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Home My WebLink AboutROBIN HILL #1 BLK 2 LT 2# Municipality of Anchorage Page 1 of 3 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: SW980384 PIDNumber: 01 '7-442-06. Ne,ne: Chuck & Peggy O'Donnell Wastewater System: - [] New ,~ Upgrade · doresa: p.o. BOX I 11273 Anch., AK ABSORPTION FIELD Ptlone: 345--~-73~ NO. of B~rooms: ~ Deep Trenc~ ~hallow Trenc~ ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION so,..,~.~: 6 ITOtal Oegt~ from Original grade: Subdivision: Deom to pioe bottom Irom original g~ae:~ Gt~vel oeo[~ b~n~at~ pi~e Lin: 2 m0cx: 2 Robin Hill No. 1 3.5' ~t.. Township: J Range: Section: [ Fiji addea above original grade: J G~vel lengm: , , 1 ~ WELL: _, Existing Gravelwi~t.: 5 I Ft Number of lines: 15' ~. ~,. ~,. 1 r107 so.~. ASTM D3034 PVC Ft. Acreage Sys tern/Date ,ns~aile~: 9 / 29 / 98 ~ ~,. ,,. TAN K S EPARATIO N D iSTAN CES ~i~ a Holding a S.T.E.P. ~om T~,~ ~,~ sm,~o. T.., ~s~.,u., J Anchoraqe Tank ~ I ~ 250 Well >100' >100' N/A N/A j~/n j Steel ~ ? SudaCewamr >100' >100' N/A N/A $/a ~ LIFT STATION - N/A LOt >5' >10I N/A I N/A J N/A :Size in gallons: Manulacturec Line I , > 5 ' >1 ~ ~ ' ~T/A ~]./A ~/A "Pump or, level at; High water ala~ Cu~ain ~O~ 3~ ~ot j J Pum~ Make & Mooel El~tri~l InsDecQons pedormed Drain I, Remarks: ~a~ a~ ~so~p~o~ ~e~ches BENCH MARK Placed Under this Permit. ocafionandDescrip~ion: Garage Slab Existing Tank Crushed, Backfilled and . Existing Trench J A~um~ Elevation:103.0 "t. Abandoned ENG~~L T~ed tn W~h D~ver~er Valve ~or Future Use. Inspections pedormed by: HEA Dates: 1st 9/29/98 Department of Health and Human Se~ices approval Reviewed and approved by: ~ Date:,O'~?-~ MEMORANDUM DATE: October 7, 1998 OCT 2 G 1998 Mu~i/cipality o't AnChorage TO: Jeff Poet Dept. Health & Human Services FROM: Mike Anderson, P.E. ~ ~ SUBJECT: Lot 2, Block 2, Robin Hills No. 1 Septic System As-Built Attached is the Certificate of Health Authority Approval along with the septic system as- built for the reconstructed system recently completed on Lot 2, Block 2, Robin Hills Subdivision No. 1. The system configuration is different from that originally designed due to the lack of grade drop between the septic tank and the absorption trenches as well as groundwater found in the monitor tubes. We originally thought sufficient drop in grade existed between the septic tank and the absorption trench to allow 4' effective depth of gravel and still maintain 4' separation from groundwater. Once the septic tank was exposed it was obvious we could not achieve 4' separation from groundwater with 4' effective depth. We therefore redesigned the system for 2 trenches with an effective depth of 2'. Unfortunately the trenches had to be entered at the end as insufficient grade existed to allow flow to the middle of the trench. The ordinance requires the length of any segment not exceed 100'. These trenches are 76.8' and 78.2' respectively. The bottoms of the trenches are level and effluent should flow evenly to all areas. DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 343-4744 On-Site Wastewater Disposal System or Well Inspection Report. Permit Number SW980384 PID No. 017-442-06 %'/ .Existing Trench A Barn To. House - 1,250 Gallon o S2 Septic Tank C2 C3 A B C S1 19.2 36.1 S2 15.0 28.2 5 20.7 46.9 28.2 51.6 74.7 53.7 75.5 59.3 .qCALE 1" = 20' ........ ,vo,,~y u, ~ncnorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 343-4744 On-Site Wastewater Disposal System or Well Inspection Report permit Number SW980384 PID No. 017-442-06 [nsulati 1,250 Gallon Tank 71i %%%/ I/ ~."4.tl/ %~.¥11.~.~/i/~.~\ttt%\,~.11/ '.X~.I~'/ ~,'-%t// ~.~-I bi .... Natural--Backfill .......... Geotextile Fabric )rainfield Rock Drainfield Rock WEST TRENCH PROFILE BUILr EAST TRENCH Natural Backfill Municipality of Anchorage Page 3A of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ' ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, AK 99519-6650 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW980384 Existing Absor Trench BarnI SITE AS_-_B_U I LT SCALE 1' = 50' PID No. 01.7-442-06 Well Four~ Bedroom. 1,250 Gallon Septic Tank New Absorption Trench MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 25, 1998 Expiration Date: Sep 25, 1999 Permit Number: SW980384 Legal Description: ROBIN HILL #1 BLK 2 LT 2 Design Engineer: 0014 Anderson Engineering Owner Name: Chuck and Peggy O' Donnell Owner Address: PO BOX 111273 ANCHORAGE , AK 99511-1273 Parcel ID: 017-442-06 Total Bedrooms: 4 Site Address: 006300 NENANA PL Lot Size: 87991 SQ. FT. Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: September 24, 1998 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 2, Block 2, Robin Hills Subdivision No. 1 Septic System Design Impacts to Adjacent Properties Dear Onsite Services Engineer: We hereby apply for a permit to upgrade the septic system on Lot 2, Block 2, Robin Hills Subdivision No. 1. The existing absorption trench has failed with effluent surfacing at the southwest end. The absorption trench must be replaced immediately to prevent damage to property and eliminate a health hazard. The attached site plan and backup documentation identify the size and location of the new absorption trench to serve the four bedroom home on the lot. The existing septic tank will be exposed, inspected and verified for continued use. If found to be unusable a new tank will be placed at the same location. Testholes placed on the property revealed silty gravels with varying amounts of sand. Soils percolate at a rate approximating 15 minutes per inch. Groundwater was encountered during the excavation at 11' and stabilized at 9.5' during the monitoring period. We have therefore designed a 5' wide shallow absorption trench with 4' of gravel beneath the distribution piping. The trench will be 100' long with atotal depth from original grade of 5'. The distribution piping will entered mid trench. The ground surface of the lot is gently sloping from east to west at rates varying from 1% to 3%. It also slopes from north to south at approximately 1%. The surface in the area of the new trench is fairly flat and will present no problem to the construction of the new trench. Lot 2, Block 2, Robin Hills No. 1 September 24, 1998 Page Two If the system is constructed as designed the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. ., The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments / / ./ Verify Integrity o Existing Septic Tank i~ Replace. if ~ecessary] EXisting Trench Y Barn..!' Well Four 1,250 Gallon Septic Tank New Absorption .Trench NOTE: No Wells of Septic Sy As Shown. SITE PLAN SCALE 1" = 50' TO House / Valve Existing Abs~rptipn Trenc~ ,Post Tank Cleanouts Barn SYSTEM PLAN SCALE 1" = 20' 1~ TH1 New 100' Long X 15' Wide X 4' · IEffective Depth Absorption Trgnch ~) TH2 LOT 2, BLOCK 2, ROBIN HILLS SUBDIVISION DESIGN FACTORS: Four Bedroom Home Perc. Rate: 15 - 30 Min./Inch Application Rate: .6 GPD/SF SYSTEM REQUIREMENTS: 5' Wide Trench System 1,250 Gallon Septic Tank 4' Drainfield Rock 4 Bedrooms X 150 GPD / .6 GPD/SF -- 1,000 SF of Absorption Area 1,000 SF/5 LF (Width) X .5 (Red. Factor) = 100 LF Trench Length Therefore: Construct a 5' Wide Absorption Trench System With One Lateral 100' in Length with 4' of Drainfield Rock Beneath the Lateral. Distribution Pipe in Trench Placed 1' Below Original Ground. Trench to be Entered at Mid Point. Total Depth of Trench to be 5'. Minimum 3' of Cover or 2' of Cover with 2" of //-'~~ii~c~i~~Bury Iric ~sulation Drainfield Rock NOTE: TYPICAL WIDE TRENCH SECTION (NO SCALE) Grade Area Over Trench to Drain Away. Minimum 3' of Cover over Septic System. Minimum 10' Separation From Lot Line. Minimum 4' Separation From Groundwater. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: 'dA~'4'¥~'~- .~,,., ,- .'.~'~' I DAT~ P~RFO;~~ Township, Range, Se~ion: 1 2 3 4 5 6 7 9 10 11 ~2 13 14 15- 16 I7 18 19 20 I Ill I II WA~ GROUND WATER ENCOUNTERED? IF .... AT WHAT DEPTH? h~niza'ing ? ~ , Reading I Gross Daze Time TEST RUN BETWEEN COMMENTS ~A~ PERFORMED BY: SITE PLAN II IIii II Jiii iii I I ii 41'1 DepYn ~o Waxer Ne~ Time Ne~ tmmutes/inct~J PERC HOLE DIAM~'TER __ F~ AND FT Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska ~502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFO; CL.-. Township, Range, Section: 9 10 11 12 13 14- 15- 16- 17- 18- 19. 20- COMMENT~ HI/,,. t,.....~ SLOPE WAS GROUND WATER ENCOUNTERED? v=e / L IF .... AT WHAT DEPTH? // 0 P Reading Date PERCOLATION RATE PLAN I I~*~t~ ;I I I/~ I I I L,/e~l/ I IIItl'llT/ i I I I/1~'1 I , I'1 Iz-l~tXI I I I -!, I¥i 1~4 III I I I Time Deottl to Water & ; z.o $o , TEST RUN BETWEEN __ THAT THIS TEST WAS PERFORMED ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 2, BLOCK 2, ROBIN HILLS SUBDIVISION NO. I GENERAL: 1. The scope of this project includes the exposing and verification of the existing septic tank and, if necessary, procurement and placement of a 1,250 gallon septic tank. It also includes the construction of a new 100' long X 5' wide X 4' effective depth absorption trench at the location shown on the site plan. The distribution piping in the trench must be placed at 1' below the original ground surface. Total depth of the trench will be 5' from the original ground surface. A diverter valve must also be placed and the existing absorption trench tied in to the new system. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION A new 1,250 gallon septic tank must be procured from an approved source and installed at the location shown on the Site Plan if the existing tank is found to be unsuitable for continued use. Lot 2, Block 2, Robin Hills September 24, 1998 Page Two 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Lot 2, Block 2, Robin Hills September 24, 1998 Page Three 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted watertight couplings (Caulder, Fernco, or equal). with Lot 2, Block 2, Robin Hills September 24, 1998 Page Four 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. Ail drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of aprofessional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. ) , MUNICIPALITY OF ANCHORAGE · [~EPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ,( ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE .- J. ~] NEW LEGAL DESCRIPTION / LOCATION NO. OF BEDR~MS J Well Absorption area Dwelling PERMIT NO. __.., D,STANCE TO: tO., ~ m~ ~ Manufacturer ~~ Material~ ~ No. of com~tments Liq, c~pacity in gallons I si e length Width Liquid depth ,,~ IF HOME'DE: ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ ~ = DISTANCE TO: Well I, O ~ ~ Foundatio~ ~ ~ ~ No. of lines Length of each line Total length of Ii Trench wid · Distance between lines ~ ~ Top of tile to finish grade Material beneath tile~ Total effective a~ea ~ ~ ~ inches , Length /~ Width Depth PERMIT NO. ~ ~ Type of Crib diameter Crib depth Total effective absorption area ~ DISTANCE T0: Well Building foundation Nearest lot line ~ ~ ~s~~ .~ Depth Driller Distance to lot line ~ DISTANCE TO: Building foundation~ (~ Sewer line OTHER PIPE MATERIALS SOIL TEST RATING ~ ·. ~0 ~- ,, A~~ DATE ) LEGAL FPT OF i'~ L MAR 1 5 ~97fl SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF D ]~,l'~1"" I'~/,i[ I'1 DRILLED AT THE RATE OF ~7o9-00 PER FOOT. PROPERTY OWNER /']~4.. & ~ ~ tx'~._ LOCATION OF VVELL SITE ,,C.~,, ,.0.... B./.J'~..Z) Sf.b~r. DRILLER WELL LOG: 0 ..... 27' S~::d4/. oLo4/. ~'4~Jz 20% Caw. o-eL. 27 .... 6;8' ~.zzzre_J,, u.,',,M.A 305;¢ .¢o.*z~ old. S e. tr o_.,zoL. .oa. aJ.J. .Oe..d.~c. Jc a..f. 716 ~e.w_,ac. ?uJJ. e~ c.a/a.i.n.9. hack. ~z ~ ~e_.o a,.fl~ .~,.o~ he.d~oc.L Zo aZJ. ooa 776--186' 186--789' A c,F~wzm2.a~ .*z. o c..k. ~h. ow.O~ ...~ o m.e. .o.i. gr~ off osa2.e2,. 1/2 789--2-40' Se_d~On.e~..aat~ /z. ock. wZ2J~ .oo~.e. ,o.o.'z. ou.~ ~W.p.e. ~ac..k.a..f. 227 .~o 22.9' ge~ and .51tou2xi A.q.c..,'t. ea_~e, u~g2A u~ £o 3000 ~ p~ da~. ,qA.~o osZ.f~ 150 ¢.e.e~ CO~T INCLUDES ALL LAEOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK ~AYA~LE TO RAMPART DRILLING ~ORK~ FOR THE ~UM O~ THAN~ YOU VERY MUCH. BERNIE CLAUS OF RAMPAR~ DRILLING WORKS I.,.I I L~I.iE:LM :E;'T'FIF;:CK '-.-' ::'F' .............. 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LIDE MORE 'TFiRN MUNICIPALITY OF ANCHORAGE DEPARTNIENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99B02 276-222ij SOILS LOG- PERCOLATION TEST [] SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: /rD'-/-- ~. "'~ )'~ SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) 7' ¢',PT TEST RUN BETWEEN FT AND DATE:. 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 017-447-n~ 1. GENERAL INFORMATION Complete legal description ..... 2 No 1 Location (site address or directions) 6300 Nenana Place Property owner Mailing address Lending agency Mailing address Chu~.k ~ P~ggY O ' D~nn~] 1 'P.O. Box 111273 Anchoraqe, Day phone 345-2733 AK 99511-1273 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Four (4) TYPE OF WATER SUPPLY: Individual well XXX- 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 NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. XXX 72-025 (Rev. 1/91) Fron! MOA~I21 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 Anderson Engineering Phone 522-777~ Address P.O. Box 240773 Anchoraqe, AK 99524 Engineer's signature ~'~~ ~'~'~ Date 10/5/98 DHHS SIGNATURE ~ Approved for ]~(¢ U/~, Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: 'Additional Comments By: 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 DH HS 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 (Re~. 1/91) Back MOA ~21 Municipality of Anch°rageRl:Rv DEPARTMENT OF HEALTH & HUMAN ..... Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescription: Lot 2~ Block 2, Robin Hills ParcelI.D.:. 017-442-06 No. 1 A, WELL DATA Well type ' ' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ¥ Date completed 9 / 1 5 / 78 Total depth 240 ' Cased to 116 ' Casing height (above ground) 2 ' Sanitary seal (Y/N) ¥ Wires properly protected (Y/N) ¥ Date of test Static water level 90 ' Well production 1.75 WATER SAMPLE RESULTS: Coliform 0 Date of sample: 9/25/98 B. SEPTIC/HOLDING TANK DATA Tank size Y FROM WELL LOG 9/15/78 AT INSPECTION 100' g.p.m. 5.3 g.p.m. Nitrate .151 rog/L Other bacteria 0 Collected by: J. Nicoctemus 1 , 250 Number of Compartments 2 Cleanouts (Y/N)__ Depression (Y/N) N High water alarm (Y/N) N Pumper Construction Immediately after Absorption rate = Soil rating (g.p.d./ftz or ft3/bdrm) .6 Length 1 55 ' Width : 5, ~, ~., Gravel thickness below pipe Effective absorption area ! ~ 1 0'7. {~'Momtonng Tube present (Y/N) - Date of adequacy test , '-' Results (Pass/Fail) :Pa s $ Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* System type If yes, give date 5' Wide Trench 2 ' Total depth 6 ' __ Depression over field (Y/N) __ For 4 Date installed 10/1 /98 Foundation cleanout (Y/N) Date of Pumping New C. ABSORPTION FIELD DATA Date installed 9/29/98 gal. water added (in.): g.p.d. bedrooms D. LIFT STATION - None Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line on Property Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: >100' >100' On adjacent lots > 1 0 0 ' On adjacent lots > 1 0 0 ' "Pump off" level at* N/A Public sewer manhole/cleanout N/A > 30 ' Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation > 5 ' Property line > 5 ' Absorption field > ,5 ' Water main/service line > 10 ' Surface wateddrainage > 100 ' Wells on adjacent lots > 100 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line > 10 ' Surface water > ! 00 ' Building foundation > 10 ' Water main/service line > 100 ' Driveway, parking/vehicle storage area > 2 ~ ' Wells on adjacent lots > 1 ri n ' Curtain drain None on Lot F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipa~_'~r~h~ ',~.b~'~,ove systems are in conformance with MOA HAA guidelines in effect on th~s date. ~ ~.o ~ ' ~ ~,., ,~, Signature ~~' ~~ ~;'~ ~ ;;~ ~'": En i e r', ame ~' Waiver Fee $ HAA Fee $ Date of Payment /z~/ /~ /'~ ~/ Receipt Number~/-~ Y~ ~--~ / 72-026 (Rev. 3/96)* Date of Payment Receipt Number ./ MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~t'-)- LiL\:~- ~,~0 HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~/', Mailing Address (c) Lending Institution Mailing Address L.} Telephone: (home) ~'~ 5'- 15~-! Business Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here i-i, if hold for pick up.) List contact person and day phone number below: / 2. TYPE OF RESIDENCE Single-Family7 Number of bedrooms ~ 3. WATER SUPPLY Individual Well ,~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site'~ Public [] Community [] Holding Tank [] Note: If¢community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page I of 2 leUOR!puoo leAoJddV leUOR!pu°C) ,to SLUJa.L peAoJdd~s!C] - ~ pe^oJddV Xq suJooJpaql~ Joj pa^oJdd¥ 'i~AOU~id¥ SHNCl '9 leas s,Jeau!bu~] ' ' O~5~.~:~:~~ Health Authority Approval (.AA) MUNICIPALITY Of ANCHORAGE (MOA) CHECKLIST - FEBRUARY 1984 ~_~.~ ~ 343-4744 ~ ~' A. WELL DATA ~¢~,,.C~~ Well Classifica~l~on '~- ~---% if A, B, C, D.E.C. Approved (Y/N) ~,~ J97~ Yield /b Well Log Present (Y/N) Date Completed O/ Total Depth ,Q.~O Cased to /IG Depth of Grouting ~o static Water Level ~ q Pump Set At '~3, Casing Height Above Ground j ~,1 Sanitary Seal on Casing (Y/N) "/ Electrical Wiring in Conduit (Y/N) .)/' Depression Around Wellhead (Y/N) t,,/ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot J E)/~ ; On Adjoining Lots ~ ~ 0 To Nearest Edge of Absorption Field on Lot ~ ¢ ~ ; On Adjoining Lots "~ I (.9 To Nearest Public Sewer Line T"~/,z~. To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot .~'"' ~ Water Sample Collected by ~- .~ ; Date d:~ ~- 17' ~ Water Sample Test Results 6~ /.~ g.-~/.../ . /~/D /V Comments /.g'¢_.~ ~.~,~a~ o,~..e' ,~.?~',,,,.~', ~x_. ~,,,,-- //~ _ _ . B. SEPTIC/HOLDING TANK DATA Date Installed cj,/~ Size I2.__RC> No. of Compartments Standpipes (Y/N) 0;~, Air-tight Caps (Y/N) Depression over Tank (Y/N) ['~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /"//,~, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To. Water-Supply Well J 0 ~, To Building Foundation ..'.'.'~'7 To Property Line lt~o ~ To Disposal Field To Water Main/Service Line ~ ..9_. ~' To Stream, Pond, Lake or Major Drainage Course Foundation Cleanout (Y/N) Date Last Pumped ct/~_7/~o ~L~ ~'o~,~- ;for Temporary Holding Tank Permit (Y/N) b/',~ Comments 72-026 (Rev. 7/88) Front Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness FCC" Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: 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 I To Existing or Abandoned System on ; On Adjoining Lots > ~-~ To Cutback (if present) D. LIFT STATION ¢"J (~ 1'4 EE Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date ~0._~-~ l'7 I c~ 9,0 MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Engineer's Seal TO551E 81PlURI LA IB P 6751 W Dimond Anchorage Alaska 99502-3904 (907) 248-5095 SEPTIC SYSTEM ADEQUACY TEST LEOAL: Lot 2, Block 2, Robin Hilt LOCATION: 6300 Nenana Drive OWNER: Wihelm Starck RESIDENCE: Single Family 3 Bedrooms WATER SUPPLY: Onsite Well, Serving this Residence Only SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: Greet Steel, ABSORPTION SYSTEM: ABSORPTION AREA: ,SOIL RATINO: INSTAL LAT I ON DATE: 3-Bedroom System 1250 Gal. Two Compartments Trench 900 sq. ft. 250 Sept. 1978 DATE OF LAST PUMPINO: Sept. 24, 1990 Rotc Rooter DATE OF TEST: Sept. 17,1990 TEST PROCEDURE: System was inspected and measured, Tank was found with four feet of cover and 45 inches of liquid. Cleanout to trench was 5.5 deep and dry. Trench monitor tube was 7 feet deep with 36 inches of liquid, 450 gallons of clean water was added to the trench at a constant rate of 5 gpm. while the waterleve!s in the tank and monitor tube were monitored. The water level in the trench monitor tube r'ose immediately when water was added. Five gallons caused a 12 inch rise. When 275 gallons had been added, the level in the trench monitor tube had risen 38 inches, while no increase was observed in the tank, The next 150 gallons caused a 4-,25 rise in the tank and the monitor. PLJring tine next 60 minutes both levels dropped 2.75 Inches, indicating that 80 gallons had been absorbed by' the ground during this period. TEST RESULTS: This septic system meets the code requirements of the Municipality of Anchor age ....... The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family.being served by the s.vstem These cnnditions are outside the control of the evaluator of this system. We can therefore not give any estimate of how long this system will function satisfactory for current or 6751 W Dimond Anchorage Alaska 99502-3904 (907) 248-5095 RESIDENTIAL WELL INSPECTION LEGAL: LOCATION: 6300 Nenana Drive OWNER: Wilhelm Starck WELL CLASS: INSTALLATION REQUIREMENTS MET: WELL LOG AVAILABLE: WELL YIELD FROM WELL LOG: PUMP YIELD FROM TEST: DATE OF INSPECTION: Lot 2, Block 2 Robin Hill Single Family Residential Well Yes Yes .75 gal. per minute 1.3 gal. per minute SePtember 17, 1990 TEST PROCEDURE: Well was pumped at aconstant rate of five gallons per minute. The accustic probe could not go past the end of well casing at 116 feet. ,Static level was found at 99 feet. After' pumping 275 gallons in $0 minutes, the well run dry. Pump was shut off and well allowed to recover for 75 minutes. Then an additional 170 gallons were delivered in 20 minutes. This indicates a recharge r'ate of 1.3 gallons per minute. TEST FOR E.COLI AND TOTAL NITROGEN: A sample of water taken from the wei! was tested for E.Coli and nitrates on September 17, 1990 E.Coli 0 Total Nitrates ND ( None Detected ) E.Coli allowable O, Max. allowable total nitrates t0.0 rog./1 TEST RESULTS: This well meets the requirement of the Municipality of Anchorage. The Municipal requ!rement for well flow is 150 gallons of water pe? bedroom per day. 1-his well exceeds this requirement. The assessment of the condition of the well applies Chh/to the conditions as they' were on the day the well was tested. The flow rate may change due to subsLirface conditions that can not be observed from the surface, or from chonges in the land use or other factors that may impact the aquifer feeding the well. MUNICIPALITY OF ANCHORAGE UNICIPALITy OF ANC~'(~R--A'~)' I DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF 825 L Street - Anchorage, Alaska 99501 ENVIRON~<ENT,,~L ENVIRONMENTAL ENGINEERING DIVISION MAR t 197'9 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~~D DIRECTIONS: Complete all parts on page 1. Incomplete requests Will not be processed. Please allow ten (10) days for processing. 1, PROPERTY OWNER PHQNE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER' PHONE MAILING ADDRESS 3. LENDING INSTITUTION ~ PHONE I MAILING ADDRESS 4. REALTOR/AGENT ~ PHONE I MAILING ADDRESS LEGAL DESCRIPTION STR LET LOCATI ON TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [~ Three [] Six [] Other 7. WATER'SUPpLY ~ INDIVIDUAL* *ATTACH WELL LOG. A well Icg is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVI DUAL/ON-SITE** **If individual/on-site, give installation date,~'~f°o, If system is over two (2) years old an adequacy test is required [] PUBLIC UTILITY 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 ~-IME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS '~ SINGLE FAMILY [] ONE ~E~] 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 [] PUBLIC UTI LITY O/_ ;~,~ _-~O~ Connection Verified INSTALLER l~Septic Tank or E~Holding Tank (~_~ ,~:I~,L_ Size: t:::-O.~["'} If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding'-Tank Absorption Area Sewer Line --] ~earest Lot Line WELL TO: ~'b~ ' Absorption Area to nearest Lot' Line '-, .~. ~ 5, COMMENTS ~..~"A"PPROVED FOR .~.~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED -//~ ' ~ ' DATE BY (Titl.e~-~// // , LEGAL DESCRIPTION 72-010 (Rev. 3/78)