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Home My WebLink AboutMADDUX PARK LT 4 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage., 'A aska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ,~'M/~)~¢ E2 ~_ ! ~ PID Number: O ! ~t'~. ~1 ~ ~ N~m~:'~C~ ~ ~. ~0~ Wastewater System: ~ New ~ Upgrade Address:~~~P~i~ A~C4 ~¢~ ABSORPTION FIELD No. of Bedrooms: Phone: ~-- ~ 7~ ~ ~ Deep Trench D.Shallow Trench D Bed D Mound ~ Other LEGAL D ESCRIPTI O N soi~ Rating: Total Depth from original grade: O, ~ CPD/Sq. Ft. II, Lot: Block: Subdiv~ion: Deplh to pipe bottom from original grads: Gravel dept'h beneath pipe ~ ~ ~ ~ ?~ ~ ~, 0 ~t. 7, 0 Township: ~ Range: Section: Fill added above original grade: Gravel length: I -- ~ Ft. ~ / Et, I Number of lines; 0istance between lines: WELL: E~fB New ~ Upgrade eravelwidth: ~'~ Ft. I -- Ft. CIsssification (Private, A,B,C): i Total Depth: Cased To: Total absorption area: Pipe material: ~.~ I Ft. ~t. 71 ~ SQ. FL b-~OZ? Driller: DateDdlted: St~licWaterLevel:Ft. installer:c ~ ~ Date installed: SEPARATION DISTANCES a s.ptic ~ Ho~di.g ~ S.T.E,~. TO Septic Absorption Lilt Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank SewerLines ~0~ ~ ~ Material: Number of Compartments: Sudace Water >~¢0 >~¢0 - - _ LIFT STATION Lot Size in gallons: Manufacturer: Line ~ 0 -- -- "Pump on" level at: "Pump off" level at; ~ High water alarm at: Foundation 1 CurtainDrain -- . -- -- -- Pump Ma~e & Model Electrical Inspections performed by: Remarks: ~ ~e~'c ~n~ ,~A//~ BENCH MARK ~j~ O~t~l~/ ~N '~ ~ LocationandDescription:~ ~ (O~~ Assumed Elevation: I~, ~ ~[, ENGINEEWS SEAL Inspections performed by: ~(~f Y¢c~ ~u~ Dates: 1st. 7(~¢/¢¢ ¢,;'~,,,,i',.,,~.;~,,,,,:~ '~D~,~ · * ,."~'~ 79-013 (Rev, 9/91) MOA 25 PERMIT NO: SW960212 / PAGE 2 OF 2 PID NO: 01825104 SWING TIES: COR."B" COR."C" FROM: COR. "A" TO: S.T.C.O. "D" 9.5' 20.3' S.T.C.O. "E" 12.5' 25.8' DBL. C.O."F" 16.4' 28.5' VALVE "G" 17.7' 28.5' TR. C.O. "H" 23' 45' 60' TR. M.T. "1" 37.5' 47' 39' TR. C.O. "J" 52' 47' 12' C.O. "K" 43' 36.5' 19' M.T. "L" 25' 15' NEW 51' LONG SOIL ABS. TRENCH CTIVE GRAVEL DEPTH PLAN VIEW 1" = 20'- 0" NEW 1000 GAL. SEPTIC TANK bECK I I EXISTING ,~ 3 BDRM o HOUSE I I "L"~TBM B" __ ORIGINAL ~[~ SOIL ABS. TRENCH GROUND 94.3' NEW 1000 GALLON SEPTIC TANK ~--~_INV. 94.5' T.H. #1 M.T. 80.8' ,~' (DRY 7/28/96) PROFILE VIEW NOT TO SCALE LOT 4, MADDUX PARK S/D SEPTIC SYSTEM UPGRADE AS-BUILT INSPECTION REPORT FLATTOP TECHNICAL SERVICES SCALE: AS NOTED 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 AUGUST, 1996 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960212 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:GREGORICH VINCENT P JR & OWNER ADDRESS:2660 IVORY DR ANCHORAGE, ALASKA 99516 PARCEL ID:01825104 PAGE 1 OF 1 DATE ISSUED: 7/19/96 EXPIRATION DATE: 7/19/97 LEGAL DESCRIPTION: MADDUX PARK LT 4 LOT SIZE: 13200 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ~ ~ ISSUED BY: ~52,/ DATE: DATE: Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 July 24, 1996 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 4 Maddux Park Subdivision Waiver Request # WR960033, PID #018-251-04, Permit #SW960212 Dear Mr. Moore: Your request for a waiver of the required 10 foot separation between a on-site wastewater disposal system and a lot line has been approved. The waived distance is the new trench to the west property line of 0 feet. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another from this department. If there are any questions or concerns regarding this waiver, please call our office at 343- 4744. Sincerely, Daniel J. Roth Civil Engineer - On-site Services DJR/ljm:Gregorich MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet Permit WR~ WR960033 PID# 018-251-04 HA# Date Received: July 8, 1996 Legal Description: Lot 4 Maddux Park Engineer: Ted Moore, P.E., Flattop Technical Services 14530 Echo Street, Anchorage, Alaska 995~6 Applicant: Vincent Gregorich Waiver Requested: Lot line waiver of new trench to west property line of 0 feet. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: X Waiver is NOT Granted: List Conditions or Reasons for above: ffF ~/~6F~ Z~U6~ Name of Reviewer Rec ~: ~02042/0586 Amount: $ 115.00 Date Paid: 7-8-96 CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALfSIS TItEODORE F. MOORE, P.E. PH: (907) 345-1355 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dem' Sh's: 14530 ECHO ST. July 8, 1996 ANCHORAGE, ALASKA 99516 MUNICIP^LITY O~ ANCHORAge ENVIRONMENTAL SERVICES DIVISION JUL 08 1996 RECEIVED The purpose of this letter is to provide the required design narrative in support of our application for a permit to upgrade the wastewater disposal facilities on Lot 4, Maddux Park S/D, located at 2660 Ivory Drive. The present system is operating in a surcharged condition. In order to make this upgrade possible, we are also requesting issuance of a lot line waiver allowing the new U'ench to be consU'ucted within 0 feet of the west lot line. Soils logs, perc test results, a site plan, design di'awings and specifications are enclosed for your review. The only available site to construct the proposed trench is just west of test holes #1 and #2. As can be seen from the soil logs, the native material between 3 feet and 17.75 feet below ground level is a silty sand with a measured perc rate of 8 minutes per inch. In test hole #2 some cleaner gravelly sand was encountered down to 10 feet which will help provide better absmption in a portion of the trench, however tl'/e extent of this sand stratum is unknown. Using the soil application rate of 0.8 gpd/sq, ft. specified in the wastewater ordinance for soils with a perc rate between 6 and 15 minutes per inch, this 3 bedi'oom residence would requh'e a total absorption at'ea of (3 x 150)/0.8 = 563 square feet. The proposed 50 foot long u'ench design with 7 feet of sewer gravel has a total absorption area of 700 squat'e feet, which should offset any adverse effects attributable to its proximity to the original system. The proposed upgrade will also incorporate a diversion valve allowing futura reconnection to the original trench as desh'ed, after the original system has had a chance to dry out. The topography of the lot in the vicinity of the proposed system slopes down towm'ds the south southwest at 3 - 15%. The proposed design concept is to construct the trench around the northwest perimeter of the existing system, staying as fat' away from it as topography and lot lines allow. Even with the requested lot line waiver, the maximum separation between U'enches that can reasonably be achieved is approximately 5 feet. As can be seen from the layout depicted on the site plan, granting the requested lot line waiver will have little or no effect on the ability to consu'uct replacement systems on Lot 3 which is on the other side of the lot line. Except as discussed above, the proposed project should have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-surface and subsm'face, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. ' (~ WELL , , LOT 5 , ~ LOT 2 , , , ', IVORY DRIVE WELL ,, , "", WELL LOT 8 LOT 4 ,, IN,S, TALL DBL C.O. :r-, ,' / ~ %/ ~. ',,( /~ & 'BULL RUN" , p¢ ,,' / ~,,,. ~C--.~o_usE '~ /',,, /... ' L -DIVERSION VALVE ,, ,,' %, % '"'--~/__ /___-:", / ~ TH , ,,' SEPTIC %.. ~ J ..... ~ C.C.., '/._ - ___ #2 , BLM LOT79 SYSTEM % ~.~ / /~.~/?'~-~CK ~ i (VACANT) ~ '7 /...¢¢..~%..~1 -- ..., , .-- 50,LO'''''°~ /~ ~.//,,/M ~ l/"~'.T~ -' .... EXISTING .... ,~-- CONSTRUCT NEW SOIL ABS~~ ,.4¢z2' ~'~,.!~. 3 BDRM ,, ~-~ .... lY ~4 : ~,~ ~_ HOUSE .................................. ~_- ............. ~ ---F'~:--/ EXISTING SOIL ~ ABS. TRENCHES,' , BLM LOT 82 LOT 1, AMBER LOT 2, AMBER ', HEIGHTS S/D HEIGHTS S/D (VACANT) ', ,.C:!:i~ 7'.:, ~ i ."'.r , · :~ ~,,: . :.,..;, , ., .... .2. ', .c,. 'er ~ ' .;' ~ . f;: , "~'~2' ~, ¢¢g¢.,~:' LOT 4, MADDUX PARK S/D WELL *5 "..:,. ,o~,~...; _: ,:. ';:.;:-~: .¢ ,';. SEPTIC SYSTEM UPG RADE ., ". ,,. (:~: ~ 3.~:; ," .','.,.;~: SITE PLAN ,~, ~-, .... FLATYOP TECHNICAL SERVICES 1 INCH = 40 FEET '''~ ~'' r' .... '' ' 14530 ECHO STREET DRAWN BY TFM ANCBORAGE, A&ASKA 99516 JUNE, 1996 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. "A" CONSTRUCT NEW 50' LONG - SOIL ABSORPTION TRENCH ..~ ~~ W. 7.0'GVL. BELOW DIST PIPE EXISTING ~,~---~ ~ /% . / 1000 GALLON CONNECT TO J' . ~ ~ SEPTIC TANK ORIGINAL TRENCH INSTALL~ PLAN VIEW SCALE: 1" = 10'- 0" MOUND BACKFILL MATERIAL 12" ORIGINAL GROUND FABRIC F-810 PERF PIPE 1/2" - 2 1/2" SEWER GRAVEL F TRENCH SECTION "A - A" SCALE: 1" = 5' - 0" LOT 4, MADDUX PARK S/D SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOP TECHNICAL SERVICES SCALE: AS SHOWN 14530 ECHO STREET DRAWN BY: TFM ANCHORAGE, AK, 99516 JULY, 1996 Flattop Technical Serv~es 14530 Echo Street, Anchorage, AK99516 Phone (907) 345-1355 Lot 4, Maddux Park S/D 2660 Ivory Drive Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of inspecting the condition of the existing septic tank and construction of a new 50 foot long soil absorption trench containing a total of 7.5 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or requked by the engineer conducting the inspections. All construction procedm'es and material specifications shall conform with Municipal and State requh'ements. All separation distances shall be in conformance with Municipal requh'ements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work m'ound any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper ddralnage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn m'eas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all m'eas distm'bed by the construction. 1.6 The homeowner shall be responsible for any necessary coordination of the work, including probable ddriving equipment over the lot line, with the owner of Lot 3 2.0 Septic Tank: 2.1 The existing septic tank may be retained in se~wice, only if it's structural integrity has been verified by the inspecting engineer, and if it has functional cleanout pipes with ah'tight caps, allowing pumping access to each compartment. Any existing septic tank which is not retained in se~wice must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil. 2.2 If requh'ed, a new 1000 gallon 2 compmlment septic tank shall be set level on undisturbed soil. Each compm~tment 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. 2.3 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. 2.4 A "Bull Run" diversion valve shall be installed downstream of the double cleanout allowing future reconnecfion to the original trench, as desh'ed. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 50 foot long trench in the location shown to a depth of 7.25 feet below the level of the invert of the discharge pipe fi'om the septic tank. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 A total of 7.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated disu'ibution pipes laid level such that the pipe inverts m'e no less than 7.0 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design ch'awings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 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 thicka~ess is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the euth'e top surface of the gravel, in addition to the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 12 inches higher than the sun'oundh~g ten'ain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for mu'anging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all at'eas disturbed by the consU'uction. 4.0 Inspections: 4.1 A minimum of 4 engineering inspections will be required dm'ing the com'se 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 sm'face to ensm'e 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 insulation or filter fabric, and (4) after rough backfill and grading is complete. The new septic tank, if needed, 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 tinting of the inspections with the engineer sufficiently fat' in advance to ensm'e the availability of the engineer. TEST HOLE LEGAL DESCRIPTION: DATE PERFORMED: PERFORMED FOR: DEPTH -- (feet) 17.75 __ COMMENTS: FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST Lot 4, Maddux Park Subdivision June 21, 1996 Vhlce Gregorich Pt. GM Fill material Pt. (Original ground) SM Reddish sandy loam SM Gray silty staid Dry, scattered cobbles and boulders Sidewalls do not smear Dense, hard digging SM siltier and wet between 12' & 13.5' Sandier and dry below SLOPE Depth to Groundwater Date No ~roundwater 6/21/96 Monitor tube dry 7/1/96 ,. . · SITE PLAN IVORY DRIVE EXISTING HOUSE SM damp near bottom B.H. PERCOLATION RATE 8 (minutes/inch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN 5.25 FT AND 5.75 FT Grouad level at Test Hole is approxin]ately 3,5' above septic tank outlet invert. Construct t~ench between 4' aad 11' B.G.L Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) 6/21 12-" Presoak -- 27 7/16 Add water and start 3:59:30 23 ~/16 #1 4:09:30 10 22 1 5/16 Add water 4:10 23 9/16 #2 4:20 10 22 1/4 1 5/16 Add water 4:20:15 23 5/8 #3 4:30:15 10 22 5/16 1 5/16 I ~7'-,.~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY FLATTOP TECHNICAL SERVICES. AOOORDANOE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEOT ON THIS DATE. DATE: TEST HOLE# 2, FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lot 4, Maddux Park Subdivision DATE PERFORMED: June 21, 1996 PERFORMED FOR: Vince Gregorich DEPTH -- (feet) Pt. SM Reddish sandy loam SM silty saad SP/SM Slightly silty gravelly saad Loose, dry. Sidewalls slough Macy cobbles in upper portioa Will perc faster than T.H. #1 SM Silty sand Dense, hard digging Similar to T.H. #1 SLOPE Depth to Groundwater Date No eroundwater 6/21/96 Monitor tube dry 7/1/96 IVORY DRIVE EXISTING HOUSE Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FTAND FT COMMENTS: This test hole was dug to check continuity of soils encountered in T.H. # 1, Soils between 4' nad 10' will perc faster, however the the ground surface at the test hole is approximately 7 feet higher than the septic tank oetlet iuvert. Therefore, design should be based on T.H. #1 perc. PERFORMED BY FLATTOP TECHNICAL SERVICES. I ,.~.,~,~ ~.~.~. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: '7 NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONIVIENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS LEGAL_ DESCRIPTION LOCATION Well (' [Absorption area DISTANCE TO: '/-- / Manufacturer ~/~. IF ~ Inside length Liq,DiSTANcECapacity in To:gall°ns Well HOMEMADE: Manufacturer IPHONE PGRADE NO. OF BEDROOMS Dwelling PERMIT NO, No, of compartments Width Liquid depth PERMIT NO. Liquid capacity in gallons Well . / Foundation DISTANCE TO: /~')(~) ~ No. of ]ine~ JMaterial /~ot line Total _~1¢..~ J Trench width length of lines ~) I Material beneath tile inches Depth Length of each line Top of tile to finish grade Length Distance between lines Total effective absorption area PERMIT NO. Width Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line 1PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank ~ A~ ~rea(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER R EMAR KS APPROVED DATE LEGAL 72-013 (Rev. 3/78) [:,EPFtF..'f'MENT hqF'F'l.. I CF, NT STEPHEN LOCRT I O1'.,I :1..44TH FIN[:, LFIKE; OT I S ¢-- ' ~'~/~ I..EGRL E4;fISDDU)< PARK : LOT SIZE :1.]:5OO S6!L.IRRE FE:E]" T'¢F'E OF SOIL RBSORPTION S'¢S'f'EM IS: TRENCH MFtXIMUM NUMBER OF' BEDROOMS = Z-': SOIL. RFtTING ,::S6! FT,.-"BR)= :175 TFIE REC, L IRED SIZE OF 'THE SCi:[[.. RBS()RPTION :5'¢s'rEM IS: ]"HE LENGTFI DIMENSION I2; THE LENGTH (IN FEET) OF THE TRENCH OR I}',RFtIt~,IFIEL[:,. THE DEF'TH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE :=-,URFRCE OF THE GROUND FIND ]'HE BOTTOM OF THE E',,4CFIVRTION (IN FEE]'). THERE I.']:; NO SE]' ~,.II[:,TH FOR TRENE:NE~5. THE GRR',,,'EL DEPTH I::;'; ]'HE MINIMUM DEPTH OF GRFt',,,°EI... BETWEEN THE OUTFRLL PIF'E Rf.,ID THE BOTTOM OF THE: E',:..',CFtVFtTION ,::IN FEET). PERMIT I:";PPL. ICFtNT HRS THE RESPONSIE;ILIT'.r' TO INFORM THIS [:,EF'RRTMENT F.:,LIRING THE INSThqLLRTION INSPEC'rIONS OF RN'¢ WELLS RDJRCENT 'TO THIS F'ROPERT'¢ RND ]'FIE NUMBER OF RESIDENCES THR'f' THE WELL [4ILL SER~,,'E. BRCKFILLING OF RN'¢ S'¢S'f'EM NITHOU"r FINRL. INSPECTION RND FIPPRO',,,'RL. B'-r' THIS; [:,EF'F:~RTMENT WILL BE SUBJEC. T ]'O PF..'O2:ECUTION. MINIMUM DISTRNCE BETWEEN hq WELL. RND FiN"r' ON-SITE SE[,IRGE DISPOSRL S'¢S'f'EM IS :200 FEET FOR R PR I ',,,'RTE [4ELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING LIPON THE T'¢PE OF PUBLIC WELL. MII",IIMUM DISTF~NCE FROM hq PRI',/RTE [4ELL TO Ft PR I ',,,'RTE SE[4ER I._INE IS 25 FEET FIND TO R E:OMMLINIT'¢ SE~4ER LINE I~.; 75 FEET. t4ELL LOGS F:~RE RE(.;!UIRE[:, RND r,lUST BE RETUF.:NED TO TIlE [:,EF'FIRTMENT kl]:THIN ]:0 DR"r'S; OF THE WELL COMPLETION. OTHER REI~.]IJIREMENTS Mhq'¢ ~:tF'PL'¢. SPECIFIC:FITIONS FIND C:ONSTF.:LICTION [:'IRGRhqMS RRE hq","hqILRBLE TO INSURE PROPER INSTFILL. RTION. I E:ERTIF'.r' THRT :1: I FIM FFIMILIFIR I.,.IITH THE RE6.'LIIREMENTS FOR ON-SITE SEWER_C; FIND t.4ELLS RS SET FORTH B'¢ ]"HE MUNICIPFIL!T'¢ OF RNCHORRGE. 2: I I.,.IILL INSTRLL THE :.:;"r'$TEM ZN hqCCORBFtNCE ['.lI'f'H THE CO[:'E~C;. 21:: I LINDERSThqN[) TH~:IT THE ON-SITE SEWER S"r'STEM MR"r' RE~;..'LIIRE ENLRRGEMENT IF THE RESI[:'ENCE I2; F.'.EMO[:'ELED TO INCLU[:'E MORE THhqN Z.'. BEDROOMS. ,..-? _ ]' '.:~ ':..1. EL' E~"r' ............... [:'FITE [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2221' SOILS LOG- PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: ~ LEGAL DESCRIPTION: 2 3 5 6 7 8 SLOPE SITE PLAN ! [ /: ! i ' /' I/ 10 11 12 13 14 15 16 17 18 19 2O COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN i FT AND ~'~""FT PERFORMED 72-008 (7/76) 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.# 0l¢ ~ o~'! ~Y 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address p, o. ~o~ 15'.~ 7 Y... Bo,.re., Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 3 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further 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 .. F/~ Address /~¢5"~ O Engineer's signature ~'~'~ 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. (Rev. 1/91) Back MOA ~Y21 ~UN~C~^urr o~: ^~c~o~e~ ~.NVIRONMENTA~ ~F. RvIcF.$ DIVISION Municipality of Anchorage AU~ 071~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Se~ices Division RECEi 825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 343-4744 Legal Descr/ption: A. WELL DATA Well type Log present CYfN) Total depth Sanitary seal (Y/N) Health Authority Approval Checklist Lg ~' ~,~ P"/ta eatad'~ x Pat r/n Parcel I.D.: O t ~ Z 5- t C~ he If A, B, or C, attach ADEC letter. ADEC water system number 'f Datecompletcd ~ t?tgO.~ ~,(ee?eo¢o( Io /ll /~9 Cased to 1 8,5" ~ Casing height (above ground) I g" y Wires properly protected (Y/N) Y' Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 c o t / t Oo m .~ FROM WELL LOG AT INSPECTION 93' 91' tltO g.p.m. 8, O 't- g.p.m. Nitrate O, t 06' rn,~[,,t~ Other bacteria None Date of sample: 1~ [ 8 / ~ {~ B. SEPTIC/HOLDING TANK DATA Date installed 7 [ ~'l [ ~ 6' Tank size Foundation cleanout (Y/N) Y DateofPumping._._~,A. (~.~..o~ Pumper C. ABSORPTION FIELD DATA Date installed '7 / 3 I / ~d' Length 5' [' Width Effective absorption area '7 ! Y Collected by: Number of Compartments Depression (Y/N) N High water alarm (YfN) Soil rating (g.p.d./ft2 or fl%drm) ~', 5" Gravel thickness below pipe ~' Monitoring Tube present(YfN) ¥ __ Cleanouts (Y/N), N.,~. Date of adequacy test N./I. (~') Results(Pass/Fail) Fluid depth in absorption field before test (in.); 0 Fluid depth (ins.) Minutes later: Peroxide treaUnent (past 12 months) (Y/N) N.A. __ Immediately after Absorption rate = If yes, give date O.Sff. pd'System type "Cc¢~' c 1~ ~-fi--f ~. - 7, ~' Total depth t I, o Depression over field (YfNr) N For 3 bedrooms __ gal. water added (in.): g.p.d. D. LIFt STATION Date installed Manhole/Access (Y/N) High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line tO~' Size in gallons "Pump on" level at* "Pump oft" level at* ; On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~' ' Property line ~ ~' Absorption field Water main/service line >, I0 ~ Surface water/drainage '2 IoO' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ ~ ' Surface water ~ t 6'6~ ' Curtain drain No~e ENGINEER'S CERTIFICATION ,..~ · ~:~, 7:" ~ 1 certify that I have determined thru field inspections and review of Municipal records :th~t~ th~;a~v~jSY~te't~gare in conformance with MOA HAA guidelines in effect on this date. Signature ~-'~ Engineer's Name "']-,~ Property Line O Water main/service line Driveway, parking/vehicle storage area ~' T~' Wells on adjacent lets I O ¥ t ~ 6x/a~o,e~' ~x. rta~,e4 7/~¥/q6~ HAA Fee $ J O0 oO Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number 0~×07/96 89; 39 CTSE ES! ~NCFIOR~GE -~ 907345i355 NO. 522 [P83 CT&E Environmental Services Inc, Laboratory Division 200 W. Potler Drive Anchorage, AK 99G 18-1 Tel: (907) 562-2343 Fex: (907) 561.5301 CT&E Ref.# 963487001 Client Name Flattop Technical Srv. Project Name/# N/A Client Sample ID L4, Maddux S/D Matrix Dri~tldng Water Ordered By PWS[D 0 Sample Remarks: Client PO# Printed Date/Time CoLlected Date/Time Received Date/Time Technical Director Relea,~ed By 08/06/96 13:56 08/02/96 11:50 08/02/96 13:25 Atto~abte Prep AnatyM3 ParameteP Resutts 0gL Units Hethod Limits 0ate Date Init t~itvete'N 0.106 0,100 mg/L ~PA 553~2 0B/0~/95 ~SC Hitri~e-N O,~OOU 0.100 mg/L EPA 353.2 08/02/96 ~H6 rotat Cotiform 0 0 ¢o[/100mL $H18 9~2Z~ 0B/0~/96 TAV t~[~S Member of tl'm SOS Group (Sect,hie Gen6rolo do Surveillance} FNVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA, FLORIDA, ILLINOIS, MARYLANO. MICHIGAN, MISSOURI, NEW JERSEY, OHI0, WEST VIRGINIA 17:01 CT&E EGI AI,ICHORRGE -~ 907345~355 leO. 5~0 D02 CT&E Environmental Services Inc, Laboratory Division ~'~r~'J~~e~l~j~r~;'~'~r~e'~jaerj~'~fjjfsjj~~ Drinking Water Analysis Report for Total Coliform Bacteria 200 w. pot,~ w~, Anchorage, AK 99§ 1 B- 1605 READ INSTRUCITONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Tel: {907) 562-2343 Fax: (907) fi61-5301 PUBLIC VvATER SYSTEM I.P, t~ ~[~ mUVAT~ W~TE~ SYST~ [3 3'¢ttd RewtlIS [~ Send/.voice Month Day Year S.~MI'LE I~,o u tlta e O Treated Water Repeat Saulpl~ (for routine sample ~ Untreated Water ~ith lab ref. no.. ) Special Purpose SAMPLE t,OCATION Time Collected Collected By Aualysis shows this Water SAMPLE to be: .);k-~' Satisfactory O Unsatisl~ctory Samph: over 30 hours old, results ilia)' be unreliable o Sample too loaf in transit; sample should not be over 48 hotlrs old al exanlination to indicate reliable testdts. Please send new sample via special deBvery mail. Dote Received Analysis Begnu Analy~icnl Method: ~Membrane Filter fl MMO-MUG ' Number of colonies/100 LaURel. No. ,,, Rosult* ~lyst S~n~ t~ A,D.g.O. Client notified Of IlllSntisfactoIT results: Da[c: Time: BACTEILIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform E. Coil O Colonies/lO0 mi Mcmhranc Filter: Direct Count __ Verification: I,TB ........ DGB. COLWIRM Fcc,1 Coliform Confirnmtiun Fired tM,~mbrane Filter Results Coliform/100 mi t~~ Member of the SGS Group(Soci*t~ G*n~¢ale d~ Surveillance) ENV~RONMFNTAL FA~ILtTIES ~N A~SKA. CALIFORNIA, FLORIDA, ILLINOIS, MARYt. AND. MICHIGAN, MISSOURI. N~W J~R~EY, OHIO, W~$T VtRG~NIA ~ DATE RECEIVED INSPECTION APPOINTMENTS ~ . ...,L TIME TIME TIME DATE DATE DATE / INSPECTOR INSPECTOR INSPECTOR~ , MUNICIPALITY OF ANCHORAGE DEPT. OF H:,:',LTJi & ~.A.~T o~ HEALTH · ~W.O~TA. P.O~Ci~ 825 L Street-Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 R E C E I V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on p~ge 1. Incomplete reques~ will not be processed, Please allow ten {10) days for processing. PHONE PROPERTY RESIDENT (If different from above) PHONE i2. ~UYER ' PHONE MAILING ADDRESS ~ 3, LENDING INSTITUTION ~ PHONE MAILING ADDRESS 4. REALTOR/AGENT /~(>~ ~~- ~- ~) ~ l / - J MAILING ADDR ES~._~- 5. LEGAL DESCRIPTION ;TR EET LOCATION 6, TYPE OF RESIDENCE ~x, SINGLE FAMILY [] MULTIPLE FAMILY 7. WATE2~ SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY NUMBER OE~.BEDROOM$ [] One [] Four [] Two [] Five ~ Three [] Six ! [] Other * ATTACH WELL LOG. Awell Icg is required for allwells drilled since June 1975, For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEW~,~E~DISPOSAL SYSTEM "~?'E~' ' INDIVIDUAL/ON-SITE~ [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE (~F REsIDENcE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified - iNSTALLER []Septic Tank pr E~]Holding Tank /' Size: /0~20 If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPT[QN AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [~"'~'APPROV ED FOR ,~ BEDROOMS F~ CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev, 6/79) 825 "~" ANCH()RAGI:i,.ALASI<A 99501 (90?) 264-411'1 GEOH, GE M, ,gULl. IVAN, I}I~PAP;!MI;N'I O1: HEAI'['tt AN() ENVIi'(ONMEN['/\L PH(')1ECTIC)N January 14, ]_981 S I.:ephen/Mary Schreck Star Route A Box 4029Q Anchorage, Alaska 99507 Subject: Lot 4 Maddux Park Subdivision Approval for your individual sower and waker facilities canno[ be granted un[il the fol].owh~g items have been completed: (2) The. water analysis repot[ be delivered t:o this office fro]ll hhe Chem Lab., 5633 g Skreet, fo}:' our review. '1'he top of the welL1 casing sealed wi'kb a sanitary · seal so ghat it- is water I:jght. This will need ho be reinspected by [:his office whon compleked. If there are any further questJ.ons, please call Lhis office a{:. 264-4720. Sincerely, Robert C, PraL:t, R.S. Associate Specialist RcP/ljw CC:: Alaska Statebank Mortgage I,oan Department 311.0 East Northern Lights Boulevard 99503 CHEMICAL & Gi~,~LOGICAL LABORATORIES ~./ ALASKA, rlNC~, ~~ TELEPHONE (907)-279,4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 §633 B Street Drinking Water Analysis RePort for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER rD, NO. Mailing Address ,,~ City State Mo. Day Year Zip Code SAMPLE TYPE: [] Routine E] Check Sample (for routine sample with lab reft no, [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. 1 2 3 4 5 LOCATION 1 [ Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received ' Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No. J Result* Analyst *No. et colonies/lO0 mi. or No. of Positive portions. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b] Rev, 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source a.m. Lab. No, presumptive 10mi 10mi 10mi 10mi 10mi 1,0mi O,lml 24 Hours 48 Hours confirmatory 24 Hours 48 Hours EMB Broth 24 hours; Broth 48 hours: Multiple Tube Report= 10mi Tribes Positive/Total ~,0ml Portions Membrane FIItar~ Direct Count Collform/100ml Verification: L.TB BGB Final Membrane Filter Results = Collform/100ml Reported By _ Date