HomeMy WebLinkAboutHENKINS BLK 4 LT 3
,,~ MUNICIPALITY OF ANCHORAGE
. ' D RTMENT OF HEALTH AND HUMAN SEF
, '. Environmental Health Division ~)..~ / ~ c.) ~ ~ 7
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name , ~ DISTANCES
~% ¢~~o¢ ~ TO ~ ABSORPTION
Address FR0~ ~ TANK FIELB WELL
Ph .... ' Permit NO. /No.
i LEGAL DESCRIPTION
fownshtp, Range, Section
TANKS
[] SEPTIC
Material
..HOLDING
No. o Compart~
TYPE OF SYSTEM
LOT LINE
FOUNDATION
AS-BUILT DIAGRAM tShow location of wel
driveway, water bodies, etc.)
_./
septic system, property lines, foundation,
[] TRENCH [] BED
Flit added [ grade
Gravei ~ength
ET
[] W. DRAIN [] OTHER
)th lrom original grade
Gravel depth beneath pipe
~, FT
Gravel width
FT
lines
FT
Total absorption area
so FT
Number ol hnes Soil rahng ~[~ FT
Pipe material
Inslaller Date Installed
ET
WELLS
~:)RIVATE [] OTHER ¢ldentifv)
Ctassdlcat~on (A.B.C)
Total Depth FT Cased to
Date Installed: FT
17034 Eagle Ri,vet Loop Road No. 204
j f=aale I~ivm-_ AIn~l~n g9~77 ce~Jfy that this inspection was pedormed according to ail '
Municipal and Stale gu'de' ' ' : ~ --
~'~ PUMPING
i~J~_~18 Mercy Drive
P. Jver. Al( 995?;
69,4.6454
Let Le,oai:
L~t Size
051-291-04
~ubdivision: HENKiNS LoC: ~ Blocki 4 '
~ectis'ni $0 ~To~nsh{pi'i5~ Range~ i~
~0000 (sq, it, or acres)
.... {he ?equi~.=_,~ants :..'-c,~ on-site ssuers
that ........... uu~ ~,~,,,,, is ¥'~],i~ io~ ~ ,T:~xi~u~
ROBERT A. SHAFER
February 19, 1988
CIVIL ENGINEER
694-2979
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, Alaska 99501
REFERENCE: Lot 3; Block 4; Henkins Subdivision
On behalf of our client, Kent Peterson, we request you issue a permit
to install a holding tank on the referenced property.
In lieu of the historical data on file with your department which shows
high groundwater conditions in the area and a groundwater encroachment
on the existing absorption area, we ask that you waive the soils testing
required to obtain a permit.
Attached for your review is a site plan showing the location of the
proposed holding tank as well as the location of the neighboring septic
systems and protective well radiuses.
additional information, please contact Roger/694-2979.
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
ss
SHAFER, P · E.
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
SCALE
/
q
'--~ MUNICIPALITY OF ANCHORAGE ~'"
DEPARTtvlENT OF HEALTH & ENVIRONi~iENTAL PRoTECTIoN
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
MAI LI r~ ADDRESS
LEGAL DESCRIPTION
LOCATION
Well
~ ~ Manufacturer
~ JLiq. eap~ei~y in g~llons J
J I O~m j IF HOmEmADE:
~ ~ ~ Manufacturer / V
Q j Well f Foundati~
~ Z I DISTANCE TO: J J CO
~ ~ ~ No. of hnes ~ Lengt~of e~ch hne of lines
~1 ~ ~ ~'
~ N Top of tile to finis~ grade
~ ] Length Width
~ J ~ype of ~r,b Crib diameA / ~Crib depth
~~' ....... E-~ Well / V ~ Buildingfoundat,on
~ Clas~,~.~..~ .u: Demi,A/A
~ DISTANCE TO: Building fou~at~ ~ Sewer line
~'NEW
· [~] UPGRADE
JDwelling
Material
Width
NO, OF BEDROOMS3
PERMIT NO,
Material
Liquid depth
PERMIT NO.
Liquid capacity in gallons
' PERMIT NO.
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
' o'~ ~OTO'TlCcE~ ~AU~ ~D
Total effective absorption area
Nearest lot line
Distance to lot line
Septic tank
~=en lines
JOl-l?{ E. SW[~iSON?
~-OU N D ATI Otg ~,
APPROVED DATE LEGAL
.......... /'~n~I-~ITE SEWER PERMIT
Location: Phone Number:
'Legal Description: Z~ ~ ~/~i~ ~ Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed: '~ Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) /~-~
The Requ~ed Size of, the Sqil Absorption/System Is:
'/GRA~/EL DEPTH ' WIDTH
~__~MUNICIPALITY OF ANCHORAGE,--~ ~/'~~
Department' ,f Health and Environments Protection ,
825 ~ Street, Anchorage, AK. ~9501
264-4720
* * * HANDWRITTEN PERMIT * * *
DEPTH LENGTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTICS) TANK SIZE = /0~/_] ,, GALLONS * *
Permit 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.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this departmentl
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
fOr a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 3L 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the r~s~dence is remodeled ~ include more that ~ bedrooms./ ~
SWP/024 (1/81)
P~rmi~t ~
APp~licant:
D ..--MUNICIPALITY OF ANCHORAGEs.
epartmen~ ~ Health and Environment~ ~rotection
825 ~ Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
· WELL ~,,~,u~ ON-SiTE SE'~[?, PERMIT
~ Mailing Address:
LOcation: Phone Number:
Legal Description: ~ Lot Size:
Typ'e of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:'
DEPTH _ ~GTH GRAVEL DEP~ WIDTH
The length dimension is the length(in fee~) of the trench or d~a~nfield. ~ The
d~pth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the ou~fall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = ~ GALLONS * *
Permit 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.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department!
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet!
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 2'5 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 51, 1 g 8 3 * * *
I Certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understan~/~at~! ~ex~ewer system may re, quire enlarg~me~t~f
th~W/~//~nc'lude]~ more~/~/~~/~that~ b~<t~boms. / / /
SigneR: /~~~? ~issued by% ~ .---/~
~ppl~cant
SWP/024(1/81)
I~NGINEERS, INC.
7'125 OLD SEWAI~D ttWY.
ANCHORAGE], ALASKA 9950,3
349 -6561
SOILS l_()(; Pt~I~COI A[I()N II[:SI
5
6
7
8
g
I0
WASGROUNO WATER
ENCOUNTERED~
12
14
15
16
17
18
19
20
COMMENTS
IF YES, AT WHATE
OEPTR' "7,~ A '"
.G¢oss Nel Oeplh lo Net
Reading Oale Time Time Wa~er Drop
PERCOLATION RATE /j/ / ',~ f'J ~ J (mlnule~/inchl
TEST'RUN
· El' ANO / , ET
BETWEEN
CEIl TI/~ EO BY
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
~)~2 \- ,---'~ / -N~'-")'L'~ . NAA# ~ \ ~) tC~""~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
LoP 3 '1 /D
Location (address or directions)
(b) Property owner ~
Mailing Address
(c) Lending Institution
Tg!ephone.:(home) ~q~-l198 Business
Telephone
Mailing Address
(d) Real Estate Company and Agent
Address '7.$'0 ~'. ~"trw~'¢~:ff
Telephone '~ '~ 7' - O/~,5",.~
(e) Mail the HAA to the following address: (or check here [], if hold for pick up.)
List contact person and day phone number below:
"Y'e '~,( t~toor4- :T 't,5"- / ~..¢'.5-
TYPE OF RESIDENCE
Single-Family [] Number of bedrooms ~ ''~
WATER SUPPLY
Individual Well []
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DISPOSAL
On-site [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my sea[ affixed hereto and as of the validation date shown below, l verify that my investigation of this
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 flies and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with alt Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
NameofFirm ~'(~[/'~ 7-~c/~n ~co:/ .~'~r~,~'r~ Telephone ~ Y.5'-- 13b-.5~
Address I q.C..T(/' ~=:c./~¢' ~'/'~ /~4,~c,r'~_~¢ ./~: ?¢.3--/5'
Date A/c,-, I % lee/
Seal
6. DHHS APPROVAL l
, ,roved,o,
Approved 'T Disapproved :~.,/~/~ ~ Conditional
Terms of ,C nonditiom Approm. /
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health A
cerificated based only upon the representations given in paragraph S above by an independent profe
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes an
institutions in order to satisfy certain federal and state requirements. Employees °f DHHS d° n°t c°ndc '
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or om
in the professional engineer's work.
72-025 (Rev. 7/88)Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
A. WELL DATA
Well Classifica~
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
EAGLE ~tY'~
If A, B, C, D.E.C. Approved (Y/N) ~//~
Well Log present (Y/N)
Total Depth 13.~ 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
To Nearest Sewer Service Line on Lot
Water Sample Collected by F//:IT 'TO
Water Sample Test Results ~ ~l'~.~ c/~,~',-('
Comments
1!
Date Completed '7
1 8 Depth of Grouting ~. A
/0,4 ~/21/011') PumpSetAt ~
2 2" Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Yield
!
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
'TEC.~ _.~VC-g ;Date '~/21/cfi '
B. ~E~I~/HOLDING TANK DATA
Date Installed 2/21/$8 Size
StandpiPes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N) Y
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well tf¢ ~'
To Property Line I(.,' - P~¢ AS ~.'r
To Water Main/Service Line ~---, l/o
To Stream, Pond, Lake or Major Drainage Course
Comments
2.oo0 G No. of Compartments :2..
Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) "/
~ Date Last Pumped 3Jl/~ll ~'/ ,).i~.'$ Pu~tPtN6
; for N/q
Temporary Holding Tank Permit (Y/N) ~.~.
To Building Foundation
To Disposal Field
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA N~/)"
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion 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
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
Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutback (if present)
D. LIFT STATION N.
Date Installed
Size in Gallons "
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA.g.u. ideJi.89~.in effect on the date of this
inspection. .?,,,.? :. ~ ~¢ .[~,
Date ~¢.il ~¢ 1¢9/~¢~ ...... '.; g~neers Sea
MOANo. ~0 -~1¢
Receipt No o:~--~ ~?0c'-c:~
Date of PaYment .?_/Z--C;~ ~ /.
Receipt No.
Waiver Fee:
Date of Payment
72-026 (Rev. 7/88)B~ck Page 2 of 2
A DIVISION OF COMMERCIAL TESTING & ENGINEERING
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 3,
Date i~eport Printed: l,iS.F~ 25 9i ~ 14:06
Client ba~ple ID~L3 M HENKiN$ S/D f~EAP, HOSE BIB
PWSID :Ui'~
Collected [,J-kR 2~ 9J 0 12:15 hrs,
Received ]fM{ 2t 91 ~ 16:57 hz~,
Pr~serw~d with :AS REQUIRED
kllowablo
Paxtmet er T~sted Result Units ~ethod I, imlts
UI T~/fY,-I~ 2.5 ~',g/t ~PA 353.2 .tO
qa'.~p!e
?, e aa:,: ks:
ROUi~INE SA~IPLF~ COLLECTED BY: CliP. iS
.[ Tests Periozmed Se~ Speciai inscxucrlone I:bove UA=Unavailable
1~.: Not Analyzed [,T-Less Ihan Gi=g~eatez Than
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
AppliCation Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Properly Owner ~ /~-~ Telephone: Home ~" ~/~ Business
Mailing Address ~K 77~/8¢ ~/¢ R~v¢~ ~N
(c) Lending lnstitution ~[~0~ R~(~ ~ Telephone
Mailing Address ~ ~ ~ ¢ ~
(d) Real Estate Company and Agent
Address ~ ~~[/
Telephone ~ ~¢ '~¢/
(e)
Mail the HAA to the followina address: or; Check here [~, if hold for pick up.
List contact person and day phone number below.
'7"ad / oore P
TYPE OF RESIDENCE
Single-Family {~
Number of Bedroom~
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite [] Public [] Community [] Holding Tank []
Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 fRev 81861 Fronl
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 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 ,~'//~c~-'o~, 7'~C~;'~'~zf -~'~'~',;~:~/' Telephone
Address
Date ,,~ ¢~/ /¢)
THEODORE F. MOOR~ ,* ~ Enaineor's
DHHS APPROVAL
Approved for ,' .;~/¢?~ (~edrooms by
Approved ~ Disapproved
Terms of Conditional Approval
Conditional
Date
CAUTION
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.
Page 2 of 2 72-o25 fRev 8/86) Back
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA)
ENVIRONMENTAL SERVICES DIVISI(~IEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY lg84
AUG 1 I 1988
RECEIVED
WELL DATA
Legal Description:
Well Classification
Well Log Present (Y/N)
Total Depth I ~" Cased to
Static Water Level 70 '
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
Cleanout/Manhole ~h/~.
If A, B, C, D.E.C. Approved (Y/N) /4,/~.
Date Completed ?/? /~-~ Yield ~,
Depth of Grouting N¢~.
Pump Set At ~ ff'~' ~
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Water Sample Collected by 7/-/=1'1 - ~'f¢4¢'¢¢,/¢ r¢cl~ ¢'¢c~ ; Date 4~'/' ~'/'~,~'
Water Sample Test Results -~z~ ~-oJ2~l~r'/~ -- 0 CC~ H~Or m /'t°o ~,¢-j
Comments t/.,,'~zlf ~'¢z.¢~'~ c~¢ [~l~ ~e~roc I~
B. ~------~--------~----';-IOLDING TANK DATA
Date Installed Size
Standpipes (Y/N) ~
Depression over Tank (Y/N)'~ ~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) W
Separation Distances from Septic/Holding Tank:
Air-tight Caps (Y/N)
To Water-Supply Well / ~",.5
To Property Line i
To Water Main/Service Line
Course ~ 75- ~
No. of Compartments E' (~ffe,"' au-
~ Foundation Cleanout (Y/N) ~"
Date Last Pumped (~/[O/~d~
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72 026 fRev 8/861 Fronl
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
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
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
D. LIFT STATION
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 guidelines in effect on the date of this inspection,
Signed ~~ ..~. ~'~d~-..'~- Date
Company ~¢:t'¢~/"/~/¢
Receipt No.
Date of Payment
Amount: $
MOA No. ~'g:~ ~ ¢'-¢~'
Page 2 of 2
72-026 fRev 81861 Back
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
/~t. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907)562-2343
FEDERAL TAX ID # 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order ~ 8344
Date Report Printed: AUG 8 88 @ 0S;28
Client Sample ID:L3, B4 HENKINS S/D
PWSID :UA
Collected AUG 4 88 @ 14:10
Received AUG 4 88 ~ 15:00 h~s.
Preseryed with :4 DEG C
Client Name : FLATTOP TECHNICAL SERVICE
Client Acct: FLATTOT
P.O.~ NONE REC'D
Req ~
Ordered By : TED MOORE
Analysis Completed :AUG 5 88
Laboratory Supervisor :STEPHEN C. EDE
Released By :
Send Reports to:
I)FLATTOP TECHNICAL SERVICE
========================================================================= .... =_==== ....=== ....=== .......== .....== .....=== .....======
Special
Instzuct:
Chemlab Roi $: 2087 Lab Smpl ID: 1 Matrix: Watez
Allowable
Parametez Tested Result/Units Method Limits
NITRATE-N 1.6 mR/1 EPA 353.2 10
Sample ROUTINE SAMPLE
Remarks: SAMPLE COLLECTED BY T.F.M.
1 Tests Pe~£ormed * See Special Instructions Above UA=Unavailable
ND= None Detected '* See Sample Remarks Above
NA~ Not Analyzed LT=Less Than, GT=Greater Than
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ¥~(~-~,~ l~_,C.~-~
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date February 22, 1988
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 3; Block 4; Henkins Subd.
Location (address or directions)
Henkins Rd.
(b) Property Owner Kent Peterson Telephone: Home 688-4152 Business
Mailing Address P.O. Box 672186 Chugiak, Alaska 99567
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
None
Telephone
Telephone
(e)
Mail the HAA to the followina address: or: Check here [~-, if hold for pick up.
List contact person and day phone number below.
17034 Eagle River Loop Road No~, 204
Eagle River, Alaska 99577
TYPE OF RESIDENCE
Single-Family [~
Number of Bedrooms
THREE
WATER SUPPLY
Individual Well E.~ Community [] PuNic []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite [] Public [] Community [] Holding Tank [~
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
PaQe 1 of 2 72-025 IRev 8zR61 Front
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed he~ etd and as of the validation date shown below, I verify that my investigation of this 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 theinlormation obtained
from the Municipality' of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system [s in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm ~EEIN~ Telephone
Address _ 170;34£agle ~{ver Loop Roan N__~ ~-0.4
Date Eagle RiYer, Alaska ~577 ~.-~ ~.~ '~__~ t~ ~
DHHS APPROVAL
Approved for ?~,',~(_.;~ bedrooms by
Approved ;/~)Q__ Disapproved
Terms of Conditional Approval
Conditional
CAUTION
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 L~HHS do not conducl inspections or analyze data
before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in tile professional
engineer's work.
Page 2 of 2 72 025 {Ht,v 8/86) Back
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
MUNICIPALITY OF AN~LIST - FEBRUARY 1984
DEPT, OF HEALTH &
ENVIRONMENTAl PROTECTION
FEll. 2 g88
Well Classification
Well Log Present~/N)
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit~)'N)
RECEIVED
264-4744
Legal Description:
If A, B, C, D.E.C. Approved (Y/N)
Date Completed '7 ~ '~ ~ ~"~
!
Cased to ! ~ Depth of Grouting
Separation Distances from Well:
Yield
Pump Set At ~
Sanitary Seal on CasinC~;ZN)
Depression Around Wellhead (Y/4~b
To Scptlc/Holding Tank on Lot ! ~ .I~' ~ ; On Adjoining Lots
To Nearest Edge of Absorption Field o,..~ ~/~.t /'¢'/'~ ; On Adjoining Lots
To Nearest Public Sewer Line ~/'~ To Nearest Public Sewer !
Cleanout/Manhole ~ To Nearest Sewer Service Line on Lot
Water Sample Collected by ~. /"~,~/~//~ ~;~]~¢-' ; ,~,,ate
Water Sample Test aesults ¢_,¢ t-4~//...¢' /,j/3-~/v.~ 1/ o ~:.~/~o¢,.~---~5/~?¢-o¢-~
Comments ~ ¢"~-~- ~/'/'~/> ~ }~'~~-¢~ ~y
//J oc_ %,
~NK DATA
Date Installed
Standpipes ~N)
Depression over Tank (Y/[~[~
Pumping/Maintenance Contract on Filed~/N)
Holding Tank High-Water Alarmd~N) y
Separation Distances from ~efCJ~/Holding Tank:
To Water-Supply Well l ~ !
Air-tight Caps(~N)
~.. -~ '~- I ~B Size '~--t¢¢;~:~ No. of Compartments
~' Foundation Cleanout ,~i¢7N)
D~te Last Pumped /"'"J~-~'d
Temporary Holding Tank Permit~:~/N) y
To Property Line
To Water Main/Service Line
Course
!
To Building Foundation ~ !
To Dispos~al Field ':: i/'~/~ 'i
To St~diam,. Pdndl L~ke,'or Major Drainage
Page I of 2
72 026 fRev 8/86) Front
C. ABSORPTION FIELD DATA I'~/A
Soils Rating in Absorption Strata
~"D~alled
Results of Last Adequacy Test ~
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
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
perry Line
; On Adjoining Lots~~'° Existing or Abandoned System on
To Cutbank (if present'~) ~
D, LIFTSTATION ~"~
Size in Gallons~'~'~
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
~ Vent (Y/N)
Pu ' Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all M CA and HAA guidelines in effect on the date of this inspection.
Signed Date
$ & $ ~;NGINEEEING
Company 170~4 I~1¢, gi~ L~p ~6~.
Eagle Rivpr, Alaska ~5~
Receipt No. ~0~/0 ~,~ ~
Date of Payment ~/2 ~
Amount: $ / ~%'~/
Page 2 of 2
72 026 (Rev 8/861 Back
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
OCT 2 ! 198~ERTIFICATE OF ~NSPECT~ON FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
R E C E IV E D
Application Date
1, GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(bi ProPerty Owner /'('eh'/ f'e/-~".¢o,~ Telephone: Home
(c) Lending Institution H,/t. Telephone
Business
Mailing Address
(d)
Real Estate Company and Agent
Address
Telephone
/e,..~: )9,¢-0 7
(e)
Mail the HAA'to the followina address: or: Check here F~, if hold for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-Family []
Number of Bedrooms
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 fRev .8/861 Front
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NOI~Y~OJNI aNY V~VQ 'HOBY]S ]ql~ 'SZS]~ 'SNOILO3dSNI ONlfllAOad ~BI~ ONIM~NION]
~MUNICIPAU'[Y OF ANCHORAGE
E~/IRoNMENTAL SERVICES DWISION
OCT 2 1 1987
A. I¥E D
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4744
Legal Description: /~ o ~:
Well Classification
Well Log Present (Y/N)
Total Depth I ~-~' ' Cased to
Static Water Level ~ o
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot I
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer- Line
Cleanout/Manhole
Water Sample Collected by T.
Water Sample Test Results
Comments -¢/' ~'
If A, B, C, D.E.C. Approved (Y/N)
Date Completed 7/7/~'..~ Yield
Depth of Grouting /V,
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
/-~,, c -o ; On Adjoining Lots I
I 'e '~ ~' ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
;Date
~,o ~.
B. SEPTIC/HOLDING TANK DATA
7/&(/¢3 Size
Date Installed
Standpipes (Y/N)
Depression over Tank (Y/N) N
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) N0 A.
Separation Distances from Septic/Holding Tank:
To Water-Supply Well 1
To Property Line
To Water Main/Service Line N,/'j ·
Course
Air-tight Caps (Y/N)
No. of Compartments ~
~' Foundation Cleanout (Y/N) ~'
Date Last Pumped /o / 3o / 87 ~,y ,Tr~'c
; for N, 4.
Temporary Holding Tank Permit (Y/N) N, ,4.
To Building Foundation 3'o" '
. To Disposal Field lO '
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026 fRev 8/86) Front
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 7 (8o- ( $ 3
Width of Field I ,,~
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 ~t
Lot N, .4.
To Water Main/Service Line N,/h
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ..¢'¢-~/r-~ c ~.-'~ f'e'" (¢~,e¢' '~,~
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 ~ Id] '
To Existing or Abandoned System on
; On Adjoining Lots '~ l¢' c
To Cutbank (if present) t'(, ,4
~ fO0 '
D. LIFT STATION N,~.
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 guidelines in effect on the date of this inspection.
Signed ..~'~ -~. ~ Date
Company /~(¢x¢¢~,~ 7'e.c~ .,.(uc_c MOA No.
Receipt No. /~ 0 / O ~
Date of Payment ~O~ //~
Amount: $
Page 2 of 2
72-026 fRev 8/861 Back
Engineer's
Seal
MEMORANDUM
DATE:
TO:
FROM: ~
SUBJECT:
September 20, 1985
File
Keith Bandt, Program Manager, Water Ou~lity Section
Henkins Subdivision Ground Water
Recent septic system failures on Lots 12, 13, and 14, Block 3 of Henkins
Subdivision, caused by ground water encroachment, prompted further investigation
of the shallow water table by Water 0uality Section personnel. One of the pur-
poses of this investigation was to explore the possibility that a stream diver-
sion around Lots 8, 9, and 10, Block 2 within the past two years had caused
water levels to increase several feet, in some cases more than 4 feet based on
historic soil logs, on Lots 12, 13, and 14, Block 3.
Shallow monitoring wells were installed up-gradient of the problem area at the
locations shown in Figure 1. Water levels were measured and samples were
collected and analyzed for fecal coliform. Results are as follows:
Weli Location
(Lot, Block)
Depth to
Water Table
(feet)
Fecal Coliform
Level
(Colonies/100 ml)
Li2, B3 2.0.
L2, B4 5.9
L4, B4 0.9_ __
L6, B4 ---3.3 10
L3, B5 1.6 >2000 (twice)
L6, B5 Dry -
L8, B5 Dry -
USGS Well 1.0 0-3*
(near L15,
NA - Not Available
*Statistical Inference
These water levels were correlated with as-built reports of septic systems pre-
pared by inspecting engineers at the time each system was installed. The pur-
pose of this task was to determine the separation distance between the base of
an absorption (leach) field and the water table, which must be a minimum of 4
feet to minimize degradation of ground water quality. This 4-foot separation is
required by AMC 15.65.060 (A) and 18 ACC 72.026 (a)(3). This 4-foot separation
also helps assure absorption of wastewater effluent and successful operation of
the system. The results of this correlation are as follows:
Renkins Subdivision Ground Water
September 20, 19R5
Page 2
Absorption Field
Location
(Lot, Block)
L12, B3
L13, B3
L14, B3
L15 , B3
L4, B4
1.0 foot below
1.2 feet below
3.0 feet below
3.5 feet below
0.3 feet above (est.)*
*Installed without municipal approval
as-built available.
Another shallow monitoring well will be installed on Lot 3, Block 4 for further
validation of the separation distance~to'~round water. In ~additton, the septic
systems on Lots 2 and 3, Block 5 will be investigated i~ light of shallow ground
water and the high fecal coliform counts (>2000) found in the well on Lot 3,
Block 5.
Streams in the immediate area, and there are many, appear to be recharged by
ground water and are thus "gaining" streams for the most part. According to a
long-time resident Mr. Don Olson (688-2434), who lives higher up in the sub-
division, the .low part of the subdivision where the problem exists was a "swamp'°
prior to development. It was subsequently drained through a series of drainage
ditches. There is therefore historic evidence to indicate that the lower
reaches of this subdivision were normally saturated. Mr. Olson also stated that
a slow and prolonged snowmelt period' this year has accentuated the problem by
recharging streams for a ~reater length of time. In reality, this prolonged
melt period charges both the stream and ground water system, since a complex
interaction usually exists between a stream and ground water.
In summary, there does not appear to be any quick or inexpensive solution to the
water table increase in this area and its effect on septic system operations.
The stream diversion mentioned earlier does not appear to play-any significant
role in causing the water table to increase on Lots 12-15, Block 3. Additional
investigation of septic systems located on Lots 2 and 3, Block 5, and Lots 3 and
4, Block 4 will be undertaken°
KB3/dEH5 ~ ~
5 5
/
/
?
/
/
/
2
202.00
1
IOO.oo
/0
/I
TRACT I
TRACT2
TRACTS ~
9
OEL'S Lane
FIGURE
n' 20
DESCRIPTION DATE BY DESCRIPTION DATE
NE
FEDERAL TAX ID # 92-0040440
Buyer ~2/ ~' ~
Address / ~,~ ~/ , Zip Code
Address /. / / //~ /~ Zip Code
Address '~ ~~/ ~:~ ~y / ZipCode
Type of Residence
Single Family
Multiple Family No. of Bedrooms
~ Other
Water Supply
~lndividual A~ACH WELL LOG. A well log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Individual Year Individual installed:
U Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector inspector Inspector Inspector
h_
Field Notes: ~ ~O_~ C.~.']C'L ~ ~,~P~ICIPALITY OF ANCHO~GE
~ [C ~ ~ DEPT. OF HEALTH
~ ENVIRONM~NI'AL PROTECTION
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE I~--
BY:
Soils Rating Date ~wer installed Wall To Absorption Area / ~ ~ Well Log Received
/ ~O ~--~__~ WelltoTank ~Q~ Septic T~k Size
HENKINS SUBDIVISION
. 10/9/85
Keith Bandt
Platted:
Zoned:
Lot Description:
P robl ems:
Probable Causes:
End Effect:
September 13, 1955 (Plat #387)
R6 in 1982. Previously, it was zoned UNRESTRICTED
61 lots and 3 tracts. Majority of the lots are 20,000 s.f.
One of the affected lots is only 14,365 s.f.
Water table has increased in recent years causing systems to
fail and sewage to leak onto the ground surface. Lots most
affected are cross-hatched on Figure 1. Based on soil tests
conducted in 1982 on several of these lots, water levels have
increased 4-6 feet.
System failure in this case can contaminate the shallow water
table, and the potential exists for contaminating the deeper
drinking water aquifers although no problems have surfaced to
date.
Due
t.
to a combination of 3 factors;
Natural phenomena - A natural increase in the water table
due to changes in the hydrologic cycle. There is historic
evidence that the area affected was very wet, saturated by
ground water, prior to development. There are presently
many indications of saturated soil as evidenced by small
streams, springs, and weeps within the affected area.
Monitoring well data helped establish the boundaries of
the affected area.
A stream diversion around lots 8,9, and 10 may be a factor
in fixing the water table elevation on Lot 15, Block 3,
although the degree of impact is difficult to assess and
is not the sole factor.
Wastewater loading from septic systems probably aggravates
the situation by contributing to the water table rise.
Lots 12-15, Block 3 and Lots 5-6, Block 4 will be required to
abandon their existing systems and hook up to a holding tank
or package treatment plant (innovative) by November 1, 1985.
Lots 3-4, Block 4 will be required to raise the absorption
field to meet the proper separation distance to ground water.
Curtain drain systems are not viable and have been excluded as
an option.
High fecal coliform levels found in a monitoring well on,Lot .
3, Block 5 are currently being investigated. The water supply
well for this lot is in close proximity and is only drilled to
a depth of 44 feet with a static water level of 6 feet from
the ground surface.