HomeMy WebLinkAboutT15N R1W SEC 8 LT 198
Municipality of Anchorage Page I of 4
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
Permit Number: ,~/ °}-~O ~ PID Number: 0,~ I
Name: 5C0'~ ,-~'t-C~CE[~ WastewaterSystem: ~New UUpgrade
Address: ABSORPTION FIELD
Phone: ~_Z~~ INo. of Bedrooms: ~ ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION 0,~ ~wsq.~. 8, ~ .
~o,: ~L~ I~ ~,oo~: Subd,v~ion: Depth to p~e b~m from orig,nai grade: Gravei depth beneath pipe
I ~ Fill added above original grade: Gravel length:
rown,.,p: i 5~ Range: iW Section: ~ ~ ~0~ Ft. 83 Ft.
Number of lines: lDistsnce between lines:
WELL: ~New ~ Upgrade Gravel width: 31 Ft. [ ~h Ft.
C[asslfication (Private, ~'~ ~ ~A'B'C): Totall~Depth: Ft. Casedj4lTo: Ft. Total absorption[~ area:l ~ SQ. Ft. Pipe material:
Date Drilled: Static Water Level: Installer: Date installed:
Pump Set at: Casing Height Above Ground: TAN K
SEPARATION DISTANCES (Septic ~ Holding : S.T.E.P.
Manufact ret: . Capacity in gallons:
To ~e~,ic Absorption Lift Holding Public/Private ~ C~I~C ran~
From Tank Field Station Tank Sewer Lines
WelF [~[t tO~ ~ ~ ?~; Material: ~+~{ Number °f C°mpa~ments:
Suflace
Water ~ ' ~o 5t~r~a~ ~m~r ~,~ LIFT STATION
Lot Size in gallons: I Manufacturer:
U.e7¢'37'CA ~A 7o' iqA
FoundaUon 30' 40' ~ ~ JO/ "Pu~p o." ,ov., ~t: I "Pu~p o." ,eve, at: I High wate. mrm ~t:
Cu~ainDrain ~ ~ ~.~ ~ jO Pump Make & Model ~ Electricallnspections pedormed by:
Remarks: BENCH MARK
Location and Description:
Heasummenk~ sh~ o~. 'f~ ornd
Inspections pefformed by: ~, Dates:let
Department of Healt~and Hpman Se~ices approval ', ,:: '~ CE
Reviewed and approved by Date:/~ - 2 -~7 '~' '~/,~ ~1: .............. ::' '~'
72-013 (Rev. 9/91) MOA 25
Permit No. ~
Page ~. of Z{.
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
Legal Description: ']-15NI I~ILU S~ RLM L+ l~g ~.~,M, PID No.:
SWING T ES
CRNER CRNER
61 F1 31FTi
52 F] 40 FT
PLAIN ViEW
MT/CO #2 ~
TH #2i o .'
COi's
?
SEPT lC TAN~t
COMPONENT
STCO
FO
A
NEW
WELL
.0 ' 100
72-013 A (1/~3) *
Permit No. ,~1~'"1'..'~ Page ,~ of z~
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
Legal Description: T'I 5~,R1~,5~ ~ ~LH L~r I~]~, .S.M. PID No.:~__
q7 riFT
!!4 ./I: [
' ? FT
~.'
96 _9 !-1
94 .~ I- I
/9.6 F i'
iEAL
7604
72-013 A (1/93) '
Permit No. ,~,J~)-fO 19~q
Page ~' of ~r
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
Legal Description:
. ~ FT
4 liN. PEP, F F~!PE
ELEV.
91.2 FI
MT
~IN.
NS'Ill AT ION
PID No.: 0. 1153Z
72-013 A (1/93) *
~L~09/~S97 2~:49 2580~47 HIDES ~
SULLIVAN WATER WELLS
FO. BOXe?02?2, CHUOIAK. A/ASKA g9~7 .
O~N;R OF tASU
teO^tDUscm,TlO~ I l,J l '"l'y_,O~ ..f E C P
DATE-St~ted __ -- Ended "//~ ~-
['EP~IT NUMBER
PAGE
,.,.I
STATIC L[VEL OF WATER F'r
DKAW DOWN
GA~ PER HR
KIND OF CASING
KIND OF FORMATION,,
,,om 4_.,.,oXO E,o F,.,o__F,,
FI.
_Fl,
Ft.
From Fl to.. _ Ft
From ~Ft. Io
From.
From Ft. to ' 'Fl
From _Ft. to . Ft.
From Ft. to Ft._
From Ft, to ...... Ft.
From__Ft. too, Ft.
From , _FI, to Ft.
Mf~CL. INFORMATION:
?E4 F oa,~ rcO ~ ,2
From Ft. to ...FI
Fro,.__~_n lo ~0\/ 10 .19~7
From ~, t.~i~:
_ Oept. Haalth & Human
From fl, to__Fl
/
7-0 %~
DRILLER'S NAME ~~--~--
SKLH Consultants
1700 Vashon Circle
Anchorage, AK 995 l 5-3142
(907) 344-7096
Municipality of Anchorage
Department of Health & Human Services
On-Site Services Section
P.O. Box 196650
Anchorage, AK 99519-6650
Re:
T15N, R1W, S8, S.M., BLM Lot 198
Construction As-built, Well & Wastewater Disposal System.
10 November 1997
RECEIVED
NOV 10 1997
Mun~c~pahty ot AncBorago
Dept. Health & Human Services
To Whom It May Concern:
Attached is the construction as-built for the referenced property. The septic system was
installed in early August. As depicted on the as-built drawings, the invert elevation of the monitor
tubes does not coincide with the elevation of the bottom of trench. I oversaw the installation of the
first MT and it was set at the bottom of the trench excavation prior to backfilling. The delay of this
submittal has been due to the lack of final grading and the MT installation. Final grading is not
expected until sometime next spring.
Lowering a flashlight down each MT shows the presence of septic rock at the MT bottom
and not natural soil as there should be; it appears, therefore, the MT's slipped up while backfilling
with septic rock. The deepest MT is approximately 0.4 feet above the trench bottom and the
highest MT is 1.3 f~et. On the basis the deepest MT is only 5 inches (0.4 ft.) shy of the proper
depth and the trench has been installed level, the owner requests the system be approved as
installed. Currently, the construction loan is scheduled to be closed prior to Thanksgiving and
since the loan cannot be closed without receipt of a HAA, your prompt review and comments on
this submittal are very much appreciated.
Currently, there is no power to the property and the well pump has yet to be wired.
Therefore, it is not possible at this time to collect a water sample for analysis. Once a sample has
been collected and analyzed the HAA checklist and HAA sheet w/Il be submitted for your review.
Sincerely,
./Stev/en C. Henslee, P E.
SKLHConsultants
1700 Vashon Cimle
Anchorage, AK 99515-3142
(907)344-7096
28 November 1997
Municipality of Anchorage
Department of Health,& Human Services
On-Site Services Section
P.O. Box 196650
Anchorage, AK 99519-6650
Re~
T15N, R1W, S8, S.M., BICM'Lot 198
Construction As-built, Well & Wastewater Disposal System.
Mr. Dan Roth:
Per your request this letter is to detail the work perfbrmed by the property owner as
this is'an owrter-installed system. I did the the required inspections during the installation
of the system and at each inspection i tbund, Mr. Stefan on site working. He not only
directed the progress of the work, but performed work himself such as measuring
excavation depths, shoveling and leveling septic rock; laying septic pipe, backfilling, etc.
Mr. Stefan was involved with all facets of the installation. During my visits, my recordl~
show the back hoe was being operated by Robert. ! do not have his last name recorded. 1' '
show his telephone number is 746-5107.
Sincerely,
/S~ven C. Henslee, P.E.
/
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970199
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES
OWNER NAME:ANDERSON HANS T & IMA L
OWNER ADDRESS:17340 MEADOW CREEK
EAGLE RIVER, AK 99577
DATE ISSUED: 7/18/97
EXPIRATION DATE: 7/18/98
PARCEL ID:05115328
LEGAL DESCRIPTION:
T15N R1W SEC 8 LT 198
LOT SIZE: 108900 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PEP, MIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL 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 (iSAACS0).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
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 SA24E DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
RECEIVED BY:
ISSUED BY:
SPECIAL PROVISIONS:
DATE: %//~/~
/
8471 Brookridge Drive - Anchorage - Alaska 99504
(907) 33%6179 ~ Fax (907) 358-3246
Consulting Engineers
July 5, 1997
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref~ Well & Septic System for Lot 198, T15N, R1W, SEC 8, S.M
To whom it may concern:
The subject property is currently undeveloped. The property owner is proposing to build a 4
bedroom home on the site, which will require the installation of a well and a septic system.
Comments regarding the proposed systems are summarized as follows:
1. SOILS: Attached is a copy of the soils logs. Both test holes had a similar profile, and
between a depth of 5.5-6.0 feet, the soils perked from 15-30 minutes per inch. No groundwater
or impermeable soils (based upon visual observation) were encountered.
2. TRENCH DESIGN:
a. Percolation Rate: 15 to 30 minutes/inch.
b. Allowable Application Rate: .6 gallons/day/ft2
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 1000 ft2
f~ Max. Total depth (below original grade): 9 feet
g. Effective Depth: 6.25 feet
h. Reduction Factor = N/A
i. Width: 2 feet minimum
j Minimum Length: 80 feet
k Effective absorption area = 1000 fi2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
system.
4. TOPOGRAPHY: Attached is a copy of the plot plan, which show some topography data.
The lot is gently sloping (1-2%) downhill, from west to east and from south to north. In short,
there are no slope concerns.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact me at 337-6179, 244-9612, or on my digital
pager at
Sincerel'
J eft'rt
Print
1-800-481~162. Thank you for your assistance.
LDT I~9, WELL & SEPTIC
SYSTEM ARE EREATER THAN
~00 FEET FROM THE PRDPBSED
WELL AND SEPTIC SYSTEM.
LOT ~D~, UNDEVELOPED
LOT 171, PRIVATE WELL
AND SEPTIC SYSTEM,
RESERVE TRENt
~~/PRDPDSED WELL
LOT PO3, ?NDEVELDPED,
LDT 172, PVT WELL
AND SEPYIC SYSTEM.
UNDEVELOPED
mARY TRENCH
ED J~SO GALLON
TANK
UNDEVELOPED
PREPARED FUR, gCUTT STEFAN ~T~..~ ......
PREPARED 9Y~SK~ATER & WA~EWATER I '~'.~ ~C~7953 ,.... ~
~'DATE~ 7/05/97
~x ~"Xx~ //'d~£N£RAL LO£ATION OF'
~ ~ ~, / RESERVE TRENCH /
~ ~. : ~' BO FEET LDNG:~ l
_ INCH PVC (D3034)
WELL [SEPT[C SYSTE~ LBT 19B, TJ~N, R1W, SEC 8['~'[" "~'~'~ ~'"" ...... :.~.
TOTAL TRENCH LENGTH
= 80 FEET.
TOTAL ABSORPTION AREA
~ 1000 ~QUARE FEET (MIN.).
BACKFILL WITH NATIVE SOIL AND MOUND.
FABRIC SILT BARRIER.
2 INCHES OF BOARD INSULATION IF BOIL
COVER IS LESS THAN 3 FEET. INSULATION SHALL
COVER THE ENTIRE WITH OF THE TRENCH.
2 FEET MIN.
NOTE:
-- 4 INCH DIA. PERFORATED PIPE, WITH HOLES
DOWN. SHALL BE LEVEL WITHIN .01 PEET.
PLACE 2 INCHES OF DRAINROCK OVER TOP
OF PIPE, TOP OF DRAINROCK SHALL BE AT
THE SAME ELEVATION OVER THE ENTIRE
TRENCH WIDTH.
~ONITORING TUBE (TYP).
PERPORA TED IN DRAINROCK.
1. TRENCHES SHALL RUN PARALLEL TO THE
SLOPE CONTOURS.
2. FOR LOCATION OF MONITORING TUBE,
SEE SITE PLAN.
3. CONSTRUCTION PRAC"rlCEB, AND MATERIAL
SPECIFICATIONS SHALL OOMPLL Y WITH
ANCHORAGE MUNICIPAL CODE 15.65, "WASTE-
WATER DISPOSAL REGULATIONS".
4. INSTALLATION SHALL COMPLY WITH SPECIAL
PROVISIONS AS NOTED ON THE SEWER PERMIT.
5. SMEARED BOTTOM AND SIDEWALLS SHALL
BE RAKED.
6. DRAINROCK SHALL BE SCREENED PER M.O.A.
SPECIFICATIONS. DIRTY DRAINROCK WILL BE
REJECTED.
TRENCH DETAIL: LOT 198, T15N, RIW, SEC 8, S.M
PREPARED FOR: SCOTT STEFAN
ALASKA WATER & WASTEWA TER SERVICES
DATE: 7/5/97 DWN: GAFINESS SCALE: NTS
Municipality of Anchorage
DEPARTMENT OF HEAl 1H & HUMAN SERVICES
825 'L' Street. Arlchorage, Alaska 99502-0660
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
4-4
11
15
16
17
18
19
2O
Iq 8
-~_e0
DATE PER FORMED.I~~:~
Township, Range, Section: T~...~,I} I~ I '~'J.~
SLOPE SIT~ PLAN
WAS CROUND WATER
ENCOUNTERED?
,F YES, AT W,,AT I Sb
eprhnq Date Gross Net Depth to Net
Time Time Water Drop
bo ~o ,.
PERCOEATION RATE /~'" tmmutes/~nch) PERC HOLE DIAMETER
TEST RUNBETWEEN ~--'~ FI AND ~',~) FT
ACCORDANCE WI~H ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE:
72-008 (Rev 4/85)
Municipality of Anchorage
DEPARTMENT OF HEAL'TH & HUMAN SERVICES
825 "L" Streel, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
r'ERFORMEO FOR:_
LEGAL DESCRIPTION:
10
11
Township, Range, Section: ~-I~
SLOPE
WAS GF~O/IND WATER
ENCO NTF:RED?
SITE PLAN
Time Time Water Drop
" ¢10 3 0 I"
17
18
3-.
19- >
~'r ¢~£;oi A; ~ON RAI f: ~1~) (m,nutes/,nch) PERC HOLE DIAMETER ~ #
~F,%1 rIHN [~E'rWEEN *~"" ~" FTAND ~.O FT
PERFORMED BY: ~_~ ~~ , ~
CERTIFY THAT ~HIS TEST WA8 PERFORMED IN
ACCORDANCE WITH ALL STATE ANDMUNICiP~LGUiDEt. iNES iN EFFECT ON THIS DATE DATE: ~/~ , ,
72-008 ~Rcv 4
I'ENADA
gl gVA TION
(100.00')
'1
J
~3' ~LM PAI-£N? ~ O-W AND UT/L/FY Y-AS~MEN?
N ~59°50'00" W &~.9.74'
~0' ~L~ PATENT ~-O-W AND UTIM~
/ /
198
PgOPOSgD
104' +
PgOPO$gO
SPLIT L~V~L
HOUSg
90,0'
90.0'
alt• _9 10 17
(o 2
•
• Municipality of Anchorage �� tt%
t' •
On-Site Water and Wastewater Program
�l� "
(907) 343-7904 e T T 4
Certificate of On-Site Systems Approval �``` oc 6 a ���
Parcel I.D. 051-153-28 Expiration Date: -1 r l — I g
1. GENERAL INFORMATION
Complete legal description T15N R1 W Sec 8 Lot 198
Location (site address) 20230 Tenada Ave.
Current Property owner(s) Alissa & Scott Stefan Day phone
Mailing address 6280 Taylor Ranch Loop Kaufman, TX 75142
Real Estate Agent Day phone
2. TYPE OF DWELLING:
[ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received byL/ tita_ Date: LZ`I I(()I
COSA to be released to the engineer,unless otherwise requested by t engineer.
•
COSA Fee $ J�26 Waiver Fee $
Date of Payment 57Zq Pet Date of Payment
Receipt Number 038196 Receipt Number
COSA# 6 5G'Ota31,0 Waiver#
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, based on procedures outlined
in the Certificate of On-Site Systems 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.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 5/25/2018
NiNU
PO •F AC �Ar AS�
Oh
0 ..*f#* TH
6. DSD SIGNATURE I f
System #1 Approved for "1 bedrooms • even •R. Pannone: if
System #2 Approved for bedrooms 00CE-8149• ��
r
Disapproved � R�OFESs�ONt'1=
Conditional approval for bedrooms, with the following stipulations:
&i *
tc � .k i at iiiecorsLLQ
P f0-it, 2d yrOLD
ON-SITE 'Y• G
WATER AND yr'
, , WASTEWA I EH o•
PROGRAM
•
Original Certificate Date:l�
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist _ X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet r c
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: T15N R1W Sec 8 Lot 198 Parcel ID: 051-153-28
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 7/1997 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 141 ft. Cased to 141 ftCasing height(above ground) 24+ in.
FROM WELL LOG AT INSPECTION
Date of test 7/1997 5/15/2018
Static water level 79 ft. 75.3 ft.
Well production 8 g.p.m. 3'5 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic
ND D ug/L Date of sample: 5/15/2018 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 8/3/1997
Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A
Date of pumping 4/27/2018 Pumper JR's Pumping
C. ABSORPTION FIELD DATA
Date installed 8/3/1997 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 GPD/SF System type Deep Trench
Length 83 ft. Width 3 ft. Gravel below pipe 6.1 ft.
Total depth 8.9 ft. Eff. absorption area 1012ft2
Monitoring tube Y Depression over field N
Date of adequacy test 5/15/2018Results(Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test:24 194in. Water added 600 gal. New depth n.
Elapsed Time: v min. Final fluid depth�'iVin. Absorption rate >= 600+ g.p.d.
N
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION «� OF,���tk
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in Ff*: . ' i■ /\ ..*T
conformance with MOA COSA guidelines in effect on this date. %••• ••• 'IVO•••• 0
Steven Pannone ••/
Engineer's Printed Name r r ••Sleveri I. [5anriorie
Date
5/25/2018 6-v:. CE-8149 ., .�
r
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BASIS OF BeARINCO LOT
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NOTE:UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR ESTABLISHING BOUNDARY OR FENCE LINES.
J`y �I PO. BOX 2749
i ����AAq� ALASKA°RIM ENGINEERING PALMER,ALASKA 99645
r 7E OF•A.qs t, AS-BUILT Engineers•aPlann'e s••Surveyors PHONE(90n745-0222
i AT' ••"~.„4,1•7
' ....:4' � .,e ms FAX(907)746-0222
tt'49TH ''\ *'0 W.O. 98-0/005IFIELDDATE: 1/7 18 SCALE: /d=50' ICK..410. IDWN.J•/7•C.
/ 0 I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGE
� •• . e INSPECTION ON THE FOLLOWING DESCRIBED PROPERTY:
9t,• •GOry1+.L'al" /,>, Govr. LOT /98, Tl5/J, R/l4, 5EC. 8, 5•M., ALASKA
, ti2234-5 ��•4:-•
1s1:,%,•....«.•`�,�•!1- ANCHORAGE RECORDING D/STRICT
ESSIOI:At .'w EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORD-
k'''(�i� ED PLAT ARE NOT SHOWN HEREON. DATED AT PALMER, ALASKA,
- THIS. 8TH DAY OF ✓ANUARy , I998
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.Oi Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Completelegaldescription 7' [~'A,/ /~ / bt,/ ~e.-c_, ~ .g~/~
Day pho0e
!
Day phone
Location (site address or directions)
"Mailing'~dmss ,~ - ,
Day phone
Unless otherwise requested, HAA will be held for pickup,
NUMBER OF BEDROOMS:
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,
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
A. WELL DATA
Well type
Log present (Y/N) Y Date completed
Total depth ,~. / Cased to /4/
Sanitary seal (Y/N) ~J
If A, B, or C, attach ADEC letter. ADEC water system number /'~//~
Casing height (above ground)
Wires properly protected (Y/N)
FROM WELL LOG
Date of test 7/'~'7
Static water level 7~ /
Well production ~' ~
AT INSPECTION
g.p.m. ~~ g.p.m.
WATER SAMPLE RESULTS:
Coliform Nitrate /~//.~ Other bacteria
Date of sample: J~-~?7~.~l'~7'~'i~J~ Collected by: .~/'/ZF/~/~'-~.~
B. SEPTIC/HOLDING TANK DATA
Date installed ~/~/~'7 Tanksize /~.~ Number of Compartments ~ Cleanouts(Y/N)
Foundation cleanout (Y/N) /~ Depression (Y/N) ~ High water alarm (Y/N)
Date of Pumping /tJ~(~/,~ ~/~ ,~ Pumper
C. ABSORPTION FIELD DATA
Date installed ~/¢~/~ 7
Length ' .o~ ~
. Width
Effective absorption area /Off~
Date of adequacy test /U
Soil rating (~ or fF/bdrm)
Gravel thickness below pipe
Monitoring Tube present (Y/N) ~
Results (Pass/Fail) /,,)/-~
~, ~/~ System type ~
~ ./ Total depth o~,?
Depression over field (WN) /~
For ,/~//~ bedrooms
Fluid depth in absorption field before test (in.);
Immediately after -- gal. water added (in.):
Fluid depth ~ (ins) Minutes later: --- Absorption rate =
Peroxide treatment (past 12 months) (Y/N) ~'~ If yes, give date
.g.p.d.
72-026 (Rev. 3/96)*
SKLH Consultants
1700 Vashon Circle
Anchorage, AK 99515-3 ! 42
(907) 344-7096
MEMORANDUM
8 December 1997
To: Mr. Scott Stefan Re:
T15N, R1W, S8, S.M, BLM Lot 198
Submittal of HAA and HAA Checklist
Attached is the MOA Health Authority Approval (HAA), the blue sheet and the HAA
Checklist, the brown sheet. You will need to submit these both to the MOA to get your
approval. A fee is recorded, so be prepared.
As I mentioned to you earlier today, your water test results were not totally satisfactory.
The nitrates test came back okay, but the coliform bacteria test result was not acceptable.
(The water was too dirty to use the MOA accepted test method.) You will need to do the
following prior to submitting the blue and brown sheets to the MOA:
1. Since the nitrates test was acceptable, no additional nitrates testing is required.
However, the MOA does require a copy of the test and, although, the lab was finished
with the analysis, they were not finished with the paper work. You will need to call
them at 562-2343 (sample number 977374) and have the results faxed or mailed to
you. Attach the paperwork to the brown sheet.
2. Regarding the coliform bacteria, you must have another water sample collected and
tested. Obviously, you will need to have your well producing clean clear water prior to
collecting the next water sample. You can either do this yourself or have a well driller
or someone else do it fbr you. I must remind you that the water sample must be
collected by someone other than the property owner to be acceptable. 1 know engineers
m~d well drillers are okay. Others may also be acceptable, however, you would have to
call the MOA to find out who they are. Speak with Dan Roth since he is reviewing
your file. Once you get acceptable results enter the results for coli~.brm and other
bacteria on the brown sheet under WATER SAMPLE RESULTS. Also, record the
date the sample was collected and deliver bothe sheets and attachments to the MOA If
you have questions, I can be reached at 786-0447 Anchorage voice mail, or
1-602~837-8909. ! do not expect to return until Feb. 2, 1998.
Steve Henslee, P.
D. LIFT STATION ~
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main ~/O Z~/~//'C
Sewer/septic service line ~0 ·
Size in gallons
"Pump on" level at*
On adjacent lots
On adjacent lots
*Datum
"Pump off" level at*
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ,,_~O / Property line '7~:~ / Absorption field
Water main/service line (~ 0 / Surface water/drainage /OO + Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~'~ '7 / Building foundation ~0 ~
Surface water /00 ~ ~
Curtain drain /~D)3~ ~0>'/ ./'~/L
F, ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and revieW ~
in conformance7 ~0~ HAA guidelines in effect on this date.
Engineer's ~ame ~- ~ :~C~/J ~. ~/~/~ g. ~I~-~
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots ~0
HAA Fee $.
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
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
~vestigation of this Health Authority Approval application shows that the on-site water supply
and/or w~.stewater 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 ,~'K~/~/ ~,~//~.~_~ Phone ?~ ~)Z~'7
Engineer's signature ~ Y&~ Date [~/~/~
/ ./ ,
DHHS SIGNATURE
/~ Approved for 4
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date//-~-/7'~ 7
.
'The M{J~icip~lity of ~chorege Department of Health and Human Services (DHHS] .issues Health Authority
Approval C~rtificates based only upon the representations given in paragraph 5 above by an independent
p ofess ona engineer registered in the State of A aska. The DHHS does this as a courtesyto purchasers of homes
and their lending institutions in order to satisfycertain 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.
72-025 [Rev. 1/91) Back MOA~ZI