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Home My WebLink AboutTIMBERLUX #3 BLK J LT 9Ti m berl ux # 3 Lot 9 Block #018-271-77 Municipality of Anchorage Page 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 Name: ~tclc ~A~ ~ Wastewater System: D New ~ Upgrade Address; /~ ~ ¢ C~v ~c%~ Y~/~ ABSORPTION FIELD ~No.o~Bedrooms: ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other Soil Rating: Total Depth from o~nal grade: LEGAL DESCRIPTION ~. ~ ~s, ~. /~ Township: ~ Range: ~ Section: Fil~ added above original grade: Gravel length: I I Gravel width: Number of lines: J Distan~ between ~ines: WELL: D New ~ Upgrade ~ ~ ~ Ft ~I /~ Ft. Classification (Private, A,B,C): Total Depth: ~sed To: Total absorption area: Pipe material: Driller:~[~ ~e Drilled: StaticWater Level:Ft. Installer:~.~ ~ Date ins~l~ PM Pump Set at: Casing Height Above Ground: ~. ~,. TANK SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Privet(Manufacturer: Capscityin gagons: [ ~ Material: Number of Compadments: Sudace w~t~ I~=~ ~ LIFT STATION LineL°t ~ ~ Size ingal,ons: ]Manufacturer: Gu~ain ~ -- .. ~el J Electrical ,nspections pedormed by: Drain Remarks: ~C~t~ .~C T~ BENCH MARK Location and Description: :~7 ENGINE~EAL Inspections pedormed by: ~¢-~ ~a~ Dates: 1st ~/~/e~ ~ 7' 49~h . Department of Health and Human Se~ices approval ~ Reviewed and approved by: ~ Date: ~///77 ::~ "~?OFESS~O~'~; AS-BUILT WASTEWATER ABSORPTION gYSTEM LOT 9, BLOCK J TIMBERLUX SUB]], NEW INSTALLATION EXIST, TRENCH __ DEEP TRENCHES 24 LF EA, ~EW DIVERTER VALVE W/DDU~L CLEAN-DUT~ SWING-TIES C.O, A ;ri r~1.5 43,3 ;'2 69,8 $9.0 T1 49.3 E7,E T8 56.5 35,3 DC 58,2 37.6 DV 59,5 39,8 FS 39.3 20.4 rl 39,6 26,0 C8 50,5 53,4 Mi 42.5 38.8 (:3 36,3 C4 15,1 E7.7 ME 33.4 11,7 3' Wide 84.7' -- 3\WorkN43MnDRE.DWG TRENCH ~ECTIDN PREPARED FOR: Nick G~rclo 15100 CurveLl Drive Anchorc~ge, AK 99516 (907~ 343-8124 TRENCH PROFILE 9%7 PANNDNE ENG, gVC P, D, BDX 142025 ANCHORAGE, ALAgKA 99514 274-0308, 272-8218 F.~x DATD 7-12-97 ,~{ .'AS-BUILT BCAL£, 1'=50' PAGE MUNICIPALITY OF A/~CHOR~tGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 A~CHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT NUMBER:SW970150 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:GARCIA NICK A OWNER ADDRESS:15100 CURVELL DR ANCHORAGE, AK. 99516 (UPGRADE) PERMIT DATE ISSUED: 6/25/97 EXPIRATION DATE: PARCEL ID:01827177 LEGAL DESCRIPTION: TIMBERLUX #3 BLK J LT 9 LOT SIZE: 49473 (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 ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (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 SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. .~.~.~ ~ ~ AL ~h0~IS IONS IF EXISTING TRENCH IS TO REMAIN FOR FUTURE USE, THEN ACCURATELY DOCUMENT ITS LOCATION AND MAINTAIN THE MIN. REQUIRED SEPARATION DISTA2~CE BETWEEN DRAINFIELDS. RECEIVED DATE: DATE: 1 OF 6/25/98 Steven R. Pannone, P.E. Consulting Engineer (907) 272-8218 P.O. Box 142025 Anchorage, Alaska, 99514 (907)272-8218 Fax Juno 8, 1997 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Lot 9, Block J Timberlux Subdivision Septic Upgrade Permit FAILED SYSTEM Gentlemen: My firm was contacted to conduct an investigation of a possible failed system. The existing system was completely inundated with liquid. The fluid levels were approximately 12 inches above the lateral pipe. I informed the owners that the system was in failure. Theownersmquestedmyfirminvestigatethepossibilityofinstaltingareplacementsystem. A single test hole was excavated on May 3 i, 1997. The soils report and a percolation test result is attached. Ground water was monitored for seven days. No groundwater or bedrock was encountered in the test hole. The lot is approximately 1.13 acres in size. Lot 9 slopes to the northwest at a rate of approximately 1 to 2 percent. The proposed installatinn will be located on the northem portion ofthe lot. The existing field will be reused. Adivertervalve will be installed between the two fields. The septic tank will be verified during the installation. It will be reused iffound competent, and replaced with a new tank outside the well radius if found to be deteriorated. Double clean-onts will be installed down stream from the tank. The proposed location is greater than i00 feet away from the existing well serving this property and 25 feet from the water service lines. The surrounding wells are located greater than 100 feet from the proposed installation. There is a 12 to 15 foot embankment to the west of the proposed installatinn. The new system will be located approximately 35 feet from this bluff~ The new system will be installed at a depth of 10.5 feet. There should be no problem with effluent day-lighting along this bank due to the depth of installation~ The proposed installation will not affect the future development of the surrounding or existing lots. See the attached design. Sincerely, Steven R. Pannone, P.E. Attachments: If you have any questions about the proposed installation, please contact me at 272-8218 :' ":'" ":":': "" '""~"" :' EXIST. TRENCH IN DESIGN WASTE~/ATER ABSORPTION SYSTEM LOT 9, BLOCK d TINBERLUX SUDD, NOTES, 1) EXISTING TRENCH HAS FAILEI), SEWAGE LEVEL IN THE TRENCH WAS 15 TD lB INCHES DN 5/31/97. TANK IS PUMPED WEEKLY 2> VERIFY INTEGRITY DF EXIST. 12509 SEPTIC TANK~ REPLACE TANK WITH NEW 1250 g TANK OUTSII)E THE 100' WELL RADIUS IF FDUNI) LEAKING. THERE ARE NO WELLS WITHIN 100' DF PROPOSE3 SYSTEM, NEIGHBORS SEPTIC IS 60' AWAY FROM PROPOSED LOCATION, PROPOSED INSTALLATION nEEP TRENCHES 30 LF B.5' EFF., 10.5 TD t0' PROP LINE SET~ACK ENSTALL VALVE CLEAN-OUTS 'FLOW iXIST. 4 ~R :IST, HOUSE TANK EE NOTE 2 EXIST, WELL THERE ARE ND SYSTEMS WITHIN THE WELL DF THIS PROPERTY. EXISTING ARE LBCATE~ GREATER THAN FROM PROPOSE3 LOCATION. ]Drawing O\Wot'k\9-JTIM~R.n~/( DESIGNI Pert Ro'te = 16 Min/Inch Solts= 850 s£/br 4 Bedroom House lOOO SF Rqd Design, 7,5' EF?ec'tive 10,5' To't(it Dep-I;h 3' Wide, 68' Long To'bit Absorp'tlon = 1020 PREPARED FDR, Nick Gnrclc~ 15100 Curvett Drive Anchorage, AK 99516 (907) 343-8124 P~nnone Eng, Svc, P, D, BOX 142025 ANCHORAGE, ALASKA 99514 272-8218, PHONE & FAX )ATE, 6-~-97 I DESIGN CALE, 1'=50~ I DESIGN DETAIL WASTEWATER ABSORPTION SYSTEM LOT 9, BLOCK d TIMBERLUX SUBD, z 7,5' Dr'o. wlng C,\Wo?'k\9-JTIMBRJ)WG PREPARED FDR~ Nick Garci: 15100 Curve[[ Drive Anchora§e, AK 99516 (907> 343-8184 P~nnone Eng, Svc, P, D, 30X 142025 ANCHORAGE, ALASKA 99514 878-8218, PHONE ~ FAX DATEI G-6-97 NOT TO SCALE DESIGN DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:' ~ --' c,,4 LEGAL DESCRIPTION: 2 3 4 § 7 8 9- 10- 11 13 14 15 16 17 18- 19- 20- Township, Range, Section: SLOPE SITE PLAN COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After MonitoriaD? ~ Date: PERCOLATION RATE /~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT Reading Date Gross Net Depth ,1~,o~' Net Time Time Water Drop PERFORMED BY: '-~ "~l~/lJ"~Ji'~t'~J¢"'~ I - ~ ~ CERTJFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/~1'/~ ~ 72-008 (Rev. 4/85) ~-~ -~/MUNICIPALITY OF ANCHORAGE '~-~..~" DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME / · [] UPGRAD~ MAI LING AD DR ESS LEGAL DESCRIPTION LO~ATION NO. OF BEDROOMS ~ ~ DISTANCE TO: J Well, Absorpyon~ area Dwell~g/ + PERMIT NO. Manufacturer Mate~ of cor~ar tments Liq,~a~c~ gallons IF HOME.DE: Inside length Width Liquid Oept~ ' ~ Well Dwelling PERMIT NO. ~ oz DISTANCE TO: O ~ ~ Manufacturer = -- ~ Material Liquid capacity in gallons - PER IT O ~; DISTANCE TO: i Well Nearest lot line ~ NO, O' lines ~ Length of each li~e Total ~en~h,f~nes X~ / Distance between lines '~ Material beneathJile inches ~ Top of tile to finish grade ~ Total e~ fective ~ ~~ inches ~00 Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ ~ DISTANCE TO: Well Building foundation Nearest lot line ~ ~ glass Depth Driller Distance to lot line PERMIT~Q. __ ~~'~ ~ DISTANCE TO: Bui[ding foundation Sewer line Septic tank Absorption area(si OTHER PIPE MATERIALS ~ ~ ~ SOl L TEST RATING INSTALLER ~ ~ ~ / ~ REMARKS ~ ~ APPROVED . DATE LEGAL 8~5 "L'~ STREET,~RNCHORRGE, 8K. 99501 ~J ~ ~/ ~ELL ~4~ C~--~ I t~ _~E~E~: ~'E~t~ ~ '~(] '~,~_~ LOC:RTION CLIRVELL DRIVE - -- 7~ ~.~::. LEGRL L~ BLK ~J" T~MBERLUX RDDN ~ LOT S~ZE 49~5 ...... c-~.LiHRE- ' FEET TYPE OF SOIL 8BSORBTIO~SYSTEM IS: TRENCH MRXIMUM NUMBER OF BEDROOMS = ~ SOIL RBTING <SQ FT/BR>= THE 'REQUIRED SIZE OF THE SOIL 8BSORPTION SYSTEM IS: [:.EF'TH= .~ LE~-~GTH= e THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFIINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE Of 7'HE GROUND RND THE BOTTOM OF THE E~CRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCBVRTION (IN FEET). PERMIT RPPLICBNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INST8LLRTION INSPECTIONS OF 8NY WELLS 8DJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. 1-1-.~I_] "-'- 2 ) I I%ISPE ~_~---I- I O~',tS RF.'E RE,~--!IJ I RE[: BRCKFILLING OF RNY SYSTEM NITHOLIT FINRL INSPECTION RND RPPRDVRL BY THIS DEPRRTMENT WILL BE ~UBJEL. T TO PROSECUTION. 'MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM ,IS · ~00 FEET FOR R PRiVRTE WELL) OR ~.5C'~ TO R~DO FEEYF FROM ~ PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS RRE~ ~QUIRED RND . ~ .. MUST BE RETLIRNED TO THE DEPRRTMENT WITHIN=.~l';'~' [.Hz:,~-"~' OF THE WELL COMPLETION.' OTHER RE~tUIREMENT5 MRV RPPLV. SPECIFICRTIONS 8ND CONSTRUCTION DIRGRRMS RRE ~',/RiLRBLE TO INSURE PROPER INSTRLLRTION. ~: ~ BM FRMJ~IRR-~ WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELL~ RS SET FORTH BY THE"~HuNICIPRLIT9 OF BNCHORRGE. 2: I WILL IN~RLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY RE~UIRE ENLRRGEMENT IF'THE RESIDENCE I5 REHODELED TO INCLUDE~ORE THRN 3 BEDROOMS. RFPLICRNT NICK GRRCIR .,-. I~S~ED _ _-DRTE V3:. CONSULTING GEOLOGIST SOILS LOG Soil Type Water Level Remarks 16 18 2O Total Depth of Excavation .~G_roundwat er. /~Not Reached Depth, if Reached Classification Method ~Visual ( ) Sieve Analysis () Material at Total Depth Bedrock Reached Depth, if Reached Gary F. Player, Consulting Geologist SURVEYORS CERT'IFICATE This survey is made for the exclusive use of the present. owners of the property, and also those who purchase, mortgage or guarentee the title there to within one year from the date hereof; and as to them I hereby certify that this survey and the above map were made in acdordance wi th acceptahle professiona 1 standards and that the intormation contained hereon is, to the best of my kr, oulcdge, information and belief, a true and accurate representation thereof, Municipality of Anchorage Department of Health and Human Services' Division of Environme,,ntal Services On-Site Services Section 825 L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343~,744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 018-271-77 1. GENERAL INFORMATION Complete legal description Expiration Date: Lot 9, Block J Timberlux~ No. 3 Location (site address or directions) 15100 Curvell Drive Current Property owner(s) Mailing address Lending agency Mr. Nick Garcia Day phone 343-8124 15100 Curvell Drive, Anchoraqe, AK 99516 Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health Authority Approval (H,~,) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except beb^,een spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Munic!paiity of Anchorage is not responsible for errors or omissions in the professional engineer's work. 5. STATE._~_I=NT OF !NSPECT!ON BY ENG!NEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for this 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Eng. Svc. Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. DHHS SIGNATURE ~ Approved for /¢' Disapproved. Conditional approval for bedrooms. Phone 272-8218 Date 4~23~2000 bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory We!l Flow Advisor,/ Expiration Date: ~ - .P. ~ - O ~ Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Reissue Date: X CEIVED MAY 1 2 2000 Municipality of Anchorage ~ DepaAment of Health and muman ~e~IC,~A~s~,vlr~ ~ .... Div~ion of Environmental Services On-Site Semites Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 995i9-6650 ~.cLanchoraDe.ak. us (907) ~3~744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT 9, BLOCK J, TIMBERLUX A. WELL DATA IfA, B, or C provide PWSID Sanitary seal _Y Cased to FROM WELL LOG 9/11/1978 UNKNOWN 20 g.p.m Parcel I.D.: 018-271-77 Well Log _Y Wires properly protected Y Casing height (above ground) 22 in. AT INSPECTION 4/22/2000 107 ft 3. i5+ g.pm Well type PRIVATE Date completed 9/i 1/i 978 Total depth ~ ft Date of test Static water level Well production WATER SAMPLE RESULTS: Colifo{m "~O~ colonies/100 mi Date of sample: 412312000 B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 7/2/i997 Tank size Cleanouts Y Foundation cleanout Y Nitrate 0.$0- mg/! Collected by: S.R. PANNONE 1250 gal Depression over tank _N Date of pumping 7/9/1999 Pumper A+ HOME SVC C. ABsoRpTION FIELD DATA Date installed 7/2/1997' Soil rating (g.p.d./ft2 or ft21bdrm) 0.._~6 ~, Length 67 ft Width 3 ft Other bacteria --° -- colonies/100 mi Number of Compartments _2 High water alarm N System type D__T Gravel below pipe 7.7 ft Total depth 13.0 ft Effective absorption area 1032 ft2 Monitoring tube Y Depression over field . _ Date of adequacy test 4/22/2000 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 3_~0 in Water added600 gal. Elapsed Time: i440 min Final fluid depth 30 in Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO (Rev. 11199) New depth4._~5 in. Absorption rate >= 600 g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at __ Datum Size in gallons N/A in"Pump ofF' level at Cycles tested in Manhole/Access High water alarm level at ,-- in Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout, N/A Holding tank N/A 100 E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot. 127 Absorption field on lot 123 Public sewer main N/A Sewer/septic service line 107 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line 63 Water service line 65 Wells on adjacent lots Absorption field 10 · Surface water 100+ 100+ Building foundation 22 Water main N/A Drainage 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 10+ Water main N/A Property line 15 Surface water 100+ Driveway, parking/vehicle storage 60' Water Service line 60 Wells on adjacent lots 100+ Cudain drain 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone, P.E. Date 4-23-00 HAA Fee $ R~,ceipt Number (Rev. t 1/99) Waiver Fee $ Date of Payment Receipt Number 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) prOCerty oWner :. Maiii~g address 'k.Lehding agency Mailing address' Agent Day phone Day phone Day phone Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well ~ Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site ~ Holding tank Community on-site Public sewer 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 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 wastewa~er 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 disposa~ system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm'-'''~&~d~/t2~ ~p__.~C~. ,¢~j¢ Address ~'O'~ /q?~ A~O~ ~ ~ EngineeCs signatur~ ~ Phone '~-'~-'~c¢~ Date DHHS SIGNATURE ¢/ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 DH HS 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. RECEIVED Municipality of Anchorage ' DEPARTMENT OF HEALTH & HUMAN SERVICEI~L 'j G 1997 Environmental Services Division Municipality et Anchorage 825 L Street, Room 502 · Anchorage, Alaska 99501r~Lo~,d-~l~-~qutn 8eryices Health Authority Approval Checklist Legal Description: ~, ~' I ~ ~'' -l~/vf-~-'~_z,o~. Parcel I.D.: C~ ~ ~ -- ~- -7-I - -'~ ~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed. Cased to FROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) A. WELL DATA Well type Log present (Y/N) Total depth ! Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ C~ ~ Nitrate d) 0 ! ~C~ L) Date of sample: "~'/1~ ~/~-- Collected by: AT INSPECTION ~'-/ t$l g.p.m. I. 'm~ g,p.m. Other bacteria ! ~ Number of Compartments ~ Cleanouts (Y/N) ~ Depression (Y/N) ,~/ High water alarm (Y/N) ~' Pumper '"-- Soil rating (g.p.d./fF or ft~/bdrm) ~:~ Gravel thickness below pipe Monitoring Tube present (Y/N) Results (Pass/Fail) t;~ B. SEPTIC/HOLDING TANK DATA Date installed ~=~/~-"/q~ Tanksize Foundation cleanout (Y/N) Date of Pumping ~ ~-~-P C, ABSORPTION FIELD DATA Date installed '~/¢ / ~.~:7' .- Length ~ ~z Width Effective absorption area Date of adequacy test- ~ System type ~"(- - ::~- ~' Total depth ! ~' ~-~ . Depression over field (WN) ~ For ~ __ gal. water added (in.): '----- --'" .g.p.d. If yes, give date ~ Fluid depth in absorption field before test (in.); ~4J ~ Immediately after '~- Fluid depth '"'"'- (ins) Minutes later: ~-- Absorption rate = Peroxide treatment (past 12 months) (Y/N) ~ bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) ' "Pump off" level at* ~ High water alarm leve.~ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ! "Z--~- Absorption field on lot ! '7.:~ Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK ON LOTTO: Foundation '~--~- Property line ~ ~ t Absorption field / ~ Water main/service line ~'~ Surface water/drainage /o¢'~ Wells on adjacent lots '~'¢ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ¢ -~" Surface water Curtain drain *' ~'~' '~- Building foundation /'¢ '~ Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots / HAA Fee $ Date of Payment Receipt Number ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal recor_d~~stems are in conformance with MOA HAA guidelines i. effect on this date. Waver Fee $. Date of Payment Receipt Number __ 72-026 (Rev. 3/96)* CT&E Environmental Services Inc. Drinking Water Analysis Report for Total Coliform · -200 w. ~otto, ~.v~ R£,4D 6~TRDCTIO~'~ O~v REVerE ~IDE BEFORE COZ~E~/:Y~ ~MpLg Tel: (~07) S62-2343 ,MUST BE COMPLETED ny WATER SUPPLIER PUBLIC WAT£R SYST£M I.D. # ~ PRIVATE WATER SY~EM ~n~ R~ul~ ~ S~ Invoie~ SAMPLE DATE: ~ Month SAMPLE TYPE: Routine Repeat Eample (for ~oufine eomple with lob re~ fie, .. ) ~ Special Purpose ~A SAMPLE LOCATION $.sd Invoice ' ' ' C~ Treated Water Time Collected Pax: 1907) 561 TO BE COMPLETED ISY Analysis shows this Wa[er SAMPL£ to ~ $atisfacto~' O S~le over 30 hours old. r~ul~ may be unreliable Sample ~oo long in trans;t; sample should to indicate eellabie resut~, Ple~ send Time Receive~ [ A~olyficfll Method: '~Memb~e FZlter g MMO.MUG Numbeto~co/onle~ 00 mi. ~b Ret, NO. Result* ~7~13 ,, :~'"'~' ........ Anch gb~ Jun Client notified o£unsatisfaeto~ results: ~ _ Phene~ Spoke with BACTERIOLOGICAL WATER .du%'ALYSIS RE:CORD .;13lo-.MuG Result: Total Coliform £ Colt Membrane Filter: Oirec[ Count~.~)'~ Celonle~100 mi Vel't/i~f/oe~ LTe . 808 COLIPIRM Fecal Coliform Confirmation Final Membraoe CcliformllO0 mi Reported ~l~el~.~a ,, ~ Tlm, ~__ hr. TOTRL P, 84 .TUL-16-1997 12:59 CT~E ESl RNCHORAGE 907561~01 P.94/04 C T&EEnvironmentalSewiceslnc. ~ LaboratoW Division ~ ~~~~~~ Laboratory Analysis Report CT&E Ref.# 973813003 Client Name Pamzone l~ng Sty. Project Name/# N/A Client Sample ID L9 BI ~ber1~ Back HOSe Mat~x Dd~ng Wat~ Or.red By PWS~ 0 Sample Remarks: Client PO# Printed Date/Time 07/16/07 11:23 Collected Date/Time 07/13/97 14:30 Received Date/Ti~07/14/97 12:00 .P,,,a,r amete r Results PQL Units Method Nitrate,N 0.100 U 0.100 mg/L $M18 4500-NOSF 10 max Total. coil form 0 cal/lOOmL sM18 g222[l Allowable Prep Analysis Limits Date Date In~t 07/15/97 JRJ 07/14/97 RAM 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-$301 3180 Pager Road, Fairbanks, AK $9709-9471 -- Tel: (907} 474-8656 Fax: (907) 474-9685 TOTRL P. 04 · MUNICIPALITY OF ANCHORAGE DEPT. C? ~ :"~: i -~ REQU T DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'~i~t~ONL'iNL'\L ~ ::CTION r 825 L Street- Anchorage, Alaska 99501 t~.~iAY 2 ~ ';[!)~L~ ~ ENVIRONMENTAL ENGINEERING DIVISION ~ [h~LJV~ ~ Te,ep,o.e,64-.,,o RECEIVEL O / ~FOR ES APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES / Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 2. BUYER MAI LING ADDR ESS PHONE PHONE 3, LENDING INSTITUTION MA LNG ADDRESS 4. REALTOR/AGENT PHONE PHONE 5, LEGAL DESCRIPTION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One /)~] Four ~ SINGLE FAMILY ? Two, c/ [] Five [] MULTIPLE FAMILY ,[~'~h r ee [] Six [] Other 7. WATER SUPPLY [~ INDrVIDUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled [] COMMUNITY since June 1975. For wails drilled prior to that date, give wen [] PUBLIC UTI LITY depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** I nd~v,dual/on-s~te, §~ve mstallatmn date If system is over two (2) years old an adequacy test is re~u~red [] PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) (~ THIS SIDE FOR OFFICIAL USE ONLY iNSPECTION APPOINTMENTS DATE RECEIVED 'IME 71ME TIME 3ATE DATE DATE ~ISPECTOR INSPECTOR I NSP ECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTi LITY Connection Verified_ 3. SEWAGE DISPOSAl. SYSTEM L~INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holdin§ Tank Size: If Tank is homemade give dimensions: ~'YPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: [] ONE [] THREE [] FiVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE iNSTALLED iNSTALLER SOILS RATING MANUFACTURER MATERIAL [] OTHI!!R Nearest Lo[ ..... Line Septic/Holding Tank Absorption Area Sewer Line Absorption Area to nearest Lot Line 5. COMMENTS DATE LEGAL DESCRIPTION [~J~-APPROVED FOR ,-~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED BY (Title)~.~_ 72-010 (Rev. 3~78) May 23, 1979 ~iek/Lee Garcia Post office Box 10-518 Anchorage, Alaska 99511 Subject: Lot 9 Block J Ti~)erlux Subdivision ~3 Approval for your individual sewer and water facilities will not be granted until ~le following items have been completed: (1) A well log is submitted to this department. (2) The water analysis r~port be delivered to this office from Chem Lab~ 5633 B Street, for Our review. If there are any further questions, pleese contact this office at 264'~-4720. Sincerely, Robert C. Pratt~ R.S. Associate Specialist iIcP/ljw First Federal Savings and Loan Post office Box 4-2200 99509