HomeMy WebLinkAboutKNOLL ON THE WOLD BLK 1 LT 11
Municipality of Anchorage Page / of. 2_'
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,d~.~¢4(~9 PID Number:
Name: Waslewater System: D New ~pgrade
Address: ABSORPTION FIELD.
-' No. of
Phone: Bedrooms: ~eep Trench D Shallow Trench ~ Bed ~ Mound ~ Other
~ -
LEGAL DESCRIPTION so, Rating: ~. ~ GPD/Sq. Ft. Total Depth from original grade:/~,
~ot: Block: Subdiv~ion: Depth to pipe bottom from original grsde: Gravel depth beneath pipe
Township: Range: ~ Section: Fill added above original grade: Gravel length:
~ Ft, ~] Ft.
WELL: U New ~1 U pg rade Gravel width: Number of lines: Distance between lines:
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: F~/~
D~te installed:
Driller: Date Drilled: Static Water Level: installer: ~
Yield: I Pump Set at: C8sing Height Above Ground: TAN K
GPMI Ft. Ft,
SEPARATION DISTANCES ~ s.pt~o ~,¢~ ~ Ho~di,O ~ S.T.~.P.
TO ~ Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~1~~
Materiak Number of Compadments:
Sudace .
~Ot 8izo in Oallons: ~
Foundation / ¢ ~ ~ / ¢ ~ ~ "Pump on" level at: "Pump off" level a~~er~
alarm
at:
Pump Make & Model
Electrical Inspections pedormed bY:
Drain
BENCH MARK
Remarks:
Location and Description:
~, Assumed Elevation:
EN61NEER'8 SEAL
inspections performed by: ~.¢e myer, ~.[, ~ Dates: 1st %Jl~Jea
Bepart~ent of Health3and ~um~Services approval/ ..... ~' .... :~'~ "'
72-013 (Rev. 9/91) MOA 25
Permit No. RW~0464 Page 2 of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
KNOLL ON THE WOLD SUBDIVISION,
Legal Description:BLOCK 1, LOT 11 PIDNo..04105147
CO1
EXISTING
· 1000 GAL
SEPTIC
TANK
D.E.C. WAIVER ISSUED
FOR 140' SEPARATION
DISTANCE BETWEEN
CLASS 'C' WELL AND
SEPTIC SYSTEM ON
LOT 10
WOOD
EXISTING lO00
SEPTIC TANK
(INTEGRITY VERIFIED)
DBL
EXIST.
ABANDONED
THAT IT MAY BE
USED IN THE
FUTURE
, FCO
SCALE 1" = 40'
72-013 A (2/91) MOA 25
C02
WELL
MT
88.4
A B
?CO 18.0 8.5
201 25.5 1%[
202 30.0 22.(
O,V. 55.5 27.(
SO3 38.0 25.~
~04 54.0 32.(
205 97.0 87.(
M.T. 88.0 77.(
TRENCH
MT C05
· 82.4' NO WATER FOUND
ENGINEER'S SEAL :,
M.nicipaiity of Anchorage ? ~
825 "L' Stroet, Anchoraoo, Alaska 00502-0~50 :"
SOILS LOG -- PERCOLATION TEST ' ~
Township, Range, Section: ': J i.; (~}
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Oeplh to Waler After
Monilorino? Date:
P
E
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __ (m~nutes/~nch) PERC HOLE DIAMETER
TEST RUN E~ETWEEN _..~____ F~ AND _
COMMENTS ,.~ ~ ~ ,_N~INEF. RING Road No. '2.C4 ~:/ /
PERFORMED BY: ~ ~~ _ CERTIFY THAT THiS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPALGUIDELIN~S~E~ONTH[SDATE. DATE:
/
72-008 (Rev, 4/85)
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930464
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:WILLIAMS LEROY C &
OWNER ADDRESS:7320 MONTAGUE CR.
ANCHORAGE, AK 99507
DATE ISSUED:il/03/93
EXPIRATION DATE:il/03/94
PARCEL ID:04103147
LEGAL DESCRIPTION: KNOLL ON THE WOLD BLK
11
1 LT
LOT SIZE: 58535 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 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:
DATE~
DATE:
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
October 27, 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 &
MECNANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipafity of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, Alaska 99519-6650
REFERENCE: Knoll On The Wold Subdivision, Block 1, Lot 11
We request you issue a permit to upgrade the septic system serving the
three bedroom house on the referenced property.
An adequacy test performed on the existing system for Health Authority Approval
purposes found the absorption capacity of the existing system to be inadequate.
A test hole was excavated and a percolation test performed in the area of the
proposed upgrade. The approximate location of the test hole is located on the
attached site plan. The monitoring tube within the test hole has been checked
and found to be dry. Attached it the proposed upgrade design.
We do not ant/c/pate 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.
Sincerely,
/~ ....
i~obert A. Shafec P.E.
RAS/LSU/Isu
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
:~ 'Laq2$ ,0!
l~Al~I(I q2AV~ID
NOI,I, VONDOA
8
0
0
0
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
(ENGIREER~S SEAL)
LEGAL DESCRIPTION: ~-~LL- (~/kJ
Township, Range, Section:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~ b
DEPTH? P
E
Depth Io Water Alter
Monitoring? Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
I0 I':1 I'>~-cc
/ l' 7-_-_-_-_-_-_-_-_-~d,,~ ~ ~ " --
PERCOLATION RATE ) ~ ' tmlnutes/mch) PERC HOLE DIAMETER
~ TEST RUN BETWEEN ~...~-'~AND ~'~ ~_ FT
rcnrun,v,cu ....... ;~.; ,.;Va, Loop Road No 2~ /////
ACCORDANC~ ~1[~i~1~PAL GU;D~L~N[:~: ~ m~ D~E ~TE:
72-008 (Rev. 4~85} ~
ON-SITE WASTEWA TER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Knoll On The Wold Subdivision, Block 1, Lot 11
GENERAL:
1.
The scope of this project includes the installation of a leachfield trench to
serve the three bedroom residence located on the referenced property and
excavation of the existing 1000 gal septic tank to verify its integrity. If the
integrity of the existing septic tank is poor the existing septic tank is to be
excavated, pumped, crushed, and abandoned in place and a new 1000 gal
septic tank installed.
Construction shall be in accordance with the approved site plan and design
drawings; Municipal permit with any special provisions or conditions; and afl
applicable State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary
underground utility locates.
Unless specifically agreed otherwise, the property owner
responsible for final grading areas subsequently depressed
settling.
shall be
from soft
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:
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shaft include two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
Page Two
Knoll On The Wold Subdivision, Block 1, Lot 11
October 27, 1993
Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building
foundation. In the line between the tank and the leachfield there shall be
two adjacent cleanouts (unless an effluent pumping system exists within the
septic tank). These cleanouts shall be located on undisturbed soil not more
than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward
the leachfield. The second cleanout shall be to clean toward the septic
tank.
Final grading over the septic tank shall be such that a positive slope exists
away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The
bottom of the excavation shall be within 2 inches of level. If the sidewalls
of the excavation become smeared, they must be raked or scratched
(ruffed-up) before gravel (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to be installed level with
the perforations faced downward. Gravel is then to be placed over the
distribution pipe to provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final grave/layer and the native
soil backfill. Ensure the silt barrier covers the entire gravel surface before
placing backfill.
Monitor tubes shall be of four (4) inch diameter and installed approximately
in the locations shown on the design. The portion of the monitoring tube
extending through the gravel shall be perforated from the bottom of the
trench to the invert of the distribution pipe. This is equivalent to the
effective depth of the gravel as noted on the design.
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 ¢6) inches. The finish grade over the trench must be mounded
to prevent the formation of a depression after settling.
Page Three
Knofl On The Wold Subdivision, Block 1, Lot 11
October 27, 1993
MINIMUM MA TERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a
Municipally approved septic tank manufacturer.
The foflowing pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Type 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 listed 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 outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 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.
7.
When sand is being used as a filter material, it's gradation specifications
must conform to current M.O.A. or D.E.C. requirements.
~ ~-~, MUNIClPALI'F¥ OF ANCHORAGE
'~" ~'~' DEPARTMENT OF HEAL'FR & ENVIRONMENTAl_ PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
[ ~ 825 L Street- Anchorage, Alaska 99501 Telephone264-4720
ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL DESCRIPTION
Manufacturer
LiE. ca }a~t~ Jrt.gal o
~ /~ IZ HOMEMADE: Inside length LWidth- Liquid depth
I
[ ~r blaterial Liquid capacity in gallons
Top of tile to finish grade
Length
Type of crib
DISTANCE TO:
Class
DISTANCE TO:
Width
Crib diamete~
Foundation
Total len(.J.~t~o~ line.~.~
Materl~ ben"b'ath tile
Depth
Nearest Jot line
Trench w['~'~Eh .-
'~ '~ inches
PERMIT N ~C~,~~
PERMIT ~O,
Crib depth Total effective absorption area
Well Building foundation Nearest lot line
Depth Driller Distance to lot line PERMIT NO.
Building foundation Septic tank Absorption area(s)
OTHER
PIPE MATERIAL~.~ ~)~ . .
~1 I_~E-ST RATINC)
INSTALLER
REMARKS
Sewer line
72-013 (l~e~. 3~78)
DATE
LEGAL
1c, O~s~ance and Oirect~on ~rom Road Intersections ], OWNER O~ ~ELL: ~/~
S~A ~ o x
2, ~ELL LOG Fe~t BeJ~ Q, WELL D[PTH: (compJeL~) Surface Elevation
Haterial Type Top Bottom /~ 3 Ft.
~ / 'ii ~ 8. FINISH 0¢ ~ELL:
- ' ' ' J ' J . . Set b~t~en ft. and
.... j
J I0. PUNPlN6 LEVEL below land surface
m r I1, WELL H~D COMPLETION: ~ In Approved Pit
12, G~OUTING: WeJJ Grou~ed: ~ Yes
.... ,ater;.,: ~lNeat C~nt ~ Other:
Type: ~ Subl~r, lble ~Rec Iprocat Jng
g's~r~d Bu~ ~lama / Con'tact L~c~n~ ~umber
L.L. Fi!F..li-I[...NI u H[::.HLI'H HI",[:, EN',,']F:rLd',IPET. TFI[ F'~',"'TEF'-"I~i,i /-~,b71
: ..,, ,:,.: .......... ........... ,_ ................ .. ' .........
~ ", ,'..(!).;...'~ " 264-4;:'2E~
'ri') .J'[..,..!I E::. L_ ~ .... ~::l~ft'...~E:, ,Z:~ll'-dl.---.".~ ~." '"[r'"E~". '.'iE;;EEIL.JIt[~":; F: 17 L~:]lf;,:..".lPli 'E "T'
PE:.*:~:I"tI'I" t";tO. '" ,.,.LUJ.¢,:,
I..j]r:'F:t'I'Z3NCRI','IPE:EL.L FfIR'Z';TF;:IP ROFIE:,
L. EL'TJFIL. [.C"F J..:'L E~[...K :l. KNO~,~.OF THE 1.4OL[:, LOT ~;IZE 5',~',E.';O '.r.:;L:)LF4RE FEET
'T'¢PE OF SF-IL. FIE:':..:;OF-:PTION ::'"; :';"r'EH IS. TRENCH
r,tF~;:.::'rh'.. _IH I'.,II...IhlBER FF'. BE[:,F.':OOM::..; = Z.": '.~;:' Z[. F.'.H I ........ I~',Ja' '::SI.'-:! F]',.'"BF,')=
]'HE REC.:IUIRE'I} E;IZE OF THE ':7:,OIL. ' ,,. .......
FIE,:, JF..f ] ION :.-:.;'T':E;TEr,'I Ir.=.;-
THE LENGTH E) ZHENSZON Z::.; THE LENGTH ,:: IN FEET::, OF' TFIE TRENCH OF;.: E:,RFiINFIELJ}.
THE DEPTH OF FI TRENCH 0,~ F'IT ZS; THE [:,I'_:;.,TRNCE BET.WEEN THE SUF::FRCE OF THE
GROLIND FIND THE BO'FTOH OF: THE E,'.'.:;CFI'v'F:ITI ON ,:; I N FEE'I" ).
'TFIERE I2; I'-,10 SET .NI[:,TH F:'OR 'I'RENC:HE'5.
THE ah.R E:I.... t'}EF'TH ]..:,"'"" THE M:[I"~II"llJH E:,EF'TH OF GF..H"' "-','El...' E:ETI,.IEEN THE OtJ"FF'FIL. L PIF'E
FIN[:, 'THE E',OTT'OM OF THE E,,'~' '"_. -I" ,~H"F I ON ,' I N FEET).
F'ERM.IT FiF'F'LICRNT FIRS THE F..E.._FIJi'~_,IE, ILIT~ T'O INFORH 'THI:5 [:,EPRRTHENT' E:,URING 'T'HE
~i: i",I'.'~.:;TI::IL..L.I::IT I 01'-.! I NSPEE:T I Cd",l:5 OF FIN'¢ IIE. LL:,'" '-' FI[:'..TFICENT TEl 'T'H I :.:~; F'F". F"Ef-..""F'T' FINE:, THE
NIJHE~ER OF RE::2:]'[,ET,t.:':E':'L:; TFIFIT' ]'HE I,.!ELL .~'~IL.L. SEF.','E:.
E:FtI.~:KFZ L.L. i NG OF F:tl",f~r' '"" '~ .... ,' '-" ......... ¢: !.:, !-::, !:;, - ,,,,¢',
::,'r..:,'lE. fl .WITHOUT FINRL II",I:,FE..f.[OI',I RI"~E:, .... .. - , ,",,... THIS
I}EF'RRTHENT .t,.t:l: L.L. E',E /E;IjBJEi::T ']"l:} F'RC SE -:UT i EiN.
HII',IIMLIH [:,I2;TRNE:E E, ETHEEi'., FI t-,.IELL. FIN[) FIN"r' F
- ,
::LI:~:F~ FEET FrOR FI F'RI'v'F:ITE HELL OR ':1 F'iFI 'FO
- . ...... ¢:d,: FREE]" FROH FI F'.E:LIC I.,.IELL [:'EF'FNf')ING
UF'IEII',I "FHET'T'I::'E IZIF' F:'UEiL_ I C I.,~!ELL. ""
HINZHUi'"I [:'IST'FIN':E F:RI]H R F~.i ...... hie .NELL TO FI F'F.:I'v'FFFE :SEI,E(I:::: L. Ii'.,IE IS '::'~ FEET FIND
TO FI COHMUNIT'T' SEI,.!ER L. INE IS "5 FEEl'. ......
.t,HEL..L. [.17r:i'~ .... :RE RE~!UIREC, FtN£:, MLI:.'.ST E~E F::ETLIRNED TO THE LE:FI-..F,.""" ...... HEI'. F F.IlTHIN :'2:El [:'R"r'i~:;
OF THE I,.IELL. CI]HF'LETION.
I:]THEF,' RI.:.:C.~. ]'REhIENTS HFI'¢ ': '" '""
-.. I-IFFL.~. £":;PECIFICFITI'.]N'5 FIN[)CON2;TF.':IJCT:J[FIN E:,IFtl3RF:IH'.::; FIRE
FI',,,'FIII...FIE',L. Ei: TEl ]:i',I'_SLIRE F'F,_FER" '" ]" * '" .tN'-:::TRLLRT]:ON.
.l: CERTI'F:'T' THRT
:'L: I RM FRHIL. IRR 14ITH ]'FIE RE6!UIREHENT':-: FOR ON-SITE b]ENERS RN[:' I,.IELLS R2; SET
FORTH B"r' THE MUN :1: C I PI'":]L I T"r' OF BI",ICHORFIGE.
;2: I NILL II"4::.;TFIL. L THE S"r'STEM IN RCCORE:'RNCE [,-!ZTH T'HE CO[:'EB.
::~:: i UNDERSTFIND TFIFIT ]'FIE ON-'.SITE 'SEI,.tER S¥S'T'EM HR"r' RE6¢JIRE ENL. FIRGEMENT IF' T'HE
RE?7, IE:,E;',ICE I:~; REHOF;,ELED TO INCLU[:,E MORE THRN ]: BE[:'ROOH.S.
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Location:
BESSE, EPPS & F<~i~ES
2220 EAST 88 AVEI~UE
ANCHORAGE, AK 99507
(907) 349-6451
WATFA/ ~ELL TEST
Subdivision: , '~,~ .~ ~._
Lot: _
Block:
Client's Name:
Address:
Tes bet:
Initial Reading c~ Meter:
GPM 24-11our Carxuci ty Ca licn~
T,~; ii i,q, !
/
DEPT. OF EN*IRONMENTAL CONSBRVATION /
ANCHORAGE/WESTERN DISTRICT OFFICE
/
437 'E' STREET, SUITE 303
ANCHORAGE, ALASKA 9950i
BILL SHEFFIELD, GOVERNOR
274-2533
February 4, 1986
Besse, Epps & Ports
2220 East 88th Avenue
Anchorage, Alaska 99503
SUBJECT: Lot 11, Block 1, Knoll o? the Wold Subdivision
Anchorage, Alaska (8621-FA-104)
Dear Sir:
The Department has reviewed the Engineer As-built plans For the
subject project. Final approval is hereby given For the water
system and the "Certificate to Operate" is attached. Any
Future expansion of the subject project uill require additional
approval From this office.
Sincerely,
Michael P. Leuis
Environmental Engineer
MPL:pkk
STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
CONSTRUCTION AND OPERATION CERTIFICATE
for
PUBLIC WATER SYSTEMS
Ac
APPROVAL TO CONSTRUCT
Plans for the construction or modification of
[] approved,
//
/~' {J~"~ ?~ f,/¢ -/~/~ublic water system located
Alaska, submitted in accordance with 18 AAC 80.100
conditionally approved (see ~ conditions).
have been reviewed and are
8Y TITLE DATE
If construction has not started within two years of the approval date, this certificate is void and new plans and
specifications must be submitted for review and approval before construction.
APPROVED
Change (contract order no. or descriptive relerence) Approved by Date
C, APPROVAL TO OPERATE
The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water
is made available to the public.
The construction of the //~u'c' ,~./J c'¢;/J-'- public
/
water system was completed on J ~'-/~/' -~/~;__ //¢'// (date). ']'he system is hereby
9ranted interim approval to operate for 90 days following the completion date.
BY TITLE DATE
As-built plans submitted during the interim approval period, or an inspection by the Department, has confirmed
the system was constructed according to the approved plans. The system is hereby granted final approval to
operate. /¢,, j
BY TITLE j DATE
18~407 (Rev. t 1/83)
DISTRIBUTION: 1, WHITE I ENGINEER (Complete Seclion C) 2. YELLOW - WATER SYSTEM EILE (Complete Section C)
3. PINK - ENGINEEPJMUN[.BOROUGH (Comrete Section C)
4. GOLDENROD - MUNI.BOROUGH ICornplete Seclion A)
Application Date
GENERAL INFORMATION c , ubdiViSiOn, section, townshiP,
Locauon t~u~'~ '/~ /~ x /~ - /~
//¢~ ~~%elephone:.Ho
ApPlicant Namely ~¢~ / g~-
(b) Applicant Address ' 'Y ¢ '¢ '
(c) Applicant is (check one): Lending institution ~; owner/builder~
Lending institutiOn ~
Address
(e) Rea~ Estate Company and Agent ~
Address
%elephone
¢) Mail the HAA to the lol~owin9 address:
TYPE OF RESIDENCE
Single-Famib ~' Multi-Famib E] other
Number oi Bedrooms ~
WATER suPPLY ~
individual Well ~ CommUnity ~ publ
Note: I1 commUnitY well system, must have written
attesting to the lega~ity and status.
confirmation irom the State Department ct Environmental ConservatiO~
SEWAGE DISPOSAL Holding Tank ~
Onsite~' public ~ community ~ "
Note: (t community well system, must have written confirmation from the
attesting to the legality and status.
State Department oi Environmental C°nservat~
paqe 1 o'i 2_
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AN[;) INFORMATION
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 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
t he d ate of ?¢J.sqRs~ti.o.n,
NameofFirm ~.~.~.._..¢- ~¢-~_.~7% .._4 ~"~x~'~--¢-, Telephone
Address _~',x¢~O ?~-.-.¢%~-- ~-¢~ ~ ./&,
Date /~-/~-z'~ ~' ~ /x.¢/~ ¢
Engineer's Seal
DHEP APPROVAL ~'~ ~,,,',1 /¢~"~~
Approved for ~..~ bed room s b~ ~"--~~¢''~-~
Approved ~ Disapproved
Terms of Conditional Approval
Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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.
Page 2 of 2
72-o25 (11/84)
MUNICIPALITY OF ANCHORAGE (MOL/
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
WELL DATA
Well Classification
Well Log Present~7)N)
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit~l)
Separation Distances from Well:
To Septic/Holding 'Tank on Lot
_ Cased to
If A, B, C, D.E,C. Approved(~4)
Date Comp/leted ~-¢"~--~/ - ~"*// Yield
Depth of Grouting
Pump Set At
//
Sanitary Seal on Casing~¢~l)
Depression Around Wellhead (Ye
; On Adjoining Lots
To Nearest Edge of Absorption Field onL/gt .~"~ /,' On Adjoining Lots
To Nearest Public Sewer Line ~'~/~,~,,/¢ To Nearest Public Sewer
Cleanout/Manhole ~/r' To Nearest Sewer Service Line
Water Sample Collected by . /.~ .~f-~,~ ; Date
Water Sample Test Results ~:~ ~/.~ ~ ~ ~/~
Comments ¢~ ~4~ ~'b%b ~ /
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipe~N) Air-tight Caps~N)
Depression over Tank
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/~Hold~g Tank:
To Water-Supply Well .,"~'~
To Property Line ~zj~,
Course
Comments ~fJ~b~ ~k//~
~'-~' '-~/ Size /'~o¢, No. of Compartments
Foundation Cleanou~)
Date Last Pumped
~ ; for ~ -
Temporary Holding Tank Permit (Y/N)
To Building Foundation //'~
/
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72~026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata/j¢/"-¢ ~ ~c*-XCType of System Design
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
/
To Building Foundation
Lot ,~¢ ~-¢"~ / ~'7~-~--'7
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipe~ Presen~N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
/'/
; On Adjoining Lots -:~-~'~'¢
To Cutbank~n.n.n.n.n.n.n.n~resent) .¢"' -"~¢~-~ -;"' ~o~,~'%'./--,--,' /
~ /~/¢t%o4q-oH F~e~oPR'" ACC oN¢./7'¢ ~,~'-K/¢'~ Pb.F~m~7'-
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** 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 /~'~,¢' *-~., //,"~/~-~¢ Date
CompanyZ.-~?/¢:¢~ ~,'~ ~/~"?~-_s MOA No.
.·
Receipt No. "~-~b (,~o
Date of Payment ,-~ - (J~ -- ~ ~.
Amount: $ (Lb~~'O'-~
Page 2 of 2
72-026 (11/84)
A4'Home -Services
15900 Francesca Drive
Anchorage, Alaska 99516
345.1890 · 27'6.7161
L_ _j
'~'"'~ ," "" -~"K
DATE DESCRIPTION 'CHARGES CREDITS BALANCE
PREVIOUS BALANCE .~
If th~ statement does no t agree w/th your records p/ease not/fy us at once.
S TA TEMEN T
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME~
DATE DATE DATE
INSPECTOR I NSP ECTOR INSPECTOR
MUNICIPALITY OF ANCNORAGE
MUNICIPALITY OF ANCHORAGE DEFL OF H&%rR
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL PROfECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION OCT 1
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER PHONE
MAI LING ADDRESS
-1~_~o ~on4r. aq~)~ C/~r~oto, hnch~e_~S¢, [~\/c.
PROPERTY RESIDENT (if different fr~ ebove) PHONE
Z BUYER PHONE
MAILING ADDRESS
3. LENDING INSTITUTION I PHONE~
A }~; i(_~ (~ ~17(,,_,~ )I ;g79
MAILING ADDRESS
4, REALTOR/AGENT [ PHONE
MAILING ADDRESS
5. LEGALDESCRIPTION
LeT'
STREET LOCATION
~. TYPE OF RESI~CENCE NUMBER OF~BEDROOMS
[] One [] Four
~'¢JzE[' SINGLE FAMILY ;~i;~.' Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Ofher
7. WATER SUPPLY
~ iNDIVIDUAL* -~ ,O ~'J"'~" * ATTACH WELL LOG. A well log is required for all wells drilled
~'""'~'-"~ '/~"'~' ~ ' since June 1975, For wells drilled prior to that date, give well
[~ -PUBLIC UTI LITY ~ depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE~
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATE[).
i THIS SIDE FOR OFFICIAL U~gE ON LY ~
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
~/ SINGLE FAMILY [] ONE ~"'"THR EE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[~] INDIVIDUAL DEPTH OF WELL
[~COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
PERMIT NUMBER
AGE DISPOSAL SYSTEM
VIDUAL/ON -SITE DATE INSTALLED
[]PUBUC UT, UTY 7
Connection Verified INSTALLER
eptic Tank or E~Holding Tank
Size:_,/Ol'J~ . If Tank is homemade SOILS RATING
give dimensions:
TYPEOFTANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
[] CONDITIONAL APPROVAL (letter must accompany certificate) -~
[] DISAPPROVED
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
SOUTHCEN I-RA L REGIONAL OFFICE
June 4, 1981
Larry Langston
211 W. 7th
Anchorage, AK
Subject:
437 E. ST'REET
S£CONO FLOOR
ANCHORAGE, ALASKA 99,50I
(907) 274.2533
P.O. BOX 615
KODIAK, ALASKA 99615
(907) 486.3350
P.O. BOX I207
SOLDOT'NA, ALASKA 995~
(907) 26'2-5210
P.O. BOX 170,°
VALDEZ, ALASKA ~9968~
f907) 835,4698
P.O. BOX 1064
WASI£L,A, ALASKA 99687
(907) 326-5038
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL N-,OI ECTION
99501 t 0 1981
Lot 10, Block 1 Knoll on the Wold SD
Contaminate separation Waiver Request
Anchorage
RECEIVED
Dear Mr. Langston:
We have reviewed the report and recommendations submitted by the Anchorage
Municipal Department of Health and Environmental Protection concerning
your request for a reduction of the Class "C" protective radii for your
water system.
We hereby grant a waiver of 18 AAC 80. 020 which requires a minimum
separation distance of 150 feet between a class "C" well and a septic
system to 140 feet in regards to the subject lot.
If you have any questions concerning our review of this project, feel
free to contact me.
D.H.E.P.
825 L Street
Anchorage, AK
99501
TLM/bab