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Home My WebLink AboutKENO HILLS #6 BLK 2 LT 4 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone:.343-4744 . . On-Site Wastewater Disposal System and/or Well Inspection Report Name: ~~ ~ Wastewater SyStem:. 'D New ~Upgrade Address:~O~ ~C ~. ~ ~[''~[ ABSORPTION FIELD Phone: ~__ +~ ~ NO. of~drooms: ~ Deep Trench ~Shallow Trench ~ Be~ ' ~ Mound ~ Other 7otal Depth from/~al grade: LEGAL DESCRIPTION SoilRa~ng: · G G~D/So. Ft. Lot: Block: Subdiv~ion: ~ ~pth to pipe boffo~rom orig~l grade: ~ ~mvel depth ben~at~pe ~ ad~d aboriginal gra~e: / Gravel length: WEL~: Q New Q Upgrade ~rav~width: ~7 Ft. Numberof C~B,C): Total Depth: ~ Total absorption area: Pipe material: Driller:~ ~~Drilled: Static Water Level: Installer: I DateJnst~lled: ~ ~ J' ~ ' SEPARATION DISTANCES ~ septic TO Septic Absorption Lift Holding Public/Private Manufacturer: ~~acitying~ M~ Number of Compa~ments: Surface ~ ~o+ >~o0 ~u LI~rTSTATION kot ' : : Remarks: ~ ~o;~ o~ ~ V~ oF BENCH MARK Location and Description: Assum~ Elevation: Depa~ment of Hea~Human Se~ices approval 72~18 (Rev, 9/91) MOA 25 ' ":N~W&. WE~TTRENCHES'IS' 75 EAST IS 70q~°FEET / C/O 'G' · C/O ~CH ] C/O OF· 4' PVC (D3034) AT 1/4 INCH PER FDDT MIN, -j, DOUBLE ~H,#1, GROUND WATER AT 10,4 FEET BELOW GRADE,~ AS-~UILT' LOT 4, BK 8, KENO HILLS #6 WARREN KAY ALASKA WATER & WASTEWATER ~ATE, 11/i0/96 DRAWN, GARNESS AS-BUILT I]RAV/tNG FOR LDCATInN DF N,T SEE PLAN FILTER FABRIC nV~R INSULATION AN/~ ~)RAINROCK, SURFACE ORAINAGE ZS I~IVORTEI) AROUN'n THE LI]VER FEET TI] 5,7 FEET BELI]V DRIGZNAL GRADE, A, INVERT DF IIRAINPIPE = 9E,14 (NORTH) 9E,I5 (SOUTH) B, ]DI3'I]N nF TRENCH = 89,15 - , :C~'.~ND.;.I~*EnUN;DVATER TO ]~EPTH DF 10,67' QN 11/3/96, '/I,* '~'~IENCH LENGTH = 69,5 FEET /~, E, 'TI]TAL A~I]RPTION AREA = 596 SO, FT, E, EXISTING SEpTTC TANK INVERT = 96,50. RUN FROR TANK Tn THE FLI]V SPLITTER = 95 FEET CAPPRnX,), LOT 4, BK 2, KENO HILES WARREN KAY ALASKA WATER & WASTEWATER 3~N' OARNESS PAGE 1 OF PERMIT NUMBER:SW960362 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:KAY WARREN & SHARON OWNER ADDRESS:17400 SPAIN DR ANCHORAGE, ALASKA 99516 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) PERMI DATE ISSUED:il/05/96 EXPIRATION DATE:il/05/97 PARCEL ID:02017134 LEGAL DESCRIPTION: KENO HILLS #6 BLK 2 LT 4 LOT SIZE: 100422 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION 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 (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. Alaska Water &, Wastewater 8471 Brookridge Drive'~ Anchorage ~ Alaska 99504 (907) 337-6179 - Fax (907) 338-3246 Consulting Engineers October 28, 1996 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Rel2 Sewer Permit for Lot 4, Bk 2, Keno Hills #6. To whom it may concern: The existing 4 bedroom house is served by a private well & septic system. The existing septic system is in a state of failure, and must be replaced prior to the sale of the house. Comments regarding the upgrade are summarized as follows: qq&~f~, 1. Soils: Attached is a copy of the soils log (~10/28/96). The soil from a depth of 1 foot to approximately 3.0 feet is a bonded mix of silt, sand, and gravel. Throughout the remainder of the test hole depth, the soil was primarily silty gravel. Groundwater was weeping in profusely at a depth of 9 feet and the soil above this level appeared to be fairly dry. It is reasonable to assume that, upon completion of the 7 day monitoring period, the groundwater level will rise to within 9 feet of the surface. I will submit a soils log (to DHHS) indicating the water level (after 7 days), .prior to issuance of a sewer permit. 2. Trench Design: a. Percolation Rate: 21 minutes/inch b. Application Rate: .6 gallons/day/fi2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 1000 ft2 f. System Type: 5 foot wide trench g. Effective Depth: 3 feet h. Total Max Depth: 4.5 feet MUNICIPALITy OF '~'ICHoRAGE. ENVIRONMENTAL SERVICEs DIVISION OCT 5 0 DgG RECEIVED i Width; 5 feet minimum j. Reduction Factor =.58 k. Length: 140 feet. 1. Effective absorption area = 1200 fi2 3. Surface Waters: There are no surface waters within 100 feet of the proposed septic system. 4. Slopes: In the vicinity of the new drainfield, the lot slopes moderately (10% to 17%) downhill to the northwest, and is generally flat in the northeast/soUthwest direction. In short, there are no slope concerns. 5. Wells: All of the adjacent lots are served by private wells, which are much greater than 100 feet from the proposed septic upgrade. 6. Abandonment of the Old Drainfield: The old trench has a total depth of approximately 10,5 feet: Based upon monitoring data, at locations downhill from the existing trench, it appears that groundwater (in late October of a dry summer) varies from 9 to 10.5 feet below grade. The separation distance to groundwater, below the old trench, is unknown. Recent water sampling/analysis indicates that the well water quality is excellent (nitrates undetected, and no bacteria). Unless directed otherwise by your department, it is our intent to save the old lift station and trench as a backup system. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or on my digital pager at. 1-800-481-1162. Thank you for your assistance. Sincerely, M.S. Warren Kay4.wps LOT 3.. ~IK ~o KEND HILLS #& PRIVATE ~/ELL AN]) SEPTIC SYSTEN, 2,35 ACEE LDT. ~ELL IS >) THAN 100 FEET FROM THE PR~DSE~ SEPTIC UP6R~gE ~ LOT 4~ 9K ~, KENS HILLS LOT 4, ~K 2, KENO HILLS #6, NEW TRENCHES, N WELL UN~EVELDPE9 LAN~ EXISTING SEPTIC TANK SEPTIC UPGRA]]E, LOT 4, ]tK 2, KENO HILLS #6 PREPAREB FDR~ WARREN KAY PREPARE]] IIYI ALASKA WATER & WASTEWATER SERVICES LOT 5o IrK 2., KENQ HILLS #6. PRIVATE WELL ANn SEPTIC SYSTEM, ~:.13 ACRE LQT, T~ VELL IS )) T~ 1~ FEET FR~ THE PRDPD~E9 SEPTIC I ~l~.~, ,.~ ~ cE.~ ~ ~., ~' ........ *,~ ~ROFESS~O~~ NEW TRENCHES, LONG EACH, CONNECT AT MID POINT OF EACH TRENCH. 70 FEET C/O THE CONTRACTOR SHALL BE RESPONSIBLE FOR UTILITY LOCATES. THE CONTRACTOR SHALL GRADE THE SITE SO THAT SURFACE WATER DOES NOT POND OVER THE DRAINFIELD AREA, 100,9' , ~ TH THE TOPOGRAPHY 1)BWNHILL DF THE NEW TRENCHES SLOPES FROM 107. TO 177. (WITHIN 50' DF TRENCHES), .OW [TTER 4' PVC (I)3034) AT 1/4 INCH PER FDDT MIN, ~ 99,5 ' TH #1, GROUND WATER AT 10,4 FEET BELOW GRADE, M,T, NEW RUN VALVE- 98,8 ,5 WELL 1850 GALLON SEPTIC TANK, lNG LIFT STA, lNG TRENCH. TOTAL DEPTH = 10,5, TRENCH IS UPHILL FROM TH#l, SEP- ARATIDN TD GROUNDWATER IS UNKNOWN, SEPTIC UPGRADEI PREPARED FORm PREPARE1) DY' DATE' LOT 4. BK 8, KENO HILLS~#6 WARREN KAY ALASKA WATER & WASTEWATER SERVICES 10/88/96 DRAWN~ GARNESS SCALE, 1' = 30' ,A. Garnes~ CE-7953 THE TR~ENCHES SHALL HAVE A MINIMUM LENGTH OF 70 FEET EACH, AND, A TOTAL EFFECTIVE ABSORPTION AREA OF 12.00 SQUARE FEET, -- ~AC,KFILL WITH NA'r'rTIVE SOIL AND MOUND, TOPSOIL & RESEEDING SHALL BE RESPONSIBILITY OF HOMEOWNER. IF HOUSE IS BEING SELLER SHALL COORDINATE WITH BUYER. MONITORING TUBE (TYP,) PERFORATED IN DRAINROCK. ::)VIDE 2 INCHES OF BOARD INSULATION IF BOIL COVER IS LESS THAN ~3 FEET. INSULATION SHALL COVER THE ENTIRE WIDTH OF THE TRENCh,, FABRIC SILT BARRIER DRAINROC,K SHALL BE SCREENED PER M.O,A ~~ 5 FEET WIDE NO TE: 1. TRENCH SHALL RUN PARALLEL TO THE SLOPE C~ONTOURS. FOR LOCATION OF C,LEAN-OUTS AND MONITORING TUBES SEE THE SITE PLAN. ,3. CONSTUCTION PRAC,TICES, AND MATERIAL SPECIFICATIONS SHALL C, OMPLY WITH ANCHORAGE MUNICIPAL CODE 15.65, "WASTEWA TER DISPOSAL REGULATIONS". 4. INSTALLATION SHALL COMPLY WITH SPECIAL PROVISIONS NOTED ON THE SEWER PERMIT. $. SMEARED BOTTOM AND SIDEWALLS SHALL BE RAKED, BOTTOM OF TRENCH SHALL BE LEVEL. 2 INCH MAXIMUM VARIATION BETWEEN HIGH AND LOW SPOTS, DETAIL FOR 5 FOOT WIDE SHALLOW TRENCH: PREPARED FOR: WARREN KAY ALASKA WATER & WASTEWATER SERVICES DATE: ¥0/28/96 I DWN: GARNESS SCALE: I 4 INCH DIA., ASTM F610 PERFORATED PIPE. HOLES DOWN. .PLACE 2' INCHES OF DRAINROC,K OVER TOP OF PIPE, AND ACROSS ENTIRE WIDTH OF TRENCH. PIPE SHALL BE INSTALLED LEVEL (WITHIN .0'1 FEET). Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DE$CRIPTION:._~..~t~ t.&t~..~ ~ ~ SLOPE SITE PLAN 1 2 3 4 5- 6- 7 8 ..--.-~. 9 10 11- 12- 18 19 20 · "~WA$ GROUND WATER , Y S, A W.AT DEPTH? Depth to Water Alter Monitoring? IO-~ Date: COMMENTS Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE__ ~-~* ~j , m,nutes/mcnj PERC HOLE DIAMETER TEST RUN BETWEEN "~ FT AND 4,,~" FT ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: " /* Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED POR: LEGAL DESCRIPTION: 1 14 ( I=~ ..... ,.,.,,~,~;h · DATE PERFOIR~%~ Township, Range, Section: ~ SLOPE SITE PLAN WAS GROUND WATER ~-~ ENCOUNTERED? iF YES. AT WHAT DEPTH? BonJt~rin§? Gross Net Depth to Net Reading Date Time Time Water Drop ) '~' ~ ~ s~ I ,~/~. PERCOLATION RATE ~ ~,,,~. ~;' TEST RUN BETWEEN ~' (minutes/tach) PERC HOLE DIAMETER _ FT AND ' FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /O/~.- ~/~/o ~: ' 825 L Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DEscRiPTiON: ~ ~ ~ ~ Township, Range, Secbon: 5 6 7 8 ~-.-9 10 11 12 13 14 15 1 17 18 19- COMMENTS SLOPE SITE PLAN $ DEPTH?IF YES' AT WHAT I~r'~ ~t~,.~.¢~o LMonitoring? j,-,/ Date: , Gross Net Delsth to Net Reading Date Time Time Water Drop ,o/~/~ ~_, ~ ~ I : I ~',L/' PERCOLATION RATE ZO * ~. (minuteshnch) PERC HOLE DIAMETER TESTRU. BETWEEN 4 FTANO 4,~' FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.~[~E: 72-008 (Rev, 4/85) MUNICIP/~.ITY OF ANCHORAGE ~ DEPARTMENT OF~ HEA~H & 'EI~v IRO NMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT IPHONE ~NEW MA RESS PTION LOCATION DISTANCE TO: M a n u f.~"e r A DISTANCE TO: IF HOMEMADE: Well Manufacturer Well DISTANCE TO: No. of line -)_ I Le _Aeec 2e Top of tile to finish grade I Absorption area DwellTg~, Matt~~~'/-~ Inside length Wid Dwelling Material Founda~3 / Nearest~t~li~e Total I;~ of li~es Trenc[~:~ Materia~ b~en~at h tile ~ Depth Type of crib Crib diameter Crib depth Well Building foundation DISTANCE TO: Class Depth Building foundation DISTANCE TO: Driller Sewer line NO. OF~DROOMS PE N , ~ No. of ~a~rtments Liquid depth PERMIT NO. Liquid capacity in gallons D st~/~:~een nes inches inches Totalf._~bsorption area IPERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Sept c tank PERMIT NO. Absorption area(s) OTHER M~TERIALS SOIL TEST RATI N~]~ ~ KS APPROVE[ DATE LEGAL 72-01 ~ev; 3/78) M-VV DRILLING, Inc. P.O. Box 10-378 · 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner WARI~,~ YJLY .Use of Well D~mastic Location (address of: Township, Range, Section, if known; or distance main road Lot: 4 Block 2 Keno }tills Subdivisic~ Size of casing &" Depth of Hole !70 feet Cased to93.0 feet Static water level 115 Screen ( ); Perforated ( Describe screen or perforation None Well pumping test at_~gailons per ~ of drawdown from static leveL. ft. (~ (below) land surface. Finish of well (check one) open end ( xxx ); (minute) for 1 hours with Date of completion Depth in feet from ~round surface 0 TO 2 2 TO 12 12 .TO 16 16 .TO 22 WELL LOG penetrated, ~-N Vii~ONM~NTAL 22 .TO. 31 31 .TO 35 35 TO. 46 46 TO 51 51 .TO. 63 63 TO 70 Hard Clay with grawl (damp) 70 TO. 75 Hard dry clay, 75 TO 83 83 TO 90 90 TO 144 144 TO 145.5 145.5 170 Clam wi~h ~ravel, loose (browa) Clay, with ~ravel, hard Fray B~drock Be~, sm~ll water seeps a~ sporadic fractures 3--CONTRACTOR INSPECTION REPORT MUNICI~,,,,'ZlTY gFANCHORAeE~ BUILDING SAF~.~ DIVISION ~ ' 35~0~A,8~ TuDoR ROAD ' INSPECTIONS (907) 563-3464 ADMINISTRATION (907) 786-8211 NAME STREET ADDRESS FOOTING ~ ELEC. TEMP. ~ PLBG. UND'GR. FOUNDATION ~ ~ ~LEC. SERVICE , ~ PLBG. RO~G~ SOND B~ ~ ~ ELEC. ROUGH '~ GAS TEMP. FRAMING ~ EL~C. FINAL ;~ GAS . INSULATION ~ OTHER !~ ?t ~ MECHANICAL - S~EETROCK ~ ~,e,~ ~ ~t~ MECH FINAL 8~RUCT. FINAL ] FIRE FINAL ~ PLBG. FINAL OTHER ~ ZONING .~ OTHER ~ NO NONCOUPLIA~CE OBSERVED --~ CORRECT!ODS ESsEnTIAL AS ~XPLAINED BELOW ~ W~LL REeXAmiNE AT N~XT ~NSP~CT~ON ~ DO ~OT CONCEAL ~', O~ COMMENTS ~ ~ /,~/i~ NS~E~?:.OR WHEN CORRECTIONS ARE MADE, PLEASE CALL FOR INSPECTION" DO NOT REMOVE THIS: NOTICE '- -- 84-002 (Rev. 2/83) PERMIT NO. A~'PLICANT WARREN C. KAY 2406 INDIANA ST. LOCATION. 9999 LEGAL LOT 4 BLK 2. KENO. HILLS SLB LOT SIZE El.iV I R. ONMENTAL '~: TEr'T I C N DEPARTMENT ~HEALTH Ai'~D ... :~ .-,.=; ....... ¢--4~ t · =,,¢.._ L STREET.,,, 'ANCHORAGE., AK. 9_~501 ,¢.4 4¢=.0 ~__-v ,... 9999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING <SD FT?BR)= ±25 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:"EPTH= 11 L Ei'-t"3 T H-- 27 6P.R"v"EL DEPTH= 7 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 ENCAVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES, THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET) RED SEF'T I C TRi"-~I< S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE '- " '-- ' INSTALLF~TION IN_~PEt..TION_, OF ANY WELLS ADJA_.ENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THRT THE WELL WILL SER'¢E T~.C~ (2) I NSPFC:TICff4S BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF' PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET: WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN gO DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS 8RE AVAILABLE TO INSURE PROPER INSTALLATION. PEi:~:M I T E:=-IP I RES DECEI'lBEF-: ]-~1. ::i_982: i CERTIFY THAT t:-I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2~ I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~ I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. 'AF'F'LI!]=~I{. WARREN C. KAY / T.H. 3 10/5/76 0.0 ORGANIC SILT Dark Brown 2.0~ GRAVELLY SAND w/TRACE SILT (SW) Occasional Cobbles, Brown 15.0' SAND W/SOME GRAVEL AND TRACE SILT Brown 18' T.D. No Water Table 10/5/76 ORGANIC SILT Dark Brown SANDY SILT SAND w/sOME SILT AND TRACE GRAVEL Brown .__ 0.0 1.0 2.0 .3 . 5 GRAVELLY SAND W/TRACE SILT Brown Boulder at 8' 10.5' SAND W/SOME GRAVEL AND TRACE SILT Brown t3.5' GRAVELLY SAND W/TRACE SILT Occasional Cobble Refusal on Boulder au 18' 18' TD NO Water Table KD: CAI..E: 1"=3' TEST HOLE LOGS HOWARD I~OEN ANCHO]~AGE, ALASKA - e_q ~1. :? Parcel .D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING V ? Z 1, GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, .provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (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 verifythat 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. DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date /1 - /2 - ~'~ 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, I/91) Bac~( MOA~I Legal Description: A. WELL DATA Well type ~q~[- ' Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production Municipality of Anchorage ~,,,MUNiCiPALiTy DEPARTMENT OF HEALTH & HUMAN SERVICES~oN~NrAL Environmental Services I~ivision 825 L Street, Room 502 · Anchorage, Alaska 99501.. (907) Health Authority Approval Checklist ~o"~' ~-j g~j [d_.?..,.50 ~--~u.A -'.1:~(~ Parcel I,D,: If A, B, or C, attach ADEC letter. ADEC/w~ater system number ~---~' Date completed ~/~/~ ~ '"7 {~ Cased to C:~,~, Oo Casing height (above ground) ',-{~_--~ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION I I /l O ///~ ~ ~ .~ . ~_, t~ gpm}.m. ~' ' ~ ~ Other bacteria ~ WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: /c~/~D/c/ B. SEPTIC/HOLDING TANK DATA ~----~'~-'-') ""'~ ~'~ Date installed ~/~-~ Tank size I ~ ~-"~) Number of Compartments ~- Cleanouts (Y/N) Foundation cleanout (Y/N) "~ ~-- ~ Depression (Y/N) /~ D High water alarm (Y/N) Date of Pumping IO/Ct~ Pumpe, e_r ~,~c~::> ~ c C. ABSORPTION FIELD DATA, ~ ,~-~--'"~ Date installed "/~/~/(~- t'/c//~'~ Soil rating (g.p.d./ff~ cr ff,~/bdrm.).: ' Length. I z~c~', ~' Width Effective absorption area V Z.O~3 '~' Gravel thickness below pipe System type "'c'~--~=~'J~:'H Total depth ~,, ~ ~ -7. I Monitoring Tube present (Y/N) '~/ Depression over field (Y/N) ~ O Date of adequacy test I',J~,.v,-J Results (Pass/Fail) ~ For '"'"'- Fluid depth in absorption field before test (in.); Fluid depth ,,---"- (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) bedrooms Immediately after ~ gal, water added (in.): Absorption rate = If yes, give date g.p.d. 72-026 (Rev. 3/96)* D. Date installed ~ Size in gallons ,.,..-,-----"'"-""- ~ff Manhole/Access (WN) "P ....... level at High water alarm level at* -~'~'~'"'~'~*Datum ~ E. SEPARATION.DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I ?--~ '~ Absorption field on lot ~ O ~/~ On adjacent lots On adjacent lots Public sewer main ~ I~'- Public sewer manhole/cleanout Sewer/septic service line ~ O '~/~' Lift station /I SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~ ct / "' -- Property line -'70 Absorption field ~ Water main/service line '~ ~ (3 .Surface water/drainage ~ oo/ Wells on adjacent lots SEPARATION DISTANCE pROM ABSORPTION FIELD O.N LOTTO: / / Property line ~'~5 4. Building foundation --~' I ~ Wate? main/service line Surface water [ 'Z. O ~ '~ Driveway, parking/vehicle storage area IO Curtain drain b.~ o~1~ ~o~.~M Wells on adjacent lots '~ '~ I c>o F. ENGINEER'S CERTIFICATION inconform~ewitlMF~~~~thisdato.°fMunicipalroc°rds~/~~~° Signature' ~.~. ,: ~ Engineer's Na~ ~~ HAA Fee $ ,~'J. Date of Pay~ Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ental Services Inc. ratorY Analysis Report r Services Client PO// Printed Date/Time 10/22/96 16:38 Collected Date/Time 10/20/96 13:10 Received Date/Time 10/21/96~ 11;15 Technical Director: Stephen C~i'Ed~' · Released Ky.~"-'~ AlLowable Prep AnaLysis,~. ReSUlts. PQL Units Method Limits Date Date-r '~ init 0.100 u 0.100 mg/L SM18 4500-NOZF 10 max 10/22/~6"~MB 0 0 cot/lOOmk SM18 92ZZB 10/21i~:'iAv 200 W, Potter Drive, Anchorage, AK 99518-1605 -- Tek {907) 562-2343 Fax: (907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-5471 -- Tel: (907) 474-8656 Fax: (9071 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND. MICHIGAN. VIISSOURI, NEW JERSEY· OHIO. WEST VIRGINIA 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 Parcell.D.# ~);~:r~j~ _ ~--~ ~_~_c_~L.\ HAA# GENERAL INFORMATION Completelegaldescription /--- ~ /~ ~- ~ G/~J' "~'~./ //~---/'~(~) ~/'/J/-~ Location (site address or eirections) /7-~'~~)~) ~F~9~//r2 ~ff~'~//q~-- Property owner /~., ~ ~/~/~'-~' ~'/¢~T/'~/"~- /'~c~ ~ Day phone Mailing address / 7~0 ~//~' ~~ ~- Lending agency ~/'~,~ ~ ~~/~~Dayphone Mailing.address ~ ~ ~ / ~ ~2 ~ ~ ~' ~/~ Agent ~ :~ ~ ~ ~ / ~ / Day phone Address Unless otherwise requested, HAA will be held for pickup, NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: tf 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, I/91) Front ~4OA#21 STATEMENT OF INSPECTION BY ENGINEER As certified bymy 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 ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm''-~c~'~z~ ,.~/~,~. ~'/~O)~-~ ~ ~5~]~hone. ~~ ~ Address ' ~ ~ ~ sionature ~~~~~ Date ~HF~; Engineer's ~ ~/__.. ~ ~ M ~ . DHHS SIGNATURE ,~ Approved for ¢ Dis,a. pproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 1/91) Back MOA~21 Muh~cwpahty of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL 'CHECKLIST A. WELL DATA Well type.~/~(~ ~tC~- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~/ Date completed ~"/" ~ )~)~--~ Driller Total depth ~"7~ r / Cased to c~, ,~ , ~. Casing height . . Sanitary seal (Y/N) ~, Wires properly protected (Y/N) Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot [ Absorption fieJd on lot Public sewer main Public sewer service line .~:~. FROM WELL LOG 'I I-5z ~_~.~j~ Q'G'"~ g.p,m, /(~?, o p-+, AT INSPECTION ; On adjacent lots ?1 On adiacent ,ors t I ~P ~ C"/~¢~ :~ Petroleum tank ~_/~ WATER SAMPLE RESULTS: Coliform /~(~ ~' 'Nitrate -.~ _('~' / Date of sample: ~ -- '~-~ "~[ Collected by: Other bacteria ~ C:),~'Z ~, B. SEPTIC/HOLDING TANK DATA Date installed ?/ Cleanouts (Y/N)'~. "~ .... ' Foundation cleanout (Y/N) ~ Depression (Y/N) . ~" ,,'~ ...:~,~ F,,,'".,. Highwater..;ia~'(Y~)?;?~.: :";:'~] Date of pumpi~ Well(s) on ,o, TO property line Surface water/drainage 72-026 [Rev. 3/91] Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) ~' "Pump on" level at High water alarm level ~ ~ rr Meets MOA electrical codes (Y/N) /N~ Manufacturer /~ ~----~/~ ~.-O Manhole/Access (Y/N) Y "Pump off" level at /~ Cycles tested ~---~ SEPARATION DISTANCE FROM LIFT STATION TO: ! Well on lot [ ~-- ~-~ On adjacent lots Surface wateh/O 0 D. ABSORPTION FIELD DATA Total absorption area Depression over field (Y~i~ Results (pass/fail) ' Peroxide treatment (past 12 months) (Y/N) Soil rating Gravel thickness Cleanouts present (Y/N) ,~_ Date of adequacy test for /~/6~ ~/~ (~U,.Jfi~.//~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /"~ ~) / On adjacent tots /(~'~/ (-'/' Propertyline To building foundation ~ ~ 1 (_.~L~. To existing or abandoned system on lot Onadjacentlots ~-~ l~-'~ / Cutbank ,,~t~ ~ Water main/service line Surface water /~.2/~ ~)~'~/'~(.:/~, Driveway, parking/vehicle storage area 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. Signatur~ Engineers~/ame ..~,¢~1~---~' ~,, ~ ;~/Y~/'~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL WAY FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645 James Sizemore 6410 Switzerland Dr. Anchorage AK 99516 Attn: - Report Date: 04/29/91 Date Arrived= 04/25/91 Date Sampled= 04/25/91 Time Sampled: 1030 Collected By: JS Our Lab ~: Location/Project: Your Sample ID: Sample Matrix= Comments: A109789 L4B2 KENO HILLS Water Flag Definitions U = Below Detection Limit DL Stated in Result B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Method Parameter Units Result Flag Analyzed EPA 300.0 Nitrate-N mg/1 0.1 U 04/26/91 Reported By= William E. Buchan Anchorage Operations Manager MUNICIPALITY OF ANCHORAGE ~ OEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~' A GENERAL INFORMATION Legal Description (include Iot,,~, subdivision, section, township, range) Location (address or directions) (b) Applicant Na,,',e~:~ Telephone: Hm ~7~ Businoss:~/~¢ lc) Applicant is (check one~: Lending Institution ~; Owner/builder~; Buyer ~; Other ~ (explain); (d) Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: he ?icl: TYPE OF RESIDENCE Single-Family,~ Multi-Family [] Number of Bedrooms ."~ Other WATER SUPPLY Individual Well ~[. Community [] Public [] Note: If community well system, must have written cc r~firmation from the State Department of Environmental Conservation attesting to the legality and status. 4, 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. 72-025 ( 11184~ Page 1 of 2 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-s~te water supply and/or wastewater disposal system ~s in compliance with all Municipal and State codes, ordinances, and regulations in effect on ,he date of th,,,n.. ect,on. Name of Firm J~ ~¢~ ~ ~ ~¢~ phone ~~¢ ~ ~ DHEP APPRO C , .~. Approved for Ix ' bedrooms b L..-" ~ Approved .'~.,--'- Disapproved Conditional Terms of Conditiohal~\ Approval CAUTION The Munciparity of Anchorage Department of Health and Environmental Protection (DHEP] issues Health Authority Approval certificates based solely upon the representations given m 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 (~ t/84~ MUNICIPALITY OF ANCHORAGE (MOAT' HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description:: ~"'~-'~ WELL DATA Well Classification ~ r / [,'/O~ ¢ ~' If A, B, C, D.E.C. Approved (~_~,) Completed ~----~/~" _~;'::LC~~'~ Yield Well Log Present (Y/N) Y Date Total Depth /7 ~ Cased to ?5' ~ Depth of Grouting Static Water Level --//.~ ,~ ,'2f---; ' - Pump Set At Casing Height Above Ground / -- Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ~ Depression Around Wellhead (Y/N) Separation Distances frbm Well: / - ~ To Septic/Holding' Tank on Lot / ("~'~ ~--.~L.) ~ ;On Adjoining Lots To Nearest Edge of Ab~°rption Field on. Lot /~(~)~(~ ~''/')~On Adjoining Lots / To Nearest Public Sew&r Line /~/~Fw'''' ~ To Nearest Public seWer Cleanout/Manhole ~//_~.. · ~ To Nearest Sewer Service Line on Lot Water Sample Collecte~ by ~ /' '~ ~'~'~f-°/"~r"=' ;Date .,,~,/,~._/ Water Sampl Test Results ~ °~'¢ l" ~"~. ~_~7{'~- '~/'~z~ Comments~)~; ¢P~/'7'2 C.~:;:). ' SEPTIC/HOLDING TANK DATA Standpipes (Y/N) Y Air-tight Caps (Y/N) y Foundation Cleanout_(Y/N~ ~ _ Depression over Tank (Y/N) ~ Date Last Pumped pu mping/Maintenance iContract on File (y/~.~//3//'~ ;for Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Peri-(YIN) Separation Distances from TO Water-Supply Well / TO Property Line --~ To Water Main/Service Line course /~O/ Comments ~ ~¢~ 4~ TO Building Foundation ~r ~_¢ ,.~ ~' ~ ,.To Disposal Field -"~-{~ / ~ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-02601/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata _ ' ,j ~'~::)~'/~ ~ Type of System Design Date,nsta,,ed o, Width of Held ~ 11 ~ /~ / Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / ~)~ /f"~.~ To Building Foundation - LOt /~ / ]~j- ''' /! To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Depth of Field G~vel Bed Thickness ~' ! Standpipes Present (Y/N) Date of Last Adequacy Test ~¢,/~-,./~---'~ To Property Line ~-5 To Existing or Abandoned System on Adjoining Lots /O ~ /~7~.) To2utbar~k (if present) LIFT STATION Date Installed Size in Gallons "Pump On" Level ~ Dimensions ~ Manhole/Access (Y/N) /V -,-'-'- "Pump Off" Level at High Water Alarm Level at ~ ~ U/ Vent (Y/N) Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ~~ ~[~ ~~. ~ ~ .~~ '* Oh~k Permitted Bedroom R~tJng Against HAA Request '* Signedl codifY t~ have c~k~xri~ °r:°nf°rme~M~t~HAA guidelines in effect °n the date °f this 'nspecti°n'~~~. Date ~ r/~ comfy Date of PaYment ,~ -- ~ Amount: $ ~ ~ Seal Page 2 of 2 72-o26 (11/84)