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Home My WebLink AboutTANAINA VALLEY LT 18 Municipality of Anchorage Page 1 of 3 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: SWgRO'~?q PiD Number: 011 -051 -93 Name:Darrell Peterson Wastewater System: [] New ~ Upgrade *~,es~: ABSORPTION FIELD 6937 Lowell Circle I No Bedrooms: Ph°ne:243_0842 '~our rq, Deep Trench ]~J~hallow Trench [] Bed ~ Mound ~ Other LEGAL DESCRIPTION Soil Rating: To[al Oep,h original grsde: .8 GPD/S~. Ft. 18 - Tanaina Valley 4 ' Ft. 4 0 Ft. 81 . 4 ' Ft. WELL: D New ~ Upgrade Gravel width: 5 i Ft 2I 1 0 i Ft. Muni. Water Ft. Ft. 814 So.F~. ASTM D3031 PVC R., Acreage Systems 8/28-31/98~ ' Yie~a: GPM ~ Pump Set at: ~ FL ~Cas,ngHeigmaboveGround:~,F,. TANK- ExiSting SEPARATION DISTANCES s Septic S Holding S S.T.E.P. We~ Muni '.ipal ~ater ystem ~s~,~ >~00' >~00' N/A N/A N/A .LIFT STATION- N/A Lot >5 ' > 10 ' N/A N/A N/A Size in gallons: Manufacturer: Line Foundation > 5 ' > 1 0 ' N/A N / A N / A "Pump on" level at: "Pump o~¢' level at: I Remarks: Flow Diversion Valve Placed. BENCH MARK Location and Description: Back Deck. Existing System Left in Tact. Existing Septic Tank Verified Sound For Continued Use. . 100.0 ~. Inspections pedormed by: .RA Dates: ls, 8/28 <98 ; 2nd 8/31/98 3rd 8/4/99 Department of Health and Human Se~ices approval ~34x,,¢... ~. ~.;~ ~;&¢~&~¢¢ ' Reviewed and approved b //¢/. Date: ~ ~'~ Municipality of Anchorage Page 2 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW980323 PID No. 011-051-93 10:' utility Easement 'C M1 Flo · Splitt L 4 o ~cM% ~hed Four )iverter Bedroom Home C 28.7 39.3 40.4 33.6 24.3 PLAN AS-BUILT o, Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 343-4744 On-Site Wastewater Disposal-System or Well Inspection Report xisting Septic Tank Permit Number SW980323 PID No. 011-051-93 2" Direct Bury ~n~ulati. on 5.2' 15' 30' 18' I I I i eotextile Fabric 81 .6 ll~Drainfield Rock 77.4 / 42.6' ! SOUTH LATERAL ~ 68.0 I I81 .5 DV - Zabel Diversion Valve SV - Zabel Splitter Valve C - Cleanout .79.6 M - Monitor Tube " 83.5 Geotextile Fabric ~' Drainfield Rock 75.9 /-. NORTH LATERAL 38 PROFILE AS-BUILT HORIZONTAL SCALE 1" = 10' NO VERTICAL SCALE MUNICIPALITY OF ANCHORAGE Deparfment of Health and Human Services On-Site Services Program 825 L Street. Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 25, 1998 Expiration Date: Aug 25, 1999 Permit Number: SW980323 Legal Description: TANAINA VALLEY LT 18 Design Engineer: 0014 Andemon Engineering Owner Name: Darrell Petemon Owner Address: 6937 Lowell Cimle Anchorage, AK 99502-1850 Parcel ID: 011-051-93 Site Address: Lot Size: 34330 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. August 22, 1998 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 18, Tanaina Valley Subdivision Septic System Design Impacts to Adjacent Properties Dear Onsite Services Engineer: The absorption trench on Lot 18, Tanaina Valley Subdivision has failed and must be replaced to prevent a health hazard to the area. We therefore request apermit to construct a new absorption trench to serve the four bedroom home on the lot. The attached site plan and backup documentation identify the size and location of the new septic system designed to serve the house. The subdivision is currently served by a community water system so no conflicts exist with any wells in the area. A testhole was placed on the lot at the location shown. Poorly to well graded sand was found under 4' to 5' of silty material. This material percolated at a rates between 10 and 15 minutes per inch. No groundwater was encountered nor was any measured during the monitoring period. We are therefore proposing to construct two new 38' long X 5' wide X 4' effective depth absorption trenches along with a flow splitter valve to evenly distribute effluent to each trench. The distribution piping will be placed at 5' below the original ground surface. Total depth of the system will be 9' below the original ground surface. A diverter valve will be placed just past the septic tank and the existing absorption trench will remain in tact for possible future use. The existing septic tank will be uncovered, inspected, and verified for continued use. The surface of the lot is fairly flat in the area of the new absorption trench with a slight 2% slope from west to east. This area is located immediately below a sharp break in grade that will not impact effluent flow. · 'Eot 18, Tanaina Valley Subdivision August 22, 1998 Page Two If the system 1. is constructed as designed the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The subdivision is currently served by a community water system. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, impact on reserved space, either surface located in the area. will have no adverse or subsurface, on any lots The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments !a.aa 'r- -- ........ ~ · ' T-'--f,-' I 1 THIS PROJECT /? NOTE: Subdivision is Served by a Community Water System. No Conflicts With Adjacent Lots. ~-=~. DrivewayIParking Effective Depth ng ~rench Spiitte~=. Valve Shed Shed ::'~. Existing Septic Four Bedroom..:. Tank Home SITE PLAN SCALE 1" = 30' To House Place Diverter Valve Existing 1,250 Gallon Septic Tank Two Post Tank Cleanouts Existing Absorption Trench Shed Flow S 'Two New 38' Long X 5'WideI X 4' Effective Depth Absorption Trenches i 10' Easement SYSTEM PLAN LOT 18, TANAINA HILLS SUBDIVISION DESIGN FACTORS: Four Bedroom Home Perc. Rate: 9 Min./Inch Application Rate: .8 GPD/SF SYSTEM REQUIREMENTS: $' Wide Trench System Verif~ Existing Septic Tank 4' Drainfield Rock 4 Bedrooms X 150 GPD / .8 GPD/SF = 750 SF of Absorption Area 750 SF/5 LF (Width) X .5 (Red. Factor) = 75 LF Trench Length Therefore: Construct a 5' Wide Absorption Trench System With Two Laterals Each 38' in Length with 4' of Drainfield Rock Beneath the Lateral. Distribution Pipe in Trench Placed 5' Below Original Ground, Place Flow Splitter Valve to Assure Even Distribution to Each Lateral. 4/~-~ ' Natural Backfill .5' Geotextile Fabric · . I ~ 4" PVC ~--Drainfield Rock NOTE: TYPICAL WIDE TRENCH SECTION (NO SCALE) Grade Area Over Trench' to Drain Away. Minimum 3' of Cover over Septic System. Minimum 10' Separation From Lot Line. Minimum 4' Separation From Groundwater. Municipality of Anchorage DEPARTMENT OF HEALTH'& HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: Lot I 8., 0/_ 2 7 8 9 10 11- 13- 14- 15- 17 18 19~ 20- COMMENTS Darrell A. Peterson DATE PER~ Tanaina Township, Range. Section: Valley SLOPE WAS GROUND WATER ENCOUNTERED? IF YE~. AT WHAT DEPTH?. None SITE PLAN lit ! ,, I1'1I '. I I i I I I II II tl I II IIII II I 11'11 I I I Readi.~ Date Gro~ Nat D~th to I Nat Tim ~/,~ - z'/~" i - I ~:ol t ~:~ - I ~/~" - I I I PERCOLATION RATE,.~ Imm~l~',nc.l~) PERC HOLE DIAMETER TEb~ RUN BE'i'WEEN ~' FT AND ~' FT Testhole presoaked. Dr±or to test. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 18, TANAINA VALLEY SUBDIVISION GENERAL: The scope of this project includes the uncovering, inspection, and verification for continued use of the existing 1,250 gallon septic tank. It also includes the placement of a flow diversion valve and the construction of two new 38' long X 5' wide X 4' effective depth absorption trench at the location shown on the site plan. A flow splitter valve will be required to assure even distribution of effluent to each trench. The distribution piping in the trenches must be placed at 5' below the original ground surface. Total depth of the trenches will be 9' from the original ground surface. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION A new 1,250 gallon septic tank must be procured from an approved source and installed at the location shown if the existing tank is found to be unsuitable for continued use. Lot 18, Tanaina Valley Subdivision August 22, 1998 Page Two A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Lot 18, Tanaina Valley Subdivision August 22, 1998 Page Three Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted watertight couplings (Caulder, Fernco, or equal). with Lot 18, Tanaina Valley Subdivision August 22, 1998 Page Four 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. 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 REPORT Nerve DISTANCES Z~E-S/~/.S /~, h4/c~c,~ ~ 'rn SEPTIC ABSORPTION AddressFROM~ TANK FIELD WELL Phone{,) Permit ,0.~ ,~.~ ~ ~] of Gedrooms WELL /8 FOUNDATION rownship. Range. Section AS-SUILT DIAGRAM (Show location of well. ~eptic system, prope~y line~, foundation. TANKS ~ SEPTIC ~ HOLDNNG ' Manufacturer Capacity i~ gallons TYPE OF SYSTEM ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER Depth to pipe bottom from Total depth from original grade Fill added above oziginal grade Gravel depth beneath pipe ~FT ~ ET Total absorption area Distance between lines ?~ SOFT -- FT WELLS ~- ~ PRIVATE ~ OTHER (Identify) installer ' Date Installed: REMARKS: m /~,/~u~ ~ ~ ~ , cediJylhalthisinspe~ionwaspe.ormeda~ordinaloall Municipal and State guidelin~ in efle~ 0n Ihis d~e: - ~/~ /~ ~. O~ ~ % ~' ~' 72-013 (3/85) M U Iq ]: C ]: P A L. I ]' Y 0 F A N C H 0 R A G E Department c~' Hea].'Lh & Human Services 825 L..~Lr(~..,..t~ Anr::horaqe~ Alasl.::~ 9950:[ .~;4:5-~ 0 N .... S I T E S E W E R F' E R Id I l" Per mit Iqumber.: F]9()() 10 Date Issued: 01126/89 Engzneen Designed O~^n] el" Name: I]wner Address: DESIGNS IN WOOD 7021 DRIF'f'WOOD PL. ANCHORAGE~ AK 99518 Day Phone~ 349-8() 14 Parcel Id: 0 :1,1-051.,,..9:% Lo'[. l,..egal: Subdivis:i. orl: "f'ANAINA VALLEY L. ot.: 18 Block: Sectic, n: 4 Township: 12N Range: 4W I..,(~t, Size 34330 (sq. Ft.. or acpe~) Max Bedr. c~oms: T'his Permit~ 4 Total Capacity: 4 SEPTIC TANK: Minimum t. oi:.al seF, t.:b'z tank capacity: tank must. have at-. ].east 2 c:ompart:ments. Depth to {'ee'[ reqLtif'es ir'/su!atic)n over tank(s). 1,250 gallons. Each septic top of septic tank(,s) < 4,0 THZS I:'Ei]:IMIT IS A REISSUE OF EXPIRIED PERMIT 880202. I E3ERTII-VY ]'HA]': I. ! am £am:L].ia~r~ with the requiremen{s ¢or' ~3n..,-s:L'Le, sewers and werl lS as ¢~]r{h by 'Lhe Municipality oF Amchor'age (MOA) and the State o~' Alaska. i vd. il insi:.all t. he system in ac:~;ordar'lce wi'Lh all MOA codes and regulat.:i, or~s, and in compliance with the design cri'[.er,:i.a o¢ this permit. t will adhere to all MOA and St.a'Le cH' Alaska requirements ~'or the set back di~'[.~rlc:e~iB ~'pl:)nl any existing we].l, ~gas~,t.e~tep disposal system c)r public I unders'Land i:.hal:. 'this per'mit is valid {or a max:Lmum oF 4 bedrooms,, l also uriderrFi:.and 't'Jna'L ~he cap;~:::i, ty cif t. he '(.c)ta~ system is 4. beclrc)oms and , - - , ,quean additional per mit., (Owner) DESIGNS ':IN WOOD unicipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 9, 1989 Designs In Wood 7021 Driftwood Place Anchorage, Alaska 99518 Subject: Lot 18 Tanaina Valley Subdivision Permit #880202, PID ~011-0~1-93 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1988. . Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the ins%allation of the on-site sewer system, the original as-built inspection report (three-part form) must be sent fo..this office for review and approval,.and for dodumen%atioK[ When applying for a new permit, the fees are: $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. erely, Daniel J. Roth Acting Program Manager On-site Services Section DJR/ljw enc: Copy of Permit FI U N I C I F' A L .[ F Y 0 F P. N C H O R A (:~ Fi: De:.par't. ment !::)[' Iqeat'Lh 8< I-h.tmarl Se~vic:es 825 L Str, ee:,'L, Anchorage, Alaska 99D01 343-,4720 0 N .... S I T E S E W E R P E R M I F'~ ~i~'i' Number.: 880202 !)at~~, I!.-:isuecl~ 09/23/88 Engineep Designed Name: DESIGNS IN WOI]D Add~,~xr;,, 7021 DRIF:TWOOD I:'LACE ANCHCtRAGE, AK 99518 Day Phone: :349-8014 Parcel Id: 0J, 1-051-93 Lot. Legal: Subd:i.v:i. sion: -I"AN~INA VALL_EY SUBD. [..~.~t: Section: 4 Township: 12N Range: 4W I_ot. Six,.~ :345:50 (sq. ft.. or acres) B~:,dro~:sms: This Per'mit.: 4 Total Capacity: 4 18 Bloc:k: !:ii>i'i:~: iANK~ Minimum total septic: 'Lard< capacit, y: t,250 gallons. Eacl~i septic 'Lard< must have at least 2:'. compar't, merrLs,, DepLh t.o 'Lop o¢ septic !;.u~k (s) < Zl.,() ['e6~t. p~qLiiPes il'IsLl[a'Lic)n (]vel" tal]l< (s~) . .t:NFOI::/M D.H.H.S,, F'RIOI'< T'O 1ST & 2ND INSPECTI[INS BY ENGINEEIR, ]:F r:.~,i:T[:ii( iIi"F;']:CE FIOLIRS.~ CAI_L 34:3.-468~ ~ND LEAVE: A MESSAGE,, CONSI'RUCT PER ENGINEEF~S AI"TACHED APPROVED DESIGN. THiS PERIdI]' EXPII':~ES :1.2!3J188 AND VAL. ID F:OR A SiNGL. E FAMJ:I.Y HOME. I C['!i:R'I :I. I- Y I.. I am t"HA]: i~:~ri:.h by t. he Municipalit. y ot Anch~page (~OA) and t. he Stat~ of A],ash:a~ .[ wi].] ir'is'La].1 the syst. em in accoPdanc:(~ ~it, h ali I"IOR codes arid I'egu].atJ. ons, al'iCl in CCllllpJ. J. al'll::[~ i-~J.~.h the desi(al'l i ~¢J.].]. adher'e 'l:.c~ a,l,i MOA ancl St, ate of ~laska requ:i, nement,~ for ti'se set back distanc:es t'r'om any existing well, wastewatep disposal system (:)r public ~eWel-age sysLem on this oP any ad.jacerr[. :[ understated that this pePmit i~ va].id for' a maximuB o[ 4 bedr, o(~ms. I also Lli'ldel"s'Land that the capac of t. he total system is 4 bedrooms arid ~:u'~y en:l. argem(( will require addi'Lional Digne:.~d ~ Issued Bye, DATE: DATE: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG t PERCOLATION TEST PERPORMED FOR: LEGAL DESCRIPTION: 4 SILT 5 7 8 9- 10- 11 (ENGINEER'S SEAL) SLOPE SITE PLAN WAS GROUNO WATER ENCOUNTERED? !1I! PERCOLATION RATE // (m~nute~qnc,h) PERC HOLE DIAMETER ~" TEST RUN BETWEEN 6 FT ANO --/ FT PERFORMED BY: '//~ /~?C/;~D~// I ~t~h~ &~ ~O~TIFY THAT THIS TEST WAS P~FORMED ACCOROANCE WITH A~ STATE ANO MUNICIPA, GUIO~IN~S IN EFFE~ ON THIS 0ATE OAT~ 72~ (R~. 8 6 14 ~21~ ~t 21 Mich~M E, 4381-E Parcel I.D. ~f GENERAL INFORMATION Corn plete legal description MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On-Site Services Section - P.O. Box 196650 Anchorage, Alaska 99519-6650 4744 - . 343- CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# ~ Location (site address or directions} Property owner Mailing address Lending agency Mailing address phone ~iyphone Agent Address ~a~y phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: z/ 3. TYPE OF WATER SUPPLY: individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Individual on-site Holding tank cOmmun ty on_site Publib sewer NOTE: If community wastewater syste~: ~ide written attesting to the legality and *t~tO~ ~i ~stem. confirmation from State ADEC So STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate foe 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 ali.Municipal and State codes, ordinances, and regulations in effect on the date of this inspection.: ,~- Name of Firm ~ ~-/Z-~"o~3 ~--C~,/~c="'L~/L4~J 6 ..... .... ' · Phone::' ZT~ -C/llO Address P.O. ~'o~ Z-'-/o777 /¢¢~f24o,~¢6¢: .,4-1/~ ~¢~,',¢~¢ Engineer's signature ~ ~' ~~: ::Date /O/,s-//¢] / DHHS SIGNATURE ~(/_ Approved for Disapproved.: Conditional approval for 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 DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issue,cl. The Municipality of Anchorage is not responsible for errors ~r omis~ions in the professional engineer's work. ?2~)2§(Rev. 1/§1} Back MOA,~I Municipality of Anchorage Department of Health & Human Services · ~ HEALTH AUTHORITY APPROVAL CHECKLIST Legal D~Scription: LOT-' I~I 'FA ~AI.A V^LL.E.y Parcel I.D. A. WELL D~ATA ! ' ~' ' ' '~' Well type (~mmuk~ ~-rg Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system, num ,ber: Date completed Driller Cased to Casing height wires properly protected (Y/N) FROM WELL LOG ATINSPECTION Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: MuNtCIPA~I'[Y 0I: ANCHORAGE EN¥ii~ONMENTAL SERVICES DIVISION RECEIVED Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed /~ ~'--8/q Collected by: Tank size /Z ~-O Compartments Cleanouts (Y/N) ~/ High water alarm (Y/N) Date of pumping Foundation cleanout (Y/N) ~/ Depression (Y/N) /"/./~ Alarm tested (Y/N) /¢//¢ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N¢~_o~/ LoT On adjacent lots ~J~- O~ Lo?-5 Foundation ~" To property line ~-'~5'/ Absorption field ~______Water main/service line ¢-~'2,- ' Surface water/drainage /Zo~'~/4/,.¢~'~-.,¢' ...... 72-0~6 {Rev. 3/91) Front MOA 21 CONTINUED'ON BAcK F~AGE C. LIFT STATION Manufacturer Manhole/Access (Y/N) Vent (Y/N) ~' level at "Pump off" level at High water alarm level ~ Cycles tested Meets MOA electrical codes (Y/N) ~ D. ABSORPTION FIELD DATA Date installed Length 7¢ / Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating /7,¢ System type ~', Gravel thickness ~'/ / Total depth Cleanouts present (Y/N) y Date of adequacy test ,"~- ~- ~'/ for /t.,/ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Weilonlot A/¢~J~ ,¢,¢4 To building foundation On adjacent lots c/ Surface water ~/¢/J~ On adjacent lots A/~N~'o~ £~T5 Propertyline To existing or abandoned system on Cutbank ~ Water main/service line Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer's Name Date /o//3-//~/ 4381 - E HAA Fees /~/2 Date of Payment Rece pt Number 72-026 (Rev, 3/91 ) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR (907) 563-6775 October 10, 1991 FOR: Wayne McFadden PWSID: #214706 My review of the records on file in this office reveals that the Country Lane Estates Subdivision Class "A" Public Water System is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Sincerely, Byron Roys Environmental Engineer BR/cf MUNICIPALITY OF ANCHORAGE ,~ Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) t- /o° 'F-A~A~.~ V~LLE~( 5 ~ 7~1~ IJ Location (address or directions) (b) Property owner ~iA~ /~ l~o~ Telephone: (home) Mailing Address ~¢Z/ ~R/~M~¢o~ ~ ~/~ (c) Lending institution Telephone ,,~¢ Business Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ,~ hold for pick up.) : - List.contact person and day phone number below: ~: '. 2. TYPE OF RESIDENCE Single-Family ~' Number of bedrooms ~' 3. WATER SUPPLY Individual Well [] Community~ Public r-I Note: If community well system, must have written conf rmation from the State Department of Environmental Conservation attesting tO th legality and status. ' 4. SEWAGE DISPOSAL On-site'~ Public [] 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. 72~)25 (Rev. 7188) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, 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 flies 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 /~/V ~ E/Z$ 0 ~J -~--~ D/~.7t4~ 6 Telephone .~'~'7--'- ~ ..~, 7 Address /l~), ~0~ ~077~ ~O~-- ~ ~¢S~¢ Date /E~/~ / 6. DHHSAPPROVAL/ Approved for ,~ bedrooms by Approved ,.?~' Disapproved Conditional Terms of Conditional Approval Engineer's Seal The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Mu nicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 ~ MUNI,,C, IPALITY OF ANCHORAGE (MOA) 1,,4~[.¢~; o: '"';;' ~:~ H'e~d'i~ ~uthority Approval (HAA) i~i-:vl[~_~_~d ::?, ;':: ~ ~Ci~i~i~LiST . FEBRUARY 1984 ~ 343-4744 ' ~ Legal Description: /-- WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Watgr 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 To Nearest Sewer Service Line on Lot WaterSample Collected by WaterSample Test Results Comments ~'E' /I-~-F-A~.H~-~ Date Completed Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed /- -'5-~-,-~"'/ Size Standpipes (Y/N) 7 Depression over Tank (Y/N) /Z. ~o No. of Compartments Air-tight Caps (Y/N) )/ Foundation Cleanout (Y/N) /'J Date Last Pumped /,)r~J To Water-Supply Well To Property Line · To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~T-~ c S L(~'T-~'¢/~ s Pumping/Maintenance Contact on File (Y/N) AJE~t~O ; for Holding Tank High-Water Alarm (Y/N) M/~ Temporary Holding Tank Permit (Y/N) /~'./'~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: 7o0 ' Y- To Building Foundation ~'?~ To Disposal Field 72-026 (Rev. ?/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /' ~'"~ ~ (/ Width of Field ,.5" f Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test To Water-Supply Well Type of System Design Length of Field 7E.)' Depth of Field E/' Gravel Bed Thickness ~/~ Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Building Foundation Lot .~ox/¢ 6,,'? {or To Water Main/Service Line 5/I To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~-5 To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage A, rea Comments ..4 ,~.~O Z',~2T I O /4 Date Install-6d~- Size in Gallons ~'~. Dimensions "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Manhole/Access (Y/N) "Pump Off" Level at ~ Vent (Y/N) ~-._.....~Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA inspectio ~n. Company 4NO Date MOA No. effect on the date of this Engineer's Seal Receipt No. 0 Date of Payment Amount: $ Receipt No Waiver Fee: $ Date of Payment 72-026 (Rev. 7188) Back Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION / ANCHORAGE/UESTERN DISTRICT OFFICE 3601 C STREET, SUITE 316 ANCHORAGE. ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: January 24, 1989 PUSIDt '21470& To Uhom It May Concenn: According to the records on ?ile in this o??ice, ESTATES Uater System is in compliance uith the Drinking Uater Regulations, the COUNTRY LANE State o? Alaska SincePely~ ~%%~CRn~:? F,el~ OW~cer Drinking Uaten