HomeMy WebLinkAboutHIGHLAND HILLS #3 BLK 2 LT 19AHighlc nd Hill,s
Block 2
Lot 19A
#050-382-53
MUNICIPALITY OF ANCHORAGE
Community Development Department
DeVelopment Services Division
On-Site Water & Wastewater Program
Mayor Dan Sullivan
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-382-53
Property owner(s): Trent K. Mullins Day phone:
Mailing address: 5240 Wild Mountain Road Eagle River, AK 99577
Site address: Same
Legal description (Sub'd., Block & Lot): Highland Hills No. 3, Block 2, Lot 19A
Legal description (Township, Range & Section)
Lot Size: 75,458 Sq. Ft. Number of Bedrooms: Three (3)
280-8292
THIS APPLICATION
([~ all that apply)
Absorption Field X
Septic Tank X
Holding Tank []
Privy []
Private Well []
Water Storage []
IS FOR:
THIS APPLICATION IS AN:
Initial []
Upgrade X
Renewal []
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Lot Line Waiver.
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
Permit No. C-'*,~
Waiver Fees:
Date of Payment:
Receipt Number:'
Waiver No.
C:\Users~AndEng\Desktop\Mike\Highland Hills\Permit Application.docC:\Users~AndEng\Desktop\Mike\Highland Hills\Permit
Application .doc
November 6, 2011
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Subject:
Lot 19A, Block 2, Highland Hills Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The existing absorption system on the subject lot has failed and must be upgraded. In
addition, the existing septic tank is within 100' from the well and the absorption trench is
too close to the lot line and passes through an electrical easement. We are therefore
requesting a permit be issued for the upgrade of the septic system to accommodate the
home on the lot. The attached Site Plan and backup documentation identify the
location and configuration of the existing and proposed septic system. The existing
1,000 Gallon Septic Tank will be abandoned in accordance with Municipal Code and
replaced with a new 1,000 Gallon Septic Tank. The existing absorption trench will be
abandoned in its current location. Also identified on the plans are the locations of the
existing well on this and adjacent lots and adjacent septic systems. No conflicts exist
between the proposed septic system and the wells on this or adjacent lots. Protective
radii are shown to the. adjacent wells. Drainage arrows are shown indicating the
current drainage patterns. The drainage patterns will be maintained after construction.
The test hole previously placed on the lot during construction of the existing septic
system indicated poorly graded sand (SP). The percolation rate was determined to be
less than 5 minutes per inch with a designation of 125 square feet per bedroom. This
rate was recently verified when the new septic system was place to the northwest of the
proposed system. That test hole completed in 2004 revealed similar materials with a
percolation rate of less than5 minutes per inch. No groundwater was found in that test
hole. We have designed the new trench with an application rate of 1.2 gallons per
date per square foot. We are proposing to place a 27' long trench by 3' wide with a 7'
effective depth. The total depth of the system will be 10' with the distribution line at 3'
below the existing surface. A new test hole will be placed and a percolation test
Lot 19A, Block 2, Highland Hills No. 3
October 22, 2011
Page Two
completed to verify the absorption characteristics of the underlying soil and verify the
absence of groundwater and bedrock. If conditions are found to be different than
anticipated a change order will be submitted with a new design for the trench. The
current weather conditions and the remote location of the lot make two mobilizations of
a backhoe extremely expensive
The ground surface on the lot slopes slightly to the northeast in the area of the
absorption trench. The trench will be placed parallel to the contours of the ground as
much as possible and in conformance with design criteria. A minimum of 100' will be
maintained between all components of the septic system and the proposed well and
from any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Michael E. Anderson, P.E.
Attachments
ANDERSON ENGINEERING
P,o. BOX 240773
November 6, 2011
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject:
Lot 19A, Block 2, Highland Hills Subdivision No. 3
Separation Distance Waiver
Absorption Trench to Lot Line
Dear On Site Services Engineer:
The existing well on the subject lot restricts the area available for a septic system. In
addition, the driveway"further restricts usable area. The existing septic system has
failed and the only area available which can be utilized and meets Municipal Code
requires placement of the absorption trench within 3' of the lot line. Placement of the
absorption trench at this location will not impact the 'property to the north. The
absorption trench on this lot is more than 20' from the lot line. We therefore
recommend a lot line waiver be issued allowing the new absorption trench to be 3' from
the north lot line.
Sincerely,
Michael E. Anderson, P.E.
, I LOT 23
I LOT. 17 .
I Well ~ I I
~, , t ~ ~1 / ,
~ ,~ , , ~ , . ~[ ,
LOT 2 ' ~ I I ~ I
/ i ~ ,'/ I ~ ~--~ ----~ ....
I ~,/ ~I~F ~ ~ ~ ~ /
, ~ , ~ /.
~ ~ /V,,' /
. ', t
NAME
MUNICIPALITY OF ANCHORAGE
V
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
[-~ UPGRADE
MAILING ~ADDRESS
LEGAL DESCRIPTION
IL-q H-q! -/
LOCATION . '
~"~ Well i Absorption area
~: ~ [ Manufacturer ~t ]MateJ'i ~1~
~ ]Lq capacty riga onsl ' I Insidelength /Width -
' ~ ~(it,].. IFHOMEMADE'_ ~ . ~
~ -- ~ Manufacture,' ~.~" ~. ....... /- (~ ~-
~ Well Foundation ares{iot li~
~Z No. of lines Length of e~h I~]ef~, Total length of.U neA
~ ~ I Top ot ti~e to Tinisn grace . Material beneath ti~e
Clfb diameter
Length ........
Type.off, rib
''/DISTANCE TO:
D STANCE TO:
Depth
Building foundation
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED
..........
NO. OF BEDROOMS
PERMIT NO ....
No, of compartments
Liqoid .qep~t h
PERMIT NO,
Liq0id_~c. zapaci~' in gallons
No.% o1 0
Distance between lines
Total effective ab¢~ea
Depth _~¢'~"-~'~ -- T~t PERMIT NO.
.Or-iD-depth ~-~ al effective absorption areg..-~- ......
Building foundation N~ac. es t-lot-,liFFE'''~-
Driller Distance to lot line 1 PERMIT NO,
Sewer line ( ~_ ~ Septic tank4- [OL)' J Absorption area(s!{_ (' ~()
DATE
LEGAL
PERMIT NO. ( ?'~0~04 )
APPLICANT
LOCATION
LEGAL
ROBERT DEAN
~-IU~ I ,_-~ ][ F '~L ! T"~~ ,]1:= Fl~-.gCl-l~ ~:~(:IE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 q~" STREET., 8NCHOR~GE., BK. 9950~.
~4-472~
SR BOX 9~5R
Lt.9 82 HIGHLAND HILLS UNIT
LOT SI~E
~0000 SQUARE FEET
TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF' BEDROOMS
SOIL RATING <S~ FT?BR): :L25
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
[:' EIPi"H= ~LO IL- E i"-I(Ei T l- ! = :~:-- ;~_. GRRVEL I['-~ [~ P'l' I-t =
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF A TRE. NCH OR PIT IS THE DISTANCE BETWEEN THE SL~,FAC. E OF THE
GROUND AND THE BOTTOM OF THF EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND 3'HE BOTTOM OF THE EXCAVATION (:IN FEET).
PER,lIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILl.. BE SUBJEC. T TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL.~ OR
150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE 0F PUBLIC WELL.
OTHER REQUIREMENTS MAY RPPLY, SPECIFICATIONS AND CONSTRUCTION DIRORAMS ARE
AVAILABLE TO INSURE PROPER INSTRLLRTION.
I CERTIFY THAT
i: I RM FAMILIAR WITH THE RE[4UIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
R: I WILL INSTRL.L THE SYSTEM IN ACCORDANCE WITH THE CODES.
]:: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY RE~!UIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
S I ~NED: __ ~ .......................
8~PLICRNT' ROBERT DEAN
.
-
06'E
Russell Oyster
694-2774
Soils ~ Foundations
Performed for:
Legal Description:
0
2~
6~
13
Z6
GEO. ZCHNICAL 8- DEVEL,..PMENT
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
SOIL LOG
CO.
Earl Ellis
688-2280
Land Development
i
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
Co~nents:
If yes, what depth.
Drain Field./
~blVIRONMENI¥\L
A & L DRILLING COMPANY
OWNER OF LAND ~r':: i~) /) " ~
ADDRESS ':' -: ' :~ ' : ' :' ~'~'<'~
LEGAL DESCRIPTION
DATE-Started
~ / / / / ,~ Ended
PERMIT NUMBER
,,RECEIVED
DEPTH OF WELL , v ~
STATIC LEVEL OF WATER FT.
£
< .~ .._ ,. -
~DRAW DOWN FT. ~;
GALS. PER HR :'~ '? '~
KIND OF CASING .,, >/
KIND OF FORMATION:
From --Irt. to
From Ft. to
From :: Ft. to
From r '~:' Ft. to
From ? 'i~ Ft. to
F~o n~_. , Ft. to
From
· ' Ft, to
From____Ft, to
From /~ :' Ft. to
From Ft. to
From Ft. to__
From ___Ft. to
From Ft. to
From_ Ft. to
From Ft. to
From Ft. to
From Ft. to
Ft. () (?/'/4'~' ,,~ O/'d ,~2 / ~" ' ~ FrorI1
__Ft. .J ~,'"'c? :~'/':,;r::'< :~/c:'<,:~ / From
"~: /'/,7) - "-:;',-.: ,, ~
_ . From~ Ft. to_~_Ft
// ~ Ft /}/'&}~:'o,- /-' - ' From _ ~Ft. to .... Ft
/-~:)' Ft. Z)~ c>;>';~?<,!~, From~_~Ft. t0 Ft
~; ":~ 7:x~.'/'~ From Ft. to Ft
Ft. to _Ft
Ft. to __Ft
I 'i! Ft
__Ft.
Ft
Ft
Ft
Ft
Ft.
Ft.
Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to_ Ft.
From _Ft. to_ Ft.
Froln Ft. to Ft
From Ft. to _Ft
From __Ft. to___Ft.
From Ft. to Ft.
From__Ft. to___Ft
MISCL. INFORMATION:
DRILLER'S NAME
I::'E~J::?.I'"I I T NO.
[:,EF'I::lfRTPIEI']T 0 Hff. I':II...I'H FIN[:, EN'v't f~:OI",Ii"'IEI'.,ITF'IL. F "KF,CC:'I' I
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B:O E:[~]';.:T [:,Et::IN
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LXL?..~ [31~!i I..I:[GHL. FIN[:, t-IIL. L.~ii: :E;,.."D
I'l I iq :1: I','lUi','i [::, :[ 'J!!;Tf:ii'-,!C:[i~ [}!JE'I",t,.I[EE]',I FI I.,JE:[...L. FIND Fli',l'.r' Oi",l--':!.':
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OF' TH[.:: !-'-IELL COi"IPL.I?T'I ON.
(3'T'l'.-I[i:]:;:: IC.':[E;~:!l...l,]: I;i:[~:EI'"I[~I'.,I'T':~; iVll::l"r' FIi'::'l:::'Ltr'. :ii;f:'l:~:3Z: I F' I Cf:IT I
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:1: C:[~::F::T ]: I:::h'~ :THFI'f'
::1..: ]: I::11'"1 FFIHII....:[FIt::~'. I.'IITH THE I:~i:I'~:L::!UII?.EP'I[£1",IT~; t:::'O1:~: 1.31",I'"<i!:]:TE ::~;EI,.l[~:I:;~:':2, F:Ii",t[::' I-'-I[i].X..:~: l'::lf:~: '.".'.:El:"['
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.[ .:,:iijlLIE[)I:: "r'
A N DE RSO N E NG I NE E R IN G
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677.7766 (FAX)
November 20, 2011
Trent Mullins
5240 Wild Mountain Road
Eagle River, AK 99577
Subject:
Lot 19A, Block 2, Highland Hills Subdivision No. 3
Status of Existing Septic System
Dear Trent:
The absorption system serving your home is currently saturated with water from the
septic tank. It is therefore not eligible for certification for continued use and must be
replaced. The system continues to absorb water, but at a pace much slower than 450
gallons per day which is the Municipal requirement for certification. We are unsure how
long the system has been in this saturated condition, but indications are no backup into
the septic tank or the house has occurred in the immediate past. We are confident
therefore the system will remain operational until the spring when a new system can be
installed.
The septic tank should be pumped to remove any accumulation of sludge prior to the
transfer of title to the property. Conversations with the new owner indicate only two
people will be present in the house and using the plumbing fixtures. The load to the
septic system should be less than 100 gallons per day. The absorption system at this
time appears capable of absorbing this amount of water on a daily basis and should not
experience further deterioration.
A break in the weather may allow construction of the new septic system before spring.
We recommend the work be undertaken whenever conditions allow the installer of the
new system to complete the work in accordance with the approved design and
Municipal requirements.
Sincerely,
Michael E. Anderson, P.E.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type Private
Date completed 11/8/78
Total depth 140 ft.
Date of test
Static water level
Lot 19A, Block 2, Highland Hills Subdivision No. 3
Parcel ID: 050-382-53
Well production
WATER SAMPLE RESULTS:
Coliform o colonies/100 mL
IfA, B, or C provide PWSID # Well Log (Y/N)
Sanitary seal (Y/N) Y Wires properly protected (Y/N)
Cased to 67 ft. Casing height (above ground).
FROM WELL LOG AT INSPECTION
11/8/78 11/19/11
65 ff. 64.7 ff.
12 g.p.m. 2.8 g.p.m.
Nitrate N/D, mg/L
Y
>18 in.
Arsenic: N/D mg/I
. B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel***
Tank size 1,000 gal.
Foundation cleanout (Y/N) Y
Date of pumping 6/25/2011
C. ABSORPTION FIELD DATA
Date of sample: 11/14/11
Number of Compartments Two
Depression over tank (Y/N)
Pumper JR's Pumping
Collected by: A. Harala
Date installed 6/79
Cleanouts (Y/N) Y
N High water alarm (Y/N) N
Date installed 5/79'** Soil rating (g.p.d./ft2 or ft2/bdrm) 125 SF/BDRM
Length 37 ft. Width 3 ft.
Total depth 8-9 ft. Eft. absorption area 444 fi2 MOnitoring tube
Date of adequacy test 11-19/11 Results (Pass/Fail) Fail
Fluid depth in absorption field before test 74 in. Water added
Elapsed Time: min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
System type Deep Trench
Gravel below pipe 6 ft.
Y Depression over field N
For 3 bedrooms
gal. New depth in.
in. Absorption rate >= g.p.d.
If yes, give date
LIFT STATION
Date installed
~Pump on" level at
Datum
in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off- level at
CyCles tested
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot * 84 ....
Absorption field on lot >lOC'
Public sewer main N/A
Sewer/septic service line >25'
Animal containment areas None
Manhole/Access (Y/N) ,
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots >1oo'
On adjacent lots >1oo'
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
in.
'SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
N/A
None
Building foundation >5' Property line >5' Absorpti;3n field >5'
water main N/A Water service line >10' Surface water >100'
Wells on adjacent lots >100'
Septic tank will be placed outside 100' protective radius from well. ,
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
prOperty line **'8' Building foundation >1o' Water main >1o'
Water Service line >1o' Surface water >lO0' Driveway, parking/vehicle storage 0'**
Curtain drain None Noted Wells on adjacent lots >lOC'
COMMENTS: ***Septic tank to be replaced and absorption trench to be reconstructed as soon as weather cenditions allow.
**Absorption trench is under existing driveway. Trench will be relo~t~ out of driveway area.
I ce~i~ that I have datelined thmugh fieId inspe~ions and
~.ew of Mumc/pal mco~s that the above systems are ,.
confo~ance with MOA COSA guidelines in effe~ on this date
Engineer's Printed Name Michael E. Andemon, P.E.
COSA Fee $ ~_,.~(~ ~ ~£~ ~_ ~).~r~,~Thn~/ waiver Fee $
Date of Payment ~[/~-~ ~-~//~/ Date of Payment
Receipt Number (~ L~ I ~ (~ Receipt Number~
(Rev. 11/05)'
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
· 4700 South Bragaw St.
P~O. Box 196650 AnchOrage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
t.
HAA #///}
Expiration Date:
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
CUrrent Property owner(s) /~.,~..~'
Malting address
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA wilt be held by DSD for pickup.
NUMBER OF BEDROOMS: Y~u ~
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
[]
[]
[]
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank 'l--I
Community On-site . []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater dispoSal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verif? 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(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm /~'?'//~S ~ /~2/~ Phone
Address ¢~0 ~ ~ /~ ~;, ~/~, ~/~
Engineer's Printed Name ~ ~ Date
':
DS~GNATURE :~ ' ' ~ ·
Approved for ~ bedrooms. ¢~;~. ~- ~ ,,"~
Disapproved. t{~¢.. .....
Conditional approval for bedrooms, with the following sdpu~au~
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
By:
Original Certificate Date': ¢/~ ¢¢
(Rev01/02)
Development Services Department
Build[n DMsion
On-Site ~ram
AK 99519-6650
ak.us
Cased to
colonies/1 O,
=arcel ID:
Y
ft.
g.I
Numberof Compartments ~-~ Cleanouts,(Y~N)
over tank (~/Ni~ ~ H!,.g,h water ~larm !Y/N)
ft.
SOi ratin
Eft; absorption area __
__ mm. F n~ f~jid ck
[.p.d,/ft2 or ft2/bdr sy~te'fi~ t)pe,
ff. Graye! .below pipe
M~nit0ring --. D~p[e~$1on oven;field __
Pass/Fail)
wate~ ~(~¢ New de
Absgrption rate~ hP.d.
D. LIFT STATION
Date installed
Size in gallons
"Pump on" level at in. "Pump off" level at ..
D. u .~, - Cycles tested
Manho'e/Access (Y/N) '
Meets a~arm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DI'STANCES FROMWEEE '~N'!~T'TO~:
Septic tank/lift station on
Absorption field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main
Wells on adjacent lots
Property line /~' ¢"~'/ Absorotion field
Water service line ;2'--4-¢"~'/ Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line /~,/z'}z Building foundation /¢'~¢"¢'/ Water main
Water Service line -~-.¢'~'-'"'/ Surface water /~ ¢'.~"'/-- ' ' ~/'~'
Driveway, parking/vehicle storage/c'~.~?~'~.z~,,¢')/'
Curtain drain ~ ~'~','~ ¢~' Wells on adjacent lots
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name
Date
HAA Fee $ ,cC,To
Receiet Number
fRev, 12/01}
Waiver Fee $
Date of Payment
Receipt Number
08-03-04 08:50A~ FRO~CT&E ESI, SGS ENV SERVICES
g075615301
T-416 P.02/03 F-684
SGS Ref.#
Client Name
l'rojeet Name///
Client Sample ID
Matrix
1044600001
Douglas Kenley P.E.
LI9A, B2, Highland Hills S/D 3
LIgA, B2, Highland Hills S/D 3
Drinking Water
PWSID 0
Sample Remarks:
All Dates/Times are Alaska Standard Time
Printed Date/Time 08/02/2004 18:10
Colleeted Date/Time 0//28/2004 20:00
Received Date/Time 07/29/2004 10:10
Technical Directo~
Released
Nitrat¢-N
PQL
Allowable Prep
Units M~thod Container [D Limits Date
0.100 U
0.100 mg/L EPA 300.0 B (<=10)
Analysis
Date lnit
07/29/04 JIB
~t~crobiolog~ Laboratory
To~al Coliform
col/100mL SM20 9222B A (<=1)
07/29/04 DKC
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONt~IENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAl_
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 19 Block 2 Highland Hills #3 Ti~N R1W Sec. 28
Location (address or directions)
Wlld MouRtain Drive
(b)
Applicant Name Bob & Sherry DeanTelephorle:Home 69LI-9117 Business 69/-t-9117
Applicant Address __ SR- Box 9352 Wild Mountain, ga. gle River, 99577
(c) Applicant is (check one): Lending Institution []; Owner/builder)[~; Buyer []; Other [] (explain);
(d) Lending Institution City Mo_~tgage
Address Cen'l;erfield Drive, ~a~le
(e) Real Estate Company and Agent N/A
Address
Telephone 69Zt-'3503
River AK. 99577
Telephone
(f) Mail the HAA to the following address:
____p i c kui~____
TYPE OF RESIDENCE
Single-Family [~ Multi-Family []
Number of Bedrooms _~
Other
WATER SUPPLY
Individual Well ~] Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environrnental Conservation
attesting to the legality and status.
SEWAGE DISPOSAl.
Onsite ][[] Public [] Community [] Holding Tank []
Note: If community well systern, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025
ENGINEERING' FIRM PROVIDING IN JCTIONS, TESTS, FILE SEAl:ICI't, DATA ,t INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of fhis Health
Authority Approval 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 _ .-- -Z;AGLE~!~ ~E-[~-~-~4~,I u %PALI6E¢- Telephone EAGLE RIVER, AK 99577
Address
P. 0. BOX 773294
Det .//
Approved for !~/~ ~" bedrooms_by_ ~ .
Approved ~' ' __~ DisapprOVe* ~. %~ Condit'~na~
Terms of Conditional Approval . ~
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paregraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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.
Page 2 of 2
72-025 (1 $~84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description:
MUNICIPALI'~ OF ANCHo~G~:
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
OCT
WELL DATA
Well Classification _/0~ I '~',~1 T- /E'
Well Log Present (Y/N) _ ~_~
Total Depth / '-/d / Cased to
Static Water Level '~/ /
Casing Height Above Ground /
Electrical Wiring in Conduit (Y/N) _
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
If A, B, C, D.E.C. Approved (Y/N)
Date Completed //E//7"° Yield
Depth of Grouting
Pump Set At ~
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots 1'~' /-
I"¢*-/' ; On Adjoining Lots /¢'¢ '/-
To Nearest Public Sewer
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
To Nearest Sewer Service Line on Lot
B. SEPTIC/HOLDING TANK DATA
Date Installed 6/'/'~ '~ ~'
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) '"'"','"~
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line /~2
To Water Main/Service Line _
Course
Size /~'~"~ ~" ( No. of Compartments
Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N)
Date Last Pumped I0/.~.
'*"" lA ; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation '~ /
To Disposal Field '~"
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test -~'~
Separation Distance from Absorption Field:
To Water-Supply Well /',/,~" /
To Building Foundation
Lot
To Water Main/Service Line ¢,/O f
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field -~ '~ /
Depth of Field ~ /
Gravel Bed Thickness ~'~ ~'
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line -/¢ y-
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
LIFT STATION j~/~
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelir~es in effect on the date of this inspection.
Date
MOA No. .~-"T ~,:P. ,¢ .r--
Signed ? ~~
Company ~-~/~ ]~- ,-¢
Receipt No. ~q
Date of Payment /
Amount: $
Page 2 of 2
72-026 (~ 1/84)
~' MUN ~ ~ ^. ¥ tk,~.ANCk ORA
MUNICIPALITY OF ANCHORAGE [}~P]', o,. ~ -~H &
~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'rI~/IRONi,"EN~AL i-i:OTi~CrlON
825 L Street - Anchorage, Alaska 99501
S o 0/979
ENVIRONMENTAL ENGINEERING DIVISION ¢ '~ ~¢
Telephone 264-4720 E C E I V E b
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing,
'' [
1. PROPERTY OWNER PHONE
MAIEfNG ADDRESS
PROPERTY RESIDENT (If different from above) / PHONE
2. BUYER PHONE
MAILING ADDRESS
3. LENDING INSTITUTION . PHONE
MAILING ADDRESS
I
MAILING ADDRESS
B, ' LEG/~L' DESCRIPTION
STR E ET~OEATI ON,
6, TYPEOF RESIDENCE
~ SINGLE FAMILY
~ MULTIPLE-.' FAMILY
NUMBER OF BEDROOMS
~ One [] Four
[] Two [] Five
[] Three [] Six
[] Other
7, WATER SUPPLY
NDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
NDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
s~nce June 1975. For wells drilled prior to that date, give well
depth (attach log f available.)
**If individua/on-site, give installation date,~/~,/ ?.~ .
If system is over two (2) years old an adequacy test is required
by this Department, "~,C4 [~'/q~['~d---- -,~,~-~'~
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78) --
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE ! DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF 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
[]SepticTankor E~HoldingTank
Size: /~)(~'~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MA N U F ACTU R E R ,,~_e...._~'
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
I
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
~ APPROVED FOR -_~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
September 25, 1979
Robert Dean
'Star Route Box 9352
Eagle River, Alaska
99577
Subject: Lot 19 Block 2 Highland Hills Subdivision #3
Approval for your individual sewer and water facilities
can not be approved until the following items have
been completed:
(l)
The water analysis report be delivered to this
office from Chem Lab, 5633 B Street, for our
review.
(2)
The depression or pit around the well casing needs
to be filled with impervious type soil so that it
slopes away from the well casing.
Please notify this department for a re-inspection when
the noted descrepancy has been corrected. If there are
any further questions, please contact this office at
264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist.
RCP/ljw
cc: First National Bank of ;mchorage
Post Office Box 548 99577
WILD MOUNTAIN DRIVE
O33
FORK
~ 22) .~o
RANDI c~
CT.