HomeMy WebLinkAboutSIEFKER #3 TR 6
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: $1d~./O2/~2 PIDNumber: 0 1,~$
Name:
DONALD BEESoN Wastewater System: ~ New ~pgrade
Address:
121~5 ~YlO~ 5~ ~]. ABSORPTION FIELD
Phone: / No. of Bedrooms:
3~- 3082 ~ ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRI PTI O N so, Rating: Total Depth from original grade:
J, O GPD/Sq. Ft. I
~: ~33[;: Subdivision: Depth Io pipe boltom Irom original grade: Gravel depth beneath pipe
Township: Range: Section: ~ Fill added above original grade: Gravel length:
J2 N ~ W I O,E ~t. ~t.
Number of lines: Distance belwee~ Hnes:
WELL:~xisT~N~ New ~ Upgrade Graveldep/h: ~. O Ft. J I -- Ft.
Classification (Private, A,B.C): Total Depth: Ca~od To: Total absorption area: ~ ~ Pipe material: D'
Ft. Ft. ~OO SQ. Ft. F-810 PERF PIP¢·
Driller; Dale Drilled: Sl~lic Water Level: Installer:
Dale installed:/ /
Yield; Pump Set al: Casing Height Above Ground:
¢.M ~,. ~, TANK
SEPARATION DISTANCES ~ptic ~ HoIdin~ ~ ~.T.~.~
~ Number of Compartmenls:
Surface
Lot Manulacturer:
Line ~O I ~/o / ~ -- ~ ~ O / Size in gallons:
Foundation ~ t ~ / ~ ~ O f "Pump on" level al: "Pump ofF' level at: High water alarm al:
CurtainDrain ~ .... Pump Make_._& Modal Electrical Inspections performed by:
Remarks: ~f~m ,~5~11~ /~ ~~ BENCH MARK
Localion and Doscription:
~r~;~, ~O~TO~ OF 5~D~NG ON ~ousE-~1~ ~q
Assumed Elevalion:/oO.
~l~ttop ~echn~c~l Se~icesl ENGINEER'S SEAL
Inspections performed by: _FLATTOP TECg~¢cS. Dates:lst. ~/L~I~I [~w?"6' z~,~
. 2nd~/~ ~¢/[ ~'~'~~ ......................
Department of Heait~¢~~ Sera.es approval I
72-013 (I/91) MOA25 ~I~i~Z¢"~ -- .... ~
PermitNo. ~ ~102,~2 Page 2- of ~
Municipality of Anchorage
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
Legal Description: ~R/tCT 6. E~IEFKE~. ~'.~
PID No.:
LO:CA
72-013 A (2/gl)MOA 25
~0' 5o1~. AB.S, 'TR£NCtt
H,T, cu. $' $~u.,~i ~i'~vL,,~
~l~tto~ ?ec~=ic~1 Services
14530 Echo Street
blSTA~CE~ Anchorage, Alaska 9951~
CORNE~S ENGINEER'S SEAL
~ ,%, ... ~
Permit No._SW ~102G2 Page '~ ' of ,~
Municipality of Anchorage
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
Legal Description: TRAct ~ ~ $1EFKE~ ~3
PID No.:
72-013 A (2/91} MOA 25
OUTLET
I'
Fkzttop Tec5nfccr] Sez~,~ces
14530 Echo Street
· ~Uchora-qe, ]l.]c~skc[ 9Qr,~e
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW910262
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:BEESON DONALD G & LJ
OWNER ADDRESS:12145 AVION ST
ANCHORAGE, AK 99516
DATE ISSUED: 8/30/91
EXPIRATION DATE: 8/30/92
PARCEL ID:01528133
LEGAL DESCRIPTION: SIEFKER #3 TR 6
LOT SIZE: 198209 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: ~~ 'J~/~
ISSUED BY: --~/'
/
DATE:
DATE:
CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 A_ .~UgUSL 26, 1991 ANCHORAGE, ALASKA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dem' Sirs:
The purpose of this letter is to provide the mquh'ed design nan'ative in support of our application for a
permit to upgrade the wastewater disposal system on Tract 6 of Siefker S/D, Unit #3, located at 12145
Avion Street. Soils logs, peru test results, a site plan, design di'awings and specifications m'e enclosed for
your review.
The residence on this lot is presently served by an undocumented system which occasionally backs up.
The proposed upgrade will be constructed in the vicinity of test holes #6 & #8. The native material below
a depth of 7.5 feet is clean sand with a measured percolation rate faster than 1 minute per inch. The sand
sU'atifications noted on the log represent subtle changes, and the measured perc rate applies to the enth'e
zone between 7.5 feet and the bottom of the test hole. Although the perc rate was measured to be faster
than 1 minute per inch, the native material, as can be seen by the typical sample enclosed, is sand
equivalent h~ characteristics to "filter sand". This material will provide adequate filtration to protect any
underlying groundwater table, and is stable enough in an undisturbed state to allow construction of a
standm'd trench. We have conservatively sized the ~ench using the application rate of 1.0 gpd/sq, ft.
specified in the ordinance for filter sand. The requh'ed effective absorption m'ea for this 4 bedi'oom
residence is (4 x 150) / 1.0 = 600 squm'e feet, which is achieved by the proposed 60 foot long soil
absorption trench containing 5 feet of sewer gravel beneath the distribution pipe.
The site plan shows a possible location for an identical replacement U'ench constructed 15 feet away
from, and parallel to, the proposed trench.
The topography of the lot slopes generally towm'ds the west at 3% - 5%.
The proposed project will have no impact on present or future water supply and wastewater disposal
systeras serving adjacent properties, nor will it have any impact on reserved space/surface and subsm'face,
or on di'ainage.
Please give me a call if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
AVION s¥
o o
a~£
o
, I
o -4 ~
'q m ~-
Flattop Technical Services
14530 Echo Street, Anchorage, AK 99516
Phone (907) 345-1355
Tract 6 Siefker S/D #3
12145 Avion Street
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of the installation of a 1250 gallon septic tank followed by a 60
foot long soil absorption trench containing 5.5 feet of sewer gravel.
1.2 Construction shall be as depicted on the approved site plan aud design drawings. Minor
deviations from these drawings may be allowed or requked by the engineer conducting the inspections.
All construction procedures and material specifications shall conform with Municipal and State
requkements.
1.3 All sepm'ation distances shall be in confm~nance with Municipal requirements, unless specifically
waived.
1.4 The contxactor shall be responsible to obtain any necessary utility locates, and to work around any
buried utilities.
2.0 Septic Tank:
2.1 The 1250 gallon septic tank shall be Municipally approved with a minimum of two compartments,
and shah 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 plus 2 feet of soil cover.
2.2 All pipe connections 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. ! The soil absorption system shall be constructed by excavating the 60 foot long trench parallel to
the existing contours of the land to a total depth of approximately 13 feet below ground level.
3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to
allow proper infiltration.
3.3 A total of 5.5 feet of sewer gravel shall be placed in the bottom of the trench. Sewer gravel shall
be0.5" 2" '
- .5 screened gravel, with less than 3% passing the #200 sieve.
3.4 The perforated distribution pipe shall be buried level in the gravel such that the bottom of the pipe
is no less than 5.0 feet above the bottom of the sewer gravel.
3.5 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 shall be
perforated.
3.6 Approved filter fabric shall be placed over the entire top surface of the sewer gravel before backfill
with unclassified cover material. The top surface of the cover material shall be raised a minimum of 6
inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to
smooth contours.
4.0 Inspections:
4.1 A total of 4 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 native material has been excavated to expose the infiltrative
surface to ensure that it is level and at the right elevation, and confo~Tns with the soil test information, (3)
after the sewer gravel is in place and the distribution pipes have been laid m~d connected up to the septic
tank, but prior to placement of filter fabric, and (4) after final 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.
PERFORMED FOR;
F!~tt6~5 Tec~.McCq se¥~,~.C~
14,530 Echo Stree[
Anc~.orc~qe, Alc~skc~ 99516
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
T.t .
LEGAL DESCRIPTION:
o, 3 PT
2
3
4
5
6
7
8
9
10
11
12
13
14
17
18
19
20
COMMENTS NO /"~', ~'. ~'~_~"
SIF:FKER
REDDISH r-AND~' £OAM
GRAY SANDy SILT
HARt~ ¢ CoHEsive-
TO ~
/
5 o1'~ E Co813 LE~
~ELo~ I-Z~
Township, Range, Section:
SLOPE
WASGROUNDWATER
ENCOUNTERED?
S
IFYES, ATWHAT ~
DEPTH? p
E
2_loTi2N~ R3k/
SITE PLAN
Depth to Waler AIl~r
M0nil0rino? Date:
Reading Oau~ Gross Not Depth lo Net
Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch) PERC HOLE DIAMETER
FT AND _ FT
PERFORMED BY: FLATTOp TECH $V'C5 ~ _,~]r-'~, ~
CERTIFY THAT THIS TEST WAS PERFORMED iN
ACCORDANCE
WITH
ALL
STATE
AND
MUNICIPAL
GUIDELINES
IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
PERFORMED FOR: I'~ O N
LEGAL DESCRIPTION: "T"~ ~o
8
9
10
11
12
13
14
15
16
17
18-
19-
2O
~tt6~ Technlc~l
]4530 Echo Street
Anchoraqe, Alaska 99516
Municipa]ily of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage, A~aska 99502-0650
SOILS LOG -- PERCOLATION TEST
S~EF KER ~.3
PT
.5I'4REDDISH ~ANDY
2 LoAM
3
4 HL DENSE SANDy SILT
5
.SL 1G H T L"-/ SOFTER
6 DIGG lNG ~ET~,'EEN
7 ~Nb ~
WASGROUND WATER
ENCOUNTERED? NO
IF YES, AT WHAT
DEPTH?
Depth lo Water Aller
Monilorinll?
Reading
EODOI~E F tAOORE 2
, ~'.',~....~ .
DATE PERFORMED: :/:~/~J
Township, Range, Section: EEC ~J jTI2N~ ~
SLOPE SITE PLAN
Date
Gross
Time
Not
Time
Depth to
Water
PERCOLATION RATE . -- (m~nuteslinch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS
Net
Drop
J
CERTIFY THAT THIS TEST WAS PERFORMED iN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEG'[ ON THiS DATE. DATE:
72-008 (Rev, 4/85)
PERFORMED FOR:
iF!att6~5 Technlca! S~iC~
14530 Echo Street
Anchorc~qe, Alaska 99516
Municipa']ity of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
L2,~ ' --
2
3
4
5
6
7
8
~: 5- 2, 9
10
11
F'5'I 12
13
14
15
16
17
18
19
20
COMMENTS
PT
SM
h4L
5M 51LT¥ SANb
LoAM
CLEAN lq~bluM 5AND
PocKETs oF' WAS GROUND WATER
ENCOUNTERED?
FINE ~AND
~OCKET OF:
GP, A VE. LL~ SANb
B~LOt~ Iq '
Township, Range, Section: $,c'~
SLOPE
S
IF YES, ATWHAT
O
DEPTH? p
E
Oeplh Io Waler After I'~', 'E {~r~
Monitoring? Bate: 7/,~1 Iq I
21~TI2N~ R3W
SITE PLAN
S[!E' ,tTTACH£~ .,
Reading Date Gross Not Depth to Net
Time Time Water Drop
PReSoAK '7/=q 12:ow. is' 27 Y~
12~0~:1o 2~ V~
PERCOLATION RATE ~--/ I (minules/mch) PERCHOLE DIAMETER
TEST RUN BETWEEN (~, O FT AND ~' ~' ET
PERFORMEDBY: ..¢LATTO~' 'TEcH. .¢u'c~ ,, ~-~_~
CERTIFY THAT THIS TEST WAS PERFORMED iN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE. DATE:
72-008 (Rev, 4/85)
PERFORMED FOR: [~ O N
Fl~tt6~ Technlc~! se~ic~
14530 Echo S[ree[
Anchorage, Alaskc~ 99518
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
I',H. ~
LEGAL DESCRIPTION:
PT
1 .SM
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17,
18-
19-
20-
COMMENTS NO ~,T. S~T
Faugh ~H T,H..1~:~
Si eF' K~'R ~.~
REbO
Township, Range, Section: SEC 31CTI2Nj
SLOPE SITE PLAN
SAHbY ,LOAM
SANbY SILT
To T,H. ~1
SoFTE~
WAS GROUND WATER
ENCOUNTERED? ~,~)
S[[E /tTT4 (_ h EJ~
s
IF YES, AT WHAT L
O
DEPTH? p
E
DSI)lh to Waler Aller
Moniloring? Dale:
Reading Dale Gross Not Depth to Net
Time Time Water Drop
PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER ,
TEST RUN BETWEEN __ FTAND __FT
T,H,~ D~G -f'O '~6PI~oVE (o~IT~NUIT¥ OF' 5'ANb
PERFORMED BY: FLATTop T,6Cft, SvCs , _"~'_~_ ~
CERTIFY THAT THIS TEST WAS PERFORMED iN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
:Flatt6~5 Technical
14530 Echo Street
Anchoraqe, Alash:a 99516
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERPORMED FOR: [')oN
LEGAL DESCRIPTION: "T'R ~o
PT
I
2
3
4
5
6
7
8
9
10
11 ~V MEblUK~
12
13,
14
15
16
17
18
19-
20-
Township, Range, Section: SEC. .2.1 ~TI2N~
SLOPE SITE PLAN
$t,4 REbb ISH SANb',/ Lo/~/',4.
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Deplh Io Waler After
Monitoring;'
I-
N
Reading Date
Gross Net Depth to
Time Time Water
PERCOLATION RATE -- (minules/mch) PERC HOLE DIAMETER
TEST RUN BETWEEN . FTAND _. FT
COMMENTS T,H, ~,E ~{jG '"r-o ~oNFIRt,,/ Co~ITt~/u_~3~Y OF ~;/~Nb FOuhIb IN
Net
Drop
PERFORMEDBV: FLATTOP ~l'[c~, SvcS_, ~.~)~4.~
CERTIFY THAT THIS TEST WAS PERFORMED iN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE:
72-008 (Rev. 4185)
PERFORMED FOR:
LEGAL DESCRIPTION;
8
9
10
11
12
13
14
15
16
17
18,
19
20
PT
2
ML
3
4
5
6
7
CoMMENTs
FlattOp Technical Se'/vic&S
14530 Echo SIree[
Anchorage, Alaska 9951R
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
BFE__5ON
S~FKER
I
Township, Range, Section: 5~C ~l ~ TZ2
SEOPE SITE PLAN
SANDY SILT
S~/ CLEAN S,Zl N b
TE'K'~uRE V,~RIE~
Lo~H
WAS GROUND WATER
ENCOUNTERED?
$[!E ,
WITH
OCcAsiONAl.
COS~LE~
DEPTH?
Moniloring? Date:
Reading
PERCOLATION RATE
TEST RUN BETWEEN
7'7H, ~ ~q~r
Time
Time
Oop[h to
Water
Net
Drop
(mutates/inch) PERC HOLE DIAMETER
FT AND ~__ FT
~'~R~ORM~D~'~: FLATTOP T~=C,. ,_~"C~.___I ..~'"~¢.~ ~ -- CERTIFY THAT THIS TEST WAS PERFORMED iN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEC'I ON i'NIS DA1 E DATE:
72-008 (Rev, 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:,'FR
PT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20-
iFlattol5 Technical Sez:vfcb's
14530 Echo Street
Anchorage, Alaskc~ 99.518
Municipality ot Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
~F_.FSON
S~dF' KE'R
pock'£'TS oF MEb~uM SANb
£TA~'FiN6 AT '7
5W F~N,E 5AN. b
WAS GROUND WATER
ENCOUNTERED?
IF YES, ATWHAT
DEPTH?
Deplh Io Water Alter
CLE~I~I '~E~,Ot~ hlonitorino?
Township, Range, Section:
SLOPE
21 ¢ T~2 N.,
SITE PLAN
iFE? N
Reading Date (;~oss Not Depth Io Net
Tirne Time Water Drop
PERCOLATIONF/ATE _____ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND -- FT
COMMENTS
CEflTiFYTHATTHISTES1 WAS PERFORMED iN
ACCORDANCE WITH ALL STA~'E AND MUNICIPAL GUIDELIN,C$1N EFFECT ON THIS DATE. DALE: ~'/'1~,/'~,/
72-008 (Rev. 4185)
PERFORMED FOR:
14530 Echo Street
Anchoraqe, Alaslcc~ 99516
Municipality ol Anchoraoe
OFPARTMF:NT OF HEALTH & HUMAN SFRVICFS
825 "L" Street, ARchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
T,H. :~ 8
LEGAL DESCRIPTION: 'TR /o
PT
1
2
3
4
6
7
8
F.s.-3
9
10
11
12
13
14
15
16
17,
18-
19
20
S~r~FKER
RE'bD ISH 5ANbY
FRoi~ PINE
OCCASIONAl-
COB%LES
Township, Range, Section: .SEC 2,1 .~ TI2 N.~ ~ 31¢
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, ATWHAT L
O
DEPTH? p
E
Depth 10 Waler Alter
Reading [)ate Gross Nut Depth to Net
Time Time (.l,4 1N') Water Drop
Pee£oAk: ~/cl Iql t2. ',2 8; 30
1z'.29:20 2.1
t~4~,o 12'. 3ot30 27 3/~
I~: 3/: ~'/ 21 ~/~
____ 3,g: 23 -21 ~/~
oF q
COMMENTS.
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES INEFFEC'I ON fHISDArE, DATE:
72'008 (Rev, 4/85)
PERCOLATION RATE '~ J r'nJnules/mch) PERC HOLE DIAMETER
TEST RUN BETWEEN "~'g ~T AND q -- FT
CERTIFY THAT THIS TEST WAS PERFORMED IN
PIc~ttS~5 Technicul S6F'~ic6's
14530 Echo Stree[
Anchorage, Alaskc~ 99516
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
625 %" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
T.H. ~q
PERPORMED FOR:
LEGAL DESCRIPTION: "TR
PT
1
2
3
4 lv`iL
5
6
7
8
9
10
12 ~T II .5 '
13
14
15
16
17
18
19
20
COMMENTS,
SIEF" KER
Township, Range, Section: SEC ~J aTJ~
SI_OPE SITE PLAN
5ANby LOAM
~ILT
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Oeplh to Water Aller
Monitoring?
NO
_ Dale:
Readin~'l
Date
Not
Time
Depth to
Water
Not
Drop
PERCOLATION RATE
TEST RUN BETWEEN
- (mmules/mch) PERC HOLE DIAMETER
FT AND __ FT
PERFORMED BY: ..F'~.~TTOP Z~ccJ.-J ,~l,/C (: i ..__~,~_~,"A-~,4_.. CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
AvIo N 5T
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
~5'7-~19.} HAA# fl-~*~~-~'' ~'] '~, .... '~ ¢
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Day phone
Day phone
Mailing address
To
Agent ~4e~v/ I~l/on eeu
Address ~'/
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
Day phone ~ 7 Z -oF'o"/
9¢5-0 /
TYPE OF WATER SUPPLY:
Individual well t..--
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality' and status of system.
TVPE 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. 1191) Front MOA tl21
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 issafe, 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
Engineer's signature
DHHS SIGNATURE
'/' Approved for ',, c..'L' ~-~--
Disapproved.
bedrooms.
Conditional appro,, for
Phone
Date /~',/ ~ J~)¢~
bedrooms, with the following stipulations:
Additional Comments
Th., 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 engineers work.
72~25 (Re,/. 1/91) Back MOA ¢K21
Legal Description:
A. WELL DATA
Well type ?b' T'
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
MUNICIPALI'I'Y OF ANGtiORAGE
ENVIRONMENTAL SERVICES OlVISIOI~
Municipality of Anchorage APR 08
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 34,~
Health Authority Approval Checklist
If A, B, or C, attach ADEC letter. ADEO water system number
Date completed
Cased to /Co" '
FROM WELL LOG
I~ 1~t~3
Casing height (above ground)
Wires properly protected (Y/N)
Date of test
Static water level 3~ ¢ '
Well production I
WATER SAMPLE RESULTS:
Coliform 0 c~!
Date of sample: ~-//
B, SEPTIC/HOLDING TANK DATA
Date installed ~ ? ! 3'/? / Tank size I ~5-¢,~,
Foundation cleanout (Y/N)
Date of Pumping
C. ABSORPTION FIELD DATA
Date installed ~)///,~
Length ~' Width
Effective absorption area ~'~O
Date of adequacy test
AT INSPECTION
"/I ~1 ¢,9
~v/~
g.p.m. G', ~ + g.p.m.
Nitrate I, 5/ 8o ~,.~,/..~_ Other bacteria No,~- ~"¢?¢-'/-,-,~'
Collected by: /-~ /~/-/~p -.~c,5 ,~,~t .¢ ¢r.~,~.~
Number of Compartments '~ Cleanouts (Y/N). '7'
Depression (Y/N). /',/ High water alarm (Y/N) M,~,,
Pumper ~,~c~or~,~' ('"~.~.,'1¢0,~ I ?~,~;~..~
Soilrating (g.p.d./fForft~/bdrm) 1,0~.~,~ Systemtype -7
~, 5- ' Gravel thickness below pipe .5- ' Total depth I
Monitoring Tube present (Y/N) Y' Depression Over field (Y/N)
Results (Pass/Fail) f~¢.r_r For z/, bedrooms
Fluid depth in absorption field before test (in.); . 'Vo/'" Immediatelyafter$~'-gal. wateradded (in.):
Fluid depth ~ ~) '7,,',~- (ins) Minutes ater: I '7,5- Absorption rate = ";> (-~'~ oo g.p.d.
Peroxide treatment (past 12 months) (Y/N) ~'o,~ ¢ ~'4~,,, If yes. give date /V. ,4
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Size in gallons
"Pump on" level at*
*Datum
"Pump off" level at*
Cycles tested
E, SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
F.
Septic/holding tank on lot I o6 '
Absorption field on lot
1/-/7,
On adjacent lots ~> / ~,'0 '
Public sewer main IV. ,,~. ';> /oo '
Sewer/septic service line
On adjacent lots ~. /o¢ '
Public sewer manhole/cleanout iV', ,4. '~ / oo,
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation '¢ 8 ' Property line "~ 8-0 ' Absorption field ~ '8~ '
Water main/service line ~ Io ' Surface water/drainage ~>- IOO ' Wells on adjacent lots '-,> /oo ¢
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line > / ¢ ' Building foundation
Surface water ~. t oo'
Water main/service line '> b-o '
Driveway, parking/vehicle storage area
Curtain drain fi/one ~ee,~ Wells on adjacent lots '~ /oo '
~ '-~A~ ~u¢ll hea~ ~n~,1~~ ~/1~ ~
ENGI~EER'SCERTIFICATION~ h~F~ ¢~x~/~ ~e/I 4o./¢. ~.~
certify mat I have ~termmed thru field ~ns¢ctions and rewew of Mumc~pal records that the above
in conformance with MOA HAA guidelines in effect on this date. ~ ~a ~1¢ ~ o ~ don ~
Signature Y~ ~ ~
Engineer's Name
Date ~r?~'; /
HAAFee $ ~' oO ~ c~
Date of Payment
Receipt Number ~'~ ~'~/'/
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
ZT~__ C?&E ~nvironment. l Ser~ie. In..
ChemLab Ref, #: 98,1448-001
Client Name: Flattop Technical Srv.
Project Name: n/a
Client Sample ID: Tract 6, Siefker S/D #3
Matrix: Drinking Water
Ordered By: Ted
PWSID n/a
Client PO~¢; n/a
Printed Date/Time: 4/6/98 00:00
Collected Date/Time: 4/2/98 12:00
Received Date/Time: 4/2/98 15:00
Technical Director: Stephen Ede
Released By: ~
Sample Remarks:
Perameter
Results PQL Units
Allowable Prep Analysis
Method Limits Date Date Init
Total Coliform (MF) 0 col/100 mi
Nitrate 1.420 0,1 mg/L
SMg222B 4/2/98 TMW
EPA 300 10,0 4/4/98 RMV
~O'd 9W10±
CT&E Environmental Services Inc.
Laboratory Division ~-~-~e.~..~;ac~..~:~..el.a,~e:~:~.~:~..~:a..~j~jj~jjjj~j~jjs~
Drinking Water Analysis Report for TOtal Coliform Bacteria :oo w. ~o,,,, ~,~,,
A~cho~age. AK 99518.1605
R~AD INXTR UCTIONS ON ~VE~E SIDE BZFO~ COL~E~ING S~MPLE Tek (9071 562.2343
MUST BE COMPL[TED BY W'A~EP, SLr~'PLI~R
PUBLIC WATER SYSTEMLD,# { J I 'l' I l
P~VATE WATER SYSTEM
Send R~ul~ ~ Send Invoiet
0 Sen#Retuk~ {3 Sendlnt, oice
SAMPLE DATE: [~ '
Month
SAMPLE TYPE:
Routine
0 Repeat Sample (for routine sample
with lab ref. no. )
D Specter] Purpose
sArd,PLE LOCATION
Day Y*ar
Treated Water
Untreated Water
Time Collected
Collected By
/ ~:oo
Fax: (907) 561.5301
"' TO BE COMPLETED BY LAJ~OP,,~.TORY
An.alysis shows this Wator S,'LMPLE to be;
$~ttisfactory
Unsatisfactory
Sample over 30 hours old. results may
be unreliable
Sample too long in transit: sample should
not be ov~ 48 hours old at examination
to indicate reliable result, PIc~c send
new sample via special de~ve~ ~ail.
Analytical Method: ~Membtane FJh~t
n MMO-MUG
' Numb,r of colonies/100 mi.
Result*
Analyst
Aneh , Fbk~ Jun
Dale:
Client notified of unsatisfacto~' results:
Phoned Spoke v'ilh
Date; Time:
[]
Faxed
Comments:
BACTER20LOGICAL WATER ANALYSIS RECORD
MMO-MUG Result: Total ColiForm
Membrane Filter: Direct Count
· Verification: LTB
Fecal Coliform Confirmation
£. Colt
~ Colonic/100 mi
BGB COLIF1RM
Final McmbranaFilter' Reselts ·
Coliform/100 mi
Time ~ hfs
~0/20'd I0£GT. OfiL06 39tlWOHDNId IS3 331J 90:80 866'~-90-tJdld
Drill,i2$ Co, (/~/f~.~ .~ . USGS No,
'~' ~L ~se of well
Well o~er ~f~.-~ '/-~?~
LocatiOn (~dress o~; To.ship, ~Ee, ~ section, if ~o~; er dist~ce from ~in
Static water level
one) Open end
Depth of hole ~./ , feet Cased to z7/.~ feet
feet (above)(b~ land surface. Finish ~f well (cheek
Screen ( ); Perforated ( ),
Describe screen or perforations
Well pumping test at__~g~llons per (~our~(~{~ut~) for
feet of drawdowa from static level
houre wt~h
Remarks
Well ~
Depth in feet from ~ive details of formations penetrated, size of material,
.._--~round surface and hardness.
. ~ to .J~5~ ~
to
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U4/18/1998 12:29 9873338591 ANCH CHRISTIAN PRESC PAGE 81
5888
QUAN, DESCRIPTION PRICE AMOUNt
~ ~ 2906 Boni~o¢ Pat~ _ ~
~ Suite ~SB (8¢~1972)
lO
16
5L320
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FOR REFERENCE