HomeMy WebLinkAboutSPRING HILLS ESTATES BLK 2 LT 7
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SFRVICES
Heal.. Divisio. D/.')--0 5'/
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Address
,~'
Phone(si
Township, Range, SeCtlOll
DISTANCES
SEPTIC
TANK
Pemut NO. ~rooms WELL
L~G^L .,SC..'T~O. LOT LINE
s ,bd,v,s;~
X SEPTIC
TANKS
[] HOLDING
TYPE OF SYSTEM
TRENCH ~ BED ~ W. DRAIN (~. OTHER
Depth to i)~Pe bOllOm hem IOlal depth Irom on§ina[ grade
FT
WELLS
~/_ PRIVATE [] OTHER {Identifv)
REMARKS:
AS-BUILT
ABSORPTION
FIELD WELL
.~o ' :~ ~ ~
'/r-~,~./,
I ~_{ ,t ,.::.~.__ J t~c~NA~_____ ce..di[y t. hat lido i,specti0n was ped0rmed according to all
Municipd and State goiddines in oiled o~lh~ date: _
7~-013
Dal.'.c.! ]:!.~sn.u;.x::tll O(~/:l.q/JlV}~
r~l:::! Iii:IR C)t:::'F: ]:l:',tii: 1t[3Ul::~i:~, C['alf..t. :}';q :3 .- ".t.~hi!!t :l F~I',ID
~qL Ili}l:Rli:['.) t I\1 IFil: F:: :t:I:I,.D~, t:ii:t'qi):l Iqli:l~l:,~ pills
I'H:[',~ I::'I.FRi"Jll I17:(1:::']:1::;:I~!:I[i I ;? /::,", :l /Jil? f.'~lqD
k,H INIIClPAI I~Y (~F ANCHORAQE
Municipalily o! Anchorage
DEPARTMENT OF HEALTH & 825 '%" Stroet, Anchorage,
SOILS LOG -- PERCOLATION
1
2
3
?
8
g
~/~/~S Township, Range,
~- ~ ~-/~T~'.~- SLOPE
10
WASGROUND WATER
ENCOUNTERED?
11
12
13
14
15
16 m
19-
20-
SiTE PLAN
S
IF YES, AT WHAT O
DEPTH? p
E
Depth Io Water Al[er --
Gross NeE Depth to Net
Reading Date Time Time Water Dr~3p
\\
PERCOLATION RATE __ (minutes~inchl PERC HOLE DIAMETER
TEST RUN BETWEEN -- FT AND __ FT
COMMENTS -- /
f
PERFORMED BY; ~-.~ I/ ~.~'~.~' , I CEf~TIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH AL[. STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE. DATE:
72-O08 (Rev. 4/85)
4" PEEF PIpE
HOLE ~ ~C K
SEWER SYSTEM 'LOCATION PLAN
NORTH JEEEY ~E~Z OIM~SIONS I"DICATEO HAVE BEEN
July 31,
MS. Susan Oswalt
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, Alaska 99502
OC rwi
& associates,inc.
Consulting Engineers
1000 E. Dimond Blvd. · Suite 205. Anchorage1 Alaska 99515 · (9~t,~,41,.~-1,10.~__
1989 ENvj~DoE~E(~FT
AL PROTE~iON
JUL 3 198
ECEIVED
SUBJECT: LOT 7, BLOCK 2 SPRING HILLS ESTATES
Dear Ms. Oswalt:
On the 12th of June we submitted a proposed Sewer System Plot
Plan for the above referenced project. Unfortunately, we
erroneously showed the location of the existing house and test
hole. The attached sewer system plan shows the house, test
hole and new septio system as it actually exists on the lot.
Due to the unstable nature of the native soil the excavator was
unable to install the deep trench septic system as originally
planned.
We changed the design from a deep trench to
absorption bed. The speoificatlons are
plan.
a 5' wide shallow
on the attached plot
A septic system as-built will be sent to you.
questions please contact us at 522-].311.
If you have any
Very Truly Yours,
CORWIN & ASSOCIATES, INC.
Gerard Kress
Engineering Technician
b-B' LOK!G
i J ,,. ,~ ~,'~0 XNA'rlVE FILL
~ . ~XSEWER R~d.K
· SEWER. SYSTEM:LOCATION PLAN
///~///// ~~ ~ NORTH .~Z ~ ~ OIMENSlONSlNOICA'rEDHAV[aE[N
~j. Cg~IB ~ ~:~ ::;?':::]:?:'F'"<;':? ~ ':~ ~:: f/;~~ :. ~:::~ '[::.::. ;.~ '~: ~:; ~: :':'~ ";:?':: '::'< <.:?:?:?: ~. NOT BY SURVEY NG TECHN QUE8
~. ,..... ~ ~: · ;: :. ~ ........
MUNICIPALITY OF ANCHORAGE
MUNICI?ALI';',/ OF .....
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMEN'rAL ENGINEERING DIVISION
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION RE -
J
~ UPGRADE
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
'Liq' ~cA~ ~ll°nsI IF HOME'DE: Inside lengthMat~
DISTANCE TO' [Well Dwelling
Manufacturer -[Material
Well Foundation ~ ~ $ Nearest Iotj)~line
Length of eacl~Line I Total length Trenoh width
Material beneath tile ~ I J inches
Top of tile to finish grade
Length Width
Depth
NO, OF BEDROOMS
PER %.
No, of comp~_.~ents
Liquid depth
PERMIT NO.
Liquid capacity in gallons
Distance betw~ lines
Total effective absorption area
PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest rot line , '
DISTANCE TO:
Depth Driller Distance to lot line PERMIT NO,
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SQIL TEST RATING
INSTALLER
72-013 (Rev. 3/78)
DE:F'I=II:~:THFJNT Cfi::' I-ffi:l:::lLl'~l f::llqE:' IENV]:I;?.OI",II"IEI",ITF'IL. PFi:OTIECI'IOiq
82~;J I.. STI4.':EIET., FII'.,IC:HOF~'.F:IGE., F'II.::: 'J}95El::L
FIF'PL. ): CIqNI":
CONTFICT F::'I .ICd',,IE:
[::, & ~J; LII',II... :[ I',1 ]: '1" E I)
[:ff.,I C H EII:R F:ff:.i[ib F:II.:::
13L.OOI'(: 2
L. ]; E;]'EI::, BI!i:[_.OI,I I=IRE THE OF'T I I:]l",l::~: I:::IVI::I :[ Lf:IErLE -I'E, '¢CIU ]: I",I DEE; ~ Gi",I I IqC:i "/OUR ':'51EPT :[ C
~:7¢:E;'I~Fi:PL C:HOC~SE 'l"t"l[~: OF:"l"]:OIq 'I"Hf:IT E:E'-::;T [:'Z'i':E; "r[OIJR
:+::.l.: GI:RFIVEL L.ENG'I"I.I 3:' '?'5 I::'T. F~:EQtJ]ffREEi; I',II.JL-f'ZI::'L.E I~'.UN!5 ,::i'.,ICq' E::':;C:IZED,:[NEi 75 F'T. EF:IC:H)
m~.l-: 'T]:::II'.,II( I'"IU'.L"';T HF:IVE I::IT L.t:Ef::I]E;T q"P.lO
]: C:EI:;UI' 11: F'"/ TH61T:
:J.. :[ F:ll'"l I=:'FIf'IZ[_ZI::IIii:
2.
'THE: I':i:EE:!L.I;I:I;;'.E:HE:I'.,IT::a; F'OF..' ON~-'-:::';J:TI..7. :E;EPlE[;i:E; FIND klEL. L.E; FIE; ZEI"
F'OI:~rTH [3'¢ THE IqUI'.,IZC:i:F:'I=II..):I'U CiI::: F:iNCHOi:;;:F:ICCE: (IqOFI) RI'.,ID 1'HE SI"RTE OF:' RLFI21KR.
]; 14:[L..I... ]:NSTFIL.[. THE: :B'¢:B'I-E:I',i ];Iq F:ICCOI;:DFli'qC;:E I,.I:[TH FIL. L HOFI CODEE; FIN[)
FINI) ;I.' 1'-4 C:OFIf:'I.L :[ I(/I'.,ICE I,I ;1: TH 'I"HE E:,IEE; :[ 6lq CF;: ]: TE:I:('. :[ FI OF' 'TI..1:1: E; F'ERI'q Z "1".
:!: 14:I:L.l.. RDHEI:?.E TO FILL, MOFi RBII?, ~a;TF:IT[!!: O1=' I=II...FISK. FI RE6!LI]:REHEI'.,ITS FOF4'. THE:. SEi:'T'
D :~ E;TF:thlCEZ F:'F;'.OH I::liq'T' E:;:4 :[ ZT :[ I'qCi I'.IIEI..I ..... I.'IFI:BI"IEPlI::I'TE;I:~'. D Z L=.;F:'O%FIL. :~'¢Z'I"EH OF: F:'LIE,'L :[ C
:.'=';E:I.,IE:[RR(3tE E;~¢:~!;'TEH Obi q'll:[E; Eli:;: I::IN~'/ IqD,..)'f'lCIEl'.,n' O1:4: IqE:RF;,.B'.r~ LOT.
;[ I.JN[)E:[;:E;'TFiND TI.tI::IT TIl:l::~.i FtEI:;;:H :1;'1" :[.% 'v'F'l[. ]: [) F'OI;;'.R i"1F'~',4 :[ HUH OF 4 [3EDROC~H2; RI'.,II::,
I::'lN'.r' EI'.,IL.Fffx~GI!~.HI.~:I'.,IT H:[L.L. Pi:EQLI:t:F~'.E: F:II'.,I FI[::,D]:T]:ONFIL I='IERHZ'I".
]: F' I=1
THEF,I
H]:L.I
EI..ECTI:~: Z CRL 14 Crl:~: K
E; ]; GNE[)
L. ]:I::T ~iTf'Fl'l"
4:[,:) FIN [EI.,.E~C:TI;;::[CF:IL.
NOT E',E F'IF'I::'Fb3',,,'E:D I.,.I;[I'HOt.IT F:II",I E{I...ECTF::[CFII~ :[NEi;PIECT]:ON
I':IF'F'L. :[ CFINT:
I"IUST BE DEllql!~ E:"r' FI L. I E:ENZEI~:, E:LE;CTI';;'. I C ]; FIN.
...... ........................................
E) ,!i'., S.~; LJi'.,IL ]: H ]: TE:D
:[ :~;E!;I..IE b Eft'/
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorago, Alasl(a 99501 264-4?20
SOILS LOG - PERCOLATION TEST
SOILS L G
PERCOLATION
TEST
LEGAL DESCRIPTION:
9
10
11
12
13
14
15
16
17
18
19-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SLOPE
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
20-
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch)
? FTAND --L~ .FT
_ __
CERTIFIED BY: / / DATE:
~V~-~/V DRILLING, Inc.
P.O. Box 10-378 * 10300 Old Ssward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
84-225
DRILLING LOG
Well Owner. J,E%.,.6No IN WOOD/iiILL+ SAi! .Use of WeIL~°-m'~!ic
Location (address of: Township, Range, Section, if known; or distance main road Lot 7, Block 2 Spring Ilills - Anchorage
Size of casing 6" .Depth of Hole_. 2hl.~' -feet Cased to 21~1.50 feet
Static water level 209 ~ft, (~]{~<) (below) land surface, Finish of well (check one)
Screen ( ); Perforated ( ),
Describe screen or perforation None
Well pumping test at 5 _gallons per (hEtii9
of drawdown from static level.
Date of completion-- July 2~, 1984 _
(minute) for 3. .hours with 100%
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
open end ( X );
0 --TO.
6~ .TO.
141 .TO. ].50
150 .TO. 190
190 .TO 2.15
215 .TO.
241 TO. 241~:~
.TO.
.TO.
.TO
.TO.
.TO.
.TO '
.TO.
Gray oilty gravel-seeping water-occasional bould.er
Gray silty gravel -- damp
Brown silty gravel
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL PROTECTIO~
Brwwn silty' gravel ~ wet
Waterbea~i__qng gravel R E C E I V E D
NW~gA Ce~tlfied Contractu~
C~4~zte Nors.. 814: &
3--CONTRACTOR
Parcel I.D. #
1.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWE:LLING
GENERAl. INFORMATION
Complete legal description
Location (site address or directions)
Property owner --.~c.~ ~ t'-~t~_-~-L~4-~E- ~ Day phone ~'~-~ - I
Mailing address ~,~--,---~- -~-~, 'Z~-~°'"J'~'~
Lending agency
Mailing address
Agent
Address
Day phone /"J~- _
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
MUNICIPALITY OF ANCHORAGE
ENVIRo .NMENTAL ,SERVICES DIVISION
JUL 02 1996
RECEIVED
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAl.:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Was[swater Ssrvi.c~s ,/¢// Phone =3_¢
8,+ t 115'fu51 :;f~¥ r. Y~'I
Address
Engineer's signature ~ ~P~/~'~ Date
6. DHHS SIGNATURE
~:~ Approved for ~'Ut- (/~') .bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By:
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.
Legal Description
A. WELL DATA
Well lype _
Log prcscaI (Y/N)
Total depth
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVIC~?84'o,~,
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501.
Health Authority Approval Checklist
LoT '7) ~I~ Z~ .g*P~'5,MG Parcel I D '
If A. B. or C. attaclt ADEC letter. ADEC water system number
",-/.~._~ Date completed 7/Z ~'/8 *
~,~,-I ,~' Cased lo '2.4'_~. · ~=~ Casing beight (above ground)
Sanitary sea[ fY/N)
Wires properly protecled (Y/N)
Date of test
Static water level
FROM WELl_, LOG
AT INSPECTION
!
Well prodnction
g.p.ln '~, 2, 4-' g.p.m.
WATER SAMPLE RESULTS:
Coliform ?~.~
Date of salnple: ~,/~ 4"/~/~
Nitrate
,,1 ~,/~- Other bacteria_
_ Collected by: __
B, SEPTIC/HOLDING TANK DATA
Date installed __ {:,/84- Tank size
Foandation cleanout (Y/N) _
Date of Ptnllpmg I O/~O/e:~''
C. ABSORPTION FIELD DATA
Date installed
t
Lcaglh ~"~ Width
Effective absorption nren {500
Date of adequacy test
I '7.~"O Namber of Compartmems 2. Cleanonts (Y/N) XIE?..~
Depression (Y/N) _ ~ High water alarm (Y/N) iq k
. Pulnpet ...~' ,'~
Immediately after ~,O~ ,
Fhfid depth in absorption field before test (in.); .-~ ., ___ gal. water added (ia.):
Fhfid depth . '*¥q .(ins.) Minntes later: "~; Absoq3tion rate = '~ ~90 _g.p.d.
y
Peroxide treatntent (past 12 ntontbs) (/N) _ tg~O,..,..Jt,./ If yes, give date __
Soilrating (g.p.d./fiZorft2/bdrm) /Z~-" Systcmtypc
/
~" Gravel thickness below pipe ~,t/>~. Total deptb ~"~ //
Monitoring Tnb¢ present(Y/N)~/~ Depression over field (Y/fY) _NO
Results (Pass/Fail) tP/¢,'8~ For 4-~ bedrooms
Manliole/Access (Y/N) ~__ "Pump off' level at*
High ~ *Datmn ~
E. SEPARATION DISTANCES
Absorption field on lot
Public sewer main
Sewer/septic set. ice line
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
; On adjacent lots
; On adjacent lots
Pnblic sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO' ._
Building foundation q* ~ Prope~y line g~ -- ~ Absorption field ~ ' '
~Vater maitffset~ice line ~ ~ Surhce water/drainage ~/oo Wells on adjacent lots
SEPARA~ON DISTANCE FROM ABSOR~ON FIELD ON LOT TO:
Building foundation
Water mai~ffsemce line >to/ oe¢*st~
Surfi~ce water ~ t o o / Driveway, parkin~vehicle storage area ~O
Cu~ain drain ~a ~o~ Wells on adjacent lots > I~ Property line
F. ENG~EER'S CERTIFICATION ~ ~'
I certify that I have dete~n~ed thru field inspections and review of Municipal recor~~ ~ ~ -
~ t~ ,g }g~.s are
...,.,.
Signature -/~~ ~ *,, ~
Date
CE-7953
............................................................................................................ · , t~:~ ........
Date of Payment .~/~ Date of Payment
Receipt Number ~/O ~ ~ Receipt Number
Rev, 8/95 OSS: haa,wk.doc
8471 Brookrklge Drive - Anchorage ~ Alaska 99504
Phone (90?) 337-6179 - Fax (90'7) 338-3246
Consnlting Engineers
July 1, 1996
Municipality of Anchorage
Dept. ttealth & Ituman Services
Division of Environmental Services
OnqSite Services Section
P.O Box 196650
Anchorage, Alaska 99519-6650
Ref: HAA for Lot '7, Bk 2, Spring Hill Estates. 9440 Spring Hill Drive.
To whom it may concern:
The subject lot is served by a private well and septic system. I tested the well and the septic
system on 6/24/96. The results are summarized as follows:
WELL TEST: The static water level in the well was determined to be 205 feet below the top of
the casing. Water was pumped at a rate of 4.24 gpm for a total of 152 minutes (645 gallons).
During the first several minutes of the test the water level dropped to 210 feet. It remained at that'
level for the remainder of the pumping period. Based upon this data, it was determined that the
well is adequate for a 4 bedroom house (600 gpd).
WATER ANAYLYIS: The water results showed no bacteria, and. 1 mg/l of nitrates (I0 mg/1 is
the allowable limit). In short, the water quality is excellent in regards to these parameters.
SEPTIC SYSTEM TEST: Prior to introducing water, the liquid level in the sump was
approximately 3 inches. Water was introduced at a rate of 4.24 gpm for a total of 152 minutes
(645 gallons). The liquid level rose a total of 1.75 inches within thc first 30 minutes of the test
and remained stable thereafter. In short, from t=30 minutes to t= 152 minutes, 517 gallons of
water was introduced, and the liquid level did not change. This corresponds to an absoq~tion rate
of at least 4.2 gpm. Based upon this data the absorption capacity of the system was deemed to be
adequate for a 4 bedroom house (600 gpd).
SEPTIC SYSTEM CONSTRUCTION: During the inspection it was noted that the C/O at the
beginning of the trench was almost submerged in water. Upon shooting the elevation of the
drainpipe inverts at each end of the trench (at the C/O and at the sump), it was noted that there is
a rise in elevation of 5.5 inches from the west to the east ends. This explains why the pipe is
surcharged at the west end.
In addition, I noted that the elevation difference between the drainpipe invert at the sump and the
bottom of the sump was 32 inches. According to the as-builts, the effective depth is 36 inches.
The elevation difference between the bottom of the sump, and the bottom of the monitoring tube
is 3. I inches, the sump being the deeper of the two. The elevation difference between the
clean-out at the beginning of the trench, and the monitoring tube is 23.5 inches (again, according
to the inspection report, the effective depth is 36 inches). The elevation difference between the
clean-out at the beginning of the trench and the bottom of the sump is 26 inches. Clearly, the data
indicates that the monitoring tube and sump are not set at the correct elevation, or that the
drainrock depth is different than what was stated on the 7/89 inspection report. Regardless, the
absorption capacity of the system appears to be excellent. The current homeowners, Jeff and
Miehelle Keck, stated to me that the system has not given them any operational problems. Please
provide direction from your department.
SEPTIC TANK: The existing septic tank is a 1250 gallon steel tank installed in June of 1984.
The condition of it is unknown. This engineer makes no warrantee regarding the life of the septic
tank.
If you have any questions, please contact me at 337-6179,
Thank you for your assistance.
Sincerely,
Jeffr~
Garness, P.E., M.S.
Consultant
or on my pager at 1-800-481-1162.
NOTE: The adequacy of a septic ,system is it~uenced by numerous factors, inchtding, but not
limited to, seasonal surface water it~ltration, groundwater variations, septic system
ma#~tenance (frequency of septic tank pumping, usage of biological additives), condition of
drain pipe and pipe joints' (which can be damaged by seismic activity and deteriorate with age),
type of substances deposited in septic system (cigarette butts', sanitary napkins', misc. objects),
and the amount of water being introduced on a continual basis. Consequently, the results of this
adequacy test are only valid for the specific day of the test. Furthermore, because of the limited
nature of this investigation, it is possible that there are hidden defects which may not have been
detected. No warrantee is made regard#tg the fitlure performance of this well or septic system
c.c. Jack White Real Estate, Bonnie Mehner.
Jeff Keck 1.wps
CT&E Environmental Services Inc.
Laboratory Division v~z',~,~'~,~'~,~,~'~,~,~'~',~'~B~~~?~
Laboratory Analysis Report
CT&E Ref.# 962544.962544001
Client Sample ID Lt 7, Bk2,Spring Hill Estates
Matrix Dri~tldng Water
Collected Date 06/24/96
Technical Director: Stephen C. Ede
Sample Remarks:
Nitrate-N
Nitrite-N
Iota[ Coliform
Results QC PQL Units Hethod Allowable Prep Analysis Init
Qua[ Limits Date Date
0.602 -- 0.100 mg/L EPA 353.2 -- 06/26/9~ ERC
0.100 U 0.100 mg/L EPA 353.2 06/26/96 ESC
0 0 co[/lOOmL SM18 9222D 06/25/96 TAV
U - Undetected
LT - Less than
GT - Greater than
O - Secondary Dilution
J - Below the calibration range
200 W. Potter Drive, Anchorage, Alt` 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301
3180 Peger Road, Fairbanks, AK 99709-5471 -- Tel: (907) 474-8656 Fax: (907) 474-9685
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
4lLm-24-96 IO::LgA Bonnie Mehne~
762 1858
"
t
'~..~":-,.~ ')i;( "'"
'--.....//'
0 M)T CORNERS
............. FOUNDATION ',.
~ ..... [)I~AINAOE ARROWS
NO Fgo
.5?l?hV~ il/i.£ $ ~=$?A T/?S
BE$81~, EPP~ ~ POTT8
2220 E. 88ih, AVE,
ANCHORAGE~ ALASKA 99507
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. # __
CEPtTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address _
Lending agency
Mailing address
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUIVIBER OF BEDROOMS: z¢--- ~q
'TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev. 1/91) Front MOA #21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of tl~e validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal, system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on,site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Nameof Firm ~---~ ~ ~ ~--I~J'~"~-.,li'J~" Phone
Address ~'~ '~',~'- / L,~'~
Engineer's signature V~-'~(-w"~ 7~.,~'/~/// Date
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Sen/ices (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. Em ployees of DH HS do not
conduct inspections or analyze data before a certificate is issued. The Municipalify of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
724)25 (Rev, 1191) Back MOA ~F21
Legal Description:
A. WELL DATA
Well type (¢~
Log present (Y/N).
Totaldepth ~,~[. [ i
Sanitary seal (Y/N)
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Lo'~' ~ i ~C,b~.VL, ~ Parcel I.D._
If A, B, or C, attach ADEC letter.
\I/ ~ Date completed
Ar)EC_.water system number
Cased to ~ ~' t ~ Casing height
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM iWELL LOG AT INSPRCTION
,0 g.p.m. 5- ,~
g.p.m.
Absorption field on lot
Public sewer main
SEPARATION DISTANCES FROM WELL 7'0:
Septic/holding tank on lot
Public sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank ~
WATER SAMPLE RESULTS:
Coliform (~ Nitrate _
Date of sample: ~ '~ J~J ~c~ ~
~), Z.(/ Other bacteria ~
Collected by: ~,~'A¢~O~/b ¢ py
B. SEPTIC/HOLDING TANK DATA
Date installed (¢ ~ ~ "-' ~'~/~`' Tank size __
Cleanouts (Y/N) k~ . Foundation cleanout (Y/N)
High water al:arm (Y/N) : /~J' [/~ Alarm tested (Y/N)
Date of pgmping 6 ~'~ ~ (L ~,~r6J, ')
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ]
To property line__ (-~/'0 I
Surface water/drainage
Compartments
Depression (Y/N)
t/,J 0
On adjacent lots / ~'.~' Foundation
. Absorption field ~ ,~' _Water main/service line
72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
~'~ .*'%.1!~ T STATION
Date i n~'~'~tled
Size in gallons '**..=
Vent (Y/N) "Pu-rhp o.n." level at
High water alarm level -'~
Meets MOA electrical codes (Y/N)
SEPARATION DIST_ANOE FROM LIFT STATION TO;
Well~o. nJot'-. On adjacent lots
D. ABSORPTION FIELD DATA A~
_ Manufacturer
Manhole/Access (Y/N)
,~ ,~'Pump off" level et
, ..-~?' ~ycles tested
Date installed
Length ,S'~ .~I Width 5~''
Total absorption area ~,~/~) 0 [~
Depression over field (Y/N) ~ 0
Results (pass/fail) _ ~A~ 5
Peroxide treatment (past 12 months) (Y/N)
Surface water
SoU rating / ~ ~" System type Y'/ ~J I~:
Gravel thickness__~.G' u Total depth ~ /"~ /'
Cleanouts present (Y/N) \/ ~
Date of adequacy test ~ ~/,~ ~ ~ /
for ~ · bedrooms
/,J Or.) (~' //~,~ U ~ ~,) If yes, give date /*)//~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot I'-~/ ~/ '
On adjacent lots ~ /*~ Property line
To building foundation __L~ To existing or abandoned system on lot
On adjacent lots ~I ~ C.~k-~,~ Water main/service line_
Surface water ~oA~ ~/~u~~king/veh~cle storage area
Curtain drain ~¢~
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature ~-/L,~'¢'~¢
Engineer's Name
HAA Fee $ __
Pate of Payment
Receipt Number
Waiver Fee: $ __
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Beck MOA 21
Kniefel Engineering
8441 Miles Court
Anchorage AK 99504
Attn: Robert Kniefel
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 907-456-3116
2505 FAIRBANKS ST. ANCHORAGE, ALASKA 99503 907-277-8378
Report Date: 06/20/91
Date Arrived: 06/18/91
Date Sampled: 06/18/91
Time Sampled: 0933
Collected By: SM
Our Lab #: Al11363
Location/Project: -
Your Sample ID: 9440 Spring Hill
Sample Matrix: Water
Comments:
Flag Definitions
U = Below Detection Limit
DL Stated in Result
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Below Detection Limit
Estimated Value
Date
Method Parameter Units Result Flag Analyzed
418 C Nitrate-N mg/1 0.4 06/19/91
Reported By: William E. Buchan
Anchorage Operations Manager
NORTrlEFIN TESTING LABORATORIES, INC.
2508 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645
3330 iNDUSTRIAL WAY FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125
TO BE COMPLETED BY CLIENT
~?'RIVA'rE WATER SYSTEM
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY LABORATORY
Received at: I~ Anch. [] Fbks.
State
SAMPLE DATE: 0(~ ~,~_ _~L~ Phone %~-- ~-~13
Mo, Day Year
Purchase Order No,
Zip Code
SAMPLE TYPE:
[] Routine [] Treated/Water
[] Special Purpose [~;~'~Jntreated Water
[] Check Sample (for original contaminated
,~ sample with lab reference no. )
2
3
4
5
6
7
8
9
Signature of Representative
Laboratory Ref, No,
FOR LABORATORY USE ONLY
Date Received
Time Received
Next Sample Due
COMMENTS:
SATISFACTORY
UNSATISFACTORY
RESAMPLE R
OTHER BACTERIA OB
TOO NUMEROUS TN'rC
TO COUNT
~RrNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMEN~fAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRON%~ENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application ])ate ____//~/~;~/ ~-
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicants Name ~;~ .~z~. .~elephone- Home Business ~p-8~g
Applicants Address
(c> Applicant is (check one) Lending fnstitution ~ ; Owq, er/builder~¢_~;
Buye Other (explain),
(d) Lending Institution
Telephone
Address
(e) Real Estate Co. & Agent
Address
(f)
Telephone
Mail the HAA to the following address:
2. ~_Zp_9_~_Res___j. denc~e
Single-Family~
Number of Bedrooms
3. Wg.t~r
Individual Well~[
Multi-Family~----~
Other (describe)
Community I~ Public [---~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
~ewase D~sposal
Onsite ~ Public E~--]. Community ~---[ ltolding Tank
Note: If community well system, must have written confirmation from the State
Department of Environmental[ Conservation attesting to the legality and status.
[Page 1 of 2]
5. .Engineering Firm Providing_Inspec.t~.pnst Tes.t_s~ File p~arch~. 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 inforraation 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 Munic:l. pal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Approved .... ,~ Disapproved ~ Condi~on~
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ~ALTH AND ENVIRObTMBNTAL PROTECTION
(DNEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICN£ES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA.- T~ ~tEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-'
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. Tt~ MUNICIPALITY OF ANCHORAGE IS NOT ~SPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
/,,JUNICIPALITY O~
£NVIRONM~Ni'AL PF~Cd t:CFION
NOV 5
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIS]~ - FEBRHARY 1984
Legal Description:
RECEIVED
Well Classification_ ~.w~7~-
Well Log P~esent (Y/N)
Total Depth ~/~/;.z Cased to
Static Water Level __ ~.~ ·
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tar~ on Lot
; On Adjoining Lots /~ ~
; On Adjoining Lots /~
To Nearest Public Sewer
To Nearest Edge of Absorptiol~ Field on Lot _/~,a¥-
To Nearest Public Se~r Line /W//~
Cleancut/Manhole ~ To ~a~est ~ ~rvi~ Li~ on ~t ~ _
Wate~ Sa~le Collected By ~.~, ; ~te /~/~/~
Wate~ S~le Test ~sults ~T}~ ~CT~
SEPTIC/HOLDING TANK DATA
Date Installed_ g/~
Standpipes (Y/N)
Depression over Tank (Y/N)
Size
No. of Cc~p~ztwents ~--
Air-tight Caps (Y/N) / _ Foundation Cleanout (_Y/N)/~ _
/%/ Date Last Pumped ~'
Pumping/Maintenance Contract on File (Y/N) ~ ; for
Holding Tank Higl~-Water Alarm (..~/N!, -- .Temporary Holding Tank Permit (_~Y/N)
Separation Distances. f~cm Septic/Holding Tank:
To Buildincj Foundation 17 /
To Disposal Field ~ '
To Stream, Pond, Lake, c~ Major D~ainage
To Water-SupplyWell /~O~-
TO ~zoperty Line .~o
To Water Main/Servic~ Line
course
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date I~stalled _
Width of Field
Square Feet of Absc~ption A~ea
Depression over Field (Y/N)
Results of Last Adequacy Test
/~*;/~;. Type of System Design
Length of Field ~// ~
Depth of Field ~' /
Grail ~d ~ick~ss ~ /
Stan~i~s ~esent (Y~)
~ of ~st A~a~ ~st
Separation Distance f~cm Absorption Field:
To Water-Supply W~ll
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/c~ Major D~ainage Course
To D~iveway, Pa~king A~ea, c~ Vehicle Stc~age A~ea
Cc~vents
~' To P~o~e~ty Line /! ~/~./
_Z ~ ' To Existing o~ Abandoned System cn
; On Adjoining Lots ~-
/~//~ To Cutbank(if present) ~/~
Date Installed
Size in Gallons
"Pump On" revel at
High Water Alarm Level at
Tested fo~
Electrical Codes(Y/N)
Dinl~nsions
Manhole/Access (Y/N)
"P~ Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
Comments
** Check Permitted Bed~oc~ Rating Against HAA Raquest **
I certify that I have checked, verified, o~ confc~r~d to all MOA HAA
on the date of this i.~spection.
Signed ~? :~,' ~ ~ Date ;~./~,/~,
!
KB1/d5/s
in effect
[Page 2 of 2]
2-15-84
BKSSE, EPPS & POTTS
2220 EAST 88 AV~qUE
ANCHOrAGe, AK 99507
(9O7) 349-6451
WATER ~F. LL TES£
Loc~tion:
Client's Name:
Address:
Test2r: ~/W~A Y
Subdivision:
Lot:
Block:
Initial Reading o~ Meter: _
Production Rate: ~,~GPM 24-Hour Capacity -- Gallo~s
CHEMICAL & G~ LOGICAL LABORATORIES £ ALASKA, INC.
TELEPHONE (g07)-279.4014 ANCHORAGE INDUSTRIAL CENTER
Drinking Water Analysm' Report for Total Coliform Bacteria
TO B~COMPLETI=_D BY, WATER SUPPLIER
WATER SYSTEM
' ,.~..o, ~:-~.
State
SAMP,.E DATE: F-I
MO.Dsy 2/Year
SAMPLE TYPE: ., ,_
~ Routine -.-
Check Sample (for routine sample
with lab ref. no._ ).~ ~[]
[] Special Purpose ; ,[] Untreated Water
TIr~e ~ ' Collecled
SAMPLE ~ ~ -' r Colleot~ed ~
TO BE COMPLETED BY LABORATORY
Analysis shows this Water,SAMPLE to be:
g Satisfactory
[] Unsatisfactory '
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample.
ate R, ce,vo /
~nalytlcal Meth~:
~'. ~ Fermentation Tu~ ~ Membrane Filter
Lab Rof. No. Result* Analyet
",1
,
!.. .- ' L,' ~ / o~-!~2o {1~) ' ', BACTERIOLOG CA~L WATER ANALY5 5 RECORD
,C'/ .,~<:~.~ ' ~'~' '" Rev. 3970 ...... ' ........
READ INSTRUCTIONS ..-,
BEFORE
COLLECTING SAMPLE U.ltl.l. 'rut3. Report, 3.~mll Tub. ~tl"~Fotal 1Omi ~o~l~l~l