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Home My WebLink AboutPARADISE VALLEY BLK 2 LT 20 Municipality of Anchorage Page J 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: .-q ~ ~0 ~! PID Number: Name: "~ FP'/ ~ ~n~ ~ ~y WastewaterSystem: ~ New ~ Upgrade 'Address:?. O. ~0~ ~0~ ~M~o~,~ A~ ~)~a 7 ABSORPTION FIELD Phone: ~ - ~ ~ lNo. of~edrooms: ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION so, Rating: Total Depth from original grade: Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: [ Range: ~ Section: Fill added above original grade: Gravel length: I I WELL: ~ New ~ Upgrade Gravel width: Number of lines: Distance between lines: Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Date Drilled: Static Water Level: Installer: Yield: ~ Pump Set at: Casing Height Above Ground: TAN K ~ GPM, Ft. Ft. SEPARATION DISTANCES ~ Septic a Holding ~ S.T.E... TO Septic Absorption Lift Holding )ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ Material: Number of Compartments: Surface LIFT STATION Lot Size in gallons: Manufacturer: "Pump on' level at: ~ "Pump off" level at: High water alarm at: Foundation 1 Cu~ainDrain ..... Pump Make & Model Electrical Inspections performed by: Location and Description: A~aom~d E~vatiom . IPo. O ENGINEER'S SEAL 2nd Reviewed and approved~ ~ .Date: 72-013 (Rev. 9/91) MOA 25 I I J // PERMIT NO: SW950241 / ? PID NO: 02042401 LOWER TB% DRAINFIELD 5'W. x78' L D M.T.~ 6" BUMP IN LINE c~ ~ UPPER DRAINFIELD 5' W. x 78,' L. 1000 GALLON ,' ~#1 SEPTIC TANK #2--7 / I' -- / /_DOUBLE c.o. OLEANOUT PAGE 2 OF 3 ' ~YdST.,/ WE~.L. / WELL 10' UTILITY EASEMENT SWING TIES FROM: COR. "A" COR. "B" TO: C.O. "C" 131.5' 49' M.T. "D" 92.5' 85' C.O. "E" 54' 124' C.O. "F" 126.5' 62' M.T. "G" 87' 93' C.O "H" 52' 134' DBL. C.O. "1" 99' 131' C.O. "J" 101.5' 133' C.O. "K" 105.5' 136.5' LOT 20, BLK 2, PARADISE VALLEY SEPTIC SYSTEM INSTALLATION AS-BUILT INSPECTION REPORT FLATTOP TECHNICAL SERVICES SCALE: 1" = 50' 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 JUNE, 1996 I i PERMit NO: SW950241 PAGE 3 OF 3 PID NO: 02042401 4'+ SOIL COVER 1000 GAL~ GREER SEPTIC TANK ORIG. GND. INV. -- 3' SOIL 104.8'-- 0.5' "BUMP" .TER 1.5' SEWER INV, GRAVEL 97.1 '-- BELOW PIPE INV. ELEV. 95.6' BOTTOM EXCAVATI~ ELEV. 94.6' 1.0' LAKE OTIS GRAVEL BOTTOM EXCAVATION ELEV. 95.6' ,,,, 98.1' ,,,, ELEV. 96.6' INV. 105.0' CROSS SECTION NOT TO SCALE ~.~T. ,H. #2 M.T. DRY 14 BELOW GROUND JUNE 3, 1996 LOT 20, BLK. 2, PARADISE VALLEY SEPTIC SYSTEM UPGRADE AS-BUILT X-SECTION FLATTOP TECHNICAL SERVICES NOT TO SCALE 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 JUNE, 1996 'LOCATION OF WELL STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES .DIVISION OF MINING & WATER MGMT WATER WELL RECORD BOROUGH SUBDIVISION LOT BLOCK SECTION QTRS SECTION ~ I-IN ' ' " -' ='~~,. ~-~ ' IDS ~NGE[]w[]E I ME.DIAN LOCATION/SKETCH: DEPTHS MEASURED FROM:r-lcasing top f-lground surfa(~ BOREHOLE DATA: Material Type and Color Depth From Tc . / . WELL OWNER:~ WELL DEPTH: · ~ ~. ~ ~;ATE OF COMPLETION Depth of hoie:~'ft Depth of casing:~ft ~-~ / ~" / ¢~ DEPTH TO STATIC WATER L~EL: ~ ~ ft balow ~top of casing ~ ground sudace Date: ,¢ / ~ / ~,.~ METHOD OF DRILLING: ,~ air rotary [] cable tool [] other USE OF WELL: [~'domestic [] irrigation [] monitor [] public supply r-I other CASING STIC~.~P: ,=~ ft. Oiam= ~ in. to/,~;ft Casing type::..,, ~~ ~. to/~t WELL INTAKE OPENING TYPE: ~'open end [] screened [] perforated [] open hole " Depths of openings: to ft SCREEN TYPE: Diam: in. Slot/Mesh Size: Length: ft GRAVEL PACK TYPE: Volume used: Depth to top: GROUT TYPE: Volume: Depth: from ft to ft DEVELOPMENT Duration: PUMPING LEVEL AND YIELD: / ? ~ ftl, after '~...--- hrs pumping ~ ~7 gpm PUMP INTAKE DEPTH: ft Horsepower: __ WELL DISINFECTED UPON COMPLETION? ~(.ES [] NO' CONTRACTOR INFORMATION: REMARKS: Regis~[C~red Business Name . ~' ~' g t o 'zed espre, sentative Date PLEASE MAIL WHITE COPY OF LOG TO: DNR/DIVISION OF MINING & WATER MGMT 3601 C St,' Suite 800 Anc'horage, Ak 99503-5935 Phi907) 762-2538, Fax (907) 562-1384 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PERMIT NUMBER:SW950241 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:DAY TIMOTHY A & TEANNA J OWNER ADDRESS:P.O. BOX 500 GIRDWOOD, AK,99587 PARCEL ID:02042401 PAGE 1 OF ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT DATE ISSUED: 8/25/95 EXPIRATION DATE: 8/25/96 LEGAL DESCRIPTION: PARADISE VALLEY BLK 2 LT 20 LOT SIZE: 45861 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL 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 (iSAACS0) . 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 SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: I I ~,:~, :~: ,.-?~,~., , ~, <;¥ ;,~ ..... .....:;,.~: ~':~.~?~,. ~,~ TI CHNiCAL :SER t t tv C~ & EN~ON~NT~ ENG~EER~G · ENERGY CONSERVA~ON & ~ TI~ODORE F. MOORE, P.E. 14~30 ECHO ST. PH: (907) 345-1355 ~CHORAGE, ~KA 99516 August 24, 199S M.O.A. DHHS - Attn.: Jim Williams P.O. Box 19-6650 Anchorage, AK 99519 Dear Mr. Williams: Per your request, on 8/22/95 1 conducted additional groundwater monitoring in support of our permit application to install a wastewater disposal system on Lot 20, Block 2, Paradise Valley S/D. I am returning herewith our permit application along with your "pink slip". On 8/22/95 1 measured there to be approximately 6 inches of water in the bottom of the old test hole monitor tube located 25-30' northeast of our test hole #2. This monitor tube slants down for a total distance of 10 feet and extends approximately 12 inches above apparent ground level. Thus, the water surface in that pipe was approximately 8 feet below ground level on 8/22/95. On the same date the monitor tube for our nearby 14' deep test hole g2 was still dry, as was the monitor tube for our test hole #1. Based on these observations, I believe that the water level you measured in the old monitor tube does not represent a true groundwater table, but rather is the result of the old test hole having "silted in" to the point where it temporarily collects surface runoff during rainy periods, such as when you made your site inspection. This belief is borne out by the fact that the monitor tube was again mostly dried out after approximately a week of non-rainy weather. The proposed drainfield design is quite shallow with a total depth to the bottom of the sewer gravel of only 3 feet, so as to utilize the more permeable shallow soils. If you now concur that the proposed design has an acceptable separation from groundwater, I would appreciate your issuance of the requested pe~xnit. Please give me a call if you have any questions on this supplemental information. cc: Teanna Day Sincerely, Ted Moore, P.E. I I CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 August 3, 1995 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 construct wastewater disposal facilities on Lot 20, Block 2, Paradise Valley S/D, located at 18721 France Circle. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed between test holes gl and 8'2. As can be seen from the soil logs, the native material between 1.5' and 3' is a silty sandy gravel with a perc rate of slightly less than 1 minute per inch. This is underlain by silty gravel with a measured perc rate of 40 minutes per inch. Our design concept is to construct 2 parallel 5' wide drainfields near the top of this silty gravel stratum with 1.5 feet of sewer gravel extending up into the more permeable overlying stratum. Using the soil application rate of 0.45 gpd/sq, ft. specified in the wastewater ordinance for soils with perc rates between 30 and 60 minutes per inch, this 3 bedroom residence requires a total absorption area of (3 x 150)/0.45 = 1000 square feet. Using the length reduction factor of 0.78 as specified in the ordinance for a gravel depth of 1.5', the proposed design consisting of 2 parallel 78 foot long drainfields has a total effective absorption area of 1000 square feet. To enhance the permeability at the interface between the sewer gravel and the underlying native soils, our design also includes a one foot thick layer of"Lake Otis" gravel. This gravel is not required by the ordinance for filtration purposes, so does not have to be 2' thick. The topography of the lot slopes in the area of the proposed construction slopes down towards the west at approximately 15%. 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 any significant impact on reserved space- surface and subsurface, o1' on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, ' Ted Moore, P.E. LOT12 LOT13 ? ? ? ? /, PARALLEL 5' WIDE x 78' LONG / / ? / / LOT19 DRAIN FIELDS T.H. , - ' ' WITH 1.5' GVL. ~-#1 ~, ,"~ L T.H._ , , \ ~ I,I .... ~ #3 7 ', ,' · ~:~ ,, ,~-, ~ ", ~ ,, ,~~ooo~.~o~~;;'1 --. ~ , .... SEP lC TANK ~ ~ ......... PROPOSED ~ ] ~ ~, ,, 'REPL. 9~INFIELDS .... T.,. / '~ ' UNSUBDIVIDED LAND LOT 20, BLK. 2, PARADISE VALLEY WELL AND SEPTIC SYSTEM SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = 60 FEET 14530 ECHO STR]~T DRAWN BY TFM ANCHORAGE, ALASKA 99516 AUGUST, 1995 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. I I ,/ 1000 GALLON SEPTIC TANK 2 PARALLEL 5' WIDE x 78' LONG SOIL ABSORPTION DRAINFIELDS WIT. SEWER GRAVE' BELOW HORIZO,N, TAL DISTRIBUTION PIPE ~ ~"A" PLUS 1.0 LAKE OTIS GRAVEL \ / 4" DIA. F-810 PERF. ~ / / DISTRIBUTION PIPE ~ 1 I~ 4" DIA. D-3034 INTERCONNECT ~ C.~ ORIGINAL ..... GROUND SECTION "A - A" SCALE: 1": 5'- 0" PLAN VIEW SCALE: 1" = 15' - 0" MONITOR TUBE CLEANOUT _ ~----FILTER FABRIC TANK ~"""--4" DIA PERF. DIST. PIPE ~1/2" - 2 1/2" SEWER GRAVEL 1' "LAKE OTIS" GRAVEL LOT 20, BLK. 2, PARADISE VALLEY S/D PROPOSED SEPTIC SYSTEM PLAN AND CROSS-SECTION FLATTOP TECHNICAL SERVICES I SCALE: AS SHOWN 14530 ECHO STREET I DRAWN BY: TFM ANCHORAGE, AK, 99516 AUGUST, 1995 I I Flattop Technical Services 14530 Echo Street, Anchorage, AK99516 Phone (907) 345.1355 Lot 20, Block 2, Paradise Valley S/D 18721 France Circle Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of installation of a 1000 gallon septic tank followed by 2 parallel 5' wide x 78 foot long soil absorption drainfields with a total sewer gravel depth of 2.0 feet plus 1.0' of "Lake Otis" gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these ch'awings may be allowed or required by the engineer conducting the inspections. All construction procedm'es 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. 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. 2.0 Septic Tank: 2.1 The new 1000 gallon, 2 compartment septic tank shall be Municipally approved and 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. 2.2 All pipe ~onnections to the tank shall be equipped with waterproof mechanical couplings. 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 tank. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating 2 parallel 5' wide x 78' long trenches to a total depth of 4' below original ground level. The alignment of these trenches shall be roughly parallel to the natural contour of the land, and the trenches shall have 10 feet of undisturbed soil between them. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. A total of 12 inches of"Lake Otis" gravel shall be placed in the bottom of the excavations. 3.3 A total of 2.0 feet of apwoved sewer gravel shall be placed in the bottom on top of the "Lake Otis" gravel with the perforated distribution pipes laid level such that the pipe inverts are no less than 1.5 feet above the bottom of the sewer grovel. Sewer gravel shall be 0.5" ~ 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shah be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 3 feet of soil cover is to be placed over the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 12 inches higher than the surrounding ten'ain to allow for subsequent settlement, and shall be graded to smooth contours to promote drainage away from the soil absorption system. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shah be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of areas distm'bed by the construction. 4.0 Inspections: 4.1 A minimum of 5 engineering inspections will be requh'ed 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 native matedai has been excavated to expose the infiltrative sm'face to ensm'e that it is level and at the right elevation, and conforms with the soil test infom-~ation, (3) after the "Lake Otis" gravel has been placed in the excavation, (4) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of filter fabric, and (5) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensm'e the availability of the engineer. I I TEST HOLE FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lot 20, Block 2, Paradise Valley S/D DATE PERFORMED: July 10 1995 ___ PERFORMED FOR: Tim & Teanna Da~ DEPTH (feet) 12¸ Pt. SM Reddish sandy lomn GP Gray sandy gravel Clean, loose, dry Silty gravel Brown, d a m p/~.C~ GM Silty gravel B.H. (Large rock) SLOPE Depth to Groundwater Date No Groundwater 7/10/95 ~be~Ory 7/24/93 SITE PLAN Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) 7/10 Hole presoaked ~ Start 11:17 23 7/16 #1 12:06 49 22 3/8 1 1/16 Add water 12:06:30 23 9/16 #2 12:36:30 30 22 13/16 3/4 Add water 12:37 23 9/16 #3 1:07 30 22 3/4 13/16 PERCOLATION RATE 40 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 3.75 FTAND 4.25 FT COMMENTS: Soil in perc test hole visually_appeared somewhat siltier than typical of stratum, so measured perc rate should be conservative. Other nearby deeper test holes support t ~e co ~clusioa that the rock found ill this test hole is probably not bedrock. PERFORMED BY FLATTOP TECHNICAL SERVICES. I ~7-...~r.~;~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /4~/~ ~ TEST HOLE LEGAL DESCRIPTION: DATE PERFORMED: PERFORMED FOR: DEPTH (feet) COMMENTS: Lot 20, Block 2~ Paradise Valley S/D July 10, 1995 Tim & Teanaa Day Pt. SM Reddish/tan sandy loam GP/GM Silty, sandy gravel (This lens perc'ed, see below) GM/ML Silty gravel Similar to T.H. #1 B,H. (No bedrock) FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST SLOPE Depth to Groundwater Date No Groundwater 7/10/93 -~onitor Tub~-Dry 7/24/95 ,,/- il T.H. ~ ,I #2 \ Clock Net Time Porcometor Net Drop Date Reading Time (minutes) Reading (inches) 7/10 12" Presoak done . Start 1:17 23 3/8 #1 1:18 1 21 7/16 1 15/16 Add water 1:18:40 23 3/8 #2 1:19:40 1 21 1/2 1 7/8 Add water 1:20:20 23 3/8 #3 1:21:20 1 21 1/2 1 7/8 PERCOLATION RATE <1 (minutes/inch) PERC HOLE DIAMETER 7" TEST RUN BETWEEN 2.5 FTAND 3.0 FT Test hole confh*ms soils similar to test hole #1, with eo bedrock to 14 feet. Recommend shallow 5' wide drainfield to m~rlmize use of shallow permeable soils. PERFORMED BY FLATTOP TECHNICAL SERVICES· I ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCEWITHALLSTATEANDMUNICiPALGUIDELiNESiNEFFECTONTHiSDATE. DATE: /4,/.~j~.,/.~t ~., /~,5- I I TEST HOLE LEGAL DESCRIPTION: DATE PERFORMED: PERFORMED FOR: DEPTH (feet) FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST Lot 20, Block 2~ Paradise Valley S/D July 10, 1995 Tim & Teanna Day Pt. SM Reddish sandy loam GM Silty sandy gravel GM/ML Silty gravel Dense, increash~gly hard with depth SLOPE ML Gray silt (soft digging) B.H. Depth to Groundwater Date No Groundwater 7/10/~5 ~oe Dry 7/24/~5 COMMENTS: #1 and #2 Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN SE'rVVEEN FT AND FT No bedrock eacountered in this 12.5' deep test hole. Soils visually appear less suitable for on-site systems than those in T,H.'s PERFORMED BY FLATTOP TECHNICAL SERVICES. I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: unicipa ity of Anchorage P.O. BOA 196650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 8, 1988 Eric K. Wallin/Carolyn Ko Lee 2211 East 66th ~D Anchorage, Alaska 99507 Subject: Lot 20 Block 2 Parad~~bdivision Permit ~870248, Ta~-424-01~ A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1987. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as-built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. Effective January 1, 1988, a new fee schedule is in effect. When re-applying for a new permit, the new fees are; $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are. any further questions, please call this office at 343-4744. Sinc ~ Program Manager On-site Services RWR/ljw enc: Copy of Permit I I {S r' av~:, :I):) e::, i:::, 'L i"i f 'L 'lo'L a ]. D6:.:,I::) 'L hf 'L (Si"ave:[ b,J:i.d'LI'i ,~"L) i~ ~:(:::,i'"'i'..k~ ]::~' '~'.t"~.::~ ?h..u"i:i.,:::::i.]::).~].J.'L'? ~::)~ ~-~i~'~c:J"icH"a(::i~:.:.:, (['"IC),'..:~.) arid and :[.n c:c)mF)].:Ja~"~c:(~.:L: ~4:i.'Ll'~ 'Lhe de~[~:~.~'..ji"~ c:P:i.'L~::~,l":L~:~ of' 'I:..f"~:~.s~ ~/~:~.~[~(::~ ~.u"'~d~a~'~?Lar')d CJ"~a'L 'Ll"~e (:::.~j::)~.;~(::::j.-l:..y (::){ 't.l"~(~.:.~ 'Lc?La]. ~y~'t.?z.~m :[.~[; ::;.~; i::)e(::t~".(::)~::)r~'~[~, and a'~"~y (.~,l'i:J~;u"Ciemel"i'L ~,~:i.].]. !'~e(::l~..~J.~".~:.) au"J adc:l:J.L:i.c~rla]. jh r,?,~'~, A PLOT PLAN OF: J P~EPARED FOR..: · ?~.':.."-"I'..:.~% p,~,o,c~ v~u.~',, ~u~,:,. ~--~-~--:____j ILL:.;:;,, "A':":..."*",. ,o,o,,_,...,,..~.:_ ~ I1~,-o,,o-o,,--~ ---'-. I J ~.~,,, %. ~'~ ..... ""_.J .~' t~ot fhe building location s~wn meets all subdivision covenants J J J 0 FUl Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ' . (ENGI~EAL) .ERFORMED FOR: 2 3 ,8 9 10 11 12 18 2O DATE PERFORMED: ~ --.~(-~-~ ~)~ , Township, Range, Section: LOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? Ileaitoring? /, y Oate: Gross Net Depth to Net Reading Date Time Time Water Drop o 7 " / ' ' Ff'-- ~$~ ~' ~,' ? '/~" ,73,3.? ~ ~, ~ ,~ ~ PERCOLATION RATE 5 {minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN ,~' ~ FT AND _.~" '~ FT · :~ ,._ COMMENTS ./tv.., ~r~- ~ ...... · -,~, PERFORMED BY: ~ $ ~ ~ ~./ I ~ ~ ' CERTIFY THAT~THIS TEST~ ,WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 7~ --~ ~ 72-008 (Rev. 4/85~ ~.~_SCP, I ? TI 0:9 Sol/ type~ co:o~, tex..':,~~ 5on?p/e~ dr/v/n] nOt~.3, d~,'h5 cl~culot:on t05:, note5 co drHhn9 bus used, etc. tetotion: J i 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 1. GENERAL INFORMATION Complete legal description 'Location (site address or directiOns) Property owner Mailing address Lending agency Mailing address Agent N.A. Address Day phone Day phone Day phone - 4. Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well ~ Community well NOTE: Public water If community well system, provide written confirmation from State A~EC attest- ' lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL:- Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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. Name of Firm Address /¥5- EngineeCs signature Phone Date /~/'¥/ DHHS SIGNATURE ~ Approved for .~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date f.,T,li[sij 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. 72-025 (Rev. 1/91) Back MOA ~21 825"L Legal DeScription: Date of test Static water level Well production WATER SAMPLE RESULTS: Date installed Foundation Cleanout Date of Pumping Date installed Lengt~ tS-~' Date of adequacy test Fluid depth Peroxide treatment (ins.) Minmes l&t~r: Ifyes~ D. LIF~ STATION Date installed Manhole/Access (Y/N) High water alarm level at* *Datum Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I Absorption' field on lot ~0~5- ' Public sewer main Sewer/septic service line Size in gallons "Pump on" level at* ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout' Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ' Building foundation 3"6' Property line O"O' Absorption field Water main/se~ice line ~> / O ~ Surface water/drainage '> leo ' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: "Pump off' level at* Building foundation I O0 ' ~- Surface water '> I OO ~ Curtain drain tqo~ ¢ _q e*','~ Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review in conformance with MOA HAA guidelines in effect on this date. Signature '~"~ ~. ~ Engineer's Name '7"~ eO c,~c., ri? ~'. Date /0 /¥/ 9( Property Line ~,Y' Water main/service line > t o ' Driveway, parking/vehicle storage area 'eO ' tG, C2~ are I-IAA Fee $ ~00 ~ Date of Payment /0/0//~,~ Receipt Number ~/-~ OV['q ) / Rev. 8/95 OSS: haa.wk.dac Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc. Laboratory Division Drinking Water Analysis Report for Total Coliform Bacteria 2oo w. ~otte~ Dr~ve Anchorage, AK 9951'8-1605 READ I/VSTR UCTIONS O~ REVERSE SIDE BEFORE COLLECTI. NG SAi~.PLE Tel: (907) 562-2343 Fax: {907) 581-5301 MUST BE COMPLETED BY WATER SUPPLIER Send Results ~ Send Invoice Send Reaultx ~ Send Invoice SAMPLE DATE: Ic2[ 71 . Month SAMPLE TYPE: Routine Repeat Sample (for routine sample with lab ref. no. ) 12 Special Purpose SAMI:'LE LOCATION Day Year Treated Water Untreated Water Time Collected Collected By Il: ~-o An '7':l-'Tr"t, TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ,O"' Satisfactory {2 Unsatisfactory {2 Sample over 30 hourS old, results may be unreliable Sample too long in transit: sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via specia2e}lve~.~.~mail. 7/2-5 Date Received Time Received Analysis Began Analytical Method: ,er'~Membrane Filter {2 MMO-MUG * Number ofcnlr,~ies/100 mi. Result* 96. 4882 ~ [y,~lyst .... Anch Fbk~ Jun [] Faxed Date: Time: Client notified of unsatisfactory results: Phoned Spoke with Faxed Date: Time: CommentS: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform Membrane Filter: Direct Count Verification: LTB Fecal Coliform Confirmation Final Membrane Filter Results / BGB E. Coif (~ Colonies/lO0 mi COLIFIRM Coliform/lO0 mi Date 6~'eL~''9~ Time /x_~. _~'() hfs Member of the SGS Group (Soci~t~ G6n6rale de Surveillance) CT&E Environmental SerVices Inc. LabOratory Division ~.ar~-j~-~-~'~rj~'j~-l~e'~'J~ CT&E Ref.# Client Name Project Name/# Client Sample l~) Matrix Ordered By PWS1D 964781001 Flattop Technical Sty. L20, Blk 2, Paradise Valley L20, Blk 2 Paradise Valley Drinking Water 0 200 W. Potter Drive Anchorage, AK 99518-1605 Tel: (907) 562-2343 Fax: (907) 561-5301 Client PO# Printed Date/Time 09/24/96 13:18 Collected Date/Time 09/19/96 12:30 Received Date/Time 09/19/96 14:00 Technical Director: Stephen C. Ede Rel sedBy Sample Remarks: ' Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Nitrate-N 2.09 0.200 mg/L SM18 4500-NO3F 09/23/96 EMB Nitrite-N 0.100U 0.100 mg/L SM18 4500-NO3F 09/23/96 EMB Total Coliform~ 13 OB W/O COLI SM18 9222B 09/19/96 TAV f~"~- S~S Member of the SGS Group (Soci~t~ G~n~rale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA