HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 7 LT 3
Municipality of Anchorage Page / of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ,.~ L,~ c/' '~ O '--,L~ Z_. PID Number:
r~e.-.~ ~ ' ~ ~ ~ ~~ Wastewater System: "~w D Upgrade
~ ~ ~.~ ~~ ~ ABSORPTION...FIELD
~ ~ Deep Trench D Shallow Trench ~Mound ~Other
Township Ran~ Section F,II added above o~gmal grade Gravel length
WELL: ~w D Upgrade G~v~, w,alh /~ Ft. Number el hnes. D,~lance~b~lw~n hnesFi
Class,hc.t,on (Privale, A,B.C): Total D~Tr Cased To Total absorphon area:
GPMI Ft Ft
SEPARATION DIS'rANCES 3 s~,~,~
Surface ~ ~
S~ze ~n gallons. [ Manulacturer'
Ourtain ~ Pump Make & Model Electrical Inspechons peHorme¢ by'
Location and Description
, / , ENG1NEER'~EAL
Inspections performed by: ~~ Dates: 1 st/W-~ ~It~v,
Department
Reviewed and approved b . _ te:~/'/~l
72-0t3 (Rev 9t91) MOA 25
Perrnit No. ~ ~,,) ~ ~ (~ ~'? Z-~ 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
59.7
47.0 ~
--4
WELL LOG
Date Drilled:
Static Water Level
Draw Down ~/A
3-25-94
10 feet
feet
Lot 3 Blk, 7
Rj ye~;iew Est.
Gallons Per Minute
Total Feet of
50¸ -
.Type Ma.tBrial Drilled;
0 feet to 5 ft, Overburden
$ ft, to
10 ft.
to
10 fi, Gravel
15 ft. Clay & Gravel
15 ft, to 25 ft. Gravel w/water
25 ft. to 40 ft, Gravel w/Sand__
40 ~t to 45 ft. Rock w/little water
45 ft. to 50 fi, Water alld Bedrock,at 50
RECEIVED
MAP, '& 1 1994
Municipality ot Anchorag. e
Dept. Health & Human Serwces
Municipality of Anchorage Page Z~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: .~i ,~",°~?'~")U\C~ ¢'~ PID Number:
Name: ~~_ ~, ~. Wastewater System: ~New ¢ Upgrade
Ad~: ~ ~O~ ~(,,~ % ~¢'.~ ~¢, ~fl,5~ ABSORPTION FIELD
Phone: No of Bedrooms. ~ Deep Trench ~ Shallow Trench ~Bed ~ Mound ~ Other
LEGAL DESCR IPTI ON so, Rating: /. Z~ GPD/Sq. Fh Total Depth from originalt, 0'grade:
Subdivision: Depth to pipe bottom [~rade: Gravel depth beneath pipe.
Township: Range: Section: Fill added above original grade: Gravel length:
Z,% rD '~ Ft. ~ I Ft.
WELL: ~ Upgrade ~ve~w~dm: N.mb~ro~mes: O~s~.~
Clas~ication (Privale. A.B.C): Total Depth: Cased To: Total absorption area: Pipe material:_~(E..
Dste installedh i
Driller~ ~ Date Brille¢: Stetro Water Level: Installer:
Yield: I Pump Set at: ~/ / Casing ....
~g~, ~o~ ~o~: TANK
SEPARATION DISTANCES u Septic ~ Holding ~S.T.E.P.
To Septic Absorplion Lift Holding Pubhc/Pdvate Manufacturer: ~ Capacity in gallons:
From Tan, Field . . Station Tank S ..... Lines ~W~. '~ l/_.~CO
Number of Compartments:
· . ¢ I Material: ~'
w~, /DZ-' ~12~~ ~
Surface ~ I
Water WOO '~/o~ ~/0~.'_ ~¢ ~/o0 LIFT STATION
Lot ~ ~ I ~ I Size in gallons: Manufacture~
Line /~ ~ ~ I0 ~ ~_~ ~. lt~t~] E~ ~
Foundation ~ ~ ~1 ~{ ~ ~ ~~"P(i~p on" leveh ~¢a. · O. [I "Pump off" level~at:ll I[ High~watertl alarm at:
pump Make & Mode~ Electrical Inspections performed by: __
CurtainDrain /~A ~)~ ~A ~J~ ~ ¢/-¢2~-¢,1_/~a ~*./~
Remarks: ~6TO~'F/L~- .~c. BENCH MARK
Location aRd Description:
[Assumed Elevation:
ENGIN~ER¢S SEAL
''-'::':.: r,, ...... f:~
Inspections performed by: · Dates: 1st / / r :: ~:%~, '
Department ot Health/~fid~ ~Om~ B~(viees appr~ual ~, ..... ~:~ .~ .,"~ . . :
Reviewed
and
approved
72-013 (Rev 9/91) MOA 25
Permit No.
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
· DRIVEWAY
50.7
PlO No.:
' 47.0
Permit No.
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
0.~0=- Feb, 14. 1~4 ~l: i4 HFI F~Ji
From : ALPINE DRILL 907 345 '~ m
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF WATER
WATER WELL RECORD
LOCATION OF WELL .. .... , ....... , .......
BOROUGH SUBOlVtI~ION , LO? BL[)CK ~ECTION QYR$ SECTION TOWNSHIP RANGE ME.DIAN
Os Ow
DEPTHS M~SURED FROM:~asing top ~g~ound surface ..... WELLDepth DEPTH:of hole: ~ ~ ft DATE OF COMPL~ION. ~
i Material Ty~e and Color From ......... T° ..........
M~HOD OF DRILLING: ~ air rotary ~ cebte tod
: ...... USE OF W~LL= ~domestic ~ irrigation ~ monitor
WELL INTAKE OPBNING TYPE: ~ opan Bnd ~ screened
.............. ~perfor~tod ~ open hole
Depths of openings: ___~ ~ tO ~ft
~ 80REEN TYPE: ~ Diam: ....
~ Slot/Mesh Size: ........ , Length: .....
Vo ume used;.,, Depth to top:
Oept, Health & Human Se v~%~k GROUT TYPE; Volume:
~ ~- Depth: from ft to _ .ft
~ '~ _~ ~ ft ~ftor ~ hfs pumplng~gpm
PUMP INTAKE DEPTH: ft Horsepower:
WELL DISINFECTED UPON COMPL~ION? ~ YES ~ NO
CONTRACTOR INFORMATION: ,, REMARKS~
Hc~tst~/l~d ~u~ine, ss ms,/nc ~ // PLEASE MAIL WHITE COPY OF LOG TO:
?~';6r~atur8 of A~hori~ed Re~pres~tative PO BOX 772116
EAGLE RIVER AK 99577.2116
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
March 24,
1994
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL iNSPECTION
& FLOW TEST
SITE pLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SiTE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 3; Block 7; Riv~rview Estates
RECEIVE/;)
MAR 5 1934
Municipalily of Anchora- e
Def~t, t]ealth & Human SerVices
S & S Engineering performed design and engineering of the on-site
wastewater ~isposal system constructed on the reference property.
Specifications provided by S & S Engineering were made a condition of
M.O.A. permit #SW 93092 dated 11/23/93 and required inspections/
documentation of the system when constructed.
The owner contracted with an excavator to perform the work as outlined
in our specifications and plans, however S & S Engineering was not the
owner's representative and did not inspect the contractors activities.
Therefore, S & S Engineering shall have no liability to the owner or
to others for acts or omissions of the contractor or any other persons
performing work on th~ project, or the failure of the contractor to
carry out the work in accordance with our construction documents.
If you require additional information please contact us,
~ENCLOSURES
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, ALASKA 99524
March 19, 1994
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Attention: Robbie Robinson
Subject:
Lot 3, Block 7, Riverview Estates
Notice of Violation No. 4439
RI/C[IV D
MAR ~ ?. 1994
i) IVtu~icipall~y of Anchora,-,,,,
Neal/h & Human
Dear Robbie:
We were asked by Whitters Excavating and Landscaping to perform
the inspections and as-built certification for the septic system on the
subject lot. No mention was made of staking the well location. We,
therefore, did not accomplish this activity. The well location was
apparently staked by either the developer of the property or the
well driller. In any case, it was not placed at the location shown on
the permit and is in the process of being moved. It is unfair,
however, to hold me responsible for the misplacement of the well.
As you know the Municipal Ordinance requires two inspections
performed by a Registered Engineer during construction of the septic
system. No mention is made as to layout of the system. This activity
is almost always performed by the excavation contractor. Normally,
the system is completely laid out and excavated prior to the first
inspection. In this case, we were not even notified to perform the
inspection until the system was laid out and excavation was
complete. Upon arriving onsite we reviewed the design which had
been completed by S & S Engineering. The layout and excavation
appeared to be in conformance with the design.
We then reviewed the sizing of the pump and the sizing and number
of orifices for the pressure drainfield. This review was completed in
accordance with the design standards furnished by Orenco Systems,
Inc., the manufacturer of the proposed pump. Our review indicated S
& S had specified too many holes per lateral to achieve a minimum of
3' of pressure at each orifice. Their configuration allows for less than
2' of pressure. We, therefore, determined only 7 openings per lateral
were required.
Dept. of Health & Human Services
March 18, 1994
Page Two
We did change the design, but only because it was absolutely
necessary. A change of this nature is based entirely on engineering
calculations and system requirements. Since I am required to certify
the system as constructed and am liable for the finished product I
should have the freedom to alter the system as I see necessary as
long as these changes do not conflict with the Municipal Ordinance
governing onsite septic systems. A Notice of Violation in this case
hardly seems justified.
Calculations concerning the spacing of the orifices in the laterals for
the drainfield are attached for your review. As you can see, the size
of the drainfield lateral, whether it be 1" or 1-1/4" is of no
consequence in evaluating and sizing the pump. I have also included
certified calculations indicating the size and spacing of the orifices in
the drainfield laterals. Once the well is moved to the proper location
a new as built will be submitted indicating the proper location.
Please let me know if you have any questions or comments.
Sincerely,
Michael E. Anderson, P.E.
HCLL 'P~aH ~!tuet~XCl 1~1o£
SHEET NO. OF
CHECKEO BY DATE
SCALE
SHEET NO. OF
OATE
200.00
I00.00
0.00
0.00
5.00 t0.00 15.00 20,00 25,00 30.00 35.00 40.00 45.00 50.00
NET DISCHARGE, GPM
~ORENCOSYSTE'I~iS.i',IN~ ~J ~28,26 COLONIAL ROAD ROSEBURG, OR97470 (503) 673-0165)]
Torn Fink,
Mayor
] un[cipal ty Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
March 10, 1994
Michael E. Andersoh, P.E.
Anderson Engineering
PO Box 240773
Anchorage, Alaska 99524
Subject: Notice of Violation(s) #4439
Lot 3 Block 7 Riverview Estates Subdivision, PID #050-791-03
Notice of Violation(s) ~4440
Lot 14 Block 8 Riverview Estates Subdivision, PID #050-792-45
Dear Mr. Anderson:
On the two above referenced lots, your company was contracted to
provide engineerinq services for the installation, inspections,
and submittal of as-built drawings. On each of these lots, a
specific design was submitted by another engineering company and
both designs were approved and permitted for installation by
this office.
In both instances, changes or modifications were made to the
approved design without obtaining approval from this office, and
without submitting a revised site plan and design under your
engineering seal. Under the terms and conditions of the subject
Notice of Violations, the below listed discrepancies must be
corrected:
Lot 7 Block 3 Riverview Estates Subdivision
1. The well serving this lot was completed at a location
approximately 140' west of the approved site. The well
must be properly abandoned and re-drilled at the
approved site and so reflected on the as-built drawing
and attachments with appropriate setbacks shown.
2. The approved and permitted drainfield design specified
1" diameter lateral distribution lines with ¼" diameter
holes (10 per lateral) spaced 1.4' oc. Your as-built
shows the distribution laterals to be 1¼" diameter with
no hole size or spacing indicated.
Anderson Engineering
March 10, 1994
Page Two
Calculations ~ust~be provided which show how the hole
size and spacing was determined and the as-built must
reflect the correct hole size and spacing.
Lot 14 Block 8 Riverview Estates Subdivision
1. The approved and permitted design for the absorption
field on this lot specified one wide drainfield 79'
long, 5' wide, 4' deep with 2' of effective gravel.
The primary drainfield was to run east to west
approximately 125' south of the road ditch. The
alternate site was located apprximately 15' north of
the primary drainfield. The 30' effective radius of
test holes #1, 2 covered both the primary and alternate
drainfield sites. A recent site inspection by this
office showed there to be two dr&infields (instead of
one) one of which was approximately 30' from the
cutbank at the road drainage ditch. This office was
not contacted regarding this change in the approved
design nor was a revised design criteria and site plan
submitted under your enqineering seal. You must submit
your revised sfte plan showing the location of the wide
drainfield, the location of any new test holes, setback
from slopes, and any other changes made in the original
approved design.
By not later than April 15, 1994, your must provide this office
with site plans and design criteria, with your engineering stamp
affixed thereto, reflecting the changes and revisions described
above.
If there are any questions, please call our office at 343-4744.
rely, _
Civil Engineer
On-site Services
RWR/ljm
CC:
John Smith, P.E.
Program Manager
On-site Services
/~-- PAGE lOFt-
MUNICIPALITY OF ANCHORAGE //~
DEPARTMENT OF HEALTH AND HUMAN SERVICES/ ~,-
P.O. BOX 196650, 825 "L" STREET, ROOM 503
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930492
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:ALASKA USA FEDERAL
OWNER ADDRESS:P.O. BOX 196613
ANCHORAGE, ALASKA 99519-6613
DATE ISSUED:il/23/93
EXPIRATION DATE:il/23/94
PARCEL ID:05079103
LEGAL DESCRIPTION: RIVERVIEW ESTATES BLK
3
7 LT
LOT SIZE: 40000 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: ~ [_~kJ .
DATE:
DATE:
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
November 15, 1993
CIVIL ENGINEERS
(907) 694-2979
FAX 694-'1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipafity of Anchorage
DEPARTMENT OF HEAL TH AND HUMAN SERVICES
825 'L ' Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Riverview Subdivision, Block 7, Lot 3
Request you issue a permit to drill a well and install a septic system to
serve the proposed three bedroom house on the referenced property.
A test hole was excavated and percolation test performed. The approximate
location of the test hole is located on the attached site plan. At the time of
excavation water was encountered at 6.5 feet and after seven day water
monitoring waster was found at 6 feet.
This property has enough area for a future septic upgrade which can be seen on
the attached site plan. We do not anticipate any adverse effects on neighboring
properties by the installation of the proposed septic system.
If you have any questions, or require additional information for your review,
please contact us.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
k
o d ~
Z
O0
10' UTIL. ESMN?.
RIVER PARK DRIVE
NVqd IllS
ON-SITE WASTEWA TER DISPOSAL SYSTEM
CONS TRUC TION PRA ¢ TICES
and
MA TERIAL SPE¢IFICATIONS
REFERENCE: Riverview Subdivision, Block 7, Lot 3
GENERAL:
The scope of this project includes the/nstaftation of a 1250 gallon septic
tank effluent pumping (S. T.E.P.) system and a pressurized absorption bed
to serve the three bedroom residence located on the referenced property.
Construction shall be in accordance with the approved site plan and design
dra wings; Municipal permit with any special provisions or conditions; and afl
applicable State and Municipal Wastewater Disposal Regulations.
The contractor shaft be responsible for obtaining any necessary
underground utility locates.
Un/ess specifically agreed otherwise, the property owner shaft be
responsible for final grading areas subsequently depressed from soft
settling. On afl leachfield mound systems, the property owner shaft be
responsible for ensuring a satisfactory vegetation growth over the mounded
area.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing
their own systems must also receive prior approval from the Municipal
Health Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shaft include two 4" cleanouts for pumping access.
The septic tank shaft be sufficiently bedded to prevent settling or shifting of
the tank.
Ali standpipes on the septic tank shall extend a m/n/mum of 12 inches
above final grade.
Page two
Riverview Estates Subdivision, Block 7, Lot 3
November 15, 1993
4. Septic tanks installed with less than 4 fl. of cover shall be insulated.
A foundation cleanout shaft be installed one to four feet from the building
foundation. In the line between the tank and the leachfield there shaft be
two adjacent o/eanouts (unless an effluent pumping system exists within the
septic tank). These cleanouts shaft be located on undisturbed soil not more
than 10 fl. from the tank. The first cleanout, in line, shall be to clean toward
the leachfield. The second cleanout shaft be to clean toward the septic
tank.
Final grading over the septic tank shaft be such that a positive s/ope exists
away from the septic tank.
PRESSURIZED MOUND SYSTEM INSTALLA T/ON:
1. Any peat or organic matter must be removed from the elevated mound site.
The bottom of the basal bed area as weft as the top of the sand filter is to
be within two inches of level.
The distribution piping is to be of PVC (ASTM D3034 or equal). Afl joints
are to be solvent cemented.
The side slopes of the top layer of the mound system must not be steeper
than 33% (3:1).
The top of the mound shall be covered with a m/n/mum of 6 inches of
topsoil and vegetated sufficiently to prevent erosion.
The distribution pipes are to be embedded in sewer rock. Care should be
taken to backfill in such a way as to prevent damage to the piping system.
Silt barrier material must be installed between the final gra vel layer and the
native soil backfill. Ensure the silt barrier covers the entire gravel surface
before placing backfill.
Backfill over the final gravel layer must not be less than twenty-four (24)
inches. Insulation must be installed when the backfill depth is less than
thirty-six (36) inches.
Page three
Riverview Estates Subdivision, Block 7, Lot 3
November 15, 1993
MINIMUM MA TERIAL SPEClFICATIONS:
Any septic tank proposed for installation must be constructed by a
Municipally approved septic tank manufacturer.
The following pipe materials are approved for use in septic system
installations in the Municipafity of Anchorage:
Tvpe of Pipe Perforated Solid
Cast Iron Yes
ASTM D3034 (PVC) Yes
ASTM F810 (HDPE) Yes
ASTM D2662 (ABS) Yes
Yes
Yes
No
Yes
Use of a type of pipe other than fisted above must be approved by the
inspecting engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Company Styrofoam HI or equal).
Septic tank inlets and out/ets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
A permeable nontoxic silt barrier (Typar 3401, M/raft 140N, or equal) must
be installed between the final leachfield gravel layer and the native soil
backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with
less than 3% passing the #200 sieve.
When sand is being used as a filter mater/a/, it's gradation specifications
must conform to current M.O.A. or D.E.C. requirements.
Page four
Riverview Estates Subdivision, Block 7, Lot 3
November 15, 1993
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the
installation of the wastewater disposal system. These inspections will occur as
follows:
The first inspection must be conducted after the excavation of
ditches, pits, trenches, er beds and before the installation of any
gravel. A septic tank may be set in place, but may not be backfilled
before this inspection.
The second inspection must be conducted after the placement of the
silt barrier, gravel, distribution lines, standpipes, cleanouts, and
insulation, but before the placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the
instal/at/on of multiple trenches, sand filters, pressurized distribution systems, etc.
Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start
of construction. If necessary, a pre-construction meeting will take place on-site.
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
DATE
Township, Range, Section:
SLOPE SITE PLAN
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20-
WAS GROUND WATER
ENCOUNTERED? .
/~-~
S
IF YES. AT WHAT ~'¢5! pO
DEPTH?
E
Deplh lo Water AIler ~;
MonJtorino? [}ale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
: ~fl ~ " ~'be I '1~ "
PERCOLATION RATE ,,~' (minutes;tach) PERC HOLE DIAMETER ~ ~
TEST RUN BETWEEN T AND ~ FT
COMMENTS Jcf/',~!~-- ~r'/:::~-~0 ~ ~ ~ ~ S~.
~0~4 EagJe~eF Lo~ "o,, No. 2~ i~~OER,IFY THAT THiS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL CT ON THIS DATE. DATE:
72-008 (Rev. 4/85) STYE ~D ~NI~AL ~I~LI~S~
DEPAFI'rMEN-I- OF HEALI!I AND ENVIIiO['qMENTAL PROTECTION
Permit !~: 840055
January 31, 1985
TO: Permit Applicant
SUNJECT: Lot 3 Block 7 River View Estates SubdivAsien
A permit issued by this Depart~nt for an individual well
and/er on-site sewer system has expired as of December 31,
1984 .
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date°
If you have drilled the well, a well log needs to be sent
to this Department for documentation ef the installation
and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as-built inspection report
and the yellow copy must be sent to this office for review
and approval, and for documentation.
If there are any further questions, }please call this office
at 264-4720.
Sincerely,
Keith E. Bandb, SupeYvisor
Environmental Engineering Program
KEB/AjW
enc: Copy of Permit
SWP/057
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]: E:IEI:,;:'I' ]: F:"T' 'l"Hl:::l"l":
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I':OI:;.:TI-I EJ"!" 'l"l-lE f"ll...IJ'-,l :[ C: ]: I:::'l::iL. ]: 'i'TT' (3[:' I::II",tE:H(.)I';irI:::IEiE ,:: HOF::I ::, I:::IF,IE:, TH[:7. '.'~T, TI::IT[:'~: O1:--
2. :[ I.,.I];L..L. ]:I",I:i.~;TFiL. I... 'T'l-'l[i~: :i~;'¢E¢'TE:!'"I '1:1",1 F:IC:E:Cq:'~'.DFIi",tI:.::E; .L,.!ITH F::IL..L. I"ICiFt CODE:F..; I::II",tE:, F;'.EGLII.J::I'T'IOt'.,!!ii;.,
I::ll",t[.':' :t: I",l (:::OI"tF'!.. :[ I:qI",IE:F~: I.,.1:1: TH THE [::'Ei::5 :[ ~:~il",l E:R .T. TEI:~:: .'( F:l 01:::' TH :[ :i-:; PE:I:;i:I'"I :[ %
:!!:. ]; H].'LI... I:":'IDHFZF,;!E!: TEl I:::ILL. I'"IOF:! I:::II",tE:, ?I'FITIE CII::' I::ILFI:5t':::I:::I I:;;:EE:¢...I:[[;~:L::HEI'-,IT:!i; I-:'CffT..: THE: ~;ET
[':' ]: :5'l"l::'li",ll::::[~::i~; I::F;i:Cq"I F:li",h" E!:;:':: :J: :~:;"1" :i: HG 1.41iii:L.L.,, I'.IFIE:;TIEI.,.II"ZlT[i~I:;i'. E:' :[ :':~;I:;:'0:51::IL. :ii.:;'¢:E;'T'EI"'I CiF;: F::'LIE;L. Z C
~i;E:P.IIEF',i:I:::IE:iI:~: :E;"¢:!i;'Fi~:H Oi",l Tl'l ]: :!!i; O1',~: I::lJ",l"," I:::IE:,.:h:i(.':E!]",IT OF:: l",!E~F::lJ:;;'.!ii!Fr' L.CIT.
4. ]: I...IF, I[>[:::I::i::~!;'t"I:::II'-,I[::, 'T'HF:FF 'I'H :[ :!:~; I::'[!:.'F]'.i"t :[ T ]: :5 'v'F:iL. :[ i::' f::'(]~;;: F:I I"11:::I::':: ]: I'dLIl"l 01:::' :.~i: E:E[:'F.:OE)i'"ILE; FINE)
I::]J",t':," Ei:I",II....F:II:;i:I.~i[E.I'"IIEF,IT !.,J Z LI... I'('.E(;:!U :[ J":'% I:::I1'.,I FIE:,[> :[ T :[ E~htI::iL. F:'EF.'ff'I :[ T.
December 21., 1983
sub.]{~ct: Errox's on ilandwritten Permits
have dis;cover'od calculation errors on J~ive permit,'-; issueci l;o
I.oL .t4, Block b, t{iv~rview Estates
[.ot b, Block 7, Riverview Estates
hot %, i%].ock 7, kiveuview I.;states
/,oi: 3, i~lock '1, Rive}rv:Lew Estates
Lot
~5 I nCC rOI y ~
Soi/ej/l)L0
Department ' Health and Environmenta- rotection
825 ~ Street, Anchorage, AK. >J501
264-4720
~,~/~~L)'~''~ * * * HANDWRITTEN PERMIT * *
Permit # WELL AND/f~ ON-SITE SEWER PERMIT
Applicant: ,~_, X/D~f Mailing Address:
Location: Phone Number:
Legal Description: ZDi ~ ~/~ 9 ~&~IF~ ~r Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed: ~/ Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) _
The Required Size of the Soil Absorption System Is:
DEPTH ~' ~-/ &~YP/~£~/~
LENGTH /~'~ . GRAVEL DEPTH " .~ ,
A,Z',~,,'~ WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HeL--D~-NG) TANK SIZE = /~ GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without'final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 1 9 8 3 * * *
I certify that:
(1 I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2 I will install the system in accordance with c~des.
(3 I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3, bedrooms. / /
SWP/024 (1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER
ENCOUNTERED?
DATE PERFORMED: /- ~'q
SLOPE SITE PLAN
IF YES, AT WHAT E
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
COMMENTS ,....~,~/~-
PERFORMED BY~ ' /~~~
72-008 (6/79)
(minutes/inch)
TEST RUN BETWEEN FT AND -- FT
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
1. GENERAL INFORMATION
Complete legal description
Lot 3; Block 7; Riverview EStates
Location (site address or directions)
NHN Riverpark Drive
Eagle River, AK
, Property owner Barry & Lisa Jones Day phone 696-0585
Mailing address HC85 Box 9318 Eagle River~ AK 99577
Lending agency
Mailing address
Northland Mortgage - Donna Nail Day phone
Agent
Address
Dave Bailey/ Remax of Eagle River
Day phone
694-4200
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
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.
72-025 (Rev. 1/91) Front MOA #21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm s & $ ENGINEERING Phone ~'¢)
17034 Eagle River Loop Road No. 204
Address E-*- g ~J~,~. A ! ~ ;_~ ~
Engineer's sig natu re . .~'-)/..~,7/'r~
/'~'~'' / ...... ~ Date
DHHS SIGNATURE
Disapproved.
Conditional approva~ for
bedrooms.
bedrooms, with the following stipulations:
By:
Additional Comments
·
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA ~21
MUNiCIPALI'f¥ OF
~NVII~ONMENTAL SERVICES DIVI~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES StP ~ 5 1~)96 L.~..~
Environmental Services Division
825 L Street, Room 502. Anchorage Alaska 99501. (907)_,~~ rED
Health Authority Approval Checklist
Legal Description: L:*'F'~ ~5~,iL 7 ¢tq¢_¢~.11~,.,( ~¢~- Parcel I.D.:
A. WELL DATA
Well type t~L&
Log present(Y~'N) "'l Date completed
Total depth
Sanitary seal ~N)
FROM WELL LOG
If A, B, or C, attach ADEC letter. ADEC water system number
Casing height (above ground)
Wires properly protected~-~N) ~
AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
g.p.m.
Coliform ~-) Nitrate
Date of sample:
/,~ ~? Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed /;-'~ -'~'~ Tank size /~,$-b Number of Compartments ,~ Cleanouts,(~/N)__,-/
Foundaton cleanout~'N) \/ Depression ('~_.)) ~ High water alarm (Y/N) '
Date Of Pumping ~' / ~ ~,~/~,~ Pumper -,/_~/?
C. ABSORPTION FIELD DATA
Date installed /P- ~?. ~' Soil rating (g.p.d./ft
Length ~-~ ] ~ Width /~ ~ Gravel thickness below pipe
Effective absorption area ' ~2 ~ ~/"
Date of adequacy test
System type
Total depth
Monitoring Tube present ~(JN)___k~ Depression over field (Y~.~
~'~/)/- ~ b~ Results~(~_~/Fail) ~/~'S For
Fluid depth in absorption field before test (in.);
Fluid depth ~ (ins) Minutes later;
Peroxide treatment (past 12 months) (Y~)'?
Immediately afterL~-?" gal. water added (in.):
Absorption rate z'f/,_~--~ "/~
= .g.p.d.
If yes. give date
bedrooms
O"
72-026 (Rev. 3/96)*
LIFT STATION
Date installed
Manhole/Access {~J)
High water alarm level at*
Cycles tested ~
E, SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum
12- 5 ~
"Pump off" level at* /O'.S- ' '
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line -¢¢ 1'/~
On adjacent lots
/,/
On adjacent lots /oo
Public sewer manhole/cleanout ¢"'//~'
Lift station /~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation __ , ~' ~ / 4- Property line ,.~z/"
Absorption field
· Water main/service line /z) //- /~
Surface water/drainage /~ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line //~ i Building foundation ~'¢ / Water main/service line
Surface water lo-~ t~ Driveway, parking/vehicle storage area
Curtain drain 'd/vt- Wells on adjacent lots 1~
ENGINEER'S CERTIFICATION
Engineers Name
/
Date
HAA Fee $.
Date of Payment
72-026 (Rev, 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
CT&E Environmental Services Inc,
Laboratory Division ~~'a~~f~f~~~'~'~J
200 W, Poller Drive
Anohorage, AK 9951B-1605
Tel: (907) 562.2343
Fax; (907) 56q-5301
CT&E Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
FWS1D
9646590O [
S & S Engineering
Lot 3 Blk 7, Riverview
Lot 3 Blk 7 Riverview
Drinking Watcr
Client POP/
Printed Date/Thne (19/23/96 12:12
Collected Date/Time 09/16/96 09:45
Received Date/Time 09/17/96 09:15
Technical DIrecto¢: Stephen C. Erie
Released By ~ ~.
S~unple Remarks:
Peremeter ResuLts P~L Units
Nitrite~N O,IOOU 0.100 mg/L
N~trate-g 1.Z7 0.100 m§/L
Tota~ Coliform 8 ob w/o co[i
Allowable Prep Analysis
Method Limits Date Date Init
SMI8 4500-M03~ 09/18/96
$M18 ~500-~o~F 09/17/96
$M18 9222B 09/17/96 TAV
i~r~ Member of the $G$ Group (Soci0t6 G~n6ralo de Surveillance)
ENVIRONMENTAL FACILITIES iN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
DEPARTMENT OF HEALTH & HUMAN SERVICES
' ' ' Division of Environmental servides
' - :-,; ,', ' , On-Site Services Section
r:./,_,. ~ P.O. BOX 196650 ' Anchorage;: Alaska ;g9519;6650
:' .., . , · 343;4744 .~ ., :~-- .~ ......
' '"''
...- CERTIFICATE 0F
r ~, . ; ~ ;' ' APPROVAL FOR A SINGLE FAMILY DWELLING
. Parce~l I.D.# __. ~--~-~) - ~7~/~'~,...? HAA#" \~Ol~
,~ ':':/i."; GENERAL INFORMATION
.... "" Complete legal description ~-?T; ~/
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
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 Stat~ A,D, EC attest!; '~.
lng to the legality and status'o'f:~bte~ ..... ~" .... '~
TYPE OF WASTEWATER DISPOSAL: ' - . ,':
Individual on-site )~.L x. '
Holding tank · .. .T
Community on-site . . :-:'.
Public sewer
NOTE: tf community Wastewater system,, provide written confirmation from State ADEC '.-.
attesting to the legalitY'and status of ~ystem.
72-025 (Rev, 1/91) Front MOA ~21
STATEMENT OF INSPECTION BY. ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of tills 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.
Address
' Engineer's signature
Phone
,,flit
Date
DHHS SIGNATURE
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
' "" AddiiJonal Comments
-,,,..
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
.:: i ::'q 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
i.:"ii''r/": ": :.'resPonsible for errors or omissions in the professional engineer's work.
72-025 (Rev, 1/91) Back MOA #21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing height
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
/
Septie/t~:~Btank on lot ~ //8
Nitrate
Absorption field on lot
Public sewer main
Sewer service line
-~ /?...~, ,'
WATER SAMPLE RESULTS:
Coliform o
Date of sample:
B. SEPTIC~=t~N6 TANK DATA
Date installed t'2.~/Z.'~/~):~. ,.
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Wires properly protected (Y/N)
AT INSPECTION
g.p.m. .g.p.rr~'
; On adjacent lots
/
; On adjacent lots
Public sewer manhole/cleanout ~,/~
Petroleum tank ////~--~
7//-- Other bacteria
Collected by:
Tank size // 2.-,.~-o ~;./,~'~/~. ~ Compartments
Foundation cleanout (Y/N) ~'~ Depression (Y/N)
Alarm tested (Y/N)
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~//~ ! On adjacent lots
To property line Absorption field /~.,
Surface water/drainage .->' /~2~:~
Foundation
Wat e r 4:¢,ak,~/se rvice line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
/2.-
Vent (Y/N) ~' "Pump on" level at
High water alarm level ~
Meets MOA electrical codes (Y/N) )Y
M an u fact u re r _/,,¢/v/~_~
Manhole/Access (Y/N)
"Pump off" Level at ¢/"
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot //~f On.adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed /2-'//2-.--/- ~' ~"//~
Length -~.-/' Width
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF)
/,~ ~ ,,
Gravel thickness.
..~7~ ,~,~T. Cleanout present (Y/N) .
_ ~'""'~' Results (pass/fail)
System type '~"-~
Total depth /
Depression over field (Y/N)
for ~
After test
If yes, give date
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot .~ /~.~'
To building foundation
On adjacent lots
Surface water .-~ /o~
Curtain drain /~/~"'~
On adjacent lots ~' / ~Z2 Property line
To existing or abandoned system on lot
Cutbank ,A'//~ Water-mci~,'service line
Driveway, parking/vehicle storage area ¢/,~"
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA gu/defines in ¢ffect on.the date of this inspection.
Engineer's Name
Date
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
CT&E Ref.#
Client Sample ID
Matrix
ClientName
Ordered By
Project Na]n c
Project#
PWSID
Commercial Testing & Engineering Co.
Environmental Laboratory Services L~~-~z/~?z/~z,~''-/z;~:×z/'-~'~'z/z/zez/z'~jz/zTz/'~
LABORATORY ANALYSIS REPORT
94.1311-1
L3 B7 R[VERVIEW ESTS. SUBD.
WATER
ANDERSON ENGINEERING
ALAN ANDERSON
UA
WORK Order 76969
Printedl)ate 03/30/94 609:09 tu's.
Collected Date 03/28/94 ~ lu's.
Received Date 03/28/94 @ 12:00 tu's.
Technical Director STEPHEN C. EDE
Released By: ~ -~. ~
S amp 1 e Rem ark s:
SAMPLE COLLECTED BY: A.H.
QC
Parameter Results Qual
Allowable Ext. Anal
Units Method Limits Date Date hilt
Nitrate-N 4.93
mg/L EPA 353.2/300.0 10 03/28/94 CMR
* See Special Instructions Above
** See Sample Remarks Above
U = Undetected, Rcported value is the practical quantification limit.
D = Secondary dilution.
UA = Unavailable
NA = Not )malyzed
LT = Less Than
cst = Greater ~Ihan
5633 B Street, Anchorage, AK 99518-1600 --Tel: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
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 g9519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY ~'//
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA#
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Lending agency
Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: '-~
NOTE:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
If community well system, provide written confirmation from State AD£O 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 Wasfewater system, provide written confirmation from State AD£O
attesting to the legality and status of system.
72-025 [Rev. 1/91) Fronl MOA #21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authori~ 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. ~.~' ~/ ~ 0 G.2-'~
Name of Firm ~,.4~)&-'/~..SO~ ~ ~J~.'--ET/_.c,d O Phone -~¢-~/--5/-~'/
Engineer's signature ~ ~ ~c~ ~ Date Z'/l~~-/¢~/'
DHHS SIGNATURE
i~~ Approved for ~ bedrooms.
Disapproved.
Conditional approval foY bedrooms, with the following stipulations:
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 p?ofessional engineer's work.
72-025 (Rev. 1/91) Back MOA fY21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 4'%~ ~c~. ~/ 12~',~-'~.,,~l~2t,,J ~'~r? Parcel I.D.
A. Well Data
Well type -~>fl..~//'+T~- If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Y Date completed '1%- 1 ~'/ Driller
Cased to ~ 3/
Casing height
Total depth
Sanitary seal (Y/N)*/~''
FROM WELL LOG
l
Date of test
Static water level
Well flow
Pump level1
Wires properly protected (Y/N)
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot /L~ Z
Absorption field on lot ~/Z'?
Public sewer main /,v~ ~---.~
Sewer service tine '~ ~.S--'
g.p.m.
,,¢
AT INSPECTION
g.p.m.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform 4'-,~ Nitrate
Date of sample: 2%/I o/,~' ,./
/, £~-~--/ A4.~/L~ Other bacteria
Collected by: /Z¢.
B. SEPTIC/HOLDING TANK DATA
Date installed / Z~/'Z-- S/9 ~ Tank size
Cleanouts (Y/N) ~ Foundation cleanout (Y/N)
High water alarm (Y/N) '"'f/'
Date of pumping /L,[ ~ C{) ,J .%'~1~_! ~L,r'/0
-~-. ,'f-~¢~. Compartments
"J"" Depression (Y/N)
Alarm tested (Y/N) "ir/'
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /~8-~ On adjacent lots
f
To property line ~/2_..~- Absorption field
Surface water/drainage "~ / 0 0 ~
Foundation "~
Water main/service line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) Y'
High water alarm level
"Pump on" level at
¥,
Meets MOA electrical codes (Y/N) Y'
Manufacturer ,~1,- /
Manhole/Access (Y/N) kC'
,, q./"
"Pump off" Level at
Cycles tested ~'--
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot /0/~ / On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed / ~ /z ', '2 z / ~ ~
Length 2_ / ~ Width
Total absorption area ,~ ~
Date of adequacy test 4 ~"b,3
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/Ft2) /'
/~' /' Gravel thickness
,,_~. Z~ Cleanout present (Y/N)
C-8 "J ~"~ Results (pass/fail)
System type -~'~-o.,ov,J
Total depth /
Depression over field (Y/N)
for --~ Bedrooms
After test
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~ /~7_7 I On adjacent lots '~/-~-'~ /
To building foundation ~ ~ !
On adjacent lots ')' ',/-~ / Cutbank __
Surface water ~/0 ~
Curtain drain 'AC/O ~ ~-~
Property line
To existing or abandoned system on lot
/',.///~ Water main/service tine
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to ali MOA and HAA guidelines in effec_t'.'O~"[hg'¢'d~te, of this inspection.
Engineer's Name ~ '(-'~/4~-u' ~ //~-0 eL-Z'/2-'r'E~J
HAA Fee $
Date of Payment ~ ~/~.~- ? ,(~
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
7721 Schoon Street #4 . Anchorage, Alaska 99518 · (907) 522-1664 · Fax (907) 344-1778
March 7,1994
Municipality of Anchorage
DHHS/Onsito 8orvi~ Div.
825 "L" Stmot, Rm 502
Anchorage, Alaska 99519
RE: River View Estates Subdivision Lot 3 Block 7
Dear Onsite Engin~r,
We have boon made aware that tho well plac~l on tho above reforone~cl property is n~ar the West
property line and may encroach the usable septic primary and secondary available sites for Lot 2
Block 7. We shall rolo~ato tho well on tho lot to tho North East area of tho property in the interests of
allowing Lot 2 tho availablility ofonsito waste water disposal.
We request that your Department issue a Health Authority Approval on a conditional basis subject to
rosolvinE this situation.
Sincerely,
Don Blackmoro
Project Coordinator
dde/DB
SUMMARY OF BUILDING INSPECTION
Owner of record: PRESTIGE HOMES
Legal descril~tlon: LOT 03 BLK 0_7 SUB_DIVISIONR~_ver' Vzew' ]Lst.~'
'-- .... (include yocordin0 dia[rictl
Site address:
This certification issued pursuant to the requirements of Alaska Statute § 18,56.300.
1 ) ,p~PBOVAt.,3
J/"/~,.~ /~. /"//~.'.<~=~__ / DAVID R. OWENS #54406 12/08/93
Si~'nature - -g--~,.~,,, .,.~. ~.,,. ,.., ICBO ,~66 Date
2)
3)
COL'~PLFTI_0. N$ O,F E00TINGS AND FQUNDATION:
Signature ,~,'.
Signature ~.,
ICBO # 166
ICBO # 166
COUPLET!ON O~ *EL1ECTR!CAL & INSTALLATION, PLUMBING AND FRAMING';
Signgture - ~, N~ t~ ~ ~6
e (Electrical inspection may be completed by an inspector qualified under the International Association of
Electrical Inspectors as ellowed under AS 18.56.300.)
,COJ~LETION O~'/!NSTALLATION oF INSULATION:
. __
Signature ~..o.,,~., N.~, I~..,. ~.,,
ICBO # 166
5)
6)
CONDITIONAL APPROVAL:_ · /' '
[.) ~ " - ' To be Completed by:~~
~ignature -- ~.,,.~ .... ~,~ iCBO ~16~ Date ' /
FINAL APPROVAL:
Signature .;
./__DAVIr~ R ~WENS
ICBO # Date
By my signature below I hereby certify that the inspections required under AS 18.56.300
have been completed and that the building meets or exceeds the standards set forth under
AS 18.56,300.
Builder's Signature
Builder's Name~,'J "~
Name of auslness'~,~S;r-,'F~.' ' e
Address ~77L. L ~Lec~,u ~r
City, State_ ./~.~?_ .... ~ Zip
Before me. a Notary Public in and for the State of Alaska,
Builder's License
Commerg Testing & Engineering Co.
Environrnen~ ~raboratory Services
CT&E Ref.~
Client Sample ID :PRIVATE ~I~L WA'~
Matrix :WATER
R~Z[.~RT of ANALYSIS 5633 B Street
:94 066l ,1 Anchorage, AK 99618-1600
· , Tel: (907) 562-2343
L3 B7 RIVERVIEW EGT* Fax: (907)561-5301
Client Name :ANDERSON ~N~NFJERING
Ordered By :ALAN ANDENSQN
Project Name
Project~ :
PWSID :UA
Sample Remarks: 5~,)UTIHE SAM}~,E COLLECTED BY, A, HARALA.
WORt< OrdeL' :75773
Printed Date :02/14/94 @ 15:34 hrs.
Collected Date :02/10/94 @ 14:00 hrs.
Received [)ate :02/11/94 @ 11:05 hr~;
Technical
Released By
Allowable Ext. Aha!
Parameter Results Qua1 Units Method Li~tits Date Dal:e InJ~
Nit rate--N 1,5~ m9/L EPA 353.2/300,0 10 02/11 LLE
See Special Instruct:[or~,_~ Above UA = Unavai].able
See Sample Remarks Ak,(~V~ NA = Not Ana],yzec~
Undetected, Reported va~ue is the practica/ quantification limit, LT = Less Than
Seconda~:y di].~ltion, GT ,~ Greater Than
Member of the SGS Group (Soci~t~ G~n~rale de Surveillance)
ENVIRONMENTAL FACILITIES IN ~;KA, COLORADO, FLORIDA. ILLINOIS, MARY~ND. NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
