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HomeMy WebLinkAboutKASILOF HILLS BLK 7 LT 19
MUNICIPALITY OF ANCHORAGE
Hea 'l and Environmental Prote(
Fourth Floor West
825 L Streot
Anchorage, Alaska 99501
279-2511, x 224, 225
INSPECTION REPORT ON-SITE f;EWAGf! DISPOSAL SYSYEh'i
.~Ef lC 'TAt"JK:
DISTANCE/I.~U"nm { ~ , ~'. ~ NUMBER OF
FROM WI_EL,/-.:_ ...... MANUFAC]URFR _ tvlA FFi~IAI.. ~/~_~ COMPARTMENT~
INSI[)[i LENGfH ........ INSI[)E ~¢l[)lll . _ [ I()tJli) [)[:PI'H ....... ~ [QUID CAPACIT . GAJ_I~OfgS.
TILE DRAIN FIELD:
· ,~ / { ~ i TOTAL LENGT~I .. j
[)1.,I ANCL IJ[IWiLEN I..IN[..~ . _ TNI{FICtl Wll)T IN. TOTAL. I.FI"ECI I'/[
AFJ',SORPrlON AREA ............ SQ. FT. L [_NGFII OF EACtl LINE .....
I)EPTII: TOP OF TiLl: 10 [-INISII ORAOE~ __ .... MATT:RIAl [Ir. NCATlt TIt_E ¢ ~AJ~OVE TILE ..... I[ .
SEEPAGE PI'T=
DI/\M E'F [iR ........ OR WID'FH .... I. E FIGTtl .... [3EPI'I t
Log Crib Rings/CRIB SIZE: I)IAMETFR ..... DEP1 H .... DISTANCE FROM: WELL
]OTAL El FECTIVF'
i~tJILDING FOLJNDAqION ....... NEAR[-_SI' LOF I INF ....... AI4SORPTION ARF'A (WAI_L AREA) .......... SQ. Fl'.
Bldg: Z~ t4 Sower Line: /D ~/ ' ' ' ~ : ~
Pipe Ha~Zs: ~ ~~ ~ ,~. ~ '. .... o' ~
# of Bedrooms: ~ ..... 71' i 16'u'
Installer: ~h--~-7
Remarks: --'------- -
July 22, 1977
R&M No. 751200
Jim Dennington
Box 567
Anchorage, Alaska
99510
Subject: Soil Investigation for Sanitary Sewer System, Lot 19,
Block 7, Kasilof Hills Subdivision, Anchorage, Alaska
Dear Mr. Dennington:
At your request of July 22, 1977, we conducted a subsurface soils
J_nvestigation at the proposed location of the sanitary sewer system on
the subject lot. The investigation complied with those procedures
required by the Municipality of Anchorage Department of Health and
Environmental Protection.
This investigation, which was accomplished on July 22, 1977, was conducted
within a backhoe trench excavated to a depth of 12 feet below the existing
ground surface. The test hole was sited according to your instructions
and its location is shown in attached Drawing A-01. A sample was taken
at the depth shown on the soils log in Drawing A-01. The sample will be
held in storage at our lab for approximately six months. In addition,
ali_ material excavated was monitored by an experienced engineering
geologist.
The topography at the excavation site is generally gently-sloping to the
West. At the time of the investigation the site had original..vegetation
c~nsisting of grass and low shrubs.
The soils encountered in the excavation are shown in the test hole log
in Drawing A-01. The symbols used in Drawing A-01 are explained in
Drawings B-01, and B-02. This log displays specific conditions encounter-
ed at the test location. However, subsurface conditions may vary in
other parts of the lot without any apparent surficial evidence of the
change. Groundwater was not encountered. Bedrock was not encountered.
At the time the hole was excavated seasonal frost was not present.
Permafrost was not encountered. ~
A hole approximately 8" in diameter was excavated to a depth of 1.5
feet within the trench for a percolation test. The top of the hole was
6' below the original ground surface.
A percolation test was performed within the bore hole at the depth shown
in the attached Table 1. All depths were measured from the top of the
July 22, 1977
Mr. Dennington:
Page -2-
hole. The data in Table 1 show average infiltration from the depths
indicated to the bottom of the hole. The measured percolation rate was
6.3 minutes per inch.
We appreciate this opportunity to be of service to you. Please contact
us if you have any questions concerning this letter of if we can be of
additional service.
Very truly yours,
R & M CONSULTANTS, INC.
Staff Geologist
Jim McCaslin Brown, Ph.D.
Head, Earth Science Department
Attachments: Drawings A-01, B-01,.B-02, Table 1
Lot 150 '
19
Backhoe Trench
Not to Scale.
Distances shown are approximate and
have not been measured by survey
methods.
T,H. 1
7-22-77
SANDY SILT w/ ORGANICS,
TRACE GRAVEL (OL)
GPJ%VELLY SAND w/ SOME
SILT
1
Grey, Moist (SH)
2I
12'T.D.
This log represents subsurface soil
conditions within the backhoe trench at the
location shown.
KO: SMH
riTE: 7-22-77
See Drawings B-01 and B-02 for explanation
of symbols.
TREHCH LOG AND LOCATIOH
DIAGRAM
JIM DENNTNC~TOM
TI~, _~E
9:33
9:34
9:35
9:36
9:37
9:38
9:39
9:40
9:41
9:42
9:43
9:48
9:53
9:58
i0:03
10:13
10:23
10:33
ELAPSED
TIME
2
3
4
5
6
7
8
9
10
15
2O
25
3O
4O
5O
6O
TABLE 1
PERCOLATION TEST
JIM DENN INGTON
R & M NO. 751200
INCHES
3 1/2
3 3/4
4
4 1/4
4 1/2
5
5 1/4
5 3./2
5 3/4
6 1/4
7
8 1/2
9
10
11 1/2
12 1/2
13
DROP IN INCHES
0
1/4
1/4
1/4
.]_/4
1/2
~/~
1/a
1/4
1/4
3/4
i
]./2
1 1/2
9 1/2 ZNCHES TOTAL DROP OR
6.3 MINUTES/~NCH
d> ~ ,~-,~,_./ ~ ~'--
SOILS
CLASSIFICATION: CONSISTENCY AND SYMBOLS
CLASSIFICATION: Identification and class{fication of the soil is accomplished in
accordance with the Unified SoLl Classification System. Normally, the grain size
distribution determines classLflcat{on of the soil. 7~e soil is defined according to
major and minor constituents with the minor elements serving as mod{fiefs of the
major elements. For cohesive soils, the clay becomes the principal noun with the
other major soLl constituents used as modifier; i.e. silty clay, when the clay particles
are such that the clay dominates soil properties. Minor soil constituents may be
added to the classLfication breakdown ~ accordance with the particle size proportion
listed below; {.e. sandy silt w/some gravel, trace clay.
no call - 0 - 3% trace - 3 - 12% some - 13 - 30%
SOIL CONSISTENCY- CRITERIA: Soil consistency as defined below and determined
by normal field and laboratory methods applies only to non-frozen mater{al'. For
these materials, the influence of such factors as soil structure, i.e. fissure
systems, shrinkage cracks, slickensides, etc., must be taken into consideration
in making any correlation with the cor/sistency values listed below. In permafrost
zones, the consistency mid strength of frozen soils may vary significantly and
unexplainably with ice content, thermal regime and soil type.
Cohesionless
N*(blows/ft) Relative Density
Loose 0 - 10 0 to 40%
Medium Dense 10- ~0 40 to 70%
Dense 30- 60 70 to 90%
Very Dense - 60 90 to 100%
*Standard Penetration "N": Blows per foot of
a 140-pound hammer falling 30 inches on a
2-{nch OD split-spoon except where noted.
Cohesive
T- (tsf)
Very Soft
Soft
Stiff
Firm
Very Firm
Hard
0 - 0.25
0.25 - 0.$
0.5 - 1.0
1.0 -2.0
2.0 -4.0
-4.0
DRILLING SYA4B OLS
WQ: Wash Out WD: While Drfllh~g
WL: Water Level BCR: Before Casing Removal
WCi: Wet Cave In AC}{: After Casing Removal
DCI: Dry Cave In AB: After Boring
WS: While Sampling TD: Tot~ Depth
Note: Water levels indicated on the boring logs are the levels measured in the
boring at the times indicated. In pervious unfrozen soils, the indicated elevations
are considered to represent actual ground water conditions. ~ hnperv{ous and
frozen soils, accurate determinations of ground water elevations cannot be obtained
w{thin a lhnited period of observation and other evidence on ground water elevations
and conditions are required.
Engineering 8, Geological Coneultants Inc.
A~C.O.~,~E ~^,.0~,~s ALASKA ~u.~u
~- I - 7'2 ]SCALE N /A
GENERAL NOTES
STANDARD_ SYMB
SILT SANDSTONE ICE, MASSIVE ' ' SCATTERED COBBLES
(ROCK FRAGMENTS)
SAND MUDSTONE ICE-SILT 8, SANOY GRAVEL
GRAVEL LIMESTONE ORGANIC SILT SILTY CLAY w/TH. SAND
SI ..... 1,4" SPLIT
Ss ..... 1.4" SPLIT
SI ..... 25" SPLIT
Sh ..... 25" SPLIT
Sx ..... 2.0" SPLIT
Sz ,' .... 1.4" SPLIT
Sp ..... 2.5" SPLIT
Hs ..... 1.4" SPLIT
SAMPLER TYPE SYMBOLS
SPOON WITH 47~ HAMMER
SPOON WITH 140~ HAMMER
SPOON WITH 140# HAMMER
SPOON WITH 340# HAMMER
SPOON WITH 140# itAMMER
SPOON WITH 340# HAMMER
SPOON, PUSHED
SPOON DRIVEN WITH AIR HAMMER
Ts .... SHELBY TUBE
Tm .... MODIFIED SHELBY TUBE
Pb .... PITCHER BARREL
Cs .... CORE BARREL WITH SINGLE TUBE
Cd .... CORE BARREL WITH DOUBLE TUBE
Bs .... BULK SAMPLE
A ..... AUGER SAMPLE
G ..... GRAB SAMPLE
HI ..... 2.5" SPLIT SPOON DRIVEN WITH AIR HAMMER
NOTE: SAMPLER TYPES ARE EITHER NOTED ABOVE THE BORING LOG OR ADJACENT TO IT AT THE RESPECTIVE
SAMPLE DEPTH.
TYPICAL BORING LOG
M
80[¢/NG NUMSE/?-.,,...E H. 30- 15
DATE D,-?/LLED-.~iO- ~1- 70
SAMPLE/? TFPE.~.
Ss
.4FTE/~ BO. RING \
9'A.
WA TER
WHILE D/tILLING''f
Ss
F/~OZEN
Elev ~74 6 '"*J ELEVA?/ON /N FEET
All Somples Ss''°~- SxtMPt-E/¢ TYPE
O'
;- MATERIAL I'
Cons~d Vis~blelce ICE-I-ML
ICE -SILT
Eslim(]le 65% Visible Ice
(~) 90, 56.2°/o,80.SpcfN-, ML4'
-~'STtqATA CHANGE
SANDY SI LT
~./ APPt~OXIMA?-E S TFtATA CHANGE
~ 5~.loJ~, ~.~, ~ ~ (CO~PS OF ENGINEERS METHOD)
~ ~ ~ ~ ~UNIFI~D 0~ F~A CtASSIFICATION
~ 'X X --TEMPERATURE, °F
~ ~ D~Y DENSITY
~ WATE~ CONTENT
Bt 0 WS/FO0 T
SAMPLE NUMBE~ .
SANDY GRAVEL
Cd 95
SCHIST ~GENENA~IZED SOIL OR ROCE DESCRIPTION
E ~OCATION ~0' ~ D~ItL DEPTH
~ WEIGHTED AVENAGE
· ADDITIONAL DATA AVAILABLE ON SUPPLEMENTAL LAB SHEETS
CONSULTANTS, INC.
EXPLANATION OF SELECTED SYMBOLS
. ~RL/\TER ANCHORAGE AREA BOROUGH
. ,T~;;.~ARTMENT OF ENVIRONMI.:NTAL QUALITY
~"~ ki~\ 3330 "C" Street
\~ r], \~A ANCHORAGE, ALASKA 99503
Performed F~o~eS~awyer
Legal Descr~p~i'on':--I.~-t '19'"B'l'ocE
This Form Reports Soils Log
Depth
Fee t
lO--
ll--
12~
13--
Case #
Dated Performed_May 1~,~ 1974
7 Subdivision Kasi[off Hills
Percolation Test
Soil Test Must Be Logged To 4' Below Proposed Seepage System -
Soil Characteristics
_ , Clays CH
Medium gravel & sand SW-SM
Coarse-to-medium gravel
with sand
GW
Was Ground Water Encountered? No ¢4m~
If Yes, At What Depth?
Reading
Date Gross Time
Net Ti me
Depth to H20
Net Drop~
Percolation Rate Minute
Proposed Installation: Seepage Pit X Drain Field
Depth of Inlet Depth to Bottom of--Pit or Trench ~6'
COMMENTS: We recommend 120 sq, ft. per bedroom based on Borough recommendations and
requirements.
Test Performed BY_ ,].__Jameson
Date Certified BY:
J'UL 1£ '94 16:04 UR STATE,!~IDE~,~,53'~87 Jul. 12,94 15:52 F'.(P.i/1
DRILLINO LO~
Well Owner I~'~'~.~_~'E'p,~.eSx~TL_/~OCC ~ff~ess
Use of Well
Local, ton (add/'os0 o~ ToYt~h]p, Range, ~etion, if k~*own; ,or dJsLanee r~atn road,__
Size o~ oa~lng~~Depth ut Flole_.B_5_.~_~eet Cued to.
Static w~ter leveL. 2.C[0_._Jt, (~ ' ~low) lanrJ. 8urt~,e. Ftr, i:sh
~reen ~( ); Per~orated ( ~ ),
De,cfi~ sofia or pe~'foratio~-,'~ ..................
Well pumping te~t ~t 1 -ga~lg~ ~ (~ (~inu~e) ~or~__hour~ wl.~h~6 ~. rt~t.
t, -. : . WELL LOG
Depthinf~et~rorn ~ . ., .. · .
ground ~fa~ Oi~ det~i~ of formations t~netr~ted, size of m~teria), color ~nd hardnes~
~q:-' :..' ...., . ,. .:. . ~. . .... ... ·
?~-,.~. ':..:.. _ , ,, . ,. ., . ~ ~;, .~ ~'.: .,.., . :.
' / :.. - ..... · .~,,,.,.:. , .. ..... ,.;,~ .
,:, . · . · ... ..'.: :. .,.....'$< .5~.'[ ..
Certificate No'$, 814 & 973
CUSTOMER
SIX INCH WATER WELL DRILLED AND CA~ED OUT TO THE DEPTH Of 20.% feet.
DRILLED AT THE RATE OP" ¢18,00 PER FOOT.
PROPERTY OWNER _J~h~~~m~ 272*8006_
LOCATION OF WELL SITE
D R I L L E R __~Bcrn.ic~Olaus~z.¢ · ' ' Works o _
WELL LOG:
0 ..... 15' Sandy gravel with 20~ cl~y~b_inder. _
___.L5---35' SilSy_ cl~v and gravel,
~--~5' Clay with 20% gravel.
_ 5~--1~5' Bedrock. A sedimentary rock.
_ 13~_-141' A granular rock showing some signs o~ water.
i41-185' Sedimentary rock.
185-187' Granular rock showing more yield of water°
i87-205' Sedimentary rock,
A yield of water showing 2 1/2 GPM or 3600 gals per day
casing of over 150 feeto
bp should be installed ten feet off bottom.
with a recovery in the
Cost of Drilling: $3600°00
Paid in full by ~. Jim Denndngton per this date,
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF
THANK YOU VERY MUCH.
DATE
BERNIE CLAUS OF RAMPART DRILLING WORKS
,
Ju v
SERVICE CHARGE OF I'/2% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS,
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.
HAA #
1. GENERAL INFORMATION
Complete legal description
Lot 19; Block 7; Kasilof~ Hills
Location (site address or directions)
10101Stroganoff Priv6
Anchorag6, AK
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Mar~'.
10101 Stroqanof f Anchoraq~,
Day phone
AK 99516
346-1455
786-7766 (w)
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
XXX
'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 s8pply
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 ~
Address
· s &
EngineeCs signat~ .~¢~ ~lv~ ~. R~~
DHHS SIGNATURE
~pproved for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By: '-'-'~-;, ,. .... Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph ,~ 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.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /._o~ /~'
A, Well Data
Well type
Log present(~)
Total depth "-~"~-
Sanitary seal (~N) ~"~-~
,~L,~' ? K'~S~LoF/~lu_,~ Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ?/z4-177 ~ Driller
Cased to ~0~-'/"""""""""~'~ Casing height
Wires properly protect,ed ~Y~N) ¥'Q..~
7-o ~S' fSY f~-~ LP~cc/roC~ o~ ?/Il/a/H
FROM WELL LOG AT INSPECTION
Date of test
Static water level ZOO
Well flow
p level1
SEPARATION DISTANCES FROM WELL TO:
Septic/hetd~tank on lot /OO /
Absorption field on lot
Public sewer main '~-
Sewer service line
g.p.m.
/Z
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout /
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
O'(-'¢/ '/~./Z Other bacteria O/~/o°~
Collec~e/d by: ~' %-~- ~Y/-JG//,-JE~-,~//,,) ~¢
B1 SEPTIC/H~LD{NG-TANK DATA
Date installed
Cleanouts ~/N) r.~
High water alarm (Y~_~ ~
Date of pumping
Tank size
Foundation cleanout(~)N)
Compartments '~
Depression (V~ /Jo
Alarm tested (Y/N) /t,///'~
SEPARATION DISTANCES FROM SEPTIC/FE~.-D-~ TANK TO:
Well(s) on lot /O~f On adjacent lots
To property line /~ (7'-~ Absorption field
Surface water/drainage ("(_.~/¢"-
,/00 re_
Foundation /CO
Water main/service line. ,/O
72-026 (3/93)'Front CONTINUED ON BACK PAGE
c. L,FTSTAT O. e"
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N) ~
SEPARATION DISTA..tCSE~OM LIFT STATION TO:
We~l~m-lof'~/~' On adjacent lots
Manufacturer
Manhole/Access (.~.~ ~
..~---'"~ump off" Level at
. ~es tested
Sudace water
D. ABSORPTION FIELD DATA
Date installed ~/f ~/~ 7
Length z~F~'~ / Width
Total absorption area
Date of adequacy test ,~,/~o
Water level in absorption field before test
Soil rating (GPD/Ft
/
Gravel thickness
Cleanout present ~)N) ~'~-~
Results ,~)'fail) '/~""~r
System type . '7'-/g~McH _
Total depth ///
Depression over field ('Y~ ,/O~
for ~u~ (~L) Bedrooms
Aftertest ~//" ~
Peroxide treatment (past 12 months) (Y/N) APO AYe- /.~ A_O,~Pd/--~ If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO: ~ 5 ~E~ ~, ~ ~o~
Well on lot_/(:~0 r
To building foundation /('~
On adjacent lots ..~O
Sudace water /OO
On adjacent lots / C~O /?L- Property line
To existing or abandoned system on lot
Cutbank "'" Z-O/~ Water main/service line
Driveway, parking/vehicle storage area / ©
Curtain drain
.-~,~,NEpJ Co~T~ucTTo~J
E. ENGINEER'S CERTIFICATION
IZ'-ZO/ F~¢~°~ LoT-I?
~or conform(
I cern'fy that I have checked, verified, OA and HAA
Signature,- ._ , _.~ ._ _,~,~ ~,~ e . . ~~,x~
~nglneers Nar~e , "
Date ~agre~m'"~'~XT~~
HAA Fee $ ~,~06~ - ~./7~
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
CT&E Re[',//
Clien! gample
Matrix
Commercial Testing & Engineering Co.
Environmental Laboratory Services ~~-'~r~a~'j~'~j~'~r~e'-~
LABORATORY ANALYSIS REPORT
94,360%1
I,OT 19 B LK 7 KASILOi? l[ll_l S
W^TER
ClicntNt~tne S Cc 8 EN'GlZXIEERiN(.~ WORK Order 80471
Ordered By RJ'S Printed Date (17/20/94 (~} 08:42 [,rs,
Collected L~4t c 07/18/94 ~) 07:15 h.ru,
Pro, ieet Name Recejvedlhte 07/18/94 ~¢(),q:15 hrs.
Projeut#
PWSII) JlA Technical Director STEFI.LEN C.
R¢le.(lsed By: ~ - _ ........
--~,,¢T;-i'~;Sf;---'25-i~t,: S^m'LF~CO~,~,~CT~r) ~¥: SS.
QC A!lowt~ble Ext Anal
Jearame.ter Results Qual Units Metimd I.in~i'..s Date Date hilt
........................................................................ ~ ......................... ;--%~ ....
--~]~ .............. 0.6~ ,ng~ EPA 353.2/3000 1,,, 07/18194 C~{
* See Special Instructions Above UA = Unavailable
'* * See Sanlp I e Remarks Ab o v e NA. = Not Analyzed
U = lh~tcctcd, R~ort ed val~ is th c practical ~,~mtificat~on I imit. LT=' ~ss
D = 8cconchry c~h~ion. OW = Greater
5633 I~ Street, Anchorage, AK 99[ii 8.1 600 -- Tel: {907) 562-2343 Fax: ¢07) 1561-5301 ....
~,~x/mmsl[,tl:f, JTAI FACILITIES IN ALASKA, COLORADO. FLORIOA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAh'4, WEST VIRGINtA
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
GENERAL INFORMATION
Complete legal description
Lot 19; Block 7; Kasilof Hills Subdivision
Location (site address or directions) 10101 S/¢~oganof D/~v6
Property owner
Mailing address
Day phone
Lending agency
Mailing address
Day phone
Agent GcrJ4g~.J~c_~E~y JACK WHITE C~PANF Day phone
Address 3204 C S¢~4¢6-t ¢LI-OJ A~.6horage, AZ. cJ~h~J)_9503
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
563-5500
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,
79-025(Rev. 1/91) Fronl MOAP21
5. STATEMEN'r 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 ;,;. :,; ......... ilL, Phone
Address
Engineer's signature
DHHS SIGNA'I'URI-'
_~ . Approved for /z~.. bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
By:
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The 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.
72q325 {Rev. 1191) Back MOA
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lo--r tot ~:,t_,~l \/~A~,~::~: ~,~.~,% ICParcel I.D.
A. WELL DATA
Well type
Log present (~'N)
Total depth
If A, B. or C, attach ADEC letter.
Sanitary seal (~/N)
ADEC water system number
Date completed
Cased to
Casing height
Wires properly protected ~Y,,~N)
AT INSPECTION EN¥1R~,NMENM, L
FROM WELL LOG
Date of test '1 - ~,~ -"]-~
Static water level OhgV-~©¥~,~,
Well flow ~2_, ~'
Pump level / ~'~ ~
g.p.m.
MAY 1 6 199:[
RECEIVED
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Public sewer Service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform (~
Date of sample: ~'- -~ ~ '~ /
B. SEPTIC/HOLDING TANK DATA
Date installed ¢'-
Cleanouts~N)
High water alarm (Y/~
Date of pumping ~'"~
Nitrate
Collected by:
Other bacteria /,,/o/,./F_
Ill & lit i~NGINEEEING
~tlo Rlwr, Alaska 99577
Tank size / ?-,'~'~~ Compartments
Foundation cleanout (~N) y Depression (Y/~ /,J
Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /00 On adjacent lots / CO
To property line / c~ Absorption field
Surface water/drainage /z2 c,
Foundation
Water main/service line
72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
Manufacturer
"Pump on" level at
High water alarm level .------"~ Cycles tested
Meets MOA electri~
SE ANCE FROM LIFT STATION TO:
~¢e1'1 on lot On adjacent lots
Manhole/Access (Y/N) ~
_ .~--~P'd~p off" level at
Surface water
D. ABSORPTION FIELD DATA
Date installed ~" J~ -7'~ Soil rating I~"~E)~¢/~ System type
Length ~¢r'~~ Width ~L~" Gravel thickness Total depth / /
Total absorption area ~O2- ~ Cleanouts present ~:~N)
Depression over field (Y/~:~ ,'~ Date of adequacy test -~- '~ ~ ~ /
Results ,~;~'fail) ~' for ~o~ 6"¢) bedrooms
Peroxide treatment (past 12 months) (Y~:) L.'~J//~/4'~ ~J ~,J If yes, give date /"//~-
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /¢~
To building foundation
On adjacent lots
Cutban k Water main/service line
Surface water
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
-7.,~.~',' ' ;t:;gle River Loop Road No. 204
Signature
Engineer's Name
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING
5633 B STREET ANCHORAGE, ALASKA99518 TELEPHONE (907)562-2343
ANALYSIS REPORT BY SAMPLE for WORKorder# 34067
Date Report Printed: MAY 10 91 @ 15:45
FAX: (907) 561-5301
Client Sample ID:LI9 87. KASILOF HILLS
PWSID :UA
Collected MAY ? 91 ~ 15:45 hre.
Received MAY 8 91 @ 13:10 Ea.
Preeerved with :AS REQUIRED
Client Name :S & S ENGINEERING
Client Aoct :SNSENGP
BPO ~ PO ~ NONE RECEIVED
Req ~
Ordered By :R. SHAPER
Analyele Completed :MAY 10 91 Send Reports to:
Laboratory SupoI. vls~r iSTE~E}I C. EDE I)S & S ENGINEERING
Releaeed By: /~ ~/~~ 2)
Chemlab Ref ~: 911886 Lab Smpl ID: I Matrix: WATER
Allowable
Parameter Tested Result Unite Method Limits
NITRATE-N ND(O.IO) r~/1 EPA 353.2 lO
Sample ROUTINE SAMPLE COLLECTED BY: RAY.
Remarke:
1 Teete Performed ' See Special Inetructions Above Uk~Unavallable
ND= None Detected *' See Sample Remarke Above
NA- Not Analyzed LT-Less Than, GT-Greater Then
ROBERT SHAFER, P.E.
ROGER SHAFER
May 13,
1991
CIVIL ENGINEERS
(907) 694-2979
FAX 094-1211
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
DISPOSALSYSTEM
DESIGN
Mr. George Mc Coy
JACK WHITE COMPANY
3201 C Street Suite 100
Anchorage, Alaska 99503
REFERENCE: Lot 19; Block 7~ Kasilof Hills Subdivision;
D~ar Mr. Mc Coy,
At your request a flow test was performed on the well serving the
referenced property on May 8, 1991.
The static water level was measured in the well at 66' below the top of
the w~l casing. A m~ter was connected to thc water system and the
flow turned on full. After 35 minutes the water level was drawn down
to the pump (195'). The pump was then shut off and the water level was
allowed to recover for approximately fifteen minutes. At that time the
pump was turned on again and the water level drawn back down to the
pump while the water quantity was metered. This process was repeated
five tim~s with consistent results. From this test we have found the
well to currently produce approx~'~ately 28.2 gallons per hour (GPH).
This flow rate is not guaranteed to remain constant, subsequent
variatio~ ~n occur.
This flow rate is co~id~red to be adequate to meet the Municipal daily
flow rcquirement~ for a four (4) bedroom house. Although there is no
requirements placed upon instantaneous flow rates, the State Department
of Enviro~ent~ Conservation recommend a water system be capable of
supplying 8 GPM over a 20 minute period for a single family house.
There is approximately 180 gallons of water storage within the well
casing (as measured during the flow test). This storage will enable the
water system to deliver the r~commended instantaneous flow rate of 8
GPM for 20 minutes.
It should be noted that even though this well and water system meet
current requirements and polices, there is no guaranty of a continued
adequate supply of water. A~t~al performance of the system will depend
upon water use habits of the occupants.
If we may_.b~of furth~ service, please conta~ us.
~/~F~ 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
MUNICIPALITY OF ANCHORAGE
DEPARTMENT~)F/i4EALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, su,bdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ~fie ~Or~ e/ Telephone: Home ~.~ ~18 ~7
__ Business'
Applicant is (check one): Lending Institution []; Owner/builder [~'; Buyer []; Other [] (explain);
(c)
(d) Lending Institution ~;¢/-1¢,4,¢g( ~_.__,[4~
Address C' f~/'- ~-' lq', ¢,,~ h~'
(e) Real Estate Company and Agent
Address
Telephone
Telephone
(t)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family [] Multi-Family []
Number of Bedrooms ~'
Other
WATER SUPPLY
Individuai 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 t of 2 72-025 01/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND 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 tile 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 disposaJ system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
NameofFirm ~l~ ~c~¢;c~/ ~e¢¢~ Telephone 3~- ~3¢~
v
Engineer's Seal
6. DHEPAPPROVAL
~or ,~q~)bedrooms by
'~ Disapproved
Terms of Conditional Approval
Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Ehvironmental 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 [)HEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality ol Anchorag~ is'"~ot responsible for errors or omissions in the
professional engineer's work.
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Descriptio.~n:
WELL DATA
Well Classification
Well Log Present (Y/N) ¥'
Total Depth ;~ OL5~ 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 ! 0 ~./t j.~ C, ~,
To Nearest Edge of Absorption Field on Lot
' ,~u/-£C/./ON
'Yiv _/ ,C)
R£C£1VED
Gloc('~ 7
If A, B, C, D.E.C. ApprOved (Y/N) t'V,/$.
Depth of Grouting iN,A-,
Pump Set At 12~~
Sanitary Seal oniCas~ng (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 ~'/i?
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed ~'-/'Y / 77
Standpipes (Y/N) _
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well I 0 ¢'~ .~"¢z,~ ¢.~.'.
To Property Line '~ ~ (-;'
To Water Main/Service Line
Size i~"~¢.~~1 No. of Compartments
Air-tight Caps (Y/N) )"' Foundation Cleanout (Y/N)
Date Last ~umped
~f ,~' ; for ~/.
N,/l-. Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
Course ';~ IO0
T!o Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~/q / 7 ?
Width of Field ~-t,
Square Feet of Absorption Area lC'E) ~
Depression over Field (Y/N) /~l
Results of Last Adequacy Test ~,~'~'f4.~ .~'
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
! t7
D'/Bd.~r-~ Type of System Design
Length of Field ~
Depth of Field II
Gravel Bed Thickness 7~
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
V
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots '~. ~PO ~
To Cutbank (if present) Nt
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 ~¢j'~'~~ ~ ~ Date ~'/i~ {'~'
MOA No.
Company
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Engineer's Seal
DATE RECEIVED
INSPECTION APPOINTMENTS c'¢J~.C~. ~.z~.)~ .((. (',' \.__ CZ-/;
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR I NSP ECTO~3
MUNICIPALITY OF ANCHORAGE J~UNICIPALITY OF ANCHORAGE
DEPARTMENT OF REALTN & ENVIRONMENTAL PROTECIIONDEP'f'
825 L Street - Anchorage, Alaska 99501 i EN~/IROI~bAE~41' ':'; ~ ''~ LCT[ON
ENVIRONMENTAL SANITATION DIVISION APR ~) 1980
Telephone 264-4720
DIFIECTIONS: Completo all parts on pa§e 1. In¢omplota requests will not ba proaessad. Plaase allow tea {19) days for processin§.
1. PROP, ERTYOWNER I PHONE
MAILING ADDRESS
PROPERTY RESIDENT {If different from above) PHONE
PHONE
MAILING ADDRESS /
LENDI ,NST,TU'r,ON PHONE
MAILING ADDRESS
4, REALTOR/AGEN.r I PHONE
I
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [~ Four
,,,.~' SINGLE FAMILY [] Two r-] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
I
NDIVIDUAL~
COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well Icg is required for all wells ddlled
since June 1975. For wells drilled prior to that date, gwe well
depth (attach Icg if available,)
8, SEWAGE DISPOSAL SYS.rEM
t~ INDIVIDUAL/ON-SITE~
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAE BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY -
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] ~NDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified iNSTALLER
[~]Septic Tank or []Holding Tank
Size: ~o~.~'''~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES Sewer Line ine
WELLTO: /OD' I I DO
Absorption Area to nearest Lot Line
5, COMMENTS
[~-~-~APP R OV E D FOR '~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must acco/~an~)certificate)
[] DISAPPROVED
A c le ra e
825 "L" STREET
ANC}tORAGE, ALASKA 99501
(907) 264-4111
GEORGE M, SULLIVAN,
MAYO,~I
DEPAIgTMENTOF HEAt. TH AND ENVIRONMENTALPRQTI~CTION
April 14, 1980
James G. Dennington
Post Office Box 567
Anchorage, Alaska 99510
Subject: Lot 1_9 Block 7 Kasilof }{ills Subdivision
Approval for your individual sewer and water facilities
can not be granted until the following items have been
completed:
(1)
The water analysis report be delivered to this
office from Chem Lab, 5633 B Street, for our
review.
(2) The septic tank p%~ped with a receipt submitted
to this office.
If there are any further questions, please contact this
office at 264--4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
CC:
Alaska Mutual Savings Bank
Mortgage ]Loan Department
Post Office Box 1].20 99510
9UNICIPALITY OF ANCHORAGF
DEPARTMEI~. OF HEALTH AND ENVIRONMENlr~_ PROTECTION
825 L Street, Anchoraa~. Alaska 99501
264-4720
#1: Time --i~_~D~ _ #2: Time
Date ~[-I~q~ ~ ~£/ Date
In sp ~_~,~_~ Insp
Date Received: April 10~ 1978
~13: Time
Date
InsD
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER ~ACILITIES~' ' ' '
1. Lending Institution Request:
Mailing Address: Pouch 7-777 99510
2. Property Owner: James G/Judy_C Dennington
Mailing Address: Box 56? 99510
g~enrj_%y hlakiQnal Bank
Phone: 276-680,0/217
Phone: 344-7471
3. Legal Description: Lot 19 Block 7 Kasilof Hills Subdivision
4: Single Family Residence: (x)
Multiple Family Residence: ( )
Number of Bedrooms:
Number of Bedrooms:
Four
Well System:
Permit #
Construction
Individual Well (x) Community/Public System ( )
Depth of Well Well Log on File ( )
Bacterial Analysis
e
Sewage Disposal System: On-site System (x) Public Utility ( )
R & M Engineering report has been ordered.
Permit II Installed Installer
Septic Tank Size A;~ Manufacturer
Absorption Area _ ~O~5__ Soils Rate . /.~'~) Material ~_~t_~
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot l~ne Absorption Area
to Nearest Lot Line
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
2. Property Owner:
Mailing Address:
3. Name of Buyer:
CMRO VA
Jarn~.q O. and Judy C_ DenninAton
Box 567 Anchorage, Alaska 99510
James G. and Judy C. Dennington
FHA
CONV X
Day Phone 344-'7471
Mailing Address: sa~tte Day Phone sa~e
4.Name of Lending Institution: Security National Bank
Mailing Address: Pouch 7-777 Anchorage, AK 99510
5. Name of Realtor or Agent: N/A
Mailing Address: Phone
Phone 276-6800 (ex. 217)
Legal Description: Lot 19, Block 7, Kasilof Hills Subdivision, according to Plat
66-69, filed in the Anchorage Recording District, 3rd Judicial Dist., State of AK
Location: NHN Stro~anof Drive Anchorage, Alaska
7. Type of Facility to be inspected: SFR No. Bdrms. four (4)
8. Water Supply
Type of Supply: Public Utility Individual X
EQ-037 (1/74)
If Individual, number of dwellings presently served c~e
If Individual, depth of well ?
Sewage Disposal System R & I'~ Engineering Report Ordered.
Individual (on-site)
Type of System: Public Utility
If Individual, date of installation
MUNICIPALITY OF ANCHORAG~
DEP], OF HEALTH &
ENVIRONMENTAL PROI'ECTION
RECEIVED
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 19 Block 7 Kasilof Hills Subdivision
Comments:
Affadavit Attached: (
Disapproved:
Letter Attached: ( )
Dahe:
Date:
Department Worksheet: