HomeMy WebLinkAboutMARIE ESTATES LT 8Onsite File
Marie Estates
Lot 8
#051-111-30
' ~ 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: .~b~ 4-/~o~o PID Number: ~ ~;I - II ! -
' ~¢~ ~ Wastewater System: ~New ~ Upgrade
~ Address: ABSORPTION FIELD
I N~. of Bedrooms:
Phone:(~O~ ~ - ~Z ~ ~ Deep Trench U Shallow Trench UBed ~Mound UOther
Total Depth from original grade:
LEGAL DESCRIPTION s°i'"~""~: O.~¢~wsq.~,.
Lot: ~ Block:~ ~ ~t~ . ~ubdiv~ion: ~A~ Depth to pipe boEom from~original grade: Ft. Gravel depth beneath~p~pe Ft.
Township: ~ Range: Section: ~ Fill added above origina ~rade: Gra~ length:
Number of lines: Distance between lines:
WELL: B New ~ Upgrade Gravel width: 2. ~ I Ft. ~ / ~ Ft.
Classification~~(Private, A,B,C): Total~Depth: Ft. Cased~zTo: Ft. Tota) absorption~area: SQ. Ft. Pipe material:~ ~o~
~ Date Drilled: Static Water Level: Installe[: ~ (~ L~ ~ Date instaged:
Yield: Pump Set at: Casing Height Above Ground:
~ ~.~ d.~. ~,. ~,+ ~,. TANK
SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P.
To Septic Absorption Lift Holding ~ublic/Private Manufacturer: J O O
From Tank Field Station Tank Sewer Lines ~C~O~G~ ~ Capacity in gallons:
Number of Compartments:
WelF iiZ~ IO~I ~ ~ ~t~ Material: ~e~
Su,aCewaterle~* ioos~ -- -- -- LIFT STATION
LineL°t ~ I J~l ~ ~ ~ Size in gallons: Manufacturer:
[ ~ "Pump on" level at: { "Pump o~ater alarm at:
Foundation 7~ ~5I --
Cudain ~ Pum~.trical Inspections pedormed by:
Drain o~ ~e~ ~ --
BENCH MARK
Remarks: ~TI Oo~, ~e¢ EX
~O ~O~O~ (' ~ ~g'OV ¢- ~0~0~ ). Location and Description:
J Assumed Elevation:j
Iqspections performed by: ~nl~m~n Dates: 1st q7
Department of Health and Human Se~ices approval t~tfa~,;:r(~(~
Reviewed and approved by: ~~/ ~~ Date: /~//u~9? 'tk~~
72-013 (Rev. 9/91) MOA 25
PERMIT NO. SW970040 PAGE 2 oF 2
_. ~uQicip, gLi~.¥_o.F Amchoraee
DEPARTIVlbN! uh HbAL/H AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
· P,I]. Box ]96650 e..Ancho~-age, Alask(~ 99519-6650·Te[ephone~ 343-4744
ON-SITE WASTEWATER UISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEaAL LOT 8, MARIE ESTATES SUBDIVISION
~.LD. NO. 051-111-50
INAL GRADE
NEW ~ __
1000 GAL ~
6'
SEPTIC -~,;3,
TANK
CO3 = 97.6'
C04 = 96.7N~
CO1 = ~, C01 kC03
CO1 92
92.2' {li~{{t{ co, = 92.1'J~
C02 " ~ C04 = 92.2'/
85;.1'-'""-"~ 85.2'~
·
NO WATER FOUND
79.2' B.O.H,
A 8
FCO 7.5' 26.5'
ST1 28.5' 37.5'
ST2 36.0' 41.0'
DBL1 38.5' 42.0'
3BL2 40.5' 45.5'
301 42.5' .32.5'
302 62.5' 52.0'
vtT1 51.5' 26.5'
303 59.0' 47.0'
C04 75.5' 47.5'
MT2 66.0' 45.0'
NEW
TH#1
STI ST2
MT2
~FINAL GRADE
NEW 1000 GAL.-
SEPTIC TANK
FLOW DIVIDER
SCALE 1" = 40'
AUGT.~2--9~ TUE 07 ~50 A~. ~--W DRILLING
M-W DR~LUNG, Inc.
P,O. Box 110378 · 10330 Old Sewacd Highway
(907) 349-8535
ANCHORAGE~ ALASKA 99511
P.01
Well Owner
DRILLING .LOG
Location (address of: Township, Range, Section, if known; or distance main road
AN~RORAG~ AT,A~KA
Use of We]] DOMESTIC
Size of casing 6" Depth of Hole ~72 Sect Casedto 271 .8 feet
Static water level 229 ft. ,~X~~'~ .[below) land surface. Finish of well (checkone) openend ( X
Screen ( ); Perforated ( ,. ;4 )~.
Describe screen or perforatton , ~I[A
Well pumping test at 4 ga~l~s p~. ~) (minute) for t hours with 100%
of drawdown from static ~"~1;'. '~.~ :
Date of completion 05 AUGU~ ~:9~?. ?. ~'
Depth in feet from '. ~:~ ,~:~;,:.:. · ·
ground surface Gl~fls 6f.t~rmations penetrated, size ot material, color and hardness
0 TO 2 .
2 TO 50
);
ft.
q0 TO
10~ TO !85
t85 TO
OCCA_ZONAL EOrJLDERS, SIL~Y, GREY
224i-T0 227
22 ?.TO 250
.~50 TO 26~
26s TO 272
.TO
TO.
/TO
__.TO
TO.
TO
.'BROWN
...<.%,-;'..,..,:. !..:/-:':;>,(: ...... '('..'~. .,
w~.n~ G~U~2T:-. ~NDY/COBBLEY
OCT 6 1997
MOniclpality of
Dept, Health & Humsn Services
2 -- STAT E
ROBERT C. COWAN, P.E.
ROBERT A. SHAFER, RE.
HEALTH AUTHORI'P,'
APPROVALS
SEWER & WATER
MA~N EXTENSIONS
SEWER&WATER
.INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOWTEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON S~T~
W~STEWATER
DISPOSAL SYSTEM
DESIGN
Date:
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
REFERENCE:
The septic inspections for the referenced property were
performed on ~-~-~ and ~-~-~] . Prior to submitting
the On-site Wastewater Disposal System and/o~ell Inspection
Report we are waiting for the ~l~c~k'[lle~ / to be
completed. ~ -~ ~.r~,~/~
If we may be of further service please contact us.
Sincerely,
an,
PoE.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUM_AN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970040
DESIGN ENGINEER:S & S ENGINEERING
OWNER NANE:NORTHERN COMMERCIAL COMPANY
OWNER ADDRESS:P.O. BOX 871647
WASILLA, AK. 99687
PARCEL ID:05111130
DATE ISSUED: 3/21/97
EXPIRATION DATE: 3/21/98
LEGAL DESCRIPTION:
FzARIE ESTATES LT 8
LOT SIZE: 52081 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (181~AC72) AND DRINKING WATER REGULATIONS (18AAC80).
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 3AND CLOSED ON THE SANE DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ENSURE THE REQUIRED SEPARATION DISTANCE OF 14 FT. IS
METREcEiVEDBy:BETWEEN PROPOS~Dg¢~_.~=EX~_TI~RENCHES~..~ TO THE NORTH.
DATE: ~/'~' /~'7
DATE:
ROBERTC. COWAN, RE.
ROBERTA. SHAFER, RE.
HEALTH AUTHORITY
APPROVALS
SEWER&WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
February 27, 1997
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 8, Marie Estates Subdivision
Request you issue a permit to drill a well and install a
septic system to serve the proposed three bedroom house on
the referenced property.
Test holes were excavated and percolation tests performed.
The approximate locations of the test holes are located on
the attached site plan.
At the time of excavation no water was encountered, the
monitoring tubes within the test holes have been checked
and found to be dry.
This property has enough area for a future septic upgrade
which can be seen on the attached site plan.
We do not anticipate any adverse effects on neighboring
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/mg
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
1"=60'
~ALE
SITE
PI AN
'"d
0
L=JO
DESIGN
r'-
10' UTILITY EASMENT
PERFORMED FORi
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15~
16
17-
18-
19
20
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT
/ o
DEPTH? p
E
Deplh to Waler Alter~:~2.~J
Monitoring? ,r--I Date:
<
Gross Net Depth to Net
Reading Date Time Time Water Drop
J 'A- le-,r/ 12.: ~ - e- %/"
PERCOLATION RATE /'a{~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN__"~ FT AND ~:~ FT
PERFORMED BY: t703~ Eerie ~ vet Loop Road, N~ J~ CERTIFY THAT THIS TEST
WAS PERFORMED IN
72-008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
10
11
12
13-
14-
15
16
17
18
19
2O
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
WAS GROUND WATER
ENCOUNTERED?
DATE
Township, Range, Section:
SLOPE SITE PLAN
S
L
IF YES, AT WHAT / O
DEPTH? p
E
Depth to Water Alter
Monitoring? '~ Date: ~'~
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ (minutes/inch) PERC ROLE DIAMETER
TEST RUN BETWEEN ~ FT AND /~ FT
COMMENTS
PERFORMED BY: 17034 Eaqle River I. oo~ !~,,~1_ ~ ~ // ~ -.-CERTIFY THAT THIS TEST WAS PERFORMED IN
Eagle River, Alaska ¢95~7 '
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
ROBERT C. COWAN, RE.
ROBERT A. SHAFER, RE.
HEALTH AUTHORITY
APPROVALS
SEWER&WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERINGSTUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
801LTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATE R
DISPOSAL SYSTEM
DESIGN
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
REFERENCE: Lot 8, Marie Estates Subdivision
February 27, 1997
~ENERAL:
1.
e
e
The scope of this project includes the installation of
a 1000 gallon septic tank and a leachfield trench to
serve the proposed three bedroom residence located on
the referenced property.
Construction shall be in accordance with the approved
site plan and design drawings, Municipal permit with
any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal
Regulations.
The contractor shall be responsible for obtaining any
necessary underground utility locates.
Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
subsequently depressed from soil settling.
Contractors installing wastewater disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
~EPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
Ail standpipes on the septic tank shall extend a
minimum of 12 inches above final grade.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
Page Two
Lot 8, Marie Estates Subdivision
February 27, 1997
4e
Se
Septic tanks installed with less than 4 ft. of cover shall
be insulated.
A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the tank
and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed
soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
e
Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed-up) before
gravel (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
4e
Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on
the design.
Page Three
Lot 8, Marie Estates Subdivision
February 27, 1997
Backfill over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent
the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
e
e
7e
The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Type of Pipe
Perforated Solid
Cast Iron
ASTM D3034 (PVC)
ASTM F810 (HDPE)
ASTM D2662 (ABS)
Yes Yes
Yes Yes
Yes No
Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N,
or equal) must be installed between the final leachfield
gravel layer and the native soil backfill.
Ail leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the #200 sieve.
When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements, which ever requirement applies.
Page Four
Lot 8, Marie Estates Subdivision
February 27, 1997
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic tank
may be set in place, but may not be backfilled before
this inspection.
The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
The final inspection-is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and in accordance
with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S
Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
Page Five
Lot 8, Marie Estates Subdivision
February 27, 1997
S & S Engineering shall have no liability to the owner or to
others for acts or omissions of the contractor or any other
persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR/INSTALLER
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907-343-7904
On-Site Water and Wastewater Section Fax: 343-
7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC201335
Subdivision: Marie Estates, Lot: 8
A water sample revealed a nitrate concentration of 8.43 milligrams per liter
(mg/L). The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on
existing health information and can therefore be used to gauge the relative
quality of water from private wells. Since nitrates are known to slowly increase,
we recommend you monitor the water quality. Please see the attached “Nitrate
Fact Sheet” for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water.
Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water
wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the
soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as “blue baby” disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively
charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several “wet chemical” methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive “screening test”, and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907-343-7904
On-Site Water and Wastewater Section Fax: 343-
7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Septic Tank Advisory
Certificate of On-Site Systems Approval # OSC201335
Subdivision: Marie Estates Lot: 8
The septic tank for this property is 23 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $7,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
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
.NOV
RECEIVED
1. GENERAL INFORMATION
Complete legal description
Lot 8; Marie Estates
Location (site address or directions)
~'Pr°perty owner Nerak Construction
Mailing address
Lending agency
Mailing address
· Agent
Address
NHN Stephen Circle
Chuqiak, AK
'P.o. Box 871647 Wasilla, AK
Day phone 373-6072
99687
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:
XXX
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.
$ & $ ENGINEERING
Name of Firm 17034 Eagle Hirer Loop Road No. 204
' . . Eagle River, Alaska 99577,
Aaaress - __ ~/> '
Engineer's signature
Phone
Date 11//o / ~ 7
DHHS SIGNATURE
/~' Approved for 3
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date//- ,~ -' ¢ '7
The Municipality of Anohorage Department of Health and Human Services (DHH$) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by 'an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72~)25 {Rev. 1/91) Back MOA~21
DEPARTMENT OF HEALTH & HUMAN SERVICES ~.~)
Environmental Services Division ~IOV ] 0 ~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
RECEIVED
Health Authority Approval Checklist
Legal Description: ~-~¢--~ /~'/'~-.~ ~--¢'$¢-~-~--.5' Parcel I.Di: ~-~ 5
A. WELL DATA
Well type
Log present (Y/N) y
Total depth ~ '7~,O.. /
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date comPleted <~ - 5 - ~ '~
Cased to ~ '7/, ~ /
FROM WELL LOG
Casing height (above ground)
Wires properly protected (Y/N) y
Date of test ~' -' 5 - 9 '7
Static water level ~'~
Well production
AT INSPECTION
g.p,m.
g.p.m.
WATER SAMPLE RESULTS:
Coliform
Nitrate
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed ~"- ¢] 7 Tanksize
Foundation cleanout (Y/N)
Date of pumping
c. ABSORP'r~ON RELD DATA'
Date. installed ,
Depression (Y/N)
Pumper
Collected by:
Other bacteria
i YO~4 F_~,.:-:,~ :~v.~ ,'.,~0~ r,~,d;~c,'. 204
Eagle Rive'}~ Alaska
Number of Compartments c~ Cleanouts (WN) y
~V/ High water alarm (Y/N)
Soil rating (g.p.d./fF or fF/bdrm) O- ~/-~'
Systemtype ~(~-p '}-rem6
~ / , / /
L~n~th '7oO-' Width 'C~, ~' / Gravel thickness below pipe -~ Total depth
Effebtive absorption area f (20¢ ~'~ Monitoring Tube present (Y/N) y Depression over field (Y/N)
Date of adequacy test /]~ f~ Results (Pass/Fail) ""-"-- For -------' bedrooms
Fluid depth in absorption field before test (in.); ~ Immediately after ~gal. water added (in.):
Fluid depth "---- (ins) Minutes later: -- ' Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (Y/N)
If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N) ..--'"'""~ "Pump on" level at*
water alarm~ *Datum
High
.J
Cycles~,~:~
"Pump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
I
Septic/holding tank on lot I ~ ~
/
Absorption field on lot / (~ ~
On adjacent lots / OO '/-
On adjacent lots /00 -/-
Public sewer main
Sewer/septic service line
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ¢~ ~ /
Property line ..~ '~' / Absorption field
I t
Water main/service line /0 '/" Surface water/drainage 100 -¢-- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
I /
Property line l c,Q Building foundation ~ ~ Water main/service line
Surface water /~::~ -/- __ Driveway, parking/vehicle storage area
Curtain drain /q 0iq ~ ,~/z~ Lz)/"/ Wells on adjacent lots /
HAA Fee $.
Date of Payment
Receipt Number
ENGINEER'S CERTIFICATION
records tha,t~.,~.'~ee~ ~ms are
I certi~ that I have determined thru field inspections and review of Municipal
in conformance with MOA H~ guidelines in effect on this date.
Date
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
ll/i2/1997 09:43 907694i211 :: '~ ...... s
~mple Re~mrks;
Primed Datefrjme ) 1/Ii/97 20:19
Collected D~t~me 111061~7
R~eiv~ Dat~mt 11/06D7 17:45
T~t~! D~or; Stephen C.
Nitrmte-N 4.6~ 0.100
?otfL OQLlfo~'m o,~ c~t/l~OmL SHift 9Z2~ 11107/~? TMU