HomeMy WebLinkAboutPRATOR BLK 4 LT 1Prator
Lot 1
Block 4
#017-091-36
Municipality of Anchorage Page " 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: ~NN)°l ~0~_~ ~ PID Number: lO I-/OS 13 ¢o l
Name: ~UL,F__--.~ ~t.-~"/ Wastewater System: D New ~ Upgrade
Aaare~:l~Ol_ p~ ~. ~ ABSORPTION FIELD
Phone: ~Z -- I~ ~¢ ~ B Deep Trench ~ShallowTrench ~ Bed ~ Mound D Other
O~ Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTI ~ -~¢ ~,~/sq.,~. q.&- I~ P%'
Block: Subdivision: Depth lo pipe boltom from original grade: Gravel depth beneath pipe
~ New D Upg ~ Ft. I I~/~ Ft.
Classification(P~ / ~Ft. CasedTo: Ft. Total absorption area:~O ~. SQ. Ft. Pipematerial:~30~ k f~O
~%~ Dateinstalfed' ~
Driller: : Static Water Level: Installer:
Pump Set at: Cas~o~ Ground:
GPM Ft. I ~Ft~ TANK
SEPARATION DISTANCES ~Septic D Holding D S.T.E.P.
To Septic Absorplion Lift Holding Public/Private Manufacturer: Capacily in gallons:
From Ta.A Field Station Tan~ S .... Lines ~O~ - '~ ~
/ / k /~ ~,/ Material: Number of Compartments:
Well ~ 0 I I 0 % N ~ ~~
s~ I~+ ,oo~ ~/A ~M I~ ~ ~ LIFT STATION
Line ~ ~01 m2~/ ~/~ ~ ~ ~
Remarks: ~ m~JG~ p~u~ ~4 ~'s BENCH MARK
~¢6~E ~5~ ~S60 been ~ ~¢LI~OM LocalionandDescriplion:
pON~ ~ %~%~ ~G~ ~ ~D~ ~ ~ Assumed Elevation:
~l&, ~ ~ ~~0~ ~MS~ ~ ~~. EN~EER'SSEAL
. ¢
Inspections performed by: ~0~~%. Dates:2:t :~2~ .......
RevieWed and appr0ved by: ~~ ~ Date: ~-::-~
72-013 (Rev. 9191) MOA 25
Permit'No.
Page ~ of '~
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:
PID No.:
ol70~/B/o
L
Permit No. ~v~C1:3 o ~_~2~ Page :~ of ~
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: LoT [ j ?~V..z~-) ~e~-~---Z:~ ~/j:::) PID No.: C)l~OCll .~(~
cio. Oo
-to -r~.y~
72-0'J3 A (?/93) '
.... £
V' ' ~ i .4. - , ' , / "~\
u ~ 1 ....... :.., .:. _~.: ...............
· ~ ~ ....... iL-i-' ~ ~¢,~.~)~:..~3-)=~.,x~ ~ -
I
/_
/
, ~ , ~ . ', ... . ...................... ~
' ' ' ' !~ ' , Io ~.~ 1~ ~ . ~ w.~ ~--, -- . ~
WELL CONSTRUCTION LOG
D,tJ~log co.AK NOW-WELL-VERN'.S DRILLING & ENT.
Driller VERN .... Ty~o et ri~ ROTARY
o,.er~LL~N .M. BAILY
location: (addteas & legal ,,~l~tlon) PRATOR SUBDIVISION
~OT.~. 1 ....DLOCK: 4
Depth of ~e11_..225',, ft. Casing: depth. ~' __ ft. diam. 6" tn,
Static water lavai, 72 f ,ft, (abava,._be. low) land surface. Data ..........
Finish of well: (open-end, screen, parfe~ate¢,~pen-hele,,other)_
Best,lbo intervals an~ ~lza:
~a. II yield tested by (pumping, bailing, air) at ~ ~M gal/mln,
for hours with,, ft. of drawd~wfl from otatie level.
870126 PERMIT ~
UE;G~ .o
Nearest community ANCHORAGE
78'-80t heavy seepage
(could perforate
above drive shoe)
145'-150' heavy 'seepage
150'-160' 1 gpm
205' 2 gpm
215' 3 gpm
DRILLER'~ ~AT£RIAL LOg
~utlaoe in feet
0 to 25 .
25 t, 45
45 46
46 _to ..... 74
74 to 80
,.'...... 11o
110 to' 125
125 ~ro 150
150 225
· ..... tO
(alze of materiel, coler, hardness of dill!lng, and water content)
Brown gravelY_~ill
Hard pan
Boulders
Hard pan ........
Bedrock. r~.~y black rock-fractured
Brown rock
Gray black rock,white streaks
light gray rock
Gray black rock-white streaks ~,,,.gpm
90?2??9?89 ALLEN BAILEY ATTY. 463 P02 SEP 14 '93 i .=~=
~ cusroM~=R'-~ Ot-4tOER NO.
VERN'S DRILLING & ENTERPRISES
ANCHOR^GE, AK 99516-2136
(907) 345-4417
PAGE 1 OF 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930263
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES
OWNER NAME:BAILEY ALLEN M &
OWNER ADDRESS:14301 PRATOR ST
ANCHORAGE, ALASKA 99516
DATE ISSUED: 8/03/93
EXPIRATION DATE: 8/03/94
PARCEL ID:01709136
LEGAL DESCRIPTION: PRATOR BLK 4 LT 1
LOT SIZE: 97095 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
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.
SPECIAL PROVISIONS: ~ ;~'f
1. SUBMIT WELL LOG FOR NEW WELL~S REQUIRED BY AMC 15.55.
PROPERLY ABANDON OLD WELL.
2. MAXIMUM NUMBER OF BEDROOMS IS THREE (3).
3. VERIFY SOILS AT ENDS OF TRENCHES DURING CONSTRUCTION.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
4. WAIVER TO SLOPE APPROVED FOR 25 FEET.
RECEIVED BY:
/
I S SUED BY: ~ i~'~ ~'~ /
DATE:
DATE:
PAGE 2 OF 2
Alaska Water
"Preserving the Last Frontier"
July 22~ 1995
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic System Replacement for Lot 1, Block
Prator Subdivision.
To whom it may concern:
Attached is the application, site plan, and design drawings
for the subject septic system replacement. Comments
regarding the proposed system are as follows:
1. TRENCH DESIGN: As can be seen 'Prom reviewing the
attached percolation test results, the soil "perked" at 2.75
minutes/inch at the location proposed for the system. For a
trench system, this corresponds to an application rate of
1.2 gpd/ft2. Since the existing home has 5 bedrooms, the
total design flow is 450 gpd, however, the homeowner has
asked me to design the system for 4 bedrooms (600 gpd).
Based upon this, the minimum amount of absorption area is
500 rtz. The proposed system is a 5' wide trench which is 3
feet deep. With a reduction factor of .58, this corresponds
to a trench length of 58 feet. The proposed trench is 60
feet long.
2. LOCATION OF CLEAN-OUTS: The clean-outs normally
required immediately downstream from the septic tank have
not been provided, since they would not be functional for
this design. Instead, I have placed clean-outs so that
jetting can be done from either end of the trench, and back
to the septic tank./~ bOG~a~ '
$. TOPOGRAPHY:/The subject trench will be installed on a
slope ~Ui!~ch=~La,s'/a lO~ grade. However, it is only about 25
feet~..~nadien-'F~from a slope which transitions to 50~ down
to the road. Due to the porosity of the accepting soil I
think the wastewater from the trench will move down~ard
rather rapidly, and the potential for it to migrate
horizontally to the cutbank is minimal. For this reason, we
are requesting that the 50 foot separation requirement be
waived in this case.
Telephone - Fax 338-3246 · 8471 Brookridge Drive · Anchorage, Alaska 99504
The proposed trench will be installed 50 feet away from the
steep cutbank to the east which drops 150 feet in elevation
to a oreek. The distance from the septic system to this
creek cannot be determined directly without the servicee of
a land surveyor; however, I obtained a copy of a 1" = 200'
scale topography map of this area from the M.O.A. According
'tO' this map (copy attached with this package) the distance
from the top of the cutbank to this creek is approximately
100'. Since we are going to be 50 feet back from this
cutbank, the 100' separation distance should easily be met.
4. UTILIZATION OF EXISTING TRENCH: Please note that the
existing trench is going to be connected to the new system
via an alternator valvo.
5. ABSENSE OF SURFACE WATERS, & SUBSIDED GROUNDWATERS: Due
¢'/~¢m bu¢' a¢'e 0un¢'~¥~¢'2~, d¢~'. In addition, the dry weather
may have significantly altered the normal groundwater
profile. Consequently, it is possible that future
groundwater monitoring on this property may indicate the
presence of water closer to the ground surface, and surface
waters which were not present during my site visits.
6. A PORTION OF NEW TRENCH WILL BE OUTSIDE THE ~0 FOOT
RADIUS OF THE TEST HOLE: A small portion (about 5 feet) of
the trench on the east end will be outside the 50 foot
radius of the test bole. I will verify the appearance of
the soils encountered in the trench during construction. If
they appear to vary from those encountered, I will perform
an additional perk test. If not, I request that the
requirement for an additional percolation test be waived.
7. OLD WELL TO BE ABANDONED: Currently, their is an old
~ell on the east side of the house which is not being used..
With the as-built drawings, I will submit documentation that
this well has been properly abandoned.
I am unaware of any impacts that this installation would
impose on adjacent wells, or septic systems. If you hav(~
any question, please call me a
Sincerely,
JAG/jag
Baileyl.WPS
04/0
· -rP, ¢-. ~-¢:A-,</~ L,.
$oc~
cIO.Ko
I-'pP_EPAC~6D '~J; ALASY-A M/A'r6J~ % WAs-t~-WA-F~-P~.
PERFORMED FOR:
LEGAL DESCRIPTION:
. 9
10
13-
14
15
16
17'
18-
19-
20-
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
Towm
SLOPE
'~,"~".L',.] ..... ...~,~" ' I
Sect,on:
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
DEPTH?
DepthtoWaterAller~oflJlorJlig? ~,~/l~ Dale: '7//'7
IF YES, AT WHAT
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~'~' 7~" (minutes/inch) PERC HOLE DIAMETER
TEST RUN ~ETWEEN ~G FT^ND
PERFORMED BY: 4 ~ ~°~S I ~ ~ &~g CERTIFY THATr__T.IS T~'T WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/~
72-008 (Rev, 4~85)
9d~5.0
944.5
944.
x
945.0
944.5
AnchOrage
January 12, 1988
P.O. BOX 196650
ANCHORAGE, ALASKA 99519-6650
(907) 343-4200
~R~ Tom Fink,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Allen M. Bailey
14301 Prator Street
Anchorage, Alaska 99516
Subject:
Lot 1 Block 4 Prator Subdivision
Permit #870126, On-site Well Permit
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1987.
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 installation of the on-site
sewer system, the original as-built inspection report (three-part
form) must be sent to this office for review and approval, and
for documentation.
Effective January 1, 1988, a new fee schedule is in effect.
When re-applying for a new permit, the new 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 %here are any further questions, please call this office at
343-4744.
Since ly,
/ Robert W. '
Program Manager
On-site Services
RWR/1 j w
enc: Copy of Permit
~3LC) E;I.:': "
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 ~\ ~ Z-- Permit~Applicant: Lesli; D. IPHONE / ~EW
/ ~ ~; ~6' ~~,"~ Washington ~/'--2~ ~UPGRADE
LOCATION '~ ' ~ ' NO. OF BEDROOMS
DISTANCE TO: /~ ~ Dwelling. ~ PERMI~O.
~ Manufacturer~ ~r~ Mat~l N°'°f~artments'
~ ~~[~A.C~ ~o: w~,, ~w~,,~.~ ,,.~,~,o.
O ~ ~ Manufacturer Material Liquid capacity in gallons
~~ ,o. of lines i Length o,~,each line Total leng~f~ies Trench w~ inches Distance~.b,tween lines
~ ~ ~ Top of tile to finish grade Material ~e~aih 'le
Length 'Width Depth ~ PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
Well foundation Nearest lot line
Building
DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
Building foundation Sewer line Septic tank Absorption area(si
~ DISTANCE TO:
OTHER ,
PiPE MATERIALS ~ ~ , ¢~
RE~ARKS J - ~
et)c: ............
,
I /
72-0 3 (Rev. 3/78)
F'ERHIT N0.
RPPL I CRNT
LOCRT I ON
LEGFtL
LEz, LIED. WRSHINGTONG
LOT '1 BLK 4 PF.:RTOR SUE:
T'¢F'E OF SOIL FIBSORF'TION SYSTEM IS:
t,:.._ OLD SEWRRD HWY
LOT'SIZE
TRENCH
_--.': 49 - E;56 ±'
999999 SQURRE FEET
- II,
HH,.:,IH_H NLIMBER OF BE[:,R~ZIOMS = 3:
SOIL RRTING ,:.'SQ FT,.-'BR)= '='R
; THE REQUIRE[:, "',I:E OF THE SOIL RBSOF.:PTIOI'.~ --,~=,TEH IS:
, [:.EF'TH= 2L~_---'~ LEf-&L~TH= 2e] -- "- '
b~ E." H %- EL
[:' E F" T t--I = 5
THE LENGTH DIMENSION IX THE LENGTH (iN FEET) OF ]'HE TRENCH OR DRRINFIELD.
]'HE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND, RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
THERE IX NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IX THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM (iF THE E;:'-':CR',,,'RTION (IN FEET::,.
REL-':!L~ 1- RE[:. SEF" T
F'ERMIT RF'F'LICRNT HRS THE RE=F_N.=,IBILIT.r TO INFOF.:M THIS [:,EF'RRTMENT [:,UR!NG THE
INSTRLLRTION iNSPECTIONS OF RNY WELLS R[:,JRCENT TO THIS PF.:CIPEF.:T'T' RN[:, TFIE
NJM6EF.. OF RE'-";IDENCES THRT THE NELL WILL SER'¢E.
T t...lt,;, ,:". ~"---' .... ':, ~I: t'-.t'_=. F" E C: ]- T ,'-, l'-& c-. RF,:F Fk" E L--::-,_ L~ ][ F.:F'. [.
BRCKFILLING 0F RNY SYSTEM g!ITHOUT FINRL INSPECTION RND RF'PI~']VRL B"r' THIS
DEPRR. TMEI".!T FIILL BE SUBJECT TO PROSECLITION.
MINIMUM DISTRNCE BETWEEN R NELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IX
· 100 FEET FOR R PRIVRTE WELL OR $50 TO 200 FEET FROM R PUBLIC NELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUH DISTRNCE FROM R PRIVRTE NELL TO R PRIVRTE SEWER LINE IX 25 FEET RND
TO R COMMUNITY SEWER LINE IX 75 FEET.
NELL LOGS RRE REQUIRE[..' RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MRY RPF'LY. SF'ECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
HbHILME, LE TU INz, Lt~.E FRUFEE. IN=,THLLMTIUN.
PER~'--~ :[ T E.--.F T F-:E_. [:,EE:EI'.1E:EF.: ._~:,!I .. 1 ......
I CERTIFY THRT
i: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELL'_-'; RS SET
FORTH B'¢ THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCOR[:,RNCE WITH THE CODEX.
2:: I UNDERSTRND THRT THE ON-SITE SENER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
F.'.ESI[.,ENCE I'-'; REb~O[.,ELE[:, TO INCLU[:,E HORE THRN 2. BEDROF~H'-'].
SIGNED: _ -
hF'F'LIC~,,F~ LESLIE D. WRSHINGT'#~/
i SSUE[:, E: ~_~-z.~-~ ___DRTE
'¢4. 0
']~ b "=/0
.ENGINEERS, INC.
7125 OLD SEWARD HWY.
ANCHORAGE, ALASKA 9950:3
.349 - 6561
[EST
SOILS LOG PERCOLAI'ION I'EST
L. EGAI. DESCRIPTION
10
11
SITE PLAN
· 12
13
ENCOUNTERED?
IF YES, ATWHAT
OEPTH~
14
15
16
17
18
19
20
e·
eoeee ~.~ ~ Time Time Water
:. SWANSON¢ ~ ~
PERCOLATION RATE
TEST RUN BETWEEN
J) 1',__~("~.~ / (minutes/inch)
. FT ANO / [0 FT
COMMENTS
PERFORMED
>' 0 o
Q
O:
o o ~ o o o o o o o ~o
¢.)
0 0
Parcel I.D. #
MUNICIPALITY OF .ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
017-091-56
1. GENERAL INFORMATION
Complete legal description PRATOR SUBDIVISION: LOT 1. BLOCK 4
Location (site addmss or dimctions) 14501 PRATOR STREET. ANCHORAGE. AK 99516
Property owner
Mailing address
Lending agency
Mailing address
MARILYN BAILEY Day phone
14501PRATOR STREET. ANCHORAGE, AK 99515
Day phone
!907~ 345-3461
Agent CAROL BUTLER Day phone (907} 257-0116
Address REMAX PROPERTIES: 2600 CORDOVA ST. ANCHORAGE. AK 99505
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
IndMdual well xx
Community well
Public water
NOTE: If community well system, provide wrttten confirmation from State ADEC attest-
ing to the legalily and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding Tank
Community on-site
Public sewer
NOTE:
XX
If community wastewater system, provide written confirmation from State ADEC
lng to the legalily and status of system.
72~925 (Rev. t/§~ ) Front MOA fl'21 Computer Vers~3n
INote: Alaska Water and Wastewater Consultants, Inc. shall be paid $1000.00 at,
or prior to, closing for the engineering sengces prot4ded.
5, STATEMENT OF INSPECTION BY' ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my
investigation of this Health Authority Approval application shows that the on-site water supply and/or
wastewatar disposal system is safe, functional and adequate for the number of bedrooms and type of
structure indicated herein. I further verify that based on the {nformation obtained fl~om the Municipality of
Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is in compliance with all Municipal an,~ State codes, ordinances, and regulations in effect
on the date of this inspection.~ /,~//~/[
Name of Firm ALASKA WATER& WASTEW~TEE CONSULTANTS, INC. Phone (907} 337-6179
// /
system in accordance with ADEC and M~o~t DHHSJ~uidelines & Regula#ona. The reported results desc6bed the
performance of the system under the conditions encountered at the time of the test, and aeparation distances
measured to readily iden~able features. The operational life of all walls and eap#c systems depend
on the local soils condition, ground water levels that may fluc~ate during the year, and the water
usage of the family being served by the system. These condlfJeas are outside the control of
the evaluater of the system. Satisfactory test results do not guarantee future performance
of the system, nor do Ihey guarantea that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not provtde any warranty for future estimate of how long the
~/stem will continue to meat the operational requirements of the ADEC or MOA DHH$.
The content of this report is for the sole benefit of the owner listed abo~e.
reliance upon or use of this report by any other person or pady is not autho~zed,
nor will it eanter any legal dght whatsoever.
6. 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 Au~ority
Approval Certiticates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of AMska. The DHHS does this as a courtesy to purchasam 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 ermm or omissions in the prefessional engineer's wcdc
72.025 (Rev. 'i/gl } Back MOA #21 Computer Vemion
Municip,,lity of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Sewfces Division JLiL O~
825 'L' Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744
N1UhilC'?ALJTY 0~: ANCH~,~GE
' ~Ipr3i"JMENTAL SEt{VICES
Health Authority Approval Checklist
Legal DescripUon:
A. WELL DATA
Well Type PRIVATE
Log present (Y/N)
Total depth 225'
Sonitmy seal (Y/N)
PRATOR S/D; LOT 1, BLOCK 4-
Parcel I.D.:
IfA, B, orC, attach ADEC letter. ADEC water systam number
Y Date completed
Omm~d to 83'
YEs
FROM WELL LOG
5129/87
017-091-56
Data of test
Static water level 72'
Wall production
WATER SAMPLE RESULTS:
Detaofs=pl,:
B. SEPTIC/HOLDING TANK DATA
Data installed 9/93 Tank size
Foundation desnout (Y/N) YES
Data of Pumping 5/27/2000
C. ABSORPTION FIELD DATA
Data installed 9/93
Length 74-'
5/29/87
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
6/27/2000
70'
.3 g.p.m. 5.5
Nitrate
~ 5- f-~/£ Other bectaria
Collected by: A.W.W.C., INC.
N/A
18"+
YES
g.p.m.
1250 Number of Compartments 2 Cle~inouta (Y/N) , YES
Depreesion (Y/N) NO High watar alarm (Y/N) N/A
PumperA+ HOME SERVICES
System type
Soil rating (g.p.d./fl2 or ft2/'edrm) 0.75 TRENCH
Width 5' Gravel thickness below pipe 3.2' Total depth 9.2' - 11'
Effective absorpbon ares 600 SQ FT MonltofingTubepreSent(Y/N) YES Depresalonoverfiald(Y/N). NO
Data of adequacy test 6/27/2000 Results (Pass/Fail) PASS For 3._ Bedrooms
Fluid depth In absorption field before test (in.); 0 Immediately after 581 gal. water added ( n.): 6
Fluid depth 2.5 (ins) Minutes later:. 70 Absorpaon ~e ~''.r ' ' '~ ~ OPD
Peroxide ireatment (past 12 months) (Y/N) NONE KNOWN Eyes, give data
72.020 (Rev. 3/90)* Computer Vat, on
D. LIFT STATION ~'
Date Installed ' ~ ....
Manhole/Access (Y/N): ~vel at* "Pump offf level at*.
High wa~ *Datum.
E. SEPARATION DISTANCE8
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer maln
Sewer/eeptic service line
100% On adjacent Iota 100'+
100'+ On adjacent lots 100'+
N/A Public sewer manhole/cleenout N/A
25'+ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5' Property line 5'+
Absorption field 5'+
Water maln/sentlce line 10'+ Surface water/drainage 100'+ .Wells on adjacent Iota 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Building foundation
Surface water__ 100%
Curtain drain NON[ KNOWN
F. ENGINEER'S CERTIFIC
I certify that I}~'~ ,te/~ .fd~t~u fi, Id Inspec#ons end review
of Munlcipal /ecor¢# tt, ~)~/ ~ a~ve sj 'sfems are in conforr
Engineer's Name v JEFffREY A. GAENESS
oate
10'+ Water maln/eervlce line 10'~__
Driveway, perkingNehlde storage ama. 1 o'+
Wells on adjacent lots 1 Do'+
HAA Fee $ ~ ~'/~ /
Date of Payment ~7 -- ~--~ O~
RecelptNumber )
?~-0~ (Re~, ~1~)* C~mputer Vernon
Waiver Fee $
Date of Payment.
Receipt Number
MUNICIPALITY OF ANCRORAGE
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
(:~ [-'~ C)q I ,~ ~ NAA#
GENERAL INFORMATION
:Complete legal description
Location (site address or directions) I Z~¢'~0 I
Property owner J~c~L~"~'~ ~" I'~,~r'~l ~ ~-I L,~ Day phone
Mailing address ¢~.-t~_._ ~ ~,-~
Lending agency /,,z
Mailing address /~ ~
Agent /~
Address ~
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
Day phone
Day phone
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
individual on-site
Holding tank
Community on-site
NOTE:
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
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,%u ),eLl),/g. pe^ I 'Moleq UMOLlS e),ep uoReP!le^ eM), J.o se pue o),e.~eLl pex!,t:l.e lees ,~u.~ ,~q pe!J!~.Jeo sv
'9
EI=I=INI~DN=1 k8 NOI.LO':IclSNI -IO .I.N=IIN':I.I. VJ.S '~;
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type ~,
Log present (Y/N) ~__-.S
Total depth
Sanitary seal (Y/N)
~ ~J~. ,dr_ ~O1~3.--i~ SIP Parcel I.D. (~1 -7('~c~
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~-/2~/O '7 Driller
Cased to ~--~ / Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of test ~/2 ~/(~ 7
Static water level '7
Well flow
Pump level1
.Gu
g.p.m.
AT INSPECTION
>r .i g.
u ~V-_~ouJ~J
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot /'(~/
Absorption field on lot /~2. /
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform d_~ Nitrate
Date of sample:
SEPTIC/HOLDING TANK DATA C
·
Date installed . Tank size
Cleanouts (Y/N) .¥~=~ ': Foundation cleanout (Y/N)
[
; On adjacent lots >~'~ JOe ici F_.C0
; On adjacent lots
Public sewer manhole/cleanout
~,~,~-.. Petroleum tank
. I r~2- Other bacteria (~
Collected by: ~,~~
Compartments
Depression (Y/N) ,~O
High water alarm(Y/N) ~ '~ ~//~- Alarm tested (Y/N) /W//~:
Date of pumping . /N///~c-' Pumper /'///~-
SEPARATION D STANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on i~t. / ~t/.,,: ~ On adjacent lots ~
To property line ~ '~-'(--~ Absorption field
!
Surface water/drainage ~-/CC) F~.-ccP
Foundation ~"[
Water main/service line
72-026 (3/93). Front CONTINUED ON BACK PAGE
/
LIFT STATION
Date~nstalled Manufacturer
Size i~ Manhole/Access(Y/N),
Vent (Y/N)~~el at
~i~t; al~ eor;I; rer~ti~c~ Ic, c d e s ~,WN~
Sudace water
Date installed
!
Length .~.~¢¢t Width Gravel thickness ~ * '¢- Total depth
Total absorption area (,=,C~ ',ce L?" Cleanout present (Y/N) k/,¢__~ Depression over field (Y/N)
Date of adequacy test ~//5¢ Results (pass/fail) (',,Z/¢~- for
Water level in absorption field before test hi, I~- After test
Peroxide treatment (past 12 months) (Y/N) /~4/¢9¢ If yes, give date /4//4
Soil rating (GPD/FF) ,.'7,~
System type
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot [O '~-,/ On adjacent lots ~ ~O(..~ / Properly line ~ ~"~'~'~/'
To building foundation / ~', ~ / To existing or ab. andoned system on lot / ~) /
/~" oc,o 'T'~-,-~ Water main/service line ~> )ch
On adjacent lots
Surface water
Curtain drain
Cutbank
v,sz4F.-~dc¢ Driveway, parking/vehicle storage area
F~"-' u
/
E. ENGINEER'S CERTIFICATION
I certify that I have checked, vedfied, or conformed to all MOA and HAA guidelines in effect on !t,~d~,te of this ins
0'~ AI,,,,~"t~, II
,."
8i~naturo :~:..~-. ........ ~. -, ..
DateEngineeCsN/~ ~~ ~' ~¢ ~ ~ .~
oection.
HAA Fee $
Date of Payment
Receipt Number
$oo,
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)' Back
APPLI( NT FILLS OUT UPPER HAl. ONLY
Phone
Property Owner f]Z. /~?~/"J ~) / L~ ~ '~ .
Address Zip Code
Lending Institution /~~ 22~. ~_,,: ~; ~)/U )'~ Phone
Address Zip Code
" Phone
Realty Co. & Agent
Address Zip Code
Legal DescriptionC..~ c~ ~ ~ , ~ ~ ~_ %.~ ~:~i~f)~ 0 ~.~ ~>'~b~ ,~ ~ t
Street Locati~ r~ ~ o [;%- ~:,~ f~--L: ~ ~
Type of Residence
Single Family
Multiplo Family ~o. o~ ~odrooms
~ Other
Water Supol~ :
'-,,2 ~, A~ACH WELL LOG. A w~l log is required for ali wells drilled since June 1975.
~ Community For welJs drilled prior to that date. give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ individual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~olding Tank
NOTE: THE iNSPECTiON FEE MUST ACCOMPANY EACH RE~EST B~.~CESSlNG.~AN BE INITIATED.
Time Time T i ~,r'---~ ~ ~"~
Inspirer Insp~tor Insp~tor I sp~to
Field Notes:
~ MUN~C~ALI~ OF ANCHO~GE
¢.ECE!VED
(~ ) APPROVED BEDROOM8 'OONDITION8 OF APPROVAL
(~ ) DISAPPROVED
( ) CONDITIONAL APP~V~'
Soils Rating Dete ~wer installed Well To Absorption Area ~ ~ Well Log Received
~ ~¢ ~ ~ ~g2 &¢ ~J Well to Tank / ~ 0 Septic T~k Size
72.023 (3182)
October 24, 1983
Allan Bailey
c/o Emma Jean ThOmpson
2211 E. dorthern Ligh'ts
Ar~chorage ~ AK 99504
Subject~ Lot i~ Block 4, Prator Suodivision
..... ~..~ ..... ~ ~ac~liti~s cannot
AD~)roval for the Individual su~4~r ~n~ wat~ ......
granted until the followin9 items ilave peen complene~.
~ // / o ~['he top of the well casing should be sealed so thau
~/~[ ]~ater t lcjnt ·
..... ~. ,~ , ' ead are in violation
~,~i n conduit.
o ~i'he water facilities were not turned on at the time of the
scheduled inspection. Please call ti!is office for another
~ appointment ·
Please notify tills Department for a reinspection when the
noted discrepancies have been corrected, if there are any
further questions~ please call this office at 26~-4720.
Sincerely,
JRuO/~, .'1/
jim £'
Associate Environn:ental opec'~mist