HomeMy WebLinkAboutKINCAID HEIGHTS LT 7· 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: ~=t=[ ooqT._ PIDNumber: OII - I~.'Z.
Name:/
(..o,~o~,~ ~u~o~,~ A-r-rd; ~,~ -r'~,~,.~.. Wastewater System: ~ New~ [] Upgrade
Address:
Phone:~ ~ ~Z~ N~ofB~: ~DeepT[ench ~ Shallow Trench BBed ~Mound ~Other
LEGAL DESCRIPTION ~¢, ~c Sci[Rating: Total Depth from original grade:
Lot: ~ Block: Subdiv~ion~U~'~ Depth to pipe b0ffom from original grsde: Gravel depth beneath pipe
Township: . Range: _ . Section: Fill added aboveooriginalt grade: Ft, Gravel length: ~ I Ft.
Gravel width: Number~of lines: Dista~n lines:
WELL: ~s~&New U Upgrade~ ~, ¢ Ft. Ft.
Clarification (Private, A,B,C): Tota~ ~ased To: Total absorption area: Pipe material:
Driller: ~ Date Drilled: Static Water Level: Installer: Date ipstal[~d: ~
~ GPM
SEPARATION DISTANOES ~Septic ~ Holding ~ S.T.E.P.
From Tank Field Station Tank Sewer Lines ~0~ ~A~
Surface ~ -- LIFT STATION
Water j ~1~ j O~1~
r alarm at:
Foundation I O ¢ I ~ -- ~
Cu~ain ~ ~ ~6~ ~No~t _ Pure--Model ~ Electrical Ins~ctions peflormed by:
Drain
I
Remarks: BENCH MARK
Location and Description:
I A~um~ Elevation:
Depadment of Health and Human Se~ices approval ~f2~.~'(T ' [:,~-z*- ..(~ -
Reviewed and approved by' ~~~, ~ Date: ~ ~ ~' E* ~ ~' '
72-013 (Rev. 9/91) MOA 25
p=RM,TNUM"ER: AS BUILT DRAWING ,'ARO~'.D .UMBER:
-- 011-1ZZ-07
SW990042
DBL2 41.7 30.9 - -
C01 60.7 60.1 - ~ / ,
~T1 60.9 58.0 -
co~ - ~.~ ~o.~ ~~
. / ~ I
WATER LI
~ '-- ~ __ ST2 11 /
II
N. 1500 ~ALLON ~'X .... ~ 1/~
' --'~E~[~ TANK
~ oF ~ ~"
~" "' t~ '"~
~o~, o~sc.~,o.: ,']]]~ l~ .......... ~ ....
KINCAIB SUBDIVISION, LOT 7
~E OF WORK:
AS-BUILT OF SEPTIC SYSTEM
pREPARED FOR: PHONg NUMBER:
BILL TAYLOR W/ COLONY BUILDERS 244-623~ ,q~e~ ...~ ......... ..~
DATE:5/20/99 iD~WN By: i SCALE
K.D.W. 1 40' 2 OF 3 ~C~rofess~°~~
',£RI~ITNUMBER: AS BUILT DRAWING
~ 011 - 122- 07
swg90042
t~f 60
: i
~,1~ (AV~,)
/
~AS~ WA~R ¢ WAS~WAT~R CONS~T¢S, ~C.
_EGAL DESCRIP~ON:
KINCAID SUBDIVISION, LOT 7 .... ; ..... ./~ ...............
AS-BUILT OF SEPTIC SYSTE~
~Lb TArLO~ W/ CObO~Y BU~b~E~S 244-62~ ~E;¢;"...
)A'E:5/20/99 ~D'WN BY: ISOA~: IPAGE:
K.D.W. NTS 5 OF 5
MUNICIPALITY OF ANCHORAGE
Oe a, ment o ,ea,th H,men Service
On-Site Services Program
825L Street, Room 502 ¢1 -
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Mar 26, 1999
Expiration Date: Mar 25, 2000
Permit Number: SW990042
Legal Description: KINCAID HEIGHTS LT 7
Design Engineer: 0041 AK Water & Wastewater Consulta
Owner Name: Colony Builders
Owner Address: 2340 Loren Circle
Anchorage, AK 99516-
Parcel ID: 011-122-07
Site Address: 006700 LAUDEN ClR
Lot Size: 42928 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank ~ Privy
[] Private Well [] Water Storage
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
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B - Anchorage - Alaska 99504
(907) 357-6179 ~ Fax (907) 338-3246
Consulting Engineers
March 22, 1999
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Rel~ Septic Design for Lot 7, Block 5, Kincaid Heights Subdivision
To whom it may concern:
The proposed 4 bedroom house will be served by a private septic SYstem and a public water
system. Two test holes were excavated on the property. Comments regarding the proposed
design are summarized as follows:
1. SOILS: Attached are logs which shows the soil profile, and the percolation test results. In
both test holes, the soils below the organic layers are a SM material to a depth of 19 feet (bottom
of both test holes). No groundwater was encountered during the excavation of the test holes. The
percolation test for TH#1 was performed between the depth of 5.0 feet to 5.5 feet and had a
percolation rate of <1 minute/inch. The percolation test for TH#2 was performed between the
depth of 6.0 feet to 6.5 feet and had a percolation rate of 7.9 minute/inch. It is our opinion that
due to the high percentage of sand, the insitu soils wilt serve as a sand filter.
2. TRENCH DESIGN:
a. Percolation Rate: <1 and 7.9 minutes/inch
b. Allowable Application Rate: 0.8 gallons/day/ft2
c. Number ofBedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 750 fi2
f. Total Depth: 13 feet (max.)
g. Effective Depth: 9 feet
h. Width: 2 feet
i. Reduction Factor: N/A
i. Minimum Length: 42 feet long
j Effective absorption area = 756 ft2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: The primary trench is on a 15 to 20 percent slope. The reserve trenches at
the toe of the slope. East of this area is mostly flat; in short, there are no slope concerns.
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 244-9612. Thank you
for your assistance. /q
Presi]:lent ~
NOTE: Attached is a site plan drawing, a design drawing, two soils logs and a 4 page
construction specification letter which are all part of the design package for this septic system.
KINCAID ROAD / I ....
NOTE: ALL PROPERTIES SHOWN IN KINCA]D ACRES
AND KINCAID HEIGHm ~E HOOKED UP TO OR
ARE ~LE TO CONNECT TO PUBUC WATER.
' : il {
t LOT 2. KINOA'D HEIGH~ ~
~_ , ,
~ .' ~ S ~ ~ ~ 4 BEDROOM
~ / ~~ "~ /~ ~ ~ m ' (sE NOTE)
~ (SEE D~IGN, P~E~F'2) /~ / 0 I
NO~: A OUP~N IS ON LOTS ~ AND ~B, NINC~D ~.
PER CONVERSATION WRH ~W.W.U.. LOT 2B IS CONNECTED
TO PWBUC WATER. ~E DUP~X ~S SER~D ~ A SE~C
S~TEM ON LOT ~
AI.AS~ WA~ A~ W~WA~.R CONS~T~s, ~C. ~~,~
PHONE= (907) 357-617g/F~: (907) ~B-52~
LEGAL
PREPAR~ FOR: PHONE NUMBER:
BILL TAYLOR W/ COLONY BUILDERS 244-6233
}A~:5/22/99 J J'L'M'/A'C'G' 1 = 100' 1 OF 2
..~' ~" , t'"'X¥ _\ ~ 1. THE CONTRACTOR IS RESPONSIBLE~FO_R__ I
~'-- \ ~ . \ ~ "~ ..,,,,/~..E?.AI~TtON DISTANCES
"- / \ A-. \ OON~UO,~ON. '-
I
I
I
~ I
ON ~ //
SEPT~ ~NK~ ~, ~ ~ ~ .//~ i I
x TH-~ -// I
.......... ',X', I
~NFt~D, EXC~ATE~ ~ X/ ~ ............ .~ I
~Y ~2 FE~ LONG. ADD g FE~ ~ ~ ~,
I
~S~ WA~ A~ W~WA~.~ CONS~T~S, ~C.
LEaL D~CRIPTION:
KI~AID H[16HT~ ~U~DIVISION, LOT ~
~E OF WORK:
PREPARED FOR: PHONE NUMBER: In~ ~'.1 ~--7953 -"
BILL TAYLOR W/ COLONY BUILDERS 244-6233 vQ~,:~... ~ .... .....,~
DATE:3/22/99 D~WN ~: SC~E: PAGE:
J.L.M. 1 = 40' 2 OF 2
6901 DEBARR ROAD. SUITE 2B * ANCHORAGE, AK, 9950¢
PHONE (907) 337-6179 * FAX (907) 338-3246 ~..
LEGAL DESCRIPTION: KINCAID HEIGHTS SUBDIVISION. LOT7"'~ ~-"'~.~.~
PERFORMED FOR: BILL TAYLOR WITH COLONY BUI~ERS ~....~
~ //_~ffr~ A. ~ ~ ~
DATE PERFORMED: 5/10/99 tfl.~]~] ~'-7953 .' &~
TEST HOLE ~q ..... ~
DEPTH t .....
~ ~ ORGANICS
~ ; GN ~ CL
~iti i~ THROUGHOUT.
,~ J{~ t" nAT~ I ~AniM~ CLOCK NET TIME WATER LEVEL NET DROP
"~' ',, .... J ......... TIHE (HINUTES) READING (INCHES)
~9 ~B 0 H PERCO~TION ~TE <1 (HIN/INCH) P=RC HOLE DIA 6 (INCHES)
20~ TESTRUNBETWEEN 5.0 r~.AND ' ~ ~.
DATE, DATE: ~/~ ~
DEPTH TO DATE
3ROUNDWATER
DRY 5/10/99
DRY 3/19/99
AI.&SKA WATER & WASTEWATER COHSULTANTS~ INC. ~ --~ ~
PHONE (gOT) 337-617a * F~ (~07)
[SOIL LOG - P[RCOLATION TEST] E~-'~~__'~
[ I
~ - 0 RGAN I CS '~%~%~
2-- , SOIL C~SSIFICATIONS ~ ~ ~
~ GM CL
~ o%~ SW MH :f'~.. X ! ]
$ ~ k ~ X 4 BEDROOM
GROUNDWATER
SM DRY ~/~/~ Z~ I
BI SO~ SIL~ SAND
WITH F~ SW
10-- AND SP LENSES ~ { I
THROUGHOUT.
11-- DATE READING CLOCK NET TIME WATER LEVEL NET DROP
TIHE (MINUTES) READING (INCHES)
12-- 5/12/99 - PERC CAVI~ W~ PRESOAKED 4 HOURS PRIOR TO TESTING.
1 5:00 - 6- _
13-- 2 5:50 50 ~1~. 2 1/8" 3 7/8"
5 5:50 - _ 6" _
14I ~ 6:00 50 MIN. 2 5/16" 3 13/16"
15 ~ ~ 5 6:00 - 6- _
6 6:50 30 MIN. I 2 5/16" 5 15/16"
16--
17--
18I
19-- B.O.H. PERCO~TION ~TE 7.9 (MIN./INCH)~ERC. HOLE DIA. ~(INCHES)
20-- ~ TEST RUN BETWEEN 6.0 ~. A~ ~6r5 FT.
//// /
COHHENTS:
DEPTH TO DATE
GROUNDWATER
DRY 3/10/99
DRY 3/19/99
AlgJVC, Inc., March 1999
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B ~ Anchorage ~ Alaska 99504
Phone (907) 337-6179 - Fax (907) 338-3246
Onsite Wastewater Disposal System Standard Construction Specifications
I. REFERENCE PROPERTY: Lot 7, Kincaid Heights Subdivision
H. DEFINITIONS:
1. Property owner: The legal property owner or his/her representative.
2. Engineer: Alaska Water & Wastewater Consultants, Inc. or AWWC, Inc.
3. Contractor: The company hired by the property owner to install the septic system.
4. DHHS: Municipality of Anchorage, Department of Health & Human Services
5. M.O.A.: Municipality of Anchorage, Department of Health & Human Services
IH. RESPONSIBILITIES:
Property Owner Responsibilities:
1. The property, owner shall contract with the contractor to perform the work outlined in these
specifications and plans, in accordance with the attached DHHS permit. There is no contractual
relationship between the contractor and the engineer. The engineer shall inspect the work as, required by
DHHS to document the installation. Final acceptance of the contractor's work rests with the owner and
the DHHS.
2. This well and/or septic system design is for a single family residence only. The homeowner is
responsible for notifying the engineer if the residence is used as a duplex, business, or multi-family
dwelling. In such cases, the installation permit must be obtained from the State of Alaska, Department of
Environmental Conservation.
3. The validity of the design site plan is limited by the accuracy of the as-built survey provided to the
engineer by the property owner or his/her representative. The property owner shall notify the engineer
regarding any known inaccuracies associated with the as-built survey. The engineer assumes no
responsibility for the accuracy of the survey.
4. The property owner is responsible for notifying the engineer of any unplatted easements, not shown on
the as-built survey, which the new well or septic system may encroach into.
5. The property owner shall notify the engineer of any seasonal groundwater or surface water runoff
conditions, known to him/her, which could potentially effect the operation of the septic system. The
proposed septic system must be at least 100 feet from any streams, ponds, creeks, swamps, bogs, or any
other surface water as defined by the DHHS.
6. The property owner is responsible for notifying the engineer if, to his/her knowledge, any of the
adjacent properties are used as a duplex, business, or multifamily dwelling. The new septic tank and
leachfield must be at least 100 feet fi'om any private well, 150 feet from any class "C" well, and 200 feet
from any commanity well, unless appropriate waivers are obtained.
1 of 4
A WWC, Inc., March 1999
7. The property owner and/or his contractor shall report to the engineer any observed condition which
would put the septic system in violation of State or Municipal regulations.
8. Unless specifically agreed upon otherwise, the property owner is responsible for final grading of the
areas which settle after construction. Prior to awarding the contract, the homeowner should communicate
to the contractor any expectations regarding, but not limited to, post construction site clean-up,
re-landscaping, and restoration of any asphalt, fences, trees, decks, ect. that are effected by the
construction. If the property is being sold, the property owner shall ensure that the aforementioned items
are addressed with the buyer, and, if the work is to be completed after the sale of the property, that
necessary funds are escrowed to fund the completion of the work.
9. ffthe property owner intends to install the septic system he/she must first have obtained approval from
the Municipality of Anchorage, DHHS (343-4744). Homeowner installations typically require more time
for engineer inspections. The homeowner should discuss the additional costs, associated with such
inspections, with the engineer, prior to starting the project.
10. The property owner is responsible for payment of all the engineer inspection charges. The number of
inspections will vary depending on the actual field conditions encountered and the construction methods
used.
Contractor Responsibilities:
1. The contractor is responsible for locating all buried utilities, easements, property lines, and surface
waters; and shall ensure that all setbacks are flagged by a registered land surveyor prior to construction.
2. Construction shall be in accordance with the approved site plan and design drawings, and any special
provisions noted on the municipal sewer permit. The contractor is responsible for notifying the engineer
of any discrepancies noted on the design plans or drawings, prior to starting work. The installation,
materials, and workmanship shall comply with all applicable State & Municipal regulations.
3. The contractor is responsible for field verifying the separation distances to all adjacent wells and septic
systems, shown on the design drawings, prior to starting construction. Any encroachments that would
effect the installation, for which waivers do not exist, should immediately be brought to the attention of
the engineer.
4. Ensure that all materials being used are in compliance with the most current guidelines established by
the Municipality of Anchorage. This includes, but is not limited to, the following:
a. Drainrock
b. Sand filter material for conventional beds, trenches, or mound systems.
c. Sand filter material and pea gravel for Intermittent Sand Filters (ISF).
d. Anchorage Sand and Gravel (AS&G) "block pea" material for Upflow Filters.
It is recommended that the contractor provide the engineer with current sieve analysis' from the
sand/gravel supplier to document the suitability of the material. The engineer assumes no responsibility
for ensuring that the materials delivered meet the MOA requirements.
5. The contractor shall ensure that the septic tank, lift station, or holding tank purchased has a burial
depth rating suitable for the actual installation.
6. Notify the engineer at least 24 hours prior to starting construction. If deemed necessary, a
preconstruction site visit shall take place. The contractor shall coordinate with the engineer any
2 of 4
AWWC, Inc., March 1999
inspections which will be required during weekends, holidays, or before/alter normal working hours (8:00
am to 5:00 PM). The property owner may incur additional charges for inspections which do not occur
during normal business hours. It is the contractor's responsibility to notify the engineer a least 2 hours
prior to any inspection.
7. The contractor shall report to the engineer any observed condition which would put the septic system
in violation of State or Municipal regulations.
8. Any remaining test hole excavations shall be filled and mounded. Unless instructed otherwise by the
engineer, the old test hole groundwater monitoring pipes shall be removed.
9. The contractor is responsible for final grading so as to ensure that surface runoff does not adversely
effect the septic system constructed, adjacent septic systems, or adjacent structures.
10. The contractor is responsible for obtaining approval from the property owner for any additional
construction costs associated with design modifications or changing field conditions, prior to doing the
work.
Engineer Responsibilities:
1. The engineer is responsible for inspecting the installation of the septic system and preparing as-built
documentation, to the satisfaction of the M.O.A.. Inspections are performed as necessary to document the
construction of the system to the satisfaction of the M.O.A. In all cases, the following inspections shall be
performed:
* The bottom of all trench/bed excavation
* Top of sand on all sand filters
* Top of drainpipe
* Septic tank, or lift station, or holding tank prior to backfill
* Placement of filter fabric and insulation
*Atter final grading is completed
Additional inspections may be required depending on the construction methods used by the contractor and
the type of system being installed.
2. The inspecting engineer has no direct authority over the contractors activities or construction practices.
Should the engineer identify conditions which dictate a design change, he or she may recommend that
work be stopped,, and/or the design be modified. If design modifications are necessary, the engineer shall
notify the property owner or his/her representative.
3. The engineer shall inspect the condition of the existing septic tank and determining its suitability for
re-use. Ifthe engineer dcterminesthe septic tank to be structurally unsound, it must be replaced.
IV. CONSTRUCTION GUIDELINES:
· General
Construction shall be in accordance with the approved site plan and design drawings, and any special
provisions noted on the municipal well and/or sewer permit. All materials, components, and construction
practices shall comply with the Municipality of Anchorage's latest ordinances regarding wells and septic
systems, as well as DHHS policies. The failure of the inspecting engineer to notice a material or
3 of 4
A WWC, Inc., March 1999
construction non-compliance does not relieve the contractor of his/her responsibility to correct such a
deficiency.
· Septic Tang Holding Tank, or Lift Station Installation:
1. The burial rating of the tank shall be adequate for the actual burial depth encountered.
2. The tank shall be level and sufficiently bedded to prevent settling or shifting of the tank.
3. All standpipes on the tank shall extend a minimum of 12 inches above final grade.
4. Tanks installed with less than 4 feet of cover shall be insulated.
5. The sewer service line from the house to the tank shall be sloped a minimum of 1/4"
per foot, unless prior approval is obtained from the engineer.
6. The inlet and outlet lines from the tank shall be bedded in drainroek or the soil shall be adequately
compaoted to prevent future settlement of the soil.
7. A foundation clean-out will be installed, 1-4 feet from the house,'ifone does not currently exist.
8. Post tank dean-outs shall be installed per MOA requirements. Does not apply to holding tanks or lift
stations with pressurized lines.
9. All tanks shall be anchored to resist buoyancy forces in high groundwater areas. This applies when
there is not adequate soil cover to resist buoyancy forces. Engineer shall make this deteanination.
10. The final soil cover shall be graded so that there is positive drainage away fi'om tank.
11. All holding tanks and lift stations shall have an audible and visible alarm inside the residence.
12. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform Electrical
Code.
13. The contractor shall remove the old tank, or abandon it in compliance with the Uniform Plumbing
Code (UPC). The contractor is solely responsible for the abandonment procedure.
· Installation of Conventional Absorption Bed & Trenches:
1. Excavate the proposed bed/trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level (2 inch maximum variation between high and low spots). If
the sidewalls or bottom of the excavation become smeared, they must be raked or scarified before
placement of the filter sand or drainrock.
2. The trench or bed should be at least 5 feet from the test hole excavation.
3. All soil tests and excavation depths are advisory to the design and are to be verified in the field by the
engineer. If design changes are necessary, and the changes effect the contractor charges to the property
owner, the contractor shall obtain approval from the property owner prior to proceeding with the work.
4. Once the drainrock is installed, the distribution pipe is to be placed level (0.02 feet difference between
high and low shots) with the perforations faced downward. Drainrock is then to be placed over the
distribution pipe, to provide a minimum of 2 inches of cover over the pipe. The drainrock shall not be
pyramided over the drainpipe but shall be the same elevation over the entire trenchPoed width.
5. A silt barrier must be installed between the final drainrock layer and the native soil backfill. The silt
barrier shall cover the entire drainrock surface.
6. Monitor robes shall be installed at the locations shown on the design drawings, and extend a minimum
of 12 inches above final grade. The portion of the monitoring robe extending through the drainrock shall
be perforated from the bottom of the trench/bed to the invert of the distribution pipe.
7. Backfill over the final drainreck layer must not be less than 2 feet. Insulation must be installed when
the backfill depth is less than 3 feet. The insulation shall cover the entire width of the trench/bed, the
contractor shall "shoot" the final grades to ensure cove~ depth is adequate, prior to notifying the engineer
that the work is complete. The final cover over the drainfield must graded so that there is no potential for
water to pond over the trench/drainfield.
4 of 4
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & H JMAN SERVICES
Division of Environmental Servic(~s
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
011 -122-'07
Parcel I.D. #
1. GENERAL INFORMATION
Complete'legal description T,ot
HAA #
Kincaid Heights Subdivision
Location (site address or directions)
corner of Lauden & Ingram
Anchorage, AK
Property owner
Mailing address
Lend!rig agency
Mailin. g address
Agent
Address
Colony Builders
Day phone 244-6233
2340 Loren Circle Anchorage, AK
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water xx
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:
XX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA#21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed.hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water 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 ALA~ WATER & W~A~ TEWATER
Address 6901 DB ~t, EOAD, 8UITE 2B
Engineer's signature ~__~ _~,~ 99~_
Alaska Water &
Wa~tewater Consultants, Jilt.,.
Shall be PAID $ 97~ . 'al.
or prior to, closing for the '~'~
Engineering Services Provide~
DHHS SIGNATURE
/'~ Approved for
bedrooms.
Disapproved.
Conditional approval for
Phone
Date -,~/~/~ ~'
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~
~ . . MAY 27 '1999
unicipality of Ancnorage /~.~.~,.
DEPARTMENT OF HEALTH & HUMAN SER~'~ ~ o~ ^NCHO~L~
Environmental Services Division ~NVIRONM~NTAL SERVICES DIVISI~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Legal Description:
A. WELL DATA
Well type
Health Authority Approval Checklist
J~/~^~0 .-~/~ . Lo~' -/ Parcel I.D.:
· ~
If A, B, or C, attach ADEC letter. ADEC water system number
Log present (~1~ _
-o'7
Total depth Cased to
Sanitary seal (Y/~.~)~/
FROM WELL LOG
Date completed ~
~ht (above ground)
Wires pro~
AT INSPECTION
Date of test , ,~
Static water level ~'"'~~
Well production ~
g.p.m. ~ g.p.m.
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate -" Other bacteria
Collected by:
B. SEPTIC/~J~i~N~ TANK DATA
Date installed ~,~//~-,~/?/~ank size
Foundation cleanout (~/N)
Date of Pumping
] ~'~ ~ Number of Compartments
Depression (Y~) ~o High water alarm (Y~
Pumper
C. ABSORPTION FIELD DATA
Date installed ~,///~??~?~/~/~Soilrating~~/bdr~m,) ~'~ Systemtype O~P
I t
Length ~'(~ Width ~-,-~ ! Gravel thickness below pipe B. ~/~ I Total depth I Z~O - t ~. _~
Effective absorption area ~&~ ¢ Monitoring Tube present ~;~N). "7'~-~ Depression °ver field (Y/(~)
Date of adequacy test ~ ~ ~ Results (Pass/Fail) ~ For ~ ~ ~- ~' ~ .bedrooms
Fluid depth in absorption field before test (in.);
Fluid depth ~ (ins) Minutes ater:
Peroxide treatment (past 12 months) (Y/N)
Immediately after
gal. water added (in.):
Absorption rate = _g.p.d.
If yes, give date
72-026 (Rev. 3/96)*
/
UFT ST^T ON
Date installed Size in gallons
Manhole/Access (Y/N)~t~
High ~ *Datum ~
Cycles tested
"Pump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Abso r ption fie~d o"~'~-~ot ~
On adjacent lots
~ent lots
Public sewer mai.~.__~
Sew~e~rvice line
Public sewer manhole~
Lift station
SEPARATION DISTANCES FROM SEPTIC/~ TANK ON LOTTO:
Foundation I o ~4-
-- Property line ~ I.p Absorption field
I.
I
Water main/service line 14) J~ Surface water/drainage Io,~ -~ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
I
Property line ~/'~ ~ Building foundation J o Water main/service line
Surface water [oo ~ -1- Driveway, parking/vehicle storage area
Curtain drain I''J,~ ,~ ~ J/~,v,~_~ ,,J Wells on adjacent lots ~ oo ~ -ff
/
ENGINEER'S CERTIFICATION //~ ~7~ · ~/
I certify that I I~¢~de~ninee~t~ field inspections and review of Municipal recor¢~~4 ,~re
in conforma~e wi~ ~A ~auid~lines in effect on this date. /~ //~" ~".1~ ~
Signature~___~ ~ ' ;:t
HAA Fee $ ~:~/~-'z~-
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*