HomeMy WebLinkAboutSPRING HILLS ESTATES BLK 2 LT 17A
Municipality of Anchorage page I of
DEPARTMENT OF HEALTH AN[) HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number:
Address:
c~ q .2. o SPRING
LEGAL DESCRIPTION
17~ 2 ~PR~NG H/£LS
wELL: ~xI ~TE] ~'~ [] Upgrade
SEPARATION DISTANCES
PID Number: OISO''S I ct 1
Wastewater System: [] New ~Upgrade
ABSORPTION FIELD
Deep Trench E] Shallow Trench [] Bed [] Mound [Z]Other
~)' B GPD/Sq. Ft
6So so.
k'INCAiD 4. .¢ONF
Total Depth from original grade:
Gravel depth beneath pipe
Gravel lenglh:
Ft.
Number of Hnes: /Dislance between lines:
TANK
Septic II Holding
Capacity in gallons:
Number et Compartments:
,~oe
BENCH MARK
Inspections performed by: 2¢t8TT°P_ .?'E_c¢_ ¢vcs: Dates:
2nd
Department of Health and Human Services approval
Reviewed and approved by: ~-~-,'-,----- c//~~-t-- Date:/¢/~¢;27 ,
72 013 (Rev 9/91) MOA 25
Assumed Elevation:
]00, o
ENGINEER'S SEAL
Permit No, ~[V ~20263 Page ___:~' of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN S[:RVICES
ENVIRONMENTAL. SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519,6650 · Telephone: 343-47~4' '
On-Site Wastewater Disposal System and/or Well Inspection Report
LegalDescription: LoT I-TA ~ J3£K ~2 5PRiN(~ 'rtlLL¢ PIDNo.: OI.5-O~/~
?Rot¢ii.E /./IEl4/
VERT~C.~L SCALE : I'~=S
301
IVq'' ~ppE
I.,IN~: FRot~
%B.N. I3oTTO~ OF
N.w', CORNER oF'
Flattop Technfca! Servic~
14530 Echo Street
Anchorage, .Alaskc~ 9951
72-013 A (2/91) MOA 25
Permil No, ._~W' fl2o263
Page
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAl- SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-47~,:''
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: /.O'_E I-lA , gL~_ 5FRIN(~ HI£L5 E$7. PIDNo.: OIS'O~I¢II
P bA' N I/IEk/
I 't=50'
~ ~lousE
IF'F
CORNERS;
'oFlattop Technlcal Servic~
14530 Echo Street
Anchoraqe, Alas](c[ 99511
ENGI~ SEAL
INSPECTION REPORT
MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION
3500 EAST TUDOR ROAD
NSPECTIONS (907) 563-3464 INFORMATION (907) 788-821
FOOTING ~ ELEO, TEMP. ~ ~ PLBG. UNDGR,
BOND REAM . ---_ ~ ELEC. ROUGH :'~: GAS TEMP.
INSULATION ~ ~ OTHER ~ MECHANICAL
SHEETROCK ~ ~ MECH. FINAL.
STRUCT, FINAL ~ FIRE FINAL ~] PLBG, FINAL
OTHER ~ ZONING ~ OTHER
NO NONCOMPLIANCE OBSERVED ~ CORRECTIONS ESSENTIAL AS
EXPLAINED BELOW
~ WILL REEXAMINE AT NEXT INSPECTION p DO ~OT CONCEAL UNTIL REINSPEOTED
Wi~EN CORRECTIONS ARE MADE, PLEASE CALL FOR INSPECTION_
DO NOT REMOVE THIS NOTICE
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
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW920263
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:MOELLER DAVID A & SANDRA K
OWNER ADDRESS:9920 SPRING HILL DRIVE
ANCHORAGE, AK 99507
DATE ISSUED: 9/02/92
EXPIRATION DATE: 9/02/93
PARCEL ID:01505191
LEGAL DESCRIPTION: SPRING HILLS ESTATES BLK 2 L
T 17A
LOT SIZE: 50392 (SQ.
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS
RECEIVED BY:
ISSUED BY:
DATE:
DATE:
CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 August 17, 1992 ANCHORAGE, ALASKA 99516
M.O.A. DHHS
P.O. Box 19.-6650
Anchorage, AK 99519
Dem' Sks:
The purpose of this letter is to provide the required design narrative in support of our application for a
permit to upgn'ade the wastewater disposal facilities on Lot 17A, Block 2, Spring Hill Estates, located at
9920 Spring Hill Drive. Soils logs, perc test results, a site plan, design ckawings and-specifications are
enclosed for your review. Due to poor percolation characteristics in the area, the present soil absorption
system is operating in a surcharged mode.
Tile proposed system will be constructed in the vicinity of test hole # 2. As can be seen from the soil
log, the native material between 4.5' and 13' is a clean fine sand with a measured perc rate of 1.8 minutes
per inch. Using a conservative soil application rate of 0.8 gallons per day per square foot, this 3 bedroom
residence requh'es a total absorption area of (3 x 150)/0.8 = 563 squat'e feet. The proposed 45' long soil
absmption trench with 6.5 feet of sewer gn'avel beneath the horizontal distribution pipe has a total
absorption area of 585 squat'e feet. A 500 gallon "Orenco" lift station will be installed just downstream of
the existing 1000 gallon septic tank to pmnp the effluent to the trench through a 1.25" HDPE discharge
line.
As illustrated on the site plan, the topography of the lot slopes generally to the north. The house is
· located neat' the toe of a hill, and the proposed site for the soil absorption trench is at approximately 50 feet
higher elevation. The slope is irregular, ranging from 35% closet' to the house to 25% in the proposed
construction at'ea. The alignment of the proposed trench will parallel the natm'al contom' of the land, and
will be set back approximately 35 feet fi'om the break in slope where it exceeds 25%. Thus, a waiver of
the normally requh'ed 50' setback is needed. Issuance of the requested waiver should not cause any
problem, since the proposed trench will be enth'ely below the original ground, and the soil conditions
make it vh'tually impossible for effluent to daylight.
The proposed project will have no impact on present or future water supply and wastewater disposal
systems setwing adjacent properties, nor will it have any impact on resmwed space/surface and subsm'face,
or on ch'ainage.
Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
LOT
~OdSE
· -----.__ ._~ SPIRING HILL DRIVE
/
/ ~ ~ --~
Ioo~ ~,~-
~ ~o~s~ I~
LOT I A
0"2 -z ~E:%
k, NO l_. L.
~£L~
HOUSE
0 $'/ST£ M
F1att0p Technical Service,
14530 Echo Street
Anchorage, Alaska 9951~
LOT I'~ A) BLOCK, 2 ,, SPR~NG H ILL
SEPTi C. S'/STEM uPGRADE
51Ti PLAH
A*-L LoCAI'IONS
gt, v'N ~'5~'~: ~ /'~RE- ~PPROXH~ATE'
A
PLAN VIEr7
SECTIOXt
A-A
Elattop Technical Service
14530 Echo Street
Anchorage, Alaska 9951t
LoT I'lA, ~LK O~ 5PRtt~g ~tlLL
,SOIL ABSOF~P'flON 'FREMCH
PLAN A~l) CRosS ~SFCTiO~,
SCALE'. AS NoT'Eh
Flattop Technical Serv~es
14530 Echo Street, Anchorage, AK99516
Phone (907) 345.1355
Lot 17A, Block 2, Spring Hill Estates
9920 Spring Hill Drive
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of installation of a 500 gallon "Omnco" lift station which pumps
effluent through a 1.25" HDPE discharge line to a 45' long soil absorption trench containing 7' of sewer
gravel. The trench elevation is approximately 50' higher than the lift station elevation.
1.2 Construction shall be as depicted on tile approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform with Municipal and State
requirements. All separation distances shall be in confmrnance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessm'y utility locates, and to work around any
bm'led utilities.
1.4 The contractor shall provide adequate cover matedai and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there m'e no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn m'eas.
1.5 Unless specifically agreed otherwise, thc homeowner shall be responsible for finish grading after
the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction.
2.0 Septic Tank:
2.1 The existing 1000 gallon septic tank may be retained in service provided an inspection at the time
of connection indicates that it remains stmctm'ally intact. The existing soil absorption bed is to be
abandoned in place with the standpipes removed.
3.0 Lift station:
3.1 The lift station shall be an "Orenco" package system as supplied by Anchorage Tank. The lift
station shall be installed in a separate 500 gallon tank located downstream of the existing septic tmlk. The
tank shall be equipped with an insulated manhole riser of sufficient length to provide ready access from
ground surface.
3.2 The contractor shall be responsible to obtain the necessm~ Municipal electric pm~nit and
inspection, and to provide a copy of the electrical inspector's report to the engineer overseeiug the
construction of the wastewater disposal system.
3.3 The on, off, and alm'm floats shall be set at tile elevations specified by tile lift station supplier, and
their proper operations shall be verified by the contractor.
3.4 The discharge line from the lift station to the soil absorptiou trench shall be 1.25" diameter 160 psi.
HDPE pipe as supplied by Maskell-Robbins or equal. An appropriate threaded adaptor shall be utilized to
connect the HDPE into the lift station tank.
4.0 Soil absorption system:
4.1 The soil absorption system shall be constructed by excavating a 45' long soil absorption trench in
the designated location. The longitudinal axis of the trench shall be pm'allel to the natural contour of the
ground and the total depth of excavation shall be 11 feet below the odgiual ground surface. The bottom of
the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper
infiltration.
4.2 A total of 7 feet of approved sewer gravel shall be placed in tile bottom of the excavation with the
perforated distribution pipe laid level such that the pipe invert is no less than 6.5 feet above the bottom of
the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200
sieve.
4.3 The horizontal distribution pipe shall be either Schedule 40 PVC co,mected with an appropriate
adapter to the HDPE discharge line, or may be an extension of the HDPE itself, provided it is kept level
and the holes are installed on the bottom side. The holes shall be 316" diameter spaced on 2' centers along
the length of the trench. The end of the distribution pipe shall be capped.
4.4 The monitor tube shall be of 4" diameter and installed at the location shown on the design
drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated.
4.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum
of 3 feet of soil cover is to be placed over the filter fabric.
4.6 The top surface of the cover material shall be raised a minimum of 12 inches higher than the
sun'ounding ten'ain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
4.7 All areas disturbed by the construction shall be covered with 4 inches of topsoil and seeded with
grass seed to promote rapid revegetation. Unless an'anger otherwise, this work shall be the responsibility
of the owner.
5.0 Inspections:
511 A total of 4 engineering inspections will be required during the conrse of the project: (1) initial
stakeout with the contractor to establish the location of tile system aud to discuss the phms, specifications
' and construction procedures, (2) after the native material has been excavated to expose the infiltrative
surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3)
after the sewer gravel is in place aud tile distribution pipes have been laid and connected up to the septic
tank, but prior to placement of filter fabric, and (4) after final backfill and grading is completo. The lift
station requh'es one inspection after it is set level and the piping connected, bnt prior to backfill. This
inspection may be incorporated with any of the above inspections.
5.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensm'e the availability of the engineer.
PERFORMED FOR:
14530 Echo Street
A~choraae, Alqskg 995~6
DEPARTMENT OF HEALTH & HUMAN
825 "L' Street, Anchorage, Alaska 99502-0650
SmLS LOG -- P RCOLAT ON TEST
LEGAL OESCRIPTION:]-OT ?~.j ~_~' 2)
p'r
Township, Range, Section: .SEC. IS ,~ T'I2N~
SLOPE SITE PLAN
5M REDblSt~ 5,~N,D"J ~o/~
.~P FiNE C..LEAN sANb
4
PoCKeTS O? ~L
9
11
12.
15
16
17
18
19-
20-
~120 SEEP
'~k ~AV'~/./q ~I£T WAS GROUND WATERENCOUNTERED?
~ 51L~ E~VEL DEPTII?
pOCkET5 OF ~ ~eplhto Waler Alter PRY
Monltoriog? lq'6*' ~'~'_
Reading
Net Depth to
Time Water
23
___24, Y,~.
2f ~/s
COMMENTS , ' ../~.C ¢.04',a~ ¢~
Net
Drop
PERCOLATION RATE O. ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN ~3E. TWEEN . °r'_-~7~____ F1 AND _ ~ FT
PERItORMED BY: Fj-- 4 TToP m~..~,_~, ~; (/.~_~___ , ~,~'__..~-~ ~:'--'L ...... CLR'f ,Fy THAT 1 HIS TEST WAS PERFORMED IN'
ACCORDANCE WITH ALI. STA'TE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: (:~//,~/l.[~/~_.~_
72-008 (REV. 4/85)
PERFORMED FOR:
¥1att6~ Technical Services
14530 Echo Street
Anchorc~cm, AJqskcc 99516
Munloll~alrty otAnonorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" 8treat, Anchorage, Alaska 99502-0650
$O|L8 LOG -- PERCOLATION TEST
Township, Range, Seot on, 5£¢ J5 'I"12N 3~.~N~
SLOPE
3- 5P/$H Fm~ SIL'I"f
5P Fm~ Ct.E/iN
10
11
12
PR~R
WAS GROIJND WATER
ENCOUNTERED?
DEPTH?
Oeplh Io W~t~r Alle, r aDRY
Gross Net O0pth to Net
~4 = Reading Date Time Time Water Orop
20 - , (mlmJleS/mch) PERC tIOLE DIAMETER .~
3ESq'RUNB~TWE~N ~ FTAND
,/,~,~,~_~*.~..... ~ ~ .....
PERFORMED BY'. ~. ~-~~-- I ..~ ~..-- CERTIFY T~AT THIS TEST WA8 PERFORMED
AOCORDANO~ W~TH ALL G'rA'~E AND MUNrCIpAL GU~DELINES iN EFFECT ON THiS DAT~, DA~E: ~/~
72~08 (Rev. 4/~)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOFIT
TANKS
SEPTIC ~ HOLDING
[] TRENCH
BED
TYPE Of: SYSTEMdE
[] W, DRAIN [] OTHER
FI FT
FT FT
FT
80 FT FT
80 FT
WELLS (~.f FIN~3
PRIVATE [] OTHER fldentifv)
DISTANCES
~_----~ SEPTIC ABSO,PTIO,
WELL
FRO~I ~
TANK FIELD
WELL I ~ ¥ f I~'~ ~
LOT LINE ?-5'" /~2 I ~9
FOUNDATION I 0 1~9 ~0
Scale: tn= ~
Inspections ~ er[ormed by:
[)aLe
l __ .'~ ~o ~:~0'~ _c~'. , ]~o0 ~ ___ cmil¥ that mis inspection was ped0rmad according 10 amm
~lunicipal and Slate guidelines in ellecl on IhJs date: ~0~ (~ ~
Health Departmen, Approval'. ~' ~/
£NGINEER S SEAL
im.~ ~ !',!~ )AVID &. ~!IANPY MUli~]...t..EF~ Day I;:)hc~rle~,::
[JWl~i,r, Addr'ess~ 99~2(.) SI::'RING I-IIL..I_ DR,, 346....:S4()4
[(::)L I ,~l;:~]:~ ~;u!)~liv:i.!;Jl:n'~: 8F'RZhIG HIM... IESTA"I'I::ii:i Lot:
Sec::tic~rl',~ 15 To~nship~J :t.,'.;'~N Rarlge~ 3W
I (:il. !ii:i. zl::! 1.21}i A (!:iq. f.l:..,, or'
capac:ity: J.~,0()0 ~i'!allc)lts,, Ea(:::l"~ sel::rt, ic
D~?p't:.h 'l:.c, I:.l::~l:', I:)f septic rani< (s) < 4.0
I.~[]:] L;[;(~I'I~. ISXIiSIJiNEi 100() GAl Ii~1::][.'/ [13 IANI:( AS SilI]WN OI',I AI"TACI-IEED
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i(:.>r-'t',l'l bV kl-te Huri:iCJl:)a]:iLy of F~rlcl]cH'a~l:i;, (MOA) and '(,11~ S't:ate ot A.laska.
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Plattop Technical Services
14530 Echo Street
Anchorage, Alaskc~ 99516
( MUNICIPALITY OF ANCHORAGE 1'~~' /~,
DEPARTMENT OF FIEAL'rH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINeeRING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT
~AME PHO~ ~J ~EW
~AIL'NG ADDRESS
LEGAL DESCRIPTION
DISTANCE TO: Well nO.~ , O Absorption area ~ Dwell[~o'~' i~ ~'~> I O 15
~ Z Manufacturer No, of compartments
Liq, capacity ie gallo./~s InsMe length Width Liquid depth
Jeep IF HOMEMADE:
, ~ Well Dwelling PERMIT NO.
O Z ~ ~anufacturer Material Liquid capacity in gallons
. Nearest lot line IO PERMITNO
~ DISTANCE TO: Well~o'~ if5 Foundati~_ ~O ~3'I~ I~
--~i[~' ~ No. of lines ~ Length~ ~ each~_ ~j~C~ zline~_ Total lengt ~.~( ~neSMaterial beneath tile Trench ~i~t~ incheSinche, Distaece b~een lines
~/ Total effective or tion area
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
¢ DISTANCE TO:
.j Class Depth Driller Distance to lot line PERMIT NO,
~ ~ Building foundation Sewer line Septic tank Absm ption area(s)
~ DISTANCE TO:
OTHER .-,
PIPE MATERIALS /~
pV c- C /
SOIL TEST RATING
APPROVED DATE LEGAL
72-013 (Rev, 3/78)
DEF'FIIR'¥'HEI'.,Ff' L:,~,. HEI::IL,'FH t::II'4D EI",I","II;[:CiI'41'IENTFIL 'I'"F..'OT[iCT:iCd",I
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I,.llqF~l,;' f'll I'; IE:~I::' [:,ql",lE EW la I.. ~: C:E:f',I'L:;EI?' EL. EE:T~'. I C I FII",I.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED EOR: ¢"~0'.'~
LEGAL DESCRIPTION:
2~
3-
4-
5-
6-
7
8
9
10
11
12
13
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IP YES, AT WHAT
DEPTH?
14
15
'16
17
18
19
20
COMMENTS
DATE PERFORMED: C)~L'~ '2. ~-/ I~ ~Z
81TE PLAN
8
Reading Date Gross Net Depth to Net
Time Time Water Drop
(minutes/incE) ~
PERCOLATION RATE
TEST RUN BETWEEN ~ ~ ~// ~
CERTIFIED BY:
72.008 (6/79)
M-W ~)RILLING, Inc.
P.O. Box 10-378 *"~0300 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
84-111
DRILLING LOG
Well Owner. DOUg, kAIN .Use of WelLDom~+.~ ~-
Location (address of: Township, Range, Section, if k~own; or distance main road Lot 17 Block 2 Spring ilill~ Estat~,~
Size of casing. 6" Depth of Hole_
Static water level 147 ft.
Screen ( ); Perforated (
Describe screen or perforation No~
Well pumping test at. 5 gallons per of drawdown from static level.
Date of completion February 1, 198~
1~7 feet Cased to ~ 56- 50 feet
(below) land surface. Finish of well (check one)
).
(minute) for ~ hours with 100%
open end (×XX );
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0 .TO 2 Ca~in~ s_~ickup
2 TO 4
4 TO__ 12
~2 ~TO 75
75 _TO 85
85 .TO 115
115 TO 154 _
1~ ~ TO~--Z---
_TO
.TO
~TO
__ .TO
__ .TO
.TO
Brown silty
Brown sa~d
Broom si].~ Mravel
Brown silty gravel -
Gray silty gr~vel - (damp)
MUNICIPALIW OF ANCHORAG~
ENVIP, ONI/.,EN'rAL piK)~ECTION
Broom eilt~ gravel - (damp)
Waterbearing gravel
NVfVgA Certified Contractor
Certificate INo's. ~4 & ~73
3--CONTRACTOR
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 ~J<~'-/'~- ~",~
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location ~address or directional
(b) Properly Owner _~... ~/~'-'
·
Mailing Address
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone: Home
Telephone
Business
Telephone
(e) Mail the HAA to the followinQ address: or: Check here..~, if.. hold for pick up. ,-"'~'*/'" '~
List contact person and day phone number below,
TYPE OF RESIDENCE
Single-Famil)~
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 E] 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 1 of 2 72-025 IRev 8/861 Fronl
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elep aZAleUS ~o suo!~eedsu! ~onpuoo !ou op SHNQ jo sa@XoldLu~ 's~uagueJ!nbeJ @~8ls pus leJepe~ u!epao/{~sUss el Jap Jo
u! suoijnl!lsu! 6u!pue[ J!aql pus seuJoq ,to sJeseqoJnd oi Asapnoo e se s!ql saop SNHQ eqJ. 'aHsslV ,to elelS sql u! peJals!~a~
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pau!elqo uo!l~Jolu! sql uo paseq 1eql X~peA Jaqpnl f 'u!eJaq Paleo!PU! eJmonJis
elenbap~ pus leUOflounl 'ales e! ~eisAs lesods!p JeiBMelSeM Jo/pus Xlddns JelBM
qileeH sfql Jo uofle6flsaAu~ XW leql ~IiJaA I 'MOlaq UMOqS alep UO~lep!leA sql 1o se pus oleJaq pexule leas Am Xq Pa~IiPeo sV
NOI&V~UOJNI aNY V&~O 'HOUV3S 391J 'S~S3~ 'SNOIIOgdSNI 9NIOIAO~d
-g
MUNICIPALrrY OF ANCHORAGE (MOA)
MuNICipALtl'Y OF ANCHOR/~.ALTH AUTHORITY APPROVAL. (HAA)
ENVIRONMENTAL SERVICES DtVISIOF~HECKLiST .. FEBRUAFIY 1984
264-4744
MAY 1 4 !987
Description:__ ~/
RECEIVED
Well Classification L~./-~'~/~''~ ___ I1 A, B, C, D.E.G. Approved (Y/N)
Well Log Present (Y/N) ~ Date Completed ~?'.-o/--,-¢'_~- /"~ Yield
Total Depth ar_¢~-/.~¢-¢¢.j Cased to ~_ -g:~?
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 _
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results ~,¢
Comments ~
Depth of Grouting ~ , _
Pump Set At _~-~ ,~-'~
Sanitary Seal on Casing (Y/N) ,/¢'
Depression Around Wellhead (Y/N)
; On Adjoining Lots
;'~ ; On Adjoining Lots ."~¢ ~'-
-ro Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date ~...,//~5'~
Date installed _.//- ::'~- ¢ ~'~'~' Size..//~'~',~ No. of Compa~ments
Standpipes (Y/N) ~.~ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N)
Depression over Tank (Y/N) ~ .~ Date Last Pumped ,~%- ~-
Pumping/Maintenance Contract on File (Y/N) ~ ;for
Holding Tank High-Water Alarm {Y/N) .... Temporary Holdin9 Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ///~o
To Property Line ~
To Water Main/Service Line
Course -~ ~J- - ~_ . , '
Comr~ems
To Building Foundation /'~5'
To Disposal Field _ ./¢ ~-~-r/4r
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field '~'
Square Feet of Absorption Area
Depression over Field (Y/N) "~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ,~¢~
To Building Foundation S~, ~"~-,~
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 ~")' ~'-5~'-/'~-~
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)
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 tha~,.h/a..ve ~.c~e/.~verified, or conformed tO all MOA aed HAA guidelines in effect on the date of this inspection.
Signed _/~'~~ Date :--:¢~- ~? __
Company ~ ~. MOANo. ~
Receipt NO. ~ ~ ~/ ~
Date of Payment ~/~¢~
Page 2 of 2 'i.~ HUGHR, sEVAN
BEVAN ENGINEERING
P.O. Box tt2852
Anchorage, AK
(907) 522-!.383
][ I:)(F!I"'I; C)I"Iii(:~CI a ~'~C.:~3, ], 'J: ]. C:)~ 'tL~h~,'t', and
is/(.,~[:J::H'I'J', l,,~'[:t:)Y' !~is~fl'lJ~) ], ((:!!B 'J:CDI'" C~C)],i'J:(:)l"'flJ
J;:':le&t!ilH~) C:I:;Hq'J:.ai:::[.'. fYiqa :i.'[: ]: (:::a',ri pr"c)v:i, chs! al']'/ ~.clclit:J, cll"i&t]. :i.l'l..[:(:)l"Jila).'lCJ. cil"J,, (J':)li
NORTHERN TESTING LABORATORIES, INC.
2505 FAIRBANKS ST. ANCHORAGE, ALASKA 99503 907-277-8378
Drinking Water Analysis Reporl for Total Coliform Bacteria
TO BE COMPLETED BY CLIENT
[] PUBLIC WATi:R SYSTEM I'D' # ~---[ I I I I'~
/~ PRIVATE WATER SYSTEM
M.iling Address
Zip Code
SAMPLE DATE: __
~ ~ ~'~ Phone ,~Zz-/'~
Mo. gay Year
Purchase Order No.
SAMPLE TYPE:
'~ Routine
~ Special Purpose
[] Check Sample (for original contaminated
sample with lab reference no.
2
[] Treated Water
~' Untreated Water
/
3
4
6
7
8
9
Signature of Representative
FOR LABORATORY USE ONLY
TO BE COMPLETED BY LABORATORY
Received at: ~/'Anch. (~ Fbks.
Date Received ~7
Time Received_
Next Sample Due
COMMENTS: ~)
SATISFACTORY
UNSATISFACTORY U
RESAMPLE R
OTHER BACTERIA OB
TOO NUMEROUS TNTC
TO COUNT
,.liform Colonies per 100 mis.
NORTHERN TESTING LABOFIAI'0RIES, INC.
600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907-479.3115
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8375
Hugh BeYan Rate Arrived: 5/07/87
Box 112852 Time Arrived: 1555
Anchorage, Alaska 995il Rate Sampled: 5!07/87
Time Sampled~ 1410-1570
Attn: Rate Completed: 5/08/87
Sample IRl: AO50787-8,g
Parameter Unit 87226-~(S 8721~-WS AREC MCC
A050~87-8 A050787-9
Nitrate-N m9/I. 0.84 0.85 10
Carel J, Garrison~ Vice-President
I MCC = Haximam Contaminant Concentration
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONblENTAL HEALTH
DEPARTMENT OF ItEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
General Information Application Date
1.
(a) Legal Description (~nclude lot~ block, subdivision, section, township, range)
Location (address or directions)
(b) Applicants Name .~_~ ~2~,_~'__~'C~
Applicants ~dress
(c) Applicant is (check one) Lending Institution
Buyer [~ ; Other ~] (explain);
(d) Lending Institution
_Tele_phone - Home
Business%~ .- ~9~
Telej~hone
Address
', Agent t~Lt~Sh'll
(e) Real E.,tate Co. &
Address ~-,'5 q Tu
Telephone
(f) Mail the H~
2. T..~y~p pf Residence
Single-Family [~r~
Number of Bedrooms
3. Water S_uj~_lJ!
Individual Well [_~z~]
Other (describe)
Community [~ Public
Note: ]if community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. ~S e__wage_ Disposal_
0a ite Public [27] o,,,muait 57'[ Hol in Tan f l[
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]
.E_.ng. ineerin_g. Firra Pro. v.iding_In__s£e_c~ions~ Tests, File Sear~c__h~ 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 regula-~
tions in effect on the date of this inspection.
(ENGINEER SEAl,)
DHEP A~roval
Approved for _~__~ bedrooms
Approved _~ Disapproved
Temps of Conditional Approval
By
CAUTION
THE MUNICIPALITY OF ANCIIORAGE DEPARTMENT OF IIEALTII AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERIiD
IN TIIE STATE OF ALASKA. TIlE DHEP DOES ~Iq{IS AS A COURTESY TO PURCHASERS OF HOMES A~D
THEIR I~',NDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. E%IPLOYEES OF DREP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. TIIE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DtlEP SEAL)
RR4/ej/D18
[Page 2 of 2] 7-19~84
~LL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (}fAA)
CHECKLIST - FEBRUARY 1984
Legal Description: __
Well Classification__
Well Log I~esent ~/N)
Total Depth ~ ~' Ca?d to
Static Water I~.~vel M IMq' Pump Set At
Casing Height Above Ground
Electrical Wiring in Conduit ~)
Separation Distances f~cm Well:
To Septic/~{oldin~ Tank on Lot
_ If A, B, o~ C, D.E.C. App~ovedJY/N)
Date Co~leted_ '~ g-I-Z~ ¥ield~ %-7~__
Depth of G~outinG
Sanitaz, y Seal on Casing
Depression A~ound Wellhead
; On Adjoining Lots ·
To Neap. est Edge of Absorption Field on Lot N4~?'l,o.{_; On Adjoining Lots
To Nearest Public Sewe~ Line
Cle anout/Manhole U/%-
Wate~ Sample Collected By
Wate~ Sample Test Results
C~nts__~_.. ~ b/~(( L~ ~
TO Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Date
B. SEPTIC/HOLDING TANK DATA
Date Installed ~ 1J-%-~.% Size {- ~o.9o.~1 .. No. of Ccgpa~tm~nts __~ Zr .
Standpipes ~N) ~e5 ai~-tight Caps IY./N) ~P3_ Foundation Cleanout ~/N) g~_.~
Dap~esslon ove~ Tank (Y~-J K)O Date Last Pumped A~/~
PumpinG/Maintenance Contract on File (Y/N) ~-_; for A;,
Holding Tank HiGh-Wate~ Alarm J_Y/N) ~- Tempo=a~y Holding Tank Rezmtit (.y/N) ~r_ _
Separation Distances f=om Septic/Holding Tank:
To Water-Supply W~ll
To lh-~operty Line ~- IO'
TO Water 'Mal, r~/Se~vlce Line
Co~nts~ ~ .~
[PaGe 1 of 2]
To Building Foundation *~- I~J. 3
To Disposal Field ~- ~1 '
To Stream, Pond, Lake, c~, Major D~ainage
2-15-84
C. ABSORPTION FIELD DATA
Soils P~ting in Absorption Strata
Date Installed ~ I{* % -~3
Width of Field J/~ ~O'
Square Feet of Absorption A~ea ~0~ %'~
Depression over Field (Y~ A)CD ~, ~ of ~st A~a~ ~st
Results of ~st A~a~ ~st ~ ~
~p~ation Distan~ f~ ~s~ption Field:
To ~'te~-Supply ~11 ~ ~r ~0o~ To ~o~ty Li~ ~ /o
B~I6,-~.. Type of System Design
Length of Field 4~ 3 u
Depth of Field ~- gl/
Gravel Bed Thickness ~- ~ ~!
Standpipes P~esent ~N)
To Building Foundation ~c (~ ~ To Existing or Abandoned System Lot 6]~ ; On Adjoining Lots ~-~0 ~
To Water Main/Service Line ~/~-- To Cutbank(if present) AJ ~h
To St~eam/Pond/Lake/c~ Majo~ D~ainage Co~mse /%/
TO D~iveway, Pa~kir~j A~ea, c~ Vehicle Sto~age A~ea ~/,~ '
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alaz~m Level at
Tested fo~
Electrical Codes(Y/N)
.... Dimensions
Manhole/Access .( Y/N )
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Maets MOA
Co~l~ents
** Cheek Permitted Bedroom Rating Against HAA l~quest **
I certify that I have checked, verified, o~ confc~med to all MOA HAA ~C~q~_9~ in effect
on the date of this i~on. -
Signed
[Page 2 of 2]
2-15-84
TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CEN~'fiR 5633 B Street
:': Drinking Wa~er Analysis Repo~ for Total Colifor~ Bacteria
'ro BE COMPLiED.BY WATER SUPPLIER TO B~ COMPLETED BY ~BORATORY
I.D. NO. ~S~sfactory
~ ~ / ~ ~ C E] Unsatisfactory
Phone No.
WATER SYSTEM:
Water System Name
Mailing Address r
~ ~- i-~ ~-1 ~'
City
Mo, Day
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.,.
[] Special Purpose
Y~er
Zip Code
) / I~ Treated Water
,~- I~ Untreated Water
E] Sample too long In transit; sample should
nofbe over 30 hours old at examination to
indicate reliable results. Please send new
sample via special delivery mail.
"' Date tRecstved
Time~ Received //<2/~"'"
Anal~/tlcal Method:
I,E] Fermentation Tu~!
embrane Filter
SAMPLE
NO. L LOCATION
~'7 I~ '~
Time Colle~led
Collected By
Lab Ref. No. Result'
1
Analyst
06.1220 (b)
Rev. 1983
BACTERIOLOGICAl. WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter:, Direct Count
Verification: LTl)
Final Memb[ane FIIter~e~;u!tf
__Date
Time:
.BGB
TN'rC: Too Numerous To Count
ColUormllOOml
Collf~'nll00ml
a.m.