The URL can be used to link to this page

Home My WebLink AboutKENO HILLS #2 BLK 4 LT 8 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE ~L~I ,~NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION ~ Absorpt~n area Dwelling ~ DISTANCE TO: [ Well ~ [~ No, of comp~tments ~ ~ Material: ManuJacturer ~C~ Inside length Width Liquid depth Liq, capacity in gallons tj_50 IF HOMEMADE: Well Dwelling PERMIT NO. , ~ ~ Z DISTANCE TO: O ~ ~ ~anufacturer Material Liquid capacity in gallons )ERMIT NO. Q Well ~ Foundation [& ~e~r~t ~°t ~i"e ~ ~ DISTANCE TO: ~o~ -- ~ length of each line Total length o~r~ Trench widt~ ~ Distance~etween lines ~ No.o~i~.~ I ~> ~O Top of tile to finish grade Material beneath tile ~ ~ inches ~ ~ ~ E" V~';~ ~/ ~,~P~ PERMIT NO. ~ Length Width Depth ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ ~ Nearest lot line ~ Well Building foundation ~ DISTANCE TO: Class Depth Drillbr Distance to lot line PERMIT NO. ~ Absorption area(s) m Building foundation Sewer line Septic tank ~ DISTANCE TO: __ OTHER PIPE MATERIALS ~ SOl L TEST RATI N G ~ ~ NSTAELER / .... ...... APPROVED DATE LEGAL - 72-013 (Rev. 3/78} · ,.,::. Z3T&.Tg O~*ALASK& ' O£PA~TMIrNT'O/=' N~.'S'URAL flESOUII~'S Orilli~! Ptfmtl Ne. -x. O. 1.. He.. ~'-"'"""'"" ~'1~'!~"'"*" '""'"""-'~" '~'""' . ~ ~KR o~ w(LLI ~;/~ ~ / Depar~_~ment t/-'~ Heal'th ~and B,2:5 ~Street, Anchorage,~kK. ~581 * '*'* HANDWRtTTEN'-PERMIT '* ~ ~* SRAVEL DEPTB.. WIDTH, t~en'~' 'or ~pit ~ t,be" di~anee.-~tween;:.~he ;:s~fac'e th, e g=~nd, and :the .ex~.~ion(':~.."feet) % ~here'. is. no set ~iS'tkn:f:or ~re:ches. ic~t ~ the'~esp'on's~ity, to ;'info:~'th~'s dep~r.tment during the ;~pec~ions of .{any wells 'ad jack: .t:o .:,,h4-s property '-and' the ~ *: ~* TWO;(2) I NS.PECTI ONS '-,ARE . i~ 2.5 ':f~:~' a~d to ~ :co~u~ty.-ss:~r .t~e:¢,'~;: ~3.~met. W,el~2lOg;s .ired' a~:,,!must,:~. 're;~nrnsd'::~o<'~hi;s d~pa~ment ~it~n-',3~0 ,d,aY's 5~"~'~h~ well comp'l_eti0n,¢. ~ (1); ~'i~,..,~-:~:~i:t~ar-:~i~:~e r.~uir~nts"~r ~:-~s~'s~ 'and wells as,, -~(,3} ' J;I'?':~unS~=st~nd~:,;~hat %:~:'D'n~site:"s:ewe'r":~Y's:temT~maY":r~ir'e":en'largement Lf~ ':~he -~-ezida=ce ..,~;' r.emO~el'ed '~ to:'' in~'l~d'e':'~re-,;~a~ '3 :h~r'ooms · Date": :SWR/0.2 4 (1/;8.!1 PERFORMED FOR: LEG'AL DESCRIPTION: 2 3 4 5 6 7 8 9 10 12 14 15 16 17 18 20- COMMENTS PERFORMED BY: 72.o08 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST Lo~ B DATE PERFORMED: ~:~. JB- B~-- SLOPE WAS GROUND WATER ~¢.~ S ENCOUNTERED? L O P E IF YES, AT WHAT ! DEPTH? 15 SITE PLAN Gross I Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: Z ~-- (minutes/inch) ~" . FT AND FT Municipality of Anchorage files and from my invest gat on,and nspection the on-site Water 7'supply'and/or wastewater disposal system is ~n compl ance w~th all Municipal and State codes, .ordin~nces~and~[~ul~tions~in, eff~t on the date of this inspect On ~?~:;;::~ ~}~:g~.~,:;: ~X:;~', '~.:, ~'~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street. Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: A. WELL DATA Well type p Log present (Y/N) Total depth Sanitary seal (Y/N) Health Authority Approval Checklist Gloeh' ~ I~,,o 19'~lt~ Parcel I.D.: IfA. B. or C. attach ADEC letter. ADEC water system number Date completed . I ~ /8 Z. Cased to °r_ I' Casing height (above ground) ~' Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test I 0 / [ ~ / g ~ 7 / ~-- Y [ q -(' Static water level 0 ' I 0 ' Well production I, 5' g.p.m. I ,.5' WATER SAMPLE RESULTS: Coliform 0 tol /t OO rn,~ Nitrate Dateofsample: 7/Z¥ /9~j t~/¥/~o~' B. SEPTIC/HOLDING TANK DATA O. -/2i' ~,/.~ Other bacteria Collected by: ~'l~h~t~,p 7'~cA~'~¢ ~/ Date installed I o /~-/~ Tanksize t~,S'o~aI Number of Compartments '~ Cleanouts(Y/N) Foundation cleanout.(Y/N) N Depressmn (Y/N) N High water alarm fi/N) Date of Pumping 5'/t$/~5- Pumper .2-.featta£ C. ABSORPTION FIELD DATA Date installed ! 0/3' / ~' Length -~ 7' Width Effective absorption area 7 Date of adequacy test 7 ! ~'// Soil rating (g.p.d./ft2 or fi2podrm) ~System type $ Total depth Gravel thickness below pipe Monitoring Tube present(y/lq) ¥ Results (Pass/Fail) pa,t,[ Depression over field (Y/N) N For ~ bedrooms Fluid depth in absorption field before test (in.); O Immediately afierqo"Ogal, water added (in.): Fluid depth ~'t:9 Minutes later: ~ un.) Absorption rate = ~ fi,Ct::;' g.p.d. Peroxide treatment (past 12 months) (Y/N) I~On4 I<:no~ If yes, give date /q. ~, D. LIVI' STATION ~. Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~ O yt ~ ¢. o, Absorption field on lot' I Public sewer main Sewer/septic service line "Pump off" level at* ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout ~> Z .¢ ' Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation J' ~ ~ro~ c. o, Property line -.~ ? ~,, Absorption field ~ ' Water main/service line > $0' Surface water/drainage n- t./g ~ ~Wells on adjacent lots '~ too' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Water main/service line ~ .~o, Building foundation Surface water ~ 7 t ~ ~ Driveway, parking/vehicle storage area Cunaindrain g~[~ o~e~ ~e(~ellsonadjacentlots ~ ENG~ER'S CERT~CATION I certi~ that I .hm'~ d~t~ne_ ..::_~ field i,spectlons and review o in conformance with MOA H~ guidelines in effect on this date. Engineer's Name ~'h ~o ~'a,~ t~. /"~oo~-( Date ~THEODO~E F. ~OORE ~ ,~ CE.3589 HAA Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc 7 7 Waiver Fee $ Date of Payment Receipt Number J CT&E Environmental Services Inc. CT&E Ref,# 95.3095-3 Mat rix WATER Client Sample ID L8 BLK4 KENO HILLS Client Name FLATTOP TECHNICAL SRV Ordered By TED MOORE Projecc Name Project~ PWSID UA WORK Order Printed Date Collected Dace Received Date Technical Director Released B~--'-'~ __ =~ . 16564 07/27/95 ~ 13:53 hrs. 07/24/95 % 12:40 hrs. 07/24/95 % 14:50 hrs. STEPHEN C. EDE Sample Remarks: SAMPLE COLLECTED BY: T.F. MOORE, QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nicrate-N 0.73 mg/L EPA 353.2 10. 07/25/95 CMR See Special Instructions Above UA = Unavailable ~ NA= Not Analyzed ~*~ See Sample Remarks Above ~ = Undetected, Reported value is the practical quantification.limit. LT = Less Than ~D = Secondary dilution. GT = Greater Than ./ PLOT PLAN AS BUILT '~ SCALE ?_.,4.,o, 0~ \"=,~O' GRID :5~'~ JOB'No. 1731 George Bell Circle Anchorage, Alaksa 99515 (907) 345-6476 I Hereby Certify that I have. surveyed the followin8 described property: Lot ~ , Block ,¥ , ~-.~NI~ ~I~,L.~ ~pl.,~,, ~,i'~tTt~'4 I,,l~ '~ ~t.~:~, Recording District, Alas. ka~ an~ that the improvements sltuatcd thereon ar~ within the property lines and do not encroach Onto the property adjacent thereto, that no improvements on the property lying adjacent .thereto encroach on the surveyed premises and that therg are no roadways, transmission lines or other visible easements on said property except as indlcatcd hereon. Dated this the ~.~'~. Day of ~J~l~( , 19~'~ , at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on tile recorded subdivision plat. 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. # 1. GENERAL INFORMATION Complete legal deScription Location (site address or d irections) (o/-.J..,Rl ROSE MOMT D[Z~,vE' Property'owner K~N ~£CK LE¥ Mailing address ~,q3 I RO$&MoNT Lending agency N~f'I Mailing address ~'.4~. G~, ~o7oz5-~ Agent (,c/~/~M? /./ocuc~ro(~ g~_ I'-/~. F~-o/~r'F~ Day phone Address ~ d' O0 ~orc~o~- Unless othbrwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Day phone 3q5- ~tESz Day p hone /I-~< q~)¢lO '?_. 70' - ?-.,~'d / Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual o n-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOA#21 J STATEMENT OF INSPECTION BY ENGINEER As certified by my Seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm F:L,41'T°? T&C/~. ~£RviCE'~ Address ]~53o EChO ST, /~N6~]oI~/~c'-~ /~,~' Engineer's signature ~'~'~(._¢_ ~, ~d.o-~.~ Phone Date DHHS SIGNATURE ~/ Approved for "~ ~. A .,~..;~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT ~: BLg u~ KENO ~ULL5 Parcel I.D. A. WELL DATA Well type DIet,lATE Log present (Y/N) Y Total depth 'g 5' Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed t0J'2.~/~'2 Driller Casedto 21 Casing height 32, Wires properly protected (Y/N) Y Date of test Static water level O Well flow I. 5 Pump level FROM WELL LOG g.p.m. AT INSPECTION MUNICIPALITY OF ANCHORAGE E:2:[~.O.HMENTAL SERVICES DIVISION 2 0 199;3 RgEpCmE i V E D SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot IoN ' Absorption field on lot J II. Public sewer main Sewer service line ~/oo [ ; On adjacent lots ; On adjacent lots '~/oo Public sewer manhole/cleanout N.,A, Petroleum tank ~o~g O~SE,~v'ED WATER SAMPLE RESULTS: Coliform 0 col / fO0 r~ Date of sample: Nitrate ~¢/'~- Other bacteria O col/~Oo Collected by: FLATTOP TECH, B. SEPTIC/HOLDING TANK DATA Date installed~ IoJ /sz C eanou ,ts (Y/N) Y High water alarm (Y/N) Tank size 12_ 50 GA ~- Compartments ;Foundation cleanout [Y/N) ku Depression (Y/N) ht.A. Alarm tested (Y/N) ~,/I . Date o[ pumping ' 7'/',~o /,9_"¢ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot lo"/' ¢'¢om (',~, Onadjacentlots '~' /oo' To property line > 2.0 Absorption field 8 Surfacewater/drainage ~ ye.' ($¢¢ cc,~i~,¢.~ Foundation Water main/service line FRo~ C.O, # '~ ~o 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed !o/s/g7- Length '77 Width Total absorption area 7J'~ Depression over fie.d (Y/N) N Results (p.ass/fail) ~o~$ V~c~f-~r (~,,~1 5,, lm7'. ~ /.~/ = o~ Peroxide treatment (past 12 months) (Y/N) NoN.£ System type Total depth '7 ¥ Soil rating Gravel thickness /+~ Cleanouts present (Y/N) Date of adequacy test for ~ bedrooms If yes, give date N,/~, To building foundation On adjacent lots ,,~ 2,o ' SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot I17- On adjacent lots ~ Ioo Propertyline J To existing or abandoned system on lot Cutbank N,A, Water main/service line Surface water ~ 3/° (~e¢ u..~.,vr r~.) Driveway, parking/vehicle storage area Curtaindrain cro~ ~ ¢~r ~1~ ~ &~ ~,~'~,'" ~-(~/'_~ ! ~3o 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. Signature Engineer's Name Date ../~ HAA Fee $ /7{`) 0~'~ Date of Payment '~- ~0- ~3 Receipt Number --.')-~ ¢ ~L~ 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ -:5-'~D Date of Payment Receipt Number'''~?~?'~- ~ Tom Fink, Mayor MuniCipality of Anc ra e Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 27, 1993 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 8 Block 4 Keno Hills #2 Waiver Request ~WR930044, PID ~020-171-20, HA930413 Dear Mr. Moore: Your request for a waiver(s) of the required 100 foot horizontal separation of a septic system to the surface water 'has been approved. The approved separation distance(s) are drainfield outfall of a foundation drain of 30 feet and 75 feet from the surface water drainage. This waiver approval applies to the existing septic system to surface water separation only. Any future upgrade to the septic system will require all separation distances be met or another approval from this department. Should the operation of the subject wastewater disposal system cause any contamination or degradation of the subject surface water, this waiver will become void. Sincerely, Daniel J. Roth Civil Engineer On-site Services ~th, P.E. Manager On-site Services ljm:~5 J~ENO HILLY '-~tl. OI= 30 ~ ~,D ~5' ' l~remm ,~ ~W,~/iv~6£ 5'~.~t~co -- / 6~R~Y ~t~lVE(~.~ PH: (907) 345-1355 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 July 20, 1993 14530 ECHO ST. ANCHORAGE, ALASKA 99516 Dear Sirs: By means of this letter we are requesting a waiver allowing the existing wastewater disposal System serving the residence on Lot 8, Block 4, Keno Hills S/D to be approximately 30 feet from the ouffall of a foundation drain which carries water during the early pan of the summer and approximately 75 feet from a surface water drainage course which also carries water in the early part of the summer. A site plan and copies of other relevant backup documents are enclosed for your review. According to the as-built inspection report on file at DHHS, the wastewater disposal system was installed in October of 1982 and consists of a 1250 gallon septic tank followed by 77 lineal feet of 5 foot wide soil absorption trench drainfield containing 42 inches of sewer gravel beneath the horizontal distribution pipe. The soils log prepared prior to construction indicates groundwater to be at 13 feet. On June 4, 1993 we conducted adequacy tests of the water supply and wastewater disposal systems. The well yield was measured to be 1.1 gpm when the water level was drawn down to the vicinity of the pump intake at 85 feet below ground level. The house was occupied prior to our test, and the sump at the end of the drainfield was found to be dry at the start of the test. The bottom of the sump was measured to be 77 inches below ground level. A total of 415 gallons of water was pumped from the well over a 5 hour period and added to the wastewater disposal system through the cleanout at the upstream end of the drainfield. At no time during the test was any fluid buildup ever measured in the sump at the downstream end of the drainfield. We based our conclusion that the system continues to function adequately for a three bedroom residence on the demonstrated surge capacity, coupled with the fact that no fluid was even close to the level of the horizontal distribution pipe. In the course of the adequacy test we noted the presence of an outlet pipe from a foundation drain which was disch~ging approximately 5 gpm of water at a location 36 feet away from the cleanout at the upstream end of the trench. The water from this pipe flowed approximately 20 feet along the surface of the ground before it was absorbed into the underlying soil. The homeowner informed us that the drain was installed several years ago to eliminate water infiltration during breakup which occured along the east side of the house foundation. The rear of the house was excavated into the side of a hill, and it appears that there is a con£ming layer in this area which caused groundwater to flow into the house and is now discharged through the foundation drain. As is indicated on the site plan, the drain ouffall is 30 feet from the closest part of the soil absorption system, and it appears that the diSCharge pipe passes directly over the beginning of the soil absorption drainfield. There is no reason the pipe would be perforated as it passes over the drainfield. We also noted a second small seasonal surface flow which originates southeast of the residence and passes through a culvert under the driveway. The outlet of this culvert is 77 feet from the septic tank cleanout and 81 feet from the cleanout at the beginning of the soil absorption drainfield. On June 4 this culvert was carrying an estimated 10 gpm flow. This water was also absorbed into the underlying soil within less than 50 feet. No surface water or discemable drainage course was observed in the northward trending swale into which both of these culverts discharged. To get a better handle on the extent and duration of these flows, we continued to monitor them periodically over the next several weeks. By June 15 the foundation drain discharge had slowed to an estimated 2 - 3 gpm, and the surface flow through the more southerly culvert was also slightly reduced. On June 30 the discharge from the foundation drain ouffall had entirely dried up, and the flow through the more southerly culvert was down to approximately 5 gpm. The homeowner reported that this flow through the southerly culvert had also entirely dried up by July 12, and we confirmed that on July 16. The fact that surface water from both of these sources is rapidly absorbed into the underlying soil, and that there is no evidence of surface flow in the northward trending swale bottom means that even if one of these surface water flows were to become contaminated by a failing septic system there is no possibility of the contamination being carded on to other surface water bodies. In fact, the potential for either of these surface water flows to become contaminated by the wastewater disposal system is slight. If the soil absorption drainfield were to become clogged and effluent daylight onto the ground surface, it would do so at from the sump at the downstream end of the drainfield, and from there the effluent would never flow towards either of the subject surface water sources. In consideration of the above information, it is our opinion that the requested waiver can safely be granted without undue concern as to the potential for contamination of either of the surface water sources by effluent originating in this wastewater disposal system. Please give me a call if you have further questions on this analysis. cc: Ken Beckley Wendy Howard, ReMax Properties Sincerely, Ted Moore, P.E. I LOT '7 I ~ 3 BDRM R~, IOO~ ALL ~RE APPt~oxI~t~T~ , I SCALE; I"-*- ~o' I NO?~.. THIS IS No? DAte: BLK ~, KENO HILL~ S ImE PLA N / FlattO~ Technical Services 14530 Echo Street /~.~Chorage, Alaska 9951R COMMERCIAL TESTING & ENGINEERING CO. ~ ENVIRONMENTAL LABORATORY SERVICES ', ~ s,Nc ..... REPORT Of ANALYSIS Chemlab Ref.~ :93.2577-1 Client Sample ID:L8 B4 KF~;O HILLS SOUTH SIDE HOSE BIB Matrix :WATER 5633 B STREET ANCHORAGE. AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 ProJect~ : PWSID :UA Sampl~ Remarks: ROUTINE SAMPLE COLLEuT~a3 BY: CHRIS WORK.Order ~:66870 RePort Completed :06/08/93 :06/04/93 @ 11:15 hrs. · 06/04/93 @ 13;40 hrs. Released By ~rx~ Qc Parameter Results QUalUnits Method Allowable Ext. Anal Limits Date Date Init 06/07 LLH cted, Reported value is the practical quantiffcation limit. · D = Secondary dilution. UA =Unavaflable NA = NOt Analyzed LT = Less Than GT = Greater Than ~S~S Member of the SGS Group (Soci~t~ G~n~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA. COLORADO. UTAH, ILLINOIS. OHIO, MARYLAND, WEST VIRGINIA,NEW JERSEY, SOUTH CAROLINA Application Da{e ~ ~O~:l~ ~7 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, secti~,~ownship, range) Location (ad~res~ or ~irections) (b) Prope~y Owner ~ ~[[.~ Telephone: Home ~ Business I Mailing Address ' (c) Lending Institution A~ ~[. ~ ~fl.,~ Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followino address: or; Check here ~, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY Individual Well~ Community [] Public [] Note: If comm unity well system, must have written confirmation from the State Department of Enwronmental 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 I of 2 72-025 ~Rev 8/86~ Front 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 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 Name of Firm Address Date Telephone Engineer's Seal DHHS APPROVAL Approved for ~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human ServiCes (DHHS) issues Health Authority Approval certificates based only upon the representations g ven 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. Em ployees 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. Page 2 of 2 '~ ~'~ 72-025 ~Rev 8/861 Back WELL DATA ~LL.L~ Classification Wel If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N} , '~/ Date Completed_ ~ ~%//~ Z., Yield Total Depth -.~--~__ Cased to ~~epth ;; Grouting /~(~/~Z;~ Static Water Level 7 Pump Set At '~ ~',.~¢ ~ 7"/ Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/I-I~t~,~ Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Man hole Water Sample Collected by Water Sample Test Results ; On Adjoining Lots NON, ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date "~ ~/~ 7 B. SEPTIC/~ TANK DATA Date Installed ¢c...T Standpipes (Y/N) '/'tX/C) Air-tight Caps (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: Size |'~- ~0 No. of Compartments T~ Foundation CleanoutfY/N) Date Last Pumped Y~-,~.~ 7 ~or Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed O Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation To Water Main/Service Line To Stream/Pond/Lake/or M&jor Drainage Course To Driveway, Parking Area. or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness 77 Stand pipes Present (Y/N) Date of Last Adequacy Test """//~."~/~ To Property Line J To Existing or Abandoned System on ; On Adjoining Lots I'"~ 0 N I~. To Cutbank (if present) ~"',~ O N ~' Comments D. LIFT STATION Date nstalled 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 Co mments ** Check Permitted Bedroom Rating Against HAA Request ** I certify th_at I havc,_checked, verifj.e¢, or conformed to a~l MOA and HAA guidelines in effect on the date of this inspection. Signed "~. ~¢~-~¢/ Date ~..~/ ¢7, I ~ ~'7 MOA No. /o o / o oo Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026,11/84) Engineer's Seal ~ ~ L~ ~L'--*~ ? ~03W. 15th AVE "C" SUITE 203 ~ ANCHORAGE. ALASKA 9950! CONSULTING ENGINEER TELEPHONE: 1907; 279-3916 SEPTIC SYSTEM AD 0 Agl LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: LOT 8, BLOCK 4, KENO HILLS 6431 ROSEMONT ED HOFKINS SINGLE FAMILY, THREE BEDROOI PRIVATE, ON SITE FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: SOIL RATING: INSTALLATION DATE: ~%,' ~ '.1 9 .--x~ ~ 713 SQ. FT. 220 OCTOBER 1982 DATE OF PUMPING: JULY 24, 1987. ISAACS PUMPING SERVICE DATE OF TEST: JULY 24, 1987. TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH ONE FOOT OF COVER AND A LIQUID DEPTH OF 48 INCHES. TRENCH HAS 2.5 FEET OF COVER AND A TOTAL DEPTH OF 6 FEET. ROCKDEPTH IS 3.5 FEET. NO LIQUID WAS OBSERVED IN THE TRENCH SUMP. MORE THAN 1000 GALLONS OF CLEAN WATER WAS ADDED TO THE TRENCH CLEAN OUT WHILE THE WATER LEVELS IN SUMP AND TANK WERE MONITORED. NO WATER WAS OBSERVED ENTERING THE TANK, WHILE THE WATERLEVEL IN THE SUMP ROSE 13 INCHES. AS SOON AS THE WATERFLOW STOPPED THE WATER LEVEL IN THE SUMP DROPPED. WITHIN TEN MINUTES THE SUMP WAS DRY. NO WATER WAS OBSERVED ON THE GROUND IN THE VICINITY OF THE SYSTEM. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requm- rements of the Municipality and State. CONSULTING ENGINEER TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL .' LOT 8, BLOCK 4, KENO HILLS LOCATION: 6431 ROSEMONT OWNER: ED HOFKINS TYPE OF WELL.- SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 1.5 GALLONS PER MINUTE PUMP YIELD.' 8 GALLONS PER MINUTE DATE OF INSPECTION: JULY 23, 1987 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 8 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. STATIC WATER LEVEL WAS FOUND AT 7 FEET BELOW TOP OF CASING. AFTER 15 MINUTES OF PUMPING THE PUMP STOPPED. A TOTAL OF 140 GALLONS HAD BEEN DRAWN. THE RECHARGE RATE WAS MONITORED FOR 25 MINUTES. DURING THIS PERIOD THE WATERLEVEL IN THE WELL ROSE FROM 73 FEET TO 53 FEET. WATER COULD BE HEARD ENTERING THE WELL AT THE 76 LEVEL. WATER SAMPLE TEST: WATER WAS TESTED ON JULY 27, 1987. 0 E.COLI, N 0.1 mg/1 TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALIT¥'OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurfac~ conditions that may not be observed from the surface, and changes land use and other factors that may impact the conditions of the aquifer feeding the well. APPLIO,,.JT FILLS OUT UPPER HA[g.,ONLY Phone Property.Owner /~ F'~' ~ ,,~tdj ~ (~O~j~l~7~. ~ Buyer ........ I '- Address (~&- Zip Code Lending Institution - . . Phone ~(),, / . ~? / ;b. zip Code Realty Co. & Agent ~ ' ~ -,, ~ ~ Zip Code Address ~ ',.) Legal Description Type of Residence - .E~lngle Family [] 'lglultiple Family No. of Bedrooms [] Other Water Supply _ ~ -~E~:~'ndividual ~-~ ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. [][] CommunitYPublic Utility ,~,~:. ' For wells drilled prior to that date, give well depth (attach log if available). Sewer Dispose, ., [~ndividual Year Individual Installed: , , [] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE.INITIATED. Time Time0 Time Time Date Date Date Dat(~_ Inspector Inspector Insp~tor Inspirer Field Notes: MUNICIPALITY OF ANCHO~E D~PT. OF HEALTH & ENVIRONMENTAL pROTECTION ~l-~ JUL ~ 9 1983 RECEIVED '(~) APP~v'ED BEDRooMS ' . *CONDITIONS OF APPROVAL ' Soils Eating Date ~wer Installed Well To Absorption Area We .L~g, Eeceived , ' ~/~ Well to Tank Septic m~k Size Z CO ~- c co ~ z co 0 ~D co Z F- I--