HomeMy WebLinkAboutKENO HILLS #4 BLK 6 LT 10MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241169 Work Type: SepticTank Upgrade Tax Code Number: 02017124000 Site Legal Address: KENO HILLS#4 BLK 6 LT 10 G:3438 Site Mailing Address: 6326 ROSEMONT DR, Anchorage Owner: FIACCO DANIEL J Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 6/26/2024 6/26/2025 104544 ❑ Disposal Field R1 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either a. Opep�ed and Closed on'th same day, or b. C,6ered, sealed, and heated to t_raven1-rf eeziflq Special Provisions: • The edge of the field is to be located in order to maintain the required 5' separation. d -By: Date: Issued By: Date: E� Lr_ Y In Development Services Department Phone- 907-343-7904 On -Site Water /lWastewater Section `4� Fax: 907-543-7907 ON-SITE SEPTIC/WELL PERMIT APPLICATION O Parcel iD.2O-171-24 DAN Pmpadyowna�a) Day phone 632GFl��SEK�{�NTORAN{�HAK yNai|inquddnaao Site address SAME Legal description (8ub'd,Block &Lot) KENO H|LLS#4 BILK 8LT1O Legal description O\zvvnohip. Range &Section) 104544 4 Lot Size Sq. Nunn�erofBedrnunoa____ APPLICATION |SFOR: (0all that apply) Absorption Field [] Septic Tank Holding Tank �] Privy Private Well R _ Initial 0GinQle FamilyR El�� — k�woAO0 Upgrade 0 Duplex (D) [] Renewal�] Multiple Dwellings �] (SF and/or [}\ Water Storage D APPLICATION IS AN: TYPE OF DWELLING: THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: | certify that the above information incorrect. | further certify that this isinaccordance with applicable Municipal Codes. (Signature ofproperty owner orauthorized agent) Permd/F(uohFoea: Date ofPayment: Receipt Number: Permit No. Waiver Fees: Date ofPayment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and FormsTermit xpplmmm.doc June 24, 2024 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic tank permit Legal: KENO HILLS#4 BLK 6 LT 10 To whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. The tank will be decommissioned per the Uniform Plumbing Code (UPC). Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241169, Deb Wockenfuss, 06/26/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241169, Deb Wockenfuss, 06/26/24 DEPARTMENT OF HEALTH AND HUMAN SERVICES -, Environmental Health Division ¢ 2- ~) ~ / 7 / 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Address~-J.~ ~1 '~---(0 ~ ~" ~ SEPTIC ABSORPTION WELL 7 8~ ~n~m~ ~c~(e ~ ~ ~1~ TANK FIELD ~N~, WELL 1 I~ ~c,~ iO~ ' Pbone(s)~ q~ --~ ~5 ~Z' t~ h~ Permd~7~No. No. of 8ed~oms LEGAL DESCRIPTION LOT LINE ~ ¢¢' ~ L°' I¢ B'°c~( S,bd~v,,'o, ~1~ FOUNDATION I~' ~ ~. HT' ~¢' Township, Range, Section AS-BUILT DIAGRAM (Show location of well. septic system, property hnes, foundahon, TANKS / N ~ SEm~C ~ HOLmNG ~ t X ~TRENCH ~ BED ~ W. DRAIN ~ OTHER J , ~ J ¢ i ' Depth to p~pe bottom from Total depth from original grade i / original grade 3,~ FT ~' 0 FT I ~ ~ Fill added above original grade Gravel depth beneath pipe ' ~ / J Gravel lengm Gravel ~dtb / ~ ~ Numberoihnes Sodratlng Pip .... .ebal ,~. ~ ~,~ ~'~ WELLS D~r~t$ F~;&D ~ O~ ~ PRIVATE ~ OTHER (Identify) ~' FT Cased to N. ~. ~ 2~ ~ ET REMARKS: p~ ~ .~nd~ ,_ T~-~ cedily that Ibis inspection was ,ed,treed accordino lo all ~ '~ ..THEODORE F MOORE ~ ... . Municipal and State guidelines in ellect on this date: Z/[I/~¢ ¢,~.. CE- 3589 Health Depa~menl Approv Dar 7 - 72-013 (3/85) WATER WELL R~CORD STATE OF ALASKA DEPARTMENT OF NATURAL RE$'OUR£S Division ofOeolooiool a 6eophy~l~olSurvey~ Dttilln~ Perm[! NO. L,O~AYION OF WELL (Pleaee i=omplele either Io~ lb'or lo,) A,D,L, No, , ,o,ll.oro.g,,, ~..A~l~lelon... Lo! Block ~l t/dqtr" ~egflon No. Town*hlpND Reng, ~ Metldle, ' OITAflOE AND DIREOT/ON FROM ROAD {NTE~SEOTION~ ~, OWNER OF Street Ad,rede end Are~ el Well Lccoflon a, WELL LOB ~ $urfe~e ~-~'f fl, Mgt~rl~l Type Tap aollom ~ ~ 1~1 ~c~k ~ 22? ~ ?.. w.,, ~ .... ;..-.~ ..... , . - ........ ~,,f~ · ,, ,' , , ~dlom, in. ¢e Il. Depth ~.5 198 ,. ~,.,$. 0~ W~L, ............... " Dlommle~ Slot/Me,h Size: ,~ ~ Backfilling Gr~vel Peek ., , ....~,' ID. STAT{~ WATER bEVEL: ~'~ fl, DOll ~,~[G'&~"' ~ft. after ~hrs, p~mplng .......... g,p.m. , ,,, ............ 1~,6ROUTIflO Well 6routed~ M~t~rlOI; ~fleOf Cement ..................................... Length of Dro~ PIpe ...... .fl, 14, 16. WAT[R WELL OOHTR~OTOR'~ OERII~IOATIONI .... ' T~]~. WRII wa~.df[U~.ufldet~y~uUsdfullun, end this rep0r{ Is true lo the bn~t of my kAuwivdgo end belief; A~,,,,,: P,O, Box 110~96, Ancilc,~A,gt~, Ak ', Aulh~rl~l~ Repr~entallve .... -, TOP TECH <.SER¥I C~ & EN~ON~NT~ ENG~EER~G * ENERGY CONSERVA~ON & ~YS~ T~ODORE F. MOORE, P.E. 14530 ECHO ST. PH: 007) 345-1355 ~CHO~GE, ~KA 99316 August 2, 1989 Robbie Robinson M.O.A. Dep't. of Health and Human Services P.O. Box 196650 Anchorage, AK 995 ! 9 Dear Mr. Robinson: k/IJNICIPALITY OF ANCHORAGE DEFT. OF HEALTH & ENVIRONMENTAL PROTECTIO~ 1989 RECEI_V_ED With regard to the as-built inspection report submitted for Lot 10, Block 6, Keno Hills $/D on 7/11/89, I am pleased to provide the following supplementary information you requested. The same material originally excavated from the planned trench was replaced into the excavation after groundwater was encountered at %5 feet, and compacted with the backhoe bucket, thereby allowing construction of the wide drainfield shown on the as-built with the bottom of the gravel at 4 feet below ground level. Based on my observations at the time of this excavation, I visually rated the soil underlying the drainfield at 125 square feet per bedroom as shown on the log attached to the as-built. Please feel free to give me a call if you have further question~ on this or other submittals. Sincerely, Ted Moore, P.E. PERFORMED FOR: MUNICIPALITY OF ANCHORAC-~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Municipality of Anchora. gg,` ~nnn DEPARTMENT OF HEALTH ~J~J~LJI~/~{I 825 "L' Street, Anchorage, Aias_ka__9.9,~02-.¢6~0 SOILS LOG -- PERG~.~T~U .: 49T-- ~ %THEODORE F. MOORE ~.~ %~k~x '.. DATE PERFORMED: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10-. I J'L 11 12 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Township, Range, Section: '7'11 AI~ SLOPE Oeplh to Water After Moniloring? Date: SITE PLAN 2O PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER , TEST RUN BETWEEN __ FTAND . FT r/~p V~';e~/ S~, ~ ~ '/~ CERTIFY THAT TH S TEST WAS PERFORMED PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECTON THIS DATE. DATE: 72-008 (Rev. 4/85) Reading Date Gross Net Depth to Net Time Time Water Drop · lF-.d,,.t..~, t.,. AN]:CH]:NI Owner,-~ .... ....~ ~'~ '"~". , 726C) ~r'fl..,q I ~:~ '""~t -~1.1 ANCHORAGE, AK '~'~ ~. I:::'ar ,::::~.~) :1: d: C):~'..'(~..--:1.7 :t..-..24. ~", .... B :t. c~c 1.:: ~ 6 Loi:. l....e~,':?~l: ..;ubd:i. vis:i.c}n:: KEIXlO Lo'L :::: ............ i :x~ ~:~ ,:"., ,, 5A (sq. {'[:.~, Max Bec:lrc)(:)m~ii 'l"l"iis F'ermii'..~ 4 Fcd:.al Capac:i.'Ly: 4 i'-2. 43-.. 34 () 0 ,..~ ...t t ... L, TANK ,".. M i n i mum 't. c)t a ]. sep't, i c tan !.:: cap..ac: :!. '['.. ¥' ~ .~. ~ ':."::" c~a ]. i c:)c~s, lii!:ac h scot :i. ,,::: i'.a. nk taus'Ir., have a:'l le:as'L ;:-'~ cornt::,a, rtmerrf, s,, [}eptl"i 'Lc:, top .[' (.>:,c.~-I.:. r e qu ~. r es :i. n su ]. at :[. c)n ov e r '!. an k (s) ,, Wi]]....I_: l...oc.;j mus't. I:)e sul::~mi'l.'t, ed to Mun:i.c:[pa].i'Ly of' Anchor'acjie Del ar'l:neri'L o!: Heal. th a~Ficl J-.h.q'i'ia~d"~ Serv:ic:es w:i.'l'..hin ::!!:() days cl~' (^~ell c:c~mp].etic~r~ ): l.-',Ei:l::~'l" I I:::'Y "l"l"ff:.~[T': :1.,, I am {am:i.l:i. ar' ~,.~:i.'t.h iLh(.:!.) P;~z.)(::lL.l:i.P~'2f¥i(~ar]'i:..~s {(:.If' ~:H'l'""l[ii'l.~.) set4ers and ~/~e:l.:l.s as sei:. {'(::ruth !:::,y i:.he Munic:i. pali'Ly c:~ Ancl"~ora~]e (MOA) and t. he SCat. e c,{' Alaska. ;~?.= I ~,.~i:l.:L :i. rls'Lai! the system in ac:c:ord~:tnce ~,,~i'Lh a].i MCIA cc)de~ and and in comp].iance with the des:i, gn c:r'.iter, ia (:~{ this pel"m:i.t,, 3, :!: will adhere t..c~ a].]. lfl[:)h and Sta'L~.:, o{ A:la~ka Pequ:i. remen~:.s ~c)r the ~(~:~'~. back d:[s'Lanc:e~ {rom any ex:i. st:[ng we:l.t~, ~-~ts't..~,~af..E~P (::lispc~sa]. system [:)r pub].:i.c I url,::h.>):,i"stand 'Lha'l. 'l:.h:i.s permi'L is w~:t. id ['ol". a maximum o{' 4 bedrc:~c)ms,, also understand that 't.h~):~ capacity c;~' the total, sys{em :is 4 bedr(::)c)ms and any er'~:!.ar~.]ement ~,,~i].]. r'equ:[pe afl add:i, tJ.c)r]a~ ~_ (~ I ', L.,' b t.~ lVl (..' l¥1 [,It'{El/t=' , / / i ,i Flattop Technical Sec'vices 14530 Echo Street Anchorage, Alaska 9951~ LoT IO, 13 L 0 C.I~ ~ I-(~NO H ) L kS ~ ITF PL,4N C) ,4 T [= .· 5'1h91~'2 NOTE: PLAN t/lEI, o' I" =.5'-0" DA7 ~ ' £/,a / ~Flattop Technical Servicc 14530 Echo Street ]~nchorage0 Alaska 9951 Lot 10. Block 6, Keno Hills S/D Specifications nnd Design Notes 1. The septic system design by Flattop Technical Services is based on soils information reported on the test hole log prepared by Bruce Corwin on 5/13/88.' The soil classification and percolation rate must be field verified at the time of construction. The 15 foot depth to water table was verified by Ted Moore on 5/12/89. 2. The design on the soil absorption system is based on the reported. percolation rate of 9 minutes per inch, which corresponds to an absorption area requirement of 158 square feet per bedroom. Thus, 632 square feet of absorption area are required for this 4 bedroom system, which is provided by the sidewalls of a 50 foot long trench containing 6.33 feet of gravel beneath the distribution pipe. 3. All material specifications and construction practices shall be in conformance with M.O.A. regulations. 4. The configuration of the system including 1250 gallon septic tank, perforated and non-perforated distribution pipe, sewer gravel, filter fabric, cleanouts and monitor tube shall be as shown on the plans, except that minor modifications may be allowed or required by the engineer doing the inspections. 5. Construct the trench parallel to the contour of the hill at the point where the slope is less than 25% and decreases further downhill. The septic tank and perforated distribution pipe shah be installed level. 6, The final grade shall achieve a minimum 4 feet soil cover over the sewer gravel. 7. Three inspections will be required: ( 1 ) initial stakeout and soils verification, (2) after trench is excavated, but before gravel is placed, and (3) after gravel is placed, septic tank installed and pipe connected, but before backfill. ': ', ? ~ ' 'c -1 Municipality of Anchorage z? ' '" ~:~,' ~, DEPARTMENT OF HEALTH & HUMAN SERVICES~[~' ~ ~; ~ ..... ': ,, ..... ,~ "' 825 "L" Street, Anchorage, Alaska 99502-0650 ¢ .......... _- · ,"::v'Jl~'¢.c:.~-33 /.:" ~ LEGAL DESCRIPTION:~ ~O/ 8~* ~ ~[~ Township, Range, Section: SLOPE SITE PLAN 3 4 7 8 9 WAS GROUND WATER 10 ENCOUNTERED? 11 IF YES, AT WHAT DEPTH? 12 Depth lo Waler After 1 3 ~onitorino? Gross Net Depth to Net Reading Date Time Time Water Drop / /Om'~, ~', cz- ~,/~ /~ ~.. ~, ~ ~ o, I~ 20- PERCOLATION RATE ~ ¢5 {m,nules/inch)PERC HOLE DIAMETER ._~ ~' ,ff JEST RUN BETWEEN "& FT AND '~- '~.~nnnn~-~- FT . 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.# (~O-/'// --~-~/ . ... · HAA:#:' ~,~o~ "-'-~ (C) t~ (--/~. / 1. GENERAL INFORMATION Complete legal description Lot 10; Blo'ck 6; Keno Hills Location (site address or directions) 6326 Rosgmonf: r)~-~ ~r¢ · ? .... Anchorage, AK ? P~-operty owner.'- tB°b Henry Day phone ~ address,, 6326 Rosomont Dr~7¢ An~hnwage; AK ':' ' :Lending agency .' P, remier: Mortgage (Cathy V. ) Day phone ",. Mailing address Agent ' Day phone 345-1582 563-7736 Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Indiv'idual,well Community Well NOTE: xxx Public water 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: XXX 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 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 Anchor:age flies 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. $ & $ ENGINEERING ~ ~"/.-[ - '~ '? ~ Name of Firm i~u~,~ ~-agle kiver Loop Road No, 2~ Phone Eagle River, Alaska ~77~ Address ~~ Engineer's signature ~ ~~/~r~ Date ~ / ~ / ~ 7 DH.~SIGNATURE Approved for Disapproved. 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 DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. E~ployees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipa'l'i~ of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~F,NVIP, ONMEN'FAt. SERVICES DIVISION Municipality of Anchorage ~, (~1~'~ DEPARTMENT OF HEALTH & HUMAN SERVICES SEP 0, 1997 Environmental Services Division © L': f" i: 825 1_ Street, Room 502. Anchorage, Alaska 99501 · (907) 34~5J4¢44~ l V i! Legal Description: A. WELL DATA Health Authority Approval Checklist 6LOC~ C ~r~,~o N~4-$ #¥ ParcelI.D.: 0-~0 -I-7l -~ Well type ~o~ Log present ~/N) Total depth Sanitary seal If A, B, or C, attach ADEC letter. ADEC water system number Date completed '7 / '1 / ~' c) Cased to ~/ ~. i Casing height (above ground) Wires properly protected (~/N) FROM WELL LOG AT INSPECTION Date of test -7 / ~ / $' c] Z4//O / ~/ Static water level ~/6 / ~'- '~'' ' Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: ~('~al[~ 7 SEPTIC/HOLDING TANK DATA Date installed (~ //6/?~j Tank size Foundation cleanout ~N) ¥¢-'~; -- Date of Pumping ~ ¢~i'7- ABsORpTION FIELD DATA. Date installed G //(~ / ~-c] Length / ~ o Width Effective absorption area ~e 1.6 Other bacteria O S & $ ENGINEERING Eagle River, Alaska 99577 Collected by: Number of Compartments '~ Clean0uts (~'~/N). yz~ 'f Depression (Y4,~ ~ O High water alarm (Y/,~))_ /q © Pumper /4 t Ho~--~f Y~,¢v,c,~ J; Soil rating (g.p.d./fF or~'~-- ~ / ~S- System type ~ -~- Gravel thickness below pipe ~o ,C' Total depth ~ ~r Monitoring Tube present (~5.~N) Y~-¢ Depression over field (Y~ '~ ~2 Date of adequacy test .'~ )! o//~' C Results ~,~/Fail) P,~ .S'.f For Z/ Fluid depth in absorption field before test (in.); O Immediately after? ~ gal. water added (in.): Fluid depth LO (ins) Minutes later: Absorption rate = g.p.d. bedrooms Peroxide treatment (past 12 months) (Y/N) ~ ¢ '~ ~'' ' ~ .~o,, ~ If yes, give date -- 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) ~~'~ "Pump off' level at* High water alarm level at* ~ *Datum Cycles4est,ad----~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~holding tank on lot ] O O ' 7' Absorption field on lot / OD -~ Public sewer main ~ /,4 Sewer/septic service line -¢1_ .!,- /-/-- On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ -)- Property line L~ Absorption field Water main/service line to ',~ Surfacewateddrainage )00 Y' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / O -/- Building foundation · Surface water I cO ¢4. Curtain drain ,'~ o ,~/~ Wells on adjacent lots Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots /o ~ /~ /O f ENGINEER'S CERTIFICATION , certify that lhave determined thru field inspections and review of Mumc,pa; ' recordC~La~'~..eO~~s.. '.,. are in conformance with IVJOA HAA guidelines in effect on this date. Signature '/~,~/'~ ~~ Engineer's Name ~b~ 6,~ (. ~ Date HAAFee $ ~ ~?O - ~/)%') / Date of Payment ~/ '7~, ,,¢_ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number Parcel I.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 )'7! HAA# ',~ ", 1. GENERAL INFORMATION Complete legal description Lot 10; Block 6; Keno Hills Subdivision Location (site address or directions) 6326 Rosemont Drive Anchorage, AK Property owner Mailing address Lending agency Mailing address Agent Address Karin Katrin Anichini 6326 Rosemont Dr. Anchoraqe, A1 Shaw/ City Mortgage 121 W. Fireweed Lane Suite 120 Day phone AK 99516 Day phone Anchorage, 345-4416 263-0700 AK 99503 Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water 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. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by myseal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 & $ ENGINEERING 17034 l~agle ~i~er t.oop Address ~agle Rl~e~ AI,askC9~577 Engineer's signature ¢//~ bedrooms. DHHS SIGNATURE /xV' Approved for Phone Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments BY:~7 ~ 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 Legal Description: LoT- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES::7? Environmental Sermces Division 825"L" Street, Room 502 ' Anchorage, Alaska 99501' (907),~ i ~ ~ Health Authority Approval Checklist lgLac~ C Kt.~o h*--~3 ParcclI.D.: A. WELL DATA Well type Log present~)/N) Total depth Sanitary seal,tN) If A, B. or C, attach ADEC letter. ADEC water system number Date completed Vt/~ / S~i Cased to ~ 3~ Casing height (above ground) Wires properly protected F~/N) Date of test Static water level FROM WELL LOG · AT INSPECTION Well production Yt s WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: t-//~'/O 6, a. ~OLDING TANK DATA Date installed (.* / 1~/cc/dj Tank size /~ ~ 0 Foundation cleanout (~/N) )/~ £ Depression (Yf~ DateofPumping 1'~//7 lq6 Pumper d Other bacteria Collected by: 5 & S ENGINEERING i/D34 Eagle River Loep Read ".,,fie River, Alaska 99577 Number of Compartments "~ Cleanouts ~/N) Y~.S High water alarm (Yf~ -r-' 0 C. ABSORPTION FIELD DATA Date instaned Length ? 0 o Width Effective absorption area ,,C O Date of adequacy test Fluid depth in absorption field before test (in.): O Immediately after (,73 gal. water added (iu.): Fluid depth o ' (ins.) Minutes later: -- Absorptiou rate = t~ O 0 -'P- _g.p.d. Peroxide treatment (past 12 months) (Y/N) ~vo,,,/_ ~,,,,~rd If yes, give date -- Soil rating (g.p.d./ft2 or~n~ ~"-:--'~' ~ ~ ~ System ~pe ~fl ~ *~ ~ ~ Gravel thickness below pipe ~. ~ Total depth ~ Monitoring Tube present(~ YI Y Depression over field (Y~ ~ 0 Results ~ail) P~5 f For ~ bedrooms D. LIFY STATION Date installed Size in gallons ~ ~iai:il~i~/cAr 13:;Sni~c:)l at* '~~vel' at*' Cycles tested ,~..--~"~~ .._.~_~ SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~-~t-W'dholding tank oil lot Absorption field oil lot / Public sewer main .,v/,4 Sewer/septic service line lo o P- ; On adjacent lots : On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM ~,~. C]HOLDING TANK ON LOT TO: Building foundation X- ! 4- Property line t/o ~ Abso~tion field Water mai~se~ice line ~o ~ ~ Surface water/drainage /oo '~ Wells on adjacent lots /oo ~/- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / Building foundation ,3 o ~- Water main/service line Surface water ] 0 0 -P- Driveway, parking/vehicle storage area Curtain drain ~ d~"rc ~o~,~ Wells on adjaccut lots ] OO 4- Propertyline F. ENGINEER'S CERTIFICATION ] certify that] have determined thru field inspections and ,'eview of 3dunicipal records t~-~.~{ ~,'.,are in confo,?uance with MOA IL'M guidelines in eJfect on this date. HAA Fee $ ~' Waiver Fee $ Da te of Pay m ent ~/~¢ Date of Payme n t Receipt Number / ¢¢~(~ ~ Receipt Nnmber Rev. 8/95 OSS: haa.wk.doc 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 1. GENERAL INFORMATION Complete le. gal description HAA # Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. 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-O25 (Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water 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. Narne of Firm ~ la/-/-o? '7'~c4~ ~ ccd ~'" c,' c.z' Phone Address Engin'eer's signature ' ~'_~- ~¢'. ~ Date 5//4*/¢/ D HI'-IS SIGNATURE ,~ Approved for ¢: Disapproved. Conditi'onal approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph' 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 MOArY21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: J,',e'J' I(// L~/oc~ d; I'¢et~o /'}*~lP~rcel I.D. A. WELL DATA Well type Log present (Y/N) Total depth P_ Z 7 Sanitary seal (Y/N) Date completed 7 / ri / 8~) Driller Cased to ¥ Z ° Casing height Wires properly protected (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number D~te 'of test` Static water level Well flow pump ira, el FROM WELL LOG g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot It ~ ~ Absorption field on lot .~ 0 Z ~ AT INSPECTION g.p.m. ; On adjacent lots ;> (oo ~ ; On adjacent lots -;> lo~ ~ Public sewer main Public sewer ~er~ice line WATER SAMPLE RESULTS: Coliform Date of sample: ~/~ Public sewer manhole/cleanout Petroleum tank Nitrate ~' ? /~J/~ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~' / I~' / ¢:~ Cleanouts (Y/N) Y' High water alarm (Y/N) Tank size } ~5-C; Compartments Foundation cleanout (Y/N) ¥ Depression (Y/N) /'h A, Alarm tested (Y/N) N, Date of pumping <)/I~' / 4)d /~y ..Z'..¢ ,~,~-- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I I & To property line 5-0 Surface water/drainage On adjacent lots ~, ~o~, Foundation Absorption field 3 / Water main/service line 72-0?6 (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 Meets MOA 'elestrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 7/11/ Length (~ ¢ Widt'h Total absorption area Depression over field (Y/N) lq Results (pass/fail) System type Peroxide treatment (past 12 months) (Y/N) ~ Gravel thickness 0'5° ~ Total depth ~¢, (2 Cleanouts present (Y/N) ~' Date of adequacy test /tt, 4, ~ (~''~ -~4 'Z. ~¢¢..j for ~/ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots ~. ¢o0,' . property line__ ~/'7 1 To existing or abandoned system on lot Cutbank tO,/~. Water main/service line Driveway, parking/vehicle storage area ~ 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 HAA Fee $ Date of Payment 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number T,OP TECHNICAL...:__ . .: CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. April 24, 1991 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 Dan Roth M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Mr. Roth: Per your requirement, on April 23 we conducted a pump test of the well serving the Anichini residence on Lot 10, Block 6, Keno Hills S/D, located at 6326 Rosemont Drive. The static water level stood at 61 feet below the top of the casing. Pumping 442 gallons of water from the well at an average rate of 3.9 gpm caused the water level to be drawn down to the pump intake at approximately 222 feet belo(v the top of the casing. We then measured the well production both in terms of recovery inside the bore hole and in terms of the the additional gallons of water which could be pumped out after the recovery period. Based on these measurements we determined that the present yield of the well is slightly in excess of 1.9 gpm. This is the fh'st instance in my experience where DHHS has not accepted the driller's reported yield for wells less than two years old. Perhaps your concern regarding the adequacy of the driller's test was based on a misunderstanding of the method he uses to detemine the yield of a new well. In my opinion Dave Harper is one of the most conscientious and reputable drillers operating in Anchorage. To single his well log data out for an unusual retest implies a question as to the quality of his work, in addition to causing considerable additional expense to my client and further delay in the processing of his loan. In this instance our test results were remarkably close to the yield data reported on the log. I hope that this retest will enable you to have greater confidence in the yield data shown on Alpine Drilling's logs in the future. We would appreciate your speedy issuance of the requested HAA certificate. Please give me a call if you have further questions. cc: Maurizio Anichini Dave Hm'per, Alpine Drilling Sincerely, Ted Moore, P.E.