bedroom Rating Against HAA l~equest I certify that I have checked, verified, or conformed to all MOA HAA Gui~ in effect on the date o~ this i~_~on ' Si Date 7/19f85 Co~ARCTIC~NGI S, INC. MOA No.ST-85-001 ~,~ Et~INE~ 2-15-84 MUNICII~ALITY OF ANCHORAGE J~UNICIPALITY OF ANCHORAGE - ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~IEPT. OF ]-I~ALTH & 825 L Street - Anchorage, Alaska 99501 J~NVIRONMEN]IAL P£~OTECTION ( ENVIRONMENTAL ENGINEERING DIVISION JUL 2 5 1979 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SI~(F6~IVI[I~ DIRECTIONS: Complete all parts on page 1, Incomplete raquests will not be processed, Please allow ten (10) days for processing. 1. PRQPERTYOWNER . [ PHONE PR'OPERTY RESIDENT (If differen~from above) ' ' PHONE 2. BUYER. PHONE MAILING ADDRESS MAILING ADDRESS 4. REALTOR/AGEN~ . /PHONE' D ll id i/f - MAI LING ADDR~S B. I~EGAL DESCRIPTION S'~REET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [~ [] One [] Four SINGLE FAMILY [] Two [] Five MULTIPLE FAMILY I~ Three [] Six [] Other 7, WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY ATTACH WELL LOG. A well log is required for all wells drilled since June 1975, For wells drilled prior to that date, give well depth {attach log if available.) B. SEWAGE DISPOSAL SYSTEM L~. INDIV DUAL/ON-SITE'* [] PUBLIC UTILITY **If individual/on-site, give installation date If system is over two [2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE NSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [~] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED [~3 PUBLIC UTILITY h Connection Verified INSTALLER []Septic Ta~nk or [] Holding Tank~ Size: /O(~t'~ If Tank is homemade SOILS RATING give dimensions: ~2, TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELL TO: Septic/Holding_/_/~)o Tank Absorption~/_r/ 0 ~ Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompa~ertificate) [] DISAPPROVED // LEGAL DESCRIPTION 72-010 (Rev. 3/78)