HomeMy WebLinkAboutREED LT 7...... Municipality of Anchorage Page
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: ~v~JC~'7 el ~ O PID Number:
Name: ~,~., ~ ~ (.Z~,-e~'J Wastewater System: [] New '1~ Up.g.r. ade
Address.: ~ O_[ ~ ~~ ~ ABSORPTION FIELD
~~ ~t~ ~ D Deep Trench ~ShallowTrench DBed DMound DOther
Total Dept~from original grade~
LEGAL DESCRIPTION Soil Rating: . ~ GPD/Sq. Ft.
Lot: ' ~ 'B~:~ ~Subdiv~i°n: Depth to~.pipe bottom~ ~fr°m ~'°riginal~ grade: Ft. Gravel depth, ,,..~"beneatho pipe~ Ft.
WELL: Q New ~ Upgrade Gravel width: ~ /~ Ft. Number ollines:~ , [Distancebe~eentines:Ft'
~~~, A,B,c); Total Depth: Cased To: Total absorption area: Pipe material:
-'%-~ Drdler ~ ~ ~Waler Level: Installer: Ft. ~ Dateinstalled /~ 7~
Yield: I,,~ ~ng Height Above Ground: TANK
~ ~t. I ~ ~'
~ARATION DISTANOE~ ~s~,,io u ,o~di,s ~S.T.S.~.
ffro~ Tank Field Station Tank Sewer Lines ~.
Well I I~ ~ IO~ ~/~ ~ 1~ Material: ~~ Number~Oompa.ments:
u, ce, '
w~t~ mo ~le ~ ~'~ LIFT STATION
Lot ~¢1, ~1, ~Oi~ ,Size in gallons: ,M~~
Line
Foundation :,~ ~O,~-- ~ "Pump on" ,eve~f," ,eve, ~alarm ,t:
Cu~ain Drain ~l~ ~J~ ~ ~/~ ~del Electrical Inspections pedormed byl
Remarks: ~~~ v~ BENCH MARK
~' ~ ~V~ ' ~ ~ ~ I AssumedDevation:
Inspestions pedormed by:~ ~~3& Dates: 1st 7
Department of Heaah and H maa Services approva
Reviewed and approved by: . Date: 7-~
72q313 (Rev. 9191) MOA 25
I1LD CRMMUNITY WELL NOW BNLY SERVES
LOT 9, REEl) S/D, LOT 9 IS CONNECTED TO
AWWU WATER, BUT SERVICE Ig NE]T ACTIVATED,
WELL SHBE]LD BE CLASSIFIED AS PRIVATE,
FIBMESTEAD RQAD
BENCHMARK IS TOP SE]UTFIWEST CE]RNER BF DECK,
ASSUNED ELEVATION = 100,00
SHE~//
TH N,T, (REHOV
HOUSE
C/O 'D
MT 'E'
/
NEW TRENCHES. 38 FOE]]' LONG~
EACH, tO+ FRBN EDGE TO EDGE,
AC = 49,7
BC = 26,5
AD - 31,8
BD = 60,7
AE = 4fl,1
BE = 42,8
AF = 60,9
BF = 28,3
AG = 43,9
BG = 8t,3
AH = 51,2
BH = 64,3
Al = 59,1
BI = 50,{)
1250
CiO
'I'
PREPARED 3Y~
DATE:
LBT 7, REED S/D
SEPTIC SYSTEH AS-BUILT:
PREPARED FOR~ SAN CDHEN
ALASKA WATER ~ WASTEWATER
IN SEPTIC TANK
C/O
'BULL RUN'
VAVLE
SPLITTER
~--XISTING TRENCH
SW970160
AS-BUILT ]]R/aWING
PID4h 051-102-06
TANK, INLET INVERT =
96,58, OUTLET INVERT =
96,36,
TANK SET LEVEL $/ITHIN
,08 FEEl'
CH DIA, PV LIN FRON
HOUgE, INVERT AT FOUNDATION
C/O : 96,89,
1-GROUND OVER TANK = 99,4 (APPROX,)
_ _ ~--,ININUM .... COVER = 8,2 FEET,,
8 INCHES OF INSULATION BOARD
OVER TANK AND ALi_ SEWER LINES,
TO FLOW SPLITTER
GROUND ELEVATION OVER SOUTH TRENCH = 97,6+, MINIMUN COVER = 2+ FEE]'.
GROUND ELEVATION OVER NORTH TRENCH = 98,5+. NININUM COVER = 8+ FEET,
.~~__FOR LOCATION DF M.T's SEE PLAN DRAWING INCH F810 DRAINPIPE,
~- . . -- 8 INCHES OF INSULATION, AND FILTER FABRIC OVER DRAINRBCK
· l, / /I~A'A' BOTTOM OF TRENCH = 90'87 SOUTH TRENCH & 90'D2 NORTlt TRENCH
[~p:~ E, NO ~EDRDCK WITHIN 6 FEET OF T~ENCH BOTTOMS,
SEPTIC A,%-BUILT: LOT 7~ REED S/D
PREPARED FI]R: SAM COHEN
ALASKA ~/ATER g~ WASTEWATER
SCALD
NTS
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
PAGE
1 OF 1
PERMIT NUMBER:SW970160
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES
OWNER NAME:COHEN SAMMY LEE & MARTHA L
OWNER ADDRESS:23012 HOMESTEAD RD
CHUGIAK, ALASKA 99567
DATE ISSUED: 6/30/97
EXPIRATION DATE: 6/30/98
PARCEL ID:05110206
LEGAL DESCRIPTION:
REED LT 7
LOT SIZE: 16750 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION 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 (iSAAC80) .
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:
ISSUED BY: ~/
DATE: ~ '-~ ~- ?'7
8471 Brookridge D~4ve - Anchorage ~ Alaska 99504
(907) 33%6179 ~ Fax (907) 338-3246
Consulting Engineers
June 14, 1997
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ret5 Septic Upgrade for Lot 7, Reed S/D.
To whom it may concern:
The existing 3 bedroom house is served by AWWU water and a private septic system. The
drainfield will not pass an adequacy test at this time (surcharged), and must be upgraded prior to
the sale of the house. Comments regarding the proposed upgrade are summarized as follows:
1. SOILS: Attached is a log which shows the soil profile, and the percolation test results. At a
depth of 5.5 to 6.0 feet the percolation rate was 21.8 minutes/inch. Do to the limitations of the
backhoe, the test hole depth was limited to ] 3 feet, which would limit the total system depth to 7
feet. In 1984, Leroy Reid, P.E. dug a test hole about 30 feet away fi'om the test hole dug on
6/3/97 (see the site plan). Reid's test hole was 17 feet deep, and did not encounter bedrock.
Based upon Reid's test hole, ! would like to extend the depth of the proposed upgrade to a
maximum of 8 feet.
2. TRENCH DESIGN:
a. Percolation Rate: 21.8 minutes/inch
b. Allowable Application Rate: .6 gallons/day/t~2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 750 ft2
f. Effective Depth: 4.0 feet
g. Reduction Factor- .5
Width: 5 feet minimum
Minimum Length: 75 feet. Will make 2 trenches, 35' long each.
Effective absorption area ~ 750 ft2
We are proposing to install a diverter valve so that flow can be periodically alternated between the
old and the new trenches.
4. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
upgrade.
5. TOPOGRAPHY: The lot slopes gently downhill from north to south, and from west to east.
Some elevation shots are noted on the site plan. There are no slope concerns.
6. PROTECTIVE WELL RADIUS: There is a well house located on the northwest corner of
the subject lot. The well was originally designed as a class "C" water supply for Lots 6,7,8, & 9
of Reed S/D. Attached is a copy of the ADEC certification to operate, dated 9/84. Do to
concerns over fuel contamination of the groundwater in this area, AWWU ran water service down
both Homestead Road, and Rosebud Row. All of the homes within the vicinity of the class "C"
well are now connected to AWWU water service, however, Lot 9 has yet to be turned on. As a
result, Lot 9 is the only property still being served by the well located on Lot 7, Reed S/D. Based
upon these facts, the well should now be treated as private, with a 100 foot protective radius.
Attached is the connection documentation, fi'om AWWU, for the adjacent properties.
When Lot 9, Reed S/D physically disconnects from the well, the owners of Lot 7 will have an
abandoned well and well house on their lot, which will have to be abandoned per ADEC
regulations.
! am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems, if you have m~y questions, please contact me at 337-6179, 244-9612, or on my digital
pager at 1-800.
Sincerel~~
~,8l-1162. Thank you for your assistance.
c.c. Sam Cohen
AWWU WATER ~ERVICE IS FRBH HDNEDTEAD RBAD. '¥B LBTS A ~, 7,
AND FROM RDSEBU]) ROW AVE, TO LOTS 8
DLI) CDMNUNITY WELL NOW ONLY SERVES
LOT 9, REED g/I), LiT 9 IS CONNECTED TH
^WWU WATER, }DUl' SERVICE IS NOT ACTIVATE/),
WELL S:I;OULI) BE CLA~:2IFIED Ag PRIVATE,'~ ..NNNN
BLf4 TRACT, PRIVATE RESIDENCE '=.
2293B HRNESTEAD RBAI], AWWU .
WAFER, AND PRIVATE SEPTIC SYSTEN, "-..._
THERE ARE NO SEPARATION DISTANCE .
CONCERNS,
NEW SEPTIC
lO0 FOOT WELL RADIUS
HI]USE
LOT 7, REEl] S/I]
AWWU WATER.
LOT ~J~ REED
giB, AWWU
WATER ~ PVT,
SEPTIC,
LOT 5,
REED S/II
CITY HSO
& PVT.
gEPTIC
LBT 9 REEl/,
PVT, WELL &
SEPITC.
LOT 10
REED
VACANT LOT
RD£EBU9 ROW
LOT 9 IS SERVEl] BY THE
WELL LDCATE~] ON LOT 7,
SEPTIC UPGRADE~
PREPARED FOR~
PREPARED BY~
SATE: 6/14/97
LOT 7, REED S/D,
SAM COHEN
ALASKA WATER & WASTEWATER
OLD CONNUNI'FY WELL NOW ONLY SERVES
LOT 9, REED S/D, LOT 9 I§ CONNECTED TO
/ -AWWU WATER, BUT SERVICE IS NOT ACTIVATED,
\,/ELL SHOULD BE CLASSIFIED AS PRIVATE,
H[]MESTEAD RGAD
iii
THE C(]NTRACTBR SHALL HAVE THE WELL RADIUS
[:LAGGED DY A REGI§TERED LAND SURVEYOR,
BENCHMARK IS TOP SOUTHWEST CORNER OF 1]ECK,
ASSUMED ELEVA'FION = lO0.OO
SHE /
NEW 1000 GALLON SFPTIC TANk
99,4/TH
lOi,4 C/O
N,T.
NEW TRENCHES, 37,5 FOOT LUNG
EACH, 10 FRON EDGE TI] EDGE,
°ZABEL° FLOW SPLITIt
HOUSE
C/O
c/o
RUN'
VAVLE
REID, P,E, TEXT HOLE,
2/~5/84, NO BEDROCK TO
]7 FEE'F, SOILS LOG ON FILE
AT ]~HHS,
OLD SEPTIC 'lANK SHALL
BE ABANDONED BY REHOV-
ING THE TOP AND FILLING
WITII ~OIl_,
TRENCH
CBNTRACTOR SHALL RAISE THE ELEVATION DF THE SE\dER LINE
WHERE IT EXITS THE HDUSE AS REOUIRED,
SEPTIC SYSTEN UPGRADE:
PREPARED FOR:
PREPARED BY:
DATE~ 6114197
LOT 7, REED S/D
SAM COHEN
ALASKA WATER 8, WASTEWATER
I]}RAWN: GARNESS
ISCALE~ ]" = 30'
THE TRENCH SHALL HAVE A MINIMUM LENGTH OF 75 FEET, AND A TOTAL
EFFECTIVE ABSORPTION AREA OF 750 SQUARE FEET.
MONITORING TUBE (TYP.)
PERFORATED IN DRAINROCK.
BACKFILL WITH NATIVE SOIL AND MOUND.
TOPSOIL & RESEEDING SHALL BE RESPONSIBILI'FY
OF HOMEOWNER.
PROVIDE 2 INCHES OF BOARD INSULATION
IF SOIL COVER IS LESS THAN 3 FEE'F.
INSULATION SHALL COVER THE EN?-IRE
WIDTH OF THE TRENCH.
DRAINROCK SHALL BE
SCREENED PER M.O.A
SPECIFICATIONS.
T'OTAL DEPTH OF
TRENOH ,SHALL
NOT EXOEED ,9
FEE T.
NOTE:
1.
2.
' , ! =DRAINRQ,~K
5 FEET WIDE
TRENCH SHALL RUN PARALLEL TO THE SLOPE OONTOURS.
FOR LOCATION OF CLEAN-OU?S AND MONITORING TUBE
SEE ?HE SITE PLAN.
3. CONSTUCTION PRACTICES, AND MATERIAL SPECIFICATIONS
SHALL COMPLY WITH ANCHORAGE MUNICIPAL CODE 15.65,
"WASTEWA TER DISPOSAL REGULATIONS".
4. INS1,-ALLA TION SHALL COMPLY WITH SPECIAL PROVISIONS
NOTED ON THE SEWER PERMIT
5. SMEARED BOTTOM AND SIDEWALLS SHALL BE RAKED.
6. BOTTOM OF TRENCH SHALL BE LEVEL. 2 INOH MAXIMUM
VARIATION BETWEEN HIGH AND LOW SPOTS.
DETAIL FOH 5 FOOT WIDE SHALLOW TRENCH:
PREPARED FOR: SAM COHEN
FIL FEB FABRIC SILT BARRIER
NT$
ALASKA WA TEF1 & WASTEWA TER SERVICES
,
DATE: 6/14/97 DWN: GARNESS I SCALE:
4 INCH DIA., ASTM F810
PERFORATED PIPE. HOLES
DOWN. PLACE 2 INCHES
OF DRAINROCK OVER TOP
OF PIPE, AND ACROSS
ENTIRE WIDTH OF TRENOH.
PIPE SHALL BE INS? ALLED
LEVEL (WITHIN ,O'i FEET).
WATER & WASTEWATER UTILITY
401 W. IN~L AIRPORT RD.
PHONE: 564-2762
LOT/TRACT
, SUBDIVISION
~.-,- .: . :-'"-:~'-:"::~"~::v';';',~',~~.>J'. .....
CONNECT PERMIT
SCHEDULEOCOMP T ON DATE '
~81NGLE.FAMILY
~ MULTI-DWELLING
No. APTS
~ COMMERCIAL
BLOCK
TAX CODE ?' /' /r'* J .... '.' 7 GRID/I~/,!.<.' /
~t~/t .
STREET ADDRESS
OWNER ~'~: " ' /
MAIL ADDRESS /' '
~AS-BUILT No.
PHONE __
,/
CONTRACTOR: / ',' '(.~
Q REPAIR EXISTING SERVICE
O ON PROPERTY ONLY
O HYDRANT ONLY
Q MAIN TAP- TO PROPERTY LINE ONLY
~,~OA or State Row Permit required)
AIN TAP & ON PROPERTY CONNECT
. (MOA Or State Row Permit required)
~-0-w NO.
ASSESSMENTS
To be levied upon connection
Main extension agreement
Improvement District
Extend connect agreement '
Pending
Paid
-.{L ,
PERMIT ISSUED BY;
CONNECTION SIZE /' CHARGE
INSPECTION FEE
PERMIT FEE
REIMBURSI BLE
NUMBER DEPOSIT
TOTAL
REMARKS:
PERMITTEE (Please Print) PHONE
MAiL ADDRESS _
CI P~ID [] .CASH
[] c~',~_
I N S?~ D BY:~,
DATE:
I HAVE READ ]'HE CONDITIONS AND REGULATIONS ON THE REVERSE SIDE OF THIS PERMIT AND AGREE
TO COMPLY WITH THEM.
PERMITTER SIGNATURE
POST IN A CONSPICUOUS PLACE AT THE JOB SITE
3~-t~m~¥.u~9, AWWU INSPECTOR
uJ
o
~z
H/~ON~i VOIONI
MUN,C,PAL,TY OF A.CHORAGE WATER 9
CONNECT PERMIT
DATE O,: APP,CAT,ON
SCHEDULED COMPLETION DATE
[~INGLE FAMILY
WATER & WASTEWATER UTILITY [] MULTI-DWELLING
401 W. INT'L AIRPORT RD.
PHONE: 564-2762 NO. APTS
[] COMMERCIAL
LOT/TRACT B LOCK
SUBDIVISION ?'.'"
TAX CODE " / /
STREET ADDRESS
OWNER
GRID AS-BUILT No.
PHONE
MAIL ADDRESS
CONTRACTOR: / ":"
Q REPAIR EXISTING SERVICE
Q ON PROPERTY ONLY
Q HYBRANT ONLY
Q MAIN TAP- TO PROPERTY LINE ONLY
x((MOA or State Row Permil required)
MAIN TAP & ON PROPERTY CONNECT
MOA Or State Row Permit required)
C) R-O-W NO.
ASSESSMENTS
To be levied upon connection
Main extension agreement
Improvement District
Extend connect agreement
Pending
Paid
/
CONNECTION SIZE / CHARGE $
INSPECTION _,, FEE $
PERMIT FEE $
REIMBURSIBLE
NUMBER .... DEPOSIT $
TOTAL $
REMARKS:
PERM~,/?/ISSUEDy. BY:
PAID [] CASH
I N S....~.~_~T E D BY:
_/~_ ~=-~ ~.~ _
DATE: ~' "~ ~D - ?~
PERMI'fq'EE (Please Print)
MAIL ADDRESS
PHONE
I HAVE READ THE CONDITIONS AND REGULATIONS ON THE REVERSE SIDE OF THIS PERMIT AND AGREE
TO COMPLY WITH THEM.
PERMITTEE SIGNATURE
POST IN A CONSPICUOUS PLACE AT THE JOB SITE
31-~21 (Rev. 11189) AWWU INSPECTOR
INDICA'~NORTH
x
,' . .: . :'?~.L_.; .:.:, '," ' ':~..:~, .",., - -~ '-' " .... '
'. ~:..~CORP "STOP ~' '~'
....... · ,- '.,. C~RB ~TOP OTO C ~, .' .... ~ . ·
:r~T, COPPER PIPE
· ':"'~,>(.,~h~?~R 2" KEY BOX
~;THAW-WlRE
THAW2P~T~NUT
. / :"' ~ ,'~RNY CONNECTOR
OTHER
SIZECONN
TAPPING SLEEVE
M.J. TEE
· .TAPPING VALVE
x
X
............... M,J, VALVE
FT, D,I. PIPE
5" VALVE BOX COMPLETE
TIE RODS
.., "''?EYEBOLTS
TESTTAPMA~_:E~ YES [] NO
OTHER
3/4" NUTS
INDICATE NORTH :"
INSPECTOR
BLK/LT/I'RAC'~ . L-T-.8
[]DOMESTIC ONLY
FIRE LINE ONLY
[] BOTH FIR[
[] FIREHYD
DATE OF TAP / / BY
SIZE MAIN [] AL'LEY:'
TYPE MAIN EXCAVATOR
DISCONNECTS
7"'YES [] NO
KEY BOX LOCATION
INSPECTION REPORT
J2~UNE .,OWN OUT 4/ ?~/¢5' [] INSULATED
[] K.B, & T.W- OK AFTER BACK-FILL
[] OPEN BORE FLUSH / /
[] 200 LB. TEST / /
[] MAIN CHLORINATED / /
[] CHLORINE FLUSHED / /
.,~OK TO TURN-ON [] DO NOT TURN-ON
COMMENTS ':-¢
INSPECTOR
' BLKJLTrrRACT LT 9
lOX-
.. '~KEARNYCONNECTOR'
OTHER
SIZE CONN
................... ON ................ TAPPING SLEEVE '"
M.J. TEE
5" VALVE B~3X cOMI:;I~E" '~ RODS
OTHER ~': ........
[] DOMESTIC ONLY [] --BOTH f
' -I~1 FIRE LINE ONLY [] FIRE HYDRANT,ONLY~-~?3'?
DATE OF TAP / / BY '"" ..........
SIZE MAIt~ [] ALLEY 'E]'/$TR~-~':r~'/E] E,~§EMENT
TYPE MA N EXCAVATOR
DISCONNECTS [] YES [] NO ~ ~ ~ r SIZE OF DISCONNECT
COMMENTS '
KEY BOX LOCATION
NSP, ECT ON REEO,~,~T
.... . ,,.., .... ,, ~,~,i,~', ..~.,
~ ~ ......... '0
~ L NE BLOWN OUT 7 / ';.,~
'"" ' ' ~t ..... ~ "%B:'&'T.W :'OK'AFTER
~ OPEN BORE FLUSH ' / / .....
[] 200 LB. TEST
[] MAIN CHLORINATED
[] CHLORINE FLUSHED
[] OK TO TURN-ON
COMMENTS
INSPECTOR C ,/,42,'4'"4""~4~=:':~ DATE
"-'~i STATE OF ALASKA '-;i,J
D~,FAHTMF, NT OF I~NVIRONMI~NTAL CONSERVATION
CONSTRUCTION AND OPERATION CERTIFICATE
for
P[JBLiO WATER SYSTEMS
APPROVAL TO CONSYRUO'?
"~" '=~ '~ '~ ~ / {7 '~ ~.... puotlc water system
,... ~' :,.~:. ; .. - , , ~
,, Alaska, ~ubmltted in agootdmlee with 18 AAO
.... have be~n reviewed and 3re
If construction has no! starta~J wIt~'.ln two year~ of tho approv[~l dJde, this cerJltlca'~o ts'void end new plans and
APPROVED CHANGE ORDERS
Approved
APPROVAL TO OPERATE
']'he "APPROVAL TO QPERATE" ,.le~tJon must be ~ompie~ed ~nd 81grad by the Departmen~ before any water
I~ m~Oe avsH~ble fo the public, .,
,. , ..,.. · ~-~:. ~ ,~ '~ ............... ~ubllC
Tho construction of mo ..... :~,.~,~ .......... = ...................... ~--
~ > ~._.Z..~. (dme), Tho ~y~tem Is hereby
graJ3ted intorlm ~ppr_w, to op~r~t~ for go d~y~ ~ollou/lpg th~ acml31a~lon date.
A~,l~ullt plet~ .submitted durh~g the Interim ~pp~ov~[ period, or ~n Inspectlo~ b~ the Dep~Hmont,
the By~t~m w~ ggn~tru~ted ~gg~rdin~ t~ Jhe ~pprovod plans. The 8yotom Jo hereby g~nted final ~ppr~v~l
operate, ~ ,[
00767
~NT~OL SERVIO~ iNC.
We~t 33r~ Avenue 3uite B
ANCHORAGE, Ab~KA 99503
Phone 27~I~81
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
I Well
I o / mSTANC~O: I /
~ ~ ~ Manufacturer
~Liq., c~acity in gallons ~ IF HOMEMADE'
/.. I L D(" d) ·
' ~..~ I ~ s~,c~ ~o:
~ ~ ~ ~ Manufacturer
id-
Absorpt~nlarea
Inside length
Dwelling
Well
DISTANCE TO; I
No. of lines Length of_eacl2_~ne
~J Top of tile to finish grade ~,
Length
I Type of crib
DISTANCE TO:
]Cass PK',bI:'O~¢~-~3
J DISTANCE TO:
Dwelling
Material
PHONE L~'5"-~ ~NEW
Material
Foundation Nea.~t lot ling ,
Total leng~ ~llines Trench width
Material beneath tile
NO. OF BEDR.~OMS
P ER M~J~T NO.
No. of con~_rtments
Liquid depth ~
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.~Z.(.~i -'~ 9~,
Distance between lines
Width
Depth
Total effective absorRt~on area
PERMIT NO. "~
Crib diameter
Crib depth,
Total effective absorption
area
Well Building foundation Nearest lot line
Depth Driller Distance to lot line PERMIT NO.
Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED
DATE
LEGAL
LOT? ~3LK ¢
F'EF.:M I T NC ·
[:,FITE I_,:,LIE[..
RPF'L I CRNT:
PI[. E RE .....
CONTFICT PHCNE:
JOHN MOORE
BOX 4-604
RNCFIORRGE.,
688-4555
LEGRL DESCRIP: SUBDIVISION: REED
SECTION: t8 TOWNSHIP:
LOT SIZE: :1.6625 (SQ. F"F. OF.: RCRES)
I.'IR~-~' BEDROOH$:
LOT: 7' BLOI]:K': NR
..~,
· :L... N RRNGE: '1l`4
LISTED E:E.L. CI,,.I RRE THE F ' ' '-
_IFTIUN.:, R\,'RILRBLE TI]I '¢OU IN DESIGNING '-¢OLIR '--;EPTIC:
_,=_,TEll. CHOO'--;E THE OPTION THRT BEST FITS "-I";'
· ~ ,.. _ r. SITE.
T R E l'-~ L~- I--I B E C. l.,l.[:. ~;:
DEPTH TO PIPE BOTTOM (FT.) 4. 0 5. 0 4.
GRRVEL DEPTH <FT. ::, 9. 0 0. 5 2:.
TOTRL DEPTH (FT. ::, i2. 0 5. 5 7.
GRRVEL WIDTH (FT.) 2. 5 t9. 0 5.
GRRVEL LENGTH (FT.) 25. 0 3:5. 0 48.
GRR',,,'EL. VOLUME (CLI. VDS. ) 2t. 9 24. 6 3:5.
TRNK SIZE (GRLS) t., ~00. 0 *:+: t., 0013. 0 ** t.,B00.
SOIl._ RRTING (~]1~. F'"t". /BM) t46 t46 t46
.** TRhlK MUST HR',,,IE RT LEH_, F TI413 CI]MPRRTMENTS
I CERTIFY THRT:
t. I RM FRMILIRR HITH THE REQLIIREMENTS FOR ON-SITE SEHERS RN[:' HELLS RS SET
FORTH B'¢ THE MUNICIPRLITY OF-RNCHORRGE (MOR) RND THE STRTE OF RLRSKR.
2. I HILL INSTRLL THE S'YSTEM IN RCCORDRNOE HITH RL.L MOR CODES RND REGULRTION'%
RND IN COMPLIRNCE I...IITH THE DESIGN CRITERIR OF THIS PERMIT.
3:. I HILL RDHERE TO RLL MOM RND STRTE OF RLRSKR REQUIREMENTS FOR THE ':;ET BRCK
DISTRNCES FROM RN'Y EXISTING WELL, WRSTEWRTER DISPOSRL S'YSTEM OR PUBLIC
SEHERRGE c]VSTEM ON THIS OR RIq9~ RDJRCENT OR NERRB'¢ LOT.
4. I UHDERSTRND THRT THIS PERMIT IS VRLID FOR R MRXIMUM OF 3. 6'EDROOMS RND
RNV ENLRRGEMENT WILL REg!UIRE RN RDDITIONRL PERMIT.
IF R
THEN
I.,.t i LL
ELEC:TRICFIL I`,.IORI-::: MUST BE [:,ONE B'T' FI LIIZ:ENSE[:, ELECTRICIRN.
LIFT STR"FION IS '= -
IN_,THLLE[. IN RN RRER COVERED B'T' MOR BIJIL[:,ING C;ODES.,
(:1.~., RN ELE_.TF.ICI-IL PER. MiT RND IN=,PEUFION MLIST BE OBTRIIqE[:,.~ ,:'2', Hz,-BUILT_,
NOT BE RPPRCWE[:, 1,4ITHBUT RN ELE_.IF..IL. HLP ' "-" ilqSF'EC:TION REPORT.= RND ,:13:) THE
DRTE
JOHN M]CRE
.... ...........
SIGNE[:'
FtPF'L I CRNI":
i SSUED B"r'
pERHIT NO ~
[:'RTE I--,~,UE[.~.
RF'F'L I CRNT:
[. [. F..E=,=,:
CONTRCT Pt-lONE:
LEGRL [:,ESCRI P:
I_OT =,I,~E:
HAX BE[:'F.':OOMS:
JOHN MOORE
BOX 4-604
RNCHORAGE., RE
688-4555
99509
SUBDIVISION: REED
SECTION: t8 TOL4NSHIP:
~6625 (SQ. FT. OR RCRES)
]<
LOT: 7
F..:RNGE: :LH
BLOCK: NR
LISTED BEL. OP.! FIRE THE OF'TIONS R',,,'FIII_RE:LE TO YOU 11',1 DESI~3NIN]i YOUR SEPTIC
..,Cz, TEll. CHOOSE TFIE OPTION THRT BEST FITS YCIIJF.: SITE.
E:E [:.
DEPTH TO PIPE BOTTOM (FT.) 2. 5 *:.~:
GRRVEL DEPTH (FT.) 0. 5
TOTRL DEPTH (FT.) 2. 0
J3Fi',FIVEL NID"FH (FT.) 17. 0
GRRVEL LENGTH (FT.) 3:4. 0
GRR',/EL VOLUME (CU. YDS. ) 2::L 4.
TFINK SIZE (GRI_S) .% .900. 0 *.'+.'
SO I L RRT I NG (SO).. FT. ,."BR) t25
.2. Ed .'1.::+:
1.0
66. 0
:.1.8. 3:
000. 0 :~'::+:
:+::+: [:,EF'TH TO PIPE BOTTOM .{ 3,.~.~ FT. REQUIF..E.=," '- IN.=,LILpI'- ~ ION
:+:* DEPTH TO PIPE E, JTTUI'I -.':: 4.. 0 FT. MRY F.'.Er, t lIRE FI LZFT STRTIEN
*:-~: TRNI< HUST HFIYE FIT LERST 'TI.40 COi"IF'RRTMEHTS
I C:ERTIFY THRT:
i. I RM FRMILIRF.'. NITH THE REQUIREMENTS FOR ON-SITE SEWEF.'.S RND NEL. LS RS '-gET
FORTH BY ]'HE MUNICIPRLITY OF RNCHOF..'RGE ,::MOR) RN[:, THE STRTE OF RLRSKR.
2. I HILL INSTRLL THE SYSTEM IN' RCCORDRNCE WITH RLL MOR CODES RND REGLILRTIONS.,
RN[:, IN COMPLIRNCE NITH THE [:,ESIGN CRITERIR OF TNI_S PEF..:MIT.
-'::. I HILL RDHEF.:E TO RLL MOR RN[:, STRTE OF RLRSKR REC..!UIREMENTS FOR ]'HE SET BRCK
[:,ISTRNCES FROM RN'T' EXISTING WELL, NRSTENFITER [:,ISPOSRL SYSTEM OR PUBLIC
SEI,.IERRGE SYSTEM ON THIS OF.: RNY RDJRCENT OR NERRB'T' LOT.
4. I UN[:,ERS.;TRN[.', THRT THIS PERMIT IS VRLID FOR FI MFIXIMUM OF 3 BE[:,ROOMS RND
FINY ENLRRGEMENT WILL REf.]UIRE RN R[.',DITIONRL PERMIT.
IF R LIFT STRTIOi'.,I IS INSTALLED IN RN RRER COVERED BY MOR BUILDING CODES.,
THEN (:1..) FIN ELECTF.:ICRL PERMIT FIN[:, iNSPECTION MUC;T BE OBTFtINE[:u (2) FiS-BUILTS
FIILL NOT BE RPPRO'¢ED !,.IITHOUT FIN ELECTRICRL INSF'ECt'ION REPORT.~ RND (]:) THE
ELEE:TF,'ICFIL 1.40RI< MUST BE [:,ONE BY R LICEI".,ISED ELECTRICiRN.
S I GNED
FFLI _.HNF
I SS;LIE[:, 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:
DATE PERFORMED:
3
SLOPE
SITE PLAN
l/J
10
13
14
15
16
17
18
1o. 2251.E
19~
20-
PERFORMED BY: ~)O,'l~¢'r/ /' ,
_./.,. ,. / /
WAS GROUND WATER JVC'lO S
ENCOUNTERED? L
E
IF YES, ATWHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
I
I
I
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch)
£
CERTIFIED BY: DATE:
,. ~:,.. ~-t ,t ,.~_,¥ /.- ..' ~/~ . ~.,, . ,~
ALASKA eFIUIROFImt~FITAL COFITROL $1~RUICI~,$, fi'lC.
(~n§in~eri,c1 ~ ~nuironm~ntol $1ucli~s
ADDRESS
PERCOLATION TEST DATA SHEET
ZIP CODE
LEaL LOCATION ~.Z~q~h'y/~._~/~'~'-//L,,
TOTAL DEPTH OF HOLE ~ ft.
ZONE TESTED <'/,-~ ft TO
READING # CLOCK TIME NET TIME DEPTH TO NET DROP RATE (min/in)
DATUM
~1~ /~t~ /~ ,~',~ .
FINAL PERCOLATION RATE
PERFORMED BY /.~.~. ~/
~ ~ (min/in)
12oo LUgs, 3~1 Au¢,u~. $,,,.,o~. A,C'~O~a9~. Alaska 99503 · (907) 276-1361
ALASKA elldlrgOFIm F1TAL COFITIgOL S RuiC $, IFlC.
~qinecrJnq $ ~nuirenmcnl~l SludJcs
September 17, 1984
Department of Health &
Environmental Protection
825 L. Street
Anchorage, Alaska 99501
SubJect: Lot 7, Block O, Reed Subdivision, Well Abandonment
Dear Susan:
This office visited subject lot on 8/24/84 to wltness procedures for
well abandonment. Twenty cubic feet of concrete was poured into casing,
casin9 was sealed and backfllled slx feet below ground level. Attached
are pictures before and after abandonment.
If you have any questions please let me know.
Sincerely,
John W. Gates
Engineerin~ Technician
1200 L~Icsl 33rd Aucnu¢. $ui1¢ [~* Ancbroq¢, Alasko 99503 *{907) 561-5040
ALASKA eFILIIROFImeFITAL COFITROL $~BIjIC~S, IFIC.
~nqJn¢¢rin(I 6 ~r~uJro~mcnlal $1udics
1200 LUest 33rd Aucnu¢. $ui1¢ B · Anchoraq¢, Alosko 99503 · (907) 276-~361
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.# O~'/ -/o-~ - o G ~. HAA#
GENERAL INFORMATION
Complete legal description
Lot 7, Reed Subdivision
Location (site address or directions) 23012 Homestead Road
Keith & Theresa Stewart
Property owner
.Mailing address
Lending agency
Mailing address
Ptarmagin Real Estate/Betty Fields
Agent
Address po Box 671109, Chugiak, AK 99567
688-2034/Ptarmagin
Day phone
Day phone
Day phone
688-2034
Unless otherwise requested, HAA will be held for pickup.
3 ~
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water ~'x~' '~
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
XXX
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. "
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/orwastewaterdisposalsystem 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 S & $ ENGINEEI~ING
17034 Eagle River Loop Road No. 204
Address
Engineer's signature /Z ½~,:1~/c.-., /'"'---
Phone
Date
DHHS SIGNATURE
/-/'/ Approved for '-7-/-d'/~. ~' bedrooms.
Disapproved.
Conditional approval for
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 enginee¢s work.
72-025 (Rev. 1/91) Back MOA #21
Municipality of Anchorage APR $ 0
DEPARTMENT OF HEALTH & HUMAN SERVIC NICIPALITY OFANEH
EN~ONMENTAL SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska ggs01 · (g07) 343-4744
Health Authority Approval Checklist
Legal Description: ,~.O'F
ParcelI.D.: O~'~/- Io~o (~
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level ~/
Well production
WATER SAM~ULTS:
Coliform ~ Nitrate
Da o~fsample:
p u ,b L--i C
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to ] Ca~t (above
ground)
..WTres properly protected (Y/N)
FROM WELL LOG /~ AT INSPECTION
g.p.m, g.p.m.
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed ~7//~/c/ ? Tanksize J ~-~O Number of Compartments
Foundation cleanout ~)N) ¥/)~ J Depression (Y/~
DateofPumping li / ~- S / c~ ¢) Pumper
C. ABSORPTION FIELD DATA
,
Date installed
Length "7 t3 Width
Effective absorption area ')leo '¢
Soil rating r fF/bdrm) O, ~, System type
~ ~ Gravel thickness below pipe ~ Total depih
'~; Monitoring Tube present (~/N)¥'2J~ Depression over field (Y/~. ~'0
Date of adequacy tes~t P / ,I~ Results (Pass/Fail)
Fluid depth in absorption field before test (in.);
For ~
Fluid depth (ins) Minutes later:
I~ero~re~2 months)(Y/N)
bedrooms
Immediately after__ al, g~a. ter-added (in.):
Absorption rate = .g.p.d.
If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed Size in gal?~s~*~
Manhole/Access (Y/N) "Pum_j~~
High water alarm level at* ~ *Datum
"Pump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer,~~ line
On adjacent lots
O~nadjad~ nt lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
I
Foundation ~- ~" Property line ~o ~-)- Absorption field ;~
Water main/service line } o -/-- Surface water/drainage /0o/-k Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Su trace water
Curtain drain
) o --)- Building foundation / o -¢- Water main/service line
/
I 0 o -~ Driveway, parking/vehicle storage area
~-o~¢ g,,,o ~/~ Wells on adjacent lots P-co '¢-
HAAFee $. ~ ~ ~ ~)
Dateof Payment /~,/"~ ~),/~?
Receipt Number z'/IZ~'//~
ENGINEER'S CERTIFICATION
I certify that l have determined thru field inspections and review of Municipal records t~t~¢~(~o~/~ ~ff~ems are
in conformance_,,wi~,~A¢~, uid~'nes in effect on this date.
Signature
Engineer's Name ~8~(,~)~ ~. ~W~ 2 , ~ ,'"
/
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Parcel I.D. #
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
O t~;'' ] -- tOZ -0~ HAA#
~IPALIT'¢ OF ANCHORAGE
~NVIRONM~NTAL "-
· ~RVIC,.,~ D/VISION
dUL 2'/ 1997
RECEIVED
///) 77o2
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Day phone
Lending agency
Mailing address
Day phone
Address
Day phone
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
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72~25 (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.
Name of Firm
Phone
Date
Address
Engineer's signature
6. DHHS SIGNATURE
/x~ Approved for
bedrooms.
Disapproved.
Conditional approval for
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 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 (Rev. 1/91) Back MOA
Legal Description:
Municipality of Anchor g. ..... ~Vle~ON~ .
DEPARTMENT OF HEALTH & HUMAN ,5~- ~w~,~-o
Environmental Services Division JUL 2 ~ 1997 ~--~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) ~43:47~4
Health Authority Approval Checklist
bo~ ~ 5 ~ ~/~ Parcel I.D.:
A. WELL DATA
Well~b~ty If A, B, or C, attach ADEC letter, ADEC water system number
Log preset_ Date completed
'Total depth ~_ Cased to __ __ Casing height (abo~
Sanitary seal (Y/N) ~ Wir~ed (Y/N)
FROM WELL LOG ~ AT INSPECTION
Date of test
B. SEPTIC/HOLDING TANK DATA
Date installed ~J~/~? Tanksize ~SO Number of Compadments
Depression (Y/N)
Foundation cleanout (Y/N)
Date of Pumping 1'4/¢:~ Pumper I,.3
C. ABSORPTION FIELD DATA
·
Date in~talled '7 /~ ::~ Soil rating (g.p.d./ft2 or:.,~C/,bdrm) ¢ ~ System type
Length ~ ~o /
Width ~'/-t-. Gravel thickness below pipe
Effective absorption area. "7(¢0 ~ Monitoring Tube present (Y/N) ~ Depression over field (Y/N)
Da~quacy test Results (Pass/Fail) For
Total depth ~,, Z -'7,
72-026 (Rev. 3/96)*
Size in gallons
Manhole/Access (Y/N)
~iygchI:ater alarm level at* ~---"'- ~Datum
E. SEPARATION DISTANCES
SFROM WELL ON LOT TO:
On adjacent lots
Absorption field on lot ~'~~._ _ ~~d~~~
Public sewer main ~hole/cleanout
~ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation -'7 / 4,
-- Property line 2,~' ± Absorption field
/
Water main/service line ~O '~ Surface water/drainage ~O(~) '~ Wells on adjacent lots
- Property line
Surface water
F,
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
14/+- io/ '
-- Building foundation Water main/service line 10 '~'
/
Io0 ~ Driveway, parking/vehicle storage area
Curtain drain I--4 Wells on adjacent lots /O~ -* PvI-
ENGINEER'S CERTIFICATION /l
de~ed--u--i-ld inspections and review of Municipalte~[n~/n /~ ~l ~ ~,'~. OF ~ ~,
I ce~ify that l have
reco~bt~~ ~ ~s are
inconformance~M~~esineffectonthisdate. ,~ ///J?/¢~:~
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
~"~"~/- \C~:::~- ~'~Lo 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---~-~-~,~-~
(C) Lending Institutio'n
Mailing Address
Telephone: (home) Business
(d)
Real Estate Company and ~,gent '¢~:~-~/~,,(d~ "("~ m.._ ./h'2 ('?~¢.J/~? &~O<:,C.~ ~
Telephone , )~
(e)
Mail the HAA to the following address: (or check here~, if hold for pick up.)
List contact person and day phone number below:
$ &-S-ENGtNEEI~N6
11034 Eagle River Loop Road No. 204
2. TYPE OF RESIDENCE
Single-Famil~ Number of bedrooms
3. WATER SUPPL:,~
/
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-sitel~/ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmentai
Conservation attesting to the legality and status.
72-025 (Re,, 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION '-
A~certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I 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 Telephone
Address
Date
S & S ENGINEERING
17034 Eagle RLver Loop Road No. 204
Eagle RlYer~ Alaska 99577
6, DHHS APPROVAL
Approved for X
Approved ~
bedrooms by /~' ate
Disapproved Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph S 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 DHHSdonotconductinspections
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. 7/88)Back Page 2 of 2
,x~jJll~'~,/
~'~%%~ CHECKLIST- FEBRUARY 1984
¥' ~o .~'~ ~ ,
%,*
A. WELL DATA
~ I
Well Classification
Well Log Present (Y/N) ~ Date Completed
Total Depth .Cased to Depth of Grouting
If A, B, C, D.E.C. Approved
Yield
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot \¢~'L:~ I-4-'
To Nearest Edge of Absorption Field on Lot _
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by ~, .~ "~c;~/1~¢i~;~1~ ; Date
Water Sample Test Results
Comments
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
B. SEPTIC/HOLDING TANK DATA
Date Installed ¢¢%o¢¢-¢¢ Size
Standpipes ~5~'N) '-/ Air-tight Caps4~/N)
Depression over Tank (Y/~¢~ t~D
Pumping/Maintenance Contact on File (Y/N)~ /
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK:
To Water-Supply Well /~'-'c;~ I-~-
To Property Line
To Water Main/Serv ce Line
No. of Compartments
"7/ Foundation Cleanout ¢~N)
~)ate Last Pumped ~ J J ~
; for --
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field (,~
To Stream, Pond, Lake or Major Drainage Course
'eom rne ntS -¢/¢ ..,A~ ¢~'?..-
72-026 IRev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Type of System Design
Length of Field ~"~' /
Depth of Field
Square Feet of Absortion Area
Depression over Field (Y~
Results of Last Adequacy Test
Gravel Bed Thickness '~ ~
~ "/¢' Statndpipes Presentd~N)
I- ~ Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well \ ~-C~
To Building Foundation ~ ~
Lot r-~/.'~
To Water Main/Service Line \ ~ {4
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments "~-'Y¢~--~ '~"'~ ~:2¢'~\¢:L)~'~
-/
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~ ¢¢
To Cutback (if present) __
Date Installed ¢
Size'i'n~.~ n s
"Pump On" Level a-'-~'~
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
MOA No.
Receipt No.
Date of Payment
Amount: $
S & S ENGINEERING
170o,-, ,--~ ......... - ......
Eagle River, Alaska 99577
72-026 (Rev. 7/88) 8ack
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
DEPT. OF ENVIRONMENTT/kL ~ONSERYATION
ANCHORAGE/WESTERN OI. STRICT OFFICE
~ R
3601 r ST EET, S lITE 1334
ANCHORAGE ~ ALASKA 99503
STEVE COWPER, GOVERNOR
OATE: September
PUS i o:
To Whom It May Concern:
Accnrdinq to the records on file in this office, the REED
SU~D.I-_V~[S.I_QN._(_~_Q.~_S_._~,_,_..-~,._.8..~_Z~.O.d_.~}. Water System is in compliance
~Jith the State of Alaska Drinking Water. Regulations,
Sincere]y,
Michael P, Lewis, PE
Environmental Engineer
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
App,ication Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ~.~¢VCt p~/o~,-~ ,/¢¢~;~¢- Telephone: Home Business
Applicant Address ~.~,,-~C.P ~.,¢/ .~-'-~ 4-'1 .,~r,'~c,r. 1~ ~:'_¢.-J /"~/.?.~. /'~,~ _~/C/~-'/~
(c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other.~L(explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single-Family/~ Multi-Family [] Other
Number of Bedrooms
3. WATER CUPPLY
Individual Well [] Community~ Public[]
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~ 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.
Page 1 of 2 72-025 (11,84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4744
Legal Description: L..o'T
WELL DATA
Well Classification C-C;'/'.h ~'~ ,,1. '~'iLv ,, A, B.B.B~)D.E.C. Approved (Y/N) 7
Well Log Present (Y/N) Date Completed Yield
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot /5-0 ' q-- ~_
To Nearest Edge of Absorption Field on Lot / 5 () 1 .,~
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
Water Sample Test Results
Comments ':~ /~/~4,~.1
B. SEPTIC/HOLDING TANK DATA
To Water-Supply Well /
~__~/To Property Line
To Water Main/Service Line
Course ~
Comments '~ ~oz_
Date installed ~/{O/~'~: Size //¢,)(-~k~,.0¢tl/ No. of Compartments ~..
Standpipes (Y/N) /" Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Y
Depression over Tank (Y/N) _~t,.~, Date Last Pumped J//~ ¢/~,, ]/
Pumping/Maintenance Contract on File (Y/N) /NJ /~q 'for /k~ /:Pt-
Holding Tank High-Water Alarm (Y/N) J~ //q Temporary Holding Tank Permit (Y/N) A,I /f:~L
Separation Distances from Septic/Holding Tank:
' -~- '~ To Building Foundation ,,~ ~
'¢' To Disposal Field ~'~
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
/
36r]l "C" STREET, SUITE 133~
/
ANCHORAGE, ALASKA 99503
STEVE COWPER, GOVERNOR
563-6775
DATE:
PWSIO ~:
To bJhom It May Concern:
12-17-87
Class C Well
Peters Creek
Accor'dinq to the records on ~ile in this of¢ice, the
.L°t~_.&_,_~_~,_.~_~j?]s_~_ ....... Water System iS in compliance with the
State oF Alaska Drinkinq Water Requlations.
Sincerely.
Ronald S. Klein
Environmental Field OFficer
Per verification of J~n Hayden, ADEC, Anchorage
t~UNICIPALITY OF ANCHORAGE
DIVISION OF EM~IR0~R~ENTAL HEALTH
DEPARTI.~']NT OF [~TH ~D ENVIRONt.~ ~0TECTIOM
APPLICATION FOR. ~{iZ~,TIi A~HORI%~f APPROVAL 6~RTIFICATE
1o danert~f, )~n'for,'nation
Application Date ..... ,, '~',:' ~
Lc,~agion (~ldress or directions)
~,<i ! .,~ , ,
l,'Ld:', ~.-.' /'::~..,? ,.~.1'~/::~:,. ,~x" .:
(b) Applicants ~
Applicants ~dress .,"~;
(c) Appliaant is (checl!~9.) Lending Inst,itution
(d) Landing !nsti~ution
Address
Telephone- Home Business
(e) Real Estate Coo & Agent
Address
(~')
Telephone
Mail the [-iAA to tke following address g
Ty~e of Residence
Number of Bedrooms
Water Sup~
Mult JmFamil y ![[-~--7
Other (describe)
-~'~=t'~;-'~ '~:~--r:~'~_~. Pubtic L~_~:
Note: If community well system~ must have ~.~itten confi.~nation from the State
Department of Enviro~entai Conset~at:l. on attesting to the legality and starsys.
On,,~ LU:: ~0.~.~ liFE::[ Commnnity 2: Holding Tank 2]
Note: If community well system, rattst have w;tittan conffrmatio~ from the State
Department of Environmental Conservation attesting ~o the legality and status,
[Page 1 of 2]
En~ineerin.~i~-m Providin~ns~pe~ctions, Tests~z, File Search~ Data and X'o%,~.
As certified by my se~ affixed hereto and as of the w~lidation date sho~,m
verify that my investigatiou of this He~th Authority Approval shows that the
water supply and/or wastewater disposal system is safe, f~ction~ and adequato.
the number of bedrooms and type of s~ructure indicated herein.. I further
based on the infoz%~a~ion obtained from the b~nicipality of ~chorage files aud
investigation mid inspection~ the on-site water supply and/or ~rastewa~er disposal
system is in complianc~ with ~1 Municipal and State codes, ordinances, and regula~
tions in effect on the date of this inspection,
.// ..f..~ ~ , / ~ .-'~ / ,
(ENGINEER SEAL)
Approved for
" bedrooms
Approved /~ Disapproved
Conditional
Terms of ConditionaI Approval
CAUTION
THE bfONICIPALITY OF ANCHOrCAG% DEPAR~ENT OF HEALTH 'J/~rD ENVIRONbfENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVJJ~ CERTIFICATES BASFJ) SOLELY UPON I'IiE REPRESEbFITM
ATIONS GIVEN IN PAHIAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTE~_~D
IN THE STATE OF ALASIQto THE DHEP DOES THIS AS A COURT]~SY TO PURCHASERS OF HOMES AND
THEIR Ij?.NDING INSTITUTIONS iN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE=~
MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. TP~ MUNIC!PALII~f OF ANCHORAGE IS NOT RESPONSIBLE FOR EI~XtORS
OR OMISSIONS IN THE PROFESSIObb%L ENGIb~ER'S WORK°
(DItEP SEAL)
RR4/e~/D18
[Page 2 of 2]
7-.19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAAi
CHECKLIST - FEBRUARY 1984
Leaal Description:
If A, B, c~ C, D.E.C. Apppg~ve )
Date Completed ~/~ Yield
~/~ DeDth of Grouting..
Well Classification
Well Leg P~esent (Y/N)
Total Depth p/~ Cased to
Static Water Level
Casing Height Abo~ Ground
'Electrical Wi~ing in Conduit (Y/N)
Separation Distano~s f~c~ Well:
To Septic/Holding Tank on Lot /~
Pump Set At
Sanitary Seal on Casing (Y/N)/~
... Depression Around Wellhead (Y/N) ~.
; O~ Adjoining Lots /~/~
To Nearest Edge of Absorption Field on Lot /~(~3' ~) ; On Adjoining Lots //~
To Nearest Public Se~ Line /~//~- To Nearest Public Sewer
Clean°Ut/Manhole p/~ To Nearest Sewe~-~ervice Line on LOt ~/~
Wate~ Sample Collected By ..
Wate~ Sample Test P~sults ,
B. SEPTIC/HOLDING TANK DATA
Size /~ 3~t/ .. No. of CQ,%3a~tments ~
Air-tight Caps (~) Foundation Cleanout .~./N)
Separation Distances f~om Septic/Holding Tank: /
To Water-Supply Well
To Property Line t~ ,.,
TO Water Main/Service nir~ ~.,/~
Co~n~
/
TO Building Foundation ~i~
To Disposal Field ~ / ~
To Stream, Pond, Lake, c~ Major Drainage
Receipt ~
Date Paid:
Amount: L.%~
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD E~TA
Soils Bating in Absorption Strata
Date .Installed
Width of Field
Square Feet of Absorption A~ea
Depression over Field
Results of last Adequacy Test
Type of System Design
Length of Field o,~-'/
/
Depth of Field
Gravel Bed Thickness'
~ Standpipes P~esent
Dete of last Adequacy Test' ~/~
Separation Distance f~om Absorption Field:
To ~ater-Supply Wall /~--~ .~2 To P~operty Line 5--
To Building Foundation ,~o~¥ ~ To Existing or' Abandoned System cn
Lot //~ ; On Adjoining Lots ~ ~g? ~
To Water Main/Service Line //~ To Cutbank(if present)
To Stream/Pond/Lake/or Majo~ D~ainage Course
(
TO D~iveway, Parking, Area, or Vehicle Storage Area /~
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" level at
High Water Alarm level at
Tested for
Electrical Codes (Y/N)
Cora~nts
Dims=ions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles c~ing Adequacy Test.
Meets MOA
Check Permitted Bedro~a Rating Against HAA Request
I certify that I have checked, verified, or ccnformmd to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed ~ ~ Date
Company /~-(?d~ ~'~ MOA NO.
KB1/dL/s
[Page 2 of 2]
2-15-84
D~PTo O~ ~N¥1RO~MENT/~L ~ONSERV/~TIO~
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "EI' STREET, SUITE 303
ANCHORAGE, ALASKA g9501
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
PWS I.D.#
To Whom it May Concern:
According to records on file in this office the ]%~X~/FZL~
~l~ q Water System is in compliance-with the State Drinking
Water Regulations
Sincerely,