HomeMy WebLinkAboutSTONEHILL BLK 1 LT 1Stonehill
Block 1
Lot 1
#060-342-01
72-013 (1/91) MOA 25
Page/ bt Z
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES i
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 40 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
i On -Site Wastewater Disposal: System and/or Well Inspection Report
0//JT PID Number'
Permit Number: SW 99
/vETBk M/L egName:
Wastewater System: -- gyNew i'i 0 Upgrade
Address.-
NC 95 9375 f1/L NA°, E A2
ABSORPTION FIELD
Phone -
No. of Bedrooms:
p Deep Trench Jy�'$halloW Trench ❑Bed 0 Mound ❑Other
LEGAL DESCRIPTION
Soli Rating:
b 2-'GPD/Se Fl.
Total Depth from original grade:,
Z, 5'
Lot) .' -'- -- Block: - . - Subdivision: - - --
' — 5TONE HILL
Depth to pipe bottom hem original grade:
2,D Ft.
Gravel depth/beneath pipe
�5 Ft.
Township:
Range: I
Section:
Fill added above original grade:
A,0. Ft.
Gravel length:
10 FI.
WELL:'
pa New 0 Upgrade
Gravel daptlh W/DTN
FL
Number of lines:
Z
Distance between het
/a Ft.
Classification (Private, A,B,C):
Pllyvs}7
Total Depth:
/00 Ft.
Cased To:
/7 Ft.
Total absorption area:ea, -
3 0 D SO. Ft.
Pipe material:
3057 4s -1M
Driller: - -
Sus uY4N
Date Drilled:
60/94
Static Water Level:
0 Ft.
Installer:
ckM st `�
Dale Install d:
Xl ii - or/94'
Yield:
30 GPM
Pump Set at:
pw
PAt 4 Ft.
Casing H fight Above Ground:
(/. Ft.
'-
TANK
.
SEPARATION
DISTANCES
Dtseptic ❑Holding
❑S.T.ER
To
F rom
Septic
Tank
Absorption
Field
DII
Station
Holding
Tank
Rublle/PrIvate
Sewer Lines
Menu/lla,c/pttu�rr��er:
9/,rte,/ T2¢NK
Capacity In gal 000
Well
,/
/071
�OZ
AIM
/s//%t'
/
�7
Material'
Materal1: C(CC/
lGLV ,.
Number of Compartments:
2
e
>
LIFT STATION
N�
Wa e
N/,4
Lot
Line
8 o/
5 y
5 J
2 5/
Size In gallons:
Manufacturer:
yy�'iS`� -
ihd5f�n
50y
6o'
NIA
"Pump on" level t:
"Pum "revel
at:
High water alarm at:
Curtain
,t M
V
V
Pump Make &
Elec Tical Inspections
performed by:
Drain
,V
-
Remarks:
BENCH
MARK
S5I'S/ Ros/otL reelP1 OVE,E
Location and Description:
-
p/PE 8ENf.1977/ bee! vC .
I --P ac 1t6c` ensmi/a
-
fUa.rORT/e.) CL�9�'aur
Assumed Elevation: /ODs 0 FI
`/Dust A/"p
Nat ce.+.cTRkc rE.° AT TN /I Ti ;70..
ENGINEER'S SEAL
r ,
J
L,
by'. E, g-, 5. Dates' 1st o�/U/9`�
sz ! sk rA
r
°° ,
E o °
Inspections
performed
2nd 09/74941
pi. eo Lou A. Butera
G��t,Foc�c�.e,3
Department of Health,.an l Hu an/ rvices approval.
" ,.. �c i -, Date y %)�
c° ��
4�,
Reviewed and approved by: �
72-013 (1/91) MOA 25
Permit No. SW 71"0/1./g1
Page
Municipality of Anchorage
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
STONk' W/ LOT l PID No.: Olga -35 2r° 1
Legal Description:
CL STONEHILL DRIVt
89'56'58'
VACANT
OWNER ADDED
ADDL CLEMIDUTS
EIIN R SIDE OF
SPLI TER 'TEE'
SEPTIC A
1000 GAL
PROPOSED SEPTIC LINE
V/4' BURIAL INSULATION
UNDER DRIVEWAY
PROPOSED SEPTIC LINE
DETAIL
S Pttt 1188'
90 -IW%
156.77
N 87.36'23' V
CL HILAND DRIVE
ELEVATIONS WELL 1oP*oP
(NOT TO SCALE) ASSUMED ELEV = wow
1' AODEO RLL
84 3'
PIELO
81.6' UPPER
77.5' LOVER
SCALE 1" = 60'
ORIGINAL
GROUND
LEVEL e 76' UPPER
79.5' LOWER
35PSI INSULATION
81.6' UPPER
77.5' LOVER
NO GVT
72.6'
• - MONITOR TUBE
• SEWER CLEANOUT
6 - WELL
LEALHEIELD
ENGINEER'S SEAL
_ �� OF .14t
5t.
* 49TH %� *14
1
/ - 1
0 • LOUIS A. BUTERA : AWl
IICo.- CE -6736
••WO
72.013 A (Rev. 9/91) MOA 25
(ltn ti trb Witting ;rug
SULLIVAN WATER WELLS
. P.O BOX 870272, CHUGIAK, ALASKA 99567 • TELEPHONE 6882759
OWNER OF LAND FEDI ' /hltC 6 2 'DEPTH OF WELL / 0 Q
ADDRESS _C_ ( $ `, 37 _ !1I6-44.,J0/2STATI•
C LEVEL OF WATER FT r10:�Jrri
LEGAL DESCRIPTION 4 4 1 1 dJc 1 S / a 1z H!LC:DRAW DOWN FT
DATE - Started Ended
. /.,r
GALS. PER FIR
KIND OF CASING
PERMIT NUMBER
/F0 b
(300
KIND OF FORMATION:
From 0 Ft to r-71 Ft cr9SrrJ6 Jr is jP • Front Ft to Ft
I
From 2 Ft. to 9 - Ft 0 L -h5 a¢UJr446 r.)- , From' Ft to Ft. - -
From 4 ' Ft to 1 Ft ..cfl/ti�- b 4'9 -id;C Jf From Ft. to - Ft
-d1.
From Ft to ' - Ft. C 81 i / From - - Ft to Ft
From r b Ft. to 7 r Ft U t'i o C t4 From Ft to Ft
From —I C Fr to IDD Ft A.= .0a ARA G r '1,4 Ynt1FI. to Ft.
1
From Ft. to Ft. 30 ` 6,6'Ai From L Ft. to Ft.
3
1
From Ft. to Ft. - - - '- ' Front ' - Ft. to Ft.
From Ft. to Ft From Ft. to Ft.
From Ft to - Ft - r From Ft to Ft.
From Ft to Ft. From Ft to Ft
From Ft to Ft. From_ Ft. to Ft
From Ft to Ft From Ft to Ft
From Ft to Ft FromFt to Ft- "- - -
From Ft. to Ft. - From Ft. -to Ft:'
From Ft. to Ft. -- - From - Ft. to Ft. - -
From Ft to Ft - - From - Ft. to Ft
MISCL. INFORMATION:
if ]_J! /g
t>io y
DRILLER'S NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF 1
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW940168
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:MILLER PETER DEM
OWNER ADDRESS:HC 85 9375 HIGHLAND RD
EAGLE RIVER, AK 99577
PARCEL ID:06034201
LEGAL DESCRIPTION: STONEHILL BLK 1 LT 1
LOT SIZE: 44375 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED: 6/03/94
EXPIRATION DATE: 6/03/95
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS) .
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
OW (fat
DATE: °VD7/9y
(°14/6/ 1
DATE:
May 24, 1994
ilwer Englneal:dug SQrdIlc e
Louis Butera, P.E.
Registered Civil Engineer
Jim Cross, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Stone Hill Lot 1
Narrative & Waiver Application
To Whom It May Concern:
The proposed septic upgrade will have very limited impact on adjacent properties for the
following reasons:
1. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, due to absorption capacity and lot size.
4. Drainage will not be affected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\C:\WPWIN60\WPDOCS\ 1994\94-017A.NAR
P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694-5195 • Fax (907) 694-3297
VACANT
CL STONEHILL DRIVE
N 09'56'58'
z
4' BURIAL INSULATION
'0 TRENCHES WITHIN .11N` INVERT 1/2'
10' OF DRIVING SURFACE
0 118.
1000 GAL SEPTIC
TANK MINIMUM
4' BURIAL INSULATION
UNDER DRIVEWAY
LOT l
135%
1 3 2 X
NO KNOWN CURTAIN DRAINS
ARTESIAN u
LL RELIEF
p
PROP.
GARAGE
PROPOSED
WELL
90-WOX
EXISTING CUTBANK
N 87.36'23' W
CL HILAND DRIVE
® - TEST HOLE
e - MONITOR TUBE
o - SEWER CLEANOUT
4- - WELL
PROPOSED LEACHEIELD
— — - EASEMENT
WELL. &c SEPTIC SITE PLAN
LEGAL: LOT 1 STONEHILL
OWNER: PETE MILLER
CONTRACTOR: OWNER
JOB # 94-017 DATE: 05/25/94 SCALE 1" = 50'
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297
i 6
/..
/or ...0' - j
O, ft' of
0 LOUIS A. BUTERA 2to
�i
j/ i,�� - CE -6736 ��v_Sr
1, PFO =
1'It�'t% ....
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LOT 1, STONE HILL
A. GENERAL
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi -family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
B. DRAINFIELD
1. The drainfield is to follow the natural land contour to maintain uniform total
depth of the drainfield bottom.
2. The bottom of the drainfield shall be level, plus or minus 1.5".
3. The total depth of the drainfield excavation is not to exceed 2.5' at any point.
4. The drainfield gravel is to be covered with typar or equivalent fabric material.
5. Soil or combination of soil and extruded board insulation to a depth of 4' or
equivalent is to be placed over the leachfield.
6. The area over the drainfield is to be finish graded to prevent ponding of surface
water runoff.
7. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 2.5' GRAVEL DEPTH = 6" below pipe
DRAINFIELD LENGTH = 75' DRAINFIELD WIDTH = 5'
SOIL RATING = 1.2 GPD/ft2 BEDROOM CAPACITY = 3
SEPTIC TANK = 1,000 gallons minimum
Twenty-four (24) hours notice required for all inspections.
C: \ W P W I N 60\ W PD O CS \ 1994\94-017 A. S PC
EAGLE RIVER
ENGINEERING SERVICES
P. 0. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
JOB
Stone Hill Lot 1 / 94-017
SHEET NO OF
CALCULATED BY C.H. DATE 05/24/94
L.B. 05/25/94
CHECKED BY DATE
SCALE
Single Family Dwelling
3 Bedrooms
3 BR x 150 gallons per day (gpd) = 450;gpd
Application rate = 1.2 gpd/ft2 for 5' wide trench
450 1.2 = 375 ft2
375 ÷ 5 = 75' total trench length
No reduction % for 6" gravel
Use (2) 38' x 5' gravel trenches
OF
k °.4.
15
e9 3+: ty
ae aaeielvs
Ce lotus A. outer° ° <
°n CE -6736 0 ,
���°opaa
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C:\WPWIM40\WPAocS\1994 \94 012A.0 A r
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: F E E.R f llla-ER
LEGAL DESCRIPTION: E+ItIEHILL LUT 1
1
2-
3-
4-
6-
7-
&011
(ENGINEERS SEAL)
DATE PERFORMED: 5-12791
Township, Range, Section:
(oR) PEAt WOK,
(o) Rep um 16gAveI,
(&r -j) 5M'i, &HD' &eAViwk,
GREY, MEDIUtl traK1Set wNaNY
I,PRSE CoPAIt fi d j 1 t $t>
I-1161-1`( FIA Citai9 PaEDEC
SMALL ANGLIL42
FrzwiENTS,
C-EJJ M6i.t
CWahli NG
DENSER,
1z.f aoo
A
17-
18-
19-
20 -
COMMENTS
Louis A. 5ulera • > +t
•'CE -6736 °�,*
'r1
A° J>0a9 -cIIa, °°N\,n
.40FEsso>
oa
SLOPE
WAS GROUND WATER ES
ENCOUNTERED? I Y
IF YES, AT WHAT
DEPTH?
Oeplh to Water Alter 6-, 71
SEEPSa€510
P
E
5ZEcH
Monitoring? Oat •
SITE PLAN
N
SE.
E
Syr_ p
LAI
4
Rng
Reading
eadi
roAK
Date
Gross
Time
Ne
Time
0 pth o
Water
Net
Drop
/
F-/3-iy
/5"ps7
/ o ,,,,
4'q. s "
3 %6
a
Ir
d: o s
/0 ,,, ,
VT.5- "
3 9//6
3
"
/6: /9
to .>,.,
vg -s"
3 $//6
PERCOLATION RATE Z' 9 )minutes/inch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN 3 FT AND Y FT
I NSTA LL I ,7€ NG r-lt -V
PERFORMED BY-
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE -51/45 l ii'
72-008 (Rev. 4/8S)
PERFORMED FOR
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PETER nu -ER
LEGAL DESCRIPTION: SION Lor 1
TH-1
1
2
3 -
4 -
5-
6-
7 -
SEEPS@ 8 _
<3 5'
C% WE-, 9
10-
11
(J-
0 140 e
U-' D
(ENGINEER'S SEAL)
DATE PERFORMED: 5-12.0-1.1
Township, Range, Section:
PR) 126(cc BIYAGc
(OR) 'f EDWAPt tIFAVEI, fall•?'
(6M) €)II SANbt @RQEL,
GREY, NED. DENSE, FEW
LAT -GE coee&,E +tit -all
SLOPE
•
<
c:
I�IC�dIYFf4aUgan rEpRecc
SM&L ANGu4AR
FMAVIEHrS, ctittU'r
12-
13 -
14 -
( eatiiN6 D€NSEK)
is,3�ZleavA
OF Al4 vtst,4
15 - *+ 1/
� •• :
ooano zoos,.. n •alit°..
"�) Louis A. Bolero I ytt
18 -�t� CP % CE -6736 n e¢`
A. Ta, "-\�^g4
s y\--x,..
G.'�.'Y
4,0/4°' ^•.aoa°at° y �a
4Alc.OFESS1O' -. r
17
19-
20 -
WAS GROUND WATER YDS
ENCOUNTERED?
IF YES• AT WHAT
DEPTH?
5
SW 9 L
SEEPS 8'
.5
E
(Myth lo gaoat .ist Aller g 5 75 `l I
Monitoring?
SITE PLAN
SE
sir_ P
LAI
N
J
Reading
SOAK
Date
Gross
Time
Ne
Time
Depth o
Water
Net
Drop
/
5-/3-qy
16: €:,/
l6-«
loan,;
IOra,b
78'%6
V7'%6
3 .za6„
3at"
'r
3
7/
16.73
lo,.,,.,
77'--,6
3 2n6,Y
PERCOLATION RATE 3• Z (minutes/inch) PERC HOLE DIAMETER
611
TEST RUN BETWEEN
COMMENTS iHSCAU_1.26j1 Hr '(U 4%11'
3 FT AND 7 FT
PERFORMED BY /Y'r I —
-�� "• CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WI1 H ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE
72-005 (Hey - 4,85)
S��y�yy
//CIS" eaae
Z. eJnt
it /9rt
Arun1<7r_o°d��o, asp
Qc72,- frier her alas ash ��.tiri cs
ra s i T
/Yin /0. Y ,""Ors 9p577
/r.; set/One > T /y -fey &e,diGc':@/t>_
7e Vdre 777 7iok 076 7 S'7?v-ic Syne r nT Smarr/,// Sv.
.L .2 % C O Gra fd'/W
Tia ,.;e• ta TSP 57,57-rn Oyscf 1' x n-
CSV Ore o"2 SSC.>ar/ A:04 CarrsT/uc77a-ad a z"lYdy y 7-
J c j v /aril rAz nrevic 5:: trc *antes. r j: -cel a 0
sr�.rce e2sc�„C/l.--.r24'&— »c,r-oesr("/IS 7""ars ra//4z
dei-, /Jii/q
Tri./,7,b
.. yr_/+v'v` �G'e^L% P/ G_' l7 liA TO �E-'1TNiS
/-;4;e.->e c-
ees/O4 zt' ' 6e7 07"fl. s- revere 2
-y r u7, rCQ
lar
5 e7
RECEIVED
J%JN 1 41994
Municipality of Anchorage
Dept. Health & Human Services
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
n FOR A SINGLE FAMILY DWELLING
Parcell.D. 6106— 34,-6/ HAA# b14Oldel9
x^ rt -2
i, Expiration Date: ' �b/f�dC'f-�
IL
Comp)etefegal�iescription �.,a., -5775tie ////1 , LOr /
1. GENEI?3 cttIF0�(MATIiJFtI,,%
!' .+v ►
r w.
Location (site address •or directions) / `%8•/Z E- ST nAJE /•i/LL
Current Property owner(s). 144 1/141.-L (. i incr ty ft (G Day phone
Mailing address
Lending agency
Mailing address
OR
Day phone
Real Estate Agent tii/1 L•Orc4nf
Mailing Addressf R U0647144- Vitr 4
Day phone €fl -64178
OF 44CLE l iP &
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
JJ Individual On-site
❑ Individual Holding tank
❑ Community On-site
❑ Public Sewer
0
0
0
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 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(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm /V eel -Nein EAIC Phone 6 94t-
Address
4t-Address 17c237 B'F.f/te PA& G/2CLE
Engineer's Printed Name S7 -6(E EI✓G
Date ///307Uz
-'3 . •.
*•491
/ •N
I VA. stoma
5. DSD SIGNATURE tee ►E Zs6 ,.�t``+
(, Approved for bedrooms. _44 3/400gOFE..... ."
Disapproved. ,������b�
Conditional approval for bedrooms, with the following stipulations:
•
u 'w= S 4,I
Additional Comments
ltjgrfe
`\\`\G`QP1/41/4kviur
Yf... &OD�i%
. O
0• ON-SITE 'O
WATER MD M'
80 WASTEWATER
•
t.
S�JJ411
By:
Attachments:
HAA Checklist X Maintenance Agreements •
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
(Rev. 01/04),
i` to Q. Q Original Certificate Date: MT/41'ortg
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Siglatass
A. WELL DATA
Well type 2_
Date completed Of
Total depth /00 ft. Cased to / ft.
FROM WELL LOG
Date of test 4 -/tie
Static water level ifgrerirfact ft.
Well production 30 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate C23 mg./I.
Arsenic: mg./I. Date of sample:Oh/0g
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material,WOM,3444- '-44fc /strec.
Tank size 1400 gal. Number of Compartments 2
Foundation cleanout (Y/N) Depression over tank (Y/N)
Date of pumping vPumper /1Z/7/0,Z
Parcel ID: bLou -4d
If A, El, or C provide PWSID # Well Log (Y/N) y
Sanitary seal (Y/N) y Wires properly protected (Y/N) X
Casing height (above ground) .7 el
C. ABSORPTION FIELD DATA
Date installed 1.41/ Soil rating (g.p.d./ft2 or ft2/bdrm) 4.2
Length ft. Width ft.
AT INSPECTION
/V3Z1/0V
Z C3
-5 g.p.mrt-
Other bacteria
0 colonies/100 ml.
Collected by: AfcrottOji.s.
Date installed A/99
Cleanouts (YIN) y
High water alarm (YIN) /1/4
System type 7-2E-iticti
Gravel below pipe a S ft.
Total depth 1-7 ft. Eff. absorption area 3rOft2 Monitoring tube X Depression over field Ai
Date of adequacy test /0 cr° '71 Results (Pass/Fail) PA -tr For 3 bedrooms
Fluid depth in absorption field before test a in. Water addedg_sZgal. New depth Z in.
Elapsed Time: g 2, min. Final fluid depth _a_ in. Absorption rate >r- 41.50 g.p.d.#
Any rejuvenation treatment (past 12 mo.) (YIN & type) L/itte
If yes, give date
Date installed -ize in gallons
"Pump on" level at _ in "Pump off" level at
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT
Septic tank/lift station on lot /66 f#
Absorption field on lot /00 r#
TO:
IL
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requ ements?
On adjacent lots /6 4 r.r
On adjacent lots /0.0r� #
Public sewer main Ain Public sewer manhole/cleanout
Sewer /septic service line 2 .5 r r Holding tank "f '4
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation /0 f r Property line /0 r'' Absorption field S r
r
Water main Water service line /� r
Wells on adjacent lots /00 'r
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
r
Property line /D i Building foundation /0 * Water main A' 4
r
Water Service line /t f
Surface water /00'4-
C
Surface water /0 D
Curtain drain (Jr(l,l< Wells on adjacent lots /00 rt
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 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 Sr'E/E /WC
Date ///30/o
Driveway, parking/vehicle storage /6 rr
HAA Fee $ 4so et
Date of Payment 14164
Receipt Number
(Rev. 12/01)
hi 712 frem
Waiver Fee $
Date of Payment
Receipt Number
12-08-04 12t2iPM FROM-C'tE E31, SGS ENV SEkV ICES
S075615301 T-193 P 02/08 F-476
•
SG$
SGS get"
Client Name
Project Name/11
Client Sample ID
Matrix
PWSID
1047802001
NorthRitn Engineering
Various
Stonehill Lot 1
Di inking Water
0
Sample Remarks:
All Dates/Times are Alaska Standard Time
Pt anted Date/Time 12/0712004 14,34
Collected Date/Time 12/01 /2004 11:30
Received DateaTimr 12/02./2004 10:07
Technical Director Stephetn1. Ede
Release Jly,r% i
Patunieter
Waters Departtaont
Nitrate -N
Microbiology Laboratory
Total Cohtorct
Results
121
11
PQL
0.100
Units Method
mist. CPA 303.0
ce1/14OmL SM209222H
C'omainer Ip Allowablc Prep Analysis
J.imiu Date Dux Init
8 (<—t0) 12/01,04 81A
•4 (<'1) l2/02I0c DPT
•
12-08-04 12:25PM FROM-CT&E ESI.. SGS ENV SERVICES
SG
9075615301 T-193 P.04/08 F-436
SOS/CT/4E ENVIRONMENTAL SERVICES
Drinking Water Analysis Report for Total Conform Bacteria
READ scleRUCT10NO ON REVERSE ROE UFORI COU.ICT1NG W WPLR
MUST BE COMPLETED BY WATER SUPPLIER
[j Pualdc WATER SYSTEM 0
f tVATE WATER SYSTEM
Q Sena Rums
SRN Nets
F„c.., fit. .......
fC-702? tt 7oz
l
Ein
r
nptm.
SAMPLE COLLECTION:
hi-wre.s ails* .w..wn cin all..a. Naac..
Otte:
62
r
aY
ewe y v..
nn: // SCS CP PM omit
Luwon: S eaNit ct 4J ' ( 4Capt%% &SJE CJC
N..
Transported
to lab ay: rb Same as collector Otter.
❑ aeon Rana
Soder epee ••neCane a ewe
Nem
200 W. POTTER DRIVE
ANCHORAGE, ALASKA 99518
Tel: 907.582-2343
Fax: 007-561-5301
l.N ear No.
1047802
” itWf la
Wren Imam
Rae Ma..
oW
r
SAMPLE TYPE:
0 Routine 0 Treated Water
CI Repeat Sample l7 Untreated Water
(Mer to NbRo.
❑ Special Purpose
RW.d Nem aenfla
TO BE COMPLETED BY LABORATORY
§smolt ReceMnd•
Date: 12-2-04
Tans: top?
Y'
^'(
❑ asis oar SD Ocoee MR
Rums mar tee wreneMe
Temp:
❑4e Hour Wits
Delivery Method: a Ranee Unions
Received BY: our
Comments
Primed Nae
0 RUSH SAMPLE
Phone*:
Fax*
$actedolookal Water Analysis Record:
Analysis Norm
Analyst:
i-». mud
v..i_
Analyecsi
MOO*
MMD#UO (PIA) RElULTat
TRW CCoim:
1, Cat
MEMERANE PRIER REttptTL�i
Deem Corer �_l CdbN..negal.
Membrana Finer Ve swan:
MMO-MUG(P/A) ww.N{LIE
Ila IST satisfactory
Pool Callers { PC' ❑ Unsatisfactory
INR • M Nuee+u.t.aee
Date:Time: 17 - 7 . o¢ /Ynec es *ear Parris
Gent ID ADEC:
MC FMN JUN
(HleRaa•
Sea to Girt
Phoned Q Faxed O
OalaRrnr
Spoke pier.
Repotted BY: if seep/
eglr..e
- .-- - .r...........a.....u.•••ln..e vas..• 4•1 WPM He
Forme FW- 0053 12117/03
•
ASBUILT
fT.l/'eL
erg's's8"w
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
AND N ENCROACHMENTS EXCEPT p AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
SER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTs, COVENANTS, OR 'RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER 140 CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SEWARD &
SCALE:
DATE=
GRID:
.C41-fter
resr.*,
DRAWN:
40071--
FB:
Ohi1
FB:
ASSOCIATES LAND SURVEYING
co
•* .•
K....
4-0(129
r
Duero Mirk hwad
+°', . LS - 6918
•
aha*ase.