HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 6 LT 23F Municipality of Anchorage Pag of-
'' 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:'~L')~t~ ~Z~ RID Number:
Address~// '~M~ ~, ABSORPTION FIELD
Phone:~¢~. ~ ~ INo. of~drooms: ~eepTre~ch D Shallow Trench DBed DMound bOther
Soil Rating: ~ Total ~lh from original grade:
Number of lines: ~ Distance between lines:
Classification (Private, A,B,C): Total Depth: Cased TO: Total 7~ area: Pipe material: ~
Yield: GPM ~ Pump Set at: Ft. ICasing "eightAbOve GrOund:Ft. TANK
SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P.
Lift Capacity in g lions:
To Septic Absorption Holding ~ublic/Private Manufacturer:
From Taok Field Station Tank Sewer Lines ~ ,~ er ~
Well ~ A/~ g~ A/~ ~ /~/e.. ~t~ Number ~partments:
Su~ace ,
Water ~ ~ ~ ~ g~ ~IFT STATIO~
L~tt ;~ //~ ~ ~ ~ ~ize in gallons: I Manufacturer:
Fou.dation ¢¢ ~ ~ ~ ~ 'Pure9 °n" level at:~ ¢ I "Pump °fl" level at2' ~ I High~at~arm~
:urn Make&Model 61ectr'callns e ions e~or d b ·
Remarks: BENCH MARK
/'], ~ ~ I Assumed Elevation:
ENGINEER'S SEAL
inspections performed by: ~~ ~ ~ Dates' 1st ~/Y
Reviewed and approved by: ( ate:
72-013 (Se'.'. 9/91) MOA 25 ~//
A~proximat~ ~at~r ~rvice
~O.I
~ MT~I
TP GOal
I0.0 min.
MT~
kUat~r
box.
W.O. 95976 CLIENT: dock ond Sondy llaoeni
DAR_ 8/2~/96 LEOAL AND ADDRESS:
FlUE # iaS~it~ L23, BK6, VdliVue Est. #2 51TI= I=LAN
DESIGN TJ 6911 Round Tree Dr.
SCALE 1"=50' Anchorc]ge, AK 99516
P,O. BOX 111790
T~M &~ cor Front ~ck = I00.0 4 ~r. r~quir~ &O0 * absorption area.
NTB
MONITOF~IN~ TUE~E CAPPED ~
PERJ=ORATED IN 5EWER
F~,O, CK, 5OL ID AtSOV'E.
4 PE'~'.FO~TATE~' PIPE ~
PET DO.U?, LAIE) LEVEL %
CLEANOUT5 - CAPPED ~CO~ ROG( 5CLIP ABOVE.
EXISTING
NT5
CO ~ MAN~OLE ~, ~ ~T~
LEAL)
pE~O~TED IN
C OSS SECTION
/ TO 5LOPE ADAY NT5
~ ~IN FIELD
HOLE5 OO~ AND
C~PPEO OH ENO.
C~ 7~¢~ w.o. 95976 CUENT:Oock Grid SonOy Thoeni ~' ~'~ T~N
R ~ DATE 8/21/96 LEGAL AND ADDRESS:
FILE ~ 183site L25, BK6, VelliVue EsL ~2
~g~511-17~0 DESIGN TJ 6911 Round Tree Dr. ~E~I~ ~ETAIL5
BioCycle ALASKA
WASTEWATER
TREATMENT
SYSTEMS
PROPERTY OWNER ANALYTICAL TESTING AGREEMENT
Between: ..a~. ~. '"~4q~ ~ ~ r (The Customer) And: BioCycle Alaska (The Company)
Ad&ess: ~ 5'// ~e"a~ro ~ ~ 2440E. TudorRoad, Ste. 162
~¢/4~ ,~,~..~ ,~2ne ~2~'ff"/~ Anchorage, Alaska 995074185
~'d~..g ~ ~/g'~ ~ (Phone) (907) 333-1608/(907) 337-9372
This agreement, dated
property owner.
,19~, is made between BioCycle Alas!m and the
This agreement is made for the express purpose of testing and monitoring of a new Bio Cycle on-
site aerated wastewater treatment and disposal system to be installed on the subject property.
The property owner(s) agree to the following conditions:
The property owner(s) will allow BioCycle Alaska and/or its representatives, including
employees of the Municipality of Anchorage, Depamnent of Health mad Human
Services, access to the subject property as required for monitoring and testing during
the design, construction and evaluation period of the new BioCycle wastewater
treatment system.
The property owner(s) agree to bear al/costs involved in a testing program wh/ch will
include sampling of the effluent fi.om the BioCycle system for a period of one (1) year.
Samples of the effluent will be collected every two months by a representative of
BioCycle Alaska. Each sample will be analyzed for total suspended solids (TSS), 5-
day biochemical oxygen demand (BOD0, nitrates, total kjeldahl nitrogen, and fecal
coliform./oq'~e cost of analysis of the samples will be $100.00 per sample for a total
cost of ~fffor the OhO (I) year testing period. There will be no charge to the property
owner for engineering services required to collect the samples and submit sample
results to the Municipality of Anchorage, Department of Health and Human Services.
Customer's Signature
Company Representative
BioCycle ALASKA
WASTEWATER
TREATMENT
SYSTEMS
GUARANTEE AND MAINTENANCE AGREEMENT
Between: Jack Thoeni(Customer)
Address: 6911 Roundtree Drive
Anchorage, AK 99516
(907) 346-1633 (Phone)
And:
BioCycle Alaska (The Company)
2440 E. Tudor Road, Ste. 162
Anchorage, Alaska 99507-1185
(907) 333-1608/(907) 337-9372 Fax
A. GUARANTEE
The Company guarantees to repair or replace free of charge any parts of the System requiring repair or replacement due to defective
manufacture:
a. within five (5) years of this Agreement, except for defects in the aeration pump, the discharge pump, and
the electrical circuitry for which the period &warranty shall be one (1) year.
b. and other than under exceptional circumstances, the company shall respond within 24 hours of the Customer's call for
service.
B. MAINTENANCE
1. On a quarterly basis (once each 3 months) during the period of(l) one year from the date ofcommisaloning of the System,and
where necessary, the Company agrees to perform the following maintenance tasks:
a. Adjust the air intake in the alarifieation chamber.
b. Clean the inside of the clarification and discharge chambers.
c. Replenish the supply of chlorine tablets, if chlorination of effluent is being performed.
d. Cheek the aeration pump; discharge pump, electrical system.
e. File a copy of the Maintenance Report with the Department of Health and Human Services, Municipality of
Anchorage, and/or with the Department of Environmental Conservation, State of Alaska, or any other local
regulatory agency having jurisdiction over the area in which the System is installed.
f. Once every three O) months the filter in the air blower will be changed.
2. In tile event the Customer requests the Company to perform maintenance to the system other than that specified in B.I. above or
where the Customer requests work to be performed which is not a part of the above guarantee, the Customer shall pay the
Company's reasonable additional charges for the work done as well as for any assoalated equipment and or supplies. Additionally,
the Customer shalI pay the Company's reasonable charges where the need for work is a result of the Customer's fallure to ensure
compliance with the operating instructions, from loading the system in excess of the design flow for the installation, or where the
problem is the result of force majeure (i.e. earthquake, flood, lightning, land slip, or from persons not authorized by the Company
interfering with the system in any way, or as a result of the Customer failing to comply with this Agreement.
3. Commencing at the end of one (1) year from the date of this contract, the Customer agrees to participate in BioCycle's ongoing
maintenance program, as required by the MOA and/or ADEC, and agrees to pay for such maintenance services at an annual rate of
$175 which shall be invoiced to the Customer by the Company at or about each anniversary date of this Agreement, with annual
renewals of the maintenance contract deemed to be automatic. The Company shall be entitled to alter the annual service charge
from time to time as reflected in the increase in the national cost of living.
C. CHLORINE WARNING
1. Due to the risk and danger involved in the mixing of different chlorine compounds, the Customer hereby agrees to re~aln from
adding chlorine compounds of any kind direefiy to the BioCyale system.
2. The Customer is also advised against using and/or discharging compounds to the system, such as chlorine, drain cleaners,
inseetleldes, biocides, medications, ete in amounts that would be harmful to the system and cause it to cease functioning in a normal
'---'--'C~stomer's Signature
Company Representative
Date: AUGUST 28, 1996
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 %" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
Dear Homeowner/Prospective Buyer:
The on-site wastewater disposal you are interested in purchasing is an "alternative" wastewater disposal
system. This system, known as a "Biocycle Aerated Wastewater Treatment System", is undergoing testing
within the Municipality of Anchorage under the Alternative System section of the Wastewater Disposal
Regulations (AMC 15.65). Them are certain risks involved with the ownership of one of these systems:
This system has been sbo~vn to be effective in other areas. The system is currently undergoing a
two year testing period in Anchorage under the guidance of the Department of Health mid Human
Services (DHHS) and the State of Alaska Department of Environmental Conservation (ADEC) to
determine its effectiveness in a subarctic enviromnent. Testing results on systems installed in 1994
have been very encouragiug. Copies of initial test results are available from the DHHS.
The Biocyele system has not been tested and approved by the National Sanitation Foundation
(NSF). Currently, Anchorage Municipal Code for Wastewater Disposal Regulatious requires
proprietary equipment to have NSF approval. This approval or changes to the Wastewater
Disposal Regulations through Municipal Assetnbly action will be necessary prior to this system
being approved as a standard system.
If tbis system fails to meet the requirements set for it to become a standard, code approved
wastewater disposal system, it may have to be removed and replaced by either a holding tank or {if
possible) other wastewater disposal system that meets Muuicipality of Anchorage requirements.
The cost of any conversions required to meet code requirements will be the responsibility of the
homeowner at the time of conversion.
I (we) certify tlmt I (we) have read the above statemeuts and am (are) aware of the risks outlined.
(Purchaser Name)
-(Purebaser Signature)
(Purchaser Name)
(Purchaser Signature)
Notarize Here
State of Alaska
Third Judicial District
Subscribed and sworn before me this 29th day of August, 1996 by J.E. Thoeni ~
and Sandra Thoeni. ~/ /~~~
My coamission expires May
12, 1999
PROPERTY OWNER AGREEMENT
FOR THE MAINTENANCE OF AN
ON-SITE WASTEWATER DISPOSAL
SYSTEM
This agreement, dated ~ - ~- ~ 199.P_, is made between the Municipality of
Anchorage Department of Health and Human Services (DHHS) and the property
owner(s~ of:
This agreement is made for the purpose of maintaining an on-site wastewater disposal
system on the subject property.
The property owners agree to the following:
Allow the MUnicipality of Anchorage the perpetual right of entry to the property during
normal working hours, to allow for effluent sampling or evaluating the general state of
repair or function of the system.
Submit to the Municipality of Anchorage, on an annual basis, an inspection and
operation statement from a registered professional engineer. This inspection and
operation statement shall verify that the engineer has inspected all effluent and air
pumps, timers, and alarms, and that any deficiencies have been repaired and that the
system is functioning as designed.
(Signature)
(Signature)
(Printed Name)
State of Alaska
Third Gudicial District
(Printed Name)
(Notarize Here)
1993
NU31~ICIPALITY OF ANCHOR-AGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM
PERMIT NUMBER:SW960246
DESIGN ENGINEER:CRITERIUM ALASKA ENGINEERS
OWNER NAME:THOENI JOHN E & SANDI~A
OWlqER ADDRESS:6911 ROUND TREE
ANCHORAGE, ALASKA 99516
PAGE 1 OF 1
(UPGRADE) PE.RM;T ~ ~ ,-
DATE ISSUED: 8/13/96
EXPIRATION DATE: 8/13/97
PARCEL ID:01512329
LEGAL DESCRIPTION:
VALLI VUE ESTATES #2 BLK 6 LT 23
LOT SIZE: 23689 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHOP-AGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 Ai~D THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18A3~C72) AND DRINKING WATER REGULATIONS (18AAC80) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM I/NDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
1.) ENSURE PROPOSED SYSTEM IS INSTALLED 10FT.
MIN. FROM EXISTING SEEPAGE PIT.
2 . ) INCLUDE DRIVEWAY AND WATERLINE LOCATION ON SEPTIC
ASBUILT AND SUBMIT WITH INSPECTION REPORT
DATE: ~/~
CRITERIUMT,, AI A$1(A ENGINEEI $
P,O, BOX 11'1790, ANCHORAGE, AK 99511-1790
(907) 349-'1003
July 28, 1996
Mr. James Cross, P.E., Program Manager
On-Site Services, Water Quality
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519-6650
Reference: Permit Apphcation, On-Site System Upgrade, Lot 23 Block 6, ValliVue Estates #2
(6911 Round Tree Drive, Anchorage, AK), CAE Job #95976
Dear Mr. Cross:
We are enclosing the soil logs and drawings showing improvements to upgrade an on-site septic system at
the referencexl address. The existing system has failed.
The improvement that we are recommending is the inslallation of a 5' wide by 42" deep trench dralnfield
at a different location on the lot. The location we have selected is approximately 30 feet west of the
existing scepage pit. Wearerecommendingtheinstallationof541inear feet of dralnfield. Thisdrainfield
will be connected to a new lifi station.
The location and size of the new drainiield was determined based on the attached soil log. Test hole #1
was excavated at the southwest comer oftt~e lot. The soils appear to be competent to support a drainfield.
There was no evidence of ground water to a depth of 14 feet. We believe there is adequate reom to install
this field in the selected area. Should modifications become necessary as we progress with the
installation, your depamnent will be contacted.
The new system will not impact existing systems on adjoining lots. The subdivision is on a community
water system and therefore no wells are located in the vicinity.
We respectfully request, on behalf of Jack and Sandy Thoeni, fl~at a pemtit be issued for these upgrades as
indicated in the attached drawing. If you have any further questions, please do not hesitate to contact us.
Theodore A. Johnson, P.E., L.S.
Principal
T AJ /jbj/Encl osures/criterum/l tr9 5 9 7 6
........... 4* PERFO~ATEU' PiPE
L ,S.l~ LEVEL
DEPARTMENT OF HEALTH & HUMAN SERVICFS ~'~r~. ~ v%.~,~;.~
o ~OR Ja~Lk & SandYB6, Valli-vueTh°eniEstates ~2 D~.~~~
~G~L~.SCm.~,ON 23, Township. Ranee. SecUon: ~~~
1
2
3-
4-
5-
6-
7
8
9
10
11
I2
13
14
15-
16-
17-
18-
19-
20-
Loam with Organics
Loam, Sandy Silt with Gravel
Silty Gravel (SM)
Gravelly Sand with Boulders,
trace of Silt (SW)
Sand with Silt (SM)
Silt (ML)
COMMENTS
WAS GROUND WATER NO
ENCOUNTERED?
Gravelly Sand with
Silt (GM)
Monitoring?
Reading Date Gross Net Depth to Net
Time Time Water Drop
6-4-96 2:05 pm o ~ 3/4 ......
" 2:15 10 6 1/4". 2 1/2"
2:'16 -o ;~ ;~/4"
2:26" 10 .6 1/2'¥ 2 3/4"
?'77 ~ 3 1/2"
2:37 10 6 1/4" 23/4"
,... ,.,,=,O 3 5/8"
2:49 lt,) ~ a/e" -, ,~i4""
PERCOLATION RATE 3.6 6-8"
__ (minutes/inch} PERO HOLE DIAME'I'ER .....
4.5 5.5
TEST RUN BETWEEN -- FTAND FT
PERFORMED BY: EMJ Eric M. Johnson
I CERTIFY THAT THIS TEST WAS PEREORMED IN
June
1
996
ACCORDANCE WITH ALL STATg AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; z].,
72~0~8 (Rev. 4/85)
SOLID ldANIFOLD PiPE
~~o~ ,so. ~ALLON e'OO¥OLE F'L AN
~ MONITORINe TMBE CAPPED ~
/ / 4' PE~ORTATED PiPE %
- OLEANODT6 - CAPPED-- %% ROOK. SOLID
NT5
MANMOLE
~ I BIOCTCLE ~ ~
LEVEL)
~~ ~VB ~C~ILL C~OSS SECTION
% 4' PE~ORATED PIPE
~ AU6 27 1996
TABL~ { MW!l,¢lpgJlty of Anchorage
IMPE~EADLE LATER 0~{, Health & Human Se~iceSTE
C~ ~ T~~ W.O 95976 CLIENT: Jack o~d ~and, ~hoen,
-/
FILE ~ 185site L23, BK6. VolliVue Est. ~2
~c~O~5,,-,ze0 /~ DESigN TJ 6911 Round Tree Dr.
~ETAIL6
2~.~ Total I~th, D' mide
tr®~h ~u/ Db' ~rav~l
Maintain driplin* plus D.®
LEQEN~
TP
(~ T~*t Pit
Monit~rin~ Tub~
O Olean Out
Draina~ Pattern
IB¢¢ ~al,
tDiooycl¢
Approx.
~2c OF 4L
~ ~heodore ATOo~on
DATE
/
/ ~ESIGN DATA
AUG 27 1996 No ~¢lb, ourt~in draim~,
Municipality 0f Anch0rag¢' ' , '
Bept. Health & Human 8ervi~ey ~y ofher5,
' ~,~~L= ,~/w.o. 95976 lCUENT: dock and %andy Thoeni/
FlaY// /83site L23, BK6, ValliVue Est. //2
P.O. BOX 111790 --
ANOHOR~GE, AK 99511-1790 DESIGN TJ ~ 6911 Round Tree Or.
TELiN ~ 800~07~-1~$~78-10~ ~ f'=50' ( Anchoroge, AK 99516
SITE PLAN
'ER ANCHORAGE AREA UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME 7]h~,~,P///~'r~'~ //'/'~2)~,~,¢¢ MAILING ADDRESS '~'~'"~ ~>/ /-' <~'~'~7 PHONE_-~c-/'~f'-~¢'¢~''
LOCATION ,~¢¢~. ~-F¢-¢ ~(;,-'C LEGALOESCR,PTION %- ~-~ ~ ~ /~r4/'// ~/~,/,~
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUFACTURER L~--"~/
MATERIAL ~)')C//"~/'~ NUMBER OF
COMPARTMENTS
INSIDE WIDTH
.LIQUID DEPTH
r IQUID CAPA(~ITY /'2,,~:~ GALLONS.
SEEPAGE Pit:
NUMBER OF PITS / DIAMETER
LINING MATERIAL~'FJ'~-, f~h~ CRIB SIZE:
BUILDING FOUNDATI'ON , NEAREST LOT LINE
OR WIDTH/(~,
DIAMETER
ADDITIONAL ABSORPTION
LENGTH ~'~'~ DEPTH /
DEPTH ~ DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA)
SQ. FT,
WELL:
TYPe
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL
OTHER SOURCES
APPROVED
DISAPPROVED
NEAREST
SEWER LINE
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK SYSTEM _
REMARKS
D ISTA NC ES:
INSTALLED BY:,/'/;//
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No. LQ-031
DIAGRAM OF SYSTEM
DATE
GRE~'~ER ANCHORAGE AREA BOF-~UGH
Department ~3E0n~ir~eme~ntal Quality
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION '~W--~r ~--~' ~';'C LEGAL DESCRIPTION ]-- -~' ~ /-~ g2?/// .~/'/-:'/"~'
SEPTIC TANK:
DISTANCEFRoM WELL~-- MANUFACTURER ~-'~/;# O~~i~- MATERIAL . C O~C ~'~A COMPARTMENTsNUMBER OF /
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /~,~'~) GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER
LINING MATERIAL~/'~C"' /~;11~~ CRIB SIZE:
BUILDING FOUNDATION -~-~/, NEAREST LOT LINE__
OR WIDTH/O, LENGTH ~'~,,~ DEPTH / ~.
DIAMETER__DEPTH ~ DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~¢'~
SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE
BUILDING NEAREST
FOUNDATION_ LOT LINE
CESSPOOL
OTHER SOURCES
APPROVED
DISAPPROVED
DEPTH DISTANCE FROM:
NEAREST SEPTIC SEEPAGE
SEWER LINE TANK SYSTEM
REMARKS
DISTANCES:
INSTALLED
PIPE MATERIAL: ~-~
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
GReATEr ANCHORAGE ArEA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
SEEPAGE PIT *, DRAIN FIELD OTHER
TO BE INSTALLED bY .
/~/
NOTE: THIS PERMIT 15 NOT VALID WITHOUT SOIL TEST
NAME OF APPLICANT ~7~
INSTALLATION LOCATION
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. 13ACKFILL~NG OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPT,° TAN S, E L TYPE { SEEPAO EA S'= > T PE.
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK ~ SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
DRAIN FIELD
TO RIVER, LAKE. STREAM.
DRAIN FIELD
/
, DRAIN FIELD
ALSO CONSIDER AREA W~S.
SEEPAGE PIT
DIAGRAM OF' SYSTEM
~ ]NTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVaBLe CAPS.
CONFORM TO BOROUGH REGULATIO~ REGARDING INSTALLATION.
~~ ~ ORDI ANCE NO. 28-68 AND THAT THE ABOVE
I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHO AREA BORO RDI~I
GREATER ANCtlORAG[ AREA BOROUGH
DEPARTMENT OF ENVTRONMENTAL QUALITY
3330 "C" Street
.ANCHORAGE, ALASKA 99503
Case
Performed For~'q~ ~.~- Dated Performed
Legal Descriotion: Lot ~_~ Block G, Subdivision u~-~
This Form Reports Soils Log__ ~ Percolation Test
Soil Test Must Be Logged To ~' ~elow Propnsed Seepage Syslem -
Depth
Feet Soil Characteristics
2--
3--
4--
5--
6--
7I
8--
9--
10I
13~
14-
Was Ground
If Yes, At
Water Encounter,~d?
What Depth?
Reading I Date Gross Time I Net Time Deoth to H20 Net Dro:
Percolation Rate Minu~;e
Proposed Installation: Seeoage Pi.t Drain Field
Depth of Inlet Depth to Bottom ~--Pit or Trenc5
COMMENTS: ~//~,~/=~,~. '-- ~ ~ ~
~ . ---%--:-.-]~ ..... ~. :~- ~---- ~-
Test Performed BY::: :':':~::X Date Certified
Date:
G/'"~TER ANCHORAGE AREA BOROUGII
~ Department of Environmental Quality
3330 "C" Street
~ ~ Anchorage, Alaska 99503
P erfo~'med for ._~/~-~-----~ Date performed
Legal Description:
'This -Form reports: -S-~TT's--~g-~-' Percolation test
Depth
Feet
1
3.-
4-
5-
6-
7-
8-
13~
d water encountered?
If yes, at what depth?
Reading
Date
-F
Percolation rate
Gross Time
minute/
Prnnn~or(_.,?_~.~ installation: Seepage. Pit ....
Net Time
Depth to H20
Net Drop
Drain Field
1. Approval requested by:
Mailing Address:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
: ~ :~/F ~t ,~ Date Received ~2~ c~ ?-~-
:! ~'~1 Time of Inspection
FOR
~/ ~. Phone:
2. Property Owner:
Phone:
4.
5.
6.
Mailing Address:
Legal Description:
Type of facility to be inspected
Well Data:
A. Type B. Depth
C. Construction
Sewage Disposal System:
No. of bedrooms
D. Bacterial Analysis~-?q
C. Septic Tank: 1. Size /::0 2. Manufacturer
~. S~e~a~e ~ ~. ~so~o~ ~ea ~>O ~' ~. ~a~e~a~
E. Disposal Field: Total length of lines
Distances:
A. Well to:
Septic tank ,/Absorption
area , Sewer Lines ,
Nearest lot line
, Other contamination
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) , Page 1 of two pages
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" St., Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
Type of Inspection: CMRO VA FHA
Property Owner:
Mai-ling Address:
Name of Buyer: ,j~/~/~/
Mailing Address': i~
Day Phone
CONV ~'
Phone
4. Name of Lending Institution:
Mailing Address: ~-~v~ C/i~/~,~/~,¢~ Phone
5. Name of Realtor or.Agent: .~J.~-z~
Mailing Address: ~ ~ ~ Phone
Legal Description:
Location:
7. Type of Facility to be inspected: ~.~r?~ '~ No.
8. Water Supply
Type of Supply: Public Utility Individual
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
Bdrms. ~/
Individual (on-site)
EQ-037 (1/74)
Rage 2 of two pages
~egal Description
~st for Approval of Individual
~er & Water Facilities
Comments
;~proval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (]/74)
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-
_~ . ~ ~.. APPROVA~.~FO'i~ ASIN~GL~E~FAMILY DWELL'lNG
Parcel I.D.# ~/'--~",/'Z-/~ -2~~43('); ~ ~;'' ~-' NAA#'
1.
GENERA[INFORMATION
Complet~ legal-description" ~ /"-~/~ ~ '~'~' ;'
Location ~ite address or directions) ~/'/ ~;r.l/yj~¢-"C<~:':-'-~,
Mailing address '~ /~ ~ ~r,
~' ~_z.._./.Day phone
Mailing address ~ ,~a~ ~/
Agent ~ ~H~ Day phone'
Address /~~ ~ ~ ~
Unloss o~Do~so roquosto~, HAA ~ill Do ~ol~ for
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
~f community well system, provide written confirmation from State ADEC attest-
lng to the.legality and status of s~tem. . .....
: Public sewer
NOTE: - If community~wastewater s~vstem; 'provide writton Confirmation from State ADEC · ' attesting to the legality and status of*s~'stem
: _,, Ho d ng tan, k:,, ~
Community on-site
72-025 (Rev. 1/91) =rent MOA#21
STATEMENT OF INSPECTION BY ENGINEER: , ~;',~, ,
As certified by my seal affixed heret~nd as 0f 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 structu re 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. ': ·
N a m e of Fi r m (/~ '~"£~"z'",C''/'~' Z/~/ ~'/~ ~w~ Phone
DHH~iGNATURE : ~ Profesd~O~ ~/
,,
~ - Approved for u" ,bedrooms. · -, , .... ~ ::
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
By:
Additional Comments
The Municipality of Anchorage Department of Health and Human sewices:(DHHSi issUes Health Authority
Approval Certificates based only upon the representations given in paragraph 5;ab. ove 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 ins!!~gtions in order to:satisfy certain.federal and state requ rements Emp oyeesof DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municil~a!i~ (~f Anchorage is not
responsible for errors or omissions in the profesSiOnal engineer's work.
Municipality of Anchorage · R E C E I V E
DEPARTMENT OF HEALTH & HUMAN SERVICES' '
Environmental Services Division
IIl~l 97
1997
825 L Street Room 502° Anchorage, Alaska 99501° (90,7,) 3~'~'-~7~4
municipality of Anchorage
Health Authority Approval Checklist Dept, Health & Human Services
Legal Description: '~"~'""~.~f~//--4 /_~/~'~'c ~-'~, ?~F_.. ParcelI.D.: d)/~-._/?_,~- ~c~.~
A. WELL DATA
Well type
Log present (Y/N) /'///J- Date completed
Total depth /,///~ Casedto /~/~'
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform /%///~
If A, B, or C, attach ADEC letter. ADEC water system number
FROM WELL LOG
Nitrate
Casing height (above ground) /4///~
Wires properly protected (Y/N) ~V///~'
AT INSPECTION
g.p.m.
Other bacteria
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed ¢;/;/~7~ ~, Tank size ?~"~O
Foundation cleaneu~N)
Date of Pumping
C. ABSORPTION FIELD DATA
Date installed ~//~,/~ ~,
Length --~ o') Width
Collected by: /"'//~
Number of Compartments Cleanouts (Y/N) /~//~
Depression (Y/N) ~/ High water alarn~N)
G~hi~ness below pipe ~ : Total depth ~ [
Effective absorption area ~'~4:~ ~ ~ ' '
Men tor Qg~u,.'.b;e'Presen ~z(.~/~)__
Date of adequacy test ~t/cu~ .~r~/~lesults(Pa~s/l~aii) ~'/'h
Fluid depth in absorption field before test (in.); ~///~
Fluid depth ~:~ (ins)Minutes later:
Peroxide treatment (past 12 months) (Y~
Depression over field (Y/N) H
For ~;~ bedrooms
Immediately after/"//'Jr-gal, water added (in.): ~A
Absorption rate = ~J~) g.p.d.
If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access~N)
High water alarm level at*
Cycles tested
"Pump on" level at* -,7'~¢ "Pump off"level at* /"~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Sept c/ho d ng tank on lot ~.//
Absorption field on lot ,/~//3[
On adjacent lots ,/"~//'~
On adjacent lots
Public sewer main /"//4 Public sewer manhole/cleanout
Sewer/septic service line ,Az//dr- Lift station /¢//~-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~ '-- Property line
Water main/service line ~' ~ Surface water/drainage ,A,.,'/,/"~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line //'~ Building foundation
Sud'ace water
Curtain drain /t,///~b
Absorption field
Wells on adjacent lots
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots /~'//'~'
F. ENGINEER'S CERTIFICATION
I certify that I have tie, ermined thru field inspections and review of Municipal records that the above sVStern.,
in conformance_wi~h,CVlOA HA,~idelines in effect on thi.~.-
.. // .- /'. ,,~,,~'e- & "~. '~'x. ~..'*
¢
Date
I~'~¢,% ...... -~ ¢ ~
HAA Fee $. ~O%*~(~ ":'":,~awer~ee $ ~ DATE
Date of Payment (¢ -:~, ~'] , Date of Payment
Receipt Number (, ~c~(~/ ~ Rec;ipt Number
72-026 (Rev. 3/96)*