HomeMy WebLinkAboutKENO HILLS #4 BLK 6 LT 9
Jul 15 22 07:46p Anchorage Well & Pump Ser
9072430742 p.1
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Pump installation Log
Well Drilling Permit Number: Date of Issue: _
Parcel Identification Number: 020 171 25
Legal Description Block Lot Property Owner Name & Address:
SANDER PAUL H & SUSAN J
KENO HILLS#4 6 9 17600 ASHLAND DRIVE
ANCHORAGE, AK 99516
Pump Installation Date: 07 - 12 - 2022
Pump Intake Depth Below Top of Well Casing:
Pump Manufacturer's Name: MYERS
Pump Model: 3NFL72-8-P4-02
Pump Size: .75 hp
Pitless Adapter Burial Depth: 14
I Pitless Adapter Manufacturer's Name:
I Pitless Adapter Installer:
150 feet
feet
MARTINSON
1 Well Disinfected Upon Completion? XYes
Method of Disinfection: PELLETS
Comments:
❑ No
Pump Installer Name: ,
ANCHORAGE WELL & PUMP SERVICE
Company:
7640 KING STREET
ANCHORAGE, AK 99518
907-243-0740
Mailing Address:
City:
State: Zip:
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
. 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
Permit Number: C~IO0,~I PID Number: 020
Neme:Wastewater System: I~f'New [] Upgrade
k E~NET~ ~EC~EY
*~'~"~31 ~os~o~ bR. ABSORPTION FIELD
Phone: 3~-~ No. of~edrooms: ~ Deep Trench ~ Shallow Tren~'
~Bed B Mound ~ Other
LEGAL DESCRIPTION so, Rating: I · ~ GPD/Sq. Ft. Total Depth~ original grade:
Depth to pipe boltom from original grade: Gravel depth beneath pipe
Subdivision: ¢ ~ Ft. Ft.
Lot: ~ Block: ~ ~0 ~1~ ~ ~-~ O
Township: II N Range: ~ ~ Section:~ Fill added above original grade: Gravel length:
O, ~ Ft. I CO Ft.
Number of lines: Dfstance ~lween lines:
WELL: ~ New ~ Upgrade Gravel depth: t Ft.; [ ~ - Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Ft. Ft. ~OO SQ. Ft. ~ No~- PERF
Driller: Date Drilled: Static Water Level: Installer: Date in.ailed)
Yield: GPM [ Pump Set at: Ft. Casing Height Above Ground:Ft. TAN K
I
SEPARATION DISTANCES ~Septic B Holding ~ S.T.E.P.
TO Septic Absorption Lift HoMing ~uhlic/Pdv~td Mm~ufacturer: Cnpacily in gallons:
From Tank Field Station Tank S .... Lines ANCH. TANk
Well ~ I I~01 ~ -- 10~ ~ Material~ ~ ~ Number of 2C°mpartments:
Surface
Water >/OO ~oo - - ~/oo LIFT STATION ~.~.
Lot Size in gallons:~ Manufacturer:
Line ~O ~ ~ ~ ~ ~
I
Foundation ~ ~ ~ ~ 0 1 ~ ~ 0 ~ "Pump on" level at: "Pump off" level at: I High water alarm at:
CuAain Pump Make & Model Electrical Inspections performed by:
Drain ~ ~ -- --
Remarks: ~' ,~(~ BENCH MARK
Location and Description:
Assumed Elevation:
Inspections performed by: ~/~~ ~c Dates:lst E/~/~/ 5w~
Department of Healt~ H rvices ~LA '.
Reviewed and approved by:~~~/~//Date' x~*'"'~./ <"*~Z:'. ...... .'
72-013 (1/91) MOA 25
Permit No. ~ I O~),--,c't Page ~ of ~
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Lc/_, I~G KENO ~JLL~ '~L.~ PID No.: 020
SouTH
F!a!top Technical Services
14530 Echo Street
AnChorage, £Has]~a 99~ ¢
72-013 A (2/91)MOA 25
Permit No. . °/I 805'1 Page ~' of .~
Municipality of Anchorage :
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 ·'Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: /--q B~, K,5.~4o ~/~.~' PID No.: 02o1'7t2.5-
.... ; ,' SEPTIC
t JlI4V£P,T ELEV.
OUTLET ...
~2
SC/}~:~ t'~--~'
~' No t, to~t'zo~tF, n.t,
72-013 A (2/91} MOA 25
~.,. G R
FILL
Flattop Technical Services
14530 ,Echo S~reet
Anchorage, Alaska 9951~.
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geologica, I 8~tGeo,physicnl Surveys
- - Drilling Permit No.
LOCATION OF WELL (Please complete either la, lb or lc.) A,O.L. No.
,o.llBorough ubdlvi' Lot B,oak 'b.ll '/4qtrs. Section.No. Township N[--~ Range ED Meridian
Material Type TOp Bottom .
0 Te~t Well 0 Other:
8. CASING:z ~ Threaded ~Welded
diam. (~ in. t~ ~--~ft. Depfh Weight ~ lbs./ft.
diam. in. to ft. Depth Stickup ~ ft. "'
9. FINISH OF WELL:
Set between ft. and ft.
Backfillin~ Gravel pack
' II.PUMPING LEVEL below land surface and YIELD
ft. after. / ,rs. pumping ~ g.p.m.
· ft. after hrs. pumping g.p.m.
1~ ~ ~ ~ ' Material: ~ Neat Cement ~ Other:
Length of Drop"Pipe ft. capacily g.p.m.
..... ~ &n ~orage
uep~. Heal[h & Hum,. 14. REMARKS:
16. WATER WELL CONTRACTOR*S CERTIFICATION: o
15. W~far Temperature ~ F ~ C
This well wo~dritled u~er ~ j~r~sdlctiop ~nd th~ report is lrue to the be~ o~my knowledge apd belief;
~.~egistered ~siness Nam~ Con~ac~ License Number
/ Authorized ~present~] ye
PAGE 1 OF
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW910051
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:BECKLEY KENNETH F
OWNER ADDRESS:6431 ROSEMONT DR.
ANCHORAGE, AK 99516
DATE ISSUED: 4/09/91
EXPIRATION DATE: 4/09/92
PARCEL ID:02017125
LEGAL DESCRIPTION: KENO HILLS #4 BLK 6 LT 9
LOT SIZE: 101060 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS
RECEIVED BY: ~'~'~'--
DATE:
DATE:
THEODORE F. MOORE, P.E.
PH: (907) 345-1355
Dan Bolles
M.O.A. DHHS
P.O.Box 196650
Anchorage, AK 99519
April9,1991
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
RECEIVED
APR 9 19 J1
Municipality of Anchorage
Dept, Health & Human Services
Dear Mr. Bolles:
We are herewith resubmitting our application for well and sewer permits for Lot 9, Block 6, Keno
Hills S/D, along with the requested supplementary information.
As agreed in om' March 28 meeting at the project site, we have redesigned the system by switching the
position of the driveway and the drainfield, thereby moving the drainfield to a position 25 feet away from
the break point where the slope starts its short 35% descent to the swale. We are therefore able to revise
our waiver request to reflect the 25 foot separation from a slope in excess of 25%. Based on the soils data
showing continuous gravelly soil to 13 feet in depth, we believe there is little or no potential for effluent
daylighting through the side of the slope.
As indicated on the enclosed log for Test Hole #3, on April 5 we conducted a percolation test at a depth
of 6 feet near the center of the proposed dralnfield. The material was similar to that encountered in the first
two test holes, and the measured percolation rate was 3.5 minutes per inch. Accordingly we have
redesigned the drainfield on the basis of 1.2 gpd/sq, ft., which yields a 5' wide by 100' long drainfield,
and there is no need for a sand filter.
Based on these soil tests we have concluded that it will be possible to construct a replacement
drainfield parallel to, and 10 feet to the east of, the proposed drainfield, at such time as the original
drainfield fails.
Copies of the new soil log, plus revised design documents are enclosed. I believe this satisfactorily
resolves each o[ygur concems with regard to this project. Please telephone me if you have any further
questions.
cc: Ken Beckley
Sincerely,
Ted Moore, P.E.
1
I
_ ~ Rose N4o_.NT
T,H?* I
DR
NO'I'J:: No WELLS OR. SEPTIc
SY$'I'EtqS WITHIN 200
OF PRoPost~ FACILITIES
T.H. 02--} 0.
POSE
w'E L,L
Lq, BFo KENO HILLS
WELL ~SEP'FIC g¥STEM
.SITE PLAIq
SCALE: l'1'~ SOt
NOTE: THIS 15 NoT A
.<;u RVE't~' b 'PLAT
~LL LOCATIONg, ARE
APPKoXtMATE'
PLAN VIEW
N~T T~
~ .__, i ~ I
~ ~oo ......... ~,
~ '~ ....... 0
~, ~...-..-.~ _.-...... ... ., ,. ~. ...... ,. ,, ,: ......;.:. ,. ,~.-....................~
-. F "A"~ .
l S~ PTI~ ~ . '
PIPE FSIO ~"D~A No~-PER¢
(S~l(~t~Tl?f S~T¥,S4Nb¥ ~RAV£L~
SECTION A-A
Lfl,B6 KENo BILLS
DRAINFIELb
PLAN A~b CROSS - ~[CTION
Flattop Technical Services
14530 Echo Street, Anchorage, AK 99516
Phone (907) 345-1355
Wastewater disposal system installation
Specifications
Revised 4/9/91
1.0 General:
1.1 The scope of the project includes the installation of a new 1250 gallon septic tank and a 5' wide by
100 foot long soil absorption drainfield.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform with Municipal and State
requirements.
1.3 All separation distances shall be in conformance with Municipal requirements, unless specifically
waived.
1.4 The contractor shall be responsible to obtain any necessary utility locates, and to work around any
buried utilities.
2.0 Septic Tank:
2.1 The septic tank shall be Municipally approved with a minimum of two compartments, and shall be
set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a
4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial
type, rigid insulation.
2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste
line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A
cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed
within 5 feet downstream of the septic tank.
3.0 Soil absorption system:
3.1 The drainfield shall be 5 feet wide and at least 100 feet long, and shall follow the natural contour
of the slope adjacent to test hole//3. The bottom of the excavation shall be level at a depth of
approximately 5 feet below original grade.
3.2 A total of 12 inches of sewer gravel shall be placed in the bottom of the excavation with the
bottom of the perforated distribution pipe no less than 6 inches above the bottom of the excavation. Sewer
gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the//200 sieve.
3.3 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on
the design drawings. The portion of the monitor tube extending through the sewer gravel shall be
perforated.
3.4 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum
of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet,
two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in
addition to the filter fabric.
3.5' The top surface of the cover material shall be raised a minimum of 6 inches higher than the
surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1. The final grade of the driveway where it passes beside the drainfield
shall not be at a lower elevation than the original ground.
4.0 Inspections:
4.1 A total of 4 engineering inspections will be required during the course of the project: (1) initial
stakeout with the contractor to establish the location of the system and to discuss the plans, specifications
and construction procedures, (2) after the native material has been excavated to expose the infiltrative
surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3)
after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic
tank, but prior to placement of filter fabric, and (4) after final backfill and grading is complete. The septic
tank requires one inspection after it is set level and the piping connected, but prior to backfill. This
inspection may be incorporated with any of the above inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
~eo!^~es ueuJnH ~ qlleeH 'ldeCl
eleJOqOUV Munlclpallly of Anchorage
~o
~!l~d~olun~
· 6 ~ARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
0 ]AI
FERFORMED FOR: KEN BEC-KLEY
LEGAL DESCRIPTION: L cl. B/o; KENO ~JLL~T°wnship,. Range, Section:
0.$'--
1
2
3
5
6
7
8
9
10
11
12
13
14
15
16-
17
18
19
2O
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Oeplh lo Water After
Monitoring? Date:
Reading Date Gross Net Depth to Net
Time Time (~/~) Water Drop
Pr~.coc, h, ¥ {5- q: oo:oo
5~r ~ fi: o 7: oo ~ 3
PERCOLATION RATE 3. S" (minutes/inch) PERC HOLE DIAMETER
""~'" f'~' TEST RUN BETWEEN J~'~" FT AND ~"' O FT
COMM~mS ?~rC '[~t' o,~ 6a,,~ ~' ~v off ~""°~'~
CC. ce 1. 2u"v'°~ I £f ~ flor c-~.~,, , Ivo .co,,,< ~'lt.e,~ ~eed,,,,( , "r: tr. a' r cO.,/ q/..Cl~l
,'~.~OnM~O uY: FLATTOP T[CI~ SC V_~ I . ~J~"~ ~ CERIIFY 1HA'I THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 March 8, 1991 ANCHORAGE, ALASKA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sks:
The purpose of this letter is to provide the required design narrative accompanying the application for a
permit to install on-site water supply and wastewater facilities to serve a proposed 4 bedroom residence on
Lot 9, Block 6, Keno Hills S/D
The soils testing was done on September 11, 1990 in accordance with the provisions of the wastewater
ordinance in effect at that time. The soil in the proposed absorption stratum was visually rated as GP with
a corresponding soil rating of 115 square feet per bedroom. No groundwater table was encountered, and
the monitor tubes will be rechecked during breakup prior to construction. The topography and soils led us
to propose a 5' wide drainfield with a two foot thick sand filter constructed in the location shown on the
site plan. Since the new ordinance specifies that sand filters are to be rated at 1.0 gpd/sq, ft., a total
drainfield length of 120 feet is now proposed to obtain the necessary 600 square feet.
To most efficiently comply with the new wastewater ordinance we propose that the permit specify that
a percolation test be conducted at the time of construction, confirming that the percolation rate is faster than
5 minutes per inch. If the percolation rate tums out to be between 1 and 5 minutes per inch, then the sand
filter can be eliminated and the drainfield length reduced to 100 feet.
The proposed location of the drainfield is optimal from the point of view of allowing gravity flow,
however since it parallels a break point where the slope changes fi'om 24% to 35% for vertical extent of
approximately 15 feet, it will requh'e the issuance of a waiver of the normally required 50' separation fi'om
slopes in excess of 25%. We feel this waiver can be justified on the basis of the relatively small vertical
extent of the 35% slope and the fact that bottom of the sewer gravel will be 5 feet below ground level.
Given these soil conditions we believe there is no possibility of effluent daylighting tin'ough the side of the
35% slope.
The location of the designated reserve area on a well drained low knoll which we believe should have
excellent soils based on the topography and our knowledge of soils in the area, however a lift station
would be required to utilize the site. In order to avoid disturbing the natural vegetation in the proposed
reserve area the owner requested us to not dig a test hole at this time.
Due to the large lot size and the proposed setback from property lines, the proposed ddrainfield will
have no impact on adjoining properties. The proposed well location will have a minimal impact limiting
possible septic system construction in the extreme northeast comer of Lot 8. There will be no known
impact on or of reserved space/sm-face and subsurface; and drainage.
Sincerely,
Ted Moore, P.E.
ROSE
o~
bR
o%
PR oPo S
3'X 1~o~
NOTE: No WELLS oP-, $-~PTIc
$¥STEt,4.S WITHIN 20O
OF' PRoPo,SE'b FACtL~.TIES
SE PT lC
RESERVE
AREA
0%
~'ROPO£E [~
SE/R
PgoposEb
W'E LL
0%
LC], B(~ KENO HILLS
WELL ¢SEP¥1C ~"/STEM
...5 ITE PLAN
DATE
bt,¢N
NOTE: THiS is NoT A
SURVE',IEb PLAT
ALL L0cATIoN<~
APPRoXimATE
PLAN' V' 't F_'w'
/''= 2.0
.....
i
.............. o ...... I.
/ S~PT~cF
~"DtA pERF./ TANK I
PIPE FBI0
PIPE b ~o~
BOTTO ~
oF El(cAV/~l'l°N
ilA'r ~w ~P
~LI~HTL~
H.T, C,O.
~Mb~bEb
SOI~-
S~X¥, $4~bY 6RAVEL5
SECTION A-A
LR,B& KENo
DRAINFIELb
PLAN ^kb CROSS -..S/~CTION
SCALE: AS SHOWN
bATE : 3/~1 DWN
Flattop Technical Services
14530' Echo Street, Anchorage, AK 99516
Phone (907) 345-1355
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project includes the installation of a new 1250 gallon septic tank and a 5' wide by
120 foot long soil absorption drainfield.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform with Municipal and State
requirements.
1.3 All separation distances shall be in conformance with Municipal requkements, unless'specifically
waived.
1.4 The contractor shall be responsible to obtain any necessary utility locates, and to work around any
buffed utilities.
2.0 Septic Tank:
2.1 The septic tank shall be Municipally approved with a minimum of two compartments, and shall be
set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a
4" cleanout. If the tank is buffed less than 4 feet, it shall be insulated with 2 inches of approved burial
type, rigid insulation.
2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste
line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A
cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed
within 5 feet downstream of the septic tank.
3.0 Soil absorption system:
3.1 The excavator shall dig a test hole to a depth of 7 feet near the middle of the proposed drainfield to
allow the engineer to conduct a percolation test of the proposed absorption stratum. If the measured
percolation rate4s faster than 1 minute per inch, the drainfield shall be constructed with a sand filter as
shown on the plans. If the measured percolation rate is between 1 and 5 minutes per inch, the sand filter
may be eliminated and the drainfield length shortened to 100 feet.
3.2 Unless the results of the percolation test indicate otherwise, the bottom of the soil absorption
system shall be prepared by excavating a 5' wide by 120 foot long level surface at a depth of 7 feet below
original ground level.
3.3 A two foot thick layer of municipally approved filter sand shall be placed in the bottom of the
'drainfield excavation creating a level surface 5 feet below the original grade.
3.4 A total of 12 inches of sewer gravel shall be placed on top of the filter sand with the bottom of the
perforated distribution pipe no less than 6 inches above the top of the filter sand. Sewer gravel shall be
0.5" - 2.5" screened gravel, with less than 3% passing the 4/200 sieve.
3.5 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on
the de§ign drawings. The portion of the monitor tube extending through the sewer gravel shall be
perforated.
3.6 Approved f'dter fabric shall be placed over the entire top surface of the sewer gravel. A minimum
of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet,
two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in
addition to the filter fabric.
3.7 The top surface of the cover material shall be raised a minimum of 6 inches higher than the
surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
4.0 Inspections:
4.1 A total of 5 engineering inspections will be required during the course of the project: (1) initial
stakeout with the contractor to establish the location of the system, to conduct the percolation test, and to
discuss the plans, specifications and construction procedures, (2) after the native material has been
excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms
with the soil test information, (3) after the sand filter material has been placed, (4) after the sewer gravel is
in place and the distribution pipes have been laid and connected up to the septic tank, but priorlto
placement of filter fabric, and (5) after f'mal backfill and grading is complete. The septic tank requires one
inspection after it is set level and the piping connected, but prior to backfill. This inspection may be
incorporated with any of the above inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
PERFORMED FOR:
F/affoP Technical Services
14530 Echo Street
Anchoraqe, Alaska 99516
Municlpa-llly of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
KEN BEC LE¥
LEGAL DESCRIPTION:. L,, ~:~ [~;~O; KENO ~lLL<~T°wnship, Range, Section:
5
6
7
8
9
10
11
12
13
14
15
16,
17
18
19
2O
PT
GP/Ghl ~ILT"~ SAhtby
~RAVEL- LooSE'
GP
SLOPE
GP
CLEA~ <jANbv ~EAVEL
~O~E Co~LE~
(..~ LA cK g IR'~
SLi6HT L¥ S/LTV
5A N-bY GRAVEL
MORE COBBLES
_ SITE PLAN
~ 'IL~ ,~k /"
I
N
/
/
/
'2~1~o
'~ //
~0~,~..'~.~ ~ S WAS GROUND WATER
I~NCOUNTERED?
DEPTH?
Deplh Io Waist After
LA~E ~OULDER Monilering? 9RY Iq~'~ Date:
Date
Reading
~'Net
Time
Gross
Time
Depth to
Water
(minutes/inch) PERC HOLE DIAMETER ,
-- FT AND FT
I~'~'''~ ~'~('~ ~ -~'~
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
PERFORMED FOR:
~]a[top Technical S~rvices
14530 Echo Street
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
KEN BEC~LEY
LEGAL DESCRIPTION: Lq. ~'~.,: k~ENO ~lLLSTownship, Range, Section: ~'eC ~C'~, TIIAIt
PT SLOPE
I
SILTY 6RAVE L
3
4
5
6
7
8
9
11
12
14
15
17
18
19
20,
COMMEN]S. EXCAI,'AT£b out
WAS GROUND WATER
ENCOUNTERED? NO , ~,.'~.
IF YES, AT WHAT
DEPTH?
§epth Io Water Aller,
Monitoring? DRY.
Reading Date Gross ~'Net Depth to Net
Time Time Water Drop
PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN -- FTAND .. FT
ENCouNTEREO Iff T,H, ~1.
SC VS , . ~.~~ CkH'IIFy 1HA1 1HIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ / ~¢ /~
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE ~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
MUNIClI~ALITY OF ANCHORAGE
P.O. Box 196650 Anchorage, Alaska 99519-66~iRONMENT^LSERViCE$'''
DIVISION
343-4744
Parcel I.D, #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1'71
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Day phone
Day phone
3¥Y- "/,.5'88
Agent b~'¢,~dy I¢o~,~c~.~ /~er~r.,~ p~.per/,~/
Address 'S ff~'o Eo~-~¢,,.',* Z /.~ /f,~c6o~-~¢ ~
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
Day phone
/t ~
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
NOTE:
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) Fronl MOA #21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health 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.
Nameof Firm r~/cz/-t~? ~-ec~, 4',~,! ~,-,/,o?~ Phone :~ '/5-/~
Address I'¢5~(., I~c~,o ~--/~., /~c6oro~,. /t~, ~)~5'/¢'
Engineer's signature ~'~ ~. ~ Date :1'-~'~e ~', t99E'
Approved for '~t~iL 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 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
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN S
Environmental Se~ices Division
825"L" Street, Room 502 · Anchorage, Alaska 99501e (907)
He~lt~ Au~orJty Approwl O~ecRIJst
Legal Description:
A. WELL DATA
Parcel I.D.:
Well type
Log present (Y/N)
Total depth /
Sanitary seal (Y/N)
Date completed
Cased to ¢ 2'
IfA, B, or C, attach ADEC letter. ADEC water system number
6'/7/9/
Casing height (above ground)
Wires properly protected (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform t9 avl/too,.,, .~
Date of sample: fi' /
B. SEPTIC/HOLDING TANK DATA
FROM WELL LOG
6'17/9/
AT INSPECTION
/d'
g.p.m. -7, /3- 4- g.p.m.
Nitrate ~, t~/ rn~7 /~ Otherbactefia None
Collectedby: ~- /~J-3fl -Tecl~ -~ vc
Date installed o//.5-/9 /
Foundation cleanout (Y/N).
Date of Pumping
C. ABSORPTION FIELD DATA
Date installed fi/y/~ I
Length 100' Width
Tank size I ~ yOffe,( Number of Compartments ~- Cleanouts (Y/N)__
High water alarm (Y/N) 3/. ,q.
Depression (Y/N) N
Pumper ~'_.c~ CC
Effective absorption area
Date of adequacy test 6'//? /
Fluid depth in absorption field before test (in.);
Fluid depth I,.C (ins.) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
Monitoring Tube present(Y/N)
Results (Pass/Fail)
Soil rating (g.p.d./ft2 or ft2/bdrm) I.
3- ' Gravel thickness below pipe
Systemtype 5' ~.
O. 7 Total depth 7 '
Depression over field (Y/N)
For ~/ bedrooms
Immediately afterT/d' gal. water added (in.):
Absorption rate = ~ o~o~ g.p.d.
Ifyes, give date b~, A.
D. LIFI' STATION /4. A.
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot / '/5
Absorption field on lot J frO'
Public sewer main N- A.
Sewer/septic service line ';> 2S'
Size in gallons
"Pump on" level at* "Pump oft" level at*
*Datum
; On adjacent lots / q~ t
.; On adjacent lots I q5'~
Public sewer manhole/cleanout At. A.
Lift station /v, A.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation $ V ' Property line cq~' Absorption field 5 '
Water main/service line '~ to~ Smfacewater/drainage ';> too' Wells on adjacent lots ->
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation ~ ~9' Property Line
Surface water > too ' Driveway, parking/vehicle storage area
Curtaindrain 20' ~ Fd/~ d,-a~, Wellsonadjacentlots '> too
ENGINEER'S CERTIFICATION
I certify that I have determined thrufield inspections and review of Municipal reco~dff, fhatjthe
in conformance with MOA HAd guidelines in effect on this date.
Signature '~-~ ~. ~
Engineer's Name 'T"heo~:~goe'e /~. 71oo
Date ~-~to~ ~ /q9 6~
HAA Fee $
Date of Payment
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number